Institute of Pharmacy S.Y. 2022 - 2023 1st Year I 2st Semester I Midterms Prof. Joshua Kenneth NG

PBS 2 (2018): HUMAN PHYSIOLOGY AND PATHOPHYSIOLOGY
Institute of Pharmacy S.Y. 2022 - 2023

1st Year I 2st Semester I Midterms
Prof. Joshua Kenneth Ng
Importances:
HUMAN PHYSIOLOGY AND PATHOPHYSIOLOGY 1. Understand and predict the body’s responses to stimuli.
Why do we need to study Human Physiology and 2. Understand how the body’s internal conditions within a
Pathophysiology? narrow range of values in the presence of continually
● Human body has many parts with coordinated functions changing internal and external environments.
maintained by a complex system of checks and balances
also known as “homeostasis”. Understanding Branches of Physiology:
● Coordinated function is responsible for the body to 1. Human physiology
interact with surroundings. ❖ study of a specific organism.
● adapts to changes in environments and interactions of 2. Cellular physiology
both inside and outside of the body or also known as ❖ biological study concerned with transport of
“stimuli”. nutrients, ions and water into and out of a cell.
❖ The way the body adjusts to the environmental 3. Systemic physiology
information. ❖ deals with organ specific systems and how they
function.
Understanding Anatomy
Anatomy Understanding Pathophysiology
● scientific discipline that investigates the structure of the ● study of the disturbance of normal, mechanical, physical
body. and biochemical functions, either caused by a disease or
● means to dissect, cut apart and separate, the parts of the resulting from a disease or abnormal syndrome or
body for the study. condition that may not qualify to be called a disease.
● covers a wide range of studies, including the structure of ● An alternate definition is "the study of the biological and
body parts, their microscopic organization, and the physical manifestations of disease as they correlate with
processes by which they develop. the underlying abnormalities and physiological
● examines the relationship between the structure of a disturbances”.
body part and its function. ● entails the study of not only disease, but also the study of
disorder and syndrome.
Two (2) Approaches of Anatomy:
➢ Systemic anatomy Disease, Disorder, and Syndrome
❖ study of the body system. Disease
❖ e.g. cardiovascular, reproductive, muscular etc. ● health disease with definite reason behind it.
➢ Regional anatomy ● e.g. osteoarthritis or the wear and tear of the bones due
❖ study of the organization of the body by area. to lack of synovial fluid.
Disorder
Two (2) General Ways in Examining Internal Structures: ● no organization, or disorganization that can lead to
1. Surface anatomy impairment.
● external features. Syndrome
2. Anatomical anatomy ● from the greek word meaning “run together”, a number of
● use of other technologies to create images. symptoms without an identifiable cause.
● e.g. ● e.g. Down Syndrome
❖ CT (Computerized Tomography) Scan
❖ PET (Positron Emission Tomography) Scan Structural and Functional Organization of the Human Body
❖ MRI (Magnetic Resonance Imaging) Scan Chemical level
❖ Ultrasounds ● hydrogen and carbon -> molecule structure
❖ X-Ray (X-Radiation) - uses different ● starts with atoms of hydrogen and carbon that eventually
wavelengths such as: combines and turns into a molecular structure.
➔ Alpha Additional Information:
➢ superficial wavelength; ➢ For example, collagen fibers or molecules have
weakest penetration. strong rough fibers that give skin structural
➔ Beta strength and flexibility.
➔ Gamma ➢ Aging process of collagen begins to deteriorate
➢ highest or strongest at age 20.
penetration wavelength. ➢ That’s why we should drink Vitamin C that has
Anatomists antioxidants and stimulates collagen
● person involved in studying anatomy. production or fibroblast.
Cell level
Understanding Physiology ● forms into organelles -> cell structure
● scientific that deals with the processes or functions of Tissue level
the living things. ● group of similar and the materials surrounding them
● structures -> dynamic rather than fixed -> unchanging (epithelial, connective, muscle and nervous).
Transcribed by: I-A BSP (S.Y. 2022-2023) 1

Organ levelterm-35 countries like Dubai.

● composed of two or more tissue types that are used Growth
together to perform one or more common functions ● refers to an increase in size of all or part of the organism.
(heart, stomach, liver and urinary bladder). It can result in an increase of cell size, number or amount
of substance surrounding the cells.
Additional Information: Additional Information:
➢ Heart - carries oxygen-rich blood to the whole ➢ Chlorella Growth Factor (CGF) - only supports
body, and carries deoxygenated blood away the growth of the body and is only a
from our body through respiration, urination etc. supplement. No approved therapeutic claims.
○ oxygenated blood - bright red Development
○ deoxygenated blood - dark red ● includes the changes an organism undergoes through
Organ System level time.
● group of organs classified as a unit because of a Differentiation
common function or set of functions. ● change in cell structure and function from generalized to
Organism level specialized.
● any living thing considered as a whole, whether Reproduction
composed of one cell such as bacterium or trillions of ● formation of new cells or new organisms.
cells such as human.
HOMEOSTASIS
1. Atoms ● hōʹmē-ō-stāʹsis; “homeo-”, meaning the same; “-stasis”
2. Molecules meaning to stop.
3. Organelle ● existence and maintenance of a relatively constant
4. Cell environment within the body despite fluctuations in either
5. Tissue the external environment or the internal environment
6. Organ similar to a “buffer” in inorganic chemistry.
7. Organ System ● narrow range of conditions including temperature,
8. Organism volume and chemical content (these can change;
variables).
CHARACTERISTICS OF LIFE Homeostatic mechanisms
Organization ● mechanisms that maintain normal body temperature
● refers to the specific relationship of many individual parts near an average value or set point.
of an organism, from cell organelles to organs, ● e.g. sweating, shivering
interacting and working together. ❖ In sweating, hypothalamus senses high
Metabolism temperatures e.g. in exercising, then it signals
● ability to use energy to perform vital functions growth, the body to produce sweat in order to cool
movement and reproduction. down.
Additional Information: ❖ In shivering, there’s continuous and short
➢ Anabolism - synthesis of complex molecules contractions of the muscles as it produces heat
from simpler ones. Requires energy. that will normalize body temperature, a.k.a. “the
➢ Catabolism - breakdown of complex molecules compensation process”.
into simpler ones. These reactions release ❖ Note:
energy. ➔ Body temperature increases and
➢ Intermittent fasting or 8-12 hrs of fasting decreases slightly around the set
forces our body to break down stored fat. point producing a normal range of
➢ When you don’t eat for 24 hrs your body breaks values.
down proteins from the muscle to convert it into ➔ Homeostatic mechanisms are not
energy and this is called “catabolism”. able to maintain body temperature
Responsiveness precisely at a set point.
● ability of an organism to sense changes in the
environment and make adjustments that help maintain Negative Feedback
its life. ● any deviation from the set point is made smaller or is
Additional Information: resisted.
➢ Circadian rhythm - helps control your daily ● Negative feedback does not prevent variation but
schedule for sleep and wakefulness or most maintains variation within a normal range.
commonly known as our ‘body clock’. ● e.g. body temperature
➢ Melatonin Additional Information:
➔ responsive only when the ➢ Catapres affects negative feedback to lower
environment is dark. blood pressure. It works by relaxing and
➔ taking melatonin has first-pass effect. widening blood vessels in lowering blood sugar
➔ can possess antioxidant activity. levels.
➔ Note that you shouldn’t take this more
than 10 mg. 1. Receptor
➔ It is a prescription drug in certain ● monitors the value of a variable such as body
temperature by detecting stimuli.

● sends a message to the control center (brain) Positive Feedback
● e.g. skin ● occur when the initial stimulus further stimulates the
❖ There’s various receptors in the skin or dermis response.
layer. ❖ In other words, positive means that the
2. Control center deviation from the set point becomes even
● determines the set point for the variable and receives greater.
input from the receptor about the variable before making ❖ required to re-achieve homeostasis.
an output or action. ❖ e.g. birth and blood loss
3. Effector In birth,
● can change the value of the variable when directed by the 1. When a woman is giving birth, the uterus becomes
control center to produce a stimulus. greatly expanded than normal to compensate for the
● e.g. nerves, effector nerves when are connected will then baby’s large size.
create a stimulus. 2. The body senses that the baby needs to be delivered. It
4. Stimulus stimulates the contraction of uterine muscles to deliver
● a changed variable that initiates the homeostatic the baby which is the initial stimulus that is needed to
mechanism enhance in order to re-achieve homeostasis.
● e.g. sweating 3. When the uterus begins to contract, it pushes the baby
against the opening of the uterus stretching it further.
Pyrexia This stimulates additional contraction providing
● medical term for fever. additional stretching until the baby is released.
4. Positive feedback is when the baby is delivered and the
A PERSON WITH PYREXIA stretching of the uterus is eliminated.
1) Rise in body temperature
2) Sweat and the body cools. In extreme blood loss,
3) Thermoreceptors in the skin detect an increase of 1. Blood pressure decreases, to the point that delivery of
temperature. the blood to the cardiac muscle is inadequate.
4) Sends to control center 2. To compensate, blood transfusion must immediately be
5) Hypothalamus stimulates blood vessels in the skin to done because extreme blood loss weakens cardiac
relax and sweat glands to produce sweat. muscles even if the brain persists in communicating the
6) Sends more blood to the body's surface to radiate heat heart to pump more blood.
away from the body. 3. If not further treated, it can lead to death.
7) Body temperature returns to normal.
8) Control center regulates and sends signals to sweat Note:
glands to reduce sweat. ● There are positive and negative side in positive feedback.
9) Blood vessels (BV) constricts and returns to normal
diameter.
Additional Information:
➢ Medulla a.k.a. “brain stem”
➔ controls heart rate, and other
involuntary movements such as
digestion, and releasing of hormones.
➔ For example, there’s very little chance
of surviving if a person has a cancer
in medulla e.g. glioma because it is
inoperable. Any wrong move will
immediately cut-off involuntary
actions such as breathing.
➢ Thermoreceptors
➔ located in the dermis.
➢ Thermogenesis
➔ rising of temperatures.
A PERSON WITH HYPOTHERMIA

1) A drop in body temperature.
2) Control center does not stimulate sweat glands.
3) Blood vessels constrict more than normal.
4) Blood is directed to deeper regions of the body.
5) Conserves heat in the interior of the body.
6) Hypothalamus stimulates shivering processes.
7) Generates heat through quick cycles of muscle ORGAN SYSTEM OF THE BODY
contractions. Major Organs of the Body
8) Body temperature returns to normal. Brain

● control center of the body meaning it controls everything ➢ Lipase

from voluntary to involuntary movements. ➔ enzyme that helps the body digest
fats.
Lungs ➢ Lactase
● site of respiration particularly gas exchange of oxygen ➔ enzyme responsible for the digestion
and carbon dioxide. of the milk sugar called “lactose”.
Heart ➢ Malabsorption
● main pump of the blood that carries oxygenated blood ➔ difficulty in the digestion or
throughout the body or carries oxygen away from the absorption of nutrients from food.
heart and also carries deoxygenated blood from the ➢ Orlistat
body. ➔ drug that is otc that rescue absorption
❖ Deoxygenated blood can be excreted through of fat-soluble.
respiration, kidneys, saliva, and mucous ➔ caused for weight loss.
membranes. ➔ causes fatty or oily stool “fatty
Liver spotting”.
● home of many enzymes, site of metabolism as well as ➢ Loperamide
drug interactions. ➔ Diphenoxylate
Additional Information: ➔ opioid drug that relieves pain for
➢ The LADMER (System Liberation, Absorption, diarrhea.
Distribution, Metabolism, Elimination, and ➔ does not treat diarrhea but masks
Response) in the relationship between dose underlying issues.
and its effectiveness. Kidneys
➢ Cytochrome P450 (CYP) ● major filtering organ in the body.
➔ enzymes for metabolism and filtering ● helps in the excretion of excess water and salts.
toxins, are a protein superfamily ● responsible for the RAAS Mechanism.
involved in the synthesis and Additional Information:
metabolism of drugs, toxins and ➢ Edema
normal cellular components. ➔ swelling caused by excessive fluid or
Pancreas water retention in the body.
● responsible for releasing insulin (regulates blood sugar ● Treated with diuretics
levels) to form metabolic processes, also responsible for specifically Furosemide,
regulation of blood sugar. Spironolactone.
Additional Information: ➔ Its hallmark symptom is Congestive
➢ Glucose Tolerance Factor (GTF) Heart Failure (CHF) treated with
➔ synthesized in vivo from absorbed Digoxin which came from the Digitalis
dietary chromium, and acts as a plant a.k.a. Purple foxglove plant.
physiological enhancer of insulin Large Intestine
activity. ● for elimination and excretion.
Spleen ● binds undigested material with water to form firm stool.
● humans can live without it.
● eliminates toxins Additional Information:
Stomach ➢ Watery stools means there’s a leakage of water
● responsible for churning process. meaning undigested food is not fully absorbed
● releases potent HCl and enzymes. resulting to loose bowel movement (LBM).
● absorbs some drugs that are meant to be absorbed in Small Intestine
the stomach. ● site of certain nutrient absorption e.g. organic molecules,
Additional Information: vitamins and minerals.
➢ Bisacodyl (Brand name: Dulcolax) ● contains microvilli, function is to absorb nutrients.
➔ stimulant laxative that is enteric Urinary Bladder
coated; can be very irritating. ● temporary storage of urine until it completely passes to
➔ Bisacodyl + milk = coating will the urethra.
dissolve and can irritate stomach. Urethra
Gallbladder ● a long, hollow tube similarly to a “straw” which serves as
● The gallbladder holds a digestive fluid called bile that's a passage of urine until excretion process is done.
released into the small intestine.
➢ Amylase
➔ an enzyme, a type of protein that
helps your body break down
carbohydrates. Integumentary System
➢ Protease
➔ enzymes that break the peptide bonds
of proteins

➢ Muscle Atrophy
➔ wasting of muscle and is life
threatening.
➔ e.g. when bedridden
Nervous System
● provides protection, regulates temperature, prevents

water loss, and helps produce vitamin D.
● consists of skin, hair, nails, sebaceous glands and sweat
glands. ● a major regulatory system that detects sensations and
controls movements, physiological processes, and
Skeletal System intellectual functions.
● consists of the brain, spinal cord, nerves, and sensory
receptors.
Endocrine System
● provides protection and support, allows body

movements, produces blood cells, and stores minerals
and adipose tissue.
● consists of bones, associated cartilages, ligaments, and
joints. ● a major regulatory system that influences metabolism,
● framework of the body. growth, reproduction, and many other functions.
● consists of endocrine glands such as the pituitary (that
Muscular System secretes hormones).
Additional info:
➢ Cortisones
➔ hormone that the endocrine system
releases.
➔ hormone for anti-inflammatory
processes and stress response.
● produces body movements, maintains posture, and

produces body heat.
● consists of muscles attached to the skeleton by tendons.
Cardiovascular System
● helps us breathe in diaphragm

● transports nutrients, waste products, gases, and

hormones throughout the body.
● plays a role in the immune response and the regulation of ● performs the mechanical and chemical processes of
body temperature. digestion, absorption of nutrients, and elimination of
● consists of the heart, blood vessels, and blood. wastes.
● consists of the mouth, esophagus, stomach, intestines,
Lymphatic System and accessory organs.
➢ Appendix
➔ accessory of the body.
➔ When a person walked or ran after
eating, the stomach pain is not due to
appendix, it is because of muscle
cramps.
➢ Appendicitis
➔ inflammation of the appendix when
an infection passes through.
➢ Sepsis
➔ response to an infection.
Urinary System
● removes foreign substances from the blood and lymph,

combats disease, maintains tissue fluid balance, and
absorbs dietary fats from the digestive tract.
● consists of the lymphatic vessels, lymph nodes, and
other lymphatic organs.
Respiratory System
● removes waste products from the blood and regulates

blood pH, ion balance, and water balance.
● consists of the kidneys, urinary bladder, and ureters.
● exchanges oxygen and carbon dioxide between the blood

and air and regulates blood pH.
● consists of the lungs and respiratory passages.
Digestive System Female Reproductive System

Directional Terms
● describe parts of the body relative to each other
1. Superior (cranial)
● above or up
2. Inferior (caudal)
● below or down
● produces oocytes and is the site of fertilization and fetal 3. Anterior / Ventral
development. ● front
● produces milk for the newborn, produces hormones that ● it goes first
influence sexual function and behaviors. ● e.g belly is front
● consists of the ovaries, uterine tubes, uterus, vagina, 4. Posterior / Dorsal
mammary glands, and associated structures. ● back
Additional Information: ● follows the anterior
➢ Kids until 2 years old must drink breast milk. 5. Proximal
➢ Breastmilk ● nearest
➔ has antibodies that detect antigens. 6. Distal
● distant
Male Reproductive System
7. Medial
● midline
8. Lateral
● away from the midline
● e.g. legs is lateral from stomach
9. Superficial
● structure close to the surface of the body
● e.g. skin
10. Deep
● toward the interior of the body
● e.g. digestive system, thorax
● produces and transfers sperm cells to the female and

produces hormones that influence sexual function and
behaviors.
● consists of the testes, accessory structures, ducts, and
penis.
TERMINOLOGIES AND ANATOMICAL BODY PLANE
Understanding Body Positions & Directional Terms
Anatomical Position
● refers to a person standing upright with the face directed
forward, the upper limbs hanging to the sides and the
palms of the hands facing forward.
1. Supine
● when lying face upward.
2. Prone
● when lying face downward.

anterior and posterior parts.
Body Parts and Body Planes

1. Quadrants
● often in abdomen which is subdivided superficially into
four sections by two imaginary lines (one vertical and
one horizontal).
2. Regions
● quadrants are sometimes subdivided into four imaginary
regions (two vertical and two horizontal)
➢ Chest x-radiation
➔ radiation particles will capture frontal
areas.
➔ will not see deeper regions unlike MRI
Body Planes
that will give 3D visual.
1. Sagittal plane
● runs vertically through body and separates it into right
Body Cavities and Serous membranes
and left parts
2. Median plane
● a sagittal plane passes through the midline of the body, Body Cavities
dividing it into equal right and left halves ● spaces/ empty area where organs can fit in a specific
● while the sagittal plane separates the body into left and cavity
right portions, the medial plane divides the body into two 1. Thoracic cavity
equal halves. surrounded by the rib cage and separated from the
3. Transverse or horizontal plane abdominal cavity by the muscular diaphragm
● runs parallel to the surface of the ground, dividing the 2. Mediastinum
body into superior and inferior parts ● divided into right and left parts by a center structure. The
4. Frontal or coronal plane section at which it houses the heart, the thymus, trachea,
● runs vertically from right to left and divides the body into esophagus and other structure

3. Abdominal cavity
● bounded primarily by the abdominal muscles and
contains the stomach, intestines, liver, pancreas, spleen
and the kidneys
● Also called as Abdominopelvic cavity
4. Pelvic cavity
● small space enclosed by the bones of the pelvis which
houses urinary bladder, part of the large intestines and
reproductive organs.
● found in lower level.
2. Pleural cavity
● as seen on each lung which is covered by visceral pleura
and parietal pleura lines the inner surface of the thoracic
wall
❖ parietal pleura - outermost covering film
❖ visceral pleura - second layer
Symphysis pubis
● space/ little bone structure found in pubic area or in
pelvic structure.
Serous Membranes ➢ -itis
● a membrane that lines the trunk cavities and cover the ➔ suffix denoting diseases
organs of these cavities characterized by inflammation, itself
● secretes fluid that fills space between parietal and often caused by an infection.
visceral membranes ➢ Pericarditis
Additional Information: ➔ inflammation of pericardium (a thin
➢ Serous Membrane is like the white film in sac that surrounds your heart. It
boiled eggs. protects and lubricates your heart and
➔ protects the inner membrane against keeps it in place within your chest.)
shock, mechanical protection, and ➢ Pleurisy
infections. ➔ inflammation of the pleura (a large,
➔ Film but rigid structure thin sheet of tissue that wraps around
➔ Without the fluid secreted by the the outside of your lungs and lines the
serous membrane, the organs will not inside of your chest cavity).
be stable.
Abdominopelvic Cavity Serous Membrane
1. Visceral serous membrane
● involves the abdomen and the pelvic region.
● inner part membrane that covers the internal organs
1. Peritoneal cavity
2. Parietal serous membrane
● a serous membrane lined cavity that houses visceral
● outer part membrane that forms walls of the body
peritoneum and covers many organs of the
cavities
abdominopelvic cavity whilst parietal peritoneum lines
the wall of abdominopelvic cavity inferior to the
Thoracic Cavity Serous Membrane diaphragm.
1. Pericardial cavity 2. Mesenteries
● surrounds the heart at which visceral pericardium covers ● consist of two layers of peritoneum fused together.
the heart whilst parietal pericardium forms the outer These anchors the organs to the body wall and provides
layer of the sac around the heart. pathways for nerves and blood vessels to reach the
● Pericardial fluid is also present in the said cavity organs.
❖ visceral pericardium 3. Retroperitoneal
➔ white film in the heart. ● other abdominopelvic organs that are closely attached,
➔ visceral means fat. do not have mesenteries but covered with parietal
❖ parietal pericardium peritoneum.

