Anatomy And Physiology

APPLIED ANATOMY AND PHYSIOLOGY THE CELL I.

ESSENTIAL CONCEPTS: A.

Cellular Composition: 1. 2. 3.

B. II.

Nucleus Cytoplasm Cell Membrane Homeostasis – State of Equilibrium

CELLULAR DYSFUNCTION: A.

A. B. C.

D.

1. 2. 3. 4. 1. 2. 3. 4.

B.

5. 6. 7. 8. 9.

Fluids – Intracellular vs. Extracellular Electrolytes – K, PO4, Na, Cl Acid-Base Balance Regulatory Mechanisms: Osmosis Diffusion Filtration Active Transport Sources of Normal Fluid Loss Kidneys 4. GI Tract Skin Lungs Homeostatic Mechanisms Renal System Cardiovascular System Pulmonary System Buffer System Endocrine System Pituitary Gland (ADH) Adrenal Cortex (Aldosterone) Parathyroid (Parathormone)

Normal ABG Values - pH: 7.35 to 7.45 - PO2: 80-100 mmHg - PCO2: 35-45 mmHg - HCO3: 22-26 mEq/L

THE NERVOUS SYSTEM 1.

BRAIN a. b. c. d. e.

Cerebrum Cerebellum Basal Ganglia Brainstem Diencephalon

PROTECTIVE STRUCTURES: a. Meninges: Dura Mater Arachnoid Mater Pia Mater b. CSF -

2.

500 – 700 ml/day produced by Choroid Plexus circulates at subarachnoid space

SPINAL CORD Cervical Thoracic Lumbar

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Sacral Coccygeal a. b. 3.

a. b.

I. a.

b.

Descending Tracts Ascending Tracts PNS CN – 12 pairs SN – 31 pairs

BONES: (206) Types of Osseous Tissue Compact Bone Spongy Bone Classification Accdg. to Shape - Long - Flat - Short - Irregular

c.

Parts of Long Bone

d.

Bone Marrow -

e.

MUSCULOSKELETAL SYSTEM

- Sesamoid

Yellow Marrow – storage of adipose tissue Red Marrow – produces RBC & WBC

Skeleton

-

Axial Skeleton – skull, vert. column, thorax Appendicular Skeleton – bones of the limbs

II.

JOINTS: Synarthrosis Ampiarthrosis Diarthrosis

III.

SKELETAL MUSCLES: (Striated Voluntary Muscle) a. Sarcolemma c. Perimysium b. Endomysium d. Epimysium

IV.

LIGAMENTS:

V.

TENDONS:

VI.

CARTILAGE a. b. c.

Hyaline Cartilage Fibrocartilage Yellow Cartilage

FUNCTIONS: I.

BONES: Protects Vital Organs Support Body Tissues Muscle Attachment Hematopoeisis Storage of Mineral Salts JOINTS: a. Ball & Socket b. Hinge c. Saddle d. Pivot e. Gliding f. Condyloid     

II.

i.

SKELETAL MUSCLES   

Provide Movement Posture Heat Production

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i.

LIGAMENTS 

Jt. Stability & Restriction of Motion



Bind Muscle to Bone

 

Shock Absorption Protects Bones & Joints

i.

TENDONS

i.

CARTILAGE

RESPIRATORY SYSTEM A.

Structures 1.

Upper Respiratory Tract – nose, sinuses, pharynx, larynx.

2.

Lower Respiratory Tract – trachea, mainstem, bronchi, segmental bronchi, terminal bronchioles, alveoli.

3.

Lungs (R) Lung

vs

3 Lobes

(L) Lung 2 Lobes

thicker, broader shorter 4.

Chest Cavity

5.

Pleura a. b.

6.

Respiratory Muscles a. Diaphragm b. Ext. Intercostals c.Accessory Muscles

7.

Pulmonary Blood Supply

8.

Neurologic Control

thinner, narrower, longer

Parietal Pleura Visceral Pleura

B.

Functions: 1. Upper Respiratory Tract a. air conduction b. protection from foreign matter c. warming/humidifying air 2. Lower Respiratory Tract a. b. c.

Trachea – connects larynx & lungs Bronchi – conduct air to alveoli Alveoli – gas exchange

3. Lungs a. b. c.

Ventilation Diffusion of Gases Acid-Base Regulation

4. Chest Cavity 5. Pleura

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6. Respiratory Muscles 7. Pulmonary Blood Supply 8. Neurologic Control CARDIOVASCULAR SYSTEM I. THE HEART 1. Pericardium – membranous sac that covers the heart a. Visceral Pericardium b. Parietal Pericardium 2. Heart Wall a. Epicardium or Visceral Pericardium b. Myocardium c. Endocardium 3. b. c. d. e.

