By E. Sobota. Southern University, New Orleans.

What develops male accessory sex organs consist of and what are its properties? If it takes only one sperm cell to fertilize (d) the absence of estrogens cheap provigil 200 mg online. Which of the following does not arise of the perineum of an embryo during the expelled during ejaculation? A number of pathogenic (disease-causing) (a) the epididymis with that of an adult male best 200 mg provigil. List the structures of the male pathogen, why does coitus provide an (d) the prostate reproductive system that form from the ideal means of propagation? Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Female Reproductive System 21 Introduction to the Female Reproductive System 726 Structure and Function of the Ovaries 728 Secondary Sex Organs 732 Mammary Glands 738 Ovulation and Menstruation 740 Developmental Exposition: The Female Reproductive System 743 CLINICAL CONSIDERATIONS 744 Clinical Case Study Answer 751 Chapter Summary 752 Review Activities 752 Clinical Case Study A 28-year-old female was brought to the emergency room following a 4-day history of moderate right-sided pelvic pain. On the morning of the fifth day the pain had become more severe, prompting her to seek medical attention. She complained of weakness and light-headedness, and stated that she hadn’t had a period for about 8 weeks. The consulting gynecologist said that a ruptured ectopic pregnancy was likely. He ordered a blood test, the results of which suggested that the patient had suffered a slight amount of hem- orrhage. A culdocentesis (needle sampling of the peritoneal cavity via the posterior vaginal wall) was positive for pooled blood. Briefly explain the se- quence of events leading up to the rupture of the ectopic pregnancy beginning with ovulation. Explain how blood from a ruptured ectopic preg- nancy can be aspirated through the vagina. FIGURE: Examining fetal structures for Hints: Carefully study the position of the uterus and uterine tubes with respect to the ovaries congenital problems, sampling fetal tissues for within the peritoneal cavity. Read about ectopic pregnancies in the clinical sections of this metabolic disorders, and conducting in utero chapter and refer to figure 22. Unfortunately, ectopic pregnancies cannot be corrected using this technique. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 726 Unit 7 Reproduction and Development delivery of the baby; and (6) to provide nourishment for the INTRODUCTION TO THE FEMALE baby through the secretion of milk from the mammary glands in REPRODUCTIVE SYSTEM the breasts. The organs of the female reproductive system, like those of The female reproductive system produces ova, secretes sex hor- the male, are categorized on a functional basis as follows: mones, receives spermatozoa from the male, and provides sites for fertilization of an ovum and implantation of the blastocyst. The primary sex organs are called go- turition follows gestation, and secretion from the mammary glands nads, and in the female are known more specifically as the provides nourishment for the baby. Ovaries produce the gametes (ova), or eggs, and produce and secrete sex steroid hormones. Secretion of the Objective 1 Explain the functional differences between the female sex hormones at puberty contributes to the develop- male and female reproductive systems. The secondary sex organs include the vagina, which receives the The reproductive systems of the male and female have some penis and ejaculated semen during coitus and through basic similarities and some specialized differences. The two sys- which the baby passes during delivery; the external geni- tems are similar in that (1) most of the reproductive organs of talia, which protect the vaginal orifice (opening); the uter- both sexes develop from similar embryonic tissues and are there- ine (fallopian) tubes, through which ovulated eggs are fore homologous; (2) both systems have gonads that produce ga- transported toward the uterus and where fertilization takes metes and sex hormones; and (3) both systems experience latent place; and the uterus (womb), where implantation and de- development of the reproductive organs, which mature and be- velopment occur. The muscular walls of the uterus play an come functional during puberty as a result of the influence of sex active role in parturition. Secondary sex characteris- ual reproduction and on the cyclic events that are characteristic tics are features that are not essential for the reproductive of the female. The reproductive organs of a sexually mature, process but are generally considered to be sexual attrac- healthy male continuously produce male gametes, or spermato- tants. A male does not produce any spermatozoa until amples of female secondary sex characteristics. Although puberty (at about age 13), but is then capable of producing viable the breasts contain the mammary glands,large breasts are spermatozoa throughout his life if he remains healthy. In fact,all female metes, or ova, of a female are completely formed, but not totally mammals have mammary glands,but only human females matured, during fetal development of the ovaries. The ova are have protruding breasts that function as a sexual attractant. Generally, girls attain puberty 6 months to at the end of each menstrual cycle. Menopause is the period 1 year earlier than boys, accompanied by an earlier growth spurt marked by the termination of ovulation and menstruation. Puberty results from the increased secre- reproductive period in females generally extends from about age tion of gonadotropic hormones from the anterior pituitary, which stim- 12 to about age 50. The cyclic reproductive pattern of ovulation ulates the ovaries to establish their ovarian cycles and sex steroid and the age span of fertility are determined by hormones. The average age of menarche is later (age 15) in girls who are The functions of the female reproductive system are (1) to very active physically than in the general population. This appears to produce ova; (2) to secrete sex hormones; (3) to receive the be due to a requirement for a minimum percentage of body fat for spermatozoa from the male during coitus; (4) to provide sites for menstruation to begin, and may represent a mechanism favored by fertilization,implantation of the blastocyst (see chapter 22),and natural selection to ensure the ability to successfully complete a pregnancy and nurse the baby. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 727 Rectouterine pouch Vesicouterine pouch FIGURE 21.

