______________________________________________________________ APPLIED ANATOMY AND PHYSIOLOGY THE CELL I. ESSENTIAL CONCEPTS: A. Cellular Composition: 1. Nucleus 2. Cytoplasm 3. Cell Membrane B. Homeostasis – State of Equilibrium II. CELLULAR DYSFUNCTION: A. Fluids – Intracellular vs. Extracellular B. Electrolytes – K, PO4, Na, Cl C. Acid-Base Balance D. Regulatory Mechanisms: 1. Osmosis 2. Diffusion 3. Filtration 4. Active Transport E. Sources of Normal Fluid Loss 1. Kidneys 2. 4. GI Tract 3. Skin 4. Lungs F. Homeostatic Mechanisms 1. Renal System 2. Cardiovascular System 3. Pulmonary System 4. Buffer System 5. Endocrine System - Pituitary Gland (ADH) - Adrenal Cortex (Aldosterone) - Parathyroid (Parathormone) THE NERVOUS SYSTEM 1. BRAIN a. Cerebrum b. Cerebellum c. Basal Ganglia d. Brainstem e. Diencephalon PROTECTIVE STRUCTURES: a. Meninges: Dura Mater Arachnoid Mater Pia Mater b. CSF - 500 – 700 ml/day - produced by Choroid Plexus - circulates at subarachnoid space 2. SPINAL CORD Normal ABG Values - pH: 7.35 to 7.45 - PO2: 80-100 mmHg - PCO2: 35-45 mmHg - HCO3: 22-26 mEq/L
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APPLIED ANATOMY AND PHYSIOLOGY · - Preload - Afterload b. Heart Rate - normal 60 – 100 bpm 2. Cardiac Cycle a. Systole – contraction phase b. Diastole – relaxation (filling)
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a. Cerebrum b. Cerebellum c. Basal Ganglia d. Brainstem e. Diencephalon
PROTECTIVE STRUCTURES: a. Meninges: Dura Mater Arachnoid Mater Pia Mater b. CSF - 500 – 700 ml/day - produced by Choroid Plexus - circulates at subarachnoid space 2. SPINAL CORD
Normal ABG Values - pH: 7.35 to 7.45 - PO2: 80-100 mmHg - PCO2: 35-45 mmHg - HCO3: 22-26 mEq/L
If sudden onset: increased heart rate, decreased level of consciousness (LOC), feeling of fullness after vasodilation from CO2 in head, dysrhythmias, If chronic: weakness, dull headache
D. Specific Immunologic Defense 1. Types of Immunity
a. Inborn Immunity b. Acquired Immunity
2. Mechanism of Specific Immunity 2 Types: a. Humoral Immunity (B-Lymphocyte)
- involves formation of antibodies 5 Types of Antibodies: - IgG – activates complement, crosses placenta - IgA – present in body fluids (blood, saliva, breast milk, vaginal secretions) - IgM – first antibody produced in immune response - IgD – important for B cell activation - IgE – allergic & hypersensitivity rxns – defense against parasites b. Cell-Mediated Immunity (T-Lymphocytes)
* T-lymphocytes (devised from thymus) Types of T-Cells:
- Helper T Cells (T4) - Suppressor T Cells (T8) - Memory T Cells - Cytotoxic T Cells
3. Stages of Specific Immune Responses
a. Recognition b. Proliferation c. Response d. Effector
ENDOCRINE AND METABOLIC SYSTEMS
A. Hormones - chemical substances secreted by endocrine glands directly into blood stream.
1. Types of Hormones: e. Protein or Peptide Hormone – insulin, vasopression, GH, ACTH. f. Amine Hormones or Amino Acids – EPI, NE g. Steroids – cortisol, Estrogen, Testosterone
2. Hormone Regulation
B. PITUITARY GLAND
1. Anterior Lobe a. GH b. Prolactin c. Thyroid-Stimulating Hormone (TSH) d. ACTH e. Follicle Stimulating Hormone f. Leutinizing Hormone
2. Posterior Lobe a. Oxytocin b. ADH/Vasopressin
C. THYROID GLAND
1. Thyroxine (T4) and Triiodothyronine (T3) 2. Thyrocalcitonin
1. Adrenal Medulla a. Epinephrine (Adrenalin) b. Nonepinephrine
2. Adrenal Cortex a. Mineralocorticoids (i.e. Aldosterore) b. Glucocorticoids (i.e. Cortisol) c. Adrenal Sex Hormones (i.e. Androgen and Estrogen)
F. PANCREAS – both an endocrine and exocrine gland.
1. Exocrine Function – secrete pancreatic digestive enzymes 2. Endocrine Function – controlled by alpha, beta and delta cells of the islets of Langerhans.
