OpenStax Anatomy and Physiology

Guided Lecture Notes and Study Guide

CHAPTER 1 2

CHAPTER 2 7

CHAPTER 3 17

CHAPTER 4 28

CHAPTER 5 36

CHAPTER 6 45

CHAPTER 7 55

CHAPTER 8 67

CHAPTER 9 70

CHAPTER 10 78

CHAPTER 11 86

CHAPTER 12 92

CHAPTER 13 96

CHAPTER 14 101

CHAPTER 15 109

CHAPTER 16 113

CHAPTER 17 121

CHAPTER 18 131

CHAPTER 19 142

CHAPTER 20 164

This file is copyright 2020, Rice University. CC-BY.

CHAPTER 21 188

CHAPTER 22 200

CHAPTER 23 210

CHAPTER 24 225

CHAPTER 25 240

CHAPTER 26 254

CHAPTER 27 263

CHAPTER 28 274

2
Chapter 1
I. Overview of Anatomy and Physiology
a. Define anatomy:
b. Anatomy is broken down into 4 different branches:
i. Macroscopic or gross anatomy:
ii. Microscopic anatomy:
iii. Regional anatomy:
iv. Systemic anatomy:
1. Which of the types of anatomy are specialization areas?
2. Which of the types of anatomy are approaches of studying
anatomy?
3. How are all the branches of anatomy similar?
c. Define physiology:
d. Define homeostasis:
II. Structural Organization of Human Body
a. Levels of organization in the human body order from smallest to most
complex:
i. Subatomic particles:
ii. Atoms:
iii. Molecules:
iv. Organelles:
v. Cells:
vi. Tissues:
vii. Organs:
viii. Organ system:
ix. Organisms:
x. Biosphere:
b. Compare and contrast chemical levels of organization from the human body’s
level of organization.
c. A pure substance or _______________ contain atoms, which are made up of
protons, ___________, and _______________ or subatomic particles.
d. Cells make-up _________, ___________ make-up organs, ____________
make-up organ systems.
e. The human body is made up of multiple different body systems. Organ
systems are made up of _________ that work together.

3
 f. Organ Systems of the human body:

Organ System Organs involved Functions

Integumentary Hair, skin and nails

Muscular

Skeletal

Endocrine

Nervous

Cardiovascular

Lymphatic

Respiratory

Digestive

Urinary

Male Reproductive

Female Reproductive

III. Functions of Human Life

a. Laws of thermodynamic
i. First law:
b. Metabolism= _______________ + _______________
c. Define catabolism:
d. Define anabolism:
e. The cellular energy currency is ___________ ____________
______________.
IV. Requirements for human life
a. Compare and contrast oxygen versus carbon dioxide for human life.
b. Nutrients
i. Water:
ii. Micronutrients:
iii. Energy-Yielding and Body Building Nutrients:
c. Optimal temperature range for human body
i. When would controlled hypothermia be used?
ii. How does it aid in medical treatment?
d. Atmospheric pressure
i. Pressure helps blood gas by

4
 e. Decompression Sickness:
i. Acclimation:
ii. Adaptation:
V. Homeostasis
a. Negative feedback:
i. Example.
b. Positive feedback:
i. Example.
VI. Anatomical Terminology

c. Directions

5
d. Body planes

e. Cavities and serous membranes

6
 VII. Medical imaging
a. X-rays were discovered by
i. Function of x-rays
b. Computed tomography:
i. When are CAT scans requested?
c. Magnetic resonance imagining (MRI):
d. Positron emission tomography (PET):
e. Ultrasonography:

Chapter 2

I. Elements and Atoms

7
A. Define:
1. Matter:
2. Mass:
a) Compare human mass and weight.
3. Elements:
a) Atom is the smallest quantity of an element
b) Nucleus contains protons and neutrons
c) How will electron shells affect molecule formation?
d) Atomic number:
e) Atomic mass:

8
 4. Compounds:
a) Glucose is composed of carbon, _______ and _________
5. Atoms:
6. Subatomic particles:
a) Carbon 12, 13 and 14 have the same ___________ and different
numbers of ______________
b) Radioactive isotopes:
(1) Used in medicine for PET scans
c) Electrons circle the nucleus of an atom in ___________________

B. Define radiology:
1. How are radioactive isotopes used medically? What are the pros and
cons of the use? What training would it take to use radioactive isotopes
for medical use?
II. Chemical Bonds
A. Valence electrons are important for compound formation because
___________________________________________________________.
B. Compounds are formed by _____________
1. Elements that lose or gain electrons become ___________.
a) What type of bond can be formed as a result?
(1) K+ is an example of what type of ion? What causes the K
element to become an ion in this case?

9
 (2) Can more than one __________ be lost or gained to
produce ions?
(3) Mg++ is an example of what type of ion?
(4) Mg++ will form a ______________ bond with
____________ to form a compound
(5)
2. The strongest __________ is a ___________ ___________.
a) Electrons are ___________ between elements that form
molecules.
b) Define polar:
c) How are polar and nonpolar bonds different and similar?
d) Water is an example of a _________ bond. Is polarity
intramolecular or intermolecular?
e) Draw a water molecule to illustrate polarity.
f) What happens to polar molecules in water?
g) What happens to nonpolar molecules in water?
3. The weakest of the bonds is the __________ ___________
a) List all the types of bond found in a glass of water. Draw examples
of the different bonds
b) Looking at the periodic table, how does electronegativity change
in elements from left to right?
c) Does this affect hydrogen bonds? How?
III. Chemical Reactions
A. Define the following and give and example of each
1. Kinetic energy:
2. Potential energy:
3. Chemical energy:
4. Mechanical energy:
5. Radiant energy:
6. Electrical energy:
B. Chemical reactions are broken down into substance that enter the reaction or the
__________ and substances that are produced in the reaction or the _________.
1. Types of chemical reactions
a) Synthesis reaction
(1) A + B→
b) Decomposition reaction
(1) AB→
c) Exchange reaction
(1) A +BC→
(2) AB + CD→
d) What causes chemical reactions to reverse?
C. Properties that affect the rate of a chemical reaction
1. Properties of the reactants
a) List properties

10
 2. Temperature
a) Higher temperature affect?
b) Lower temperature affect?
3. Concentration and Pressure
a) Abundance?
b) Amount of space?
4. Enzyme and other catalysts
a) Explain how enzymes lower activation energy of a chemical
reaction using the figures below:

IV. Inorganic Compounds Essential to Human Functioning

A. Compare and contrast inorganic and organic compounds
B. Properties of water:
1. Solution= ___________ + _____________
2. Give an example of hydrophobic molecules
3. Give an example of hydrophilic molecules

11
 4. ________________reaction used to break molecules into monomers and
______________ reaction used to build molecules

C. How are solute concentrations measured?

1. Define molarity
a) What is the molarity of NaCl?
b) What is the difference between a mole and molarity?
2. Define colloid:
3. How is a suspension different from a colloid?
D. Salts are formed when __________ form __________ bonds. Salts also
_________________ in water resulting in separate __________.
E. Define pH:
1. What is the pH of human blood?
a) Is human blood acid or basic?
b) __________ causes the human blood to become ___________.
However, homeostatic mechanisms
__________________________back to the normal range.
c) ____________ solution contains a weak acid and its conjugate
base and work to help maintain _____________.
2. Compare and contrast acids, bases and salts.
3. What is the pH of stomach acid?
4. How will acid react in water, use HCl as the example?
5. How is the reaction of HCl in water different from H3PO4 ?
6. How does a base pH differ from an acid?
7. Define base:

12
 V. Organic Compounds Essential to Human Functioning
A. Organic compounds typically contain which elements?
1. How many bonds will carbon form? Why?

Functional Groups Important in Human Physiology

Functional Structura
Importance
group l
formula
Hydroxyl groups are polar. They are components of all four types of organic compounds discussed in
Hydroxyl —O—H this chapter. They are involved in dehydration synthesis and hydrolysis reactions.
Carboxyl groups are found within fatty acids, amino acids, and many other acids.
Carboxyl O—C—OH
Amino —N—H2 Amino groups are found within amino acids, the building blocks of proteins.
Methyl —C—H3 Methyl groups are found within amino acids.
Phosphate —P—O 2– Phosphate groups are found within phospholipids and nucleotides.
4

Table 2.1

B. What are Four organic compounds essential for human functioning?

1. Carbohydrates
a) Chemical formula for a generic carbohydrate is
________________
b) Another name for carbohydrate?
(1) Maltose is an example of which type of carbohydrate?
(2) Glucose is an example of which type of carbohydrate?
c) Are starches considered to be carbohydrates? Why or why not?
d) Why is glucose stored as glycogen?
e) Carbohydrates are used for cellular fuel in the form of
__________ __________ ___________
2. Lipids
a) Are made of repeating units of hydrogens and carbons
(1) Are hydrocarbons polar or nonpolar? Explain.
b) Fat or _________________ are commonly found in tissues and
consist of a ____________ core and ______________ fatty acids

c) Which reaction is illustrated below to form triglyceride from

monomers?

13
d) Saturated vs. unsaturated how are they different?

(1)Which is solid at room temperature?

(2)Plant oils contain which type(s) of fatty acid?
(3)The best diets will be low in ____________ fats.
(4)Why are trans fats harmful? Give examples of foods with
the most trans fats?
e) Human cell membranes are made up of _____________, which
are ________________. This means they contain
______________ or “water loving” polar head and
_____________ or “water hating” nonpolar tails
f) Describe a typical steroid. Give an example.

____________ are cell signaling molecules and can aid in regulation

of blood pressure and inflammation when
________________________________

14
3. Proteins
a) Monomers of proteins are __________ linked together via
___________ bonds, which are types of ___________ bonds.
b) Structural components of an amino acid:

c) Hierarchy of protein shape

(1) Primary:
(2) Secondary:
(3) Tertiary:
(4) Quaternary:

15
d) Enzymes
(1) Describe the jigsaw puzzle model:

16
 e) How are enzymes affected by reactions?
4. Nucleic Acid
a) DNA:

17
b) RNA:
(1) How is it different from DNA?
(2) What are the major types?
(a) What are the functions of the types?
(3) Which nucleotide is present in DNA but not RNA?
c) ATP:
(1) Define phosphorylation:

18
Chapter 3
I. The Cell Membrane
Function:
1. Plasma membrane is ___________ _____________, allowing for certain
molecules to enter the cells while others cannot.
Cell membrane characteristics:
2. Phobicity
a) Hydrophobic
b) Hydrophilic
c) Amphipathic
(1) Membrane lipid

3. Fluids
a) Intracellular fluid (ICF) is found in the ___________
b) Interstitial fluid (IF) is found in the _____________
c) Extracellular fluid (ECF) is found in the _________
4. Membrane proteins
a) Integral proteins:
(1) Channel:
(2) Recognition proteins
(a) Receptor:
(i) Ligand:
(3) Glycoproteins:
(a) Glycocalyx:
b) Peripheral proteins:

19
5. Membrane transport
a) Passive transport:
(1) Simple diffusion:
(a) How is spraying Lysol in one corner of your room
an example of simple diffusion?
(2) Osmosis:
(a) How is osmosis different from simple diffusion?

(b) Tonicity
(i) If a patient comes into the hospital
dehydrated, what percentage saline should
be in the IV?

(3) Facilitated diffusion:

(4) Filtration:
b) Active transport:
(1) Protein pump
(a) Na+/K+ pump:
(i) How many sodium ions are moved out of
the cell?
(ii) How many potassium ions are moved into
the cell?
(iii) What is the charge inside of the cell after?
(iv) Electrical gradient:

20
 (b) Endocytosis:
(i) Phagocytosis:
(ii) Pinocytosis:
(iii) Receptor mediated endocytosis:
(a) Give examples of when receptor
mediated endocytosis used instead
of other forms of endocytosis?
(c) Exocytosis:

(2) How is transport affected by cystic fibrosis?

(a) Which ion is mostly affected? How?
(b) What are the results for patients?

II. The Cytoplasm and Cellular Organelles

Cytosol is the ______ _______ portion of the cytoplasmic compartment where
__________ ________________ occur.
1. Describe how the cell is similar to a factor producing and shipping
products. Use each organelle as a part of the factory.

Organelle Functions

nucleus

mitochondria

lysosomes

Smooth Endoplasmic reticulum

21
Rough endoplasmic reticulum

peroxisome

vacuole

Golgi apparatus

nucleolus

ribosomes

Define apoptosis:

How are free radicals involved in this process? Include oxidative stress in your explanation.

Cytoskeleton
2. Compare and contrast cilia and flagella.
3. Centrioles or ______________ are cytoskeletal elements found near the
nucleus and are made up of tubulin. Myosin is an example of this
cytoskeletal element.
4. Actin or _____________, which are thinner cytoskeletal elements. The
diameters of these elements range from 3-6 nm. Actin is found in
_______________ tissue.
5. _____________ ______________ have a diameter of 10 nm. These
elements are made up of _____________. These elements help to

22
 anchor _____________ within the cell to other cells by ___________
junctions.
III. The Nucleus and DNA Replication
The computer of the cell is the ________________.
Red blood cells are anucleate because
_______________________________________________.
The membrane surrounding the nucleus is the _____________
______________, which is a double layer containing ________ _______ that
allow for movement of molecules in and out of the nucleus.
How is the nucleoplasm different from the cytoplasm?
Prepare a venn diagram to compare and contrast chromatid, chromatin and
chromosome.
Define nucleosome:
DNA strands run ____________ to each other, with the________strand from 5’
to 3’ and the_________ strand from 3’to 5’.
Prior to cell division, __________ ____________ occurs to duplicate the genetic
material in the cells and prepare for new daughter cell formation.
THE THREE MAIN STEPS OF DNA REPLICATION:
1. Initiation:
2. Elongation:
3. Termination:

IV. Protein Synthesis

23
True/False. One gene=one protein.
The active products of gene expression are ________________.
The full complement of proteins in the cell are the ________________.
Triplet:

Central Dogma: DNA-transcribed to mRNA-translated to protein

Since mRNA is transcribed from DNA, does that mean they have the same
language or monomers?
1. What are those monomers?
Is the triplet code used as the template for protein synthesis?
2. What is a codon? When is it used?
3. How are DNA and RNA polymerases different?
Stages of transcriptions
4. Initiation:
5. Elongation:
6. Termination:

24
Where does transcription occur in eukaryotic cells?
Post transcriptional modification of mRNA includes:
7. Spliceosome:
8. Introns:
9. Exons:
10. Poly A tail:
11. 5’ cap:
Types of RNA in eukaryotic cells:
12. mRNA:
13. rRNA:
14. tRNA:

25
Stages of Translation:

15. Initiation:
16. Elongation:
17. Termination:
18. Where does translation occur?
19. When will free ribosomes complete protein synthesis versus the rough
endoplasmic reticulum?
20. How will the anticodon result in an amino acid’s production?

26
V. Cell Growth and Division
Gametes:
1. haploid, n, cells contain how many chromosomes?
Somatic cells:
2. Diploid, 2n, cells contain how many chromosomes?
3. Two copies of a single chromosome is a __________________ pair.
Cell cycle:
4. Mitosis
a) Interphase:
(1) G1
(2) S phase
(3) G2
(4) G0
(5) M
b) Prophase:
(1) Prometaphase:
c) Metaphase:
d) Anaphase:
e) Telophase:
5. Cytokinesis:
6. Checkpoints:
a) CDK- __________ ___________ _____________,molecules that
work together with cyclins to ___________________________.

27
 Cancer and homeostatic imbalance
7. Cell cycle control=_______________ ______________
8. Cyclins:
a) Proto-oncogene products:
9. Cancer
a) Define proto-oncogene:
b) Tumor suppressor genes:
VI. Cellular Differentiation
Stem cells
1. Most undifferentiated stem cells _______________, or first embryonic
stem cell
2. Stem cells that become any human tissue ___________________.
3. _________________ can differentiate into any type of cell of a certain
type.
a) ___________________ cells limited to becoming only a few
different cell types.
b) _______________ already specialized and can only become
more of the same type of cell.

Define differentiation:

28
Chapter 4
I. Types of tissue
A. What are the differences between cells and tissues?
B. Four major types in the human body:
1. Epithelial tissue
a) General locations:
b) Major functions:
2. Connective tissue:
a) General locations:
b) Major functions:
3. Muscle tissue:
a) General locations:
b) Major functions:
4. Nervous tissue:
a) General locations:
b) Major functions:

C. Which germ layers give rise to the different types of tissue?

D. How are tissue membranes different from tissues?

29
 1. Epithelial membrane:
a) Which tissues make up the membrane?
b) Examples of membrane locations.
c) Three types of epithelial membranes:
(1) __________ membranes produces mucus which lines
_______________________________
(2) ____________membranes line the _____________ cavity
of the body and contains ______________ fluid.
(3) _____________membranes is unique because
___________________________________
2. Connective membrane:
a) Synovial membrane is found in
b) How are synovial membranes different from other membranes?
II. Epithelial Tissue
A. Which embryonic layer will the epithelial cells differentiate from?
B. The polarity of epithelial cells refers to the _____________ surface which is the
exposed surface and the _____________ surface which is exposed to the
underlying body structures.
1. __________ ___________ is an important mixture of glycoproteins and
collagen fibers. This allows epithelial cells to attach to
_________________ tissue, which is always found under epithelial cells.
2. Compare and contrast basal lamina and reticular lamina?
3. Will you find blood vessels that innervate epithelial tissue? Why or why
not?
C. List general functions of epithelial tissue.
1. Give examples of locations where each function is prevalent.
2. When would epithelial cells need cilia? Would they be flagellated? Why or
why not?
a) Why are cilia important for breathing?
D. Epithelial cells lack intercellular material, but are tightly connected via
____________________________________________________, which all aid in
connecting cells and allowing for intercellular communication.
1. Cell polarity is further solidified by the ____________ junctions.
2. ____________ junctions stabilize epithelial cells. How?
a) List and explain the differences between the types of _________
junctions.
b) What role will cadherins play in cell junctions? How are cadherins
different from integrins?
c) Microfilaments present in the cells’ cytoplasm aid in the _______
and ___________ of tissue.
3. Cells communicate by sending molecules through ________ junctions.
E. Epithelial cells are characterized by shape and cell number:
1. Three major cell shapes:
a) Fish scale like or ____________.

30
 b) Cube shape or ___________.
c) Rectangular shape or taller than wide or ___________.
2. One layer of cells is considered ______________.
3. Two or more layers of cells is considered ____________.
F. Squamous epithelia
1. _____________ lines lymphatic and cardiovascular systems. This tissue
type is important for which feature in these two systems?
2. Simple squamous epithelium also makes up the ___________ membrane
lining body cavities and internal organs.
3. __________ squamous epithelium contains normal squamous cells at the
_________ surface with _____________ or ___________ cells at the
basal surface.
a) Where would you find this tissue type in the body? What would be
the function?
b) What is the best way to identify the differences?
c) Which type of epithelium would make up the surface of the body?
What are the functions of the tissue?
4. Cuboidal epithelia
a) Major functions:
b) Found?
c) What are the differences between the simple and stratified layers?
5. Columnar epithelia
a) ____________ columnar found in the digestive tract and female
reproductive tract. Why are some ciliated?
(1) How does this aid in the reproductive process?
b) How are simple columnar and pseudostratified columnar
epithelium different?
(1) Where would pseudostratified columnar epithelium be
found in the human body?
(2) Why are _________ cells important?
(3) Are cilia needed on all columnar epithelial cells that contain
goblet cells? Why or why not?

31
 c) Where would you find stratified columnar epithelium in the human
body?
6. In the urinary system, ____________ epithelium tissue is found. This
tissue is important in aiding the _______________________ of the
bladder.
G. Glandular Epithelia:
1. ___________ glands or __________ are diffused through the
bloodstream to their target cells. Examples:
2. __________ glands release their content outside of the body such as
breast milk, sweat and mucous.
a) These glands can be unicellular or multicellular. ________ cells
are examples of unicellular cells.
b) ________ glands can either excrete their content via a
__________ duct or ___________.

32
c) Modes of glandular secretion:

33
 III. Connective Tissue Supports and Protects
A. The most abundant type of tissue in the human body.
B. Commonly found under __________ tissue.
C. Distinguish by the presence of a ____________ which contains extracellular
substances and aids in tissue function.
1. The _________ substance is the major component of the matrix.
D. Tissue types are listed below: List a functions and location

Connective tissue proper Supportive connective tissue Fluid connective tissue

Loose connective tissue: Cartilage: Blood

1. Areolar 1. Hyaline: 1. Functions:
a. Functions: a. Functions: 2. locations:
b. Locations: b. locations:
2. Adipose: 2. Fibrocartilage
a. Functions: a. Functions:
b. Locations: b. locations:
3. Reticular: 3. Elastic
a. Functions: a. Functions:
b. locations: b. locations:

Dense connective tissue: Bones: Lymph

1. Regular elastic 1. Compact bone: 1. Functions:
a. Functions: a. Functions: 2. locations:
b. locations: b. locations:
2. Irregular elastic: 2. Cancellous bone:
a. Functions: a. Functions:
b. locations: b. Locations:

E. What is tendinitis?
1. What causes tendinitis?
2. Where is tendinitis mostly likely to occur in the body?

IV. Muscle Tissue and Motion

A. Muscle tissue like nervous tissue is excitable. What does excitability mean?
B. Three types of muscle tissue:
1. __________ muscle is found in the heart and works to
_______________________.
a) Cardiomyocytes attach to each other via cell junctions called
_______________ disc.
b) Is blood pumping through the body voluntary or involuntary?
2. ___________ muscle is found in the skeleton and works to
_______________________.
a) These cells are striated which means
b) How are these cells different from cardiac muscle?

34
 3. ________ muscle is found lining hollow organs and works to
____________________________________________.

V. Nervous Tissue Mediates Perception and Response

A. What is the main function of nervous tissue?
1. How are signals sent and received?
B. Nervous tissue contains two main cell types:
1. Neurons:
2. Neuroglia:
C. Neurons are exist in three main types:
1. Multipolar:
2. Unipolar:
3. Bipolar:
D. What are the differences in the morphology of the three types?
1. Where would each type be found?
2. Which is the most abundant?
E. What are the major types of neuroglia in the CNS?
F. What are the major types of neuroglia in the PNS?

VI. Tissue Injury and Aging

A. __________ is the body's response to injury. Four major signs appear:
1. Are there any other signs?
2. Will all of the signs appear at once?
B. Cell death initiates the __________ response in some cases. When would this
response not occur?
C. Chemicals, _____________, are released to initiate the inflammatory response.
1. Vasodilation is also involved in the parasympathetic response. How can
your body identify injury versus parasympathetic response?
D. What are histamines?
1. They are present during allergic reactions. How are they helpful in both
allergic reactions and inflammatory responses?
E. List the steps in the process of wound healing.

35
F. What are some of the changes to the human body during aging?
1. How are telomeres affected by aging?
2. Are cancer risks increased with age? Why or why not?

36
Chapter 5
I. Functional Anatomy of Skin
A. Most accessible but often least appreciated organ system.
1. The skin, or simply integument, accounts for approximately 16%
of your total body weight.
2. The skin’s surface, 1.5 - 2.0 m2, is constantly worn away, attacked
by micro-organisms, irradiated by sunlight, and exposed to
environmental chemicals.
3. Skin is composed of two major components:
a. Cutaneous membrane:
i. The epidermis consists of stratified squamous.
ii. The dermis consists of a papillary layer of areolar
tissue and a reticular layer of dense irregular
connective tissue.
b. Accessory Structures:
i. Nerve fibers and corpuscles
ii. Hair follicles, hair shafts, and arrector pili muscles
iii. Oil glands and sweat glands
iv. Arteries, veins, and lymph vessels forming the
cutaneous network
4. The hypodermis (also known as the subcutaneous layer or
superficial fascia) separates the integument from the fascia
around the deeper organs. Note this layer is NOT part of the
integument.

5.1 The Layers of the Skin

1. The EPIDERMIS is composed of layers with various functions.
A. The epidermis is dominated by keratinocytes, the body’s most abundant
epithelial cells. These cells form several layers called strata.
1. Thin skin, which covers most of the body surface, contains four strata and
is about as thick as the wall of a plastic sandwich bag (roughly 0.08 mm).
2. Thick skin, which occurs on the palms of the hands and soles of the feet,
possesses five strata. It is about as thick as a standard paper towel
(roughly 0.50 mm).
3. Note that the terms “thick” and “thin” refer to the relative thickness of the
epidermis, not the integument as a whole.
B. Strata of the Epidermis
1. Stratum Basale
a. The deepest epidermal layer consisting of a single row of basal
cells, or germinative cells, that are undergoing rapid mitotic
divisions. These cells are sometimes called stem cells because

37
 their mitotic divisions replace the more superficial keratinocytes that
are lost or shed at the surface.
b. Hemidesmosomes attach the cells of this layer to the basal lamina
that separates the epidermis from the areolar tissue of the adjacent
papillary layer of the dermis.
c. Approximately 10 – 25% of cells in this layer are melanocytes
which produce melanin, a brown, yellowish-brown, or black skin
pigment.
d. In hairless skin, specialized cells called merkel cells exist in small
numbers. These cells are sensitive to touch and when
compressed, they release chemicals that stimulate sensory nerve
endings.
2. Stratum Spinosum
a. Consists of approximately 8 – 10 layers of keratinocytes bound
together by desmosomes and microfilaments of pre-keratin.
b. The name stratum spinosum, which means “spiny layer”, refers to
the fact that the cells look like miniature pincushions in standard
histological sections.
c. Large numbers of dendritic cells are found in this layer. These
are specialized cells that participate in the immune response by
stimulating a defense mechanism against 1) microorganisms that
manage to penetrate the superficial layers of the epidermis and 2)
superficial skin cancers.
3. Stratum Granulosum
a. Consists of 3 – 5 cell layers where the keratinocytes appearance
begins to change. The name stratum granulosum means “grainy
layer”.
b. These cells become flattened, the plasma membrane becomes less
permeable, and the organelles deteriorate.
c. By the time the cells reach this layer, most have stopped dividing
and have started making large amounts of keratin and
keratinohyalin stored in numerous visible granules.
d. Beyond this layer, there is no nutrient availability.
4. Stratum Lucidum
a. In the thick skin of the palms and soles, a stratum lucidum
separates the stratum corneum from deeper layers.
b. The cells of this layer are flattened, densely packed, largely devoid
of organelles, and filled with the proteins keratin and keratohyalin.
c. By the time they reach the stratum lucidum, the cells are dead and
undergoing dehydration.
5. Stratum Corneum
a. Outermost layer of keratinocytes (sometimes called the “horny
layer”).
b. A broad zone of 15 – 30 layers of keratinized cells that accounts for
up to three-quarters of the epidermal thickness.

38
 c. Keratinization is the formation of protective, superficial layers of
cells filled with keratin.
d. The dead cells in each layer of the stratum corneum remain tightly
interconnected by desmosomes. It takes 7 to 10 days for a cell to
move from the stratum basale to the stratum corneum. The dead
cells generally remain in the exposed stratum corneum for an
additional two weeks before they are shed or washed away.
e. Glycolipids in this layer provide a waterproofing quality to the
epidermis.
C. The deeper layers of the epidermis form epidermal ridges which extend into the
dermis and are adjacent to the dermal projections called dermal papillae that
project upward to the epidermis. These ridges and papillae are significant
because they greatly increase the surface area for attachment, firmly binding the
epidermis to the dermis.
D. The ridge patterns in the thick skin on the surface of the fingertips produce
fingerprints, which have been used to identify individuals in criminal
investigations for more than a century.
E. Like all other epithelia, the epidermis lacks local blood vessels. Epidermal cells
rely of the diffusion of nutrients and oxygen from capillaries within the dermis. As
a result the cells with the highest metabolic demand are closest to the underlying
dermis

Name the types of tissues associated with the epidermis, dermis, and hypodermis.

List the 5 major layers of epidermis and describe the functions and characteristics of
each.

2. The DERMIS supports the epidermis, and the hypodermis connects the dermis to
the rest of the body.
A. The dermis lies between the epidermis and hypodermis. The dermis consists of
two layers:
1. Papillary layer = consists of a highly vascularized areolar tissue with all of
the typical cell types within it.
a. This layer also contains the capillaries, lymphatic vessels, and
sensory neurons that supply the surface of the skin.
b. The papillary layer gets its name from the dermal papillae that
project between the epidermal ridges.
c. This layer nourishes and supports epidermis.

39
 2. Reticular layer = consists of an interwoven meshwork of dense irregular
connective tissue containing both collagen and elastic fibers.
a. Bundles of collagen fibers extend superficially to blend into those of
the papillary layer and deeply to blend with the hypodermis.
b. The collagen fibers provide strength while the elastic fibers provide
flexibility.
c. This layer restricts the spread of pathogens, stores lipid reserves,
attaches skin to deeper tissues, possesses sensory receptors, and
contains blood vessels for temperature regulation.
B. Cleavage Lines = within the dermis, the collagen and elastin fibers are arranged
in parallel bundles oriented to resist the forces applied to the skin during normal
movements. The resulting pattern of fiber bundles establishes the lines of
cleavage. These lines are clinically significant: a cut parallel to a cleavage line
will usually remain closed and heal with little scarring whereas a cut at a right
angle to a cleavage line will be pulled open as movement occurs and result in
greater scarring.

List the 2 major areas of the dermis and describe the characteristics of each.

3. The hypodermis separates the skin from deeper structures.

1. It stabilizes the position of skin in relation to underlying tissues (such as skeletal
muscles or other organs) while permitting independent movement.
2. Because it is often dominated by adipose tissue, the hypodermis also represents
an important site for 1) insulation, 2) cushioning, and 3) the storage of energy
reserves.
3. At puberty men accumulate subcutaneous fat at the neck, on the arms, along the
lower back, and over the buttock. In contrast, women accumulate subcutaneous
fat at the breasts, buttocks, hips, and thighs. In both genders, there are almost
no fat cells on the back of the hands and feet but distressingly large numbers in
the abdominal regions (resulting in the “potbelly”).

4. Factors influencing skin color include epidermal pigmentation and dermal

circulation.
A. The color of one’s skin is genetically programmed. However, increased
pigmentation, or tanning, can result in response to ultraviolet radiation.
B. Skin color is influenced by the presence of pigments in the epidermis:
1. Melanin = a brown, yellowish-brown, or black pigment produced by
melanocytes.
a. Melanocytes are located within the stratum basale, squeezed
between or deep to the keratinocytes. Melanocytes manufacture
melanin from the amino acid tyrosine, and package it in
intracellular vesicles called melanosomes.
b. Melanosomes travel within the processes of melanocytes and are
transferred intact to keratinocytes. The transfer of pigmentation

40
 colors the keratinocyte temporarily, until the melanosomes are
destroyed by fusion with lysosomes.
c. In individuals with pale skin, this transfer occurs in the stratum
basale and stratum spinosum, and the cells of more superficial
layers lose their pigmentation. In dark-skinned individuals, the
melanosomes are larger, and the transfer may occur in the stratum
granulosum as well; thus skin pigmentation is darker and more
persistent.
d. The skin covering most areas of the body has about 1000
melanocytes per square millimeter. Differences in skin
pigmentation among individuals do not reflect different numbers of
melanocytes but instead different levels of melanin production.
2. Carotene = an orange-yellow pigment that normally accumulates in
epidermal cells. It is most apparent in cells of the stratum corneum of
light-skinned individuals, but it also accumulates in fatty tissues in the
deep dermis and hypodermis. Carotene is found in a variety of orange
and yellow vegetables (sweet potatoes, carrots, squash).
C. The blood supply affects skin color because blood contains red blood cells filled
with the red pigment hemoglobin.
1. When bound to oxygen, hemoglobin is bright red, giving capillaries in the
dermis a reddish tint that is most apparent in light-skinned individuals.
2. If those vessels are dilated, the red tones become much more
pronounced. For example, your skin becomes flushed and red when your
body temperature rises because the superficial blood vessels dilate so
that the skin can act like a radiator and lose heat.
3. When the blood flow decreases, oxygen levels in the tissues decline, and
under these conditions hemoglobin releases oxygen and turns a much
darker red. Seen from the surface the skin takes on a bluish color. This
coloration is called cyanosis. In individuals of any skin color, cyanosis is
most obvious in areas of very thin skin (lips and under the fingernails).

Describe the factors that normally contribute to skin color.

5.2 Accessory Organs of the Skin

A. Hair and its associated structures:
1. Hair follicles are a complex structure composed of epithelial cells and
connective tissues that are responsible for the formation of a single hair.
The hair follicle has three regions (the internal root sheath, the external
root sheath, and glassy membrane).
2. Hair production begins at the base of the hair follicle. Here a mass of
epithelial cells forms a cap, called the hair bulb that surrounds a smaller
hair papilla, a peg of connective tissue containing capillaries and nerves.
3. Root hair plexus are sensory nerves that surround the hair bulb and give
hair the ability to detect touch.

41
 4. Associated with each hair follicle is a bundle of smooth muscle cells called
an arrector pili muscle. These muscles will contract and cause hairs to
stand up or become erect.
5. The human body has about 2.5 million hairs and 75% of them are on the
general body surface and not on the head. Hairs are non-living structures
composed of keratinocytes.
6. Parts of a Hair:
a. Hair shaft is the portion of the hair that extends through the follicle
and protrudes above the skin line.
b. Hair root the portion that anchors the hair into the skin
c. Cuticle forms the surface of the hair. Composed of hard keratin.
d. Cortex an intermediate layer of cells deep to the cuticle. Contains
thick layers of hard keratin, which give hairs their stiffness.
e. Medulla, or core, consists of cells at the center of the hair matrix
filled with soft keratin.
f. Hair matrix consists of superficial cells of the hair bulb. These
germinative cells in the hair matrix produce the hair.
7. Variations in hair color reflect differences in hair structure and variation in
the pigment produced by melanocytes at the hair papilla. Different forms
of melanin give a dark brown, yellow-brown, or red color to the hair. As
pigment production decreases with age, hair color lightens. White hair
results from the combination of a lack of pigment and the presence of air
bubbles in the medulla of the hair shaft.
B. Nails = thick sheets of keratinized epidermal cells.
1. Nails protect the exposed dorsal surfaces of the tips of the fingers and
toes. They also help limit distortion of the digits whey they are subjected
to mechanical stress.
2. The cells producing the nails can be affected by conditions that alter body
metabolism, so changes in the shape, structure, or appearance of the
nails can provide useful diagnostic information.
3. Parts of a nail:
a. Nail body = consists of dead, tightly compressed keratinocytes
packed with keratin. The nail body is the portion of the nail to which
polish might be applied.
b. Nail bed = the nail body covers an area of the epidermis that
contains rapidly dividing cells that divide to replace the cells that
are lost.
c. Nail root = the epidermal fold not visible from the surface and
anchors the nail body into the underlying tissues; the deepest
portion of the nail root lies very close to the bone of the fingertip.
d. Hyponychium = the free edge of the nail composed of a thickened
stratum corneum; the distal portion that continues past the nail bed.
e. Eponychium = a portion of stratum corneum of the nail root that
extends over the exposed nail; more commonly called the cuticle.
f. Lunula = a pale crescent shaped area near the root where the
dermal blood vessels are obscured; may not be present in all nails

42
 Describe the structure and function of nails.

C. Glands
1. Sebaceous glands = oil glands
a. Simple alveolar glands that are found all over the body except on
the palms and the soles. Sebaceous follicles secrete onto skin
surfaces located on the face, back, chest, nipples, and external
genitalia.
b. Contractions of the arrector pili muscles squeeze the sebaceous
gland and force the sebum (a mixture of triglycerides, cholesterol,
proteins, and electrolytes) into the hair follicle and onto the surface
of the skin.
c. These glands are the holocrine type, the cells fill up with oil then
bust.
d. Sebum is secreted into a hair follicle, or occasionally a pore, or
follicle, on the skin surface.
e. Sebum softens and lubricates hair and surrounding skin and also
has anti-bacterial properties.
2. Sweat glands
a. Distributed all over the surface of the body except the nipple, parts
of the external genitalia, and the lips.
b. Eccrine (merocrine) sweat glands are very numerous in the
palms, soles of the feet and forehead.
i. Eccrine gland secretions, commonly called sweat, are a
hypotonic filtrate of the blood that passes through secretory
cells of the sweat gland and is release by exocytosis.
ii. Once released, the sweat travels via a duct to the surface of
the skin where it opens into a funnel-shaped pore.
iii. Normal pH of sweat is between 4 and 6.
c. Apocrine sweat glands* are largely confined to the axillary and
anogenital areas.
i. Larger than eccrine sweat glands and release their
secretions into hair follicles.
ii. The secretions produced are similar to sweat but they also
contain fatty substances and proteins.
iii. Apocrine glands begin functioning at puberty.
d. Ceruminous glands
i. Modified Apocrine glands that line the external ear canal and
secrete a sticky, bitter substance called cerumen.
ii. Cerumen=earwax.
e. Mammary glands
i. Specialized Apocrine sweat gland that secretes milk.

