Anatomy and Physiology QnA

Shoniwa Learnmore, Bsc NE., RGN.
Boroma Peter T., Bsc NE., RGN

Essentials of Anatomy and Physiology for Nurses:
A Question and Answer Approach
First Edition
Shoniwa Learnmore, Bsc NE., RGN.
Nurse Educator
School of Nursing
Harare Central Hospital, Harare, Zimbabwe
&
Boroma Peter T., BSc NE., RGN

Nurse Educator
School of Nursing
Mutare Provincial Hospital, Harare, Zimbabwe
EEBP
Ebenezer Essential Books Publishing
To
Shoniwa Muchineripi
My dear brother
For you created my inmost being;

you knit me together in my mother's womb.
I praise you because I am fearfully and wonderfully made;
your works are wonderful,
I know that full well.
My frame was not hidden from you
when I was made in the secret place.
When I was woven together in the depths of the earth,
your eyes saw my unformed body.
All the days ordained for me
were written in your book
before one of them came to be.
Ps 139:13-16
NIV
Essentials of
Anatomy and Physiology
for Nurses:
A Question and Answer Approach
© 2019 by Shoniwa Learnmore
Printed in South Africa
ISBN: 978-0-6398060-2-0 print
Dewey Decimal Classification Number
Essentials of Anatomy and Physiology for Nurses:

A Question and Answer Approach, First Edition
Author - Learnmore Shoniwa and Boroma Peter
610.73 Nursing Education,
Also 612.014 Anatomy and Physiology
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Disclaimer
Anatomy and physiology is an ever-changing field. The authors and content reviewers of Essentials of Anatomy and Physiology for
Nurses: a Question and Answer Approach have made every effort to provide information that is accurate and complete as of the date of
publication. However, in view of the rapid changes occurring in medicine and nursing field, as well as the possibility of human error, this
book may contain technical inaccuracies, typographical or other errors. The information contained herein is provided "as is" and without
warranty of any kind. The author, content reviewers and the publishers disclaim responsibility for any errors or omissions or for results
obtained from the use of information contained herein.
Preface
Anatomy and physiology is one of the most important courses in the nursing curriculum.
The knowledge of anatomy and physiology is essential for understanding other courses such
as medical-surgical nursing, pharmacology etc. Anatomy and physiology questions
contribute a significant part of the end of block examinations and the state final examination
papers. It is therefore crucial that the student develops mastery of anatomy and physiology.
This book helps the student to do so.
In this book we have tried to use examination type questions to help the student cover the
essential aspects of anatomy and physiology. Anatomy and physiology textbooks are
typically large volumes and the practical problem for most students is to go through these
large textbooks and pick up all the essential and relevant matter. This book should therefore
be useful to the student who is preparing for the anatomy and physiology end of block
examination. These students have time challenges because of the relatively short periods at
their disposal and the amount of matter they are expected to cover during the block.
The student who is preparing for the medical-surgical conditions should find this book
helpful in that it helps the student revise the relevant anatomy and physiology of the systems
they are expected to cover. The understanding of the normal anatomy and physiology is a
crucial aspect of medical-surgical conditions.
The book is also helpful to the student preparing for the state final examinations. Anatomy
and physiology questions form a significant part of the state final examination papers. The
book allows the student who is preparing for state final examinations to revise the essential
aspects of the course at a relatively faster pace than they can do reading the typical anatomy
and physiology textbook. Students studying for the state final examinations have a lot of
other courses they have to revise.
In this book we have tried to help the student focus on the essential aspects of anatomy and
physiology using a question and answer approach. This approach was favoured because it
helps keep the textbook shorter but still address most of the essential matter.
We have tried to present the information is a simplified manner so as to make the
information easy for the student to understand. We hope that such an approach would be
helpful to students revising anatomy and physiology.
Although the book is guided by the objectives and content of the current nursing curriculum
we cannot claim that this book is exhaustive. We have tried to keep the text shorter and we
have only included anatomy and physiology that we feel that the student must know. For
such reasons this textbook is not intended to replace the recommended anatomy and
physiology textbooks. We hope the book will achieve its purpose that is to help the student
revise the essentials of anatomy and physiology at a relatively fast pace.
The information in this textbook has been reviewed by several nurse educators in schools of
nursing in Zimbabwe. We have tried to give as correct information as possible but we are
aware that inaccuracies may still be present in the textbook because of human error and the
dynamic nature of knowledge. We therefore welcome suggestions and criticism so that we
can have a better textbook for students to use.
Thank you.
Shoniwa Learnmore
1 May (Worker’s Day) 2019
Acknowledgements
During the process of writing this book i was admitted in hospital for weeks with a serious
cerebrovascular condition. I would therefore like, first of all, to thank the following for their
love, care and support: my family and friends, Harare Central Hospital-School of Nursing
staff, my friends the Mumbire family, Sibongile Dube, group A2017 nursing students,
nursing and medical staff at Harare Central Hospital who took good care of me, Mr Gumiso
and my former student Sr Chada, and Faith C. Mkwesha for her big heart.
Now, writing this book required many direct and indirect personal and professional inputs. I
want to thank my brother and founder of Digitext, Muchineripi Shoniwa, for designing the
book cover, editing, proofreading, and creating the book design.
I must recognize my friend Mr Chiduku (Librarian, School of Nursing-Harare Central

Hospital) for helping me locate some of the reference material used in the writing of this
book.
Let me also express my gratitude to my colleagues at Harare Central Hospital-School of

Nursing) for their understanding and support. I must mention the motherly role played by
Mrs I. R. Sambo, my principal tutor, during the writing of this book.
I would like to acknowledge the contributions of fellow nurse educators and members of the
Nurse Educators Association of Zimbabwe/NEAZ, for their support. In particular I would
like to mention my co-author Mr Boroma Peter for working tirelessly to meet the publisher’s
deadlines for the creation of this book. I want to thank the following for their support and
for reviewing the content of the book: Mr Boroma, Mr Sibanda, Mrs Moyo, Mrs
Nyanhongo, Mr Masanzu, Mr Shangwa, and Mr Chinyangana.
I am grateful for the inspiration of my teachers Mrs Bukutu, Mr Bvekerwa, and Dr

Chinamasa.
Let me recognise a few special individuals in my life, these are my mother (S. Mugwagwa),
my children (Takunda, Praise, Marvellous, and Learnmore Jnr), my friend Munyaradzi
Mumbire and his family, my love Sibongile Dube. Their love and care gives meaning to my
life.
Shoniwa Learnmore
Harare, Zimbabwe
18 April (Independence Day) 2019
To the student/How to use this book
Content Reviewers
Kusemwa-Muyambi Prettyosa Mukwamba Mutsa Maceline

MSC N (Med-Surg.)., BSc NE., M&E., BSc NE., Dip. ICCN., RGN
Dip. Paeds., RGN Nurse Educator
Nurse Educator, Schools of Nursing School of Nursing
Chitungwiza Central Hospital Parirenyatwa Group of Hospitals
Maisiri Jeshuwa Muvhu Sheila

BSc NE., RGN M Adult Ed., BSc NE., RGN
Nurse Educator Nurse Educator
School of Nursing School of Nursing
Harare Central Hospital Masvingo Provincial Hospital
Masanzu Tonderai Mushambi Elizabeth Rumbidzayi

BSc NE., RMN., RGN MSc NSMSN., BSc NE., ICN., RGN.,
Nurse Educator FMA., EMT
School of Nursing Training Manager
Harare Central Hospital MARS-Zimbabwe
Matandane Angela Shangwa Runeni

MSc Development Studies., BSc NE., M Adult Ed., BSc NE., RGN
OTN., RGN Nurse Educator
Nurse Educator, School of Nursing School of Nursing
Harare Central Hospital Mashoko Christian Hospital
Mukucha Waddilove Moyo Esnath

MADS., BSNS NE.,RGN MA Ed., BSc NE., RGN
Nurse Educator Nurse Educator
School of Nursing School of Nursing
Harare Central Hospital Kwekwe Hospital
Content
Chapter 1: Introduction to Anatomy and Physiology-------------001
Chapter 2: Cells and Tissues-------------------------------------------007
Chapter 3: Skeleton------------------------------------------------------013
Chapter 4: Muscles and Joints-----------------------------------------025
Chapter 5: Integumentary System------------------------------------036
Chapter 6: Cardiovascular System------------------------------------047
Chapter 7: Respiratory System----------------------------------------055
Chapter 8: Digestive System--------------------------------------------071
Chapter 9: Urinary System---------------------------------------------102
Chapter 10: Endocrine System------------------------------------------119
Chapter 11: Nervous System---------------------------------------------130
Chapter 12: Special Senses-----------------------------------------------130
Chapter 13: Endocrine System------------------------------------------130
References:--------------------------------------------------------------------190
Author: Shoniwa L. (BSc. NE., RGN)
Reviewed by Boroma P. (BSc. NE., RGN) &
Mukwamba M. M. (BSc M&E., BSc NE.,
Dip. ICCN., RGN)
Objectives
At the end of this chapter, the student should be able to:
 Define key terms used in introduction to the human body and chemistry of
life.
 Outline the stractural levels of organisation of the human body.
 Describe the concerps external environment and internal environment.
 Describe the two types of feedback mechanisms i.e. negative and positive
feedback mechanisms.
 Outline the components of a feedback mechanism.
 State the components and functions of the differnt systems of the body.
 Define the terms used in introduction to the chemistry of life.
 Describe pH and the pH scale.
 State the pH values of different body fluids.
 State the functions of electrolytes in the human body.
 State the functions of each of the following biological molecules:
carbohydrates, lipids, and proteins.
 Define the following terms related to the movement of substances in the
human body.
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
1. Define each of the following terms:
a. Anatomy [1]
b. Physiology [1]
c. Pathology [1]
d. Internal environment [1]
e. External environment [1]
f. Homeostasis [1]
g. Negative feedback mechanism [1]
h. Positive feedback mechanism [1]
i. Enzymes [1]
Definition of terms
a. Anatomy
Anatomy refers to the study of the structure of the human body and the
physical relationships between body parts.
b. Physiology
Physiology (physio=nature;-logy=study) refers to the study of body

functions i.e. how parts of the body work, and the way in which parts of
the body cooperate together to maintain life.
c. Pathology
Pathology refers to the study of abnormalities, their causes, and the

structural and functional changes that occur in disease processes.
d. Internal environment
Internal environment refers to the environment inside the body in which

cells exist.
[16]
e. External environment
External environment refers to the environment outside the human body.
f. Homeostasis
Homeostasis (homeo=sameness;-stasis=standing still) refers to a state of

equilibrium in the body’s internal environment due to interaction of the
body’s regulatory processes. Homeostasis is also defined as the
maintenance of the internal environment of the body within stable but
dynamic limits.
g. Negative feedback mechanism
Negative feedback mechanism refers to a control mechanism in which the

effector response reverses the original stimulus, retaining homeostasis.
h. Positive feedback mechanism
Positive feedback mechanism refers to a control mechanism in which the

original stimulus progressively increases the response such that the
response is amplified e.g. uterine contraction in labour.
i. Enzyme
Enzymes are biological catalysts which speed up the rate of chemical

reactions in the body.
2. Outline the structural levels of organization of the human body [5]
Levels of organization of the human body
a. Cellular level
[17]
The cell is the basic structural and functional unit of the human body.
Each cell type is specialized to perform specific functions. Cells with
similar structure and function combine to form a tissue.
b. Tissue level
A tissue is a group of cells with similar strucutre and function that work
together to perform a particular function. The basic types of tisseus are:
epithelial tissue, connective tissue, muscle tissue, and nervous tissue.
Different tissues combine to form an organ.
c. Organ level
An organ is a comination of different tissues that carry out a specific

function in the human body. Examples of organs include the liver, heart,
lungs etc.
d. System level
A system consists of different organs and tissues that have a common

function i.e. they work together to contribute to one or more survival
needs of the body. Examples of systems include the digestive system, the
respiratory system, the nervous system etc.
e. Organismal level
An organism is the living individual or unit. The organismal level is the

highest level of organization of the body.
3. Describe each of the following concepts:
a. External environment [4]

b. Internal environment [4]
a. External environment
[18]
The external environment surrounds the body. It provides the oxygen and
nutrients required by the cells. Waste products of cellular activity are
excreted into the external environment. The skin provides a barrier
between the external environment and the internal environment.
b. Internal environment
The internal environment is the water-based medium in which body cells

exist. Cells are bathed in fluid called interstitial or tissue fluid. Oxygen
and other substances pass from the internal transport systems through the
interstitial fluid to reach the cells. Cell waste products move through the
interstitial fluid to the transport systems to be excreted.
4. Describe the concept called homeostasis [4]
Homeostasis
Homeostasis refers to the maintenance of the composition of the internal

environment within narrow limits (or in a fairly constant state). When the
body fails to maintain homeostasis there is a serious risk to the well-being
of the individual. There are many factors in the internal environment
which must be maintained within narrow limits and these include body
temperature, water and electrolyte concentrations, pH (acidity or alkalinity
of body fluids), blood glucose level, blood and tissue oxygen and carbon
dioxide levels, and blood pressure.
5. Describe the concept called homeostatic imbalance [4]
Homeostatic imbalance
Homeostatic imbalance refers to the failure of the body to maintain the

internal environment within the optimum limits. It arises when the control
of a factor in the internal environment is inadequate and the level of the
factor falls outside the normal range (the level gets too high or too low).
Homeostatic imbalance leads to an abnormal state that may lead to illness
and ultimately death.
[19]
Examples of homeostatic imbalances include hyperthermia (an abnormal

increase in body temperature) hypoglycaemia (=abnormally low levels of
blood glucose), and hypertension (=abnormally high blood pressure).
a. Homeostatic imbalance
As long as all the body’s controlled conditions remain within certain narrow limits,
body cells function efficiently, negative feedback systems maintain homeostasis,
and the body stays healthy. Should one or more components of the body lose their
ability to contribute to homeostasis, however, the normal equilibrium among body
processes may be disturbed. If the homeostatic imbalance is moderate, a disorder or
disease may occur; if it is severe, death may result.
A disorder is any abnormality of structure or function.
Disease is a more specific term for an illness characterized by a recognizable set of
signs and symptoms. A local disease affects one part or a limited region of the
body; a systemic disease affects either the entire body or several parts of it.
Diseases alter body structures and functions in characteristic ways. A person with a
disease may experience symptoms, subjective changes in body functions that are
not apparent to an observer. Examples of symptoms are headache, nausea, and
anxiety.
Objective changes that a clinician can observe and measure are called signs. Signs
of disease can be either anatomical, such as swelling or a rash, or physiological,
such as fever, high blood pressure, or paralysis. The science that deals with why,
when, and where diseases occur and how they are transmitted among individuals in
a community is known as epidemiology. Pharmacology is the science that deals
with the effects and uses of drugs in the treatment of di
D7G
****
6. Outline the components of a feedback system [6]
[A feedback system is a cycle of events in which the internal environment is

monitored and regulated. A variable monitored by a feedback system e.g. body
temperature are refered to as a controlled condition. Disruption that changes a
controlled condition is called a stimulus]
Components of a feedback system

[20]
A feedback system consists of a receptor, control centre, and an effector.
a. Receptor
A receptor is a body structure which detect changes in a controlled

condition or changes in internal environment of the body. When changes
occur the receptor generates nerve impulses which are sent to the control
centre. Examples of receptors include receptors which sense changes in
temperature i.e. thermoreceptors and receptors which sense changes in
blood pressure i.e baroreceptors.
b. Control centre
A control centre e.g. the thermoregulatory centre of the brain, receives

input from receptors and generates output commands when they are
needed. Output from the control center is ussually in the form of nerve
impulses (or hormones).
c. Effector
An effector is a body structure that receives output from the control center
and produces a response or effect that changes the controlled condition.
Examples of effectors include muscles and glands.
7. Describe each of the following using appropriate examples:
a. Negative feedback mechanism [5]

b. Positive feedback mechanism [5]
a. Negative feedback mechanism
In a negative feedback mechanism the effector resoponse decreases

(=negates) the effects of the original stimulus to restore homeostasis. In
other words the mechanism rerveses a change in the controlled condition
(=variable factor). There are many negative feedback mechanisms in the
human body.
[21]
Body temoperature is one example of a condition controlled by negative

feedback.
When body temperature falls below the normal range this is detected by
specialized receptors called thermoreceptors (the detector). The receptors
generate impulses which are then transmitted to the thermoregulatory
centre (the control centre) located in the hypothalamus of the brain.
The thermoregulatory centre sends output to structures of the body

(efectors) which restore body temperature to normal. These are:
 Skeletal muscles leading to shivering which leads to the

generation of body heat.
 Blood vessels of the skin causing a vasoconstriction which
reduces blood flow and heat loss.
 Sweat glands leading to a reduction in the production of swaet.
 Errector pilli muscles which raise the hairs of the skin so as to
trap air. The trapped air acts as an insulator preventing heat loss.
The result is the restoration of body temperature back to normal.
b. Positive feedback mechanism
Positve feedback mechanisms are also refered to as ammpliufier or

cascade systems. There are a few os these in the human body.
A positive feedback mechanism progressively increases the response so

that it is progressively amplified.
Examples of positive feedback mechanisms include blood clotting and

uterien contractions during labour.
Contractions of uterine muscles during labour are stimulated by the

hormen oxytocin. Contractions force the baby’s head into the cervix
causing it to stretch. Stretch receptors (the detectors) of the cervix are
stimulated leading to the generatiion of nerve impulses which are
[22]
transmitted to the brain (the control centre). The result is the release of
more oxytocin. Oxytocin cause the smooth muscles of the uterus (the
effector) contract even more forcefully. The head of the baby is pusshed
even farther into the cervixcausing it co stretch. The cycle of stretching,
oxytocin release, and stornger contractions continue progressivley until
the baby is deklivered. When the baby is delivered the release of oxytocin
stpos.
8. State the components and functions of each of the following transport

systems of the body
a. Blood [4]
b. Circulatory system [4]
c. Lymhatic system [4]
a. Blood
Components
Blood consists of blood cells (=erythrocytes (red blood cells), leukocytes

(white blood cells) and thrombocytes (platelets)) and plasma. Plasma
consists of nutrients, oxygen, chemical substances such as hormones, and
waste materials such as carbon dioxide and nitrogenous wastes.
Functions
 Erythrocytes (red blood cells) transport of oxygen and nutrients

to cells and some carbon dioxide and wastes away from cells.
 Blood helps to regulate acid-base balance i.e. pH.
 Leukocytes protect of the body against microbes and other
potentially damaging substances that gain entry to the body.
 Thrombocytes play an essential part in the process of blood
clotting.
b. Circulatory system
[23]
Components
The circulatory system consists of the heart and blood vessels.
Functions
 Blood vessels transports blood to the lungs where oxygen is

gained and carbon dioxide is excreted.
 Blood vessels also transport blood to cells in all parts of the body.
 The heart pumps blood around the body.
c. Lymphatic system
Components
The lymphatic system consists of lymph vessels, lymph nodes as well as

the spleen, thymus, and tonsils.
Functions
 Transports lymph along lymph vessels and returned it to the

bloodstream.
 Lymph nodes filter lymph removing microbes and waste
materials.
 White blood cells (=lymphocytes) mature in the lymphatic
system.
8. State the components and functions of each of the following

communication systems of the body:
a. Nervous system [4]

b. Endocrine system [4]
c. Special senses [4]
a. The nervous system

[24]
Components
The nervous system consists of the brain and spinal cord (=the central
nevous system; CNS), and sensory and motor nerves (=peripheral nervous
system; PNS). The components of the nervous system are; brain, spinal
cord, sensory nerves, motor nerves, and special sense organs such as the
ear.
Functions
 The nervous system regulates body activities.

 The system detect changes in the internal and external
environment and respond to these changes by sendinf output to
muscles and glands.
b. Endocrine system
Components
The system consists of endocrine glands and tissues located in

differentparts of the body. The individual glands that are part of the
endocrine system are: pineal gland, hypothalamus, pituitary gland,
thymus, thyroid gland, parathyroid glands, adrenal glands, pancreas,
ovaries, and testes.
Functions
 The system secretes hormones that regulate body activities.
c. Special senses
Special senses are specialized sensory receptors located in organs an

tissues of the head.
Components and functions of special senses

[25]
Component Function(s)
Ears Sense of hearing and balance
Eyes Sense of sight
Toungue and taste buds Sense of tatse
Nose (=olfactory structures) Sense of smell
8. State the components and functions of each of the following systems

responsible for the intake of raw materials into the body:
a. Digestive system [4]

b. Respiratory system [4]
NB: Raw materials needed by the body are: oxygen and nutrients (=food and
water)
a. Digestive system
Components
The system consists of the following organs: mouth, pharynx, oesophagus,

stomach, small and large intestines, and anus. The system also includes
the following accessory organs: salivary glands, liver, gallbladder, and
pancreas.
Functions
 Mechanical digestion of food.

 Chemical digestion of food due to the action of digestive
enzymes.
 Absoprtion of nutrients and water into the bloodstream.
 Elimination of solid wastes i.e. faecal matter.
[26]
b. Respiratory system
Components
The components of the respiratory systme are: lungs, pharynx, larynx,

trachea, and bronchial passages.
Functions
 Intake of oxygen from the atmosphere iunto the bloodstream.

 Removal of carbon dioxide from the blood stream into the
atmosphere.
 Regulation of acid-base balance (=pH).
 Production of sound and speech.
9. State the components and functions of the following systems responsible

for the eliminations of wastes from the human body:
a. Urinary system [4]

b. Respiratory system [4]
c. Digestive system [4]
Wastes eliminated from the body include carbon dioxide, nitrogenous wastes,
and faecal matter
a. Urinary system
Components
Components of the urinary system are: kidneys, ureters, urinary bladder,

and the urethra.
Functions
[27]
 Production, storage, and elimination of urine.

 Removal of waste products of protein metabolism (=nitrogenous
wastes) such as urea in urine.
 Regulaion of blood volume and composition.
 Maintenance of acid-base balance (pH) of body fluids.
 Maintenence of electrolyte balance of the body.
 Regulation of the production of erythrocytes (=red blood cells).
b. Respiratory system
(see Chapter 1; question *)
c. Digestive system
(see Chapter 1; question *)
10. State the components and functions of each of the following systems
involved in locomotion:
a. Skeletal system [4]

b. Muscular system [4]
a. Skeletal system
Components
The components of the skeletal system are bones and joints.
Functions
 Supporting and protecting the body and its delicate organs such
as the brain.
 Bones provide the surface area for the attachment of muscles and
tendons.
[28]
 The production of blood cells takes place in the bones.

 Bones store minerals such as calcium and phosphorus.
 Joints allow the movement of the body and its parts.
b. Muscular system
Components
The muscular system consists of skeletal muscles.
Functions
 Contraction of skeletal muscles enable movement of the body

such as walking.
 Skeletal muscles help in the maintenance of posture i.e. body
position.
 Muscular activity produces heat for the body.
11. State the components and functions of the reproductive system

(a system involved in procreation) [4]
Components
Components of the reproductive system are: the gonads (testes and

ovaries) and associated organs i.e. in females: uterus, fallopian tubes,, and
vagina, in males: epididymis, ductus deferens (vas deference), and the
penis.
Functions
 Production of gametes (sperm and ova) which unite to form a

new organism.
 Production of hormones that regulate reproduction.
12. State the components and functions of the integumentary system (a system
[29]
that is part of the non-specific defence mechanism of the body) [4]
Components
Components of the integumentary system are the skin and associated

structures such as nails, hair, sweat glands, and sebaceous glands.
Functions
 Protection of the body from microbes, chemicals, physical injury,

and dehydration.
 Regulation of body temperature through production of sweat and
regulation of blood flow through the dermis.
 Elimination of some wastes from the body.
 Formation of vitamin D.
 Detection of sensations such as touch, pain, warmth, and cold.
13. Describe each of the following defence mechanisms:
a. Non-specific defence mechanisms [4]

b. Specific defence mechanisms [2]
a. Non-specific defence mechanisms
The following form the non-specific defence mechanisms of the body:
 The skin protects the body from invasion by microbes.

 Mucus traps microbes and other foreign materials on its sticky
surface.
 Some body fluids contain antimicrobial substances, e.g. gastric
juice contains hydrochloric acid which kills most ingested
microbes.
 The inflammatory response involved in tissue healing is also part
of the non-specific defence mechanism.
[30]
b. Specific defence mechanisms
Specific defence mechanisms involves specific immune responses against

foreign substances (=antigens) such as microbes, cancer cells or
transplanted tissue cells, and pollen.
Following exposure to an antigen lifelong immunity against further
invasion by the same antigen usually develops.
11. Define the following terms related to the chemistry of life:
a. Electrolytes [1]
b. Acid [1]
c. Base [1]
d. pH [1]
e. pH scale [1]
Definition of terms:
a. Electrolytes
Electrolytes are solutions of ionic compounds. They are called electrolytes

because they can conduct an electric current. Electrolytes can also be
defined as ionic compounds that breaks apart into cations and anions when
dissolved in water.
b. Acid
Acid refers to a compound that breaks apart (=dissociates) into one or

more hydrogen ions (H+) when it dissolves in water. Acid can also be
defined as substances that are capable of releasing hydrogen ions (H +)
when in solution.
c. Base or alkali
Alkali or base refers to a compound that breaks apart (=dissociates) into

one or more hydroxyl ions (OH-) when it dissolves in water. Alkali or base
[31]
can also be defined as a substance that is able to release hydroxyl ions

(OH-) when in solution or can accept hydrogen ions (H +).
d. pH
pH refers to the acidity or alkalinity of a solution. It is a measure of the

amount of hydrogen ions (H+) the solution contains.
e. pH scale
pH scale refers to a scale that expresses the acidity or alkalinity of a

substance. pH scale can also be defined as the standard scale for the
measurement of the acidity or alkalinity of substances.
12. Describe the pH scale [4]
The pH scale
The scale is numbered from 0 to 14 and is based on the amount of

hydrogen ions (H+) in a solution of a substance. On the scale 0 to 7 is
acidic meaning that the solution has more hydrogen ions (H +) than
hydroxyl ions (OH-). The midpoint of the scale is 7 and is the neutral point
meaning that there are equal numbers of hydrogen and hydroxyl ions in
the solution. On the scale 7 to 14 is alkaline (basic) meaning that the
solution has more hydroxyl ions than hydrogen ions.
13. State the functions of electrolytes in the body [3]
Importance of electrolytes in the body
a. Conduct electricity (electrical impulses) essential for muscle and nerve

function.
b. Exert osmotic pressure which keeps body fluids in their own
compartments and control water movement within the body.
c. Form buffers needed in the maintenance of acid-base balance in the body.
[32]
14. List the pH values of each of the following body fluids:
a. Blood [1/2]
b. Saliva [1/2]
c. Gastric juice [1/2]
d. Bile [1/2]
e. Urine [1/2]
pH values of body fluids
Body fluid pH value

Blood 7.35-7.45
Gastric juice 1.5-3.5
Saliva 5.4-7.5
Bile 6.0-8.5
Urine 4.5-8.0
15. State four (4) functions of each of the following biological molecules:
a. Carbohydrates [4]
b. Lipids (=fats) [4]
c. Proteins [4]
a. Carbohydrates
 Carbohydrates provide energy needed to drive cellular activities.

 Carbohydrates also provide a form of energy storage, e.g.
glycogen.
 Carbohydrates form an integral part of the structure of DNA and
RNA.
 Carbohydrates can act as receptors on the cell surface, allowing
the cell to recognize other molecules and cells.
[33]
b. Lipids (=fats)
 Phospholipids form an integral part of the cell membranes.

 Lipids also provide insulation preventing heat loss from the body.
 Lipids also provide protection of body parts such as the eye ball
and the kidneys.
 Lipids are also a form of energy storage in the body.
c. Amino acids and proteins
 Proteins form carrier molecules such as haemoglobin.