a. ALPHA cells – secrete GLUCAGON b. BETA cells – secrete INSULIN c. DELTA cells – secret SOMATOSTATIN and GASTRIN
G. GONADS
1. Ovaries - Estrogen and Progesterone 2. Testes - Testosterone
GI SYSTEM B. Structures
1. Oral Structures 2. Esophagus
* Esophageal Opening a. Upper Esophageal Sphincter b. Lower Esophageal Sphincter (Cardiac Sphincter)
1. Liver – largest glandular organ – located in right upper abdominal quadrant – 4 lobes – left, right, caudate and quadrate – Contains HEPATOCYCTES (Liver Cells) and KUPFER’S CELLS (Phagocytic Cells) – BILE is composed of H2O, electrolytes,
lecithin, fatty acid, cholesterol, bilirubin and bile salts. – blood supply is from PORTAL VEIN (75%) and HEPATIC ARTERY (25%)
2. Biliary System Canaliculi
a. Hepatic Duct b. Oddi’s Sphincter c. Gall Bladder
3. Pancreas - fish-shaped organ - extends horizontally from duodenum to spleen
- the pancreatic exocrine units (ACINI) produce bet. 1,200 – 3,000 ml of pancreatic juice.
B. FUNCTION
2. Liver
a. regulates blood glucose levels b. synthesis of glucose from amino acids of lactate c. converting ammonia to urea d. synthesis of plasma proteins and clotting factors e. breaking down fatty acids into ketone bodies f. storing vitamin and trace metals g. drug metabolism and detoxification h. bile secretion
3. Biliary System
a. Draining bile b. Storing bile in gall bladder
4. Pancreas – has endocrine and exocrine function
a. Secretes pancreatic juice for digestion 3 Types of Digestive Enzymes
- AMYLASE hydrolyzes CHO to disaccharides - LIPASE hydrolyzes FAT to fatty acids and glycerol - TRYPSIN splits protein
b. Secretes H2O and bicarbonate to neutralize gastric juice.
URINARY AND RENAL SYSTEM A. Structure
1. Urinary System a. Ureters b. Bladder c. Urethra d. Urinary Meatus
c. Renal Circulation – Renal Arteries d. Neurologic Control – Symphathetic/Parasymphathetic
B. FUNCTION
1. Urinary System: a. Ureters – transport urine to bladder b. Bladder – reservoir for urine c. Urethra – carries urine from bladder to the outside of the body. d. Urine Formation
3 Processes: 1. Filtration – happens in Glomerulus 2. Reabsorption – done by prox & distal convoluted tubules. 3. Secretion – reabsorption in reverse
e. Micturition (voiding) - under voluntary and involuntary control - 150 – 300 ml – urge to void - 400 – 600 ml – normal bladder capacity - 1.5 L/day – normal urine output - bladder normally contains no residual urine after voiding.
2. Kidneys – overall function
a. blood pressure regulation by renin secretion
b. RBC production by erythropoietin secretion
c. Metabolism of vitamin D.
INTEGUMENTARY SYSTEM A. STRUCTURE
3 Layers of Skin: 1. Hypodermis (Subcutaneous Layer)
Henle’s loop - Countercurrent multiplying exchange mechanism established between long, thin loops of Henle of juxtamedullary nephrons and adjacent vasa recta.
- Filtrate leaves hypotonic
Distal tubule - Na+ reabsorbed and K+ secretad in presence of aldosterone; opposite occurs in absence of aldosterone.
- H2O reabsorbed with Na+; ADH also influences water reabsorption
- Filtrate leaves hypotonic or isotonic.
