BIOH 211 Learning Objectives - February 2021

1. Blood

After studying this unit in both lecture and lab, students will be expected to:
- 1.1 General Functions and Composition of Blood
- a. Describe the major functions of blood.
- b. Describe the general composition of blood (e.g., plasma, formed elements).
- c. List the major components of blood plasma, e.g., water, plasma proteins, electrolytes.
- d. Identify the major types of plasma proteins, their functions, and sites of production.
- e. List the five types of leukocytes in order of their relative prevalence in healthy human blood and describe the major function(s) of each type.
- f. Identify the various types of formed elements indicated in pictures or images of blood smears.
- g. Identify the specific type of leukocyte indicated in images of a blood smear.
- h. Define hematocrit.
- i. Calculate hematocrit when given the appropriate numerical values.
- j. Identify common factors that could cause an increase or decrease in hematocrit values.
- 1.2 Hematopoiesis (Hemopoiesis)
- a. Define hematopoiesis.
- b. Explain the basic process of erythropoiesis, the significance of the reticulocyte, and regulation through erythropoietin (EPO).
- c. Identify common causes of an increase or decrease in the rate of erythropoiesis.
- d. Describe the structure and function of hemoglobin, including its breakdown products.
- e. Describe the life cycle of an erythrocyte and identify the organs responsible for removing aged or defective erythrocytes from circulation.
- f. Define anemia.
- g. Identify the three basic categories of anemia: 1) inadequate production of erythrocytes and/or hemoglobin, 2) hemolytic anemia, 3) hemorrhagic anemia. Provide common examples of each (e.g., iron deficiency and kidney disease are common causes of inadequate erythropoiesis).
- h. Define leukopoiesis and thrombopoiesis, name the primary hormone(s) that regulate each, and describe the role of megakaryocytes in thrombopoiesis.

2. Hemostasis

After studying this unit in both lecture and lab, students will be expected to:
- 2.1 Phases of Hemostasis
- a. Name and describe the three phases of hemostasis.
- b. Describe the vascular spasm phase of hemostasis, including the role of endothelial cells and serotonin.
- c. Describe the role of platelets in hemostasis and the steps involved in the formation of the platelet plug.
- d. Describe the intrinsic and extrinsic pathways of the final phase (coagulation), what initiates each pathway, and the final steps from Common factor X that result in the formation of an insoluble fibrin clot.
- e. Describe the process of fibrinolysis, including the roles of plasminogen, tissue plasminogen activator (tPA), and plasmin.
- f. Describe the role of aspirin in the prevention of unwanted blood clots.

3. ABO and Rh Blood Typing

After studying this unit in both lecture and lab, students will be expected to:
- a. Identify ABO blood types, including Rh factor, using Eldon cards or images of Eldon cards.
- b. Define agglutination.
- c. Describe the role of surface antigens and plasma antibodies in blood typing.
- d. Identify the specific surface antigens and plasma antibodies present in each blood type.
- e. Determine blood transfusion compatibilities given simple scenarios with ABO blood types and Rh factor status.
- f. Describe the development and clinical significance of anti-Rh antibodies, including when the use of Rhogam is indicated.