43
 Compare and contrast the modified sweat glands including: eccrine, apocrine,
ceruminous, and mammary glands.

Compare the structure, location, and product of sweat glands versus oil glands.

5.3 Functions of the integumentary system

A. Protection
B. Sensory: The integument contains many sensory receptors:
1. Free nerve endings = numerous unencapsulated nerve endings for pain
and temperature detection
2. Tactile discs = extend from the dermis into the epidermis where they
connect to Merkel cells and monitor the chemical secretions from these
cells which produce tactile stimuli.
3. Tactile corpuscles (Meissner’s corpuscles) = receptors located in the
dermal papillae; responsible for the detection of light touch
4. Lamellated corpuscles (Pacinian corpuscles) = receptors located in the
reticular layer of the dermis; responsible for detection of deep pressure
and vibration
C. Thermoregulation: your skin can help regulate your body temperature via
vasodilation and vasoconstriction.
D. Vitamin D synthesis: Hormonal Vitamin D = also known as calcitriol. When
exposed to ultraviolet light, epidermal cells in the stratum spinosum and stratum
basale converts a cholesterol-related steroid into cholecalciferol. Although
cholecalciferol can be obtained from the diet, few foods contain it. In fact most
foods that contain cholecalciferol have been fortified with it. The liver then
converts cholecalciferol into an intermediary product used by the kidneys to
synthesize the hormone calcitriol. Calcitriol is required for stimulating normal
absorption of calcium and phosphorus in the small intestine. An inadequate
supply of calcitriol leads to impaired bone growth and maintenance such as
typical of rickets.

5.4 Diseases, disorders and injuries of the immune system

A. Skin cancers are the most common types of cancer.
1. The most common form of skin cancer is basal cell carcinoma. This is a
cancer that originates in keratinocytes of the stratum basale, due to
mutations caused by overexposure to the UV light. Metastasis virtually
never occurs in basal cell carcinomas, and most people survive these
cancers.
2. In contrast, melanoma is the least common form of skin cancer but is
extremely dangerous. In this condition cancerous melanocytes within the
stratum basale grow rapidly and metastasize through the lymphatic

44
 system. The outlook for long-term survival is in many cases determined
by how early the condition is diagnosed. If the cancer is detected early,
while it is still localized, the affected area can be surgically removed, and
the 5-year survival rate is 99 percent. If the condition is not detected until
extensive metastasis has occurred, the 5-year survival rate drops to 14%.
3. Squamous cell carcinoma originates in the stratum spinosum layer and
like basal cell carcinoma, it rarely metastasizes.
B. Eczema is an allergic reaction that manifests as dry, itchy patches of skin that
look like a rash. It may swell, flake, crack and bleed and can be treated with
corticosteroids and immunosuppressants.
C. Acne occurs from an overproductive, blocked sebaceous gland.
D. Injuries and Burns: First degree burn effects only the epidermis. Second
degree burn goes deeper and effects both epidermis and dermis. Third degree
burn extends through the epidermis and dermis to damage underlying tissue and
nerve endings. Fourth degree burn includes damage to all of the above as well
as muscle and bone. Full thickness burns can NOT be repaired by the body and
require a skin graft.

E. Scars are collagen-rich skin formed after the process of wound healing that
differs from normal skin. Keloids are raised scars
F. Bedsores happen in areas exposed to prolong pressure resulting in loss of blood
flow and necrosis of the tissues.
G. Stretch Marks result from the skin is stretched beyond its normal capacity.
H. Calluses and Corns form from areas of constant abrasion.

5.5 Age-related changes alter the appearance of structure of the integument.

A. Melanocyte activity declines, and in light skinned individuals, the skin becomes
pale. With less melanin in the skin, people become more sensitive to sun
exposure and more likely to experience sunburn.
B. Sebaceous gland secretions decreases with age and the skin becomes dry and
often scaly.
C. The epidermis thins as germinative cell activity declines, and the connections
between the epidermis and dermis weakens, making older people more prone to
injury, skin tears, and skin infections.
D. The metabolic activity in the skin decreases as well. Synthesis of calcitriol
(vitamin D3) decreases leading to muscle weakness and brittle bones.
E. The number of dendritic cells decreases to about half the levels seen at maturity.
This reduction in cells may decrease sensitivity of the immune response and
further encourage skin damage and infection.
F. The dermis becomes thinner and has fewer elastic fibers, making the integument
weaker and less resilient. The results – sagging and wrinkling – are most
pronounced in body regions with the most sun exposure.
G. Merocrine sweat glands become less active and with impaired perspiration
processes, older people cannot lose hear at fast as younger people. Thus the
elder are at greater risk of overheating in warm environments.

45
 H. A reduction in dermal blood supply cools the skin, which can stimulate
thermoreceptors and make a person feel cold even in a warm room. Reduced
circulation and sweat gland function lessens their ability to lose body heat, which
can cause their body temperature to soar dangerously high.
I. With declining levels of sex hormones, differences in secondary sexual
characteristics with respect to hair distribution and body-fat distribution begin to
fade. As a consequence, people age 90 – 100 of both sexes tend to look alike.
J. Hair follicles stop functioning or produce thinner, finer hairs. With decreased
melanocyte activity, these hairs are gray or white.

Describe the various skin disorders discussed in class as well as the age related
changes that occur in skin.

Define the following terms: strata, keratin, cyanosis, epidermal ridges, dermal
papillae, cleavage lines, striae, cutaneous network, and melanosomes.

Chapter 6
6.1 The Functions of the Skeletal System
1. Support = provides structural support for the entire body. Individual bones or
groups of bones provide a framework for the attachment of soft tissues and or
organs.
2. Protection = delicate tissues and organs are often surrounded by skeletal
elements. The ribs protect the heart and lungs, the skull encloses the brain, the
vertebrae shield the spinal cord, and the pelvis cradles delicate urinary and
reproductive organs.
3. Leverage = many bones of the skeleton function as levers that can change the
magnitude and direction of the forces generated by skeletal muscles. The
movements produced range from the delicate motions of a fingertip to powerful
changes in the position of the entire body.
4. Storage of minerals = the calcium salts of bone represents a valuable mineral
reserve that maintains normal concentrations of calcium and phosphate ions in

46
 the body fluids. Calcium is the most abundant mineral in the human body. A
typical human body contains 1-2 kg of calcium, with more than 98 % of it
deposited in the bones of the skeleton.
5. Blood cell production = also known as hematopoiesis; red blood cells, white
blood cells, and platelets are produced in the red bone marrow, which fills the
internal cavities of many bones.

6.2 Bone Classification:

A. The adult skeleton system includes approximately 206 separate bones and a
number of associated cartilages. This body system is divided into the axial
skeleton and appendicular skeleton.
1. Axial skeleton = (80 bones) consists of the bones of the skull, hyoid,
sternum, rib cage, vertebral column, sacrum, and coccyx.
2. Appendicular skeleton = (126 bones) includes bones of the limbs and
the pectoral and pelvic girdles that attach the limbs to the axial skeleton.
B. Bones are classified according to shape and structure and also their surface
features.
1. Flat bones = thin, roughly parallel surfaces. Flat bones form the roof of
the skull, sternum, the ribs, and the scapulae. They provide protection
from underlying soft tissues and offer an extensive surface for the
attachment of skeletal muscles.
2. Sutural bones = also known as Wormian bones; are small, flat, irregularly
shaped bones between the flat bones of the skull. There are individual
variations in the number, shape, and position of sutural bones. Their
borders are like pieces of a jigsaw puzzle, and they range in size from a
grain of sand to a quarter.
3. Long bones = are relatively long and slender. They are located in the
arm, forearm, thigh, lower leg, palms, soles, fingers and toes. The femur,
the long bone of the thigh, is the largest and heaviest bone in the body.
4. Irregular bones = have complex shapes with short, flat, notched, or
ridged surfaces. The spinal vertebrae, the bones of the pelvis, and
several of the skull bones (mandible for example) are irregular bones.
5. Sesamoid bones = are generally small, flat, and shaped somewhat like a
sesame seed. They develop inside of tendons and are most commonly
located near joints at the knees, the hands, and the feet. Everyone has
sesamoid patellae, or kneecaps, but individuals vary in the location and
abundance of other sesamoid bones. This variation, among others,
accounts for disparities in the total number of bones in the skeleton.
6. Short bones = small and boxy. Examples of short bones include bones
of the wrist (carpals) and bones of the ankles (tarsals).

6.3 Bone Structure

A. Gross Anatomy of long bones: Long bones are designed to transmit forces along
the shaft and have a rich blood supply.
1. Diaphysis = long tubular shaft that forms the axis of a typical long bone;
the walls of the shaft are made primarily of compact bone.

47
 2. Epiphyses = ends of the bones composed primarily of spongy bone,
also called trabecular bone. Spongy bone consists of an open network
of struts and plates (called trabeculae) that resemble a latticework with red
bone marrow filling in the spaces between. The spongy bone is then
covered by a thin layer of compact bone and articular cartilage.
a. Proximal epiphyses=end closest to the origin of attachment.
b. Distal epiphyses=end furthers from the origin of attachment.
3. Metaphysis = a narrow zone that connects the diaphysis to the
epiphyses. The epiphyseal plate, a thin layer of hyaline cartilage more
commonly called the growth plate, is important for growth in the length of
bones.
4. Medullary cavity = within the shaft of a long bone is a cavity where bone
marrow is located. In childhood, the medullary cavity is filled with red
bone marrow but as we age, fat accumulates within the red marrow
transforming it to yellow bone marrow. Red bone marrow is important
for hematopoiesis but yellow bone marrow is no longer hematopoietic and
instead stores fat as an important energy source.
5. Membranes associated with bone:
a. Periosteum=outermost covering of bone made primarily of dense
irregular tissue and held on by Sharpey’s fibers (collagen).
b. Endosteum=internal membrane of bone made of connective
tissue. Also lines the many canals that pass through bone to
supply blood and nerves to the bone.
6. Nutrient foramen = in order for bones to grow and be maintained, they
require an extensive blood supply. The nutrient foramen is a tunnel that
penetrates the diaphysis and provides access for the blood vessels into
the shaft of the bone.
a. Nutrient artery = transports oxygenated, nutrient-rich blood to the
bone.
b. Nutrient vein = transports deoxygenated, waste-laden blood from
the bone.
7. Metaphyseal artery and metaphyseal vein = carry blood to and from the
area of the metaphysis and to the epiphysis.
8. Articular cartilage = covers portions of the epiphysis that articulate with
other bones. The cartilage is avascular, hyaline cartilage. It relies
primarily on diffusion from the synovial fluid to obtain oxygen and nutrients
and to eliminate wastes.

B. Bone Markings: also known as surface features

1. Depressions and openings allowing blood vessels and nerves to pass
i. Fossa = a shallow depression or recess in the surface of a bone
ii. Fissure = a narrow, slit-like opening or an elongated cleft or gap
iii. Foramen = round or oval opening through the bone
iv. Canal or meatus = a large passageway through the a bone
v. Sulcus or groove = a furrow or narrow trough in a bone

48
 vi. Sinus = a chamber within a bone filled with air and lined with a
mucous membrane.
2. Projections that are sites for muscle and ligament attachment
a. Tuberosity= large, round or rough projection that may cover a
broad area
b. Crest=narrow ridge of bone; usually prominent
c. Trochanter=very large, irregularly shaped projection
d. Line=narrow ridges of bone; less prominent than a crest
e. Tubercle=small, rounded projection
f. Epicondyle=raised area above a condyle
g. Spine=sharp, slender, and often pointed process
3. Projections that form joints
a. Head=expanded proximal end of a bone carried on a narrow neck
b. Facet=smooth, flat articular surface
c. Condyle=smooth, rounded articular surface
d. Ramus=arm-like bar of a bone
C. Microscopic anatomy of compact bone cells and tissues.
1. Osteon = the basic structural and functional unit of bone consisting of
bone cells organized around a central canal and separated by concentric
lamellae.
2. Central canal = also known as the Haversian canal, runs parallel to the
axis of bone and are located in the middle of each osteon. Each central
canal possesses an artery and vein, lymph vessel, and nerve.
3. Perforating canals = passageways that extend perpendicular to the axis
of the bone and connect the central canals of adjacent osteons.
4. Lamellae = nested, concentric rings of matrix surrounding the central
canal.
1. Circumferential lamellae = specialized lamellae found at the outer
and inner surfaces of bone, where they are covered by the
periosteum and endosteum, respectively. These lamellae are
produced during the growth and maintenance of bone.
2. Interstitial lamellae = fill in the spaces between adjacent osteons
of compact bone. These lamellae are remnants of osteons whose
matrix components have been almost completely recycled by the
action of bone digesting cells.
5. Lacunae = mature bones cells, called osteocytes, are trapped within an
open space called a lacuna. Osteocytes cannot divide and therefore each
lacuna contains only one osteocyte.
6. Canaliculi = processes of the osteocytes extend into narrow crevices,
called canaliculi, that penetrate the lamellae and connect the lacunae to
the central canal.
D. Bone is associated with four cells that account for approximately 2% of the bones
weight.
1. Osteocytes = mature bone cells that maintain the protein and mineral
content of the surrounding matrix through the turnover of matrix
components. Osteocytes secrete chemicals that dissolve the adjacent

49
 matrix, and the release minerals enter the circulation. The osteocytes
then rebuild the matrix, stimulating the deposition of mineral crystals.
Osteocytes also participate in the repair of damaged bones.
2. Osteoblasts = immature bone cells located on the surface of bone;
produce new bone matrix in a process called osteogenesis, or
ossification. Osteoblasts make and release the proteins and other
organic components of the matrix. Before calcium salts are deposited,
this organic matrix is called osteoid. Osteocytes develop from
osteoblasts that have become completely surrounded by bone matrix and
trapped within a lacuna.
3. Osteoprogenitor cells = mesenchymal cells located with the periosteum
and endosteum. These stem cells divide to produce daughter cells that
differentiate into osteoblasts, and they are important in the formation of
osteocytes.
4. Osteoclasts = bone digesting cells that remove and recycle bone matrix.
These are giant cells with 50 or more nuclei. Osteoclasts are not related
to osteoprogenitor cells or their descendants. Instead, they are derived
from the same stem cells that produce phagocytic white blood cells, called
monocytes. Acids and proteolytic enzymes secreted by osteoclasts
dissolve the matrix and release stored minerals. This process, called
osteolysis, or resorption, is important in bone remodeling.
E. Chemical composition of bone:
1. Organic Osteoid = roughly 1/3 of the weight of bone is contributed by
collagen fibers. Collagen fibers are strong and flexible, but if they are
compressed, they bend.
2. Inorganic Hydroxyapatites = mineral salts account for almost 2/3 of the
weight of bone. Calcium phosphate interacts with calcium hydroxide to
form crystals of hydroxyapatite. As they form, these crystals incorporate
other calcium salts, such as calcium carbonate, and ions such as sodium,
magnesium, and fluoride. By combining the hydroxyapatite with the
collagen fibers, a strong, somewhat flexible, material is produced.
Furthermore, this protein-crystal combination is highly resistant to
shattering. In fact, bone is far superior to concrete and is more in par with
steel-reinforced concrete.

6.4 Bone Formation and Development

A. The formation of bone, osteogenesis or ossification, begins during embryonic
development. Two types of osteogenesis occur in the embryo:
1. Endochondral Ossification
1. Formation of most bones using a hyaline cartilage model. Begins
approximately 6 weeks after fertilization.
2. Hyaline cartilage does not turn into bone instead it is broken down
as ossification occurs.
3. Steps of endochondral ossification:
i. Cavitation of hyaline shaft: (picture #1 and #2 in the
diagram)

50
 a) Chondrocytes within the shaft hypertrophy (enlarge)
and the surrounding matrix begins to calcify.
b) The impermeable matrix causes chondrocytes to die
from lack of nutrients leaving the matrix that starts to
deteriorate (cavitate).
c) Blood vessels grow around the edges of the cartilage.
d) The cells of the perichondrium convert to osteoblasts
producing a superficial layer of bone sometimes
called the bony collar.
ii. Invasion of internal cavities: (picture #3 in the diagram)
a) Blood vessels penetrate the cartilage and invade the
central region. This area within the shaft of hyaline
cartilage is called the primary ossification center.
b) Migrating with the blood vessels are fibroblasts (which
differentiate into osteoblasts), lymph vessels, nerve
fibers, red marrow elements. Collectively, these are
called the periosteal bud.
c) The osteoblasts secrete osteoid around remaining
fragments of hyaline, forming trabeculae, or spongy
bone.
iii. Formation of the Medullary cavity: (picture #4 in the
diagram)
a) As the primary ossification center enlarges,
osteoclasts break down newly formed spongy bone
and opens up a medullary cavity in the center of the
diaphysis.
b) The osseous tissue of the outer shaft becomes thicker
forming compact bone.
iv. Formation of epiphyses: (picture #5 in the diagram)
a) Secondary ossification centers appear in the area
at the opposite ends of the bone. The cartilage in the
epiphyses calcifies and deteriorates, forming cavities
that allow entry of a periosteal bud.
b) Soon the epiphyses are filled with spongy bone. The
spongy bone is NOT broken down during the
remodeling process.

2. Intramembranous Ossification
a. Formation of bones without a cartilage model. Typical in flat bones,
mandible, clavicles, and patella. Begins approximately 8 weeks
after fertilization.
b. Mesenchyme cells differentiate into osteoblasts within fibrous
connective tissues. This type of ossification normally occurs in the
deeper layers of the dermis or in the connective tissues of tendons.

51
 c. Steps of intramembranous ossification:
a. Formation of bone matrix within fibrous membrane:
a) Mesenchymal cells cluster and secrete organic
components of the matrix. The location of this activity
is the ossification center.
b) The resulting osteoid mineralizes and the
mesenchymal cells differentiate into osteoblasts.
c) As ossification proceeds, the osteoblasts get trapped
within lacunae and differentiate into osteocytes.
b. Formation of woven bone and periosteum:
a) Osteoid accumulates, fuses together forming struts
called trabeculae, or spicules, around blood vessels.
b) The overall structure is similar to spongy bone.
c. Formation of compact bone plate:
a) Initially, the intramembranous bone consists of
spongy bone only.
b) Subsequent remodeling around trapped blood vessels
can produce osteons typical of compact bone.
c) As the rate of growth slows at the surface, the
connective tissue around the bone becomes
organized into the fibrous layer of the periosteum.
B. The growth of bone occurs by two primary processes:
A. Longitudinal Growth (length)
a. Hyaline cartilage cells form tall columns at the epiphyseal plate (or
growth plate) and within the articular cartilage.
b. The cells at the top of the stack divide quickly, increasing the
thickness of the epiphyseal plates and causing the entire long bone
to lengthen.
c. Older chondrocytes closer to the shaft enlarge, die, and the
surrounding cartilage matrix deteriorates.
d. The deterioration leaves spicules of calcified cartilage.
e. Osteoblasts in the medullary cavity then ossify the cartilage
spicules, forming spongy bone.
f. The hyaline cartilage at the epiphyseal plate is eventually replaced
entirely by bone. Once completely replaced with bone, the
epiphyseal plate is now called the epiphyseal line. This typically
occurs in the person’s early twenties and as a result the person
stops growing in height.
B. Appositional Growth (width)
a. Osteoprogenitor cells beneath the periosteum differentiate into
osteoblasts and form new osteons on the external bone surface.
b. While bone is being added to the outer surface through appositional
growth, osteoclasts are removing and recycling lamellae at the
inner surface. As a result, the medullary cavity gradually enlarges
as the bone increases in diameter.

52
 c. Appositional growth is important in increasing the diameter of
existing bones but it does not form the original bone.

6.5 Fractures: Repair of cracked or broken bones:

A. Hematoma formation
1. Blood vessels in bone tear and hemorrhage occurs.
2. Over a period of several hours, a large blood clot, or hematoma,
develops.
B. Fibrocartilage callus formation
1. Capillaries grow into the hematoma and phagocytic cells invade the area.
2. Fibroblasts and osteoblasts migrate to the fracture.
3. Fibroblasts secrete collagen fibers and/or differentiate into chondroblasts
that secrete a cartilage matrix.
4. Osteoblasts form spongy bone.
5. The mass of repair tissue is referred to as a fibrocartilage callus.
6. An internal callus connects bone ends and an external callus protrudes
from the outer bone surface.
C. Bony callus formation
1. Osteoblasts and osteoclasts continue to migrate inward and multiply
rapidly in the fibrocartilaginous callus.
2. As the material calcifies, the tissue becomes a bony callus.
D. Fractures are classified on the basis of:
1. Whether the bone penetrates the skin.
a. Simple (closed) =bone breaks cleanly, but does not penetrate the
skin.
b. Compound (open) =broken ends of bone protrude through the
tissue and skin.
2. Orientation of the break.
a. Transverse=break occurs perpendicular to the long axis of a bone.
b. Linear=breaks parallel to the long axis of the bone.
3. Position of the bone ends after the fracture.
a. Non-displaced=the bone ends retain their position.
b. Displaced=the bone end are out of normal alignment.
E. Types of Fractures
1. Comminuted = bone fragments into many pieces.
2. Compression = bone is crushed from upward and downward forces
3. Depressed = broken bone is pressed inward (skull)
4. Spiral = raged break as a result of excessive twisting of the bone.
5. Epiphyseal = break occurring along the epiphyseal plate
6. Greenstick = bone breaks incompletely
7. Colle’s = distal part of the radius breaks
8. Pott’s = malleolus of tibia and fibula break
6.6 Exercise, Nutrition and Hormones and Bone Tissue
A. Exercise – lack of exercise and stress on bone can lead to loss of bone mass.
B. Nutrition

53
 1. Calcium and Vitamin D: Since the body cannot make calcium, it must be
obtained from the diet. However, calcium cannot be absorbed from the
small intestine without vitamin D. Therefore, intake of vitamin D is also
critical to bone health. Dairy as well as leafy vegetables are a source of
calcium.
2. Vitamin K also supports bone mineralization and may have a synergistic
role with vitamin D in the regulation of bone growth. Green leafy
vegetables are a good source of vitamin K.
C. Hormones:
1. Growth Hormone: synthesized in the pituitary controls bone growth in
multiple ways. It It triggers chondrocyte proliferation in epiphyseal plates,
resulting in the increasing length of long bones. GH also increases
calcium retention, which enhances mineralization, and stimulates
osteoblastic activity, which improves bone density.
2. Thyroxine: secreted by the thyroid gland promotes osteoblastic activity
and the synthesis of bone matrix.
3. Sex Hormones: Estrogen and Testosterone promote osteoblastic activity
and production of bone matrix, and in addition, are responsible for the
growth spurt that often occurs during adolescence. They also promote the
conversion of the epiphyseal plate to the epiphyseal line (i.e., cartilage to
its bony remnant), thus bringing an end to the longitudinal growth of
bones.
4. Calcitriol = the active form of vitamin D, is produced by the kidneys and
stimulates the absorption of calcium and phosphate from the digestive
tract.

6.7 Calcium Homeostasis: Interactions of the Skeletal System and Other Organ
Systems
A. Bone is constantly undergoing deposition and resorption in a process known as
remodeling.
B. Coordinated activity by osteoblasts and osteoclasts regulates both processes.
1. Bone deposition occurs where bone is injured or added bone strength is
needed and is accomplished by osteoblasts. Bands of new matrix
deposited in the area are referred to as an osteoid seam.
2. Bone reabsorption is accomplished by osteoclasts. Osteoclasts secrete
lysosomal enzymes that digest the organic matrix and then secrete
metabolic acids that convert calcium salts into soluble forms.
C. Remodeling is under negative feedback hormonal control.
1. Changes in the levels of blood calcium will trigger the release of either
parathyroid hormone (PTH) or calcitonin.
2. When blood calcium levels are too low: the parathyroid gland secretes
parathyroid hormone, or PTH. PTH has three effects all leading to a
drop in blood calcium levels:

54
 a. Bone response = stimulates osteoclasts so they accelerate the
erosion of bone matrix which leads to the release of stored calcium
ions into the blood.
b. Intestinal response = PTH enhances the calcium-absorbing effects
of calcitriol on the intestine. As a result the rate of intestinal
calcium absorption increases.
c. Kidney response = PTH increases the production of the hormone
calcitriol, which is continuously secreted by the kidneys at low
levels. This hormone in turn stimulates calcium reabsorption at the
kidney tubules.
3. When blood calcium levels are too high: the C cells of the thyroid gland
secrete calcitonin. Calcitonin has three effects all leading to a drop in
blood calcium levels:
a. Bone response = calcitonin inhibits osteoclasts but does not affect
osteoblasts so that they continue to deposit calcium ions into the
matrix of bone.
b. Intestinal response = calcitonin decreases the rate of calcium
absorption from foods in the digestive tract.
c. Kidney response = calcitonin inhibits the absorption of calcium in
urine so that more calcium is excreted from the body.
D. By providing a calcium reserve, the skeleton plays the primary role in the
homeostatic maintenance of normal calcium ion concentration of body fluids.
The skeleton is also important in the homeostatic balance of other ions as well.

6.8 Bone Disorders

A. Pituitary growth failure = or dwarfism, results from inadequate production of
growth hormone which leads to reduced epiphyseal cartilage activity and
abnormally short bones. Rare in the United States because children can be
treated with synthetic growth hormone.
B. Achondroplasia = results from abnormal hyaline cartilage development.
Because hyaline cartilage forms the model for long bone formation, the individual
will have short, stocky limbs but the torso and head are of normal size.
C. Marfan syndrome = very tall with long, slender limbs due to excessive cartilage
formation at the epiphyseal plates. Other defects in the structure of connective
tissues commonly cause life-threatening cardiovascular problems.
D. Gigantism = results from an overproduction of growth hormone before puberty.
Puberty is often delayed. The most common cause is a pituitary tumor which
may be treated by surgery, radiation, or drugs that suppress the release of
growth hormone.
E. Acromegaly = result from too much growth hormone after the epiphyseal plates
close so that the bones do not grow longer but instead get thicker (especially the
bones of the face, hands, and jaw). This leads to changes in their physical
appearance.
F. Fibrodysplasia ossificans progressiva (FOP) = a rare gene mutation that
causes the deposition of bone around skeletal muscles and the normally soft

55
 tissues of the body. There is no effective treatment for this painful and
debilitating condition, and patients seldom survive into their 40’s.
G. Paget’s Disease = overactive osteoclasts cause pores and weakening of the
long bones leading to bending/bowing. Osteoblasts try to compensate for the
overactive osteoclasts, but the bone laid down is weak and brittle and prone to
fractures.

Chapter 7
I. Division of the skeletal system
1. Function of the skeleton:
2. How is movement produced?
3. ____________ are found in an average adult human body.
4. What is the function of the lower skeleton?
5. What is the function of the upper skeleton?
B. Axial skeleton
1. Includes skull, __________________________ and _______________.
a) There are ________ bones in the axial skeleton.
2. The only bone not connected to another bone in the body is the
____________.
3. The middle ear consists of ________ _____________.
4. The skull consist of ________ bones
5. The vertebral column contains ______________ vertebra, including the
__________ and the _____________.
6. The thoracic cage consists of the _____________, and the sternum.
C. Appendicular skeleton

56
 1. ____________ bones make up the appendicular skeleton.

II. The skull=____________

A. Two major divisions:
1. Facial bones
2. Brain case or cranial vault
B. The only mobile bone of the skull is the _______________.
C. Anterior view of the skull
1. Eyeballs are contained in the __________ of the skull.
2. The nasal cavity is divided by the __________ _________. The cavity
contains the ___________ ___________ of the ethmoid bone and the
lower _________. Inside the nasal cavity two sets of bony projections
appear on the lateral wall; the largest set are the _____________
_______________ and the set above those are the __________
___________.

57
D. Lateral view of the skull
1. The zygomatic arch consist of two bones, _______________ or the
apple of the cheek and ____________ and two processes
_________________________________ and
_______________________________.
2. The mandible articulates and connects to the skull via the ____________
fossa and the _______________ fossa of the skull. This allows for
chewing to occur.

58
3. Skull cap= _____________
4. The plates of the skull consist of:
a) ___________ plate which is a pair of bones on the upper lateral
side of the skull
b) ____________ plate which is paired and either side of the skull.
The plates were named because of thie graying of the hair in this
area occurs first.
(1) The ___________ ___________ can be felt on the side of
the head just behind the earlobe.
c) _____________ bone which is a single bone located anterior and
contains the forehead.
(1) The slight depression between eyebrows is the
________________.
d) _____________ bone is also a single bone in the posterior skull.
The area that forms the nape of the neck is actually the ________
___________ ________. The brainstem becomes the spinal cord
once it passes through the _____________ magnum.

59
60
 e) The sutures connecting all plates are :
E. The __________ bone contains the __________ ___________ or the home for
the pituitary gland in the _____________ fossa, when the brain is in the skull.
F. 30% of injury related deaths related to _____________ injuries. Which ages are
most likely affected?
1. What are some causes of traumatic brain injury?
2. The upper lip or upper jaw = ____________ bone
G. The ________ bone is a pair of bones that contain the ____________ plate or
the roof of the mouth.
H. Cleft lip and palate
1. What is the difference between the cleft lip versus the cleft palate?
2. How often can each occur?
I. The ________ sinuses occupy air-filled spaces that can contain ________
mucosa.

III. The vertebral column

A. Vertebra are connected via _______________ _________, which is made of
______________ connective tissue.

61
 1. The vertebral column is broken down into 3 major categories:
a) Cervical
(1) C1 or ______ articulates with the skull
(2) C2 or ______ articulates superiorly with C1
b) ____________
c) ____________
2. The number of vertebrae in each category corresponds with times of
meals
a) Cervical vertebra number ______
b) _________ vertebra number _____
c) _________ vertebra number _____
3. The sacrum contains __________ of fused vertebrae, while the coccyx
contains ______.
4. Which two regions of the vertebral column retain the fetal curvature?
5. What disorders can occur due to improper curvature of the vertebral
column?
B. Structure of a vertebra
1. The large opening between the vertebral arch and body ________
_________, which will contain the spinal cord.
2. In contrast, the spinal nerves travel through the _____________ foramen
when the vertebrae are aligned together.
3. What you feel when you run your fingers down the middle of someone's
back is the _________ process of the vertebrae.
4. Vertebrae articulate with each other via ______________ and
______________ articular processes.
5. _____________ processes are paired and project laterally from each
vertebrae. However, only cervical vertebrae have transverse _________.

62
 6. Vertebrae that have a “giraffe” appearance due to the elongated
downward facing _________ process are ________________. There are
______ of these in an adult human.

7. These vertebrae have a “moose” appearance due to shorter spinous

processes and ___________ centrum or body. These are __________
vertebrae.

8. The _______ or tailbone is derived from the fusion of ___________

vertebrae during development.

C. What is the major job of a chiropractor?

1. Why do chiropractors use a drug-free approach to healing?

63
IV. Thoracic cage
A. What is the major function of the thoracic cage?
B. The ___________ is broken down into 3 major parts. The __________ which is
wider and the superior portion. The central portion or __________, which
receives the most force during chest compression while administering CPR.
Finally, the __________ process, which is easily broken if CPR is not
administered correctly.
C. The rib cage consists of ____________ ribs.
1. ____________ pairs of true ribs
2. ____________ pairs of false ribs, __________ pairs of which are floating
ribs
3. ___________ ribs are connected to the sternum via _____________
connective tissue.

V. Embryonic development of the axial skeleton

A. The brain and spinal cord are formed from a primitive structure during embryonic
development called the ___________.
1. The _________ tube is the first differentiation, which occurs during the
first six weeks of gestation.
2. What is the function of endochondral ossification?
B. Why is the brain case larger in infants?
C. What is the scientific term for the “soft spot”?
1. What type of tissue is located in this region?

64
Chapter 8
Divisions of the skeleton:

65
The skeleton can be divided into two basic parts; the axial skeleton and the appendicular
skeleton. The axial skeleton is the bones associated with the central portion of the body and
include the bones of the skull, thoracic (chest) cage, and the vertebral column. The
appendicular skeleton is made up of the bones associated with the limbs and includes the
pectoral girdle, the upper limbs, the pelvic girdle, and the lower limbs.

You are responsible for learning all the bones of the skeleton and all the markings listed on the
next several pages. 

APPENDICULAR SKELETON

8.1 Pectoral Girdle

1. Scapula  (right or left) - 2
a. Coracoid process
b. Acromion process
c. Spine
d. Supraspinous fossa
e. Infraspinous fossa
f. Glenoid fossa (cavity)
g. Subscapular fossa
h. Suprascapular notch
i. Vertebral (medial) border
j. Axillary (lateral) border
k. Inferior angle
l. Superior angle
2. Clavicle - 2
a. Acromial (lateral) end
b. Sternal (medial) end
8.2 Bones of upper limb
1. Humerus  (right or left) - 2
a. Head
b. Anatomical neck
c. Surgical neck
d. Greater tubercle
e. Lesser tubercles
f. Intertubercular groove
g. Deltoid tuberosity
h. Medial epicondyle
i. Lateral epicondyle
j. Trochlea
k. Capitulum
l. Olecranon fossa
m. coronoid fossa
2. Radius - 2
a. Head
b. Neck

66
 c. Shaft
d. Styloid process
e. Ulnar notch
f. Radial tuberosity
3. Ulna - 2
a. Olecranon process
b. Trochlear notch
c. Radial notch
d. Coronoid process
e. Head
f. Styloid process
4. Carpals (8 bones in each wrist)
5. Metacarpals (5 bones forming the palm of each hand)
6. Phalanges (14 bones forming the fingers of each hand)
a. Proximal phalanx
b. Middle phalanx (not present in the pollex)
c. Distal phalanx
8.3 Pelvic girdle (os coxae) - 2
1. Ilium
a. Iliac crest
b. Anterior superior iliac spine (ASIS)
c. Anterior inferior iliac spine (AIIS)
d. Posterior superior iliac spine (PSIS)
e. Posterior inferior iliac spine (PIIS)
f. Iliac fossa
g. Sacroiliac joint (only present in articulated skeleton)
h. Greater sciatic notch
2. Ischium
a. Ischial spine
b. Lesser sciatic notch
c. Ischial tuberosity
3. Pubis
a. Pubic rami
b. Pubic symphysis
c. Obturator foramen
4. Acetabulum (acetabular fossa) – hip socket
8.4 Bones of the lower limb
1. Femur (right or left) - 2
a. Head
b. Fovea capitis
c. Neck
d. Greater trochanter
e. Lesser trochanter
f. Gluteal tuberosity
g. Shaft
h. Linea aspera

67
 i. Medial epicondyle
j. Lateral epicondyle
k. Medial epicondyle
l. Lateral condyle
m. Intercondylar fossa
n. Patellar surface
2. Patella - 2
3. Tibia (right or left) - 2
a. Medial condyle
b. Lateral condyle
c. Intercondylar eminence
d. Tibial tuberosity
e. Shaft
f. Anterior border
g. Medial malleolus
4. Fibula - 2
a. Head
b. Shaft
c. Lateral malleolus
5. Tarsals (7 bones in each ankle)
a. Talus – bone of the ankle
b. Calcaneous bone of the heel
6. Metatarsals (5 bones forming the top of each foot)
7. Phalanges (14 bones forming the toes of each foot)
a. Proximal phalanx
b. Middle phalanx (not present in the hallux)
c. Distal phalanx
8.5 Development of the appendicular skeleton
A. Each upper and lower limb initially develops as a small bulge called a limb bud,
which appears on the lateral side of the early embryo. The upper limb bud appears
near the end of the fourth week of development, with the lower limb bud appearing
shortly after.
B. During the sixth week of development, the distal ends of the upper and lower limb
buds expand and flatten into a paddle shape. This region will become the hand or
foot.
C. All of the girdle and limb bones, except for the clavicle, develop by the process of
endochondral ossification.

