TRUE

FALSE

—Conjunctivitis:

inflammation of the eyes lids

Conjunctivitis: symptoms include photophobia, visual blurring, redness, edema, pain, and lacrimation

Dry Eye Disease: chronic, bilateral desiccation of the conjunctiva and cornea due to an inadequate tear film

Conjunctivitis: Treatment with omega 3 fatty acid dietary supplements

Dry Eye Disease: symptoms include itching, burning, irritation, and photophobia.

Sclera

Retina

lens

optic nerve

Iris

Aqueous Humor (AH): •Derived from capillary plasma in the ciliary epithelial cells & released into the posterior chamber (AH inflow)

Unconventional Pathway: Flows through trabecular meshwork (TM) into the Canal of Schlemm, eventually returning to the systemic circulation

Unconventional Pathway accounts for the majority of AH outflow.

Helps maintain intraocular pressure (IOP) and the eye’s shape

Can not distribute any drugs

IOP is determined by the balance in aqueous humor (AH) production (inflow) and drainage (outflow)

Normal IOP is 100- 130 mmHg

Elevated IOP is usually due to increased resistance to outflow (TM dysfunction)

IOP is used to diagnose of glaucoma

IOP is a strong risk factor for the development of glaucoma

Glaucoma: characterized by progressive optic nerve damage at least partly due to increased IOP

Surgery is only option treatment for glaucoma

Cataract: congenital or degenerative opacity of the lens.

Cataract: reatment is surgical removal and placement of an intraocular lens

Uveitis: inflammation of the retina

Retina: Thin, transparent, highly-organized structure of neurons and blood vessels

Choroid: —Highly vascular middle layer which supplies nutrients to interior structures of the eye and removes metabolic waste

Retina: Forms the light-sensitive  outermost layer of tissue in the posterior segment for vision perception

Sclera: Gives eye its white color

Sclera: the innerrmost layer of the eye

Vestibular: a part of inner ear and responsible for equilibrium

The inner ear is composed of the oval window, the cochlea, the semicircular canals, and the vestibular

The inner eye is also called labyrinth (a system of coiled membranous tubes filled with fluid)

Ear contains auditory (outer, middle, inner) and Vestibular (equilibrium)

The tympanic membrane is connected to the first of the ossicles (tiny bones), the malleus (hammer), followed by the incus (anvil), and stapes (stirrup)

occurs when there is damage to the inner ear (cochlea), or to the nerve pathways     

    from the inner ear to the  brain

can often be corrected medically or surgically

reduces the ability to hear  faint sounds- even when speech is loud enough to

    hear, it may still be unclear or muffled

can be caused by illnesses, genetic, exposure to loud noise, malformation of the inner

    ear, drug toxicity, head trauma

most common type of temporary hearing loss

Headache

Vertigo/dizziness

Nystagmus

Ataxia

Nausea

Otitis externa

Otitis media

inner ear infections

tinnitus

Tympanic membrane lesions

—Orbit (eye socket)

Sclera

Eye lids

Retina

Lacrimal system

Osteoporosis is a metabolic bone disease characterized by high bone mineral density (BMD)

Osteoporosis can occur as the result of a number of disorders, but is most often associated with the aging process

Those with the highest BMD are at most risk of fracture.

Primary or idiopathic osteoporosis-the most common

Secondary osteoporosis: caused by factors such as diseases, medications and other substances

Aluminum-containing antacids

Advanced age

Female Gender

Excessive alcohol intake

Smoking

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system attacks the synovial membrane

It causes chronic inflammation, along with joint pain, swelling and stiffness

rheumatoid arthritis eventually can lead to joint damage and disability

Rheumatoid arthritis is characterized by degenerative changes of the articular cartilage, can affect any one of 200 or so synovial joints in the body, and can occur as a primary idiopathic disorder or as a secondary disorder

The onset of the disease can occur at any age, but its peak incidence is between 50 and 75 years of age

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

osteoarthritis an autoimmune disease in which the body’s immune system attacks the synovial membrane

osteoarthritis is characterized by degenerative changes of the articular cartilage

Age is one of the strongest risk factors for OA

Women are more likely to have OA than men, and they tend to have more severe OA

Osteoarthritis leads to joint pain, tenderness, stiffness and loss of flexibility

Gout is a genetic disorder which results in high levels of uric acid in the blood

Hyperuricemia always result in gout

Primary gout, may be a consequence of enzyme defects that result in an overproduction of uric acid, inadequate elimination of uric acid by the kidney, or a combination of the two

In secondary gout, hyperuricemia may be caused by increased breakdown of nucleic acids

Gout is always preceded by hyperuricemia

In clinical manifestations, there are five stages of Gout

In asymptomatic hyperuricemia stage, most cases of hyperuricemia always develop into gout

Acute attack of Gout can not resolve spontaneously

Chronic gout stage: Development of tophi (uric acid deposits in cartilage tissue, tendons and soft tissues)

Chronic gout stage: Recurrent attacks of acute gout.

