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ANATOMY &
PHYSIOLOGY
Elizabeth Mack Co
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Anatomy & Physiology, 1st Edition
Elizabeth Mack Co
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Dedication
In many ways, I have tried to package my classroom self into the pages of this book. I started teaching years ago,
but answering questions, writing case studies, telling stories, and—most importantly—being inspired
by the curiosity and wonder of thousands of students changed me. It was because of the students
that I became the teacher that I am today. And so, I dedicate this, my first book, to them.
For my students, thank you.
iii
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Brief Contents
Unit 1 Levels of Organization
Unit 3 Regulation, Integration,
Control
1
The Art and Science
of Learning in Anatomy
and Physiology 2
2
Introduction to the Human
Body 14
14 Anatomy of the Nervous
System 524
3
The Chemical Level of
Organization 48
15 The Somatic Nervous
System 574
4
The Cellular Level of
Organization 100
5
The Tissue Level of
Organization 150
Unit 2 Support and Movement
13 The Nervous System and
Nervous Tissue 478
16 The Autonomic Nervous
System 624
17 The Endocrine System 650
Unit 4 Fluids and Transport
18 The Cardiovascular System:
Blood 694
6
The Integumentary
System 202
7
Bone Tissue and the Skeletal
System 236
8
Axial Skeleton 278
20 The Cardiovascular
System: Blood Vessels and
Circulation 794
9
The Appendicular
Skeleton 326
21 The Lymphatic and Immune
System 860
10 Joints 354
19 The Cardiovascular System: The
Heart 730
11 Muscle Tissue 386
Unit 5 Energy, Maintenance,
and Environmental Exchange
12 The Muscular System 428
22 The Respiratory System 908
23 The Digestive System 962
iv
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24 Metabolism and Nutrition 1034
25 The Urinary System 1072
26 Fluid, Electrolyte, and Acid-Base
Balance 1128
Brief Contents v Unit 6 Deviations from
Homeostasis
27 The Reproductive Systems 1162
28 Anatomical and Physiological
Response to Disease 1220
Appendix (Answers) A1
Glossary G1
Index I1
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Table of Contents
Unit 1 Levels of Organization
1
1.1
The Art and Science of
Learning in Anatomy and
Physiology 2
3
The Chemical Level of
Organization 48
3.1
lements and Atoms: The Building Blocks
E
of Matter 50
3.1a Elements and Compounds 50
3.1b Atoms and Subatomic Particles 51
The Science of Learning 3
1.1a F oreign, Familiar, and Mastery-Level
Understanding 3
3.1c The Behavior of Electrons 55
3.2
Chemical Bonds 58
3.2a Ionic Bonds 59
1.1b Memory Formation and “Chunking” 5
3.2b Covalent Bonds 59
1.1c Retrieval Practice 6
3.2c Hydrogen Bonds 61
1.2
Bloom’s Taxonomy 6
1.3
What Is a Learning Objective? 9
3.3a The Role of Energy in Chemical Reactions 64
1.4
The Anatomy of Art 10
3.3b Characteristics of Chemical Reactions 66
1.4a Image Translation in Anatomy 10
3.3c Factors Influencing the Rate of Chemical
Reactions 68
3.3
1.4b Comparing a Micro and Macro View 10
1.4c Learning from Physiology or Process Diagrams 11
2
2.1
Introduction to the Human
Body 14
Overview of Anatomy and Physiology 15
3.4
Chemical Reactions 64
Inorganic Compounds Essential to Human
Functioning 70
3.4a Water 71
3.4b Salts 74
3.4c Acids and Bases 75
3.5
2.1a The Themes of Anatomy and Physiology 17
rganic Compounds Essential to Human
O
Functioning 78
3.5a The Chemistry of Carbon 78
2.2
Structure and Function 18
3.5b Carbohydrates 80
2.3
Evolution and Human Variation 20
3.5c Lipids 83
2.4
Flow 21
3.5d Proteins 87
2.5
Homeostasis 23
3.5e Nucleic Acids 91
2.6
Structural Organization of the Human Body 27
2.6a The Levels of Organization 27
2.7
Anatomical Terminology 31
4
The Cellular Level of
Organization 100
4.1
he Cell Membrane and Its Involvement in
T
Transport 102
2.7a Anatomical Position 32
2.7b Regional Terms 32
2.7c Directional Terms 32
2.7d Sections and Planes 35
2.7e Organization and Compartmentalization 38
4.1a S tructure and Composition of the Cell
Membrane 102
4.1b Membrane Proteins 104
4.1c Transport across the Cell Membrane 105
vi
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4.2
The Cytoplasm and Cellular Organelles 115
4.2a Organelles of the Endomembrane System 115
4.2b Organelles for Energy Production and
Detoxification 117
4.2c The Cytoskeleton 120
4.3
4.4
4.5
4.6
Unit 2 Support and Movement
6
The Integumentary
System 202
6.1
Layers of the Skin 203
The Nucleus and DNA 125
4.3a Organization of the Nucleus and Its DNA 126
Protein Synthesis 129
6.1a The Epidermis 204
4.4a From DNA to RNA: Transcription 131
6.1b The Dermis 212
4.4b From RNA to Protein: Translation 132
6.1c The Hypodermis 213
Cell Replication 134
6.2
Accessory Structures of the Skin 215
4.5a The Cell Cycle 135
6.2a Hair 215
4.5b DNA Replication 135
6.2b Nails 219
4.5c Cell Cycle Control 140
6.2c Sweat Glands 220
Cellular Differentiation 143
6.2d Sebaceous Glands 221
4.6a Stem Cells 144
Table of Contents vii 6.3
Functions of the Integumentary System 223
6.3a Protection 223
5
5.1
6.3b Sensory Function 223
The Tissue Level of
Organization 150
Types and Components of Tissues 151
6.3c Thermoregulation 224
6.3d Vitamin D Synthesis 225
6.4
Healing the Integument 227
6.4a Injuries 227
5.1a The Four Types of Tissues 152
5.1b Extracellular Matrix 153
5.1c Cellular Connections 155
5.2
Epithelial Tissue 156
7
Bone Tissue and the Skeletal
System 236
7.1
The Functions of the Skeletal System 237
5.2a Generalized Functions of Epithelial Tissue 157
5.2b The Epithelial Cell 159
5.3
5.2c Classification of Epithelial Tissues 160
7.1a Support, Movement, and Protection 238
5.2d Glands of Epithelia 166
7.1b Mineral Storage, Energy Storage, and
Hematopoiesis 240
Connective Tissue 169
5.3a Functions of Connective Tissues 170
7.2
5.3b Classification of Connective Tissues 170
7.2a Long Bones 242
5.3c Connective Tissue Proper 170
7.2b Short Bones 243
5.3d Supportive Connective Tissues 178
7.2c Flat Bones 243
7.2d Irregular Bones 243
5.3e Fluid Connective Tissue 181
5.4
Muscle Tissue 183
5.5
Nervous Tissue 186
5.6
Membranes 188
5.7
Bone Classification 241
7.2e Sesamoid Bones 243
7.2f Bone Markings 248
7.3
he Microscopic Structure of Cartilage
T
and Bone 249
5.6a Tissue Membranes 188
7.3a Cartilage Cells and Tissue 250
Tissue Growth and Healing 190
7.3b Bone Cells and Tissue 250
5.7a Tissue Injury and Repair 190
7.3c Compact and Spongy Bone 252
5.7b Tissue and Aging 191
5.7c Tissues and Cancer 193
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viii Table of Contents
7.4
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F ormation and Growth of Bone
and Cartilage 256
9
The Appendicular
Skeleton 326
9.1
The Shoulder Girdle 329
7.4a Intramembranous Ossification 256
7.4b Endochondral Ossification 257
7.5
Growth, Repair, and Remodeling 259
9.1a Clavicle 330
7.5a Cartilage Growth 259
9.1b Scapula 330
7.5b How Bones Grow in Length 260
7.5c How Bones Grow in Diameter 261
9.2
9.2a Humerus 332
7.5d Bone Remodeling 263
9.2b Radius and Ulna 334
7.5e Hormones and Bone Tissue 263
7.5f Bone Repair 266
7.6
Bones and Homeostasis 268
9.2c Bones of the Wrist and the Hand 336
9.3
The Pelvic Girdle and Pelvis 338
9.3a Os Coxae 339
7.6a Nutrition and Bone Tissue 269
7.6b Exercise and Bone Tissue 270
Bones of the Arm 332
9.3b Features of the Whole Pelvis 341
9.4
Bones of the Leg 345
9.4a Femur 345
8
Axial Skeleton 278
8.1
Divisions of the Skeletal System 279
8.1a The Axial Skeleton 280
8.1b The Appendicular Skeleton 281
8.2
9.4d Bones of the Foot 349
10 Joints 354
8.2a Introduction to the Skull 281
10.1 Classification of Joints 355
8.2c The Skull as a Whole 294
8.2d Anterior View of the Skull 294
8.2e The Orbit 294
8.2f The Nasal Cavity, Septum, and Conchae 295
8.2g Paranasal Sinuses 297
8.2h Lateral View of the Skull 300
8.2i Posterior View of the Skull 301
8.2j The Interior of the Skull—the Brain Case 301
8.2k Development and Aging of the Skull 304
8.2l Bones Associated with the Skull: The Ossicles
and the Hyoid Bone 308
The Vertebral Column 309
8.3a Regions of the Vertebral Column 309
8.3b Curvatures of the Vertebral Column 310
8.3c General Structure of a Vertebra 311
8.4
9.4c Tibia and Fibula 347
The Skull 281
