BOOK
Basic Science for the MRCS E-Book
Andrew T Raftery | Michael S. Delbridge | Helen E. Douglas
(2012)
Additional Information
Book Details
Abstract
This book is a concise revision guide to the core basic sciences – anatomy, physiology and pathology – which comprise the essential knowledge required by the trainee entering the specialty of surgery. It has been written in a style to facilitate easy learning of the essential facts, with indications of both their clinical relevance and importance. This book concentrates on those topics which tend to be recurring examination themes for initial surgical training. It will be an invaluable resource for the basic surgical trainee studying for the Intercollegiate MRCS examination, as well as proving useful for those in higher surgical training and for the surgically inclined, well-motivated student.
- The book covers in one volume all the essentials of the basic sciences – anatomy, physiology and pathology - to aid the candidate for the MRCS examination.
- In covering the applied basic science the books explains the application and clinical relevance of the three sciences
- The text is written in an appropriate ‘bullet-point’ style to allow easy reading and rapid exam preparation
- The contents concentrate on the recurring common themes of the examination, thus helping direct appropriate learning and focussing on the specific impoartnta areas of knowledge
- The book is illustrated with line drawings which are clearly annotated to aid learning.
In this Second Edition, chapters have been updated and sections expanded to cover topics which are particularly relevant to examinations. The microbiology chapter has been rewritten, and the section on skin healing has also been extensively rewritten to include a section on burns, skin grafting and the anatomy of flaps. Each chapter has new OSCE scenario questions added to bring together the basic science and its clinical application in OSCE examinations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Basic Sciencefor the MRCS: A revision guide for surgical trainees | iii | ||
| Copyright | iv | ||
| Preface | v | ||
| Acknowledgements | vi | ||
| Contents | vii | ||
| Section I: Anatomy | 1 | ||
| Chapter 1: The thorax | 3 | ||
| Development | 3 | ||
| Heart and great vessels | 3 | ||
| Heart (Fig. 1.1) | 3 | ||
| Great vessels (Fig. 1.2) | 4 | ||
| Fetal circulation (Fig. 1.3) | 4 | ||
| Congenital anomalies | 5 | ||
| Malposition | 5 | ||
| Left-to-right shunt | 5 | ||
| Atrial septal defect (ASD) | 5 | ||
| Ventricular septal defect (VSD) | 6 | ||
| Patent ductus arteriosus (PDA) | 6 | ||
| Eisenmenger's syndrome | 6 | ||
| Right-to-left shunt (cyanotic) | 6 | ||
| Fallot's tetralogy | 6 | ||
| Other congenital anomalies | 6 | ||
| Coarctation of the aorta | 6 | ||
| Abnormalities of valves | 6 | ||
| The diaphragm (Fig. 1.4) | 6 | ||
| SECTION II: PHYSIOLOGY | 179 | ||
| Chapter 7: General physiology | 181 | ||
| Homeostasis | 181 | ||
| Nervous system | 181 | ||
| Hormonal system | 181 | ||
| Thermoregulation | 181 | ||
| Heat production | 181 | ||
| Heat loss | 181 | ||
| Regulation of body temperature | 181 | ||
| Peripheral thermoreceptors | 182 | ||
| Reflex vasoconstriction | 182 | ||
| Reflex vasodilatation | 182 | ||
| Receptors on internal surfaces | 182 | ||
| Body temperature | 182 | ||
| Core temperature | 182 | ||
| Peripheral temperature | 182 | ||
| Abnormal temperature regulation | 182 | ||
| Fever (pyrexia) | 182 | ||
| Heatstroke | 182 | ||
| Hypothermia | 183 | ||