4. The Heart

After studying this unit in both lecture and lab, students will be expected to:
- 4.1 Microscopic and Gross Anatomy
- a. Describe the position of the heart in the thoracic cavity.
- b. Identify and describe the location, structure, and function of the different layers of the pericardium and the function of the serous fluid contained within.
- c. Compare and contrast the structure and function of the atria and ventricles.
- d. Identify the external and internal structures of the heart on a model, dissected specimen or images, and describe the function of each.
- e. Identify the specific coronary vessels as itemized on the common lab lists, and trace the flow of blood through these specific vessels, beginning at either the right or left coronary artery and proceeding to the coronary sinus and right atrium.
- f. Identify each layer of the heart wall (i.e., epicardium, myocardium, endocardium) on a model, dissected specimen, or image and describe the histological composition and function of each.
- g. Describe the microscopic anatomy of the myocardium, including the location and function of the intercalated discs.
- 4.2 Blood Flow Through the Heart
- a. Trace the path of blood through the right and left sides of the heart, including its passage through the specific heart valves.
- 4.3 Physiology of Cardiac Muscle Contraction
- a. Describe the process used by pacemaker cells to generate pacemaker and action potentials, including the types of ion channels involved and the movement of specific ions to create each phase.
- b. Describe the events that occur within a contractile cardiac muscle cell in response to the arrival of an action potential from the cardiac conduction system, including the types of ion channels involved and the movement of specific ions to create each phase.
- c. Compare and contrast the roles of sympathetic and parasympathetic innervation in the depolarization of cardiac pacemaker cells and ventricular contractile cells.
- 4.4 Cardiac Cycle
- a. Define cardiac cycle, systole, and diastole.
- b. List the phases of the cardiac cycle in order, including ventricular filling, isovolumetric contraction, ventricular ejection, and isovolumetric relaxation.
- c. Describe the specific events that occur during each phase of the cardiac cycle, including the opening and closing of specific heart valves in each phase due to pressure changes in the heart chambers and the great vessels (i.e., blood vessels entering and leaving the heart).
- d. Relate the first and second heart sounds to the events of the cardiac cycle.
- e. Note: Per HAPS guidelines, the more appropriate term is isovolumic (and not isovolumetric) because the volume within the ventricles remains constant, while the length of the cardiac muscle fibers changes. However, isovolumetric is the term used in the textbook and thus we will use isovolumetric to eliminate student confusion.

5. Regulation of Cardiac Output (CO), Stroke Volume (SV), and Heart Rate (HR)

After studying this unit in both lecture and lab, students will be expected to:
- a. Define cardiac output (CO) and state its units of measurement.
- b. Calculate cardiac output, given stroke volume and heart rate.
- c. Predict how changes in heart rate (HR) and/or stroke volume (SV) will affect cardiac output (CO).
- d. Describe the concept of ejection fraction.
- e. Define end diastolic volume (EDV) and end systolic volume (ESV), and calculate stroke volume (SV) given values for EDV and ESV.
- f. Define venous return, preload, and afterload, and explain the factors that affect them.
- g. Explain how venous return, preload, and afterload each affect stroke volume.
- h. State the Frank-Starling law of the heart and explain its significance.
- i. Explain the influence of positive and negative inotropic agents on stroke volume and provide specific examples of positive and negative inotropic agents.
- j. Describe the influence of positive and negative chronotropic agents on heart rate and provide specific examples of positive and negative chronotropic agents.
- k. Describe the role of the autonomic nervous system in the regulation of cardiac output.

6. Electrical Conduction System of the Heart and the Electrocardiogram

After studying this unit in both lecture and lab, students will be expected to:
- a. List the parts of the electrical conduction system of the heart in the correct sequence for one contraction.
- b. Identify the parts of the electrical conduction system of the heart on a diagram or illustration.
- c. Explain why the SA node normally paces the heart.
- d. Explain how the cardiac conduction system produces coordinated heart chamber contractions.
- e. Name the deflections in a normal electrocardiogram (ECG) and explain the electrical events represented by each deflection.
- f. Calculate the heart rate from an ECG tracing.
- g. Define cardiac arrhythmia and ectopic focus.
- h. Recognize various cardiac arrhythmias as represented on ECG tracings.