Collecting duct - Na+ reabsorbed and K+ regulated by aldosterone
1. Apocrine Glands - respond to autonomic rather than thermal stimulation - located in axilla, areola, groin, perineum, circumanal and periumbilical
2. Eccrine Glands - respond to elevated environmental & body temperature - distributed in skin all over the body - secretes sweat which is clear, aqueous solution containing 99% H2O & 1% solid
5. What is commonly referred to as the antecubital region? a. Ankle region b. Breast bone area c. Anterior surface of the elbow d. Skin crease where the thigh meets the trunk
6. Abdominopelvic cavity is divided into nine (9) separate regions. The region located superior to the umbilical region is called:
a. Epigastric c. Iliac b. Hypogastric d. Lumbar
7. It is the area of the back between the ribs and the hips: a. Deltoid b. Gluteal c. Lumbar d. Occipital
8. In which part of the body do you find the popliteal area? a. Posterior knee area c. Posterior surface of the head b. Posterior thoracic area d. Posterior surface of the lower leg
9. The skin can increase the body temperature through the following methods, except: a. Sweating through the sweat glands b. Activation of the erector pili muscles c. Vasoconstriction of the blood vessels in the skin d. Shunting of blood from the skin to the internal organs
10. Which of the following glands is adjacent to a hair follicle and produces a greasy secretion? a. Sweat glands c. Cerumenous glands b. Sebaceous glands d. Sudoriferous glands
11. Which of the following is not a function of the skin? a. Enuresis c. Production of Vit. D b. Protection d.Temperature regulation
12. What is the primary component of the nail? a. Enamel c. Lamella b. Keratin d. Melanin
13. In what layer of the skin can you find the basale? a. Dermis c. Adipose tissue b. Epidermis d. Subcutaneous tissue
14. What is the outermost layer of the epidermis? a. Stratum lucidum c. Stratum spinosum b. Stratum corneum d. Stratum granulosum
15. Which of the following structures is found in roughly the same amount in both dark-skinned and light skinned individuals?
a. Keratin c. Melanocytes b. Melanin d. Receptors
16. Which of the following organ systems synthesizes vitamin D? a. Digestive c. Integumentary b. Endocrine d. Skeletal
17. The pelvis is composed of the following bones? a. Ileum, ischium, pubis c. Ischium, pubis, radius b. Pubis, sacrum, ileum d. Pubis, sacrum, pubis
18. Which of the following cells have the primary function of laying down lamella?
a. Osteoblast c. Osteocytes b. Osteoclast d. Osteophytes
19. What is the largest joint in the body commonly affected with osteoarthritis? a. Ankle c. Knee b. Hip d. Shoulder
20. Which of the following parts of the skeletal system is associated with the appendicular skeleton? a. Clavicle c. Sacrum b. Radius d. Sternum
21. Paracentesis is the removal of excessive peritoneal fluid such as in cases of ascites. If the cannula is inserted in the flank, which of the following muscles will not be passed through?
a. Internal oblique c. Rectus abdominis b. External oblique d. Transversus abdominis
22. Which is not a “true rib”? a. 2nd rib c. 6th rib b. 4th rib d. 8th rib
23. Which of the following is a voluntary muscle? a. Cardiac muscle c. Skeletal muscle b. Gastric muscle d. Smooth muscle
24. Which neurotransmitter has the primary function of stimulating skeletal muscles? a. Acetylcholine c. Dopamine b. Catecholamine d. Serotonin
25. Which of the following bones extends from the pelvis to the knees and is referred to as the largest and longest bone in the body?
a. Femur c. Patella b. Fibula d. Tibia
26. According to the food guide pyramid, which of the following foods should have the highest daily servings? a. Cereals c. Meat products b. Fruit group d. Vegetable group
27. The following statements pertaining to vitamin D are true, except: a. Formed in the kidneys b. Present in natural foods in small amounts c. Water-soluble, essential for bone formation d. Deficiency will result in rickets, osteomalacia and osteoporosis
28. In which of the large intestines is the vermiform appendix attached? a. Cecum c. Ascending colon b. Rectum d. Descending colon
29. Which sphincter will open to allow the contents of the stomach to pass to the duodenum? a. Antral c. Duodenal b. Cardiac d. Pyloric
30. Which of the following refers to the rhythmic, wavelike intestinal contraction that moves food through the garstointestinal tract?
a. Absorption c. Ingestion b. Defecation d. Peristalsis
31. What structure serves as a common passageway for both the respiratory and digestive systems? a. Esophagus c. Mouth b. Larynx d. Pharynx
32. The Cecum can be found in which quadrant of the abdomen? a. Left lower quadrant c. Right lower quadrant b. Left upper quadrant d. Right upper quadrant
33. Which of the following organs is found in the right upper quadrant?
34. Which of the following statements is not true about the circulatory system? a. There are three principal circulatory divisions namely the pulmonary, coronary and systemic division. b. The coronary arteries branching out from the ascending aorta supplies blood to the myocardium of the heart. c. The systemic circulation includes all blood vessels that transport blood in all the body other than those of the pulmonary circulation d. The pulmonary circulation includes the blood vessels that carry blood from the right ventricle through the lungs and to the left atrium
35. Where is the arterial pulse in the neck best palpated? a. Carotid triangle c. Submandibular triangle b. Submental triangle d. Supraclavicular triangle
36. Which of the following blood vessels carry unoxygenated blood? a. Arch of aorta c. Hepatic artery b. Carotid artery d. Pulmonary artery
37. Which of the following is the pacemaker of the heart? a. Bundle of His c. Atrioventricular node b. Sinoatrial node d. Atrioventricular bundle
38. Which of the following valves separate the right atrium from the right ventricle? a. Mitral valve c. Tricuspid valve b. Bicuspid valve d. Seminilunar valve
39. Which of the following is true about blood? a. It is a cell c. It is an organ b. It is a tissue d. It is a system
40. Which of the following best defines serum? a. Liquid portion of clotted blood b. Mucoid portion of unclotted blood c. Solid and liquid portion of venous blood d. Cells and electrolytes found in arterial blood
41. Which of the following is not a function of the lymphatic system? a. Returns fluid leaked from the blood b. houses the cells involved in immunity c. Disposes debris in the lymphatic stream d. Keeps blood constantly supplied with oxygen and removes carbon dioxides
42. The following are actions of the parasympathetic fibers, except: a. Stimulates peristalsis b. Promote secretion of lacrimal glands c. Induce bile and insulin release d. Constrict peripheral blood vessels
43. Which of the following muscles (or groups of muscles) is responsible for forced expiration? a. Abdominals c. External Intercoastals b. Diaphragm d. None of the above
44. Most aspirates commonly go to the right mainstem bronchus. What is the explanation for this? a. The left mainstem bronchus is shorter b. The right mainstem bronchus is narrower c. The right mainstem bronchus is nearly vertical d. The left mainstem bronchus has fewer branches
45. What lobe is found in the right lung but not in the left lung? a. Apical lobe c. Middle lobe b. Lower lobe d. Upper lobe
46. What part of the lung will most likely be damaged by penetrating injuries in the Supraclavicular area?
a. Lingula c. Upper lobe b. Apical lobe d. None of the above
47. Which of the following lung volumes and capacities tend to increase with old age and during cases of obstructive lung disease?
a. Vital capacity c. Total lung capacity b. Residual volume d. Expiratory reserve volume
48. Which of the following lobes of the right lung are separated by the horizontal fissure? a. Upper and lower lobes c. Upper and middle lobes b. Middle and lower lobes d. Upper, middle and lower lobes
49. Which of the following refers to the collection of multipolar nerve cells along the course of the sympathetic trunk?
a. Sympathetic ganglion c. Sympathetic irritation b. Sympathetic imbalance d. Sympathetic nerve
50. Why is urinary incontinence normal in infants? a. Urinary bladder cannot “hold in” the urine. b. Internal urethra sphincter is not yet developed. c. External urethra sphincter is not yet developed. d. The pressure in the urinary bladder is too strong.
51. The following statements pertaining to the kidneys are true, except: a. The kidneys are located retroperinoneally. b. Each kidney moves 1 inch during full inspiration c. The left kidney is palpable in the left lumbar region. d. The right kidney is lower due to the bulk of the liver.
52. Which of the following statements about the urethra is incorrect? a. The male urethra is about 8 inches long. b. The female urethra is only about 1.5 inches long. c. The paraurethral glands are found in both males and females. d. The male urethra serves both as the passage for urine and semen.