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An additional term in the literature purchase provigil 200mg amex, transitional MS order 100mg provigil mastercard, refers to those patients who are evolving into the secondary progressive stage. Some patients begin with no attacks and a progressive course, and later in their disease begin having exacerbations (progressive-relapsing). Clinically isolated syndromes (CISs) are monoregional acute monophasic syndromes that encompass optic neuritis, transverse myelitis, isolated brainstem, or cerebellar syndromes. MRI scans with T2 lesions predict a greater than 80% conversion to MS by 10 years. Have not had any laboratory tests CHAPTER 8: DETERMINING THE DIAGNOSIS AND PROGNOSIS 37 2. Have disease onset at a very early or very late age ADDITIONAL READING Coyle PK. The Nature of Multiple Sclerosis in Advanced Concepts in Multiple Sclerosis Nursing Care. This page intentionally left blank Chapter 9 The Immune System and Its Role in MS Objectives: Upon completion of this chapter, the learner will: Cite normal immune system activity Discuss abnormal immunology involved in MS Describe the rationale for immumodulating MS treatmentsThe immune system protects people from pathogens such as: A. Immunity to certain pathogens; this is common to all healthy individuals 2. Immediate destruction of some pathogens by phagocytic cells such as macrophage and neutrophils B. Cellular immunity Cytotoxic T-cells (CD 8) TH1 cells (CD 4) 39 40 NURSING PRACTICE IN MULTIPLE SCLEROSIS: A CORE CURRICULUM 3. Cells of the immune system begin life in the bone marrow as stem cells D. These cells are activated in the lymphoid tissues where they are presented with antigen G. Both B-cells and T-cells must receive an additional signal in order to be activatedHumoral immunity is produced by: A. Neutralization—binding to pathogens and blocking the path to body cells 2. Opsonization—enabling phagocytic cells to recognize pathogens by coating the pathogen 3. Antigen-specific lymphocytes undergo apoptosis once the antigen is removed 3. Some antigen-specific lymphocytes persist and are the basis for immunologic memory 4. The cells that present antigen to T-cells are antigen-pre s e n t i n g cells dendritic cells macrophages 5. These cells display antigen protein particles on specialized cell surface molecules known as MHC. Two classes of MHC molecules exist: CHAPTER 9: THE IMMUNE SYSTEM AND ITS ROLE IN MS 41 MHC I MHC II 7. MHC II are expressed on the surface of macrophages or B-cells and are recognized by TH1 or TH2 cells (CD4). CD 4 Cell cytokine production: TH1 cells activate macrophages and produce: ✧ interferon gamma ✧ TNF alpha ✧ TNF-beta ✧ IL-2 TH2 cells activate B-cells and produce: ✧ IL-4 ✧ IL-5 ✧ IL-10 ✧ TGF-betaInappropriate immune response includes: A. Autoimmune diseaseAllergy is the result of a specific IgE antibody to an innocuous antigen. The regulatory mechanisms that keep these cells in check are not working properly. T-cells can recognize self-antigens if they are sufficiently similar to the non–self-antigen. TH1 cells are stimulated in the periphery by presentation with antigen (i. Once activated, they proliferate and release cytokines and met- alloproteinases that break down the extracellular matrix of the blood brain barrier (BBB). Once in the CNS, TH2 cells are presented with myelin protein that is similar to the antigen presented in the periphery. They then become reactivated, releasing the damaging cytokines interferon gamma, TNF-alpha, TNF-beta, and IL-2. Immunomodulating and immunosuppressive agents that have an effect on some aspect of the immune response. Downregulates expression of MHC class II molecules induced by IFN-gamma 4. When GA-induced T-cells are presented to MBP in the CNS, they are stimulated to proliferate and release cytokines (TGF-beta, IL-4, IL-10) E. Mitoxantrone has a broad spectrum of immunosuppression with some B-cell suppression 3. Imuran is a broad-spectrum immunosuppressant with milder effect and some B-cell suppression 4. Methotrexate has little immunosuppression ADDITIONAL READING Costello K. Chapter 10 Disease Altering Therapies Objectives: Upon completion of this chapter, the learner will: Discuss relapse management in multiple sclerosis Describe immunomodulation in relapsing forms of MS Cite management of worsening disease Describe strategies to promote adherence to complex protocolsRelapse management: A.

