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7221 Medical Sciences I DETAILED CONTENT OUTLINE A Medical/Dental Terminology MD01.01 Interpret medical word roots, prefixes and suffixes. A. Word roots 1. aden 2. angio 3. arterio 4. arthro 5. carcin 6. cardio 7. cephal 8. cerebro 9. chem. 10. chole 11. colo 12. costo 13. cranio 14. cyan 15. cysto 16. cyte 17. derma 18. entero 19. epidemi 20. erythro 21. gastro 22. gingival 23. gloss 24. glycol 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. hepat hemo hydro hystero leuko lingua mamm, mast myelo myo nephro, ren neuro ocul, ophthal oophor odont, dent osteo oto ped, pod phleb pneumo, pulm psych rhin salpingo throac trach B. Prefixes 1. a,an 2. ab 3. ad 4. ante 5. anti 6. aut 7. bi 8. brady 9. circum 10. contra 11. di 12. diplo 13. dys 14. ecto 15. endo, intra 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. epi hemi hyper hypo inter later lipo mal mega, macro micro mono, uni neo ortho peri poly Summer 2005 MS I Content Outline Page 1 31. 32. 33. 34. 35. 36. post pre pro pseudo retro semi C. Suffixes 1. a, ac, al 2. algia 3. ase 4. centre 5. cide 6. cente 7. dipsia 8. ectomy 9. emesis 10. emia 11. esthesia 12. genesis, genic 13. gram, graph 14. ia 15. iasis 16. ism 17. itis 18. lysis 19. malacia 20. megaly 21. oid MD01.02 37. 38. 39. 40. 41. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. sub tachy tele trans ultra ologist ology oma orrhagia orrhea osis ostomy pathy penia phobia plasty plegia pnea ptosis sclerosis scope stasis toxic trophy uria Analyze words commonly used in medical/dental care. A. Interpret word combinations B. Application Summer 2005 MS I Content Outline Page 2 C. Body Systems MD03.01 Explain the structural units of the body. A. Anatomy and physiology B. Directions/position 1. Anatomical position 2. Anterior and ventral 3. Posterior and dorsal 4. Cranial and caudal 5. Superior and inferior 6. Medial and lateral 7. Proximal and distal 8. Superficial or external and deep or internal C. Planes and sections 1. Sagittal plane 2. Coronal (frontal) plane 3. Transverse (cross section) D. Cavities 1. Dorsal cavity 2. Cranial cavity 3. Spinal cavity 4. Thoracic cavity 5. Abdominal cavity 6. Pelvic cavity E. Abdominal/pelvic regions 1. Epigastric 2. Umbilical 3. Hypogastric 4. Hypochondriac 5. Iliac (inguinal) 6. Lumbar MD03.02 Analyze body tissues and membranes. A. Tissues 1. Epithelial tissue 2. Connective tissue a. Adipose b. Cartilage c. Tendons d. Ligaments 3. Muscle tissue 4. Nervous tissue B. Membranes (Epithelial) 1. Mucous membranes 2. Serous membrane a. Parietal or visceral b. Pleural membrane c. Pericardial membrane d. Peritoneal membrane C. Organs and systems 1. Organs a. Organ systems b. Organelles c. Organism 2. Systems Summer 2005 MS I Content Outline Page 2 a. b. c. d. e. f. g. h. i. D. Integumentary Skeletal Muscular Digestive Respiratory Urinary (Excretory) Nervous (Sensory) Endocrine Reproductive Integumentary System MD04.01 Explain the structure of the integumentary system. A. Layers of the skin 1. Epidermis – outer layer a. Stratum corneum i. Outermost of three epidermal layers ii. Contains keratin b. Stratum germinativum c. Melanocytes and melanin d. Papillae 2. Dermis – inner layer a. Connective tissue b. Blood vessels c. Nerve endings d. Muscles e. Hair follicles f. Oil and sweat glands g. Fat cells 3. Subcutaneous a. Adipose B. Appendages 1. Hair a. Cortex and medulla b. Root and shaft c. Hair follicle d. Papilla e. Arrector pili muscle 2. Nails a. Matrix b. Keratin 3. Glands a. Sudoriferous glands i. Sweat = 99% water ii. Location iii. Pores iv. Activated by heat, pain, fever and nervousness b. Sebaceous glands i. Sebum – protects and lubricates skin Summer 2005 MS I Content Outline Page 3 MD04.02 Analyze the functions of the integumentary system. A. Skin 1. Protection a. Intact skin best protection b. Skin generally too dry for microbial growth c. Most skin bacteria associated with hair follicles or sweat glands d. Best way to prevent spread of disease is handwashing 2. Regulation of body temperature 3. Manufactures vitamin D 4. Sensory perception 5. Storage 6. Sun screen 7. Absorption B. Glands 1. Sudoriferous glands (sweat glands) a. Perspiration is 99% water b. Distributed over the entire skin surface, large numbers under the arms, palms of hands, soles of feet and forehead c. Perspiration excreted through pores d. May be activated by heat, pain, fever and nervousness e. Underarm odor caused by bacteria mixed with sweat f. Ave fluid loss = 500 cc/day 2. Sebaceous glands a. Sebum - oil b. Protects and lubricates skin MD04.03 Discuss characteristics and treatment of common skin disorders. A. Acne 1. Disorder of sebaceous glands 2. Sebum plugs pores and area fills with leukocytes 3. Also, blackheads, cysts, pimples and scarring B. Albinism – absence of melanin C. Alopecia – baldness D. Athlete’s foot 1. Contagious fungal infection 2. Usually contracted in public baths and showers 3. Rx – antifungal agents E. Boils (carbuncles) 1. Painful, bacterial infection of hair follicle or sebaceous glands 2. Rx – antibiotics, excision and drainage of affected area F. Dermatitis 1. Non-specific skin inflammation 2. Rash – reaction to soap, plants, etc. 3. Skin blotches – caused by stress G. Eczema 1. Acute or chronic inflammatory skin disease 2. Skin dry, red, itchy and scaly 3. Rx – remove cause, hydrocortisone to help alleviate symptoms H. Excoriation - abrasion I. Herpes 1. Genital herpes Summer 2005 MS I Content Outline Page 4 a. Viral blister in genital area b. Spread through sexual contact c. Periods of remission and exacerbation d. Rx – Acyclovir e. Can be passed to newborn during genital delivery 2. Herpes simplex I a. Viral b. Fever blister or cold sore 3. Shingles (herpes zoster) a. Viral infections of nerve endings b. On chest or abdomen, accompanied by severe pain J. Impetigo 1. Acute, inflammatory and contagious 2. Seen in babies and young children 3. Caused by staphylococcus or streptococcus 4. Vesicles that rupture and develop distinct yellow crusts K. Pruritis - itching L. Psoriasis 1. Chronic inflammatory skin disease 2. Dry reddish patches covered with silvery-white scales M. Ringworm 1. Contagious fungal infection 2. Raised, itchy circular patches with crusts N. Scabies 1. Communicable 2. Severe itching 3. Mite burrows in skin, lays eggs, eggs hatch O. Skin cancer 1. Associated with exposure to sun (UV rays) 2. Most common type of cancer in people i.Basal cell carcinoma a. Most common, least malignant b. Usually on face c. Rx – surgical removal or radiation 4. Squamous cell carcinoma a. Mostly scalp and lower lip b. Grows rapidly, metastasizes to lymph nodes c. Rx – surgical removal or radiation d. Prognosis good with early diagnosis 5. Melanoma a. Malignant b. Occurs in melanocytes c. Metastasizes to other areas quickly d. Brown or black irregular patch that occurs suddenly e. Change in existing wart or mole may indicate melanoma f. Rx – surgical removal of melanoma and surrounding area and chemotherapy P. Burns 1. First degree a. Superficial, skin red and dry b. Involves only epidermis c. Rx – cold water d. Heals in one week 2. Second degree a. Epidermis and dermis b. Pain, swelling, redness and blistering Summer 2005 MS I Content Outline Page 5 c. Subject to infection d. Rx – pain medication, dry sterile dressing e. Healing within two weeks 3. Third degree a. Epidermis, dermis, and subcutaneous layers (full thickness) b. Loss of skin, blackened skin c. May be life threatening d. Rx – prevention of infection, fluid replacement, skin grafting 4. Rule of nines – method of measuring percent of body burned Q. Skin lesions 1. Pustule 2. Tumor 3. Ulcer (superficial and decubitus) 4. Vesicle R. Urticaria (hives) 1. Itchy wheals or welts 2. Usually allergic reaction to drugs, food, etc. 3. Rx – avoid allergen S. Warts (verrucae) 1. Caused by virus 2. Some disappear spontaneously, others removed with liquid nitrogen, chemicals or laser E. Skeletal System MD05.01 Explain the structure of the bones. A. Structure of long bones 1. Osteocytes 2. Fontanel 3. Structure a. Diaphysis (compact bone) b. Epiphysis c. Medullary canal d. Endosteum e. Spongy bone f. Periosteum g. Articular cartilage B. Parts of the skeleton 1. Axial skeleton a. Skull i. Parietal ii. Frontal iii. Occipital iv. Temporal v. Nasal bone vi. Zygomatic arch vii. Infraorbital foramen viii. Mental foramen ix. Mandible x. Maxilla xi. Vomer xii. Mastoid process xiii. Styloid process xiv. External auditory meatus Summer 2005 MS I Content Outline Page 6 xv. Suture b. Spinal column/vertebra i. Cervical vertebrae ii. Thoracic vertebrae iii. Lumbar vertebrae iv. Sacrum v. Coccyx c. Ribs and sternum i. Xiphoid process 2. Appendicular skeleton a. Clavicle and scapula b. Humerus, radius and ulna c. Carpals, metacarpals and phalanges i. Thumb ii. First through fourth digits d. Pelvis i. Ilium ii. Ischium iii. Pubis e. Femur, patella, tibia and fibula f. Tarsals, metatarsals, phalanges g. Calcaneus C. Joints 1. Ball and socket joints 2. Hinge joints 3. Pivot joints 4. Gliding joints 5. Suture MD05.02 Analyze the function of the skeletal system. A. Supports B. Protects internal organs C. Movement and anchorage 1. Abduction and adduction 2. Circumduction and rotation 3. Flexion and extension 4. Pronation and supination D. Mineral storage (calcium and phosphorus) E. Hemopoiesis 1. White blood cells made in yellow marrow 2. Red blood cells made in red marrow F. Bone formation 1. Embryo skeleton starts as osteoblasts, then change to cartilage 2. Ossification (bone replaces cartilage) starts at 8 weeks 3. Fontanel – soft spot on baby’s head 4. Periosteum – tough covering of long bones, contains blood vessels, lymph vessels and nerves G. Vertebral column 1. Encloses spinal cord 2. Separated by pads of cartilage = intervertebral discs H. Bones 1. 12 pairs of ribs = 7 true, 3 false, 2 floating 2. Femur is longest and strongest bone in body Summer 2005 MS I Content Outline Page 7 I. MD05.03 Joints 1. Synovial fluid - lubrication 2. Types of joints a. Ball and socket joints – ball-shaped head, examp. Hip and shoulder b. Hinge joints – move in one direction or plane, examp. Knees, elbows, outer joints of fingers c. Pivot joints – rotate on a 2nd, arch-shaped bone, examp. radius and ulna d. Gliding joints – flat surfaces glide across each other, examp. vertebrae e. Suture – immovable joint in skull Discuss characteristics and treatment of common skeletal disorders. A. Trauma 1. Fracture – any break in a bone a. Greenstick fracture – common in children, bone bent and splintered but never completely separates b. Comminuted fracture – splintered or broken into many pieces c. Compound fracture (open fracture) broken bones pierce skin, can lead to infection d. Simple fracture (closed fracture) bone broken, broken ends do not break the skin e. Spiral fracture – bone twists, resulting in one or more breaks f. Closed reduction – cast or splint g. Open reduction/internal fixation – surgical intervention with devices such as wires, metal plates or screws to hold the bones in alignment c. Traction – pulling force used to hold the bones in place, used for fractures of long bones 2. Sprain – sudden or unusual motion, ligaments torn 3. Strain – overstretching or tearing of muscle 4. Dislocation – bone displaced from proper position in joint 5. Whiplash – trauma to the cervical vertebra, usually from a car accident B. Arthritis – inflammation of one or more joints 1. Rheumatoid – chronic, autoimmune disease, joint becomes swollen and painful, joint deformities common 2. Osteoarthritis – degenerative, occurs with aging, joints become large and painful, Rx with medications C. Spinal defects – abnormal curvature 1. Kyphosis - hunchback 2. Lordosis - swayback 3. Scoliosis – lateral curvature D. Bursitis – inflammation of bursa (joint sacs) E. Herniated disk 1. Intervertebral disk ruptures or protrudes, putting pressure on spinal nerve, usually lumbo-sacral 2. Treat with bedrest, traction and surgery F. Osteomyelitis – bone infection G. Osteoporosis 1. 80% affected are women 2. Loss of bone mass leading to thin, porous bones that are prone to fracture Summer 2005 MS I Content Outline Page 8 3. On x-ray, looks like swiss cheese 4. Prevented by dietary calcium H. Rickets 1. Found in children 2. Caused by lack of vitamin D 3. Bones become soft 4. Rx with calcium, vitamin D and sunshine I. Gout – uric acid deposited in joint cavity, mostly the great toe in men F. Muscular System MD06.01 Describe the structure of the muscles A. Muscles 1. Nearly half our weight comes from muscle tissue 2. There are 650 different muscles in the human body 3. Muscles give shape and form 4. Muscles produce body heat B. Types of muscles 1. Voluntary a. Skeletal – muscles attached to bone b. The sarcolemma is the cell membrane 2. Involuntary a. Smooth (visceral) – found in internal organs b. Cardiac – found in heart 3. Sphincter – circular muscles in openings between esophagus and stomach, anus and urethra C. Principal skeletal muscles 1. Biceps brachii 2. Brachioradialis 3. Buccinator 4. Deltoid 5. Diaphragm 6. External oblique 7. Hamstrings 8. Gastrocnemius 9. Gluteus maximus 10. Gluteus medius 11. Intercostal muscles 12. Latissiumus dorsi 13. Masseter 14. Pectoralis major 15. Quadriceps femoris 16. Rectus abdominus 17. Rectus femoris 18. Sartorius 19. Soleus major 20. Sternocleidomastoid 21. Tibialis anterior 22. Trapezius 23. Triceps brachii 24. Vastus lateralis 25. Vastus medialis Summer 2005 MS I Content Outline Page 9 MD06.02 Analyze the function of the muscular system A. Responsible for: 1. Body movement 2. Posture 3. Body heat B. Characteristics 1. Contractibility – muscle becomes shorter and thicker causing muscle movement 2. Excitability – respond to stimuli 3. Extensibility – ability to stretch muscles 4. Elasticity – ability to return to original length C. Movement 1. Muscles move bones by pulling on them 2. Groups of muscles usually contract to produce a single movement 1. Motor unit – a motor neuron plus all the muscle fibers it stimulates 2. Neuromuscular junction – junction between the motor neuron’s fiber which transmits the impulse, and the muscle cell membrane 3. Acetylcholine – chemical neurotransmitter, diffuses across the synaptic cleft (carries impulse across synaptic cleft) 4. Muscle fatigue – caused by the accumulation of lactic acid in the muscles 5. Oxygen debt – after exercise, the amount of oxygen needed by the muscle to change lactic acid back to glucose 3. Diaphragm – dome-shaped muscle, separates abdominal and thoracic cavity, aids in breathing D. Muscle tone – muscles slightly contracted and ready E. Exercise and training MD06.03 Identify characteristics and treatment of common muscle disorders A. Conditions 1. Atrophy – wasting away of muscle due to lack of use 2. Hypertrophy – an increase in the size of the muscle cell 3. Contracture – tightening or shortening of a muscle 4. Flat feet (talipes) – weakening of leg muscles that support arch, downward pressure on foot flattens arches, Rx with exercise, massage and corrective shoes. 5. Hernia – organs protrude through weak muscle 6. Muscular dystrophy – group of diseases in which muscle cells deteriorate 7. Myasthenia gravis – progressive muscular weakness and paralysis, sometimes death, cause unknown, fatal when respiratory muscles are paralyzed 8. Tetanus (Lockjaw) Infectious disease, continuous spasms of voluntary muscles, bacteria enters body through puncture wound, prevent by anti-toxoid vaccine 9. Torticollis (Wry neck) – inflammation of trapezius and/or sternocleidomastoid muscle B. Injury and overuse 1. Strain – muscle tear, symps are pain and swelling, Rx – ice packs 2. Muscle spasm (cramp) – sustained contraction of muscle Summer 2005 MS I Content Outline Page 10 3. Myalgia – muscle pain 4. Tendonitis – inflammation of tendon C. Treatment 1. Massage 2. IM injections G. Hematology MD07.01 Describe the structure of the blood. A. Adult = 8-10 pints B. Composition 1. Plasma 2. Serum 3. Cellular components (red blood cells, white blood cells, platelets) C. Plasma 1. Straw colored 2. Contains water, blood proteins, plasma proteins, nutrients, etc. D. Erythrocytes 1. Shape = biconcave discs, donut-shaped 2. Hemoglobin a. Gives red color b. Heme is iron, globin is protein c. Arterial blood is bright red = lots of oxygen d. Venous blood is dark crimson = lots of CO 2 E. Leukocytes 1. May be granular, agranular, translucent or ameboid 2. Larger than erythrocytes 3. Types of white cells a. Neutrophils b. Eosinophils c. Basophils d. Lymphocytes e. Monocytes F. Thrombocytes 1. Platelets 2. Make the blood clot 3. Smallest solid components of blood 4. Not cells – fragments of megakaryocytes MD07.02 Analyze the function of the blood. A. Four main functions 1. Transport oxygen, nutrients, cellular waste products and hormones 2. Aids in distribution of heat 3. Regulates acid-base balance 4. Helps protect against infection B. Plasma 1. Liquid part of blood 2. Plasma proteins a. Fibrinogen – blood clotting b. Albumin – osmotic pressure and volume Summer 2005 MS I Content Outline Page 11 Prothrombin – helps blood coagulate, production dependent on Vitamin K 4. Reduction of Heparin Erythrocytes 1. Contain hemoglobin a. Transports O2 to tissues and CO2 away from cells b. Red cells travel to lungs to get O2 and give up CO2, then to tissues to deliver O2 and pick up CO2 2. Erythropoiesis – manufacture of red cells in bone marrow 3. Life span a. Red cells live 120 days b. Old cells broken down by spleen and liver 4. Hemolysis – rupture of erythrocyte from blood transfusion or disease Leukocytes 1. Fight infection 2. Phagocytosis – white cells surround, engulf and digest harmful bacteria 3. Basophils produce heparin – and anticoagulant 4. Diapedesis – when white cells move through capillary walls into neighboring tissues 5. Inflammation a. Body’s reaction to chemical and physical trauma b. Pathogenic – disease producing microorganisms that can cause infection c. Symptoms – redness, local heat, swelling and pain d. Why? Bacterial toxins, increased blood flow, collection of plasma in tissues (edema) Thrombocytes (Platelets) 1. Synthesized in red marrow 2. Necessary for the initiation of the blood clotting process Coagulation 1. Cut or injury causes to break/clump 2. Chain reaction follows and involves the release of thromboplastin, prothrombin, thrombin and fibrinogen 3. Fibrin creates a mesh that traps red blood cells, platelets and plasma, creating a blood clot 4. Anticoagulants prevent blood clotting 5. Heparin is an anticoagulant Blood types 1. Four major types, determined by presence or absence of an antigen on the surface of the red blood cell a. A b. B c. O d. AB 2. Inherited from parents 3. Antibody – a protein in the plasma that will inactivate a foreign substance that enters the body a. Someone with type A blood has b antibodies b. Someone with type B blood has a antibodies c. Someone with type AB blood has no antibodies d. Someone with type O blood has a and b antibodies 4. Universal donor – O 5. Universal recipient – AB 6. Red cells may also contain Rh factor c. C. D. E. F. G. Summer 2005 MS I Content Outline Page 12 MD07.03 J. Analyze characteristics and treatment of common blood disorders. A. Inflammation 1. Pus 2. Abscess 3. Pyrexia 4. Leukocytosis 5. Edema B. Leukopenia – decrease in WBCs C. Anemia – deficiency in number or % of RBCs 1. Iron-deficiency anemia a. Usually women, children and adolescents b. Deficiency of dietary iron causing insufficient hemoglobin c. Rx with iron supplements, green leafy vegetables 2. Aplastic anemia a. Bone marrow does not produce enough blood cells b. Cause – drugs or radiation therapy 3. Sickle cell anemia a. Chronic, inherited blood disorder b. RBCs abnormal sickle (crescent) shape c. Sickle cells break easily and carry less oxygen d. Occurs primarily in African Americans D. Polycythemia – too many RBCs E. Embolism – moving blood clot F. Thrombosis (thrombus) – formation of a blood clot in a vessel G. Hematoma 1. Localized mass of blood found in organ, tissue or space 2. Caused by injury that causes a blood vessel to rupture H. Hemophilia 1. Hereditary – sex-linked, transmitted from mother to son 2. Missing clotting factor 3. Blood clots slowly 4. Rx with missing clotting factor, avoid trauma I. Thrombocytopenia 1. Not enough platelets 2. Blood does not clot properly J. Leukemia 1. Malignancy 2. Overproduction of immature white blood cells 3. Research on cord blood K. Septicemia – pathogens or toxins in the blood, Rx with antibiotics L. Erythroblastosis fetalis 1. Hemolytic disease of the newborn 2. Rx - RHO gam – must be given within 72 hours of childbirth Treatment and diagnosis 1. Bone marrow aspiration – removal of bone marrow sample with a needle for diagnostic purposes 2. Arthroscopy – examination of joint using arthroscope with fiber optic lens, most knee injuries treated with arthroscopy 3. Radiography – x-ray of bones Summer 2005 MS I Content Outline Page 13 H. Circulatory System MD08.01 Explain the structure of the heart. A. Size, shape and location 1. Size of closed fist 2. In thoracic cavity 3. Apex 4. Four chambers B. Layers 1. Pericardium 2. Myocardium 3. Endocardium 4. Septum C. Structures to and from heart 1. Superior and inferior vena cava 2. Pulmonary artery and vein 3. Aorta D. Chambers and valves 1. Atria (atrium) 2. Ventricles (ventricle) 3. Tricuspid valve 4. Mitral (bicuspid) valve 5. Pulmonary semilunar valve 6. Aortic semilunar valve MD08.02 Analyze the function of the heart A. Four main functions of circulatory system a. Pump b. Blood transport system around body c. Carries oxygen and nutrients to cells, carries away waster products d. Lymph system – returns excess tissue fluid to general circulation B. Heart a. Ave. 72 beats per minute, 100,000 beats per day b. Superior and inferior vena cava bring deoxygenated blood to right atrium c. Pulmonary artery takes blood from right ventricle to lungs d. Pulmonary veins bring oxygenated blood from lungs to