FINAL

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  1. Mod 8, Obj 2
    5 layers of epidermis
    • From superficial to deep:
    • stratum corneum
    • stratum lucidum
    • stratum granulosum
    • stratum spinosum
    • stratum basale
    • "Cher Likes Getting Skin Botoxed"
    • Stratum - layer, get other name by their appearance (under microscope)
  2. stratum corneum
    • top layer of skin
    • "horn-like"
    • NO NUCLEUS, dead cells
  3. stratum lucidum
    • if going superficial to deep, the 2nd layer of the epidermis
    • "clear"
    • found only in thick (hairless) skin
    • makes calluses
  4. stratum granulosum
    • "grainy" ~ lipids are accumulated to give skin it's waterproof ability, which gives it the grainy appearance
    • 3rd layer of epidermis
  5. stratum spinosum
    • 4th layer of epidermis
    • "spiny" - in appearance, it looks like there are "spines" or junctions btwn the cells
    • has other cell types besides keratinocytes
  6. stratum basale
    • 5th and deepest layer of epidermis
    • layer from which all others regenerate
    • single layer of cuboidal cells which continually (rapidly) divide (by mitosis)
    • *stem cells are produced, then divide. one cell remains in the stratum basale, the other progresses and becomes a keratinocyte (skin cell)
    • As skin cells move up, the acquire keratin and lipids in other skin layers
  7. other cell types of the epidermis (besides keratin)
    found only in the deeper layers: basale and spinosum
  8. keratinocytes
    • come from cells which divide and grow in basale layer, then migrate upwards, losing their nuclei and becoming bags of keratin
    • Dead keratinocytes shed from superficial surface

    Keratin - simply bags of protein. As the epidermis is mostly composted of dead cells, which have expelled their nucleus and all organelles to become these bags
  9. corneocytes
    • another name for the keratinocytes which are pushed superficially and become dead bags of keratin
    • are constantly shed from surface of stratum corneum
  10. squames
    • the shed flakes of skin
    • humans shed about 600000 per hour
    • an estimated 1/3 of "house dust" is shed skin flakes
  11. check understanding in graphics for MOD 8, OBJ 2
  12. MOD 8, OBJ 4
    four types of cells found in epidermis
    • stem cells
    • melanocytes
    • langerhans cells
    • merkel discs
  13. dead keratinocytes
    • a cell membrane surrounding the protein keratin, which gives skin it's strength
    • make up about 90% of the cells of the epidermis
    • takes 4 - 6 weeks for new cells to reach top layer
  14. a cell is most vulnerable (to uv, radiation, etc.) when
    it's dividing
  15. melanocytes
    • carry & produce melanin, which give skin color
    • make up about 8% of cells in epidermis
    • tries to protect from energy (UV, etc.). So more UV you're exposed to, the more melanin is produced (which appears as a tan)
  16. melanin
    pigment granules in melanocytes, which give skin color
  17. Langerhans cells
    • one of 4 cell types in epidermis
    • provide immune defense
    • skins version of a macrophage cell or phagocyte
    • Skins version of dendritic cell (type of immune cell)
  18. Merkel disc
    • the rarest epidermal cell (of the 4 types)
    • cells that are attached to sensory neurons that detects light touch

    So a type of nervous system cell
  19. stem cells
    • found in stratum basale
    • full of intermediate filament protein keratin
    • they divide to regenerate skin keratinocytes
    • cells terminally differentiate as they move more superficially
    • eventually lose nuclei & just become surrounded by membrane
    • also secrete lipids that give skin waterproof and flexible properties
  20. functions of the skin
    • skin protects the body and defends against microbial invaders
    • also serves to cool the blood, when necessary, and detect sensory modalities of touch: pressure, vibration, pain and temp.
    • keratin & lipids of skin help w waterproof seal
    • skin is also critical in the activation of precursors which form Vit D
  21. MOD 8, OBJ 6
    dermis
    • 1/5 areolar connective tissue and 4/5 dense connective tissue
    • is strong and resilient, can be stretched and snaps back to original form
    • are few cells, mostly collagen and elastic fibers
    • two regions of dermis: Papillary region and reticular region
  22. Papillary region
    • 1/5 thickness of dermis ~ consists of areolar connective tissue w thin collagen and fine elastic fibers
    • important for it's tight attachment to epidermis
    • is thrown up into ridges that penetrate up into the epidermis
    • each ridge tends to contain blood vessels (capillary loops) and Meissner corpuscles and free nerve endings
  23. "ridges" in thick skin
    On palms, fingertips, and soles the underlying structure of dermis (the ridges) cause fingerprints - gives grip ability and sensitivity
  24. reticular region
    • the remaining 4/5 of dermis ~ consists of dense irregular connective tissue w bundles of thick collagen and some coarse elastic fibers
    • Spaces btwn fibers contain some adipose cells, hair cells, nerves, and glands
    • nerves and blood vessels run here
    • hair roots (if present) and glands are found here
  25. What's in the dermis?
    • collagen and elastic fibers = strength and stretching
    • Muscle tissue - arrector pili muscles @ base of hair follicles
    • blood vessels = oxygen and nutrients to epidermis (DERMIS IS VASCULAR!)
  26. striae
    • stretch marks
    • caused by stretching of skin that causes tears in dermis, such as from obesity or pregnancy
    • Is permanent
  27. Check graphics page 360 to clarify understanding
  28. MOD 9, OBJ 2
    What type of tissue is bone?
    connective tissue
  29. four types of bone cells
    • osteogenic cell
    • osteocyte
    • osteoblast
    • osteoclast
    • **Osteoblast and Osteoclast are regulated by hormones
  30. osteogenic cell
    • a bone stem cell
    • develops into an osteoblast
    • the precursor to all the other cell types
  31. Osteoblasts
    • dividing cells that make bone
    • responsible for laying down the organic and inorganic extracellular matrix of bone
    • follow behind osteoclasts, rebuilding bone
    • remember B in blasts: bone building blasts
  32. osteocytes
    • "bone cells"
    • maintain bone tissue
  33. Osteoclasts
    • constantly tunnel through bone, using acid to dissolve mineralized matrix and enzymes to dissolve organic matrix
    • followed by osteoblasts; in this way, bone is constantly renewed and can strengthen when needed
    • Bone-chewing
  34. Important role of osteoblasts and osteoclasts
    keeping blood calcium and phosphorus within normal limits, so they are controlled by hormones
  35. two components of bone
    inorganic and organic
  36. inorganic part of bone
    • primarily hydroxyapatite ~ Ca5(PO4)3(OH)
    • Is a compound of calcium, phosphate, and hydroxyl groups held together by ionic bonds
    • this forms the rigid, brittle inorganic matrix of bone
  37. Organic part of bone
    mostly made up of collagen type I along with several minor proteins
  38. Why do we need both mineral (inorganic) and organic (collagen) components of bone working together?
    • If theres too much mineral, bone becomes too brittle and fractures easily
    • If bone has too much collagen, bones are soft and pliable
  39. osteogenesis imperfecta
    • "brittle bone disease"
    • having too much mineral in the bone, which causes it to be brittle and fracture easily
  40. rickets
    • happens in children, when their bones have too much collagen making them soft and pliable, making characteristic bent bones
    • happens in absence of D vitamins, children are unable to absorb sufficient calcium to lay down the large amount of mineralized bone they need
    • in adults it's called osteomalacia
  41. osteomalacia
    • happens in adults, when their bones have too much collagen, making them soft and pliable
    • the failure to make mineralized bone is not usually due to Vit D deficiency, but metabolic disturbances, cancer, or chemotherapy for cancer which can cause problems with calcium homeostasis
    • In children, it's called rickets
  42. MOD 9 OBJ 9
    Two hormones that control osteoclast and osteoblast activity
    • Parathyroid hormone (PTH)
    • Calcitonin (CT)
  43. Parathyroid hormone
    • if blood calcium gets too low, released from set of small pea-shaped glands next to thyroid
    • increases osteoclastic activity: which breaks down the mineralized portion of bone and calcium (and phosphate) is released into the bloodstream
    • body sees bones as calcium reservoir
    • inhibits osteoblasts, increases blood Ca++ , decreases bone formation
    • increased blood calcium levels trun hormonal switch "off"
  44. For every molecule of hydroxyapatite the body breaks down, how much calcium do you get?
    10 calcium atoms
  45. Negative feedback loop vs. positive feedback loop
    • negative is self controlling, cannot spin out of control if overstimulated.
    • Ex: blood pressure
    • positive isn't self controlling, only shut down when system is depleted or prob. corrected. Ex: childbirth. rarely used
  46. Calcitonin
    • made by parafollicular cells (C cells) in the thyroid gland
    • released when calcium is high; stimulates osteoblasts, inhibits osteoclasts, decreases Ca++, increases bone formation
    • absorb calcium from the bloodstream and deposit it as hydroxyapatite in bone
    • *think  Calcitonin = theres a ton of calcium, too much!
  47. Summary of Low Blood Calcium levels
    Low blood Ca++ → parathyroid releases PTH → PTH stimulates osteoclasts → osteoclasts release calcium from bone → blood calcium returns to normal and PTH release stops
  48. Summary of high blood calcium levels
    High blood Ca++ → thyroid releases calcitonin → calcitonin stimulates osteoblasts → osteoblasts deposit calcium in bone → blood Ca++ returns to normal and calcitonin release stops
  49. calcitriol
    • a third hormone released from the kidneys when they detect low blood Ca++ works in digestive system to increase the absorption of calcium from foods
    • helps blood and PTH restore normal Ca++ levels
  50. Two D vitamins
    • Vit D2 (ergocalciferol) and Vit D3 (cholecalciferol)
    • are made in skin w help of UV-B light (natural sunlight)
    • important in management of calciumhelp in intestinal absorption of calcium in foods
  51. MOD 9, OBJ 15
    atlas
    • C1 vertebrae
    • recall that Atlas in Greek mythology held up the earth
    • no body, minimal spinous processholds up the head
  52. atlanto-occipital joint
    • the joint btwn the occipital bone of skull and atlas
    • allows us to nod up and down, saying yes
  53. axis
    • C2 vertebrae; small body
    • articulates (forms a joint) with the atlas that allows for head rotation
    • has dens which is a tooth-like "peg" which projects superiorly into the vertebral foramen of atlas
  54. transverse ligament
    attached to C1, wraps around dens to hold in place but allows for head rotation, shaking head in "no"
  55. cervical vertebrae
    • C3 - C7 are more "typical"
    • a unique feature of C3 - C7 is they are bifid (two-pronged) spinous process
  56. vertebra prominens
    • C7, the last of the cervical vertebrae
    • called such because it's prominent
    • can feel when palpate back, right below neck
  57. thoracic vertebrae
    only ones that articulate with ribs (12 thoracic vertebrae articulate -make joints- with 12 ribs)
  58. two points at which each rib (left and right) touches a vertebra
    • the transverse process of a vertebra touches the tubercle of a rib
    • The body of the vertebra touches the head of a rib
  59. where do thoracic vertebrae make joints with each other?
    at the inferior articular facet and superior articular facet
  60. Lumbar vertebrae
    • designed to carry a large amount of weight; therefore have thick, strong body
    • gives them the appearance of a "scotty dog" in lateral medial x-ray views
  61. sacrum & coccygeal vertebrae
    • Sacrum is made up of 5 fused vertebrae (S1 - S5)
    • Coccyx is made up of 3-4 fused vertebrae (# varies)
  62. transitional vertebrae
    • a relatively common anatomical variation
    • includes lumbarization of S1 and sacralization of L5
  63. lumbarization
    • of S1 vertebrae
    • In 10% of humans, there is an "extra" joint btwn S1 and S2, then S2-S5 are fused.
    • Because S1 is acting like a lumbar vertebra, it's called lumbarization of the S1 vertebra
  64. sacralization
    • of L5
    • In 14% of people (ex: 1 in 7), the L5 vertebrae is fused w the S1-S5 stack to form six fused vertebrae.
    • Because L5 is "acting" like a sacral vertebra, it's called sacralization of L5 vertebra
  65. MOD 9, OBJ 16
    Thorax
    • the chest
    • thoracic skeleton is made up of sternum + 12 pairs of ribs
  66. naming of ribs
    T1 articulates with the first rib, T2 articulated with the 2nd rib... hence, ribs are numbered superior to inferior
  67. costal cartilage
    • a type of hyaline cartilage
    • make the connection btwn true ribs (1-7) and the sternum
  68. false ribs
    • ribs 8-10
    • called false cause the use rib 7 to articulate with sternum, rather than making connection directly
    • again, it's hyaline costal cartilage that makes the connection
  69. glenoid fossa
    the socket for the head of the humerus; on scapula
  70. what bones support the shoulder (pectoral) girdle
    the clavicle and scapula; together forming the glenoid fossa
  71. pelvis
    • supports the lower extremity
    • has 3 bones on each side (6 total): ilium, ischium, pubis
    • depression forming a large socket for head of femur is called acetabulum
  72. MOD 10, OBJ 11
    neuromuscular junction
    • the point of contact btwn the nervous system and muscular system
    • neurons in the spinal cord send out a cable-like axon which ends at this junctionthe signal sent at the junction (which happens by the release of acetylcholine) triggers contraction of the entire muscle fiber
  73. neurotransmitters
    • chemical substances which allow neurons to work
    • they transmit info from neurons, cause an electrical change in cell that receives message
  74. What controls the muscular system
    Neurons (nerve cells), which are the thinking and info processing cells of the nervous system
  75. acetylcholine
    • (ACh)
    • the neurotransmitter motor neurons use to cause muscle cell contraction
  76. How do motor neurons work
    • when it receives the proper stimulus, it releases acetylcholine onto the sarcolemma of muscle fiber
    • there, specialized receptors turn chemical signal into electrical signal
    • called nicotinic acetylcholine receptors
  77. nicotinic acetylcholine receptors
    • specialized receptors which turn the chemical signal into an electrical signal which spreads over the entire surface of the muscle fiber, penetrating into T tubules where they meet the sarcoplasmic reticulum in triads.
    •  This causes calcium release from it's stores in the SR
  78. synaptic release
    • the way neurotransmitters are released from nerves
    • understand that an electrical signal in both nerve and muscle is what triggers events in both cells
  79. motor neuron
    • brain cells (or nerve cell) that controls movement (muscle tissue)
    • they receive input through the spinal cord
    • generate an electrical impulse (action potential) which travels along a "cable" (axon) to its end (axon terminal)releases acetylcholine - receiving cell is skeletal muscle cell
    • single motor neuron branches several times & contacts muscle fibers
  80. alpha motor neuron
    the last neuron in the motor neuron chain, has it's cell body and dendrites (info receivers) INSIDE SPINAL CORD
  81. action potential
    • the electrical impulse generated by motor neurons, as long as a certain combination of events occur
    • is a change in voltage that lasts for just a brief period of time and makes things happen (from neg to pos to neg.. as neg charge is normal)
    • *remember scientists use the word "potential" to mean "voltage"
    • *the motor neuron action potential releases acetylcholine from the end of the motor neuron
  82. axon
    part of the nerve cell that takes signals away from the nerve body; therefore the action potential travels from the spinal cord to the muscle, using the axon of the cell for the journey
  83. axon terminal
    • the end of the axon, where action potential triggers the release of acetylcholine
    • *attached to the synaptic end bulb
  84. synaptic end bulb
    • at the end of the axon terminal
    • Where the exchange or signal, passing from neuron to the muscle cell to allow for a series of events to take place to get contraction
  85. how does muscle cell action potential actually happen?
    • after the ACh (acetylcholine) is released from the axon terminal, it diffuses across tiny gap btwn nerve and muscle and binds to receptors on muscle cell.
    • these receptors allow the flow of Na+ (sodium) and K+ (potassium); which cause the voltage inside muscle cell to change from neg. to pos.
    • This "flip" in voltage is the muscle cell action potential
  86. order of events which occur in motor neuron and at neuromuscular junction
    • 1. motor neuron action potential arrives at neuromuscular junction, triggers release of acetylcholine in synapse btwn neuron & muscle
    • 2. Acetylcholine binds up with acetylcholine receptors, which then sends that electrical impulse (action potential) along muscle surface (on plasma membrane of sarcomere)
    • 3. When this impulse reaches T tubules, initiates release of Ca++ from sarcoplasmic reticulum
    • 4. Once acetylcholine is no longer needed (no need for constant contraction), cleared away by acetylcholinesterase
  87. nerve agent intoxication
    makes the ACh keep binding to receptors and opening ion channels; making the muscle stay w positive voltage forever
  88. Sequence of events that link muscle cell action potential to release of calcium from sarcoplasmic reticulum
    • Again, action potential travels along surface of muscle
    • Penetrates into the interior muscle cell at transverse tubules (T tubules)
    • The action potential in T Tubule initiates release of Ca++ from sarcoplasmic reticulumCa++ interacts w proteins to help contraction btwn myosin and actin
  89. From Ca++ Release to Contraction
    • The Ca++ released from SR then binds w troponin (a regulatory protein)
    • troponin then changes it's shape, which causes the tropomyosin to move aside and expose binding site for myosin on the actin filament
  90. AChE
    • acetylcholinesterase ~ an enzyme used to stop the action of ACh
    • breaks apart the ACh molecule at it's ester linkage, into acetate and choline - nether of these can bind to receptors
    • the action potential ends and leftover pieces of ACh are taken up into the presynaptic axon terminal for recycling
  91. troponin
    • a special protein found only in muscle cells
    • binds which calcium (which is released from the SR) and changes shape
    • moves tropomyosin aside and exposes binding sites for myosin on the actin filament
  92. tropomyosin
    • normally covers a myosin binding site on the actin molecule; keeps myosin (which wants to bind actin very much) from being able to reach it's binding site on actin
    • therefore, when troponin shoves tropomyosin out of the way, myosin can grab actin
  93. MOD 11 OBJ 3
    Sensory = ____________; motor = ___________
    • Sensory = afferent
    • Motor = efferent
  94. transduction
    a process by which sensory information is converted to a form the nervous system can useThis info flows into the control center from the PNS
  95. PNS
    • peripheral nervous system includes the cranial nerves, spinal nerves, ganglia, enteric plexi, and sensory receptors
    • has ability to regrow nerves (functional recovery) if damaged, where the CNS does not
  96. Two groups of nervous/motor systems
    • ANS or Visceral motor System - those that are controlled automatically. Hooked up to autonomic ganglia and nerves
    • Somatic nervous/motor system - the voluntary (consciously controlled) motor system. Hooked up to motor nerves
  97. MOD 11 OBJ 4
    ANS
    • Autonomic nervous system comprised of those effectors which are NOT under conscious control
    • Divided into 2 systems: Sympathetic & Parasympathetic
    • *do not involve cerebral cortex, which is where consciousness resides
  98. Pathway of info from ANS
    • First structures are autonomic ganglia and nerves
    • Next info passes through one or several neurons of the ANS (can be considered the "motor") to the effectors (which "do" something): smooth muscle, cardiac muscle or glands (those effectors not under voluntary control)
  99. sympathetic nervous system
    • division of ANS
    • "fight or flight"
  100. Parasympathetic nervous system
    • division of ANS
    • "rest and digest"
  101. synapse
    contacts btwn nerve cells
  102. α motor neurons
    • alpha motor neurons
    • info from the somatic nervous system are relayed to alpha motor neurons, which make contact with skeletal muscle at the neuromuscular junction
  103. MOD 11 OBJ 6
    Two cell types of the nervous system
    Neurons and glial cells
  104. Glia
    • Glial cells
    • Major role in support and nutrition of brain
    • Do not manipulate info
    • Maintain the structural and chemical environment of the brain, so that neurons can do their jobs
    • 4 types in CNS & 2 types in PNS
  105. 4 types of glial cells in CNS
    • astrocytes
    • oligodendrocytes
    • microglia
    • ependymal cell
  106. Astrocytes
    • (think of Astronaut) 
    • also called astroglia; type of glial cell in CNS
    • make up the pia mater  (the borders of CNS)
    • cooperate w/ blood vessels to form BBB, which protects brain from chemical or microbiological damage
    • End feet of astrocytes make up pia mater"sponge up" access ions, toxins, and waste products
  107. oligodendrocytes
    • also called oligodendroglia
    • cells that form wrappings around the axon
    • only have one job: form myelin sheaths (layers of thin lipid sheets wrapped) to insulate nerve axons that must send info over long distances
    • *only found in CNS. CANNOT regrow if cut or damaged
  108. microglia
    • type of glial cell in CNS
    • the brains equivalent of monocytes
    • *since the brain is termed an "immunologically privileged site", no immune cells can pass the BBB
    • ONLY MICROGLIA are normally allowed to carry out immune functions in the brain
  109. ependymal cells
    • make up a single layer of border cells lining the ventricles which make cerebrospinal fluid
    • have cilia that continuously "row" CSF through the ventricular system
    • *only found in CNS
  110. MOD 11 OBJ 15
    Ions that differ in concentration btwn the inside and outside of a neuron are subject to two independent forces:
    • Concentration forces
    • Electrical forces
  111. Concentration forces on ions
    All atoms, including sodium, potassium, chloride and calcium ions, want to move from where they are in high concentration to where they are in low concentration