8.2b Bones of the Skull 286
8.3
9.4b Patella 347
10.1a Structural Classification of Joints 356
10.1b Functional Classification of Joints 356
10.2 Fibrous Joints 359
10.2a Suture 359
10.2b Syndesmosis 360
10.2c Gomphosis 361
10.3 Cartilaginous Joints 361
10.3a Synchondrosis 361
10.3b Symphysis 362
10.4 Synovial Joints 363
10.4a Structural Features of Synovial Joints 364
10.4b Cushioning and Support Structures Associated
with Synovial Joints 364
10.4c Types of Synovial Joints 366
10.5 Movements at Synovial Joints 370
8.3d Regional Vertebrae 314
10.5a Flexion and Extension 370
8.3e Intervertebral Discs 318
10.5b Abduction and Adduction 370
The Thoracic Cage 320
8.4a Sternum 321
8.4b Ribs 322
10.5c Circumduction 372
10.5d Rotation 372
10.5e Supination and Pronation 373
10.5f Dorsiflexion and Plantar Flexion 373
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10.5g Inversion and Eversion 373
12.2 Naming Skeletal Muscles 434
10.5h Protraction and Retraction 373
12.3 Axial Muscles 437
Table of Contents ix 10.5i Depression and Elevation 373
12.3a Muscles of Facial Expression 437
10.5j Excursion 374
12.3b Muscles That Move the Eyes 439
10.5k Opposition and Reposition 374
12.3c Muscles That Move the Lower Jaw 439
10.6 Anatomy of Selected Synovial Joints 375
12.3d Muscles That Move the Tongue 440
10.6a Temporomandibular Joint 375
12.3e Muscles That Move the Head 443
10.6b Shoulder Joint 376
10.6c Elbow Joint 376
12.3f Muscles of the Posterior Neck and
the Back 444
10.6d Hip Joint 377
12.3g Muscles of the Abdomen 446
10.6e Knee Joint 379
12.3h Muscles of the Thorax 447
11 Muscle Tissue 386
11.1 Overview of Muscle Tissues 387
11.2 Skeletal Muscle 390
11.2a Skeletal Muscle Cells 392
11.2b The Sarcomere 393
11.2c The Neuromuscular Junction 394
11.3 S
keletal Muscle Cell Contraction
and Relaxation 395
11.3a The Sliding Filament Model of Contraction 396
11.3b Excitation-Contraction Coupling 397
11.3c Events at the Neuromuscular Junction 398
11.3d Events Along the Sarcolemma 399
11.3e Events at the Sarcomere 401
11.3f ATP and Muscle Contraction 402
11.3g Skeletal Muscle Cell Relaxation 404
11.4 Skeletal Muscle Metabolism 405
11.4a Sources of ATP 405
11.5 Whole Muscle Contraction 410
11.5a The Length-Tension Range of a Sarcomere 412
11.5b Sustained Muscle Contraction 412
11.5c Muscle Tone 414
11.5d Motor Units 414
11.6 Cardiac Muscle Tissue 417
12.3i Muscles of the Pelvic Floor and
Perineum 450
12.4 Appendicular Muscles 452
12.4a Shoulder Muscles 453
12.4b Muscles That Move the Humerus 455
12.4c Muscles That Move the Forearm 456
12.4d Muscles That Move the Wrist, Hand, and
Fingers 456
12.4e Muscles That Move the Feet and Toes 471
Unit 3 Regulation, Integration, Control
13 The Nervous System and
Nervous Tissue 478
13.1 O
rganization and Functions of the Nervous
System 479
13.1a The Functions of the Nervous System 480
13.1b The Central and Peripheral Nervous Systems 481
13.2 Nervous Tissue and Cells 484
13.2a Neurons 484
13.2b Glial Cells 487
13.3 Neurophysiology 491
13.3a Membrane Potential 497
13.4 Communication between Neurons 510
13.4a Synapses 511
11.7 Smooth Muscle 419
12 The Muscular System 428
12.1 Interactions of Skeletal Muscles, Their Fascicle
Arrangement, and Their Lever Systems 429
12.1a Interactions of Skeletal Muscles in the Body 429
12.1b Patterns of Fascicle Organization 431
14 Anatomy of the Nervous
System 524
14.1 General Anatomy of the Nervous System 525
14.1a Anatomical Patterns of Nervous Tissue 526
14.1b Blood and Cerebrospinal Fluid 533
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x Table of Contents
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14.2 The Central Nervous System 536
14.2a E
mbryonic Development of the Nervous
System 537
14.2b The Brain 539
16.4 Broad Impacts of Autonomic Responses 642
16.4a Stress 643
14.2c The Diencephalon 549
17 The Endocrine System 650
14.2d Brainstem 551
17.1 An Overview of the Endocrine System 652
14.2e The Cerebellum 554
17.1a Chemical Signaling 652
14.2f Brain Systems and Functions that Bridge Brain
Regions 554
17.1b Neural and Endocrine Long-Distance
Signaling 653
14.2g The Limbic System 557
14.2h The Spinal Cord 557
14.3 The Peripheral Nervous System 560
17.2 Hormones 656
17.2a Types of Hormones 656
17.2b Pathways of Hormone Action 659
14.3a Ganglia 561
17.2c Factors Affecting Target Cell Response 662
14.3b Nerves 561
17.2d Regulation of Hormone Secretion 662
15 The Somatic Nervous
System 574
15.1 S
tructure and Function of Sensory and Motor
Pathways 576
15.1a Reflexes 577
17.3 Endocrine Control by the Hypothalamus and
Pituitary Gland 665
17.3a Posterior Pituitary 668
17.3b Anterior Pituitary 669
17.4 The Major Hormones of the Body 674
17.4a The Thyroid Gland 674
17.4b The Parathyroid Glands 679
15.2 Sensory Receptors 583
17.4c The Adrenal Glands 681
15.3 General Senses 587
17.4d The Adrenal Medulla 684
15.3a Touch 587
17.4e Disorders Involving the Adrenal Glands 684
15.4 Special Senses 593
17.4f The Pancreas 685
15.4a Vision 594
17.4g The Thymus 688
15.4b Taste (Gustation) 602
17.4h The Heart 688
15.4c Smell (Olfaction) 606
17.4i The Gastrointestinal Tract 688
15.4d Hearing (Audition) 607
17.4j The Kidneys 688
15.4e Equilibrium (Balance) 613
17.4k Adipose Tissue 688
17.4l The Skin 689
16 The Autonomic Nervous
System 624
17.4m The Liver 689
Unit 4 Fluids and Transport
16.1 Overview of the Autonomic Nervous System 626
16.1a S ympathetic Division of the Autonomic Nervous
System 626
16.1b Parasympathetic Division of the Autonomic
Nervous System 632
16.2 C
hemical Components of the Autonomic
Responses 634
18 The Cardiovascular System:
Blood 694
18.1 The Composition of Blood 695
18.1a The Functions of Blood 696
18.1b Whole Blood 696
16.3 Autonomic Reflexes and Homeostasis 638
16.3a The Structure of Reflexes 638
18.1c Plasma 697
18.1d Erythrocytes 700
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18.1e The Life Cycle of Erythrocytes 703
Table of Contents xi 18.1f Leukocytes and Platelets 706
19.4c Other Factors Influencing Heart Rate and
Contractility 781
18.1g Classification of Leukocytes 708
19.4d Stroke Volume 782
18.1h Platelets 712
18.2 P
roduction of the Formed Elements 713
18.2a Sites of Hematopoiesis 713
18.2b Differentiation of Formed Elements
from Stem Cells 714
18.2c Hemopoietic Growth Factors 715
18.3 Hemostasis 715
18.3a Vascular Spasm 717
18.3b Formation of the Platelet Plug 717
18.3c Coagulation 717
18.3d Fibrinolysis 719
18.3e Plasma Anticoagulants 719
18.4 Blood Typing 720
18.4a A
ntigens, Antibodies, and
Transfusion Reactions 720
19 The Cardiovascular System:
The Heart 730
19.1 Heart Anatomy 731
19.1a Location of the Heart 732
19.1b Chambers and Circulation through the
Heart 734
19.1c Membranes, Surface Features, and Layers 736
19.1d Layers 738
19.1e Internal Structure of the Heart 741
19.1f Coronary Circulation 748
19.2 Cardiac Muscle and Electrical Activity 751
20 The Cardiovascular
System: Blood Vessels
and Circulation 794
20.1 Anatomy of Blood Vessels 795
20.1a Structure-Function Relationships 798
20.1b Arteries 801
20.1c Arterioles 802
20.1d Capillaries 802
20.1e Metarterioles and Capillary Beds 804
20.1f Venules 805
20.1g Veins 805
20.1h Veins as Blood Reservoirs 805
20.1i Alternative Blood Flow Pathways 807
20.2 Blood Flow, Blood Pressure, and Resistance 809
20.2a Arterial Blood Pressure 810
20.2b Pulse 811
20.2c Variables Affecting Blood Flow and Blood
Pressure 812
20.2d Factors That Contribute to the Pressure
Gradient 812
20.2e Factors That Contribute to Resistance 813
20.2f Venous System 818
20.3 Capillary Exchange 821
20.3a The Role of Lymphatic Capillaries 823
20.4 Homeostatic Regulation of the Vascular
System 824
19.2a Structure of Contractile Cardiac Muscle 752
20.4a Neural Regulation 824
19.2b Cardiac Muscle Metabolism 755
20.4b Endocrine Regulation 825
19.2c Conduction System of the Heart 755
20.4c Autoregulation of Blood Flow 826
19.2d Electrocardiogram 762
19.2e Nervous System Influence on Heart
Activity 768
19.3 Cardiac Cycle 771
20.5 Circulatory Pathways 828
20.5a Pulmonary Circulation 829
20.5b Systemic Arteries 830
20.5c The Aorta 830
19.3a Pressures and Flow 771
20.5d Arteries Supplying the Upper Limbs 838
19.3b Phases of the Cardiac Cycle 773
20.5e Arteries Serving the Lower Limbs 838