Chambers Right Atrium Right Ventricle Left Atrium Left Ventricle

4. Heart Valves a. Antriovertricular Valves Tricuspid Bicuspid or Mitral b.

Semilunar Valves Pulmonic Valve Aortic Valve

* Papillary Muscles * Chordae Tendinae 5. Cardiac Conduction System a. Electrical pathways Sinoatrial (SA) node) - Pacemaker AV Node - @ Sinus Rhythm 60-100 Dpm Bundle of His Purkinje Fibers b. Electrical Impulse Activity – Measured by ECG Phases of ECG – P, Q, R, S, T * P Wave – atrial depolarization * QRS Complex – ventricular depolarization * T Wave – Ventricular repolarization 6. a. b.

Coronary Arteries Right Coronary Artery Left Main Coronary Artery

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Arterial Blood Gases Type Respiratory acidosis pH < 7.35 partial pressure of arterial carbon dioxide (Paco2) > 45 mm Hg (too much carbon dioxide (CO2) = too much acid = acidosis

Causes Respiratory failure, respiratory arrest, pulmonary edema, chronic obstructive pulmonary disease, pneumonia, pneumothorax, atelectasis, overdose, aspiration

Clinical Manifestations 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

Treatment

Respiratory alkalosis pH > 7.45; Paco2, <35 mm Hg (too little CO2= too little acid – alkalosis)

Hyperventilation, pain, anxiety, hypoxemia, ventilators

Lightheadedness, unable to concentrate, numbness, tingling, tinnitus.

Treat the cause. Encourage slow breaths.

Metabolic acidosis pH < 7.35; bicarbonate (HCO3) < 22 mEq/L (too little HCO3 = too little base acidosis

Diabetic ketoacidosis; starvation (ketoacidosis), lactic acidosis; renal failure, diarrhea; acetylsalicylic acid poisoning

Changes in LOC (confusion, drowsiness), headache, nausea and vomiting, Kussmaul’s respirations (increased rate and Increased depth), dysrhythmias)

Metabolic alkalosis pH < 7.35; HCO3 > 26 mEq/L (too much HCO3 = too much base - alkalosis

Vomiting, nasogastric tube; diuretics antacids, too much HCO3; too much IV, HCO3 ordered by health care provider

Tingling, dizziness and bradypnea (conserve O2), hypertonic muscles, dysrhythmias

Administer sodium bicarbonate, monitor intake and output, ABGs, vital signs, and dyshythmias; use seizure precautions Restore fluid volume and electrolytes. Monitor vital signs, intake and output, ABGs, and dysrhythmias. Perform a neurology assessment.

Improve ventilation (chest physiotherapy: turn, cough, deep breathe; suction; oxygen (O2) Assess vital signs, breath sounds, and neurologic assessment signs. Monitor arterial blood gases (ABG) and pulse oximetry readings.

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II. FUNCTIONS OF THE HEART

1.

Cardiac Output – SV X HR Stroke Volume – amt. of blood ejected per beat Preload Afterload b. Heart Rate - normal 60 – 100 bpm a.

2. a. b.

Cardiac Cycle

3.

Systole – contraction phase Diastole – relaxation (filling) phase

Heart Sounds tricuspid & mitral valves closure aortic & pulmonic valves closure ventricular gallop atrial gallop

a. b. c. d.

S1 S2 S3 S4

4. a. b. c. d.

Neurologic Factors Regulating Heart Function Sympathetic Stimulation Parasympathetic Stimulation Chemoreceptor Response Baroreceptor Response

– – – –

THE VASCULAR SYSTEM A. STRUCTURE 1.

Arteries

2.

Arterioles

3.

Capillaries

4.

Venules

5.

Veins Superficial Veins Deep Veins

6.

Lymphatic System - Lymphatic Vessels - Lymph Nodes - Lymph Ducts

Right Lymphatic Duct Thoracic Duct

HEMATOLOGIC SYSTEM A. STRUCTURE 1. Bone Marrow a. Red Marrow b. Yellow Marrow c. Stem Cells 2. Blood Cells normal Hematocrit – 45% a. Erythrocytes (RBC) 5 million cells/mm3 of blood Biconcave disks containing hemoglobin normal Life Span is 120 days b. Leukocytes (WBC)

-

5,000 – 10,000 cells/mm3 of blood * 2 Major Types 1. Granular Leukocyte

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Artery (Conducting Vessels) 3 layers –Tunica Adventitia Tunica Media Tunica Intima Thicker & More Elastic Deeper ion Location (-) Valves