 Proteins also form enzymes found in the body.
 Hormones such as insulin are formed from proteins.
 Proteins also form antibodies.
 In the absence of carbohydrates proteins can be used to provide
energy in the body.
16. Describe each of the following terms related to the movement of

substances in the body:
a. Diffusion [1]
b. Osmosis [1]
c. Intracellular fluid [1]
d. Extracellular fluid [1]
a. Diffusion
Small substances diffuse down the concentration gradient crossing

membranes by dissolving in the lipid part of the membrane, e.g. lipid-
soluble substances like oxygen, carbon dioxide, fatty acids, steroids or
passing through water-filled channels, or pores in the membrane, e.g.
small water-soluble substances like sodium, potassium, calcium.
b. Osmosis
[34]
Osmosis is a passive movement of water molecules down their

concentration gradient across a semipermeable membrane.
c. Intracellular fluid
Intracellular fluid refers to the fluid found inside the cells of the body.
d. Extracellular fluid
Extracellular fluid refers to fluid that is found outside the cell of the body.
It consists of blood, plasma, lymph, cerebrospinal fluid and fluid in the
interstitial spaces (the fluid in which the cells of the body are bathed).
[35]
Author: Boroma P. (BSc. NE., RGN)

Reviewed by Mukucha W. (MADS.,
BSNS NE., RGN) &
Shoniwa L. (BSc. NE., RGN)
Objectives:
After studying this chapter, the student should be able to:
 Define the following terms used in cells and tissues: cell, anatomical
position, and median plane
 Draw a well labelled diagram of a simple human cell.
 State the functions of organelles found in the cell:
 Outline the two types of cell division, namely mitosis and meiosis.
 Define the term mutation and state its causes and the effects of mutation.
 Outline the processes by which substances are transported across the cell
membrane.
 List the main types of tissues found in the human body.
 State the functions of each of the main types of tissues found in the human
body.
 List the organs and structures found in each of the following cavities of
the body: cranial cavity, thoracic cavity, abdominal cavity, and pelvic
cavity.
[36]
1. Define each of the following terms used in cells, tissues, and the skeleton:
a. Cell [1]
b. Anatomical position [1]
c. Median plane [1]
Definition of terms
a. Cell
The cell is the basic structural, functional, and biological unit of all known
living organisms.
b. Anatomical position
Anatomical position is the description of any region or part of the body in

a specific stance.
c. Median plane
The median plane also called a mid-sagittal plane is used to describe the
sagittal plane as it bisects the body vertically through the midline marked
by the navel, dividing the body into a left and a right side.
2. Draw a well labelled diagram of a simple human cell [5]
[37]
3. State the functions of the following organelles found in the cell:
a. Nucleus [1]
b. Mitochondria [1]
c. Ribosomes [1]
d. Endoplasmic reticulum [1]
e. Golgi apparatus [1]
f. Lysosomes [1]
g. Microtubules [1]
h. Microfilaments [1]
Functions of organelles found in the cell
a. Nucleus
The primary function of the nucleus is to make ribosomes, which act as

workhorses to transcribe information from deoxyribonucleic acid (DNA).
b. Mitochondria
The main function of mitochondria is the production of adenosine

triphosphate (ATP) by a process known as cell respiration.
c. Ribosomes
The function of a ribosome is the manufacture of proteins in biological

cells using RNA and amino acids.
The function of a ribosome is to build an amino acid chain which will
create a specific form of protein.
[38]
d. Endoplasmic reticulum
Produce and move lipids, an essential component of a cell's outer

membrane, and steroids.
Final production of glucose, an energy storage molecule.
Metabolizes natural and ingested toxins.
Transport proteins made by ribosomes on its surface.
Modify some of the proteins produced by the ribosomes.
e. Golgi apparatus
Sorting and processing proteins and assist in the distribution of lipids.
f. Lysosomes
Break down materials into compounds which can be used or discarded by

the cell.
Cell upkeep, ranging from consuming worn-out structures within the cell
to attacking foreign bacteria.
g. Microtubules
Microtubules allow whole cells to migrate from one place to another by

contracting at one end of the cell and expanding at another.
h. Microfilaments
Important role of microfilaments is to contract muscles.

[39]
Microfilaments have a role in cytoplasmic streaming. Cytoplasmic

streaming is the flow of cytoplasm (the contents of the cell, including the
fluid part called cytosol and cell organelles) throughout the cell. It allows
nutrients, waste products, and cell organelles to travel from one part of the
cell to another.
4. Outline the two types of cell division namely mitosis and meiosis [10]
a. Mitosis
Mitosis is a form of eukaryotic cell division that produces two daughter

cells with the same genetic component as the parent cell. Chromosomes
replicated during the S phase are divided in such a way as to ensure that
each daughter cell receives a copy of every chromosome. In actively
dividing animal cells, the whole process takes about one hour.
The replicated chromosomes are attached to a 'mitotic apparatus' that
aligns them and then separates the sister chromatids to produce an even
partitioning of the genetic material. This separation of the genetic material
in a mitotic nuclear division (or karyokinesis) is followed by a separation
of the cell cytoplasm in a cellular division (or cytokinesis) to produce two
daughter cells.
In some single-celled organisms mitosis forms the basis of asexual
reproduction. In diploid multicellular organisms sexual reproduction
involves the fusion of two haploid gametes to produce a diploid zygote.
Mitotic divisions of the zygote and daughter cells are then responsible for
the subsequent growth and development of the organism. In the adult
organism, mitosis plays a role in cell replacement, wound healing, and
tumour formation.
[40]
b. Meiosis
Meiosis is the form of eukaryotic cell division that produces haploid sex
cells or gametes (which contain a single copy of each chromosome) from
diploid cells (which contain two copies of each chromosome). The process
takes the form of one DNA replication followed by two successive nuclear
and cellular divisions (Meiosis I and Meiosis II). As in mitosis, meiosis is
preceded by a process of DNA replication that converts each chromosome
into two sister chromatids.
5. Define the term mutation [1]
Mutation
Mutations are alterations in DNA sequences that result in changes in the

structure of a gene.
6. State the causes and the effects of mutation [5]
Causes of mutation
 Mutations arise spontaneously at low frequency owing to the

chemical instability of purine and pyrimidine bases and to errors
during DNA replication.
 Natural exposure of an organism to certain environmental factors,
such as ultraviolet light and chemical carcinogens also can cause
mutations.
[41]
Effects of mutation
 Mutation is linked to cause of certain diseases such as cancer,

diabetes mellitus, and asthma.
 Mutation can happen as antibiotic resistance of a bacteria, sickle
cell resistance against malaria and immunity of a person against
HIV.
 Causes genetic disorders such as Down’s syndrome.
7. Outline the processes by which substances are transported

across the cell membrane:
a. Passive transport [1]

b. Diffusion [1]
c. Facilitated diffusion [1]
d. Osmosis [1]
e. Active transport [1]
f. Sodium pump [1]
g. Bulk transport [1]
h. Phagocytosis [1]
i. Pinocytosis [1]
j. Filtration [1]
Processes by which substances are transported across the cell membrane
a. Passive transport
[42]
Passive transport is a movement of ions and other atomic or molecular

substances across cell membranes without need of energy input.
b. Diffusion
Refers to a passive process involving the movement of molecules from a

region of high concentration to a region of low concentration i.e. down
their concentration gradient.
c. Facilitated diffusion
Facilitated diffusion is a process by which molecules are transported

across the plasma membrane with the help of membrane proteins.
Facilitated diffusion uses integral membrane proteins to move polar or
charged substances across the hydrophobic regions of the membrane.
Channel proteins can aid in the facilitated diffusion of substances by
forming a hydrophilic passage through the plasma membrane through
which polar and charged substances can pass.
Channel proteins can be open at all times, constantly allowing a particular
substance into or out of the cell, depending on the concentration gradient;
or they can be gated and can only be opened by a particular biological
signal.
Carrier proteins aid in facilitated diffusion by binding a particular
substance, then altering their shape to bring that substance into or out of
the cell.
d. Osmosis
[43]
Osmosis is the movement of water molecules through a semipermeable

membrane according to the concentration gradient of water molecules
across the membrane, which is inversely proportional to the concentration
of solutes. Semipermeable membranes, also termed selectively permeable
membranes or partially permeable membranes, allow certain molecules or
ions to pass through by diffusion.
e. Active transport
Active transport refers to the movement of substances from a region of

low concentration to a region of high concentration that is against their
concentration gradient. Active transport requires energy.
f. Sodium pump
The process of moving sodium and potassium ions across the cell
membrane is an active transport process involving the hydrolysis of ATP
to provide the necessary energy. It involves an enzyme referred to as
Na+/K+-ATPase. This process is responsible for maintaining the large
excess of Na+ outside the cell and the large excess of K+ ions on the
inside.
g. Bulk transport
It is the movement of macromolecules such as proteins or polysaccharides

into or out of the cell .There is two types of bulk transport, exocytosis and
endocytosis, and both require the expenditure of energy (ATP).
h. Phagocytosis
[44]
Phagocytosis is the process by which large particles are taken in by a cell.

For example, when microorganisms invade the human body, a type of
white blood cell called a neutrophil will remove the invaders through this
process, surrounding and engulfing the microorganism, which is then
destroyed by the neutrophil.
i. Pinocytosis
This is a process that takes in molecules, including water, which the cell
needs from the extracellular fluid. Pinocytosis results in a much smaller
vesicle than does phagocytosis, and the vesicle does not need to merge
with a lysosome.
j. Filtration
Refers to the process by which small particles pass through a membrane

while large particles are held back. Filtration occurs due to hydrostatic
forces.
8. List the four (4) main types of tissues [2]
Main types of tissues
Epithelial tissue Connective tissue

Muscle tissue Nervous tissue
[45]
9. State the functions of each of the following types of tissues:
a. Epithelial tissue [2]

b. Connective tissue [2]
c. Smooth muscle tissue [2]
d. Cardiac muscle tissue [2]
a. Epithelial tissue
Epithelial tissue, or epithelium, covers the surfaces of organs including the

skin, the trachea, the reproductive tract, and the digestive tract’s inner
lining.
It creates a barrier that helps protect organs, and it also has roles in
absorbing water and nutrients, getting rid of waste, and secreting enzymes
or hormones.
b. Connective tissue
Most connective tissues, except for lymph and blood, contains fibers,
which are long, narrow proteins. Fibers can be collagenous, which bind
bones to tissues; elastic, which allow organs like the lungs to move; or
reticular, which provide physical support to cells. Connective tissue also
allows oxygen to diffuse from blood vessels into cells.
c. Smooth muscle tissue
Smooth muscle is found in the intestines, where it helps move food

through the digestive tract, and it is also found in other organs like blood
vessels, the uterus, and the bladder
[46]
d. Cardiac muscle tissue
Cardiac muscle is found in the heart and contracts to pump blood
10. List the organs and structures found in each of the following
cavities of the body:
a. Cranial cavity [1/2]

b. Thoracic cavity [3]
c. Abdominal cavity [5]
d. Pelvic cavity [3]
Organs and structures found in cavities of the body
Cavity Structures
a. Cranial cavity Brain tissue
b. Thoracic cavity Lungs; heart; trachea; part of
oesophagus; thymus gland; thoracic
duct
c. Abdominal cavity Stomach; liver; gallbladder; spleen;
pancreas; small intestine; kidneys; large
intestine; adrenal glands.; urinary
bladder
d. Pelvic cavity Reproductive organs; urinary bladder;
pelvic colon; rectum; blood vessels;
nerves
[47]
11. Draw a well labelled diagram showing the regions of the abdominal cavity [5]
[48]

Reviewed by Mukucha W. (MADS., BSNS NE., RGN)
Objectives
 State the functions of bones.

 List the types of bones giving an example for each.
 Describe the (macroscopic) structure of a long bone.
 Describe the microscopic structure of a compact bone.
 Outline factors that affect bone growth and remodeling.
 Describe the hormonal regulation of bone growth.
 Outline the classification of fractures.
 Describe the process/stages of bone healing.
 Outline the complications of fractures.
 State the functions of each of the following: human skull, vertebral
column, thoracic cage, and the appendicular skeleton.
 Describe the structure of the mandible.
 Describe the characteristics of a typical vertebra.
 Draw well labelled diagrams of each of the following: mandible, typical
rib, humerus, radius and ulnar, femur, and tibia and fibula.
[49]
1. Outline six (6) the functions of bones (=skeleton) [6]
Functions of bones
a. Support.
The skeleton is the structural framework of the body. It supports soft

tissues and gives attachment to ligaments, tendons, and muscles.
b. Protection.
The skeleton protects delicate and important organs and structures of the
body e.g. the skull protects the brain, the rib cage protects the heart, lungs
and great vessels, the vertebra protects the spinal cord.
c. Assistance in movement.
Bones form joints and provide attachment to muscles which move the
body and parts of the body.
d. Mineral homeostasis (storage and release of minerals)
Minerals such as calcium and phosphorous are stored in bones. These

minerals are released from the bones into blood to maintain mineral
balance.
e. Blood cell production (=haemopoiesis)
Bones contain red bone marrow which produces red blood cells, white
blood cells, and platelets. This process is called haemopoiesis.
f. Fat storage
Yellow bone marrow consists mainly of adipose cells, which store

triglycerides. The stored triglycerides (=fats) are a potential chemical
energy reserve.
[50]
2. List five (5) types of bones and give an example(s) of each [6]
Types of bones
Type of bones Example

a. Long bones Femur, tibia, and fibula.
b. Short bones Carpals
c. Irregular bones Vertebrae and some skull bones
d. Flat bones Sternum, ribs and most skull bones
e. Sesamoid bones Patella
3. Describe the structure (=macroscopic bone structure) of a long bone [8]
General structure of a long bone
A long bone is one that has greater length than width. It has a shaft
(=diaphysis) and two extremities (=Epiphyses). A typical long bone
consists of the following parts:
a. Diaphysis
The diaphysis refers to the shaft of the bone i.e. the long
cylindrical, main portion of the bone. The diaphysis is composed
of compact bone with a central canal containing yellow bone
marrow.
b. Epiphyses
Epiphyses are the proximal and distal ends of the bone. The
epiphyses (singular is epiphysis) are the proximal and distal ends
of the bone. The epiphyses are composed of an outer covering of
compact bone with spongy (=cancellous) bone inside.
c. Metaphyses
[51]
Metaphysis refers to regions that separate the diaphysis and the

epiphysis. Each metaphysis contains of an epiphyseal (=growth)
plate consisting of hyaline cartilage that allows the diaphysis of
the bone to grow in length. When a bone ceases to grow the
epiphyseal cartilages ossify.
d. The articular cartilage
Articular cartilage refers to a thin layer of hyaline cartilage which

covers bone surfaces that form joints. The cartilage is smooth
which reduces friction at the joint.
e. Periosteum
The periosteum is a vascular membrane that covers long bones

(except within joint cavities). The periosteum has two layers i.e.
(1) an outer layer made of tough and fibrous membrane and (2)
the inner layer which contains osteoblasts and osteoclasts (cells
responsible for bone growth and breakdown). Thickening of a
bone occurs by the deposition of new bone tissue under the
periosteum. Periosteum allows attachment of tendons.
f. Medullary cavity (=marrow cavity)
The medullary cavity refers to a hollow, cylindrical space within

the diaphysis. The cavity contains yellow bone marrow and
numerous blood vessels.
g. Endosteum
Endosteum refers to a thin membrane that lines the medullary

cavity. It contains a single layer of bone-forming cells and a
small amount of connective tissue.
4. Draw a well labelled diagram illustrating the structure of a long bone

[6]
[52]
5. Describe the microscopic structure of a compact bone [6]
The microscopic structure of compact bone
Compact bone is made up of osteons (=Haversian systems). Osteons are

parallel tube-shaped units.
Central canal
Each osteon is made up of a central (=Haversian) canal and surrounded by

concentric lamellae. The central canal contains nerves, lymph vessels, and
blood vessels.
Lamellae
Lamellae refer to cylindrical plates of bone arranged around each central

canal and resemble the growth rings of a tree.
Perforating canals
Perforating canals are tunnels which link neighboring central canals.
Lacunae
Lacunae (singular is lacuna) are small spaces between adjacent lamellae of

the osteon. In each lacuna is an osteocyte.
Canaliculi
Canaliculi are a series of tiny channels through which lacunae

communicate with each other. Canaliculi allow circulation of interstitial
fluid through the bone. Inside the canaliculi are slender fingerlike
processes of osteocytes. Neighboring osteocytes communicate via gap
junctions.
[53]
Interstitial lamellae
Interstitial lamellae are found between the osteons. Interstitial lamellae are
remnants of older Haversian systems partially broken during remodeling
and growth of bone.
Volkmann’s canals
Volkmann’s canals are transverse perforating canals through which blood

vessels, lymphatic vessels, and nerves from the periosteum penetrate the
compact bone.
Circumferential lamellae
Circumferential lamellae are lamellae arranged around the entire outer and
inner circumferences of the shaft of a long bone. The circumferential
lamellae directly deep to the periosteum are called outer circumferential
lamellae. They are connected to the periosteum by perforating
(=Sharpey’s) fibers. The circumferential lamellae that line the medullary
cavity are called inner circumferential lamellae.
6. Outline three (3) factors that affect bone growth and remodeling [6]
Factors affecting bone growth and remodeling
a. Minerals
Minerals such as calcium, phosphorus, magnesium, fluoride, and

manganese are needed for bone growth and remodeling.
b. Vitamins
Vitamin A promotes the activity of osteoblasts, vitamin C is needed for

synthesis of collagen (the main bone protein), vitamin D promotes the
absorption of calcium from foods in the gastrointestinal tract making it
available for bone growth, vitamin K and B12 are also needed for the
synthesis of bone proteins.
[54]
c. Hormones.
Hormones which promote bone growth and remodeling include the

growth hormone (GH), thyroid hormones (T3 and T4), and insulin.
7. Describe the hormonal regulation of bone growth [5]
Hormonal regulation of bone growth
Hormones that regulate the growth, size, and shape of bones include the
following.
a. Growth hormone (GH) and the thyroid hormones (=tri-iodothyronine and

thyroxine; T3 and T4)
GH and T3 and T4 regulate bone growth particularly in infancy.
b. Testosterone
Testosterone promotes rapid bone growth at puberty in males and also

helps in the maintenance of bone structure throughout life.
c. Oestrogens
Oestrogens are responsible for the wider pelvis in females that develops
during puberty. Oestrogens also maintain bone mass in the adult female.
Low levels of oestrogens that occur after menopause may lead to
osteoporosis.
d. Calcitonin and parathyroid hormone
Calcitonin and parathyroid hormones regulate bone growth by regulating

the uptake and release of calcium in bones. Calcitonin increases calcium
uptake into bone, and parathormone decreases it.
[55]
e. Insulin
Insulin promotes bone growth by increasing the synthesis of bone

proteins.
8. Outline the classification of fractures [3]
Classification of fractures
a. Simple fracture
Simple fracture is a fracture that does not involve protrusion of bone ends
through the skin
b. Compound (=open) fracture
In a compound fracture the bone ends protrude through the skin
c. Pathological fracture
A pathological fracture occurs as a result of weakening of bones by

disease.
d. Comminuted fracture
In comminuted fracture the bone is splintered and smaller bone fragments

lie between the two main fragments.
e. Greenstick fracture
A greenstick (=) partial fracture is a fracture in which one side of the bone
is broken and the other side bends.
f. Impacted fracture
[56]
An impacted fracture is a fracture in which one end of the fractured bone

is forcefully driven into the interior of the other.
9. Outline the process/stages of bone healing [10]
The bone healing process
a. Formation of fracture hematoma
The fracture tears blood vessels leading to leakage of blood. Collections

of clotted blood (fracture haematoma) form between the bone ends and
surrounding tissue 6 to 8 hours after the injury. Circulation of blood stops
at the site where the fracture haematoma forms causing bone cells to die.
b. Inflammation
Swelling, acute inflammation, and accumulation of exudate follows in

response to injury and the presence of dead cells. Phagocytes
(=neutrophils and macrophages) and osteoclasts begin to remove dead or
damaged tissue. Fibroblasts migrate to the site and granulation tissue and
new capillaries develop. This stage may last several weeks.
c. Fibrocartilaginous callus formation
Fibroblasts from the periosteum invade the site and produce collagen
fibre. Cells from the periosteum develop into chondroblasts and begin to
produce fibrocartilage. These events lead to the development of a callus
(mass of tissue consisting of collagen fibers and cartilage) between the
broken ends of the bone. Formation of the fibrocartilaginous callus takes
about three weeks.
d. Bony callus formation
Osteogenic cells close to well vascularized healthy bone develop into

osteoblasts. The osteoblasts begin to produce spongy bone trabeculae. In
time the fibrocartilaginous callus is converted to spongy bone called a
boney (hard) callus. The boney callus lasts about 3 to 4 weeks.
[57]
e. Bone remodeling
Remodeling refers to reshaping of the callus. Osteoclasts remove

fragments of broken bone. The medullary canal is gradually reopened
through the callus (in weeks and months). In time the bone heals
completely with callus tissue completely replaced with mature compact
bone.
10. Outline five (5) factors that delay healing of fractures [5]
Factors that delay healing of fractures
a. Tissue fragments between bone ends
The presence of sequestrate (=splinters of dead bone) and soft tissue

fragments delay the healing of fractures.
b. Deficient blood supply
Poor blood supply delays growth of granulation tissue and new blood
vessels. Hypoxia leads to a reduction in the number of osteoblasts and an
increase in the number of chondrocytes. This leads to the deposition of
cartilage instead of bone leading to weak repair.
c. Poor alignment of bone ends
Poor alignment of bone delays bone healing and may lead to permanent
disability.
d. Continued mobility of bone ends
Continuous movement results in fibrosis of the granulation tissue followed

by fibrous union of the fracture.
e. Miscellaneous
[58]
Other factors which delay wound healing include infection, systemic

illness, malnutrition, aging, and drugs such as corticosteroids.
11. Outline two (2) complications of fractures [4]
Complications of fractures
a. Infection (osteomyelitis)
Pathogens enter through broken skin, although they may occasionally be

blood-borne.
Healing will not occur until the infection resolves.
b. Fat embolism
Fat from bone marrow may enter into the circulation system through
injured veins causing fat embolism. The emboli can lodge and block blood
vessels of the lungs (pulmonary embolism).
12. State six (6) functions of the human skull [6]
Functions of the human skull
The various parts of the skull have specific and different functions:
a. The cranium protects the brain.
b. The bony eye sockets protect the eyes from injury as well as giving
attachment to muscles which rotate the eye ball.
c. The temporal bone protects the delicate structures of the ear.
[59]
d. Some bones of the face have sinuses (air filled cavities) which have tiny
openings into the nasal cavity. Sinuses give resonance to voice.
e. Some bones of the face form the walls of the nasal cavities and thus keep
the air passages open.
f. The maxilla and the mandible provide alveolar ridges in which the teeth
are embedded.
g. Contraction and relaxation of muscles of mastication e/g/ masseter raises

and lowers the mandible during chewing of food.
13. List eight (8) bones of the face [8]
Bones of the face
2 zygomatic bones 1 maxilla 2 nasal bones

2 lacrimal bones 1 vomer 2 palatine bones
2 inferior conchae 1 mandible
14. Describe the structure of the mandible [4]
Structure of the mandible
The mandible originates as two parts that unites at the middle. Each half
consists of the following parts:
Body
[60]
Each half of the mandible has a curved body with an alveolar ridge
containing the lower teeth.
Ramus
The part which projects upwards almost at right angles to the posterior end
of the body.
Condylar process
The condylar process is located at the end of the ramus and it articulates
the temporal bone forming the temporomandibular joint.
Coronoid process
This is located towards the end of the ramus and it gives attachment to
muscles and ligaments that close the jaw.
Angle
The angle is the point where the ramus joins the body.
15. Draw a well labelled diagram of the left mandible (lateral view) [5]
16. List the bones that form the vertebral column [2]
Bones of the vertebral column
7 cervical bones 12 thoracic bones 5 lumbar bones

1 sacrum (5 fused bones) 1 coccyx (4 fused bones)
[61]
17. State six (6) functions of the vertebral column [6]
Functions of the vertebral column
a. When vertebrae are arranged one above the other they form a vertebral
(=neural) canal provides protection to the spinal cord which is located
inside the canal.
b. Adjacent vertebrae form intervertebral foramina through which 31 pairs of

spinal nerves pass from the spinal cord to all parts of the body. The
foramina also provide access to the spinal cord for blood vessels and
lymph vessels.
c. In the thoracic region of the vertebral column the ribs articulate with the
vertebrae forming joints which move during breathing.
d. The numerous individual bones with their intervertebral discs allow

movement of the whole column.
e. The vertebral column supports the brain. Intervertebral discs act as shock
absorbers protecting the brain.
f. The vertebral column forms the axis of the trunk, giving attachment to the
ribs, shoulder girdle and upper limbs, and the pelvic girdle, and lower
limbs.
18. Describe the characteristics of a typical vertebra [5]
Characteristics of a typical vertebra
A typical vertebra has the following characteristics:
a. The body
[62]
The body is the broad, flattened, and main part of the vertebrae.
Between adjacent vertebrae is a pad of fibrocartilage called the
intervertebral disc.
b. The vertebral (=neural) arch
The vertebral arch lies behind the body. It encloses the vertebral
foramen and forms its posterior and lateral walls. The lateral
walls of the foramen are formed from plates of bone called
pedicles, and the posterior walls are formed from laminae.
c. Transverse process
A transverse process is a lateral prominence which project from

regions where the pedicle meets the lamina.
d. Spinous process
A spinous process is located where two laminae meet at the back.
e. Vertebral foramina
The vertebral foramina form the vertebral (=neural) canal that

contains the spinal cord.
19. Draw a well labelled diagram of a lumber vertebrae [6]
20. State four (4) functions of the thoracic cage [4]
Functions of the thoracic cage
a. The thoracic cage protects organs such as the heart, lungs, great blood
vessels etc.
[63]
b. It forms joints between the upper limbs and the axial skeleton. The upper
part of the sternum, the manubrium, articulates with the clavicles forming
the only joints between the upper limbs and the axial skeleton.
c. It gives attachment to the muscles of respiration: such as (1) intercostal

muscles which pull the ribcage upwards and downwards during
inspiration and (2) the diaphragm which contracts and moves down during
inspiration.
d. The thoracic cage enables breathing (=ventilation) to take place.
21. Draw a well labelled diagram of a typical rib [4]
22. Outline two (2) functions of the appendicular skeleton [4]
Functions of the appendicular skeleton
a. Voluntary movement
The bones, muscles and joints of the limbs are involved in voluntary
movement such as running, jumping, and writing.
b. Protection of delicate structures
Blood vessels and nerves lie along the length of bones of the limbs and are
protected by the bones, muscles, and the skin.
23. Draw a well labelled diagram of each of the following bones:
a. The right humerus (anterior view) [5]

b. Right radius and ulnar (anterior view) [5]
c. Left femur (posterior view) [5]
d. Left tibia and fibula (anterior view) [5]
[64]
[65]

Reviewed by Kusemwa-Muyambi P. (MSc N ((Med-Surg.)).,
BSc NE., Dip. Paeds., RGN) &
Muvhu S. ( M Adult Ed., BSc NE., RGN)
Objectives
 Define terms used in muscles and joints.

 Outline the types of joints.
 Describe the classification of synovial joints.
 Describe the characteristics of a typical synovial joint.
 State the functions of synovial fluid.
 Define the types of movements that can occur at synovial joints.
 State the functions of the different skeletal muscles found in the body.
 Draw well labelled diagrams of each of the following: basic structure of a
synovial joints, shoulder joint, elbow joint, hip joint, and knee joint.
[66]
1. Define each of the following terms:
a. Joint [1]
b. Articulation [1]
Definition of terms
a. Joint
Joint refers to the site at which any two or more bones articulate or come
together. Joint can also be defined as a point of contact between bones,
between cartilage and bones, or between teeth and bones.
Joint refers to the meeting places of bones.
b. Articulation
Articulation refers to the coming together of two or more bones at a joint.
2. Outline the three (3) types of joints [6]
Types of joints
a. Fibrous or fixed joints
The bones at the joint are held together by fibrous connective tissue that is
rich in collagen fibres. This types of joint permits very little or no
movement. Examples of fibrous joints include joints between the bones of
the skull (=sutures) and those between the teeth and the maxilla or
mandible.
Fibrous joints are exemplified by the sutures between skull bones.
b. Cartilaginous or slightly movable joints
[67]
The bones at the joint are held together by a pad of fibrocartilage. The pad
of fibrocartilage allows for very slight movement where the pad is
compressed.
Movement at these joints depends on the deformity of the tissue
(=cartilage) interposed between the bones.
Examples of cartilaginous joints include the symphysis pubis, the joints
between the vertebral bodies, and the manubrio-sternal joint.
c. Synovial or freely movable joints
The bones forming this synovial joint have a synovial cavity and are held
together by a fibrous capsule (=articular capsule) composed of dense
irregular connective tissue. Accessory ligaments are often present and help
to hold the bones together. Synovial joints allow a lot of movement to take
place at the joint. Movement at these joints depends upon the apposed
surfaces being able to slide upon one another.
Examples of synovial joints are the hip and the knee joints.
3. Outline the different types of synovial joints [5]
Types of synovial joints
NB: Joints are classified according to the range of movement possible or to the
shape of the articulating parts.
a. Ball and socket joints
The head or ball of one bone articulates with a socket of another. The
shape of the bones allows for a wide range of movement.
Movement at the joint is in two axes at right angles i.e. flexion-extension,
and abduction-adduction. The combination of these movements results in
circumduction.
Examples of a ball and socket joint are the hip joint and the shoulder
joints.
b. Hinge joints
[68]
The joint resemble a door hinge in that the to-and-from movement is

restricted to one plane.
These joints allow the movements of flexion and extension only e.g. the
elbow, knee, ankle joints, and the interphalangeal joints.
c. Gliding (=plane) joints
Movement at these joints is mainly gliding (=translation) of one plane

surface across another.
The articular surfaces glide over each other, e.g. sternoclavicular joints,
acromioclavicular joints and joints between the carpal bones and those
between the tarsal bones.
d. Pivot joints
These joints permit only rotational movement.