19.3c Heart Sounds 776
20.5e Overview of Systemic Veins 840
19.4 Cardiac Physiology 779
19.4a Resting Cardiac Output 779
19.4b Exercise and Cardiac Function 781
20.5f The Hepatic Portal System 847
20.6 Development of Blood Vessels and Fetal
Circulation 850
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xii Table of Contents
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21 The Lymphatic and Immune
System 860
21.1 Anatomy of the Lymphatic and Immune
Systems 861
21.1a Functions of the Lymphatic System 862
21.1b Structure of the Lymphatic System 864
21.2 Overview of the Immune Response 872
21.3 B
arrier Defenses and the Innate Immune
Response 874
21.3a Cells of the Innate Immune Response 875
21.3b Recognition of Pathogens 878
21.3c Soluble Mediators of the Innate Immune
Response 879
21.3d Inflammatory Response 879
21.3e Fever 882
21.4 The Adaptive Immune Response 884
21.4a T
he Benefits of the Adaptive Immune
Response 885
21.4b T Cell-Mediated Immune Responses 886
21.4c Antigens 886
21.4d T Cell Development and Differentiation 887
21.4e Mechanisms of T Cell-Mediated Immune
Responses 887
22.4 Gas Exchange 935
22.4a Gas Exchange 936
22.5 Transport of Gasses 942
22.5a Oxygen Transport in the Blood 942
22.5b Carbon Dioxide Transport in the Blood 947
22.6 Respiratory Rate and Control of Ventilation 949
23 The Digestive System 962
23.1 Overview of the Digestive System 963
23.2 General Gross and Microscopic Anatomy of the
Gastrointestinal (GI) Tract 967
23.2a Microscopic Structure of the GI Tract 967
23.2b Nerve Supply 970
23.2c Blood Supply 970
23.2d The Peritoneum 971
23.3 The Mouth, Pharynx, and Esophagus 973
23.3a The Mouth 974
23.3b The Tongue 976
23.3c The Salivary Glands 976
23.3d The Teeth 978
23.3e The Pharynx 980
23.3f The Esophagus 983
21.4f The Cellular Basis of Immunological Memory 888
23.3g The Stomach 985
21.4g T Cell Types and their Functions 889
23.3h Gastric Secretion 989
21.4h B Cells and their Functions 891
23.3i The Mucosal Barrier 991
21.4i B Cell Differentiation and Activation 892
23.3j The Small and Large Intestines 992
21.4j Antibody Structure 892
23.3k The Small Intestine 992
21.4k Active versus Passive Immunity 896
23.3l The Large Intestine 998
21.4l Responses to Different Pathogens 899
23.4 Accessory Organs in Digestion: The Liver,
Pancreas, and Gallbladder 1004
23.4a The Liver 1005
Unit 5 Energy, Maintenance,
and Environmental Exchange
22 The Respiratory System 908
22.1 Functions and Anatomy of the Respiratory
System 909
22.1a Conducting Zone 911
22.1b The Respiratory Zone 921
22.1c The Gross Anatomy of the Lungs 922
22.2 The Process of Breathing 925
22.3 Respiratory Volumes and Capacities 933
23.4b The Gallbladder 1009
23.4c The Pancreas 1009
23.5 Chemical Digestion and Absorption: A Closer
Look 1012
23.5a Chemical Digestion 1012
23.5b Absorption 1017
24 Metabolism and
Nutrition 1034
24.1 Overview of Metabolic Reactions 1036
24.1a Catabolic Reactions 1037
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24.1b Anabolic Reactions 1039
24.1c Metabolic Reactions 1040
24.2 Macronutrients and Metabolism 1041
25.5 Additional Endocrine Activities of the
Kidney 1109
25.5a Vitamin D Synthesis 1110
24.2a Glycolysis 1042
25.5b Erythropoiesis 1110
24.2b Citric Acid Cycle 1045
25.5c Calcium Reabsorption 1110
24.2c Oxidative Phosphorylation and the Electron
Transport Chain 1047
24.3 Metabolic States of the Body 1055
24.3a The Absorptive State 1055
24.3b The Postabsorptive State 1055
24.3c Starvation 1057
24.4 Energy and Heat Balance 1058
Table of Contents xiii 25.6 Gross and Microscopic Anatomy of the
Urinary Tract (Ureters, Urinary Bladder,
and Urethra) 1111
25.6a The Ureters 1111
25.6b The Bladder 1112
25.6c The Urethra 1114
25.7 Urine Characteristics and Elimination 1117
24.4a Metabolic Rate 1060
24.5 Nutrition and Diet 1060
24.5a Food and Metabolism 1061
24.5b Vitamins and Nutrients 1061
24.5c Minerals 1062
26 Fluid, Electrolyte, and Acid-
Base Balance 1128
26.1 Body Fluids and Fluid Compartments 1130
26.1a Body Water Content 1130
25 The Urinary System 1072
25.1 Functions of the Urinary System 1073
25.2 G
ross and Microscopic Anatomy
of the Kidney 1075
25.2a External Anatomy 1075
26.1b Fluid Compartments 1131
26.1c Composition of Bodily Fluids 1133
26.1d Fluid Movement between Compartments 1133
26.1e Solute Movement between
Compartments 1136
26.2 Water Balance 1138
25.2b Internal Anatomy 1075
26.2a Regulation of Water Intake 1139
25.2c The Structure and Function of the Nephrons 1079
26.2b Regulation of Water Output 1141
25.3 Physiology of Urine Formation 1087
25.3a Glomerular Filtration Process and Rate 1088
26.2c Role of ADH 1141
26.3 Electrolyte Balance 1143
25.3b Net Filtration Pressure (NFP) 1090
26.3a Roles of Electrolytes 1144
25.3c Mechanisms of Reabsorption and
Secretion 1093
26.3b Regulation of Sodium and Potassium 1146
25.3d Reabsorption and Secretion in the Nephron
Loop 1099
25.3e Reabsorption and Secretion in the Distal
Convoluted Tubule 1103
25.3f The DCT and the Juxtaglomerular
Apparatus 1103
25.3g Collecting Ducts and Recovery of Water 1104
25.4 H
omeostasis and Control over the Formation
of Urine 1106
25.4a Renin–Angiotensin–Aldosterone 1106
25.4b Antidiuretic Hormone (ADH) 1108
25.4c Natriuretic Hormones 1108
26.3c Regulation of Calcium and Phosphate 1147
26.4 Acid-Base Balance 1148
26.4a R
espiratory Regulation of Acid-Base
Balance 1150
26.4b Renal Regulation of Acid-Base Balance 1151
26.5 Acid-Base Homeostasis 1153
26.5a Metabolic Acidosis 1153
26.5b Metabolic Alkalosis: Primary Bicarbonate
Excess 1154
26.5c Respiratory Acidosis: Primary Carbonic Acid/CO2
Excess 1154
26.5d Respiratory Alkalosis: Primary Carbonic Acid/CO2
Deficiency 1154
26.5e Compensation Mechanisms 1155
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xiv Table of Contents
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Unit 6 Deviations from
Homeostasis
27.6d Spermiogenesis 1197
27.6e Testosterone 1198
27.7 Sex (Coitus) 1200
27.8 Pregnancy, Birth, and Lactation 1204
27 The Reproductive
Systems 1162
27.8a Fertilization 1204
27.8b The Preembryonic Stage 1204
27.8c Development of the Placenta 1206
27.1 Overview of Human Reproductive Systems 1163
27.8d Hormones of Pregnancy 1208
27.2 Development of Reproductive Structures 1166
27.8e Labor and Childbirth 1209
27.2a D
evelopment of the Sexual Organs in the
Embryo and Fetus 1166
27.2b Further Sexual Development Occurs at
Puberty 1170
27.2c Breasts 1171
27.3 Anatomy of Biological Females 1173
27.3a External Genitalia 1173
27.8f Postpartum 1209
27.8g Lactation 1209
28 Anatomical and Physiological
Response to Disease 1220
27.3b Vagina 1174
28.1 Hypertension Case Study 1221
27.3c Ovaries 1175
28.2 Cystic Fibrosis Case Study 1225
27.3d The Uterine Tubes 1176
27.3e The Uterus and Cervix 1177
27.4 The Ovarian and Uterine Cycles 1179
28.2a Lungs 1226
28.3 Pulmonary Embolism Case Study 1230
28.4 Femoroacetabular Impingement Case Study 1233
27.4a The Ovarian Cycle 1180
28.5 Arthritis Case Study 1235
27.4b The Uterine Cycle 1186
28.6 Cardiac Failure Case Study 1238
27.5 Anatomy of Biological Males 1189
27.5a External Genitalia 1190
27.5b The Penis 1190
27.5c The Scrotum 1192
27.5d The Testes 1193
27.6 Spermatogenesis and Spermiogenesis 1195
27.6a Nurse Cells 1196
27.6b Gametes 1196
27.6c Spermatogenesis 1197
28.7 Stroke Case Study 1241
28.8 Type 2 Diabetes Mellitus Case Study 1243
28.9 Chronic Obstructive Pulmonary Disease
Case Study 1247
28.10 Pregnancy Case Study 1251
Appendix (Answers) A1
Glossary G1
Index I1
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About the Author
Dr. Elizabeth Mack Co is Assistant Clinical Professor in the Departments of Biology
and Health Sciences at Boston University (BU). She teaches Gross (cadaveric) Anatomy,
Human Physiology, and Physiology of Reproduction. Her teaching career spans a variety of
courses, including Human Infectious Diseases, Introductory Biology, Cellular and Molecular Biology, Human Biology, Human Pathophysiology, and Histology. Dr. Co received her
Ph.D. in Biomedical Sciences (with a focus on Immunology) from the University of California, San Francisco; she earned her BA with High Honors in Biology and Education at
Mount Holyoke College in Massachusetts.