    also called chemical forces or diffusional forces
  112. Electrical forces on ions
    • describes the "pull" of a positively charged ion exerts on a negatively charged ion.  
    • * Particles with the same charge repel each other, and opposites attract
  113. What happens when protein gates in the cell membrane open?
    • It allows ions to flow; voltage turns to current
    • In terms of Ohm's Law, resistance is going from almost infinity to a measurable number
    • *REMEMBER these channels are selective for only one type of ion!
  114. At rest, what charges are a neuron inside vs. outside
    • the neuron is always negative inside relative to outside.
    • based on electrical forces, positively charged ions always want to flow in, and negatively charged ions always want to flow out
  115. How do ions pass through the cell membrane
    must have channels or "doorways"must be open for passage
  116. Concentration and electrical forces on K+
    • Potassium is present at much higher concentration inside neuron.
    • *K+ has positive charge, inside is negative
    • Therefore, concentration force pushes K+ out.
    • The electrical force (neg. inside cell) pushes positively charged K+ inWhen K+channels are open, the two forces work in opposite directions
  117. Concentration and electrical forces on Na
    • Sodium is present at higher concentration outside neuron
    • electrical forces pull sodium into cell, where it's more negative
    • Since Na+ outside the cell is so much greater than inside, the concentration forces act to push Na+ into the neuron
    • *Both concentration and electrical forces act in the same direction when Na+ channels open, pushing sodium into the neuron
  118. MOD 11 OBJ 17
    Action potential
    • When the neuron is actively trying to manipulate the flow of charges across cell membrane
    • used by neurons that need to send information over long distances through axons (takes place along axonal membrane)
    • results from active opening and closing of voltage-gated channels
  119. Steps in the action potential
    • resting potential - begins here
    • threshold - stimulus causes depolarization
    • depolarization: Na+ channels open, Peak, Na+ channels inactivate & K+ channels open
    • Repolarization
    • After-hyperpolarization (hyperpolarization)
    • return to resting potential
  120. polarization & depolarization
    • polarization simply refers to negativity
    • DEpolarization means something is losing some of its negativity
  121. Special property of axonal membrane voltage-gated sodium channels
    • When voltage becomes less negative, the sodium channels open.
    • Because of driving forces (concentration & electrical) on sodium pushing it into the cell, Na+ begin rushing in and make cell membrane less negative inside.
    • This opens up more and more voltage-gated sodium channels.Is a self regenerating, explosive, positive feedback
    • When all sodium channels are opened, reaches "tipping point" called threshold
  122. Threshold
    • the point at which depolarization will trigger an action potential
    • reached when all sodium voltage-gated channels have been opened
    • means that the sodium current now overwhelms the leak current and axonal membrane reaches sodium equilibrium potential
  123. How do the proteins which block the voltage-gated channels changed to allow Na+ to pass
    • *So initial depolarization of threshold changed shape of proteins in sodium channels, causing them to go from closed state to open state
    • (*recall shape of proteins (mod 3) as primary, secondary, tertiary, and quaternary structures. Voltage can change the shape by changing charges on amino acids)
    • So the change in voltage at threshold is enough for the proteins in the gated channels to change and open
    • As sodium begins to rush in, and the charge inside the cell becomes more positive, more gates open allowing more sodium in
  124. How is action potential stimulated
    by the opening of voltage-gated Na+ channels, causing depolarization
  125. What two things happen when threshold (and sodium equilibrium potential) is reached
    • 1. sodium channel inactivation
    • 2. voltage-gated K+ channels are activated, but slowly
    • Both of these events cause the axonal membrane to become more negative.
    • Therefore, Na+ quits flowing in, K+ flows out
  126. sodium channel inactivation
    • *Voltage-gated sodium channels can open only for about 1 msec. 
    • The process by which a second Na+ "gate" closes, triggered by initial voltage change but swinging more slowly than first one
  127. How is potassium equilibrium reached?
    • When the voltage-gated K+ channels are triggered by the same voltage change that affected Na+, but like the 2nd inactivation gate of Na+ , they are slow to react.
    • When they do, all channels open
    • This pulls the axonal membrane potential back down toward potassium equilibrium (-80 mV)
    • also referred to as hyperpolarizing phase, or after-hyperpolarizing
  128. refractory period - during the action potential
    • The time during which the sodium channels are inactivated, and potassium channels are open
    • Nothing can change the state of these channels, therefore the axonal membrane is said to be resistant to change
  129. absolute refractory period
    • the time during which firing an action potential is impossible
    • When the voltage-gated Na+ channel activation gates are open & when the voltage-gated K+ channels are open & Na+ channels are inactivating
  130. relative refractory period
    • The time during which it's merely difficult to fire an action potential, cause not all of the voltage-gated channels are reset
    • it's not impossible, but relatively difficult to fire a new spike
    • During which voltage-gated K+ channels are still open; Na+channels are in the resting state
  131. Recap on Action potential
    • Start w resting potential. Change in voltage which reaches threshold.
    • Causes depolarization as voltage-gated sodium channels open.
    • At peak (sodium equilibrium), sodium channels close, Potassium channels slowly start to open.
    • Potassium leaks out of cell, making inside more negative (repolarization).
    • Overshoots resting potential (hyperpolarization).
    • When we re-establish 9-1 ratio (9 K+ to 1 Na+ leakage), we achieve resting potential
  132. Action potentials only take place at...
    • the axonal membrane of a neuron
    • in virtually all neurons, there are no voltage-gated channels in the dendrites and cell bodies, no action potentials can occur herebegins at trigger point
  133. REVIEW PG 507, BE ABLE TO LABEL ACTION POTENTIAL CHART
  134. MOD 11 OBJ 21
    Sequence of events in chemical synapse
    • 1. Action potential arrives at synaptic end bulb
    • 2. Ca++ enters presynaptic terminal (recall Ca++ inside is zero, so opening a channel means it always enters)
    • 3. Ca++ interacts w synaptic vesicles; they move to, and fuse, w presynaptic membrane
    • 4. neurotransmitter is released from vesicles & binds to post-synaptic transmitter receptor
    • 5. Receptor protein undergoes a change in shape that allows ions to flow
    • 6. Ion flow results in PSP (post synaptic potential) - either inhibitory or excitatory
  135. omega figure
    • the resulting shape when synaptic vesicles fuse w presynaptic terminal membrane
    • during exocytosis
  136. IPSP
    • inhibitory postsynaptic potential
    • when the ion flow through the postsynaptic receptors results in the cell becoming more negative
    • moves membrane potential further away from threshold
  137. EPSP
    • Excitatory postsynaptic potential
    • when the ion flow through the postsynaptic receptors causes the cell to become more positive
    • moves membrane potential closer to threshold
  138. postsynaptic potential (PSP)
    • The change in membrane voltage of the postsynaptic cell. 
    • As ions flow through the opened gates, the voltage across the membrane of the postsynaptic cell changes
    • Depending on which ions are admitted, the postsynaptic potential may be depolarization or hyperpolarization
  139. CHECK GRAPHIC ON PG 514
  140. MOD 11 OBJ 32
    What's the similarities and differences btwn nervous and endocrine systems?
    • The nervous system and the endocrine system "blend hormones and neurotransmitters together", sharing the same neurotransmitter/hormones, receptors and signaling pathways.
    • There are some chemicals that are both a hormone and a neurotransmitter
    • Both use chemical signaling mediated through receptors. 
    • Main difference is the distance traveled by the chemical signal: very short in most neurons, and very long in the case of hormones
  141. Types of cell signaling
    • Autocrine
    • Paracrine
    • Endocrine
  142. Endocrine signaling
    • where a hormone is released in bloodstream to act on receptors on a distant organ
    • endo = "within"
  143. Paracrine signaling
    • where a chemical signal travels a short distance to neighboring cells in the same organ
    • Neurotransmission at synapses is just a special case of this general property of tissues
    • can operate btwn cells that are not neuronspara = "next to"
  144. Autocrine signaling
    • where a chemical signal acts on receptors on the same cell that released the chemical signal
    • Usually this acts to turn the signal off
    • also called auto receptors; "self" signaling
  145. MOD 12 OBJ 1
    What is the breakdown of the vertebral column; how many vertebrates in cervical, thoracic, etc...
    • 7 cervical
    • 12 thoracic
    • 5 lumbar
    • 5 sacral 
    • 3 - 4 coccyx (varies per person)
  146. filum terminale
    the very end of the spinal cord"terminal thread"
  147. What is comprised in the H or butterfly shape of the spinal cord
    central core is gray matter, which is surrounded by white matter
  148. central core is gray matter, which is surrounded by white matter
    • gray matter is neuronal bodies, where info (including reflex) is processed
    • white matter is myelinated axons traveling over a great distance; contains ascending (sensory) and descending (motor) tracts
  149. How is the H-shaped gray matter further subdivided and what does each subdivision do?
    • Posterior (dorsal) horn, which processes sensory information
    • Anterior (ventral) horn, which contains cell bodies of alpha motor neurons (α motor) which controls muscles
  150. Ventral vs dorsal
    • dorsal = posterior
    • ventral = anterior (VVVRrrooom - go forward)
  151. foramen magnum
    • the "large hole" in the bottom of the skull
    • Where the adult spinal cord extends from to about L1 or L2
    • *fact that spinal cord is shorter than vertebral column allows for lumbar puncture
  152. cauda equina
    • "horse's tail"
    • the bundle of nerves at the end of the spinal cord
    • floats in bag of CSF
  153. lumbar puncture
    • also called a "spinal tap"
    • a needle is introduced into the vertebral column, most common location is L3/L4 intervertebral space. 
    • The nerve roots float out of the way and a sample of cerebrospinal fluid can be collected
  154. epidural anesthesia
    • used to relieve pain in lower body
    • anesthetic agent is injected around the nerves as they exit the "dural sleeve"
    • *remember analogy of each nerve in the cauda equina as ur arm, as they pass out from vertebral column, they bring a "sleeve" of dura mater
  155. MOD 12 OBJ 3
    What aid is there for determining the anterior vs. posterior sides of a spinal cord in a cross-section view?
    • The arms of the "H" extend all the way to the surface in the posterior (dorsal) horn
    • The anterior (ventral) horn "H"s are covered w a layer of white matter axons
    • *In diagrams, the dorsal part of the H mostly always reaches or comes closest to the outside border. Ventral doesn't come very close
  156. Recall which kind of nerves run through the anterior and posterior "roots"
    • Ventral (anterior) root is motor info
    • Posterior (dorsal) root is sensory info
  157. dorsal root ganglion
    • also called posterior root ganglion
    • contains the cell bodies of sensory neurons which pick up info on body surface and muscles and transmits it via the dorsal root to the dorsal horn of the spinal cord gray matter for processing
    • *remember the ganglion is the bulge in the posterior root of the spinal nerve OUTSIDE the spinal cord
  158. dorsal root
    • the posterior half of "split" spinal nerve
    • attaches to the dorsal horn of gray matter
    • carries sensory only
  159. ventral horn
    • also called anterior horn
    • anterior section of the H in the spinal cord gray matter
    • where the cell bodies of alpha motor neurons lie
  160. ventral root
    • also called anterior root
    • made up of the myelinated axons of the alpha motor neurons (in the ventral horn)
    • these axons bundle together as they leave the spinal cord and form this root
    • The axons will eventually terminate as the nural part of the neuromuscular junction on skeletal muscle
  161. intermediate/intermediolateral horn
    another name for the lateral horn of the spinal cord
  162. spinal nerve
    • example of a mixed nerve
    • made up of the dorsal and ventral roots joined together
  163. mixed nerve
    nerve that contains both incoming sensory info and outgoing motor info
  164. Make sure you can label graphic on pg 536
  165. MOD 12 OBJ 6
    visceral nervous systems
    • another name for autonomic
    • involuntary & reflexive
    • critically important for maintaining homeostasis
    • contracts smooth muscle, cardiac muscle, or changes the secretion of glands
    • controlled at levels below consciousness (spinal cord & brainstem)
  166. somatic motor system
    • voluntary motor system
    • contracts skeletal muscle
    • controlled consciously by cerebral cortex
  167. sympathetic nervous system
    • division of ANS
    • "fight or flight" response
    • pupils dilate, mouth goes dry, digesting stops to shunt blood to skeletal muscles, heart beats faster, more oxygen in lungs (bigger lumena in the bronchioles)
  168. 2 major groups of autonomic ganglia
    • sympathetic ganglia (components of sympathetic division of ANS
    • parasympathetic ganglia (components of parasympathetic division of ANS)
  169. sympathetic ganglia
    the site of synapses btwn sympathetic preganglionic and postganglionic neurons
  170. preganglionic neuron
    • the first of two motor neurons in ANS
    • leads from CNS to ganglion
  171. postganglionic neuron
    • the second of two motor neurons in the ANS
    • leads from the ganglion to the organ innervated
  172. preganglionic/postganglionic neurons in sympathetic nervous system
    • cell bodies for "pre" are generally found in thoracic levels of spinal cord in the lateral horn
    • pass through rami & make synaptic contact using acetylcholine, onto postganglionic neurons in sympathetic trunk ganglia