Movement is around one axis (rotation), e.g. proximal and distal
radioulnar joints and the joint between the atlas and the odontoid process
of the axis.
e. Condyloid (=bicondylar) joints
The joint consists of two convex, knuckle-shaped condyles articulating

with concave surfaces. The joints allow flexion and extension movements
and a limited degree of rotation. The joints are exemplified by the knee
and the temporomandibular joints.
f. Saddle (=sellar) joints
The joint has apposing surfaces which are concavo-convex. Each surface
has a direction in which it is maximally convex and at right angles to this
surface is maximally concave. In the joint, the convexity of the larger
surface is opposed to the concavity of the other bone. The joints allow
movement in two planes at right angles and some degree of axial
movement.
The carpometacarpal joints of the thumb are the best example.
[69]
4. Describe the characteristics of a typical synovial joint [6]
Characteristics of a typical synovial joint
Synovial joints have the following characteristics:
a. Articular or hyaline cartilage
The parts of the bones which are in contact are always covered with
hyaline cartilage. The cartilage provides a smooth articular surface and is
strong enough to absorb compression forces and bear the weight of the
body. Cartilage has no blood supply and receives its nourishment from
synovial fluid.
b. Capsule or capsular ligament
The joint is surrounded and enclosed by a sleeve of fibrous tissue which

holds the bones together. It is sufficiently loose to allow freedom of
movement but strong enough to protect it from injury.
The joints are enclosed in a fibrous capsule, supported by ligaments.
c. Synovial membrane
The synovial membrane is composed of epithelial cells. It lines the

capsule.
d. Synovial fluid
This is a thick sticky fluid, of egg-white consistency, secreted by synovial

membranes into the synovial cavity. The synovial fluid provides nutrients
to structures in the joint, removes microbes and dead cells, lubricates the
joint, and maintains the stability of the joint.
e. Other intra-capsular structures
[70]
Intra-capsular structures include fat pads, and menisci. These structures

assist in the maintenance of joint stability.
f. Extra-capsular structures
Extra-capsular structures include ligaments that add to the stability of the

joint.
5. Draw a well labelled diagram of the basic structure of a

synovial joint [4]
6. State five (5) functions of synovial fluid [5]
Functions of synovial fluid
a. Provides nutrients for the structures within the joint cavity.

b. Contains phagocytes, which remove microbes and cellular debris.
c. Acts as a lubricant.
d. Maintains joint stability.
e. Prevents the ends of the bones from being separated, as does a little water
between two glass surfaces.
7. Define each of the following types of movements that can occur at

synovial joints:
a. Flexion [1]
b. Extension [1]
c. Abduction [1]
d. Adduction
e. Circumduction [1]
f. Rotation [1]
g. Pronation [1]
h. Supination [1]
i. Inversion [1]
[71]
j. Eversion [1]
Types of movements that occur at synovial joints
a. Flexion
Flexion refers to bending.

In flexion there is a decrease in the angle between the articulating bones.
b. Extension
Extension refers to straightening.

In extension there is an increase in the angle between the articulating
bones.
c. Abduction
Abduction refers to a movement away from the mid-line of the body.
d. Adduction
Adduction refers to a movement towards the mid-line of the body.
e. Circumduction
Circumduction refers to the movement of the distal end of a part of the

body in a circle.
f. Rotation
Rotation refers to the movement around the axis of the limb itself.
In rotation a bone revolves around its own longitudinal axis.
g. Pronation
[72]
Pronation refers to the movement of the forearm so that the palm is turned
backward or downward.
h. Supination
Supination refers to the movement of the forearm so that the palm is

turned forward or upward.
i. Inversion
Inversion refers to the movement of the soles medially so that they face
each other.
j. Eversion
Inversion refers to the movement of the soles laterally so that they face
away from each other.
8. Draw well labelled diagrams of the following joints:
a. Shoulder joint (section) [5]

b. Elbow joint (section) [5]
c. Hip joint (section) [5]
d. Knee joint (section viewed from the side) [5]
9. State the functions of each of the following muscles

associated with the shoulder joint:
a. Deltoid muscle [1]

b. Pectoralis major [1]
c. Latissimus dorsi [1]
d. Teres major [1]
Functions of muscles associated with the shoulder joint

[73]
a. Deltoid muscle
The anterior fibres cause flexion, the middle or main part, abduction and
the posterior fibres extend the shoulder joint
b. Pectoralis major
It draws the arm forward and towards the body, i.e. flexes and adducts.
c. Latissimus dorsi
It adducts, medially rotates and extends the arm.
d. Teres major
It extends, adducts and medially rotates the arm.
10. State the functions of each of the following muscles associated with
the elbow joint:
a. Biceps muscle [1]

b. Triceps muscle [1]
c. Brachialis muscle [1]
Functions of muscles associated with the elbow joint
a. Biceps muscle
Helps to stabilise and flex the shoulder joint. Assists with flexion and
supination at the elbow joint.
b. Triceps muscle
[74]
Helps to stabilise the shoulder joint. Assists in adduction of the arm and
extends the elbow joint.
c. Brachialis muscle
It is the main flexor of the elbow joint.
11. State the functions of the following muscles associated with the hip joint:
a. Psoas muscle [1]

b. Iliacus muscle [1]
c. Quadriceps femoris [1]
d. Gluteal muscles [1]
e. Sartorius [1]
f. Adductor group [1]
Functions of muscles associated with the hip joint
a. Psoas muscle
Flexes the hip (together with the iliacus).
b. Iliacus muscle
Flexes the hip joint (together with the Psoas).
c. Quadriceps femoris
The rectus femoris muscle of the quadriceps flexes the hip joint. Together
the group extends the knee joint.
d. Gluteal muscles
They cause extension, abduction and medial rotation at the hip joint.
[75]
e. Sartorius
It is associated with flexion and abduction at the hip joint. Flexes the
knee.
f. Adductor group
They adduct and medially rotate the thigh.
12. State the functions of each of the following muscles associated

with the knee joint:
a. Hamstring muscles [1]

b. Gastrocnemius [1]
c. Quadriceps femoris [1]
Functions associated with the knee joint
a. Hamstring muscles
They flex the knee joint.
b. Gastrocnemius
It crosses both knee and ankle joints, causing flexion at the knee and
plantarflexion at the ankle.
c. Quadriceps femoris
This extends the knee joint.
13. List eight (8) muscles of the face and state the function of each [8]
[76]
Muscles of the face and their functions
a. Occipitofrontalis
It raises the eyebrows.
b. Levator palpebrae superioris
It raises the eyelid (=opens the eye).
c. Orbicularis oculi
It closes the eye.
d. Buccinator
Presses the cheeks in towards the teeth in chewing, whistling, blowing,

and sucking.
e. Orbicularis oris
It closes and protrudes the lips. Shapes the lips during speech.
f. Masseter
Draws the mandible up to the maxilla in chewing.
g. Temporalis
It closes the mouth and assists with chewing.
h. Pterygoid
It closes the mouth and pulls the lower jaw forward.

[77]
14. List two (2) muscles of the neck and state the function(s) of each [4]
Muscles of the neck and their functions
a. Sternocleidomastoid
Assists in turning the head from side to side.

Draws the head towards the shoulder.
Flex the cervical vertebrae or draw the sternum and clavicles upwards
when the head is maintained in a fixed position. This occurs in forced
respiration.
b. Trapezius
Pulls the head backwards, squares the shoulders and controls the
movements of the scapula when the shoulder joint is in use.
15. List the muscles of the back and state the function of each [6]
Muscles of the back and their functions
a. Trapezius
It pulls the head backwards, squares the shoulders and controls the
movements of the scapula when the shoulder joint is in use.
b. Teres major
It extends, adducts and medially rotates the arm.
c. Psoas
Together with the iliacus it flexes the hip joint.

[78]
d. Latissimus dorsi
It adducts, medially rotates and extends the arm.
e. Quadratus lumborum
Together the two muscles fix the lower rib during respiration and cause
extension of the vertebral column (bending backwards). If one muscle
contracts it causes lateral flexion of the lumbar region of the vertebral
column.
f. Sacrospinalis
Their contraction causes extension of the vertebral column
16. Name the main muscles of the abdominal wall [3]
Muscles of the abdominal wall
Rectus abdominis External oblique Internal oblique

Transversus abdominis Quadratus lumborum Psoas
17. State four (4) functions of the muscles of the abdominal wall [4]
Functions of the muscles of the abdominal wall
a. Compress the abdominal organs.

b. Flex the vertebral column in the lumbar region.
c. Bends the trunk sideways.
d. Oblique muscles rotate the trunk.
18. Describe the inguinal canal [5]
[79]
[This question is related to a condition referred to as intestinal obstruction in which

the flow of the contents of the intestines is obstructed. One of the common causes
of intestinal obstruction is an inguinal hernia]
Structure the inguinal canal
The inguinal canal is 2.5 to 4 cm long. It passes obliquely through the

abdominal wall. It runs parallel to and immediately in front of the
transversalis fascia and part of the inguinal ligament. In males it contains
the spermatic cord. In females it contains the round ligament. It constitutes
a weak point in the otherwise strong abdominal wall through which
herniation may occur.
19. List the muscles of the pelvic floor [1]
Muscles of the pelvic floor
i. Levator ani
ii. Coccygeus
20. State the functions of muscles of the pelvic floor [2]
Functions of muscles of the pelvic floor
a. Supports the organs of the pelvis such as the uterus and the rectum.
b. Maintains continence.
[80]

Reviewed by Matandane A. (MSc Development Studies.,
BSc NE.,OTN., RGN. &
Muvhu S. ( M Adult Ed., BSc NE., RGN)
Objectives
At the end of the chapter, student should be able to:
 Describe the structure of the skin.

 State the functions of receptors located in the skin.
 Draw a well labelled diagram illustrating the structure of the skin.
 Outline the functions of the skin.
 Outline the factors which promote or delay wound healing.
 Describe the process of wound healing by first and second intention.
[81]
1. Describe the structure of the skin [8]
The structure of the skin
The skin has a surface area of about 1.5 to 2 m2 in adults. It contains

glands, hair and nails. The skin as two main layers namely the epidermis
and the dermis underneath the skin is a layer of subcutaneous fat.
Epidermis
The epidermis is the most superficial layer of the skin. This layer consists
of stratified keratinized epithelium. The epidermis has neither blood
vessels nor sensory nerve endings. There are several layers of cells
forming the epidermis. The most superficial layer is the stratum corneum
and the deepest layer is the germinative layer. Cells that are on the surface
are dead, thin and flat. Cells found in the deeper layers of the epidermis
are alive and are bathed in interstitial fluid which comes from the dermis.
Hairs, secretions from sebaceous glands and ducts of sweat glands pass
through the epidermis to reach the surface.
Dermis
The dermis is a tough and elastic layer found below the epidermis. The
dermis consists of connective tissue, collagen fibres and elastic fibres.
Cells found in the dermis include fibroblasts, macrophages and mast cells.
The deepest layer of the dermis has areolar tissue and adipose tissue.
Structures in the dermis
The following structures are found in the dermis of the skin:
Structure Function(s)
a. Blood vessels Supply nutrients and oxygen to

structures in the dermis.
[82]
b. Lymph vessels Drain interstitial fluid back to the

general circulation.
c. Sensory nerve endings These are receptors that are sensitive

to touch, change in temperature,
pressure and pain.
d. Sweat glands Secrete sweat and evaporation of

sweat from body surfaces takes heat
from the body and this helps in the
regulation of body temperature.
e. Hairs and arrector pili Contraction of erector pili raises the

hairs. This traps air which acts as an
insulating layer and help to keep the
body warm.
f. Sebaceous glands Secrete an oily substance called

sebum. Sebum keeps the hair soft and
pliable, provides some waterproofing,
and acts as a bactericidal and
fungicidal agent and prevents the skin
from drying.
2. List the sensory receptors located in the skin and state the function(s)
of each [3]
Sensory receptors in the skin
Sensory receptor Function

a. Meissner's corpuscle Sensation of light pressure
b. Pacinian corpuscle Sensation of deep pressure
c. Free nerve endings Sensation of pain
[83]
3. Draw a well labelled diagram illustrating the structure of the skin [8]
4. Outline six (6) functions of the skin [6]
Functions of the skin
a. Protection
The skin provides protection to the body in various ways.
 The skin is a barrier that protects the body from infection,

chemicals, physical agents e.g. abrasion, heat, and dehydration.
 The skin has specialised cells that are responsible for detecting
foreign agents and stimulate an immune response. Epidermal
Langerhans cells detect the presence of invading microbes and
macrophages phagocytize bacteria and viruses that enter the skin.
 Sebum secreted by sebaceous glands prevents drying of the skin

and hair, and has chemicals that kill bacteria.
 Sweat is acidic and its pH retards the growth of some microbes.
 Melanin (a skin pigment) protects against harmful effect of ultra-

violet rays from the sun.
 Sensory receptors in the skin detect unpleasant or painful stimuli

and initiate reflexes that protect the body from injury.
b. Formation of vitamin D
Formation of vitamin D (from a substance called 7-dehydrocholesterol)

occurs when the skin is exposed to ultra-violet rays from sunlight. Vitamin
D is needed to bone formation and maintenance.
[84]
c. Sensation
The skin has receptors sensitive to touch, pressure, vibration, temperature,

and pain.
d. Absorption
The skin can absorb chemicals such as drugs such as steroids e.g. cortisol
and lipid soluble vitamins (A, D, E, K). The skin however can also absorb
toxic chemicals such as acetone, carbon tetrachloride, heavy metals such
as lead, mercury etc.
e. Excretion
The skin has a small excretory role. Substances that can be excreted
through the skin include sodium chloride, spices, and ammonia and urea
(in renal failure).
f. The skin regulates body temperature
The skin regulates body temperature by regulating heat loss and heat gain.
Heat loss is promoted by vasodilation of the blood vessels in the skin and
through sweating. Heat gain is promoted through vasoconstriction and the
erection of hairs of the skin.
g. Blood reservoir
The skin is a blood reservoir since about 10% of the total blood volume is
housed in blood vessels of the dermis.
5. Outline factors that promote wound healing [6]
Factors that promote wound healing
a. Systemic factors
[85]
These factors include (1) good nutritional status, (2) good general health,
(3) good immunity (4) good blood supply, (5) freedom from systematic
conditions such as diabetes mellitus, and (6) freedom from systemic
infections.
b. Local factors
Local factors that promote wound healing include (1) good blood supply
to the wound (for supply of oxygen and nutrients and removal of waste
products), (2) freedom from contamination by microbes, foreign bodies, or
toxic chemicals
6. State factors that delay wound healing [4]
[NB: factors that delay wound healing are just the inverse of the factors identified
in the previous question e.g. (1) poor nutritional status, (2) poor general health, (3)
poor immunity etc.]
7. Describe the process of wound healing by first intention

(=primary healing) [8]
The process of wound healing by first intention
This occurs where there is minimal destruction of tissue and when the
damaged edges of a wound are in close apposition e.g. surgical wounds.
The stages of wound healing are:
Stage 1: Inflammation
An inflammatory response occurs at the injured surfaces. There is

accumulation of cell debris and clots in the gap between the cut
surfaces. Phagocytes migrate to the injured area and remove the
blood clot and cell debris. Fibroblasts also migrate to the area and
begin to lay down collagen fibres. Collagen fibres begin to bind
the cut surfaces together.
[86]
Stage 2: Proliferation
There is a rapid multiplication of epithelial cells across the

wound, through the clot. The epidermis meets and grows
upwards until the full thickness is restored. The blood clot above
the new tissue becomes a scab and in 3-10 days separates.
There is development of granulation tissue which includes new
capillaries that restore blood supply to the wound.
Fibroblasts continue to secrete collagen fibres and phagocytes
continue to remove bacteria and cell debris.
Stage 3: Maturation
The granulation tissue is replaced by fibrous scar tissue.

Rearrangement of collagen fibres occurs and the strength of the
wound increases. In time the scar becomes less vascular,
appearing after a few months as a fine line.
8. Describe wound healing by second intention (=secondary healing) [8]
Wound healing by second intention
This follows destruction of a large amount of tissue i.e. when injury

extends to the dermis and subcutaneous layers or when the edges of a
wound cannot be brought into apposition. Healing by second intention is
more complex than healing by first intention.
The stages of wound healing are (1) inflammation, (2) proliferation, and
(3) maturation.
Stage 1: Inflammation
During this phase a blood clot forms in the wound. This is

followed by an inflammatory process (develops above the
healthy tissue) which helps to eliminate microbes, foreign
material and dead tissue in preparation to repair. Vasodilation
and the increased permeability associated with inflammation
[87]
enhance the movement of macrophages to the injured area.

Macrophages begin to remove dead tissue, and microbes, and
mesenchymal cells migrate to the area and these cells develop
into fibroblasts. The action of microphages helps the necrotic
material (slough) to begin to separate from healthy tissue.
Stage 2: Proliferation
Granulation tissue develops at the base of the cavity. Granulation

tissue consists of new blood capillaries, phagocytes, and
fibroblasts. Phagocytes continue to remove dead tissue and
microbes from the wound. Fibroblasts lay down collagen fibres
in a random manner in the injured area. Granulation tissue
continues to grow towards the surface of the wound.
Granulation tissue reaches the level of the dermis and epithelial
cells at the edges of the wound proliferate and grow towards the
centre beneath the scab.
Stage 3: Maturation
Once the epidermis has been restored to normal thickness the

scab sloughs off. Granulation tissue is replaced with scar tissue
and usually this occurs over several months. There is
reorganization of collagen fibres and a decrease in the number of
fibroblasts. The scar tissue that results is shiny and does not
contain sweat glands, hair follicles or sebaceous glands.
[88]

Reviewed by Kusemwa-Muyambi P. (MSc N (Med-Surg.)).,
BSc NE., Dip. Paeds., RGN) &
Mushambi E. (MSc NSMSN., BSc NE., ICN., RGN.,
FMA., EMT)
Objectives
 Describe the structure of the heart.

 Describe the flow of blood through the heart.
 Draw a well labelled diagram of the heart showing the flow of blood
through the heart.
 Describe the conducting system of the heart.
 Draw a well labelled diagram illustrating the conducting system of the
heart.
 Outline the factors that affect the heart rate.
 Describe the cardiac cycle.
 Outline the factors that affect cardiac output.
 Describe the control mechanisms for the regulation of blood pressure.
 Describe the circulation of blood through the lungs (=pulmonary
circulation),
 Describe the blood supply to the brain.
 Draw a well labelled diagram showing the main arteries that supply blood
to the brain (=circle of Willis).
[89]
*1. Describe the structure of the heart [8]
Structure of the heart
Location, shape and size
The heart lies inside the thoracic cavity, resting on the

diaphragm. It is hollow and cone-shaped, varying in size.
The heart is within the mediastinum in between the lungs.

Its posterior border is near the vertebral column, and its anterior
border is near the sternum.
An average adult has a heart that is about 14 cm long by 9 cm

wide.
The base of the heart is actually the upper portion, where it is
attached to several large blood vessels. This portion lies beneath
the second rib.
The distal end of the heart extends downward, to the left, ending
in a blunt point called the apex, which is even with the fifth
intercostal space.
Layers forming the walls of the heart
The three layers comprising the wall of the heart are the outer
pericardium, middle myocardium, and inner endocardium.
a. Pericardium
[90]
The pericardium is the outermost layer covering the heart. It is

composed of two distinct but continuous layers, the fibrous
pericardium and the serious pericardium separated from each
other by a potential space containing a lubricating substance
called serous fluid.
The cavity has a serous fluid-secreting lining.
b. Myocardium
Myocardium is the middle layer of the heart wall. It is composed

of cardiac muscle fibers, which enable heart contractions. The
myocardium is the thickest layer of the heart wall, with its
thickness varying in different parts of the heart.
The myocardium of the left ventricle is the thickest as this
ventricle is responsible for generating the power needed to pump
oxygenated blood from the heart to the rest of the body.
Cardiac muscle contractions are under the control of the
peripheral nervous system, which directs involuntary functions
including heart rate.
Cardiac conduction is made possible by specialized myocardial
muscle fibres. These fibres bundles, consisting of the
atrioventricular bundle and Purkinje fibres, carry electrical
impulses down the center of the heart to the ventricles.
The impulses trigger the muscle fibres in the ventricles to
contract.
c. Endocardium
[91]
Endocardium is the thin inner layer of the heart wall. This layer
lines the inner heart chambers, covers heart valves and is
continuous with the endothelium of large blood vessels.
The interior of the heart
a. Heart chambers
The inside of the heart is divided into four hollow chambers, with
two on the left and two on the right.
The upper chambers are called atria and receive blood returning
to the heart. They have auricles, which are small projections that
extend anteriorly.
The lower chambers are called ventricles and receive blood from
the atria, which they pump out into the arteries. The left atria and
ventricle are separated from the right atria and ventricle by a
solid wall-like structure (septum). This keeps blood from one
side of the heart from mixing with blood from the other side
(except in a developing foetus).
b. The atrioventricular valve
The atrioventricular valve (=AV valve), which consists of the

mitral valve on the left and the tricuspid valve on the right,
ensures one-way blood flow between the atria and ventricles.
The right atrium receives blood from two large veins called the
superior vena cava and the inferior vena cava as well as a smaller
[92]
vein (the coronary sinus), which drains blood into the right
atrium from the heart’s myocardium.
The tricuspid valve has projections (cusps) and lies between the
right atrium and ventricle. This valve allows blood to move from
the right atrium into the right ventricle while preventing
backflow.
The cusps of the tricuspid valve are attached to strong fibres
called chordae tendineae, which originate from small papillary
muscles that project inward from the ventricle walls.
When the tricuspid valve closes, they pull on the chordae
tendineae to prevent the cusps from swinging back into the
atrium.
The right ventricle’s muscular wall is thinner than that of the left
ventricle, as it only pumps blood to the lungs with a low
resistance to blood flow.
The left ventricle is thicker because it must force blood to all
body parts, with a much higher resistance to blood flow.
Blood vessels supplying the heart
a. Arterial Blood supply to the heart
Right and left coronary arteries
b. Venous drainage
A number of cardiac veins that joins to form coronary sinus.
[93]
2. Describe the flow of blood through the heart [8]
The flow of blood through the heart
 Deoxygenated blood flows from the head and rest of the body
through the superior and inferior venae cavae.
 The superior and inferior venae cavae empty blood into the right
atrium.
 The blood passes via the right atrioventricular valve into the right
ventricle.
 From the right ventricle, the blood is pumped into the pulmonary
artery or trunk via the pulmonary valve.
 The pulmonary artery divides into left and right pulmonary
arteries, which carry blood to the lungs.
 In the lungs the blood loses carbon dioxide and absorbs oxygen.
 Two pulmonary veins from each lung carry oxygenated blood
back to the left atrium.
 The blood then passes through the left atrioventricular valve into
the left ventricle.
 The blood is pumped from the left ventricle into the aorta via the
aortic valve. The blood then flows to the head and the rest of the
body.
3. Draw a well labelled diagram of the heart showing the flow of

blood through the heart [6]
4. Describe the conducting system of the heart [8]
[94]
The conducting system of the heart
Strands and clumps of specialized cardiac muscle contain only a few

myofibrils and are located throughout the heart. These areas initiate and
distribute impulses through the myocardium, comprising the cardiac
conduction system that coordinates the cardiac cycle.
Sinoatrial Node
The cardiac conduction system (CCS) consists of distinctive components

that initiate and conduct the electrical impulse required for the coordinated
contraction of the cardiac chamber. The sinoatrial (SA) node is a
collection of specialised cells (pacemaker cells), and is located in the
upper wall of the right atrium, at the junction where the superior vena cava
enters.
These pacemaker cells can spontaneously generate electrical impulses.
The wave of excitation created by the SA node spreads via gap junctions
across both atria, resulting in atrial contraction (atrial systole) – with blood
moving from the atria into the ventricles.
The rate at which the SA node generates impulses is influenced by the

autonomic nervous system:
 Sympathetic nervous system – increases firing rate of the SA

node, and thus increases heart rate.
 Parasympathetic nervous system – decreases firing rate of the SA
node, and thus decreases heart rate.
[95]
Atrioventricular Node
After the electrical impulses spread across the atria, they converge at the
atrioventricular node – located within the atrioventricular septum, near the
opening of the coronary sinus.
The AV node acts to delay the impulses by approximately 120ms, to
ensure the atria have enough time to fully eject blood into the ventricles
before ventricular systole.
The wave of excitation then passes from the atrioventricular node into the
atrioventricular bundle.
Atrioventricular Bundle
The atrioventricular bundle (bundle of His) is a continuation of the

specialised tissue of the AV node, and serves to transmit the electrical
impulse from the AV node to the Purkinje fibres of the ventricles.
It descends down the membranous part of the interventricular septum,
before dividing into two main bundles:
Right bundle branch – conducts the impulse to the Purkinje fibres of the
right ventricle
Left bundle branch – conducts the impulse to the Purkinje fibres of the left
ventricle.
Purkinje Fibres
The Purkinje fibres (sub-endocardial plexus of conduction cells) are a

network of specialised cells. They are abundant with glycogen and have
extensive gap junctions.
[96]
These cells are located in the subendocardial surface of the ventricular

walls, and are able to rapidly transmit cardiac action potentials from the
atrioventricular bundle to the myocardium of the ventricles.
This rapid conduction allows coordinated ventricular contraction
(ventricular systole) and blood is moved from the right and left ventricles
to the pulmonary artery and aorta respectively.
5. Draw a well labelled diagram illustrating the conducting system

of the heart [6]
6. Outline six (6) factors that affect the heart rate [6]
Factors that affect the heart rate
a. Autonomic nervous system
Although heart rate is established by the SA nodal cells, it can be affected

by the autonomic nervous system. Changing heart rate is the body’s
principal short-term mechanism of controlling cardiac output and blood
pressure. When stroke volume decreases, the body attempts to maintain
adequate cardiac output by increasing the rate and strength of cardiac
contraction. The most important control of heart rate and strength of
contraction is autonomic innervation.
b. Cardioacceleratory center
The medulla oblongata, located in the brain, includes a cluster of neurons

that make up the cardioacceleratory center (CAC). Sympathetic fibers that
begin in the CAC innervate the SA node, the AV node, and parts of the
[97]
myocardium. CAC stimulation causes these fibers to release

norepinephrine, thereby increasing heart rate and contraction strength.
c. Cardioinhibitory center
The medulla oblongata also contains an opposing cardioinhibitory center

(CIC). Parasympathetic fibers that begin in the CIC also innervate the SA
node and AV node. CIC stimulation results in the transmission of nerve
impulses along the parasympathetic fibers and the release of acetylcholine,
which decreases heart rate.
d. Circulating chemicals: hormones and drugs
Norepinephrine and Epinephrine
In response to sympathetic stimulation, norepinephrine is released in the

myocardium, and norepinephrine and epinephrine are released by the
adrenal medullae. Norepinephrine increases heart rate and myocardial
contractility. Epinephrine excites the SA node, thereby increasing the rate
and strength of myocardial contraction.
Other hormones including thyroxine increase heart rate by their metabolic

effect.
Some drugs, dissolved gases and electrolytes in the blood may either in-
crease or decrease the heart rate. Cardiac glycosides, for example,
decrease the heart rate (a negative chronotropic effect).
e. Temperature
[98]
Changes in body temperature can also affect heart rate and contractility.
Increased body temperature results in increased heart rate. Decreased body
temperature slows heart rate and results in less powerful contractions.
f. Higher centres
Strong emotions, such as anger, fear, and anxiety, tend to increase heart
rate.
Other mental states, such as depression and grief, probably stimulate the
cardioinhibitory center, resulting in a slower heart rate.
g. Position
When the person is upright, the heart rate is usually faster than when lying
down.
h. Exercise
Active muscles need more blood than resting muscles and this is achieved
by an increased heart rate.
i. Sex
Sex and age also affect heart rate. The heartbeat of females is generally
faster than that of males.
j. Age
[99]
Heart rate is fastest at birth and decreases throughout life.
7. Describe the cardiac cycle [8]
The cardiac cycle
The cardiac cycle refers to a series of events that involve the heart
pumping blood heart into the aorta and the pulmonary artery.
During each cardiac cycle, the heart contracts and then relaxes.
The period of contraction is called systole
The period of relaxation is called diastole.
The cardiac cycle consists of the following phases: atrial systole,

ventricular systole, and complete cardiac diastole.
Phase 1: Atrial systole
The superior vena cava and the inferior vena cava transport blood into the
right atrium.
At the same time as the four pulmonary veins convey blood into the left
atrium.
The atrioventricular valves are open and blood flows through to the
ventricles.
The SA node triggers a wave of contraction that spreads over the
myocardium of atria, emptying the atria and completing ventricular filling.
Atrial systole 0.1s
Phase 2: Ventricular systole
[100]
Impulses from the SA node reach the AV node.