● the region where electrons can be found
Chemical bonding
● level of interaction between atoms to form molecules by
either sharing or transferring their outermost electrons.
● In a chemical bond, the fate of the electrons between two
atoms depends on the relative difference in
electronegativity between the atoms.
1. Valence shell
● outermost shell
● There is a maximum number of electrons that each shell
can hold.
● Outer shells do not contain electrons until the inner shells
Additional Information: have reached their maximum.
➢ Peritonitis ● The innermost shell (the shell closest to the nucleus)
➔ inflammation of the peritoneal cavity holds a maximum of 2 electrons, and the remaining
shells hold a maximum of 8 electrons.
2. Octet rule
CHEMICAL BASIS OF LIFE
● tendency of atoms to combine with other atoms until
each has 8 electrons in its valence shell.
Basic Chemistry of Life 3. Electronegativity
Chemistry ● ability of the atom’s nucleus to pull electrons toward it.
● scientific discipline concerned with the atomic ● In a chemical bond, the fate of the electrons between two
composition and structure of substances and the atoms depends on the relative difference in
reactions they undergo. electronegativity between the atoms.
Matter ➢ Free Radicals
● anything that occupies space and has mass. ➔ unstable electrons that can cause
● all living things are composed of matter. various diseases.
Mass ➔ causes cancer, dementia, etc.
● amount of an object of a given mass. ➢ Antioxidants
● the amount of matter in an object. ➔ stabilize unstable electrons.
Weight ➔ e.g. drugs such as ascorbic acid
● the gravitational force acting on an object of a given Conzace
mass. ● vitamin supplement that
contains electrons that can
1. Elements transfer to the other
● simplest type of matter having unique chemical electron.
properties ➢ Hydroquinone
● 96% of the body’s weight results from the mixture of ➔ delays oxidation process of cells
oxygen, carbon, hydrogen and nitrogen. ➔ Hydroquinone + tretinoin
● e.g. ● component of Maxipeel.
❖ Calcium - helps form bones
❖ Sodium - essential for neuronal activity Three Types of Chemical Bonding
2. Atom
1. Ionic Bonding
● smallest particle of an element that has the chemical
● occurs when the electrons are transferred between
characteristics of that element
atoms, creating opposite charged ions.
3. Molecules
2. Covalent Bonding
● resulting combination of atoms.
● forms when atoms share one or more pairs of electrons.
● sharing of electrons, rather than the transfer of electrons,
Atomic Structures occurs because the atoms have similar
1. Protons electronegativities.
● positive charge ● the strongest bonding
2. Electrons 3. Hydrogen bonding
● negative charge ● a dipole-dipole interaction which has positive end of one
3. Neutrons polar molecule and can be weakly attracted to the
● neutral charge negative end of another polar molecule
● Generally, it is a weaker type of bonding than ionic or
Nucleus covalent bonding
● proton + neutrons in an atom and accounts for 99.97% of ● Specifically for Nucleic Acids: DNA and RNA
an atom’s mass ● Water
Electron cloud ❖ universal solvent because it is non-reactive
● the weakest bonding DISSOCIATION OF IONS

● m each When ionic compounds dissolve in water, their
ions dissociate or separate, from the other because the
positively charged ions are attracted to the negative ends
of the water molecules, and the negatively charged ions
are attracted to the positive ends of the water molecules.
Electrolytes
● also known as “dissociated ions”.
● have the capacity to conduct electric current or the flow
of charged particles
● e.g.
❖ Electrocardiogram (ECG)
➔ a recording of electric currents
produced by the heart.
Chemical Reactions
● formation or breaking of chemical bonds between atoms,
ions, molecules, or compounds.
Hydrogen bonding vs. Covalent bonding
Types of Chemical Reactions
1. Direct Union
● a.k.a. Combination, Synthesis
● formation of more complex compounds e.g. atoms
wherein the reactants can be both elements, an element,
a compound, or both compounds.
2. Decomposition/ Analysis
Molecules and Compounds ● breaking down of more complex compounds from larger
to simpler compounds or elements.
Molecules
3. Single Replacement
● formed when two or more atoms chemically combine to
● a.k.a. Displacement, Single displacement, Substitution
form a structure that behaves as an independent unit.
● reaction of an element with an ionic compound.
Compounds
● single element replaces one of the ions in the compound.
● a substance resulting from the chemical combination of
4. Double Replacement
two or more different types of atoms
● a.k.a. Double displacement, Metathesis
● reaction of two ionic compounds to form two different
ionic compounds.

● has fewer H+ than OH− and thus a pH greater than 7.0.
Rate of Chemical Reactions

Reactants
● substances that enter into a chemical reaction.
Concentration
● substances that result from the chemical reaction.
Temperature
● Because molecular motion changes as environmental
temperature changes, the rate of chemical reactions is
partially dependent on temperature.
Catalysts
● increases the rate of a chemical reaction, without itself
being permanently changed or depleted. Salts
● a compound consisting of a positive ion other than H+
Enzyme and a negative ion other than OH−.
● protein molecule that acts as a catalyst. Buffers
● a chemical that resists changes in pH when either an
acid or a base.
INORGANIC MOLECULES
Organic Chemistry
● the study of carbon-containing substances.
Inorganic Chemistry
● deals with those substances that do not contain carbon.
Acid, Bases, and Salts ● e.g. Carbon dioxide (CO2) and carbon monoxide (CO) are
1. Acid classified as inorganic molecules, even though they
● substance that dissociates into 1 or more (H+) and one or contain carbon.
more negative ions.
● Proton donor Inorganic Molecules
2. Base ● deals with those substances that do not contain carbon
● substance that dissociates into 1 or more negative (OH-) with exceptions of molecules such as carbon monoxide
and one or more positive ions. and carbon dioxide.
● Proton acceptor ● Inorganic substances play many vital roles in human
3. Salt anatomy and physiology such as oxygen, carbon dioxide
● substance that dissociate in water into cations and and water
anions.
● Salts are formed by the reaction of an acid and a base. Carbon dioxide
● Neither H+ or OH- ● consists of one carbon atom bound to two oxygen
atoms. Each oxygen atom is bound to the carbon atom
pH Scale by a double covalent bond.
● a measure of the H+ concentration of a solution ● Carbon dioxide is produced when food molecules, such
Neutral Solution as glucose, are metabolized within the cells of the body
● an equal number of H+ and OH− and thus a pH of 7.0. Oxygen
Acidic Solution ● a small, nonpolar, inorganic molecule consisting of two
● has a greater concentration of H+ than of OH− and thus a oxygen atoms bound together by a double covalent bond.
pH less than 7.0 ● About 21% of the gas in the atmosphere is O2, and it is
Basic/Alkaline Solution essential for most living organisms.

Water bound to a glycerol molecule.

● an inorganic compound that consists of one atom of ❖ Saturated fatty acid
oxygen joined by polar covalent bonds to two atoms of ➔ contains only single covalent bonds
hydrogen between carbon atoms which
● Polar molecule – Hydrogen bonding declares full with hydrogen or
● have a unique properties that contributes to its functions ‘saturated’ (no space/full).
for living organisms. ➔ reason why coconut or vegetable oil
solidify at room temperature is
Critical Functions of Water: because of full atoms.
1. Stabilizing body temperature. Because heat energy
causes not only movement of water molecules, but also disruption
of hydrogen bonds, water can absorb
large amounts of heat and remain at a stable
temperature.
2. Providing protection. Water is an effective lubricant. For
example, tears protect the surface of the eye from the rubbing of
❖ Unsaturated fatty acid
the eyelids
➔ contains one or more double covalent
3. Facilitating chemical reactions. Most of the chemical reactions
bonds and can occur anywhere along
necessary for life do not take place unless the reacting molecules
the carbon chain (there’s space for a
are dissolved in water.
hydrogen to bond with the chain). It is
4. Transporting substances. Many substances dissolve in water
also the best or healthier type of fats
and can be moved from place to place as the water moves.
compared to saturated fatty acid
because of the spacing happening in
ORGANIC MOLECULES its carbon chain, particularly
● study of carbon-containing substances. polyunsaturated fatty acids.
● key element for organic molecules is carbon. Carbon can ➢ Monounsaturated fats - one
form covalent bonds with other atoms forming large, double covalent bond
diverse and complicated molecules necessary for life. between carbons atoms.
● carbon atoms bound together by covalent bonds and ➢ Polyunsaturated fats - two
constitute the framework of many large molecules. or more double covalent
● organic molecules have four (4) major groups essential bonds between carbons
to living organisms: atoms.
1. Carbohydrates ➢ Trans fat - is not healthy
2. Lipids because it is chemically
3. Proteins altered by addition of H-
4. Nucleic acids atoms (affects/increases
shelf-life).
Lipids
● substances that dissolve in non-polar solvents such as
alcohol or acetone but not in polar solvents such as
water e.g. oil in water.
● composed of carbon, hydrogen and oxygen and other
elements such as phosphorous, nitrogen and other minor
components. Example of Lipids: Phospholipids
● Examples of lipids are fats, phospholipids, eicosanoids
● composed of a polar region containing phosphate and a
and steroids.
non polar region consisting of two fatty acid chains.
❖ Glucocorticoids, anabolic steroids, etc. fall
● Important in structural components of cell membranes.
under the category of steroids and are naturally
❖ Hydrophilic (water-loving)
produced in our body.
➔ dissolves in water.
❖ Hydrophobic (water-fearing)
Example of Lipids: Fats ➔ Nonpolar molecules that do not
● important energy storage molecules. dissolve in water.
● also store vitamins, particularly vitamin A, D, E, K
(fat-soluble vitamins). Example of Lipids: Eicosanoids
❖ the reason why you don’t have to frequently
● composed of a polar region containing phosphate and a
take in these vitamins is because (1) it is stored
nonpolar region consisting of two fatty acid chains.
in the liver and (2) it is stored in our own
● Important in structural components of cell membranes.
adipose tissues(body fat) / fat cells.
❖ Hydrophilic (water-loving)
Glycerol & Fatty acids
➔ dissolves in water.
● building blocks of fats.
❖ Hydrophobic (water-fearing)
❖ Triglycerides
➔ Nonpolar molecules that do not
➔ most common type of fat molecules
dissolve in water.
● main distinction is its ‘Prostaglandin’ responsible for sequence, and thus the structure of proteins. Mutations
inflammation and most NSAIDS (Non-Steroidal Anti in the DNA can lead to consequences such as disorders
Inflammatory Drugs) target this. (down syndrome).
Ribonucleic acid (RNA)
Example of Lipids: Steroids ● important for protein synthesis via translation process
● composed of carbon atoms bound together into four which carries genetic information translated by
ringlike structures. ribosomes into various proteins.
❖ Cholesterol ❖ COVID 19 Vaccines use mRNA or messenger
➔ important example of steroid RNA.
molecule which can be synthesized
into bile salts, reproductive hormones
and others.
Proteins
● composed of carbon, hydrogen, oxygen, and nitrogen.
● Amino acids
❖ building blocks of proteins.
● There are twenty (20) amino acids existing.
● A protein consists of many amino acids joined together
in a specific sequence to form a chain.
● Denaturation
❖ If the hydrogen bonds that maintain the shape
of the protein are broken, the protein becomes
nonfunctional.
❖ e.g. egg
➔ translucent before heating and
becomes white & opaque after BASIC CELL STRUCTURES AND FUNCTIONS
heating.
Additional info:
➢ Serine Functions of a Cell
➔ naturally found in silk worms. Functions of a CellFunctions of a CellFunctions of a Cell
➔ beneficial to health and skin health. The following are four important functions performed by our body
➢ Tryptophan cells:
➔ Neurotransmitters derived from 1. Cell metabolism and energy use. The chemical reactions that
tryptophan amino acid occur within cells are collectively called “cell metabolism”. Energy
➔ When synthesized it can produce the released during metabolism is used for cell actIvitIes, such as the
happy hormone known as the synthesis of new molecules, muscle contractIon, and heat
‘serotonin’. production, which helps maintain body temperature.
➢ Tyrosine
➔ starting amino acid for epinephrine 2. Synthesis of molecules. Cells synthesize various types of
and noradrenaline a.k.a. molecules, including proteins, nucleic acids, and lipids.
norepinephrine.
Enzymes 3. Cell Communication. Cells produce and receive chemical and
● protein catalysts that increase the rate at which a electrical signals that allow them to communicate with one
chemical reaction proceeds without the enzyme being another. For example, nerve cells communicate with one another
permanently changed. and with muscle cells, causing muscle cells to contract.
● increase the rate of chemical reactions by lowering the
activation energy, which is the energy necessary to start 4. Reproduction and inheritance. Each cell contains a copy of the
a chemical reaction. geneIc informatIon of the individual. Specialized cells (sperm cells
and egg cells “oocytes”) transmit that geneIc informatIon to the
next generation (fertilization occurs which lead to a living
Nucleic Acids: DNA and RNA
organism).
● large molecules composed of carbon, hydrogen, oxygen,
nitrogen, and phosphorus.
● DNA and RNA are building blocks of nucleotides. Movement through the Cell Membrane
● Each nucleotide is composed of a sugar ● cell membranes are selectively permeable
(monosaccharide) to which a nitrogenous organic base Selective permeability
and a phosphate group are attached (deoxyribose / ● allows some substances and materials to pass through
ribose). but with exemption of some molecules.
Deoxyribonucleic acid (DNA) ● e.g. P (Potassium) I (Inwards/Intracellular)
● genetic material of cells, and copies of DNA are S (Sodium) O (Outwards/Outercellular)
transferred from one generation of cells to the next. DNA ❖ Ca2+ ion since positive has an outward
contains genes, which determine the amino acid movement.
❖ Cl- since negative, has an inward movement.
1. Passive Transport - stationary; does not require cell energy.

● Diffusion
❖ movement from an area of higher
concentration of a solute to an area of lower
concentration of that same solute in solution.
● Osmosis
❖ there is water involved.
❖ diffusion of water (a solvent) across a
selectively permeable membrane, such as the
cell membrane, from a region of higher water ➢ Isotonic
concentration to one of lower water ➔ iso = same; tonic = strength
concentration. ➔ outside = inside
● Facilitated Diffusion ➢ equal concentration
❖ a carrier-mediated transport process that ➢ same concentration of
moves substances across the cell membrane solutes and solvent
from an area of higher concentration to an area ➔ Result: cell remains constant
of lower concentration of that substance. ➢ Hypotonic
➔ hypo = less; tonic = strength
2. Active Transport - does require energy in the form of ATP ➔ outside < inside
(Adenosine Triphosphate). ➢ lower concentration
● Endocytosis ➢ fewer solutes and more
❖ endo- meaning within, or inside. solvent
❖ movement into cells by vesicles. ➔ water moves into the cell
➔ Phagocytosis - cell-eating ➔ Result: Cell expand and lyse (burst)
➔ Pinocytosis - cell-drinking ➢ Hypertonic
● Exocytosis ➔ hyper = more; tonic = strength
❖ exo- meaning outer, or outside. ➔ outside > inside
❖ movement out of cells by vesicles. ➢ higher concentration
➢ more solutes and less
solvent
➔ water move out from cell
➔ Result: Causing crenation (shrinkage
of cells)
➢ Sodium-potassium pump
➔ usually seen on the lining of the
stomach. Structures of Eukaryotic Cell
➔ responsible for the cleaning of Cell membrane
hydrochloric acid (HCl) in the ● outermost component of a cell.
stomach. ● encloses the cytoplasm and forms the boundary between
➔ PPIs (proton pump inhibitors) are material inside the cell and material outside it.
used such as Omeprazole, ● supports the cell contents, acts as a selective barrier that
Esomeprazole and Rabeprazole, determines what moves into and out of the cell, and
which inhibits the sodium-potassium plays a role in communication between cells.
pump. ● selectively permeable (only allows smaller molecules to
pass through the cell).
❖ Bigger molecules such as lipids, and fats can
hardly pass through on this phospholipid
barrier.
● Fluid-mosaic model - phospholipids
Ribosomes
● Specifically, 80s ribosomes are found in the cytoplasm or
attached to the rough endoplasmic reticulum. Golgi Apparatus
● “ribo” meaning site of protein synthesis. ● functions in membrane formation and protein secretion
● e.g. ● collects, modifies and distributes proteins and lipids
manufactured by endoplasmic reticulum.
60s + 40s = 80s ribosomic units

Nucleus
● contains DNA in the form of chromosomes.
Lysosomes
● stores digestive enzymes.
Endoplasmic Reticulum
● series of membranes forming sacs and tubules that Peroxisomes
extend from the outer nuclear membrane into the ● break down fatty acids, amino acids and hydrogen
cytoplasm. peroxide particularly the free radicals or foreign
● serves as the transporting network. materials.
❖ Rough Endoplasmic Reticulum
➔ synthesizes large amounts of proteins
for export from the cell (with
ribosomes).
❖ Smooth Endoplasmic Reticulum
➔ site for lipid synthesis and
detoxification of chemicals within the
cells (without ribosomes).
➔ store calcium ions.
Vacuoles
● helps bring food into the cells.
● maintains cell size and rigidity.

particles are embedded, upward and away from the

lungs.
● tiny hairs in the nose and lungs which is responsible for
the movement of mucus.
2. Flagella
● have a structure similar to that of cilia but are much
longer, and they usually occur only one per cell.
● responsible for the movement of the cell.
● e.g. tail of a sperm cell
3. Microvilli
Mitochondria
● specialized extensions of the cell membrane that are
● primary site for ATP production.
supported by microfilaments.
● aid in absorption of vitamins and nutrients in small
intestines.
● can be seen in the intestines, particularly small
intestines.
Chloroplast
● contains enzymes necessary for photosynthesis.
Vesicle
● a small, membrane-bound sac that transports or stores
materials within cells.
Centrosomes
● involved in mitotic spindle and microtubule formation.
● can be seen in DNA and RNA structures.
Projections of Eukaryotic Cell

1. Cilia
● project from the surface of cells.
● coordinated movement transports mucus, in which dust
GENERAL PHYSICAL ASSESSMENT ■ This is created by directly tapping the

body wall.
INSPECTION, PALPATION, PERCUSSION, AUSCULTATION ● observation is described via three (3) percussion notes:
1. Dullness
1. Inspection
2. Resonance
● method in physical examination that focuses on looking
3. Tympany
at the appearance or looking at the body.
2. Palpation
● an objective examination that uses hands or fingers to Interpretation of Results
detect any abnormalities such as tenderness or masses. 1. Tympany
● e.g. breast palpation ● air-filled intestines or pathologically over pneumothorax.
3. Percussion 2. Resonance
● an assessment method at which it produces sound by ● normally heard over healthy lung tissue.
lightly tapping with hands or fingers on specific areas of 3. Dullness
the body. ● heard over solid tissue like spleen, liver or the thigh.
4. Auscultation ● Pathologically, pleural effusion, ascites or lung
● a method in physical examination that aims in listening
to internal sounds of the body. 💡
consolidation.
Ascites
○ When there is excess fluid collection in the
INSPECTION METHOD spaces of your lungs or abdomen.
● the first method in physical examination that aims to look
at the person or body part.
● Inspects for any lesions, color, visible trauma, erection of
the body, physical characteristics, environment
adaptation, clothing/grooming, gait, inspection of output
breathing and other abnormalities.
Gait
● term used to characterize how a person walks.
Types of Gait
● A flat sound is a soft, high-pitched, short sound that can
1. Spastic gait
be heard when percussing the thigh. Flat sounds can be
● if a person drags his/her feet while walking.
heard when percussing bone or muscle.
● can be seen in patients suffering Parkinson’s disease.
● A dull sound is moderately loud, lower in pitch and longer
2. Scissors gait
in duration than a flat sound and can be heard when
● crisscross walking motion.
percussing the liver. These sounds are typically heard
3. Steppage gait
over solid or fluid-filled areas.
● when a person walks, toes pointed towards the ground
● A resonant sound is a loud, low-pitched, long sound that
while walking.
can be heard over the lung. Resonant sounds are often
4. Waddling gait
heard in air-filled areas, like the lung.
● involves short steps as well as swinging the body.
● A hyper resonant sound is more like a drum. Listen for a
5. Propulsive gait
really low-pitch, echo or booming sound. You can’t
● when a person walks his head and neck pushed forward.
recreate this on a healthy patient, but remember it’s
louder, lower, and longer, than a resonant sound.
PERCUSSION METHOD ● A tympanic sound is a loud, high-pitch, long sound that
● technique used to assess the density of underlying can be heard by percussing the gastric air bubble or a
structures. puffed cheek.
● A percussion note is created by either tapping the
patient’s body directly with the distal end of a finger or by PALPATION METHOD
tapping the examiner’s finger.
● observation done using fingers or hands during
○ Indirect
examination to assess the size consistency, shape,
■ original method by Piorry and Skoda
location and tenderness of an organ or body part.
which replaced direct method
1. Edge of liver
because of the risk of trauma.
● use of left hand, starting to right lower quadrant to right
■ This is created by tapping indirectly
upper quadrant
through a pleximeter.
2. Point of maximal impulse
■ uses the middle finger (flexor) of the
● use of examiner’s fingertips on the fifth intercostal space
dominant hand, taps quickly and
and midclavicular line
directly over the point where the other
3. Temperature
middle finger touches the patient’s
● sense of temperature using back of the hand
skin.
○ Direct
■ original method by Auebrugger and
Laennec.