| Factors affecting thermoregulation | 183 | ||
| Fluid balance and fluid replacement therapy | 183 | ||
| Body water | 183 | ||
| Functions of the kidney | 183 | ||
| Diuresis | 183 | ||
| Water diuresis | 183 | ||
| Osmotic diuresis | 184 | ||
| Water balance | 184 | ||
| Regulation of total body water | 184 | ||
| Disturbances of total body water content | 184 | ||
| Water depletion | 184 | ||
| Water intoxication | 185 | ||
| Electrolyte disorders | 185 | ||
| Sodium | 185 | ||
| Regulation of sodium | 185 | ||
| Renal | 185 | ||
| Extrarenal | 185 | ||
| Sodium excess | 186 | ||
| Sodium depletion | 186 | ||
| Potassium | 186 | ||
| Hyperkalaemia | 187 | ||
| Hypokalaemia | 187 | ||
| Acid-base balance | 187 | ||
| Carbonic acid-bicarbonate system | 187 | ||
| Disturbances of acid-base balance | 188 | ||
| Respiratory acidosis | 188 | ||
| Respiratory alkalosis | 188 | ||
| Metabolic acidosis | 188 | ||
| Metabolic alkalosis | 189 | ||
| Mixed acid-base disorders | 189 | ||
| Interpretation of acid-base changes | 189 | ||
| Anion gap | 190 | ||
| Fluid balance and fluid replacement therapy | 190 | ||
| Fluid balance in the uncomplicated patient | 190 | ||
| Change in fluid and electrolyte requirements in response to surgery and trauma | 190 | ||
| Fluid and electrolyte problems in surgical patients | 191 | ||
| Blood and plasma | 191 | ||
| Gastrointestinal losses | 191 | ||
| Intraperitoneal fluid loss | 191 | ||
| Septicaemia | 191 | ||
| Excessive insensible fluid loss | 192 | ||
| Colloid and crystalloid solutions | 192 | ||
| Types | 192 | ||
| Uses | 192 | ||
| Albumin | 192 | ||
| Dextran | 192 | ||
| Gelatins | 192 | ||
| Hydroxyethyl starch | 192 | ||
| Choice of plasma expanders | 193 | ||
| General problems of plasma expanders | 193 | ||
| Crystalloids | 193 | ||
| Common types | 193 | ||
| Uses | 193 | ||
| Oedema and lymphatic function | 194 | ||
| Causes of oedema | 194 | ||
| Obstruction to lymphatics | 194 | ||
| Chapter 8: Respiratory system | 196 | ||
| Introduction | 196 | ||
| Components | 196 | ||
| Function | 196 | ||
| Airway function | 196 | ||
| Mechanics of Ventilation | 196 | ||
| Pulmonary ventilation | 196 | ||
| Lung pressures (Fig. 8.1) | 197 | ||
| Surfactant and surface tension (Fig. 8.2) | 197 | ||
| Compliance (Fig. 8.3) | 198 | ||
| Respiratory muscles | 199 | ||
| Work of breathing (Fig. 8.4) | 199 | ||
| Regional variations in ventilation (Fig. 8.5) | 199 | ||
| Clinical physiology | 200 | ||
| Pneumothorax | 200 | ||
| Spontaneous (primary) pneumothorax | 200 | ||
| Spontaneous (secondary) pneumothorax | 200 | ||
| Traumatic (closed) pneumothorax | 200 | ||
| Tension pneumothorax | 200 | ||
| Open pneumothorax or `sucking´ chest wound | 200 | ||
| Pulmonary assessment | 201 | ||
| Lung volumes (Box 8.1) | 201 | ||
| Dead space and alveolar ventilation rate | 201 | ||
| Peak expiratory flow rate (PEFR) | 203 | ||
| Closing capacity | 203 | ||
| Flow-volume and volume-time curves | 203 | ||
| Diffusion capacity | 203 | ||
| Pulmonary blood flow | 204 | ||
| Structure of the lung | 204 | ||
| Regulation of pulmonary blood flow | 204 | ||
| Regional variations in pulmonary blood flow | 204 | ||
| Cardiac output and pulmonary vascular resistance | 204 | ||
| Ventilation and perfusion | 205 | ||
| Clinical physiology | 205 | ||
| Pulmonary embolus | 205 | ||
| Pleural effusion | 205 | ||
| Pulmonary oedema | 206 | ||
| Adult respiratory distress syndrome | 207 | ||
| Gas diffusion and exchange | 207 | ||
| Gas diffusion | 207 | ||
| Gas exchange (Table 8.1) | 207 | ||
| Gas transport (Fig. 8.11) | 207 | ||
| Oxygen transport | 208 | ||
| Carbon dioxide transport | 208 | ||
| Regulation of Respiration | 210 | ||
| Neurological regulation | 210 | ||
| Chemical regulation | 210 | ||
| Hypoxia and respiratory failure | 211 | ||
| Hypoxia and hypoxaemia | 211 | ||
| Respiratory failure | 212 | ||
| Clinical physiology | 212 | ||
| Response to hypoxia | 212 | ||
| Acute | 212 | ||
| Chronic | 212 | ||
| Oxygen therapy and mechanical ventilation | 212 | ||
| Oxygen therapy | 212 | ||
| Mechanical ventilation | 213 | ||
| Indications | 213 | ||
| Intermittent positive pressure ventilation (IPPV) | 213 | ||
| Complications | 213 | ||
| Chapter 9: Cardiovascular system | 215 | ||
| Cardiac muscle | 215 | ||
| Cardiac action potential (Fig. 9.1) | 215 | ||
| Phase 0 | 215 | ||
| Phase 1 | 215 | ||
| Phase 2 | 216 | ||
| Phase 3 | 216 | ||
| Phase 4 | 216 | ||
| Excitation/contraction coupling | 216 | ||
| Generation and conduction of cardiac impulse | 216 | ||
| Generation of cardiac output | 216 | ||
| Phases of the cardiac cycle (Fig. 9.2) | 217 | ||
| Phase IVc | 217 | ||
| Phase I | 217 | ||
| Phase IIa | 217 | ||
| Phase IIb | 217 | ||
| Phase III | 217 | ||
| Phase IVa | 217 | ||
| Phase IVb | 217 | ||
| Intracardiac pressures | 218 | ||
| Heart sounds | 218 | ||
| First heart sound | 218 | ||
| Second heart sound | 218 | ||
| Third heart sound | 218 | ||
| Fourth heart sound | 218 | ||
| Venous pulse (Fig. 9.4) | 218 | ||
| a-wave | 218 | ||
| c-wave | 218 | ||
| v-wave | 218 | ||
| x-descent | 218 | ||
| y-descent | 218 | ||
| Coronary circulation | 218 | ||
| Cardiac output (co) | 219 | ||
| Regulation of cardiac output | 219 | ||
| Starling's law of the heart (Fig. 9.5) | 219 | ||
| Factors modifying cardiac output | 219 | ||
| 1. Contractility | 220 | ||
| 2. Preload | 220 | ||
| 3. Afterload | 220 | ||
| Measurement of cardiac output | 220 | ||
| Fick method | 220 | ||
| Thermodilution | 220 | ||
| Dye dilution | 220 | ||
| Doppler ultrasound | 221 | ||
| Blood pressure | 221 | ||
| Control of blood pressure (general systemic blood pressure) | 221 | ||
| Factors determining arterial blood pressure | 221 | ||
| Control of local blood pressure and blood flow | 221 | ||
| Peripheral resistance (systemic vascular resistance; SVR) | 221 | ||
| Monitoring the circulation | 221 | ||
| ECG | 221 | ||
| Blood pressure | 222 | ||
| Central venous pressure | 222 | ||
| Pulmonary capillary wedge pressure (pulmonary artery occlusion pressure; PAOP) | 223 | ||
| Pulse oximetry | 223 | ||
| Cardiac output | 223 | ||
| Urine output | 223 | ||
| Echocardiography | 223 | ||
| Echo Doppler | 223 | ||
| Cardiovascular support | 223 | ||
| Ventilate | 223 | ||
| Infusion | 223 | ||
| Pump | 223 | ||
| Pharmacological support | 224 | ||
| Adrenaline | 224 | ||
| Noradrenaline | 224 | ||
| Isoprenaline | 224 | ||
| Dopamine | 224 | ||
| Dobutamine | 224 | ||
| Dopexamine | 224 | ||
| Vasodilators | 224 | ||
| Phosphodiesterase inhibitors | 224 | ||
| Chapter 10: Gastrointestinal system | 226 | ||
| Functions | 226 | ||
| Nervous and hormonal regulation within the GI tract | 226 | ||
| Nervous regulation | 226 | ||
| Hormones and neurotransmitters | 226 | ||
| Oral cavity, pharynx and oesophagus | 227 | ||
| Chewing | 227 | ||
| Saliva | 227 | ||
| Swallowing | 227 | ||
| Oesophageal sphincter | 227 | ||
| Stomach | 228 | ||
| Gastric mucosa | 228 | ||
| Gastric secretion | 228 | ||
| Gastric acid (Fig. 10.1) | 228 | ||
| Pepsinogen secretion | 229 | ||
| Mucus secretion | 229 | ||
| Intrinsic factor secretion | 229 | ||
| Regulation of gastric secretion | 229 | ||
| Gastric motility | 229 | ||
| Storage | 229 | ||
| Mixing and propulsion | 230 | ||
| Clinical physiology | 230 | ||
| Vomiting | 230 | ||
| Treatment of peptic ulceration | 230 | ||
| Medical treatment | 230 | ||
| Surgical treatment | 231 | ||
| Post-gastrectomy syndromes | 231 | ||
| Effects of vagotomy | 231 | ||
| Small intestine | 231 | ||
| Small intestine mucosa | 231 | ||
| Absorption (Table 10.1) | 233 | ||
| Carbohydrates (Fig. 10.3) | 233 | ||
| Fats (Fig. 10.4) | 233 | ||
| Protein (Fig. 10.5) | 233 | ||
| Fluids and electrolytes | 233 | ||
| Vitamins | 235 | ||
| Iron | 235 | ||
| Calcium | 235 | ||
| Small intestinal motility | 235 | ||
| Clinical physiology | 235 | ||
| Physiological effects of duodenal resection | 235 | ||
| Physiological effects of terminal ileal resection | 235 | ||
| Pancreas | 236 | ||
| Exocrine secretions | 236 | ||
| Fluid component | 236 | ||
| Enzyme component | 236 | ||
| Proteolytic enzymes | 236 | ||
| Amylase | 236 | ||
| Lipolytic enzymes | 236 | ||
| Regulation of exocrine secretions | 236 | ||
| Cephalic | 236 | ||
| Gastric | 236 | ||
| Intestinal | 236 | ||
| Endocrine secretions | 236 | ||
| Clinical physiology | 237 | ||
| Physiological effects of pancreatic resection | 237 | ||
| Liver and gall bladder | 237 | ||
| Liver | 237 | ||
| Bile production (Fig. 10.6) | 237 | ||
| Metabolic functions | 237 | ||
| Carbohydrate metabolism | 237 | ||
| Protein metabolism | 237 | ||
| Lipid metabolism | 238 | ||
| Protein synthesis | 239 | ||
| Vitamin D activation | 239 | ||
| Detoxification | 239 | ||
| Vitamin and mineral storage | 239 | ||
| Phagocytosis | 239 | ||
| Haemopoiesis | 239 | ||
| Clinical physiology | 239 | ||
| Jaundice | 239 | ||
| Prehepatic jaundice | 239 | ||
| Hepatocellular jaundice | 240 | ||
| Cholestatic jaundice | 240 | ||
| Gall bladder | 240 | ||
| Clinical physiology | 240 | ||
| Physiological effects of cholecystectomy | 240 | ||
| Large bowel | 241 | ||
| Water absorption | 241 | ||
| Colonic flora | 241 | ||
| Large intestinal motility | 241 | ||
| Defecation | 241 | ||
| Clinical physiology | 241 | ||
| Diarrhoea | 241 | ||
| Osmotic | 242 | ||
| Secretory | 242 | ||
| Inflammatory | 242 | ||
| Abnormal motility | 242 | ||
| Constipation (Box 10.1) | 242 | ||
| Nutrition | 242 | ||
| Requirements | 242 | ||
| Regulation | 243 | ||
| Chapter 11: Urinary system | 245 | ||
| Components | 245 | ||
| Functions | 245 | ||
| Structure | 245 | ||
| Renal blood supply | 245 | ||
| Renal circulation | 245 | ||
| Regulation of renal blood flow | 245 | ||
| Glomerulus (Fig. 11.1) | 246 | ||
| Microscopic structure | 246 | ||
| Glomerular filtration | 246 | ||
| Proximal convoluted tubule | 247 | ||
| Loop of Henle | 247 | ||
| Countercurrent multiplier mechanism (Fig. 11.2) | 247 | ||
| Distal convoluted tubule and collecting ducts | 248 | ||
| Regulation of NA+ and water reabsorption | 248 | ||
| Antidiuretic hormone | 248 | ||
| Renin-angiotensin-aldosterone system (RAS) | 248 | ||
| Atrial natriuretic peptide (ANP) | 248 | ||
| Ion and nutrient reabsorption | 249 | ||
| Potassium | 249 | ||
| Calcium and phosphate | 249 | ||
| Hydrogen and bicarbonate (Fig. 11.3) | 249 | ||
| Glucose and amino acids | 250 | ||
| Urea | 250 | ||
| Glomerular filtration rate (GFR) and renal plasma flow | 250 | ||
| Measuring GFR | 250 | ||
| Measuring renal plasma flow | 250 | ||
| Micturition | 250 | ||
| Clinical physiology | 251 | ||
| Bladder function and spinal injury | 251 | ||
| Hormone production | 251 | ||
| Renin | 251 | ||
| Erythropoietin | 252 | ||
| 1α-hydroxylase | 252 | ||
| Chapter 12: Endocrine system | 253 | ||
| Introduction | 253 | ||
| Pituitary and hypothalamic function | 253 | ||
| Control of pituitary function | 253 | ||
| Anterior pituitary | 253 | ||
| Posterior pituitary | 253 | ||
| Anterior pituitary hormones | 254 | ||
| Adrenocorticotrophic hormone (ACTH) | 254 | ||
| Thyroid-stimulating hormone (TSH) | 254 | ||
| Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) | 254 | ||
| Prolactin | 254 | ||
| Growth hormone (GH) | 254 | ||
| Posterior pituitary hormones | 254 | ||
| Oxytocin | 254 | ||
| Antidiuretic hormone | 254 | ||
| Clinical physiology | 254 | ||
| Pituitary disorders | 254 | ||
| Increased hormone secretion | 254 | ||
| Decreased hormone secretion | 254 | ||
| Thyroid function | 255 | ||
| Anatomy | 255 | ||
| Synthesis of thyroid hormone (Fig. 12.1) | 255 | ||
| Clinical physiology | 255 | ||
| Antithyroid drugs | 255 | ||
| Secretion and transport of thyroid hormone | 255 | ||
| Effects of thyroid hormone | 256 | ||
| Clinical physiology | 256 | ||
| Thyroid disorders | 256 | ||
| Hyperthyroidism | 256 | ||
| Hypothyroidism | 256 | ||
| Sick euthyroid syndrome | 257 | ||
| Calcium and phosphate regulation | 257 | ||
| Calcium | 257 | ||
| Regulation of calcium balance | 258 | ||
| Parathormone | 259 | ||
| Vitamin D | 259 | ||
| Calcitonin | 259 | ||
| Regulation of phosphate balance | 259 | ||
| Clinical physiology | 259 | ||
| Disorders of calcium and phosphate balance | 259 | ||
| Hypoparathyroidism | 259 | ||
| Hyperparathyroidism | 259 | ||
| Vitamin D deficiency | 260 | ||
| Hypocalcaemia | 260 | ||
| Hypercalcaemia | 260 | ||
| Hypophosphataemia | 260 | ||
| Hyperphosphataemia | 260 | ||
| Adrenal function | 261 | ||
| Cortex | 261 | ||
| Synthesis and excretion | 261 | ||
| Actions of the adrenal cortex hormones | 261 | ||
| Aldosterone | 261 | ||
| Cortisol | 262 | ||
| Androgens | 262 | ||
| Medulla | 262 | ||
| Clinical physiology | 263 | ||
| Disorders of adrenal function | 263 | ||
| Addison's disease | 263 | ||
| Hyperaldosteronism | 263 | ||
| Cushing's disease/syndrome | 263 | ||
| Adrenogenital syndrome | 264 | ||
| Phaeochromocytoma | 264 | ||
| Growth hormone | 265 | ||
| Clinical physiology | 266 | ||
| Disorders of growth hormone secretion | 266 | ||
| Gigantism | 266 | ||
| Acromegaly | 266 | ||
| Endocrine function of the pancreas | 266 | ||
| Insulin | 266 | ||
| Carbohydrate metabolism | 266 | ||
| Protein metabolism | 267 | ||
| SECTION III: PATHOLOGY | 291 | ||
| Chapter 14: Cellular injury | 293 | ||
| Mechanisms of cellular injury | 293 | ||
| Cell death | 293 | ||
| Necrosis | 293 | ||
| Coagulative necrosis | 293 | ||
| Colliquative necrosis | 293 | ||
| Caseous necrosis | 293 | ||
| Gangrenous necrosis | 294 | ||
| Fibrinoid necrosis | 294 | ||
| Fat necrosis | 294 | ||
| Apoptosis | 294 | ||
| Function of apoptosis | 294 | ||
| Mediators of apoptosis | 294 | ||
| p53 | 294 | ||
| bcl-2 | 294 | ||
| fas (CD 95) | 294 | ||
| Caspases | 294 | ||
| Morphological features of apoptosis | 294 | ||
| Diseases of increased apoptosis | 295 | ||
| Diseases of decreased apoptosis | 295 | ||
| The process of healing | 295 | ||
| Regeneration and repair | 295 | ||
| Cell renewal | 295 | ||
| Repair | 295 | ||
| Granulation tissue | 295 | ||
| Clinical problems with organisation and wound contraction | 295 | ||
| Organisation | 295 | ||
| Wound contraction | 295 | ||
| Injuries to specific tissues | 295 | ||
| Skin | 295 | ||
| Skin anatomy (Fig. 14.1) | 295 | ||
| Incised wound (surgical incision)-healing by first intention | 296 | ||
| Tissue loss-healing by second intention | 296 | ||
| Abnormalities of skin healing | 296 | ||
| Keloid | 296 | ||
| Hypertrophied scar | 296 | ||
| Anatomy of repair of defects | 296 | ||
| Reconstructive ladder (Fig. 14.3) | 297 | ||
| Grafts | 297 | ||
| Skin grafts | 297 | ||
| Mechanism of skin graft take | 297 | ||
| Split-thickness skin grafts (Fig. 14.4) | 298 | ||
| Full-thickness skin grafts (Fig. 14.5) | 298 | ||
| Flaps | 298 | ||
| Classification | 298 | ||
| Local flaps | 298 | ||
| Transposition flap (Fig. 14.9A) | 298 | ||
| Rotation flap (Fig. 14.9B) | 299 | ||
| Advancement flap (Fig. 14.9C) | 299 | ||
| Z-plasty (Fig. 14.9D) | 299 | ||
| Free flaps (Fig. 14.10) | 299 | ||
| Radial forearm flap | 299 | ||
| Anterolateral thigh flap | 300 | ||
| Deep inferior epigastric perforator (DIEP)/transverse rectus abdominis myocutaneous (TRAM) flap | 300 | ||
| Bone | 300 | ||
| Factors affecting bone healing | 301 | ||
| Liver | 301 | ||
| Kidney | 301 | ||
| Cardiac muscle | 301 | ||
| Neural tissue | 302 | ||
| Peritoneum | 302 | ||
| Gastrointestinal tract | 302 | ||
| Mucosal erosions | 302 | ||
| Mucosal ulcers | 302 | ||
| Gastrointestinal anastomoses | 302 | ||
| Factors affecting wound healing | 303 | ||
| Local | 303 | ||
| Systemic | 303 | ||
| Injury due to ionising radiation | 303 | ||
| Mode of action | 304 | ||
| Effects on tissues | 304 | ||
| Effect on individual tissues | 304 | ||
| Bone marrow | 304 | ||
| Skin | 305 | ||
| Intestines | 305 | ||
| Gonads | 305 | ||
| Lung | 305 | ||
| Kidney | 305 | ||
| Whole body irradiation | 305 | ||
| Ultraviolet light | 305 | ||
| Therapeutic irradiation | 305 | ||
| Radical applications | 305 | ||
| Adjuvant radiotherapy | 305 | ||
| Palliative radiotherapy | 305 | ||
| Fractionation of dose | 305 | ||
| Response modifiers | 306 | ||
| Injury due to burns | 306 | ||
| Types of burn | 306 | ||
| Thermal | 306 | ||
| Electrical | 306 | ||
| Chemical | 306 | ||
| Causes of burns | 306 | ||
| Predisposing medical conditions | 306 | ||
| Burn injury response | 306 | ||
| Local response (Fig. 14.11) | 306 | ||
| Systemic response | 307 | ||
| Carbon monoxide effects | 307 | ||
| Assessing a burn | 308 | ||
| The extent of body surface area burnt (Fig. 14.12) | 308 | ||
| The depth of the burn (Fig. 14.13) | 308 | ||
| Chapter 15: Disorders of growth, morphogenesis and differentiation | 311 | ||
| Growth | 311 | ||
| Cell turnover | 311 | ||
| Cell cycle | 311 | ||
| Phases of the cell cycle (Fig. 15.1) | 311 | ||
| Other factors involved in the cell cycle | 311 | ||
| Control of cell division | 311 | ||
| Therapeutic interruptions of cell cycle (Fig. 15.2) | 312 | ||
| Factors affecting growth | 312 | ||
| Genetic factors | 313 | ||
| Hormones | 313 | ||
| Nutrition | 313 | ||
| Blood supply | 313 | ||
| Oxygen supply | 313 | ||
| Nerve supply | 313 | ||
| Growth factors | 313 | ||
| Increased growth | 313 | ||
| Physiological hypertrophy and hyperplasia | 313 | ||
| Pathological hypertrophy | 313 | ||
| Pathological hyperplasia | 313 | ||
| Atrophy | 314 | ||
| Physiological (Box 15.1) | 314 | ||
| Pathological | 314 | ||
| Decreased growth (hypoplasia) | 314 | ||
| Differentiation | 314 | ||
| Control of differentiation | 314 | ||
| Morphogenesis | 314 | ||