    The "post" neurons then release norepinephrine onto the effector organs
  173. sympathetic chain ganglia
    • also called sympathetic trunk ganglia
    • part of the "wiring" which lies in vertical row on either side of vertebral column
    • extends from base of skull to coccyx
    • contains postganglionic cell bodies for the effector organs of the thorax and abdomen
    • From T1 to L2
    • Postganglionic neurons release norepinephrine
  174. Lateral Horn
    • bulge in H area of spinal cord, in btwn the dorsal and ventral horns, from T1 to L2
    • contains the sympathetic preganglionic neuron cell bodies
    • also called intermediate or intermediolateral horn
  175. superior cervical ganglion
    • sympathetic trunk ganglia in the neck for head
    • the location of the postganglionic neuron for the effector organs of the head (eye, salivary glands)
    • the postganglionic axon makes it's way along blood vessels of the head to finally terminate effector organs of head (eye, salivary glands)
  176. epinephrine
    • adrenaline
    • made by adrenal glands
    • circulates in bloodstream to increase fight-or-flight response
  177. Positive feedback loop of sympathetic nervous system
    • adrenal glands are stimulated to make more epinephrine, which circulated through bloodstream to increase "fight or flight."
    • *sympathetic nervous system is activated AS A UNIT. All effector organs are "turned on" at the same time
  178. MOD 12 OBJ 7
    Parasympathetic nervous system
    • "rest and digest" system - division of ANS
    • Not activated all at once under normal circumstance 
    • includes active digestion, sexual arousal, heart & lungs slow, pupils constrict
    • wired different than sympathetic n. system & uses different neurotransmitters
    • *only time this system is activated all at once is if person is exposed to nerve agent or insecticide intoxication
  179. Location of parasympathetic N. system cell bodies for all organs except in pelvic region
    • found in 4 cranial nerve nuclei in brainstem: 3, 7, 9 and 10
    • axons come out and innervate ganglia which are found near those organs they innervate
    • EXCEPTION: Vagus nerve (CN X) where cell bodies are in brain stem and axons go out to intramural ganglia
  180. what neurotransmitter is used in parasympathetic nervous system
    preganglionic cells release acetylcholine onto postganglionic cells, which in turn release acetylcholine onto the effector organ
  181. Location of parasympathetic preganglionic cell bodies for pelvic organs
    • found in sacral spinal cord, "pelvic splanchnic nerves"
    • Axons go directly out to intramural ganglia which is found in walls of effector organs
    • includes colon, bladder, genital erection, and uterine contraction
    • also uses acetylcholine
  182. location of parasympathetic postganglionic neuron cell body for effector organs on the face
    • includes eyes and salivary glands
    • found in one of the ganglia associated with cranial nerves
    • (ciliary, pterygopalatine, submandibular, optic nerves)
  183. Location of parasympathetic preganglionic/postganglionic neuron for other effector organs, particularly those of thorax and abdomen
    • preganglionic is found in vagus nucleus inside brainstem
    • their axons form the Vagus nerve (CN X)
    • Postganglionic neuron is short & found in an intramural ganglion
  184. intramural ganglion
    collection of cell bodies found within the wall of a structure
  185. Vagus nerve
    • CN X
    • The vagus nerve (Latin, “wandering”) travels widely over the neck, thorax and abdomen, innervating a wide variety of internal organs. carries some taste information from taste buds in the soft palate and uvula (the “hangy thing” at the back of your throat)
    • Mostly, however, the vagus carries autonomic parasympathetic information to the internal organs.
  186. Control of micturation
    (urination) - controlled by the parasympathetic n. system
  187. *recap: Sympathetic vs Parasympathetic neurons
    • Parasympathetic: Preganglionic neurons found in either brainstem or S2-S4 regions. Have long preganglionic axons which innervate postganglionic neurons w short axons that innervate structure in question
    • Sympathetic: Preganglionic neurons found T1 - L2, have short preganglionic axons that lead to postganglionic neurons in sympathetic chain ganglia
  188. MOD 12 OBJ 10
    Effectors of the visceral motor system
    • (also called Autonomic motor system)
    • contracts smooth muscle or cardiac muscle, OR changes the secretion of glands
  189. effectors of somatic nervous system
    skeletal muscle
  190. What neurotransmitter receptors on effector organs are used in the 2 divisions of ANS
    • Sympathetic division acts through a variety of norepinephrine receptors 
    • Parasympathetic division acts through muscarinic acetylcholine receptors on effector organs
  191. Little more detail on Sympathetic noradrenaline receptors
    • Several "sub-flavors": α1, α2, β1, β2, β3 
    • noradrenaline receptors
    • So when you hear about "beta-blockers",  referring to drugs that block one of the beta categories of the sympathetic noradrenaline receptors
  192. Several "sub-flavors": α1, α2, β1, β2, β3 noradrenaline receptorsSo when you hear about "beta-blockers",  referring to drugs that block one of the beta categories of the sympathetic noradrenaline receptors
    nicotinic acetylcholine receptors found on skeletal muscle cells at the neuromuscular junction
  193. Describe control of ANS
    • involuntary
    • reflexive = based on reflexes (may have voluntary override)
    • spinal cord and brainstem nuclei = unconscious
  194. describe control of somatic nervous system
    • voluntary
    • planned
    • cerebral cortex = conscious
  195. MOD 12 OBJ 14
    meninges
    • singular: meninx
    • the collective term for the three-layered membrane which covers and protects the braincomprised of the dura mater, arachnoid mater, and pia mater
  196. dura mater
    • "tough mother"
    • a leathery covering, the outer most layer of the meninges
  197. arachnoid mater
    • "spiderweb mother"
    • resembles a wet spider web and is normally filled with CSF
    • is the middle layer of meninges
  198. pia mater
    • "delicate mother"
    • the inner-most layer of meninges
    • like a coating of pain on surface of brain which cannont be separated from parenchyma of brain
  199. parenchyma
    the substance of the brain
  200. epidural space
    space btwn the skull and dura
  201. subdural region
    area btwn the dura and arachnoid layers of meninges
  202. subarachnoid space
    • area btwn the arachnoid and the pial surface of brain
    • filled w CSF
  203. Pts who suffer bleeding in brain ...
    • may have blood:
    • collecting in the epidural space
    • tearing apart of the subdural region
    • or filling the subarachnoid space
  204. BE ABLE TO LABEL GRAPH ON 560
  205. MOD 12 OBJ 15
    cerebrospinal fluid
    • CSF
    • a filtrate of blood plasma that cushions and supports the brain, as well as supplying a favorable ionic environment for neurons
    • fills ventricles and subarachnoid space
    • almost identical to plasma, slightly lower in glucose & amino acids than plasma & much lower in protein
    • circulates and is turned over about 4x a day. Cause of this lumbar puncture may detect bleeding that originated (ex) in subarachnoid space around frontal cortex
  206. ventricles
    • series of hollow spaces in brain
    • should be a "first" and "second" but there isn't.
    • eitherway, there is 4
  207. lateral ventricles
    • shaped like the letter C w a tail
    • located beneath white matter of cerebrum
    • *should be named 1st and 2nd ventricle, but isnt
  208. third ventricle
    is a slit-like space btwn the two eggs of the thalamus
  209. fourth ventricle
    btwn the brainstem and cerebellum
  210. apertures
    connects the ventricles to each other
  211. interventricular foramina
    connects the lateral ventricles and third ventricle
  212. cerebral aqueduct
    joins the third and fourth ventricles
  213. how does the 4th ventricle communicate w the subarachnoid space surrounding brain & spinal cord
    • via three apertures: 
    • two lateral apertures and a single median aperture
  214. choroid plexus
    • a specialized tissue that is found mainly in the lateral ventricles and fourth ventricle (which contains ependymal cells)
    • makes CSF
  215. ependymal cells
    a type of glial cell which filters the blood in the choroid plexus, makes CSF
  216. arachnoid villi
    • a collection of structures within the "superior sagittal sinus" of the skull
    • superior = top, sagittal = midline, sinus = fluid filled space
    • So there is a sinus filled w venous blood, Walls made of dura mater.
    • Arachnoid villi project out into sinus where venous blood can reabsorb CSF
  217. Summary of CSF production, circulation and resorption
    • Production: choroid plexus
    • Circulation:
    • Lateral ventricles (cortex and basal nuclei)
    • 3rd ventricle (thalamus)
    • 4th ventricle: cerebellum n pons
    • subarachnoid space of spinal cord/ brain
    • Resorption: arachnoid villi - dumped back into venous circulation
  218. hydrocephalus
    • "water brain"
    • occurs when ventricles or apertures in an adult become occluded
    • can also result from overproduction of CSF or from slow absorption of CSF
    • when it backs up, puts pressure on the brainis life threatening condition
  219. lumbar cistern
    • the subarachnoid space which contains the free-flowing nerve roots of the cauda equina at the caudal end of the spinal cord
    • area in which CSF can be sampled ("spinal tap" or lumbar puncture)
  220. Check graphics in Obj 15, 561
  221. MOD 12 OBJ 23
  222. spinal nerves
    • are segmental = they cover a specific region of skin and/or muscle
    • always mixed (sensory + motor)
  223. cranial nerves
    12 nerves which innervate head-only muscle groups, head-only sensations, and head-only autonomic functions along with all the "regular-stuff" that the head needs
  224. Mnemonic to remember names of nerves
    On Old Olympus' Towering Top, A Fine Virginian Gentleman Viewed A Hawk
  225. Mnemonic to remember which cranial nerves are sensory, motor, or both
    Six Sailors Made Merry, But My Brother Said Bad Business My Man
  226. Cranial Nerve I
    Olfactory - carries olfactory info from the olfactory epithelium inside the nasal sinuses to the brain
  227. Cranial Nerve II
    • Optic Nerve - carries optic info from the retina 
    • lining the inside of the eye to the brain
  228. Cranial Nerve III
    • Oculomotor - innervates 4 of the six eye muscles:
    • medial rectus
    • superior rectus
    • inferior rectus
    • inferior oblique muscles
    • *also innervates the iris muscles
  229. Recall names the muscles of the eye that "twist" the eye
    • superior oblique (which passes through the trochlea = bony loop in the superior part of orbit)
    • inferior oblique
    • oblique = "slanting" or twisting
  230. Cranial Nerve IV
    • Trochlear nerve
    • innervates the superior oblique muscle (which passes through the trochlea)
    • can remember SO4 for superior oblique is nerve 4
  231. Cranial Nerve V
    • Trigeminal nerve 
    • TRI = 3 divisions
    • ophthalmic or v1 - eye n forehead 
    • maxillary or v2 - check n maxilla
    • mandibular or v3 - mandible
    • *management of this nerve is critical part of dental practice
    • *both Motor and sensory
  232. Sensory of Cranial Nerve V
    • has function of proprioception for jaw muscles 
    • Keeps us from crushing teeth by biting too hard on nut or seed; helps jaw muscles relax son as force on teeth releases
  233. Motor of Cranial Nerve V
    • for muscles of Mastication
    • chewing muscles
  234. Cranial Nerve VI
    • abducens nerve
    • abducts the eye (carries it away from midline)
    • also innervates the lateral rectus
  235. Cranial Nerve VII
    • Facial Nerve
    • primarily motor for the muscles of facial expression; some taste sensation and salivary glands
    • Innervates the lacrimal glands, submandibular and sublingual glands (Which produces saliva)
  236. Sensory function of cranial nerve VII
    • carry taste info from the anterior 2/3 of the tongue
    • this info joins w other taste fibers to form the chorda tympani
  237. Cranial Nerve VIII
    • Vestibulocochlear nerve - has 2 divisions
    • cochlear branch & vestibular branch