Outside of teaching, Dr. Co holds positions in a number of science organizations,
including:
• The HAPS (Human Anatomy and Physiology Society) Learning Objectives Panel
• Principal Investigator of Assessing Student Engagement and Efficacy of Remote Learning, BU
• Independent Contractor and Presenter for Howard Hughes Medical Institute (HHMI)
BioInteractive
• Society for College Science Teachers
• National Science Teachers Association
• American Association of Anatomists
• American Physiological Society
As a professor, Dr. Co is renowned for her passion—both in regard to the human body and
about learning itself. In 2018 she was nominated by students and members of the faculty at
BU and received the Metcalf Award for Excellence in Teaching, Boston University’s highest
teaching award.
Dr. Co’s current research focuses on learning, particularly critical thinking skills development. She puts this research into practice by integrating an active learning and study skills
curriculum in her courses. One of the focal points she investigates is how “student awareness about their learning impacts their assessment performance.”
xv
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Preface
As I move around in the world from doctors’ offices to dinner
parties, I occasionally am asked what I do for work. When I
reply “I teach Anatomy and Physiology,” people tend to have
very strong reactions. From “Oh! I absolutely LOVED that
course in college” to “A&P almost ended my interest in medicine” to “Oh, wow, you must have a very hard job.” Everyone
has intense feelings about A&P. I typically reply “Actually, I
have the BEST job in the world because everyone has a body
and so there is a common baseline of shared curiosity.” But the
fact of the matter is that A&P can be intimidating for students
(and for us teachers, too!) because there is a lot of information
that can be taught. One of the keys as an instructor to having
students leave with positive intense feelings is finding a balance
in how much information to present and how to present it.
One of the goals I had for this book was to lighten and streamline the content. Instructors are in a perennial push-pull with
the desire to reduce the burden on our students and the desire
to prepare them for their future exams and courses. If we sacrifice anatomical structures by not teaching enough of them,
we might leave our students underprepared; if we sacrifice the
interesting connections, our students may lack the passion and
excitement for the subject; and if we keep everything in, they
might be overwhelmed. In the writing of this book, I wanted
to give instructors and learners the choice whether to explore
deeper into the interesting connections and content. I separated
these topics into “Cultural Connections” and “Digging Deeper”
features. Cultural Connections are usually ways that the topics
being covered connect to everyday health, or the way that history impacts health or science today. Digging Deeper features
often discuss relevant diseases or the science behind healthcare
technology.
Increasing student persistence is a core need shared across
community colleges and universities in the United States, with
30–50 percent1,2of students never completing the two-semester
Anatomy & Physiology course. Recognizing that the course can
be extraordinarily challenging due to its expansive depth and
breadth of coverage, I address this lack of student persistence
by improving student preparedness and helping students see
themselves and the world around them reflected in what they
Gultice, Amy, Ann Witham, and Robert Kallmeyer. “Are your students ready
for anatomy and physiology? Developing tools to identify students at risk for
failure.” Advances in Physiology Education (June 2015): 108-115. Doi:10.1152
/advan.00112.2014, https://pubmed.ncbi.nlm.nih.gov/26031727/
2
Vedartham, Padmaja B. Investigating Strategies to Increase Persistence and
Success Rates among Anatomy & Physiology Students: A Case Study at Austin
Community College District. 2018. National American University, Ed.D.
dissertation. ERIC, https://eric.ed.gov/?id=ED583935
1
are learning to engage them in the learning process. Increasing
student confidence in both these areas will allow them to tackle
the rigors of this course and lead to greater persistence in their
education—and hopefully their career path.
Learner Support
As an instructor, how often are you asked “So, what will be on
the test?” When we stop to think about the job of a student, they
are not only trying to learn the material, but trying to learn how
the instructor teaches and assesses their students. One effective mechanism for conveying the expectations of the course is
through the use of learning objectives. Learning Objectives (LOs)
can be used by an instructor to frame their pedagogy, as a list
of goals for your students to make sure that you prepare them
for. Sharing these same LOs with your students communicates
to them what you are going to be assessing them on. In other
words, it effectively answers the question “What will be on the
test?” before it is even asked.
The Human Anatomy and Physiology Society (HAPS) has set
out to define a set of learning outcomes (LOs) for Anatomy,
Physiology, and A&P courses. As a member of the Physiology
LO panel, I have participated firsthand in the careful process
through which these LOs are created. The LOs are honed over
months through the collaboration of some of the colleagues
I respect most in our field. It is no exaggeration that some of
these LOs have individually taken hours to write or improve.
They are the most thorough, well-considered and well-crafted
set available. I have written this text almost completely tailored
to the LOs provided by HAPS. On occasion I provide additional LOs specific to the content I have created; often these are
higher-order LOs.
Chapter 1 is dedicated entirely to helping each student build a
learning framework so they are more prepared to engage with
all the content that follows. This chapter explains the science
behind learning and introduces the concept of metacognition
to set the foundation for learning A&P in a systemic way. From
there, each chapter orients students around the metacognitive
aspects of the content to help them tie the concepts to the wider
world around them.
Features in each chapter that support student learning and success in A&P include:
• Learning Checks: This feature provides periodic section
assessments throughout the chapter to check your learning.
• Student Study Tips: These tips are written by actual students
who have been successful in A&P.
xvi
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• Learning Connections: Chapter 1 details different ways to
•
•
•
•
•
learn the material in A&P. Throughout the book, Learning
Connections suggest learning approaches.
Chapter Review: At the end of every chapter are assessment
questions for each section, including a Mini Case with questions. LOs, questions, and a brief summary are provided for
each section.
Cultural Connections: Sometimes the things that we fall in
love with in A&P are the ways that the material connects to
our everyday lives. Cultural Connections are small features
in each chapter that attempt to do just that. Consider these
topics the ones you are most likely to share with others at
the dinner table.
Digging Deeper: The content in this text is streamlined, but
sometimes you may want to know more about a given topic.
This feature provides that deeper exploration.
Apply to Pathophysiology: In most of scientific history we
have learned about how the body works by studying the
times when it doesn’t! We did not understand blood sugar
regulation until we studied diabetes; we did not understand
much about how viruses affect our cells until the HIV pandemic. The Apply to Pathophysiology feature helps students
strengthen their understanding of physiology by examining
a disease state.
Anatomy of: This feature describes different concepts
graphically.
Critical Thinking
A 2017 study of Google employees3 found that among the qualities of the most successful workers, STEM expertise comes in
last. The top skills were listening well, teamwork, and critical
thinking. Fostering critical thinking in the classroom is often
cited as a goal of instructors, including myself. When I first
began measuring my students’ critical thinking skills using
Bloom’s taxonomy and my own exam data (Co, 2019),4 I was
shocked that, despite this being a top priority of mine, my
students performed poorly on higher-order cognitive skill questions. I realized that my pedagogical approach had been to show
critical thinking, to tell them how important it is, but that, as
with any skill, I needed to give them supported opportunities to
practice.
Based on these findings, I developed a new pedagogical
approach in my classroom. I teach critical thinking practice
through multiple choice questions that build upon each other,
concept by concept, to arrive at an understanding of a complex
3
https://www.washingtonpost.com/news/answer-sheet/wp/2017/12/20
/the-surprising-thing-google-learned-about-its-employees-and-what-it-means
-for-todays-students
4
Co, E. (2019). “The power of practice: adjusting curriculum to include emphasis on skills.” Journal of College Science Teaching 48 (5): 22–27.
Preface xvii system or pathology. Blood pressure, for example, is a factor in
the body with many layers (osmosis, Starling’s forces, capillary
dynamics, vasoconstriction, neural control). To create a critical
thinking activity on blood pressure, I start with simple concepts
such as osmosis, which helps the students to remind themselves
of the fundamental ideas and build confidence. From there we
move on, like steppingstones in a path, to more and more complex ideas.
In this text I provide stepwise practice for students to build
their critical thinking skills in each chapter. These Apply to
Pathophysiology features first ask students to recall fundamental
information and then apply it in a new situation.
To give students additional practice in critical thinking, Chapter 28 is composed entirely of case studies. The 10 cases within
can be assigned at the end of the semester or at intervals as the
instructor chooses.
Inclusivity and Diversity—and Accuracy
The need to include more diverse content in the Anatomy
and Physiology course was one of my biggest inspirations for
writing this text. An example of how this issue came into my
awareness occurred about 10 years into my teaching career. I
attended a science museum with an exhibit on the human body
that, naturally, I gravitated toward. One feature used a size
measurement to estimate the volume of blood in each museum
visitor. My body, the exhibit computer told me, contained
4.6 liters of blood. I walked away shaking my head. I’d been
teaching physiology for a decade and everyone knows the
human body contains 5 to 5.5 liters of blood. How many times
had I said that in class? All the calculations we use in class on
the cardiovascular system are based on this range.
It dawned on me that I, a slightly smaller-than-average woman,
may not necessarily be represented in physiological estimates. I
dug into the background on this and discovered that most of the
average numbers we teach came from studies of men—young
men, probably mostly white men, with an average weight of
150 pounds. Since then, when I teach, I introduce the idea of
“average man,” a mythological 150-pound white man on whom
we base our calculations. The students and I look around our
classroom (which is a large auditorium) and reflect that average man is not usually among us. We are beautifully diverse
and require a wider range of numbers. In this book I have
tried, when possible, to research and provide more accurate
and representative numbers for us. In other cases I provide the
anatomical and physiological factors that influence the value
range.
This text will not only prompt students to think deeper about
their learning; it will also challenge them to take a broader look
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xviii Preface
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at the cultural assumptions that have an impact on anatomy and
medicine. For example, Hoffman et al. (2016)5 explored biases
held by medical students and revealed deeply racist beliefs that
could affect their patient care—ideas such as the one that Black
Americans have higher pain tolerances and therefore require
less treatment for their pain. I believe that no one holds onto
racist or bias-laden beliefs because they want to; rather, racist
ideas persist because they haven’t been sufficiently challenged.
There hasn’t been, in the education of these medical students,
enough accurate information about the diversity and unity
in function that exists among human bodies. Anatomy and
Physiology is often the threshold into health education that our
future clinicians pass through, and so this subject represents
especially fertile ground to facilitate critical thinking when it
comes to biases within scientific information.
In developing this text, I benefited from the reviews of a number
of instructors, including Inclusion and Diversity (I&D) advocate
Dr. Edgar Meyer, author of “Diversity and Inclusion in Anatomy
& Physiology Education, Degree Programs, and Professional
Societies.”6 My goal was to create an inclusive and diverse textbook in Anatomy & Physiology. Taking into consideration Dr.
Meyer’s feedback, I created a seven-point I&D plan, including:
1. More diverse models and imagery throughout the text
2. “Cultural Connections” features that link science with
culture
3. In-class active learning opportunities to maximize inclusive
and diverse academic experiences
4. Curriculum and anatomy pertaining to transgender and
gender nonconforming individuals
5. Inclusive language that is sensitive to diversity in students
6. Clinical examples detailing the predispositions of certain
racial and socioeconomic groups to display health care disparities, such as sickle cell anemia
7. Defining “average” values and providing comparative data,
where applicable
Organization of the Text
Chapter 1, “The Art and Science of Learning in Anatomy and
Physiology,” is devoted to explaining methods students can use
to approach learning. Dr. Co’s commitment to her students
comes through as she explains the proper mindset needed to
5
Hoffman, K.M., Trawalter, S., Axt, J.R., and Oliver, N.M. (2016). “Racial bias in
pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites” Proceedings of the National Academy of
Sciences 113 (16): 4296–4301. Doi: 10.1073/pnas.1516047113, https://www.pnas
.org/content/113/16/4296
6
Meyer, E. R., and Cui, D. (2019). “Diversity and inclusion in anatomy & physiology education, degree programs, and professional societies.” HAPS Educator
23 (2): 396–419. Doi: 10.21692/haps.2019.012, https://files.eric.ed.gov/fulltext
/EJ1233545.pdf
study Anatomy & Physiology. She shares study tips from her
previous students to offer a peer perspective to learners.
Chapters are organized as follows:
• Unit 1 (Level of Organization) contains chapters that exam-
ine the levels of organization of the structures of the human
body.
• Unit 2 (Support and Movement) includes the chapters of the
musculoskeletal system.
• Unit 3 (Regulation, Integration, and Control) contains chapters about systems that contribute to homeostasis through
control over other systems.
• Unit 4 (Fluids and Transport) examines the systems that
regulate fluids and fluid flow throughout the body.
• Unit 5 (Energy, Maintenance, and Environmental Exchange) is
all about exchange with the external environment.
• Our last unit, Unit 6 (Deviations from Homeostasis), contains two chapters that are beyond the homeostatic function
of the body: reproduction and the changes that occur in our
bodies in disease.
Art
Throughout my teaching career I have spent a lot of time and
energy observing how students interact with instructional art.
Often illustrations, symbols, or representations that seem easy
to understand using our expert eyes are not intuitive for an
introductory learner. In designing each figure, I drew the structures and concepts as I would do and have done while talking
to students in office hours. Our amazing illustrators then took
what I produced and turned it into art. This instructional art
approach is infused throughout the book but especially prominent in our “Anatomy of…” features.
Years ago, I learned in an undergraduate educational psychology class that science students often had trouble developing a
scientist identity because they didn’t see images of scientists
that looked like them. The idea of representation has wide
ranging ripple effects. Clinicians see a variety of patients; students see a variety of possible selves. When we choose a limited
palate of representative humans in instructional art, we limit
the scope of what students are exposed to in several ways.
Therefore, I asked our art team to work with me on creating
and sourcing images that represented a spectrum of bodies
from young to old, across different sizes, gender expressions
and ethnicities.
Whether you are a student or an instructor, please know that
I have written this book for you. I hope that it helps you learn
or teach and that you find it helpful in your A&P journey. I
would love to hear back from you about it, whether it is typos,
constructive suggestions, ideas for enrichment or, perhaps you’d
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like to suggest your own study tips. Please know my virtual door
is always open and I would love to chat with you.
I hope you develop the most positive feelings about A&P!
Liz Co, July 2022
eco@bu.edu
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Preface xix • Lecture PowerPoints: Key points from the text are outlined,
along with images and active-learning activities to keep students engaged.
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We created both print and digital content in this product with
direct ties to HAPS learning outcomes. Each piece of information was intentionally chosen to support A&P student learning.
Throughout the text and MindTap, students and instructors can see
which content is tied to each learning outcome. The Human Anatomy
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The HAPS A&P Learning Outcomes measure student mastery of the
content typically covered in a two-semester Human A&P curriculum at
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Instructor Resources
• Test Bank: Build your exam from a list of multiple-choice
and short-answer questions.
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Acknowledgments
Writing a book is an enormous and consuming task. As I sit here writing the
acknowledgments, I feel as though I could write for days because there are
so many people who have helped either directly or indirectly.
Nanette Tomicek, thank you for your insights on the hardest of the chapters.
Janet Brodsky, your precision is unparalleled, I am thankful for your partnership throughout the book.
I’ll start with my family. In many ways, this book is my third child, I feel as
though I dreamed about it, hoped for it, and poured my heart and soul into
it. It also, at times, interrupted my life in the ways that a newborn can.
Therefore, my first acknowledgment is to my two human children, Talia and
Eliot, who had to be patient and understanding and occasionally got less of
their mom’s time for the duration of the writing cycle. For all the times you
sat next to me writing your books as I wrote mine, drew bones on the floor
of my office while I finished a paragraph, and generally cheered me on,
thank you. You are the loves of my life.
Hilary Engebretson, your comments as a reviewer were always spot on. You
corrected content, adjusted my voice, and lent a perspective that always
helped me bring things back in check. I very much appreciate your
contributions.
Sam, thank you for describing my early morning typing as a “steady pitter
patter” instead of disruptive, for all the things you took on or waited for
when I needed to write, for all of your listening, but most of all, for your
steadfast and contagious belief in LFC, I do not think this book could or
would exist without you.
I need to thank my work wife, who patiently answered my exasperated
phone calls, took walks with me when I needed to get out of my head, edited
many sentences, brought clarity and insight to biological concepts, and who
has always been in my corner, thank you. I wouldn’t have wanted to share
this work journey or all those nachos with anyone else.
Now for the book team, first, thank you, Julie Scardiglia, for being the maven of details and always patiently redirecting me to my priorities. Brendan
Killion patiently kept us all on task and driving forward, and we all owe him
thanks that this book is being published in 2022, instead of 2032.
Akshat Mehta, Angelina McNulty, and Emily Ackerman, you each brought
your own strengths to the book and I am so very grateful. Akshat, I’ve always said that there is a teacher in you! Thank you for sharing that teacher
with the world in the pages of this book. Angelina and Emily, many, many
students will be helped by the student study tips you’ve shared with them.