53. What hormones do the kidneys secrete in response to a lowered blood pressure? a. Aldosterone c. Anti-diuretic hormone b. Angiotensin d. Renin
54. How many percent of blood volume is passed through the kidneys with each heartbeat? a. 20% b.25% c.30% d.50%
55. Which of the following is not a function of a nephron? a. Tubular secretion c. Glomerular filtration b. Hormonal synthesis d. Tubular reabsorption
56. Which of the following is true about the anatomy of the renal system? a. The kidneys are located anteroperitoneally. b. The kidney has an outer renal cortex and inner medulla. c. It consists of two kidneys, two ureters, two urethras and one urinary bladder. d. The renal cortex is composed of the renal pyramid separated by the renal column.
57. Which organ system is responsible for eliminating nitrogenous wastes from the body and regulating water and electrolytes?
a. Urinary system c. Lymphatic system b. Digestive system d. Integumentary system
58. What is the covering of most long nerve fibers that protects and insulates the fibers and increases the transmission rate of nerve impulses?
a. Hypothalamus c. Midbrain b. Medulla oblongata d. Pons
60. Following a tonsillectomy, a patient noted loss of taste on the posterior one-third of the tongue. Which of the following cranial nerves was probably injured?
a. Facial nerve c. Lingual nerve b. Vagus nerve d. Glossopharyngeal nerve
61. When a patient attempts to protrude his tongue, it is deviates to the right. What nerve is affected? a. Lingual nerve c. Hypoglossal nerve b. Accessory nerve d. Glossopharyngeal nerve
62. When injecting an anesthetic agent into the subarachnoid space, which of the following is an important landmark for determining where to insert the needle through the skin of the back?
a. Coccyx c. 3rd sacral vertebra b. Iliac crest d. Inferior angle of the scapula
63. Bell’s palsy is characterized by a unilateral paralysis of what nerve? a. Tibial nerve c. Peroneal nerve b. Facial nerve d. Obturator nerve
64. The end of the spinal cord is an apex to which a prolongation of the pia mater descends to be attached to the back of the coccyx. What do you call this extension of the pia mater?
a. Cauda equine c. Conus medullaris b. Filium terminale d. Ligamentum dendiculatum
65. Which of the following is not a function of the hypothalamus? a. Body temperature regulation b. Sleep and wakefulness regulation c. Proprioception and discriminative touch d. Water and electrolytes balance regulation
66. Which of the following lobes of the brain functions for the conscious perception of vision?
a. Frontal c. Parietal b. Occipital d. Temporal
67. Sore-eyes, which is common in the summer months, affects which of the following parts of the eyes? a. Cornea c. Vitreous humor b. Conjunctiva d. Aqueous humor
68. Which of the following statements is true about sysnapsis? a. It is the pairing of heterogenous chromosomes during the early meiotic phase b. It is the forming of a single chromosome c. It is the pairing of heterogenous chromosomes during the late meiotic prophase d. It is the pairing of homologous chromosomes during the early meiotic prophase
69. Photoreceptors are found all throughout the retina, except where the optic nerve leaves the eyeball. This “blindspot” corresponds to which of the following sites?