left atrium e. Aorta takes blood from left ventricle to rest of body f. Four heart valves permit flow of blood in one direction C. Pump a. Heart is a double pump b. Right heart = right atrium tricuspid valve right ventricle pulmonary semilunar valve pulmonary artery lungs (for oxygen) c. Left heart = Lungs pulmonary veins left atrium mitral valve left ventricle aortic semilunar valve aorta general circulation D. Heart sounds (lubb dupp) E. Electrical activity Summer 2005 MS I Content Outline Page 14 1. SA (sinoatrial) node = pacemaker, sends out electrical impulses, spreads impulse over atria and makes them contract 2. AV (atrioventricular) node = carries impulse to bundle of His 3. Bundle of His = conducting fibers in septum, divides into right and left branches in ventricles to Purkinje fibers 4. Purkinje fibers = cause ventricles to contract MD08.03 Analyze circulation and the blood vessels A. Cardiopulmonary circulation – carries blood from heart to lungs 1. Oxygenated and deoxygenated blood 2. Oxygen/carbon dioxide exchange B. General circulation 1. Coronary arteries 2. Aorta 3. Systemic circulation C. Blood vessels 1. Arteries a. Carry oxygenated blood away from the heart to the capillaries b. Elastic, muscular and thick-walled c. Transport blood under very high pressure 2. Arterioles 3. Veins a. Carry deoxygenated blood away from capillaries to heart b. Less elastic and muscular than arteries c. Thin walled, collapse easily when not filled with blood d. Superior and inferior vena cava carry blood to heart 4. Venules 5. Capillaries a. Smallest blood vessels b. Only seen with microscope c. Connect arterioles and venules e. Walls are one-cell thick, allow for selective permeability 6. Valves – permit flow of blood only in direction of heart 7. Capillaries 8. Jugular vein – located in neck 9. Carotid artery – carries blood to brain D. Blood pressure 1. Systolic – ave = 120 (Systole is contraction phase) 2. Diastolic – ave = 80 (Diastole is relaxation phase) E. Pulse – alternating expansion and contraction of an artery as blood flows through it 1. Brachial 2. Carotid 3. Femoral 4. Pedal 5. Popliteal 6. Radial Summer 2005 MS I Content Outline Page 15 MD08.04 Discuss characteristics and treatment of common cardiac and circulatory disorders. A. Heart diseases 1. Symptoms a. Arrythmia (dysrrhythmia) – any change from normal heart rate or rhythm b. Bradycardia – slow heart rate (<60) c. Tachycardia – rapid heart rate (>100) 2. Coronary artery disease a. Angina pectoris – chest pain, lack of O2 to heart muscle, treat with nitroglycerine b. Edema – fluid in tissues, often caused by poor circulation 3. Myocardial infarction (MI, heart attack) a. Lack of blood supply to myocardium b. Symps – severe chest pain radiating to left shoulder, arm, neck and jaw, nausea, diaphoresis, dyspnea c. Rx – bedrest, oxygen, medication d. Morphine for pain e. Anticoagulant therapy to prevent further clots from forming f. Surgery may be necessary 4. Heart disease a. Congestive heart failure – ventricles unable to contract effectively and blood pools in the heart, edema in lower extremities, blood backs up in lungs b. Endocarditis – inflammation of membrane that lines heart and covers valves c. Myocarditis – inflammation of heart muscle d. Pericarditis – inflammation of outer membrane of heart, symptoms are chest pain, cough, dyspnea, tachycardia, fever d. Mitral valve prolapse – valve closes imperfectly, symptoms in response to stress include fatigue, palpitations (racing heart) headache, chest pain, anxiety e. Murmur – defect in heart valve, causing gurgling or hissing sound B. Vascular diseases 1. Aneurysm – ballooning of an artery, thinning and weakening 2. Arteriosclerosis – arterial walls thicken and lose elasticity 3. Atherosclerosis – fatty deposits form on walls of arteries and block circulation 4. Hypertension a. High blood pressure b. Silent killer – usually no symptoms c. Leads to strokes, heart attacks, kidney failure d. Higher in African-Americans & post-menopausal women e. Risk factors – smoking, overweight, stress, high fat diets, family history f. Treatment – relaxation, low fat diet, exercise, weight loss, medication 5. Hypotension – low blood pressure, systolic <100 6. Embolism – traveling blood clot Summer 2005 MS I Content Outline Page 16 7. Varicose veins a. Swollen, distended veins b. Heredity or due to poor posture, prolonged periods of standing, physical exertion, age and pregnancy c. Hemorrhoid – varicose rectal vein 8. Phlebitis – inflammation of lining of vein, accompanied by clotting of blood, symptoms are edema, pain and redness C. Diagnosis and treatment 1. Electrocardiogram – electrical tracing of the heart 2. Coronary bypass – healthy vein from leg removed and attached before and after the coronary obstruction, creating an alternate route for blood supply to the myocardium 3. AED – automated external defibrillator 4. Defibrillation – electrical shock to bring the heart back to a normal rhythm 5. CPR – cardiopulmonary resuscitation, used in presence of cardiac arrest 6. Artificial pacemaker – when heart has conduction (electrical impulse) defect, demand pacemaker fires when heart rate drops below minimum, causes heart to contract 7. Angiogram – x-ray of blood vessel using dye 8. Angioplasty – balloon used to open clogged vessels 9. Cardiac catheterization – catheter fed into heart, dye injected, x-rays taken as dye moves through coronary arteries 10. Heart transplant a. To replace irreparably damaged heart b. Problem – histocompatibility c. Rx – immunosuppressants d. Artificial hearts –experimental 11. Stent – tiny, expandable stainless steel tube that holds coronary artery open to improve blood flow I. Lymphatic System MD09.01 Explain the structure of the lymphatic system. A. Lymph a. Straw-colored, similar to plasma b. Interstitial fluid – in spaces between cells c. Composed of H2O, lymphocytes, O2, digested nutrients, etc., but no red cells or proteins (too large) B. Lymph vessels a. Closely parallel veins b. Located in almost all tissues and organs that have blood vessels c. Thoracic duct – largest lymph vessel C. Lymph nodes a. Tiny, oval shaped, size of pinhead to size of almond b. Located alone or grouped c. Most in head, neck, axilla, chest, abdomen and groin Summer 2005 MS I Content Outline Page 17 D. Tonsils a. Get smaller as person gets older b. Located in throat c. Adenoids – tonsils on upper part of throat E. Spleen a. Sac-like mass of lymphatic tissue b. Upper left abdominal cavity, just below diaphragm F. Thymus – upper, anterior chest above the heart MD09.02 Analyze the function of the lymphatic system. A. Lymph – fluid that goes between capillary blood and tissues 1. Carries digested food, O2, and hormones to cells 2. Carries wastes back to capillaries for excretion 3. Since lymphatic system has no pump, skeletal muscle action squeezes lymph along 4. Lymph in tissues is interstitial fluid B. Lymph vessels – transport excess tissue fluid back into circulatory system 1. 2. 3. 4. C. D. E. E. F. Valves prevent backward flow Lymph flows in only one direction – from body organs to heart Closely parallel veins Tissue lymph enter small lymph vessels which drain into larger lymph vessesl (lymphatics) into two main lymphatics – the thoracic duct and right lymphatic duct Lymph nodes 1. Produce lymphocytes 2. Filter out harmful bacteria 3. If substance can’t be destroyed, node becomes inflamed Tonsils 1. Lymph tissue that produces lymphocytes 2. They get smaller as a person gets older Spleen 1. Produce lymphocytes and monocytes 2. Filter blood 3. Blood reservoir – stores large amounts of RBCs, contracts during vigorous exercise or loss of blood to release RBCs 4. Recycles old red cells – destroys and removes old or fragile RBCs Thymus gland 1. Produces lymphocytes 2. Also considered an endocrine gland Immunity – body’s ability to resist disease 1. Natural immunity – at birth, inherited and permanent a. Unbroken skin b. Mucus and tears c. Blood phagocytes d. Local inflammation 2. Acquired immunity – body’s reaction to invaders a. Passive acquired immunity – from injecting antibodies, only lasts a few weeks b. Active acquired immunity – lasts longer i. Natural acquired immunity – result of recovering from disease, body manufactures own antibodies and person doesn’t get the disease again ii. Artificial acquired immunity – from being vaccinated Summer 2005 MS I Content Outline Page 18 3. Immunization – antigen injected into a person to stimulate production of antibodies MD09.03 Discuss characteristics and treatment of common lymphatic disorders. A. Tonsillitis 1. In childhood, tonsils become infected and enlarged 2. Difficulty swallowing 3. Tonsillectomy in extreme cases B. Lymphadenitis (adenitis) 4. Swelling (enlargement) of lymph glands 5. Occurs when infection present and body making WBCs to fight infection C. Hodgkin’s disease 1. Cancer of lymph nodes 2. Painless swelling of lymph node early symptom 3. Rx – chemotheraphy and radiation D. Mononucleosis 1. Caused by virus 2. Young adults and children 3. Spread by oral contact (kissing) 4. Symptoms – lymphadenitis, fever, fatigue, leukocytes 5. Rx - bedrest E. Hypersensitivity 1. Abnormal response to drug or allergen 2. Antibodies made in response to foreign material (allergen) irritate certain body cells 3. Allergen – antigen that causes allergic response (Examp. Ragweed, penicillin, bee stings, foods, etc.) F. Anaphylaxis (Anaphylactic shock) 1. Severe or fatal allergic reaction 2. Antigen-antibody response stimulates massive secretion of histamine 3. Symptoms – breathing problems, headache, facial swelling, falling blood pressure, stomach cramps, vomiting 4. Rx – Adrenaline 5. Those prone should wear medic alert bracelet G. AIDS and HIV 1. Acquired immunodeficiency syndrome 2. Cause – HIV virus 3. Three responses to HIV infection: a. AIDS – full disorder b. ARC – AIDS-related complex c. Asymptomatic infection 4. Screening test for HIV available 5. AIDS victim subject to opportunistic infections (cancer, infections) that a healthy person would fight off but AIDS victim has compromised immune response 6. Incubation period – 1 month to 12 years 7. Rx and prevention – advances being made 8. ARC – AIDS-related complex – HIV but not AIDS – less severe symptoms 9. Transmission a. Sex with someone HIV positive b. Sharing needles with infected drug users Summer 2005 MS I Content Outline Page 19 c. At birth from infected mother 10. Cannot be spread by casual contact, coughing, sneezing, shaking hands and sharing eating utensils 11. Prevention – avoid risky behaviors and observe standard precautions MD09.04 Apply standard precautions. A. Standard precautions 1. Used in patient care setting when there is contact with blood or body fluids, mucous membrane or non-intact skin 2. Handwashing – single most effective way to prevent infection a. Wash after touching body fluids, even if wearing gloves b. Wash immediately after removing gloves and between patient contacts c. Use soap and friction d. Wash for a minimum of 10 seconds 3. Personal protective equipment a. Gloves – when touching blood and body fluids b. Mask, goggles, face shield, gown – when patient care activities can generate splashing or spray of blood, body fluids 4. Patient care equipment and linens a. Handle with care b. Don’t let it touch your clothing, clean or discard appropriately B. Occupational health and bloodbourne pathogens a. Beware of needles b. Never recap used needles c. Dispose of all needles and sharp objects in sharps container d. Use mouthpieces, resuscitation bags, or other ventilation devices as alternative to mouth-to-mouth resuscitation. e. A patient who contaminates the environment should be in a private room or relatively isolated area. C. The AIDS patient a. Sometimes treated as outcasts b. Healthcare worker should be supportive c. Use of gloves for normal patient contact is not necessary J. Respiratory System MD10.01 Describe the structure of the respiratory system. A. Nasal cavity (nose) 1. Nasal septum divides nose into R and L sides 2. Cilia – hairs that trap dirt and particles B. Sinuses 1. Cavities in skull 2. Connected to nasal cavity by ducts 3. Lined with mucous membrane C. Pharynx 1. Throat 2. 