    (on gross brain, divisions can be easily seen because it looks like a figure 8 in cross-section)
  238. cochlear branch of CN VIII
    carries info from spiral-shaped cochlea (which is responsible for taking sound waves and coding the info in a form nervous system can use)
  239. vestibular branch of CN VIII
    • carries info from semicircular canals and vestibule
    • hearing and balance
  240. recall semicircular canals & vestibule
    • semicircular canals cod for head rotation in each of 3 major planes
    • vestibule (saccule & utricle) codes for head movement
  241. otolith organs
    • the saccule and utricle, which make up the vestibule
    • the two "bumps" btwn the cochlea and semicircular canals
  242. Cranial Nerve IX
    • glossopharyngeal nerve
    • innervates posterior 1/3 of tongue and also the parotid gland
    • carries information from the carotid body (sensory organ in carotid artery that senses blood pressure)
  243. Cranial Nerve XI
    • accessory nerve (also called spinal accessory nerve)
    • pure motor for trapezius and sternocleidomastoid
    • *recall trapezius is the big muscle along the back of neck and shoulders"
    • IDK... let me think about it"
  244. Cranial Nerve XII
    • Hypoglossal Nerve
    • purely motor, does 1 thing: sticks out the tongue
    • **odd thing is that tongue is PULLED forward out of mouth, since muscles can only pull and not push
  245. MAKE SURE TO REVIEW GRAPHICS PF 572
  246. MOD 13 OBJ 4
    upper motor neurons
    • all the neurons in the brain and spinal cord that influence movement, but do not make direct contact w a skeletal muscle fiber
    • Ex: the neurons w axons in the pyramidal system
  247. lower motor neuron
    • term used to refer to the neuron that makes the final contact btwn the nervous system and effector organ
    • those in spinal cord that directly innervate skeletal muscle
    • Ex: alpha motor neuron (α-motor) - cell bodies in ventral horn of spinal cord, axon travels as part of nerve to neuromuscular junction on skeletal muscle
  248. MOD 13 OBJ 5
    relevant stimulus
    • environmental energy (or stimulus) that is capable of being transduced by a receptor
    • each type of sensory receptor has it's own type of relevant stimulus it responds to
    • Can be quite narrowly defined... as in only certain wavelengths of light can trigger a response; only certain types of sound wavers can activate receptors in hearing, etc.
  249. transduction
    • the process through which the environmental energy (picked up by a receptor) is transformed into nervous system energy - which is then processed
    • Therefore, is the first step in any sensory system
  250. Sensory system pathways
    • *all but olfaction is relayed through thalamus
    • First transduction happens
    • then info must be taken to cortex to reach consciousness
    • there is a region of cortex responsible for perception of each kind of sensation
    • If it does not reach cortex, it's not perceived
  251. importance of thalamus
    • the master switchboard which is responsible for deciding which stimuli reaches consciousness.
    • Therefore, all sensory systems (except olfactory) are routed through the thalamus before they reach cortex
    • *if we sensed everything in our environment, we would be overwhelmed w stimuli. Thalamus takes care of that
  252. MOD 13 OBJ 7
    three basic types of sensory receptors
    • exteroceptors
    • interoceptors
    • proprioceptors
  253. exteroceptors
    • receive stimuli from external environment
    • includes 5 senses + 1:
    • touch, sight, sound, taste, smell, balance
  254. vestibular sense
    a 6th sense that could be added to the 5 senses: the force of gravity, either as a steady pull or in movement
  255. interoceptors
    • receive their energy from the internal environment
    • Ex: O2 levels in blood, glucose level in blood, CO2 level in blood, stretch of stomach and bowel
  256. proprioceptors
    • receptors that integrate info about the state of stretch of skin, muscles and tendons, w info about gravity, in order to produce a perception of where our joints are in space
    • *Position of joints, muscles and tendons
  257. MOD 13 OBJ 8
    6 types of Sensory receptors in another classification scheme
    • Mechanoreceptors
    • Thermoreceptors
    • Nociceptors
    • Photoreceptors
    • Chemoreceptors
    • Osmoreceptors
    • **"My Tits Need Pleasing Caresses Only"
  258. Mechanoreceptors
    • detect movement, such as pressure of clothing on skin, a finger touching you, muscles being stretched, or pressure waves of air (sound)
    • Movement of small rocks in the inner ear produce sensation of balance
    • *axon terminals in medulla
    • FOUND IN: somatosensory, proprioception, auditory and vestibular (balance) systems
    • ☼Mechanics Sometimes Prop Anally & Vaginaly
  259. Thermoreceptors
    • detect temps btwn 4°C (40° F) and 50°C (122° F)
    • Below 40° and above 122°, tissue damage and pain results
    • axon terminals in dorsal horn of spinal cord
    • It's believed one set of thermoreceptors operates for temps below body temp and another for those above body temp
    • FOUND IN: Somatosensory system
  260. Nociceptors
    • "pain receptors" - detect harmful or damaging stimuli
    • When tissue is damaged, a # of chemical factors are released from damaged cells, which stimulates receptors on free nerve endings in skin
    • Axon terminals in dorsal horn of spinal cord
    • *derive name from same root as noxious and obnoxious
    • FOUND IN: Somatosensory system
  261. Photoreceptors
    • detect photons (particles/waves of light energy)
    • different wavelengths of light correspond to different hues: one photoreceptor type for each of the primary colors (red, yellow, blue)
    • FOUND IN: visual (sight) system - duh
  262. Chemoreceptors
    • detect chemicals in the internal or external environment
    • Ex's are found in senses of taste, smell, and O2 , CO2, and pH receptors which monitor the bloodstream
    • FOUND IN: Olfactory, gustatory (taste), O2 , CO2, pH receptors in blood
  263. Osmoreceptors
    • located in hypothalamus, detect the salt levels in blood and respond by secreting chemicals that regulate water retention or loss
    • relevant stimulus: osmotic pressure
    • FOUND IN: hypothalamus, endocrine system
    • ☼"Ocean has Salt Water"
  264. MOD 13 OBJ 13
    dermatomal map
    a map pairing regions of skin surface with the corresponding dorsal root (spinal nerve)
  265. dermatomes
    • the skin slices on a dermatomal map
    • an area of skin that is innervated by a single spinal nerve
  266. Landmark dermatomes for C6/C7
    thumb and index finger ("six-shooter")
  267. Landmark dermatomes for T4
    Nipple line
  268. Landmark dermatomes for T10
    umbilicus
  269. Landmark dermatomes for L1 - L5
    lower extremities ("L for Legs")
  270. MOD 13 OBJ 19
    How many extraocular muscles are there?
    6: medial rectus, lateral rectus, superior rectus, inferior rectus, superior oblique, inferior oblique
  271. palpebrae
    • sing: palpebra
    • eyelids
  272. palpebral fissure
    space btwn the eyelids - so space when they are open and the eye can see out
  273. conjunctiva
    a thin mucous membrane that covers the sclera and is also continuous with the internal surfaces of the upper and lower palpebrae
  274. Lacrimal caruncle
    • in medial corner of eye
    • remember it drains the tears
  275. medial commissure / lateral commissure
    • medial commissure = medial corner of eye, next to lacrimal caruncle
    • lateral commissure = lateral corner of eye
  276. conjunctivitis
    • often called "pink eye"when the conjunctiva becomes inflamed
    • can be causes from either a bacterial or viral infection
  277. The three tunics of the eye
    • fibrous tunic
    • vascular tunic
    • nervous tunic
  278. tunics (of the eye)
    three tissue layers that are each continuous, like layers of an onion
  279. Fibrous tunic
    • the outermost tunic of the eye
    • consists of the sclera and cornea
  280. sclera
    • part of the fibrous tunic
    • is the "white of the eye"
    • provides shape and protects the inner part of the eye
  281. cornea
    • part of the fibrous tunic
    • is the clear covering over the pupil
    • admits and refracts (bends) light
  282. vascular tunic
    • the middle of the 3 tunics
    • also called the uvea
    • consists of the iris, ciliary body, and choroid
  283. iris
    • part of the vascular tunic
    • the colored part of the eye surrounding the pupil
    • regulates amount of light that enters the eyeball
  284. ciliary body
    • Part of the uvea
    • controls the shape of the lens
    • filters blood to secrete aqueous humor into anterior chamber of eye
    • alters shape of lens for near or far vision (accommodation)
  285. choroid
    • part of the uvea
    • provides blood supply to retina and other structures of the eye
    • absorbs scattered light
  286. uvetitis
    • when the entire vascular layer is inflamed
    • may threaten the pt's sight
  287. nervous tunic
    • the innermost tunic of the eye
    • consists of retina
  288. retina
    • makes up the nervous tunic
    • receives light and converts it into receptor potentials and nerve impulses
    • Output to brain is via axons of ganglion cells which form the optic (II) nerve
  289. REVIEW GRAPHICS PG 613
  290. MOD 13 OBJ 26
    olfaction
    the sense of smell
  291. olfactory receptors
    • found on superior surface of nasal sinuses
    • the olfactory receptor sheet in humans is about the size of a postage stamp
  292. odorants
    small molecules, carried by air, that are dissolved in mucus layer that covers the olfactory epithelium
  293. olfactory transduction
    • depends on a G protein pathway
    • Olfactory cells have cilia w protein receptor molecules that specifically bind a certain type of odorant
    • When an odorant binds to a olfactory receptor, it triggers the G protein biochemical pathway
  294. MOD 13 OBJ 33
    sound conduction pathway:
    REFER TO GRAPHIC PG 636
    • 1 waves of air arrive in external auditory canal
    • 2 air moves tympanic membrane
    • 3 tympanic membrane moves ossicles (malleus bangs on incus, incus moves causing the stapes to move)
    • 4 Stapes moves oval window
    • 5 Oval window moves perilymph fluid in scala vestibuli
    • 6 Waves of fluid in scala vestibuli set up vibrations in basilar membrane, which moves hair cells
    • 7 Fluid can pass from scala vestibuli to scala tympani at helicotrema 
    • 8. Fluid in scala tympani
    • Round window is outlet for pressure
  295. helicotrema
    • the "u-turn" of the spiral organ
    • where the scala vestibuli becomes the scala tympani
  296. MOD 13 OBJ 34
    Pitch
    • is the frequency (interchangeable with wavelength) of sound waves 
    • *refers to the length between two "peaks" in the wave
    • measured in waves per second - Hertz (Hz)the basilar membrane is "tuned" to vibrate the most at a certain frequency
    • -near helicotrema: low pitch - long wave length
    • -near oval window: high pitch - short wave length
  297. amplitude =
    loudness
  298. What frequencies are outside the range of human hearing
    below 20 Hz and above 20,000 Hz
  299. place coding
    • refers to the fact that a particular place on the basilar membrane codes for a particular note/pitch/frequency, 
    • therefore, it's called "place coding" cause a place on the B membrane codes for each pitch
  300. MOD 13 OBJ 36
    vestibular sense
    • sense of balance
    • balance depends on knowing where our bodies lie in relationship to gravity
    • two important features of that relationship that must be calculated: 
    • static equilibrium
    • dynamic equilibrium
  301. static equilibrium
    • used to measure the tilt of the heat, either side to side or front to back
    • referred to as linear acceleration by engineers
  302. dynamic equilibrium
    • used to measure head rotation or movement
    • called angular acceleration BY engineers
  303. MOD 14 OBJ 9
    hypophysis
    • what the pituitary gland was formerly referred to
    • pea-shaped gland - anatomically & functionally connected to hypothalamus by the infundibulum
    • has two lobes: anterior and posterior
    • It's also commonly referred to as the "master glad"; but recall it is controlled by the hypothalamus
  304. hypothalamus
    • the major link btwn the nervous and endocrine systems: received input from several regions in brain
    • controls pituitary gland
    • *Produces regulating hormones that circulate to adenohypophysis and stimulate it to secrete it's own hormones
    • *sends nerve impulses to neurohypophysis which stimulate it to secrete oxytocin and ADH
  305. infundibulum
    a funnel-shaped stalk which connects the pituitary gland to the hypothalamus
  306. adenohypophysis
    • the anterior lobe of the pituitary
    • about 75% of pituitary weight - functionally connected to hypothalamus by blood vessels
    • The hypothalamus produces regulating hormones to circulate down to anterior lobe & stimulates lobe to secrete it's own hormones*
    • "Adeno-" means gland, so the relationship btwn hypothalamus and anterior pituitary is gland to gland
  307. neurohypophysis
    • the posterior pituitary, or second lobe
    • functionally connected to hypothalamus by specialized neurosecretory neuronsto stimulate neurohypophysis, the hypothalamus sends nerve impulses which stimulate it to secrete oxytocin and ADH
    • *Does not synthesize any hormones - hormones from this gland are produced by neurosecretory cells in hypothalamus and secreted down axons w vesicles to be stored and later released from posterior pituitary
    • *"neuro" refers to the connection btwn posterior lobe & hypothalamus-by neurons
  308. MOD 14 OBJ 11
    "7 hormones of the adenohypophysis
    • hGH = Human growth hormone
    • TSH = Thyroid stimulating hormone
    • ACTH = Adrenocorticotropic hormone
    • FSH = Follicle stimulating hormone
    • LH = Lutenizing hormone
    • PRL = Prolactin
    • MSH = Melanocyte-stimulating hormone
  309. hGH
    • human growth hormone 
    • stimulated growth of body cells
    • Correlates with Growth hormone-releasing hormone (GHRH)
  310. TSH
    • Thyroid stimulating hormone
    • Stimulates thyroid gland
    • Correlates with thyrotropin-releasing hormone (TRH)
    • *thyrotropin = in - only one that has a c is the sex ones.
    • So n is legs closed, c is legs open
  311. ACTH
    • Adrenocorticotropic hormone
    • Stimulates cortex of adrenal gland
    • Correlates with Corticotropin-releasing hormone (CRH)
    • *corticotropin = in - only one that has a c is the sex ones. So n is legs closed, c is legs open
  312. FSH
    • Follicle stimulating hormone
    • targets ova/sperm development and production
    • Correlates with Gonadotropic-releasing hormone (GnRH)
    • *Gonadotropic - ic = legs open.
  313. LH
    • Lutenizing hormone
    • Maturation of uterine lining, testosterone production, and ovulation
    • Correlates with gonadotropic-releasing hormone (GnRH)
  314. PRL
    • Prolactin
    • lactation of mammary glands
    • Correlates with prolactin-releasing hormone(PRH)
  315. MSH
    • Melanocyte-stimulating hormone
    • Darkens melanocytes
    • Correlates with corticotropin-releasing hormone(CRH)
    • *corticotropin - in - only one that has a c is the sex ones. So n is legs closed, c is legs open
  316. TRH
    • thyrotropin-releasing hormon
    • estimulates pituitary to release TSH
    • *thyrotropin - in - only one that has a c is the sex ones. So n is legs closed, c is legs open
  317. GHRH
    • growth hormone-releasing hormone
    • stimulates pituitary to release hGH
  318. CRH
    • Corticotropin-releasing hormone
    • stimulates pituitary to release ACTH & MSH
  319. GnRH
    • Gonadotropic-releasing hormone
    • Stimulates pituitary to release FSH & LH
  320. PRH
    • Prolactin-releasing hormone
    • stimulates pituitary to release prolactin
  321. MOD 14 OBJ 13

