Table Of ContentEquipping You with 21st-Century Skills
to Succeed in A&P and Beyond…
The 12th Edition of Elaine Marieb and Katja Hoehn’s best-selling A&P text and media program
motivates and supports both novice learners and expert students, more than ever before. Each
carefully-paced chapter guides you in advancing from mastering terminology to applying knowledge
in clinical scenarios, to practicing the critical thinking and problem-solving skills that are required for
entry to nursing, allied health, and exercise science programs.
GLOBAL This is a special edition of an established title widely used by colleges and GLOBAL
universities throughout the world. Pearson published this exclusive edition
EDITION for the benefit of students outside the United States and Canada. If you EDITION
pthuartc hita hseads btheiesn b oimopko wrtitehdin w tihteh oUunti ttehde Satpapteros voarl Cofa tnhaed aP, uyboluis shheor uoldr Abeu tahwoarr.e EDITGLO
IONBAL
Human Anatomy
Marieb and Hoehn’s Human Anatomy & Physiology is the quintessential text for novice as well H
as expert learners. It equips students to critically evaluate new information, connect that u
information to the foundation they have already established, and to apply it in a clinical setting. m
& Physiology
The Twelfth Global Edition continues to focus on the three unifying themes the text is known a
n
for—interrelationships of the body’s organ systems, homeostasis, and the complementarity
A
of structure and function. The content has been updated to highlight the most recent
n
developments in this dynamic field. a
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o
TWELFTH GLOBAL EDITION
Key Features m
• NEW! A feature on COVID-19 has been added to keep students up to date with recent y
developments. &
Elaine N. Marieb
• NEW! Boxes on notable scientists highlight the lives and work of eminent scientists and P
h
researchers, showing the human side of science. y Katja Hoehn
s
• UPDATED! Homeostatic Imbalance discussions on topics such as Marfan syndrome, io
brittle bone disease, tetanus, and more help students clinically apply the concepts they have lo
learned. g
y
• By walking students through complex processes using clear, easy-to-follow illustrations with
integrated text explanations, Focus Figures help students develop visual literacy skills
essential for success in A&P. T
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• To prepare students for their careers, Clinical Case Studies challenge them to apply their E
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knowledge to realistic clinical scenarios. F
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• A wide range of self-assessment questions, including Apply, Predict, What If?, Draw, H
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and Make Connections questions, enables students to exercise critical thinking skills and L
prepare for tests. O
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Available separately for purchase is Mastering A&P for Human Anatomy & Physiology, the teaching E
and learning platform that empowers instructors to personalize learning for every student. It D
includes extensive resources, such as Dynamic Study Modules, Interactive Physiology 2.0, ITIO
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Pearson’s trusted educational content, this optional suite helps deliver the learning outcomes
that students and instructors aspire to.
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ehrie
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A01_MARI1803_12_GE_FM.indd 1 05/08/2022 19:31
Identify “Big Picture” Concepts
Before Exploring Details
Before you look up details and information within a chapter, read the Chapter-
Opening Roadmap, which visually groups and organizes “big picture” concepts
and shows how they are related. To focus your studying, review the numbered
Key Concept Headings, Learning Outcomes, and summaries.
8
UNIQUE! Chapter Roadmaps Joints
provide a visual overview of the key
concepts in the chapter and show
how they relate to each other. Each
key concept “brick” in the roadmap
corresponds to a numbered section
In this chapter, you will learn that
within the chapter.
Joints determine how bones move relative to each other
by first asking then asking
8.1 How are joints classified? 8.6 What happens
when things go wrong?
Each numbered section within the then exploring
and finally, exploring
chapter begins with a Key Concept
Developmental Aspects
Heading that helps you quickly grasp 8.2 Fibrous joints 8.3 Cartilaginous 8.4 Synovial joints of Joints
joints
the “big idea” of the discussion that
follows. looking closer at focusing on
Movement of 8.5 Selected
synovial joints synovial joints
The graceful movements of ballet dancers and the rough- 8.1 Joints are classified into
and-tumble grapplings of football players demonstrate the
great variety of motion allowed by joints, or articulations— three structural and three functional
the sites where two or more bones meet. Our joints have two categories
fundamental functions: They give our skeleton mobility, and
they hold it together, sometimes playing a protective role in Learning Outcomes
the process. ✔ Define joint or articulation.
✔ Classify joints by structure and by function.
Joints are classified by structure and by function. The structural
CAREER CONNECTION classification focuses on the material binding the bones together
and whether or not a joint cavity is present. Structurally, there
are fibrous, cartilaginous, and synovial joints (Table 8.1 on
p. 285). Only synovial joints have a joint cavity.
The functional classification is based on the amount of move-
ment allowed at the joint. On this basis, there are synarthroses
(sin0ar-thro9sēz; syn 5 together, arthro 5 joint), which are immov-
able joints; amphiarthroses (am0fe-ar-thro9sēz; amphi 5 on both
Career Connection Videos
sides), slightly movable joints; and diarthroses (di0ar-thro9sēz;
feature a health care professional Watch a video to learn how dia 5 through, apart), or freely movable joints. Freely movable joints
the chapter content is used predominate in the appendicular skeleton (limbs). Immovable and
who describes how the chapter in a real health care setting. slightly movable joints are largely restricted to the axial skeleton.
Go to Mastering A&P® > Study Area > This localization of functional joint types makes sense because
content relates to their everyday Animations and Videos or use quick the less movable the joint, the more stable it is likely to be.
work. You can access all of the access URL https://bit.ly/3P8hiZa In general, fibrous joints are immovable, and synovial joints
are freely movable. However, cartilaginous joints have both rigid
Career Connections videos through 281
an open access web page at https://
bit.ly/3P8hiZa. Learning Outcomes are presented at
See p. 281
M08_MARI1803_12_GE_C08.indd 281 22/07/22 13:42
the beginning of each chapter section
to give you a preview of essential
information to study.
A01_MARI1803_12_GE_FM.indd 2 05/08/2022 19:31
Pace Yourself:
Learn & Review the Basics
Summary Tables present key information and serve as “one-stop shopping” study tools.
192 UNIT 2 Covering, Support, and Movement of the Body
Table 5.1 Summary of Cutaneous Glands
ECCRINE SWEAT GLANDS APOCRINE SWEAT GLANDS SEBACEOUS GLANDS
5
Functions ●●Temperature control May act as sexual scent glands ●●Lubricate skin and hair
●●Some antibacterial properties ●●Help prevent wateCr hloasspter 5 The Integumentary System 193
●●Antibacterial properties
Typee oxft ernal eaHry cpoatnonailc. fi Tltrhateei orf sbelocorde ptliaosmna mixesF wiltriatthe osfe bblouomd p lpasrmoad wuitche add ded Sebum (an oily secretion)
Secretion proteins and fatty substances Check Your Understanding
by nearby sebaceous glands to form a sticky, bitter substance
Method of Merocrine (exocytosis) Merocrine (exocytosis) Holocrine
Secrcetaiolnled cerumen, or earwax, that is thought to deter insects and 17. Which cutaneous glands are associated with hair follicles?
Secrbetlioonc k entrySk ion fs ufrofarceeign material. Usually upper part of hair follicle; U1s8ua. llyW uphpeenr p Aartn otfh hoainr yfo lrleiclteu; rned home from a run in 30°C weather,
Exits Duct At rarely, skin surface sometimes, skin surface
his face was dripping with sweat. Why?
●B●odyM LoacmatiomnaryE vgerlyawnhedres,. b Mut easpmecimallya praylm sg, lands,M aosntloy tahxilelarr yt aynpd ean oogfe nsiptael -regions Everywhere except palms and soles
19. What is the difference between heat-induced sweating
cialized swsoeleas,t f ogrelhaenadd, secrete milk. Although they are prop-
and a “cold sweat,” and which variety of sweat gland is
erly part of the integumentary system, we will consider the
involved?
Seem pa. m19m2ary glands in Chapter 27 with female reproductive
so-called pores of a person’s complexion, which are openings eccrine glands, they lie dee2p0er. in A tPhPe LdYe r mSeisb oarc eevoenu isn gthlae nsudbs- are not found in thick skin. Why is
of haoir rfgolalinclse.s.) cutaneous tissue, and their ducts empty into hair follicles.
their absence in those body regions desirable?
Eccrine gland secretion, commonly called sweat, is a hypo- Apocrine secretion contains the same basic components as
tonic filtrate of the blood that passes through the secretory cells true sweat, plus fatty substances and proteins. Consequently, Fito r answers, see Answers Appendix.
Sebaceous Glands
of the sweat glands and is released by exocytosis. It is 99% water, is viscous and sometimes has a milky or yellowish color. The
with some salts (mostly sodium chloride), traces of metabolic secretion is odorless, but when bacteria on the skin decom-
wTashtees s(uerbeaa, cureico aucsid ,g alnadn admsm (osneia-)b, aan9ds ha umsic;r o“bger-keiallsinyg” ), opro osei lit sg olragnandics molecules,5 it. 8tak es onF ai rmsustky aannd gden efraollyr emost, the skin is a
p(eFptiigdeu rceal l5ed.9 dae)r,m acridei ns.i Nmoprmlea lblyr, asnwcehate ids aaclivdieco wlaitrh ga lpaHn ds thuantp laeraesa nfot oudnodr, the basis of body odor.
baetlwl eoevn e4r a tnhd e6 .body except in the thick skin of the palms Aapnodc rsinoel egsla. nds begbina furnrctiioenirng at puberty under the
Sweating’s major role is to prevent the body from overheat- influence of the male sex hormones (androgens) and play little
They are small on the body trunk and limbs, but quite large on
ing. Heat-induced sweating begins on the forehead and spreads role in maintaining a conLsetaantr bnodiny tgem Opeurattucroe. mTheeir precise
intfheeri ofralyc eo,v enre thcek r,e amnadin duepr pofe trh ec hboedsyt.. ETmhoetisoen aglllya ninddsu cseedc retef uannc toioinl yis snuobt y-et known. Three lines of evidence suggest that
swsteaanticnge— ctahlel esod-c salelebdu “mco ld( ssew9ebaut”m br)o.u Tghht eo nc beyn ftrriaghl t coer lls otfh etyh em aayl vbeeo thlie human✔ eq uDiveaslcenritb oef ohthoewr a nthimea lssk’ isnex auaclc omplishes at least five different
naercvcouusmneussl—atbee goiinlsy o nli tphied psa lumns,t islo ltehs,e ayn db aexcilolame (ea rsmop ietsn) gorgsecedn tt hglaatn dtsh:e (y1) SexualT feoxrfeutp lnRacyet iincocanrelsal. siecs othneisr agctuiviidtye; (y2o) u to review
and then spreads to other body areas. they enlarge and recede wspithe tchiefi pch apseasg oef sa wwohmeanre’s ma ecnostnrucael pt was first
burst, so functionally these glands are holocrine glandcsy c(le; apn.d 1 (53)6 b)e. havioraliL nstiutkrdeoie dst hsuheco ewsdk th.iant tohefi ra s egcrreatpioen,s mouayr skin keeps its contents juicy and 5
ATphoe carcincuem Suwlaeteadt lGipliadns dasnd cell fragments constitutea cste abs upmhe.romones (chemwichaol mlee.s Tsehngee srsk rienle aansedd ibtys oanpep inednid-ages perform a variety of functions,
vidual that trigger a response in other members of the same
The aMpproosxtim, batuelty n20o0t0 aalplo,c rsienbe aswceeaot uglsa ngdlsa (napd9so -kdreinv) ealreo p ass poeucitegs)r.owths including protection, body temperature regulation, cutaneous sen-
Slaoergfe ehl ypa ci.ro 1 nff9oin3leldic tloe tsh ea anxdil lsaeryc arnedte a nsoegbeunimtal ianretaos .a I nh sapiirte follicleT,w oor i mopcocrtaa-nt types osfa mtioodnif,i emd eaptaobcroinleic g lfaunndsc atiroe:ns, blood reservoir, and excretion.
of their name, they are merocrine glands, which release their
psroidouncat bllyy e xtooc yat opsois rleik eo tnhe t ehcec rsinkei snw esaut rgflaancdes.. LAarrgreerc tthoanr pili ●c●oCnetrruamcintioouns sg lands. Ceruminous glands (sĕ-roo9mĭ-nus; cera
fBoruciel dseinbugm V ooucta obfu tlhaer hya Cir ofoalclihcilnesg t oA tchtei vsiktiine ssu irnfa Mc5e .awasxt)e arrei mnogdi fAied& aPPpo®rcr oianrete ge laacn dftsui fnoou wnnda iny thtoe l ilneinagr onf twheo rd roots and
A&SPe bteurmm sinooftleongsy a wndh illueb briucialdteins gth aen hda iprr aancdti csiknign ,i mprpeovertnatsn th alairn guage skills.
Given its superficial location, the skin is our most vulnerable
from becoming brittle, and slows water loss from the skin. Per-
organ system, exposed to microorganisms, abrasion, tempera-
haps even more important is its bactericidal (bacterium-killing)
ture extremes, harmful chemicals, and UV radiation. The skin
action. Sebaceous glands increase their activity during puberty
constitutes at least three types of barriers: chemical, physical,
under the influence of male sex hormones.
and biological.
M05_MARI1803_12_GE_C05.indd 192 23/06/2022 20:49
HOMEOSTATIC CLINICAL Chemical Barriers
IMBALANCE 5.7
Chemical barriers include skin secretions and melanin.
Acne is an active inflammation of the sebaceous glands
Although the skin’s surface teems with bacteria, the low pH of
accompanied by “pimples” (pustules or cysts), whiteheads,
skin secretions—the acid mantle—retards their multiplication.
or blackheads on the skin. If
In addition, dermcidin in sweat and bactericidal substances
A01_MARI1803_12_aGcEc_uFMm.inudlda t3ed sebum blocks 05/08/2022 19:31
in sebum kill many bacteria outright. Skin cells also secrete
a sebaceous gland duct,
natural antibiotics called defensins that literally punch holes in
it can cause a whitehead
bacteria, making them leak like sieves. Wounded skin releases
(closed comedone) or a
large quantities of protective peptides called cathelicidins that
blackhead (open come-
are particularly effective in preventing infection by group A
done). Acne is associated
streptococcus bacteria.
with infection by Propioni-
As discussed earlier, melanin provides a chemical pigment
bacterium acne. It can range
shield to prevent UV damage to skin cells.
from mild to so severe
that it leads to permanent Physical Barriers
scarring.
The continuity of skin and the hardness of its keratinized cells
Overactive sebaceous
provide physical barriers. As a physical barrier, the skin is a
glands can cause sebor-
Figure 5.10 Cradle cap remarkable compromise. A thicker epidermis would be more
rhea (seb0o-re9ah; “fast-
(seborrhea) in a newborn. impenetrable, but we would pay the price in loss of suppleness
flowing sebum”), known
and agility.
as “cradle cap” in infants
The outstanding barrier capacity of the skin arises from the
(Figure 5.10). Seborrhea begins on the scalp as pink, raised structure of its stratum corneum, which has been compared
lesions that gradually become yellow to brown and begin to
to bricks and mortar. Multiple layers of dead flat cells are the
slough off oily scales.
bricks and the glycolipids surrounding them are the mortar.
Epidermal continuity works hand in hand with the acid man-
Table 5.1 summarizes the three types of cutaneous glands. tle and chemicals in skin secretions to ward off bacterial
M05_MARI1803_12_GE_C05.indd 193 23/06/2022 20:49
Study the Figures
as You Read the Text
Anatomy and Physiology is a visual science. To succeed, you need to practice and develop visual
literacy skills for understanding and interpreting information. To help you achieve this goal, the text
and associated figures are tightly integrated so that you do not have to flip pages back and forth to
connect visuals with words.
26 Focus Figures walk you through
complex processes using exceptionally
clear, easy-to-follow illustrations with
integrated text explanations.
FOCUS FIGURE 21.1 An Example of a Primary Immune Response
The immune system has three lines of defense
against foreign invaders. Third Line of Defense: Adaptive Defenses
1Dendritic cells (APCs) engulf Lymph node
viruses and dead virus-infected cells.
Litest f’sir slot oekx paot shuorwe ttoh ein bfoludeyn dzae fveinrudss. against a2 lymDepnhd nroitdice c welhlse mrei gthraetye to
activate T lymphocytes.
3Dendritic cell activates CD4 cell, which forms
a clone of helper T (TH) cells and memory cells.
CD4 cell
First Line of Defense: Surface Barriers Dendritic cell Memory CD4 T cell
The mucous membrane lining the airways helps
prevent the virus from entering theM boudcuy.s traps viruses. TH cell TH cells
See pp. Cpihliaar ysnwxe, ewph ceornet aitm isi nswataeldlo mwuecdu as ntdo wdaigreds tthede. Cilia CD8 cell TH cell B cell
Mucus
840–841
Virus Bronchiole ctf4ooealgrlmseD taseh naned drc lrmaoitcneitcemi v caooetfrle lyc ayCcnteDodll8t soT .cHxei lccl e,T lw l( ThCic)h com4efbel lpm,T lwaHos hrmcyiec aBlhl c acfeecoltllrlismsv .aasnt eads c alo Bn e
Memory B cell
Second Line of Defense: Innate Internal Defenses Memory CD8 T cell
Virus-infected cells release interferon to
warn nearby uninfected cells.
Icnhfelammicmaalstory Perehnlageguaoslficn vygitr euinss fe(lesa .magn.m,d ra e“tssoiodruye nncdht emtmhaeicc raaollaps.rh ma”g ebsy) Cik(nvieltilrailanl uTcgelC ai lnlcruf eeilamlclrst me)v dtiura ucnrsegitelelyssts. b y TC cells Pcelallssma
Focus Figure Ipanrlfatlesamrmioaml epasr toaiotnendi n bisnr ictnoreg tash smein oagrr eeca aipm bilmyla duriynl aept ecinermgll se aanbdil ity. tTt5ohha ees iyTitn Ceaf cteotecfalt lciesnk dmf aecincegtdlriloa sk.ntiel.l
Perforins Antibodies
“Mini-Animation” p Cerampeillaabriylity Canodm cpaleumseesn otp ascotnivizaatitoionn e onfh vainruces sp ianrftliacmlems.ation Ht(afruregmee)ot svr iaerulx sitmreasmc.eullnuliatyr ab5nlbotoiPbdloa) dstmioe ass, i ctwee lholsifc r hien ltfereaacsvteeio l n(v.ia
Coaching Activities NK cells recognize and kill
bring some of the Adirlateterisole VirusC3b virus-infected cells.
Focus Figures to life
Antibodies neutralize viruses by covering Agglutination and complement
using short video Perforins tahned pernotteeri nosu trh caetl las.l lNowo ethnetr yv i=ru ns ot oin bfiencdti oton . ancetuivtraotpiohnil se nahnadn mcea cprhoapghoacgyetos.sis by
segments. 840 841
Blue text represents the voice of an A&P
instructor, highlighting important points to
remember.
828 UNIT 4 Maintenance of the Body
21.5 In humoral immunity, Activation and Differentiation of B Cells
antibodies are produced that target An immunocompetent but naive B Antigen
lymphocyte is activated when match- 31 unique In-Line Figures are
extracellular antigens ing antigens bind to its surface recep- Cross-linked strategically placed within the text to
receptors
tors and cross-link adjacent receptors visually reinforce the text discussion.
Learning Outcomes
together. Antigen binding is quickly
✔ Define humoral immunity. followed by receptor-mediated endo-
✔ Describe the process of clonal selection of a B cell and cytosis of the cross-linked antigen-receptor complexes. As we
See p. 828
recount the roles of plasma cells and memory cells in
described previously, this is called clonal selection and is fol-
humoral immunity.
lowed by proliferation and differentiation into effector cells
✔ Compare and contrast active and passive humoral
(Figure 21.11). (As we will see shortly, interactions with T cells
immunity.
are usually required to help B cells achieve full activation.)
✔ Describe the structure and functions of antibodies and
Most cells of the clone differentiate into plasma cells, the
name the five antibody classes.
antibody-secreting effector cells of the humoral response.
Now that you understand the common steps in lymphocyte Plasma cells develop the elaborate internal machinery (largely
maturation and activation, let’s examine how this basic pattern rough endoplasmic reticulum) needed to secrete antibodies
applies to B lymphocytes. When a B cell encounters its antigen, at the unbelievable rate of about 2000 molecules per second.
that antigen provokes the humoral immune response, in which Each plasma cell functions at this breakneck pace for 4 to 5
antibodies specific for that antigen are made. A01_MARI1803d_1a2y_sG Ea_nFdM t.ihndedn d4ies. The secreted antibodies, each with the same 05/08/2022 19:32
Adaptive defenses Humoral immunity
Primary response Antigen
(initial encounter Antigen binds to a
with antigen) receptor on a
specific B
lymphocyte (clonal
selection). (B
lymphocytes with
Proliferation to
noncomplementary
Activated B cells form a clone
receptors remain
inactive.)
Plasma cells Memory B cell—
21 (effector B cells) primed to respond
to same antigen
Secreted
antibody
molecules
Secondary response Clone of cells Subsequent
(can be years later) identical to challenge by the
same antigen
ancestral cells
results in a larger,
more rapid
response.
Plasma
cells
Secreted
antibody Memory
molecules B cells
Figure 21.11 Clonal selection of a B cell.
M21_MARI1803_12_GE_C21.indd 828 19/07/2022 10:50
Apply Your Knowledge to a Range &
Variety of Questions
1184
Answers Appendix
As you build your knowledge and confidence in A&8P5, 8practiceU rNeIsTp o4nMdianingt etnoa tnhcee omf tohree B cohdayllenging
Chapter 21 a membrane attack complex (MAC)]. Specifically, in complement-mediated
questions—you are likely to encounter similar questions on a test or licensing exam. Your extra effort
cell lysis, MAC complexes cause a target cell (usually a bacterium) to become
will pay off at exam time! Table 22.1 The Upper Respiratory System
Check Your Understanding 1. The innate defense system is always ready to leaky. This allows water to enter and cytoplasmic contents to exit the celClh, akpitlel-r 11 Fundamentals of the Nervous System and Nervous Tissue 431
STRUCTURE DESCRIPTION, GENERAL AND DISTINCTIVE FEATURES FUNCTION
respond immediately, whereas it takes considerable time to mount the adaptive
ing the cell. In contrast, cytotoxicN oTse c (eexltlesr naanl d NJuKtt incge lelxste krnialll ptohretiiorn t ias rsugpeptosr t(euds buya blolyne and carStoilamgee. IDnteefrninail tions: PVroodltuacgese m, uRceuss;i sfitlatenrsc, ew, aCrmusr,r aenndt moistens
defense system. The innate defenses consist of surface barriers and internal Chencokse Yaondu nra Usanl denrasstaal ncadviitny gis divided by midline nasal septum and lined with mucosa. incoming air; resonance chamber for speech
virus-infected cells) by releasing perforins and granzymes onto the identified Voltage, the measure of potential energy generated by separated
cavity)
defenses, whereas the adaptive defenses consist of humoral and cellular immu- target cell. Perforins form a po5r. e Hino wth deo etas rag neutc lceReuoslol w fm oitfhe ninma stbahler c aabnvraietiyn, c adoninfftdea ring fsrr ooamlnfa zacty nomruyc eelepsui tsh elium. electrical charges, is Rmeceeapstuorres dfo irn s eenisteh eorf vsmoletlsl (V) or millivolts
nity, which rely on B and T lymphocytes. 2. Surface barriers (the skin and Pwairtahnina saa ln euron?Mucosa-lined, air-filled cavities in cranial bones surro(u1n dminVg n=asa0l. 0ca0v1it yV ). VLioglhtategne s kisu lal;l wmaayy sa lsmo ewaasrumre, md obiesttewne, aennd t fiwltoe r
A greater vaerinetteyr athnrdo uragnhg teh iosf pore, activat6i.n gsHi noeuwnsez issy am meyse ltinh ash(t et aprti.h g2 4fgo5er)m.r eadp ionp thtoe sCiNs S(,c aenldl wsuhiact iisd iets) . points and is calledi nthcoem pinogt eanirtial difference or simply the
mucous membranes) constitute the first line of defense. 3. Opsonization is the self-assessment questions have
23. The cell being activated is a CPfuhDanrc4ytn iocxne?ll and sPoa scsaoguewlda yb ceoncnoemctien ge niathsael rc aavi thy etolp laerry nTx and orapl ocatveintyt tioa l between tPhaes spagoeinwtasy. fTorh aei rg arneda tfeoro dth e difference in
been added to the Check Your
process of making pathogens more susceptible to phagocytosis by decorating 7. What is the structeusroapl hcalagsusisf.i cTahtrieoen soufb dthivei snioenusr:o nna ssohpohwanry nx, oropharynx, and
Understandcienlgl oserc tai ornesg wulitahtionr y T cell. 24. HIV is particularly hard for the immune system to charge between two points, the higher the voltage.
below? What is itlsa urysnugaol pfuhnacrytinoxn.al classification? Name
tmheeinrt spurroftaecien sw airthe emxoalmecpuleless o tfh mat oplheacguolecsy ttheas tc aacnt baisn odp. sAonntiinbso. d4i.e sO aunrd o wconm cpellelsPe- arechd icchta,p Wtehrd aaetn fdIef ai?nt,c Dbluredacewa Au, psaepn dl(y 1M, ) aitk ed estroys h8.e lp tAhePerP pLTYa r Wtcse hlalilcbshe, l sewtdru haHpc–aiotcdutuh.rhsaoe lgs a aetrnonedns ) s.kfilues n(ylcy tmpiolpnahayol ietdyr ptsies siounfe namedauasrsopenst i ivnveo lved in proctuercTrtiheoenn t fa,l goaanwidn s oitft cealenc btreFaia ncucatisillgei tecdanh ttseaosr gedexop fowrsooumrrek o—onf efimo prm oeuixnnate m tsoyp slateen,m otto ht ope roin wihsae alre d
Connectionism. Dmouzennitsy o fa nnedw ( 2v)is iut ahla s a high mutation rate and so it can avoid detection by the a flashlight. The amount of charge that moves between the two
is involved in sensing the smell of your perfume? Which
are killed by NK cells when they have been infected by viruses or when they questions aismk ymouu ntoe lsaybsetl esmtru cbtyu rcehs anging its stuyprfea isc ene aendetidg teon trsa.n 2sf5er. tBhei nimdpinulgse os fto a tnhe a blrlaeirng feonr onto points depends on two factors: voltage and resistance. Resis
have become cancerous. 5. Redness, heat, swelling, and pain are the cardinal or interpret visual information. integration? tance is the hindrance to charge flow provided by substances
specific IgE antibodies attached to mast cells triggers the mast cells to release
through which the current must pass. Substances with high
signs of inflammation. Redness and local heat are both caused by vasodilation of histamine. directly posterior to the larycnx, wheCreen ttrhael respiratory and diges- elec●t●ricTahle r ecsoinstdauncctei nagre z oinnseu lcaotnosriss,t sa nodf athllo osfe twheit hre slopwira rteosriys -pas-
arterioles, which increases the flow of blood (warmed by the body core) to the tive pathways divberge, and extendpsr otcoe sthse inferior edge of the tance asraeg ceownadyusc ftroorms. the nose to the respiratory bronchioles. These
affected area. The swelling (edema) is due to the release of histamine and other Review Questions 1. d; 2. b; 3.c dri;c o4i.d d c;a 5rt.i laag; e6. .T ah;e 7 l.a rcy;n 8go. pdh;a 9ry. ndx; i1s 0c.o n(1ti)nbu,o gus; with the Ohmpr’osv liadwe fgaiivrleys rtihgeid r ecloantidounistsh ifpo rb aeitrw toee rne avcohl ttahgee g, acsu errxecnhta, nge
esophagus posteriorly. sites. The conducting zone organs also cleanse, humidify,
(2)d, i; (3)a, e; (4)a, e, f, h; (5)e, h; (6)c, f, g; 11. d; 12. The antibody classes and and resistance:
chemical mediators of inflammation, which increase capillary permeability. The esophagus conducts food and fluids to the stomach; air and warm incoming air. As a result, air reaching the lungs
a d
their likely locations in the bodye natreers: tIhgeM la—rynaxt taancthereidor ltyo. BDu crienlgl pswlaasllmowa inmge, mfoobdr ahnaes the has fewer irritants (dust, bvacotletarigae, (eVtc ).) than when it entered
This increased permeability allows proteins to leak into the interstitial fluid (IF), Current (I ) =
as a monomer and in plasma a9s. “ar iMpghAetKn Eot afC OmwNaNeyEr,”C; T IaIOgnNdAS a — iWr hpdiacishms apegarerst t oeffmo tuhpneo rdnae riuinlryo snset iocsp ritses. tfiiobenrs? the body, and it is warm arneds idsatamnpce, l(ikRe) the air of the tropics.
increasing the IF osmotic pressure and drawing more fluid out of blood vessels How do nerve fibers differ from the fibers of connective
and into the tissues, thereby causing swelling. The pain is due to two things: such as saliva, tears, intestinal juiCtcisehs,ue eac nk(sd eYe om Cuhirla kpU;tn eIrdg 4eD) ra—sntda atnhttdea ifcnibhgeersd i nt om Bus cclee (lsle pe lasma OThhme’s Llaawr tyelnlsx us three things:
Chapter 9)?
(1) the actions of certain chemical mediators (kinins and prostaglandins) on membrane as a monomer; IgG—1in. pAliar smmovain; gI gfrEom— thaeFt tonaro casehn setwod et hrtsoe, slmaereya nAsxnt ps cwaeseslrelsss A bipynp a es nnkduiimxn.b, er ●● CBuarsreicn tA (In)a itso dmireyctly proportional to voltage: The greater the
mucosae of the gastrointestinal and roef ssptriurcatutorersy. L tisrta (cint so,r daenr)d a st omnasniyl so.f these structures as voltage (potential difference), the greater the current.
nerve endings, and (2) the swelling, which can compress free nerve endings. The larynx (lar9ingks), or voice box, extends for about
See p. 431you can. ●● T5h cemre firso nmo tnheet lceuvrerle onft tfhloe wth biredt wtoe ethne p soixinthts ctehravti chaalv vee trhteeb ra.
6. A mutation in the gene that codes for interferon would make Julian particu- 2. Name the two types of mucous membrane found in the same potential.
11.4 The resting membrane Superiorly it attaches to the hyoid bone and opens into the
larly susceptible to viruses. 7. Four key characteristics of adaptive immunity Chapter 22 nasal cavity. ●● Claurryrenngto ipsh ianrvyenrxs.e lIyn freerliaotreldy tiot irse sciostnatnincueo: uTsh we igtrhe athteer ttrhaec hea
are that it involves B and T lymphocytes, it is specific, it is systemic, and it“ hDarsa w” questions ask you to create pot3e. n tDiRaAWl dCereaptee an sdumsm oarny t adblief tfoe hreelp nyocue stsu diyn th ieo n r(eFsiisgtuarnec e2,2 t.h5eb )s.maller the current. 11
Check Your Understanding 1. Thep shtarruyncxt ubyr ecso mthpaarti nagi ra npda csosnetsra bstyin ga rites tthhreee n paasrtas.l For
visuals that reinforce important concepts by concentration and permeability In thTeh beo ldayry, nelxe chtarsic tahlr ceue rfruennctst iroenfsle:ct the flow of ions across
memory. 8. A complete antigen has both immunogenicity and reactivity, whereas each part, identify what it conducts (air, food, or both), the
drawing a structucraev, iatnyn o(ntaatrinegs, an fiagsuarle v, eosr tibule, nasal conchae), nasopharynx, oropharynx, and cellular membranes. (Unlike the electrons flowing along your
a hapten has reactivity but not immunogenicity. 9. Self-antigens, particularlcyre ating a summalaryr ytanbgloe.pharynx. 2. The nasalL ceaavrintyin cgtoy pOnetu aotifnc eosp mibthoeetlsihu mre fsopuinrda ttoherrye ,m anudc tohsea a sasnocdia oteldfa tcotnosirlsy. hou●s●e wPriorvinidge, tah pearete anrte ( onpoe nfr)e aei rewleacytrons “running around” in
MHC proteins, mark a cell as self. 10. Development of immunocompetence of ✔ Describe the relationship beFtowr eaennsw ceurrsr, esneet, Avnoslwtaegrse ,A apnpden dix. a liv●i●ngA scyt satse ma s.)w Ritecchainllg t hmaetc thhaenries mis tao s rloiguhtet daiifrf aenredn fcoeo idn i nthtoe the
X mucosa. 3. ❯ 4. The epiglottis resistance. numbeprsr oopf epro cshitainven ealnsd negative ions on the two sides of cellu-
DI a B or T cell is signaled by the appearance on its surface of specific and unique seals the larynx when we 22✔ Ide2nt2if.y2 dif feTrehnet t ylCpooewns douefc mrt sermeEbpsripathnieerl iaiuotmno chrayn nseyTlsos.ntseilsm lar p●l●asVmoai cme epmrobdrauncetiso (na [cbheacrgaue ssee pita rhaotiuosne)s, sthoe t hveorcea ils fao lpdost e(nv-ocal
N receptors for an antigen. In the case of a B cell, this receptor is a membrane- swallow. 5. The incomplete, ✔ DceoNfiannseos priehssattrisnyng ox mfe mcboArinarnde upoctteiPnnsteigauld aoansndtr ddate isfrcieeridbsepP iihtsra arytnogerayl tial acrcoosrsd tsh)]ose membranes. The plasma membranes provide
E bound antibody. (In T cells, it is simply called the T cell receptor.) 11. Dendritic electrochemical basis. ciliated Tubal the resiTshtaen cfrea tmo ecwurorrekn to ffl otwhe. larynx is an intricate arrangement
P All of the End-ofC-C-shhaappteedr Rceavrtiielawg e rings of zone structures columnar
P cells, macrophages, and B cells can all act as APCs. Dendritic cells are moqstu estions are now organized into 3 levels Like all cells, neurons have a resting membrane potential. Roleo fo nf iMnee cmarbtrialangee sI ocno nCnheacntende lbsy membranes and ligaments
A of difficulty basedth oen t Bralocohema’ sa lTlaoxwo nito tmo ye xpandH owLeeOvareorrn,p huinanrgliyk nOex umtocsot moAteihrse ar ncdells, Snteruartoifniesd can rapidPlya lacthiannege (Figure 22.6). Except for the epiglottis, all laryngeal carti-
ERS isamenltpeigcoteritnna gnre.t cWfeophr taTotr cisse clbol eraircnetgsivp saoetnlieodcnitn.e g1d 2 tio.s Itanh apctal oratnnicatiulg lseaenrl .ec 1clot3ino. eTn ,oh tfeh BeT aocnre tlTilg techneal tld swo teohsua ttlh dhe ascLL useea rvvt-eeellg 12o:: rRAiepemps:leym/Abnafearrnlo/yUdzmn ecd ocenorstltrlaaanpcdst ianngd. 6y.e Tt kheee mp aitn ytnhheo euwir✔✔r o nmLn eaDsDseutr iemrtyrshusontbcricngnorrtosiauugb npgrwueeehhi ossatop.hhrruoky etbtn, e setxlnhtetrtewtiu’ fAfansooceli t.eooerf urTi ddnvarrh senocti,udo s ef snuax dsbnpyuiclsSslsoctiqqtttitreoyuurienma naa utgsmm,.in o faIadooimnneneuu ddedrossl rilbredoeasecss artpi htctiioer oap fnutruLon ioncirdnifcyep gt t(rizluhnsoeoatoensanl n nooeedff ) oRmfee ctmhlfaauelbglssr Teietaohs hncn aeaeh t r o lapepafn rrl hnoagtwyseteemal,o silsn i ahcnis saime etr shlcteediaamll-tears tbcghairtlecaiaa vtpgnp eeaeel dsassa t. stieaoh srtnyeo a r cptto hhetieadhp nep tcy neamprereelitsdd i o ll(waifn giie etoph. n i. Is a t1( fo0vroera0r srm)ieio.e menEtdysba ) bclo eihyfts tahne
W Level 3: Evaluate/tSiynnyt haelsvizeeoli together have a electriclaitryy nanxd, trreavcihseita t,h aen rde sbtirnogn cmhei.mbrane potential. allouwpsr itgoh pt aospse. nF obro oekx,a mwpitlhe ,t hae p bootaosks’isu “ms piionne ”c hlyainnnge li na ltlhoew asn te-
vive is (c), one that recognizes MHC but not self-antigen. 14. The secondary only potassium ions to pass.
S large surface area. This and theS e✔the iDpne.n s8ec5rsi8sb eao ntfh dteh A meniarsk wreeeusrpps oiArfa ptthpoeer ynred smipxieramtobrrya mneesm mbraankee, and rior midline of the neck. This “book spine” is the laryngeal
N response to an antigen is faster than the primary response because the immune Basicr ePlartien sctriupctluerse toof f uEnlceticotnr.icity Mpreommbirnaennec ceh (alanhn-erlisn 9ajree-a lla)r, gweh picrho tceainns b, eo sfeteenn wexittehr nsaelvleyr aasl the
A system has already been “primed” and has memory cells that are specific for tbhreomnc ihduesa lb efocra ugsaes ietx ics hwanidgeer. T a7hn.e d✔ Th umh Ipmdeaoe asprnnsee atb iagfvoyneed wutyrht taiie sycw o(easalrl)eg s cita nhtmnr aidscone afss lotlctyrhe ml nenikid enluieegntlfr gytta h. lo —ie8rn d.r i eettT hsrh pheuais enrr a ttihttiglwoe hy rsoyota ummc rieear cnaincuuhm l atb-heer saulwbuAlaanydrisgat semo.r p’S sieo nnam p.m epOa lceltehh (saeF nrti hngcaeuhlnrase ,n i 2nlne2 eaf.le6ksma aa)ga.r leeTe hosg erab ntteheocydnar:ug oPsaideat ercmtda o arctlfihe lta ahsgneeenx pie shrl soot,ytr eapmirineco anlelys
that particular antigen. 15. An IgM antibody is shown at right. (You can tell tions of the lungs are the pulmowfh openoreas iarotylinvv eeec o tiayrlinpc.deu lonafet gcioahtanirv,g ewe c phhraiecrdghoe msd.ie nHlaiovtewesre, svm edar,ek toihnxegyr tegh aoersneea rrteeeggdiioo nnss fthoerm cshtsi aman umnleaolt leien ci tursel asgprr oo“nwgsatethe t”do u tshrpianetcg ci fhpiacu nbsgeigertnsy a.sl hIsna. pfTeehr ietoorer o tapore etn ht hea rntehdey cmrlooaisdine c ar-
because it consists of five Y-shaped parts—that is, it is a pentamer.) IgG antibody tilage is the ring-shaped cricoid cartilage (kri9koid), perched
blood to the lungs for oxygenpaotsiiAotinnvae taloynm doi rcr anelletyug,r atnthisev eloloyxw yceghr aererngsapetider.ad tBo beryclo asuoyssdet e tomop tpchooenssi thieset sca hroatf, r tghees lar- types of gated channels:
atop and anchored to the trachea inferiorly.
is most abundant in blood. IgM is secreted first in a primary immune response. attraycntx, ,e tnrearcghye am, ubsrto nbceh ui,s eadn d( wluonrgks m. Fuusnt cbteio dnoanlley), tthoe s erepsapriartaet ory
and the bronchial circulation, which provides systemic (oxygenated) blood to ●● CheTmhirceael lpya igras toefd scmhaalnl ncealrst,i laalgseos —knaorwynte anso liidg a(anrd0ĭ-gtaet9endo id),
themsy.s Otenm tahse a o wthheorl eh caonnds,i stthse o cf otwmoi nzgo nteosg:ether of opposite
IgA is most abundant in secretions. 16. Antibodies can bring about destruction cchuanneniefolsr, mop (eknu w-nhee9nĭ- fthoerm ap),p aronpdr icaoter ncihceumlaictea lc (ainr ttihlaisg ceas—se fao rm
of pathogen via “PLAN”—phagocytosis, lysis (via complementA)0,1 _aMgARgI1l8u03t_i1n2_aGtEi_oFMn.,in dd 5 loufn lgu ntigs scuaep.i l9l.a Aryn egniodtoetnhseilnia cl ocrcehneaavlsr●loegs●nre.t Tcs,Ti ohnalmihnegb iype rs eore sanissitsetpzeu dsiaya r o temagifnot oteeonhorr egiiyds nyr e zfltwsooohpnhacuitreian ca,ct htdiatoo h nrtieynh nb e ab efrtcr oehuot ruensa ae cripldeth l isbtsaoioeetls eepcmd saaoo,r a ufaaw ltsgmveoeaedr seok a elm.ela llxFre b cocodhrtrufra a cittnnchthsgaei,sele a , nids npeaurrto ot0rf5a /0nt8hs/2me0 2li2at t t e1er9r):3a 2bl ianndds (pFoisgtuerrieo r1 w1.a7lals). of the larynx. The most
or neutralization. 17. Vaccinations protect by providing the initial encounter to blood in the body passes throcuhagrhg etash loveef looulpin,p agol lsc imtaeip csiriloglsanc rohipeaissc tashtberu opcuotutter oensnt.iacle t oe vdeor wy omrki.n Wuete c.a ll ●● Vchoalntagegse ing athteed m cehmabnranneel sp ootpeennti aaln (dF icgluorsee 1 i1n.7 rbe)s.ponse to
this potential energy.
an antigen—the primary response to that antigen. As a result, when the patho-
Angiotensin converting enzyme is part of the renin-angiotensin-aldosterone
gen for that illness is encountered again,
hormone cascade, which increases blood pressure. 10. The driving force for
the pathogen elicits the much faster, more Antigen-
pulmonary ventilation is a pressure gradient created by changes in the thoracic
powerful secondary response, which is gen- binding
volume. 11. The partial vacuum (negative pressure) inside the pleural cavity is
M22_MARI1803_12_GE_C22.indd 858 19/07/2022 13:14
erally effective enough to prevent clinical sites
caused by the opposing forces acting on the visceral and parietal pleurae. The
illness. 18. ❯ The stem region determines
visceral pleurae are pulled inward by the lungs’ natural tendency to recoil and
Hinge
the class of antibody. 19. Plasma cells make M11_MARI1803_12_GE_C11.indd 431 28/06/2022 09:50
the surface tension of the alveolar fluid. The parietal pleurae are pulled outward
region
large amounts of antibodies—proteins that
by the elasticity of the chest wall. If air enters the pleural cavity, the lung on
are exported from the cell. Rough endoplas- Stem
that side will collapse. This condition is called pneumothorax. 12. A lack of
mic reticulum is the site where proteins that region
surfactant increases surface tension in the alveoli and causes them to collapse
are exported are synthesized. Ribosomes,
between breaths. (In other words, it markedly decreases lung compliance.)
the Golgi apparatus, and secretory vesicles
13. ❯ Intrapulmonary pressure
are also required for protein synthesis and export, and so would also be abundant Expiration Inspiration
increases during expiration and
in these cells. 20. Class II MHC proteins display exogenous antigens. Class
decreases during inspiration. When
+2
II MHC proteins are recognized by CD4 T cells. APCs display class II MHC intrapulmonary pressure is zero rela- e)
rg
proteins. 21. Helper T cells are central to both humoral and cellular immunity uH
tive to atmospheric pressure, air flow ssm 0
because they are required for activation of both cytotoxic T cells and most B is zero. This occurs at the three points rem
cells. 22. (a) Immune cells that secrete proteins that form a pore are cytotoxic T P(
labeled in the graph, which are between –2
cells and NK cells. In this case, perforins are the proteins that form the pore. (b)
inspiration and expiration. After air
Time
Complement proteins are plasma proteins that can form a pore [which is called
flow stops, it changes direction.