| Congenital disorders of differentiation and morphogenesis | 315 | ||
| Chromosomal abnormalities affecting whole chromosomes | 315 | ||
| Chromosomal abnormalities affecting parts of chromosomes | 315 | ||
| Single gene alterations | 315 | ||
| Functional aspects of developmental disorders | 315 | ||
| Anomalies of organogenesis | 315 | ||
| Agenesis (aplasia) | 316 | ||
| Atresia | 316 | ||
| Hypoplasia | 316 | ||
| Dysgenesis (dysplasia) | 316 | ||
| Ectopia (heterotopia) | 316 | ||
| Acquired disorders of differentiation and growth | 316 | ||
| Metaplasia | 316 | ||
| Dysplasia | 316 | ||
| Polyps | 317 | ||
| Pathological processes causing polyps | 317 | ||
| Symptoms of polyps | 317 | ||
| Examples of polyps | 317 | ||
| Neoplasia | 318 | ||
| Chapter 16: Inflammation | 319 | ||
| Classification | 319 | ||
| Acute inflammation | 319 | ||
| Causes of acute inflammation | 319 | ||
| Macroscopic signs and symptoms of acute inflammation | 319 | ||
| Stages of acute inflammation | 319 | ||
| Changes in vessel calibre | 319 | ||
| Increased vascular permeability | 320 | ||
| Formation of cellular exudate | 320 | ||
| Chemical mediators of acute inflammation | 320 | ||
| Plasma factors | 320 | ||
| Complement system | 320 | ||
| Kinin system | 321 | ||
| Coagulation system | 321 | ||
| Fibrinolytic system | 321 | ||
| Role of macrophages | 321 | ||
| Role of lymphatics | 321 | ||
| Role of neutrophil polymorphs | 321 | ||
| Special types of inflammation | 321 | ||
| 1. Serous | 321 | ||
| 2. Catarrhal | 321 | ||
| 3. Fibrinous inflammation | 321 | ||
| 4. Haemorrhagic inflammation | 321 | ||
| 5. Suppurative inflammation | 321 | ||
| 6. Membranous inflammation | 322 | ||
| 7. Pseudomembranous inflammation | 322 | ||
| 8. Necrotising inflammation | 322 | ||
| Effects of acute inflammation | 322 | ||
| Beneficial effects (exudate) | 322 | ||
| Harmful effects (release of lysosomal enzymes) | 322 | ||
| Sequelae of acute inflammation | 322 | ||
| Resolution | 322 | ||
| Conditions favouring resolution | 322 | ||
| Sequence of events leading to resolution | 322 | ||
| Suppuration | 322 | ||
| Organisation | 322 | ||
| Circumstances favouring organisation | 322 | ||
| Sequence of organisation | 322 | ||
| Progress to chronic inflammation | 322 | ||
| Systemic effects of inflammation | 322 | ||
| Chronic inflammation | 323 | ||
| Features of chronic inflammation | 323 | ||
| Causes of chronic inflammation | 323 | ||
| Primary chronic inflammation | 323 | ||
| Progression from acute inflammation | 323 | ||
| Recurrent episodes of acute inflammation | 323 | ||
| Transplant rejection | 323 | ||
| Macroscopic appearances of chronic inflammation | 323 | ||
| Granulomatous disease | 323 | ||
| Epithelioid histiocytes | 324 | ||
| Types of giant cell | 324 | ||
| Causes of granulomatous disease | 324 | ||
| Chapter 17: Thrombosis, embolism and infarction | 325 | ||
| Thrombosis | 325 | ||
| Causes of thrombosis | 325 | ||
| Damage to vessel wall | 325 | ||
| Arterial thrombosis | 325 | ||
| Venous thrombosis | 325 | ||
| Alterations in blood flow | 325 | ||
| Alterations of the constituents of the blood | 325 | ||
| Stages in the development of thrombosis | 326 | ||
| Fate of thrombi | 326 | ||
| Embolism | 326 | ||
| Thromboembolism | 326 | ||
| Venous thromboembolism | 326 | ||
| Arterial thromboembolism | 326 | ||
| Gas embolism | 326 | ||
| Fat embolism | 327 | ||
| Tumour emboli | 327 | ||
| Amniotic fluid embolism | 327 | ||
| Foreign body embolism | 327 | ||
| Therapeutic embolism | 327 | ||