    pituitary dwarfism
    • caused by hyposecretion of hGH during childhood
    • w/o hGH, epiphyseal plates will close before pt reaches mature level
    • deficient growth of tissue will affect all body systems; however child will have normal body proportions
    • *not only cause of dwarfism
  322. giantism
    • caused by hypersecretion of hGH during childhood (during pts growth phase)
    • overall body proportions will remain consistent, but pt will be very tall
    • main cause is tumor of anterior pituitary
    • detection and treatment have made giantism fairly rare
  323. acromegaly
    • a disorder caused by excessive hGH during adulthood
    • deals with increased density in bone and tissue
    • Enlargement and elongation of bones of the face, jaw, cheeks and hands, associated tissues can enlarge causing circulatory, nerve and skin probs. 
    • The long bones of the extremities are unaffected cause growth plates are already closed
    • Commonly causes arthritis and carpal tunnel syndrome due to excess tissue growth
  324. MOD 14 OBJ 15
    diabetes insipidus
    • most common condition related to ADH
    • Two physiological types:
    • *Either form has same effect: pt will not reabsorb water and therefore secrete large volumes of very dilute urine - from 1-1.5 liters (normal) to >2.5+ per day
  325. Two types of diabetes insipidus
    • neurogenic = insufficient production or secretion of ADH
    • nephrogenic = diminished renal response to ADH that was produced
  326. diabetes insipidus vs diabetes mellitus
    • *"insipidus" = tasteless - urine is very dilute
    • "mellatis" = sweet - urine is sweet
  327. MOD 14 OBJ 18
    T4
    • thyroxin (tetraiodothyronine)
    • (tetra = 4)
    • T4, hormone secreted by thyroid
    • *prefix describes # of iodine molecules
  328. T3
    • Triiodothyronine
    • *prefix describes # of iodine molecules
  329. Thyroid hormone actions:
    • regulate oxygen use
    • increase basal metabolic rate
    • increase protein synthesis 
    • increase carb and fatty acid catabolism
    • increase reactivity of nervous system by increasing sensitivity to epinephrine and norepinephrine
    • Control tissue growth and development along with hGH
  330. importance of thyroid hormone: increasing BMR
    • BMR = basal metabolic rate 
    • the rate of oxygen consumption while awake, at rest and fasting. 
    • When need for ATP increases, use of all nutrients increases
  331. importance of thyroid hormone: stimulating synthesis of additional sodium-potassium pumps
    • Is a major action with a cascade of effects
    • With the increase in the Na/K pumps, the demand for ATP is greater
    • As ATP is produced, calories are used, and more heat is produced (exothermic)
    • This is how thyroid hormones help a person regulate their normal body temp
  332. importance of thyroid hormone: 
    *increasing protein synthesis
    *increasing fatty acid & glucose catabolism
    *decreasing blood cholesterol
    • Increasing protein synthesis encourages growth
    • Fatty acids and glucose are used to synthesize ATP
    • Reduces blood cholesterol by increasing cholesterol excretion
  333. importance of thryoid hormone: 
    *increasing the effects of nor/epinephrine
    *Accelerating body growth
    • Increasing efforts of epinephrine/norepinephrine enhances the sympathetic nervous response (heart rate, force of heart contraction, and BP)
    • Accelerating body growth, especially during fetal life and adolescence, by working synergistically w hGH and insulin to develop the skeletal and nervous systems
  334. MOD 14 OBJ 22
    parathyroid glands
    • small, round masses of tissue attached to the posterior surface of the lateral lobes of thyroid
    • Typically there are 4: two parathyroid glands attached to each lobe (one superior and one inferior)
    • contain chief (principal) cells which produce and secrete PTH
  335. Actions of PTH
    • parathyroid hormone
    • Stimulated when blood calcium levels are LOW; brings it up by:
    • Stimulating osteoclastic activity
    • increases levels of calcitriol (active form of Vit D) in GI tract
    • Decreasing amount of calcium lost in urine
    • also decreases blood phosphate levels
    • *think of "para" - for = lets get calcium for our neighbors and friends
  336. Compare the actions of the parathyroid hormone and calcitonin
    • they are antagonists
    • PTH's goal is to increase blood calcium levels
    • Calcitonin wants to lower calcium levels
    • This is how the body maintains normal calcium, phosphate, and magnesium homeostasis
    • *Parathyroid hormone vs. calcitonin made in the Parafollicular cells
  337. MOD 14 OBJ 25
    mineralocorticoids
    • a cortical hormone secreted by the zona glomerulosa
    • help control water and electrolyte (Na+ and K+) balance
    • *Job is to keep blood volume and BP homeostasis
    • Aldosterone is main mineralocorticoid "mineral" = controls minerals; "corticoids" = comes from cortex
  338. aldosterone
    • plays largest role of mineralocorticoids
    • Job is to raise blood volume & BP
    • Conserves Na+ & H2O through reabsorption in kidneys
    • Promotes the excretion of H+ and K+  from kidneys into urine
    • *the increased water reabsorption results in blood volume and BP increase
    • *"Where's Aldo?" - earth needs water
    • Controlled by RAAS
  339. RAAS
    • Renin-angiotensin-aldosterone system
    • controls the secretion of aldosterone - whose job is to raise Blood volume & BP
    • Stimulated by decrease in BP by all or one:decrease in blood volume
    • dehydration
    • Na+
    • Hemorrhage(Notice they all cause loss in BP & blood volume)
  340. Basic summary of the process resulting in release of Aldosterone
    • Low BP stimulates juxtaglomerular cells in kidneys to secrete the enzyme renin
    • Renin circulates in blood & converts angiotensinogen into angiotensin I
    • As angiotensin I circulates to lungs, the enzyme ACE converts angiotensin I to angiotensin II
  341. -ogen
    • refers to molecule that is not activated yet
    • When activated, becomes a biologically active molecule
  342. renin
    • secreted by juxtaglomerular cells in the kidney; which are stimulated by low BP
    • This circulates in the blood and converts angiotensinogen into angiotensin I
  343. angiotensinogen
    • a plasma protein produced in the liver*-ogen = inactive
    • converted into angiotensin I by the enzyme renin
  344. Angiotensin I
    • circulates in blood till it comes into contact with an enzyme in the lungs called ACE
    • then it is converted into angiotensin II
  345. ACE
    • angiotensin-converting enzyme
    • when it comes into contact with angiotensin I, it converts it into angiotensin II
  346. angiotensin II
    • has 2 main actions to increase blood pressure:
    • stimulates vasoconstriction
    • stimulates the release of aldosterone from adrenal cortex (which then circulates to kidneys
  347. MOD 14 OBJ 26
    cortisol
    • main glucocorticoid
    • is a person's anti-hypoglycemic hormone
    • will do whatever it can to keep glucose levels up; even if it means gluconeogenesis
    • *Main stress hormone
  348. effects of cortisol
    • regulate metabolism
    • gluconeogenesis
    • anti-inflammatory effects
    • Resist stress (extremes)
  349. gluconeogenesis
    • the formation of new glucose
    • takes place when we haven't had any carbohydrates
    • Goes to other body sources to get nutrients & forms glucose-like-stuff 
    • does this by promoting breakdown of proteins (typically muscle) and triglycerides from adipose tissue to form glucosE
  350. Anti-inflammatory effects of cortisol
    • very powerful anti-inflammatory
    • works by suppressing inflammation
    • *side effect is suppressing immune system
    • therefore, having high levels of cortisol lowers immune defense
  351. Pheochromocytoma
    • an adrenal medulla disorder involving a benign tumor of the chromaffin cells
    • results in hypersecretion of epinephrine & norepinephrine
    • Causes prolonged sympathetic fight or flight response:
    • high heart rate
    • high BP
    • increased metabolism (weight loss)
    • anxiety/nervousness
    • hyperglycemia
    • sweating and headaches
  352. MOD 14 OBJ 32
    Glucagon vs insulin
    are antagonist
  353. Alpha cells
    • type of endocrine cells making up 17% of pancreatic islets
    • secrete glucagon - raise blood sugar:
    • Increases blood glucose levels
    • Acts on hepatocytes to convert glycogen to glucose - released into blood raises glucose levels to normal
    • *stimulated by low blood glucose levels
    • **if blood glucose continues to rise, hyperglycemia inhibits release of glucagon
  354. What all does insulin do?
    • Accelerated facilitated diffusion of glucose into cells (increases # of transport proteins)
    • Speed conversion of glucose into glycogen
    • Increases uptake of amino acids by cells to increase protein synthesis
    • Speeds up synthesis of fatty acids
    • Decreases gluconeogenesis
  355. MOD 15 OBJ 3
    Two main components of the blood
    • 45% - Cells, or more specifically formed elements = WBC, RBC, platelets
    • 55% - Plasma - typically clear, yellow liquid
    • *called formed elements cause of platelets: they aren't cells, they are fragments of cells
  356. what exactly are platelets?
    • they are actually the remnants of cells
    • *we have great big cells in bone marrow (megakaryocytes) which are too big to leave bone marrow.
    • Therefore, when they implode and the cytoplasm breaks apart, it's the  cytoplasm fragments that become the platelets
    • Thats why they are classified as formed elements
  357. What is the breakdown of plasma
    • 92% water, 8% solutes
    • * 7 of the 8% are plasma proteins. The other 1% are misc solutes
  358. What are Plasma Proteins
    • Many types that have individual functions, frequently as carrier molecules
    • Collectively they contribute to osmotic balance
    • Majority produced by hepatocytes, so liver problems can lead to plasma protein problems
  359. What are the names of the plasma proteins and what's the % breakdown
    • 54% albumins
    • 38% globulins - named from "globe" like appearance
    • 7% fibrinogen (clotting protein)
    • 1% misc solutes: electrolytes, nutrients, gases, hormones, and waste products
  360. gamma globulins
    • important type of globulins
    • also called immunoglobulins or antibodies
    • produced in response to organic molecules the body see's a foreign
    • Serve as flags for immune system, so it knows what needs to be destroyed
  361. How many of each formed element are in the blood
    • Platelets = 150-400 K
    • WBC = 5 - 10 K
    • RBC = 4.8 - 5.4 million
    • *PER CUBIC millimeter
    • (μL = microliter- is same thing)
  362. MOD 15 OBJ 5
    Describe the structure of mature RBC's
    • Are bi-concave discs (like donut but middle doesn't go all the way through) - gives high surface to volume ration
    • Demonstrate reversible-deformity - able to squeeze through small spaces (capillaries) and snap back into shape
    • Live 120 days
    • *the bi-concave shape results through the loss of it's nucleus
  363. What happens as a RBC matures... how do they survive?
    • Loses it's nucleus and organelles - this provides max cytoplasmic space to carry O2
    • hemoglobin increases
    • decreased cellular size
    • *cause they lack mitochondria, they don't use any of the oxygen they carry. They utilize glycolysis to stay alive
  364. Describe the function of RBC
    • Carry oxygen
    • If damaged, they are removed from circulation by phagocytic white blood cells, the spleen, and the liver
  365. hemoglobin
    • the oxygen & CO2  carrying molecule of red blood cell
    • Makes blood red
    • approx 280 million in each RBC
    • Each consist of 2 main components: heme and globin
    • each hemoglobin has 4 globin and 4 hemes
    • Therefore, one red cell can carry 1.1 billion oxygen atoms
  366. MOD 15 OBJ 7
    Erythropoiesis
    • part of hematopoiesis, specifically production and maturation of RBC
    • produced continuously
  367. -emia
    • means "in the blood"
    • or emic
  368. How is the rate of erythropoiesis measured?
    • by a reticulocyte (retic) count
    • measured as they are coming out of the bone marrow
  369. hypoxemia
    • results when the number of red blood cells lost exceeds the number made
    • Therefore, too little oxygen in the blood
    • *this lack of oxygen isn't from breathing problems, there just isn't enough red cells to transport the available oxygen around the body
    • The decreased amount of oxygen stimulates the kidneys to secrete EPO
  370. EPO
    • erythropoietin = cytokine
    • a hormone secreted by the kidneys when oxygen levels in blood become low
    • circulates to red marrow and speeds up maturation and release of immature red cells
  371. reticulocyte
    • an almost mature RBC
    • still contains some mitochondria, ribosomes, and endoplasmic reticulum
    • released into blood stream and will mature over next 1-2 days
    • Normally, 0.5 - 1.5% of circulating red blood cells are reticulocytes
  372. Hct
    • hematocrit
    • the % of a pt's whole blood that is occupied by red blood cells
    • average is 45%, with men being a little higher and women being a little lower
  373. MOD 15 OBJ 9
    Leukocyte
    • a white blood cell
    • Larger then red cells
    • Have nuclei
    • Don't have hemoglobin
    • normal WBC count is 5.0 - 10.0 x 103
    • Two groups, divided by presence of cytoplasmic granules:
    • Granulocytes and Agranulocytes
    • *the granules are visible under microscope when stained
  374. granulocytes
    • also called granular leukocytes
    • 3 specific groups:
    • Neutrophils
    • Eosinophils
    • Basophils
    • *names come from staining characteristics
  375. Neutrophil
    • type of granulocyte
    • Makes up 60-70% of total WBC's in blood stream
    • Function: Powerful phagocyte, increased in bacterial infections and inflammation
    • In an eosin stain, stains somewhere btwn red and dark purple
    • Self destructs after attack, in pus
  376. Eosinophil
    • Type of granulocyte
    • Makes up 2-4% of total WBC's in blood stream
    • Function: Allergic reactions, parasitic infections
    • *full of histamine 
    • Has large red granules when stained
  377. Basophil
    • Type of granulocyte
    • makes up .5-1% of total WBC's in blood stream
    • Function: is poorly understood, chronic inflammation
    • has traces of anticoagulant and histamine
    • Has large dark blue granules (when stained)
    • **B = Blue
  378. agranulocytes
    • one of 2 types of WBC
    • do contain some cytoplasmic granules, but they are much less prominent and don't stain as well as their granulocytic counterparts
    • Include Lymphocytes and Monocytes
  379. Lymphocytes
    • type of agranular leukocytes
    • Makes up 20-25% of total WBC's in bloodstream
    • provide long term immunity
    • Function: Major role in viral infections and cancer prevention
    • include T Lymphocytes, B lymphocytes, and NK (Natural killer) cells
  380. Monocytes
    • type of agranular leukocytes
    • makes up 3-8% of total WBC's in bloodstream
    • Function: differentiate into macrophages (phagocyte), present in chronic inflammation and infections
    • Enlarge and mature into macrophages in various tissues of the body
    • Have various names depending on where it's at
    • Comes into play if infection sticks around longer after neutrophils attack
  381. MOD 15 OBJ 13
    hemostasis
    • the overall process by which bleeding is stopped
    • Three mechanisms:
    • Vascular spasm
    • Platelet plug formation
    • coagulation
  382. Vascular spasm
    • the constriction of damaged blood vessels
    • One of 3 mechanisms involved with hemostasis
    • limits the amount of blood lost
    • due to chemicals released from platelets, damage to the smooth muscle, and pain receptor reflexes
    • *Only vessels with smooth muscle can do this, capillaries can't
  383. Platelet plug formation
    • Platelets are very active in hemostatic process - like little bags of procoagulant chemicals
    • Three step process:
    • 1st ~ platelets adhere to wall of blood vessel
    • 2nd ~ platelets release their chemical contents (which encourages further vasoconstriction and recruitment of other platelets) 
    • 3rd ~ due to chemical release, the newly activated platelets become sticky (platelet aggregation)
    • W activation of enough platelets, a loose platelet plug is formed
  384. platelet aggregation
    the clumping of platelets during hemostasis
  385. coagulation
    • taking plasma and making a clot
    • Series of complex enzymatic reactions designed to activate specific coagulation proteins; most are plasma proteins
    • Activated in step-wise/cascading fashion (such as knocking down domino's... said domino's referred to as clotting or coagulation factors)
    • The coagulation proteins are enumerated with Roman numerals
    • Most clotting factors synthesized by liver
  386. MOD 15 OBJ 25
    Innate immunity
    • consists of a # of different cellular and chemical barriers
    • Non-specific
    • Non-adaptive - meaning it doesn't change from exposure to exposure
    • Has two lines of defense
  387. Components of Innate immunity
    • skin
    • mucous membranes
    • cilia
    • endogenous antimicrobials
    • inflammation
    • phagocytosis
    • fever
  388. Adaptive immunity
    • Provides the ability to respond against specific invaders 
    • Is specific & adaptive
    • Generates memory
    • *sometimes considered 3rd line of defense
    • T and B lymphocytes, Plasma cells, Antibodies, and enzymes
  389. MOD 15 OBJ 27
    inflammation
    • big part of non-specific, non-adaptive, innate response; internal defenses
    • process has three stages: 
    • vasodilation and increased vascular permeability
    • emigration of phagocytes from blood to tissue
    • tissue repair
  390. Local signs & symptoms with inflammation
    • redness
    • pain
    • heat
    • swelling
    • possible loss of tissue funtion
  391. What causes the redness and heat during inflammation?
    • Vasodilation leads to redness and heat due to increased blood flow
    • (only happens in vascular tissue since it's mediated by things coming through blood vessels)
  392. What causes the swelling during inflammation?
    • increased vascular permeability for the emigration of phagocytes 
    • also leads to fluid and proteins leaking into the interstitial space and causing swelling
  393. What's the deal with the perception of pain during inflammation?
    • Fluid, histamine, and broken cells release prostaglandins (which cause pain)
    • is the result of targeted free nerve endings by cytokines and pro-inflammatory chemicals
  394. MOD 15 OBJ 28
    antigen
    • a substance that is recognized as foreign and reacts with products of the immune system
    • 4 things determine the antigenicity of a substance:
    • recognition as foreign
    • structural complexity
    • size
    • organic in nature
    • *Recognition as foreign most important - something can fit all the others, but if the body deems it as part of itself, it will leave it alone
  395. Lymphocytes
    • type of agranular leukocyte (WBC)
    • They are classified by the location where they mature~
    • T-lymphocytes originate from stem cells in bone marrow, leave as pre-T cells and mature in thymus
    • B-lymphocytes originate and mature in bone marrow
    • *So a lymphocyte will either be a T or B
  396. hapten
    • a molecule that fits the criteria of an antigen, except for size
    • doesn't trigger immune response (unless it binds w another molecule, making it big enough)
  397. epitopes
    • also called antigenic determinants
    • refers to different sites or antigens on a pathogen
    • can react with the immune system IF IT IS LARGE ENOUGH ~ initiating an immune response
    • A pathogen can have multiple sites (or antigens)
    • *They are antigens which the body see's as foreign so it will induce immune response
  398. MOD 15, OBJ 29
    What are the subtypes of T lymphocytes
    • *Produced in bone marrow, mature in thymus
    • Divide into:
    • T helper (CD4) cells
    • T-cytotoxic (CD8 - marker on cell) cells
    • T-regulator cells
    • Memory T-helper cells
    • Memory T-cytotoxic cells
  399. "clusters of differentiation"
    • CD for short
    • old name used for T helper & T cytotoxic cells
    • initially researchers though the markers of white cells indicated a specific cell type. Thought they occurred in groups or clusters
  400. T-helper cells
    • also called CD4 T-cells, due to presence of CD4 marker
    • The middle man or main "helper" of immune response ~ act as a co-stimulator for both the B cells and T cytotoxic cells
    • receive info from non-specific phagocytic cells & pass that info on to generate specific response to a particular antigen
    • *part of BOTH cell-mediated and antibody-mediated immunity
  401. T-cytotoxic cells
    • T-cells which destroy abnormal cells
    • virally-infected cells and cancerous cells are main target
    • Also called CD8 T-cells
    • Does cell-to-cell combat & kills bad cells
  402. T-regulator cells
    • keep immune system from getting out of control
    • decrease the reactivity of other types of T-cells
    • essential for maintaining self-tolerance
  403. Memory T-cytotoxic and Memory T-helper cells
    • produced w an initial exposure to an antigen to provide memory of the event and a rapid response if re-exposed to the antigen
    • do not participate in the first time around
  404. MOD 15 OBJ 30
    Two types of adaptive immunity
    • Cell mediated immunity = Side w T cells
    • Anti-body mediated immunity = humoral side - B cells ( humor meaning fluid: the antibody "missiles" made by B cells travel through blood to get to where they need to go)
    • both triggered by exposure to specific antigens
  405. cell-mediated immunity
    • involves action of T-cytotoxic lymphocytes
    • cell to cell combate
    • detect and destroy abnormal cells
    • Virally-infected cells, cancer cells, and cells infected by intracellular bacteria
  406. antibody-mediated immunity
    • involves action of B-lymphocytes
    • activated to become plasma cells and produce antibody
    • also makes memory
  407. MOD 15 OBJ 35
    Five classes of antibodies
    • IgG
    • IgM
    • IgA
    • IgE
    • IgD
  408. IgG
    • One class of antibody
    • Monomer w two antigen-binding sites
    • 80% of the antibody in the blood
    • Only class that can cross placenta
    • Provide long-term immunity
    • Found in: blood, lymph and intestines
  409. IgM
    • Once class of antibody
    • Pentamer w ten antigen-binding sites
    • First to be secreted by plasma cells
    • great complement activator
    • short-lived response
  410. IgA
    • One class of antibody
    • Dimer w four antigen-binding sites
    • Most numerous in body secretions: sweat, tears, saliva, mucus, breast milk, and gastrointestinal 
    • Levels decrease during stress (so you probably have NONE)
  411. IgE
    • One class of antibody
    • Monomer w two antigen-binding sites
    • less than 0.1% of antibody in blood
    • located on mast cells in tissue
  412. IgD
    • One class of antibody
    • Monomer w two antigen-binding sites
    • 0.2% of antibody in blood
    • acts as antigen receptors on B lymphocytes
  413. REVIEW GRAPHIC OF ANTIBODY CLASSES PG 747
  414. MOD 15 OBJ 38
    Primary vs. Secondary antibody-mediated response
    • Primary:
    • 1st exposure
    • 5-7 day delay
    • Production of IgM antibodies followed by IgG

    • Secondary:
    • Second & subsequent exposures
    • Very little delay due to memory T-helper and B cells
    • Production of IgM followed by a long-lasting population of IgG (MANY MADE)
  415. antibody titer
    • is a test that detects the relative amount of antibody
    • indicator for an antibody-mediated response
  416. MOD 16 OBJ 6
    4 chambers of heart
    • R & L Atria are superior and are holding chambers and reservoirs for blood
    • R & L Ventricles are inferior portion and pump blood to lungs & body
  417. 2 Atruim
    • Right atrium - chamber which receives deoxygenated blood from body
    • Left atrium - chamber which receives oxygenated blood from lungshave thin walls, little muscle tone
  418. 2 ventricles
    • Right ventricle - receives blood from right atrium, it pumps the deoxygenated blood out to the lungs
    • Left ventricle - receives oxygenated blood from left atrium, it pumps oxygenated blood out to body
  419. 4 valves of heart
    • 2 atrioventricular valves (AV) = tricuspid and bicuspid valve
    • 2 semilunar (outflow) valves
    • Don't actively open; operate by pressure when enough pressure builds up behind a valve, it forces valve open.
    • Prevent backflow
  420. Atrioventricular valves
    • valves that control the flow of blood btwn atria and ventricles:
    • Tricuspid valve - (right atrioventricular valve) btwn right atria and right ventricle
    • Bicuspid valve - (mitral valve or left AV) btan left atria and left ventricle
  421. Semilunar valves
    • Are the outflow valves which control the flow of blood leaving the heart from the ventricles:
    • Pulmonary semilunar valve: regulates blood flow from the right ventricle to pulmonary trunk (to lungs)
  422. names for tricuspid valve
    Right AV valve
  423. names for pulmonary valve
    • pulmonary semilunar valve
    • also known as an outflow valve
  424. names for bicuspid valve
    • Left AV
    • mitral valve - (recall mitral comes from it looking like a bishops hat... like a pope)
  425. names for aortic valve
    aortic semilunar valve
  426. atrial "kick"
    • the small pumping action of atria
    • Drainage of blood from atria to ventricles, drains by gravity
    • when atria contract, they force remaining blood out (like ketchup bottle)
  427. MOD 16 OBJ 11

