1.

THE HUMAN BODY – introduction

Pre-reading
1. Which parts of the human body can you name in English?
2. Which structures of the head can you name in English?
3. Which part of the human body is the biggest?

The human body has a complex structure. It is built up of millions of cells which form
organs and systems. The human body consists of three main parts: the head, the trunk and
the upper and lower limbs (or extremities). The head is the part of the body which contains
the brain and the organs of sight, hearing, smell and taste. The face is in the front of the
head. The eyes, protected by the eyebrows and eyelids with eyelashes, are situated on both
sides of the nose. The forehead lies above the eyes and the cheeks are below them. The
mouth, which is the organ of speech and food intake, is bounded by the upper and lower lips.
It contains the tongue and the teeth which are the organs of biting and chewing food. The
mouth leads to the pharynx (or the throat) through which the food passes to the digestive
system, and the air passes to the larynx. On both sides of the head are the ears, which are the
organs of hearing. The lowest part of the head is the chin.
The head connects the head to the trunk, which is the biggest part of the body. It
consists of two main cavities separated by the diaphragm: the thorax (or the chest) and the
abdomen. The area between the shoulders and the buttocks is the back.
The upper limbs are connected to the trunk by the shoulder girdle. They are
composed of three segments: the arm, the forearm and the hand with four fingers and one
thumb. The lower limbs also consist of three parts: the thigh, the leg and the foot with toes.
On the terminal segments of the fingers and toes are the nails. The joints of the upper limbs
are the elbow and the wrist. The joints of the lower limbs are the hip joint, the knee and the
ankle.

Exercise A. Answer the following questions:

1. What are the main parts of the body?
2. Which is the highest part of the face? Which is the lowest?
3. Where are the cheeks located?
4. Where are the organs of hearing situated?
5. Which is the biggest part of the human body? What cavities does it consist of?
6. Which parts does the elbow join?
7. Does the thigh belong to the upper or lower limbs?

Exercise B. Complete the sentences, using the following words: above, below, between, on
the sides of.
1. The neck is located ............... the head and the trunk.
2. The forearm is ............... the arm.
3. The ears are situated ............... the head.
4. The leg is ............... the thigh.
5. The ankle is located ............... the foot.
6. The middle finger is ............... the forefinger and the ring finger.

1
2
Exercise C. Which parts of the body from the box below can you:
1. bend 5. nod
2. cross 6. clench
3. raise 7. stretch
4. shrug 8. open/close

arms; back; eyebrows; eyes; feet; hands; head; legs;

mouth; shoulders; teeth; fist; fingers

Exercise D. Match the following idioms with their meaning:

1. to be all ears
2. to give someone a hand
3. to do sth behind sb‘s back
4. to have green hands
5. to keep a straight face
a. to try not to laugh
b. to be good at gardening
c. to listen very carefully
d. to help someone
e. to act deceitfully

Exercise E. Fill in the blanks with one suitable word:

BODY ORGANIZATION
Structural and functional levels of organization characterize the human body, and each of its
parts contributes .................... (1) the total organism.
Cellular Level
The cell is the basic structural and functional component of life. Humans are multicellular
organisms composed .................... (2) 60 to 100 trillion cells. It is at the microscopic cellular
level that such vital functions of life as metabolism, growth, irritability (responsiveness to
stimuli), repair, and replication are carried .................... (3). Cells are composed of atoms —
minute particles that are bound .................... (4) to form larger particles called molecules.
Certain molecules, in turn, are grouped in specific ways to form small functional structures
.................... (5) organelles. Each organelle carries .................... (6) a specific function within
the cell. A cell‘s nucleus, mitochondria, and endoplasmic reticulum are organelles. The
human body contains many distinct kinds of .................... (7), each specialized to perform
specific functions. Examples of specialized cells are bone cells, muscle cells, fat cells, blood
cells, liver cells, and nerve cells. The unique structure of each of these cell types is directly
related .................... (8) its function.
Tissue Level
Tissues are layers or groups of similar cells that perform a common .................... (9). The
entire body is composed of only four principal .................... (10) of tissues: epithelial,
connective, muscular, and nervous tissue. An example of a tissue is the muscle within the
heart, whose function it is to pump the .................... (11) through the body. The outer layer of
skin (epidermis) is a tissue because it is composed of similar cells that together serve
.................... (12) a protective shield for the body. Histology is the science concerned
.................... (13) the microscopic study of tissues.

3
 Organ Level
An organ is an aggregate of two or .................... (14) tissue types that performs a specific
function. Organs occur throughout the body and vary greatly .................... (15) size and
function. Examples of organs are the heart, spleen, pancreas, ovary, skin, and even any of the
bones within the body. Each organ usually has one or more primary tissues and several
.................... (16) tissues. In the stomach, for example, the inside epithelial lining is
considered the primary tissue because the basic functions of secretion and absorption occur
within this layer. Secondary tissues of the stomach are the connective, nervous, and muscle
tissues.
System Level
The systems of the body constitute the next level of structural organization. A body system
consists of various organs .................... (17) have similar or related functions. Examples of
systems are the circulatory system, nervous system, digestive system, and endocrine system.
Certain organs may serve .................... (18) systems. For example, the pancreas functions
with .................... (19) the endocrine and digestive systems and the pharynx serves both the
respiratory and digestive systems. All the systems of the body are interrelated and function
together, making .................... (20) the organism.

Exercise F. Find the appropriate word in the box to fill in the gaps:

bear coined drum meanings early experience grape origin

science terms themselves throughout to universally warlike

ANATOMICAL NOMENCLATURE

Anatomy is a descriptive .................... (1). Analyzing anatomical terminology can be a

rewarding .................... (2) in that one learns something of the character of antiquity in the
process. However, understanding the roots of words is not only of academic interest.
Familiarity with technical .................... (3) reinforces the learning process. Most anatomical
terms are derived from Greek or Latin, but some of the more recent terms are of German and
French.................... (4). Some anatomical structures .................... (5) the names of people
who discovered or described them. Such terms are totally nondescriptive; unfortunately, they
have little meaning in and of.................... (6). Many Greek and Latin terms were....................
(7) more than 2,000 years ago. Deciphering the .................... (8) of these terms affords a
glimpse into our medical heritage. Many terms referred .................... (9) common plants or
animals. Thus, the term vermis means worm; cochlea, snail shell; cancer, crab; and uvula,
little .................... (10). Even the term muscle comes from the Latin musculus, which means
mouse. Other terms suggest the .................... (11) environment of ancient Greece and Rome.
Thyroid, for example, means shield; xiphos means sword; and thorax, breastplate. Sella
means saddle and stapes means stirrup. Various tools or instruments were referred to in
.................... (12) anatomy. The malleus and anvil resemble miniatures of a blacksmith‘s
implements, and tympanum refers to a .................... (13). You will encounter many new
terms .................... (14) your study of anatomy. You can learn these terms more easily if you
know the meaning of their prefixes and suffixes. Anatomy is a very precise science because
of its .................... (15) accepted reference language for describing body parts and locations.

4
 Grammar Focus – ‘each’ and ‘every’

Read these sentences from the text and say whether ‗each‘ and ‗every‘ are interchangeable
with each other:
The teeth in each half of the dental arch in each jaw are divided into four groups. Each
group is adapted to a different function. Every tooth consists of three parts.
Exercise G. Study the examples and complete the rules below with each and every:
There‘s a bathroom in each room (every room) in this hotel.
She was sitting with a child on each side of her.
Every dentist will tell you that it‘s a periapical abscess.
Each of the patients had a different disease.
How often do you have English lessons? Every Wednesday and Friday.

 Each and every are similar in meaning. Often it is possible to use either each or
every.
 Each and every are not the same. We use ................. when we think of things
separately, one by one ............................. may refer to two and more.
 We use ............................. when we think of things as a group. The meaning is similar
to ‗all‘. ........................ always refers to more than two.
 You can say only ................................. of us/them.
 We use ............................. to say how often something happens.

Exercise H. Insert each or every (in some sentences both are possible):
1. ........................... candidate should know how to fill in the form.
2. ........................... of them told me the same story.
3. ........................... side of a square has the same length.
4. ........................... of us should remember to come for a dental check-up .....................
six months.
5. After ........................ of the patients had been examined, the nurse took them to the X-
ray department.
6. ........................... instrument should be left in a jar with disinfectant.
7. There are two boys in the waiting room. ....................... of them has a knocked out
tooth.
8. There are maple trees on ........................ side of the street.

Comment upon: Make a habit of two things: to help, or at least to do no harm. Hippocrates

5
6
 2. ORGANS AND SYSTEMS OF THE HUMAN BODY

Organs, such as the heart, the lungs, the stomach, the kidneys, the skin, and the liver, are
made up of two or more types of tissue organized to serve a particular function. For example,
the heart pumps blood, the lungs bring in oxygen and eliminate carbon dioxide, and the skin
provides a barrier to protect internal structures from the external environment.
Most organs contain all four tissue types. The layered walls of the small intestine provide a
good example of how tissues form an organ. The inside of the intestine is lined by epithelial
cells, some of which secrete hormones or digestive enzymes and others of which absorb
nutrients. Around the epithelial layer are layers of connective tissue and smooth muscle,
interspersed with glands, blood vessels, and neurons. The smooth muscle contracts to move
food through the gut, under control of its associated networks of neurons.

Exercise A. Match the system with the corresponding function and organs/structures:

Major organ systems of the human body

Organs, tissues, and

Organ system Function structures involved
Transports oxygen, nutrients, and other
substances to the cells and transports
wastes, carbon dioxide, and other
substances away from the cells; it can
also help stabilize body temperature and
Reproductive pH Skin, hair, and nails

Defends against infection and disease and

transfers lymph between tissues and the Skeletal, cardiac, and smooth
Skeletal blood stream muscles

Processes foods and absorbs nutrients, Bones, cartilage, joints,

Muscular minerals, vitamins, and water tendons, and ligaments

Provides communication within the body

via hormones and directs long-term Mouth, nose, pharynx, larynx,
change in other organ systems to maintain trachea, bronchi, lungs, and
Urinary homeostasis diaphragm

Provides protection from injury and fluid

loss and provides physical defence
against infection by microorganisms; Heart, blood, and blood
Integumentary involved in temperature control vessels

Digestive Provides movement, support, and heat Lymph, lymph nodes, and

7
 Organs, tissues, and
Organ system Function structures involved
production lymph vessels

Collects, transfers, and processes Brain, spinal cord, nerves,

information and directs short-term change and sensory organs—eyes,
Immune in other organ systems ears, tongue, skin, and nose
Leukocytes, tonsils, adenoids,
Produces gametes—sex cells—and sex thymus, and spleen
Cardiovascular hormones; ultimately produces offspring

Pituitary, pineal, thyroid,

parathyroids, endocrine
Delivers air to sites where gas exchange pancreas, adrenals, testes, and
Nervous can occur ovaries.

Mouth, salivary glands,

esophagus, stomach, liver,
Supports and protects soft tissues of the gallbladder, exocrine
body; provides movement at joints; pancreas, small intestine, and
Lymphatic produces blood cells; and stores minerals large intestine

Removes excess water, salts, and waste

products from the blood and body and Kidneys, ureters, urinary
Endocrine controls pH bladder, and urethra
Fallopian tubes, uterus,
vagina, ovaries, mammary
Defends against microbial pathogens— glands (female), testes, vas
disease-causing agents—and other deferens, seminal vesicles,
Respiratory diseases prostate, and penis (male)

Exercise B. Fill in the blanks with one suitable word:

Planes of Reference
In order to visualize and study the structural arrangements of various organs, the body
.................... (1) be sectioned (cut) and diagrammed according .................... (2) three
fundamental planes of reference: a sagittal plane, a coronal plane, and a transverse plane. A
sagittal plane extends vertically .................... (3) the body dividing it .................... (4) right
and left portions. A midsagittal (median) plane is a sagittal plane that passes lengthwise
through the midplane of the body, dividing it .................... (5) into right and left halves.
Coronal, or frontal, planes also pass lengthwise and divide the body into anterior (front) and
posterior (back) portions. Transverse planes, also .................... (6) horizontal, or cross
sectional, planes, divide the body into superior (upper) and inferior (lower) portions.

8
 The value of the computerized tomographic X-ray (CT) scan is .................... (7) it
displays an image .................... (8) a transverse plane similar to that which could otherwise
be obtained only in an actual section through the body. Prior .................... (9) the
development of this technique, the vertical plane of conventional radiographs made it
difficult, if not .................... (10), to assess the extent of body irregularities.

Clinical Procedures
Certain clinical procedures are important in determining anatomical structure and function in
a living individual. The most common of these are as follows:
• Inspection. Visually observing the body to note any clinical .................... (11), such as
abnormal skin colour, swelling, or rashes. Other observations may include needle
.................... (12) on the skin, irregular breathing rates, or abnormal behaviour.
• Palpation. Applying the fingers with firm .................... (13) to the surface of the body to
.................... (14) surface landmarks, lumps, tender spots, or pulsations.
• Percussion. Tapping sharply on various locations on the thorax or abdomen to ....................
(15) resonating vibrations as an aid in locating excess fluids or organ abnormalities.
• Auscultation. Listening .................... (16) the sounds that various organs make – breathing,
heartbeat, digestive sounds, and so .................... (17).
• Reflex testing. Observing a person‘s automatic (involuntary) response .................... (18) a
stimulus. One test .................... (19) a reflex mechanism involves tapping a predetermined
tendon with a reflex .................... (20) and noting the response.

Exercise C. Study the table below, then choose 5 organs/parts of the body and describe their
location, using the terms indicated.

Directional Terms for the Human Body

Term Definition Example

Superior (cranial, cephalic)
Inferior (caudal)
Anterior (ventral)
Posterior (dorsal)
Medial
Toward the head; toward the The thorax is superior to the
top abdomen.
Away from the head; toward the The neck is inferior to the head.
bottom
Toward the front The navel is on the anterior side
of the body.
Toward the back The kidneys are posterior to the
intestine.
Toward the midline of the body The heart is medial to the lungs.

Lateral Away from the midline of the
body
Internal (deep) Away from the surface of the
body
External (superficial) Toward the surface of the body
Proximal Toward the trunk of the body
The ears are lateral to the nose.
The brain is internal to the
cranium.
The skin is external to the
muscles.
The knee is proximal to the
foot.