💡 Mitral Area
● We observe sounds in the mitral area, because usually
when a person experiences chest pain or angina or lack
AUSCULTATION METHOD of oxygen in certain muscles of the heart, pumping of the
● a method in physical examination that aims at listening heart becomes poor. That is why we observe it through a
to internal sounds of the body. stethoscope.
● These sounds may be observed in heart, lungs and
bowel Lung Auscultation Method
● used by a variety of healthcare professionals during a ● performed to examine the lung sounds that might
physical exam. indicate any added sounds.
● performed using a medical device such as a ● Normal breath sounds are classified as vesicular,
stethoscope. bronchovesicular, bronchial or tracheal.
● Added sounds such as crackles, wheezes, pleural friction
rubs, stertor and stridor.
💡 When heart murmurs are heard, there should be thorough or

further examination done.
Heart Auscultation Method

Heat auscultation
● performed to examine the heart sounds that might
indicate any irregularities.
💡 When you have abnormal lung sounds that may indicate you have
asthma and is need of additional physical assessment.
Heart sounds
● noises generated by the heart due to resultant flow of
blood through it.
● flows through special chambers of the heart and creates
noises.
1. Lub-dub sounds (S1 and S2)
❖ closing of atrioventricular (consists of
left and right atrium and left and right
ventricles) and semilunar valves
(acts as faucets of the heart).
2. Lub-dab-ta (S3/Kentucky gallop)
❖ Third heart sound – CHF (Congestive
Heart Failure) or volume overload 💡 Expiratory Sound
a.k.a. hypervolemia, the body has too
much fluid meaning there’s too much
blood the heart pumps.
💡 ● the way the patient exhales.
Inspiratory Sound
● the way the patient inhales.
3. Ta-lub-dub (S4)
❖ aortic stenosis and hypertrophic Bowel Auscultation Method
cardiomyopathy (muscles of the heart ● performed to examine the intestinal sounds that might
are starting to weaken). indicate peristaltic movement.
● produces bowel sound as rumbling, growling or gurgling
Tests different irregularities such as heart murmurs (arrhythmia) or noise.
bruit (turbulent backflow of blood due to valves not closing ● Peristalsis
properly) and regurgitation. ❖ a series of symmetrical contraction and
relaxation of muscles that propagate in a wave
in an anterograde direction.
● If there is no bowel sound produced, it indicates ileus,

intestinal obstruction or some other conditions.
RESPIRATION RATE
● means the number of breaths per minute.
VITAL SIGNS ● Normal: 12 – 20 breaths per minute.
● are objective measurements essential to physiological ● Tachypnea
functions of a living organism. ❖ above 20 breaths/minute.
● “Vital” – critical first step in clinical evaluation. ❖ exercise, emotional change and pregnancy
● include the heart rate, respiratory rate, blood pressure, pain, pneumonia, pulmonary embolism, asthma,
and temperature. foreign body aspiration, anxiety and diabetic
● Along with height and weight, the vital signs provide ketoacidosis (a type of metabolic disorder).
important screening and diagnostic information as well ● Bradypnea
as monitoring data for assessment of short-term and ❖ below 12 breaths/minute.
long-term response to medication therapy. ❖ use of CNS depressants results in respiratory
failure.
TEMPERATURE ● parameters include rate, depth of breathing, and pattern
● a variable, complex as well as non linear, affected by of breathing.
many sources of internal and external variables.
● 36.5 to 37.5 degrees centigrade (97.7 to 99.5 degrees
Fahrenheit).
● regulated by hypothalamus in a narrow thermodynamic
range.
● maintained to optimize the synaptic transmission of
biochemical reactions.
● recorded via axillary, rectal, gut, oral and tympanic
membrane. Blood Pressure
❖ Rectal - where the most accurate recording of ● essential vital sign to comprehend the hemodynamic
temperature occurs. condition of the patient.
● measured through mercury, electronic and infrared ● two types of BP monitoring: aneroid and digital
thermometer. monitoring.
● precautions to avoid when taking blood pressure:
❖ avoid caffeinated drinks or tobacco 30 mins – 1
Factors in Temperature Record
hour before monitoring
1. Age
❖ full bladder = 10mmHg
2. Site of the temperature recording
❖ crossed legs
3. Physical fitness
❖ incorrect fit and size of a cuff
4. Environment
❖ body position and arm position
5. Specific condition (fertility, menstrual, pregnancy)
Terminologies
PULSE RATE
Blood pressure
● common sites for pulse rate measurement:
● force of blood against the walls of the artery.
❖ radial pulse,
Hypertension
❖ ulnar pulse,
● high blood pressure.
❖ brachial pulse in the upper extremity,
Hypotension
❖ carotid pulse in the neck,
● low blood pressure.
❖ posterior tibialis or the dorsalis pedis
Brachial artery
➔ Most commonly used are (1) radial
● a blood vessel that goes from your shoulder to below the
pulse, and (2) the carotid pulse.
elbow by measuring the blood pressure in the artery.
● Normal: 60-100 beats/minute.
Systolic pressure
● Tachycardia
● highest pressure in an artery when the heart is pumping
❖ above 100 beats/minute.
blood to your body.
● Bradycardia
Diastolic pressure
❖ below 60 beats/minute.
● lowest pressure in an artery when your heart is at rest.
Blood pressure measurement

● a calculation of both the systolic and diastolic It is

written or displayed with the systolic number first and the How to calculate BMI
diastolic pressure second. ● With the metric system, the formula for BMI is weight in
kilograms divided by height in meters squared. Because
Blood Pressure height is commonly measured in centimeters, divide
1. Normal height in centimeters by 100 to obtain height in meters.
● blood pressure numbers of less than 120/80 Formula:
mm Hg are considered within the normal range. ● Weight (kg) / [Height (m)]2
2. Elevated blood pressure ○ Example: Weight = 68 kg, Height = 165 cm (1.65
● when readings consistently range from 120-129 m)
systolic and less than 80 mm Hg diastolic. ○ Calculation: 68 ÷ (1.65)2 = 24.98
People with elevated blood pressure are likely
to develop high blood pressure unless steps are
taken to control the condition.
3. Hypertension Stage 1
● when blood pressure consistently ranges from
130-139 systolic or 80-89 mm Hg diastolic.
● At this stage of high blood pressure, doctors
are likely to prescribe lifestyle changes and may
consider adding blood pressure medication
based on your risk of atherosclerotic
cardiovascular disease (ASCVD), such as heart
attack or stroke.
4. Hypertension Stage 2
● when blood pressure consistently ranges at
140/90 mm Hg or higher. At this stage of high
blood pressure, doctors are likely to prescribe a
combination of blood pressure medications WAIST TO HIP RATIO
and lifestyle changes. ● indicated for the measurement for the fat proportion
5. Hypertensive crisis located in the waist and hip.
● This stage of high blood pressure requires ● If the waist is bigger than the hips, this may result in
medical attention. If your blood pressure having too much fat concentrated around the middle part
readings suddenly exceed 180/120 mm Hg, of the body known as "intra-abdominal obesity".
wait five minutes and then test your blood ❖ This type of fat location is related to a higher
pressure again. chance of getting heart disease and type 2
diabetes.
○ Men – 0.95 or less
○ Women - 0.80 or less
HEIGHT AND WEIGHT

Body Mass Index Terminologies
● measurement of body fat based on the height and weight Abdominal respiration
that applies to adults ● a.k.a. “diaphragmatic breathing”
● used to indicate weight categories and as a tool that may ● involves deep breathing into the stomach and fully
lead to health problems engaging the diaphragm.
● BMI categories: Auscultatory gap
○ Underweight = <18.5 ● a.k.a “silent gap”
○ Normal weight = 18.5–24.9 ● period of absence of specific sounds during manual
○ Overweight = 25–29.9 measurement of blood pressure.
○ Obesity = BMI of 30 or greater ● might be linked to reduced blood flow, HTN or

atherosclerosis. enlarge to compensate with the

Eupnea growing stage of the human body.
● unlabored breathing. ● Reduced elasticity of blood vessel walls in
Korotkoff sounds aging people results from gradual changes in
● heart sounds produced by the vibrations of the ventricles.
Orthostatic hypotension
● a.k.a. “postural hypotension”
💡
connective tissue.
When aging, there are changes in
the body Women undergo menopausal
● happens when there is a sudden drop of blood pressure stage, hormone change happens and
after standing or sitting down. the fluctuation in hormones when the
Pulsus alternans body stopped producing hormones
● alternating strong and weak sounds. would affect the tissues of the human
Pulsus paradoxus body which can result to normal
● a phenomenon when blood pressure decreases after physiological changes as we age:
breathing in. ➔ hot flashes
Cheyne – Stokes respiration ➔ bone resorption
● a progressive deeper, faster breathing followed by ➔ Osteoporosis
gradual decrease that can result in a temporary stop in ➔ skin aging
Apnea
breathing. ●
💡
The study of many forms of cancer.
Cancer - abnormal growth of cells
●
●
no movement of lung muscles resulting in temporary
cessation of breathing.
a.k.a. sleep apnea
💡
in the human body.
Skin can produce and divide normal
cells up to 30 days; when cancer
Biot’s respiration (ataxic breathing) develops in the skin, there is rapid
● abnormal pattern of breathing. development and growth of cells
Kussmaul respiration causing the person to have certain
● deep and labored breathing caused by metabolic skin cancers such as:
acidosis , DKA and kidney failure. ➔ Carcinoma
● rapid and shallow → deep, labored and gasping ➔ Melanoma
TISSUES Epithelial Tissues

● covers and protects surfaces, both outside and inside the
Tissues And Histology body.
Tissue
● a group of specialized cells and the extracellular Characteristics of Epithelial Tissue:
substances surrounding them. 1. Mostly composed of cells.
● cells of a particular tissue share a common structure and ● Epithelial tissue consists almost entirely of
function. cells, with a very little extracellular matrix
Histology between them.
💡💡
● the microscopic study of tissue structure. 2. Covers body surfaces
❖ ”Histo” - means tissue ● Epithelial tissue covers body surfaces and
❖ ”Ology” - means study forms glands that are derived developmentally
from body surfaces. The body surfaces include
Importances Of Studying Tissues the exterior surface, the lining of the digestive
1. Important in understanding how individual cells are organized to urinary, reproductive, and respiratory tracts, the
form tissues and how tissues are organized to form organs, organ heart and blood vessels, and the linings of
systems and complete organisms.
2. The structure of each tissue type is related to its function, and 💡
many body cavities.
Skin is an example which are made
up of cells that covers the majority of
the structure of the tissues in an organ is related to the organ’s
function.
💡 Heart contains different tissue from the rest of the 💡 the body.
Whether surface of the heart,
digestive system, reproductive system,
body and the tissue of the heart is related to the function
and structure of the organ. ovaries, kidneys, it is covered with
3. Four basic tissue types are epithelial, connective, muscle, and
nervous. 💡 epithelial tissue.
Epi means "on" and thel means
"covering" or "lining".
4. Changes in tissues can result in development, growth, aging,
trauma, or disease. 3. Distinct cell surfaces.
Example: ● Most epithelial tissues have one free, or apical
● Skeletal muscles enlarge because skeletal (apʹi-kăl), surface where cells are exposed and
muscle cells increase in size in response to not attached to other cells.
❖ Lateral surface – where cells are
exercise.
💡 It is similar when going into the
puberty stage, skeletal muscles
attached to other epithelial cells.
❖ Basal surface – attached to a
basement membrane
❖ Basement membrane - a specialized ● sweat glands, mucous glands that are enzyme-secreting
type of extracellular material secreted portions.
by epithelial and connective tissue ❖ Sweat glands
cells. The basement membrane helps ➔ produce sweat to normalize
attach the epithelial cells to the thermoregulation of the body.
underlying tissues, like the adhesive. ❖ Mucous glands
It plays an important role in ➔ produce saliva to keep the mouth
supporting and guiding cell migration lubricated that helps in the chewing
during tissue repair. The basement process of the food.
membrane is typically porous, which 5. Absorbing substances.
allows substances to move to and ● Cell membranes of certain epithelial tissues contain
from the epithelial tissue above it. carrier proteins that help in regulation of absorption of
4. Cell and matrix connections materials.
● specialized cell contacts bind adjacent ● Intestines contain epithelial tissues that absorb digestive
epithelial cells together and to the extracellular food which isolates vitamins, ions and minerals which
💡
matrix of the basement membrane.
They have signaling capacity to the
adjacent epithelial cells to keep cells
are absorbed thoroughly in the body.
Classification of Epithelial Tissue:
💡intact together.
Skin is composed of different layers
of cell that has matrix connection
Three (3) types of epithelium “based on number of cell layers and
the shape of superficial cells”:
1. Simple epithelium
which binds cells together to compose ● consist of a single layer of cells, with each cell extending
into organ to organ system to from the basement membrane to the free surface.
organism. ● Shape of Cells:
5. Nonvascular ❖ Squamous
● Blood vessels in the underlying connective ❖ Cuboidal
tissue do not penetrate the basement ❖ Columnar
membrane to reach the epithelium; thus, all 2. Stratified epithelium
gasses and nutrients carried in the blood must ● consists of more than one layer of cells, but only the
reach the epithelium by diffusing from blood basal layer attaches the deepest layer to the basement
vessels across the basement membrane. membrane.
6. Capable of regeneration ● Shape of Cells:
● Epithelial tissue has the ability to replace ❖ Squamous (Keratinized, Non-keratinized)
damaged cells with new epithelial cells.\ ❖ Cuboidal
● Undifferentiated cells (stem cells) continuously ❖ Columnar (very rare)
💡
divide and produce new cells.
There are organ systems in the
body that are not capable of cell
3. Pseudostratified columnar epithelium
● a special type of simple epithelium.
● prefix pseudo- means false, so this type of epithelium
regeneration; but when organs appears to be stratified but is not.
contains epithelial tissues, they are ● consists of one layer of cells, with all the cells attached
💡capable of cell regeneration.

There are studies in medicine that
stem cells have capability to replace
to the basement membrane.
💡damaged cells.
Helps the body to recover and
replace damaged cells in the body.
Functions of Epithelial Tissue:

1. Protecting underlying structures.
● skin protects underlying structures such as bones,
muscles and nerves.
2. Acting as a barrier.
● skin act as a barrier to prevent excess water loss in the
interior of the body
3. Permitting the passage of substances.
● epithelium allows many substances to move through it
like oxygen and carbon dioxide which is exchanged
between air and blood by diffusion through the epithelial
tissues of the lungs.
4. Secreting substances. Three (3) types of epithelium “based on idealized shapes of the
● secrets substances to keep certain functions and epithelial cells”:
definition in underlying organs. 1. Squamous
● cells are flat or scalelike. only the surface cells are columnar. The deeper layers
● Irregular pattern, size, and shape. are irregular or cuboidal in shape.
2. Cuboidal 8. Transitional epithelium
● cells are cube-shaped about as wide as they are tall. ● a special type of stratified epithelium that can be greatly
3. Columnar stretched In the unstretched state, transitional epithelium
● cells tend to be taller than they are wide. consists of five or more layers of cuboidal or columnar
cells that often are dome-shaped at the free surface.
Classification of Epithelial Tissue: ● specialized epithelium at which stratified cells that
1. Simple squamous epithelium appear cuboidal when organs or tubes are not stretched.
● a single layer of thin, flat cells. Some substances easily ● appears squamous when organs or tubes are stretched
pass through this thin layer of cells, but other substances by fluid e.g. lining of the urinary bladder, ureters, or
do not. urethra - function is to accommodate the fluctuation of
● irregular shapes, size, and pattern of cells. volume fluid that the organ has, and protects them from
2. Simple cuboidal epithelium caustic effects e.g transitional epithelium protects
● a single layer of cubelike cells that carry out active urinary bladder from the caustic effects of urine.
transport, facilitated diffusion or secretion. Because
these cells have a larger volume, they have a greater SIMPLE SQUAMOUS EPITHELIUM
secretory capacity than simple squamous epithelial cells. ● structure is flat and hexagonal.
● square shape of cells. Example:
Pinocytosis ● In the integumentary system, stratified squamous forms
➔ the uptake of extracellular fluids and the outer layer and is called “keratinized stratified
dissolved solutes, such as fat squamous”.
droplets, vitamins, and antigens. ❖ The thick layer of cells provides protection
3. Simple columnar epithelium against abrasion and forms a barrier that
● a single layer of tall, thin cells. prevents microorganisms and toxic chemicals
● The large size of these cells enables them to perform from entering the body.
complex functions. For example, the simple columnar ❖ Keratin reduces the loss of water from the
epithelium of the small intestine produces and secretes body.
mucus and digestive enzymes. ● In the lungs, simple squamous epithelium allows gas
● digestive system particularly stomach and small exchange
intestines that have simple columnar epithelium to ● In the kidneys, simple squamous epithelium helps filter
perform complex tasks. wastes from the blood while keeping blood cells inside
❖ The stomach releases digestive enzymes and the blood vessels
HCL to churn and help dissolve the food to
pass through small intestines.
❖ Small intestines once food passes through,
because of its basic environment, there are
certain epithelium that will help absorb the
vitamins, nutrients, minerals and ions to help
distribute it to our body .
4. Pseudostratified columnar epithelium – secretes mucus, which
covers the free surface.
❖ Mucus - clear thick fluid that protects the lining
of the intestines.
○ Without the lining or protective covering, the
intensity of the pH of the HCl in the stomach, it
can erode the lining of the stomach and
intestine which can result in peptic ulcer.
○ Mucus is similar to saliva. SIMPLE CUBOIDAL EPITHELIUM
5. Stratified squamous epithelium- this forms a thick epithelium ● single layer of cube shaped cells.
because it consists of several layers of cells. The deepest cells are ● some cuboidal epithelial cells have cilia that move
cuboidal or columnar and are capable of dividing and producing mucus over the surface or microvilli that increase the
new cells. As these newly formed cells are pushed to the surface, surface area for secretion and absorption.
they become flat and thin. As the cells flatten, the cytoplasm of the Example:
epithelial cells is replaced by a protein called keratin, and the cells ● In the large intestines, they have greater secretory
die. capacity than simple squamous epithelial cells.
● layered cells with irregular pattern, size, and shape of ○ Microvilli and cilia function as a secretion and
cells e.g. skin. absorption by cells of the kidney tubules.
○ Large intestines secrete substances like water
6. Stratified cuboidal epithelium - consists of more than one layer to form firm and create volume to the stool.
of cuboidal epithelial cells.
7. Stratified columnar epithelium
● consists of more than one layer of epithelial cells, but

SIMPLE COLUMNAR EPITHELIUM Example:

Example: ● In the urinary system, the transitional epithelium lines
● In small intestines, it produces and secretes mucus and cavities that can expand are found greatly in the urinary
digestive enzymes. bladder.
❖ tall and narrow cells that some have cilia. ❖ This also protects underlying structures from
❖ movement of particles of the lungs’ bronchioles the caustic effects of urine.
are through ciliated cells. ❖ can be seen in the urinary bladder .
PSEUDOSTRATIFIED COLUMNAR EPITHELIUM

● contains projections called “cilia”
○ Cilia helps in removal of dirt particles seen in
the lungs, lining of nasal cavity, trachea, and
pharynx to ward off foreign materials.
Example:
● In respiratory system, it secretes mucus which covers its
free surface
STRATIFIED SQUAMOUS EPITHELIUM

● consist of many layers, irregular shapes, size, and layer.
Example:
● In skin, the skin grows in stratum basale up until the
surface is called “stratum corneum”.
● skin consists of many layers that are cuboidal and
progressively flattened towards the surface called
keratinized and nonkeratinized. Structural and Functional Relationship of Epithelial Tissues
❖ Keratinized This includes:
➔ lacks nucleus and water content. 1. Cell layers and Cell shapes
➔ cytoplasm is replaced by a protein 2. Free Surfaces
called keratin and the cells are dead. 3. Cell connectivity
❖ Nonkeratinized 4. Glands
➔ surface cell retains nucleus and
cytoplasm before it becomes dead Cell layers and Cell shapes
cells which are still moist. Simple epithelium
● Humans replace cells every thirty (30) days. ● found in organs that primarily function to move
❖ Psoriasis - fast rate of shedding of cells. materials.
➔ Skin is scaly, dry, and has impaired ● Move through diffusion, osmosis, facilitated diffusion,
barrier because the rate of shedding and pinocytosis.
of cells is fast. Stratified epithelium
➔ Severe psoriasis can hinder ● well adapted for its protective function. As the outer cell
movement or locomotion. layers are damaged, they are replaced by cells from
➔ Psoriasis arthritis deeper layers.
❖ an example of autoimmune Stratified squamous epithelium
disorder that involves ● found in areas of the body where abrasion can occur,
psoriasis-immune system such as in the skin, anal canal, and vagina.
targets joints and cartilages ● site for getting laboratory samples (skin biopsy,
at a drastic phase. swabbing of anus and vagina) because of the presence
❖ Skin needs to be hydrated and needs petroleum of epithelium.
jelly to keep moisture evaporated. Differences in function are also reflected in cell shape.
● Psoriasis Arthritis ❖ Cells are normally flat and thin when the
❖ caused by autoimmune disorder as the immune function is diffused.
system targets cells and joints of the skin and ❖ Cells with the major function of secretion or
cartilages at a rapid phase. absorption are usually cuboidal or columnar.
● It protects against abrasion, forms a barrier against ➔ They are larger because they contain
infection, and reduces water loss from the body. more organelles, which are
❖ Skin is the first line of defense against the responsible for the function of the
infection. cell.
❖ It can be seen in the skin, cornea ,puth, and People who smoke cigarettes eventually experience changes in the
esophagus. epithelium of the larger airways.
● In the integumentary system, the stratified squamous ● The delicate pseudostratified columnar epithelium, which
epithelium forms the outer layer and is called performs a cleaning function by moving mucus and
“keratinized stratified squamous epithelium”. debris from the passageways, is replaced by stratified
squamous epithelium, which is more resistant to
TRANSITIONAL EPITHELIUM irritation but does not perform a cleaning function.

○ Epithelium lining becomes thin in the area of which a duct is present.

nasal cavity, trachea, bronchioles, bronchi, and ● composed of many cells and usually multicellular glands
whole lung lining. ● some exocrine glands are composed of a single cell e.g.
○ Cilia dies and mucus becomes absent that is goblet cells for secretion.
responsible to eradicate, lubricate, and destroy 2. Endocrine glands
foreign materials. ● a gland that becomes separated from epithelium of their
origin and has no ducts with extensive networks of blood
Free surfaces vessels.
● Most epithelia have a free surface that is not in contact
with other cells and faces away from underlying tissues.
1. Endothelium
● lining of blood vessels is a specialized type of simple
squamous epithelium with smooth surfaces which
greatly reduces friction as blood flows through the blood
vessels.
2. Microvilli
● cylindrical extensions of the cell membrane that increase
the free surface area that permits absorption and Multicellular Exocrine Glands “According to Structure”
secretion 1. Simple glands
3. Cilia ● have a single, non branched duct.
● propel materials along the free surface of cells. 2. Compound glands
● have multiple, branched ducts.
Cell connections 3. Tubular glands
● Cell connections are needed to hold one cell to one ● glands with secretory regions shaped as tubules.
another or to the basement membrane. 4. Acinar glands
1. Desmosomes ● glands that are shaped in sac-like structure or alveolar.
● are mechanical links that bind cells together.
2. Hemidesmosomes or modified desmosomes
● acts as an anchor to cells to the basement membrane.
3. Tight junctions
● bind adjacent cells together and form permeability
barriers. Tight junctions prevent the passage of materials
between epithelial cells because they completely
surround each cell.
4. Gap junctions
● small channels that allow small molecules and ions to
pass from one epithelial cell to an adjacent one.
Functions of Epithelial Tissue: Multicellular Exocrine Glands “According to How Products

1. Mechanically bind the cells together leave the Cell”
2. Help form a permeability barrier 1. Merocrine
3. Provides a mechanism for intercellular communication ● most common type which involves the release of
secretory products by exocytosis.
● found on almost all parts of the body.
2. Apocrine
● involves the release of secretory products as pinched-off
fragments of the glands.
● becomes hyper especially during puberty stage.
3. Holocrine
● involves the shedding of entire cells.
● secrete substances that contains cells (loose cells).
Glands
● secretory glands primarily composed of epithelium with
supporting network of connective tissue.
1. Exocrine glands
● a gland that maintains open contact with epithelium at

molecules, and bones store minerals, such as calcium and

phosphate.
5. Cushioning and insulating. Adipose tissue cushions and
protects the tissues it surrounds and provides an insulating layer
beneath the skin that helps conserve heat.
● Hypodermis
❖ subcutaneous tissue (adipose tissue) that
cushions and protects against mechanical
injuries.
❖ More adipose tissue means more insulation in
the body.
● Cushioning
❖ means that there is protection in the body
especially the internal organs of the body.
CONNECTIVE TISSUES ❖ Excess adipose tissue would be trouble the
function of the internal organs
● a diverse primary tissue type that makes up part of every
6. Transporting. Blood transports gasses, nutrients, enzymes,
organ in the body.
hormones, and cells of the immune system throughout the body.
● differs from the other three tissue types in that it consists
● White blood cells are being transported by the blood.
of cells separated from each other by an abundant
7. Protecting. Cells of the immune system and blood provide
extracellular matrix.
protection against toxins and tissue injury, as well as against
❖ can be found everywhere in the body
microorganisms.
❖ If skin does not have connective tissues, skin is
● White blood cells and T cells provide protections against
not intact, not bouncy, and not supple.
foreign substances.
● Viruses can only spread through hijacking of cells in the
body.
❖ The immune system would first detect the
foreign substance in which they will attack the
foreign substance to prevent the foreign
substance from becoming disease.
Functions of Connective Tissues

1. Enclosing and separating other tissues. Sheets of connective
tissue form capsules around organs, such as the liver and the
kidneys. Connective tissue also forms layers that separate tissues
and organs.
2. Connecting tissues to one another. Tendons are strong cables,
or bands, of connective tissue that attach muscles to bone, and
ligaments are connective tissue bands that hold bones together. Cells of Connective Tissue
● Ligaments Blasts
❖ attach from bone to bone (BBL). ● helps in making or forming things; creates the matrix.
● Tendons Clasts
❖ attach from muscle to bone (MBT). ● to form or break down to initiate remodeling; breaking
Note: Rupture of ligaments and tendons can cause so much pain down the matric for remodeling.
because they hold specific functions. Both contain fibrous Cysts
elements that need weeks to months to heal. ● powerhouse or the brain of -blasts and -clasts; maintains
3. Supporting and moving parts of the body. Bones of the skeletal the matrix.
system provide rigid support for the body, and semirigid cartilage Osteo
supports structures, such as the nose, the ears, and the surfaces ● meaning bones.
of joints. Osteoblasts
● Nose consists of cartilages. ● creates the matrix and forms the bone.
❖ Cartilages support the nasal structure of the Osteoclasts
nose. Without this, there would be trouble ● breakdown some bone matrix for remodeling.
breathing. Bone remodeling
➔ Cartilage can be molded into different ❖ process where bones need to be replaced or
sizes and shapes.They can be cleaned which can make it tough and
harvested from different parts of the well-maintained
body such as in ears. ❖ Without remodeling, the bones can tarnish and
4. Storing compounds. Adipose tissue stores high-energy dull which can be prone to fractures.