5” long D. Larynx (voice box) 1. Triangular chamber below pharynx 2. Contains vocal cords 3. Adam’s apple Summer 2005 MS I Content Outline Page 20 4. Epiglottis – covers larynx during swallowing E. Trachea (windpipe) 1. 4 ½” long 2. Walls have bands of C-shaped cartilage 3. Lined with ciliated mucous membrane F. Bronchi and Bronchioles 1. Lower end of trachea divides into R and L bronchus 2. Become bronchial tubes and bronchioles as branches enter lungs G. Alveoli 1. Clusters of thin-walled sacs made of single layer epithelial tissue 2. Inner surfaces covered with surfactant 3. Each alveolus surrounded by capillaries H. Lungs 1. Fill thoracic cavity 2. Upper part = apex 3. Lower part = base 4. Lung tissue porous and spongy, it floats 5. R lung larger and shorter, 3 lobes 6. L lung has 2 lobes I. Pleura 1. Membrane that covers lungs 2. Double-walled sac 3. Space is pleural cavity 4. Pleural cavity filled with pleural fluid to prevent friction J. Upper respiratory tract MD10.02 Analyze the function of the respiratory system. A. Cilia – hair in nose that traps dirt and particles B. Sinuses 1. Lined with mucous membrane to warm and moisten air 2. Give resonance to the voice C. Pharynx 1. Common passageway for air and food 2. When food swallowed, epiglottis closes over opening to larynx, preventing food from entering lungs D. Larynx 1. Produces sound (voice box) 2. Made of cartilage fibrous plates E. Trachea 1. C-shaped cartilage rings keep trachea open and more rigid 2. Coughing and expectoration get rid of dust-laden mucous F. Bronchi and bronchioles – passageway for air from trachea to alveoli in lungs G. Alveoli 1. Surfactant – keep alveoli from collapsing 2. O2 and CO2 exchange takes place between alveoli and capillaries H. Pleura – pleural cavity filled with pleural fluid to prevent friction I. Pulmonary ventilation (breathing) 1. Inspiration (inhalation) a. Intercostal muscles lift ribs outward b. Sternum rises and the diaphragm contracts and moves downward c. This increases the volume of the lungs and air rushes in 2. Expiration (exhalation) a. Opposite action from inhalation b. Passive process Summer 2005 MS I Content Outline Page 21 J. Respiratory movements 1. 1 inspiration + 1 expiration = 1 respiration 2. Normal adult = 14 – 20 respirations/min 3. Increases with exercise, body temperature, certain diseases 4. Newborn resp = 40 – 60/min 5. During sleep – resps decrease 6. Emotion can change rate of respiration 7. Coughing – deep breath followed by forceful expulsion of air – to clear lower respiratory tract 8. Hiccups – spasm of the diaphragm and spasmodic closure of the glottis 9. Sneezing – air forced through nose to clear respiratory tract 10. Yawning – deep prolonged breath that fills lungs, increases blood O2 K. Control of breathing 1. Neural factors a. Respiratory center located in medulla oblongata b. Increase or decrease of O2 or CO2 in the blood will trigger respiratory center c. Phrenic nerve – stimulates diaphragm 2. Chemical factors a. Depends on level of blood CO2 b. Chemoreceptors in aorta and carotid arteries sensitive to the amount of blood O2 MD10.03 Identify characteristics and treatment of common respiratory disorders. A. Pleurisy 1. Inflammation lining lungs in conjunction with lung infection 2. Symptoms – sharp, stabbing pain with breathing, dyspnea and fever B. Common Cold 1. Contagious viral, respiratory infection 2. Contributing factors – chilling, fatigue, poor nutrition, not enough sleep 3. Rx – stay in bed, drink warm liquids and fruit juice, good nutrition 4. Good handwashing = best prevention C. Pharyngitis – red, inflamed throat D. Laryngitis 1. Inflammation of larynx 2. Symps – sore throat, hoarseness, loss of voice, difficulty swallowing E. Sinusitits 1. Infection of mucous membrane that lines sinus 2. Caused by bacteria or virus 3. Symps – headache, pressure, thick nasal discharge, loss of voice resonance 4. Rx – symptomatic, surgery for chronic sinusitis F. Bronchitis 1. Inflammation of mucous membranes of trachea and bronchi 2. Symps – cough, fever, substernal pain and rales (raspy sound) 3. Chronic bronchitis – middle or old age, caused by cigarette smoking Summer 2005 MS I Content Outline Page 22 G. Influenza (Flu) 1. Viral infection upper respiratory tract 2. Symps – fever, mucopurulent discharge, muscular pain, extreme exhaustion 3. Rx – symptomatic H. Pneumonia 1. Infection of lung 2. Caused by bacteria or virus 3. Alveoli fill with thick fluid 4. Symps – chest pain, fever, chills, dyspnea 5. Diagnosis – x-ray and listening to lungs 6. Rx – oxygen and antibiotics I. Tuberculosis 1. Infectious bacterial lung disease 2. Tubercles (lesions) form in lungs 3. Symps – cough, low grade fever in the afternoon, weight loss, night sweats 4. Diagnosis – skin test, if positive, follow up with chest x-ray and sputum 5. Rx – antibiotics J. Rhinitis – runny nose K. Asthma 1. Inflammatory airway obstruction 2. Caused by allergen or psychological stress 3. 5% of Americans have asthma 4. Symps – difficulty exhaling, dyspnea, wheezing, tightness in chest 5. Rx – antinflammatory drugs, inhaled broncholdilator L. Emphysema 1. Alveoli become distended, lose their elasticity, can’t rebound, may eventually rupture 2. Air becomes trapped in alveoli, can’t exhale, forced exhalation required 3. Dyspnea increases as disease progresses 4. Rx – alleviate symptoms, decrease exposure to respiratory irritants, prevent infections M. Cancer of the Lungs 1. Found mainly in smokers 2. Symps – cough and weight loss 3. Diagnosis – x-ray and bronchoscopy (flexible tube passed through mouth or nose into bronchi and lungs) 5. Rx – surgery, chemotherapy, and/or radiation N. Pulmonary embolism 1. Blood clot breaks off and travels to lung 2. Often occurs after surgery when a person has been on bedrest 3. Symps – sudden, severe pain in chest, dyspnea 4. Rx – anticoagulants O. Sudden Infant Death Syndrome (SIDS) 1. Crib death 2. Usually between 2 wks to 1 year 3. Cause – unknown 4. Rx – sleep monitor P. Epistaxis 1. Nosebleed 2. Rx – elevate head, tilt forward, pinch nostrils, cold packs Summer 2005 MS I Content Outline Page 23 Q. Related terms 1. Apnea 2. Dyspnea 3. Tachypnea 4. Hyperpnea 5. Orthopnea 6. Hyperventilation 7. Rales K. Nervous System MD11.01 Describe the structure of the brain, spinal cord, and nerves. A. Neuron 1. Dendrite 2. Axon 3. Myelin sheath (neurilemma) B. Brain 1. Coverings a. Cerebral cortex b. Meninges 2. Ventricles 3. Cerebrum a. Convolutions and sulci b. Lobes i. Frontal ii. Parietal iii. Occipital iv. Temporal 4. Cerebellum 5. Diencephalon a. Thalamus b. Hypothalamus 6. Brain stem a. Midbrain b. Pons c. Medulla oblongata C. Spinal cord D. Nerves 1. Cranial nerves 2. Spinal nerves MD11.02 Analyze the function of the nervous system. A. Neuron function – transmit message from one cell to the next 1. Dendrites carry impulse to the cell body 2. Axons carry impulse away from cell body 3. Neurilemma (myelin sheath) a. Covering that speeds up nerve impulse along axon b. Fatty substance that protects axon 4. Synapse – space between neurons 5. Neurotransmitter – chemicals that carry an impulse across the synapse Summer 2005 MS I Content Outline Page 24 6. Nerve impulse – A stimulus creates an impulse. The impulse travels into the neuron on the dendrite(s) and out on the axon. At the end of the axon, a neurotransmitter is released that carries the impulse across the synapse, to the next dendrite. B. Nervous tissue 1. Sensory neurons (afferent) – carry impulses from skin and sense organs to spinal cord and brain 2. Motor neurons (efferent) – carry messages from brain and spinal cord to muscles and glands 3. Associative neurons (interneurons) – carry impulses from sensory neurons to motor neurons C. Central nervous system 1. Brain a. Brain tissue will die in 4-8 mins without oxygen b. Meninges i. Dura mater – tough, dense fibrous connective tissue ii. Pia mater – covers brains surface iii. Arachnoid – middle layer iv. Subdural space – between arachnoid and dura mater v. Subarachnoid space – between arachnoid and pia mater, filled with cerebrospinal fluid, acts as liquid shock absorber and source of nutrients for brain. c. Ventricles – 4 cavities i. Cerebrospinal fluid fills ventricles and acts as shock absorber ii. Blood-brain barrier – prevents substances (like drugs) from penetrating brain tissue, but also makes infections like meningitis difficult to cure iii. Choroid plexus – blood vessels that make cerebrospinal fluid d. Cerebrum – responsible for conscious thought, judgment, memory, reasoning, and will power e. Diencephalon = Thalamus and hypothalamus i. ANS control ii. Temperature control iii. Appetite control iv. Emotional state v. Sleep control f. Cerebellum i. Maintenance of balance ii. Maintenance of muscle tone iii. Control of muscle movements g. Pons – Controls respiration h. Midbrain – vision and hearing i. Medulla oblongata – Controls heart rate and blood pressure 2. Spinal cord a. Surrounded by cerebrospinal fluid b. Acts as reflex center c. Conducts nerve impulses to and from brain D. Peripheral nervous system 1. Cranial nerves 2. Spinal nerves Summer 2005 MS I Content Outline Page 25 E. Autonomic nervous system – regulates visceral organs, no subject to conscious control 1. Sympathetic system a. Fight or flight – when the body perceives danger, SNS sends message to adrenal medulla to secrete adrenaline and heartbeat increases 2. Parasympathetic system – counters SNS, decreases heart rate 3. Reflex – unconscious and voluntary a. Stimulus b. Examples MD11.03 Analyze characteristics and treatments of common nervous system disorders. A. Disorders of the CNS 1. Meningitis a. Inflammation of the lining of the brain and spinal cord b. May be bacterial or viral c. Symps – headache, fever, stiff neck d. In severe form, may