Distal Away from the trunk of the The hand is distal to the elbow.
body

9
Exercise D. Read the text below, then do the exercises related to it.

Inspection, palpation, percussion, auscultation – the unalterable, ever-applicable tetrad.

Whatever part of the patient you examine, whatever disease you suspect, the four motions
must be gone through in that order. You look first, then feel; when you have felt, you may
tap, but not before; and last of all comes the stethoscope.
They taught us to feel lumps, liver and spleen; how to percuss correctly and
understand the evasive murmurs transmitted through a stethoscope. Diagnosis is simple
observation and application of logic in practice.
I began to see how the ward was managed by Sister whom I avoided like a pile of
radium. Every bodily function that could be measured – the pulse, the amount of urine, the
quantity of vomit, the number of baths – was carefully written down against the patient‘s
name in the treatment book, which reduced the twenty or so humans in the ward to a daily
row of figures in her aggressive handwriting.
There were two functions of the physiology in which Sister took special interest. One
was temperature. The temperature charts shone neatly from the foot of the beds, and each
showed a precise horizontal zigzag of different amplitude. The temperatures were taken by
the junior nurses, who used four or five thermometers. However, the figures were looked
upon as unimportant, because Sister always substituted figures of her own if the ones of the
patient did not fit her idea of what the temperature of the case ought to be.
The other particular concern of the Sister was the patient‘s bowels. A nurse was sent
round the ward every evening with a special book to ask how many times each patient had
performed during the past 24 hours. The number of occasions was written in a separate
square at the foot of the temperature chart. A nought was regarded by Sister as unpleasant,
and more than two blank days she took as a personal insult. Treatment was simple. One
nought was allowed to pass without punishment, but two automatically meant purgative,
three – castor oil, and four – supreme penalty of an enema.
We rapidly became accustomed to our position of inferiority to everyone of the ward
staff. We did all the medical investigations – urine testing, blood samples, and so on. For the
first few weeks, everything seemed easy. It was only at the end of the third month that I
realised how ignorant I was.
From Doctor in the House, by R. Gordon.

1. Find in the text synonyms to the following words and word combinations:
external examination, to percuss, amount, to be especially concerned with sth, intestines, a
zero, urinalysis, a blood test, to understand sth.

2. Answer the following questions related to the text above:

a. What are the methods of examining a patient?
b. What were the students taught at the hospital?
c. What were the two physiological functions Sister took special interest in?
d. What did the students do at the hospital?
e. Why do you think Gordon realised how ignorant he was only at the end of the third month?

3. Translate the following sentences, paying attention to the structures it is...that, it is...who:
a. It is complications that make the flu a dangerous disease.
b. It was an ambulance that brought the patient to the hospital.
c. It was a woman‘s high blood pressure that caused the doctor‘s alarm.
10
d. It is our doctor who prescribed me these pills.
e. It is at our chemist‘s that I bought this medicine.

4. Use the constructions it is.... that, it is.... who in the following sentences:
a. This new medicine is prescribed for ulcer.
b. The patient‘s urinalysis indicated some kidney trouble.
c. Our district doctor made the diagnosis of pneumonia and sent my mother to a hospital.
d. After the flu, I had a heart complication.
e. A dirty syringe may cause an infection.

Grammar Focus – ‘like’ and ‘as’

1. Match each of the sentences with the rules below:

1. He works as a dentist.
2. Their house looks like a castle.
3. I‘ll finish this book by Saturday, as I promised.
4. Some medicines, like codeine and morphine, are powerful pain-killers.
5. You can do it as you wish.

a. We use ‗like‘ to say that things are similar.

b. We use ‗like‘ before we exemplify something (= ‗for example‘).
c. We use ‗as‘ before a subject + verb (= ‗in the way‘).
d. We use ‗as‘ to talk about the jobs that people do.
e. We use ‗as‘ when we refer to information that both speaker and listener know, e.g. ‗as
you know,‘ ‗as I said,‘ ‗as she expected.‘

1..............; 2..................; 3......................; 4.....................; 5....................... .

2. Fill in with as or like:

1. ........ I said before, I can‘t help you.
2. I love winter sports .............. skiing, snowboarding and skating.
3. She was late for work, .......... I expected.
4. Stop yelling; don‘t behave ........ a child.
5. Although he is wealthy, he dresses ............... a tramp.
6. I‘ll give this book back tomorrow,.............. we agreed.

3. Match the idioms with their definitions:

1. to bite one‘s lip
2. to have a lump in the throat
3. to be down in the mouth
4. to be a bit long in the tooth
5. to have a sweet tooth
a) to like food containing a lot of sugar
b) to be old
c) to stop from saying something
d) to feel depressed
e) to feel so emotional that you are not able
to speak.

Comment upon: There are, in effect, two things, to know and to believe one
knows; to know is science; to believe one knows is ignorance. Hippocrates

11
12
 3. THE CIRCULATORY SYSTEM

Exercise A. Fill in the blanks with the correct derivative or root word

Functions of the Circulatory System

The many functions of the circulatory system can be grouped into two broad areas:
transportation and protection.
1. Transportation. All of the substances involved in 1..................... (CELL) metabolism are
transported by the circulatory system. These substances can be categorized as follows:
a. Respiratory. Red blood cells called erythrocytes transport oxygen to the tissue cells. In the
lungs, oxygen from the inhaled air attaches to haemoglobin molecules within the erythrocytes
and is transported to the cells for aerobic respiration. Carbon dioxide produced by cellular
respiration is carried by the blood to the lungs for 2..................... (ELIMINATE) in the
exhaled air.
b. Nutritive. The digestive system is 3..................... (RESPONSIBILITY) for the mechanical
and 4..................... (CHEMISTRY) breakdown of food to forms that can be 5.....................
(ABSORPTION) through the intestinal wall into the blood and lymph vessels. The blood then
carries these absorbed products of 6..................... (DIGEST) through the liver to the cells of
the body.
c. Excretory. 7.................... (METABOLISM) wastes, excess water and ions, as well as other
molecules in plasma (the fluid portion of blood), are filtered through the capillaries of the
kidneys into kidney tubules and 8 .................... (EXCRETION) in urine.
d. Regulatory. The blood carries hormones and other 9 .................... (REGULATE)
molecules from their site of origin to 10 .................... (DISTANCE) target tissues.
2. Protection. The circulatory system 11 .................... (PROTECTION) against injury and
foreign microbes or toxins introduced into the body. The clotting mechanism protects against
blood loss when vessels are damaged, and white blood cells called leukocytes render the
body immune to many disease-causing agents. Leukocytes may also protect the body through
phagocytosis.
Major Components of the Circulatory System
The circulatory system is frequently 12 .................... (DIVISION) into the cardiovascular
system, which consists of the heart, blood vessels, and blood, and the 13 ....................
(LYMPH) system, which consists of lymphatic vessels and lymphoid tissues within the
spleen, thymus, tonsils, and lymph nodes.
The heart is a four-chambered double pump. Its pumping action creates the pressure needed
to push blood in the vessels to the lungs and body cells. At rest, the heart of an adult pumps
about 5 litres of blood per minute. It takes only about a minute for blood to be circulated to
the most distal extremity and back to the heart.
Blood vessels form a tubular network that permits blood to flow from the heart to all living
cells of the body and then back to the heart. Arteries carry blood away from the heart, while
veins return blood to the heart. Arteries and veins are 14 .................... (CONTINUE) with
each other through smaller blood vessels. Arteries branch 15 .................... (EXTENSIVE) to
form a network of progressively smaller vessels. Those that are 16 ....................
(MICROSCOPE) are called arterioles. Conversely, microscopic-sized veins called venules
deliver blood to progressively larger vessels that empty into the large veins. Blood passes
from the arterial to the 17 .................... (VEIN) system in capillaries, which are the thinnest
and most numerous blood vessels. All exchanges of fluid, nutrients, and wastes between the

13
blood and tissue cells occur across the walls of capillaries; thus, they are considered the basic
18 .................... (FUNCTION) units of the circulatory system.
Fluid derived from plasma passes out of capillary walls into the 19 ....................
(SURROUND) tissues, where it is called interstitial fluid or tissue fluid. Some of this fluid
returns directly to capillaries and some enters into lymphatic vessels 20 ....................
(LOCATION) in the 21 .................... (CONNECT) tissues around the blood vessels. Fluid in
lymphatic vessels is called lymph. This fluid is returned to the venous blood at particular
sites. Lymph nodes, positioned along the way, cleanse the lymph prior to its return to the
venous blood. 22 .................... (ENDOTHERM) (warm-blooded) animals, including humans,
need an efficient 23 .................... (CIRCULATE) system to transport oxygen-rich blood
rapidly to all parts of the body. Of the vertebrates, only birds and mammals with their 24
.................... (CONSISTENT) warm body temperatures are considered endothermic, and only
birds, mammals, and a few reptiles (crocodiles and alligators) have a four-chambered heart.

Knowledge Check
1. Name the components of the circulatory system that function in oxygen transport, in the
transport of nutrients from the digestive system, and in protection.
2. Define the terms artery, vein, and capillary and describe the function of each of these
vessels.
3. Define the terms interstitial fluid and lymph. How do these fluids relate to blood plasma?
4. Describe the functions of the circulatory system.
5. Describe the major components of the circulatory system.

Exercise B. Fill in the blanks with one suitable word from the word-box:
a.
accounts between blood exception for function high indicator
BLOOD
known represents specialized to tube volume weight

Blood, a highly 1 .................... connective tissue, consists of formed elements—erythrocytes,

leukocytes, and platelets (thrombocytes) — that are suspended and carried in the blood
plasma. The constituents of blood 2 .................... in transport, immunity, and blood-clotting
mechanisms. The total blood 3 .................... in the average-sized adult is about 5 litres,
constituting about 8% of the total body 4 .................... . Blood leaving the heart is referred 5
....................as arterial blood. Arterial blood, with the 6 .................... of that going to the
lungs, is bright red in colour because of the 7 .................... concentration of oxyhemoglobin
(the combination of oxygen and hemoglobin) in the erythrocytes. Venous blood is blood
returning to the heart. Except 8 .................... the venous blood from the lungs, it contains less
oxygen and is, therefore, a darker red than the oxygen-rich arterial 9 .................... . Blood has
a viscosity that ranges 10 .................... 4.5 and 5.5. This means that it is thicker than water,
which has a viscosity of 1.0. Blood has a pH range of 7.35 to 7.45 and a temperature within
the thorax of the body of about 38° C (100.4° F). When you donate blood, a ―unit‖ (half a
litre) is drained. This 11 .................... approximately a tenth of your total blood volume.
Blood is composed of a cellular portion, called formed elements, and a fluid portion, called
blood plasma. When a blood sample is centrifuged, the heavier formed elements are packed
into the bottom of the 12 ...................., leaving blood plasma at the top. The formed elements
constitute approximately 45% of the total blood volume, a percentage 13 .................... as the
hematocrit. The blood plasma 14 .................... for the remaining 55%. The hematocrit closely

14
approximates the percentage of red blood cells per given volume of blood and is an important
15 .................... of the oxygen-carrying capacity of blood.

b. Formed Elements of Blood

best contrast from immunity include maintain molecules
numerous of produced smallest synthesized transporting types within

The formed elements of blood 1 .................... erythrocytes (red blood cells, or RBCs);
leukocytes (white blood cells, or WBCs); and platelets (thrombocytes). Erythrocytes are by
far the most 2 .................... of these three types. A cubic millimeter of blood contains 5.1
million to 5.8 million erythrocytes in males and 4.3 million to 5.2 million erythrocytes in
females. By 3 ...................., the same volume of blood contains only 5,000 to 10,000
leukocytes and 250,000 to 450,000 platelets. Blood plasma is the fluid portion, or matrix, of
the blood. It can 4 .................... be visualized when the formed elements are removed. Blood
plasma constitutes approximately 55% of a given volume of blood. It is a straw-coloured
liquid, about 90% water. The remainder of the blood plasma consists 5 .................... proteins,
inorganic salts, carbohydrates, lipids, amino acids, vitamins, and hormones. The functions of
blood plasma include 6 .................... nutrients, gases, and vitamins; regulating electrolyte and
fluid balances; and maintaining a consistent blood pH of between 7.35 and 7.45. Plasma
proteins constitute 7% to 9% of the blood plasma. These proteins remain 7 .................... the
blood and interstitial fluid and assist in maintaining body homeostasis. The three 8
.................... of plasma proteins are albumins, globulins, and fibrinogen. Albumins account
for about 60% of the plasma proteins and are the 9 .................... of the three types. They are
10 .................... by the liver and provide the blood with carrier molecules and with the
viscosity needed to 11 .................... and regulate blood pressure. Globulins make up about
36% of the plasma proteins. The three types of globulins are alpha globulins, beta
globulins, and gamma globulins. The alpha and beta globulins are 12 .................... in the
liver and function in transporting lipids and fat-soluble vitamins. Gamma globulins are
produced by lymphoid tissues and are antibodies of 13 ..................... The third type of plasma
protein, fibrinogen, accounts for only about 4% of the protein content. Fibrinogens are large
14 .................... that are synthesized in the liver and, together with platelets, play an important
role in clotting the blood. When fibrinogen is removed 15 .................... blood plasma, the
remaining fluid is referred to as serum.

Exercise C. Fill in the blanks with one suitable word:

THE HEART
The structure of the heart enables it to serve as a transport system pump that keeps blood
continuously circulating through the blood vessels of the body.

a. Location and General Description

The hollow, four-chambered, muscular heart is roughly the size of a clenched 1. ....................
. It averages 255 grams in adult females and 310 grams in adult males. The heart contracts an
estimated 42 million times a year, pumping 700,000 gallons of blood. The heart is located in
the thoracic 2. .................... between the lungs in the mediastinum. About two-thirds of the
heart is located left of the midline, with its apex, or cone-shaped end, pointing 3 ....................
and resting 4 .................... the diaphragm. The base of the 5 .................... is the broad superior
end, where the large vessels attach. The parietal pericardium is a loosefitting serous sac of
15
dense fibrous connective tissue 6 .................... encloses and protects the heart. It separates the
heart 7 .................... the other thoracic organs and forms the wall of the pericardial cavity,
which contains a watery, lubricating pericardial 8 ..................... The parietal pericardium is
actually composed 9 .................... an outer fibrous pericardium and an inner serous
pericardium. It is the serous pericardium that produces the lubricating pericardial fluid that
allows the heart to 10 .................... in a kind of frictionless bath.

b. Heart Wall
The wall of the heart is composed 1 .................... three distinct layers. The outer layer is the
epicardium, also 2 .................... the visceral pericardium. The space 3 .................... this layer
and the parietal pericardium is the pericardial cavity, just described. The thick middle layer of
the heart wall is called the myocardium. It is composed of cardiac muscle tissue and
arranged in such a 4 .................... that the contraction of the muscle bundles results 5
.................... squeezing or wringing of the heart chambers. The thickness of the myocardium
varies in accordance 6 .................... the force needed 7 .................... eject blood from the
particular chamber. Thus, the thickest portion of the myocardium surrounds the left ventricle
and the atrial walls are relatively thin. The inner layer of the wall, called the endocardium, is
continuous 8.................... the endothelium of blood 9 ..................... The endocardium also
covers the valves of the heart. Inflammation 10 .................... the endocardium is called
endocarditis.

c. Chambers and Valves

The interior of the heart is divided 1 .................... four chambers: upper right and left atria
(singular atrium) and lower right and left ventricles. The atria contract and empty 2
.................... into the ventricles, which also contract in unison. The walls of the atria are
reinforced 3 .................... lattice-like pestinate muscles. Contraction of these modified
cardiac muscles ejects blood 4 .................... the atria to the ventricles. Each atrium has an ear-
shaped, expandable appendage called an auricle. The atria are separated from each 5
.................... by the thin, muscular interatrial septum; the ventricles are separated from each
other by the thick, muscular interventricular septum. Atrioventricular valves (AV valves)
lie between the atria and ventricles, and semilunar valves are located at the bases of the two
large vessels leaving the heart. Heart valves maintain a one-way flow of blood. Grooved
depressions 6 .................... the surface of the heart indicate the partitions 7 .................... the
chambers and also contain cardiac vessels that supply blood to the muscular wall of the 8
.................... . The most prominent groove is the coronary sulcus that encircles the heart and
marks the division between the atria and ventricles. The partition between the right and left
ventricles is denoted by two (anterior and posterior) interventricular sulci.
Right Atrium
The right atrium receives systemic venous blood from the superior vena cava, which drains
the upper portion of the 9 ...................., and from the inferior vena cava, which drains the 10
.................... portion. The coronary sinus is an additional opening into the right atrium that
receives venous blood from the myocardium of the heart itself.
Right Ventricle
Blood from the right atrium passes 11 .................... the right atrioventricular (AV) valve
(also called the tricuspid valve) to fill the right ventricle. The right AV valve is characterized
12 .................... three valve leaflets, or cusps. Each cusp is held in position by strong
tendinous cords called chordae tendineae. The chordae tendineae are secured to the
ventricular wall by cone-shaped papillary muscles. These structures prevent the valves 13

16
.................... everting, like an umbrella in a strong wind, when the ventricles contract and the
ventricular pressure increases.
Ventricular contraction causes the right AV valve to close and the blood to leave the right
ventricle through the pulmonary trunk and to enter the capillaries of the lungs via the right
and left pulmonary arteries. The pulmonary valve (also 15 .................... the pulmonary
semilunar valve) lies at the base of the pulmonary trunk, where it prevents the backflow of
ejected blood into the right ventricle.
Left Atrium
After gas exchange has occurred 16 .................... the capillaries of the lungs, oxygenated
blood is transported 17 .................... the left atrium through two right and two left pulmonary
veins.
Left Ventricle
The left ventricle receives blood from the left atrium. These two chambers are 18
.................... by the left atrioventricular (AV) valve (also called the bicuspid valve or mitral
valve). When the left ventricle is relaxed, the valve is open, allowing blood to flow 19
.................... the atrium into the ventricle; when the left ventricle contracts, the valve closes.
Closing of the valve 20 .................... ventricular contraction prevents the backflow of blood
into the atrium.

Knowledge Check
a. Describe the location of the heart in relation to other organs of the thoracic cavity and their
associated serous membranes.
b. Describe the structure and functions of the three layers of the heart wall.
c. Describe the chambers and valves of the heart and identify the grooves on its surface.
d. Trace the flow of blood through the heart and distinguish between the pulmonary and
systemic circulations.

Grammar Focus
WISHES AND RELATED FORMS

Wish
• Wishes about the present
For wishes about the present we use / wish + the past simple. The time referred to is an
imaginary present.
I wish I knew the answer to this question. (I do not know the answer.)
I wish I didn't have so much work to do. (I do have a lot of work.)
• Wishes about the past
For wishes about the past we use / wish + the past perfect. The time referred to is past time.
I wish I had gone to your party last week. (I did not go.)
• Wishes about the future
We can use could to refer to a future event.
/ wish June could meet me next week.
We also use could to refer to something that is generally difficult or impossible.
I wish I could drive.
I wish I could contact him, but I don't have my mobile phone with me.
We can also use have to to refer to a future event.
I wish I didn't have to get up early tomorrow.
• Wishes using would
When we want to complain about a bad habit we use I wish + would.
17
I wish Peter wouldn't chew gum all the time. We also use / wish + would to refer to
something that we would like to happen.
I wish the police would do something about these people!

If only
We can replace / wish with If only for emphasis.
If only I knew the answer to this question!
If only I had gone to your party last week! In speech, only is often heavily stressed

It’s time
The construction it's time I/you/we ... is followed by a past tense.
Sorry, but it's time we went home. The meaning here is similar to a second conditional.
If we went home, it would be better. High can be added for extra emphasis.
It's high time you learned to look after yourself!
- It's time can also be used with the infinitive. The meaning changes slightly. It's time you
started work! (you are being lazy and not working) It's time to start work. (a simple statement
of fact)

I’d rather
The construction I'd rather I/you/we ... is followed by a past tense.
I'd rather you didn't tell John about this. The meaning here is similar to a second conditional.
If you didn't tell John about this, it would be better.

Suppose and imagine

In informal speech we can use suppose or imagine in place of if. The construction is a
normal second conditional.
Suppose you lost your keys. What would you do?
Imagine you were rich. How would you feel?

Practice

1. Underline the most suitable verb form in each sentence.

a) I wish Peter doesn't live/didn't live/wouldn't live so far away from the town centre. We'll
have to take a taxi.
b) I feel rather cold. I wish I brought/had brought my pullover with me.
c) What a pity. I wish we don't have to/didn't have to/wouldn't have to leave.
d) I wish you tell/told/had told me about the test. I haven't done any revision.
e) I wish the people next door hadn't made/wouldn't make/couldn't make so mud noise. I can't
hear myself think!
f) Darling, I love you so much! I wish we are/had been/would be/could be together always!
g) I'm sorry I missed your birthday party. I really wish I come/came/had come/would come.
h) I like my new boss but I wish she gave/would give/could give me some more
responsibility.
i) Having a lovely time in Brighton. I wish you are/were/had been here.
j) This car was a complete waste of money. I wish I didn't buy/hadn't bought it.

2. Underline the most suitable verb form in each sentence.

a) A cheque is all right, but I'd rather you pay/paid me cash.
b) Imagine you live/lived in New York. How would you feel?
18
c) If only I have/had/would have a screwdriver with me.
d) If you want to catch the last train, it's time you leave/left.
e) I'd rather you don't/didn't tell anyone about our conversation.
f) I've got a terrible headache. If only I didn't drink/hadn't drunk that wine.
g) If you don't mind, I'd sooner you practised/had practised/would practise your violin
somewhere else.
h) It's high time you learn/learned to look after yourself.
i) Jean thinks that everyone likes her. If only she knows/knew what people say behind her
back!
j) I'd rather we stay/stayed at home this Christmas for a change.

3. Put the verbs in brackets in the correct form:

1. I‘d rather she (not, take) ........................................ so many pain-killers. She‘d better see a
dentist.
2. Don‘t treat her as if she (be) ............................... a child.
3. If only he (tell)............................... Dr Green about his disease on his first visit.
4. He wishes he (speak) ............................. English more fluently.
5. Suppose you (lose) ......................... your way while trekking in the mountain, what would
you do then?
6. If only she (revise) ..................................all the material before her last exam.
7. I‘d rather you (start)............................ the therapy right now.
8. You look at me as though I (tell) ........................... you a lie.

Comment upon: A natural talent is required; for, when Nature opposes, everything else is in
vain; but when Nature leads the way to what is most excellent, instruction in the art takes
place, which the student must try to appropriate to himself by reflection, becoming an early
pupil in a place well adapted for instruction. He must also bring to the task a love of labour
and perseverance, so that the instruction taking root may bring forth proper and abundant
fruits. Hippocrates

19
20
 4. BLOOD DISORDERS

Exercise A. Fill in the blanks with the correct derivative or root word.

Because blood is the 1 .................... (FUNCTION) component of the circulatory system, and
because the circulatory system works in such close 2 .................... (ASSOCIATE) with other
body systems, blood analysis is perhaps the most 3 .................... (INFORMATION) part of a
physical exam. 4 .................... (PERIPHERY) arterial pulsations, usually obtained at the
radial artery, provide information about blood flow. Capillary filling, following blanching, is
an 5 .................... (INDICATE) of peripheral arterial 6 .................... (CIRCULATE) and is
generally tested at the nail bed. This is done by firmly pressing the thumbnail against the
patient‘s toenail or fingernail and then quickly releasing the pressure. If the pinkish colour
returns quickly to the 7 .................... (WHITE) (blanched) area, circulation is considered
normal. Lack of peripheral coloration indicates vascular 8 .................... (SUFFICIENT).
Certain cardiovascular and blood 9 .................... (NORMAL) are expressed through the skin.
Cyanosis is characterized by a bluish coloration of the skin resulting from decreased oxygen
concentration. Anemia is characterized by pallor of the skin because of a 10 ....................
(DEFICIENT) of erythrocytes or hemoglobin. Jaundice is a condition in which the skin is
yellowed because of 11 .................... (EXCESS) bile pigment (bilirubin) in the blood. Edema
is an excessive 12 .................... (ACCUMULATE) of interstitial (tissue) fluid, causing a
swelling of a portion of the body. Erythema (er''ı˘-the'ma˘) is a 13 .................... (RED) of the
skin usually caused by an infection, inflammation, toxic reaction, sunburn, or a lesion. None
of these conditions are themselves diseases, but each is 14 .................... (SYMPTOM) of
problems that may involve the cardiovascular system.
Blood analysis is an essential part of any thorough physical 15 ....................
(EXAMINE). Blood cell counts are used to determine the percentage of formed elements in
the blood. An excess of red blood cells, called polycythemia (more than 6 million/ mm3),
may indicate certain bone diseases. Excessive leukocyte 16 .................... (PRODUCE), called
leukocytosis, is generally diagnostic of infections or diseases within the body. Leukopenia is
a decrease in leukocyte count. The disease leukemia causes the 17 .................... (RESTRICT)
reproduction of 18 .................... (MATURE) leukocytes, which depresses erythrocyte and
platelet formation and causes anemia and a tendency to bleed. Coagulation time, blood
sedimentation rates, prothrombin time, and various serum analyses are other blood tests that
19 .................... (PROVISION) specific information about body function or 20 ....................
(FUNCTION). Several blood diseases are distinguished by their rate of 21 ....................
(OCCUR).
Sickle-cell anemia is an autosomal recessive disease that occurs almost exclusively in
blacks. Although about 10% of American blacks have the sickle-cell trait, 22 ....................
(FORTUNE) fewer than 1% have sickle-cell disease. The distorted shape of the diseased cells
reduces their capacity to transport oxygen, resulting in an abnormally high 23 ....................
(DESTRUCT) of erythrocytes. With the decrease in erythrocytes, the patient becomes
anemic. Mononucleosis is an infectious disease that is transmitted by a virus in saliva, and is
therefore commonly called the ―kissing disease.‖ Mononucleosis is characterized by 24
.................... (TYPICAL) lymphocytes. It affects primarily adolescents, causing fever, sore
throat, 25 .................... (LARGE) lymph glands, and fatigue.

21
Exercise B. Fill in the blanks with one suitable word.

Heart Diseases
Heart diseases can be classified 1 .................... congenital or acquired. Congenital heart
problems result 2 ....................abnormalities in embryonic development and may be
attributed 3 .................... heredity, nutritional problems (poor diet) of the pregnant mother, or
viral infections. Congenital heart diseases occur in approximately 3 of every 100 births and
account for about 50% of early childhood deaths. Many congenital heart defects can be
corrected surgically, however, and others are not of a serious nature.
Heart murmurs can be congenital or acquired. Generally, they are of no clinical
significance; nearly 10% of all people have heart murmurs, ranging 4 .................... slight to
severe. A septal defect is the most common type of congenital heart problem. An atrial
septal defect, or patent foramen ovale, is a failure of the fetal foramen ovale to close at the
time 5 .................... birth. A ventricular septal defect is caused by an abnormal development
of the interventricular septum. This condition may interfere 6 .................... closure of the
atrioventricular valves and may be indicated by cyanosis and abnormal heart sounds.
Pulmonary stenosis is a narrowing of the opening into the pulmonary trunk from the right
ventricle. It may lead 7 .................... a pulmonary embolism and is usually recognized 8
.................... extreme lung congestion.
The tetralogy of Fallot is a combination of four defects in a newborn that
immediately causes a cyanotic condition. The four characteristics of this condition are (1) a
ventricular septal defect, (2) an overriding aorta, (3) pulmonary stenosis, and (4) right
ventricular hypertrophy. The pulmonary stenosis obstructs blood flow 9 .................... the
lungs and causes hypertrophy of the right ventricle. In an overriding aorta, the ascending
portion arises midway 10 .................... the right and left ventricles. Openheart surgery is
necessary to correct tetralogy of Fallot, and the overall mortality rate is about 5%. Acquired
heart disease may develop suddenly or 11 ..................... Heart attacks are included in this
category and are the leading cause of death in the United States. It is estimated that one 12
.................... five individuals over the age of 60 will succumb to a heart attack. The
immediate cause of a heart attack is generally one of the following: inadequate coronary
blood supply, an anatomical disorder, or conduction disturbances. Other types of acquired
heart diseases affect the layers of the 13 .................... . Bacterial endocarditis is a disease of
the lining of the heart, especially the cusps of the valves. It is caused 14 ....................
infectious organisms that enter the bloodstream. Myocardial disease is an inflammation of
the heart muscle followed by cardiac enlargement and congestive heart failure. Pericarditis
causes an inflammation of the pericardium—the covering 15 .................... of the heart. Its
distinctive feature is pericardial friction rub, a transitory scratchy sound heard during
auscultation. A tissue is said to be ischemic when it receives an inadequate supply of oxygen
because of an inadequate blood 16 ..................... The most common cause of myocardial
ischemia is atherosclerosis of the coronary arteries. The adequacy of blood flow is relative—
it depends 17 .................... the metabolic requirements of the tissue for oxygen. An
obstruction in a coronary artery, for example, may allow sufficient blood flow at rest but 18
.................... produce ischemia when the heart is stressed by exercise or emotional factors. In
patients with this condition, angioplasty or coronary artery bypass surgery may be performed.
Myocardial ischemia is associated 19 .................... increased concentrations of blood lactic
acid produced by anaerobic respiration of the ischemic tissue. This condition often causes
substernal pain, which also may be referred to the left shoulder and arm, as well 20
.................... to other areas. This referred pain is called angina pectoris. People with angina
22
frequently take nitroglycerin or related drugs that help 21 .................... the ischemia and pain.
These drugs are effective because they stimulate vasodilation, which improves circulation to
the heart and decreases the work that the heart must perform to eject blood 22 ....................
the arteries. Myocardial cells are adapted to respire aerobically and cannot respire
anaerobically for 23 .................... than a few minutes. If ischemia and anaerobic respiration
continue for more than a few minutes, necrosis (cellular death) may occur in the areas most
deprived of oxygen. A sudden, irreversible injury of this kind is 24 .................... a
myocardial infarction, or MI. Myocardial ischemia may be detected by characteristic
changes in the ECG. The diagnosis of myocardial infarction is aided 25 ....................
examining the blood concentration of various enzymes that are released from the damaged
cells.
Vascular Disorders

Exercise C. Choose the correct word from the word-box.

a.
afflicted by can common dysfunction pressure problems
systolic to type
Hypertension, or high blood 1 ...................., is the most common 2 ....................of vascular
disorder. In hypertension, the resting 3 ....................blood pressure exceeds 140 mmHg and
the diastolic exceeds 90 mmHg. An estimated 22 million adult Americans are 4
....................by hypertension. About 15% of the cases are the result of other body 5
...................., such as kidney diseases, adrenal hypersecretion, or arteriosclerosis, and are
diagnosed as secondary hypertension. Primary hypertension is more 6 ....................and cannot
be attributed 7 ....................any particular body 8 ..................... If hypertension is not
controlled 9 ....................diet, exercise, or drugs that reduce the blood pressure, it 10
....................damage various vital body organs, such as the heart or kidneys.

b.
addition arteries called expansion flow frequently in lung
through understood
Arteriosclerosis, or hardening of the 1 ...................., is a generalized degenerative vascular
disorder that results 2 ....................loss of elasticity and thickening of the arteries.
Atherosclerosis is a type of arteriosclerosis in which plaque material, 3
....................atheroma, forms on the tunica intima, narrowing the lumina of the arteries and
prohibiting the normal 4 ....................of blood. In 5 ...................., an atheroma often creates a
rough surface that can initiate the formation of a blood clot called a thrombus. An
embolism, or embolus, is a detached thrombus that travels 6 ....................the bloodstream
and lodges so as to obstruct or occlude a blood vessel. An embolism lodged in a coronary
artery is called a coronary embolism; in a vessel of the 7 ....................it is a pulmonary
embolism; and in the brain it is a cerebral embolism, which could cause a stroke. The causes
of atherosclerosis are not well 8 ...................., but the disease seems to be associated with
improper diet, smoking, hypertension, obesity, lack of exercise, and heredity. Aneurysms,
coarctations, and varicose veins are all types of vascular disfigurations. An aneurysm is an 9
.................... or bulging of the heart, aorta, or any other artery. Aneurysms are caused by
weakening of the tunicas and may rupture or lead to embolisms. A coarctation is a
constriction of a segment of a vessel, usually the aorta, and is 10 .................... caused by
tightening of remnant of the ductus arteriosus around the vessel.
23
c.
aftermath common however no occur removal result to
veins with

Varicose veins are weakened 1 ....................that become stretched and swollen. They are
most 2 ....................in the legs because the force of gravity tends 3 .................... weaken the
valves and overload the veins. Varicose veins can also 4 ....................in the rectum, in which
case they are called hemorrhoids. Vein stripping is the surgical 5 ....................of superficial
weakened veins. Phlebitis is inflammation of a vein. It may develop as a 6 ....................of
trauma or as an 7 .................... of surgery. Frequently, 8 .................... , it appears for 9
....................apparent reason. Phlebitis interferes 10 ....................normal venous circulation.

Exercise D. Choose a), b) or c) to fill in the blanks.

Disorders of the Lymphatic System

Infections of the 1 ....................are generally accompanied by a swelling and tenderness of
lymph nodes 2 .................... the infection. An inflammation of lymph nodes is referred 3
.................... as lymphadenitis. In 4 .................... lymphadenitis, an abscess usually forms in
the nodal tissue. An abscess is a localized pocket of pus formed by tissue destruction. If an
infection is not contained by localized lymph nodes, lymphangitis may 5 ..................... In
this condition, red streaks can be seen through the skin extending proximally from the
infected area. Lymphangitis is potentially dangerous because the uncontained infection may
cause septicemia (blood poisoning). The term lymphoma is used to describe primary
malignancies 6 .................... lymphoid tissues. Lymphomas are generally classified as
Hodgkin’s disease lymphomas or non-Hodgkin’s lymphomas. Hodgkin‘s disease
manifests 7 .................... as swollen lymph nodes in the neck and then progresses to involve
the spleen, liver, and bone marrow. The prognosis for Hodgkin‘s disease is good if it is
detected early. Non-Hodgkin‘s lymphomas include an array of specific and more 8
.................... lymphatic cancers. The lymphatic system is also frequently infected by
metastasizing carcinomas. Fragmented cells from the original tumour may enter the
lymphatic 9 .................... with the lymph and travel to the lymph nodes, where they may
cause secondary cancerous growths. Breast cancer will typically do this. The surgical
treatment involves the removal of the infected nodes, along 10 .................... some of the
healthy nodes downstream to ensure that the cancer is eliminated.

1. a) organ b) body c) tissue

2. a) nearly b) far c) near
3. a) to b) for c) from
4. a) prolonged b) long c) short
5. a) come b) ensue c) see
6. a) within b) for c) above
7. a) it b) himself c) itself
8. a) clear b) dark c) obscure
9. a) tubes b) ducts c) tubules
10.a) with b) on c) from

24
 Trauma to the Circulatory System
Hemorrhage and shock are two clinical considerations that directly involve the circulatory
system. Knowledge of how to treat a victim experiencing these conditions is of paramount
importance in administering first aid.

Exercise E. Put the following steps in the correct order.

a) Control of Bleeding
Because serious bleeding is life threatening, the principal first-aid concern is to stop the loss
of blood. The following are recommended steps in treating a victim who is hemorrhaging.

1. If the bleeding does not stop and continues to seep through the dressing, do not remove the
dressing. Rather, place additional absorbent material on top of it and continue to apply direct
pressure.

2. If direct pressure does not stop the bleeding, the pressure point to the wound site may need
to be compressed. In the case of a severe wound to the hand, for example, compress the
brachial artery against the humerus. This should be done while pressure continues to be
applied to the wound itself.

3. Once the bleeding has stopped, leave the bandage in place and immobilize the injured body
part. Get the victim to the hospital or medical treatment centre at once.

4. Maintain direct pressure until the bleeding stops. Dress the wound with clean bandages or
cloth lightly bound in place.

5. To reduce the chance that the victim will faint, lay the person down on a blanket (if
available) and slightly elevate his or her legs. If possible, elevate the site of bleeding above
the level of the trunk. To minimize the chance of shock, cover the victim with a blanket.

6. Without causing further trauma, carefully remove any dirt or debris from the wound. Do
not remove any impaling objects. This should be done at the hospital by trained personnel.

7. Apply direct pressure to the wound with a sterile bandage, clean cloth, or an article of
clothing.

b) Recognizing and Treating Victims of Shock

Shock is the medical condition that occurs when body tissues do not receive enough oxygen-
carrying blood. It is often linked with crushing injuries, heat stroke, heart attacks, poisoning,
severe burns, and other life-threatening conditions. Symptoms of patients experiencing shock
include the following.
• Skin. The skin is pale or gray, cool, and clammy.
• Pulse. The heartbeat is weak and rapid. Blood pressure is reduced, frequently to below
measurable values.
• Respiration. The respiratory rate is hurried, shallow, and irregular.
• Eyes. The eyes are staring and lusterless, possibly with dilated pupils.
• State of being. The victim may be conscious or unconscious. If conscious, he or she is
likely to feel faint, weak, and confused. Frequently, the victim is anxious and excited. Most

25
trauma victims will experience some degree of shock, especially if there has been
considerable blood loss.
Immediate first-aid treatment for shock is essential and includes the following steps:

1. Take precautions for internal bleeding or vomiting. If the victim has blood coming from
the mouth, or if there is indication that the victim may vomit, position the person on his or her
side to prevent choking or inhaling the blood or vomitus.

2. Treat injuries appropriately. If the victim is bleeding, treat accordingly. Immobilize

fractures and sprains. Always be alert to the possibility of spinal injuries and take the
necessary precautions

3. See that hospital care is provided as soon as possible.

4. Keep the victim warm and comfortable. If the weather is cold, place a blanket under and
over the person. If the weather is hot, position the person in the shade on top of a blanket.
Loosen tight collars, belts, or other restrictive clothing. Do not give the person anything to
drink, even if he or she complains of thirst..

5. Get the victim to lie down. Lay the person on his or her back with the feet elevated. This
position maintains blood flow to the brain and may relieve faintness and mental confusion.
Keep movement to a minimum. If the victim has sustained an injury in which raising the legs
causes additional pain, leave the person flat on his or her back.

Grammar focus – CONDITIONALS

1. Real/likely situations: first conditional

• With if
A first conditional describes a real or likely situation. A present tense is used after if, but the
time referred to is the future. Will/Won't are common in the result clause.
If you fall, I won't be able to catch you! This means that there is a real possibility this will
happen. Going to can be used instead of will.
If it rains, we're going to get wet. The modal verb can is also common in first conditional
sentences.
If the cases are too heavy, I can help you carry them.
• Unless, provided, as long as. Unless means If... not.
Unless you leave at once, I'll call the police. If you don't leave at once, I'll call the police.
Provided and as long as can also introduce a condition. Provided you leave now, you'll catch
the train.
• With the imperative
It is common to use the imperative instead of if. Get me some cigarettes, and I'll pay you
later.
• With should
We can use should instead of if in a conditional sentence. It means if by any chance ... and
makes the action less likely.
Should you see John, can you give him a message?
2. Unreal/imaginary situations: second conditional
• With if
26
A second conditional describes an unreal or imaginary situation. A past simple tense is used
after if, but the time referred to is the present/future. Would is common in the result clause.
If you fell, you would hurt yourself. This means that there is a small possibility that this will
happen. The situation and its result are imagined.
The modal verbs might and could are common in second conditional sentences.
If you became a millionaire, you might be unhappy.
• Were
Were is often used instead of was in formal language. Note that were is not stressed in
speech.
If I were taller, I'd join the basketball team.
If I were you, I'd leave now. (I and you are stressed in speech)
• Were to
Were to is another way of expressing a second conditional sentence. If they were to offer me
the job, I'd turn it down.

3. Unreal/imaginary past situations: third conditional

A third conditional describes an unreal or imaginary situation in the past. A past perfect tense
is used after if. Would + have + past participle is used in the result clause.
If John had studied more, he would have got better marks. This means that John didn't study
more. A past situation, different to the one that really happened, is imagined.
The modal verbs might and could are common in this kind of sentence. If you had tried
harder, you might have succeeded.
4. Mixed conditions
For past events which have a result continuing in the present, it is possible to use the form of
a third conditional in the if-clause, and the form of a second conditional in the result clause.
If you had saved some money, you wouldn't be so hard up.

Practice
1. Underline the most suitable verb forms in each sentence.
a) If the machine stops/will stop, you press/will press this button.
b) I can't understand what he sees in her! If anyone treats/will treat/treated me like that, I
am/will be/would be extremely angry!
c) If you help/helped me with this exercise, I will/would do the same for you one day.
d) According to the timetable, if the train leaves/left on time, we will/would arrive at 5.30.
e) If it is/will be fine tomorrow, we go/will go to the coast.
f) If we find/found a taxi, we will get/would get there before the play starts.
g) It's quite simple really. If you take/will take/took these tablets every day, then you lose/will
lose/lost/would lose weight.
h) I don't like this flat. I think I am/I will be/I'd be happier if I live/will live/would
live/lived in a house in the country.
i) I don't know how to play baseball, but I'm sure that if I will do/did, I play/will play/would
play a lot better than anyone in this awful team!
j) If I phone/will phone/phoned you tonight, are you/will you be/would you be in?

2. Underline the most suitable verb forms in each sentence.

a) Why didn't you tell me? If you told/had told me, I had helped/would have helped you.
b) If Bill didn't steal/hadn't stolen the car, he wasn't/wouldn't be/hadn't been in prison now.
c) If Ann wasn't driving/didn't drive/hadn't driven so fast, her car didn't crash/wouldn't
crash/wouldn't have crashed into a tree.
27
d) Let me give you some advice. If you smoked/would smoke/had smoked less, you didn't
feel/wouldn't feel/wouldn't have felt so tired.
e) What bad luck! If Alan didn't fall/hadn't fallen/wouldn't fall over, he won/would win/would
have won the race.
f) If you invited/had invited me last week, I was able/had been able/would have been able to
come.
g) I'm sure your letter hasn't arrived yet. If it came/had come I'm sure I noticed/had
noticed/would have noticed it.
h) We have a suggestion to make. How do you feel/would you feel if we offered/would
offer/had offered you the job of assistant manager?
i) If you lent/had lent us the money, we paid/would pay/had paid you back next week.
j) Terry never catches anything when he goes fishing. And if he catches/caught/had caught a
fish, he throws/would throw it back!

3. Put each verb in brackets into a suitable verb form.

a) Why didn't you phone? If I (know) ....had known you were coming, I
(meet)........................... you at the airport.
b) It's a pity you missed the party. If you (come)..................................., you
(meet)...................................... my friends from Hungary.
c) If we (have).................................. some tools, we ....................... to repair the car, but we
haven't got any with us.
d) If you (not help) ...............................................me, I (not pass) ...............................the
exam.
e) It's a beautiful house, and I (buy)............................................ it if I
(have)......................................... the money, but I can't afford it.
f) I can't imagine what I (do)................................................. with the money if I (win)
............................... the lottery.
g) If Mark (train) .....................................................harder, he
(be)............................................... a good runner.
h) If Claire (listen)................................................. to her mother, she (not marry)
........................................David in the first place.

4. In pairs, ask and answer the following questions:

What would you do if
1. you saw an accident in the street?
2. you could have a year off from your studies?
3. you found an abandoned cat or dog in the street?
4. a fire broke out at your place?
5. you got a toothache?
6. your brother/sister fell and hurt herself?
7. you met your favourite singer in the street?
8. you were a president for a month?
9. you were told you could magically change something in your appearance?
10. you could be 14 again?

Comment upon: Timidity betrays want of powers, and audacity a want of

skill. Hippocrates

28
29
 5. THE SKELETAL SYSTEM

Exercise A. Fill in the blanks with one suitable word.

The adult skeletal system consists 1 ................... approximately 206 bones. The exact number
of bones differs 2 ................... person to person depending on age and genetic factors. At
birth, the skeleton consists of about 270 bones. As further bone development (ossification)
occurs 3 ................... infancy, the number increases. During adolescence, however, the
number of bones decreases, as separate bones gradually fuse. Each bone is actually an organ
that plays a 4 ................... in the total functioning of the skeletal system. The science
concerned 5 ................... the study of bones is called osteology. Some adults have extra bones
within the sutures (joints) of the skull called sutural (wormian) bones. Additional bones may
develop in tendons in response 6 ................... stress as the tendons repeatedly move across a
joint. Bones formed this way are 7 ................... sesamoid bones. Sesamoid bones, like the
sutural bones, vary 8 ................... number. The patellae (―kneecaps‖) are two sesamoid bones
all people have.
For convenience of study, the skeleton is divided into axial and appendicular
portions. The axial skeleton consists of the bones that form the axis of the body and support
and protect the organs of the 9 ..................., neck, and trunk. The components of the axial
skeleton are as follows:
1. Skull. The skull consists of two sets of bones: the cranial bones that form the cranium, or
braincase, and the facial bones that support the eyes and nose and form the bony framework
of the oral 10 ....................
2. Auditory ossicles. Three auditory ossicles (―ear bones‖) are present in the middle-ear
chamber of each ear and serve to transmit 11 ................... impulses.
3. Hyoid bone. The hyoid bone is located 12 ................... the larynx (―voice box‖) and below
the mandible (―jawbone‖). It supports the tongue and assists in swallowing.
4. Vertebral column. The vertebral column (―backbone‖) consists of 26 individual bones
separated by cartilaginous intervertebral discs. In the pelvic region, several vertebrae are
fused to form the sacrum, which is the attachment portion of the pelvic girdle. A few terminal
vertebrae are fused to form the coccyx (―tailbone‖).
5. Rib cage. The rib 13 ................... forms the bony and cartilaginous framework of the
thorax. It articulates posteriorly with the thoracic vertebrae and includes the 12 pairs of ribs,
the flattened sternum, and the costal cartilages that connect the ribs to the 14 ................... .
The appendicular skeleton is composed of the bones of the upper and lower extremities and
the bony girdles that anchor the appendages 15 ................... the axial skeleton. The
components of the appendicular skeleton are as follows:
1. Pectoral girdle. The paired scapulae (―shoulder blades‖) and clavicles (―collarbones‖) are
the appendicular components of the pectoral girdle, and the sternum (―breastbone‖) is the
axial component. The primary function of the pectoral girdle is to provide attachment 16
................... the muscles that move the brachium (arm) and antebrachium (forearm).
2. Upper extremities. Each upper extremity contains a proximal humerus within the
brachium, an ulna and radius within the antebrachium, the carpal bones, the metacarpal
bones, and the phalanges (―finger bones‖) of the hand.
3. Pelvic girdle. The two ossa coxae (―hipbones‖) are the appendicular components of the
pelvic girdle, and the sacrum is the axial component. The ossae coxae are united anteriorly 17
................... the symphysis pubis and posteriorly by the sacrum. The pelvic girdle supports the

30
weight of the body 18 ................... the vertebral column and protects the viscera within the
pelvic cavity.
4. Lower extremities. Each lower extremity contains a proximal femur (―thighbone‖) within
the thigh, a tibia (―shinbone‖) and fibula within the leg, the tarsal bones, the metatarsal
bones, and the phalanges (―toe bones‖) of the 19 ................... . In 20 ..................., the patella
(―kneecap‖) is located on the anterior surface of the knee joint, between the thigh and leg.

Exercise B. Fill in the blanks with the correct derivative or root word.

FUNCTIONS OF THE SKELETAL SYSTEM

The bones of the skeleton perform the mechanical functions of support, 1 ...................
(PROTECT), and leverage for body 2 ................... (MOVE) and the 3 ...................
(METABOLISM) functions of hemopoiesis and storage of fat and minerals.
The 4 ................... (STRONG) of bone comes from its inorganic components, of such 5
................... (DURABLE) that they resist 6 ................... (DECOMPOSE) even after death.
Much of what we know of 7 ................... (HISTORY) animals, including humans, has been
determined from preserved skeletal remains. When we think of bone, we frequently think of a
hard, dry structure. In fact, the term skeleton comes from a Greek word meaning ―dried up.‖
Living bone, however, is not inert material; it is dynamic and 8 ................... (ADAPT). It
performs many body functions, including support, protection, leverage for body movement,
hemopoiesis in the red bone marrow, fat 9 ................... (STORE) in the medullary cavity, and
mineral storage.
1. Support. The skeleton forms a 10 ................... (RIGIDITY) framework to which the softer
tissues and organs of the body are attached. It is of interest that the skeleton‘s 206 bones
support a mass of muscles and organs that may 11 ................... (WEIGHT) 5 times as much
as the bones themselves.
2. Protection. The skull and vertebral column 12 ................... (ENCLOSURE) the brain and
spinal cord; the rib cage protects the heart, lungs, great vessels, liver, and spleen; and the
pelvic girdle supports and protects the pelvic viscera. Even the sites where blood cells are
produced are protected within the 13 ................... (SPONGE) bone tissue of certain bones.
3. Body movement. Bones serve as anchoring 14 ................... (ATTACH) for most skeletal
muscles. In this capacity, the bones act as levers (with the joints functioning as pivots) when
muscles 15 ................... (CONTRACTION) and cause body movement.
4. Hemopoiesis. The process of blood cell formation is called hemopoiesis. It takes place in
tissue called red bone marrow located internally in some bones. In an 16 ...................
(INFANCY), the spleen and liver produce red blood cells, but as the bones mature, the bone
marrow takes over this formidable task. It is estimated that an average of 2.5 million red
blood cells are produced every second by the red bone marrow to 17 ...................
(REPLACEMENT) those that are worn out and destroyed by the liver.
5. Fat storage. Lipid is stored in the adipose tissue within the medullary cavity of certain
bones. The adipose tissue and its lipid content are known as yellow bone marrow.
6. Mineral storage. The inorganic matrix of bone is composed 18 ................... (PRIMARY)
of the minerals calcium and phosphorus. These minerals which account for approximately
two-thirds of the weight of bone, give bone its 19 ................... (FIRM) and strength. About
95% of the calcium and 90% of the phosphorus within the body are deposited in the bones
and teeth. Although the 20 ................... (CONCENTRATE) of these inorganic salts within the
blood is kept within narrow limits, both are essential for other body functions. Calcium is 21
................... (NECESSITY) for muscle 22 ................... (CONTRACT), blood clotting, and the
movement of ions and nutrients across cell membranes. Phosphorus is 23 ...................
31
(REQUIREMENT) for the 24 ................... (ACTIVE) of the nucleic acids DNA and RNA, as
well as for ATP utilization. If mineral salts are not present in the diet in sufficient amounts,
they may be withdrawn from the bones until they are replenished through proper nutrition. In
25 ................... (ADD) to calcium and phosphorus, lesser amounts of magnesium, sodium,
fluorine, and strontium are stored in bone tissue.

Exercise C. Read the text about the human skull and then answer the questions.

THE SKULL
The human skull, consisting of 8 cranial and 14 facial bones, contains several cavities that
house the brain and sensory organs. Each bone of the skull articulates with the adjacent bones
and has diagnostic and functional processes, surface features, and foramina.
The skull consists of cranial bones and facial bones. The eight bones of the cranium
articulate firmly with one another to enclose and protect the brain and sensory organs. The 14
facial bones form the framework for the facial region and support the teeth. Variation in size,
shape, and density of the facial bones is a major contributor to the individuality of each
human face. The facial bones, with the exception of the mandible (―jawbone‖), are also
firmly interlocked with one another and the cranial bones.
The skull has several cavities. The cranial cavity is the largest, with an approximate
capacity of 1,300 to 1,350 cc. The nasal cavity is formed by both cranial and facial bones
and is partitioned into two chambers, or nasal fossae, by a nasal septum of bone and
cartilage. Four sets of paranasal sinuses, located within the bones surrounding the nasal
area, communicate via ducts into the nasal cavity. Middle- and inner-ear cavities are
positioned inferior to the cranial cavity and house the organs of hearing and balance. The two
orbits for the eyeballs are formed by facial and cranial bones. The oral, or buccal cavity
(mouth), which is only partially formed by bone, is completely within the facial region.
During fetal development and infancy, the bones of the cranium are separated by fibrous
unions. There are also six large areas of connective tissue membrane that cover the gaps
between the developing bones. These membranous sheets are called fontanels, meaning
―little fountains.‖ The name derives from the fact that a baby‘s pulse can be felt surging in
these ―soft spots‖ on the skull. The fontanels permit the skull to undergo changes in shape,
called molding, during parturition (childbirth), and they accommodate the rapid growth of the
brain during infancy. Ossification of the fontanels is normally complete by 20 to 24 months
of age.
1. Anterior (frontal) fontanel. The anterior fontanel is diamond-shaped and is the most
prominent. It is located on the anteromedian portion of the skull.
2. Posterior (occipital) fontanel. The posterior fontanel is positioned at the back of the skull
on the median line. It is also diamond-shaped, but smaller than the anterior fontanel.
3. Anterolateral (sphenoid) fontanels. The paired anterolateral fontanels are found on both
sides of the skull, directly lateral to the anterior fontanel. They are relatively small and
irregularly shaped.
4. Posterolateral (mastoid) fontanels. The paired posterolateral fontanels, also irregularly
shaped, are located on the posterolateral sides of the skull. A prominent sagittal suture
extends the anteroposterior median length of the skull between the anterior and posterior
fontanels. A coronal suture extends from the anterior fontanel to the anterolateral fontanel.
A lambdoid suture extends from the posterior fontanel to the posterolateral fontanel. A
squamous suture connects the posterolateral fontanel to the anterolateral fontanel.

32
1. How many bones are there in the human skull?
2. Name the cavities of the skull.
3. What are the bones of the cranium separated by, during fetal development?
4. What are the fontanels and what role do they play?
5. At what age is the ossification of the fontanels completed?
6. Name the types of fontanels.
7. What is the role of the squamous suture?

Developmental Disorders

Exercise D. Choose the suitable word from the word box.

a.
affected both congenital during for from palate

Congenital malformations account 1 ................... several types of skeletal deformities.

Certain bones may fail to form 2 ................... osteogenesis, or they may form abnormally.
Cleft palate and cleft lip are malformations of the 3 ................... and face. They vary in
severity and seem to involve genetic 4 ................... and environmental factors. Spina bifida
is a 5 ................... defect of the vertebral column resulting 6 ...................a failure of the
laminae of the vertebrae to fuse, leaving the spinal cord exposed. The lumbar area is most
likely to be 7 ..................., and frequently only a single vertebra is involved.

b. Nutritional and Hormonal Disorders

abnormal body characterized condition flexible growth influence
often result soft sunlight than tissue unable up

Several bone disorders 1 ................... from nutritional deficiencies or from excessive or

deficient amounts of the hormones that regulate bone development and growth. Vitamin D
has a tremendous 2 ................... on bone structure and function. When there is a deficiency of
this vitamin, the body is 3 ................... to metabolize calcium and phosphorus. Vitamin D
deficiency in children causes rickets. The bones of a child with rickets remain 4 ...................
and structurally weak, and bend under the weight of the 5 .................... A vitamin D
deficiency in the adult causes the bones to give 6 ...................stored calcium and phosphorus.
This demineralization results in a 7 ................... called osteomalacia. Osteomalacia occurs
most 8 ................... in malnourished women who have repeated pregnancies and who
experience relatively little exposure to 9 .................... It is marked by increasing softness of
the bones, so that they become 10 ...................and thus cause deformities. Because hormones
exert a strong influence on bone development, however, a few endocrine disorders will be
briefly mentioned here. Hypersecretion of growth hormone from the pituitary gland leads to
gigantism in young people if it begins before ossification of their epiphyseal plates. In adults,
it leads to acromegaly, which is 11 ...................by hypertrophy of the bones of the face,
hands, and feet. In a child, growth hormone deficiency results in slowed bone 12 ...................
—a condition called dwarfism. Paget‘s disease, a bone disorder that affects mainly older
adults, occurs more frequently in males 13 ...................in females. It is characterized by
disorganized metabolic processes within bone 14 .................... The activity of osteoblasts and
osteoclasts becomes irregular, resulting in thick bony deposits in some areas of the skeleton
and fragile, thin bones in other areas. The vertebral column, pelvis, femur, and skull are most
33
often involved, and become increasingly painful and deformed. Bowed leg bones, 15
...................curvature of the spine, and enlargement of the skull may develop. The cause of
Paget‘s disease is currently not known.

c. Neoplasms of Bone & Osteogenic sarcoma

common dots originates pain procedure substance through type
usual which
Malignant bone tumours are three times more 1 ................... than benign tumours. Pain is the
2 ...................symptom of either type of osseous neoplasm, although benign tumours may not
have accompanying 3 .................... Two types of benign bone tumours are osteomas, which
are the more frequent and 4 ................... often involve the skull, and osteoid osteomas, which
are painful neoplasms of the long bones, usually in children. Osteogenic sarcoma is the most
virulent 5 ...................of bone cancer. It frequently metastasizes 6 ...................the blood to the
lungs. This disease usually 7 ...................in the long bones and is accompanied by aching and
persistent pain. A bone scan is a diagnostic 8 ................... frequently done on a person who
has had a malignancy elsewhere in the body that may have metastasized to the bone. The
patient receiving a bone scan may be injected with a radioactive 9 ................... that
accumulates more rapidly in malignant tissue than in normal tissue. Entire body radiographs
show malignant bone areas as intensely dark 10 ................... .

d. Aging of the Skeletal System

age brittle
blood cure debilitation deformity density effective fracture
include increased loss pace results weight

Senescence affects the skeletal system by decreasing skeletal mass and 1 ................... and
increasing porosity and erosion. Bones become more 2 ................... and susceptible to
fracture. Articulating surfaces also deteriorate, contributing to arthritic conditions. Arthritic
diseases are second to heart disease as the most common 3 ...................in the elderly.
Osteoporosis is a weakening of the bones, primarily as a result of calcium 4 ................... .
The causes of osteoporosis 5 ...................aging, inactivity, poor diet, and an imbalance in
hormones or other chemicals in the 6 ................... . It is most common in older women
because low levels of estrogens after menopause lead to 7 ................... bone resorption, and
the formation of new bone is not sufficient to keep 8 ................... . People with osteoporosis
are prone to bone 9 ..................., particularly at the pelvic girdle and vertebrae, as the bones
become too brittle to support the 10 ................... of the body. Complications of hip fractures
often lead to permanent disability, and vertebral compression fractures may produce a
permanent curved 11 ................... of the spine. Although there is no known 12 ...................
for osteoporosis, good eating habits and a regular program of exercise, established at an early
13 ................... and continued throughout adulthood, can minimize its effects. Treatment in
women through dietary calcium, exercise, and estrogens has had limited positive 14
................... . In addition, a drug called alendronate (Fosamax), approved by the FDA in
1995, has been shown to be 15 ................... in managing osteoporosis. This drug works
without hormones to block osteoclast activity, making it useful for women who choose not to
be treated with estrogen replacement therapy.

34
 Grammar focus – ADJECTIVES

Read this sentence from the text and say affix is used to form the adjectives in bold:
The procedure is totally painless [...] aluminium oxide, a tasteless substance commonly found
in toothpaste.

Most common adjectives (e.g. short, dark, nice) do not have a special ending. However, there
are adjectives which are formed from nouns or verbs by addition of endings. Check the
examples and add some of your own:

-able fashionable
-al emotional
-ate fortunate
-ent dependent
-ful careful
-ian Russian
-ible possible
- ary imaginary
- less careless
-ly friendly
- ous famous
- some troublesome

Exercise E.
a) Make adjectives from the following words:
 accident - ___________________
 month-_______________________
 base - ______________________
 quarrel - ______________________
 coward - ____________________
 rust - ________________________
 fear - _______________________
 taste - ________________________
 fool - _______________________
 vigour - ______________________

b) Choose appropriate adjectives from the list above to complete the sentences:
1. How could I be so ............................... as to believe the story he told me?
2. His bike is old and .............................. but still usable.
3. This chapter provides only ................................ information on the endodontic treatment.
4. I don‘t think their meeting was .................................. . They must have arranged it earlier.
5. If you want to be healthy and fit, take a .................................... exercise for an hour twice a
week.
6. She is a ............................. person; she constantly argues with everybody.
7. It is his ............................. nature that he doesn‘t want to go to the dentist.
8. The profit is calculated on the basis of our ....................................... earnings.
9. There are very few restaurants that serve ...................................... and healthy meals.
10. She was ...................................... that she might fail the exam.
35
Exercise F. Common prefixes used with adjectives are: a-; ab-; dis-; hyper-; il-; im-; in-; ir-
; mal-; un-. Make the opposites by adding the prefix from the given list in place of dots:

1. There is nothing ......moral about being wealthy.

2. Although the patient was ....symptomatic, he was feeling very bad.
3. It was ...responsible to ignore the sudden deterioration of her condition.
4. The ambulance brought a(n) .....conscious patient to the Emergency Department.
5. It‘s ....legal to drive when the red light is on.
6. A lot of students take up a job because they want to become ...dependent of their parents.
7. His ...normal level of glucose in the blood suggests that he‘s got diabetes mellitus.
8. The girl was very thin because she was .....nourished.
9. There is ...content among the hospital staff about the pay and working conditions.
10. The vitality test has shown that the tooth is ...sensitive to hot and cold temperature.

Comment upon: Conclusions which are merely verbal cannot bear fruit, only those do which
are based on demonstrated fact. For affirmation and talk are deceptive and treacherous.
Wherefore one must hold fast to facts in generalizations also, and occupy oneself with facts
persistently, if one is to acquire that ready and infallible habit which we call "the art f
medicine. HippocratesHippocrates

6. 65
5

36
37
 6. THE MUSCULAR SYSTEM

Pre-reading
1. Define the term myology and describe the three principal functions of muscles.
2. Explain how muscles are described according to their anatomical location and cooperative
function.

Exercise A. Fill in the blanks with the correct derivative or root word

Myology is the study of muscles. More than 600 skeletal muscles make up the muscular
system, and 1 ................... (TECHNICAL) each one is an organ—it is composed of skeletal
muscle tissue, 2 ................... (CONNECT) tissue, and 3 ................... (NERVE) tissue. Each
muscle also has a particular function, such as moving a finger or blinking an eyelid.
Collectively, the skeletal muscles account for approximately 40% of the body 4 ...................
(WEIGH). Muscle cells (fibres) contract when stimulated by nerve impulses. The 5
................... (STIMULATE) of just a few fibres is not enough to cause a 6 ...................
(NOTICE) effect, but isolated fibre contractions are important and occur continuously within
a muscle. When a 7 ................... (SUFFICIENCY) number of skeletal muscle fibres are
activated, the muscle contracts and causes body movement. Muscles perform three principal
functions: (1) movement, (2) heat production, and (3) body support and 8 ...................
(MAINTAIN) of posture.
1. Movement. The most obvious function performed by skeletal muscles is to move the body
or parts of the body, as in walking, running, writing, chewing, and swallowing. Even the
eyeball and the auditory ossicles have associated skeletal muscles that are 9 ...................
(RESPONSIBILITY) for various movements. The contraction of skeletal muscle is equally
important in breathing and in moving internal body fluids. The stimulation of individual
skeletal muscle fibres maintains a state of muscle 10 ................... (CONTRACT) called tonus,
which is important in the movement of blood and lymph. Tonus is also important in
continuously exercising skeletal muscle fibres.
The involuntary contraction of smooth muscle tissue is also essential for movement of
materials through the body. Likewise, the involuntary contraction of cardiac muscle tissue
continuously pumps blood throughout the body.
2. Heat production. Body temperature is held remarkably constant. Metabolism within the
cells releases heat as an end product. Because muscles constitute approximately 40% of body
weight and are in a continuous state of fibre activity, they are the primary source of body
heat. The rate of heat production increases greatly during strenuous exercise.
3. Posture and body support. The skeletal system 11 ................... (PROVISION) a
framework for the body, but skeletal muscles maintain posture, 12 ................... (STABLE)
the flexible joints, and support the viscera. Certain muscles are active postural muscles whose
primary function is to work in opposition to gravity. Some 13 ................... (POSTURE)
muscles are working even when you think you are relaxed. As you are sitting, for example,
the weight of your head is balanced at the atlanto-occipital joint through the efforts of the
muscles located at the back of the neck. If you start to get 14 ................... (SLEEP), your head
will suddenly nod forward as the postural muscles relax and the weight (resistance)
overcomes the effort. Muscle tissue in the body is of three types: smooth, cardiac, and
skeletal. Although these three types 15................... (DIFFERENCE) in structure and function,
and the muscular system refers only to the skeletal muscles 16 ...................
(COMPOSITION) of skeletal tissue, the following basic properties characterize all muscle
tissue:
38
1. Irritability. Muscle tissue is sensitive to stimuli from nerve impulses.
2. Contractility. Muscle tissue responds to stimuli by contracting lengthwise, or shortening.
3. Extensibility. Once a stimulus has subsided and the fibres within muscle tissue are 17
................... (RELAXATION), they may be stretched even beyond their resting 18
................... (LONG) by the contraction of an opposing muscle. The fibres are then prepared
for another contraction.
4. Elasticity. Muscle fibres, after being stretched, have a tendency to recoil to their original
resting length. Muscles are usually 19 ................... (DESCRIPTION) in groups according to
anatomical location and 20 ................... (COOPERATE) function. The muscles of the axial
skeleton include the facial muscles, neck muscles, and anterior and posterior trunk muscles.
The muscles of the appendicular skeleton include those that act on the pectoral and pelvic
girdles and those that move limb joints.

Knowledge Check
1. How do the functions of muscles help maintain body homeostasis?
2. What is meant by a postural muscle?
3. Distinguish between the axial and the appendicular muscles.

MUSCLES OF THE AXIAL SKELETON

Exercise B. Choose the suitable word from the word-box.

a. Muscles of Facial Expression

around communication into located musculature neck nerves
originate strength without
Humans have a well-developed facial 1 ...................that allows for complex facial expression
as a means of social 2 ................... . Very often we let our feelings be known 3 ................... a
word spoken. The muscles of facial expression are 4 ................... in a superficial position on
the scalp, face, and 5 ................... . Although highly variable in size and 6 ................... , these
muscles all 7 ................... on the bones of the skull or in the fascia and insert 8 ...................
the skin. They are all innervated by the facial 9 .................... The locations and points of
attachments of most of the facial muscles are such that, when contracted, they cause
movements 10 ................... the eyes, nostrils, or mouth.

b. Muscles of Mastication & Ocular Muscles

both eyeball eyelid from function muscle names opposite
powerful provide
The large temporalis and masseter muscles are 1 ................... elevators of the mandible in
conjunction with the medial pterygoid muscle. The primary 2 ...................of the medial and
lateral pterygoid muscles is to 3 ................... grinding movements of the teeth. The lateral
pterygoid also protracts the mandible.
The movements of the 4 ................... are controlled by six extrinsic ocular (eye) muscles.
Five of these muscles arise 5 ................... the margin of the optic foramen at the back of the
orbital cavity and insert on the outer layer (sclera) of the eyeball. Four rectus muscles
maneuver the eyeball in the direction indicated by their 6 ................... (superior, inferior,
lateral, and medial), and two oblique muscles (superior and inferior) rotate the eyeball on
its axis. The medial rectus on one side contracts with the medial rectus of the 7 ...................
39
eye when focusing on close objects. When looking to the side, the lateral rectus of one
eyeball works with the medial rectus of the opposite eyeball to keep 8 ................... eyes
functioning together. The superior oblique muscle passes through a pulleylike cartilaginous
loop, the trochlea, before attaching to the eyeball. Another 9 ................... , the levator
palpebrae superioris, is located in the ocular region but is not attached to the eyeball. It
extends into the upper eyelid and raises the 10 ................... when contracted.

c. Muscles That Move the Tongue

contracted extrinsic highly lengths mobility nursing teeth than
toward within
The tongue is a 1 ................... specialized muscular organ that functions in speaking,
manipulating food, cleansing the 2 ..................., and swallowing. The intrinsic tongue
muscles are located 3 ................... the tongue and are responsible for its 4 ................... and
changes of shape. The extrinsic tongue muscles are those that originate on structures other 5
................... the tongue and insert onto it to cause gross tongue movement. The four paired 6
................... muscles are the genioglossus styloglossus, hyoglossus, and palatoglossus.
When the anterior portion of the genioglossus muscle is 7 ..................., the tongue is
depressed and thrust forward. If both genioglossus muscles are contracted together along
their entire 8 ..................., the superior surface of the tongue becomes transversely concave.
This muscle is extremely important to 9 ................... infants; the tongue is positioned around
the nipple with a concave groove channelled 10 ................... the pharynx.

d. Muscles of Respiration
air diaphragm downward elevation expiration inspiration intercostals
into passive relaxed rhythmically rib simultaneous thorax through
The muscles of respiration are skeletal muscles that continually contract 1 ................... ,
usually involuntarily. Breathing, or pulmonary ventilation, is divided 2 ...................two
phases: inspiration (inhalation) and expiration (exhalation). During normal, relaxed 3
..................., the contracting muscles are the diaphragm, the external intercostal muscles,
and the interchondral portion of the internal intercostal muscles. A downward contraction of
the dome-shaped 4 ................... causes a vertical increase in thoracic dimension. A 5
................... contraction of the external intercostals and the interchondral portion of the
internal intercostals produces an increase in the lateral dimension of the 6 ................... . In
addition, the sternocleidomastoid and scalene muscles may assist in inspiration through 7
................... of the first and second ribs, respectively. The intercostal muscles are innervated
by the intercostals nerves, and the diaphragm receives its stimuli 8 ................... the phrenic
nerves. Expiration is primarily a 9 ................... process, occurring as the muscles of
inspiration are 10 ................... and the rib cage recoils to its original position. During forced
expiration, the interosseous portion of the internal intercostals contracts, causing the 11
................... cage to be depressed. This portion of the internal 12 ................... lies under the
external intercostals, and its fibres are directed 13 ................... and backward. The abdominal
muscles may also contract during forced 14 ................... , which increases pressure within the
abdominal cavity and forces the diaphragm superiorly, squeezing additional 15 ...................
out of the lungs.

40
e. Muscles of the Abdominal Wall

abdominal aid fat increases oblique pairs protect

separates sheath wall

The anterolateral abdominal wall is composed of four 1 ................... of flat, sheet-like

muscles: the external abdominal oblique, internal abdominal oblique, transversus abdominis,
and rectus abdominis muscles. These muscles support and 2 ................... the organs of the
abdominal cavity and 3 ................... in breathing. When they contract, the pressure in the
abdominal cavity 4 ................... , which can aid in defecation and in stabilizing the spine
during heavy lifting. The external abdominal oblique is the strongest and most superficial
of the three layered muscles of the lateral abdominal 5 ................... . Its fibres are directed
inferiorly and medially. The internal abdominal oblique lies deep to the external abdominal
6 ................... , and its fibres are directed at right angles to those of the external abdominal
oblique. The transversus abdominis is the deepest of the 7 ................... muscles; its fibers
run horizontally across the abdomen. The long, strap-like rectus abdominis muscle is
entirely enclosed in a fibrous 8 ................... formed from the aponeuroses of the other three
abdominal muscles. The linea alba is a band of connective tissue on the midline of the
abdomen that 9 ................... the two rectus abdominis muscles. Tendinous inscriptions
transect the rectus abdominis muscles at several points, causing the abdominal region of a
well-muscled person with low body 10 ................... to appear segmented.

f. Muscles of the Pelvic Outlet

arch canal cavity constrictor diaphragm genitalia passage rectum
sex-based side
Any sheet that separates cavities may be termed a 1 ................... . The pelvic outlet—the
entire muscular wall at the bottom of the pelvic 2 ................... — contains two: the pelvic
diaphragm and the urogenital diaphragm. The urogenital diaphragm lies immediately deep
to the external 3 ...................; the pelvic diaphragm is situated closer to the internal viscera.
Together, these sheets of muscle provide support for pelvic viscera and help regulate the 4
................... of urine and feces. The pelvic diaphragm consists of the levator ani and the
coccygeus muscles. The levator ani is a thin sheet of muscle that helps to support the pelvic
viscera and constrict the lower part of the 5 ..................., pulling it forward and aiding
defecation. The deeper, fan-shaped coccygeus aids the levator ani in its functions. The
urogenital diaphragm consists of the deep, sheetlike transversus perinei muscle, and the
associated external anal sphincter muscle. The external anal sphincter is a funnel-shaped 6
................... muscle that surrounds the anal canal. Inferior to the pelvic diaphragm are the
perineal muscles, which provide the skeletal muscular support to the genitalia. They include
the bulbocavernosus, ischiocavernosus, and the superficial transversus perinei muscles. The
muscles of the pelvic diaphragm and the urogenital diaphragm are similar in the male and
female, but the perineal muscles exhibit marked 7 ................... differences. In males, the
bulbospongiosus of one 8 ...................unites with that of the opposite side to form a
muscular constriction surrounding the base of the penis. When contracted, the two muscles
constrict the urethral 9 ................... and assist in emptying the urethra. In females, these
muscles are separated by the vaginal orifice, which they constrict as they contract. The
ischiocavernosus muscle inserts onto the pubic 10 ................... and crus of the penis in the
male and the pubic arch and crus of the clitoris of the female. This muscle assists the erection
of the penis and clitoris during sexual arousal.
41
g. Muscles of the Vertebral Column
column extensor gravity lateral opposition processes sacrum
superficial support turn
The strong, complex muscles of the vertebral column are adapted to provide 1 ...................
and movement in resistance to the effect of 2 .................... The vertebral column can be
flexed, extended, hyperextended, rotated, and laterally flexed (right or left). The muscle that
flexes the vertebral 3 ................... , the rectus abdominis, has already been described as a
long, strap-like muscle of the anterior abdominal wall. The 4 ................... muscles located on
the posterior side of the vertebral column have to be stronger than the flexors because
extension (such as lifting an object) is in 5 ................... to gravity. The extensor muscles
consist of a 6 ................... group and a deep group. The erector spinae muscles constitute a
massive superficial muscle group that extends from the 7 ................... to the skull. It actually
consists of three groups of muscles: the iliocostalis, longissimus, and spinalis muscles. Each
of these groups, in 8 ................... , consists of overlapping slips of muscle. The iliocostalis is
the most 9 ................... group, the longissimus is intermediate in position, and the spinalis, in
the medial position, comes in contact with the spinous 10 ...................of the vertebrae.

Exercise C. Choose a), b) or c) to fill in the blanks.

Diseases of Muscles
Fibromyositis is an inflammation of both skeletal muscular 1 ...................and the associated
connective tissue. Its causes are not fully 2 .................... . Pain and tenderness frequently
occur in the extensor muscles of the lumbar region of the spinal column, where there are
extensive aponeuroses. Fibromyositis of this region is called lumbago or rheumatism.
Muscular dystrophy is a 3 ................... disease characterized by a gradual atrophy and
weakening of muscle tissue. There are several kinds of muscular dystrophy, none of 4
................... etiology is completely understood. The most frequent type affects children and is
sex-linked to the male child. As muscular dystrophy progresses, the muscle fibres atrophy
and are 5 ................... by adipose tissue. Most children who have muscular dystrophy die
before the age of 20.
The disease myasthenia gravis is characterized by extreme muscle 6 ................... and low
endurance. It results from a 7 ................... in the transmission of impulses at the
neuromuscular junction. Myasthenia gravis is believed to be a(n) 8 ................... disease, and it
typically affects women between the ages of 20 and 40.
Poliomyelitis (polio) is actually a(n) 9 ................... disease of the nervous system that causes
muscle paralysis. The viruses are usually localized in the anterior (ventral) horn of the spinal
cord, where they affect the motor nerve impulses to skeletal muscles. Neoplasms (abnormal
10 ................... of new tissue) are rare in muscles, but when they do occur, they are usually
malignant.
1. a) system b) tissue c) organ
2. a) understood b) perceived c) seen
3. a) genetic b) genetical c) genetics
4. a) which b) whom c) whose
5. a) renewed b) replaced c) recovered
6. a) weak b) weakness c) strength
7. a) deficiency b) deficient c) defect
8. a) autoimmune b) acquired c) accidental
9. a) genetic b) viral c) autoimmune
10.a) growths b) increase c) enlargement
42
 Grammar focus – COMPARISON OF ADJECTIVES

Comparative adjectives

• Comparatives with –er

One-syllable adjectives, and two-syllable adjectives ending in -y, generally add -er to make
the comparative form (with y changing to i). Adjectives ending in -e add only -r.
small, smaller early, earlier late, later
- Comparatives with more
Other two-syllable adjectives, and adjectives of more than two syllables, use more or less.
more/less modern more/less interesting
• Comparatives with -er or more
A small group of two-syllable adjectives have both forms. Examples are: clever, common,
narrow, polite, quiet, simple, tired. polite, politer/more polite
• Irregular comparatives Irregular comparatives are:
good, better bad, worse far, farther/further Note that further has two meanings: a normal
meaning of more far, and another meaning of just more.
How much further do we have to go? (more far)
I can't really advise you any further. (more) Old has a regular form older, and an irregular
form elder that is used as an adjective.
This is my elder sister.

Superlatives

Superlatives follow similar rules to comparatives in paragraphs 1 and 2 above.

One-syllable adjectives use (the) -est and longer adjectives use (the) most.
small, smaller, the smallest early, earlier, the earliest late, later, the latest
modern, more modern, the most modern
interesting, more interesting, the most interesting Irregular forms are:
good, the best
bad, the worst

Making comparisons

• The simplest kind of comparison uses than.

You look younger than your brother.

• Comparatives can be repeated to suggest continuing change.
This lesson seems to be getting longer and longer. Jim started feeling more and more tired.
• Comparatives can be made stronger or weaker by using these words: stronger: much far a
lot
weaker: a bit a little
This book is much/a little more expensive.
- Note this construction that repeats the word the. The faster you drive, the more petrol you
use.
• Expressions with best.
Sorry, but this is the best I can do.
I tried my best. May the best man win. (this can refer to two or more people)
43
Comparative clauses

• With than
Food here is more expensive than I thought.
• With not as/so ... as.
Being a nurse is not as interesting as being a doctor.
• With (just) as ... as.
Living in the country is just as expensive as living in London.
• With such ... as.
I've never been to such a good party as that one.
• When we compare actions we can use an auxiliary at the end of the sentence.
I can swim a lot better than Jack. OR I can swim a lot better than Jack can. You paid more
for your car than me. OR You paid more for your car than I did. Note how modals like can
are repeated, but other verbs use a form of do.

Practice
1. Put one suitable word in each space.
a) My brother is two years older than me.
b) The train takes just................................. long as the bus.
c) I thought the second hotel we stayed in was........................................... more friendly.
d) Unfortunately we are ..................................well-off than we used to be.
e) Do you think you could make a ..................................less noise?
f) These exercises seem to be getting harder and ............................................
g) Jean doesn't need as much help as Harry ....................................................
h) David didn't enjoy the match as much as I...................................................

2. Rewrite each sentence beginning as shown. Do not change the meaning.

a) Jill can run raster than Peter.

Peter can't run as fast as Jill (can).
b) I thought this journey would last longer than it did.
This journey didn't ......................................................................................
c) I didn't arrive as early as I expected.
I arrived .......................................................................................................
d) You are working too slowly.
You'll have to ..............................................................................................
e) I have a brother who is older than me.
I have an ......................................................................................................
f) Martin thought the second part of the film was more interesting.
Martin didn't think the first ..........................................................................
g) Paula's work is less careful than before.
Paula has been working ...............................................................................
h) There aren't any trains earlier than this one.
This is ..........................................................................................................
i) All other cafes are further away.
This cafe .....................................................................................................
j) Is this the best price you can offer?
Can't you ....................................................................................................

44
3. Complete each sentence with the most suitable word or phrase.
a) I really think that apologising is .....C............ you can do.
A) not as much as B) a little C) the least D) as far as
b) I can't stand this weather. It's getting.........................
A) more and more B) worse and worse C) coldest and coldest D) further and further
c) Although Brenda came last, everyone agreed she had................... her best.
A) done B) made C) had D) got
d) I wish Charles worked as hard as Mary ....................
A) did B) can C) will D) does
e) The more you water this plant, the.................. it will grow.
A) best B) tall C) wetter D) faster
f) From now on, we won't be able to go out as much as we .....................
A) were B) had C) used to D) will
g) I've never owned ......................independent cat as this one!
A) a more than B) such an C) a so D) as much an
h) Brian has been working ....................since he was promoted.
A) much harder B) as harder C) just as hardly D) more hardly
i) I've been feeling ..................tired lately, doctor.
A) such a B) the most C) more and more D) much
j) This exercise will give you ..................practice.
A) farther B) much more C) as better D) a lot

4. Put one suitable word in each space, beginning with the letter given.
a) Is William feeling any better. today?
b) Everyone ate a lot, but Chris ate the m.................
c) What's the 1....................... news about the situation in India?
d) I'd feel a lot b.................... if you let me help.
e) Graham has been sinking d..................... into debt lately.
f) It's 35 degrees today! It must be the h..................... day so far this year.
g) Only £45? Is that all? Oh well, it's b....................... than nothing.
h) He had to wait a f.............. two months before he got his promotion.
i) Ruth wore her b................. dress to her sister's wedding.
j) Harry has got over the w.............. of his cold.

Comment upon: Whoever is to acquire a competent knowledge of medicine, ought to be

possessed of the following advantages: a natural disposition; instruction; a favourable
position for the study; early tuition; love of labour; leisure. Hippocrates

45
46
47
 7. THE DIGESTIVE SYSTEM

Pre-reading
1. Describe the activities of the digestive system and distinguish between digestion and
absorption.
2. Identify the major structures and regions of the digestive system.
3. Define the terms viscera and gut.

Exercise A. Fill in the blanks with the correct derivative or root word.

Food is 1 .................... (NECESSITY) to sustain life. It provides the 2 ....................

(ESSENCE) nutrients the body cannot produce for itself. The food is utilized at the 3
.................... (CELL) level, where nutrients are required for chemical 4 ....................
(REACT) involving synthesis of enzymes, cellular 5 .................... (DIVIDE) and growth,
repair, and the production of heat energy. Most of the food we eat, however, is not suitable
for cellular utilization until it is mechanically and chemically reduced to forms that can be
absorbed through the 6 .................... (INTESTINE) wall and transported to the cells by the
blood. Ingested food is not technically inside the body until it is absorbed; and, in fact, a large
portion of this food remains 7 .................... (DIGEST) and passes through the body as waste
material. The principal function of the digestive system is to prepare food for cellular
utilization. This involves the following 8 .................... (FUNCTION) activities:
• Ingestion—the taking of food into the mouth
• Mastication—chewing 9 .................... (MOVE) to pulverize food and mix it with saliva
• Deglutition—the swallowing of food to move it from the mouth to the pharynx and into the
esophagus
• Digestion—the mechanical and chemical breakdown of food material to prepare it for 10
.................... (ABSORB)
• Absorption—the passage of molecules of food through the mucous membrane of the small
intestine and into the blood or lymph for 11 .................... (DISTRIBUTE) to cells
• Peristalsis—rhythmic, wavelike intestinal contractions that move food through the
gastrointestinal tract
• Defecation—the discharge of indigestible wastes, called feces, from the gastrointestinal
tract. 12 .................... (ANATOMY) and functionally, the digestive system can be divided
into a tubular gastrointestinal tract (GI tract), or digestive tract, and accessory digestive
organs. The GI tract, which extends from the mouth to the anus, is a continuous tube
approximately 9 m (30 ft) long. It traverses the 13 .................... (THORAX) cavity and enters
the abdominal cavity at the level of the diaphragm. The organs of the GI tract include the oral
cavity, pharynx, esophagus, stomach, small intestine, and large intestine. The accessory
digestive organs include the teeth, tongue, salivary glands, liver, gallbladder, and
pancreas. The term viscera is frequently used to refer to the 14 .................... (ABDOMEN)
organs of digestion, but actually viscera can be any of the organs (lungs, stomach, spleen,
etc.) of the thoracic and abdominal cavities.
Gut is an anatomical term that generally refers to the developing stomach and intestines in
the embryo. It usually takes about 24 to 48 hours for food to travel the length of the GI tract.
Food ingested through the mouth passes in assembly-line fashion through the tract, where
complex molecules are 15 .................... (PROGRESS) broken down. Each region of the GI
tract has specific functions in preparing food for utilization
48
Knowledge Check
1. Which functional activities of the digestive system break down food? Which functional
activities move the food through the GI tract? Where does absorption take place?
2. List in order the regions of the GI tract through which ingested food passes from the mouth
to the anus.
3. List organs of the GI tract and the accessory digestive organs.

Exercise B. Fill in the blanks with one suitable word.

a. Cheeks, Lips, and Palate

The cheeks form the lateral walls of the oral 1 .................... . They consist of outer layers of
skin, subcutaneous fat, facial muscles that assist 2 .................... manipulating food in the oral
cavity, and inner linings of moistened stratified squamous epithelium. The anterior portion of
the cheeks terminates in the superior and inferior lips that surround the oral orifice. The lips
are fleshy, highly mobile organs 3 .................... principal function in humans is associated 4
.................... speech. Lips also serve for suckling, manipulating food, and keeping food 5
.................... the upper and lower teeth. Each lip is attached from its inner surface to the gum
by a midline fold of mucous membrane 6 .................... the labial frenulum. The lips are
formed from the orbicularis oris muscle and associated connective tissue, and are covered
with soft, pliable 7 ..................... Between the outer skin and the mucous membrane of the
oral cavity is a transition zone called the vermilion. Lips are red to reddish brown because of
blood vessels close 8 .................... the surface. The numerous sensory receptors in the lips aid
in determining the temperature and texture of food. The palate, which forms the roof of the
oral cavity, consists of the bony hard palate 9 .................... and the soft palate posteriorly. The
hard palate, formed 10 .................... the palatine processes of the maxillae and the horizontal
plates of the palatine bones, is covered with a mucous membrane.

b. Transverse palatine folds, or palatal rugae, are located 1 .................... the mucous
membrane of the hard palate. These structures serve 2 .................... friction ridges against
which the tongue is placed 3 .................... swallowing. The soft palate is a muscular arch
covered 4 .................... mucous membrane and is continuous with the hard palate anteriorly.
Suspended 5 .................... the middle lower border of the soft palate is a cone-shaped
projection called the palatine uvula. During swallowing, the soft palate and palatine uvula
are drawn 6 ...................., closing the nasopharynx and preventing food and fluid from
entering the nasal cavity. Two muscular folds extend downward from 7 .................... sides of
the base 8 .................... the palatine uvula. The anterior 9 .................... is called the
glossopalatine arch, and the posterior fold is the pharyngopalatine arch. Between these
two 10 .................... is the palatine tonsil.

c. Tongue
As a digestive organ, the tongue functions to move food 1 .................... in the mouth during
mastication and to assist 2 .................... swallowing food. It is also essential in producing
speech. The tongue is a mass of skeletal muscle covered 3 .................... a mucous membrane.
Extrinsic tongue muscles (those that insert upon the tongue) move the tongue from side to
side and in and 4 .................... . Only the anterior two thirds of the tongue lies in the oral
cavity; the remaining one 5 .................... lies in the pharynx and is attached to the hyoid bone.
Rounded masses of lingual tonsils are located on the superior surface of the base of the
tongue. The inferior surface of the tongue is connected along the midline anteriorly 6
49
.................... the floor of the mouth by the vertically positioned lingual frenulum papillae.
The papillae give the tongue a distinct roughened surface that aids the handling of food.
Some of 7 .................... also contain taste buds that respond to sweet, salty, sour, and bitter
chemical stimuli. Three types of papillae are present 8 .................... the surface of the tongue:
filiform, fungiform, and vallate. Filiform papillae are sensitive to touch, have tapered tips,
and are by 9 .................... the most numerous. These papillae lack taste buds and are not
involved in the perception of taste. The larger, rounded fungiform fungiform papillae are
scattered 10 .................... the filiform type. The few vallate papillae are arranged in a V shape
on the posterior surface of the tongue.

d. Teeth
Humans and other 1 .................... have heterodont dentition. This means that they have
various types of teeth that are adapted 2 .................... handle food in particular ways. The
four pairs (upper and lower jaws) of anterior most teeth are the incisors. The chisel-shaped
incisors are adapted 3 .................... cutting and shearing food. The two pairs of cone-shaped
canines (cuspids) are located at the anterior corners of the 4 ....................; they are adapted
for holding and tearing. Incisors and canines are further characterized 5 .................... a single
root on each tooth. Located 6 .................... the canines are the premolars (bicuspids), and
molars. These teeth have two or three roots and somewhat rounded, irregular surfaces called
dental cusps for crushing and grinding food. The buccal surface of the premolars and
molars is adjacent 7 .................... the cheek. The labial surface of the incisors and canines is
adjacent to the lip. The lingual surface of all teeth is adjacent to the tongue. Humans are
diphyodont; that is, normally two sets of teeth develop in a person‘s lifetime. Twenty
deciduous (milk) teeth begin to erupt at about 6 months of 8 ...................., beginning with
the incisors. All of the deciduous teeth normally erupt by the age of 2 1/2. Thirty-two
permanent teeth replace the deciduous teeth in a predictable sequence. This process begins
at about age 6 and continues until about age 17. The third molars (―wisdom teeth‖) are the 9
.................... to erupt. There may not be room in the jaw to accommodate the wisdom teeth,
however, in which case they may grow 10 .................... and become impacted, or emerge
only partially. If they do erupt at all, it is usually between the ages of 17 and 25. Presumably,
a person has acquired some wisdom by then—hence, the popular name for the third molars.

e. Esophagus
The esophagus is that portion of the GI 1 .................... that connects the pharynx to the
stomach. It is a collapsible tubular organ, approximately 25 cm (10 in.) long, originating 2
.................... the larynx and lying posterior 3 .................... the trachea. The esophagus is
located within the mediastinum of the thorax and passes 4 .................... the diaphragm just
above the opening into the stomach. The opening through the diaphragm is called the
esophageal hiatus. The esophagus is lined 5 .................... a nonkeratinized stratified
squamous epithelium; its walls contain either skeletal or smooth muscle, depending on the
location. The upper third of the esophagus contains skeletal muscle; the middle third, a
combination 6 .................... skeletal and smooth muscle; and the terminal portion, smooth
muscle only. The lower esophageal (gastroesophageal) sphincter is a slight thickening of
the circular muscle fibres 7 .................... the junction of the esophagus and the stomach. After
food or fluid pass 8 .................... the stomach, this sphincter constricts to prevent the stomach
contents 9 .................... regurgitating into the esophagus. There is a normal tendency for this
to occur because the thoracic pressure is lower than the abdominal pressure 10 .................... a
result of the air-filled lungs.

50
Exercise C. Read the text and then answer the questions

The stomach—the most distensible part of the GI tract—is located in the upper left
abdominal quadrant, immediately below the diaphragm. Typically J-shaped when empty, the
stomach is continuous with the esophagus superiorly and empties into the duodenal portion of
the small intestine inferiorly. In the stomach, which serves as a ―holding organ‖ for ingested
food, the food is mechanically churned with gastric secretions to form a pasty material called
chyme. Once formed, chyme is moved from the stomach to the small intestine. The stomach
is divided into four regions: the cardia, fundus, body, and pylorus. The cardia is the narrow
upper region immediately below the lower esophageal sphincter. The fundus is the dome-
shaped portion to the left of and in direct contact with the diaphragm. The body is the large
central portion, and the pylorus is the funnel-shaped terminal portion.
The pyloric sphincter is the modified circular muscle at the end of the pylorus, where it joins
the small intestine. Pylorus is a Greek word meaning ―gatekeeper,‖ and this junction is just
that, regulating the movement of chyme into the small intestine and prohibiting backflow.
The stomach has two surfaces and two borders. The broadly rounded surfaces are referred to
as the anterior and posterior surfaces. The medial concave border is the lesser curvature,
and the lateral convex border is the greater curvature. The lesser omentum extends between
the lesser curvature and the liver, and the greater omentum is attached to the greater
curvature. The wall of the stomach is composed of the same four tunics found in other
regions of the GI tract, with two principal modifications: (1) an extra oblique muscle layer is
present in the muscularis, and (2) the mucosa is thrown into numerous longitudinal folds,
called gastric folds or gastric rugae, which permit stomach distension. The mucosa is further
characterized by the presence of microscopic gastric pits and gastric glands. There are five
types of cells in the gastric glands that secrete specific products.
• Goblet cells secrete protective mucus.
• Parietal cells secrete hydrochloric acid (HCl).
• Principal cells (chief cells) secrete pepsinogen, an inactive form of the protein-digesting
enzyme pepsin.

1. Where is the stomach located?

2. What shape does it have?
3. What is the cardia?
4. What is the pyloric sphincter?
5. What is the role of the pyloric sphincter?
6. What is the wall of the stomach composed of?
7. What types of cells are there in the gastric cells?

Exercise D. Choose the suitable word from the word-box

Problems of the Digestive System

a.
abnormality both common disorders during normal occur
opening size surgery
Most of the congenital 1 ....................of the digestive system develop 2 ....................the fourth
or fifth week of embryonic life. A cleft palate is a congenital 3 .................... between the oral
and nasal cavities; therefore, it involves 4 ....................the digestive and respiratory systems.
51
Esophageal atresia, or failure to develop the 5 .................... structure of the esophageal-
stomach area, is another disorder of the upper GI tract that requires 6 .................... to correct.
Pyloric stenosis is a common 7 .................... in which the pyloric sphincter muscle is
hypertrophied, reducing the 8 .................... of the lumen. This condition affects
approximately 1 in 200 newborn males and 1 in 1,000 newborn females. Stenoses, atresias,
and malrotations of various portions of the GI tract may 9 .................... as the gut develops.
Umbilical problems involving the GI tract are fairly 10 .................... , as is some form of
imperforate anus, which occurs in about 1 in 5,000 births.

b.
affect bacterium blood canning caused ingested invades
mucosa pathogenic toxins
Dysentery is an inflammation of the intestinal 1 ...................., characterized by frequent loose
stools containing mucus, pus, and 2 .................... . The most common dysentery is amoebic
dysentery, which is 3 .................... by the protozoan Entamoeba histolytica. Cysts from this
organism are 4 .................... in contaminated food, and after the protective coat is removed by
HCl in the stomach, the vegetative form 5 .................... the mucosal walls of the ileum and
colon.
Food poisoning is caused by consuming the 6 .................... produced by pathogenic bacteria.
Salmonella is a bacterium that commonly infects food. Botulism, the most serious type of
food poisoning, is caused by ingesting food contaminated with the toxin produced by the 7
.................... Clostridium botulinum. This organism is widely distributed in nature, and the
spores it produces are frequently found on food being processed by 8 .................... . For this
reason, food must be heated to 120° C (248° F) before it is canned. It is the toxins produced
by the bacterium growing in the food that are 9 ...................., rather than the organisms
themselves. The poison is a neurotoxin that is readily absorbed into the blood, at which point
it can 10 .................... the nervous system.

c. Disorders of the Liver

abnormally agents compromised destroyed diseases fibrous high
improperly indicative itself may regenerate result through
unusually
The liver is a remarkable organ that has the ability to 1 .................... even if up to 80% has
been removed. The most serious 2 .................... of the liver (hepatitis, cirrhosis, and
hepatomas) affect the liver throughout, so that it cannot repair 3 .................... . Hepatitis is
inflammation of the liver. Certain chemicals 4 .................... cause hepatitis, but generally it is
caused by infectious viral 5 .................... . Hepatitis A (infectious hepatitis) is a viral disease
transmitted 6 .................... contaminated foods and liquids. Hepatitis B (serum hepatitis) is
also caused by a virus and is transmitted in blood plasma during transfusions or by 7
.................... sterilized needles and syringes. Other types of viral hepatitis are designated as
hepatitis C, D, E, and G. In cirrhosis the liver becomes infused with 8 .................... tissue.
This causes the liver tissue to break down and become filled with fat. Eventually, all
functions of the liver are 9 .................... . Jaundice is a yellow staining of the tissues
produced by 10 .................... blood concentrations of either free or conjugated bilirubin.
Because free bilirubin is derived from hemoglobin, 11 .................... high concentrations of
this pigment may result from an 12 .................... high rate of red blood cell destruction. This
52
can occur, for example, as a 13 ....................of Rh disease (erythroblastosis fetalis) in an Rh
positive baby born to a sensitized Rh negative mother. Jaundice may also occur in healthy
infants, because excess red blood cells are normally 14 ....................at about the time of birth.
This condition is called physiological jaundice of the newborn and is not 15 .................... of
disease. Premature infants may also develop jaundice due to inadequate amounts of hepatic
enzymes necessary to conjugate bilirubin and excrete it in the bile. In adults, jaundice is
commonly exhibited when the excretion of bile is blocked by gallstones.

Exercise E. Give nouns related to the following words and use them in sentences of your
own:
 abnormal - ..................................................
 defective - ...................................................
 develop - ..................................................
 dissolve - ..................................................
 erupt - ...................................................
 mineralise - ...................................................
 mobile - ...................................................
 obliterate - ...................................................
 occlude - ...................................................
 regurgitate - ...................................................

Grammar focus – ADVERBS

Study these sentences from the reading passage. The words in bold are adverbs. Say which
words they describe.
It is caused by poorly mineralised dentine. A new deposit of dentine is formed around the
wall of the pulp cavity after the tooth has been completely formed.

 Adverbs usually qualify or modify verbs, adjectives, other adverbs or whole

sentences. Adverbs tell us how (adverbs of manner), when (adverbs of time), where
(adverbs of place), how often (adverbs of frequency), how much (adverbs of degree)
something happens.
 Their position in a sentence is elastic, however, they often come after the word they
modify. Most adverbs of manner are formed by adding –ly to the adjective: regular –
regularly, slow – slowly. However, some adverbs have the same form as the
adjectives: early, fast. Adjectives ending in –ly (friendly, motherly, lonely) form their
adverbs by adding he word way/manner/fashion, etc 9She behaved in a friendly way).

Exercise F. Put the words in brackets in the correct form (some adverbs have the same form
as adjectives):
1. This anaesthetic acts ......................... (local) on the oral mucosa.
2. When I noticed some abnormality with my tooth, I went ................................. (direct)
to my dentist.
3. The dentist said, ‗Open your mouth ......................................... (wide).‘
4. No matter how .......................................... (hard) she tries, she always fails.
5. You have to follow the dentist‘s instructions .................................... (exact).
6. Mark pays the rent for his flat .............................................. (month), but I have to pay
it .......................... (week).
53
 7. All his exams were ................................... (high) assessed by his teachers.
8. I‘m afraid I did .................................(bad) in the last test in anatomy.
9. You shouldn‘t drive ......................................(fast) if you don‘t want to get a speeding
ticket.
10. He lives ..........................................(near) the university, but he is always
........................ (late) for lectures.
11. This dental treatment is very expensive. It costs ................................... (near) £100.
12. Have you had your dental check-up .............................................. (late)?

Comment upon: Medicine is of all the Arts the most noble; but, owing to the ignorance of
those who practice it, and of those who, inconsiderately, form a judgment of them, it is at
present far behind all the other arts. Hippocrates

54
55
56