7. The Circulatory System

After studying this unit in both lecture and lab, students will be expected to:
- 7.1 Blood Vessels
- a. Define the terms: artery, capillary, and vein.
- b. List the three tunics associated with most blood vessels and describe the composition of each tunic.
- c. Identify the arteries and veins on the lab list on various models, dissections specimens, and/or images and diagrams.
- d. Define vasoconstriction and vasodilation.
- e. List types of capillaries, state where in the body each type is located, and correlate their anatomical structures with their functions.
- f. Describe the functional significance of the venous reservoir.
- g. Define anastomosis and explain its functional significance (e.g., cerebral arterial circle [Circle of Willis]).
- 7.2 Systemic and Pulmonary Circuits (Circulations)
- a. Describe the systemic and pulmonary circuits (circulations) and explain the functional significance of each.
- b. Identify the major arteries and veins of the pulmonary circuit (see lab list).
- c. Identify the major arteries and veins of the systemic circuit (see lab list).
- d. Define a portal system.
- e. Describe the structure and functional significance of the hepatic portal system.
- 7.3 Fetal versus Postnatal Circulation
- a. Identify structures of fetal circulation as itemized on the lab list.
- b. Trace the pathway of blood flow from the placenta, through the fetal heart and body, and back to the placenta using structures from the lab list.
- c. Describe the changes in major fetal cardiovascular structures that typically occur beginning at birth, and the ultimate postnatal remnants (fates) of these structures (see lab list).
- 7.4 Blood Pressure and Its Functional Interrelationships with Cardiac Output (CO), Peripheral Resistance, and Hemodynamics
- a. Define blood pressure and peripheral resistance.
- b. State and interpret the equation that relates fluid flow to pressure and resistance.
- c. Describe the role of arterioles in regulating tissue blood flow and systemic arterial blood pressure.
- d. List the local, hormonal, and neural factors that affect peripheral resistance and explain the importance of each.
- e. Given values for systolic and diastolic blood pressure, calculate pulse pressure (PP) and mean arterial pressure (MAP).
- f. State the equation relating mean arterial pressure (MAP) to cardiac output (CO) and total peripheral resistance (TPR).
- g. Predict and describe how mean arterial pressure (MAP) would be affected by changes in total peripheral resistance (TPR) or by changes in cardiac output (CO) or any of its components - heart rate (HR), stroke volume (SV), or preload.
- h. Explain the mechanisms of capillary exchange of gases, nutrients, and wastes.
- i. Describe the forces that create capillary filtration and reabsorption.
- j. Explain how changes in net filtration pressure (NFP) can result in edema and how a functional lymphatic system normally prevents edema.
- k. Describe how muscular compression and the respiratory pump aid venous return.
- l. Explain how local control mechanisms and myogenic autoregulation influence blood flow to tissues.
- m. List some chemicals that cause either vasodilation or vasoconstriction and explain the circumstances in which they are likely to be active.
- n. Identify the primary hormones involved in the regulation of blood pressure, the source of each hormone, and the specific effects of each hormone (ADH, angiotensin, aldosterone, ANP, EPI and NE).
- o. Explain the steps of the baroreceptor reflex and describe how this reflex maintains blood pressure homeostasis when blood pressure changes.
- p. Explain the role of the autonomic nervous system in regulation of blood pressure and volume.

8. Circulatory Shock

After studying this unit in both lecture and lab, students will be expected to:
- a. Define circulatory shock and identify the three main categories of shock (hypovolemic, vascular, and cardiogenic).
- b. Describe how the signs and symptoms of shock relate to the events that are occurring during circulatory shock, including any compensatory mechanisms that may be possible.
- c. Explain why EpiPens are used to treat anaphylactic shock.

9. Lymphatic and Immune Systems

After studying this unit in both lecture and lab, students will be expected to:
- a. Identify the structures of the lymphatic system (cells, tissues, and organs) and describe the function of those structures as itemized on the lab list.
- b. Describe the formation of lymphatic fluid, its composition, and circulation.
- c. Trace the flow of lymph from the lymphatic capillaries of the right leg, through the various vessels and major structures, to the left subclavian vein.
- d. Compare and contrast the three lines of defense and describe the different defense mechanisms that fall under each line of defense.
- e. Define diapedesis, chemotaxis, and opsonization, and explain their importance for innate defenses.
- f. Describe the steps involved in phagocytosis and provide examples of important phagocytic cells in the body.
- g. Describe the various non-specific (innate) mechanisms used to protect against disease, including phagocytosis, inflammation, fever, interferons, and complement proteins.
- h. Summarize the cells and chemicals involved in the inflammatory process.
- i. List and explain the causes of the four cardinal signs of inflammation.
- j. Explain the benefits of inflammation.
- k. Describe the mechanism of fever, including the role of pyrogens.
- l. Explain the benefits of fever.
- m. Describe the role of an antigen-presenting cell (APC) and identify the specific types of cells that can function as APCs.
- n. Describe the specific functions of the following cell types:
- a. Natural Killer cells
- b. Dendritic cells
- c. Immunocompetent B cells
- d. Plasma cells
- e. Helper T cells
- f. Cytotoxic T cells
- g. Memory cells
- o. Define epitope and describe the role epitopes play in specific (adaptive) immunity.
- p. Describe how the antibody-mediated immune response is activated.
- q. Name the five classes of antibodies, identify common locations in the body where each class is found, and describe the specialized actions of each class.
- r. Compare and contrast the defense mechanisms used by antibodies to those of the activated complement system.
- s. Compare and contrast the response time, level of antibody production, and predominate class of antibodies produced during the primary and secondary humoral responses.
- t. Describe the cell-mediated immune response and attack by cytotoxic T cells, including the roles of granzymes and perforin.
- u. Describe the differences between active and passive immunity and recognize examples of each.
- v. Compare and contrast type I acute hypersensitivity reactions to type IV delayed hypersensitivity reactions.

