Massive Physiology Set

Treatment of fracture

A force that causes a serious breakage in the bone may also cause other damage in the body, therefore a full body examination is required. Prevent blood loss Check ABCs (Airway, breathing, circulation) Treat patient with pain relief Treat fracture with Nothing, Plaster of Paris Splint (to keep bone in place and prevent pain), Surgery. Bones will heal naturally on their own like a cut in the skin (if they are in place) TREATMENT ISN'T TO QUICKEN HEALING BUT TO PREVENT PAIN

Lubricant composition in joints

A low friction layer - lubricin Lubricant is made by the synovial fluid on the surface of the articular cartilage

Shock

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.

how to break a bone

Applying a bending force Applying Pulling force Applying Pushing force Applying Twisting force Bash it with a mallet - In order to break a bone you must apply force, the directionality of the force results in a different type of break.

Which one of the following is the predominant cause of a low blood pressure in neurogenic shock? A. Movement of fluid into the cells B. Movement of fluid into the vascular space C. Increased sympathetic nervous system activity D. Polyuria E. Reduced sympathetic nervous system activity

E. Reduced sympathetic nervous system activity

Which of the following is an inherited disorder of bone characterised with dense bone and increased fracture risk? A. Osteoarthritis B. Osteoporosis C. Osteomalacia D. Rickets E. Osteopetrosis

E. Osteopetrosis

Which of the following are acceptable methods of fracture treatment? A. skin traction B. plaster of Paris C. internal fixation D. external fixator E. all of the above

E. all of the above

Primary sclerosing cholangitis

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts that presents with obstructive jaundice 80% have associated IBD increased risk for cancer (by 10%)

how to increase vascular resistance

Lie down if airway OK Legs up IV Fluids Adrenaline (Epinephrine

Ligaments and tendon structural differences

Ligaments: - low % of collagen - higher % of ground substance - random organisation - weaving pattern orientation Tendons - high % of collagen - lower % of ground substance - organised - long axis direction orientation

Correction of hypovolaemia

Mainstay with be initially Intravenous IV fluids and then blood

Structure of smooth muscle

Uni nucleated Actin and myosin No troponin Peristalsis

Colonoscopy

Visualisation mucosa Diagnosis and monitoring of pathology Histology / Therapeutic Day case Sedation Bowel preparation

Osteomalacia causes

Vitamin D deficiency (Required for Calcium absorption) Calcium Deficiency Phosphate deficiency

Functional balance training:

Weight bearing activities Target core muscles of abdomen and back Core strength and balance

Blood pressure =

cardiac output x systemic resistance

Enchondral ossification

cartilaginous model of most bone formation

Colloid fluids

fluids contain large protein &/or starch molecules, stay in intravascular spaces

intramembranous ossification

formation of skull

FFP

fresh frozen plasma (contains clotting factors)

GORD

gastro-oesophageal reflux disease

GERD

gastroesophageal reflux disease

Cardiac Output =

heart rate x stroke volume

hypertension

high blood pressure 140/90

Bone Classification

location and shape long, short, flat, irregular

Gastric Ulcers

peptic ulcers that occur in the stomach cause by Heliobacteria Pylori

left hemiplegia

paralysis of the left side of the body due to injury on the right hemisphere

Shock decompensation

past the compensation threshold low blood pressure

ischemic

pertaining to a lack of blood flow

Primary biliary cholangitis

previously called primary biliary cirrhosis, is a chronic disease in which the bile ducts in your liver are slowly destroyed.

renal insufficiency

reduced ability of the kidney to perform its functions (reduced blood flow to kidney)

Idiopathic

relating to or denoting any disease or condition which arises spontaneously or for which the cause is unknown.

parasympathetic response

rest and digest

muscle fibre enclosed by a plasma membrane

sarcolemma

muscle support element

sarcolemma covering

cytoplasm of a muscle fibre

sarcoplasm

Bile Acids

steroids synthesized from cholesterol Bile acids are amphipathic and enable emulsification

accessory organs

teeth, tongue, salivary glands, liver, gallbladder, pancreas

Tendon Injuries

tendinitis, tendinosis, insertional, rupture

Shock - compensation

(trying to reach a normal state)

Ileocolic valve

junction of small intestine and large intestine One way valve Shuts by increase in caecal pressure Resists backflow by 50-60cm H2O

Treatment of GERD

lifestyle and dietary modifications, along with antacids and certain prescription drugs.

internal anal sphincter

smooth muscle, involuntary

How to dampen immune response in anaphylactic

Antihistamine Steroids

main proteins of muscle fibre

actin (Thin, Z-line) myosin (Thick, M-line)

Fluids that promote clotting

Calcium Tranexamic Acid FFP Platelets Cryoprecipitate

Leading cause of osteoarthritis

- Idiopathic (relating to or denoting any disease or condition which arises spontaneously or for which the cause is unknown.)

muscle contusions

(Bruise) caused by a fall or severe blow; blood vessels may break causing discoloration and pain

Roll of Calcium in Muscle Contraction

- A motor neuron releases acetylcholine (ACh) - ACh binds to receptors on the sarcolemma - The action potential triggers release of Ca2+ - Ca2+ binds with troponin which reveals tropomyosin binding sites on actin for myosin binding - Sliding of myosin and actin over each other causing contraction

Aims of anaphylaxis treatment

- Acutely and Life Saving - try to compensate for drop in vascular resistance and therefore blood pressure, treat bronchospasm. - Compensate for the fluid shifts. Massive fluid shifts occur during anaphylaxis due to increased vascular permeability. Up to 35 percent of intravascular volume can shift to the extravascular space within 10 minutes during anaphylaxis - Dampen down allergic response

Stroke, clinical Investigation

- Cardiac ECG/24 hour Holter ECHO CXR - Brain CT/MRI - Vessels Doppler's - Blood tests ESR, CRP, Glucose

What are bones made of?

