This book is prepared to help the students studying in Phase 1 part of the medical curriculum at FMHS, UNIMAS, gain basic anatomical knowledge that is required for

physical examination and diagnosis of diseases.

The format of the book reflects the Objectively Structured Practical Examination (OSPE) conducted in our faculty (FMHS, UNIMAS) where the basic sciences are

integrated with the clinical sciences through the Problem-Based Learning (PBL) approach. This format helps the students to learn not only gross anatomy, but also

other branches of anatomy namely histology, embryology and neuroanatomy in an integrated and applied manner

Maung, Maung Nyo

Nan, Ommar.

Unimas Institutional Repository

(Objective Practical Questions and Answers) Maung Maung Nyo - Nan Ommar h l ~ a t K ~ i f l y R t  Rr*"'ry- - - -  : ' - ',. - t!WR.Slrl-! MALA1 T l r  C fi f?.A:t 4 "  _ _ 0 4 ~ n  W - ~ S - ~ R - T L Q ~  P KHIDMAT MAKLUMAT AKADEMIK Universititi Malaysia Sarawak 20 10 First Published 2010 O UNTMAS AII rights.reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the Publisher. Published in Malaysia by Universiti Malaysia Sarawak, Kota Samaralian, Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia. Printed in Malaysia by, ADS Media Lot 12,2nd Floor, Wisma Pheonix, Jalan Song Thian Cheok, P.O. Box 3277,93764 Kuching, Sarawak Perpustakaan Negara Malaysia Catalogue-In-Publication Data Maung Maung, Nyo Essentials of Integrated anatomy (objective practical questions and answers) / Maung Maung Nyo, Nan Ommar. Bibliography: p. 68 Includes Index ISBN 978-967-5527-04-3 1. Anatomy, Human--Problems, exercises, etc.. 2.Human physiology-- Problems, exercises, etc. I. Hunian physiology--Problems, exercises, etc. 11. Title. 6 12 14 )I 6 Preface This book is prepared to help the students studying in Phase 1 part of the medical curriculum at FMHS, UNIMAS, gain basic anatomical knowledge that is required for physical examination and diagnosis of diseases. The format of the book reflects the Objectively Structured Practical Examination (OSPE) conducted in our faculty (FMHS, UNIMAS) where the basic sciences are integrated with the clinical sciences through the Problem-Based Learning (PBL) approach. This format helps the students to learn not only gross anatomy, but also other branches of anatomy namely histology, embryology and neuroanatomy in an integrated and applied manner. There are 75 illustrations in this book, comprising photographs of anatomy models and bones, hand drawings and photomicrographs of paraffin embedded tissue specimens that are part of teaching materials at our faculty (FMHS, UNIMAS). The photomicrographs were made by using DIMAS-Digital Image Measurement and Analysis System, Professional Edition, Version 4, a versatile software program that allows actual images seen in the light microscope to be captured on the video camera. Each station in this book deals with not only anatomy and allied sciences, but also with physiology, biochemistry, orthopaedics and general medicine so that students have to think ofeach question or station in an integrative manner before they attempt an answer. We hope that the OSPE stations in this book will serve as models for constructing OSPE stations in the future as the integrative nature of each station is shown. We also believe that students will gain much by using this book in learning not only anatomy and allied sciences but also other basic medical sciences and clinical medicine. Professor Dr Marrng Maung Nyo M.B.,B.S.(Yangon), Ph.D.(London), M.A.(Med.Ed.) (Michigan State), M.D.(USA) FMHS, UNIMAS Dr Nan Ommar B.Sc. (Anatomy, Hons), M.B.,B.S.(Yangon), M.Sc. (Yangon) Associate Professor, FMHS, UNIMAS Acknowledgements It is with great pleasure that we express our deep gratitude to Tan Sri Datu Professor Dr Taha bin Arif , Dean of the Faculty of Medicine and Health Sciences (FMHS), UNIMAS, for approving and encouraging us to write this book. We are also grateful to Professor Hashami Bohari, the previous Deputy Dean for Undergraduate and Student Development, who provided us with an amicable working environment to write such book and to Professor Henry Gudum, the previous Deputy Dean for Research, FMHS, UNIMAS, for providing an excellent facilities for histology works and photomicrography. No least helpful was Professor Dr Viji Thambyrajah, our Head of Department of Basic Medical Sciences, for encouraging and supporting us to write this book from the beginning to the successful completion of this work. Wemust mention Mr. Albert Jugah Paon, Chieftechnician ofthe Anatomy Laboratories, FMHS, UNIMAS, for providing us