The AV node is stimulated to generate impulses which quickly spread via
the AV bundle, the bundle branches and Purkinje fibres to muscles of the
ventricles.
This results in a wave of contraction which sweeps upwards from the apex
of the heart and across the walls of both ventricles pumping the blood into
the pulmonary artery and the aorta.
Ventricular systole 0.3 s.
The atrioventricular valves close, preventing backflow of blood into the
atria.
Phase 3: Complete cardiac diastole
After contraction of the ventricles there is complete cardiac diastole i.e.

when atria and ventricles are relaxed.
During this time the myocardium recovers until it is able to contract again,
and the atria refill in preparation for the next cycle.
Complete cardiac diastole is 0.4 seconds.
*8. Outline the factors that affect cardiac output [8]
Factors that affect cardiac output
a. Atrial/Bainbridge reflex
The atrial reflex also referred to as the right heart reflex or Bainbridge
reflex is triggered by an increase in venous return to the heart.
[101]
Baroreceptors in the superior and inferior venae cavae sense pressure

changes and send impulses to the SA node, increasing heart rate.
b. Ventricular reflex
Whereas the atrial reflex affects heart rate, the ventricular reflex affects
stroke volume. The amount of blood ejected is dependent on the amount
of blood filling the ventricle during diastole, called the end-diastolic
volume, and the amount of blood left in the ventricle after systole, which
is the end-systolic volume.
c. Role of the autonomic nervous system
Although heart rate is established by the SA nodal cells, it can be affected

by the autonomic nervous system. Changing heart rate is the body’s
principal short-term mechanism of controlling cardiac output and blood
pressure. When stroke volume decreases, the body attempts to maintain
adequate cardiac output by increasing the rate and strength of cardiac
contraction. The most important control of heart rate and strength of
contraction is autonomic innervation.
d. Cardioacceleratory center
The medulla oblongata, located in the brain, includes a cluster of neurons

that make up the cardioacceleratory center (CAC). Sympathetic fibers that
begin in the CAC innervate the SA node, the AV node, and parts of the
myocardium. CAC stimulation causes these fibers to release
norepinephrine, thereby increasing heart rate and contraction strength.
[102]
e. Cardioinhibitory center
The medulla oblongata also contains an opposing cardioinhibitory center

(CIC). Parasympathetic fibers that begin in the CIC also innervate the SA
node and AV node. CIC stimulation results in the transmission of nerve
impulses along the parasympathetic fibers and the release of acetylcholine,
which decreases heart rate.
f. Norepinephrine and Epinephrine
In response to sympathetic stimulation, norepinephrine is released in the

myocardium, and norepinephrine and epinephrine are released by the
adrenal medullae. Norepinephrine increases heart rate and myocardial
contractility. Epinephrine excites the SA node, thereby increasing the rate
and strength of myocardial contraction
g. Acetylcholine
Parasympathetic stimulation results in the release of acetylcholine, which

inhibits heart activity by decreasing the force of cardiac contractions.
h. Extra cellular fluid ion concentration
Elevated levels of extracellular potassium or sodium ions can decrease

heart rate and stroke volume. Abnormal potassium levels interfere with
the SA node, affecting heart rate. Too much potassium causes cardiac
contractions to become weak and irregular and too little potassium
decreases the heart rate. High concentrations of sodium interfere with
calcium activity in muscle contractions, reducing contractility.
[103]
i. Calcium ion concentrations
Abnormal calcium ion concentrations affect the strength and duration of

cardiac contractions, which then affects stroke volume. High calcium
levels cause strong and lengthy contractions. Low calcium levels weaken
contraction strength.
Factors that affect cardiac output

********
Is determined by the volume of blood in the ventricles immediately before they
contract.
Depends on the amount of blood returning to the heart through the superior and
inferior venae cavae (the venous return).
Leads to stronger myocardial contraction, and more blood is expelled.
a. Strength of myocardial contraction

Is due to the effects of autonomic stimulation of the heart, hormones e.g.
adrenaline, noradrenaline, thyroxine, and some drugs e.g. digoxin.
b. Blood volume
This is normally kept constant by the kidneys and if deficient the cardiac output
decrease.
c. Venous return
Is the major determinant of cardiac output?
Factors that affect venous return include:
[104]
Position of the body. Gravity assists the venous return from the head and-neck
when standing or sitting.
Muscular contraction. The contraction of skeletal muscles surrounding the deep
veins puts pressure on them, pushing blood towards the heart.
The respiratory pump. During inspiration the expansion of the chest creates a
negative pressure within the thorax, assisting flow of blood towards the heart.
****
9. Describe the control mechanisms for the regulation of blood pressure [8]
The mechanisms for the control of blood pressure
a. The cardiovascular centre
The cardiovascular center provides a rapid, neural mechanism for the

regulation of blood pressure by managing cardiac output or by adjusting
blood vessel diameter. Located in the medulla oblongata of the brain stem,
it consists of three distinct regions:
The cardiac center stimulates cardiac output by increasing heart rate and
contractility. These nerve impulses are transmitted over sympathetic
cardiac nerves.
The cardiac center inhibits cardiac output by decreasing heart rate. These
nerve impulses are transmitted over parasympathetic vagus nerves.
b. The vasomotor center
The vasomotor center regulates blood vessel diameter. Nerve impulses

transmitted over sympathetic motor neurons called vasomotor nerves
innervate smooth muscles in arterioles throughout the body to maintain
[105]
vasomotor tone, a steady state of vasoconstriction appropriate to the

region.
c. Baroreceptors
Baroreceptors are sensory neurons that monitor arterial blood pressure.

Major baroreceptors are located in the carotid sinus (an enlarged area of
the carotid artery just above its separation from the aorta), the aortic arch,
and the right atrium.
d. Chemoreceptors
Chemoreceptors are sensory neurons that monitor levels of CO2 and O2.
These neurons alert the cardiovascular center when levels of O2 drop or
levels of CO2 rise (which result in a drop in pH). Chemoreceptors are
found in carotid bodies and aortic bodies located near the carotid sinus and
aortic arch.
e. Higher brain regions
Higher brain regions, such as the cerebral cortex, hypothalamus, and

limbic system, signal the cardiovascular center when conditions (stress,
fight‐or‐flight response, hot or cold temperature) require adjustments to
the blood pressure.
f. The kidneys: the renin-angiotensin-aldosterone mechanism
The kidneys provide a hormonal mechanism for the regulation of blood

pressure by managing blood volume.
[106]
The renin‐angiotensin‐aldosterone system of the kidneys regulates blood

volume. In response to rising blood pressure, the juxtaglomerular cells in
the kidneys secrete renin into the blood. Renin converts the plasma protein
angiotensinogen to angiotensin I, which in turn is converted to angiotensin
II by enzymes from the lungs. Angiotensin II activates two mechanisms
that raise blood pressure:
Angiotensin II constricts blood vessels throughout the body (raising blood
pressure by increasing resistance to blood flow). Constricted blood vessels
reduce the amount of blood delivered to the kidneys, which decreases the
kidneys' potential to excrete water (raising blood pressure by increasing
blood volume).
Angiotensin II stimulates the adrenal cortex to secrete aldosterone, a
hormone that reduces urine output by increasing retention of H2O Na+
by the kidneys (raising blood pressure by increasing blood volume).
g. Hormones
Epinephrine and norepinephrine, hormones secreted by the adrenal

medulla, raise blood pressure by increasing heart rate and the contractility
of the heart muscles and by causing vasoconstriction of arteries and veins.
These hormones are secreted as part of the fight‐or‐flight response.
h. Antidiuretic hormone (ADH)
Antidiuretic hormone (ADH), a hormone produced by the hypothalamus

and released by the posterior pituitary, raises blood pressure by
stimulating the kidneys to retain H2O (raising blood pressure by
increasing blood volume).
[107]
Atrial natriuretic peptide (ANP), a hormone secreted by the atria of the

heart, lowers blood pressure by causing vasodilation and by stimulating
the kidneys to excrete more water and Na +(lowering blood pressure by
reducing blood volume).
i. Nitric oxide (NO)
Nitric oxide, secreted by endothelial cells, causes vasodilation.
j. Nicotine
Nicotine in tobacco raises blood pressure by stimulating sympathetic

neurons to increase vasoconstriction and by stimulating the adrenal
medulla to increase secretion of epinephrine and norepinephrine.
k. Alcohol
Alcohol lowers blood pressure by inhibiting the vasomotor centre (causing

vasodilation) and by inhibiting the release of ADH (increasing H2O
output, which decreases blood volume).
l. Temperature
The hypothalamus in the brain controls body temperature and influences

the CVC which responds by adjusting the diameter of blood vessels in the
skin — leads to elevation in BP.
10. List the main sites of the body where pulse can be palpated [4]
[108]
Main sites of the body where pulse can be palpated
Brachial artery Radial artery Femoral artery

Common carotid artery Posterior tibial artery Popliteal artery
Temporal artery Facial artery
11. Describe the circulation of blood through the lungs

(=pulmonary circulation) [8]
Circulation of blood through the lungs
 Pulmonary circulation is a system of blood vessels that forms a closed

circuit between the heart and the lungs.
 The pulmonary circuit begins with the right ventricle, which pumps
deoxygenated blood through the pulmonary artery.
 This artery divides above the heart into two branches, to the right and left
lungs, where the arteries further subdivide into smaller and smaller
branches until the capillaries in the pulmonary air sacs (alveoli) are
reached.
 In the capillaries the blood takes up oxygen from the air breathed into the
air sacs and releases carbon dioxide.
 It then flows into larger and larger vessels until the pulmonary veins
(usually four in number, each serving a whole lobe of the lung) are
reached.
 The pulmonary veins open into the left atrium of the heart.
12. Describe the blood supply to the brain [8]
[109]
Blood supply to the brain
It is absolutely vital that the brain receives a constant supply of oxygen and
glucose through the circulatory system.
 Anteriorly the blood supply is from the right and left internal carotid
arteries which travel up the front of the neck on either side.
 Posteriorly, the right and left vertebral arteries travel up through the
cervical vertebrae.
 The internal carotid arteries each give off two branches, the anterior
cerebral artery, and the middle cerebral artery.
 The vertebral arteries meet to form the short basilar artery which gives off
two branches, the right, and left posterior cerebral arteries. These two
separate blood supplies are linked by small blood vessels so completing
the circle of Willis and ensuring a constant blood supply to the brain.
 The posterior communicating arteries link the posterior cerebral arteries
with the middle cerebral arteries.
 The anterior communicating artery links the two anterior cerebral arteries.
13. Draw a well labelled diagram showing the main arteries that supply
blood to the brain (=circle of Willis) [6]
[110]

Reviewed by Mukwamba M. M. (BSc M&E.,
BSc NE., Dip. ICCN., RGN) &
Shangwa R. (M Adult Ed., BSc NE., RGN)
Objectives
 List organs and structures which form the respiratory system.

 State the functions of the respiratory system.
 Draw a well labelled diagram showing organs of the respiratory system.
 Outline the functions of each of the following: nose and nasal cavity, pharynx,
larynx, trachea, bronchioles, and alveoli.
 Describe the structure of the trachea.
 Draw a well labelled diagram showing the structure of the larynx.
 Describe the plaura and pleural cavity.
 Describe the mechanism of breathing (=respiratory cycle) applying Boyle’s law.
 Describe gaseous exchange in the body (=internal and external respiration)
applying Dalton’s law.
 Compare and contrast the composition of inspired and expired air.
 Describe the transport of ageses in the bloodstream.
[111]
1. List any six (6) organs and structures that form the respiratory system [3]
The organs of the respiratory system
Nose Pharynx Larynx

Trachea Bronchi x 2 Lungs x 2
Muscles of respiration: diaphragm and intercoastal muscles
2. State six (6) functions of the respiratory system [6]
Functions of the respiratory system
a. Provides for gas exchange: intake of oxygen for delivery to body cells and
removal of carbon dioxide produced by body cells.
b. Helps regulate blood pH.
c. Contains receptors for sense of smell,
d. Filters inspired air,
e. Produces vocal sounds (phonation),
f. Excretes small amounts of water and heat
2. Draw a well labelled diagram showing organs of the

respiratory system [8]
3. Outline five (5) functions of the nose and nasal cavity [5]
Functions of the nose and the nasal cavity
a. Warming
Air inspired from the environment gains heat as it passes through the nose
and the nasal cavity.
b. Filtering and cleaning of air

[112]
Hairs in the nose trap large foreign particles in inspired air and the mucus
lining the nasal cavity traps smaller particles such as dust and microbes.
c. Humidification
Dry inspired air gains moisture from the nasal cavity and eventually gets
saturated with water vapour.
d. The sense of smell
The nose is the organ of the sense of smell. There are nerve endings that
detect smell, located in the roof of the nasal cavity. These nerve endings
are stimulated by chemical substances given off by odorous materials. The
resultant nerve impulses are conveyed by the olfactory nerves to the brain
where the sensation of smell is perceived.
e. Modification of voice
The nasal cavity gives resonance to voice.
4. Describe the physiology of smell [5]
Physiology of smell
 Odorous material gives off odorant molecules.

 The odorant molecules are carried into the nasal cavity with inhaled
air.
 The molecules dissolve in the mucus lining the mucosa of the nasal
cavity.
 The molecules stimulate olfactory receptors (chemoreceptors) located
in the mucosa of the roof of the nasal cavity.
 When stimulated the olfactory receptors generate nerve impulses that
are transmitted by the olfactory (I) nerves to the paired masses of grey
matter called olfactory bulbs.
[113]
 From the olfactory bulb some nerve fibres project to the primary
olfactory area located in the temporal lobe of the cerebrum. In the
olfactory area the nerve impulses are interpreted as smell. Pathways
from the olfactory area extend to the frontal lobe, an important region
for odour identification and discrimination.
 Some nerve fibres from the olfactory bulb project to the limbic
system and hypothalamus. These connections account for emotional
and memory-evoked responses to odour e.g. nausea on smelling a
food which made on seriously ill.
5. Outline six (6) functions of the pharynx [6]
Functions of the pharynx
a. Passageway for air and food
The pharynx acts as a passage way for inspired air into the lungs. It also
acts as a passage for ingested food.
b. Warming and humidifying
Cold and dry inspired air gets heat and moisture as it passes through the
pharynx.
c. Taste
The oropharynx and the nasopharynx have receptors for the sense of taste.
d. Hearing
The auditory tube, extending from the nasal part to each middle ear,
allows air to enter the middle ear. Satisfactory hearing depends on the
presence of air at atmospheric pressure on each side of the tympanic
membrane (ear drum).
e. Protection
[114]
Lymphatic tissue and the tonsils located in the pharynx provide protection
from infection by producing antibodies in response to antigens such as
microbes.
f. Speech
The pharynx provides resonance to sounds ascending from the larynx.
6. Draw a well labelled diagram illustrating the structure of the

larynx (viewed from the front) [6]
7. Outline five (5) functions of the larynx [5]
Functions of the larynx
a. Production of sound
Expired air causes vibration of the vocal cords leading to the production of
sound.
b. Speech
Sounds produced when expired air causes the vocal cords to vibrate are
then manipulated by the tongue, cheeks, and lips leading to the production
of speech.
c. Protection of the lower respiratory tract
The larynx prevents aspiration of food particles into the lower respiratory
passages during swallowing.
d. Passageway for air
[115]
The larynx is a passageway for air moving from the pharynx into the
trachea.
e. Humidifying, filtering, and warming
Air is filtered, humidified and warmed as it passes through the larynx.
8. Describe the structure of the trachea [6]
[This question is related to a procedure called tracheostomy. A tracheostomy is a

surgically created opening through the upper rings of the trachea below the cricoid
cartilage. Indications of a tracheostomy include laryngeal obstruction and other
conditions in which there is severe respiratory embarrassment]
Structure of the trachea
Position and dimensions
The trachea is a tubular passage for air. It is located anterior to

the oesophagus. It extends from the larynx to the superior border
of the fifth thoracic vertebra (T5), where it divides into the right
and left primary bronchi.
The trachea is about 12 cm long and 2.5cm in diameter in adults.
Layers of the tracheal wall
The layers of the tracheal wall, from superficial to deep, are (a)
adventitia, (b) hyaline cartilage, (c) submucosa, and (d) mucosa.
a. Adventitia
The adventitia of the trachea consists of fibrous and elastic tissue

i.e. areolar connective tissue. The adventitia encloses the hyaline
cartilage and joins the trachea to surrounding tissues.
b. Hyaline cartilage
[116]
This layer consists of 16-20 incomplete, horizontal rings of

hyaline cartilages stacked one above the other. The rings are
connected to each other by dense connective tissue.
Each ring resembles the letter C. The open part of the C-shaped
cartilage ring faces posteriorly toward the oesophagus. The open
part of the rings is spanned by fibromuscular membrane. Within
this membrane are transverse smooth muscle fibers, called the
trachealis muscle, and elastic connective tissue that allow the
diameter of the trachea to change during inhalation and
exhalation.,
The solid C-shaped cartilage rings provide a semi-rigid support to

maintain patency of the airways.
c. Submucosa
The submucosa consists of areolar connective tissue that contains

seromucous glands and their ducts.
d. Mucosa
This consists of ciliated columnar epithelium, containing mucus-

secreting goblet cells. The cilia and mucus traps dust and
microbes inhaled in air.
9. Outline four (4) functions of the trachea [4]
Functions of the trachea
a. Support and patency
The cartilages of the trachea prevent obstruction of the airway as the head
and neck moves.
[117]
The absence of cartilage in the posterior of the trachea allows the trachea
to constrict and dilate due to autonomic nerve stimulation as well as to
indent as food passes through the oesophagus.
b. Mucociliary escalator
Movement of the cilia located on the mucous membrane of the trachea

moves mucus and trapped particles upwards towards the larynx to be
expectorated or swallowed.
c. Cough reflex
The trachea has nerve ending which are sensitive to irritation. When
irritated the nerve endings generate impulses which are transmitted by the
vagus nerve to the respiratory centre leading. This leads to the generation
of a cough reflex that expels the irritating particles and mucus.
d. Warming, humidifying and filtering of air
Air passing through the trachea continues to be warmed, humidified and

filtered.
10. Outline three (3) functions of the bronchioles and the alveoli [4]
Functions of the bronchioles and the alveoli
a. External respiration
The bronchioles and the alveoli allow the exchange of gases between
blood in lung capillaries and air in the alveoli.
b. Defence against microbes
The bronchioles and the alveoli have mast cells and lymphocytes which
produce antibodies in response to antigens.
[118]
At this level, ciliated epithelium, goblet cells and mucus are no longer
present. Defence relies on protective cells present within the lung tissue.
These include lymphocytes and plasma cells, which produce antibodies in
the presence of antigens, and m
Macrophages and polymorphonuclear lymphocytes present in the

bronchioles and alveoli ingest foreign particles such as microbes which
find their way to the bronchioles and alveoli.
c. Warming and humidifying
Air in the bronchioles and alveoli gains heat and moisture.
11. Describe the pleura and the pleural cavity [6]
[This question is associated with certain respiratory and cardiothoracic conditions.

In disease states the layers of the pleura become separated by fluids i.e. pleural
effusion, by air i.e. pneumothorax, or by blood i.e. haemothorax]
The pleura and pleural cavity
The pleura is a closed sac of serous membrane which encloses and covers
each lung. The pleura consists of two layers i.e. (a) the visceral layer and
(b) the parietal layer.
a. The parietal pleura
The parietal pleura is the superficial layer which is adherent to

the inside of the chest wall and the thoracic surface (i.e. upper
surface) of the diaphragm.
b. The visceral pleura
The visceral pleura is the deeper layer which is adherent to the

lung, covering each lobe and passing into the fissures which
separate them. This layer covers the lungs completely except at
the hilum.
[119]
The pleural cavity
Between the two layers of pleura is a potential space called the pleural
cavity. Within the pleural cavity is a thin film of serous fluid called pleural
fluid. The fluid is secreted by the membranes and allows them to glide
easily over each other during breathing. Pleural fluid also causes the two
membranes to adhere to one another.
12. Describe the mechanism of breathing (=respiratory cycle) applying

Boyle’s law [7]
Mechanism of breathing
Breathing depends on changes in the dimensions and pressures of the

lungs. The cycle of respiration consists of three phases namely inspiration,
expiration, and pause.
Boyle’s law can be applied to the mechanism of breathing. The law states
that:
The volume of a given mass of a gas is inversely proportional to its

pressure, provided temperature remains constant.
a. Inspiration
 The diaphragm is a dome-shaped muscle that forms the floor of

the thoracic cavity. The muscle is stimulated by the phrenic nerve
to contract, flattens and moves down.
 At the same time the external intercoastal muscles contract and

elevate the ribs i.e. causes the rib cage to move upwards and
outwards.
 The result is an increase in the anteroposterior and lateral

diameters of the chest cavity.
[120]
 During the expansion of the thoracic cavity the parietal pleura

moves with the walls of the thorax and the diaphragm. This
reduces the pressure in the pleural cavity. The visceral pleura
follows the parietal pleura pulling the lung with it. This stretches
the lungs causing the volume of the lungs to increase. The
increase in volume causes pressure in the lungs to decrease below
atmospheric pressure, according to Boyle's law.
 The pressure inside the lungs (=intrapulmonic pressure) drops

from 760 to 758 mmHg creating a pressure difference between
the atmosphere and the alveoli.
 Air therefore flows from the atmosphere, where the pressure is

high, into the lungs, where the pressure is lower. Air continues to
flow into the lungs as long as a pressure difference exists.
b. Expiration
 Normal expiration is a passive process because there is no muscle

contraction, but muscle relaxation. The diaphragm relaxes and
becomes dome-shaped and moves up into the thoracic cavity.
 There is simultaneous relaxation of the external intercoastal

muscles causing the ribs to fall downwards i.e. the ribcage falls
downwards and inwards.
 These movements decrease the vertical, lateral, and

anteroposterior diameters of the thoracic cavity, which decreases
lung volume. The decrease in the volume of the lungs is due to
elastic recoil of lung tissue owing to the presence of elastic fibers
in lung tissue.
 The decrease in the volume of the lungs causes pressure in the

lungs to increase according to Boyle's law i.e. alveolar pressure
increases to about 762 mmHg.
 The increase in pressure causes air to be expelled from the lungs,

where the pressure is high into the atmosphere, where the
[121]
pressure is lower. Air continues to flow out of the lungs for as

long as the pressure differences exist.
c. Pause
There is a pause before the next cycle begins.
14. Describe external respiration applying Dalton's law [6]
External respiration
External respiration refers to the exchange of gases between air in the

alveoli of the lungs and blood in lung capillaries. External respiration
depends on the differences in the partial pressures of gases between the
alveoli and lung capillaries. These partial pressure differences are due to
the differences in the concentrations of the gases between the alveoli and
the lung capillaries.
Dalton's law states that:
In a mixture of gases each gas exerts a partial pressure that is directly

proportional to its concentration in the mixture.
a. Diffusion of CO2
Blood arriving from tissue cells contains a high level of carbon dioxide
because tissues produce carbon dioxide as a waste product of metabolism.
The concentration of carbon dioxide in lung capillaries is higher than the
in the alveoli.
According to Dalton’s law it follows that the partial pressure of carbon
dioxide is higher in blood in lung capillaries (pCO2=46 mmHg) than in the
alveoli (pCO2=38 mmHg).
Carbon dioxide therefore diffuses from the lung capillaries where its
concentration and partial pressure is high into the alveoli where its
concentration and partial pressure is low.
b. Diffusion of O2
[122]
Blood arriving from tissue cells contains a low level of oxygen because
tissues use oxygen during metabolic processes.
The concentration of oxygen in the air in the alveoli is higher than that of
blood in lung capillaries.
According to Dalton’s law it follows that the partial pressure of oxygen
(pO2) is higher in the alveoli (pO2=103 mmHg) than in the lung capillaries
(pO2=40mmHg).
Oxygen therefore diffuses from the alveoli, where its concentration and
partial pressure is high to the lung capillaries, where its concentration and
partial pressure is low.
15. Compare and contrast the composition of inspired and expired air [4]
The composition of inspired and expired air
Component Inspired air % Expired air %

Oxygen 21 16
Carbon dioxide 0.04 4
Nitrogen and rare gases 78 78
Water vapour Variable Saturated
Comment
a. Inspired air has a higher oxygen concentration than expired air.

b. Expired air has a higher carbon dioxide concentration than inspired air.
c. Expired air is saturated with water vapour while the amount of water
vapour in inspired air varies with the humidity of the atmosphere.
d. Inspired and expired air has the same nitrogen concentration.
16. Describe internal respiration applying Dalton's law [6]
Internal respiration
[123]
Internal respiration refers to the exchange of gases (O2 and CO2) by

diffusion between blood in the systemic capillaries and tissue cells.
Dalton's law states that:
In a mixture of gases each gas exerts a partial pressure that is directly

proportional to its concentration in the mixture.
Diffusion of CO2
 Tissue cells have a high concentration of CO2 than blood in capillaries.

This is because metabolic processes taking place in cells give off carbon
dioxide (CO2) as a waste product. Blood in systemic capillaries is coming
from the lungs where carbon dioxide has been lost.
 The partial pressure of carbon dioxide (pCO2) in tissue cells is therefore

higher (pCO2=45mmHg) than in systemic capillaries (pCO2=40mmHg)
according to Dalton’s law.
 Carbon dioxide therefore diffuses from tissue, cells where its

concentration and pressure is high, to systemic capillaries, where it
concentration and partial pressure is low.
Diffusion of O2
 Blood in systemic capillaries is rich in oxygen picked in the lung and

therefore has a high concentration of oxygen. Tissue cells use up oxygen
for their metabolic activities and the concentration of oxygen in tissue
cells is low.
 According to Dalton’s law then, the partial pressure of oxygen is higher in

systemic capillaries (pO2=100 mmHg) than in the cells/tissues
(pO2=30mmHg).
 Oxygen therefore diffuses from the blood capillaries where its

concentration and partial pressure is high into the cells/tissues where its
concentration and partial pressure is low
[124]
17. Describe the transport of gases in the blood stream [4]
Transport of gases in the blood
a. Oxygen
Oxygen is transported in blood in two ways:
 Most of the oxygen (about 98.5%) is transported bound to the

haemoglobin in red blood cells. When oxygen chemically
combines with haemoglobin, oxyhaemoglobin is formed.
 A small percentage of oxygen (about 1.5%) is transported

dissolved in blood plasma (because oxygen does not easily
dissolve in water).
b. Carbon dioxide
Carbon dioxide is transported in blood in three ways:
 Most of the carbon dioxide (about 70%) is transported in blood as

bicarbonate ions (HCO3-).
 About 23% is transported loosely combined with haemoglobin

i.e. as carbaminohaemoglobin.
 The smallest percentage (about 7%) of carbon dioxide is

transported dissolved in plasma.
18. Explain the main mechanisms by which respiration is controlled [8]
Mechanism by which respiration is controlled
[125]
There are several mechanisms involved in the control of respiration. Some of

them are:
a. Voluntary control (=cortical control)
Control of respiration is normally involuntary. Voluntary control is

however possible because the cerebral cortex has connections with the
respiratory centre. Voluntary control of respiration is exercised during
activities such as speaking and singing.
b. Respiratory centre (=medullary respiratory centre)
The respiratory centre is formed by groups of nerve cells that control the
rate and depth of respiration. These nerve cells are situated in the brain
stem, in the medulla oblongata. Impulses leaving the respiratory centre
pass in the phrenic and intercostal nerves to the diaphragm and intercostal
muscles respectively. In this way the respiratory centre controls the rate
and depth of respiration.
c. Pneumotactic area (=pontine respiratory group; PRG)
The pneumotactic area is a collection of neurons in the pons of the brain.

The area plays a role in inhalation and exhalation by modifying the rate
and rhythm of breathing generated by the respiratory centre.
d. Chemoreceptors
Chemoreceptors are receptors that respond to changes in the partial

pressures of oxygen and carbon dioxide in blood and cerebrospinal fluid.
These receptors are located centrally and peripherally.
Central chemoreceptors: are on the surface of the medulla oblongata and

are bathed in cerebrospinal fluid. When the arterial pCO2 rises
(hypercapnia) the central chemoreceptors respond by stimulating the
respiratory centre, increasing ventilation of the lungs and reducing arterial
pCO2.
[126]
Peripheral chemoreceptors: these are situated in the arch of the aorta and
in the carotid bodies. Are more sensitive to small rises in arterial pCO 2
than to similarly low arterial pO2 levels. Impulses, generated in the
peripheral chemoreceptors, are conveyed by the glossopharyngeal and
vagus nerves to the medulla and stimulate the respiratory centre. the rate
and depth of breathing are then increased. An increase in blood acidity
(decreased pH or raised H+) stimulates the peripheral chemoreceptors,
resulting in increased ventilation.
e. Proprioceptor stimulation of breathing
Proprioceptors are receptors which monitor the movement of muscles and

joints. Impulses from these receptors stimulate the respiratory centre
leading to change in the rate and depth of breathing e.g. during exercise.
f. The inflation reflex (=Hering-Breuer reflex)
The walls of the bronchi and bronchioles have receptors sensitive to

stretch (=baroreceptors). Overinflation of the lungs stimulates these
receptors leading to the generation of impulses which inhibit the
respiratory centre. This causes further inhalation to stop and exhalation to
begin.
g. Other influences on respiration
Limbic system stimulation
Impulses from the hypothalamus and the limbic system stimulate the
respiratory centre leading to an increase in the rate and depth of breathing.
In this manner emotional stimuli can alter breathing as in crying, laughing,
and fear.
Temperature
In fever respiration is increased due to increased metabolic rate, while in

hypothermia respiration is decreased.
[127]
Pain
Sudden, severe pain can bring about a brief apnoea. Prolonged somatic
pain increases breathing. Visceral pain may slow the rate of breathing.
Irritation of the lungs
Physical or chemical irritation of the pharynx or larynx brings about

immediate cessation of breathing followed by coughing or sneezing.
Blood pressure
Carotid and aortic baroreceptors are sensitive to blood pressure. A sudden

rise in blood pressure decreases the rate of breathing and a decrease in
blood pressure increases the rate of breathing
Stretching the anal sphincter muscle
This action increases the breathing rate and is sometimes used to stimulate
respiration in a newborn baby or a person who has stopped breathing.
19. Outline five (5) factors that influence respiration [8]
[This question is a variation of the previous question. All the factors identified in
the previous question do influence respiration]
20. Describe the nervous control of respiration [5]
[Nervous control of respiration refers to the control of respiration through nerve

impulses. Nervous control of respiration is therefore by (a) the respiratory centre,
(b) the pneumotactic area, (c) proprioceptors, and (d) stretch receptors in the lungs
i.e. the inflation reflex. All these mechanisms have already been discussed]
21. Describe the chemical control of respiration [5]
[128]
[Chemical control of respiration refers to the control of respiration through

chemical composition. Chemical control of respiration is therefore through (a)
central chemoreceptors and (b) peripheral chemoreceptors. These mechanisms have
already been discussed]
22. Describe the role of the lungs in the maintenance of

acid-base balance (=pH) [6]
[NB: the use of chemical equations and formula when attempting this question may
not be necessary. These have been used here to enhance the student’s
understanding of how the lungs regulate pH]
The role of the lungs in the maintenance of acid-base balance
The respiratory system (=lungs) play an important role in the regulation of

the pH of blood. Regulation of blood pH by the respiratory system
involves the respiratory centre, chemoreceptors, and the lungs.
The respiratory centre is a vital centre located in the medulla oblongata

and the pons. The centre receives information from chemoreceptors and
responds by influencing the rate and depth of breathing (=ventilation) by
sending impulses to the diaphragm and the intercoastal muscles.
Chemoreceptors are special receptors that are located on the surface of the
medulla oblongata (=central chemoreceptors) and in the arch of the aorta
and the carotid bodies (=peripheral chemoreceptors). These receptors are
sensitive to changes in the levels of hydrogen ions (pH), as well as levels
of carbon dioxide (pCO2) and oxygen (pO2) in the blood stream. When
stimulated by these changes, chemoreceptors send information to the
respiratory centre which in turn sends impulses to the diaphragm and the
intercoastal muscles. In this manner the respiratory centre influences the
rate and depth of breathing (=ventilation).
When blood is too acidic i.e when there is an excess of hydrogen ions
Chemoreceptors detect the increase in the levels of hydrogen ions in

blood. Information is sent to the respiratory centre. The centre sends
impulses that have an effect of increasing the rate and depth of breathing
[129]
(=ventilation). An increase in ventilation helps to remove carbon dioxide

and therefore carbonic acid from the bloodstream. The events that occur
have an effect of decreasing the levels of hydrogen ions i.e cause an
increase in pH back to normal. These events are summarized in the
following equations:
The excess hydrogen ions (H+) are bound by bicarbonate
H+ + HCO3-  H2CO3
(hydrogen ion) (bicarbonate) (carbonic acid)
Carbonic acid is broken down into carbon dioxide and water.
H2CO3  CO2 + H2O

(carbonic acid) (carbon dioxide) (water)
The increase in ventilation removes carbon dioxide from the blood stream.
The result is a decrease in the levels of hydrogen ions in the bloodstream
increasing blood pH back to normal.
When blood is becoming more basic i.e. when there is a shortage of

hydrogen ions
Chemoreceptors detect the decrease in the levels of hydrogen ions in the

bloodstream. Impulses are sent to the respiratory centre. The centre sends
out impulses that have an effect of decreasing the rate and depth of
breathing (=ventilation). A decrease in ventilation leads to an
accumulation of carbon dioxide and therefore carbonic acid in blood. The
result is an increase in the levels of hydrogen ions i.e a decrease of pH
back to normal. The events that occur are summarized in the following
equations:
Carbon dioxide combines with water to form carbonic acid.
CO2 + H2O  H2CO3

(carbon dioxide) (water) (carbonic acid)
[130]
Carbonic acid releases hydrogen ions into the blood stream.
H2CO3  HCO3- + H+
(carbonic acid) (bicarbonate) (hydrogen ion)
Release of hydrogen ions into the bloodstream decreases the pH of blood

back to normal.
[131]

Matandane A. (MSc Development Studies.,
BSc NE., OTN., RGN) &
Moyo E. MA Ed., BSc NE., RGN
Objectives
At the end of chapter, the student should be able to:
 List the organs of the digestive system.