- Cells, - Organic matrix, - Inorganic matrix

Isotonic contraction

- Change in muscle length - Movement of body part - Dynamic Strength endurance

Symptoms of osteoarthritis

- Change in surface - Increased tissue swelling - Change in colour - Cartilage fibrillation - Cartilage erosion down to subchondral bone - Cysts - Net loss of matrix components and decreased tensile strength - fibrils become more disorganised and thinner (collagen stays constant)

Types of Bone Disorders:

- Congenital: Osteogenesis imperfecta - Metabolic : osteoporosis/osteomalacia - Fracture - Infective: Osteomeyelitis/Paget's disease

Osteoarthritis Treatment (surgical):

- Correction of deformity (osteomy) Re-set the shape the bone to offload the joint - Joint fusion - permanent stiffening (arthrodesis)

Functions of Articular Cartilage

- Designed to facilitate the transmission of load across a joint - Reducing friction (friction is a force, allows for reducing the frictional force, less energy expenditure for overcoming frictional force) - Aids joint lubrication

Muscle contraction theories

- Excitation-Contraction Couple - All or none response - Sliding filament theory

Lubrication of Articular Cartilage

- Fluid film lubrication - Bearing surfaces never come into contact because of the fluid film

All of none response

- For a motor unit to be recruited into activity motor nerve impulse must meet or exceed the threshold -When this occurs, all muscle fibers in the motor unit acts maximally -If the threshold is not met, no fibers in that unit act -More force is produced by activating more motor units

cancellous/trabecular bone

- Function: RBC production - The softer spongy bone that makes up the bulk of the inside portion of most bones. The cells of trabecular bone vary in size and density.

compact (cortical) bone

- Function: Strength and stiffness - hard, dense bone tissue, usually found around the outer portion of bones - makes up 80% of bone mass - Osteon/Harversian system

Bone structure

- Hard outer layer (compact/cortical) - Inner spongey layer (cancellous / trabecular)

Sepsis Treatment:

- High flow oxygen to help oxygen delivery - Blood cultures to identify bacteria and give specific antibiotics in future - Give broad IV antibiotics almost immediately to eradicate bacteria - Give fluids as patient is likely to not be eating and drinking properly - blood pressure go up and HR go down - Measure lactate gives parameters of how stressed the individuals body is and which ward patients' needs to be - Measure urine output - get patient to pee in a tube or use catheter

Fracture diagnosis

- History Injury - Clinical Pain Swelling (Bones are filled with blood, if broken, released blood will cause swelling) Deformity Open - Scans X-ray MRI CT Nuclear Scan

Liver disease

- Liver disease makes up a third of mortality in the uk - Many deaths are in people in working age 18-65 - 3/4 of death are from alcohol - Non-alcohol fatty disease is likely to become the second most common - Viral hepatitis (A,B and C) - Autoimmune liver disease - diagnosis is challenging, and less developed treatments

Liver and Haematopoiesis

- Liver is primary site of rbc formation in foetuses - In adults haematopoiesis occurs in bone marrow, but if there is a bone marrow dysfunction, liver is also affected.

Liver anatomy

- Liver sits under the ribcage, underneath the diaphragm, next to the stomach - Divided into 8 section - Hepatoportal triad Portal vein, - hepatic artery - Bile duct - Gall bladder

structure of articular cartilage

- Made up of hyaline cartilage - Avascular (no blood vessels) - Aneural (no nerves) - Alymphatic (no attachment to the lymphatic system)

Chondrocytes

- Mesenchymal stem cells - Responsible for maintaining ECM (matrix) - Shape, number, size depends on region of articular cartilage - Cells cannot talk or communicate to each other due to being Avascular, - Aneuroal and Alymphatic - Are unable to differentiate

Osteoarthritis Treatment (non-surgical):

- Non-surgical Pain reliver (paracetamol) - eventually stop working) - Weight loss - to reduce load on joints - Regular exercise - make muscles stronger and more resistance - Walking aids - Inject local anaesthetic to the joint

response to sepsis

- Normal blood volume - Distribution of blood is altered (leaks or ruptures) - Insufficient flow for aerobic metabolism - Immune response - cytokine release- pro-inflammatory release Continued Activation of PMNs and macrophages for bacterial clearance and tissue repair

Cardiac Muscles

- Only found in heart - Striatied - Involuntary - Usually mono-nucleated but sometimes more - Heart muscle cells behave as a single unit adjacent cardiac cells are joined via electrical synapses (gap junctions) junctions appear as dark lines called intercalated discs

Neurogenic Shock

- Parasympathetic and Sympathetic Nervous System help regular blood pressure and heart function - Dysfunction between the Parasympathetic and Sympathetic system can result in CHAOS - Spinal injuries can be fixed, however it is unlikely the spine will repair, but it prevents further damage being done.

Bone Mass Physiology:

- Peak bone mass at 28y - Then the bone mass is maintained for the next decade (until 40y) - After 40y the bone mass declines - For women, bone mass reaches the fracture threshold at 60y

symptoms of endometriosis

- Pelvic pain - Infertility - Bleeding of ectopic endometrium, causing pooling of blood - Adhesions of internal organs - dark chocolate cysts - scar tissue - can affect, kidney bowels and uterus

Management of osteoporosis

- Pharmacologic: Calcium and Vitamin D supplementation Bisphosphonates Teriparatide Strontium Ranelate Denosumab - Non- Pharmacologic: Diet Exercise Alcohol and Smoking Preventing Falls - Most important Eyes/lighting/walking aids/banister/carpets

Secondary causes of osteoarthritis

- Post traumatic - if becomes damaged it does not repair well - Inflammatory - synovium produces a lot of fluid during inflammation, also leaks cells, cells that shouldn't be there - Infection - some pathogens infect joints of infection of bone can transfer into the joints

proteoglycans in articular cartilage

- Proteins and sugar - Aggregate to make large macromolecules - Sugars have a -ve charge which makes the hydrophilic - This allows them to trap water - Molecule to stiffen - Use water to prevent compression

Types of Atrial Fibrillation

- Regularly regular - Regularly irregular - Irregularly irregular - atrial fibrillation

Types of muscles

- Skeletal muscle (Striated) (voluntary muscles - the muscles that you can move) - Smooth Muscles (Not striated) (not voluntary muscle s- found in the vascular system) - Cardiac Muscles

Intra-membranous ossification

- Skull and collar bone and some clavicle bones - growth plates - Produces spongy bone. This bone may subsequently be remodelled to form compact bone.

muscle strains

- Stretch, tear or rip to muscle or adjacent tissue - mostly from eccentric contractions

Protein Metabolism by Liver

- Synthesis of non-essential amino acids - albumin - Mop -up reactive oxygen species and - Metabolism of amino acids to lipids or glucose - Converting ammonia (toxic) into glutamine or glutamate. - remove toxic ammonia

Differential diagnosis of stroke

- TIA - Hypoglycaemia - Seizure (Post Seizure effect) - Todd's paresis - Functional (Patients lie)- - Focal structural lesions

Heart Burn

- The first symptom of gastroesophageal reflux disease (GERD), is the burning, radiating substernal pain that occurs when stomach acid regurgitates into the oesophagus. - Heartburn is most likely when a person has eaten or drunk to excess, and in conditions that force abdominal contents superiorly, such as extreme obesity, pregnancy, and running, which splashes stomach contents upward with each step.

Liver functions

- The metabolism of fats, proteins, and carbohydrates. - Excretion of bilirubin, cholesterol, hormones, and drugs. -Enzyme activation. - Storage of glycogen, vitamins, and minerals. - Synthesis of plasma proteins, such as albumin, and clotting factors. Blood detoxification and purification. - Bile production and secretion.

Water in articular cartilage

- The water exists as a gel - Provides resistance to compression - Flows through cartilage and across articular surface - Aids lubrications - Provides nutrition to chondrocytes - Synovial fluid provides articular cartilage with nourishment

Collagen in articular cartilage

- Type II collagen (90%) - Most abundant structural macromolecule in the ECM - Changes orientation (ta - Collagen is a triple helix - Responsible for mechanical maintenance

composition of articular composition

- Water (60-80%) - Chondrocytes (lazy cells) (10%) - Mesenchymal stem cells - Type II collagen matrix (10-30%) and proteoglycans (protein-sugar molecules) (3-10%)

What is bile

- a bitter greenish-brown alkaline fluid that aids digestion and is secreted by the liver and stored in the gallbladder. - Fat Emulsifier

What is the pancreas?

- a large gland behind the stomach that secretes digestive enzymes into the duodenum - enzymes digest chyme - bicarbonates neutralise stomach acid

anisotropic

- bone is strongest when it is vertical (only 50% as strong when horizontal)

Functions of tendons and ligaments

- coordinate the movement of the joint. - prevent movement in the wrong direction

Gall Stones

- copper-sulfate crystals (cholesterol) But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.

Crystalloid fluids

- fluids clear as particles are dissolved in the solution, solutions can be electrolytes, glucose, or combinations of both, may be administered through peripheral vein or central vein (PICC; CVC, implantable port) - 3 types: isotonic, hypotonic, hypertonic

Cardiovascular support - mechanical heart function

- pacemaker devices

Airway support (invasive)

-Input tube into patient under anaesthetic, -Replace breathing tube with a tracheostomy - a tube at the front of the neck -Ventilator - allows for pressure and oxygen levels to be depicted - lots of data and information about patient progress. -Work in reverse until patient can breathe alone again

Pelvic floor

-The muscular base of the abdomen attached to the pelvis. -muscles that keep the rectum in place -rich efferent and afferent nerve supply - supports pelvic organs

Diagnosis of endometriosis

-based on symptoms and physical exam -can also be established through laparoscopy -Often takes 7.5 year for diagnosis

Function of the pelvic floor

-support pelvic organs -resist increases in abdominopelvic pressure -voluntary control of urination and defecation - sexual functions

Ways to manage GORD

-weight loss - Diet changes (low fat diet= gastric emptying) - Changing sleeping position (more upright) - antacids - decrease acid secretion (proton pump inhibitors) - follow up with patients

Sub-structures of the musculoskeletal system

1 Bone 2. Muscle 3. Tendons 4. Ligament 5. Cartilage 6. Fascia 7. Joints

Functions of the musculoskeletal system

1) provide support 2) protection of organs 3) mobility to carry out activities 4) RBC production 5) storage of minerals 6) sound transmission and hearing

The gastro-hepatic system:

1. CCK and Secretin are secreted by the duodenal enteroendocrine cells 2. Pancreatic secretions 3. Bile secretion by liver 4. Gall Bladder Contraction 5. Hepatopancreatic sphincter relaxation

Q 4 Which of the following statements regarding the bone are correct? (3) A The shaft of a long bone is called the diaphysis. (ends at joints are called epiphysis) B The organic matrix of bone is secreted by chondroblasts. C Most bones are formed by endochondral ossification of a hyaline cartilage model. D Bone remodeling is a function of the activity of osteoblasts and osteoclasts E The long bones develop from fibrous connective tissue:intra-membranous ossification

A The shaft of a long bone is called the diaphysis. (ends at joints are called epiphysis) C Most bones are formed by endochondral ossification of a hyaline cartilage model. D Bone remodeling is a function of the activity of osteoblasts and osteoclasts

Which of the following statements about Aspirin is true? A. Aspirin may cause intracerebral haemorrhage B. Aspirin is mainly a COX-2 inhibitor C. Aspirin activates thromboxane D. Aspirin can be used in treatment of peptic ulcers E. Aspirin is commonly used in primary prevention of stroke

A. Aspirin may cause intracerebral haemorrhage

Which of the following may help in the diagnosis of gastro-oesophageal reflux disease? A. Bravo capsule B. Endo-oesophageal ultrasound C. Hydrogen breath test D. Gastric emptying studies E. SeHCAT study

A. Bravo capsule

Which factor is NOT associated with the development of gastric cancer? A. IL-1 beta/NAT-1 genes B. FAP (APC gene) C. Chronic Helicobacter pylorus infection D. Iron deficiency anaemia E. Low socio-economic class

A. Iron deficiency anaemia

Risk factors for stroke include: A. Low HDL levels B. Low cholesterol C. Low blood pressure D. Low BMI E. Low height

A. Low HDL levels

Which acid-base balance is most commonly associated with shock? A. Metabolic Acidosis B. Neutral pH C. Metabolic Alkalosis D. Respiratory Acidosis E. Respiratory Alkalosis

A. Metabolic Acidosis

Acute osteomyelitis is most commonly caused by: A. Staphylococcus aureus B. MRSA C. Escherichia coli D. Pseudomonas E. Mycobacterium tuberculosis

A. Staphylococcus aureus

A 75 year old female is sent for a colonoscopy to investigate recurrent diarrhoea. Which of the following is true? A. The terminal ileum can be visualised B. It is risk free C. It requires no bowel preparation D. It has no therapeutic value E. Pre oxygen is used to insufflate the colon

A. The terminal ileum can be visualised

Warfrin

Anticoagulant, very small therapeutic range

type 2 primary osteoporosis

Age-associated osteoporosis (senile) Affects everyone Systemic Senescence Loss of stem precursors Bone loss due to cortical bone Abnormal T score

Albumin

Albumin is a large plasma protein Needed to make clotting factors

ischemic penumbra

An area of tissue within the brain surrounding the ischemic core that has lost the appropriate level of blood supply to function but that is still receiving enough collateral blood flow from other vessels to stay alive.

Anaphylaxis

Anaphylaxis is an acute, severe, life-threatening allergic reaction in pre-sensitised individuals, leading to a systemic response caused by the release of immune and inflammatory mediators from basophils and mast cells.

slow twitch muscles

Are good for endurance activities like long distance running or cycling

Tissue injury and sepsis

Bacteria excretes endotoxins Endotoxins Cause disruption to the vascular tree and capillaries Disruption of the capillary walls Inflammation of capillary lining Disruption of tight junctions between cells Bacteria can invade tissues through these disruptions Tissue infections Cytokine release and immune recruitment Inflammatory reactions to neutralise the endotoxin and bacteria

Q 5 What canals join bone cells to the central canal? A Lacunae B Canaliculi C Haversian D Volksmans E Tubular

B Canaliculi (connect osteocyte to bone)

Which of the following is NOT a feature of the Systemic Inflammatory Response Syndrome (SIRS)? A. Temperature B. Blood pressure C. White Cell Count D. Respiratory rate E. Heart rate

B. Blood pressure

Which of the following investigations is commonly used for imaging the brain? A. PET scan B. CT angiogram C. X-ray D. DAT scan E. Renal angiography

B. CT angiogram

Chronic inflammation of the pancreas (chronic pancreatitis) can lead to which of the following? A. Thyrotoxicosis B. Diabetes mellitus C. Cirrhosis of the liver D. Essential hypertension E. All of the above

B. Diabetes Mellitus

5. After the food bolus enters the stomach which of the following most effectively inhibits gastric acid secretion? A. Sucralfate B. Omeprazole (proton pump inhibitor) C. Misoprostol D. Ranitidine (H2 receptor blocker) E. Magnesium sulphate

B. Omeprazole (proton pump inhibitor)

Medial meniscus tears of the knee are more common than lateral meniscus tears because: A. the medial meniscus is more mobile B. the medial meniscus is less mobile C. the medial meniscus is thinner than the lateral meniscus D. the medial meniscus is larger than the lateral meniscus E. none of the above

B. the medial meniscus is less mobile

The following are most commonly indicative of stroke: A. loss of consciousness B. weakness of right arm which fully recovers after 5 days C. blurred vision D. tingling feelings on one side E. headache

B. weakness of right arm which fully recovers after 5 days

Management of stroke

Blood thinner (Aspirin) (Warfarin) Temp Maintenance (Paracetamol) Blood sugar maintenance (insulin) Maintenance of blood flow (TED stocking) Maintenance of blood pressure

hooks law

Bone is able to lengthen by 5% before it fails

Osteomalacia characteristics

Bone pain Muscle Pain Pseudo Fractures Symptomatic

Q 6 The growth centers of long bones are called the A Cartilagenous accretion zone B Osseogenous region C Epiphyseal growth plate D Mitotic cavity E Harvesian system

C Epiphyseal growth plate

Which of the following would be most helpful in managing a patient who only evacuates their rectum once every 2 weeks? A. SeHCAT test B. Oesophago-gastro-duodenoscopy (OGD) C. Colonic transit (SHAPE method) studies D. Pelvic ultrasound E. Oesophageal manometry

C. Colonic transit (SHAPE method) studies

In the management of pancreatic exocrine insufficiency which of the following applies? A. A bile salt chelator is the first line treatment B. Acute pancreatitis should be excluded C. Faecal elastase is diagnostic D. Osmotic laxatives improve symptoms E. Diet high in fat (>40g/day) is helpful in the long term

C. Faecal Elastase is Diagnostic

All of the following fractures are associated with osteoporosis except: A. Fracture of the spine B. Colle's fracture C. Fracture of the clavicle D. Fracture of the neck of femur E. Fracture of the proximal humerus

C. Fracture of the clavicle

Which of the following disorders is a condition in adults characterised by bone and joint pain associated with muscle weakness? A. Osteoarthritis B. Osteoporosis C. Osteomalacia D. Rickets E. Osteopetrosis

C. Osteomalacia

Concerning the anal sphincter: which of the following is true? A. Internal anal sphincter is under voluntary control B. It is innervated by the sciatic nerve C. The external sphincter is responsible for 25 % resting tone D. The resting pressure should be below 45 mmHg E. It alone contributes to faecal continence

C. The external sphincter is responsible for 25 % resting tone

Which of the following investigation is NOT usually useful in stroke? A. MRI brain scan B. CT extracranial angiogram C. chest X-Ray D. cardiac ECHO E. 30 continuous days of cardiac rhythm monitoring

C. chest X-Ray

A 20 year old man in A/E following an RTA has a shortened right leg which is internally rotated and adducted. The likely diagnosis is: A. fracture of the neck of femur B. fracture of the shaft of femur C. posterior dislocation of the right hip D. anterior dislocation of the left hip E. injury to the spine

C. posterior dislocation of the right hip

Best to Worst evidence based medicine

CACHRANE - very good and thorough evidence Systematic Reviews (Meta-analysis) Randomised Trials Cohort studies (no intervention - looking at a cohort of patients and comparing groups and their conditions) Case-control Studies Case series, case reports Editorials, Expert Opinion.

endochondral ossification

Cartilage intermediate Formation of all other bones in the body Allows growth of long bones lengthways

Transient Times in the colon

Cecum:4 hrs Ascending colon: 6hrs Transverse Colon: 9 hrs Descending Colon: 12 hrs

Types of IV fluids

Colloid and Crystalloid

Ligaments

Connect bone to bone

Tendons

Connect muscle to bone

Q10 Which of the following statement is incorrect about adaptation of bone for load bearing? A Bone is a composite structure with its materials giving strength in compression and tension B There is lifelong turnover of bone which allows it to respond to loading conditions C The shape and width of bone has an important effect on its load carrying capacity D Each bone is equally strong irrespective of the direction of load E Hollowness of bone makes it more efficient in load bearing

D Each bone is equally strong irrespective of the direction of load

Receptive relaxation occurs in response to swallowing a bolus of food in which structure? A. Oral cavity B. Middle third of the oesophagus C. Gastric antrum D. Lower oesophageal sphincter E. Cricopharyngeus

D. A. Lower oesophageal sphincter

Which of the following is not a commonly recognised mimic for stroke? A. Brain tumour B. Abscess C. Epilepsy D. Encephalopathy E. Arteriovenous malformation

D. Encephalopathy

Which is more likely to be associated with Ulcerative Colitis rather than Crohn's disease? A. Stricture B. Terminal ileal involvement C. Fistula formation D. Ileoanal pouch E. Perianal infection

D. Ileoanal pouch

3. Gastric emptying may be inhibited by which of the following: A. Highly selected vagotomy for gastric ulcer B. High duodenal pH C. Gastritis D. Long chain fatty acids in duodenum E. Sucrose

D. Long chain fatty acids in duodenum

Which of the following is seen on blood test in osteoporosis? A. Low calcium; high phosphate; high alkaline phosphatase B. Low calcium; low phosphate; high alkaline phosphatase C. Normal calcium; normal phosphate; high alkaline phosphatase D. Normal calcium; normal phosphate; normal alkaline phosphatase E. None of the above

D. Normal calcium; normal phosphate; normal alkaline phosphatase

A 75 kg adult male is kicked in the abdomen and is admitted as an emergency. Which of the following vital signs are consistent with a diagnosis of class 3 hypovolaemic shock? A. Blood loss equivalent to 15-30% blood volume B. Normal blood pressure C. Pulse rate 110 bpm D. Respiratory rate 30-40 min-1 E. Urine output 20-30 ml hr-1

D. Respiratory rate 30-40 min-1

What class of drug is typically used to treat neurogenic shock? A. Beta - Blocker B. Calcium Channel antagonist C. Loop diuretic D. Vasopressors E. Steroids

D. Vasopressors

A 65 year old female presented with a fracture of T12 vertebrae. On blood testing, the alkaline phophatase and PTH were high; the calcium and phosphate were low. These could be explained by which diagnosis? A. Osteoporosis B. Paget's disease C. Primary hyperparathyrodism D. Vitamin D deficiency E. Trauma

D. Vitamin D deficiency

How to determine bone mass

DEXA Dual-Energy X-ray Absorptiometry

HBV - Nucleotide inhibitors

Decreased morbidity from hepatitis B

DILI

Drug Induced Liver Injury

Q 1 Which of the following is NOT a function of bone A Protection B Support C Reservoir for calcium ions D Sound transmission E Blood cell production and destruction

E Blood cell production and destruction (blood cells are destroyed in the spleen)

Q 3 Which of the following is true about bone? A woven bone is only found during fracture healing B osteoid or the organic matrix makes up about 5% of dry bone weight C osteoblasts which are multinucleated cells, produce the bone matrix D the main type of collagen in bone is Type II E the main constituent of inorganic bone, hydroxyapatite is Calcium Phosphate

E the main constituent of inorganic bone, hydroxyapatite is Calcium Phosphate

Q 2 which statement is INCORRECT about the structure of a long bone A the hard outer layer is called compact or cortical bone B the hard outer layer accounts for 80% of bone mass C the outer bone layer provides bone its strength and stiffness D the outer layer has the Harvesian system E the outer layer undergoes the most changes with old age

E the outer layer undergoes the most changes with old age (the inner layer has most changed with age)

In bile salt malabsorption, which of the following is correct? A. It occurs in 17-20% patients after removal of the gall bladder. B. It may be responsible for the diarrhoea in 28% of patients with Crohn's disease affecting the small bowel. C. It commonly occurs after small bowel resection for Crohn's disease. D. It may lead to deficiencies in Vitamins D, E, A and K. E. All of the above

E. All of the Above

2. Which of the following can damage the gastric mucosal barrier, stimulate gastric HCl secretion and lead to gastric erosions? A. Cholecystokinin B. Secretin C. Gastrin D. Vibrio cholera E. Helicobacter pylorus

E. Helicobacter pylorus

Delay in giving antibiotics .....

Every 1 hour delay in giving antibiotics results in a 7.6% increase in mortality - (however this is in controlled environment and specific - giving unnecessary antibiotics gives rise to resistance)

Pelvic floor disorders

Faecal incontinence Constipation Evacuatory disorders Female (more common) Male (less common) Functional pelvic floor disorders Rectal Prolapse 3rd and 4th degree tears Rectocoele repair Complex fistulae

Mechanisms causing osteoporosis

Failure of the bone cycle Imbalance between rate of resorption and formation Failure to complete remodelling

liver cirrhosis

Fibrosis of the liver. chronic liver disease characterized by replacement of liver tissue by fibrosis caused by alcoholism, hepatitis B and hepatitis C, and fatty liver disease. Low serum albumin and high serum Immunoglobuins (IgA). β-γ "bridge" is seen in SPE.

Ohm's Law

Flow = Perfusion pressure / Vascular Resistance

Causes of Biliary Disease

Gallstone disease Immunological Oncological

Gastric Disease

Gastric Disease Hyperacidity / bile reflux Ulcer Cancer Post-surgery syndromes : gastrectomy and obesity surgery Gastric emptying issues Ileus Outlet obstruction Anorexia/bulimia

What is endometriosis?

Growth of endometrial tissue outside of uterus - affects 1 in 10 women

Function of Colon

H2O/ Na+ Absorption Storage

Fracture Healing

Healing starts as soon as the fracture occurs Blood clots Clot Is replaced by granulation tissue (soft callus / cartilage) Granulation tissue is replaced by lamellar bone Bone cannot be laid out in an acidic environment (as bone resorption occurs in an acidic environment) Bone is remodelled by osteoblasts.

Modifiable risk factors for stroke

High Blood Pressure (BP) Arterial Fibrillation (irregular fast heartbeat) AF Cigarette smoking Diabetes mellitus High cholesterol

Symptoms of sepsis / pneumonia

High Temp High Respiratory Rate High heart rate Low blood Pressure 88% Oxygen saturation - typical Low urine passed Rash

Effects of anaphylaxis

Hypotension ( lower blood pressure, vaso dilatation, leaky vessels) Tachycardia Vasodilatation Leaky vessels (increased permeability) Hypoxia (blue lips) Histamine Sneezing Quick swelling of the face and airways Nausea Urticaria Skin Flushing Skin

Types of Shock

Hypovolemic (not enough volume of blood) Septic Shock Cardiogenic Shock (heart is not pumping properly - not adequate blood flow and pressure) Anaphylactic Shock (inflammatory reaction) Neurogenic Shock (damage in the nerves that affect vells dilatation / vasoconstriction affecting blood pressure)

Causes of Gastroparesis

Idiopathic Surgery Diabetes Parkinson's Opiates /Antidepressants

Wolff's law

If loading on a bone increases, bone will re-model itself over time to become stronger to resist this loading The reverse is also true

Colonic Refelexes

Ileocolic valve Gastro-ileal reflex Gastrocolic reflex

Clinical response to sepsis

Immune response - cytokine release- pro-inflammatory release Continued Activation of PMNs and macrophages To clear bacteria and debris To repair tissue CARS response Compensatory Anti-Inflammatory Response Normal response to limit systemic inflammatory process Global deactivation of immune system Suppress pro-inflammatory genes Restore homeostasis Restore normal parameters

Chronic liver disease

Includes alcohol related fatty-liver disease and non-fatty liver disease Progressive Liver cirrhosis Liver cancer Decompensated liver disease

Common causes of stroke

Increased Age Male sex

Gastro-ileal reflex

Increased gastric activity -causes relaxation of the ileocecal sphincter (normally closed) Food leaves stomach Caecum relaxes

Symptoms and signs of chronic liver disease

Jaundice Clotting derangement Low albumin levels in blood Change in drug metabolism

Q 8 Which is not part of bone tissue? A Keratin B Calcium phosphate C Bone cells D Collagen E Mucopolysaccharides

Keratin

Cardiovascular support- drugs

Manipulating Adrenergic Receptors with drugs (sympathetic and parasympathetic) can be manipulated using drugs (vasopressin (anti-diuretic hormone), phenylephrine (mild drug), adrenaline and noradrenaline , deputamine (synthetic beta-stimulant) and dopamine)

Airway support (non-invasive)

Masks with valves that control the concentration of O2 delivered Reservoir mask Optaopal - machine that provides oxygen whilst taking into account normal patient breath and humidity, increasing patient compliance CPAP- delivering oxygen under pressure allowing lungs to be opened under pressure

Cardiac Output

Mean Arterial Pressure / Total Peripheral Resistance

Rectal sensitivity

Measure how big balloon is when patient feels: First sensation Urge Maximum tolerated

Osteomalacia

Metabolic disease of bone: Inadequate mineralisation Lack on inorganic component. Problem in hydroxyapatite synthesis A qualitative Disorder Rickets and Osteomalacia are the same condition however rickets affects children and Osteomalacia affects adults.

Stomach functions

Mixing propulsion Controlled sequential Emptying

Roles of intensive care

Monitoring Infusion Therapy Multi-Organ Support Docs, Nurses, HCA, Physicians, Dieticians, technicians and engineers, Paramedics specialists Emergency Team Response (Cardiac arrest, Trauma, Haemorrhage) Organ Transplant Care of the Dying Support relatives Advice

Osteoarthritis

Most common disease that affects the joints Change in colour and shape and shine and cartilage wares off in patches

Functions of Muscles

Movement Stabilise joints Generate Heat ( shivering ) Shape

isometric contraction

Muscle contracts but there is no movement, muscle stays the same length - Static strength endurance

Fast twitch muscle

Muscle fibers that contract rapidly and powerfully, with little endurance. They have few mitochondria and large glycogen reserves. They depend on anaerobic pathways to generate ATP during muscle contraction (Type 2)

causes for cardiogenic shock

Myocardial Infarction Cardiovascular Disease Valvular Disorders Arrhythmias Sepsis Toxins

Treatment of acute liver injury

N-acetylcysteine avoid breakdown of paracetamol into toxic product further Supportive - waiting for recovery of liver (has improved in recent years) Plasma Exchange Transplantation (has improved and reduced occurrence has reduced in recent years)

Treatments of DILI

N-acetylcystine Treatment for paracetamol overdose Urosodeoxycholic acid Steroid Liver transplant

Physiology of colon cells

Na+ / H- exchanger coupled to Cl -/ HCO3- exchanger H2O follows osmotic gradient

Parameters during septic shock

Normal blood volume Distribution of blood is altered (leaks or ruptures) Insufficient flow for aerobic metabolism

Universal Blood donor

O negative

CT colonography

OPD No preparation apart from diet Tag stool with gastrographic Elderly Incomplete colonoscopy Extra intestinal findings

Q9 The organic component of bone matrix is produced by: A Osteoblasts B Osteocytes C Osteoclasts D Chondrocytes E Chondroblasts

Osteoblasts

Osteoporosis

Osteoporosis is characterised by: - Low bone mass - Micro architectural deterioration of the bone (Structural problem) - A structural problem which lead to the loss of bone mass - Quantitative disorder - often silent until too late Leading to: Increased bone fragility Increased risk of fracture

Mechanisms of DILI

Oxidative Stress Mitochondrial Injury Hepatobiliary transport inhibition

Type 1 primary osteoporosis

Postmenopausal osteoporosis Only affects women Oestrogenic withdrawal Excessive PTH Overstimulated Osteoclasts Most often causes loss of trabecular bone Abnormal T score

Types of osteoporosis

Primary Type I: estrogen/testosterone; Primary Type II: Ca++ metabolism; Secondary: caused by hormone, metabolic, or neoplastic abnormalities

Acute liver injury

Paracetamol is the most common cause of acute liver failure in the UK Toxic effect of paracetamol in liver during breakdown (NAPQI)

secondary osteoporosis

Pathological Many different causes: - Abnormal T score AND Abnormal Z score

outer covering of bone

Periosteum

Interferon

Protein produced by cells in response to being infected by a virus; helps other cells resist the virus. (original glycoprotein used to treat Hepatitis C - poor success rate due to fever side-effects)

What to observe in patients with suspected hypovolemic shock

Pulse, (High) Blood Pressure (Low) Skin (Cold) Capillary re-fill (slow) Alertness (Confusion and anxiety)

Causes of hepatic cell death

Rise in blood concentration of liver enzymes Clotting derangement Jaundice

Septic Shock

Shock caused by severe infection, usually a bacterial infection.