VS

Vein (Capacitance Vessels) 3 Layers –Tunica Adventitia Tunica Media Tunica Intima Thicker & Less Elastic More Superficially located (+) Valves

Carries Oxygenated Blood Higher Pressure

-

Carries Unoxygenated Blood Lower Pressure

70% of all WBCs Subdivided into Neutrophils Eosinophils Basophils

2. Mononuclear Leukocyte (Agranular) Subdivided into Lymphocytes Monocytes c. Thrombocytes (Platelets) -

-

150,000 – 450,000 cells/mm3 produced in bone marrow, Megakaryocytes normal Life Span is 7 to 14 days 3. Plasma -

&

spleen

from

55% of Blood Volume Contains Plasma Proteins – Albumin Globulin Fibrinogen

-

B.

lungs

FUNCTIONS 1.

2. 3.

Gen Functions of Blood: O2 Transportation Waste Transportation Hormonal Transportation Defense Against Infection Chemical, Acid-Base & Thermal Regulation Homeostasis Bone Marrow Blood Cells

a. b. -

Erythrocytes Leukocytes Neutrophils Eosinophils Basophils Monocytes Lymphocytes – B – Lymphocytes T – Lymphoytes

c. Thrombocytes * Coagulation Factors (Table)

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Blood Coagulation proteins Factor I II III IV V VII VIII IX X XI XII XIII Prekallikrein High-molecularweight kininogen 4. a. b.

Synonyms Fibrinogen Prothrombin Tissue thromboplastin, tissue factor Calcium ion Proaccelerin factor, labile factor Serum prothrombin, conversion accelerator, stable factor Antithemophilic factor Christmas factor Stead-Power factor Plasma thromboplastin antecedent Hageman factor Fibrin stabilizing factor Fletcher factor Fitzgerald factor, Flaujeac factor, Williams factor, contact activation cofactor

Plasma Plasma Proteins Constituent Substances in Plasma Blood Coagulation (Clotting and Hemostasis) 1) Vascular Phase 2) Platelet Phase 3) Coagulation Phase Maintenance of Acid-Base Balance -

Clot Lysis Transportation of Nutrients and Hormones

IMMUNE SYSTEM A. B.

1. 2. 1. 2. 3. 4. 5. 6.

C.

1. 2. 3. 4.

5. 6. 7. D.

1.

a. b. c. d.

Functions Defense Against Infection Maintenance of Homeostasis Organs & Tissues Bone Marrow Thymus Lymph Nodes Spleen Tonsils/Adenoids Hematopoietic System Nonspecific Immunologic Defense (Natural Immunity) Physical Barriers Chemical Barriers Biologic Response Modifiers Actions of White Blood Cells Neutrophils Eosinophils & Basophils Granulocytes Monocytes & Macrophages Inflammatory Response Natural Killer Cells Complement Specific Immunologic Defense Types of Immunity

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a. b.

2.

Inborn Immunity Acquired Immunity 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) - delayed hypersensitivity reactions - transplant rejection - viral, fungal, chronic infections * 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 Recognition Proliferation Response Effector

a. b. c. d.

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. b. c. d. e. f. 2. Posterior Lobe a. b.

GH Prolactin Thyroid-Stimulating Hormone (TSH) ACTH Follicle Stimulating Hormone Leutinizing Hormone Oxytocin ADH/Vasopressin

C. THYROID GLAND

1. Thyroxine (T ) and Triiodothyronine (T ) 4

3

2. Thyrocalcitonin D. PARATHYROID GLAND 1. Parathormone

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E. ADRENAL GLANDS 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. 1.

2.

PANCREAS – both an endocrine and exocrine gland. Exocrine Function – secrete pancreatic digestive enzymes 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. 2.

Ovaries - Estrogen and Progesterone Testes - Testosterone GI SYSTEM

B.

C.

Structures 1. Oral Structures 2. Esophagus * Esophageal Opening a. Upper Esophageal Sphincter b. Lower Esophageal Sphincter (Cardiac Sphincter) 3. Stomach * 3 Parts a. Fundus b. Body c. Antrum (Pylorus) 4. Sphincters 5. Small Intestine a. Duodenum b. Jejunum c. Ileum 6. Large Intestine a. Cecum b. Colon c. Rectum 7. Iliocecal Valve 8. Appendix 9. GI Tract Layers (5) – 1. Inner Mucosal Layer 2. Submucosal layer 3. Circular Smooth Muscle Layer 4. Longitudinal Smooth Muscle Layer 5. Outer Peritoneal Layer - Parietal Peritoneum - Visceral Peritoneum Function 1. 2. rectum.

Digestion – occurs in upper GIT, stomach and small intestines. Elimination – defecation occurs in the large intestine and

HEPATIC SYSTEM A.

Structure

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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. b. c. d. e. f. g. h.

regulates blood glucose levels synthesis of glucose from amino acids of lactate converting ammonia to urea synthesis of plasma proteins and clotting factors breaking down fatty acids into ketone bodies storing vitamin and trace metals drug metabolism and detoxification bile secretion

3. Biliary System a. b.

Draining bile 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. 1.

Structure Urinary System a. b. c. d.

2. Kidneys

Ureters Bladder Urethra Urinary Meatus

– lie between T12 – L3 – retroperitoneal in location

a.

External Structures Hilum Renal Capsule

b.

Internal Structures

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Medulla Renal Pyramids Papillae Renal Pelvis Nephron – Glomerulus – Proximal Tubule – Loop of Henle – Distal Tubule – Collecting Duct

-

c. d.

Renal Circulation – Renal Arteries 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.

3 Layers of Skin: 1. 2.

STRUCTURE Hypodermis (Subcutaneous Layer) Innermost Layer Loose areolar connective tissue or adipose (fat) tissue

Dermis (Corium) Middle Layer composed of collagen fibers Provide mechanical strength Contains blood vessels, nerves, lymphatics, hair follicles, sebaceous & sweat glands

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Major Functions of nephron components Nephron Component

Major function

Glomerulus Proximal tubule

- Fitration - 65% sodium (Na) and water (H2O) reabsorbed (antidiuretic hormone (ADH) not required) - Glucose, potassium (K), amino acids reabsorbed - Bicarbonate (HCO3-) reabsorbed - Hydrogen (H+) secreted - Urea reabsorbed - Filtrate leaves isotonic - Countercurrent multiplying exchange mechanism established between long, thin loops of Henle of juxtamedullary nephrons and adjacent vasa recta. - Filtrate leaves hypotonic - 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. - Na+ reabsorbed and K+ regulated by aldosterone - Acid-base regulation; H+ secretion, HCO3 – reabsorption, ammonia secretion, ammonium excretion. - ADH Determine final urine volume.

Henle’s loop

Distal tubule

Collecting duct

2 Layers: a. b.

Papillary Layer / Upper Layer Reticular Layer / Lower Layer

3. -

Epidermis 5 Layers – Stratum Corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basale

a. b.

Contains 2 Main Types of Cells: Melanocytes – produce melanin Keratinocytes

a. b. c. d.

Appendages: Hair Nails Sebaceous Glands Sweat Glands

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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

B.

FUNCTIONS: 1.

Protective Function

2.

Water Balance

3.

Sensory Function

Receptors: Naked Nerve Endings – mediate all four sensory modalities cold, warmth, pain, touch Free Nerve Endings – mediate pain Merkel’s Disks / Meissner’s – touch Ruffini’s Endings – warmth Pacinian Corpuscles – pressure Krause’s End Bulb – cold 4. Vitamin D Production 5. a. Radiation b. Conduction c. Convection 6.

b. c. d.

Thermoregulatory Function Heat Production Heat Loss

Immunologic Functions Wheal & Flare Reaction Release of Histamine & Bradykinin Immune Complexes

7.

Circulatory Function

8.

Aesthetic Function

REVIEW QUESTIONS 1. Which of the following is the study of the structure, shape of the body and the body parts, and their relationships to one another? a. Anatomy c. Homeostasis b. Genetics d. Physiology 2. Which of the following sections is made along a horizontal plane dividing the body or organ into superior and inferior parts? a. Coronal c. Sagittal b. Intermediate d. Transverse 3. Which of the following cavities is inferior to the diaphragm and contains the digestive, urinary and reproductive organs? a. Abdominopelvic c. Spinal b. Cranial d. Thoracic

4. Which directional term is defined as more internal and away from the body surface? a. Deep c. Medial b. Lateral d. Superficial

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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 darkskinned 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?

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a. Ankle b. Hip

c. Knee 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 b. 4th rib

c. 6th 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? a. Liver c. Sigmoid colon b. Rectum d. Spleen

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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

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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. Cell body c. Myelin b. Dendrite d. Nucleus 59. What structure is not part of the brain stem?

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a. Hypothalamus b. Medulla oblongata

c. Midbrain 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

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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 nd b. 2 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

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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? a. Vulva c. Vestibule b. Vagina d. Fourchette 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?

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a. B cells b. T cells

c. Basophils 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? a. Vaccination b. Transplacental route c. Contact with pathogen d. Injection of immune serum

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