Au xl

MUSCULAR SYSTEM
Match the words with the definitions:

gastrocnemius; Achilles tendon; bursal talocrural joint; malleolus; plantarflexion; calcaneusl hyaline cartilage; greater trochanter; piriformis; greater sciatic notch; z1-gomatic bone; internal auditory meatusl pectoialis major; ribs; deltoid muscle; teres major; Iatissimus dorsi; suprascapular notch; foramen; humerusl clavicle; sternum; deltoid tuberosity; ilium; gruteus maximusl tibia; fibura; liopsoas; coccyx; cruciform ligaments (cruciate ligaments) l)opening 2)is a long bone in the arm or forelimb that runs from the shoulder to the elbow 3)provides a cushion between bones and tendons and/or muscles around joint a 4)muscle that is in the back part of the lower leg and also called the calf 5)rynovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb *ith the proximal end of the talus bone in the foot 6)makes up a large portion of the shape and appearance of the buttocks IF thicl-r fan-shaped muscle. situated at the chest t)*ankbone; shinbone 9!he muscle forming the rounded contour of the shoulder l0)heel bone I llLe r-enual ends of ribs: in the larynx, trachea, and bronchi; and on the articular sJrfaoe of bones 1?icalf Lnne 13) is tre flnovement rltich increases the approximate 90 degree angle between the front pat of&e ibor ad the shin l4}arm"sc1e in tre glural regon of the lower limb quadrilderal eminence and a part of the skeletal system lll@ r=gule6e plauurir gasEocnemius (calf) and soleus muscles to the calcaneus -!ftrac+ps

tleefrtte

iirsitufuqaimtos"rds

itid

lftbe Weqn rrr aad tegEst bone of the pelvis hfuPEfiurs bone ofthe temporal bone of the skull
the middle and inner ear

that carries nerves from

shwred im a foramen by the sacrospinous ligament

lIk&etboae. malarf6ag

I9trhrranefurfrebonl'prominence on each

side of the ankle

]3hd iEGE lfieral part of the upper border of the scapula, just next to the base of &m*tprocss S{Fdeofthe Slnolhbme
S$Fftlmgorrved
SSFElrEEr- fla,
bones which form the ribcage upper limb and one of six scapulohumeral muscles dorso-lateral muscle on the trunk, posterior to the arm

lSffreas$one 2t|freregion on the shaft of the humerus to which the deltoid muscle attaches 3g)dffid hip muscles or inner hip muscles

30)tailbone 31)pairs of ligaments arranged like a letter X

iI.

Complete the sentences in a suitable way:

l. ... is a space or shallow depression located at the back of the knee-joint. 2. . are the string-like tendons felt on either side of the back of the knee. 3. . forms the lower and back part of the hip bone (os coxae). 4. ... are layers of flat broad tendons. They have a shiny, whitish-silvery color, and
,. ..

5. 6.
7

histologically similar to tendons . an adjective that means of or pertaining to the abdominal segment of the torso, between ihe diaphragm and the sacrum or lower spine ... the largest and the most superficial (outermost) of the three flat muscles of the
are
..

lateral anterior abdomen. . . . is the superior border of the wing of ilium and the superolateral margin of the greater pelvis. 8. ... is a paired muscle running vertically on each side of the anterior wall of the human abdomen 9. . . . is formed by the aponeuroses of the Obliqui and Transversus. It contains the Rectus abdominis and Pyramidalis muscles. 10. ... is the midline carlilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia 1 L . . . is a layer of dense irregular connective tissue which surrounds the cartilage of developing bone. It consists of two separate layers: an outer fibrcus layer anC inner chondrogenic layer. 12. .. . is a hyaline cartilage plate in the metaphysis at each end of a long bone. 13. ... is the wider portion of a long bone adjacent to the epiphyseal plate.It is this part cf the bone that grows during childhood; as it grows, it ossifies near the diaphysis and the epiphyses. 14. ... a state in which muscles are floppy, lacking their normal elasticity. 15. ... is the wasting away of a normaliy developed organ or tissue due to degeneration of cells. In the case of muscle tissue, the individual muscle fibers decrease in size due to a progressive loss of myofibrils 16. .. . is prolonged painful involuntary. contraction of skeletal muscle. 17 . ... is inflammation of fibrous connective tissues in muscles. It often affects the muscles of the trunk and back. 18. ... is inflammation of muscle fibers 19. ... represents a sustained involunrarl'rnuscriar contraction (which may occur either as part ofa generaiized disorder sucl a: s:as:ic paralysis, or as a local response to an othenvise unconnected pai:^ui co:iiiion. i 20. ... represents muscular h1-pertonicitl'{i.e. a: :i;:e-e i:-:ie srate of readiness of muscle fibers to contract: an increase in pa::t:- c::-:1:-:: ','. ;:h an increased resistance to stretch. \loderate cases shou'ir-ci'=:-;:-: ::;---:-:: ::eat effort and a lack of normal coo:cinaiion. rrhi:e sii::: c.-.:. s:-:'.,. a]-:::=:::=: ::-,:r ements that are coordinated.

---t:=:.-. :;-l-: :- --'' 3:Si:etChing' the - la -: ''" -:,--:= -: =:.-s:.e. resulting in pain and swelling of

.: Dermanent loss of blood supply to the '3r'ne -.:.: tissue dies and the bone collapses' : :-: : -:. "' ,..:: : l:-r e\pands due to abnormal development of

i-

'::::.: :.::osis. or ischemic bone necrosis is a

-=:-..:,::1,

-- -:, -:,:. :: :iore. of the following:uneven growlh of

= _=-- --.,-.\

- : --:r:-: -- '.i:-;: one (or more) of the parathyroid glands --: : --:-:',1--.1l-Jlrilone. $'hich can result in the loss of bone

: - - ::,: : --:::\\'omen. - :: ::.: -.-::::r for an infection in abone. Infections can reach abone'r'' ::; : :: :-:- -:: ;our bioodstream or spreading from nearby tissue' Infectiois ;: * . :.. . - =. bone itself if trauma exposes your boneto germs' Bone : :-:- :. :-=-:--'li1' affect the long bones ofyour body, such as your leg'0"::s jr : -:::: a-- :-rne. as well as youf spine and pelvis' to fractures and det-o::::-:-- . ::-:::--:lant

: ::. ' i-.-i,= :,: bones in children potentially leading t: i :-- ---: :3 most frequent childhood diseases in many developing coun::lc.
cause is a vitamin D deficiency

Osteogenesis imperttc:a: Bursitis: Avascular necrosis; Fibrous dysplasia: Osie:=:----, Osteoporosis: Ricke',s: Primarl'h1'perparathyroidism; Paget's disease; Rheuma:.--:

Arthritis ; O steoml'e1 iti s

CARDIOVASCULAR SYSTEM
I Match the terms of the left with the right definition on the right:
Angioiogy 2. Aortopathy
1.

a)disease

ofan

aorta

b)stone within a vein

3. Endoarterectomy

4. Venogram
5. Phlebolith

c)X-ray picture of a vein d)removing fatty deposits on an artery e)study of blood vessels and lymphatics
f)movements of the heart g)the heart muscle h)disease ofthe heart i)pain in the heart

6. Cardialgia 7. Cardiograph 8. CardiomyophathY

9. Myocardium 10. Cardiomotility 11.

j)instrument for recording heart beat k)surgical correction by cutting part of a

heart valve

Valvotomy

12. Vasculitis

i3. CardiovalvulotomY
14. Angiogram

l5.Angiosclerosis
16. Dextrocardia 17. PhonocardiograPhY 18. Endocarditis 19. Pericardium

l)incision into a valve m)hardening of blood vessels n)inflammation of blood vessels o)X-ray picture of blood vessels p)surgical repair of heart valve r) inflammation inside heart (lining) s)recording heart sounds t)condition of right heart u)membrane sac around the heart

20. Valvoplasty

II Match the technical term on the left with the definition on the right:
Heart phlebo-

Aorta Vein Blood cloot Blood

thromboaortocardiohaem(at)-

III

Give the medical term of the following conditions:

paralysis of the heart abnormal softening of the bones

1. 2.

3.
4. 5. 6.

1 8.
9. 10.

11.

12.
13.

14.
15.
16.

congenital condition in which some teeth are missing abnormal condition where the heart is located towards the right side of the chest surgical removal of the uterus surgical creation of an opening through the abdominal wall into the stomach near the pylorus painful sensations in the tongue blood poisoning caused by bacterial toxic substances in the blood the presence of stones (calculi) in the kidney inflammation involving both the brain and the spinal cord persistent watery mucus discharge from the nose beneath the skin surgical repair of the jaw surgical puncture to remove fluid from the chest cavity pertaining to the neck and the arms drooping of an upper eyelid

IV. Give the adjective of the following: Neurosis; epilepsy; pleurae; larynx; ovary;brachim; meninges; lymph; nerve;
anastomosis ; dyspnea; pectus ; auris ; haemorrhagia; schizophren i a

V. Fill the gaps with the right word:

a). ...is the property of a system, either open or closed, that regulates its internal environment and tends to maintain a stable, constant condition. b). ...play a fundamental role in hemostasis and are a natural source of growth factors. c). ... is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids, formed in the small intestine. d)....is on the right side of the heart, between the right atrium and the right ventricle. e). . . . is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart. 0.... is a phase of the cardiac cycle where the myocardium is contracting in a coordinated manner in response to an endogenous electrical stimulus, and pressure is being generated within the chambers of the heart driving blood flow. g)....is the impulse-generating (pacemaker) tissue located in the right atrium of the heart, and thus the generator of sinus rhythm. It is a group of cells positioned on the wall of the right atrium, near the entrahce of the superior vena cava. h). . .. is a network of streams that both branch out and reconnect, such as blood vessels or leaf veins. i). . . . is the system of blood vessels that link the hypothalamus and the anterior pituitary in the brain. j) . . . . i, the proportion of blood volume that is occupied by red blood cells. k).... is a young cell of the granulocytic series, occurring normally in bone marrow, but not in circulating blood. l). ...is the thickening and stiffening of heart muscle'

the heart;
heart.

m). There are three types of heart infections:. . . which affects the tissue surrounding '.. which affects the muscular middle layer of the walls of the heart; ...which affects the inner membrane that separates the chambers and valves oiyor.

throat. p). ... is a type of abnormal heart rhythm -also known as an arhythmia. r)..... can be found on the legs and face. They can cover either a small or
SKlN.

n).... is a slower than normal heart rate (fewer than 60 times a minute). o). . ' 'disease is also called mucocutaneous lymph node syndrome because it also affects lymph nodes, skin, and the mucous membranes inside the mouth, nose and

large area

of

s)....are enlarged veins that can be flesh-colored, dark purple, or blue. They often look Iike cords, and appear twisted and bulging. They are swolien and raised above the surface of the skin.

RESPIRATORY SYSTEM
I. Fill the gaps with the right word:
a).... is a passage of airway in the respiratory tract that conducts air into the lungs. '.. are the first airway branches that no longer contain cartilage. They are braiches of the bronchi. c). . . . is an anatomical structure that has the form of a hollow cavity, found in the lung. d)' .. are air-filled spaces, communicating with the nasal cavity, within the bones of the skull and face. e).... is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface ofthe soft palate; it differs from the oral and laryngeal parts ofthe pharynx in that its cavity always remains patent (open). f).... opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the two palatine arches, is the palatine tonsil. g). The anterior border of the right lung is almost vertical, and projects into the costomediastinal sinus; that of the left lung presents, below, an angular notch, the..., in which the pericardium is exposed. h). ... is a serous membrane which folds back upon itself to form a two-layered, membrane structure. It has an outer layer (parietal) and an inner one (visceral). i). . ' . is a flap of elastic cartilage tissue covered with a mucus membrane, attached to the root of the tongue. It projects obliquely upwards behind the tongue and the hyoid bone, pointing dorsally. j).... is the conic projection from the posterior edge ofthe middle of the soft palate, composed of connective tissue. k).. .. are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation. l)...' is a sheet of internal muscle that extends across the bottom of the rib cage, separates the thoracic cavity (heart, lungs & ribs) from the abdominal cavity and perfoins an important function in respiration.
b).

m).... is a hole in the diaphragm through which the esophagus passes. It is located in the
right crus of the diaphragm. n)-.... is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. o) , . . .1s the specialty that deals with diseases of the lungs and the respiratory tract. It is called chest medicine and respiratory medicine in some countries and areas. p). . .. is a muscle of the human body which runs from the chin to the tongue; is the major muscle responsible for protruding (or sticking out) the tongue' r). The action of the anterior and middle ...is to elevate the first rib and rotate the neck to tire same side; the action of the posterior . . . is to elevate the second rib and tilt the neck to the opposite side. s). These nerves provide the only motor supply to the diaphragm as well as sensation to the central tendon. In the thorax, each .,.supplies the mediastinal pleura and pericardium. t), . ,.is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. At rest, it lies at the level of the base of the mandible in the front and the third cervical vertebra behind.

II.

Match the terms of the left with the right definition on the right:
1).incision into the oesoPhagus 2).instrument to view the oesophagus 3).removal of the oesophagus 4).pain in the oesophagus S).inflammation in the oesoPhagus
6). pain in the pleura 7). incision in the chest 8). instrument for viewing the

a). Oesophagoscope b). OesophagectomY c). Oesophagotomy

d). Oesophagitis e). Oesophagalgia f). Phrenohepatic g). Pleuritis (pleurisy) h). Pleurodynia

i). Pharyngoscope j). Thoracotomy

k). Bronchus l). Bronchogenic m). Bronchoplegia n). BronchoesophagostomY o). Broncomycosis

pharynx 9). relating to the diaPhragm 10). inflammation of the ribs and side 1l).fungi in bronchi 12).windpipe 13).originating in bronchi 14).paralysis of bronchi
and {S).opening between oesophagus bronchi L6). incision on the trachea

p).Rhinoplasty r). Tracheotomy s). TracheostomY t). Pneumonosis u).Rhinorrhoea

17).surgical repair of the nose 18).discharge from nose L9).operation to maintain airways 20).disease of lungs

m.

Match the technical term on the left with the definition on the right: -agogue Condition of pain

inside/within Inducing/stimulating Straight Around

ortho-dynia -periendo-

IV. Give the disease that best fits the description: L is a contagious, viral infectious disease of the upper respiratory system, caused
2. 3.
primarily by rhinoviruses and coronaviruses. is a type of pneumonia associated with bacterial infection. is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream. 4. is a chronic inflammation of the bronchi (medium-size airways) in the lungs; s defined clinically as a persistent cough that produces sputum (phlegm) and mucus. 5. is a long-term, progressive disease of the lung that primarily causes shortness of
breath.

6.

7.
8.

is a predisposition to chronic inflammation of the lungs in which the airways (bronchi) are reversibly narrowed. shortness of breath), also called shortness of breath (SOB) or air hunger, is a debilitating symptom that is the experience of unpleasant or uncomfortable

respiratory sensations, also known as diffuse parenchymal lung disease (DPLD), refers to a group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs) 9. is a medical condition and potential emergency wherein air or gas is present in the pleural cavity (chest). 10. is fluid accumulation in the lungs. I f . is inflannnnation of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). 12. is the most common congenital deformity of the anterior wall of the chest , in which several ribs and the sternum grow abnormally. 13. is a term for suspension of external breathing. 14. is characterized by rapid breathing. 15. refers to an abnormally slow breathing rate. 16. is normal, good, unlaboured ventilation, sometimes known as quiet breathing or resting respiration. 17. is shortness of breath (dyspnea) which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. 18. the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs. 19. is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded. 20. inflammation of the two layers of the pleura.

NERVOUS SYSTEM

I.

Fill the gaps with the right word: Are almond-shaped groups of nuclei located deep within the medial temporal lobes of the brain in complex vertebrates, including humans. 2. One of the most important functions of the it is to link the nervous system to the endocrine system via the pituitary gland (hypophysis). 3. Is an endocrine gland about the size of a pea and weighing 0.5 g. 4. Is a structure located on the brain stem. It is superior to (up from) the medulla oblongata, inferior to (down from) the midbrain, and rostral to (in front of; the cerebellum. 5. Is one of the two components of the central nervous system and consists mostly of myelinated axons. 6. Is a major component of the central nervous system, consisting of neuronal cell bodies, neuropil (dendrites and both unmyelinated axons and myelinated axons), glial cells (astroglia and oligodendrocytes) and capillaries. 7. Contains the cardiac, respiratory, vomiting and vasomotor centers and deals with autonomic functions, such as breathing, heart rate and blood pressure. 8. Consist of three layers: the dura mater, the arachnoid mater, and the pia mater. 9. Comprises the tectum (or corpora quadrigemini), tegmentum, the ventricular mesocoelia (or "iter"), and the cerebral peduncles, as well as several nuclei and fasciculi. 10. Are a group of nuclei in the brains of vertebrates, situated at the base of the forebrain and strongly connected with the cerebral cortex, thalamus and other

1.

areas. 11. Is a clear

bodily fluid that occupies the subarachnoid space and the ventricuiar system around and inside the brain. In essence, the brain "floats" in it. 12. Extends through the jugular foramen, then passing into the carotid sheath behveen the internal carotid artery and the internal jugular vein down below the head, to the neck, chest and abdomen, where it contributes to the innervation of the viscera. 13. Is a structure that permits a neuron to pass an electrical or chemical signal to another cell. 14. is the interval between the arachnoid membrane and pia mater. 15. Is the outermost part of the spinal canal.

il.
aden

Match the common name with the medical one:

bile ribs bladder,sac
sugar

anglo arterio arthro cardio cephal cerebro chem chole colo

skin
intestine drug among the people gland
red

III. FiII in the blankwith the appropriate suffix'

1. pain 2. inflammation

3. tumor

4. stoppage
5. urine 6. poisonous

7. fear 8. condition of 9. hardening 10. destruction

1i.

sensation

12. breathing 13. pertaining to 14. enlarged

15. surgical rePair

16. softening 17. a disease 18. blood

i9. enzYme
20. vomit

the description: IV.Give the name of the disorder that best fits
of the facial nerve causing weakness of the 1.A form ofNeuritis that involves paralysis

*ur.t.rofonesideofthefaceandaninabilitytoclosethe-eye'

reiulting from damage to the brain 2. A nonprogressive disorder of movement

before,during, or immediately after birth' middle age and disease of the motor system occurring in 3. A progre.rir" A.g.r;il .uurirg muscle weakness and wasting'

10

4' A chronic disease of the nervous system that can affect young and middle-aged adults. The course of this illness usually involves recurrent relapses followed by remissions, but some patients experience a chronic progressive course. 5' A condition characterized by extreme disabling fatigue that has lasted for at least six months, is made worse by physical or mental exeition,-does not resolve with bed rest, and cannot be attributed to other disorders.
6.