with the excellent models, specimens and microscopes for us to photograph. Our acknowledgement will not be complete without mentioning the role played by our students for which this small work is dedicated. They provided us with the stimulus necessary to write this book and feedback to improve every station and photograph. We are therefore very grateful to our students. Lastly, but not the least, we also like to thank many people who encouraged us to write, who assisted us in any way and whose comments brought improvement to our work. So thank you very much to our friends and colleagues. We also wish to thank Resni Mona Abdullah, Head of Publication Division, UNIMAS and her staff particularly, Angeline Lee Ling Sing for their untiring effort and co- operation. Professor Dr Maung Maung Nyo Associate Professor Dr Nan Omrnar Faculty of Medicine and Health Science (FMHS), UNIMAS Pusat Khidmat M~klarnat Akademik CrMVeRSTTI MALAYSIA SARAWAK W 3 O O  K d a  %marahan Contents Preface Acknowledgements Chapter 1 : The Tissues of the Body Chapter 2: The Lymphatic System Chapter 3: The Gastrointestinal and Hepatobiliary System Chapter 4: The Cardiovascular System Chapter 5: The Respiratory System Chapter 6: The Musculoskeletal System Chapter 7: The Endocrine System Chapter 8: The Nervous System Chapter 9: The Urinary System Chapter 10: The Reproductive System References a - . ,  Chapter 1 The Tissues of the Body Station No.: 1. I Study the photomicrograph of the epithelium. 1.1 Identify the type of epithelium. Stratified sqt~amous epithelium ( non-lteratinized) (2 murks) 1.2 List THREE histological features of the above identified type of epithelium. (3 marks) (i) Many layer of squumot~s cells with nzrcletrs in the center of each cell. (ii) Cell size become flatter as it becomes super3cial. (iii) Cells in contact with the basement membrane are cuboidal in shape with darkly stained nuclezrs. 1.3 Name TWO organs where the above epithelium can be found. (i) Oe.~ophagus (ii) Vaginu 1.4 State the main function of the above type of epithelium. (I mark) Protection: Resistance against wear and tear 1.5 List TWO other types of epithelium that are composed of many layers of cells and the location for each type. (2 marks) Type o f  epitlielium Locatio~i (i) Pansitional epithelium - Urinary Tract (ii) Stratified ~t~bodial/colt~rnnar epithelizrni - Lining of large ducts of sweat glands and salivury glands '&re I . I  Photomicrograph of a type of epitheliu Station No.: 1.2 Study the photomicrograph of the epithelium. 1.1 Identify the type of epithelium. Transitional epithelium (2 marks) 1.2 List THREE histological features of the above identified type of epithelium. (3 marks) (i) Cells are about 3 to 5 layers thick. (ii) Basal cells are roughly cuboidal or columnai; intermediate cells are polygonal and the surface cells are large with rounded nuclei, some surface cells are binucleate. The surface outline of the superjicial cells has a characteristic scalloped appearance and the superjcial cytoplasm is fuzzy. (iii) Extremely thin basement membrane. 1.3 Name TWO organs where the above epithelium can be found. (2 marks) (i) Ureter (ii) Urinary bladder 1.4 State the properties of the above type of epithelium. (i) Highly stretchable (ii) Resistant to urine (1 mark) 1.5 List FOUR characteristic of epithelial tissues of each type. (i) closely aggregated cells with minimal extracelluar matrix (ii) lies on a basement membrane (iii) always have a free surface (iv) lack blood vessels (avascular) ( v )  regenerate readily (Any 4) (2 marks) Figure 1.2 Phrttomicmgmph of a type of epithelium Station No.: 1.3 Study the photomicrograph of a muscle tissue. Identify the type of muscle. Skeletal muscle (2 marks) List THREE histological features of the type of muscle identified in 1.1. (3 marks) (i) Cells are long ,cylindrical and striated (ii) Cells are multinucleated and nuclei are located at the periphery of the cells (iii) Cells are arranged in parallel bundles (i) Epimysium (ii) Perimysium (iii) Endomysium State the THREE connective tissue sheaths associated with the above muscle tissue. (3 marks) Name the embryonic germ layer that gives rise to muscle tissue. Mesoderm (I mark) Name TWO contractile proteins of muscle tissue. (I mark) (i) Actin (ii) Myosin ' ,  .