❖ It uses HCl to break down bones The Protein Fibers of Extracellular Matrix
Osteocytes The protein fibers of the extracellular matrix of connective tissue
● maintains and regulates mineral deposition at the bone has three (3) types: collagen, reticular, and elastic.
matrix. 1. Collagen fibers
Fibers/Fibrous ● resemble microscopic ropes, are very flexible but resist
● connective tissues. stretching.
Fibroblasts ● Collagen in the skin gives shape to the body.
● cells that form the fibrous connective tissue. 2. Reticular fibers
Fibrocytes ● very fine, short collagen fibers that branch to form a
● maintains the formation of fibrous connective tissue. supporting network.
Chrondo ● thinner and finer compared to elastic fibers.
● meaning cartilages. 3. Elastic fibers
Chondroblasts ● have the ability to return to their original shape after
● create and form a cartilage matrix. being stretched or compressed, giving tissue an elastic
Chondrocytes quality. This tissue stretches like a rubber band in
● maintains the extracellular matrix of the cartilage. response to force and recoils when relaxed.
Special Cells ● connective tissues" or "tiny ropes" which form thick
● found in the white blood cells. rubber band-like elastic fibers which keeps the skin
💡
Macrophages bouncing.
● large white blood cells capable of moving and ingesting When the skin is overstretched due to excess
foreign substances. fat, pregnancy or puberty, it can lead to striae or
❖ “Jellyfish-like” cell that wards off foreign stretch marks.
materials that the body does not recognize. ➢ It means that the collagen fibers and
Mast cells elastic fibers of the skin did not
● nonmotile (stationary) cells that are responsible for bounce back to original shape
releasing various chemicals such as histamine. ➢ Moisturize using shea butter can
❖ can be seen in nasal cavity and lungs reduce the appearance of stretch
● When allergic to certain dust, it means that it stimulates marks
mast cells that can lead to sneezing. ➢ It is hard to remove stretch marks
❖ Sneezing is a normal function to eradicate because the protein fibers of the skin
foreign materials. are broken ‒ it would take years for
❖ Mast cells stabilizers is a form of medication laser treatment.
that stabilizes mast cells that can limit the
trigger of allergies:
❖ ex.
➔ Cromolyn (First choice)
➔ Loratidine
➔ Cetirizine
The Extracellular Matrix

The extracellular matrix of connective tissue has 3 major
components:
1. Protein fibers
2. Ground substance
3. Fluid The Ground Substance of Extracellular Matrix
Has functional characteristics for example, they enable bones and ● consists of non fibrous molecules and the “shapeless”
cartilage to bear weight, tendons and ligaments to withstand background against which the collagen fibers are seen
tension, and the skin’s dermis to withstand punctures, abrasions, through microscope.
and other abuse. ● Proteoglycans
❖ enables bones and cartilages to bear weight. ❖ large molecules that consist of a protein core
💡💡
❖ If overweight, cartilages and bones act as a attached to many long polysaccharides.
supporting framework to the body. proteo - means protein
❖ Tendons and ligaments withstand tension. glycans - means polysaccharides
❖ Skin dermis withstand puncture, abrasions, and (sugar)
other abuse. ❖ It can trap large quantities of water which
❖ can be found in the second layer of skin which allows them to return to their original shape
💡
houses different organs and other components when compressed or deformed.
such as sebaceous glands and arrector pili ➔ Temporarily traps water from the
➔ holds electrolytes, water, and ions. environment as it only attracts water
➔ 💡
molecules
Example: Hyaluronic acid (HA)
which occurred from hyaluronan
molecule. It can hold water 100x to its
original or normal capacity. Three (3) Types of Adult Connective Tissue

1. Connective tissue proper
● loose and dense.
2. Supporting connective tissue
● cartilage and bone.
3. Fluid connective tissue proper
● blood and hematopoietic tissue.
● hematopoietic tissue; red marrow and yellow marrow.
The Fluid of Extracellular Matrix

● functions as the main transportation of fluids, oxygen,
nutrients, metabolic waste and chemical messenger
specialized by fluid connective tissues such as blood and
lymph
● In blood, the liquid matrix is called “plasma”, of which
RBCs, WBCs and platelets are suspended. Connective Tissue Proper
❖ Function of blood: transportation of fluids,
oxygen, nutrients, metabolic waste and Loose Connective Tissue Proper
chemical messenger specialized by fluid ● consists of a relatively few protein fibers that form a lacy
connective tissues. network with numerous spaces filled with ground
➢ Blood carries oxygen and carbon dioxide can be filtered substance and fluid.
in the heart. Three (3) subdivisions of Loose Connective Tissue:
❖ Carbon dioxide can be excreted through 1. Areolar tissue
● Plasma contains specialized proteins, salts and ● connective tissue primarily consists of collagen fibers
hormones. and a few elastic fibers.
● contains more collagen fibers and few elastic fibers
● filled with space that contains hyaluronic acid (HA).
❖ found in skin
2. Adipose tissue
● consists of adipocytes, or fat cells, which contain large
amounts of lipid for energy storage.
● Unlike other connective tissue types, adipose tissue is
composed of large cells and a small amount of
extracellular matrix, which consists of loosely arranged
collagen and reticular fibers with some scattered elastic
CLASSIFICATION OF CONNECTIVE TISSUE fibers.
Connective tissue types blend into one another, and the ● can be seen in hypodermis found on the skin.
transition points cannot be identified precisely. As a result, ● serves as a protection against mechanical injury and
connective tissue is somewhat arbitrarily classified by the type and cushioning the internal organs.
proportions of cells and extracellular matrix. 3. Reticular tissue
● forms the framework of lymphatic tissue, such as in the
Two (2) main types of Connective Tissue spleen and lymph nodes, as well as in bone marrow and
1. Embryonic connective tissue the liver.
● by 8 weeks of development of an embryo, most become
specialized to form different types of adult connective
tissues.
2. Adult connective tissue
● most widely distributed type of connective tissue found
in adults.

Fluid Connective Tissue Proper

● a connective tissue that does not contain fiber.
● In blood, it consists of cells and cell fragments
suspended in an intracellular fluid matrix known as the
plasma.
● can be found in ligaments connected from bone to bone
consist of only cells WBCs (Leukocytes), RBCs
(Erythrocytes) and Platelets (Thrombocytes) as well as
cell fragments suspended in intracellular fluid matrix
known as the “plasma:
● Enables various functions such as transport of nutrients,
removal of wastes and carrier of oxygen to deliver in
various body parts.
❖ RBCs
➔ carries oxygen
❖ WBCs
➔ fighting foreign materials such as
bacteria, viruses and fungi
❖ Platelets
Dense Connective Tissue Proper

💡
➔ blood-clotting factors
When stroke occurs, platelets are
compact or clumped that forms
● as a relatively large number of protein fibers that form particulate that can block veins and
thick bundles and fill nearly all of the extracellular space. arteries.
These protein fibers are produced by fibroblasts. ● In lymph, which is a fluid located in the lymphatic vessels
Two (2) major subdivisions of Dense Connective Tissue: contains the lymphocytes.
1. Dense collagenous connective tissue ● Lymphocytes are primary cells of adaptive immune
● has an extracellular matrix consisting mostly of collagen responses capable of defending the body against foreign
fiber. substances.
● can be found in ligaments connected from bone to bone. ○ detects rapidly and real time
2. Dense elastic connective tissue
● has abundant elastic fibers among its collagen fibers.
The elastic fibers allow the tissue to stretch and recoil.
● can help in articulation or speech because of the
abundant elastic fibers that allows tissues to stretch and
recoils.
● vibration produces sound that generates voice.
● teeth guide voice in articulation.
Supportive Connective Tissue

Cartilage
● composed of chondrocytes or cartilage cells, located in
💡
spaces called “lacunae”.
Collagen in the matrix gives cartilage
flexibility and strength.
● Cartilage is resilient because the proteoglycans of the
matrix trap water, which makes the cartilage relatively
rigid and enables it to spring back after being
compressed.
● Cartilage provides support, but if bent or slightly
compressed, it resumes its original shape.
● Lack of blood vessels makes the cartilage heal slowly
after injury.
❖ Blood vessels help transport nutrients and
oxygen.

Fluid Connective Tissue

Blood
● unique because the matrix is liquid, enabling blood cells
and platelets, collectively called formed elements, to
move through blood vessels.
● liquid matrix enables blood to flow rapidly through the
body, carrying nutrients, oxygen, waste products, and
other materials.
Three (3) Types of Cartilages

1. Hyaline
● most abundant type of cartilage and has many functions.
It covers the ends of bones where they come together to
💡
form joints.
Epiphyseal plate - plate at the end of the
bone.
2. Fibrocartilage
● has more collagen than does hyaline cartilage, and
bundles of collagen fibers can be seen in the matrix.
● fibro means more collagen because collagen is dense.
● can be found in the intervertebral disks. MUSCLE TISSUE
● slip-disc or sciatica pain. Muscle tissue
3. Elastic cartilage ● responsible for making contraction or to shorten and
● contains elastic fibers in addition to collagen and make movement possible.
proteoglycans. The elastic fibers appear as coiled fibers Muscle contraction
among bundles of collagen fibers. ● results from contractile proteins located within the
● can be found in the ears. muscle cells and the length of muscle cells is greater
than the diameter.
➢ Element responsible for muscle contraction is
calcium and magnesium which can result in
conscious involvement.
● Muscle cells are also known as “muscle fibers” → tiny
threads.
➢ Muscle fibers resemble threads but they can be
minuscule when you look at them.
Three (3) Types of Muscle Tissue

1. Skeletal Muscle
● described as voluntary (under conscious control)
because a person can purposefully cause skeletal
muscle contraction to achieve specific body movements
e.g. flexing of arms or standing up.
❖ Nervous system
➔ sudden contraction without
conscious involvement (involuntary)
e.g. jerking action
● long and cylindrical with several nuclei per cell.
● striated or banded
Location: attach to the bone or other connective tissue

NERVOUS TISSUE
2. Cardiac Muscle
● forms the brain, spinal cord and nerves.
● responsible for pumping blood.
● responsible for coordinating and controlling many body
● controlled by brain
activities
● involuntary (unconscious) control.
❖ e.g. voluntary and involuntary movements
● cylindrical but shorter than skeletal muscle.
● awareness and adaptation to environment, emotions,
● striated and have one nucleus per cell.
reasoning skills and memory.
● branched and connected by intercalated disks
● communication of nervous tissue to one cell to another
❖ controlled electrical function because of
occurs via electrical signals → action potentials
intercalated disks.
○ Electrical signals to communicate to various
❖ controlled to prevent arrhythmias
nerve tissues to another
●
💡
consists of neurons and support cells
Nervous tissue is not capable of
regeneration.
3. Smooth Muscle
● found mostly in the organ system which forms the hollow
organs.
● responsible for various functions Terminologies
❖ moving food through the digestive tract Neurons
❖ emptying the urinary bladder ● responsible for conducting action potentials.
● involuntary movement Cell body
●
💡
tapered at each end, not striated; have a single nucleus.
If there are striations, it would limit peristaltic
●
Dendrites
contains the nucleus.
💡
movement.
Peristaltic movement helps bring down food
to the large intestines.
●
●
receives stimuli leading to electrical charges.
branching or roots
Axon
● carries nerve impulses away from the cell body.
● transmits action potentials.
Glia
● support cells of NVS that nourishes, protects and
insulates the neurons.
●
💡
food of the nervous system
Inside gilia, a myelin sheath is found which
💡
acts as an insulating layer.
If the myelin sheath is torn, multiple sclerosis
may happen.
TISSUE MEMBRANES
Tissue membrane
● a thin sheet or layer of tissue that covers a structure or
lines a cavity.
● composed of four (4) tissue membranes
❖ 1 external; 3 internal
External Tissue Membrane

1. Cutaneous membrane
❖ “cuta” means skin
● Stratified squamous cells & connective tissue
Internal Tissue Membrane

1. Mucous membrane
2. Serous membrane
3. Synovial membrane
Mucous Membrane TISSUE DAMAGE AND INFLAMMATION

● line cavities that open to the outside of the body, such as Inflammation
the digestive, respiratory, and reproductive tracts ● occurs when tissues are damaged.
● consist of epithelial cells, their basement membrane, and ● can also result from the immediate and painful events
a thick layer of loose connective tissue. that follow trauma, such as closing your finger in a car
● functions vary, depending on their location, but they door or cutting yourself with a knife.
💡
include protection, absorption, and secretion.
Respiratory mucous membrane - involves
mucous membrane of the nose, mouth and
● mobilizes the body’s defenses and isolates and destroys
microorganisms, foreign materials, and damaged cells so
that tissue repair can proceed.
trachea that serves as protection and ● Inflammation produces five (5) major symptoms:
absorption. 1. redness
● Mucous membranes also line the nasal passages. When 2. heat
it becomes inflamed, we experience the “runny nose” 3. swelling
💡
characteristic of the common cold or an allergy.
Clogged nose happens when the blood
4. pain
💡vessels in the nose are dilated,

Headache and congestion of the nose is due
💡
5. disturbance of function
Body detects there is bacteria
to dilation of blood vessels hence the use of
decongestants.
💡inside the pore.
Response of the body is to attack
the bacteria in the pores which
generates puss in the outside of the
Serous Membrane skin; puss would mean there is
💡
● produces watery secretion. invasion of white blood cells
● line cavities that do not open to the exterior of the body Bacteria in the pore can lead
such as the pericardial, pleural, and peritoneal cavities. inflammation of the skin.
● do not contain glands, but they secrete a small amount ● Although unpleasant, the processes of inflammation are
💡
of fluid called “serous fluid”, which lubricates the surface usually beneficial.
of the membranes. It is the sign that the body is
● protect the internal organs from friction, help hold them fighting against external foreign
in place, and act as a selectively permeable barrier to substances.
prevent large amounts of fluid from accumulating within
the serous cavities.
Synovial Membrane
● line the cavities of freely movable joints.
● made up of only connective tissue and consist of
modified connective tissue cells.
● produce “synovial fluid”, which makes the joint very
slippery, thereby reducing friction and allowing smooth
movement within the joint.
❖ If the synovial membrane deteriorates, it can
cause osteoarthritis.

stimulated by direct damage.

6. Pain, limitation of movement resulting from edema, and tissue
destruction all contribute to the disturbance of function, which
can be adaptive because it warns the person to protect the injured
💡
area from further damage.
When the infection site already contains
many bacteria which can result to edema and
💡
tissue destruction.
Edema - swelling caused by too much fluid in
the body e.g. blisters.
TISSUE REPAIR
Tissue Repair
● the substitution of viable cells for dead cells.
●
💡
can occur by regeneration or by fibrosis.
2X Regeneration
In regeneration, the new cells are the same type as those that were
destroyed, and normal function is usually restored.
● Regeneration can completely repair some tissues, such
as the skin and the mucous membrane of the intestine.
In these cases, regeneration is accomplished primarily by
stem cells.
● Stem cells are self-renewing, undifferentiated cells that
continue to divide throughout life.
Chemical Mediators Associated with Inflammation ● With each division, there is a daughter stem cell and a
1. The release of histamine and prostaglandins. second cell that can undergo differentiation. The
❖ Prostaglandins (pge or pga) differentiated cells are the same cell types as the dead
➔ responsible for certain human body responses cells.
such as pain, inflammation and fever. ● Regeneration can also involve division of differentiated
➔ There are other NSAIDs such as ibuprofen, cells in connective tissue and glands, such as the liver
naproxen that target prostaglandins and pancreas. These cells do not normally divide, but
(eicosanoids).
➔ Paracetamol does not inhibit the inflammation
process; it is only antipyretic and analgesic.
💡
retain the ability to divide after an injury
Liver and pancreas cells do not divide but
retain the ability to divide after an injury.
➢ MOA: Unknown but it can affect
thermoregulation in the hypothalamus In fibrosis, or replacement, a new type of tissue develops that
(in theory). eventually causes scar production and the loss of some tissue
➢ Only used for fevers, headache, function.
dysmenorrhea. ● Fibrosis is the predominant repair mechanism in some
2. Some mediators cause dilation of blood vessels, which tissues.
produces redness and heat. ● In the adult brain, heart, and skeletal muscle there are
3. Dilation of blood vessels is beneficial because it increases the relatively few stem cells and the mature neurons, cardiac
speed with which blood cells and other infection-fighting and muscle, and skeletal muscle do not divide.
💡
repair-inducing substances are brought to the injury site.
Dilation is crucial because it can induce white
blood cells to rush to the infected site and start
●
●
Although these cells cannot divide, they are able to
recover from a limited amount of damage.
Although neurons cannot form additional neurons, a
repair process. small population of stem cells has been found in the
4. Chemical mediators of inflammation also increase the adult brain.
permeability of blood vessels, allowing materials and blood cells ● These stem cells can divide and form new neurons.
to move out of the vessels and into the tissue, where they can ● It may be possible to develop treatments for some brain
deal directly with the injury.
● Permeability allows exchange of materials, oxygen and 💡
injuries that stimulate the stem cells.
Nervous tissues and cardiac muscles are not
blood cells to the certain tissues and platelets to start
inflammation and repair of the body.
5. Pain associated with inflammation is produced in several ways.
💡💡
capable of tissue repair itself.
Can be done by stem cell therapy only.
Keloid - overstimulation of protein fibers
Nerve cell endings are stimulated by direct damage and by some inside the wound. It is the result of several
chemical mediators to produce pain sensations. In addition, the factors such as injuries and deep wounds or
increased pressure in the tissue caused by edema and pus
💡
accumulation can cause pain.
Excess dilation of blood vessels can cause
💡
simply scar wounds that are raised or bumped.
Injection of hydrocortisone (a
steroid corticosteroids medicine) can
💡
pain.
Pain occurs when nerve endings are
calm keloids and reduce its size.

SKELETAL SYSTEM: BONES AND JOINTS
Osteology and Physiology

Axial Skeleton
● originates from the axial section of the skeletal system
which comprises the bones in the head, neck, and the
core of the body.
Appendicular Skeleton
● bones that make up the body’s limbs.
● These make up the extremities of our body.
Effects of Aging on Tissue

● Collagen fibers start to deplete at 20s.
● The consequences of some age-related changes are
obvious, whereas others are subtle. For example, the
appearance of skin changes as people age, and athletic
performance declines, after approximately 30 to 35
years.
● With advanced age (50s above), the number of neurons
and muscle cells decreases substantially. Reduced visual
acuity, smell, taste, and touch occur, and the functional
capacities of the respiratory and cardiovascular systems
decline.
💡 From a normal 60-100 beats per minute at a
normal age, it can deplete in advanced age.
● At the tissue level, age-related changes affect cells and
the extracellular matrix produced by them. In general, FUNCTIONS OF THE SKELETAL SYSTEM
cells divide more slowly in older people compared to Skeleton
younger ones. The rate of red blood cell synthesis ● derived from a Greek word meaning “dried”.
💡
declines in the elderly.
Regular 30-day cell regeneration can be
prolonged in advanced age which can take up to
1. Support.
● Rigid, strong bone is well suited for bearing weight and is
the major supporting tissue of the body.
45 days. ● Cartilage provides firm yet flexible support within certain
● Injuries in the very young heal more rapidly and more structures, such as the nose, external ear, thoracic cage,
completely than in older people, in part because of the and trachea.
more rapid cell division. ● Ligaments are strong bands of fibrous connective tissue
● The collagen fibers become more irregular in structure, that attach to bones and hold them together.
even though they may increase in number. As a ● Framework of the body.
consequence, connective tissues with abundant 2. Protection.
collagen, such as tendons and ligaments, become less ● Bone is hard and protects the organs it surrounds.
flexible and more fragile. ● For example, the skull encloses and protects the brain,
● Elastic connective tissues become less elastic when its and the vertebrae surround the spinal cord. The rib cage
fibers break apart and bind to Ca2+. The reduced protects the heart, lungs, and other organs of the thorax.
flexibility and elasticity of connective tissue is 3. Movement.
responsible for increased wrinkling of the skin, as well as ● Tendons, strong bands of connective tissue, attach
an increased tendency for older people’s bones to break. skeletal muscles to bones. Thus, contraction of skeletal
● The walls of arteries become less elastic because of muscles pulls the tendons, which moves the bones. In
changes in collagen and elastic fibers. this way, we can move our appendages for normal.
● Two types of connective tissue:
1. Tendons - skeletal muscles to bones
2. Ligaments - this helps the bone to hold its

structure; attaches bone to bone. categories.

4. Storage. ● include the vertebrae and facial bones.
● Some minerals in the blood—principally, calcium and ● In vertebrae or spinal columns, they have intercalating
phosphorus—are stored in bone. Should blood levels of structures which mean they are irregular in structure.
these minerals decrease, the minerals are released from
bone into the blood. Structure of Long Bone
5. Blood cell production. 1. Diaphysis
● Many bones contain cavities filled with red bone marrow, ● shaft of the long bone.
which produces blood cells and platelets. ● consist of a central shaft and two ends called
“epiphysis”.
EXTRACELLULAR MATRIX ● filled with Marrow (red and yellow marrow)
1. Collagen 2. Epiphysis
● “Koila-” which means glue and “-gen” which means ● end of the bone.
producing. ○ Proximal and distal epiphysis
● tough, ropelike protein that holds the shape of the bone 3. Metaphysis
together. ● The long bone is still growing.
2. Proteoglycans ● consist of epiphyseal plate:
● “Proteo-” means protein and “-glycan” means ○ growth plate
polysaccharide ○ composed of cartilage between the diaphysis
● Sugar complex and epiphysis
● large molecules consisting of many polysaccharides ○ When the epiphyseal stops growing, it will be
attaching to and encircling core proteins. replaced by a bone (epiphyseal line).
● form large aggregates. 4. Articular Cartilage
● can attract and retain large amounts of water between ● cover the end of the long bone with hyaline cartilage.
the polysaccharides. ● To prevent friction, wear, and tear or end bone or
● e.g. hyaluronic acid - with high attraction of water epiphysis.
3. Tendons and Ligaments ● makes movement or articulation smooth.
● contains large amounts of collagen fibers, specifically 5. Periosteum
dense collagen fiber, making these structures very tough, ● “Peri” means around; “osteon” means bone.
like ropes or cables. ● consist of 2 layers and contain blood vessels and nerves.
● responsible for bearing weight in joints. 6. Medullary Cavity
● springs back to its original shape after being bent or ● space filled with marrow.
slightly compressed. ○ Red marrow - site of blood cell formation
● excellent shock absorber. ○ Yellow marrow - adipose tissue
4. Cartilage 7. Endosteum
● contains collagen and proteoglycans. ● the surface of the medullary cavity is lined with a thinner
● Collagen makes cartilage tough, whereas the water-filled connective tissue membrane.
proteoglycans make it smooth and resilient. ● contains a single layer of cells.
● excellent shock absorber. ● protects medullary cavity.
Kinds of Bones
1. Long bones
● longer than they are wide.
● Most of the bones of the upper and lower limbs are long
bones (thigh bone).
● This shape enhances their function in movement of
appendages.
2. Short bones
● approximately as wide as they are long.
● Cube-shaped or round
● Tarsal and carpal bones
● (-) for diaphysis
○ Ends of bones do not contain diaphysis
● examples are the bones of the wrist (also known as Major Types of Bone
carpal). 1. Compact Bone
3. Flat bones ● also known as “cortical bone”.
● relatively thin, flattened shape. ● denser, with fewer spaces than spongy bone.
● well-suited to providing a strong barrier around soft ● contains lacunae.
organs such as the brain and heart. ● forms the perimeter of the diaphysis of a long bone and
● examples of flat bones are certain skull bones, the ribs, the thinner surfaces of all other bones.
the scapulae (shoulder blades), and the sternum. ● has a predictable pattern of repeating units called
4. Irregular Bones “osteons”.
● shapes that do not fit readily into the other three 2. Spongy Bone
● also known as “cancellous bone”. ● formation of bone through ossification/ osteogenesis.

● consist of a lacy network of bones with small ● bone-forming cells.
marrow-filled spaces. ● function in the formation of bone, as well as in the repair
● consists of delicate interconnecting rods or plates of and remodeling of bone.
bone called trabeculae. ● When osteoblasts become surrounded by matrix, they
● Trabeculae are referred to as osteocytes;
○ resemble the beams or scaffolding of a ❖ mature type of osteoblasts.
building. ● synthesizes and secretes organic materials.
○ bears weight. 2. Osteocytes
○ help bones resist bending and stretching. ● main bone cells (mature bone cells).
● maintain daily metabolism.
3. Osteoclasts
● bone-destroying cells.
● present and contribute to bone repair and remodeling by
removing existing bone, called “bone resorption”.
● It releases a certain type of acid – Hydrochloric acid
(HCl).
● signals the osteocytes and osteoblast to form.
● concentrated in the endosteum;
○ inner covering of bone.
4. Osteogenic
● helps and normalizes the function of the three bone cells.
● Specialized or unspecialized stem cells and is also called
as “OsteoChondral progenitor cell”.
● helps in osteoblast and chondroblast formation.
● located in the inner layer of the periosteum (outer
covering) and endosteum which are found in our bones.
● responsible for bone remodeling;
○ process of removing old bone and adding new
bones.
Two Types of Osteogenic Bone

1. Woven Bone
● first formed during fetal development.
● formed during the repair process of fractured bone.
2. Lamellar Bone
● matured bone or the adult bone.
● consist of lamellae;
○ The bone is formed in the thin sheets of
Histology of Bone extracellular matrix with osteocytes located
Bone consists of: between the lamellae spaces and the spaces is
● 25% of water also known as the “lacunae”.
● 25% of collagen fibers
● 50% crystallized mineral salts Structure of the Compact Bone
○ Hydroxyapatite - composed of calcium
phosphate and calcium carbonate.
■ Important in making the bone tough,
rigid or strong.
■ Responsible for making the bones
super strong even after years of
death.
■ Without this, our bones will become
brittle, flexible, fragile, and will
eventually shatter.
Mature Bone Matrix
● Organic (35%) - collagen and proteoglycans
○ Provides strength and flexibility
● Inorganic (65%) - hydroxyapatite
○ Provides compression and strength
Bone Cells
1. Osteoblasts 1. Haversian Canal
● also known as the “central canal”.
● vessels that run parallel along to the long axis.

● each osteon consists of concentric rings of lamellae
surrounding a central canal, or “Haversian canal”.
2. Volksmann Canal
● Perforating
● vessels run perpendicular to the long axis.
3. Haversian System
● Where osteon and haversian canal are located.
● single central canal + contents (osteon), concentric
lamellae and osteocytes = Haversian System.
4. Concentric Lamellae
● surrounded by the central canal.
5. Circumferential Lamellae
● can be found on the outer surface which extends around
the bone.
6. Interstitial Lamellae
● In between.
● are the remnants of osteons that remain after a PROCESS OF BONE DEVELOPMENT
resorption canal incompletely erodes those osteons. 1.) A cartilage model with the general shape of the mature
bone, is produced by chondrocytes. A perichondrium
Bone Development surrounds most of the cartilage model.
Bone Ossification
● Ossification (comes from the word os meaning bone +
facio, meaning to make) is the formation of bone by
osteoblasts. After an osteoblast becomes completely
surrounded by a bone matrix, it becomes a mature bone
cell, or osteocyte.
Two Types of Bone Ossification

1. Intramembranous ossification
● occurs when osteoblasts begin to produce bone within
connective tissue membranes. This occurs primarily in 2.) The chondrocytes enlarge, and cartilage is calcified. A
the bones of the skulls. bone collar is produced, and the perichondrium of the
● Occurs in skull bones, mandible, and the diaphysis of the diaphysis becomes the periosteum.
clavicles. ❖ When there is calcification of cartilage, the
● within the membrane - cancellous bone chondrocytes also begin to proceed into
● outer Surface - compact bone atrophy (wasting away). In which cartilage
● When human beings are just a fetus their skull is not eventually disappears and becomes the bone.
completely ossified, meaning that it is not yet fully
formed as a bone
● Fontanels - not ossified at birth. Comprise of cartilages
or soft bones. Has two types:
○ Anterior Fontanels
○ Posterior Fontanels
3.) A primary ossification center forms as blood vessels and

osteoblasts invade the calcified cartilage. The blood
vessels form from inside and out. Eventually, its amount
increases. The osteoblasts lay down bone matrix,
forming cancellous bone. It invades the calcified
cartilage.
2. Endochondral Ossification
● Bone formation that occurs inside hyaline cartilage is
called “endochondral ossification”.

BONE REPAIR
1. Hematoma Formation
4. Secondary ossification centers form in the epiphyses
● Blood released from damaged blood vessels forms a
of long bones.
hematoma.
● Blood Formation
● Clot (Fibrous Protein)
● Stops bleeding.
5. In a mature bone, the epiphyseal plate has become the

epiphyseal line and all the cartilage in the epiphysis
except the articular cartilage, has become the bone.
2. Callus Formation
● The internal callus forms between the ends of the bones,
and the external callus forms a collar around the break.
External callus prevents further damage on the bone
● Considered as scar that protects further injury of the
bone of the break
● Mass tissue formation
○ Internal Callus- forms between the ends of the
bone.
○ External Callus- forms a “collar” around the
Four (4) Zones of the Epiphyseal Plate ○ 💡break.

Collar- prevents further damage or injury in
our bones.
1. Resting Cartilage
● Bone will grow but cartilage does not divide
rapidly hence, “resting”.
2. Proliferation
● Hastens up the production of cartilage via
chondrocytes, which makes new cartilages.
3. Hypertrophy
● Where chondrocytes mature and enlarge.
4. Calcification
● Calcified cartilage matrix
● Chondrocytes become osteoblast and occur in
the bone of diaphysis.
3. Callus Ossification
● Woven, spongy bone replaces the internal and external
calluses.
● Calluses ossified to produce woven.
● Cancellous bone 4-6 weeks after injury.
consists of many tiny cylinders known as osteons.

○ Each osteon is made of many lamellae, which
are these concentric layers made of an organic
part - mostly collagen, and an inorganic part
called hydroxyapatite, which is mostly calcium
phosphate.
Haversian Canal
● It is in the center of every osteon which contains the
blood supply and innervation for the bone cells.
Medullary Canal
● It is in the center of the bone which is a hollow space
lined by a honeycomb-looking structure called the
4. Bone Remodeling spongy or cancellous bone.
● Compact bone replaces woven bone, and part of the ● contains the bone marrow, which is the site of blood cell
internal callus is removed, restoring the medullary cavity. production.
● Woven bone to compact bone. Spongy Bone
●
● 💡
Repair is completed.
When you have a bone fracture and it undergoes bone
repair, new bone is much stronger and rigid than old bone
● It is made of crosslinking tiny roads called trabeculae.
○ It makes bones resistant to mechanical stress,
that was injured. so that they can bear weights without caving in.
● Just like the medullary cavity, the spaces in the spongy
bone of the epiphysis are occupied by bone marrow.
Bone Marrow
● That’s where we find the hematopoietic stem cells, the
blood-making cells of the bone marrow, which give rise to
the lymphoid progenitor cells ;
○ which mature and differentiate into
lymphocytes like T and B cells, the main cells
involved in your adaptive immunity, and the
● myeloid progenitor cells
○ which differentiate into red blood cells,
Bone Remodeling and Repair
platelets, and myeloblasts – the progenitors of
Bone Remodeling
● Old, brittle bone tissue is removed or resorbed and basophils, neutrophils, eosinophils and
replaced by new tissue. monocytes.
○ Reshaping bones after a fracture Osteoblasts
○ Repairing micro-cracks which form from ● Release a substance called “M-CSF - Macrophage
ordinary activities colony-stimulating” factor
■ Form when bones are under stress ○ helps stimulate myeloid cells like monocytes.
● Produce a substance called “RANKL - Receptor Activator
Periosteum
● Covers the bones’ surface except at the articular of Nuclear factor Kβ Ligand”, which binds to RANK
cartilages receptors on the surface of nearby monocytes.
○ the parts involved in the joints ○ RANKL induces those monocytes to fuse
● Consists of an outer fibrous layer together to form a multinucleated osteoclast
○ protects the bones and provides attachment for cell.
tendons and ligaments ○ RANKL also helps the osteoclast mature and
● It also has an inner cellular layer
activate so that they can start resorbing bones.
○ Houses progenitor stem cells.
Progenitor Stem Cells Bone Remodeling
● These progenitor stem cells develop into both ● the process begins when osteoblasts sense micro cracks
osteoblasts and chondroblasts at their location, like when your bones are bearing much
○ Osteoblast -secrete bone matrix weight.
○ Chondroblasts - produces cartilage Osteoclasts
Femur
● starts secreting lysosomal enzymes – mostly
● the longest bone in the body.
Epiphysis collagenase.
● the two ends of the bone that forms the joints. ○ digests the collagen protein in the organic
Diaphysis matrix.
● shaft of the bone ● Howship’s lacunae
● It has an external part – the cortical bone which
○ where drill pits on the bone surface. ● Osteoblasts release RANKL to initiate remodeling, and
● also start producing hydrochloric acid - HCl. osteoprotegerin to help turn it off.
○ dissolves hydroxyapatite into soluble calcium – ● Bone remodeling is involved in repairing those tiny cracks
Ca2+ and phosphate – (PO4)2- ions, and these in your bones due to normal activities, and in helping
ions get released into the bloodstream. bones heal after a fracture.
● There is also a scattering of osteocytes which are
trapped within the bony matrix. When these get freed up INTEGUMENTARY SYSTEM
by the dissolving of bone, they get eaten up or
phagocytosed by the osteoclasts. SKIN
Osteoblasts ● largest organ of the body comprising 6% of the weight.
● Now to keep bone resorption under control, the ● main barrier between the body and the environment
● subdivided into 3 layers:
osteoblasts also secrete osteoprotegerin;
1. Epidermis
○ binds to RANKL and prevents it from activating 2. Dermis; and
RANK receptors. 3. Subcutaneous fat layer
○ This slows down activation of osteoclasts.
● Apoptosis
○ This is the means by which once osteoclasts
complete their job, they commit suicide.
● Following bone resorption, osteoblasts start secreting
osteoid seam;
○ a substance mainly made of collagen, to fill in
the lacunae created by the osteoclasts.
● Calcium and phosphate begin to deposit on the seam,
forming hydroxyapatite.
● Also, as osteoblasts keep producing new bone material,
many get trapped within tiny lacunae within the bony
matrix, and turn into osteocytes. Three Layers of the Skin
● Bone remodeling is affected by various hormones. 1. Epidermis
Parathyroid glands ● outermost layer of the skin.
● The four small pea-like structures located on the thyroid ● comprised of the stratum corneum, stratum lucidum,
gland in the neck, release parathyroid hormone in stratum granulosum, stratum spinosum and stratum
basale.
response to a drop in blood calcium levels.
● Functions:
● The parathyroid hormone travels to the bones and
❖ acts as a barrier against mechanical, thermal,
stimulates the osteoblasts to release RANKL, which harmful substances and physical injury.
triggers bone resorption. ❖ prevents loss of moisture.
● This allows calcium ions-Ca2+ to be released into the ❖ first line defense against microorganism.
bloodstream, and that corrects the deficiency.
● Now, when the blood calcium level is higher than normal, Layers of Epidermis
the parathyroid gland releases less parathyroid hormone 1. Stratum corneum
● comprise of the horny layer with dead keratin layer/ dead
to have less bone resorption.
skin cells.
Calcitonin
2. Stratum lucidum
● A hormone that is produced by parafollicular cells in the 3. Stratum granulosum
thyroid gland ● contains/ releases lamellar granules.
● High calcitonin levels inhibit bone resorption which 4. Stratum spinosum
results in lower blood calcium levels. ● Where you can find desmosomes, langerhans cells, and
Wolff’s law keratinocytes.
❖ Keratinocytes play multiple roles essential for
● A phenomenon where bones that bear a lot of weight
skin repair. They also produce a wide variety of
remodel at such a high rate cytokines, which is important in mediating
● Another factor on bone remodeling is mechanical stress. cutaneous immune responses, inflammation,
● Next there’s Vitamin D which stimulates intestinal wound dealing, and growth and development of
absorption of calcium, which then causes calcitonin certain neoplasms.
levels to increase and that inhibits bone resorption. ❖ Neoplasm - means there is tumor or growth
Bone remodeling whether it is benign or malignant carcinoma.
5. Stratum basale
● A continuous process by which bones are resorbed by
● where you can find the melanocytes – produce the
osteoclasts, and remade by osteoblasts. hormone melanin, a chemical that gives color to the skin

and hair. defense against invading organisms.

2. The skin pH is between 5 and 6.
3. Slightly acidic due to amphoteric AA, lactic acid and fatty acids.
4. Keratin
● a dead protein substance that supports the skin
structure.
❖ Soft keratin – root sheath of hair, medulla and
horny layer of epidermis.
❖ Hard keratin – nails, cortex of hair and follicles
SKIN COLOR
The color of skin is determined by multifactorial:
● Amount of melanin present in the epidermis
● Presence of carotene in the epidermis, dermis and
hypodermis.
❖ Carotene
2. Dermis ➔ a natural substance, found in carrots.
● also known as the “corium”. ➔ When we are photographed under the
● 1/8 of an inch thick which constitutes the main mass of sun, the skin appears to be yellowish
the skin and supports numerous blood vessels, or orange in color because of the
lymphatics and nerves. presence of carotene.
● Functions: ● Proportion of reflected and scattered light.
❖ Supports epidermal appendages – the sweat ❖ Reflection also gives color to the skin.
glands, sebaceous glands. ● Amount of blood in the dermal and subcutaneous BV
❖ Stores electrolytes, blood and water ❖ Cold weather - Blood vessels in skin constricts
or narrow which reduces the amount of heat
loss through skin in attempt to maintain
internal temperature or homeostasis, bc of this
the skin receives less blood and turns into
bluish color.
❖ Warm weather - Blood vessels will dilate in an
attempt to cool the body, the skin will appear
more reddish.
● Eumelanin, Pheomelanin and Neuromelanin
❖ Eumelanin pigments
➔ these are components in the melanin
which consists of the three (3)
primary colors, and mostly present in
3. Hypodermis darker skin color.
● a.k.a. “subcutaneous fat layer” ➔ gives brownish color.
● found underneath the dermis. ❖ Pheomelanin pigment
● Functions: ➔ gives red and yellow pigment.
❖ acts as a cushion at which fat is manufactured ➔ found in caucasian, or lighter skin
and stored. color people.
❖ provides attachment to underlying muscle, ❖ Neuromelanin
fascia or periosteum. ➔ produced by our brain. A
❖ plays an important role for thermoregulation, ➔ also determines the skin color and the
insulation, storage of energy and protection. release of melanin into the
melanocytes.
HUMAN HAIR
Human Hair
● specialized epidermal structures, which consists of a
root with the dermis and hair shaft which projects
beyond the surface.
● dead structure composed of keratinized cells.
● Projection seen beyond the surface is responsible by
muscle, these two (2) types of muscle are:
❖ Arrector pili - a muscle responsible for
contraction of hair follicle.
❖ Arrectores pilorum – bristling and hairraising
General Characteristics of Skin effect.
1. Contains natural microbiomes that are important for first-line
MELANIN SYNTHESIS
Melanin Synthesis
● The natural color of hair is caused by varying amounts of
melanin pigment granules.
● Melanin
❖ a complex polymer insoluble black to brown
pigment formed by the action of tyrosinase on
tyrosine.
➔ Formation of chemical through an
enzyme; starting material is Tyrosine,
to convert into DOPA that needs
enzyme – tyrosine hydroxylase.
➔ From DOPA to dopaquinone, the
enzyme responsible for that is
tyrosinase.
➔ From dopaquinone, it will be
subdivided into chromophores to give SEBACEOUS GLANDS
you the black brown pigments/ Sebaceous Glands
melanin – the leuco dopachrome and ● a.k.a. “oil glands”
cysteine. ● found on all parts of the body except palms and soles.
● It serves as a protection against UV radiation. ● composed of multiple lobules and their secretion is
❖ Skin whitening agents such as hydroquinone – made up of whole cells.
found in the market such as maxi peel – a ● Sebum
whitening agent inhibits tyrosinase enzyme. ❖ lipid droplets that provide emollient film,
❖ As it is inhibited, the connection will be protective barrier, emulsify various agents
disrupted, if it is not inhibited, it will continue. applied on skin, aid in synthesis of Vitamin D,
● Cu is a cofactor of tyrosinase in the synthesis of melanin and prevent bacterial infection.
→ catalyst for disulfide bonds
HAIR PIGMENTATION
● Brown, black, blond and gray hair color owe their differing The Structure and Properties of Hair
tones (arrangement & concentration). 1. Hair follicles, which in tens of thousands are deeply
❖ Red hair – pheomelanin (iron). invaginated in the scalp tissue, are the essential growth
❖ Grey hair – less pigment granules. structures of hair.
❖ Black hair – large quantity of eumelanin. 2. Base of hair follicle - cells proliferate and, as they stream
❖ Blond hair – low quantity of eumelanin. upwards, the complex and intertwined processes of
protein synthesis, structural alignment, and keratinization
NAILS transform the cytoplasm into the tough fibrous material
Nails known as hair
● are epidermal appendages, a form of hard keratin and 3. The development of hair is a dynamic, cyclical process in
designed to protect the fingers and toes from harm. which duration of the growth cycle depends not only on
● Alpha-keratin the body site, but also on such variables:
❖ tough protective protein polymer responsible ● Age
for nail formation. ● Nutritional habits
● Hormonal factors

2. Papules
SKIN LESIONS & TRAUMA ● are raised bumps that are up to 1 cm in diameter;
● refers to any skin area that has different characteristics plaques are similar, though larger than 1 cm.
from the surrounding skin, including color, shape, size, ● an inflammatory type of lesion.
and texture. ● Immune system affects this type of infection that
● Skin lesions are very common and often appear as a hardens or solidifies underneath the skin.
result of a localized damage to the skin, like sunburns or ● e.g. Nevi, warts, actinic keratoses, acne, skin cancer and
contact dermatitis. lichen planus.
❖ Insect bites are also skin lesions.
● Others, however, can be manifestations of underlying
disorders, such as infections, diabetes, and autoimmune
or genetic disorders.
● Classification: Primary skin lesions and secondary
lesions
Primary Skin Lesions

Primary skin lesions 3. Pustules
● originate on previously healthy skin and are directly ● are pus-filled, elevated lesions up to 1 cm in diameter.
associated with a specific cause. ● common in bacterial infections and folliculitis and may
● common examples of primary skin lesions include arise in some inflammatory disorders.
freckles, moles, and blisters, among others.
4. Vesicles
● such as with herpes simplex infection are up to 1 cm in
diameter and look like clear, fluid-filled blisters.
❖ Bullae - clear fluid-filled blisters > 10 mm in
diameter
● e.g. Acute ACD, burns, insect bites, bullous pemphigoid
and herpes
What do skin lesions look like?

Skin lesions can present in a variety of different sizes, shapes, and
forms. Moreover, skin lesions can appear isolated or in groups, and
either localized in a single area or widespread throughout the body.
1. Macules
5. Wheal
● are flat, well-circumcised lesions up to 1 cm (0.39 inches)
● a smooth papule or plaque that is transient (meaning
in diameter, while patches are similar but are larger than
that it occasionally appears and disappears).
1 cm.
● e.g. in contact with poison ivy
● e.g. freckles, flat moles, tattoos, rubella, measles,
port-wine stains and rickettsial infection.

❖ Excessive use of high potency of topical

corticosteroids, drugs such as: clobetasol,
halobetasol.
➔ It is because of the synthesis of
lipocortin, which inhibits the enzyme
phospholipase A2 – responsible for
the mitotic activity and protein
synthesis of our skin, if it is not
present, reduction of collagen, elastic,
Secondary Skin Lesions and reticular fiber is the effect.
● Manifestation of skin atrophy: skin thinning
Secondary skin lesions
● develop from the example of a primary skin lesion, either
due to traumatic manipulation, such as scratching or
rubbing, or due to its treatment or progression.
● e.g. crusts, sores, ulcers, and scars
3. Crust
● consist of dried serum, blood, or pus. Crusting can occur
in inflammatory or infectious skin diseases.
● e.g. Impetigo - skin infection, hallmark is crusting around
the mouth.
❖ Drug of choice: Mupirocin; Bactroban (both
ointment)
1. Scales
● are accumulations of thickened stratum corneum (the 4. Skin erosion
outermost layer of the skin, consisting of dead skin cells) ● are open areas of skin that result from loss of part or all
that become dry and flaky and sometimes peel off; while of the epidermis. Erosions can be traumatic or can occur
crusts are dry exudates like sebum, pus, or blood. with various inflammatory or infectious skin diseases.
● e.g. seborrheic dermatitis, fungal infections, psoriasis ● Causes:
and chronic dermatitis. ❖ Excessive pressure of apparatus in patient.
❖ Apparatus was placed in a long period of time
and not addressed by antibacterials.
❖ Infectious diseases such as gangrene, and skin
eating diseases.
❖ An excoriation is a linear erosion caused by
scratching, rubbing, or picking.
2. Skin atrophy
● degeneration and thinning of the epidermis and dermis. It
is usually a manifestation of aging.
● Physiology of skin atrophy due to topical steroids.
❖ Topical steroids cause the synthesis of
lipocortin, which inhibits the enzyme
phospholipase A2.
❖ Phospholipase A2 acts on the cell membrane 5. Skin ulcer
phospholipids, to release arachidonic acid ● result from loss of the epidermis and at least part of the
which causes the inflammation. dermis.
❖ The inhibition of phospholipase A2 results in ● Causes:
the reduction of inflammation, mitotic activity ❖ Patients with uncontrollable diabetes condition
and protein synthesis. ❖ Too much glucose in the blood can cut off the
● Causes: supply in the BV of the skin, therefore no
nutrient can go to the skin. 8. Lichenification

❖ e.g. Vasculitis, venous stasis dermatitis, ● a thickening of the skin with accentuation of normal skin
physical trauma, diabetes markings; repeated scratching or rubbing.
❖ Use keratolytic agent to lessen the thickening.
6. Fissure 9. Telangiectasia
● linear or cracks in the skin, often painful breaks within the ● are foci of small, permanently dilated blood vessels that
skin surface, as a result of excessive xerosis. may occur in areas of sun damage, rosacea, systemic
● Causes: diseases.
❖ hemorrhoids ❖ It is associated with excessive use of topical
❖ External fissure: tearing of the skin corticosteroids.
7. Scars
● are areas of fibrosis that replace normal skin after injury. 10. Beau’s Lines
● Some scars become hypertrophic or thickened and ● are horizontal (transverse) depressions in the nail plate
raised. that run parallel to the shape of the white, moon shaped
❖ Hypertrophic portion of the nail bed (lunula) seen at the nail’s origin.
➔ excessive production of collagen, ● result from a sudden interruption of nail keratin synthesis
elastic, and reticular fibers over a skin and grow distally with the nail plate.
injury or a large wound . ● As the nail grows, the Beau’s lines can disappear.
❖ Keloid
➔ are hypertrophic scars that extend
beyond the original wound margin.
❖ In order to cover the scar, the skin produces
more collagen and elastin than normal. Skin
overproduces, and produces keloid.
11. Clubbing
● a soft tissue swelling of the terminal phalanx resulting in
flattening of the angle that exists between the nail bed
and the nail.
● Clubbing typically occurs in combination with other
dermatologic and skeletal findings but can also less
8. Keloid commonly occur in isolation.
● are hypertrophic scars that extend beyond the original
wound margin.
12. Koilonychia
● affects the shape of the nails which are flattened and

have concavities ● The most common place to find milia are on your face.
● Indented nails ● Milia are harmless and only affect your appearance.
● refers to soft nails that have a spoon-shaped dent in ● Causes:
them. Often these “spoon nails” form gradually. ❖ Using heavy creams, moisturizers, petroleum
● Patients with Anemia, vitamin B deficiencies jelly.
➔ Build up of excess dead cells and can
be filled underneath the skin; cannot
be crushed or pinched–laser or
cauterization treatment.
13. Splinter hemorrhage

● a longitudinal, red brown hemorrhage under a nail and
17. Osler’s node
looks like a wood splinter. Seen end-on, the hemorrhage
● are tender, purple-pink nodules with a pale center and an
is in the lower part of the nail plate or underneath it.
average diameter of 1 to 1.5 mm.
● It the the broken blood vessels inside the nail, nail
● generally found on the distal fingers and toes, though
trauma, stuck/pinched or sudden release of artificial nail
they can also present on the lateral digits, hypothenar,
● The most common cause of a splinter hemorrhage is
and thenar muscles.
trauma, including the application of an acrylic nail.
● The pain usually proceeds nodule development, and they
disappear in hours to days, leaving no sequelae.
14. Patch
● a flat area of color change in the skin that is 1 cm or
more wide.
● Causes:
➔ Significant condition 18. Comedo
➢ psoriasis, ● a plugged follicular orifice.
➢ An-an (tinea versicolor) - fungal ❖ Open comedones - a.ka. black heads–are gray,
infection, white patch that spreads orange, brown or blackterm-49 papules. The
out in the skin. keratinous contents can be expressed or
extracted. There is excess oil and dead skin
cells build up exposed due to oxidation.
❖ Closed comedones - are uninflamed
skin-colored papules. They must be punctured
to remove their contents. There is excess oil
and dead skin cells build up.
15. Onycholysis
● a common nail disorder in which the nail plate has
separated from the nailbed typically resulting in a well
defined area of white opaque nail.
● It may be idiopathic or secondary to trauma, skin disease,
nail infections, tumors, or systemic events.
19. Nevus
● a.k.a. “balat (in Tag.)”
● a benign collection of pigment producing cells
(melanocytes) in the epidermis, dermis, or both.
● can be present at birth or shortly thereafter, or acquired
throughout childhood, peaking during the third decade.
16. Milia
● are small, white cysts on your skin. Cysts are filled
pockets under the surface of your skin.
20. Ecchymosis
● a.k.a. “bruise”
● refers to the discoloration of the skin due to the rupture
of the blood vessels below the surface of the skin.
● are typically described as purpuric (i.e., purplish patches)
and do not blanch (i.e., briefly become white or pale in
appearance) when pressure is applied.
Factors in Hair Types
1. The more oval or asymmetrical hair follicle is, the curlier
the hair will be
2. Genetics
3. Altered curl pattern with heat or chemicals
4. Hormones and medications
Type 1: Straight Hair

21. Hirsutism
● Type 1 has no natural curl.
● a condition that causes excess hair to grow on certain
● The individual strands may be fine or coarse, thick or thin,
parts of your body. It mainly affects women and people
but they fall without waving from root to tip.
assigned female at birth.
● Type 1 hair has a tendency to become oily.
● Hirsutism doesn’t have a known cause, but it’s a
symptom of other conditions, including polycystic ovary
syndrome. Type 2: Wavy Hair
● Excess production of male hormones known as ● Type 2A
testosterone. Females normally secrete tiny amounts of ❖ The natural state of type 2 hair is a gentle,
testosterone to balance the hormones. tousled texture. From the roots to around eye
❖ Primary female hormone: estrogen level, hair is fairly straight. And from eye level to
● Cause: the ends, it must have a loose, undefined wave.
❖ PCOS ● Type 2B
❖ Type 2B hair curls from the midpoint to the
ends. The curls have a more defined S shape.
● Type 2C
❖ The most well-defined S-shaped waves are type
2C. The wave pattern may begin close to the
crown and tumble downward.
❖ Type 2C hair is often thick and can be prone to
frizz in damp weather.
Type 3: Curly Hair

● Type 3A
❖ With type 3A hair, S-shaped curls form loose
HAIR TEXTURE AND DENSITY loops. The curls have a circumference a little
Hair Type wider than the large end of a taper candle.
● primarily based on your hair’s curl pattern. The amount of ● Type 3B
curl in hair is determined by the hair follicle. ❖ Type 3B curls have a wider circumference Curls
● The shape of your follicle determines whether your hair spring from the roots and have ample volume.
is: ● Type 3C
❖ Type 1: Straight hair ❖ These curls are tight and springy; they would
❖ Type 2: Wavy hair coil perfectly around a drinking straw.
❖ Type 3: Curly hair
❖ Type 4: Coily hair Type 4: Coily Hair
● Type 4A
❖ The curl pattern for 4A hair is an S-shaped coil
you could wrap around a chopstick.
● Type 4B

❖ The curls in 4B are hair in a zigzag pattern. Parts of the Outer Ear:
● Type 4C 1. Auricle (Pinna)
❖ Type 4C coils are the tightest and most fragile. ● The only visible part of the ear.
It’s really easy to break them if you comb ● consists of elastic cartilage.
roughly or too often. ● Function: collect sound waves; important for directional
Hair Density hearing.
● refers to the number of hair strands in the hair. It is 2. External auditory meatus (Auditory Canal)
determined by how close hair strands are to each other. ● outer third is formed by cartilage, the inner two thirds are
This, in turn, determines how thin or thick hair appears. formed by bone.
● Loss of hair can reduce its density. ● lined by thin keratinized stratified squamous epithelium
HEAD & NECK along the entire canal; it also covers the external
tympanic membrane.
Head and Neck Examination ● Epithelium contains ceruminous glands that produce
● Examination of the head and neck is a fundamental part cerumen (ear wax): yellow-brownish, waxy, bactericidal
of the standard physical examination. It is typically one secretion.
of the first parts of the physical examination and is ● Function: transmission of sound waves to the tympanic
performed with the patient in a seated position. membrane.
● Because the complete head and neck examination is 3. Tympanic membrane (Eardrum)
lengthy, it is usually tailored to the patient's history and ● thin, cone-shaped membrane.
presenting complaint. In adult patients, the parts of the ● cutaneous outer, fibrous middle, and mucous inner layer
examination dealing with the ears and nose are generally ❖ Umbo: the point where ossicles attach to the
not required unless there is a pertinent complaint. tympanic membrane.
❖ Cone of light: a cone-shaped light reflection of
Head Examination the otoscope light in the anterior inferior
1. Trigeminal nerve – A sensorimotor that originates in the pons. quadrant, which helps with orientation
● divides into 3 branches: the ophthalmic, maxillary and ● Function: Sound waves cause vibration of the tympanic
mandibular. membrane, which in turn transmits these vibrations to
● main sensory supply to the face, scalp, oral cavity and the ossicles of the middle ear (i.e., the malleus, incus,
meninges. and stapes).
2. Facial nerve – also known as the “cranial nerve”.
● provides motor innervation to the muscles of facial II. Middle Ear
expression and parasympathetic innervation to the ● Middle portion of the ear that is located internal to the
lacrimal, submandibular and sublingual glands. tympanic membrane and external to the oval window of
the inner ear.
● consists of a tympanic cavity, a mastoid process and
eustachian tube.
● Function: transmits sound waves from the air to the
ossicles and then to the inner ear.
Parts of the Middle Ear

1. Tympanic cavity
● air-filled space that is located within the petrous portion
of the temporal bone.
● contains ossicles, muscles, and nerves.
● connected to the nasopharyngeal cavity via the
eustachian tube.
2. Oval window
● An opening located in the middle ear at the base of the
cochlea through which sound waves are transmitted to
AURAL the inner ear.
● covered by the footplate of the stapes.
Ear Examination 3. Round window
● a membrane-covered opening in the middle ear that lies
Ear
below the stapes-covered oval window.
● organ of hearing and balance.
● vibrations of the footplate of the stapes are transmitted
● It is divided into three sections: the outer, the middle, and
to the round window through the perilymph, which
the inner ear.
causes it to vibrate in the opposite phase of the oval
window.
I. Outer Ear ● injury to the round window (e.g., violent nose blowing,
● external portion of the ear which comprises the auricle barotrauma while diving) causes sensorineural hearing
(pinna), external auditory meatus (auditory canal) and loss.
tympanic membrane (eardrum). 4. Ossicles

● Three small bones in the middle ear that form a chain of

bones connecting the tympanic membrane laterally to
the oval window of the inner ear medially:
❖ Malleus - inserts laterally into the tympanic
membrane; the most lateral ossicle.
❖ Incus - connects to the malleus laterally and to
the stapes medially.
❖ Stapes - inserts medially into the membrane of
the oval window; the most medial ossicle.
● Function: The ossicles receive the acoustic vibrations
from the tympanic membrane and amplify them. They
then transmit the amplified acoustic vibrations to the
fluid of the inner ear via the oval window with minimal
energy loss.
5. Eustachian tube (pharyngotympanic tube)
● connects the middle ear cavity with the nasopharynx
● Function:
❖ Controls the pressure within the middle ear and
allows the pressure to be equalized on both III. Inner Ear
sides of the tympanic membrane (e.g., ● innermost portion of the ear that contains organs of
important for altitude compensation). hearing (i.e. cochlea) and equilibrium (i.e., vestibule) and
❖ Usually closed but opens when chewing, is situated within the petrous part of the temporal bone.
swallowing, or yawning (ear clearing).
6. Tensor tympani muscle Parts of the Inner Ear:
● a skeletal muscle that attaches to the malleus. 1. Labyrinth
❖ Origin: cartilaginous and bony margins of the ● It is subdivided into:
eustachian tube. ❖ Osseous labyrinth (bony labyrinth)
❖ Insertion: handle of the malleus. ➔ bony wall of the inner bone in the
❖ Action: Contraction of the muscle pulls the temporal bone.
malleus medially. This action tenses the ➔ contains the vestibule, the three
tympanic membrane and damps vibration in the semicircular canals, and the cochlea.
ear ossicles, resulting in a reduction of the ➔ lined with periosteum.
perceived amplitude of sound. ❖ Membranous labyrinth
❖ Innervation: medial pterygoid nerve, a branch ➔ lodged within the osseous labyrinth in
from the mandibular nerve (V3) perilymph (low potassium, high
7. Stapedius muscle sodium; transmits sound vibrations
● smallest skeletal muscle in the human body; attaches to from the stapes covered oval window
the stapes. to the round window).
❖ Origin: pyramidal eminence (hollow protrusion ➔ filled with endolymph (high
from the posterior wall of the tympanic potassium, low sodium).
membrane). ➔ contains sensory organs.
❖ Insertion: neck of the stapes. ● contains complex series of fluid-filled spaces:
❖ Action: contraction of the muscle pulls the neck ❖ Vestibular duct (scala vestibuli)
of the stapes laterally, thereby damping the ➔ filled with perilymph; begins at an oval
vibrations of the stapes and allowing it to window; connected with a tympanic
control the amplitude of sound waves being duct at helicotrema (passage at
transmitted to the inner ear. apical end of cochlea).
❖ Innervation: the nerve to stapedius, a branch ❖ Cochlear duct (scala media)
from the facial nerve. ➔ filled with endolymph; contains a
8. Mastoid process spiral organ of Corti and auditory hair
● process of the temporal bone behind the ear. cells.
● becomes pneumatized (aerated) with age, with mastoid ❖ Tympanic duct (scala tympani)
air cells formation. ➔ filled with perilymph; ends at a round
window.
2. Cochlea
● fluid-filled, snail-shaped cavity in the labyrinth.
● Layers of the cochlea:
❖ Bone
❖ Vestibular duct
❖ Reissner membrane
❖ Cochlear duct
❖ Basilar membrane
➔ thin at the basal end and wide at the

apical end; supports the Organ of Ear Examination

Corti. Otoscopy
❖ Tympanic duct ● a clinical procedure done to examine underlying
❖ Bone structures of the ear, particularly the external auditory
● Function: transformation of airborne vibrations into canal, tympanic membrane and middle ear.
auditory neural signals. Air Inflation Otoscopy (Pneumatic otoscope)
● Stria vascularis ● very useful to evaluate middle ear disease. Assess the
❖ produces potassium-rich endolymph for the mobility of the tympanic membrane by applying positive
scala media, which is essential for the and negative pressures with the rubber squeeze bulb.
endocochlear potential.
● The cochlear duct (scala media) contains hair cells.
❖ These are specialized cells situated on a basilar
membrane.
❖ They have apical modifications called
“stereocilia”.
● Vibrations lead to stimulation of a specific location on
the basilar membrane, depending on the sound
frequency (tonotopy).
❖ High-frequency sounds
➔ stimulate hair cells at the base of the Procedure Otoscopy Examination
cochlea; the basilar membrane in this ● The otoscopic exam is performed by gently pulling the
area is thin and rigid. auricle upward and backward. In children, the auricle
❖ Low-frequency sounds should be pulled downward and backward. This process
➔ stimulate hair cells at the apex of the will move the acoustic meatus in line with the canal.
cochlea near an area called ● Hold the otoscope like a pen/pencil and use the little
helicotrema; the basilar membrane in finger area as a fulcrum. This prevents injury should the
this area is wide and flexible. patient turn suddenly
3. Vestibular system
● the system of balance and spatial orientation.
● Consists of:
❖ Otolith organs - fluid-filled pouches lined with
sensory epithelium (maculae acusticae).
➔ Utricle: senses motions in the
horizontal plane (e.g.,
forward-backward, left-right
movements).
➔ Saccule: senses motions in the
sagittal plane (e.g., up-down ● Inspect the external auditory canal.
movement). ● Evaluate tympanic membrane.
❖ Three semicircular canals (horizontal, superior, ❖ Note the color (red, white, yellow) and
and posterior semicircular canals) - sense translucency (transparent, opaque) and
rotary movements (i.e., angular accelerations) position (retracted, neutral or bulging) of the
at their dilated ends (i.e., crista ampullaris or drum.
ampullary crest). ❖ Identify the pars tensa with its cone of light, the
● specialized cells known as “vestibular hair cells” handle and short process of malleus, and the
transduce minute displacements into neural signals that anterior and posterior folds of the pars flaccida
are then transmitted to the brainstem via the vestibular and position of the malleus handle.
part of the vestibulocochlear nerve.

Interpretation of Otoscopy Results

I. Normal findings:
● Auditory canal:
❖ Some hair, often with yellow to brown cerumen
● Ear Drum:
❖ Pinkish gray in color , translucent and in neutral
position.
❖ Malleus lies in an oblique position behind the
upper part of the drum.
❖ Mobile with air inflation.
II. Abnormal findings: I. Tuning Fork Assessments:
● External auditory canal ● performed in order to distinguish between conductive
❖ Tenderness on pulling an auricle. (Otitis hearing loss and sensorineural hearing loss.
externa) ● Two (2) tests: Weber test and Rinne test
❖ Canal swollen, narrowed, moist, with pus.
(Otitis externa)
❖ Yellow to brown, sticky to hard cerumen and
obscuring drum. (Ear Wax)
❖ Foreign bodies
● Ear drum
❖ Color:
➔ Red and loss of landmarks. (Acute
Purulent Otitis Media)
➔ Amber: Serous effusion (Barotrauma)
❖ Bulging: (Acute Otitis media)
❖ Retraction: (Tympanosclerosis)
❖ Translucent: Air fluid level (Otitis media)
❖ Hemorrhagic vesicles: (Bullous myringitis)
❖ Hole: (Perforation) 1. Weber Test
● Tests for lateralization (sound is heard louder in
one ear than the other).
● Place the base of a vibrating tuning fork on the
middle of the forehead and ask the patient from
which ear the sound is louder.
● The sound is normally heard equally in both
ears.
● Interpretation:
❖ Lateralization → asymmetric hearing
loss
❖ No lateralization → normal hearing or
bilateral hearing
2. Rinne Test
● Tests for air conduction vs. bone conduction in
Auditory Acuity the examined ear.
I. Screening Assessments: ● Place the base of a vibrating tuning fork on the
● Whispered voice test: While standing behind the patient, mastoid process of the ear. Once the patient no
whisper a phrase or numbers in each ear → Ask the longer hears a tone, immediately hold the “U”
patient to repeat what you whispered. part of the fork over the outer ear and ask the
● Finger rub test: Place your fingers several centimeters patient if they can still hear it.
from either ear → Rub your fingertips together and ask ● Air conduction is normally greater than bone
the patient if they heard it. conduction, so the patient should still be able to
hear the tuning fork next to the outer ear after
Interpretation: If any asymmetry is detected, or the patient they can no longer hear it when placed on the
complains of impaired hearing, further evaluation is indicated mastoid process.
● Interpretation:
❖ Unable to hear the tuning fork; →
there is conductive hearing loss (bone
conduction > air conduction) in the
examined ear (Rinne test is negative).

Parts and Function of Eyes

1. Choroid
● layer containing blood vessels that lines the back of the
eye and is located between the retina (the inner
light-sensitive layer) and the sclera (the outer white eye
wall).
2.Ciliary Body
● The structure contains muscle and is located behind the
iris, which focuses the lens.
3. Cornea
● The clear front window of the eye which transmits and
focuses (i.e., sharpness or clarity) light into the eye.
OPHTHALMIC Corrective laser surgery reshapes the cornea, changing
the focus.
Visionary Element of Eyes 4. Fovea
● How we see depends upon the transfer of light. ● The center of the macula provides sharp vision.
● Light passes through the front of the eye (cornea) to the 5. Iris
lens. The cornea and the lens help to focus the light rays ● The colored part of the eye which helps regulate the
onto the back of the eye (retina). amount of light entering the eye. When there is bright
● The cells in the retina absorb and convert the light to light, the iris closes the pupil to let in less light. And when
electrochemical impulses which are transferred along the there is low light, the iris opens up the pupil to let in more
optic nerve and then to the brain. light.
6. Lens
● Focuses light rays onto the retina. The lens is
transparent, and can be replaced if necessary. Our lens
deteriorates as we age, resulting in the need for reading
glasses. Intraocular lenses are used to replace lenses
clouded by cataracts
7. Macula
● The area in the retina that contains special light-sensitive
cells. In the macula these light-sensitive cells allow us to
see fine details clearly in the center of our visual field.
The deterioration of the macula is a common condition
as we get older (age related macular degeneration or
● The eye works much the same as a camera. The shutter ARMD).
of a camera can close or open depending upon the 8. Optic Nerve
amount of light needed to expose the film in the back of ● a bundle of more than a million nerve fibers carrying
the camera. visual messages from the retina to the brain. (In order to
● The eye, like the camera shutter, operates in the same see, we must have light and our eyes must be connected
way. to the brain.) Your brain actually controls what you see,
● The iris and the pupil control how much light to let into since it combines images. The retina sees images upside
the back of the eye. When it is very dark, our pupils are down but the brain turns images right side up. This
very large, letting in more light. The lens of a camera is reversal of the images that we see is much like a mirror
able to focus on objects far away and up close with the in a camera. Glaucoma is one of the most common eye
help of mirrors and other mechanical devices. conditions related to optic nerve damage.
● The lens of the eye helps us to focus but sometimes 9. Pupil
needs some additional help in order to focus clearly ● The dark center opening in the middle of the iris. The
pupil changes size to adjust for the amount of light

available (smaller for bright light and larger for low light).
This opening and closing of light into the eye is much like
the aperture in most 35 mm cameras which lets in more
or less light depending upon the conditions.
10. Retina
● The nerve layer lining the back of the eye. The retina
senses light and creates electrical impulses that are sent
through the optic nerve to the brain. (Rods and Cones)
11. Sclera
● The white outer coat of the eye, surrounding the iris
12. Vitreous Humor
● The, clear, gelatinous substance filling the central cavity
of the eye. ● Confrontation visual field testing involves having the
13. Aqueous Humor patient looking directly at your eye or nose and testing
● The eye is always producing aqueous humor to maintain each quadrant in the patient's visual field by having them
a constant eye pressure, aqueous humor also drains count the number of fingers that you are showing. This is
from the eye in an area called the drainage angle a test of one eye at a time.
● It is useful as there are a variety of conditions that can
affect peripheral vision such as glaucoma, retinal
detachment, stroke, vascular occlusions within the eye
and certain brain tumors.
Extraocular Muscle Function Testing

Extraocular Muscle Function Testing
● examines the function of the eye muscles.
I. Normal results:
14. Rods and Cones ● Normal movement of the eyes in all directions.
● The retina has special cells called “photoreceptors”. II. Abnormal results:
These cells change light into energy that is transmitted to ● Eye movement disorders may be due to abnormalities of
the brain. There are two types of photoreceptors: rods the muscles themselves. They may also be due to
and cones problems with the nerves that connect to these muscles
❖ Rods - perceives black and white, and enables or in the sections of the brain that control these muscles.
night vision
❖ Cones – perceives color, and provide central
(detail) vision.
OPHTHALMIC HEALTH CONDITIONS

1. Flame hemorrhage
Visual Acuity ● a subset of retinal hemorrhages occurring within the
Visual Acuity retinal nerve fiber layer.
● clarity or sharpness of vision. ● In general, hemorrhages are precipitated by breakdown
20/20 vision of vessel walls; wall instability etiologies can include:
● A term used to express normal visual acuity (the clarity physical pressure from trauma or surgery, increased
or sharpness of vision) measured at a distance of 20 pressure within the vessels, wall inflammation, weak
feet. connective tissue, and/or systemic coagulation
● 20/20 vision only indicates the sharpness or clarity of pathologies.
vision at a distance.
● Other important vision skills, including peripheral
awareness or side vision, eye coordination, depth
perception, focusing ability and color vision, contribute to
your overall visual ability.
Visual Field Testing

2. Xanthelasma MOUTH, NOSE, AND THROAT

● A harmless yellow bump on or near your eyelid skin.
● A type of xanthoma, or cholesterol deposit, a Mouth
xanthelasma can be soft, chalky or semi-solid. Removal Mouth
options range from surgery to using a chemical peel or ● also known as “oral cavity” or “buccal cavity”.
heat or cold. ● an orifice through which food and air enter the body.
● The mouth opens to the outside at the lips and empties
into the throat at the rear; its boundaries are defined by
the lips, cheeks, hard and soft palates, and glottis.
● In addition to its primary role in the intake and initial
digestion of food, the mouth and its structures are
essential in humans to the formation of speech.
3. Myopia (nearsightedness)
● A condition in which an image of a distant object
becomes focused in front of the retina, either because
the eyeball axis is too long or because the refractive
power of the object is too strong.
4. Hyperopia (farsightedness)
● The refractive error in which an image of a distant object
becomes focused behind the retina, either because the
eyeball axis is too short, or because the refractive power
of the object is too weak.
● This condition makes close objects appear out of focus
and may cause headaches, eye strain and/or fatigue.
Squinting, eye rubbing, lack of interest in school and
difficulty in reading are often seen in children with
hyperopia.
1. Tongue
● a large muscle firmly anchored to the floor of the mouth
by the frenulum linguae.
● It mixes food and also carries sensory receptors for
taste.
2. Teeth
● It is the chief structure of the mouth.
● Tear and grind ingested food into small pieces that are
suitable for digestion.
5. Palpebral fissure
3. Palate
● Elliptic space between medial and lateral canthi of the
● Separates the mouth from the nasal cavity, allowing
two open eyelids.
separate passages for air and for food.
4. Hard palate
● It composes two-thirds of the total palate area, is a plate
of bone covered by a moist, durable layer of
mucous-membrane tissue, which secretes small
amounts of mucus. This layer forms several ridges that
help grip food while the tongue agitates it during
chewing.
● Provides space for the tongue to move freely and
supplies a rigid floor to the nasal cavity so that pressures
within the mouth do not close off the nasal passage. In
many lower vertebrates the hard palate bears teeth
5. Soft palate
● The soft palate is composed of muscle and connective
tissue, which give it both mobility and support. This
palate is very flexible. When elevated for swallowing and
sucking, it completely blocks and separates the nasal
cavity and nasal portion of the pharynx from the mouth
and the oral part of the pharynx.

● While elevated, the soft palate creates a vacuum in the 6. Hairy tongue
oral cavity, which keeps food out of the respiratory tract ● an unusual, harmless condition characterized by a 'hairy'
enlargement and discoloration of the filiform papillae.
The filiform papillae are tiny conical bumps found on the
ORAL HEALTH CONDITIONS surface of the front two-thirds of the tongue that do not
1. Tooth decay carry taste buds.
● Dental caries result when plaque forms on the surface of
a tooth and converts sugars contained in foods and
drinks into acids that destroy the tooth over time.
2. Periodontal disease
● Periodontal disease affects the tissues that both
surround and support the teeth. The disease is
characterized by bleeding or swollen gums (gingivitis),
pain and sometimes bad breath.
7. Koplik spots
● are classically described as being bright red spots with
white or bluish white centers that may resemble grains of
sand. They may occur anywhere in the mouth, often
precede the generalized exanthem, and are
pathognomonic for measles (rubeola).
3. Fetor hepaticus
● A musty smell, sometimes described as a mix between
rotten eggs and garlic.
● This is associated with severe liver cirrhosis, likely due to
sulfur compounds such as methyl mercaptan and
dimethyl sulfide
4. Mouth sores
● a.k.a. “Aphthous ulcer”
● Sores can appear on any of the soft tissues of your
mouth, including the lips, inside of your cheeks, gums, 8. Herpetic stomatitis
tongue, and floor and roof of your mouth. ● Herpes infection causes painful sores in lips, gingiva,
● Mouth sores, which include canker sores, are usually a tongue, palate & buccal mucosa, which is characterized
minor irritation and last only 1 or 2 weeks. In some cases, by sudden onset and severity of symptoms .It also
they can indicate an infection from a virus, such as causes symptoms like fever and muscle ache. The
herpes simplex, or more severe causes, such as mouth causative agent for herpetic infection has been identified
cancer as herpes simplex virus which is a DNA virus, in two
forms HSV-1 & HSV-2.
5. Oral candidiasis
● a.k.a. “Oral thrush”
● An infection of the oral cavity caused by Candida
9. Leukoplakia
albicans.
● Oral leukoplakia is a white patch or plaque that develops
● It is fungal a infection of the mouth often called 'thrush'
in the oral cavity. The condition is potentially malignant
because its white spots resemble the breast of the bird
and is strongly associated with tobacco use.
with the same name.
10. Oral Squamous cell carcinoma

● Oral cancer refers to cancer occurring between the

vermilion border of the lips and the junction of the hard membranes.
and soft palates or the posterior one third of the tongue.
● Over 95% of people with oral squamous cell carcinoma
smoke tobacco, drink alcohol, or both.
11. Fissured tongue

● a.k.a. “Scrotal tongue”
● A benign condition characterized by one or more shallow
or deep grooves or furrows (fissures) on the top surface
of the tongue.
Sinuses
Sinuses
● The sinuses are cavities, or air-filled pockets, near the
nasal passage. As in the nasal passage, the sinuses are
lined with mucous membranes.
12. Geographic tongue ● There are 4 different types of sinuses:
● a.k.a. “Benign migratory glossitis”
● An inflammatory disorder that usually appears on the top Four (4) Different Types of Sinuses
and sides of the tongue. 1. Ethmoid sinus
● Typically, affected tongues have a bald, red area of ● This sinus is located inside the face, around the area of
varying sizes that is surrounded, at least in part, by an the bridge of the nose. It is present at birth, and
irregular white border. continues to grow.
● The appearance of the affected portion of the tongue 2. Maxillary sinus
results from loss of the finger-like and mushroom shaped ● This sinus is located inside the face, around the area of
projections (papilla) which normally cover the tongue’s the cheeks. It is also present at birth, and continues to
surface grow
3. Frontal sinus
● This sinus is located inside the face, in the area of the
forehead. It does not develop until around 7 years of age.
4. Sphenoid sinus
● This sinus is located deep in the face, behind the nose. It
does not typically develop until the teen years.
Nose
Nose
● helps you to breathe and to smell.
● The inner part of the nose is above the roof of the mouth.
The nose is made up of:
1. External meatus
● Triangular-shaped projection in the center of the face.
2. External nostrils
● Two chambers divided by the septum.
3. Septum
● Made up mainly of cartilage and bone and covered by
mucous membranes. The cartilage also gives shape and
support to the outer part of the nose.
4. Nasal passages Sinusitis
● Passages that are lined with mucous membranes and Sinusitis
tiny hairs (cilia) that help to filter the air. ● It is an inflammation of the tissues in your sinuses
5. Sinuses (spaces in your forehead, cheeks and nose usually filled
● Four pairs of air-filled cavities, also lined with mucous with air).

● It causes facial pain, a stuffy or runny nose, and Thyroid gland

sometimes a fever and other symptoms. It’s usually ● an endocrine gland in your neck.
caused by the common cold, but other viruses, bacteria, ● It makes two hormones that are secreted into the blood:
fungi and allergies can also cause sinusitis. ❖ Thyroxine (T4)
➔ THis hormone contains four atoms of
iodine and is often called T4.
❖ Triiodothyronine (T3)
➔ The other is called triiodothyronine,
which contains three atoms of iodine
and is often called T3.
● In the cells and tissues of the body, the T4 is converted to
T3. It is the T3, derived from T4 or secreted as T3 from
the thyroid gland, which is biologically active and
influences the activity of all the cells and tissues of your
body.
● These hormones are necessary for all the cells in your
body to work normally.
Throat
Throat
● It is a ring-like muscular tube. It is the passageway for air,
food, and liquid. It also helps in forming speech. The
throat is made up of:
1. Voice box (larynx)

● The larynx is a cylindrical grouping of cartilage, muscles,
and soft tissue that contains the vocal cords. The vocal
cords are the upper opening into the windpipe (trachea),
the passageway to the lungs.
2. Epiglottis
● A flap of soft tissue located just above the vocal cords.
The epiglottis folds down over the vocal cords to prevent
food and irritants from entering the lungs.
3.Tonsils and adenoids
● They are made up of lymph tissue and are located at the
back and the sides of the mouth. They protect against
infection. But they don't really have a function after
childhood. Thyroid
● A normal thyroid is estimated to be 10 grams with an
upper limit of 20 grams or 2 to 4 teaspoons.
❖ Hypothyroidism (underactive thyroid)
➔ not enough thyroxine is produced for
the body’s needs. This is the most
common thyroid disorder.
❖ Hyperthyroidism (overactive thyroid)
➔ too much thyroxine is produced for
the body’s needs.
Inspection of Thyroid
I. Inspection: Anterior Approach
1. The patient should be seated or standing in a
comfortable position with the neck in a neutral or slightly
extended position.
2. Cross-lighting increases shadows, improving the
detection of masses.
3. To enhance visualization of the thyroid, you can:
a. Extending the neck, which stretches overlying
tissues.
b. Have the patient swallow a sip of water,
Thyroid watching for the upward movement of the

thyroid gland.
II.A Palpation: Anterior Approach
1. The patient is examined in the seated or standing
position.
2. Attempt to locate the thyroid isthmus by palpating
between the cricoid cartilage and the suprasternal notch.
3. Use one hand to slightly retract the sternocleidomastoid
muscle while using the other to palpate the thyroid.
4. Have the patient swallow a sip of water as you palpate,
feeling for the upward movement of the thyroid gland. 4. Hyperthyroidism (overactive thyroid)
● happens when the thyroid makes more thyroid hormones
than the body needs.
● Methimazole, propylthiouracil (PTU)
5. Hypothyroidism (underactive thyroid)
● a common condition where the thyroid doesn’t create
and release enough thyroid hormone into your
bloodstream.
● This makes your metabolism slow down. Also called
underactive thyroid, hypothyroidism can make you feel
II.B PALPATION OF THYROID Palpation: Posterior Approach
tired, gain weight and be unable to tolerate cold
1. The patient is examined in the seated or standing
temperatures. The main treatment for hypothyroidism is
position.
hormone replacement therapy.
2. Standing behind the patient, attempt to locate the thyroid
● Levothyroxine, liothyronine, liotrix
isthmus by palpating between the cricoid cartilage and
the suprasternal notch.
3. Move your hands laterally to try to feel under the
sternocleidomastoids for the fullness of the thyroid.
4. Have the patient swallow a sip of water as you palpate,
feeling for the upward movement of the thyroid gland.
THYROID HEALTH CONDITIONS

1. Exophthalmos
● a.k.a. “bulging eyes and proptosis” Palpation and Interpretation of Lymph Nodes
● It is the protrusion of one or both eyes anteriorly out of Lymph nodes in the head and neck region are not visible under
the orbit due to an increase in orbital contents within the normal circumstances and can hardly be palpated. After
rigid bony orbit. It most commonly manifests in inflammation in the head and neck area, lymph nodes are often
thyroid-associated eye disease such as Graves' disease. somewhat enlarged reactively. In that case, the node is also
slightly firmer in consistency.
1. Size: The lymph nodes size says little about the severity of the
condition, only with very large nodes is the chance of a severe
illness enhanced.
2. Pain: Pain during palpation indicates active inflammation.
Sometimes the skin above the lymph node will appear red and
warm to the touch.
3. Consistency: A soft lymph node is usually harmless. Very firm
2. Graves’ disease lymph nodes are often based on metastasis, but firmness also
● autoimmune disorder of thyroid which can cause over occurs in certain forms of Hodgkin's disease and granulomatous
activity of thyroid. inflammations. A rubbery consistency fits more with malignant
3. Goiter lymphoma and chronic leukemia.
● abnormal enlargement of thyroid gland.

4. Anemia
5. Thyrotoxicosis
6. Pregnancy
4. Fusing: Enlarged lymph nodes that have grown fused to one Carotid bruit
another or with the skin, are suspected for an active infection or ● a vascular sound usually heard with a stethoscope over
malignancy the carotid artery because of turbulent, non-laminar
blood flow through a stenotic area. A carotid bruit may
Carotid Arteries point to an underlying arterial occlusive pathology that
Carotid Arteries can lead to stroke.
● The carotid arteries are the primary vessels supplying
blood to the brain and face. MUSCULAR SYSTEM
❖ Right common carotid artery (RCCA)
➔ originates in the neck from the
brachiocephalic artery while the
❖ Left common carotid artery (LCCA)
➔ arises in the thorax from the arch of
the aorta.
Auscultation of Carotid Arteries Muscles

1. Auscultate the carotid arteries with bell for low-pitched sounds Muscles
● I. Normal: ● Muscles make up the bulk of the body and account for
❖ A pulse is normally heard, but without sounds 1/3 of its weight.
during systole. ● Blood vessels and nerves run to every muscle, helping
● II. Abnormal: control and regulate each muscle function.
❖ If bruit is heard, note whether it is systolic or
continuous.
➔ Examine in the upright and supine
position.
➔ Auscultate over the aortic and
subclavian area to determine whether
the bruit is transmitted or originates in
the carotid artery.
2. Carotid bruit: (Carotid artery stenosis)
3. Transmitted murmur: (Aortic stenosis, Subclavian artery
stenosis, Arch branch stenosis)Venous hum: Continuous thrill and
murmur at the root of the neck in sitting position disappearing in The Muscular System creates body heat and moves the:
supine position and compression. Hyperdynamic state
● Bones of the Skeletal system ● A typical muscle spans a joint and tapers at each end
● Food through Digestive system into a fibrous tendon anchored to a bone. Some muscles
● Blood through the Circulatory system divide to attach to different bones.
● Fluids through the Excretory system ❖ Ligaments – bone to bone attachment
❖ Tendons – muscle to bone attachment
The Muscular Tissues
Muscular tissues have three (3) types:
1. Skeletal Muscle
2. Smooth Muscle
3. Cardiac Muscle
The Skeletal Muscles

Tendon
Skeletal muscles
Tendon
● attach to and move bones by contracting and relaxing in
● Tendons are tough, fibrous cords of connective tissue
response to voluntary messages from the nervous
that link skeletal muscles to bones.
system.
● Within them, Sharpey’s fibers pass through the bone
● Skeletal muscle tissue is composed of long cells called
covering (periosteum) to embed in the bone.
muscle fibers that have a striated appearance.
● Tendons in the hands and feet are enclosed in self-
● Muscle fibers are organized into bundles supplied by
lubricating sheaths to protect them from rubbing against
blood vessels and innervated by motor neurons.
the bones.
● Skeletal (striated or voluntary) muscle consists of
● From the hand bones, tendons extend upwards to
densely packed groups of hugely elongated cells known
muscles near the elbow.
as “myofibers”.
❖ A typical myofiber is 2–3 centimeters ( 3/4–1
1/5 in) long and 0.05 millimeters (1/500 inch) in
diameter and is composed of narrower
structures – “myofibrils”.
● Myofibers are grouped into bundles called “fascicles”.
● These contain thick and thin myofilaments made up
mainly of the proteins: ”actin and myosin”.
● Numerous capillaries keep the muscle supplied with the
oxygen and glucose needed to fuel contraction.
Tendons and tendon sheaths in the hand:
● The typical male body contains approximately 640

muscles, which compose around two-fifths of its weight.
● The same number in a female body makes up a slightly
smaller proportion. Skeletal muscles are also known as “voluntary muscles”, since we

control their actions at will, and as striated muscles, from their

microscopic appearance.
In the muscular system, skeletal muscles are connected to the

skeleton, either to bone or to connective tissues such as
ligaments.
Muscles are always attached at two or more places.
When the muscle contracts, the attachment points are pulled

closer together; when it relaxes, the attachment points move apart.
The Cardiac Muscle

● The third type is cardiac muscle, making up the walls of
the heart.
● It is part of both the muscular system and the circulatory
system.
● It is responsible for circulating blood throughout the
body.
● It has its own pacemaker for rhythmic beating.
● The middle layer, “the myocardium”, is responsible for the
heart’s pumping action.
● Cardiac muscle, found only in the myocardium, contracts
in response to signals from the cardiac conduction
system to make the heart beat.
● Cardiac muscle is made from cells called “cardiocytes”.
How do skeletal muscles move? ● Cardiac muscle is found only in the heart.
● It happens when the muscular system and the nervous ➔ Pumps blood throughout body;
system work together. ➔ Contains more mitochondria than skeletal
● Somatic signals are sent from the cerebral cortex to muscle cells.
nerves associated with specific skeletal muscles.
● Most signals travel through spinal nerves that connect
with nerves that innervate skeletal muscles throughout
the body.
Neuromuscular Junction
Muscle contraction begins when the nervous system generates a
signal.
● The signal, an impulse called an “action potential”,
travels through a type of nerve cell called a “motor
The Smooth Muscle neuron”.
Smooth Muscles ● The neuromuscular junction is the name of the place
● Second type is smooth muscle, in the walls of body parts where the motor neuron reaches a muscle cell.
such as the airways, stomach, alimentary canal, and ● Skeletal muscle tissue is composed of cells called
blood vessels. muscle fibers.
● This is called “involuntary muscle”, because it works
automatically rather than under conscious control, or
smooth muscle, from its magnified appearance.
● Smooth muscle lines organs and is involuntary.
➔ Moves food through digestive organs
➔ Empties liquid from the bladder
➔ Controls width of the blood vessels

How do muscle fibers contract?

● A multistep molecular process within the muscle fiber
How do skeletal muscles move? begins when acetylcholine binds to receptors on the
● The top image is of a brain neuron sending an electronic muscle fiber membrane.
signal to a motor neuron, shown below. ● A cross-bridge forms between actin and the myosin
● When the nervous system signal reaches the heads triggering contraction. As long as Ca++ ions
neuromuscular junction a chemical message is released remain in the sarcoplasm to bind to troponin, and if ATP
by the motor neuron. is available, the muscle fiber will continue to shorten.
● The chemical message, a neurotransmitter called ● When acetylcholine reaches receptors on the
“acetylcholine”, binds to receptors on the outside of the membranes of muscle fibers, membrane channels open
muscle fiber. That starts a chemical reaction within the and the process that contracts relaxed muscle fibers
muscle, to make it contract. The sequence of events that begins.
result in the contraction of an individual muscle fiber
begins with a signal—the neurotransmitter, ACh—from
the motor neuron innervating that fiber.
● The local membrane of the fiber will depolarize as
positively charged sodium ions (Na+) enter, triggering an
action potential that spreads to the rest of the
membrane, including the T-tubules.
● This triggers the release of calcium ions (Ca++) from
storage in the sarcoplasmic reticulum (SR). The Ca++
then initiates contraction, which is sustained by ATP.
● As long as Ca++ ions remain in the sarcoplasm to bind to
troponin, which keeps the actin-binding sites
“unshielded,” and as long as ATP is available to drive the
cross-bridge cycling and the pulling of actin strands by
myosin, the muscle fiber will continue to shorten to an
anatomical limit.
How do muscle fibers relax?

● When the stimulation of the motor neuron providing the

impulse to the muscle fibers stops, the chemical reaction Facial Muscles and Facial Expressions
that causes the rearrangement of the muscle fibers Importance: To steady and move the head and to move facial
proteins is stopped. features such as the eyebrows, eyelids, and lips, the muscles of the
● Ca++ ions are pumped back into the SR, which causes face, head and neck interact.
the tropomyosin to re-shield the binding sites on the actin
strands. A muscle may also stop contracting when it runs The musculature involved is highly complex, allowing for a huge
out of ATP and becomes fatigued. range of facial expressions.
● This reverses the chemical processes in the muscle
fibers and the muscle relaxes. Facial Muscles
● Some facial muscles are anchored to bones.
● Others are joined to tendons or to dense, sheet-like
clusters of fibrous connective tissue called aponeuroses.
● This means that some facial muscles are joined to each
other.
● Many of these muscles have their other end inserted into
deeper layers of the skin.
● The advantage of this complex system is that even a
slight degree of muscle contraction produces movement
of the face’s skin, which reveals itself as a show of
expression or emotion.
How do muscles work?