Is a superficial layer that borders on the epidermis

Has dense connective tissue along with tough collagen

Contains large blood vessels to support skin cells

Contains large blood vessels to support skin cells

Contains the dermal papillae

Discolored nail plate with development of ridges with chronic infections

Accumulation of hyperkeratotic debris within the plate

Infection develops from the dorsal surface

Elevated levels of serum adrenal androgen dehydroepiandrosterone sulfate (DHEAS)

Low levels of estrogen causing decrease nail growth

Nail

Hair

Eccrine sweat glands

Apocrine sweat glands

Sebaceous glands

A shield against UV radiation

Mechanoreceptors

A protectant from mechanical stress

A thermoregulator

Defense against environmental antigens

Ceramic

Dermis

Epidermis

Graphite

Hypodermis

Regulate body temperature

Enhances sensation

Provide protection in various areas

Can contribute to re-growing damaged epidermis

Can contribute to re-growing damaged epidermis

Onychomycosis

Tenderness and swelling around the proximal or lateral nail folds

Painful inflammation of the cuticle

Paronychia

Abnormal growth and distribution of hair on the nail plate

Associated with ovarian or adrenal disease

Caused by a fungal infection

Caused by circulating autoantibodies directed against cell surface adhesion molecules of the epidermis

Characterized by scales and plaques

Chronic, proliferative, and involves the scalp and nails

Langerhans cells

Melanocytes

Lunula

Merkel cells

Macrophages

Can present symptoms such as fever, headache, malaise, sore throat, and cough

Can result in blindness (corneal ulcerations)

Is characterized by inflammation of skin and mucous membranes

Is a single disease

Difficulty with eating and breathing may develop with severe manifestations

Protect the body from dehydration

Stores water and fat

Regulates body temperature

Helps dispose of waste materials

Acts as a receptor for touch

TRUE

FALSE

saliva: secreted by 3 salivary glands: Submandibular gland, Sublingual gland, Parotid gland

Saliva is comprised mostly of water containing various amounts of mucus, sodium, bicarbonate, chloride, potassium, lipase and salivary amylase

ptyalin: enzyme that initiates carbohydrate digestion in the mouth and stomach)

Only sympathetic divisions of ANS stimulate the glands to increase salivation

Lower esophageal sphincter (cardiac sphincter): prevents regurgitation

Upper esophageal sphincter (cardiac sphincter): prevents the entry of air into esophagus during respiration

Swallowing occurs in two phases: Oropharyngeal (involuntary) Esophageal (voluntary)

Repeated waves of primary peristalsis are required to clear the esophagus of food.

primary peristalsis: vagal motor nerves induce a wave of contraction that spreads along the esophagus at 3-5 cm/s

secondary peristalsis: Distension of the esophagus by the bolus can trigger another wave of contraction

Anatomic boundaries of the stomach: Lower esophageal sphincter (LES) and Pyloric sphincter

Parietal cells which secrete hydrochloric acid and intrinsic factor

Chief cells which secrete gastrin.

Hormone pepsinogen from the G cells

Glands of the antrum secrete mucus

Gastric Emptying: the rate of gastric emptying depends on volume of gastric content, chemical composition and gastrin release

Volume of gastric content: large volumes of food increase gastric pressure, peristalsis and the rate of emptying

Chemical composition: fats and non-isotonic solutions delay gastric emptying

Gastrin release: enhances peristalsis

Gastric fluid composition: H+ and Cl ions.

Acetylcholine (ACh)

prostaglandins

Gastrin

Nitric oxide

Histamine

Histamine

Secretin

caffeine

Somatostatin

Nitric oxide

Aspirin and NSAIDs

Helicobacter pylori

Ethanol

Prostaglandins

nitric oxide

Small intestine includes: duodenum, jejunum, ileum, cecum

Digestion and absorption of most nutrients occur in the duodenum and jejunum, while that of bile salts takes place in the terminal ileum

The brush border contains several digestive enzymes such as secretin and cholecystokinin

The process of intestinal digestion is initiated in the stomach by actions of HCl and Gastrin

The process of intestinal digestion is continues in the proximal portion of the small intestine

large intestine includes: cecum, appendix, colon, rectum, anal canal

Mucosa of the large intestine has villi and does produce digestive enzymes.