10. Respiratory System

After studying this unit in both lecture and lab, students will be expected to:
- a. Identify various structures of the respiratory system on models, dissected specimens, and/or images (see lab list).
- b. Describe the histological composition and/or function of various structures of the respiratory system, as directed on the lab list.
- c. List, in order, the respiratory structures that air passes through during inspiration, beginning at the nares and ending in the alveolar sac (see lab list for relevant structures that should be included).
- d. Define atmospheric pressure, intrapulmonary pressure, intrapleural pressure, and transpulmonary pressure.
- e. Explain the relationship of intrapleural pressure, transpulmonary pressure, and intrapulmonary pressure relative to atmospheric pressure during ventilation.
- f. Explain the inverse relationship between gas pressure and volume of the gas (i.e., Boyle’s Law) and apply this relationship to explain airflow during inspiration and expiration.
- g. Identify the primary muscles used for quiet inspiration, deep inspiration, and forced expiration.
- h. Identify the primary nerves responsible for ventilation.
- i. Define anatomical dead space.
- j. Name and describe the three layers of the alveolar respiratory membrane.
- k. Describe the source, chemical properties, and function of pulmonary surfactant.
- l. Define and be able to calculate different respiratory volumes and capacities, including appropriate units, as directed on the lab list.
- m. Describe the processes of alveolar (external) gas exchange and systemic (internal) gas exchange.
- n. Define hypoxia and hypoxemia and distinguish between the two terms.
- o. Define utilization coefficient and venous reserve.
- p. Explain the effects of changes in body temperature and/or pH on hemoglobin’s affinity for oxygen, as illustrated when the oxygen-hemoglobin saturation curve shifts to the right or the left.
- q. Describe how shifts in the oxygen-hemoglobin saturation curve affect the utilization coefficient and venous reserve.
- r. List and describe the ways that oxygen and carbon dioxide are transported in the blood and the prevalence of each (i.e., how is most oxygen transported in the blood and how is most carbon dioxide transported in the blood).
- s. List and describe five factors that influence the efficiency of alveolar gas exchange (partial pressure gradient, gas solubility, respiratory membrane thickness, respiratory membrane surface area, ventilation-perfusion coupling).
- t. Predict the effects of increased thickness of the respiratory membrane or a decrease in respiratory membrane surface area on hemoglobin saturation.
- u. Use the mechanisms of ventilation-perfusion coupling to predict the effect that reduced alveolar ventilation has on the distribution of pulmonary blood flow and to predict the effect that reduced pulmonary blood flow has on bronchiole diameter.
- v. State the reversible chemical equation for the reaction of carbon dioxide and water to carbonic acid and then to hydrogen ion and bicarbonate ion.
- w. Describe the chloride shift that occurs in erythrocytes during systemic (internal) gas exchange and its physiologic significance.
- x. Explain the relationship between pH and hydrogen ion concentration.
- y. Predict how changing the partial pressure of carbon dioxide will affect the pH and the concentration of bicarbonate ions in the plasma.
- z. Describe the locations and functions of the brainstem respiratory centers.
- aa. List and describe the major chemical and neural stimuli to the respiratory centers.
- bb. Explain how the inspiratory and expiratory neurons of the ventral respiratory group control ventilation during eupnea.