You are learning assistants through and through. Thank you for providing
your unique insights the process of learning A&P. I am not only grateful
for your contributions to the book, but for the privilege of getting to a part
of your journey as you transitioned from my students to my colleagues. I
cannot wait to see what you do next in the world.
This text would not make half as much sense as it does and would have commas in all the wrong places, if not for the careful editing of Christopher
Chien. Thank you.
One of the most important things to me in conceiving this book was that
the images within it represent a diverse set of bodies. I dreamed that we
could fill the pages of the book with beautiful images of people of different
shapes, sizes, ages, and appearances. Dragonfly brought that dream into
vivid color and created a book that is more magnificent than I could have
dreamed. I owe the amazing artists a huge thank you.
To Kelsey Kerr, Katherine Caudill-Rios, Maureen McLaughlin, and Diana
Baniak. You saw an author in me. When I believed that a book would be a
dream, you picked me out, coached me along, and willed it into reality. I am
a person of many, many words, but I am not sure if I will ever find all of the
right ones to be able to thank you for helping me make this transition. You
are the birth coaches of this book baby. I am forever thankful.
This text, MindTap content, and instructor supplements were improved
thanks to the insights of many Anatomy & Physiology instructors who
shared their ideas, concerns, and feedback with the product team at Cengage. Thank you to the following participants who dedicated their time to
improving the product through focus groups, surveys, interviews, and product testing.
Special thanks to the following reviewers:
Janet Brodsky, Ivy Tech Community College
Stephen Burnett, Clayton State University
Mary Colon, Seminole State College of Florida
Hilary Engebretson, Whatcom Community College
Stephen Henry, Houston Community College
Austin Hicks, The University of Alabama
Nathaniel King, Palm Beach State College
Ann LeMaster, Ivy Tech Community College
Edgar Meyer, University of Mississippi Medical Center
Andrew Nguyen, CUNY Queensborough Community College
Julie Posey, Columbus State Community College
Rosemary Stelzer, University of Wisconsin-Milwaukee
Nanette Tomicek, Thomas Jefferson University
Padmaja Vedartham, Lone Star College System
Kelsha Washington, Florida A&M University
Theo Worrell, Delgado Community College
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1
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The Art and Science
of Learning in Anatomy
and Physiology
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The Art and Science of Learning in Anatomy and Physiology Chapter 1 3 Chapter Introduction
In some ways learning can be discipline specific. However, in many ways learning is learning, regardless of the content.
In this chapter we will explore some of the science behind how we learn in order to help you foster success in Anatomy
and Physiology (A&P).
1.1 The Science of Learning
1.1a Foreign, Familiar, and Mastery-Level Understanding
Let’s take an example of a person who is learning a new language. We could also use an
example of a spectator trying to learn about the game of baseball, or a student studying physics, or an architect learning about building construction, but let’s take a new
language. Let’s say our learner’s name is Talia. Talia goes to Spanish class for the first
time. The teacher speaks in Spanish and Talia understands none of it. She guesses as to
the instructions based on the instructors’ gestures and tone of voice. After a few classes,
Talia begins to pick up on some of the vocabulary of the class. She is learning Spanish
words in her own time, using flashcards, online quizzing apps, recognizing phrases. She
eventually becomes very familiar with Spanish words. After a few years, Talia travels to
Mexico. She finds she is able to recognize enough Spanish words to be able to understand signs and ads that are printed in Spanish. However, Talia now sits in a café in
Mexico City. A friendly stranger approaches her and begins to make conversation in
Spanish. Will Talia be able to converse with the stranger?
Probably not, because there is a difference between being familiar with a language
and being able to converse in it. Conversation is a skill, a dynamic skill that involves
listening, decoding, recall, comprehension, and creativity. Talia has not yet practiced
these skills. She has the content she needs but will need to practice the skill of conversation before she can employ it with ease.
Learning A&P (or really most anything) can be thought of the same way: there is
the content of what you are learning, and the skills involved in its mastery and application. In terms of A&P, we have vocabulary, concepts, functions, structures, and locations, and then we need to learn how to connect ideas and apply knowledge in a new
context, analyze new data. For example, if you were to become a clinician and a patient
had a pain in their abdomen, it would not be sufficient to list off a memorized set of
organs in the abdomen. You, the clinician, must apply your knowledge of the area and
an understanding of the symptoms that the patient is experiencing and analyze the data
from clinical tests to diagnose and treat the patient. You must think critically about the
information you know and apply it in a new circumstance, one that may be nuanced or
unique. Therefore, it is insufficient to simply memorize in A&P; we must learn the lifesaving skills of application, analysis, and critical thinking.
Let’s go back to Talia, the Spanish language learner, for a moment. Talia needs
to engage in separate processes of memorizing vocabulary and practicing the skill of
conversation. She cannot dive first into practicing the skill, nor is it sufficient to stop
at memorization. If we were to diagram Talia’s learning it would look something like
Figure 1.1. Talia’s stage 1 of learning happened in the classroom when she was a beginning learner. She is currently at an advanced level of stage 2; she has a lot of vocabulary
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4 Unit 1 Levels of Organization
Figure 1.1 Stages of Learning
Stage 1:
Foreign
Stage 2:
Familiar
Stage 3:
Mastery
and is able to understand written text and recall meaning. If she practices the skills
involved in conversation, she will reach stage 3—mastery of Spanish—and able to
converse with ease.
The science of learning tells us that the transition between foreign and familiar
is one that is best achieved through repetition and exposure. The methods of repeat
exposure may look different from one type of learning to another, but in A&P learning,
this may look like: reading/rereading your notes, copying your notes over, watching
and rewatching lectures, reading and rereading your textbook, and using flashcards to
memorize terminology.
The transition from familiarity to mastery, however, is a bit different. Here, the
difference in our language-learning example is between being able to translate printed
words or being fluid in a conversation. In A&P, mastery means not only being able to
identify the deltoid muscle but being able to predict functional deficits with deltoid
injury, or being able to identify, based on a set of symptoms, the location of an injury.
In further mastery, you may find, as a clinician, that you need to communicate about
A&P on a variety of levels. For example, you may use one set of terms to discuss a case
with a colleague who is also a clinician, but you may need to translate information
when conveying it to others in ways that are respectful of their level of knowledge and
understanding.
In A&P, examples of practice might include: teaching or explaining the material to someone else, drawing a structure or structures, writing out an explanation
of a concept, recreating a graph with explanations, completing practice problems, or
answering the question what happens if these components don’t work? (Figure 1.2 and
Table 1.1).
Figure 1.2 T ransitioning Between the Stages of Learning Using a Variety of Learning
Techniques
Stage 1:
Foreign
Transition from foreign to familiar
through repetitive exposure to
the material:
• Reading/rereading your notes
• Copying your notes over
• Watching and rewatching
lectures
• Reading and rereading your
textbook
• Using flashcards to memorize
terminology
Stage 2:
Familiar
Stage 3:
Mastery
Transition from familiarity to mastery
through practice:
• Teaching or explaining the material to
someone else
• Drawing a structure or structures
• Writing out an explanation of a concept
• Recreating a graph with explanations
• Completing practice problems
• Answering the question what happens
if these components don’t work?
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The Art and Science of Learning in Anatomy and Physiology Chapter 1 5 Table 1.1 Learning Strategies That Build Familiarity and Those That Build Mastery
Familiarity-Building Learning Strategies Mastery-Building Learning Strategies
Reading
Drawing a representation of an anatomical structure
Looking over notes
Teaching someone else the material
Copying notes over
Quizzing yourself
Flashcards
Having a friend quiz you
Listening to/watching lectures
Explaining a process
Labeling an unlabeled drawing
Ordering the parts of a process after mixing them up
Looking at a process you’ve learned, ask yourself
about each component “what would happen if this was
broken, how would that impact the entire process?”
1.1b Memory Formation and “Chunking”
Everyone has limits to their learning and memory. People who enter memorization
competitions (yes! There are such things!) have a variety of different strategies for
learning vast quantities of information quickly. The first technique is quite easy to
employ. It is storytelling. Let’s say that you have been asked to remember four words
and recall them back four hours later. The four items are cookie, staircase, yellow, and
music. Imagine you go about the rest of your day for the next four hours and then are
asked to recall these four random words. Few people would be able to do so easily. But
what if you paused for a moment, after getting your list of words, and created a quick
story or visual for learning (Cookie monster is sitting on the bright yellow staircase listening to his favorite music)? If you paint this image in your mind, it is much more likely
that you will be able to remember the four words a long time from now. Similarly, in
A&P we can create short stories known as mnemonic devices. For example, there are
12 nerves that exit the brain and innervate structures mostly found in the head and
neck. These 12 nerves are known as cranial nerves. Their names are: olfactory, optic,
oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal. You got that? What was the fifth one? It’s a
challenge. However, what if, in order to remember them, we take just their first initials:
OOOTTAFVGVAH and make a story such as On, on, on they traveled and found Voldemort guarding very ancient horcruxes? If you have read the Harry Potter books (or seen
the movies) you will remember this mnemonic pretty easily. You still have to learn the
names of the cranial nerves and that the second V, for example, stands for vagus, but it
makes the process easier.