Gastrin and cholecystokinin stimulate gastrocolic reflex

By the time the fecal mass enters the sigmoid colon, feces (or excrement) consists of food residue, unabsorbed GI secretions, shed epithelial cells and bacteria.

Movement of feces into the sigmoid colon and rectum stimulates the defecation reflex (rectosphincteric reflex).

The stomach is relatively sterile because HCl kills ingested pathogens or inhibits bacterial growth

Duodenum: contain bacteriodes, clostridia, anaerobic lactobacilli and coliform

Ileum to cecum: low concentration of aerobes, primarily streptococci, lactobacilli, staphylococci, enterobacteria and bacteriodes.

Intestinal bacteria: Synthesis of vitamins K and B

Intestinal bacteria: Metabolism of nitrogenous substances and drugs

Liver, gall bladder and exocrine pancreas secrete substances necessary for digestion

Bile is a bitter-tasting yellowish green fluid containing bile salts (conjugated bile acids), cholesterol, bilirubin (a pigment), electrolytes and water.

Primary function of gallbladder is to store and concentrate bile between meals

Contraction is achieved by: Cholecystokinin secreted by duodenal and jejunal mucosa in the presence of fat

Relaxation is achieved by: Vasoactive intestinal peptide (VIP)

Aqueous secretions of the pancreas are isotonic and contain K+, H+, Na+, bicarbonate, Mg2+, Ca2+ and Cl-

Pancreatic enzymes hydrolyze: Proteins, Carbohydrates, and Fats

Endocrine pancreas secretes insulin, glucagon, somastostatin and pancreatic polypeptide.

Relaxation is achieved by Pancreatic polypeptide and Stimulation of sympathetic nerves

Bile salts are required for intestinal emulsification and digestion of fats

Gastrointestinal reflux disease (GERD) is the reflux of acid and pepsin from the stomach to the esophagus leading to esophagitis

Risk factors for GERD include: Drugs that relax the LES (anticholinergics, nitrates, calcium channel blockers, nicotine).

GERD may be a trigger for asthma or chronic cough.

Risk factors - Vomiting, coughing, lifting, bending or obesity increases abdominal pressure and can contribute to GERD

The severity of GERD-induced inflammation depends on the composition of gastric contents and the length of exposure

Long-term consequences of GERD is the appearance of precancerous lesions (e.g. Barrett’s esophagus) with progression to adenocarcinoma.

Clinical manifestations of GERD include: Heartburn from acid regurgitation

Clinical manifestations of GERD include: Chronic cough

Clinical manifestations of GERD include: Asthma attacks

Alcohol and acid-containing foods (such as citrus fruits and drinks) can cause discomfort during swallowing.

Genetic

Helicobacter pylori

NSAIDs

Psychological stress

spicy food

Duodenal ulcers are caused when acid and pepsin concentrations in the duodenum penetrate the mucosal barrier and leads to ulceration

Chronic intermittent pain in the epigastric area

Pain begins right after eating (when stomach is full)

Bleeding from duodenal ulcers can hematemesis or melena (black tarry stool)

Pain is due to sensorineural stimulation by acid or muscle spasm, or both

ulcers of the stomach and usually occurs in patients aged 20-30 years

It is caused by H. Pylori

Defect is caused by abnormality that increases the mucosal barriers permeability to H+ ions

Pain occurs before eating

Gastric ulcers tend to be chronic and cause more anorexia, vomiting and weight loss than duodenal ulcers

The vomiting center is found in the medulla oblongata and includes the reticular formation and nucleus tractus solitarius

Stimulation of the vomiting center can occur as side effects of several drugs

Stimulation of the vomiting center can occur indirectly via medulla oblongata

During vomiting, the duodenum and antrum of the stomach produce retrograde peristalsis while the body of the stomach and the esophagus relax

Nausea is a subjective experience that is associated with different conditions: Visceral pain, Labyrinthine stimulation (motion sickness), Use of opioids

Hyponatremia

Hypokalemia

Hypochloremia

Hypoglycemia

Metabolic acidosis

Dopamine

Dobutamine

Serotonin (5-HT3)

Substance P

Opioids

TRUE

FALSE

Renin: Regulation of blood pressure

Renal cortex: Is the inner part of each kidney that contains tubules and the collecting duct

Erythropoietin: Production of

erythrocytes

1,25-dihydroxyvitamin D3: Metabolism of

calcium

Renal medulla: Contains all of the glomeruli, most of the proximal tubules, and some segments of

the distal tubule

Each kidney contains 2.1 million nephrons

Mesangial cells: Have phagocytic properties and release inflammatory cytokines and

growth factors.