68
Chapter 9
I. Classification of Joints
A. Bones connect to each other at articulations or _____________.
B. How are joints classified?
C. Structural classification of joints include
1. Fibrous joints:
2. Synovial joints:
3. Cartilaginous joints:
D. Functional classification includes
1. Synarthrosis:

2. Amphiarthrosis:

69
 3. diarthrosis:

II. Fibrous joints

A. Suture:
1. Location of joint:
2. Newborns and infants have wider areas between the bones containing
connective tissue called ______________.
a) How do they aid in delivery?
b) Fusion of bones or _______________.

70
 B. Syndesmosis:
1. Location of joint:
2. ___________ connect bone to bone.
3. Interosseous membrane:
C. Gomphosis:
1. Also known as ______________________________
2. Location of joint:
3. _____________ because they are immobile.

III. Cartilaginous joints

A. Synchondrosis:
1. Location of joint:
2. When would a synchondrosis joint be temporary or permanent?
a) Example of a temporary synchondrosis joint:
b) Example of a permanent synchondrosis joint:

B. Symphysis:
1. Location of joint:

71
 2. _____________ connects bones
IV. Synovial joint

A. Where would you find an articular capsule?

1. Function:
B. Each bone is covered by a thin layer of hyaline cartilage called the
____________ cartilage.
C. Lining each articular capsule is a _________ membrane which secrete
___________ _________.
D. Compare and contrast ligaments and tendons.
1. Extrinsic ligament:
2. Intrinsic ligament:
3. Intracapsular ligament:
E. Bursa:
1. Located between the skin and underlying bone, _______________ bursa.
a) Example:
2. Found between the muscle and underlying bone, ____________ bursa.
a) Example:
3. Found between a tendon and bone, ____________ bursa.
a) Example:
F. Inflammation of a bursa near a joint, ___________.
1. Symptoms:
2. Common areas of inflammation:
3. Treatment:
G. Types of synovial joints:

72
Joint type Location Description

Pivot

Hinge

Condyloid

Saddle

Plane

Ball and Socket

H. How is arthritis different from bursitis?

1. What bacterial or viral infections can lead to arthritis?
2. Which type of arthritis is most common?
3. Treatment for arthritis:
V. Types of body movement
A. Which joints aid in the body’s ability to achieve range of motion?
B. Compare and contrast flexion and extension.
C. ________ is excessive extension of a joint beyond its normal range of motion,
resulting in injury.

73
 D. Alternatively, ____________ excessive flexion at a joint.
E. Medial and lateral motions of limbs in the coronal plane is _________________
and ______________.
1. ___________ lateral movement of a limb away from the midline of the
body.
a) Give an example.
2. ___________ is movement of a limb toward the midline of the body.
a) Give an example.
F. Would hula hooping be an example of circumduction? Explain.
G. How is circumduction different from rotation?
1. Which joints are involved in rotation?
2. How is medial rotation different from lateral rotation?
H. Athletic shoe stores often help people find the best sneakers based on their
supination or pronation. Describe the foot and leg alignment of a person that
supinates versus pronates.
I. Pointing of the toes is an example of __________________.
J. ____________ is turning of the foot toward the midline.
K. ____________ is turning of the foot away from the midline of the body.
L. Slouching in a chair would be an example of which type of body movement?
M. Sitting erect with great posture in a chair would be an example
of____________________.
VI. Anatomy of selected synovial joints
A. Adjacent vertebrae articulate with each other at ________________ joints.
1. What types of joints are these?
B. When the cervical vertebrae articulates with the occipital condyles of the skull the
joint formed is the _____________________.
C. This allows for the movement of the head for nonverbal _________.
D. While the articulation of C1 and C2 vertebrae to allow nonverbal ________ is a
result of the ________________ joint.
E. _____________________ joint allows for the opening and closing of the mouth
via mandibular depression and mandibular elevation.
1. This joint is formed by the articulation of which bones and parts of the
bones?
2. What causes the dislocation of this joint?
3. Which demographic is mostly affected by disease associated with this
joint?
4. How is this treated?

74
F. Another name for the shoulder joint is the ________________.
G. Describe the rotator cuff. What causes injury to the rotator cuff?
1. Another name for a frozen shoulder is a ______________________.
a) What causes this to occur?

H. The uniaxial hinge joint that makes up the elbow is the _______________ joint.
1. Which bones and parts articulate to form this joint?
2. How is hyperextension prevented at the elbow joint?
3. The ____________ ligament is on the medial side of the joint, while the
______________ ligament supports the lateral side of the joint.
4. The _____________ ligaments encircle the radius head.

75
 I. The hip joint is a ____________ ball-and-socket joint between the _________
and ________.
1. The socket portion of the hip joint is the __________.
2. When in the upright standing position which ligaments pull the head of the
femur deeply into the acetabulum?
3. Why is the hip prone to osteoarthritis?
J. The largest joint in the body is the _______________.
1. Why is this joint so large?
2. The patella serves to protect the _____________ from friction against the
________________.
3. Describe the dynamic ligament.
4. When a patient has a torn meniscus, what does this mean? How is it
treated?
a) How does this affect their ability to walk?
5. When would a person need a knee replacement?
K. The ankle is formed by the ____________ joint.
1. What occurs during an ankle sprain?
2. How is it treated?
3. How does this affect mobility?

VII. Development of joints

A. When are joints formed?
1. How?
B. Where do synovial joints form?

76
Chapter 10
I. Muscle tissue
A. All three types of muscle tissue exhibit ___________, which means
______________________________________________________.
B. When a muscle contracts, the muscle fibers ____________.
1. This occurs when _________ protein pulls on __________ protein.
2. What happens to expose the actin binding sites?
3. As a person ages what happens to the muscle elasticity?
C. Which two types of muscle have striations?
1. How are they morphologically different?
D. Why is smooth muscle not striated?
1. Does this affect its contractibility?
II. Skeletal muscle
A. What is the function of skeletal muscle?
B. How is heat generated by the skeletal muscle?
C. Skeletal muscle consists of three connective tissue layers or ________.
1. List the three layers and their functions
a) _____________ is the outermost layer of connective tissue
around the muscle.
(1) It consists of ___________ connective tissue which allows
muscle contraction and movement while maintaining
structural integrity.
b) The middle layer of connective tissue or ____________.
(1) This layers helps to organize bundles of muscle into
____________.
c) Each muscle fiber is encased in a thin layer of ____________ and
__________ fibers in the ____________ layer of connective
tissue.

77
D. Explain how tendons and skeletal muscle works to pull on the bone.
1. Tendon-like sheets or ______________ connective tissue between skin
and bones.
E. Skeletal muscle fibers can have a diameter of up to ______ and a length of up to
________ in the upper leg.
1. Define
a) Sacrcolemma:
b) Sarcoplasm:
c) Sarcoplasmic reticulum:
d) Sarcomere:
e) Tropomyosin:
f) Troponin:
g) myofibril:

78
 2. The thin filament of a sarcomere is the __________.
3. The thick filament of a sarcomere is the ___________.
4. The _________________ junction is where the neuron terminal meets
the muscle fiber.
5. Describe a membrane potential.
a) What causes the electrical charge of the cell?
b) Which cations are more prevalent inside of the cell at resting?
c) Which cations are more prevalent inside of the cell during
depolarization?
d) Describe an action potential generation and the different parts of
the wave.
e) ___________-____________ coupling is used to explain the idea
that skeletal muscle contraction is relied upon ____________ or
stimulation.
(1) Release of ______ ions from the sarcoplasmic reticulum
allows interaction with shielding proteins causing the actin-
binding sites to become exposed for myosin binding.
(2) What is the motor end-plate?
(a) Where is it located?
f) At the neuromuscular junction, which neurotransmitter is released
from the neurons?
(1) What is the function of the neuron?

III. Muscle fiber contraction and relaxation

A. What is the first step of muscle contraction?

79
 B. This will lead to the depolarization of muscle membranes once
_________________________.
C. Next, ___________ ions are released from the ____________________.
1. This causes the initial ______________.
D. Calcium then binds to ____________ once the myosin binding site is exposed by
the morphological change of ________________.
E. ________ binds to actin when ATP is available, pulling on actin and shortening
the _____________.

F. When does muscle contraction stop?

G. How are cross bridge formation and the sliding filament model different?

H. How does creatine phosphate aid in muscle contraction?

I. What is the role of potassium in muscle contraction?

J. Define oxygen debt:
K. Muscular dystrophy:
1. What is the function of dystrophin in muscle contraction?
2. Duchenne muscular dystrophy mostly affects males, why?
3. Why would the use of myoblast be thought to aid in treatment of this
disease?
a) Why has this treatment not worked?

IV. Nervous system control of muscle tension

A. Muscle tension:
1. ______________ contractions is when the tension in the muscle stays
constant and a load is moved as the muscle length changes.
a) _____________ contraction involves the shortening of muscle to
move a load.
(1) Example:
b) _____________ contraction occurs as tension diminishes and
muscle lengthens.
(1) Example:
2. _______________ contraction is when tension is produced without
changing the angle of the skeletal joint.
a) Why will this contraction result in no movement of a load?
(1) Example:

80
B. Motor unit:

1. A _________ motor unit allows for very fine motor control of muscle
because a single motor neuron supplies a small number of muscle fibers
in a muscle.
a) Example:
2. A __________ motor unit allows for gross movement because a single
motor neuron supplies a large number of muscle fibers in a muscle.
a) Example:

81
 3. Which of the motor units is most excitable?
4. How are motor units employed to lift a piano buy two men up to the third
floor of a building?
C. Describe the length-tension relationship.
1. What is the ideal length of a sarcomere to produce maximal tension?
D. Twitch:
E. Treppe:

F. Muscle tone:
G. Hypotonia:
H. Hypertonia:
V. Types of muscle fibers
A. What two criteria are important for classifying muscle fibers?
B. The three main types of skeletal muscle fibers are:
1. Slow oxidative fibers which ________________________________.
2. Fast oxidative fibers which __________________________________.
3. Fast glycolytic fibers which ___________________________________.
C. Contraction speed is dependent on the _________ATPase hydrolysis of ATP.
D. Primary metabolic pathway used by a muscle fiber determines if the fiber is
____________ or ___________.
1. Compare and contrast the two types of pathways.
E. Slow oxidative fibers are able to function for long periods of time with fatigue.
How does this aid doctors during long surgeries?
F. Fast glycolytic fibers contain high amounts of ____________ which allows for the
production of ATP via _____________. These fibers produce high levels of
__________.
1. Are these muscle fibers slow or fast to fatigue? Explain.
G. What type(s) of fiber(s) would you expect to find in the lower back of someone
working from home during quarantine?

VI. Exercise and muscle performance

A. When bodybuilders begin their weight lifting journey, are they making new
muscle cells? Explain.
1. Hypertrophy:
2. Atrophy:
B. Compare and contrast slow twitch muscle and fast twitch muscle.
C. Explain a time when a distance runner would utilize fast twitch?

82
 D. Performance enhancing drugs are used to
___________________________________________________.
1. _____________ steroids are used to boost muscle mass and power
output. These steroids are forms of ______________.
2. Are performance enhancing drugs legal?
E. Describe how muscle tissue is affected by aging?
F. How would muscle tissue be affected in persons that are quadriplegic?
VII. Cardiac muscle tissue
A. Contraction of cardiac muscle allows pumping of __________ into the vessels of
the __________ system.
B. Unlike skeletal muscle fibers, cardiac muscle contains many ________________
and __________ for ATP production.
C. Cardiac muscle contracts in waves to allow the heart to pump via
____________________.
1. Two important structures important for muscle contraction are
_____________ and ___________________.
2. Explain how each will aid in muscle contraction.

D. Describe the role of the pacemaker in muscle contraction.

1. Define functional syncytium:
E. Why are longer action potentials important for cardiac muscle?
VIII. Smooth muscle
A. Location:
B. How does smooth muscle aid in the eye?
C. Smooth muscle fibers are football shaped with ______ nucleus, ranging from
__________________ in length.
D. Will you find sarcomeres in smooth muscle? Why or why not?
E. ____________ body is analogous to the Z-discs of skeletal and cardiac muscle
and fastened to the ______________.
F. Define calveoli:
G. Smooth muscle cells contain ___________ instead of the troponin-tropomyosin
complex.
H. Calcium ions pass through the opened calcium channels in the ____________,
and additional calcium is released from the _________, binds to __________.
I. Myosin kinase is then activated by the ____________________ complex; this
will then activate the _______________.
1. The myosin head is then _____________ which causes the activation of
ATP by converting _______________________.
2. The _______ filaments are anchored to the ________; the structures
invested in the inner membrane of the __________ at _________
junctions, have cord-like intermediate filaments attached to them.
3. What happens when the thin filaments slide past the thick filaments?

83
 J. When does muscle contraction stop?
K. Describe the latch-bridge and smooth muscle contraction.
L. The division of smooth muscle to produce more cells is ______________.
IX. Development and regeneration of muscle tissue
A. Which embryonic tissue will muscle arise from?
1. Skeletal muscle of head and limbs develop from?
2. Other skeletal muscles arise from ________________.
3. Define myoblast:
a) Myotube is made from the fusion of several different myoblast
cells leading to the _____________.
B. Unlike the skeletal muscle, _________ junctions develop in cardiac and single-
unit smooth muscle during early development.
C. ACh receptors are initially present along most of the surface of the ___________.
1. Spinal nerve innervation causes the release of growth factors that
stimulate the formation of ______________.
D. How are satellite cells and myoblast different?
E. Stem cells for smooth muscle cells are ___________.
1. Why are smooth muscle cells able to regenerate more readily than
cardiac and skeletal muscle?
F. What happens when a muscle cell dies?
G. __________ work with patients to maintain muscles and target muscles
susceptible to ____________.
1. How can they help prevent atrophy?
2. How can physical therapy aid patients that have been in a coma for some
time?

84
Chapter 11

11.1 Interactions of Skeletal Muscles, Their Fascicle Arrangement, and Their Lever

Systems
A. The skeletal muscles of the muscular system account for almost half of the
weight of our bodies.
1. The human body contains approximately 700 skeletal muscles that differ
widely in size, shape, and function.
2. Although the individual skeletal muscle fibers contract the same way and
to the same degree, the performance of a skeletal muscle varies
depending on the way the muscle fibers are organized and how the
muscles attach to the skeleton.
B. All muscles have at least two points of attachment:
a. Origin = the fixed attachment point
b. Insertion = the moveable attachment point
c. The origin is typically proximal to the insertion when the body is in
anatomical position.
C. When complex movements occur, muscles commonly work in groups rather than
individually. Their cooperation improves the efficiency of a particular movement.
For example, large muscles of the limbs produce flexion or extension over an
extended range of motion.
a. Agonist=a muscle that provides the major force for producing a specific
movement.  Also known as the “prime mover”.
b. Antagonist=muscles that oppose, or reverse, a particular movement.
c. Synergists=muscles that help prime movers by: Adding a little extra force
to the same movement or undesirable or unnecessary movements that
might occur as the prime movers contract.
d. Fixators=when synergists immobilize a bone, or a muscle’s origin.
D. Fascicle Organization
1. Circular = also called a sphincter muscle; when the fascicles are arranged
in concentric rings (example:  orbicularis oris)
2. Convergent=when the muscle has a broad origin and the fascicles
converge toward a single tendon or insertion (example:  pectoralis major)
3. Parallel=the long axes of the fascicles run parallel to the long axis of the
muscle.  Strap-like muscles (example:  sartorius and biceps brachii)
4. Pennate=the fascicles are short and they attach obliquely to a central
tendon that runs the length of the muscle.
a. Unipennate=the fascicles insert into only one side of the tendon
(example:  extensor digitorum longus)
b. Bipennate=fascicles insert into the tendon from opposite sides so
that the muscle’s “grain” resembles a feather (example:  rectus
femoris)

85
 c. Multipennate=arrangement looks like many feathers situated side
by side (example:  deltoid)
E. Muscle Mechanics: Lever Systems
1. The operation of most skeletal muscles involves the use of leverage
and a lever system.
2. A lever is a rigid bar – such as a board, a crowbar, or a bone – that
moves on a fixed point, or fulcrum, when a force is applied to it. The
applied force, or effort, is used to move a resistance, or load.
3. In the human body, joints are the fulcrums, your bones act as levers,
and your muscle provide the effort.
4. Levers can operate in one of two ways:
a. Mechanical advantage: the load is close to the fulcrum and
the effort is applied far from the fulcrum. This situation
requires minimal effort to move a large load and is therefore
designed for power. Power lever
b. Mechanical disadvantage: the load is far from the fulcrum
and the effort is applied near the fulcrum. This situation
requires the force to be greater than the load to be moved but
although it cannot move a large load, it can move loads farther
and faster. Speed lever
5. Depending on the relative positions of the three elements (effort,
fulcrum, and load), a lever belongs to one of three classes:
a. First-class lever = the fulcrum (F) lies between the applied
force (AF) and the load (L). An example: scissors or the
capitis muscles.
b. Second-class lever = the load (L) lies between the applied
force (AF) and the fulcrum (F). An example: wheelbarrow or
the gastrocnemius.
c. Third-class lever = the most common of levers in the body,
the applied force (AF) is located between the load (L) and the
fulcrum (F). An example: tweezers and biceps brachii.

11.2 Muscle Names

A. Common terms are used in the names of muscles (see the table on page 430)
1. Terms indicating specific regions of the body
a. Abdominis (abdomen)
b. Brachialis (brachium)
c. Capitis (head)
d. Carpi (wrist)
e. Cervicis (neck)
f. Cleido- or clavius (clavicle)
g. Coccygeus (coccyx)
h. Costalis (rib)
i. Femoris (femur)
j. Glosso- or glossal (tongue)
k. Hallucis (great toe)

86
 l. Ilio- (ilium)
m. Inguinal (groin)
n. Nasalis (nose)
o. Oculo (eye)
p. Oris (mouth)
q. Palpebrae (eyelid)
r. Pollicis (thumb)
s. Popliteus (back of knee)
t. Psoas (loin)
u. Radialis (radius)
v. Scapularis (scapula)
w. Temporalis (temporal)
x. Tibialis (tibia)
y. Ulnaris (ulna)
z. Uro- (urinary)
2. Terms indicating position, direction, or fascicle organization
a. Anterior (front)
b. Externus (superficial)
c. Extrinsic (outside)
d. Inferioris (inferior)
e. Internus (deep, internal)
f. Lateralis (side)
g. Mediallis and medius (in the middle).
h. Oblique (diagonal)
i. Posterior (back)
j. Profundus (neck)
k. Rectus (straight or paralleled)
l. Superficialis (superficial)
m. Superiorus (superior)
n. Transversus (transverse)
3. Terms indicating structural characteristics
a. Number of origins
i. Biceps (two origins)
ii. Triceps (three origins)
iii. Quadriceps (four origins)
b. Shape
i. Deltoid (triangle)
ii. Orbicularis (circle)
iii. Pectinate (comblike)
iv. Platy (flat)
v. Rhomboid (rhombus)
vi. Serratus (serrated)
vii. Spleinus (bandage)
viii. Teres (long and round)
ix. Trapezius (trapezoid)
c. Other striking features

87
 i. Alba (white)
ii. Brevis (short)
iii. Gracilis (slender)
iv. Lata (wide)
v. Latissimus (widest)
vi. Longissimus (longest)
vii. Longus (long)
viii. Magnus (large)
ix. Major (larger)
x. Maximus (largest)
xi. Minimus (smallest)
xii. Minor (smaller)
xiii. Vastus (great)
4. Terms indicating actions
a. General
i. Abductor
ii. Adductor
iii. Depressor
iv. Extensor
v. Flexor
vi. Levator
vii. Pronator
viii. Rotator
ix. Supinator
x. Tensor
b. Specific
i. Buccinator (trumpeter)
ii. Risorius (laughter)
iii. Sartorius (like a tailor)

11.3 Muscles of facial expression

A. Frontalis: wrinkle skin of forehead, raise eyebrows
B. Orbicularis oculi: close eyelids
C. Orbicularis oris: close and purse lips
D. Risorius: pulls corners of lips laterally, grimace
E. Zygomaticus major and zygomaticus minor: pulls corners of lips up, smile
F. Buccinator: tone in cheek, sucking, whistling
G. Levator palpebrae: opens the eye
H. Platysma: depresses mandible, corners of lips down (not visible on any model in
Cartersville)
Muscles of mastication
A. Masseter: strongly elevate mandible, close jaws
B. Temporalis: strongly elevate mandible, close jaws
Muscles moving the head and spine
A. Sternocleidomastoid: together, flex forward; singly, tilt and rotate
B. Sternohyoid: depresses larynx and hyoid bone

88
 C. Occipitalis: moves the scalp posteriorly
D. Splenius capitis: turn the head side to side to say “no”
E. Erector spinae: extends the vertebral column
Extrinsic muscles of the eye: move the eyeball
A. Superior rectus: eyeball up
B. Medial rectus: eyeball medial
C. Inferior rectus: eyeball down
D. Lateral rectus: eyeball lateral
E. Superior oblique: eyeball downward and outward rotation
F. Inferior oblique: eyeball upward and outward rotation
Muscles of the abdominal wall
A. External abdominal oblique
B. Internal abdominal oblique
C. Transversus abdominis
D. Rectus abdominis
E. Linea Alba
Muscles for breathing
A. Diaphragm: pushes abdominal contents down (inspiration)
B. External intercostal muscles: raise and spread ribs (inspiration)
C. Internal intercostal muscles: forced expiration only
Muscles of the pelvic floor
A. Coccygeus group: tone supports pelvic organs
B. Levator ani: controls bowel elimination
C. External anal sphincter: controls bowel elimination

Muscles acting on the scapula

A. Trapezius: upper portion elevates; lower, depresses
B. Serratus anterior: rotates
C. Pectoralis minor: pulls anteriorly
D. Levator scapulae: elevates
E. Rhomboideus major: elevate and adduct
F. Rhomboideus minor: elevate and adduct
Muscles acting on the humerus (at shoulder joint)
A. Pectoralis major: flexes, adducts, and medially rotates
B. Latissimus dorsi: extends, adducts, and medially rotates
C. Deltoid: abducts
D. Supraspinatus: abducts
E. Infraspinatus: laterally rotates
F. Subscapularis: medially rotates
G. Teres major: extends, adducts, and medially rotates
H. Teres minor: laterally rotates
I. Coracobrachialis: flexes and adducts
Muscles acting on the forearm (at elbow joint)
A. Brachialis: flexes
B. Brachioradialis: flexes
C. Biceps brachii: flexes and supinates

89
 D. Triceps brachii: extends
E. Supinator: supinates forearm
F. Pronator teres: pronates forearm
Muscles acting at the wrist joint
A. Flexor carpi radialis: flexes and abducts hand at wrist
B. Flexor carpi ulnaris: flexes and adducts hand at wrist
C. Extensor carpi radialis: extends, abducts hand at wrist
D. Extensor carpi ulnaris: extends and adducts hand at wrist
E. Palmaris longus: flexes wrist
Muscles acting on the fingers
A. Flexor digitorum superficialis: flexes fingers
B. Flexor digitorum profundus: flexes fingers
C. Extensors digitorum: extends fingers
D. Interosseous: intrinsic, abduct fingers at metacarpo-phalangeal joint
E. Lumbricals: intrinsic, adduct fingers at metacarpo-phalangeal joint
Muscles acting on the femur at the hip joint
A. Iliacusandpsoas major:flexes
B. Iliopsoas: formed from the merger of the iliacus and psoas major
C. Gluteus maximus: extend, lateral rotation
D. Gluteus medius: abduct, medial rotation
E. Gluteus minimus: abduct, lateral rotation (not visible on any model in
Cartersville)
F. Adductor longus and adductor magnus: adduct and flexes
G. Pectineus: adducts, flexes, and medially rotates thigh
H. Tensor fasciae latae: abducts, and medially rotates thigh, steadies trunk
Long muscles of the thigh, cross two joints
A. Gracilis: flexes knee and adducts femur
B. Sartorius: flexes knee and femur, laterally rotates femur

Muscles acting on the leg at knee joint

A. Quadriceps femoris: extends leg at knee
1. Rectus femoris
2. Vastus lateralis
3. Vastus intermedius
4. Vastus medialis
B. "Hamstrings": flex leg and extend thigh (cross two joints)
1. Semitendinosus (medial and superficial)
2. Semimembranosus (medial and deep)
3. Biceps femoris (lateral)
Muscles acting on foot at ankle joint
A. Gastrocnemius: plantar flexes foot
B. Soleus: plantar flexes foot
C. Tibialis anterior: dorsiflexes foot
D. Tibialis posterior: inverts foot
E. Fibularis longus: everts foot
F. Fibularis brevis: everts foot

90
 G. Extensor digitorum longus: prime mover of toe extension and dorsiflexes the
foot
H. Flexor digitorum longus: plantar flexes and inverts foot, flexes the toes and
helps foot grip the
group

Chapter 12
1. Anatomical Division of the Nervous System
a. Central Nervous System has two parts:
i. Brain- Define these terms:
1. Neurons
2. Glial cells
3. Soma
4. Axon
5. Dendrite
6. Gray matter
7. White matter
ii. Spinal cord- Define these terms:
1. Ganglion vs. nucleus
2. Tract
b. Peripheral Nervous System
i. Nerves that have left the spinal cord
1. Define Afferent neurons
2. Define Efferent neurons
2. Functional Divisions of the Nervous System
a. Sensation, Response, and Integration
i. Sensory functions
ii. Motor functions
iii. Integration
b. Somatic Nervous System
i. Conscious Perception
ii. Voluntary response of muscles
iii. Reflexes
c. Autonomic Nervous System: What is the role of the ANS?
i. Smooth and Cardiac muscle

91
 ii. Glands
iii. Enteric Nervous System
1. Smooth muscle and glands of digestive tract
3. Nervous Tissue
a. Define these terms
i. Synapse
ii. Axon hillock
iii. Node of Ranvier
iv. Axon terminal
v. Synaptic end bulb

Label the
Diagram

Label the
Diagram

4. Types of Neurons, according to axon shape

a. Unipolar
b. Bipolar
c. Multipolar

92
 Label the
Diagram

5. Types of Neurons, according to function

a. Glial cells
i. Astrocyte
1. Blood Brain Barrier (BBB)
ii. Oligodendrocyte: Myelin in CNS
iii. Microglia
iv. Ependymal cell
1. Cerebrospinal fluid (CFS)
2. Ventricle
3. Choroid plexus
v. Glial cells of PNS
1. Satellite cell
2. Schwann cell: Myelin in PNS
6. Function of Nervous System
a. Thermoreceptor
b. Graded Potential
c. Threshold
d. Action Potential
e. Neurotransmitter
f. Thalamus
g. Cerebral cortex
h. Upper Motor Neuron
i. Precentral Gyrus of the Frontal Cortex
j. Lower Motor Neuron
7. Cell Membranes
a. Non-specific channel
b. Gated channel
i. Ligand-gated channel
ii. Ionotropic receptor
iii. Mechanically gated channel
iv. Voltage-gated channel
v. Leakage channel
8. Membrane Potential

93
 a. Resting Membrane Potential
b. Action Potential
i. Define: Depolarization
ii. Define: Repolarization
c. Activation Gate
d. Inactivation Gate
e. Refractory Period
i. Define: Absolute refractory period
ii. Define: Relative refractory period
f. Propagation of the Action Potential
g. What is the difference between Continuous vs. Saltatory Conduction?
9. Communication Between Neurons
a. Graded potentials
b. Excitatory Postsynaptic Potential (EPSP)
c. Inhibitory Postsynaptic Potential (IPSP)
d. Summation
10. Neurotransmitter Systems
a. Cholinergic system
b. Nicotinic receptor
c. Muscarinic receptor
11. What receptors do these use: Glutamate, Glycine, and GABA
12. Metabotropic receptor
a. Define: G protein
13. Disorders of the Nervous System
a. What are some features of Alzheimer’s and Parkinson’s diseases?

Check your understanding:

1. The _____________ is the glial cell that forms the BBB.
2. The _____________ is the glial cell that forms the myelin in the PNS.
3. The _____________ is the glial cell that forms the myelin in the CNS.
4. The _____________ is the glial cell that forms CSF.
5. The parts of the neuron that receives impulses are the ________________
6. The action potential originates at the _________________ and travels down the
___________ of the neuron, until it reaches the _______________________, which
contains vesicles filled with _________________, which are then released.
7. The space where two neurons communicate is the ___________________
8. Which neuron makes skeletal muscles contract: Upper Motor Neuron or Lower Motor
Neuron?
9. If a channel excludes certain ions, but allows others to pass, what kind of channel is it?
10. What type of channel opens because a signaling molecule binds to it?
11. What type of channel responds to changes in the electrical properties of the membrane?
12. What type of channel is shown in the below diagram as a “pore”?

94
 13. What is an action potential?
14. What is the difference between Saltatory conduction and continuous conduction?
15. What are the two types of receptors that acetylcholine can bind to?
16. Which one uses a G protein: ionotropic or metabotropic receptors?

Chapter 13
14. Embryological Development
a. The Neural Tube
i. Endoderm develops into _____________
ii. Mesoderm develops into _____________
iii. Ectoderm develops into _____________
1. Neural plate
2. Neural groove
3. Neural fold
4. Neural tube
Label the
5. Neural crest Diagram

95
 b. Primary and Secondary Vesicles
i. Prosencephalon develops into _____________
1. Telencephalon develops into _____________
2. Diencephalon develops into _____________
ii. Mesencephalon develops into _____________
iii. Rhombencephalon develops into _____________
1. Metencephalon develops into _____________
2. Myelencephalon develops into _____________
c. Spinal Cord
15. The Central Nervous System
a. Cerebrum
i. Cerebral cortex
ii. Longitudinal fissure
iii. Cerebral hemisphere
iv. Corpus callosum: What is its function?
v. Basal nuclei: What is its function?
vi. Basal forebrain: What is its function?
vii. Limbic system: What is its function?
viii. Gyrus and sulcus
1. Lateral sulcus: Divides which lobe does it separate?
2. Central sulcus: Divides which lobes?
3. Parieto-occipital sulcus
ix. Brodmann’s areas 41 and 42
x. Precentral gyrus
xi. Broca’s area
xii. Prefrontal lobe
xiii. Subcortical structures
1. Hippocampus
2. Amygdala
3. Basal nuclei
4. Substantia nigra: releases which neurotransmitter?
b. Diencephalon
i. Thalamus: What is its function?
ii. Hypothalamus: What is its function?
c. Brain Stem
i. Midbrain: What is its function?
ii. Pons: What is its function?
iii. Medulla: What is its function?
d. Cerebellum: What is its function?
e. Spinal Cord
i. Anterior median fissure
ii. Posterior median sulcus
iii. Dorsal nerve root

96
iv. Ventral nerve root
v. Gray horns
1. Posterior horn
2. Anterior horn
3. Lateral horn
vi. White columns
1. Ascending tracts
2. Descending tracts
3. Posterior columns
4. Anterior columns
5. Lateral columns

Label the
Diagrams

97
16. Circulation and the CNS
a. Arterial supply
i. Common carotid arteries
1. External carotid: supplies what area?
a. Orthostatic reflex
2. Internal carotid
3. Vertebral arteries
4. Basilar artery
5. Circle of Willis: What is its purpose?
b. Venous Return
i. Superior sagittal sinus
ii. Occipital sinuses
iii. Straight sinus
iv. Transverse sinuses
v. Sigmoid sinuses
vi. Jugular vein
c. Protective Coverings
i. Dura mater: Describe
ii. Arachnoid mater: Describe
1. Subarachnoid space: What is it filled with?
2. Arachnoid granulations: What is its function?
iii. Pia mater: Describe
d. Ventricular System
i. Central canal
ii. Lateral ventricles
iii. Third ventricle
iv. Fourth ventricle
v. Cerebral aqueduct
vi. Choroid plexus

98
 vii. Cerebral Spinal Fluid (CSF)
17. The Peripheral Nervous System
a. Ganglia: Define
i. Dorsal root ganglion: Contains what types of cell bodies?
ii. Sympathetic chain ganglia
iii. Plexus: Define
b. Nerves
i. Structure
1. Epineurium
2. Perineurium
3. Endoneurium
4. Fascicles
ii. Cranial nerves
1. CN I Olfactory: What is its function?
2. CN II Optic nerve: What is its function?
3. CN III Oculomotor: What is its function?
4. CN IV Trochlear: What is its function?
5. CN V Trigeminal: What is its function?
6. CN VI Abducens: What is its function?
7. CN VII Facial: What is its function?
8. CN VIII Vestibulocochlear: What is its function?
9. CN IX Glossopharyngeal: What is its function?
10. CN X Vagus: What is its function?
11. CN XI Accessory: What is its function?
12. CN XII Hypoglossal: What is its function?
iii. Spinal nerves
1. Cervical plexus
a. Phrenic nerve: What does it supply?
2. Brachial plexus
a. Axillary nerve
b. Radial nerve
c. Ulnar nerve
d. Median nerve
3. Lumbar plexus
a. Femoral nerve
b. Saphenous nerve
4. Sacral plexus
a. Sciatic nerve
i. Tibial nerve
ii. Fibular nerve

99
Check your understanding:
17. The ridges in the cerebrum are _____________ and the grooves are ____________.
18. Lower motor neurons original in the _________________________.
19. Brodmann’s area 41 keeps information about ____________________.
20. Broca’s area is responsible for __________________.
21. The prefrontal lobe forms the basis of _______________________________________
22. What structures are punctured during a lumbar puncture?
23. What are the functions of CSF?
24. What causes sciatica?

Chapter 14
18. Sensory Perception
a. Sensory Receptors: How can they be classified functionally?
i. Structural receptor types
1. Free nerve ending
2. Encapsulated ending
3. Specialized receptor cell (give an example)
ii. Functional receptor types
1. Chemoreceptor
2. Osmoreceptor
3. Nociceptor
4. Mechanoreceptor
5. thermoreceptor
b. Sensory Modalities
i. General sense (give an example)
ii. Proprioception
iii. Kinesthesia
iv. Visceral senses
v. Somatosensation (list the 7 types)
vi. Special senses
1. Gustation (taste)
a. Papillae
b. Taste buds
c. Gustatory receptor cells

100
2. Olfaction (smell)
a. Olfactory epithelium
b. Olfactory sensory neurons
c. Odorant molecules
d. Olfactory bulb
3. Audition (hearing)
a. External Ear
i. Auricle
b. Middle Ear
i. Tympanic membrane
ii. Eustachian tube
iii. Ossicles
1. Malleus
2. Incus
3. stapes
c. Inner Ear
i. Cochlea
ii. Vestibule
iii. Spiral ganglia
iv. Oval window
v. Scala vestibuli
vi. Cochlear duct
vii. Scala tympani
viii. Round window
ix. Organ of Corti
1. Basilar membrane
2. Hair cells
3. Tectorial membrane
d. Equilibrium
i. Utricle and saccule
ii. Semicircular canals
iii. Vestibular ganglion
iv. Otolithic membrane
v. Ampulla
vi. Cupula
4. Somatosensation (This is listed in the book here, but it is not a
special sense. How does this differ from a special sense?)
a. Touch
i. Merkel’s discs: where are these located?
ii. Ruffini’s corpuscle: where are these located?
iii. Meissner’s corpuscle: where are these located?
iv. Pacinian corpuscle: where are these located?
b. Proprioception
i. Golgi tendon organ

101
 c. Interoception (do an internet search for more information!)
5. Vision
a. Palpebral conjunctiva
b. Lacrimal gland: What is its function?
c. Lacrimal duct: What is its function?
d. Extraocular eye muscles
i. Superior rectus
ii. Medial rectus
iii. Inferior rectus
iv. Lateral rectus
v. Superior oblique
vi. Inferior oblique
e. Fibrous Tunic
i. Sclera
ii. Cornea: what is its function?
f. Vascular Tunic
i. Choroid: what is its function?
ii. Ciliary body
iii. Zonule fibers
iv. lens
v. iris
vi. pupil
vii. retina
g. Cavities
i. Anterior cavity
1. Aqueous humor
2. Anterior chamber
3. Posterior chamber
ii. Posterior cavity
1. Vitreous humor
h. Optic Nerve
i. Optic disc
ii. Blind spot
i. Macula
i. Fovea centralis
ii. Visual acuity
j. Photoreceptors
i. Rods: contains what pigment?
ii. Cones: contains what pigments? What 3 colors are
detected?
c. Sensory Nerves
i. Spinal nerves
1. Dorsal roots: What do they contain?
2. Ventral roots: What do they contain?