 Outline the processes/ functions performed by the digestive system.
 Describe the basic structure of the alimentary canal.
 Describe the structure of a tooth.
 State the functions of saliva.
 Describe the structure of the stomach.
 State/outline the functions of each of the following: the stomach, small
intestines, large intestines, pancreas, liver, and gall bladder
 Describe the secretion of gastric juice.
 State the functions of gastric juice.
 Describe the position and structure of the appendix.
 Describe the position and structure of the inguinal canal.
 Describe the structures of the pancreas.
 State the functions of pancreatic juice.
 Describe the structure of the gall bladder.
[132]
 Draw well labelled diagrams of each of the following: a section of a tooth,

longitudinal section of the stomach, the villus and its component parts, the
large intestine identifying its different sections, the pancreas in relation to
the duodenum and the biliary tract, the biliary tract showing the direction
of flow of bile.
1. Identify the organs of the digestive system [3]
Organs of the digestive system
Mouth Pharynx Esophagus Stomach

Small intestine Large intestine Rectum and anal canal
Accessory organs of the digestive system
Teeth Tongue Salivary glands Liver

Gallbladder Pancreas
2. Outline the five (5) basic processes (=functions) performed by the

digestive system [5]
a. Ingestion
Ingestion refers to the process by which foods and liquids are taken into
the mouth i.e. eating and drinking.
b. Secretion
Organs of the digestive system and accessory organs and tissues secrete
water, acids, buffers, mucus, hormones, and enzymes into the lumen of the
gastrointestinal tract.
c. Mixing and propulsion
[133]
Peristalsis mixes food and secretions and propels the contents of the
gastrointestinal tract along the tract.
d. Digestion
Mechanical digestion refers to the breaking down of food into smaller

particles by physical means such as the churning movements of the
stomach. Chemical digestion involves the breaking down of complex food
molecules into smaller molecules through the action of digestive enzymes.
e. Absorption
Water, minerals, vitamins, and drugs are absorbed from the lumen of the
gastrointestinal tract into blood capillaries or lymph vessels.
3. Draw a well labelled diagram illustrating organs of the digestive

system (=gastrointestinal system/gastrointestinal tract) [6]
3. Describe the basic structure of the alimentary canal [8]
The basic structure of the alimentary canal
The basic structure of the alimentary tract consists of the following layers:
a. Adventitia and peritoneum (=outer covering)
Adventitia
The part of the alimentary canal located in the thoracic cavity (e.g. the
oesophagus) has an outer covering consisting of a single layer of loose
fibrous tissue called the adventitia.
Peritoneum (=serosa)
[134]
Organs of the alimentary canal located in the abdominal and pelvic cavity
are covered by the peritoneum. The peritoneum is a closed sac of serous
membrane consisting of two layers (a) the parietal layer which lines the
abdominal wall and (b) the visceral layer which covers the organs
(viscera) within the abdominal and pelvic cavities.
The two layers of peritoneum are actually in contact and friction between
them is prevented by the presence of serous fluid.
The peritoneum is richly supplied with blood and lymph vessels, and
contains a considerable number of lymph nodes (lymph nodes prevent the
spread of local infection).
The arrangement of the peritoneum is such that the organs are invaginated
into the closed sac from below, behind and above so that they are at least
partly covered by the visceral layer.
b. Muscle layer (=muscularis)
Consists of two layers of smooth muscle: (a) an outer layer of longitudinal

fibers and (b) an inner layer of circular fibres.
Between these two muscle layers are blood vessels, lymph vessels and a
plexus (network) of nerves (called the myenteric plexus).
The myenteric plexus supply the smooth muscle layers causing peristalsis
(contraction and relaxation of smooth muscles) which propels contents
along the alimentary canal.
c. Submucosa
The submucosa consists of loose connective tissue (areolar connective

tissue) that binds the mucosa to the muscle layer. Within this layer are
blood and lymphatic vessels (receive absorbed nutrients) and nerves.
d. Mucosa
The mucosa consists of three layers of tissue (from the innermost layer to
the outermost layer) i.e. mucous membrane, lamina propria, and
muscularis mucosa
[135]
Mucous membrane
The mucous membrane lines the lumen of the gastrointestinal tract. This
layer is formed by columnar epithelium (and three main functions:
protection, secretion and absorption).
Lamina propria
Lamina propria consists of loose connective tissue and has many blood
and lymphatic vessels (through which nutrients are absorbed). The layer
also contains lymphatic tissue which protects against infection (especially
in the tonsils, small intestine, appendix, and large intestine).
Muscularis mucosa
A thin outer layer of smooth muscle.
4. Describe the structure and distribution of the peritoneum [5]
Structure and distribution of the peritoneum
The peritoneum is a closed sac of serous membrane containing serous

fluid. It is richly supplied with blood and lymph vessels. The peritoneum
also has numerous lymph nodes which prevent the local spread of
infection.
Layers of the peritoneum
The peritoneum has two layers: (1) parietal peritoneum and (2) visceral
peritoneum.
a. The parietal layer lines the anterior abdominal wall.

b. The visceral layer, which covers the organs (viscera) within the
abdominal and pelvic cavities.
[136]
The peritoneal cavity:
The peritoneal cavity is a potential space between the 2 layers of

peritoneum. The space contains small amounts of serous fluid. The fluid
prevents friction between the two layers of peritoneum.
In males it is completely closed but in females the uterine tubes open into
it and the ovaries are the only structures inside.
Distribution of the peritoneum
 Organs are invaginated into the closed sac from below, behind
and above so that they are at least partly covered by the visceral
layer.
 The stomach and intestines are almost completely surrounded by
peritoneum. The greater omentum as a fold of peritoneum which
encloses the stomach, extends beyond the greater curvature of the
stomach, and hangs down in front of the abdominal organs like
an apron.
 The pancreas, spleen, kidneys and adrenal glands are invaginated
from behind but only their anterior surfaces are covered.
 The liver is invaginated from above and is almost completely
covered by peritoneum.
 Main blood vessels and nerves pass close to the posterior
abdominal wall and send branches to the organs between folds of
peritoneum.
 Pelvic organs are covered only on their superior surface
5. Draw a well labelled diagram showing a section of a tooth [6]
6. Describe the structure of a tooth [6]
Structure of a tooth
Teeth are located in sockets of alveolar processes of the mandible and

maxillae. Alveolar processes are covered by gums (=gingiva). Sockets are
lined by the periodontal ligament or periodontal membrane made of dense
[137]
fibrous connective tissue. The periodontal ligaments or membrane anchor

the teeth in the socket walls and act a shock absorber during chewing.
External regions of the tooth
The tooth has three external regions: (1) the crown, (2) the root, (30
and the neck.
a. The crown
The crown is the part which is visible above the gums i.e. the part
which protrudes from the gums.
b. Root
This is the part of the tooth embedded bone.
c. The neck
The neck is the slightly narrowed region of the tooth between the
crown and the root. Cement is a bone-like substance that covers
the root of the tooth and fixes the root in its socket.
The internal structure of the tooth
Internally the tooth has the following;
a. Dentine
Dentine is a hard ivory-like substance that forms the majority of

the tooth. Dentine gives the tooth its basic shape and rigidity.
Dentine is harder than bone because it contains more
hydroxyapatite than bone.
b. Enamel
[138]
Enamel is a thin layer of a very hard substance which covers the

dentin of the crown. Enamel consists primarily of calcium
phosphate and calcium carbonate. It protects the tooth from wear
and tear during chewing.
c. Pulp cavity
The pulp cavity is an enlarged space located at the centre of the

tooth. The pulp cavity lies within the crown of the tooth. It
contains blood vessels, lymph vessels and nerves.
d. The apical foramen
The apical foramen is a small foramen at the apex of each root

through which blood vessels, lymph vessels, and nerves enter the
pulp cavity.
7. List the components of saliva [3]
Components of saliva
Water Mineral salts Salivary amylase

Mucus Lysozyme Immunoglobulins
8. Outline the functions of saliva [5]
Functions of saliva
a. Chemical digestion of polysaccharides
The digestive enzyme found in saliva, salivary amylase, breaks down

starch to maltose, maltotriose, and -dextrin.
[139]
b. Lubrication of food
Dry food entering the mouth is moistened and lubricated by saliva before
it can be made into a bolus ready for swallowing.
c. Cleansing and lubricating
The flow of saliva is necessary to cleanse the mouth and keep its tissues
soft, moist and pliable. Saliva prevents damage to the mucous membrane
by rough foodstuffs.
Mucus lubricates food so it can be moved easily in the mouth and be

swallowed.
d. Non-specific defence
The non-specific defence mechanisms of saliva include (1) the enzyme

lysozyme which kills bacteria, (2) immunoglobulin A (IgA) which combat
invading microbes.
e. Taste
Saliva dissolves food. Dissolved food molecules can then stimulate the
taste buds leading to the sensation of taste.
9. Describe the structure of the stomach [8]
Structure of the stomach
The stomach is continuous with the oesophagus at the cardiac sphincter

and with the duodenum at the pyloric sphincter.
Curvatures of the stomach
The stomach has two curvatures as follows:
[140]
a. Lesser curvature
The lesser curvature is the concave medial border of the stomach.

The lesser curvature is short and lies on the posterior surface of
the stomach. It is the downward continuation of the posterior wall
of the oesophagus. Just before the pyloric sphincter it curves
upwards to complete the J shape.
b. Greater curvature
The greater curvature is the convex lateral border of the stomach.

The curvature is longer. The greater curvature is the downward
continuation of the anterior wall of the oesophagus. From the
cardiac sphincter it angles acutely upwards, curves downwards
then slightly upwards towards the pyloric sphincter.
Regions of the stomach:
The regions of the stomach are: (a) the cardia, (b) the fundus, (c) the
body, and (d) the pyloric antrum (=pylorus).
a. The cardia surrounds the opening of the esophagus into the

stomach.
b. The fundus is the rounded portion superior to and to the left of
the cardia.
c. The body is the large central portion of the stomach inferior to
the fundus.
d. The pyloric region of the stomach is divisible into three regions:
(1) the pyloric antrum which connects to the body of the
stomach, (2) the pyloric canal which leads to the third region, (c)
the pylorus, which connects to the duodenum.
Sphincters of the stomach
a. Cardiac sphincter is located between the oesophagus and the

stomach.
[141]
b. Pyloric sphincter
Is located at the distal end of the pyloric region of the stomach.

The sphincter guards the opening between the stomach and the
duodenum.
Walls of the stomach
The walls of the stomach consist of the following:
a. Peritoneum
The peritoneum is the outermost layer of the stomach. It consists

of a closed sac of serious membrane called the peritoneum. The
peritoneum has two layers: (1) the parietal layer which lines the
abdominal wall and (2) the visceral layer which covers the
stomach. Between these two layers is a small amount of serous
fluid. The peritoneum is richly supplied with blood and lymph
vessels, and contains a large number of lymph nodes.
b. Muscle layer
The muscle layer consists of three layers of smooth muscle

fibres: (1) the outer layer has longitudinal fibres, (2) the middle
layer has circular fibres, and (c) the inner layer has oblique fibres.
This arrangement of muscle fibres allows for churning motion
and peristaltic movement.
c. Submucosa
The submucosa consists of loose connective tissue and elastic

fibres. Within this layer are blood vessels, nerves and lymph
vessels.
d. Mucosa
[142]
When the stomach is empty the mucosa of the lies in large folds
called rugae. When full the rugae are 'ironed out'. The mucosa
has numerous gastric glands which consist of specialised cells
that secrete gastric juice into the stomach.
10. Draw a well labelled diagram showing the longitudinal section

of the stomach [8]
11. State eight (8) functions of the stomach [8]
Functions of the stomach
a. The stomach mixes saliva, food, and gastric juice to form chyme.
b. The stomach temporarily stores food before it is released into the small
intestines. This allows times for digestive enzymes to act on the food.
c. Chemical digestion of food due to the action of the pepsin enzyme which
convert proteins to polypeptides. Pepsin therefore begins the digestion
proteins). Gastric lipase aids digestion of triglycerides.
d. Mechanical breakdown which involves the physical breaking down of

food into smaller particles due to the churning movement of the stomach.
e. Absorption of water, alcohol and some lipid-soluble drugs takes place in

the stomach.
f. Non-specific defence mechanisms of the stomach include the following:

(1) hydrochloric acid produced in the stomach destroys microbes ingested
in food and drink, (2) the vomiting reflex.
g. The acidic environment of the stomach dissolves ion salts. This is required
before iron can be absorbed further along the gastrointestinal tract.
h. The stomach produces the intrinsic factor needed for absorption of vitamin
B12 in the small intestines
[143]
i. Regulation of the passage of gastric contents into the duodenum. This is

due to the contraction and relaxation of the pyloric sphincter.
j. The stomach secretes gastrin into blood
12. Describe the secretion of gastric juice [6]
Secretion of gastric juice
The secretion of gastric juice occurs in three (3) phases namely the (a) cephalic
phase, (b) gastric phase, and (c) intestinal phase.
a. Cephalic phase
This refers to the flow of gastric juice before food actually enters the
stomach.
The secretion of gastric juice is due to reflex stimulation of the vagus
nerves initiated by the sight, smell or taste of food.
b. Gastric phase
This refers to the flow of gastric juice that occurs when food reaches the
stomach. Presence of food stimulates the enteroendocrine cells in the
pyloric antrum and duodenum to secrete a hormone called gastrin. Gastrin
passes directly into the circulating blood. When the gastrin in blood
reaches the stomach it stimulates the gastric glands to produce more
gastric juice.
In this way the secretion of digestive juice is continued after the
completion of the meal and the end of the cephalic phase.
c. Intestinal phase
The intestinal phase occurs when the partially digested contents of the
stomach reach the small intestine. Endocrine cells in the mucosa of the
small intestines produce a hormone complex called enterogastrone (i.e.
[144]
secretin and cholecystokinin (CCK)). Enterogastrone slows down the

secretion of gastric juice.
13. State six (6) functions of gastric juice [6]
Functions of gastric juice
a. The water in gastric juice further liquefies the food swallowed.
b. Hydrochloric acid in gastric juice acidifies the food and stops the action of
salivary amylase.
c. The acidic environment created by gastric juice destroys microbes

ingested in food and drink.
d. The acidic environment created by the acid in gastric juice is optimum for
the effective digestion of proteins by the enzyme pepsin.
e. Hydrochloric acid activates pepsinogens to pepsins. Pepsins begin the

digestion of proteins into smaller molecules.
f. Intrinsic factor (aprotein) in gastric juice promotes the absorption of

Vitamin B12 in the small intestines.
g. The mucus in gastric juice prevents mechanical injury to the stomach wall
by lubricating the contents. It prevents chemical injury by acting as a
barrier between the stomach wall and the corrosive gastric juice.
14. Draw a well labelled diagram of the villus illustrating its

component parts [4]
15. State six (6) functions of the small intestines [6]
Functions of the small intestines
[145]
a. Peristaltic movements propel the contents of the small intestines.
b. The small intestines also secrete intestinal juice.
c. Completion of chemical digestion of carbohydrates, protein and fats takes

place in the small intestines. The digestion of nucleic acids begins and
completes in the small intestines.
d. The small intestine has lymph follicles which protect against infection.
e. The small intestine secretes the hormones cholecystokinin (CCK) and

secretin.
f. Most of the absorption of nutrients occurs in the small intestines. Some

water is also absorbed from the small intestines.
16. Draw a well labelled diagram of the large intestine (=the colon
and rectum) identifying its different sections [6]
17. Outline five (5) functions of the large intestines (=colon

and rectum) [5]
Functions of the large intestines
a. Absorption
Water, mineral salts, vitamins, and some drugs are absorbed from the
large intestines into blood capillaries.
b. Formation of faeces
The absorption of water from the contents of the large intestines leads to
the achievement of the semisolid consistency of faeces.
c. Microbial activity
[146]
Bacteria in the large intestines (e.g. Escherichia coli, Enterobacter

aerogenes, Streptococcus faecalis and Clostridium perfringens) convert
proteins to amino acids, break down amino acids, and synthesize vitamin
B, vitamin K and folic acid.
d. Mass movement
Mass movements refer to strong peristalsis that occurs at fairly long

intervals (about twice an hour) in the large intestines. These peristaltic
movements propel the contents from the transverse colon into the
descending, sigmoid colons and rectum.
e. Defaecation
Defaecation involves contraction of the muscle of the rectum and

relaxation of the internal anal sphincter.
18. Describe the position and structure of the vermiform appendix [3]
[This question is related to an emergency surgical condition called appendicitis in

which the vermiform appendix in infected, inflamed, and eventually perforate. The
management of appendicitis is surgical and involves a procedure called
appendectomy]
Structure and position of the vermiform appendix
The appendix is a fine tube which is closed at one end. It leads away from
the caecum. The length of the appendix is about 13 cm in adults. The
walls of the appendix have the same structure as the walls of the large
intestine. The appendix however contains more lymphoid tissue.
19. Describe the position and structure of the inguinal canal [5]
[147]
[This question is related to a condition referred to as intestinal obstruction in which

the flow of the contents of the intestines is obstructed. One of the common causes
of intestinal obstruction is an inguinal hernia]
Structure the inguinal canal
The inguinal canal is 2.5 to 4 cm long. It passes obliquely through the abdominal
wall. It runs parallel to and immediately in front of the transversalis fascia and part
of the inguinal ligament. In males it contains the spermatic cord. In females it
contains the round ligament. It constitutes a weak point in the otherwise strong
abdominal wall through which herniation may occur.
20. Draw a well labelled diagram showing the pancreas in relation to

the duodenum and the biliary tract [6]
21. Describe the structure of the pancreas [8]
Structure of the pancreas
Colour, size and weight
The pancreas is pale and weighs about 60 grams. The gland is about 12–
15 cm long and 2.5 cm thick.
Location
The pancreas is located in the epigastric and left hypochondriac regions of

the abdominal cavity. The pancreas is a retroperitoneal gland. It lies
posterior to the greater curvature of the stomach.
Anatomical subdivisions
The pancreas consists of a (1) head i.e. the expanded portion, (2) body i.e.
the main central portion, and (3) tail i.e. the narrow portion) and is usually
connected to the duodenum by two ducts.
Associated structures
[148]
The head lies in the curve of the duodenum. The body of the pancreas lies
behind the stomach and the tail lies in front of the left kidney and just
reaches the spleen. The abdominal aorta and the inferior vena cava lie
behind the gland.
The exocrine pancreas
This consists of a large number of lobules made up of small alveoli. The

walls of the alveoli consist of secretory cells. Each lobule is drained by a
tiny duct and these tiny ducts unite to form the pancreatic duct. The
pancreatic duct extends the whole length of the gland. The pancreatic duct
joins the common bile duct to form the hepatopancreatic ampulla
(=ampulla of Vater).
The passage of pancreatic juice and bile through the hepatopancreatic

ampulla into the duodenum of the small intestine is regulated by a mass of
smooth muscle surrounding the ampulla known as the hepatopancreatic
sphincter (= sphincter of Oddi).
Another duct of the pancreas i.e. accessory duct (=duct of Santorini) leads
from the pancreas and empties into the duodenum about 2.5 cm superior
to the hepatopancreatic ampulla.
The endocrine pancreas
Distributed throughout the gland are groups of specialised cells called the
pancreatic islets (islets of Langerhans). The islets have no ducts so the
hormones that they produce e.g. insulin and glucagon diffuse directly into
the blood.
22. Outline the functions of the pancreas [4]
Functions of the pancreas
a. Exocrine pancreas
[149]
The exocrine pancreas produces pancreatic juice which contains enzymes

that digest carbohydrates (e.g. pancreatic amylase), proteins (e.g. trypsin),
and fats (e.g. lipase).
b. Endocrine pancreas
The endocrine pancreas secretes the hormones insulin and glucagon, these
two hormones principally regulate blood glucose levels.
23. List the components of pancreatic juice
Composition of pancreatic juice
Water Salts Protein-digesting enzymes: trypsin,

chymotrypsin, carboxylase, elastase
Sodium bicarbonate Lipase Nucleic acid-digesting enzymes:
deoxyribonuclease, ribonuclease
Pancreatic amylase
24. State five (5) functions of pancreatic juice [5]
Functions of pancreatic juice
a. Sodium bicarbonate in pancreatic juice neutralizes the acid in contents

from the stomach. This creates an optimum environment for the activity of
digestive enzymes in the small intestines.
b. Pancreatic amylase in pancreatic juice digests starch.
c. Trypsin, chymotrypsin, carboxypeptidase, and elastase digest proteins.
d. Lipase digests triglycerides.
[150]
e. Ribonuclease and deoxyribonuclease that digest ribonucleic acid (RNA)

and deoxyribonucleic acid (DNA) into nucleotides.
25. Outline ten (10) functions of the liver [10]
Functions of the liver
a. Carbohydrate metabolism
The following takes place in the liver:
 The liver converts glucose to glycogen and triglycerides for

storage when there is excess glucose in the bloodstream.
 The liver also converts of glycogen back to glucose when blood
glucose levels are low.
 The liver can also convert certain amino acids and lactic acid to
glucose.
 The liver can convert other sugars, such as fructose and
galactose, into glucose.
b. Fat metabolism
 Storage of some triglycerides.

 Breaks down fatty acids to generate ATP.
 Synthesize lipoproteins, which transport fatty acids, triglycerides,
and cholesterol to and from body cells.
 Synthesize cholesterol; and use cholesterol to make bile salts.
c. Protein metabolism
[151]
 Deamination of amino acids: involves the removal of the

nitrogenous portion i.e. The amino group (NH2) from amino
acids so that the amino acids can be used for ATP production or
converted to carbohydrates or fats.
 Break down of genetic material of worn-out cells of the body to

form uric acid which is excreted in the urine.
 Transamination i.e. removal of the nitrogenous portion of an

amino acid and attach it to a carbohydrate molecules forming
new non-essential amino acids.
 Synthesis of plasma proteins and most of the blood clotting factor

such as alpha and beta globulins, albumin, prothrombin, and
fibrinogen.
d. Metabolism of ethanol
This follows consumption of alcoholic drinks.
e. Inactivation of hormones and drugs
Hormones such as insulin, glucagon, cortisol, aldosterone, thyroid and sex

hormones, are inactivated in the liver.
The liver detoxifies substances such as alcohol and excretes drugs such as
penicillin, erythromycin, and sulfonamides into bile.
f. Synthesis of vitamin A from carotene
The liver syntheses vitamin D from a provitamin called carotene.
g. Production of heat
Many metabolic processes take place in the liver. These processes

generate large amounts of heat for the body.
[152]
h. Secretion of bile
The hepatocytes synthesise the constituents of bile from the mixed arterial
and venous blood in the sinusoids. The constituencies of bile are bile salts,
bile pigments and cholesterol.
Bile salts emulsify fats and promote absorption of lipids in the small
intestine.
i. Storage
The following are stored in the liver: (1) glycogen, (2) fat-soluble vitamins
i.e. A. D. E. K), (3) some water-soluble vitamins e.g. riboflavin, niacin,
pyridoxine, folic acid and vitamin B12, (4) minerals e.g. iron and copper.
j. Phagocytosis
Kupffer cells (=hepatic microphages) of the liver destroy aged red blood
cells, white blood cells, and some bacteria.
26. Draw a well labelled diagram showing the biliary tract and the direction
of flow of bile [8]
27. Describe the structure of the gall bladder [6]
Structure of the gall bladder
The gall bladder is a pear-shaped sac. The gall bladder is attached to the posterior
surface of the liver by connective tissue.
Anatomical subdivisions of the gall bladder are:
a. Fundus: the expanded end of the gall bladder.

b. Body: the main part.
c. Neck: is continuous with the cystic duct.
[153]
Layers forming the walls of the bladder
The gall bladder has the same layers of tissue as those described in the basic
structure of the alimentary canal, with some modifications.
a. Peritoneum
The peritoneum covers only the inferior surface. The gall bladder is in
contact with the posterior surface of the liver. It is held in place by the
visceral layer of the peritoneum.
b. Muscle layer
The muscle layer of the gall bladder has an additional layer of oblique
muscle fibers to the general structure of the gastrointestinal tract.
c. Mucous membrane
The mucosa of the bladder had rugae i.e. folds which allows the gall
bladder to distend as it fills with bile.
28. State three (3) functions of the gall bladder [3]
Functions of the gall bladder
a. The gall bladder stores bile before it is release into the bile ducts to the
duodenum.
b. The gall bladder concentrates bile by absorbing water through its walls.
c. Contraction of the smooth muscles of the gall bladder releases bile into the
bile ducts to the duodenum. Contraction is stimulated (1) the hormone
cholecystokinin (CCK), secreted by the duodenum, (2) the presence of fat
and acid chyme in the duodenum.
[154]

Reviewed by Maisiri J. (BSc. NE., RGN)
Objectives
At the end of the chapter, the student should be able to:
 List the organs and structures forming the urinary system.

 Draw a well labelled diagram showing organs of the urinary system.
 Describe the gross (=macroscopic) structure of the kidney.
 Draw a well labelled diagram showing a longitudinal section
(=gross/macroscopic structure) of a kidney.
 Describe the structure of the nephron (microscopic structure of a kidney).
 Draw a well labelled diagram of the nephron and associated blood vessels.
 Outline the functions of the kidneys.
 Describe the physiology of urine formation.
 Describe the structure of the urinary bladder.
 Describe the physiology of micturation in adults.
 Describe the role of the kidneys (=urinary system) in the maintenance of
blood pH (=acid-base balance).
[155]
1. List structures forming the urinary system [2]
Structures forming the urinary system
Kidneys x 2 Ureters x 2 Urinary bladder Urethra
2. Draw a well labelled diagram showing organs and structures

forming the urinary system [5]
3. Describe the gross (=macroscopic) structure of the kidney [6]
Gross structure of the kidney
Dimensions
A typical adult kidney is on average 10-12cm long, 5-7cm wide, and 3cm
thick.
Mass
The adult kidney has a mass of 135-150g.
Layers of tissues of the kidneys
The kidney has three layers of tissue i.e. (1) fibrous capsule, (2) renal
cortex, and (3) renal medulla.
(1) Fibrous capsule
This is a layer of dense irregular connective tissue which covers the

kidney.
[156]
(2) Renal cortex
The renal cortex is a reddish-brown layer of tissue found immediately

under the fibrous capsule and outside the renal pyramids. The portion of
the renal cortex located between the renal pyramids is called renal
columns.
(3) Renal medulla
The medulla is the innermost layer consisting of conical striations called

renal pyramids. Each renal pyramid has a base (the broad end) and an
apex (the narrow end).
Papilla
A papilla is found at the apex of a renal pyramid. Urine formed in the

kidneys passes through the papilla into a minor calyx.
Hilum
The hilum refers to the concave border of the kidney. Renal blood vessels,
lymph vessels, nerves, and the ureter leave the kidney through the hilum.
Renal pelvis
The renal pelvis is a funnel-shaped structure. It receives urine formed in

the kidney and passes it to the ureter.
Calyces
Calyces are distal branches of the renal pelvis. A minor calyx receives
urine from the papilla and delivers it into a major calyx. Urine flows from
the major calyx into the renal pelvis.
Ureters
[157]
The ureter is continuous with the renal pelvis and conveys urine from the
pelvis to the urinary bladder.
The walls of the renal pelvis contain smooth muscle and are lined with
transitional epithelium. Peristalsis of the smooth muscle propels urine
from the pelvis into the uterus to the bladder.
4. Draw a well labelled diagram showing the longitudinal

(=macroscopic/ gross structure) section of the right kidney [6]
5. Describe the structure of the nephron (=microscopic structure

of the kidney) [8]
Structure of the nephron
The nephron is the functional unit of the kidney. It consists of (1) the
glomerular (=Bowman’s) capsule and the glomerulus, and (2) the renal
tubule.
The glomerular capsule and glomerulus
The glomerular capsule is a double-walled epithelial cup-shaped structure.