Chunking is the term for grouping items together as you learn them. It’s a way
to cheat your working memory into holding onto more information. Let’s take an
example. Please remember the following numbers—4195082637—in order, and repeat
them back in five minutes. It seems like a challenging task. What if, instead, we chunk
them like this: (419) 508-2637? That form of chunking is widely employed for memorizing telephone numbers. Birth dates are another example; instead of 10152004 you
may remember a birthday as 10/15/2004. So how do we chunk information in A&P?
One great example is learning structure and function together. Forms of chunking you
might use could be:
●
●
●
●
similarities and differences.
structure and function.
structures in order, for example, from top to bottom or superficial to deep.
structures that are together in one location—for example, the three layers of protective tissue, called meninges, over the brain—can be learned together in one chunk.
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6 Unit 1 Levels of Organization
Table 1.2 Examples of Chunking
Example 1: Chunking structures
by shared functions
Example 2: Chunking structures
by similarities
Cellular Structures and
Their Functions
● Lysosomes break down material
through enzymes
● Peroxisomes break down material
through hydrogen peroxide
● Smooth endoplasmic reticulum
breaks down some toxins
● Nucleus holds the instructions for
building proteins
● Ribosomes build proteins
● Golgi apparatus modifies proteins
Structures within
the Abdominal Cavity
● Stomach
● Greater omentum
● Small intestine
● Large intestine
● Lesser omentum
● Liver
● Mesocolon
chunked
chunked
Recycling Functions
● Lysosomes
● Peroxisomes
● Smooth
endoplasmic
reticulum
Protein-Building Functions
● Nucleus
● Ribosomes
● Golgi apparatus
Organs
● Stomach
● Small intestine
● Large intestine
● Liver
Membranes
● Greater omentum
● Lesser omentum
● Mesocolon
Two examples of chunking in A&P are provided in Table 1.2. Chunking is a great
tool to incorporate as you move from foreign to familiar in your learning.
1.1c Retrieval Practice
Retrieval practice refers to memory strengthening. The more often you are asked to
recall information, the easier it becomes to remember. Let’s say that you change the
passcode to your new mobile phone, email account, or favorite website. The first few
times you enter this passcode it may be difficult to remember, but after the thirtieth
time you’ve logged in, the passcode becomes rote, or habitual. The learning concept of
retrieval practice is part of the philosophy behind assigning homework or quizzes or
in-class questions during a course. The more times you are asked about a concept, a
structure, or an idea, the more habitual it becomes to recall that piece of information.
Your instructor may provide opportunities for you to practice retrieval, such as quizzes,
but you can do this for yourself as a learner as well.
Examples of retrieval practice in studying can be:
●
●
●
●
●
using flashcards, redrawing, or rewriting from memory.
labeling an unlabeled diagram.
paraphrasing a process or idea (especially effective if you are trying to tell someone
else about this process or idea).
predicting what questions could be asked of you about a structure/concept/idea.
summarizing information at the end of a section or chapter.
Retrieval practice is a great tool to use as you move from foreign to familiar in
your learning.
1.2 Bloom’s Taxonomy
In our example of learning a new language, we differentiated between content (words,
concepts, ideas) and skills (application, analysis, and so on). In education there is a
well-accepted framework for considering the skills involved in a question or task. The
framework is called Bloom’s Taxonomy (Figure 1.3).
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The Art and Science of Learning in Anatomy and Physiology Chapter 1 7 Figure 1.3
Bloom’s Taxonomy
CREATE
ANALYZE
EVALUATE
USE INFORMATION TO
CREATE SOMETHING NEW
CRITICALLY EXAMINE INFO &
MAKE JUDGMENTS
Design, Build, Construct,
Plan, Produce, Devise, Invent
Judge, Test, Critique,
Defend, Criticize
TAKE INFO APART &
EXPLORE RELATIONSHIPS
Categorize, Examine,
Compare/Contrast, Organize
APPLY
USE INFORMATION IN A NEW (BUT SIMILAR) SITUATION
Use, Diagram, Make a Chart, Draw, Apply, Solve, Calculate
UNDERSTAND
UNDERSTANDING & MAKING SENSE OUT OF INFORMATION
Interpret, Summarize, Explain, Infer, Paraphrase, Discuss
REMEMBER
FIND OR REMEMBER INFORMATION
List, Find, Name, Identify, Locate,
Describe, Memorize, Define
The framework conveys a few central points:
●
●
●
●
Different assessment questions or tasks target different skills. If you are asked,
“which of the following words best defines the term tissue?” You are being asked to
recall the definition of tissue. If, instead, you were asked “You are looking through
the microscope at a tissue that has a high degree of cellularity, with every cell
contacting another cell except for a free edge at the top of your view. What type of
tissue are you most likely looking at?” You are being asked to apply what you know
about tissue types to a new situation you have never encountered before. These
tasks and the skills involved are different from each other.
These skills are iterative. You cannot apply information in a new context if you
cannot remember it. Therefore, application depends on knowledge.
The skills build on each other, but one is not necessarily harder than another. It
could be more challenging to apply knowledge than to remember something, but if
you were asked a remembering question about a tiny obscure tidbit of knowledge,
or asked to apply a general concept, the application question in this case would be
easier than the remembering question.
Everyone is working with a different brain. Some students are natural memorizers; these students need to work on their skills of application and analysis. Some
students struggle with memorization, but problem solving comes easily to them.
To be the most successful, you need to learn about yourself as a learner first, then
work on the skills that need the most building.
You can talk with your instructor about what to expect on your assessments in
your A&P course. Within this book we label the assessment questions with the Bloom’s
level the question is targeting to get you familiar with your skills and growth areas.
It is common for 70–80 percent of the questions on an exam to be either remembering or understanding questions, and 20–30 percent of the questions to be applying or
analyzing questions. Your instructor may also include questions or tasks that target the
creating Bloom’s level in your course. Study strategies that target each Bloom’s level are
summarized in Table 1.3.
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8 Unit 1 Levels of Organization
Table 1.3 Learning Strategies and Question Examples That Target Each Bloom’s Level
Bloom’s Level
Skills
Example Question
Remember
●
Memorize
Define
● Recall details
Which of these is the
correct definition of
osmolarity?
Recognize a
concept in a new
situation
● Thoroughly
understand a
concept
Which of the solutions
in this diagram is
hyperosmotic?
Apply information in
a new situation
● Use a previous
example to
or model to
understand a new
example
What will happen to
interstitial fluid volume
if the concentration
of glucose increased
there?
Assess a new piece
of data or graph to
make a conclusion
The blood pressure
readings of four
patients can be found
in this table. Which one
might have the highest
blood osmolarity?
Justify a conclusion
Choose a best
among a group
of plausible
explanations
Which of these
diseases is likely to
cause an increase
in osmolarity of the
blood?
Produce a new
work, idea, or
writing
Design a solution that
is hyperosmotic to
blood plasma. Describe
the effects on the
tissues (and red blood
cells) if this solution
was injected into the
bloodstream
●
Understand
●
Apply
●
Analyze
●
Evaluate
●
●
Create
●
Individual Strategies
Practice labeling diagrams
List characteristics
● Flashcard practice/quiz
● Draw, classify, select, or
match items
● Write out the textbook
definitions
●
●
Describe a biological process
in your own words
● Provide examples of a
process
● Write a sentence using new
vocabulary words
●
Review each process you
have learned and then ask
yourself: what would happen
if you increase or decrease a
component?
● If possible, graph a biological
process and create scenarios
that change the shape or
slope of the graph
●
Analyze and interpret data
in primary literature or a
textbook without reading the
author’s interpretation and
then compare your analysis
to the author’s
● Compare and contrast two
ideas or concepts
● Create a map of the main
concepts by defining the
relationships of the concepts
using one- or two-way
arrows
●
●
Practice justification of each
of the wrong answers for
complex questions
Write a paragraph
summarizing a major idea or
process
● Draw your own physiological
diagram to illustrate a
concept or process
●
Group Strategies
Check a drawing that
another student labeled
● Create lists of concepts
and processes that your
peers can match
● Place flash cards in a bag
and take turns
●
●
●
Discuss content with peers
Take turns quizzing each
other about definitions
and have your peers check
your answers
Practice writing out
answers to practice
questions (or write your
own) and have your peers
check your answers
● Take turns teaching your
peers a biological process
while the group critiques
the content
●
Work together to analyze
and interpret data and
defend your analyses to
your peers
● Work together to identify
all of the concepts in a
paper or textbook chapter,
create individual maps
linking the concepts
together with arrows
and words that relate the
concepts, and then review
your peer’s maps and
defend your own
●
●
Justify your stance to your
group on each answer of
case study questions
Design your own fictional
case study and ask your
peers to do the same.
● Exchange case studies for
each other to solve
●
Adapted from Crowe et al., 2008.
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The Art and Science of Learning in Anatomy and Physiology Chapter 1 9 The activities that you use to study and learn can incorporate all these ideas. As
you study you want to make sure you move from familiarity-building techniques to
mastery-building techniques (Table 1.1). You also want to be sure to incorporate activities that target different Bloom’s levels (Table 1.3). Remember that no two learners have
the same brain; therefore, the ways that you learn best may very well be different from
those of a friend or even your instructor! As you progress through your education, you
will discover that some learning strategies work for you and some do not! You may also
find that some strategies work better for some material, while other strategies are more
adapted for other courses. For example, you may find differences in how you approach
even A&P material within the same course. Ultimately, as you become more in tune
with your learning processes, you will have a better sense of which strategies to apply
when and in what order.