Air flow is zero
Z01_MARI1803_12_GE_ANSA.indd 1184 18/07/2022 14:52
158 UNIT 1 Organization of the Body
we use areolar connective tissue (ah-re9o-lar) as our prototype, collagen, elastic, and reticular fibers. Of these, collagen fibers
or model (Figure 4.9 and Figure 4.11a). All other subclasses are by far the strongest and most abundant.
are simply variants of this plan.
Collagen Fibers These fibers are constructed primarily of the
fibrous protein collagen. Collagen molecules are secreted into
Ground Substance
the extracellular space, where they assemble spontaneously into
Ground substance is the unstructured material that fills the cross-linked fibrils, which in turn are bundled together into the
spaPce breteweepn thae crelles an d fcoontairns thYe foiberus. Itr ha s Fthreue tuthirck ecoll agCen fiabersr seeen weithr a m i&crosc op e. Because their fibrils
components: cross-link, collagen fibers are extremely tough and provide high
●● Interstitial fluid. The ground substance consists of large tensile strength (the ability to resist being pulled apart) to the
4 amountsP of rfluaid acndt fuincctioens a sS a moolelcuvlar isineve gthro uRgh eamaltr-ix.W Indeeod, strrelssd test s Pshowr tohat cbollalgeen fmibers asre stronger
which nutrients and other dissolved substances can dif- than steel fibers of the same size!
fuse between the blood capillaries and the cells. The fibers Elastic Fibers Long, thin, elastic fibers form branching networks
embedded in the ground substance make it less pliable and in the extracellular matrix. These fibers contain a rubberlike pro-
hinder diffusion somewhat. tein, elastin, that allows them to stretch and recoil like rubber
●● Cell adhesion proteins. These proteins serve mainly as a con- bands. Connective tissue can stretch only so much before its thick,
Tnehceti vaeu titshsuoer gs louef tthhati sa ltloewxts, c Eonlaniencteiv Me tiasrsiueeb c eallns dto Katatatcjha Hoerhonpe, liskhea croell aignesnig fihbtesrs f breocmom teh taeuirt. oThwenn, cwlhinenic tahle etexnpsieorni elentsc e to
htoe tlhpe yexotura cperlleuplaar rmea ftroixr. your future career in health careu.p A, ellla cstliicn ifcibaelr se xsnaamp pthlee sc oannndec ativpep tliiscsautei obancsk atore i tss ingonramlaeld with
length and shape. Elastic fibers are found where greater elasticity
●● aPnro teeaosgyly-ctoan-fis. nTdh e“ pCrloitneiocgalyl”c alnasb ceoln.sist of a protein core is needed, for example, in the skin, lungs, and blood vessel walls.
to which large polysaccharides called glycosaminoglycans
(GAGs) (gli0kos-ah-me0no-gli9kanz) are attached. The strand-
HOMEOSTATIC
likHeo GmAeGoss [tea.gti.,c cIhmonbdarloaitninc esu dlfiascteu sasniodn hsy aalleurrto ynoicu a tcoi d CLINICAL
IMBALANCE 4.2
(htih0aeh -clou-nrsoenq9iuk)e]n sctiecsk oofu tb forodmy sthyes tpermotes inn octo rfeu lnikcet itohne ifnibge rs
Marfan syndrome is an inherited disorder that causes a change
ofo ap btiomttlael lbyr.u Rshe.l eTvhaen ptr optheoogtloysc ahnasv teen bde teon f oardmd heudg et oa ggre-
in the types of proteins that comprise elastic fibers. As a result
gasteelse icnt ewdh idcihs cthues sGioAnGs sf oinrt evritswuianle r aenidn ftorarpc ewmateenr, tf.orming a
of this change, the elasticity in tissues is reduced, leading to
substance that varies from a fluid to a viscous gel. The higher
NEW! Discussions have been added on Marfan the overgrowth (aortic enlargement and long arms, legs, and
the GAG content, the more viscous the ground substance.
syndrome, brittle bone disease, tetanus, and fingers) and instability (lung collapse and eye problems) of tis-
anxiety disorders. sues. Although people suffering from Marfan syndrome are
Connective Tissue Fibers
born with the condition, not all of them show symptoms at birth
The fibers of connective tissue are proteins that provide sup-
or during childhood; some only develop symptoms as adults.
port. Three types of fibers are found in connective tissue matrix:
See p. 158
Chapter 16 The Endocrine System 673
Connective tissue is composed of (1) fibers, (2) ground substance, and (3) cells.
well, complEaixntsr aocf erlelpuelaarte md a“tcroixlds,” and is extremely “puffy”
Cl(iendiecmaalt oCuas)s. eE xSptluaidn itehes raeareso pn rfoovr itdheesde asyt mthpeto emnsd. CLINICAL CASE STUDY
of Chapters 5–29 and challenge you to apply your
FLibeevrsel 3 Evaluate/SyntheGsroizuned substance One-Year-Old Girl with CReelltsarded Growth
knowledge to realistic clinical scenarios. Capillary
• Collagen fiber
20. Which type of hormone receptor—plasma membrane bound or Miriam gave birth to a twin boy and girl a year ago. She
• Elasitnict rfaibceerllular—would be expected to provide the most long-lived is concerned about • Fat cell
• Retirceuslapro fnibseer to hormone binding and why? Theresa, her daughter,
21. Name two endocrine glands (or regions) that are important in since her growth and
the stress response, and explain why they are important. development is much
22. How are the hyperglycemia and lipidemia of insulin deficiency slower than that of her
• Mast cell
linked? brother. Miriam visits
23. List some problems that elderly people might have as a result a pediatric outpatient
of decreasing hormone production. clinic, where she
24. Mary 8M3o0rgan haUs NjuITst 4beMena ibntreonuagnhcte ionft oth teh Beo edmyergency room informs the physician • (Nae tuytpreo pohf ilwhite blood cell)
of City General Hospital. She is perspiring profusely and is that, apart from having retarded growth, Theresa has a poor
breathailnmgo rsat psiixd lmy iallniodn idrreeagthusl aprelry y. eHare. rW bhreilaet ihm smmuenlilzsa ltiikone parcoegtroanmes botualpispmet,i rteab, iseusff, earnsd ftreotman ucso n(asntitpitaotxioinn), baencda uiss el etthheasreg riacp. iTdhlye phy-
(sweetto a nprde vfreunitt yth),e aonudt bhreera kb loofo ldif ge-ltuhcroesaete tneisntgs ionufte catti o6u5s0 diseases fatasl idciisaena soersd werosu bldlo koildl ate psetsr stoon c bh•ee fFcoikbrer To abhclaetisrvetes aim’sm guronwityt hc ohuolrdm one
mg/10te0n md lt oo ffo bcluoso odn. cShhield irse nin, t haceside ovsaicsc. iWnehs iccahn haolsrom boen eef fdercutigv e in be e(sGtaHbl)i,s htheydr. oTihde- sdtiomnautleadt ianngt ihboordmieos npero (vTidSeH i)m, manedd itahtye rporxoi-ne
shoulda dbuel tas.d Hmoiwniesvteerr,e adc,c aenssd two hvayc?cines remains regrettably unequal Steectei(oT np4,). b l6uetv7 et3hlse.ir effect is short-live•d M (atwcroo ptoh athgreee weeks).