That surrounds the glomerulus.
The glomerulus is a network of capillaries enclosed by the glomerular
capsule. Blood is filtered from the glomerulus into the glomerular capsule.
The renal tubule
Continuing from the glomerular capsule the nephron is described in three

parts i.e. proximal convoluted tubule, medullary loop (=loop of Henle)
and distal convoluted tubule, leading into a collecting duct.
a. The proximal convoluted tubule
[158]
The proximal convoluted tubule is continuous with the

glomerular capsule.
b. The loop of Henle
The loop of Henle (=medullary loop) is continuous with the

proximal convoluted tubule. The first part of the loop of Henle
dips into the renal medulla and is called the descending limb of
the loop of Henle. The loop takes a sharp turn and returns to the
renal cortex as the ascending limb of the loop of Henle.
c. The distal convoluted tubule
Continuous with the ascending loop of Henle is the distal

convoluted tubule and it empties into the collecting ducts.
Collecting ducts unite forming larger ducts that empty into the
minor calyces.
Blood vessels associated with the nephron
a. Afferent arteriole
The renal artery divides into smaller arteries and arterioles. In the
renal cortex an arteriole called the afferent arteriole enters into
the glomerular capsule. The arteriole then subdivides to form a
cluster of capillaries called the glomerulus.
b. Efferent arteriole
The arteriole leading away from the glomerulus is referred to as

the efferent arteriole. This arteriole breaks up into a second
network of capillaries to form a capillary bed. These capillaries
supply oxygen and nutrients to the rest of the nephron.
c. Venous drainage
[159]
Venous blood from the capillary bed eventually leaves the

kidneys in renal veins which empty into the inferior vena cava.
6. Draw a well labelled diagram of the nephron (=microscopic structure

of the kidney) and associated blood vessels. [6]
7. Outline six (6) functions of the kidneys [6]
Functions of the kidneys
a. Regulation of blood electrolyte concentrations
The kidneys help regulate the blood levels of several electrolytes such as
sodium (Na+), potassium ions (K+), calcium ions (Ca2+), chloride ions (Cl-)
and phosphate ions (HPO42-).
b. Regulation of blood pH
The kidneys regulate blood pH (=acid-base balance) through excretion or

conservation of hydrogen ions (H+) and bicarbonate ions (HCO3-).
c. Regulation of blood volume
The kidneys regulate blood volume by adjusting the amount of water

excreted in urine.
d. Regulation of blood pressure
The kidneys secrete an enzyme called renin. The enzyme regulates blood
pressure through the renin-angiotensin- aldosterone mechanism.
e. Maintenance of blood osmolality
The kidneys maintain a relatively constant blood osmolality through

regulating the amount of water and electrolytes excreted in urine.
[160]
f. Production of hormones
The kidneys produce a hormone called erythropoietin which promotes the

production of erythrocytes (=red blood cells). The kidneys also produce a
hormone called calcitriol (an active form of vitamin D) which regulate
calcium levels in the body.
g. Regulation of blood glucose levels
The kidneys, like the liver, can synthesize new glucose molecules from
the amino acid glutamine (this process is referred to as gluconeogenesis).
In this way the kidneys participate in the maintenance of blood glucose
levels.
h. Excretion of wastes and foreign substances
The kidneys removes metabolic wastes from the body including the
nitrogenous compounds (=urea and uric acid), excess ions, and some
drugs in urine.
8. Describe the physiology of urine formation [8]
Physiology of urine formation
There are three processes involved in the formation of urine namely simple
filtration, selective reabsorption, and secretion.
a. Simple filtration (=glomerular filtration)
Filtration involves the movement of small molecules such as water and

solutes from the blood in the glomerulus into the glomerular capsule.
Filtration occurs because the pressure in the glomerulus is higher than the
pressure in the glomerular capsule. In this way water and small molecules
pass through from blood into filtrate. Large molecules such as blood cells,
plasma proteins (e.g. albumin) and other large molecules remain in the
blood.
[161]
b. Selective reabsorption (=tubular reabsorption)
Selective reabsorption occurs as the filtrate flows through the convoluted

tubuless, loop of Henle, and the collecting ducts. Substance needed by
the body such as glucose and amino acids are reabsorbed into the blood
stream. Selective reabsorption occurs through active transport (using
energy to transport substances against their concentration gradients).
Other substances reabsorbed by active transport include sodium, calcium,
potassium, phosphate and chloride.
c. Secretion (=tubular secretion)
Substances not required by the body (e.g. excess ions) and foreign
materials (e.g. drugs not cleared from the blood by filtration) are cleared
by secretion. Filtration involves the transport of substances from blood
into the filtrate. Secretion occurs in the renal tubules and collecting ducts.
Secretion of hydrogen ions is important in the regulation of blood pH.
9. Describe the role of the kidneys in the maintenance of blood pH

(=acid-base balance) [5]
The role of the kidneys in acid-base balance
The urinary buffer system has a vital role in the regulation of the pH of
blood. Although this buffer system is slower to compensate for changes in
the pH of blood, it is more effective. There are many powerful
mechanisms by which the kidneys regulate the pH of blood.
When blood is becoming too acidic i.e. when there is an excess of

hydrogen ions:
The kidneys help to increase the pH of blood in a number of ways:
1. Secretion of hydrogen ions
[162]
Hydrogen ion secretion takes place in the proximal and distal convoluted
tubules of the nephron. The excess hydrogen ions are removed from the
bloodstream into urine.
The fate of the secreted hydrogen ions:
The hydrogen ions (H+) secreted into urine combines with buffers.
 The phosphate buffer
The excess hydrogen ions combine with hydrogen phosphate

(HPO42-) ions to form dihydrogen phosphate (H 2PO4-) ions. The
dihydrogen phosphate ions are excreted in urine as sodium salts
(NaH2PO4).
 The ammonia buffer
When blood pH is becoming too low the kidneys increase the

production of ammonia (NH3). Ammonia is secreted by the
epithelial cells of the renal tubules. (Ammonia is produced from
glutamine and the process is catalyzed by an enzyme called
glutaminase). Ammonia combines with the excess hydrogen ions
in urine to form ammonium (NH4+) ions. Ammonium ions are
excreted in urine as ammonium salts.
 The carbonic acid-bicarbonate buffer
Excess hydrogen ions combine with bicarbonate (HCO3-) to form

carbonic acid (H2CO3). Carbonic acid is broken down into carbon
dioxide (CO2) and water (H2O). The water is excreted in urine
and the carbon dioxide is reabsorbed from urine back into the
bloodstream.
2. The reabsorption of bicarbonate ions (HCO 3-) from urine
When blood pH is getting too low bicarbonate ions are absorbed from
urine into the blood stream (reabsorption of bicarbonate ions). The
[163]
increase of bicarbonate ions (a base) in the bloodstream increase the pH of

blood back to normal.
When blood is becoming too basic i.e. when there is shortage of hydrogen
ions
When blood pH in becoming too basic, the kidneys help to lower the pH
in a number of ways:
1. Bicarbonate secretion
Bicarbonate (HCO3-) secretion takes place in the distal convoluted tubules.

The more bicarbonate ions are removed from the bloodstream into urine
the more the pH of blood decreases.
2. Hydrogen phosphate (HPO4-) secretion
More hydrogen phosphate ions are secreted into urine.
3. Ammonia secretion
The rates of ammonia secretion is also reduced in the kidneys.
10. Describe the structure of the urinary bladder [8]
Structure of the urinary bladder
The urinary bladder is a hollow, distensible muscular organ.
Location
The bladder is situated in the pelvic cavity behind the symphysis pubis. In
females the bladder lies anterior to the vagina and inferior to the uterus. In
males the bladder lies in front of the rectum.
[164]
Shape
The bladder is roughly pear-shaped but it becomes more oval (=spherical)

as it fill with urine.
Capacity
The averages capacity of the bladder is 600-800mL. The capacity is

smaller in females because the uterus occupies the space above the
bladder.
Coverings: peritoneum and adventitia
The peritoneum covers the superior surface of the bladder. Anterior and
posterior surfaces of the bladder are covered with a layer of areolar
connective tissue (=adventitia).
Layers forming the walls of the bladder
a. An outer layer of connective tissue which contains blood vessels,

lymph vessels, and nerves.
b. A middle layer called the detrusor muscle (=intermediate

muscularis) consisting of three layers of smooth muscle fibers i.e.
inner longitudinal, middle circular, and outer longitudinal.
c. The mucosa which is the innermost layer consisting of

transitional epithelium.
The mucosa has folds called rugae that allow the bladder to
extend.
Orifices
The bladder has three orifices forming a trigone (=triangle) i.e. two
posterior orifices which are openings of the ureters and a lower orifice
which opens into the urethra.
[165]
Sphincters
The bladder has two sphincters i.e. (1) the internal sphincter consisting of
circular smooth muscle fibers and is not under voluntary control and (2)
the external sphincter consisting of skeletal muscle and is under voluntary
control.
11. Describe the physiology of micturation in adults [6]
Physiology of micturation
 Micturation occurs due to a combination of involuntary and voluntary

muscle contractions.
 When urine volume exceeds 200-400 mL pressure in the bladder increases
causing the walls of the bladder to stretch. Stretching of the walls
stimulate stretch receptors in the bladder walls leading to the generation of
nerve impulses.
 The nerve impulses are conveyed to the micturation center located in the
sacral area (S2 and S3) of the spinal cord.
 A micturation reflex is initiated and impulses are transmitted from the
micturation center to bladder muscle (=detrusor muscle) and the internal
urethral sphincter.
 The impulses cause the bladder muscles to contract and the internal
urethral sphincter to relax. At the same time the micturation center sends
impulses to the external urethral sphincter leading to its relaxation.
 Contraction of bladder muscles, relaxation of the internal and external
urethral sphincters cause micturation to take place. Micturation can also
be assisted by lowering of the diaphragm and contraction of abdominal
muscles (Valsalva’s manoeuvre).
 In adults the filling of the bladder initiates a conscious desire to urinate
before the micturation reflex actually takes place. Adults have the ability
to delay micturation for a limited period by exercising voluntary control
over the external urethral sphincter.
 Overdistension of the bladder causes pain and involuntary relaxation of
the external urethral sphincter causing urine to escape.
[166]

Reviewed by Masanzu Tonderai (BSc NE. RMN., RGN)
Objectives
At the end of this chapter, student should be able to:
 List the glands that from the endocrine system.

 Outline the functions (=actions) of hormones secreted by the pituitary
glands.
 Describe the structure and position of the thyroid gland, and structure s
associated with the gland.
 Outline the functions of thyroid hormones in the body.
 Describe the negative feedback regulation of thyroid hormones.
 Draw a well labelled diagram of the thyroid gland and its associated
structures.
 State the functions of each of the parathyroid hormone and calcitonin.
 State the functions of insulin in the body.
 Describe how blood glucose levels are regulated.
 State the actions of adrenocorticoid hormones.
 State the actions of adrenaline and noradrenaline in the body.
[167]
1. List any eight (8) glands that form the endocrine system [4]
Glands forming the endocrine system
Pituitary gland x 1 Thyroid gland x 1 Parathyroid glands x 4

Adrenal glands x 2 Pineal gland x 1 Thymus gland x 1
Ovaries in the female x 2 Testes in the male x 2 Pancreatic islets (islets of
Langerhans)
2. Outline the functions of the hormones secreted by the anterior

lobe of the pituitary gland [7]
Hormones secreted by the anterior lobe of the pituitary gland and their functions
a. Growth hormone (GH)
Growth hormone promotes the growth of tissues especially muscles and

bones.
The hormone also regulates metabolism including protein synthesis, tissue

repair, lipolysis, and elevation of blood glucose levels.
b. Thyroid stimulating hormone (TSH; thyrotropin)
TSH stimulates the thyroid gland to synthesize and secrete thyroid

hormones.
c. Adrenocorticotrophic hormone (ACTH; corticotrophin)
ACTH stimulates the adrenal cortex to secrete glucocorticoids (mainly

cortisol).
d. Prolactin (PRL)
[168]
PRL together with other hormones stimulates milk production in the

breasts.
e. Follicle stimulating hormone (FSH)
FSH stimulates testes to produce sperm.

FSH also promotes the maturation of ovarian follicles and ovulation.
In females the hormone stimulates secretion of oestrogen by the ovaries.
f. Luteinizing hormone (LH)
In males LH stimulates the testes to secrete testosterone. In females, LH

stimulates formation of corpus luteum and the secretion of estrogens and
progesterone.
g. Melanocyte-stimulating hormone (MSH)
The exact role of MSH in humans is unknown but when present in excess
it causes darkening of the skin.
3. Outline the actions of the hormones secreted by the posterior lobe of

the pituitary gland [4]
Hormones secreted by the posterior pituitary and their functions
a. Oxytocin
Oxytocin stimulates uterine muscles to contract during labour and

delivery.
After delivery oxytocin stimulates muscle cells of the breasts to contract
leading to the ejection of breast milk.
b. Antidiuretic hormone (ADH)
[169]
ADH decreases the production of urine by causing the kidneys to retain

more water.
High concentrations of ADH cause vasoconstriction in blood vessels of
the skin and abdominal organs leading to an increase in blood pressure.
ADH also decreases the water lost through sweating.
4. Describe the structure and position of the thyroid gland its related
structures [8]
Structure and position of the thyroid gland
The thyroid gland is located in the neck just inferior of the larynx and in
front of the trachea. The gland is situated at the level of the 5th, 6th and
7th cervical and 1st thoracic vertebrae.
The thyroid gland is a highly vascular and it weighs about 25 g. It is

surrounded by a fibrous capsule.
The gland is shaped like a butterfly and consists of two lobes, one on
either side of the thyroid cartilage and upper cartilaginous rings of the
trachea. The lobes of the thyroid gland lobes are joined by a narrow
isthmus. The isthmus lies in front of the trachea. Lobes of the thyroid
gland are roughly cone-shaped, +/- 5 cm long and 3 cm wide.
The thyroid gland is composed of cuboidal epithelium that forms spherical

follicles. The walls of the follicles consist of follicular cells. The follicular
cells produce two hormones: thyroxine (=tetraiodothyronine; T4) and
triiodothyronine (T3). (T3 and T4 together are known as thyroid
hormones).
Between the follicles are parafollicular cells (= C-cells) which secrete a

hormone called calcitonin (regulates calcium levels in the body).
The following structures are associated with the thyroid gland:
 The larynx: the thyroid gland is located in the neck just inferior of the
larynx.
[170]
 The trachea: the thyroid gland is located in front of the trachea.

 Superior and inferior thyroid arteries: the superior thyroid artery is a
branch of the external carotid artery and the inferior thyroid artery is a
branch of the subclavian artery. These arteries supply arterial blood to
the gland.
 Thyroid veins: thyroid veins drain venous blood from the gland into
the internal jugular veins.
 Parathyroid glands: two parathyroid glands lie against the posterior
surface of each lobe and are sometimes embedded in thyroid tissue.
 The recurrent laryngeal nerve: this nerve passes upwards close to the
lobes of the gland and on the right side it lies near the inferior thyroid
artery.
5. State five (5) functions of the thyroid hormones (T3 and T4) [5]
Functions of the thyroid hormones
a. Thyroid hormones increase the basal metabolic rate (BMR) by stimulating

the use of oxygen to produce adenosine triphosphate (ATP).
b. The production and use of ATP by cells caused by thyroid hormones

cause an increase in heat generation leading to an increase in body
temperature.
c. Thyroid hormones regulate metabolism. They promote the synthesis of

proteins, use of glucose and fatty acids, increase lipolysis, and increase
excretion of cholesterol (leading to a reduction in blood cholesterol
levels).
d. Thyroid hormones promote body growth, particularly of nervous and

skeletal tissues (together with the growth hormone and insulin).
e. Thyroid hormones enhance some effects of catecholamines (=adrenaline

and noradrenaline) leading to increase in heart rate, contraction of heart
muscle, and blood pressure.
6. Describe how levels of thyroid hormones (T3 and T4) are regulated
[171]
in the body(=negative feedback regulation of thyroid hormones) [8]
Regulation of thyroid hormones
When blood levels of T3 (=triiodothyronine) and T4 (=thyroxine) are low the

following occurs:
 The hypothalamus is stimulated to secrete more thyroid-releasing

hormone (TRH).
 TRH stimulates the anterior lobe of the pituitary gland to secrete more
thyroid-stimulating hormone (TSH).
 TSH stimulates the thyroid gland to secrete more thyroid hormones (T3
and T4).
 Blood levels of thyroid hormones increase as a result.
When blood levels of T3 (=triiodothyronine) and T4 (=thyroxine) are high the

following events occur:
 Raised blood levels of T3 and T4 inhibit the hypothalamus leading to a

reduction in the secretion of thyroid –releasing hormone (TRH).
 The anterior lobe of the pituitary gland is also inhibited leading to a
reduction in the secretion of thyroid-stimulating hormone (TSH).
 Low levels of TSH lead to a reduction of the secretion of thyroid
hormones by the thyroid gland.
 Blood levels of thyroid hormones are thereby reduced.
7. Draw a well labelled diagram illustrating the position of the thyroid

gland and its related structures [8]
[This question is often associated with thyroidectomy. In such cases the question
may require the student to draw a well labelled diagram of the thyroid gland and
related structures that may be damaged during thyroidectomy].
8. State the function(s) of each of the following hormones:
a. Parathyroid hormone (Parathormone; PTH) [4]

[172]
b. Calcitonin [2]
a. Functions of parathyroid hormone (PTH, parathormone)
PTH increases levels of calcium (Ca2+) and magnesium (Mg2+) in blood

and reduces levels of HPO42-) in blood.
PTH promotes the formation of calciferol (=the active form of vitamin D),
which increases the rate of dietary calcium and magnesium absorption
from the gastrointestinal tract.
PTH stimulates osteoclasts leading to an increase in resorption of calcium

from bones.
PTH also increases the amount of calcium reabsorbed by the kidneys and
promotes the excretion of HPO42- in urine.
b. Calcitonin (CT)
Calcitonin reduces blood calcium levels.
CT inhibits osteoclasts leading to a decrease in resorption of calcium from

bones.
The hormone also inhibits the reabsorption of calcium by the kidneys

leading to an increase in calcium excretion in urine.
9. List the hormones secreted by the endocrine pancreas and name

the cells that produce each of the hormones [3]
Hormones produced by the endocrine function
Hormone Cells where produced

a. Glucagon Alpha cells of the pancreatic islets.
b. Insulin Beta cells of the pancreatic islets.
[173]
c. Somatostatin (=growth Delta cells of the pancreatic islets.

hormone release inhibiting
hormone; GHRIH)
10. State the functions of insulin in the body [6]
[This question is related to an endocrine and metabolic condition known as diabetes

mellitus (DM). DM may be caused by inability of the body to produce the hormone
insulin or failure of the cells of the body to respond to its presence. In DM blood
glucose fluctuate significantly. There are several serious complications of DM
hence the need for its proper management. The management of DM often involves
the injection of insulin]
Functions of insulin
a. Insulin promotes the uptake of glucose and its use by cells.
b. The hormone also increases the conversion of glucose to glycogen

(=glycogenesis), particularly in the liver and skeletal muscles.
c. Insulin promotes the uptake of amino acids by the cells and the synthesis
of proteins from amino acids.
d. Insulin promotes the synthesis of fatty acids and the storage of fat in
adipose tissue (=lipogenesis).
e. Insulin decreases the conversion of glycogen to glucose i.e. the hormone

inhibits glycogenolysis.
f. Insulin prevents the breakdown of fats and proteins. The hormone

prevents the formation of new glucose molecules from proteins for
example i.e. insulin prevents gluconeogenesis.
11. State the functions of glucagon in the body [2]
[174]
Functions of glucagon
a. Glucagon prevents the conversion of glycogen to glucose in the liver and

skeletal muscles i.e. it inhibits glycogenolysis.
b. The hormone also promotes the formation of new sugar molecules from
proteins for example i.e. insulin promotes gluconeogenesis.
12. Describe how blood glucose levels are regulated in the body [6]
[This question is related to an endocrine and metabolic condition known as diabetes

mellitus (DM). DM may be caused by inability of the body to produce the hormone
insulin or failure of the cells of the body to respond to its presence. In DM blood
glucose fluctuate significantly. There are several serious complications of DM
hence the need for its proper management. The management of DM often involves
the injection of insulin]
Regulation of blood glucose levels
Normal blood glucose levels are controlled mainly by the opposing actions of
insulin and glucagon:
 Glucagon increases blood glucose levels

 Insulin reduces blood glucose levels.
When blood glucose levels are rising above normal the following events occur:
 Increased blood glucose levels stimulate the secretion of insulin.

 Insulin lowers blood glucose levels by: (1) stimulating uptake and use of
glucose by cells, (2) increasing glycogenesis, (3) accelerating uptake of
amino acids by cells, and the synthesis of protein, (4) promoting synthesis
of fatty acids and promoting lipogenesis, (5) decreasing glycogenolysis,
and (6) preventing the breakdown of protein and fat to produce new sugar
molecules (gluconeogenesis).
When blood glucose levels are decreasing below normal the following events
occur:
[175]
 Low blood glucose levels promote the secretion of glucagon.

 Glucagon increases blood glucose levels by: (1) stimulating the
conversion of glycogen to glucose in the liver and skeletal muscles
(=glycogenolysis) and (2) stimulating gluconeogenesis.
13. State the actions of each of the following groups of adrenocorticoid hormones:
a. Glucocorticoids [7]
b. Mineralocorticoids [2]
c. Androgens (sex hormones) [2]
Actions of adrenocorticoid hormones
a. Glucocorticoids (mainly cortisol)
 Glucocorticoids stimulate the breakdown of proteins to amino acids. The

amino acids may then be used for the synthesis of other proteins such as
enzymes or for the generation of ATP.
 Glucocorticoids stimulate liver cells to convert amino acids and lactic acid
to glucose i.e. they promote gluconeogenesis (formation of new sugar
from, for example, amino acids and proteins). The glucose is used by cells
for ATP production.
 Glucocorticoids promote lipolysis i.e. the breakdown of breakdown of

triglycerides (into fatty acids and glycerol) and release of fatty acids from
adipose tissue into the blood. Fatty acids can be used for energy
production.
 Glucocorticoids provide resistance to stress. They increase blood glucose

level which provides tissues with a source of ATP to combat stressors
such as fasting, temperature extremes, infection, surgery etc.
[176]
 In pathological and pharmacological quantities have an anti-inflammatory

action and suppress the response of tissues to injury delaying wound
healing
 High doses of glucocorticoids also depress immune responses.
 Glucocorticoids promoting absorption of sodium and water from renal

tubules (a weak mineralocorticoid effect).
b. Mineralocorticoids (mainly aldosterone)
 Mineralocorticoids promote the reabsorption of sodium (Na+) by the renal

tubules leading to water retention. The net result is an increase in blood
volume and blood pressure.
 Increase blood levels of sodium (Na+) and water.
 The hormones also decrease blood levels of potassium by promoting the

excretion of potassium in urine.
c. Androgens (sex hormones; mainly dehydroepiandrosterone, DHEA)
 Androgens may contribute to the onset of puberty and contribute to early

growth of axillary and pubic hair in both sexes.
 In females androgens contributes to libido and are source of oestrogens

after menopause.
14. State five (5) actions of adrenaline and noradrenaline

(=epinephrine and norepinephrine) [5]
Actions of adrenaline and noradrenaline
a. The hormones increase the heart rate and the force of contraction of heart
muscle.
[177]
b. Increase in heart rate and force of contraction of heart muscle causes an

increase in cardiac output and blood pressure. Increasing blood pressure
c. The hormones increase blood flow to vital organs such as the liver, heart,
brain, skeletal muscles, and adipose tissue. This occurs due to the dilation
of blood vessels supplying the vital organs and constriction of blood
vessels to less essential organs such as the skin.
d. Adrenaline and noradrenaline increase metabolic rate and also increase

blood levels of glucose and fatty acids.
e. The hormones cause dilation of the pupils.
f. The hormones also dilate airways to the lungs (bronchodilation).
[178]

Reviewed by Masanzu T. (BSc NE., RMN. RGN) &
Shoniwa L. (BSc. NE., RGN)
Objectives
 Draw a well labelled diagrams illustrating a myelinated neuron and a non-

myelinated neuron.
 Describe the generation and transmission of an action potential.
 State the function of each of the sensory nerves and motor nerves.
 Describe the transmission of nerve impulses at the synapse and the
neuromuscular junction.
 Outline the functions of neuroglial cells.
 Describe the structure of the meninges.
 State the functions of cerebrospinal fluid.
 Describe the production and flow of cerebrospinal fluid.
 Draw a well labelled diagram illustrating the flow of cerebrospinal fluid.
 Outline the functional areas of the cerebrum.
 State the functions of the the following: hypothalamus, reticular
formation, and the cerebellum.
 Describe the spinal reflex arc.
 Draw a well labelled diagram illustrating a simple reflex arc.
 State the function(s) of each of the 12 cranial nerves.
 Compare and contrast the effects of stimulation of the sympathetic and the
parasympathetic divisions of the autonomic nervous system on body
systems.
[179]
1. Draw a well labelled diagram illustrating:
a. Myelinated neuron [6]

b. Non-myelinated neuron [6]
2. Describe the generation and transmission of an action potential [8]
The generation and transmission of an action potential
a. Resting membrane potential
Resting membrane potential describes the steady state of the cell, which is
a dynamic process that is balanced by ion leakage and ion pumping.
Without any outside influence, it will not change. To get an electrical
signal started, the membrane potential has to change.
b. Depolarisation
This starts with a channel opening for Na+ in the membrane. Because the
concentration of Na+ is higher outside the cell than inside the cell by a
factor of 10, ions will rush into the cell that are driven largely by the
concentration gradient. Because sodium is a positively charged ion, it will
change the relative voltage immediately inside the cell relative to
immediately outside. The resting potential is the state of the membrane at
a voltage of -70 mV, so the sodium cation entering the cell will cause it to
become less negative. This is known as depolarization, meaning the
membrane potential moves toward zero.
The concentration gradient for Na+ is so strong that it will continue to

enter the cell even after the membrane potential has become zero, so that
the voltage immediately around the pore begins to become positive. The
electrical gradient also plays a role, as negative proteins below the
membrane attract the sodium ion. The membrane potential will reach +30
mV by the time sodium has entered the cell.
c. Repolarisation
[180]
As the membrane potential reaches +30 mV, other voltage-gated channels

are opening in the membrane. These channels are specific for the
potassium ion. A concentration gradient acts on K+, as well. As K+ starts
to leave the cell, taking a positive charge with it, the membrane potential
begins to move back toward its resting voltage. This is called
repolarization, meaning that the membrane voltage moves back toward the
-70 mV value of the resting membrane potential.
Repolarization returns the membrane potential to the -70 mV value that

indicates the resting potential, but it actually overshoots that value.
Potassium ions reach equilibrium when the membrane voltage is below -
70 mV, so a period of hyperpolarization occurs while the K+ channels are
open. Those K+ channels are slightly delayed in closing, accounting for
this short overshoot.
5. State the function of each of the following:
a. Sensory nerves [1]

b. Motor nerves [1]
a. Sensory nerves
Sensory nerves, sometimes called afferent nerves, carry information from

the outside world, such as sensations of heat, cold, and pain, to the brain
and spinal cord.
b. Motor nerves
Motor nerves, or efferent nerves, transmit impulses from the brain and
spinal cord to the muscles.
4. Describe the transmission of nerve impulses
a. At the synapse [5]

b. At the neuromuscular junction [5]
[181]
a. Nerve impulse transmission at the synapse
The point at which nerve impulses pass from one neurone to another is
refered to as the synapse. The synapse consists of synaptic knobs of of
branches of axons of the presynaptic neurone and dendrites and cell
bodies of the postsynaptic neurone. There is no physical contact between
the neurones but only a potential space called the synaptic cleft.
The neurone sysnthesise a chemical called a neurotransmitter. The
neurotransmitters are transported along the axon and are stored in
vescicles located in the synaptic knobs.
An action potential causes the vescicles to release the neurotransmitter (by
exocytosis) into the synaptic cleft. The neurotransmitter acts on receptor
sites on the cell membrane of the postsynaptic neurone. The
neurotransmitter can have an excitory effect at the synatpse or an
inhibitory effect.
Imediately after the neurotransmitter has stimulated the postsynaptic
membrane it is removed by the action of enzymes or is taken back
(=reuptake) into the synaptic knob. The action of the neurotransmitter at
the synapse is therefore short-lived.
b. Nerve impulse transmission at the neuromuscular junction
The point at which nerve impulses are passed from the axon of a motor
neurone to a muscle fibre is refered to as the neuromuscular junction.
Axons of motor neurones divide into fine fialaments whic terminate in
minute pads called motor end-plates. The motor end-plates are in close
proximity with a sensitive surface of a muscle fibre. There is no physcial
contact but only a potential space. Each muscle fibre is stimulated by one
motor end-plate.
The nerve impulse is passed across the space between the motor end-plate
and the muscle fibre by a neurotransmitter called acetylcholine.
A group of muscle fibres and motor end-plates that supply them is refered
to as a motor unit. Nerve impulses cause serial contractions of motor units
in muscle. Each unit contracts to its full capacity. The strength of muscle
contraction depends on how many motor units in the muscle are in action
at that particular time.
6. Outline the functions of neuroglial cells [5]
[182]
Functions of neuroglial cells
a. The primary function of astrocytes is to provide structural and metabolic