A severe burning or stabbing pain often following the course of a nerve.

7. Inflammation of the nerves, which may be painful.

8. Tremor,

rigidity and poverty of spontaneous movements.

9' Pain felt down the back and outer side of the thigh, leg, and foot. The back is stiff and painful. There may be numbness and weakness in ttre tei.

l0' Is a genetic nervous system disorder that

causes tumors to grow around nerves.

ENDOCRII\E SYSTEM
Insert the right words into the gaps: ' is the set of metabolic pathways thationstruct molecules from smaller units. . is a roughly 24-hour cycle in the biochemical, physiological or behavioural processes of living entities. 3' '..are recurrent periods or cycles repeated throughout aZ4-hour circadian day (used in sleep studies). 4. . ' . is the amount of energy expended while at rest in a neutrally temperate environment, in the post-absorptive state (meaning that the di[estivl system is inactive, which requires about twerve horrs of faJng in humins). 5. ' ' ' is a branch of medicine dealing with disorder of the endocrine system and its specific secretions called hormones. 6. " 'are glands that secrete their products (excluding hormones and other chemical messengers) into ducts (duct glands) which lead directly into the external

I. 1' " 2' ' '

environment. .. 'are paired almond-shaped glands, one for each eye, that secrete the aqueous layer of the tear film. 8. . ' . are glands of the endocrine system that secrete their products, hormones, directly into the blood rather than through a duct. 9. This gland is found in the neck, inferioito 1b.low) the thyroid cartilage (also known as the Adam's apple) and at approximately the same level as the cricoid cartilage. 10. ...are cells that release a hormone into the circulating blood in response to a neural stimulus.
7.

I1

I 1 . Situated along the perimeter of the adrenal gland, the . . . mediates the stress response through the production of mineralocorticoids and glucocorticoids, including aldosterone and cortisol respectively.

small endocrine gland in the vertebrate brain. It produces melatonin, a hormone that affects the modulation of wake/sleep patterns and photoperiodic (seasonal) functions. Exocrine glands; ultradian rhythms; thyroid; anabolism; adrenal cortexl circadian rhythm; endocrinology; pineal gland (also called the pineal body, epiphysis cerebri, epiphysis or the "@9re");endocrine glands; basal metabolic rate; lacrimal glands; neuroendocrine cells
12. Is a

II.Give the disorder that best fits the description: L.Also called a bronchocele, is a swelling in the thyroid gland, which can lead to a swelling of the neck or larynx (voice box). 2. Is the absence of a menstrual period in a woman of reproductive age. 3. Is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with the biological sex they were born with). 4. Is a medical term for decreased functional activity of the gonads 5. Term used to describe ambiguous genitalia and gonadal mosaicism in individuals of gonochoristic species, especially human beings. 6. Is decreased function ofthe parathyroid glands, leading to decreased levels of
parathyroid hormone. 7. Is a syndrome that results when the pituitary gland produces excess groMh hormone after epiphyseal plate closure at puberty. 8. Is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the latter.

m.
A.
1.

Match the medical terms with the explanations:

a). bacteria in blood

hypervolaemia 2. hypoxaemia 3. vasculitis 4. bacteraemia 5. toxaemia

B

b). blood vessel inflammation c). blood poisoning d).increase in blood volume e). blood oxygen deficiency
a). muscle inflammation b). bile duct inflammation c). bone inflammation d). brain inflammation e). inflammation of the space behind the nose
a). visual examination of the stomach b). visual examination of cavities c). instrument to view rectum d). taking photos with endoscope

cholangitis 2. osteomyelitis 3. encephalitis 4. myositis 5. rhinopharyngitis

1.

2.

laparoscopy proctoscope 3. gastroscopy 4. panendoscopy

1.

12

5. photoendoscopy

e). visual examination of abdominal cavity a). opening into the intestine b). disease of intestines c). intestinal stone

enteritis 2. enterolith 3. enteropathy 4. enterotomy 5. enterostomy

1.

d). inflammation of intestines e). incision into intestines

IV. Match technical medical with their nontechnical meanings or explanations. Column B l.Column A (a) angi/o 1. bile
(b) cyst/o
(c) cheil/o

2. common bile duct 3. bladder

(d) chol/o (e) choledoch/o 2. Column A: (a) gastroenterology (b) gastroenteropathy

stomach (c) gastroenteritis

4. lip
5. vessel

Column B Column t. Removal of the stomach z. Technique of viewing the intestines and
3. Study
+.

(d) gastroenteroscopy (e) gastrectomy

of intestines and stomach Inflammation of intestines and stomach s. Disease of intestines and stomach

13

The Muscular Systerm (MusculoskeleaE Systern)

Muscle Cell Types There are three types of muscle tissue: I . s:pgJetal (or voluntary/striated) muscle, the most abundant tissue in the human b<-,dy, producing movement. Each skeletal-muscle fiber is roughly cylindrical, contains many nuclei, and is crossed by alternating light and dark bands called striations. Fibers bind together, via connective tissue, into bundles; and these bundles, in turn, bind together to form muscles. Thus, skeletal nruscles are composite structures composed of many muscle fibers, nerves, blood vessels, and connective tissue. Skelet. ,nuscles are controlled by the somatic l'lervous system (SNS). 2. smooth (or visceral) muscle, forming the muscle layers in the rvalls of the digestive tract, bladder, various ducts, arteries and veins, and other internal organs. Srnooth- muscle cells are elongated and thin, not striated. have only one nucleus, and interlace to form sheets rather than bundles of muscles. Srnooth r cle is controlled by the autonomic nervous system (ANS). 3. ardiac (or heart) muscle, a cross between the smooth and striated muscles, comprising the heart tissue. Like smooth muscle, it is innervated by the autonomic nervous system (ANS).
F.ach

of more than 600 muscles is served by nerves which link the muscle to the brain
'rti
:

and spinal cord.

Musculoskeletal System The musculoskeletal system consists.lf the skeletal system -- bones arrd.ioints (union two or more bones) -- and lhe skeletal muscle system (voluntary or striated muscles). These trvo systems work together to provide basio functions that are essential to life. including:

ci

. " . . " n

Protection: protects the brain and internal organs Support: maintains upright posture Blood cell formation: hematopoiesis Mineral homeostasis Storage: stores fat and minerals. Leverage: A lever is a simple machine that rnagnifies speed of movement or force. The levers are mainlythe lorrg bones of the body and the axes arethe.ioints where the bones meet.

Tissues There are 5 basic tissues comprising the musculoskeletal system:

1. 2. 3.

[rones.

4.

ligarnents (attachirrg boue to bone) eartilage (protective gel-1ike subtance lining the joints and intenzertebral discs). sl<cleta! museles. and

5.

tendons (attaching musele to bone)"

Muscl"s by Function Each"r,uscle has its own special name. Muscles, however. are also described by tneir function. Muscles that bend a liml, areJlexors; those which straighter-r a limb are extensors (e.g. elbow flexors and elbow extensors.) Muscles which move a limb to the side, away from the body, are abductors;those which move a limb sideways tor,vard the body are adductors (e.g. hip abductors and hip adductors') Other functional groLlps are eleyators, depressors, rotators, doriflexors, plonar flexors, and
palntar ;flexors.

Major Skeletal Muscles

The muscular body is divide into ten different areas where muscles can be found: facial. neck, shoulder, arm, forearm, thorax, abdomen, hip, pelvis/thigh, Ieg'

Facial ln the faci..i are one finds all the muscles which move"the face. OrbicLrlaris oculi are'.ne which two muscles that move the eye are. Frontalis and Temporalis are the trvo muscles movethe forehead and sides of your head. Zygomaticus and Masseter are tl'ie tr'vo oris is muscles that work in conjunction to n,ove your jaw and upper lip area. Orbicularis the muscle which moves Your liPs. Neck The leck area is almost entirely moved by the sternohyoid and Sternocleidomastoid. the These muscles allow the neck to move your head left and right. Thel' worl< with platysma muscie to control how far you can move youl' head left and right. What allows your head to move up and down is the trapezius. The trapezius is so Iarge that it extend down tothe shoulder and thorax area. Thetrapezius is a good example of how some just like a trapezoid' muscles are named by their shape. The trapezius looks
Shoulder

'['his group takes A group of muscles all work together to move the u4role shoulder area.
major. into account the trapezius. deltoid, infraspinatus. teres major, and the rhornboid a of geometric shape like the The Lhornboid major is called so because its shaped joint-hyperlink your shouder. in rhombus. Along with the help of the b,ill and socket

is Most known amongst teenage weight iifters is the arm area. The famous bicep brachii ball a huge the muscle that allows you to bring your forearm close to your body alrd forur of muscle which catches a lot of attention amongst weight lifters. The tricep brachii and a brachialis arethetwo othermuscles located inthe arm region. Tl-rese muscles allow ./ person to do push-upsl F orearna A rnajori r of the musele in the forearm help control a part of the arm. Atllongst thesr- is of the the Blrachiodialis major, palmaris longus, and Fiexor carpi radialis.'Ihe name flexor carpi radialis is a good example of how muscles are named by their function and location. This prusele is named earpibecause of the bones tliat it helps rnove. the carples. Also. the name of radialis is n-rade by the bone that its attaehed to, the radiurs.

Arm

Thorax

The thorz.,, is the set of muscles which carrying your head, arms, stonach, and any other upper body areas. These muscles are the trapezius and iatissirnus dorsi. Usually, the majority of the muscles of the thorax can be damaged easily is one does not stretch before exercise, or lifts a heave load.

Abdomen The abdorninal area consists of the muscles that allows you to bend down and move your waist frorn side to side. The internal oblique and external oblique are the nnuscles that move your body from left to right. The Transversus abdominus and Rectus abdominus, along with the trapezius an latissimus dorsi allow you to bend down and grab objects.

Hip
Only two muscles make up the hip area. These are the gluteus medius and giuteus maximus. Drobably the laziest muscles in the whole system the gluter-rs set of muscles are used onl1 "o sit down on. Pelvis/Thigh An overlapping of muscles is what makes this area so firm. The pelvis area is usually referred to as the upper part of the leg. Muscles like the pectineus and illiopsoas, which help support the upper leg area are known as pelvic muscles. Thigh muscles are very rich in capillaries and support the whole body. The upper thigh muscles are abductor longus, Gracilis, Sartorius, and Tensor fasciae latea. The lower thigh rnuscles are rectus femoris, vastus lateralis and rnedialis. Located in the back of your leg are the hamstrings. Leg Helping the thigh region support the body is the leg region. These muscles like the Gaslrocnemius, soleus, porenius longus, and Tibialis anterior absorb the irnpacl wlren otle walks ar.d "uns. They also give better coordination for moving. The thigh region trusi the body fon ,ard while the leg region co.idinates where it should be thrr.rsted and where it should stand.

-\;-:'

Disorders of Bones and Joints

Disorders of the skeleton often invoive surrounding tissues-ligaments, tendons, and muscles, and may be studied together as diseases of the musculoskeletal slstem. Tho medical specialty that concentrates on diseases of the skeletal and muscular systems is orthopeiics. Physical therapists and occupational therapists must also understand these systems" Most abnormalities of the bones and loints appear tn simple x-rays. Radioactive bone scans, CT, and MRI scans are used as well. Also indicative or disorders are changls in blood levels of calcium and alkaline phosphatase, an enzyme needed for calcification of bone.

Infection Osteomyelitis is an inflammation of bone (root oste/o) caused by pus-forming bacteria that enter through a wound or are carried by the blood. Often the blood-rich ends of the iong bones are invaded, and the infection then spreads to other regions, such as the bone miurow and even the joints" The use of antibioties has greatly reduced the threat of osteomyelitis. Tuberculosis may spread to bone, especially the long bones of the arms and legs and the bones of the wrist and ankle. Tuberculosis of the spine is Pott's disease. infeoted vertebrae are weakened and may collapse, causing pain, deformity, and pressure on the spinal cord. Antibiotics ean be usecl to control tuberculosir, u, iorrg
as the strains are not resistant

to these drugs and the host is not weakened by other diseases.

Fractures

A fracture is a break in a bone. The effects of a fracture depend on the location and severity of the break, the amount of associated injury, possible complicationr, ,r.L as infections, and success of tealing, which may take months. In a closed or simple fracture, the skin is not broken. If the fracture is accompanied by a wound in the skin it is described as an open fracture. Reduction of a fracture refers to realignment of the broken bone. If no surgery is required, the reduction is described as closed; an open reduction is one that requires surgery to place the bone in proper position.
Metabolic Bone Diseases Osteoporosis is a loss of bone mass that results in weakening of the bones" A decline in estrogen after menopause makes women over 50 most susceptible to this disorder. Efforts to prevent osteoporosis include adequate intake of calcium, engaging in weight-bearing exercise, and estrogen replacement therapy (ERT). Osteoporosis may also be caused by nutritional deficiencies, disuse, as in paralysis or immobilization in u .*rt, and excess steroids from lhe adrenal cortex. In osteomalacia there is a softening of bone tissue due to lack of fonnation of calcium salts. possible causes include deficiency of vitamin D, needed to absorb calcium an<i phosporus from the intestine, renal disorders, liver disease, and certain intestinal disorders. When osteomalacia occurs in children, the disease is called rickets" It is usually due to deficiency of vitamin D. Paget's disease (osteitis deformans) is a disorder of aging in which bones become larger but weaker. It usually involves the bones of the axial skeleton, causing pain, fractures, and hearing loss. With time there may be neurologic signs, heart failure, and predisposition to cancer ofthe bones.
Neoplasms Osteogenic sarcoma (osteosarcoma) most commonly occurs in the growing region of a bone, especially around the knee. This is a highly malignant tumor that often requires amputation. It most commonly metastasizes to the lungs. Chondrosarcoma usually appears in midlife. As the name implies, this tumor arises in cartilage. It most frequently metastasizes to the lungs and may require amputation. In cases of malignant bone tumors, early surgical removal is important to prevent metastasis. Signs of bone tumors are pain, easy fracture, and increases in serum calcium and alkaline phosphatase. Aside fiom primary tumors, neopiasms at other sites often metastasize to bone, most commonly to the spine.

Arthritis

means inflammation of a joint. The most common fonn is osteoarthritis or joint (DJD). This is a gradual degeneration of articular (oint) cartilage due to wear-and* disease degenerative tear. It usually appears at midlife and beyond zurd involves the weight-bearing joints and joints of the fingers" X-rays show a narrowing of the joint cavity and thickening of the bone" The eartilage may erack and trreak

In general, arthritis

..,,i, causing inflammation in the joint and exposing the underlying bone. Osteoarthritis is treated with
;nalgesics to relieve pain, anti-inflammatory agents, such as c<lrticosteroids, and nonsteroidai anti-inflammatory drugs (NSAIDs)" Rheumatoid arthritis is a systemic inflammatory discase ,:f the.;oints that commonly appears in youriq adult women. Its exact causes are unknown, but it may involvc immunologic reactions. A group of antibodies called rheumatoid factor often appears in the blood, but is not aiways specific for rheumatoid arthritis, as it may occur in other systemic diseases as well. There is an overgrowth of the synovial membrane that lines the joint cavity. As this covers and destroys the joint cartilage, synovial fluid accumulates, eausing swelling of the joint.

There is degeneration of the underlying bone, eventually causing fusion of the bones, or ankvlosis" T'reatment inciudes rest, physical therapy, analgesics, and anti-inflammatory drugs. Gout is caused by an increased level of uric acid in the blood, salts of which are deposited in the joints. It mostiy occurs in middle-aged men and almost always involves pain at the base of the great toe. The cause may be a primary metabolic disturbance or a secondary effect of another disease, as of the kidneys" Gout is treated with drugs to suppress for:mation of uric acid or to increase elimination of uric acid (uricosuric agent).

Disorders of the Spine

Ankylosing spondylitis is a disease of the spine that appears mainly in males. Joint cartiiage is destroyed and eventually the disks between the vertebrae calcify and the bones fuse (ankylosis)" Changes begin low in the spine and progress upward, limiting mobility' In cases of a herniated disk, the central mass (nucleus pulposus) of the disk between two vertebrae ruptures into the spinal canal. This commonly occurs in the lumbosacral or cervical regions of the spine as a result of injury or healy lifting. The herniated or "slipped" disk puts pressure on the spinal cord or spinal nerves, often causing pain along the sciatic nerve (sciatica). There may be spasms of the back muscles leading to disability. Treatment is by bed rest and drugs to reduce pain, muscle spasms, and inflammation, followed by an exercise program to strengthen muscles. In severe cases, it may be necessary to perform a diskectomy
(surgical removal of the disk) and fuse the vertebrae.