25. Kyle, bao 5th- yfeoar rc-hoilldd rbeno ya,n hda asd bueltes ng lgorboawllyin.g by leaps and bounds;
his heighCt oisn v1e0n0ti%on aalb voavcec innoersm haavl ef oshr ohritsc oamgein. gHs.e T hhaes b bigegeens t short- 1. ✚ NCLEX-STYLE Theresa’s r• eLtyamrdpehdo cgyrtoewth could be due to:
a. The positive feedback of GH on the hypothalamus
complcaoimniinngg oisf thheata dthaecyh aerse annodt avliwsiaoyns apsr oebffleecmtivs.e Aor C loTn gs-claanst ing as Susumu Tonegawa (b. 1939) (a type of white blood cell)
reNveEaWlws ea! wlBaoorugxlede pslii ktouen.i tI asnrc ysio etmunmet ioisntrd.s i (vfaie)d auWtaulhsr,i cech od nhetoatmramiinlosan taienb igso pbureotit netihgn es (for is a Jabp.a nAe spei tsuciiteanrtyi sttu wmhoor wthoant is causing hypersecretion of GH
selcivreetsee xdaa nimndp e lwxe,c oeegrskgs? sa (lobbuf) m eWimnh)ia ncta ecunosent dasilctlieioergnni ctw irsietlsls p.K oTynhsleee ses txeoh wtihbeiil tlv iasfc hcoinwe. the Nocb. eHl Pyrpizeer sienc Prehtyisoino loogf yg roorw th hormone–releasing hormone
Figure c4oy.ro9reu cA ttirhvePeeo a mlhsaserui avcmseou anhrnenusm e saciotdrreivea ne lo o itmtfi stsmasckuiueeenn:n i?Atc y(e cpd.)ri foWfteohrsat ytf rpiosem t h( maec optirdvoeeb lia)m bclmoen unnietyct, ive tissMueed. iTcihnise( GinH 19R8H7 )f obry e tlhueci hdaytpinogth alamus
tissue uncdaeursliee bsoo fet phh iiitsnh ehthleieaa daanantcdibh soeudsr yra osnuodnu vrdcises cuaaanpld ip lilanror tibehslee. dm(Segse?ree eF igofu prer o4te.1c1tiao nf oitr par om-icrograpthh.e) dg.e nHeytpiocs emcreetciohna onfi sGmHs by the anterior pituitary
vides (Figure 21.13). Instead of being made by your plasma cells, underlyTinhge raedsaa’pst ibvleo oimd mteusntsi tiyn. dicate that her GH levels are
26. Aaron, a 42-year-old single father, goes to his physician
ready-made antibodies are introduced into your body. As a result, A npororbmleaml, binu ta dhaeprt TivSe Him lmevuenlist ya re elevated, and her T levels
complyaoinuirn Bg ocfe lnlsa uasree an aont dc hcahlrloenngice dfa btiyg uaen.t iHgeen rse, piomrmts uhnaovlionggi cal waasr eth laotw, a. lTthhoeu pghhy tshiec iparne steelnlcse M iriam that since Ther4esa’s GH
felt famtigeumeodr ya ndode lsi sntolet sosc cfourr, aabnod utht eh aplrfo tae cyteioanr, p bruovt ihdee dh bayd the “bor- ofl emveilllsi oanres noofr mdiaflf,e hreenr tr eatnartid-ed growth is not due to pituitary
attriburtoewde tdh”i sa ntoti bsotdreiesss .e Hndes hwahse lno tshte cyo nnastiudrearllayb dlee gwraedieg hint tahned b, ody. boddwy aprrfiostemin.s was known, there
M04_MARI1803_12_GEs_trCa0n4.gineddl y P ,1 a5hs8issi vsek iimn mlouonkisty t aisn nceodn,f eervreedn nthaotuurgahll yh eo ns pae fnedtuss l oorn gin fant weren’t enough genes in the 27/07/2022 1176:11
hours wath weno trhke amnodt hraerre’sl ya nvteibnotudrieess coruotsssi dthee. pHlaisc ednotcat oorr afirne dins gested hu2m. a n✚ gNeCnLoEmX-eST tYoL Ea c Gcoivuennt tfhoer levels of TSH and T4 in Theresa’s
very lowwit hb tlhoeo dm potrheesrs’us rme ialkn.d F ao rr aspevide,r awl emaokn pthusl saeft.e Br lboirotdh, ttehset sb aby theseb. lSoood h, owwh icwhe oref tahlel ftohleloswe ing is most likely the cause of her
show itsh aptr oAteacrtoend dfrooems nalolt t hhea vaen taigneenms itao, wbuhti chhi st hpel amsmotha egr lhuacso bsee,e n differseingtn asn atinbdo dsyiems pptroomdus?ced? By comparing the DNA of
cortisoexl,p aonsded N.a+ are low, and his plasma K+ is high. His doctor maturae. aSnhde i mhams aat uprietu Bit acreyl ltsu,m Toorn, ewgahwicah disis ccaouvseirnegd hthyapte rsecre-
orders anP AasCsiTvHe ismtimmuulnaittiyo nc atens ta,l isno wbhe iccho nAfearrroend’ sa sretcifriectiiaolnly by the regiontiso onf o Df NTASH th.at produce antibodies become greatly
of coratidsmoli nisis mteeriansgu reexdo gafetneor uhse a inst igbiovdenie sa (sfyrnotmh eotiuct sfiodrem y oouf r own rearrabn.g eHde ra sth tyhreo iBd gcelalnl dm iast uproeosr,l yw dheicvhe liosp heodw. a small
ACTHb.o (day)) W ash gata wmmoual dg laocbcuoluinn,t hfoarrv Aesatreodn ’fsr olomw t hpela psmlasam Naa o+ f an numbce.r oSfh ea nhtaibs oGdrya-vperso’d duicsienags eg.enes generate the huge
and hiigmhm pulnasem doan Kor+.? E (xbo)g Wenhouast iasn ttihbeo dreieass oanre fuosre ddo toin pgr eavne AntC hTepHa - varietdy .o fH aenrt ipbaordaitehsy sreoeind. glands are defective.
titis A (antiserum) and treat poisonous snake bites (antivenom),
stimulation test? (c) Which gland is primarily affected if ACTH
3. Miriam does not completely understand what Theresa’s
does not cause a normal elevation of cortisol secretion? What is See p. 830
blood tests indicate. She asks the physician if she needs to
this abnormality called? (d) Which gland is primarily affected if
put Theresa on a high-calorie diet to speed up her growth.
ACTH does cause an elevation of cortisol secretion?
Adaptive defenses Humoral immunity What would be the physician’s answer?
4. The physician diagnoses Theresa with congenital hypo-
A01_MARI1803_12_GE_FM.indd 6 Asintetigen-binding Heavy chain tFhoyrr ohiodwis mlo,n agn sdh ostualrdts T ah terreeastam been to inn vthoilsv tirnega tsmynetnhte?t ic T4. 05/08/2022 19:32
21 Light chain
Hinge region
Stem region
(a) (b)
Heavy chain Light chain
variable region variable region
Heavy chain Disulfide bond
constant region
Light chain
constant region
Figure 21.14 Antibody structure. sulfur atoms called disulfide bonds (S–S). class). Together, the variable regions form
(a) Schematic antibody structure (based Each chain has a variable (V) region (which the antigen-binding sites—two per antibody
on IgG) consists of four polypeptides—two differs in antibodies made by different monomer. (b) Computer-generated image
short light chains and two long heavy chains cells) and a constant (C) region (essentially of antibody structure.
joined together by covalent bonds between identical in different antibodies of the same
M16_MARI1803_12_GE_C16.indd 673 25/06/2022 19:18
M21_MARI1803_12_GE_C21.indd 830 27/07/2022 19:02
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