Renal corpuscle: contain glomerulus, Bowman glomerular capsule and mesangial cells

Renal corpuscle is the functional unit of the kidney

Glomerular endothelial cells membrane filters selected blood components and Composed of cells called podocytes

Glomerular endothelial cells regulate glomerular blood flow.

Glomerular filtration membrane Synthesize nitric oxide (a vasodilator)

Glomerular endothelial cells synthesize endothelin-1 (a vasoconstrictor)

Juxtaglomerular (JG) cells - specialized cells are located around the

efferent arteriole

Juxtaglomerular apparatus Control of renal blood flow (RBF), glomerular filtration, and renin

secretion

If mean arterial pressure increase or vascular resistance

increases, then the renal blood flow decreases

Solute and water excretion is changes as arterial

pressure changes.

Autoregulation

helps maintenance of 80 to 180 mm Hg constant GFR

Myogenic mechanism (stretch) As arterial pressure increase, glomerular perfusion decreases (and vice versa) and arteriole relaxes

Tubuloglomerular feedback: When sodium filtration increases, GFR decreases

Atrial natriuretic peptide (ANP) is secreted from myocardial cells in the atria

Brain natriuretic peptide (BNP) is secreted from myocardial cells in the brain

C-type natriuretic peptide

is secreted from vascular endothelium and in the nephron.

and causes vasodilation.

Urodilatin is secreted by distal convoluted tubules and the collecting ducts.

and causes vasodilation, natriuretic, and diuretic effects

Stimulates the secretion of

aldosterone by the adrenal cortex

a potent vasodilator

Stimulates antidiuretic hormone

(ADH) secretion and thirst (hypothalamus and pituitary gland)

Increase NaCl reabsorption proximal tubule

Decrease plasma volume and decrease blood pressure

Glomerulus is freely permeable to water and large colloids such as plasma proteins

Positive-charged particles permeate the membrane more readily than neutral- or

negative-charged particles

Tubular reabsorption

is the movement of fluid and solutes from peritubular lumen to the tubular

capillaries

Tubular secretion is the movement of fluid and solutes from tubular lumen to the peritubular

capillaries

Opposing forces Capillary hydrostatic pressure

Proximal tubule: reabsorption of Na, H2O (need ADH) and secretion of H+

Loop of Henle: descending loop H2O reabsorption and Na diffuses out

Loop of Henle: Ascending loop Na reabsorption Na and H2O stay in

Distal tubule: reabsorption of Na, H2O and secretion of K, H+, some drugs

Collecting duct: reabsorption of H2O (doesn't need ADH)

Proximal tubule: Na+H+ exchanger

Loop of Henle: Na+Cl- cotransporter

Distal tubule: Na+K+2Cl transporter

Collecting duct: epithelial Na+ channel

Involves water, sodium, and chloride transport

Involves water, sodium, potassium and chloride transport

Contributes to the production of concentrated urine

Fluid flows in the opposite direction through parallel tubes

Fluid becomes more and more

dilute as it encounters the distal tubule

Concept of clearance Permits an indirect measure of GFR, tubular secretion, tubular

reabsorption, and RBF

Para-aminohippuric acid (PAH) clearance is used to determine renal plasma flow and blood

flow

GFR Is the best estimate for the functioning of renal tissue

Plasma creatinine concentration: Normal value is 0.7 to 1.2 mg/dl AND Is most valuable for monitoring the progress of acute rather than chronic renal disease

Blood urea nitrogen (BUN) Is a better indicator for hydration status and good measure of GFR

Kidney stones are also called renal hydronephrosis

Masses of crystals, protein, or mineral salts form in

the urinary tract and may obstruct the urinary tract

Male: Most prevalent rick factor

Treatment

including parenteral and/or oral analgesics for acute pain

Treatment including decrease fluid intake

Dyssynergia: Overactive or hyperreflexive bladder function

Overactive: Symptom syndrome of urgency, with or without urge

incontinence; usually associated with frequency and nocturia

Treatment for Overactive bladder syndrome: antimuscarinic agents; botulinum toxin

therapy; surgery

Detrusor areflexia: Underactive, hypotonic, or atonic bladder

Renal transitional cell carcinoma is the most common renal tumors

Urinary tract infection (UTI) is the inflammation of the urinary epithelium in the urinary tract