# I.. ' 4  8 ' ' I  r n  : Figure 1.3 Photomicrograph of a type of muscle Station No.: 1.4 Study the slide of a nervous tissue stained by H&E. 1.1 Identify the type of neuron showed by the arrow. (2 marks) Mz~ltipolar neuron 1.2 List TWO characteristic features of the above tnentioned neuron. (i) Large cell bocly with promient nwcleza and n~~cleolzis. (ii) Many processes (iii) Presence of Nissl bodies 1.3 State specific function of the cell. Irritability and condz/ctivity/controIs skeletal muscle contraction. Motor neuron 1.4 Name TWO neuroglia cells located in the central nervous system. (2 marks) (i) Ependmal cells lining the central canal (ii) Astrocytes (iii) Microglia (iv) Oligodendrocytes (Any two) 1.5 List TWO other types of neurons and state the fi~nction of each type. Tvpe of neirron Fimction (i) pseuclozmipolar. nezlron sen.ro1:): nezii-OM (ii) bipolar ~eziron special .sen.sory nezrron Station No.: 1.5 Study the modelldiagram. 1.1 Identify the structure. Skin (2 marks) 1.2 List TWO major layers that form the above identified structure. (i) Epidermis (ii) Dermis. 1.3 Name the type of epithelium seen in the above identified structure. StratiJied squamous epithelium keratinized -- (2 marks) 1.4 Name TWO types of glands seen in the model and state the type of secretion for each gland. Type of gland (i) Sebaceous gland (ii) Sweat gland Type of secretion sebzim, a lipid mixture sweat, watery secretion (2 marks) 1.5 Name FOUR types of sensory receptors identified in the above structure. (i) Free newe endings (ii) Merkel S disc (iii) Meissner S corpuscle (iv) Pacinian corpziscle (2 marks) 1.6 List FOUR functions of the above identified structure. (2 marks) (i) Protection (ii) Sensation (iii) Thermoregulation (iv) Vitamin D synthesis, etc Station No. : 1.6 Study the photomicrograph of the epidermis. 1.1 Identify the layers of the epidermis labeled ' 1 '; '2'; '3'; and '4'. 1 Strattlm corneum 2 Stratzrm grantllosum 3 Stratum spinosztm 4 Stratum germinativz~m (4 marks) 1.2 Name the embryonic germ layer that gives rise to the epidermis. Ectodern~ (2 marks) 1.3 Name FOUR types of cell present in the epidermis and state the specific function of each tY Pee (4 marks) Type o f  cell Function (i) Keratinocytes (ii) Langerhan S cells (iii) Melanocytes (iv) Merkel cells Produces the protein keratin that helps to protect the skin Antigen presenting cell Produces melanin pigment to protect the skin.ji-om tlltm violet rays Associated ~)itl7 a disc-like sei7.sury ending Station No. : 1.7 Study the photomicrograph of a type of cartilage. 1.1 Identify the type of cartilage. Fibrocartilage (2 marks) 1.2 State the arrangement of cells and fibers seen in the above tissue. (2 marks) Cells are located in spaces called lacunae and are arranged in rows between the parallel btrndles of collagen~?bers. 1.3 Name the major type of tissue to which cartilage belongs. (1 mark) Connective tissue 1.4 List TWO structures where the type of cartilage identified can be found. (2 marks) (i) Intevertebral disc, (ii) Pubic symphysis, (iii) Some articular cartilages,ligaments and connections of'some tendons to bone. (Any 2) 1.5 Name TWO other types of cartilage and the locations for each type. (3 marks) Type of Cartilage Location (i) Elastic cartilage e.rterna1 ear, epiglottis,parts qf lu13ingeal cartilages and wall ofai~ditoiy / the  (ii) H))aline cartilage nasal septum, tracheal rings, most artict~lar surfaces, sternal end of  ribs Station No.: 1.8 Study the photomicrograph of a gland present in the skin. 1.1 Identify the gland. Sebaceous gland (2 marks) I 1.2 State the histological feature of the above identified gland. (2 marks) It is a branched acinar gland composed of lobules of large polyhedral pale staining cells containing lipid droplets and a small dark staining central nuclei. The lipid has been removed during tissue preparation leaving the cytoplasm poorly stained. 1.3 State the mode or pattern of secretion of the gland identified in 1.1. (1 mark) Holocrine (discharged by degeneration of cells and releasing their contents into the hair follicle). 1.4 State the nature and function of the secretion produce by the gland identified in 1.1. (1 mark) Oily secretion called sebum. Lubrication & bactericidal 1.5 Name TWO structures seen in the photomicrograph which are closely associated to form a unit with the gland identified in 1.1. (2 m a r k  (9 Arrectorpili muscle (ii) Hair follicle 1.6 Mention TWO other types of gland present in the skin. (2 marks, (i) Merocrine Sweat glands (ig Apocrine glands Station No Chapter 2 The Lymphatic System Identify the part of the thymus seen under the field. State ONE reason for your identification. 

Essentials of integrated anatomy : objective practical questions and answers

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Essentials of integrated anatomy : objective practical questions and answers

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