102
 3. Contralateral: define this term
ii. Cranial nerves
1. Ipsilateral: define this term
19. Central Processing
a. Sensory Pathways
i. Spinal Cord and Brain stem ascending pathways
1. Dorsal column system: what sensations travel here?
a. Fasciculus gracilis
b. Fasciculus cuneatus
2. Spinothalamic tract: what sensations travel here?
3. Trigeminal pathway: what area of the body is covered by this?
4. Gustation: travels in which two cranial nerves?
5. Audition: travels in which cranial nerve?
6. Optic chiasm: what happens here?
ii. Diencephalon
1. Thalamus
2. Hypothalamus
b. Cortical Processing
i. Sensory homunculus: define
ii. Primary sensory cortex
iii. Association area
iv. Multimodal integration area
20. Motor Responses
a. Cortical responses
i. Executive functions: What are these?
ii. Working memory
iii. Secondary motor cortices
1. Premotor cortex
2. Supplemental motor area
3. Broca’s area: a stroke here causes what symptoms?
iv. Primary motor cortex
b. Descending pathways
i. Betz cells
ii. Corticobulbar tract
iii. Corticospinal tract: what are the pyramids?
1. Lateral tract
2. Anterior tract
c. Extrapyramidal controls
i. Tectospinal tract
ii. Reticulospinal tract
iii. Vestibulospinal tract
iv. Rubrospinal tract
d. Ventral Horn output: what fibers are found here?
e. Reflexes

103
 i. Withdrawal reflex: give an example
ii. Stretch reflex: give an example
iii. Corneal reflex: describe

Label the
Diagrams

104
105
Check your understanding:
25. The two types of somatosensory signals that are transduced by free nerve endings are
_______________________ and ______________________.
26. The type of receptor that transduces temperature is called a __________________.
27. The type of receptor that transduces pain is called a _____________________.
28. The sensation of heat in spicey foods involves which molecule in the food?
29. The area in the brain that serves as the important relay for communication between the
cerebrum and the rest of the nervous system is the __________________.
30. Sensory input first goes to the _________________ portion of the brain.
31. The hypothalamus communicates with the ___________________ system, which
controls emotions and memory functions.

106
107
Chapter 15
1. Autonomic Nervous System
a. Sympathetic Division of the Autonomic Nervous System (fight or flight)
i. Sympathetic chain ganglia: Where are they located?
1. Target effector: define
2. Central neuron (pre-ganglionic neuron)
a. Short and myelinated; most go to a ganglion
b. Some go to the adrenal medulla chromaffin cells
3. Ganglionic neuron (post-ganglionic neuron)
a. Long and unmyelinated
b. Go to target organs
ii. Collateral ganglia
1. Celiac ganglion
2. Superior mesenteric ganglion
3. Inferior mesenteric ganglion
b. Parasympathetic Division of the Autonomic Nervous System (rest and digest)
i. What two regions of the vertebral column do they travel from?
ii. Where are the terminal ganglia located?
iii. Vagus nerve: supplies 90% of the parasympathetic nervous system
c. Chemical Signaling in the ANS
i. Cholinergic synapses (acetylcholine is released)
1. Nicotinic receptors
a. Ligand-gated channel
2. Muscarinic receptor
a. G-Protein-coupled receptor
ii. Adrenergic (norepinephrine or epinephrine is released)
1. Alpha adrenergic receptors (type 1, 2, and 3)
a. G-Protein-coupled receptor
2. Beta adrenergic receptors (type 1 and 2)
a. G-Protein-coupled receptor

108
2. Autonomic Reflexes and Homeostasis
a. Somatic reflex involves one lower motor neuron
b. Autonomic reflex involves two lower motor neurons
i. Preganglionic neuron
ii. Postganglionic neuron
c. Vasomotor reflex
i. Baroreceptors
d. Referred pain
e. Short vs. Long reflexes: describe
f. Balance in competing autonomic reflex arcs
i. Competing neurotransmitters
ii. Autonomic tone
3. Central Control
a. Forebrain structures
i. Hypothalamus
ii. Amygdala
b. Medulla
i. Cardiovascular center
1. Cardiac accelerator nerves
2. Vasomotor nerves
4. Drugs that Affect the ANS
a. Broad Autonomic effects
i. Nicotine: what effect does it have?
b. Sympathetic effect
i. Sympathomimetic drugs (agonists)
1. Phenylephrine
a. Sinus decongestants
b. Mydriasis: what is the antidote? See p.681
2. Cocaine
3. Caffeine
ii. Sympatholytic drugs (antagonists)
1. Beta blockers for congestive heart failure: Name one drug

109
 2. Antianxiety medicines: Name one drug
c. Parasympathetic effects
i. Parasympathomimetic drugs
1. Pilocarpine: what is it used for?
ii. Anticholinergic drugs
1. Atropine: What is the antidote?
2. Scopolamine: What is the antidote?

Fill in the “Example” Column

Check your understanding:

32. What are the effects of the sympathetic nervous system on heart rate? Breathing rate?
Blood flow to skeletal muscle? Blood flow to digestive system? Sweat gland secretion?

110
33. What are the effects of the parasympathetic nervous system on heart rate? Breathing
rate? Blood flow to skeletal muscle? Blood flow to digestive system? Sweat gland
secretion?
34. Parasympathetic preganglionic fibers are (long or short) and post-ganglionic fibers are
(long or short).
35. Parasympathetic preganglionic fibers primarily influence the ____________,
______________, and __________________ in the thoracic cavity and the
_______________, _______________, ________________, __________________,
and __________________________________ of the abdominal cavity.
36. What is an example of a somatic reflex?
37. What is an example of an autonomic reflex?
38. Where are baroreceptors located? What is their function?
39. Describe “referred pain”.
40. Describe orthostatic hypotension.
41. What do the sympathetic vasomotor nerves do to blood vessels? What will that do to
blood pressure?
42. What does the parasympathetic Vagus nerve do to blood vessels? What will that do to
blood pressure?
43. Feedback from which receptors tells the body to activate either sympathetic or
parasympathetic nerves to adjust the blood pressure back to normal? (Hint: see #7)
44. Why does nicotine cause cardiovascular disease?
45. How do beta blockers affect heart rate and blood vessel constriction to help someone
who has congestive heart failure?

111
Chapter 16
16.1 Overview of the Neurological Exam
A. The neurological exam is a clinical assessment tool used to rapidly determine which
specific parts of the CNS are affected by damage or disease. The exam can be broken
down into the following subsets:
1. Mental Status Exam = assesses the higher cognitive functions such as memory,
orientation, and language.
2. Cranial Nerve Exam = tests the function of the 12 cranial nerves and, therefore,
the central and peripheral structures associated with them.
3. The Sensory Exam = tests the sensory functions associated with the spinal
nerves.
4. The Motor Exam = tests the motor functions associated with the spinal nerves
5. The Coordination Exam = tests the ability to perform complex and coordinated
movements. The Gait Exam = specifically assesses the motor function of
walking and can be considered part of the coordination exam because walking is
a coordinated movement.
B. Causes of Neurological Deficits:
1. Stroke also called CVA cerebrovascular accident= the loss of blood flow to a
part of the brain
a. Ischemic stroke = the loss of blood flow to an area because vessels are
blocked or narrowed. This is often caused by an embolus (blood clot or
fat deposit), thickening of the vessel wall or drop in blood volume =
hypovolemia. Transient ischemic attack (TIA) is similar to an ischemic
stroke, but symptoms are resolved within 24 hours.
b. Hemorrhagic stroke = bleeding into the brain because of a damaged
blood vessel. Accumulated blood fills in a region of the cranial vault and
presses against the tissue in the brain. This pooling blood causes
secondary symptoms such as loss of function, pressure on neighboring
arteries resulting in a larger damage area, potentially compromising the
blood-brain barrier resulting in additional fluid on brain = edema.
2. Blunt force trauma can also cause neurological deficits.
3. Neurodegenerative diseases, developmental, and other disorders
a. Alzheimer’s disease = a progressive disorder characterized by the loss
of higher cerebral functions and is the most common cause of senile
dementia or senility. Symptoms may appear at 50 – 60 years or age.
Associated with ACh shortages, shrinkage of the gyri, and formation of
neural tangles among the CNS neurons and Alzheimer plaques within the
cerebrum.
b. Parkinson’s disease = neurodegenerative disorder of the substantia
nigra resulting in decreased production of dopamine. The basal nuclei
become more active, which raises skeletal muscle tone and produces
rigidity and stiffness. Individuals, with Parkinson disease have difficulty
starting voluntary movements, because opposing muscle groups do not

112
 relax; they must be overpowered. Once a movement is underway, every
aspect must be voluntarily controlled through intense effort and
concentration.
c. Huntington’s disease = genetic disorder of the basal nuclei result in too
much movements. occurs 1 in 20,000 births and is the result of a
dominant gene located on chromosome 4. Causes a progressive
neurological degeneration leading to death within 20 years from onset of
symptoms. Symptoms show in 20s or 30-40 years of age.
d. Amyotrophic Lateral Sclerosis (ALS) = progressive, degenerative
disorder that affects the motor neurons in the spinal cord, brain stem, and
cerebral hemispheres. The degeneration affects both upper and lower
motor neurons. Because a motor neuron and its dependent muscle fibers
are so intimately related, the destruction of the CNS neurons causes
atrophy of the associated skeletal muscles.
e. Rabies – A bite from a rabid animal injects the rabies virus into the
peripheral tissues, where virus particles quickly enter the synaptic knobs.
Retrograde flow then carries the virus into the CNS, with potential fatal
consequences. Many toxins (including heavy metals), some pathogenic
bacteria, and other viruses also bypass CNS defenses by exploiting
axoplasmic transport.
f. Multiple Sclerosis (MS) = autoimmune disease causing deterioration of
the myeline that affects axons in the optic nerve, brain, and spinal cord.
MS results in paralysis and potentially death. The disorder is progressive
and functional impairment increases following each new incident.
Women are 1.5 times more likely to have MS than men.
g. Cerebral Palsy – refers to a number of disorders that affect voluntary
motor performance; they appear during infancy or childhood and persist
throughout the life of affected individuals. The cause may be trauma
associated with premature or unusually stressful birth, maternal exposure
to drugs, or a genetic defect that causes the improper development of
motor pathways.
h. Referred Pain – the sensation of pain in a part of the body other than its
actual source.

16.2 The Mental Status Exam

A. Functions of the cerebral cortex
The cerebrum is the seat of many of the higher mental functions, such as memory and
learning, language, and conscious perception, which are the subjects of subtests of the
mental status exam. As discussed in Ch. 13 the cerebrum is a thin layer of gray material
about 1 mm thick that is highly folded. Brodmann first described about 50 different
regions of the cerebrum that correspond to their various functions. There are three types
of processing regions:
1. Primary = The primary cortical areas are where sensory information is initially
processed, or where motor commands emerge to go to the brain stem or spinal
cord.
2. Association = Association areas are adjacent to primary areas and further
process the modality-specific input.
3. Integration areas = Multimodal integration areas are found where the modality-
specific regions meet; they can process multiple modalities together or different

113
 modalities on the basis of similar functions, such as spatial processing in vision
or somatosensation. Example of picking up a glass and based on what is in it
determines what body movements we make.
B. Cognitive Abilities:
1. Orientation and Memory
a. Orientation = the patient’s awareness of his or her immediate
circumstances.
i. Awareness of time = date. “Do you know what day it is?”
ii. Awareness of place = location of where they are and why as well
as who they are. “Do you know where you are?,” “What is your
name?,” “Who is the current president?”
b. Memory = the patient’s ability to recall information. Memory is largely a
function of the temporal lobe, along with structures beneath the cerebral
cortex such as the hippocampus and the amygdala. Short term memory can
be assessed using the three-word test. Patients are given three words (ex.
Book, clock, train) and after a brief time period are asked to recall the three
words. Amnesia can be defined as losing memories of events of the past
retrograde amnesia or inability to make future memories anterograde
amnesia.
2. Language and Speech
a. Language is at the core of what it means to be self-aware. Asking the
patient to perform a set of actions can assess the ability to understand
language. “Use you right pointer finger to touch the tip of your nose and
then your left elbow.” Often, language deficits can be determined without
specific subtests; if a person cannot reply to a question properly, there
may be a problem with the reception of language. Aphasia is the loss or
speech or language.
b. Speech
1. Broca’s area = responsible for speech production. Expressive
aphasia = speech production is compromised leading to broken or
haulted speech with incorrect grammar usage.
2. Wernicke’s area = responsible for processing or understanding
speech. Receptive aphasia = patients do not understand what is
said to them or what they are saying even when they are talking.
3. Conduction aphasia = patient’s inability to connect
understanding of speech to production of speech. Symptoms
include inability to faithfully repeat spoken language.
3. Sensorium = the parts of the brain involved in reception and interpretation of
sensory stimuli. From the primary cortical areas of the somatosensory, visual,
auditory, and gustatory senses to the association areas that process information
in these modalities, the cerebral cortex is the seat of conscious sensory
perception. Two subtests assess specific functions of these cortical areas.
a. Praxis = a practical exercise in which the patient performs a task
completely on the basis of verbal description without any demonstration
from the examiner. For example, the patient can be told to take their left
hand and place it palm down on their left thigh, then flip it over so the
palm is facing up, and then repeat this four times. 
b. Gnosis – sensory perception involving two processes.

114
 i. Stereognosis = involves the naming of objects strictly on the
basis of the somatosensory information that comes from
manipulating them with their eyes closed.
ii. Graphesthesia = recognize numbers or letters written on the
palm of the hand with a dull pointer, such as a pen cap.
4. Judgment and Abstract reasoning = Making judgments and reasoning in the
abstract are necessary to produce movements as part of larger responses.
“When your alarm goes off, do you hit the snooze button or jump out of bed?” Is
10 extra minutes in bed worth the extra rush to get ready for your day? Will
hitting the snooze button multiple times lead to feeling more rested or result in a
panic as you run late? The prefrontal cortex is related to personality
16.3 The Cranial Nerve Exam allows directed tests of forebrain and brain stem structures
A. Sensory Nerves
1. The olfactory nerve (CN I) receives sense of smell
2. Optic nerve (CNII) receives sense of vision. Testing vision relies on the tests that are
common in an optometry office such as the Snellen chart. Testing the extent of the
visual field means that the examiner can establish the boundaries of peripheral vision
as simply as holding their hands out to either side and asking the patient when the
fingers are no longer visible without moving the eyes to track them. Physical
inspection of the optic disk, or where the optic nerve emerges from the eye, can be
accomplished by looking through the pupil with an ophthalmoscope.
3. Vestibulocochlear nerves (CN VIII) receives sense of equilibrium and hearing.
Problems with balance, such as vertigo, and deficits in hearing may both point to
problems with the inner ear. Problems with hearing can be assessed using a tuning
fork to determine types of hearing loss:
a. Conductive hearing = relies on vibrations being conducted through the ossicles
of the middle ear.
b. Sensorineural hearing = relies on the transmission of sound stimuli through the
neural components of the inner ear and cranial nerve.
c. The Rinne test uses a vibrating tuning fork is placed on the mastoid process and
the patient indicates when the sound produced from this is no longer present.
Then the fork is immediately moved to just next to the ear canal so the sound
travels through the air. If the sound is not heard through the ear, meaning the
sound is conducted better through the temporal bone than through the ossicles, a
conductive hearing deficit is present.
d. The Webber test also uses a tuning fork to differentiate between conductive
versus sensorineural hearing loss. In this test, the tuning fork is placed at the top
of the skull, and the sound of the tuning fork reaches both inner ears by travelling
through bone. In a healthy patient, the sound would appear equally loud in both
ears. With unilateral conductive hearing loss, however, the tuning fork sounds
louder in the ear with hearing loss. This is because the sound of the tuning fork
has to compete with background noise coming from the outer ear, but in
conductive hearing loss, the background noise is blocked in the damaged ear,
allowing the tuning fork to sound relatively louder in that ear. With unilateral
sensorineural hearing loss, however, damage to the cochlea or associated
nervous tissue means that the tuning fork sounds quieter in that ear.
4. Taste sensation is relayed to the brain stem through fibers of the facial (CN VII) and
glossopharyngeal nerves (CN IX) and the vagus nerve (X).
5. The trigeminal nerve (CN V) is a mixed nerve that carries the general somatic
senses from the head, similar to those coming through spinal nerves from the rest of

115
 the body. The primary sensory subtest for the trigeminal system is sensory
discrimination. A cotton-tiped applicator, which is cotton attached to the end of a thin
wooden stick, can be used easily for this. The wood of the applicator can be snapped
so that a pointed end is opposite the soft cotton-tipped end. The cotton end provides
a touch stimulus, while the pointed end provides a painful, or sharp, stimulus. While
the patient’s eyes are closed, the examiner touches the two ends of the applicator to
the patient’s face, alternating randomly between them. The patient must identify
whether the stimulus is sharp or dull.
B. Gaze Control
The three nerves that control the extraocular muscles are the:
1. Oculomotor (CN III) - Movement of eyelid and eyeball (via superior rectus,
inferior rectus, medial rectus, and inferior oblique), shape of lens, contracts pupil
size
2. Trochlear (CN IV) - Movement of eye by the superior oblique
3. Abducens (CN VI) - Movement of the eyeball by the lateral rectus
4. Saccades = rapid, conjugate movements of the eyes to survey a complicated
visual stimulus, or to follow a moving visual stimulus. Testing eye movement is
simply a matter of having the patient track the tip of a pen as it is passed through
the visual field. 
5. Diplopia, or double vision, as the two eyes are temporarily pointed at different
stimuli.
6. Convergence = when the two eyes move to look at something closer to the face,
they both adduct. To keep the stimulus in focus, the eye also needs to change
the shape of the lens, which is controlled through the parasympathetic fibers of
the oculomotor nerve. The change in focal power of the eye is referred to
as accommodation. Accommodation ability changes with age; focusing on
nearer objects, such as the written text of a book or on a computer screen, may
require corrective lenses later in life. Coordination of the skeletal muscles for
convergence and coordination of the smooth muscles of the ciliary body for
accommodation are referred to as the accommodation–convergence reflex.
7. A crucial function of the cranial nerves is to keep visual stimuli centered on the
fovea of the retina. The vestibulo-ocular reflex (VOR)coordinates all of the
components, both sensory and motor, that make this possible
C. Nerves of the Face and Oral Cavity
The facial (CN VII) and glossopharyngeal (CN IX) nerves convey gustatory stimulation to the
brain. The hypoglossal nerve is the motor nerve that controls the muscles of the tongue,
except for the palatoglossus muscle, which is controlled by the vagus nerve. There are
two sets of muscles of the tongue. The extrinsic muscles of the tongue are connected
to other structures, whereas the intrinsic muscles of the tongue are completely
contained within the lingual tissues. 

1. Facial nerve = controls muscles controlling facial expressions, secretion of saliva

by the submandibular and sublingual glands and tears by the lacrimal gland, and
sensory function for taste from the anterior 2/3 of the tongue
2. Glossopharyngeal = controls secretion of saliva by the parotid glands, elevation
of pharynx during swallowing, and taste.
3. Aguesia = loss of taste

116
 4. Bells Palsy = characterized by muscle weakness that causes one half of the
face to droop. Bell's palsy may be a reaction to a viral infection and usually
resolves on its own within six months.
5. These nerves can be tested by sticking out the tongue and saying “ah”
D. Motor Nerves of the Neck
The accessory nerve (CN XI) innervates the sternocleidomastoid (flex head forward and
side to side) and trapezius muscles (extension and hyperextension of head as well as
shrugging of shoulders).
16.4 The Sensory and Motor Exams
A. Sensory Modalities and Location
1. Somatic senses are incorporated mostly into the skin, muscles, or tendons,
whereas the visceral senses come from nervous tissue incorporated into the
majority of organs such as the heart or stomach.
2. The somatic senses are those that usually make up the conscious perception of
the how the body interacts with the environment.
3. The visceral senses are most often below the limit of conscious perception
because they are involved in homeostatic regulation through the autonomic
nervous system.
4. Testing of the senses begins with examining the regions known as dermatomes
that connect to the cortical region where somatosensation is perceived in the
postcentral gyrus.
5. To test the sensory fields, a simple stimulus of the light touch of the soft end of a
cotton-tipped applicator is applied at various locations on the skin. 
6. The Romberg test The patient is asked to stand straight with feet together then
after achieving balance the patient closes their eyes and has to maintain the
balance.
B. Muscle Strength and Voluntary Movement
1. The skeletomotor system is largely based on the simple, two-cell projection from
the precentral gyrus of the frontal lobe to the skeletal muscles. Outputs from the
frontal lobe synapse at the ventral horn motor neurons (Upper Motor Neuron
UMN and Lower Motor Neuron LMN) before projecting to the skeletal muscle.
2. The lack of muscle tone, known as hypotonicity or flaccidity, may indicate that
the LMN is not conducting action potentials that will keep a basal level of
acetylcholine in the neuromuscular junction.
3. If muscle tone is present, muscle strength is tested by having the patient contract
muscles against resistance. The examiner will ask the patient to lift the arm, for
example, while the examiner is pushing down on it.
4. Diseases that result in UMN lesions include cerebral palsy or MS, or it may be the
result of a stroke. A sign of UMN lesion is a negative result in the subtest
for pronator drift.
5. The patient is asked to extend both arms in front of the body with the palms facing
up. While keeping the eyes closed, if the patient unconsciously allows one or the
other arm to slowly relax, toward the pronated position, this could indicate a
failure of the motor system to maintain the supinated position.
C. Reflexes
See Ch. 15 reflex discussion on stretch reflex and superficial reflexes.

117
 1. For the arm, the common reflexes to test are of the biceps, brachioradialis,
triceps, and flexors for the digits. For the leg, the knee-jerk reflex of the
quadriceps is common, as is the ankle reflex for the gastrocnemius and soleus. 
2. Plantar reflex that tests for the Babinski sign on the basis of the extension or
flexion of the toes at the plantar surface of the foot. The plantar reflex is
commonly tested in newborn infants to establish the presence of neuromuscular
function. To elicit this reflex, an examiner brushes a stimulus, usually the
examiner’s fingertip, along the plantar surface of the infant’s foot. An infant would
present a positive Babinski sign, meaning the foot dorsiflexes and the toes
extend and splay out. As a person learns to walk, the plantar reflex changes to
cause curling of the toes and a moderate plantar flexion. 
D. Comparison of Upper and Lower Motor Neuron Damage
1. Many of the tests of motor function can indicate differences that will address
whether damage to the motor system is in the upper or lower motor neurons.
Signs that suggest a UMN lesion include muscle weakness, strong deep tendon
reflexes, decreased control of movement or slowness, pronator drift, a positive
Babinski sign, spasticity, and the clasp-knife response. Spasticity is an excess
contraction in resistance to stretch. It can result in hyperflexia, which is when
joints are overly flexed. The clasp-knife response occurs when the patient initially
resists movement, but then releases, and the joint will quickly flex like a pocket
knife closing.
2. A lesion on the LMN would result in paralysis, or at least partial loss of voluntary
muscle control, which is known as paresis. The paralysis observed in LMN
diseases is referred to as flaccid paralysis, referring to a complete or partial
loss of muscle tone, in contrast to the loss of control in UMN lesions in which
tone is retained and spasticity is exhibited. Other signs of an LMN lesion
arefibrillation, fasciculation, and compromised or lost reflexes resulting from
the denervation of the muscle fibers
16.5 The Coordination and Gait Exams
A. Locations and Connections of the Cerebellum
1. Cerebellum = accounts for 11% of the brain’s mass.
2. The cerebellum functions in the coordination and modulation of motor command
from the cerebral cortex and maintaining balance and equilibrium.
3. The cerebellum is partially hidden by the cerebral hemispheres and is the second
largest structure in the brain.
4. The cerebellum is separated from the cerebrum by the transverse fissure.
5. The cerebellum also possesses fold-like wrinkles called folia, is divided into two
hemispheres, and further subdivided into lobes: the anterior lobe and posterior
lobe.
6. The two cerebellar hemispheres are separated by the vermis while the anterior
and posterior lobes are separated by the primary fissure.
7. The white matter of the cerebellum is called the arbor vitae and is surrounded by
gray matter called the cerebellar cortex.
B. Coordination and Alternating Movement
1. Testing for cerebellar function is the basis of the coordination exam. The subtests
target appendicular musculature, controlling the limbs, and axial musculature for
posture and gait. The assessment of cerebellar function will depend on the

118
 normal functioning of other systems addressed in previous sections of the
neurological exam. Motor control from the cerebrum, as well as sensory input
from somatic, visual, and vestibular senses, are important to cerebellar function.
2. The subtests that address appendicular musculature, and therefore the lateral
regions of the cerebellum, begin with a check for tremor. The patient extends
their arms in front of them and holds the position while the examiner watches for
tremors.
3. The check reflex depends on cerebellar input to keep increased contraction
from continuing after the removal of resistance. The patient flexes the elbow
against resistance from the examiner to extend the elbow. 
C. Posture and Gait
1. Gait can either be considered a separate part of the neurological exam or a
subtest of the coordination exam that addresses walking and balance. 
2. A subtest called station begins with the patient standing in a normal position to
check for the placement of the feet and balance. The patient is asked to hop on
one foot to assess the ability to maintain balance and posture during movement. 
3. Subtests of walking begin with having the patient walk normally for a distance
away from the examiner, and then turn and return to the starting position. The
examiner watches for abnormal placement of the feet and the movement of the
arms relative to the movement. The patient is then asked to walk with a few
different variations. Tandem gait is when the patient places the heel of one foot
against the toe of the other foot and walks in a straight line in that manner.
Walking only on the heels or only on the toes will test additional aspects of
balance.
D. Ataxia = presents as a loss of coordination in voluntary movements. Ataxia can also refer
to sensory deficits that cause balance problems, primarily in proprioception and
equilibrium. Ataxia is often the result of exposure to exogenous substances (alcohol,
ketamine or mercury), focal lesions (stroke, trauma, MS, or tumor), or a genetic disorder.

119
Chapter 17
17.1 An Introduction to the Endocrine System and Hormones. The endocrine
system works with or in harmony with the nervous system to control and coordinate
all the activities of the body and to maintain homeostasis. Endocrinology - field of
medicine that focuses on the treatment of endocrine system disorders.
1. The endocrine system and nervous system are similar yet different:
1. Both systems rely on the release of chemicals that bind to specific
receptors on their target cells.
2. Both share many chemical messengers; when released into the
bloodstream they are called hormones but when released into a synapse,
they are called neurotransmitters.
3. Both systems are regulated primarily by negative feedback control.
4. Both share a common goal: to preserve homeostasis by coordinating and
regulating the activities of other cells, tissues, organs, and systems.
2. Mechanisms of Intercellular Communication
1. Direct communication – via gap junctions; use ions, small solutes, and
other lipid-soluble materials as chemical mediators; effects are usually
limited to adjacent cells of the same type that are interconnected by
connexons.
2. Paracrine communication – via extracellular fluids; use paracrine
factors as chemical mediators; effects are primarily limited to the local
area where paracrine factor concentrations are relatively high; target cells
must have appropriate receptors.
3. Endocrine communication – via the bloodstream; use hormones as
chemical mediators; effects are on target cells located in other tissues or
organs; target cells must have an appropriate receptor.
4. Neural communication – via synaptic clefts; use neurotransmitters as
chemical mediators; effects are limited to very specific areas; target cells
must have appropriate receptors.
3. Structures of the endocrine system:
1. Thalamus
2. Pineal gland
3. Pituitary gland
4. Thyroid
5. Thymus
6. Adrenal
7. Pancreas
8. Ovaries
9. Testes

17.2 Hormones are chemical messengers released by endocrine cells/glands into

bloodstream to be transported throughout the body to regulate the metabolic

120
functions and activities of other cells of the body. See table at end of outline for list
of endocrine glands and their related hormones.
A. Hormones and paracrine factors of the body can be divided into groups:
1. Amino acid derivatives – hormones derived from a single amino acid.
Examples include: the thyroid hormones such as thyroxine and
triiodothyronine; the catecholamines such as epinephrine,
norepinephrine, and dopamine; and melatonin
2. Peptide hormones – chains of amino acids. Examples include:
a. Polypeptides: antidiuretic hormone (9 amino acids) and oxytocin
(9 amino acids)
b. Small proteins: insulin (51 amino acids), growth hormone (191
amino acids) and prolactin (198 amino acids)
c. Glycoproteins: thyroid-stimulating hormone, luteinizing hormone,
and follicle-stimulating hormone
3. Lipid derivatives – consist of carbon rings and side chains built either
from fatty acids chains or cholesterol.
a. Eicosanoids – built from fatty acid chains and include:
leukotrienes and prostaglandins.
b. Steroid hormones – built from cholesterol molecules and include:
testosterone, estrogen and progesterone, corticosteroids, and
calcitriol.
B. Pathways of Hormone Action
1. Lipid-soluble = A steroid hormone directly initiates the production of
proteins within a target cell. Steroid and thyroid hormones easily diffuse
through the cell membrane. The steroid hormone binds to its receptor in
the cytosol, forming a receptor–hormone complex. The receptor–hormone
complex then enters the nucleus and binds to the target gene on the DNA.
Thyroid hormones bind to receptors already bound to DNA. Transcription
of the gene creates a messenger RNA that is translated into the desired
protein within the cytoplasm.
2. Water-soluble = Water-soluble hormones cannot diffuse through the cell
membrane. These hormones must bind to a surface cell-membrane
receptor. The receptor then initiates a cell- signaling pathway within the
cell involving G proteins, adenylyl cyclase, the secondary messenger
cyclic AMP (cAMP), and protein kinases. In the final step, these protein
kinases phosphorylate proteins in the cytoplasm. This activates proteins in
the cell that carry out the changes specified by the hormone.
C. Hormones are regulated by feedback mechanisms and hormonal interactions
1. Factors Affecting Target Cell Response. Hormones must have receptors
on their target tissue.
a. Downregulation - the presence of a significant level of a hormone
circulating in the bloodstream can cause its target cells to decrease
their number of receptors for that hormone, allowing cells to
become less reactive to the excessive hormone levels.
b. Upregulation - cells increase their number of receptors due to the
level of a hormone becoming chronically reduced.

121
 2. Interactions between hormones:
a. Antagonistic effects - one hormone inhibits the response of
another therefore they generate opposite responses; example:
insulin lowers blood sugar while glucagon raises blood sugar
b. Synergistic effects - two hormones with similar effects produce an
amplified response. In some cases, two hormones are required for
an adequate response. For example, two different reproductive
hormones—FSH from the pituitary gland and estrogens from the
ovaries—are required for the maturation of female ova (egg cells).
c. Permissive effects - one hormone is needed to activate another;
example: rennin stimulates the conversion of Angiotensin I into
Angiotensin II
3. Feedback mechanisms
a. Negative feedback systems - physiological response causes a
decrease in the release of the hormone; most commonly used
b. Positive feedback systems - physiological response causes an
increase in the release of the hormone; rarely used
D. Role of endocrine gland stimuli: Hormones can stimulate behavior or behavior
may stimulate hormones. Elevated hormone levels do not equate to elevated
behavior.

17.3 Hypothalamus and Pituitary

A. Hypothalmus
1. The hypothalamus provides the highest level of endocrine control. It
integrates the activities of the nervous system and endocrine system.
2. The hypothalamus accomplishes this integration through three
mechanisms:
a. The hypothalamus contains autonomic centers that exert direct
neural control of the endocrine cells, called chromaffin cells, of the
adrenal medulla. When the sympathetic division is activated, this
direct control allows the immediate stimulation of the adrenal gland.
b. Hypothalamic neurons synthesize two hormones – ADH and OXT –
and transport them along axons within the infundibulum to the
posterior lobe of the pituitary for storage and secretion.
c. The hypothalamus secretes regulatory hormones that control the
secretions of the anterior pituitary gland. These regulatory
hormones, called releasing hormones (RH) and inhibiting
hormones (IH), flow via a network of fenestrated capillaries called
the hypophyseal portal system.
B. Pituitary Gland – Hypophysis
1. Also known as the “master gland” is located within the sella turcica of the
sphenoid bone.
2. Connected to the hypothalamus via the infundibulum and a network of
capillaries called the hypophyseal portal system. Divided into two lobes:
an anterior lobe and a posterior lobe.

122
3. Neurohypophysis – the posterior lobe of the pituitary gland connected to
the hypothalamus by the infundibulum; contains the axons of the
hypothalamic neurons. Stores and secretes hormones synthesized in the
hypothalamus:
a. Antidiuretic hormone (ADH also known as vasopressin) –
increases water reabsorption within the renal tubules of the kidney.
This results in a decrease in water loss from urine.
b. Oxytocin (OXT) – stimulates the smooth muscle contractions of
the uterus which initiates child birth. After delivery, stimulates the
ejection of milk. In both sexes, known as the “cuddle hormone” as
it surges during arousal and orgasm.
4. Adenohypophysis – the anterior lobe of the pituitary gland connected to
the hypothalamus by the hypophyseal portal system. Controlled by
regulating hormones, called releasing hormones (RH) and inhibiting
hormones (IH) from the hypothalamus:
a. Thyroid stimulating hormone (TSH) – targets the thyroid gland;
stimulates the thyroid to grow and increase its secretion of the
thyroid hormones, T3 and T4. Released in response to thyrotropin-
releasing hormone (TRH) from hypothalamus.
b. Adrenocorticotropic hormone (ACTH or corticotropin) –
stimulates the release of steroid hormones by the adrenal cortex.
Released in response to corticotropin-releasing hormone (CRH)
from the hypothalamus.
c. Follicle stimulating hormone (FSH or gonadotropin) – promotes
ovarian follicles to develop in females and, in conjunction with
luteinizing hormone, stimulates the secretion of estrogens. In
males FSH promotes the physical maturation in sperm. Released
in response to gonadotropin-releasing hormone (GnRH) from the
hypothalamus.
d. Luteinizing hormone (LH) – induces ovulation in females and
promotes the secretion of estrogen and progesterone. In males it
stimulates the production of sex hormones called androgens,
specifically testosterone. Released in response to gonadotropin-
releasing hormone from the hypothalamus.
e. Growth hormone (GH) – stimulates cell growth and reproduction
by accelerating the rate of protein synthesis particularly in skeletal
muscle and bone. Regulated by growth hormone-releasing
hormone (GH-RH) and growth hormone-inhibiting hormone (GH-IH)
from the hypothalamus.
f. Prolactin (PRL or luteotropic hormone) – works with other
hormones to stimulate mammary gland development and the
production of milk during pregnancy and during nursing. Regulated
by several prolactin-releasing hormones and prolactin-inhibiting
hormone (PIH).

123
 g. Melanocyte stimulating hormone (MSH) – stimulates
melanocytes of the skin to increase their production of melanin.
Non-functional in adults.

17.4 Thyroid Gland

A. Located in the neck just below the larynx and anterior to the trachea. Divided
into a right and left lobe connected by a narrow isthmus. Regulated by TSH
from the pituitary gland.
B. The thyroid gland contains large numbers of thyroid follicles – hollow spheres
lined by a simple cuboidal epithelium called the follicle cells.
1. The follicle cells surround a cavity that holds a viscous colloid, a fluid
containing a large quantity of dissolved proteins.
2. The follicle cells synthesize a globular protein called thyroglobulin and
secrete it into the colloid of the thyroid follicle.
3. The thyroglobulin molecules contain the amino acid tyrosine. The
thyroglobulin is combined with iodide ions absorbed from the diet to form
the thyroid hormones: T3 (triiodothyronine) and T4 (thyroxine).
4. Thyroid hormones have several effects in the body:
a. Stimulates red blood cell production and thus enhanced oxygen
delivery.
b. Stimulates the activity of other endocrine tissues.
c. Accelerates the turnover of minerals in bone.
d. Elevates rates of oxygen consumption and energy consumption in
cells; increase basal metabolic rates.
e. Increases heart rate and force of contraction resulting in increased
blood pressure.
f. Increases sensitivity to sympathetic stimulation.
g. Maintains the normal sensitivity of respiratory centers to changes in
oxygen and carbon dioxide concentrations in the blood.
C. Between the follicles is a second population of endocrine cells called
parafollicular cells, or C (clear) cells. Clear cells produce calcitonin (CT)
which lowers blood calcium levels when they are too high. Calcitonin works by
increasing the amount of calcium excreted in urine and increasing the deposition
of calcium in bone by stimulating osteoblast activity.

