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MENTAL ILLNESS CRITERIA & DEFINITIONS • Statistical Model: “Normality’’ is that which a majority (e.g., 68%) of the population exhibits, based upon a statistical normal curve. • Societal Expectations: ‘‘Normality” is conformity to sociological roles. • Consensus of Opinions of Experts: Experts (viz., psychologists and psychiatrists) stipulate what is normal. • Subjective Discomfort: The person admits to a problem. • Social or Vocational Incapacity: The inability to function in societal or work-defined roles. • Misinterpretation of Reality: The person is out of touch with or distorting perceived “reality.’’ • Immaturity: Maturity level is below the degree of what is expected at specified age or social milieu. Note: No single criterion for mental illness can describe all types of abnormalities. Defining mental illness relative to social norms or maladaptive behaviors invariably commits one to making a normative (i.e., value) judgment that one’s societal norms are “correct.” Hence, all definitions of mental illness invariably become theory-laden.
THOMAS SZASZ’S OBJECTION The concept of mental illness is a socially construced myth for the purpose of advancing certain social and political agenda. Clinical psychology is an instrument of repression to enforce conformity and stigmatize nonconformist and ‘‘deviant’’ people with the label “mentally ill.’’
REZNEK’S DEFINITION OF MENTAL ILLNESS Something is a mental illness if, and only if, it is an abnormal and involuntary process that does mental harm and should best be treated by medical means. Note: “Abnormality” is used in the constructivist (i.e., normative) sense and not in the statistical or idealistic sense, inasmuch as society determines what is acceptable “normal” behavior.
MEDICAL MODEL METHODOLOGY 1. Describe Symptoms 2. Diagnose (identify specific pathology) 3. Etiology (probable cause of disease) 4. Prescribe Treatment 5. Prognosis (expected course of disease)
CAUSAL FACTORS • Primary Cause: The agent believed to have initially caused the disease. In the medical model, the primary cause is assumed to be a virus, bacteria, chemical toxin such as lead poisoning, genetic inheritance, chemical disorder, or structural brain pathology. • Predisposing Cause: Organism is predisposed to disease under some circumstances (e.g., alcoholism). • Precipitating Cause: A specific event or factor triggers onset of the disease (e.g., it is suspected that Alzheimer’s disease has an environmental precipitating cause). • Reinforcing Cause: Factor that maintains the disease (e.g., severe stress may reinforce the need for narcotic opiates); environmental chemicals may also reinforce the disease.
WORLD’S #1 ACADEMIC OUTLINE
BASIC TERMINOLOGY • • • •
Symptom: The behaviorally manifest signs of a disorder. Syndrome: A collection of symptoms that identifies a disease. Acute: A disorder that has a sudden onset but is short-lived. Chronic: A persistent, long-lasting disorder.
CAUSE OF DISORDERS • Chemical: Usually, an imbalance of certain brain chemicals (e.g., it is suspected that an imbalance in the neurotransmitter serotonin plays a causal role in the onset of schizophrenia). • Infection by micro-organisms (e.g., syphilitic paresis is thought to be caused by the bacteria that initially infected the subject with syphilis, resulting in the subsequent dementia). • Genetic: Genetic mutations and/or predispositions may play a causal role in the onset of a disorder (e.g., manicdepressive illness is thought to have a genetic predisposing factor). • Constitutional Weakness: The organism may have an enduring biological defect that pre-disposes it to some illness. • Physical Deprivation, such as lack of sleep, malnutrition, etc. may play a causal role in the onset of disease. • Brain Pathology: Physical brain disorder, either congenital or traumatic (e.g., head injury), as the cause of mental illness.
CLASSIFICATION & DIAGNOSIS The process of classifying and identifying a disease by reference to symptoms and behavior deviating from “normal.” The major categorizing reference for the classification of mental disorders is the DSM (viz., Diagnostic and Statistical of Disorders in the DSM are sometimes classified unreliably and are invalid for diagnostic agreement among psychiatrists; with the exception of the diagnosis of “manic depressive illness,” the inter-observer diagnostic reliability of DSM is poor). People labelled by DSM classifications are often stigmatized for life.
ASSESSMENT TECHNIQUES The process of identifying the nature and severity of the condition, formulating treatment goals, and evaluating the effect of the treatment. • Medical evaluation • Personality and environmental variables • Interviews with patient • Psychological tests and rating scales • Direct observation of behavior
TREATMENTS • Psychosurgery: Partial or total frontal lobotomy, or other procedure, wherein brain tissue is severed or excised. • Electroconvulsive Shock Therapy (ECS): Administering electrical current of various intensity to the brain to alleviate symptoms of severe chronic depression. • Psychoactive Drugs: Alter mood or behavior by affecting metabolic processes that affect the brain. They are administered to stabilize moods (e.g., lithium for manic-depression), alleviate depressed states (e.g., Prozac), or to induce/subdue certain emotional states.
ADVANTAGES OF MEDICAL MODEL Promotes a more human understanding of patients, aids in the understanding of some organic mental disorders and further initiates research in brain functioning.
DISADVANTAGES OF MEDICAL MODEL Enviromental variables are unduly minimized or neglected; diagnostic and treatment methods are questionable, thus fostering an “institutionalization syndrome.” This approach removes responsibility from the person to want to be cured; it promotes dependence upon hospitals and chemicals.
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PSYCHOLOGICAL PERSPECTIVE As humans attempt to adapt to their environment, maladaptive behavior causes abnormal behavior. The psychological perspective assumes that both normal and abnormal adaptive patterns are learned, not inherited. Thus, treatment consists of substituting healthy adaptive behaviors for maladaptive behaviors. The goal of this approach is to explain abnormality in terms of inefficient and ineffective coping mechanisms. A psychological treatment works only if the patients actively participate in their treatment; the approach is usually ineffective in the case of involuntary institutionalization. • Neo-Freudians: Concentrate on the power of the ego, instead of the id. Emphasized social interactions in the formation of personality, deemphasized instincts and biological factors. In psychotherapy, they emphasize the present, not the past, and tend to advocate shorter periods of treatment. Specific problems that could be readily treated are focused upon.
GENERAL CAUSES OF ABNORMALITY These merely predispose persons to abnormal behavior: • Maternal Deprivation: Especially, orphans who are institutionalized and/or are abandoned by their natural parents. • Pathological Family Patterns: Maladaptive family behavior (e.g., faulty role model) which the child imitates and internalizes; faulty relationship between parent and child (e.g., over-protective, domineering, alcoholic and/or emotionally abusive parents, etc.) • Psychic Trauma (Especially in the psychoanalytic view): An early-repressed childhood traumatic experience is repressed (e.g., abandonment, death or divorce, sexual abuse, etc.) and then resurfaces later as a disorder. • Pathological Interpersonal Relationships: Stressful, anxiety-causing, maladaptive personal relationships (e.g., co-dependent, narcissistic, or control-obsessive), or no relationships at all. • Severe Stress: Extreme pressure on the coping mechanisms which take a destructive toll on psychological processes (e.g., post-traumatic stress disorder resulting from combat, captivity, torture, natural disasters, being kidnapped or terrorized, etc.)
OVERVIEW OF PSYCHOLOGICAL SCHOOLS OF THOUGHT • Psychoanalytic: Early development molds the personality and adaptation; the determinants of behavior are largely subconscious processes. • Neo-Freudian: Focus is on pathological social and interpersonal relationships. • Behavioristic: Faulty learning and conditioning processes produce abnormality; the determinants of behavior can usually be understood only by investigating overt observable behavior. • Humanism: Focus is on how blocked personal growth and value conflicts lead to abnormality.
PSYCHOANALYTIC PERSPECTIVE • Objective Anxiety: Fear and detectable anxiety. • Neurotic Anxiety: (i.e., “free-floating” anxiety): Fear of the actualization of repressed sexually destructive drives. Fear that the individuals will lose control and act out their drives. In such situations, the ego may create various defense mechanisms. • Superego Anxiety: A guilty conscience. • Treatment Methodology: Does not give direct advice, but attempts to assist patients to gain insight into the conditions of their illnesses. • Defense Mechanisms: Function to keep the drives repressed, and prevent the individual from acting them out. The defense mechanism is itself subconscious, because if the person were aware of it, then the patient would be aware of the drives the mechanism is defending against.
Psychological Perspective (continued)
The most productive defense mechanism is sublimation. Sublimation is the re-direction of sexual energy into productive, socially approved areas. The major function and advantages of defense mechanisms are to prevent the ego from being overwhelmed by anxiety. • Disadvantages of Employing Defense Mechanisms: Emotional rigidity and avoidance of problems instead of solving them, resulting in less authenticity and spontaneity; less-efficient ego due to wasting energy.
A COMPENDIUM: DEFENSE MECHANISMS • Reaction Formation: Manifesting behaviors or proclaiming intentions the very opposite of one’s actual unacceptable intentions; e.g., adulterous spouses frequently pronounce their fidelity. • Projection Formation: Accusing another of the very tendencies that one finds anxiety-provoking and unacceptable in oneself; e.g., persons who have been unfaithful (or are considering the same) make frequent jealous accusations against their spouses. • Denial: Denying the existence of an anxiety-provoking situation; e.g., the spouse confronted with evidence of infidelity by his/her partner simply dismisses the evidence as irrelevant because his/her partner would ‘‘never do such a thing.’’ • Repression: Excluding stressful thoughts, impulses, and memories from conscious awareness; e.g., a witness to a ghastly accident may be unable to recall any details of the event. Forgetting certain events, physical debilitation, and emotional stolidity are some manifestations of repression. • Displacement: Substituting a less-threatening object for one causing anxiety and directing reactive impulses toward the substitute; e.g., a boy who is constantly belittled and teased by older classmates may go home and torment his younger sibling. • Regression: Manifesting behaviors which are clearly infantile or immature relative to a person’s chronological age; e.g., a young woman married to an older man may refer to him as ‘‘daddy” and act as a child when confronted with severe stress. • Rationalization: Explaining away, in a seemingly logical manner, unacceptable situations, events, feelings, thoughts, or intentions. There are two basic kinds of rationalization: a. Sour-Grapes Rationalization: A desirable object/ result is devalued when the individual fails to achieve it; e.g., a man whose marriage proposal is rejected may comment that “she was too pretty anyway, and would have caused me nothing but worry and insecurity.” This keeps him from feeling the full extent of his sadness from being rejected. b. Sweet-Lemons Rationalization: A less-than-desirable object/result that is gained is overvalued; thus, the amount of dissatisfaction the person feels is minimized; e.g., a woman who is married to a dull, unattractive, unsuccessful man may comment “but he is always faithful and he is my guy.”
THE BEHAVIORAL MODEL Reaction to the unscientific, and unobservable, nature of psychoanalysis and introspective psychology. This approach emphasizes the scientific method in dealing with abnormality, and only observable phenomenon are taken into consideration. Behaviorism ordinarily presupposes that all behaviors are learned through conditioning. Cognitive behaviorism recognizes non-observable phenomenom that also affect behavior, such as thoughts and ideas (it is argued that these can be considered observable phenomena as long as we allow that the observation can be made by “an audience of one,’’ namely, the person having the thought or idea). Behaviorism is totally deterministic and denies the existence of free will; its treatment methods are most applicable to specific disorders (e.g., phobias).
PARADIGM OF BEHAVIORAL THERAPY Behavior therapy includes any technique based upon conditioning principles/theory. Theory does not appeal to any cognitive causes to explain behavior unless reference to cognitive causes can be translated away operationally or “anchored’’ to overt observable behavior. “Exemplars’’ are frequently utilized as models of research strategy (e.g., Waton’s “Little Albert experiment’’; Pavlov’s classical conditioning of dogs; Skinner’s operant conditioning of pigeons, etc.)
LEXICON OF BEHAVIORISTIC TERMINOLOGY • Reinforcer: Event, object, or stimulus that increases the frequency of the behavior it follows. • Stimulus: Typically, an enviromental event that elicits a behavioral response from an organism. • Response: A physiological and/or behavioral reaction to some environmental stimulus. • Unconditioned Response: A seemingly previously unlearned—i.e., unconditioned—response to a stimulus; e.g., some operant conditioning learning theorists hypothesize that the only unconditioned response the human organism is born with is anxiety as a response to unexpected loud noises or sudden loss of support. It is thought that all other responses are learned through stimulus generalization, reinforcement, chaining, or shaping. • Conditioned Response: Any response that is followed by a reinforcer will have the probability of its reoccurrence increased. A conditioned response occurs only when a reinforcer is present. • Orientation: The propensity of an organism to attend to a novel stimulus—e.g., one notices and becomes alert when one hears an unfamiliar sound in the middle of the night. • Habituation: The tendency of an organism to become less responsive and become desensitized upon repeated exposure to the same stimulus—e.g., persons living near an airport may not be bothered by the loud sound of over-flying aircraft because they have become habituated to the noise. • Stimulus Generalization: The propensity of an organism to exhibit the same response to a different but similar stimulus—e.g., in Watson’s ‘‘Little Albert’’ experiment, the infant was initially conditioned to respond with fear to a white rabbit. However, he soon generalized this response to any white furry object. • Extinction: The process of disconnecting the contingency between a behavior and its consequences—e.g., in treating phobias with “systematic desensitization,’’ the fear-provoking stimulus is gradually paired with a calm response, thus eliciting an extinction of the phobic response.
TREATMENT METHODOLOGY Behavior therapy is increasingly cognitivistic in its approaches as a response to the tacit recognition that appeals to some mentalistic variables which seem necessary to successfully address some disorders. Thus, systematic desensitization employs techniques of mental imagery; rational emotive therapy studies the maladaptive affect of irrational ideas. Still, these techniques seem best suited for behaviors which can be narrowly operationally specified phobias, sexual dysfunctions, etc.
DIAGNOSTIC CLASSIFICATION OF MENTAL ILLNESS PROPOSED BIOLOGICAL CAUSES: Compelling evidence suggests that schizophrenia may have an organic cause which may be hereditary. If this is true, the medical model would afford the best course of treatment. Causes may be: • Brain abnormalities, such as imbalances in certain neurotransmitters (e.g., serotonin). • Neurophysiological abnormalities, such as faulty neuron circuitry. The question is: Is brain pathology the cause or the effect of a disorder?
CAUSAL ATTRIBUTIONS Proposed causal explanations for neuroses include the following: • Behaviorist: Stress is a stimulus for anxiety. The neurotic behavior functions as a negative reinforcer for the amelioration of stress; thus, the resultant reduction in anxiety prompts further avoidance responses which further reinforce the neurotic behavior, thus initiating a vicious cycle. • Psychoanalytic: An unacceptable id impulse triggers anxiety, eliciting the utilization of a defense mechanism as an avoidance mechanism for the anxiety, once again instigating a vicious cycle. Freud claims phobic reactions occurred when anxiety was displaced from an unacceptable object to a neutral object; whereas, behaviorists argue that phobia is caused by classical conditioning. Behavior modification is the most effective treatment for phobias. • General Proposed Eclectic Causes: Faulty personality development due to parental dysfunction or toxic social conditions. Negative self-concept feedback from primary group in early development. Faulty learning and conditioning of maladaptive behavior patterns. Interpersonal theorists argue that a conflict between peer-group norms and parental norms can also cause neurotic behaviors.
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• Psychological and Personal Factors: Characteristics in the subject produce the neurosis. Specific problems that could be readily treated were focused upon. Subject may view the world as threatening, dangerous, and overwhelming. As a response, he/she may build “a wall” around himself/herself to block out the perceived threat of the world, at the same time isolating himself/herself. • Biological Organic Defect: No conclusive evidence exists for an organic cause of neuroses.
TREATMENT METHODOLOGY Various treatment strategies have been developed and proposed for neuroses, including: • Anti-Anxiety Drugs: Sometimes thought to only “mask” the symptoms and not treat the actual disorder. • Behavior Modification: Views the symptoms as the problem, and changes environmental factors that allegedly maintain the disorder. • Cognitive Behavior Therapy: i.e., rational emotive therapy proposes changing deficient thought patterns of the neurotic, which may change behavior. This presupposes that cognition causes behavior and ignores the possibility that the cause of neurotic behavior may not be manifest to conscious awareness.
WARNING: The following summary of mental illness categories is provided only for general information purposes and/or to facilitate study in advanced courses in abnormal psychology. Any attempt to use this guide as a means of diagnosing, labeling, or categorizing any person as “mentally ill” is entirely unwarranted and inappropriate. Such diagnoses should only be attempted with the aid of a mental-health professional with credentials.
DSM-IV CLASSIFICATIONS The DSM-IV utilizes a multi-axial system of assessment on several axes. The five axes included in this multi-axial classification are: Axis I: Clinical Disorders Other Conditions That May Be a Focus of Clinical Attention Axis II: Personality Disorders and Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Mental Retardation: Characterized by significantly below-average intellectual functioning accompanied by significant impairment in adaptive abilities in at least two of the following cases: self-care, home living, social skills, use of community resources, self-direction, academic skills, work, leisure, health, and safety. • Motor Skills Disorder: Characterized by marked impairment in motor coordination. Diagnosis only applies if the impairment significantly restricts academic or daily living activities; the condition is not due to any known medical condition, and criteria are not met for pervasive developmental disorder. • Communications Disorders: Essential feature includes significantly substandard performance on standardized measures of expressive language development on measures of both nonverbal, intellectual ability and receptive language development. • Pervasive Developmental Disorders: Characterized by severe, pervasive developmental impairment, including areas: reciprocal social interaction skills, communication, skills, or the presence of stereotyped behavior, interests, and activities. The qualitative defining impairments are distinctively deviant relative to the individual’s mental age or developmental level. • Attention-Deficit and Disruptive Behavior Disorders: Notable feature is the presence of hyperactivity/impulsivity and inattention at levels in excess of and prevalence more frequent than is observed in individuals of comparable stages of development. • Feeding or Eating Disorders of Infancy or Early Childhood: Essential feature is the presence of persistent feeding and eating disturbances; includes pica, rumination disorder, and feeding disorder of infancy or early childhood. • Tic Disorders: Characterized by a sudden, rapid, recurrent, non-rhythmic, stereotyped vocalization or motor movement; includes Tourette’s disorder, chronic motor or vocal tic disorder, transient tic disorder, and tic disorder NOS (Not Otherwise Specified). • Elimination Disorders: Two subcategories include encopresis and enuresis. The condition is usually involuntary, and primary physiological causes should be ruled out. Encopresis involves defecation in inap-
DSM-IV CLASSIFICATIONS (continued)
propriate places or occasions. Enuresis involves urination in inappropriate places or occasions. To qualify for diagnosis, the condition needs to be present for prolonged periods with frequently repeated incidents.
OTHER DISORDERS OF INFANCY, CHILDHOOD, OR ADOLESCENCE •Separation Anxiety Disorder: Essential feature is the onset of excessive anxiety upon separation from home or close personal attachments. Anxiety manifest is greater than what is expected of individuals at a similar maturational level. • Selective Mutism: Characterized by a persistent failure to speak in specific social situations where speaking is expected, yet speaking in other situations. Must interfere with social, educational, or vocational achievement. Diagnosis is not warranted when condition can be explained by feelings of social or cultural awkwardness, or if disturbance can be accounted for by embarrassment related to some form of pervasive developmental disorder or psychotic disorder. • Reactive Attachment Disorder of Infancy or Early Childhood: Usually associated with pathological care, the disturbance is characterized by disturbed and developmentally inappropriate social relatedness in most contexts. Onset of the disorder is generally before age five. Condition is not accounted for by only developmental delay or pervasive developmental disorder. • Stereotypic Movement Disorder: Characterized by repetitive, seemingly driven, nonfunctional motor behavior. Behavior interferes with normal activities or has the propensity to cause self-inflicted injury. Behavior is not better accounted for by compulsion, a nervous tic, or a stereotype that is part of pervasive developmental disorder. Physiological effects of a substance or a general medical condition also need to be ruled out. • Disorders of Infancy, Childhood, or Adolescence NOS (Not Otherwise Specified): A residual category for disorders, with onset in infancy, childhood, or adolescence, that cannot accurately be included in other classification.
DELIRIUM, DEMENTIA, AMNESTIC & OTHER COGNITIVE DISORDERS • Delirium: Essential feature of condition is a disturbance of consciousness and an alteration in cognition that develops over a short interval. Subtypes include: delirium due to general medical condition, substance-induced delirium, delirium due to multiple etiologies, and delirium NOS. • Dementia: Essential features include multiple cognitive deficits that include memory impairment. The dementias are also categorized according to presumed etiology; for example, Alzheimer’s type, substance-induced, etc. • Amnestic Disorder: These are disorders that include memory impairment in the absence of significant cognitive impairments. Also listed according to presumed etiology; for example, substance-induced, due to general medical condition, etc.
MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION NOT ELSEWHERE CLASSIFIED • Catatonic Disorder Due to a General Medical Condition: Characterized by the presence of catatonia attributed to the direct physiological effects of a general medical condition. Catatonia is manifested by such symptoms as motoric immobility, excessive motor activity, extreme negativism, mutism, peculiar voluntary movement, echolalia, or echopraxia. • Personality Change Due to a General Medical Condition: Indicated by the presence of a persistent personality disturbance, attributed to the direct physiological effects of a general medical condition. The personality disturbance must manifest a significant change from the individual’s previous characteristic personality pattern. • Mental Disorder NOS Due to a General Medical Condition: A residual category applicable to cases wherein it is established that a disturbance is due to the direct physiological effects of a general medical condition, but the criteria for any other specific mental disorders due to a general medical condition are not met.
SUBSTANCE-RELATED DISORDERS This broad classification encompasses any disorder related to the ingestion or exposure to a drug of abuse, the side effects of medications, or to a toxin. A wide range of substances can play a causal role in such disorders. For example, alcohol, cannabis, cocaine, hallucinogens, etc., as well as idiosyncratic reactions to various medications. Lastly, many toxins can instigate these disorders, including carbon monoxide, heavy metals, carbon dioxide, etc.
SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS • Schizophrenia: Characterized by grossly disorganized affect, behavior, and conditions. Condition lasts at least six months and includes at least one month of active phase symptoms of at least two of the following: hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior.
Furthermore, several subcategories of this disturbance are identified, including paranoid, disorganized, catatonic, undifferentiated and residual. • Schizophreniform Disorder: Symptomatology equivalent to schizophrenia but disturbance is of less duration (one to six months) and is not accompanied by a decline in functioning. • Schizoaffective Disorder: Condition characterized by a mood disorder episode wherein active-phase symptoms of schizophrenia occur with and are preceded or followed by at least two weeks of delusions and hallucinations in the absence of prominent mood symptoms. • Delusional Disorder: Essential features include at least one month of non-bizarre delusions in the absence of other active phase symptoms of schizophrenia. • Brief Psychotic Disorder: A psychotic disturbance with a duration of one to 30 days. • Shared Psychotic Disorder: Disturbance developing in an individual influenced by someone else manifesting delusions with a similar content. • Psychotic Disorder Due to General Medical Condition: Disturbance such that the psychotic symptoms are attributed to the direct physiological effect of a general medical condition. • Substance-Induced Psychotic Disorder: Psychotic symptoms are attributed to the direct physiological effect of a drug, medication, or toxin. • Psychotic Disorder NOS: Residual category for classifying psychotic disorders that do not meet the criteria for any specific psychotic disorder or manifest psychotic symptomatology about which there is inadequate or contradictory data.
MOOD DISORDERS Depressive disorders are subcategorized as follows: • Major Depressive Disorder: Characterized by at least two weeks of depressed mood or loss of interest, accompanied by at least four additional symptoms of depression. • Dysthymic Disorder: Indicated by at least 2 years of depressed mood for more days than not, accompanied by additional depressive symptoms that do not meet the criteria for major depressive episode. • Depressive Disorder NOS: Encompasses disorders with depressive features that do not meet the criteria for other specific depressive mood disorders. Bipolar disorders are subcategorized as follows: • Bipolar I Disorder: Indicated by at least one manic or mixed episode, with intermittent major depressive episodes. • Bipolar II Disorder: Characterized by at least one major depressive episode accompanied by at least one hypomanic episode. • Cyclothymic Disorder: Is evidenced by at least two years of numerous periods of hypomanic symptoms that do not meet the criteria for manic episode and numerous periods of depressive symptoms that do not meet the criteria for major depressive episode. • Bipolar Disorder NOS: Includes disorders with bipolar features that nonetheless cannot be categorized in any of the specific bipolar disorders. Other mood disorders are subcategorized as follows: • Mood Disorder Due to General Medical Condition: Indicated by a prominent and persistent disturbance in mood attributed to the direct physiological effect of a general medical condition. • Substance-Induced Mood Disorder: Indicated by a significant and persistent disturbance in mood best attributed to the direct physiological effect of a drug of abuse, a medication, another somatic treatment for depression, or exposure to a toxin. • Mood Disorder NOS: A residual disorder for classifying disorders with mood symptoms that cannot be categorized as any specific mood-disorder, and are difficult to categorize as depressive disorder NOS or bipolar disorder NOS.
ANXIETY DISORDERS These disorders are frequently characterized by “panic attacks,” discrete periods wherein the individual experiences fear, even terror, oftentimes concurrently with feelings of doom. Physiological correlates may include symptoms such as palpitation, shortness of breath, sweating, chest pain, feelings of suffocation, and a feeling of “losing control” and fear of “going crazy.” Furthermore, such disorders oftentimes include elements of “agoraphobia,” avoidance of, and anxiety about, places or situations, from which escape might be difficult or embarrassing. • Panic Disorder Without Agoraphobia: Manifested by recurrent unexpected panic attacks, about which there is persistent concern. Panic disorder with agoraphobia would include agoraphobia as an additional element. • Agoraphobia Without History of Panic Disorder: Indicated by the occurrence of agoraphobia and panic-like symptoms without a history of unexpected panic attacks. • Specific Phobia: Essential feature includes clinically significant anxiety elicited by the presence of a feared object or situation, often accompanied by avoidance behavior. • Social Phobia: Characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior. • Obsessive-Compulsive Disorder: Manifested by obsessions (causing marked anxiety and distress) and/or by compulsions (which serve to neutralize anxiety). The obsessions are frequently specific recurring thoughts, whereas compulsions are repetitious ritualistic behavior, which are performed. • Post-Traumatic Stress Disorder: Manifested by the re-
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experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with trauma. • Acute Stress Disorder: Indicted by symptoms similar to post-traumatic stress disorder, occurring in the immediate aftermath of an extremely traumatic event. • Generalized Anxiety Disorder: Characterized by at least six months of persistent and excessive anxiety and worry. Anxiety disorders due to a general medical condition, substance-induced, or NOS have similar characterizations as in previous sections.
SOMATOFORM DISORDERS This category encompasses disorders characterized by the presence of observable physical symptoms that are indicative of a general medical condition, yet are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder. The symptoms must cause clinically significant distress or impairment in social, vocational, or other areas of functioning. Furthermore, the symptoms must be unintentional (not under voluntary control). Some subcategories include the following: • Conversion Disorder: Indicated by unexplained symptoms or deficits affecting voluntary motor or sensory functions that suggest a neurological or other general medical condition. Psychological factors are believed to be involved with the symptoms or deficits. • Pain Disorder: Characterized by pain as the predominant focus of clinical attention. Psychological factors are judged to play an important role in the onset, severity, exacerbation or maintenance of the pain. • Hypochondriasis: The preoccupation with the fear of having, or the idea that one is afflicted with, a serious disease based upon the individual’s misinterpretation of bodily symptoms or functions. • Body Dysmorphic Disorder: The preoccupation with an exaggerated or imagined effect in physical appearance.
FACTITIOUS DISORDERS These disorders are characterized by physical or psychological symptoms that are intentionally produced or feigned in order to pretend to be ill. The conclusion that a particular symptom is intentionally produced is made by reference to direct evidence (for example, the individual is found to be in possession of drugs that can produce the symptoms) or by a process of elimination whereby alternative causes are ruled-out.
DISSOCIATIVE DISORDERS The essential feature of these disorders is a disruption in the integration of consciousness as this relates to memory, identity, or perception of the environment. Such disturbances may be gradual, transient and chronic. The following categories have been identified: • Dissociative Amnesia: The inability to recall important personal information, usually of a traumatic or stressful nature, that cannot be explained with ordinary forgetfulness. • Dissociative Fugue: Characterized by episodes of sudden, unexpected travel away from home or one’s ordinary place of work, accompanied by an inability to recall one’s past and confusion about personal identity or the assumption of a new identity. • Dissociative Identity Disorder (Formerly Multiple Personality Disorder): Essential features include the presence of two or more distinct personality states or identities that recurrently assume control of the individual’s behavior, accompanied with the inability to recall important personal information that is too extensive to be accounted for by ordinary forgetfulness. • Depersonalization Disorder: Characterized by a persistent and recurring feeling of being estranged from one’s self, of being a spectator of one’s own life, and of being detached from one’s mental processes or body that is accompanied by intact reality testing (that is, the individual is aware that this is only a feeling of self-alienation and not reality as such).
SEXUAL & GENDER IDENTITY DISORDERS • Sexual dysfunctions are indicated by disturbances in sexual desire and in the psychophysiological changes that characterize the sexual response cycle, and cause marked distress and interpersonal difficulty. Furthermore, disturbance is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological affects of a substance or a general medical condition. • Paraphilias are characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. • Gender identity disorders are manifested by strong, persistent cross-gender identification accompanied with persistent discomfort with one’s sex.
SEXUAL DYSFUNCTIONS Sexual Desire Disorders • Hypoactive Sexual Desire Disorder: Indicated by a deficiency or absence of sexual fantasies and desire for sexual activity.
DSM-IV CLASSIFICATIONS (continued)
• Sexual Aversion Disorder: Characterized by the aversion to and active avoidance of genital sexual contact with a sexual partner. Sexual Arousal Disorders • Female Sexual Arousal Disorder: Indicated by the persistent, recurrent inability to attain, or maintain until completion of the sexual activity, an adequate lubricationswelling response of sexual excitement. • Male Erectile Disorder: Indicated by the persistent, recurrent inability to attain, or maintain until the completion of the sexual activity, an adequate erection. Orgasmic Disorders • Female Orgasmic Disorders (Formerly Inhibited Female Orgasm): Characterized by persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Since women manifest wide variability in their orgasmic response, this diagnosis should be made with care; such factors as age, sexual experience, general health, and the degree of sexual stimulation applied should all be weighed carefully. • Male Orgasmic Disorder (Formerly Inhibited Male Orgasm): Characterized by a persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Again, factors involving age, experience, general health, and focus and intensity of stimulation received should be carefully considered. Most commonly, this disturbance may cause the male to be unable to reach orgasm in intercourse, though orgasm can be achieved via other means (for example, autoerotically, or by a partner’s manual or oral stimulation). Sexual Pain Disorders • Dyspareunia (Not Due to a General Medical Condition): Indicated by genital pain experienced with sexual intercourse; although most commonly present during intercourse, the pain may also be present before or after intercourse. Both males and females can be effected. • Vaginismus (Not Due to a General Medical Condition): Essential features include the persistent or recurrent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration is attempted with a penis, finger, tampon, or speculum. Sexual Dysfunction Due To A General Medical Condition: Indicated by the presence of a clinically significant sexual dysfunction best attributed exclusively to the direct physiological effects of a general medical condition. Disturbances may involve pain during intercourse, hypoactive sexual desire, male erectile dysfunction, etc. Paraphilias • Exhibitionism: Involves deriving sexual pleasure or excitement from exposing one’s genitals to a stranger. Occasionally, the individual masturbates while exposing himself/herself. There is usually no attempt to initiate sexual activity with the stranger. • Fetishism: Involves the utilization of non-living objects (the “fetish”) for purposes of deriving sexual pleasure or producing sexual excitement. The absence of the fetish may be accompanied by erectile dysfunction in males. • Pedophilia: Involves sexual activity with a prepubescent child (usually younger than 13 years of age); the pedophile must be at least 16 years of age and at least five years older than the child. Both sexual maturity of the child and the age difference must be taken into account. • Sexual Masochism: Involves acts (real, not simulated) in which the individual derives sexual excitement from being humiliated, beaten, bound, or otherwise made to suffer. • Sexual Sadism: Involves acts (real, not simulated) in which the individual derives sexual excitement from the physical or psychological suffering (including humiliation) of the victim. • Transvestic Fetishism: Involves cross-dressing for the purpose of deriving sexual pleasure or excitement. Typically, a male masturbates while he is cross-dressed, imagining himself to be both the male subject and female object of a sexual fantasy. This disorder is only described for heterosexual males and is not indicated when the crossdressing occurs as an element of gender identity disorder. • Voyeurism: Involves the surreptitious observation of unsuspecting individuals, usually strangers, who are naked, in the process of disrobing, or engaging in sexual activity. The act of looking is to achieve sexual excitement and possibly orgasm if masturbation is engaged in concurrently with the act of voyeurism. Generally, no sexual activity is sought with the individual observed. • Paraphilia NOS: Residual category to include coding paraphilias that do not meet the criteria of the specific categories. Examples include, but are not limited to, necrophilia (corpses), partialism (exclusive focus on part of the body), zoophilia (non-human animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine), and telephone scatologia (obscene phone calls).
GENDER IDENTITY DISORDERS Two criteria must be satisfied for this diagnosis to apply: • There must be a strong and persistent cross-gender identification that is not due merely to a desire to attain the perceived cultural or social advantages of being the other sex. • There must also be present a persistent discomfort with one’s sex or a sense of inappropriateness in the gender role of that sex.
EATING DISORDERS • Anorexia Nervosa: Characterized by the individual’s refusal to maintain a minimally normal body weight, intense fear of gaining weight, and significantly distorted perception of the shape and size of one’s body. • Bulimia Nervosa: Characterized by binge eating and inappropriate compensatory methods to prevent weight gain (for example, induced vomiting, misuse of laxatives and diuretics, etc.) Furthermore, self-evaluation is excessively influenced by body shape and weight.
•
SLEEP DISORDERS Primary Sleep Disorders: Are sleep disorders wherein the causal role of another mental disorder, a general medical condition, or a substance, have been ruled out. Two subcategories include: • Dyssomnias: Abnormalities in the amount, quality, or timing of sleep. Hence, such disturbances as primary insomnia, primary hypersomnia, and narcolepsy would be included. • Parasomnias: Indicated by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions. Hence, such disturbances as nightmares, sleep terror, and sleepwalking would be included.
•
•
IMPULSE-CONTROL DISORDERS NOT ELSEWHERE CLASSIFIED The essential feature of these disorders is the failure to resist an impulse, drive, or temptation to perform an act that is harmful to self or others. Typically, the individual experiences increased tension or arousal before committing the act, followed by relief, pleasure, or gratification after completion of the act. Ensuing feelings of guilt, regret, or self-recrimination may or may not be present. • Intermittent Explosive Disorder: Characterized by discrete episodes of failure to restrain aggressive impulses, resulting in serious assaults or destruction of property. The degree of aggressiveness displayed is grossly disproportionate to the objective physical or psychological provocation. • Kleptomania: Indicated by the repeated failure to resist impulses to steal objects not needed for personal use or monetary value. The theft is not due to vengeance, need for survival, nor is it due to hallucinations. • Pyromania: Essential feature is the ignition of fires for pleasure, gratification and relief of tension. There is a fascination with, curiosity about, and attraction to situational contexts with fire, witnessing its effects, or participating in its aftermath. • Pathological Gambling: Indicated by persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. • Trichotillomania: Essential feature is the recurrent pulling out of one’s hair for pleasure, gratification, or relief of tension that results in noticeable hair loss.
•
•
•
ADJUSTMENT DISORDERS Characterized by the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors. Such stressors may include a romantic break-up, business or financial difficulties, or marital discord, etc.
PERSONALITY DISORDERS Enduring patterns of inner experience and behavior that significantly deviates from the expectations of the individual’s culture, is pervasive and inflexible, originates in adolescence or early adulthood, is stable over time, and leads to clinically significant distress or impairment in one or more important areas of functioning (e.g., social, academic, or occupational). • Paranoid Personality Disorder: Indicated by a pattern of pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent. Events and the actions of others are interpreted in the most negative light possible, and convictions of others’ hostility are based on little or no objective evidence. • Schizoid Personality Disorder: Essential features include a pervasive pattern of detachment from social relationships and a restricted range of emotions in interpersonal settings. The individual typically will avoid social interaction, prefers solitary activities and interests, and seems to derive little or no pleasure from sensory, bodily, or interpersonal relationships. Affect is usually “flat” and expressionless, and there is a preference for abstract intellectual interests, such as mechanical, mathematical, or computer-related pursuits. • Schizotypal Personality Disorder: Characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. Individuals will frequently have incorrect interpretations of casual incidents and external events as being especially meaningful. These beliefs are not held, however, with delusional conviction. The individual may nonetheless be superstitious or preoccupied with the paranormal to a degree inordinate for his/her specific cultural milieu. “Magical” and superstitious fallacious thinking is also common. • Antisocial Personality Disorder (also referred to as Psychopathy, Sociopathy, or Dyssocial Personality Disorder): Essential features include a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into 4
•
adulthood. Deceit, manipulation, and exploitation are central characteristics of this personality disorder. A pattern of impulsivity may also be present, such that decisions are made capriciously, with little or no forethought or planning. Borderline Personality Disorder: Indicated by a pervasive pattern of instability in interpersonal relationships, of self-image and affects, accompanied by marked impulsivity with an onset in early adulthood and present in a variety of contexts. Individual will often be intensely concerned with abandonment and will go to great lengths to avoid real or imagined abandonment. The perception of impending loss, rejection, separation, or abandonment or the loss of external stability and structure can produce profound alterations in self-image, affect, cognition and behavior. Histrionic Personality Disorder: Characterized by pervasive and excessive emotionality and attention-seeking behavior, originating in early adulthood and manifesting in a variety of contexts. Individual feels uncomfortable and unappreciated if he/she is not the center of attention. Individuals with this disorder will often behave in a melodramatic, histrionic, and flirtatious manner. Narcissistic Personality Disorder: Characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy, with an onset in early adulthood and manifest in a variety of contexts. The individual has an exaggerated sense of self-importance, often displaying a conceited, boastful demeanor while overestimating his/her abilities and accomplishments. Avoidant Personality Disorder: Characterized by an inordinate preoccupation with being disapproved of, socially rejected, or criticized. Individual suffers from chronic feelings of inadequacy and is hypersensitive to the possible negative evaluations of others. Typically, significant interpersonal or social involvement is avoided, due to fear of being exposed, ridiculed, or embarrassed. Due to constant need for reassurance, security, and certainty of acceptance, individual often leads a rather isolated or restricted social existence. Dependent Personality Disorder: Indicated by an inordinate and chronic need to be taken care of, resulting in submissive clinging behavior and a fear of separation, abandonment, or rejection. Due to a self-perception of being unable to function without the help of others, the individual displays a variety of submissive and dependent behaviors so as to elicit care giving and nurturing behavior from others. Individual tends to be indecisive about even everyday matters, and requires much advice and reassurance from others due to his/her extremely passive nature. Obsessive-Compulsive Personality Disorder: Essential features include an extreme preoccupation with order, systematization, and organization. Many repetitive rituals are engaged in to ensure a sense of control and stability, and individual abhors any unpredictability, chaos, or spontaneity in his/her lives. Rules, orderliness, perfectionism, fastidiousness, and priggish morality often characterize behavior associated with this disorder. The punctiliousness and excessive attention to detail not only stifle any creativity, spontaneity or flexibility in the individual’s life, but ultimately prove selfdefeating in that the major point of the activity is defeated in as much as the inordinate time spent “perfecting” a project. Personality Disorder NOS: Residual category for classifying disorders which, while manifesting some of the criteria of the various specific personality disorders, nonetheless do not meet all the criteria for any one of them.
OTHER CONDITIONS THAT MAY BE A FOCUS OF CLINICAL ATTENTION This broad category encompasses conditions or problems that may be a focus of clinical attention in that they are coded on Axis I and related to the previously described mental disorders in the following manners: • Although the individual has no mental disorder, the problem is the focus of diagnosis or treatment. • The individual suffers from a mental disorder unrelated to the problem, which is the focus of the initial diagnosis or treatment. • The individual suffers from a mental disorder that is related to the problem, and the problem is sufficiently severe to warrant independent clinical attention. NOTE TO STUDENT: This QUICK STUDY ® guide is an outline of the major topics taught in Abnormal Psychology courses. Due to its condensed format, use it as a Abnormal Psychology guide, but not as a replacement for assigned class work. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ®2001, 2006 BarCharts Inc. 0108
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OVER 1,000 ANATOMICAL IDENTIFICATIONS - COVERS ALL MAJOR SYSTEMS
THE MOST COMPREHENSIVE ALL-IN-ONE ANATOMY CHART Frontal SKELETAL Zygomatic Mandible Manubrium Clavicle Lesser tubercle Greater tubercle Bicipital groove Sternum Ribs Xiphoid process
Maxilla Temporal Cervical vertebrae Coracoid process Acromion Scapula Costal cartilage Humerus Lumbar vertebrae Trochlea
Occipital
Ilium Acetabulum (socket)
Sacrum
Ischium Pubic symphysis
Sternum Ribs
Olecranon
Radius
Medial condyle of tibia Fibula
Tibia
Cuneiforms (I, II, III) Metatarsals Phalanges
Metacarpals
Cervical vertebrae (I-VII)
Obturator foramen Phalanges Ischium (see below) Femur Metacarpals Patella Lateral condyle Medial condyle Tibia Fibula Calcaneus Tibia Metatarsals Cuneiforms CARPALS (I, II, III) 1. Scaphoid 5. Trapezium 6. Trapezoid 2. Lunate Phalanges 3. Triquetal 7. Capitate 8. Hamate 4. Pisiform
Fibula
Cuboid Metatarsals
Vertebrae prominens (VII) Thoracic vertebrae (I-XII)
Transverse costal facet Costal facet Transverse process Superior and inferior articulating processes
Lumbar vertebrae (I-V)
Spinous processes Intervertebral foramen
Inner layer Periosteum Interstitial lamellae Concentric lamellae
Osteon (haversian system) Lacunae containing osteocytes Canaliculi
Endosteum
Vein Nutrient foramen Yellow marrow Femur
Circumferential lamellae
Medullary cavity
Disc
Occipital
Mastoid process Acoustic (or external auditory) meatus Styloid process Zygomatic arch
Compact bone
Ventral root (motor)
Head of femur
Neck of femur
Spinous process Superior articular process Pedicle Transverse process
Proximal secondary epiphysis Great trochanter
Epiphyseal lines
BONE STRUCTURE
Gray and white rami communicans Fovea capitis
Proximal epiphysis
Inferior articular process and facet Sympathetic trunk
1
Wing of sphenoid Ethmoid Lacrimal Temporal Nasal Nasal conchae Zygomatic Infraorbital foramen Mastoid process Vomer Maxilla Mandible Mental foramen
Temporal
Dorsal root (sensory)
Parietal
Squamous suture
Frontal
Parietal
all nonarticulating surfaces)
Promontory
Coccyx (3-5 Var.) (coccygeal vertebrae)
Coronal suture
Sensory ganglion Cancellous bone
Auricular surface (for ilium)
Lambdoid suture
Periosteum (covers
Diaphysis
Body
Phalanges POSTERIOR VIEW SKULL Supraorbital foramen
Blood vessels within haversian or central canal
Blood vessels within Volkmann’s or perforating canal
Trabeculae Pedicle
Sacrum (I-V fused)
Lateral condyle Nutrient a.
Outer layer
Phalanges ** = cut a. = artery a.a. = arteries ex. = extensor fl. = flexor L. = Left (l.i.) = large intestine l. = ligament l.l. = ligaments m. = muscle m.m. = muscles n. = nerve n.n. = nerves R. = Right (s.i.) = small intestine v. = vein v.v. = veins
(behind hamate)
LATERAL VIEW
Perforating or Sharpey’s fibers Distal epiphysis
Atlas vertebrae Axis vertebrae
5678
Distal carpals
Calcaneus
ANTERIOR VIEW VERTEBRAL COLUMN Lateral epicondyle Patellar groove
Ulna
Pubic tubercle
Navicular
Navicular
Ilium Radius
(see below)
Talus
Talus Cuboid
Posterior, superior iliac spine Posterior, inferior iliac spine
Decending ramus of pubis
Medial malleolus Lateral malleolus
Humerus
Coccyx (3-5) Anterior superior Carpals 1 2 3 4 iliac spine
Lateral epicondyle of femur
Patella
Scapula
Lumbar vertebrae (I-V) Sacroiliac joint Sacrum (5 fused)
Ilium
Lateral condyle of tibia
Femur
Clavicle
Thoracic vertebrae (I-XII)
Humerus
Sacrum Coccyx Ischial Metacarpals spine Phalanges Lesser Greater trochanter sciatic notch Lesser trochanter Femur Medial epicondyle of femur
Pubis
Italics are bone features
Acromion Spine of scapula
Clavicle
Radius Ulna Carpals
Head
Neck
Cervical vertebrae (I-VII)
Hyoid
Scapula
Parietal Occipital
Mandible
Ulna Lateral epicondyle of humerus Posterior superior iliac spine Coronoid process Medial sacral crest Tuberosity
Iliac crest
SYSTEM
Maxilla Cervical vertebrae (I-VII)
Medial epicondyle of humerus
Capitulum
Frontal Temporal
Parietal
Frontal
Spinous process White matter (sensory) Lamina Superior articular Synapse facet Superior articular Gray matter Mamillary process process White matter (motor) Transverse Accessory Pia mater Process process Motor n. fibers Arachnoid matter Pedicle Nerve fibers Dura mater Vertebral body Body (centrum) Sympathetic ganglion Intervertebral disc
Superior vertebral notch Vertebral foramen
VERTEBRAE & NERVE STRUCTURE
NERVOUS SYSTEM R. lymphatic duct
Cerebrum (brain)
Parotid lymph nodes Cervical lymph nodes
Cerebellum Cervical plexus
Brachiocephalic v.
Brachial plexus L. thoracic duct
Intercostal n.n. Axillary n.
Intercostal nodes
Axillary lymph nodes
Radial n.
Spinal cord
Lymphatic vessels Radial n. Cubital lymph node Intestinal nodes
Cauda equina {
Subcostal n.n.
Median n.
Common iliac nodes
Lumbar plexus
Cisterna chyli Para-aortic nodes Inguinal lymph nodes
Sacral plexus Nasal cavity Auditory (eustachian) tube Oral cavity Tongue Larynx Trachea Secondary bronchi
Superior, middle & inferior conchae
Pharynx Glottis Vocal fold (cord) Primary bronchi R. lung
Palmar plexus
Popliteal lymph nodes Superficial lymph vessels
Ulnar n.
Femoral n.
Cardiac notch
Iliohypogastric n. Ilioinguinal n.
Saphenous n.
Gluteal n.n. Pudendal n. Sciatic n. Tibial branch of sciatic n. Peroneal branch of sciatic n.
Bronchiole & lobule
Pleura
Plantar vessels Digital n.n. Diaphragm
LYMPHATIC NETWORK Thyroid (ventral) Parathyroids (dorsal) Adrenal (suprarenal)
RESPIRATORY SYSTEM Pituitary (hypophysis) Pineal Thymus (in child)
Parotid gland Tongue Pharynx
Gallbladder Duodenum (s.i.)
ENDOCRINE SYSTEM
Ovaries (female) Testes (male)
Ascending colon (l.i.) Jejunum (s.i.) Cecum Ileum (s.i.)
Anus
COLON
Transverse colon ** (below)
L. colic (splenic) flexure
Ascending colon
Adrenal gland (endocrine system)
Haustra
Esophagus Stomach Spleen (lymphatic system)
Free tenia (tenia libera)
Pancreas (behind stomach)
Ureter
Sigmoid colon
Cecum Vermiform appendix Rectosigmoid junction Rectum Anus Exterior anal sphincter m.
Ovary Uterus Endometrium Myometrium Cervical canal Urinary bladder Pubic bone Clitoris
Rectum Fat Prostate gland Anus Bulbourethral gland (Cowper’s) Epididymus Testicular tubules Scrotum
Labia minora Vaginal opening
MALE REPRODUCTIVE SYSTEM
Labia majora 2
Descending colon Free tenia (tenia libera)
R. ureter
L. ureter Urethra
Urinary bladder
Sigmoid colon Prostate (male)
URINARY SYSTEM Descending colon Sacrum
Fimbria
Seminal vesicle
Testis
R. kidney
Ileum
Uterine tube
Sacrum
Navicular fossa
Mesocolic Omental tenia tenia Semilunar folds
L. kidney
Transverse colon (l.i.) Descending colon (l.i.) Appendix Sigmoid colon Rectum
DIGESTIVE SYSTEM & VISCERA
Urinary bladder Vas deferens Pubis Ejaculatory duct Urethra Corpus cavernosum Corpus spongiosum Prepuce
Glans penis and external urethal meatus
R. colic (hepatic) flexure
Trachea Submandibular salivary gland Liver
Pancreas
Oral cavity Sublingual salivary gland
Cervix Sigmoid colon Vagina Coccyx Rectum Urethra Tendon levator ani Anus Muscles of pelvic bowl
FEMALE REPRODUCTIVE SYSTEM
CIRCULATORY SYSTEM
Cereberal a. Superficial temporal a. & v.
Circle of Willis (see below) Sinus sagittalis sup.
Internal jugular v.
L. middle cerebral a. Confluens sinum
External jugular v. Facial a. & v.
Brachiocephalic a.
VEINS
Jugular v. L. external carotid a. Common carotid a.
Brachial v. Superior vena cava Inferior vena cava
Subclavian a. Axillary a.
(Blood flows toward heart)
Superior vena cava
Pulmonary a. L. pulmonary v.v.
Hepatic portal v. Capillaries of liver Inferior vena cava v. Portal circulation
Ulnar a.
Palmar venous network
Renal v.v. Kidneys
External iliac a. Internal iliac a.
Internal iliac v.
Deep femoral v.
Femoral a. Popliteal a. Genicular a.a. Recurrent tibial a. Anterior tibial a. Circle of Willis
Great saphenous v. Genicular v.v.
Anterior communicating a. Middle cerebral a. Lenticulostriate a.
Precentral a.
Great saphenous v. Middle temporal a.
Posterior communicating a.
Internal carotid a. Posterior cerebral a. Superior cerebellar a.
Dorsalis pedis a. R. common carotid R. external jugular v. R. subclavian a. L. common carotid R. brachiocephalic v. Superior vena cava Ascending aorta R. atrium R. coronary a. R. ventricle Inferior vena cava
Anterior inferior cerebral a.
Arch of aorta
L. auricle L. superior pulmonary v.
R. pulmonary a.
Great cardiac v.
Superior vena cava
Circumflex branch of left coronary a.
R. superior pulmonary v.
L. atrium Posterior branch of left coronary a.
R. inferior pulmonary v.
Coronary sinus
Sulcus terminalis
Posterior v. of left ventricle
R. atrium Inferior vena cava R. coronary a.
Apex Middle cardiac v.
Plantar a. anastomosis Inferior thyroid v.
Posterior descending a.
Common carotid a. Sinoatrial (SA) a.
Subclavian a. and v. L. brachiocephalic v. Sinoatrial (SA) node Arch of aorta Ligamentum arteriosum Middle internodal L. pulmonary a. tract Pulmonary trunk Posterior L. pulmonary internodal v.v. tract L. atrium Mitral valve Marginal branches Aortic valve Atrioventricular L. ventricle (AV) node L. posterior R. bundle branch papillary m. Atrioventricular Muscular interventricular (AV) a. septum Purkinje fibers Apex Posterior interventricular Abdominal aorta branch
L.brachioBrachiocephalic trunk cephalic v. R. brachiocephalic v. L. subclavian a. Aortic arch L. pulmonary a.a. Superior vena cava L. pulmonary R. pulmonary a. v.v. R. pulmonary v.v. L. atrium Great cardiac v. Pulmonary valve L. anterior descending R. atrium (or anterior intraventricular) coronary a. Tricuspid valve L. ventricle R. ventricle Apex Fat Descending aorta Inferior vena cava
ANTERIOR HEART
L. pulmonary a.
L. ventricle
Internal jugular v. L. external External jugular v. jugular v.
Inferior thyroid v.
POSTERIOR HEART
Vertebral a.
Basilar a. Internal acoustic (labyrinthine) a.
Internal iliac a. Femoral a. Internal iliac
Capillaries of legs & feet
Anterior cerebral a.
Ascending frontal a.
Plantar venous network
Capillaries of pelvis
L. inferior pulmonary v.
Ophthalmic a.
Anterior tibial v.
Capillaries of colons
Femoral v.
Palmar a. anastomoses L. lateral circumflex a.
Femoral v.
L. atrium Decending thoracic aorta L. ventricle Celiac a. Gastric a. Splenic a. Hepatic a. Stomach Gastric aorta Spleen Descending abdominal aorta Renal a.a. Superior mesenteric a. Inferior mesenteric a.
R. atrium R. ventricle
Celiac trunk Abdominal aorta Renal v. Renal a. Gonadal a. Radial a.
Cephalic v.
Pulmonary capillaries R. pulmonary a.
Arch of Aorta
Brachial a.
External iliac v. Internal iliac v.
L. pulmonary a.
R. pulmonary v.v.
Aortic arch Pulmonary a.
Hepatic portal v. Superior mesenteric v. Superior mesenteric a. Basilic v. Median v.
Capillaries ARTERIES of arms (Blood flows away from heart) & hands Arteries of head, arms & hands Aortic arch
Capillaries of head
L. internal carotid a.
Vertebral a.
Subclavian v. Cephalic v.
BLOOD CIRCUITS
CIRCULATION 3
Inferior thyroid v.
Main right coronary a.
Aortic valve: R. cusp L. cusp Posterior cusp Bachmann’s bundle Main L. coronary a. Circumflex branch Anterior internodal tract Anterior interventricular branch (L. anterior descending)
Common AV bundle (of His) L. bundle branch Perforating branches to interventricular septum Purkinje fibers
NERVES & ARTERIES
MUSCLES Auricularis superior Corrugator fibers Auricularis anterior Risorius Orbicularis oris Platysma Pectoralis major Serratus anterior Rectus sheath
Frontalis Temporalis Orbicularis oculi Masseter Omohyoid Sternohyoid Trapezius Sternomastoid Deltoid Linea alba
Temporalis Occipitalis
Linea semilunaris
Deltoid Brachialis Triceps brachii Ex. carpi radialis longus
Biceps brachii
Bicepital aponeurosis
Bicepital aponeurosis** Pronator teres Brachioradialis Obliquus externus Fl. carpi radialis
Rectus abdominis
Fl. carpi ulnaris Palmarus longus Gluteus medius Palmar aponeurosis
Ex. carpi radialis brevis
Cremaster** Pyramidalis Sartorius Adductor magnus Gracilis Fasciae lata (Band of Richer) Tendons of quadriceps ex. Lateral patellar retinaculum Fat pads
Tensor fasciae latae Iliopsoas Pectineus Adductor brevis Adductor longus Outer Rectus femoris Vastus lateralis
Medial patellar retinaculum Patellar tendon Tibialis anterior Ex. digitorum longus Superior ex. retinaculum Inferior ex. retinaculum Ex. digitorum longus tendons Ex. hallucis longus tendon
Vastus medialis Gastrocnemius Peroneus longus
Ex. hallucis longus Peroneus tertius Ex. hallucis brevis
Sartorius
Vastus lateralis
Masseter** Depressor labii inferioris** Depressor anguli oris** Incisivus labii inferioris Levator scapulae Sternohyoid Omohyoid Subclavius Sternomastoid** Serratus anterior Biceps brachii short head** Subscapularis Biceps brachii long head** Latissimus dorsi Pectoralis minor Coracobrachialis Deltoid** Internal intercostal Serratus anterior External intercostal Linea alba Brachialis Pronator teres** Fl. carpi radialis** Palmaris longus** Fl. digitorum superficialis** Biceps brachii** Fl. carpi ulnaris** Fl. digitorum superficials** Arcuate Obliquus externus** line Obliquus internus** Inguinal l. Transversus abdominis Gluteus Fl. digitorum minimus profundis Iliopsoas Pectineous Gracilis** Abductor Fl. pollicis digiti longus minimi Adductor brevis Adductor pollicis Lumbricales Adductor longus SemitenAdductor magnus dinosus**
ANTERIOR VIEW
Biceps femoris Gastrocnemius
Popliteal fosa
Peroneus longus
Tibialis anterior
Soleus
Fl. hallucis longus Ex. digitorum brevus Peroneus tertius tendon
Ex. digitorum longus Peroneus brevis Peroneus tertius Peroneal retinaculum
Soleus
Inner hamstring tendons
Fl. digitorum longus
Peroneus longus tendon Calcaneal Peroneus brevis tendon (Achilles) tendon Fl. retinaculum Abductor digiti minimi
LATERAL VIEW Corrugator Levator palpabreum
Superior tarsus
Splenius capitis** Semispinalis capitis
Medial ptergoid Stylohyoid Mentalis** Levator scapulae Digastric Omohyoid Rhomboid minor Rhomboid major Supraspinatus Infraspinatus Teres minor** Triceps brachii longhead** Triceps brachii lateral head** Teres major Deltoid** Serratus anterior Triceps brachii medial head Erector spinae External intercostals Serratus posterior inferior Obliquus externus** Obliquus internus Ex. carpi radialis brevis** Supinator Fl. digitorum profundis Pronator teres Abductor pollicis Gluteus longus medius Ex. pollicis longus Piriformis Ex. pollicis Superior brevis gemellus Ex. indiObturator cis internus Gemellus inferior Sacrotuberous 1st Dorsal l. interosseous Quadratus 2nd D.I.O. inferior 3rd D.I.O. Adductor brevis Biceps femoris** Abductor 4th D.I.O. Adductor magnus digiti minimi
Frontalis
Fl. digitorum brevis
Galea aponeurotica Frontalis Temporalis Orbicularis oculi
Occipitalis
Orbicularis oculi Nasalis Procerus Zygomaticus minor Levator labii superiorus Levator labii alaeque nasi Orbicularis Masseter oris Buccinator Mentalis Depressor anguli oris Depressor labii Mentalis inferioris Orbicularis oris Trapezius Acromion (scapula) Supraspinatus Infraspinatus Greater tubercle Teres minor Teres major
Zygomaticus major Masseter Buccinator Depressor anguli oris
Sternomastoid Sternohyoid Omohyoid Clavicle Coracoid process Pectoralis minor Pectoralis major Serratus anterior Rectus abdominis Tendinous inscription
Humerus Obliquus externus Latissimus dorsi Iliac crest
DEEP MUSCLES POSTERIOR VIEW LATERAL VIEW 4
Abductor hallucis
POSTERIOR VIEW MUSCLES OF THE HEAD Temporalis
Levator labii aleque nasi**
Semimembranosus
Gluteus maximus
Semimembranosus
Levator anguli oris Incisivus labii superioris Muscular node
Gluteus medius
Semitendinosus
Gastrocnemius
Nasalis Buccinator
Ex. retinaculum
Vastus lateralis Gracilis
hamstring tendon
Levator labii superioris**
Triceps brachii
Adductor magnus Rectus femoris
Biceps femoris
Zygomatic minor** Zygomatic major**
Teres minor
Fl. carpi ulnaris
Tendon of ex. pollicis longus
Ex. digitorum brevis
ANTERIOR VIEW DEEP MUSCLES Lateral palpebral l.
Infraspinatus
Ex. carpi Brachioradialis ulnaris
Iliotibial band
Ex. digitorum longus
Splenius capitis Deltoid
Ex. carpi radialis brevis
Obliquus externus
Ex. digitorum communis Adductor Hypopollicis thenar longus m.m. Adductor Ex. pollicis pollicis brevis Lumbricales Gluteus Synovial fl. tendon sheaths maximus Fl. synovium Fl. retinaculum Thenar m.m. Ulnar bursa
Linea alba Fl. carpal l.
Occipitalis
Splenius capitis Semispinalis capitis Levator scapulae Scalenus medius Trapezius Sternocleido mastoid Rhoboideus major Omohyoid Teres major Scalenus anterior Latissimus Pectoralis dorsi major Anconeus Serratus anterior Ex. carpi radialis longus Biceps brachii Ex. digitorum communis Rectus abdominis
Splenius capitis Levator scapulae Trapezius
Tendinous inscriptions
Semispinalis capitis
Frontalis
Umbilicus
Supraparietal lobule Precentral Superior SURFACE BRAIN gyrus frontal sulcus Central sulcus (of Middle frontal gyrus Rolando) Inferior frontal sulcus Postcentral sulcus Lateral ventricle(s) Postcentral gyrus Inferior (first & second) frontal gyrus: Inferior parietal Cingulate sulcus Opercular part lobule Triangular part Interthalamic adhesion Supramarginal Orbital part gyrus Anterior commissure Frontal pole Angular Paraterminal gyrus Olfactory bulb gyrus Temporal pole Thalamus (3rd ventricle) ParietoSuperior temporal gyrus occipital Hypothalamus sulcus Temporal lobe Superior temporal sulcus Optic chiasm Transverse Middle temporal gyrus Mamillary body cerebellar Pons fissure Inferior temporal sulcus Hypophysis Pons Cerebral peduncle Inferior temporal gyrus Cerebellum (Pituitary gland) Medulla oblongata Horizontal fissure of cerebellum Medulla oblongata
BRAIN (SAGITTAL SECTION) Sulcus of corpus callosum Corpus callosum Parietal lobe Parieto-occipital sulcus
Occipital lobe Pineal body Posterior commissure Corpus quadral gemminal Cerebral aqueduct Cerebellar peduncles Superior medullary vellum Cerebellum Fourth ventricle
Arbor vitae
Cerebellar cortex
Spinal cord
C1 C2 C3 C4 C5 C6 C7 C8 T1 T2 T3 T4
Cervical plexus C1 - C4 Cervical n.n. C1 - C8 Brachial plexus C5 - T1
Thoracic n.n. T1 - T12
Precentral sulcus Cingulate gyrus Fornix Frontal lobe
Central sulcus
1st Cervicle vertebrae (transverse process**) Supraclavicular n.
BRACHIAL PLEXUS Trace of the mandible
T5 T6
Axillary n.
T7
L2 L3 L4 L5 S1 S2 S3 S4 S5
Sacral n.n. S1 - S5
Superior gluteal n. Inferior gluteal n. Posterior femoral cutaneous n. Pudendal n. Sciatic n. Inferior rectal n. Dorsal nerve of penis (clitoris)
Coccygeal n.
Ulnar n. Filum dora mater
Cutaneous nerve of forearm
T10
HIP LIGAMENTS Inguinal l. Pubofemoral l.
Pubic tubercle
Ex. insertions
Lateral bands
Joint capsule Collateral l.l. Distal phalanx Distal interphalangeal (DIP) joint Middle phalanx Proximal interphalangeal (PIP) joint Proximal phalanx Metacarpophalangeal (MP) joint Articular cartilage th 5 metacarpal Tendon of ex. indicis Tendons of ex. digitorum
Slips of long ex. tendons to lateral bands
Capsular l.
Pubocapsular l.
Dorsal expansion (hood)
Surface 2nd Metacarpal bone
Great trochanter
1st Dorsal interosseous m. 1st Palmar interosseous m.
Transverse acetabular l. Ishiocapsular l. Lesser trochanter
KNEE LIGAMENTS BACK Popliteal surface Adductor tubercle Medial condyle of the femur (articular surface) Medial epicondyle Intercondyler fossa Posterior cruciate l. Medial meniscus Medial condyle of the tibia Tibial (medial) collateral l.
HIP & SCIATIC NERVE
COMPONENTS OF THE FINGER Iliofemoral l. (Y l. of Bigelow)
Joint l.
Obturator membrane
Perineal n. Femur
Intertendinous bands
Tibia
12th Thoracic vertebrae (pedicle**) 1st Lumbar vertebrae (pedicle**) 5th Lumbar vertebrae (pedicle**) Sacrum, is made up of 5 fused vertebrae (pedicles**) Iliohypogastric n. Ilioinguinal n. Genitofemoral n. Lateral femoral cutaneous n. Trace of the pelvis Femoral n.
L1
Sacral plexus L5 - S4
Median n.
T9
Symphysis pubis
Lumbar plexus T12 - L4 Lumbar n.n. L1 - L5
Radial n.
T8
SACRAL PLEXUS
T11 T12
7th Cervicle vertebrae Upper trunk (pedicle and transverse process**) Middle trunk 1st Thoracic vertebrae Inferior trunk (pedicle**) Trace of the scapula Lateral cord Posterior cord Medial cord Humerus Musculocutaneous n.
Thoracic n.n. T1 - T12
Trapezoid
Intertrochanteric line & capsule attachment
Trapezium
Schaphoid
Pisiform Hamate Triquetrum Styloid process Ulna Capitate Radius
Articular capsule
Supraspinous l.
Posterior superior iliac spine Latissimus dorsi
Articular capsule Ilium
Iliac crest
Dorsal sacral foramina Sacroiliac joint Posterior inferior iliac spine Greater sciatic notch Acetabulum Head of femur
Piriformis
Ishiofemoral l.
Great trochanter Neck of femur
Patella Lateral epicondyle
Intercondyler line Lateral condyle of the femur (articular surface) Anterior cruciate l. Lateral epicondyle Anterior meniscofemoral l.
Lateral condyle of the femur Lateral meniscus Fibular (lateral) collateral l.
Posterior meniscofemoral l. Lateral meniscus Fibular (lateral) collateral l.
Lateral condyle of the tibia Patellar l. Head of the fibula
Lateral condyle of the tibia Posterior l.l. of the fibular head
Anterior l.l. of the fibular head Fibula
Head of the fibula 5
Obturator internus
Sacral hiatus
Sciatic n. Ischial tuberosity
Femur
Lumbar vertebrae 3, 4, & 5 Thoracolumbar fasciae
Superior & inferior articulating facets
Coccyx Pubis Spine of ischium Obturator membrane
Lesser trochanter Obturator foramen Ramus of ischium
Ischial bursa
Trochanteric bursa
Sciatic n. Sacrospinal l.
Sacrotuberous l. Trochanteric bursa
KNEE LIGAMENTS FRONT Femur Adductor tubercle Medial epicondyle Medial condyle of the femur Medial meniscus Medial condyle of the tibia Tibial (medial) collateral l. Tibial tuberosity Tibia
HEAD: EYE, EAR, NOSE & MOUTH Central sulcus Parietal lobe Occipital lobe
Cerebellum Inner ear (cochlea) (semicircular canals) Tympanic membrane (eardrum) Temperomandibular joint & capsule Head of the mandible Spinal cord Nuchal l. Cervical n.n. Esophagus
7th cervical vertebrae Hair shaft Pore of sweat gland Merkel’s discs Epidermis (touch) Erector pili m.
Dermis (temperature) Sebaceous glands
Frontal lobe Conjunctiva Lateral rectus m. Temporal lobe Greater arterial circle of iris Sclera Olfactory bulb Choroid (nasal sensory n.n.) Sinus venosus of sclera (Schlemm’s canal) Frontal sinus Retina Optic n. Trabecular network Nasal bone Inferior temporal a. & v. Cornea L. medial nasal concha Posterior Sphenoid chamber Fovea sinus centralis Anterior Pharyngeal in macula lutea chamber tonsil L Cortex L. inferior Lamina cribosa nasal concha ne Capsule of retina Inferior nasal s Nucleus meatus Optic n. (II) Schwalbe’s Hard palate line Iris Auditory tube Fibers of ciliary (eustachian) zonule (suspensory Central a. & v. of Soft palate (uvula) ligament of lens) retina Ciliary process Tongue Inferior nasal a. & v. Orbicularis Anterior oris m. ciliary v. Palatine tonsil fibers Medial rectus m. Ciliary m. Circular Meridional fibers Mandible Ora serrata EYE Genioglossus m. Hyoid bone Geniohyoid m. Auricular cartilage Temporal m. Temporal bone Semicircular canals (external acoustic Epiglottis Mylohyoid m. meatus cartilage) Auditory ossicles Vestibular n. Thyroid cartilage Malleus Incus Stapes Vocal cord Cochlear n. Larynx Cricoid cartilage Facial n. (VII) ** Free n. endings Auricle Stratum corneum Cochlea Stratum lucidum (auditory n.) Stratum granulosum Stratum spinosum Tensor tympani Stratum basale m. (continues through Dermal papillae Epitympanic bone to malleus) Papillary layer recess Stapedius Meissner’s corpuscle (touch) Round m. (cochlear) Reticular layer External Tympanic Sensory n. window acoustic Cuticle membrane meatus Huxley’s layer Auditory Henle’s layer Hair Tympanic cavity Levator veli External sheath (eustachian) follicle (middle ear) palatini m. Glassy membrane tube Connective tissue layer Corpuscle of Krause (cold)
Hypodermis
Sensory n.
Sweat gland
Sweat gland Motor n. (autonomic) Connective tissue Fat lobule Vater-Pacini (pacinian) v. corpuscle (heavy pressure)
Hair matrix Papilla of hair follicle Hair cuticle
External sheath Glassy membrane Corpuscle of Ruffini (heat)
ANATOMY OF THE HAND (PALMAR SURFACE)
a. Motor n. (autonomic)
SKIN
EAR EAR (INTERIOR)
Cochlear duct Tectorial membrane Scali tympani
Deep transverse metacarpal l.l.
Malleus (hammer)
Opponens digiti minimi m. Adductor pollicis m.
Fl. digiti minimi brevis Abductor digiti minimi
Abductor pollicis brevis m. Opponens pollicis m.
Fl. retinaculum
Tendon fl. pollicis longus m.
FOOT
Ulnar n.
Superior extensor retinaculum Tibia bone Tibialis anterior tendon
Tendon fl. digitorum superficialis m.
Inferior extensor retinaculum Talus bone Navicular bone Dorsal cuneonavicular l.l.
Ulna
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Articular capsule Distal phalanx Proximal phalanx
6
Peroneus longus tendon Peroneus brevis Fibula bone Tibialis posterior Soleus Fl. hallucis longus Fl. digitorum longus Calcaneal (Achilles) tendon Calcaneus bone
1st Metatarsal bone Collateral l.l.
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Trochlea
Cuneiform bone Tarsometatarsal l.l. Ex. hallucis longus
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Ex. digitorum longus Ex. hallucis longus
Fl. carpi ulnaris m.
Tendon fl. digitorum profundis m. Radius
Saccule Cochlear duct Stapes (stirrup) in oval (vestibular) Spiral ganglion window Ductus reuniens Round (cochlear) window (closed by secondary tympanic membrane)
Tibialis anterior
Pisiform bone
Tendon adductor pollicis longus m. Tendon ex. pollicis brevis m.
Tendon ex. carpi radialis longus m.
Eardrum (tympanic membrane)
Common synovial sheath
Median n. Tendon fl. carpi radialis m.
Scali vestibuli
Incus (anvil)
Lumbrical muscles I-IV
Facial n. (VII) **
Vestibular membrane
Tensor tympani m.
Synovial sheath
Vestibular n.
Cochlear n.
Stapedius m.
Tendon fl. digitorum superficialis m.
Fl. pollicis brevis m.
Vestibular ganglion
Endolymphatic sac
Distal phalanges
Tendon fl. digitorum profundis m. Digital fibrous sheath
Ampullae Endolymphatic duct
Common crus Semicircular canals & ducts Anterior (superior) Posterior Lateral
Phalanges 2-5
Fl. retinaculum Quadratus plantae m. Tibialis posterior tendon Peroneus Fl. digitorum tendon longus Fl. hallucis longus tendon Lumbricales Fl. hallucis brevis Sesamoid bone Fl. hallucis longus tendon
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WORLD’S #1 ACADEMIC OUTLINE
TOOL MAKING
Archaeology A branch of anthropology focusing on the analysis of human material remains in an attempt to reconstruct past cultures
0.0-0.01 Million years ago
Upper Paleolithic / Later Stone Age
SOME COMMON METHODS Excavation: Uncovering buried materials from the past so that they may be recorded and analyzed Survey: Locating artifacts and potential sites through methods such as ground walking, soil analysis and various remote sensing techniques Grid system: A technique used in excavation allowing better recording of the location of artifacts; a grid is mapped out over the excavation area, which is then excavated one layer at a time and mapped according to the grid system
Engraver
Borer
0.05 Middle Paleolithic / Middle Stone Age
Mousterian point
Toothed blade
0.25 Lower Paleolithic / Early Stone Age Acheulean
DATING TYPES Relative dating: The temporal location of artifacts is described in reference to other artifacts to determine a relative age Absolute dating: Also known as chronometric dating; determines the actual age of an artifact in terms of years, centuries, or other units of time • Radiocarbon (C-14) dating: Absolute dating method measuring the half-life and decay rate of C-14 to nitrogen in organic materials • Amino acid racemization: A chronometric dating technique used on organic material; utilizes changes in proteins when an organism dies to calculate the age at death • Potassium-argon (K-Ar) dating: Chronometric dating method measuring the decay of potassium (K-40) to argon (Ar-40) in volcanic deposits • Argon-argon (40Ar-39Ar) dating: Absolute dating technique used in conjunction with potassium-argon dating that estimates relative quantities of argon-39 to argon-40 gases in volcanic deposits • Obsidian hydration dating: Chronometric dating of obsidian artifacts by measuring the water absorbed on worked surfaces of the artifact • Thermoluminescence dating: Absolute dating technique used to determine the age of ceramics, tiles, bricks and any other fired clay artifacts • Dendrochrononlogy: Also known as tree-ring dating, this absolute dating technique compares a tree sample that is relevant archaeologically to an established tree-ring chronology for the area to determine the year the wood was first utilized by humans • Electron spin resonance: Chronometric dating method that measures trapped electrons in shell and bone
POTTERY • All fired clay artifacts made by humans • Hundreds of types: Food storage vessels, cooking pots, ladles, burial chambers, and pipes, etc. • Widespread use is one of the most compelling indications of sedentism at a site • Pottery decoration used in classifying and tracking change in pottery styles Aztec pottery
1.7
Pick
Hand ax Oldowan
2.5
Chopper
Flake scraper
TRANSITIONAL PERIODS Paleoindians in the New World • Literally, "Old Indians"; first group of humans to come to the New World • Most researchers agree Paleoindians came to the New World sometime before 12,000 years ago, during the Paleolithic ("Old Stone Age") • Hunted mostly big game animals; known for distinctive fluted arrowhead points Mesolithic • Literally, "Middle Stone Age," an archaeological period of time beginning around 12,000 B.C. • Humans became more sedentary and began to subsist on more stationary food resources • Natufian: A cultural tradition beginning in Southwest Asia during the Mesolithic period - Comprised of the first people who occupied permanent settlements and began domestication in this area • Archaic: Term applied to Mesolithic cultures in the New World - Characterized by enormous cultural diversity as populations adapted to different environments - Caused an array of cultures with unique life-ways and technology Neolithic • Literally, "New Stone Age"; established plant and animal domestication beginning about 11,000 years ago in the Middle East • Domestication of plants and animals: Evolutionary process where humans (intentionally or unintentionally) modify plant and animal genetics to better control their exploitation • Early sites - Near East • Levant: The Natufians began the domestication of wheat, barley and lentils (about 10,000 B.P.) 1
Tool Traditions • Oldowan tool tradition: - The earliest identifiable tool-making tradition, associated with Homo habilis, the Oldowan begins the Paleolithic (Old Stone) Age, 2.5 million years ago - Tools were made by striking a stone core, producing flakes which were used as blades and choppers and the cores were used as hammerstones - Primary tool produced was the pebble chopper • Acheulian tool tradition: Tool-making tradition after the Oldowan period, dating from about 1.5 million years ago, associated with Homo erectus - Made the same way as above, but much larger and adhering to more standardized shapes - Primary tool produced was the Acheulian hand axe, a pear-shaped tool • Mousterian tool tradition: Tool-making tradition of the Neandertals from 100,000 - 400,000 years ago in Europe, Southwest Asia, Northern Africa - Tools generally much smaller, more varied and much more skillfully worked than those previous - Tool makers utilized pressure-flaking techniques in contrast to the earlier percussion-flaking techniques Tool techniques • Levallois: Found often in the Mousterian tool tradition; flake tools of standard sizes were made by striking a shaped core • Blade technique: Blade produced by striking a core of stones • Pressure-flaking: Bone, antler or wood tools used to press small flakes off a flint core - Allows for more control over the finished flakes
• Europe-Greece: Cereal and animal domestication as early as 8000 B.P. • Africa - Nile River Valley: Sheep and goat domestication from 6000 B.P. • China - Southern and northern: Early rice cultivation, about 7000 B.P. • Southern Mexico - Tehuacan Valley: Early evidence of maize, about 7000 B.P. • South America - Peru - Highland Peru: Early evidence of beans and maize, about 5500 B.P. - Coastal Peru: Early evidence for gourds, squash and peppers, about 5000 B.P. • North America: Southeast U.S.: Domestication of Inca ruins gourds, 7000 B.P.
CIVILIZATIONS Once used to refer to the pinnacle of the evolutionary line of social development, refers today to urbanized, class-segregated, state-level societies Early sites Mesopotamia: • "The land between two rivers"; between Iran and Arabia and Syria, along the Tigris and Euphrates rivers, where first civilizations flourished from 5600 B.P. • The early Mesopotamian civilization of Sumer witnessed growth of cities into a unified state system • Cuneiform: Early form of writing used to record economic transactions; later used to record stories
Civilizations continued... • The Sumerians are widely known for the flood story in the Epic of Gilgamesh, paralleling the story of Noah and the flood in the Judeo-Christian Bible • Ziggurats: Large, stepped platform temples; a major feature of this religiously oriented civilization Egypt: • One of the first great civi- did you know... lizations Pharaohs commissioned • First unified by the ruler, many architectural tribNarmer-Menes, about 5000 utes: some are still B.P. standing (including the • State was based on god- pyramids) like status of the pharaohs • Scribes used hieroglyphs (a combined pictographic and phonographic form of writing) to record the complex transactions of collection and redistribution processed by the elite ruling class • Late Period (1070-332 B.C.); Pharaonic power declined and was replaced by the Ptolemaic line, instituted by Alexander the Great in 332 B.C. Roman occupation in 30 B.C. officially ended the great Egyptian civilization Indus River Valley: • Harappan Civilization: - Around 4700 B.P.; began along the Indus River in South Asia - Known for massive citadel walls (made from fired clay bricks) engineered to prevent flooding - City streets were well planned; lined with brick faced houses, sometimes 3 stories, many with plumbing - Suddenly declined for unknown reasons, approx. 4000 B.P. China: • Circa 4000 BP, several rulers gained power and prominence • Lived in walled towns - in constant competition and war • Unification of region brought by the Shang civilization of the Yellow Valley at 3700 BP; became most dominant state throughout northern China - Famous for bronze work Crete, Greece, and Rome: • Minoa: Flourished around 4000 B.P by constantly increasing their trade network - The eruption of the volcano Thera at 3473 B.P. accelerated demise • Mycenae: 3600 B.P.; took over trading routes of the Minoans - Rulers acquired much prestige for trading of tin, copper, etc. - Linear B: Writing system made up of 89 characters established Mesoamerica: • Maya: - Beginning about 4000 BP - Complex societies, diverse agricultural techniques (slash and burn in lowlands, terracing and raised fields in highlands); comMayan temple plex belief system - Built great cities with pyramids and central plazas such as Teotihuacan, which housed 12,000 people and extended 8 square miles • Aztec: - Circa 1100 AD. - Developed a great civilization in Mexico - Capital city, Tenochtitlan had rich central precincts, large residential areas, spectacular markets and gardens - Conquered by the Spanish in 1519 South America: • The Inca Empire: - Rule unified majority of South America - Primarily based in Peru - Control extended throughout the Andes mountains; extraordinary bureaucratic and military organization; collapsed in confrontation with the Spanish at 1534
THEORIES FOR THE EVOLUTION OF CIVILIZATIONS • Irrigation systems - Karl Wittfogel’s Hydraulic Theory: Civilization arose because development of irrigation networks called for establishment of organizational management specialists (who eventually became the first ruling class) • Trade networks: Civilization arose because redistribution centers necessitated a centralized management authority; eventually became a centralized government • Environmental and social circumscription; Robert Carniero’s Circumscription Theory: - Civilization develops where populations are contained in an area limited by environmental features, such as mountains, bodies of water, or other groups of people - As circumscribed populations grow and competition for limited resources intensifies, social stratification develops as elite class controls resources - Warfare and conquest of neighboring populations are necessary outcomes, as access to resources is sought - To be successful, such campaigns must be led by a centralized authority, eventually becoming a centralized government • Religion - Indirect role in the development of civi- did you know... In many early civilizations, lization - Religious systems inte- rulers themselves were gral in the formation of considered semi-divine early states - Many monumental architectural structures in early states have religious functions - Often rituals for the maintenance of the social, economic, and political orders were publicly performed by priests on behalf of rulers
LANGUAGE The complete set of sounds and words a culture uses to convey meaning; languages must conform to rules of grammar and syntax in order to convey the intended meaning • Linguistics: Scientific study of language • Structural linguistics: Analysis of a language’s structure. • Phonetics: Study of the way speech sounds are produced, transmitted and received • Phonemes: Smallest units of sound that can affect the meaning of spoken language • Morphemes: Smallest units of sound which carry meaning (e.g., words, suffixes, etc.) • Morphology: Study of the way sounds are organized to create units of meaning • Syntax: Rules followed in phrase and sentence making • Grammar: Formal structure dictating syntax and the subtleties of morphemes • Paralinguistics: Study of the sounds, noises and parts of speech that work together with language to comprise communication; for example, pitch, speed, tone, etc. • Sapir-Whorf Hypothesis: Proposed by Edward Sapir (1929) and elaborated on by Benjamin Whorf in subsequent years; argues languages predispose their native speakers to perceive the world dictated by the language structure • Ethnolinguistics: Study of the interrelationship of language and culture • Sociolinguistics: Study of the use of language in its social context • Glottochronology: Method of dating the historical divergence of related languages by comparing and measuring change in their basic vocabularies
Cultural Anthropology The study of contemporary human societies
CULTURE The shared, learned, symbolic, integrated, adaptive set of behaviors, beliefs, attitudes, values and ideals common to a particular group • Classic Tylor (1871) definition: Culture is "that complex whole which includes knowledge, belief, art, law, morals, custom and any other capabilities and habit acquired by man as a member of society." • Contemporary definition: Learned behaviors and beliefs (values, habits, ideals, etc.) shared by members of a society • Characteristics: - Shared: Cultural knowledge is shared by the group; not an individual phenomenon - Learned: Culture is constantly learned from other members of the culture - Symbolic: Shared through symbolic means, such as language and art - Integrated: The whole of culture is comprised of the interrelation of disparate parts - Adaptive: Constantly changing; as old traits become maladaptive, they are modified or traded for new ones that more efficiently address old problems • Fieldwork: Research method used to learn about human beings through firsthand observations in their natural cultural environments • Participant observation: A field research technique where an anthropologist lives with, works among and participates with the people of a culture for an extended period of time, usually at least a year • Ethnocentrism: Believing one’s own cultural values are supreme over all others • Cultural relativism: Cultural values are thought to be arbitrary standards that should not be used to evaluate cultural behavior; rather, behaviors should be understood within their own cultural context 2
ENCULTURATION The process of an individual learning their society’s culture • Personality: The set of thoughts, feelings and actions that define an individual • Dependence training: Child-rearing practices promoting dependence and compliance in assigned tasks • Independence training: Child-rearing practices fostering independence, self-reliance and a need for personal achievement • Group personality: Studies undertaken in the 1930s and 40s; attempting to determine the dominant psychological patterns of various cultural groups - Modal personality: Personality type most frequently present in a group. - National character: Dominant psychological orientation found among the people of a nation - Core values: The values of central significance to a specific culture
SUBSISTENCE The way a group gets its food • Adaptation: Process by which organisms are modified based on interactions with their environment; allows more efficient interaction • Foraging: Also known as hunting and gathering; subsistence on plants and animals naturally occurring in an environment • Pastoralism: Subsistence based on raising livestock (cattle, sheep, goats, etc.) • Horticulture: Small-scale cultivation using relatively simple techniques and tools as well as "slash-and-burn" • Agriculture: Larger-scale cultivation using more complex techniques and tools; relies on permanently cultivated fields, tools such as plows and draft animals, and other technologies, such as irrigation
FAMILY AND KINSHIP
MARRIAGE
Kin group that resides together comprised of at least one parent and one child Nuclear family: Family organization comprised of a husband, a wife, and their dependent children living in one household Extended family: Group of blood-related nuclear families living in one household Residence types or patterns: • Ambilocal residence: Also known as bilocal residence; a married couple living with either of the husband’s or the wife’s relatives • Avunculocal residence: Married couple residing with the husband’s mother’s brother • Matrilocal residence: Married couple living with or near the wife’s relatives • Neolocal residence: Husband and wife establish their residence anywhere, regardless of the location of their relatives • Patrilocal residence: Married couple living with or near the husband’s relatives Kinship: Relationship between members of a social group related by either blood or marriage • Unilineal descent: Also known as unilateral descent; dictates descent exclusively through either the father’s or mother’s line • Ambilineal descent: Traced equally through either the mother’s or the father’s line • Bilateral descent: Traced through both the mother’s and the father’s lines • Matrilineal descent: Traced through the mother’s line only • Patrilineal descent: Traced through the father’s line only • Lineage: A set of kin genetically linked to a common ancestor tracing their descent by known links through either male or female lines • Clan: Also called a sib; a set of kin who believe they are genetically linked but can’t trace their descent through known links; often made up of several lineages • Phratry: A unlineal descent group made up of at least two clans believing themselves to be of common ancestry • Moiety: A unilineal, exogamus descent group found in a dual organization society
Socially accepted sexual and economic union Cultural Marriage Combinations between individuals in a society • Gender: Differences between males and Social group Social females based on cultural expectations and group experiences; categorizes an individual as masculine or feminine Exogamy Monogamy Endogamy • Incest taboo: Prohibition of sexual relations between related individuals. + + + • Affine: Relative acquired through marriage or + • Consanguine: Biological, or "blood" relative • Endogamy: Marriage within one’s social group (such as one’s kin group, caste, etc.) Polygamy Polygyny Polyandry • Exogamy: Marriage outside of one’s social group • Monogamy: Two individuals join together and do not have other spouses; serial monogamy occurs when monogamy is the norm, but divorce and remarriage are common • Polygamy: Males or females may take more than one spouse • Polygyny: Male is allowed to have more than one wife • Polyandry: Female is allowed to have more than one husband; the most common form is fraternal polyandry, in which a woman marries a set of brothers • Exchange: Formalization of marriage by an economic exchange - Dowry: Marriage exchange in which the bride’s kin gives goods to the groom or his kin Bridewealth/Bride price: Marriage exchange in which the groom’s kin gives goods to the bride or her kin
Kinship terminological systems • Eskimo system: Also known as a lineal system; specific terms are assigned to the members of the nuclear family, with all other relatives subsumed under the category of either "aunt," "uncle," or "cousin" • Hawaiian system: Relatives of the same sex and generation are referred to by the same term • Iroquois system: One’s father and father’s brother are referred to by a single term, as are one’s mother and mother’s sister, but one’s father’s sister and one’s mother’s brother are given separate terms; parallel cousins are classified with brothers and sisters, while cross cousins are classified separately, but (unlike Crow and Omaha kinships) not equated with relatives of some other generation • Crow system: Usually associated with matrilineal descent in which father’s sister and father’s sister’s daughter are called by the same term, mother and mother’s sister are merged under another, while father and father’s brother are merged under a third; parallel cousins are equated with brothers and sisters • Omaha system: The patrilineal equivalent of the Crow system; the line of mother’s patrilineal kin is equated across generations • Sudanese or Descriptive system: One’s father, father’s brother, and mother’s brother are distinguished from one another, as are mother, mother’s sister, and father’s sister; cross and parallel cousins are distinguished as well as from siblings
ECONOMICS The study of systems of production, distribution and exchange Production: Development or creation of goods or services Distribution: Process of changing produced goods for consumption; according to economist Karl Polanyi, distribution occurs according to one of three types of systems: • Reciprocity: Items of roughly equal value are exchanged without the use of money; there are three types: - Generalized reciprocity: Neither the value of a good nor the schedule for repayment are specified - Balanced reciprocity: Both the value of the exchanged goods and the schedules of payment are specified
- Negative reciprocity: Giver of the goods attempts to gain the advantage in the exchange • Redistribution: Exchange process where goods are directed to an economic center to be organized, counted and redistributed • Market exchange: Value of a good or service is determined by supply and demand, and the medium of exchange is something symbolic (such as money) Exchange: Buying and selling, or trade, of goods or services Formalist: School of thought that argues economic theory is valid cross-culturally Substantivist: School of thought that argues for understanding economic activity in its specific cultural contexts Leveling mechanisms: Customs that keep wealth somewhat equally distributed
ART
POLITICAL ORGANIZATION
Expression of human creative abilities in verbal, ornamental, musical or pictorial forms • Folklore: Set of ballads, myths, folktales, legends, proverbs, riddles and superstitions of a cultural group • Myth: Sacred story attempting to explain nature and creation • Legend: Larger-than-life narrative told as if it were true • Tales: Story created or embellished for entertainment • Ethnomusicology: Analysis of music did you know... as an aspect of Music is an important aspect culture of many cultures
The way a society is organized around issues of power and economics • Band: A relatively small group of people with a division of labor based on age and sex, with social relations based on egalitarianism; typically found among foraging people • Tribe: A variety of somewhat independent groups united by a common language and culture; generally larger than bands; there may be a chief who speaks for the group, but social relations are still egalitarian, with labor divided along age and sex lines; typically found among farmers and herders • Chiefdom: Several individual communities are hierarchically subsumed under the rule of a centralized chief • State: Centralized political system found in large, complex societies; has the power to coerce its members into maintenance of the hierarchy imposed by the elite ruling class by means of law and physical enforcements • Controls: Customs and practices that regulate societal behavior - Internal controls: Members of the society are personally responsible for their actions, i.e. individuals act according to a culture’s conceptions of what is proper, right, and correct; often rely on belief in supernatural forces that may inflict punishment for improper actions - External controls: Also known as sanctions; social institutions enforcing social norms and order; such as courts, police and councils of elders • Law: Formal rules or sanctions providing the basis for determining guilt, as well as the means or type of punishments
NON-KIN GROUPS Groups or associations of individuals not based on family relations • Sex association: Category of people based on sex • Age grade: Category of people based on age; typically, groups of similar age are organized into age sets, which move through a series of age grades together through life • Common-interest associations: Result when those with common interests group together; sometimes membership is required by law, such as the draft or a labor union • Class: Social category whose members are judged as relatively equal based on the predominating system of evaluation • Caste: Group in which membership is determined by birth and marriage and dictated by endogamy (marriage within the group) 3
RELIGION
CULTURE CHANGE
Belief system that posits a human relationship to the supernatural • Animism: Belief that nature is animated by spirit beings • Animatism: Belief in the existence of impersonal supernatural forces • Priest or priestess: Member of a culture serving as a full-time religious specialist • Shaman: Member of a culture who serves as a (usually) part-time religious specialist; believed to have the ability to communicate directly with supernatural beings and powers • Ritual: Patterned acts performed in an attempt to manipulate the spiritual world - Rites of passage: Performed at specific stages in the life cycle to mark important status changes, e.g., birth, marriage, and death - Rites of intensification: Performed to return cohesiveness to the group before or during a crisis or before a potential crisis - Rite of reversal: Allows for a reversal of ordinary roles and obligations of individuals • Magic: Practiced by individuals believed to have the power to psychically manipulate the supernatural and natural world • Witchcraft: Practiced by individuals believed to have a psychic power, often unconscious, that can harm others or cause sickness; sorcery is associated with a conscious attempt to adversely affect an individual or group • Revitalization movement: Social movement, often religious, organized to restore a culture to its former, supposedly more desirable, state
All cultures experience change over time, depending on their particular circumstances; changes in the environment, foreign contact, and even internally imposed cultural modifications can lead to culture change • Innovation: Utilizing existing cultural elements in a novel manner • Invention: New tool, practice or principle that offers a fresh solution to either an old or new problem • Diffusion: Spread of cultural traits through trade, migration and borrowing; often leads to culture change as old traits are replaced by newly diffused ones • Culture loss: New innovations often lead to the loss of older ones; this can affect a loss of the entire culture as interdependent institutions are modified or thrown away • Acculturation: Forced adaptation resulting from continual contact with other cultures • Modernization: Cultural change experienced by societies that transition to a more Westernized, industrial lifestyle
Biological Anthropology The study of the biological aspect of humans and our ancestors, including molecular biology and genetics, primatology, paleoanthropology and human biology
MENDELIAN GENETICS Gregor Mendel • Father of Genetics • Silesian monk, educated at University of Vienna • Experimented on heredity in pea plants • Experiments conducted 1856-1863 • Defined the unit of inheritance (gene) as being discrete • Work published in 1866, but not recognized until 1900
Gregor Mendel
The Theory • Describes traits expressed through a single gene, a section of DNA that codes for a particular trait • A gene may have several different forms or alleles • Observable traits and characters represent the phenotype of the organism • The genotype is the genetic makeup; those genes that are expressed and unexpressed - Homozygous: Having the same alleles for a particular trait - Heterozygous: Having different alleles for a particular trait • A gene can be dominant or recessive - Dominant genes are are always expressed when present - Recessive genes are expressed only when paired with another recessive gene Principles of Mendelian Genetics. • Principle of Segregation: In the formation of gametes, homologous chromosomes separate so each gamete is equally likely to contain either member of the original pair • Principle of Assortment: Random distribution of the members of any pair of alleles is independent of the distribution of other pairs in the formation of gametes Complex Traits • Most complex traits are affected by multiple genetic and environmental factors • Polygenic trait: Depends on the action of more than one gene Mutation • Any heritable change in a gene • The basic mechanism of evolution
MOLECULAR BIOLOGY AND GENETICS DNA - The Genetic Code • 1869: DNA discovered • 1920s: DNA shown to be in chromosomes • 1944: First evidence that DNA is the genetic material of an organism • 1953: James Watson and Francis Crick discovered the three dimensional structure of DNA • DNA, deoxyribonucleic acid, controls heredity - Molecular structure of DNA is a double helix consisting of a linear sequence of paired nucleotide bases - Nucleotides of DNA are adenine, thymine, guanine and cytosine - Pairing between nucleotides of DNA is complementaryadenine pairs with thymine, cytosine pairs with guanine
A
H H H G H C H H T H
O -O
P
O
O
O CH2
T
-O
O -O P O O CH2
CH2 O O-
O H H
A O P O O CH2
P
O
C
H H H
G
CH2 O P OO CH2 O
Protein synthesis O P OO H • DNA codes for RNA (ribonucleic acid) = transcription G C H H • RNA codes for proteins = translation CH2 O O -O P O Transcription O P OO O - The production of a strand of messenger RNA (mRNA); H CH2 G C H complementary in base sequence to a DNA strand H CH2 O O - Base pairing in DNA and RNA -O P O O P OO - Complementary base pairing specifies the linear O CH2 H A sequence of RNA H T - RNA differs from DNA by having a ribose sugar instead 5' 3' of a deoxyribose sugar DNA - Genetic code - RNA contains the base uracil in place of thymine - Adenine pairs with uracil; thymine pairs with adenine; guanine pairs with cytosine and cytosine pairs with guanine Translation - The genetic code is read as a codon, or series, of three bases from the mRNA strand; each codon codes for a single amino acid - Each transfer RNA (tRNA) contains a complementary codon to a codon sequence in mRNA; tRNA’s position amino acids during translation - Amino acids are strung together to form a polypeptide chain; the order of the chain determined by the sequence of codons contained in the mRNA - Occurs on ribosomes, which contain several types of ribosomal RNA (rRNA) MITOSIS
MEIOSIS
• Process where a single, diploid parent cell gives rise to two diploid daughter cells genetically identical to each other and to the original parent cell • Multi-phase process in which sister chromatids comprising the replicated chromosome separate and are deposited into the cells being formed
• A single, diploid parent cell gives rise to four haploid daughter cells genetically distinct from each other and the original parent cell • Produces gametes • Multi-phase process includes the possible swapping of genetic material between homologous chromosomes in the process of crossing-over
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PRIMATOLOGY Characteristics • Vision: Primates place a greater emphasis on vision than they do olfaction • Forward facing eyes - Binocular vision: Overlapping field of vision for each eye - Stereoscopic vision: Depth perception due to integration of visual information in the brain - See in color • Large brain relative to body size • Female usually produces small litters of one or two offspring • Increased parental investment in offspring • Increased period of development, including gestational and postnatal development • Show a variety of locomotor modes: - Arboreal quadrupedalism: Moving on all four limbs in the trees - Terrestrial quadrupedalism (knuckle-walking): Moving on all four limbs on the ground - Vertical clinging and leaping: Moving or jumping between vertical substrates, such as tree trunks - Brachiation (suspension; semi-brachiation): Moving underneath a substrate by using the arms - Bipedalism: Moving on top of a substrate with just the hindlimbs • Locomotion tends to be hindlimb dominated • Unspecialized molars • A maximum of two incisors, one canine, three premolars, and three molars on each half of the jaw • Grasping big toe and thumb • Nails on all digits instead of claws, and tactile pads on the hands and feet • Generally limited to tropical regions CLASSIFICATION OF PRIMATES Order: Primates • Suborder: Strepsirhini - Superfamily: Lemuroidea (Lemurs) - Superfamily: Lorisoidea (Lorises and Galagos) • Suborder: Haplorhini - Hyporder: Tarsiiformes (Tarsiers) - Hyporder: Anthropoidea • Infraorder: Platyrrhini (New World Monkeys) • Infraorder: Catarrhini (Old World Monkeys, Apes and Humans) - Superfamily: Cercopithecoidea (Old World Monkeys) - Superfamily: Hominoidea • Family- Proconsulidae • Family- Hylobatidae • Family- Hominidae - Subfamily- Ponginae (Pongo) - Subfamily- Homininae • Tribe- Gorillini • Tribe- Hominini (Homo sapiens) - Subfamily- Homininae, incertae sedis Strepsirhines vs. haplorhines • Features of strepsirhines - Shortest developmental period - Moist rhinarium (nose pad) - Split upper lip (philtrum) - Postorbital bar, no postorbital closure - Tapetum lucidum (reflective layer Strepsirhine (lemur) behind the retina) - Most species are nocturnal (active at night) - Unfused frontal bone and mandible - Tooth comb - Grooming claw on second digit of foot Haplorhine • Features of haplorhines (chimpanzee) - Extended development; humans have the longest pre- and postnatal periods
- Fused frontal bone and mandibular symphysis - Postorbital closure - Upright incisors - Larger brain relative to body size - Most species are diurnal - More complex social behaviors Behavior and Ecology Primate Diets • Types of diets based on primary food source - Frugivore: Fruits Leaves, did you know... - Folivory: stems Primates are omni- Insectivory: Insects vores, but most - Gumnivory: Gums species have certain and saps adaptations in their - Gramnivory: Seeds, gut and teeth herbs and grains designed for special• Primates aggressively ization of diet control a specific territory encompassing several feeding areas; a territory may be part of an entire home range of a species - Home range: Area within which an animal normally lives, or the total territory occupied by a group in the course of one year - Primates aggressively defend territories Primate Social Groups • Variables used to define social groups: - Mating type - Residence group composition - Foraging group coherence - Philopatry type (permanent residence in natal groups) Why do primates live in social groups? • Resource defense model: Social groups enhance access to resources • Predation model: Primates live in social groups to reduce vulnerability to predators Social organization by mating type • Solitary (one adult): A single female and her offspring whose range is overlapped by a single male; the male may have a home range that overlaps those of several different females; males and females generally interact only for mating (ex. orangutans and galagos) • Monogamy (one male - one female): One adult male and one female along with any immature offspring; mating is exclusive within the pairbond (ex. gibbons, titi monkey) • Polyandry (one female - multimale): One reproductively active female and two or more reproductively active males plus offspring; there may be other mature, related females; however, the single reproducing female actively suppresses their reproduction; males help rear offspring • Polygyny (one male - multifemale): Seen in species where females leave their natal group; lots of female transfer; strong sexual dimorphism (ex. howlers, langurs, gelada baboons, gorillas) • Polygyny (multimale - multifemale): Either sex transfers to a different group when mature; most are female-bonded groups (ex. macaques, baboons, vervets, squirrel monkeys, capuchins, some colobines); complicated system not easily applied (e.g., in chimps, males form a cohesive group whose home range overlaps that of several females) Social Interactions • Those behaviors assumed to affect the fitness of one or more individuals • Usually reduce interactions to the least common denominator - the actor and recipient • Social Interactions: - Selfish: Benefits the actor but not the recipient - Mutualistic: Benefits the actor and the recipient - Altruistic: Benefits the recipient but not the actor - Spiteful: Benefits neither the recipient nor the actor 5
PALEOANTHROPOLOGY Early Evolutionary Theory Pre-Darwinian Theory • Georges Comte de Buffon (1707-1788) - Proposed the idea of organic change; species could change, but not give rise to new species • Erasmus Darwin (1731-1802) - Grandfather of Charles Darwin - Believed species could change through competition and sexual selection • Jean-Baptiste Lamarck (1744-1829) - Provided first persuasive theory of organic evolution - Principle of Use and Disuse: The more frequently an organ is used, the more prominent it becomes; those less frequently used are likely to diminish altogether in succeeding generations • Inheritance of Acquired Characteristics: - Features enhanced or lost through principles of "use and disuse" pass to all offspring, provided the acquired modifications are common in both sexes, or at least to individuals which produce young; (ex. Giraffe predecessors were constantly stretching upward to reach foliage, causing their necks to grow longer; these longer necks are inherited; over the course of generations the necks of all giraffes get longer) • Georges Cuvier (1769-1832) - Proposed that species could become extinct - Proponent of Catastrophism: Features of the Earth are the result of periodic geologic revolutions • Charles Lyell (1797-1875) - Proponent of James Hutton’s principle of Uniformitarianism, which suggested that geologic features are the result of continuous, gradual change Darwinian Theory • Charles R. Darwin (1809-1882) - Proposed the theory of evolution through natural selection, which can be broken down into three separate inferences: • Struggle for exisCharles R. Darwin tence among individuals - Potential exponential increase of populations - Populations tend to remain stable in size - Limitation of resources • Differential survival (natural selection) - Struggle for existence - Variation in physical and behavioral characters - Heritability of individual variation • Evolution through action of natural selection over many generations • Alfred Russel Wallace (1823-1913) - Proposed a hypothesis of evolution through natural selection at the same time, but independently, from Darwin Mechanisms of Evolution • Natural selection: Differential reproduction or survival of replicating organisms caused by agencies not directed by humans • Genetic drift: A random change in the frequency of alleles in a population - Founder effect: Occurs when a small population colonizes a new habitat and subsequently increases in number - Bottleneck: A severe but temporary reduction in population size that reduces the amount of genetic variation • Migration (gene flow): Transfer of genes from one population into another by interbreeding • Mutation: Change in the composition of a gene or the genetic make-up of the organism
Paleoanthropology continued...