lead to paralysis, coma and death e. Diagnosis – lumbar puncture f. If bacterial, treat with antibiotics 2. Encephalitis a. Inflammation of the brain b. Viral or chemical c. Symps – fever, lethargy, extreme weakness, visual disturbances 3. Epilepsy a. Seizure disorder of the brain, characterized by recurring and excessive electrical discharge from neurons b. Cause – uncertain c. Grand mal seizure – severe, convulsive seizure d. Petit mal seizure – milder, seems to be staring or daydreaming 4. Cerebral palsy a. Disturbance in voluntary muscular action due to brain damage b. May be due to birth injury or abnormal brain development c. Spastic quadriplegia – spastic paralysis in all four limbs d. Symps – head rolling, grimacing, difficult speech and swallowing e. No impairment of intellect 5. Poliomyelitis a. Disease of nerve pathways of spinal cord causing paralysis b. Almost eliminated in USA by vaccine 6. Hydrocephalus a. Increase of cerebrospinal fluid in the brain, usually from a blockage b. Symps – enlargement of head, usually noticed at birth c. Rx – bypass or shunt to relieve pressure 7. Parkinson’s disease a. Symps – tremors, shuffling gait, pill-rolling and muscular rigidity b. Cause – decrease in neurotransmitter dopamine c. Rx – L-dopa and other drugs to treat symptoms Summer 2005 MS I Content Outline Page 26 8. Multiple sclerosis a. Chronic inflammatory disease of the CNS b. Immune cells attack myelin sheath of axon, leaving scar tissue c. Nerve impulses blocked d. Cause – unknown e. Symps – weakness of extremities, numbness, double vision, nystagmus, speech problems, loss of coordination, possible paralysis f. Usually strikes young adult women age 20 - 40 9. Dementia a. Loss of 2 areas of complex behavior, such as language, memory, visual or spacial abilities, or judgment b. Interferes with a person’s daily life 10. Alzheimer’s disease a. Progressive disease, begins with problems remembering b. Nerve endings in brain degenerate and block signals that pass between nerve cells c. Cause – unknown d. First stage (2-4 years) confusion, short-term memory loss, anxiety, poor judgement e. 2nd stage (2-10 years) increase memory loss, difficulty recognizing people, motor problems, logic problems, loss of social skills f. 3rd stage (1-3 years) inability to recognize oneself, weight loss, seizures, mood swings and aphasia 11. CVA (stroke) a. Interruption of blood and oxygen to brain b. Tissue death c. Third leading cause of death in U.S. d. Risk factors – smoking, hypertension, heart disease, family history e. Cause – 90% blood clots, 10% ruptured blood vessels in the brain f. Symptoms – hemiplegia, sudden severe headache, dizziness, loss of vision in one eye, aphasia, dysphasia, coma, possible death B. Disorders of the PNS 1. Bell’s palsy a. 7th cranial nerve involved b. One side of the face droops (eye does not close properly, mouth droops, numbness on effected side) c. Cause – unknown d. Symptoms disappear in a few weeks 2. Neuritis a. Inflammation of nerve b. Symps – severe pain, loss of sensation, muscular atrophy, weakness, and paresthesia (tingling, burning and crawling of skin) C. Diagnostic tests 1. Lumbar puncture (spinal tap) removal and analysis of cerebrospinal fluid 2. EEG (electroencephalogram) recording of electrical activity of brain Summer 2005 MS I Content Outline Page 27 3. CAT scan (computerized axial tomography) produces cross sectional images 4. MRI (magnetic resonance imaging) uses a magnetic field along with radio frequency to produce cross-section images of the body. Patient inserted into chamber built within a huge magnet. D. Paralysis – loss of power of motion or sensation E. Hemiplegia – paralysis on one side of the body F. Quadriplegia – paralysis of all four extremities L. Sensory System MD12.01 Describe the structure of the eye. A. Eye 1. 1” in diameter 2. Protected by orbital cavity, eyebrows, eyelashes, eyelids 3. Lacrimal glands – tears empty into nasal cavity 4. Conjunctiva – thin membrane lines eyelids 5. Wall of eye made up of three coats B. Sclera 1. Outer layer 2. White of the eye 3. Tough coating, helps maintain shape of eye 4. Muscles responsible for moving eye attached to sclera = extrinsic muscles C. Cornea 1. Front of sclera (clear part) no blood vessels 2. Transparent so light rays can pass through D. Choroid coat 1. Middle layer, contains blood vessels 2. Opening in front is pupil 3. Colored, muscular layer surrounding pupil is iris 4. Intrinsic muscles – change size of iris to control amount of light entering through pupil E. Lens 1. Crystalline structure located behind iris and pupil 2. Elastic, disc-shaped, biconvex 3. Situated between the anterior and posterior chambers F. Anterior Chamber – filled with aqueous humor G. Posterior Chamber – filled with vitreous humor H. Retina 1. Innermost layer 2. Light rays focus image on retina 3. Image travels to the cerebral cortex via optic nerve 4. Rods – sensitive to dim light 5. Cones – sensitive to bright light and color 6. Optic disc – on retina, known as blind spot, nerve fibers that form optic nerve MD12.02 Analyze the function of the eye. A. Eye 1. Protected by orbit, eyebrows, eyelashes, eyelids 2. Lacrimal glands – tears empty into nasal cavity and clean the eyes 3. Conjunctiva – secretes mucous to lubricate eyes Summer 2005 MS I Content Outline Page 28 B. Sclera 1. Tough coating, helps maintain shape of eye 2. Extrinsic muscles - responsible for moving eye attached to sclera C. Cornea - Transparent so light rays can pass through D. Choroid coat 1. Middle layer, contains blood vessels 2. Intrinsic muscles – change size of iris to control amount of light entering through pupil 3. Pupil constricts – gets smaller – in bright light 4. Pupil dilates – gets larger – in dark light E. Lens 1. Where light rays are refracted 2. Accommodation – change in the shape of the lens to allow for near and distant vision F. Retina 1. Light rays focus image on retina 2. Image travels to the cerebral cortex via optic nerve 3. Rods – sensitive to dim light 4. Cones – sensitive to bright light and color 5. Optic disc – on retina, known as blind spot, nerve fibers that form optic nerve G. Pathway of vision - Image travels through cornea, then pupil, through lens, hits retina, picked up by rods and cones and carried to optic nerve where the brain interprets image MD12.03 Describe the structure of the ear, nose, and tongue. A. Outer ear 1. Pinna (auricle) – visible ear 2. External auditory canal – ear canal 3. Cerumen – ear wax 4. Tympanic membrane – ear drum, separates outer and middle ear B. Middle ear 1. Cavity in temporal bone 2. Connects with pharynx by Eustachian tube 3. Bones a. Malleus (hammer) b. Incus (anvil) c. Stapes (stirrup) C. Inner ear 1. Cochlea - spiral shaped organ of hearing 2. Organ of Corti – delicate hairlike cells that pick up vibrations of fluid and transmit them as a sensory impulse 3. Semicircular canals – three structures in inner ear that contain liquid D. Tongue 1. Muscle tissue 2. Surface covered with papillae MD12.04 Analyze the function of the ear, nose, and tongue. A. Outer ear 1. Pinna (auricle) – collects sound waves 2. Cerumen – ear wax, protects the ear Summer 2005 MS I Content Outline Page 29 B. Middle ear 1. Connects with pharynx by Eustachian tube – which equalizes pressure in the middle ear with outside atmosphere 2. Bones transmit sound waves from ear drum to inner ear C. Inner ear 1. Cochlea - spiral shaped organ of hearing, contains a membranous tube, the cochlear duct – which is filled with fluid that vibrates when sound waves are transmitted by the stapes 2. Organ of Corti – delicate hairlike cells that pick up vibrations of fluid and transmit them as a sensory impulse along the auditory nerve to the brain 3. Semicircular canals – three structures in inner ear that contain liquid set in motion by head and body movements 4. Impulses sent to cerebellum to help maintain body balance (equilibrium) D. Pathway of hearing – ear to external auditory canal to tympanic membrane to ossicles (malleus, incus and stapes) to cochlea to auditory nerve to brain E. Nose 1. Smell accounts for 90% of taste 2. Tissue in the nose, olfactory epithelium, contains specialized nerve cell receptors 3. Those receptors stimulate the olfactory nerve to the brain F. Tongue 1. Mass of muscle tissue 2. Bumps on surface are papillae, they contain taste buds 3. Receptors in taste buds send stimuli through 3 cranial nerves to cerebral cortex MD12.05 Analyze characteristics and treatment of common sensory disorders. A. Disorders of the eye 1. Conjunctivitis (Pink eye) a. Inflammation of conjunctival membranes in front of eye b. Redness, pain, swelling and discharge c. Highly contagious d. Rx – antibiotic eye drops 2. Glaucoma a. Excessive intraocular pressure causing destruction of the retina and atrophy of the optic nerve b. Caused by the overproduction of aqueous humor, lack of drainage, or aging c. Symps – develop gradually, mild aching, loss of peripheral vision, halo around light d. Tonometer – measures intraocular pressure e. Rx – drugs or laser surgery 3. Cataracts a. Lens of eye gradually becomes cloudy b. Frequently occurs in people over 70 c. Causes painful, gradual blurring and loss of vision d. Rx – surgical removal of the lens 4. Sty (hordeolum) a. Abscess at the base of an eyelash in sebaceous gland b, Symps – red, painful, swollen c. Rx – warm, wet compresses Summer 2005 MS I Content Outline Page 30 5. Eye injury - Glass or fragment in eye – cover eye and seek medical help, do not remove the object 6. Color blindness a. Cones affected b. Genetic disorder that is carried by female and transmitted to males B. Vision defects 1. Presbyopia a. Lens loses elasticity, can’t focus on close or distant objects b. Usually after age 40 c. Rx – bifocals 2. Hyperopia a. Farsighted b. Focal point beyond retina, eyeball too short c. Convex lenses help 3. Myopia a. Nearsighted b. Eyeball too long c. Concave lenses help 4. Astigmatism a. Irregular curvature of the cornea or lens, causing blurred vision or eye strain b. Rx – corrective lenses 5. Diplopia – double vision 6. Strabismus (cross-eyed) a. Eye muscles to not coordinate their actions b. Usually in children c. Rx – eye exercises or surgery 7. Ophthalmoscope – instrument for viewing inside the eye 8. Snellen eye chart – chart that uses letters or symbols in calibrated heights to check for vision defects C. Disorders of the ear 1. Hearing loss a. Hearing is fragile, loud noise over period of time can cause hearing loss b. Symps – tinnitus (ringing in ears) and difficulty understanding what people are saying 2. Otitis Media a. Infection of middle ear b. Often complication of common cold in children c. Rx – antibiotics d. Myringotomy – tubes inserted through tympanic membrane to relieve pressure 3. Otosclerosis a. Chronic , progressive middle ear disorder b. Stapes becomes spongy and then hardens, becoming fixed and immobile c. Rx – stapedectomy and total replacement of stapes 4. Tinnitus – ringing of ears from impacted wax, otitis media, loud noise, etc. 5. Types of hearing loss a. Conductive – sounds prevented from reaching inner ear b. Sensorineural – problem with inner ear and auditory nerve Summer 2005 MS I Content Outline Page 31 D. Disorders of the nose 1. Rhinitis a. Inflammation of lining of nose with congestion, drainage b. Cause – allergies, drugs, infection, odors, etc. c. Rx – eliminate cause, antihistamine M. Digestive System MD13.01 Describe the structure of the digestive system. A. Alimentary canal 1. Digestive tract or GI tract 2. 