support for neurons. Astrocytes aid in signaling between neurons and
brain blood vessels. This allows blood flow to increase or decrease
depending on neuron activity. Other functions of astrocytes include
glycogen storage, nutrient provision, ion concentration regulation, and
neuron repair.
b. Functions of ependymal cells include CSF production, nutrient provision

for neurons, filtration of harmful substances, and neurotransmitter
distribution.
c. Microglia are extremely small cells of the central nervous system that
remove cellular waste and protect against microorganisms (bacteria,
viruses, parasites, etc.). Microglia are thought to be macrophages, a type
of white blood cell that protects against foreign matter. They also help to
reduce inflammation through the release of anti-inflammatory chemical
signals. Microglia also function to protect the brain when neurons become
injured or diseased by disabling the malfunctioning neurons.
d. Ependymal cells are glial cells that line the central cavities of the brain
and the spinal cord; the beating of their cilia helps to circulate the
cerebrospinal fluid that fills those cavities and forms a protective cushion
around the CNS.
e. Oligodendrocytes wrap their flat extensions tightly around the nerve

fibres, producing fatty insulating coverings called myelin sheaths.
Schwann cells form the myelin sheaths around nerve fibres that are found
in the PNS.
f. Satellite cells cover and protect neurons of the peripheral nervous system.
They provide structure and metabolic support for sensory, sympathetic,
and parasympathetic nerves. Sensory satellite glial cells are involved in
the development of chronic pain.
6. Describe the structure of the meninges [8]
[183]
The brain and spinal cord are covered by four membranes called
collectively the meninges.
a. Pia mater
The pia mater is the meningeal envelope that firmly adheres to

the surface of the brain and spinal cord. It is a very thin
membrane composed of fibrous tissue covered on its outer
surface by a sheet of flat cells thought to be impermeable to fluid.
The pia mater is pierced by blood vessels that travel to the brain
and spinal cord.
b. Arachnoid mater
Over the pia mater and separated from it by a space called the
subarachnoid space is the arachnoid, a thin, transparent
membrane. The arachnoid mater is an avascular coat also loosely
applied to the brain and spinal cord and closely adherent to the
dura mater. It penetrates the dura mater at intervals and forms the
arachnoid villi or granulations which filter cerebrospinal fluid
back into the venous system. It is composed of fibrous tissue and,
like the pia mater, is covered by flat cells also thought to be
impermeable to fluid. The arachnoid does not follow the
convolutions of the surface of the brain and so looks like a
loosely fitting sac. In the region of the brain, particularly, a large
number of fine filaments called arachnoid trabeculae pass from
the arachnoid through the subarachnoid space to blend with the
tissue of the pia mater. The arachnoid trabeculae are embryologic
remnants of the common origin of the arachnoid and pia mater,
and they have the frail structure characteristic of these two of the
meninges. The pia mater and arachnoid together are called the
leptomeninges.
c. Dura mater
The dura mater, the outer covering, is a tough fibrous coat

consisting of two layers. The outer layer lines the skull, the inner
one loosely covering the brain and spinal cord. These two layers
are closely adherent, but they separate to form the venous
[184]
sinuses. The outer portion of the dura mater over the brain serves
as a covering, or periosteum, of the inner surfaces of the skull
bones.
The inner layer dips down between the two cerebral hemispheres
forming the falx cerebri. It also forms a fold separating the
cerebral hemispheres from the cerebellum forming the tentorium
cerebelli. The dura mater is the outer covering of the spinal cord
also, but extends beyond the end of the spinal cord to the level of
the second sacral vertebra. Between the dura mater and the
arachnoid mater is a potential space, the subdural space in which
there is a network of blood vessels. The dura mater surrounds and
supports the large venous channels (dural sinuses) carrying blood
from the brain toward the heart.
Within the vertebral canal the dura mater splits into two sheets
separated by the epidural space, which is filled with veins. The
outer of these two sheets constitutes the periosteum of the
vertebral canal. The inner sheet is separated from the arachnoid
by the narrow subdural space, which is filled with fluid. In a few
places, the subdural space is absent, and the arachnoid is
intimately fused with the dura mater. The most important area of
fusion between these two meninges is in the walls of the large
venous channels of the dura mater where elongations of the
arachnoid, like fingers, penetrate the dura mater and project into
the veins. These fingerlike processes of the arachnoid, called
arachnoid villi or arachnoid granulations, are involved in the
passage of cerebrospinal fluid from the subarachnoid space to the
dural sinuses. Spinal anesthetics are often introduced into the
subarachnoid space.
7. List any six (6) the components of cerebrospinal fluid [3]
Components of cerebrospinal fluid
Water Creatinine & Urea Protein Plasma proteins (albumin

and globulin in small quantities)
Glucose Leukocytes (a few) Mineral salts :Sodium Phosphate
[185]
8. State four (4) functions of cerebrospinal fluid [4]
Functions of cerebrospinal fluid
a. Cerebrospinal fluid plays an essential role in homeostasis of the interstitial

ﬂuid of the brain parenchyma and regulation of neuronal functioning.
b. Provide physical support and buoyancy for the brain. CSF protective,
because its volume fluctuates reciprocally with changes in intracranial
blood volume to contribute to a safe intracranial pressure (ICP).
c. Provide a pathway for removal of metabolites from the brain extracellular

fluid into the venous system.
d. Sustain proper osmotic and ionic balances in the extra cellular fluid for
normal neuronal function.
9. Describe the production and flow of cerebrospinal fluid [8]
Production and flow of cerebrospinal fluid
 The cerebrospinal fluid (CSF) is produced from arterial blood by the

choroid plexuses of the lateral and fourth ventricles by a combined
process of diffusion, pinocytosis and active transfer. A small amount
is also produced by ependymal cells. The choroid plexus consists of
tufts of capillaries with thin fenestrated endothelial cells. These are
covered by modified ependymal cells with bulbous microvilli. The
total volume of CSF in the adult ranges from140 to 270 ml. The
volume of the ventricles is about 25 ml. CSF is produced at a rate of
0.2 - 0.7 ml per minute or 600-700 ml per day.
 The circulation of CSF is aided by the pulsations of the choroid
plexus and by the motion of the cilia of ependymal cells.
 Beginning in the lateral ventricles, CSF flows through two
passageways (interventricular foramena) into the third ventricle.
[186]
 From the third ventricle it flows down a long, narrow passageway (the
aqueduct of Sylvius; the cerebral aqueduct) into the fourth ventricle.
 From the fourth ventricle it passes through two small openings
(foramina) located at the roof of the fourth ventrcle into the
subarachnoid space and surround the brain.
 Cerebrospinal fluid also flows from the fourth ventrcle down the
central canal of spinal cord.
 The arachnoid villi act as one-way valves between the subarachnoid
space and the dural sinuses. CSF is absorbed through blood vessels
over the surface of the brain back into the bloodstream. Some
absorption also occurs through the lymphatic system.
 Once in the bloodstream, it is carried away and filtered by the kidneys
and liver in the same way as are other body fluids.
10. Draw a well labelled diagram illustrating the flow of

cerebrospinal fluid [6]
11. Outline the functional areas of the cerebrum [8]
Functional areas of the cerebrum
Motor areas of the cerebrum are as follows:
a. The precentral (motor) area.
The precentral area is located in the frontal lobe of the cerebral

cortex anterior to the central sulcus.
Function: the area initiate the contraction of skeletal muscles.
b. The premotor area
The premotor area is located in the frontal lobe immediately

anterior to the precentral (motor) area.
Functions
[187]
The area exerts a controlling influence over the motor area,

ensuring an orderly series of movements.
The motor speech area located in the lower part of the premotor
area controls the movements necessary for speech.
The frontal area
This extends anteriorly from the premotor area to include the remainder of
the frontal lobe.
Function: communication between this and the other regions in the

cerebrum are responsible for the behavior, character and emotional state of
the individual.
Sensory areas of the cerebrum
a. The postcentral (sensory) area
This is the area behind the central sulcus.
Functions: perception of sensations of pain, temperature, pressure

and touch, knowledge of muscular movement and the position
the body.
b. The parietal area
This area lies behind the postcentral area and includes the greater
part of the parietal lobe of the cerebrum.
Functions:
The area is associated with obtaining and retaining accurate
knowledge of objects. Objects can be recognized by touch alone
because of memory from past experience retained in this area.
c. The sensory speech area
[188]
This area is situated in the lower part of the parietal lobe and
extends into the temporal lobe.
Functions:
The area is responsible for the perception of the spoken word.
d. The auditory (hearing) area
This area lies immediately below the lateral sulcus within the
temporal lobe.
Functions: the area receives and interpret impulses transmitted

from the inner ear by the cochlear (auditory) part of the
vestibulocochlear nerves (8th cranial nerves) leading to the
perception of sound.
.
e. The olfactory (smell) area
The olfactory area lies deep within the temporal lobe.
Function: receives impulses from the nose via the olfactory (I)
nerves and interprets the impulses as smell.
f. The taste area
The taste area is located just above the lateral sulcus in the deep
layers of the sensory area.
Function: receives impulses from the taste receptors located in

taste buds of the tongue and interprets them as taste.
g. The visual area
The visual area is located lies behind the parieto-occipital sulcus

and includes the greater part of the occipital lobe.
[189]
Function: receives impulses from the eyes via the optic (II) nerve
and interprets the impulses as visual impressions.
12. State any six (6) the functions of the hypothalamus [6]
Functions of the hypothalamus
a. Hormone secretion is regulated by the hypothalamus through the releasing

and inhibitor factors such as the thyrotropin releasing, gonadotropin
releasing, corticotrophin releasing, somatostatin and dopamine.
b. Releases gonadotropin realising hormone stimulates the production of

luteinizing hormone and follicle stimulating hormone to determine the
oestrogen and testosterone production.
c. Regulates both sympathetic and parasympathetic systems.
d. Control body water through the antdiuretic hormone secretion that

increase sodium and water retention.
e. The hypothalamus control appetite and food intake through the

ventromedial, dorsomedial, paraventricular and lateral hypothalamus
nucleus.
f. Regulates body temperature through heat loss either by sweating or

vasodilation and heat production through vasoconstriction and
thermogenesis.
13. State the functions of the reticular formation [4]
Functions of the reticular formation
a. Modulates spinal reflex activity and may also modulate sensory input by
regulating the gain at synapses within the spinal cord. The reticulospinal
tract also carries axons that modulate autonomic activity in the spinal
cord.
[190]
b. Regulates arousal and level of consciousness is a generalized function of

the reticular formation. The neurons of the reticular formation are excited
by a variety of sensory stimuli that are conducted by way of collaterals
from the somatosensory, auditory, visual, and visceral sensory systems.
c. The ascending reticular formation responsible for the sleep-wake cycle,

thus mediating various levels of alertness. This part of the reticular system
projects to the mid-line group of the thalamus, which also plays a role in
wakefulness. From there, information is sent to the cortex.
d. The descending reticular formation is involved in posture and equilibrium

as well as autonomic nervous system activity. It receives information from
the hypothalamus. The descending reticular formation also plays a role in
motor movement.
14. State the functions of the cerebellum [4]
Functions of the cerebellum
a. Receives information from the sensory systems, the spinal cord, and other
parts of the brain and then regulates motor movements.
b. Coordinate voluntary movements such as posture, balance, and speech,

resulting in smooth and balanced muscular activity.
c. Coordinate the timing and force of these different muscle groups to

produce fluid limb or body movements.
d. The cerebellum is important for motor learning. The cerebellum plays a

major role in adapting and fine-tuning motor programs to make accurate
movements through a trial-and-error process.
e. Cognitive functions. Although the cerebellum is most understood in terms

of its contributions to motor control, it is also involved in certain cognitive
functions, such as language.
[191]
15. Describe the spinal reflex arc [6]
The spinal reflex arc
A reflex action is an immediate motor response to a sensory stimuli.

Spinal reflexes are those which act through the spinal cord.
A simple reflex arc consists of three elemens Ii.e. (a) a sensory neurone,
(b) a connector neurone, and (c) a lower motor neurone.
The skin and muscles tissue have receptors for different senses such as
pain, temperature, touch, stretch etc. When these receptors are stimulated
they generate nerve impulses. The nerve impulses are passed to a sensory
neurone (=sensory nerve fibre) to the posterior horn of the spinal cord.
In the spinal cord impulses are passed form the sensory neurone to a
connector neurone.
The connector neurone in turn stimulates a lower motor neurone which

results in efferent nerve impulses which are transmitted to the effector
organ, a skeletal muscle, causing it to contract. This results in the pulling
away of the affected aprt of the body away from the source of the
stimulus.
It is found that although these spinal reflexes do not need the brain for
their action, sensory information is also sent to the brain through the
ascending pathways. Impulses from the brain may be inhibitory, so
modifying the action of a reflex. Some cranial nerves are also involved in
reflexes, such as the light reflex, when the pupil of the eye contracts if a
light is shined in it. The maintenance of posture and muscle tone involves
reflexes and there are also superficial reflexes.
16. Draw a well labelled diagram illustrating a simple reflex arc [6]
17. Outline the function(s) of the 12 cranial nerves [12]
Cranial nerves and their functions

[192]
Cranial nerve Type Functions

I: Olfactory Nerve Sensory nerve Controls sense of smell
II: Optic Nerve Sensory nerve Controls vision by sending
information from retina
III: Oculomotor Nerve Motor nerve Controls most eye muscles.
Works closely with Cranial
Nerves 4& 6. Controls eye
movement, pupil dilation, and
pupillary constriction. It also
controls the muscles that elevate
the upper eyelids.
IV: Trochlear Nerve- Motor nerve- Controls the downward and
outward movement of the eye.
Works closely with Cranial
Nerves 3 & 6.
V: Trigeminal Nerve Motor and Carries sensory information from
sensory nerve most of the head, neck, sinuses,
and face. Also carries sensory
information for ear and tympanic
membrane. Provides motor
supply to the muscles of
masticulation (chewing), and to
some of the muscles on the floor
of the mouth. Also provides
motor supply to tensor tympani
(small muscle in the middle ear
which tenses to protect the
eardrum).
VI: Abducens Nerve Motor nerve Controls the outward movement
of the eye.
VII: Facial Nerve Mixed Supplies the muscles of facial
expression. Supplies posterior
belly of digastric muscle (small
muscle on underside of jaw).
Supplies Stylohyoid muscle (used
in swallowing).Supplies stapedius
muscle (middle ear). Controls
taste sensations from the anterior
2/3 of the tongue.
[193]
VIII: Vestibulocochlear Sensory nerve Controls hearing and balance.

Nerve Vestibular nerve receives
positional information. Cochlear
nerve transmits information on
sound to the brain.
IX: Glossopharyneal Mixed Controls some muscles used in
Nerve swallowing including movement
and sensation of throat, nasal
passages and tongue. Controls
taste from the posterior one third
of tongue.
X: Vagus Nerve Mixed Controls muscles of the pharynx
and larynx. Processes sensory
information from external ear,
pharynx, larynx and viscera.
Serves the throat, nasal passages,
heart, lungs and stomach.
XI: Spinal/Accessory Motor nerve Controls muscles used in head
and shoulder movement.
XII: Hypoglossal Nerve Motor nerve Controls muscles of the tongue.
18. Compare and contrast the effects of stimulation of the sympathetic and the
parasympathetic divisions of the autonomic nervous system on body systems [12]
Effects of sympathetic and parasympathetic stumulation on body systems
Body system Sympathetic stimulation Parasympathetic stimulation

Cardiovascular Exerts an accelerating effect upon Decreases the rate and force ofthe
the sinoatrial node in the heart, heartbeat.
increasing the rate and force of the Causes constriction ofthe coronary
heartbeat. arteries reducing the blood supply to
Causes dilatation of the coronary cardiac muscle.
arteries, increasing the blood supply
to cardiac muscle.
Causes dilatation of theblood vessels
supplying skeletal muscle, increasing
the supply of oxygen and nutritional
materials and the removal of
metabolic waste products, thus
increasing the capacity of the muscle
[194]
to work.
Raises peripheral resistance and
blood pressure by constricting the
small arteries and arterioles in the
skin. In this way an increased blood
supply is available for highly active
tissue, such as skeletal muscle, heart,
brain.
Constricts the blood vessels in the
secretory glandsof the digestive
system, reducing the flow of
digestive juices. This raises the
volume of blood available for
circulation in dilated blood vessels.
Blood coagulation occurs more
quickly because of vasoconstriction.
Respiratory This causes dilatation of the airways, Produces constriction of the bronchi.
especially the bronchioles, allowing
a greater amount of air to enter the
lungs at each inspiration and
increases the respiratory rate. In
conjunction with the increased heart
rate, the oxygen intake and carbon
dioxide output of the body are
increased.
Digestive The liver converts an increased The stomach and small intestine. The
amount of glycogen to glucose, rate of digestion and absorption of food
making more carbohydrate is increased.
immediatelavailable to provide The pancreas. There is an increase in the
energy. secretion of pancreatic juice and the
The adrenal (suprarenal) glands are hormone insulin.
stimulated to secrete adrenaline and
noradrenaline which potentiate and
sustain the effects of sympathetic
stimulation.
The stomach and small intestine.
Smooth muscle contraction and
secretion of digestive juices are
inhibited, delaying digestion, onward
movement and absorption of food
and the tone of sphincter muscles is
increased.
Themetabolic rate is greatly
increased.
Urinary Urethral and anal sphincters. The Urethral and anal sphincters.
muscle tone of the sphincters is Relaxationof the internal urethral
[195]
increased, inhibiting micturition and sphincter is accompanied by contraction

defecation. of the muscle of the bladder wall and
micturitionoccurs.
Thebladder wall relaxes.
Similar relaxation of the internal anal
sphincter is accompanied by contraction
of the muscle of the rectum and
defecation occurs. In both cases there is
voluntary relaxation of the external
sphincters.
Eyes This causes contraction of the This causes contraction of the circular
radiating muscle fibres muscle fibres of
of the iris, dilating the pupil. the iris, constricting the pupil. The
Retraction of the levator palpebral eyelids tend to close,
muscles occurs, opening the eyes giving the appearance of sleepiness
wide and
giving the appearance of alertness
and excitement. The
ciliary muscle that adjusts the
thickness of the lens is
slightly relaxed.
Skin Causes increased secretion ofsweat, There is no parasympathetic nerve

leading to increased heat loss from supply to the skin
the body.
Produces contraction ofthe arrectores
pilorum (the muscles in the hair
follicles of the skin), giving the
appearance of 'goose flesh'.
Causes constriction ofthe blood
vessels preventing heat loss.
[196]

Reviewed by Muvhu S. (M Adult Ed., BSc NE., RGN)
Objectives
At the end of this chapter, student should be able to:
 List the special senses and identify the sense organ for each.
 Describe the structure of the human ear.
 Draw a well labelled diagram illustrating the structure of the human ear.
 Describe the physiology of (a) hearing and (b) balance.
 Describe the physiology of smell.
 Describe the physiology of taste.
 Describe the structure of the human eye.
 Describe the structure of the lens.
 Draw a well labelled diagram showing a section of the human eye.
 Describe the physiology of sight.
 Describe the production and flow of aqueous fluid.
 State the functions of each of the extraocular muscles of the eye.
 Describe the accessory organs of the eye.
 State the functions of tears.
[197]
1. Define the term special senses and then list the five (5) special senses [1]
Definition
Special senses refers to specialised sensory receptors (nerve endings)

located in organs and tissues located in the head.
Special senses and sense organs
Special sense Sense organ

a. Sight Eye
b. Hearing Ear
c. Balance Ear
d. Smell Olfactory structures (nose)
e. Taste Taste buds on the tongue
2. Describe the structure of the human ear [8]
Structure of the ear
The ear is divided into three main regions i.e.

(a) The external (=outer) ear-conveys sound waves and channels them
inwards.
(b) The middle ear-conveys sound vibrations to the oval window.
(c) The internal (inner) ear-houses the receptors for hearing and balance.
The external ear
The outer ear consists of (a) the auricle (=pinna), (b) the external acoustic
meatus (=auditory canal), and (c) the tympanic membrane (=eardrum).
a. The auricle
[198]
The auricle is the expanded portion projecting from the side of the head. It
consists of fibroelastic cartilage covered by skin. The rim of the auricle is
called the helix. The inferior soft pliable portion is referred to as the
lobule. The auricle is attached to the head by ligaments and muscles.
b. The external acoustic meatus
This refers to a curved tube (slightly S-shaped) about 2.5cm long located
in the temporal bone. It extends from the auricle to the tympanic
membrane. The tube is lined with skin containing hairs, sebaceous and
ceruminous glands that secrete cerumen (ear wax).
c. The tympanic membrane
The tympanic membrane is a thin oval and semitransparent partition

between the external acoustic meatus and the middle ear. The membrane
is covered by epidermis and lined by a simple cuboidal epithelium.
The middle ear (=tympanic cavity)
The middle ear is a small, irregular, air-filled cavity located in the petrous
portion of the temporal bone. The cavity is separated from the external ear
by the tympanic membrane and from the internal ear by a thin bony
partition that has two membrane covered openings i.e. the oval window
and the round window.
The anterior wall of the middle ear contains an opening that leads directly
into the pharyngotympanic (=Eustachian) tube. The tube connects the
middle ear with the nasopharynx.
Ossicles
The ossicles are three tiny bones which extend across the middle ear. The
names of the bones are malleus, incus, and stapes. The ossicles are
attached to each other by ligaments. The malleus is attached to the
tympanic membrane and the footplate of the stapes is attached to the oval
window.
[199]
The internal ear (=labyrinth)
The internal ear is referred to as the labyrinth because it is a complicated

series of tubes. The organs of hearing and balance are located in the
internal ear. The internal ear is divided into two parts i.e. (a) the bony
labyrinth and (b) the membranous labyrinth.
a. The bony labyrinth
The bony labyrinth refers to cavities and tubes found in the

temporal bone. These cavities are lined by periosteum. The parts
of the bony labyrinth are:
The vestibule
The vestibule is an expanded portion nearest to the middle ear.

The lateral walls of the vestibule contain the oval window and the
round window.
The cochlear
The cochlear is the snail shell-shaped part of the bony labyrinth.
Semicircular canals
These are three bony canals that project superiorly and

posteriorly from the vestibule. At the end of each canal is a
swollen enlargement called the ampulla.
b. Membranous labyrinth
The membranous labyrinth is a system of membranous tubes that

lie within the bony labyrinth. These tubes have the same parts as
the bony labyrinth in which they are located. A fluid located
outside the tubes i.e. between the membranous labyrinth and the
bony labyrinth is called perilymph. Within the tubes is a fluid
[200]
called endolymph. The parts of the membranous labyrinth are (a)

vestibule, (b) semicircular ducts, and (c) cochlear.
Vestibule
The membranous labyrinth in the vestibule contains two sacs

called utricle and saccule. The two sacs are connected by ducts.
Semicircular ducts
Semicircular ducts are the portion of the membranous labyrinth

that lie within the semicircular canals. The ampulla of the
semicircular canals, the utricle, and saccule contain receptors
(=hair cells) for the sense of balance. The urticular nerve, the
saccular nerve, and the umpullar nerve transmit impulses from
the receptors and join to form the vestibular part of the
vestibulocochlear (VIII) nerve.
The cochlear duct
The cochlear duct is the part of the membranous labyrinth located

in the cochlear. The cochlear duct is filled with endolymph. The
cochlear duct contains the organs of Corti (=spiral organ). The
organ of Corti has hair cells which are the receptors for the sense
of hearing. Nerve fibres from the organ of Corti combine to form
the cochlear part of the vestibulocochlear (VIII) nerve.
3. Draw a well labelled diagram illustrating the structure of the

human ear [8]
4. Describe the physiology of hearing [8]
Physiology of hearing
The following events occur in the physiology of hearing:
[201]
 Sound causes vibrations in air called sound waves.

 The auricle collects and concentrates sound waves into the external
auditory canal.
 Sound waves strike the tympanic membrane causing it to vibrate back and
forth in response to alternating waves of high and low pressure in the air.
 Vibrations of the tympanic membrane are amplified and transmitted
across the tympanic cavity by the three ossicles i.e. malleus, incus, and
stapes.
 Vibrations of the foot plate of the stapes causes the oval window to move
in and out.
 Movements of the oval window create fluid pressure waves in the
perilymph of the scala vestibule of the cochlea.
 Fluid pressure waves travel through the perilymph of the scala vestibuli,
then the vestibular membrane, and then move into the endolymph inside
the cochlear duct.
 Fluid pressure waves in the endolymph cause the basilar membrane to
vibrate. This causes the hair cells of the organ of Corti (=spiral organ) to
move against the tectorial membrane. The movement stimulate the
generation of nerve impulses.
 The nerve impulses that are transmitted via the cochlear part of the
vestibulocochlear nerve.
 Nerve impulses are transmitted via the cochlear part of the
vestibulocochlear nerve (=auditory nerve) to the auditory area of the
temporal lobe of the cerebrum.
 In the auditory area the nerve impulses are interpreted as sounds.
5. Describe the physiology of balance (=equilibrium) [6]
Physiology of balance
There are two types of balance i.e.
 Static equilibrium-maintenance of the position of the body

relative to force of gravity. Tilting of the head, linear acceleration
and linear deceleration stimulate receptors for static equilibrium.
[202]
 Dynamic equilibrium-maintenance of the position of the body in

response to sudden movements such as rotational acceleration
and deceleration.
Receptors for static equilibrium
The utricle and saccule of the vestibule has hair cells which are
the receptors for static equilibrium. Change in the position of the
head stimulates these receptors leading to the generation of nerve
impulses.
Receptors for dynamic equilibrium
The ampulla of the semicircular ducts has the receptors for

dynamic equilibrium. These receptors detect rotational
acceleration and deceleration leading to the generation of nerve
impulses.
Collectively the receptor organs for equilibrium are called the vestibular
apparatus. These receptor organs include the utricle, saccule, and the
ampulla of the semicircular ducts.
 Nerve fibres from receptors for equilibrium in the utricle,

saccule, and the semicircular canals join to form the vestibular
part of the vestibulocochlear (VIII) nerve.
 The vestibulocochlear nerve transmits impulses to an integrating

centre called the vestibular nuclei. The vestibular nuclei are
located in the medulla oblongata and pons. There are nerve
pathways which link the vestibular nuclei and the cerebellum.
 The vestibular nuclei also receives input from the eyes and
stretch receptors in muscle (=proprioceptors). The vestibular
nuclei integrates information form the vestibular apparatus, eyes,
and proprioceptors and sends commands to the following:
[203]
a. Muscles involved in the movements of the eyes cranial nerves-

oculomotor (III) nerves, trochlear (IV) nerves, and abducens (VI)
nerves.
b. Muscles involved in controlling head and neck movements via

the accessory nerves (XI) to assist in maintaining equilibrium.
c. Skeletal muscles of the body via the spinal cord to help in

maintaining equilibrium.
d. Vestibula area of the parietal lobe of the cerebrum leading to the

awareness of the position and movements of the head and limbs.
6. Describe the physiology of smell [6]
Physiology of smell
 Odorous material gives off odorant molecules.