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Discuss what is meant by an inflammatory pollutants may accumulate in the adipose (a) acne (c) eczema lesion order 100 mg provigil with amex. What are some frequent causes of tissue (subcutaneous fat) of the (b) melanoma (d) seborrhea skin lesions? Explain the relationship of the dermis clinical situations where this knowledge 9 provigil 200mg otc. The skin of a burn victim has been with the circulatory and nervous systems. Integumentary Explain the variations of this layer in becomes drier, wrinkled, and slower to regeneration will be slow with some males and females. Which vary in thickness in different parts of the structural changes, how would you advise kind of burn is this? Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton Skeletal System: Introduction 6 and the Axial Skeleton Organization of the Skeletal System 132 Functions of the Skeletal System 134 Bone Structure 135 Bone Tissue 138 Bone Growth 140 Developmental Exposition: The Axial Skeleton 141 Skull 144 Vertebral Column 158 Rib Cage 164 CLINICAL CONSIDERATIONS 165 Clinical Case Study Answer 168 Important Clinical Terminology 169 Chapter Summary 170 Review Activities 170 Clinical Case Study A 68-year-old man visited his family doctor for his first physical examination in 30 years. Upon sensing a disgruntled patient, the doctor gently tried to determine the reason. In response to the doctor’s inquiry, the patient blurted out, “The nurse who measured my height is incompe- tent! I know for a fact I used to be six feet even when I was in the Navy, but she tells me I’m 5′10″! He explained to the patient that the spine contains some nonbony tissue, which shrivels up a bit over the years. The patient interrupted, stating indignantly that he knew anatomic terms and principles and would like a detailed explanation. How would you explain the anatomy of the vertebral column and the changes it undergoes during the aging process? Hints: The patient’s normal posture and the fact that he had no complaints of pain indicated good health for his age. FIGURE: Decreased height, postural changes, and loss of bone density are just a few of the age-related alterations that may afflict the skeleton. The patellae (“kneecaps”) are two OF THE SKELETAL SYSTEM sesamoid bones all people have. For convenience of study, the skeleton is divided into axial The axial and appendicular components of the skeletal system of and appendicular portions, as summarized in table 6. The axial skeleton consists of the bones that form strong, flexible body framework. The components of the axial skeleton are axial and appendicular components. The skull consists of two sets of bones: the cranial The adult skeletal system consists of approximately 206 bones. Three auditory ossicles (“ear bones”) curs during infancy, the number increases. During adolescence, are present in the middle-ear chamber of each ear and however, the number of bones decreases, as separate bones grad- serve to transmit sound impulses. The hyoid bone is located above the larynx total functioning of the skeletal system. The vertebral column (“backbone”) the skull called sutural (wormian) bones. Additional bones may consists of 26 individual bones separated by cartilaginous develop in tendons in response to stress as the tendons repeat- intervertebral discs. Bones formed this way are called wormian bone: from Ole Worm, Danish physician, 1588–1654 sesamoid: Gk. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton Chapter 6 Skeletal System: Introduction and the Axial Skeleton 133 Parietal bone Frontal bone Temporal bone Skull Occipital Zygomatic bone bone Maxilla Mandible Clavicle Pectoral Scapula girdle Costal cartilages Sternum Rib cage Ribs Humerus Vertebral column Ulna Ilium Pelvic girdle Os Pubis Sacrum coxae Coccyx Ischium Radius Carpal bones Metacarpal bones Phalanges Femur Patella Tibia Fibula Calcaneus Tarsal bones Creek Metatarsal bones Phalanges (a) (b) FIGURE 6. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton 134 Unit 4 Support and Movement are fused to form the sacrum, which is the attachment por- tion of the pelvic girdle. A few terminal vertebrae are fused FUNCTIONS to form the coccyx (“tailbone”). The rib cage forms the bony and cartilaginous The bones of the skeleton perform the mechanical functions of sup- framework of the thorax. It articulates posteriorly with the port, protection, and leverage for body movement and the meta- thoracic vertebrae and includes the 12 pairs of ribs, the bolic functions of hemopoiesis and storage of fat and minerals. Objective 2 Discuss the principal functions of the skeletal system and identify the body systems served by these functions. The com- The strength of bone comes from its inorganic components, of ponents of the appendicular skeleton are as follows: such durability that they resist decomposition even after death. The paired scapulae (“shoulder blades”) mans, has been determined from preserved skeletal remains. In fact, the term skeleton comes from a Greek word meaning is the axial component.