30 ft. tube from mouth to anus B. Accessory organs of digestion 1. Tongue 2. Teeth 3. Salivary glands 4. Pancreas 5. Liver 6. Gall bladder C. Peritoneum D. Mouth 1. Hard palate 2. Uvula E. Salivary glands 1. Three pairs 2. Parotid – largest F. Teeth 1. Gingiva - gums 2. Deciduous - 20 3. Adult mouth has 32 teeth G. Esophagus 1. 10” long muscular tube 2. Connects pharynx and stomach H. Stomach 1. Cardiac sphincter 2. Pyloric sphincter 3. Rugae I. Small Intestine 1. Duodenum – 12” long 2. Jejunum – 8 ft. long 3. Ileum – 10 – 12 ft. long J. Pancreas - Located behind stomach K. Liver 1. Largest organ in body 2. Located below the diaphragm, upper right quadrant 3. Connected to gallbladder and small intestine by ducts L. Gallbladder 1. Small, green organ 2. Inferior surface of liver M. Large Intestine (Colon) 1. Approx 2” in diameter 2. Cecum 3. Appendix 4. Rectum 5. Anus Summer 2005 MS I Content Outline Page 32 MD13.02 Analyze the function of the digestive system. A. Digestion 1. Bolus – soft, pliable ball of semi-digested food 2. Peristalsis – wavelike motions that move food along esophagus, stomach and intestines 3. Ptyalin – in saliva in mouth, converts starches to simple sugar 4. In stomach: a. Gastric juices released b. Stomach churns and mixes food and juice (chyme) c. Small amounts chyme enter duodenum d. Takes 2-4 hours for stomach to empty 5. In small intestine: a. Digestion completed, absorption occurs b. Addition of enzymes from pancreas and liver (via gallbladder) 6. In large intestine: a. Large quantities of H20 absorbed back into bloodstream b. Bacteria help break down undigested food c. Gas formation (flatulence) from bacterial action d. Feces – undigested semi-solid waste e. Defecation – colon and rectal muscles contract, external anal sphincter under conscious control B. Enzymes – help digestion C. Functions of Digestive System 1. Physical breakdown of food 2. Chemical digestion of food into the end products of fat, carbohydrates, and protein 3. Absorb nutrients into blood capillaries of the small intestine 4. Eliminate waste products of digestion D. Mouth 1. Food enters digestive system through mouth 2. Inside mouth covered with mucous membrane 3. Roof of mouth is hard palate 4. Uvula – prevents food from going up nose when you swallow E. Tongue 1. Attached to floor of mouth 2. Helps in chewing and swallowing 3. Made of skeletal muscle 4. Taste buds on surface F. Salivary glands 1. Three pairs 2. Secrete saliva 3. Parotid – largest salivary glands, become inflamed during mumps G. Teeth 1. Gingiva – gums that support and protect teeth 2. Mastication – chewing 3. Deciduous – baby teeth H. Stomach 1. Cardiac sphincter a. Circular layer of muscle b. Controls passage of food into stomach 2. Pyloric sphincter – regulates entrance of food into duodenum 3. Rugae a. Mucous coat lining Summer 2005 MS I Content Outline Page 33 b. Folds when stomach empty 4. Muscular coat contracts (peristalsis) to push food into small intestine I. Small Intestine 1. Three sections 2. Absorption a. Digested food (nutrients) pass into bloodstream and on to body cells b. Undigestible passes on to large intestine J. Pancreas 1. Exocrine function – secretes digestive enzymes 2. Also has endocrine function K. Liver 1. Manufactures bile 2. Produces and stores glucose in the form of glycogen 3. Detoxifies alcohol, drugs and other harmful substances 4. Manufactures blood proteins 5. Stores vitamin A, D and B complex L. Gallbladder 1. Stores bile 2. When fatty foods digested, bile released by gallbladder M. Large Intestine 1. Chyme – semi-liquid food MD13.03 Analyze characteristics and treatments of common digestive disorders. A. Heartburn 1. Acid reflux 2. Symp – burning sensation 3. Rx – avoid chocolate, peppermint, coffee, citris, fried or fatty foods, tomato products, stop smoking, take antacids, don’t lay down 2-3 hours after eating B. Pyloric stenosis 1. Narrowing of pyloric sphincter, often found in infants 2. Symp – projectile vomiting 3. Rx - Surgery C. Gastritis – acute or chronic inflammation of the stomach lining D. Gastroenteritis 1. Inflammation of mucous membrane lining of stomach and intestine 2. Common cause – virus 3. Symps – diarrhea and vomiting 4. Complication - dehydration E. Ulcer 1. Sore or lesion that forms in the lining of the stomach 2. Gastic ulcers in the stomach, duodenal ulcers in the duodenum 3. Primary cause – H. pylori (bacteria) 4. Contributing factors – smoking, alcohol, stress, certain drugs 5. Symp – burning pain in abdomen between meals and early morning, may be relieved by eating or taking an antacid 6. Diagnosis – x-ray, gastroscopy 7. Rx – H2 blockers (drugs) that block release of histamine Summer 2005 MS I Content Outline Page 34 F. Colitis (Irritable Bowel Syndrome) 1. Large intestine inflamed 2. Cause – unknown 3. Symps – episodes of diarrhea or constipation G. Appendicitis 1. When appendix becomes inflamed 2. If it ruptures, bacteria can spread to peritoneal cavity, causing peritonitis 3. Symps – RLQ pain, rebound tenderness, fever, nausea and vomiting 4. Rx - appendectomy H. Hepatitis A 1. Infectious hepatitis 2. Cause – virus 3. Spread through contaminated food and water I. Hepatitis B (Serum hepatitis) 1. Caused by virus found in blood 2. Transmitted by blood transfusion or being stuck by contaminated needle (drug user) 3. Health care workers at risk should be vaccinated 4. Use standard precautions for prevention J. Cirrhosis 1. Chronic, progressive disease of the liver 2. Normal tissue replaced by fibrous connective tissue 3. 75% caused by excessive alcohol consumption K. Cholecystitis – inflammation of the gall bladder L. Cholelithiasis (gall stones) 1. Can block bile duct causing pain and digestive disorders 2. Small ones may pass on their own, large ones are surgically removed 3. Surgical removal of the gallbladder = cholecystectomy M. Pancreatitis 1. Inflammation of pancreas 2. 1/3 of cases – cause unknown 3. Sometimes associated with chronic alcoholism N. Diverticulosis (diverticulitis) 1. Little sacs (diverticuli) develop in wall of colon 2. Most people over age 60 have this 3. When the sacs become inflammed = diverticulitis O. Diarrhea 1. Loose, watery, frequent bowel movements when feces pass through colon too rapidly 2. Caused by infection, poor diet, nervousness, toxic substances or food irritants P. Constipation 1. When defecation is delayed, feces become dry and hard 2. Rx – diet of cereals, fruits andvegetables (roughage), drinking plenty of fluids, exercise and avoid tension Q. Colon cancer 1. Colonoscopy 2. Hemoccult 3. Colostomy R. Caries – tooth decay, cavities S. Gingivitis – inflammation of the gums T. Jaundice – yellow color the skin Summer 2005 MS I Content Outline Page 35 U. Laparoscopic cholecystectomy 1. Most common method of cholecystectomy 2. Small abdominal incisions allow insertion of surgical instruments and small video camera 3. Surgeon performs procedure by watching monitor and manipulating instruments 4. Stomach muscles are not cut so healing is quicker N. Nutrition MD14.01 Analyze the function of nutrients. A. Water 1. Essential nutrient 2. 55 – 65% of body weight 3. Water loss through evaporation, excretion, and respiration B. Carbohydrates 1. Main source of energy 2. Excess carbs converted to fat 3. Calorie a. Unit measuring amount of energy contained within the chemical bonds of different foods b. Empty calories – foods like candy with no nutritional value 4. Roughage – indigestible part of carbs (cellulose) C. Lipids (Fats) 1. Source of energy – twice as many calories as same amount of carb or protein 2. Body fat cushions internal organs, insulates against cold 3. Fats carry fat-soluble vitamins 4. Cholesterol a. Animal fat found in meat, cheese, eggs b. Excess can build up in artery walls causing atherosclerosis c. Recommended blood level under 200 mg/dl d. HDL – High density lipoprotein – “good”, removes excess cholesterol from cells to carry back to liver to be broken down and eliminated e. LDL – Low density lipoprotein – carry fat to cells D. Proteins 1. Many functions: a. Enzymes b. Source of energy c. Muscles, hormones, clotting, antibodies all depend on proteins 2. Amino acids are building blocks of proteins 3. Complete proteins contain all amino acids – milk, eggs, cheese 4. Incomplete proteins – do not contain ALL amino acids – vegetables, beans, wheat 5. Body can’t store amino acids 6. Adults in US eat too many proteins, putting extra burden on kidneys and liver to excrete E. Minerals 1. Inorganic compound needed for human growth and maintenance 2. Most important: a. Sodium Summer 2005 MS I Content Outline Page 36 b. Potassium c. Calcium d. Iron 3. Trace elements – present in small amounts, toxic levels close to healthy levels 4. Most minerals present in average adult diet 5. Fluorine – in drinking water, for bones and teeth 6. Iodine – in fish, shellfish, iodized salt, needed to make thyroid hormones 7. Iron – liver, lean meats, needed to make hemoglobin F. Vitamins 1. Biologically active organic compound 2. Function as coenzyme for normal health and growth, some behave like hormones 3. A, D, E and K – fat soluble, can be stored in the body 4. B vitamins and Vitamin C are water soluble, can’t be stored, excess excreted G. Fiber 1. Found in plant foods like whole grain breads, cereals, beans, peas, other vegetables and fruit 2. Important for proper bowel functioning, may lower risk of heart disease and some cancers MD14.02 Analyze dietary guidelines. A. Metabolism 1. Metabolism is the rate of the use of nutrients by the body to produce energy 2. Basal metabolic rate = amount of energy needed to maintain life when body is at rest. B. Recommended daily dietary allowances (RDA) – chart that lists recommended intake of vitamins and minerals C. Food Guide Pyramid D. Nutrition labeling 1. Serving size 2. Servings per container 3. Calories 4. Grams of fat, cholesterol, sodium, total carbs, fiber, and protein 5. Vitamins and minerals 6. Lists recommended daily allowances of nutrients E. Diet therapy 1. Regular diet 2. Liquid diet 3. Low cholesterol diet 4. Sodium restricted diet 5. Bland diet F. Healthy diet 1. Eat a variety of foods 2. Maintain desirable weight 3. Avoid too much fat, saturated fat (animal fat) and cholesterol 4. Eat foods with adequate starch and fiber (roughage) 5. Avoid too much sugar 6. Avoid too much sodium 7. Don’t drink alcohol Summer 2005 MS I Content Outline Page 37 MD14.03 Identify characteristics and treatment of common eating disorders. A. Obesity 1. Most common nutritional disorder 2. 