11. Endocrine System

After studying this unit in both lecture and lab, students will be expected to:
- a. Compare and contrast how the nervous and endocrine systems control body functions.
- b. Identify various endocrine organs and specific structures of the endocrine system as itemized on the lab list.
- c. Identify the two major chemical classes of hormones found in the human body (amino acid-based and steroids) and provide specific examples of each.
- d. Compare and contrast how steroid and amino acid-based hormones are transported in the blood, the locations of their target cell receptors, and the mechanisms of action of plasma membrane hormone receptors vs. intracellular hormone receptors.
- e. Given a specific second messenger system (cAMP, DAG, IP3/PIP), identify an example of a hormone that utilizes this system, the specific effector enzyme involved, the substrate used to produce the second messenger, and the specific intracellular effects resulting from the hormone in the example.
- f. Describe the various signals that initiate hormone production and secretion (humoral, neural, and hormonal) and provide examples of each.
- g. Describe three types of hormone interactions (permissiveness, synergism, and antagonism) and give examples of each.
- h. Describe the locations and the anatomical relationships of the hypothalamus, anterior pituitary, and posterior pituitary.
- i. Describe the anatomy, location, major hormones secreted, control pathway(s) for hormone secretion, and the hormones’ primary targets and effects for the following glands:
- a. Hypothalamus
- b. Anterior pituitary gland
- c. Posterior pituitary gland
- d. Thyroid gland
- e. Adrenal gland (medulla and cortex)
- f. Parathyroid gland
- g. Pancreas
- h. Thymus
- j. Provide examples of hormones that are secreted from diffuse endocrine tissues or single endocrine cells.
- k. Identify the different types of local chemical messengers. List two major types of eicosanoids and describe their functions.
- l. Describe the general adaptation syndrome in response to stress, identify the hormones involved, and their specific functions.
- m. Given the hyper- or hyposecretion of a hormone, predict the changes that would occur and the potential consequences within the body of those changes (e.g., Grave’s disease, Hashimoto’s, diabetes mellitus type I and II, diabetes insipidus, Cushing disease, Addison’s disease, gigantism, acromegaly, and pituitary dwarfism).

12. Digestive System

After studying this unit in both lecture and lab, students will be expected to:
- a. Describe the major functions of the digestive system.
- b. Identify and describe the anatomic structure and function of each of the gastrointestinal tract layers: mucosa, submucosa, muscularis externa, and serosa or adventitia.
- c. Identify the specific mesenteries of the peritoneal cavity (see lab list).
- d. Describe the composition and functions of saliva.
- e. Identify and describe the different regions of the pharynx with respect to the passage of air and/or food.
- f. Identify the organs, accessory organs, and specific structures of the digestive system on dissected specimens, models, and/or images as itemized on the lab list.
- g. Identify and describe the gastric glands and intestinal crypts, including the specific cells found in each and their functions.
- h. Distinguish between segmentation and peristalsis.
- i. Identify the specific segments of the small intestine (i.e., duodenum, jejunum, ileum) in sequence from proximal to distal.
- j. Describe the anatomic specializations of the small intestine (e.g., circular folds, villi, and microvilli) to increase surface area and relate to the organ’s functions.
- k. Describe the source, stimuli for release, targets, and actions of the major gastrointestinal (GI) tract hormones (e.g., gastrin, cholecystokinin, secretin, GIP).
- l. Compare and contrast sympathetic and parasympathetic innervation effects on the digestive system.
- m. Explain the effects and chemicals involved in the cephalic phase, gastric phase, and intestinal phase of digestion on various parts of the gastrointestinal (GI) tract.
- n. Describe the functions, production, and regulation of secretion of hydrochloric acid (HCl).
- o. Describe the enteric nervous system (ENS) and explain its role in controlling digestive system function.
- p. List the major digestive enzymes. For each enzyme, identify its source, specific substrates, location within the digestive system where each enzyme is active, and the products of chemical digestion (enzymatic hydrolysis) that result.
- q. Define emulsification and explain how and where bile salts facilitate fat digestion.
- r. Describe the absorption and transport of different nutrients (e.g., monosaccharides, amino acids, fatty acids, monoglycerides).