    Three ions involved with action potential of a cardiac autorhythmic cell
    • Na+ ~ with funny channels
    • Ca++ ~ after threshold is reached, making membrane more and more positive
    • K+ ~ like neuron, channels open for 2nd half of action potential for repolarization
  428. Funny channels
    • a special kind of Na+ channel only found in autorhythmic cells
    • opening causes the membrane of autorhythmic cell to slowly drift back to threshold after an action potential ~ therefore, it has NO RESTING POTENTIAL!!
    • ALWAYS IN CHANNEL
    • These channels open when cell becomes more neg after action potential
  429. Recall charges on inside vs. outside of cell
    • Inside is more negative that outside
    • Helps to draw Na+ and Ca++ into cell
  430. steps in autorhythmicity
    • AFTER ACTION POTENTIAL:
    • 1. Na+ funny channels open causing membrane to "drift" towards threshold
    • 2. After threshold is hit, Ca++ channels open causing depolarization of cell membrane
    • 3. K+ channels open causing repolarization of cell membrane
    • *Again, these cells never go back down to a flat line of resting. Once it is repolarized, the funny channels open again, and begin drifting back to threshold leading to action potential
  431. What would happen if there was an excess of K+ outside of cell?
    • Would lower the K+ being pulled out of the cell by concentration gradient. The negative charge inside cell would equal pull out. No K+ movement eventually will stop all action potentials
    • Can cause a decrease in heart rate and contractility
    • What they use when someone is put to death by lethal injection. 
    • The heart just stops
  432. What is the issue with old blood - the reason blood bags used for transfusion are dated with expiration date?
    • If blood sits for too long, RBC die and release intracellular K+
    • This is dangerous as it can cause K+ overload
    • *Recall that RBC only live 120 days. When blood is taken, there are RBC that are close to death. Can't sit for too long.
  433. What happens with increase of Na+ in the blood
    • Na+ blocks Ca++ from entering the cells, stopping the action potential
    • this slows down the heart & stops action potential
  434. What happens with a moderate increase in Ca++
    will speed up and strengthen the heart
  435. MOD 16 OBJ 14
    EKG
    • also called ECG
    • is a recording of the electrical changes on the surface of the body resulting from the depolarization and repolarization of the myocardium
    • As the electrical wave spreads over the surface of the heart, the charges shift from one place to another
  436. What can an abnormal ECG show?
    probs within conduction pathways of heart can show if heart is enlarged, if certain regions of heart are damaged, and cause of chest pain
  437. ECG waves
    • P Wave
    • QRS complex (wave)
    • T wave
    • *Atrial repolarization is hidden behind the large QRS complex
  438. Explain what is happening in each "wave" or segment of an EKG
    • P wave = atrial depolarization
    • P - Q interval = atrial "kick" fills ventricles
    • QRS wave = ventricles depolarize, atria repolarize
    • S - T segment = blood flows out, empting ventricles
    • T wave = ventricular repolarization
  439. What is measured in the P - Q interval?
    • This is the area btwn P and Q, during which atrial "kick" fills ventricles
    • On the ECG, it measures the time it takes for atria to depolarize
    • *The cell must depolarize in order for the muscle to contract
  440. What is measured in the S - T segment?
    Measures the time it takes to empty the ventricles before the repolarize
  441. What is measured during the Q - T interval?
    • Includes the area from the start of QRS complex to end of T wave
    • measures time from ventricular depolarization to end of ventricular repolarization
  442. What is the difference btwn a normal EKG reading compared to increased and max HR
    • As heart rate increases, PQRST get closer
    • at max HR, no space btwn PQRST
  443. Abnormal EKG tracings:
    • consist of missing waves, abnormal wave shape or abnormal time interval btwn waves
    • Examples: A-fib, V-tach, V-fib
  444. A-fib
    • Atrial fibrillation
    • most common acute ECG abnormality
    • Almost normal QRS but missing P
  445. V-tach
    • Ventricular tachycardia
    • ventricle depolarizes, but pumping action not effective
    • can progress to V-fib
  446. V-fib
    • ventricular fibrillation
    • disorganized electrical activity
    • life threatening
  447. REVIEW GRAPHICS OF WAVEFORMS
  448. MOD 16 OBJ 19
    EDV
    • End-diastolic volume
    • amount of blood that are in the ventricles after they fill - BEFORE CONTRACTION
    • approx 120 ml
  449. ESV
    • End-systolic volume
    • amount of blood remaining in ventricles after contraction
    • about 50 ml
  450. SV
    • Stroke volume
    • amount of blood pumped out of heart after ventricles contracted
    • SV = EDV - ESV
  451. ejection fraction
    • % of blood ejected
    • Ejection fraction = 

    *recall stroke volume is EDV - ESV
  452. Frank-Starling mechanism
    • states that the more blood that returns to the heart, the greater the force the heart can pump blood out
    • Ex: when exercising, you need more blood flow. need to have bigger contraction
  453. cardiac output
    • refers to the amount of blood being pumped out each minute
    • CO = SV X HR
    • { cardiac output = volume of blood ejected by ventricle during each contraction x # of heart beats per minute }
  454. MOD 16 OBJ 20
    structures of a blood vessel
    • lumen
    • tunica interna
    • tunica media
    • tunica externa
  455. tunic
    • layers which make up the vessel walls
    • all blood vessels in body share components of three basic tunics:
    • Tunica interna
    • Tunica media
    • Tunica externa
  456. endothelium
    • consists of a thin layer of squamous epithelium which lines the internal layer of blood vessels
    • endothelial cells are active participants in a variety of vessel-related activities that influence blood clotting, blood flow, and capillary permeability
  457. tunica interna
    • forms the innermost layer of a blood vessel
    • consists of a simple layer of squamous epithelium (endothelium)
    • connected to a basement membraneprovides very smooth, almost friction free surface for blood cells to "skate" on
  458. Tunica media
    • middle tunic in blood vessels
    • is a muscular and connective tissue layer that displays the greatest variation among the different tissues
    • responsible for vasoconstriction and vasodilation in arteries to control blood flow and blood pressure
    • Tunica media much thicker in artery
  459. tunica externa
    • the outer covering, or layer, of blood vessels
    • made up of elastic and collagen fibers (connective tissue)
    • contains numerous sympathetic nerves which control the diameter of the vesselalso contains vasa vasorum
  460. vasa vasorum
    tiny blood vessels which are especially present in large vessels like the aorta
  461. Arteries vs. veins
    • Artery: smooth muscle layer is thicker; lumen diameter can change depending on muscle tone
    • Veins: thinner walls, less or absent smooth muscle and elastic tissue layer; lumen diameter doesn't change; have valves to prevent backflow. Operate at much lower pressures than arteries
  462. Different types/sizes of blood vessels
    • Elastic arteries
    • Muscular (distributing) arteries
    • arterioles
    • capillaries
    • venules
  463. elastic arteries
    • Also called conducting arteries
    • large in diameter
    • thin walls
    • able to withstand high pressure
    • Ex: aorta
  464. muscular arteries
    • also called distributing arteries
    • medium in diameter
    • their tunica media contains more smooth muscle, which is also thicker
    • has fewer elastic fibers than elastic arteries
    • these arteries will vasoconstrict/dilate, control blood pressure, shunt blood flow to other places in body
  465. arterioles
    • smallest arteries
    • they deliver blood to capillaries
    • important in adjusting the rate of blood flow into capillaries
    • has sympathetic nerves in tunica externa to regulate muscular layer that regulates resistance
    • also have muscular cufts, or sphincters, to regulate blood flow
  466. Veins
    • have thinner walls, less muscle and elastic
    • operate at much lower pressures
    • Blood here travel against gravity, so veins have valves to keep it flowing in one direction
  467. varicose veins
    • results from valves that have become incompetent and "floppy"
    • backflow of blood results
    • pooling occurs(venous stasis)
    • increased risk of clots forming
  468. MOD 16 OBJ 22
    Processes of capillary exchange of nutrients, gases and wastes:
    • Filtration - delivery to tissues
    • reabsorption - taking the garbage out
  469. filtration
    process by which blood pressure drives fluid and solutes out of blood capillaries into the interstitial fluid & delivers oxygen, glucose, and other nutrients to cells
  470. reabsorption
    • process by which interstitial fluid pressure drives fluid into blood capillaries
    • carbon dioxide, acid, urea, and other wastes are exposed of
  471. Starling forces
    refers to the balance btwn the blood hydrostatic pressure and the interstitial fluid osmotic pressure
  472. Starling's law of the capillary
    refers to the equation that relates to the "starling forces"explains the pressure/forces that occur at the capillary level - getting the goods to the cells and then taking the garbage out
  473. hydrostatic blood pressure
    • refers to force at capillaries from blood pressure
    • -on the arteriole end of the capillary bed, pressure is high & moves stuff out into the interstitial fluid; force is about 33 mmHg
    • -on the venule end, pressure drops to about 17 mm Hg.
  474. Interstitial fluid osmotic pressure
    • force which comes from plasma proteins that can't cross into interstitial fluid 
    • (recall osmosis - water wants to flow to areas of high concentration so it can dilute it to a lower concentration.
    • Here, it wants to dilute the proteins within the capillaries.)
    • This pressure pretty much stays consistant at both ends of capillary bed @ 25 mmHg
  475. What happens at the arteriole end of the capillary?
    • forces favor filtration:
    • Blood hydrostatic pressure (pushing force from heart) is about 33mm Hg. 
    • Interstitial fluid osmotic pressure ) It opposes blood hydrostatic pressure @ 25 mmHg
    • Subtracting the two pressures (33 - 25) gives us about +8 mmHG pressure favoring filtration
    • Hence, filtration is the winning force
  476. What happens at the venule end of the capillary?
    • Forces favor reabsorption
    • Blood hydrostatic pressure drops to 17 mmHg
    • Interstitial F.O.P opposes B.H.P and stays at 25 mmHg
    • Since the IFOP is greater than the BHP, the flow reverses, and reabsorption takes place(17 - 25 = -8 mm Hg)
    • *In healthy person, about 20 L are filtered daily from capillaries. About 17 L are reabsorbed. The remaining 3 L are reabsorbed by lymphatic system.
  477. Autoregulation
    • the ability of capillaries to regulate blood flow - so we can shunt blood to areas with higher demand
    • due to low oxygen in tissues
    • Is able to increase capillary blood flow:
    • - to muscles undergoing metabolic demand
    • - brain in areas of greater neural activity
    • - skin autoregulates oxygen & nutrients; neural mechanisms control body temp
    • - lungs operate in opposite way: low oxygen → vasoconstriction, high oxygen → vasodilation
  478. thoroughfare channel
    • main channel from capillary to venule
    • If precapillary sphincters are closed, blood flows here...
  479. circle of Willis
    • Also called cerebral arterial circle
    • is an anastomosis at base of brain
    • formed from branches of the R & L internal carotid and also basilar arteries
  480. anastomosis
    • ~Recall that mostly, arteries branch like a tree as they move away from the heart
    • At anastomoses, arteries form a circle
    • branches fuse off of that
    • often to provide a " backup plan" if one route of blood supply is blocked
    • ex: found at the base of the brain (circle of Willis)
  481. 3 branches of arteries which rise from aortic arch
    • Left common carotid
    • Left subclavian
    • (Right) brachiocephalic trunk
  482. Ridiculous name changes of artery supplying upper extremity
    subclavian A → crosses clavicle & becomes...axillary A → crosses plane of shoulder joint & becomes...brachial A
  483. REVIEW GRAPHICS PG 805
  484. vertebral veins
    • originate in occipital area of brain
    • they descend through foramina of cervical vertebrae & empty into brachiocephalic veins of neck
  485. brachial veins
    paired, drain forearms, elbow joints, arms, and humorous
  486. principal veins for draining blood from upper limbs
    basilic and cephalic
  487. renal veins
    bring filtered blood back to systemic circulation
  488. great saphenous veins
    • longest veins in body, traveling from foot to groin
    • used for grafts in coronary bypass surgery
  489. How is blood delivered to coronary circulation
    when ventricles relax (Ventricular diastole), blood from aorta flows back and fills the coronary circulation
  490. circumflex
    • branch of left coronary artery
    • takes oxygenated blood to walls of left ventricle and left atrium
  491. LAD
    • left anterior descending also called anterior interventricular
    • branch of left coronary artery
    • delivers oxygenated blood to walls of both ventricles
  492. marginal
    • branch of right coronary artery
    • takes blood to right ventricle
  493. posterior interventricular branch
    • branch of right coronary artery
    • takes blood to walls of both ventricles
  494. angioplast
    • balloon that pushes on artery walls
    • has blades that cut out blockage in coronary artery
  495. Principle coronary veins
    • great cardiac vein
    • anterior cardiac vein
    • middle cardiac vein
    • small cardiac vein
    • *all drain into coronary sinus which drains directly into right atrium
  496. great cardiac vein
    • lies in anterior interventricular sulcus
    • drains ventricles and left atrium
  497. anterior cardiac vein
    • drains right ventricle
    • opens directly into right atrium
  498. middle cardiac vein
    • lies in posterior interventricular sulcus
    • drains posterior left and right ventricles
  499. small cardiac vein
    drains right atrium and right ventricle
  500. Where do coronary veins drain
    Into the coronary sinus, which drains directly into the right atrium
  501. REVIEW GRAPHICS!! 
  502. MOD 17 OBJ 4
    List the pathway of an air molecule starting from outside air & ending in bloodstream
    • outside world
    • mouth or nose
    • pharynx
    • larynx
    • trachea
    • left or right primary bronchus
    • secondary bronchus
    • tertiary bronchus
    • bronchiole
    • terminal bronchiole
    • respiratory bronchiole
    • alveoli
    • bloodstream
  503. MOD 17 OBJ 6
    respiration
    process of gas exchange in the body
  504. pulmonary ventilation
    the mass movement of air into and out of the lungs
  505. inhalation
    • movement of air into the lungs from the atmosphere
    • active process requiring muscle action
  506. Exhalation
    • movement of air out of the lungs into the atmosphere
    • passive process during quiet breathing due to the elastic recoil of the lungs
    • active (muscle help) during vigorous exercise or certain disease conditions causing difficult expiration (copd)
  507. MOD 17 OBJ 7
    Kinetic molecular theory
    • the idea that gas is made up of little billiard balls zipping around and colliding w each other
    • They are free to bounce around
    • The collisions of these molecules with the wall of a container is pressure
    • The speed at which the balls move is temp
  508. Where does pressure come from & how is pressure measured?
    • Pressure comes from collisions btwn the molecules and walls of container:
    • Higher temp → more collisions → higher pressure
    • More molecules → more collisions → higher pressure
    • Smaller container → more collisions → higher pressure
    • Measured in atm (atmospheres)
    • 1 atm = 760 mm Hg
  509. Boyle's law
    • says that pressure x volume (P x V) is constant @ constant temp
    • Pressure and volume are inversely related:
    • If volume goes up, pressure goes down
    • If volume goes down, pressure goes up
    • P1V1 = P2V2    

    •  
    • where  means "inverse" of
  510. Muscles used during inspiration
    • Contraction of the diaphragm and external intercostal muscles increase the volume of the thoracic cavity
    • As volume increases, pressure decreases
    • Pressure in thoracic cavity now slightly less than atmospheric pressure
    • Therefore, air will flow from high to low pressure into thoracic cavity
  511. Additional muscles used during deep, labored breathing
    • used to further enlarge the thoracic cavity
    • includes:
    • the sternocleidomastoid, which elevates the sternum
    • the scalene muscles and pectoralis minor which elevate ribs
  512. Describe muscle movements in chest
    • During inhalation:
    • the lifting of the sternum = "pump handle" = moves out anteriorly
    • action of ribs = "bucket handle" = up and out laterally
  513. Describe pressures of quiet exhalation
    • Is a passive process during quite breathing
    • Elastic recoil of chest wall & lungs causes volume in thoracic cavity to decrease
    • *As volume decreases, pressure increases. 
    • Therefore, pressure is now higher in thoracic cavity than atmospheric air & air flows out from high to low press.
  514. Describe pressure of forced exhalation
    Abdominal muscles and internal intercostals contract further, decreasing the volume of the thoracic cavity and increasing the pressure
  515. Alveolar pressure with inhalation vs exhalation
    • *Recall atmospheric pressure about 760 mm Hg
    • Inhalation: thoracic cavity increases in size & volume of lungs expands = alveolar pressure decreases to 758 mm Hg
    • This allows atmos. air flow into lungs
    • Expiration: muscles relax, thoracic cavity decreases in size & lungs recoil = alveolar pressure increases to 762 mmHg
    • Air moves from high pressure in lungs to low pressure in atmosphere
  516. Spirometer/spirogram
    • A spirometer tests pulmonary function, which measures the volume of air exchanged during breathing and the respiratory rate
    • A spirogram is the record of this measurement
    • Four respiratory volumes and four respiratory capacities are measured
  517. What respiratory volumes are measured using a spirometer
    • Tidal Volume
    • Inspiratory reserve volume
    • expiratory reserve volume
    • residual volume
  518. Four respiratory capacities measured on a spirogram
    • Inspiratory capacity
    • Functional residual capacity
    • Vital capacity
    • Total lung capacity
  519. VT
    Tidal volume: volume of air inspired or expired during normal quiet breathing
  520. Inspiratory reserve volume
    all the air you can breathe in from the top of tidal volume (during a very deep inhalation)
  521. Expiratory reserve volume
    all the air you can breathe out from the bottom of tidal volume during a forced exhalation
  522. Residual volume
    • Air still present in lung tissue after the thoracic cavity has been opened
    • Keeps alveoli open, prevents them from collapsing
  523. Respiratory capacities
    combinations of specific lung volumes
  524. inspiratory capacity
    • the sum of tidal volume and inspiratory reserve volume
    • All the air you can suck in total
    • *expiratory capacity would be the total volume you blow out...tidal volume + expiratory reserve volume
  525. functional residual capacity
    the sum of residual volume and expiratory reserve volume
  526. vital capacity
    • the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume
    • All the air you can breathe in, and then out
  527. total lung capacity
    sum of vital capacity and residual volume
  528. What difference is there btwn males and females regarding lung capacity
    • Males are a little bigger - total lung capacity at 6000 ml
    • Females are only 4200 ml
  529. REVIEW SPIROGRAM  PG 838
  530. MOD 17 OBJ 15
    Recall difference btwn external and internal respiration
    • External is exchange of gas in lungs (@ alveoli)
    • Internal is exchange of gas btwn blood & tissues
    • Occurs by passive diffusion, which is governed by the behavior of gases, as described by 2 gas laws (Daltons & Henry's)
  531. partial pressure
    • The pressure of a specific gas in a mixture
    • The subscript is the chemical formula of the gas, Px
    • Ex: PO2  = partial pressure for oxygen; 
    • PH2O = partial pressure for water, etc.
    • Thus, the partial pressure exerted by each component in a mixture can be determined by multiplying the percentage of gas in mix by the total pressure of mixture.
  532. What does partial pressures determine?
    • the movement of O2 and CO2 btwn the atmosphere and lungs, btwn the lungs and blood, and btwn the blood and body cells
    • Each gas diffuses across a permeable membrane from the area where it's partial pressure is greater to the area where it's partial pressure is less
  533. Internal respiration
    • the exchange of O2 and CO2 btwn systemic capillaries and tissue cells
    • occurs in tissues throughout the body*Recall gases diffuse from high to low pressure
    • Partial pressure of O2 lower in tissues & higher in blood = diffuses into tissues
    • CO2 is waste product of metabolism. Partial pressure higher in tissues, lower in blood = leaves tissues & enters blood
  534. Explain how oxygen is carried in bloodstream to tissues
    • Almost all the oxygen is carried by hemoglobin (98.5%) (1.5% dissolved in plasma)
    • it picks up oxygen where concentration (partial pressure) is highest and releases oxygen where it's partial pressure is lowest
    • *alveolar air has highest PO2 ; tissue has lowest PO2
  535. Explain how carbon dioxide is carried in bloodstream to lungs
    • Most of carbon dioxide (70%) is carried in bloodstream as HCO3- (bicarbonate ion)
    • *high partial pressure of CO2 drives formation
    • 23% is bound to hemoglobin, 7% dissolved in plasma
    • Tissue has highest PCO2 , alveolar air has lowest
  536. Explain conversion of CO2 to bicarbonate ion
    • First, CO2 leaves tissues, drawn into RBC, combines w H2O to form carbonic acid (H2CO3-)
    • Carbonic acid then dissociates into HCO3- and H+
    • The bicarbonate ion leaves the RBC, making a shift w Cl- ion (called chloride shift) which goes into RBC (keeping ion charges balanced)
  537. What happens after bicarbonate ion leaves RBC
    • floats around in plasma
    • At alveoli, the reaction reverses 
    • HCO3- goes BACK into RBC, Cl- comes back out (another chloride shift takes place)
    • HCO3- combines w H+, making carbonic acid (H2CO3)
    •  The carbonic acid dissociates into H2O + CO2 (uses the enzyme carbonic anhydrase)CO2 can then diffuse to alveoli and be exhaled
  538. buffers in the human body
    prevent rapid, drastic changes in pH of body fluids by converting strong acids and bases into weak acids and bases
  539. carbonic acid-bicarbonate buffer system
    • most important buffer system in human biology
    • acts as H+ and/or OH- "sponge" so that pH is kept relatively constant
  540. So what's the equation of the carbonic-acid-bicarbonate buffer system
    • H2O + CO2 ↔ H2CO3 ↔ H+ HCO3-
    • *H2CO3 = carbonic acid, HCO3- = bicarbonate ion
  541. What happens when pH is low (w carbonic acid-bicarbonate buffer system)
    • H+ is increased
    • Therefore, when H+ is abundant (acidic conditions), excess H+ are "sponged up" by HCO3- to form H2CO3. = more water and Co2 are made
    •  ↤ reaction goes that way
    • H2O + CO2 ↔ H2CO3 ↔ H+ + HCO3-
  542. What happens when pH is high
    • Means H+ is decreased
    • When H+ is scarce (alkaline), excess H+ is released by H2CO3 to form HCO3- and H+
    • So it pushes the reaction to the right & more bicarbonate ion is made
    •  → reaction goes this way
    • H2O + CO2 ↔ H2CO3 ↔ H+ + HCO3
  543. MOD 18 OBJ 2
    Layers of GI tract
    • Four layers: (deep to superficial)
    • mucosa
    • submucosa
    • muscularis
    • serosa
    • basically the same throughout
    • Always a lumen (open in center, duh)Outside covered in serous membrane
  544. mucosa
    • deepest layer of GI tract; lines the lumen
    • Has 3 sublayers: (order from lumen out...)
    • epithelium
    • lamina propria
    • muscularis mucosae
  545. epithelium in mucosa
    • TWO TYPES:
    • Oral cavity and esophagus have stratified squamous epithelium (think of tortilla chips)
    • Stomach and intestines have simple columnar epithelium
  546. lamina propria
    • intermediate layer of mucosa
    • layer of areolar connective tissue w blood and lymphatic vessels to pick up material absorbed by the epithelium
  547. muscularis mucosae
    • outermost layer of mucosa
    • a thin muscle layer that makes the inside of the GI tract all crinkly and folded
  548. submucosa
    • 2nd layer of the GI tract (from lumen out)
    • comprised of areolar connective tissue
    • contains blood, lymphatic vessels, and submucosal plexus of the enteric nervous system
  549. muscularis
    • 3rd layer of GI tract (from lumen out)
    • IN mouth & pharynx: striated (voluntary) muscle to control swallowing
    • Rest Of GI tract: smooth (involuntary) muscle, usually in 2 layers, keeps materials moving through peristalsis
  550. 2 layers of the muscularis
    • circular muscle and longitudinal muscle
    • help facilitate the movement of food (peristalsis
  551. muscularis externa
    another name for muscularis; to distinguish it from the thinner, weaker muscle layer of the muscularis mucosae
  552. peristalsis
    • movement of food through GI tract
    • caused by circular and longitudinal muscles in muscularis layer
  553. serosa
    • most superficial layer of the GI tract
    • made up of areolar connective tissue covered by simple squamous epithelium
  554. In the abdominal cavity, what is the serosa layer called
    • visceral peritoneum
    • cause it forms the "guts" side of the peritoneal cavity
    • weakest area: arteries, vessels, lymph & nerves entering GI tract
  555. MOD 18 OBJ 10
    Explain how stomach acid is secreted
    • Secreted by parietal cells
    • HCl aids in digestion & protects from invaders
    • H+ and Cl- are both released by the parietal cell, and bond to make stomach acid
  556. How is the H+ ion formed to be expelled from the parietal cell of the stomach
    • Water + CO2 enter the parietal cell
    • With the help of the enzyme carbonic anhydrase, the bond and form carbonic acid (H2CO3)
    • Because it's an acid, it dissociates into a H+ and a bicarbonate ion ( HCO3-)
    • The H+ is then pumped out of the parietal cell by an active transport pump using ATP. So H+ is traded (pumped out) for a K+ (pumped in)
    • H+ can now bond to Cl & make stomach acid
  557. carbonic anhydrase
    • found within parietal cells
    • the enzyme that turns carbon dioxide and water in the stomach into carbonic acid (H2CO3)
  558. How is the Cl- ion formed & expelled from the parietal cell of the stomach?
    • Recall the process which made the H+ ion + bicarbonate ion 
    • An antiporter allows the remaining bicarbonate ion (HCO3-) to be dumped into bloodstream
    • (recall it carries RBC)
    • BUT when the HCO3- leaves parietal cell, Cl- is brought into the parietal cell (from interstitial fluid).
    • Since Cl- is at lower concentration OUTSIDE cell, Cl- flows down concentration gradient, exists parietal cell and bonds with the H+ (that also left the parietal cell)
  559. What can cause the stomach to ulcerate
    Disease causing an increase in secretion of stomach acid, or more commonly decrease the secretion of protective materials (such as mucus from surface mucous cells and mucous neck cells)
  560. gastric ulcers
    • results from the disruption of the secretion of protective mucus
    • The bacteria Helicobacter pylori will cause a disruption in the secretion of mucus
  561. PPI's
    • Proton-Pump inhibitors - a class of drugs used to reduce the secretion of H+Cl- in parietal cells by inhibiting the proton pump (H+/K+ATPase)
    • can also reduce symptoms of GERD (Gastroesophageal reflux disease)
  562. check graphic 875
  563. MOD 18 OBJ 11
    3 regions of the small intestine
    • From stomach to large intestine:
    • duodenum
    • jejunum
    • ileum
  564. Folds in small intestine
    • recall that we need alot of surface space for absorption without taking up alot of volume. 
    • Solution is "folds" 
    • So there are 3 sizes:
    • BIG macroscopic folds
    • MEDIUM microscopic folds
    • SMALL microscopic folds
  565. plicae circularis
    • "circular folds" w/in mucosa layer
    • lines the lumen, making it wrinkly
    • creates more surface area for absorption
    • THESE ARE THE "BIG" FOLDS, able to see with naked eye
  566. villi
    • "shaggy" finger-like projections on the luminal (mucosa) surface of the small intestine
    • Covered by simple columnar epithelium cells, "specialized" for absorption 
    • Within the villi is lamina propria, which contains lacteals and circulatory vessels
    • "shaggy" finger-like projections on the luminal (mucosa) surface of the small intestine
    • A single extension is called a villus, many together are called villiFORM THE "MEDIUM FOLDS"
  567. Describe the specialized epithelium that covers the villi in the mucosa layer of the small intestine
    • Is specialized simple columnar epithelium, which covers the villi
    • The shape of the epithelial cells allows them to absorb water and nutrients on luminal surface, process the nutrients necessary, and drop those substances into capillary bed in lamina propria
    • *the epithelial cells are layered with microvilli
  568. microvilli
    • are a smaller version of villi
    • cover the villi's epithelial cells, giving it a velvety look*because it has the velvety look, or like brush bristles, is referred to as the "brush border"again, increases surface area
    • FORMS THE "SMALL FOLDS"
  569. lacteal
    • a small lymph vessel in the lamina propria of the villi in small intestine
    • carries lipids (within chylomicrons) sent from the absorptive epithelium
    • eventually drain into thoracic duct and releases lipids into bloodstream at Left jugular/subclavian junction
  570. myenteric plexi
    • lies btwn the circular and longitudinal layers of the muscularis
    • clusters of neurons that control the autonomic movements of the intestines (they generate peristaltic waves)
  571. Specialized cells that line the villi
    • Goblet cells
    • Paneth cells
    • Enteroendocrine cells
  572. Paneth cells
    • enzyme-secreting cell of villus in the small intestine
    • secrete lysozyme
    • also capable of phagocytosis
    • protection = can think of the enzymes as antibacterial
    • **Think Panther... crouches n stocks it's pray (its near bottom n btwn villi)
  573. enteroendocrine cells
    • line the villus in the small intestine
    • secrete various hormones to either speed up or slow down the digestive process:
    • secretin from S cells
    • CCK (cholecystokinin) from CCK cells
    • GIP (glucose-dependent insulinotropic peptide) from K cells
  574. Recall the symport system
    • Is a type of secondary active transport (meaning it requires energy to work)
    • A molecule and an ion move in the same direction to drive the pump. 
    • In example with Na+ and glucose (for intestinal cells), the Na+ would move down it's concentration gradient into the cell, and drag glucose w it.
  575. Where does the energy come from for the symport system
    • Doesn't use ATP - uses concentration
    • *The energy used is best explained this way: Think of a damn. On one side is a large body of water. Therefore, a large amount of stored energy. 
    • Since the sodium is highest in concentration outside the cell, it can be compared to the large body of water that's been damned up.
  576. Large intestine (regions)
    • begins where the ileum (final portion of small intestine) has an outlet (through ileocecal sphincter) into the cecum
    • It then continues upward as the ascending colon, crosses from right to left as the transverse colon, and drops down the left flank as the descending colon
    • At this point it makes an S-shaped curve called the sigmoid colon
    • There, a straight down segment called the rectum attaches to anal canal, leading to the anus
  577. ileocecal sphincter
    the "valve" which allows material to pass from ileum of small intestine to cecum of large intestine
  578. histology of large intestine
    • follows "standard" GI tract pattern the absorptive surface is limited to absorption of (mostly) water
    • No plicae, no villi - so doesn't have all the folds like small intestine
    • like small intestine, has a velvety appearance ONLY cause the absorptive cells have microvilli on surface
    • there are also openings for intestinal glands
  579. crypts of Lieberkühn
    intestinal glands
  580. cells types of the large intestine
    • only 2 cell types present:
    • goblet cells & water-absorbing absorptive cells
    • *it is the absorptive cells that have microvilli
    • NO enzyme-secreting cells: digestion carried out by bacteria; some B and K made by bacteria
    • NO enteroendocrine cells
    • **Go Asshole
  581. MOD 18 OBJ 20
    biliverdin
    What the iron molecule is called after it is ripped from heme molecule (from RBC recycling)
  582. Explain how heme is made into bilirubin
    • Recall heme is an oxygen carrier in hemoglobin
    • As RBC only live about 120 days, heme is constantly broken down.
    • The spleen uses an enzyme to convert heme to biliverdin, which then spontaneously converts to bilirubin
    • *Bilirubin made this way is referred to as "unconjugated"
  583. heme oxygenase
    the enzyme used by the spleen (and other cells, if needed) to convert heme to biliverdin
  584. What is meant by "unconjugated" bilirubin
    • bilirubin that hasn't made it to the liver yet
    • means it's insoluble in blood
    • it gloms onto the blood protein albumin and is carried to the liver
    • *once it's in the liver, albumin leaves the molecule, it can leave and is now referred to as conjugated bilirubin
  585. glucuronic acid
    • a small molecule.
    • what happens to "unconjugated" bilirubin when it gets to the liver
    • In the liver it is conjugated into this, making it water-soluble
    • In this form, it makes up a major portion of bile
  586. What produces can be created from conjugated bilirubin?
    • Urobilinogen
    • Stercobilin
  587. urobilinogen
    • one product which conjugated bilirubin can be converted to
    • in this form, it travels in the blood circulation:A small amount is processed in kidneys, giving urine it's yellow color
    • **urobilinogen - urine
  588. Stercobilin
    • Formed when conjugated bilirubin in bile is released into the intestines
    • has a brown color, which gives feces it's brown color
  589. What happens if bile becomes obstructed
    • It is no longer released in normal quantities through the hepatopancreatic sphincter
    • In this case, little or no conjugated bilirubin is converted to stercobilin - feces w be paleAt the same time, urobilinogen accumulated in urine, giving it darker than normal color
  590. In what ways can the liver become incapacitated
    hepatitis (results from a virus)drug or alcohol abuse
  591. jaundice
    • happens in newborns when the liver switches from making red blood cells to digestive roles; and changeover does not occur smoothly
    • Bilirubin can't be conjugated, & skin n eyes become yellowish
    • yellow color from accumulation of unconjugated bilirubin
  592. Pancreas
    • Can be thought of as 2 organs in one, w 2 functions:
    • Endocrine pancreas - inner part (islets)
    • Exocrine pancreas - digestive (acini); the outer part of the pancreatic structure
  593. Recall difference btwn exocrine and endocrine
    • Exocrine means secreting externally
    • endocrine means secreting internally
    • *in this module, exocrine will refer to the "outside" meaning the lumen of the GI tract
  594. recall pancreatic islets
    • where the cells of the endocrine pancreas live
    • in the middle of the pancreatic structure
  595. Recall cells of the pancreatic islet & their endocrine products
    • Alpha cells - glucagon
    • Beta cells - insulin
    • Delta cells - somatostatin
    • F cells (also called PP cells) - pancreatic polypeptide
    • Epsilon cells - ghrelin
  596. Summarize enzymes secreted by pancreas
    • Amylase (4 starches)Trypsin, chymotrypsin, elastase - for proteins
    • Carboxypeptidase - amino acid at carboxyl end of proteins
  597. Ghrelin
    • product of epsilon cells in pancreas
    • seems to have effect of stimulating appetite:
    • increase in ghrelin increase appetite
    • Mice that are genetically alter to interfere w this system are not only skinny, but live longer
  598. acini
    • -of the pancreas
    • makes up most of the pancreas
    • secrete pancreatic juice which:
    • helps neutralize stomach acid
    • inactivate pepsin released from stomach
    • supply necessary enzymes for digesting food in small intestine
  599. Where is the pancreatic juices released?
    They meet up with the fat-emulsifying bile in the hepatopancreatic ampulla & are released into the duodenum on demand
  600. sodium bicarbonate
    • NaHCO3
    • "baking soda"
    • released from pancreas
    • buffers stomach acid
  601. amylase
    • released from pancreas
    • is a starch-digesting enzyme
  602. What protein-digesting enzymes are in pancreatic juice
    • Trypsin
    • Chymotrypsin
    • Carboxypeptidase
    • elastase
    • break down proteins into amino acids
  603. What enzymes in pancreatic juice break down nucleic acids?
    • nucleic acids = RNA & DNA
    • Ribonuclease and deoxyribonuclease
  604. Describe how each digestive organ aids in the process of chemical digestion:
    • Oral cavity: salivary glands secrete enzymes to break down starches n fats
    • Esophagus: None
    • Stomach: HCl breaks down food, Pepsin breaks down proteins, Gastric lipase breaks down fats
    • Small intestine: Pancreas secrets Bicarb to neutralize acid + enzymes to break food; bile salts emulsify fats; + wide variety of enzymes
    • Large intestine: beneficial bacteria make Vit K, digest cellulose (fiber), make methane
  605. brush border
    • region of small intestine which contain enzymes
    • Called such because under a microscope it appears "bushy". This is from proteins (enzymes) which coat the microvilli, giving the fuzzy appearance
  606. MOD 19, OBJ 5
    nephron
    • the main functional unit of the kidney - where urine is made
    • each kidney contains approx 1 million
    • 2 types: Cortical and juxtamedullary nephrons
    • also includes 2 structures: renal corpuscle & renal tubules
  607. renal tubules
    • part of nephron
    • role is to modify the filtrate (product of filtration) to facilitate the final product of urine formation
    • 3 total, named based on shape and/or position related to glomerulus:
  608. Names & location of renal tubules
    • Proximal convoluted tubule - tightly-coiled & attached directly to glomerulus
    • loop of Henle - forms hair-pin turn by connecting two lengths, or limbs or the tubule, the ascending and descending
    • Distal convoluted tubule - similar to proximal tubule as it is tightly coiled, but further away from glomerulus
    • *convoluted meaning twists and turns, like the mouse trap ride
  609. Explain flow of "urine" through renal tubules
    • products leave glomerulus via proximal convoluted tubule
    • Flows into/through loop of Henle
    • Then into distal convoluted tubule
    • From here, several distal convoluted tubules (from other nephrons) combine to form a single collecting duct (or tube)
    • Again, many collecting ducts combine to form a papillary duct, which then empties into a minor calyx
  610. Good way to imagine the renal corpuscle
    • Picture a fist pushed against a partially deflated balloon:The fist would be the glomerulus
    • The balloon would be the double-layered capsule
  611. renal corpuscle
    • Is the filtering structure of the nephron
    • located in cortex
    • consists of 2 compartments: the glomerulus (glomerular capillaries) and glomerular capsule
  612. glomerulus
    • part of renal corpuscle
    • is the filtering structure made up of the glomerular capillaries
  613. MOD 19 OBJ 11
    Importance of regulating GFR
    • Glomerular filtration rate - needs to be held fairly constant
    • If too low, nearly all filtrate may be reabsorbed & certain waste products may not adequately be excreted; there is buildup of waste products in blood
    • If too high, needed substances may pass to quickly through renal tubules that some are not reabsorbed, n would be lost in urine
  614. Body's mechanisms to control GFR
    • Renal autoregulation
    • Neural regulation
    • Hormonal regulation
  615. Explain renal autoregulation of GFR
    • 2 ways kidneys can auto-control: 
    • myogenic mechanism & tubuloglomerular feedback

    *If positive net-filtration was mostly influenced by renal BP, the GFR would fluctuate throughout the day w sleep, exercise, anxiety, etc.
  616. myogenic mechanism
    • One type of renal autoregulation:The process by which the kidney's can adjust the blood pressure in and out of the glomerulus by constricting or dilating the afferent and efferent arterioles
    • If BP is high, the afferent arteriole can constrict to reduce blood flow to the glomerulus
    • This will reduce the GFR
  617. tubuloglomerular feedback
    • One type of renal autoregulation:controlled by JGA (juxtaglomerular apparatus)
    • Macula densa detect increased electrolytes (Na+, Cl-, and water) showing up in distal tubules
    • If these are present in increased amounts, may be due to increased GFR, so not enuf time to reabsorb
    • Therefore, JGA inhibits the release of NO (nitric oxide), resulting in vasoconstriction
  618. Explain why inhibiting NO would cause vasoconstriction
    • NO (nitric oxide) is a potent vasodilator
    • With less present, the arterioles will constrict and decrease the GFR
    • This will give time to reabsorb the electrolytes
  619. Explain Neural regulation of GFR
    • Renal blood vessels are controlled primarily by sympathetic nervous system
    • Norepinephrine causes constriction of afferent and efferent arterioles and decreased GFR
    • By inhibiting sympathetic control & decreasing norepinephrine, will result in dilation of afferent arteriole = increasing GFR
  620. Explain hormonal regulation of GFR
    • Two main hormones contribute to GFR, and have opposite effects:
    • Angiotensin II  decreases GFR
    • ANP (atrial natriuretic peptide): increases GFR
  621. Angiotensin II
    is potent vasoconstrictor of the renin-angiotensin-aldosterone system, so increased amounts will decrease GFR
  622. ANP
    • atrial natriuretic peptide
    • produced by cells in atria. 
    • If there is an increase in blood volume, cells in atria stretch and sense increase, signals heart to secrete ANP
    • Causes cells in glomerulus to to become more porous, letting more blood get through Thus increasing GFR
  623. MOD 19 OBJ 13
    How can substances be reabsorbed via tubular reabsorption?
    • By one of two routes:
    • paracellular reabsorption - btwn renal tubule cells
    • transcellular reabsorption - through the renal tubule cells
    • *This is necessary since things are filtered simply by size, whether we need it or not. The things we need must be reabsorbed
  624. What must take place for transcellular reabsorption?
    The substance must cross the apical membrane of the tubule cell, pass through the cytoplasm, and enter into the interstitial fluid by crossing the basolateral membrane
  625. Where is the majority of solute and water reabsorbed & in what %'s?
    • In the proximal convoluted tubule 
    • To maximize reabsorption capacity, the cells here are cuboidal epithelium w microvilli
    • Reabsorbs:
    • 65% of water, sodium & potassium
    • 100% of glucose and amino acids
    • 50% of the urea
  626. Transport proteins
    • Proteins present on the surfaces of cells to actively reabsorb many of the solutes
    • Each type of transporter has a limit to how fast it can reabsorb a particular solute, kinda like a speed limit
  627. Tm
    • transport maximum
    • A transport proteins "speed limit" to how fast it can reabsorb a particular solute
    • If the level of a solute exceeds the transport maximum, any excess will be excreted into the urine
  628. Extra thoughts on glucose in blood & diabetics
    • Why polyuria (excessive urination): Glucose is a big substance &  it pulls fluid out of tissues.
    • But in urine, if there's excessive glucose in filtrate, water follows leading to excessive urination
    • So with large substances, if we're not reabsorbing them, they pull more water out with them in the urine
  629. glucosuria
    • a condition in which glucose is lost into the urine
    • Happens when diabetics don't keep blood glucose under 200 & exceeds the renal transport max for glucose
  630. How is the reabsorption of water controlled
    • All water reabsorption in the kidneys is controlled by osmosis
    • Two different ways: 
    • Obligatory reabsorption
    • Facultative reabsorption
  631. obligatory reabsorption
    • Occurs as water follows solutes because of osmosis
    • So as solutes are reabsorbed, water is "obliged" to follow
    • Where solids go, water follows; concentration gradient set up
    • Occurs as water follows solutes because of osmosis
    • So as solutes are reabsorbed, water is "obliged" to follow
    • Where solids go, water follows; concentration gradient set up
  632. facultative reabsorption
    • Occurs because body is trying to "facilitate" a specific need
    • Again, due to osmosis, but under influence of ADH (antidiuretic hormone) , which influences cells in the distal convoluted tubule & collecting ducts
    • Accounts for 10% of total water reabsorption
  633. Two main functions of tubular secretion & secreted substances
    • Secretion of H+ controls pH
    • Hydrogen and ammonium ions are secreted and bicarbonate conserved to maintain physiological pH
    • Secreted substances: H+, K+, NH4+ (ammonia waste products) , creatinine (waste), and some drugs
  634. MOD 19 OBJ 26
    Describe "body fluids"
    • Consists of the water and solutes in the body's fluid compartments
    • 60% of body mass
    • Many compartments, or rather "containers"
  635. State the relative volumes for intra and extracellular compartments
    • 2/3's of body fluids are intracellular
    • 1/3 is extracellular
    • *The extracellular environment can be divided into a number of compartments, but the main space if the interstitial compartment
  636. MOD 19 OBJ 29
    Describe water movement in body
    • Recall the volumes of fluid in intracellular and interstitial compartments are not the same
    • For cells not to shrink or swell, osmolarity of both fluids must stay the same
    • Changes in osmolarity will cause water to move from one compartment to another
    • Can be compensated as long as it's not sudden or excessive
    • Kidneys can excrete water at 15 ml/minute
  637. What happens with excessive water consumption
    • A decrease in plasma and interstitial osmolarity causes water to move into the intracellular environment, resulting in cellular swelling
    • If severe enough, can cause cellular death (water intoxication)
    • This is why there isn't a pure water IV solution
  638. Water intoxication
    • When water intake is so much that osmolarity in plasma & interstitial causes water to go straight into cells (lower concentration)
    • Causing cells to swell
    • symptoms include severe headache, light-headedness
    • Can lead to convulsions, coma, and death
  639. MOD 19 OBJ 31
    buffer
    • helps regulate pH
    • a molecule that has the ability to bind H+, and therefore temporarily reduce the acidity in a solution
    • thus reducing the pH of the solution
    • It doesn't remove the H ions but simply binds to them
  640. Common buffer systems:
    • Protein buffering system
    • Carbonic acid-bicarbonate buffering system
    • Phosphate buffering system
  641. Protein buffering system
    • Most abundant buffering system in the plasma and intracellular fluid
    • The carboxyl functional group can bind H+Side chains on 7 of 20 amino acids can bind H
  642. Recall carbonic acid-bicarbonate buffering system
    If we have excess H+, they can combine w bicarb to form carbonic acid, which dissociates into water and carbon dioxide

    H+ + HCO3- ⇔ H2CO3 ⇔ H2O + CO2
  643. What systems help regulate pH
    Respiratory and Renal
  644. How should you remember CO2, H+, and HCO3-
    • CO2 can combine w water to form carbonic acid, which dissociates into bicarb and H+
    • Therefore, a buildup of carbon dioxide will be ACIDIC
    • H+ = acid
    • bicarb = HCO3- = base
  645. respiratory control of pH
    • An increase in Carbon dioxide results in an increase in H+, so any condition causing the accumulation of CO2 will result in the lower pH
    • Changes in rate and depth of ventilation can alter the blood pH, and takes place in minutes
    • Therefore, alter rate and depth of vents to exhale or retain CO2
  646. hyperventilation
    • doubling the ventilation rate
    • Will increase the pH about .23 units
  647. hypoventilation
    • Reducing the ventilation rate by 75%
    • Can decrease the pH by about 0.4 units
  648. Explain the renal control of pH... how is it able to help
    • Metabolic reactions produce large amounts of acids
    • The kidneys can secrete large amounts of H+: H+ are exchanged for Na+ in the proximal convoluted tubule; also via proton pumps in collecting duct - getting rid of H+
    • The collecting ducts can secrete H+ when pH is low and HCO3- when pH is high
    • Recall a proton is a H+
  649. Summarize what systems control: H+, CO2, and HCO3-
    • Kidneys regulates H+ & HCO3-
    • Respiratory regulates CO2
  650. Explain Acidosis and Alkalosis
    • Recall normal pH is 7.35 - 7.45
    • Acidosis = blood pH below 7.35
    • Alkalosis = blood pH above 7.45
  651. Respiratory acidosis
    • Any condition that results in inadequate exhalation, thus accumulation of CO2
    • Can be caused by:
    • Hypoventilation
    • Emphysema
    • Overdose of respiratory-suppressive drugs
  652. Respiratory alkalosis
    • Results from exhalation of too much CO2
    • hyperventilating 

    • Can be caused by:
    • Severe anxiety 
    • Oxygen deficiency
  653. What happens in metabolic Acidosis
    • Decrease in plasma HCO3- (can be caused from diarrhea) 
    • Non-respiratory acid accumulation (ketosis, lactic acidosis, etc.)
    • Failure of kidneys to excrete H+ (cause of renal dysfunction)

    Ketones = byproduct of fat metabolism, seen in diabetes
  654. What happens in metabolic alkalosis
    • Too basic from either:
    • Non-respiratory acid loss (ex: vomiting)
    • OR
    • Excessive HCO3- due to alkaline drugs (antacids)
  655. MOD 20 OBJ 12
    Summarize what is happening in the ovarian and uterine cycles early in the menstrual cycle
    • During last half of menstruation, FSH released from anterior pituitary causes one lucky primordial follicle in ovary to start developing. 
    • It becomes a primary follicle
    • As FSH remains high, the primary follicle develops into a secondary follicle at the beginning of endometrial proliferation phase
  656. Summarize what is happening in the ovarian and uterine cycles in proliferation phase up to ovulation
    • At beginning of proliferation, a secondary follicle was formed
    • As it further develops into a mature follicle, it begins secreting estrogens to help maintain the growth & development of the stratum functionalis
    •  At midpoint of cycle, approx day 14, a burst of FSH and LH triggers ovulation which marks  beginning of secretory phase
  657. summarize spikes of hormones throughout cycle
    • At beginning of cycle, FSH spikes a little to encourage follicle development
    • As follicles develop, a increase in estrogen occurs
    • At ovulation, LH suddenly spikes to release egg, which then drops back off
    • That's when progesterone increases, along with a slight increase in estrogen, from the corpus luteum
    • Once progesterone drops (if not fertilization occurs) triggers menstration
  658. Inhibin
    • hormone secreted by corpus luteum
    • Inhibits release of FSH (mostly) and, to lesser extent, LH
    • Simply keeps body from starting another cycle before it's ready
  659. Relaxin
    • hormone secreted by corpus luteum
    • Inhibits contractions of uterine smooth muscle to allow easier implantation (from cycle to cycle)
    • Plays key role during labor= increases flexibility of pubic symphysis & dilates uterine cervix, also relaxation so baby can drop
  660. MOD 20 OBJ 14
    Describe hormonal control in the male for gamete production
    • Similar to females, GnRH is secreted (from hypothalamus) which acts to secrete FSH or LH
    • *No follicles in males, duh
    • FSH acts as stimulant to spermatogenic cells and Sertoli cells of testes
    • LH acts on Leydig cells of testes, which secrete testosterone...which may be converted to the active form DHT
  661. DHT
    • dihydrotestosterone
    • a male hormone that alters secondary sexual characteristics
  662. How is spermatogenesis promoted?
    In the presence of FSH, testosterone and androgen-binding protein (from Sertoli cells) promote spermatogenesis
  663. What does the hormone "inhibin" do in males
    Controls a negative feedback loop which ensures that sperm are not over-produced
  664. MOD 20 OBJ 20
    Define fertilization
    • When the sperm and egg unit
    • Forms a diploid = zygote
    • Is the moment which starts out developmental "clock"
  665. Describe first week after fertilization
    • the embryo travels from uterine tube, where fertilization almost always occurs near distal end of tube, 
    • Along the way, it continues the process of mitotic cell division
  666. two-cell embryo
    • results from the first division of the zygote, resulting in two symmetrical, equal cells
    • *the splitting of the cell at this point will result in monozygotic twins forming
  667. four-cell embryo
    • next division of embryo, takes place on day 2
    • produces 4 equal, almost identical cells
  668. morula
    • the stage after four-cell embryo; seen at day 4
    • when simple pattern of cell division is lost
    • "raspberry"
  669. blastocyst
    • when the embryo forms a hollow, fluid filled ball
    • seen about day 5
  670. What leads to implantation
    • happens about day 6
    • blastocyst makes contact w endometrium of uterus
    • inner cell mass develops
    • Problem: embryo is "foreign issue (half of genes not from mom) so involves evading mother's defense mechanisms (since dad's DNA is foreign)
  671. Inner cell mass
    develops when the point of contact btwn blastocyst and endometrium causes uterus to release chemical factors
  672. implantation
    • days 8 - 12
    • Upon implantation, the blastocyst divides into three parts:
    • ~trophoblast
    • ~innercell mass→ embryonic disc
    • ~yolk sac
    • The endometrial lining becomes the decidua
    • By day 12, embryo is completely covered by endometrial tissue
  673. Gastrulation
    • Happens approx day 16
    • the process by which an embryo folds in on itself to form 3 layers:
    • ectoderm ~ becomes skin & nervous system
    • mesoderm ~ becomes connective tissue, muscles and bones
    • Endoderm ~ becomes gut tube
  674. carcinoma vs. sarcoma
    • When cancer occurs, it's named by tissue of origin
    • Carcinoma refers to tissue from the ectoderm
    • Sarcoma refers to the tissue from the mesoderm
  675. Name ectoderm derivatives:
    • epidermis
    • teeth
    • jaws
    • nervous system
    • posterior pituitary
    • **Even Tom & Jerry Need Pussy
  676. Name Mesoderm derivatives:
    • Somites
    • Kidneys
    • Heart
    • Reproductive system
    • Gonads
    • **Sadly Kissing Happened Regularly, George
    • (and it all happened in mesa, AZ)
  677. Name endoderm derivatives
    • Lungs 
    • bladder
    • Thyroid
    • Liver
    • Pancreas
    • Lining of digestive tract
    • **Please... Let The Bitch Lie Longer?? (I just want to END it)
  678. What is the breakdown of somites (from the mesoderm derivatives)
    • Look like little "speed bumps" of the mesoderm, when form into:
    • dermatome = dermis
    • sclerotome = vertebrae
    • myotome = skeletal muscles, appendicular skeleton
  679. YOUR AT THE END! :-D  You Got this!!

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