15% over optimal weight 3. Affects physical and mental health B. Anorexia Nervosa 1. Serious mental disorder 2. Mostly teenage girls 3. Criteria for diagnosis a. Intense fear of getting fat, even when losing weight b. Distorted body image c. Loss of 25% of original body weight d. Refusal to maintain normal weight e. No known physical illness f. Amenorrhea C. Bulimia 1. Episodic binge eating followed by purging 2. Usually women, older than teens D. Anorexia – loss of appetite E. Malnutrition – poor nutrition due to diet or illness F. Deficiency diseases 1. Fluorine = Tooth Decay 2. Iodine = Goiter (Enlarged Thyroid) 3. Iron = Anemia O. Urinary System MD15.01 Describe the structure of the urinary system A. Kidney 1. Bean-shaped 2. Located between peritoneum and the back muscles (retroperitoneal) 3. Renal pelvis – funnel-shaped structure at the beginning of the ureter 4. Medulla a, Inner, striated layer b. Striated cones are renal pyramids c. Base of pyramids empty into cuplike cavities called calyces 5. Cortex – composed of millions of microscopic nephrons B. Nephron – functional unit of kidney 1. Bowman’s capsule 2. Glomerulus 3. Proximal convoluted tubule 4. Loop of Henle 5. Distal convoluted tubule 6. Collecting tubule C. Ureters 1. One from each kidney 2. Smooth muscle tube with mucous membrane lining D. Urinary bladder 1. Hollow, muscular organ 2. Made of elastic fibers and involuntary muscle 3. Stores urine – about 500 cc Summer 2005 MS I Content Outline Page 38 E. Urethra 1. Connects bladder with urinary meatus 2. Urinary meatus is opening to body MD15.02 Analyze the function of the urinary system A. Four main functions 1. Excretion – removing nitrogenous wastes, certain salts and excess water from blood. 2. Maintain acid-base balance 3. Secrete waste products in the form of urine 4. Eliminate urine from bladder B. Nephron – functional unit of the kidney – for urine formation 1. Filtration a. First step in urine formation b. Blood from renal artery enters glomerulus c. Blood pressure in glomerulus forces fluid (filtrate) to filter into Bowman’s capsule d. Filtrate does not contain plasma proteins or RBCs – they’re too big 2. Reabsorption a. Water (90%) and useful substances are reabsorbed b. If blood levels of certain substances are high (glucose, amino acids, vitamins, sodium) then those substances will NOT be reabsorbed 3. Secretion a. Opposite of reabsorption b. Secretion transports substances from blood into collecting tubules c. Electrolytes are selectively secreted to maintain body’s acidbase balance C. Urinary output 1. Ave = 1500 ml/day 2. Urinalysis – examination of urine to determine presence of blood cells, bacteria, acidity level, specific gravity and physical characteristics D. Ureters 1. Carry urine from kidney to bladder 2. Peristalsis pushes urine down ureters E. Urinary bladder 1. Stores urine – usually about 500 cc 2. Emptying urine (voiding) is involuntary but controlled through nervous system (voluntary) F. Control of urinary secretion 1. Chemical control a. Reabsorption of H2O in distal convoluted tubule controlled by ADH (antidiuretic hormone) b. Secretion and regulation of ADH controlled by hypothalamus c. Diuretics inhibit reabsorption of H2O 2. Nervous control a. Direct control through nerve impulses on kidney blood vessels b. Indirect control through stimulation of endocrine glands Summer 2005 MS I Content Outline Page 39 MD15.03 Analyze characteristics and treatment of common urinary disorders. A. Kidney (renal) failure 1. Acute kidney failure 1. Caused by nephritis, shock, injury, bleeding, sudden heart failure or poisoning 2. Symps – oliguria (scant urine) or anuria (no urine produced) 2. Chronic kidney failure – gradual loss of function of nephrons B. Renal calculi (kidney stones) 1. Made of calcium and uric acid crystals 2. Gradually they get larger until they block ureters 3. First symptom – severe pain 4. Other symps – nausea and vomiting, frequency, chills, fever, hematuria 5. Diagnosis – by symptoms, ultrasound or x-ray 6. Rx – increase fluids, medications, lithotripsy C. Lithotripsy 1. Surgical procedure to remove kidney stones 2. Shock waves hit dense stones and break them up 3. Done on outpatient basis D. Nephritis – infection or inflammation of the kidney E. Cystitis 1. Bladder infection, usually caused by E. Coli bacteria 2. Symps – dysuria (painful urination) and frequency 3. More often in females (shorter urethra) 4. Rx - antibiotics F. Incontinence – involuntary urination G. Dialysis (hemodialysis) 1. Treatment for kidney failure 2. Involves the passage of blood through a semipermeable membrane 3. Dialysis serves as substitute kidney 4. Can be done at home or in clinic 5. Usually takes 2-4 hours, 2-3 times a week H. Kidney transplant 1. As a last resort to treat kidney failure 2. Involves donor organ from someone with a similar immune system 3. Main complication - rejection I. Terminology and Treatments 1. Enuresis – bedwetting 2. Glycosuria – sugar in urine 3. Nocturia – frequent urination at night 4. Polyuria – large amounts of urine 5. Pyuria – pus in urine 6. Anuria – no urine 7. Dysuria – painful urination 8. Hematuria – blood in urine 9. Diuretic – a drug or substance that increases the amount of urine secreted Summer 2005 MS I Content Outline Page 40 P. Endocrine System MD16.01 Describe the structure of the endocrine system. A. Pituitary gland 1. Tiny structure size of grape 2. Located at base of brain 3. Connected to hypothalamus 4. Divided into anterior and posterior lobes B. Thyroid gland 1. Butterfly-shaped mass of tissue 2. On either side of larynx, over trachea 3. H-shaped C. Parathyroid glands 1. Four glands, each the size of a grain of rice 2. Attached to posterior thyroid D. Thymus 1. Endocrine gland and lymphatic organ 2. Located behind sternum, above and in front of heart 3. Begins to disappear at puberty E. Adrenal glands - located on top of each kidney F. Gonads 1. Ovary in female 2. Testes in male G. Pancreas 1. Located behind the stomach 2. Endocrine and exocrine functions MD16.02 Analyze the function of the endocrine system A. Types of glands 1. Endocrine a. Secrete hormones directly into bloodstream b. Ductless 2. Exocrine a. Secrete substance through a duct b. Sweat, salivary, lacrimal and pancreas B. Function of endocrine system 1. To secrete hormones 2. Hormones are chemical messengers that coordinate and direct target cells and organs C. Hormone control 1. Negative feedback – drop in hormone level triggers a chain reaction a. Blood level of hormone falls b. Brains gets message and sends out hormone to stimulate gland c. Gland secretes more hormone d. When blood level of hormone increases, brain hormones stop 2. Nervous control – in some cases, sympathetic nervous system causes direct release of hormone from gland (for example, when stress causes the adrenal medulla to secrete adrenalin) D. Pituitary gland 1. The master gland 2. Anterior pituitary lobe Summer 2005 MS I Content Outline Page 41 E. F. G. H. I. J. K. a. Growth hormone – GH (somatotropin) responsible for growth and development b. Prolactin – develops breast tissue, stimulates production of milk after childbirth c. Thyroid-stimulating hormone – TSH – stimulates thyroxine d. Adrenocorticotropic hormone – ACTH – stimulates adrenal cortex e. Follicle-stimulating hormone – FSH – stimulates growth of graafian follicle and production of estrogen in females, sperm in males f. Luteinizing hormone – LH – stimulates ovulation and formation of corpus luteum, which produces progesterone in females 3. Posterior pituitary lobe a. Vasopressin – converts to ADH (antidiuretic hormone) in the bloodstream, acts on kidney to concentrate urine and preserve H2O in the body b. Oxytocin – released during childbirth causing contractions of the uterus Thyroid gland 1. Main hormone, thyroxine, is controlled by secretion of TSH 2. Thyroxine controls the rate of metabolism 3. Calcitonin, another hormone that controls calcium ion concentration in the body, prevents hypercalcemia Parathyroid glands – produce parathormone which helps control blood calcium, prevents hypocalcemia Thymus 1. Endocrine gland and lymphatic organ 2. Located behind sternum, above and in front of heart 3. Begins to disappear at puberty Adrenal glands 1. Adrenal cortex secretes corticoids (anti-inflammatory hormones) and sex hormones 2. Androgens – male sex hormones 3. Adrenalin – hormone from adrenal medulla, powerful cardiac stimulant, “fight or flight” hormone Gonads 1. Estrogen – development of female reproductive organs, secondary sex characteristics 2. Progesterone – plays a part in the menstrual cycle 3. Testosterone – male reproductive organs and secondary sex characteristics Pancreas 1. Islets of Langerhans – insulin production 2. Insulin promotes utilization of glucose by the cells Prostaglandins – tissue hormones Summer 2005 MS I Content Outline Page 42 MD16.03 Analyze characteristics and treatment of common endocrine disorders. A. Gigantism 1. Hyperfunction of pituitary – too much growth hormone 2. In preadolescence – overgrowth of long bones leads to excessive tallness B. Acromegaly 1. Hyperfunction of pituitary – too much growth hormone in adulthood 2. Overdevelopment of bones in face, hands and feet 3. Attacks cartilage so chin protrudes 4. Rx – drugs to inhibit growth hormone, radiation C. Dwarfism 1. Hypofunction of pituitary in childhood 2. Small size, but body proportions and intellect normal 3. Rx – early diagnosis, injection of growth hormone D. Hyperthyroidism 1. Overactive thyroid gland 2. Too much thyroxine leads to enlargement of gland 3. Symps – consuming large quantities of food but lose weight 4. Goiter – enlargement of gland 5. Exophthalmos – bulging of eyeballs 6. Rs – partial or total removal of gland, drugs to reduce thyroxine, radiation E. Hypothyroidism 1. Not enough thyroxine 2. May be due to lack of iodine (simple goiter) 3. Symps – dry, itchy skin; dry and brittle hair, constipation, muscle cramps at night F. Tetany 1. Hypoparathyroidism, decreased calcium levels affect functions of nerves 2. Symps – convulsive twitching develops, person dies of spasms in the respiratory muscles 3. Rx – Vitamin D, calcium and parathormone G. Cushing’s Syndrome 1. Hypersecretion of adrenal cortex 2. May be caused by adrenal tumor or prolonged use of prednisone 3. Symps – high blood pressure, muscle weakness, obesity, poor healing, tendency to bruise, excessive hair growth, menstrual disorders, rounded moon face, buffalo hump 4. Rx – surgical removal of tumor H. Addison’s Disease 1. Hypofunction of adrenal cortex 2. Symps – bronzing of skin, hypoglycemia, hypotension 3. Rx – Replace deficient hormones I. Diabetes Mellitus 1. Cause – decreased secretion of insulin 2. Symps – polyuria, polyphagia, polydipsia, weight loss, blurred vision, and possible diabetic coma 3. If not treated, excess glucose in blood (hyperglycemia) and secreted in urine (glycosuria) 4. If too much insulin