Muscle pairs:
● Muscles are grouped together in pairs on your skeleton
● Muscles can’t push - they only contract and pull the
bones to which they are anchored.
Relaxed or contracted:
● When one muscle of a pair contracts, the other relaxes
Pulling muscles: Laughter Lines

● Skeletal muscles only pull in one direction. For this
● Healthy young skin contains resilient fibers made of the
reason they always come in pairs. When one muscle in a
protein elastin which help it return to its original position,
pair contracts, to bend a joint for example, its partner
for example, after smiling.
then contracts and pulls in the opposite direction to
● With increasing age, the elastin degenerates and the
straighten the joint out again.
skin’s dermis becomes more loosely attached to the
muscle beneath.
● This causes wrinkles as the skin can no longer stretch or
shrink easily.
● Initially “crow’s feet” radiate from the corners of the eyes.
These are followed by lines around the brow and mouth,
in front of the ears, between the eyebrows, on the chin
and bridge of the nose.
Smiling
● The facial musculature enables many subtle nuances of
appearance that convey an enormous variety of
emotions.
● A smile often indicates pleasure, and a frown the Tendinitis

opposite – but not always. ● Inflammation of a tendon or its attachment point, due to
● The smile is a highly ambiguous and versatile overuse of the muscle.
expression, which can also convey relief or pity, or widen Carpal Tunnel Syndrome
into a grin for sarcastic disapproval. ● The carpal tunnel is the passageway in the wrist where
the median nerve and flexor tendons pass through a
narrow opening.
● Carpal tunnel syndrome, which is also called “median
nerve compression”, occurs when the tendons become
inflamed, causing compression of the median nerve.
● Symptoms include pain, numbness, and eventual
weakness in the hand. Carpal tunnel syndrome can occur
for a variety of reasons including hereditary
predisposition, repetitive movements, diabetes, or thyroid
disorders.
Frowning
● Likewise, a frown can articulate various feelings,
including disappointment and confusion.
● In addition to the mouth, other regions of the face are
involved to add shades of meaning.
Bursitis
● Bursae are small fluid- filled sacs that cushion the bones,
MUSCULAR PATHOPHYSIOLOGY: COMMON DISORDERS AND tendons, and muscles near the joints.
CONDITIONS ● Bursitis occurs when bursae become red and inflamed,
Muscles allow us to move, but sometimes the wear and causing pain.
tear that comes from moving our bodies can lead to disorders of ● This condition often occurs near joints that perform
the muscular system. frequent repetitive motion, such as the shoulder, elbow,
hip, and knee.
Cramps
● Painful, spastic contractions of a muscle; usually due to
a buildup of lactic acid.
Fibromyalgia
● a.k.a. “chronic muscle pain syndrome”
● Non-life-threatening, chronic, widespread pain in muscles
with no known cure.
Hypertrophy
● Enlargement of a muscle due to an increased number of
myofibrils, as occurs with increased muscle use.
Muscular dystrophy
● Group of genetic disorders in which all types of muscle
degenerate and atrophy.
1. Duchenne Muscular Dystrophy
2. Myotonic Muscular Dystrophy
Duchenne Muscular Dystrophy

● DMD is a progressive weakening of the skeletal muscles.
It is one of several diseases collectively referred to as
“muscular dystrophy.”
● DMD is caused by a lack of the protein dystrophin, which
helps the thin filaments of myofibrils bind to the
sarcolemma. Without sufficient dystrophin, muscle
contractions cause the sarcolemma to tear, causing an
influx of Ca++ leading to cellular damage and muscle
fiber degradation. Over time, as muscle damage
accumulates, muscle mass is lost, and greater functional
impairments develop.
● DMD is an inherited disorder caused by an abnormal X ● Types of Myotonic Dystrophy:
chromosome. It primarily affects males, and it is usually ❖ Type 1 DM (DM1)
diagnosed in early childhood. DMD usually first appears ➔ long known as “Steinert disease”,
as difficulty with balance and motion, and then occurs when a gene on chromosome
progresses to an inability to walk. It continues 19 called “DMPK” contains an
progressing upward in the body from the lower abnormally expanded section located
extremities to the upper body, where it affects the close to the regulation region of
muscles responsible for breathing and circulation. another gene, SIX5.
● Because DMD is caused by a mutation in the gene that ❖ Type 2 DM (DM2)
codes for dystrophin, it was thought that introducing ➔ recognized in 1994 as a milder
healthy myoblasts into patients might be an effective version of DM1, is caused by an
treatment. abnormally expanded section in a
gene on chromosome 3 called
“ZNF9”.
➔ DM2 was originally called PROMM,
for “proximal myotonic myopathy”, a
term that has remained in use but is
somewhat less common than the
term DM2.
Myotonic Dystrophy
● Progressive muscle wasting and weakness.
● Myotonic dystrophy (DM) is a form of muscular
dystrophy that affects muscles and many other organs in
the body which is a rare, autosomal dominant muscle
disorder.
● The word “myotonic” is the adjectival form of the word Myasthenia Gravis
“myotonia,” defined as an inability to relax muscles at ● Myasthenia gravis is characterized by episodic muscle
will. weakness and easy fatigability.
● Muscles are weak and fail to relax following forceful ● Myasthenia gravis results from an autoimmune attack on
contractions; affects the hands most severely; dominant postsynaptic acetylcholine receptors, which disrupts
trait in 1/20,000 births. neuromuscular transmission. The trigger for
● Myotonic dystrophy often is abbreviated as “DM” in autoantibody production is unknown, but the disorder is
reference to its Greek name, “dystrophia myotonica”. associated with abnormalities of the thymus,
● Another name used occasionally for this disorder is autoimmune hyperthyroidism, and other autoimmune
“Steinert disease”, after the German doctor who disorders (e.g. Rheumatoid arthritis, Systemic lupus
originally described the disorder in 1909. erythematosus, Pernicious anemia).
● Myasthenia gravis develops most commonly in women

aged 20 to 40 and men aged 50 to 80, but it can occur at of the shoulder raises the arms out to the sides of the
any age, including childhood. body.
● Symptoms worsen with muscle activity and lessen with 4. Adduction
rest. ● is a movement towards the midline. Adduction of the hip
squeezes the legs together.
5. Supination
Musculoskeletal System
● With your hand resting on a table in front of you, and
Musculoskeletal System keeping your shoulder and elbow still, turn your hand
● The structural components of the body; muscles, bones, onto its back, palm up.
joints, and connective tissues like tendons and ligaments 6. Pronation
surrounding these structures. ● the elbow and shoulder still, flip your hand onto its front,
palm down.
Process in Musculoskeletal System Examination
Observation
● begins with accessing any visible gross abnormalities of
skin and other components of the musculoskeletal
system.
Palpation
● uses from light to firm pressure to identify and quantify
the abnormalities of the musculoskeletal system,
pain/tenderness, trigger points.
Manipulation
● consists of different techniques to assess the range of
7. Dorsiflexion
motion (ROM), strength, sensations, reflexes, and gait.
● refers to flexion at the ankle, so that the foot points more
superiorly. Dorsiflexion of the hand is a confusing term,
Anatomical Terms of Movement and so is rarely used.
1. Flexion 8. Plantar flexion
● refers to a movement that decreases the angle between ● refers to extension at the ankle, so that the foot points
two body parts. Flexion at the elbow is decreasing the inferiorly. Similarly, there is a term for the hand, which is
angle between the ulna and the humerus. When the knee palmar flexion.
flexes, the ankle moves closer to the buttock, and the
angle between the femur and tibia gets smaller.
2. Extension
● refers to a movement that increases the angle between
two body parts. Extension at the elbow is increasing the
angle between the ulna and the humerus. Extension of
the knee straightens the lower limb.
9. Inversion
● involves the movement of the sole towards the median
plane – so that the sole faces in a medial direction.
10. Eversion
● involves the movement of the sole away from the median
3. Abduction plane – so that the sole faces in a lateral direction.
● is a movement away from the midline – just as abducting
someone is to take them away. For example, abduction

move posteriorly i.e. picking something up.
Range of Motion
11. Opposition Range of Motion
● brings the thumb and little finger together. ● It is characterized by the capability of a joint or body part
12. Reposition to undergo its complete spectrum of movements. It is
● is a movement that moves the thumb and the little finger the measure of the distance and direction of movement
away from each other, effectively reversing opposition. around a specific joint or body part.
● While the normal range of motion varies among different
joints in the body, the level of flexibility typically plays an
important role in the extent of movement around them.
● A joint must have good flexibility to have full range of
motion.
● Flexibility is a factor that is considered to affect
ligaments, muscles, tendons, bones, and joints.
Two (2) Types of Range of Motion:

1. Active Range of Motion
13. Circumduction ● is patient-initiated, which can access not only joint
● can be defined as a conical movement of a limb mobility but also an intact musculoskeletal and nervous
extending from the joint at which the movement is system
controlled. It is sometimes talked about as a circular 2. Passive Range of Motion
motion, but is more accurately conical due to the ‘cone’ ● examination is by initiating manipulation of the joint.
formed by the moving limb.
14. Protraction
● describes the anterolateral movement of the scapula on
the thoracic wall that allows the shoulder to move
anteriorly. In practice, this is the movement of ‘reaching
out’ to something.
15. Retraction
● refers to the posteromedial movement of the scapula on
the thoracic wall, which causes the shoulder region to Importance of Range of Motion (ROM)

1. Blood Flow tending towards the little finger.

2. Muscle Strength ● RA > OA
3. Heightened Flexibility
4. Decreased Pain
5. Stronger Performance
6. Reduced Stiffness
7. Lower Potential for Injury
DEFORMITIES IN HAND
1. Mallet Finger
● the end joint is flexed, cannot actively straighten – due to
the extensor tendon injury or small fracture.
2. Ulnar drift
● When one or more fingers lean towards the pinky –
common with rheumatoid arthritis. 2. Osteoarthritis
3. Knuckle subluxation ● a degenerative joint disease that can affect the many
● The joint becomes unstable from injured or stretched tissues of the joint.
ligament. ● Historically, osteoarthritis (OA) was known as a “wear
4. Swan neck finger and tear” condition, generally associated with aging.
● The joint at the base of the finger is bent, the middle joint ● Osteoarthritis can degrade cartilage, change bone shape
is straight, and the outermost joint is bent. and cause inflammation, resulting in pain, stiffness and
5. Boutonnière finger loss of mobility.
● The middle joint in the finger is flexed and the end joint
hyperextended.
6. Z-shaped thumb
● The base joint of the thumb is bent.
7. Bouchard’s nodes
● Bony bumps/nodules on the middle joint of the finger
from arthritis.
8. Heberden’s nodes
● Bony bumps on the end joint of the finger from arthritis.
9. Wrist subluxation
● The wrist joint becomes unstable from arthritis or injury.
3. Rheumatoid Arthritis
DEFORMITIES IN FOOT ● an inflammatory arthritis in which joints, usually including
1. Hammertoe those of the hands and feet, are inflamed, resulting in
● A bending of the middle joint, most commonly the swelling, pain, and often destruction of joints.
second toe. ● The immune system damages the joints and connective
2. Bunion tissues.
● Causes a bony bump on the inner (medial) side of the big ● Joints (typically the small joints of the limbs) become
toe. painful and have stiffness that persists for more than 60
3. Claw toe minutes on awakening and after inactivity.
● The base joint of the toe is straight, the middle joint is ● Fever, weakness, and damage to other organs may occur.
bent, and the third joint may be curled. ● Diagnosis is based mainly on symptoms but also on
4. Mallet toe blood tests for rheumatoid factor and on x-rays.
● Causes the last joint of the toe bend downward; most ● Treatment can include exercises and splinting,
common in the second toe. medications (nonsteroidal anti-inflammatory drugs,
5. Valgus deformity disease-modifying antirheumatic drugs, and
● Deformity where the joint bends outward, away from the immunosuppressive drugs), and sometimes surgery.
midline. Found mostly in the knees, though any joint can
have this deformity.
6. Varus deformity
● Deformity when the joint bends inward, toward the
midline. Found mostly in the knees, though other joints
can also have this.
Musculoskeletal Terminologies
1. Ulnar deviation
● a.k.a. “ulnar drift”
● A hand deformity in which the swelling of the
metacarpophalangeal joints (the big knuckles at the base
of the fingers) causes the fingers to become displaced,

4. Crepitation SKELETAL SYSTEM PART II

● Crepitus describes a popping, clicking or crackling sound In human anatomy we normally have 206 bones.
in a joint. Joint popping sounds, what some may call ● 126 bones - appendicular skeleton
bone cracking – may mean that air is moving in the joint, ● 64 bones - on upper extremities
which is usually harmless. ● 62 bones - on lower extremities
● Crepitus with pain can be a sign of wear and tear or ● 80 bones - Axial skeleton
injury. ● Paired (86 paired)- left and right
- Paired means it works together
Example: Bones and upper limbs
● Unpaired (34 unpaired)- midlines
- Unpaired means it is floating
Example: Bones of vertebral column
Axial Skeleton (80 Bones)

● Is composed of the skull, thoracic cage, and vertebral
5. Boutonniere deformity
column.
● A type of joint damage that happens mostly to fingers
● Upright axis of the body
but can also happen to toes. It can happen because of an
injury like a burn or a cut or can result from rheumatoid ● Protects the brain, SC, and vital organs.
arthritis. The middle joint becomes stuck and the tip of Auditory ossicles- 3 paired (6)
the joint hyperextends. Skull- 22 bones (P/UP) (braincase- 8; facial bones- 14)
Hyoid- 1 unpaired
Sternum- 1 unpaired
Vertebral Column- 26 unpaired (CTLSO= 7,12,5,1,1)
Thoracic Cage- 12 paired (24)
Skull
● consists of 22 bones P/UP.
● Maxila- Upper Jaw
● Mandible- Lower jaw (site of attachment and mastication)
PARTS OF SKULL
● Temporal bone- refers as “time”
- Turns white as a sign of time
6. Kyphosis - This is where the hair is attached
● An abnormally rounded upper back.
● Parietal bone- Largest portion of the head
7. Lordosis (swayback)
● An inward curve at the lower back. ● Frontal bone- Largest portion of the head
8. Scoliosis - Also known as forehead
● A sideways curve that makes the spine appear S-shaped ● Occipital- back of the head
or C-shaped from the back. ● Sphenoid- beside temporal
● Ethmoid
★ Note: The cracks on the skull is called sutures
SUTURES:
● CORONAL SUTURE - Parietal to frontal
● SAGITTAL SUTURE- Parietal to parietal
● LAMBDOID SUTURE- Parietal to occipital
● SQUAMOUS SUTURE- Parietal to temporal
● WORMIAN SUTURE
FONTANELS
● Anterior Fontanel
● Posterior Fontanel
● Anterolateral Fontanel (sphenoidal fontanel)
● Posterolateral Fontanel
➢ Mastoid Fontanel
HYOID
● Hold by facial muscles and ligaments
● No direct attachment to the skull
● “Floats”
● Attachment tongue muscles and muscles for swallowing
and speech.
● Also elevate larynx (voice box) and holds neck
STERNUM
● Also known as Dagger bone or breast bone

VERTEBRAL COLUMN ➢ Not totally attached to sternum

● Central Axis (base of the skull to pelvis) ➢ If you have injury eg. you break your nose, the
FUNCTIONS: extra bone from the floating ribs can be use
● Supports the weight of the head and trunk
● Protects SC 1. Brain case - also called as Neurocranium
● Allow Spinal N. to exit - Surround and protect the brain
● Muscle movement Brain case (8)
● Movement of trunk and head Temporal (2)
VERTEBRAL SECTIONS: Parietal (2)
● Cranial- 7 cervical bones Frontal (1)
➔ Identified as C1 to C7 Occipital (1)
● Thoracic- 12 cervical bones Sphenoid (1)
➔ Identified as T1 to T12 Ethmoid (1)
● Lumbar- 5 cervical bones 2. Facial bone - also known as Viscerocranium
➔ Identified as L1 to L5 - Supports organ of vision, smell and taste (attachment of
● Sacrum- 1 cervical bone mastication)
● Coccyx- 1 cervical bone Maxilla (2)
➢ Some of the vertebral parts has identified due to their Zygomatic (2)
sections in their area because of the intervertebral disk Palatine (2)
❖ SCIATICA - Nerve pain of sciatic nerve Lacrimal (2)
- Can cause chronic back pain Nasal (2)
- Nsaids and analgesics are used to relieve pain Inferior nasal cocha (2)
- Can affect other regions of the body Mandible (1)
● CURVES Vomer (1)
➔ Primary Curve (Kyphosis)
➢ Thoracic Appendicular Skeleton (126 Bones)
➢ Sacral ● Consists of upper and lower extremities
➢ Kyphosis- known as hunchback ● Upper extremities- 64 bones
➔ Secondary Curve (Lordosis) ● Lower extremities- 62 bones
➢ Cervical ● pper extremities (UE) and Lower extremities
➢ Lumbar
➢ Lordosis- abnormal “L” shape (e.g: The posture (LE) and girdles (attached to the body)
of duck) “Sway back” ● The girdles is attached all over the body and
➢ Scoliosis- abnormal lateral curvature of spine “S” shaped mostly seen on pelvic
- Partially reversible by physical therapy and ● UE= 64
wearing of back brace (back brace consists of
tantalum and titanium)
● LE= 62
- Can affect the respiratory and digestive system ● Clavicle (composed of 2 bones) - Located
- Depends on the region on the chest area
PARTS OF VERTEBRA:
● Body ● Scapula (composed of 2 bones)- also
● Vertebral Foramen known as the shoulder blades
● Vertebral Arch
● Pedicle ★ Fossa- A shallow depression in the
● Lamina bone surface. Here it may receive
● Transverse Process
● Spinous Process
another articulating bone or act to
● Articular Process support brain structures. Examples
● Intervertebral Notches include trochlear fossa, posterior,
IV DISKS (INTERVERTEBRAL DISKS):
● Pads of adjacent vertebrae middle, and anterior cranial fossa.
● Act as shock absorbers ● Humerus (composed of 2 bones)- can be
➢ Annulus, fibrosis, nucleus pulposus
THORACIC CAGE seen on our arms
● Protects the visceral structure ● Radius (composed of 2 bones)- Bone in
➢ Heart and Lungs
forearm, starts from the thumb up until the
● True Ribs (composed of 1-7 ribs)
➢ Directly attached to sternum elbow
● False Ribs (composed of 8-10 ribs) ● Ulna (composed of 2 bones)- Always paired
➢ Common costal cartilage
➢ Not directly attached to sternum with Radius and also located in the forearm.
● Floating Ribs (composed of 11-12) Starts from finger up until elbow
● Carpal Bones:8 pairs

➢ If the median nerve located in carpal
is stuck (naipit) it can be carpal
tunnel syndrome which can form
edema
➢ PROXIMAL: Scaphoid, lunate,
triquetrium, pisiform
➢ DISTAL: Trapezium, trapezoid,
capitate, hamate
● Metacarpals:

Institute of Pharmacy S.Y. 2022 - 2023 1st Year I 2st Semester I Midterms Prof. Joshua Kenneth NG

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Institute of Pharmacy S.Y. 2022 - 2023 1st Year I 2st Semester I Midterms Prof. Joshua Kenneth NG

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PBS 2 (2018): HUMAN PHYSIOLOGY AND PATHOPHYSIOLOGY

Institute of Pharmacy S.Y. 2022 - 2023

Transcribed by: I-A BSP (S.Y. 2022-2023) 1

Organ levelterm-35 countries like Dubai.

temperature by detecting stimuli.

A PERSON WITH HYPOTHERMIA

Transcribed by: I-A BSP (S.Y. 2022-2023) 3

● control center of the body meaning it controls everything ➢ Lipase

Transcribed by: I-A BSP (S.Y. 2022-2023) 4

● provides protection, regulates temperature, prevents

● provides protection and support, allows body

● produces body movements, maintains posture, and

Transcribed by: I-A BSP (S.Y. 2022-2023) 5

● transports nutrients, waste products, gases, and

● removes foreign substances from the blood and lymph,

● removes waste products from the blood and regulates

● exchanges oxygen and carbon dioxide between the blood

Digestive System Female Reproductive System

Transcribed by: I-A BSP (S.Y. 2022-2023) 6

● produces and transfers sperm cells to the female and

TERMINOLOGIES AND ANATOMICAL BODY PLANE

Understanding Body Positions & Directional Terms

Transcribed by: I-A BSP (S.Y. 2022-2023) 7

anterior and posterior parts.

Body Parts and Body Planes

Transcribed by: I-A BSP (S.Y. 2022-2023) 8

Transcribed by: I-A BSP (S.Y. 2022-2023) 9

● the region where electrons can be found

● the weakest bonding DISSOCIATION OF IONS

Transcribed by: I-A BSP (S.Y. 2022-2023) 11

● has fewer H+ than OH− and thus a pH greater than 7.0.

Rate of Chemical Reactions

Transcribed by: I-A BSP (S.Y. 2022-2023) 12

Water bound to a glycerol molecule.

1. Passive Transport - stationary; does not require cell energy.

60s + 40s = 80s ribosomic units

Transcribed by: I-A BSP (S.Y. 2022-2023) 16

particles are embedded, upward and away from the

Projections of Eukaryotic Cell

GENERAL PHYSICAL ASSESSMENT ■ This is created by directly tapping the

Transcribed by: I-A BSP (S.Y. 2022-2023) 18

💡 When heart murmurs are heard, there should be thorough or

Heart Auscultation Method

Transcribed by: I-A BSP (S.Y. 2022-2023) 19

intestinal obstruction or some other conditions.

Transcribed by: I-A BSP (S.Y. 2022-2023) 20

● a calculation of both the systolic and diastolic It is

HEIGHT AND WEIGHT

Transcribed by: I-A BSP (S.Y. 2022-2023) 21

atherosclerosis. enlarge to compensate with the

TISSUES Epithelial Tissues

Classification of Epithelial Tissue:

💡capable of cell regeneration.

Functions of Epithelial Tissue:

Transcribed by: I-A BSP (S.Y. 2022-2023) 24

SIMPLE COLUMNAR EPITHELIUM Example:

PSEUDOSTRATIFIED COLUMNAR EPITHELIUM

STRATIFIED SQUAMOUS EPITHELIUM

Transcribed by: I-A BSP (S.Y. 2022-2023) 25

○ Epithelium lining becomes thin in the area of which a duct is present.

Functions of Epithelial Tissue: Multicellular Exocrine Glands “According to How Products

Transcribed by: I-A BSP (S.Y. 2022-2023) 26

molecules, and bones store minerals, such as calcium and