Medical terminology L. Match the following terms to their proper definitions: a) orthopedics, b) gout, c) Pott's disease, d) j) osteogenic sarcoma, e) fracture l) alkaline phosphatase, g) osteoarthritis, h) osteoporosis, i) ankylosis, nucle.irs pulposus, k) osteomalacia, l) arthritis, m) ankylosing spondylitis, n) herniated disk, o) Paget's disease, p) anti-inflammatory agent, q) osteomyelitis, r) diskectomy, s) chondrosarcomae t) nonsteroidal anti-inflammatory drug.

1. An enzyrne needed in the formation of bone. Z. A chronie, progressive inflammatory disease involving the joints of the spine and surrounding sofl

4. 5. Inflammation of a joint. 6. A malignant tumor of cartilage'

7

3"

tissue. Most oommon in young males. Also ealled rheumatoid spondylitis" Immobility and fixation of a joint' Drug that reduces inflamrnation.

progressive deterioration ofjoint cartilage with growth of new bone and soft tissue in and around th< joint. tire most common form of arthritis. Results from wear-and tear, injury, or disease. Also eallec degenerative joint disease' B. Surgical removal of a herniated inter"'ertebral disk' 9. A break in a bone. by deposit of urie aciel salts il 10. A form of acute arthritis, usually beginning in the knee or foot; caused the joints. disk into the splnal canal. Pressure ot I 1. protrusion of the centre (nucleus pulposus) of an intervertebral or "slipped" disk' nerve roots causes pain" Usually n.",rir in the cervical or lumbar region" Ruptured include aspirin and other inhibitors o 12. Drug that reduces inflammation, but is not a steroid. Examples proslaglandins, which are naturally produced substances that promote inflammation"

i 3. The central portion

of an intervertebral disk

ii.

and associated structures' Literallv The study and treatment of disorders of the skcleton, rnuscles, "straight" (ortho) plus "child" (ped)' 15. A malignant bone tumor; osteosarcoma' of the bones due to vitamin D deficiency or other disease 16. A sortelning and *.ut "niog infection, usually bacterial 17. Inflammation of bone and bone marrow caused by common in white women past menopause" ig. A condition characterized by reduction in bone density" Most levels' Causative factors include diet, activitY, and estrogen of long aru"i"rired by-thiekening and softening of bones and bowing 19. Skeletal disease of the elderly, "t
bones; osteitis deformans' tuberculosis 20. Inflammation of the vertebrae, usually caused by

ni

definitions and write the appropriate letter (a2. Match the terms in each of theses sets with their e) to the left of each number. a. bones ofthe ankle 1 " acetabulum b. bones of the wrist Z. axis c" socket for the heaci of the femur -- 3. phalanges d" second cervical vertebra __ 4. carPals e. bones ofthe fingers and toes

5. tarsals

__ 6. metacarPals -- 7" patella 8. pubis --_ 9. zygomatic 10. occipital

a. anterior hone of the Pelvis b" faeial bone c. kneecaP

d. bones ofthe hand

e. posterior

skull bone

1. osteoclast

a. outgrowth of bone

periosteum -tZ. 13. exostosis 14. osteoPenia i5. olecranon

16. malleolus

b. deficiencY of bone tissue c. cell that destroYs bone d. bone Projection at the elbow e. fibrous membrane around bone
a" spinal taP

mYeloPoiesis 1 S.sPondYlolisthesis -_ 19. ankYlosis rachiocentesis

tl.

b. disPlacement of a vertebra c. bone Projection at the ankle

d" immobilitY

of a joint bone mamow of e. formation

a. removal

-20.
2i.
meniscectomY

22.lordosis 23. scoliosis 24.laminectomY ZS.subluxation

of Part of a vertebra b. removal of knee cartilage e. partial dislocation d" iidewaYs curvature of the sPine e" curvature of the lumbar sPine

Disorders of the Muscular SYstem

particularly in the nervous system an( disorders by affected be may function .eisewhere, Muscle Any disorder of muscle affect tir""*"r."rar system diiectly' ulio* a"r"ritld ."raiiior,, rrr" tissue. muscie ir connective Jirorders include eleitrical studies of diagnosingro.rr.i. Techniqu*r_io, myopathy" as -of damage' is described released in increased amounts from .*y*". una^r.rrr*"u.ruy @Mq), erectromyography action,

;;;;i;t,

(creatine phosphokinase)' progressive, n.ninflammator of hereditary diseases invcrving b lduscular Dystrophy refers tissue- with gradual replaceme,t una wasting t'*u["*" fh*r* *,rs.ler. of mentz and '"191t degeneratio' be cardioffipathy (disease of cardiac muscle) conneetive tissue and fat. There impairment.

mainly

-cir

i, *ry ;ir;

* ;';.*

"i

The most conunon fomr is Duchenne muscular dystrophy, a sex-linked disease passed from mothilr.to This appears at age 3 to 4, and patients are incapaciiated 6y"ugr 10 to 15. Death "on' is commonly caused 5y respiratory failure or infection. Polymyositis is the inflammation of skeletar muscle leading to weakness, frequently associated with dysphagia (difficulty in swallow'ing) or cardiac problems. The cause is unkLclwn, and may be related to viral infection or to autoirnrnunity. often the disorder is associated with some other systemic disease such as rheumatoid arthritis or lupus erythematosus. When the skin is involved, the condition is termed derrnatomyositis. In this ease, there is erythema (redness of the skin), dermatitis (inflammation of the skin), and a typical lilae-colored rash, predominantly on the face. In addition to enzyme studies and EMG, muscle biopsy is usea in diagnosis. I\{yasthenia gravis is an acquired autoimmune disease in which antibodies interfere with muscle stimulation at the neuromuscular junction. There is a progressive loss of mussle power, especially in the external eye muscles and other musoles of the face"
"'r';'o

'

1" Match the terms in each of theses sets with their deflnitions and write the appropriate letter (a-e) to the left of each number.

_- L deltoid
2. triceps branchii

a" Iarge muscle across the back below the trapezius

-__ 3" pectoralis

___ 5.

major 4. latissimus dorsi *_

gastrocnemius

b. posterior mrmcle of the upper arm that extends the fnrearm c. triangular muscie that covers the shoulder d. main muscle of the calf e. large muscle aeross the upper chest
a. muscle between the

6. rectus abdominis

ribs

__ 7. gluteus maximus __ 8" sartorius 9. semitendinosus

"*-

10. intercostal
11. myokinesis
12"

b. muscle that runs vertically at the center of the trunk e. main muscle of the buttocks d" posterior muscle of the thigh e. long, straplike muscle that runs across the inner thigh
a. faulty muscle tone

myotenositis

13. myogoblin 14. dystonia 15. rhabdomyoma

b. muscle tumor c. oxygen-storing pigment in musele d. inflammation of muscle and tendon e. musele movement
a. muscle spasm due

_17 " ataxia 18. torticollis _)9. tetany __-'2A. avulsion

16" aponeurosis

to a metabolic imbalance

b. forcible tearing away of a part c. flat, sheetlike tendon d. lack of muscle eoordination
e.

wryneek

2" tr'itl in the blanks:

junction is 2" Any muscle that produces flexion at aioint is called a(n) ..".."."". 3" The quadriceps femoris muscle has ....""."........"......attaehrnent points (heads)" 4" T'he sheath of connective tissue that eovers a muscle is called 5" A band of connective tissue that attaches a rnuscle to a bone is a(n)
1" The neurotransmitter released at the neurornuscular

Disorders of the Muscular System

Muscle function may be affected by disorders else'where, particularly in the nervous system and connective tissue. The conditions described below affect the musctilar system directly. Any disorder of muscles is described as myopathy. Techniques for diagncsing muscle disorders include eleotrical studies of muscle in action, electromyography (EMG), and serum assay of enz).rnes released in increased amounts from darnaged museles, mainly CPK (creatine phosphokinase)
N{uscular Dystrophy Muscular dystrophy refers to a group of hereditary diseases involving progressive, noninflammatory degeneration of muscles. There is weakness and wasting of muscle tissue with gradual replacement by connective tissue and fat. There may also be cardiomyopathy (disease of cardiac muscle) and mental impairment. The most common form is Duchenne muscular dystrophy, a sex-linked disease passed from mother to son. This appears at age 3 to 4, and patients are incapacitated by age 10 to 15. Death is commonly caused by respiratory failure or infection. Polymyositis Polymyositis is inflammation of skeletal muscle leading to weakness, frequently associated with dysphagia (difficulty in swallowing) or cardiac problems. T'he cause is unknown, and may be related to viral infection or to autoimmunity. Often the disorder is associated with some other systemic disease such as rheumatoid arthritis or lupus erythematosus. When the skin is involved, the condition is termed dermatomyositis. In this case, there is erythema (redness of the skin), dermatitis (inflammation of the skin), and a typical lilac-colored rash, predominantly on the face. in addition to enzyme studies and EMG, muscle biopsy is used in diagnosis. Myasthenia Gravis

Myasthenia gravis is an acquired autoimmune disease in which antibodies interfere with muscle stimulation at the neuromuscular junction. There is a progressive loss of muscle power, especially in the
extemal eye muscles and other muscles of the face.

Match the terms in each of theses sets with their definitions and write the apprripriate letter (a-e) to the left of each number.

l.

__ 1. deltoid __ 2. triceps branchii _- 3. pectoralis major

a. large muscle across the back below the trapezius

_ _

4. latissimus dorsi 5, gastrocnemius

6. rectus abdominis

b. posterior muscle of the upper arm that extends the forearm c. triangular muscle that eovers the shoulder d. main muscle of the calf e. large muscle across the upper chest
a. muscle between the ribs b. muscle that runs vertically at the center of the trunk c. main muscle ofthe buttocks d. posterior muscle of the thigh e. long, straplike muscle that runs across the inner thigh

_ _ _ _

7. gluteus maximus 9. semitendinosus

10. intercostal
11. myokinesis

__ 8. sartorius

a. faulty muscle tone

12. myotenositis 13. myogoblin 14. dystonia

15. rhabdomyoma

b. muscle tumor c. oxygen-storing pigment in muscle d. inflammation of muscle and tendon e. muscle movement
a. muscle spasm due to a metabolic imbalance

16. aponeurosis

17. ataxia
18.

torticollis

b. forcible tearing away of a Part c. flat, sheetlike tendon

9. tetany 20. avulsion

d. lack of muscle coordination e. wryneck

) Fill in the blanks:

1. The neurotransmitter released at the neuromuscurar junction is 2. Any muscle that produces flexion at a joint is called a(n) .."."."... J. The quadriceps femoris muscle has .......................attachment points (heacs). 4. The sheath of connective tissue that eovers a muscle is called 5" A band of connective tissue that attaches a muscle to a bone is a(n)

Circulatory System: The Circle of Blood

On average, the body has about 5 liters of blood continually traveling through it by way of the circulatory system. The heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The body's circulatory system really has three distinct parts: pulmonary circulation, coronary circulation, and systemic circulation. Or, the lungs (pulmonary), the heart (coronary), and the rest of the system (systemic). Each part must be working independently in order for them to all work together.

Systemic Circulation
Systemic circulation supplies nourishment to all of the tissue located throughout your body, with the exception of the heart and lungs because they have their own systems. Systemic circulation is a major part of the overall circulatory system.The blood vessels (arteries, veins, and capillaries) are responsible for the delivery ofoxygen and nutrients to the tissue. Oxygen-rich blood enters the blood vessels through the heart's main artery called the aorta. The forceful contraction of the heart's left ventricle forces the blood into the aorta which then branches into many smaller arteries which run throughout the body. The inside layer of an artery is very smooth, allowing the blood to flow quickly. The outside layer of an artery is very strong, allowing the blood to flow forcefully. The oxygen-rich blood enters the capillaries where the oxygen and nutrients are released. The waste products are collected and the waste-rich blood flows into the veins in order to ' circulate back to the heart where pulmonary circulation will allow the exchange of gases in the lungs.During systemic circulation, blood passes through the kidneys. This phase of systemic circulation is known as renal circulation. During this phase, the kidneys filter much of the waste from the blood. Blood also passes through the small intestine during systemic circulation. This phase is known as portal circulation. During this phase, the blood from the small intestine collects in the portal vein which passes through the liver. The liver filters sugars from the blood, storing them for later.

Pulmonary Circulation
Pulmonary circulation is the movement of blood from the heart, to the lungs, and back to the heart again. This is just one phase of the overall circulatory system.The veins bring waste-rich blood back to the heart, entering the right atrium throughout two large veins called vena cavae. The right atrium fills with the waste-rich blood and then contracts, pushing the blood through a one-way valve into the right ventricle. The right ventricle fills and then contracts, pushing the blood into the pulmonary artery which leads to the lungs. In the lung capillaries, the exchange of carbon dioxide and oxygen takes place. The fresh, oxygen-rich blood enters the pulmonary veins and then returns to the heart, reentering through the left atrium. The oxygen-rich blood then passes through a one-way valve into the left ventricle where it will exit the heart through the main artery, called the aorta. The left ventricle's contraction forces the blood into the aorta and the blood begins its journey throughout the body.

The one-way valves are important for preventing any backward flow of blood. The circulatory system is a network of one-way streets. if blood started flowing the wrong way, the blood gases (oxygen and carbon dioxide) might mix, causing a biious threat to your body.

Coronary Circulation
Coronary circulation refers to the movement of blood through the tissues of the heart. The circulation of blood through the heart is just one part of-the

system

overall circulatory

Heart
The human heart is about the size of a clenched fist. It contains four chambers: two atria and two ventricles. Oxygen-poor blood enters the right atrium through a major vein called the vena cava. The blood passes through the iicuspid valve irito the right ventricle. Next, the blood is pumped through the pulmonary artery to the lungs for gas exchange. Oxygen-rich blood returns to the left atrium via ihe pulmonary vein. The oxygen-rich blood flows through the bicuspid (mitral) valve into the left ventricle, from which it is pumped through a major uit.ry, the aorta. Two valves called semilunar valves are found in the pulmonary artery and aorta.

'The ventricles contract about 70 times per minute, which represents a person's pulse rate. Blood pressure, in contrast, is the pressure exerted against the walls of the arteries. Blood pressure is measured by noting the heightio which a column of mercury can be pushed by the blood pressing against the arterial walls. A norrnal blood pressure is a height of 120 miliimeterr oi-"r"ury during t ( "u.t "ont.u.tion s2tstole), and a height of 80 millimeters of mercury during heart relaxation ( diastole). Normal blood pressure is usually expressed ur 2120 over g0.,,

Coronary arteries supply the heart muscle with blood. The heart is controlled by nerves that originate on the right side in the upper region of the atrium at the sinoatrial node. This node is called the pacemaker.Il generates nerve impulses that spread to the atrioventricular node where the impulses are amplified and spread to other regions ofthe heart by nerves called purkinje fibers.

Blood Blood is the medium of transport in the body. The fluid portion of the blood, the plasma, is a straw-colored liquid composed primarily of water. All the important nutrients, the hormones, and the clotting proteins as well as the waste products are

transported in the plasma. Red blood cells and white blood cells are also suspended in the plasma. Plasma from which the clotting proteins have been removed is serrm. Red blood cells
Red blood cells are erythrocytes. These are disk-shaped cells produced in the bone marrow. Red blood cells have no nucleus, and their cytoplasm is filled with

hemoglobin.

Hemoglobin is a red-pigmented protein that binds loosely to oxygen atoms and carbon dioxide molecules. It is the mechanism of transport of these substances. (Much carbon dioxide is also transported as bicarbonate ions.) Hemoglobin also binds to carbon monoxide. Unfortunately, this binding is irreversible, so it often leads to carbon-monoxide poisoning.

A red blood cell circulates for about 120 days and is then destroyed in the spleen, an organ located near the stomach and composed primarily of lymph node tissue. When the red blood cell is destroyed, its iron component is preservedtor reuse in the liver. The remainder of the hemoglobin converts to bilirubin. This amber substance is the chief pigment in human bile, which is produced in the liver.
Red blood cells commonly have immune-stimulating polysaccharides called antigens 'on the surface of their cells. Individuals having the A antigen have blood type A (as well as anti-B antibodies); individuals having the B antigen have blood type B (as well as anti-A antibodies); individuals having the A and B antigens have blood type AB (but no anti-A or anti-B antibodies); and individuals having no antigens have blood type O (as well as anti-A and anti-B antibodies).

White blood cells

White blood cells are referred to as leukocytes. They are generally larger than red blood cells and have clearly defined nuglei. They are also produced in ih" bon" marrow and have various functions in the body. Certain white blood cells called Iymphocytes are essential components of the immune system. Other cells called neutrophils and monocytes function primarily as phagocytes; that is, they attack and engulf invading microorganisms. About 30 percent of the white blood cells are lymphocytes, about 60 percent are neutrophils, and about 8 percent are monocytes. The remaining white blood'cells are eosinophils and basophils. Their functions are uncertain; however, basophils are believed to function in allergic responses. Platelets Platelets are small disk-shaped blood fragments produced in the bone marrow. They lack nuclei and are much smaller than erythrocytes. Also known technically as thrombocytes, they serve as the starting material for blood clotting. The platelets adhere to damaged blood vessel walls, and thromboplastin is liberated from the

injured tissue. Thromboplastin, in turn, activates other clotting factors in the blood. Along with calcium ions and other factors, thromboplastin converts the blood protein prothrombin into thrombin. Thrombin then catalyzei the conversion of its blood protein fibrinogen into a protein calledfibrir, *hi.h forms patchwork a mesh at the injury site. As blood cells are trapped in the mesh, a blood clot forms.