1.3 What Is a Learning Objective?
Learning objectives (LOs) are used as a means of transparency between the instructor and the learner. They are, essentially, a means of answering the age-old student
question: What are we supposed to learn? In this book we have included LOs at the top
of every section of text. The LOs appear again at the end of each chapter along with
questions that target those objectives. The goal of this design is to help you to become
familiar with anticipating the types of assessment questions you want to prepare for.
The text indicates higher-order and lower-order Bloom’s level LOs using different
icons. Remember that you may want to use different learning strategies for different
levels. Your instructor may have additional LOs that they include in their lectures or
syllabus. Again, LOs are tools of transparency; your instructor is communicating with
you about what they feel is important for you to learn. You can also ask your instructor
questions when you are unsure of your objectives. An example of an LO and how to use
it in your learning can be found in Figure 1.4.
Figure 1.4
Anatomy of a Learning Objective (LO)
Example LO from Chapter 4 and one approach to learning the material it targets.
Anatomy of an LO
Compare and contrast
The content
chromatin, chromosomes, and chromatids.
The verb
Description
Timing
Function
Chromatin
Loosely wound
DNA
Interphase
DNA (genes) accessible
for transcription
Chromosome
Compacted
DNA
Mitosis
Meiosis
Condense DNA for
movement and sorting
during mitosis and
meiosis
One of two
replicates
Mitosis
Meiosis
One of two replicated
sisters separates
to daughter cells
Drawing
Chromatid
or
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10 Unit 1 Levels of Organization
1.4 The Anatomy of Art
1.4a Image Translation in Anatomy
Learning anatomy will require a skill you have likely not had a lot of time to practice
in your education: learning visually. Unlike most of your classes where the majority
of your interaction with the material was through words or numbers, anatomy—and
to some extent physiology—really asks that you learn images. In particular, you will
be asked to transfer your visual understanding from images you have seen before to
novel images. You will often find that you have studied an image from one perspective,
only to need to translate to another. For example, if you have studied an image from
the front, you will use what you understand about the three-dimensional relationships
among the organs or structures to be able to break down and understand an image of
the same area taken from above. Similarly, studying tissues through microscopes is
challenging for the first few times you do it. After practice, your ability to translate what
you see to the structures you have learned will grow. Beginning A&P students often
find these skills challenging, until they practice them over time. Looking at a new image
can be overwhelming at first. Like many anatomists, you may find it helpful to first find
a landmark, a structure you know well. From that landmark, you can begin to identify
the other structures around it that you recognize. In Figure 1.5 you can walk through
this process. Figure 1.5A illustrates a simple and straightforward diagram of the heart
from an anterior (front) perspective. For simplicity, only three structures are labeled
in this exercise. Now examine Figure 1.5B, which is an image of the same organ in the
same perspective (anterior/front) but drawn by a different artist. Can you find the
three structures? Now examine Figure 1.5C. Here you are looking at the same organ (the
heart) from a different perspective (superior/from above). Find your three structures
again. Repeating this strategy with new images is a great way to work toward mastery.
In your study process, you can repeat this with unlabeled images as many times as is
helpful to you. A last step in this process can be to draw the image for yourself. Keep
in mind that the point of this is not about artistry, but that working through the task of
representing the relationship among anatomical structures is a fantastic way to assess
your mastery of the material.
Another example of image translation is applying what you are learning in one
type of image to another type. In A&P texts we use drawings more than any other
type of instructional image because medical illustrators can make the structures stand
out from each other using color and lines and it is the easiest type of image for the
beginning anatomist to be able to discern. However, as a clinician, the anatomical
imagery you will use every day is much less straightforward. As we learn, we can begin
to practice the translation of our knowledge from drawing to more relevant types of
images by using photography and clinical images such as CT scans and X-rays. As with
the examples in Figure 1.5, the first step in this process is to find a landmark. From
there, build your understanding of the image out by finding and labeling the structures
adjacent to your landmark. Compare the artist drawing (see Figure 1.5A), a photograph
(Figure 1.5D), and a magnetic resonance image (MRI) of the heart (Figure 1.5E). In
Figure 1.5A we have labeled the largest artery in the body, the aorta. Can you find the
aorta in Figures 1.5D and 1.5E?
1.4b Comparing a Micro and Macro View
A frequently used illustration technique in A&P is presenting a zoomed-in view of
a structure simultaneously with the zoomed-out view. In science, we typically use
the terms micro and macro for these views, respectively. You can see an example in
Figure 1.6. Can you find where on the macro view (Figure 1.6A) the structure presented
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The Art and Science of Learning in Anatomy and Physiology Chapter 1 11 Figure 1.5
Image Translation
Anatomy requires visual literacy and image translation. Here we compare two drawings of the anterior perspective of the heart (A and B) with a
superior perspective of the heart (C). Translating these diagrams to a photo (D) and finally an MRI (E) requires a strong working knowledge of the
heart structures.
Aorta
Superior
vena cava
Aorta
Superior
vena cava
Superior
vena cava
Left
ventricle
Left
ventricle
B
Left
ventricle
C
Morris Huberland/Science Source
Wanuttapong suwannasilp/Alamy Stock Photo
A
Aorta
D
E
in the micro view (Figure 1.6B) is? Always make sure to reorient yourself when you are
presented with figures such as these.
1.4c Learning from Physiology or Process Diagrams
Illustrating a dynamic process in a static image is a challenging task for our illustrators.
These images, as straightforward as we try to make them, can be complicated to digest
as a learner.
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12 Unit 1 Levels of Organization
Figure 1.6
Micro and Macro Views
Comparing a (A) micro and (B) macro view of a muscle cell sarcomere.
Z disk
Z disk
Thin
ÿlament
(actin)
Thick
ÿlament
(myosin)
A
Sarcomere
Z disk
Z disk
Thin ÿlament
(actin)
Thick ÿlament
(myosin)
Elastic
ÿlaments
(titin)
B
Before you set about trying to memorize or learn from a figure, make sure that
you understand what the figure is trying to convey. Together, let’s go through Figure 1.7.
This is a fairly standard drawing of a foundational physiological concept (osmosis). As
we break down this image, some questions you might ask yourself are:
●
●
●
●
There are four different arrows used in the image—one orange, one green, a
single-headed arrow in black, and a double-headed arrow in black. What are the
arrows trying to illustrate?
There are red dots. What do these represent? Is it significant that the red dots are
on one side of the U-shaped tube and not the other?
There is a dashed line at the bottom of this tube. What does it represent?
Is this image trying to show two U-shaped tubes side-by-side, or is it trying to
show what happens in one tube over time?
Arrows are of particular trickiness in physiological diagrams. They can be used
to show the direction of movement in a dynamic process, used to convey time, or
used to illustrate differences. In this image they are doing all three things! Which
arrow do you think is trying to convey the passage of time? If you answered the
green arrow, you are correct! The orange arrow is trying to convey the direction of
movement, in this case of water. In the U-shaped tube on the right, time has passed,
water has moved, and the black arrow is pointing out to you that an increase in water
volume can be observed.
Asking yourself questions about a figure you are learning from not only ensures
that you are beginning your learning with the correct understanding but also works
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The Art and Science of Learning in Anatomy and Physiology Chapter 1 13 Figure 1.7
n Example Figure Illustrating the Movement of Water in Response to an
A
Osmotic Gradient
Solute
Volume
increase
Osmosis
Semipermeable
membrane
to fortify your knowledge of the key components of the process. You should also take
into consideration the figure legend and related text to assist in your interpretation of a
diagram.
Cultural Connection
It’s All Greek to Me!
The average A&P student will learn more new vocabulary words in each chapter than an introductory language student! Similar to learning any language, A&P students must memorize the
words but also master how to use these words in communication with others. Conveniently,
there is some redundancy within A&P terminology and so you can often use clues to understand the words. The majority of terms used in A&P are derived from ancient Greek and Latin
words. More specifically, a predominant number of anatomical terms come from Latin, and
a predominant number of medical terms (e.g., conditions, diseases, professions, and so on)
come from ancient Greek. The emphasis on using these two languages likely originated with
the very first anatomical study, which occurred in ancient Rome and early medicine and which
was a focus in ancient Greece.
Anatomists described structures in the body using plain descriptors, but as language
changed over the centuries we were left with very complex terminology. For example, in
Chapter 3 you will learn the term ligand. The first half of this word, liga, is from the Latin ligare, which means “to bind.” Later, in Chapter 10, you will learn the term ligament; a ligament
is a structure that connects, or binds, two bones together. Doing the work in Chapter 3 to
understand the origin of liga makes learning in Chapter 10 easier! Throughout the text we will
assist you with the interpretation of these Greek and Latin-derived words.
As a student your primary goal is to master the content of this course. However,
this herculean task is much easier if you know about yourself as a learner and have an
array of tools to employ in your process. As you go through the course, consider which
tools are working for you and which content or skill areas you have the most room
to grow in. It is important to make sure you incorporate a variety of diverse learning
techniques into your journey to mastery of the material. You will find tips and strategies throughout the book, but your instructors and this chapter are resources that are
always available as you consider, observe, and refine your learning techniques.
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