Most

common pathogens cause UTI are Pseudomonas aeruginosa; Staphylococcus

saprophyticus

Cystitis: Inflammation of upper urinary tract

Pyelonephritis: Bladder inflammation

Clinical manifestations

including Frequency, dysuria, urgency, and low back and/or suprapubic pain

Acute pyelonephritis: Acute infection of the ureter, renal pelvis, and/or renal parenchyma

Chronic pyelonephritis: Inflammation and fibrosis in the interstitial spaces between the tubules, leading to chronic

kidney failure

Clinical manifestations of acute glomerulonephritis: Hematuria with red blood cell casts and Proteinuria exceeding 3 to 5 g/day with albumin

Acute glomerulonephritis: increased glomerular perfusion (glomerular blood flow)

Acute glomerulonephritis: increased

permeability to proteins and red blood cells

Clinical manifestations of chronic Glomerulonephritis: Proteinuria and Hypercholesterolemia

Diabetic nephropathy and lupus nephritis can lead to chronic glomerulonephritis

Nephritic Syndrome: Caused by increased permeability of the glomerular

filtration membrane

Clinical manifestations of Nephrotic Sediment: Blood is present in the

urine with red cell

casts, white cell casts,

and varying degrees of

protein, which is

usually not severe

Clinical manifestations of Nephritic Sediment: Contains massive

amounts of protein and

lipids and either tiny

amount of blood or no

blood.

Uremia: Syndrome of renal failure

Both azotemia and uremia:

Accumulation of nitrogenous

waste products in the blood

Signs and symptom of Azotemia: Fatigue, anorexia, nausea,

vomiting, pruritus, and

neurologic changes

Renal insufficiency or renal

failure, causing Uremia

Azotemia: Increased serum urea levels

and frequently increased

creatinine levels

Acute Kidney Injury: Sudden decline in kidney function with a decrease in GFR

and accumulation of nitrogenous waste products

Chronic Kidney Disease: Progressive loss of renal function associated with systemic

diseases

Chronic Kidney Disease: Kidney damage: GFR less than 30 mL/min/1.73 m2 for 3

months or more, irrespective of cause

Acute Kidney Injury types: prerenal, intrarenal and postrenal

Gaseous exchange

Delivery of nutrients to lung tissues

Acting as a blood reservoir for the left ventricle

Filtering system to remove clots, air and debris from the circulation

A cluster of inspiratory nerve cells located in the medulla

A cluster of inspiratory nerve cells located in the pons

Receives afferent impulses from peripheral chemoreceptors in the carotid and aortic bodies (which detect PaCO2 and PaO2

Sends efferent impulses to the diaphragm and inspiratory intercostal muscles

Sets the basic automatic rhythm of respiration

A.   Alveolar ducts

Alveoli

Respiratory bronchioles

Segmental bronchi

Lobar bronchi

Vasodilation

Loss of elastic lung fibers and alveolar tissue

Relaxation of bronchial smooth muscle

Hypersecretion of mucus

Hypertrophy of submucosal glands

Bronchospasm 

A.   Relaxation of bronchial smooth muscle

Mucosal edema

Vasodilation

Increased capillary permeability

Slow emptying of the lungs

.  

Wheezing

Dyspnea

More force is required to expel a given volume of air

Less time is required to expel a given volume of air

DRG is almost inactive during normal, quiet respiration

DRG sends efferent impulses to the diaphragm and inspiratory intercostal muscles

DRG sets the basic automatic rhythm of respiration

E.   

DRG is a cluster of inspiratory nerve cells located in the medulla

DRG receives afferent impulses from peripheral chemoreceptors in the carotid and aortic bodies (which detects PaCO2 & PaO2)

Pulmonary circulation  

Gas-exchange airways

Conducting airways

Bronchial Circulation

Chest Wall and Pleura

It is characterized by permanent enlargement of gas-exchange airways

It is characterized by an increase in the uptake of acetylcholine by the vagal nerves

Centriacinar emphysema occurs in smokers with chronic bronchitis

A major cause of secondary emphysema is the inhalation of cigarette smoke

Primary emphysema is linked to an inherited deficiency of the alpha1-antitrypsin enzyme

An imbalance between proteases and anti-proteases

Dopamine release

Oxidative stress

Antigen-antibody reactions

Apoptosis of lung structural cells

It can caused by an imbalance between proteases and anti-proteases

B.  

  It is a leading cause of morbidity and mortality worldwide

Most common cause of disease is smoking tobacco 

It can be caused by exposure to occupational dusts and chemicals

It can caused by apoptosis of lung structural cells

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE