MBLEx Comprehensive Read and Recall Study Guide

Circulatory System Structure and Function

• The primary role of the circulatory system is the transportation of oxygen, nutrients, hormones, and immune components to bodily tissues while simultaneously removing carbon dioxide and metabolic waste products.

• The heart consists of $4$ chambers: the right atrium, the right ventricle, the left atrium, and the left ventricle.

• The right side of the heart is responsible for receiving oxygen-poor blood from systemic circulation and pumping it toward the lungs.

• The left side of the heart receives oxygen-rich blood returning from the lungs and pumps it out to the rest of the body.

• Atria serve as receiving chambers where blood enters the heart.

• Ventricles serve as pumping chambers that push blood out to the pulmonary or systemic circuits.

• Heart valves function to maintain a unidirectional blood flow and prevent backflow.

• An artery is defined as a vessel carrying blood away from the heart; this term describes the direction of flow, regardless of oxygen content.

• A vein is defined as a vessel carrying blood toward the heart.

• Capillaries are extremely small vessels where the exchange of oxygen, carbon dioxide, nutrients, fluids, and wastes occurs between the blood and tissues.

• The pulmonary artery carries oxygen-poor blood from the right ventricle to the lungs.

• The pulmonary veins carry oxygen-rich blood from the lungs into the left atrium.

• Erythrocytes are red blood cells whose main function is the transport of oxygen via hemoglobin.

• Hemoglobin is the oxygen-binding protein found within erythrocytes.

• Leukocytes are white blood cells that facilitate immune defense.

• Lymphocytes are a specific category of white blood cells essential for immune responses.

• Thrombocytes, or platelets, are cell fragments necessary for blood clotting.

Blood Pressure and Circulation Dynamics

• Blood pressure represents the force exerted by circulating blood against the internal walls of the blood vessels.

• Systolic pressure measures the force during ventricular contraction.

• Diastolic pressure measures the force while the ventricles relax between contractions.

• A pulse is a pressure wave produced in an artery by heart contractions.

• Entry-level practitioners must recognize major pulse points, including the carotid, brachial, radial, femoral, popliteal, posterior tibial, and dorsalis pedis.

• Blood supports tissue healing by delivering oxygen, nutrients, immune cells, and repair materials while removing metabolic wastes.

• Massage and bodywork influence circulation through mechanical pressure and muscle movement, which can temporarily assist local fluid movement and venous return.

• Treatment modifications or avoidance are necessary when circulatory pathology makes massage unsafe.

• Study focuses exclude detailed coronary anatomy, specific white-cell subtypes beyond lymphocytes, or the chemical clotting cascade.

Digestive System Anatomy and Physiology

• The path of food through the digestive tract follows this sequence: mouth → pharynx → esophagus → stomach → small intestine → large intestine → rectum → anus.

• Peristalsis is the involuntary, wave-like contraction of smooth muscle that propels material through the tract.

• Smooth muscle is the primary muscle type found within the walls of the digestive tract.

• The stomach functions to store and mechanically mix food while initiating the chemical digestion of proteins.

• The small intestine is the site where the majority of digestion and nutrient absorption occurs.

• The large intestine absorbs water and electrolytes (minerals) and compacts fecal material.

• The liver produces bile and processes nutrients absorbed from the digestive tract.

• The gallbladder stores and concentrates bile before releasing it into the small intestine.

• The pancreas releases digestive enzymes and bicarbonate into the small intestine and performs endocrine functions like insulin production.

• The autonomic nervous system regulates digestion, with the parasympathetic division supporting ‐rest and digest‐ functions and the sympathetic division reducing digestive activity during stress.

• Relaxation-oriented massage can indirectly support normal digestion by promoting parasympathetic activity.

Endocrine System and Hormonal Regulation

• The endocrine system comprises glands and tissues that secrete hormones into the bloodstream to regulate various body functions.

• A hormone acts as a chemical messenger that travels to target organs or cells to alter their activity.

• The hypothalamus links nervous and endocrine regulation, helping to control the pituitary gland and maintain homeostasis.

• The pituitary gland is considered the master gland because its hormones regulate other endocrine glands, though it is itself regulated by the hypothalamus.

• The thyroid gland primarily influences metabolic rate, growth, and energy consumption.

• Adrenal glands produce hormones for stress response, blood pressure, metabolism, and fluid balance; adrenaline (epinephrine) specifically supports the fight-or-flight response.

• The pancreatic islets produce insulin (which lowers blood glucose by aiding cell uptake and storage) and glucagon.

• Melatonin, produced mainly by the pineal gland, regulates the sleep-wake/circadian rhythm.

• Ovaries produce estrogen and progesterone; testes produce testosterone.

• Massage can influence the endocrine system by reducing stress responses, but practitioners do not treat endocrine diseases.

Integumentary System

• The system consists of the skin and appendages, including hair, nails, sweat glands, and sebaceous glands.

• The skin is divided into the epidermis (outer protective epithelial layer), the dermis (deep connective tissue layer with vessels, nerves, and glands), and the subcutaneous/hypodermal tissue.

• Skin functions include protection against pathogens, temperature regulation, sensation, limiting water loss, and vitamin D synthesis.

• Sudoriferous glands are sweat glands.

• Sebaceous glands secrete sebum, an oil that lubricates skin and hair.

• A dermatome is a skin area supplied by sensory fibers from a specific spinal nerve root.

• Massage stimulates skin and sensory receptors, spreads lubricant, increases local warmth, and allows for the identification of skin changes requiring modification.

Lymphatic and Immune Systems

• Lymph is fluid derived from interstitial fluid that enters the lymphatic vessels.

• The system returns excess tissue fluid to the bloodstream and participates in immune defense.

• Lymph drains into venous circulation near the junctions of the subclavian and internal jugular veins.

• Lymph nodes are filtering structures containing immune cells located along lymphatic vessels.

• The spleen filters blood, participates in immune function, and removes aged blood cells.

• Tonsils monitor pathogens entering the mouth and nose.

• Lymph movement is driven by skeletal muscle contraction, breathing changes, vessel smooth muscle, and one-way valves; there is no central pump.

• Innate immunity is nonspecific defense present from birth; adaptive (acquired) immunity is specific defense developed after exposure with memory.

• Blood cells are primarily formed in red bone marrow; lymphocytes mature in lymphatic tissues.

• Massage can influence superficial fluid movement, but specialized lymphatic work requires advanced training.

Muscular System and Fiber Arrangement

• The $3$ muscle tissue types are skeletal (striated, voluntary, moves skeleton, produces heat), cardiac (striated, involuntary, heart-specific), and smooth (non-striated, involuntary, found in organs and vessels).

• The organization of muscle from largest to smallest is: whole muscle → fascicle → muscle fiber (cell) → myofibril → sarcomere (the basic contractile unit).

• Parallel/strap muscles have fibers running parallel to the long axis (e.g., greater shortening range).

• Fusiform muscles are spindle-shaped with a thick belly and tapered ends (e.g., biceps brachii).

• Pennate muscles (unipennate, bipennate, multipennate) have fibers attaching obliquely to a tendon for high fiber density.

• Flat/convergent muscles have a broad origin converging to a narrow attachment (e.g., pectoralis major).

• Circular muscles function as sphincters.

Muscle Contraction and Mechanics

• Sliding Filament Theory: Muscle shortening occurs as thin actin filaments slide past thick myosin filaments within the sarcomere; the filaments do not change length.

• Contraction is initiated by a motor nerve signal that makes calcium available, enabling actin-myosin cross-bridge cycling using ATP.

• Concentric contraction: Muscle produces force while shortening.

• Eccentric contraction: Muscle produces force while lengthening under load.

• Isometric contraction: Muscle produces tension without changing length or joint angle.

• Muscle Roles:

  • Agonist (Prime Mover): Chiefly responsible for a movement.

  • Antagonist: Opposes or controls the agonist's action.

  • Synergist: Assists the prime mover or prevents unwanted movement.

  • Stabilizer (Fixator): Holds a part steady for efficient movement elsewhere.

• A lever consists of a rigid bone moving around a fulcrum (joint) under muscle effort against a resistance (load).

  • $1^{st}$ class lever: Fulcrum between effort and resistance (e.g., head extension at atlanto-occipital joint).

  • $2^{nd}$ class lever: Resistance between fulcrum and effort (e.g., rising onto toes).

  • $3^{rd}$ class lever: Effort between fulcrum and resistance; most common in the body (e.g., elbow flexion).

Nervous System and Sensory Receptors

• The Central Nervous System (CNS) consists of the brain and spinal cord.

• The Peripheral Nervous System (PNS) includes nerves and ganglia outside the CNS.

• Divisions of the PNS:

  • Somatic: Conscious sensation and voluntary skeletal muscle control.

  • Autonomic: Involuntary functions like heart rate and digestion.

    • Sympathetic: Mobilization and fight-or-flight.

    • Parasympathetic: Rest, recovery, and digestion.

• Directions of signals:

  • Afferent: Sensory data traveling toward the CNS.

  • Efferent: Motor commands traveling away from the CNS.

• A mixed nerve contains both sensory and motor fibers.

• A reflex is an automatic response stimulus organized through the spinal cord or brainstem.

• Receptor Types:

  • Mechanoreceptors: Respond to touch, pressure, stretch, and vibration.

  • Nociceptors: Respond to potentially damaging stimuli (pain).

  • Thermoreceptors: Detect temperature changes.

  • Proprioceptors: Monitor body position and movement (includes Muscle Spindles and Golgi Tendon Organs).

  • Muscle Spindles: Sense muscle length and stretch rate.

  • Golgi Tendon Organs (GTOs): Sense tension/force at musculotendinous junctions.

• Major nerve plexuses include cervical, brachial, lumbar, and sacral.

Reproductive and Respiratory Systems

• Female Structures: Ovaries, fallopian tubes, uterus, cervix, vagina.

• Male Structures: Testes, epididymides, vas deferens, seminal vesicles, prostate, urethra, penis.

• Hormones: Estrogen (female development/cycle), testosterone (male development/muscle), relaxin (pregnancy-related connective tissue changes).

• Respiratory Path: Nose/mouth → pharynx → larynx → trachea → bronchi → bronchioles → alveoli (gas exchange sites).

• Hemoglobin transports the majority of oxygen in the blood.

• External gas exchange: Oxygen moves into blood from alveoli; CO2 moves into alveoli from blood.

• The diaphragm contracts and descends to increase thoracic volume during inhalation.

Skeletal System and Senses

• Functions: Support, movement leverage, mineral storage, and blood cell production.

• Axial Skeleton: Skull, vertebral column, and thoracic cage.

• Appendicular Skeleton: Limbs, shoulder, and pelvic girdles.

• Bone Shapes: Long, short, flat, irregular, and sesamoid.

• Synovial Joint Components: Articular cartilage (friction reduction), joint cavity, synovial fluid (lubrication/nutrition), and capsule.

• Ligaments connect bone to bone; massage acts on soft tissues around bones, not the bones themselves.

• Special Senses Cranial Nerves:

  • Olfactory ($I$): Smell.

  • Optic ($II$): Vision (photoreceptors: rods and cones).

  • Vestibulocochlear ($VIII$): Hearing (mechanoreceptive hair cells) and balance.

  • Facial ($VII$), Glossopharyngeal ($IX$), and Vagus ($X$): Taste.

Urinary System and Tissue Repair

• Kidneys (containing functional units called nephrons) filter blood, remove waste, and regulate fluid/electrolyte and acid-base balance.

• Ureters carry urine to the bladder for storage, followed by disposal through the urethra.

• Negative feedback is a homeostatic mechanism where a change triggers a response that opposes that change.

• Signs are objective/measurable; Symptoms are subjective reports from the client.

• Acute inflammation signs: Redness, heat, swelling, pain, and loss of function.

• Healing phases: Inflammatory, Proliferative (repair), and Remodeling (maturation).

• Energetic Anatomy concepts include Qi (vital energy), Yin and Yang (dynamic balance), Meridians (pathways), and Chakras (energy centers).

Major Muscles Table

• Bicep brachii (Anterior arm): Scapula to radius; elbow flexion and forearm supination.

• Triceps brachii (Posterior arm): Scapula/humerus to ulna; elbow extension.

• Deltoid (Shoulder cap): Clavicle/scapula to humerus; abduction (middle), flexion (anterior), extension (posterior).

• Pectoralis major (Anterior chest): Clavicle/sternum/ribs to humerus; shoulder adduction and medial rotation.

• Latissimus dorsi (Lower/posterior trunk): Thoracolumbar/ilium/ribs to humerus; shoulder extension and adduction.

• Trapezius (Posterior neck/back): Skull/spine to clavicle/scapula; elevates, retracts, and depresses scapula.

• Rhomboids: Spine to medial scapula; scapular retraction.

• Levator scapulae: Cervical spine to superior medial scapula; elevates scapula.

• Serratus anterior (Lateral ribs): Ribs to anterior medial scapula; scapular protraction.

• Rotator Cuff (SITS):

  • Supraspinatus: Abduction initiation.

  • Infraspinatus: Lateral rotation.

  • Teres minor: Lateral rotation.

  • Subscapularis: Medial rotation.

• Core/Trunk:

  • Rectus abdominis: Trunk flexion.

  • External oblique: Contralateral rotation.

  • Internal oblique: Ipsilateral rotation.

  • Erector spinae: Spinal extension.

  • Quadratus lumborum: Side-bending, pelvic hiking.

• Lower Body:

  • Iliopsoas: Powerful hip flexion.

  • Gluteus maximus: Hip extension/lateral rotation.

  • Gluteus medius: Hip abduction/pelvic stability.

  • Quadriceps: Knee extension.

  • Hamstrings: Knee flexion/hip extension.

  • Gastrocnemius and Soleus: Ankle plantarflexion (via Achilles tendon).

  • Tibialis anterior: Dorsiflexion and inversion.

• Neck:

  • Sternocleidomastoid: Bilateral flexion; unilateral contralateral rotation.

  • Scalenes (transverse processes to ribs $1–2$): Flexion and rib elevation.

Range of Motion and Joint Terminology

• Joint Mobility Types:

  • Synarthrosis: Immovable.

  • Amphiarthrosis: Slightly movable.

  • Diarthrosis: Freely movable (synovial).

• Movements:

  • Flexion (decreases angle) vs. Extension (increases angle).

  • Abduction (away from midline) vs. Adduction (toward midline).

  • Medial (internal) vs. Lateral (external) rotation.

  • Pronation (palm down) vs. Supination (palm up).

  • Dorsiflexion (toes up) vs. Plantarflexion (toes down).

  • Inversion (sole medial) vs. Eversion (sole lateral).

• Assessment ROM Categories:

  • Active (AROM): Client moves the joint; shows willingness/motor control.

  • Passive (PROM): Practitioner moves the relaxed joint; evaluates tissue limits.

  • Resisted: Client moves against practitioner resistance; tests contractile tissue.

Pathology, Contraindications, and Medications

• Contraindication Types:

  • Local: Avoid specific area.

  • Systemic/General: Avoid massage or require medical clearance (e.g., fever, acute infectious illness).

• Conditions:

  • Strain (muscle/tendon injury) and Sprain (ligament injury).

  • Trigger Point: Sensitive area in a taut muscle band.

  • Hypertension (elevated BP), Atherosclerosis (artery plaque), and Varicose Veins (dilated veins).

  • Autoimmune: Lupus (systemic), Rheumatoid Arthritis (joints/inflammatory).

  • Neurologic: Multiple Sclerosis (demyelinating), Parkinson's (movement/tone), Peripheral Neuropathy (impaired sensation).

  • Endangerment Sites: Anterior triangle of neck, axilla, cubital fossa, femoral triangle, and popliteal fossa.

• Medications:

  • Analgesics: Blunt pain feedback; risk of overpressure.

  • Anticoagulants: Increase bruising/bleeding risk.

  • Muscle Relaxants: Cause sedation/dizziness; use caution with transfers.

  • Diabetes medications: Alert for hypoglycemia signs.

Professional Practice and Ethics

• SOAP Documentation:

  • Subjective: Client reports (symptoms, goals).

  • Objective: Factual findings (posture, ROM, palpation, treatment given).

  • Assessment: Professional interpretation within scope (not medical diagnosis).

  • Plan: Future sessions and self-care.

• Ethics and Boundaries:

  • Autonomy: The client's right to informed choice.

  • Power Differential: Unequal influence in the professional relationship.

  • Transference (client projection) and Countertransference (practitioner reaction).

  • Dual Relationships: Having secondary relationships (friendship/business) with clients.

• Sanitation Hierarchy: Sanitation (cleaning) → Disinfection (destroying most microbes) → Sterilization (destroying all life, including spores).

• Anatomical Directions: Superior (higher), Inferior (lower), Medial (midline), Lateral (side), Proximal (closer to trunk), Distal (farther from trunk), Superficial (surface), Deep (inward).

Word Building and Terminology

• Hyper- (excessive); Hypo- (deficient); Tachy- (fast); Brady- (slow).

• Peri- (around); Endo- (inner); Epi- (above); Intra- (within); Inter- (between).

• -itis (inflammation); -algia (pain); -pathy (disease); -ectomy (removal); -ology (study of).

• Roots: Oste/o (bone), My/o (muscle), Neur/o (nerve), Cardi/o (heart), Derm/o (skin).