given, blood sugar can get too low (hypoglycemia) and person can develop insulin shock Summer 2005 MS I Content Outline Page 43 J. Q. 5. Type II diabetes is not insulin-dependent – most common, usually familial, occurs later in life, usually treated with diet 6. Test for diabetes – blood sample at home, normal blood sugar is 80-100 mg Steroid abuse in sports 1. Anabolic steroids (androgens) can help build bigger, stronger muscles 2. Risks far outweigh temporary improvements a. Males – liver changes, atrophy of testicles, breast enlargement, cardiovascular disease b. Females – amenorrhea, abnormal body hair, baldness, voice changes Reproductive System MD17.01 Describe the structure of the male reproductive system. A. Testes 1. Found in scrotum 2. Size of small egg 3. Made up of 250 lobules, each with coiled seminiferous tubules B. Epididymis 1. Collection of tubes above the testes 2. Connect the testes with the vas deferens C. Vas Deferens 1. Runs from epididymis to ejaculatory duct 2. Seminal vesicles connect to vas deferens 3. Ejaculatory duct connects vas deferens with urethra D. Scrotum – sac of skin that contains testes E. Penis 1. Contains erectile tissue 2. End covered by foreskin – loose fitting skin F. Prostate Gland 1. Surrounds beginning of urethra 2. Size and shape of chestnut G. Bulbourethral glands – located on either size of prostate below prostate MD17.02 Analyze the function of the male reproductive system. A. Testes 1. Produce male gametes (spermatozoa) 2. Produce male sex hormone – testosterone 3. Inside, each lobule contains coiled seminiferous tubules where sperm develop 4. In embryo, testes formed in the abdomen and during the last 3 months, migrate into scrotum B. Epididymis – where sperm are stored C. Vas Deferens – serves as a passageway for sperm from epididymis to ejaculatory duct D. Scrotum – serves as container for testes E. Penis 1. Contains erectile tissue 2. Organ of copulation Summer 2005 MS I Content Outline Page 44 3. Tip of penis covered with foreskin, which is often removed during circumcision F. Prostate Gland – secretes a fluid that enhances sperm motility and adds fluid to semen G. Bulbourethral glands – add alkaline secretion to semen that helps sperm live longer H. Erection and ejaculation 1. Urethra has dual role – excretion of urine and to expel semen 2. Erection caused when erectile tissue fills with blood 3. Ejaculation expels semen 4. Impotence – unable to copulate (hold an erection) I. Infertility – lack of conception due to fallopian tube damage, low sperm count, hormone imbalance, and other disorders MD17.03 Describe the structure of the female reproductive system. A. Ovaries 1. In lower part of abdominal cavity 2. About the size of an almond 3. Each ovary contains thousands of microscopic sacs B. Fallopian tubes 1. 4” long – not attached to ovaries 2. Smooth muscle and cilia help propel ova into uterus C. Uterus 1. Hollow, thick-walled, pear-shaped, highly muscular organ 2. Lies behind urinary bladder and in front of rectum 3. Fundus – bulging upper part of the uterus 4. Cervix – narrow neck of uterus that extends into vagina 5. Uterine wall a. Outside thick muscular layer is myometrium b. Inside mucous lining is endometrium D. Vagina – smooth muscle with a mucous membrane lining E. External genitalia 1. Vulva – external organs of reproduction 2. Labia – folds of skin that surround the entrance to the vagina 3. Perineum – area between vagina and rectum F. Accessory organs 1. Breasts (mammary glands) 2. Areola – darkened area that surrounds the nipple MD17.04 Analyze the function of the female reproductive system. A. Ovaries 1. Primary sex organs of the female 2. Produce ova (female gamete) and manufacture female sex hormones (estrogen and progesterone) 3. During the reproductive years, a single follicle in the ovary matures every 28 days with an ovum inside 4. Reproductive ability begins with menarche (first menstrual cycle) during puberty Summer 2005 MS I Content Outline Page 45 B. Ovulation 1. Mature ovum is released (ovulation) about 2 weeks before menstrual period begins 2. After ovulation, the ovum travels down the fallopian tube 3. Fertilization takes place in fallopian tube, usually within two days of ovulation 4. Following fertilization, the zygote implants in the uterus 5. Development of follicle controlled by FSH, ovulation caused by LH C. Fallopian tubes – smooth muscle and cilia help propel ova into uterus D. Menstrual cycle 1. Occurs every 28 days, divided into 4 stages 2. Follicle stage – FSH from pituitary ovary, stimulates follicle with ovum to mature releases estrogen and prepares uterine lining, lasts 10 days 3. Ovulation stage – Pituitary stops FSH and releases LH, 14th day – follicle ruptures and mature ovum released 4. Corpus luteum stage – Corpus luteum secretes progesterone. If ovum fertilized, corpus luteum continues secrete progesterone, which prevents further ovulation and maintains uterine lining, lasts 14 days 5. Menstruation stage – If no embryo, corpus luteum dissolves progesterone and uterine lining breaks down and is discharged, 3-6 days 6. Menopause a. When monthly menstrual cycle comes to an end b. Approximately age 50 c. Symptoms include hot flashes, dizziness, headaches and emotional changes E. Conception and pregnancy 1. Gametes are produced by gonads a. Female gonad = ovary b. Female gamete = ovum (ova) c. Male gonad = testes d. Male gamete = sperm 2. Chromosomes a. Female gametes have 22 pairs of autosomes and single pair of sex chromosomes – XX b. Male gametes have 22 pairs of autosomes and single pair of sex chromosomes - XY 3. Fertilization – when games combine to form a zygote (fertilized egg cell) a. One sperm penetrates and fertilizes the ovum b. Zygote has 46 chromosomes c. Zygote cells divide and multiply as it travels down fallopian tube and implants in uterus d. At 7 days, zygote becomes an embryo e. At 3 months it becomes a fetus 4. Pregnancy a. Gestation = prenatal period or pregnancy b. Normal pregnancy = 40 weeks or 280 days or 3 months c. Quickening – first recognizable movement of fetus in 4th – 5th month d. Miscarriage – spontaneous abortion Summer 2005 MS I Content Outline Page 46 MD17.05 Analyze characteristics and treatment of common reproductive disorders. A. Reproductive procedures 1. Artificial insemination – semen placed into vaginal canal, usually around time of ovulation. 2. In-vitro fertilization – ova fertilized with sperm in laboratory, zygote transferred to uterus 3. Laparoscopy – tube inserted though small incision in abdominal wall 4. Hysterectomy – surgical removal of uterus 5. Mastectomy – surgical removal of breast 6. Mammogram – breast x-ray to detect tumors, usually recommended for women over age 40 7. Vasectomy – male sterilization, removal of part of the vas deferens 8. Cryptorchidism – undescended testicle, may require surgical correction 9. Circumcision – surgical removal of the foreskin B. Male reproductive disorders 1. Epididymitis a. Painful swelling in groin and scrotum due to infection in epididymis b. Rx - antibiotics 2. Orchitis a. Inflammation of testes b. May be complication of mumps, flu or other infection c. Symps – swelling of scrotum, fever and pain d. Rx – antibiotics, analgesics, cold compresses 3. Prostatitis a. Infection of prostate b. First symptom – difficult urination c. Rx - antibiotics 4. Benign Prostatic Hypertrophy (BPH) a. Enlarged prostate b. Common in men over age 60 c. Prostate enlarges and clamps down on urethra d. Symps – Urinary frequency e. Rx – prostatectomy, sometimes laser surgery or no Rx 5. Prostate cancer a. Most common cancer in men over 50 b. Can be detected by blood test c. Symps – frequency, dysuria, urgency, nocturia, and sometimes hematuria d. Rx - prostatectomy C. Female reproductive disorders 1. Amenorrhea a. Absence of menstruation b. Caused by hormonal imbalance, other disorders and pregnancy 2. Pre-menstrual syndrome (PMS) a. Irritability, nervousness, mood swings and fluid retention prior to menstrual period b. Rx – medication and diet 3. Dysmenorrhea Summer 2005 MS I Content Outline Page 47 a. Painful menstruation b. Cramping may be caused by release of prostaglandins c. Rx - medication 4. Mastitis – infection in breast 5. Ectopic pregnancy – egg implants in fallopian tube instead of uterus, surgical removal required 6. Endometriosis a. Endometrial tissue outside of uterus and abnormal patches in uterus b. Results in internal bleeding, formation of scar tissue, dysmenorrheal, infertility, heavy or irregular bleeding c. Cause - unknown 7. Breast cancer a. Most common cancer in women b. Early detection and treatment vital – breast self exam (BSE) should be done monthly c. Rx – mastectomy, chemotherapy and radiation 8. Cervical cancer a. Detected by Pap (Papanicolaou) Smear – sample of cell scrapings taken for microscopic study b. Rx – early detection, hysterectomy, chemotherapy and radiation 9. Toxic shock syndrome a. Bacterial infection caused by staphylococcus b. Symps – fever, rash, hypotension c. Cause – use of tampons d. Rx - antibiotics 10. Vaginal yeast infections a. Caused by candida albicans b. Symps – itching and burning c. Rx – antifungal medication D. Sexually transmitted diseases 1. STDs or venereal disease 2. Transmitted via body fluids 3. Can be serious, painful, and cause long-term complications, including death 4. Some STDs have no symptoms 5. Female symptoms – discharge, pelvic pain, burning or itching, unusual bleeding 6. Male symptoms – discharge from penis 7. Both gender symptoms – sores or blisters, burning and pain during urination, flu-like symptoms, swelling in groin 8. Prevention = abstinence, condoms provide some protection 9. Once a person is diagnosed, all current and past sexual partners must be notified and treated 10. Gonorrhea a. Bacterial infection b. Males have painful urination and discharge, females have no symptoms c. Rx – antibiotics d. Untreated can lead to sterility 11. Genital herpes a. Caused by a virus b. Small blisters on genitalia Summer 2005 MS I Content Outline Page 48 c. Symptoms disappear after 2 weeks but reappear throughout the lifetime of the individual d. Females may need a C-section to prevent infection of newborn during childbirth 12. Syphilis a. Bacterial b. First stage – chancre sore at site of infection c. In final stage (10-40 years after infection) liver damage, heart disease, brain damage, paralysis and death d. Rx - penicillin E. Contraception – methods of preventing pregnancy 1. Male sterilization – vasectomy 2. Female sterilization – tubal ligation R. Health Care Professions MD18.01 Analyze opportunities in preparing for a medical/healthcare profession. A. HOSA Career Health Display B. HOSA National Recognition Program C. HOSA Clinical Specialty MD18.02 Perform mathematical conversions common to the medical/health professions. A. Metric unit of measurement 1. Meter 2. Gram 3. Liter B. Common Conversions C. Temperature MD18.03 Revise personal career development plan. Summer 2005 MS I Content Outline Page 49