13. Nutrition and Metabolism

After studying this unit, students will be expected to:
- a. Define metabolic rate and describe the conditions under which basal metabolic rate is measured.
- b. Describe factors that affect metabolic rate.
- c. Explain the importance of thermoregulation in the body.
- d. Compare and contrast the absorptive vs post-absorptive nutritional states, including the hormonal regulation of each (i.e., insulin and glucagon).
- e. Define the following terms: a. Glycogenesis, b. Glycolysis, c. Ketogenesis, d. Lipogenesis, e. Lipolysis, f. Gluconeogenesis.
- f. Differentiate between LDLs and HDLs.
- g. Summarize the metabolic functions of the liver, including carbohydrate, fat, and protein metabolism, vitamin storage, and biotransformation processes (e.g., detoxification of alcohol and processing of bilirubin).

14. Urinary System

After studying this unit in both lecture and lab, students will be expected to:
- a. Describe the major functions of the urinary system and which organs are responsible for those functions.
- b. Identify the structures of the urinary system, including the microanatomy of the nephron, as itemized on the lab list using dissected specimens, models, and/or images.
- c. Describe the functions and histological composition of various structures of the urinary system as directed on the lab list.
- d. Trace the path of blood flow through the kidney, from the renal artery to the renal vein.
- e. Distinguish between a cortical and juxtamedullary nephron and their associated vascular structures.
- f. Describe the specific functions of the various structures within a nephron.
- g. Identify the location, structures, and cells of the juxtaglomerular apparatus (JGA) and describe their functions.
- h. Explain the role of the juxtaglomerular apparatus (JGA) in tubuloglomerular feedback.
- i. Describe the processes of urine formation and the location where each occurs.
- j. Define glomerular filtration rate (GFR) and describe the mechanisms used by the body to maintain a constant GFR.
- k. For the renin-angiotensin system (RAS), describe the factors that initiate renin release, the pathway from angiotensinogen to angiotensin II (ANGII), and the effects of ANGII on various tissues.
- l. Describe the specific effects of each hormone (ADH, aldosterone, and ANP) in determining the volume and composition of urine. Trace the flow of filtrate from the renal corpuscle through the collecting duct.
- m. Trace the path of urine from the distal collecting ducts to the external urethral orifice.
- n. Describe the micturition reflex and the role of the autonomic nervous system in the reflex.

15. Water, Electrolyte, and Acid-Base Balance

After studying this unit, students will be expected to:
- a. Define extracellular fluid (ECF) and interstitial fluid (IF) and compare the relative volumes of each.
- b. Describe the normal routes of body water entry and loss.
- c. Define the four types of water imbalance (dehydration, hypovolemia, water intoxication, and fluid overload) and describe their effects on the osmolarity of body fluids.
- d. Describe the appropriate hormonal response used to attempt to restore normal volumes and osmolarity for each of the four water imbalances above.
- e. Describe the major buffer systems of the body (e.g., bicarbonate buffer system, protein buffer system) and their locations (e.g., extracellular fluid) in the body.
- f. Define acidosis and alkalosis.
- g. List the four basic categories of acid-base imbalances (respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis) and provide common causes of each.
- h. Describe the concept of physiological compensation in relation to disruption of pH homeostasis and provide examples (e.g., how would the body compensate for metabolic alkalosis versus respiratory alkalosis).

16. Reproductive System

After studying this unit in both lecture and lab, students will be expected to:
- a. Identify the organs and structures of the male and female reproductive systems as itemized on the lab list using models, dissected specimens, and/or images.
- b. Describe the functions of various structures of the male and female reproductive systems, as directed on the lab list.
- c. Describe the functions of the hormones involved in the regulation of the reproductive processes and the source of each hormone.
- d. Compare and contrast the processes of oogenesis and spermatogenesis.
- e. Distinguish between the processes of spermatogenesis and spermiogenesis.
- f. Describe a typical ovarian cycle, including the hormones that regulate each phase and the specific events that occur during each phase (i.e., development, ovulation, and transformation of ovarian follicles to corpus luteum and then corpus albicans).
- g. Name the phases of the uterine (menstrual) cycle, identify the hormone that regulates each phase, and describe the anatomical changes in the uterine wall that occur during each phase.
- h. Describe the correlation between the uterine and ovarian cycles.
- i. Trace the pathway of the oocyte from the ovary to the uterus.
- j. Trace the pathway of sperm from the epididymis to the external urethral orifice during ejaculation.
- k. Name and describe the stages of meiosis in chronological order and relate them to spermatogenesis and oogenesis.
- l. Describe events that can lead to genetic variability of gametes.