Lymphatic system
The lymphatic system is an extension of the circulatory system consisting of a fluid known as lymph, capillaries called lymphatic vessels, ani structures called lymph nodes. Lymph is a watery fluid derived from plasma that has seeped out of ihe blood system capillaries and mingled with the cells. Rather than returning to the heart through the blood veins, this lymph enters a series of one-way tymptratic vessels that return the fluid to the circulatory system. Along the way, the ducts pass through hundreds of tiny, capsulelike bodies called tymptr noaes. Located in the neck armpits, and groin, the lymph nodes contain cells that filter the lymph and phagocytize foreign particles.
The spleen is composed primarily of lymph node tissue. Lying close to the stomach, the spleen is also the site where red blood cells are destroyld.lhe spleen serves as a reserve blood supply for the body.

.The lymph nodes are also the primary sites of the white blood cells called lymphocytes. The body has two kinds of lymphocytes: B-lymphocytes and rlymphocytes. Both of these cells can be stimulated by microorganisms or other foreign materials called antigens in the blood. Antigens are pi&ed up by phagocytes and lymph and delivered to the lymph nodes. Here, ih" ly-pt ocyes are-stimulated through a process called the immune response. Certain antigens, primarily those of fungi and protozoa, stimulate the T-lymphocytes. After stimulation, these lymphocytes leave the lymph nodes, enter the circulation, and proceed to the site where the antigens of microorganisms were detected. The Tlymphocytes interact with the microorganisms cell toiell and destroy them. This process is called cell-mediated immunity.

B-lymphocytes are stimulated primarily by bacteria, viruses, and dissolved materials. On stimulation, the B-lymphocytes revert to large antibody-producing cells called plasma cells. The plasma cells synthesize proteins called antibodier, which are released into the circulation. The antibodies flow to the antigen site and destroy the microorganisms by chemically reacting with them in a highly specific manner. The reaction encourages phagocytosis, neutralizes many microbial toxins, eliminates the ability of microorganisms to move, and causes them to bind together in large masses. This process is called antibody-mediated immunify. After the microorganisms have been removed, the antibodies remain in the bloodstream and provide lifelong protection to the body. Thus, the body becomes immune to specific disease microorganisms.

Disorders of the Circulatory System

Atherosclerosis

The accumulation of fatty deposits within the lining of an artery is termed atherosclerosis. These a.reas, called plaques, gradually thicken and harden with fibrous material, sells, and other deposits, restricting the lumen (opening) of the vessel and redueing blood flow to the tissues, a condition knorm as ischemia. Atherosclerosis of the eoronary vesseis is a primary cause of heart disease. One sign of such coronary artety disease (CaOl is the type of chest pain known as angina pectoris. This is a feeling of constriction around the heart or pain that may radiate to the left arm or shoulder, usually brought oriUy exertion. Often there is anxiety, diaphoresis (sweating), and dyspnea (difficulty in breathing;. angina pectoris is treated by control of exercise and administration of nitroglycerin to dilate .oronuiy vesJels" Other drugs may be used to regulate the heartbeat, strengthen the force of heart cpntraction, or prevent formation of blood clots. Severe cases may be candidates frir angioplasty, which is surgical dilatation of the blocked vessel by means of a catheter. Still further, the blocked vessel may be surgieally bypassed with a vascular graft. Atherosclerosis also predisposes to thrombosis, the formation of a blood clot or thrombus in a vessel" Sudden occlusion (blockage) of a coronary artery by a thrombus causes local necrosis (death) i:f tissue and formation of an infarct. This is the myocardial infarction or "heart attack" that is a leading cause of sudden death. Symptoms include pain over the heart (precr:rdial pain) or upper parl of the abdomen (epigastric pain) that may extend to the jaw or arms, pallor (paleness), diaphoresls, nuoseu, and dyspnea. There may be a burning sensation similar to indigestion or heartbum. Often there is an abnormality of heart rhythm, or arrhythmia, usually fibrillation, an extremely rapid, ineffective beating of the hearl" Outcome is based on the degree of damage and early treatment to dissolve the clot and reestablish normal heart rhythm. Myocardial infarction (MI) can be diagnosed by electrocardiography (EKG), study of the electrical impulses given off by the heart as it functions, by measurement of certain enzymes (CPK, LDH, AST) released into the blood from the damaged heart muscle, and by a variety of other methods. Atherosclerosis is a major cause of disease in industrialized countries, and the factors that contribute to it are familiar to most people: heredity, high blood presswe, cigarette smoking, a diet high in fat, lack of exercise, and stress. Other vessels commonly affected are the aorta, the earotid arteries ieadiiig to the head, the cerebral arteries, arid afteries in thre leg"
Embolism Occlusion of a vessel by a thrombus or other mass carried in the bloodstream is embotism" and the mass itself is called an embolus. Usually the mass is a blood slot that breaks loose from the wail of a vessel, but it rnay also be air (as from injection or trauma), fat (as from marrow released after a bone break), bacteria, or other solid materials. Often a venous thrombus will travel through the heart and then lodge in an artery of the lungs, resulting in a life-threatening pulmonary embolism. An embolus from a carotid artery often blocks a cerebral vessel, causing a stroke.

Aneurysm

An arterial wall weakened by atherosclerosis or other cause rnay "nalloon out, forming aa aneurysm" If the aileurysm ruptures, hemorrhage results, causing a strttke, or cerebrovaseular accident (CVA), if a cerebral artery is involved. In a dissecting aneurysm, blood hemorrhages into the thick
middie layer of the artery wail, separating the muscle as it spreads and sometimes rupturing the rressel. The aorta is most commonly involveci. It may be possible to repair a disseeting aneurysm surgicaliy with a graft.

Heart Failure
When the heart fails to cntpty cllbctivcty for any reason, the general term heart failure is applied. The resulting increased pressure in the venous system leads io edema, often in the lungs (pulmonary edema), and justifies the description congestive heaft failure (CHp)" Other symptoms are cyanosis, dyspnea, and syncope. Heart failure is treated with rest, drugs to strengthen heart contractions, diuretics to eliminate fluid, and restriction of salt in the diet. Hypertension

Hypertension, or high blood pressure: is a contributing factor in all the conditions described atcve. In simple terms, hypertension is defined as a systolic f...r,rr* greater than 140 mm Hg or a diastolic pressure greater than 90 mm I{g. It causes the left ventiicle to eniarge (hypertrophy) as a result of increased work. Some cases are secondary to other disorders, such -as'kidney maifrrnction or endocrine disturbance, but most cases of hypertension are due to unknown causes and are described as primary or essential hypertension. The condition is controlled with diuretics, vasorjilators, and most recently with drugs"

Medical terminology 1. Match the following terms to their proper definitions: a) atherosclerosis, b) cyanosis, e) dyspnea, d) edema, e) embolism, f) embolus, h) fibrillation, i) heart failure, j) hyperiension, k) infarction, l) ischemia, m) murmur, n) phlebitis, o) stenosis, p) stroke, q) syncope, r) thrombosis, s) thrombus. of fatty, fibrous patches (plaques) in the rining of arteries, eausing narrowing of the lumen and hardening of the vessel wall. The most common fonn of arteriosclerosis" (R.oot ather/o means "porridge" or "gruel"). 20. A blood clot that forms within a blood vessel" 2t. Inflarnmation of a vein. 22. Localized necrosis (death) of tissue resulting from a blockage or a narrowing of the artery that supplies the area. A myocardial infarction (MI) ocours in eardiac muscle and usually rlsuits from formation of a thrombus in a coronary artery. 23. Swelling of body tissues due to the presence of excess fluid. Causes include cardiovascular disturbances, kidney failure, inflammation, and malnutrition. 24.Loeal deficiency of blood supply due to obstruction of the circulation. 25. Constriction or narrowing of an opening. 26. Bluish discoloration of the skin due to lack of oxygen. 27. Development of a blood clot within a vessel. 28. A condition caused by the inability of the heart to maintain adequate circulation of blood" 29. Difficult or labored breathing" 30" A temporary loss of eonsciousness due to inadequate blood flow to the brain; fainting. 31. Spontaneous, quivering and ineffectual coniraction of rnuscle fibers, as in the atria or the ventricles" 32" An abnormal heart sound" 33. Sudden damage to the brain resulting from reduction of blood flow. Causes include atherosclerosis, thrombosis, or herncrrhage ftom a ruptured aneurysm. Also called cerebrovascular aecident. (CVA) 34. Obstruction of a blood vessel by a blood clot or other matter carried in the eirculation. 35. A mass carried in the circulation. tlsually a blood clot, but rnay alser by air, fat, bacteria, or other solid matter fiorn within or from outside the body. 36. A condition of higher than normal bl<lod pressure.
19. The development

VOCABTILAIT Y PRAC'TIC]E

1. Fiii

il

tlie blanl<s rvitlr tlie :rpproliriatc.,r,ord.

a) Intake. expeiiing. pliat'i,',r,* traoirea. air Sai's, Iari,trx. pici.,s 1p. ai'n.toius;. i^iasie itrcduct. moutli, L'rcinch ial iubes. The s5,'stem oithe boci;"'tha1 is resporrsible lor the .., clos,gelr a6d tire ... ,-rf carLron c!ioxide is caliecj -l'i-re the respiratory s).'stem. inain pafts of ihe respiratot.).s.,rs1s11i ar.e: tlre nose. . ... ancj tlie lungs. As in the circLiiatory
systen'i. the passages or tubes in the resniratory system become smaller and srnalier as the5, go fr-st1 the nrouth to the ... in the iLrngs. Oxygen ancj oarbon ciioricie pass ii'eeii fi'om ihe ... to surroundins blood vessels and vice versa. Blood carries cxygen to the cells and ,". carbon ciioxide as a ... .

b) Respilatory system, tisst:es, lymph nodes, lifeline. tissues, vital sigrrs, by blood cells. properly, ti'ri'n-rr-rs, nutrieirts. blooc clotring. relrove" circulation.

r,,,;r.,-

ol-rvastes, white

Gooci ... is vitai toihealth, Ceils, ..., organs and 'oody systems cannc)i lirnction .." if circLrlation is inadequate. The cireulatory svstem is the "." for the cniire body. When yr)Li rxaslrre .... you are measuring the vitality of the body. The circuiatory systetr serves three primar)/ functions. Tirey are: carrying fbod ancl oxygen to cells ... the biood vesselsl renroving.". fiorn cells: fighting infection by carrying ... and other ciisease flghting
substances.

The heai'i, blood celis, blood vessels. and ,.. are considered part of tlre cii'culaiory system. Someiimes the spleen and... are also inciuded. Tl-,e n:ain function within this s1,51sm is the puinping of blooci b,v the heart to all pafis of the body, inclr"rciing the tiny ceils. T'he purpose is to bring dissolved food (.."j, oxygen, hortnones, antibodies and ... factors to lhe cells, and to ... r,vaste proCucts from the cells, The circuiation of blood also helps to heep the 'oody at an even temperature and balance the fluid level. The circulatorv system g,orlcs closell,'rvith the ...
.

2. Tlte tenq;le, tlte throat, tlte left lireasl, the inner elbow, the wrist, the tliigh, the foot are the seven prirnary puise points in tlie humen body. For each of them you are to supply synonyms, as in the
example"
e.g., the temple - temporal pulse

3.

h'Ia"ke

uit the lvord famiiy of the foliowing rycrds: pharynx, larynx, trachea.
oi"

4. il{rtclr the u,orC rvith the correct description

insuliit

dcfinition:

Carb<thvdraies, plasma, vt,ltite corpu,scles, aorta, capiilctries, bile, stomctcit, incoittinence. excretiL)n.,

sac-lil<e bulge in the alimentary canal belo'w the esophagus and above the srna.li intestine which c!igests arid holds food A hon one secreted by the itancreas essential for prr'spsl.metabolisrn of srigar. Sugars, starches, and ceilulose. Foocis containrng carbon hydl'ogen, and oxygen. A secretion of the liver stored in the gall bladder and releaseC into the srnail intesiine to aid in

digesting fats. The iargest artery carrying blood frcm the left sicje of the heait. Tiny L,lood vessels with thin r,vails that ailorv ox,vgen and nutrients to be passed thi-oLrgli tirem to
nearby cells.

The liquid porlion of tiie blood. White blcod cells. They, fight infbction. 'I-lre process of excreting and eliminating rvastes fiorn the bocii,. The inability to control one's bolel or bladder' f,unctiorrs.

_ l. endocardium _2. mitral 3' pericardium - 4" SA node _ _ 5. vena cava _

6. thrombosis

2. Match the terms in each of theses sets with thr:ir definitions and write the appropriate letter (a-e) to the left of each number.
a. heart's pacemaker b. thin membrane that lines the heart c. pertaining to the left atrioventricular valve d. vessel that empties into the right atrium

e. fibrous sac around the heart a. local blood deficiency

_,7. dysrhghmia _ 8. cardioversion __ 9. aneurysm

10. ischemia

b. formation of a blood clot in a vessel c. abnormal heartbeat d. defibrillation e. localized dilatation of a blood vessel
a. twisted and swollen vessel b.part of the heart's conduction system e. accumulation of fatty material in the vessels d. ineffective quivering of muscle e. interruption in the heart conduction system a. central opening, as

fibrillation *-12. heart block _ 13. atheriosclerosis _ 14" varix _ 15. Purkinje fibers _ 16. embolism _17. ductus arteriosus _ 18. lumen _ 19. infarct __20" precordium. _
11.

of avessel'

b. area over the heart c. blockage of a vessel with a clot or plug d. vessel that bypasses the lungs in fetal circulation e. area of dead tissue caused by lack of blood supply

disease _Z2.lymphedema _23. tkombolysis __24.lymphadenopathy _25" aneurysmectomy

__21. Hodgkin's
I " Each upper

of a dilatation in a vessel b. swelling of tissue due to lymph blockage c" malignant disease of lymphoid tissue d. any disease of a ll,rnph node e. dissolving of a blood clot
a. removal

3. Fill in the blanks: receiving chamber of the heart is a(n) . . .. 2. The heart chamber that pumps into the aorta is the . .. 3. A vessel that carries blood back to the heart is a(n) . " ". 4. The microscopic vessels through which materials are exchanged between the blood and the tissues are the . ... 5. The relaxation phase of the heart cycle is called . " . . 6. The large lymphoid organ in the upper left abdomen is the .. ". 7. The large artery that supplies the head is the ..... 8. The large vein that drains the head is the .. ... 9. Endarteritis is inflammation of the lining of a(n) ."... 10. Pirlebostasis is stoppage of blood flow in a(n) .... 1 1 . Thrombophlebitis is inflammation of a vein associated with formation cf a(n) . " ". i2. Blood returning to the heart from the lungs enters the chamber of the heart named the .,.. 13 " A small artery is called a(n) . . .. 14. The adjeetive ischemic means lacking in.... 15. The lymphoid gland in the chest is the . ... 16" An embolectomy is the removal of a(n).".. 17" The largest artery is the .... 18" At its lower end, the aorta divides into a pair of arteries called the " . . . 19. T'he longest vein in the body, which runs the length of the leg, is the . " ,. 20. A phlebotomist is one who drains blood from a .. ..
"

21. 22. 23. 24.

A varicotomy is the incision of a(n) " . .. A sin"us rhythm is a normal heart rhythm that originar.cs at the Another term for the leaflet of a valve is the . . ". The word that means inflammation of a vein is . . . "
4. Select the correct answer:

.. ".

1. The wordpercutaneous means: a. on the skin

b. through the skin c. into a vessel

d. into the blood

e" into the skin

2. The word transluminal pertains to the lumen of a vessel, whieh is the

a.

wall

b. branch c. outer layer d. central opening

valve 3. The term that means baclc/low, as of blood, is a" infarction b. regurgitation c. amplitude d. prolapse e. tourniquet 4.The popliteal vein is in the a. arm b. thish c. knee d. heart e" ankle 5. The interventricular septum is the a. cavity of the ventricle b. wall between the atrium and ventricle c. valve between the atrium and ventricle
e"

e. vessel that carries

blood out ofthe ventricle

5.

1. septum 2. apex

Write the adjective form of each of the following words:

3. 4.

aorta artery 5. vein 6. ventricle 7. diastole 8. sclerosis 9. spleen 10. varix

Urinary system
The principal function of the urinary system is to maintain the volume and composition of body fluids within normal limits. One aspect of this function is to rid the body of wasie products that accumulate as a result of cellular metabolism, and because of this, it is sometimes referred to as the excretory system. The urinary system maintains an appropriate fluid volume by reguiating the amount of water that is excreted in the urine. Other aspects of its function include regutating ine concentrations of various electrolytes in the body fluids and maintaining normal pU of tne blood. In addition to maintaining fluid homeostasis in the body, the urinary system controls red blood cell production by secreting the hormone erythropoietin. The urinary system also plays a role in maintaining normal blood pressure by secreting the en4rme renin. The urinary system consists

ofthe kidneys, ureters, urinary bladder, and urethra

The kidneys are the primary organs of the urinary system. The kidneys are the organs that filter the blood, remove the wastes, and excrete the wastes in the urine. They are the orfans that perform the functiors of the urinary system. The other components are accessory structures to eliminate the urine from the body. The paired kidneys are Iocated between the twelfth thoracic and third lumbar vertebrae, one on each side of the vertebral column. The right kidney usually is slightly lower than the left because the liver displaces it downward. The kidneys protected by the lower ribs, lie in shallow depressions against the posterior abdominal wall and behind the parietal peritoneum. This means they are retroperitoneal. Each kidney is held in place by connective tissue, called renal fasci4 and is surrounded by athick layer ofadipose tissue, called perirenal fal which helps to protect it. A tough, fibrous, connective tissue renal capsule closely envelopes each kidney and provides support for the soft tissue that is inside. In the adult, each kidney is approximately 3 cm thick, 6 cm wide, and12 cm long. It is roughly bean-shaped with an indentation, called the hilum, on the medial side. The hilum leads to a large cavify, called the renal sinus, within the kidney. The ureter and renal vein leave the kidney, and the renal artery enters the kidney at the hilum. The outer, reddish region is the renal cortex.This surrounds a darker region called renal medulla. The latter consists of a series od renal pyramids which appear striated because they contain straight tubular structures and blood vessels. The wide bases of the pyramids are adjacent to the cortex and the pointed ends, called renal papillae, are directed toward the center ofthe kidney. Portions ofthe renal cortex extend into the spaces between adjacent pyramids to form renal columns. The cortex and medulla make up the parenchyrna, or functional tissue, of the kidney. The central region of the kidney contains the renal pelvis, which is located in the renal sinus and is continuouS with the ureter. The renal pelvis is a large cavity that collects the urine as it is produced. The periphery of the renal pelyis is intemrpted by cuplike projections called calyces. A minor calyx surrounds the renal papillae of each pyramid and collects urine from that pyramid. Several minor calyces converge to form a major calyx. From the major calyces the urine flows into the renal pelvis and from there into the ureter.
Each kidney contains over a million functional units, called nephrons, in the parenchyma (cortex and medulla). A nephron has two parts: a renal corpuscle and a renal tubule.The renal corpuscle consists of a cluster of capillaries, called the glomerulus, surrounded by a double-layered epithelial cup, called the glomerular capsule. An afferent arteriole leads into the renal corpuscle and an efferent arteriole leaves the renal corpuscle. Urine passes from the nephrons into collecting ducts then into the minor calyces.The juxtaglomerular apparatus, which monitors blood pressue and secretes renin, is formed from modified cells in the afferent arteriole and the ascending limb of the nephron loop.

Each ureter is a small tube, about 25 cm long, that carries urine from the renal pelvis to the urinary bladder. It descends from the renal pelvis, along the fori"rio. abdominair*tl b.hind th. parietal peritoneum, and enters the urinary 6luad"r on ti. portoio.

inferior surface.

surrounding organs. The inner lining of the urinary bladder is a mucous membrane of transitional epithelium that is continuous with that in the ureters. When the bladder is empty, the mucosa has numerous folds called rugae, The rugae and transitional epithelium allow the biadder to expand as it fiils. The second layer in the walls is the submucosa thai ,rppo.t, the mucous membrane. It is composed of connective tissue with elastic fibers. The next laylr is the muscularis, which is composed of smooth muscle. The smooth muscle fibers are interwoven in all directions and collectively these are called the detrusor muscle. Contraction of this muscle expels u.ine aom ttre bladder. on the superior surface, the outer layer of the bladder wall is parietal peritoneum. ln all other regions, the outer layer is fibrous connective tissue. There is a triangular area, called the trigone, formed by three openings in the floor of the urinary bladder. TwJ of the openings are from the ureters and form the base of the trigone. Small flaps of mucosa cover these openings and act as valves that allow urine to enter the bladder but prevent it from backing up fromihe bladder into the ureters' The third opening, at the apex of the trigone, is the openinglnto the urethra. A band of the detrusor muscle encircles this opening to foim the internal uretLal sphincter.
The final passageway for the flow of urine is the urethra, a thin-walled tube that conveys urine from the floor of the urinary bladder to the outside. The opening to the outside is the external urethral orifice. The mucosal lining of the urethra is transitionaiepithelium. The wall also contains smooth muscle fibers and is supported by connective tissue. The internal urethral sphincter surrounds the beginning of the urethra, where it leaves the urinary bladder. This sphincter is smooth (involuntary) muscle. Another sphincter, the extemal urethral sphincter, is skeletal (voluntary) muscle and encircles the urethra where it go., through tt p.fri. n"or. These two sphincters control the flow of urine through the urethra.In-females, tf," " ,r."ih.u is short, only 3 to 4 cm (about 1.5 inches) long. The external urethral orifice opens to ine outsiae jrrt *i"rio. to the opening for the vagina. In males, the urethra is much longei, about 20 cm (7 to g inches) in l:ngrt, and transports both urine and semen. The first part, nExt to the urinarytladder, passes through the prostate gland and is called the prostatic urethra. The second pui, ushort iegion that penetrates the pelvic floor and enters the penis, is called the membranous urethra. The third part, the spongy urethr4 is the longest region. This portion of the urettra extends the entire length of the penis, and the external urethral orifice opens to the outside at the tip ofthe penis.

is a temporary storage reservoir for urine. It is located in the pelvic cavity, posteriorlo the symphysis pubis, and belowlhe parietal peritoneum. The size and sirape of the urinary bladder varies with the amount of urine it contains and with pressure it receives from

The urinary bladder

ENDOCRINE SYSTEM
The endocrine system is instrumental in regulating mood, growth and development, tissue function, metabolism, and sexual function and reproductive processes.In general, the endocrine system is in charge of body processes that happen slowly, such as cell growth. Faster processes like breathing and body rnovement are controlled

by the nervous

system' But even though the nervous system and endocrine system are separate systems,

they often work together to help the body function properly.

What Is the Endocrine System?

The foundations of the endocrine system are the hormones and glands. As the body,s chemical messengers, hormones transfer information and instructions from one set of cells to another. Many different hormones rnove through the bloodstream, but each type of hormone is designed to affect only certain cells.A gland is a group of cells that produces and secretes, or gives off, chemicals. A gland selects and removes materials from the blood, processes them, and secretes the finished chemical product for use somewhere in the body. Some types of glands release their secretions in specific areas. For instance, exocrine glands, such as the sweat and salivary glands, release secretions

in the skin or inside the mouth. Endocrine glands, on the other hand, release more than 20 major hormones directly into the bloodstream where they can be transported to cells in
other parls of the body.The major glands that rnake up the human endocrine system include the:

. . . r . . .

hypothalamus

pituitary gland thyroid parathyroids

adrenal glands

pineal body

reproductive glands (rvhich include the ovaries and testes)

The hypothalamus, a collection of specialized cells that is located in the lower central part of the brain, is the main link between the endocrine and nervous systems. Nerve cells in the hypothalamus control the pituitary gland by producing chernicals that either stimulate or suppress hormone secretions fiorn the pituitary.

Although it is no bigger than a pea, the pituitary gland, located at the base of the brain just beneath the hypothalamus, is considered the most irrportant paft of the endocrine

system. It's often called the "master gland" because it makes hormones that control several other endocrine glands. The production and secretion of pituitary hormones can be influenced by factors such as emotions and changes in the seasons. To accomplish

this, the hypothalamus provides information sensed by the brain (such as environmental temperature, light exposure patterns, and feelings) to the pituitary.The tiny pituitary is

divided into two parts: the anterior lobe and the posterior lobe. The anterior lobe regulates the activity of the thyroid, adrenals, and reproductive glands. The anterior lobe
produces hormones such as:

o . . .

growth hormone, which stimulates the growth of bone and other body tissues and plays a role in the body's handling of nutrients and minerals

prolactin which activates milk production in women who are breastfeeding thyrotropin, which stimulates the thyroid gland to produce thyroid hormones corticotropin which stimulates the adrenal gland to produce certain hormones

The pituitary also secretes endorphins, chemicals that act on the nervous system and reduce feeiings of pain. In addition, the pituitary secretes hormones that signal the

reproductive organs to make sex hormones. The pituitary gland also controls ovulation and the menstrual cycle in women.The posterior lobe of the pituitary releases antidiuretic hormone, which helps control the balance of water in the body. The posterior lobe also produces oxytocin, which triggers the contractions of the uterus in a
woman having a baby. The thyroid, located in the front part of the lower neck, is shaped like a bow tie or butterfly and produces the thyroid hormones thyroxine and triiodothyronine. These hormones control the rate at which cells burn fuels from food to produce energy. The

production and release of thyroid hormones is controlled by thyrotropin which is secreted by the pituitary gland. The more thyroid hormone there is in a person's bloodstream, the faster chemical reactions occur in the body.
Attached to the thyroid are four tiny glands that function together called the parathyroids. They release parathyroid hormone, which regulates the level of calcium in the blood with the help of calcitonin, which is produced in the thyroid. The body also has two triangular adrenal glands, one on top of each kidney. The adrenal glands have two parts, each of which produces a set of hormones and has a different

function. The outer part, the adrenal cortex, produces hormones called corticosteroids that influence or regulate salt and water balance in the body, the body's response to stress, metabolism, the immune system, and sexual development and function. The inner part, the adrenal medulla, produces catecholamines, such as epinephrine. Also called adrenaline, epinephrine increases blood pressure and heart rate when the body
experiences stress.

The pineal body, also called the pineal gland, is located in the middle of the brain. lt secretes melatonin, a hormone that may help regulate when you sleep at night and when you wake in the morning.
The gonads are the main source of sex hormones. Most people don't realize it, but both guys and girls have gonads. In guys the male gonads, or testes are located in tl-re scrotum.

They secrete hormones called androgens the most important of which is testosterone . A girl's gonads, the ovaries are located in her pelvis. They produce eggs and secrete the female hormones estrogen and progesterone. Estrogen and progesterone are also

involved in the regulation of a girl's menstrual cycle. These hormones also play a role in pregnancy. Although the endocrine glands are the body's main hormone producers, some other organs not in the endocrine system - such as the brain, heart, lungs, kidneys, liver, and skin - also produce and release hormones. The pancreas is also part of the body,s hormone-secreting system, even though it is also associated with the digestive system because it produces and secretes digestive enzymes. The pancreas produces (in addition to others) two important hormones, insulin and glucagon. They work together to maintain a steady level of glucose, or sugar, in the blood and to keep the body supplied with fuelto produce and maintain stores of energy.

What Does the Endocrine System Do?

Once a hormone is secreted, it travels from the endocrine gland that produced it through the bloodstream to the cells designed to receive its message. These cells are called target

cells. Along the way to the target cells, specialproteins bind to some of the hormones. These proteins act as carriers that control the amount of hormone that is available for the cells to use. The target cells have receptors that latch onto only specific hormones, and each hormone has its own receptor, so that each hormone will communicate only with

specific target cells that have receptors for that hormone. When the hormone reaches its target cell, it locks onto the cell's specific receptors and these hormone-receptor cornbinations transmit chemical instructions to the inner workings of the cell.

When hormone levels reach a certain normal amount, the endocrine system helps the gland has body to keep that level of hormone in the blood. For example, if the thyroid gland senses secreted the right amount of thyroid hormones into the blood, the pituitary gland adjusts the normal levels of thyroid hormone in the bloodstream. Then the pituitary of thyrotropin, the hormone that stimulates the thyroid gland to produce
its release

thyroid hormones.
increases Another example of this process is parathyroid hormone. Parathyroid hormone parathyroid the level of calcium in the blood. When the blood calcium level rises, the This turnoff glands sense the change and reduce their secretion of parathyroid hormone' process is called a negative feedback system'

Things That Can Go Wrong With the Endocrine System For example, if the Too much or too little of any hormone can be harmful to your body. tall' If pituitary gland produces too much growth hormone, a teen may grow excessively problems it produ"es too little, a teen may be unusually short. Doctors can often treat or replacing certain with the endocrine system by controlling the production of hormones teens include: hormones with medication. Some endocrine probleffrs that affect
produce Adrenal insufficiency. This condition occurs when the adrenal glands don't weakness' may include enough corticosteroids. The symptoms of adrenal insufficiency Doctors treat adrenal fatigue, abdorninal pain, nausea, dehydration, and skin changes' insufficiency with medications to replace corticosteroid hormones'

type 1 diabetes Type 1 diabetes. When the pancreas fails to produce enough insulin, disorder, which occurs. In kids and teens, type I diabetes is usually an autoimmune and destroy the cells of the means that some parts of the body's immune system attack levels and reduce the risk of pancreas that produce insulin. To control their blood sugar need regular injections developing diabetes problems, kids and teens with this condition
of insulin.
can't produce normal Type 2 diabetes. unlike type 1 diabetes, in which the body to insulin normally' Kids amounts of insulin, in type 2 diabetes the body can't respond Some kids and teens can control their and teens rvith the condition tend to be overr'veight. medications, but many will blood sugar level with dietary changes, exercise, and oral

needtotakeinsulininjectionslikepeoplewithtypeidiabetes.

uill maiie teir 3r-'s E: 5n{. qrs _JC,t 3\v-ESsir-eir. This rare condition (sometimes called gigantisn r is usr.miil caused b1- a piruitan-tumor and can be treated by removing the tumor. The opposite can happen rvhen a kid or teen has a pituitary glad that
grorving

irk

with medication.Hyperthyroidism. Hrperthl,roidism is a condition in w'hich the levels of thyroid hormones in the blood are very high. In kids and teens, the condition is usually caused by Graves' disease, an immune system problem that causes the thyroid gland to become very active. Doctors ma,v treat hyperthyroidism with medications, surgery, or
radiation treatments.

doesn't produce enough grourh hormone. Doctors may treat these growth problems

Hypothyroidism. Hypothyroidism is a condition in which the levels of thyroid hormones in the blood are very low. Thyroid hormone deficiency slows body processes and may lead to fatigue, a slow heart rate, dry skin, weight gain, constipation. Kids and teens with this condition may also grow more slowly and reach puberty at a later age. Hashimoto's thyroiditis is an immune system problem that often causes problems with the thyroid and blocks the production of thyroid hormone. Doctors often treat this problem with
medication.

Precocious puberty. If the pituitary glands release hormones that stimulate the gonads to produce sex hormones too early, some kids may begin to go through puberty at a very
young age. This condition is called precocious puberty. Kids and teens rvho are affected by precocious puberty can be treated with medication that will help them develop at a normal rate.

The Digestive Process

The main purpose of the Digestive system is to break down food and absorb nutrients. There are two basic divisions to the digestive system, these are the gastrointestinal (GI) tract' also known as the alimentary canai, and the accesory digestive organs. your mouth, pharynx, esophagus, stomach, small intestine and large iniestilre compo"se the GI tract, and your teeth, tongue, salivary glands, liver, gall blidaer and pancrels are accessory organs.The.digestive system carries out six basic processes; ingestion, secretion, propulsion, digestion, absorption and defecation" lngestion is iaking food into the mouth. Secretion is the act of expelling a liquid. The cells lining the GI tract secrete about
9

liters (9.5 quarts) of water, acid, buffers, ancl enzymes eich day to lubricate the canal and aid in the prooess of digestion. Propulsion consiits of alternating contraction and relaxation of smooth muscle in the walls of the GI tract to squeeze food downwards. Digestion has two parts, mechanical and chemic al. Mechanical digestion is chewing up the food and your stomach and smobth intestine chuming the food, while chemical digestion is the work the enzymes do when breaking large carbohydrate, lipid, protein and nucleic acid molecules down into their subcomponents -these and others are the nutrients-. Absorption occurs in the digestive system when the nutrients move from the gastrointestinal tract to the blood or lymph. Defecation is the process of expelling what the body couldn't use" The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and 6y the chernical action of salivary enzymes (these enzymes are produced by the salivary glands and break dorvn starches into smaller molecules).The esophagus - After being &ewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth io the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This musele movement gives ui th" abiliiy to eat or drink even when we're upside-dorvn" In the stomach - The stomach is a laige, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme. In the small intestine - After being in the stomach, food enters the duodenum, t-he first part of the srnall intestine" It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food. tn ihe large intestine After passing through the small intestine, food passes into the large intestine. In the large intestile, some of the water and electrolytes (chemicals like sodium) are removed from the food" Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon" The end of the proeess - Solld waste is then"stored in the rectum until it is excreted via the anus. Digestive System Glossary:
anus - the opening at the end of the digestive system from which feces (waste) exits the body.

appendix - a small sac located on the cecum. ascending colon - the part of the large intestine that run upwarcls; it is located after the eecum. bile - a digestive chemical that is produced in rhe liver, stored in the gall bladder, and seereted into the small intestine. cecum - the first part of the large intestine; the appendix is connected to the ceeum. chyme - food in the stom-ac\ttrat is partly digested and mixed with stomach acids" Chy,me goes on to the small intestine for further <iigestion. descending colon - the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon. duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the
JeJunum.

epiglottis is the flap of cartilage lying behind the tongue and in front of the entrance to the larynx (voice box). At rest, the epiglottis is upright and allows air to pass through the larynx and into the rest of the respiratory system. During swaliowing, it folds baci to cover the entrance to the larynx, preventing food and drink from entering ihe windpipe(trachea)
esophagus - the long tube between the mouth and the stomach. It uses rhythmie muscle movements (called peristalsis) to force food from the throat into the stomach. gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in the liver) into the small intestine. ileum - the last part of the small intestine before the large intestine begins. jejunum - the long, coiied mid-section of the small intestine; it is between the duodenum and the ileum. Iiver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks down fats) and some blood proteins" omentum is an apronlike double fold of fatty membrane that hangs down in front of the intestines. It contains blood vessels, nelves, lymph vessels and lymph nodes" It acls as a storage for fat and also may limit the spread of infectionin the abdominal cavity. pancreas - an enzyme-producing gland located below the stomactr and above the intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small intestine. peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is invoiuntary * you cannot control it. It is also what allows you to eat and

drink while upside-down. rectum - the lower part ofthe large intestine, where feces are stored before they are excreted. salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules" sigrnoid colon - the part of the large intestine between the descending colon and the rectum. stomach - a sack-like, muscular organ that is attached to the esophagus. Both chernical and mechanical digestion takes place in the stomach. When food enters fre stomach, it is churned in bath of acids and enzymes. transverse colon - the part of the large intestine that runs horizontally across the abdomen.

Disorders of the Ear and Hearing

conductive hearing loss can be treated successfuliy" Otitis is any inflammation of the ear" Otitis media refers to an infection that leads to the accumulation of fluid in the middle ear cavity. One cause is malfunction or obstruction of the eustaclfan tube, such as by ailergy, enlarged adenoids, injury, or congenital abnormalities. Another cause is infection that spreads to the middle ear, most commonly from the upper respiratory tract. Continued infection may lead to accumulation of pus and perforation of the eardrum. Otitis media usually affects children under 5 years of age and may result in hearing loss. If untreated, the infection may spread to other regions of the ear and head treatment is with antibiotics. A tube may also be placed in the tympanic membrane to ventilate the middle ear cavity, a procedure called a myringotomy. In otosclerosis the bony structure of the inner ear deteriorates and then refbrms into spongy bone tissue that may eventually harden. Most commonly, the stapes beeomes fixed against the innei ear and is unable to vibrate, resulting in conductive hearing loss. The cause is unknown, but some cases are hereditary" The damaged bone can usually be removed surgically. In a stapedectomy the stapes is removed and a prosthetic bone is inser:ted" Meniere's Disease is a disorder that affects the inner ear. It appears to involve the productioir and circulation of the fluid that fills the inner ear, but the cause is unknown. The symptoms are vertigo (dizziness), hearing loss, pronounced tinnitus (ringing in the ears), and a feeling of pressure in the ear" The course of the disease is uneven, and symptoms may become less severe with time. Meniere's disease is treated with drugs to control nausea and dizziness, such as those used to treat motion sickness. In severe cases, the inner ear or part of the 8th cranial nerve may be destroyed surgically. An acoustic neuroma is a tumor that arises from the neurilemma (sheath) of the Sth cranial nerve. As the tumor enlarges, it presses on surrounding nerves and interferes with blood supply. This leads to tinnitus, dizziness, and progressive hearing loss. Other symptoms develop as the tumor presses on the brain stem and other cranial nerves. Usually it is necessary to remove the tumor surgically.

Hearing Loss. Hearing impairment may result from disease, injury, or developmental problems that affect the ear itself or any nervous pathways concerned with the ,.nr. of hearing. Sensorineural hearing loss results from damage to the eighth cranial nerve or to central auditory put-h*uyr. Heredity, toxins, exposure to ioud noises, and the aging process are possible causes for this type gf hearing toss. ii may range lrom inability to hear certain frequencies of sound to a complete loss tf hearing (deafness). Conductive hearing loss results from blockage in sound transmission 6 the inner ear. Causes include obstruction, severe infection, or fixation of the middle ear ossicles. Often the conclitions that cause

Disorders of the Eye and Vision

Errors of Refraction" If the eyeball is too long, images will form in front of the retina. In order to focus clearly, an object must be brought eloser to the eye. This condition of nearsightedness is technically called myopia. The opposite condition is hyperopia, or farsightedness, in which the eyeball is too short and images form behind the retina. Objects must be moved away from the eye in order to focus clearly. The same effect is produced by presbyopia, which accompanies aging. The lens loses elasticity and can no longer accommodate for near vision. The person becomes increasingly farsighted. An astigmatism is an inegularity in the curve of the cornea or lens that distorts light entering the eye and blurs vision. Most of these impairments can be compensated for with glasses. Infection. Several microorganisms can cause conjunctivitis (inflammation of the conjunctiva). T'his is a highly infeetious disease commonly called "pinkeye". The bacterium Chlaniydia trachomatis causes trachoma, inflammation of the oornea and conjunctiva that results in scarring. 'Ihis disease is easily cured with sulfa drugs and antibiotics. Gonorrhea contracted in the birth process is the usual cause of an acute conjunctivitis in newboms ealled ophthalmia neonatorum. Silver nitrate is routinely instilled in the eyes of newbonis to prevent such infections. Disorders of the Retina. Retinal detachment, separation of the retina from the underiying layer of the eye (the choroid), may be caused by atumor, hemorrhage, or injury to the eye. This interferes with vision and is eommonly repaired with laser surgery.

Degeneration of the macula, the point of sharpest vision, is a common cause of visual problems in the elderly. When associated with aging, this del,erioration is described as senile macular dLgeneration (SMD)" Other causes are <irug toxicity and hereditary diseases.

Circulatory problems associated with diabctes mellitus eventually cause changes in the retina referred to as diabetic retinopathy. In addition to vascular damage, there is a yellowish, waxy exudate high in lipoproteins. With time, new blood vessels form and penetrate the vitreous humor, causing hemorrhage, detachment of the retina, and blindness. A cataract is an opacity (cloudiness) of the lens. Causes of eataract include disease, injury, chemicals, and exposure to physical forces, especially the ultraviolet radiation in sunlight. The cataracts that frequently appear with age may result from exposure to environmeniai factors in combination with degeneration due to aging. In order to prevent blindness, the cloudy lens must be removed surgically by one of several methods" Following cataract removal, an artificial lens can be implanted or the person can wear a contact lens or special glasses. Glaucoma is an abnormal increase in pressure r,,ithin the eyeball. It occurs when more aqueous humor is produced than can be drained away from the eye. There is pressure on blood vessels in the eye and on the optic nerve, leading to blindness" There are many causes of glaucoma, and screening for glaucoma should be a part of every routine eye examination" Fetal infeetion with German rneasles (rubella) early in pregnancy can cause glaucoma, as well as cataracts and hearing impairment. Glaueoma is usually treated with medication to reduce pressure in the eye, and is occasionaliy treated with surgery"
1" N{atch the terms in each of theses sets with their definitions and write the appropriate Ietter (a-e) to the left of each number. a. inner ear _ 1. proprioception 2. olfaetion b. sense of smell _* gustation 3. c" small bones of the middle ear __ d. sense of taste _ 4. labyrinth 5. ossicles e" awareness of body position _

_ _ _ _ _

6"

pinna

a. passage that cormects the middle ear and pharynx

7. vestibular apparatus
8. Eustachian tube 10" lens 11. presbyacusis

__ 9. lacrimal gland

b. produces tears c. projecting portion of the ear d. part of the ear concemed with equilibrium e. changes shape for near and far vision
a. normal refiaction of the eye b. complete color blindness c. loss of hearing due to age d. nearsightedness e" instrument for measuring the eyes

_12. _- 13. achromatopsia

myopia

_ l
_-

.emmetropia

15. ophtalmometer

_ 16. strabismus _17. vertigo

a. point of sharpest

vision

_ _

18. mastoid process

19. cataract

_20"
2"

fovea

b. false sensation of movcment e. deviation of the eye d. projection of the temporal bone e. opacity of the lens

Fill in the blanks:

i.

2"

3. 4. 5. 6.
7

8.

The coiled portion of the inner ear that contains the receptor for hearing is the . ". The innermost layer of the eye that eontains the receptors for vision is the ... 'fhe scientifie name for the eardrum is .. . The niiddle layer of the eye, consisting of the choroids, eiliary body, and iris is the ... The term oculornotar refers to rnovements of the . ". The ossicle that is in c,ontact with the inner ear is the ". The muscular ring that adjusts the size of the pupil is the ... Ivlydriasis is abnormal dilation of the ...
"

System
The nerrrous system consists ofthe central nervous system (whioh is the brain and spinal cord) and

Clinical study
neurology

Physiology

peripheial nervous system. The Lrain is the organ thought, emotion, and sensory processing, anJ "f serves many aspects of communication and eontrol of various othei systems and tunctions. The speciat senses consist of vision, hearing, taste, and smell. The eyes, ears, tongue, and nose gather inforrnat'on about the body's environment.
The musculoskeletal system consists of the human skeleton (which includes bones, ligaments, tendons, and cartilage) and attached muscles. It gives the -movemen," body basiJsiructure and rhe abitity for

:,",1i"-t-:',"'ce, (dlsease)' psychtatry (behavioral),

:l^11f1]*:l"sv (hearing, otolaryngo.logy

taste, smell)

(vision),

neurophysiology

In addition to their structural role, the larger bones cusorclers) in the body contain bone marrow, the site of production of blood cells. Also, all bones are major storag sites for calcium and phosphate. The circulatory system consists ofthe heart and blood vessels (arteries, veins, capillaries)" The heart
propels the circulation

(skeleton), ::]:ol"q (bone orthopedics

cell physiology,
musculoskeletal

physiology

ofthe blood, which

serves as

transfer oxygen, fuel, nutrients, waste products, immune cells, and cardiology (heart), signalling molecules (i.e., hormones) from one part hematology (blood) of the body to another. The btood consists of fluid . that carries cells in the circulation, including some that move from tissue to blood vessels and back, as well as the spleen and bone murow.
a "transportation system" to

cardiovascular

physiology

The respiratory system consists ofthe nose, nasopharynx, trachea, and lungs. It brings oxygen frornthe air and excretes carbon dioxidJ and water pulmollology' back into the air. The gastrointestinal system consists ofthe mouth, esophagus, stomach, gut (small and large intestines), and rectum, as well as the liver, pancreas, gallbladder, and salivary glands. It converts food gastroenterology into small, nutritional, non-toxic molecules for distribution by the circulation to all tissues ofthe body, and excretes the unused residue. The integumentary system consists of the covering of the body (the skin), including hair and nails as well as other functionally important structures such asthe sweat glands and sebaceous glands, The skin dermatology provides containment, structure, aird protection for other organs, but it also serves urs a major sensory interface with the outside world.

respiratory physiology

gastrointestinal

physiology

cell physiology, skin physiology

urinary system consists ofthe kidneys, ureters, bladder, and urethra. It removes water from the nephrology (function), blood to produce urine, which carries a variefy of urology (struetural waste molecules and excess ions 6nd water out of disease) the body.
The The reproductive system consists ofthe and the intemal and externai sex organs.

renal pliysiology

The

gonads

gynecology (wornen), andrology (men),

reproductive physiology

reproductive system produces gametes in each sex, sexology (behavioral for their combination, and a nurturing usp""tsj embryology environment for the hrst 9 months of development (divelopmentat asfects; of the offspring.
a mechanism

The irnmune system consists of the white blood cells, the thymus, lymph nodes and lyrnph channels, which are also part of the Iymphatic system. The immune system provides a mechanism for the body to distinguish its own cells and tissues from immunology cells and substances and to neutralize or destroy the Iatter by using specialized proteins such as antibodies, cytokines, and toll-like receptors, among many others.

alien

immunology

The endocrine system consists ofthe principal endoorine glands: the pituitary, thyroid, adrenals, pancreas, parathyroids, and gonads, but nearly all organs and tissues produce specific endocrine hormones as well. The endocrine hormones serve as endocrinologl signals from one body system to another regarding

endocrinology

enornous array ofconditions, and resulting in variety of changes of firnction.

an

1.

Mary is a healthy 2l-year-old Olympic athlete who no longer has her menses due to her excessive training. Her condition is called .

2.

a. menorrhagia b. dysmenorrhea c. amenorrhea d. menorrhea

3.

Stopping a patient's blood flow during surgery is vital for the patient's survival" This act ofstopping blood flow is called a. hemostasis b" phlebostasis c. arteriostasis d. venostasis when doctors refer to pain in the internal organs of the body, they use the term _. a. visceroskeletal

b. c.

viscerogenic
visceroptosis

4.

visceralgia Human blood contains two types of cells, red and white. The white blood eells are also called
d.

a. b. c.

melanocyte

_"

leukocyte
cyanocyte

5.

d.

xanthocyte

When an examination of the interior ofthe eye is needed, the instrument that a doctor uses is called

a. b. c. 6.

ophthalmologist
ophthalamopathy ophthalmoscope
as

d. ophthalmoplegia High blood sugar is a conCition knorvn a. hypoglycemia b. hyperglycemia c. hypoglycogen d. hyperglycogen

._"

7.

sometimes the testicles of a male child fail to descend from the abdominal cavity when he is born. This condition of hidden testicles is called

8.

instrument is called _. a" colopopathy b. colposcope c. vaginascope

cryptorchidism orchidism d. orchidoplasty When a woman's vagina needs to be examined for abnormalities, a specific instrument is used. This

a" b" c.

cryptotesticles

9.

d.

rynoscope

There are three main layers oftissue in humans" The outer germ layer is called the a- ectoderm b" endoderm c, mesoderm

_.

10. There

l.

of tissue in humans. The middle germ layer is called the ectoderm endoderm mesoderm d. paraderm There are many one-celled organisms in the world. Another word for one-cell is

a. b. c.

d. retroderm are three main layers

_.

a. b. c"

nullicyte

monocyte

d.

multicyte muticellular
dehydration
dehydrated

12. A high fever can cause the body to lose water. This loss of water is called

a. b. c.

exhydration tumor is found, it is often cut out and removed. This process is called
aberesis

d. exhydrated

13" when

a" b. c.
d.

_.

exeresis decretion

excretion
a certain class

14. Opium belongs to

narcosis d. pseudocotic 15' Whenever a solution is injected into thdblood, it must have the same osmotic prossure as red blood cells. A solution which has the same osmotic pressure is called:.

a. b. c.

narcolepsy

of drugs that produces sleep. This type of drug is called

_.

narcotic

a. b. c.

isotonic anotonic peritonic d. circumotonic

16. When people have an allergic reaction, they may develop hives, which are limited in the space that they cover. Hives may be called _ wheals"

a. b. c.

isoscribed

diascribe.d

periscribed

d. circumscribed 17. Soft contact lenses easily attract water. They are

a"

hyrirophobia

_"

t'

b. c.
d.

hydrophobic

hydrophilic
hydrosis
homogeneous heterogeneous

18. When a country's population has people from different ethnic backgrounds, the population is

a. b. c.

_.

homosexual
has a

d. heterosexual

19. When a patient

a. b. c.

problem over the stomach region of the body, the region is called

epigasuic

_.

infragastic
subgasric
area is said

d. intragastric

20. When an area is &ee from infection, the

21. Atype of drug that works against infection is called

a. sepsis b. septic c. aseptic d.d. antiseptic

to be

a. anticonvulsive b. antipyretic c. anitnarcotic d.d. antibiotic

22.

Wher- a person has his/her heart on the right side of the body, the condition is

called

cardiac

a. transposition b. contralateral c. intransposition d.d. anti-transposition

23. Arteries

a. b. c.
d.

and nerves can divide into two branches. This division is also called

unifurcation bifurcation

_.

trifiroation
hemifurcation

24' A child may be bom with a deformity or condition. This type of deformity or condition is called

25.

congenital consanguinity Sometimes tissue is cui into parts for the purpose of study. This action is called a. consection b. dissection c. transsection d. unsection

a. b. c.

unicongenital

bicongenital

d.

_.

:\ )'!

[,1,

[ir

i,. ;
1i.,
r

tii,1,

'
,

[r
q

q
A.

,4,

'( o irl
-t
('j
'{r

TJ

:3 i

=.., .,.].1: l.i:,i,'):_i l.i,: t: -,:.1,l ,;:- : :,,; i,',;', ?-!:'it;; ij ; ":"?i -1'.',';,t ';i r': " ': 'l] . {;;;r,'t ?e t; i..ij tit rr1r o;j o s,xE I ;l:j- 4i' ;i; '' i; ..:;'1: u'l .-,. j:i Ij..i'::'-,:1i'' j' ! r, .;i ii I.tj u j: # r l::-:t:-l.'y *f';,;,:';L,i! ir I r., o' tt -i t' ;: ,, E"i i, ,'l :.!j ..:, ,. ;'. -i .l -. ;, '' i ! ,'. ;.3 li:y.:;.i':--;t.r: 1-.i:..:,, 1)'.1 ::
i:'!,":-r., :.,a

'.1
tl

i ;'.'i;
, .:: t,

"''

'.',

['i''

ilr'
-1 aJ .l:

iI

'
I

I11,,:,:'

,i .l

i;i,iil
f'.';1.
r

,,.
,

i l: it

ii',

,' ,,,i. ":

iJ

ir,,: i ,;ii:;t
':. )1 ".: :. \

i
',

a
T

t t L)
14

,*
:ll

,. ?.-.L ' ;,.n.$ r'J<

:a.

s ,i

'r)

: Y*n,-/] ; ,da!, .^5P :F.F

2

I r.: :r

. .:1-

i 1.i: ': .::J,- 6 1'3,i i ='1'. : !.3.q 5n ii"-.Ei f i y",; a;:;:"ii;=':-:!! 'r: i'[i ].,q;gt.u. ri ai=. i * i1.",,;i:). i*"HE ? ; ir'.::" iE:"aH:;2I,G; :; i',, : i 1,,1,! : a:-:;s 15"I,i : ?,tio::,, i :::-?::'i' I t'i.>-':i:'.u'i -E -:.a t! t,il !'; !'g -': \t: ir'. .. n, ;i-, 3 I3 H;,l;9 " iri,::i:i :;;
).,
:

'..

::-'

oj

*i

()

-:1 .'Y

'ail YraEl2:-:;
::: .l o U Q u ..,

-1';

--

-l

r:!?.'i!.t

i i ,:i ! ;,,;;iiii *i:l:E;;;

;,ilrli,1ii,1zzli;iiiiiii,iliii'

iii;

it1

ii I i i i: il ii iifi r :r t11i; i,i,:1,,1.l I ii !i t i ir l=;tt ',ii; i;r;ir ri i[:,i iiiiX !;:,i;tr,:: r,' li ii tr rir; lllr; s;i rii,?'-lr*rixl lli liiil

$
;:1

;i!:3i li: iigii?ieilll Il

iiiil i liii I il t lll

I
.e*.ilS
1r

i 1i'j'1

tt*i;ii :i: i iriiil'l,i

i
1:
I

::N:ri.1

ii:iiu
.t4l'.i:

tii.ri:ll
'5r?.i"
,

I',r'l

I r';

,{ll;rli'. \l:r
1
"1

tii'

;'1,

-:ri : i..::'
ij
j

lt! ,:.\

lil;'.l rii"'..{
il,:iir
,ll'r...

r$:'i i',r

ilifiidi
.$!r::i'li

J,'

p
{v)

*:

: ;

> -Y=;:1 9.;'-rU .Z' i::=,

= d

o -: u

| 6

iE :g?== s-=?=!r;

3 _

=:S:: i Ei:j:: ;=i:?