Testing for allergies

Skin Prick testing (small amount of antigen on skin and scraping it) - High rate of false positives Intradermal injection Blood tests - allergic antibodies to suspected antigen Food challenges - hospital environment

What is the gall bladder?

Small membranous sac that stores bile and releases it into the intestine

Investigations of anorectal physiology

Sphincter manometry Balloon testing Neurological

Colonic investigations

Stool culture Colonoscopy CT colonography

Stroke

Stroke is a clinically defined syndrome causing focal neurological symptoms which last greater than 24 hours

Systemic Response to Injury

Sympathetic nervous system activation Endocrine activation Immunological changes Haematological changes

X-Mode

Take blood out of patient - Put through a membrane oxygenator - blood returned to body ( done when lungs are completely ineffective) - less stress on the heart as blood is also pumped outside the body.

bone remodeling

The entire skeleton is replaced every 7 years Remodelling is constant 10% of adult skeleton is replaced annually The original skeleton must be broken down (resorbed) Osteoclasts are able to dissolve the inorganic matrix creating an erosion cavity - resorption 3 Weeks The new skeleton must be re-laid (ossification) Osteoblasts form a new matric- replacing the resorbed old bone - filling in the erosion cavity 2 months

Hypovolaemia

a decreased volume of circulating blood in the body

Hiatal Hernia

a structural abnormality (most often due to abnormal relaxation or weakening of the gastroesophageal sphincter) in which the superior part of the stomach protrudes slightly above the diaphragm. Since the diaphragm no longer reinforces the sphincter, gastric juice may enter the oesophagus, particularly when lying down. If the episodes are frequent and prolonged, esophagitis (inflammation of the oesophagus) and oesophageal ulcers may result. An even more threatening sequel is oesophageal cancer.

Fibroscan

a test that can reveal any fibrosis or fatty deposits within the liver. It is a non-invasive, quick and simple test that works using ultrasound and gives an immediate result -non-invasive

Aspirin

acetylsalicylic acid, blood thinner, COX1 inhibitor, secondary prevention for stroke

Cryoprecipitate

an insoluble concentrate of certain coagulation factors obtained from fresh frozen plasma, contains Fibrinogen, maintains clot stability

Arrangement of skeletal muscles

bags of dried spaghetti

what does acid do to the surface of the oesophagus

burns it (corrosion), acute inflammatoion and/or chronic inflammation, may lead to scarring may present as asthma or a cough

articular cartilage

covers the surfaces of diarthrodial joints (2 bones coming together)

muscle channel element

cisterna and tubules

Types of muscle contractions

concentric, eccentric, isometric, polymetric

CPAP

continuous positive airway pressure allowing lungs to be opened under pressure

tendinosis

degeneration of a tendon believed to be caused by microtears in the tendon connective tissue

Thrombolysis

destruction of a blood clot

Fracture

discontinuity of bone (cortex) A break in the cortex Related to force applied

cardiomyopathy

disease of the heart muscle

Where does bile go?

duodenum

Achalsia

failure of the lower esophagus sphincter (LES) muscle to relax

tachycardia

fast heart rate

sympathetic response

fight or flight

contractile element of muscle

filament

inorganic bone matrix

hydroxyapatite and CaPO4 crystals 60% of dry weight - is necessary to provide structure and strength

Prevention of stroke

increase daily activity, smoking cessation, healthy diet, wear compression or knee high stockings daily

Warm perfusion machines for liver transplant

increase viability for donated organs, decreased transplant morbidity

Gastrocolic reflex

increased peristalsis of the colon after food has entered the stomach

Viscoelasticity

increased strain = tendons and ligaments become stiffer

muscle fibre

individual muscle cell

tendinitis

inflammation of a tendon

Common triggers of anaphylaxis

insect venom (50.1%), foods (25.1%) drugs (15.1%).

optical (optaopal)

machine that provides oxygen whilst taking into account normal patient breath and humidity - increasing patient compliance

bravo capsule

measures oesophageal pH with an animony pH sensor

transient intrinsic attack TIA

mini stroke that lasts less than 24 hours

isokinetic contraction

occurs when tension developed by muscle is maximal over full range of motion while shortening or lengthening at a constant speed. - Muscle length changes - constant rate of joint movement

Bilirubin

orange-yellow pigment in bile; formed by the breakdown of hemoglobin when red blood cells are destroyed

bone organic matrix

organic compounds including type 1 collagen, chondrotin sulphate, and matrix proteins - necessary for bone to provide flexibility in the bone to prevent bones being brittle

bone cells

osteoblasts, osteocytes, osteoclasts, osteoprogenitors

external anal sphincter

skeletal muscle, voluntary

Bradycardia

slow heart rate

Types of muscle fibres

slow twitch (type 1) and fast twitch (type 2)

larger bone diameter =

stronger bone

muscle cramps

sudden and sometimes painful contractions of the muscles myosin fibres not fully detaching from actin due to insufficiency of ATP

Sphincter manometry

test that measures how well the rectum and anal sphincters work together to eliminate stool (feces).

Neurological anorectal physiology testing

testing neural function of the anal sphincter

Balloon testing

testing rectal sensitivity and compliance

The Cori Cycle

the cycle of lactate to glucose between the muscle and liver

hemiparesis

weakness on one side of the body

Irreversible shock

worsening blood tests, no response to medication, apoptosis