 The odorant molecules are carried into the nasal cavity with inhaled
air.
 The molecules dissolve in the mucus lining the mucosa of the nasal
cavity.
 The molecules stimulate olfactory receptors/chemoreceptors located
in the mucosa of the roof of the nasal cavity.
 When stimulated the olfactory receptors generate nerve impulses that
are transmitted by the olfactory (I) nerves to the paire3d masses of
grey matter called olfactory bulbs.
 Form the olfactory bulb some nerve fibres project to the primary
olfactory area located in the temporal lobe of the cerebrum. In the
olfactory area the nerve impulses are interpreted as smell. Pathways
from the olfactory area extend to the frontal lobe, an important region
for odour identification and discrimination.
 Some nerve fibres from the olfactory bulb project to the limbic
system and hypothalamus. These connections account for emotional
and memory-evoked responses to odour e.g. nausea on smelling a
food which made one violently ill.
[204]
7. Describe the physiology of taste [6]
Physiology of taste
 Food contains chemical molecules. Chemical molecules in food that

stimulate taste receptors are known as testants.
 These chemical molecules dissolve in saliva and make contact with and
stimulate receptors located in the taste buds of the tongue.
 These receptors are sensory nerve endings three cranial nerves i.e. the
glossopharyngeal, facial and vagus nerves (cranial nerves VII, IX and X).
The facial (VII) nerve serves taste buds in the anterior two-thirds of the
tongue; the glossopharyngeal (IX) nerve serves taste buds in the posterior
one third of the tongue; and the vagus (X) nerve serves taste buds in the
throat and epiglottis.
 When the receptors in taste buds nerve impulses are generated.
 From the taste buds, nerve impulses propagate along these cranial nerves
to the medulla oblongata. From the medulla nerve fibres carrying taste
signals to the limbic system and the hypothalamus. Other fibres transmit
the impulses to the thalamus.
 Nerve impulses are transmitted from the thalamus to the taste area located
in the parietal lobe of the cerebral cortex. This gives rise to the conscious
perception of taste.
8. Describe the structure of the human eye [8]
Structure of the human eye
[The structure of the human eye shall be described in two part i.e. the layers
forming its wall and the structures inside the eye.]
Layers forming the walls of the eyeball
The walls of the eye have three layers of tissue as follows: (a) the outer
fibrous layer consisting of the sclera and cornea, (b) the middle vascular
layer or uveal tract consisting of the choroid, ciliary body and iris, (c) and
the inner nervous tissue layer i.e. retina.
[205]
The outer fibrous layer
The outer fibrous layer consists of the sclera and the cornea.
a. Sclera
The sclera is made of a fibrous membrane which forms the

outermost layer of tissue of the posterior and lateral aspects of the
eyeball. Anteriorly the sclera is continuous with the cornea. The
sclera maintains the shape of the eye and gives attachment to
muscles that rotate the eye ball.
b. Cornea
The cornea is a clear transparent epithelial membrane that lies

anterior to the cornea. The cornea being transparent allows light
to enter the eye and it participates in refraction (bending of light
rays).
The middle vascular layer (=uveal tract)
The middle vascular layer or uveal tract consists of the choroid,

ciliary body, and iris.
a. Choroid
The choroid lines the posterior five-sixths of the inner surface of

the sclera. The layer is deep chocolate brown in colour and is
very rich in blood vessels. The choroid absorbs light rays that
reach the retina.
b. Ciliary body
The ciliary body is the anterior continuation of the choroid. It

consists of ciliary muscle (smooth muscle fibres) and secretory
epithelial cells.
[206]
Ciliary muscle fibres change the shape and thickness of the lens
so as to focus light rays onto the retina (this process is called
accommodation). The secretory epithelium produces aqueous
fluid.
c. Iris
The iris extends anteriorly from the ciliary body. It lies behind
the cornea and in front of the lens. The iris has two layers of
smooth muscle fibres and has an opening at its centre called the
pupil. The function of the iris is to control the amount of light
that enters the eye by changing the size of the pupil.
The inner nervous tissue layer: retina
The retina is the innermost layer of the wall of the eye. The layer has
receptors sensitive to light called photoreceptors. The receptors are named
according to their shape i.e. rods and cones. The photoreceptors have a
pigment inside called the photopigment.
The retina has a yellow spot near the centre of the posterior part called
macula lutea. In the centre of the yellow spot is a depression called fovea
centralis. The fovea centralis consists of cones only and gives the sharpest
daylight vision.
Interior of the eye
Structures inside the eyeball are (a) the lens, (b) an anterior segment
containing aqueous fluid (humour), (c) and a posterior segment containing
the vitreous body (humour). The lens divides the eye into two segments
i.e. the anterior segment and the posterior segment.
a. Lens
The lens is a biconvex highly elastic structure that divides the

interior of the eye into two segments. The lens lies behind the
pupil. It is consists of lens fibres enclosed within a capsule. The
lens is suspended from the ciliary body by suspensory ligaments.
[207]
The contraction and relaxation of ciliary muscles cause the shape

and thickness of the lens to change.
b. Anterior segment
The anterior segment is the part which lies in front of the lens.
The segment is filled with a clear fluid called aqueous fluid.
Aqueous fluid supplies nutrients and removes wastes from the
cornea, lens and lens capsule.
c. Posterior segment
The posterior segment lies behind the lens. The segment is filled
with a clear jelly-like transparent substance called vitreous body
(=vitreous humour). Vitreous body maintains pressure in the eye
ball preventing it from collapsing i.e. maintains the shape of the
eyeball.
9. Describe the structure of the lens. [6]
[This question is related to an eye condition called cataract. A cataract is an

opacification of the crystalline lens leading to blindness. There are several causes
of cataracts but the incidence of cataracts is higher with old age. The management
of a cataract is surgical i.e. the removal of the cataract. The commonest procedure
is extracapsular cataract extraction and insertion of an intraocular lens
(ECCE+IOL)]
Structure of the lens
The lens is circular and biconvex in shape. It is located immediately

behind the pupil. It is flatter on its anterior than on its posterior surface.
The lens is a transparent and elastic structure.
Its anterior surface is bathed by aqueous humour and its posterior surface
by the vitreous body.
The lens is made of a mass of tightly packed transparent fibrous cells
called lens fibres. These fibres are enclosed in an elastic capsule.
The lens is suspended within the eye by the suspensory ligaments which
are attached to the ciliary body and to the lens capsule.
[208]
The thickness and shape of the lens is controlled by the ciliary muscles of
the ciliary body through the suspensory ligaments. Change in the
thickness and shape of the lens helps to focus light rays on to the retina.
This process is called accommodation.
Contraction of the ciliary muscle moves it forward releasing its pull on the
lens. This increases the thickness of the lens. The nearer the object being
viewed the thicker the lens becomes.
*9. Describe the physiology of sight [8]
Physiology of sight
 Objects within the visual field reflect light rays towards the eyes.
 The light rays travel through air and reach the cornea.
 The light rays are refracted (=bent) as they pass through the cornea.
 The light rays pass through the pupil which controls the amount of light
entering the eyes.
 The light rays pass through the lens which alters its thickness in response
to the contraction or relaxation of the ciliary muscles.
 Changes in the thickness of the lens focuses the light rays onto the retina
(this process is called accommodation).
 Light rays stimulate the photoreceptors in the retina.

 Stimulation of the photoreceptors causes them to generate nerve impulses.
[209]
Transduction of light energy into a receptor potential occurs in the outer segment of
both rods and cones. The photopigments are integral proteins in the plasma
membrane of the outer segment.
The first step in visual transduction is absorption of light by a photopigment, a

colored protein that undergoes structural changes when it absorbs light, in the outer
segment of a photoreceptor. Light absorption initiates the events that lead to the
production of a receptor potential.
Photopigments respond to light in the following cyclical process:

In about a minute, trans-retinal completely separates from opsin. The final products
look colorless, so this part of the cycle is termed bleaching of photopigment.
 The nerve impulses are transmitted via the optic nerve to the visual area of
the occipital lobe of the brain.
The Visual Pathway
Visual signals in the retina undergo considerable processing at synapses among the
various types of neurons in the retina.
Then, the axons of retinal ganglion cells provide output from the retina to the brain,
exiting the eyeball as the optic (II) nerve.
Brain Pathway and Visual Fields
The axons within the optic (II) nerve pass through the optic chiasm, a crossing
point of the optic nerves. Some axons cross to the opposite side, but others remain
uncrossed. After passing through the optic chiasm, the axons, now part of the optic
tract, enter the brain and most of them terminate in the lateral geniculate nucleus of
the thalamus.
Here they synapse with neurons whose axons form the optic radiations, which
project to the primary visual areas in the occipital lobes of the cerebral cortex, and
visual perception begins.
[210]
We have binocular vision due to the large region where the visual fields of the two
eyes overlap—the binocular visual field.
 In the visual area the nerve impulses are interpreted to form visual images.
Light and Dark Adaptation
When you emerge from dark surroundings into the sunshine, light adaptation
occurs—your visual system adjusts in seconds to the brighter environment by
decreasing its sensitivity.
On the other hand, when you enter a darkened room such as a theater, your visual
system undergoes dark adaptation—its sensitivity increases slowly over many
minutes.
The difference in the rates of bleaching and regeneration of the photopigments in

the rods and cones accounts for some (but not all) of the sensitivity changes during
light and dark adaptation As the light level increases, more and more photopigment
is bleached. While light is bleaching some photopigment molecules, however,
others are being regenerated. In daylight, regeneration of rhodopsin cannot keep up
with the bleaching process, so rods contribute little to daylight vision. In contrast,
cone photopigments regenerate rapidly enough that some of the cis form is always
present, even in very bright light.
If the light level decreases abruptly, sensitivity increases rapidly at first and then
more slowly. In complete darkness, full regeneration of cone photopigments occurs
during the first 8 minutes of dark adaptation. During this time, a threshold (barely
perceptible) light flash is seen as having color. Rhodopsin regenerates more slowly,
and our visual sensitivity increases until even a single photon (the smallest unit of
light) can be detected. In that situation, although much dimmer light can be
detected, threshold flashes appear gray-white, regardless of their color. At very low
light levels, such as starlight, objects appear as shades of gray because only the
rods are functioning.
10. Draw a well labelled diagram illustrating a section of the

human eye [8]
[211]
11. Describe the production and flow of aqueous fluid

(=aqueous humour) [6]
Production and flow of aqueous fluid
 Aqueous fluid is filtered out of blood capillaries in the ciliary processes of

the ciliary body.
 The ciliary body has a secretory epithelium that has secretory glands
called ciliary glands.
 The ciliary glands secrete aqueous fluid.
 The aqueous fluid enters the posterior chamber.
 It circulates in front of the lens then passes through the pupil to enter the
anterior chamber.
 The fluid passes through the trabecular meshwork into the Schlemm’s
canal (=scleral venous sinus) located in the angle between the iris and the
cornea.
 From the Schlemm's canal the aqueous fluid enter the venous circulation.
12. List the six (6) extraocular muscles of the eye ball and state the
function of each [6]
Extraocular muscles of the eye ball and their functions
Muscle Function
a. Medial rectus Rotates eyeball inwards
b. Lateral rectus Rotates eyeball outwards
c. Superior rectus Rotates eyeball upwards
d. Inferior rectus Rotates eyeball downwards
e. Superior oblique Rotates eyeball downwards and outwards
f. Inferior oblique Rotates eyeball upwards and outwards
13. Describe the accessory organs of the eye [8]
[212]
Accessory organs of the eye
Accessory organs of the eye are eyebrows, eyelids and eyelashes, and the
lacrimal apparatus.
a. Eyebrows
Eye brows are two ridges which arch transversely above the upper eye
lids. They have numerous hairs that project obliquely from the surface of
the skin.
Function: protect the eyeball from sweat, dust, other foreign bodies, and
direct rays from the sun.
b. Eyelids and eye lashes
Eyelids are two movable folds of tissue situated above and below the front
of each eye. The eye lids have short curved hairs called eyelashes.
Functions of eyelids and eyelashes are:

(1) Shade the eyes during sleep, protect the eyes from excessive light and
foreign objects, protecting the eye from injury.
(2) Spread lubricating secretions and tears over cornea, preventing drying.
c. Lacrimal apparatus
The lacrimal apparatus is a group of structures that produce and drains

tears (=lacrimal fluid).
For each eye this consists of 1 lacrimal gland and its ducts, 2
lacrimalcanaliculi, 1 lacrimal sac, and 1 nasolacrimal duct.
Functions
The lacrimal glands secrete lacrimal fluid. The fluid drains into which
drains into lacrimal ducts that empty tears onto the surface of the
conjunctiva of the upper lid. The tears pass over the anterior surface of the
[213]
eyeball to enter two small openings called lacrimal puncta (singular is

punctum). Tears then pass into two ducts, the lacrimal canals, which lead
into the lacrimal sac and then into the nasolacrimal duct. The nasolacrimal
duct carries tears into the nasal cavity.
14. List the components of tears [2]
Components of tears
Water Mineral salts Antibodies Lysozyme (an enzyme)
15. State the functions of tears [4]
Functions of tears
a. Tears wash away irritating materials, e.g. dust from the eyes.
b. Lysozyme, a bactericidal enzyme found in tears, prevents infection
c. Fluid prevents drying of the conjunctiva and cornea.
d. Tears provide nutrients to the cornea.
[214]

Reviewed by Maisiri J.(BSc NE., RGN)
Objectives
 State the functions of the female reproductive system.

 Draw a well labelled diagram showing the female reproductive organs
located in the pelvic cavity.
 Describe the structure of the uterus.
 Draw a well labelled diagram showing a section of the uterus.
 State the changes that occur in females at puberty.
 Describe the menstrual cycle.
 State the changes which occur in females after menopause.
 Describe the structure of the female breast.
 Draw a well labelled diagram showing a section of the female breast.
 List the organs which make the male reproductive system.
 State the functions of the male reproductive system.
 Draw a well labelled diagram illustrating a section of the male
reproductive system.
 State the changes which occur in males at puberty.
[215]
1. Outline six (6) functions of the female reproductive system [8]
Functions of the female reproductive system
a. Formation of female gametes (the ova).
Ovaries produce and release the female gametes i.e. ova.
b. Production and secretion of hormones
Ovaries produce and secrete female sex hormones i.e. progesterone and
oestrogens.
c. Reception of male gametes (the spermatozoa).
The vagina receives the male gametes during sexual intercourse.
d. Fertilization and the development of the foetus
Fertilization of the ova normally takes place in the uterine tubes.

Implantation of the fertilized ovum and the development of the foetus take
place in the uterus.
e. Parturition (=childbirth)
Contraction of the muscles of the uterus leads to childbirth; the vagina is a

passageway for childbirth.
f. Lactation
Mammary glands (=breasts0 synthesize, secrete, and eject milk for the
nourishment of the baby.
[216]
2. Draw a well labelled diagram showing the female reproductive

organs in the pelvis [8]
3. Describe the structure of the uterus [8]
Structure of the uterus
Size and shape
The uterus is a muscular and hollow organ. It is shaped like a pear. The
uterus is about 7.5cm long, 5 cm wide and its walls are about 2.5cm thick
(in females who have never been pregnant; is larger in females who have
recently been pregnant and smaller after menopause).
It weighs from 30 to 40 grams.
Position
The uterus is located in the pelvic cavity between the urinary bladder and
the rectum. It leans forward, and is bent forward almost at right angles to
the vagina. Its anterior wall rests partly against the bladder below, and
forming the vesicouterine pouch between the two organs.
Anatomical subdivisions of the uterus
The anatomical subdivisions of the uterus are as follows:
a. Fundus: a dome-shaped portion superior to the uterine tubes.

b. Body: a tapering central portion.
c. Cervix: an inferior narrow portion that opens into the vagina.
d. Isthmus: a constricted region about 1cm long located between the
body of the uterus and the cervix.
e. Uterine cavity: the interior of the body of the uterus.
f. Cervical canal: the interior of the cervix. The cervical canal
opens into the uterine cavity at the internal os and into the vagina
at the external os.
[217]
Ligaments
The uterus is maintained in position by a number of ligaments as

follows:
a. Two road ligaments attach the uterus to either side of the pelvic
cavity.
b. Two uterosacral ligaments connect the uterus to the sacrum.
c. Cardinal (=lateral cervical) ligaments are located inferior to the
bases of the broad ligaments and extend from the pelvic wall to
the cervix and vagina.
d. Round ligaments are bands of fibrous connective tissue between
the layers of the broad ligament; they extend from a point on the
uterus just inferior to the uterine tubes to a portion of the labia
majora of the external genitalia.
Layers forming the walls of the uterus
Three layers of tissue form the walls of the uterus i.e. (a) perimetrium
(=peritoneum), (b) myometrium, and the (c) endometrium.
a. The perimetrium (=serosa)
The perimetrium consists of peritoneum. Anteriorly it extends

over the fundus. It is found between the uterus and the bladder
forming the vesicouterine pouch. Posteriorly the peritoneum
extends over the fundus, the body, and the cervix.
The peritoneum located between the uterus and the rectum forms
the rectouterine pouch (=pouch of Douglas).
Laterally the peritoneum covers the fundus.
b. Myometrium
The myometrium is made of three layers of smooth muscle fibres

i.e. a thicker middle layer is circular; an inner layer and outer
layers which are longitudinal or oblique.
[218]
The myometrium is the thickest layer of the uterine wall. The

layer is thickest in the fundus and thinnest in the cervix.
c. Endometrium
The endometrium is the innermost layer and consists of columnar

epithelium containing a large number of glands that secrete
mucus. This layer is highly vascularized.
The endometrium is divided into two (2) layers functionally i.e.
(1) the functional layer and (2) the basal layer.
 The functional layer (=stratum functionalis)
The functional layer is the uppermost layer and lines the

uterine cavity. The layer thickens and becomes rich in
blood vessels in the first half of the menstrual cycle. If
the fertilization does not occur the layer is shed off
during menstruation.
 The basal layer (=the stratum basalis)
This is the deeper layer of the endometrium and it lies

next to the myometrium.
The layer is permanent i.e. it is not lost during
menstruation. The basal layer generates fresh functional
layer during each cycle.
4. Draw a well labelled diagram showing a section of the uterus [6]
5. State any six (6) changes that occur in the female at puberty [6]
Changes that occur in the female at puberty
a. Maturation of the uterus, uterine tubes, and the ovaries.
b. Onset of the menstrual cycle and ovulation (=menarche).

[219]
c. Development and enlargement of breasts.
d. Growth of pubic and axillary hair.
e. Increase in the rate of growth in height and widening of the pelvis.
f. Increase in the amount of fat deposited in the subcutaneous tissue,

especially at the hips and breasts
5. Describe the menstrual (sexual) cycle [8]
The menstrual cycle
The menstrual cycle refers to changes which occur in the ovaries and in
the uterine walls. These changes occur as a result of changes in the blood
concentrations of the following hormones:
 Luteinizing hormone releasing hormone (LHRH): secreted by the

hypothalamus. It stimulates the anterior pituitary to secrete
follicle stimulating hormone (FSH).
 Follicle stimulating hormone (FSH): promotes the maturation of

ovarian follicles and the secretion of oestrogen.
 Luteinizing hormone (LH) stimulates the development of the

corpus luteum and the secretion of progesterone.
The menstrual cycle takes on average 28 days. The duration of the female
reproductive cycle typically ranges from 24 to 36 days. For this
discussion, we assume duration of 28 days.
Phases of the menstrual cycle
On average the length of the menstrual cycle is about 28 days. The cycle
consists of the following phases: (1) menstrual phase (about 4 days), (2)
[220]
proliferative (=preovulatory) phase (about 10 days) and (3) the secretory

(=postovulatory) phase (about 14 days).
a. Menstrual phase
The menstrual phase lasts for roughly the first 5 days.
 If fertilization does not occur the corpus luteum starts to

degenerate.
 Degeneration of the corpus luteum results in a decrease in the
levels of progesterone and oestrogen.
 The decrease in the levels of progesterone and oestrogen
stimulates the release of prostaglandins.
 Prostaglandins cause a vasoconstriction which results in poor
oxygen supply to cells. The result is the sloughing off of the
functional layer of the endometrium. Sloughing off of the
functional layer causes a menstrual flow from the uterine cavity
through the cervix and vagina to the exterior.
 The pituitary gland begins to produce FSH beginning another
cycle.
b. Proliferative phase
The proliferative phase is the time between the end of menstruation and
ovulation. It lasts from days 6 to 13 in a 28-day cycle.
 Production of the FSH by the pituitary gland stimulates the

ovarian follicle to grow towards maturity.
 The ovarian follicle produces oestrogen.
 Oestrogen causes proliferation of the functional layer of the
endometrium i.e. there is rapid cell multiplication accompanied
by an increase in the numbers of mucus-secreting glands and
blood capillaries.
 The functional layer grows thicker in preparation of reception of
the fertilized ovum.
 The proliferative phase ends when ovulation occurs and
oestrogen production declines.
[221]
c. Secretory phase
The secretory phase of the menstrual cycle is the time between ovulation
and onset of the next menses. It lasts for 14 days in a 28-day cycle i.e.
from day 15 to day 28.
 LH stimulates the lining cells of the ovarian follicle to develop

the corpus luteum.
 The corpus luteum produces progesterone.
 Progesterone produced by the corpus luteum promotes growth
and coiling of the endometrial glands, vascularization of the
superficial endometrium, and thickening of the endometrium.
 The endometrium becomes oedematous and the secretory glands
produce increased amounts of watery mucus (assists the passage
of the spermatozoa through the uterus to the uterine tubes)
 If fertilization does not occur the corpus luteum degenerates.
Degeneration of the corpus luteum leads to a decrease in the
levels of progesterone and estrogens.
 Decreased levels of progesterone and oestrogen cause
menstruation to occur and a new cycle begins.
6. State any six (6) changes that occur in the female after menopause [6]
Changes that occur at menopause
a. The ovaries gradually become less responsive to FSH and LH, and
ovulation and the menstrual cycle become irregular, eventually ceasing
short-term unpredictable vasodilatation with flushing, sweating and
palpitations, causing discomfort and disturbance of the normal sleep
pattern.
b. There is shrinkage of the breasts.
c. Axillary and pubic hair becomes sparse.
[222]
d. There is atrophy of the sex organs.
e. There are episodes of uncharacteristic behaviour sometimes occur, e.g.

irritability, mood changes.
f. There is a gradual thinning of the skin.
g. There is loss of bone mass that predisposes to osteoporosis.
h. There is a slow increase in blood cholesterol levels that predisposes

postmenopausal women to cardiovascular disorders.
7. Describe the structure of the female breast (mammary gland) [8]
Structure of the breast
The breast is a hemisphere projection anterior to the pectoralis major and

serratus muscles of the chest. The breast is attached to these muscles by a
layer of fascia composed of dense connective tissue.
Strands of connective tissue (=suspensory ligaments; Cooper’s ligaments)

run between the skin of the breast and fascia. These ligaments support the
breast.
The breast consists of fibrous tissue, fatty tissue, and glandular tissue.
Each breast consists of about 20 lobes of glandular tissue and each lobe is
made up of a number of lobules that radiate around the nipple.
The lobules consist of a cluster of alveoli which open into small ducts and
these unite to form large excretory ducts called lactiferous ducts.
The lactiferous ducts converge towards the centre of the breast where they
form lactiferous sinuses.
[223]
The ducts and glandular tissue of the breast are fibrous supported by
fibrous tissue.
Fat covers the surface of the gland and is found between the lobes.
The nipple is a small conical eminence at the centre of the breast. The
nipple has a series of closely spaced openings of ducts called lactiferous
ducts, where milk emerges.
The areola is a pigmented area that surrounds the nipple. The areolar
appears rough because it contains modified sebaceous (oil) glands.
Sebaceous glands (=Montgomery's tubercles) found on the surface of the

areola produce an oily substance which lubricate the nipple during
lactation.
8. Draw a well labelled diagram showing a section (or illustrating

the structure) of the female breast [8]
9. List the organs that make the male reproductive system [4]
Organs of the male reproductive system
Testes x 2 Epididymis x 2 Vas deferens x2

Spermatic cords x 2 Seminal vesicles x 2 Ejaculatory ducts x 2
Prostate gland x 1 Penis x 1
10. State two functions of the male reproductive system [2]
Functions of the male reproductive system
a. Production of male gametes (=spermatozoa).
b. Transmission of spermatozoa to the female

[224]
10. Draw a well labelled diagram illustrating a section of the

male reproductive system [6]
11. State six (6) changes which occur in the male at puberty [6]
Changes which occur in males at puberty
a. Growth of muscle and bone, and a marked increase in height and weight
b. There is an enlargement of the larynx and deepening of the voice.
c. Growth of hair on the face, axillae, chest, abdomen and pubis.
d. There is an enlargement of the penis, scrotum and prostate gland.
e. Seminiferous tubules mature and the production of spermatozoa begin.
f. The skin thickens and becomes oilier.
[225]
References
1. Clancy J. and McVicar A. (2009) Physiology and Anatomy for Nurses and
Healthcare Practitioners: a Homeostatic Approach (3rd Ed.) London. Hodder
Anold.
2. Ganong W.F. (2005) Review of Medical Physiology (22nd Ed.) New York. Lange
Medical Bppks/McGraw-Hill.
3. Glenister T.W.A. and Ross J. R. W. (2000) Anatomy and Physiology for Nurses
(3rd Ed.) New Delhi. CBS Publishers and Distributors.
4. Guyton A. C. and Hall J. E. (2000) Textbook of Medical Physiology (10th Ed.)

New Delhi. Saunders.
5. Jenkins G. W. and Tortora G. J. (2013) Anatomy and Physiology : from Science to

Life. Hoboken, NJ. John Wiley & Sons.
6. Marieb E. N. and Hoehn K. (2007) Human Anatomy and Physiology (7th Ed.) San
Fransisco. Pearson.
7. Martini F. and Nath J. L. (2009). Fundamentals of Anatomy & Physiology. San

Francisco. Pearson/Benjamin Cummings
8. Shier D., Butler J., and Lewis R. (2007) Hole’s Human Anatomy and Physiology
(11th Ed.) Boston. McGraw-Hill.
9. Shoniwa L. and Boroma P. T. (2019) Essentials of Biochemistry for Nurses (1st

Ed.) South Africa. Shoniwa L. and EEBP/Digitext Trading Pty Ltd.
10. Shoniwa L. (2018) Essentials of Biophysics for Nurses (1st Ed.) South Africa.
Shoniwa L. and EEBP/Digitext Trading Pty Ltd.
11. Tortora G. J. and Derrickson B. (2014) Principles of Anatomy and Physiology

(14th Ed.) Philadelphia. Wiley.
[226]
12. Snell R. S. (2010). Clinical Neuroanatomy (7th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins
13. Standring S. and Gray H. (2008). Gray's anatomy: The anatomical basis of clinical
practice. Edinburgh: Churchill Livingstone/Elsevier.
14. Tortora G. J. and Grabowski S. R. (1998) Introduction to the Human Body: the
Essentials of anatomy and physiology (6th Ed.) Philadelphia. John Wiley and
Sons.
15. Vidya Ratan (2004) Handbook of Human Physiology (7th Ed.) New Delhi. Jaypee
Brothers Medical Publishers.
16. Waugh A. and Grant A. (2018). Ross and Wilson Anatomy and Physiology in
Health and Illness (13th Ed.) Edeinburgh. Churchill Livingstone.
17. Widmaier E., Raff H., and Strang K. T. (2004) Vander, Sherman and Luciano’s
Human Physiology (9th Ed.) Boston. McGraw-Hill.
18. Winwood R. S. and Smith J. L. (1985) Sear’s Anatomy and Physiology for Nurses
(6th Ed.) New Delhi. Jaypee Brothers.
[227]
Other titles from EEBP & Digitext
1. Essentials of Biophysics for Nurses

Author: Shoniwa Learnmore
ISBN: 978-0-620-80112-6
Pages: 196
Published: August 2018
2. Essentials of Biochemistry for Nurses

Authors: Shoniwa Learnmore and Boroma Peter T.
ISBN: 978-0-6398060-4-4
Pages: 168
Published: April 2019
Titles coming soon
1. Essentials of Pharmacology for Nurses: Groups and Classes

ISBN: 978-0-6398060-3-7
2. Essentials of Pharmacology for Nurses: General Principles

ISBN: 978-0-6398060-1-3
3. A Handbook of Essential Drugs for Nurses

ISBN: 978-0-6398060-6-8
[228]
4. 20+ Nursing Research Questions and Answers

Authors: Shoniwa Learnmore and Shangwa Runeni
ISBN: 978-0-6398060-0-6
5. Essentials of Basic Surgery, Plastic Surgery, and Burns for Nurses

ISBN: 978-0-6398060-5-1
[229]

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Shoniwa Learnmore, Bsc NE., RGN.

Boroma Peter T., Bsc NE., RGN

Boroma Peter T., BSc NE., RGN

For you created my inmost being;

Printed in South Africa

ISBN: 978-0-6398060-2-0 print

Dewey Decimal Classification Number

Essentials of Anatomy and Physiology for Nurses:

Cover Designing, Proofreading and Printing by

Generally, Font Used: Avian, Size 9,

I must recognize my friend Mr Chiduku (Librarian, School of Nursing-Harare Central

Let me also express my gratitude to my colleagues at Harare Central Hospital-School of

I am grateful for the inspiration of my teachers Mrs Bukutu, Mr Bvekerwa, and Dr

Kusemwa-Muyambi Prettyosa Mukwamba Mutsa Maceline

Maisiri Jeshuwa Muvhu Sheila

Masanzu Tonderai Mushambi Elizabeth Rumbidzayi

Matandane Angela Shangwa Runeni

Mukucha Waddilove Moyo Esnath

Chapter 1: Introduction to Anatomy and Physiology-------------001

Chapter 2: Cells and Tissues-------------------------------------------007

Chapter 4: Muscles and Joints-----------------------------------------025

Chapter 5: Integumentary System------------------------------------036

Chapter 6: Cardiovascular System------------------------------------047

Chapter 7: Respiratory System----------------------------------------055

Chapter 8: Digestive System--------------------------------------------071

Chapter 9: Urinary System---------------------------------------------102

Chapter 10: Endocrine System------------------------------------------119

Chapter 11: Nervous System---------------------------------------------130

Chapter 12: Special Senses-----------------------------------------------130

Chapter 13: Endocrine System------------------------------------------130

At the end of this chapter, the student should be able to:

1. Define each of the following terms:

Physiology (physio=nature;-logy=study) refers to the study of body

Pathology refers to the study of abnormalities, their causes, and the

Internal environment refers to the environment inside the body in which

External environment refers to the environment outside the human body.

Homeostasis (homeo=sameness;-stasis=standing still) refers to a state of

g. Negative feedback mechanism

Negative feedback mechanism refers to a control mechanism in which the

h. Positive feedback mechanism

Positive feedback mechanism refers to a control mechanism in which the

Enzymes are biological catalysts which speed up the rate of chemical

2. Outline the structural levels of organization of the human body [5]

Levels of organization of the human body

An organ is a comination of different tissues that carry out a specific

A system consists of different organs and tissues that have a common

An organism is the living individual or unit. The organismal level is the

3. Describe each of the following concepts:

a. External environment [4]

The internal environment is the water-based medium in which body cells

4. Describe the concept called homeostasis [4]

Homeostasis refers to the maintenance of the composition of the internal

5. Describe the concept called homeostatic imbalance [4]

Homeostatic imbalance refers to the failure of the body to maintain the

Examples of homeostatic imbalances include hyperthermia (an abnormal

6. Outline the components of a feedback system [6]

[A feedback system is a cycle of events in which the internal environment is

Components of a feedback system

A feedback system consists of a receptor, control centre, and an effector.

A receptor is a body structure which detect changes in a controlled

A control centre e.g. the thermoregulatory centre of the brain, receives

7. Describe each of the following using appropriate examples:

a. Negative feedback mechanism [5]

a. Negative feedback mechanism