a. Choroid c. Optic chiasma b. Optic disc d. Fovea centralis
70. Which of the following bones comprise the ossicle? a. Incus, malleus, stirrup c. Stapedius, hammer, anvil b. Malleolus, anvil, stirrup d. Hammer, incus, malleolus
71. Which of the following statements best describes the middle ear? a. Lines with ceruminous glands b. Contains hairs, hair cells and nerve fibers c. Flanked medially by oval and round windows d. Subdivided into 3: cochlea, vestibule and semicircular canals
72. Smell sensation is transmitted by the brain by the olfactory nerve. Which of the following cranial nerves is the
olfactory nerve? a. 1st cranial nerve c. 3rd cranial nerve b. 2nd cranial nerve d. 7th cranial nerve
73. The only function of the 4th cranial nerve is to innervate which of the following muscles in the eyes? a. Medial rectus c. Inferior oblique b. Lateral rectus d. Superior oblique
74. The following cranial nerves transmit taste sensations from the tongue except: a. Facial nerve c. Trigeminal nerve b. Vagus nerve d. Glossopharyngeal nerve
75. Which of the following is part of both endocrine and reproductive systems? a. Pancreas c. Testis b. Pituitary d. Uterus
76. Which o f the following is considered both an endocrine and exocrine glad? a. Ovary c. Adrenal glands b. Pancreas d. Thyroid gland
77. Which of the following hormones decreases blood calcium level? a. Calcitonin c. Parathormone b. Insulin d. Triiodothyronine
78. Which of the following is known as the “master gland”? a. Adrenal gland c. Thymus gland b. Pituitary gland d. Thyroid gland
79. What is the site of synthesis of antidiuretic hormone (ADH)? a. Adenohypophysis c. Hypothalamus b. Neurohypophysis d. Adrenal medulla
80. Which of the following structures secretes the male hormone testosterone to maintain spermatogenesis? a. Leydig cells c. Sertoli cells b. Seminal vesicles d. Spermatogenic cells
81. Which of the following is the chief means of regulating hormonal blood levels? a. Baroreception c. Positive feedback b. Chemoreception d. Negative feedback
82. Which of the following endocrine glands also functions as the site of maturation of a special type of white blood cells?
a. Adrenals c. Thymus b. Pancreas d. Thyroid
83. The following hormones are released by the anterior lobe of the pituitary gland and are regulated by hypothalamic hormones, except:
a. Oxytocin c. Luteinizing hormone b. Prolactin d. Adrenocorticotrophic hormone
84. To which part of the female reproductive system does the cervix belong?
a. Fallopian tube c. Vagina b. Uterus d. Vulva
85. In what part of the fallopian tube does fertilization commonly occur? a. Ampulla c. Isthmus b. Infundibulum d. Fimbriae
86. Which of the following hormones from the anterior pituitary gland is required to stimulate spermatogenesis? a. Growth hormone c. Follicle stimulating hormone b. Luteinizing hormone d. Adrenocorticotrophic hormone
87. What term is used to refer to the female external genitalia?
88. In which of the following structures of a sperm can you find the mitochondria? a. Head c. Body b. Neck d. Tail
89. How many chromosomes are there in the female egg cell and male spermatozoa? a. 18 chromosomes c. 23 chromosomes b. 20 chromosomes d. 26 chromosomes
90. In which phase of the sexual contact does the sympathetic branch of the autonomic nervous system take a major role?
a. Excitement c. Ejaculation b. Plateau d. Resolution
91. Sperm and egg cells have 23 pairs of chromosomes. The father’s (sperm) chromosome will determine the sex of the baby.
a. Both statements are true b. Both statements are false c. First statement is true; the second is false d. First statement is false; the second is true
92. Which of the following urogenital muscles primarily cause erection of the female clitoris? a. Bulbocavernosus c. Ischiocavernosus b. Bulbospongiosus d. Deep transverse perineal muscle
93. Which of the following structures found in the female breast is not located superficially? a. Ampulla c. Nipple b. Areola d. Tubercles
94. What term is used to refer to the basic nerve cell of the nervous system which contains a nucleus within a cell body?
a. Nephron c. Cranial nerves b. Neuron d. Peripheral nerves
95. What hypersensitivity reaction appears immediately after exposure to an allergen and is considered as the most common type of allergic reaction?
a. Type I (Anaphylactic reaction) b. Type II (Cytotoxic reaction) c. Type III (Immune complex reaction) d. Type IV (Cell-mediated or delayed hypersensitivity)
96. Which of the following statements pertaining to polymorphonuclear leukocytes is false? a. They mature in the spleen b. They survive for less than a week c. They make up the majority of WBC’s d. Eosinophils and neutriphils are an example
97. Which of the following cells is the immunologic system’s chief site of filtering response to antigens? a. Spleen c. Thymus b. Tonsils d. Peyer’s patches
98. Which of the following cells is responsible for the production of antibodies and acts as mediator of the body’s humoral response?
a. B cells c. Basophils b. T cells d. Macrophages
99. Which of the following WBC’s do not function as phagocytes? a. Basophils c. Monocytes b. Eosinophils d. Neutrophils
100. What is the best way to establish artificially acquired active immunity?