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In which side of her heart (right or left) did the previously diagnosed blood clot most likely reside? Explain anatomically where the cause of her new problem is located and describe how it came to arrive there quality 200 mg provigil. FIGURE: Observation and palpation are important diagnostic tools used to assess vascular problems cheap provigil 100mg fast delivery. Blockage of blood flow may have serious consequences downstream from the point of occlusion. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 538 Unit 6 Maintenance of the Body The blood contained within vessels serves this trans- FUNCTIONS AND MAJOR portation function. An estimated 60,000 miles of vessels COMPONENTS OF THE throughout the body of an adult ensure that continued suste- nance reaches each of the trillions of living cells. However, CIRCULATORY SYSTEM the blood can also transport disease-causing viruses, bacteria, An efficient circulatory system is necessary for maintaining the life and their toxins. As a safeguard, the circulatory system has de- of complex multicellular organisms. In order to perform its various functions, the circulatory Objective 1 Describe the functions of the circulatory system. A unicellular organism can provide for its own maintenance and Functions of the Circulatory System continuity by performing the wide variety of functions needed for life. By contrast, the complex human body is composed of The many functions of the circulatory system can be grouped trillions of specialized cells that demonstrate a division of labor. All of the substances involved in cellular very basics of their existence. The majority of the cells of the metabolism are transported by the circulatory system. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 539 ported to the cells for aerobic respiration. Carbon diox- blood), are filtered through the capillaries of the kid- ide produced by cellular respiration is carried by the neys into kidney tubules and excreted in urine. The circulatory system protects against injury that can be absorbed through the intestinal wall into and foreign microbes or toxins introduced into the body. The blood then carries The clotting mechanism protects against blood loss when these absorbed products of digestion through the liver vessels are damaged, and white blood cells called leuko- to the cells of the body. Leukocytes may also protect the well as other molecules in plasma (the fluid portion of body through phagocytosis (see fig. Superior vena cava Pulmonary artery Lung Capillaries Left atrium Pulmonary veins Pulmonary valve Right atrium Left atrioventricular valve Right atrioventricular valve Aortic valve Aorta Right ventricle Inferior vena cava Left ventricle Capillaries Vessels transporting oxygenated blood Vessels transporting deoxygenated blood Creek Vessels involved in gaseous exchange FIGURE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 540 Unit 6 Maintenance of the Body Major Components BLOOD of the Circulatory System Blood, a highly specialized connective tissue, consists of The circulatory system is frequently divided into the cardiovas- formed elements—erythrocytes, leukocytes, and platelets cular system, which consists of the heart, blood vessels, and (thrombocytes)—that are suspended and carried in the blood blood, and the lymphatic system, which consists of lymphatic plasma. The constituents of blood function in transport, immunity, vessels and lymphoid tissues within the spleen, thymus, tonsils, and blood-clotting mechanisms. Objective 3 List the different types of formed elements of The heart is a four-chambered double pump. Its pumping blood; describe their appearance and explain their action creates the pressure needed to push blood in the vessels to functions. At rest, the heart of an adult pumps about 5 liters of blood per minute. It takes only about a minute Objective 4 Describe the origin of erythrocytes, leukocytes, for blood to be circulated to the most distal extremity and back and platelets. Blood vessels form a tubular network that permits blood to Objective 5 List the different types of substances found in flow from the heart to all living cells of the body and then back blood plasma. Arteries carry blood away from the heart, while veins Objective 6 Describe the origin and function of the different return blood to the heart. Arteries and veins are continuous with categories of blood plasma proteins. Arteries branch extensively to form a network of progres- sively smaller vessels. Conversely, microscopic-sized veins called constituting about 8% of the total body weight. Blood passes from the arterial to tion of that going to the lungs, is bright red in color because of the the venous system in capillaries, which are the thinnest and most high concentration of oxyhemoglobin (the combination of oxygen numerous blood vessels. All exchanges of fluid, nutrients, and and hemoglobin) in the erythrocytes. Venous blood is blood return- wastes between the blood and tissue cells occur across the walls ing to the heart.