Anatomy and Physiology QnA
Anatomy and Physiology QnA
Anatomy and Physiology QnA
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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
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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 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.
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
Chapter 3: Skeleton------------------------------------------------------013
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
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
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
c. Pathology
d. Internal environment
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
e. External environment
f. Homeostasis
i. Enzyme
a. Cellular level
[17]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
d. System level
e. Organismal level
a. External environment
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
Homeostasis
Homeostatic imbalance
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
****
a. Receptor
b. Control centre
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.
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.
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.
a. Blood [4]
b. Circulatory system [4]
c. Lymhatic system [4]
a. Blood
Components
Functions
b. Circulatory system
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Components
Functions
c. Lymphatic system
Components
Functions
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
b. Endocrine system
Components
Functions
c. Special senses
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
NB: Raw materials needed by the body are: oxygen and nutrients (=food and
water)
a. Digestive system
Components
Functions
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
b. Respiratory system
Components
Functions
Wastes eliminated from the body include carbon dioxide, nitrogenous wastes,
and faecal matter
a. Urinary system
Components
Functions
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b. Respiratory system
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
Components
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
b. Muscular system
Components
Functions
Components
Functions
12. State the components and functions of the integumentary system (a system
[29]
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Components
Functions
[30]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
a. Electrolytes [1]
b. Acid [1]
c. Base [1]
d. pH [1]
e. pH scale [1]
Definition of terms:
a. Electrolytes
b. Acid
c. Base or alkali
d. pH
e. pH scale
The pH scale
[32]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
a. Blood [1/2]
b. Saliva [1/2]
c. Gastric juice [1/2]
d. Bile [1/2]
e. Urine [1/2]
15. State four (4) functions of each of the following biological molecules:
a. Carbohydrates [4]
b. Lipids (=fats) [4]
c. Proteins [4]
a. Carbohydrates
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
b. Lipids (=fats)
a. Diffusion [1]
b. Osmosis [1]
c. Intracellular fluid [1]
d. Extracellular fluid [1]
a. Diffusion
b. Osmosis
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Objectives:
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]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
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.
[37]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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]
a. Nucleus
b. Mitochondria
c. Ribosomes
d. Endoplasmic reticulum
e. Golgi apparatus
f. Lysosomes
g. Microtubules
h. Microfilaments
4. Outline the two types of cell division namely mitosis and meiosis [10]
a. Mitosis
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
Mutation
Causes of mutation
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Effects of mutation
a. Passive transport
[42]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
b. Diffusion
c. Facilitated diffusion
d. Osmosis
[43]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
e. Active transport
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
h. Phagocytosis
[44]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
[45]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
a. Epithelial tissue
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.
10. List the organs and structures found in each of the following
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]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
11. Draw a well labelled diagram showing the regions of the abdominal cavity [5]
[48]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Objectives
[49]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Functions of bones
a. Support.
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.
Bones contain red bone marrow which produces red blood cells, white
blood cells, and platelets. This process is called haemopoiesis.
f. Fat storage
2. List five (5) types of bones and give an example(s) of each [6]
Types of bones
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
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
e. Periosteum
g. Endosteum
[52]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Central canal
Lamellae
Perforating canals
Lacunae
Canaliculi
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
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]
a. Minerals
b. Vitamins
c. Hormones.
Hormones that regulate the growth, size, and shape of bones include the
following.
b. Testosterone
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.
[55]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
e. Insulin
Classification of fractures
a. Simple fracture
Simple fracture is a fracture that does not involve protrusion of bone ends
through the skin
c. Pathological fracture
d. Comminuted fracture
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
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
b. Inflammation
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.
e. Bone remodeling
10. Outline five (5) factors that delay healing of fractures [5]
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.
Poor alignment of bone delays bone healing and may lead to permanent
disability.
e. Miscellaneous
[58]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Complications of fractures
a. Infection (osteomyelitis)
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).
The various parts of the skull have specific and different functions:
b. The bony eye sockets protect the eyes from injury as well as giving
attachment to muscles which rotate the eye ball.
[59]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
The mandible originates as two parts that unites at the middle. Each half
consists of the following parts:
Body
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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]
[61]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
c. In the thoracic region of the vertebral column the ribs articulate with the
vertebrae forming joints which move during breathing.
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.
a. The body
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
The body is the broad, flattened, and main part of the vertebrae.
Between adjacent vertebrae is a pad of fibrocartilage called the
intervertebral disc.
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
d. Spinous process
e. Vertebral foramina
a. The thoracic cage protects organs such as the heart, lungs, great blood
vessels etc.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
a. Voluntary movement
The bones, muscles and joints of the limbs are involved in voluntary
movement such as running, jumping, and writing.
Blood vessels and nerves lie along the length of bones of the limbs and are
protected by the bones, muscles, and the skin.
[64]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
[65]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Objectives
[66]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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
Types of 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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
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.
NB: Joints are classified according to the range of movement possible or to the
shape of the articulating parts.
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
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
d. Pivot 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]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
c. Synovial membrane
d. Synovial fluid
[70]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
f. Extra-capsular structures
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]
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j. Eversion [1]
a. Flexion
b. Extension
c. Abduction
d. Adduction
e. Circumduction
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
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Pronation refers to the movement of the forearm so that the palm is turned
backward or downward.
h. Supination
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.
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
d. Teres major
10. State the functions of each of the following 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
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Helps to stabilise the shoulder joint. Assists in adduction of the arm and
extends the elbow joint.
c. Brachialis muscle
11. State the functions of the following muscles associated with the hip joint:
a. Psoas muscle
b. Iliacus muscle
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.
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e. Sartorius
It is associated with flexion and abduction at the hip joint. Flexes the
knee.
f. Adductor group
a. Hamstring muscles
b. Gastrocnemius
It crosses both knee and ankle joints, causing flexion at the knee and
plantarflexion at the ankle.
c. Quadriceps femoris
13. List eight (8) muscles of the face and state the function of each [8]
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
a. Occipitofrontalis
c. Orbicularis oculi
d. Buccinator
e. Orbicularis oris
It closes and protrudes the lips. Shapes the lips during speech.
f. Masseter
g. Temporalis
h. Pterygoid
14. List two (2) muscles of the neck and state the function(s) of each [4]
a. Sternocleidomastoid
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]
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
c. Psoas
d. Latissimus dorsi
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
17. State four (4) functions of the muscles of the abdominal wall [4]
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i. Levator ani
ii. Coccygeus
a. Supports the organs of the pelvis such as the uterus and the rectum.
b. Maintains continence.
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Objectives
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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.
Structure Function(s)
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2. List the sensory receptors located in the skin and state the function(s)
of each [3]
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3. Draw a well labelled diagram illustrating the structure of the skin [8]
a. Protection
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.
b. Formation of vitamin D
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c. Sensation
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).
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.
a. Systemic factors
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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
[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.]
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
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Stage 2: Proliferation
Stage 3: Maturation
The stages of wound healing are (1) inflammation, (2) proliferation, and
(3) maturation.
Stage 1: Inflammation
Stage 2: Proliferation
Stage 3: Maturation
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Objectives
The three layers comprising the wall of the heart are the outer
pericardium, middle myocardium, and inner endocardium.
a. Pericardium
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b. Myocardium
c. Endocardium
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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.
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).
The right atrium receives blood from two large veins called the
superior vena cava and the inferior vena cava as well as a smaller
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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.
b. Venous drainage
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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.
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Sinoatrial Node
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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
Purkinje Fibres
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6. Outline six (6) factors that affect the heart rate [6]
b. Cardioacceleratory center
c. Cardioinhibitory center
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
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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
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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 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
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During this time the myocardium recovers until it is able to contract again,
and the atria refill in preparation for the next cycle.
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.
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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.
d. Cardioacceleratory center
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e. Cardioinhibitory center
g. Acetylcholine
Depends on the amount of blood returning to the heart through the superior and
inferior venae cavae (the venous return).
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:
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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]
c. Baroreceptors
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.
g. Hormones
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j. Nicotine
k. Alcohol
l. Temperature
10. List the main sites of the body where pulse can be palpated [4]
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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]
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Objectives
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1. List any six (6) organs and structures that form the respiratory system [3]
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
3. Outline five (5) functions of the nose and nasal cavity [5]
a. Warming
Air inspired from the environment gains heat as it passes through the nose
and the nasal cavity.
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.
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
Physiology of smell
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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.
The pharynx acts as a passage way for inspired air into the lungs. It also
acts as a passage for ingested food.
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
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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
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.
The larynx prevents aspiration of food particles into the lower respiratory
passages during swallowing.
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The larynx is a passageway for air moving from the pharynx into the
trachea.
The layers of the tracheal wall, from superficial to deep, are (a)
adventitia, (b) hyaline cartilage, (c) submucosa, and (d) mucosa.
a. Adventitia
b. Hyaline cartilage
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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.,
c. Submucosa
d. Mucosa
The cartilages of the trachea prevent obstruction of the airway as the head
and neck moves.
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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
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.
10. Outline three (3) functions of the bronchioles and the alveoli [4]
a. External respiration
The bronchioles and the alveoli allow the exchange of gases between
blood in lung capillaries and air in the alveoli.
The bronchioles and the alveoli have mast cells and lymphocytes which
produce antibodies in response to antigens.
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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
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.
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.
Mechanism of breathing
a. Inspiration
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b. Expiration
c. Pause
External respiration
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
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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]
Comment
Internal respiration
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Diffusion of CO2
Diffusion of O2
a. Oxygen
b. Carbon dioxide
[125]
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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.
d. Chemoreceptors
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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.
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
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Pain
Sudden, severe pain can bring about a brief apnoea. Prolonged somatic
pain increases breathing. Visceral pain may slow the rate of breathing.
Blood pressure
This action increases the breathing rate and is sometimes used to stimulate
respiration in a newborn baby or a person who has stopped breathing.
[This question is a variation of the previous question. All the factors identified in
the previous question do influence respiration]
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[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]
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
H+ + HCO3- H2CO3
(hydrogen ion) (bicarbonate) (carbonic acid)
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.
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H2CO3 HCO3- + H+
(carbonic acid) (bicarbonate) (hydrogen ion)
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Objectives
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.
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Peristalsis mixes food and secretions and propels the contents of the
gastrointestinal tract along the tract.
d. Digestion
e. Absorption
Water, minerals, vitamins, and drugs are absorbed from the lumen of the
gastrointestinal tract into blood capillaries or lymph vessels.
The basic structure of the alimentary tract consists of the following layers:
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)
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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.
c. Submucosa
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
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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
The peritoneum has two layers: (1) parietal peritoneum and (2) visceral
peritoneum.
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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
Structure of a tooth
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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
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.
a. Dentine
b. Enamel
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c. Pulp cavity
Components of saliva
Functions of saliva
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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.
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.
d. Non-specific defence
e. Taste
Saliva dissolves food. Dissolved food molecules can then stimulate the
taste buds leading to the sensation of taste.
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a. Lesser curvature
b. Greater curvature
The regions of the stomach are: (a) the cardia, (b) the fundus, (c) the
body, and (d) the pyloric antrum (=pylorus).
b. Pyloric sphincter
a. Peritoneum
b. Muscle layer
c. Submucosa
d. Mucosa
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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.
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.
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
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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.
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b. Hydrochloric acid in gastric juice acidifies the food and stops the action of
salivary amylase.
d. The acidic environment created by the acid in gastric juice is optimum for
the effective digestion of proteins by the enzyme pepsin.
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.
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d. The small intestine has lymph follicles which protect against infection.
16. Draw a well labelled diagram of the large intestine (=the colon
and rectum) identifying its different sections [6]
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
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d. Mass movement
e. Defaecation
18. Describe the position and structure of the vermiform appendix [3]
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]
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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.
The pancreas is pale and weighs about 60 grams. The gland is about 12–
15 cm long and 2.5 cm thick.
Location
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
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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.
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.
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.
a. Exocrine pancreas
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b. Endocrine pancreas
The endocrine pancreas secretes the hormones insulin and glucagon, these
two hormones principally regulate blood glucose levels.
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a. Carbohydrate metabolism
b. Fat metabolism
c. Protein metabolism
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d. Metabolism of ethanol
g. Production of heat
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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]
The gall bladder is a pear-shaped sac. The gall bladder is attached to the posterior
surface of the liver by connective tissue.
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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.
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.
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Objectives
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Dimensions
A typical adult kidney is on average 10-12cm long, 5-7cm wide, and 3cm
thick.
Mass
The kidney has three layers of tissue i.e. (1) fibrous capsule, (2) renal
cortex, and (3) renal medulla.
[156]
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Papilla
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
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
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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.
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.
[158]
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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
c. Venous drainage
[159]
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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 secrete an enzyme called renin. The enzyme regulates blood
pressure through the renin-angiotensin- aldosterone mechanism.
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f. Production of hormones
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.
The kidneys removes metabolic wastes from the body including the
nitrogenous compounds (=urea and uric acid), excess ions, and some
drugs in urine.
There are three processes involved in the formation of urine namely simple
filtration, selective reabsorption, and 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.
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.
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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 hydrogen ions (H+) secreted into urine combines with buffers.
When blood pH is getting too low bicarbonate ions are absorbed from
urine into the blood stream (reabsorption of bicarbonate ions). The
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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
3. Ammonia secretion
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.
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Shape
Capacity
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).
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.
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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.
Physiology of micturation
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Objectives
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1. List any eight (8) glands that form the endocrine system [4]
Hormones secreted by the anterior lobe of the pituitary gland and their functions
d. Prolactin (PRL)
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The exact role of MSH in humans is unknown but when present in excess
it causes darkening of the skin.
a. Oxytocin
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4. Describe the structure and position of the thyroid gland its related
structures [8]
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 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 larynx: the thyroid gland is located in the neck just inferior of the
larynx.
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5. State five (5) functions of the thyroid hormones (T3 and T4) [5]
6. Describe how levels of thyroid hormones (T3 and T4) are regulated
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[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].
b. Calcitonin [2]
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 also increases the amount of calcium reabsorbed by the kidneys and
promotes the excretion of HPO42- in urine.
b. Calcitonin (CT)
Functions of insulin
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).
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Functions of glucagon
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]
Normal blood glucose levels are controlled mainly by the opposing actions of
insulin and glucagon:
When blood glucose levels are rising above normal the following events occur:
When blood glucose levels are decreasing below normal the following events
occur:
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13. State the actions of each of the following groups of adrenocorticoid hormones:
a. Glucocorticoids [7]
b. Mineralocorticoids [2]
c. Androgens (sex hormones) [2]
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.
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a. The hormones increase the heart rate and the force of contraction of heart
muscle.
[177]
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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.
[178]
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Objectives
[179]
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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.
c. Repolarisation
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a. Sensory nerves
b. Motor nerves
Motor nerves, or efferent nerves, transmit impulses from the brain and
spinal cord to the muscles.
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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.
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.
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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.
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.
[183]
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The brain and spinal cord are covered by four membranes called
collectively the meninges.
a. Pia mater
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
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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.
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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).
d. Sustain proper osmotic and ionic balances in the extra cellular fluid for
normal neuronal function.
[186]
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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.
Functions
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This extends anteriorly from the premotor area to include the remainder of
the frontal lobe.
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.
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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.
This area lies immediately below the lateral sulcus within the
temporal lobe.
Function: receives impulses from the nose via the olfactory (I)
nerves and interprets the impulses as smell.
The taste area is located just above the lateral sulcus in the deep
layers of the sensory area.
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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]
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.
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a. Receives information from the sensory systems, the spinal cord, and other
parts of the brain and then regulates motor movements.
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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.
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]
18. Compare and contrast the effects of stimulation of the sympathetic and the
parasympathetic divisions of the autonomic nervous system on body systems [12]
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
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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.
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Objectives
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.
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1. Define the term special senses and then list the five (5) special senses [1]
Definition
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
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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.
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).
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.
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The vestibule
The cochlear
Semicircular canals
b. Membranous labyrinth
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Vestibule
Semicircular ducts
Physiology of hearing
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Physiology of balance
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
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.
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:
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Physiology of smell
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Physiology of taste
[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.]
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
The outer fibrous layer consists of the sclera and the cornea.
a. Sclera
b. Cornea
a. Choroid
b. Ciliary body
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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 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.
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
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.
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.
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).
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 nerve impulses are transmitted via the optic nerve to the visual area of
the occipital lobe of the brain.
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.
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
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.
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
12. List the six (6) extraocular muscles of the eye ball and state the
function of each [6]
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
[212]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
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.
c. Lacrimal apparatus
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
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Components of tears
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]
Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Objectives
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Ovaries produce and secrete female sex hormones i.e. progesterone and
oestrogens.
e. Parturition (=childbirth)
f. Lactation
Mammary glands (=breasts0 synthesize, secrete, and eject milk for the
nourishment of the baby.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
Ligaments
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.
Three layers of tissue form the walls of the uterus i.e. (a) perimetrium
(=peritoneum), (b) myometrium, and the (c) endometrium.
b. Myometrium
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
c. Endometrium
5. State any six (6) changes that occur in the female at puberty [6]
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:
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.
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)
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
a. Menstrual phase
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.
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.
6. State any six (6) changes that occur in the female after menopause [6]
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
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Essentials of Anatomy and Physiology for Nurses: A Question and Answer Approach
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.
9. List the organs that make the male reproductive system [4]
11. State six (6) changes which occur in the male at puberty [6]
a. Growth of muscle and bone, and a marked increase in height and weight
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References
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Medical Bppks/McGraw-Hill.
3. Glenister T.W.A. and Ross J. R. W. (2000) Anatomy and Physiology for Nurses
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12. Snell R. S. (2010). Clinical Neuroanatomy (7th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins
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15. Vidya Ratan (2004) Handbook of Human Physiology (7th Ed.) New Delhi. Jaypee
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