HUMAN EVOLUTION Trends • Alteration of skeletal features - Bipedalism - Reduction of face (less prognathic) - Reduction in molar tooth size - Thick enamel on molars - Loss of C/P3 complex - Well developed second cusp on the lower premolars - Change in dental eruption patterns - Ape- M1, I1, I2, M2, P3, P4, C, M3 - Human- M1, I1, I2, P3, C, P4, M2, M3 • Efficient exploitation of terrestrial habitat • Increasing brain size and complexity • Tool use Early Hominins • Late Miocene hominins - Sahelanthropus tchadensis • Dated between 6-7 million years ago (mya) • Found in the Sahel region of Chad • Very primitive, may not be a hominin - Orrorin tugenensis • 5.6 - 6.2 million years old from Kenya • May be earliest biped - Ardipithecus ramidus • 4.39 - 5.8 million years old from Ethiopia • "Gracile" Pliocene hominins - All possess primitive, ape-like features, including a chimpanzee-sized brain (~400ml) - Australopithecus anamensis: 3.9 to 4.2 mya from Kenya - Australopithecus afarensis • 2.8 to 4.0 mya from Ethiopia and Tanzania • The famed Lucy skeleton is a member of this species - Australopithecus africanus: 2.5 to 3.0 mya from South Africa - Australopithecus bahrelghazali: 3.0 to 3.5 mya from Chad - Australopithecus garhi: 2.5 mya from Ethiopia - Kenyanthropus platyops: 3.2 to 3.5 mya from Kenya • "Robust" Pliocene hominins - All are characterized by large molars and dishshaped faces - Paranthropus aethiopicus: 2.5 to 2.8 mya from Kenya and Ethiopia - Paranthropus boisei: 1.0 to 2.5 mya from Ethiopia, Kenya and Tanzania - Paranthropus robustus: 2.0 mya from South Africa
Hominoids Lemurs, New world Old world monkeys Orangutans Gorilla Chimp Bonobo Human lorises Tarsiers monkeys Present Pleistocene 1.7 Pliocene 5 Sivapithecus
Morotopithecus 24 Oligocene
Aegyptopithecus
36 Eocene
Paleocene 65
Eosimiidae
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Adapidae
55
Omomyidae
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Late Cretaceous Period Primate stock
Primate evolution
• Evolution of Old World monkeys - Propliopithecid family may be ancestral to Old World monkeys, apes, and humans; or possibly just apes - From late Eocene - early Oligocene of Egypt and Oman - Propliopithecus, Aegyptopithecus, Catopithecus • Evolution of apes - Evolved approximately 20 million years ago - Proconsul: Earliest apes - Sivapithecus: Early great apes; relatives of modern orangutans
Early Homo • Less primitive than the australopithecines • Homo habilis - 1.5 to 2.4 mya from did you know... Kenya, Tanzania and Early homo habilis South Africa made the earliest discovered stone tools - Brain size 660 ml - Less primitive than the known as the Oldowan industry australopithecines • Homo rudolfensis - 1.8 to 2.4 mya from Kenya and Malawi - The cranial capacity is approximately 775cc - Associated with the Oldowan industry • Homo erectus - Dates between 400,000 and 1.8 mya - Complex of derived and primitive features, but more like modern humans than earlier species - Associated with the Acheulian stone tool industry - First hominin species to be found outside Africa - Evolved first in Africa, spread to other areas including Europe and Indonesia - Cranial capacity on average, was 946cc (727-1225 ml) - Shows the earliest and best evidence for the development of complex language - First hominin to utilize fire • Homo georgicus - Dated at 1.81 to 0.05 mya from Dmanisi (Georgia) - Little is known about this species • Homo heidelbergensis - Formerly Archaic Homo sapiens - Existed in Africa, Asia and Europe from 800,000 to 100,000 years ago - More robust than modern humans - Cranial capacity averaged 1,283 ml (1,100-1,450 ml) - Used Acheulian tools; may have used later Mousterian tools • Homo neanderthalensis - Lived between 32,000 and 300,000 years ago - Range restricted to Europe and the Middle East - Possessed many typical archaic features- sloping forehead, low skull, no chin, large brow ridges - Bodies were adapted for life in a cold climate - Largest average brain size of any known hominin; averaging1400 ml (1,125-1,750 ml) - Associated with the Mousterian tool industry; small-flake tools with evidence of retouching 6
Kenyapithecus
Miocene Million years ago
Primate Evolution • Cenozoic Era - Epochs Paleocene (65-55 mya), Eocene (55-36 mya), Oligocene (36-23.5 mya), Miocene (23.5-5.3 mya), Pliocene (5.3-1.6 mya), Pleistocene (1.6 mya - Present) • Primate Origins - Early Paleocene (65 mya) - Early primates (ex. Plesiadapis) lack the complete suite of features generally associated with extant primates; for this reason some researchers separate out this early group - True primates (strepsirhines) appear in the fossil record around the early Eocene (55 mya) • Hypotheses for primate origins - Arboreal hypothesis • Primates evolved by adapting to life in trees, which required enhanced vision, grasping hands and feet - Visual predation hypothesis • Early primates first adapted to life in the bushy forest undergrowth and low tree branches • Foraging for insects necessitated evolution of enhanced vision, grasping hands and feet, nails for capturing prey • True Primates - Appear in the early Eocene - Adapids of North America, Europe and Asia - During the Oligocene (35-23.5 m.y.a.), haplorhines were the most numerous primates • Origin of New World monkeys - The parapithecid family may be ancestral to the New World monkeys as exemplified by Apidium and Qatrania - Rafting Theory of NW Origins: Suggests primates made it to the New World by rafting from Africa approximately 25 million years ago
- Appear to have been nomadic, living in different shelters at different times of the year - Practice many types of ritualistic behavior, including funeral rituals • Homo sapiens - First appear in the fossil record between 200,000 and 160,000 years ago - Produced delicate stone tools - First evidence of art was the use of red ocher about 70,000 years ago - First cave paintings- 32,000 years ago - Modern humans expanded into areas not inhabited before by other hominins - Australia: 50,000 years ago - North America: 25,000 to 15,000 years ago
THEORIES OF MODERN HUMAN ORIGINS • Multiregionalism/Coninuity model - Suggests modern humans evolved from regional H. erectus populations that exchanged genes • Out-of-Africa/Replacement Model - Suggests modern humans originated from a single population in Africa - After evolving in Africa, spread to other parts of the world, replacing other hominid species either through competition or assimilation
PRICE: U.S. $5.95 CAN. $8.95 Authors: Michael S. Harris, PH.D Douglas Broadfield, PH.D ISBN-13: 978-142320387-2 ISBN-10: 142320387-9
Note to Student: Due to its condensed format, use this QuickStudy ® guide as a reference, but not as a replacement for assigned class work. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2004 BarCharts, Inc. 0707
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Aromatherapy
Soothe your body & mind, and improve your health naturally using these powerful oils & techniques!
Oils Used in Aromatherapy
Essential Oils Volatile and fragrant liquid or semiliquid substances extracted from plants by distillation or cold-pressing ■ Powerful healing agents that contain the highly concentrated vital energy of plants ■ All-natural, complete, free of additives ■
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What Is Aromatherapy
A holistic approach to wellness • Traces its origins to ancient times when our ancestors recognized the effect of aromatic plants on the human body, mind and spirit ■ Utilizes natural essential oils extracted from a wide variety of plants to promote health and vitality and to instill a sense of harmony with the natural world ■ A safe and effective alternative for dealing with many routine, day-to-day challenges to good health and well-being ■
Using Essential Oils Essential oils should only be unless used externally, otherwise directed by a qualified health-care professional Do not use for self-treatment of serious medical problems without appropriate professional advice Always dilute prior to use on the body Know the specific therapeutic properties and safety precautions for each oil you use Use only in very small amounts
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Massage Best for body aches, skin care, stress and other emotional states tial oil (or ■ Add 4 to 8 drops of a single essen a blend of essential oils) to 4 teaspoons of ■
carrier oil Massage into the body, avoiding the eyes and other delicate or sensitive areas
Bath Best for body aches, colds, skin care, stress and other emotional states ■ Add 2 drops of a single essential oil (or up to 4 drops of a blend of essential oils) to a tablespoon of honey or whole milk • Stir into a warm bath, being careful not to get bath water in the eyes • Soak for 10 to 20 minutes
Carrier Oils Fatty, nonvolatile oils extracted from seeds, nuts or fruits ■ Moisturize and nourish the skin ■ Used to dilute essential oils for application to the body ■
Examples Sweet almond oil, grapeseed oil and olive oil
Inhalation Best for colds, flu and sinusitis ■ Add 2 to 4 drops of a single essential oil (or a blend of essential oils) to a pot of steaming (not boiling) water that has been removed from the heat source ■ Keeping your face about 10 inches from the pot, with eyes closed, lean over the pot and inhale WARNING: Do not use this method if you have asthma
Diffusion Best for colds, emotional states, and sanitizing the air to help preve nt colds/flu ■ Many devices for diffusin g essen tial oils into the air are available commercially and come with instructions for use oil ■ Or, add 4 to 8 drops of any essential of bowl a to oils) tial essen of (or blend steaming water that has been removed from its heat source; set in a secure place where pets and children cannot drink it not ■ Light bulb ring diffus ers are recommended because they can ruin your oils (they give off too much heat)
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Warning
Safety Precautions
Keep essential oils away from babies, children and pets ■ Every essential oil is different; for safe and effective use, be sure you are familiar with the specific actions and precautions for each oil (many oils have special precautions) ■ Always follow recommended dilutions and application procedures; do not exceed recommended amounts ■ Never use the essential oil of a plant to which you are allergic ■ Do not allow essential oils to get in or near the eyes, and do not apply them onto the genital region, inside the nose or mouth, or onto seriously damaged skin ■ Do not massage someone who has an infectious illness (such as the flu or measles) or cancer; do not massage over varicose veins, infected areas, broken bones or injuries ■ Do not take essential oils internally except under the supervision of a qualified health-care professional ■ If essential oils accidentally get into the eyes, flush immediately with whole milk or cream (these fats will dissolve and remove the essential oils) ■ In case of accidental ingestion of essential oils, obtain immediate medical assistance Allergy Test Perform 2 skin patch tests on small areas of the arm on successive days before using the oil on larger areas ■
Purchasing Essential Oils Appropriate oils are usually labeled aromatherapy grade or therapeutic grade ■ Look for essential oils labeled “100% pure” (rose and jasmine are often available diluted in carrier oil, since the price of the pure oils is prohibitively expensive for many people) away from anything labeled ■ Stay fragrance or nature identical oils; these are synthetic, have no therapeutic properties, and should never be used in aromatherapy ■
Tip In order to be effective, essential oils must be of the highest quality
Storing Essential Oils ■ ■ ■ ■ ■
Use of essential oils with babies and children requires different procedures than those covered in this guide 1
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Store in tightly closed, dark or opaque glass jars Keep away from heat, moisture and direct light Open bottles only for use and close again as soon as possible Do not refrigerate The shelf life of most essential oils is about 12 to 18 months (when properly stored) Citrus oils and juniper oil generally have a shelf life of about 6 months (when properly stored)
Essential Oils Frankicense
Bergamot
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Botanical Name Citrus bergamia Actions analgesic, antiseptic, antispasmodic, calmative, carminative, diuretic, stomachic, uplifting Uses acne, anxiety, colds/flu, cold sores, cystitis, depression, flatulence, stomachache, stress Cautions/Comments phototoxic*
1
Botanical Name Boswellia carteri Actions analgesic, antidepressant, anti-inflammatory, astringent, calmative, cicatrizant, cytophylactic, diuretic, emmenagogue, expectorant, strengthening, tonic, uterine, vulnerary Uses anxiety, bronchitis, colds/flu, coughs, depression, dysmenorrhea, laryngitis, mature skin, meditation aid, menorrhagia, nervous exhaustion, scars, slack skin, stress
Cedarwood, Atlas Botanical Name Cedrus atlantica Actions antifungal, antiseptic, aphrodisiac, astringent, calmative, diuretic (mild), expectorant, mucolytic, tonic Uses acne, arthritis, bronchitis, cystitis, depression, fungal infections, oily skin, rheumatism, stress Cautions/Comments avoid during pregnancy
2
Geranium Botanical Name Pelargonium graveolens Actions analgesic, antidepressant, anti-inflammatory, astringent, cicatrizant, cytophylactic, diuretic, hemostatic, lymphatic stimulant, tonic, vasoconstrictor, vulnerary Uses acne, bruises, depression (mild), fluid retention, menopause, nervous tension, neuralgia, PMS, scars, skin care (all types), sore throat, stress Cautions/Comments may cause wakefulness if used at night
8
Chamomile, Roman
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Botanical Name Anthemis nobilis Actions analgesic, antidepressant, anti-inflammatory, antineuralgic, antiseptic, calmative, carminative, digestive, diuretic, emmenagogue, febrifuge, hepatic, muscle relaxant, nervine, tonic, vulnerary Uses anxiety, arthritis, dry skin, flatulence, headaches, immune system, indigestion, insomnia, menstrual cramps, muscle pain, neuralgia, PMS, rheumatism, sprains, stress Cautions/Comments may cause drowsiness; can cause dermatitis in allergic individuals
Grapefruit
9
Juniper
Clary Sage
5
6
10
Botanical Name Salvia sclarea Actions antidepressant, anti-inflammatory, antispasmodic, aphrodisiac, astringent, calmative, diuretic, emmenagogue, hypotensive, nervine, regenerative, tonic, uterine Uses anxiety, depression, frigidity/impotence, insomnia, menopause, mental exhaustion, muscle spasms, stomach cramps, stress, wrinkles Cautions/Comments avoid during pregnancy; do not use while drinking alcohol; may cause intense dreams; larger amounts may cause headache; may impair concentration and cause drowsiness
4
Botanical Name Citrus paradisi Actions antidepressant, antiseptic, astringent, depurative, diuretic, lymphatic stimulant, tonic Uses acne, colds/flu, depression, fluid retention, muscle stiffness, nervous exhaustion, slack skin Cautions/Comments phototoxic *; short shelf life
Botanical Name Juniperus communis Actions antirheumatic, antiseptic, astringent, calmative, depurative, diuretic, emmenagogue, lymphatic stimulant, nervine, rubefacient, sudorific, tonic Uses acne, amenorrhea, anxiety, colds/flu, cystitis, detoxification, dysmenorrhea, fluid retention, gout, lower back pain, rheumatism, stress Cautions/Comments avoid during pregnancy and in cases of kidney disease; it is slightly irritating, so use in low concentrations; short shelf life
Lavender
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Cypress
Botanical Name Lavandula angustifolia Actions analgesic, antidepressant, antifungal, antiinflammatory, antirheumatic, antiseptic, antispasmodic, calmative, cholagogue, choleretic, cicatrizant, cytophylactic, deodorant, diuretic, emmenagogue, hypotensive, nervine, tonic, vulnerary Uses acne, burns (mild), coughs, cuts (minor), dermatitis, dysmenorrhea, flu, fungal infections, headaches, insomnia, irritability, muscle aches and spasms, nausea, nervous tension, rheumatism, sciatica, sore throat, sprains, stomach cramps, stress Cautions/Comments may cause drowsiness; it’s one of the most versatile and widely used essential oils
Botanical Name Cupressus sempervirens Actions antirheumatic, antiseptic, antispasmodic, astringent, calmative, deodorant, diuretic, insect repellent, tonic, vasoconstrictor Uses body aches, coughs, dysmenorrhea, edema, foot odor, mature skin, menopause, menorrhagia, oily skin, rheumatism, stress/tension Cautions/Comments avoid during pregnancy
Eucalyptus Botanical Name Eucalyptus globulus Actions analgesic, antifungal, antineuralgic, antirheumatic, antiseptic, antispasmodic, decongestant, depurative, expectorant, febrifuge, immune tonic, insect repellent, rubefacient, stimulant, vulnerary Uses arthritis, burns (mild), colds/flu, concentration, cuts, disinfectant, insect repellent, muscle aches, nervous exhaustion, neuralgia, rheumatism, sinus congestion Cautions/Comments avoid in cases of high blood pressure or epilepsy; avoid when taking homeopathic remedies; avoid excessive use; may cause wakefulness if used at night
Lemon
12
2
Botanical Name Citrus limonum Actions anti-inflammatory, antirheumatic, antisclerotic, antiseptic, astringent, carminative, cicatrizant, depurative, diuretic, febrifuge, immunostimulant, rubefacient Uses acne, arthritis, cellulite, colds/flu, coughs, dyspepsia, gout, herpes, oily skin, rheumatism Cautions/Comments short shelf life; phototoxic*; mild skin irritant, so use in low concentrations; may cause sensitization
Petitgrain
Marjoram, Sweet Botanical Name Origanum marjorana Actions analgesic, antiseptic, antispasmodic, calmative, carminative, cephalic, diuretic, emmenagogue, expectorant, hypotensive, nervine, stomachic, tonic, vasodilator Uses anxiety, arthritis, bruises, colds, coughs, exhaustion, flatulence, headache, insomnia, menstrual cramps, muscle aches and strains, nervous tension, rheumatism, sprains, stomach cramps, stress Cautions/Comments avoid during pregnancy; may cause drowsiness; avoid excessive use
13
14
Botanical Name Citrus aurantium var. amara Actions antidepressant, antiseptic, calmative, digestive, nervine, tonic Uses acne, anxiety (mild), dyspepsia, insomnia, nervous exhaustion, stress
19
Rosemary Botanical Name Rosmarinus officinalis Actions analgesic, anticatarrhal, antineuralgic, antirheumatic, antiseptic, antispasmodic, astringent, carminative, cephalic, cholagogue, choleretic, cytophylactic, diuretic, emmenagogue, expectorant, hepatic, hypertensive, nervine, restorative, rubefacient, stimulant, stomachic, sudorific, tonic, vulnerary Uses acne, alopecia, arthritis, colds/flu, coughs, dysmenorrhea, dyspepsia, fluid retention, gout, greasy hair, muscle pain, neuralgia, rheumatism, sciatica Cautions/Comments avoid during pregnancy and in cases of asthma, hypertension and epilepsy; may cause insomnia and restlessness; use in moderation; avoid during pregnancy
20
Myrrh Botanical Name Commiphora myrrha Actions anticatarrhal, antifungal, anti-inflammatory, antiseptic, astringent, balsamic, calmative, carminative, cicatrizant, emmenagogue, expectorant, tonic, vulnerary Uses arthritis, athlete’s foot, chapped or cracked skin, colds/flu, coughs, diarrhea, dyspepsia, laryngitis, mature skin, sore throat
Orange, Sweet
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16
Botanical Name Citrus sinensis Actions antidepressant, antiseptic, antispasmodic, calmative, carminative, cholagogue, choleretic, stomachic, tonic Uses constipation, depression, dyspepsia, insomnia, nervous tension, stress
Rosewood Botanical Name Aniba rosaeodora Actions analgesic, antiseptic, aphrodisiac, cephalic, deodorant, regenerative, tonic Uses acne, colds/flu, exhaustion, frigidity, headaches, nervous tension, scars, skin care (all types), wrinkles Cautions/Comments its production contributes to deforestation in the rainforest
21
Palmarosa Botanical Name Cymbopogon martinii var. martinii Actions anti-inflammatory, antiseptic, calmative, cicatrizant, hydrating, nervine, regenerative, tonic Uses acne, anxiety, insomnia, nervous exhaustion, restlessness, scars, skin care (all types), stress
Sandalwood Botanical Name Santalum album Actions antidepressant, anti-inflammatory, antiseptic, antispasmodic, aphrodisiac, astringent, calmative, carminative, diuretic, emollient, expectorant, tonic Uses acne, coughs, cystitis, depression, dry/cracked skin, frigidity/impotence, insomnia, laryngitis, nervous exhaustion, sore throat, stress
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Patchouli Botanical Name Pogostemon cablin Actions antidepressant, antifungal, anti-inflammatory, antiseptic, aphrodisiac, cicatrizant, cytophylactic, diuretic, insect repellent, nervine, tonic Uses acne, cracked skin, depression, frigidity, fungal infections, mature skin, nervous exhaustion, slack skin, stress Cautions/Comments although small amounts of patchouli generally have a calming effect, too much may be stimulating
17
Tea Tree
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Peppermint
18
*
Botanical Name Mentha piperita Actions analgesic, antifungal, anti-inflammatory, antiseptic, antispasmodic, carminative, cephalic, cholagogue, expectorant, febrifuge, nervine, stomachic, vasoconstrictor Uses colds/flu, coughs, dyspepsia, flatulence, headaches, mental fatigue, muscular aches and pains, nausea, neuralgia, ringworm, stomach cramps Cautions/Comments avoid when taking homeopathic remedies; may cause restlessness or insomnia if used at night or to excess; use in moderation; may cause sensitization
Botanical Name Melaleuca alternifolia Actions analgesic, antifungal, anti-inflammatory, antiseptic, balsamic, cicatrizant, expectorant, immune stimulant, sudorific, vulnerary Uses acne, arthritis, athlete’s foot, blisters, burns (minor), colds/flu, cold sores, coughs, cuts, insect bites, ringworm, warts Cautions/Comments may cause sensitization; tea tree put into a hot bath may cause itching
Ylang Ylang
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Remember
Botanical Name Cananga odorata Actions antidepressant, antifungal, antiseptic, antispasmodic, aphrodisiac, calmative, hypotensive, nervine, tonic Uses acne, alopecia, anger, anxiety, depression, frigidity, insomnia, irritability, nervousness, skin care (all types), stress Cautions/Comments use in moderation—too much can cause headache; may cause sensitization
Always perform skin patch tests when using an oil for the first time [see Safety Precautions, page 1] * Do not apply / use for 12 hours prior to sun /sunlamp exposure
3
Glossary alopecia Hair loss amenorrhea Absence or suppression of menstrual bleeding analgesic Reduces or relieves pain anaphrodisiac Reduces sexual desire anticatarrhal Aids removal of excessive mucus or phlegm in the sinuses or other body areas antifungal Helps prevent and heal fungus infections antineuralgic Reduces or relieves nerve pain antirheumatic Helps prevent and relieve symptoms of rheumatism antisclerotic Helps prevent hardening of tissues; aids sclerosis of the arteries antiseptic Cleanses tissues of germs and microorganisms antispasmodic Reduces or relieves spasms aphrodisiac Increases sexual desire astringent Produces contraction of tissue balsamic Having a sweet aroma and soothing qualities calmative Produces soothing/calming effect carminative Soothing to the digestive system; relieves gas and stomach cramps cephalic Benefits the head or brain; helps to clear the head and improve thinking cholagogue Stimulates contraction of the gallbladder, aiding in the evacuation of bile choleretic Stimulates the liver to excrete bile cicatrizant Stimulates the formation of scar tissue
Therapeutic Index of Traditional Use acne atlas cedarwood, bergamot, geranium, grapefruit, juniper, lavender, lemon, palmarosa, patchouli, petitgrain, rosemary, rosewood, sandalwood, tea tree, ylang ylang anxiety bergamot, chamomile (roman), clary sage, frankincense, juniper, lavender, marjoram, palmarosa, petitgrain, ylang ylang arthritis atlas cedarwood, chamomile (German and Roman), eucalyptus, juniper, lemon, marjoram, myrrh, rosemary, tea tree athlete’s foot lavender, myrrh, patchouli, tea tree bites/stings chamomile (German and Roman), geranium, lavender, tea tree bruises chamomile (German), lavender, marjoram, rosemary burns (mild) chamomile (German), lavender, tea tree colds and flu atlas cedarwood, eucalyptus, frankincense, lavender, peppermint, rosemary, tea tree coughs atlas cedarwood, eucalyptus, frankincense, lavender, marjoram, rosemary, sandalwood, tea tree DISCLAIMER: This guide is intended for informational purposes only. It is not intended for the diagnosis, treatment or cure of any medical condition or illness, and should not be used as a substitute for professional medical care. BarCharts, Inc., its writers and editors are not responsible or liable for the use or misuse of the information contained in this guide. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 2005 BarCharts Inc. 0608
cystitis Inflammation of the bladder cytophylactic Increases the activity of leukocytes (white blood cells); stimulates regeneration of cells depurative Purifies and detoxifies the blood dermatitis Inflammation of the skin digestive Benefits the digestive system and the process of digestion diuretic Increases the production and elimination of urine; stimulates removal of fluid from tissues dysmenorrhea Painful menstruation dyspepsia Indigestion; abdominal pain and/or gas, heartburn, and sometimes nausea edema Abnormally large amounts of fluid in intercellular tissue spaces; swelling emmenagogue Stimulates menstruation emollient Softens tissue and soothes inflammation expectorant Promotes discharge of mucus and phlegm from the respiratory system febrifuge Reduces fever flatulence Intestinal gas hemostatic Reduces or stops bleeding hepatic Pertaining to the liver hypertensive Raises blood pressure; helps to counteract low blood pressure hypoglycemiant Lowers blood sugar hypotensive Lowers blood pressure; helps to counteract high blood pressure immunostimulant Stimulates the immune system lymphatic Pertaining to or acting on the lymphatic system
menorrhagia Excessive menstrual bleeding mucolytic Dissolves and breaks down mucus nervine Tones and strengthens nerves/ nervous system; relaxes and soothes mind and body neuralgia Recurring pain along the pathway of a nerve phototoxic Increases skin’s sensitivity to ultraviolet light, possibly resulting in severe sunburn regenerative Heals; renews tissue; benefits the skin restorative Helps to strengthen the body and restore health rheumatism A chronic disorder that causes pain and aching in muscles or joints rubefacient A substance producing an increase in blood flow where applied to the skin, causing redness sensitization An immune reaction where repeated exposure to a substance results in sensitivity to it; similar to allergic response stomachic Improves appetite and aids digestion; strengthens and tones the stomach styptic Reduces external bleeding sudorific Induces sweating tonic Strengthens the body, helps preserve and restore health uterine Acts on and benefits the uterus vasoconstrictor Reduces blood flow vasodilator Increases blood flow vulnerary Aids in the healing of wounds and sores
cuts/scrapes (minor) chamomile (German), eucalyptus, lavender, myrrh, tea tree depression (temporary, mild) bergamot, geranium, grapefruit dry skin atlas cedarwood, chamomile (Roman), frankincense, geranium, lavender, palmarosa, patchouli, sandalwood fatigue/nervous exhaustion clary sage, eucalyptus, frankincense, geranium, grapefruit, lavender, ylang ylang headache chamomile (Roman), lavender, peppermint indigestion bergamot, chamomile (Roman), marjoram, peppermint, rosemary insect bites chamomile (German), lavender, tea tree jet lag bergamot, eucalyptus, frankincense, lavender, ylang ylang laryngitis eucalyptus, frankincense, lavender, sandalwood mature skin clary sage, cypress, frankincense, geranium, lavender, myrrh, rosewood, sandalwood, ylang ylang menstrual cramps chamomile (Roman), lavender, marjoram muscle pain and spasm chamomile (German and Roman), eucalyptus, lavender, marjoram, peppermint, rosemary
nervousness/stress bergamot, chamomile (Roman), clary sage, frankincense, geranium, lavender, sandalwood, sweet orange, ylang ylang oily skin atlas cedarwood, bergamot, cypress, geranium, juniper, lavender, petitgrain, tea tree premenstrual syndrome (PMS) chamomile (Roman), frankincense, geranium, grapefruit, juniper, lavender, sandalwood rheumatism atlas cedarwood, chamomile (German and Roman), cypress, eucalyptus, juniper, lavender, marjoram, rosemary ringworm [see athlete’s foot] sleeplessness chamomile (Roman), clary sage, lavender, marjoram, petitgrain, sandalwood sprains chamomile (German and Roman), eucalyptus, lavender, marjoram, rosemary (soak sprains or apply compresses; do not massage) sunburn (mild) chamomile (Roman), eucalyptus, lavender wrinkles frankincense, geranium, lavender, palmarosa, patchouli, sandalwood
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PHYSICAL CHANGES
SCOPE OF THE PROBLEM A. Incidence & Prevalence 1. Asthma is a common disorder that affects 15 to 17 million people in the United States 2. Thought to occur in 6.2% of the US population 3. Most common chronic disease of childhood, affecting an estimated 4.8 million children 4. Causes approximately 100 million days of restricted activities each year. 5. Asthma precipitates more than 2 million adult emergency department visits each year 6. 500,000 hospitalizations occur annually due to exacerbation of asthma symptoms; ranks as the 6th leading cause of hospital admissions 7. More than 5,000 deaths due to asthma occur each year in the United States – most are preventable B. Costs: Total economic impact of asthma is $6.2 billion – including hospitalizations, emergency department visits, outpatient visits and lost school and workdays C. The Asthma Trend 1. Self-reported asthma has increased by 75% from 1980 to 1994 2. Asthma among children is a growing problem with a 72% increase between 1982 and 1994 3. Death and disability related to asthma has increased dramatically over the past 20 years D. The History of Asthma Management 1. Many patients and their physicians underestimate asthma's severity 2. For more than 35 years, asthma was considered to be an episodic, reversible airway constriction 3. Advances in medical research have shown that asthma should be considered a chronic airway inflammatory disease characterized by at least partially reversible airway constriction 4. The severity of symptoms do not often correlate with the objective physical findings 5. Despite the availability of effective anti-asthmatic medications, many people have asthma that is not well controlled 6. Inadequate treatment and inappropriate therapy are the major contributors to asthma illness and death 7. The National Heart, Lung, and Blood Institute published new guidelines in 1997 as a means to improve the detection and treatment of asthma 8. The four key components for asthma control in the NHLBI guidelines are: a. Assessment and monitoring (how to detect and watch the trend of asthma) b. Pharmacological therapy (medications used to maintain long-term control of asthma symptoms) c. Control of factors contributing to asthma severity (identifying and removing triggers for asthma) d. Individual education for a partnership in asthma care (developing an individualized care plan written by the patient and physician to help the asthmatic person take control of their disease)
A. What happens when you breathe? RESPIRATORY SYSTEM 1. When you breathe in, air travels through your nose and/or mouth through a tube called the trachea (also known as the “windpipe”) Trachea 2. Air enters a series of smaller tubes that Primary branch off from the trachea; these bronchi branched smaller tubes are the bronchi, and they divide further into Secondary smaller tubes called the bronchioles bronchi 3. It is in the bronchi and the bronchioles that asthma has its main effects; there are three components that result in Bronchiole difficulty breathing: & lobule a. When the airways come into contact with an asthma trigger, the tissue inside the bronchi and bronchioles become inflamed (inflammation) b. At the same time, the muscles on the outside of the airways tighten (constriction or bronchospasm), causing the airways to narrow c. A thick fluid (mucus) enters the airways, which become swollen and may be partially or completely plugged by the mucus B. Inflammation 1. Inflammation occurs when an exposure to an asthma trigger causes cells within the airways of the lung to release strong substances that result in airway tissue swelling 2. Swelling of the airway wall causes it to become more rigid and interferes with airflow 3. This inflammation results in a complex interaction within the lung’s airways, resulting in bronchospasm 4. Inflammation of the airways is an early and persistent component of asthma 5. Persistent, inadequately treated inflammation may lead to permanent changes in the airway structure C. Bronchospasm 1. Bronchospasm is an exaggerated tightening of the BRONCHOSPASM airways resulting in a smaller sized opening for air to pass in and out of the lungs during breathing Bronchiole 2. Bronchospasm is also referred to as airway hyperresponsiveness 3. The propensity for airways to narrow too easily and to “mush” is a major feature of asthma 4. Bronchospasm may result from exposure to an asthma trigger 5. The level of airway narrowing usually correlates with the severity of the asthma attack D. Mucus Production 1. Increased mucus production results when glands within the airways release an excess of thick mucus during an attack 2. Although this is meant to protect the lung from a trigger, this thick, abundant mucus results in further narrowing of the airways, even to the point that the mucus actually clogs a small airway completely
WHAT IS ASTHMA? 2. The most common triggers include: a. Strong emotional expression (laughing or crying hard) b. Aspirin and other medications c. Smoke (tobacco, wood) d. Changes in weather NORMAL GAS EXCHANGE e. Pollen Bronchiole f. Dust g. Animal fur and Alveoli dander CARBON h. Feathers DIOXIDE i. Molds Alveolus OXYGEN j. Grass k. Viruses Capillaries l. Cold air m. Exercise
A. Asthma is a life-long disorder of the lungs and airways B. It is characterized by airway inflammation or swelling combined with excessive airway tightness, resulting in a restriction of airflow into and out of the lungs C. Asthma has a recurring pattern of periodic episodes of difficult breathing alternating with periods of relief D. Asthma involves many cells and cellular elements within the body that play a role in its long-term effects E. During an asthma episode, you may feel like you cannot catch your breath and you may cough, wheeze or feel chest tightness F. Symptoms occur more frequently at night or in the early morning G. Characterized by sudden periodic episodes of difficulty 1. Often referred to as “attacks,” they are usually related to exposure to a trigger (a certain substance that a person’s airways are sensitive to) 1
INDICATIONS
4. Some other conditions may also result in wheezing: a. Foreign body aspiration b. Cystic fibrosis c. Croup, or other viral infections of the upper airway d. Inflammation of the epiglottis e. Tuberculosis f. Habitual cough g. Congestive heart failure h. Chronic obstructive lung disease i. Allergic reaction to an inhaled substance D. Goals of Asthma Therapy: 1. Prevent chronic and troublesome symptoms 2. Maintain near normal or normal lung function 3. Maintain normal activity levels 4. Prevent recurrent exacerbations of asthma and minimize the need for emergency department visits or hospitalizations 5. Provide optimal medication management with few or no side effects 6. Meet the patient’s and family’s expectations of asthma care E. Periodic Assessment and Monitoring: 1. Once your physician has determined that you have asthma and its severity, it is important that you are monitored in an ongoing manner 2. Ongoing monitoring will determine whether the goals of therapy are being met
(Correlates to Measurement and Monitoring of the NHLBI 1997 Recommendations) A. Initial Assessment: When your physician is considering the possibility you may have asthma, he will most likely take the following steps: 1. Obtain a detailed medical history from you, looking for the following indicators: a. Wheezing: High-pitched whistling sounds when breathing out. b. A recurrent history of cough (that is worse at night), difficulty breathing and chest tightness c. Symptoms that occur or worsen in the presence of any of the triggers listed on previous page d. Family history: The doctor may ask if any of your family members have problems with asthma or allergies e. Your physician may ask you many questions about your home, including how old it is, how it is heated and cooled, whether you have carpet or concrete and if you have any pets f. He/she will also ask if anyone smokes in your home or around you g. Your doctor will ask you about your job or school to determine if there are exposures outside the home that may trigger asthma 2. Perform a physical examination a. Physical examination focuses on the upper respiratory tract, chest and skin b. The physician will look for over-expansion of the chest with the appearance of hunched shoulders and chest deformity c. Assessment of the number of chest, neck and abdominal muscles used to breath in and out d. He/she will listen for the sounds of wheezing and for prolonged time spent breathing out (exhalation) e. An asthmatic person may have increased nasal secretions and swelling of the mucous membranes of the nose and mouth f. The physician will also look for any signs of an allergic skin condition, such as dermatitis or eczema 3. Diagnostic Testing a. Spirometry Measurements 1) A painless breathing test that measures your lung power 2) You may be asked to repeat this breathing test after inhaling some medication; this helps determine whether there is airflow obstruction and whether it is reversible 3) Generally used in adults and children over age 4 4) Typically measures Forced Vital Capacity or FVC, the maximal volume of air forcibly exhaled from the peak of inhalation 5) Also measures Forced Expiratory Volume in 1 second or FEV1, the volume of air exhaled during the first second of the FVC b. These additional studies are not routine, but may be considered: 1) Further pulmonary function studies: An expansion of the painless breathing test 2) Chest x-ray: A radiographic image of your chest 3) Allergy testing: Skin testing to determine what you are allergic to c. The presence of multiple key indicators along with the spirometry measurements are needed to determine the likelihood of asthma B. Determining the Severity of Asthma: Once your physician has determined that you have asthma, it may be classified into one of the following categories, based upon how asthma is affecting you; this will determine which treatment is best suited for you 1. Mild intermittent asthma: a. Symptoms 2 or fewer times a week b. No symptoms between episodes c. Episodes usually brief 2. Mild persistent asthma: a. Symptoms more than twice a week, but less than once a day b. Episodes may affect physical activity 3. Moderate persistent asthma: a. Daily symptoms b. Asthma episodes 2 or more times a week (some may last days) c. Episodes interfering with physical activity 4. Severe persistent asthma: a. Symptoms most of the time b. Physical activity limited c. Frequent asthma episodes C. All that Wheezes is Not Asthma 1. Although wheezing is a key symptom of asthma, there are other things that must be considered before labeling a person as an asthmatic, or an episode of breathlessness as an asthma attack 2. For instance, if a child in respiratory distress with an audible wheeze is automatically labeled asthmatic, you could miss the presence of a foreign body that has become lodged in the upper airway with detrimental or deadly consequences 3. It is important to consider the history, current symptoms and health examination findings as a whole, not assuming anything without putting these all together
TAKING CONTROL Asthma doesn’t have to put major limits on your life. There are many things that you can do to take control of your asthma and minimize its impact. A. Know Your Asthma Symptoms: Any one of these symptoms may mean you have asthma, or may be having an attack; you can have one or more of these symptoms or even different ones 1. Wheezing 2. Difficulty catching your breath 3. Coughing 4. Tightness in the chest 5. Feeling tired 6. Trouble exhaling 7. Waking up often in the middle of the night 8. Heavy breathing B. Track Your Triggers: Each case of asthma is unique; learn what can trigger an asthma episode for you; go over the list of common asthma triggers and check off the ones that set off your asthma episode or make them worse ❒ Air pollution – smoke or fumes ❒ Aspirin or other medications ❒ Breathing cold air, air conditioning ❒ Changes in the weather ❒ Cockroaches, their feces and dried body parts ❒ Colds, other respiratory infections ❒ Dust or dust mites ❒ Exercise, playing hard or using stairs ❒ High humidity ❒ Mold, mildew ❒ Perfume, body deodorants ❒ Pet fur or dander ❒ Pollen ❒ Stress ❒ Strong chemical smells – paint, cleaning fumes ❒ Strong emotional responses – laughing or crying ❒ Tobacco smoke ❒ Other If you are not sure what triggers your asthma, it will help to keep a log of your asthma attacks such as the one below: DATE & TIME OF ATTACK
12/2/2003 2 PM
WHERE WERE YOU?
IN THE BASEMENT AT HOME
WHAT YOU WERE DOING?
GETTING OUT THE DUSTY, DAMP AND COLD HOLIDAY DECORATIONS
C. Limit Exposure to Asthma Triggers: 1. Pets a. Keep pets away from the bedroom b. Keep pets away from carpets or upholstery c. Have pets bathed weekly d. Keep pets outside e. Find new homes for pets 2
SPECIAL DETAILS
2. Cockroaches a. Do not leave food out b. Empty the garbage every night c. Exterminate your home with poison baits or traps rather than chemical agents 3. Mold and Mildew a. Reduce indoor humidity by installing a dehumidifier b. Clean tubs, sinks and showers regularly with a bleach containing cleanser c. Avoid damp places, such as basements d. Clean heating and air conditioning ducts regularly e. Replace worn carpet 4. Dust Mites a. Encase your bed mattress and pillows in an allergen-impermeable cover b. Wash sheets and blankets weekly in hot water c. Avoid feather pillows and down comforters d. Reduce indoor humidity e. Remove carpet from the bedrooms f. Avoid lying down on a carpeted floor or upholstered couch g. Ask someone to vacuum for you or use a dust mask while vacuuming h. Dust with a damp cloth weekly i. Clean curtains and shades often j. For children, minimize the number of stuffed toys and wash the toys weekly in hot water 5. For Pollen a. Limit time spent outdoors during the season in which you have the greatest problem with allergies b. Use air conditioning rather than opening windows c. Stay inside during the midday and afternoon when the pollen count is highest d. Avoid hanging laundry outside to dry 6. For Allergies a. Consider allergy testing b. Ask your physician about special treatment for allergies 7. For Infections a. Ask your physician about an annual flu shot b. Treat cold symptoms and respiratory infections promptly 8. For Cold Air a. Breathe through your nose while outdoors so air is warmed b. Wear a scarf around your face on extremely cold days 9. For Smoke and other Irritants a. Avoid tobacco smoke! b. Limit use of wood-burning stoves and fireplaces c. Avoid strong-smelling products and perfumes 10. Exercise a. If possible, avoid exertion outside when levels of air pollution or pollen counts are high b. Speak to your physician about pre-medication prior to exercise or exertion 11. Aspirin Sensitivity a. Use safe alternative medications in place of aspirin b. Speak to your physician about what over-the-counter medications should be avoided 12. Occupational Exposure a. Be aware of the possibility you may be exposed to asthma triggers in your workplace b. Discuss avoidance, ventilation, respiratory protection and tobacco smoke-free environment with on-site health care providers or managers
4. Metered-Dose Inhalers (MDI’s) METERED-DOSE a. Metered-dose inhalers are a primary means INHALER of delivering asthma medications b. Metered-dose inhalers are devices designed to release a premeasured amount of medication into the air c. They are not all alike, but in general they have a chamber that holds the medication and a propellant that turns the medication into a fine mist d. When properly used, the MDI gets the medication into the airways where it is needed quickly, but when used incorrectly, symptoms may persist and worsen, leading to a severe asthma attack e. Using a spacer attached to the MDI results in better delivery of the medication to airways; the spacer holds the discharged, premeasured cloud of medication mist in a chamber until the patient breathes in. f. How Do I Use a Metered-Dose Inhaler? 1) Before using any MDI, review the product instructions and ask your physician, nurse or pharmacist for help, if needed 2) Remove the cap and look inside to see that nothing is blocking the mouthpiece 3) Hold the inhaler upright with the mouthpiece at the bottom and shake it 4) Attach to the spacer chamber (if you are using one) 5) Tilt your head back slightly and breathe out fully 6) Place the inhaler or chamber mouthpiece between your lips and seal it around the opening 7) Press down on the inhaler to release the medication as you start to breathe in 8) Breathe in slowly and steadily; take 3 - 5 seconds for each breath 9) Hold your breath for 10 seconds to allow the medication to settle in the lungs 10) Breathe out slowly 11) Repeat puffs as prescribed by your physician 12) If a steroid inhaler is used, rinse your mouth after use g. The Future of MDI’s 1) Most MDI’s deliver premeasured doses of medicine to the lungs using the propellant chlorofluorocarbons, or CFCs 2) Too many CFCs can damage the ozone layer around the earth, so the Environmental Protection Agency has given manufacturers several years to develop alternative ways to deliver medications 3) Several innovations are under way: 4) Hydrofluoroalkane (HFA) propellant is environmentally safe; this form of MDI tastes less bitter and comes in a smaller canister size than the CFC MDI’s 5) Dry-powder inhalers (DPI) deliver medication without a propellant • This device releases a fine cloud of dry powder when the patient closes his lips around the mouthpiece and breathes in h. Other Guidelines for Using MDI’s: 1) Using an MDI requires some practice initially 2) Over time, you may find your MDI use less precise • It is recommended that you practice the steps as outlined above every few months to ensure that you are using this device correctly • If you feel the inhaler spray land on your tongue or on the back of your throat, the medication is not reaching your lungs • You may want to practice the steps to improve your timing or demonstrate your technique for your physician 3) A 200-puff canister should last 30 days 4) If you use more than one type of MDI, clearly label each so that you use them as indicated; for example, label inhaled corticosteroid MDI’s as daily and bronchodilators as quick relief treatment 5) Clean spacers often 6) If you have trouble using an MDI, ask your physician for a spacer device 5. Using a Nebulizer a. A nebulizer machine turns medication into a mist, so the mist can be breathed in through a face mask or mouthpiece b. There are many different kinds of nebulizers available, so ask your healthcare provider to show you how your nebulizer works c. Read and follow manufacturer’s instructions d. Add medication to the nebulizer cup as directed NEBULIZER by your physician e. Attach the mouthpiece or mask to the cup with the medicine in it f. Take deep, slow breaths g. Continue until all the medication in the cup is used up h. Rinse or wash the equipment according to manufacturer’s recommendations
MEDICATIONS A. Long-term or maintenance medication prevent asthma attacks 1. Used daily as prescribed even if you feel no symptoms 2. Not used for rescue therapy during an asthma attack 3. Does not help reverse an asthma attack, but can prevent one 4. Inhaled steroids are the mainstay of maintenance care or prevention 5. May also use the following medications for maintenance: a. Long-acting bronchodilators – smooth muscle relaxation b. Most cell stabilizers c. Leukotriene modifiers – pills used to prevent airway inflammation d. Methylxanthines – pill or injection through a vein to counteract bronchospasm and inflammation e. Allergy medications - as a pill or injection B. Short-term or Rescue Therapy 1. Used to treat acute episodes/attacks 2. Work by relaxing the muscle around the airways that tighten during an asthma attack, allowing the air tubes to open 3. Short-acting bronchodilators (3 types) a. Beta2 agonists 1) Preferred rescue therapy 2) Inhaled agent (MDI [see below]or nebulizer treatment) 3) Side effects include rapid heartbeat, anxiety, and tremors b. Anticholinergic agents c. Combination drugs 3
PARTNERING WITH YOUR PHYSICIAN
HELPING A CHILD MANAGE ASTHMA
A. Make an asthma diary (See Taking Control, Page 2) B. Monitor Your Asthma with a Peak Flow Meter 1. A peak flow meter measures how well your PEAK FLOW lungs are able to expel air METER 2. Using one on a regular basis is an effective means of monitoring your asthma 3. Peak flow meters come in many shapes and sizes, but they all work the same way a. Each device consists of a plastic tube, a mouthpiece and a small pointer along a scale b. When you seal your lips around the mouthpiece and exhale, the scale shows the amount of force of the air blown out of the lungs c. This force is measured in liters per minute and is called the Peak Expiratory Flow, abbreviated PEF 4. During an asthma attack, the airways become narrowed, causing symptoms discussed earlier under Physical Changes, Page 1 a. This narrowing does not occur suddenly, but builds up gradually. Your airways may have begun to narrow before you feel any symptoms of asthma b. Monitoring your peak expiratory flow (PEF) can indicate airway narrowing even before you actually feel any symptoms c. The trend of your PEF numbers can indicate an impending problem, allowing you to adjust your asthma medications accordingly to avoid a severe episode 5. A peak flow meter can help both you and your doctor by: a. Showing what makes your asthma worse b. Helping to determine whether a particular treatment plan is working well c. Signaling a need for more or different types of medications to add to your treatment plan d. Setting a peak flow level that indicates emergency care is imperative. 6. Peak flow meters can be used by anyone, including children ages 5 and older; to use your peak flow meter: a. Slide the pointer all the way down to the bottom of the scale b. Stand up and take a deep breath c. Place your lips over the mouthpiece, taking care not to allow any gaps. Do not put your tongue inside the mouthpiece hole d. Blow as quickly and as forcefully as you can in a single blow; the idea is not to see how long you can blow, but rather how fast and hard you can push the air out of your lungs e. Take the meter out of your mouth and record the number next to the pointer f. Repeat steps 1 through 6 for two more blows, recording the highest of the three measurements; record this number in your asthma diary 7. Charting Your Asthma a. When you first start using a peak flow meter, you should take PEF readings at least twice per day at various times and record these numbers b. After 2-3 weeks, look over the numbers and pick out the highest reading c. This number is your personal best peak flow reading and indicates good asthma control d. Once you have found your personal best, your physician can help you set up three “zones;" these zones are based on percentages of your personal best number and can be used as guidelines for managing your asthma 1) Green Zone: More than 80% of your personal best number; this signals good asthma control and that you should take your asthma medications as usual 2) Yellow Zone: 50% - 80% of your personal best; this indicates caution; some airway narrowing is present, so you should take your short-acting quick-relief medication right away to prevent asthma symptoms; ask your doctor if you need to change or increase your daily medications and be especially careful to avoid your asthma triggers 3) Red Zone: Less than 50% of personal best and indicates a medical alert; significant airway narrowing is present, and you must take your quick-relief medication right away and call your physician, or go directly to a local emergency room 4) Remember these are general guidelines; talk to your doctor
A. The key to a normal childhood with asthma is to keep asthma under control. Be aware that you child may feel: 1. Different from other children 2. Embarrassed 3. Depressed 4. Fearful that an asthma episode may get out of control 5. Frustrated 6. Angry B. Help your child feel confident in his ability to keep asthma under control: 1. Help your child prepare for the doctor’s appointment 2. Help your child use the MDI’s, nebulizer, and peak flow meter 3. Watch for changes in your child’s breathing 4. Inform teachers and other responsible adults 5. Make sure medications are available 6. Ask that other children learn about asthma 7. Make an action plan for people who care for your child based upon the 3 asthma zones 8. Help your child develop an exercise plan by encouraging exercise, taking MDI medications in advance, warming up to exercise and breathing through their nose as much as possible 9. Consider sending your child to asthma summer camp 10. Offer praise and love often
80
0
70 0
60 0
50
0
55 0
45 0
30
0
35
20 0
10
75 0
65
0
40 0
0
25 0
0
10 0
50
ZONE
STATUS
Green zone: all clear. Peak flow is from ____ 80% to 100% of (your personal best peak flow reading) to ____ (multiply your personal best times .80)
Doing well: Your asthma is under control
Yellow zone: caution. Peak flow is at 50% - 80%. the peak flow range is from ____ (your personal best multiplied by .80 to ____ (your personal best times .50)
Increase in symptoms: Airways are beginning to narrow; treatment plan may not be working
Red zone: Medical alert. Peak flow is less than 50%. Peak flow is less than ____ (your personal best times .50)
Danger: No improvement or increasing symptoms
THE CONNECTION BETWEEN ASTHMA AND ALLERGIES A. Long regarded as trivial, people are beginning to realize that allergies are serious disorders that may trigger sneezing, wheezing, coughing and itching B. Allergies may also be linked to serious chronic respiratory illnesses, including asthma C. Allergies reflect an overreaction of the immune system to substances D. However, like asthma, allergies can be managed to minimize the effect on your life E. When asthma is diagnosed, it may be important to determine if you also have allergies F. Treating asthma without treating underlying allergies may not result in optimal health
FYI:
SOME VALUABLE SOURCES OF INFORMATION AND SUPPORT:
3. Asthma and Allergy Foundation of America 1233 20th St.NW, Suite 402 Washington, DC 20036 1-800-7-ASTHMA (1-800-727-8462) 2. American Lung Association http://www.aafa.org 1-800-LUNG-USA E-mail address:
[email protected] (1-800-586-4872) http://www.lungusa.org
1. National Asthma Education and Prevention Program NHLBI Information1 Center P.O.Box 30105 Bethesda, MD 20824-0105 http://www.nhlbi.nih.gov
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ACTION
CREDITS Author: : Jody J. Grahn, MSN, APRN, BS Layout: Jim Ashley
Avoid asthma triggers Continue on currently prescribed therapy
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Remember that these are general guidelines, so talk to your doctor. Together you can work as a team to keep your asthma under control
quickstudy.com
Adjust your therapy and activities as indicated in personal asthma management plan; take action promptly before a severe attack occurs Call your doctor or go to the nearest emergency room. If you have difficulty walking & talking due to shortness of breath or if your lips or fingernails are blue, call 911 immediately
DISCLAIMER: Always consult your doctor or therapist with any concerns or problems with your condition. This guide is intended only for informational purposes and helpful hints. In no way is this chart meant to be a substitute for professional medical care. Neither BarCharts®, nor its writers, designers or editing staff, are in any way responsible or liable for the use or misuse of the information contained in this guide. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2003 BarCharts Inc. Boca Raton, FL. 0608
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WORLD’S #1 ACADEMIC OUTLINE
BIOCHEMICAL PERIODIC TABLE 1
Key Elements in the Body
H
1. 3. 6. 7. 8. 9. 11. 12. 13. 14.
Hydrogen
3
Li Lithium
11
12
Na
Mg
Sodium
Magnesium
19
20
Hydrogen Lithium Carbon Nitrogen Oxygen Fluorine Sodium Magnesium Aluminum Silicon
22
15. 16. 17. 19. 20. 22. 25. 26. 27. 28.
Phosphorus Sulphur Chlorine Potassium Calcium Titanium Manganese Iron Cobalt Nickel
25
26
29. 30. 32. 33. 34. 35. 50. 53.
Copper Zinc Germanium Arsenic Selenium Bromine Tin Iodine
27
28
6
13
29
7
8
9
C
N
O
F
Carbon
Nitrogen
Oxygen
Fluorine
14
15
16
17
Al
Si
P
S
Cl
Aluminum
Silicon
Phosphorus
Sulfur
Chlorine
30
32
33
34
K
Ca
Ti
Mn
Fe
Co
Ni
Cu
Zn
Ge
As
Se
Potassium
Calcium
Titanium
Manganese
Iron
Cobalt
Nickel
Copper
Zinc
Germanium
Arsenic
Selenium
50
GLUCOSE
35
Br Bromine
53
Sn
I
Tin
Iodine
BROADER CHEMICAL PRINCIPLES 2. Hydrophilic = Lipophobic: Affinity for polar Energy = 1 q1.q2 group; soluble in water, repelled by nonpolar 1. Electrostatic: Strong ε r12 Examples: alcohol, amine, carboxylic acid interaction between ions; for 3. Amphipatic: Polar and nonpolar functionality; charges q1 and q2; separated by r12, Polarizability common for most biochemical molecules: fatty R and solvent dielectric constant, ε ; δacids, amino acids and nucleotides C O water has large ε; stabilizes C. Behavior of Solutions R zwitterion formation 1. Miscible: 2 or more substances form 1 phase; α: Measures 2. Polarizability, R-Oδoccurs for polar + polar or non-polar + non-polar distortion of electron cloud by other H 2. Immiscible: 2 liquids form aqueous and organic R nuclei and electrons layers; compounds are partitioned between the δN R 3. Dipole moment, µ : Asymmetric layers based on chemical properties (acid/base, R electron distribution gives partial polar, nonpolar, ionic) charge to atoms 3. Physical principles: Dipole 4. London forces (dispersion): Interaction a.Colligative properties depend on solvent identity and concentration of solute; a solution has a higher Attraction due to induced dipole + - + boiling point, lower freezing point and lower vapor moments; force increases with µ pressure than the pure solvent 5. Dipole-dipole interaction: The stable b.Biochemical example: Osmotic pressure - Water positive end of one dipole is attracted diffuses through a semi-permeable membrane from a + - - + to the negative end of another dipole; hypotonic to a hypertonic region; the flow produces strength increases with µ less stable a force, the osmotic pressure, on the hypertonic side 6. Hydrogen bonding: Enhanced Osmotic Pressure dipole interaction Hydrogen Bonding Π = iMRT between bonded H and Π: Osmotic pressure (in atm) δN the lone-pair of i: Van’t Hoff factor = # of ions per solute molecule Hδ+ H H neighboring O, N or S; M: Solution molarity (moles/L) Ammonia R: Gas constant = 0.082 L atm mol–1 K–1 gives “structure” to T: Absolute temperature (in Kelvin) liquid water; solubilizes δR O alcohols, fatty acids, 4. Solutions of gases Hδ+ Oδ- ... Hδ+ amines, sugars, and Water a.Henry’s Law: The amount of gas dissolved in a Hδ+ Alcohol liquid is proportional to the partial pressure of the gas amino acids
A.Intermolecular Forces H O
H C
H
C
DNA
TRIGLYCERIDE H H C H H H
H
C H
H H C
H C C H H H
C
C
H C
H H
H
H C
H C C
H C H
H
H
C
H
H
C
H
C
H
H
H
H
H C
H
H
H
H C
C H
H C H C H
H
C
H H H
C H H O C H H C H H C C H O H C C H C O C H C H H H H H C H H H C H O C C H C H H C C C O H H H O H C
H
H
H
C
H
H
B. Types of Chemical Groups
δN R
R
R
1. Hydrophobic = Amine Lipophilic: Repelled by polar group; insoluble in water; affinity for non-polar Examples: alkane, arene, alkene
b.Carbon dioxide dissolves in water to form carbonic acid c.Oxygen is carried by hemoglobin in the blood d.Pollutants and toxins dissolve in bodily fluids; react with tissue and interfere with reactions Examples: Sulfur oxides and nitrogen oxides yield acids; ozone oxidizes lung tissue; hydrogen cyanide disables the oxidation of glucose
BONDS & STRUCTURE IN ORGANIC COMPOUNDS
REACTIONS, ENERGY & EQUILIBRIUM A.Mechanisms Resonance
1. Most bonds are polar covalent; the more O O electronegative atom is the “–” end of the bond C C <=> Example: For >C=O, O is negative, C is positive N N+ 2. Simplest Model: Lewis Structure: Assign valence electrons as bonding electrons and nonbonding lone-pairs; more accurate bonding models include valencebonds, molecular orbitals and molecular modeling 3. Resonance: The average of several Lewis structures describes the bonding Example: The peptide bond has some >C=N< character
B. Molecular Structure Typical Behavior of C, N & O Atom C4
e–
4 bonds
N 5 e – 3 bonds, 1 lone pair O6
e–
2 bonds, 2 lone pairs
sp3
sp2
sp
-C-C-
>C=C<
-C≡C-
>N-
R=N-
-C≡N
-O-
>R=O
R
C
R
a.Isomers: same formula, different bonds H OH C b.Stereoisomers: same formula and bonds, H OH C different spatial arrangement c.Chiral = optically active: Produces + or – H rotation of plane-polarized light d.D: Denotes dextrorotary based on clockwise D(+) - Glyceraldehyde rotation for glyceraldehyde e.L: Denotes levorotary based on counter-clockwise O H rotation for glyceraldehyde; insert (–) or (+) to C denote actual polarimeter results HO H C f. D/L denotes structural similarity with D or L glyceraldehyde H OH C g.Chiral: Not identical with mirror image h.Achiral: Has a plane of symmetry H i. Racemic: 50/50 mixture of stereoisomers is L(–) - Glyceraldehyde optically inactive; + and – effects cancel j. R/S notation: The four groups attached to the chiral atom are ranked a,b,c,d by CH3 CH3 molar mass Br H Br H C •The lowest (d) is directed away from = the viewer and the sequence of a-b-c C Br produces clockwise (R) or counter- H Br H clockwise (S) configurations CH 3 CH3 •This notation is less ambiguous than ThreeFischer D/L; works for molecules with >1 dimensional projection chiral centers k.Nomenclature: Use D/L (or R/S) and +/– in the compound name: Example: D (–) lactic acid l. Fisher-projection: Diagram for chiral compound m.Molecular conformation: All Alkene molecules exhibit structural variation H H H Me due to free rotation about C-C single C C C C bond; depict using a NewmanH Me Me Me diagram Cis Trans n.Alkene: cis and trans isomers; >C=C< does not rotate; common in Chain Positions fatty acid side chains C δ
C γ
C β
R C α
C
C
C
1. Saturated: Maximum # of Hs (all C-C) γ β δ 2. Unsaturated: At least one >C=C< 3. Nucleophile: Lewis base; attracted to the + charge of a nucleus or cation 4. Electrophile: Lewis acid; attracted to the electrons in a bond or lone pair Carbon-chain Prefixes
1 2 3 4 5 6
methethpropbutpenthex-
7 8 9 10 11 12
heptoctnondecundecdodec-
13 14 15 16 17 18
tridectetradecpentadechexadecheptadecoctadec-
19 20 22 24 26 28
P ∆H
O
H
nonadeceicosdocostetracoshexacosoctacos-
Exothermic
Endothermic
Ea
1. Geometries of valence electron hybrids: sp2 - planar, sp3 - tetrahedral, sp - linear 2. Isomers and structure
C. Common Organic Terminology
1. Biochemical reactions involve a number of simple steps that together form a mechanism 2. Some steps may establish equilibria, since reactions can go forward, as well as backward; the slowest step in the mechanism, the rate-determining step, limits the overall reaction rate and product formation 3. Each step passes through an energy barrier, the free energy of activation (Ea), characterized by an unstable configuration termed the transition state (TS); Ea has an enthalpy and entropy component Potential energy
A.Bonding Principles
of
1. ∆G = Σ prod ∆G0f – Σ react ∆G0f 2. For coupled reactions: Hess’s Law: 3. Combine reactions, add ∆G, ∆H, ∆S 4. An exergonic step can overcome an endergonic step Example: ATP/ADT/AMP reactions are exothermic and exergonic; these provide the energy and driving force to complete less spontaneous biochemical reactions; Example: ATP + H2O => ADP + energy 1. LeChatlier’s Principle
Ea R
Reactants Reaction progress Products
D. Standard-Free Energy Formation, ∆G0f :
E. Equilibrium
Transition state
∆H
∆G > 0 endergonic not spontaneous small Keq ∆G = –RT ln(Keq) – connection with equilibrium
P P
B. Key Thermodynamic Variables 1. Standard conditions: 25ºC, 1 atm, solutions = 1 M 2. Enthalpy (H): ∆H = heat-absorbed or produced ∆H < 0 exothermic ∆H > 0 endothermic
C. Standard Enthalpy of Formation, ∆H0f 0 0 1. ∆H = Σ prod ∆Hf – Σ react ∆Hf 2. Entropy (S): ∆S = change in disorder 3. Standard Entropy, S0: ∆S = Σ prod S0 – Σ react S0 4. Gibbs-Free Energy (G):
∆G = ∆H – T∆S; the capacity to complete a reaction ∆G = 0 at equilibrium Keq = 1 steady state ∆G < 0 exergonic large Keq spontaneous
a.Equilibrium shifts to relieve the stress due to changes in reaction conditions b.Keq increases: Shift equilibrium to the product side c.Keq decreases: Shift equilibrium to the reactant side
2. Equilibrium changes
and
temperature
a.For an exothermic process, heat is a product; a decrease in temperature increases Keq b.For an endothermic process, heat is a reactant; an increase in temperature increases Keq
3. Entropy and Enthalpy factors ∆G = ∆H – T∆S a.∆H < 0 promotes spontaneity b.∆S > 0 promotes spontaneity c.If ∆S > 0, increasing T promotes spontaneity d.If ∆S < 0, decreasing T lessens spontaneity Note: T is always in Kelvin; K = ºC + 273.15
KINETICS: RATES OF REACTIONS A.Determination of Rate For a generic reaction, A + B => C: 1. Reaction rate: The rate of producing C (or consuming A or B) 2. Rate-law: The mathematical dependence of the rate on [A], [B] and [C] 3. Multiple-step reaction: Focus on rate-determining step - the slowest step in the mechanism controls the overall rate
B. Simple Kinetics 1. First-order: Rate = k1[A] Examples: SN1, E1, aldose rearrangements 2. Second order: Rate = k2[A]2 or k2[A][B] Examples: SN2, E2, acid-base, hydrolysis, condensation
C. Enzyme Kinetics 1. An enzyme catalyzes the reaction of a substrate to a product by forming a 2
stabilized complex; the enzyme reaction may be 103-1015 times faster than the uncatalyzed process 2. Mechanism: Step 1. E + S = k1 => ES Step 2. ES = k2 => E + S Step 3. ES = k3 => products + E [E] = total enzyme concentration, [S] = total substrate concentration, [ES] = enzyme-substrate complex concentration, k 1 - rate ES formation, k2 - reverse of step 1, k3 - rate of product formation
3. Data analysis: Michaelis-Menten Examine steady Equation: state of [ES]; rate Vmax [S] of ES formation v = K + [S] m equal rate of disappearance Km = (k2 + k3)/k1 (Michaelis constant) v – reaction speed = k3[ES] Vmax = k3 [E]
4. Practical solution: Lineweaver-Burk approach:
1 v 1
Vmax 1/v=Km/Vmax(1/[S])+1/Vmax The plot “1/v vs. 1/[S]” is 1 Km linear slope = V Km max Slope = Km /Vmax , 1 [s] y - intercept = 1/Vmax Lineweaver-Burke x - intercept = –1/Km Calculate Km from the data
D. Changing Rate Constant (k) 1. Temperature increases the rate constant: Arrhenius Law: k = Ae–Ea/RT • Determining Ea: Graph “ln(k) vs. 1/T”; calculate Ea from the slope
2. Catalyst: Lowers the activation energy; reaction occurs at a lower temperature 3. Enzymes a. Natural protein catalysts; form substrate-enzyme complex that creates a lower energy path to the product b.In addition, the enzyme decreases the Free Energy of Activation, allowing the product to more easily form c.Enzyme mechanism is very specific and selective; the ES complex is viewed as an “induced fit” lock-key model since the formation of the complex modifies each component Enzyme + Substrate
Enzyme/Substrate complex
Enzyme + Product
ORGANIC ACIDS & BASES Arrhenius
E+S
Base
aqueous H3O+
aqueous OH–
proton donor
Brønsted-Lowry
E/S complex
Enzyme E+P
E. Energetic Features of Cellular Processes 1. Metabolism: The cellular processes that use nutrients to produce energy and chemicals needed by the organism a. Catabolism: Reactions which break molecules apart; these processes tend to be exergonic and oxidative b.Anabolism: Reactions which assemble larger molecules; biosynthesis; these processes tend to be endergonic and reductive
2. Anabolism is coupled with catabolism by ATP, NADPH and related high-energy chemicals 3. Limitations on biochemical reactions a.All required chemicals must either be in the diet or be made by the body from chemicals in the diet; harmful waste products must be detoxified or excreted b.Cyclic processes are common, since all reagents must be made from chemicals in the body c.Temperature is fixed; activation energy and enthalpy changes cannot be too large; enzyme catalysts play key roles
MAJOR TYPES OF BIOCHEMICAL REACTIONS
D. Buffers
1. A substance that can react as an acid or a base 2. The molecule has acid and base functional groups; Example: amino acids 3. This characteristic also allows amphoteric compounds to function as OH single-component buffers for O P OH biological studies
B. Acids
OH
1. Ka= [A–][H+]/[HA] Phosphoric acid pKa = –log10(Ka) 2. Strong acid: Full dissociation: HCl, H2SO4 and HNO3: Phosphoric acid 3. Weak acid: Ka << 1, large pKa 4. Key organic acid: RCOOH Examples: Fatty acid: R group is a long hydrocarbon chain; Vitamin C is abscorbic acid; nucleic acids contain acid phosphate groups Acid Acetic
pKa 4.75
Acid Formic
pKa 3.75
Carbonic
6.35
Bicarbonate
10.33
H2PO4–
7.21
HPO42–
12.32
H3PO4
2.16
NH4+
9.25
C. Organic Bases
H C 4
N3 HC
2 1
Common Buffers Buffer composition
approx. pH 4.8
ammonia + ammonium salt
9.3
carbonate + bicarbonate
6.3
diacid phosphate + monoacid phosphate
7.2 COOH
E. Amino Acids
1. Amino acids have amine (base) H2N C H and carboxylic acid functionality; R the varied chemistry arises from the chemical nature of the R- group L Amino acid • Essential amino acids: Must be provided to mammals in the diet
2. Polymers of amino acids form proteins and peptides
COO +
• Natural amino acids adopt the L H3N configuration
3. Zwitterion; self-ionization; the “acid” donates a proton to the “base”
ethane C2H6, methyl (Me) -CH3, ethyl (Et) -C2H5
Addition Nucleophilic: Electrophilic:
Add to a >C=C< Nucleophile attacks >C=O
Hydrogenate Hydrate Hydroxylate
Alkene
>C=C<
ethene C2H4, unsaturated fatty acids
Aromatic ring
-C6H5
benzene - C6H6, phenylalanine
Substitution Nucleophilic:
Replace a group on alkane (OH, NH2) SN1 or SN2
Amination of R-OH deamination
Alcohol
R-OH
methanol Me-OH, diol = glycol (2 -OH), glycerol ( 3 -OH)
Ether
R”-O-R’
ethoxyethane Et-O-Et, or diethyl ether
Elimination: E1 and E2
Reverse of addition, produce >C=C<
Dehydrogenate Dehydrate
Aldehyde
O R-C-H
methanal H2CO or formaldehyde, aldose sugars
Isomerization
Change in bond connectivity
aldose => pyranose
Ketone
O R-C-R’
Me-CO-Me 2-propanone or acetone ketose sugars
Oxidationloss of eReductiongain of eCoupled Processes
Biochemical: Oxidize: ROH to >C=O Add O or remove H Hydrogenate Reduce: Reverse of fatty acid oxidize Metals: Change valence
Carboxylic acid
O RC-OH
Me-COOH ethanoic acid or acetic acid Me-COO- Acetate ion
Ester
O RC-OR’
Me-CO-OEth, ethyl acetate, Lactone: cyclic ester, Triglycerides
Amine
N-RR’R”
H3C-NH2, methyl amine, R-NH2 (1º) - primary, RR'NH (2º) - secondary, RR'R"N (3º) - tertiary
Hydrolysis
Water breaks a bond, add -H and -OH to form new molecules
Hydrolyze peptide, sucrose triglyceride
Amide
O R-C-NRR'
H3C-CO-NH2, acetamide Peptide bonds
R-NH or R-OH combine via bridging O or N
Form peptide or amylose
Condensation
Cyclic Ethers: O
O
Pyran
Furan
3
H
R
• Isoelectric point, pI: pH that produces balanced charges in the Zwitterion
Examples C
C
Zwitterion
TYPES OF ORGANIC COMPOUNDS
C
CH
Pyrimidine
acetic acid + acetate salt
H
Alkane
6
N
Henderson Hasselbalch Equation: pH = pKa + log (salt/acid)
C 1. Kb=[OH–][B+]/[BOH] N 7 N1 6 5 C pKb = –log10(Kb) 8 CH 2. Strong base: Full HC 2 3 4 C 9 N dissociation: NaOH, KOH N H 3. Weak base: Kb << 1, Purine large pKb 4. Organic: Amines & derivatives Examples: NH3 (pKb = 4.74), hydroxylamine (pKb =7.97) and pyridine (pKb = 5.25) 5. Purine: Nucleic acid component: adenine (6-aminopurine) & guanine (2-amino-6-hydroxypurine)
Type of Compound
5 CH
1. A combination of a weak acid and salt of a weak acid; equilibrium between an acid and a base that can shift to consume excess acid or base 2. Buffer can also be made from a weak base and salt of weak base 3. The pH of a buffer is roughly equal to the pKa of the acid, or pKb of the base, for comparable amounts of acid/salt or base/salt 4. Buffer pH is approximated by the Henderson Hasselbalch equation Note: This is for an acid/salt buffer
A.Amphoteric
Common Acids & pKa Enzyme
6. Pyrimidine: Nucleic acid component: cytosine (4-amino2-hydroxypyrimidine), uracil (2,4-dihydroxypyrimidine) & thymine (5-methyluracil)
proton acceptor
electron-pr acceptor electron-pr donor electrophile nucleophile
Lewis
Active site
Enzyme
Acid
BIOCHEMICAL COMPOUNDS e.Disaccharides Disaccharide M-OH + M-OH → M-O-M Common • 2 units • Lactose (β-galactose + β-glucose) β (1,4) link Name •Sucrose (α-glucose + β-fructose) α, β (1,2) link Acetic acid • Maltose (α-glucose + α-glucose) α (1,4) link
A.Carbohydrates: Polymers of Monosaccharides 1. Carbohydrates have the general formula (CH2O)n 2. Monosaccharides: Simple sugars; building blocks for polysaccharides Common Sugars
CH2OH
Triose
3 carbon
glyceraldehyde
Pentose
5 carbon
ribose, deoxyribose
Hexose
6 carbon
glucose, galactose, fructose
H
HO
a.Aldose: Aldehyde CHO CH2OH type structure: H C OH C O H-CO-R HO C H HO C H b.Ketose: Ketone type H C OH H C OH structure: R-CO-R H C OH H C OH c.Ribose and CH2OH CH2OH deoxyribose: Aldose Ketose Key component in D Glucose D Fructose nucleic acids and ATP CH2OH
CH2OH
O
O H
H
H
H
H
OH
OH
H
OH
Ribose
H
H
OH
H
OH
Deoxyribose
d.Monosaccharides cyclize to ring structures in water • 5-member ring: Furanose (ala furan) •6-member ring: Pyranose (ala pyran) • The ring closing creates two possible structures: α and β forms •The carbonyl carbon becomes another chiral center (termed anomeric) •α: -OH on #1 below the ring; β: OH on #1 above the ring •Haworth figures and Fischer projections are used to depict these structures (see figure for glucose below) Haworth Figure
Fischer Projection H
C
OH
H
C
OH
HO
C
H
H
C
OH
H
C
6 CH OH 2 5
H O
O H
H
1
4
HO
OH 3
H
H
OH
2
OH
CH2OH
α-D-Glucopyronose
2.Polysaccharides a.Glucose and fructose form polysaccharides b.Monosaccharides in the pyranose and furanose forms are linked to from polysaccharides; dehydration reaction creates a bridging oxygen c.Free anomeric carbon reacts with -OH on opposite side of the ring d.Notation specifies form of monosaccharide and the location of the linkage; termed a glycosidic bond
CH2OH O
O H
H
H OH
H
H
OH
O
H
H OH
H
H
OH
OH
Maltose - Linked α D Glucopyronose
f. Oligosaccharides • 2-10 units • May be linked to proteins (glycoproteins) or fats (glycolipids) •Examples of functions: cellular structure, enzymes, hormones g.Polysaccharides • >10 units Examples: - Starch: Produced by plans for storage
Common Fatty Acids Systematic
Formula
ethanoic
CH3COOH
Butyric
butanoic
C3H7COOH
Valeric
pentanoic
C4H9COOH
Myristic
tetradecanoic
C13H27COOH
Palmitic
hexadecanoic
C15H31COOH
Stearic
octadecanoic
C17H35COOH
Oleic
cis-9-octadecenoic
C17H33COOH
Linoleic
cis, cis-9, 12 octadecadienoic
C17H31COOH
Linolenic
9, 12, 15octadecatrienoic (all cis)
C17H29COOH
Arachidonic 5, 8, 11, 14C19H31COOH eicosatetranoic (all trans) OH
O
OH
O
C
C
- Amylose: Unbranched polymer of α (1,4) linked glucose; forms compact helices - Amylpectin: Branched α (1,6) linkage
amylose
using
- Glycogen: Used by animals for storage; highly branched polymer of α (1,4) linked glucose; branches use α (1,6) linkage - Cellulose: Structural role in plant cell wall; polymer of β (1,4) linked glucose - Chitin: Structural role in animals; polymer of β (1,4) linked N-acetylglucoamine
3. Carbohydrate Reactions a.Form polysaccharide via condensation b.Form glycoside: Pyranose or furanose + alcohol c.Hydrolysis of polysaccharide d.Linear forms are reducing agents; the aldehyde can be oxidized e.Terminal -CH2-OH can be oxidized to carboxylic acid (uronic acid) f. Cyclize acidic sugar to a lactone (cyclic ester) g.Phosphorylation: Phosphate ester of ribose in nucleotides h.Amination: Amino replaces hydroxyl to form amino sugars i. Replace hydroxyl with hydrogen to form deoxy sugars (deoxyribose)
Saturated Stearic Acid
4. Common fatty acid compounds a.Triglyceride or triacylglycerol: Three fatty acids bond via ester linkage to glycerol A b.Phospholipids: phosphate group bonds to one of three positions R-PO4 or HPO4 group
1. Lipid: Non-polar compound, R insoluble in water C O Examples: steroids, fatty acids, HO triglycerides 2. Fatty acid: R-COOH Essential fatty acids cannot be synthesized by the body: linoleic, linolenic and arachidonic 3. Properties and structure of fatty acids: a.Saturated: Side chain is an alkane b.Unsaturated: Side chain has at least one >C=C<; the name must include the position # and denote cis or trans isomer c.Solubility in water: <6 C soluble, >7 insoluble; form micelles d.Melting points: Saturated fats have higher melting points; cis- unsaturated have lower melting points 4
R1
CO
O
CH2
R2
CO
O
CH
CO
O
CH2
R3
Triglyceride
of fatty acid/glycerol;
5. Examples of other lipids a.Steroids: Cholesterol and hormones Examples: testosterone, estrogen R''
R = Nearly always methyl R' = Usually methyl R'' = Various groups 1
11
R H
8
5 4
H
17
13
16
14
15
9
10
3
R
12
2
Fatty Acid
B. Fats and Lipids
Unsaturated Oleic Acid
H
H
7 6
Generic Steroid
b.Fat-soluble vitamins: • Vitamin A: polyunsaturated hydrocarbon, all trans • Vitamins D, E, K
6. Lipid reactions
3 Fatty Acids + Glycerol
HO CH2 a.Tr i g ly c e r i d e : R1 CO OH T h r e e - s t e p R2 CO OH HO CH p r o c e s s : R3 CO OH HO CH2 dehydration reaction of fatty acid and glycerol b.The reverse of this reaction is hydrolysis of the triglyceride c.Phosphorylation: Fatty acid + acid phosphate produces phospholipid d.Lipase (enzyme) breaks the ester linkage of triglyceride
BIOCHEMICAL COMPOUNDS continued
C. Proteins and Peptides - Amino Acid Polymers R2 O
d.Quaternary structure: The conformation of protein subunits in an oligomer
H
6. Chemical reactions of proteins:
1. Pe p t i d e s a r e N C H C OH formed by H COOH linking amino H2N C H + R1 acids; all 2 Amino acids natural peptides contain L-amino acids
a.Synthesis of proteins by DNA and RNA b.Peptides are dismantled by a hydrolysis reaction breaking the peptide bond c.Denaturation: The protein structure is disrupted, destroying the unique chemical features of the material d.Agents of denaturation: Temperature, acid, base, chemical reaction, physical disturbance
a.Dipeptide: Two linked amino acids b.Polypeptide: Numerous linked amino acids c.The peptide bond is R2 H the linkage that O N C H connects a pair of C amino acids using a COOH dehydration reaction; H2N C H the N-H of one amino R1 Dipeptide acid reacting with the OH of another => -N- bridge d.The dehydration reaction links the two units; each amino acid retains a reactive site
7. Enzymes a.Enzymes are proteins that function as biological catalysts b.Nomenclature: Substrate + - ase Example: The enzyme that acts on phosphoryl groups (R-PO4) is called phosphatase
8. Enzymes are highly selective for specific reactions and substrates
2. The nature of the peptide varies with amino acids since each R- group has a distinct chemical character a.R- groups end up on alternating sides of the polymer chain b.Of the 20 common amino acids: 15 have neutral side chains (7 polar, 8 hydrophobic), 2 acidic and 3 basic; the variation in R- explains the diversity of peptide chemistry (see table, pg. 6)
3. Proteins are polypeptides made up of hundreds of amino acids a.Each serves a specific function in the organism b.The structure is determined by the interactions of various amino acids with water, other molecules in the cell and other amino acids in the protein
4. Types of proteins: a.Fibrous: Composed of regular, repeating helices or sheets; typically serve a structural function Examples: keratin, collagen, silk b.Globular: Tend to be compact, roughly spherical; participates in a specific process: Examples: enzyme, globin c.Oligomer: Protein containing several subunit proteins Examples fibrinogen hemoglobin
Common Mol Wt 450,000 68,000
insulin ribonuclease trypsin
5,500 13,700 23,800
Protein Function Physical structures Binds O2 Glucose metabolism Hydrolysis of RNA Protein digestion
5. Peptide Structure: a.Primary structure: Primary Structure Ala-Ala-Cys-Leu The linear sequence of amino acids connected by peptide bonds • Ala-Ala-Cys-Leu or A-A-C-L denotes a peptide formed from 2 alanines, a cysteine and 1 leucine •The order is important since this denotes the connectivity of the amino acids in the protein b.Secondary structure: Describes how the polymer takes shape Example: Helix or pleated sheet •Factors: H-bonding, hydrophobic interactions, disulfide bridges (cysteine), ionic interactions c.Tertiary structure: The overall 3-dimensional conformation
1.
2. 3. 4. 5. 6.
Six Classes of Enzymes (Enzyme Commission) Type Reaction Oxidoreductase Oxidation-reduction Examples: oxidize CH-OH, >C=O or CH-CH; Oxygen acceptors: NAD, NADP Tranferase Functional group transfer Examples: transfer methyl, acyl- or amine group Hydrolase Hydrolysis reaction Examples: cleave carboxylic or phosphoric ester Lysase Addition reaction Examples: add to >C=C<, >C=O, aldehyde Isomerase Isomerization Example: modify carbohydrate, cis-trans fat Ligase Bond formation, via ATP Examples: form C-O, C-S or C-C
9. An enzyme may require a cofactor Examples: Metal cations (Mg 2+, Zn 2+ or Cu 2+); vitamins (called coenzymes) 10. Inhibition: An interference with the enzyme structure or ES formation will inhibit or block the reaction 11. Holoenzyme: Fully functional enzyme plus the cofactors 12. Apoenzyme: The polypeptide component
D. Nucleic Acids: Polymers of Nucleotides 1. Nucleotide: A phosphate group and organic base (pyrimidine or purine) attached to a sugar (ribose or deoxyribose) • Name derived from the base name •Example: Adenylic acid = adenosine-5’monophosphate = 5’ AMP or AMP
2. Nucleoside: The base attached to the sugar •Nomenclature: Base name + idine (pyrimidine) or + osine (purine) •Example: adenine riboside = adenosine; adenine deoxyriboside = deoxyadenosine Nucleic Acid Components
3. Cyclic nucleotides: The Phosphate phosphate group attached to Sugar Base the 3’ position bonds to the Nucleotide 5’ carbon 3’, 5’ cyclic AMP = cAMP and cGMP 4. Additional Phosphates a.A nucleotide can bond to 1 or 2 additional phosphate groups b.AMP + P => ADP - Adenosine diphosphate ADP + P => ATP - Adenosine triphosphate c.ADP and ATP function as key biochemical energy-storage compounds
5. Glycosidic bond: Linkage between the sugar and base involve the anomeric carbon (carbon #1) >C-OH (sugar) + >NH (base) => linked sugar - base 6. Linking Nucleotides: The B polymer forms as each S phosphate links two sugars; #5 P position of first sugar and #3 S B position of neighboring sugar P 7. Types of nucleic acids: S Double - stranded D NA B (deoxyribonucleic acid) and Linking R NA Nucleotides single - stranded (ribonucleic acid) 8. Components of a nucleotide: sugar, base and phosphate a.Sugar: ribose (RNA) or deoxyribose (DNA) b.Bases: purine (adenine and guanine) and pyrimidine (cytosine, uracil (RNA) and thymine (DNA))
9. In DNA, the polymer strands pair to form a double helix; this process is tied to base pairing 10. Chargaff’s Rule for DNA: a.Adenine pairs with thymine P (A: T) and guanine pairs with cytosine (C: G) b.Hydrogen bonds connect the base pairs and supports the helix c.The sequence of base pairs along the DNA strands serves as genetic
information
for
P S-T...A-S P P S-C...G-S P P S-G...C-S P P Chargaff’s Rule
reproduction and cellular control
11. DNA vs RNA: DNA uses deoxyribose, RNA uses ribose; DNA uses the pyrimidine thymine, RNA uses uracil 12. Role of DNA & RNA in protein synthesis a.DNA remains in the nucleus b.Messenger-RNA (m-RNA): Enters the nucleus and copies a three-base sequence from DNA, termed a codon. m-RNA then passes from the nucleus into the cell and directs the synthesis of a required protein on a ribosome c.Transfer-RNA (t-RNA): Carries a specific
Base
Nucleoside
Nucleotide
adenine
Adenosine Deoxyadenosine
Adenylic acid, AMP dAMP
guanine
Guanasine Deoxyguanisine
Guanylic acid, GMP dGMP
cytosine
Cytidine Deoxycytidine
Cytidylic acid, CMP dCMP
uracil
Uridine
Uridylic acid, UMP
RNA, oriented by m-RNA and r-RNA, then
thymine
Thymidine
Thymidylic acid, dTMP
chemically connected by enzymes
5
amino acid to the ribosomal-RNA (r-RNA) and aligns with the m-RNA codon d.Each codon specifies an amino acid, STOP or START; a protein is synthesized as different amino-acids are delivered to the ribosome by t-
COMMON AMINO ACIDS hydrophobic = yellow, basic = blue, acidic = red, polar = green Amino acid MW essential - e
pKa pKb
pI R-pKa
-R
Alanine 89.09
Ala A
2.33 9.71
6.00
hydrophobic
Arginine e 174.20
Arg R
2.03 9.00
10.76 12.10
basic
Asn N 2.16 8.73
5.41
NH CH2 CH2 CH2
polar
O H2N
Aspartate 133.10
Asp D 1.95 9.66
Cysteine 121.16
Cys C
Glutamate 147.13
Glu E
Glutamine 146.15
Gln Q
2.77 3.71
acidic
1.91 5.07 10.28 8.14
polar
2.16 9.58
3.22 4.15
acidic
2.18 9.00
5.65
polar
Histidine e 155.16 Isoleucine e 131.18
Gly G His H
Ile I
2.34 9.58 1.70 9.09 2.26 9.60
5.97 7.59 6.04 6.02
C
HOOC
HOOC
CH2 CH2
Leu L
2.32 9.58
Lysine e 146.19
Lys K
2.15 9.16
Methionine e 149.21
Met M 2.16 9.08
5.98
CH2
CH2
CH2 NH
N
hydrophobic
CH3
CH2
CH2 CH2
HC CH3
hydrophobic
CH2
CH3 S
Phenylalanine Phe F e 165.19
2.18 9.09
Proline 115.13
1.95 6.30 10.47
Pro P
hydrophobic CH3
5.74
5.48
CH2
CH2
CH2
CH2
hydrophobic CH2
CH2
H C
CH2
Ser S
2.13 9.05
5.68
polar
Threonine e 119.12
Thr T
2.20 8.96
5.60
polar
N H
COOH
HO
CH2
CH3
CH OH
Tryptophan e 204.23
Trp W 2.38 9.34
Tyrosine 181.19
Tyr Y
Valine - e 117.15
Val V
5.89
hydrophobic
CH2 N H
2.24 9.04
5.66 10.10
polar
2.27 9.52
5.96
hydrophobic
M
adenine - purine base
HO
• Leu UUA UUG CUU CUC CUA CUG • Ala GCU GCC GCA GCG
C6H6
CH2
CH3 HC CH3
m
milli (10-3)
ADP
adenosine diphosphate
Man
mannose sugar
AMP adenosine monophosphate Met
aa methionine
Arg
aa arginine
mL
milliliter
Asn
aa asparagine
mm
millimeter
Asp
aa aspartate
N
atm
atmosphere
Avogadro’s number
(pressure unit)
elemental nitrogen
• Met START AUG • STOP UAA UAG UGA
adenosine triphosphate
n
nano (10-9)
C
aa cysteine
O
orotidine
cytosine - pyrimidine
elemental oxygen P
aa proline
calorie
phosphate group
Cys
aa cysteine
elemental phosphorous
D
aa aspartate
DNA deoxyribonucleic acid dRib
2-deoxyribose sugar
E
aa glutamate
F
aa phenylalanine
Fru
fructose sugar
G
aa glycine
• Val GUU GUC GUA GUG
Gal
galactose sugar
Glc
glucose sugar
Glu
aa glutamate
• His CAU CAC
H
aa histidine
h
hour
aa histidine
I
aa isoleucine
pico (10-12)
Phe
aa phenylalanine
Pro
aa proline
Q
R
aa glutamine
aa arginine gas constant
Rib
ribose sugar
RNA ribonucleic acid S
aa serine Svedberg unit
Planck’s constant His
p
coenzyme Q, ubiquinone
guanine - purine base
• Arg CGU CGC CGA CGG AGA AGG
aa asparagine
ATP
Dalton
• Cys UGU UGC
aa methionine Molar (moles/L)
aa alanine
cal
• Tyr UAU UAC
aa lysine
Ala
elemental carbon
• Ile AUU AUC AUA
• Trp UGG CH2
hydrophobic
Serine 105.09
aa alanine
• Glu GAA GAG
-H
CH2
A
• Thr ACU ACC ACA ACG
CH2
basic
H2N
Lys
CH2
polar
basic
amino acid
• Asp GAU GAC
O
9.74 10.67
aa
CH2
HC CH3
Leucine e 131.18
• Phe UUU UUC
HS
H2N C
Glycine 75.07
ABBREVIATIONS USED IN BIOLOGY & BIOCHEMISTRY
• Lys AAA AAG
NH
H2N C
Asparagine 132.12
H3C-
AMINO ACID RNA CODONS
s
second (unit)
Ser
aa serine
T
aa threonine thymine - pyrimidine absolute temperature
Thr
aa threonine
Trp
aa tryptophan
Tyr
aa tyrosine
U
uracil - pyrimidine
V
aa valine
inosine
• Ser UCU UCC UCA UCG
elemental iodine
• Gln CAA CAG
Ile
aa isoleucine
J
Joule (energy unit)
K
• Ser AGU AGC
aa lysine
volt (electrical potential)
Kelvin - absolute T
• Pro CCU CCC CCA CCG
elemental potassium (103)
Val
aa valine
W
aa tryptophan
k
kilo
• Asn AAU AAC
L
aa leucine liter (volume)
X
xanthine
• Gly GGU GGC GGA GGG
Lac
lactose sugar
Y
aa tyrosine
Leu
aa leucine
yr
year
elemental tungsten
Note: Source - CRC Handbook of Chemistry & Physics
free downloads &
U.S. $5.95 CAN. $8.95
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Author: Mark Jackson, PhD.
quickstudy.com
Note: Due to the condensed nature of this chart, use as a quick reference guide, not as a replacement for assigned course work. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2004 BarCharts, Inc. 0607
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ISBN-13: 978-142320390-2 ISBN-10: 142320390-9
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• Study of the Plant Kingdom... Our Essential Partners in Life • ALTERNATION OF GENERATIONS
INTRODUCTION What’s so special about plants? • They are photosynthetic, using the ultimate energy source, the sun, to make their own food. For this reason they are called autotrophs. Plants power most ecosystems and are thus essential to life on Earth.
Have you thanked a plant today?
GAMETE EVOLUTION Plants have developed different strategies for gamete production and fusion. • Isogamy – Gametes are equally motile and of similar size. • Anisogamy – One gamete Female(+) Male(-) is large and less motile, with nutrient reserves, while the other is smaller and more motile, with few nutrient reserves. • Oogamy – One gamete is non-motile and large, with large nutrient reserves (egg), while the other is smaller and motile (sperm) and must locate the larger gamete.
Isogamy
A unique evolutionary strategy for reproduction where a single plant organism has two phases to its life history. • Gametophyte – Haploid, multicelled individual produces gametes via mitosis. Dominant form in lower plants. • Sporophyte – Diploid, multicelled individual from gamete fusion (zygote); produce haploid spores via meiosis for dispersal; spores germinate via mitosis to produce gametophytes. Dominant form in higher plants. • Isomorphic A/G – Gametophyte and sporophyte individuals are morphologically indistinguishable. • Heteromorphic A/G – Gametophyte and sporophyte individuals are morphologically distinct.
PLANT CLASSIFICATION SEEDS, VASCULAR Angiosperms
Oogamy Gymnosperms
PLANT EVOLUTION
• New problems on land: Plants must adapt to living in the air, a non-aquatic, dry medium. This presents some problems: - Obtaining water and preventing water loss. - Transporting water and nutrients. - Gas exchange (requires moisture) - Gravity - Reproduction when gametes swimming in water is limited. - Temperature flux of air is more rapid than in water. Plant adaptations/solutions • Chlorophyll A & B, to capture sunlight – similar to green algae chlorophyll. • Starch storage, for prolonged inactive periods during seasonal variations. • Gametes protected and kept moist inside plant tissues. • Stomata (leaf openings) to regulate gas exchange. • Wax surfaces to prevent excess water loss. • Root system to pull in water and nutrients from soil. • Conduction tissues to transport water, nutrients and food. • Support tissues to battle gravity for vertical growth. • All of these adaptations have greatly enhanced the success of plants on land today.
Spore n n
n
Antheridium
Archegonium Sperm
Egg
n Spores
Syngamy
Meiosis
2n
2n Spore mother cell
Zygote 2n
Embryo
Sporangia
Diploid
Sporophyte (2n)
NONVASCULAR PLANTS 1st Plants on Land • Lack vascular tissues • Gametophyte is dominant, sporophyte nutritionally dependent on gametophyte. • Small; live in moist environments; gametes released into water. a. Division Hepatophyta (Liverworts) b. Division Anthocerophyta (Hornworts) c. Division Bryophyta (Mosses)
Anisogamy
Plant evolution: Land colonization occurred about 400 mya, likely from aquatic, green algae ancestor.
Haploid Gametophyte (n)
(a)
(b)
SEEDLESS, VASCULAR Ferns
Club Mosses Sporophyte Gametophyte
Horsetails
Growing region Foot of sporophyte
Whisk Ferns
(c) Capsule
NONVASCULAR
Sporophyte Mosses
Seta Foot
Liverworts
Hornworts
GREEN ALGAL ANCESTOR 1
Gametophyte
SEEDLESS VASCULAR PLANTS
SEED “Ferns”
Microphyll Evolution Stem
Microphyll
Vascular tissue Vascular Projection supply to projection
Unbranched stem
Leaf with one vein
Extinct fossil forms that may show transition from seedless vascular plants (e.g., ferns) to vascular seed plants (e.g., gymnosperms and angiosperms).
Megaphyll Evolution
FLOWERS
Main axis of stem
Dichotomously branching stems
Side branch
Overtopping (one branch becomes main axis of stem) Megaphylls
Leaves with many veins Webbing of side branch systems
• Most plants are angiosperms and thus produce flowers with both male and female reproductive structures. • Flower anatomy - Sepals, petals - Stamen (Male Portion): Anther, filament - Pistil (Carpel, Female Portion): Stigma, style, ovary, ovule
{
The pistil contains the female organs
Stigma Style Ovary Ovule
Petal
{
Seedless Vascular plants • Possess xylem & phloem for transport of materials. • Sporophyte is dominant. • Evolution of leaf for efficient light capture. - Microphylls, megaphylls (In botany, the prefixes "micro" and "mega" generally refer to similar structures in male and female parts of the plant, respectively). • Division Lycophyta (Club Mosses) - Roots present. - Leaves present (microphylls). • Division Psilophyta (Whisk Ferns) No roots or leaves • Division Sphenophyta ( Horsetails) - Roots present. - Stems contain silica. - Leaves present (microphylls). - Division Pterophyta (Ferns) - Roots present. - Leaves (= fronds) - Fronds present (megaphylls). - Fern life history (see fig. below) - Sporophyte, sori, sporangia, spores, gametophyte (= prothallus), archegonium with eggs and antheridium with sperm • The Plant Scene (300 mya): Many seedless vascular plants and some nonvascular plants exhibited lush, dense growth covering large expanses in Earth’s history. • Much of today’s oil, coal and gas deposits were formed by these plants. Evolution of the "seed" plants • Terrestrial adaptations of seed plants. - Gametophytes protected in moist sporophytic, reproductive tissues. - Pollination replaced swimming for sperm delivery to egg. - The seed evolved - a dormant embryo with surrounding nutrients protected from environmental conditions. Seeds replaced spores as dispersal agents, using wind, water or animals. • The seed - a fertilized egg - Inside an ovule. - Integument, megasporangium ➔ megaspore ‘gametophyte ➔ egg sperm
Anthers (microsporangia)
The stamen contains the male organs
OVULE TO SEED Megasporangium (2n)
Seed coat (2n) (derived from integument)
Integument (2n) Spore case (n)
Female gametophyte (n)
Pollen tube (n)
Egg nucleus (n)
Micropyle
Food supply (derived from female gametophyte tissue)
Discharged sperm nucleus (n) Embryo (2n) (new sporophyte) Megaspore (n)
(b) Fertilized ovule
(a) Ovule
Filament
Sepal
Receptacle
(c) Seed
FERN LIFE HISTORY The sporophyte (still attached to the gametophyte) grows, develops
rhizome
zygote
sorus
Diploid Stage fertilization Archegonium egg
egg producing structure
sperm
sperm producing structure
meiosis
Haploid Stage
Sporangia The spores are released from a spore chamber
Spores develop Prothallus mature gametophyte (underside)
A spore germinates and grows into a gametophyte
Antheridium
TRENDS IN ALTERNATION OF GENERATIONS Gametophyte (n)
Sporophyte (2n) Gametophyte (n)
Sporophyte (2n) Sporophyte (2n)
• Sporophyte dependent on gametophyte (e.g., bryophytes)
Gametophyte (n)
• Large sporophyte and small, independent gametophyte (e.g., ferns) • Reduced gametophyte dependent on sporophyte (seed plants) 2
• Angiosperms have dominated the plant scene since the demise of dinosaurs and many gymnosperms (Cenozoic era, 65 mya to present). • Seed in a protective container or cotyledon • Angiosperm life cycle: - Microspore mother cell ➔ microspores ➔ pollen grain (male gametophyte)which includes tube cell and generative cell (sperm) - Megaspore mother cell ➔ megaspore ➔ embryo sac with 7 cells and 8 nuclei (female gametophyte) ➔ egg - Two sperm move through the pollen tube and engage in a double fertilization (where one sperm fuses with the egg to form a zygote/embryo, and the other sperm fuses with a large, central cell to form endosperm/nutrient reserve for the embryo) until it can produce its first leaves and begin photosynthesis. - Pollination and fertilization occur within hours to days, making angiosperms quick reproducers, compared to gymnosperms. • Flowers ensure pollination by insects, birds and mammals. - Flowers and pollinators co-evolved. • Seed dispersal - Important because plants may drop seeds close by, but new individuals will possibly compete with parent plants. - Wind, water and animals are common dispersal agents. - Fruits can entice animals to aid in dispersal. • Fruits – ripened ovary (see fig.) • Monocots and Dicots - two major groups of angiosperms (see fig. for differences) - Monocots include grasses, corn, sugar cane, palm trees, lilies and orchids. - Dicots include most trees, vines, shrubs and cacti.
THE GYMNOSPERMS - “naked seed” plants • Dominant plant when dinosuars ruled (Mesozoic era, 220 - 65 mya). • Do not produce flowers. • Ovules/seeds exposed. • Division Cycadophyta - Slow-growing palm-like trees found primarily in tropics and sub-tropics. • Division Ginkgophyta - Only one living member. - Ginkgo biloba (common diet supplement) • Division Gnetophyta - Closest living relatives of angiosperms - Ephedra - Drug ephedrine originally derived from this plant. - Cells resemble xylem vessel cells of angiosperms. - Cone clusters resemble flowers. • Division Coniferophyta (Conifers, Evergreens) - Oldest, tallest, most massive plants (e.g., 380 ft. tall Redwood tree). - Leaves form needles, which slow desiccation and are resistant to grazing by herbivores. - Important economically as wood/paper source, resin, turpentine and Christmas trees • Pine life cycle: - Ovulate cone = megastrobilus with megasporophylls (scales) - Micropyle, where pollen lands on ovulate cone. - Pollen cone = microstrobilus with microsporphylls - The process from pollination to fertilization can take over a year, which proved slow once the angiosperms evolved.
GYMNOSPERM LIFE CYCLE Megaspore(n) Scale of female cone Female cone
HAPLOID Gametophyte generation Megasporangium Ovule
Male cones
Pollen chamber
Note that the same plant has both pollen-producing male cones and egg-producing female cones
Micropyle Female
MEIOSIS gametophyte(n)
Egg Microspores(n) Microspore Reduced mother cells(2n) archegonium
Germinating pollen produces pollen tubes to reach the egg. Male gametophyte (germinating pollen grain)
Pollen grain
FERTILIZATION Scale of male cone
Sporophyte(2n)
The gametophytes are tiny
DIPLOID Sporophyte generation
Female gametophyte(n)
Seed coat Suspensors Seed Female gametophyte
Zygotes(2n) Winged seed
Embryo Female cone Developing embryo
Wing
The seed protects the embryo
Scale of female cone
THE ANGIOSPERMS - “enclosed seed” plants FRUIT DEVELOPMENT Endosperm
ANGIOSPERM LIFE CYCLE
Primary endosperm cell
Pollen grains (n) Generative cell
Anther
Fruit flesh
Ovary
Meiosis Integument
Seed coat Tube cell Fruit
Microspores (n) Anther
Pollen mother cells (2n)
Stigma
Functional megaspore (n) Megaspore mother cell (2n)
Pollen tube
8-nucleate embryo sac (megagametophyte) (n)
Zygote
Embryo
MONOCOTS VS DICOTS MONOCOTS
DICOTS
Sperm cells
Florals parts in multiples of 4 of 5
Floral parts in multiples of three
Meiosis
Ovary Adult sporophyte (2n) with flowers Germination
LEAVES
Ovule Seed (2n) Endosperm (3n)
Double fertilization
Formation of pollen tube (n)
Long tapering blades with parallel venation
Broad to narrow leaves with netted venation
STEMS
Seed coat Egg Vascular bundles are scattered
Vascular bundles arranged in a circle
SEEDS
Endosperm (3n) Embryo (2n)
Contain 1 cotyledon
3
Flower
Contain 2 cotyledons
PLANT ARCHITECTURE
STEM STRUCTURE
• Plant needs and solutions: - Leaves - Collection and conversion of solar energy - Stems - Positioning and support of leaves - Roots - Anchorage and absorption - Vascular system - Transport Axillary bud
• • • •
Cellulose-based cell walls for support and growth toward sunlight Epidermis Dicots with cortex and pith separated by ring of vascular bundles. Monocots with ground tissue with scattered vascular bundles.
Shoot tip (terminal bud)
Vessels Meristematic cell in xylem (brick-shaped cells)
Epidermis Vascular bundle
Young leaf
Cortex
Pith
Flower
Node Internode
Epidermis
Node
Transverse section of a stem, with enlargement of a vascular bundle shown to the right
Leaf Ring of vascular bundles divides ground tissue into cortex and pith
Vascular tissues
Sieve-tube members and companion cells in phloem
Seeds (inside fruit)
Air space Vessel in xylem
Epidermis
Thick-walled sclerenchyma cells forming a sheath around the mature vascular bundle
Ground tissue
Ground tissues
Vascular bundle
Withered cotyledon
Fibers in phloem
Shoot system Root system
Root hairs Primary root
Root tip Root cap
Lateral root
Groundvascular bundles distributed through ground tissue
Transverse section of a stem, with enlargement of a vascular bundle shown to the right
ROOT STRUCTURE
LEAF STRUCTURE • • • • • •
Sieve-tube member Companion cell in phloem in phloem
Epidermis Cuticle with wax to resist desiccation (produced by epidermis). Guard cells with stomata to regulate gas exchange. Mesophyll - Photosynthetic layer. Dicots with palisade and spongy layers; monocots with one layer. Vein - Vascular bundle for transport of materials.
Epidermis Endodermis
Root section Palisade mesophyll
Cortex Casparian strip
Vein vascular bundle
Endodermis Upper epidermis
Casparian strip
Cuticle
• • • • •
Bundle sheath Xylem Stoma Lower epidermis
Stoma
Guard cells
Spongy mesophyll
4
Movement of water through the endodermis to the center of the root
Epidermis - Has root hairs for increased absorption area for water/minerals. Cortex Endodermis - With casparian wax strips Stele - Central cylinder with vascular tissues inside Apoplastic pathway vs. symplastic pathway: Water enters through root epidermis and passes in the spaces "between" cortex cells apoplastically unti reaching the endodermis. Casparian strips prevent water from passing between endodermal cells. Thus, water is forced through the cell membranes symplastically where it is filtered before reaching the vascular tissues within the stele. In this way, potentially harmful substances might be removed by the selectively-permeable membranes of the endodermal cells.
PLANT DEVELOPMENT
VASCULAR TISSUES • Xylem, used for water/mineral transport. - Tracheids - Thin, hollow, dead cells with perforated, tapered ends. - Vessel members (element) - Thick, hollow, dead cells with large holes on end. • Phloem used for sugar/food transport. - Sieve tube members (element), hollow, living cells with perforated ends. - Companion cells, living cells that help keep sieve tube member cells alive.
Pits in wall
Sieve plate One vessel member
no cytoplasm (cells are dead at maturity)
MERISTEMATIC TISSUES • Growth after germination • Upward growth - Epicotyl or Coleoptile - Phototropism - Plant growth and movement in response to light. • Downward growth - Radicle or hypocotyl - Gravitropism - Plant growth response to gravity via statolith sensors. • Meristematic tissues form all tissues of adult plant (similar to germ tissues of animals). • Apical meristems - Responsible for increase in plant height. • Lateral meristem - Responsible for increase in plant diameter (girth). • Three primary meristems: - Protoderm - Epidermis - Ground meristem Cortex and ground tissues - Procambium - Vascular bundles with xylem and phloem.
sievetube member (alive) companion cell (alive) Portion of one vessel
Portions of tracheids
Portion of one sieve tube
IMPORTANT SYMBIOSES WITH PLANTS • Root nodules & bacteria - Bacteria fix nitrogen and are housed in root nodules to supply "fertilizer," thus allowing the plant to thrive, even in soils that are nutrient poor. • Mycorrhizae - Most plants today have an association between their roots and fungi in the soil. This association, or mycorrhizae, is critical in aiding water/mineral uptake by the plant.
VEGETATIVE (asexual) REPRODUCTION Plants typically produce new parts/structures without sexual reproduction, thus allowing the quick spread of the plant into the immediate habitat.
Fleshy leaves Stem
Stem
Corm
Bulb
Apical Meristem
Protoderm Ground meristem Procambium Three Primary Meristems:
Vascular bundle Vascular cambium
Stem of primary plant body
Cork cambium
Lateral Meristems (their location in stems showing secondary growth)
SEEDLING DEVELOPMENT Foliage leaves
New plant
Cotyledon
Stolon (runner)
Epicotyl Rhizome Cotyledon
Root
Cotyledon
Hypocotyl
Hypocotyl
Asexual Reproductive Modes of Flowering Plants Mechanism
Representative
Characteristics Radicle
Vegetative reproduction on modified stems Runner (stolon)
Strawberry
Rhizome Corm
Bermuda grass Gladiolus
Tuber
Potato
Bulb
Onion lily
Parthenogenesis
Orange tree, rose
Vegetative propagation
Jade plant, African violet
Tissue culture propagation
Orchids, lily, tulip, wheat, rice, corn
New plants arise at nodes on an above ground horizontal stem New plants arise at nodes of underground horizontal stem New plant arises from axillary bud on short, thick, vertical underground stem
Seed coat
Bean
Foliage leaves Epicotyl
Hypocotyl
Cotyledon
New shoots arise from axillary buds on tubers (enlarged tips of slender underground rhizomes)
Hypocotyl Radicle
New bulb arises from axillary bud on short underground stem Embryo develops without nuclear or cellular fusion (e.g., from unfertilized haploid egg; or develops adventitiously, from tissue surrounding embryo sac) New plant develops from tissue or organ (e.g., a leaf) that drops or is separated from plant New plant induced to arise from cell of a parent plant that is not irreversibly differentiated
Pea Coleoptile
Radicle
Corn 5
Foliage leaves
Plant development continued: • Vascular cambium - Produces xylem inward and phloem outward • Cork cambium - Cork • Wood is produced from xylem: - Annual rings (see fig.) - Heartwood vs. sapwood (see fig.) - Heartwood - Clogged xylem, little water transport - Sapwood - Newer xylem, free flowing water transport • Bark is produced from phloem, cork cambium, cork - Lenticels are cracks in the bark to facilitate gas exchange. - "Girdling plants" or cutting a horizontal band around the circumference of the plant, can be deadly because the vascular cambium, in which nutrients and water travel vertically, can be damaged. Lawn equipment (especially weed whackers) is a potential source of this kind of plant damage. • Exchange and Transport - Plants obtain gases, nutrients, minerals and water via internal fluids. - Gas exchange- stomata, roots, lenticels - Internal transport- xylem and phloem - Fluids move in xylem via adhesion, cohesion, evaporation and osmosis. • Theories of upward movement: - Capillary action - Some water moves up small vascular cells naturally. - Root pressure - Solutes inside the root tissues draw some water up. - Transpiration pull (cohesion-adhesion-tension)- The main motive force for transporting water up to the top of a plant (sometimes several hundred feet). - Essentially, as water evaporates from the leaf surface, the cohesive and adhesive properties of water pull water molecules from below, establishing a water tension/pressure. One drawback is it requires loss of water from the plant. In dry conditions or arid environments, this water loss for vertical transport can be critical to plants – thus, a replenishing water supply in the roots is vital. • Fluid movement in phloem (see fig.) - Sugars produced by the leaves via photosynthesis must be distributed to the rest of the plant. Gravity can assist this basically downward movement. However, getting the sugars into the cells of the phloem requires energy (i.e. active transport). Sometimes large quantities of sugars/starch are stored in special vegetative structures (e.g., tubers).
SECONDARY GROWTH Xylem Heartwood Cork (with cambium)
"Bark"
Vascular cambium
ANNUAL RINGS 1993
1992 Annual ring 1991
1990 250 um
INTERNAL TRANSPORT IN PHLOEM Xylem
Phloem
Companion cell
This QUICKSTUDY ® guide is an outline of the basic topics taught in Botany courses. Due to its condensed format, use it as a Botany guide but not as a replacement for assigned class work.
Leaf (source of sucrose)
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Sieve Companion cell
Water Sucrose 6
osmosis of water active transport of sucrose
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WORLD’S #1 ACADEMIC OUTLINE
BRAIN IN PLACE Parietal lobe Inferior parietal lobule
LATERAL VIEW
Precentral gyrus
Frontal lobe Temporal lobe
Central fissure
Olfactory bulb (nasal sensory n.n.)
Central fissure (of Rolando)
Superior frontal sulcus
Supraparietal lobule
Lateral fissure
Middle frontal gyrus Inferior frontal sulcus
Postcentral gyrus
Supramarginal gyrus
Optic n.
Angular gyrus
Frontal sinus
Occipital lobe
Sphenoid sinus
Parieto-occipital sulcus
Nasal bone
Transverse cerebral fissure
Inferior frontal gyrus:
Postcentral sulcus Inferior parietal lobule
Opercular part Triangular part
Supramarginal gyrus
Orbital part
L. medial nasal concha
Cerebellum
L. inferior nasal concha Hard palate Orbicularis oris m.
Superior temporal gyrus Parietooccipital sulcus Angular gyrus
Temporal pole Superior temporal sulcus
Mandible
Cervical n.n. Spinal cord
Tongue
Auditory (eustachian) tube Soft palate (uvula)
MEDIAL VIEW
Genioglossus m.
Precentral sulcus Central sulcus
Posterior commisure Pineal body
Olfactory bulb
Inferior nasal meatus
Head of the mandible
Corpus callosum
Frontal pole
Pharyngeal tonsil
Inner ear (cochlea) (semicircular canals) Nuchal l. Tympanic membrane (eardrum) Temperomandibular joint & capsule
Parietal lobe
a. a.a. L. l. m. n. n.n.
= = = = = = =
artery arteries Left ligament muscle nerve nerves
Anterior communicating a. Anterior cerebral a.
Fornix
Lateral ventricle(s) (1st & 2nd) Anterior commisure Paraterminal gyrus
Corpora quadrigemina
Medulla oblongata
ARTERIES Middle infraorbital a.
Medial striate a. Internal carotid a. Lateral orbitofrontal a. Ascending frontal a.
Occipital lobe
Cerebral aqueduct
Posterior cerebral a.
Pontine a.a. Internal acoustic (labyrinthine) a.
Middle cerebral a. & branches Frontal lobe Cingulate sulcus Thalamus (3rd ventricle) Hypothalamus
Middle & lateral lenticulostriate a.a.
Anterior inferior cerebellar a.
Anterior choroidial a.
Optic chiasm
Cerebellar peduncles
Hypophysis (pituitary gland)
Superior medullary vellum
Posterior communicating a. Anterior spinal a. Superior cerebellar a.
Temporal lobe
Cerebellum
Arbor vitae Spinal cord
Pons
Horizontal fissure of cerebellum
Inferior temporal sulcus Inferior temporal gyrus
Interthalamic adhesion
Parietooccipital sulcus
Cerebellar cortex
Cerebellum
Sulcus of corpus callosum Cingulate gyrus
Middle temporal gyrus
Transverse cerebellar fissure
Mamillary body Pons 4th ventricle Medulla oblongata
Basilar a.
Vertebral a.
Cerebral peduncle Posterior spinal a.
Posterior inferior cerebellar a.
FRONTAL SECTION
Optic chasm Olfactory bulb I
Medial thalamic nucleus Insular gyrus
Claustrum Mamillary body nucleus
Optic tract
Lateral sulcus
Trochlear n. IV
Temporal lobe
Trigeminal n. V Interpeduncular fossa
Hippocampus
Abducens n. VI
Pons Longitudinal fasciculus of pons Flocculus
Cerebral penduncle Middle cerebellar peduncle
Choroid plexus of ventricle IV
Intermedius & vestibulocochlear n.
Facial n. VII
Pyramidal decussation Spinal cord
Intermedial n. Vestibulocochlear n. VIII Glossopharyngeal n. IV
Flocculus Medulla oblongata Cerebellum
Foramen caecum Medulla oblongata
Facial n.
Vagus n. rootlets
Mamillary body Oculomotor n. III Cerebral penducle
Optic n. II
Lateral sulcus
Choroid plexus of lateral ventricle, inferior horn
Glossopharyngeal n. rootlets
Hypophysis (pituitary)
Olfactory tract
3rd ventricle
External capsule
Frontal lobe
Frontal pole
Head of caudate nucleus
Globus pallidis
ANTERIOR VIEW
Longitudinal cerebral fissure
Longitudinal cerebral fissure Corpus callosum trunk Septum pellucidum Columns of fornix
Choroid plexus of lateral ventricle Internal capsule Putamen lentiform nucleus
Vagus n. X Hypoglossal n. XII Accessory n. XI
VENTRICLES
1st cervical n. 2nd cervical n.
Interthalamic adhesion
Lateral ventricle central part
Inferior olive
Spinal cord 3rd ventricle
Interventricular foramen of Monroe
Anterior horn
Posterior horn
Anterior commisure Optic recess
Cerebral aqueduct
Optic chiasm
HORIZONTAL SECTION Genu of corpus callosum Anterior horn of lateral ventricle
Septum pellucidum
Columns of fornix
Inferior horn of lateral ventricle
Infundibular recess 4th ventricle Olfactory bulb I Lateral recess of Olfactory tract 4th ventricle
Median aperture
Optic chiasm II
Central canal
Longitudinal cerebral fissure Frontal pole of cerebrum Head of caudate nucleus Straight gyrus Anterior part of internal capsule Olfactory sulcus Orbital sulci Orbital gyri Internal capsule Temporal pole Claustrum External capsule
Lateral sulcus
Putamen Subthalamic nucleus
Globus pallidis
Red nucleus
Posterior part of internal capsule
3rd ventricle
Thalamus Tail of caudate nucleus
Superior colliculus
Inferior horn of lateral ventricle
Choroid plexus Optic radiation
Vermis of cerebellum
INFERIOR VIEW
Anterior perforate substance Lateral sulcus Tuber cinereum Uncus Rhinal sulcus Inferior temporal sulcus Inferior temporal gyrus Cerebral peduncle Posterior perforated substance Red nucleus Substantia nigra Cerebral aqueduct Lateral occipitotemporal gyrus Medial occipitotemporal gyrus Collateral sulcus Parahippocampal gyrus Lingual gyrus Calcerine sulcus Isthmus of cingulate gyrus
Pineal body
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ISBN-13: 978-142320717-7 ISBN-10: 142320717-3
Occipital pole of cerebrum
Optic n. II Hypophysis (pituitary gland) Optic tract Mamillary body Oculomotor n. III Trochlear n. IV Pons Ophthalmic n. TriMaxillary n. geminal Mandibular n. n. V Abducens n. VI Facial n. VII Intermedial n. Vestibulocochlear n. VIII Choroid plexus Glossopharyngeal n. IX Hypoglossal n. XII Vagus n. X Accessory n. XI Medulla oblongata Lobus simplex
Cerebellum 1st cervical n. Spinal cord Superior semilunar Vermis lobule Longitudinal cerebral fissure
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WORLD’S #1 ACADEMIC OUTLINE
VENOUS SYSTEM Pulmonary valve Tricuspid valve R. atrium R. brachial v.v. R. basilic v. R. cephalic v. Hepatic v.v. Inferior vena cava R. median cubital v. R. radial v. R. common iliac v. R. cephalic v. R. basilic v. R. ulnar v. R. superficial palmar venous arch
L. facial v. L. inferior labial v. L. internal jugular v. L. external jugular v. L. subclavian v. Brachiocephalic v. L. pulmonary a. Superior vena cava Pulmonary trunk R. ventricle L. renal v. L. internal iliac v. L. external iliac v. L. profunda femoris
Accessory R. proper palmar saphenous v. digital v.v. R. superficial femoral v. R. great saphenous v. R. genicular v.v.
R. peroneal v. R. anterior tibial v. R. dorsal venous network of foot
SCHEMA: HEAD & NECK Superior sagittal sinus Inferior sagittal sinus Straight sinus Frontal v. Transverse sinus Angular v. Transverse v. Maxillary v. Retromandibular v. Superior labial v. Facial v. Inferior labial v. Vertebral v. Mastoid emissary v. Internal jugular v. External jugular v. Deep cervical v. Middle thyroid v. R. subclavian v. Brachiocephalic v.
L. pulmonary v.v. L. axillary a. L. circumflex a. L. atrium L. ventricle Deep brachial a. L. brachial a. Superior ulnar collateral a. Inferior mesenteric a. L. radial a. Anterior interosseous a. L. external iliac a. L. internal iliac a. L. ulnar a. L. lateral circumflex a. Deep palmar arch Superficial palmar arch Radialis indicis a. Muscular branches Proper palmar digital a. Descending branch of lateral circumflex a. L. popliteal a. Genicular a.a. L. tibial recurrent a.
CIRCULATORY SYSTEM
L. lateral External circumflex jugular v. femoral v.v. Brachiocephalic a. Subclavian v. Cephalic v. Brachial v. Superior vena cava Pulmonary valve R. atrium Tricuspid valve R. ventricle Inferior vena cava Hepatic portal v. Superior mesenteric v. Superior mesenteric a. Basilic v. Median v. Cephalic v.
Superficial temporal a. & v. Facial a. & v. Deep femoral a. Vertebral a. R. superficial Common femoral a. carotid a. Subclavian a. Aortic arch Axillary a. Pulmonary a. L. atrium Mitral valve L. ventricle Brachial a. Celiac trunk Abdominal aorta Renal v. Renal a. Testicular a. Radial a. Ulnar a. External iliac a. Internal iliac a. Deep femoral v.
R. dorsal venous arch of foot R. dorsal digital v.v.
ARTERIAL SYSTEM
Superficial temporal a. Angularis Facial a. Mental a. R. common carotid a. R. vertebral a. R. subclavian a. Aortic arch Ascending aorta Aortic valve Mitral valve Descending thoracic aorta Splenic a. Common hepatic a. Superior mesenteric a. R. renal a. Abdominal aorta R. testicular (ovarian) a. R. common iliac a. Femoral a.
Internal jugular v.
R. intercapitular v.v.
a. = artery a.a. = arteries L. = left R. = right v. = vein v.v. = veins
Supratrochlear v. L. superficial temporal v. L. superior labial v.
External iliac v. Internal Palmar iliac v. venous network Femoral v. Great Frontal a. saphenous v. Anterior Genicular cerebral a. Circle of Willis v.v. Anterior Superficial tibial v. parietal a. Middle cerebral a. Posterior cerebral a. Superficial temporal a. Transverse facial a. Maxillary a. Great saphenous v. Basilar a. Angular a. Plantar Superior labial a. venous Inferior labial a. network Facial a. Internal carotid a. Dorsalis pedis a. External carotid a. Vertebral a. Common carotid a. Superior thyroid a. Thyrocervical trunk Brachiocephalic trunk Arch of aorta L. subclavian a.
L. anterior tibial a. Peroneal a. Lateral malleous a. Dorsalis pedis a. Lateral tarsal a. Arcuate a. Dorsal digital a.
Palmar a. anastomoses
L. lateral circumflex a.
Femoral a.
BLOOD CIRCUITS
Veins (Blood flows toward heart) Arteries (Blood flows away from heart)
Capillaries of head
Popliteal a. Genicular a.a. L. pulmonary v.v. R. pulmonary a. Superior vena cava R. pulmonary v.v. Recurrent tibial a.
Pulmonary a. R. atrium Anterior tibial a. R. ventricle Hepatic portal v. Hepatic a. Capillaries of liver Inferior vena cava Portal circulation Plantar a. anastomosis Renal v.v. Kidneys Internal iliac v. Femoral v. Capillaries of pelvis Capillaries of legs & feet
Capillaries of arms & hands Head, arm & hand a.a. Aortic arch L. pulmonary a.
Arch of aorta
Pulmonary capillaries L. atrium Descending thoracic aorta L. ventricle Celiac a. Gastric a. Stomach Splenic a. Spleen Gastric aorta Descending abdominal aorta Renal a.a. Superior mesenteric a. Inferior mesenteric a. Capillaries of colons Internal iliac a. Internal iliac a. Femoral a.
BRAIN & NECK Lateral orbitofrontal a. Ascending frontal a. Precentral a. Central a. Anterior parietal a. Posterior parietal a. Posterior pericallosal a. Angular a. Parieto-occipital a. Posterior temporal a.
CIRCLE OF WILLIS
Medial Frontal Branches: Posterior Middle Anterior Callosomarginal a. Frontopolar a. Pericallosal a. Anterior communicating a.
Anterior cerebral a.
Lenticulostriate a.
Temporal branch of the posterior cerebral a.
Lumen
Tunica adventitia Valve
Tunica adventitia Terminal arteriole Meta-arteriole
Postcapillary venule
Precapillary sphincters
Intercellular cleft
Basal lamina** Fenestrations
Tight junction Endothelial cell** Cell nucleus
Capillary bed Red blood cell
Blood flow
CORONARY ARTERIES & CARDIAC VEINS
L. coronary a.
Aortic valve
Branch to sinoatrial node
Oblique v. of L. atrium Great cardiac v. Circumflex branch of L. coronary a.
Anterior R. atrial branch of R. coronary a. Anterior cardiac v.v. R. coronary a. R. marginal branch of R. coronary a.
Vertebral a. External carotid a.
Anterior inferior cerebral a.
Transverse facial a. Internal carotid a. Facial a.
HEPATIC PORTAL VEINS
Tunica media
Tunica media
Occipitalis a. Posterior auricular a. Ascending pharyngeal a.
Vein
Subendothelial layer
Subendothelial layer Internal elastic lamina
Supratrochlear a.
Angular a.
Vertebral a.
Tunica intima: Endothelium
Tunica intima: Endothelium
Supraorbital a.
Maxillary a.
Superior cerebellar a.
BLOOD VESSELS Artery
Basilar a. Internal acoustic (labyrinthine) a.
Posterior cerebral a.
External carotid a. Common carotid a. Subclavian a. Vertebral a.
Deep temporal a.
Parietal branch of superficial temporal a. Frontal branch of Middle superficial temporal a. temporal a.
Infraorbital a.
Internal carotid a.
Internal carotid a.
Basilar a. L. middle cerebral a. Posterior cerebral a.
SKULL & ARTERIES
Precentral a.
Posterior communicating a.
Posterior communicating a.
Anterior temporal a.
Ascending frontal a.
Middle temporal a.
Central a. of retina Ophthalmic a. Anterior cerebral a.
Posterior temporal a.
Ophthalmic a.
Middle cerebral a.
Supraorbital a. Posterior ciliary a.
Middle temporal a.
Anterior communicating a.
Inferior vena cava R. gastric v. R. branch Liver (transparent) Portal v. Cystic v. Gallbladder Pancreaticoduodenal v.v. Pancreas R. colic flexure Duodenum Middle colic v. Superior mesenteric v. Inferior vena cava R. colic v. Ascending colon Ileocolic v.v. Cecal vv. Cecum Ileum Appendix Appendicular v. Common iliac v.v.
ARTERIES OF BRAIN Anterior cerebral a.
Descending palatine a. Superior labial a. Inferior labial a. Mentalis a. Inferior alveolar a. Submentalis a. Deep lingual a. Lingual a. Superior thyroid a. Hepatic v.v. Esophagus L. gastric v. L. branch Stomach (transparent) Spleen Splenic v. L. gastroepiploic v. Inferior mesenteric v. L. colic v.v. Inferior mesenteric v. Jejunal & ileal v. Descending colon Sigmoid v.v. Sigmoid colon Superior rectal v. Rectum Middle infraorbital a. Anterior communicating a.
Recurrent a. (of Heubner) Internal carotid a.
Lateral orbitofrontal a. Ascending frontal a.
Posterior communicating a.
Middle cerebral a. & branches
Anterior interventricular branch (L. anterior descending) of L. coronary a.
Middle & lateral lenticulostriate a.a.
Coronary sinus
Anterior choroidal a.
Internal acoustic (labyrinthine) a.
Superior cerebellar a.
Anterior inferior cerebellar a.
Posterior cerebral a. Pontine a.a.
Small cardiac v. Opening of coronary sinus
Posterior L. ventricular branch
Middle cardiac v. Posterior interventricular branch of R. coronary a. (posterior descending a.)
Edge of the transparent heart
NOTE TO STUDENT Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2004 BarCharts Inc. 0108
Customer Hotline: 1-800-230-9522
Posterior v. of L. ventricle
Basilar a. Anterior spinal a.
Vertebral a. Posterior spinal a.
Posterior inferior cerebellar a.
(Inferior view)
ISBN-13: 978-142320719-1 ISBN-10: 142320719-X
CREDITS
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WORLD’S #1 ACADEMIC OUTLINE
PERMANENT TEETH
** = cut Stria of Retzius a. = artery Fissure l.l. = ligaments Cusp Lateral incisor Tuft m. = muscle Enamel Cuspid (canine) n. = nerve n.n. = nerves Crown 1st bicuspid v. = vein (premolar) Contact area
Labial surface Central incisor
Cingulum Gum Distal surface
1st molar
Triangular ridge
2nd
Enamel prism Pulp horn Contour line of Owen Interdental papilla
Dentin Pulp
2nd bicuspid (premolar)
Interproximal surface
Pulpal vessels & n.n. Dentogingival fibers
Pulp chamber Neck
molar
Circular fibers Trans-septal fibers
Gingiva
Cusp
3rd molar
Dentinal tubules
Contingent surface
Cementum
Root
Oblique fibers of periodontium Root canal**
Interradicular septum
Buccal surface
3rd molar
Compact bone
2nd molar
Gingival margin
Mandible**
1st molar
Pulpal sensory n.
Cancellous bone
Apical foramen
2nd bicuspid
Mesial surface Gingival papilla Lingual surface Incisal edge
DECIDUOUS ARCH Labial surface Cingulum Dental tubercle
1st bicuspid MOUTH Cuspid Superior labial frenulum Lateral incisor Superior lip Central incisor Hard palate Gingiva Palatine raphe Palatopharyngeal arch Soft palate Central incisor Lateral incisor Cuspid 1st
Gum Interproximal surface Cusp
Apical fibers Alveolar n., a. & v.
MARGINAL GINGIVA
Palatoglossal arch
Enamel spindle
Stria of Retzius
molar
Gingival sulcus Oral sulcular epithelium Oral epithelium
Junctional epithelium
2nd molar
Collagen fibers in cross section
Neutrophilic granulocyte
Vessels of the gingival plexus
Lymphocyte Distal surface
Posterior wall of oropharynx
Buccal surface Gingival margin
Dentinal tubules Palatine tonsil Uvula
2nd molar
Mesial surface Lingual surface Incisal edge Central incisor
1st molar Cuspid Lateral incisor
TOOTH
Enamel spindle
Collagen fibers in long section
Periodontal l.l.
Marginal alveolar bone
Acellular cementum
Sharpey’s fibers
Tongue Gingiva Inferior labial frenulum
Vestibule Inferior lip
Facial View
Tomes granular layer Lingual View
Cusp of Carabelli
3rd molars
2nd molars
1st 2nd Cuspids 1st bicuspid bicuspid molars (premolars) (premolars) (canine)
Lateral incisors
Central incisors
Lateral incisors
PERMANENT TEETH
1st 2nd Cuspids 1st (canine) bicuspid bicuspid molars (premolars) (premolars)
2nd molars
3rd molars
TRIGEMINAL NERVE Middle superior alveolar n. Posterior superior alveolar n. Zygomatic n. Long & short ciliary n.n. Ciliary ganglion Pterygopalatine branches Nasociliary n. Lacrimal n. Frontal n. Tentorial branch Ophthalmic n. (V1)
PRE-ERUPTION
Infraorbital foramen
Permanent teeth:
Communicating branch
3rd molar (wisdom tooth) (not illustrated) 17-25 yr.
Zygomaticotemporal n.
2nd molar 12-13 yr. 1st molar 6-7 yr. 2nd bicuspid (premolar) 12-13 yr. 1st bicuspid (premolar) 11 yr. Cuspid (canine) 11 yr. Lateral incisor 8 yr. Central incisor 7 yr.
Zygomaticofacial n. Anterior superior alveolar n. Infraorbital n. Infraorbital foramen Dental branches
Maxillary n. (V2) Pons Trigeminal n. (V) Trigeminal (semilunar) ganglion Mandibular n. (V3) Foramen ovale Posterior division Medulla oblongata Auriculotemporal n. Anterior division Posterior deep temporal n. Lateral pterygoid n. Chorda tympani n. Buccal n. Anterior deep temporal n. Lingual n. Inferior alveolar n. Mylohyoid n. Mandibular foramen
Gingival branches Labial branches Mental branches
Mental foramen
1st molar 10-15 mo. Canine (eyetooth) 16-20 mo. Lateral incisor 8-10 mo. Central incisor 6-8 mo.
Mental n.
Inferior alveolar n. Inferior dental branches Inferior dental plexus Middle temporal a.
Inferior gingival branches Buccinator m.** Parotid gland Palatine glands
Parietal branch of superficial temporal a. Tongue
Frontal branch of superficial temporal a. Deep temporal a. Posterior superior alveolar a.
Posterior auricular a. Parotid duct
Uvula**
Deciduous teeth: 2nd molar 2 yr.
Infraorbital a.
Occipitalis a.
Supraorbital a.
Parotid gland
Supratrochlear a. Descending palatine a. Angular a.
Parotid duct
Anterior superior alveolar a.
Sublingual caruncle with opening of submandibular duct
Saliva
Infraorbital a. Maxillary a. Superior labial a.
Transverse facial a.
Dental branches Sublingual ducts Buccinator m.** Masseter m.** Anterior lingual glands
Sublingual gland
Inferior labial a.
Vertebral a.
Mentalis a. Inferior alveolar a.
Internal carotid a.
Deep lingual a.
Mylohyoid m.**
Salivary pool Submandibular duct
Ascending pharyngeal a.
Submandibular glands
External carotid a. Facial a.
Lingual a. Superior thyroid a. Mylohyoid branch
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NOTE TO STUDENT: Use this comprehensive QuickStudy ® study guide in the classroom, at home or anywhere you need complete information about the digestive system. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2004 BarCharts Inc. 0308
Submentalis a.
SKULL & ARTERIES ISBN-13: 978-142320721-4 ISBN-10: 142320721-1
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EMERGENCY NUMBERS EMERGENCY RESCUE - 911 or ______________________________ DOCTOR ________________________ POISON CONTROL_______________ POLICE_________________________ FIRE____________________________
HOW TO CALL FOR HELP Stay calm. Getting hysterical often panics the victim, hinders communication with emergency medical personnel and causes even more harm and delay
When calling for help, give: • Precise location, address and telephone number from where you are calling; if the address is unknown, look around for landmarks, businesses or cross streets • The nature of the emergency or injury • The number of people involved • Your name • Ages and gender of victims involved
WORLD’S #1 QUICK REFERENCE GUIDE
COMMON AILMENTS Foreign Matter in Eye Symptoms:
• Irritation, redness, pain • Unable to open eye • Visual problems Treatment:
• Flush eye with water or use eye wash kit • Examine eye to see if matter is removable • CAREFULLY remove with corner of a folded tissue; if unable to remove, seek medical advice • If irritation persists or eye is encrusted with yellow drainage, seek medical advice • If severe pain, inability to open eye, or visual problems exist, go to E.R.
Black Eye • Apply a cold compress to reduce swelling and pain • If pain persists, or visual problems develop, go to E.R.
Nosebleeds • Sit upright, leaning slightly forward • Pinch nostrils for 5 to 10 minutes • Do NOT blow your nose • If bleeding continues, apply ice pack to bridge of nose or back of neck, or apply pressure to upper lip
Earache • Hold a hot water bottle or heating pad on ear • Control pain with over-the-counter medication • Consult physician if pain persists, is severe or accompanied by fever
Toothache • Rinse mouth with warm salt water to remove any food debris • Take over-the-counter medication for pain • Apply ice pack to face • Do not place aspirin directly on the tooth • A topical anesthetic may be applied for temporary relief • See the dentist as soon as possible
Loss of Permanent Tooth • Rinse tooth gently, do NOT hold by root end • Try to reinsert the tooth into socket • If you cannot reinsert the tooth, place in a container of milk • See dentist or E.R. WITHIN ONE HOUR
LYME DISEASE BROKEN/ DISLOCATED BONES & FRACTURES Treatment:
• Seek medical attention • If victim must be moved, immobilize the injured area first • If an arm or leg is involved, splint the part in the position in which it was found before moving the victim; do not attempt to straighten the limb • Use folded blankets or towels around the area to aid immobilization • If it is an open fracture (one where the bone breaks through the skin), control bleeding (see “Bleeding Wounds,” page 2)
Symptoms (caused by the bite from a deer tick): • Red, bull’s-eye-shaped rash that increases in diameter daily around bite • Chills • Dizziness • Fatigue
• Fever • Muscle and joint pain • Nausea • Severe headache • Stiff neck Treatment:
• If suspected, seek medical attention; there is no effective home remedy
QUICK TIPS • Substitute a bag of frozen vegetables for an ice pack • Put ice in a resealable bag and wrap in paper towel or cloth • Do not use cotton on an open wound • Always have hydrogen peroxide on 1
hand for minor cuts and scrapes • If wound is really dirty, pour or dab on hydrogen peroxide; avoid squirting directly into wound • Keep ipecac syrup to induce vomiting if recommended by poison control
WOUNDS
SHOCK
Cut, Puncture, Scrape, Abrasion Treatment:
• Stop bleeding by applying pressure • Clean area thoroughly with antiseptic or warm, soapy water • Apply antibiotic ointment and bandage • With a puncture wound, or wound inflicted by a rusty/dirty item, seek medical care within 24 hrs., as antibiotics/tetanus shot may be required • If the cut is on an extremity, hold above heart level to stop bleeding • If there are signs of infection, redness, swelling, yellow discharge, increased pain or fever, see your physician • If wound is deep, long, or gapes open, see your physician or go to E.R.
Bleeding Wounds When dealing with a severely bleeding wound or amputation, if you have to leave the victim to seek help, first get the bleeding under control • Call rescue - if blood is bright red, there may be an artery involved; be sure to tell the operator • Have victim lie down, preferably with head slightly lowered to prevent fainting • If wound is on an extremity, raise above heart level • Cut away clothing and apply pressure with a clean, absorbent cloth
If unavailable, apply pressure with hand • Maintain pressure for 10 minutes, do NOT remove original bandage; if it becomes blood-soaked, apply another bandage over it • If bleeding cannot be controlled, apply pressure to a point above the wound • If internal organs are exposed, apply wet, clean cloth with gentle pressure • Attempt to control bleeding with pressure until medical personnel arrive • A tourniquet is not recommended
Penetrating Objects • Call rescue • Do NOT remove any penetrating or foreign objects • Apply sufficient bandages to immobilize the object and support its position in the wound
SPRAINS & STRAINS Symptoms:
• Severe pain • Bruising, swelling and heat • Unable to move injured part Treatment:
• Rest affected limb • Ice on and off for 48 hrs. • Compress with elastic bandage • Elevate affected limb
Shock due to Injury Symptoms:
• Weakness and cold, clammy skin with pale or bluish tinge • Rapid, shallow breathing • Faint and/or rapid pulse • Restlessness, confusion or agitation • Nausea and sweating Treatment:
• Call for medical assistance • Lay victim down, tilt head to one side • Loosen clothing; keep victim warm • Control any bleeding • Keep victim calm and quiet • Do not administer liquid; moisten lips if necessary • Elevate legs if there are no suspected hip, leg, head, neck or back injuries
Allergic Reaction & Anaphylactic Shock Symptoms:
• Sudden appearance of hives that are widespread and itching • Swelling of the lips, tongue and mouth (may feel itchy) • Wheezing or difficulty breathing • Nausea, vomiting or cramps • Lightheadedness Treatment:
• Call rescue to determine severity of reaction • If available, take recommended dose of oral antihistamine • If food-related, brush teeth to prevent ingesting more allergen
BURNS & SCALDS Note: Any burn to the face, hands, feet, mouth or groin needs immediate medical attention.
First-degree burn: A minor burn, affecting only the top layers of skin Symptoms:
• Redness and pain Treatment:
• Run under cold water or apply a cold, wet cloth off and on for 24 hrs. • Do not rub or apply butter or petroleum-based products • Keep clean to prevent infection
Second-degree burn: Affects the underlying layers of skin as well as outer layers Symptoms: • Redness, pain, swelling and blisters
Treatment:
Treatment:
• Immediately immerse affected area in cold water or apply cold, wet compresses • Cover the area loosely with clean gauze or cloth • Do not apply butter or petroleum-based products or sprays • Do NOT break blisters; if blisters open, keep dressing on area • If a large area is affected, or if burn starts draining, seek medical attention
Third-degree burn: Destroys all the layers of skin and nerves Symptoms: • Skin may be white or black in appearance • Can be extremely painful, or completely painless if there is nerve damage • Underlying tissue and/or muscle may be exposed 2
• Call rescue • Lightly cover area with a sheet or sterile gauze (do not secure with tape) • If breathing has stopped, begin CPR
Fire If clothing is on fire, smother flames with a blanket, coat, etc; do not remove clothing stuck to skin
Sunburn • Take cool baths or apply wet, cool compresses • Apply aloe or lotion to sooth skin • Take over-the-counter pain medication for fever, chills or pain • Do NOT use butter or petroleumbased products • Do NOT break blisters • For severe sunburn, with severe pain, swelling or large blistered area, go to E.R.
DRUG OVERDOSE Symptoms:
• Abnormal pupil size or pupils nonreactive (they do not contract when a light is shined on them) •Agitation • Confusion/hallucinations • Difficulty breathing • Drowsiness • Nausea • Paranoia • Staggering • Sweating • Unconsciousness • Violent behavior • Vomiting
Treatment:
Treatment:
• Take victim to E.R. or call rescue • Do not try to reason with the victim • Do not try to restrain the victim if you are going to jeopardize your own safety; call police • If breathing has stopped, begin CPR
Alcohol Poisoning Symptoms: • Seizures • Slurred speech • Stumbling, staggering • Unconsciousness • Violent behavior • Vomiting
FOOD POISONING
CONVULSIONS
Symptoms:
Symptoms:
• Severe stomach cramps • Nausea and vomiting • Weakness • Diarrhea within a few hours of eating • Stomach flu-like symptoms, fever Treatment:
• Identify the source of the poisoning if possible; if it is from mushrooms or canned food, seek medical assistance immediately • For minor food poisoning, the symptoms will eventually subside; vomiting can provide relief • Call rescue if there are signs of paralysis, difficulty breathing, difficulty speaking or swallowing, if pain is severe, if there is blood in the vomit or stool, or the stomach is distended
INTERNAL BLEEDING Symptoms: Not always apparent, but any number of the following symptoms may be present:
• Tender, swollen, bruised areas • Vomiting/coughing up blood • Bleeding from the rectum or vagina •Light-headedness, shallow breathing •Dilated pupils •Abdominal swelling or hardness •Cold, clammy skin • Color blue or pale Treatment: Have victim lie quietly; keep him/her warm and seek medical attention immediately
• Blackout, fainting or confused behavior • Drooling • Twitching and thrashing • Loss of bladder control • Vigorous muscle spasms Treatment:
• Call rescue • Do not restrain the victim • Do not put anything in the victim’s mouth • Do not move the victim; unless necessary • If a child is convulsing from high fever, cool body slowly with cool, wet compresses; DO NOT immerse the child in the tub Until help arrives, note whether: • The victim is having multiple seizures or they last longer than 2 minutes • Victim can be awakened between seizures • The victim has health problems such as diabetes, high blood pressure or alcoholism
• Call rescue While waiting: • Stay with the victim • Try to put the victim to bed; prop victim on side in case vomiting occurs; this will prevent aspiration of the vomit (vomit gets into lungs, causing suffocation) • Check on the victim frequently • If person is violent, call police • If coherent, try to give sports drinks to increase electrolyte levels • Watch for seizures
HEART ATTACK Symptoms:
• Pain in middle of chest, behind breastbone • Pain in the arm, shoulder and/or back • Feeling of severe indigestion • Tightness/crushing feeling in chest • Short, fast or noisy breathing • Tightening or pain in jaw • Sweating/nausea • Victim pale or bluish in color Treatment:
• Call rescue - don’t wait for symptoms to pass • Keep victim as calm as possible • Do not leave the victim alone • Do not take anything by mouth, unless it’s a prescribed heart medication • If breathing stops, begin CPR
LOSS OF A BODY PART
STROKE
Treatment:
Symptoms:
• Call rescue • Victim and extremity must get to hospital immediately • Apply pressure to wound with a clean cloth to control bleeding (see “Bleeding Wounds,” page 2) • Elevate area above heart level, if possible • Lay victim flat and keep warm to prevent shock • Wrap severed body part in clean cloth and place in plastic bag; immerse in ice water; if not available, keep as cool as possible • Do not put extremity directly on ice 3
• Sudden numbness or weakness in face, arm or leg, especially on one side of the body confusion, trouble • Sudden speaking or understanding • Blurred vision or trouble seeing • Dizziness, loss of balance or coordination • Sudden trouble walking • Severe headache with no known cause Treatment:
• Call rescue immediately and monitor condition until help arrives
THE ELEMENTS Heat exhaustion Symptoms:
If symptoms are severe, call for medical attention immediately • Dizziness, weakness, nausea, headache and vomiting • Cool, moist, pale or flushed skin • Profuse sweating • Feeling thirsty and hot • Muscle cramps Treatment:
• Drink plenty of fluids, especially sports drinks • Move to a cool area
Heat stroke Symptoms:
• Sweating has stopped • Body temperature rises rapidly • Not aware of thirst or heat • Confused, delirious, irrational behavior • May lose consciousness or have convulsions • Red, hot, dry skin • Muscle cramps
• Dilated pupils • Shallow breathing • Rapid, weak pulse Treatment:
• Seek medical attention immediately • Get to a cool place • Cool skin with cold, wet cloths or cold water • Apply to armpit, neck and groin areas • Elevate feet • Give sips of water or sports drinks
Frost Bite Symptoms:
• Numbness or insensitivity in the suspected area • Discolored skin • Waxy appearance to the skin • Pain or discomfort • Skin is cold to the touch Treatment:
• Soak in warm water, approximately 100-105 degrees – NO warmer • Do not let the body part touch the container holding the water
POISONING Swallowed Household chemicals, medications and pesticides Symptoms:
• Soak until the area is red and feels warm • Bandage the area with a soft cloth or gauze; gently put cotton inbetween fingers and toes • Seek medical help
Hypothermia (exposure to the cold) Symptoms:
• Decreased levels of consciousness • Glassy stare • Numbness • Rigid muscles • Shivering • Slow, erratic pulse • Slurred speech Treatment:
• Call for medical assistance immediately • Remove wet clothing; warm victim • Have victim lie down • Give warm drinks - not with alcohol or caffeine • DO NOT immerse the victim in water • Handle the victim very gently
CARBON MONOXIDE POISONING
Inhaled • Call rescue • Move victim to fresh air • If not breathing, start CPR; take precautions to avoid poisoning from residue on the victim’s lips or face; use a pocket mask for additional protection, if available
• Burns on mouth and lips or unusual breath odor • Unexplained stains and odor on clothing Common poisonous household • Nausea and vomiting chemicals – keep where chil• Difficulty breathing or coughing dren cannot get to them! • Disoriented behavior • Air conditioning refrigerant • Acetaminophen • Drooling • All medications and drugs • Abdominal pain • Ammonia and window cleaner • Excessive sleeplessness • Anti-freeze • Dizziness or double vision • Bleach • Heart palpitations • Drain opener • Weakness • Fabric softener Treatment: • Fertilizer • Furniture polish • Locate the source of poisoning • Call poison control center and res- • Gasoline • Hair treatments cue immediately • Laundry and dish detergents • Keep victim calm • Keep a supply of ipecac syrup on • Lighter fluid • Moth balls hand, especially with children, if • Paint thinner instructed to induce vomiting • Plant food • Read the poison source label, if • Rubbing alcohol available, for further instructions • Turpentine • Remove soiled clothing • Vitamins 4
Carbon monoxide is an odorless, colorless, potentially deadly gas that may be present: • When a car is left running in a poorly ventilated room • When a car’s exhaust system is blocked • As a byproduct of manufacturing or industry • In or around burning buildings • When a gas-powered heating unit malfunctions Symptoms: • Severe headache • Lethargy • Disorientation • Agitation • Coma • Unconsciousness Treatment: Be sure area is well-ventilated before rescue; it may only take moments to be overcome if sufficient fumes remain • Call rescue • Get the victim into open, fresh air immediately • Check for pulse and breathing; administer CPR if necessary • If there is a pulse, but the victim is not breathing, start mouth-tomouth resuscitation
INSECTS, SNAKES, SPIDERS & SEA CREATURES Bee & Wasp Stings
Spider Bites
Difficulty breathing, headache or coughing, could be signs of allergic reaction; seek medical attention immediately (see “Anaphylactic Shock,” page 2) Symptoms: • Red, swollen, painful area with a small point of entry in the center Treatment: • Remove the stinger by scraping skin with a credit card or cardboard edge; do not use tweezers; they can inject more venom into the skin • Wash area with soap and water • Apply ice pack • Apply calamine lotion or use a paste of baking soda and water, or over-thecounter 1% hydrocortisone cream
Snake Bites Take a good look at the snake, if possible - you may need to provide a description Symptoms: • Sharp pain • Swelling • Weakness • Shortness of breath • Vomiting • Dizziness Scarlet King Snake • Blurred vision Treatment:
• Call rescue • Have the victim lie quietly, keeping the bitten area below heart level to slow the blood flow to the heart • Clean the area - wipe AWAY from the bite to prevent more venom from entering the wound • Do NOT cut the bite or try to suck out the venom • Do not apply ice
• Spiders are found in dark areas, such as under furniture, woodpiles, in shoes, barns, basements, etc. • If possible, bring the spider or the remains of the spider with you to the physician for identification Both the black widow and brown recluse spider bites need to be attended to immediately by a medical professional
Treatment:
• Gently pick off any tentacles, using gloves or edge of credit card • Rinse the area with salt or fresh water or soak with vinegar • 1% hydrocortisone cream may be used on affected area • If rash or pain persists, seek medical advice
Animal Bite
Black Widow Symptoms:
•A b d o m i n a l pain • Pain in muscles • Pain in soles of feet • Swollen eyelids • Excessive sweating • Bite looks like a small pin prick • Dull, numbing pain • Headache • Shortness of breath • Tightness in chest Brown Recluse Spider Symptoms: • Bite appears as an ulcer circled by a red ring • Stinging sensation • Weakness • Fever • Joint Pain • Nausea • Shock Treatment: • Wash area with soap and water • Apply a cold compress
Man-o-war (Jellyfish) Sting Symptoms:
• Sudden severe stinging sensation when swimming in ocean water • Tentacles stuck to the skin
• Wash carefully with soap and water • Apply an antiseptic, such as hydrogen peroxide • Apply antibiotic cream and bandage • Rabies is always a concern with any animal bite; be sure to notify animal control so the animal may be captured (if necessary), tested for rabies, and quarantined • Seek medical attention immediately • If bite is severe, try to stop the bleeding (see “Bleeding Wounds,” page 2) and call rescue
Fire Ants (only in southern states): Symptoms:
• Itchy, stinging rash • Blisters Treatment:
• Apply ice pack to bites to relieve pain and swelling • 1% hydrocortisone cream can be applied to relieve itching • If an allergic reaction occurs, or if large areas are bitten, seek medical attention
PLANTS - POISON IVY, OAK & SUMAC • Rash in the pattern of streaks or patches • Pimples or blisters Treatment:
Poison Ivy
Poison Oak
Poison Sumac
Symptoms:
• Redness of skin and extreme itching
• Wash exposed skin immediately with soap and water • Clean under fingernails to prevent spreading • Remove and wash clothes and clean shoes of victim to prevent spreading 5
• Apply cool compresses • Apply anti-itch medication (calamine lotion/1% hydrocortisone cream) • Consult physician if rash persists, itching can’t be controlled, rash is on face, eyes or genitals, and/or rash has pus or odor • Seek medical help if there is swelling or difficulty breathing
HYPERVENTILATION
HEAD, NECK & BACK INJURY If injury is suspected, DO NOT move victim unless absolutely necessary Symptoms: • Head, neck or back are in an odd position • Paralysis • Unable to move fingers and/or toes • Numbness in any part of the body Treatment: • Call rescue • If there is head injury, assume there is neck injury • Keep victim as still as possible
• Immobilize the head and neck carefully with rolled towels or clothing tucked around the sides of the neck and head • If CPR needs to be performed, do not move the head or neck; instead, pull the lower jaw forward • If the victim must be moved to avoid further injury, hold the head, neck and shoulders absolutely still when moving; several people should assist if available; use a board, door or other rigid, flat object to transport the victim to safety
CHOKING MANEUVER For Conscious Child or Adult Symptoms:
• If airway is completely blocked, victim may not be able to breathe, cough or speak; ask him/her if he/she is choking, a nod or “yes” gesture will confirm
• Use quick presses of the fist in 5 upward thrusts • Repeat until obstruction is coughed up, or victim begins breathing
For Unconscious Child or Adult • Have someone call rescue • Straddle prone victim, as shown • Place heels of hands against victim’s abdomen, below rib cage, just above the navel • Use quick presses of the hand in 5 upward thrusts; repeat if necessary • If object is visible in mouth, sweep object out with hooked finger
Treatment:
• Stand behind victim with arms wrapped around waist, as shown • Lock hands into a fist • Place the thumb side of fist against victim’s abdomen, below rib cage, just above the navel
Treatment:
• Call rescue
• Deep, rapid, irregular breathing • The feeling of loss of control of breathing Treatment:
• Calm the person; ask him/her to concentrate on taking slow, deep breaths • If this is not effective, call rescue
CONCUSSION Symptoms (caused by a blow to the head): • Severe headache • Dizziness • Sudden urge to sleep • Vomiting • Increased size of one pupil • Restless, agitation, irritability Treatment:
• Monitor levels of consciousness • Do not allow victim to fall asleep • Call rescue or bring victim to E.R.
FAINTING Symptoms that fainting is about to occur: • Sensation of dizziness, weakness, cold sweats, rapid pulse To prevent onset: • Have victim sit down and place head between knees or lie down If victim faints: • Raise feet 12 to 15 inches • Apply wet, cool, cloth to forehead • If consciousness does not return within 8 minutes, call rescue US $5.95
ELECTROCUTION • NEVER touch a victim of electric shock until the source of electricity has been separated from victim, turned off, or proper precautions have been taken • Shut off fuse box or unplug the source of electricity
Symptoms:
• If victim is not breathing, administer CPR until medical help arrives • With lightening strikes, begin CPR immediately, if necessary (electricity has already passed through the body) • When breathing has started, elevate victim’s feet and keep him/her warm to avoid shock
ISBN-13: 978-142320726-9 ISBN-10: 142320726-2
All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2002, 2003 BarCharts, Inc. 0508
This guide was compiled, written and edited by a consortium consisting of 2 EMT's, a nurse practitioner and a certified first aid instructor.
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WORLD’S #1 ACADEMIC OUTLINE
Basic Concepts A. Organismal Reproduction 1. One of the most important requisites of all life, from the earliest life forms to present-day organisms, is reproduction 2. Characteristics or traits of organisms must be passed on during reproduction B. Cellular Reproduction 1. Life as we know it is based on the cell, the basic unit of life 2. Cell theory states all organisms are made up of cells and come from cells C. DNA 1. DNA (deoxyribonucleic acid) is the molecule of inheritance in ALL cellular forms of life D. Chromosomes 1. Eukaryotic cells possess nuclear DNA with structural and enzymatic proteins, forming chromatin, which is visible as chromosomes during parts of the cell cycle 2. Prokaryotic cells possess simpler DNA 3. Sexually reproducing organisms typically have pairs of homologous chromosomes (look-alike chromosomes) E. RNA 1. RNA (ribonucleic acid) is found in several forms, most of which are used in protein synthesis 2. RNA is the molecule of inheritance in some viruses, which are not cell-based life forms F. Genes 1. Functional unit of inheritance and basis for most traits 2. Located at loci, or specific positions, on DNA; to be preserved and transmitted 3. Control biological processes through production of proteins and RNA
4. Genotype refers to the genetic composition of the organism 5. Phenotype refers to the observable inherited traits (e.g., physical, behavioral, physiological characteristics); based on the inherited genotype
Genes Form Basis of Inheritance Nucleus B A T
A
G
C
A
C
D
T
T
A
C
G
Gene
G. Ploidy 1. Homologous chromosome pairs have the same loci, thus genes 2. When both chromosomes are present, for each gene there are two representatives; this is represented by the symbol 2n or diploid condition 3. When only half of each homologous chromosome pair is present, such as in gametes, this is represented by the symbol n or haploid H. Alleles 1. Alternate forms of the same gene that could occupy the same locus (e.g., brown versus blue eye color)
chromosomes possess two 2. Homologous representatives of each gene (i.e., 2n) 3. Homozygous refers to the diploid condition where both alleles of the genotype are identical (e.g., AA, aa) 4. Heterozygous refers to the diploid condition where both alleles of the genotype are different (i.e., Aa) 5. Dominant alleles form a phenotypic expression regardless of the other allele on the matched chromosome of the homologue (e.g., “AA” or “Aa” genotypes will both express the phenotype designated by the “A” allele) 6. Recessive alleles fail to form a phenotypic expression unless the other allele on the matched chromosome is also recessive (e.g., “aa” genotype is the only way for the phenotype designated by the “a” allele to be expressed, assuming no other gene pairs influence inheritance [see epistasis discussion in Gene Action Categories, page 2]) 7. Additional types of allelic interactions will be discussed in subsequent sections 8. Determining gamete types: Assuming there are no mutations, alleles present in gametes are determined by the diploid genotypes of parents a. For homozygous genotypes, haploid gametes will be identical for the given traits (i.e., AA individual would produce “A” gametes only; AAbb individual would produce “Ab” gametes only) b. For heterozygous genotypes, haploid gametes will be different for the given traits (i.e., Aa individual would produce “A” & “a” gametes; AaBb individual would produce “AB, Ab, aB, ab” gametes— assuming two traits are unlinked [see Independent Assortment & Dihybrid Crosses, page 2])
Mendelian Genetics A. Gregor Mendel (1822–1884) 1. An Austrian monk who, through his love and interest in nature, developed the basic ideas of genetics long before chromosomes and genes (i.e., molecular biology) were discovered a. He developed his ideas by studying plants; in particular, his most famous work involved crosses with pea plant varieties 2. His results and interpretations contrasted with a prevailing (at that time) theme of inheritance called “blending”—the concept that inherited traits mixed to create a in composite characteristic offspring B. Mendel’s Genetics Laws 1. Segregation of Alternate Factors & Monohybrid Crosses a. Specifically, Mendel discovered that with certain traits, there were individual plants which, if only crossed with other plants just like them, would almost always produce the exact same phenotype
b.
c.
d.
e.
f. g. h.
i. j. k.
i. These individuals were called true-breeders ii. We now call this condition homozygous He also found that some individuals with similar appearance, when crossed, would not have all offspring of the same kind i. We now call this condition heterozygous Mendel decided to systematically do single-trait crosses to determine the causes for the previously stated observations Specifically, a parental generation (P) initiated these experimental crosses by using two truebreeding pea plants for opposite phenotypes (e.g., purple versus white flowers) Offspring from this cross (F1) all showed only one of the traits (e.g., purple flowers), and this trait was called the dominant trait Traits from the P generation “did not blend” in these F1 individuals F1 individuals, the hybrids, were cross-pollinated— the monohybrid cross—to produce F2 individuals 3/4 of the F2 individuals expressed the dominant trait, while 1/4 expressed the trait of the other P parent (e.g., white) that had not been expressed in the F1 generation—this latter trait was the recessive form The expected phenotypic ratio of the F2 individuals in monohybrid crosses would be 3:1 The expected genotypic ratio of the F2 individuals in monohybrid crosses would be 2:1:1 The diagram at right, called a Punnett square, summarizes results of a single-trait cross similar to those done by Mendel on pea plants and other organisms: 1
Mendel’s 1st Law: Segregation of Alternate Factors Normal male (gg)
Gray female (GG) P generation Gametes produced by P generation F1 generation
g
G
All Gg Dominant G masks recessive g Gametes produced G g by F1 generation G
All Gg g
GG
Gg
Gg
gg
F2 G e n e r a t i o n
l. Mendel concluded there had to be some physical entities or “factors” passed on by each parent of a cross i. We now know these to be genes ii. He also concluded that these factors came in pairs, which then became unpaired (in the production of gametes, which occurs during meiosis) and recombined during fertilization iii. The two P generation individuals had the factors in alternate forms called alleles (e.g., purple versus white flowers)
Mendelian Genetics (continued )
iv. Each of these true-breeding parent plants had a pair of identical factors, but their gametes had only one v. Thus, F1 individuals were hybrids genotypically, but only expressed the dominant phenotype m. Monohybrid Cross: Once Mendel realized the F1 individuals were genotypic “hybrids,” he predicted the recessive trait that “disappeared” would reappear if: i. F1 hybrid individuals were crossed to produce F2 offspring ii. The results summarized in “h” above confirmed his predictions 2. Independent Assortment & Dihybrid Crosses a. Mendel continued his crossing experiments by looking at multiple traits simultaneously b. P generation, consisting of two true-breeding parents of different forms (phenotypes) for two traits, were crossed, producing F1 individuals c. The F1 genotypic hybrids for both traits were crossed—the dihybrid cross—producing F2 individuals d. 9/16 of the F2 individuals expressed both dominant traits; 3/16 expressed 1 dominant trait, and 1 recessive trait; 3/16 expressed the opposite dominant trait, and the opposite recessive trait; 1/16 expressed both recessive traits e. The expected phenotypic ratio of the F2 individuals in dihybrid crosses would be 9:3:3:1 f. The expected genotypic ratio of the F2 individuals in dihybrid crosses would be 1:1:1:1:2:2:2:2:4—a total of 9 genotypes g. The following Punnett square summarizes results of two-trait crosses, similar to those done by Mendel:
Mendel’s 2nd Law: Independent Assortment Gray, short-haired P generation
Normal, long-haired Parents ggss
GGSS Gametes produced by P generation
GS
F1 generation
gs
All GgSs Gametes form by segregation of alleles & individual assortment gs gS Gs GS
All GgSs
GS
GG SS Gray, short
GG Ss Gray, short
Gs
GG Ss Gray, short
GG ss Gray, long
Gg SS Gray, short Gg Ss Gray, short
Gg Ss Gray, short Gg ss Gray, long
gS gs
Gg SS Gray, short
Gg Ss Gray, short
Gg Ss Gray, short
Gg ss Gray, long
F2
G e n e r gg SS gg Ss a Normal, Normal, t short short i o gg Ss gg ss n Normal, Normal, short long
F2 phenotypes 9
Gray, short-haired
Gray, long-haired
3
Normal, short-haired
Normal, long-haired
h. Mendel concluded statistically that these results occurred because the alleles for one trait did not affect the inheritance of alleles for the other trait, which is independent assortment i. Special note: Mendel did not observe independent assortment for all traits studied [see Mendel’s Ratios & Beyond, “C” on this page, for more about gene linkage] 3. Trihybrid Crosses & Beyond
a. Tracking three or more traits simultaneously is possible; the following summarizes such crosses: P = AABBCC x aabbcc (true breeders crossed) F1 = AaBbCc x AaBbCc (trihybrid individuals crossed) F2 = 27:9:9:9:3:3:3:1 (phenotypic ratio) b. The following Punnett square summarizes results of Mendel’s three-trait crosses—specifically, the F2 individuals produced from the F1 trihybrid individuals: Trihybrid Cross ABC
ABc
AbC
Abc
aBC
aBc
abC
abc
ABC AABBCC
AABBCc
AABbCC
AABbCc
AaBBCC
AaBBCc
AaBbCC
AaBbCc
ABc
AABBCc
AABBcc
AABbCc
AABbcc
AaBBCc
AaBBcc
AaBbCc
AaBbcc
AbC
AABbCC
AABbCc
AAbbCC
AAbbCc
AaBbCC
AaBbCc
AabbCC
AabbCc
Abc
AABbCc
AABbcc
AAbbCc
AAbbcc
AaBbCc
AaBbcc
AabbCc
Aabbcc
aBC
AaBBCC
AaBBCc
AaBbCC
AaBbCc
aaBBCC
aaBBCc
aaBbCC
aaBbCc
aBc
AaBBCc
AaBBcc
AaBbCc
AaBbcc
aaBBCc
aaBBcc
aaBbCc
aaBbcc
abC
AaBbCC
AaBbCc
AabbCC
AabbCc
aaBbCC
aaBbCc
aabbCC
aabbCc
abc
AaBbCc
AaBbcc
AabbCc
Aabbcc
aaBbCc
aaBbcc
aabbCc
aabbcc
3. The following diagram summarizes many types of gene c. Probability rules can be used to calculate actions, each of which will be discussed in greater detail in genotypes and phenotypes, in place of the sections that follow using Punnett squares (especially useful in multiple-trait crosses) i. Addition Rule: The occurrence of Gene Actions Parental Dominance mutually exclusive events equals the Genotypes I Incomplete Dominance sum of their individual probabilities; Parental Codominance that is, calculate probabilities n Phenotypes Pleiotropy associated with the dominant and h Paired gene (factor) Multiple Alleles e alleles are segregated & recessive alleles as demonstrated in a Monogenic vs. r independently sorted monohybrid cross: Polygenic Inheritance 1 1 1 i during meiosis, • AA = /4 , Aa = /2 , aa = /4 Epistasis t producing gametes that • For example, in a monohybrid Sex Determination combine to form a cross, the chance of a dominant Linked vs. Unlinked Genes Progeny offspring phenotype is equal to 1/4 (AA) + n Sex-Linked Traits Phenotypes 1/ 2 (Aa) = 3/ 4 c Autosomal Linkage Sex-Influenced Traits e Progeny ii. Multiplication Rule: The probability Sex-Limited Traits of independent events occurring Genotypes Environmental Interactions simultaneously is equal to the product of their individual probabilities • For example, the probability of being D. Gene Action Categories a. Dominance: One allele dominates or masks the effects AABbcc = (1/4) x (1/2) x (1/4) = 1/32 of the other allele(s) OR 2/64 [see Punnett square above] b. Incomplete Dominance: Neither allele is expressed fully; in such cases, phenotypes are “blended” d. Branch (Fork) Diagrams are alternatives to c. Codominance: Both alleles are expressed fully (NOTE: Punnett squares; multiplication rule used to It is frequently difficult to distinguish this pattern from calculate genotypic and phenotypic ratios incomplete dominance) e. Additional mathematical relationships d. Pleiotropy: One gene affects several phenotypes associated with multiple-trait crosses e. Multiple Alleles: Three or more alleles for a gene are i. n = number of heterozygous gene pairs present within a population (although diploid individuals ii. 2n = number of different gametes formed can only have two at a time) iii. 3n =number of different genotypes f. Monogenic versus Polygenic Inheritance: Traits based formed on a single gene versus traits based on multiple genes iv. 2n =number of different phenotypes g. Epistasis: One gene alters the effect of another gene formed h. Sex Determination: For many organisms, special 4. Back Cross: A cross of an F1 individual (Aa) chromosomes have genes that determine gender; in with either of the two P generation individuals some, such as sea turtles and alligators, environmental (AA or aa) factors, such as the temperature at which eggs develop, 5. Test Cross: A cross of an individual having a determine gender dominant phenotype (but unknown genotype— i. Linked versus Unlinked Genes: Genes on the same e.g., AA or Aa) with an individual that is chromosome are linked; genes on different homozygous recessive (aa) chromosomes are unlinked and assort independently a. If the recessive phenotype shows up in i. Gene Mapping: Recombinant progeny (involving approximately half of the offspring, the crosses) can be used in some organisms to map gene unknown genotype is determined to be a loci; molecular techniques are used for many species, heterozygote including humans (e.g., Human Genome Project C. Mendel’s Ratios & Beyond [also see structural genomics discussion in 1. Mendel’s work paved the way for the most Molecular Genetics, page 5]) basic understanding of inheritance; however, j. Sex Linkage: In humans, genes found on the X or Y future discoveries revealed that many traits chromosomes (e.g., color blindness) are inherited in ways much more complex k. Autosomal Linkage: Multiple genes found on non-sex than those demonstrated in the basic chromosomes monohybrid and dihybrid crosses l. Sex-Influenced Traits: Same genotype expressed 2. Thus, 3:1 and 9:3:3:1 phenotypic ratios are differently in males versus females (e.g., baldness in uncommon in nature humans) 2
m. Sex-Limited Traits: Same genotype expressed only in one sex; suppressed in the opposite sex (e.g., beard development and breast development in humans) n. Chromosomal Non-Disjunctions: During meiosis, chromatids and/or homologous chromosomes may fail to separate, triggering alterations in phenotypic expressions of genotypes i. Aneuploidy: Abnormal number (too few/too many; missing pieces/extra pieces) of chromosomes o. Polyploidy: Presence of more than two sets of chromosomes (e.g., 3n = triploid) p. Environmental Effects: Phenotypes that are affected by non-genetic, environmental factors (e.g., differential pigment development in Siamese cats) based on temperature; cooler body areas have heavier melanin deposition [see sex determination, item “h” in this list] E. Human Genetics 1. We know more about the genetics of many organisms than that of humans, mostly because there are fewer ethical issues and shorter generation times for non-human organisms 2. The Human Genome Project has helped in the discovery of genes and their functions through molecular studies [see Molecular Genetics section, page 5] 3. The inheritance patterns of some human traits have been worked out (using mostly Mendelian Genetics) and are summarized in the table that follows: Human Traits & Known Inheritance Patterns Name of Trait
Phenotypes
Mode of Inheritance
ABO Blood Groups
Type A, B, AB, O
Autosomal Codominant – Multiple Alleles: Type A = AA or IAIA; AO or IAi Type B = BB or IB IB; BO or IBi Type AB = AB or IA IB Type O = OO or ii
Achondroplasia
Dwarfism
Autosomal Dominant: Aa = dwarf, aa = normal (AA is lethal)
Albinism
Lack of pigmentation in eyes, hair, Autosomal Recessive: A_ = normal, aa = albino skin
Color Blindness
Cystic Fibrosis
Cannot distinguish red or green
Hypersecretion of mucus in lungs
Sex-Linked Recessive: XC XC or XC Xc = normal-vision female XC Y = normal-vision male XcXc = color-blind female Xc Y = color-blind male Autosomal Recessive: C_ = normal, cc = disease
4. Human Pedigree: Studying inheritance patterns of humans is complex both biologically and ethically; thus, much of what we know is based on looking at family histories or trees (pedigree analysis) a. Specifically, phenotypes of all known family members from as many generations as possible are assembled; this is especially important when attempting to trace the sources/causes of genetic disorders i. Proband refers to the first person for whom a particular genetic condition has been diagnosed: If this is a male, he is called the propositus; if this is a female, she is called the proposita ii. The diagnosis and identification of the proband individual serves as the basis for determining the genetic basis of the condition through the use of standardized diagrams iii. Following is a chart illustrating some standard symbols used in pedigrees and a sample pedigree:
Human Pedigree Symbols Normal male Normal female Sex unknown, normal Male with phenotype of interest
Female with phenotype of interest
Dimples
Dimple(s) in cheek(s)
Autosomal Dominant: D_ = dimples, dd = no dimples
Ear Lobes
Free vs. attached
Autosomal Dominant: D_= free lobes, dd = attached lobes
Sex unknown with phenotype of interest
Blue → dark brown
Autosomal Incomplete Dominant: BB = dk. brown, Bb = lt. brown, bb = blue, model with 3 Genes? Recent studies suggest “NO” specific eye color genes exist
Male heterozygous for recessive allele
Freckles
Freckles vs. no freckles
Autosomal Dominant: F_ = freckles, ff = no freckles
Stillbirth or spontaneous abortion
Hairy Ears
Hair on ear edge (pinna)
Y-Linked Dominant: XYH = hairy-eared male, XYh = normal male
Mating
Hairline Shape
Widow’s peak vs. straight
Autosomal Dominant: W_ = widow’s peak, ww = straight line
Mating between relatives
Height
Variable height
Polygenic: aabbccddeeff = shortest, AABBCCDDEEFF = tallest
Blood clotting impairment
Sex-Linked Recessive: XHXH or XHXh = normal female XhXh = hemophiliac female XHY = normal male XhY = hemophiliac male
Eye Color
Hemophilia
Proband or
Huntington’s Disease Mental decay
Autosomal Dominant: H_ = disease, hh = normal
Muscular Dystrophy “Duchenne”
Muscle weakening & loss of coordination
Sex-Linked Recessive: XDXD or XDXd = normal female XdXd = dystrophic female XDY = normal male XdY = dystrophic male
Pattern Baldness
Receding hairline
Sex-Influenced: BB = bald male, thin-hair female Bb = bald male, full-hair female bb = full hair in both sexes
Phenylketonuria (PKU)
Missing enzyme for phenylalanine metabolism
Autosomal Recessive: P_ = normal (results in mental impairment), pp = PKU
Polydactyly
Extra toes & fingers
Autosomal Dominant, Incomplete Penetrance: P_ = extra toes or fingers (but may be normal) pp = normal # of toes & fingers
Rh Blood Groups
Rh factor on red blood cells (RBC) Autosomal Dominant: R_= Rh-positive, r = Rh-negative
Sickle-Cell Anemia
Female heterozygous for recessive allele
Deceased
Roman numerals represent generation II
I
First born
One-egg Monozygotic twin
Defective RBC blood disorder
Autosomal Incomplete Dominant: SS = anemia, Ss = carrier, ss = normal
Skin Pigmentation
Dark to light
Polygenic: aabbcc = lightest → AABBCC = darkest
Tay-Sachs Disease
Nervous degeneration
Autosomal Recessive: T_ = normal, Tt = carrier, tt = disease
Tongue Folding
Fold vs. not fold
Autosomal Dominant: F_ = fold, ff = unable to fold tongue
Tongue Rolling
Roll vs. not roll
Autosomal Dominant: R_= roll, rr = unable to roll tongue
3
Siblings
Last born
Two-egg Monozygotic twin
Sample Pedigree
Sample Genetics Problems Please refer to the Human Traits & Known Inheritance Patterns table [see page 3] for assistance with problems involving human traits; attempt to work out the problems on a blank sheet of paper before viewing the solutions to each problem, which are shown in the next section [see Solutions to Sample Genetics Problems, pages 4–5]; in crosses tracking more than one trait simultaneously, assume multiple traits are unlinked unless stated otherwise 1. Orange and black fur in domestic cats are sex-linked, with the gene locus on the X chromosome; cats have similar sex determination patterns as humans; the two fur-color alleles display codominance, with heterozygous cats displaying a calico pattern (i.e., separate patches of black and orange fur; a calico female is mated to a black male): a. What is the probability that a female kitten will be a calico? b. What is the probability a male kitten will be a calico? 2. There is a gene that affects peapod color and has two alleles: G = yellow and g = green; there is another gene that affects peapod shape and has two alleles: W = round and w = wrinkled: a. Mendel’s original crosses (P generation) would have consisted of which two genotypes? b. List the possible types of gametes produced by these original parent plants c. If gametes from question “b” are joined in fertilization, determine the genotype(s) of the offspring d. If the individuals of question “c” are crossed with each other, how many genotypes will be possible in the offspring? e. Determine the phenotypic ratios of the offspring produced in question “d” 3. A certain hypothetical species called an EWOK has a gene that controls “fur” color—a dominant allele causes blue fur, and a recessive allele causes red fur; another gene controls “ear” length—a dominant allele causes long ears, and a recessive allele causes short ears; these two genes are linked, and a cross is performed between an individual homozygous for both dominant traits and an individual homozygous recessive for both traits: a. Determine the phenotypes(s) of all possible offspring b. How many types of gametes can be produced by the offspring listed in question “a”? c. What would be the possible phenotypes of the offspring in a test cross involving the offspring of question “a”? (Do a test cross on the offspring listed in question “a”); ASSUME NO CROSSING OVER d. Do the same thing here as you did in question “c,” but now give the possible phenotypes ASSUMING CROSSING HAS OCCURRED 4. Jenna has type A blood and does not exhibit symptoms of diabetes; her husband, Stephan, has type B blood and is diabetic; Stephan and Jenna have a male child, Oscar, who has type O blood and, like his father, has diabetes; based on the information given, answer the following questions: a. Name the genotypes of both parents and Oscar b. What is the probability that their next child will have the same genotype and phenotype as Oscar’s?
5. A genetics marriage counselor has a couple, Carly and Cedric, both with no hemophilia symptoms, seeking professional advice; Carly says that both her parents are normal, but she has a brother with hemophilia; Cedric, the man she will marry, is normal but knows one of his cousins has hemophilia: a. What is the probability of disease in children they might have? 6. In cattle, when red and white cattle are mated, the offspring are roan (a mixture of red and white fur); for another trait in cattle, hornless is dominant to possessing horns; white hornless cattle and red horned cattle are crossed: a. F1 individuals would have what genotype(s)? b. If F1 individuals are crossed, how many would be expected to be roan and hornless? c. If F1 individuals are crossed, how many would be expected to be white and horned? 7. Three siblings, a brother and two sisters, are examined for color-blindness; the examiner discovers that the boy and one sister are color-blind, while the other sister has normal color vision: a. Determine the genotype and phenotype of each parent 8. Diabetes, a recessive trait in humans, occurs in 10% of a certain population; a normal female and a normal male in this population have a child who is diabetic: a. What is the probability that their next child will be a diabetic? 9. A “hypothetical” recessive allele in humans causes feet to grow backward, while the normal dominant allele causes feet to grow forward; another gene controls foot length, and its alleles display incomplete dominance, so when a person is heterozygous for foot-length alleles, he/she will have normalsized feet, but when homozygous for either of the two foot-length alleles, the person will be either big-footed or small-footed; a cross occurs between a backward-pointing, large-footed male and a homozygous forward-pointing, normal-size-footed female: a. The female can produce how many types of gametes as far as these traits are concerned? b. Determine all possible phenotypes of the offspring c. In the original cross, if the male parent had backward-pointing feet of normal size, how many different phenotypes in the offspring would be possible? d. In the original cross, if the female parent had normal-size feet but was backward-pointing, how many different phenotypes in the offspring would be possible? e. In the cross with the female in question, “d,” will any offspring have forward-pointing feet? 10.Sheri has type A blood and normal color vision capabilities; her mother was type O and also had normal color vision, while her father was type AB and color-blind; Sheri recently married Randy, who had identical phenotypes for both traits as those of her father: a. Determine the possible phenotypes of children they might have
Solutions to Sample Genetics Problems 1. This problem involves a trait that exhibits codominance, and the gene is located on the X chromosome in cats; to solve this problem, assume sex determination in cats is the same as for humans Genetics Key: XB = black, XO = orange, Y = no allele for this trait XB XB = black female XB XO = calico female XB XO XOXO = orange female XB XBXB XBXO XB Y = black male Y XBY XOY XO Y = orange male The Cross: male = XB Y x female = XB XO Answers: a. 50% of the female kittens will be calico b. 0% of the male kittens will be calico (the two codominant alleles must both be present to produce a calico phenotype; males can only have one allele, as they only have one X chromosome) 2. This problem is a basic two-trait, progeny-testing cross as originally described by Mendel Answers: a. P generation: either GGWW, ggww OR GGww, ggWW b. Gametes: either GW, gw OR Gw, gW c. F1 individuals: GgWw
d. F1 x F1 cross yields nine genotypes in the F2 individuals e. F1 x F1 cross yields a phenotypic ratio of 9:3:3:1 3. Both fur color and ear length display complete dominance; however, both genes are linked, and thus, when calculating gamete possibilities, be aware that the two genes will NOT assort independently Genetics Key: Fur Color: B = blue, b = red BB = blue Bb = blue bb = red Ear Length: L = long, l = short LL = long Ll = long ll = short The Cross: BBLL x bbll → BbLl Answers: a. One phenotype produced: Blue fur, long ears b. 2 (BL, bl; because the dominant and recessive alleles are on separate chromosomes, respectively) c. The test cross of BbLl x BL bl bbll without crossing over bl BbLl bbll yields the following results: Two phenotypes produced: (1) Blue fur, long ears; (2) Red fur, short ears 4
d. The test cross of BbLl x bbll with crossing over yields the following results*: BL Bl bL bl bl
BbLl
Bbll
bbLl
bbll
Four phenotypes produced: (1) Blue fur, long ears; (2) Blue fur, short ears; (3) Red fur, long ears; (4) Red fur, short ears [* NOTE: It is possible crossing over would not recombine the dominant and recessive alleles; in such case, only two phenotypes (“c” above) would be produced; however, because crossing over might produce recombinant progeny, the answer reflects the possible gametes and progeny] 4. This problem involves two separate inheritance patterns: ABO blood group and diabetes [see Genetics Key in solution to question #6] The Cross: Stephan = BOdd x Jenna = AODd; Oscar = OOdd (to produce this child’s genotype and phenotype, both parents must have “O” alleles for blood type and “d” alleles for diabetes) AD
Ad
OD
Od
Bd
ABDd
ABdd
BODd
BOdd
Od
AODd
AOdd
OODd
OOdd
Solutions to Sample Genetics Problems (continued )
Answers: a. & b. 1/8 offspring will have type O blood and be diabetic (genotype = OOdd) 5. Carly, Cedric and both sets of parents have normal phenotypes (otherwise, they would have stated they have the disease); for Cedric and Carly’s father, the genotype/phenotype are: XHY = normal male (it does not matter that Cedric’s cousin has the disease); however, Carly’s genotype/phenotype can be: XHXH or XHXh = normal female; but because Carly has a brother with hemophilia (genotype/phenotype: XhY = hemophiliac), their mother would have to contribute a gamete with the hemophilia allele; thus, the mother’s genotype is XHXh, which is a normal phenotype but carrier genotype; following is a Punnett square with the cross of Carly’s parents: The results show that Carly can XH Xh be either XHXH or XHXh: That H H H H h represents a 50% chance of being X X X X X a carrier; if she is a carrier, the Y XHY XhY Punnett square directly above would also represent the cross between Cedric and her; by applying the Multiplication Probability Rules [see section 3, c, ii, page 2], probabilities of conditions in the offspring can be calculated Answer: a. Carly’s genotype cannot be definitively determined Carly’s probability of being XHXh = 50% (0.5) Probability of a daughter with the disease = 0% (0.0) 0.5 Carly is a carrier x 0.0 Daughter is diseased 0.0 0% overall probability of daughters with the disease Probability of a son with the disease = 50% (0.5) 0.5 Carly is a carrier x 0.5 Son is diseased 0.25 25% overall probability of sons with the disease 6. This problem involves two separate inheritance patterns: Cattle fur color, which exhibits incomplete dominance; and horn development, which exhibits complete dominance Genetics Key: Fur Color: W = white, w = red WW = white Ww = roan ww = red Horn Development: H = hornless h = horns present HH = hornless Hh = hornless hh = horns present The Cross: The use of the symbol “F1” traditionally indicates progeny testing, as originally employed by Mendel in his pea plant crosses; this requires that the original parents be pure breeders or homozygous, and that the hornless genotype must be HH, not Hh; thus, the P generation crosses could be either: WWHH x wwhh OR WWhh x wwHH Answers: a. F1 genotype: WwHh F1 x F1 cross: WH
WH WWHH
Wh WWHh
wH WwHH
wh WwHh
Wh
WWHh
WWhh
WwHh
Wwhh
Answer: a. Male parent: XcY = color-blind male Female parent: XCXc = normal-vision female 8. This problem involves a trait involving complete dominance; in this case, the normal or “good” allele is dominant, and the defective allele that causes diabetes is recessive: Genetics Key: D = normal, d = diabetes DD = normal, Dd = normal, dd = diabetic The Cross: Both parents must be heterozygotes: Dd x Dd = dd child Answer: a. 25% probability for all subsequent offspring to have the same genotype/phenotype as the first child 9. To solve this problem, and others that are unfamiliar, first create a key for symbols and the type of genetic inheritance pattern; foot growth direction displays complete dominance, while foot size displays incomplete dominance: Genetics Key: Foot Growth Direction: B = forward, b = backward BB = forward Bb = forward bb = backward Foot Size: L = large or big, l = small or little LL = large feet Ll = normal feet (incomplete dominance) ll = small feet The Cross: Male = bbLL x Female = BBLl Answers: BL Bl a. The female can produce two gamete types (BL, Bl) bL BbLL BbLl b. Two phenotypes produced: (1) forwardpointing, big feet; (2) forward-pointing, normal-sized feet BL Bl c. Changing the original cross to male = bbLl x bL BbLL BbLl female = BBLl yields the bl BbLl Bbll results shown: The cross shown yields three phenotypes (forward/big, forward/normal, forward/small) d. Changing the original cross bL bl to male = bbLL x female = bbLl yields the results bL bbLL bbLl shown: e. Changing the original cross to male = bbLL x female = bbLl would yield no offspring with forward-pointing feet 10. This problem involves two separate inheritance patterns in humans: ABO blood group and colorblindness The Cross: Randy = AB XcYx; Sheri = AO XCXc (this must be her genotype, as her mother contributed an “O” allele for blood type, and her father contributed an “Xc” allele for colorblindness) AXc
AY
BXc
BY
AAXCXc
AAXCY
ABXCXc
ABXCY
wH
WwHH
WwHh
wwHH
wwHh
AXC
wh
WwHh
Wwhh
wwHh
wwhh
AXc AAXcXc
AAXcY ABXcXc ABXcY
AOXCXc
AOXCY BOXCXc BOXCY
OXc AOXcXc
AOXcY BOXcXc BOXcY
b. 6 out of 16 (38%) would be roan & hornless, with genotypes of either WwHH or WwHh c. 1 out of 16 (6%) would be white & horned, with a genotype of WWhh 7. The key to solving this problem is that the sister is colorblind, which is the genotype/phenotype: XcXc = color-blind female; this means that both parents contributed the “Xc” allele; the other sister was normal, which would make her genotype/phenotype: XCXc = normal-vision female; thus, the mother must have contributed the “XC” or normal allele
OXC
Answer: a. Male and female offspring would have every combination of blood type A, B & AB with every combination of vision (i.e., normal vs. color-blindness); based on the known genetics patterns, however, type O blood would not be present in any offspring, regardless of gender 5
Molecular Genetics A. The Central Dogma 1. Soon after the discovery of the structure of DNA, the function of nucleic acids in general was better understood; the following subsection summarizes the major processes involved in molecular biology; when relating these processes to inheritance, this is called molecular genetics: a. DNA Replication: New DNA is copied from existing DNA—a process that uses or conserves half the original DNA, while the other half is new (i.e., semiconservative replication) b. DNA Transcription: Messenger RNA (mRNA) is copied from DNA; intervening sequences (introns) are removed and remaining portions (exons) are ready to be translated c. DNA Translation: Proteins are synthesized from mRNA by ribosomes
The Central Dogma DNA Strand Transcription
Messenger RNA
Transfer RNA
Ribosomal RNA
Translation Proteins Amino Acids
Ribosomes
Protein
2. Retroviruses: Group of RNA viruses possessing a special enzyme, reverse transcriptase, that allows the viral genome to go in the reverse direction of the information flow of the central dogma; this allows the viral RNA to be converted into DNA, thereby altering the host cell’s genome a. DNA ← Viral DNA B. Mutations 1. Any random, permanent change in the DNA molecule; many are harmful, some have no effect, and a few actually benefit the organism; nature selects those mutations that are beneficial or adaptive in organisms to help shape the course of evolution a. Point Mutation: Change in one nucleotide base pair b. Chromosomal Mutation: Change in chromosome number or structure C. Genomics 1. Study of the entire genome of species a. Structural Genomics: Gene mapping and sequencing b. Functional Genomics: Studying how gene sequences operate, including proteomics (study of functioning of proteins coded by genes) c. Comparative Genomics: Analysis of gene sequences of different species
Molecular Genetics (continued ) D. Developmental Genetics 1. Advances in molecular biology have revolutionized the study of developmental biology; for example, studies on the fruit fly Drosophila have illustrated fundamental processes in cellular differentiation a. Homeotic Genes: Sets of genes that control basic body patterns in organisms, including members of the fungal, plant and animal kingdoms b. Homeobox: Specific nucleotide sequences (composed of about 180 base pairs) typically associated with homeotic genes c. Hox Genes: Subset of homeobox genes that are found in many different animals and are highly conserved (i.e., basically the same), indicating that, evolutionarily, they arose very early in the development of life on Earth
Homeobox Hox Genes of Animals Are Highly Conserved Fly homeobox DNA sequence
Frog DNA
Fly homeobox DNA sequence is mixed with Frog DNA
Heat
Strands separate
Cool
Fly homeobox DNA binds to frog DNA, confirming sequence similarity E. Cancer Genetics 1. Cancers frequently involve three types of mutated genes: a. Oncogenes: Stimulate abnormal cell growth and division, which can lead to malignant tumors; originate from normal genes, called proto-oncogenes,
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which regulate the cell cycle; viruses can also transmit oncogenes to host cells b. Tumor-Suppressor Genes: Normally prevent the uncontrolled growth and division of cells and tissues; mutations may deactivate these genes, which can lead to cancers c. Mutator Genes: Can increase the mutation rates of other genes, thereby increasing the chance of cancerous tissues developing F. Non-Mendelian Inheritance 1. Mitochondrial & Chloroplast Genomes a. The Endosymbiotic Hypothesis suggests that mitochondria and chloroplasts are derived evolutionarily from prokaryotes; the strongest evidence for this hypothesis is that both organelles have their own set of DNA: mtDNA in mitochondria and cpDNA in chloroplasts b. Genes on these non-nuclear sources of DNA are called extranuclear genes; they have “non-Mendelian” inheritance patterns, because they do not engage in meiotic segregation and re-assortment processes c. Uniparallel Inheritance: Offspring (male and female) have characteristics of just one parent d. Maternal Inheritance: In most sexually reproducing, eukaryotic organisms, the haploid genome and cytoplasm with organelles from the female gamete are passed to the zygote, while the male gamete essentially contributes only a haploid genome; very little cytoplasm is transferred to the zygote; thus, traits associated with mtDNA are inherited from the maternal parent 2. Infectious Heredity: Symbiotic bacteria and viruses that are transmitted in cytoplasm G. Molecular Evolution 1. Although morphological characteristics (visible phenotypes) have been the traditional focus of evolutionary biology, emergent molecular techniques have allowed the study of the evolution of DNA and protein sequences 2. Molecular Phylogenies: Phylogenetic trees, illustrating evolutionary relatedness of all species, have been revised and updated using modern molecular techniques; one major development was dividing life into three large groups or domains: Bacteria, Archaea and Eukarya
Population & Evolutionary Genetics Genes in populations versus individuals A. Populations evolve just as species do B. Genotype: Genetic composition of an individual C. Gene Pool: Genetic composition of a population of individuals; that is, all alleles for all genes in a population D. Evolution involves changes in gene pools over time; to understand changes in gene pools as populations evolve, an understanding of non-evolving populations is necessary The Hardy-Weinberg Law A. Both allelic frequencies and genotypic ratios (i.e., gene pools) remain constant from generation to generation in sexually reproducing populations, if the following conditions of equilibrium exist: 1. Mutations do not occur 2. No net movement of individuals out of or into a population occurs 3. All offspring produced have the same chances for survival, and mating is random; that is, no natural selection occurs 4. The population is large so that chance would not alter frequencies of alleles B. Algebraic equivalent of the Hardy-Weinberg Law: 1. p2 + 2pq + q2 = 1, where: a. p = frequency of dominant allele b. q = frequency of recessive allele c. p2 = AA genotype d. 2pq = Aa genotype e. q2 = aa genotype C. Example: 1. If, in a group of six individuals, there are nine dominant (A) alleles and three recessive (a) alleles, then p = 9/12 or 0.75 and q = 3/12 or 0.25; a total of 12 gametes will be produced, nine of which will have the dominant allele and three with the recessive allele 2. The algebraic equation above can be used to predict the ratios of the three possible genotypes as a result of fertilizations: a. Frequency of AA genotypes is p2 or (0.75)2 = 0.56 b. Frequency of Aa genotypes is 2pq or 2(0.75)(0.25) = 0.38 c. Frequency of aa genotypes is q2 or (0.25)2 = 0.06 3. The frequencies of dominant and recessive alleles are still the same—the specific alleles have been redistributed Hardy-Weinberg & Natural Populations A. Few (if any) populations are in equilibrium; therefore, changes in allele frequencies and, thus, gene pools do occur in natural populations B. The Hardy-Weinberg Law helps to identify the mechanisms of these evolutionary changes by predicting that one or more of the four conditions required are not met; that is: 1. Mutations occur 2. Individuals leave and enter populations 3. Non-random mating and natural selection occur 4. Small populations exist
Allele Frequency Changes Frequency of allele for gray body is higher
Gray male
Frequency of allele for gray body is lower
Normal female
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CIRCULATION
WORLD’S #1 ACADEMIC OUTLINE
L. common carotid a.
Inferior thyroid v. L. brachiocephalic v.
Brachiocephalic trunk R. common carotid trunk
Subclavian a. & v.
ANTERIOR HEART
R. common carotid Inferior thyroid v.
Internal jugular v.
L. pulmonary a. Arch of aorta
Internal jugular v. R. external jugular v.
L. external jugular v.
Internal jugular v.
a. = artery a.a. = arteries L. = Left m. = muscle m.m. = muscles R. = Right v. = vein v.v. = veins
L. auricle R. pulmonary a.
R. subclavian a.
External jugular v. R. brachiocephalic v.
Arch of aorta
Superior vena cava
Ligamentum arteriosum L. pulmonary a.
R. pulmonary a. R. pulmonary v.v.
L. pulmonary v.v. Pulmonary trunk L. atrium Mitral valve L. ventricle Aortic valve L. posterior papillary m.
Pulmonary valve R. atrium Tricuspid valve
Muscular interventricular septum
Aortic arch L. pulmonary a.a.
Superior vena cava
Ascending aorta
Aortic valve
L. atrium
L. pulmonary v.v. L. atrium
Ascending aorta R. atrium
L. ventricle
R. coronary a.
L. anterior descending (or anterior intraventricular) coronary a.
Inferior vena cava Fat
Great cardiac v.
Apex
Circumflex branch of L. coronary a.
Anterior cardiac v.v.
Coronary sinus
R. coronary a. L. ventricle
R. superior pulmonary v. R. inferior pulmonary v.
Great cardiac v.
Posterior L. ventricular branch
R. marginal branch of R. coronary a.
Sulcus terminalis
Posterior branch of L. coronary a.
Posterior v. of L. ventricle Apex L. ventricle Coronary sinus
NERVES & ARTERIES
Aortic valve Branch to sinoatrial node L. coronary a. Oblique v. of L. atrium Anterior R. atrial Great branch of R. cardiac v. coronary a.
Mitral valve
R. atrium
L. superior pulmonary v. L. inferior pulmonary v.
Circumflex branch of L. coronary a.
CORONARY ARTERIES & CARDIAC VEINS
Pulmonary trunk
Pulmonary valve
R. brachiocephalic v.
Descending aorta
Abdominal aorta
INTERIOR HEART
L. subclavian a.
R. ventricle
Apex R. ventricle
Superior vena cava
L. brachiocephalic v.
L. common carotid
Inferior vena cava
POSTERIOR HEART
Sinoatrial (SA) a.
R. atrium Inferior vena cava R. coronary a. Posterior descending a. L. atrium Middle cardiac v. Main R. coronary a. Aortic valve: R. cusp L. cusp Posterior cusp
Sinoatrial (SA) node Middle internodal tract Posterior internodal tract
Bachmann’s bundle Main L. coronary a. Anterior internodal tract Circumflex branch
Marginal branches Atrioventricular (AV) node Common AV bundle (of His)
Tricuspid valve
R. bundle branch
Small cardiac v. Opening of coronary sinus Papillary m.m.
R. ventricle
Muscular interventricular septum Papillary m.m.
Posterior v. of L. ventricle
Middle cardiac v. Posterior interventricular branch of R. coronary a. (posterior descending a.)
Anterior interventricular branch (L. anterior descending) of L. coronary a.
Edge of the transparent heart
Atrioventricular (AV) a. Purkinje fibers Posterior interventricular branch Perforating branches to interventricular septum
Purkinje fibers Anterior interventricular branch (L. anterior descending) of L. coronary a.
L. bundle branch
BEGINNING OF DIASTOLE
END OF DIASTOLE
Sinoatrial (SA) node
Contracting atria
END OF SYSTOLE
SYSTOLE
Atrioventricular (AV) node
Contracting ventricles
HEART IN DIASTOLE
HEART IN SYSTOLE
Anterior semilunar cusp
Pulmonary valve L. semilunar cusp L. anterior descending a.
R. semilunar cusp R. coronary a. Marginal branch
Aortic valve L. coronary a.
Anterior semilunar cusp
Pulmonary valve L. semilunar cusp L. anterior descending a.
R. semilunar cusp R. coronary a. Marginal branch
Aortic valve L. coronary a.
Anterior cusp
Posterior semilunar cusp
Posterior semilunar cusp
Mitral valve
Mitral valve
Anterior cusp
Tricuspid valve
Tricuspid valve Anterior cusp
Anterior cusp Posterior cusp
Posterior cusp
Posterior cusp
Posterior cusp Medial cusp
Medial cusp Posterior v.
Posterior v. Small cardiac v.
Coronary sinus Middle cardiac v.
Coronary sinus
Annulus fibrosis
NOTE TO STUDENT
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Small cardiac v. Annulus fibrosis
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INTRODUCTION Urinary incontinence is the inability to control urination; it can range in severity from slight leakage to total loss of bladder control This chart is designed to help you understand the causes of incontinence and give helpful hints on its management; this information is not a substitute for professional medical care; always consult your physician if problems arise It is estimated there are over 13 million incontinent adults in the U.S. today; women are twice as likely to have this condition as men; children may also have bladder control problems; urinary incontinence is treatable and usually does not require surgery; some causes of incontinence include muscle weakness, an enlarged prostrate blocking the urethra, and diseases or injuries involving nerves and muscles; pregnancy, bladder infections and certain medications may temporarily cause incontinence
NORMAL CONTROL OF URINE • Urine control is very complex; the brain, spinal cord and muscles of the bladder, urethral sphincter and pelvic floor must work together • Urine is stored when the brain makes the bladder relax and pelvic muscles contract • When control centers in the brain quiet, the pelvic muscles relax, and the bladder can squeeze and empty BLADDER Medications that can affect bowel or bladder control: Diuretics Anti-hypertensives Sedatives Antihistamines Narcotics Antidepressants
TYPES OF INCONTINENCE Stress Incontinence: • Occurs when the pressure closing the bladder is greater than the pressure in the urethra • Results in loss of urine while coughing, laughing or changing position • Most prevalent in women, especially after childbirth and hysterectomy • Occurs when the muscles and tissues closing or supporting the urethra are weak or damaged, such as with childbirth, weight gain or some types of surgery • May worsen with altered levels of estrogen during the menstrual cycle, or after surgical or natural menopause • Surgery is designed to restore the normal position of the bladder and/or the bladder neck and urethra
WORLD’S #1 ACADEMIC OUTLINE
Urge Incontinence: • An overwhelming urge to urinate, followed by the release of a sometimes large amount of urine • Caused by bladder wall spasms; also described as unstable, spastic or overactive • Can be set off by the sound of running water, walking past a favorite bathroom, returning home, or sudden bladder filling due to alcohol or other diuretics • Common after menopause and in older persons when the bladder muscle is more irritable • Also common when MS, diabetes, stroke or Parkinson’s interrupts control messages from the brain’s higher centers • Irritation sometimes increased by concentrated urine from inadequate fluid intake, or by caffeine, citrus juice, artificial sweeteners, or spicy foods • Usually not related to excess urine in the bladder but rather to an irritated bladder muscle from infection, bladder calculi (stones), polyps or cancer
Overflow Incontinence: • Leakage of typically small amounts of urine when the pressure in an overfull bladder overcomes the pressure in or around the urethra • May cause urine to flow back up into the kidneys, damaging or destroying them • Usually due to either a bladder that contracts weakly or a blockage of the urethra • Common in men with an enlarged prostate, especially when taking cold medications • Nerve damage due to diabetes, spinal injury, MS or a birth defect may prevent bladder wall muscle from contracting or prevent muscles that close the urethra from relaxing • Treatments include medication review, surgery to remove obstruction, clean intermittent catheterization, and as a last resort, indwelling catheterization • Urethral blockage may cause bladder spasms/instability over time that persists after prostate surgery
Functional Incontinence: • Occurs in people with borderline bladder control who are unable to reach the toilet in time because of physical problems like arthritis or muscles affected by a stroke • Also caused by environmental barriers, such as stairs, distance or crowds preventing timely access to bathroom • May occur in those with dementia or severe depression who don’t remember how to get to the bathroom or even care about it • Offering assistance to get to the bathroom every 1—2 hours and a drink of water following use of the toilet may correct this • Having a commode nearby or keeping the route to the bathroom free of obstacles and well lit may also help
Fecal Incontinence (loss of normal bowel control): • There are over 1 million people in the US suffering from fecal incontinence
• Commonly caused by chronic constipation from inadequate fiber and fluids
• May also be caused by a weak anal sphincter • Ignoring the first urge to have a BM causes the stool to dry out, increasing constipation
• When unable to expel hard rectal contents, liquid stool higher in the intestine may move past the obstruction, giving the appearance of diarrhea • A full rectum also may press against the bladder or urethra, and cause urinary problems
EVALUATION OF INCONTINENCE Evaluation of Incontinence: • Focused history and physical examination • Analysis of a urine sample • A toileting diary covering several days, recording toilet use and accidents
• Stress test – observation of leakage with activity • Measurement of urine in bladder after urinating Specialized tests not part of basic evaluation: • Urodynamics: Determination of functional status of urinary bladder and urethra • Cystoscopy: A narrow telescope-like tube is used to help in identifying lesions, pouches, holes and blockages • Imaging: Examines the bladder, ureters and kidneys for lesions and blockages
Summary of information collected to diagnose possible causes of incontinence: • Focused history • A diary, covering several • Physical examination days, recording toilet • Analysis of urine use and accidents sample • Estimate of urine left in bladder after emptying it
CATHETERIZATION Indwelling catheterization Indicated only when urine output must be closely monitored, incontinence hampers healing of a stage 3 or 4 pressure ulcer, in the terminally ill to avoid undue pain or trauma, or as the last resort to avoid institutionalization • Insertion is a sterile procedure to prevent UTI • Use the smallest catheter that drains well (14 or 16 Fr.) • Avoid balloons > 10 ml, unless for hemostasis • Base catheter changes on patient need, not a predetermined interval • Urine may leak around catheter because of bladder spasms, too large a catheter or balloon, catheter blockage or infection Intermittent self-catheterization • Far safer over time than an indwelling catheter • Clean technique and washing catheter with soap and water is recommended • Catheter guides, grasp aids and mirrors may assist females but should be ultra-portable to avoid postponing catheterization
SKIN CARE • Urine and especially feces can seriously damage skin if allowed to remain
• Use absorptive products with polymer gel and change when wet
• Wash skin with incontinence wipe or cleanser but avoid excess friction; avoid soap as it removes natural protective lubricants • Barriers such as the petroleum-based products and zinc oxide protect against breakdown • Skin breakdown or pressure ulcers (bedsores or decubiti) are increased with mobility limitations • Collection devices help when treatment fails; there are many types (disposable & reusable): liners, drip collectors, condoms, pads, guards, undergarments, briefs and bed pads; device should be comfortable and discreet, and keep skin, clothes and furniture dry; overpadding damages skin and reduces leakage awareness
(Also consult BarCharts® Wound Care Guide)
TREATMENT Behavioral Techniques: These decrease the frequency and amount of incontinence in most persons when used by experienced health care providers, have no reported side effects and do not limit future treatment options; clinical practice guidelines typically suggest trying behavioral methods first; listed in order of participation required: • Scheduled toileting: Help offered at fixed or regular intervals • Habit training: Toileting scheduled to match usual voiding habits • Prompted voiding: Person is asked if they are wet or dry, assisted to the bathroom, and praised for appropriate toileting • Pelvic muscle rehabilitation: Exercises making the pelvic floor bulkier, giving better closure and support to the bladder • Urge suppression: Using pelvic muscle contractions, controlled breathing and/or distraction to quiet an irritable bladder • Bladder training: Drinking adequate fluid and gradually prolonging voiding intervals
Other Interventions • Medicine: Over-the-counter and prescription drugs may be beneficial but some have side effects, such as a dry mouth • Pessary: A rubber, silicon or plastic device inserted in the vagina to give additional support • Electrical stimulation: Uses a vaginal or rectal probe to make pelvic muscles tighten • Implanted nerve stimulator: Implanted near the sacral area of the spine to stimulate nerves controlling bladder function • Artificial sphincter: Inflatable ring surgically implanted around the urethra or rectum; patient squeezes bulb to temporarily transfer water from the ring to an internal reservoir, allowing emptying of the bladder or bowels • Other surgery: Goal is to restore the normal position of the bladder and/or urethra, or to relieve urethral or prostatic obstruction
PELVIC FLOOR EXERCISES These exercises strengthen muscles that support the pelvic contents and close off the urethra and anus Guidance of a health care professional is helpful; exercises usually improve control, but only if: • They are done regularly and correctly • Pelvic muscles are completely relaxed before beginning exercises • Abdominal and gluteal muscles are kept relaxed throughout the entire exercise • Breathing is regular, without holding at any time • Exercises are not done to point of exhaustion
How to do Pelvic Floor Muscle Exercises: • Locate correct muscle by pretending you are trying to avoid passing gas; never practice by repeatedly interrupting the urine stream • A lifting and tightening sensation can be felt when done correctly; men will see the base of their penis pull in; women can feel pressure when two fingers are inserted into the vagina • Keep muscles tense as long as comfortable, between 2-5 seconds at first Customer Hotline # 1.800.230.9522 ISBN-13: 978-142320729-0 ISBN-10: 142320729-7
• Relax muscles for the same duration • Repeat a total of 10 times, if possible • Do exercises each time the bladder has been emptied, or at other times, to a total of 50 squeezes daily
• Over a period of weeks, try to build up to 10second holds, with 10-second rests in between
Aids to learning PFM Exercises: Dr. Kegel pioneered pelvic floor muscle exercises in the 1950s as a way to regain bladder control without surgery; he gave his patients a simple pressure sensor to use for biofeedback because he had observed that 40% of them could not learn to exercise properly with just verbal instruction • EMG, surface or internal: Displays on a computer monitor the signals nerves send to the support muscles and external sphincters, making it easier to learn to control and strengthen them; home devices are also available • Vaginal pressure sensor: Worn in vagina while exercising, with a measuring device attached • Vaginal weights: Tampon-shaped devices graduated in weight, worn in the vagina while walking
GLOSSARY anus: Outlet of rectum, FOLEY containing sphincter muscles to close it off; lies in the fold between the buttocks bed & chair pad: STRAIGHT Reusable or disposable; CATHETERS that protects upholstered furniture or mattress commode: A portable toilet biofeedback: Sound or visual display of any normally non-visible bodily function, so as to learn to modify it; often used to gain control of muscles which support and close off urethra and anus bladder: A balloon-like muscular organ that stores and empties urine BPH (Benign Prostatic Hypertrophy): Non-cancerous enlargement of prostate, common in older men; usually controlled by medication; if the passage of urine becomes completely blocked, this is an emergency, and medical help should be sought immediately briefs (reusable): Absorbent adult diaper with elastic (pullup), snaps, or plastic and tape at the hip catheter: A soft tube that is inserted through the urethra to drain the bladder catheter guide: Plastic device that helps a female find her urethra during catheterization condom or external catheter: Worn on the penis (similar to a condom) and connected to a leg bag or bedside drainage bag drip collector: Absorbent pocket that holds the penis and adheres to the undergarment, to collect small amounts of urine enuresis alarm: A sensor used in the crotch of pajamas or in a bed pad, to set off an alarm when wet fecal impaction: Hardened stool or feces in the rectum which prevent normal bowel movements foley catheter: Catheter with a built-in “balloon” inflated after insertion, to hold the catheter in place
DISCLAIMER: Always consult your doctor or nurse specialist with any concerns or problems with your condition. This guide is intended only for informational purposes and helpful hints. In no way is this guide meant to be a substitute for professional medical care. Neither BarCharts®, nor its writers & editors, are in any way responsible or liable for the use or misuse of the information contained in this guide. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2000, 2002 BarCharts, Inc. 0608
It is connected to a drainage bag and used during surgery to monitor outflow during critical conditions, or when no other method to control urine is feasible; causes dependence; may damage bladder and urethra, and allows bacterial invasion; bladder infections are difficult to control while it is being used guard: Incontinence protection that is slightly larger than a pad, with plastic or foam on the outside; holds more than a pad Kegels: Pelvic floor muscle exercises done using biofeedback, pioneered by Arnold Kegel, MD kidneys: Two beanshaped organs that 2000 CC filter waste from the blood and produce urine leg bag: A plastic pouch connected to a catheter, supported by a pocket in a garment or by straps DRAIN BAG fastening it to the leg jelly: lubricating Liquid substance used to lubricate a catheter to make insertion easier nocturia: Excessive (>2) urination during night nocturnal enuresis: Urine leakage during sleep pads: Shaped like a sanitary napkin, but especially designed for urine collection, so less likely to leak penile clamp: Semi-rigid clamp that surrounds the penis to control accidental urine loss pelvic floor muscles: Group of muscles extending from the pubic bone to the tail bone, providing support for the pelvic organs, and opening and closing the urethra and anus bowel prolapse: Descent of uterus, bladder or other organs toward or past womb openings in pelvic floor prostate: A gland in the pubic male pelvis that surrounds bone the urethra just below the bladder protective clothing: Apparel with plastic layers or panels pelvic floor muscles to protect against wetting raised toilet seat: Fits over or attaches to toilet, raising the seat to make it easier to get off toilet retracted penis pouch: Pouch attached with adhesive barrier at base of penis, to divert urine from an inverted or small penis to a drainage bag sphincter: The muscle around the urethra or anus, controlling the emptying of the bladder or rectum undergarment: Similar to a loincloth, with straps attached by buttons or Velcro™; panty liners and pullup types similar to regular underpants are also available ureters: Two thin tubes that carry urine from the kidney to the bladder urethra: Tube from bladder base to the outside, about 8 inches long in men, 1-11/2 inches in women urologist: A doctor who specializes in conditions of the urinary tract in both men and women UTI (Urinary Tract Infection): Symptoms include burning, frequent and painful urination; in the elderly, behavioral changes may be the only sign
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WORLD’S #1 QUICK REFERENCE GUIDE
an introduction to
Health Care definitions
purpose > What are a patient’s rights and responsibilities?
health Dynamic state of balance character-
> What are the different types of health care?
ized by anatomical, physiological, social, psychological and spiritual integrity
> Who provides health care services?
health care Services provided for the pur-
> Where are the services provided?
pose of promoting, maintaining, monitoring or restoring physical or mental health
> How is health care financed?
health care industry Complex array of preventive, remedial and therapeutic services provided by health facilities, practitioners, government and voluntary agencies, noninstitutional care facilities, medical equipment and pharmaceutical manufacturers and health insurance companies
•The health care industry is one of the most complex, regulated, diversified and technologically advanced systems in American society •This guide presents an overview of selected components within the delivery system •The patient receives health care from health professionals in a setting as a result of a particular health insurance plan •Providers are reimbursed by the payer (patient, government, managed care company, private insurance company) according to the contractual terms of the health plan
health care system A structured network of services encompassing personal health care, public health services, teaching and research activities, and health insurance coverage patient / client Recipient of a health service provider A health professional and / or facility / organization /company authorized to provide health care
Health Care preventive care
hierarchy of care
Focus on disease prevention and health maintenance
Range of services within the system
Primary
• Education on good health habits and resources to prevent illness / disease • Focus on disease prevention and health maintenance • Identification of individuals at risk for developing specific health problems • Appropriate interventions to prevent a health problem ¤ Primary Care • Early detection and routine treatment of health problems • Usually the health care system entry point • Provided in an ambulatory facility ¤ Secondary Care • Traditional acute care for: Emergency care Diagnosing and treating an illness • Individuals may enter system at this level • Intermediate level of health care ¤ Tertiary Care • Specialized, highly technical care • Performed in a sophisticated, research / teaching medical center
A c tiv itie s dir e ct e d t owa r d: • Improving general well-being • Involving specific protection for selected diseases Ex. Immunizations, school education programs
Secondary Fo cuses on: • Early diagnosis • Rapid initiation of treatment • Ex. Screening tests
Tertiary • Concern with rehabilitation and return of a patient to maximum usefulness with a minimum risk of recurrence • Want to prevent further deterioration Ex. rehabilitation therapies (physical / occupational therapy)
¤ Preventive Care
■
■
1
• Given by highly trained specialists using advanced technology ¤ Restorative Care • Intermediate follow-up and rehabilitation for convalescing patients • Includes subacute care ¤ Continuing Care • Long term with little expectation of improvement in physical / mental status • Care of the chronically ill • Performed at home or in a medical facility • Includes palliative care (relieves / reduces uncomfortable symptoms, does not cure) and respite care (temporary relief for the primary caregiver)
SETTINGS Sites / locations where one or many health services are provided; some settings fit into multiple categories; Ex. hospitals
¤ Ambulatory Care • Care provided on an outpatient basis — does not require an overnight stay in a health facility • Includes a variety of services — preventive care activities, diagnostic testing, therapies and rehabilitation • Office based medical practice — most predominate setting
Hierarchy Of Care continued
• Additional settings include: Clinics Hospital Health Dept. School Industrial Prison Family Planning Walk-in Volunteer
Centers Surgical Renal Dialysis Community Health Urgent / Emergency Care Birthing MRI Women’s Health Pain Management
Agencies Volunteer Home Health Care
• Clinical laboratories, internet, mobile diagnostic and medical screening services
¤ Hospitals
• Provide a variety of inpatient and outpatient health services • Voluntary accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• Characteristics: o Licensed o Continuous nursing services o Structured medical staff o Specialized departments (radiology, laboratory, etc.) • Categories: o Ownership: Government / private (investor owned / not for profit) o Scope / type of service: General / specialized o Location: Urban / rural o Length of stay: Short-term / long term
¤ Long Term Care
• Medical, nursing, social, personal care, rehabilitative and palliative care provided on a recurring or continuing basis to individuals with chronic disease, disability or mental disorders • Settings include: o Community based: Adult daycare centers, hospice, home (health care / delivered meals), senior centers, community residential care facilities o Institutions: Skilled nursing facilities, assisted living facilities, continuous care retirement communities, Alzheimer’s facilities
Health Professionals definitions
Licensure by Endorsement Process of evaluating an “out-of-state” professional’s credentials malpractice professional misconduct / negligence • Four criteria for malpractice: ■ Duty: Obligation / responsibility to the patient ■ Breach of duty: Failure to perform responsibility ■ Damages: Injury must have occurred ■ Causation: Injury was caused by breach of duty professional liability Legal obligation of health professionals, or their insurers, to compensate patients for damages caused by acts of omission or commission by practitioners reciprocity Mutual agreement between two states whereby each state recognizes the license from the other state registration Listing of licensed or certified health professionals on an official roster scope of practice Professional practice boundaries (rights, responsibilities, restrictions) standards of care Expected professional conduct in a given situation (reasonably prudent person concept)
accreditation Process whereby an independent, impartial organization / agency formally recognizes a health facility or an educational program as meeting its predetermined standards ex. Commission on Accreditation of Allied Health Education Programs (CAAHEP) certification Permission granted by a nongovernment agency or association to practice a profession after successful completion of preestablished standards code of ethics Set of ethical standards / principles which guide an individual’s behavior / conduct ethics Moral standards / principles governing professional conduct: ethical principles include: • Autonomy Independent decision-making, personal choice • Beneficence Doing good, kindness, charity • Fidelity Observance of promises and duties, promise-keeping • Justice Righteousness, equitableness, fairness • Nonmaleficence Duty to do no harm Good Samaritan laws State laws protecting health professionals from civil liability when providing emergency assistance; assistance cannot be reckless / grossly negligent licensure Permission granted by a government agency to practice a profession after successful completion of preestablished standards; requirements vary by state
CRC CRT CST CT (ASCP)
professional designations ARNP ATR-BC CCT C DA CDT CMA CNMT CO COMT C OT C OTA CP C PhT C PO
Advanced Registered Nurse Practitioner Registered Art Therapist — Board Certified Certified Cardiographic Technician Certified Dental Assistant Certified Dental Technician Certified Medical Assistant Certified Nuclear Medicine Technologist Certified Orthotist Certified Ophthalmic Medical Technologist Certified Ophthalmic Technician Certified Occupational Therapy Assistant Certified Prosthetist Certified Pharmacy Technician Certified Prosthetist & Orthotist
CTRS DC DDS DMD DO DPM DTR EMT EMT-P HT (ASCP)
2
Certified Rehabilitation Counselor Certified Respiratory Therapist Certified Surgical Technologist Cytotechnologist (American Society of Clinical Pathologists) Certified Therapeutic Recreation Specialist Doctor of Chiropractic Doctor of Dental Surgery Doctor of Dental Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Dietetic Technician, Registered Emergency Medical Technician Emergency Medical Technician — Paramedic Histologic Technician (American Society of Clinical Pathologists)
Patient / Client physician/patient
relationship
£ Physician is patient’s advocate: what is in the best interest of the patient • Relationship has evolved from a paternalistic to a collaborative decision making model • Mutual agreement and joint obligations between physician and patient £ Physician/Patient Privilege • Protection of confidential physician/patient communication in a legal proceeding: o Patient consent needed ■ Privilege belongs to the patient; utilized for patient’s benefit ■ Statutory law usually applies; exceptions in many states ■ Relates to confidential disclosures during the course of treatment £ Fiduciary Relationship • An individual has a duty to act for the benefit of another within the confines of the relationship; physician / patient relationship based upon confidentiality, trust, honesty and good faith • Hippocratic Oath states, “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about…”
confidentiality
£ Privileged communication between health professional and the patient £ Patient’s right to privacy information cannot be released without the patient’s consent £ Health professionals have a legal / ethical duty not to disclose confidential information £ Legal exceptions vary by state and include: • Abuse (child, elder, spouse) • Court order • Gun / knife wounds • Infectious / communicable diseases
consent
£ Giving approval, permission or agreement £ Basic patient right £ Patient Self-Determination Act, 1990: • An individual has the right to accept or refuse medical or surgical treatment £ Patient signs a general / blanket consent form when admitted into a health care facility £ Special consent forms required for most invasive procedures — research studies, clinical trials, surgery, chemotherapy, and other specialized interventions £ Express Consent • Verbal or written consent • Clearly and directly stated £ Informed Consent • Signed, dated, witnessed agreement must be signed prior to the treatment intervention • Patient authorizes specific intervention • Purpose Patient autonomy, right to make decisions regarding health care • Components: o Informed: ■ Information is provided on the risks, complications, benefits, alternatives, description of the intervention, definition of and probability of success and consequences if intervention is refused o Consent: Agreement /authorization for intervention • Conditions: o Conscious, mentally competent adult (if minor, parent(s) or legal surrogate) o Voluntarily signed o Information on intervention has been given to the patient o All patient’s questions have been answered o All statements are clear, rational and understood by the patient £ Implied Consent Inferred from one’s behavior or silence; Ex. medical emergency, unanticipated situation
medical records
£ A permanent, legal record of a patient’s care: patient’s medical care profile / data base £ Medical records are required by accrediting, certifying and licensing agencies and organizations £ Documentation must be correct, complete, legible, factual and timely £ Each health care facility has its own charting policies and procedures £ Purpose Patient care management, reimbursement, teaching/research, communication, legal and medical review
HTL (ASCP)
PT A RCI S RC S RD RDH RDMS RHIA RN R.Ph. RR T RT (N) RT (R) RT (T) R VS SCT (ASCP)
Histotechnologist (American Society of Clinical Pathologists) LCSW Licensed Clinical Social Worker LMHC Licensed Mental Health Counselor LPN Licensed Practical Nurse LVN Licensed Vocational Nurse MD Doctor of Medicine MLT (ASCP) Medical Laboratory Technician (American Society of Clinical Pathologists) MT (ASCP) Medical Technologist (American Society Of Clinical Pathologists) MT-BC Music Therapist-Board Certified NA Nursing Assistant OD Doctor of Optometry OTR Occupational Therapist, Registered PA-C Physician Assistant-Certified PT Physical Therapist 3
Physical Therapist Assistant Registered Cardiovascular Invasive Specialist Registered Cardiac Sonographer Registered Dietician Registered Dental Hygienist Registered Diagnostic Medical Sonographer Registered Health Information Administrator Registered Nurse Registered Pharmacist Registered Respiratory Therapist Radiologic Technologist (Nuclear Medicine) Radiologic Technologist (Radiographer) Radiologic Technologist (Radiation Therapist) Registered Vascular Specialist Specialized Cytotechnologist (American Society of Clinical Pathologists)
Medical records continued
£ Basic Rule “If it wasn’t recorded, then it wasn’t done.” £ Contents Medical/family history, complaints, observations, progress notes, orders, results from diagnostic tests/procedures, treatments, medications, diagnosis and documents (informed consent forms, advance directives, etc) £ Ownership Physical property of the health care facility or practitioner £ Accessibility Generally, with proper written authorization the patient has accessibility; governed by state law £ Retention Time period determined by state/federal laws £ Health Insurance Portability and Accountability Act 1996 (HIPAA) • First federal privacy standards protecting patients’ medical records and other individually identifiable health information • Addresses the following issues: o Access to medical records: Generally, patients should be able to see and obtain copies of their medical records and request corrections if they identify errors and mistakes o Notice of privacy practices: Covered health plans, doctors and other health care providers must provide a notice to their patients on how their personal medical information will be used and their rights under the privacy regulation o Use of Personal medical information: Sets limits on how individually identifiable health information may be used o Prohibition on marketing: Sets restrictions and limits on the use of patient information for marketing purposes o Stronger state laws: Standards do not affect state laws that provide additional privacy protections for patients • Confidential communication Patients can request their doctors, health plans and other covered entities take reasonable steps to ensure communications are confidential • Complaints: o Consumers may file a formal complaint regarding the privacy practices of a covered health plan or provider o Enforcement by the U.S. Department of Health and Human Services Office for Civil Rights (OCR)—civil and criminal penalties • Law reflects basic principles of: o Consumer control o Public responsibility o Boundaries o Security o Accountability
patients’ rights &
responsibilities
£ Rights • Receive accurate, easily understood information about health plans, professionals, and facilities • Choice of providers and plans that ensure access to appropriate high quality health care • Access to emergency health services when and where needed • Participate in health care decisions • Considerate, respectful care from health professionals at all times and under all circumstances • Communicate with providers in confidence individually identifiable information is protected • Fair and efficient process for resolving differences with health plans, practitioners, and facilities £ Responsibilities • Practice good health habits live a healthy lifestyle • Comply with treatment plan learn about medical condition • Communicate relevant information to health practitioners • Recognize risks and limits of medical science • Know health plan coverage, options, administrative andoperational procedures • Respect other patients and health professionals • Make a good faith effort to meet financial obligations • Report wrongdoing and fraud to the appropriate authorities 4
treatment r ights
£ A patient can: • Accept or reject treatment (informed consent vs. informed refusal) • Leave a hospital against medical advice £ Emergency Medical Treatment and Active Labor Act 1986 (EMTALA) • Patient anti-dumping law • Established criteria for: o Emergency services o Interhospital patient transfer • Hospitals must provide: o Medical screening exam—does an emergency condition exist? o Prior to transfer, stabilizing treatment for an emergency patient and a woman in active labor o Continued treatment until patient’s discharge or transfer • In emergencies, patient has right to treatment, regardless of ability to pay or insurance coverage • Gives guidelines for transfer of a non-stabilized patient • Applies to all hospitals receiving federal funds • Penalties for violation of the law
advance direct i ves
£ Written legal documents whereby an individual indicates treatment preferences /instructions should s(he) become decisional incapacitated • Signed, dated, witnessed documents put in medical record £ Types of and requirements for directives vary by state law £ Patient Self-Determination Act 1990 • Applies to most institutional providers and prepaid plans participating in Medicare or Medicaid • Law requires that providers and prepaid plans: o Document (in the medical record) whether the individual has an advance directive o Educate staff and community about directives o Develop and provide patients written information on their rights to execute an advance directive o Ask each admitting patient if s(he) has an advance directive: patient has the right to prepare one if s(he) so desires o Ensure state law compliance regarding advance directives o Inform patients of the facility’s policies and procedures concerning implementation of an advance directive o Do not discriminate in the provision of care/ treatment on the presence or absence of an advance directive £ Types of Advance Directives: • Instructive o Living Will ■ Written instructions for life prolonging procedures—provide, withhold or withdraw ■ Can include non-specific or specific treatment statements ■ Takes effect when a patient cannot communicate his/her wishes o Do Not Resuscitate (DNR) order ■ Written instructions that the patient does not wish to be resuscitated in the event of cardiopulmonary arrest • Health Care Surrogate/Proxy o Also called Durable Power of Attorney for Health Care o Authorizes another individual (proxy/surrogate) to make health care decisions for the patient o Patient must be decisional incapacitated/incompetent unable to make medical decisions o A surrogate can be given the power to: ■ Refuse or consent to treatment/medication ■ Withdraw life sustaining treatment ■ Access medical records ■ Make anatomical gifts ■ Authorize admission/discharge from a health facility
Financing definitions Ambulatory Patient Classifications (APCs) A prospective payment system for ambulatory care services; APCs are groupings of services and procedures that are clinically similar and use comparable resources Benefits Health services provided according to the health plan contract Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA) Requires employers to permit employees/family members to continue group health coverage at their expense, but at group rates, if they lose coverage due to certain events Co-payment Specified charge for a service, paid by enrollee when service is provided Deductible A specific amount of money the enrollee must pay before insurance benefits begin Diagnosis Related Groups (DRGs) Prospective payment system for inpatient hospital services; classification system based on diagnostic category/code Employee Retirement Income Security Act 1974 (ERISA) Protects individuals enrolled in pension, health and other benefit plans sponsored by private sector employers; Administered by U.S. Department of Labor Enrollee/subscriber Member receiving health services under a particular health plan Home Health Resource Groups (HHRGs) a prospective payment system for home health services: classification based on
the health condition (clinical characteristics) and service needs of the beneficiary Managed care A system combining the functions of health insurance, delivery and administration to promote cost-effective health care Medicare Supplement Policy (Medigap) Health insurance that pays certain costs not covered by Medicare Out-of-pocket expenses Costs not covered by a health insurance plan Pre-existing condition Medical condition that existed prior to the date insurance coverage began Preferred providers Providers who contract to offer health services in a particular health plan Primary Care Provider (PCP) Health professional serving as the initial interface between the enrollees and the health care system; usually a physician, the PCP coordinates the treatment of enrollees Premium Amount paid by a policyholder for insurance coverage Prepayment Advance payment for health services Resource Utilization Groups (RUGs) A prospective payment system for skilled nursing facility care; nursing home residents are classified based on their clinical condition, used services and functional status Self-insurance plan Financial risk for provided health services carried by the sponsoring employer Third party payer Intermediary between patient and provider reimburses provider for patient’s care; Ex. insurance companies and governments (federal /state /local) Utilization Review (UR) A formal utilization assessment for appropriateness and economy of delivered health care services
insurance / reimbursement
£ Health Insurance plan • Financing method for health services • Contractual agreement whereby one party (insurer) agrees to indemnify or reimburse another party for services according to the contract terms • Contains the benefits, exclusions and other coverage requirements • Two categories of health financing: o Private Financing : o Public Financing : ■ Managed Care Plans ■ Medicaid ■ Individual private health insurance ■ Medicare ■ Group insurance ■ Military Health Services (TRICARE) ■ Self-Insurance ■ Department of Veterans Affairs ■ Indian Health Services ■ State Children’s Health Insurance Program (SCHIP) • Health Insurance Portability and Accountability Act 1996 (HIPAA) Eligible individuals guaranteed the right to purchase individual health insurance with no pre-existing condition exclusions, if certain federal requirements are met £ Provider Reimbursement Methods • capitation Flat rate per person for health services during a specified time • fee for service Specific dollar amount for each service performed; some third-party payers use a “discounted fee for service” • per diem rate A per day flat inpatient rate determined by bundling/combining all services provided per patient • Prospective Payment System (PPS) An established predetermined rate for health services based on the setting where the service is provided: o APCs — ambulatory care o HHRGs— home health o DRGs — hospital inpatient o RUGs— skilled nursing facility • Resource-Based Relative Value Scale (RBRVS) Used by Medicare for physician reimbursement; relates payments to resources physicians use o Three categories of resources—physician’s work, practice expenses and malpractice insurance expenses • retrospective payment system Patient day rate determined after 3rd party payers have formulized “allowable costs” • salary Compensation paid for work/services 5
managed care models The listed models are representative: there are many variations within the basic models Health Maintenance Organization (HMO) Healthcare practice providing comprehensive health services to voluntary enrollees for a fixed, prepaid fee; emphasis on prevention and early detection of disease • Different models include: o Staff: HMO salaried physicians, clinic-type arrangement, only HMO members o Group: HMO contracts with a multi-specialty physician group: group provides all medical services o Network: HMO contracts with multiple physician group practices o Independent Practice Association (IPA): HMO contracts with a legally organized association of private practice physicians Preferred Provider Organization (PPO) • Contracted agreement between providers and purchasers of services • Discounted fee for service • Enrollee financially penalized if non-participating provider used • Preauthorization required for selected services Exclusive Provider Organization (EPO) • Similar to PPO in structure and purpose • Enrollee limited to contracted providers Point of Service (POS) • Hybrid of HMO and PPO • Provider chosen when care is needed • Financial incentive to use participating providers Integrated Delivery System/Network (IDS/IDN) Group of organizations providing coordinated, comprehensive and cost effective health services; Ex. Physician—Hospital Organization (PHO)— hospital (or a group of hospitals) and physicians
Selected Gove r nment Programs ¤ Medicare • Title XVIII of the Social Security Act • Established in 1965 • Administered by the Centers for Medicare and Medicaid Services (CMS) — a federal agency • Health insurance program for: o People age 65 or older o People under age 65 with certain disabilities o People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) • Part A — Hospital Insurance o Helps cover medically necessary: ■ Inpatient hospital stay ■ Skilled nursing facility care ■ Home health care ■ Hospice care ■ Blood — received as an inpatient o Certain conditions must be met o Most people do not have to pay a premium for Part A • Part B — Medical Insurance o Helps cover medically necessary: ■ Medical and other services — doctors’ services, outpatient medical / surgical services and supplies, durable medical equipment, outpatient mental health care, occupational and physical therapy, diagnostic tests, second surgical opinions ■ Clinical laboratory services ■ Home health care ■ Outpatient hospital services ■ Blood — received as an outpatient ■ Preventive Services — selective screening tests and flu, pneumococcal and Hepatitis B shots o Services and supplies must be medically necessary o Most people pay a monthly premium for Part B • Uses a Prospective Payment System (PPS) for provider reimbursement • Quality Improvement Organization (QIO) Program National Network of QIOs, designed to monitor and improve health care utilization and quality for Medicare beneficiaries ¤ Medicaid • Title XIX of the Social Security Act • Established in 1965 • Jointly funded cooperative venture between federal and state governments • Purpose To assist states in providing adequate medical care to “eligible needy persons” • Within federal guidelines, each state: o Establishes its own eligibility standards o Determines the type, amount, duration and scope of services o Sets the payment rate for services o Administers its own program DISCLAIMER Always consult your doctor or therapist with any concerns or problems with your condition. This guide is intended only for informational purposes, and is not meant to be a substitute for professional medical care. Neither BarCharts®, its writers, designers nor editing staff, are in any way responsible or liable for the use or misuse of the information contained in this guide. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 2005 BarCharts Inc. 0706
• Largest program providing medical and health related services to low income people • Program varies considerably from state to state • States must provide coverage for the “categorically needy”; may provide coverage for the “medically needy” • Five broad coverage groups for Medicaid: o Children o Pregnant women o Adults in families with dependent children o Individuals with disabilities o Individuals 65 and over • Basic services that must be offered to the “categorically needed” include: o Inpatient / outpatient hospital services o Physician / pediatric and family nurse practitioner services o Laboratory / x-ray services o Nursing facility services for individuals aged 21 or older o Family planning services and supplies o Home health care for persons eligible for skilled nursing services o Rural health clinic / federally qualified health center and ambulatory center services o Prenatal care o Vaccines for children o Midwife services o Early and periodic screening, diagnosis and treatment services for individuals under age 21 ¤ State Children’s Health Insurance Program (SCHIP) • Title XXI of the Social Security Act • Established in 1997 • Federal / state partnership state administered with each state setting its own guidelines on eligibility and services • Purpose Expand health insurance coverage for children • Covers uninsured low-income children who are: o Not eligible for Medicaid o Under the age of 19 yrs o An uninsured low income child resides in a family with an income: ■ Below 200% of the Federal Poverty Level (FPL) OR ■ 50% higher than the state’s Medicaid eligibility threshold • A state can: o Expand Medicaid eligibility o Design a separate children’s health insurance program o Develop a combination of the two options o The federal government must approve each state’s plan • Insurance pays for: o Doctor visits o Hospitalizations o Immunizations o Emergency room visits
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6
WORLD’S #1 ACADEMIC OUTLINE
SPINE
TEMPEROMANDIBULAR & HYOID **=cut a.=artery ex.=extensor fl.=flexor l.=ligament l.l.=ligaments
Lateral (temperomandibular) l.
Hiatus of vertebral a.
Temporal bone
Ligamentum nuchae (nuchal l.)
Anterior atlantooccipital membrane
Capsule of lateral atlantoaxial joint
Atlar l.
Intervertebral discs
Stylohyoid l.
Iliolumbral l.
Sphenomandibular l. Superior costal facet
TEMPEROMANDIBULAR JOINT Articular tubercle Articular disc
Costotransverse joint Interarticular l.
Intertransverse l.
Intervertebral disc
Superior costotransverse l.
Posterior longitudinal l.**
Supraspinous l. Posterior sacral foramina
Greater sciatic foramen Iliofemoral l.
Joint of head of rib (opened)
Posterior sacroiliac l.l.
Great trochanter
Posterior sacrococcygeal l.
Ischiofemoral l.
Nucleus pulposus**
Styloid process
Supraspinous l.**
Mandible
Ligamentum flavum**
LUMBAR SPINE
Nucleus pulposus**
Intervertebral disc** Superior articular process
Anterior longitudinal l.**
Sacrospinous l. Sacrotuberous l.
Lesser trochanter
Vertebral body**
PELVIS (SUPERIOR VIEW)
Interspinous l.** Intertransverse l.
L4
Sacrolumbar l.
Lamina Auricular surface Intertransverse l.
Spinous process
Sacrum
Articular capsule
L4
Transverse process
STERNOCLAVICULAR & SHOULDER Superior Clavicle transverse scapular l. Costoclavicular l.
Anterior sternoclavicular l. Interclavicular l.
1st rib** Costal cartilages**
Posterior sacrococcygeal profundis l.
Coccyx
Ligamentum flavum
Coracoclavicular l.: conoid part Trapezoid part Acromioclavicular l. Acromion Coracoacromial l. Supraspionus tendon** Coracohumeral l.
Greater trochanter Iliofemoral l.
Superior pubic l. Obturator foramen
Intertubular synovial sheath Humerus** Scapula Radiate Glenohumeral l. sternocostal l.
Biceps brachii tendon (long head)**
Superior pubic ramus
Inferior pubic ramus
ELBOW (LATERAL VIEW) Humerus**
Annular l.
Radius** Articular capsule
Femur**
Lesser trochanter
(ANTERIOR VIEW) Humerus**
Biceps brachii tendon**
Articular capsule
Medial epicondyle
Lateral epicondyle Radial collateral l.
Subscapularis tendon**
2nd rib**
Sternal synchondrosis
Inguinal l. Anterior inferior iliac spine Lesser sciatic foramen
Lineaterminalis Pubic symphysis
Bursal openings
Manubrium**
Anterior superior iliac spine
Pubic tubercle
Inferior articular process L5
Iliac crest Arcuate line (pelvic rim)
Sacrospinal l. Anterior sacrococcygeal l. Sacrotuberal l.
Posterior sacrococcygeal superficialis l.
Lateral sacrococcygeal l.
Iliolumbar l.
Greater sciatic foramen Promontory
Articular capsules Posterior longitudinal l.**
Interspinal l.
L5
Anterior longitudinal l.**
Vertebrae (L5)
Intertransverse l.
Obturator membrane Ischial tuberosity
Zona orbicularis
Femur **
Ventral sacroiliac l. Annulus fibrosus
Sternocostal interarticular l.
Ligamentum flavum
Anterior superior iliac spine
Spinous process**
Joint capsule
Articular disc
Articular capsules
Iliac crest
Annulus fibrosus**
Clavicle**
Superior articular facet
Intervertebral disc
Inferior costal facet
Radiate l. of head of rib
Axis (C2)
PELVIS (POSTERIOR VIEW)
Costal facet
Anterior longitudinal l.**
Hyoid bone
Inferior longitudinal fascicles Transverse l. of atlas Superior longitudinal fascicle
{
Transverse costal facet (T1)
Transverse foramen
Ligamentum flavum
Deeper (accessory) portion of tectorial membrane
Stylomandibular l. Mandible (transparent)
Posterior atlanto-occipital membrane
Capsule of lateral atlantoaxial joint
Spinous process (C6)
Transverse process (C7)
Atlas (C1)**
Capsule of atlanto-occipital joint
Articular capsules of zygoapophyseal joints
Atlantoaxial l.
Styloid process
Base of skull**
Posterior atlantooccipital membrane Capsule of atlantooccipital joint
Joint capsule
CRANIOCERVICAL
Tectorial membrane**
Occipital bone
Cruciform l.
BarCharts, Inc. ®
Annular l.
Triceps brachii tendon**
Radial collateral l.
Ulna**
Interosseous membrane**
Ulnar collateral l.
Biceps brachii tendon**
Oblique cord
Radius**
Interosseous membrane**
Ulna**
WRIST & HAND (PALMAR VIEW)
HIP LIGAMENTS
Deep transverse metacarpal l.l.
Sesamoid Joint capsules
Symphysis pubis
HIP LIGAMENTS (OPENED) Epiphysial Acetabular line** labrum (lip) Femoral head cartilage**
Inguinal l.
Pubic tubercle
Pubofemoral l.
Palmar l.l. (palmar plates)
Iliofemoral l. (Y l. of Bigelow)
Collateral l.l.
Cancellous bone
Fat pad**
Joint capsule
Great trochanter
Pubocapsular l.
Palmar carpometacarpal l.l. Hamatometacarpal l.
Fl. retinaculum**
Hamulus of hamate Radiate carpal l. Pisohamate l. Pisometacarpal l. Pisiform
Tubercle of trapezium
Great trochanter
Obturator membrane Transverse acetabular l.
Tubercle of scaphoid
Tuberosity of ischium
Ulnar collateral l. Palmar radiocarpal l.
Distal radioulnar joint capsule
Interosseous membrane** Radius
Ulna
WRIST (DORSAL VIEW)
Dorsal carpometacarpal l.l. Hamate
Metacarpal 1 Trapezoid
Dorsal intercarpal l.l. Scaphoid Radial collateral l.
Medial
epicondyle
Interosseous membrane**
Carpometacarpal articulation & l.l. Metacarpal 4
Intercarpal articulation & l. Radiocarpal Lunate articulation & l. Radius
Collateral l.l. Deep transverse metacarpal l.
Palmar plate l.
Hamate & hamulus
Carpal tunnel Pisiform Fl. retinaculum**
RIGHT FOOT (LATERAL VIEW) Anterior tibiofibular l.
Fibula**
Dorsal talonavicular l.
Superior ex. retinaculum Anterior talofibular l.
Tibial (medial) collateral l.
Fibular (lateral) collateral l.
Posterior cruciate l.
Superior peroneal retinaculum Calcaneal (Achilles) tendon**
Tibia
Lateral condyle of the tibia
Fl. hallucis longus tendon** Collateral l.l. Joint capsules
Deep transverse metatarsal l.
Sesamoids
Plantar l.l. (plates)
Peroneus brevis tendon**
Inferior peroneal retinaculum Long plantar l.
Peroneus longus tendon**
Dorsal calcaneocuboid l.
NOTE TO STUDENT Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2002, 2005 BarCharts Inc. 0608
Customer Hotline # 1.800.230.9522
Dorsal metatarsal l.l. Dorsal cuneocuboid l.l.
Tibial (medial) collateral l. Tibial tuberosity
{
Inferior ex. retinaculum Dorsal talonavicular l.
Posterior talocalcaneal l.
Ex. hallucis longus tendon**
Tibialis anterior Plantar cuneonavicular l.
Dorsal cuneonavicular l.l. Dorsal intercuneifom l. Medial cuneiform Plantar cuboidnavicular l. Dorsal tarsometatarsal l.l. Collateral l.l. Plantar calcaneonavicular l. Ex. hallucis Tibia (medial malleolus) longus tendon** Tibialis posterior tendon** Fl. digitorum longus tendon** Fl. hallucis longus tendon**
Superior peroneal retinaculum
Fl. retinaculum Fl. digitorum brevis**
ISBN-13: 978-142320732-0 ISBN-10: 142320732-7
Tibia
Tibia** Medial taloPosterior tibiotalar l. calcaneal l. Tibiocalcaneal l. Fibula** Inferior longitudinal fascicles Talus Anterior tibiotalar l.
Medial cuneiform
Inferior peroneal retinaculum
Calcaneus
Patellar l.
RIGHT FOOT (MEDIAL VIEW)
Metatarsal 1
Metatarsal 5
Fibula (lateral malleolus)
Calcaneofibular l.
Anterior l.l. of the fibular head
Fibula
Long plantar l. Posterior talocalcaneal l.
Medial condyle of the tibia
Posterior l.l. of the fibular head
Plantar metatarsal l.l. Dorsal cuneonavicular Plantar l.l. tarsometatarsal l.l. Dorsal intercuneiform Cuboid l.l. Peroneus longus Dorsal tarsometatarsal l.l. tendon Peroneus brevis tendon Plantar calcaneocuboid l.
Posterior talofibular l.
Medial meniscus
Head of the fibula
Fl. digitorum brevis tendon**
Bifurcate l. Dorsal cuboidnavicular l.
Medial condyle of the femur
Head of the fibula
RIGHT FOOT (INFERIOR VIEW)
Interosseus talocalcaneal l.
Tibia**
Lateral meniscus Fibular (lateral) collateral l.
Lateral meniscus
Tibialis Posterior Fl. digitorum longus tendon**
Inferior ex. retinaculum
Ex. (hallucis) longus tendon**
Medial epicondyle
Lateral condyle of the tibia
Medial condyle of the tibia
FINGER (MEDIAL VIEW)
Adductor tubercle
Lateral epicondyle
Posterior meniscofemoral l.
Medial meniscus
Femur
Lateral condyle of the femur
Anterior meniscofemoral l.
Intercondyler fossa
Ulna**
Patella
Intercondyler line Lateral condyle of the femur (articular surface) Anterior cruciate l. Lateral epicondyle
Adductor tubercle
Marrow cavity
KNEE LIGAMENTS (FRONT) Femur
Medial condyle of the femur (articular surface)
Capitate
Trapezium
Femur**
Popliteal surface
Pisiform Triquetrum Ulnar collateral l. Distal radioulnar joint capsule
Femur shaft
Lesser trochanter
KNEE LIGAMENTS (BACK)
Metacarpal 5
Dorsal metacarpal l.l.
Dorsal radiocarpal l.l. Radius**
Ischiocapsular l.
Intertrochanteric line & capsule attachment
Lesser trochanter
Deltoid l.
Palmar ulnocarpal l.
Bony trabeculi
Interarticular round l.
Capitate
Lunate
Joint capsule
Zona orbicularis
Acetabular cartilage**
Capsular l. Palmar metacarpal l.l.
Hip capsule
Calcaneal (Achilles) tendon** Superior ex. retinaculum Navicular
Phalanges Peroneus longus tendon
Articular capsules
Sesamoid Metatarsal 1 Plantar l.l. (plates) Deep transverse metatarsal l.
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Calcaneus Long plantar l.
Plantar calcaneocuboid l. Tibialis anterior tendon**
WORLD’S #1 ACADEMIC OUTLINE
BarCharts, Inc. ®
LYMPHATIC SYSTEM
HEAD & NECK Occipital nodes ** = a. = L. = l. = m. = R. = v. = v.v. =
cut artery Left ligament muscle Right vein veins
R. lymphatic trunk
ARM AXILLA & THORAX Central axillary nodes
Parotid lymph nodes
Retroauricular nodes Superficial parotid nodes Posterior submandibular node Brachiocephalic v.** Buccal node Intercostal nodes
Jugulodigastric nodes
Brachial nodes
Axillary lymph nodes Subscapular nodes
Submental nodes
Upper deep cervical nodes (jugular)
Lymphatic vessels
Submandibular nodes
Lower deep cervical nodes
Interpectoral nodes
Intestinal nodes
Cubital lymph nodes
Paramammary nodes
Cisterna chyli
Suprahyoid node
Transverse cervical nodes
Pathways to opposite breast
R. lymphatic duct Para-aortic nodes
Subclavian chain of nodes
Parasternal nodes
Subclavian nodes
Cervical lymph nodes
L. thoracic duct
Internal jugular nodes
Common iliac nodes
Pathways to subdiaphragmatic nodes
THORACIC DUCT Palmar vessels
Inguinal lymph nodes
NODES & VESSELS Efferent lymphatic vessels**
R. subclavian lymph trunk
Medulla
Superficial lymph Superior vessels vena cava
V. & a. of node** Medullary sinus Hilum Direction of lymph flow
Afferent lymphatic vessels**
R. jugular trunk R. lymphatic duct
Popliteal lymph nodes
Medullary cords
L. jugular trunk
Cortex Intercostal lymph nodes
Germinal center in follicle
Reticulin Capsule Subcapsular sinus
Vascular pattern
Brachiocephalic v.** Accessory hemiazygos v. Intercostal lymph nodes Thoracic duct
Marginal zone
Trabecula
L. subclavian lymph trunk
Azygos v.
Follicle Valve
Thoracic duct
Posterior intercostal v.v.
Direction of lymph flow Tunica adventicia
Hemiazygos v.
Lymph capillary R. lumbar trunk
Capillary bed
Precapillary sphincter
Subcostal v.
Tunica media
Tunica intima
Lateral aortic lymph nodes
Cisterna chyli
Arteriole** Venule** Minivalve (lymphatic fluid entrance port) Filament to connective tissue
Plantar vessels Intestinal trunk
Endothelial cell Retroaortic lymph nodes
Lateral aortic lymph nodes L. lumbar trunk
LARGE INTESTINE
DEEP ABDOMINAL & INGUINAL NODES L. gastric a.
Thoracic duct**
Superior mesenteric nodes Cardiac ring of nodes
Hepatic v.v.**
Thoracic duct**
Cisterna chyli
Celiac nodes
Celiac node Inferior vena cava**
Epicolic nodes
Abdominal aorta
Thoracic duct
L. lumbar trunk
Cisterna chyli
L. lumbar nodes
R. lumbar trunk
Subaortic common iliac nodes
Inferior vena cava**
Common iliac nodes
Lateral common iliac nodes
Paracolic nodes Middle colic nodes
R. colic nodes Paracolic nodes Ileocolic nodes
Inferior mesenteric nodes
Sacral nodes
Intermediate external iliac nodes
Interiliac external iliac node
Highest deep inguinal node (Rosenmuller or Cloquet)
Cecal nodes
L. colic nodes
Internal iliac nodes
Inguinal l.
Superolateral superficial inguinal nodes
Deep inguinal nodes Fascia lata
Inferior superficial inguinal nodes
Cremaster m.**
Cut fascia
Cribiform fascia
Sigmoid colon**
Paracolic nodes Appendicular nodes
Common iliac nodes
Aorta**
Superior rectal nodes
HEART & LUNGS
L. gastric nodes L. superior pancreatic nodes
Thoracic duct**
Preaortic nodes
Great saphenous v.
STOMACH & PANCREAS Esophagus**
Sigmoid nodes
Diaphragm**
Celiac nodes
Splenic nodes
Cisterna chyli
R. tracheal nodes Inferior deep cervical node
L. tracheal nodes Inferior deep cervical node
L. brachiocephalic v.**
Thoracic duct
Subclavian chain of nodes
R. brachiocephalic v.**
R. superior tracheobronchial nodes
Aortic arch node L. superior tracheobronchial nodes
Inferior tracheobronchial nodes
R. superior pancreatic node
Bronchopulmonary (hilar) nodes
Pulmonary nodes
Suprapyloric nodes
Subpleural lymph plexus
Subpleural lymphatic plexus
Bronchopulmonary (hilar) nodes
Interlobular lymph vessels
Pyloris L. gastroepiploic (gastro-omental) node Pancreas (behind stomach)
Infrapyloric nodes
R. gastroepiploic (gastro-omental) nodes
Head of pancreas Stomach (transparent)
Superior mesenteric nodes Duodenum
Superior mesenteric a.** Preaortic nodes
NOTE TO STUDENT
Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher.
©2002, 2005 BarCharts Inc. 0807
ISBN-13: 978-142320734-4 ISBN-10: 142320734-3
Pulmonary nodes
Interlobular lymph vessels
Heart (transparent)
Retrocardiac nodes Anterior mediastinal nodes
CREDITS
Images ® Vincent Perez perezstudio.com Layout: Dominic Thompson
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L. gastric nodes
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Infracardial nodes
BarCharts, Inc.®
FOUNDATION OF MEDICAL WORDS A. Structure Most medical words are composed of two or more terms. To define a medical word: • divide the word into its terms • analyze the terms • define the word Examples: Pericarditis peri = around; card = heart; itis = inflammation Inflammation around the heart Oncology onco = tumor, mass; logy = study of Study of tumors
B. Terms Term + Term (.....+.....) = medical word There are five categories of terms: 1.Prefix - beginning of a word (ex., pre____; post_____) Designated by a “____” after the term. 2.Suffix - ending of a word (ex., _____stomy; _____itis) Designated by a “____” before the term. 3.Root - foundation/base of a word (ex., hepat; gastr) 4.Combining vowel - vowel (usually “o”) added to a root (ex., gastro). Use a combining vowel when joining: a. Root to another root (ex., gastrohepatitis) b. Root to a suffix beginning with a consonant (ex., cardiomegaly)
5.Combining form - root + vowel (ex., hepat/o; gastr/o) Designated by a “/” between the root and the vowel Examples: Hyperleukocytosis hyper (prefix) = excessive leuko (combining form) = white cyt (root) = cell osis (suffix) = condition of Definition: condition of excessive white blood cells (leukocytes) Hematotoxic hemato (combining form) = blood tox (root) = poison ic (suffix) = pertaining to Definition: pertaining to blood poisoning
TIPS: 1.Some terms have more than one definition. To determine the correct definition in a particular medical word, analyze the other terms in the word. Example: Poliomyelitis polio = gray (matter) myel = spinal cord, bone marrow itis = inflammation Definition: Inflammation of the gray matter of the spinal cord. The bone marrow does not have gray matter. 2.Some terms may function as a root/combining form in one word and a suffix in another word. Classification depends upon the specific medical word. Examples: Cytology cyto (combining form) = cell logy (suffix) = study of Definition: Study of cells Erythrocyte erythro (combining form) = red cyte (suffix) = cell Definition: Red blood cell
WORLD’S #1 ACADEMIC OUTLINE
THE HUMAN BODY A. Development Cells - tissues - organs - systems - organism 1.Cells: Major Components a. Cell membrane b. Cytoplasm c. Nucleus
-genesis
2.Tissues: Primary Types a. Connective b. Epithelium c. Muscle d.Nervous
3.Organs a. Composed of two or more different tissues b. Have specific functions
4.Systems: Related organs with common functions 5.Organism: A living person
B. Cavities A space containing organs 1.Dorsal a. Cranial b. Vertebral (spinal)
2.Ventral a. Abdominal b. Pelvic c. Thoracic
C. Planes An imaginary flat surface 1.Frontal – anterior/posterior 2.Sagittal – right/left 3.Transverse – upper/lower
D. Positions A reference point for location or direction. 1.Anterior/Ventral – front of the body Posterior/Dorsal – back of the body 2.Deep – away from the surface Superficial – on the surface 3.Inferior – situated below Superior – situated above 4.Lateral – pertaining to the side 5.Medial – pertaining to the middle 6.Prone – lying face down Supine – lying face up TERMS acu-algia anomal/o anthrop/o
DEFINITIONS needle pain irregular man, human being
antr/o aque/o axi/o bar/o bio-, bi/o blast/o, -blast
antrum water axis weight, pressure life, living early embryonic stage, immature heat cancer down, downward tail chemical, chemistry time, timing deep sleep body cold cell back to lead power, strength pain
calor/i carcin/o catacaud/o chem/o chron/o -coma corpor/o cry/o cyt/o, -cyte dors/o duct/o dynam/o -dynia
equieti/o fil/i, fil/o -form
1
WORDS acupuncture cephalalgia anomaly anthroposomatology antrotomy aqueous axial barotaxis biogenesis blastocyte calorimetry carcinoma catabiotic caudal chemosurgery chronobiology semicoma corporeal cryotherapy cytology dorsoventral conduction dynamogenesis gastrodynia
ger/o, geront/o gymn/o -hexia hist/o hydr/o iatr/o -ician ion/o kary/o kel/o -labile later/o -logist -logy -lucent lumin/o ly/o medi/o medic/o mer/o mesomorph/o nom/o nomennos/o nucle/o nutri/o -oma onc/o organ/o path/o pharmac/o physi/o -plasm -poiesis prote/o psamm/o -puncture pyr/o pyret/o sanit/a scirrh/o somat/o -some spectr/o system/o techn/o temp/o, tempor/o the/o -therapy, therapeut/o therm/o -tumescence, tumesc/o -type, typ/o ventr/o -verse vir/o viscer/o vit/o zyg/o
equality, equal equilibrium cause etiology thread filopressure specified shape, multiform form production, neogenesis formation aged, old age geriatrics naked gymnophobia condition cachexia tissue histoclastic water, hydrogen hydrolysis treatment, physician iatrogenic specialist clinician ion ionogram nucleus karyorrhexis tumor, fibrous keloid growth unstable, perishable frigolabile side bilateral specialist neurologist study of cardiology light-admitting radiolucent light luminescence dissolve, loosen lyophilic middle medial heal, healing medical part meromicrosomia middle mesoderm shape, form dolichomorphic custom, law nomotopic name nomenclature disease nosology nucleus nucleoplasm to nourish nutrition tumor, mass histocytoma tumor, mass oncogenesis organ organomegaly disease pathogenic drugs pharmacology nature physiologist formation, growth neoplasm formation cytopoiesis protein proteolysis sand, sand-like psammoma material to pierce a surface venipuncture fire, fever, heat pyrogen fever pyretogenic health sanitarian hard scirrhoma body somatoscopy body chromosome image, spectrum spectrocolorimeter system systematic art, skill technology time, the temples tempostabile a god treatment
theotherapy therapeutics
heat swelling
thermometer detumescence
class, representative form belly, front of the body turn virus internal organs life union, junction
somatotype ventrolateral transverse virologist visceromegaly vitamin zygogenesis
TERMINOLOGY SETS A. DIRECTIONAL TERMS abaway from adtoward, near ambiaround, on both sides amphiaround, on both sides anaupward, backward antebefore, forward anter/o front antiagainst apoaway, separation catadown, downward circumaround contraagainst, opposite dextr/o right diathrough, apart disapart, to separate ec-, ectooutside, out en-, endoinside, within epiabove, over, upon esowithin exout, away from exooutside of, outward extraoutside forebefore, in front of hyperabove, excessive, beyond hypounder, deficient, below infrabelow, beneath interbetween intrawithin juxtanear later/o side levoleft medi/o middle mesomiddle paraalongside, near, beyond, abnormal perthrough, throughout periaround, surrounding postafter, behind poster/o behind, towards the back prebefore, in front of probefore proxim/o near retrobehind, backward sinistr/o left subunder, beneath superabove, beyond supraabove, beyond tel/e distant, end transacross B. FIVE rrh’s -rrhagia, -rrhage -rrhaphy -rrhea -rrhexis rrhythm/o
excessive flow suture flow, discharge rupture rhythm
C. NUMERICAL VALUES half demihemisemione monounione and a half sesquitwo bidithree trifour tetraquadrifive quinquepentpentasix hexhexasex-
heptaseptseptieight octaoctinine noniten (101) decahundred (102) hectothousand (103) kilomillion (106) megabillion (109) gigatrillion (1012) teraquadrillion (1015) petaquintillion (1018) exaone tenth (10-1) decione hundredth (10-2) centione thousandth (10-3) millione millionth (10-6) microone billionth (10-9) nanoone trillionth (10-12) picoone quadrillionth (10-15) femtoone quintillionth (10-18) attoseven
D. SURGICAL PROCEDURES -centesis surgical puncture of a cavity -desis surgical fixation, fusion -ectomy surgical removal -pexy fixation -plasty surgical correction/repair -rrhaphy suture -sect to cut -stomy surgical opening -tomy surgical incision -tripsy to crush, break E. PATHOGENS acar/o arachn/o bacteri/o -coccus fung/i helminth/o, -helminth hirud/i, hirudin/i ixod/i myc/o parasit/o pedicul/o scolec/o verm/i vir/o
mites spider bacteria berry-shaped bacterium fungus, mushroom worm leech ticks fungus parasite louse worm worm virus
SKELETAL SYSTEM A. Bones 1.Formation – Ossification 2.Types – Long/short/flat/irregular 3.Tissues – Compact/spongy (cancellous) 4.Markings – Depressions/openings/projections 5.Axial skeleton a. Skull b. Vertebral column c. Thoracic cage
6.Appendicular skeleton a. Upper extremities b. Lower extremities c. Pectoral girdle d.Pelvic girdle
B. Joints/articulations 1.Structural classification a. Fibrous b. Cartilaginous c. Synovial
2.Functional classification a. Synarthroses b. Amphiarthroses c. Diathroses 2
TERMS ankyl/o arthr/o articul/o brachi/o burs/o calcane/o carp/o centr/o cephal/o cervic/o chir/o, cheir/o chondr/o cleid/o coccyg/o cost/o cox/o crani/o cubit/o dactyl/o euryfaci/o femor/o fibul/o geni/o gnath/o gnos/o goni/o gyr/o holohumer/o hypsiili/o ischi/o ithykyph/o lamin/o lip/o -listhesis lord/o lox/o lumb/o maxill/o mega-, megalo-megaly mel/o om/o opisth/o oste/o panpatell/o ped/o pelv/i perone/o petr/o phalang/o -physis pod/o -porosis pub/o rachi/o sacr/o scapul/o scoli/o skelet/o spin/o spondyl/o stern/o synov/o tal/o tars/o tibi/o vertebr/o xiph/o
DEFINITIONS WORDS stiff, crooked, bent ankylosis joint arthrodysplasia joint articulation arm brachiocephalic bursa bursolith heel calcaneodynia wrist carpoptosis center centrosclerosis head cephaledema neck, cervix cervicofacial hand chiropodalgia cartilage chondrodystrophy clavicle cleidorrhexis coccyx coccygodynia rib costosternal hip coxarthrosis skull cranioclast elbow, forearm genucubital digit (finger or toe) dactylospasm wide, broad eurycephalic face facioplasty femur ischiofemoral fibula fibulocalcaneal chin genioplasty jaw gnathoschisis knowledge acrognosis angle goniometer circle, spiral gyrospasm entire, complete holoarthritis humerus humeroradial high hypsicephaly ilium iliolumbar ischium ischiodynia erect, straight ithylordosis humpback kyphoscoliosis lamina laminectomy fat lipochondroma slipping spondylolisthesis curvature, bending lordoscoliosis oblique, slanting loxarthron loin lumbodynia maxilla maxillotomy large megalopodia enlargement dactylomegaly limb, limbs melalgia shoulder omodynia backward, behind opisthognathism bone osteochondroma all panarthritis patella patellofemoral foot, child pedal pelvis pelvimeter fibula peroneotibial stone, petrous region petromastoid of temporal bone phalanges phalangitis growth, growing diaphysis foot podiatrist porous, decrease osteoporosis in density pubis pubovesical spine rachioplegia sacrum sacrocoxalgia scapula scapulopexy crooked, twisted scoliorachitic skeleton skeletogenous spinal cord, spine spinocerebellar vertebrae spondylopyosis sternum sternocostal synovia, synovectomy synovial membrane talus talofibular tarsus, edge of eyelid tarsoclasis tibia tibiotarsal vertebra vertebrosternal sword-shaped, xiphocostal xiphoid
NERVOUS SYSTEM A. Cells 1.Neuron – Dendrites, cell body, axon 2.Neuroglia (glial)
B. Central Nervous System (CNS) 1.Brain – Cerebrum, cerebellum, brainstem, diencephalon 2.Spinal cord – Ascending/descending tracts 3.Membranes (meninges) – Dura mater, arachnoid, pia mater 4.Cerebrospinal Fluid (CSF)
C. Peripheral Nervous System (PNS) 1.Cranial nerves (12 pairs) 2.Spinal nerves (31 pairs) 3.Afferent (sensory) division: sensory receptors 4.Efferent (motor) division a. Somatic nervous system (voluntary) b. Autonomic nervous system (involuntary)
i. Sympathetic nervous system ii. Parasympathetic nervous system TERMS -algesia, alges/o astr/o atel/o -bulia, -boulia cerebell/o cerebr/o -crasia drom/o, -drome encephal/o esthesi/o, -esthesia gangli/o, ganglion/o gli/o heli/o hydr/o hypn/o hypothalam/o keraun/o klept/o -lemma -lepsy -lexia log/o, -log, -logue -mania medull/o mening/o ment/o -mnesia myel/o narc/o neur/o noci-noia -paresis phaner/o -phobia, phob/o phren/o picr/o piez/o, pies/i, -piesis -plegia
DEFINITIONS pain sensitivity star, star shaped incomplete, imperfect will cerebellum cerebrum, brain mixture (good or bad), temperament running
WORDS analgesia astrocytoma atelomyelia abulia cerebellospinal cerebroid eucrasia
brain sensation, feeling
encephalomalacia esthesioneurosis
ganglion
gangliocytoma
dromotropic
glue, neuroglia sun water, hydrogen sleep hypothalamus
gliocyte heliophobia hydrocephalocele hypnogenic hypothalamohypophysical lightning keraunoneurosis theft, stealing kleptomania confining membrane epilemma seizure epilepsy speech, word bradylexia word, speech, logorrhea thought madness, obsessive hypomania preoccupation medulla, marrow medulloblast meninges, meningocele membranes mind dementia memory ecmnesia bone marrow, myelocele spinal cord numbness, stupor narcoanesthesia nerve neurotripsy to cause harm, nociceptor injury or pain mind, will paranoia partial paralysis hemiparesis visible, apparent phaneromania fear, aversion phobophobia mind, diaphragm bitter pressure paralysis
tachyphrenia picrotoxin piesesthesia quadriplegia
poli/o -pore -praxia psych/o psychr/o radicul/o rhiz/o schiz/o somn/i, -somnia syring/o tauto-taxia, tax/o tel/o tephr/o thanat/o thec/o vag/o
gray (matter) opening, passageway action, activity mind cold nerve root root split, division sleep tube, fistula identical, same arrangement, coordination end gray (ashen) death sheath vagus nerve
poliomyelitis neuropore parapraxia psychokinesis psychrophobia radiculitis rhizotomy schizophasia insomnia syringomyelocele tautomeral dystaxia telodendron tephromyelitis thanatomania neurothecitis vagolysis
MALE REPRODUCTIVE SYSTEM A. Scrotum Sac containing the testes
B. Testes 1.Seminiferous tubules - spermatozoa 2.Interstitial cells - testosterone
C. Ducts 1.Epididymis 2.Vas deferens/ductus deferens 3.Ejaculatory duct 4.Urethra
D. Penis Erectile tissue
E. Glands 1.Seminal vesicles 2.Prostate gland 3.Bulbourethral (Cowper’s) gland
F. Secretion Semen 1.Sperm 2.Glandular secretions TERMS andr/o balan/o -cele -cide crypt/o epididym/o genit/o gon/o gonad/o olig/o orch/o, orchi/o, orchid/o osche/o phall/o phim/o prostat/o semin/i sperm/o, spermat/o test/o, testicul/o vas/o venere/o vesicul/o zo/o
2.Ureters - Tubes 3.Bladder - Trigone 4.Urethra - Tube
B. Urine 1.Formation - Filtration, reabsorption, secretion 2.Composition - Water, nitrogenous waste, salts, other substances TERMS a-, analbumin/o ammon/o -atresia atretoazot/o calci/o cali/o cupr/o cyan/o cyst/o -ectasis, -ectasia fusc/o glomerul/o keton/o lith/o nephr/o noct/i py/o pyel/o ren/o uric/o ur/o -uresis ureter/o urethr/o -uria urin/o vesic/o
DEFINITIONS without, not albumin ammonium closure, occlusion closed, lacking an opening nitrogen, urea calcium calyx copper blue bladder, cyst dilation, expansion dark brown glomerulus ketones stone, calculus kidney night pus renal pelvis kidney uric acid urine urination ureter urethra urine condition urine urinary bladder
WORDS anuria albuminometer ammonuria urethratresia atretocystia azoturia hypocalciuria pyelocaliectasis cupruresis urocyanosis cystogram nephrectasia urofuscohematin glomerulopathy ketonuria pyelolithotomy nephrotoxic noctalbuminuria pyocalix pyelophlebitis renogastric uricosuria uroerythrin diuresis ureterocolostomy urethrorrhagia pyuria urinalysis vesicoclysis
FEMALE REPRODUCTIVE SYSTEM A. Ovaries
DEFINITIONS male glans penis hernia, swelling killing, agent which kills hidden, concealed epididymis reproduction genitals gonads scanty, few, little testis
WORDS androgen balanoblennorrhea hydrocele spermicide
scrotum penis muzzle prostate gland semen spermatozoa
oscheoplasty phallodynia paraphimosis prostatocystotomy seminiferous spermatogenesis
testis vas deferens, vessel sexual intercourse seminal vesicle animal
testectomy vasovasostomy
cryptorchism epididymectomy genitourinary gonocyte gonadogenesis oligospermia orchidopexy
venereologist vasovesiculitis azoospermia
URINARY SYSTEM A. Organs 1.Kidneys - Cortex, medulla, nephron, collecting duct, renal pelvis 3
1.Oocyte development 2.Ovulation
B. Fallopian tubes/uterine tubes Fertilization
C. Uterus 1.Wall a. Perimetrium b.Myometrium c. Endometrium
2.Parts a. Fundus b. Body c. Cervix
D. Vagina Hymen
E. External genitalia/vulva 1.Labia majora/minora 2.Clitoris 3.Bartholin’s glands
F. Breasts 1.Mammary glands 2.Nipple 3.Areola 4.Lactation
G. Menstrual cycle 1.Phases 2.Hormonal interaction 3.Cessation
TERMS amni/o cervic/o chori/o -clasis, -clast, -clasia colp/o culd/o -cyesis embry/o episi/o fet/o galact/o gravid/o -gravida gynec/o helc/o hymen/o hyster/o lact/o lecith/o -lipsis mamm/o mast/o men/o metr/o nat/o neonullio/o obstetr/o omphal/o oophor/o ov/o, ov/i ovari/o -para, -parous -partum perine/o
DEFINITIONS amnion neck, cervix chorion break, breaking
C. Circulation
G. Pancreas Endocrine/exocrine tissue
1. Pulmonary 2. Systemic
H. Large intestine Parts - cecum, colon, rectum, anus
D. Blood pressure vagina cul-de-sac pregnancy embryo vulva fetus milk pregnancy pregnant woman woman, female ulcer hymen uterus milk yolk, ovum omit, fail breast breast menses, menstruation uterus birth new none egg, ovum midwife navel ovary egg, ovum ovary to bear, bring forth childbirth, labor perineum
phys/o sacchar/o
deformed, maimed air, gas sugar
salping/o terat/o thel/o toc/o, -tocia tub/o uter/o vagin/o viv/i vulv/o
fallopian tube monster nipple childbirth, labor tube uterus vagina life, alive vulva
per/o
WORDS amnioscopy cervicovaginitis chorioadenoma cranioclasis
CARDIOVASCULAR A. Heart 1.Four chambers a. Two upper (atria) b. Two lower (ventricles)
2.Wall a. Endocardium b. Myocardium c. Pericardium
3.Two partitions a. Interatrial septum b. Interventricular septum
4.Four valves a. Atrioventricular
i. Tricuspid ii. Bicuspid (mitral) b. Semilunar
i. Pulmonary ii. Aortic
B. Blood vessels 1. Arteries - arterioles 2. Veins - venules 3. Capillaries
colporrhaphy culdoscopy ovariocyesis embryopathy episiostenosis fetography galactacrasia gravidocardiac unigravida gynecography helcomenia hymenitis panhysterectomy lactorrhea centrolecithal menolipsis mammography mastalgia menorrhagia myometritis neonatology neonatal nulliparity oogenesis obstetrician omphalocele oophorohysterectomy ovicide ovariocentesis septipara postpartum colpoperineoplasty peromelia physometra saccharogalactorrhea salpingocyesis teratogenesis thelorrhagia dystocia tuboplasty uterolith vaginography viviparous vulvopathy
TERMS abdomin/o
1.Systole (contraction) 2.Diastole (relaxation)
E. Pulse Rhythmical expansion and contraction of an artery as a result of the heart contraction
F. Electrical/Conduction system 1.Components - SA node - AV node - bundle of His - bundle branches - Purkinje fibers 2.Measurement - EKG/ECG TERMS aneurysm/o angi/o aort/o arteri/o arteriol/o
DEFINITIONS aneurysm vessel aorta artery arteriole
ather/o
fatty substance, plaque atrium slow heart movement irrigation, washing heart embolus suppress, restrain enlargement less, smaller movement, motion flutter, throbbing
atri/o bradycardi/o cine-clysis coron/o embol/o isch/o -megaly mi/o -motor palpit/o, palpitat/o phleb/o presbyrhe/o
vein aging, elderly flow, current, stream -spasm involuntary contraction sphygm/o pulse -sphyxia pulse -stenosis narrowed, constricted tachyfast tel/e end, distant -tension stretched, strained valv/o, valvul/o valve varic/o varicose veins vas/o vessel, vas deferens vascul/o vessel ven/o vein ventricul/o ventricle of the heart or brain venul/o venule
WORDS aneurysmectomy angioblast aortomalacia arteriolith arteriolosclerosis atheroma atrioseptopexy bradycardia cardioptosis cineangiograph venoclysis coronary embolectomy ischemia atriomegaly miocardia venomotor palpitation phleborrhexis presbycardia rheocardiography vasospasm sphygmoscope asphyxia aortostenosis tachycardia telecardiography hypertension valvulotome varicophlebitis vasohypotonic vasculitis venography ventriculogram venular
GASTROINTESTINAL SYSTEM A. Oral cavity Tongue, teeth, hard/soft palate, gums, salivary glands
B. Pharynx C. Esophagus D. Stomach 1.Sphincters 2.Parts - fundus, body, pylorus
E. Small intestine Parts - duodenum, jejunum, ileum
F. Liver Right and left lobes 4
DEFINITIONS abdomen
WORDS abdominocentesis cholagogue dentagra amylolysis anorectocolonic arsenicophagy ateloglossia
producer, leader severe pain starch anus arsenic incomplete, imperfect bil/i bile biligenesis bucc/o cheek buccal cec/o cecum cecoileostomy celi/o abdomen celiomyositis cheil/o, chil/o lip cheiloschisis -chezia, -chesia defecation dyschezia chol/e gall, bile cholangiostomy choledoch/o common bile duct choledocholithiasis chyl/o chyle chylopoiesis col/o colon proctocolectomy dent/i tooth dentalgia dips/o thirst adipsia duoden/o duodenum duodenohepatic -emesis vomiting hyperemesis enter/o intestines enteroclysis (small intestines) esophag/o esophagus esophagocele gastr/o stomach dextrogastria ge/o earth, soil geophagia gingiv/o gums gingivoplasty gloss/o tongue glossolalia gluc/o glucose, sugar glucokinetic glyc/o glucose, sugar glycosialorrhea hepat/o liver hepatosplenomegaly idi/o individual, distinct, idioglossia unknown ile/o ileum ileoileostomy jejun/o jejunum jejunorrhaphy lapar/o abdomen, laparoscope abdominal wall lingu/o tongue retrolingual loph/o ridge lophodont odont/o tooth anodontia or/o mouth intraoral -orexia appetite hyperorexia orth/o straight, normal, orthodontist correct palat/o palate palatoplegia -pepsia digestion dyspepsia peritone/o peritoneum peritoneoclysis phag/o, eating, ingestion phagodnamomphagia eter -posia drinking polyposia -prandial meal postprandial proct/o rectum, anus proctopexy ptyal/o saliva ptyalogenic pyl/e portal vein pylemphraxis pylor/o pylorus pyloroplasty pyr/o heat, fire, fever pyrosis rect/o rectum rectocele sial/o saliva sialolith sigmoid/o sigmoid colon sigmoidoscope sit/o food sitophobia splanchn/o viscera splanchnoptosis -stalis contraction peristalsis staphyl/o uvula, grapelike staphylorrhaphy clusters stomat/o mouth stomatomalacia -tresia opening, proctotresia perforation typhl/o cecum, blindness typhlectasis uran/o palate uranoschisis zym/o enzyme, ferment zymolysis -agogue -agra amyl/o an/o arsenic/o atel/o
BLOOD A. Composition 1.Plasma (55%) - Pale, yellow fluid 2.Formed elements (cells) - 45% a. Erythrocytes b. Leukocytes
i. Granulocytes (eosinophils, basophils, neutrophils) ii. Agranulocytes (monocytes, lymphocytes) c. Thrombocytes (platelets)
B. Blood Groups 1.ABO Group a. Types - A/B/AB/O b. Determined by antigen(s) on erythrocyte
2.Rh Group a. Rh+ / Rhb. Presence or absence of Rh antigen on erythrocyte
C. Blood Clotting (coagulation) 1.Chemical reactions 2.Clot prevention 3.Clot retraction TERMS agglutin/o anis/o bas/o, basi/o coagul/o -crit -emia eosin/o erythr/o ferr/i, ferr/o gigant/o -globin granul/o hem/o, hemat/o kal/i leuk/o myel/o natr/o neutr/o norm/o -pheresis -phil, -philia -phore -phoresis phosphat/o poikil/o pykn/o, pycn/o rhod/o sangu/i, sanguin/o sapr/o schist/o, -schisis ser/o sider/o spher/o strept/o thromb/o -volemia
DEFINITIONS clumping unequal
WORDS agglutinophilic anisonormocytosis base, foundation basophil coagulation, coagulopathy clotting separate thrombocytocrit blood condition erythremia red, rosy, dawn eosinopenia red erythrocytoschi sis iron ferrometer huge gigantocyte protein hemoglobin granules agranulocytosis blood hemocytozoon potassium white bone marrow, spinal cord sodium neutral normal, usual removal affinity for, tendency towards bearer, processor bearing, transmission phosphate variation, irregular thick, dense red, rosy blood
hyperkalemia leukocytotoxin myelocytosis hypernatremia neutropenia normochromo cyte plateletpheresis hemophilia siderophore electrophoresis phosphatemia poikiloblast pyknocyte rhodocyte sanguiferous
rotten, decay split, cleft
sapremia schistocyte
serum, serous iron round, sphere twisted, curved clot, thrombus
serosanguineous sideropenia spherocytosis streptococcemia thromboelastogram normovolemia
blood volume
ENDOCRINE SYSTEM A. Characteristics 1.Ductless glands called endocrine glands 2.Glands secrete hormones directly into the blood stream 3.Hormones affect growth/development, reproduction, metabolism
B. Endocrine Glands 1.Pituitary a. anterior b. posterior
lepid/o lepr/o onych/o pachypapul/o perspir/o phyt/o
hollow, concave, depressed flakes, scales leprosy nail thick papule, pimple breathe through plant
pil/o prurit/o pseudo-
hair itching false
psor/o py/o rhytid/o seb/o steat/o sud/o trich/o ul/o ungu/o verruc/i xer/o
itching pus wrinkle sebum fat sweat hair scar, scarring nail wart dry
koil/o
2.Thyroid 3.Parathyroid 4.Adrenal a. medulla b. cortex
5.Pancreas 6.Testes 7.Ovaries 8.Pineal 9.Thymus TERMS acr/o aden/o adren/o cortic/o crin/o hirsut/o hormon/o medull/o myx/o pancreat/o
DEFINITIONS extremities gland adrenal glands cortex secrete, separate hairy hormone medulla, marrow mucus pancreas
parathyroid/o phe/o
parathyroid dusky
pineal/o pituitar/o thym/o thyr/o tox/o, toxic/o -trophy, troph/o
pineal gland pituitary gland thymus gland thyroid gland poison nourishment, growth
WORDS acrogeria adenectopia adrenomegaly corticoadrenal crinogenic hirsutism hormonopoiesis medulloadrenal myxedema pancreatolithotomy parathyroidoma pheochromoctoma pinealopathy pituitarism thymotoxin thyrocele thyrotoxicosis hypertrophy
INTEGUMENTARY SYSTEM A. Skin Layers 1.Epidermis 2.Dermis/corium 3.Subcutaneous/hypodermis
koilonychia lepidosis leproma onychomycosis pachydermatocele papulopustular perspiration phytophotodematitis pilomotor pruritogenic pseudochromhidrosis psoriasis pyodermatitis rhytidectomy seborrhea steatocryptosis sudokeratosis hypertrichosis uloid subungual verrucosis xeroderma
RESPIRATORY SYSTEM A. Upper Respiratory Tract 1.Nose - Nasal cavity, paranasal sinuses 2.Pharynx - Nasopharynx, oropharynx, laryngopharynx
B. Lower Respiratory Tract 1.Larynx - Vocal Cords 2.Trachea - C-shaped rings of cartilage 3.Bronchi a. Right/left bronchus b. Bronchioles - alveoli
4.Lungs a. Lobes - right (3) / left (2) b. Pleura
B. Hair 1.Components
C. Pulmonary Ventilation
a. Shaft b. Root c. Bulb
1.Inspiration/expiration 2.Diaphragm
2.Cycle - Growth/resting
C. Glands 1.Sebaceous/oil - sebum 2.Sudoriferous/sweat a. apocrine b. eccrine
D. Nails Components 1.Free edge 2.Nail body 3.Nail root DEFINITIONS thorny, spiny ray, radiation bromine containing compound, odor caus/o, cauter/o burn, burning -chroia skin coloration chrom/o color chrys/o gold cutane/o skin derm/o, skin dermat/o erythem/o flushed, redness eschar/o scab graph/o writing hidr/o sweat ichthy/o fish iod/o iodine kerat/o horny tissue, cornea TERMS acanth/o actin/o brom/o
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WORDS acanthoma actinodermatitis bromoderma causalgia xanthochroia chromomycosis chrysiasis subcutaneous dermatopathy erythema escharotomy graphesthesia hyperhidrosis ichthyosis iododerm keratolysis
TERMS alveol/o aspir/o, aspirat/o blenn/o brachybronch/o bronchiol/o -capnia, capn/o coni/o epiglott/o lal/o, -lalia lampr/o laryng/o lept/o
DEFINITIONS WORDS alveolus alveolitis inhaling, removal aspiration
mucus short bronchus bronchiole carbon dioxide dust epiglottis speech, babble clear larynx slender, thin, delicate lob/o lobe mediastin/o mediastinum mogidifficult nas/o nose osm/o, sense of smell, -osmia odor, impulse osphresi/o, sense of smell, -osphresia odor ox/o, -oxia oxygen -pagus conjoined twins pector/o chest phas/o, -phasia speech phon/o, -phonia voice, sound phren/o mind, diaphragm pimel/o fat, fatty pleur/o pleura -pnea breathe
blennothorax brachypnea bronchorrhagia bronchiolectasis hypercapnia coniofibrosis epiglottitis laliatry lamprophonia laryngoxerosis leptophonia lobectomy mediastinoscopy mogiphonia nasolabial anosmia osphresiometer hypoxia thoracopagus pectoralgia dysphasia rhinophonia phrenalgia pimelorthopnea pleurocholecystitis hyperpnea
pneum/o pneumon/o -ptosis -ptysis pulmon/o respir/o, respirat/o rhin/o sept/o silic/o sinus/o span/o spir/o steth/o therm/o thorac/o trache/o traumat/o xen/o
lung, air lung, air prolapse, drooping spitting lung breathe, breathing
pneumopexy pneumonomycosis laryngoptosis hemoptysis pulmonologist respirator
nose partition silica, quartz cavity, sinus scanty, scarce breathe chest heat chest trachea trauma, injury, wound strange, foreign
rhinolithiasis septorhinoplasty silicosis sinusotomy spanopnea bronchospirometer stethoscope thermopolypnea thoracoschisis tracheostenosis traumatopnea xenophonia
1.Excitability 2.Contractility 3.Elasticity 4.Extensibility
-pterygium
tenorrhaphy tenontography kinesiotherapy
tone, tension
myatonia
pupill/o retin/o scler/o scot/o son/o staped/o stich/o, -stichia stigmat/o -tropia tympan/o uve/o vitre/o
SPECIAL SENSES: EYE/EAR A. Eye 1.Layers/Tunics a. Fibrous
i. Sclera ii. Cornea b. Vascular
i. Choroid ii. Ciliary body iii. Iris
a. clear, watery fluid b. formed from interstitial fluid
2.Lymphatic Vessels - Valves 3.Lymphatic Organs a. Tonsils
i. palatine ii. pharyngeal iii. lingual b. Lymph Nodes - concentration of nodes
i. inguinal ii. axillary iii. cervical
2.Middle a. Auditory/eustachian tube b. Auditory ossicles - Malleus/incus/stapes
c. Spleen d.Thymus
3.Inner Bony labyrinth-semicircular canals/vestibule/cochlea
2.Smooth a. Involuntary/nonstriated b. Located in walls of hollow organs
3.Cardiac
WORDS myasthenia auxotonic achalasia ergometry fasciodesis fibromyoma flexor ideomuscular kinesioneurosis leiomyoma ligamentopexy myolysis musculoskeletal myorrhexis paleokinetic palikinesia pygalgia rhabdoid rhabdomyolysis rotator myostasis sthenometry myostroma
TERMS acous/o acoust/o ambly/o audi/o, audit/o aur/o, auricul/o blephar/o cochle/o conjunctiv/o cor/o corne/o -cusis cycl/o dacry/o dipl/o hygr/o ir/o, irid/o kerat/o lacrim/o logad/o myring/o ocul/o ophthalm/o ophry/o -opia, -opsia opt/o ot/o palpebr/o phac/o phak/o phot/o platy-
pupillatonia retinotoxic sclerectasia scotopia sonometer stapedectomy polystichia astigmatism anatropia tympanosclerosis uveoplasty vitreocapsulitis
1.Lymph
a. Auricle b. External auditory canal c. Tympanic membrane/eardrum
a. Voluntary/striated b. Movement c. Naming d.Attached to the skeleton
pimelopterygium
A. Lymphatic System
c. Nervous - Retina
1.External
1.Skeletal
abnormality of the conjunctiva pupil retina sclera darkness sound stapes rows mark, point to turn eardrum uvea glassy, vitreous body
LYMPHATIC & IMMUNE SYSTEM
B. Ear
B. Types
ISBN-13: 978-142320291-2 ISBN-10: 142320291-0
syndesmectopia
a. Eyebrows b. Eyelids c. Lacrimal apparatus d.Conjunctiva e. Eyelashes
A. Characteristics
U.S. $5.95/CAN $8.95
ten/o tenont/o -therapy, therapeut/o ton/o
ligament, connective tissue tendon tendon treatment
2.Associated Structures
MUSCULAR SYSTEM
a. Involuntary/striated b. Found in the heart TERMS DEFINITIONS -asthenia, weakness asthen/o aux/o growth, acceleration -chalasia relaxation erg/o work fasci/o fascia fibr/o fiber, fibrous flex/o bend ide/o idea, mental images kinesi/o, movement - kinesia,-kinetic lei/o smooth ligament/o ligament -lysis dissolution, breakdown muscul/o muscle my/o, myos/o muscle pale/o old palin-, palirecurrence, repetition pyg/o buttocks rhabd/o rod rhabdomy/o striated/skeletal muscle rot/o, rotat/o turn, revolve -stasis standing still, standing sthen/o, -sthenia strength -stroma supporting tissue of an organ
syndesm/o
DEFINITIONS hearing hearing, sound dim, dull hearing ear
B. Immune System WORDS acousia acoustics amblyoscope audiometer auriculotemporal
eyelid blepharorrhaphy cochlea cochleitis conjunctiva conjunctivitis pupil corectasia cornea corneosclera hearing presbycusis ciliary body, circular cyclodialysis tear dacryoadenectomy double diploscope moisture hygroblepharic iris iridemia cornea, horny tissue keratomalacia tear, lacrimal duct lacrimotomy whites of the eyes logadectomy eardrum myringomycosis eye oculonasal eye ophthalmodynia eyebrow ophryitis vision heteropsia eye, vision optometer ear otopyorrhea eyelid palpebritis lens phacocele lens phakoma light photophobia broad, flat platycoria
NOTE TO STUDENT This QUICKSTUDY® reference guide is a comprehensive list of medical terminology. This is a powerful study tool that can be quickly and repeatedly referred to during and well beyond your college years. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2000, 2002 BarCharts Inc. Boca Raton, FL. 1106
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1.Non-specific response - skin, inflammation, phagocytosis 2.Specific response a. acquired immunity
i. natural (active/passive) ii. artificial (active/passive) b. antibody-mediated immunity c. cell-mediated immunity TERMS adenoid/o alloautoaxill/o -edema -emphraxis immun/o inguin/o lien/o lymph/o nod/o -penia peri-phylaxis ple/o sarc/o -sepsis splen/o tetan/o thym/o tonsill/o top/o vaccin/o
DEFINITIONS adenoids other, different self armpit swelling stoppage, obstruction protection, immune groin spleen lymph knot deficiency around protection more flesh putrefaction spleen tetanus thymus tonsils particular place or area vaccine
CREDITS Author: Dr. Corinne B. Linton Customer Hotline # 1.800.230.9522
hundreds of titles at
quickstudy.com
WORDS adenoidectomy allotoxin autoantitoxin axillary lymphedema splenemphraxis immunogenic inguinodynia lienomalacia lymphangiophlebitis nodular lymphocytopenia perilymphangitis anaphylaxis pleocytosis lymphosarcoma antisepsis splenectasis tetanophilic thymectomy tonsillolith splenectopy vaccinogenous
BarCharts, Inc. ®
FOUNDATION OF MEDICAL WORDS A. Structure Most medical words are composed of two or more terms. To define a medical word: • divide the word into its terms • analyze the terms • define the word Examples: Pericarditis peri = around; card = heart; itis = inflammation Inflammation around the heart Oncology onco = tumor, mass; logy = study of Study of tumors
B. Terms Term + Term (.....+.....) = medical word There are five categories of terms: 1.Prefix - beginning of a word (ex., pre____; post_____) Designated by a “____” after the term. 2.Suffix - ending of a word (ex., _____stomy; _____itis) Designated by a “____” before the term. 3.Root - foundation/base of a word (ex., hepat; gastr) 4.Combining vowel - vowel (usually “o”) added to a root (ex., gastro). Use a combining vowel when joining: a. Root to another root (ex., gastrohepatitis) b. Root to a suffix beginning with a consonant (ex., cardiomegaly)
5.Combining form - root + vowel (ex., hepat/o; gastr/o) Designated by a “/” between the root and the vowel Examples: Hyperleukocytosis hyper (prefix) = excessive leuko (combining form) = white cyt (root) = cell osis (suffix) = condition of Definition: condition of excessive white blood cells (leukocytes) Hematotoxic hemato (combining form) = blood tox (root) = poison ic (suffix) = pertaining to Definition: pertaining to blood poisoning
TIPS: 1.Some terms have more than one definition. To determine the correct definition in a particular medical word, analyze the other terms in the word. Example: Poliomyelitis polio = gray (matter) myel = spinal cord, bone marrow itis = inflammation Definition: Inflammation of the gray matter of the spinal cord. The bone marrow does not have gray matter. 2.Some terms may function as a root/combining form in one word and a suffix in another word. Classification depends upon the specific medical word. Examples: Cytology cyto (combining form) = cell logy (suffix) = study of Definition: Study of cells Erythrocyte erythro (combining form) = red cyte (suffix) = cell Definition: Red blood cell
WORLD’S #1 ACADEMIC OUTLINE
THE HUMAN BODY A. Development
Cells - tissues - organs - systems - organism 1.Cells: Major Components a. Cell membrane b. Cytoplasm c. Nucleus
2.Tissues: Primary Types a. Connective b. Epithelium c. Muscle d.Nervous
3.Organs a. Composed of two or more different tissues b. Have specific functions
4.Systems: Related organs with common functions 5.Organism: A living person
B. Cavities
A space containing organs 1.Dorsal a. Cranial b. Vertebral (spinal)
2.Ventral a. Abdominal b. Pelvic c. Thoracic
C. Planes
An imaginary flat surface 1.Frontal – anterior/posterior 2.Sagittal – right/left 3.Transverse – upper/lower
D. Positions
A reference point for location or direction. 1.Anterior/Ventral – front of the body Posterior/Dorsal – back of the body 2.Deep – away from the surface Superficial – on the surface 3.Inferior – situated below Superior – situated above 4.Lateral – pertaining to the side 5.Medial – pertaining to the middle 6.Prone – lying face down Supine – lying face up
TERMS acid/o acuacu/o, acut/o adip/o aer/o agit/o -algia ambul/o anomal/o anthrac/o anthrop/o antr/o aphth/o apic/o aque/o atmoaxi/o bar/o bary-basia bathy-, bathobio-, bi/o blast/o, -blast -calculia
DEFINITIONS acid, sour, bitter needle sharp, severe fat air, gas rapidity, restlessness pain to walk irregular coal, carbon, carbuncle man, human being antrum ulcer apex water steam, vapor axis weight, pressure heavy, dull, hard walking deep, depth life, living early embryonic stage, immature to compute 1
WORDS acidity acupuncture subacute adiponecrosis aerophagy agitophasia cephalalgia ambulatory anomaly anthracosis anthropometry antrotomy aphthosis apicotomy aqueous atmometer abaxial barotrauma baryphonia brachybasia bathycardia biogenesis blastocyte dyscalculia
calor/i campt/o capsul/o, caps/o carcin/o cari/o -cataphasia cathar/o, cathart/o -cathisia, -kathisia caud/o cavit/o, cav/o chem/o chron/o clin/o -coimesis -coma consci/o constrict/o contus/o corpor/o critic/o cry/o cyt/o, -cyte dem/o desicc/o dilat/o dolich/o dolor/o dors/o duct/o dynam/o -dynia dysechin/o ectr/o ele/o emmetr/o enanti/o equierethism/o eti/o eu-facient febr/i fil/o, fil/i, filament/o -form frig/o, frigid/o funct/o gel/o gemell/o -gen, gen/o -genesis -genic ger/o, geront/o -grade hapl/o heredo-hexia hist/o homeohydr/o iatr/o -ician ion/o
heat bent capsule, container cancer caries, rottenness affirmation cleansing, purging
calorimetry camptocormia capsulitis carcinolysis cariogenic acataphasia catharsis
sitting
acathisia
tail caudal hollow, cavity cavitation chemical, chemistry chemosurgery time, timing chronobiology to slope, bend clinocephaly sleeping dyscoimesis deep sleep semicoma awareness, aware unconscious narrowing, binding vasoconstriction to bruise contusion body corporeal crisis, dangerous critical cold cryotherapy cell cytocide people epidemic to dry electrodesiccation enlarge,expand vasodilator long dolichofacial pain dolorogenic back dorsoventral to lead conduction power, strength dynamometer pain gastrodynia bad, difficult, painful dysphonia spiny, prickly echinocyte congenital absence ectrogeny oil eleoma the correct measure, emmetropia proportioned opposite, opposed enantiobiosis equality, equal equilibrium irritation erethismic cause etiology good, normal, well eubiotics to cause, make liquefacient happen fever febriphobia thread, threadlike filamentous specified shape, form multiform
cold performance to freeze, congeal twins producing, generating production, formation produced by, forming
frigorism dysfunctional gelosis gemellology pathogen neogenesis carcinogenic geriatrics centigrade haploid heredoimmunity cachexia histoclastic homeodynamics
aged, old age step simple, single heredity condition tissue likeness, constant, sameness water, hydrogen hydrolysis treatment, physician iatrogenic specialist clinician ion ionophoresis
same ipsilateral specialist pharmacist inflammation hepatitis nucleus karyorrhexis tumor, fibrous keloid growth kraur/o dry kraurosis kym/o waves kymography -labile unstable, perishable frigolabile later/o side bilateral ligat/o binding, tying ligature lim/o hunger bulimia -logist specialist neurologist -logy study of cardiology -lucent light-admitting radiolucent lumin/o light luminescence ly/o dissolve, loosen lyoenzyme -malacia softening osteomalacia -masesis mastication, chewingdysmasesis medi/o middle medial medic/o heal, healing medical mer/o part meromicrosomia mesomiddle mesoderm method/o procedure, technique methodology -mimesis imitation, simulation pathomimesis morph/o shape, form dolichomorphic mort/o death mortician nom/o custom, law nomotopic nomenname nomenclature nos/o disease nosology nucle/o nucleus nucleoplasm nutri/o, nutrit/o nourish nutrition ole/o oil oleovitamin -oma tumor, mass histocytoma onc/o tumor, mass oncogenesis organ/o organ organomegaly palliat/o soothe, relieve palliative pant/o all, whole pantomorphia path/o disease pathogenic pharmac/o drugs pharmacology phyl/o race, species, type phylogenesis physi/o nature physiologist physic/o physical, natural physicochemical phyt/o, -phyte plant phytotoxin pin/o to drink pinocytosis plan/o flat, level, wandering planocellular plant/o sole of the foot plantalgia -plasm formation, growth neoplasm plex/o network (nerves plexectomy or vessels), plexus -poiesis formation cytopoiesis posit/o arrangement, place reposition prosop/o face prosopospasm prote/o protein proteolysis psamm/o sand, psammomatous sand-like material puls/o, pulsat/o to beat, beating pulsation -puncture to pierce a surface venipuncture purul/o pus formation purulent pyr/o fire, fever, heat pyrogen pyret/o fever pyretolysis -receptor, receiver thermoreceptor -ceptor resuscit/o revive resuscitation reticul/o netlike reticular sanit/a health sanitarian scirrh/o hard scirrhoma somat/o body somatotype -some body chromosome spectr/o image, spectrum spectrogram -stabile stable, fixed thermostabile -stasis standing still, hemostasis standing -stat device/instrument for hemostat keeping something stationary stere/o solid, stereoradiography three dimensional ipsi-ist -itis kary/o kel/o
succ/o ymptom/o synaps/o, synapt/o system/o systol/o techn/o tele/o temp/o, tempor/o -therapy, therapeut/o therm/o tors/o trem/o, tremul/o tri/o -tumescence, tumesc/o -type, typ/o ventil/o ventr/o vers/o, -verse vir/o viscer/o vit/o volv/o, volut/o zyg/o
juice occurrence point of contact, to join system contraction skill, art perfect, complete period of time, the temples treatment
succorrhea asymptomatic synaptogenesis
heat twisting, twisted shaking, trembling to sort out, sorting swelling
thermometer sinistrotorsion tremor triage detumescence
class, representative form to aerate, oxygenate belly, front of the body turn, turning virus internal organs life to roll union, junction
somatotype
systematic presystole technology teleomitosis tempolabile therapeutics
ventilation ventrolateral cardioversion virologist visceromegaly vital involution zygogenesis
TERMINOLOGY SETS A. DIRECTIONAL TERMS abadambiamphianaanteanter/o antiapocatacircumcontradextr/o diadisdist/o ec-, ectoen-, endoepiesoexexoextraforehyperhypoinfrainterintrajuxtalater/o levomedi/o mesoparaperperipostposter/o prepropros/o proxim/o reretrosinistr/o
away from toward, near around, on both sides, about around, on both sides up, backward, against before, forward front against away, separation down, under around against, opposite right through, throughout apart, to separate distant outside, out inside, within above, over, upon within out, away from outside, outward outside before, in front above, excessive, beyond under, deficient, below below, beneath between within near side left middle middle alongside, near, beyond, abnormal through, throughout around, surrounding after, behind behind, towards the back before, in front of before forward, anterior near back, again behind, backward left 2
subsupersupratel/e transultra-
under, beneath above, beyond above, beyond distant, end across beyond, excess
B. FIVE rrh’s -rrhagia, -rrhage -rrhaphy -rrhea -rrhexis rrhythm/o
excessive flow, profuse fluid discharge suture flow, discharge rupture rhythm
C. NUMERICAL VALUES demihemisemione monounione and a half sesquitwo bidithree trifour tetraquadrifive quinquepentpentasix hexhexasexseven heptaseptseptieight octaoctinine noniten (101) decahundred (102) hectothousand (103) kilomillion (106) megabillion (109) gigatrillion (1012) teraquadrillion (1015) petaquintillion (1018) exaone tenth (10-1) decione hundredth (10-2) centione thousandth (10-3) millione millionth (10-6) microone billionth (10-9) nanoone trillionth (10-12) picoone quadrillionth (10-15) femtoone quintillionth (10-18) attohalf
D. SURGICAL PROCEDURES -centesis -desis -ectomy -pexy -plasty -rrhaphy -sect -stomy -tomy -tripsy
surgical puncture of a cavity surgical fixation, fusion surgical removal fixation surgical correction/repair suture to cut surgical opening surgical incision to crush, break
E. DIAGNOSTIC PROCEDURES aspir/o, aspirat/o -assay auscult/o, auscultat/o echoelectr/o -gram -graph -graphy -meter
removal to examine, analyze to listen reverberating sound electricity written record instrument for recording process of recording instrument for measuring
process of measuring to view to touch gently to tap x-ray, radiation instrument for visual examination visual examination instrument for cutting
-metry -opsy palp/o, palpat/o percuss/o radi/o -scope -scopy -tome
F. PATHOGENS acar/o arachn/o bacteri/o -coccus fung/i helminth/o, -helminth hirud/i, hirudin/i ixod/i myc/o parasit/o pedicul/o scolec/o verm/i vir/o
mites spider bacteria berry-shaped bacterium fungus, mushroom worm leech ticks fungus parasite louse worm worm virus
G. COLORS white green orange-yellow blue red, rosy, dawn red yellow dark brown gray, bluish green yellow white yellow black gray purple red, rosy rosy red gray (ashen) yellow
alb/o, albin/o chlor/o cirrh/o cyan/o eosin/o erythr/o flav/o fusc/o glauc/o jaund/o leuk/o lute/o melan/o poli/o purpur/i rhod/o rose/o rubr/o, rubr/i tephr/o xanth/o
FIVE SENSES A. Hearing
B. Smell
C. Touch
acous/o acoust/o audi/o audit/o -cusis
olfact/o -osmia osm/o -ophresia osphresi/o
haph/e pselaphes/o tact/o thigm/o
D. Taste
E. Vision
-geusia gustat/o gust/o
-opia -opsia opt/o
SYNONYMS abdomen abdomin/o celi/o lapar/o
air aer/o phys/o pneum/o pneumon/o
all panpant/o
bile bil/i chol/e
bladder cyst/o vesic/o
blood hem/o hemat/o sangu/i sanguin/o
body corpor/o somat/o -some
breast mamm/o mast/o
cecum cec/o typhl/o
chest pector/o steth/o thorac/o
breathe -pnea respir/o respirat/o spir/o
childbirth -para -parous -partum -tocia toc/o
cornea of the eye corne/o kerat/o
death mort/o necr/o thanat/o
different allohetero-
disease nos/o path/o
dry kraur/o xer/o
ear aur/o auricul/o ot/o
eardrum myring/o tympan/o
eye ocul/o opthalm/o opt/o
eyelid blephar/o palpebr/o
face faci/o op/o prosop/o
fat adip/o lip/o steat/o pimel/o
feces corp/o scat/o sterc/o
fever febr/i pyr/o pyret/o
first arch/i arch/e -arche primiprot/o
foot ped/o pod/o
hair pil/o trich/o
half demihemisemi-
hearing acous/o acoust/o audi/o audit/o -cusis
heart cardi/o coron/o
heat calor/i therm/o
huge gigant/o megameglo-
itching prurit/o psor/o
kidney nephr/o ren/o
lens of the eye phac/o phak/o
life biobi/o vit/o viv/i
lip cheil/o chil/o labi/o
ligament desm/o ligament/o syndesm/o
little, small -ole -ule
lung pneum/o pneumon/o pulmon/o
milk galact/o lact/o
mind ment/o -noia phren/o psych/o
mouth or/o stomat/o
mucus blenn/o muc/o myx/o
muscle muscul/o my/o myos/o
nail onych/o ungu/o
night noct/i nyct/o
nose nas/o rhin/o
nucleus kary/o nucle/o
oil ele/o ole/o
ovary oophor/o ovari/o
pain -algia dolor/o -dynia
palate palat/o uran/o
pregnancy pupil -cyesis cor/o gravid/o pupill/o
rectum proct/o rect/o
saliva ptyal/o sial/o
same homeohomoipsitauto-
skin cutane/o derm/o dermat/o
sound son/o phon/o
specialist -ician -ist -logist
stone lith/o petr/o
straight ithyorth/o
strength dynam/o -sthenia sthen/o
sugar gluc/o glyc/o sacchar/o
sweat hidr/o sud/o
swelling -edema -tumescence tumesc/o
tear dacry/o lacrim/o
thick pachypycn/o pykn/o
time chron/o temp/o tempor/o
tongue gloss/o lingu/o
tooth dent/i odont/o
tumor/mass onc/o -oma
uterus hyster/o metr/o uter/o
vagina colp/o vagin/o
vein phleb/o ven/o
vertebral/spinal column rachi/o spin/o spondyl/o
vulva episi/o vulv/o
water aque/o hydr/o 3
vessel angi/o vas/o
GLOSSARY A a-, anababdomin/o ablat/o abrad/o, abras/o acanth/o acar/o acid/o acous/o acoust/o acr/o actin/o acuacu/o, acut/o adaden/o adenoid/o adip/o adren/o aer/o agglutin/o agit/o -agogue -agra alb/o, albin/o albumin/o -algesia, alges/o -algia alloalveol/o ambiambly/o ambul/o ammon/o amni/o amphiamyl/o an/o anaandr/o aneurysm/o angi/o anis/o ankyl/o anomal/o anteanter/o anthrac/o anthrop/o antiantr/o aort/o -apheresis aphth/o apic/o apoaque/o arachn/o arch/i, arch/e, -arche arsenic/o arteri/o arteriol/o arthr/o articul/o aspir/o, aspirat/o -assay -asthenia, asthen/o astr/o atel/o ather/o atmo-atresia atretoatri/o attoaudi/o, audit/o aur/o, auricul/o auscult/o, auscultat/o autoaux/o axi/o axill/o azot/o
without, not away from abdomen to remove, take away to scrape off thorny, spiny mites acid, sour, bitter hearing hearing, sound extremities ray, radiation needle sharp, severe toward, near gland adenoids fat adrenal glands air, gas clumping rapidity, restlessness producer, leader severe pain white albumin pain sensitivity pain other, different alveolus around, on both sides, about dim, dull to walk ammonium amnion around, on both sides starch anus up, backward, against male aneurysm vessel unequal stiff, crooked, bent irregular before, forward front coal, carbon, carbuncle man, human being against antrum aorta separation, removal ulcer apex away, separation water spider first arsenic artery arteriole joint joint inhaling, removal to examine, analyze weakness star, star shaped incomplete, imperfect fatty substance, plaque steam, vapor closure, occlusion closed, lacking an opening atrium one quintillionth (10-18) hearing ear to listen self growth, acceleration axis armpit nitrogen, urea
B bacteria glans penis bath weight, pressure heavy, dull, hard base, foundation walking deep, depth two books bile life, living early embryonic stage, immature blenn/o mucus blephar/o eyelid brachi/o arm brachyshort bradyslow brom/o bromine containing compound, odor bronch/o bronchus bronchiol/o bronchiole bucc/o cheek -bulia, -boulia will burs/o bursa bacteri/o balan/o balne/o bar/o barybas/o, basi/o -basia bathy-, bathobibibli/o bil/i bio-, bi/o blast/o, -blast
C cac/o bad, ill calcane/o heel calci/o calcium -calculia, to compute calcul/o cali/o calyx calor/i heat campt/o bent -capnia, capn/o carbon dioxide capsul/o, caps/o capsule, container carb/o carbon carcin/o cancer cardi/o heart cari/o caries carp/o wrist catadown, under -cataphasia affirmation cathar/o, cleansing, purging cathart/o -cathisia, sitting -kathisia caud/o tail caus/o, cauter/o burn, burning cavit/o, cav/o hollow, cavity cec/o cecum -cele hernia, swelling celi/o abdomen -centesis surgical puncture of a cavity centione hundredth ( 10-2) centr/o center cephal/o head cerebell/o cerebellum cerebr/o cerebrum, brain cervic/o neck, cervix -chalasia relaxation cheil/o, chil/o lip chem/o chemical, chemistry -chezia, -chesia defecation chir/o, cheir/o hand chlor/o green chol/e gall, bile choledoch/o common bile duct chondr/o cartilage chori/o chorion -chroia skin coloration chrom/o color chron/o time, timing chrys/o gold chyl/o chyle -cide killing, agent which kills cinemovement circumaround cirrh/o orange-yellow -clasis, -clasia break cleid/o clavicle clin/o to slope, bend -clysis irrigation, washing coagul/o coagulation, clotting
-coccus coccyg/o cochle/o -coimesis col/o colp/o com-, con-coma coni/o conjunctiv/o consci/o constrict/o contracontus/o cor/o corne/o coron/o corpor/o cortic/o cost/o cox/o crani/o -crasia cric/o crin/o -crit critic/o cry/o crypt/o crystall/o cubit/o culd/o cune/o cupr/o -cusis cutane/o cyan/o cycl/o -cyesis cyst/o cyt/o, -cyte
embol/o embry/o -emesis -emia emmetr/o
berry-shaped bacterium coccyx cochlea sleeping colon vagina with, together deep sleep dust conjunctiva awareness, aware narrowing, binding against, opposite to bruise pupil cornea heart body cortex rib hip skull mixture (good or bad), temperament ring secrete, separate separate crisis, dangerous cold hidden, concealed crystal, transparent elbow, forearm cul-de-sac wedge, wedge-shaped copper hearing skin blue ciliary body, circular pregnancy bladder, cyst cell
-emphraxis en-, endoenanti/o encephal/o enter/o eosin/o epiepididym/o epiglott/o episi/o equierethism/o erg/o erythem/o erythr/o eschar/o esoesophag/o esthesi/o, -esthesia eti/o eueuryexexaexcit/o exoextra-
tear digit (finger or toe) ten (101) one tenth (10-1) half people tooth skin to dry surgical fixation, fusion ligament second, secondary right two through, throughout a twin, testis conjoined twin enlarge,expand double thirst apart, to separate distant long pain back running to lead duodenum power, strength pain bad, difficult, painful
E ec-, ectoechin/o echoeco-ectasis, -ectasia -ectomy ectr/o -edema ele/o electr/o
gluc/o glyc/o gnath/o gnos/o gon/o gonad/o goni/o -grade -gram granul/o -graph graph/o -graphy gravid/o -gravida gustat/o, gust/o gynec/o gyr/o
glucose, sugar glucose, sugar jaw knowledge genitals, semen gonads angle step written record granules instrument for recording writing process of recording pregnancy pregnant woman taste woman, female circle, spiral
H
haph/e touch hapl/o simple, single hect/o hundred (102) helc/o ulcer heli/o sun helminth/o, worm -helminth cause hemihalf good, normal, well hem/o, hemat/o blood wide, broad hepat/o liver out, away from heredoheredity quintillion (1018) heterodifferent, other to arouse hex-, hexasix outside, outward -hexia condition outside heptaseven hidr/o sweat F hirsut/o hairy faci/o face hirud/i, hirudin/i leech -facient to cause, make happen hist/o tissue fasci/o fascia holoentire, complete febr/i fever homeolikeness, constant, femor/o femur sameness -15 femtoone quadrillionth (10 ) homosame, similar ferr/i, ferr/o iron hormon/o hormone fet/o fetus humer/o humerus fibr/o fiber, fibrous hyal/o resembling glass, glassy fibul/o fibula hydr/o water, hydrogen fil/o, fil/i, thread, threadlike hygr/o moisture filament/o hymen/o hymen flav/o yellow hyperabove, excessive, beyond flex/o, flect/o bend hypn/o sleep flu/o, flux/o to flow hypounder, deficient, below fluor/o fluorine hypothalam/o hypothalamus follicul/o small sac, follicle hypsihigh forebefore, in front hyster/o uterus -form specified shape, form frig/o, frigid/o cold I funct/o performance iatr/o treatment, physician fung/i fungus, mushroom ichthy/o fish fusc/o dark brown -ician specialist icter/o jaundice G ide/o idea, mental images galact/o milk idi/o individual, distinct, galvanodirect electric current unknown gamet/o gamete ileum gam/o marriage, sexual union ile/o ili/o ilium gangli/o, ganglion immun/o protection, immune ganglion/o infrabelow, beneath gastr/o stomach inguin/o groin ge/o earth, soil interbetween gel/o to freeze, congeal intrawithin gemell/o twins iod/o iodine -gen, gen/o producing, generating ion/o ion -genesis production, formation ipsisame -genic produced by, forming ir/o, irid/o iris geni/o chin isch/o suppress, restrain genit/o reproduction ischi/o ischium ger/o, geront/o aged, old age is/o equal gest/o, gestat/o to bear -ist specialist -geusia taste ithyerect, straight gigabillion (109) gigant/o huge -itis inflammation gingiv/o gums ixod/i ticks glauc/o gray, bluish green gli/o glue, neuroglia J -globin protein jaund/o yellow glomerul/o glomerulus jejun/o jejunum gloss/o tongue juxtanear
D dacry/o dactyl/o decadecidemidem/o dent/i derm/o, dermat/o desicc/o -desis desm/o deuter/o dextr/o didiadidym/o -didymus dilat/o dipl/o dips/o disdist/o dolich/o dolor/o dors/o drom/o, -drome duct/o duoden/o dynam/o -dynia dys-
embolus embryo vomiting blood condition the correct measure, proportioned stoppage, obstruction inside, within opposite, opposed brain intestines (small intestines) red, rosy, dawn above, over, upon epididymis epiglottis vulva equality, equal irritation work flushed, redness red scab within esophagus sensation, feeling
outside, out spiny, prickly reverberating sound environment dilation, expansion surgical removal congenital absence swelling oil electricity 4
K kal/i potassium kary/o nucleus kel/o tumor, fibrous growth ken/o empty kerat/o horny tissue, cornea keraun/o lightning keton/o ketones kilothousand (103) kinesi/o, movement -kinesia, -kinetic klept/o theft, stealing koil/o hollow, concave, depressed kraur/o dry kym/o waves kyph/o humpback
L -labile lacrim/o lact/o lal/o, -lalia lamin/o lampr/o lapar/o laryng/o later/o laxat/o lecith/o -legia lei/o -lemma lepid/o lepr/o -lepsy lept/o letharg/o leuk/o levo-lexia lien/o ligament/o ligat/o lim/o lingu/o lip/o -lipsis -listhesis lith/o lob/o logad/o log/o, -log, -logue -logist -logy loph/o lord/o lox/o -lucent luc/i lucid/o lumb/o lumin/o lute/o luxat/o ly/o lymph/o -lysis
unstable, perishable tear, lacrimal duct milk speech, babble lamina clear abdomen, abdominal wall larynx side to slacken, relax, loosen yolk, ovum reading smooth confining membrane flakes, scales leprosy seizure slender, thin, delicate drowsiness white left speech, word spleen ligament binding, tying hunger tongue fat omit, fail slipping stone, calculus lobe whites of the eyes word, speech, thought specialist study of ridge curvature, bending oblique, slanting light-admitting light clear loin light yellow dislocate dissolve, loosen lymph dissolution, breakdown
M softening breast madness, obsessive preoccupation -masesis mastication, chewing mast/o breast maxill/o maxilla medi/o middle mediastin/o mediastinum medic/o heal, healing medull/o medulla, marrow megamillion (106) mega-, megalo- large -megaly enlargement mel/o limbs, limb -malacia mamm/o -mania
melan/o meli-, melitmen/o mening/o ment/o mer/o mesometametall/o -meter method/o metr/o -metry micromi/o milli-mimesis mis/o -mnesia mogimonomorph/o mort/o -motor muc/o multimuscul/o mutilat/o my/o, myos/o myc/o myel/o myring/o myx/o
black honey, sugar menses, menstruation meninges, membranes mind part middle after, beyond, change metal instrument for measuring procedure, technique uterus process of measuring one millionth (10-6), small less, smaller one thousandth (10-3) imitation, simulation hatred of, aversion memory difficult one shape, form death movement, motion mucus many, much muscle to maim, disfigure muscle fungus bone marrow, spinal cord eardrum mucus
orch/o, orchi/o, orchid/o -orexia organ/o ornith/o orth/o osche/o oscill/o -osis osm/o, -osmia osphresi/o, -osphresia oste/o ot/o ov/o, ov/i ovari/o ox/o, -oxia oxy-
appetite organ bird straight, normal, correct scrotum to swing condition, status, abnormal increase sense of smell, odor, impulse sense of smell, odor bone ear egg, ovum ovary oxygen sharp, quick, sour
phot/o phren/o phyc/o phyl/o -phylaxis phyll/o -phyma physic/o physi/o phys/o -physis phyt/o, -phyte picopicr/o piez/o, pies/i, -piesis pil/o pimel/o pin/o pineal/o pituitar/o plagi/o plan/o plant/o -plasm plasm/o
light mind, diaphragm seaweed, algae race, species, type protection leaf, leaf-like tumor, growth physical, natural nature air, gas growth, growing plant one trillionth (10-12) bitter pressure
hair fat, fatty to drink pineal gland pituitary gland slanting, oblique P flat, level, wandering pachythick sole of the foot -pagus conjoined twins formation, growth palat/o palate plasma, formative pale/o old palin-, palirecurrence, repetition substance palliat/o soothe, relieve -plasty surgical correction/repair palp/o, palpat/o to touch gently platybroad, flat palpebr/o eyelid ple/o more palpit/o, palpitat/o flutter, throbbing -plegia paralysis panall plesi/o nearness, similarity pancreat/o pancreas pless/i striking pant/o all, whole pleur/o pleura papill/o nipple-like, papilla plex/o network (nerves or papul/o papule, pimple vessels), plexus paraalongside, near, beyond, plic/o, plicat/o to fold, pleat abnormal -ploid, -ploidy number of chromosome -para, -parous to bear, bring forth sets parasit/o parasite plurimore, several parathyroid/o parathyroid -pnea breathe -paresis partial paralysis pneum/o lung, air -partum childbirth, labor pneumon/o lung, air patell/o patella pod/o foot path/o disease -poiesis formation -pause cessation poikil/o variation, irregular pector/o chest poli/o gray (matter) ped/o foot, child polymany, much pedicul/o louse pon/o fatigue, overwork, pain pel/o mud -pore, por/o opening, passageway pelv/i pelvis -porosis porous, decrease in -penia deficiency density pent-, penta- five -posia drinking -pepsia digestion posit/o arrangement, place perthrough, throughout postafter, behind percuss/o to tap poster/o behind, towards the back periaround, surrounding potenti/o power, strength perine/o perineum -prandial meal peritone/o peritoneum -praxia action, activity per/o deformed, maimed prebefore, in front of perone/o fibula presbyaging, elderly perspir/o breathe through primifirst pest/i plague, pests -privia loss, deprivation petaquadrillion (1015) before -petal moving toward, seeking proproct/o rectum, anus petr/o stone, petrous region pros/o forward, anterior of temporal bone prosop/o face -pexy fixation prostat/o prostate gland phac/o lens prote/o protein phag/o, -phagia eating, ingestion prot/o first phak/o lens proxim/o near phalang/o phalanges prurit/o itching phall/o penis psamm/o sand, sand-like material phaner/o visible, apparent pselaphes/o touch pharmac/o drugs pseudofalse phas/o, -phasia speech psor/o itching phe/o dusky psych/o mind phen/o appearance psychr/o cold -pheresis removal -phil, -philia affinity for, tendency -pterygium abnormality of the towards conjunctiva phim/o muzzle pteryg/o wing-shaped phleb/o vein -ptosis prolapse, drooping -phobia, phob/o fear, aversion ptyal/o saliva phon/o, -phonia voice, sound -ptysis spitting -phore, phor/o bearer, processor pub/o pubis -phoresis bearing, transmission pulmon/o lung phosphat/o phosphate puls/o, pulsat/o to beat, beating
N one billionth (10-9) numbness, stupor nose birth sodium death new kidney nerve neutral mole, birthmark to cause harm, injury or pain noct/i night nod/o knot -noia mind, will nom/o custom, law nomenname noninine norm/o normal, usual nos/o disease not/o the back nucle/o nucleus nullinone nutri/o, nutrit/o nourish nyct/o night nanonarc/o nas/o nat/o natr/o necr/o neonephr/o neur/o neutr/o nev/o noci-
O obstetr/o octa-, octiocul/o odont/o -oid -ole ole/o olfact/o olig/o -oma om/o omphal/o onc/o onych/o o/o oophor/o ophry/o ophthalm/o -opia, -opsia opisth/o op/o -opsy opt/o or/o
testis
midwife eight eye tooth resembling little, small oil smell scanty, few, little tumor, mass shoulder navel tumor, mass nail egg, ovum ovary eyebrow eye vision backward, behind juice, face to view eye, vision mouth 5
-puncture pupill/o purgat/o purpur/i purul/o py/o pyel/o pyg/o pykn/o, pycn/o pyl/e pylor/o pyret/o pyrex/o pyr/o
to pierce a surface pupil cleansing purple pus formation pus renal pelvis buttocks thick, dense portal vein pylorus fever feverishness, fever heat, fire, fever
Q quadriquinquequint/i
four five fifth
R rachi/o radi/o radicul/o ram/i re-receptor, -ceptor rect/o reflex/o, reflect/o registrat/o relaps/o ren/o respir/o, respirat/o resuscit/o reticul/o retin/o retract/o retrorhabd/o rhabdomy/o rhe/o rhin/o rhiz/o rhod/o rhytid/o rose/o rot/o, rotat/o -rrhagia, -rrhage -rrhaphy -rrhea -rrhexis rrhythm/o -rubr/o, rubr/i
spine x-ray, radiation nerve root branch back, again receiver rectum to bend back recording to slide back kidney breathe, breathing revive netlike retina drawing back behind, backward rod striated/skeletal muscle flow, current, stream nose root red, rosy wrinkle rosy turn, revolve excessive flow,profuse fluid discharge suture flow, discharge rupture rhythm red
S sacchar/o sacr/o salping/o sangu/i, sanguin/o sanit/a sap/o sapr/o sarc/o saur/o scaph/o scapul/o scat/o scel/o, -scelia schist/o, -schisis schiz/o scint/i scirrh/o scler/o -sclerosis scolec/o scoli/o -scope -scopy scot/o scrib/o, script/o seb/o
sugar sacrum fallopian tube blood health soap rotten, decay flesh lizard a scapha, boat-shaped scapula feces leg split, cleft split, division spark hard sclera hardening worm crooked, twisted instrument for visual examination visual examination darkness to write sebum
U.S. $5.95 / CAN $8.95
March 2005
-sect secund/i sedat/o semisemin/i senil/o sens/o, sensat/o sensor/i -sepsis, septic/o sept-, septisept/o ser/o sesquisexsial/o sicc/o sider/o sigmoid/o silic/o sinistr/o sinus/o, sin/o sit/o skelet/o soci/o sodi/o solut/o somat/o -some somn/i, -somnia son/o span/o -spasm, spasm/o spectr/o sperm/o, spermat/o sphen/o spher/o sphygm/o -sphyxia spin/o spir/o splanchn/o splen/o spondyl/o spongi/o spor/o squam/o -stabile -stalsis staped/o staphyl/o -stasis -stat steat/o -stenosis, sten/o stere/o steril/o stern/o steth/o sthen/o, -sthenia stich/o, -stichia stigmat/o stomat/o -stomy strat/i strept/o strict/o -stroma stroph/o subsucc/o suct/o sud/o sulc/o supersupra-
to cut second to calm half semen old, old age feeling, perception sensory putrefaction, putrifying seven partition serum, serous one and a half six saliva to dry iron sigmoid colon silica, quartz left cavity, sinus food skeleton social, society compound containing sodium dissolved body body sleep sound scanty, scarce involuntary contraction image, spectrum spermatozoa
suspend/o, suspens/o sym-, synsymptom/o synaps/o, synapt/o syndesm/o synov/o syphil/o syring/o system/o systol/o syzygi/o
to hang up, suspend with, together occurrence point of contact, to join ligament, connective tissue synovia, synovial membrane syphilis tube, fistula system contraction bound together, conjunction
T fast touch talus grave low tarsus, edge of eyelid identical, same arrangement, coordination techn/o skill, art tect/o rooflike tegment/o covering tel/e end, distant tel/o end tele/o perfect, complete temp/o, tempor/o period of time, the temples ten/o tendon tenont/o tendon -tension, tens/o stretched, strained tephr/o gray (ashen) teratrillion (1012) terat/o monster termin/o boundary, limit tertithird test/o, testicul/o testis tetan/o tetanus tetrafour thalam/o thalamus thanat/o death thec/o sheath thel/o nipple theor/o speculation -therapy, therapeut/o treatment theri/o animals therm/o heat thigm/o touch thiopresence of sulfur thorac/o chest thromb/o clot, thrombus -thymia mind, emotions thym/o thymus gland thyr/o thyroid gland tibi/o tibia toc/o, -tocia childbirth, labor -tome instrument for cutting tom/o a cutting (section/layer) -tomy surgical incision ton/o tone, tension tonsill/o tonsils top/o particular place or area torpid/o sluggish, inactive tors/o twisting, twisted tox/o, toxic/o poison trachel/o neck trache/o trachea trachyrough transacross traumat/o trauma, injury, wound trem/o, tremul/o shaking, trembling -tresia opening, perforation trithree tri/o to sort out, sorting trich/o hair -tripsy to crush, break -trophy, troph/o nourishment, growth -tropia to turn tachytact/o tal/o taph/o tapin/o tars/o tauto-taxia, tax/o
wedge, sphenoid bone round, sphere pulse pulse spinal cord, spine breathe viscera spleen vertebrae, spinal column spongelike, spongy spore, seed squamous, scales stable, fixed contraction stapes uvula, grape like clusters standing still, standing device/instrument for keeping something stationary fat narrowed, constricted solid, three dimensional barren sternum chest strength rows mark, point mouth surgical opening layer twisted, curved to tighten, bind supporting tissue of an organ twisted under, beneath juice to suck sweat furrow, groove above, beyond above, beyond
NOTE TO STUDENT This QuickStudy ® reference guide is a comprehensive list of medical terminology. Use it to your advantage in class, during homework and as a memory refresher while preparing for exams. Reinforce your knowledge of medical terminology with this convenient guide. This is a powerful study tool that can be quickly and repeatedly referred to during and well beyond your college years. 6
tubercul/o tub/o -tumescence, tumesc/o turbid/i turg/o, turgid/o tympan/o -type, typ/o typhl/o typh/o tyr/o
tubercle, tuberculosis tube swelling cloudy, confused to swell, swollen eardrum (tympanic membrane) class, representa -tive form cecum, blindness typhus, typhoid cheese, caseous
U -ule ul/o ultraunungu/o uniuran/o -uresis ureter/o urethr/o -uria uric/o urin/o ur/o uter/o uve/o uvul/o
little, small scar, scarring beyond, excess not, reversal nail one palate urination ureter urethra urine condition uric acid urine urine uterus uvea uvula
V vaccin/o vag/o vagin/o valv/o, valvul/o varic/o vari/o, variat/o vas/o vascul/o ven/o venere/o ventil/o ventr/o ventricul/o venul/o verm/i verruc/i vers/o, -verse vertebr/o vesic/o vesicul/o vestibul/o vibr/o, vibrat/o viril/o vir/o viscer/o viscid/o, viscos/o vitell/o vit/o, vital/o vitre/o viv/i -volemia volv/o, volut/o vulv/o
vaccine vagus nerve vagina valve varicose veins change, vary vessel, vas deferens blood vessel vein sexual intercourse to aerate, oxygenate belly, front of the body ventricle of the heart or brain venule worm wart turn, turning vertebra urinary bladder seminal vesicle, a vesicle vestibule to quiver, shake masculine, manly virus internal organs sticky, glutinous yolk life glassy, vitreous body life, alive blood volume to roll vulva
X xanth/o xen/o xer/o xiph/o
yellow strange, foreign matter dry sword-shaped, xiphoid
Z zon/i, zon/o zo/o zyg/o zym/o
CREDITS Author: Dr. Corinne B. Linton
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zone, encircling region animal union, junction enzyme, ferment
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WORLD’S #1 ACADEMIC OUTLINE
HEAD & TRUNK (ANTERIOR VIEW)
ARM (ANTERIOR VIEW) ex. = extensor fl. = flexor insertions = blue L. = left
l. = ligament m.m. = muscles origins = red R. = right
Corrugator
Deltoid Biceps brachii short head Trapezius
Temporal
Pectoralis minor
CLAVICLE (SUPERIOR VIEW) Anterior
Procerus Depressor supercilii
Pectoralis major Deltoid
Orbicularis oculi
Omohyoid Coracobrachialis Biceps brachii long head Supraspinatus
Levator labii alaeque nasi
Sternocleidomastoid Pectoralis major
Triceps brachii long head
Levator labii superioris
Zygomatic minor
Levator anguli oris
Zygomatic major
Nasalis Orbicularis oris
Subclavius
Temporal
Pectoralis major Serratus anterior
Latissimus dorsi Teres major Subscapularis
Deltoid
Brachialis
Fl. carpi radialis
Brachioradialis
Palmaris longus
Ex. carpi radialis longus
Buccinator
Depressor anguli oris
Incisivus labii inferioris
Scalenus posterior
Orbicularis oris
Scalenus medius
Mentalis
Piriformis
Scalenus anterior
Iliopsoas Gluteus minimus Vastus medialis Vastus lateralis
Longus colli
Scalenus posterior
Subclavius Vastus intermedius Sternocleidomastoid Pectoralis minor
Fl. digitorum superficialis
Supinator Biceps brachii Pronator teres Interosseous membrane Fl. pollicis longus Pronator quadratus Brachioradialis Abductor pollicis brevis Opponens pollicis
Fl. digitorum profundis
Intercostals Serratus anterior
Pectoralis major Rectus abdominis
Fl. carpi ulnaris Abductor digiti minimi
Latissimus dorsi
Fl. digiti minimi brevis
L. crus of diaphragm
Ex. carpi ulnaris
Fl. pollicis brevis
Abductor pollicis brevis
Fl. carpi ulnaris
Psoas minor
Fl. carpi radialis
4th
2nd & 3rd dorsal interosseous Fl. digitorum superficialis
dorsal interosseous
1st palmar interosseous Fl. digitorum profundis
HAND (PALMAR VIEW)
Ex. hallucis brevis
Biceps femoris Adductor Ex. digitorum brevis Gracilis brevis Peroneus brevis Middle pharyngeal constrictor Hyoglossus Peroneus tertius Stylohyoid l.
2nd palmar interosseous
Fl. pollicis longus
Calcaneal tendon (triceps crurae)
Pectineus Adductor longus
Thyrohyoid
2nd dorsal Hyoepiglottic l. interosseous 3rd dorsal interosseous Mylohyoid 4th dorsal Stylohyoid interosseous
Intermediate digastric Abductor tendon digiti minimi Omohyoid Sternohyoid Ex. digitorum brevis Geniohyoid
HYOID BONE (SUPERIOR VIEW)
Ex. digitorum longus
Sartorius Semitendinosus Tibialis anterior Ex. hallucis longus Peroneus tertius
Pyramidalis
Obturator externus
dorsal interosseous
Peroneus brevis
Rectus abdominis
Fl. digiti minimi brevis
Fl. pollicis brevis
Ex. digitorum longus
Psoas minor
Rectus femoris
3rd palmar interosseous Abductor digiti minimi
Abductor pollicis brevis
Iliacus Obturator internus
Obturator membrane Abductor digiti Quadratus femoris minimi Ex. carpi ulnaris Semitendinosus Pisometacarpal l. Adductor magnus Opponens digiti minimi
Opponens pollicis
Quadraceps femoris
Piriformis
Coccygeus
Patellar l. Gracilis
Peroneus longus
Psoas major
Vastus medialis
Biceps femoris
Transversus abdominis
Pisohamate l.
Abductor pollicis longus
Vastus medialis Adductor magnus
R. crus of diaphragm
Opponens digiti minimi Obliquus externus Palmar interosseous abdominis Quadratus Abductor digiti minimi Obliquus lumborum Adductor pollicis Fl. digiti internus minimi brevis abdominis Palmar Fl. pollicis longus Transversus interosseous abdominis Fl. digitorum Obliquus externus superficialis Dorsal interosseous abdominis Fl. digitorum Tensor fasciae latae profundis Sartorius Fl. digiti minimi brevis Adductor pollicis Fl. pollicis brevis
Articularis genus
Obliquus internus Vastus intermedius abdominis Transversus abdominis Rectus femoris Lateral arcuate l. of diaphragm Vastus lateralis Medial arcuate l. of diaphragm Iliotibial tract
Fl. carpi radialis
Abductor pollicis brevis
1st
LEG & FOOT (ANTERIOR VIEW)
Brachialis
Annular l.
Adductor pollicis
Trapezius
Obturator internus
Depressor labii inferioris
Fl. carpi ulnaris
Ex. carpi radialis brevis
Posterior
Incisivus labii superioris
Masseter
Pronator teres
Coracobrachialis
Sternocleidomastoid
Ex. digitorum brevis
Ex. hallucis brevis
Tibialis Peroneus Quadratus brevis anterior plantae Peroneus Ex. tertius hallucis Dorsal brevis interosseus Abductor Abductor hallucis digiti Ex. minimi hallucis Plantar longus interosseus Ex. Ex. digitorum Tibialis digitorum brevis anterior longus 1st dorsal interosseous Abductor hallucis Ex. hallucis brevis Ex. hallucis longus
FOOT (DORSAL VIEW)
CLAVICLE (INFERIOR VIEW) Sternohyoid
HEAD & TRUNK (POSTERIOR VIEW)
Posterior
Subclavius
Occipitalis
Trapezius
Trapezius
ARM (POSTERIOR VIEW)
Semispinalis capitis
Anterior
Deltoid
Pectineus Levator scapulae Vastus medialis Medial pterygoid
Inferior oblique
Adductor brevis
Splenius cervicis
Infraspinatus
C7
Teres minor
Rhomboid major
Triceps brachii long head
Supraspinatus
Triceps brachii lateral head Teres major
Serratus posterior superior
Anconeus
Ex. digiti minimi
Iliocostalis lumborum Intercostals
Longissimus capitis T6
Pronator teres
3rd dorsal interosseous Abductor digiti minimi 4th dorsal interosseous
4th dorsal interosseous Abductor digiti minimi 3rd palmar interosseous 2nd palmar interosseous Ex. digiti minimi
Iliocostalis lumborum Peroneus brevis Latissimus dorsi Obliquus internus abdominis
Serratus posterior inferior
Longissimus thoracis Brachioradialis Ex. carpi radialis L5 brevis Multifidus Abductor pollicis longus Latissimus dorsi Ex. carpi Gluteus maximus radialis longus Ex. pollicis brevis Levator ani: (pubococcygeus)
2nd dorsal interosseous
Ex. pollicis longus Adductor pollicis
Fl. digitorum
Quadratus lumborum
T12
Ex. pollicis brevis
Ex. carpi ulnaris
Fl. hallucis longus
Obliquus externus abdominis
Trapezius
Ex. pollicis longus
Obliquus externus abdominis Tibialis Gluteus medius posterior Gluteus minimus Tibialis Tensor fasciae latae anterior Sartorius Fl. hallucis Rectus femoris brevis Piriformis Abductor hallucis Sacrospinous l. Plantar interosseus Gemellus superioris Quadratus femoris Fl. hallucis longus Gemellus inferioris Semimembranosus Fl. digitorum brevis
Obturator internus Transversus perinei profundis
Adductor Gracilis magnus Biceps Semitendinosus Genioglossus femoris Uvulae Geniohyoidis Digastric (anterior belly) Levator labii superioris Abductor hallucis Mylohyoid Levator anguli oris Platysma Ex. carpi radialis brevis Zygomatic minor Superior pharyngeal constrictor Tibialis Ex. carpi radialis longus Superior constrictor Tensor veli palatini posterior Internus pterygoid Abductor pollicis longus Zygomatic major Masseter Buccinator Fl. hallucis brevis Temporal 1st dorsal interosseous Tensor veli palatini Lateral pterygoid Stylohyoid l. Adductor pollicis Styloglossus Tibialis anterior Tensor tympani Stylohyoid Ex. pollicis brevis Stylopharyngeus Adductor hallucis Levator veli palatini Styloid process oblique head Ex. pollicis Longus capitis Digastric longus Rectus capitis Fl. hallucis (posterior belly) st anterior 1 palmar interosseous brevis Rectus capitis lateralis Superior oblique Ex. digitorum Abductor Sternocleidomastoid communis: Rectus capitis hallucis Splenius capitis central bands Posterior major Adductor hallucis Longus capitis Ex. indicis Rectus capitis transverse heads Occipitalis Posterior minor Nuchal l. Trapezius Fl. hallucis longus Ex. digitorum Semispinalis communis: capitis lateral bands
1st dorsal interosseous Ex. digitorum communis: central bands lateral bands
BASE OF SKULL
HAND (DORSAL VIEW) NOTE TO STUDENT
Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 2005 BarCharts, Inc. 0608
Customer Hotline # 1.800.230.9522
Biceps femoris
Peroneus longus
Latissimus dorsi
Abductor pollicis longus
Interosseous membrane
Popliteus
Soleus
Latissimus dorsi
Supinator
Ex. indicis
Gastrocnemius (lateral head)
Serratus anterior
Longissimus thoracis
Ex. carpi ulnaris Fl. digitorum profundis
Semimembranosus
Serratus posterior inferior
Ex. digitorum communis
Anconeus
Gastrocnemius (medial head)
Plantaris
Rhomboid major
Ex. carpi radialis brevis
Fl. carpi ulnaris
Iliocostalis thoracis
Splenius capitis
Ex. carpi radialis longus
Triceps brachii
Biceps femoris (short head)
Serratus posterior superior Adductor magnus
Brachioradialis
Triceps brachii medial head
3rd dorsal interosseous
Adductor longus
Scalenus posterior
Rhomboid minor
Trapezius
Brachialis
Vastus lateralis Gluteus maximus Vastus intermedius
Adductor magnus Longissimus thoracis
Deltoid
Latissimus dorsi (small origin slip)
2nd dorsal interosseous Ex. carpi ulnaris
Iliopsoas
Semispinalis capitis
Rhomboid minor
Gluteus medius
Quadratus femoris
Longissimus capitis
Rectus capitis posterior major
Supraspinatus
Levator scapulae
Splenius capitis
Rectus capitis posterior minor
Deltoid Subclavius Sternocleidomastoid Trapezius Pectoralis major
Ex. digiti minimi
Obturator externus
Sternocleidomastoid
Pectoralis major
Palmar interrosseous m.m.
LEG & FOOT (POSTERIOR VIEW)
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Tibialis posterior
Soleus & gastrocnemius via calcaneal (Achilles) tendon Abductor digiti minimi Adductor hallucis Abductor digiti minimi Fl. digitorum brevis Fl. digitorum longus Abductor digiti minimi Quadratus plantae Peroneus longus tendon & insertion Fl. digiti minimi brevis Abductor digiti minimi Plantar interosseous Fl. digitorum brevis Fl. digitorum longus
FOOT (PLANTAR VIEW)
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WORLD’S #1 ACADEMIC OUTLINE
Frontalis Temporalis Temporalis Occipitalis Orbicularis oculi Masseter Splenius capitis Omohyoid Corrugator fibers Levator scapulae Sternohyoid Auricularis anterior Trapezius Trapezius Risorius Linea alba Deltoid Orbicularis oris Deltoid Brachialis Platysma Linea semilunaris Triceps Biceps brachii Pectoralis major brachii Rectus abdominis Ex. carpi Serratus anterior Bicepital aponeurosis ** radialis longus Rectus sheath Pronator teres Ex. carpi Tendinous inscriptions Brachioradialis radialis brevis Bicepital aponeurosis Obliquus externus Ex. digitorum Fl. carpi ulnaris Fl. carpi radialis communis Palmaris longus Abductor Fl. synovium Gluteus medius pollicis Fl. retinaculum longus Fl. carpal l. Thenar m.m. HypoUlnar bursa Ex. pollicis thenar Linea m.m. Palmar Adductor brevis alba aponeurosis pollicis Gluteus Lumbricales maximus Cremaster ** Iliotibial Synovial fl. Pyramidalis band tendon sheaths Sartorius Biceps Tensor fasciae latae Adductor magnus femoris Iliopsoas Gracilis Pectineus Outer Fasciae latae (Band of Richer) Adductor brevis hamstring Tendons of quadriceps ex. tendon Adductor longus Lateral patellar retinaculum Rectus femoris Fat pads Gastrocnemius Vastus lateralis Medial patellar retinaculum Vastus medialis Peroneus longus Patellar tendon Gastrocnemius Tibialis anterior Soleus Peroneus longus Ex. digitorum longus Ex. digitorum longus Peroneus Superior ex. retinaculum brevis Ex. hallucis longus Inferior ex. retinaculum Peroneus tertius Peroneus tertius Ex. digitorum Ex. hallucis brevis Peroneal longus tendons Ex. digitorum brevis retinaculum Ex. hallucis longus tendon
MUSCULAR SYSTEM
DEEP MUSCLES (FRONT)
Auricularis superior
Corrugator Lateral palpebral l.
Zygomatic minor ** Zygomatic major ** Levator labii superioris ** Nasalis Buccinator Incisivis labii superioris Muscular node Masseter ** Incisivis labii inferioris Depressor anguli oris ** Depressor labii inferioris ** Digastric Levator scapulae Biceps Omohyoid brachii long head ** Sternohyoid Biceps Subscapularis brachii short head ** Latissimus dorsi Subclavius Serratus anterior Sternomastoid ** Deltoid ** Pectoralis minor Coracobrachialis Internal intercostal Serratus anterior External intercostal Transversus Brachialis abdominis Pronator teres ** Linea alba Palmaris longus ** Biceps brachii ** Arcuate Fl. digitorum Obliquus line superficialis ** externus Fl. carpi ** ulnaris ** Fl. Obliquus internus digitorum ** profundis Inguinal l. Gluteus minimus Iliopsoas Fl. Pectineous pollicis Adductor brevis longus Adductor longus Adductor policis Gracilis ** Abductor digiti minimi Adductor magnus
Frontalis
Frontalis Semispinalis capitis Semispinalis capitis Splenius capitis Scalenus medius Levator scapulae Sternomastoid Trapezius Omohyoid Rhomboid major Scalenus anterior Pectoralis major Teres major Serratus anterior Biceps brachii Anconeus Rectus abdominis Ex. carpi Obliquus externus radialis longus Brachioradialis
Ex. carpi radialis brevis Ex. carpi ulnaris Rectus femoris Fl. carpi ulnaris Adductor magnus Vastus lateralis Vastus lateralis Gracilis Tibialis anterior Semitendinosus Ex. digitorum longus Semimembranosus Fl. hallucis longus
Popliteal fossa Inner hamstring Ex. digitorum brevis tendon Peroneus tertius tendon Tibialis posterior tendon Peroneus brevis tendon Calcaneal (Achilles) Abductor digiti minimi tendon Corrugator
Galea aponeurotica Frontalis Levator palpebrae Temporalis Superior Orbicularis tarsus oculi Orbicularis oculi Zygomatic minor ** Nasalis Levator labii alaeque nasi ** Zygomatic minor Buccinator Levator labii superiorus Temporalis Masseter ** Procerus Levator labii Levator anguli oris alaeque nasi Muscular node Masseter Nasalis Levator labii superiorus Mentalis ** Buccinator Occipitalis Depressor Zygomatic major anguli oris Masseter Zygomatic minor Orbicularis oris Mentalis Depressor labii inferioris Depressor anguli oris
Trapezius Acromion (scapula) Supraspinatus Infraspinatus Greater tubercle Teres minor Teres major Humerus Latissimus dorsi Iliac crest
Semispinalis capitis Deltoid Infraspinatus Teres minor Triceps brachii Latissimus dorsi Ex. digitorum communis Ex. retinaculum
Sartorius Tendon of ex. pollicis longus
MUSCLES OF THE HEAD
DEEP MUSCLES (LATERAL VIEW)
Occipitalis
Sternocleidomastoid Sternohyoid Omohyoid Clavicle Coracoid process Pectoralis minor Pectoralis major Rectus abdominis Serratus anterior Tendinous inscription Obliquus externus Umbilicus
** = cut Gluteus ex. = extensor medius fl. = flexor Gluteus l. = ligament maximus l.l. = ligaments Biceps m. = muscle femoris m.m. = muscles Gastrocnemius Soleus Fl. digitorum longus Abductor hallucis Fl. digitorum brevis Fl. retinaculum
DEEP MUSCLES (REAR) Splenius capitis ** Semispinalis capitis
Medial ptergoid Stylohyoid Levator scapulae Rhomboid minor Omohyoid Rhomboid major Supraspinatus Infraspinatus Teres minor ** Triceps brachii Triceps long head ** brachii lateral head** Teres major Deltoid ** Serratus anterior Triceps Erector brachii spinae medial head External intercostals Serratus posterior inferior Obliquus externus** Obliquus internus Ex. carpi radialis brevis ** Supinator Pronator teres Fl. digitorum Ex. profundis indicis Abductor pollicis Gluteus longus medius Ex. pollicis Piriformis longus Superior Ex. gemellus pollicis Obturator brevis internus Gemellus 1st dorsal inferior interosseous Quadratus 2nd D.I.O. femoris 3rd D.I.O. Adductor 4th D.I.O. brevis Abductor digiti minimi Sacrotuberous l.
ARM
Gluteus medius
Pectoralis major
Deltoid Biceps brachii: Short head Long head
Serratus anterior
Triceps brachii
Triceps brachii: medial head
Brachialis
Sartorius
Iliotibial band
Obliquus externus
Rectus femoris
Biceps femoris: Long head Short head
Vastus lateralis Vastus intermedius
Semimembranosus
Brachioradialis Pronator teres Ex. carpi radialis longus
Fl. carpi radialis
Ex. carpi radialis brevis
Palmaris brevis Palmar aponeurosis Fl. digiti minimi Abductor digiti minimi
Lumbricales Deltoid
Deltoid Latussimus dorsi
Biceps brachii
Brachialis Olecranon Ex. digitorum communis Abductor pollicis brevis Opponens pollicis Lumbricales Dorsal expansion Fl. digitorum superficialis Fl. digitorum profundis
Fl. pollicis longus
Fl. digitorum profundis Tendon fl. digitorum superficialis
Fl. carpi ulnaris Ex. digitorum longus
Brachioradialis Anconeus Ex. carpi radialis longus Ex. carpi radialis brevis Ex. carpi ulnaris Abductor pollicis longus
Ex. digiti minimi (E.C.R.B.) Ex. indicis
Ex. pollicis brevis
(E.C.R.L.)
Ex. retinaculum
3rd dorsal interosseus
Ex. pollicis longus Abductor digiti minimi 4th dorsal interosseus 1st dorsal interosseus Adductor pollicis
dorsal interosseus
Abductor pollicis longus Ex. pollicis brevis
Ex. indicis Abductor digiti minimi Ex. pollicis brevis
Ex. pollicis longus
Ex. carpi radialis brevis
1st dorsal interosseous
Lumbricales Abductor digiti minimi 3rd palmar interosseus 2nd P.I.O. 1st P.I.O. Synovial sheath Distal phalanges
Deep transverse metacarpal l.l. Lumbrical muscles I-IV Opponens digiti minimi Fl. digiti minimi brevis Abductor digiti minimi Common synovial sheath Fl. retinaculum Ulnar nerve Pisiform bone Fl. carpi ulnaris Median nerve Tendon fl. digitorum superficialis Tendon fl. digitorum profundis Ulna Radius
Soleus Peroneus longus
2nd D.I.O. 3rd D.I.O. 4th D.I.O. Ex. indicis
Tendon fl. digitorum profundis
Digital fibrous sheath Adductor pollicis Fl. pollicis brevis Abductor pollicis brevis Opponens pollicis Tendon fl. carpi radialis Tendon abductor pollicis longus Tendon ex. pollicis brevis Tendon fl. pollicis longus Tendon ex. carpi radialis longus
NOTE TO STUDENT Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2001, 2003 BarCharts Inc. 0608
Tibialis anterior Ex. digitorum longus
Peroneus brevis Calcaneal (Achilles) tendon Fl. hallucis longus Gluteus medius Tensor fasciae latae Sartorius Rectus femoris Vastus lateralis Iliotibial band Patella Lateral meniscus
Peroneus tertius Ex. retinaculum Ex. digitorum brevis
Iliopsoas Pectineus Peroneal retinaculum
Abductor digiti minimi
Adductor brevis Adductor longus Adductor magnus Gracilis Vastus medialis Medial meniscus
Patellar l. Gastrocnemius: lateral head Peroneus longus
Gracilis Semitendinosus Sartorius Gastrocnemius: medial head Tibialis anterior
Gluteus medius Gracilis Semitendinosus Semimembranosus Sartorius Gastrocnemius: lateral head medial head Soleus Fl. digitorum longus
Ex. hallucis longus
Peroneus brevis
Tibialis posterior
Peroneus tertius
Ex. retinaculum
Fl. retinaculum
Ex. digitorum brevis
Ex. hallucis brevis
Abductor hallucis Adductor hallucis
Ex. digitorum longus Peroneus tertius
Ex. hallucis brevis
Abductor Fl. hallucis retinaculum 1st dorsal Abductor interosseus hallucis 2nd D.I.O. 3rd D.I.O. Fl. hallucis 4th D.I.O. brevis 1st plantar interosseus Adductor hallucis 2nd P.I.O. 3rd P.I.O. Fl. hallucis longus
Ex. digitorum brevis
Ex. expansion
Adductor magnus Iliotibial band Vastus lateralis Popliteal fossa Plantaris Peroneus longus Peroneus brevis
Inferior ex. retinaculum
Ex. digitorum brevis
Cancaneal (Achilles) tendon Peroneus brevis Calcaneus Peroneal retinaculum Ex. digitorum brevis Abductor digiti minimi Fl. digitorum brevis
Fl. digitorum longus Ex. digitorum longus Tibialis anterior
Superior ex. retinaculum
Cancaneal (Achilles) tendon Peroneal retinaculum Calcaneus
FOOT
Fl. Tibialis anterior digitorum longus Medial malleolus Tibialis posterior (tibia) Fl. Ex. hallucis retinaculum longus Ex. hallucis longus
Lateral malleolus (fibula)
Gluteus maximus
Fl. hallucis longus
Soleus
Ex. digitorum longus
2nd
Ex. pollicis longus
Adductor pollicis Fl. pollicis longus
Teres major
Triceps brachii: Long head Lateral head Medial head
HAND Fl. digitorum profundis
Infraspinatus Teres minor
Patellar l.
Gastrocnemius: lateral head
Fl. carpi ulnaris
Fl. retinaculum Abductor pollicis brevis Fl. pollicis brevis
Patella
Fibular head
Palmaris longus
Fl. digitorum superficialis
LEG
Tensor fasciae latae
Gluteus maximus
Ex. hallucis longus Trochlea Fibula
Tarsometatarsal l.l. Ex. hallucis longus
Tibialis anterior tendon
Tibialis posterior tendon Collateral l.l. Articular capsule Fl. hallucis brevis Lumbricales Fl. hallucis longus tendon Fl. digitorum tendon
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Peroneus longus tendon Peroneus brevis
Tibialis posterior Fl. digitorum Soleus longus tendon Fl. hallucis Calcaneal (Achilles) tendon longus Dorsal Fl. retinaculum cuneonavicular Quadratus plantae m. l.l. Peroneus longus tendon
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CERVICOBRACHIAL PLEXUS
LUMBOSACRAL PLEXUS
Cerebellum 1st cervical vertebrae (transverse process)** Trace of the mandible Supraclavicular n. 1st cervical n. 7th cervicle vertebrae (pedicle & transverse process)** 1st thoracic vertebrae Upper trunk (pedicle)** Middle trunk Trace of the scapula Cervical Inferior trunk plexus Lateral cord Posterior cord 8th cervical n. Medial cord 1st thoracic n. Humerus Spinal cord Musculocutaneous n. Trace of the scapula
Cervical plexus C1-C4 Cervical n.n. C1-C8 Brachial plexus C5-T1
C1 C2 C3 C4 C5 C6 C7 C8 T1 T2 T3 T4 Thoracic T5 n.n. T1-T12 T6
Brain
1st lumbar vertebrae (pedicle)** 5th lumbar vertebrae (pedicle)**
Iliohypogastric n. Ilioinguinal n. Genitofemoral n. Lateral femoral cutaneous n. Trace of the pelvis Intercostal n.n. Femoral n. Superior gluteal n. Inferior gluteal n.
Brachial plexus
Posterior femoral cutaneous n. Musculocutaneous n.
T10 Ulnar n.
Iliohypogastric n.
Inferior rectal n. Dorsal n. of penis (clitoris)
Deep branch
Ilioinguinal n. m. = muscle n. = nerve n.n. = nerves ** = cut
Pudendal n.
Median n. Ulnar n. Posterior brachial cutaneous n. Femur Muscular branches
Subcostal n.
Median n.
Coccygeal n.
Sciatic n.
Radial n.
Cauda equina Radial n. Cutaneous n. of forearm
T9
Sacral plexus L5-S4 Sacral n.n. S1-S5
L5 S1 S2 S3 S4 S5
Axillary n.
Conus medullaris Axillary n.
T8
T11 Thoracic n.n. T12 T1-T12 L1 Lumbar plexus L2 T12-L4 L3 Lumbar n.n. L4 L1-L5
Sacrum, is made up of 5 fused vertebrae (pedicles)**
Trace of the spinal column
T7
12th thoracic vertebrae (pedicle)**
Perineal n.
Superficial branch Muscular branches
Lumbar plexus Trace of the pelvis
Dorsal branch
Sacral plexus
Superior & inferior gluteal n.n.
Palmar branch Dorsal digital n.n.
Sciatic n.
Femoral n. Palmar digital n.n. of the median n. Dorsal digital n.n.
SPINAL CORD Dorsal root (sensory)
Palmar digital n.n. of the ulnar n. Posterior femoral cutaneous n. NERVE STRUCTURE Femoral n. Nucleolus Nucleus Muscular branches Axon hillock
Pudendal n. White matter (sensory)
Ventral root (motor)
Synapse
Spinous process
Common peroneal (fibular) n.
White matter (motor)
Myelin sheath Dendrites
Tibial n.
Pia mater
Sensory ganglion
Axon (n. fiber)
Saphenous n.
Gray matter
Muscular branches
Motor n. fibers
Nissl substance
Schwann cell nucleus
Arachnoid matter
Superior articular process
Cell body Deep peroneal n.
N. fibers
Pedicle Transverse process
Striated m. Saphenous n.
Dura mater
Gray & white rami communicantes
Sympathetic ganglion
Medial dorsal cutaneous n.
Axonal terminal Telodendria
Common dorsal digital n.n.
Common plantar digital n.n. Medial plantar n.
Proper plantar digital n.n. Vertebral body (centrum)
NERVOUS SYSTEM
Endoneurium Perineurium
Blood vessels
Sympathetic trunk Intervertebral disc
Schwann cell
Fascicle
Myofibrils
Lateral plantar n. Inferior articular process & facet
Impulse direction Neurilemma (sheath of Schwann)
Node of Ranvier (axon)
Epineurium
CUTANEOUS INNERVATION: DERMATOMES & PERIPHERAL NERVE DISTRIBUTIONS C2 V1 V2 V3 C3 C4
Greater occipital n. Lesser occipital n. Ophthalmic n. Maxillary n. Trigeminal n. Mandibular n.
Lesser occipital n.
Transverse cervical n. C3
Supraclavicular n.n.
Axillary n.
Lower lateral brachial cutaneous n. Medial antebrachial cutaneous n.n.
T5 T6 T7 T8 T9 T10
Lateral antebrachial cutaneous n.n. Iliohypogastric n. Genitofemoral & ilioinguinal n.
T11 T12 L1 S2 L2
Ulnar palmar n.
Radial n. superbrachial branch Median n.: palmar branch
Digital branches
S3 Genitofemoral n.
L3
Palmar digital branch
Dorsal n. of penis Lateral femoral cutaneous n. Scrotal branch of perineal n.
L4
C6 C7
C8
Laterial cutaneous rami of thoracic spinal n.n. Axillary n. Intercostobrachial & medial brachial cutaneous n.n. Posterior brachial cutaneous n. Inferior lateral cutaneous n. Lateral antebrachial cutaneous n. Posterior antebrachial cutaneous n. Medial antebrachial cutaneous n. Radial n. superficial & dorsal digital branches
S4 S5 Co1
Ulnar n. Median n. L1
Anterior femoral cutaneous n. Obturator n.
L2 Common peroneal n. Infrapatellar branch of the saphenous n.
L5
Posterior cutaneous rami of thoracic spinal n.n.
C4 C5 C6 C7 C8 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 S1 S2 S3
Medial brachial cutaneous & intercostobrachial n.n.
T4
C8
Posterior branches of occipital n.
C2
T3
C7
Great auricular n.
Intercostal n.n. 1. Anterior cutaneous rami 2. Lateral cutaneous rami
T2
C6
Greater occipital n.
Transverse cervical n. Supraclavicular n.n.
T1
C5 T1 C8
= Ophthalmic n. = Maxillary n. = Mandibular n. = Cervical = Thoracic = Lumbar = Sacrum = Coccyx
Great auricular n.
C5 C6
V1 V2 V3 C T L S Co
L3
Ilioinguinal n. Superior cluneal n.n. Inferior & medial cluneal n.n. Lateral femoral cutaneous n.n. Annococcygeal n. Posterior scrotal (labial) n. Posterior femoral cutaneous n.
Lateral sural cutaneous n.
Obturator n.
Medial crural cutaneous branches of the saphenous n. L4 S1 L5
Infrapatellar branch of the saphenous n. S2
Superficial peroneal (fibular) n.
Common peroneal n. Lateral sural cutaneous n.
S1
Sural n.
L4
Deep peroneal (fibular) n.
Medial crural cutaneous branches of the saphenous n. Sural n. Superficial peroneal n. Tibial n.
L5
Lateral plantar n. Medial plantar n.
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NOTE TO STUDENT Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete nervous system information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage & retrieval system, without written permission from the publisher. ©1999, 2003, 2005 BarCharts Inc. 0608
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WORLD’S #1 ACADEMIC OUTLINE
Nursing Care
Procedures
Key steps, tasks & decisions crucial to patient care—including vital signs, documentation & communication, specimens, wound care & more! ¤ This guide provides procedure-specific knowledge on the methods of performing certain tasks ¤ But nursing is more than just the competent completion of a series of tasks; it is equally important that the nurse uses critical thinking to integrate knowledge of the individual patient and his/her nursing care needs in the application of these procedures to each nursing situation ¤ Critical thinking for nursing procedures is the ability to think in a systematic and logical manner, with openness to questions and reflection on the reasoning process used to ensure safe nursing practice and quality care
introduction
¤ A procedure is a series of activities, tasks, steps, decisions, calculations and other processes, which, when undertaken in the appropriate sequence, produces the described result, product or outcome ¤ These procedures include the objects and tools used by the nurse, such as stethoscopes, pharmaceuticals, monitors, catheters and other tubes, and computers; these tools must be used with knowledge, reflective practice and professional judgment to result in an outcome that benefits patients and society
THE NURSE KNOWS: to assess each patient to determine his/her specific individual needs
therapeutic communications
¤ Therapeutic nurse/patient relationships can occur only when each person views the other as a unique human being; characteristics of the therapeutic relationship include clear definitions of goals and boundaries • goal-directed and purposeful interaction involves: º establishing a contract for the time, place and focus of the nurse/patient meetings º planning conditions for termination at the onset and throughout the relationship • roles and responsibilities should be clearly defined º the nurse is the professional caregiver and facilitator º the patient’s needs and problems are the focus of the relationship • confidentiality is maintained by: º sharing information only with professional staff who have a need to know º informing the patient of all information to be shared beforehand º advising the patient that information that deals with harming him/herself or others will be communicated to the staff as needed ¤ Therapeutic behaviors by the nurse include: • self-awareness of thoughts, feelings and behaviors • clarification of personal values • empathic understanding • effective communication • realistic goal setting • collaborative work with patients • responsible and ethical practice ¤ Therapeutic use of self is the ability to use one’s personality consciously and with full awareness in an attempt to establish relatedness and to structure nursing interventions; the nurse must possess: self-awareness, selfunderstanding, self-reflection
Rapport
Implies special feelings on the part of both the patient and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust and a nonjudgmental attitude
Trust
Implies a feeling of confidence in another person’s presence, reliability, integrity, veracity and sincere desire to provide assistance when requested; trust is the basis of a therapeutic relationship
Respect
Implies the dignity and worth of an individual regardless of his/her unacceptable behavior
Genuineness
Refers to the nurse’s ability to be open, honest and “real” in interactions with the patient; genuineness implies congruence between what is being felt and what is being expressed
Empathy
A process wherein an individual is able to see beyond outward behavior and sense accurately another’s inner experience at a given time; with empathy, the nurse’s feelings remain on an objective level—it differs from sympathy in that, with sympathy, the nurse subjectively shares what the other person is feeling and experiences a personal need to alleviate distress
¤ Nonverbal Communication • research suggests that nonverbal communication is more important to understanding human behavior than words alone—the nonverbal “channels” seem to be more powerful than what people say: º eye contact º facial expressions º gestures º posture & body orientation º proximity º paralinguistics ¤ 5 principles regarding the establishment of professional boundaries: • rule of abstinence: the professional must abstain from personal gratification at the patient’s expense • duty to neutrality: the professional should not interfere in the patient’s personal relationships • promotion of patient’s autonomy and self-determination • fiduciary relationship: the professional should act in the best interests of the patient • respect for human dignity
THE NURSE KNOWS: • the difference between a caring relationship and an overinvolved relationship is narrow: you must learn to distinguish between professional and personal interactions • always begin with the question: was the intervention designed for the benefit of the patient or the nurse?
• aseptic technique is an infection control procedure that decreases the transmission of pathogens and, thereby, reduces the incidence of infection º medical asepsis: practices that reduce the number, growth and spread of microorganisms or the absence of pathogens ■ AKA: “clean technique” ■ clean objects have the presence of some microorganisms that are usually not pathogenic ■ soiled/dirty objects have the presence of a high number of microorganisms that are potentially pathogenic ■ medical asepsis procedures include: > hand washing > gloves > daily linen changes > clean floor and furniture > designation of clean and dirty areas
clean conditions asepsis: the absence of microorganisms ¤ Microorganisms are found everywhere in the world • pathogens (pathogenic microorganisms) cause disease • nonpathogenic organisms do not cause disease • some microorganisms are nonpathogenic in their normal environment (e.g., escherichia coli [E. coli] in the intestines) but are pathogens in other environments (e.g., E. coli in the urinary tract results in a urinary tract infection [UTI]) ¤ Providing a safe environment to prevent the transmission of nosocomial infections • an infection acquired in the hospital/health-care setting that was not present or incubating at the time of admission is called a nosocomial infection 1
Clean Conditions (continued)
clean areas: linen room, medication room dirty areas: specimen/lab area, central service pick-up area, used-linen receptacles ▲ cross-contamination must be avoided ▲ articles that touch the floor are contaminated and must be disposed of properly > cleaning is conducted from the cleanest to the least-clean area; for example, clean an incision from the central portion outward to the periphery of the skin º surgical asepsis: practices that eliminate all microorganisms from an object or area ■ AKA: “sterile technique” ■ removes all microorganisms and spores from an object or area > spores: single-celled organisms in a resting or inactive state ¤ Reducing or eliminating infectious agents • contact with inanimate objects can be the source of transmission of microorganisms • this chain of infection can be broken by reducing or destroying the microorganisms on an object º cleansing: removal of soil and organic material from instruments or equipment ■ reusable objects need to be cleansed after use with each patient ■ objects are cleansed before disinfection or sterilization ■ objects are cleansed with water, mechanical action and, sometimes, a detergent > rinse under cold water (warm water causes protein in organic material to coagulate and stick) > create friction to the object while under the running water > rinse under warm water > dry the object ■ nurses need to use personal protective equipment—such as gloves, masks, goggles—during cleansing to prevent potential hazard to the nurse from splashing of contaminated materials º disinfection: the elimination of pathogens, except for spores ■ chemical solutions are used to clean inanimate objects, such as stethoscopes, blood pressure cuffs, linens, electronic fetal monitor attachments and some types of endoscopes ■ some common disinfectants are alcohol, sodium hypochlorite, quaternary ammonia bleach > a germicide is a chemical that can be applied to both animate and inanimate objects to eliminate pathogens > germicides used on human skin include antiseptic preparations, such as alcohol and silver sulfidine º sterilization: the total elimination of all microorganisms, including spores ▲
■
▲
■
■
methods of sterilization include: > moist heat/steam > radiation > chemicals > ethylene gas choice of method depends upon type of contamination, amount of contamination and object to be sterilized boiling water is not an effective sterilization method, as some viruses and spores can survive temperatures above 121° Fahrenheit (F)
Hand Washing ¤ The Centers for Disease Control and Prevention found that: • there is only a 48% compliance rate for hand washing • on average, hands were washed for 8.5 to 9.5 seconds, but a minimum of 10 to 15 seconds is needed to prevent the spread of infection • compliance with effective hand washing technique is higher among nurses than other health-care personnel, including physicians ¤ The most basic and effective infection control measure (when done properly) ¤ The rubbing together of all surfaces and crevices of the hands ¤ Essential elements of effective hand washing • soap or chemical º prevents the spread of microorganisms • water º adequate flow of water, but without splashing that will contaminate THE NURSE KNOWS: uniform always wash your hands— º warm water—cold water inhibits • after arriving at work sudsing and cleansing, and hot water • before leaving work damages the skin • between patient contacts wetness facilitates distribution of soap º • after removing gloves over entire surface • before and after performing • friction: physical removal of soil and invasive procedures transient flora—most important!! • after handling contaminated º rub vigorously with a circular motion equipment while keeping fingers lower than wrists º rub all sides of each finger, then between the fingers, then the palms, and finally, the backs of the hands • hand washing must take a minimum of 10 to 15 seconds in order to produce the mechanical action necessary to allow antimicrobial products to achieve the intended effect • hands soiled with organic matter require soap or detergents with antiseptics and water to be effectively cleaned • waterless antiseptics agents are useful only when hands look clean
• breathing: 12 to 18 respirations (breaths) per minute º respirations should be counted for at least 30 seconds; the total number of breaths in a 15-second period is relatively small, and any miscounting can result in rather large errors when multiplied by 4 º try to count respirations as inconspicuously as possible so that the patient does not consciously alter his/her rate of breathing; this can be done by observing the rise and fall of the patient’s hospital gown while you appear to be taking his/her pulse º respiratory rate, particularly in the presence of cardiopulmonary illness, can be a very reliable marker of disease activity • pulse: 60 to 80 beats per minute (at rest) º can be measured at any place where there is a large artery (e.g., carotid or femoral) or simply by listening over the heart º for the sake of convenience, it is generally done by palpating the radial impulse ■ place the tips of your index and middle fingers just proximal to the patient’s wrist on the thumb side, orienting them so that they both are over the length of the vessel • blood pressure (BP) systolic: less than 120 mm of mercury (mm Hg) diastolic: less than 80 mm Hg º readings are reported in millimeters of mercury (mm Hg) º the size of the BP cuff will affect the accuracy of these readings ■ the inflatable bladder, which can be felt through the vinyl covering of the cuff, should reach approximately 80% around the circumference of the arm ■ the width of the inflatable bladder should cover approximately 40% of the upper arm > if the cuff is too small, the readings will be artificially elevated > if the cuff is too large, the readings will be artificially low
vital signs (VS)
¤ Vital signs (VS) are physical indications that an individual is alive: • temperature • heartbeat or pulse • breathing rate • blood pressure (BP) ¤ These signs can be observed, measured and monitored to assess an individual’s level of physical functioning • normal vital signs vary, depending upon age, sex, weight, exercise tolerance, and condition º Preparing to check vital signs: ■ examination/hospital room should be quiet, warm and well-lit ■ prior to measuring vital signs, the patient should have had the opportunity to sit or rest in bed for approximately 5 minutes, so that the values are not affected by the exertion required to walk to the exam room or other activities • all measurements are made while the patient is seated/reclining º observation: before diving in, take a minute or so to look at the patient in his/her entirety, making your observations ■ does the patient seem anxious, in pain, upset? ■ what about dress and hygiene? ■ remember, the data collection process begins as soon as you lay eyes on the patient ¤ Normal ranges for the average healthy adult • temperature: 97.8–99.1° Fahrenheit (F); 36.5–37.2oC o º normal = 98.6° F; 37 C generally obtained using an oral thermometer that provides a digital º reading when the sensor is placed under the patient’s tongue º temperature is measured in degrees, either Celsius (C) or Fahrenheit (F), with a fever defined as greater than 38–38.5° C or 100.4–101.5° F º rectal temperature, which most closely reflects the body’s core temperature, is approximately one degree Fahrenheit (1° F) higher than oral temperature
THE NURSE KNOWS: these numbers provide critical information about a patient’s state of health—that’s why they’re called “vital signs” 2
granulation: tissue development > granulation tissue (new tissue) grows inward from the surrounding healthy connective tissue > granulation tissue is filled with new capillaries that are fragile and bleed easily; granulation tissue is red and translucent, with a granular appearance ■ wound contraction: the process of wound closure; contraction is noticeable 6 to 12 days after injury > the edges of the wound are drawn together by the action of myofibroblasts, which are specialized cells that contain bundles of parallel fibers in the cytoplasma; these myofibroblasts bridge across a wound and then contract to pull the wound closed maturation phase: the final stage of healing; begins on day 21 (approx.) º and can continue for up to 2 years, depending on the depth of the wound; scar tissue is remodeled by collagen deposition, lysis (disintegration) and debridement (removal, usually surgical) of wound edges ¤ Wound Drainage • there are 3 types of wound drainage: º serous exudate, which is primarily serum (the clear portion of blood); appearance is watery and has a low protein count; seen with mild inflammation, such as blister formation after a burn º purulent exudate, which is pus; generally occurs with severe inflammation and infection; exudate is thick because of the presence of leukocytes, liquefied dead tissue debris, and bacteria; purulent drainage may vary in color (yellow, brown, green), depending on the causative organism º hemorrhagic exudate, which is primarily red blood cells (RBC) and is caused by capillary damage; this type of exudate is associated with severe inflammation; the color of the exudate reflects whether the bleeding is fresh (bright red) or old (dark red) ¤ Wound Healing • there are 3 types of wound healing: º primary intention: wounds with minimal tissue loss and edges that are well-approximated (closed); healing occurs with minimal granulation tissue and minimal scarring º secondary intention: wounds with extensive tissue loss or in which the wound edges cannot be approximated; repair time is longer as granulation tissue gradually fills in the deficit; tissue replacement and scarring is greater, and the susceptibility to infection is increased º tertiary intention: delayed closure; conditions in which healing by tertiary intention may occur include poor circulation or infection; suturing of the wound is delayed until the problem resolves and more favorable conditions exist for wound healing ¤ Hyperbaric Oxygen Treatment (HBO2 or HBOT) • oxygen used under pressure can assist wound healing by increasing the amount of oxygen delivered to body tissues by the bloodstream º HBO2 provides the oxygen needed to stimulate and support wound healing, and to kill germs º HBOT is a supplemental therapy to be used in addition to the current medical and surgical therapy
wounds & wound care
■
¤ Skin: the body’s largest organ and its primary defense against infection ¤ Wound: a disruption in the integrity of body tissue • any wound sets in motion a complex set of responses • wound healing occurs in a 3-phase process: º defensive (inflammatory) phase: occurs immediately after injury and lasts 3 to 4 days; hemostasis and inflammation are the major events ■ hemostasis: the cessation of bleeding > occurs with vasoconstriction of large blood vessels > platelets, activated by the injury, aggregate to form a platelet plug and stop the bleeding > activation of the clotting cascade leads to the formation of fibrin and a fibrinous meshwork, which traps platelets and other cells > fibrin clot formation provides initial wound closure, and prevents excessive loss of blood and body fluids ■ inflammation: the body’s defensive adaptation to tissue injury; involves both vascular and cellular responses > tissue injury stimulates the release of chemical mediators, such as histamine (from mast cells), serotonin (from platelets), complement and kinins; all these are vasoactive substances that cause the blood vessels to dilate and become more permeable, resulting in increased blood flow, which carries the nutrients and oxygen that are essential to wound healing ▲ increased blood flow transports leukocytes (white blood cells [WBC]) to the area to participate in phagocytosis (the envelopment and disposal of microorganisms) ▲ increased blood supply also removes the dead cells, bacteria and exudates (material and cells discharged from the blood vessels) > inflammation results in the area’s appearing red, edematous (swollen) and warm to the touch, with varying amounts of exudates present º reconstructive (proliferative) phase: begins on day 3 or 4 following the injury and lasts for 2 to 3 weeks ■ begins with collagen depositions; collagen is the most abundant protein in the body and is the material of tissue repair > connective tissue contains fibroblasts, which migrate into the wound as a result of cellular mediators > fibroblasts secrete collagen > initially, collagen is gel-like; however, over months of healing time, it forms collagen fibrils and adds tensile strength to the wound > as the wound become stronger, the risk of wound separation or rupture decreases > a properly healing wound can resist normal stress, such as tension or twisting, after 15 to 20 days ■ angiogenesis: the formation of new blood vessels > with injury, the endothelial cells in the existing vessels produce enzymes that break down the basement membrane; as a result, new vessels form and grow across the wound to increase blood flow, and the supply of nutrients and oxygen necessary for wound healing
• collection from a closed drainage system º a sterile specimen can be obtained to culture the urine º to obtain a “fresh” specimen: ■ manipulate the tubing so that urine drains from the tubing into the collection bag ■ clamp the tubing below the aspiration port for 10 to 15 minutes ■ wash hands and wear gloves ■ cleanse the aspiration port and insert needle/syringe to aspirate urine (this is a sterile procedure) ■ transfer the specimen to a sterile container; seal, label and transport to lab immediately • clean/voided specimens º a clean-catch or midstream-voided specimen is done to collect a specimen of urine uncontaminated by skin flora º the first voiding in the morning is the best time to obtain this specimen º different aseptic techniques are used for women and men: ■ women are instructed to cleanse from the front to the back ■ men are instructed to cleanse from the tip of the penis downward > for infants and young children, a sterile collection bag is placed over the perineum or penis/scrotum
urine collection
¤ The type of testing determines the method of collection ¤ All urine collection requires the use of universal precautions to prevent the transmission of microorganisms • random collection º order is written for a UA (routine urine analysis) º collected at any time using a clean container, not a sterile container º after the patient urinates into the specimen collection container, it is sealed, labeled and placed in a biohazard bag for transport to the laboratory º specimens need to be submitted to the laboratory immediately to prevent the growth of bacteria or changes in the urine’s composition • timed collections º urine is collected over a 24-hour period and stored in a plastic gallon container ■ container contains a preservative ■ if the analyte to be studied is light-sensitive, a dark plastic container is needed ■ container is refrigerated or kept on ice throughout the 24-hour time period º at the beginning of the collection period, the patient voids and discards the first specimen; all subsequent urine is saved until the end of the 24-hour period—a complete, forced voiding at the exact end of the 24-hour period is the last specimen added to the container
THE NURSE KNOWS: • privacy and respect for the person is critical in obtaining a urine specimen • proper collection technique and timely transport of the specimen to the lab will influence the validity of the results 3
º the first sample of blood drawn from a central line cannot be used for diagnostic testing º the amount removed, prior to obtaining a sample for testing, is directly related to the dead space of the catheter ■ equipment needed: > 5-ml heparinized syringe > ice ■ contraindications to arterial punctures: > patient is hyperthermic > immediately after suctioning or respiratory treatments > following changes in ventilator settings > patient is on anticoagulant therapy or has a clotting disorder > patient has peripheral vascular disease
blood specimens
¤ Venous Samples • venipuncture: puncturing of a vein with a needle to aspirate blood º equipment needed: ■ sterile needle and syringe ■ vacuum tube holder with a sterile two-sided needle ■ collecting tubes (universally color-coded): > red = no additive > lavender = EDTA (ethylenediaminetetraacetic acid) > light blue = sodium citrate > green = sodium heparin > gray = potassium oxalate > black = sodium oxalate º sources of variability that can lead to inaccuracy ■ hemoconcentration: reduced plasma volume and increased concentration of blood cells, plasma proteins and protein-bound constituents ■ hemolysis: breakdown of red blood cells (RBC) and the release of hemoglobin ■ contamination with IV fluids: when blood is drawn from a site above an intravenous infusion
THE NURSE KNOWS: • to perform an Allen test to measure for collateral circulation before the arterial puncture • to wait a minimum of 20 minutes after any respiratory treatments
¤ Capillary Punctures • skin punctures to obtain small quantities of blood or when the patient has poor peripheral veins • common sites for capillary puncture: º for neonatals & infants ■ heel: the plantar surface of the heel, beyond the lateral and medial limits of the calcaneus (heel bone); the puncture should NEVER be performed on the central area of the infant’s foot (area of the arch) for children & adults º ■ fingertip: the inner aspect of palmar fingertip ■ earlobe: when the patient is in shock or the extremities are edematous
THE NURSE KNOWS: • to keep the length of time a patient stands before venipuncture to a minimum, which increases accuracy of results • to minimize the length of time of tourniquet application during venipuncture, which decreases the incidence of hemoconcentration • to use a needle gauge appropriate to the size of the vessel, which prevents hemolysis ¤ Arterial Samples • arterial puncture: puncturing a peripheral artery, such as the radial or femoral artery, to aspirate blood • central line puncture: arterial blood samples can also be obtained from an arterial line
THE NURSE KNOWS: • application of heat prior to capillary puncture leads to vasodilation • after the puncture, the first drop of blood is discarded to avoid hemolyzed cells
prescribed to decrease GI mucosal irritation; foods to be avoided are raw fruits (except bananas), vegetables, seeds, plant fiber, whole grains; dairy products are limited to 2 servings per day º high-fiber diet: consists of foods high in fiber and/or cellulose; used to increase the forward motion of indigestible wastes through the colon º sodium-restricted diet: used with patients who have excess fluid volume, hypertension, heart failure, myocardial infarction and/or renal failure; sodium intake may be restricted as follows: ■ mild: 2,000 to 3,000 mg (2 to 3 grams) ■ moderate: 1,000 mg (1 gram) ■ strict: 500 mg (1/2 gram)
nutrition
¤ Physiologic Basis • the consumption of nutrients is necessary to support the physiologic activities of digestion, absorption and metabolism, as well as to maintain homeostasis • nutrition is the process by which the body metabolizes and uses nutrients • the metabolism of nutrients plays a critical role in supplying the body with the substances needed to maintain internal homeostasis • nutrients are classified into 3 groups: º energy nutrients, which release energy for maintenance of homeostasis º organic nutrients, which build and maintain body tissues, and regulate body processes º inorganic nutrients, which provide a medium for chemical reactions, transport materials, maintain body temperature, promote bone formation and conduct nerve impulses
¤ Enteral Nutrition • used for patients with a functional GI tract who will not or cannot eat, and therefore, are at risk for malnutrition • tube feedings are contraindicated in patients with: º diffuse peritonitis º intestinal obstruction º intractable vomiting º severe diarrhea • enteral feeding tubes º large-bore nasogastric tube: a tube is inserted through nostril and passed into gastric cavity ■ advantages > easy to place > large volume can be delivered intermittently > acid environment may reduce infection > less risk of dumping syndrome > uses normal GI-emptying mechanisms and prevents intestinal overload ■ disadvantages > limited use (1 week maximum) > gastric retention, reflux and aspiration are possible > large tube is uncomfortable and visible to others > allows regurgitation by interfering with normal upper and lower esophageal sphincter function > gastric ulceration may occur º gastrostomy or PEG tube: tube is inserted directly into gastric cavity ■ advantages
¤ Diet Therapy • therapeutic nutrition requires consideration of the patient’s total needs: cultural, socioeconomic, psychological and physiological • nurses need a solid comprehension of diet therapy in order to assist the patient in making lifestyle adaptations and informed choices º nothing by mouth (non per os – NPO): a type of diet modification, as well as a fluid restriction; this intervention is ordered to rest the gastrointestinal (GI) tract, either prior to surgery and certain diagnostic procedures, or when the source of the patient’s nutritional problem is unidentified º clear liquid diet: consists of liquids that have NO residue, such as water, apple juice and gelatin; dairy products are not allowed º liquid or full-liquid diet: consists of substances that are liquid at room temperature (e.g., ice cream, pudding) º soft diet: promotes mechanical digestion of foods; used for patients with difficulty in chewing or swallowing, or with impaired digestion and/or absorption; foods to be avoided include nuts, seeds (including tomatoes or berries with seeds), raw fruits and vegetables, fried foods, whole grains º low-residue diet: consists of reduced fiber and cellulose, 4
Nutrition (continued)
> long-term use possible > allows intermittent feeding > normal gastric emptying time occurs > tube is not visible to others > medication administration is easier > less risk of infection > esophageal irritation is avoided ■ disadvantages > requires surgical placement with sedation or local anesthesia > necessitates local skin care > may ulcerate gastric mucosa º nasointestinal tube: tube is inserted through nose and passed into intestines—either duodenum or jejunum ■ advantages > smaller tube, more comfortable > less risk of aspiration and reflux ■ disadvantages > requires X-ray confirmation of placement > tube is more difficult to place > elevated position needs to be maintained > constant infusion is needed because of osmotic response of the small intestine > cramping, diarrhea, vomiting and distension are more common > tube may migrate back into stomach, increasing the risk of aspiration > greater risk of infection due to alkaline environment > limited use (4 weeks maximum)
º jejunostomy (tube surgically inserted into jejunum) ■ advantages > tube position is guaranteed > tube is not visible > less risk of reflux and aspiration ■ disadvantages > requires general anesthesia for placement > continuous infusion is required > cramping, diarrhea, vomiting and distension are more common > tube can migrate back into stomach, increasing the risk of aspiration > greater risk of infection due to alkaline environment º types of enteral formulas ■ osotonic: contains proteins, fats and carbohydrates with a high molecular weight and osmolarity equal to that of the body ■ elemental: contains monosaccharides and amino acids with minimal triglycerides content in hypertonic concentrations ■ fluid restriction formula: contains highly concentrated source of kilocalories • parenteral feedings: provide nutrition via a route outside the alimentary tract º infusion of solution directly into the vein to meet daily nutritional needs º total parenteral nutrition (TPN): consists of an intravenous solution containing dextrose, amino acids, fats, essential fatty acids, vitamins and minerals
• avoid evaluative statements: “patient is uncooperative,” “patient is lazy”; instead, cite specific behaviors or actions that you observed, i.e., “patient said, ‘I hate this place,’ and kicked the trash can” • state time intervals precisely; e.g., “every 3 hours,” not “occasionally” • do not make relative statements: “a mass the size of an egg”; rather, state: “mass 3 cm x 5 cm”—always be specific • draw pictures when appropriate; i.e., location of scars, bruises, skin lesions • refer to findings by using anatomic landmarks, such as LUQ (left upper quadrant) ¤ Accurate charting/documentation reflects the nurse’s decision-making ability and the patient’s plan of care ¤ Methods of Documentation • narrative charting: a story format that describes the patient’s status, interventions and treatment, as well as the patient’s response to treatment º advantage ■ easy to use in an emergency situation in which a simple chronologic order of events needs to be recorded º disadvantages ■ lacks analysis and critical decision-making on the part of the nurse ■ difficult to avoid subjectivity • SOAP: a structured logical format applied to narrative charting; the acronym SOAP stands for: º S: subjective data—what the patient says º O: objective data—what is observed/inspected º A: assessment/analysis—the conclusion reached on the basis of the data in “S” and “O” formulated as the patient’s problem or nursing diagnosis º P: plan—actions to be taken to change the status of the patient’s problem ■ advantage > requires analysis of collected data to identify the problem ■ disadvantage > no opportunity to evaluate and revise the plan of care within the same note • PIE: acronym for problem, intervention, evaluation • AIR: acronym for assessment, implementation, revision (a variation of PIE) • focused charting: a method of identifying and organizing the narrative documentation of patient concerns to include data, actions and responses • CBE (charting by exception): a method that requires the nurse to document only deviations from pre-established norms
documentation
¤ Documentation is written evidence of: • the interaction between and among health professionals, patients, families and health-care organizations • the administration of tests, procedures, treatments and patient education • the patient’s response to diagnostic tests, procedures, treatments and interventions ¤ Systematic documentation is critical because it presents the care administered by nurses in a logical manner, as follows: • assessment data identifies the patient’s specific condition or alterations, and provides the foundation of the nursing care plan • risk factors and/or the identified alteration in health patterns direct the formation of the nursing diagnosis and the nursing care priorities • identifying the nursing diagnosis promotes the development of the patient’s goals (short-term and long-term) and expected outcomes, as well as triggering the creation of nursing actions or interventions • the plan of care identifies the actions necessary to resolve the nursing diagnosis • implementation or the act of “nursing” is evidenced by actions the nurse performs to assist the person being nursed in achieving the expected outcomes ¤ Documentation requirements differ, depending on the health-care facility • all nursing documentation must reflect the nursing process and the individualized context of the patient, and the nursing situation • nursing documentation must be logical, focused and relevant to care, and also must represent each phase of the nursing process ¤ General Documentation Guidelines • be certain you have the correct patient record or chart, and that the patient’s name and identifying information is on EVERY page of the record • document as soon as the patient encounter is concluded to ensure accurate recall of data • date and time each entry—accurately • sign each entry with your full legal name and professional credentials • do not leave space between entries • if an error is made, use a single line to cross out the error, then date, time and sign the correction—never erase, cross out or use correction fluid • never change another person’s entry, even if it is incorrect • use quotation marks to indicate direct patient responses • document in chronological order • write legibly • use pens with permanent black ink, which photocopies well • document in a complete but concise manner by using phrases and abbreviations (as appropriate) • document all telephone calls made or received by you that are related to a patient’s care • avoid using judgmental language: “good,” “poor,” “bad,” “normal,” “abnormal,” “appears to be,” etc.
THE NURSE KNOWS: documentation based on the nursing process facilitates effective care, as the story of the patient’s care can be traced from assessment, to identification of the problems and calls for nursing, to the planning, implementation and evaluation of nursing care 5
¤ Skin Care • skin, the body’s largest organ, provides a protective barrier between internal and external environments: º regulates body temperature º secretes sebum º excretes sweat º transmits sensations º facilitates absorption of vitamin D • skin care promotes optimal functioning of the skin; excessive or abrasive skin care can damage the skin and result in a loss of protective functions • optimal skin care includes: º perineal care: to prevent or eliminate infection and odor, to promote healing, remove secretions and provide comfort º back rubs: to stimulate circulation, relax muscles and relieve muscle tension º foot and nail care: to prevent problems that may interfere with ambulation and standing º oral care: to maintain the integrity of the mucous membranes, teeth, gums and lips º hair care: to promote hair growth, prevent hair loss, prevent infections and infestations, promote circulation of the scalp, evenly distribute oils along hair shafts and maintain physical appearance ■ brushing and combing ■ shampooing ■ shaving
hygiene
¤ Hygiene: the science of health; it provides cleanliness, comfort, relaxation, positive self-image and skin integrity • hygiene is influenced by social and cultural practices, personal preferences, socioeconomic status and knowledge • nurses need to be aware of the meaning of self-care activities in the area of hygiene ¤ Cleansing baths: purpose is personal hygiene and part of routine care • an excellent time to perform a complete skin assessment • provides time for the nurse to meet the patient’s psychosocial needs • provides a time to educate the patient on basic and special hygiene needs • types of baths º shower: for ambulatory patients, with minimal assistance from the nurse º tub bath: permits washing and rinsing in the tub º self-help bath: for patients confined to bed; the nurse prepares bath equipment but provides minimal assistance—usually limited to washing difficult-to-reach places º complete bed bath: for dependent patients confined to bed—the nurse washes the patient’s entire body º partial bath: cleaning only body areas that would cause discomfort or odor if not washed º therapeutic bath: usually done in a tub and typically lasting from 20 to 30 minutes ■ requires a physician’s order stating the: > type of bath > temperature of the water > surface to be treated > type of medicated solution to be used
THE NURSE KNOWS: • all hygiene practices are influenced by the patient’s background and cultural values • to ask the patient before performing care and to show sensitivity to the practices that are different from your own
movement, body alignment & body mechanics
¤ Mobility is the ability to move and engage in activity; it promotes health and well-being ¤ Immobility is the inability to move and engage in activity; it presents a threat to physical, mental and social well-being • mobility activities include: º walking º sitting º standing º pushing/pulling º performing activities of daily living (ADLs) • mobility influences the function of many body systems, such as the respiratory, gastrointestinal and urinary and enhances systems, Physiologic Effects of Immobility muscle tone and energy level ¤ Body alignment refers to the Neurologic Gastrointestinal (GI) position of body parts in relation • sensory deprivation • decreased appetite • stress ulcers to each other • constipation • muscle tone and bone strength • fecal impaction allow a person to maintain an erect posture Cardiovascular Urinary • proper body alignment is • increased cardiac workload • urinary stasis characterized by: • orthostatic hypotension • urinary tract infection (UTI) • formation of thrombus • calculi º head upright º face forward º shoulders square Respiratory Integumentary º back straight • increased respiratory effort • pressure ulcers º abdominal muscles tucked in • hypostatic pneumonia • skin shearing º arms straight at side • altered gas exchange hands palm forward º º legs straight Musculoskeletal Psychological º feet forward • anxiety ¤ Physiologic effects of mobility • decreased bone density • contractures • depression and immobility • helplessness, hopelessness • immobility affects a variety of • muscle atrophy • increased pain • increased dependency body systems and functions
ISBN-13: 978-142320742-9 ISBN-10: 142320742-4
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¤ Nursing procedures that prevent the complications of immobility • bedrest º a therapeutic intervention that: ■ provides rest for patients who are exhausted ■ decreases the body’s oxygen consumption ■ reduces pain and discomfort º bedrest can also be counterproductive; inactivity caused by bedrest causes structural changes in joints and shortens muscles; changes such as decreased range of motion (ROM) and contractures can occur within 48 hours º it is an important nursing responsibility to prevent immobility—approximately 7 days are needed for the patient to regain the function lost during 1 day of bedrest • body alignment º when patients are unable to move independently, nurses are entrusted to use proper turning and positioning techniques º if the patient is unable to move independently, he/she must be repositioned every 2 hours ■ when positioning a patient in bed, the hips should be even with the middle of the bed (between the knee gatch and the head elevation portion) º 3 essential principles to be considered with positioning patients: ■ pressure: compromises circulation and leads to skin breakdown and ulceration ■ friction: caused when the skin is dragged across a rough surface, such as bed sheets, stretchers or other surfaces ■ skin shear: tearing of the deep layers of skin as a result of being dragged across a hard surface ¤ Range-of-motion (ROM) exercises • ROM exercises are used to preserve full flexibility, maintain muscle tone and strength, prevent contractures and improve circulation • during ROM exercises, each joint is taken through its full functional motion
Disclaimer: This guide is intended for informational purposes only. Due to its condensed format, this guide cannot cover every aspect of the subject, and should be used in conjunction with course lectures and texts. This guide is not intended for the diagnosis, treatment or cure of any medical condition or illness, and should not be used as a substitute for professional medical care. BarCharts, Inc., its writers and editors are not responsible or liable for the use or misuse of the information contained in this guide. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2007 BarCharts, Inc. 0508
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WORLD’S #1 ACADEMIC OUTLINE
ADVENTITIOUS LUNG SOUNDS
ASSESSING LUNG SOUNDS To auscultate lung sounds, move the diaphragm of your stethoscope according to the numbers on the corresponding diagram. There are three normal breath sounds. (B) Bronchial breath sounds-loud, harsh, high pitched. Heard over trachea, bronchi (between clavicles and midsternum), and over main bronchus.
(BV) Bronchovesicular breath sounds-blowing sounds, moderate intensity and pitch.
SOUND
CHARACTERISTICS
LUNG PROBLEM
Crackles
popping, crackling, bubbling, moist sounds on inspiration
pneumonia, pulmonary edema, pulmonary fibrosis
Rhonchi
rumbling sound on expiration
pneumonia, emphysema, bronchitis, bronchiectasis
Wheezes
high-pitched musical sound during both inspiration and expiration (louder)
emphysema, asthma, foreign bodies
Heard over large airways, on either side of sternum, at the Angle of Louis, and between scapulae.
(V) Vesicular breath sounds-soft breezy quality, low pitched. Heard over the peripheral lung area, heard best at base of lungs. B
V
1
2
V
2
V
3 BV
BV
3
4
4
5
5
6
6
7
7
ARTERIAL BLOOD GAS ANALYSIS (ABGS)
V
4
4 V
5
5
V
V
V
V
V
9
NORMAL EKG PATTERN COMPLEX
NORMAL LENGTH OF TIME
WHAT IT REPRESENTS
P wave
<.12 sec
depolarization of atriapreparation for contraction
.12 to .2 sec
time for impulse to spread from atria to ventricles
0.04 to 0.11 sec
depolarization of the ventricles
-0.5 and +1.0 mm below and above the baseline
completion of ventricular depolarization
ST segment QT interval
up to 0.43 sec
electrical systole
T wave
<5 mm in amplitude
repolarization of ventricles sometimes follows T wave may indicate hypokalemia
U wave 1 second R
T P
1.0 millivolt (mV) 0.5 mV
U
S QRS complex
0.1mV
Q-T interval
CARDIAC ENZYMES
LDH2 SGOT, AST Aspartate aminotransferase
Faint; heard after nurse has concentrated Faint murmur heard immediately Moderately loud, not associated with thrill Loud and may be associated with a thrill Very loud; associated with thrill Very loud; heard with stethoscope off chest, associated with thrill
1.The systolic phase begins with the first heart sound (S1), the closure of the mitral and tricuspid (AV) valves. 2.The diastolic phase begins with the second heart sound (S2), the closure of the aortic and pulmonic (semilunar) valves.
Q
LDH1 Lactic dehydrogenase
GRADING OF HEART MURMURS Grade I Grade II Grade III Grade IV Grade V Grade VI
Heart sounds produced by valve closure are best heard where blood flows away from the valve instead of directly over the valve. The white circled areas on the corresponding diagram indicate optimal placement of the stethoscope for auscultating heart sounds.
S-T segment
CK-MB Creatine kinasemyocardial muscle
A quick method of analysis: Look at the pH first. Draw an arrow if it is low or high. An arrow indicating low (↓) means acidosis. An arrow indicating high (↑) means alkalosis. Next, look at the respiratory indicator (PaCO2). Draw an arrow if it is low or high. Interpretation: If the arrows are in the opposite direction, the problem is respiratory in nature-either resp. acidosis or resp. alkalosis. Next, look at the metabolic indicator (HCO3). Draw an arrow if it is low or high. Interpretation: If the pH arrow and the metabolic arrow are in the same direction, the problem is of metabolic in nature-either metab. acidosis or metab. alkalosis. Additional analysis: Compensation is present if the arrows of PaCO2 and HCO3 are opposite. Partial compensation is present if the arrows of PaCO2 and HCO3 point in the same direction.
HEART SOUNDS
1 mm (0.04 second)
ENZYME
7.35 to 7.45 35 to 45 mm Hq 22-26 mEq/L
5 mm (0.2 second)
P-R segment
P-R interval
pH PaCO2 HCO3
V
8
8 9
PR interval QRS complex
pleurisy, pneumonia, pleural infarct
BV V
3
V V
3
V V
BV
Pleural Friction dry, grating sound on Rub both inspiration and expiration
2
2
V BV
1
1
V
B
B
1
OCCURS AFTER ACUTE ISCHEMIC EVENT
PEAKS
0-7 U/L >0.05 fraction of total CK
4 to 6 hrs
18 to 24 hrs
29-37% 0.15 to 0.40 fraction of total
48 hrs
4 to 6 days
42-48% 0.20 to 0.45 fraction of the total
48 hrs
4 to 6 days
7 to 27 U/L
8 to 12 hrs
48 hrs
NORMAL
CRANIAL NERVES (CN) CRANIAL NERVE
TYPE
FUNCTION
I
Olfactory
sensory
smell
II
Optic
sensory
III
Oculomotor
motor parasympathetic
IV V
VI
SYMPTOM ANALYSIS ASSESSMENT
identify familiar odors with each nare separately vision Snellen chart, examine ocular fundus with ophthalmoscope, assess light reflex extraocular eye movement, assess EOM with 6 cardinal elevation of eyelid positions of gaze pupil constriction
cover/uncover test assess constriction with light extraocular eye movement same as CN III somatic sensations of palpate temporal and cornea and face masseter muscles teeth clenched
Trochlear Trigeminal Ophthalmic branch
motor sensory
Maxillary branch
sensory
somatic sensations of face, test corneal reflex, touch oral cavity, anterior 2/3 forehead, cheeks, and chin with of tongue, teeth cotton wisp
Mandibular branch
sensory
somatic sensation lower face
symmetrical comparisons
motor motor
mastication lateral eye movement
bite down or chew look to ‘right and left’
motor
facial expression
smile, frown, puff cheeks
Abducens
VII Facial
sensory
taste, anterior 2/3 of tongue
identify taste
parasympathetic
salivation
assess for saliva
sensory
equilibrium
observe balance
When assessing a client’s problem, remember all these areas to help the client describe the problem fully. Using the mnemonic device, PQRST, a systematic and thorough assessment is possible by considering all of the following areas. P Provocative/Palliative What causes it? What makes it better? What makes it worse? Q Quality/Quantity How does it feel, look, or sound, and how much of it is there? R Region/Radiation Where is it? Does it spread? S Severity Scale Does it interfere with ADL? How does it rate on a severity scale of 1 to 10? T Timing When did it begin? How often does it occur? Is it sudden or gradual? How long does an episode of the symptom last?
GLASGOW COMA SCALE (GCS) A neurologic assessment scale that provides objective measurement of level of consciousness, pupil reaction, and motor activity. The total of the three scores can range from 3 to 15. A client who is oriented, opens the eyes spontaneously, and follows commands scores a 15. A client in a deep coma would score a 3. The first GCS score becomes the baseline. Future scores indicate trends or changes in neurologic status. MEASURE Eye response
VIII Vestibular IX
Cochlear Glossopharyngeal
sensory sensory motor
X
Vagus
XI
Spinal accessory XII Hypoglossal
hearing hearing acuity, Weber & Rinne test taste, post. 1/3 of tongue, identifies taste pharyngeal sensation swallowing test gag reflex, use tongue blade, note rise of uvula with “ahhh”
sensory
sensation in pharynx, larynx, and external ear
test same as CN IX
motor
swallowing
test same as CN IX
parasympathetic motor
thoracic and abdominal visceral activity neck and shoulder movement
motor
tongue movement
draw pencil line toward umbilicus push chin against hand, shrug shoulder move tongue side to side against a tongue depressor
INSULIN TYPES AND ACTION TIMES ACTION Short Intermediate Long Premixed
TYPE OF S.C. INSULIN
APPEARANCE
Regular Semilente NPH Lente Protamine zinc Ultralente 70% NPH & 30% regular
clear cloudy cloudy cloudy cloudy cloudy cloudy
INSULIN PEAKS
SEMILENTE SHORTER ACTING
ACTION IN HOURS Onset Peak Duration 5-8 1/2-1 2-4 8-16 1-1.5 2-8 18-26 1-2 6-12 18-26 1-3 6-12 28-36 4-6 18-24 36 4-6 14-24 18-24 1/2 2-12
Motor response
Verbal response
RESPONSE opens spontaneously opens to verbal command opens to pain no response reacts to verbal command reacts to painful stimuli identifies localized pain flexes and withdraws assumes flexor posture assumes extensor posture no response is oriented and converses is disoriented but converses uses inappropriate words makes unintelligible sounds no response
SCORE 4 3 2 1 6 5 4 3 2 1 5 4 3 2 1
PRESSURE SORE STAGING Stage I Nonblanchable erythema that remains red 30 min. after pressure has been relieved. Epidermis remains intact. Stage II Epidermis is broken, lesion is superficial and there is partial-thickness skin loss. Stage III Full-thickness skin loss down through the dermis which may include subcutaneous tissue. Stage IV Full-thickness skin loss extending into supportive structures, such as muscle, tendon, and bone.
I
II
III
IV
LONGER ACTING
I N S U L I N H E NT P O N RE H = HUMULIN THE FASTEST ACTING INSULIN EGULAR M (REGULAR) IS CLOSER TO THE PLUNGER. RAPID T E T E DI U = ULTRALENTE THE SLOWER ACTING INSULIN IS CLOSER TO THE NEEDLE.
A T E
MUSCLE STRENGTH 5 Normal strength. Muscle is able to move through a full range of motion (ROM) against gravity and applied resistance. 4 Muscle is able to move through a full ROM against gravity but with weakness to applied resistance. 3 Muscle is able to move actively against gravity alone. 2 Muscle is able to move with support against gravity. 1 Muscle contraction is palpable and visible. 0 Muscle contraction or movement is undetectable. A
COMMON MEDICAL ABBREVIATIONS ABG a.c. ADL ad lib AP A&P ASHD AV b.i.d. bpm c CAD cc cm C&S CSF CT cu DIC DSA FUO g, gm gr gt, gtt HS ICS IU kg KVO, KO KUB l lb LUQ M m µ mEq mg µg ml µl mm NPO OTC oz p.c. PERRLA
arterial blood gas before meals activities of daily living as desired anteroposterior anterior and posterior arteriosclerotic heart disease arteriovenous, atrioventricular twice a day beats per minute with coronary artery disease chief complaint, cubic centimeter centimeter culture and sensitivity cerebrospinal fluid computed tomography cubic disseminated intravascular coagulation digital subtraction angiography fever of undetermined origin gram grain drop, drops at bedtime, hour of sleep intercostal space international unit kilogram keep vein open, keep open kidneys, ureters, and bladder liter pound left upper quadrant molar meter, minim micron milliequivalent milligram microgram milliliter microliter millimeter nothing by mouth over the counter ounce after meals pupils equal, round, reactive to light and accommodation by mouth P.O. as needed, whenever necessary prn percutaneous transluminal coronary PTCA angioplasty every q every hour qh every 2 hours q2h four times a day q.i.d. right lower quadrant RLQ rule out R/O range of motion ROM right upper quadrant RUQ prescription Rx without s SC, SQ subcutaneous subcutaneous subq International System of Units SI short of breath SOB one-half ss immediately stat symptoms sx T&C type and crossmatch t.i.d. three times a day temperature, pulse, respirations TPR teaspoon tsp urinalysis UA ung, ungt ointment upper respiratory infection URI urinary tract infection UTI A
5 P’S OF CIRCULATORY CHECKS
INTRAMUSCULAR INJECTION SITES M ID -D ELTOID A REA The recommended boundaries of the injection area form a rectangle bounded by the lower edge of the acromion process on the top to a point on the lateral side of the arm opposite the axilla or armpit on the bottom. Avoid the acromion and humerus, as well as the brachial veins and arteries. Limit the number of injections here as the area is small and cannot tolerate repeated injections or large quantities of medications >1 ml.
Pain Pallor Paralysis Paresthesia Pulse
P
EDEMA Assess by placing thumb over the dorsum of the foot or tibia for 5 seconds 0 No edema 1+ Barely discernible depression 2+ A deeper depression (less than 5 mm) accompanied by normal foot and leg contours 3+ Deep depression (5 to 10 mm) accompanied by foot and leg swelling 4+ An even deeper depression (more than 1 cm) accompanied by severe foot and leg swelling
POSTERIOR GLUTEAL AREA (DORSOGLUTEAL) The most common site for injections. Restrict injections to that portion of the gluteus medius which is above and outside of a diagonal line drawn from the greater trochanter of the femur to the posterior superior iliac spine. VENTROGLUTEAL AREA A good site as it is removed from major nerves and vascular structures. Palpate to find the greater trochanter, the anterior superior iliac spine and the iliac crest. When injecting into the left side of the patient, place the palm of the right hand on the greater trochanter and the index finger on the anterior superior iliac spine. Spread the middle finger posteriorly away from the index finger as far as possible along the iliac crest, as shown in the drawing. A “V” space or triangle between the index and middle finger is formed. The injection is made in the center of the triangle with the needle directed slightly upward toward the crest of the ilium. (When injecting into the right side of the patient, use your left hand for placement).
PULSES Peripheral pulses should be compared for rate, rhythm, and quality. Pulses are graded as follows: 0 Absent +1 Weak and thready +2 Normal +3 Full +4 Bounding
VASTUS LATERALIS AREA A relatively safe injection site free from major nerves and blood vessels. This injection area is bounded by the midanterior thigh on the front of the leg, the mid-lateral thigh on the side, a hand’s breadth below the greater trochanter of the femur at the proximal end and another hand’s breadth above the knee at the distal end.
DOSAGE CUP
Z-TRACK TECHNIQUE A Z-track technique is used for administering any irritating fluid to ‘seal’ medication in the muscle. Figure A shows the normal tissue before the injection. As in figure B, retract the tissue, insert the needle, administer medication, remove the needle, and release tissue. Note in figure C, the tissue relationships after the angled Z-tract left by the needle. A
B
CALCULATING I.V. DRIP RATE The physician’s order states: 1,000 ml LRS to infuse over 8 hours. The administration set delivers 15 drops per milliliter. What should the drip rate be? Use the equation: Total no. of ml _______________ x drip factor = drip rate Total no. of min Set up the equation using the given data: 1,000 ml _______________ x 15 gtt/ml = X gtt/min 8 hr x 60 min. After multiplying the number of hours by 60 minutes in the denominator of the fraction, the equation is: 1,000 ml ______________ x 15 gtt/ml = X gtt/min 480 min After dividing the fraction, the equation is: 2.08 ml/min x 15 gtt/ml = X gtt/min The final answer is 31.2 gtt/min, which can be rounded to 31 gtt/min. The drip rate is 31 drops per minute.
C
HOUSEHOLD/APOTHECARY/ METRIC EQUIVALENTS Household Volume --1 tsp 1 Tbs 1 cup 1 pint 1 quart Weight ------2.2 pounds Length 1 inch 39.37 inches
I.V. FLOW RATES Vary with the type of administration set and the manufacturer. Drops/minute to infuse Drops/ Mgf. (GTTS) cc 1,000ml 24 hr 20 hr 10 hr 8 hr 6 hr 42 50 100 125 166 cc/hr 31 42 12 25 15 10 Abbott Baxter 8 17 21 28 10 7 Healthcare 17 34 42 56 20 14 Cutter 42 56 17 34 20 14 IVAC 12 25 31 42 15 10 McGaw
Apothecary
Metric
= = = = = =
15-16 minims 1 fld. dram 3-4 fld. drams 8 fld. ounces 16 fld. ounces 32 fld. ounces
= = = = = =
1 milliliter(ml)* 4-5 ml 15-16 ml 240 ml 480 ml 960 ml
= = = =
1 grain 15-16 grains 1 dram ---
= = = =
60-65 mg 1 gram 4 grams 1 kg
= =
-----
= =
2.54 cm 1 meter
CONVERSION FACTORS Weight 1 gr 1 mg 1 Gm 1 kg Volume 1 ml* 5 ml 15 ml 30 ml
* ml and cc are equivalent
= = = =
60-65mg 1000 mcg 1000 mg = 1000 Gm =
15 or 16 = minims = 1 fld. dr = 4 fld. dr = 8 fld. dr
15 gr 2.2 lb
o C
o F
37.0 37.8 38.4 39 39.6
98.6 100 101.1 102.2 103.3
= 1 tsp = 1 tbsp oF = ( oC x 1.8) + 32 = 1 ounce oC = ( oF-32) ÷ 1.8
SERUM ELECTROLYTES
COMPLETE BLOOD COUNT (CBC) AND DIFFERENTIAL CBC COMPONENT Red blood cells (RBC) Hematocrit (Hct) Hemoglobin (Hgb) Red blood cell indices MCV (mean corpuscular vol) MCH (mean corpuscular Hgb) MCHC (mean corpusc. Hgb conc) White blood cells (WBC) Differential WBC Neutrophils Bands Eosinophils Basophils Monocytes Lymphocytes T lymphocytes B lymphocytes Platelets
ADULT Male 4.5 - 6.2 mm3 40 - 54% 13.5 -18 g/dl
Female 4.2 - 5.4 mm3 37- 47% 12 -16 g/dl
ELECTROLYTE NORMAL ADULT RANGE
Calcium 4.5 to 5.5 mEq/L
80 - 94 µm3
84 - 99 µm3 26 - 34 pg 32 - 36% 5,000 -10,000/mm3
48-77% (3,000 -7,500/mm3 ) 3 - 8% (150 - 700/mm3 ) 1- 4% (50 - 400/mm3 ) 0 -1% (25 -100/mm3 ) 1- 9% (100 - 500/mm3 ) 25 - 40% (1,500 - 4,500/mm3 ) 60 - 80% of lymphocytes 10 - 20% of lymphocytes 150,000 - 450,000/mm3
CONDITIONS WITH ABNORMAL FINDINGS INCREASED DECREASED GI malabsorption, alkalosis, resp. acidosis, ATN, burns, cachexia, celiac bacteremia, chronic disease, chronic renal hepatic disease disease, diarrhea acidosis, adrenocortical insufficiency, anemia, anxiety, asthma, burns, dialysis, dysrhythmias, hypoventilation
GI suction, vomiting, diarrhea, intestinal fistulas, ATN, alcoholism, alkalosis, bradycardia, colon cancer, CP, chronic cirrhosis, CHF, Crohn’s disease
Sodium 135 to 145 mEq/L
CHF, dehydration, diabetes insipidus, diaphoresis, diarrhea, hypertension, ostomies, toxemia, vomiting
GI malabsorption, diarrhea, ascites in cardiac failure, bowel obstruction, burns, CP, cirrhosis, DM, emphysema
Chloride 97-107 mEq/L
alcoholism, resp. alkalosis, anemia, CHF, dehydration, fever, head trauma
metab. acidosis, burns, CNS disorders, edema, emphysema, G.I. loss
Potassium 3.5 to 5.3 mEq/L
FOUR PRIMARY ASSESSMENT TECHNIQUES 1. INSPECTION: The process of examining the surface of the body and its movements utilizing visual, auditory and olfactory senses for gathering information. Inspection should be purposeful and systematic comparing bilateral body parts, and continues throughout the entire examination. 2. PALPATION: The technique of using touch to gather information about temperature, turgor, texture, moisture, vibrations, and shape. May use light palpation, which is the application of pressure by closed fingers and depressing the skin and underlying structures about 1/2 inch, or deep palpation, using inward pressure to about 1 inch. The client should be provided with privacy, the nurse should have warm hands with short fingernails, and the area of tenderness should be palpated last. 3. PERCUSSION: The art of striking one object with another to create sound, so that one can assess the location, size and density of underlying tissues. The nondominant hand is placed on the area to be percussed with fingers slightly separated and the dominant hand is used as the striking force by exerting a sharp downward wrist movement so that the tip of the middle finger on the dominant hand strikes the joint of the middle finger on the nondominant hand. The five percussion tones are: tympany - loud, drumlike sound resonance - moderate to loud, low-pitch, hollow sound hyperresonance - very loud, low-pitch, booming sound flatness soft, high-pitch, flat sound dullness - soft to moderate, high-pitch, thud-like sound 4. AUSCULTATION: The act of listening to sounds produced by the body using a stethoscope. The stethoscope has a diaphragm that detects high-pitched sounds best and a bell that detects low-pitched sounds best. Four characteristics of sound should be noted: Pitch Loudness Quality Duration
COAGULATION STUDIES COAGULATION SCREENING TESTS 3-9 min.
Bleeding Time (Simplate)
Partial thromboplastin time (PTT)
Men: 9.6 to 11.8 sec Women: 9.5 to 11.3 sec 25-38 sec
Whole-blood clotting time
5 to 15 min
Prothrombin time (PT)
FIBRINOLYTIC STUDIES Euglobin lysis No lysis in 2 h Fibrinogen split products (FSP):
<10 mcg/ml of FSP
Thrombin time
10 to 15 sec
7 WARNING SIGNS OF CANCER C A U T I O N
Change in bowel or bladder habits. A sore that doesn’t heal. Unusual bleeding or discharge. Thickening or lump in breast or elsewhere. Indigestion or difficulty in swallowing. Obvious change in wart or mole. Nagging cough or hoarseness.
BASIC HEAD TO TOE ASSESSMENT ASSESSMENT AREA
WHAT TO OBSERVE
General survey
General appearance and behavior, posture, gait, hygiene, speech, mental status, height and weight, hearing and visual acuity, VS, nutritional status
Head and neck
Skull size, shape, symmetry, hair and scalp, auscultate for carotid bruits, clench jaws, puff cheeks, palpate TMJ, use cotton wisp for facial sensations, test EOMs, cover/uncover test, corneal light reflex, Weber and Rinne test, use ophthalmoscope and otoscope, inspect and palpate teeth and gums, test rise of uvula, test gag reflex, test sense of smell and taste, inspect ROM neck, shrug shoulders, palpate all cervical lymph nodes, palpate trachea for symmetry, palpate thyroid gland
Upper extremities Inspect skin, blanche fingernails, palpate peripheral pulses, rate muscle strength, assess ROM, test DTRs Posterior thorax
Inspect spine for alignment, assess anteroposterior to lateral diameter, assess thoracic expansion, palpate tactile fremitus, auscultate breath sounds
Anterior thorax Observe resp. pattern, palpate resp. excursion, auscultate breath sounds, auscultate heart sounds, inspect jugular veins, perform breast exam Abdomen
Auscultate for bowel sounds, inspect, light and deep palpation, percuss for masses and tenderness, percuss the liver, palpate the kidneys, blunt percussion over CVAs (posterior thorax) for tenderness
Lower extremities
Inspect skin, palpate peripheral pulses, assess for Homan’s sign, inspect and palpate joints for swelling, assess for pedal and ankle edema, assess ROM
General neurologic
Test stereognosis-object identification in hands, test graphesthesia-writing on body with closed pen, test two point discrimination, assess temperature perception, inspect gait and balance, assess recent and remote memory, test cerebellar function by finger to nose test for upper extrem, and running each heel down opposite shin for lower extrem, test the Babinski reflex
Follow with genitalia exam if appropriate
ODOR ASSESSMENT ODOR Ammonia
Sweet, fruity odor Stale urine odor
SITE Urine Vomitus Wound site Rectal area Oral cavity Skin
POSSIBLE CAUSES Urinary tract infection Bowel obstruction Wound abscess Fecal incontinence Diabetic acidosis Uremic acidosis
Sweet, heavy odor
Wound drainage
Bacterial (pseudomonas) infection
Musty odor
Within a cast
Infection inside cast
Trach or mucous
Infection of bronchial tree (pseudomonas bacteria)
Fecal odor
Fetid sweet odor
CREDITS
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Osteoarthritis Is It Osteoarthritis?
Introduction ■ Osteoarthritis is the most common
disease in humans • Almost everyone experiences some effects by the age of 70 ■ It is a natural inflammatory disease of wear and tear that begins when joint cartilage starts to become worn • Cartilage works as a “shock absorber” to reduce stress on the joint • When it is worn away, increased stress on the joint causes pain and instability • As the cartilage continues to wear down, it may disappear altogether in some spots, leaving bone to grind against bone ■ According to the American College of Rheumatology, the goals of osteoarthritis management are to: • Control pain • Minimize disability • Provide education to the public and teach persons with the disease about prevention and treatment
■ Two
other types of arthritis commonly found in people are rheumatoid arthritis and gout ■ Sometimes, people with arthritis are not sure what kind they have; differing types have different presentations, diagnoses and treatments ■ Rheumatoid arthritis is an infectious, as well as an inflammatory, disease that causes symptoms such as fever and general malaise over the whole body ■ Gout is cause by the build up of uric acid crystals in the joint, causing a lot of pain, warmth and swelling • Common joints affected by gout are in the big toe and ankle ■ People can have several forms of arthritis at the same time ■ If you have any joint pain, see your primary care provider to help prevent joint deformity and loss of joint use
Did You Know? Over half of Americans over age 65 have osteoarthritis to some extent
Medical Doctors care physicians: Treat patients before they are referred to specialists ■ Rheumatologists: Specialize in treating arthritis and related conditions that affect joints, muscles and bones ■ Orthopaedists: Specialize in treatment of and surgery for bone and joint disease ■ Physiatrists (rehabilitation specialists): Help patients make the most of their physical potential
Other Health Care Professionals ■ Physical therapists: Work with patients to
improve joint function ■ Occupational therapists: Teach ways to
■ Primary
■
■
■
■ ■
■ Your knees, hands, hips or back are often sore
• Bending, kneeling, stair climbing are difficult • You have trouble opening jars, grasping objects • Joints are stiff and painful at the end of day • Joints may occasionally seem to give way ■ You are stiff after periods of inactivity, but movement decreases stiffness ■ You notice slight swelling and enlargement of joints • You notice bony lumps on the middle or end joints of your fingers or the base of your thumb ■ Joints may not move as far or as freely as before ■ There is discomfort in a joint before or during a change in the weather (a drop in barometric pressure)
What Is Osteoarthritis? ■ Osteoarthritis (OS-tee-oh-are-THRY-tis) (OA),
Health Professionals Who Treat Osteoarthritis Many types of health professionals care for people with osteoarthritis
You may have osteoarthritis if:
protect joints, minimize pain and conserve energy Dietitians: Teach ways to use diet to improve health and maintain healthy weight Nurse educators: Specialize in helping patients understand their overall condition and implement treatment plans Licensed acupuncture therapists: Reduce pain and improve function by inserting fine needles into the skin at various points Psychologists: Help patients cope with difficulties in the home and workplace Social workers: Assist patients with social challenges caused by disability, unemployment, financial hardships, home health care and other needs 1
also known as degenerative joint disease, is one of the most common types of arthritis ■ Occurs when the cartilage cushioning the joint breaks down, causing bones to rub against each other, creating pain, swelling, bone spurs (tiny growths of new bone) and loss of movement ■ Most commonly affecting middle-aged and older people ■ Scientists don’t know if it is a single disease or many disorders with a similar final presentation ■ The most common joint affected is the knee joint, the second most common is the hip joint • Fingers, spine, the tempomandibular joint (TMJ) of the jaw and shoulders are other commonly affected joints
Healthy Joint
Arthritic Joint Muscle Tendon
Inflamed Synovial Membrane Synovial Fluid Destroyed Cartilage Cartilage Synovial Membrane Bone
6
Facts about Osteoarthritis
1 7 million people in the U.S. visit their health care provider each year for symptoms of osteoarthritis 2 80% of people with osteoarthritis report some limitations in activity 3 Osteoarthritis is the leading cause of disability in the U.S. 4 Knee osteoarthritis is often as disabling as any cardiovascular disease, except stroke 5 About 50% of persons with osteoarthritis do not know what type of arthritis they have and, as a result, cannot make informed decisions about their care 6 Musculoskeletal disease, like osteoarthritis, costs the U.S. economy nearly $87 million per year in direct expenses, and lost wages and production
Clinical Features of Osteoarthritis ■ Chronic pain that may last long after the
inflammation of the disease has resolved ■ Stiffness: On arising in the morning and after inactivity • This can be especially problematic for elders who are sedentary or can’t move about ■ Tenderness on pressure to the affected area ■ Bony swelling and crepitus (a grating or crackling sound or sensation ) - related to irregularity of the joint and loss of cartilage ■ Bony swelling of the hands and joint deformity cause Heberden’s nodes, or large, painful nodules of the joints at the end of the fingers ■ Loss of movement and limited range of motion of the affected joints
Who Gets Osteoarthritis? ■ Most often affects middle to older-aged adults ■ 20 million Americans have symptoms ■ 75% of women 60-70 years old have
osteoarthritis in the joints of their hands ■ Osteoarthritis of all joints occurs more often in
women than men ■ Osteoarthritis is more common in Europeans
and Americans, and less common in African Americans, Asians, Indians and Chinese ■ By age 80, there is a decline in the incidence of osteoarthritis in both men and women ■ In a 2003 study, 30% of patients did not take prescribed medications for osteoarthritis; 27% did not do prescribed exercises ■ 67% of patients advised to use an assistive device, such as a cane or walker, did not do so – leading to increased falls, fractures and negative outcomes
■ Instability of the affected joints,
making falls common in older adults ■ Loss of function: Inability to use
hands, walk and bend ■ Depression and physical isolation
because of loss of function and pain • Many persons with severe osteoarthritis become unable to participate in family and community activities, causing social isolation and depression
Did You Know?
The Knee ■ Most commonly affected joint ■ Overloading the knee joint can
cause cartilage breakdown and failure of the ligaments • For every 1 pound weight increase, the overall force across the knee in a single leg stance increases 2-3 pounds ■ Knee laxity is a mechanical displacement or rotation of the tibial bone in relation to the femur bone; increases with age; greater in women than men ■ Proprioception is the conscious and unconscious perception of joint position and movement
Osteoarthritis can affect the mind and emotions as much as the body and joints
• Critical to joint stability • Proprioceptive accuracy in the knee declines with age, worsens with inactivity
Most common causes of osteoarthritis of the knee include: ■ Obesity (more de-
structive in women then in men) ■ Genetic tendency ■ Joint overuse or injury
When Your Joints Are Sore ■ Rest the painful joint ■ Take acetaminophen - 500mg
Primary Causes of Osteoarthritis
every 4-6 hours ■ Ice pack the area to reduce
inflammation
If the pain persists for more than 48 hours, call your health care provider
■ Age – with use, joints begin to deteriorate and
the cartilage wears away women have higher rates of osteoarthritis; may have lower estrogen levels, predisposing them to osteoarthritis Higher bone density increases the risk for osteoarthritis, decreases the risk for osteoporosis Genetic factors account for at least 50% of cases of osteoarthritis of the hands and hips (with a smaller percentage for knee osteoarthritis); some are born with defective cartilage or slight defects in the way the joints fit together Lack of exercise (the “use it or lose it” principal) Joint injury (athletic injury, sprain or strain to ligaments and tendons puts more stress on the joint itself)
Prevention
■ Menopausal
■ ■
■ ■
Diagnosing ■ Adequate vitamin C levels re■ Physical examination shows de-
creased movement within the joint ■ A history of pain, stiffness and
instability in the joint that worsens with disuse ■ X-ray will show that the spaces between the bones of the joint are smaller than they should be 2
duce the risk for osteoarthritis by 33% ■ Adequate vitamin D levels will slow the progression of the disease, especially in the case of osteoarthritis of the hip ■ Antioxidants provide defense against tissue injury and protect the cartilage from deterioration
Treatments for Osteoarthritis
Managing the Pain ■ Major
Pharmacologic Therapy ■ Hyaluronic acid injections provide a lubricating fluid
to the joint; decrease the rubbing of bone on bone and reduce inflammation ■ Pharmacologic therapies for pain reduction are discussed in the section on pain management
Questions To Ask Your Doctor or Pharmacist About Medicines
■
■
■ How often should I take this medicine? ■ Should I take this medicine with food or between
meals? ■ What side effects can I expect? ■ Should I take this medicine with other prescription
medicines I take? ■ Should I take this medicine with over-the-counter medicines I take?
■ ■
Non-pharmacologic Therapy ■ Physical therapy: Promotes strength of muscle
surrounding the joint; prevents further deterioration ■ Isometric exercises increase strength ■ Weight loss: Reduces stress on the joint, especially
knee and hip joints
Surgical Therapy ■ Surgery may be performed to:
• Remove loose pieces of bone and cartilage from the joint if they are causing mechanical symptoms (buckling or locking) • Resurface (smooth out) bones • Reposition bones • Replace joints
Arthroplasty: ■ The process that removes
the cartilage debris resulting from osteoarthritis ■ Highest success rate in knee Hip Joint osteoarthritis Femur ■ Also removes rough surfaces of bone spurs that accumulate late in osteoarthritis and removes inflamed parts of the synovium ■ Can reduce pain and inflammation, but does not stop the progression of osteoarthritis ■ Joint replacement • Goal is to relieve the pain in the joint caused by osteoarthritis to the cartilage - the pain from the loss of cartilage and inflammation may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move • Total joint replacement will be considered if other treatment options will not relieve the pain and disability • After the joint has been replaced, physical therapy will be essential to full recovery • Osteoarthritis often affects the hip joint; instability of the joint can cause persons to fall and fracture the femur; primary reason for joint replacement or stabilization at the hip
■
psychological and social factors contribute to the pain, including depression and social isolation Cognitive behavioral therapy can be affective for osteoarthritis pain, including distraction, goal-setting and affirmations Education to modify patients’ behavior, increase understanding, make informed decisions about therapy, and adhere to treatment plans Total joint replacement Acetaminophen (such as Tylenol®) for mild pain has been shown to be as effective and better tolerated as any anti-inflammatory medication antiinflamNon-steroidal matory (NSAID) medications are often prescribed for osteoarthritis; inhibit the production of prostaglandins at the cyclooxygenase (COX) enzyme (prostaglandins are responsible for the signs and symptoms of inflammation, including pain)
■ Tramadol (Ultram®) is a non-
narcotic analgesic used alone or with acetaminophen; a combination of tramadol and acetaminophen, called Ultracet®, acts quickly and has a longer duration than Ultram® alone. Tramadol has few side effects and will not cause constipation.
Tramadol should not be taken by persons who have experienced a seizure or are at risk for seizure. ■ When other pain relief measures
are ineffective, narcotic analgesics may be necessary • Morphine, fentanyl or methadones are preferred narcotic analgesics; they have fewer side effects than codeine preparations • Meperidine (Demerol®) is ineffective in oral doses ■ Topical agents include topical capsaicin, which depletes substance P, a pain-causing neurotransmitter
The Dangers of Non-Steroidal Anti-inflammatory Drugs (NSAIDS) ■ GI toxicity: NSAIDS work by
inhibiting the body process that produces prostaglandins (inflammation builders) but also protects the stomach lining from erosion; an estimated 16,500 elders die each year due to the GI toxicity of NSAIDS ■ COX – 2 NSAIDS are selective to just the prostaglandin side of the process, so the stomach-protective side of the process stays intact; COX – 2 NSAIDS are a common cause of renal failure, especially in the failure elderly (renal associated with COX – NSAID use produces significant mortality in this age group) ■ The NSAIDS as a group also increase blood pressure from 3—6 mmHg, increasing risk for stroke, renal disease or heart failure 3
■ When these drugs are prescribed by
your health care provider and side effects are monitored to maintain overall health, they can be very useful ■ As with all other drugs, NSAIDS should be taken as directed
NSAIDS cannot be used or should be used with extra caution in these cases: • • • •
• • • • • •
Allergy to aspirin or any NSAID During pregnancy During breast feeding If you are on blood-thinning agents (anticoagulants), such as coumadin If there is a defect of the bloodclotting system Active peptic ulcer Asthma Kidney impairment Heart impairment Liver impairment
Alternative & Complementary Therapies All alternative and complementary therapies should be discussed with your health care provider before use ■ While most are safe and effective, some may interfere with other
medications or cause undesirable side effects ■ It is important to make sure providers of some therapies (like
acupuncture and massage) are certified
Angelica root compress: Add five drops of the oil to a hot bath to reduce muscle spasms Boswellia: Anti-inflammatory Castor oil hot packs: Apply to affected joints for pain relief Cayenne (capsaicin): Used topically to relieve arthritis pain
Acupuncture A traditional Chinese medicine involving stimulation of special points on the body ■ Fine needles are used to stimulate 360 acupuncture points in the body ■ Between four and 10 needles are normally used at each session ■ Studies show acupuncture can relieve certain conditions; according to traditional Chinese medicine, the body is controlled by a life force known as “Qi,” and acupuncture points are used to change the flow of Qi that has been disrupted by illness ■ Acupuncture has proven an effective tool for osteoarthritis pain and inflammation
Glucosamine In clinical studies, the use of glucosamine reduced pain and reduced the need for NSAIDS and other analgesic medications
Condroitin A combination of molecules found in cartilage; the use of oral condroitin may decrease osteoarthritis pain and reduce the need for other analgesic medications
Massage Reduces musculoskeletal pain of osteoarthritis and surrounding muscles while increasing the relaxation response, reducing the levels of substance P and pain-inducing neurotransmitters ■ Increases the level of endorphins (the body’s
natural pain relievers) in the body
Further Information
Herbal Therapies
Celery seed: Anti-inflammatory Cherries, hawthorn berries and blueberries: Contain anthocyanidins and proanthocyanidins, flavonoids that enhance collagen and the structure of joints Devil’s claw (Harpagphytum procumbens): Analgesic, anti-inflammatory; dosage 1-2 grams three times daily Fenugreek packs: For acute inflammation, place seeds in a warm, moist compact surrounding the area Ginger (zingiber officinale): Anti-inflammatory; dosage 0.5 – 1 mg of powdered ginger daily Phytodolor (populus tremula, fraxinus excelsior and solidago virgaurea): Anti-inflammatory; shown to reduce pain of osteoarthritis as well as low doses of NSAIDS Turmeric (curcumin longa): Anti-inflammatory; dosage 400 mg three times daily White willow: Anti-inflammatory and pain-relieving effects; slow-acting but as effective as aspirin; patients should take enough to equal 100 mg of salicin (the active ingredient in white willow) per day Yucca: Pain relief
See QuickStudy® guides Vitamins & Minerals and Herbal Therapy for more information on natural remedies
The following are reputable and welldeveloped sites that provide information that has been studied and found to be helpful for osteoarthritis
National Institute for Arthritis and Musculoskeletal and Skin Disease NIAMS Information Clearing House 1 AMS Circle Bethesda, Maryland 20892-3675 (301) 495-4484 Fax: (310) 718-6366 http://www.niams.nih.gov
Arthritis Foundation P.O. Box 7669 Atlanta Georgia 30357-0669 1-800-283-7800; you may want to check your directory for a local chapter Fax: 404-872-0457 http://www.arthritis.org
American College of Rheumatology/Association of Rheumatology Health Professionals 1800 Century Place Suite 250 Atlanta, GA 30345-4300 (404) 633-3777 Fax: 404-633-1870 http://www.rheumatology.org
For more information on health and aging, contact: National Institute on Aging Information Center P.O. Box 8057 Gaithersburg, MD 20898-8057 1-800-222-2225 http://www.niapublications.org 4
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WORLD’S #1 QUICK REFERENCE GUIDE
Pharmacology Drug Fundamentals, Plus the Most Frequently Prescribed Drug Classifications—Including Indications, Reactions, Examples & More
definitions
pharmacokinetics
pharmacodynamics Study of the mechanisms of action of drugs within the body and how drugs produce their effects in the body pharmacogenetics Study of drug reactions in the body that are unanticipated or unusual, and may have a hereditary basis for the response pharmacokinetics Study of drug actions as they move through the body; the way the body absorbs, distributes, metabolizes and excretes drugs; mathematical study of drugs based on time and dose pharmacology Study of biologically active compounds, how they react in the body and how the body reacts to them pharmacotherapeutics Study of drugs used to prevent, treat or diagnose disease pharmacy Preparation and dispensing of drugs toxicology Study of harmful or poisonous effects of drugs
drug names
Routes drugs take to get into the body • Enteral: o Enters the body through the GI tract o Taken by mouth, through the rectum, under the tongue or held in the cheeks • Parenteral: o Enters the body through a different means (i.e., other than the GI tract) o Can be injected into the veins, arteries, muscles, spinal cord, or under the skin; inhaled through the lungs; transdermally through the skin via ointment or patch Absorption • Bioavailability Percent absorbed into systemic circulation after administration o Bioavailability depends on route of administration as well as the drug’s ability to cross membranes and reach its target o First Pass Effect: ■ Drugs absorbed through the stomach and small intestine must pass through the liver before circulating systemically ■ Liver can inactivate the drug, making less of the drug available to reach the target organ • Absorption at cellular level occurs through passive transport, active transport, pinocytosis and facilitated diffusion Distribution • Influenced by several factors: o Tissue permeability: Ability of drug to pass through the membranes rapidly affects the extent to which the drug moves around in the body o Blood flow: Once in the blood stream, will get to the organs and tissues that are highly perfused o Plasma proteins binding: Drug can bind to a protein that will render the drug inactive; only an unbound drug can attach to the receptors o Binding to subcellular components o blood pH Drug Storage Sites • Adipose tissue Primary site; lipid-soluble; drugs tend to remain for long periods of time due to low metabolic rates of drugs and poor blood perfusion of tissue • Bone Toxic agents like heavy metals • Muscle Binding can cause muscle to store drugs • Organs Liver and kidneys Metabolism • Biotransformation Chemical changes that occur in the drug following administration • Metabolite Altered version of the chemical compound • Can have a higher or lower rate of activity than the original drug; if higher, drug is given as an inactive or prodrug form • Prodrug Requires metabolism or activation of drug in order for it to act within the body Excretion • First order Rate of removal of drug from the body is proportional to the concentration of the drug in the plasma • Half-life Time required to decrease the blood levels of a drug by one-half • A one-time drug dosage will be eliminated almost completely by 5 half-lives • A drug given on a continuous dosage schedule will reach steady state concentration after 5 half-lives • Steady state Rate of drug administration is equal to the rate of drug excretion • Organs that excrete drugs Kidneys, lungs, sweat glands, mammary glands, salivary glands, skin and GI tract
DRUG
Chemical Name
Generic Name
Trade Name
Chemical Name: Scientific name, describes the atomic and molecular structure of a drug
Generic Drug: Nonproprietary name, abbreviation of the chemical name
Brand Name: Trade name, selected by the pharmaceutical company that made the drug
pharmacodynamics Receptors • Protein molecules with one or more binding sites, located on cell membranes • Receive a signal from the body’s chemicals: neurotransmitters, hormones, enzymes • Signal will cause a molecular event on the inside of the cell to occur • Drugs Enhance (agonist), diminish (partial agonist) or block (antagonist) the generation, transmission or receiving of the signal • Affinity Attraction between a drug and a receptor • High affinity Drug will bind easily to the receptor • Low affinity Requires a higher concentration of the drug to get a therapeutic response Drug Potency • Amount of drug required to produce a therapeutic response Dose Response Curve • Effective Dose (ED) Amount of drug that produces a therapeutic response in 50% of the people taking it • Toxic Dose (TD) Amount of drug that produces adverse effects in 50% of the people taking it • Therapeutic Index (TI) Margin of safety; ratio between the TD and the ED • The higher the TI, the safer the drug is considered to be; in general, nonprescription drugs have much higher TIs than prescription drugs
schedule drugs Schedule Class Schedule 1: C-1 Schedule 2: C-II
Characteristics • High abuse potential; not legal; no acceptable medical use; no prescriptions available • High abuse potential and severe dependence liability; current, accepted medical use; prescription drug-signed; not stamped prescription; 30-day supply, no refills Schedule 3: C-III • Less abuse potential; low-moderate physical dependence; high psychological dependence; by prescription only, expires within 6 months; max. 5 refills on one script Schedule 4: C-IV • Less abuse potential than C-III drugs; accepted medical use; limited physical and psychological dependence; written or verbal prescription, expires in 6 months; max. 5 refills on one script Schedule 5: C-V • Limited abuse potential; accepted medical use; small amounts of narcotics used as antitussives (cough medicine) or antidiarrheals; may not need a prescription but must be recorded as a transaction 1
Examples (C-I to C-IV) • Heroin, LSD, cocaine, marijuana, methaqualone • Opium, morphine, coca, methadone • Amphetamines, codeine, barbiturates, Valium, Xanax, anabolic steroids • Chloral hydrate, meptrobamate, paraldehyde, phenobarbital
Pharmaceutical C lass i f ications ¤ Common drug examples: • Doxazosin mesylate Cardura • Prozosin hydrochloride Minipress • Tamsulosin hydrochloride Flomax • Terazosin hydrochloride Hytrin ¤ Adverse reactions Orthostatic hypotension, headache, palpitations, fatigue, nausea, weakness, dizziness, fainting
adrenergics Mimic naturally occurring catecholamines (epinephrine, norepinephrine and dopamine) or stimulate the release of norepinephrine Indications Alpha-adrenergic agonists used to treat hypotension ¤ Common drug examples: • Norepinephrine Lovophed • Pseudoephedrine Cenafed, Dimetapp, Sudafed, Triaminic DM (OTC used to treat other conditions) ¤ Adverse reactions: Increased blood pressure, AV block; other effects include: nausea, vomiting, sweating, goose bumps, rebound miosis, difficulty in urinating, headache, dilated pupils, photophobia, burning, stinging and blurry eyes Beta 1 adrenergic agonists Bradycardia, low cardiac output, paroxysmal atrial or nodal tachycardia, ventricular fibrillation, cardiac output ¤ Common drug examples: • Dobutamine hydrochloride Dobutrex ¤ Adverse reactions Tachycardia, palpitations and other arrhythmias, premature and ventricular contractions, tachyarrhythmias and myocardial necrosis Beta 2 adrenergic agonists Acute and chronic bronchial asthma, emphysema, bronchitis, acute hypersensitive (allergic) reaction to drugs, delays delivery in premature labor, dysmenorrhea ¤ Common drug examples: • Albuterol sulfate Proventil, Ventolin, Volmax • Bitolterol mesylate Tornalate • Metaproterenol sulfate Alupent • Pirbuterol acetate Maxair • Salmeterol xinafoate Serevent • Terbutaline Brethine, Bricanyl ¤ Adverse reactions Nervousness, tremors, headaches, tachycardia, palpitations, hypertension, nausea, vomiting, cough Dopamine Improves blood flow to the kidneys; used in acute renal failure, heart failure and shock ¤ Common drug examples: • Dopamine hydrochloride Intropin ¤ Adverse reactions Headaches, ectopic beats, tachycardia, hypotension, bradycardia, nausea, vomiting, hyperglycemia, asthma attacks, anaphylactic reactions
aminoglycosides
¤ Indications: • Treat infections resistant to penicillin, septicemia, urinary tract infections, infections of skin, soft tissue and bone, gram-negative bacillary meningitis • Used in combination with other antibiotics to treat staphylococcal infections, endocarditis, tuberculosis, pelvic inflammatory disease ¤ Common drug examples: • Amikacin sulfate Amikin • Gentamicin sulfate Cidonycin, Gentasol • Neomycin sulfate Mycifradin ¤ Adverse reactions Systemic ototoxicity and nephrotoxicity, skeletal weakness and respiratory distress; oral meds can cause nausea, vomiting, diarrhea; local injections can cause phlebitis and abscess
androgens Testosterone used to promote maturation of male sex organs and development of secondary sex characteristics; promotes retention of calcium, nitrogen, phosphorus, sodium, and potassium; enhances anabolism ¤ Indications Androgen deficiency resulting from testicular failure or deficiency of pituitary origin, palliative for metastatic breast cancer, postpartum breast engorgement, hereditary angioedema, endometriosis, fibrocystic breast disease ¤ Common drug examples: • Danazol Cyclomen, Danocrine • Fluoxymesterone Halotestin • Testosterone Testopel pellets ¤ Adverse reactions: • Extensions of hormonal action o Males: Frequent and prolonged erections, bladder irritability, gynecomastia o Females: Clitoral enlargement, deepening of the voice, facial or body hair growth, unusual hair loss, irregular or absent menses • Metabolic reactions Fluid and electrolyte retention, hypercalcemia, decreased blood glucose level, increased serum cholesterol, hepatic dysfunction ¤ Contraindicated Men with breast or prostatic cancer or symptomatic prostrate hypertrophy, patients with severe cardiac, renal or hepatic disease or with undiagnosed genital bleeding
adrenocorticoids Glucocorticoids Regulate carbohydrate, lipid and protein metabolism; block inflammation; regulate body’s immune response ¤ Indications Asthma, advance pulmonary tuberculosis, pericarditis, acute and chronic inflammation, adrenal insufficiency, antenatal use in preterm labor, hypercalcemia, cerebral edema, acute SCI, MS, shock ¤ Common drug examples: • Betamethasone Beclovent, QVAR, Vanceril • Hydrocortisone Cortet, Hycort • Methylprednisone Medrol, Meprolone, Metacort • Prednisone Apo-prednisone, Deltasone, Meticort, Orasone, Sterapred • Triamcinolone Azmacort, Nasacort ¤ Adverse reactions Primarily a catabolic effect on muscle, bone, ligament, tendon; suppression of hypothalamic-pituitary-adrenal pathway; Cushingoid syndrome with long-term use; other effects include euphoria, insomnia, psychotic behavior, pseudotumor, mental changes, nervousness, restlessness, heart failure, hypertension, edema, acute tendon ruptures, delayed wound healing • Withdrawal symptoms if drugs stopped abruptly Fever, myalgias, arthralgias, malaise, nausea, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia Mineralocorticoid Regulates electrolyte homeostasis ¤ Indications Adrenal insufficiency, orthostatic hypotension in diabetics ¤ Common drug examples • Fludocortisone acetate Florinef ¤ Adverse reactions Salt and water retention, hypertension, cardiac hypertrophy, edema, heart failure, bruising, diaphoresis, urticaria, allergic rash, hypokalemia [Note: All adrenocorticoid drugs have both glucocorticoid and mineralocorticoid properties to some extent]
angiotensin-converting e n z y m e i n h i b i t o r s
¤ Indications Treat high blood pressure and heart failure ¤ Common drug examples: • Benazepril hydrochloride Lotensin • Captopril Capoten • Enalapril maleate Vasotec • Fosinopril sodium Monopril • Lisinopril Prinvil, Zestril ¤ Adverse reactions Persistent dry cough, skin rash, loss of taste, weakness, headaches, palpitations, fatigue, proteinuria, hyperkalemia
angiotensin II r e c e p t o r a n t a g o n i s t s Vasodilates arterioles by blocking the effects of angiotensin II, enhance renal clearance of sodium and water ¤ Indications Treatment of high blood pressure ¤ Common drug examples: • Candesartan cilexetil Atacand • Eprosartan mesylate Teveten • Irbesartan Avapro • Losartan potassium Cozaar • Telmisartan Micardis • Valsartan Diovan ¤ Adverse reactions Dizziness, anxiety, confusion, cough, upper respiratory infections, myalgia, insomnia, hypotension, visual changes, GI/GU effects
alpha-adrenergic b l o c k e r s
anticholinergics
Lower blood pressure by dilating peripheral blood vessels, reducing peripheral resistance ¤ Indications Raynaud’s disease, acrocyanosis, frostbite, phlebitis, diabetic gangrene, hypertension, benign prostatic hyperplasia
¤ Indications: • Spastic conditions including Parkinson’s disease, muscle dystonia, muscle rigidity and extra-pyramidal disorders
2
Pharmaceutical Classifications (continued)
¤ Common drug examples: • Amobarbital Amytal • Phenobarbital Bellatal, Solfoton • Primidone Mysoline • Secobarbital sodium Seconal ¤ Adverse reactions Drowsiness, lethargy, vertigo, headaches and CNS depression, hypersensitivity can occur (rash, fever) • After hypnosis hangover effect, impaired judgment, mood distortion, rebound insomnia • Geriatric patients Confusion • Pediatric patients Hyperactivity
• Prevent nausea and vomiting from motion sickness, adjunctive treatment for peptic ulcers and other GI disorders, bronchospasms, and GU tract disorders • Treat poisoning from certain plants and pesticides • Use preoperatively to decrease secretions and block cardiac reflexes ¤ Common drug examples: • Antiparkinsonians: o Benztropine mesylate: cogentin • Belladonna alkaloids: o Scopolamine hydrobromide: IsoptoHyoscine, Scopace • Synthetic quaternary anticholinergics: o Glycopyrroltae: Robinul • Tertiary synthetic and semisynthetic derivatives: o Dicyclomine hydrochloride: Antispas, A-spas, Dibent, Dilomine, Lomine, Ortyl ¤ Adverse reactions Dry mouth, decreased sweating, headache, dilated pupils, blurred vision, dry skin, urinary hesitancy and urine retention, constipation, palpitations and tachycardia; other peripheral effects include dry mucous membranes, dysphasia, stupor, seizures, hyperthermia, hypertension and increased respiration • Toxic doses May cause disorientation, confusion, hallucinations, delusions, anxiety, agitation and restlessness
benzodiazepines Enhance/facilitate actions of the gamma-aminobutyric acid (GABA) ¤ Indications Seizure disorders, anticonvulsants, anxiety, tension and insomnia, surgical adjuncts for conscious sedation or amnesia, skeletal muscle spasms or tremors, delirium, schizophrenia as an adjunct, nausea and vomiting induced by chemotherapy, neonatal opiate withdrawal ¤ Common drug examples: • Alprazolam Alprazolam, Xanax • Chlordiazepoxide Libritab • Clonazepam Klonopin, Rivotril • Clorazepate dipotassium Catapres, Dixarit • Diazepam Valium, Zetran • Estazolam ProSom • Flurazepam Apo-Flurazepam, Dalmane • Lorazepam Apo-Lorazepam, Ativan • Midazolam Versed • Oxazepam Apo-Oxazepam, Serax • Temazepam Restoril • Triazolam Halcion ¤ Adverse reactions Drowsiness and impaired motor function; constipation, diarrhea, vomiting, changes in appetite, urinary alterations, nightmares, hallucinations, insomnia • Toxic effects Visual disturbances, short-term memory loss, vertigo, confusion, severe depression, shakiness, slurred speech, staggering, bradycardia, difficulty breathing
anticoagulants
¤ Indications Prevent clot formation in patients with DVTs and pulmonary embolism, provide anticoagulation during hemodialysis, prevention of postoperative clot formation after surgery, decrease risk of strokes, decrease risk of MI in patients with atherosclerosis ¤ Common drug examples: • Danaparoid Orgaran • Delteparin Fragmin • Enoxaparin Lovenox • Heparin Heparin Lock Flush, Hep-lock • Tinzaparin Innohep ¤ Adverse reactions Insomnia, headache, dizziness, confusion, peripheral edema, nausea, constipation, pain, fever, vomiting, joint pain, rash
antihistamines
beta b l o c k e r s
¤ Indications Allergies, pruritis, vertigo, nausea and vomiting, sedation, suppression of cough, dyskinesia ¤ Common drug examples: • Allergies: o Azelastine hydrochloride: Astelin, Optivar o Chlopheniramine maleate: Aller-Chlor, Chlor-Trimeton, Chlor-Tripolon o Clemastine fumarate: Tavist o Diphenhydramine hydrochloride: Allergy DM, Benadryl, Diphen, Dormin, Midol PM, Nytol, Sominex, Twilite o Promethazine hydrochloride: Anergan 50, Phenergan • Pruritus: o Cyproheptadine hydrochloride: Periactin o Hydroxyzine hydrochloride: Anxanil, Atarax, Multipax, Quiess, Vistacon • Vertigo, nausea, vomiting: o Cyclizine hydrochloride: Marezine o Cyclizine lactate: Marezine, Marzine o Dimenhydrinate: Dimetab, Hydrate, Triptone o Meclizine hydrocholoride: Antivert, Antrizine, Bonine, Vergon o Promethazine hydrochloride: Anergan, Phenergan • Sedation: o Diphenhydramine: Diphenhydramine syrup • Cough suppression: o Diphenhydramine syrup • Dyskinesia: o Diphenhydramine ¤ Adverse reactions Drowsiness and impaired motor function; anticholinergic action will cause dry mouth and throat, blurred vision and constipation • Toxic effects Sedation, reduced mental alertness, apnea, cardiovascular collapse, hallucinations, tremors, seizures, dry mouth, flushed skin, and fixed, dilated pupils; (reverses when drug is withdrawn)
Reduce the workload of the heart by blocking the sympathetic conductance at the beta receptors on the SA node and myocardial cells, thus decreasing the force of contraction and causing a reduction in heart rate ¤ Indications Hypertension, angina, arrhythmias, glaucoma, myocardial infarction, migraine prophylaxis ¤ Common drug examples: • Beta 1 Blockers: o Acebutolol: Sectral o Atenolol: Tenormin o Betaxolol hydrochloride: Betoptic, Kerlone o Bisoprolol fumarate: Zebeta o Esmolol: Brevibloc o Metoprolol tartrate: Lopressor • Beta 1 & 2 Blockers: o Carteolol: Cartrol, Ocupress o Carvedilol: Coreg o Labetalol hydrochloride: Normodyne, Trandate o Levobunolol hydrochloride: AKBeta, Betagen o Metipranolol hydrochloride: Opti Pranolol o Nadolol: Corgard o Pindolol: Visken o Propranolol: Inderal o Sotalol: Betapace o Timolol maleate: Blocarden, Timoptic ¤ Adverse reactions Insomnia, nausea, fatigue, slow pulse, weakness, increased cholesterol and blood glucose levels, bradycardia, depression, hallucinations, sexual dysfunctions, skin hyperpigmentation • Toxic effects Severe hypotension, bradycardia, heart failure, bronchospasms
anxiolytic skeletal m u s c l e r e l a x a nt
bile a c i d s e q u e s t r a n t s
barbiturates
calcium c h a n n e l b l o c k e r s
¤ Indications Lowering cholesterol ¤ Common drug examples: • Cholestyramine Locholest, Prevalite, Questran • Colesevelam Welchol • Colestipol Colestid ¤ Adverse reactions Headache, anxiety, vertigo, dizziness, insomnia, fatigue, syncope, tinnitus, constipation, nausea, vomiting, anemia, muscle and joint pain
¤ Indications Anxiety, muscle spasm, tetanus, acute alcohol withdrawal, adjunct for epilepsy ¤ Common drug examples: • Diazepam Apo-Diazepam, Valium ¤ Adverse reactions Drowsiness, slurred speech, tremor, fatigue, ataxia, headache, insomnia, hypotension, bradycardia, nausea, constipation, joint pain, physical or psychological dependence ¤ Indications Seizure disorders (tonic-clonic and partial seizures), sedation, hypnosis, preanesthesia sedation, psychiatric use
Relaxes smooth muscle to provide vasodilation and affects cardiac muscle to reduce HR and SV 3
Pharmaceutical Classifications (continued) ¤ Common drug examples: • Medroxyprogesterone acetate Amen, Curretab, Cycrin, Provera • Megestrol acetate Megace • Norethindrone Micronor, Nor-Q.D. • Norethindrone acetate Aygestin, Norlutate • Norgestrel Ovrette • Progesterone Crinone ¤ Adverse reactions Change in menstrual bleeding pattern, breast tenderness and secretion, weight changes, increases in body temperature, edema, nausea, acne, somnolence, insomnia, hirsutism, hair loss, depression, cholestatic jaundice and allergic reactions; flushing, increased sugar levels, increase in BP, decreased sexual desire, headache
¤ Common drug examples: • Co-trimoxazole Apo-Sulfatrim, Bactrim, Cotrim, Septra • Sulfasalazine Azulfidine ¤ Adverse reactions Rash, fever, pruritus, erythema, photosensitivity, joint pain, bronchospasm; hematologic, renal and GI reactions all can occur
sulfonylureas Lower blood glucose levels by stimulating insulin release from the pancreas ¤ Indications Type 2 diabetes mellitus, neurogenic diabetes insipidus ¤ Common drug examples: • First Generation: o Chlorpropamide: Diabinese, Novo-propamide o Tolazamide: Tolinase o Tolbutamide: Orinase • Second Generation: o Glimepiride: Amaryl o Glipizide: Glucotrol o Glyburide: DiaBeta, Glynase Pres Tab, Micronase ¤ Adverse reactions Headache, nausea, vomiting, anorexia, heartburn, weakness and paresthesia • Toxic effects Anxiety, chills, cold sweats, confusion, cool pale skin, difficulty concentrating, drowsiness, excessive hunger, nervousness, rapid heartbeat, weakness, unusual fatigue
protease i n h i b i tors Antiviral medication used with HIV patients ¤ Indications HIV infection and AIDS ¤ Common drug examples: • Amprenavir Agenerase • Ritonavir Norvir • Indinavir sulfate Crixivan • Saquinavir Fortovase • Lopinavir and ritonavair Kaletra • Saquinavir mesylate Invirase • Nelfinavir mesylate Viracept ¤ Adverse reactions Kidney stones, pancreatitis, diabetes or hyperglycemia, ketoacidosis and paresthesia all require medical attention; less problematic are symptoms of generalized weakness, GI disturbances, headaches, insomnia, taste perversion, dizziness, somnolence
tetracycline
Antibiotic ¤ Indications Bacterial, antiprotozoal, rickettsial and fungal infections; sclerosing agent for pleural or pericardial effusion, adjunct therapy for H. pylori and other GI infections, Lyme disease ¤ Common drug examples: • Doxycycline hyclate Periostat, Vibramycin • Minocycline hydrochloride Dynacin, Nimocin, Vectrin • Tetracycline hydrochloride Achromycin, Panmycin, Tetralen ¤ Adverse reactions Anorexia, flatulence, nausea, vomiting, stool disturbances, epigastric burning, abdominal discomfort, rash
selective serotonin reuptake i n h i b i tor s Enhance serotonergic transmission through blocked reuptake at the synapse ¤ Indications Depression, panic and eating disorders, obsessive compulsion, premenstrual dysphoria, posttraumatic stress and bipolar disorders, alcohol dependence, premature ejaculation, diabetic neuropathy ¤ Common drug examples: • Citalopram hydrobromide Celexa • Fluoxetine Proxac, Sarafem • Fluvoxamine maleate Luvox • Paroxetine hydrochloride Paxil • Sertraline hydrochloride Zoloft ¤ Adverse reactions GI complaints, headaches, dizziness, somnolence, sexual dysfunction, tremors; less common reactions include breast tenderness or enlargement, extra-pyramidal effects, dystonia, fever, palpitations, weight gain or loss, rash, hives, itching
thrombolytic en z y mes Developed to reduce a blood clot and prevent permanent ischemic damage ¤ Indications Thrombosis, thromboembolism ¤ Common drug examples: • Alteplase Activase, Cathflo Activase • Anistreplase, reteplase Eminase • Streptokinase Streptase • Tenecteplase TNKase • Urokinase Abbokinase ¤ Adverse reactions Cerebral hemorrhage, fever, hypotension, arrhythmias, edema, nausea, vomiting, arthralgia, headache
skeletal m u s c l e r e l a x a n t I Polysynaptic inhibitors (inhibit interneuron transmission in the spinal cord) ¤ Indications Muscle spasms caused by acute injuries, supportive therapy for tetanus ¤ Common drug examples: • Carisoprodol Soma • Chlorzoxazone Paraflex, Parafon Forte • Cyclobenzaprine hydrochloride Flexeril • Methocarbamol Carbacot, Robaxin, Skelex • Orphenadrine citrate Norflex ¤ Adverse reactions Drowsiness, vertigo, tremor, headaches, lightheadedness, nausea, vomiting, confusion
tricyclic a n t i d e p r e s s a nts Enhance adrenergic neurotransmitter transmission through blocked reuptake at the synapse ¤ Indications Depression, obsessive compulsive disorder, enuresis, severe chronic pain, phobic disorders, bulimia, short-term treatment of duodenal or gastric ulcers ¤ Common drug examples: • Amitriptyline hydrochloride Elavil, Levate, Novotriptyn • Clomipramine hydrochloride Anafranil • Desipramine hydrochloride Norpramin • Doxepin hydrochloride Sinequan, Triadapin • Imipramine hydrochloride Apo-Imipramine, Impril, Novopramine • Imipramine pamoate Tofranil-AM • Nortriptyline hydrochloride Aventyl HCL, Pamelor • Trimipramine maleate Surmontil ¤ Adverse reactions Sedation, anticholinergic effects, orthostatic hypotension; specific drugs may cause seizures
skeletal m u s c l e r e l a x a n t I I Indirect and direct skeletal muscle relaxants ¤ Indications Spasticity caused by an upper motor neuron lesion like MS ¤ Common drug examples: • Baclofen Lioresal • Diazepam Valium • Dantrolene sodium Dantrium ¤ Adverse reactions Drowsiness, dizziness, weakness, fatigue, hypotension, paresthesias, confusion, dysarthria, constipation, vomiting, liver dysfunction
vitamin K i n h i b i t o r s
sulfonamides
¤ Indications Pulmonary emboli, DVT, MI, atrial arrhythmias ¤ Common drug examples: • Warfin Coumadin ¤ Adverse reactions Fever, anorexia, nausea, vomiting, cramps, diarrhea, mouth ulcerations, hemorrhage, jaundice
First drugs to treat systemic, bacterial infections ¤ Indications: • Bacterial infections Effective with staphylococci, streptococci, clostridium tetani, urinary tract infections, nocardiosis, otitis media • Parasitic infections Inflammation, pneumonic plague U.S. $5.95 CAN. $8.95 NOTE TO STUDENTS Due to its condensed format, please use this QuickStudy ® as a guide, but not as a replacement for assigned classwork. DISCLAIMER: This guide cannot cover every possible adverse reaction or toxic effect, and is intended for informational purposes only; it is not intended for the diagnosis, treatment or cure of any medical condition or illness, and should not be used as a substitute for professional medical care. BarCharts, Inc., its writers and editors are not responsible or liable for the use or misuse of the information contained in this guide.
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Authors: Becky Rodda, PT, MHS, OCS Suzanne L. Tinsley, PhD, PT Customer Hotline # 1.800.230.9522 All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 2006 BarCharts, Inc. 0608
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WORLD’S #1 ACADEMIC OUTLINE
Endochondral Ossification
Skeletal System
Hyaline cartilage
Optional review: “Bone Structure” section, p.1 of QuickStudy ® Anatomy guide.
Epiphysis
Functions
Metaphysis
1. Support: Framework for body. 2. Movement: Muscular attachment. 3. Protection: Brain, spinal cord, thorax, etc. 4. Mineral & lipid storage: Ca, P, etc., and lipids in yellow marrow. 5. Hemopoiesis: Blood cell formation in red marrow.
Skeletal Development & Growth Skeleton develops by transformation of embryonic mesodermal connective tissue into cartilage and/or bone (i.e., ossification). Two major types exist: 1. Intramembranous ossification: Undifferentiated mesoderm (mesenchyme) transformed to bone. Examples: Dermal bones (flat skull bones, mandible and clavicle). a. Osteoprogenitor stem cells (to become bone-forming cells) cluster and form organic matrix with collagen fibers. b. Cells enlarge, compress and calcify matrix, forming spicules around collagen fibers. These cells, or osteoblasts, form an ossification center. c. As more bony spicules develop and coalesce, osteoblasts are trapped in bony chambers (lacunae) and become mature, boneproducing osteocytes. d. Osteoclasts reabsorb bone and allow for shaping and remodeling to final form of bone structure (e.g., spongy vs. compact bone, or final shape of entire bone).
2. Endochondral ossification: Bone converted from a hyaline cartilage model resembling shape of future bone. Examples: Most bones of appendicular and axial skeleton. a. Chondrocytes deep within the diaphysis enlarge (hypertrophy), compressing and calcifying the cartilage into spicules. b. Calcification of cartilage prevents diffusion of nutrients from perichondrium to chondrocytes, killing these cells and leaving empty lacunae. c. Osteoblasts form inside the perichondrium of the cartilage model, forming a periosteum or bony collar. d. Blood vessels grow into spaces created by dead chondrocytes and decaying cartilage. e. Osteoblasts from periosteum move in via the blood and form a primary ossification center around remaining cartilage matrix (occurring in three-month fetus). f. Osteoclasts move into diaphysis via the blood to reabsorb spongy bone to create yellow marrow cavity. g. Steps “a - d” occur in epiphyses (ends of long bones), creating secondary ossification
Articular cartilage
Diaphysis
Compact bone
Epiphyseal cartilage
Periosteum Secondary ossification center
centers (often occur shortly after birth). Although no cavity is created and spongy bone remains, the epiphyses of large bones serve as primary sites of red marrow. h. Where primary and secondary ossification centers meet (metaphysis), a thin layer of cartilage, epiphyseal plate, remains until adulthood, allowing for increases in bone length. In adults, the cartilage is converted to bone, creating an epiphyseal line - bone lengthening is no longer possible at this point.
Factors Affecting Bone Development 1. Stress: Gravitational and functional (muscle contraction) forces increase bone development. Absence or reduction of these forces (e.g., space flight) can cause abnormal growth. 2. Hormones: Sex hormones (estrogens and androgens), growth hormone, thyroxine, calcitonin, and calcitriol stimulate bone growth. Parathormone inhibits bone growth. 3. Nutrition: Vitamin D is required for calcitriol formation, which aids in absorption of calcium and phosphate. Vitamin C is involved in collagen synthesis. Vitamin A stimulates osteoblasts.
Muscular System Muscle Types
1. Muscle fiber: Contractile cells. 2. Sarcolemma: Plasma membrane of muscle fiber. 3. Myofibrils: Small fibers packed within muscle fiber; composition varies along length creating banding appearance. 4. A band: Dark area on myofibrils. 5. I band: Light area on myofibrils. 6. Z line(disc):Middle of I band. 7. Sarcomere: Between two Z lines, unit of contraction. 8. H zone: Light area in A band. 9. M line: Middle of H zone. 10. Myofilaments: Fibers found in myofibrils. 11. Thick filaments: Myosin protein; forms A band; bound at M Line. 12. Thin filaments: Actin, tropomyosin, and troponin proteins; form I band; bound at Z line.
Contraction of Skeletal Muscle 1. A nerve signal triggers the release of acetylcholine into neuromuscular synapse. 2. Receptors in sarcolemma combine with acetylcholine, triggering a propagated action potential (PAP) that spreads across membrane and deep into muscle fiber via transverse tubules.
Contraction of Sarcomere Sarcomere I-Band
A band
M-Line
Z-line
I-Band
Z-line
H-Zone Sarcomere between contractions
actin
myosin Same sarcomere contracted
1. Skeletal muscle: Moves bones directly or indirectly; voluntarily (conscious) controlled; striated (banded). 2. Cardiac muscle: Pumps blood through body; involuntarily controlled; striated. 3. Smooth muscle: Moves materials through structures; involuntarily controlled; no striations
Functions of Skeletal Muscle 1. Movement: Moves body parts and materials. 2. Posture: Maintenance of body positions. 3. Temperature homeostasis: Heat production.
Skeletal Muscle Anatomy Knowledge of skeletal muscle fiber microanatomy is necessary to understand contraction mechanism. 1
3. Lateral sacs (terminal cisternae) of sarcoplasmic reticulum are stimulated by PAP to release calcium ions. 4. The thick filaments, myosin, have specialized heads binding to special sites on actin. 5. However, a muscle fiber at rest has its myosin binding sites blocked by tropomyosin.
Muscular System (continued) When calcium ions (Ca+2) combine with troponin, this triggers a shift in the position of tropomyosin, allowing the myosin heads to bind with actin forming cross-bridges. 6. ATP hydrolysis energizes the myosin head, causing it to attach to actin and swivel, pulling on the thin filament. A new ATP molecule is necessary for myosin to detach from the thin filament and return the head to its original position. 7. The myosin head now can reattach to a new segment of the filament. As long as calcium ions and ATP are available, this cycle can continue.
Functions 1. Sensory: Detects changes in environment. 2. Integration: Decides on a course of action. 3. Motor: Responds to change.
Neurophysiology 1. Membrane potentials Living body cells are electrically polarized, with the inside (cytoplasm) more negative than the outside (interstitial fluid). This electrical charge difference is called the membrane potential.
Ion Positions & Resting Membrane Potential
Role of Microfilaments & ATP During Contractions
cross bridge
Ca2+
Na+ A P
CI-
P
P
a
CI-
K+
A P
myosin
P
Depolarization Depolarization +30 (Na+ inflow)
Extracellular fluid (positively charged) K+
Na+
Na+
CI-
P
b Ca2+ Org-
A P P P
Org-
contraction cycle Ca2+
A P P P
e
A P P
P
d
Types of Skeletal Muscle Fiber 1. Red muscle fibers a. Slow twitch, fatigue resistant - Splits ATP slowly; rich blood supply; large stores of myoglobin; many mitochondria for aerobic metabolism. • Examples: Postural muscles of neck, back. b. Fast twitch, fatigue resistant - Splits ATP rapidly; otherwise, same as (1a). • Example: Leg muscles.
Org-
K+
Neuron cytoplasm CI(negatively charged)
c Ca2+
K+
Org-
Na+
K+ Org-
K+
a. Resting membrane potential (RMP): Typically -70 millivolts (mV) - Distribution of key ions • K+ higher inside cell • Na+ and Cl- higher outside cell • Organic ions higher inside - Distribution and RMP caused by: - Membrane pumps • Example: Na/K pump takes Na+ out while bringing in K+. - Membrane permeability • K+ leaks more easily through membrane than Na+. - Negatively-charged organic ions • Proteins prevent many K+ ions from escaping.
Although significant differences exist, the basic mechanism in both muscle types involves interactions between actin and myosin similar to those in skeletal fibers.
Threshold
-55 -70 Stimulus
Hyperpolarization
Resting membrane potential
Time in milliseconds (msec)
- Absolute refractory period: Time during which no new action potential can occur regardless of stimulus strength. Occurs during main spike. - Relative refractory period: Time during which a new action potential can be initiated - requires a stronger than normal stimulus. Occurs during hyperpolarized state. c. Propagated Action Potential (PAP) “The Nerve Impulse” Initial action potential generates action potentials nearby; PAPs move along membrane of neuron.
Propagated Action Potential Stimulus ++ +++ +++++ ++ ++ +++ ++ +++ +++++ ++ ++ +++
Na+ diffusion
Na+
Na+
Area of action potential traveling along neutron
Na+
Plasma membrane
K+ diffusion
Reversal of polarization
Na+
a. Fast twitch, fatigable - Splits ATP rapidly; few blood vessels; little myoglobin; large glycogen stores for anaerobic metabolism. • Example: Arm muscles.
Contraction of Cardiac & Smooth Muscle
Repolarization (K+ outflow)
0
Ion Movements Cell exterior
2. White muscle fibers
3. Most skeletal muscles in the body have a mixture of all three fiber types in various proportions depending on the muscle function.
Org-
Membrane potential - millivolts (mV)
troponin tropomyosin actin
- Small changes in RMP will remain localized and graded (dependent on strength of stimulus) as channels open and K+ flows out of the cell to quickly halt the depolarization. - However, if a stimulus reaches a critical point or threshold, the membrane goes through a full-scale depolarization, reversing the polarity with the inside becoming positive and the outside negative. - This is an action potential and an all-ornothing response as stimulus strengths greater than the threshold will trigger the same response.
Nervous System
K+
K+
Cell interior
ATP
Sodiumpotassium pump
+ +
Na+ Na+ ++ ++ ++ ++ ++ ++ Na+ Na+
2
+++ ++ ++ +++
Area of repolarization Na+ Na+ + + + ++ ++ K K Na ++ ++ ++ + +++ ++ ++ +++ Na+ Na+ +++ ++ ++ +++ +
b. Graded (local) and action potentials - Voltage-gated channels: Open to ions in response to change in RMP. • Examples: Na+ and K+ channels. - Opening Na+ channels causes a depolarization as Na+ rushes inside and the cytoplasm becomes more positive (i.e., approaches zero from -70 mV).
+++ ++ ++ +++
+
+
d. Saltatory conduction: Myelinated axons transmit PAP much faster (up to 50 times faster) as impulse jumps from areas lacking myelin (Nodes of Ranvier). It also saves energy as much less ion pumping is required to restore RMP.
Saltatory Conduction Along an Axon +
+ +
+ +
+
+
+
+ +
+
+ +
+ +
+ +
+ +
Nodes of Ranvier + +
+ +
+
+ +
+ + + +
Visual Conditions Emmetropia
+ +
Myopia
- Far point: Distance from eye that does not require accommodation; generally six meters (20 ft.) • 20/20 vision is normal focusing at 20 ft. • 20/40 is only focusing objects at 20 ft. that a normal eye can focus at 40 ft. • 20/10 is focusing objects that a normal eye could only focus at 10 ft.
+ +
Visual Far Point
+ +
+
+ + + +
+ + + +
+
+ +
+ +
Area of action potential
Hypermetropia + +
+ +
+ +
+
+ +
+ +
+ + + +
+
2. Synapses Transfer information (nerve impulses) from one cell (presynaptic neuron) to another (postsynaptic neuron). Two major types exist: a. Electrical synapses: Cells are in direct contact. May allow for faster communication between cells and synchronization of certain stereotyped responses. Rare in the nervous system. b. Chemical synapses: Cells are separated by a synaptic cleft. Neurotransmitters (e.g., acetylcholine, norepinephrine, serotonin) released from the presynaptic neuron can trigger different responses by the postsynaptic neuron. Most abundant synapse type in nervous system. - Excitatory PostSynaptic Potential (EPSP): Response by cell that triggers depolarization, making PAP more likely. PostSynaptic Potential - Inhibitory (IPSP): Response by cell that triggers hyperpolarization, making PAP less likely. - Synaptic delay: Time required for signal to cross synapse - 0.5—1 msec. - Neuromodulators: Chemicals that alter neuronal activity by influencing the release of neurotransmitters or the response of the postsynaptic cell to a neurotransmitter. • Examples: Endorphins and enkephalins which relieve pain by preventing the release of the neurotransmitter substance P.
2. Accommodation: Objects closer than six meters (20 ft.) generally have light rays that must be refracted greatly, thus requiring the eye to accommodate or adjust. Involves three major actions: a. Lens shape: Ciliary muscle contraction regulates the shape of the lens. Presbyopia occurs when lens loses elasticity with age, which decreases ability to accommodate.
Visual Accommodation Ciliary muscle relaxes, flattening the lens for distant vision
3. Photoreceptors of the retina a. Rods: Respond to light levels, but not color; low threshold; good in dim light (i.e., night); common in peripheral areas of retina. b. Cones: Respond to light levels and color (red, green, blue); high threshold; good in bright light conditions (e.g., day); common in fovea for visual acuity.
Ciliary muscle contracts rounding the lens for close vision
Physiology of Hearing & Equilibrium Optional review: “Ear” and “Ear Interior” sections, p.6 of Anatomy guide.
b. Pupil size: Pupillary dilator muscles relax while pupillary constrictors contract to eliminate divergent light rays, making refraction easier to accomplish. c. Eye convergence: Eyes turn medially to focus light on the fovea or area of greatest visual acuity.
Eye Convergence
Physiology of Vision
1. Sound waves: Produced by alternately compressing air and then relaxing the compression. ↑ Amplitude → ↑ Intensity (= Loudness) ↑ Frequency → ↑ Pitch 2. Transmission of sound waves to inner ear: Sound waves are directed by pinna (ear lobes) into external auditory meatus and eventually tympanic membrane (ear drum). - Vibrations transferred to malleus→incus→stapes.
3. Function of cochlea: Stapes vibrates oval window, which pushes fluid in the vestibular canal.
Optional review: “Eye” section, p.6 of Anatomy guide. 1. Optics: Light travels in a straight line until a new medium is encountered - it may then bend or be refracted. a. The refractive tissues of the eye form a convex surface. b. The distance at which the bent light converges to a focal point creates three conditions: - Emmetropia: Focal point hits retina. - Myopia: Focal point is in front of retina creating nearsightedness. Corrective lenses or surgery may correct refractive abnormalities. - Hypermetropia: Focal point is behind retina, creating farsightedness.
Hearing
- Depending on the frequency of the sound wave, an area of the basilar membrane vibrates, triggering propagated action potentials that travel via the auditory nerve to the brain.
Equilibrium 1. Static equilibrium: Maintaining body (head) position relative to gravity. 2. Dynamic equilibrium: Maintaining body (head) position in response to sudden movements. - Near point: Minimum distance from eye that object can be focused using accommodation. 3
- Vestibular complex is the sensory structure for equilibrium and consists of the vestibule and semicircular canals.
Heart & Circulation Optional review: “Heart” and “Blood Circuit” sections, p.3 of Anatomy guide and Heart and Circulatory System guides.
Blood Functions
Regulate cellular activity for: 1. Metabolism 2. Growth 3. Development 4. Homeostasis 5. Reproduction
1. Transport: O2, CO2, food, wastes, hormones. 2. Homeostasis: pH, temperature, defense, clotting, ion and fluid balance.
Hormones
1. Water solution and cells; ratio is called hematocrit.
1. Function: Muscular organ contracts rhythmically, forcing blood through the body. 2. PAPs in the heart a. Propagated Action Potentials occur when the Sinoatrial (SA) Node depolarizes spontaneously 70-80 time/min. b. These rhythmic excitations spread via a conduction system through the heart, creating systole and diastole phases. c. An electrocardiogram (ECG or EKG) is a recording of these electrical changes.
Composition
Major Endocrine Glands Pineal gland Hypothalamus Pituitary gland Thyroid gland Parathyroid glands Thymus gland Adrenal glands Pancreas
Erythrocytes (red blood cells) (45%)
1. Clotting factors released from injured tissue and platelets 2. Plasma proteins synthesized in liver, circulated in inactive form Gonads
Ovaries (female)
3
Prothrombrin circulating in plasma
Thrombrin
Fibrinogen circulating in plasma
4
Fibrin
Signals pass to heart apex
Bundle branches
4 Signals spread throughout ventricles
Purkinje fibers Heart apex
3. Cardiac output: a. The volume of blood pumped by the heart every minute is related to the number of ventricular contractions (heart rate) and the amount of blood pumped per contraction (stroke volume). b. Numerous factors influence cardiac output. c. Total blood volume in body (4-6 L) is pumped every minute at rest. d. During exercise, total blood volume may circulate through body every 10 seconds (5-6 times per min).
Hemostasis
Blood Clotting Events Testis (male)
ECG
clotting. Prevention of blood loss. Three phases involved: 1. Vascular constriction: Walls of vessels may narrow at injury site to temporarily halt blood loss until next hemostatic phase. ↑pressure → ↑constriction; thus, applying pressure to a wound can increase this response. 2. Platelet plug formation. 3. Coagulation: Blood clotting.
AV node
SA node (pacemaker)
2. Plasma: Mostly H2O, proteins (e.g., albumins, globulins, fibrinogen) and other solutes (e.g., electrolytes, nutrients, gases, enzymes, vitamins, wastes). 3. Formed elements: Cells produced in bone marrow by hemopoiesis. a. Erythrocytes: Red blood cells; composed of hemoglobin, used for gas transport; formation stimulated by erythropoietin from kidney; recycled in spleen. b. Leukocytes: White blood cells; most involved in defense. - Granulocytes: • Neutrophils • Eosinophils • Basophils - Agranulocytes • Monocytes • Lymphocytes (B and T cells) c. Platelets: Thrombocytes; involved in
AV node
4. Blood pressure: a. Arteries have highest pressure, which fluctuates between systole and diastole. b. Pressure drops off quickly in arterioles and is very low in the veins. c. At any given moment, most blood is found in the venous portion. d. Breathing and movement help push blood back to the heart by contracting muscles, which in turn compress veins.
Pressure Changes in Circulatory System 120 100 80 60 40 20 0
Systolic Pressure
Diastolic Pressure Venae cavae
Although every cell may release hormones, certain areas of the body serve as principal endocrine glands that release circulating hormones, resulting in numerous, complex responses by target cells. Hormone actions in general are regulated by negative feedback systems.
Buffy coat, made of platelets and leukocytes (white blood cells)
2 Signals delayed at
wave of signals to contract
Veins
Endocrine glands
1 Pacemaker generates Plasma (55%)
Venules
2. Neurotransmitters (see Chemical Synapses section of this guide). 3. Circulating hormones: Released into blood and transported to cells throughout body.
Electrical Signals Regulating Heartbeat Appearance of centrifuged blood
Arterioles Capillaries
a. Autocrine: Same cell is affected. b. Paracrine: Neighboring cells affected.
Blood Hematocrit
Pressure (mm Hg)
Chemicals derived from amino acids, lipids (e.g., steroids) and peptides are produced by and released from cells and trigger a response in same or other cells by binding to receptors (located inside or outside of cell). Three major types: 1. Local hormones (cytokines): Released into interstitial fluid (e.g., prostaglandins, histamines, growth factors).
Arteries
Functions
Cardiovascular System
Aorta
Endocrine System
Lymphatic System
Respiratory System
Optional review: “Lymphatic Network” section, p.2 of Anatomy guide.
Optional review: “Respiratory System” section, p.2 of Anatomy guide and Respiratory System guide.
1. Fluid homeostasis: Returns excess fluids that leak from blood capillaries to bloodstream. 2. Transport: Lipids from intestine delivered to bloodstream. 3. Protection: Part of immune response; involves lymph nodes, thymus, spleen.
Immune System Nonspecific Immunity Ability to protect against many different organisms, defective body cells and chemicals by using the same generalized responses. Major components: 1. Barriers: Skin and mucous membranes cover and protect the body. 2. Phagocytosis: Microphages (neutrophils and eosinophils) and macrophages (mostly from monocytes) consume debris and foreign cells. 3. Natural Killer (NK) cells: Engage in immune surveillance or monitoring body for abnormal cells. May involve interferon cytokines. 4. Inflammation: Damaged tissues release histamines and other cytokines that trigger swelling, redness, heat and pain as phagocytes are activated. May activate complement system to enhance response. 5. Fever: Higher (within limits) body temperature speeds up body’s response and may inhibit bacterial/viral replication.
Specific Immunity Protection based on individualized responses by recognition of “nonself ” antigens. Two major components: 1. Cell-mediated response: Cytotoxic (killer) T cells attack foreign cells directly. 2. Humoral (antibody) response: B cells produce immunoglobulin antibodies (IgG, IgE, IgD, IgM, or IgA) that are specific for antigens. - Helper T cells enhance this response; suppressor T cells inhibit. - Phagocytosis, complement system, inflammation may assist in attack.
Summary of Specific Immune Response Attack by antibodies
Antibody-mediated immunity
B cells activated
Antigens
Specific Defenses (Immune response)
Direct physical and chemical attack
Communication and feedback Cell-mediated immunity
Phagocytes activated
T cells activated
1. Function: Exchange O2 and CO2. 2. Mechanics of breathing: Ventilation of the lungs occurs by muscular contractions/relaxations that alter pressure within the thoracic cavity.
- Some absorption occurs in large intestine (e.g., ions, water). - Undigested materials (feces) are expelled (defecation) via the rectum.
Digestive Processes
Gas Exchange 1. Dalton’s Law: The pressure of a gas mixture is equal to the sum of the separate or partial pressures (e.g., Air = 1 atmosphere or 760mm Hg: pN2 = 78% or 593mm Hg; pO2 = 21% or 160mm Hg). 2. Henry’s Law: Each gas in a mixture will dissolve proportionally to its partial pressure. 3. Alveolar air: The composition of air reaching the alveoli helps determine the dynamics of gas exchange with the blood. 4. O2 transport in blood: Only 3% can dissolve in plasma; 97% of O2 is transported by hemoglobin. - The binding of O2 to hemoglobin is influenced by several factors: • pO2, pH (Bohr effect), pCO2, temperature. • Active tissues have low pO2, low pH, high pCO2 and high temperatures, all of which increase oxygen delivery.
Oxygen/Hemoglobin Dissociation Curves: Bohr Effect Percent of oxygen saturation
Functions
3. Chemical digestion: Digestive enzymes break down large macromolecules (proteins, lipids, carbohydrates) into their constituent parts. 4. Absorption: Most food molecules are absorbed in the small intestine.
100
Food INGESTION
Pharynx
MECHANICAL DIGESTION
Esophagus
• Chewing • Churning • Segmentation
PROPULSION • Swallowing • Peristalsis
CHEMICAL DIGESTION
Stomach
ABSORPTION Lymph vessel
Small intestine
Food
Primarily H20 Feces
pH 7.5 pH 7.3
80
DEFECATION pH 7.1
Anus
60 40 20 0
Blood vessel
Large intestine
20
40 60 PO2 (mm Hg)
80
100
5. CO2 transport in blood: Only 7% can dissolve in plasma; 23% binds to hemoglobin; 70% transported as HCO3-.
5. Control of digestive processes: Complex interactions involving hormones and neural reflexes highly coordinate mechanical and chemical digestion to facilitate absorption.
Digestive Hormones & Enzymes Ingested food
= promotes = inhibits
Gastrin released from stomach mucosal cells
Digestive System Optional review: “Digestive System & Viscera” section, p.2 of Anatomy guide and Digestive System guide. 1. Function: Break down food so cells can be nourished. 2. Mechanical digestion: Various activities aid in presenting foods to the GI tract for absorption. a. Mastication (chewing): Breaks down large particles, mixing them with saliva. b. Deglutition (swallowing): Moves (via peristalsis) materials from mouth, to the pharynx, on to stomach. c. Gastric/intestinal motility: Peristalsis and mixing movements (segmentation) facilitate formation of small particles for absorption (requires chemical digestion, too). 5
Lowers pH Secretion of HCL and pepsin is stimulated, increasing motility of stomach
Delivery of acid chyme to small intestine is increased Undigested Acid in chyme fats and proteins Cholecystokinin released from intestinal mucosa
Bile released from gallbladder
Secretin released from intestinal mucosa
Digestive enzymes released from pancreas
Bicarbonate solution released from pancreas Neutralizes acid
Food digestion
Urinary System
Reproductive System
Optional review: “Urinary System” section, p.2 of Anatomy guide.
Optional review: “Male and Female Reproduction” sections, p.2 of Anatomy guide and Reproductive System guide.
1. Function: Maintain blood homeostasis: i.e., pressure, pH, ionic balance and conserve nutrients while eliminating wastes.
Excretion vs. Digestion Food intake
Undigested food
Digestion
Absorption
1. Perpetuate the species. 2. Maintain sexual characteristics. 3. Human Life Cycle: Haploid gametes (sperm, eggs) produced through meiosis, which also scrambles the DNA, creating unique cells. At fertilization, gametes fuse forming a diploid zygote and development occurs via mitosis.
Gametogenesis & Fertilization Haploid gametes (n = 23) n Egg
Metabolic wastes n Sperm
Elimination as feces
Excretion
Meiosis
2. Nephron: Functional unit of kidney found in cortex/medula. Two major portions: a. Renal corpuscle: Blood enters Bowman’s capsule via glomerulus where a filtrate is formed. b. Renal tubules: Glomerular filtrate enters proximal convoluted tubule → loop of Henle → distal convoluted tubule → collecting duct where it is now urine.
Kidney & Nephron Structure Kidney medulla
Kidney cortex
Glomerulus Collecting duct
Renal artery Renal vein
Renal capsule
Fertilization
Multicellular diploid adults (2n = 46)
Diploid zygote (2n = 46)
2n
Mitosis and development M
4. Spermatogenesis: At puberty, the brain releases Gonadotropin-releasing hormone (GnRH), triggering a complex set of responses ultimately ending in the production of sperm. - Normal sperm development requires slightly lower temperature; thus, testes descend from body in scrotum.
Hormones & Spermatogenesis = promotes
Hypothalamus
= inhibits
GnRH Anterior pituitary LH
FSH
Distal tubule Testes
Renal pelvis
Proximal tubule
Ureter
Loop of Henle NEPHRON
Interstitial (Leydig) cells
Sertoli cells
Testosterone Stimulate spermatogenesis
3. Tubular secretion and reabsorption: a. Glomerular filtrate entering renal tubules consists mostly of plasma minus proteins. b. 180 L (47 gallons) of filtrate are produced per day. c. Nearly all the plasma (and nutrients) must be reabsorbed by capillaries that follow the renal tubules. d. The loop of Henle dips deep into the medulla of the kidney, which has an interstitial fluid laden with solutes to help the blood vessels reabsorb water. e. Electrolytes may be actively and passively removed from the filtrate to help maintain ion balance of the blood and interstitial fluid of the kidney. f. Collecting tubule’s permeability to water can be increased by antidiuretic hormone (ADH), which allows for more water reabsorption and more concentrated urine.
Hypothalamus GnRH
= promotes = inhibits
Anterior pituitary LH/FSH
Functions
Utilization of nutrients by cells
Hormones & Oogenesis
Testosterone
Inhibin
Reproductive tract, other organs
Ovary Estrogen and Progesterone Uterus
a. The ovulated primary follicle leaves behind a corpus luteum, which prevents other oocytes from developing and being released (progesterone-estrogen effect). b. If fertilization and implantation occur, fetus will temporarily keep corpus luteum functioning by releasing human chorionic gonadotropin, or HCG (detected in pregnancy test kits). c. If fertilization does not occur, endometrium partially sloughs off (menses) and cycle occurs again monthly until menopause.
7. Male sexual response: The penis must become erect to facilitate fertilization by penetrating the vagina. a. Ejaculation activates sperm that are expelled via semen into the vagina. b. Ejaculation is usually accompanied by a pleasurable sensation called orgasm.
8. Female sexual response: Analogous engorgement of clitoris and associated vaginal tissues may occur leading to orgasm, but this response is not necessary for fertilization. 9. Fertilization: A high sperm count (i.e., multiple sperm) is necessary, as small quantities of enzymes are released from sperm and collectively break down barriers surrounding egg. a. Once a single sperm enters the egg, a series of events prevents other nearby sperm from entering. b. Normal fertilization occurs in the fallopian tubes, after which the embryo moves into the uterus, where it implants on the endometrium and forms a placental connection with the mother.
10. Development: At 10 weeks, the embryo has the basic human body plan and is called a fetus. - Developmental changes occur before and after birth (parturition).
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5. Oogenesis: A female is born with her total supply of eggs. - At puberty, GnRH release triggers a cascade of events (the ovarian cycle), where each month one (usually) oocyte is released (ovulation) from the ovary into a fallopian tube where fertilization can occur.
6. Ovarian cycle: A complex, hormonallycontrolled system where growing oocytes surrounded by cells (follicles) compete for ovulation. - Estrogen effect: Simultaneously thickens the endometrium (lining of uterus) for possible implantation after fertilization. 6
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WORLD'S #1 ACADEMIC OUTLINE
THE BASIC PRINCIPLES OF PSYCHOLOGY FOR INTRODUCTORY COURSES INTRODUCTION BIOLOGICAL BASES LEARNING OF PSYCHOLOGY CONTINUED • DEFINITION: Scientific study of behavior and mental processes and how they are affected by an organism’s physical and mental state and external environment • GOALS: Describe, understand, predict and control (or modify) behavior or mental processes • PSYCHOLOGY AS A SCIENCE: 1. Descriptive studies - describe but not explain a. Case history - description of one individual b. Observation i. Naturalistic - natural environment ii. Laboratory - setting controlled by researcher
c. Surveys - questionnaires and interviews d. Tests i. Reliability - used to measure whether individual differences in test scores are due to actual differences in the characteristic being measured or due to chance errors and fluctuations ii. Validity - refers to the extent to which a test measures what it purports; the validity of a test must be empirically established – relating the test to particular criterion that it claims to measure
2. Correlational Studies - strength of relationships between variables, does not show causation 3. Experiment - researcher controls variable(s) to discover its effect on other variables a. Independent variable - manipulated/controlled by researcher b. Dependent variable - measured by researcher (data) c. Experimental and control groups - only experimental group exposed to independent variable, otherwise treated the same d. Change in dependent variable caused by independent variable, since all else remained the same e. Confounding Variable - an observed effect that may be due to an intervening third variable between the dependent and independent variables; the confounding variable must be systematically controlled or, if possible, eliminated, otherwise obtained results are invalidated f. Inferred Variable - a non-observable variable that is inferred as the mediator between two observed events; for instance, inferring the experience of "fear" from certain measurable physiological anxiety responses; it is frequently difficult to avoid circular explanations in positing an inferred variable g. Subject Variable - a condition that is part of the subject’s make-up and cannot be assigned randomly; e.g., sex, height, hair-color etc; because of their nonrandomnizability, causal conclusions cannot be derived from subject variable experiments h. Non-Subject Variable - a characteristic that is not part of a subject’s make-up, and thus can be randomly assigned; e.g., whether the subject received a certain drug or a placebo
LEARNING Change in behavior as a result of experience • CLASSICAL CONDITIONING 1. Pavlov’s studies a. Unconditioned stimulus (UCS) - food - elicits an unconditioned response (UCR) - salivation b. Pair neutral stimulus - tone - with UCS - food c. Neutral stimulus becomes conditioned stimulus (CS) - tone - which elicits conditioned response CR salivation
2. Principles of classical conditioning a. Extinction - when the CS is not presented with the UCS, it will diminish b. Stimulus generalization - similar stimuli may elicit the same response as the CS
c. Stimulus discrimination - different responses are made to stimuli which are similar to the CS
• OPERANT CONDITIONING 1. Reinforcer (reward) - increases probability
response
a. Positive reinforcement - response followed by presentation of reinforcing stimulus b. Negative reinforcement - response followed by removal of unpleasant stimulus
2. Punishment - stimulus that follows response decreases probability response will occur 3. Principles of Operant Conditioning a. Extinction - response no longer reinforced b. Stimulus generalization - response will occur to similar stimuli c. Stimulus discrimination - responses do not occur to different stimuli d. Timing of reinforcers - the sooner a reinforcer or punisher follows an action, the greater its effect e. Schedules of reinforcement i. Continuous reinforcement - a particular response is always reinforced ii. Intermittent reinforcement - reinforcing only some responses (a) fixed ratio (FR) - reinforcement after a fixed number of responses, high rates of responding (b) variable ratio (VR) - reinforcement after average number of responses, very high, steady rates of responding (c) fixed interval (FI) - reinforcement after fixed amount of time, scalloped response pattern (d) variable interval (VI) - reinforcement after a variable amount of time, low, steady rate of response
f. Shaping - reinforce successive approximations to the desired response g. Chaining - a method of connecting responses into a sequence of behaviors; at the end of the chain there must always be a reinforcer; the chain is constructed by beginning at the end and working backward; all behaviors have to be previously conditioned into the organism’s repertoire
• STRUCTURE OF THE NERVOUS SYSTEM 1. Central - brain and spinal cord 2. Peripheral - sensory and motor nerves which transmit information a. Somatic - control skeletal muscles b. Autonomic - regulates internal organs and glands i. Parasympathetic - conserves energy ii. Sympathetic - expends energy
• COMMUNICATION WITHIN NERVOUS SYSTEM 1. Neuron - basic unit of nervous system a. cell body - keeps neuron alive b. dendrites - receive information from other neurons c. axons - send information to other neurons d. myelin - insulates axon to enable information to be transmitted faster
2. Communication between Neurons a. Synapses - gaps between neurons b. Message travels through axon to synaptic knob on axon's tip vesicles open and release c. Synaptic neurotransmitter into synaptic gap d. Neurotransmitter fits into receptor sites on receiving dendrite, causing it to be more or less likely to fire
• THE BRAIN 1. Hindbrain a. Medulla, pons, reticular activating system, cerebellum b. Responsible for reflexive, automatic behavior
2. Midbrain - information conduit 3. Forebrain a. Thalamus - directs sensory messages b. Hypothalamus - emotion and survival drives c. Pituitary gland - controls many other endocrine glands d. Cerebral cortex i. Occipital lobes - vision ii. Parietal lobes - sensory information iii.Temporal lobes - process sounds iv. Frontal lobes - motor movements
4. Two brain hemispheres a. Each one controls opposite side of body b. Left hemisphere dominant for most people
4. Cognitive Behavior Modification The principles of learning theory are applied to alter undesirable thoughts, rather than only observable behaviors a. Social Learning Theory - (Bandura) four processes which influence learning are:
STRESS AND HEALTH • STRESS - EMOTIONAL AND PHYSICAL RESPONSES TO STIMULI 1. Caused by stimuli and the way those stimuli are perceived 2. Biological reaction
i. Attention ii. Memory iii.Behavior iv. Motivation
b. Specific cognitive processes that are recognized: i. Attribution ii. Expectancy iii.Logical iv. Verbal v. Imaginable
a. Fight or flight - increase heart rate, breathing, tense muscles b. Increased activity in the sympathetic nervous system c. Adrenal glands secrete epinephrine (adrenalin) and norepinephrine 3. Coping with stress
a. Reappraise situation b. Maintain control over the stressful situation
c. Rational emotive therapy - (Ellis) considers the central core of dysfunctional behavior to be due to irrational beliefs; the therapy focuses on the alteration of these irrational beliefs d. Problem-solving therapy - focuses on enhancing the patient’s ability to make decisions and solve problems in stressful or difficult situations e. Paradoxical intervention - patients are instructed to purposely perform undesirable symptomatic behaviors on command in an effort to demonstrate their ability to gain control over these behaviors f. Attribution therapy - attempts to facilitate the patient’s ability to re-attribute undesirable feelings and symptoms to something less threatening and more acceptable
1
• PSYCHOLOGY AND ILLNESS 1. Heart disease a. Type A personalities - hard-working, competitive, increased incidence of heart disease b. Type B personalities - easy going
2. Cancer a. Exposure to carcinogens increases the risk b. Psychological factors influence functioning of immune system
• HEALTH AND SOCIAL RELATIONSHIPS 1. Friends - assisted coping a. Emotional, cognitive and tangible support b. Cultural differences in the value placed on friendships
2. Friends as stress producers a. Contagion effect - others can exaggerate stress b. Friend under stress can increase your stress level c. Burden of caring for others can increase stress
SENSATION AND PERCEPTION • SENSATION - Awareness of physical changes • MEASURING SENSATION 1. Absolute thresholds - detection of percent of time 2. Difference thresholds (j.n.d. - just difference)
signal 50 noticeable
a. Difference in sensation detectable 50 percent of time b. Weber’s Law - change necessary for j.n.d. is a proportion of original stimulus
• THE EYE 1. Light enters through the cornea 2. Lens focuses light on the retina 3. Retina - at the back of the eyeball a. Rods - respond to dim light b. Cones - respond to color c. Fovea - center of retina, contains only cones, site where vision is sharpest
• THE EAR 1. Outer ear - collects sounds waves 2. Middle ear - waves strike eardrum which passes them to three tiny bones which intensify the force of the vibrations 3. Inner ear - contains receptor cells (hair cells) located within the cochlea which initiate nerve impulses which travel to the brain
• TASTE 1. Four basic tastes - salty, sour, bitter and sweet - each associated with different receptors or taste buds
• SMELL 1. Receptors in mucous membrane of nasal passage
• SKIN SENSES and
1. World seen as constant, although the sensations may change 2. Needs, beliefs, emotions and expectations all influence perception
LANGUAGE, THINKING AND INTELLIGENCE • LANGUAGE - Rule-governed system of symbols used to represent and communicate information 1. Understanding language a. Phonology - knowledge of sounds b. Semantics - knowledge or word meanings c. Syntax - knowledge of grammatical structure i. Deep structure - meaning ii. Surface structure - organization of words
d. Psycholinguistics - the study of the ability to produce and understand language
2. Acquiring language a. Rules and strategies are innate i. Basic timing and sequence of language development is similar across cultures ii. Children learn the rules of their native language, (i.e., overgeneralization)
b. Particular language acquired is based on experience
3. Language and thought - language has an impact on how easily we process information
• THINKING 1. Using concepts - apply past experiences to present thoughts a. Concept - a mental grouping of a set of objects or events on the basis of important common features b. Must be learned through definition or example c. Concepts aid in predicting and interpreting events and organizing experiences
2. Problem solving - set of information used to achieve goal a. Strategies i. Define the problem
ii. Use algorithms (systematic methods guaranteed to produce a solution) or iii.Use heuristics (a rule that may or may not produce a solution), (i.e., simplification, reasoning by analogy)
b. Insight - sudden understanding of solution
• INTELLIGENCE - capacity to acquire and use knowledge 1. Measuring intelligence a. Binet - IQ tests - mental age (as determined by a test) divided by chronological age = IQ b. Wechsler - tests include verbal, mathematical and nonverbal thinking skills c. Average score is 100, scores describe a bell-shaped (normal) distribution d. I.Q. (Intelligence Quotient) is computed by dividing a person’s "mental age" by their "chronological age" and multiplying by one hundred; yielding the formula: IQ = (MA/CA) X 100
2. Uses of IQ tests a. As a predictor of school success b. Concerns about being "culture fair"
3. Nature of intelligence - one ability or many? 4. Influence of the environment a. Hereditability - studies over a forty-year span have revealed 50 – 80 % genetic component to IQ. Consequently, the general conclusion seems to be that heredity has a substantial effect on IQ scores, with at least half the observed variation in IQ scores attributable to genetic differences b. Experience determines point within genetic range
5. Extremes in intelligence
1. Touch (pressure), warmth, cold and pain
• PERCEPTION organization interpretation of sensations
LANGUAGE, THINKING AND INTELLIGENCE CONTINUED
a. Intellectually Challenged - IQ below 70
SOCIAL PSYCHOLOGY • ROLES - A social position governed by norms 1. Norms - conventions by which we live 2. Zimbardo’s Prison Study a. Students assigned to "guard" or "prisoner" roles b. Student behavior reflected their assigned roles
3. Milgram’s Obedience Study a. Participants thought they were part of an experiment in learning b. "Teacher" was instructed to shock "learner" for wrong answer c. Majority of "teachers" complied with the instructions to administer shock
• SOCIAL COGNITION - how the social influences thoughts, environment perception and belief 1. Attribution - motivation to explain behavior a. Situational - caused by the environment b. Dispositional - caused by something within individual c. Fundamental attribution error - overestimate dispositional and underestimate situational causes d. Self-serving bias - use dispositional attributions for good behaviors and situational attributions to excuse our own behaviors
2. Stereotypes - summary impressions when all members of a group share common traits 3.Attitude - a relatively enduring opinion including both cognitive and emotional components
i. Biologically based - Downs syndrome, fetal alcohol syndrome ii. Psychosocial - disease, malnutrition, lack of intellectual stimulation
a. Attitudes and behavior influence each other b. Cognitive dissonance - when an attitude and behavior conflict, we are motivated to make them consistent
b. Intellectually gifted - skills on one or more intellectual domains
4. Prejudice - unjustif ied negative attitudes toward a group
MEMORY Ability to retain and retrieve information • INFORMATION PROCESSING THEORY 1. Information must be encoded to be processed by brain a. Storage - retention of information b. Retrieval - accessing information
2. Three memory systems a. Sensory - literal copy of information - held for 1-2 seconds b. Short-term i. Limited capacity (7 + or - 2 items) ii. Information held for about 30 seconds; then it is forgotten or further encoded and placed in long-term memory
c. Long-term i. Unlimited capacity ii. Information stored and retrieved by category
3. Forgetting
• CONFORMITY - behavior that occurs as a result of real or imagined group pressure • OBEDIENCE - following orders from an authority • INDIVIDUALS AND GROUPS 1. Groupthink - tendency for all group members to think alike and suppress dissent 2. Group Polarization - tendency of a group to take a more extreme position than those of individual members 3.Responsibility a. Diffusion of responsibility - avoidance b. Social loafing - individual slows down to let the group shoulder the load c. Bystander apathy will not occur when one i. Perceives the need to help ii. Decides to take responsibility iii.Weighs the costs of helping iv. Knows how to help
• LOVE - (Sternberg)
a. In sensory memory - through decay b. In short-term memory i. Limited capacity subject to “filling up” ii. Can retain information through rehearsal (a) Maintenance (rote) rehearsal (b) Elaborative rehearsal - associating new with old information
c. In long-term memory i. Decay - information fades if not used ii. Forgetting (a) Interference - similar items interfere (b) Motivated - conscious or unconscious “hiding” a memory (c) Cue-dependent - unable to gain access to the information (d) Zeigarnik effect - interrupted, or incomplete tasks seem to be better remembered than completed tasks (e) Non-verbal memory - pictures are remembered significantly better than words; motor memory seems to be impervious to decay
2
1.Has three related components: a. Intimacy b. Passion c. Commitment
2.Depending on the combination of these elements, produces different dimensions in a relationship: a. Liking - intimacy alone Love intimacy and b. Companionate commitment c. Empty Love - commitment alone d. Fatuous Love - passion and commitment e. Infatuation - passion only f. Romantic Love - intimacy and passion g. Consummate Love - intimacy, passion, and commitment
PERSONALITY CONTINUED
DEVELOPMENT • DEFINITIONS 1. Learning - influence of experience (nurture) 2. Maturation - unfolding of biological patterns (nature) 3. Critical Periods - early development periods during which particular early experiences are essential 4. Stages - organization of behaviors and thoughts during particular early periods of development defined by relatively abrupt change
2. Psychosexual development
• COGNITIVE DEVELOPMENT
3. Anxiety - unjustified fears resolved by ego through use of defense mechanisms
1. Piaget a. Assimilation - fit new information into what is known b. Accommodation - change existing beliefs in response to new knowledge c. Stages of development i. Sensory-motor stage (birth - 2) - object permanence ii. Preoperational stage (2-7) - use of symbols and language; egocentric; lack the principles of conservation iii. Concrete operational stage (7-11) - understand conservation, identity, grounded in concrete experiences iv. Formal operations stage (12-adult) - abstract reasoning
2. Language development - acquisition depends on biological readiness and experience
• SOCIAL DEVELOPMENT 1. Attachment - emotional tie between infant and caretaker (Harlow’s monkey studies) 2. Sex typing - learning “masculine” or “feminine” a. Identification with the same sex parent b. Rewards and punishments for sex appropriate behavior
3. Erikson’s stages a. Trust Versus Mistrust: 0 – 2 years of age b. Autonomy Versus Doubt and Shame: 2- 3 years of age c. Initiative Versus Guilt: 3 – 6 years of age d. Industry Versus Inferiority: 6 – 11 years of age
• MORAL DEVELOPMENT - Kohlberg Theory: 1. Preconventional morality - obey because ordered to or will be punished 2. Conventional morality - based on trust, loyalty or understanding social order 3. Postconventional morality - laws are situational and can be changed
• CHRONOLOGICAL DEVELOPMENT 1. Newborn Child a. Reflexes - automatic behaviors, rooting, sucking, swallowing, startle, etc. b. Vision - nearsighted, interested in novelty c. Social skills i. Smile at 4-6 weeks in response to faces ii. Rhythmic "conversations"
2. Adolescence a. Biological development - increased hormone production; sex organs mature; growth spurt b. Intellectual development - formal operational (abstract reasoning), independence, questioning
3. Aging a. Transition Theories - unanticipated, anticipated, nonevent, chronic hassle b. Major Milestones - starting out, marriage or living alone, parenthood, empty nest, midlife crises, retirement, widowhood
a. Oral stage (0-1) - sucking, feeding, etc. b. Anal stage (2-3) - defecation c. Phallic stage (3-5) - sexual attraction to the opposite sex parent produces the Oedipus complex d. Latency period (5-puberty) - sexual feelings forgotten; child concentrates on skill development e. Genital stage - adult sexual relationships
a. Repression - active exclusion of unconscious impulses from consciousness b. Projection - attribute to others our thoughts and feelings c. Reaction formation - behavior patterns opposite to our anxiety producing urges d. Displacement - redirects anxiety producing behaviors to a more acceptable target e. Rationalization - substitute “good” reasons for real reasons for behavior
4. Defense Mechanisms a. Denial - the refusal to acknowledge an external source of anxiety b. Fantasy - utilizing imagination to satisfy desires that are, in reality, highly unlikely (e.g., sexually fantasizing about a celebrity) c. Intellectualization - the repression of the emotional component of an anxiety-provoking event; the event is treated in a purely analytical manner d. Regression - resorting to infantile behaviors as a method for avoiding anxiety and/or responsibility e. Identification - identifying with the anxietyproducing stimulus in an attempt to reduce one’s own anxiety (opposite of projection) f. Overcompensation - an attempt to conceal perceived deficiencies in one area by excelling in another; e.g., a student with poor academic performance becomes an excellent athlete g. Sublimation - the re-channeling of sexual or aggressive impulses in a socially acceptable direction; e.g., an aggressive person becomes a professional boxer
• HUMANISTIC THEORIES - people are rational, capable of choice and desire to achieve personal growth 1. Carl Rogers - self-concept directs behavior, conflict between real and ideal self 2. Abraham Maslow - individual strives for selfactualization - fulfillment of potential
• EXISTENTIAL PSYCHODYNAMICS 1. Yalom - primary drive of the individual is to derive meaning from the complexities of their life experiences; to understand a structure, rationale, or justification to the events they have experienced; failing this, life is seen as absurd and pointless, leading to despair, depression, and existential crises; the primary concerns of this approach to psychotherapy deal with confronting the issues of death, freedom, existential isolation, and meaninglessness
• SOCIAL COGNITIVE THEORY - how and under what situations thoughts and behaviors are learned • CONSISTENCY IN PERSONALITY 1. Trait - relatively enduring quality or characteristic 2. Cross-situational - most central to self-concept
• PERSONALITY ASSESSMENT
PERSONALITY Distinctive patterns of behavior, thoughts and emotions that characterize individual's patterns of adaptation • THE ORIGINS OF PERSONALITY 1. Biological and genetic influences 2. Experience - cultural and unique 3. Stability and change a. Genetic characteristics relatively stable through life b. Less active, hostile and impulsive with age c. Personality changes as a result of life experiences
• FREUD 1. Personality consists of three parts a. Id - basic biological urges; unconscious b. Ego - gratifies urges within acceptable bounds; conscious c. Superego - values and ideals of society; conscience
1. Assessment methods must be: a. Reliable - same results over time b. Valid - measure what it is supposed to measure
2. Interview a. Advantage - tailored to individual's previous answers b. Disadvantage - low reliability
3. Observation a. times particular behavior occurs b. Good reliability
4. Self-report a. MMPI - to diagnose psychological disorders b. Ten primary scales measure personality dimensions
5. Projective techniques - individual provides an interpretation of ambiguous material a. Rorschach inkblots b. Thematic Apperception Test (TAT) c. Concerns about reliability and validity since interpretations are subjective
3
MOTIVATION AND EMOTION • MOTIVATION - need or desire to act a certain way to achieve a goal 1. Range of motives a. Physiological - hunger, thirst, pain avoidance b. Social - learned c. Maslow - motives organized in a hierarchy of needs physiological, safety, love and belonging, esteem, self-actualization
2. Motivational system - set of motives and behaviors that operate in a particular life area a. Hunger and eating i. Hunger signals - stomach contractions, hypothalamus, environment ii. Food preferences - cultural, personal and biological origins
b. Sexual motivation - hormones c. Work i. Extrinsic motivation - working for external reward ii. Intrinsic motivation - working for pleasure of activity itself
3. Maslow’s hierarchy of motivations a. In the hierarchy of needs, the needs at each level must be satisfied before going on to the next level b. The hierarchy of needs i. Physiological needs - food, water, sex, and shelter ii. Safety needs - security needs iii.Belongingness and love needs - acceptance and friendship iv. Esteem needs - self-esteem, and esteem from others v. Self-actualization needs - realizing one’s potential as a creative, productive person
• EMOTION 1. Defining features of emotions - subjective experience, physiological arousal, expressive behavior, changes in cognition 2. Inborn - people from different cultural backgrounds can identify emotions 3. James-Lange Theory - emotion is a result of a perception of bodily changes and behaviors 4. Cannon-Bard Theory - emotion is a result of perception of a stimulus which causes both physiological changes and subjective feelings 5. Cognitive Labeling Theory - emotion is a result of the interpretation of the causes of physiological arousal 6. Frustration-aggression hypothesis - aggression results from blocking of efforts to achieve a goal
CONSCIOUSNESS • JAYNES’ THEORY 1. Consciousness not only evolves neurobiologically, but is also formed by the individual’s interactions with culture 2. The foundation of consciousness is based in the physiology of the brain’s left and right hemispheres; there are three fundamental forms of human awareness that are the outcome of this process: a. Bicameral - controlled by right hemisphere of brain, which dominates left-hemisphere activity; individual subordinates consciousness of self to control by a group, a higher power, or other individual b. Modern - the dominance of the right brain hemisphere over the left is weakened as civilization develops and humans become more autonomous and independent; as humans become more independent, individual consciousness emerges c. Throwbacks to bicamerality - the re-emergence of bicameral consciousness in modern life is manifested by episodes of schizophrenia, hypnosis and poetic and religious frenzy
• SLEEP RHYTHMS 1. REM - rapid eye movements associated with dreaming
CONSCIOUSNESS CONTINUED 2. Stages of brain waves a. Alpha Waves - regular, high-amplitude, low frequency wave b. Stage 1 - small, irregular brain waves, light sleep c. Stage 2 - bursts of sleep spindles d. Stage 3 - delta waves; deep sleep e. Stage 4 - extremely deep sleep f. Entire cycle is 30-45 minutes and then reverses
• WAKEFULNESS 1. Conscious processes 2. Subconscious processes - can be brought into consciousness when necessary 3. Nonconscious processes - remain outside awareness but influence behavior
• ALTERED STATES 1. Meditation - eliminate distracting thoughts 2. Psychoactive drugs - influence perception, thinking or behavior a. Stimulants - speed up nervous system activity cocaine, amphetamines b. Depressants - slow central nervous system activity alcohol, tranquilizers c. Opiates - relieve pain and produce euphoria - opium, morphine, heroin d. Psychedelic drugs - alter consciousness - LSD, mescaline
3. Hypnosis - heightened state of suggestibility when subjects can sometimes control unconscious body functions 4. Weil’s Theory a. Humans have an innate drive to experience states of non-ordinary consciousness b. Individuals and cultures experiment with ways to change their ordinary states of consciousness c. Altered states of consciousness are common; e.g., daydreaming, sleeping, etc d. Individuals often are unaware they are in the midst of an experience of non-ordinary consciousness; e.g., daydreams, or alcoholic ‘black-out’ episodes e. Altered states of consciousness form a continuum or spectrum ranging from normal, alert, waking consciousness to sensory deprivation, to coma f. Psychotropic and psychedelic drugs do not cause altered states of consciousness—they are merely a way to elicit such states g. Understanding the mechanisms of altered states of consciousness can be an avenue to greater understanding of the nervous system; furthermore, such knowledge may lead to the discovery of untapped human potential and a better understanding of ordinary waking consciousness
ABNORMAL BEHAVIOR • TYPES 1. Statistical deviation 2. Violation of cultural standards 3. Maladaptive behavior 4. Emotional distress 5. Legal (impaired judgment and lack of self-control)
• ANXIETY DISORDERS 1. Generalized anxiety disorder - chronic anxiety 2. Phobia - fear of specific situation, activity or thing 3. Obsessive-compulsive disorder a. Obsessions - recurrent thoughts b. Compulsions - repetitive behaviors
• MOOD DISORDERS - (depression & mania) 1. Causes a. Biological (brain chemistry) b. Social (life situations) c. Attachment (disturbed relationships) d. Cognitive (maladaptive thoughts)
• PERSONALITY DISORDERS 1. Paranoid - excessive suspiciousness 2. Narcissistic - exaggerated sense of self-importance 3. Antisocial - lack of social emotions
• DISSOCIATIVE DISORDERS - amnesia, multiple personality • SOMOTOFORM DISORDERS - take the form of physical disorders • PSYCHOTIC DISORDERS 1. Schizophrenia - bizarre delusions, hallucinations, severe emotional problems, withdrawal a. Family dynamics - distorted patterns of communication b. Biological - brain disease(s) or abnormalities in neurotransmitters c. Stress - combination of heredity and stress
2. Organic brain disorders - i.e. diseases, brain injury
• VIEWS ON THE REALITY OF MENTAL ILLNESS 1. Szasz’s Objection - the concept of "mental illness" is a socially constructed myth for the purpose of advancing certain social and political agenda; clinical psychology is an instrument of repression to enforce conformity and stigmatize non-conformists as "deviant" people with the label "mentally ill" 2. Reznek’s Definition - something is a mental illness if, and only if, it is an abnormal* and involuntary process that does mental harm and should best be treated by medical means *Note - "abnormal" is used in the constructivist or normative sense, and not in the statistical or idealistic sense, as "normal" is a relative term determined by society
TREATMENT AND THERAPY
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ISBN-13: 978-142320215-8 ISBN-10: 142320215-5
• MEDICAL TREATMENTS 1. Antipsychotic drugs (major tranquilizers) schizophrenia 2. Antidepressant drugs (stimulants) - mood disorders 3. Surgery - to destroy brain areas believed responsible for emotional disorders 4. Electroconvulsive therapy - induces seizures used to treat major depression
• PSYCHOTHERAPY
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1. Psychodynamic (insight) therapies - explore the unconscious dynamics of personality a. Freud i. Understanding past produces insight ii. Free association and transference
b. Neo-Freudians - use Freud’s techniques, usually time limited
2. Behavioral therapies
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a. Systematic desensitization - exposure to a hierarchy of stimuli while relaxing to decrease fears b. Aversive conditioning - punishment for unwanted behavior
4
TREATMENT AND THERAPY CONTINUED c. Implosion - client required to imagine the anxietyproducing stimulus in its most vivid and extreme manifestation; client experiences full anxiety response without suffering any harm; consequently, the stimulus no longer elicits anxiety due to extinction of the response d. Flooding - same procedure and theory as implosion, but real or realistically depicted stimuli are used instead of imaginary ones
3. Cognitive therapy - to correct unrealistic thinking 4. Humanistic therapy a. Client-centered - Carl Rogers i. build self esteem ii. critical qualities of the therapist - warm, genuine and honest
b. Gestalt - Frederick Perls - self-actualization
5. Family and Group therapies - theorize that problems develop in a social context and must be dealt with in that context
• EVALUATING THERAPIES 1. Therapies are less effective with serious disorders 2. Relationship between client and therapist is critical 3. Certain therapies are effective for certain specific problems
• MEDICAL TREATMENTS 1. Advantages of Medical Model - promotes a more humane understanding of patients; aids in the understanding of some organic mental disorders and further initiates research in brain function 2. Disadvantages of Medical Model - environmental variables are unduly minimized or neglected; diagnostic and treatment methods are questionable, thus fostering an institutionalization syndrome; this approach removes responsibility for recovery from the patient while promoting a dependence upon hospitals and chemicals
• BEHAVIORISM 1. Cognitive components to behavior (e.g., expectations, verbalization, imitation etc.) are unduly minimized or ignored 2. Overly operationalistic - physical correlates are closely identified with mental states (e.g., fear is identified with the physiological manifestations of anxiety); overlooks the possibility that the interpretation of observable physical symptoms can determine their reality; for instance, the physiological correlates of anxiety may be interpreted as fear, excitement, anger, or sexual arousal depending upon prior expectations, cultural values etc 3. Ignores the role played by intervening inferred cognitive variables
• COGNITIVE BEHAVIORISM 1. Difficult to avoid circular definitions in invoking the meaning of certain mental constructs 2. Difficult to determine what extent to allow decreasingly operationalizable mental entities 3. The role of psychosomatic variables may be overlooked or minimized 4. Some argue that the underlying cause of observable symptoms is ignored by behavioral therapies Note - Clinically, both behaviorism and cognitive behaviorism only seem effective in the treatment of very specific disorders; e.g., phobias, specific undesirable behaviors; cannot effectively be applied to amorphous problems such as undifferentiated existential depression
• PSYCHOANALYSIS 1. Freud’s initial theory based only on case studies and anecdotal evidence, and a patient population which was very limited, atypical, and selective 2. Postulates entities that are by definition unobservable and cannot be operationalized for valid scientific evaluation 3. Psychoanalysis has been demonstrated (by Eysenck) to be ineffective in treating emotional disorders 4. In reaction to criticism and undermining evidence against their theory, Neo-Freudians have modified their theory with post-hoc hypotheses to the point that it is no longer scientifically testable even in principle
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RIGHT PLANTAR FOOT
Brain
LEFT PLANTAR FOOT
Head, brain, teeth
Head, brain, teeth Pineal gland
Brain
Pituitary gland
Head, brain, teeth
Hypothalamus Head, brain, teeth
Sinus
Cervical spine Eye Neck Thyroid, parathyroid glands
Sinus Inner ear, eustachian tube
Inner ear, eustachian tube Ear Top of shoulder
Larynx Lung, chest Accessory thyroid, bronchi Trachea, esophagus, bronchi, thymus gland
Ear Top of shoulder
Shoulder, arm
Heart Solar plexus
Shoulder, arm
Elbow
Diaphragm Liver Thoracic spine Stomach Adrenal gland
Liver Elbow Gallbladder
Spleen Knee Pancreas
Duodenum
Knee
Leg
Transverse colon
Leg
Kidney
Descending colon
Lumbar spine
Ascending colon
Ureter Small intestine Cecum, ileocecal valve, appendix
Bladder Sigmoid colon
Anus, rectum
Sciatic nerve Sciatic nerve Sacrum Accessory lower back, rectum, colon, uterus
Accessory coccyx Accessory lower back, rectum, colon, uterus
Accessory pelvis, hip, knee, ankle, foot
Locations may vary from one individual to another
Hip Thigh
Sciatic nerve
Sciatic nerve
Sigmoid colon
Cecum, ileocecal valve, appendix Ovary, testicle
Hip
Groin lymphatics
Anus, rectum
Groin lymphatics Fallopian tube, vas deferens
Fallopian tube, vas deferens Ascending colon Small intestine Gallbladder Kidney Transverse colon Adrenal gland Duodenum Stomach Lung, chest, breast
Descending colon Small intestine Adrenal gland Stomach
Solar plexus
Kidney Pancreas
Liver
Heart Esophagus Eye Neck
Esophagus
Brain
Eye Neck Head, brain Sinus
Elbow
Ear Lower leg Accessory pelvis, Elbow Arm knee, ankle, foot Knee Foot Diaphragm RIGHT LATERAL FOOT Solar plexus
Ear
Sinus
Thigh Arm
Top of shoulder
Spleen
Brain
Top of shoulder 1
Knee
Foot Lower leg
Transverse colon
Lung, chest, breast
Diaphragm
Ovary, testicle Accessory pelvis, knee, ankle, foot
LEFT LATERAL FOOT
RIGHT PALMAR HAND
LEFT PALMAR HAND
Brain
Locations may vary from one individual to another Brain
Sinus, head, brain Neck, sinus Eustachian tube, ear, inner ear Ear
Eye Pineal gland
Ribs Top of shoulder
Top of shoulder
Ear Ribs
Pituitary gland
Top of shoulder
Brain
Solar plexus Lung, chest, breast
Shoulder, upper chest
Neck Lung, chest, breast
Neck
Arm
Thyroid, parathyroid glands Cervical spine Heart Stomach
Gallbladder Liver Leg Knee
Shoulder, upper chest Arm Spleen Leg Knee
Thoracic spine Diaphragm Adrenal gland Pancreas Kidney Lumbar spine Ureter Small intestine Bladder Sacral spine Prostate, uterus Coccygeal spine Fallopian tube, vas deferens
Hip, pelvis Transverse colon Ascending colon Cecum, ileocecal valve, appendix Ovary, testicle
Top of shoulder
Solar plexus
Sciatic nerve Accessory ovary, testes
Top of shoulder
Fallopian tube, vas deferens
Ribs
Transverse colon Hip, pelvis Descending colon Ovary, testicle
Anus, rectum Sigmoid colon Ovary, testicle Sciatic nerve Vagina, penis Lung, Small intestine Sciatic chest, Diaphragm Sigmoid colon nerve Stomach breast
Eye
Sinus, neck Sinus, head, brain
Brain Sigmoid colon
Kidney Adrenal gland
Rectum, anus Ovary, testicle Fallopian tube, vas deferens Sciatic nerve
Transverse colon
Pancreas Stomach
Small intestine
Top of shoulder
Lung, chest, breast
Diaphragm
Heart
Coccygeal spine
Neck
Head, sinus Eye
Prostate, uterus
Brain
Ribs
Cervical spine Sinus, neck
Pituitary gland, pineal gland
Fallopian tube, vas deferens
Thoracic spine
Sinus, head, brain
Kidney Rectum, anus
Pancreas
Vagina, penis Brain
Adrenal gland Heart Coccygeal spine Prostate, uterus Sacral spine Vagina, penis Bladder
Neck Head, sinus
Transverse colon Lumbar spine Sacral spine
Brain
Lumbar spine Ureter Thoracic spine
LEFT LATERAL HAND
Bladder
Ureter Cervical spine
Pituitary gland, pineal gland 2
RIGHT LATERAL HAND
LEFT DORSAL HAND Brain
RIGHT DORSAL HAND
Brain
Locations may vary from one individual to another
Sinus, head, brain
Sinus, head, brain Neck, sinus
Neck, sinus Ear
Inner ear, eustachian tube Eye Ear Top of shoulder Head, sinus Top of shoulder
Brain
Neck Lung, chest, breast
Ribs
Top of shoulder
Neck Lung, chest, breast
Ribs
Arm
Arm
Spleen
Pituitary gland, pineal gland Cervical spine Heart Thoracic spine Diaphragm Adrenal gland
Leg Knee
Gallbladder
Liver Leg Knee
Pancreas
Stomach
Hip, pelvis
Kidney Lumbar spine
Descending colon
Hip, pelvis
Small intestine
Cecum, ileocecal valve, appendix
Ureter Sacral spine Bladder Prostate, uterus Coccygeal spine Ovary, testicle
Vagina, penis
Fallopian tube, vas deferens
Ribs
Anus, rectum
Inner ear, eustachian tube
Sigmoid colon
Eye
Sciatic nerve Ear
Fallopian tube, vas deferens Ascending colon Ovary, testicle
Stomach
Arm
Leg
Lung, chest, breast
Spleen Knee
Hip, pelvis
Sciatic nerve
Sinus, neck
Sinus, head, brain
Cecum, ileocecal valve, appendix
Ovary, testicle
Accessory ovary, testes Sciatic nerve
Small intestine Diaphragm
Hip, pelvis Ovary, testicle
Ascending colon Knee Gallbladder
Sciatic nerve
Liver
Coccyx Leg
Top of shoulder
Arm Brain
Inner ear, eustachian tube
Lung, chest, breast Ribs Ear
Pineal gland
Neck
Coccyx Prostate, uterus
Pituitary gland Eye Sinus, neck
Brain
Sinus, head, brain
Heart Cervical spine Thoracic spine Thyroid, parathyroid glands
Fallopian tube, vas deferens Vagina, penis
Rectum, anus
Bladder
Heart
Ureter Fallopian tube, vas deferens Lumbar spine Prostate, uterus Sacral spine Kidney Thoracic spine Cervical spine RIGHT MEDIAL HAND
Top of shoulder Adrenal gland Neck Thyroid, parathyroid glands Pineal gland Pituitary gland
Brain
Diaphragm
Sacrum Adrenal gland
Head, brain
Ureter Small intestine
Kidney
Brain
Bladder
Lumbar spine
LEFT MEDIAL HAND 3
RIGHT DORSAL FOOT
LEFT DORSAL FOOT Brain
Brain
Pineal gland Pituitary gland Hypothalamus Head, brain, teeth Sinus Cervical spine
Inner ear, eustachian tube
Inner ear, eustachian tube
Neck Eye Larynx Esophagus, bronchi
Ear
Ear Top of shoulder
Lung, chest
Top of shoulder
Thoracic spine
Upper arm
Heart Solar plexus
Spleen
Diaphragm
Shoulder, arm Gallbladder
Liver Stomach
Elbow
Elbow
Adrenal gland
Knee
Duodenum
Pancreas
Knee
Kidney Transverse colon
Transverse colon
Small intestine Ureter
Ascending colon
Lumbar spine
Descending colon
Cecum, ileocecal valve, appendix
Fallopian tube, vas deferens Groin lymphatics
Thigh
Bladder Thigh
Sigmoid colon
Anus, rectum
Locations may vary from one individual to another
Accessory lower back, sciatic nerve, rectum, colon, uterus
Accessory lower back, sciatic nerve, rectum, colon, uterus
Prostate, uterus Penis, vagina
Sciatic nerve
Groin lymphatics Sciatic nerve
Prostate, uterus
Fallopian tube, vas deferens
Penis, vagina
Coccyx
Small intestine Kidney
Groin lymphatics Fallopian tube, vas deferens
Adrenal gland
Small intestine Kidney
Stomach Liver Diaphragm Heart
Esophagus Lung, chest
Pancreas Adrenal gland
Duodenum
Neck
Stomach Pituitary Diaphragm Heart Esophagus Neck
Sinus
Thoracic spine
Brain
Thyroid, parathyroid glands
Ureters Lumbar spine
Head, brain, teeth Accessory pelvis, Sacrum Ureters coccyx, knee, ankle, foot Bladder
LEFT MEDIAL FOOT
Sinus Liver Thyroid, parathyroid glands Thoracic spine Cervical spine Lumbar spine Lung, chest Transverse colon
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Coccyx Sacrum
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Accessory pelvis, coccyx, knee, ankle, foot
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FEMALE REPRODUCTION SYSTEM
MALE REPRODUCTION SYSTEM
Descending colon
Uterine tube
Sacrum
Fimbria
Vas deferens
Sigmoid colon
Ovary
Endometrium Cervix Vagina
Cervical canal Urinary bladder Urine Pubic bone
Navicular fossa Glans penis
Coccyx Rectum Anus
Clitoris Labia minora Labia majora
Urethra
Vaginal opening
Isthmus
Dome (fundus) Uterine (fallopian) tube Infundibulum
Prepuce (foreskin)
Tendon levator ani
Pelvic bowl m.m.
Sacrum Seminal vesicle Rectum Fat Ejaculatory duct Prostate gland Pelvic bowl m.m. Anus Bulbourethral gland (Cowper’s) Epididymus Testicular tubules
Spermatic cord Urine Pubis Urethra Corpus cavernosum Corpus spongiosum
Uterus
Myometrium
External urethral meatus
Corpus luteum Degenerating corpus luteum Corpus albicans
Scrotum Testis
Ovulated oocyte
UTERINE CYCLE
Fertilization Anaphase 2 cell stage Sperm
Morula
Blood vessels
Fimbria Endometrium
Lysis of zona pellucida
Ovary
Uterus
Isthmus a.a. = arteries l. = ligament m. = muscle m.m. = muscles v. = vein
Connecting tissue stroma
Blastocyst
Secondary follicle
Primary follicles
Cervix
Sigmoid colon
Urinary bladder Ureter
Oocyte Implanting blastocyst Anastomosis Venous sinusoid
Day 14
Uterine gland Day 28
Day 0 Vagina
Spiral a.a.
Bleeding
Bleeding Epithelium
Arcuate a. Spermatogenisis:
Spermatagonium Daughter cells A & B: primary spermatocytes Early spermatides
Basal v.
Endometrial v.
Basal a.
Smooth m. fiber
Major diameter Ovulated secondary oocyte Head Cross section of seminiferous tubule Fertilization Nucleus Basal lamina Anaphase Midpiece Minor diameter Tail Nucleus of sertoli cell Sertoli cell Spermatozoa Daughter cells Acrosome Corpus Secondary Ovum luteum spermatocytes Mitochondria
Fimbria on infundibulum Vesicular (graafian) follicle Primary follicle Primordial follicles Ovary
Corpus albicans Late spermatides
4 cell stage
Ovarian l.
Flagellum Tight junction between sertoli cells
Spermatid cytoplasm Mature spermatozoon
Uterine tube Microtubules Polar body Nucleolus Nucleus
STAGES OF SPERM & OVUM
Ooplasm
Extra cellular space Inner cell mass Zona pellucida Implanting blastocyst Granulosa cells
Uterus
SEXUAL INTERCOURSE Kidney
Ureter Fimbria Uterine tube Ovary Ovarian l.
Kidney
Uterus Lumen (cavity) of uterus
Spinal cord
Ureter Symphysis pubis
Bladder
Ductus deferens
Urine
Sacrum
Bladder Urine Ejaculatory duct
Fertilization Sperm Secondary oocyte Corpus luteum
Vagina
Prostate gland
Urethra Clitoris
Bulbourethral gland
Fimbria
Seminal vesicle Sacrum
Development of ovarian follicles Cervix
Spinal cord
Rectum Sperm Anus Rectum
Penis
Anus
Ductus deferens
Epididymis Testis Scrotum Seminepherous tubules
FULL-TERM BABY
FULL-TERM BABY PRIOR TO DELIVERY
Placenta
Uterus
Uterus
Umbilical cord
Umbilical cord
FULL-TERM BABY BEING DELIVERED Bladder
Umbilical cord Placenta
Cervix (fully dilated)
Uterus
Placenta
Sacrum
Sacrum
Urethra
Bladder
Amnion
Amnion
Bladder Pubic symphysis
Coccyx
Cervix Anus
Vagina
NOTE TO STUDENT
Mucous plug
Urethra
This QUICKSTUDY® reference guide is the single most comprehensive “REPRODUCTIVE SYSTEM” chart ever published. Use it to your advantage in class, during homework and as a memory refresher while preparing for exams. Reinforce your knowledge of human anatomy with our “REPRODUCTIVE SYSTEM” chart. They are powerful study tools that can be quickly and repeatedly referred to during and well beyond your college years. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 1999 BarCharts Inc. 0608
Vagina
Anus
Cervix
ISBN-13: 978-142320754-2 ISBN-10: 142320754-8
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WORLD’S #1 ACADEMIC OUTLINE
A PICTORIAL GUIDE TO MINERALOGY M ETALLIC L USTER
Agate
Biotite Mica
Mineral
Hardness Streak Color
Specific Other Properties Gravity
Bornite Chalcopyrite Chromite Galena Goethite Graphite Hematite Limonite Magnetite Marcasite Native Copper Pyrite Sphalerite
3.0 3.5-4 5.5 2.5 5-5.5 1.0 5-6.5 5-5.5 6.0 6-6.5 2.5-3 6-6.5 3.5-4
5.1 4.2 4.7 7.5 4.3 2.2 4.9-5.2 4.2 5.2 4.9 8.9 5.0 4.0
black/gray dark gray brown gray brown/yellow dark gray reddish brown/yellow dark gray dark gray copper dark gray white/yellow
red, purple, iridescent, brittle, soft yellow, brittle, conchoidal fracture silver, black, weakly magnetic silver, cubic cleavage brown to black black, greasy, writes silver, reddish, no cleavage brown, amorphous black, magnetic yellow/gold, brittle, no cleavage copper, brown, malleable fool’s gold, cubic crystals brown, dodecahedral cleavage, transparent
N ON -M ETALLIC L USTER
Calcite
Galena
Gypsum 2
Pyrite
Quartz (Rose)
Mineral
Hardness Streak Color
Specific Gravity
Luster
Agate (Quartz)
7
white
2.5-2.8
vitreous
Apatite
5
white
3.1
Augite Azurite Barite Biotite Mica Calcite Chalcedony (Quartz) Chert (Quartz) Chlorite Chrysocolla
5.5 3.5-4 3 2.5-3 3 7 7 2 2-4
white light blue white gray-brown white white white white light blue
3.3-3.5 3.7 4.5 2.7-3.1 2.7 2.5-2.8 2.5-2.8 2.6-3.0 2.0-2.4
Corundum Diamond
9 10
white white
4.0 3.52
Dolomite
3.5-4
white
2.8
Epidote Flint (Quartz) Fluorite Garnet Glauconite Gypsum Halite Hematite Hornblende Jasper (Quartz) Kaolinite Limonite
6-7 7 4 7 2-2.5 2 2.5 1.5-5.5 5.5 7 1-2 1.5-5.5
white white white white green white white red/brown green white white yellow/brown
3.4 2.5-2.8 3.0-3.3 3.4-4.3 2.4-2.9 2.3 2.1-2.6 4.9-5.3 3.0-3.3 2.5-2.8 2.6 3.6-4.0
Malachite Muscovite Mica
3.5-4 2-2.5
green white
3.9-4.0 2.7-3.0
Native Sulfur Olivine Opal Plagioclase Feldspar Potassium Feldspar Quartz Serpentine
1.5-2.5 7 6 6 6 7 2-5
yellow white white white white white white
2.1 3.3 1.9-2.3 2.6-2.8 2.6 2.7 2.2-2.6
Talc
1
white
2.7
Topaz
8
white
3.5
Tourmaline
7-7.5
white
3.1
Turquoise
5-6
pale blue
2.7
Fluorite
Gypsum 1
Muscovite Mica
Quartz
Sulfur (Native)
1
Other Properties
varying banded colors, no cleavage vitreous brown, yellow, green, conchoidal fracture vitreous green, 2 cleavage@900 earthy blue, reacts w/HCl vitreous crystals, 3 cleavage not@900 pearly brown, one cleavage vitreous colorless, rhombohedral cleavage waxy white, cryptocrystalline waxy gray, cryptocrystalline vitreous green, one cleavage vitreous blue, amorphous, conchoidal fracture adamantine brown, red, blue, purple, hard adamantine colorless, hardest, conchoidal fracture, octahedral cleavage vitreous white, gray, pink, rhombohedral cleavage vitreous green-yellow, one cleavage waxy black, cryptocrystalline vitreous violet, blue, octahedral cleavage vitreous dark red, no cleavage greasy green, marine origin silky colorless, white, one cleavage vitreous colorless, cubic cleavage earthy red, no cleavage vitreous green, brown, cleavage@600-1200 waxy red, cryptocrystalline earthy white, gray, brown, one cleavage vitreous yellow-brown, amorphous to dull silky green, will react with HCl colorless or silvery-white, pearly one cleavage resinous yellow, conchoidal fracture vitreous green-yellow, conchoidal fracture colorless, white, amorphous greasy vitreous black, white, gray, 2 cleavage@900 vitreous pink, white, 2 cleavage @ 900 vitreous many colors, conchoidal fracture silky or green, gray, brown, fibrous waxy pearly or white, greenish-white, gray greasy vitreous yellow, brown, blue, green, basal cleavage vitreous yellow, green, brown, no cleavage, conchoidal fracture waxy light blue green, microcystalline, conchoidal fracture
MINERALS A mineral is a naturally occurring, inorganic, solid material with a defined chemical composition and crystalline structure A. Atoms and Crystal Form: 1. Atom: The smallest particle of an element that maintains the element’s properties 2. Atoms are composed of neutrons, protons, and electrons
a. Atomic Structure: The arrangement of protons, neutrons and electrons b. Atomic Number: Number of protons in a nucleus c. Atomic Weight: Average weight of an atom d. Isotope: Forms of an element with identical atomic numbers, but different numbers of neutrons in the nucleus
3. Crystalline Structure: The specific and repeated arrangement of atoms 4. Crystal Form: The geometric shape of a crystal, determined by crystalline structure, can usually be observed at the surface of the mineral a. Crystal Face: Each flat surface of a mineral b. Cryptocrystalline: Crystals too small to see with the bare eye c. Amorphous: Noncrystalline, or lacking atomic structure due to rapid cooling, glassy appearance; example: opal d. There are 64 crystal forms separated into 6 classes: i. Isometric class: Equal measure ii. Tetragonal class: Square cross sections, rectangular faces iii.Hexagonal/Triagonal class: Six-sided iv. Orthorhombic class: Rectangular profile, rectangular faces v. Monoclinic class: Rectangular faces and trapezoid faces vi. Triclinic class: Trapezoid faces
E XAMPLES
OF
C RYSTAL F ORMS :
Cube (Isometric class): Galena Octahedron (Isometric class): Magnetite Hexagonal pyramid (Hexagonal class): Nepheline Rhombohedron (Hexagonal class): Dolomite Scalenohedron (Tetragonal class): Chalcopyrite
B.
Mining
1. Ore: Useful metallic mineral found in large enough quantities to be profitable in mining 2. Variables in mining ores: a. Amount of metal present compared to total amount in Earth’s crust; small amounts may not be worth mining b. Cost to mine or accessibility to ore, i.e., an ore deep in the oceanic crust is more difficult and costly to mine than in the continental crust c. Value of the ore: Depends on the demand; a more precious metal may be mined in smaller quantities if in demand
C. Mineral Groups 1. Silicates: Minerals with silicon and oxygen
a. Silica tetrahedron: Silicon forms a pyramid-shaped structure with oxygen, basic building block for silicate minerals b. Silicate structures and examples: Isolated (single) olivine Single Chain augite (pyroxene) Double Chain hornblende (amphibole) Sheet biotite (mica) 3-D Framework feldspars, quartz 2. Non-Silicates
a. Carbonates: Minerals with carbon and oxygen, including calcite, from which we procure limestone (roads) and marble (decorative slabs) b. Oxides: Oxygen-based solids; example: magnetite c. Sulfides: Contain sulfur; example: pyrite d. Sulfates: Contain sulfur and oxygen; example: gypsum e. Halides: Contain a halogen element and a metal, halite f. Native metals: Iron, zinc, gold, silver, nickel, copper
D. Properties of Minerals 1. Luster: Appearance or quality of light reflected from the surface
a. Metallic: Resembles metal; example: gold, silver, pyrite b. Nonmetallic: Unlike metal i. Adamantine: Resembles a diamond, brightest luster ii. Resinous: Resembles resin; example: sulfur iii.Vitreous: Resembles glass, most common; example: quartz and fluorite iv. Pearly: Resembles Mother of Pearl; example: muscovite, biotite (mica) v. Silky: Mineral with fine fibers; example: gypsum vi. Waxy: Resembles wax; example: chalcedony vii. Earthy: Resembles earthy materials like dirt, having no reflection; example: bauxite, clay, diatomaceous earth
2. Color: The surface color of a mineral a. Most minerals have a variety of colors; example: quartz b. Some minerals have a unique color that may help identify it; example: sulfur is yellow
3. Hardness: The ability to withstand scratching a. Tested using an object or mineral of known hardness on a mineral of unknown hardness or vice versa b. Moh’s hardness scale relates 10 common minerals from hardest to softest c. Scratch Test: Higher-numbered materials can scratch lower-numbered materials
M OH ’ S S CALE Hardness
Mineral
10 9 8 7 6 5.5 5 4 3.5 3 2.5 2 1
Diamond Corundum Topaz Quartz Feldspar
Object of known hardness
Glass, knife
Penny (copper) Calcite Finger nail
2
a. Created by scratching mineral on streak plate or unglazed porcelain (applies to minerals with a hardness of 6 or less; if greater than 6, the powdered form of the mineral is the streak color) b. Color of streak may differ from surface color; example: hematite is metallic silver while the streak is red-brown
5. Cleavage: Tendency to break or separate along a flat surface due to a lack of or weakness in atomic structure; example: muscovite, biotite (mica) a. Cleavage plane: Flat surface created from cleavage breakage b. Striation: Thin, straight cuts on the cleavage plane c. Fracture: Surface created from breakage not related to atomic structure i. Uneven: Irregular, rough ii. Conchoidal: Curved, smooth surface; example: obsidian
N UMBER
OF
C LEAVAGE
Planes & Directions
Drawing Example
1 (basal cleavage)
micas, chlorite
2 at 90˚
feldspar
2 not at 90˚
amphibole
3 at 90˚ (cubic cleavage)
galena
3 not at 90˚ (rhombohedral cleavage)
dolomite, calcite
4 (octahedral cleavage)
fluorite
6 (dodecahedral cleavage)
sphalerite
6. Specific Gravity a. The ratio of the weight of a mineral to the weight of an equal volume of water b. Density of water = 1gm/cm3=1gm/ml i.e., lead = 7.7, or is 7.7 times heavier than an equal volume of water c. Useful in comparing relative weights between minerals
7. Tenacity: Ability to withstand breakage a. b. c. d. e.
Brittle: Will shatter when struck Malleable: Can be shaped Elastic: Returns to initial form Flexible: Pliable Splintery: Similar to wood
8. Special Properties
Apatite Fluorite
Gypsum Talc
4. Streak: Color of mineral in powdered form
a. Taste: Some minerals can be identified by taste; example: halite (salty) b. Smell: May help identify a mineral; example: kaolinite smells moldy when moist; sulfur has a unique smell c. Feel: Texture can be determined d. Reaction to Acid: Carbonate minerals will react to hydrochloric acid or vinegar e. Magnetic: Will be drawn to a magnet; example: magnetite
ROCK CYCLE
b. Pyroclasts: Lava projected from volcanic explosions that quickly cools i. Ash, less than 2 mm in size ii. Lapilli, between 2 and 64 mm in size iii.Blocks, greater than 64 mm in size Magma
C. Properties of Igneous Rocks 1. Texture: Determined by rate of cooling; faster cooling results in smaller crystals
a. Pegmatitic: Grains larger than 1 cm, very coarse, very slow-cooling; example: diorite-pegmatite b. Phaneritic: Grains between 1 and 10 cm, coarse; example: granite c. Porphyritic: Large crystals embedded in small crystals; example: basalt porphory
Melting
Crystallization Melting Igneous Rock
Metamorphic Rock
i. Phenocrysts: Large crystals, due to slow cooling ii. Groundmass: Small crystals, due to rapid cooling
d. Aphanitic: Grains less than 1 mm, very fine, very fast-cooling; example: rhyolite e. Glassy: No crystals, amorphous; example: obsidian f. Vesicular: Contains varying sizes of gas pockets that remain in the lava, leaving the rock with voids; example: pumice g. Frothy: Formed from gas pockets, porous texture; example: scoria h. Pyroclastic: Made of pyroclasts; example: tuff
Heat & pressure
Heat & pressure
Weathering, erosion & deposition
2. Mineral Composition: Determined by evaluating the percent present of the following common minerals:
Sedimentary Rock
Sediment
a. b. c. d.
Cementation & compaction (lithification)
Quartz Amphibole Biotite Muscovite
a. Felsic: Light-colored, made of feldspars and silicates i. Quartz ii. Plagioclase feldspar iii.Potassium feldspar iv. Muscovite
b. Mafic: Dark-colored, made of magnesium and iron (ferric)
Igneous Rocks: Molten rock from deep within the Earth that has cooled
i. Olivine ii. Pyroxene iii.Amphibole iv. Biotite
1. Magma: Molten rock inside the Earth a. b. c. d.
e. f. g. h.
3. Color: Helps determine the mineral composition
IGNEOUS ROCKS A.
Plagioclase feldspar Olivine Potassium feldspar Pyroxene
Produces intrusive igneous rocks Consists mainly of silicate materials Contains gases, such as water vapor Differs in rate of cooling, composition of chemicals, and amount of gases
c. Ultramafic: Very dark-colored d. Intermediate: Between light- and dark-colored
D. Bowen’s Reaction Series
2. Lava: Molten rock on the surface of the Earth
If a mineral, which has already formed, remains in the magma, it will react with the remaining magma to produce the next mineral in the sequence; for example, olivine forms first; olivine then reacts with remaining magma to form pyroxene
a. Produces extrusive igneous rocks b. Most gaseous elements have escaped
I GNEOUS R OCK F ORMATIONS
B OWEN ’ S R EACTION S ERIES Magma Temperature Volcanic Plug
High (early crystallization)
Volcano
Discontinuous Reaction Continuous Reaction Series Series (Mafic Minerals) (Felsic Minerals)
(Calcium-rich) Olivine Pyroxene
Volcanic Ash
Amphibole
Lava Flows
(Sodium-rich) Low (late crystallization)
Dikes
Peridotite Gabbro or Basalt Diorite or Andesite
Potassium feldspar Muscovite Quartz
Granite or Rhyolite
Sill Batholith
B.
Rock Types
Biotite
Laccolith Stock
Plag iocla se
Weathering, erosion & deposition
1. Continuous Reaction Series (Right side of the Bowen Series) a. Calcium-rich parts of the magma form small crystals of feldspar b. These react with sodium in the magma to become more and more sodium rich c. Crystal structure does not change
Formations 1. Intrusive Igneous Rock: Formed inside the Earth’s crust in varying rock bodies
2. Discontinuous Reaction Series (Left side of the Bowen Series)
a. Batholith: Largest intrusive igneous rock body, greater than 100 square miles, widens with depth (plutonic, very deep) b. Stock: Similar to but smaller than batholith, less than 100 square miles c. Laccolith: Bulge of magma parallel to bedding plane d. Sill: Thin sheet, runs parallel to bedding plane e. Dike: Cuts through formations, usually in fractures
a. Minerals that form react with remaining magma to form new mineral b. New mineral is the result of a structural change of previous mineral
3. End of Cooling a. When everything is almost cool, remaining magma will have high silicone content, and quartz will form b. When cooling is complete, minerals that cooled at the same time will usually be close to one another (feldspar, micas and quartz cool near one another to make granite)
2. Extrusive Igneous Rock: Formed on the surface of the Earth (volcanic)
a. Lava flows: Lava seeping out of volcanoes 3
TABLE
IGNEOUS ROCKS
OF
I GNEOUS R OCK
Color Index & Graphic Illustration 0
100
Felsic (Light)
Intermediate
Pyroxene
Biotite
Intrusive Extrusive
Amphibole
Rock Names DIORITEPEGMATITE
GABBROPEGMATITE
DIORITE
GABBRO
Porphyritic
RHYOLITE/ GRANITE
PORPHYRITIC/ ANDESITE/DIORITE
PORPHYRITIC/ BASALT/GABBRO
Aphanitic: Fine-grained
RHYOLITE
ANDESITE
BASALT
Glassy Frothy
OBSIDIAN SCORIA (VESICULAR BASALT)
PUMICE
PERIDOTITE
Rarely Encountered
Pyroclastic or VOLCANIC TUFF (fragments < 2 mm) fragmental VOLCANIC BRECCIA (fragments > 2 mm)
SEDIMENTARY ROCKS
1. Clastic rocks: (detrital) a. Accumulated debris from weathering and transport b. Made up of mostly clay minerals and quartz c. Conglomerate: Made up of gravel-sized particles
A. Sediments: Pieces or fragments from existing rock that accumulate on the Earth’s surface
2. Chemical rocks: Created from chemical precipitation
1. Weathering: Physical or chemical breakdown of rock that creates sediments at or near the surface of the Earth
a. Formed from materials in solution in bodies of water b. Most abundant form is limestone
a. Mechanical weathering and erosion
3. Organic (Biochemical) rocks: Created from biological remnants, such as plants, shells, bones, or other organic matter
i. Frost wedging ii. Unloading iii.Biological activity: Roots, burrows
C. Shapes, Sizes Sediments
b. Chemical weathering
and
Sorting
of
1. Shapes
i. Water to rust (oxidation) ii. CO2 and water make carbonic acid iii.Granite reacts with water and gas to make clay minerals + potassium and silica
a. Angular: Sediment has sharp corners and edges b. Rounded: Sediment has undergone abrasion and has rounded, smoothed edges
2. Transport: Method of moving sediments
2. Sizes
e. Ground water f. Wave currents
a. Clay: <1⁄256mm, creates mudstone b. Silt: Between 1⁄256 and 1⁄16 mm, creates siltstone c. Sand: Between 1⁄16 and 2 mm, creates sandstone d. Pebble: Between 2 and 64 mm, creates a conglomerate e. Cobble: Between 64 and 256 mm, creates a conglomerate f. Boulder: >256 mm, creates a conglomerate
3. Depositional environment: Places where the sediment is deposited a. Continental - deserts, lakes, river beds, swamps, caves b. Continental and Marine - deltas, sand bars, lagunes, estuaries c. Marine - the ocean floor
4. Lithification: Method of sediments becoming consolidated sedimentary rocks a. Compaction: Weight compresses deeper sediments b. Cementation: Materials are “cemented” together from precipitation of a mineral in spaces between sediment c. Crystallization: Sedimentary rock created from a solution
B.
Texture Pegmatic: GRANITEVery coarse-grained PEGMATITE Phaneritic: GRANITE Coarse-grained
Volcanic Rock with Obsidian
c. Wind d. Gravity
Olivine
N ES IA
Potassium Feldspar (K-Spar)
20
Red Scoria
N S
Plagioclase Feldspar
RO M AG
Pumice
Origin
a. Running water, rivers b. Glaciers
Ultramafic
Quartz
0
Rhyolite
Mafic (Dark)
100
Granite
60 Mineralogical Composition as Percent of Volume 40
Red Granite
85
Muscovite
80
Obsidian
45
FE R
Basalt
15
Angular
3. Sorting a. Poorly-sorted: Particles of different sizes Well-Rounded together, i.e., a glacier does not sort sediments b. Well-sorted: Particles of the same size together, i.e., a river sorts rocks from heaviest (upstream) to lightest (downstream)
Sedimentary rocks: Rocks formed from existing sediments through lithification 4
(Sedimentary Rocks continued)
C LASTIC S EDIMENTARY R OCKS
D. Properties of Sedimentary Rocks 1. Texture
a. Carbonate, test with HCl; examples: calcite and dolomite b. Silica; examples: quartz and chert c. Clay minerals; examples: kaolinite, silicate d. Organic matter; examples: plants, shells, bones e. Evaporites, minerals created from a solution; example: gypsum f. Rock Particles; example: conglomerates g. Heavy Minerals; example: garnet h. Feldspar, known as arkosic
E.
a. Ripple Marks: Marks preserved from flow in one direction (asymmetrical) b. Oscillation Marks: Marks preserved from flow back and forth (symmetrical) c. Mud Cracks (Desiccation marks): Markspreservedfromexposure to air d. Raindrop Impressions: Marks preserved from rain e. Trace Fossils: Marks preserved from the movement of animals
General Description
coarse sand, angular pebble-sized, angular sand size clay size pebble-sized, round sand and clay size sandstone sand size sandstone sand size, rounded clay and silt size silt size
feldspar and quartz present in matrix of cemented sand calcite present minerals not visible, smooth in matrix of cemented sand quartz/sand mixed with clay rock fragments quartz present claystone or siltstone that has layers minerals not visible, earthy
C HEMICAL S EDIMENTARY R OCKS
Well-Sorted
Name
Texture (of sediments)
General Description
Chemical Limestone Chert Dolomite Ironstone Rock Gypsum Rock Salt Travertine
visible crystals dense crystalline, dense dense visible crystals visible crystals dense
has calcite, will react w/HCl conchoidal fracture powder will react w/HCl iron present, dark-colored gypsum present halite present, salty will react w/HCl, dark bands
O RGANIC (B IOCHEMICAL ) S EDIMENTARY R OCKS
Sedimentary Rock: Durango, CO
Sedimentary Structures: Structural features resulting from sediment transportation and deposition
1. Stratification: Distinct layers (strata or bed) formed from moving and depositing sediments 2. Cross Bedding: Stratification at an angle 3. Graded Bedding: Each bed is comprised of sediments that increase in size as the depth of the bed increases (coarsest on bottom); common for deep marine environments 4. Surface Impressions: Impressions preserved in the bed
Texture (of sediments)
Arkose Breccia Calcarenite Claystone Conglomerate Graywacke Lithic Quartz Shale Siltstone
Name
Texture (of sediments)
General Description
Bituminous Chalk Coquina Diatomite Peat Skeletal Limestone
coal bioclastic, dense bioclastic bioclastic bioclastic bioclastic bioclastic
black, like soot white, will react w/HCl cemented shells like chalk, no HCl reaction plant material shells, will react w/HCl
METAMORPHIC ROCKS A. Metamorphism: To change form within the Earth from existing rocks through heat, pressure and chemical activity, not a result of weathering or sedimentation 1. Heat
Chert
a. b. c. d.
Most important agent Provides energy for chemical reactions Created from igneous rock bodies movement through the existing rock Created from geothermal gradient, 25˚C increase in temperature with each kilometer increase in depth (geothermal gradient) e. For example, clay recrystallizes into feldspar and mica at high temperatures
2. Pressure and Stresses a. Confining pressure
Coquina
i. Equal pressure on all sides due to deep burial ii. Depth determines amount of pressure iii.For example, an object in the water has equal amounts of pressure on all sides
b. Directed Stress: Specific pressure to a rock, not uniform, such as in the forming of a mountain
Dolomite
GEOTHERMAL GRADIENT 0 5
0
200
Temperature oC 400 600
800
0
2
10 15
4
20
6
Pressure in Kb
2. Composition: Possible matter found in sedimentary rocks
Poorly-Sorted
Name
Depth in kilometers
a. Clastic: Made of transported sediments and deposition; observe particle size, shape of grain and how well-sorted b. Bioclastic: Remains of organic material c. Crystalline: Interlocking crystals of different sizes, considered dense if crystals are less than 1 ⁄4 mm d. Amorphous: Dense, having no crystal structure e. Oolitic: Made of oolites, small round particles made of calcium carbonate
25
8 i. Differential stress: 30 Stresses in different directions, not equal 35 10 ii. C o m p r e s s i v e stress: Stress that causes the object to be squeezed iii.Shear stress: Stresses in opposite directions that cause the object to move parallel to the stress
3. Chemical Activity Shale
Sandstone
Limestone
a. Change in atomic composition due to heat and/or pressure may cause crystal to recrystallize b. Water is the most common chemical agent 5
Metamorphic Rocks continued
B.
ii. Phyllitic: Caused by low-grade to intermediate-grade metamorphism; rock containing very fine-grained mica and chlorite minerals that form in a wave-like manner; glossy luster; looks wrinkled; texture of phyllite iii.Schistose: Caused by intermediategrade metamorphism; medium- to coarse-grained platy minerals such as micas, chlorite, and quartz present, texture of schist iv. Gneissic: Caused by intermediategrade to high-grade metamorphism; rock containing layers of varying mediBlack Canyon of Gunnison um to coarse minerals, light and dark layers alternating, texture of gneiss v. Migmatitic: Caused by extreme heat and pressure, melting; rock containing igneous (granite) and metamorphic rock, texture of migmatite
Types of Metamorphism
1. Contact metamorphism: Changes caused by proximity to magma or deep, hot rock 2. Regional metamorphism: Changes caused by intense stress and high temperatures 3. Hydrothermal metamorphism: Changes caused by hot liquids 4. Fault Zone metamorphism: Changes caused by fault movement
C. Degrees of Metamorphism 1. Metamorphic grade: Degree of metamorphism applied to rock a. High-grade: Very high amounts of heat and pressure; example: gneiss b. Intermediate-grade: Medium amounts of heat and pressure; example: schist c. Low-grade: Lower amounts of heat and pressure, more dense and compact; example: slate
2. Metamorphic facies: Minerals present in metamorphic rock correlate to amount of heat and pressure
b. Nonfoliated texture: Lacks foliations, or layers, of minerals; granular, common for contact metamorphism
a. Low pressure, high temperature; hornfels facies b. High pressure, high temperature; granulite facies, amphibolite facies, and greenschist facies c. High pressure, low temperature; blueschist facies and eclogite facies
i. Cataclastic: Made of fragments or angular pieces of existing rocks created by grinding, often near faults, hydrothermal veins ii. Granular: Rocks containing minerals of similar size crystals that can be seen with the bare eye, such as quartzite iii.Microgranular: Rock containing minerals of similar size that cannot be seen with the bare eye, such as hornfels iv. Glassy: No crystals can be seen, smooth, has conchoidal fracture; example: anthracite coal v. Porphyroblastic: Rock containing large crystals (porphyroblasts) in a matrix of finer crystals, schist
D. Changes in Mineralogy: Changes in texture or composition of the mineral due to heat and pressure 1. Recrystallization: Changed by smaller crystals joining to create larger crystals of the same mineral; common 2. Neomorphism: New minerals created from existing mineralogical compositions 3. Metamorphism: New minerals created through gaining or losing chemicals
E.
Properties of Metamorphic Rocks
2. Composition: Assists in identification of nonfoliated rocks; some properties of the metamorphosed rock (sedimentary, igneous or metamorphic) can remain in the new rock a. b. c. d. e. f.
1. Texture a. Foliated texture: Contains foliations, minerals brought into line or with one another; layers, due to heat and pressure, common for regional metamorphism; type of foliation can identify rock i. Slaty: Caused by low-grade metamorphism; dense rock containing very fine-grained mica minerals, separates in sheets, texture of slate
Gneiss
Anthracite coal
TABLE
OF
Sandstone: Can create quartzite Limestone: Can create marble Basalt: Can create schist or amphibolite Shale: Can create slate Granite: Can create schist Rhyolite: Can create schist
Slate
Schist
Marble
M ETAMORPHIC R OCKS
Name
Texture
Type of Metamorphism
Preexisting Rock
Description
Anthracite Coal Gneiss
nonfoliated, glassy foliated, gneissic
regional metamorphism regional metamorphism
bituminous coal schist
Greenstone Hornfels Marble Migmatite Phyllite Quartzite Schist Serpentine Skarn Slate
nonfoliated, granular nonfoliated, microgranular nonfoliated, granular foliated, migmatitic foliated, phyllitic nonfoliated, granular foliated, schistose nonfoliated, granular nonfoliated, granular foliated, slaty
regional metamorphism contact metamorphism contact metamorphism regional metamorphism regional metamorphism contact metamorphism regional metamorphism regional metamorphism contact metamorphism regional metamorphism
gabbro or basalt many rocks limestone or dolomite gneiss and granite slate quartz sandstone phyllite basalt or gabbro limestone or dolomite shale or mudstone
shiny, black, conchoidal fracture coarse grains, undergoes neomorphism, contains layers of light and dark bands, quartz and micas present undergoes metasomatism conchoidal fracture, dense, dark gray to black recrystallized, white, gray, pink alternating metamorphic and igneous rock wrinkly, contains micas, crystals not visible, shiny hard, recrystallized, white, brownish wrinkly, porphyroblasts, crystals visible undergoes metasomatism undergoes metasomatism breaks along flat surface, black to dark gray, dense
CREDITS Author: Diane Adam Layout: Rich Marino
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DISCLAIMER ISBN-13: 978-142320700-9 ISBN-10: 142320700-9
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This QuickStudy® guide is a basic outline of common rocks and minerals. Due to its condensed nature, we recommend you use it as a guide but not as an indepth reference. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2002, 2003 BARCHARTS, INC. 1107
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HEAD: EYE, EAR, NOSE & MOUTH
Frontal lobe Olfactory bulb (nasal sensory n.n.)
** = a. = L. = l. = m. = m.m. = n. = n.n. = v. =
Central sulcus
cut artery left ligament muscle muscles nerve nerves vein
Temporal lobe
Frontal sinus
Parietal lobe Optic n. Occipital lobe
Nasal bone Sphenoidal sinus L. middle nasal concha
Cerebellum
Pharyngeal tonsil L. inferior nasal concha Inferior nasal meatus Hard palate Auditory (eustachian) tube
Inner ear (cochlea) (semicircular canals)
Soft palate (uvula) Tongue
Tympanic membrane (eardrum)
Orbicularis oris m. Palatine tonsil
Temperomandibular joint & capsule
Mandible
Genioglossus m.m. Geniohyoid m.
Head of the mandible Spinal cord Epiglottis
Mylohyoid m.
Hyoid bone
Nuchal l.
Thyroid cartilage
Cervical n.n. 7th cervical vertebrae
Cricoid cartilage
Esophagus
Larynx
HEARING
HEARING Temporal m.m.
Auricular cartilage (external acoustic meatus cartilage)
Vocal cord
Vestibular n. Ampullae
Semicircular canals
Endolymphatic duct
Temporal bone Vestibular n. Auditory ossicles Malleus Incus Stapes
Cochlear n. Facial n. (VII) **
Semicircular canals & ducts Anterior (superior) Posterior Lateral
Vestibular ganglion
Facial n. (VII) **
Utricle
Endolymphatic sac Cochlear n.
Cochlea
Tensor tympani m. (continues through bone to malleus)
Epitympanic recess
Tensor tympani m.
Cochlear duct Tectorial membrane
Incus (anvil) Tympanic membrane
External acoustic meatus
Scali vestibuli Vestibular membrane
Stapedius m.
Auricle
Auditory (eustachian) tube
Eardrum (tympanic membrane)
Stapedius m. Tympanic cavity (middle ear) Levator veli palatini m. Round (cochlear) window
Scali tympani Malleus (hammer)
Stapes (stirrup) in oval (vestibular) window Round (cochlear) window (closed by secondary tympanic membrane)
Cochlear duct Spiral ganglion Saccule
Ductus reuniens
TOUCH
Hair shaft
TASTE
Erector pilae m. Stratum corneum Pore of sweat gland
Stratum lucidum
Gingiva
Free n. endings
Merkel’s discs
Superior lip
Superior labial frenulum
Stratum granulosum Stratum spinosum Stratum basale Dermal papillae
Meissner’s corpuscle (touch)
Epidermis (touch)
Papillary layer Reticular layer Sensory n. Hair follicle Cuticle Huxley’s layer Henle’s layer External sheath Glassy membrane Connective tissue layer Corpuscle of Krause (cold) Sweat gland
Sebaceous glands Dermis (temperature)
Sweat gland Hypodermis
Hard palate Palatine raphe Soft palate Palatoglossal arch Uvula Palatine tonsil
Palatopharyngeal arch Posterior wall of oropharynx
Tongue
Gingiva Vestibule
Inferior labial frenulum
Inferior lip Vocal cord
Esophagus
Epiglottis Interaratenoid notch Palatopharyngeal arch & m. ** Median glossoepiglottic fold Palatine tonsil
Sensory n. Motor nerve (autonomic) Hair matrix
Connective tissue
Papilla of hair follicle v.
Palatoglossal arch & m. **
Foramen cecum
Lingual tonsil
Vallate papillae
Fat lobule
Foliate papillae Median sulcus
Hair cuticle
a. Vater-pacini (pacinian) corpuscle (heavy pressure)
Glassy membrane
Corpuscle of Ruffini (heat)
Filiform papillae Motor nerve (autonomic)
External sheath
SMELL
Ethmoid bone
Olfactory bulb Olfactory n.n.
Frontal sinus Anterior ethmoidal n.
Olfactory tract Sphenoidal sinus
Anterior septal branch of anterior ethmoidal a.
Sella turcila Septal branch of posterior ethmoidal a.
Fungiform papillae
Apex
Septal cartilage
Posterior branch of sphenopalatine a.
SEEING
Lateral rectus m.
Sclera
Choroid
Conjunctiva Greater arterial circle of iris Sinus venosus of sclera (Schlemm’s canal) Trabecular network Cornea Posterior chamber Anterior chamber
Central a. & v. of retina
Schwalbe’s line Iris
Nasopalatine a. & n. in the incisive canal
Nasopalatine n. Vomer
NOTE TO STUDENT
Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 2000 BarCharts Inc. 0608
Customer Hotline # 1.800.230.9522
Vitreous body Inferior temporal a. & v. Fovea central in macula lutea Lamina cribosa of retina Optic n. (II)
L Cortex e Capsule n s Nucleus Greater alar cartilage
Retina
Inferior nasal a. & v.
Fibers of ciliary zonule (suspensory ligament of lens) Anterior ciliary v. Ciliary process
ISBN-13: 978-142320755-9 ISBN-10: 142320755-6
Medial rectus m. Ciliary m.
Meridional fibers Circular fibers
CREDITS
Images ® Vincent Perez / perezstudio.com Layout: Rich Marino
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Ora serrata
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WORLD’S #1 ACADEMIC OUTLINE
Frontal Zygomatic Temporal
Maxilla
Lumbar vertebrae Capitulum
Neck
Acetabulum Sacrum (socket) Ischium Pubis Pubic symphysis Femur Patella Tibia Navicular Cuneiforms (I, II, III)
Phalanges
Vertebrae prominens (VII) Thoracic vertebrae (I-XII)
Lumbar vertebrae (I-V)
Sacrum (I-V fused)
Transverse costal facet Costal facet Transverse process
Temporal Occipital Lambdoid suture Mastoid process Acoustic (or external Styloid auditory) meatus process
Superior & inferior articulating processes Occipital Spinous processes Intervertebral foramen Pedicle Body Disc
Cervical vertebrae CI-Atlas Coccyx vertebrae (3-5 Var.) Promontory CII-Axis (coccygeal Auricular surface vertebrae vertebrae) (for ilium) CIII VERTEBRAL COLUMN CIV
a. = artery Italics are bone features
Fibula HAND 1.Scaphoid 5. Trapezium 2.Lunate 6. Trapezoid 3.Triquetal 7. Capitate 4.Pisiform 8. Hamate
Tibia
Tibia
(behind hamate)
Calcaneus
Navicular Cuneiforms (I, II, III)
Metatarsals
Phalanges
Frontal
Squamous suture Temporal Ethmoid
Wing of sphenoid Nasal Lacrimal Zygomatic Mastoid process Infraorbital foramen Nasal conchae Maxilla Mandible Zygomatic Mental foramen arch Frontal
Lateral condyle Lateral epicondyle Patellar groove Distal epiphysis Nutrient a.
Nasal
Vein Nutrient foramen Yellow marrow Femur Medullary cavity
Parietal
Sphenoid Temporal Vomer Occipital Maxilla Dens (odontoid process) Palatine Mandible I Mandible Cervical vertebrae II III Sphenoid (cut lamina) IV Ethmoid
Perforating or Sharpey’s fibers Outer layer Inner layer
Blood vessels within Volkmann’s or perforating canal
Diaphysis
Frontal
Phalanges
POSTERIOR VIEW BONE STRUCTURE
Supraorbital foramen
Parietal
Temporal
Phalanges Metacarpals
Medial condyle
Talus
Coronal suture
Frontal
Ilium
Obturator foramen Ischium (see below) Femur Lateral condyle
LATERAL VIEW
Parietal
Posterior, inferior iliac spine
5 6 7 8
Patella
Parietal
Axis vertebrae
Posterior, superior iliac spine
Distal carpals
Cuboid
Atlas vertebrae
Humerus
Radius
Phalanges
Metatarsals
ANTERIOR VIEW SKULL
Scapula
Ulna
Metacarpals
Calcaneus
Talus Cuboid
Clavicle
Pubic tubercle
Fibula
Metatarsals
Cervical vertebrae (I-VII)
Scapula
Medial malleolus Lateral malleolus
Parietal
Spine of scapula Mandible Acromion Hyoid Thoraic vertebrae (I-XII) Clavicle Sternum Lumbar vertebrae (I-V) Sacroiliac joint Ribs Sacrum (5 fused) Ilium Coccyx Radius (3-5) Anterior superior iliac spine Carpals Descending (see below) 1 2 3 4 ramus of pubis
Humerus Bicipital groove Sternum Olecranon Ribs Xiphoid process Ulna Medial epicondyle of humerus Lateral epicondyle Head of humerus Posterior superior Tuberosity iliac spine Coronoid process Medial sacral Radius crest Ulna Sacrum Metacarpals Coccyx Carpals Phalanges Ischial spine Greater trochanter Lesser sciatic notch Lesser trochanter Medial epicondyle of femur Femur Lateral epicondyle of femur Fibula Lateral condyle of tibia Medial condyle of tibia
Humerus
Occipital
Cervical vertebrae (I-VII)
Maxilla
Cervical vertebrae (V-VII)
Manubrium Clavicle Lesser tubercle Greater tubercle
SYSTEM
Frontal Temporal
Parietal
Occipital
Mandible
Cervical vertebrae Coracoid process Acromion Scapula Costal cartilage
Trochlea Iliac crest Ilium
SKELETAL
Periosteum Interstitial Concentric lamellae
Endosteum
Blood vessels within haversian or central canal
Osteon (haversian system) Canaliculi Circumferential lamellae
Trabeculae Cancellous bone Neck of femur Proximal secondary epiphysis Great trochanter
Periosteum (covers all nonarticulating surfaces) Compact bone Head of femur
Epiphyseal lines
Fovea capitis Proximal epiphysis
SCAPULA (FRONT)
Coracoid Superior notch process Clavicle Acromion
Head of humerus
SCAPULA (BACK)
ELBOW (FRONT)
Coracoid process Acromioclavicular joint Acromion
Clavicle
Superior notch
Humerus
Superior angle
Greater tubercle
Spine
Lesser tubercle
Greater tubercle
Glenoid cavity of scapula Intertubercular groove Scapula
Medial angle
ELBOW (BACK)
Head of humerus
Lateral epicondyle
Olecranon fossa
Capitulum
Trochlea
Neck
Head Neck
Coronoid process
Deltoid tuberosity Scapula
Deltoid tuberosity
Lateral epicondyle
Medial epicondyle
Head
Humerus
Olecranon
Medial supracondylar crest
Lateral supracondylar crest
Radial notch of ulna Tuberosity
Inferior angle
Ulna
Humerus
Radius
HIP (FRONT)
Iliac tuberosity
Iliac crest Wing (ala) of ilium
HAND (FRONT) Carpal bones Lunate Scaphoid Capitate Trapezium Trapezoid
Anterior superior iliac spine
Pubic symphysis
Anterior inferior iliac spine Head of femur Neck of femur Greater trochanter
Pubic tubercle
Pubic arch
Styloid process of radius
Proximal phalanx
Carpal bones Triquetral Pisiform Hamate
1 2
3
4
Carpal bones Triquetral Hamate
5
Proximal phalanx
1
Metacarpal bones
3
5 4
Distal phalanx
2
Metacarpal bones Proximal phalanx
Middle phalanx
Proximal phalanx Middle phalanx
Distal phalanx
Distal phalanx
Femur
Ischial tuberosity Posterior superior HIP iliac spine (BACK)
Iliac crest
KNEE (FRONT)
Posterior inferior iliac spine Lateral epicondyle
KNEE FOOT (BACK) (TOP)
Linea aspera Femur Lateral condyle
Greater sciatic notch
Intercondylar notch Adductor tubercle
Patella
Lateral condyle Lateral epicondyle I
Neck of femur Apex
Greater trochanter
Medial epicondyle
Head Medial condyle Intercondyler eminence Apex Tuberosity Head
Ischial tuberosity Intertrochanteric crest Lesser trochanter Linea aspera
Carpal bones Lunate Scaphoid Capitate Trapezoid Trapezium
Styloid process of ulna
Distal phalanx
Lesser trochanter
Radius
Ulna
Ulna
Sesamoids
Trochanter line Ramus ischium Obturator foramen
HAND (BACK)
Radius
Neck Ischial spine
Lateral malleolus Calcaneus Navicular Cuneiforms Cuboid Lateral III Intermediate II Medial I 54 3 2 Metatarsals Phalanges Proximal Middle Distal
Lateral condyle
Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance.
U.S.$3.95 / CAN.$5.95
Base Body Head
Navicular Cuneiforms Metatarsals Phalanges
Fibula
Calcaneus ISBN-13: 978-142320756-6 ISBN-10: 142320756-4
1
Talus Fibula
Femur
NOTE TO STUDENT
Talus Trochlea Neck Head
Tibia
Tibia
All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2001, 2003, 2005 BarCharts Inc. 0608
Customer Hotline # 1.800.230.9522
Medial malleolus
Tibia
CREDITS Images ® Vincent Perez perezstudio.com
Layout: Rich Marino
free downloads &
hundreds of titles at
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Cuboid
FOOT (SIDE)
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DESCRIPTIVE STATISTICS
Methods used to simply describe data set that has been observed KEY TERMS & SYMBOLS quantitative data: data variables that represent some numeric quantity (is a numeric measurement). categorical (qualitative) data: data variables with values that reflect some quality of the element; one of several categories, not a numeric measurement. population: “the whole”; the entire group of which we wish to speak or that we intend to measure. sample: “the part”; a representative subset of the population. simple random sampling: the most commonly assumed method for selecting a sample; samples are chosen so that every possible sample of the same size is equally likely to be the one that is selected.
1. A student receives the following exam grades in a course: 67, 88, 75, 82, 78 a. Compute the mean: x = ∑ x = 67 + 88 + 75 + 82 + 78 = 390 = 78 n 5 5 b. W hat is the median exam score? in order, the scores are: 67, 75, 78, 82, 88; middle element = 78 c. What is the range? range = maximum – minimum = 88 – 67 = 21 d. Compute the standard deviation: (67 − 78) + (88 − 78) + (75 − 78) + (82 − 78) + (78 − 78) ∑ (x − x ) 246 s=
2
2
=
n −1
2
2
n: size of a sample. x: the value of an observation. f: the frequency of an observation (i.e., the number of times it occurs). frequency table: a table that lists the values observed in a data set along with the frequency with which it occurs. (population) parameter: some numeric measurement that describes a population; generally not known, but estimated from sample statistics. EX: population mean: μ; population standard deviation: σ; population proportion: p (sometimes denoted π) (sample) statistic: some numeric measurement used to describe data in a sample, used to estimate or make inferences about population parameters. EX: sample mean: x ¯ ; sample standard deviation: s; sample proportion: p ˆ
2
4
e. What is the z score for the exam grade of 2. The residents of a retirement community are surveyed as to how many times they’ve been married; the results are given in the following frequency table:
N: size of a population.
Sample Problems & Solutions
2
=
4
= 61.5 = 7.84
x − x 88 − 78 10 88? z = s = 7.84 = 7.84 = 1.28
Sums x = # of marriages 0 1 2 3 4 n/a f = # of observations 13 42 37 12 6 110 = n xf 0 42 74 36 24 176
∑ xf 176 = = 1.6 n 110 b. C ompute the median: Since n =Σf = 110, an even number, the median is the average n n of the observations with ranks 2 and 2 +1 (i.e., the 55th and 56th observations) a. Compute the mean: x =
!
hile we could count from either side of the distribution (from 0 or from 4), it is W easier here to count from the bottom: The first 13 observations in rank order are all 0; the next 42 (the 14th through the 55th) are all 1; the 56th through the 92nd are all 2; since the 55th is a 1 and the 56th is a 2, the median is the average: (1 + 2) / 2 = 1.5
c. Compute the IQR: To find the IQR, we must first compute Q1 and Q3; if we divide n in half, we have a lower 55 and an upper 55 observations; the “median” of each would have rank n+1 = 28; the 28th observation in the lower half is a 1, so Q1 = 1 and the 28th 2 observation in the upper half is a 2, so Q2 = 2; therefore, IQR = Q3 – Q1 = 2 – 1 = 1
Formulating Hypotheses Type measures of center (measures of central tendency) indicate which value is typical for the data set
Statistic
measures of relative standing (measures of relative position) indicate how a particular value compares to the others in the same data set
Important Properties
from raw data ∑x x= n
mean
from a frequency table
x=
median
the middle element in order of rank
n odd: median has rank n + 1 2 n even: median is the n n and + 1 average of values with ranks 2 2
mode
the observation with the highest frequency
mid-range measures of variation (measures of dispersion) reflect the variability of the data (i.e., how different the values are from each other)
Formula
sample variance sample standard deviation
∑ xf n
∑ (x − x ) n −1
s=
∑ (x − x ) n −1
not sensitive to extreme values; more useful when data are skewed only measure of center appropriate for categorical data not often used; highly sensitive to unusual values; easy to compute
maximum + minimum 2
s2 =
sensitive to extreme values; any outlier will influence the mean; more useful for symmetric data
not often used; units are the squares of those for the data
2
square root of variance; sensitive to extreme values; commonly used
2
interquartile range (IQR)
IQR = Q3 – Q1 (see quartile, below)
less sensitive to extreme values
range
maximum – minimum
not often used; highly sensitive to unusual values; easy to compute
percentile
data divided into 100 equal parts by rank (i.e., the kth percentile is that value greater than k% of the others)
important to apply to normal distributions (see probability distributions)
quartile
data divided into 4 equal parts by rank: Q3 (third quartile) is the value greater than ¾ of the others; Q1 (first quartile) is greater than ¼; Q2 is identical to the median
used to compute IQR (see IQR, above); Q3 is often viewed as the “median” of the upper half, and Q1 as the “median” of the lower half; Q2 is the median of the data set
z score
z=
x−x s
to find the value of some observation, x, when the z score is known: x = x + zs 1
measures the distance from the mean in terms of standard deviation
PROBABILITY KEY TERMS & SYMBOLS probability experiment: any process with an outcome regarded as random.
Examples of Sample Spaces Probability Experiment
Sample Space
toss a fair coin
{heads, tails} or {H, T}
toss a fair coin twice
sample space (S): the set of all possible outcomes from a probability experiment.
{HH, HT, TH, TT} there are two ways to get heads just once
roll a fair die
events (A, B, C, etc.): subsets of the sample space; many problems are best solved by a careful consideration of the defined events.
{1, 2, 3, 4, 5, 6}
roll two fair dice
{(1,1), (1,2), (1,3). . . (2,1), (2,2), (2,3). . . (6,4), (6,5), (6,6)} total of 36 outcomes: six for the first die, times another a six for the second die
have a baby
P(A): the probability of event A; for any event A, 0≤P(A)≤1, and for the entire sample space S, P(S) = 1
{boy, girl} or {B, G}
pick an orange from one of the trees in a grove, and weigh it
“equally likely outcomes”: a very common assumption in solving problems in probability; if all outcomes in the sample space S are equally likely, then the probability of some event A can be calculated as
{ some positive real number, in some unit of weight} this would be a continuous sample space
P ( A) =
Important Relationships Between Events Relationship
Definition
Implies That...
disjoint or mutually exclusive
the events can never occur together
P(A and B) = 0, so P(A or B) = P(A) + P(B)
!
Probability Rules Rule
nowing that events are disjoint can make things much easier, since K otherwise P(A and B) can be difficult to find.
complementary
the complement of event A (denoted AC or A) means “not A”; it consists of all simple outcomes in S that are not in A
the occurrence of one event does not affect the probability of the other, and vice versa
Formula
addition rule (“or”)
P(A) + P(AC) = 1 (any event will either happen, or not) thus, P(A) = 1 - P(AC); P(AC) = 1 - P(A)
!
!
P(A|B) = P(A), and P(B|A) = P(B), so P(A and B) = P(A)P(B)
P(A and B) = P(A)P(B|A) equivalently, P(A and B) = P(B)P(A|B) if A and B are independent, P(A and B) = P(A)P(B)
While it doesn’t matter whether we “condition on A” (first) or “condition on B” (second), generally the information available will require one or the other.
conditional probability rule (“given that”)
Events are often assumed to be independent, particularly repeated trials.
P(A or B) = P(A) + P(B) - P(A and B) if A and B are disjoint, P(A or B) = P(A) + P(B)
ubtract P(A and B) so as not to count twice the elements of both S A and B.
multiplication rule (“and”)
he law of complements is a useful tool, since it’s often easier to find the T probability that an event does NOT occur. independent
P ( A and B) P ( A and B) P(B A) = P ( B) P ( A)
P(A B) =
y multiplying both sides by P(B) or P(A), we see this is a rephrasing of B the multiplication rule; conditional probabilities are often difficult to assess; an alternative way of thinking about “P(A|B)” is that it is the proportion of elements in B that are ALSO in A.
Probability Distributions When some number is derived from a probability experiment, it is called a random variable. Every random variable has a probability distribution that determines the probabilities of particular values. For instance, when you roll a fair, six-sided die, the resulting number (X) is a random variable, with the following discrete probability distribution:
total probability rule
In the table to the right, P(X) is called the probability X P(X) distribution function (pdf). 1 1/6 Since each value of P(X) represents a probability, pdf’s must follow the basic probability rules: P(X) must always be 2 1/6 between 0 and 1, and all of the values P(X) sum to 1. 3 1/6 Other probability distributions are continuous: They do not assign specific probabilities to specific values, as above in the 4 1/6 discrete case; instead, we can measure probabilities only over 5 1/6 a range of values, using the area under the curve of a probability density function. 6 1/6 Much like data variables, we often measure the mean (“expectation”) and standard deviation of random variables; if we can characterize a random variable as belonging to some major family (see table below), we can find the mean and standard deviation easily; in general, we have:
!
To find the probability of an event A, if the sample space is partitioned into several disjoint and exhaustive events D1, D2, D3, ..., Dk, then, since A must occur along with one and only one of the D’s: P(A) = P(A and D1) + P(A and D2) + ... + P(A and Dk) = P(D1)P(A|D1) + P(D2)P(A|D2) + ... + P(Dk)P(A|Dk)
he total probability rule may look complicated, but it isn’t! T (see sample problem 3a, next page).
Bayes’ Theorem
With two events, A and B, using the total probability rule: P(B A) =
P ( A and B) P ( A and B) P ( B) (A B) = = P ( A) P ( A and B) P ( A and B c ) P ( B) P(A B) + P ( B c ) (A Bc )
ayes’ Theorem allows us to reverse the order of a conditional B probability statement, and is the only generally valid method! Sample Problems & Solutions 1. Discrete random variable, X, follows the following probability distribution:
Type of Random Variable
General Formula for Mean
General Formula for Standard Deviation
discrete (X takes some countable number of specific values)
µ = E (X) = ∑ X P (X)
σ = SD ( X ) = ∑ X 2 P ( X ) − µ 2
continuous (X has uncountable possible values, and P(X) can be measured only over intervals)
µ = E ( X ) = ∫ XP ( X ) dX
σ = SD ( X ) =
!
number of simple outcomes ∈ A total number of simple outcomes
X 0 1 2 P(X) 0.15 0.25 0.4 XP(X) 0 0.25 0.8 X2 P(X) 0 0.25 1.6
3 sums 0.2 1 (always) 0.6 1.65=E(X) 1.8 3.65
a. What is the expected value of X?
∫ X P ( X ) dX − µ 2
µ = E + ( X ) = ∑ XP ( X ) = 1.65
2
b. What is the standard deviation of X? 2 2
σ = SD ( X ) = ∑ X P ( X ) − µ = 3.65 − 1.65 2
ortunately, most useful continuous probability distributions do not require integration in practice; F σ = SD ( X ) = ∑ X 2 P ( X ) − µ 2 other formulas and tables are used. 2
= 3.65 − 1.65 2 = 0.9275 = 0.963
PROBABILITY (continued) Several Important Families of Discrete Probability Distributions Name
Used When
Parameters
uniform all outcomes are consecutive integers, and all are equally likely
PDF
Mean Standard Deviation
a = minimum b = maximum
P (X) =
n = fixed number of trials p = probability that the designated event occurs on a given trial
P(X) =nCx px(1 – p) n-x
np
np (1 − p)
P(X) = e -λ λx x!
λ
λ
1 b − a +1
a+b 2
(b − a)2 12
Not common in nature. binomial
some fixed number of independent trials with the same probability of a given event each time; X = total number of times the event occurs
Commonly used distribution; symmetric if p = 0.5; only valid values for X are 0 ≤ X ≤ n. Poisson
!
events occur independently, at some average rate per interval λ = mean number of events of time/space; X = total number of times the event occurs per interval
There is no upper limit on X for the Poisson distribution.
geometric a series of independent trials with the same probability of a given event; X = # of trials until the event occurs
!
p = probability that the event occurs on a given trial
1 p
P(X) = (1 – p)x-1p
1− p p
2
Since we only count trials until the event occurs the first time, there is no need to count the nCx arrangements, as in the binomial.
hyperdrawing samples from a finite population, with a categorical geometric outcome X = # of elements in the sample that fall in the category of interest
N = population size n = sample size K = number in category in population
P (X) =
Cx N − K Cn − x N Cn
K
n
() K N
( )( )
K K 1− N N N −1
n ( N − n)
Sample Problems & Solutions c. ...has a pool, given that it has air conditioning? his is the same as asking, “What proportion of the homes with air ! Tconditioning also have pools?” Whenever we use the phrase “given that,” a conditional probability is indicated:
1. A sock drawer contains nine black socks, six blue socks, and five white socks—none paired up; reach in and take two socks at random, without replacement; find the probability that... here are 20 socks, total, in the drawer (9 + 6 + 5 = 20) before any are T taken out; in situations like this, without any other information, we should assume that each sock is equally likely to be chosen.
!
P(pool | AC) = P ( pool and AC ) 0.23 = = 0.261 P ( AC ) 0.88 d. ...has air conditioning, given that it has a pool?
a. …both socks are black
This probability is much greater, since more homes have air conditioning than pools.
(both are black) = P(first is black AND P second is black) = P(first is black)P(second is black | first is black)
=
9 8 9×8 72 × = = = 0.189 20 19 20 × 19 380
b. …both socks are white [Expect a smaller probability than in the preceding problem, as there are fewer white socks from which to choose!] A s above, we lose both one of the socks in the category, as well as one of the socks total, after selecting the first:
5 4 5× 4 20 × = = = 0.053 20 19 20 × 19 380 c. …the two socks match (i.e., that they are of the same color) here are only three colors of sock in the drawer: T P(match) = P(both black) + P(both blue) + P(both white)
=
9 8 6 5 5 4 122 × + × + × = = 0.321 20 19 20 19 20 19 380
d. …the socks DO NOT match ! For the socks not to match, we could have the first black and the second blue, or the first blue and the second white...or a bunch of other possibilities, too; it is much safer, as well as easier, to use the rule for complements—common sense dictates that the socks will either match or not match, so: P(socks DO NOT match) = 1 – P(socks do match) – 1 – 0.321 = 0.690 2. In a particular county, 88% of homes have air conditioning, 27% have a swimming pool, and 23% have both; what is the probability that one of these homes, chosen at random, has... a. ...air conditioning OR a pool? The given percentages can be taken as probabilities for these events, so we have: P(AC) = 0.88, P(pool) = 0.27 and P(AC and pool) = 0.23 b. ...NEITHER air conditioning NOR a pool? By the addition rule: P(AC or pool) = P(AC) + P(pool) – P(AC and pool) 0.88 + 0.27 – 0.23 = 0.92 Upon examination of the event, this is the complement of the above event: P(neither AC nor pool) = P(no AC AND no pool) = 1 – P(AC or pool) = 1 – 0.92 = 0.08
[CAUTION! This is NOT the same as the preceding problem—now we’re asked what proportion of homes that have pools ALSO have air conditioning.] The event in the numerator is the same; what has changed is the condition:
!
P(AC | pool) =
P ( pool and AC ) 0.23 = = 0.852 0.27 P ( AC )
3. The TTC Corporation manufactures ceiling fans; each fan contains an electric motor, which TTC buys from one of three suppliers: 50% of their motors from supplier A, 40% from supplier B, and 10% from supplier C; of course, some of the motors they buy are defective—the defective rate is 6% for supplier A, 5% for supplier B, and 30% for supplier C; one of these motors is chosen at random; find the probability that... We have here a bunch of statements of probability, and it’s useful to list them explicitly; let events A, B, and C denote the supplier for a fan motor, and D denote that the motor is defective, then: P(A) = 0.5, P(B) = 0.4, and P(C) = 0.1 The information about defective rates provides conditional probabilities: P(D|A) = 0.06, P(D|B) = 0.05, and P(D|C) = 0.3 We can also note the complementary probabilities of a motor not being defective: P(DC|A) = 0.94, P(DC|B) = 0.95, and P(DC|C) = 0.7 a. ...the motor is defective
!
To find the overall defective rate, we use the total probability rule, as a defective motor still had to come from supplier A, B, or C: P(D) = P(A and D) + P(B and D) + P(C and D) = P(A)P(D|A) + P(B)P(D|B) + P(C)P(D|C) = (0.5)(0.06) + (0.4)(0.05) + (0.1)(0.3) = 0.03 + 0.02 + 0.03 = 0.08 If 8% overall are defective, then 92% are not—that is, we can also conclude that P(DC) = 1 – P(D) = 1 – 0.08 = 0.92
b. ...the motor came from supplier C, given that it is defective his is like asking, “What proportion of the defectives come from supplier C?” T Denote this probability as P(C|D); we began with P(D|C) (among other probabilities)—we are effectively using Bayes’ Theorem to reverse the order; however, we already have P(D), so: 3
P(C|D) =
P (C and D) 0.03 = = 0.375 0.08 P ( D)
PROBABILITY (continued)
SAMPLING DISTRIBUTIONS Because sample statistics are statistic expected standard derived from random samples, value error they are random. sample μ The probability distribution σ mean of a statistic is called its samn pling distribution. Due to the central limit theo...if n ≥ 30, or if the population rem, some important statistics distribution is normal have sampling distributions that approach a normal sample p p (1− p) distribution as the sample size proportion increases (these are listed in n the table at right). ...if np ≥ 15 and n(1 – p) ≥ 15 Knowing the expected value and standard error allows us to find probabilities; then, in turn, we can use the properties of these sampling distributions to make inferences about the parameter values when we do not know them, as in real-world applications.
Continuous Probability Distribution Computer software or printed tables are usually used to compute probabilities for continuous random variables, but some important families include: Name
Denoted Parameters
Properties
normal (Gaussian)
X μ = mean (or some σ = standard other deviation letter)
symmetric, unbounded, bellshaped; arises commonly in nature and in statistics, as a result of the central limit theorem
any other distributions approach the normal as n M (or some other parameter, such as λ or df ) increases. standard normal
μ = mean = 0 a special variant of normal, σ = standard with μ = 0 and σ = 1; deviation = 1 represented in “Z tables”
Z
sed for inference about proportions; the cumulative probability is U provided in Z tables: For a particular value z, the cumulative probability is Φ(z) = P(Z < z); i.e., the area under the density curve to the left of z. student’s t t
df = degrees of freedom
similar in shape to normal μ = 0 (always!)
Sample Problems & Solutions
not symmetric (skewed right)
1. 60% of the registered voters in a large district plan to vote in favor of a referendum; a random sample of 340 of these voters is selected. a. What is the expected value of the sample proportion?
Used for inference about means. chi-square
df = degrees of freedom
χ2
E ( p) = p = 0.6
Used for inferences about categorical distributions.
b. What is the standard error of the sample proportion?
SE ( p) =
Sample Problems & Solutions
c. What is the probability that the sample proportion is between 55% and 65%?
1. For a standard normal random variable Z, find P(Z < 1.5). Since, by definition, the values from the standard normal table are Φ (z) – P(Z < z) ... P(Z < 1.5) = Φ(1.5) = 0.9332
First, find the z scores for those proportions:
p ( p) 0.55 − 0.6 _ − 0.05 = = −1.88 8 and 0.0266 0.0266 SE ( p) p ( p) 0.65 − 0.6 _ 0.05 z= = = 1.88 0.0266 0.0266 SE ( p) z=
2. For a t distribution with df = 20, which critical value of t has an area of 0.05 in the right tail? t table generally provides the tail area, rather than the cumulative A probability, as given in standard normal tables; with the row = df = 20, and the column = tail area = 0.05, a t table produces the value of 1.725
Now, P (0.55) ˆp (0.65) = P – (1.88) Z (1.88) = Φ(1.88) – Φ(-1.88) = 0.9699 – 0.0301 = 0.9398
3. The heights of military recruits follow a normal distribution with a mean of 70 inches and a standard deviation of 4 inches; find the probability that a randomly chosen recruit is...
2. The standard deviation of the weight of cattle in a certain herd is 160 pounds, but the mean is unknown; a random sample of size 100 is chosen. a. Compute the standard error of the sample mean:
a. shorter than 60 inches First, we must transform values of the variable (height) to the standard normal distribution, by taking z scores; here:
z=
!
SE ( x ) =
x − µ 60 − 70 −10 = = = -2.5 σ 4 4
ince we want the “less than” probability, the solution comes S directly from the standard normal z table: P(X < 60) = P(Z < -2.5) = Φ(-2.5) = 0.0062
ince this problem refers to a single observation, not the sample S mean, we use the standard deviation, not the standard error.
!
ot knowing the value of μ, we can only express the boundaries N for “within 40 lbs. of the mean” as X = μ + 40 and X = μ – 40 We can still compute z scores:
x − µ 72 − 70 2 = = = 0.5 σ 4 4 Since this is a “greater than” probability, subtract the cumulative probability from 1: P(X > 72) = P(Z > 0.5) = 1 – Φ(0.5) = 1 – 0.6915 = 0.3085
First, the z score: z =
x − µ µ + 40 − µ 40 = = = 0.25 and σ 160 160 x − µ µ − 40 − µ − 40 z= = = = − 0.25 σ 160 160 z=
c. between 64 and 76 inches tall
hat is, “within 40 lbs. of the mean” is the same as within 0.25 T standard deviation.
In this case, there are two boundaries: The only way to find the area under the curve between them is to find the cumulative probabilities for each, and then to subtract; this entails finding z scores for both X = 64 and X = 76:
z=
σ 160 = = 16 lbs. n 100
b. For an individual animal in this herd, what is the probability of a weight within 40 lbs. of the population mean?
b. taller than 72 inches
!
p (1 − p) 0.6 (1 − 0.6) = = 0.0266 n 340
We find the probability: P (-0.25 < Z < 0.25) = Φ(0.25) – Φ(-0.25) = 0.5987 – 0.4013 = 0.1974
x − µ 64 − 70 −6 x − µ 76 − 70 6 = = = −1.5 and z = = = = 1.5 σ 4 4 σ 4 4
c. What is the probability that the sample mean falls within 40 lbs. of the population mean? ven though we don’t know the population mean, the z score E formula will allow us to find this probability.
Now: P(64 < x < 76) = P (-1.5 < Z < 1.5) = Φ(1.5) – Φ(-1.5) = 0.9332 – 0.0668 = 0.8664
!
U(z) = P(Z
z=
ince this is the sample mean, we must use the standard error S of 16 lbs., rather than the standard deviation, in computing the z scores:
➚
x − µ µ + 40 − µ 40 = = = 2.5 and 16 16 SE ( X ) x − µ µ − 40 − µ − 40 z= = = = −2.5 16 16 SE ( X )
Now: P (-2.5 < Z < 2.5) = Φ(2.5) – Φ(-2.5) = 0.9938 – 0.0062 = 0.9876
U(z)
0
!
z 4
his probability is dramatically higher than the probability for an T individual head of cattle!
STATISTICAL INFERENCE Null and alternative hypotheses have the following very important properties:
Sample Problems & Solutions
When we want to draw conclusions about a population using data from a sample, we use some method of statistical inference. A hypothesis test is a procedure by which claims about populations (hypotheses) are evaluated on the basis of sample statistics.
In each of the following cases, formulate hypotheses to test the claim; indicate which hypothesis represents the claim. 1. The manager of a bank claims that the average waiting time for customers is less than two minutes.
The procedure begins with a null hypothesis (Ho) and an alternative (or “research”) hypothesis (H1); if the sample data are too unusual, assuming Ho to be true, then Ho is rejected in favor of H1; otherwise, we fail to reject the null hypothesis, and thereby fail to support the alternatives. the null hypothesis (H0)
the alternative hypothesis (H1or Ha)
is assumed true for the purpose of carrying out the hypothesis test
is supported only by carrying out the test, if the null hypothesis can be rejected
ALWAYS provides a specific value for the NEVER provides a specific value for the parameter; parameter, its “null value”; always instead, contains “>” (right-tailed), “<” (left-tailed), or contains “=” “≠” (two-tailed) the null value implies a specific sampling distribution for the test statistic
without any specific value for the parameter of interest, the sampling distribution is unknown
can be rejected—or not rejected— but NEVER supported
can be supported (by rejecting the null)—or not supported (by failing to reject the null)—but NEVER rejected
!
he tail(s) of the hypothesis test are determined by the alternative hypothesis (H1)—this is one T of the most important attributes of the test, regardless of which method is used.
There are two major methods for carrying out a hypothesis test: the traditional approach (or fixed significance) and the p-value approach (observed significance); the following table lists the steps for each approach: p-value approach
traditional approach
formulate null and alternative hypotheses
formulate a null and an alternative hypothesis
observe sample data
determine rejection region(s) based on the level of significance and the tail(s) of the test
compute a test statistic from sample data
observe sample data
compute the p-value from the test statistic
compute the test statistic from sample data
reject the null hypothesis (supporting the alternative) at a significance level α, if the p-value ≤ α; otherwise, fail to reject the null hypothesis
reject the null hypothesis (supporting the alternative) at the significance level, if the test statistic falls in the rejection region; otherwise, fail to reject the null hypothesis
ith the p-value approach, the final decision is made by comparing probabilities, whereas with W the traditional approach, the decision is made by comparing values of random variables; because there is a one-to-one correspondence between the values of the random variables and the probabilities, the two methods will always yield consistent results; we can convert between the two using the following simple (but important!) rule: reject the null hypothesis (H0) at significance level α
→ ←
(left-tailed) 2. Your friend says that a coin you are tossing is not fair. fair coin is one that shows heads 50% of A the time; the friend states that the coin is NOT fair. This is an H1 claim: H0: p = 0.5, vs. H1: p ≠ 0.5
!
(two-tailed) 3. A highway patrolman claims that the average speed of cars on a highway is at most 70 mph.
!
Steps for Carrying Out a Hypothesis Test
!
ince the claim refers to the average, S this is a test for μ. As a “less than” claim, it is represented by H0, and the hypothesis test is: H0: μ = 2, vs. H1: μ < 2
!
p-value ≤ α
he claim directly refers to the average; T since this is an “at most” claim, it is represented by H0. The hypothesis test is: H0: μ = 70, vs. H1: μ > 70 (right-tailed) 4. A motorist claims that more than 80% of the cars on a highway travel at a speed exceeding 70 mph. ince the claim is really about a proportion– S don’t be fooled by the “70 mph!”—the hypotheses refer to p. As the motorist makes a “more than” claim, it is the null hypothesis, H0. H0: p = 0.8, vs. H1: p > 0.8
!
(right-tailed) 5. The manager of a snack-food factory states that the average weight of a bag of their potato chips is exactly 5 oz. (no more, no less). his is an “is exactly” claim that refers T to the average; thus, the claim is H0. The test is: H0: μ = 5, vs. H1: μ ≠ 5
!
(two-tailed)
Test Statistics Parameter population proportion
population mean
!
Test Statistic
Distribution Under H0
Assumptions
Formulating Hypotheses
np ≥ 15 and n(1 – p) ≥ 15
if claim consists of... it is represented by...
n ≥ 30, or the population distribution is normal
and the hypothesis test is two-tailed ≠
Z=
pˆ − p0 SE ( pˆ )
standard normal Z
t=
x − µ0 SE ( x )
t distribution with df = n – 1
ince the t distribution approaches the standard normal Z, many teachers and texts advise that S it’s OK to use Z if n is sufficiently large.
difference of proportions (independent samples) test for independence (categorical data) multinomial goodnessof-fit (categorical data)
!
np ≥ 15 and n(1 – p) ≥ 15
χ =∑ 2
(O − E )2 E
χ2 distribution with df = (r – 1)(c – 1) r = # of rows c = # of columns
χ2 tests for categorical data assume that the expected counts (E) in each cell are at least 5 under the null χ2 distribution with df = k – 1 hypothesis and k = # of categories
2 tests for categorical data do not have directional alternative hypotheses; rejection χ regions are always in the right tail. 5
“…is not equal to…”
“…is less than…”
alternative hypothesis (H1)
alternative hypothesis (H1)
and the hypothesis test is left-tailed < “…is greater than…” alternative hypothesis (H1) and the hypothesis test is right-tailed > “…is equal to…”/“ …is exactly...”
null hypothesis (H0)
and the hypothesis test is two-tailed ≠ “…is at least…”
null hypothesis (H0)
and the hypothesis test is left-tailed < “…is at most…”
null hypothesis (H0)
and the hypothesis test is right-tailed >
Statistical Inference (continued)
Errors in Inference
Sample Problems & Solutions
Decision
Reality
reject H0 (supporting H1)
!
H0 true
H0 false
type I error P(reject H0 | H0 true) = α = level of significance
correct inference P(reject H0 | H0 false) = 1– β = power
hen the null hypothesis (H0) is rejected, we can support the alternative hypothesis (H1). W This is a substantive finding: We have sufficient evidence that H0 is not correct.
fail to reject H0 correct inference (failing to support H1) P(fail to reject H0 | H0 false) = 1 – α = level of confidence
!
If H0 is not rejected, then we cannot support H1 either; this is NOT a substantive finding: We have failed to find evidence against H0, but have not “confirmed” or “proved” it to be true!
notes
!
type II error P(fail to reject H0 | H0 true) = β
Under the null hypothesis, we have a specific value for the parameter This determines a specific sampling distribution, so that α and 1 – α can be precisely determined.
If the null hypothesis is false, there is no specific value for the parameter Thus, we can only estimate β and 1 – β by making some alternative assumption about the parameter.
1. In some hypothesis tests, the null hypothesis is rejected; if an error has been made, which kind of error is it?
!
he only error of inference in which the null T hypothesis is rejected is a type I error.
2. A researcher conducts a hypothesis test at a significance level of 0.05, and computer software produces a p-value of 0.0912; unknown to the researcher, the null hypothesis is really false— what is her decision…Is it some type of error? First, consider her decision: She will reject or fail to reject the null hypothesis; we have no test statistic, only a p-value.
! But, since the p-value is less than the
significance level, α, H0 is rejected; but also, since H0 is false, this is a type II error.
It is important to note that these probabilities are conditioned on reality, rather than the decision. That is, given that H0 is true, α is the probability of rejecting H0; it is NOT the probability that H0 is true, given that it has been rejected!
Percentage Cumulative Distribution
Finding Rejection Regions & P-Values Tail(s) of Rejection Region Hypothesis Test
P-Value
< left-tailed
values of the test statistic less than some critical value with area α in the left tail
> right-tailed
values of the test statistic greater than some area under the density curve to the critical value with area α in the right tail right of the test statistic
≠ two-tailed
values of the test statistic less than some critical value with area α in the left tail, or greater than some critical value with area α in the right tail
area under the density curve to the left of the test statistic
for selected z values under a normal curve
double the tail area under the curve away from the test statistic z - value
-3
-2
-1
0
+1 +2 +3
Sample Problems & Solutions 1. At an aquaculture facility, a large number of eels are kept in a tank; they die independently of each other at an average rate of 2.5 eels per day. a. Which distribution is appropriate? Since the events are independent, and we’re given an average rate per fixed interval, a Poisson distribution can be used, with parameter: λ = 2.5 b. Find the probability that exactly two eels die in a given day: Find P(X) for X = 2 e−2.5 2.5 2 P (2) = = 0.1283 2! c. What is the probability that at least one eel dies in the span of one day? Since the Poisson distribution has no maximum, there is no alternative but to use the law of complements: P(at least one dies)= 1– P(none at all die) = e−2.5 2.5 0 1 − P (0) = 1 − = 1 − e−2.5 = 1 − 0.0821 = 0.9 9179 0! hard d. Compute the probability that at least one eel dies in the span of 12 hours: ! This is harder, since the duration of the interval has changed; but, we can scale the Poisson parameter λ proportionally: If the average rate is 2.5 eels per day, then the rate is 1.25 (half as many) per half-day; thus:
1 − P (0) = 1 −
e−1.25 1.25 0 = 1 − e−1.25 = 1 − 0.2865 = 0.7135 0!
2. A cat is hunting some mice; every time she pounces at a mouse, she has a 20% chance of catching the mouse, but will stop hunting as soon as she catches one. a. Which distribution is appropriate? As there is a fixed probability of the event, but the experiment will be repeated until the event occurs, a geometric distribution can be used, with parameter p = 0.2 U.S. $5.95
Customer Hotline # 1.800.230.9522 NOTE TO STUDENT: This guide is intended for informational purposes only. Due to its condensed format, this guide cannot cover every aspect of the subject; rather, it is intended for use in conjunction with course work and assigned texts. Neither BarCharts, Inc., its writers, editors nor design staff, are in any way responsible or liable for the use or misuse of the information contained in this guide.
Easy
b. What is the probability that she’ll catch a mouse on her first attempt? With a 20% chance of success each time, the probability of succeeding the first time is simply 0.2 We can also use the geometric pdf, with x=1: P(1) = (1– 0.2)1-1 (0.2) = 0.2 c. What is the probability that she’ll catch a mouse on her third attempt? The first success occurring on the third trial means x = 3: P(3) = (1 – 0.2)3 - 1(0.2) = (0.8)2(0.2) = 0.128 d. How many times is she expected to pounce until she succeeds?
E (X) =
1 1 = =5 p 0.2
3. John is playing darts; each time he throws a dart, he has an 8% chance of hitting a bull’s-eye, independently of the result for any other dart thrown; he throws a total of five darts. a. Which distribution is appropriate? With a constant probability of success, and a fixed number of independent events, the total number of successes follows a binomial distribution, with parameters: n = 5, p = 0.08 b. How many bull’s-eyes is John expected to hit? E(X) = np = 5(0.08) = 0.4 c. What is the probability that he hits exactly two bull’s-eyes? x = 2: P(X) = 5C2 0.082 (1 – 0.08)5-2 = (10)(0.0064)(0.92)3 = 0.0498 d. What is the probability that he hits at least one bull’s-eye? As always, P(at least one) = 1 – P(none at all) = 1 – P(0) = 1 – 5C0 0.080(1 - 0.08)5-0 = 1 – 0.925 =1 – 0.6591 = 0.3409
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Great saphenous v.
Medial malleolus tibia
Patellar l.
Peroneus tertius m. Digital fat Tibialis posterior tendon pads Lateral malleolus (fibula)
Proximal digital crease
Index finger
Biceps femoris tendon
Distal palmar crease
2nd metacarpal head
LEFT FOOT (DORSAL VIEW)
Patella
Iliotibial tract
Pes anserinus: Sartorius m. Fl. carpi ulnaris tendon Gracilis m. Semitendinosus m. Distal wrist crease Gastrocnemius m. Pisiform bone lateral head Mid-palmar crease Soleus m. Hypothenar eminence Tibialis anterior m. Abductor digiti minimi m. Ex. digitorum longus m. Proximal palmar crease Lumbrical pad Peroneus brevis m.
Thenar crease
Lower eyelid (palpebra inferior)
Band of Richer (fascia lata)
Proximal wrist crease
Interphalangeal crease
Iris
Xiphoid notch Inferior palpebral sulcus Linea alba Biceps brachii m.: a. = artery Short head ex. = extensor fl = flexor Long head l. = ligament Triceps brachii m.: lateral head Cephalic v. m. = muscle Serratus anterior m. m.m. = muscles Costal ridge v. = vein Brachialis m. Biceps tendon Brachioradialis m. Bicipital aponeurosis Pronator teres m. Medial epicondyle Fl. carpi radialis m. Costo-iliac space Palmaris longus m. Umbilicus (navel) Fl. carpi ulnaris m. Pubic Obliquus externus m. symphysis Fl. carpi radialis tendon Sartorius m. Anterior superior iliac spine Pisiform Iliopsoas m. bone Tensor fasciae latae m. Mons pubis Radial styloid Palmaris longus tendon Adductor Proximal wrist crease m.m. & fat Distal wrist crease Vastus lateralis m. Fl. digitorum superficialis m. Fl. carpi ulnaris tendon Rectus femoris m.
Areola
Fl. digitorum superficialis m.
Pupil Limbus of cornea
Inferior lacrimal papilla & puncta
Serratus anterior m.
RIGHT HAND (PALMAR VIEW)
Cilia (lashes) Lateral canthus (angle)
Lacrimal caruncle Pectoralis major m. Lacrimal lake
Mental prominence
Flank (obliquus externus) Linea semilunaris Iliac crest Trapezium Fl. carpi radialis tendon Thenar eminence Thenar crease Proximal palmar crease Lumbrical pad Distal palmar crease Digital fat pads Distal interphalangeal crease
Bulbar conjunctiva over sclera
Plica semilunaris
Sternal body
Cheek bone (zygomatic)
Red lip margins
EYE
Eyebrow
Upper eyelid (palpebra superior)
Medial commisure Lesser supra- of lids clavicular fossa Medial palpebral l.
Pillar of mouth
Ridge of philtrum Mentolabial sulcus
Brown ridge
Laryngeal prominence
Angle of mandible
Inferior bucolabial sulcus
Cornea
Superior lacrimal Sternohyoid m. papilla & puncta
Root of nose Omohyoid m. Superior palpebral sulcus Supraclavicular fossa Bridge of nose (nasal bone) Helix Infraclavicular fossa Concha Antihelix Pectoralis major m.: Tragus Clavicular segment Antitragus Sternal segment Lobe Coastal segment Masseter m.
Philtrum
Thumb
Superior palpebral sulcus
Epicranial aponeurosis Glabella Temporal m. Frontal eminence Epicranial aponeurosis Scalenus anterior m. Frontalis m. Frontalis m. Frontal sinus (brow ridge)
Eyebrow Upper eyelid Pupil Temporal m. Iris Sclera Lower eyelid Inferior palpebral sulcus Zygomatic arch Wing of nose Greater alar cartilage Nasolabial furrow Modiolus (node)
Head of 1st metatarsal
Abductor digiti Interphalangeal joint minimi m. Hallux (great toe) Tarsal bones Lunula Nail Hallux Nail Abductor hallucis m.
1
Abductor digiti minimi m. Ex. digitorum brevis tendon
Middle phalanges
EAR Auricular (Darwin’s) tubercle
POSTERIOR VIEW
Crura of anithelix Triangular fossa
Greater alar cartilage Vibrissae (external hairs)
MOUTH & NOSE Wing of nose
Medial crus Semispinalis capitis m. Epicranial aponeurosis Nostril Superior pillar of mouth Crus of helix Temporal m. Lateral crus Occiput Scaphoid Ridge of philtrum fossa Buccal fat Anterior notch Nuchal furrow Philtrum Helix Nasolabial External acoustic meatus Tendinous floor furrow of trapezius m. (auditory canal) Modiolus (node) Concha of Helix New skin Rhomboid major m. auricle Supratragic tubercle (under trapezius) (white line) Mastoid Inferior bucolabial Antihelix process Inferior angle of scapula Masseter m. sulcus Splenius Tragus Trapezius tendon Red lip Posterior capitis m. margins Angle of mandible auricular sulcus Infraspinatus m. Cavity of concha SternocleidoSuperior Inferior pillar of mouth m. mastoid Thoracic spine labial tubercle Antitragus Cervicial spine Mouth slit (rima oris) Rear deltoid m. Mentolabial sulcus Clavicle Intertragic incisure Inferior lip (labium) Acromion (scapula) Fat Earlobe Mental prominence Rhomboid triangle Trapezius m. Scapular spine Serratus anterior m. (under latissimus dorsi m.) Cymba conchalis
Deltoid m.
Teres major m.
7th cervical vertebrae Rhomboid minor m. Teres minor m. Scapula medial border
Trapezius m. lower files Ribs Trapezius m. apex Median furrow Erector spinae m. (iliocostalis lumborum)
Triceps brachii m. lateral head
Brachioradialis m. Lateral epicondyle Head of radius Condyloid depression Medial epicondyle Erector spinae m. Externus oblique m. Lumbar triangle Iliac crest Ex. digiti minimi m. Ex. carpi ulnaris Erector spinae tendons over multifidous m.
Latissimus dorsi m. upper border Triceps brachii m. long head Triceps brachii m. medial head Olecranon creases Ex. carpi radialis longus m. Olecranon with overlying bursa Ex. carpi radialis brevis m. Anconeus m. Ex. digitorum communis m. Sacral triangle
Abductor pollicis longus m. Fl. carpi ulnaris m.
Gluteus maximus m.
Ulnar ridge
Triquetrum Buttock fat
Gluteus medius m. Great trochanter
Anatomical snuffbox
Radius
Sacral dimple
Dorsal v.
Intergluteal crease
Ulnar styloid process
Vastus lateralis m.
LEFT FOOT (PLANTAR VIEW)
Femur (medial epicondyle) Semitendinosus tendon
Tubercle of 5th metatarsal bone
Tibia (medial epicondyle) Gastrocnemius m. medial head Abductor hallucis m. Soleus m. Medial arch
Lateral arch Abductor digiti minimi m.
Metatarsophalangeal fat pad for 3,4 & 5
Plantar aponeurosis Fl. digitorum longus m. Adbuctor hallucis m.
Peroneus brevis m.
Medial malleolus (tibia) 1st metatarsophalangeal fat pad Fl. retinaculum Peroneus longus tendon Median crease Ex. digitorum brevis m. Abductor digiti minimi m. Plantar fascia Phalangeal fat pads
Navicular tuberosity
1st dorsal interosseus m. Ex. digiti minimi tendon
Hamstrings Lumbrical expansion group m.m. Abductor digiti minimi m. tendon Biceps femoris m. long head Abductor magnus m. & fat Semitendinosus m. Gracilis m. Semimembranosus m.
Posterior superior iliac spine
Ex. pollicis longus tendon
Calcaneal fat pad
Subgluteal crease
Ex. pollicis brevis m. Trapezium
RIGHT HAND (DORSAL VIEW)
Biceps femoris m. Proximal wrist crease short head Anatomical snuffbox Distal wrist Biceps femoris tendon crease Abductor pollicis longus & Popliteal swelling Ex. retinaculum Trapezoid ex. pollicis brevis tendons bone Sartorius m. 2nd metacarpal bone Ex. carpi radialis Fibula head brevis tendon Trapezium bone Fl. knee crease Ulnar head Cephalic v. Styloid process of ulna st dorsal 1 Gastrocnemius m. Triquetral bone interosseus m. lateral head Basilic v. 1st metacarpoEx. digitorum phalangeal joint communis & ex. indicis tendons Calcaneal Abductor digiti minimi m. (Achilles) Web tendon Thumb Ex. digiti minimi tendon Ex. expansion Tibialis Dorsal finger creases: posterior Proximal Proximal tendon Distal interphalangeal joint Lateral malleolus (fibula) Phalangeal bone bodies nd Proximal heel crease 2 metacarpophalangeal joint Distal Distal heel crease interphalangeal joint Calcaneus Little finger Calcaneal heel fat Lunula Metatarsophalangeal fat pads Ring finger Index finger Nail Digital fat pads Middle finger Medial arch Abductor hallucis m.
2
LATERAL VIEW
HEAD (LATERAL VIEW)
Epicranial aponeurosis Epicranial aponeurosis
Mastoid process
Temporal ridge
Temporal ridge Temporal m.
Temporal m.
Posterior triangle of neck
Superior palpebral sulcus
Sternocleidomastoid m.
Levator scapulae m.
Frontal process (zygomatic bone) Frontal eminence Frontalis m.
Triangular fossa
Frontal sinus
Masseter m.
Nuchal ridge
Submandibular triangle
Trapezius m.
Superior neck crease
Omohyoid m.
Helix
Clavicle
Head of humerus
Mouth slit (rima oris) Nasolabial furrow Mentolabial sulcus Mental prominence Modiolus (node)
Temperomandibular joint Zygomatic arch
Front deltoid m.
Side deltoid m. Trapezius m. Infraspinatus m. Teres minor m.
Sclera
Mastoid process
Coracoid process (scapula)
Rear deltoid m.
Alar cartilage
Lobe
Clavicular head of sternocleidomastoid m.
Spine of scapula
Lateral cartilage
Antitragus
Cricoid cartilage & thyroid gland
7th cervical vertebrae
Iris
Concha
Inferior neck crease
Acromion (scapula)
Root of nose Bridge of nose (nasal bone)
Antihelix
Thyroid cartilage
Trapezius m.
Tragus
Parotid gland
Pectoralis major m.
Buccal fat
Masseter m.
Areola
Submandibular gland
Nipple Rectus abdominis m.
Teres major m. Edge of latissimus dorsi m. [See lateral arm for continuation] Ribs
Obliquus externus m. (area of interdigitation) Costal cartilage
Rectus abdominis m. Linea semilunaris
Head of humerus
Umbilicus
Latissimus dorsi m.
Thyroid cartilage
Angle of mandible
RIGHT ARM & HAND (LATERAL VIEW)
Tendinous intersections
Serratus anterior m.
Hyoid bone
Sternocleidomastoid m.
RIGHT ARM & HAND (MEDIAL VIEW)
Front deltoid m.
Obliquus externus m. (flank portion)
Ribs
Rear deltoid m.
Iliac crest
Erector spinae m.
Side deltoid m.
Deltoid & pectoralis major m.m. Coracobrachialis m.
Anterior superior iliac spine Inferior rib margin
Sartorius m.
Triceps brachii m. lateral head
Mons pubis Triceps tendon
Rectus femoris m. Iliotibial tract
Biceps femoris m. long head
Triceps brachii m. medial head Olecranon folds
Anconeus m.
Patella Iliotibial tract
Biceps femoris tendon
Ex. ulnaris m.
Fat Head of fibula
Patellar l.
Gastrocnemius m. lateral head
Tibial tuberosity
Ex. digiti minimi m.
Radius Tibialis anterior m.
Peroneus longus m.
Ex. retinaculum Peroneus tertius m.
Peroneus brevis m.
Ulnar head
Lateral malleolus (fibula) Calcaneal (Achilles) tendon
Triquetrum
Tibialis anterior tendon Proximal heel crease
Ex. hallucis longus tendon
Distal heel crease
Ex. carpi radialis longus tendon
Ex. hallucis brevis m. Ex. digitorum brevis m.
Fl. hallucis longus m.
2nd metacarpal bone 1st dorsal interosseus m.
5th metatarsal tuberosity
Calcaneus
Ex. tendons
Ex. digitorum longus tendons
Calcaneal fat pad
Digital creases
Peroneal tendons
Ex. digitorum communis m. Brachioradialis m. Ex. pollicis brevis tendon Fl. carpi radialis m. Anatomical snuffbox Palmaris longus m. Ex. pollicis longus tendon
Abductor pollicis longus m.
Ex. digitorum longus m.
Soleus m.
Bicipital aponeurosis
Olecranon of ulna
Lateral epicondyle of femur
Popliteal fossa
Basilic v.
Palmaris longus tendon Proximal wrist crease Proximal wrist crease Distal wrist crease Thenar eminence Distal wrist crease Palmaris brevis m.
Opponens pollicis m.
Thenar eminence
Joint capsule & tendons
Fl. pollicis brevis m. Interphalangeal crease Nail
Fl. pollicis longus tendon
Skin web Digital fat pads
Digital fat pads Tactile elevation
Fl. carpi ulnaris m. Ex. digitorum communis m. Ex. ulnaris m. Fl. digitorum superficialis m. Fl. carpi ulnaris tendon Pisiform Head of ulna Triquetrum Ex. digiti minimi tendon Hypothenar eminence Abductor digiti minimi m.
Thumb fat pad
5th metacarpal bone
Lumbrical pad
Metacarpophalangeal joints
Digital fat pads
Interphalangeal crease
Lumbrical pad
Abductor digiti minimi m.
3
Olecranon folds
Ex. carpi radialis brevis m.
Quadriceps femoris tendon Semimembranosus m.
Medial epicondyle of humerus
Brachioradialis m. Brachialis m. Biceps tendon Biceps tendon Ex. carpi radialis longus m.
Vastus lateralis m.
Biceps femoris m. short head
Pronator teres m.
Brachialis m.
Great trochanter (femur)
Gluteal fat
Triceps brachii m. medial head
Biceps brachii m. short head
Tensor fasciae latae m. Gluteus maximus m.
Triceps brachii m. long head
Biceps brachii m. long head
Gluteus medius m. Flank fat pad
Medial intermuscular septum
Cephalic v.
Phalanges
RIGHT LEG (MEDIAL VIEW)
AXILLA & BREAST
Acromion process
Gluteal fat
Supraclavicular fossa
Pectoralis major m.
Femoral a. & v. Adductor magnus m.
Coracobrachialis m.
Trapezius m.
Omohyoid m.
Clavicle
Deltoid m.
Sternocleidomastoid m. Jugular notch (suprasternal)
Biceps brachii m.: Long head Short head
Gracilis m.
Manubrium (sternum) Deltopectoral groove
Rectus femoris m. Adductor longus m.
Sternal angle
Triceps brachii m. medial head Triceps brachii m. long head
Semimembranosus m. Sartorius m.
Costal cartilage Body (sternum)
Teres major m.
Semitendinosus m.
Axillary tail of mammary gland
Latissimus dorsi m.
Areola Xiphoid (sternum)
Band of Richer (fascia lata)
Serratus anterior m. & rib cage Nipple (papilla)
Vastus medialis m.
Semimembranosus m. Breast (mammary gland & fat)
Areolar glands
Costal margin
FEMALE HIPS
Popliteal swelling Umbilicus
Rectus abdominis m.
Linea alba
Patella
Obliquus externus m.
Iliac crest Fl. knee crease
Abdominal crease
Anterior superior iliac spine Medial condyle of femur
Inguinal l.
Pes anserinus: Sartorius m. Gracius m. Semitendinosus m.
Fat
Gluteus medius m.
Great trochanter
Patellar l.
Pubic symphysis
Tensor fasciae latae m. Tibial tuberosity
Mons veneris
Gastrocnemius m. medial head Tibial plateau
Thigh crease
Rectus femoris m. Tibialis anterior m. Adductor group Anterior margin of tibia
Vulva Labium majus
Soleus m.
Sartorius m.
Vaginal crease
Vastus lateralis m.
Tibia medial surface Linea semilunares
Umbilicus
Linea alba
Calcaneal (Achilles) tendon
Medial malleolus
Inguinal l Ex. retinaculum
Rectus abdominis m.
Proximal heel crease
Anterior superior iliac spine
Gluteus medius m.
Tibialis anterior tendon Ex. digitorum longus tendon
MALE HIPS
Sartorius m.
Distal heel crease Tensor fasciae latae m.
Ex. hallucis longus tendon
Pubic symphysis
Tibialis posterior tendon
Cuneiform l.
Calcaneus
1st metatarsal bone
Great trochanter Inguinal fold Ductus deferens & cremaster m.
Calcaneal fat pad
1st interphalangeal joint
Adductors grouped Tuberosity of navicular bone
Femoral triangle
Nail
Penis Medial arch Abductor hallucis m.
Digital fat pad Metatarsophalangeal joint
Head of 1st metatarsal
NOTE TO STUDENT Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance. All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. ©2004 BarCharts Inc. Boca Raton, FL. 0608
Rectus femoris m.
Scrotum Prepuce (foreskin)
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WORLD’S #1 ACADEMIC OUTLINE
FEMALE UROGENITAL SYSTEM (LATERAL VIEW)
MALE URINARY SYSTEM (ANTERIOR VIEW) Inferior vena cava
Esophagus**
Fibrous capsule
Diaphragm**
Renal cortex
Kidney
R. adrenal gland
Renal column
Renal pelvis
L. adrenal gland
Renal pyramid
R. kidney Renal hilum
L. kidney R. renal a.
Renal medulla
3rd lumbar vertebrae
Renal papillae
L. renal a.
Area cribosa
Ureter
R. renal v.
L. renal v. Base of pyramid
Uterine tube
Renal pelvis
Abdominal aorta
Descending colon
Fimbria R. testicular a.
L. testicular v. Inferior mesenteric a.**
Anterior longitudinal l.
Cervix
Ovary
Sacrum
Uterus Endometrium
Ureter R. common iliac a.
L. common iliac v.
Sigmoid colon
Myometrium Vagina
Cervical canal
Coccyx
Urinary bladder
Sacral n.n.
Internal iliac vessels**
Ductus deferens
Urine
Rectum
Pubic bone
Levator ani m.
Anus Clitoris Urachus (median umbilical l.)**
Rectum**
Urethra**
RIGHT KIDNEY
Tendon levator ani
Labium minus
Prostate
Labium majus Urinary bladder
Urethra
Pelvic bone m.m.
FEMALE UROGENITAL SYSTEM (ANTERIOR VIEW)
Renal column Renal papillae
Upper pole
Kidney
Renal medulla
Vaginal opening
Area cribrosa
Medial margin Fibrous capsule
Renal cortex Renal columns
Superior segment
Renal pyramids
Upper anterior segment
Renal medulla
Renal vessels Renal cortex
Renal hilum
Papillary foramina
Renal papillae
Lower anterior segment
Renal pelvis Area cribosa
Lateral margin Fibrous capsule
Inferior segment
Capsular & perirenal a.a.
Main renal a.
Renal pyramids
Suspensory l. of ovary
Ureter Vesicula appendix chydatid of morgagni Mesosalpinx
Fimbria Base of pyramid
Base of pyramid
Fundus of uterus Body (corpus) of uterus
Corpus albicans
Ovary Main renal v.
Interlobar a.a.
Segmental a.a. & v.v.
Lateral margin
Renal calices
Arcuate a.a. & v.v.
Renal pelvis
Interlobular a.a.
Medial margin Ureter Lower pole
Proper ovarian l.
Round l. Urinary bladder Cervical canal with palmate folds Body of clitoris Crus of clitoris Glans of clitoris Prepuce of clitoris Frenulum of clitoris Urethra Urethral opening Labium minus Orifice of vagina Opening of greater vestibular gland Labium majus Vagina Bulbospongiosus m.
Tubal folds
Corpus luteum Follicle Epoöphorum Endometrium Myometrium ** = cut Opening of ureter a. = artery
a.a. = arteries
Sacrouterine l. L. = Left Trigone of bladder l. = ligament m. = muscle Cervix of uterus Inferior fascia of urogenital diaphragm Fornix of vagina Bulb of vestibule External uterine opening
m.m. = muscles n.n. = nerves R. = Right v. = vein v.v. = veins
Greater vestibule (Bartolin’s) gland & duct
NEPHRON
Afferent glomerular arteriole Fibrous capsule
Glomerular (Bowman’s capsule)
MALE UROGENITAL SYSTEM (LATERAL VIEW) Kidney
Capsular branches
Glomerulus
Area cribosa
Efferent glomerular arteriole Stellate venules
Distal convoluted uriniferous tubule
Fibrous capsule
Renal cortex Renal column
Renal pelvis
Renal pyramid Renal medulla
Renal hilum
Renal papillae
3rd lumbar vertebrae
Cortex Base of pyramid
Ureter Interlobar a.
Proximal convoluted uriniferous tubule
Interlobar v. Straight arterioles Arcuate a. & v.
Peritubular capillaries
Seminal vesicle
Urinary bladder
Ejaculatory duct
Urine
Sigmoid colon
Vas deferens
Rectum
Spermatic cord Straight venule
Renal (uriniferous) tubule (nephron)
Outer zone of medulla
Straight segments of renal tubules
Sacrum
Urethra
Bulbourethral gland (Cowper’s)
Pubis Prostate gland
Fat Corpus cavernosum
Renal medulla (pyramid)
Inner zone of medulla
Loop of Henle: Descending limb Ascending limb
Pelvic bone m.m.
Corpus spongiosum
Anus
Navicular fossa
Vasa recta
Epididymus Glans penis Collecting duct
Interlobar a. & v.
Scrotum
Lobar a. & v.
External urethral meatus
Area cribosa
RENAL CORPUSCLE
Testicular tubules Prepuce (foreskin)
MALE UROGENITAL SYSTEM (ANTERIOR VIEW)
Basement membrane
Macula densa
Testis
Distal convoluted tubule
Basement membrane
Superior segment
Kidney Upper anterior segment
Juxta glomerular cells Afferent arteriole Efferent arterioles
Medial margin
Renal vessels
Red blood cells Endothelium Glomerulus
Smooth m.
Renal medulla
Lower anterior segment
Renal papillae
Inferior segment
Renal calices Base of pyramid
Urinary bladder (sectioned & transparent) External iliac vessels Inferior epigastric vessels Prostatic utricle
Glomerular capsular space
Basement membrane of capillary
Renal pelvis Ureter
Pedicles Plasma Pseudo fenestrations Cell nucleus Endothelial cells Glomerular capillary
Filtration slits (slit pores) Proximal tubule Microvilli
NOTE TO STUDENT
Primary urine (filtrate)
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Seminal vesicle Ductus deferens Uvula of bladder Urethral crest Opening of ejaculatory duct seminal colliculus
Abdominal m.m. Inguinal l. Bulb of penis
Opening of prostatic ducts Bulbourethral (Cowper’s) gland Opening of bulbourethral duct Pampiniform venous plexus Testicular a. Dartos Epididymis Cremaster m. Appendix epididymis Internal spermatic fascia Appendix testis External spermatic fascia Scrotal skin Testis (covered by visceral layer of tunica vaginalis) Corpus cavernosum layer Parietal Corpus spongiosum Trabeculae Tunica albuginea Intercavernous septum of Urethral glands deep (Buck’s ) fascia Corona of glans Valve of navicular fossa Navicular fossa Glans of penis Prepuce External urethral meatus Crus of penis
Bowman’s capsule: Visceral epithelium (podocytes) Parietal epithelium Basement membrane
Trigone of urinary bladder Opening of ureter
Urachus**
Prostate (sectioned & transparent)
Fenestrations
Renal cortex Renal column Renal pyramids
Renal hilum
Lateral margin
Blood flow
Fibrous capsule
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THORACIC & ABDOMINAL
HEART & LUNG LYMPHATICS R. tracheal nodes
L. tracheal nodes
Inferior deep cervical node
RESPIRATORY SYSTEM Nasal cavity
Superior, middle & inferior conchae (turbinates)
Auditory (eustachian) tube
Inferior deep cervical node
L. brachiocephalic v.**
Pharynx
Thoracic duct
Subclavian chain of nodes R. superior tracheobronchial nodes Inferior tracheobronchial nodes
R. brachiocephalic v.**
Oral cavity
Glottis
Tongue
Vocal fold (cord)
Aortic arch node L. superior tracheobronchial nodes Bronchopulmonary (hilar) nodes Subpleural lymphatic plexus
Pulmonary nodes Subpleural lymph plexus
Larynx
Primary bronchi
Trachea
R. lung
Secondary bronchi
VISCERA
Bronchopulmonary (hilar) nodes
Interlobular lymph vessels
Cardiac notch
Pleura
Interlobular lymph vessels
Diaphragm Infracardial nodes
Pulmonary nodes
Bronchiole & lobule Thyroid cartilage
Hyoid bone
Retrocardiac nodes
Thyroid cartilage
L. gastric nodes
Cricoid cartilage
** = cut a. = artery a.a. = arteries Aortic arch L. = Left (l.i.) = large intestine L. lung l. = ligament Ascending l.l. = ligaments aorta m. = muscle
Thyroid gland
Anterior mediastinal nodes Heart (transparent) Trachea Superior vena cava R. lung
ANTERIOR HEART Internal jugular v.
Heart
Spleen
Inferior thyroid v.
Arch of aorta L. pulmonary a.
Internal jugular v.
R. pulmonary a.
Transverse colon
L. external jugular v.
R. subclavian a.
POSTERIOR HEART
Stomach Liver
R. common carotid a.
R. external jugular v.
m.m. = muscles n. = nerve n.n. = nerves R. = Right (s.i.) = small intestine v. = vein v.v. = veins
Superior vena cava
Small intestine L. auricle
Ascending colon
L. common carotid a.
R. superior pulmonary v.
Descending colon L. brachiocephalic v. L. subclavian a.
R. brachiocephalic v.
Aortic arch
L. superior pulmonary v. Cecum
L. inferior pulmonary v.
L. pulmonary a.a.
Superior vena cava
R. inferior pulmonary v.
Great cardiac v. Circumflex branch of L. coronary a. L. pulmonary v.v.
Ascending aorta
L. atrium
R. atrium R. coronary a.
Urinary bladder Sigmoid colon
Posterior branch of L. coronary a.
R. atrium
L. ventricle
Inferior vena cava
Posterior v. of L. ventricle L. ventricle
R. ventricle L. anterior descending (or anterior intraventricular) coronary a.
Inferior vena cava Descending aorta
Fat
Apex
Great cardiac v.
R. coronary a. Apex
Coronary sinus 1
Sulcus terminalis
Posterior descending a. L. atrium Middle cardiac v.
DIGESTIVE SYSTEM
POSTERIOR DIGESTIVE SYSTEM Trachea**
Renal impression Transverse Sulcus for inferior vena cava colon (l.i.) Stomach Liver Spleen Liver Spleen (lymphatic system) Pancreas BRONCHIAL TREE (transparent) Pancreas (behind stomach) Edge of the stomach Duodendum (s.i.) Cricothyroid l. Transverse colon (l.i.) Thyroid cartilage Gallbladder Edge of the liver Omental 6th cervical Jejunum (s.i.) tenia Descending colon (l.i.) Cricoid cartilage vertebrae Mesocolic tenia behind transparent (s.i.) Ascending Tracheal cartilage Descending colon (l.i.) Trachea colon (l.i.) Jejunum (s.i.) Apex Pleura Ileum (s.i.) (transparent) Pleura Shell of the L. lung Appendix Ascending Sigmoid colon Shell of the R. lung colon (l.i.) Cecum Rectum Annular l.l. R. main bronchus L. main bronchus Cecum Ileum (s.i.) Upper lobe bronchus: Upper lobe bronchus (transparent) Apical Free tenia v.v. Superior division bronchus: Anterior Sigmoid colon Apical Appendix Anus Posterior Posterior Rectum Anterior Intermediate bronchus Lingular bronchus: Superior Lower lobe bronchus Anus Inferior Superior lower Lower lobe bronchus Superior lower Middle lobe bronchus: Tracheal bifurcation Lateral Medial Anteromedial basal Lower lobe bronchus: Posterior basal Anterior basal Lateral basal Lateral basal Posterior basal Medial basal (cardiac) Medial basal Basal anterior Vena caval foramen R. dome of the diaphragm Diaphragmatic pleura L. dome of the diaphragm Duodenum (s.i. behind transverse colon)
Esophagus Stomach (transparent)
Costal pleura
Esophagus**
CIRCULATORY SYSTEM Brachiocephalic a. Subclavian v. Cephalic v.
Cardiac impressions
STOMACH & PANCREATIC LYMPHATICS Aorta**
Thoracic duct**
Superior vena cava Vertebral a. Common carotid a.
L. gastric nodes L. superior pancreatic nodes Diaphragm**
External jugular v. Splenic nodes Internal jugular v. Common carotid a. Brachiocephalic a. Aortic arch Ascending aorta
Celiac nodes Cisterna chyli
R. superior pancreatic node Suprapyloric Subclavian a. nodes Axillary a.
Brachial v.
Pyloris Aortic arch
Renal a. Gonadal a.
Hepatic portal v.
Circumflex a.
Superior mesenteric v.
Internal iliac a. Deep femoral v.
Superior mesenteric a.
Ampulla External iliac v.
Abdominal esophagus Pyloric opening Lesser curvature Pyloric sphincter m.**
st
Internal iliac v. L. lateral circumflex a.
STOMACH Cardiac opening
External iliac a.
Superior (1 ) part of duodenum
Superior vena cava
L. gastroepiploic (gastro-omental) node Pancreas (behind stomach) Heart R. gastroepiploic (gastro-omental) nodes Superior mesenteric nodes Descending thoracic aorta Preaortic nodes Superior mesenteric a.**
Infrapyloric nodes Pulmonary a. Head of Brachial a. pancreas Celiac trunk Stomach Abdominal aorta (transparent) Renal v. Duodenum
Inferior vena cava
POSTERIOR CIRCULATORY SYSTEM
Gastric canal
Abdominal aorta
Cardiac notch External iliac a. & v. Internal Fundic stomach iliac a. & v. Serosa
Hepatic v.v.
Stomach musculature: Longitudinal layer**
Greater curvature Gastric folds (rugae)
Pyloric canal 2
Pulmonary v.v. Inferior vena cava
Brachial a. & v.
Splenic v.v.
Oblique layer**
Z line (zigzag) junction of gastric & esophageal mucosa
Pulmonary a.
Axillary a. & v.
Circular layer**
Duodenum
Subclavian a.
Testicular a.
Renal a. & v.
Accessory saphenous v. Lateral circumflex a. & v.
HEPATIC PORTAL VEINS
BILE & PANCREATIC DUCT Inferior vena cava R. gastric v. L. gastric v. R. branch Liver (transparent) Portal v. Cystic v.
Coronary l.**
R. lobe of liver
L. lobe of liver Round l.
Falciform l.
L. hepatic duct R. hepatic duct Common hepatic duct Cystic duct Common bile duct
Gallbladder Accessory pancreatic duct
Body Neck Pancreas** Pancreatic notch Main pancreatic duct Head
Major duodenal papilla Duodenum**
R. colic (hepatic) flexure
Inferior mesenteric v. L. colic v.v. Inferior mesenteric v. Jejunal & ileal v.v. Descending colon Sigmoid v.v.
Ileocolic v.v. Cecal vv.
Jejunum**
LARGE INTESTINE
Ileum
Cecum
L. colic (splenic) flexure
SMALL INTESTINE Thoracic duct**
Haustra
Omental tenia Ileum
Superior mesenteric nodes
Abdominal aorta**
Descending colon
Cisterna chyli Paracolic nodes
Vermiform appendix
Horizontal part Ghost of the ascending colon**
Middle colic nodes
Anus
Inferior mesenteric nodes
L. colic nodes
Sigmoid nodes
ILEOCECAL SPHINCTER & APPENDIX Submucosa**
Preaortic nodes
Common iliac nodes
Ghost of the rectum**
RECTUM Colon **
Superior rectal nodes
Mesocolic tenia** Ileocecal a.**
Superior rectal valve** Middle rectal valve**
Longitudinal m. of ileum**
Longitudinal muscle layer** Rectal fascia**
Circular m. of ileum**
Peritoneal reflection
Circular muscle layer** Inferior rectal valve** Levator ani m.**
Terminal part of ileum** Anal column
Papilla ilealis**
Internal venousplexus in submucous space Ileocecal fold Appendicular a.
Semilunar fold**
Ghost of the appendix
Paracolic nodes
Appendicular nodes
Cecum**
Ileum
Cecal nodes
Exterior anal sphincter m.
Ileocecal valve & opening**
Ghost of the descending colon**
Paracolic nodes
R. colic nodes Ileocolic nodes
Submucosa**
Jejunum
Semilunar folds
Rectum
Peritoneum** Longitudinal m. of colon** Circular m. of colon**
Duodenojejunal flexure
Ascending part Epicolic nodes
Sigmoid colon
Rectosigmoid junction
Free tenia**
Duodenum
Celiac nodes
Mesocolic tenia
Cecum
Superior part
Ampulla Duodenum: (Descending part) Ghost of the transverse colon**
Free tenia (tenia libera)
Ascending colon
Rectum
Transverse colon (below)**
Ascending colon
Omental tenia**
Sigmoid colon Common iliac v.v. Superior rectal v.
Appendix
Appendicular v.
LYMPHATICS & LARGE INTESTINE
Free tenia (tenia libera)
L. branch Stomach (transparent) Spleen Splenic v. L. gastroepiploic v.
Inferior vena cava R. colic v. Ascending colon
Duodenojejunal flexure
Duodenal longitudinal folds
Esophagus
Gallbladder Pancreaticoduodenal v.v. Pancreas R. colic flexure Duodenum Middle colic v. Superior mesenteric v.
Tail
Lesser duodenal papilla
Hepatic v.v.
Anal verge
Vermiform appendix** Anal sinus Anorectal (dentate) line Anocutaneous line
Opening of vermiform appendix** 3
Internal anal sphincter m.** External anal sphincter m.: Deep** Superficial** Subcutaneous** Fibrous septum** Corrugator cutis Anal gland** ani m.** Anal crypt** Anal valve**
LYMPHATIC SYSTEM
MALE URINARY SYSTEM (ANTERIOR VIEW) Inferior vena cava
Esophagus**
R. adrenal gland
Axillary lymph nodes
Brachiocephalic v.**
L. adrenal gland R. kidney
Intercostal nodes
L. kidney R. renal a.
L. thoracic duct
R. lymphatic trunk
Diaphragm**
Lymphatic vessels
L. renal a.a.
R. renal v.
Intestinal nodes
L. renal v.
Renal pelvis
Cubital lymph nodes
Abdominal aorta
R. testicular a.**
L. testicular v.
Anterior longitudinal l.
Inferior mesenteric a.** Ureter
R. common iliac a.**
L. common iliac v.
Sacral n.n.**
R. KIDNEY
Internal iliac vessels**
Renal column**
Para-aortic nodes Renal papillae** Area cribrosa**
Renal medulla**
Rectum**
Inguinal lymph nodes
Upper pole
Levator ani m.
Ductus deferens**
Cisterna chyli Common iliac nodes
Renal cortex** Papillary foramina
Urachus (median umbilical l.)**
Urinary bladder
Superficial lymph vessels Capsular & perirenal a.a.
Fibrous capsule** Prostate
Main renal a.** Main renal v.**
Renal pyramids**
Urethra**
Base of pyramid
Segmental a.a. & v.v.
Interlobar a.a.**
FEMALE UROGENITAL SYSTEM (LATERAL VIEW)
Lateral margin Renal pelvis
Arcuate a.a. & v.v.** Renal cortex**
Ureter**
Fibrous capsule** Interlobular a.a.**
Kidney
Renal pelvis
MALE UROGENITAL SYSTEM (LATERAL VIEW)
Renal calices
Kidney Area cribosa**
Renal column Lower pole
Renal hilum
Ureter
Renal papillae**
Base of pyramid**
Renal cortex** Renal column** Renal pyramid**
Renal pelvis**
rd
Area cribosa**
Uterine tube
Medial margin
Renal hilum 3 lumbar vertebrae Ureter Urinary bladder Urine Vas deferens
Renal medulla**
3rd lumbar vertebrae
Fibrous capsule**
Renal medulla** Renal papillae** Base of pyramid** Seminal vesicle** Ejaculatory duct**
Urethra
Descending colon
Fimbria
Sigmoid colon** Rectum**
Spermatic cord Cervix**
Ovary
Sacrum
Uterus**
Bulbourethral gland (Cowper’s)
Sigmoid colon**
Endometrium**
Prostate gland**
Myometrium** Vagina**
Cervical canal**
Fat**
Corpus cavernosum** Coccyx
Urinary bladder** Urine
Anus**
Clitoris
Tendon levator ani
Labium minus Vaginal opening** Urethra**
NOTE TO STUDENT Use this comprehensive study guide in the classroom, in the gym, at home or anywhere you need complete anatomical information. This guide is not designed to take the place of classroom attendance.
Pelvic bowl m.m.**
Pelvic bowl m.m.**
Corpus spongiosum**
Rectum**
Pubic bone**
Labium majus
Sacrum
Pubis**
Navicular fossa**
Anus**
Glans penis**
Epididymus**
Prepuce (foreskin)**
Scrotum**
Testicular tubules**
External urethral meatus**
ISBN-13: 978-142320760-3 ISBN-10: 142320760-2
Testis**
CREDITS Images ® Vincent Perez/perezstudio.com Layout: Rich Marino, Andrea Hutchinson
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WORLD’S #1 ACADEMIC OUTLINE
VOLUME (LIQUID)
BASIC MEASUREMENT SYSTEMS All measurement is derived from seven basic units and is described internationally as the Systéme International d’Unitiés (SI) or sometimes referred to as SI-metric. These basic units are: Ampere A Electric Current Candela cd Luminosity (intensity of light) Kelvin K Thermodynamic Temperature Kilogram kg Weight (mass) Meter (Metre) m Length Mole mol Substance (molecule) Second s Time
Unit
LENGTH Unit Angstrom Cable Centimeter Chain (Gunter’s/surveyor’s) Chain (Ramden’s/engineer’s) Decimeter Dekameter Fathom Foot Furlong Hand (horse’s height) Inch Kilometer League Link (Gunter’s) Link (Ramden’s) Meter Micrometer (Micron) Mile (statute/land) Mile (nautical/sea) Millimeter Mil Point (type size) Pica (type size) Rod Yard
Abbr SI/metric Å cb cm chG chR dm dam fm ft fur – in km – – – m µ mi nmi mm mil – – rd yd
Imperial
.0001µ (10-10) 219.456 m .01 m 20.1168 m 30.48 m .1 m 10 m 1.83 m .3048 m 201.168 m 10.16 cm 2.54 cm 1,000 m 4.8 km .201 m .305 m – .001 mm 1.609 km 1.85 km .001 m .0254 mm .353 mm 4 mm 5.029 m .9144 m
.000,000,004 in 120 fathoms/720 ft .3937 in 66 feet/4 rods 100 ft 3.937 in 32.8 ft 6 ft 12 in ¹⁄₈ statute mi 4 in – .621 mi 3 statute mi 7.92 in 12 in 39.37 in 3.9370x10-5 in 5,280 ft 6076.11549 ft .03937 in .001 in .0138 in 12 points (.1668 in) 16.5 ft 3 ft
Unit
Abbr SI/metric A a ha cm 2 ft 2 in 2 km 2 m2 mi 2 mm 2 rd 2 yd 2
Unit
Unit Dram (avdp) Grain Gram Kilogram Milligram Ounce (avdp) Ounce (troy) Pennyweight Pound (avdp) Stone Ton (long or British) Tonne (metric) Ton (short)
Abbr
Equivalent
Btu cal15 HP J Kw
.0002929 Kw 4.1858 J 746 watts .7376 ft/lbs 1.341 HP
cm3 ft3 in3 ST yd3
SI/Metric 1,000 mm3 .02832 m3 16.387 cm3 1 m3 .7646 m3
Abbr
SI/Metric
dr (avdp) gr g kg mg oz oz tr dwt lb st lt mt sh t
1.772 g .0648 g .001 kg 1,000 g .001 g .0280 kg .03 kg 1.555 g .454 kg 6.35 kg 1,016 kg 1,000 kg 907.18 kg
NUMERICAL PREFIXES 1
/10 1 /2 1 2 3 4 5 6 7 8 9 10 11 12 15
ENERGY Unit
Imperial
Imperial .061 in3 1,728 in3 –
1.3 yd3 27 ft3
WEIGHT
43,560 ft 2 1076.39 ft 2 2.471 A .155 in 2 144 in 2 .386 mi 2 10.764 ft 2 640 A .00155 in 2 272.25 ft 2 9 ft 2
British Thermal Unit Calorie (@15.5˚c) Horsepower (mechanical) Joule (absolute) Kilowatt
Abbr
Cubic centimeter Cubic foot Cubic inch Stere (cubic meter) Cubic yard
Imperial
4,047 m 2 100 m 2 10,000 m 2 100 mm 2 .0929 m 2 6.4516 cm 2 1,000,000 m 2 10,000 cm 2 2.59 km 2 – 25.293 m 2 .836 m 2
SI/Metric
VOLUME (DRY)
AREA Acre Are Hectare Square centimeter Square foot Square inch Square kilometer Square meter Square mile Square millimeter Square rod Square yard
Abbr
Barrel (US) fluid bbl 26.2 gal (UK) 31.5 gal* Dram (US) dr 3.697 ml .125 oz gi .142 L 4.8038 oz Gill (¹⁄₄ UK pint) Gallon (UK) gal 4.546 L 1.201 gal Gallon (US) gal 3.785 L 4 qt Liter L .001 m3 1.057 qt Ounce, fluid (UK) oz .028 L .96 oz Ounce, fluid (US) oz .02957 L 2 tbs Pint (UK) pt 1.2 pt (US) 19.2 oz Pint (US) pt .833 pt (UK) 16 oz Quart qt .946 L 2 pt *A barrel may be recognized by different liquid sizes in different states and for different substances. Sizes may be stated in gallons, cubic inches or weight. See notes on page 2.
1
Deci Semi, hemi, demi Uni Bi, di Tri, ter Tetra, tetr, quadri Penta, quint Sex, hex, hexa Hept, sept, septo Oct, octo Non, ennea Dec, deca, deka Hendeca, undeca Dodeca Quindeca
Imperial .0625 oz .00229 oz .03527 oz 2.2 lb .00003 oz .0625 lb 1.0971 oz .05486 oz 16 oz 14 lb 2,240 lb 2204.6 lb 2,000 lb
SI PREFIXES Factor 10 24 10 21 10 18 10 15 10 12 10 9 10 6 10 3 10 2 10 10 -1 10 -2 10 -3 10 -6 10 -9 10 -12 10 -15 10 -18 10 -21 10 -24
Prefix yottazettaexapetateragigamegakilohectodekadecicentimillimicronanopicofemtoattozeptoyocto-
Symbol Y Z E P T G M k h da d c m µ or r n p f a z y
LENGTH
AREA
LIQUID CAPACITY
DRY CAPACITY
Centimeters & Inches cm x .394 = in in x 2.54 = cm
Sq. Centimeters & Sq. In. cm2 x .155 = in2 in2 x 6.452 = cm2
UK & US Gallons UK gal x 1.201 = US gal US gal x .833 = UK gal
Cubic Centimeters & Cubic Inches cm3 x .061 = in3 3 in x 16.387 = cm3
Centimeters & Millimeters cm x 10 = mm mm x .1 = cm
Sq. Meters & Sq. Chains (G)* m2 x .0025 = ch2 ch2 x 404.686 = m2
UK & US Quarts UK qt x 1.201 = US qt US qt x .833 = UK qt
Sq. Rods & Sq. Chains (G)* rd2 x 625 = ch2 (G) ch2 x 16 = rd2
UK & US Pints UK pt x 1.201 = US pt US pt x .833 = UK pt
Sq. Chains & Acres ch2 (G) x .1 = A A x 10 = ch2(G)
UK & US Ounces UK oz x .961 = US oz US oz x 1.041 = UK oz
Sq. Chains (G)* & Sq. Feet ch2 (G) x 4,356 = ft2 ft2 x .00023 = ch2 (G)
UK Gallons & Liters UK gal x 4.546 = L L x .220 = UK gal
Hectares & Sq. Miles ha x .0039 = mi2 mi2 x 258.999 = ha
UK Quarts & Liters UK qt x 1.137 = L L x .880 = UK qt
Cubic Meters & Cubic Feet m3 x 35.315 = ft3 ft3 x .028 = m3
Hectares & Acres ha x 2.471 = A A x .405 = ha
UK Pints & Liters UK pt x .568 = L L x 1.760 = UK pt
Pints & Quarts pt x .5 = qt qt x 2 = pt
Acres & Sq. Miles A x .00156 = mi2 mi2 x 640 = A
UK Ounces & Milliliters UK oz x 28.413 = ml ml x .035 = UK oz
Sq. Kilometers & Sq. Miles km2 x .386 = mi2 mi2 x 2.590 = km2
US Gallons & Liters US gal x 3.785 = L L x .264 = US gal
Sq. Meters & Acres m2 x .000247 = A A x 4046.856 = m2
US Quarts & Liters US qt x .947 = L L x 1.056 = US qt
Sq. Meters & Hectares m2 x .0001 = ha ha x 10,000 = m2
US Pints & Liters US pt x .473 = L L x 2.113 = US pt
Sq. Meters & Sq. Feet m2 x 10.764 = ft2 ft2 x .093 = m2
US Ounces & Liters US oz x .03 = L Liter x 33.8 = US oz
Chains (G)* & Yards ch x 22 = yd yd x .455 = ch
Sq. Meters & Sq. Yards m2 x 1.196 = yd2 yd2 x .836 = m2
US Ounces & Milliliters US oz x 29.572 = ml ml x .034 = US oz
Fathoms & Feet fa x 6 = ft ft x .167 = fa
Sq. Meters & Sq. Rods m2 x .03954 = rd2 rd2 x 25.293 = m2
Gills (US) & Ounces (US) gi x 4 = oz oz x .25 = gi
Kilometers & Feet km x 3280.84 = ft ft x (3.048 x 10–4) = km
Sq. Yards & Sq. Feet yd2 x 9 = ft2 ft2 x .1111 = yd2
Gills (US) & Cubic Centimeters
Kilometers & Yards km x 1093.6 = yd yd x .00091 = km
*(G) = Gunter’s or surveyor’s chain
Gills (UK) & Cubic Centimeters gi x 142.065 = cc cc x .00704 = gi
Centimeters & Picas cm x 2.371 = picas picas x .4233 = cm Centimeters & Points cm x 28.4528 = points points x .0351 = cm Millimeters & Inches mm x .0394 = in in x 25.4 = mm Millimeters & Micrometers (Microns) mm x 1,000 = µ µ x .001 = mm
Meters & Chains (G) m x .04971 = ch ch x 20.117 = m Meters & Fathoms m x .547 = fm fm x 1.83 = m Meters & Feet m x 3.281 = ft ft x .305 = m Meters & Yards m x 1.094 = yd yd x .914 = m Meters & Furlongs m x .005 = fur fur x 201.17 = m Chains (G)* & Feet ch x 66 = ft ft x .015 = ch Chains (G)* & Rods ch x 4 = rd rd x .25 = ch
Kilometers & Statute Miles km x .621 = mi mi x 1.609 = km Kilometers & Nautical Miles km x .540 = n mi n mi x 1.852 = km Nautical Miles & Statute Miles n mi x 1.15 = s mi s mi x .869 = n mi
*(G) = Gunter’s or surveyor’s chain
gi x 118.29 = cc cc x .00845 = gi
KITCHEN LIQUID MEASURES 1 gal ¹⁄₂ gal ¹⁄₄ gal
4 qt 2 qt 1 qt ¹⁄₂ qt ¹⁄₄ qt
8 4 2 1 ¹⁄₂
pt 16 cups 128 fl pt 8 cups 64 fl pt 4 cups 32 fl pt 2 cups 16 fl pt 1 cup 8 fl ¹⁄₂ cup 4 fl ¹⁄₄ cup 2 fl ¹⁄₈ cup 1 fl ¹⁄₂ fl
oz 3.79L oz 1.89L oz .95L .47L oz oz .24L oz .12L 8 Tbs 24 tsp oz .06L 4 Tbs 12 tsp oz .03L 2 Tbs 6 tsp oz .015L 1 Tbs 3 tsp
2
WEIGHT Grains (gr) & Grams gr x .065 = g g x 15.432 = gr
(g)
Drams
(avdp)* & Ounces (avdp) dr (avdp) x .062 = oz (avdp) oz (avdp) x 16 = dr (avdp)
Cubic Inches & Cubic Feet in3 x .000579 = ft3 3 ft x 1,728 = in3
Pennyweight & Grams dwt x 1.5552 = g g x .643 = dwt
Cubic Feet & Cubic Yards ft3 x .037 = yd3 yd3 x 27 = ft3
Grams & Ounces (US) g x .035 = oz oz x 28.349 = g
Cubic Meters & Cubic Yards m3 x 1.308 = yd3 yd3 x .765 = m3
Ounces (troy) & Grains oz tr x 480 = gr gr x .00208 = oz tr Ounces (troy) & Grams oz tr x 31.103 = g g x .032 = oz tr Ounces (troy) & Ounces (avdp) oz tr x 1.097 = oz (avdp) oz (avdp) x .911 = oz tr
Ounces (avdp) & Pounds (avdp) oz (avdp) x .0625 = lb (avdp) lb (avdp) x 16 = oz (avdp)
Quarts & Pecks qt x .125 = pk pk x 8 = qt
Milligrams & Grains mg x .015 = gr gr x 64.799 = mg
Pecks (US) & Bushels (US) pk x .25 = bu bu x 4 = pk
Grains & Carats gr x .32399 = c c x 3.0865 = gr Grams & Carats (metric) g x 5 = c (metric) c (metric) x .2 = g
Bushels (US) & Barrels (US)* bu x .0305 = bbl bbl x 3.281 = bu Bushels (UK) & Bushels (US) bu (US) x .969 = bu (UK) bu (UK) x 1.032 = bu (US) * A barrel is not the same container as a steel drum, which typically holds 55 gallons (US). Barrels come in different sizes based on their contents, as defined by various statutes. Oil = 42 gal Beer = 31 gal (US) Beer = 50 liters (Europe) Dry Goods = 7,056 in3 Cranberries = 5,826 in3 Flour = 196 lbs. Cornmeal = 200 lbs. Cement = 376 lbs. Lime = 280 lbs.
Milligrams & Carats (metric) mg x .005 = c (metric) c (metric) x 200 = mg Pounds & Kilograms lb x .454 = kg kg x 2.205 = lb Tons (long) & Pounds (avdp) lt x 2,240 = lbs (avdp) lbs (avdp) x .0004464 = lt Tons (short) & Pounds (avdp) sht x 2,000 = lbs (avdp) lbs (avdp) x .0005 = sht Tonnes (metric) & Pounds (avdp) t x 2204.62 = lbs (avdp) lbs (avdp) x .0004536 = t *avdp = avoirdupois (from French), meaning “goods of weight”
KITCHEN DRY MEASURES 1 cup ³⁄₄ cup ²⁄₃ cup ¹⁄₂ cup ¹⁄₃ cup ¹⁄₄ cup ¹⁄₈ cup ¹⁄₁₆ cup ¹⁄₄₈ cup
8 fl 6 fl 5¹⁄₃ fl 4 fl 2 ²⁄₃ fl 2 fl 1 fl ¹⁄₂ fl ¹⁄₆ fl
oz oz oz oz oz oz oz oz oz
16 Tbs 12 Tbs 10²⁄₃ Tbs 8 Tbs 5¹⁄₃ Tbs 4 Tbs 2 Tbs 1 Tbs ¹⁄₃ Tbs
48 36 32 24 16 12 6 3 1
tsp tsp tsp tsp tsp tsp tsp tsp tsp
237 177 158 118 79 59 30 15 5
ml ml ml ml ml ml ml ml ml
LUMBER SIZES Nominal inches
Actual (dry) inches mm
COMMON NAILS
Actual (green) inches mm
60d
THICKNESS 1 1¹⁄₄ 1¹⁄₂ 2 2¹⁄₂ 3 3¹⁄₂ 4 4¹⁄₂ 6 8
³⁄₄ 1 1¹⁄₄ 1¹⁄₂ 2 2¹⁄₂ 3 3¹⁄₂ 4 5¹⁄₂ 7¹⁄₂
19 25 32 38 51 64 76 89 102 140 191
²⁵⁄₃₂ 1¹⁄₃₂ 1⁹⁄₃₂ 1⁹⁄₁₆ 2¹⁄₁₆ 2⁹⁄₁₆ 3¹⁄₁₆ 3⁹⁄₁₆ 4¹⁄₁₆ 5⁹⁄₁₆ 7⁹⁄₁₆
20 26 33 40 52 65 78 90 103 141 194
1⁹⁄₁₆ 2⁹⁄₁₆ 3⁹⁄₁₆ 4⁵⁄₈ 5⁵⁄₈ 6⁵⁄₈ 7¹⁄₂ 8¹⁄₂ 9¹⁄₂ 10¹⁄₂ 11¹⁄₂ 13¹⁄₂ 15¹⁄₂
40 65 90 117 143 168 190 216 241 267 292 343 394
50d 40d 30d 20d 16d 12d
WIDTH 2 3 4 5 6 7 8 9 10 11 12 14 16
1¹⁄₂ 2¹⁄₂ 3¹⁄₂ 4¹⁄₂ 5¹⁄₂ 6¹⁄₂ 7¹⁄₄ 8¹⁄₄ 9¹⁄₄ 10¹⁄₄ 11¹⁄₄ 13¹⁄₄ 15¹⁄₄
38 64 89 114 140 165 184 210 235 260 286 337 387
10d 9d 8d 7d 6d 5d 4d 1
2
3
4
5
6
NOT TO SCALE
BOLT GRADES
GEOMETRY LENGTH
h
Rectangle
Stove Bolt
Area (A) = Width (w) x Height (h)
SAE Strength Standard Markings
Strongest
Weakest
Hex Bolt
w
Carriage Bolt
Triangle
h
Machine Screw
8
7
b
Bolt to Screw
Pythagorean Theorem:
c
b
If a right triangle has hypotenuse (c) and sides (a) and (b), then: c2 = a2 + b2
a a h
5
3
0, 1 & 2
¹⁄₁₆
¹⁄₆₄ ¹⁄₃
1
⁵⁄₆₄
¹⁄₃₂ ¹⁄₃₂
2
³⁄₃₂
¹⁄₃₂ ³⁄₆₄
3
⁷⁄₆₄
³⁄₆₄ ¹⁄₁₆
4
⁷⁄₆₄
³⁄₆₄ ¹⁄₁₆
5
¹⁄₈
¹⁄₁₆ ⁵⁄₆₄
Cone
6
¹⁄₈
¹⁄₁₆ ⁵⁄₆₄
Volume (V) = πr2h 3 Area of curved surface: A = πr√r2+h2
⁵⁄₃₂ ¹⁄₁₆ ³⁄₃₂ 8 ¹¹⁄₆₄ ⁵⁄₆₄ ³⁄₃₂ 9 ³⁄₁₆ ⁵⁄₆₄ ⁷⁄₆₄ 10 ³⁄₁₆ ³⁄₃₂ ⁷⁄₆₄
Sphere
11 ¹³⁄₆₄ ³⁄₃₂ ¹⁄₈
Circle
r
Area (A) = πr 2 Circumference (C) = 2πr π = 3.1416 r= radius
h r
r
LENGTH IN INCHES
0
Volume (V) = 4πr3 3 Surface Area: A = 4πr2
S O F T
W O O D
H A R D
W O O D
¹⁄₄
³⁄₈ ¹⁄₂
⁵⁄₈
³⁄₄
⁷⁄₈
12 ⁷⁄₃₂
⁷⁄₆₄ ¹⁄₈
¹⁄₄
⁷⁄₆₄ ⁹⁄₆₄
Oval Head
Round Head
Flat Head
16 ¹⁷⁄₆₄ ⁹⁄₆₄ ⁵⁄₃₂
h
Right Cylinder
18 ¹⁹⁄₆₄ ⁹⁄₆₄ ³⁄₁₆
Common Sizes
Volume (V) = πr2h Lateral surface area (A) = 2πrh
20 ²¹⁄₆ ¹¹⁄₆₄ ¹³⁄₆₄
Some Availability
24
³⁄₈
³⁄₁₆ ⁷⁄₃₂ 3
1 1¹⁄₄ 1¹⁄₂ 1³⁄₄ 2 2¹⁄₄ 2¹⁄₂ 2³⁄₄ 3 3¹⁄₂ 4 4¹⁄₂ 5
Screw Length
7
14
NOTE: There is no “4” grade.
STANDARD WOOD SCREWS
S H A N K
Area (A) = (a+b) x h 2
Bolt to Bolt
PILOT HOLE SIZES G A U G E
Trapezoid b
r
6
Area (A) = ¹⁄₂ Base (b) x Height (h)
FAHRENHEIT-TO-CELSIUS CONVERSION ˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
˚F
˚C
-50 -49 -48 -47 -46 -45 -44 -43 -42 -41 -40 -39 -38 -37 -36 -35 -34 -33 -32 -31 -30 -29 -28 -27
-45.6 -45.0 -44.4 -43.9 -43.3 -42.8 -42.2 -41.7 -41.1 -40.6 -40.0 -39.4 -38.9 -38.3 -37.8 -37.2 -36.7 -36.1 -35.6 -35.0 -34.4 -33.9 -33.3 -32.8
-26 -25 -24 -23 -22 -21 -20 -19 -18 -17 -16 -15 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3
-32.2 -31.7 -31.1 -30.6 -30.0 -29.4 -28.9 -28.3 -27.8 -27.2 -26.7 -26.1 -25.6 -25.0 -24.4 -23.9 -23.3 -22.8 -22.2 -21.7 -21.1 -20.6 -20.0 -19.4
-2 -1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
-18.9 -18.3 -17.8 -17.2 -16.7 -16.1 -15.5 -15.0 -14.4 -13.9 -13.3 -12.8 -12.2 -11.6 -11.1 -10.5 -10.0 -9.4 -8.9 -8.3 -7.8 -7.2 -6.7 -6.1
22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
-5.5 -5.0 -4.4 -3.9 -3.3 -2.8 -2.2 -1.7 -1.1 -0.5 0.0 0.5 1.1 1.7 2.2 2.8 3.3 3.9 4.4 5.0 5.5 6.1 6.7 7.2
46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69
7.8 8.3 8.9 9.4 10.0 10.5 11.1 11.7 12.2 12.8 13.3 13.9 14.4 15.0 15.5 16.1 16.7 17.2 17.8 18.3 18.9 19.4 20.0 20.5
70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93
21.1 21.7 22.2 22.8 23.3 23.9 24.4 25.0 25.5 26.1 26.7 27.2 27.8 28.3 28.9 29.4 30.0 30.5 31.1 31.7 32.2 32.8 33.3 33.9
94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117
34.4 35.0 35.5 36.1 36.7 37.2 37.8 38.3 38.9 39.4 40.0 40.5 41.1 41.7 42.2 42.8 43.3 43.9 44.4 45.0 45.5 46.1 46.7 47.2
118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141
47.8 48.3 48.9 49.4 50.0 50.5 51.1 51.7 52.2 52.8 53.3 53.9 54.4 55.0 55.5 56.1 56.7 57.2 57.8 58.3 58.9 59.4 60.0 60.5
142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165
61.1 61.7 62.2 62.8 63.3 63.9 64.4 65.0 65.5 66.1 66.7 67.2 67.8 68.3 68.9 69.4 70.0 70.5 71.1 71.7 72.2 72.8 73.3 73.9
166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189
74.4 75.0 75.5 76.1 76.7 77.2 77.8 78.3 78.9 79.4 80.0 80.5 81.1 81.7 82.2 82.8 83.3 83.9 84.4 85.0 85.5 86.1 86.7 87.2
190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212
87.8 88.3 88.9 89.4 90.0 90.5 91.1 91.7 92.2 92.8 93.3 93.9 94.4 95.0 95.5 96.1 96.7 97.2 97.8 98.3 98.9 99.4 100.0
TC X 1.8 + 32 = TF
WIND CHILL INDEX (˚F) REVISED 2001 0 mph
40˚
35˚
30˚
25˚
20˚
15˚
10˚
5˚
0˚
5 mph
36
31
25
19
13
7
1
-5
-11
10 mph 34 15 mph 32
27 25
21 19
15 13
9 6
3
-4
0
-7
20 mph 30
24
17
11
4
-2
-9
25 mph 29
23
16
9
3
-4
-11
30 mph 28
22
15
8
1
-5
-12
35 mph 28
21
14
7
0
-7
-14
40 mph 27
20
13
6
-1
-8
45 mph 26
19
12
5
-2
-9
-10
-16
-13
-19
-15
HEAT INDEX
-16
-22
-22
-28
-26
-32 -35
-28
-34
-35
-41
-39
-45
-42
-48
-40 -47 -51 -55
-46 -53 -58 -61
-52 -59 -64 -68
-57 -63 -66 -72 -71 -77
-22
-29
-74 -81
-17
-24
-31
-37
-44
-51
-58
-64
-71
-78 -84
-19
-26
-33
-39
-46
-53
-60
-67
-73
-80 -87
-21
-27
-34
-41
-48
-55
-62
-69
-76
-52 -89
-15
-22
-29
-36
-43
-50
-57
-64
-71
-78
-84 -91
-16
-23
-30
-37
-44
-51
-58
-65
-72
-79
-86 -93
50 mph 26 19 12 4 -3 -10 -17 -24 -31 -38 -45 -52 -60 -67 -74 -81 -88 -95 WINDCHILL (˚F) = 35.74 + 0.6215T - 35.75(V0.16) + 0.4275T(V0.16 ) V = WIND SPEED (mph) T (˚F) = AIR TEMP.
SAFFIR-SIMPSON HURRICANE SCALE CAT.
IN. MERCURY MILLIBARS
> 28.94
1
WIND/KPH
WIND/MPH
WIND/KNOTS SURGE/FT
74-95
119-153
> 980
CURRENT TEMPERATURE ˚F
-5˚ -10˚ -15˚ -20˚ -25˚ -30˚ -35˚ -40˚ -45˚
64-82
4-5
R E L A T I V E H U M I D I T Y
Moderate. Overturned mobile homes, downed trees, shingles blown off and some signs down.
70˚
75˚
80˚
85˚
90˚
95˚
100˚
64
69
73
78
83
87
91
10%
65
70
75
80
85
90
95
20%
66
72
77
82
87
93
99
30%
67
73
78
84
90
96
10 4
40%
68
74
79
86
93
101
11 0
50%
69
75
81
88
96
107
12 0
60%
70
76
82
90
100
114
13 2
70%
70
77
85
93
106
124
14 4
80%
71
78
86
97
113
136
15 7
90%
71
79
88
102
122
150
17 0
100%
72
80
91
108
133
166
184
BEAUFORT WIND SCALE
DAMAGE LIKELY Minimal. Broken trees, shrubs and street signs. Inwater boat and mobile home damage.
0˚ 0%
WIND SPEED KPH
MPH
KNOTS
#
DESCRIPTION
0
0
0
0
calm
1-5
1-3
1-3
1
light air
6 - 11
4-7
4-6
2
light breeze
2
28.50-28.91
965-979
154-177
96-110
83-95
6-8
3
27.91-28.47
945-964
178-209
111-130
96-113
9-12
4
27.17-27.88
920-944
210-249
131-155
114-135
13-18
Extreme. Roofs blown off, building walls collapsed. Storm surge near beach flooding homes.
12 - 19
8 - 12
7 - 10
3
gentle breeze
> 18
Catastrophic. Concrete structures damaged. Small structures and cars overturned and blown away.
20 - 28
13 - 18
11 - 16
4
moderate breeze
29 - 38
19 - 24
17 - 21
5
fresh breeze
39 - 49
25 - 31
22 - 27
6
strong breeze
50 - 61
32 - 38
28 - 33
7
near gale
5
< 27.17
< 920
> 249
> 155
> 135
FUJITA-PEARSON
SUN TANNING INDEX
TORNADO SCALE REVISED 2007
SKIN PROTECTION FACTOR # TO USE
CLASS
TYPE SKIN REACTION Tans little or not at all, 1 always burns easily & severely, then peels Usually burns easily & 2 severely; tans minimally & lightly, also peels
EXAMPLES
People with fair skin, blue 12-20 or hazel eyes, blonde or red hair
Burns moderately, gains Average caucasian
Burns minimally, tans 4 easily & above average with each exposure
People with light brown skin, dark brown hair, dark eyes
Rarely burns, tans easily Brown-skinned persons
5 & substantially
6 Tans profusely & never burns
SPF#
People with fair skin, blue eyes, freckles, white, 20-30 unexposed skin
3 average tan
Black-skinned persons
Extensive. Large trees down; signs, awnings and windows broken. Mobile homes destroyed.
F F F F F F
0 1 2 3 4 5
KPH
MPH
DAMAGE LIKELY
64 - 116 117 - 180 181 - 253 254 - 332 333 - 419 420 - 512
40 - 72 73 - 112 113 - 157 158 - 207 208 - 260 261 - 318
light moderate considerable severe devastating incredible
62 - 74
39 - 46
34 - 40
8
gale
75 - 88
47 - 54
41 - 47
9
strong gale
89 - 102
55 - 63
48 - 55
10
storm
103 - 117 64 - 72
56 - 63
11
violent storm
> 64
12
hurricane
> 118
> 73
SMALL CRAFT ADVISORY GALE WARNING STORM WARNING
HURRICANE WARNING
8-10
ULTRAVIOLET INDEX
Price: U.S. $4.95 / CAN. $7.50
5-8
VALUE EXPOSURE
quickstudy.com
free downloads &
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4 2
0-2
Minimal
3-4
Low
5-6
Moderate
7-9
High
> 10
Very High
All rights reserved. No part of this publication may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the publisher. © 2002, 2003 BarCharts, Inc. 0408
Customer Hotline # 1.800.230.9522 4
TROPICAL STORM WARNING
(TF - 32)/1.8 = TC
ISBN-13: 978-142320710-8 ISBN-10: 142320710-6
