BSC 100: HUMAN PHYSIOLOGY WITH
Explain both the structural and functional
PATHOPHYSIOLOGY MIDTERMS (QUESTIONS)
PERIPHERAL NERVOUS SYSTEM
DID YOU GET IT?
24. Where is the epineurium located?
Around each nerve fiber.
25. Which cranial nerve pair is the only one to serve
structures outside the head and neck?
Vague nerves.
26. What is a nerve plexus?
Nerve plexus = complex network of nerves.
27. Ron has a horrible pain in his right buttock, thigh,
and leg. He is told he has sciatica. Which spinal
nerve is involved, and what plexus does it belong to?
Sciatic nerve of the sacral plexus.
28. Which regions or organs of the body are served by
the autonomic nervous system? Which are served by
the somatic nervous system?
Visceral organs (smooth and cardiac
muscles and glands) are served by the ANS.
Skeletal muscles are served by the somatic
nervous system.
29. How does the motor pathway of the autonomic
nervous system differ from that of the somatic nervous
system?
The ANS has a two-motor neuron pathway
from the CNS to the organ to be served. The
somatic nervous system has just one motor
neuron in the motor pathway.
30. Which division of the autonomic nervous system is
the “fight-or-flight” system?
Sympathetic division.
31. Why must premature babies be placed in
incubators until their hypothalamus matures?
They are unable to regulate their body
temperature until the hypothalamus matures.
32. What is orthostatic hypotension? Why do many
older people suffer from this condition?
It is hypotension caused by a rapid change
in position, such as getting up quickly from a
reclining position. The sympathetic nervous
system, which regulates blood pressure, is less
efficient in old age.
SHORT ANSWER ESSAY
13. What distinguishes spinal nerves from cranial
nerves?
cranial nerves: originate from the brain and
extend to the head and neck (12 pairs) spinal
nerves: arise from the spinal cord to supply below
the head (31 pairs) 8 pairs cervical, 12 pairs
thoracic, 5 pairs lumbar, 5 pairs sacral, 1 pair
coccygeal.
14.
classifications of the nervous system. In your
explanation, include the subdivisions of each.
The structural and functional
classifications of the nervous system are based on
its structures and activities, respectively. The
structural classification of the nervous system
involves every organ in the nervous system, and it
is further subdivided into two, and these
subdivisions are the central nervous system (CNS)
and the peripheral nervous system (PNS). The CNS
includes the organs that are found in the dorsal
cavity, which are the brain and the spinal cord.
These two organs act as the centers in the nervous
system for integrating and command. Specifically,
the brain and the spinal cord interpret the sensory
information received by the system and give
appropriate instructions. Meanwhile, the PNS
consists of the extending nerves from the spinal
cord and the brain. These nerves refer to the
cranial and spinal nerves. The cranial nerves are
the carrier of the impulses to and from the brain,
while the spinal nerves are the carrier of impulses
to and from the spinal cord. Overall, the
communication line that connects all parts of the
body by carrying messages from sensory
receptors to the CNS and carrying messages from
the CNS to the glands and muscles is the PNS.
The functional classification of the nervous
system is limited only to the organs in the PNS. The
functional classification of the nervous system is
also further subdivided into two, and these
subdivisions are the sensory and motor divisions.
The sensory or afferent division includes the
nerves that send impulses from the sensory
receptor to the CNS and inform the CNS of the
happenings inside and outside of the body.
Meanwhile, the motor or efferent division includes
the nerves that send back impulses from the CNS
to the effector organs, which are the glands and
muscles. The motor division has two subdivisions
called somatic and autonomic nervous systems.
The somatic nervous system permits the
conscious or voluntary control of one’s skeletal
muscles. However, there are still some skeletal
muscle activities that are involuntary, like skeletal
muscle reflexes. Meanwhile, the autonomic
nervous system is responsible for automatic or
involuntary events such as the activity of cardiac
muscle. The autonomic nervous system has two
parts called sympathetic and parasympathetic. The
sympathetic nervous system is found in the spinal
cord’s thoracic and lumbar regions, and its main
function is stimulating the fight or flight response
of the body by activities such as regulating the
heart rate, perspiration rate, and so on. As for the
parasympathetic nervous system, it is found in
between the medulla and the spinal cord, and it
mainly focuses on the “feed and breed” and “rest
and digest” responses of the body.
15. What is the basis for the functional classification of
neurons?
 The direction of the nerve impulse
transmission relative to the CNS is the basis for the
functional classification of neurons. On this basis,
the neurons are classified into sensory, motor, and
association neurons. The sensory or afferent
neurons refer to the carriers of impulses from the
sensory receptor to the CNS. The motor or efferent
neurons serve as the carriers of impulses from the
CNS to the muscle and glands and/or viscera. The
association neurons or interneurons act as the
connectors between motor and sensory neurons in
neural pathways.
16. Two major cell groups make up the nervous
system—neurons and supporting cells such as
astrocytes and Schwann cells. Which are “nervous”
cells? Why? What are the major functions of the other
cell group?
Neurons are the "neurons cells"; they
exhibit irritability and conductivity. The major
functions of the glia are protecting, support,
myelination, and a nutritive/metabolic function
relative to the neurons. Schwann cells are
myelinating cells in the peripheral nervous system.
17. Briefly explain how nerve impulses are initiated and
transmitted, and why conduction at synapses is always
one-way.
A threshold stimulus causes a change in
membrane permeability that allows Na+ to enter
the neuron through sodium gates. This causes
local depolarization and generates the action
potential, which is then self-propagating. This
event is quickly followed by a second permeability
change that restricts Na+ entry but allows K+ to
leave the neuron.
18. Name four types of cutaneous sensory receptors.
Which of the cutaneous receptor types is most
numerous? Why?
Pain receptors; Pacinian corpuscles (deep
pressure) and Meissner's corpuscles (light
pressure); temperature receptors (e.g., Krause end
bulbs [cold] and Ruffini's corpuscles [heat]) The
pain receptors are most numerous because pain
indicates actual or possible tissue damage.
19. What is the function of Broca’s area? In which part
of the brain is it found?
LOCATION: Left frontal lobe just superior to
the lateral fissure (ONLY found on left side)
FUNCTION: Controls muscles responsible
for the production of speech (works with
the primary motor cortex)
20. Make a rough drawing of the left cerebral
hemisphere. On your drawing, locate at least five
different functional areas, and then indicate their
specific functions.
• Primary motor cortex: All voluntary somatic
motor responses arise from this region.
• Premotor cortex: This region controls
learned motor skills of a repetitious or
patterned nature.
• Somatosensory association area: Acts to
integrate and analyze different
somatosensory inputs, such as
temperature, touch, pressure and pain.
• Primary somatosensory cortex: Receives
all somatosensory information from
receptors located in the skin and from
proprioceptors in muscles; identifies the
body region being stimulated.
• Visual area: Receives information that
originates in the retinas of the eyes.
• Auditory area: Receives information that
originates in the hearing receptors of the
inner ear.
• Prefrontal cortex: Mostly involved with
elaboration of thought, intelligence,
motivation and personality. It also
associates experiences necessary for the
production of abstract ideas, judgment,
planning and conscience and is important
in planning motor activity.
• Wernicke's area: Speech area involved in
the comprehension of language, especially
when the word needs to be sounded out or
related.
• Broca's area: Previously called the motor
speech area; now known to be active in
many other activities as well.
21. Other than serving as a conduction pathway, what
is a major function of the pons? Why is the medulla the
most vital part of the brain?
The pons also has important nuclei that
participate in the control of respiratory rhythm. The
medulla is vital because it contains the major
respiratory centers, the vasomotor center (which
controls blood vessel diameter, hence blood
pressure), and the cardiac centers. Without
breathing and heart activity, life stops.
22. What are the basal nuclei made of, and what is their
function?
Basal nuclei are a region located at the base
of the brain composed of 4 clusters of neurons, or
nerve cells. The basal nuclei help regulate
voluntary motor activities by modifying
instructions (particularly in relation to starting or
stopping movement) sent to the skeletal muscles
by the primary motor cortex. A tight band of
projection fibers, called the internal capsule,
passes between the thalamus and the basal nuclei.
23. Describe how the brain is protected by bone,
membranes, fluid, and capillaries.
Bone: Enclosed by the skull. Membranes:
The meningeal membranes—dura mater,
arachnoid mater, and pia mater—enclose the brain
within the skull and provide a passage for the
circulation of CSF and its return to the blood. Fluid:
Cerebrospinal fluid (CSF) cushions the brain from
physical trauma. Capillaries: The capillaries of the
brain are permeable only to glucose, a few amino
acids, and respiratory gases. Hence, they protect
the brain from possibly harmful substances in the
blood.
24. What is gray matter? White matter? How does the
arrangement of gray and white matter differ in the
cerebral hemispheres and the spinal cord?
Gray matter is neural tissue composed
primarily of nerve cell bodies and unmyelinated
fibers. White matter is composed primarily of
myelinated fibers. In the cerebral hemispheres,
most of the gray matter is outermost (superficial),
and the white matter is deep. In the spinal cord, the
white matter is superficially located and the gray
matter is internal or deep.
25. What are two functions of the spinal cord?
It connects a large part of the peripheral
nervous system to the brain. Acts as a minor
coordinating center responsible for some simple
reflexes like the withdrawal reflex.
26. How many pairs of cranial nerves are there? Which
are purely sensory? Which activates the chewing
muscles? Which helps regulate heart rate and activity
of the digestive tract?
There are twelve pairs of cranial nerves.
Among the twelve cranial nerves, the purely
sensory ones are the olfactory, optic, and
vestibulocochlear nerves. Specifically, these
nerves are responsible for carrying the impulses
for the senses such as smell, vision, balance, and
hearing. Then, the cranial nerve that activates the
chewing muscles is the trigeminal nerve through
its motor fibers. Lastly, the cranial nerve that helps
regulate the heart rate and activity of the digestive
tract is the vagus nerve through its
parasympathetic motor fibers.
27. What general area of the body do the cranial
nerves, other than the vagus nerves, serve? What do
the vagus nerves serve?
Head and neck.
28. Which glial cells promote the circulation of the
cerebrospinal fluid?
Ependymal cells promote the circulation of
the cerebrospinal fluid through the beating of their
cilia.
29. What region of the body is served by the dorsal rami
of the spinal nerves? By the ventral rami?
Dorsal rami: Posterior body trunk. Ventral
rami: Limbs and anterior, lateral body trunk.
30. Name the four major nerve plexuses formed by the
ventral rami and the body region served by each.
Cervical, Brachial, Lumbar, Sacral
31. How does the autonomic nervous system differ
from the somatic nervous system?
First of all, the somatic nervous system
permits the conscious or voluntary control of one’s
skeletal muscles, though there are still some
skeletal muscle activities that are involuntary, like
skeletal muscle reflexes. Meanwhile, the
autonomic nervous system is responsible for
automatic or involuntary events such as the
activity of cardiac muscle. The autonomic nervous
system and somatic nervous system differ in terms
of their effector organs, released
neurotransmitters, and motor pathways. Also, the
autonomic nervous system differs from the
somatic nervous system in that there is a chain of
two motor neurons from the CNS to the effector.
32. What is the difference in function of the sympathetic
and parasympathetic divisions of the autonomic
nervous system (a) in general and (b) as specifically
relates to the operation of the cardiovascular and
digestive systems?
Generally, the sympathetic and
parasympathetic divisions of the autonomic
nervous system function differently since the
former is responsible for mobilizing the body under
extreme situations like exercise, fear, and so on,
while the latter allows unwinding and conserving
energy. In terms of cardiovascular and digestive
systems operations, the sympathetic division,
which is the fight or flight system, works by
bringing effects that can help in coping with the
stressor, and its activation increases heart rate and
blood pressure. Meanwhile, the parasympathetic
division, which is the rest and digest and
housekeeping system, involves works, such as
promoting normal digestion, eliminating feces, and
conserving energy in the body.
33. The sympathetic and parasympathetic fibers serve
the same organs. How can their opposing effects be
explained?
Although both the sympathetic and
parasympathetic preganglionic fibers release
acetylcholine, their postganglionic fibers (in close
contact with the effector organs) release different
neurotransmitters. The sympathetic fibers release
norepinephrine and the parasympathetic fibers
release acetylcholine. These different
neurotransmitters produce opposing effects in the
effector organs.
34. How does a Schwann cell help insulate a nerve
fiber?
They produce myelin outside the CNS.
They're specialized support cells that wrap tightly
around an axon in a jelly roll fashion and enclose
it.As a result, the neuron is insulated.
35. Compare CVAs and TIAs in terms of causes,
symptoms, and consequences.
• Both result from restricted blood flow to
brain tissue.
• CVA result in permanent or long-lasting
deficits including paralysis, aphasia, &
visual disturbances.
• In TIAs the disturbances, though similar,
are temporary because neurons don’t die,
since there is only a transient restricted
blood flow to the area.
• TIAs are warning signs for CVAs in the
future.
36. Define senility. Name possible causes of
permanent and reversible senility.
Senility is a deterioration of one’s mental
abilities and is characterized by confusion,
difficulty in concentrating, forgetfulness,
irritability, and inability to think clearly. The
possible causes of permanent senility include
factors that result in an inadequate supply of
oxygen to neurons, such as high blood pressure
and arteriosclerosis, which is the decreased
elasticity of the arteries. Also, the aging process
that can gradually decline oxygen supply can lead
to permanent senility. Meanwhile, the possible
causes of reversible senility include constipation,
dehydration, depression, hormone imbalances,
low blood pressure, poor nutrition, and some
drugs.
CRITICAL THINKING AND CLINICAL
APPLICATION QUESTIONS
37. Mrs. Jones has had a progressive decline in her
mental capabilities in the past five or six years. At first,
her family attributed her occasional memory lapses,
confusion, and agitation to grief over her husband’s
death six years earlier. When examined, Mrs. Jones
was aware of her cognitive problems and was shown
to have an IQ score approximately 30 points lower than
would be predicted by her work history. A CT scan
showed diffuse cerebral atrophy. The physician
prescribed a mild tranquilizer for Mrs. Jones and told
her family that there was little else he could
recommend. What is Mrs. Jones’s problem?
She has Alzheimer’s disease. Loss of
neurons in the basal forebrain is associated with a
shortage of the neurotransmitter acetylcholine. By
prescribing an acetylcholinesterase inhibitor, the
acetylcholine that she does have will not be
reabsorbed or broken down as quickly and will
slightly improve cognitive skills.
38. Joseph, a man in his early 70s, was having
problems chewing his food. He was asked to stick out
his tongue. It deviated to the right, and its right side was
quite wasted. What cranial nerve was impaired?
Hypoglossal (XII).
39. Andy is about to take the stage to play the guitar in
front of the biggest audience he has ever played for.
He can feel his heart pounding in his chest and his
hands are sweating. Explain Andy’s physiological signs
in terms of the autonomic nervous system.
Andy might be feeling something because
he is about to play guitar in front of a lot of people,
he might be excited, nervous, shy, and so on, but
the bottom line is that the sympathetic division of
the autonomic nervous system is working to cope
up with the situation that he is currently in. The
pounding of the heart and the sweating hands are
results of sympathetic nervous system activity.
40. A semiconscious young woman is brought to the
hospital by friends after falling from a roof. She did not
lose consciousness immediately, and she was initially
lucid. After a while, though, she became confused and
then unresponsive. What is a likely explanation of her
condition?
Intracranial hemorrhage.
41. During John’s checkup, one year after an accident
severed his right accessory nerve, the physician noted
severe muscle atrophy. What two prominent muscles
have been affected?
Sternocleidomastoid and trapezius
muscles.
42. Mrs. Chen, a new mother, brings her infant to the
clinic because he has suffered repeated seizures.
When questioned, she states that her labor was
unusually long and difficult. What condition do you
suspect? Will the infant’s condition worsen?
Cerebral palsy-the condition will not
worsen.
43. Jake has been recently administered medication
through an injection in his right buttock. Now he is not
being able to dorsiflex his right foot. His doctor
suspects that he has footdrop. What could have
happened?
The sacral plexus is near the right buttock,
and among its important nerves is the sciatic
nerve, specifically the common fibular. This nerve
serves the lateral aspect of leg and foot and a
damage in this result to foot drop, which is the
inability to dorsiflex foot. The injection might have
damaged the sciatic nerve, especially in the
common fibular.
44. Mr. Harrison is an 82-year-old bedridden
gentleman who has discovered a new interest in
learning about his body. While being tended by the
visiting nurse, he remarks that the supporting cells in
nervous tissue (such as Schwann cells and
oligodendrocytes) act like the rubber coating around
household wiring. What does he mean by this analogy?
Schwann cells and oligodendrocytes
deposit a fatty coat called myelin around axons.
Like the rubber coat around household wires,
myelin acts as an electrical insulator.
45. Maria had an automobile accident that caused
injury to her head. As a result, she could not
understand what was said to her, though she was able
to pronounce words herself. What was her probable
condition? What caused it?
Her probable condition is aphasia. This
condition is usually caused by damage to the left
cerebral hemisphere. There are many types of
aphasias and Maria is specifically suffering from
sensory aphasia, in which she loses her ability to
understand spoken language.
46. Why does exposure to toxins have more
devastating neural effects during early pregnancy than
in late pregnancy?
The nervous system is formed during the
first month of development, so exposure to toxins
at this time will cause great neural damage.
47. Jason is the star of his hometown ice hockey team.
During a game, he is hit with a hockey stick so hard
that he hits the ice. When he tries to get up, he is
unable to flex his left hip or extend his left knee, but he
has no pain. Which nerve has been damaged?
The femoral nerve, which originates at
lumbar vertebrae one, two, three, and four
experienced traumas by the hockey stick. The
femoral motor nerve innervates the rectus femoris
muscle, which is only one of four quadriceps
muscles that cause both hip joint flexion and knee
joint extension. This nerve is also responsible for
cutaneous sensation in that area. Clancy is not
feeling any pain which further indicates femoral
nerve damage.
48. Derek got hit in the back of the neck with a baseball,
and now he can’t shrug one shoulder. Which cranial
nerve is involved?
Accessory (IX) nerves.
49. When Taylor begins to feel drowsy while driving,
she opens her window, turns up the volume of the car
stereo, and sips her ice-cold water. How do these
actions keep her awake?
By changing the outside environment by
feeling the wind while driving or turning up the
volume, or drinking the cold water, Taylor is taking
her body out of a "habituation" state by introducing
new environmental stimuli. this allows her brain to
receive new sensory input (through her skin,
mouth, and ears), integrate the information, and
allow for motor output to potentially increase her
oxygen intake through higher heart and respiratory
rate through the activation of the sympathetic
division. potentially the limbic system may also be
activated as well.
50. As the aroma of freshly brewed coffee drifted by
Joe’s nose, his mouth began to water, and his stomach
started to rumble. Explain these reactions in terms of
ANS activity.
If we are hungry or feel the urge to eat, just
the sight, smell or thought of food will cause our
digestive system to signal the brain to get all
systems prepared for the entry of food. This
causes the muscles that line the stomach and
intestines to start moving and release digestive
fluids, which in turn interact with the air and
fermented gas floating inside our intestinal system
(not too appetizing to think about while on the
buffet line). Most often this process is silent, but
does have the potential to play the "gastric
symphony," otherwise known in medical circles as
"borborygmi."
SPECIAL SENSES
DID YOU GET IT?
1. What is the role of the eyelids?
The eyelids protect the eyes.
2. Which four accessory glands or structures help
lubricate the eye?
The tarsal glands, ciliary glands,
conjunctiva, and lacrimal glands all contribute to
lubricating the eye, though their secretions differ.
3. What is the role of lysozyme in tears?
Lysozyme is a component of tears that
helps to destroy bacteria and protect the eye from
infection.
4. What is the visual role of the external eye muscles?
They direct the eyeball toward what you
wish to view.
5. What is the meaning of the term blind spot in relation
to the eye?
The blind spot contains no photoreceptors;
it is the site where the optic nerve leaves the
eyeball.
6. What function does the choroid of the vascular layer
have in common with the pigmented layer of the retina?
Both contain pigment, which prevents light
scattering in the eye.
7. How do the rods and cones differ from each other?
Rods have a rod-like outer segment
containing the photopigment, whereas cones have
a shorter cone-shaped outer segment. Rods
respond to low light conditions and produce black-
and-white vision; cones need bright light and
provide color vision.
8. What are the refractory media of the eye?
Refractory media include the cornea,
aqueous humor, the lens, and vitreous humor.
9. What name is given to the ability of the eye to focus
on close objects?
Accommodation.
10. What is the difference between the optic tract and
the optic nerve?
The optic nerves leave the eyeballs, and the
medial half of the fibers of each optic nerve cross
over to the opposite side, joining there with the
fibers from the outside half of the opposite eye to
form the optic tracts.
11. In what way does the photopupillary reflex protect
the eyes?
It causes pupillary constriction in very
bright light. Intense light stimulation can injure the
photoreceptors.
12. How is astigmatism different from myopia and
hyperopia?
Astigmatism results from unequal
curvatures on the lens surface, not from an eyeball
that is too long or too short to focus the image on
the retina. The unequal curvatures of astigmatism
result in points of light that focus on the retina as
lines, not points, leading to blurry images.
13. Which region(s) of the ear (external, middle, or
internal) serve hearing only?
External and middle ears serve hearing
only.
14. Which structures of the ear transmit sound
vibrations from the eardrum to the oval window?
The ossicles (hammer, anvil, and stirrup).
15. What sense do the vestibule and semicircular
canals serve?
Balance or equilibrium.
16. Describe the different receptors for static and
dynamic equilibrium and their locations.
Dynamic receptors located in the
semicircular canals (crista ampullaris) have
embedded in the gel-like cupula; static receptors
located in the vestibule (maculae) have otoliths
that move when the head moves, causing hairs
embedded in the otolithic membrane to bend.
17. What are otoliths, and what is their role in
equilibrium?
Otoliths are tiny stones made of calcium
salts that are located in the maculae of the
vestibule. They respond to static equilibrium cues
relative to the position of the head in space.
18. From the air outside the body, through what
substances do sound waves travel to excite the
receptor cells of the cochlea?
Tympanic membrane to bones of ossicles
to fluids of the cochlear scalae.
19. Which nerve transmits impulses from the spiral
organ of Corti to the brain?
Cochlear nerve (division of cranial nerve
VIII).
20. Do high-pitched sounds peak close to or far from
the oval window?
Close to the oval window.
21. How do sensorineural deafness and conduction
deafness differ from each other?
Sensorineural deafness results from
damage to neural structures involved in hearing
(cochlear nerve, auditory region of the brain),
whereas conductive deafness results from
anything that prevents sound vibrations from
reaching the cochlea (earwax, fusion of the
ossicles, fluid in the middle ear).
22. What general name is used to describe both taste
and smell receptors? Why?
Chemoreceptors, because they respond
chemicals in solution.
23. Where, relative to specific structures, are most
taste buds located?
On the tongue.
24. Why does it help to sniff substances that you want
to smell?
Odor receptors are located at the superior
aspect of the nasal cavity. Sniffing brings the air
upward.
25. Fifty-year-old Mrs. Bates is complaining that she
can’t read without holding the newspaper out at arm’s
length. What is her condition, and what is its cause?
Presbyopia; caused by reduced elasticity of
the lens as a result of aging.
26. Which of the special senses is least mature at
birth?
Vision.
27. What is presbycusis?
Deafness of old age.
SHORT ESSAY QUESTIONS
11. Distinguish between tarsal and ciliary glands.
• Tarsal glands- These glands produce an
oily secretion that lubricates the eye
• Ciliary glands- are modified sweat glands,
lie between the eyelashes (cilium = eyelash),
and their ducts open at the eyelash follicles.
12. Explain crying in physiological terms.
Tears contain mucus, antibodies, and
lysozyme , an enzyme that destroys bacteria. Thus,
they cleanse and protect the eye surface as they
moisten and lubricate it. When lacrimal secretion
increases substantially, tears spill over the eyelids
and fill the nasal cavities, causing congestion and
the “sniffles.” This happens when the eyes are
irritated by foreign objects or chemicals and when
we are emotionally upset.
13. Diagram and label the internal structures of the eye,
and give the major function of each structure.
Ciliary body: releases a clear liquid in the eye
Cornea: in which light enters the eye
Iris: responsible for controlling the size of the
pupil
to
Lens: changes the focal distance to focus at
shapes at various lengths
Aqueous body: thin watery fluid that is between
the anterior and posterior chambers of the eye
Sclera: protects the eye
Vitreous body: large portion of the body in which
light passes through for visuals
Retina: receive light that the lens has focused,
convert the light into neural signals, and send
these signals on to the brain for visual
recognition.
Choroid: Nourishes the retina and assists with
absorption of light to prevent its scattering within
the eye.
Optic nerve: transfer visual information from the
retina to the vision centers of the brain via
electrical impulses
Optic disc area: the point on the retina where all
the nerve fibers (axons) from the photoreceptors
converge and exit to become the optic nerve.
14. Name the extrinsic eye muscles that allow you to
direct your eyes.
Superior, inferior, lateral, and medial rectus
muscles; and the superior and inferior oblique
muscles.
15. Locate and describe the functions of the two
humors of the eye.
Vitreous humor: Posterior to lens; reinforces
eyeball.
Aqueous humor: Anterior to lens; reinforces
eyeball and provides nutrients to the avascular
lens and cornea.
16. What is the blind spot, and why is it so called?
The optic disc in our retina is the blind spot
because there are no rods or cones there that
processes the light passing by.
17. What name is given to the rounded opening in the
pigmented iris through which light passes?
pupil
18. What is the fovea centralis, and why is it important?
A small pit in the retinal layer that contains
cones only is located lateral to the optic disk in
each eye. Anything that must be viewed critically
(discriminative vision) is focused here because it
is the area of greatest visual acuity.
19. Trace the pathway of light from the time it hits the
cornea until it excites the rods and cones.
From the cornea’s aqueous humor, through
pupil to aqueous humor to lens to vitreous humor
to retina. The path of light goes through the
ganglion cells first, then the bipolar cells before
stimulating the rods and cones.
20. Trace the pathway of nerve impulses from the
photoreceptors in the retina to the visual cortex of the
brain.
Photoreceptors (rods and cones) to bipolar
cells to ganglion cells to optic nerve through the
optic chiasma to optic tract to thalamus to visual
cortex in the occipital lobe via the optic radiation.
21. Define hyperopia, myopia, and emmetropia.
Hyperopia- Farsightedness. The individual has no
problem with distance vision, which requires no
accommodation; in near vision, however, the
image is focused behind the retina because of a
lazy lens or foreshortened eyeball.
Myopia- Nearsightedness. The individual has no
problem with near vision, but in distance vision,
the image is focused anterior to the retina because
of an overly strong lens, an elongated eyeball, or a
cornea that is too curved.
Emmetropia- Normal vision. The image is focused
correctly on the retina in both near and far vision.
22. Why do most people develop presbyopia as they
age? Which of the conditions in question 21 does it
most resemble?
As one ages, the lens loses its elasticity, causing
it to focus less acutely for close vision.
23. There are only three types of cones. How can you
explain the fact that we see many more colors?
When two (or more) different cone types are
stimulated simultaneously the color perceived is
intermediate (in wavelength or light) between them.
Thus, stimulation of red and green cones produces
the sensation of yellow; when all cones are
simultaneously excited, we perceive white (all
colors = white).
24. A rise in intraocular pressure can be damaging for
the retina and optic nerve. How is this pressure kept
within the normal range?
Through the aqueous and the vitreous
humor in our lens, that is secreted to prevent from
inward collapsing and increased IOP.
25. Many students struggling through mountains of
reading assignments are told that they need glasses
for eyestrain. Why is it more of a strain on the extrinsic
and intrinsic muscles to look at close objects than at far
objects?
Close vision involves both convergence and
accommodation. Convergence requires the
activation of the external eye muscles (primarily
the medial recti) and the ciliary body within the eye.
Distance vision requires none of these specific
muscle actions because this position is when the
eye is at rest.
26. Name the structures of the outer, middle, and inner
ears, and give the general function of each structure
and each group of structures.
Outer Ears- the auricle (pinna) has no function in
humans. The external acoustic meatus conducts
sound vibrations from the external environment to
the tympanic membrane (eardrum), which is
involved in hearing only.
Middle Ears- The ossicles, which span the
tympanic cavity, conduct vibrations received from
the tympanic membrane to the oval window and
fluids of the inner ear. The pharyngotympanic tube
allows middle ear pressures to be equalized with
those of the atmosphere. Involved in hearing only.
Inner Ears- Semicircular canals, vestibule, and
cochlea are all part of the bony labyrinth. The
semicircular canals and vestibule function in
equilibrium maintenance, whereas the cochlea
functions in hearing.
27. Sound waves hitting the eardrum set it into motion.
Trace the pathway of vibrations from the eardrum to the
spiral organ of Corti, where the hair cells are stimulated.
Eardrum to ossicles (hammer to anvil to stapes) to
oval window to perilymph in the bony cochlea to
the membranous labyrinth to endolymph in
cochlear duct to basilar membrane and organ of
Corti
28. What is the difference between the perilymph and
the endolymph?
Perilymph- *Similar to cerebrospinal fluid, and
therefore is extracellular fluid.
*has a high Na+ (~ 140 mM) and low K+
(~ 10mM) concentration
*In the bony labyrinth, it fills the space
between the bone tissue and the outer surface of
the membranous labyrinth.
*It fills the scala vestibuli and scala
tympani in the cochlea.
Endolymph- * Its fluid composition is unique and is
found only in the auditory and vestibular systems.
* It has a high K concentration (~ 150
mM), and virtually no Na
*It is present inside the inner
membranes of the membranous labyrinth.
*It is in the scala media, or cochlear
duct, in the auditory system.
29. Normal balance depends on information
transmitted from a number of sensory receptor types.
Name at least three of these receptors.
-Inner ear vestibular apparatus (maculae in the
vestibule and cristae ampullaris in the semicircular
canals)
-eyes
-proprioceptors of muscles and tendons
30. Which cranial nerves are involved in taste
registration?
• Cranial Nerve VII- Facial Nerve
• Cranial Nerve IX- Glossopharyngeal Nerve
• Cranial Nerve X- Vagus Nerve
31. Name the five primary taste sensations.
Sweet, sour, bitter, salty, and umami.
32. Where are the olfactory receptors located, and why
is that site poorly suited for their job?
In the superior most mucosa of the
olfactory passageways. This is a poor site
functionally because most air (which carries
odors) passes inferior to this site
33. What is Meniere’s syndrome?
It is a condition where it suspected causes are
arteriosclerosis, degeneration of cranial nerve VIII,
and increased pressure of the inner ear fluids.
Progressive deafness occurs. A patient become
nauseated and often have howling or ringing
sounds in their ears and vertigo (a sensation of
spinning) that is so severe that they cannot stand
up without extreme discomfort.
34. Which special sense requires the most learning?
Vision requires the most "learning" as
babies can initially only focus on near objects. The
eye must first enlarge, then external muscle
coordination must develop, as must focusing
ability and color vision. Depth perception develops
relatively late, maturing just before school age.
35. For each of the following descriptions, indicate
whether it applies to a macula or a crista ampullaris:
1inside a semicircular canal; 2contains otoliths;
3responds to linear acceleration and deceleration; 4has
a cupula; 5responds to rotational acceleration and
deceleration; 6inside the vestibule.
1. Crista ampullaris; 2. macula; 3. macula; 4. crista
ampullaris; 5. crista ampullaris; 6. macula
CRITICAL THINKING AND CLINICAL
APPLICATION QUESTIONS
36. An engineering student has been working in
construction to earn money to pay for his education.
After about eight months, he notices that he is having
problems hearing high-pitched tones. What is the
cause-and-effect relationship here?
His hearing receptors in the organ of Corti
are being damaged (and are dying) by the
excessively loud noise; sensineural deafness is
occurring.
37. Nine children attending the same day-care center
developed red, inflamed eyes and eyelids. What are
the most likely cause and name of this condition?
The children probably had conjunctivitis,
caused by bacteria or viruses; it is highly
contagious and could be easily transmitted
between children at the day care center.
38. Dr. Nguyen used an instrument to press on Mr.
Cruz’s eye during his annual physical examination on
his 60th birthday. The eye deformed very little,
indicating that the intraocular pressure was too high.
What was Mr. Cruz’s probable condition?
High intraocular pressure generally
indicates that the patient has glaucoma.
39. Brandon suffered a ruptured artery in his middle
cranial fossa, and a pool of blood compressed his left
optic tract, destroying its axons. What part of the visual
field was blinded?
The left optic tract carries all the visual
information from the right half of the visual field.
Thus, Lionel cannot see the right half of visual
space.
40. Sylvia Marcus, age 70, recently had surgery for
otosclerosis. The operation was a failure and did not
improve her condition. What was the purpose of the
surgery, and exactly what was it trying to accomplish?
The surgeon was trying to remove the tiny
stapes from the oval window, to which it had rigidly
fused, causing conduction deafness
(stapedectomy).Such delicate surgery is difficult
because the stapes is so tiny. Here, it proved
impossible to remove this ossicle neatly enough to
clear the oval window and restore hearing.
41. Kathy visits her doctor as she has been struggling
to read books, food labels, and her computer screen.
An eye test reveals that Kathy is hyperopic. What sort
of lenses would Kathy need? Explain.
Kathy needs convex lenses that is thick in
the middle that converges light and shortens the
focal length of light that passes through them. It is
suitable for hyperopic or far-sighted patients,
because their eyes are too short, that light cannot
focused on time before it hits the retina.
42. Julie and her father love to find the constellations in
the sky on starry nights. One evening, Julie came
running into the house and whispered excitedly to her
mother. “Mom, I’ve got power! When I look hard at a
star it disappears!” What is happening?
Rods are very light sensitive
photoreceptors used in dim light. Cones require
intense light. Focusing hard on the star focuses
light on the fovea centralis which only has cones,
no rods. Perhaps the starlight is not strong enough
to stimulate the cones. Vision at night relies heavily
on rods.
43. While visiting her father’s office on the 25th floor of
the Harris Building, 5-year-old Emma wandered away
into the hall. Fascinated by the buttons in the elevator,
she entered and pressed 1, and the highspeed elevator
plummeted to the first floor. Later she told her father
that she felt like she “kept on going” when the elevator
stopped. Explain her sensation.
Static equilibrium receptors (maculae)
report the position of the head with respect to
gravitational pull changes when the body is
standing still as in the elevator. Otoliths
responding to changes in gravity sensation bent
hair cells within the organ of Corti during elevator
"drop" and continued on after the elevator stopped.
44. Mrs. Garson has an immune disorder that causes
dry mouth, and she complains to her doctor that she’s
lost her sense of taste. How might her symptoms be
explained?
Mrs. Garson's immune disorder reduced
sensitivity within her taste bud receptors by the
lack of salivary fluid available to mix with her
ingested food. Gustatory cells are only able to
respond to chemicals dissolved in saliva. Even
the choicest cut of prime rib will not taste good
to someone who has dry mouth.
45. Serge can see colors, but he confuses certain
colors, especially red and green. What is the cause
of his condition?
Serge has a red-green color blindness. It
is happened when our eyes lack green and red
receptors, and may confuse them as the same
colors, depending on the cone type present. It is
a sex-linked condition that is common among
males.
46. Explain the role of vitamin A in vision
Vitamin A plays a crucial role in our vision,
as they are the ones who maintains our clear
cornea. They also bind, in a form called retinal,
with a protein called opsin, to make rhodopsin,
an essential light absorbing molecule needed for
color vision and seeing in low light conditions.
ENDOCRINE SYSTEM
DID YOU GET IT?
1. Walking barefoot, you step on a piece of broken
glass and immediately pull your foot back. Why is it
important that the signal triggering this motion come
from the nervous system and not from the endocrine
system?
The endocrine system delivers its
commands slowly via hormones carried by the
blood. The nervous system uses rapid electrical
messages that are much faster, allowing you to lift
your foot off the glass more quickly.
2. What is a hormone? What does target organ mean?
A hormone is a chemical messenger used
by the endocrine system. The target organ of a
hormone is the specific cells or tissues that the
hormone affects.
3. Why is cAMP called a second messenger?
Because cAMP is not a first messenger,
which is a molecule that attaches to a receptor on
the cell’s plasma membrane and triggers the
reactions leading to synthesis of the second
messenger in the cell.
4. What are three ways in which endocrine glands are
stimulated to secrete their hormones?
. Endocrine organs are stimulated by
hormones, by chemicals other than hormones, and
by the nervous system.
5. What are two important differences between
endocrine and exocrine glands?
Endocrine glands are ductless, and they
release their hormone products directly into the
intercellular fluid. Exocrine glands release their
nonhormonal products to an epithelial surface via
a duct.
6. Both the anterior pituitary and the posterior pituitary
release hormones, but the posterior pituitary is not an
endocrine gland. What is it?
The posterior pituitary is nervous tissue
that acts as a storage and releasing area for
hormones sent to it by the hypothalamus.
7. Barry is excreting huge amounts of urine. He has an
endocrine system problem, but it is not diabetes
mellitus, which has a similar sign. What is his possible
problem?
Diabetes insipidus, in which copious
amounts of urine are voided as a result of
hyposecretion of ADH.
8. What are tropic hormones?
Tropic hormones stimulate certain
endocrine organs to secrete their hormones.
9. Why is iodine important for proper thyroid gland
function?
 Functional thyroid hormone has iodine as
part of its structure.
10. What hormone is called the “sleep hormone,” and
which endocrine organ produces it?
Melatonin, produced by the pineal gland.
11. How are the thyroid and parathyroid glands linked
anatomically?
The parathyroid glands reside on the
posterior thyroid gland.
12. What hormone increases the blood calcium ion
level, and which endocrine gland produces this
hormone?
PTH, produced by the parathyroid glands,
increases the blood calcium ion level.
13. What hormone reduces the blood calcium ion level,
and which endocrine gland produces this hormone?
Calcitonin, produced by the parafollicular
cells of the thyroid gland, reduces the blood
calcium ion level.
14. How do thymosin and other thymus hormones help
to protect the body?
Thymosin programs the T lymphocytes,
which essentially direct our immune responses.
15. What hormone stimulates the kidneys to reabsorb
more sodium ions?
Aldosterone stimulates the kidneys to
reabsorb more sodium ions.
16. Which group of hormones produced by the adrenal
cortex have anti-inflammatory effects and participate in
the long-term stress response?
Glucocorticoids such as cortisol.
17. Mrs. Bellamy’s husband has suffered a heart attack
and is hospitalized. Would you expect her blood
glucose level to be elevated, normal, or lower than
normal? Why?
Her blood glucose level would be elevated
because of her stress. When we are stressed, both
glucocorticoids (adrenal cortical hormones) and
epinephrine and norepinephrine (adrenal
medullary hormones) are produced in increased
amounts. Both sets of hormones promote a rise in
the blood glucose level.
18. Insulin and glucagon are both pancreatic
hormones. Which stimulates cellular uptake of
glucose?
Insulin stimulates cellular uptake of
glucose.
19. Which gonadal hormone causes a young girl’s
reproductive organs to mature at puberty—estrogen or
progesterone?
Estrogen.
20. Which two digestive system organs are important
sources of hormones associated with digestion?
Stomach and small intestine.
21. What temporary organ produces the same
hormones as the ovaries?
Placenta.
22. Failure of which endocrine organ(s) leads to
menopause in women?
Ovaries.
23. In the elderly, the decline in the level of which
hormone is associated with muscle atrophy? With
osteoporosis in women?
Growth hormone decline results in muscle
atrophy; estrogen decline leads to osteoporosis.
SHORT ANSWER ESSAY
10. Explain how the nervous and endocrine systems
differ in (a) the rate of their control, (b) the way in which
they communicate with body cells, and (c) the types of
body processes they control.
a. Nervous system control is extremely
rapid (millisecondsto seconds), whereas
endocrine control takes minutes to days to bring
about its effects.
b. Nervous system communication is via
electro-chemical impulses, whereas the endocrine
system uses blood-borne chemical "messengers"
called hormones.
c. The nervous system controls immediate,
short-term
processes, such as stimulation of muscle
contraction and glandular secretion, whereas the
endocrine system controls daily maintenance
processes that go on for long periods of time
(sometimes continuously), such as growth and
maturation, metabolism, and the functioning of the
reproductive system.
11. Which endocrine organs are actually mixed
(endocrine and exocrine) glands? Which are purely
endocrine?
The endocrine organs that are mixed glands
are the pancreas and gonads. The pancreas and
gonads, which are the testes and ovaries, have
both endocrine and exocrine functions. Meanwhile,
the purely endocrine glands are the anterior
pituitary, adrenals, parathyroid, and thyroid.
12. Briefly describe how a steroid hormone affects the
activity of the target cell.
Steroid hormones can directly influence the
target cell’s DNA or act via second messenger.
13. Provide one example for each way endocrine
glands are stimulated to release their hormones.
The three ways to stimulate the endocrine
glands to release their hormones depend on the
type of stimuli that could be hormonal, humoral,
and neural. When endocrine organs act in
response to other hormones, this refers to
hormonal stimuli. For example, the hormones
produced by the hypothalamus stimulate the
release of hormones of the anterior pituitary gland,
and these hormones also stimulate other
endocrine organs to release hormones. To be more
specific, the anterior pituitary releases thyroid-
stimulating hormones that stimulate the thyroid to
release T3 and T4 hormones. In humoral stimuli,
the hormone release is stimulated by the changing
blood levels of ions and nutrients. For instance, an
increase in the level of blood glucose stimulates
the pancreas to release insulin. In some cases, the
hormone release is stimulated by nerve fibers,
which refers to neural stimuli. One example of this
is the adrenal medulla's stimulation by the
sympathetic nervous system under a state of
stress to release catecholamines such as
norepinephrine and epinephrine.
14. Define negative feedback.
A process that brings about a reversal of
any change in conditions. it ensures that an
optimum steady state can be maintained, as the
internal environment is returned to its original set
of conditions after any change. it is essential for
homeostasis.
15. Explain why not all organs are target organs for all
hormones.
Target organs will have specialized
receptors on it for that particular hormone. Other
cells in other organs won't have those receptors.
16. Describe the body location of each of the following
endocrine organs: anterior pituitary, pineal gland,
thymus, pancreas, ovaries, testes. Then, for each
organ, name its hormones and their effect(s) on body
processes. Finally, for each hormone, list the important
results of its hypersecretion or hyposecretion.
• Anterior pituitary: Protrudes from the
inferior surface of the brain, incased in the
sella turcica of the sphenoid bone.
Produces:
A) Growth Hormone(GH) which causes
overall body growth but particulary skeletal
& muscualar growth. A lack during
childhood leads to pituitary dwarfism.
Oversecretion produces giganticism (kids)
or acromegaly (adult).
B) Prolactin (PRL) which stimulates
lactation in females. An excess leads to
inappropriate lactation.
C) Gonadotropic hormones LSH adn LH,
which stimulate the production of
ova/estrogen/progesterone in females and
sperm/testosterone in males. A lack results
in sterility. Overproduction of FSH leads to
understimulation of adrenal cortex
hormones. For LH, hypersecretion also
leads to infertility & miscarriage in women
D) TSH, which stimulates the production of
thyroxin by the thyroid gland. A lack results
in hypothyroidism (cretinism in kids,
myxedema in adults). TSH hypersecretion
to cause disease is rare. Can lead to
increased metabolism.
E) ACTH, which regulates the activity of the
adrenal cortex. Hypersecretion results in
Cushing's Syndrome. Hyposecretion
results in Addisons disease.
• Posterior Pituitary: Releases 2 hormones
made by the hypothalamus, ADH &
oxytocin. A lack of ADH leads to insipidus,
while oversecretion leads to hyponatremia
or low blood sodium concentration. For
oxytocin, hyposecretion leads to failure to
progress in labor contractions as well as
difficulty in milk let-down, while hyper
secretion isn't commonly observed, but can
lead to suppression of ACTH.
• Pineal Gland: Found at the superioposterior
end of the 3rd ventricle in the brain. the
pineal gland release melatonin, which is
important for regulating sleep& wake cycles
and inhibits precocious sexual
development in humans.Early
hyposecretion results in sexual maturity
earlier than normal, while hyposecretion
can lead to depression & sleepiness.
• Thymus: Found in the anterior thorax,
overlying the trachea and heart. Its
hormone, thymosine, serves to program the
T-lymphocytes of the immune system for
recognition of self from nonself. Athymic
individs lack the ability to mount an
effective imunne response. Hypersecretion
isn't observed.
• Pancrease: Located in the abdomen, in the
mesentery btw the stomach & duodenum.
Produces, insulin, (basically a
hypoglycemic hormone that promotes the
uptake & metabolism of glucose by body
cells. lack of insulin leads to diabetes
mellitus. Hypersecretion may lead to
hypoglycemia or 'insulin shock'.) Glucagon
(basically a hyperglycemic that promotes
the release of glucose by liver when blood
glucose levels are low. NO documented
hypersecretion or hyposecretion problems.
• Ovaries: Located in abdominopelvic cavity,
lateral to uterus. Produces estrogen &
progesterone. Lack of these hormone leads
to inability to conceive kids & reduced
development of secondary female
characteristics. Hypersecretion can lead to
premature sexual development in females &
infertility.
• Testes: Located in the scotal sac, medial to
the superior thighs. Produces testosterone,
a lack of which leads to a reduction in
sperm count & reduced development of
secondary male characteristics.
Hypersecretion can lead to premature
sexual development in males & muscle
hypertrophy.
17. What anatomical feature makes it possible for the
releasing hormones from the hypothalamus to
influence the activity of the anterior pituitary?
The hypothalamus liberates hormones into
the blood of the portal circulation, which connects
the blood supply of the hypothalamus with that of
the anterior pituitary. (In a portal circulation, two
capillary beds are connected by one or more veins;
in this case, the capillaries of the hypothalamus are
drained by veins that empty into the capillaries of
the anterior pituitary.)
18. What is the primary function of antidiuretic
hormone? Why is it also called “vasopressin”?
From the name itself, antidiuretic hormone
inhibits diuresis or urine production. The
antidiuretic hormone primarily functions by
causing reabsorption and conservation of body
water by the kidney tubule cells. The antidiuretic
hormone is called vasopressin because, in
excessive amounts, it can lead to an increase in
blood pressure through the constriction of
arterioles.
19. What is the most common cause of hypersecretion
by endocrine organs?
Hypersecretion by an endocrine gland is
often caused by a tumor. For example, a tumor of
the pituitary gland can cause hypersecretion of
growth hormone.
20. What is the role of alpha and beta cells in the
regulation of blood glucose?
The role of alpha and beta cells in
regulating blood glucose is the release of insulin
and glucagon. The alpha cells release glucagon
with a hyperglycemic effect, which helps increase
the glucose level in the blood, and a low blood
glucose level stimulates this. The glucagon's
target organ is the liver, and it stimulates the
breakdown of stored glycogen into glucose that is
later release into the blood. Meanwhile, the beta
cells release insulin with a hypoglycemic effect,
and a high blood glucose level stimulates this.
Specifically, insulin increases the rate of glucose
uptake, metabolism, and ability to import glucose
across cells' plasma membranes; thus, it sweeps
glucose out of the blood, which results in a
decrease in the glucose level in the blood.
21. The adrenal cortex produces corticosteroids. What
is the difference between mineralocorticoids and
glucocorticoids with regard to their production sites?
What major functions do they monitor?
The mineralocorticoids and glucocorticoids
are among the corticosteroids, which are steroid
hormones produced by the adrenal cortex. The
differences between the mineralocorticoids and
glucocorticoids are evident in their production
sites and the major functions they monitor. The
mineralocorticoids' production site is the
outermost cell layer of the adrenal cortex, while the
production site of the glucocorticoids is the middle
cortical layer. The mineralocorticoids' major
function is regulating blood's mineral content,
specifically the potassium and sodium
concentration. On the other hand, glucocorticoids
primarily function by increasing the blood glucose
level to promote normal cell metabolism and the
body's resistance to long-term stressors.
Additionally, the glucocorticoids decrease edema
to control the more undesirable effects of
inflammation, and they lessen pain by inhibiting
the pain-causing prostaglandins.
22. What is insulin resistance?
Insulin resistance is a state of the inability
of insulin receptors to respond to insulin. This
situation is usually observable in people
experiencing type 2 diabetes. The treatments for
type 2 diabetes include oral hypoglycemic
medications or a special diet to reduce insulin
resistance by increasing the target tissues'
sensitivity to insulin. This also improves the islets'
action and the beta cells' sensitivity to the
stimulation caused by glucose.
23. In general, the endocrine system becomes less
efficient as we age. List some examples of problems
that elderly individuals have as a result of decreasing
hormone production.
Menopause, low calcitonin=brittle bones;
low insulin=diabetes.
CRITICAL THINKING AND CLINICAL
APPLICATION QUESTIONS
24. Jenny’s body mass index (BMI) is too high, and she
wants to lose some weight. Is there a hormone that can
suppress appetite? Explain.
Yes, there is a hormone that can suppress
appetite, and this is Leptin. This hormone is a
peptide and its source is the adipose tissue. The
stimulus for the secretion of this hormone is fatty
food. The target organ of this hormone is the brain,
and it suppresses appetite and increase energy
expenditure.
25. The parents of 14-year-old Megan are concerned
about her height because she is only 4 feet tall and they
are both close to 6 feet tall. After tests by their doctor,
certain hormones are prescribed for the girl. What is
the probable diagnosis? What hormones are
prescribed, and why might the girl expect to reach
normal height?
The diagnosis is hyposecretion of growth
hormone. The prescription is commercial pituitary
growth hormone. The reason that the girl might
reach her growth potential is that the epiphyseal
plates of her bones have not yet sealed, allowing
additional growth of the skeleton and body in
response to the hormone
26. Shannon, a 28-year-old, has been in the first stage
of labor for 15 hours. Her uterine contractions are
weak, and her labor is not progressing normally.
Shannon and her doctor desire a vaginal delivery, so
the physician orders that Pitocin (a synthetic oxytocin)
be infused. What is the effect of this hormone?
 Pitocin works exactly like oxytocin to
stimulate contraction of the smooth muscle of the
myometrium, thus strengthening the uterine
contractions to expel the baby.
27. Mr. Flores brings his wife to the clinic, concerned
about her nervousness, heart palpitations, and
excessive sweating. Tests show hyperglycemia and
hypertension. What hormones are probably being
hypersecreted? What is the cause? What physical
factors allow you to rule out thyroid problems?
The catecholamine epinephrine and
norepinephrine. The usual cause of hypersecretion
is a tumor in the adrenal medulla. The
catecholamines promote a rise in blood sugar
(hyperglycemia), whereas thyroid hormones
trigger glucose catabolism.
28. What are the possible harmful effects of using
anabolic steroids to increase muscle mass and
strength?
Bloated face (a sign on steroid excess),
shriveled testes and infertility, liver damage, liver
cancer, possible increase in risk for coronary heart
disease, and psychiatric problems.
29. Melissa, age 40, comes to the clinic, troubled by
swelling in her face and unusual fat deposition on her
back and abdomen. She reports that she bruises
easily. Blood tests show an elevated glucose level.
What is your diagnosis, and which glands might be
causing the problem?
Melissa may have Cushing's syndrome-
which is hyper secretion of glucocorticoids from
the middle region of the adrenal cortex.
30. Multiple births are observed commonly in women
treated for infertility with drugs that stimulate the
release of gonadotropic hormones. What could be the
reason?
The use of gonadotropic hormones may
cause multiple births possibly due to multiple
ovulations at the same time, rather than the usual
single ovulation each month.
31. Ryan had symptoms of excessive secretion of PTH
(a high blood calcium ion level), and his physicians
were certain he had a parathyroid gland tumor. Yet
when surgery was performed on his neck, the surgeon
could not find the parathyroid glands at all. Where
should the surgeon look next to find the tumorous
parathyroid gland?
The doctor should look on the posterior
surface of the thyroid gland.
BLOOD
DID YOU GET IT?
1. Which body organ plays the main role in producing
plasma proteins?
The liver is the major source of plasma proteins.
2. What are the three major categories of formed
elements?
Erythrocytes, leukocytes, and platelets.
3. What determines whether blood is bright red
(scarlet)or dull red?
The color of blood varies with the amount
of oxygen it is carrying. From most oxygen to least,
the blood goes from scarlet to dull red or purple.
4. What is the role of hemoglobin in the red blood cell?
Hemoglobin transports oxygen and a small amount
of carbon dioxide in the blood.
5. Which white blood cells are most important in body
immunity?
Lymphocytes are the main actors in body
immunity.
6. If you had a severe infection, would you expect your
WBC count to be closest to 5,000, 10,000, or 15,000
per mm3?
Infection in the body causes an increase in WBC
count, thus 15,000/mm3.
7. Little Lisa is pale and fatigued. What disorder of
erythrocytes might she be suffering from?
Anemia.
8. What is the name of the stem cell that gives rise to
all formed elements?
The hemocytoblast gives rise to all formed
elements.
9. What property of RBCs dooms them to a limited life
span of about 120 days?
Lack of a nucleus; therefore, they cannot
carry out transcription and translation to produce
proteins (enzymes and others).
10. How is the production of platelets different from that
of all other formed elements?
The stem cell (megakaryocyte) undergoes
mitosis many times, forming a large multinucleate
cell, which then fragments into platelets.
11. What factors enhance the risk of thrombus
formation in intact blood vessels?
Inactivity, leading to blood pooling, and
anything that roughens or damages the lining of a
blood vessel (laceration, atherosclerosis, or
physical trauma).
12. What are the classes of human blood groups based
on?
The self-antigens (agglutinogens) the RBCs bear.
13. What is the probable result of infusing mismatched
blood?
A transfusion reaction in which the RBCs
are lysed and hemoglobin enters the bloodstream,
potentially leading to kidney shutdown.
14. Cary is bleeding profusely after being hit by a truck
as he was pedaling his bike home. At the hospital, the
nurse asked him whether he knew his blood type. He
told her that he “had the same blood as most other
people.” What is his ABO blood type?
O-positive.
15. What is the difference between an antigen and an
antibody?
An antigen is a substance foreign to the
body that activates and is attacked by the immune
system. An antibody is a protein released by
immune cells that binds with a specific antigen
and inactivates it in some way.
16. How does fetal hemoglobin differ from that of the
adult?
Fetal HbF has a greater ability to bind
oxygen and binds it more strongly than adult HbA.
17. What blood-related disorders are particularly
common in the elderly?
Leukemia, pernicious anemia, and clotting
disorders are particularly common in the elderly.
SHORT ANSWER ESSAY
13. What is the blood volume of an average-sized
adult?
5-6 liters
14. Name as many different categories of substances
carried in plasma as you can.
Blood plasma contains over 100 different
solutes including nutrients, gasses, hormones,
wastes and products of cell activity, ions and
proteins. Some are electrolytes, albumin, globulins,
fibrinogen and gamma.
15. Define formed elements. Which category is most
numerous? Which makes up the buffy coat?
The formed elements are living blood cells.
The least numerous of the formed elements are the
leukocytes. The buffy coat in a hematocrit tube is
comprised of the white blood cells and platelets.
16. Define anemia, and give three possible causes.
Anemia is the bloods inability to carry oxygen.
1. Decrease in RBCs
2. Inadequate hemoglobin content in RBCs
3. Abnormal hemoglobin in RBCs
17. What is positive chemotaxis? What kind of motion
is involved in this?
Positive chemotaxis is a process that
respond to chemicals released from damaged cells,
it involves amoeboid motion, which they engulf
chemicals via pseudopodia.
18. Name the formed elements that arise from myeloid
stem cells. Name those arising from lymphoid stem
cells.
Myeloid Stem Cells- erythrocytes, platelets,
monocytes, neutrophils, eosinophils and
basophils
Lymphoid Stem Cells- lymphocytes
19. What is the function of platelets?
- The primary function of platelets is to prevent
hemorrhage from defects in the blood vessel wall
by forming an aggregate at the site of injury.
- In addition to primary hemostasis, platelets
participate in the reactions of blood coagulation,
inflammation and wound healing.
20. Describe the process of hemostasis. Indicate what
starts the process.
The process starts when a blood vessel is broken.
1. Vascular spasms occur which narrow the blood
vessel at the point it was broken.
2. Platelets swarm into the hole and stick to the
side of the broken blood vessel and each other
forming a platelet plug.
3. Coagulation events occur. Tissue factor is
released, interacts with phospholipid PH3.
Thrombin and fibrinogen form into long thread
like proteins that form a web and catch red blood
cells
21. What is the difference between a thrombus and an
embolus?
A blood clot that forms in an undamaged
vessel is called a(n) thrombus, and if it breaks
loose and travels through the bloodstream it is
called a(n) embolus.
22. What are agglutinins?
Antibodies in plasma bringing about
transfusion mismatch (targets RBC specifically)
23. What factors induce the red bone marrow to
produce leukocytes?
An infection triggers the red bone marrow
to produce more leukocytes, as a response.
24. What is a transfusion reaction? Why does it
happen?
A transfusion reaction involves
agglutination of foreign RBCs, leading to clogging
of small blood vessels, and lysis of the donated
RBCs. It occurs when mismatched blood is
transfused.
25. Explain why an Rh− person does not have a
transfusion reaction on the first exposure to Rh+ blood.
Why is there a transfusion reaction the second time he
or she receives the Rh+ blood?
There are no preformed anti-Rh antibodies
in his/her blood. After the first exposure to Rh
positive blood, the immune system reacts and the
starts making antibodies.
26. Why is phlebotomy often considered the most
important procedure for a medical laboratory?
 Phlebotomists collect blood for donation or
for testing, so the blood can be analyzed in a
clinical laboratory. Blood tests are used to
diagnose illness, evaluate the effectiveness of
medications and determine whether a patient is
receiving proper nutrition.
CRITICAL THINKING AND CLINICAL
APPLICATION QUESTIONS
27. Following a surgery for hip replacement, Albert has
been experiencing severe chest pain. He also feels
dizzy, sweats heavily, and coughs up blood often. What
is the likely diagnosis?
Pulmonary embolism (PE) is a serious,
potentially life-threatening complication of Deep
vein thromboembolism (DVT). commonly occurs
when part or all of a deep venous clot dislodges
from the vein where it originated, and is then
carried along with the venous blood flow through
the right chamber of the heart and into the
pulmonary arterial circulation, where it can
partially or completely block a branch of the
pulmonary artery. Typically, PE causes shortness
of breath, rapid breathing, rapid heart rate,
sweating, and chest pain.7 Some patients cough
up blood, while others faint.
28. A bone marrow biopsy of Mr. Lee, a man on long
term drug therapy, shows an abnormally high
percentage of nonhematopoietic connective tissue.
What condition does this indicate? If the symptoms are
critical, what short-term and long-term treatments are
indicated? Which treatment is he more likely to be
given: infusion of whole blood or of packed red cells?
This is indicative of aplastic anemia, as is
shows abnormally high percentages of
nonhematopoietic connective tissue, which is a big
symptom. Short-term effects may require a blood
transfusion, but if his condition worsens, he's
going to need a bone marrow transplant. Also, the
blood should be packed with RBCs because the
patient is hardly making any.
29. A woman comes to the clinic complaining of fatigue,
shortness of breath, and chills. Blood tests show
anemia, and a bleeding ulcer is diagnosed. What type
of anemia is this?
The symptoms that the woman is displaying
definitely make it iron-deficiency anemia. It's more
common in women, and the lack of iron in the diet
or slow/prolonged bleeding depletes iron reserves
that are needed for producing hemoglobin.
30. A patient is diagnosed with bone marrow cancer
and has a hematocrit of 70 percent. What is this
condition called?
They have a condition called polycythemia
vera, which is a condition that results from bone
marrow cancer. Polycythemia may result in being
out of breath.
31. A middle-aged college professor from Boston is in
the Swiss Alps studying astronomy. He arrived two
days ago and plans to stay the entire year. However,
he notices that he is short of breath when he walks up
steps and that he tires easily with any physical activity.
His symptoms gradually disappear; after two months,
he feels fine. Upon returning to the United States, he
has a complete physical exam and is told that his
erythrocyte count is higher than normal. (a) Attempt to
explain this finding. (b) Will his RBC count remain at
this higher-than-normal level? Why or why not?
He has secondary polycythemia, which can
result from bone marrow cancer, or can just
happen due to the increase in altitude. What
happens is that excessive numbers of RBCs are
increased blood viscosity, which causes it to flow
sluggishly in the body and impairs circulation. His
RBC count should decrease once he leaves the
Alps.
32. Why is someone more likely to bleed to death when
an artery is cleanly severed than when it is crushed and
torn?
A person is more likely to bleed to death
when an artery is cleanly severed, because there
isn't any more artery left, so there's lots of open
space and nowhere for the clotting process to
begin. Think of it like a garden hose - if it's cleanly
severed, lots of water flows through, but if it's
mangled, the water has a harder time getting
through.
33. What could be wrong with Linda’s newborn baby
whose skin has taken on a purplish-blue color?
The blue coloring is called cyanosis and is
often seen in babies with a heart defect, because
the heart cannot pump the oxygenated blood to the
rest of the body.
34. Shao-Mei and Elisha, who are good friends, decide
to donate blood. Shao-Mei discovers that her blood
group is AB Rh− and Elisha’s blood group is O Rh−.
Explain how Elisha could help Shao-Mei if she ever
needed a blood transfusion. Why cannot Shao-Mei
help Elisha in the same way?
Elisha's blood group is O Rh- which is
known as the universal blood type donor. O- blood
can be used by patients of any blood type. However,
patients like Elisha can only receive O- blood. That
is why Elisha could help Shao-Mei if ever she
needs a blood transfusion. On the other hand,
Shao-Mei's blood which is AB Rh- is known as the
rarest blood type and a universal blood type for
plasma. It can only be given to patients with a blood
type of AB- and AB+. Patients with AB- blood type
can only receive from AB-, O-, A-, and B- blood.
Additionally, blood types are defined as the
classification of blood. It is based on the presence
or absence of inherited antigenic substances on
the surface of red blood cells (RBCs). Hence, since
Shao-Mei's blood cannot donate to patients that
have O - blood type in that way she became unable
to help Elisha.
35. Mr. Malone is going into shock because of blood
loss, so paramedics infuse a saline solution. Why
would this help?
Saline infusion temporarily replaces the
lost blood volume, thereby helping to restore Mr.
Malone's circulation.
 CARDIOVASCULAR SYSTEM 10. What does the term cardiac output mean?

DID YOU GET IT?

CO = amount of blood pumped out by each side of
the heart in 1 minute.
1. What is the location of the heart in the thorax?

11. What would you expect to happen to the heart rate

The heart is in the mediastinum between the
of an individual with a fever? Why?
lungs.

Fever increases the heart rate because the rate of

2. Which heart chamber has the thickest walls? What
metabolism of the cardiac muscle increases.
is the functional significance of this structural
difference?
12. What is the most important factor affecting stroke
volume?
The left ventricle has the thickest walls.
This reflects its function, which is to pump blood
Venous return.
through the whole body.

13. Assume you are viewing a blood vessel under the

3. How does the function of the systemic circulation
microscope. It has a large, lopsided lumen, relatively
differ from that of the pulmonary circulation?
thick tunica externa, and a relatively thin tunica media.
Which kind of blood vessel is this?
Pulmonary circulation strictly serves gas
exchange. Oxygen is loaded and carbon dioxide is
It is a vein.
unloaded from the blood in the lungs. Systemic
circulation provides oxygen laden blood to all body
14. Arteries lack valves, but veins have them. How is
organs.
this structural difference related to blood pressure?
4. Why are the heart valves important?
Blood pressure in veins is much lower than
that in arteries because veins are farther along in
Heart valves keep blood flowing in one direction
the circulatory pathway. Hence, veins need extra
through the heart.
measures to force blood back to the heart.
5. Why might a thrombus in a coronary artery cause
15. How is the structure of capillaries related to their
sudden death?
function in the body?
The coronary arteries supply the
Capillary walls consist only of the
myocardium (cardiac muscle) with oxygen. If that
innermost intima layer, which is very thin.
circulation fails, the heart fails.
Capillaries are the exchange vessels between the
blood and tissue cells; thus, thin walls are
6. What is the function of the intrinsic conduction
desirable.
system of the heart?
16. In what part of the body are the femoral, popliteal,
The intrinsic conduction system of the
and arcuate arteries found?
heart coordinates the action of the heart chambers
and causes the heart to beat faster than it would
Lower limb.
otherwise.

17. In what part of the body are the axillary, cephalic,

7. To which heart chambers do the terms systole and
and basilic veins located?
diastole usually apply?

Upper limb.
Left ventricle

18. Which vessel the hepatic portal vein, hepatic vein,

8. During isovolumetric contraction of the cardiac cycle,
or hepatic artery has the highest content of nutrients
which chambers are relaxing, and which are
after a meal?
contracting?

Hepatic portal vein.

The atria are relaxing, and the ventricles are
contracting
19. In what two important ways is the pulmonary
circulation different from the systemic circulation?
9. What causes the lub-dup sounds heard with a
stethoscope?
The pulmonary circulation is much shorter
and requires a less powerful pump than the
The operation of the heart valves
systemic circulation does. Pulmonary arteries
carry oxygen-depleted/carbon dioxide– rich blood,
whereas the pulmonary veins carry oxygen-
rich/carbon dioxide– depleted blood. The opposite
is true of the arteries and veins of the systemic
circulation.
20. Which artery is palpated at the wrist? At the groin?
At the side of the neck?
Radial artery at the wrist; femoral at the groin;
common carotid at the side of the neck.
21. How does blood pressure change throughout the
systemic circulatory pathway?
It decreases from heart to venae cava.
22. What is the effect of hemorrhage on blood
pressure? Why?
Hemorrhage reduces blood pressure initially
because blood volume drops.
23. Would you expect fluid to be entering or leaving the
capillaries at the venous end of a capillary bed?
Fluid enters the capillary bed at its venous end.
SHORT ANSWER ESSAY
19. Draw a diagram of the heart showing the three
layers composing its wall and its four chambers. Label
each. Show where the AV and semilunar valves are,
and name them. Show and label all blood vessels
entering and leaving the heart chambers.
20. Trace one drop of blood from the time it enters the
right atrium of the heart until it enters the left atrium.
What is this circuit called?
Blood that enters the right atrium on its way to the
left atrium is in the pulmonary circuit.
21. What is the function of the fluid that fills the
pericardial sac?
The fluid in the pericardial sac allows the
heart to beat in a relatively frictionless environment,
and to reduce friction during heart activity.
22. Define systole and diastole.
Systole is contraction of the muscle while diastole
is relaxation of the muscle.
23. Define stroke volume and cardiac cycle.
Stroke Volume- a volume of blood ejected by a
ventricle during systole.
Cardiac Cycle- sequence of events encompassing
one complete contraction and relaxation of the
ventricles and atria.
24. How does the heart’s ability to contract differ from
that of other muscles of the body?
Cardiac muscles can contract spontaneously and
independently of nervous stimulation.
25. Name the elements of the intrinsic conduction
system, in order, beginning with the pacemaker.
The elements of the intrinsic conduction
system of the heart, beginning with the pacemaker,
are: the SA node or pacemaker, AV node, AV
bundle, right and left bundle branches, and
Purkinje fibers.
26. Which system is responsible for decreasing heart
rate after a crisis has passed?
Parasympathetic Nervous System
27. What is congestive heart failure? What is the
difference between pulmonary congestion and
peripheral congestion?
Congestive heart failure (CHF) is a clinical
condition in which the heart is unable to pump
enough blood to meet the metabolic needs of the
body because of pathological changes in the
myocardium. The three main causes of CHF are
coronary artery disease (CAD), diabetes mellitus,
and hypertension
• Pulmonary congestion is defined as
accumulation of fluid in the lungs, resulting
in impaired gas exchange and arterial
hypoxemia.
• Peripheral arterial disease (PAD) is a known
comorbidity of CHF and is associated with
worse morbidity and mortality.
28. Describe the structure of capillary walls.
Capillary walls are composed of a single
layer of cells and a basement membrane. This thin
structure permits the exchange of nutrients and
wastes between blood and tissue cells. They are
essentially just the tunica intima (endothelium plus
the basement membrane); They are exceedingly
thin.
29. How is blood supply to the myocardium organized?
The coronary arteries provide the main
blood supply to the heart. The coronary arteries
also supply the myocardium with oxygen to allow
for the contraction of the heart and thus causing
circulation of the blood throughout the body.
30. Name three factors that are important in promoting
venous return.
The presence of valves, the milking action
of skeletal muscles against the veins as the
muscles contract, the respiratory pump (pressure
changes in the thorax during breathing)
31. Arteries are often described as vessels that carry
oxygen-rich blood, and veins are said to carry oxygen-
poor (carbon dioxide–rich) blood. Name two sets of
exceptions to this rule that were discussed in this
chapter.
-Pulmonary Arteries: Carry oxygen-poor blood
-Pulmonary veins: Carry oxygen-rich blood
-Umbilical Arteries: Carry oxygen poor blood from
the fetus
-Umbilical Veins: Caries oxygen rich blood to the
fetus
32. Trace a drop of blood from the left ventricle of the
heart to the wrist of the right hand and back to the heart.
Now trace it to the dorsum of the right foot and back to
the right heart.
Wrist: Blood starts in the left ventricle and exits
into the arch of the aorta. From here it enters the
brachiocephalic artery and then the right
subclavian artery. As it travels through the armpit
and into the upper arm the blood passes from the
subclavian to the right axillary and then right
brachial arteries. Last, the blood flows through the
right ulnar artery until it reaches the wrist. To get
back to the heart the blood would first travel
through the right ulnar vein and then to the right
brachial veins. Like with the arteries, the brachial
veins turn into the right axillary and subclavian
veins and finally reach the right brachial cephalic
vein. Lastly the blood would enter the superior
vena cava and reenter the heart in the right atrium.
Foot: Blood would leave the left ventricle and enter
the arch of the aorta, and then continue
descending through the thoracic and abdominal
aortas. Finally, around the level of L4 the blood
would branch off into the right common iliac artery
and then continue on to the right external iliac
artery. The blood would next travel through the
right common femoral artery and the superficial
femoral artery until it reached the right popliteal
artery. From here it would split off into the right
anterior tibial artery and finally would reach the
dorsum of the foot via the right dorsalis pedis
artery. The blood would then return to the heart via
the arterial tibial veins which empty into the right
popliteal vein. Blood then travels to the right
femoral vein, the right external iliac vein and the
right common iliac vein. This then merges with the
left common iliac vein to form the inferior vena
cava which empties into the right atrium.
33. What is the function of the hepatic portal
circulation? In what way is a portal circulation a
“strange” circulation?
The hepatic portal circulation functions to
ensure that all blood draining the digestive system,
and carrying nutrients from a recently digested
meal, will pass through the liver before entering the
rest of the circulation. This circulation is strange
because it consists of veins feeding the capillaries
of an organ which is usually a job of the arteries.
34. In a fetus, the liver and lungs are almost entirely
bypassed by blood. Why is this? Name the vessel that
bypasses the liver. Name two lung bypasses. Three
vessels travel in the umbilical cord; which of these
carries’ oxygen- and nutrient-rich blood?
In fetus, liver and lungs are nonfunctional (the liver
relatively so). Ductus venosus bypasses the liver.
Ductus arterioles & foramen ovale bypass the
lungs. The umbilical vein carries nutrient-rich &
oxygen-rich blood to the fetus through the
umbilical cord.
35. Define pulse. Palpate your pulse. Which pulse point
did you use?
Pulse: The extension and recoil of an artery that
occur with each heartbeat.
• Arterial Pulse Points: Temporal artery,
facial artery, common carotid artery,
brachial artery, radial artery, femoral artery,
popliteal artery, posterior tibial artery, and
dorsalis pedis artery
36. Which artery is palpated at the inner elbow? At the
dorsum of the foot?
• Inner Elbow- Brachial artery
• Dorsum of the foot- Dorsal pedis artery
37. Define systolic pressure and diastolic pressure.
-Systolic Pressure: Pressure exerted by blood on
the arterial walls during ventricular contraction.
-Diastolic Pressure: Pressure exerted by blood on
the arterial walls when the ventricles are relaxing
(during diastole).
38. Which part of the nervous system plays an
important role in regulating blood pressure? By which
action does it increase blood pressure?
 The autonomic nervous system regulates
blood pressure via several mechanisms. It
regulates the degree of constriction or dilation of
the blood vessels in body. Constriction of the
blood vessels will result in an increase in the blood
pressure and dilation of the blood vessels will
result in a decrease in the blood pressure.
39. In which position—sitting, lying down, or standing—
is the blood pressure normally highest? Lowest?
Explain why.
Highest: In the recumbent position (lying down)
Lowest: Immediately after standing up
The sympathetic nervous system quickly
compensates in healthy individuals. Often, you can
become hypotensive after sitting for an extended
period of time.
40. Microcirculation is the flow of blood through a
capillary bed consisting of a vascular shunt and true
capillaries. What is the difference between a vascular
shunt and a true capillary?
Vascular shunt - mechanism to divert blood fluid,
consists of a metarteriole & thoroughfare channel
True capillaries - 10-100 capillary branches off a
metarteriole delivering blood to local tissues,
merge at thorough fare channel.
41. What are varicose veins? What factors seem to
promote their formation?
Veins that become twisted & dilated
because of incompetent valves. Inactivity (lack of
skeletal milking activity against the veins) allows
the blood to pool in the lower extremities .
Increased pressure that restricts venous return
(ex: pregnancy & obesity)
42. Explain why blood flow in arteries is pulsatile and
blood flow in veins is not.
Blood flow in arteries is pulsatile because it
is under greater amount of pressure compared to
veins. Arteries are located closer to ventricles, so
their walls must be capable of expanding and
contracting under the changes in pressure when
the ventricles contract.
When blood reaches veins, the pressure is
very low, and so instead of veins having a pulsatile
ability to maintain pressure, they instead have
valves to prevent backflow.
43. What is the relationship between cross-sectional
area of a blood vessel and velocity (speed) of blood
flow in that vessel?
Blood flow is inversely proportional to
resistance. Increase in cross-sectional area causes
the velocity of blood flow to decrease.
44. Which type of blood vessel is most important in
regulating vascular resistance, and how does it achieve
this?
Arterioles are blood vessels that are most
important in regulating vascular resistance. These
vessels can constrict as result of activity from the
sympathetic nervous system, which alters blood
pressure.
45. What is the foramen ovale, and what is its function?
The foramen ovale is an aperture in the
muscular tissue between the left and right atrium
that allows blood to cross the atria and bypass
pulmonary circulation during fetal development.
CRITICAL THINKING AND CLINICAL
APPLICATION QUESTIONS
46. John is a 30-year-old man who is overweight and
smokes. He has been diagnosed with hypertension
and arteriosclerosis. Define each of these conditions.
How are they often related? Why is hypertension called
the “silent killer”? Name three changes in your lifestyle
that might help prevent cardiovascular disease in your
old age.
Hypertension: High blood pressure;
Arteriosclerosis- hardening of arteries
Relation: arteriosclerosis is caused by
hypertension. People who have high blood
pressure are more likely to have coronary artery
disease.
Hypertension is called the “Silent Killer”
because it has no obvious symptoms to indicate
that something is wrong.
Three Changes: exercise, proper sleep,
don't smoke
47. Following a viral infection, George has been feeling
a sharp stabbing pain in the retrosternal region. The
pain gets worse when he breathes deeply and also
when he lies down. A physical examination reveals that
he has pericarditis. Can you explain why pericarditis
causes this severe pain?
Pericarditis causes severe pain because
our heart was rubbing against the infected layers
of our pericardium.
48. Hannah, a 14-year-old girl undergoing a physical
examination before being admitted to summer camp,
was found to have a loud heart murmur at the second
intercostal space on the left side of the sternum. The
murmur takes the form of a swishing sound with no
high-pitched whistle. What, exactly, is producing the
murmur?
Heart murmur caused by the bicuspid valve
49. Colin is in the hospital to have a coronary
angiography so that a possible coronary stenosis can
be detected. A catheter is inserted through the right
radial artery. What route must the catheter travel to
reach the coronary arteries?

The catheter must be inserted from the right

groin or wrist, then the catheter will travel to the
heart, until it reaches to the coronary arteries,
where it will be detected by the angiograph.

50. Stuart, a 49-year-old man, has been diagnosed

with coronary artery disease. He needs a bypass graft
in his circumflex artery and right coronary artery. Which
parts of his heart muscle are most likely to see an
improved blood flow after the procedure?

ischemic myocardium

51. Mr. Grimaldi was previously diagnosed as having a

posterior pituitary tumor that causes hypersecretion of
ADH. He comes to the clinic regularly to have his blood
pressure checked. Would you expect his blood
pressure to be chronically elevated or depressed?
Why?

His blood pressure should be chronically

elevated because hypersecretion of ADH causes
excess water retention by the kidneys, leading to
perpetually high blood pressure.

52. Grandma tells Hailey not to swim for 30 minutes

after eating. Explain why taking a vigorous swim
immediately after lunch is more likely to cause
indigestion than cramping of your muscles.

Cramping is caused by dehydration, lack of

sodium or potassium. In this sense, eating has
nothing to do with cramping.

53. The guards at the royal palace in London stand at

attention while on duty. On a very hot day, it is not
unusual for one (or more) to become lightheaded and
faint. Explain this phenomenon.

When they stand all day without moving

their leg muscles, blood pools in their lower limb
veins and cannot adequately return to the heart. If
it is a very hot day and they are additionally losing
volume via sweat, it is possible they will not be able
to pump enough blood up to adequately perfuse
their brains which causes them to become light-
headed and faint.