.9 * <- c :i

==.i ir:!='-: 7i:j ==7ir=r:'::V;;i L3--'.r ia=,iI:= != :J=;=.BrE='a!.":-, -== 'a:.=t=i E";n=+iZ=i1z*: =:E ++,=,=n= *J=_--:-, .='; x __d==Gq =1,11 ,e:;3t;=
== = - _? Z = * 'J -' . 7 -l

-:c=?=t ==i-i3=5: iyr-iz1?

=.'.aa=-y:

a-.r.

-2"===.;

==ja==Z 5=.: \ .-

,I;=-5-=1=-iji, a = = = - 'r >. - :- i

a=.:ir_-cZi.?i."-/,c o=-j,:t|.!-

/:=.=_

o.! =jj.J z=E

1 =

z
?

>-

L) :a

: = ; i i

'i

i:== =: i.';= r:;Z ==; =:1'= l-.;- =-: ::T = =i''= -=-: ?.2 j a* ":, = i- r'=j = : 1-i r.:-'.,:a;===-= J ia= ?=.i =:= = =-. = .2..-J =:ri7 =: c == : : =:-= : " a,1 : :.a: Zi-," -Z -.= = -Z = -. -! J -;'a.: l: = = : .- ::.j = ---,, - u= o ;; at== :-.== = ;'-:.:=.

==it = :;:;ioi;;:r =: :="4 ii:= -:.::ri=^ 1.-: a a:==,z;rr;:":j'= -=;i a;:;: ; t7a: ;S= l:: .r; j r*--. :; | z i -- 7'= =-r . - { ! - : =; : = i =': r: ==7
:=
=

E;.:;;; f ?ii;Z:, I;ia: i:=

:=; i !.;1,^;. l=;.i; i,_. ; iZ r' o;dc72= =

-5Ii= i:==i

I7?:J:= =e:;: =;=:_:u ig!:IIZ ;a=;Za) ii:q;a i:;!::''==i=:i=-_; 2 '=olf: ,i= ;=';=i:-a{J, =-';o-=9.2i;-:..5]3

1i =::=.,=c1 u6 j =? i:r= a,=7.7::i, =_!i:9:::==!:=E ;:E i-2 :=?ai:..2:=io-='

=Z;c:Z1=-',*

;i2 z =i=z.i;i =:=:z:i =': i t; iZ =i.j=i;; ! = = l; :: =:.1 ;.r,-llri= r::E

s5 i

; ! i z: a+:?i;;; i'j_\?. =3: =-a:=;:;-".-=i; i"t==r' '=Z==?:i"!:=g; =-ii i=2i.t1; ::;=7ilz,.zi'_,;; i E==:=:; =: i;i ii=::;;;=i=:== :: ? ; : i:+Z; ieZ i: =.E Z ?, t; : I===z:., . =i-:.=ir:t=rl-t.=.i =: =ri:.1=;i= =:.,; .:; :i : :E _"=
=3 i':.;a=r
z-.

--

- i-==.i : .-,:a;:= =- ..- - :-: " ..:.. ; =i-ii;=;-. 7 -. iZ= :. : Ii : ; : :.":.=;: . | ;i:=7:=::1:1!=;:.:;= - :: i i tr r i !:;a i'i;-;i :5 ;:: ;i-:;Z;ar. =;i=ai:i;r c= iz it = ;i= iiz== 1r3 :a : I . :.:-, I :=;;=!- I iai, =
.=

= t:

="

.,.
-.I

4
$

'l
't i
J

:-c

:'

,1

i
*l

,:.i',Liin@

,i

a.

;r : ='/ :^

:
{1

.:c

*r6
! -

>

cl

a]

\=
!4= \ OTJ 4O

raE -.1 /i a

a<-t \C
t-

=.. =, :i

i;, irz;=;a21,:: l'ijE :: j'==i j=: ji;i :! ;== -5

=
=

-: i:a,12.!;tilE; !J j. ;':-i _+ == =!:= = =r;;''.a : " C 5 - = j ,,rL : :- -_i .*= =Z ;i .: Z -- - i - a =;= = - =

o ! = .. - v. r -!.: =.-

r:

.. : ,i"l-=. -

= = =t

==!f i;55=;

'J 'J a a=.>

a c t:,t: =,7, =-

i c = =.!

;:

il

r-

>. + 2=
- :
q,

.o

\:
a c

L 3-

:z :.
j:

E
i---

i-

a,,

\c
CJ

'\

:--.u!j

-= ;2

-a

t,
A

*-

=:r;-:=: =;a jf : !-- :==:: 1 . = '=

i .: i

=-;z:: :^;:: '.''i:i:=t:-.-:) === ^--lj : - I ', 2 - _. = ! / = j.i= "..= t ;2-:2 !; l,; ;Zi== -;e''.a =5i -='.; -=;;;: ===.: ::^=i'=:tI ,i=; i=-';,lili, -o=.:: ?+: i-i-:= =_i=12.::: =:.=1:;=a::1i =i '=-:i--:-:.= :;,:.7 i;;===f zi=:':.t= === a:=;i=::?- -..:.==..-:=-:=-:i:
;a
:

== ::-=:;1=:;i=?-;;il:t== i.rii i=r=21::. :i

:":-'= C ! -- -, :1 = L \ ! ': J ..: I 2 = .-=.: *
-a .-

=ii.=;.i2j:,.=_= !ai-:=:= - ! i .= 1>: ? a-^i ^ i i; = =J:l j-: = i c:.-.: :..1, U =E2IE;:s L11:.: -t : * a :
- ='= = J = i'= ? - '','.

='=; f lz.J ^:r! S i;,2::,'=;;Z'!: ia= =;; :=!.'!-:-aaa-.'-; --2-:.;ai5'1=2;.!Z=i: :2?!-= E'a;+tz ;==:a ::=.',;l\ f :-:5:!i i =-iz)'..-,,_ ,;!==4i..

-. ':a
=.: :: ';. 2 .: >

;!, E;

iZ

1 1 a - ,J =

:a

ii

:Z c
=

=.

;i :;
)q

ii
= t' -:
.:
V,

=t: ;= !
,=

-=

ji;

\
cr

i=1-:r,.=7 ! = =_a:

I e-

iu i=
=

= -:: =la

=.i=-."1

f;

,:.:
-:

-:'

'-

-\il

ir,:

:3 cl

,l-'r:

--l

a .\
a

\j

:
\t !

ia -i

{
>

r.

ll.,i,i:ai,:.

:.fiir+'.
.
.t, ::. ,.
.

.' f.i,j'.',
...
i- r'llll'l::
::,

..:.'.::,::

,{j -j

!n cv)

-t
U
! ,{

{ \
i

?
o.

-t

tal

,
e_

la

..,-::J1-;ii;

L:

.l
a.)

';i i'l !) i\, i\

U) Qajoo ,\

r:rl

,'i

,_.1

o. 'l

:: tJ.l

.\l
il

U4) '-,
t,.i -: Ct

'-r

L)

c'. l
r,J

.t4

r::i :\a
ie:h

-(-)

;
d:?
'L.

.:i

:{,

-t
c t:
t)

()

t)
L-

>

O
J

o a

i, a i -.r; .,: 3 :. U '{ L"i :t l() t4 il.\ i-t .]i

Q()
;:1

o
n
()

(\

cc
1-_

LU

c.

ot

0 .o o ()
C:

U
rJ
:A

.:l
tl
(.1

o
i,i
cJ

::

s
':r

4)

::U o:

o := E

o'

l:]

q
rJ

s q
l

r:

'(J d

:9. 8 *; .., $ o :r; ,,3, di ! b .f o L' o ';. o ;i 7 Z Y> r: '^ rI 7\', 'i 3 E Z _E 3 P i .i s n I 5 i 1a h, \ [ :rg 5 .s n : E H 3" t ii -q q ! 'I ul i ; : o ;';* l:.-l .g
U
u-]

; -_d B i]. ::r il E o :,n o"i -E:, '-3 I I ir I\ ':1]:..::o* : -* I 5:, o rf; i.l ='i 4 3i
o!.t2oiO

OcJ-XilorO --:.tr)i?:1o

;:
{
* cn

2 cj E :f

.. c;

s ! f.
u
t1

r g a ;o * g
E

*.J <1

tJ-,1

a
It

3 i

?'.

r; :'

,^ -o;

r .: o fr E ct,r u o ii
= E E : ;. ,S 0 C. A i:jf

;j i

.2

:\[
,4: J\

.:1 cl

|J

\
l1

Ct

.s
0l

tr

.:l

o-

Z
cf

5 tl

.i
H

o
cr

.3o ; } In, ;-.j:

{!

g b{ .3'H X .il ; *'-: = i , ';: y} >i E5 = -8 i" E :i i 2 o rr * i3 il : 9 :

I 6 .: f, o O 'dl'l ,.. X ;= 5 I .: ,, C* r{l 'A (u q
U
.c
"E

o.

cl

o-

-:
,"4d,l]@-+

.C,'ai !J
:1,' -.ii

:,\
'-)
CI
":.-:

-.;

i'r

ci' ()

;r:
t,-,

.i;
'

:.
::l t: ,:,

o
: ]:

o U
(d

.:

,a)

:>,

: '

.)tr

O tr"

a\

::;

.:i
"[]
t) ,,2

.9

.rl ''l
l-

:li ':) al
1:i ':,\

50

. _- f-'

-l':i

lll fl

--\

i)

,.
, i:

I.i,

ti

i.: ,)

L)

'r::: ;;' :i .n .. -!
(]
,-, L:

-ri
;.-i

..
f--

')

.:

, ,-l ..., (qi

'.t

r-r-?,.

:) ,,
..
r.Lj |-:
:f ;>
!J dJ

.j

-,

::l ;i

a)

:r 1r cr|J UA
NJ .J d6

1li :l

oic
^\E '7^

iI
-ct

(
o
oq nJ

J l.rrl)itr3
,i::
-\

:\ r.i

L
<L

F co .1i o
EF,u L
-

,:X"c.Lo l,i E ],r "-r(^C '.:i n .:,;l 2

='no J) .:i

o.

Tr :.f g - :.i'
'! /-:

)\
CJ

ap'
L .!

o.

o)

o=.:itrkISlotj ;-b E H.: 3 E ; b

EEE-9o.P?!

.^

!
U
N,

. -t . h
i' -r :'!

a \J
\.'

__l /1 -i

fr
)! (
(^

l*lfu1 'Xl,'!! a. tn ii. i:. ltr ';ii lJl

HCDZ.i

;-i lt,l

o7o d., 3 'i ci r.. E.H -4 -;F .r>, P o. a(/)q

do c tr

ou

t-'->

c{

u
--c. -i :: !l ()9O (* -E
Yf,

() tr

(/)() a> r)z Yd

(1
u

Illlillll
o

ts

a0

U
cJ-

i5
ri

t)

ci

HH(i

a.l

..

l.r)

P';rq,d ;d3;-Er-rT9il
dojC^:]O!)\.::O

-o

a.

rI
CJ

\
o

(J

,
E
H

,ii.x6 ,'iH-i
l1

-ici.i'"d-oF-.orici

m c cr d A E A Zf

E
H

qJ

t-."

,:il

o
o
c)

u u
9

>o r!o -9o

o
.=6

o
o.

'= >eo qO
(.)

U
h

9o

Z'a
oJ

-4,

>9 ?3
o

oJ :4, q

>. _=

t.) -c U

.,:E".zE;
i*=^'-.-:J>i--

-9 o,u-.9-= +4da5=a !':r=-?! nXX.:.:. "=+Y^

==

;t,Aaz=,.

Vo o';
9o

UU
?,

FO

..

a.

oa x->. -o dco
o

or

E:doE-=raa!;k

a;?''::.rE.1o='a'a 9=2.r:';-;3i.9i=o -otv

.==
O

4
C)

Eo
ds qO rc

o OO

d o>5

Zx 9-9
q'=

ocr o-.
oi:

C;

_o
.;!

d*
N_

-o ;o
rl

-. o

r.
q3

.2c
a:1 lo ,'P :^-

;U a-O

o ')
h: ot.
>1

>'a ;c

-3 J')

.:

a{

cf

>\

:i.: ilr
!

(>

::
U

=c

c
: .i

l3 1q

-t--:
Y

*.c { >.-?
4 , \7.J\ 'J>

v-a
1:
U 4'= ,J.

|:
^

,r= -:=l

fH

<!
!:*J

=2
,^

i'-=
q oJ

:i

'; J !;l

<

_:.

-a

Ui

.=-r it -., o

-..: U

l l

-at

c.l

I I I 'l

.:: :)' c -, .(,)

ci

l-1, a)

-l ,1, ti, tJ

.i

.]
:.r

.c (:
a-i t

J)

;-,

tt

:li

.:
n

:I U\ i:r ':

$ t:
a1

;i: -tl
C)

() :1 .,, a .i c r: ,^ c; ;i 'll)t i,irn

-. |j'

o.

:
'

lli

':

c i:l

-(:

,t

,(\ -l ,i
-l
(.)
1,,)

(]
d
a.h

.O

!:

o"r Y,O,,L
ct > a ,_.,-

'-

-, :: :l
-. =\a a'!

i!

-,

.:
,:'

':f

7
G,
7

,)
a

a-\ x
:t.
.-)

,i .: q: ,.t r- a -l D_. -CC 7:6O :1 l) ::

ta) -

.-n

u I
1.
:-.

-:
1)

:l:

lt:

U)

a-

l*

-a:

'11 ':aa ') "' ,)C ti', ,at <. r,it t':

f '.1,

-a

LJ

'i

-=

: "t) ;t t'' t,

i;

tv':

*t tt
-Ja

.;
L]
J
(_)

o (0
.::
-a
a.r)

,
C

.!
ail
a:

E
u

c
.:

a.:)

L' C

,
;4,

c:

J:

a
.:)
atJ

:
= C
.2.

.-) a
\)

/-f

,-,

('
tr

.,! i

'-h

: o
'O i: t)

-lq,J

F-

cia Q17 JfO

=
c,
a--

,J= j

OC)
l::

..,)

a
-J :j

'l U

;-,

1il

:: -;
*C: c! a:

::
c0
.1
:::

=
aJ

n. q J

:.1

.-,

'( lJ
Q
:l:

c) )!,

-:

ci

c
,l)

')

?.

t
..,

'-t

,
'\

I'

o
..!. i:
-a

l:

.l

v,q,: ,!,

,:

2
ci

Q=--

.-: j' ; L' U ., ,r-== J'>,-*r Lv6,

tl, ts U

'r:

reG,y
i e

._: ' -- :' :. --,.:)iJ@

c-)

C
-.:-.)

-. 9 -: ()'-L :=d =u.

:,; t. l-qoq-= u)
-':'L-\!

c, -C) y
i a

'ft
6
ci

at '-

rJ

!U

-/

n
a)
'-4 'i)

,.: o '- o ) o = rt'?. -.6i'.-'G' '7=U=qJn, '-'.J.,a-.-=Y = 7,.--q u,-'t.;.= =. -Q\<':=o .-!--=u^,6
et 4 t_

c) > P c:ficJ,(J-O ..v2-.ra . C- ^, -

a ,=

rc!
--

cr -

a?a^7,a ----:--r-C7a-L4

iEb:
a

JJ
CJ

= ':--z-?Y:147."?9i2 ; U = i'i ts.:)

= = =
P.rL.-u ^-,:e'L=a.\l Lr_7-OOu

-.r; =r.7': 2 5 o =z;..aa"a 9::.8 . Uo: ! : :

r?,a2,7;12iv=a3=3 s :.-:?r.rr,rFS,AS:-t=

a Z >.)';;

In

-r.6r'!

--,,!qrJ..===

=69(2 >u,)'l <-"7q

;-i:ta-=--,
) = ,; =

u,;
r \J

i?:2.e,
^=,4-?U
Yl

9-dV)= ;=-r-'a
a

2; tz 2 2 = ?. .; 2 1r-JSr:c=aJ-.=7== >'=^')--:'l=-= = e 4 | Z1r:: 3A 6

9-4

ii=.=-i.=
Uldti:= c-z'!=i9.

U\:).=,_;=*a '^9u.;!
_vvttt,F

.-

<,,^
l

vtn,6a;'=,t--

-aXic-uF F Fq -q.Ab-c
.--t--;.-

=V i.z - ,-' ^'= ^ U,^Ou,'-

r;zZ 4E,EAZ .i. '2=7r_.=-.a 2r'Z^7

dSaTe' * yr .=
=o====.,-...'== ri 9 a @ = o . o J ., p lt tt Y -

= ? U ?. ==

899== 9=--u:
?0rA=-t-.-'== -q*-a

1,=\Y>,
e

;e:86

'i.=.--rr. z 7.= a Z '*'=9>-r=

=

!.
=

X ih= - ,, a =>?'22.7: .?'-:, /::

--;|-a v. z'/

= a ='= o= =oY=3 - a-,. Ct

uar_) )r,L,-a -Ye-L

>.

7.22='! --. 2 A t o ;: 9 i,
--

jjuYo.:r=.,_ri-;,= =-iiirr>=.>';, =ui'a-J'>2iri>* "'o o ;

) /t'f \.

2Y2"e'il U'.9 .'? a a

a '; 5
: s

6= =oo",7.d,-1 __U

< * u

t.'; "' 'iJ uy\r,=.9ca = o Y!= i-, ,,. o

J^.JA

? O
u1 '7

r=--z= I? 7E)*=)= i!=.=4=c 7e=.Ei

9L=a!*cJo=';-/a:

Z9=3o -vtOq?,at7!^,_7 ,zdo"

,=/e/'=,-a-i.='t.:

E7e 21 t $ e p 12.'i
i" ! Y

! d';"4 = Ei=+'2;..= :;.

1.
?

9l:1 2A';.= Jo-a='-tY c\l'=>72.c.:-

=
=

, :: -:, O.= <,'c

=J='='=drc;=2=Z': ,, .:,'rl' g;EZFfr'8, "-,22L= U =r.z'1 =?*2+arZ

2,.^ u'C r'\ \-./

zn?,4= -c.:lv'7

.g <i===at.

==zai

:f g; = -:) r = e 3 p u Y i i b H 3'AZ') ;', -: i Se Z Z* i h , / , - e ; i -a a 27,X A:; e !.68 : '' -=e. 4?, e eona a e 3 ? : ? 2 :--.'3 7, t ,. " =i F e dl 3i ; E .;, == =, d ? == = "" = u 3 5 2 3 = i 6': = i 7C.E F 7,, p a 35 F. 2 =;.6 :, 6 =. 7 i .e X ; .i=.'= ='l == Z 7 Ea \ i = c, = Vi A= .tZ e :;,:9l's = = 26 i 0. = 9 e = *. S g: = r 2 17 3.aZ t.: B = ; i= i 9 A 7*= - = - = =_p E?-t * - .= "E i' 2 E 2 e 2 ) E g A3 E p
?1

Z a i. '- s 2 " z i-y E 3 + ;_ _=-a 2 =' q Z ).2.o. ! : : Zi.;.= U 6 9=, = ^ g f ?;t2E 7 y,.= Z t .= E ; ,Z i: i. " ;^P5:oac'')4-::Z'a= aEzi.?Zh;lV4g E!: =. r:Z c; a I .i='s: aa U :=4 t r =i -E I e: b =,\ :': ; ; J , i a .*- ,- ,, = :7
Y-n

"?,2 e) s 2 :i Z ? 4Z i. '= > 1. I O.:, ,a - - ci u o o =.F :j' a a n l 1. A Y, 7. ). 6 : ; =5 a +, i ;

i; =T t

i 2TZ t '

::r'
l(.'i )( ','1 : (
'.

LU(
C,

',f,'

a2 F ! !: ? 2 :r 3 : ; = 'qY = =90ga?;,7"uu-=:u= ! Z 7? : o.ar o /, ? Zi 9='=-, (r ! =.-q ^ -= - -: ; - ;.=.2.;4,= a ? ? EHX!3;yYYei;='6'6= .= : =r=:a==r2=2=z<=?v=z .-. r. = q 'h ; - -- ?. 2 ?, : 9 +a = a L'Z z'e = E 3 7 :..= a e' ? Z ,i7 ; 3 ? , = z a Z t 1 i E cj;llr,-. i?.' 1,69=7i?_=;.= = -ti y.y.= = u ;z= a: = - a q X-o 17,=ZJ .io=39'.,4!2u-Y-2.? "3=Z\22 2 gEz =>'^'.n--'OF 'i= 3 y> sE5

= F U -c'r 7 -- u a- = - '? = 6'; F u Z':: U6 2 *'H .>_ ?.=.L,c UE ! ; - > ; i \ yl i c.c < = c. E - o.Y ='--. rg q'='i ( o.z c: :r,
=.i^r--Uii-q4-=

'

i :
i

t-. | ,:

r'

,t

t"';1

i i7

.\'

', ,' +

I'z\: ,!))
i,-

a;= =, '? = a= i-.= --'.=

) ==.= 'taqil

1; =

-= a, t

': n ==T-= ='* ",'.7. Z = ;:=.a 7*o=

i4 c, =

: ., I =,e .Y..9=;(f -:.:.:.a * -: c =."= ,'a = L'5 r 4 a 1.! i:E =uY.::=3= :-:=Z==== l!

-_,,/,

C)

+ ) :,

Z;2 i==1 t-37E2?,23 = - c = u.7. r. n 3 :r= ;i

= -

;:-

5;-=.-:i

,,..:

5:o -:i. 2

=il
!: j
-:r

? 2 7 Q f, Y , E7 3 ! ; !-=:: ;-1,7!1t+2 -: I-:AEz.-eZ ,='=?a=r2iy :-=ii"ii, ==15==?= = a- *, ..=3=3-'??.2 , i Z = a 4 4' :7 .= - 2 ! = *-7 ;',.2 '-'i - y :, =',' : ;: (*' - Z I - ;*?E : = ='.r==,; -'; :-. = 7, =9
= ' : ..; : r f .;:

-.=. =&.,:l-. Z;.=i,.V-=a =liBi==?g Z=Z=F.==2

4 .'=
'.

i;1?.2i?2 j7et.l .=;1

:
-..

i=)z
=a;
-

= :aeai=29=
:e t u
th v

..

^ -

:9
-

r,,a.:

-:

:i, r::/.=

-:

*-D i

7. =, ,.' >2
7 "\

.=1t.^-/-;-!!v-

t\

== J : ; 2 Z : =9 =.'; = = = ?= : ;.-:: = iZ ;i 'i == = ! i -', = : .1' vT. z=.= Z I \z = 1= =9:!-. i = z = . .t = t !^r = -"= = r p, = = i = ..:i Z: ? i ?l = '::a5 =.2-'4ai;.,.t
I

! t =:.6 .: ='; ? a'i ,^/'q-:v n O {. : I -- --, ' = Z = .a, ?-'

== J--W-,= L = >', _) w, J = -

i:7., l. v t: :. V'2 1 vt * "^ = Y .- : :,!l

.2
:

.- t;iJ- Z -'. = .2

:L.-

O',.'- !

a =

^ --

Z
C,

= = U 2. _-n fJ .^

11

Y=

r:6
-

J=.=

:l-l

= 9 I = /.. o U 7
-

=
=

= CJ

-,'- !

i==-:

*?

i Z iEE'=Z z e22 lzz"iE 1 e\iz ; ===|io 8',i74 ,812A p-z ; T ; z 2 1.t ZEi i2=:=i,E7: 7E ? ?lf ; *E z P=z? iV ZE::2= 2?i=7a;' EiZE".=ziE zi=-12 = ;= a r., E+ cZa,=ii=tiZ'z=72 =:E:=;= E E? : i.;za -e 2=e'z= = ?i?=-Z iiaEZi;5E ; "" , r.*2;87?; 2V? -= ?. I zEY -= j===ZE'iza =v r.'-T -* y i.,7E;2?a Z2 i=" A- i"s='u=ZvTao= rZr, =, I^ Z a ==Z zl' 2 ?Z Z ==i 7 Z 2 z =!E i== i7 i .-*3 ii i2, 2'=i y z = =- i Z t i; ega 2 z z.i\= = E? i i v ='i r i2 i Z17f i-, i =--= == 7 i : i 2 3 F: r'4 E v : z i i?7A=_Z=2,; a i e v ?, =, i 7 z 2a 2'i :; ': * E -e 6E 5T i ex r_?;z u -,4, = -.; -=21? 2 ZZ=_EJZ ^ #^ 2 ZVAi iEZE razE a z zz zi ia 7 ?2 aZZiEiZ':.EZA at p

i ?E

-^

2z

*z

i2i1?

a;

=-?,-; q ;r=ZEz-a=zaiEE;;*=, ; B E i "z,iEz z' z :2 ==z*E = *zZ;; E;: z=,2iriiZliE= ZEi ?+ 7-22'z 7 7 | z- v = n:l2,2 p =2.:=e=? ,z i-=: ?il= ": tvZ2'iE ZeZ?i.=i=aE = !=:EuZiZ'p=g2on*7 q'9;:?'''2 Zz = e;.:-;o ? r:=l I Ze:?iit4=i,'=* z'.;-t;r.?atz u ?.!,,i a: t z, 3a =.5 =2=,ai ?,E aE z ?'j'u;Z2a z z= lzzE==,x;7i?,727t'=F_z ,.2 .,2. z 2=a= +; i *2E;=i c ('T,e:= E il v 7 i, i' iiz; y iei,=- i E'i,"2 E ? E244,+ =';iE Z*2ZE ZaZZT4E=rEEi = = B i ; t ;! i liiEzz?z ::z;e**Ezzi:iE7T'r ?z? .,1 =, E i AZ ? E p : Z,E E E E z i E a ; E iZT i Z i 1 Z, E Z E E A 7 z -. v, i z -= ', i i zZ; =? e e i Y e $z h E+r' i E = Q a v)7 i -eel i3;i7;i = Lz=.=a 2a: =, ;7. = L=7
u
_q

>-

=o

?ii

==

4E 4cs=a4u

2.ti77E*2ir-

l,rrrrrlscrrb r: nri{ 1:;u 1,i,,,,r'1 .1,':-1,,,,.1,,,,.,.r, ,,,,r, .uclsnV 1 ':i,.it:tl Srrrlsclllrrr ,(trn t:.ro.; no,l lrrur;l ;otorur)iO .t(l

"

1r,1r

l6

rr:rltl)uV uloo)l A\olll/\\ or;lrrr .rrr.rl s.llrrl.l..lt.ltqt)\.,1 /-

.,61 'f ll:rnul \/ )l I'il'v x s.tllll.l..l|.rl(lll)

,r,,,.i

suot

- ra\Eads aoua::tLtlr
rrcsorrJ

lsan b r{t e1 u a tu o 1 d d n s

6u

t1s e

e 0ulqceotcicly
'ro,(
1o

(.Julru.rrro.{ lnr:r1 p1rro.1 ,,(ri:,16y 1 .l)(x)r) ().\\l i\ltl

ll.l

rr;rirrr:ll crll (roo, rl)lll^\ llrr rr..{ plnrlr

'
1

,r,,i:l,ijj';l]':]
,

rr,r,:<1 r.rr

,r.rr o) ,,,,

"\-l

'Jr0rll JJ^o 1s061 uotllt[tis3.rd s,rrcinrrlllJt(l o.lJrl^\,rr0rr1 n0,( ol) JrU Jst].tx:l .\/

tt.,( .r rt i.t1,r,,c,,,,s''l,f]irq']i',1i,:]f $ rrorlrl:l;loll Jrll lu,(r.g..orr ,(r.rrrs trr.1 .J1

utooJ e Jol 6uu1oo1 .g

'l)ur:llolS 'Jil)urlC u,ol.l
J)rnll.lu.l:)r:11

,(rruo; .rt;l no,( ()l) A\ol| .fl

,lanbueq aJuilaluol, atil lnoqe 6up1s1 ' 'r,,.i,r,,i ,i1t r1, .1,..1r,,, 11r,,,,G4 :,i,rLug Lct i,irrolu irlrltlf tl \-l ^\orl 'rut ll)l .llJA\ :Jll.trlr:l! ro '1r1ir.r s.lull.l. ;u().t.nt1 r1 i l.'lcfo rrl s..rclur Jll -7lV clll u() Iursr.l (ruI rllt^\ 3ur1.to,r nrt,( cru.llO:i:lr.ltr:]!.rO ',r\()i5-Ulr_) tUo.l] Uo t.lu[] .ON :U(u.lIB .l(.1 lt.lr](i ul.l
1.,,,,1, 1 ',r.,(

lli' l:ililll:[:,i.]';'t;;1; :Lji+

lruJo Irrol.l

...,,,,,,,, J,l l""' 1,.,,, rrr itrrllrs JrJ,1\ llo,\ 'scl()u.l() riJssl:ru

i:i:lll,lJ:l ) I,ii,l l J X irrrlul n,i.i nr,,.r r .ii

.

.autl aalJoc, aql u! 6utpuelg .7

)jr'rl.r. 'os {rs or n.,( Jo r)rr I , ,,li}t],;t'tt r,, 'rlrrtrrr ,(.rl,r :lrlr:tl .rlro,( pr,(olit.: .o.)llll)l! .rq :uo.l nrtl .lq I

l,lil;f

(llsnotaatd taut lott) ta4eads actraJaJttoJ e 6utqceoLdc!y

4:1 7 -9 " Cr 7 atq^c-.i..<'

=- _'z=L--ii---"= =,+, =y29=q; ciaF97'"=c=uo==i-Cl (n ca

=_

i 2 9'a o

i g,-:

6a
C -

<.=

b:;=iZaZ L.:=--.; ;. 3'9.

,i!r=E=? u - u y, = 7, E-*iE?;E X Z Z .< A = =

4' z 7 -'t

A= -G=;Ctdli

-f !.! i-

g! E; s! , E|EE.E =. E.ig57,zi- irz?-*i== ] i.= i == "- z Z-6 ;,i i Y.F=,;t .9d ; =,: i ! a ; ie c E EE. EEE, E E.E=Z. x'! = ;2:.t ".i:4 ".i, F,E e 2.";,iri z li'; EE E A il!' g, *E E E Z E 7E= i izz= E i4'z=E i""V z?l E , .;:,:ikt,.3E: agE= = alE .?=t??EZTEiEE=i:i= z o'G2= =!; i:'z B i7:2'i+ ; iiir^E i , ?.1. E= '',i.i:1?i."T. rE *z '",iE i : = = z == : ?-? ti.' I m; ? ,t',E vCz'^ e= ;7E r P,= v2 a z;,i,n z Q'' Y E :*il[ E g i,'2,' z'.=,, ? Z E? 1!.EzYr rEZ* ,.q = = ;c) |iE .9 .l ':':a iZE=z=sEIg! c)='3"'i7EeEEaiE " :ca ',ii; '; = :'d : D.7 =; 7. z i!..rr Z Z -:'E '!Z !o -i 2i= zE E,E;I2i lriin *zi *1 t a2 Y -- x.=Zl.y]. i =$* - , eEiEE,iEiiEZE',i .= = i=.2 ='-=2 = z = "= i, ; "e ',,.8 E za E ei Ei ; EizEi Z'"{ E ; r: ;= i=;. T ;i = ;.e? ; = Z *= =t 7E: = EEi.E*t,EIE \EEEi = 2':4 e"'-'d'E 'A '9 '9 ?EEEi' ',ZZ,Z V ?"2-E z, E'=$,; :'r.... .''= o =,-r1".-f:to: '
e,.J

<,' .?i.93;=.!;I - =,n ;3'<i ; = =Z2Ee,=y.

--

g izE |i, E ; : i t=i+lE? - r', r-.Z 2 a' a== ! a i e Z p ;;u s = ? " E z ;i r+:= E;=ei'; Z, :;:e.?.::1,=i';r.i, = !2. 1; yi,: == i=2 in?"7i;=ZEiJ1
-= p a

,.: liJ

i!

?;iZ a i != ic- 14 ZZ;t . E "i ;; = i=Z i'114?412;,1.=!1 + -trz ?i,::; =zi? 3 I iT,!, *: rr,r{=r,
;=

?,

=q a)

-d

e'4

e-,

U:

.,

ii

=J

"-,

j-..:., j:.........ij,-..,,1...,.t.:'.t.'tt "1::.',''1,|i.;;,-;,,n.+::i:.:. :...-r:- ,, : .: : :1:_.,i ;::_.1.',.i.;a::t:, ._ ,. t-,-t.;t-,,.--,'..,1 .;,.,-1 ''..;'f.1':,tt ','tt,,:.'t'ltj:1,''tf'...;':a.;
':

='ol

:.::.

. .-..) = ! = !.:,? f., _ 2 CZ.= ;.,2 -'=,; -aL ., = ?', ; 2 =','. i-. - a= =ag=ty1.i_-li.==6 -.=l7' Y>'? i'-= n = - =Z ('J.=.J Z :' !== l-= -; ='1 -,= z _ -. -+ a 2'Q? ='u =.= .; = 2 ;.1 y, i., a 1-Z y 1, - u 2,:: .i'= . : ;c = V e .i,. ; i 1'.1- e,'' = .,, :j 2 -. .Z: = 'li : I ."_i Z Y :, 4 .. = =
i, :i
:

,:

- i: or i1 1i1;. +=_;i ?=2_i 3;ll, : ;

S
: i -:

.-

i s ..t

= -;Z j i = z:_,= ici .:::^/--=:--=-a.-='i -_ ==:; * ,. f. I.: i _.:., a t.-j a- 3 Z i .= : a.! i i i t= . = :i= :.!,= i'!: : I Z= = .'2 '!. ) -.= -=: ": C i: - -:: - = =-,i =:! =-; . r=r, i = z! =?7=! 7. ?=== =-= :=-!.===i=.>-=={:.6' t, i :-' a = r.,, 1 Z 7: a Z :'. i :1 1 :-,.2:-"-a-a.->==-=4 =':' -2 r_ V; + I., ; |i r, i_ 2 + = _;'t= --:i :r = ]. a r:'= .1 = = - : ?; : =.1 ='; i = = i -.-i= y: ,: I : t Z :') t; > .' i,=2 i -= ; :== = :.: a a-=:r :: : lr; i 3 r .r2.2 \; - 1'=.: i.,'= = -.,.'- v
?,

Z - _ = .. =.ri =,= - Z.-,- =;_t = 2r.na===.F,:.Jri;t1=y". > .; aic:.1: 7 i u.= -ca a'= .': ? :'.vuE=a= =a ^ a f. 7 u ct 1 == i v ! 1 u.= a =-? a.':'. -. = e = , Z 2= 1 "u :, l- * :- :: : -- = t .^ = = -, " .2 L .:1 = -'., r'.= n - :1d =a = a = - =-a i ='' V.-.=r) - == -=:= == i - = Z', = =:=:1..=-=-i.i_=;:i -. .. - -:= I J---Z:: = : .;; .' r. = 7 4= :'.,; *.: 7 ; = -'"'iZ t );. = ='=,."

:: :

Ir. )

--

'-

-'=

tr --- a i = -

-/-.=--_:-_-':=-';.=: -'t - U
,. :-

.= :'-'.1

.r'

.?