17.5 Parathyroid Gland

A. Two pair of glands embedded in the posterior surfaces of the thyroid gland.
B. Composed of two cell populations
1. Oxyphil cells – have no known function.
2. Chief cells – produce parathyroid hormone (PTH) which increases
blood calcium levels when they are too low.
C. PTH and calcitonin work as antagonists to maintain homeostasis of blood
calcium levels. PTH specifically targets:
1. Bones – activates osteoclasts causing calcium and phosphate ions to be
released into the blood.
2. Intestine – increases calcium absorption from food.

124
 3. Kidneys – promotes activation of vitamin D and increases calcium
reabsorption in the kidney tubules.

17.6 Adrenal Gland

A. Located retroperitoneal and superior to the kidney. Composed of two distinct
regions: the adrenal cortex (outer) and adrenal medulla (inner).
B. Adrenal cortex produces steroid hormones from cholesterol (corticosteroids)
and is divided into three regions:
1. Zona glomerulosa (outer) – releases mineralocorticoids, principally
aldosterone, which controls electrolyte balance in the kidneys.
2. Zona fasciculate (middle) – produces glucocorticoids such as cortisol
and cortisone which influence metabolism of glucose, protein, and fat;
controlled by ACTH.
3. Zona reticularis (inner) – produces androgens or adrenal sex hormones
such as testosterone which influence masculinization.
C. Adrenal medulla releases hormones when the body is under stress and consists
of hormone-producing cells called chromaffin cells.
1. Epinephrine (aka adrenaline) – (80%) elevates blood sugar, regulates
body during stress or anger; raises blood pressure, heart beat, glycogen
breakdown and increases all other sympathetic effects of the nervous
system.
2. Norepinephrine (aka noradrenaline) – helps maintain blood pressure,
and accounts for 20% of the hormones released by the medullary portion
of the adrenal gland.
3. Effects of Epi/NE:
a. Signals the liver and skeletal muscle cells to convert glycogen into
glucose, resulting in increased blood glucose levels.
b. These hormones increase the heart rate, pulse, and blood pressure
to prepare the body to fight the perceived threat or flee from it.
c. Dilates the airways, raising blood oxygen levels.
d. Prompts vasodilation, further increasing the oxygenation of
important organs such as the lungs, brain, heart, and skeletal
muscle.
e. Triggers vasoconstriction to blood vessels serving less essential
organs such as the gastrointestinal tract, kidneys, and skin, and
downregulates some components of the immune system.
f. Other effects include a dry mouth, loss of appetite, pupil dilation,
and a loss of peripheral vision.

17.7 Pineal Gland

A. Located in the roof of the 3rd ventricle of the brain called the epithalamus region.
B. Composed of special secretory cells called pinealocytes.
C. The major product is melatonin whose concentrations rise and fall in a diurnal
cycle. Levels are lowest during daylight hours and highest at night.

125
 1. Melatonin appears to maintain the basic circadian rhythms – daily
changes in physiological processes that follow a regular day-night pattern.
2. Melatonin protects against tissue damage by acting as an antioxidant
and that protects the central nervous system from free radicals such as
hydrogen peroxide.
3. Melatonin may inhibit reproductive development and functioning.

17.8 Gonadal and Placental Hormones

A. Ovaries: located in the pelvic cavity. Produce estrogen which regulates
secondary sex characteristics (breast, pubic hair, etc.). Also produce
progesterone which helps to stimulate the uterus to bring about thickening and
vascularization of the endometrium in preparation for implantation of a fertilized
egg.
B. Testes: located in the scrotum. Secretes testosterone, the male sex hormone,
which brings about development of secondary sex characteristics, normal sex
behaviors, and production of sperm. Also produces inhibin which inhibits the
release of FSH and GnRH when sperm counts are high.
C. Placenta: a temporary organ only formed during pregnancy. Produces hCG
hormone (human chorionic gonadotrophic) with aid in maintaining pregnancy and
keeping the corpus luteum intact.

17.9 The Endocrine Pancreas

A. Located posterior and inferior to the stomach. A unique organ that has both and
endocrine and exocrine abilities.
B. Islets of Langerhans: endocrine cells that produce hormones.
1. Alpha cells – produce glucagon
2. Beta cells – produce insulin
3. Delta cells – produce somatostatin which inhibits insulin and glucagon
secretion and slows the rates of food absorption and enzyme secretion
along the digestive tract.
4. PP cells – produce the hormone pancreatic polypeptide (PP) which
inhibits gallbladder contractions and regulates the production of some of
the digestive enzymes.
C. Acinar cells: exocrine cells that produce enzymes and other digestive
chemicals. (must know for GI chapter)
1. Sodium bicarbonate – serves as a buffer of the HCl produced in the
stomach.
2. Proteases – secreted as inactive enzymes but become activated in the
small intestine to form the activated: carboxypeptidase, chymotrypsin,
and trypsin. These enzymes break down large polypeptides into
oligopeptides, tripeptides, dipeptides and some amino acids.
3. Pancreatic amylase (almost identical to salivary amylase) – enzymes that
further digest the carbohydrates, only briefly started in the mouth, into
oligosaccharides and disaccharides.
4. Pancreatic lipase – enzyme that breaks down lipids into fatty acids and
glycerol.

126
 5. Pancreatic nucleases – enzymes that breaks down nucleic acids such as
deoxyribonuclease (DNA) and ribonuclease (RNA).
D. Insulin and glucagon work as antagonists to maintain homeostasis of blood
sugar.
1. Insulin lowers blood glucose levels by enhancing membrane transport of
glucose into body cells, converting excess glucose to glycogen for short-
term storage (glycogenesis) and into fat for long-term storage in
adipocytes (lipogenesis).
2. Glucagon raises blood glucose levels by breaking down glycogen into
glucose (glycogenolysis), synthesizes glucose from lactic acid and other
non-carbohydrate molecules (gluconeogenesis), and releases glucose to
the blood by liver cells.

17.10 Organs with secondary endocrine function

A. Heart secretes ANP that literally means “producing salty urine. ANP Inhibits
aldosterone release by the adrenal cortex. The brain also secretes BNP that
performs the same job.
B. Gastrointestinal tract possesses cells that produce secretin, gastrin, CCK,
GIP, VIP, ghrelin, galanin, neuropeptide Y, and many more.
C. Kidney secretes EPO for red blood cell production and rennin for activation of
angiotensin II, a potent vasoconstrictor.
D. Skeleton produces at least two hormones:
1. Fibroblast growth factor 23 (FGF23) is produced by bone cells to
triggers the kidneys to inhibit the formation of calcitriol from vitamin D3
and to increase phosphorus excretion during high blood calcium levels.
2. Osteocalcin, produced by osteoblasts, stimulates the pancreatic beta
cells to increase insulin production. It also acts on peripheral tissues to
increase their sensitivity to insulin and their utilization of glucose.
E. Adipose tissue releases leptin following the uptake of glucose and lipids
resulting in satiety.
F. Skin produces cholecalciferol, the inactive form of vitamin D.
G. Thymus Gland: located posterior to the sternum and between the lungs. Large
in infant, increases in size until puberty and then shrinks as the individual
continues to age. The major hormonal product of the thymus gland is thymosin
which appears to be essential for the normal development of T lymphocytes and
the immune response.
H. Liver is responsible for secreting at least four important hormones or hormone
precursors:
1. Insulin-like growth factor (somatomedin) is the immediate stimulus for
growth in the body, especially of the bones.
2. Angiotensinogen is the precursor to angiotensin, mentioned earlier,
which increases blood pressure.
3. Thrombopoetin stimulates the production of the blood’s platelets.
4. Hepcidin blocks the release of iron from cells in the body, helping to
regulate iron homeostasis in our body fluids.

127
17.11 Development and Aging of the Endocrine System
A. Development: The endocrine system arises from all three embryonic germ
layers.
1. Endoderm: thyroid and parathyroid glands, as well as the pancreas and
the thymus.
2. Mesoderm: The endocrine glands that produce the steroid hormones,
such as the gonads and adrenal cortex
3. Ectoderm: pituitary gland, pineal gland, adrenal medulla
B. Aging
As the body ages, changes occur that affect the endocrine system, sometimes
altering the production, secretion, and catabolism of hormones. For example, the
structure of the anterior pituitary gland changes as vascularization decreases and
the connective tissue content increases with increasing age. This restructuring
affects the gland’s hormone production. Certain hormones and gland production
decrease with age: reduced cortisol and aldosterone from adrenal gland, lower
estrogen and progesterone from ovaries, as well as lower testosterone levels.

128
 Endocrine Glands and Their Major Hormones
Endocrine Associated Chemical class Effect
gland hormones

Pituitary Growth hormone (GH) Protein Promotes growth of body tissues

(anterior)

Pituitary Prolactin (PRL) Peptide Promotes milk production

(anterior)

Pituitary Thyroid-stimulating Glycoprotein Stimulates thyroid hormone release

(anterior) hormone (TSH)

Pituitary Adrenocorticotropic Peptide Stimulates hormone release by adrenal

(anterior) hormone (ACTH) cortex

Pituitary Follicle-stimulating Glycoprotein Stimulates gamete production

(anterior) hormone (FSH)

Pituitary Luteinizing hormone Glycoprotein Stimulates androgen production by gonads

(anterior) (LH)

Pituitary Antidiuretic hormone Peptide Stimulates water reabsorption by kidneys

(posterior) (ADH)

Pituitary Oxytocin (OXY) Peptide Stimulates uterine contractions during

(posterior) childbirth

Thyroid Thyroxine (T4), Amine Stimulate basal metabolic rate

triiodothyronine (T3)

Thyroid Calcitonin Peptide Reduces blood Ca2+ levels

Parathyroid Parathyroid hormone Peptide Increases blood Ca2+ levels

(PTH)

Adrenal Aldosterone Steroid Increases blood Na+ levels

(cortex)

Adrenal Cortisol, Steroid Increase blood glucose levels

(cortex) corticosterone,
cortisone

Adrenal Epinephrine, Amine Stimulate fight-or-flight response

(medulla) norepinephrine

Pineal Melatonin Amine Regulates sleep cycles

Pancreas Insulin Protein Reduces blood glucose levels

Pancreas Glucagon Protein Increases blood glucose levels

129
Endocrine Associated Chemical class Effect
gland hormones

Testes Testosterone Steroid Stimulates development of male secondary

sex characteristics and sperm production

Chapter 18

18.1. An Overview of Blood

I. Background
1. Blood is what type of tissue?
2. What are the three components of the formed elements?
II. Functions of Blood
1. What is the primary function of blood?
A. Transportation
1. What is one substance blood is responsible for transporting?
a) Why is this important?
2. Blood assists in transportation of blood gases. What gas is transported to
the lungs for exhalation?
3. Waste products in the blood are transported to _________ for excretion.
B. Defense
1. What cells in the blood are responsible for immune defense?
2. What in the blood is responsible for blood clotting?
C. Maintenance of Homeostasis
1. Temperature regulation is regulated by __________ feedback.

130
 2. Increasing the amount of blood circulating to the periphery would have
what effect on overall body temperature?
3. Aside from temperature, what other aspects of body homeostasis do
blood and its components regulate?
III. Composition of Blood
1. Erythrocytes are _______
blood cells.
2. What is hematocrit, and
what does it measure?
3. The pale, thin layer found
above erythrocytes in a
centrifuged sample is
the__________ ________,
and it contains ________
blood cells.
4. What is a normal value for
Packed Cell Volume
(PCV)?
5. The image shows a normal centrifuged sample on the left, and a sample
with anemia in the middle. What is different between the samples, and by
extension what is the pathophysiology associated with anemia?

IV. Characteristics of Blood

1. What pigment in the blood is responsible for the coloration?
2. Do you expect blood to be more or less viscous than water?
3. Blood is normally higher or lower than body temperature?
4. What is a normal value for the blood volume of an adult?
V. Blood Plasma
1. Proteins make up about 7 percent of the volume of plasma, and the rest
of the volume is from _________.
2. Blood contains numerous substances that are all suspended within what
medium?
B. Plasma Proteins
1. Why and how does albumin help to transport lipids?
a) Why can’t lipids travel directly in the plasma?
2. Gamma globulins are involved in immunity, and also known as
__________ or ____________.
3. What plasma protein is essential for blood clotting?
4. Albumin, most of the globulins, and fibrinogen are all produced by what
organ?
C. Other Plasma Solutes
1. What is responsible for transporting oxygen and some carbon dioxide in
the blood?
2. What is the difference between plasma and the formed elements?

18.2. Production of the Formed Elements

I. Background

131
 1. What is hemopoiesis?
II. Sites of Hemopoiesis
1. In adulthood hemopoiesis primarily occurs in bones, but there is some
extramedullary hemopoiesis in the ___________ and ___________.
III. Differentiation of Formed Elements from Stem Cells
1. All of the formed elements of the blood originate from hemocytoblasts or
___________ ___________ ______.
2. The hemopoietic growth factors stimulate hemopoietic stem cells to
__________ and __________.
A. Lymphoid Stem Cells
1. Lymphoid stems cells produce what mature cells types?
2. Lymphoid stem cells migrate where in the body?
B. Myeloid Stem Cells
1. Myeloid stem cells give rise to ________ blood cells, __________ that
produce platelets, monocytes, and granular leukocytes.

IV. Hemopoietic Growth Factors

A. Erythropoietin (EPO)
1. Low oxygen stimulates the production of EPO in the kidneys. EPO signals
for increase in what cell type in the blood?
B. Thrombopoietin
1. Thrombopoietin stimulates the production of what element in the blood
responsible for blood clotting?

132
 C. Cytokines
1. Cytokines are signaling molecules that help with resistance to disease.
The two major subtypes of cytokines are the
_____________________________ and the _______________.
2. IL-1, IL-2, and IL-3 are all what subtype of cytokine?
V. Bone Marrow Sampling and Transplants
1. Taking a sample of bone marrow is done through a _________
_________ ___________.

18.3. Erythrocytes

I. Background
1. What is the primary function of erythrocytes?
2. Do erythrocytes leave the vascular network? Do leukocytes?
II. Shape and Structure of Erythrocytes
1. A __________ is an immature erythrocyte.
2. What are erythrocytes missing that most cells in the body have? Why?
3. What fills erythrocytes?
4. Why is the biconcave shape of red blood cells important to their function?
III. Hemoglobin
1. Hemoglobin is made up of four folded protein chains known as
___________, and a red pigment molecule that contains iron known as
___________.

2. When is oxygen is bound to the iron in hemoglobin is forms

_______________, and when oxygen is released to the tissue it forms
_______________.
3. Insufficient hematopoiesis results in anemia, and excess hematopoiesis
or an overproduction of red blood cells results in _________________.

133
 4. Binding of carbon dioxide to the amino acids in hemoglobin forms
__________________.
5. A pulse oximeter reading of 85 would indicate low blood oxygen or
____________.
6. Erythropoietin (EPO), is produced in the kidneys and stimulates the
production of the _______________.

IV. Lifecycle of Erythrocytes

1. Where are erythrocytes produced?
2. Iron is necessary for red blood cell production. Where is iron stored in the
body?
3. _______________ and _______________ are proteins used to help store
iron.
4. Old red blood cells are degraded by ________________.
5. After degradation of a red blood cell the globin is broken down into
________ __________.
6. After degradation of a red blood cell the non-iron portion of heme is
degraded into a green pigment _____________, and then into a yellow
pigment ______________.

134
V. Disorders of Erythrocytes
1. After a diagnosis of anemia what symptoms could an afflicted individual
expect?
2. ________ _________ ________ results in blood cells with a
characteristic crescent shape due to a mutation in a hemoglobin gene.
3. Anemia can occur due to lack of _______, a key mineral found inside of
heme.
4. _______________ is a disease common in the Mediterranean and Middle
East where red blood cells do not mature.
5. Polycythemia can occur transiently in a person when they do not have
enough ____________ intake.

18.4. Leukocytes and Platelets

I. Background
1. White blood cells,
also known as
______________,
protect against
invading
microorganisms, and
the body’s own cells
with mutated DNA.
A. Characteristics of
Leukocytes
1. Compared to
erythrocytes, are
leukocytes less
numerous or more
numerous?
2. In order for
leukocytes to leave
the vasculature and
reach a destination in
the tissue they are
able to utilize
emigration or
_____________.
3. Attraction of
leukocytes through
______________
_____________ to sites in need of an immune response is due to
chemical messages.

II. Classification of Leukocytes

1. Neutrophils, eosinophils, and basophils all contain numerous granules
and are ______________ leukocytes.

135
 2. Monocytes and lymphocytes are ________________ leukocytes.
A. Granular Leukocytes
1. What is the most abundant leukocyte in a healthy individual?
2. Older neutrophils are polymorphonuclear. What does this mean, and how
does it help to identify them?
3. What strategies do neutrophils employ to deal with invading bacterial
pathogens?
4. What granular leukocyte is best suited to handle a parasitic worm
infection?
5. Which leukocyte is the least abundant, and contains granules with
histamine and heparin?

III. Agranular Leukocytes

1. What does the name lymphocyte tell us about the cells?
2. What are the three major categories of lymphocytes?
3. Cells that do no express “self” can be recognized by ________
__________ ________, which help provide some nonspecific immunity.
4. ___ Lymphocytes produce antibodies as a part of humoral immunity.
5. _______ Cells live for many years and allow the body to have a tailored
response to a specific pathogen after a previous exposure.
6. Macrophages found in the tissue originate as ____________.
IV. Lifecycle of Leukocytes
1. What is the general lifespan of a leukocyte?
V. Disorder of Leukocytes
1. __________ is when too few leukocytes are produced, as compared to
excessive leukocyte production in
___________.
2. Cancers of leukocytes include __________
which involves an abundance of leukocytes,
and ____________ where malignant and T
and B cells accumulate in tissues.
VI. Platelets
1. Platelets, also known as _____________,
are produced as a cell fragment from a
______________________.
2. What is the primary function of platelets?
VII. Disorders of Platelets

136
 1. Thrombocytosis is when there are too few or too many platelets?
2. Thrombocytopenia is when there is an insufficient number of platelets.
Why would this be dangerous?

18.5. Hemostasis

I. Background
1. What is hemostasis?
2. What happens if hemostasis fails?
II. Vascular Spasm
1. Vascular Spasm is the first step of hemostasis. What happens during this
step to help reduce the loss of blood?
III. Formation of the Platelet Plug
1. What is a platelet plug?
2. What signals for platelets to form a platelet plug?
3. What substances do platelets release to contribute to hemostasis?
IV. Coagulation
1. ______________ is formation of a blood clot.
2. ________, the end product of the coagulation cascade is a protein used
to bind the clot
together.
A. Clotting Factors Involved in
Coagulation
1. Why are clotting
factors crucial to
blood clotting?
2. What organ is
responsible for the
production of most of
the clotting factors?
3. What purpose does
Vitamin K serve in
clotting?
B. Extrinsic Pathway
1. What triggers the
extrinsic pathway to
coagulation?
C. Intrinsic Pathway
1. What triggers the
intrinsic pathway to
coagulation?
2. Is this pathway faster
or slower than the
extrinsic pathway?
D. Common Pathway
1. What factor, once
activated, starts the
common pathway?

137
 V. Fibrinolysis
1. ________ is blood plasma without clotting factors.
2. Fibrinolysis is degradation of what?
3. Plasmin plays what role in fibrinolysis?
VI. Plasma Anticoagulants
1. Antithrombin and heparin are what kinds of substances?
2. Why would an anticoagulant be administered to a patient in surgery?
VII. Disorders of Clotting
1. What is hemophilia?
2. What is a thrombus? What is an embolus? What is the difference?
3. Why would a physician recommend for a patient to take a low dose of
aspirin?

18.6. Blood Typing

I. Background
1. Why is blood typing important? When is it necessary to know about blood
groups?
II. Antigens, Antibodies, and Transfusion Reactions
1. What are antigens?
2. What are antibodies?
3. _______________ is when antibodies bind to non-self erythrocytes and
result in clumping.
4. Clumps of erythrocytes are degraded through a process known as
_________________
5. Why is degradation of
a large quantity of red
blood cells all at once
dangerous?
III. The ABO Blood Group
1. A person with blood
type A would express
what antibodies in
their blood plasma?
2. A person with blood
type O would express
what antigens on their
red blood cells?
IV. Rh Blood Groups
1. If someone has
antigen D present on
their red blood cells
are they considered
Rh positive or Rh
negative?

138
 2. When are Rh antibodies formed, and how is this timing different from
standard ABO antibodies?
3. Hemolytic Disease of the newborn (HDN) can occur during the second
pregnancy of a Rh+ or Rh- mother?
V. Determining ABO Blood Types
A. How would you determine someone’s blood type?
B. What blood type is the sample below?

VI. ABO Transfusion Protocols

1. What blood type is a universal donor? Why?
2. What blood type is a universal recipient? Why?

139
140
Chapter 19

19.1. Heart Anatomy

I. Background
1. Why is the heart an essential organ?
II. Location of the Heart
1. Where specifically is the heart located within the mediastinum?
2. Where is the base of the heart?
3. Laterally the heart is bordered by the lungs. How does the left lung
accommodate the apex of the heart?

141
III. Shape and size of the Heart
1. What is hypertrophy?
2. What effect does aerobic exercise have on the heart?
3. Pathophysiological enlargement of the heart is known as _____________
________________.
IV. Chambers and Circulation through the Heart
1. The upper chambers of the heart are known as the __________.
2. The ____________ are the lower chambers of the heart, and the primary
pumping chambers.
3. The pulmonary circuit transports oxygenated blood to, and deoxygenated
blood from the ____________.
4. The ___________ _____________ transports oxygenated blood to the
body and returns deoxygenated blood back to the heart.

142
5. Upon contraction the right ventricle pumps blood into the _________
_________ which bifurcates into the left and right pulmonary arteries.
6. The pulmonary arteries deliver blood to the lungs, and through gas
exchange this blood gets oxygenated at the ___________
______________.
7. After oxygenation, the blood is returned to the heart through the
_______________ _____________.
8. Blood returns to the heart, and specifically the right atrium, via the
________ __________ ___________ and __________ __________
_______________.

143
V. Membranes, Surface Features, and Layers
A. Membranes
1. The sac around the heart is known as the ______________, and it both
protects the heart and helps to maintain its position within the thorax.
2. The ___________, also known as the visceral pericardium, is the outer
layer of the heart wall.

144
 3. What is responsible for secreting the serous fluid found in the pericardial
cavity?
a) What purpose does this fluid serve?

B. Surface Features of the Heart

1. The “ear like” superficial extension of the atria are known as
________________.
2. The grooves located on the heart are known as sulci. The groove
between the atria and the ventricles is the _______________.
3. The groove on the anterior side of the heart between the left and right
ventricles is the _______________ ____________________
___________ and the posterior groove between the ventricles is the
____________________ __________________ _______________.

145
C. Layers
1. The layers of the heart from deep to superficial are the
___________________, __________________, and
______________________.
2. The thickest layer of the heart, and the layer that is responsible for
pumping is the ______________________.
3. Why is the swirling pattern of the heart muscle useful?

146
 4. Which chamber is more muscular, the left or the right ventricle? Why?

5. The endocardium, the innermost layer of the heart is coated with

squamous epithelium known as ________________. This epithelium is
continuous with the lining of the vessel that attaches to the heart.

VI. Internal Structure of the Heart

A. Septa of the Heart
1. What structure divides the left and right atria?
2. What is the fossa ovalis, and why was the foramen ovale necessary in the
fetal heart?
3. What structure divides the left and right ventricle?
a) How is this structure different than the interatrial septum?
4. The atrioventricular septum contains openings to allow blood to flow, but
only in one direction due to the presence of ___________.
5. Valves between the atria and ventricles are known as _____________
___________.

147
 6. Valves between the ventricles and the pulmonary trunk or aorta are the
__________________ _____________.
7. Due to the openings present, the atrioventricular septum is reinforced by
dense connective tissue known as the ______________
________________.
B. Right Atrium
1. In addition to the deoxygenated blood supplied by the superior and
inferior vena cavae, the right atrium also receives blood from the coronary
circulation via the _____________ _______________.
2. The inferior vena cava drains blood from what part of the body?
3. The _____________ __________ is muscle that lines the auricle and
anterior surface of the right atrium.
C. Right Ventricle
1. The right ventricle receives blood from the ___________ __________.
2. What valve separates the right atrium from the right ventricle?
3. What do the chordae tendineae, in conjunction with the papillary muscles,
prevent from happening?

4. ______________ _____________ are the ridges of cardiac muscle found

in the left and right ventricle.
5. Upon contraction the right ventricle ejects blood into what vessel?
D. Left Atrium
1. What vessels return oxygenated blood from the lungs back to the left
atrium of the heart?
2. What valve is found between the left atrium and left ventricle?
E. Left Ventricle
1. The left and right ventricle pump the same amount of blood, so why is the
left ventricle more muscular?
F. Heart Valve Structure and Function

148
1. The right atrioventricular valve is also known as the __________
________ because it has three flaps.
2. The ______________ semilunar valve is found between the right
ventricle and pulmonary trunk.
3. Where is the mitral, or bicuspid, valve is located where in the heart?

149
 4. The bicuspid and tricuspid valves are open in the illustration above. That
means blood can flow from the __________ into the _______________.

5. The semilunar valves are open in the picture above which means that
blood could flow from the _____________ to the pulmonary trunk and
aorta.
VII. Coronary Circulation
1. What are cardiomyocytes?
2. Why do cardiomyocytes require a reliable supply of oxygen and
nutrients?
3. What circulation supplies cardiomyocytes with blood?
A. Coronary Arteries
1. What is the purpose of coronary arteries?
2. Where are epicardial coronary arteries found?
3. Where is the circumflex artery located?
4. What does the name anterior interventricular artery tell you about its
location?
5. What is an anastomosis? When would an anastomosis be beneficial?
6. What part of the heart is supplied with blood by the marginal arteries?

150
 B. Coronary Veins
1. What purpose do coronary veins serve?
2. Blood from the great, middle, small, and anterior cardiac veins all return
their deoxygenated blood to what chamber of the heart?

19.2. Cardiac Muscle and Electrical Activity

I. Background
1. The ability of the heart to initiate an action potential at a fixed rate is
known as _________________.
2. The two types of cardiac muscle cells are the _________________
____________ __________ responsible for contraction, and the
________________ _________________ ________ that form the
conduction system of the heart.
II. Structure of Cardiac Muscle
1. Cardiac muscle cells are striated like skeletal muscle, but are shorter and
branched. These branched cells are joined at junctions known as

151
 _____________ __________ which help to synchronize the contraction
of the muscle cells.

VIII. Conduction System of the Heart

1. The components of the conduction system of the heart includes the
sinoatrial node, _____________ _______________, the atrioventricular
bundle, and the __________________ ___________.

152
A. Sinoatrial (SA) Node
1. Where is the sinoatrial node found within the heart?
2. The sinoatrial node is the pacemaker of the heart, and as such it initiates
the __________ ___________ or the electrical pattern that leads to
contraction of the heart.

B. Atrioventricular (AV) Node

1. What role does the atrioventricular septum play in the conduction
pathway? In order words, what does it prevent?

153
 2. Where is the AV node located in the heart?
C. Atrioventricular Bundle (Bundle of His), Bundle Branches, and Purkinje Fibers
1. The atrioventricular bundle pass through which septum of the heart?
2. What part of the heart do the different atrioventricular bundle branches
supply? Which is larger, and why?
D. Membrane Potentials and Ion Movement in Cardiac Conductive Cells
1. Skeletal muscle cells and neurons have a stable resting membrane
potential. How does this compare the membrane potential of cardiac
conductive cells?
2. What is spontaneous depolarization (prepotential depolarization). Why is
it important in cardiac conductive cells?

E. Membrane Potentials and Ion Movement in Cardiac Contractile Cells

1. What does the long refractory period in cardiac muscle cells allow time
for?
2. What ion movement allows for the plateau phase seen in cardiac
contractile cells?
3. How long is a cardiac contractile cell’s action potential compared to
skeletal muscle?

154
 F. Calcium Ions
1. What are the two critical roles of calcium ions in cardiac muscle cells?
G. Comparative Rates of Conductive System Firing
1. Without external control does the SA node reach threshold at a faster or
slow rate than the other conductive cells (AV node, AV bundle, and
Purkinje Fibers)?
IX. Electrocardiogram
1. What is an electrocardiogram (ECG), and what is it used for?
2. What do the following ECG deflections represent in terms of electrical
activity in the heart?
a) P Wave
b) QRS Complex
c) T Wave
3. What are segments and intervals in the ECG?
a) What is the difference between them?

155
 4. What is a heart block? Why might these be dangerous?
5. What is an example of a condition that would require an artificial
pacemaker?
X. Cardiac Muscle Metabolism
1. Under normal conditions is metabolism in cardiac myocytes aerobic or
anaerobic?

19.3. Cardiac Cycle

I. Background
1. The cardiac cycle encompasses what period of time?
2. What is systole?
3. The period of time when the chambers fill with blood is known as
____________.

156
XI. Pressure and Flow
1. Fluid move along their pressure gradient from __________ pressure to
___________ pressure.
2. During ventricular systole blood moves from the __________ pressure in
the ventricles to the ________ pressure in the pulmonary trunk and aorta.
XII. Phases of the Cardiac Cycle
1. At the beginning of the cardiac cycle when both the atria and the
ventricles are in diastole what valves are open, and what valves are
closed?
a) What does this tell you about the pressure in the chambers?
A. Atrial Systole and Diastole
1. During atrial systole blood flow from what chamber to what chamber in
the heart?
2. What valves are open and closed during atrial systole?
B. Ventricular Systole
1. What ECG event precedes ventricular systole?
2. What is end diastolic volume (EDV) or preload?
a) What is a normal end diastolic volume for a standing adult?
3. What is isovolumic contraction?
a) What is the difference between isovolumic contraction and
ventricular ejection?
4. After ventricular ejection there is still blood left in the heart (normally 50-
60mL). This blood remains in the ventricle is the ____________
__________ __________ (____).
C. Ventricular Diastole

157
 1. What is the isovolumic ventricular relaxation phase, and why is no there
no blood volume change in the ventricles?
2. What set of valves open during late ventricular diastole? Why?

XIII. Heart Sounds

1. What causes the following heart sounds?
a) S1 (lub) -
b) S2 (dub) –

2. Upon auscultation with a stethoscope a physician hears a murmur, what

does that mean?
3. In order to hear the mitral valve clearly would it be best to place the bell of
the stethoscope near the base or the apex of the heart?

158
 19.4. Cardiac Physiology

I. Background
1. What body systems help to regulate cardiac function?
XIV. Resting Cardiac Output
1. What is cardiac output, and how is it calculated?
2. The amount of blood pumped by each ventricle per beat is the
__________ __________.
3. What is a normal heart rate for an individual at rest?

4. During each heart beat only a portion of the blood in the ventricle is
ejected. This is known as the ____________ ____________ and can be
calculated by dividing the stroke volume by the end diastolic volume.

XV. Exercise and Maximum Cardiac Output

1. What happens to heart rate and stroke volume during exercise?

159
 2. The difference between resting and maximal cardiac output (CO) is
known as ____________ ______________
XVI. Heart Rates
1. What is the trend of maximal heart rate as we age?
XVII. Correlation between Heart Rates and Cardiac Output
1. At very high heart rates why does cardiac output decrease?
2. The range in which both the heart and lungs receive the maximal benefit
from aerobic exercise is the ____________ ___________
____________.
XVIII. Cardiovascular Centers
1. What is autonomic tone?
2. The network of nerve fibers found at the
base of the heart is the ____________
____________ and it contains both
sympathetic and parasympathetic nerve
fibers.
3. The sympathetic nervous system has what
effect on heart rate?
4. Adult resting heart rate is normally <100
bpm, but without any nervous system
stimulation the SA node will fire at 100 bpm.
Is the sympathetic or parasympathetic
nervous system acting on the SA node at
rest to drive heart rate down?

160
XIX. Input to the Cardiovascular Center
1. What is a cardiac reflex?
2. In the baroreceptor reflex, if increased stretch and pressure are detected
how will the cardiac center respond?
3. According to the atrial or Bainbridge reflex if increased venous return
stretches the atria what will reflexively happen to heart rate?
4. The limbic system and therefore emotional state can also influence heart
rate. What effect would a stressful situation have on heart rate?
XX. Other Factors Influencing Heart Rate
1. Beyond autorhythmicity and innervation what are some other factors
impact heart rate?
A. Epinephrine and Norepinephrine
2. What hormones are released from the adrenal medulla?

161
 a) What effect do they have on heart rate?
B. Thyroid Hormones
1. An increase in thyroid hormones would have what effect on heart rate?
C. Calcium
1. Calcium impacts both heart rate and contractility. What change would you
expect from someone taking a calcium channel blocker?
D. Caffeine and Nicotine
1. Both caffeine and nicotine have a stimulatory effect on cardiac centers.
What effect do you expect these substances to have on heart rate?
E. Factors Decreasing Heart Rate
1. Electrolyte balance is critical to heart function. Which of the following ions
is of greater clinical significance to heart function sodium or potassium?
2. What effect does hypothermia have on heart rate?
3. How might hypothermia be used in a surgical setting?
XXI. Stroke Volume
1. How is stroke volume calculated?
A. Preload
2. Increased filling time would have what effect on stroke volume?
3. What is the Frank-Starling mechanism? How is it related to preload?
B. Contractility
1. What is contractility? Why is it important to cardiac function?
2. As contractions becomes more forceful what happens to stroke volume
and therefore end systolic volume (ESV)?
3. Is sympathetic stimulation a positive or negative inotrope?
C. Afterload
1. What is afterload?
2. As afterload increases what would you expect to happen to stroke
volume?

19.5. Development of the Heart

162
I. Background
1. When does the heart begin to beat in development?
2. The anterior surface of the embryo features a prominent protrusion where
the heart is developing. This is known as the __________
_____________.
3. The heart forms from what germ layer?
4. As the cardiogenic cords develop a lumen forms within them and they are
known as _______________ __________. These then fuse to become
the primitive heart tube.

5. The ____________ _________ portion of the heart tube develops into the
aorta and pulmonary trunk.
6. The primitive ventricle develops to become the ________ ventricle.
7. The primitive atrium becomes what part of the right and left atria?
8. The SA node, a critical part of the conductions system, develops from the
____________ _____________.
9. Which valves develop first, the atrioventricular valves or the semilunar
valves?

163
Chapter 20

20.1. Structure and Function of Blood Vessels

I. Background
1. Arteries carry blood ___________ __________ the heart
2. Capillaries are where nutrients and wastes are _______________.
3. Veins ____________ blood to the heart.
4. Blood is transported in two circuits, the __________ circuit and the
_______________ circuit.

II. Shared Structures

2. Due to the higher pressure in arteries do they have thicker or thinner
walls than veins?
3. The hollow passageway that blood flows through in arteries, capillaries,
and veins is the __________.

164
 4. Valves contain _____________ that provide unidirectional flow of blood
back to the heart.
5. Large arteries and veins need a blood supply separate from what passes
through their lumen, and this blood supply the “vessels of the vessel” is
the ___________ ______________.
6. What are the three layers, or tunics, of arteries and veins from the lumen
out?
a) Tunica _____________
b) Tunica _____________
c) Tunica _____________
A. Tunica Intima
1. What composes the tunica intima?
2. What type of arteries have a thick internal elastic membrane?
a) What purpose do the elastic fibers serve?
B. Tunica Media
1. What kind of muscle is found in the tunica media?

165
 2. Vasoconstriction has what effect on blood flow?
3. The ____________ _____________, or “nerves of the vessel” help to
regulate vasoconstriction and vasodilation in the vessels.
4. The external elastic membrane separates the tunica media from what?
C. Tunica Externa
1. Why is it important for the tunica externa to hold the vessel in place?
III. Arteries
1. Compared to veins, are arteries exposed to higher or lower pressures?
2. The aorta, the largest artery in the body is an _____________
_____________.

3. Beyond elastic arteries are ____________ _____________ which have a

thick tunica media. These are also known as distributing arteries.
IV. Arterioles
1. Arterioles lead to _________________.
2. Arterioles are both the primary site for ______________ and regulation of
_____________ ________________.
V. Capillaries
1. What is perfusion?
2. What do capillaries exchange with the tissue?
3. _______________ is used to describe flow through the capillaries.
A. Continuous Capillaries
1. How common are continuous capillaries in the body?
2. What type of junctions are found between the endothelial cells of
continuous capillaries?
a) Do the junctions here mean these capillaries do not participate in
exchange?

B. Fenestrated Capillaries
1. What is a fenestration?
a) Why are these beneficial to have in capillaries in the small
intestine?

166
 C. Sinusoid Capillaries
1. Why are sinusoid capillaries necessary in bone marrow?
VI. Metarterioles and Capillary Beds
1. A metarteriole arises from a _____________ _____________ and
supplies a ___________________.
2. What purpose do the precapillary sphincters serve in the metarteriole?
3. When precapillary sphincters are closed blood will pass through a
______________ _____________ to bypass the capillary bed. This is
known as a vascular shunt.
4. The irregular pulsating flow of blood through a capillary bed is
_____________.

VII. Venules
1. After a capillary, small veins known as
____________ carry blood towards
larger veins.
VIII. Veins
1. Veins conduct blood ___________
__________ the heart.
2. The pressure of blood in veins is
__________ compared to arteries.

IX. Veins as Blood Reservoirs

1. Veins hold a significant portion of the
body’s blood volume at any given time.
This makes veins high
______________ vessels due to their
ability to distend.
2. Venous reserve is blood located within
the venous networks and within what
organs?
a) How can this reserve volume
be utilized by the body?

167
20.2. Blood Flow, Blood Pressure, and Resistance

I. Background
1. What is blood flow, and what are the units?
2. Blood flows from ________ pressure to ________ pressure.
3. _____________ is the factor that impedes blood flow.
4. The term blood pressure without a specific designator indicates pressure
measured in the ______________.
II. Components or Arterial Blood Pressure
A. Systolic and Diastolic Pressures
1. What is systolic pressure? What is a normal value for systolic pressure?
2. What is diastolic pressure? What is occurring in the heart during diastole?

B. Pulse Pressure
1. The difference between systolic pressure and
diastolic pressure is ____________
____________.
2. Why would a high (100 mm Hg) pulse
pressure not be conducive to good health?
C. Mean Arterial Pressure
1. What is Mean arterial pressure (MAP)?
2. How is MAP calculated?
3. What happens when MAP is too low? How
could this damage tissue?
III. Pulse
1. What is pulse, and what is responsible for
causing a pulse?
2. Measurement of pulse is measurement of
heart _______.

168
IV. Measurement of Blood Pressure
1. What causes Korotkoff sounds?
2. How can we use Korotkoff sounds and a sphygmomanometer to measure
blood pressure?
3. What is the first Korotkoff sound heard during a blood pressure
measurement?
4. What is the point at which the last sound is heart? What does that
indicate?

V. Variables Affecting Blood Flow and Blood Pressure

1. What are the five variables that affect blood flow and blood pressure?
A. Cardiac Output
1. An increase in cardiac output will have what impact on blood pressure
and blood flow?
B. Compliance
1. What is compliance?
2. Are veins or arteries more compliant?
C. A Mathematical Approach to Factors Affecting Blood Flow
1. Which factor in Poiseuille’s equation will have the greatest effect on blood
pressure and blood flow with the smallest change? Why?
D. Blood Volume
1. An increase in blood volume will have what effect on blood pressure and
blood flow?
2. What is hypovolemia? Why might it occur?
3. What could cause hypervolemia?
E. Blood Viscosity
1. What is viscosity and why is it important to blood pressure and blood
flow?
F. Vessel Length and Diameter
1. Would an increase in vessel length increase or decrease resistance?
2. How does weight gain change vessel length in the body?

169
 3. How can blood vessels change in diameter?
4. What would happen to blood flow if vascular tone is reduced and the
vessel diameter increases?
G. The Roles of Vessel Diameter and Total Area in Blood Flow and Blood Pressure
1. Where in the body is the velocity of blood flow the fastest, and where is it
the slowest?
a) How does this relate to cross-sectional area?

VI. Venous System

1. What factors help to maintain the pressure gradient between the veins
and the heart?
A. Skeletal Muscle Pump
1. When contracting skeletal muscles how does the skeletal muscle pump
help to return blood to the heart?

B. Respiratory Pump
1. What pressure changes occur during inhalation to help move blood into
the thorax?

170
 C. Pressure Relationship in the Venous System
1. Why does the cross-sectional area decrease as blood moves from
venules to veins?
a) What does this mean in terms of blood velocity through the veins
as compared to the venules?
D. The Role of Venoconstriction in Resistance, Blood Pressure, and Flow
1. How is the outcome of venoconstriction different than the outcome of
vasoconstriction?

20.3. Capillary Exchange

I. Background
1. What is the primary purpose of the cardiovascular system?
a) What is the role of the capillaries in this purpose?
II. Bulk Flow
1. What are the two pressure driven mechanisms involved in bulk flow?
2. _____________ is movement of fluid from the capillaries to the tissue
bed, and _____________ is movement from the tissue bed to the
capillaries.
A. Hydrostatic Pressure
1. The force exerted by the blood confined within blood vessels or heart
chambers is ____________ ____________________ ______________.
2. Pressure exerted against the walls of capillaries is _______________
________________ __________________.
3. Interstitial fluid hydrostatic pressure (IFHP) is the pressure in the tissue
and it opposes capillary hydrostatic pressure. In order for fluid to filter out
of the capillaries which pressure is normally higher CHP, or IFHP?
B. Osmotic Pressure
1. Osmotic pressure is the pressure that drives ________________.
2. The proteins in the blood are exert pressure known as ___________
_______________ _______________ ____________ (BCOP).
3. BCOP draws water into the capillary because it is higher than
_______________ ______________ ____________ ________________
___________ (ICOP).
C. Interaction of Hydrostatic and Osmotic Pressures
1. What happens to capillary hydrostatic pressure (CHP) at the beginning of
the capillary compared to the end of the capillary?
2. What is net filtration pressure (NFP)?
3. Compare the CHP at the beginning and end of the capillary to the NFP.

171
III. The Role of Lymphatic Capillaries
1. Why is the amount of fluid filtered at the capillaries not equal to the
amount reabsorbed? Where does the difference in fluid go?
2. Does the fluid filtered into the lymph return to the blood? If so, where?

20.4. Homeostatic Regulation of the Vascular System

I. Background
1. Is there enough blood flow to distribute blood equally to all tissues?
2. What happens to blood flow during exercise?
II. Neural Regulation
1. What is the primary site in the brain that regulate vascular homeostasis?
A. The Cardiovascular Centers in the Brain
1. What are the three distinct parts of the cardiovascular control center?
a) The _______________ _____________ that regulate heart rate
and stroke volume
b) The _______________ _____________ that decrease heart rate
and stroke volume
c) The _______________ _____________ that control diameter of
the vessels.
B. Baroreceptor Reflexes
1. What is a baroreceptor?
a) How does it measure pressure?
2. In response to low blood pressure what happens to the firing of the
baroreceptors?
a) What is the body’s response to increase pressure back to normal?

172
 3. What is the atrial reflex and how does it help to maintain appropriate
cardiac output?
C. Chemoreceptor Reflexes
1. What do chemoreceptors measure?
2. Where are the chemoreceptors located in the body?
3. When carbon dioxide and hydrogen ion levels increase in the blood how
does the body respond?
III. Endocrine
1. What hormones help to regulate the vascular system?
A. Epinephrine and Norepinephrine
1. What releases epinephrine and norepinephrine?
2. Are these hormones part of the sympathetic or parasympathetic
response?
3. What effect do these hormones have on heart rate and force of
contraction?
B. Antidiuretic Hormone
1. What triggers the release of Antidiuretic Hormone/Vasopressin?
2. How does this hormone modify blood volume and blood pressure?
C. Renin-Angiotensin-Aldosterone Mechanism
1. Angiotensin II is a potent ____________________.
2. How does aldosterone raise blood pressure?

173
 D. Erythropoietin
1. EPO stimulates the production of what in bone marrow?
2. As the number of red blood cells increases what happens to blood
viscosity?
E. Atrial Natriuretic Hormone
1. How does Atrial Natriuretic Hormone decrease blood pressure?
IV. Autoregulation of Perfusion
1. What is autoregulation?
2. Why do tissues need to regulate their own blood flow?
A. Chemical Signals Involved in Autoregulation
1. Decreased oxygen concentration, or increased carbon dioxide
concentration leads to precapillary sphincter _______________.
2. Release of endothelin would result in what action at the precapillary
sphincter? How would this impact blood flow to the local capillary bed?
B. The Myogenic Response
1. The ______________ ________________ stabilizes blood flow and
protects against dramatic fluctuations in blood pressure and blood flow.
V. Effect of Exercise on Vascular Homeostasis
1. What happens to cardiac output during exercise? Why?
2. What happens to blood pressure during exercise? Why?
3. Which areas of the body experience vasoconstriction and vasodilation
during intense exercise?
4. What are some of the long-term benefits of aerobic exercise?
VI. Clinical Considerations in Vascular Homeostasis
A. Hypertension and Hypotension
1. What is hypertension?
a) What is a normal blood pressure and how does that compare to a
hypertensive blood pressure?
B. Hemorrhage
1. How is hemorrhage different from minor blood loss?
2. How does the body try to compensate during hemorrhage?

174
 C. Circulatory Shock
1. What leads to circulatory shock?
2. What is hypovolemic shock?
a) What can cause this type of shock?
3. What is cardiogenic shock and how is it different than hypovolemic
shock?
4. What are three types of vascular shock?
a) What do they all have in common?

20.5. Circulatory Pathways

I. Background
1. Connect one other system covered to the circulatory system? How do
they interact?

175
 2. What is a trunk in the vascular system?
II. Pulmonary Circulation
1. What is the purpose of the pulmonary circuit?
2. The ____________ ________ is the vessel that exits the right ventricle.
3. The pulmonary arteries branch from the pulmonary trunk and after many
divisions delivers _____________ blood to the capillaries of the lungs for
oxygenation.
4. What vessels return oxygenated blood back to the left atrium?

176
III. Overview of Systemic Arteries
1. Blood pumped from the left ventricle passes through the ___________
which delivers blood to the rest of the body through the systemic arteries.

177
IV. The Aorta
1. The ascending aorta leads to the ____________ __________ which then
continues on to the descending aorta.
2. Superior to the diaphragm the aorta is known as the ____________
___________, and inferior to the diaphragm the aorta is the
_______________ _____________.
A. Coronary Circulation
1. What are the first vessels that branch from the ascending aorta?
B. Aortic Arch Branches
1. What are the three major branches of the aortic arch?
2. Which of the three major branches is only found on the right side of the
body and has no left counterpart?
3. What do the subclavian arteries provide blood to?
4. The common carotid arteries supply what part of the body with blood?
a) More specifically what do the external and internal carotid arteries
provide?
5. What is a transient ischemic attack (TIA)?
a) Compare a TIA to a cerebrovascular accident (CVA)
6. How does the arterial circle (circle of Willis) help to prevent a disruption in
blood flow to the brain?
7. The internal carotid artery has an anterior cerebral artery, middle cerebral
artery, and ophthalmic artery branch. What do these supply with blood?

178
C. Thoracic Aorta and Major Branches
1. What are the visceral branches of the thoracic aorta?
2. The ______________ ____________ supply blood to the lungs and
visceral pleura.
3. What does the pericardial artery supply?
4. The superior phrenic artery supplies what muscle with blood?

179
D. Abdominal Aorta and Major Branches
1. What are the branches of the celiac trunk?
2. What do the superior and inferior mesenteric arteries supply?
3. The adrenal arteries supply blood to the _____________
_____________.
4. The kidneys are supplied with blood from the _______________ artery
5. The gonads are supplied with blood from the _______________ artery
6. What supplies blood to the abdominal wall?
7. Inferiorly what does the abdominal aorta divide to become?
a) What small vessel continues inferiorly after the division?
8. Does the external or internal iliac artery supply the lower limbs with
blood?

180
181
II. Arteries Serving the Upper Limbs
1. The subclavian artery supplies what artery in
the armpit?
2. The brachial artery supplies what part of the
body?
3. The arteries of the forearm share their names
with what other bodily structures?
4. Palmar arches supply the ____________
_____________ of the fingers with blood.

III. Arteries Serving the Lower Limbs

1. What are the branches of the femoral artery?
2. What is the name of the artery posterior to the
knee?
3. What does the anterior tibial artery supply?
4. Based upon the name where is the posterior
tibial artery located?
5. What two arches supply blood to the foot and toes?

IV. Overview of Systemic Veins

1. Systemic veins return blood to the _________ ________.
a) Do they return oxygenated or deoxygenated blood?
2. Are deep or superficial veins normally named similar to their arterial
counterparts?

A. The Superior Vena Cava

1. What part of the body does the superior vena cava receive blood from?
2. There is one brachiocephalic artery, but _______ brachiocephalic veins.
a) What part of the body do the brachiocephalic veins receive blood
from?
3. The subclavian vein, external and internal jugular veins fuse to form the
___________________ ______________.
4. What veins drain into the azygos vein?
a) What vessel does the azygos vein drain into?

B. Veins of the Head and Neck

1. Blood from the brain is drained primarily via what vein?
2. What does the external jugular vein receive blood from?
C. Venous Drainage of the Brain
1. What is the largest sinus in the brain?
2. What sinus drains the eye socket?

D. Veins Draining the Upper Limbs

182
 1. Digital veins drain into the palmar venous arches which in turn drain into
the ____________ and ___________ veins.
2. What are three superficial veins of the arm?
3. What branch of the basilic vein joins the cephalic vein? What is this
branch commonly used for?

E. The Inferior Vena Cava

1. The inferior vena cava drains blood from what part of the body?
2. What drains blood from the kidneys to the inferior vena cava?
3. Which of the gonadal veins drains into the inferior vena cava?
4. The ______________ __________ drains blood from the liver to the
inferior vena cava.

F. Veins Draining the Lower Limbs

1. The inferior surface of the foot is drained by what veins?
2. The anterior tibial vein, posterior tibial vein, and fibular vein combine to
form what vein behind the knee?
3. Which saphenous vein is located on the medial side of the leg?
4. The femoral vein drains into which branch of the common iliac vein?
5. The common iliac veins become what vein at L5?

V. Hepatic Portal System

1. The _____________ _______________ ______________ allows the
liver to process absorbed digestive materials and certain wastes.
2. What veins drain into the hepatic portal vein?
3. Is the hepatic portal vein the only blood vessel that supplies the liver?

183
20.6. Development of Blood Vessels and Fetal Circulation

I. Background
1. The hemangioblasts precursor cells become ______________ which give
rise to blood vessels and pluripotent stem cells.
2. What is angiogenesis? Do all blood vessels form from one single vascular
tube?
3. What kind of blood (oxygenated/deoxygenated) do the umbilical vein and
arteries carry?
4. What are the three shunts present in the fetal circulatory system that
divert blood away from the pulmonary circuit and towards the systemic
circuit?
5. The foramen ovale connects what two chambers of the heart?
6. What remains after the ductus arteriosus closes?
7. Where is the ductus venosus located?

184
185
Chapter 21

21.1. Anatomy of the Lymphatic and Immune Systems

I. Background
1. What are the general components of the immune system?
2. What is the purpose of the lymphatic system?
II. Functions of the Lymphatic System
1. What is lymph?
2. What is transported within lymph?
3. What purpose do lymph nodes serve?
III. Structure of the Lymphatic System
1. Lymphatic vessels are blind ended. What does this mean, and how is it
different from blood capillaries?

2. The heart pumps blood throughout the body, does it also pump lymph?
3. Where does lymph flow to?
A. Lymphatic Capillaries
1. Where does the lymph come from that enters lymphatic capillaries?

2. What purpose do the flaps of overlapping cells serve in lymphatic

capillaries?
3. Aside from transporting lymph, what do lymphatic capillaries in the
intestines (lacteals) transport as well?
a) What is chyle?
B. Larger Lymphatic Vessels, Trunks, and Ducts
1. What purpose do valves serve in lymphatic vessels?
2. How are lymphatic trunks formed?
3. What parts of the body drain into the right lymphatic duct and the thoracic
duct?

4. What blood vessel receives the lymph from the lymphatic ducts?
5. What is the cisterna chyli?
IV. The Organization of Immune Function
1. What is an example of a barrier defense?
2. After the barrier defenses and the innate immune response what is the
last temporal phase of immune function?
3. What is the difference between a phagocytic cell and a lymphocyte?

186
 V. Lymphocytes: B Cells, T Cells, Plasma Cells, and Natural Killer Cells
1. Both B and T cells both develop in the bone marrow, but where they
mature is different. Where do B and T cells mature?
A. B Cells
1. B Cells produce _________________.
2. What is an antigen?
B. T Cells
1. Do T cells secrete antibodies like B Cells?
2. What do T cells secrete?
C. Plasma Cells
1. A plasma cell is a differentiated _____ cell.
D. Natural Killer Cells
1. Natural Killer (NK) cells participate in what part of the immune response?
VI. Primary Lymphoid Organs and Lymphocyte Development
1. The primary lymphoid organs are the ___________ ____________ and
the thymus gland.
2. The lymphoid organs are where lymphocytes _______________,
___________________, and are selected.
A. Bone Marrow
1. Is red or yellow bone marrow responsible
for hemopoiesis?
2. Do B or T cells complete the majority of
their development in bone marrow?
3. Thymocytes leave the bone marrow and
mature in the _________________.
B. Thymus
1. Where is the thymus found in the body?
2. Which part of the thymus is where
thymocytes migrate before leaving, the
cortex or the medulla?

VII. Secondary Lymphoid Organs and their Roles

in Active Immune Response
1. After development and maturation in the primary lymphoid organs, what is
the purpose of secondary lymphoid organs?
2. What is a naïve lymphocyte?
3. What are some features secondary lymphoid organs have in common?
4. What is a germinal center?
a) What type of immune cell is found within?
A. Lymph Nodes
1. What is the function of lymph nodes?
2. What role doe dendritic and macrophages play?
3. What role do T and B cells play?

4. What are the pathways into and out of the lymph nodes?
B. Spleen
1. Why is the spleen known as the “filter of the blood?”
2. What is primarily found in the red pulp of the spleen?

187
 3. Where in the spleen are adaptive immune responses mounted?
C. Lymphoid Nodules
1. Where are lymphoid nodules found?
2. Why are tonsils important?
3. Swelling of a tonsil indicates what?
4. Why might palatine tonsils be removed?
D. Mucosa-associated lymphoid tissue (MALT)
1. What is MALT, and where is it found?
2. What is BALT?
a) What type of pathogens does it help protect against?

21.2. Barrier Defense and the Innate Immune Response

I. Background
1. What are the two
overlapping mechanisms
that the body uses to
destroy a pathogen?
2. Which of the two
generates a specific
response to a pathogen?
3. How do barrier defenses
handle infections?
4. What is an example of a
barrier defense, and how
does it protect the body?
II. Cells of the Innate Immune
Response
1. What is phagocytosis,
and how is it used as part
of the immune response?
A. Phagocytes: Macrophages and Neutrophils
1. What are the three major phagocytic cells of the immune system?
2. Macrophages have different names depending on their location. What are
they known as in the liver?
3. How are neutrophils different from macrophages?
a) Which is an agranulocyte?
4. What types of cells does a monocyte differentiate in to?
B. Natural Killer Cells
1. Natural killer (NK) cells can induce apoptosis. What is apoptosis, and why
is it useful in the immune process?
2. How does the fas ligand help the NK cells to trigger apoptosis in infected
cells?
3. How does perforin help to destroy and infected cell?
III. Recognition of Pathogens
1. What is the purpose of a pattern recognition receptor (PRR)?
a) How does it allow for phagocytic cells to identify pathogens?

188
IV. Soluble Mediators of the Innate Immune Response
A. Cytokines and Chemokines
1. What is a cytokine?
2. How is a chemokine different from a cytokine?
B. Early Induced Proteins
1. What are early induced proteins? When are they present within the body?
2. When do cells secrete interferons?
3. The liver makes C-reactive protein. How does this protein help with a
bacterial infection?
4. What is opsonization, and how does it help the body to deal with an
infection?
C. Complement System
1. Why is complement not
considered a part of the
early immune response?
2. What are the two
pathways to activate the
complement cascade?
3. What is the membrane
attack complex, and what
happens at the end of the
complement cascade?
V. Inflammatory Response
1. What is the hallmark of
the innate immune
response?
2. Why is the inflammatory
response important?
3. Acute inflammation can
lead to ________
__________________
that persists.
4. What are the four
important parts of the
inflammatory response?

21.3. The Adaptive Immune Response: T Lymphocytes and Their

Functional Types

I. Background
1. Why is the adaptive immune response necessary? Do the innate and
early induced responses normally completely eliminate pathogens?

189
II. The Benefits of the Adaptive Immune Response
1. How is the adaptive immune response different from the innate immune
response?
a) The adaptive immune response is to specific ______________,
and is versatile enough to respond to nearly any pathogen.
A. Primary Disease and Immunological Memory
1. What is different between a primary and secondary adaptive response?
a) What role does immunological memory play?
B. Self Recognition
1. Why is self recognition important?
2. What happens in autoimmune disease?
III. T Cell-Mediated Immune
Responses
1. Why are T cells a critical
part of the adaptive
immune response?
2. What is an alpha-beta T
cell receptor, and what is
it used for?
3. What is the difference
between the variable and
constant region
domains?
IV. Antigens
1. How many antigenic
determinants (epitopes)
might a pathogen
contain?
2. Why are protein antigens
more complex than
carbohydrate antigens?

A. Antigen Processing and Presentation

1. What is an antigen presenting cell, and why is it important for T cells to
recognize antigens?
2. What is MHC, and how does it help in antigen presentation?

3. MHC class II molecules process what type of antigen?

B. Professional Antigen-presenting Cells
1. “Professional” antigen presenting cells are the only cells that express
MHC class ___ molecules.
2. What tare the three types of professional antigen presenting cells?
V. T Cell Development and Differentiation
1. T cell tolerance eliminates T cells that might do what?

190
 2. What is positive selection?
a) Why is it a crucial step in T cell maturation?

3. What is negative selection?

a) Why is it important that the cells do not bind to self-antigens?
VI. Mechanisms of T Cell-mediated Immune Responses
1. When is a mature T cell activated?
2. What is clonal expansion, and why is it necessary for a robust immune
response?

VII. Clonal Selection and Expansion

1. In clonal selection what T cells proliferate?
2. If multiple antigens on the pathogen generate a response it is a
________________ ______________. Multiple T cell clones will respond.
VIII. The Cellular Basis of Immunological Memory
1. Why are both memory T cells and effector T cells needed for a primary
adaptive immune response?
IX. T Cell Types and their Functions
1. Mature T cells express one of two markers. What are those markers?

2. CD4 T Cells are associated with ___________ functions and CD8 T cells
are associated with _____________.
A. Helper T Cells and Their Cytokines
1. How do helper T cells (Th) function?
2. What is the difference in cytokine secretion between Th1 and Th2 cells?
B. Cytotoxic T Cells
1. Why is it important for a cytotoxic T cell (Tc) to induce apoptosis in a
virally infected cell prior to virus replication?
C. Regulatory T Cells
1. Why do regulatory T cells (Treg) modulate the immune response? What
happens with an unrestrained T cell response?

21.4. The Adaptive Immune Response: B-Lymphocytes and

Antibodies

I. Background
1. What is immunoglobin?
2. What secretes antibody?
a) What are the five classes of antibodies found in humans?
II. B Cell Differentiation and Activation
1. What is central tolerance, and why is it necessary in B cell development?
2. What happens to B cells that bind to self-antigens in clonal deletion?

191
 3. What happens to B cells during peripheral tolerance that bind to self-
antigen, but do not receive a signal from a Th2 cell?
III. Antibody Structure
1. What are the two polypeptide chains that compose an antibody?
A. Four-chain Models of Antibody Structures
1. Why is the Fc region of the antibody important?
2. Where on an antibody does an antigen bind?

B. Five Classes of Antibodies and their Functions

1. What are the two basic function of antibodies?
2. What two types of antibodies can act as the antigen receptor for naïve B
cells?

3. IgM is the largest of the antibody molecules. What is the structure of this
antibody?

192
 4. What is class switching? When does it occur during the response to an
infection?
5. IgG can cross the placenta. How is this potentially beneficial?
6. IgA is unique in that it is the only antibody that leaves the body. Why is
this useful?
7. IgE is associated with ____________, and the severe reaction of
anaphylaxis.
C. Clonal Selection of B Cells
1. What B Cells are selected and expanded during clonal selection?

D. Primary versus Secondary B Cell Responses

1. What is different between a primary and secondary B cell response?
a) How does this impact the ability to deal with the second exposure
to a pathogen?

193
IV. Active versus Passive Immunity
1. What are two ways a person can acquire active immunity?
2. What is passive immunity, and how can a person receive passive
immunity?
V. T cell-dependent versus T cell-independent Antigens
1. T cell-independent antigens are usually ______________ moieties.
2. What are the two signals necessary for T cell-dependent antigens to elicit
a response?

21.5. The Immune Response Against Pathogens

I. Background
1. During the first 4-5 days of infection what part of the immune
system partially controls pathogen growth?
2. What is seroconversion?
3. What happens in HIV disease that results in fluctuations in the amount of
anti-HIV antibodies?

194
II. The mucosal Immune Response
1. _____________________ is a process that coats a pathogen with
antibodies and prevents the pathogen from binding to receptors.
2. What role does neutralization play in the influenza vaccine?
3. How do the microfold, or M cells, of the intestines help the body to mount
an immune response if necessary?

III. Defenses against Bacteria and Fungi

1. Mycobacterium leprae can survive inside of macrophages. The
___________________ __________________ ___________________
pathways helps macrophages to clear the bacteria through the use of
nitric oxide.
2. What are opportunistic infections?
IV. Defenses against Parasites
1. IgE and eosinophils are both used to deal with what type of infection?
2. How does IgE labeling of a parasite helps to clear the infection?
V. Defenses against Viruses
1. What are the three primary mechanisms the body uses against viruses?
2. Why are antibodies ineffective against viruses inside of cells?
3. Do interferons usually clear viral infections?
4. How do cytotoxic T cells clear viral infections?
VI. Evasion of the Immune System by Pathogens
1. Why is tuberculosis a chronic infection and not cleared by the immune
system?
2. Why is a Staphylococcus aureus infection easier to treat than a methicillin
resistant Staphylococcus aureus strain?
3. How does mutation and genetic recombination potentially lead to better
evasion of the immune system in some pathogens?

21.6. Diseases Associated with Depressed or Overactive Immune

Responses

I. Background
II. Immunodeficiencies
1. What is the difference between inherited and acquired
immunodeficiencies?
A. Inherited Immunodeficiencies
1. Why is SCID a sever inherited immunodeficiency? What portion of the
immune system is compromised?
a) Why is a bone marrow transplant a treatment method for SCID?
B. Human Immunodeficiency Virus/AIDS

195
 1. Why is HIV unique among viruses that depress the immune system?
2. How does HIV screening work?
3. Why are the CD4+ receptor positive cells depleted in HIV?
III. Hypersensitivities
1. What is a “hypersensitivity?”

A. Immediate (Type I) Hypersensitivity

1. Antigens that cause allergic responses are called _______________.
a) The immediate hypersensitivity is due to which immunoglobulin?
2. How quickly does a type I hypersensitivity onset?
3. What are some potential triggers to a type I hypersensitivity reaction?
B. Type II and Type III Hypersensitivities
1. Type ______ hypersensitivity occurs due to IgG mediated lysis of a cell
by complement, and can occur due to a mismatched blood transfusion.
2. Type ______ hypersensitivity occurs when a disease process results in
an accumulation of DNA and other cellular materials along with antibodies
accumulate and precipitate causing inflammation.
C. Delayed (Type IV) Hypersensitivity
1. In delayed hypersensitivity the first exposure results in
________________________, and re-exposure results in a response of
higher magnitude.
2. How is a delayed hypersensitivity used to test for tuberculosis?
IV. Autoimmune Responses
1. When tolerance breaks down an ____________________ response can
occur.

2. How could an environmental trigger leader to an autoimmune disease?

3. Are there genetic factors in autoimmune disease? What genes play a
role?

21.7. Transplantation and Cancer Immunology

I. Background
1. What is tissue typing? What does it have to do with MHC
molecules?
II. The Rh Factor
1. Would a person who is B- or B+ express the Rh antigen?
2. Why would a mother who is Rh- mount an immune response against a
Rh- fetus’ red blood cells in erythroblastosis fetalis?

III. Tissue Transplantation

1. What are the two characteristics of MHC molecules that are important to
consider in organ transplantation?

196
 2. What happens if a donor and recipient do not match?
3. Why is graft-versus-host disease unique to bone marrow transplants and
not to other organ transplants?
IV. Immune Responses Against Cancer
1. What are some cancers that can be caused by a virus?
2. What are the three stages of the immune response to cancer?
3. What happens in escape that allows the cancer to continue growing?

197
Chapter 22

22.1. Organs and Structures of the Respiratory System

I. Background
1. What are the primary functions of the respiratory system?

2. What the two functional sections of the respiratory system, and what is
the difference between them?
II. Conducting Zone
1. The conducting zone provides a route for air to pass through, removes
debris, and what else?
A. The Nose and its Adjacent Structures
1. What feature of the external nose connects the root to the rest of the
nose?

2. What bones form the bridge of the nose?

3. The nose is divided into the left and right sections by the _____________
____________.
4. What purposes do the conchae and nasal meatuses serve?
5. Paranasal sinuses _____________ and ______________ incoming air.
6. What purposes do the conchae and nasal meatuses serve?
7. _______________ __________________ lines the conchae, meatuses,
and paranasal sinuses and is composed of pseudostratified ciliated
columnar epithelium.
B. Pharynx
1. What are the three major regions of the pharynx?

2. What purpose does the nasopharynx serve? What passes through it?
3. The _______________________ is a passageway for both air and food.
4. What is the oropharynx connected to anteriorly?
5. The laryngopharynx is connected to the ______________ anteriorly and
the _______________ posteriorly.
C. Larynx
1. The larynx connects the pharynx to the ________________.
2. What is the largest piece of cartilage in the thyroid?

3. Where does the epiglottis rest when in the “closed” position?

4. What purpose doe the true vocal cords serve?
5. When swallowing how does the epiglottis prevent food from entering the
trachea?

198
 D. Trachea
1. The trachea connects the larynx to the ______________.
2. What happens with the fibroelastic membrane of the trachea when
inhaling and exhaling?
3. What purpose do the C-shaped rings of cartilage in the trachea serve?

E. Bronchial Tree
1. The trachea branches into the left and right primary bronchi at the carina.
What functional purpose does the carina serve?
2. What is the
bronchial tree?
3. Why are the
walls of the
bronchioles
muscular?
III. Respiratory Zone
1. What is different
functionally
between the
conducting and
the respiratory
zone?
2. Where does the
respiratory zone
begin?
A. Alveoli
1. An

________________ __________ leads to a cluster of alveoli, an alveolar

sac.
2. What cell type makes up the majority of the surface area of an alveolus?

3. Type ______ alveolar cells are responsible for producing surfactant.

4. What immune cell is present within the lungs?
5. What makes up the respiratory membrane? What purpose does it serve?

22.2. The Lungs

I. Background
1. What is the main function of the lungs?
2. What is the epithelial surface of the lungs permeable to?
II. Gross Anatomy of the Lungs
1. What borders the lungs inferiorly?

199
 2. What encloses the lungs?
3. Where is the cardiac notch in the lungs and why is it necessary?

4. Lungs are divided into lobes. _____________ separate the lobes.

5. The left lung has _______ lobes, and the right lung has _____ lobes.
III. Blood Supply and Nervous Innervation of the Lungs
A. Blood Supply
1. Why is blood supply necessary for the lungs?
2. The pulmonary artery carries ____________________ blood to the
alveoli of the lungs.
3. The pulmonary veins exit the lungs through the ______________ and
drain oxygenated blood to the left side of the heart.
B. Nervous Innervation
1. Bronchoconstriction is controlled by the ____________________ system,
and bronchodilation is controlled by the _________________ system.
2. What is the purpose of the pulmonary plexus?
IV. Pleura of the Lungs
1. The ______________ pleura is a serous membrane that surrounds the
lung.
2. What are the two layers of the pleura? What is the space between them?

3. The pleura produce pleural fluid to lubricate and reduce

_________________, as well as help the lungs to enlarge due to surface
tension.

22.3. The Process of Breathing

I. Background
1. Breathing, or _______________ ________________, is movement of air
into and out of the lungs.
2. What are the three major pressures that drive pulmonary ventilation?
II. Mechanisms of Breathing
1. What pressures depend on physical features of the lungs?
A. Pressure Relationships
1. Inspiration and expiration depend on the difference between pressures
where?
2. What does Boyle’s law tell us about the relationship between pressure
and volume of a gas?

3. What is a normal atmospheric pressure?

4. Intra-alveolar pressure always equalizes with ___________________
________________.

5. __________________ pressure remains about -4mm Hg lower than intra-

alveolar pressure.
6. The difference between intrapleural and intra-alveolar pressure is
__________________ pressure.

200
 B. Physical Factors Affecting Ventilation
1. Contraction and relaxation of what muscle fibers controls breathing?
2. What is the relationship between flow and resistance?
a) What happens if the tube the air passes through narrows?
3. What is thoracic wall compliance?
III. Pulmonary Ventilation
1. Air flows _________________ a pressure gradient, from high pressure to
low pressure.
2. A respiratory cycle is on sequence of __________________ and
_______________________.
3. What happens to the volume and pressure of the thoracic cavity when the
diaphragm contracts?

4. During quiet breathing is expiration active or passive? Why?

5. During forced breathing is expiration active or passive? Why?
IV. Respiratory Volumes and Capacities
1. What are the four major types of respiratory volumes?
2. What is the respiratory volume that corresponds to movement of air
during quiet breathing?
3. ________________ _____________ (RV) is air that remains in the lungs
to prevent the alveoli from collapsing.

4. What are respiratory capacities?

5. What capacity is the amount of air a person can move in and out of their
lungs?
6. ______________________ ___________________ _______________
(FRC) is the amount of air that remains in the lung after a normal tidal
expiration. It is the sum of the reserve and residual volumes.
7. What is the difference between anatomical and alveolar dead space?
V. Respiratory Rate and Control of Ventilation
1. What is the normal respiratory rate of an adult?
A. Ventilation Control Centers
1. Where are the major brain regions responsible for pulmonary ventilation
located in the brain?

2. The ___________________ __________________

___________________ (DRG) is involved in constant breathing and the
__________________ ________________ _______________ (VRG) is
involved in forced breathing.
3. The apneustic center, located in the pons controls the _______________
of inspiration.
4. The pneumotaxic center controls the __________ of breathing.
B. Factors That Affect the Rate and Depth of Respiration
1. The concentration of what gas is the major factor in stimulating
respiration?
2. Where are central and peripheral chemoreceptors located?
3. Increased carbon dioxide in the blood leads to what effect on respiration?

201
 4. If peripheral chemoreceptors sense inadequate oxygenation what
happens?

22.4. The Process of Breathing

I. Background
1. What is the purpose of the respiratory system?
2. What gases are exchanged at the respiratory membrane?
II. Gas Exchange
A. Gas Laws and Air Composition
1. What two gases make up the vast majority of the air we breathe?
a) Which gas is the most abundant?
2. What is partial pressure?
a) How can we use partial pressure to figure our total pressure?
3. What is Dalton’s Law?

4. How can we use partial pressure to predict where a gas will move?
B. Solubility of Gases in Liquids
1. What does Henry’s law tell us about the solubility of a gas in a liquid?
2. Why is the amount of water vapor greater in the lungs than in the
atmosphere?
3. Why is the concentration of carbon dioxide greater in the alveoli than in
the atmosphere?
C. Ventilation and Perfusion
1. _________________ is the movement of air into and out of the lungs,
and __________________ is the flow of blood in the pulmonary
capillaries.
2. How does the body handle a situation in which the partial pressure
difference across the respiratory membrane is narrowing?
3. Ventilation is regulated by the diameter of the _____________________,
and perfusion is regulated by the diameter of the _______________
_________________.
III. Gas Exchange
1. Where are the two locations in the body where gas exchange occurs?
2. What is the difference between internal and external respiration?
A. External Respiration
1. When gas exchange occurs across the respiratory membrane where
does the majority of oxygen end up in the blood?
a) Does it primarily dissolve into the plasma?
2. Why does oxygen diffuse from the alveoli to the blood? What is the partial
pressure difference that drives this movement?
3. Why does carbon dioxide diffuse from the blood to the alveoli? What is
the partial pressure difference?
B. Internal Respiration
1. Why does oxygen move from the blood to the tissues in internal
respiration?
2. Why is there more carbon dioxide in the tissues than in the blood?

202
22.5. Transport of Gases

I. Background
1. What is respiration? How is it different from ventilation?
II. Oxygen Transport in the Blood
1. Does oxygen dissolve into the blood easily? Is it soluble?
2. What is the primary way oxygen is transported in the blood?
3. What part of hemoglobin carries oxygen?
4. __________________ (Hb-O2) is formed when oxygen binds to
hemoglobin.

A. Function of Hemoglobin
1. How many protein subunits compose hemoglobin?
2. As oxygen binds does that make is easier or more difficult for the next
oxygen molecule to bind?
3. What is a normal hemoglobin saturation in a healthy individual?
B. Oxygen Dissociation from Hemoglobin
1. What does an oxygen-hemoglobin dissociated curve describe?
2. As the partial pressure of oxygen increases what happens to oxygen
saturation of hemoglobin?

203
204
 3. Do highly metabolizing tissues need more or less oxygen than their
normal metabolism counterparts?
4. Higher temperature promotes hemoglobin and oxygen to dissociate
_____________, and lower temperature ________________
dissociation.
5. What is the Bohr effect?
C. Hemoglobin of the Fetus
1. Where do the mother and fetus exchange oxygen?
2. How does the fetus receive enough oxygen when the difference between
the maternal and the fetal blood is not large?

III. Carbon Dioxide Transport in the Blood

1. What are the three major mechanisms used to transport carbon dioxide in
the blood?

205
 A. Dissolved Carbon Dioxide
1. How much carbon dioxide is usually dissolved into the blood plasma?
B. Bicarbonate Buffer
1. How much of the carbon dioxide is bound up with bicarbonate?
2. What enzyme allows for the rapid formation of carbonic acid from carbon
dioxide and water?
3. Carbonic acid dissociates into what two molecules?
4. Why is the chloride shift important? What does it help to maintain?
C. Carbaminohemoglobin
1. How does hemoglobin transport carbon dioxide?
2. What happens to the color of hemoglobin when it is not transporting
oxygen?
3. Why does carbon dioxide move from the tissue to the blood at systemic
capillaries, and from the capillaries to the alveoli in the lungs?
4. What is the Haldane effect, and what happens to the ability of carbon
dioxide to bind to hemoglobin when its saturated with oxygen?

22.6. Modifications in Respiratory Functions

I. Background
II. Hyperpnea
1. __________________ is an increase in rate and depth of ventilation.
2. What might cause hyperpnea?
3. How is hyperventilation different from hyperpnea?
4. What might be responsible for hyperpnea in exercise developing before a
drop in oxygen?
III. High Altitude Effects
1. What happens at higher altitudes that leads to lower hemoglobin
saturation?
2. What mechanisms help maintain oxygenation to the tissue at rest while at
high altitudes?
3. Why is it important to drink more fluid at altitude?
4. What is AMS, and what can cause it?
A. Acclimatization
1. What is acclimatization and how can it help to prevent AMS?
2. How does erythropoietin (EPO) help with acclimatization?

206
22.7. Embryonic Development of the Respiratory System

I. Background
1. When are breathing movements observed in development?
a) How is the fetus provided with oxygen until birth?
II. Time Line
1. When does the respiratory system being to develop?
A. Weeks 4-7
1. The olfactory pit enlarges to become what part of the respiratory tract?
2. The lung bud becomes the ________________.
3. The bronchial buds become what segment of the respiratory tract?

B. Weeks 7-16
1. When do respiratory bronchioles form?
C. Weeks 16-24
1. When do the cells of the respiratory tract differentiate?
2. When are fetal breathing movements observed?
D. Weeks 24-Term
1. Pulmonary capillaries form for what purpose?
2. At what point would a premature baby be expected to be able to breathe
on its own?
3. Is the respiratory system completely developed at birth?
III. Fetal “Breathing”
1. What is inhaled and exhaled during fetal breathing?
2. What purpose might fetal breathing serve?
IV. Birth
1. What fills the lungs prior to birth?
2. Why is pulmonary surfactant critical immediately after birth?
V.

207
Chapter 23

23.1. Overview of the Digestive System

I. Background
1. What is the function of the digestive system?

2. What is an example of cooperation between the digestive system and

another body system?
II. Digestive System Organs
1. What is the difference between the organs of the alimentary canal and the
accessory digestive organs?
A. Alimentary Canal Organs
1. Where does the alimentary canal begin and end?
2. As food passes from mouth to anus how can it pass from outside the
body to the body’s “inner space.”
B. Accessory Structures
1. What role do accessory digestive organs play in digestion?
2. What are some of the accessory digestive organs?
III. Histology of the Alimentary Canal
1. What are the layers of the alimentary canal from lumen outwards?

2. The __________________ consists of epithelium and directly contacts

the digested food.
3. Why is it advantageous for the epithelium in the alimentary canal to have
a short lifespan?
4. Why is it beneficial for the MALT to be found in the lamina propria?
5. What is the purpose of the smooth muscle found in the muscularis
mucosa?
6. What types of tissue are found in the submucosa?
7. What is different about the muscularis externa of the stomach as
compared to the small intestines?
8. Where is the serosa found?
a) Where is the serosa not found?
IV. Nerve Supply
1. Why are receptors and nerves necessary in the mouth?
2. They myenteric and submucosal plexuses regulate what parts of
digestion?
3. What effect does sympathetic and parasympathetic activation have on
digestion?
V. Blood Supply
1. What are the two function of blood vessels serving the digestive system?
2. Lacteals absorb what digested components?
3. What purpose does the hepatic portal system, and the liver, serve in
blood supply to the digestive system?

208
VI. The Peritoneum
1. What is the purpose of the fluid found between the visceral and parietal
peritoneum?
2. What does retroperitoneal mean, and what is an example of a
retroperitoneal organ?
3. What are the five major peritoneal folds?

23.2 Digestive System Processes and Regulation

I. Background
1. Does the mouth perform mechanical digestion, chemical digestion, or
both?
2. List 3 accessory organs and include their function.
3. What is the major function of the large intestine?
II. Digestive Processes
1. What are the six processes of digestion?
2. Where does ingestion occur?
3. How does peristalsis move food through the digestive tract?

4. Mastication and segmentation are examples of ________________

digestion.
5. Enzymes assist with __________________ digestion.
6. Where does the majority of absorption in the digestive tract occur?
7. Where does defecation occur at in the digestive tract?

III. Regulatory Mechanisms

1. The digestive system is controlled both by __________________ and
___________________ regulatory mechanisms.
A. Neural Controls
1. What do mechanoreceptors, chemoreceptors, and osmoreceptors detect?
2. Extrinsic nerve plexuses stimulate ____________ reflexes, and intrinsic
nerve plexuses stimulate _________________ reflexes.
3. What type of reflex is initiated when the sight or smell of food increase
secretion of digestive juices?
B. Hormonal Controls
1. What is the main digestive hormone of the stomach?
2. CCK and secretin are secreted by what organ?

23.3 The Mouth, Pharynx, and Esophagus

I. Background

209
II. The Mouth
1. The cheeks, tongue, and palate make up the ________________
__________________.
2. What makes labia, or lips red?
3. The ______________ _________________ attaches the inner surface of
the lip to the gum.
4. The opening between the oral cavity and oropharynx is the
________________.
5. The maxillary and palatine bones make up the ____________ palate, and
skeletal muscle primarily composes the ________________ palate.

6. Between the palatoglossal and palatopharyngeal arches are the

_________________ tonsils.
III. The Tongue
1. What are at least three
things the tongue doe to
help in the digestive
process?
2. Why is it important to have
a flexible tongue?
3. How does the tongue aid in
swallowing of a bolus of
food?
4. Fungiform papillae contain
___________
___________, and filiform
papillae have
_________________
_________________.
5. Lingual lipase helps to
break down
_____________________ in the stomach.
6. The ___________________ ___________________ attaches the tongue
to the floor of the mouth.
IV. The Salivary Glands
1. Does saliva secretion increase or decrease when eating?
A. The Major Salivary Glands
1. Where are the parotid glands located?
B. Saliva
1. What is the major component of saliva?
2. Salivary amylase initiates the breakdown of
________________________.
3. What is the role of immunoglobin A and lysozyme in saliva?

C. Regulation of Salivation
1. What effect do the parasympathetic and sympathetic branches of the
autonomic nervous system have on salivation?
2. How does the site or smell of food stimulate salivation?

210
 V. The Teeth
1. Teeth are used for what purpose in the
digestive process?
A. Types of Teeth
1. How many dentitions throughout a life?
2. Baby teeth are
_________________________ teeth, and
they are replaced by ___________________
teeth.
3. What teeth are the most anterior and used
for biting food?
4. Canines, also known as ________________
are best suited for piercing tough food.
5. Premolars are just anterior to
_____________ which are used to crush
food.
B. Anatomy of a Tooth
1. ________________, or the gums, surround
the necks of the teeth.
2. The top portion of a tooth above the gum is
the _________________, and the portion
embedded is the __________________.
3. The inside of the tooth contains the _______________
_____________________.
4. Around the pulp cavity is the bone like tissue known as
____________________.
5. What is cementum, and where is it located in relationship to enamel?

VI. The Pharynx

1. The throat, also known as the ____________________, receives food
from the mouth.
2. Which segments of the pharynx
are for air only, and which
sections are for food an air?

3. How is food directed towards

the esophagus during
swallowing?

VII. The Esophagus

1. The esophagus connects the
__________________ to the
____________________.
A. Passage of Food through the
Esophagus
1. What happens when the upper
esophageal sphincter relaxes?

211
 2. What is the purpose of the lower esophageal sphincter?
3. What happens when the lower esophageal sphincter malfunctions?
B. Histology of the Esophagus
1. Why does the esophagus have an adventitia and not a serosa?
VIII. Deglutition
1. Deglutition moves food from the _____________ to the
_____________________.
2. What are the three stages of deglutition?

A. The Voluntary Phase

1. How does the tongue facilitate the voluntary phase?
B. The Pharyngeal Phase
1. During the pharyngeal phase deglutition apnea occurs. What is deglutition
apnea?
C. The Esophageal Phase
1. What is the role of peristalsis in the esophageal phase?
2. How do the circular and longitudinal muscles work together to move the
bolus of food to the stomach?
3. What is the purpose of the mucous lining the esophagus?

23.4 The Stomach

I. Background
1. The stomach is attached to the inferior end of the esophagus and leads to
the first part of the small intestine, the _______________________.
2. The stomach can expand more than 75 times its empty volume, but when
empty it is about the size of a _____________.
3. Is anything absorbed in the stomach?
II. Structure
1. What are the four main regions of the stomach?
2. The _________________ connects to the esophagus.
3. The dome shaped region of the stomach that extends above the cardia is
the ___________________.
4. Below the fundus is the main part of the stomach which is the
_________________.
5. The pyloric canal connects the stomach to the
________________________.
6. The pyloric sphincter controls what?
7. What are rugae and what purpose do they serve?

III. Histology
1. What additional layer of the muscularis is present in the stomach and
why?

2. What are gastric pits and gastric glands?

3. What hormone is secreted by the gastric glands?
4. _____________ cells secrete hydrochloric (HCl) acid and intrinsic factor?

212
 5. Chief cells secrete pepsinogen, the inactive form of ______________.
6. Mucous neck cells secrete _____________.
7. Enteroendocrine cells, or G cells, secrete the hormone
___________________.
IV. Gastric Secretion
1. The _______________ phase happens before food enters the stomach.
2. The gastric phase is initiated by the entry of __________ in the stomach.
3. The intestinal phase initially stimulates stomach secretory activity, but
later inhibits it after chyme distends the ____________________.
V. The Mucosal Barrier
1. Why does the stomach need a mucosal barrier?
2. How does bicarbonate help to prevent damage to the stomach?
3. How frequently does the stomach lining get replaced? Why?
VI. Digestive Functions of the Stomach
1. What digestive activities does the stomach not participate in?
A. Mechanical Digestion
1. What are mixing waves, and why are they essential to stomach
digestion?
2. How does gastric emptying occur? How much chyme is passed out of the
stomach at a time?
B. Chemical Digestion
1. What role does the fundus play in digestion?
2. When is salivary amylase active, and lingual lipase active?
3. What is the purpose of intrinsic factor?

23.5 The Small and Large Intestines

I. Background
1. What digestive function do the intestines not perform?
II. The Small Intestine
1. Why is the small intestine the primary digestive organ?
2. Chyme that enters the small intestine comes from what organ?
A. Structure
1. What is the sequence that chyme pass through the small intestine? Firs
the __________________, then __________________ and finally the
_________________.
2. The bile duct and main pancreatic duct pass their contents into the
duodenum and the ________________________________
_____________ also known as the ampulla of Vater.
3. What sphincter regulates the flow of bile and pancreatic juice into the
duodenum?

4. What is the middle section of the small intestine?

5. The ileocecal sphincter is the junction between what two parts of the
digestive tract?
6. What artery supplies blood to the small intestines?
B. Histology

213
 1. What are some ways the mucosa and submucosa are modified to
increase the absorptive surface area?

2. What is a circular fold, and how does it modify how food passes through
the intestines?
3. What is found within the villi?
a) What purpose do lacteals serve?
4. What composes the brush border?
5. Intestinal juice is produced in _______________ ________________.
6. What do duodenal glands produce? Why is this product important in the
duodenum?
7. MALT is found in what layer of the intestines?
C. Mechanical Digestion in the Small Intestine
1. What is the purpose of segmentation in the
small intestines?
2. What does motilin signal for?
3. The migrating motility complex serves
what purpose in intestinal digestion?
4. What is the gastroileal reflex?
D. Chemical Digestion in the Small Intestine
1. Do lipids undergo any substantial digestion
before entering the small intestines?
2. Why is chyme delivered the intestines in
small amounts?
III. The Large Intestine
1. What is the purpose of large intestine?
A. Structure
1. The large intestine starts and end where in the digestive tract?
B. Subdivisions
1. The first part of the large intestines, the _______________, receives
digested contents from the small intestines.
2. What has the appendix been postulated to do?
3. What is the pathway of food through the segments of the colon?
4. What are the flexures and where are they located?

214
 5. What is the purpose of the rectal valves?
6. What are the two sphincters of the anal canal?
a) Which is voluntary?
C. Histology
1. Compared to the small intestines, what do the large intestines not have?
2. What is absorbed by the enterocytes of the large intestine?

D. Anatomy
1. The teniae coli have tonic contractions that bunch the colon up into
_________________.

215
 2. What is an anal column?
3. Why is there a difference in sensitivity above and below the pectinate
line?
E. Bacterial Flora
1. What do the normal bacterial flora provide that is beneficial?
F. Digestive Functions of the Large Intestine
1. What is the difference between haustral contractions and mass
movement?
2. How does distension in the stomach lead to increased motility in the large
intestines?
3. What is saccharolytic fermentation that bacteria take part in? How does it
lead to flatus?
G. Absorption, Feces Formation, and Defecation
1. What do the large intestines remove to convert liquid chyme into feces?
2. Why does the Valsalva maneuver aid in defecation?

23.6 Accessory Organs in Digestion: The Liver, Pancreas, and

Gallbladder

I. Background
1. What are three accessory organs that
contribute to digestion in the small
intestine?
II. The Liver
1. Where is the liver located in the
abdomen?
2. The hepatic artery and hepatic portal
vein enter the liver at the
______________
_________________.
3. What does the hepatic portal vein
deliver to the liver?

A. Histology
1. Plates of hepatocytes are found in
each __________________
_________________.
2. Bile created by hepatocytes
accumulates in _______________ __________________________ to be
taken to the bile ductules and bile ducts.
3. The common hepatic duct joins with the cystic duct to form the
___________________ _____________________
________________________ which takes bile to the small intestines.
4. What is a hepatic sinusoid?

216
 5. The hepatic sinusoids combine and send blood to a central veins which
then flows through the _________________ ________________ to get to
the inferior vena cava. Bile flows the opposite way towards the ducts.
6. What role do

reticuloendothelial cells play in the liver?

7. What are the three components of a portal triad?
B. Bile
1. Bile emulsifies lipids. What is emulsification?
2. The bile salts and phospholipids in bile increases the surface area
available for what to interact with the separated lipids?
3. How are bile salts reclaimed from the digestive tract?
4. How is bilirubin produced in the body?
5. How is bilirubin excreted from the body?
6. When not actively digesting where is bile stored?
III. The Pancreas
1. What are the exocrine and endocrine functions of the pancreas?

217
 2. What do the acini in the pancreas produce?
3. The smaller pancreatic duct is the __________________ duct.
A. Pancreatic Juice
1. What do the enzymes in pancreatic juice help the body to digest?
2. Enteropeptidase from the brush border of the intestines is critical to the
function of the protein degrading enzymes from the pancreas in what
way?
B. Pancreatic Secretion
1. What regulates pancreatic secretion?
2. What does the pancreas release to neutralize acidic chyme?

IV. The Gallbladder

1. What is the purpose of the gallbladder?
2. Bile from the gallbladder is ejected through the ______________ duct.

218
23.7 Chemical Digestion and
Absorption: A Closer Look

I. Background
1. What is the difference between
mechanical and chemical
digestion?
II. Chemical Digestion
A. Carbohydrate Digestion
1. Where does chemical digestion of
carbohydrates begin?
2. Pancreatic ______________
breaks down carbohydrates in the
small intestines.
3. ___________________ breaks
down α-dextrin one glucose at a
time.
4. Sucrose, lactose, and maltose are
broken down by what three
enzymes?

219
B. Protein Digestion
1. Where does protein digestion start in the digestive system?
2. What enzymes are secreted by the brush border to help breakdown
proteins?

C. Lipid Digestion
1. Which lipase is the most important to digestion?
a) What organ produces it?
D. Nucleic Acid Digestion
1. What are the two types of pancreatic nucleases?
a) What do they digest?
2. Nucleosidase and phosphatase are produced by what in the digestive
tract?

220
III.

Absorption
1. Is 10 liters of food a reasonable amount to absorb per day?
2. What are the five mechanisms used for absorption?
3. What is different about absorption of water-soluble vs lipid-soluble
nutrients?
A. Carbohydrate Absorption
1. Carbohydrates are broken down and absorbed in the form of
________________________.
2. What happens to indigestible fiber?
B. Protein Absorption
1. Where are most proteins absorbed in the digestive tract?
2. How long of amino acid chains are usually absorbed?
C. Lipid Absorption
1. Where are the majority of lipids absorbed?
2. What is a micelle?
3. Chylomicrons are ____________-soluble and enter into the lacteals after
passing out of the cell.
4. _________________________ ______________ breaks down the
triglycerides of the chylomicrons.
D. Nucleic Acid Absorption
1. How are nucleic acids absorbed?
E. Mineral Absorption
1. All ions except _______________ and ________________ are always
absorbed in the intestines even when not needed.
2. What type of transport is used to absorb iron?

221
 3. Why do women have more iron transporters in their intestinal epithelium
than men?
4. What effect does PTH have on calcium absorption of dietary calcium?
F. Vitamin Absorption
1. Where are fat soluble vitamins (A, D, E, and K) primarily get absorbed?
2. How is absorption of B12 different than other vitamins?
a) Why is intrinsic factor necessary to assist in the absorption?
G. Water Absorption
1. Why does water move from the chyme into the epithelial cells?

222
Chapter 24

24.1. Overview of Metabolic Reactions

I. Background
1. _____________________ is the sum of a chemical reactions in the body.
2. What is the difference between catabolism and anabolism?
II. Catabolic Reactions
1. Why is ATP an important product of catabolic reactions?
2. How can the energy stored in ATP be used? What portion of the ATP is
removed?

223
 3. What is the most common source of energy to fuel the body?
4. -Oxidation is used to breakdown what type of macromolecule?
5. Amino acids are monomers of ____________________.
III. Anabolic Reactions
1. Anabolic reactions are also known and __________________________
reactions.
IV. Hormonal Regulation of Metabolism
1. What is an example of a catabolic hormone?
2. Insulin, testosterone, and estrogen are all examples of _______________
hormones.
V. Oxidation-Reduction Reactions
1. The loss of an electron is __________________, and the electron is
passed on to another molecule which is __________________.
a) These two reactions happen together in an
____________________-______________ reaction.
2. NAD is reduced to ___________________, and FAD is reduced to
________________.

24.2. Carbohydrate Metabolism

I. Background
1. What are polysaccharides and monosaccharides?
a) What is the difference between them?
2. What purpose does salivary amylase serve in the mouth?
3. What is produced form cellular respiration that can be used for energy?

224
II. Glycolysis
1. Glycolysis transfers some energy from glucose to ADP to produce
__________.
2. What is the product at the last step of glycolysis?
3. Glucose, a 6 carbon sugar, is broken down into what three carbon
molecules?
4. What is the citric acid cycle or the TCA?
a) When does pyruvate enter the cycle?
5. What is the energy-consuming phase of glycolysis?
a) Beyond the energy-consuming phase what is the net gain or ATP
from glycolysis?
6. Why is the addition of a phosphate to glucose to create glucose-6-
phosphate important?
7. Hexokinase is found nearly everywhere in the body, but where is
glucokinase found?
8. What happens overall in the energy-yielding phase of glycolysis?
a) Why is this important?
9. Does the pyruvate produced from glycolysis always enter the citric acid
cycle?
A. Anaerobic Respiration
1. When oxygen is not available pyruvate is converted to _____________
______________
through anaerobic
means.
2. Why does
exercise lead to
the production of
lactic acid?
B. Aerobic Respiration

225
 1. In aerobic respiration oxygen serves as the ______________
_______________ acceptor.

III. Krebs Cycle/Citric Acid Cycle/Tricarboxylic Acid Cycle

1. The Krebs cycle coupled with the electron transport chain are used to
produce _________ for cellular energy.
2. Where in the cell does pyruvate get converted into acetyl CoA?
3. How much ATP is directly produced from acetyl CoA?
4. Is oxaloacetate used up through the Krebs cycle?
5. How is carbon dioxide produced through the Krebs cycle?
IV. Oxidative Phosphorylation and the Electron Transport Chain
1. What does the electron transport chain (ETC) use to produce ATP?
2. What is oxidative phosphorylation?
3. The
accumulation of
H+ where
creates a
gradient
compared to
the
mitochondrial
matrix?
4. How does ATP
synthase use
the proton
gradient to
create ATP?
5. How much ATP
is produced in
glycolysis, TCA,
and ETC?
a) How
much
ATP is

produced total?
V. Gluconeogenesis
1. Where does gluconeogenesis primarily take place at?
2. What is an example of an organ that can only use glucose for energy?

226
 3. Why is it important that hexokinase and phosphofructokinase-1 are not
used in gluconeogenesis?

24.3. Lipid Metabolism

I. Background
1. Oxidation of lipids can be used both to
generate _______________ and to
synthesize new ____________ from
smaller constituent molecules?
2. Lipid metabolism breaks triglycerides
into monoglycerides through what
enzymes?
3. What is responsible for emulsifying
ingested fats in the intestines?
4. What role does CCK play in
digestion?
5. Why are chylomicrons essential for
transport of fats and cholesterol?

227
II. Lipolysis
1. Where does lipolysis occur at within the cell?
2. How much energy can be produced from fat compared to carbohydrates?
3. Fatty acid oxidation converts fatty acids into ________________
_____________ molecules.
III. Ketogenesis
1. When are ketone bodies created?
2. Excess acetyl CoA is converted into
______________________________ ________________ (HMG CoA)
IV. Ketone Body Oxidation
1. When does the brain use ketone bodies as a source for energy?
2. What is a symptom of ketogenesis?
3. When -hydroxybutyrate is oxidized acetoacetate and ____________ is
released.

V. Lipogenesis
1. When does lipogenesis occur?
2. What types of cells have lipogenesis occur within them?
3. Why is the creation of citrate necessary for lipogenesis?

228
24.4. Protein Metabolism

I. Background
1. Are proteins stored in
the body?
2. What effect does
pepsin have on
polypeptides?
3. HCl denatures
proteins but can be
harmful to the
intestines. What is
used to neutralize the
acidity?
4. How does the
pancreas contribute
to protein digestion?
5. Why are inactive
proenzymes
important for the health of digestive organs?
6. What are the inactive forms of trypsin and chymotrypsin?
a) What is the role of these proteolytic enzymes?

229
 7. What is formed when amino acids are decomposed?
II. Urea Cycle
1. Why is the urea cycle necessary?
2. What are the two products of
transamination?
3. How is urea eliminated?
4. How can amino acids be used as a
source of energy?

230
24.5. Metabolic States of the Body

I. Background
II. The Absorptive State
1. Is the absorptive state when a person is fed or fasted?
2. How does insulin help with absorption?
3. If ingested fats and carbohydrates are not used immediately what
happens to them?
III. The Postabsorptive State
1. During the postabsorptive state what is the storage form of sugar the
body initially relies upon?
2. Glucagon results in the liver producing sugar through
______________________.
3. After a period of fasting when food is ingested why does the liver continue
to undergo gluconeogenesis?
IV. Starvation
1. What organ is prioritized when in a starvation state?
2. Why are ketones used to supply the needs of glucose dependent organs?
a) What does this spare?
3. When are proteins finally used for energy in starvation?

231
24.6. Energy and Heat Balance

I. Background
1. ________________________ is the process in which the body regulates
its temperature.
2. When producing ATP how much energy is lost as heat?
3. Is thermoregulation governed by positive or negative feedback?
4. What can the hypothalamus do to help decrease body temperature in a
hot environment?
5. What can the body do in an environment that is colder than body
temperature?
6. What is a thermoneutral environment?
II. Mechanisms of Heat Exchange
1. Heat flows from
_____________
concentration to
___________ concentration.
2. _________________ is the
transfer of heat between two
objects in direct contact.
3. What is convection and how
is it different from
conduction?
4. How do the rays from the
sun warm a room?
5. How does evaporative
cooling work?
III. Metabolic Rate
1. What is metabolic rate?
2. When at rest the amount of
energy expended is known
as ______________
________________
___________ or BMR.
3. How much of the BMR is
typically dedicated to
thermoregulation?

24.7. Nutrition and Diet

I. Background
1. How is energy primarily
stored inside the body?
II. Food and Metabolism
1. What is a Calorie (C)?
2. How many calories does the
average person need to carry out usual daily activities?

232
 3. How many excess calories would result in an
additional pound of body weight?
4. Which takes more energy to digest,
carbohydrates or proteins?
5. How much of a plate full of food should be
made up of fruits and vegetables?
III. Vitamins
1. What are vitamins?
2. The _____ vitamins play the largest role of
any vitamins in metabolism.
3. Are vitamins only available from the diet, or can some by formed?
4. What vitamins are fat-soluble?
5. How are excess water-soluble vitamins eliminated?
IV. Minerals
1. What are minerals?
2. Can minerals be made in the body?
3. What are the most common minerals?
a) Where are they stored?

233
Chapter 25

25.1. Physical Characteristics of Urine

I. Background
1. What allows the urinary system to filter
blood?
2. The glomeruli filter the blood mostly based
on size. What is too big to be filtered, and
therefore not found in the urine?
3. What is a normal volume of urine to
produce a day?
4. Should red blood cells be found in the
urine?
5. What is a urinalysis? Why is it useful in
assessing renal health?
a) What diseases could result in a
large quantity of urine?
6. What pigment gives urine its characteristic
color?
7. What is an example of a color change of
urine that may indicate a disease state?
8. How much urine is excreted in oliguria,
anuria, and polyuria?
9. Would diabetes insipidus lead to oliguria,
anuria, or polyuria?
10. Why is it important to regulate urine pH?
What happens when urine pH is chronically
high or low?
11. What is specific gravity? What does it tell us about urine?
12. If leukocyte esterase is found in the urine what may be occurring?
13. What does the presence of ketones in the urine potentially tell us about
what is being used for energy?
14. Nitrites, if found in the urine, may indicate what kind of infection?

25.2. Gross Anatomy of Urine Transport

I. Background
1. What is filtered to form urine?
2. What does the urinary system protect the body against?
II. Urethra
1. The urethra transports urine from the bladder to where?

234
 2. What is the trigone and where is it located?
3. Is the internal urinary sphincter or the external urinary sphincter under
voluntary control?
A. Female Urethra
1. What anatomically makes a UTI more likely in women?
B. Male Urethra
1. What part of the male urethra passes through the prostate?
2. Why are mucous glands present in the male urethra?
III. Bladder
1. What role does the bladder serve in the urinary tract?
2. The bladder is a retroperitoneal organ. What does retroperitoneal mean?

3. Is the detrusor muscle the only way to create the force necessary to void
urine?
A. Micturition Reflex
1. What is micturition?
2. When is incontinence likely to occur?
3. The sacral micturition center is necessary for voluntary or involuntary
micturition?

235
IV. Ureters
1. The ureters are retroperitoneal,
which makes sense as they drain
urine from the
___________________ to the
_________________ which are
also retroperitoneal.
2. The oblique angle that the ureters
join the bladder creates a
__________________ sphincter,
or one-way valve.
3. What type of epithelium lines the
ureters?
4. Are the ureters passive, or do they
actively move urine through
muscular contractions?

25.3. Gross Anatomy of the Kidney

I. Background
1. What protects the kidneys?
2. Estimate how much of the heart’s cardiac output do the kidneys receive at
rest?
II. External Anatomy
1. Why is the left kidney located higher than the right?
2. What purpose does the renal fat pad serve?

236
 3. What glands are found on top of the kidneys?
III. Internal Anatomy
1. Which is found deeper inside the kidney the renal cortex or medulla?
2. What separates the renal pyramids?
3. The renal ____________________ are bundles of collecting ducts that
transport urine to the calyces.

IV. Renal Hilum

1. What enters and exits the kidney at the renal hilum?
A. Nephrons and Vessels
1. What arterioles supply the nephrons of the kidney?

237
 2. What purpose do nephrons serve in the kidney?
3. The glomerulus is formed from a tuft of what arteriole?
4. The Bowman’s capsule and glomerulus form the _______________
________________.
5. Blood that is not filtered passes from the glomerulus on to the
_________________ arteriole which then becomes the peritubular
capillaries and vasa recta.
B. Cortex
1. What components of the nephron are found within the renal cortex?
2. The loop of Henle in juxtamedullary
nephrons descends into what part of the
kidney?

25.4. Microscopic Anatomy of the Kidney

I. Background
II. Nephrons: The Functional Unit
1. What is the term forming urine used to
describe?
2. What are the three principle functions that
the nephrons carry out?
3. The kidneys can help to regulate blood
pressure via the production of
________________.
A. Renal Corpuscle

238
1. How do the podocytes, and their pedicels, help with filtration from the
glomerulus to the proximal convoluted tubule (PCT)?
2. What part of the podocytes forms the filtration slits?

3. Why are the capillaries in the glomerulus fenestrated?

4. How do mesangial cells regulate the rate of filtration?
5. The juxtaglomerular apparatus (JGA) is the where the
_________________ ________________________
___________________ (DCT) comes into contact with the arterioles.
6. The ______________________ _____________________ is the wall of
the DCT that forms a part of the JGA.
7. How does the macula densa help to regulate flow through the nephrons?

239
 8. How does the juxtaglomerular cells help to regulate blood flow to the
glomerulus?
9. What happens when to glomerular filtration rate (GFR) when the
osmolarity of the filtrate is too high?

B. Proximal Convoluted Tubule (PCT)

1. What purpose does the brush border in the PCT serve?
C. Loop of Henle
1. What is different between the descending and ascending limb of the loop
of Henle?
D. Distal Convoluted Tubule (DCT)
1. Why does the DCT need a lot of mitochondria?
a) How does this compare to the PCT?
E. Collecting Ducts
1. Are the collecting ducts a part of the nephron?
2. What effect does the insertion of an aquaporin have on the recovery of
water from the collecting ducts?
3. Are more collecting ducts present when antidiuretic hormone is present or
absent?

240
25.5. Physiology of Urine Formation

I. Background
1. What are the three processes that produce urine?
2. The production of urine modifies the composition of the
________________.
II. Glomerular Filtration Rate (GFR)
1. What is Glomerular Filtration Rate (GFR)?
2. What is a normal GFR for both kidneys in one day?
3. ________________ forces fluid and solutes through a semipermeable
barrier.
4. What is hydrostatic pressure?
a) What exerts hydrostatic pressure on the filtration membrane in
renal capsule?
5. What is colloid osmotic pressure?
6. Can cells or large proteins pass through the fenestrations or between the
podocyte processes?
7. What does a positive net filtration pressure (NFP) tell us about filtration?

241
 8. What happens to the body when there is an insufficient amount of plasma
proteins in the blood?
9. What is systemic Edema?
III. Net Filtration Pressure (NFP)
1. How does the kidney deal with a wide range of blood pressure?
2. At what point is blood pressure insufficient for filtration to occur?
a) What is shock?
3. How can inulin be used to figure out GFR?

25.6. Tubular Reabsorption

I. Background
1. Where is most water recovered in the
nephron?
II. Mechanisms of Recovery
1. How does active transport move substances
from low concentration to high concentration?
2. Diffusion moves substances from
______________ concentration to
____________ concentration.
3. Symport move two or more substances in the
____________ direction, and antiporters move
substances in the ___________________
direction.
4. Acid-base balance is maintained through the
_____________ and the ______________.
III. Reabsorption and Secretion in the PCT

242
 1. What does reabsorbed mean in the context of the nephrons?
2. Where is water “obliged to follow sodium?

3. The apical surface of the cells in the PCT face what?

4. How much of sodium and potassium are absorbed in the PCT?
5. How much of filtered glucose is reabsorbed in the PCT?
a) What is glycosuria?
6. Why does bicarbonate need to be recovered?

IV. Reabsorption and Secretion in the Loop of Henle

1. What is the difference between a cortical and juxtamedullary nephron?
2. The descending and ascending portions of the loop of Henle are
specialized to recover what ion?
A. Descending Loop
1. The osmolarity of the interstitium increases the further the descending
loop is into the renal medulla. How does this help to move water into the
nephron?
B. Ascending Loop
1. The thick portion of the ascending limb is impermeable to __________
due to the absence of aquaporins.

243
 2. The reabsorption of NaCl, and the inability for water to move creates what
kind of filtrate by the time it reaches the DCT?
3. Leaky tight junctions allow certain solutes to move according to their
_______________ gradient.
C. Countercurrent Multiplier System
1. The reabsorption of NaCl
and the presence of urea in
the interstitial space creates
a ___________ osmolar
environment in the depths of
the medulla.
2. What is the net result of the
countercurrent multiplier
system?
3. Why is it important that blood
flows slowly in the vasa
recta?
V. Reabsorption and Secretion in the
Distal Convoluted Tubule
1. How much water has been
recovered by the time the
filtrate reaches the DCT?
2. How does the movement of sodium out of the lumen of the collecting duct
help to move chloride ions?
3. Parathyroid hormone (PTH) signals for the reabsorption of what ion?
VI. Collecting Ducts and Recovery of Water
1. Principal cells allow for recovery or loss of _______________.
2. Intercalated cells help to regulate blood pH by secreting or absorbing
___________ or _________________________.
3. The presence of vasopressin would allow for more or less water
reabsorption>
a) Would urine be dilute or concentrated?
4. Aldosterone assists with recovery of what ion?

25.7. Regulation of Renal Blood Flow

I. Background
1. Why is it important that the flow of blood through the kidney is
maintained?
II. Sympathetic Nerves
1. During rest sympathetic stimulation to the kidneys results in
___________________ and increased blood flow through the kidneys.
2. Why during times of stress do the kidneys receive less blood?
III. Autoregulation
1. What is autoregulation?
a) What mechanisms do the kidneys have to maintain their rate of
blood flow?
B. Arteriole Myogenic Mechanism

244
 1. According to the myogenic mechanism what is the smooth muscle
response to stretch?
a) How does this response help to maintain flow?
C. Tubuloglomerular Feedback
1. Increased fluid flow is detected how in the macula densa?
2. ATP and adenosine acting as paracrine factors have what effect on the
afferent arteriole and GFR?
3. NO has what effect on the afferent arteriole and GFR?

25.8. Endocrine Regulation of Kidney Function

I. Background
1. What is the difference between endocrine and paracrine acting
messengers?
II. Renin-Angiotensin-Aldosterone
1. Renin converts angiotensinogen into what?
2. ACE converts Angiotensin I into what?
3. Angiotensin II is a vaso_______________. Therefore, it raises blood
pressure.
4. What effect does Angiotensin II have on the efferent and afferent
arterioles?
5. What can stimulate the release of aldosterone?
a) Aldosterone promotes the reabsorption of what ion?
III. Antidiuretic Hormone (ADH)
1. Diuretics such as coffee, tea, and alcohol all promote water
________________.
2. ADH promotes water recovery through what mechanism?
IV. Endothelin
1. Endothelins are potent vaso______________________.
2. Chronically elevated endothelins, such as in diabetic kidney disease, has
what effect on GFR?
V. Natriuretic Hormones
1. What is natriuresis?
2. Natriuretic hormones have what effect on ADH release?
3. Under what conditions is atrial natriuretic hormone released?
VI. Parathyroid Hormone
1. Parathyroid hormone (PTH) is released in response to a decreased
amount of what ion?
2. Why does parathyroid hormone block the reabsorption of phosphate?

25.9. Regulation of Fluid Volume and Composition

I. Background
1. What aspect of blood volume maintenance is the kidney able to effect a
change over?
II. Volume-sensing Mechanisms

245
 1. Why is blood pressure used as an indicator for blood volume in the body?
a) What do the baroreceptors measure?
2. How do the kidneys respond to low blood pressure?
3. How does the heart, specifically the atria, respond to an increase in
stretch such as when blood pressure rises?
4. How can ADH or vasopressin help in a situation in which a significant
amount of blood is lost?
III. Diuretics and Fluid Volume
1. How do caffeine and alcohol increase urine volume?
2. How do osmotic diuretics work?
IV. Regulation of Extracellular Na+
1. An increase in sodium has what effect on water retention?
a) What happens to blood pressure when blood volume increases?
2. What hormone(s) may signal to retain more sodium?
V. Regulation of Extracellular K+
1. When more sodium is reabsorbed what tends to happen to potassium?
VI. Regulation of Cl-
1. Chloride is important for ____________-_____________ balance.
VII. Regulation of Ca++ and Phosphate
1. Parathyroid Hormone (PTH) has what effect on the kidneys?
VIII. Regulation of H+, Bicarbonate, and pH
1. Why is bicarbonate an important buffer in the body?
2. The kidneys can rid the body of both ______________ and
______________.
IX. Regulation of Nitrogen Wastes
1. How do the kidneys help to eliminate nitrogenous wastes from the body?
X. Elimination of Drugs and Hormones
1. How are water soluble drugs eliminated?
2. Are there some drugs that can’t be filtered by the kidneys?

25.10. The Urinary System and Homeostasis

I. Background
II. Vitamin D Synthesis
1. Why is the kidney
necessary for vitamin D to
be active?
2. Without active vitamin D
what can happen
pathophysiologically?
III. Erythropoiesis
1. How does EPO help the
body to maintain sufficient
oxygenation at high
altitudes?

246
 2. What produces EPO in the body?
3. How can exercise influence EPO production?
IV. Blood Pressure Regulation
1. What happens to blood pressure if the kidneys are unable to recover
water in the collecting ducts?
2. How do the kidneys, lungs, and liver all work together to allow the renin-
angiotensin-aldosterone system to function?
3. What effect does Angiotensin II have on blood pressure?
V. Regulation of Osmolarity
1. How does hypo-osmolarity lead to edema?
2. Severe dehydration can lead to what osmotic state within the body?
VI. Recovery of Electrolytes
1. Why is regulation of blood potassium important?
VII. pH Regulation
1. Kidneys work with the lungs to regulate the pH of the blood. What
happens to enzyme when they are outside their optimum pH range?

247
Chapter 26

26.1. Body Fluids and Fluid Compartments

I. Background
1. Substances dissolved into the water
of the body are known as
_______________.
2. What are some examples of
electrolytes?
3. Water moves from regions of
_______________ concentration to
_______________ concentration.
II. Body Water Content
1. What happens to the percent of the
body made of water as we age?
2. What part of the body is composed
of a significant amount of water, and
what has a small proportion of
water?
III. Fluid Compartments
1. What is a fluid compartment?
2. Fluid found inside the cells of the
body is known as
________________
________________ (ICF)
3. What are the two components of
extracellular fluid (ECF)?

A. Intracellular Fluid
1. Which fluid compartment has the highest volume?

248
 B. Extracellular Fluid
1. What travels in the plasma?
2. What are some examples of other water-based portions of ECF?
IV. Composition of Body Fluids
1. What is different between the ECF and interstitial fluid (IF)?
2. What is found in high concentration in ICF that is in smaller amounts in
ECF?

3. Do most body fluids have a charge associated with them?

4. How are the high levels of potassium and low levels of sodium maintained
in the ICF?

V. Fluid Movement between Compartments

249
 1. What is hydrostatic pressure?
a) How does this pressure help capillaries with filtration?
2. What allows for reabsorption of fluid at the venous end of the capillary?

3. Why is hydrostatic pressure vital for kidney filtration?

4. How does the osmotic gradient between fluid compartments allow for
redistribution of water?
5. When sweating and losing water from tissue, how is this fluid
replenished?
VI. Solute Movement between Compartments
1. Active transport of solutes allows for movement from _______________
concentration to ____________ concentration.
2. Passive movement of solutes moves them from ___________
concentration to ____________ concentration.
3. What can pass through the cell membrane without facilitation?

26.2. Water balance

I. Background
1. Is all water in the body ingested, or
can some be generated?
2. How does most water leave the
body?
II. Regulation of Water Intake
1. What is plasma osmolality?
2. In a state of dehydration how does
the body act to conserve water?

250
 3. What triggers thirst?
4. How are baroreceptors able to detect changes that occur due to
dehydration?
5. How does the renin-angiotensin-aldosterone system help to conserve
water during dehydration?
6. What can happen after a prolonged period of dehydration?
III. Regulation of Water Output
1. If the body cannot produce the minimum necessary amount of urine what
happens to metabolic wastes?
2. What is diuresis?
IV. Role of ADH
1. Where is ADH or vasopressin produced?
a) How do osmoreceptors help to determine how much vasopressin
is produced?
2. What are the two major effects of ADH vasopressin?
3. When ADH vasopressin are present would you expect more or less
aquaporins in the collecting tubules?

4.

4. What are some examples of diuretics that are regularly consumed in

everyday life?

26.3. Electrolyte Balance

I. Background
1. What are some of the roles ions, or electrolytes, fulfill in the body?
2. What are the six most important electrolytes?
II. Role of Electrolytes
1. Where are most calcium and phosphate found in the body?
2. How are most ions excreted?
A. Sodium
1. Sodium is the major cation of ____________________________ fluid.
2. Excess sodium can contribute to what pathophysiological condition?
3. What can cause hyponatremia?
4. How can a relative decrease in sodium result in swelling of cells?
5. What can cause hypernatremia?

251
 B. Potassium
1. Potassium is the major ________________________ cation.
2. What is hypokalemia?
3. What can lead to hypokalemia?
4. What is hyperkalemia?
5. Why is hyperkalemia dangerous for the function of the heart?
C. Chloride
1. Is the majority of chloride normally found inside and outside of cells?
2. Hyperchloremia can occur due to what?
D. Bicarbonate
1. Bicarbonate has what charge?
2. Water and what else can combine to create carbonic acid and therefore
bicarbonate?
3. Tissues that are highly metabolizing produce more or less carbon
dioxide?
E. Calcium
1. Aside from bones, what else is calcium used for in the body?
2. How can a deficiency in vitamin D lead to hypocalcemia?
F. Phosphate
1. Where is most of the phosphate in the
body found?
2. Aside from bones what is phosphate
used for in the body?
3. What can lead to hypophosphatemia?
III. Regulation of Sodium and Potassium
1. Sodium is ___________________ from
the renal filtrate, and potassium is
__________ into the filtrate.
A. Aldosterone
1. Aldosterone increases the excretion of
_______________ and the reabsorption
of _______________.
2. Overall aldosterone increases
____________ levels in the plasma.
B. Angiotensin II
1. The vasoconstriction and increase in
blood pressure has what effect on GFR?
2. Angiotensin II signal for an increase in
what hormone from the adrenal cortex?
IV. Regulation of Calcium and Phosphate
1. What is the overall effect of parathyroid hormone (PTH) on blood
calcium?
2. What effect does dihydroxyvitamin D (calcitriol) have on the intestinal
epithelial cells?
3. What effect does calcitonin have on blood calcium?

26.4. Acid-Base Balance

252
 I. Background
1. Why are buffers important to regulating blood pH?
2. What are the most common buffers? Weak _________________ or weak
________________.
II. Buffer Systems in the Body
1. How fast are buffers systems able to act relative to the respiratory or
renal mechanisms that regulate blood pH?
2. Plasma proteins, phosphate, and bicarbonate are all ___________
systems in the blood.
A. Proteins Buffers in Blood Plasma and Cells
1. Protein buffering accounts for how much of the total buffering power of
the blood and within cells?
B. Hemoglobin as a Buffer
1. Hemoglobin is found inside of what type of cell?
2. The conversion of CO2 into ____________ allows for buffering.
C. Phosphate Buffer
1. Phosphates can buffer both _______________ and
_________________.
D. Bicarbonate-Carbonic Acid Buffer
1. The weak acid or weak bases of carbonic acid and bicarbonate prevent a
significant change in ______ of the blood.
2. Is there normally more bicarbonate or carbonic acid in the blood?
3. Carbonic acid levels are controlled by exhalation of CO2, but what
controls the levels of bicarbonate in the blood?
III. Respiratory Regulation of Acid-Base
Balance
1. When holding your breath CO2 in the
blood rises and therefore
______________ ______________
does as well.
2. Hyperventilation has what effect on
carbonic acid in the blood?
3. Why does respiratory rate and depth
increase with exercise?
a) How do chemoreceptors play
a role?
4. What is hyper and hypocapnia?
5. What substances or drugs can cause
hypercapnia?
IV. Renal Regulation of Acid-Base Balance
1. Renal regulation addresses the
________________ component of the
buffer system.
2. Inhibition of carbonic anhydrase can
have what effect on blood
bicarbonate?

253
 3. Cells of the renal tubules are not permeable to bicarbonate so how does
the body maintain enough bicarbonate?

4. What happens to bicarbonate if sulfates or phosphates capture hydrogen

ions and prevent them from being used to create carbonic acid?
5. Hydrogen ions also compete with what ion in the renal tubules?
6. Why can bicarbonate be used in place of chloride in neutralizing positive
ion charges?

26.5. Disorders of Acid-Base Balance

I. Background
1. What is physiological acidosis?
a) What are some of the symptoms?
2. Why is the respiratory contribution to acid-base balance discussed in
terms of CO2?

II. Metabolic Acidosis: Primary Bicarbonate Deficiency

1. When there is a bicarbonate deficiency it leads to a
__________________ acidosis.

254
 2. Are all causes of metabolic acidosis caused medical or
pathophysiological conditions?
III. Metabolic Alkalosis: Primary Bicarbonate Excess
1. What common over the counter medication can cause a transient
metabolic alkalosis?
IV. Respiratory Acidosis: Primary Carbonic Acid/CO2 Excess
1. Respiratory acidosis occurs due to an excess of ________________
acid.
V. Respiratory Alkalosis: Primary Carbonic Acid/CO2 Deficiency
1. How can hyperventilation lead to a respiratory alkalosis?
VI. Compensation Mechanisms
1. What are three compensatory mechanisms that keep blood pH in the
appropriate range?
A. Respiratory Compensation
1. How rapidly can respiratory compensation occur?
2. Why is the respiratory system better suited to handle a metabolic acidosis
rather than a metabolic alkalosis?
B. Metabolic Compensation
1. In a respiratory acidosis how do the kidneys help to compensate?
a) Can this compensation continue to be increase indefinitely?
C. Diagnosing Acidosis and Alkalosis
1. In metabolic acidosis pCO2 is normal and then what happens?
2. Why would bicarbonate levels in the blood increase as a compensation to
respiratory acidosis?
3. Respiratory alkalosis would have what renal compensation?

255
Chapter 27

27.1. Anatomy and Physiology

of the Male Reproductive
System

I. Background
1. What is a gamete?
2. A sperm has how many
chromosomes compared
to a somatic cell (cell of
the body)?
3. What is the purpose of
sperm?
II. Scrotum
1. Why is the location of the
sperm important?
2. How do the dartos and
cremaster muscles help
to regulate the temperature of the testes?

III. Testes
1. The testes are the male gonads. What are gonads?
2. The tunica albuginea both covers
the testis and helps to divide the
testis into ____________________.
3. When do the testis descend into the
scrotal cavity?

4. What develops in the seminiferous

tubules?

256
 5. Formed sperm are released into where within the testes?
A. Sertoli Cells
1. ____________ cells, or sustentacular cells, secrete what types of
signals?
2. Why is a blood-testis barrier necessary?
B. Germ Cells
1. What are the stem cells of the testis?
2. The division of germ cells produces what type of spermatocyte?
3. What is spermatogenesis?
C. Spermatogenesis
1. When in the lifecycle does spermatogenesis start?
2. Mitosis begins with a diploid spermatogonia, but the mature gametes are
______________ and contain 23 chromosomes.
3. ____________________ is the process of cellular division to produce
haploid gametes.
4. After mitosis of the spermatogonia the ___________________

spermatocyte begins meiosis I.

5. ___________________ spermatocytes each with half the number of
chromosomes undergo meiosis II.
6. After the second meiotic division the new cells produced are
________________.
7. What is the process that transforms the early spermatids into true sperm?
IV. Structure of Formed Sperm
1. Where is the haploid nucleus of a sperm found?
2. What fills the acrosomal cap? Why?
3. Why is the mid-piece of the sperm filled with tightly packed mitochondria?
4. The flagellum helps the sperm to perform what function?

257
V. Sperm Transport
1. Where are sperm transported from?
a) Where are they transported to?
A. Role of the Epididymis
1. After passing through the seminiferous tubules, sperm continue to mature
in the __________________________.
2. As sperm move through the epididymis, they acquire the ability to move
on their own. Why is this important?
B. Duct System
1. During ejaculation where do sperm pass through to pass towards the
urethra?
2. The spermatic cord includes the ductus deferens and what else?
3. What is a vasectomy?
4. What is the inguinal canal, why does the ductus deferens pass through it?
5. What glands contribute to the contents of semen?
C. Seminal Vesicles
1. The seminal vesicles contribute a large amount of fructose to semen.
Why is this necessary?
2. The ejaculatory ducts transport the semen to what gland next?
D. Prostate Gland
1. The prostate gland helps to thicken the sperm why is this beneficial in the
female reproductive tract?
2. What are some of the symptoms of an enlarged prostate?
E. Bulbourethral Gland
1. The fluid from the bulbourethral glands helps to do what?
VI. The Penis
1. The penis is _____________ for non-sexual actions, and _____________
with sexual arousal.
2. What are the chambers found inside the shaft of the penis?
3. The two larger chambers are the _________________
_________________________.
4. The corpus spongiosum surrounds the _______________.
5. The end of the penis is the ______________ ________________.
6. The foreskin or _______________ is a collar around the penis.
7. What is the role of Nitric Oxide in the erection process?

258
VII. Testosterone
1. What cells produce testosterone?
A. Functions of Testosterone
1. Why is testosterone important for the male reproductive system?
a) What happens when there are low levels?
2. Is all testosterone produced in the testes?
B. Control of Testosterone

1. How does gonadotropin-releasing hormone (GnRH) lead to production of

testosterone?
2. What effect does follicle-stimulating hormone have on the male
reproductive system?
3. What happens to GnRH secretion when testosterone is high? Low?
a) What type of feedback governs this system?

259
27.2. Anatomy and Physiology of the Female Reproductive
System

I. Background
1. What is similar and different between
the male and female reproductive
systems?
2. The ovaries are the female gonads.
What gamete do they produce?
II. External Female Genitalia
1. What is the vulva?
2. What changes about the mons pubis
after puberty?
3. What role do the labia minora serve?
4. Why does the clitoris have an
abundant nerve supply?
5. Why is the hymen only a partial
membrane?
6. The greater vestibular glands that are
found on either side of the vaginal
opening are known as
___________________
____________.

III. Vagina
1. The vagina allows for the exit of what materials?
2. The middle and inner layers of the vagina, including the rugae, allow for
what?
3. Microorganisms that live inside the vagina protect against what?

260
IV. Ovaries
1. The mesovarium supports the ovaries and connects them to the
___________ ligament.
2. The oocyte and the supporting cells are collectively known as a
____________.
V. The Ovarian Cycle
1. How long is the ovarian cycle?
a) Is this the same as the menstrual cycle?
2. What is oogenesis and folliculogenesis? Are they the same?
A. Oogenesis
1. Gametogenesis in females in oogenesis. What is the ovarian stem cell
used for this process?
2. When do oogonia form primary oocytes?
a) What happens to
these primary
oocytes until
puberty?
b) What happens to
the number of
primary oocytes
throughout the
lifetime?
3. What is ovulation?
4. What triggers the
resumption of meiosis in
a primary oocyte?
5. What are polar bodies?
a) Are these viable
gametes?
6. When is meiosis of a
secondary oocyte
completed?
a) After meiosis II a
haploid ___________
is produced.
7. Does the sperm contribute
cytoplasm or organelles
during fertilization?
B. Folliculogenesis
1. __________________ is the
growth and development of
follicles.
2. Primordial follicles are at a
resting state and have a
single layer of cells known as
the _______________
_________.

261
 3. Primordial follicles that respond to recruitment signals develop into
_____________ _______________.
4. Secondary follicles develop connective tissue, blood vessels, and theca
cells. Theca cells produce ________________.
5. Follicles in the antrum that are fully formed are ______________ follicles.
6. What is atresia?
C. Hormonal Control over the Ovarian Cycle
1. GnRH signal the anterior pituitary to produce what two hormones?
2. FSH stimulates follicles to
do what?
3. LH results in the production
of what hormone?
4. The dominant follicle
releases so much estrogen
the negative feedback
doesn’t occur. What
happens instead?
5. A surge of what hormone
leads to ovulation?
6. After ovulation the
remainder of the follicle
forms the ___________
____________ or
“yellowish body.”
7. The corpus luteum does
not release estrogen, but
instead it releases the
hormone
_____________________
which triggers the negative
feedback in the
hypothalamus and pituitary.
8. If pregnancy does not occur the corpus luteum degrades into the
_____________ _______________.
VI. The Uterine Tubes
1. The uterine or fallopian tubes allow the oocyte to travel from the
_____________ to the ________________.
2. The narrow medial end of the uterine tube is the ______________, and
the wide distal portion is the __________________ and have projections
known as fimbriae.
3. Where in the uterine tubes does fertilization occur?
4. How are oocytes transported from the ovaries through the uterine tubes?

262
 5. The uterine tubes are open at the end near the ovaries. Why can this
potentially be problematic in the event of an infection?
VII. The Uterus and the Cervix
1. What organ nourishes and supports the growing embryo?
2. The fundus is superior to the opening of the uterine tube. The body of the
uterus leads to the narrow inferior portion of the uterus, the
____________.
3. What helps hold the uterus in position?
4. The perimetrium, myometrium, and endometrium are all layers of the
uterus. Which one contains the most muscle?
5. What happens to the stratum functionalis of the endometrium during
menstruation?
6. What hormone maintains the
thick stratum functionalis?
a) Once this signal stops
and the endometrial
tissue in the stratum
functionalis dies it is
shed during
______________.
b) The first menses after
puberty is
_______________.
VIII. The Menstrual Cycle
1. How variable is the length of
a menstrual cycle?
2. What are the three phases of
the menstrual cycle?
A. Menses Phase
1. What happens during the
menses phase?
2. FSH and LH are _________
during the menses phase.
3. Decline in progesterone
triggers the shedding of the
_________________ of the
endometrium.

263
 B. Proliferative Phase
1. The proliferative phase is when the ________________ proliferates.
2. What hormone leads to the endometrium rebuilding?
3. Normally high estrogen decreases FSH and LH, and maturation of a
tertiary follicle. The high estrogen from the dominant follicle switches the
normally negative feedback to __________ feedback driving the LH surge
for ovulation.
C. Secretory Phase
1. What hormone begins the secretory phase of the menstrual cycle?
2. If pregnancy is to occur how does the uterus prepare during the secretory
phase?
3. If pregnancy does not occur what happens to the endometrial lining?
IX. The Breasts
1. Breasts are an accessory
reproductive organ, what is their
primary function?
2. Why does the areola have raised
areolar glands?
3. _________________ glands
produce milk and are modified
sweat glands.
4. Milk is produced in alveoli and then
passes through ___________________ sinus and ducts to exit the
breast.
5. What is the role of the suspensory ligaments?
6. How do the normal hormonal fluctuations of the menstrual cycle affect the
breast?
X. Hormonal Birth Control
1. How do birth controls supplying a constant level of estrogen and
progesterone help to prevent pregnancy?
2. What is the difference in the birth control that have 21 active days and 7
placebos versus the pills that have low dose active pills every day?
3. What happens when a birth control pill is missed or delayed?

27.3. Development of the Male and Female Reproductive

Systems

I. Background
1. How much does the reproductive system change between infancy and
puberty?
II. Development of the Sexual Organs in the Embryo and Fetus
1. Without chemical prompting fertilized eggs develop into what sex?
2. What is the role of the SRY gene in sexual development?
3. What happens when bipotential is expressed to testosterone or when it is
not exposed to testosterone?
4. What tissues in the reproductive tract are not bipotential?
5. The female duct is the ________________ duct, and the male duct is the
______________ duct.

264
III. Further Sexual Development Occurs at Puberty
1. What is puberty?
2. Aside from maturation of the reproductive system during puberty there is
also a development of secondary sex characteristics. What are secondary
sexual characteristics?
3. When is LH production detectable? Does this occur at the start of
physically visible puberty or before?
4. During puberty what happens to the sensitivity of the hypothalamus and
pituitary gland?
a) What happens to the sensitivity to the of the gonads to FSH or
LH?
5. FSH and LH increase during puberty, which leads to more sex hormones
and the initiation of _______________________ and
_________________________.

A. Signs of Puberty
1. As girls develop through puberty development of breast tissue typically
occurs first, followed by growth of axillary and pubic hair, a growth spurt,
and then ________________, the start of puberty.

265
2. What is usually the first physical sign of puberty in boys?
a) Testosterone stimulates growth of the ________________ and
thickening of the vocal folds which cause the voice to drop in
pitch.
b) When does the male growth spurt occur relative to the female
growth spurt?

266
Chapter 28

28.1. Fertilization

I. Background
1. What is fertilization?
2. After fertilization a zygote contains what?
II. Transit of Sperm
1. Why are millions of sperm necessary for one to fertilize the egg?
2. What is capacitation? How does this assist in fertilization and give sperm
the “capacity” to fertilize an oocyte?
III. Contact Between Sperm and Oocyte
1. The two protective layers around the oocyte are the _______________
_______________ which is more external, and the ____________
________________ that surrounds the plasma membrane.
2. What purpose do the chemical attractants serve that are released by the
corona radiata?
3. What is the
acrosomal reaction,
and what are the
enzymes in the
acrosome used for?
4. Is one sperm
sufficient to degrade
the corona radiata
and zona pellucida?
5. How does the
oocyte prevent
polyspermy?
6. Is the cortical
reaction the fast or
slow block?
7. What is the
fertilization
membrane?
IV. The Zygote
1. Upon fertilization the oocyte must complete _____________ in order to
become an ovum.
2. After the female and male genetic material intermingle the diploid
__________________ results.
3. What are fraternal twins, and how do they result?
4. How do identical twins develop?
a) How frequently does this occur?

267
28.2. Embryonic Development

I. Background
1. The time for full development of a fetus in utero is
_____________________.
2. During weeks 3-8 of development the developing human is an
_______________.
3. When is a developing human a fetus?
II. Pre-implantation of Embryonic Development
1. The conceptus is the zygote and what
else?
2. The first few divisions, or cleavages of the
cells creates daughter cells known as
__________________.
3. What is the 16 cell conceptus known as?
4. The blastocoel is a fluid-filled cavity inside
of the ________________.
5. The inner cell mass will become the
__________ and the trophoblasts will
develop into the __________________.
III. Implantation
1. How long after fertilization until
implantation occurs?
2. Where in the uterus does
implantation usually occur?
3. Is implantation normally
successful?
4. What is the synctiotrophoblast,
and how does it help to keep the
blastocyst adhered?
5. What is hCG, and why is it
commonly used in pregnancy
tests?
6. What is an ectopic pregnancy and
why is this not conducive to a
healthy pregnancy?
7. Where does implantation occur in
placenta previa?
IV. Embryonic Membranes
1. The amniotic cavity appears
between what two layers?
2. What fills the amnion during the
second week?
3. How does the amniotic fluid protect
the developing fetus?

268
 4. What does the yolk sac provide?
5. That allantois becomes part of what organ?
V. Embryogenesis
1. The two-layer disc of cells
becomes a three layered disc
during __________________.
2. The primitive streak appears on
the ______________ surface.
3. What are the three layers that
develop during the third week of
development?
4. What does the endoderm
become in the embryo?
5. Which layer becomes the hair,
nails, and skin?

VI. Development of the Placenta

1. What takes over feeding the embryo during weeks 4-12?
2. How does the placenta connect to the conceptus?
3. The chorionic membrane’s chorionic villi form what part of the placenta?

269
 4. What is placentation, and when does it occur?
5. What does the placenta provide for the embryo and fetus?
6. What are substances can pass through the placenta through diffusion?
7. What is moved via active transport?
8. Why is it important that maternal and fetal blood do not interact?
VII. Organogenesis
1. Neurulation developing
rudimentary portion of what body
system?
2. The neural tube is composed of the
folds of the __________ _______
converging.
3. The notochord arises from what
germ layer?
4. The somites develop into what part
of the skeleton?
5. Through embryonic folding the
embryo assumes a C-Shape. The
yolk sac is where in the fold, and
becomes what structure?

270
 6. Development of the rudimentary structures of all organs and tissues is a
process known as ____________________.
7. When does the heart start beating in development, and when does it start
pumping blood?
8. What allows for the paddle shaped hands to develop into discrete
fingers?
9. Ossification allows for what to develop?

28.3. Fetal Development

I. Background
1. When is a developing human a fetus?
2. At the end of fetal development what is the
newborn capable of?
II. Sexual Differentiation
1. Does sexual differentiation occur during the
embryonic or fetal period of development?
2. Development of testes and a vas deferens
occur in ____________ development, and
development of ovaries and the uterus occurs
in ________________ development.
III. The Fetal Circulatory System
1. The fetal circulation is integrated with what
during prenatal development?
2. What is a shunt?
a) Why is a shunt necessary in fetal
development?
3. What provides the fetus with oxygen while the
respiratory system can’t oxygenate itself?

271
 4. What semifunctional organ does the ductus venosus mostly skip over?
5. What do the foramen ovale and ductus arteriosus allow the circulatory
system to skip over?
6. Why is the blood in the
aorta only partially
oxygenated?
7. How does the
deoxygenated fetal blood
reach the umbilical
arteries?
IV. Other Organ Systems
1. What takes over
erythrocyte production
from the liver during fetal
development?
2. Sensory organs develop
during what weeks of
development?
a) What is
meconium, and
where does it
accumulate?
3. What is quickening and
when is it felt?
4. What purpose does vernix caseosa serve in childbirth?
5. Why are full term babies not seen with lanugo, but some premature
babies have it?
6. Why is it important for the fetus to produce surfactant during weeks 21-
30?

28.4. Maternal Changes During Pregnancy, Labor, and Birth

I. Background
1. How long is a full-term pregnancy?
2. How long is each of the trimesters of
pregnancy?
II. Effects of Hormones
1. During weeks 7-12 what primarily generates
the hormones that nourish the blastocyst?
2. When does the placenta take over as the
primary endocrine organ of pregnancy?
3. Estrogens climb throughout pregnancy what
actions do they have?
4. How does relaxin prepare the mother’s body
for childbirth?
5. Why is thyroid hormone increased during
pregnancy?

272
 6. Prolactin stimulates enlargement for what gland?
III. Weight Gain
1. What is the most obvious sign of pregnancy?
2. What contributes to the weight gain?
3. When does a mother need to consume more calories to maintain a
healthy pregnancy?
IV. Changes in Organ Systems During Pregnancy
A. Digestive and Urinary System Changes
1. What may be responsible for “morning sickness?”
a) When does it usually subside?
2. Why does heartburn occur in later stages of pregnancy?
3. Why is urination more frequent?
B. Circulatory System Changes
1. Why does blood volume increase with pregnancy?
C. Respiratory System Changes
1. What happens to the respiratory minute volume during pregnancy?
a) Why is this change necessary?
2. Why does lightening help with dyspnea during pregnancy?
D. Integumentary System Changes
1. Why do stretch mark appear
during pregnancy?
2. What causes darkening of the
areolae and the linea nigra?
V. Physiology of Labor
1. When does parturition usually
occur with multiple fetuses?
2. What inhibits uterine
contractions during the first
several months of pregnancy?
3. How does the ratio of
estrogen to progesterone change to make the myometrium more
sensitive to contraction signals?
4. What are Braxton Hicks
contractions?
a) Is this labor?
5. Oxytocin driven contractions occur
in a ______________ feedback
loop.
6. What is true labor?
VI. Stages of Childbirth
A. Cervical Dilation
1. How much must the cervix dilate to
accommodate delivery?
2. Dilation normally takes how long?
3. How does the frequency of
contractions change throughout
labor?
4. Why is the relaxation period
between contractions necessary for
fetal health?

273
 B. Expulsion Stage
1. When does the expulsion stage begin?
2. What is the vertex presentation?
3. What is breech presentation?
4. Why was an episiotomy common?
5. When the newborns head is presented what tasks are performed?
C. Afterbirth
1. What is the afterbirth?
2. How long is the postpartum period?
3. Why is it important that all of the placenta is expelled?
4. What purpose does involution of the uterus serve?
5. How long is lochia discharge continue after pregnancy?

28.5. Adjustments of the Infant at Birth and Postnatal Stages

I. Background
1. Why is birth a crisis situation for a fetus?
2. How long is the neonatal period?
II. Respiratory Adjustments
1. How do labor contractions constricting the umbilical cord stimulate
breathing in the newborn?
2. What respiratory and vascular adjustments are made upon the first
breath?
III. Circulatory Adjustments
1. How do the umbilical blood
vessels occlude in the absence
of clamping?
2. What happens to the ductus
venosus?
3. What closes the foramen ovale?
IV. Thermoregulatory Adjustments
1. Why is it difficult for a newborn
to regulate their body heat
compared to an adult?
2. What is nonshivering
thermogenesis and how does it
us brown adipose tissue to
generate heat?
3. How does brown fat differ from
white fat?
V. Gastrointestinal and Urinary
Adjustments
1. How does the sterile fetal intestinal tract develop normal bacterial flora?
2. Why do newborns produce dilute urine?

274
28.6. Lactation

I. Background
1. What is lactation?
2. What does breast milk provide for the infant and for the mother?
II. Structure of the Lactating Breast
1. Mammary glands are modified
____________ glands.
2. What transports milk in the
breast?
3. Milk is secreted from
______________, fills the
alveoli, and is squeezed into the
ducts.
4. Why do Montgomery glands
secrete oil?
III. The Process of Lactation
1. Prolactin has what effect on the
maternal body?
2. Prolactin is high during
pregnancy, but no milk is
produced. What inhibits milk
production?
3. How does suckling lead to milk
secretion?
4. What role do oxytocin play in
the milk letdown reflex?
5. What effect does frequent milk
removal have on prolactin?
IV. Changes in the Composition of
Breast Milk
1. What is colostrum?
a) When is mature breast milk secreted?
2. Colostrum is rich with immunoglobulins. What do these do for the
newborn?
3. Why is cow’s milk not a sufficient replacement for breast milk?
4. Milk produced adjusts to the amount needed by the infant(s). What
happens to produced milk when suckling stops?
5. What is the difference between foremilk and hindmilk?
6. The laxative properties of breast milk help to expel meconium. Why is this
necessary?
a) Why is elevated bilirubin especially dangerous to a newborn?

28.7. Patterns of Inheritance

I. Background

275
II. From Genotype to Phenotype
1. Each person has a ________ pairs of chromosomes.
2. In a karyotype there are __ pairs of autosomal chromosomes and ___
pair of sex chromosomes.
3. What is the difference between a genotype and a phenotype?
4. Each parent supplies how much of a person’s chromosomes?
5. Do alleles need to be the same on a pair of chromosomes?
a) What is it called when they are identical?
b) What is it called when they are different?
6. What is the different between a dominant and nondominant allele?
7. Are all characteristic determined by a single allele?
III. Mendel’s Theory of Inheritance
1. What did Mendel use to learn how
physical characteristics were
transferred to subsequent
generations?
2. Why was the tallness in the peas
dominant and dwarfism
recessive?
a) Tallness and dwarfism
were called these
variations a
____________.
3. What was the ratio observed in
the second-generation offspring?
4. What lead Mendel to believe in
“heritable factors” that were
transmitted how?
5. What is codominance?
6. What is random segregation?
7. What is independent assortment?
a) How does independent assortment lead to more variety in
offspring?
8. Why are humans more difficult to study than pea plants?
IV. Autosomal Dominant
Inheritance
1. What does autosomal
dominant mean?
2. Using a Punnett square
what is the likelihood of
a child inheriting an
autosomal dominant
condition from a
homozygous recessive parent and a heterozygous parent?

276
 V. Autosomal Recessive
Inheritance
1. What is
autosomal
recessive?
2. Would someone
who is
heterozygous
display
symptoms of a
autosomal
recessive
disease?
3. A child born to
two carriers of
an autosomal recessive disease has what percentage change of
inheriting the disease?
a) What about a child born to a carrier and someone unaffected?

VI. X-linked Dominant or Recessive Inheritance

1. What is an X-linked transmission pattern?
2. If a father has an X-linked dominant condition
how many of his daughters will inherit it?
Why?
a) What is a mother has it? What is the
odds of her children having the
disease?
3. What are some examples of X-linked
recessive inheritance traits?
4. Why can’t males be carriers of X-linked
recessive diseases?

VII. Other Inheritance Patterns: Incomplete Dominance, Codominance,

and Lethal Alleles
1. What is incomplete dominance?

277
 2. What is an example of incomplete dominance in humans?
3. With codominance what is expressed?
a) What is an example of codominance in humans?
4. What would a person need to inherit to have O blood type?
5. What is a recessive lethal allele?
a) What is an example?
6. Are dominant lethal inheritance patterns common?
a) Why is Huntington’s passed on despite being dominant lethal?
VIII. Mutations
1. Do all mutations affect a person’s phenotype?
2. What can cause a mutation?
IX. Chromosomal Disorders
1. What is an example of a disease caused by an incorrect number of
chromosomes?
2. What is nondisjunction and what can it result in?
3. What is monosomy, and how does it relate to Turner Syndrome?

This OpenStax ancillary resource is © Rice University under a CC-BY 4.0 International license; it may be
reproduced or modified but must be attributed to OpenStax, Rice University and any changes must be
noted.

278