| Non-thromboembolic vascular insufficiency | 327 | ||
| Atheroma | 327 | ||
| Torsion | 327 | ||
| Spontaneous vascular occlusion | 328 | ||
| `Steal´ syndrome | 328 | ||
| External pressure occlusion | 328 | ||
| Ischaemia, infarction and gangrene | 328 | ||
| Ischaemia | 328 | ||
| Causes | 328 | ||
| General | 328 | ||
| Local | 328 | ||
| Severity of ischaemia | 328 | ||
| Infarction | 328 | ||
| Sequence of events | 328 | ||
| Systemic effects of infarcts | 328 | ||
| Low-flow infarction | 329 | ||
| Gangrene | 329 | ||
| Specific forms of gangrene | 329 | ||
| Chapter 18: Neoplasia | 331 | ||
| Classification of tumours | 331 | ||
| Behavioural classification | 331 | ||
| Histogenetic classification | 331 | ||
| Major categories of tumour origin | 331 | ||
| Differentiation | 331 | ||
| Nomenclature of tumours | 331 | ||
| Epithelial tumours | 332 | ||
| Benign tumours | 332 | ||
| Malignant tumours | 332 | ||
| Carcinoma in situ | 332 | ||
| Connective tissue tumours | 332 | ||
| Teratomas | 332 | ||
| Embryonal tumours (blastomas) | 332 | ||
| Apudomas and carcinoid tumours | 332 | ||
| Mixed neoplasm | 332 | ||
| Hamartomas | 332 | ||
| Poorly named tumours (misnomas!) | 333 | ||
| Tumour growth patterns | 333 | ||
| Histological pattern | 333 | ||
| Carcinogenesis | 333 | ||
| Chemicals | 333 | ||
| Radiation | 333 | ||
| Viruses | 333 | ||
| Hormones | 334 | ||
| Bacteria, fungi, parasites | 334 | ||
| Other agents | 334 | ||
| Host factors and carcinogenesis | 334 | ||
| Race | 334 | ||
| Diet | 334 | ||
| Inherited predisposition | 334 | ||
| Age | 334 | ||
| Gender | 335 | ||
| Premalignant disease | 335 | ||
| Carcinogenic process | 336 | ||
| Multistep theory | 336 | ||
| Genetics of cancer | 336 | ||
| Evidence for genetic alterations causing cancer | 336 | ||
| Genetic mechanisms in carcinogenesis | 337 | ||
| Oncogenes | 337 | ||
| Tumour suppressor genes | 337 | ||
| Examples of tumour suppressor genes | 338 | ||
| Rb gene and retinoblastoma | 338 | ||
| p53 tumour suppressor gene | 338 | ||
| Behaviour of tumours | 338 | ||
| Invasion | 338 | ||
| Clinical consequences of local invasion | 338 | ||
| Metastasis | 338 | ||
| Steps in the metastatic cascade | 338 | ||
| Routes of metastasis | 339 | ||
| Lymphatic | 339 | ||
| Haematogenous | 339 | ||
| Transcoelomic | 339 | ||
| Seeding or implantation at surgery | 339 | ||
| Clinical effects of tumours | 339 | ||
| Local | 339 | ||
| Systemic | 339 | ||
| Effects of metastases | 339 | ||
| Paraneoplastic effects | 339 | ||
| Humoral | 339 | ||
| Immunological | 339 | ||
| Metabolic effects | 340 | ||
| Others | 340 | ||
| Tumour markers | 340 | ||
| Tumour dependency | 340 | ||
| Breast | 340 | ||
| Prostate | 340 | ||
| Thyroid | 341 | ||
| Prognosis of tumours | 341 | ||
| Tumour staging | 341 | ||
| Dukes' classification | 341 | ||
| TNM classification | 341 | ||
| Other staging | 341 | ||
| Screening | 341 | ||
| Screening programmes | 342 | ||
| Breast | 342 | ||
| Cervix | 342 | ||
| Chapter 19: Immunology | 343 | ||
| Immunity | 343 | ||
| Innate immunity | 343 | ||
| Adaptive immunity | 343 | ||
| Essential features of the immune system | 343 | ||
| Specificity | 343 | ||
| Diversity | 343 | ||
| Memory | 343 | ||
| Recruitment of other defence mechanisms | 343 | ||
| Antigen | 343 | ||
| Humoral immunity | 344 | ||
| Antibody production | 344 | ||
| Cell-mediated immunity | 346 | ||
| Major histocompatibility complex antigens (MHC) | 346 | ||
| The structure of the immune system | 346 | ||
| Lymph nodes (Fig. 19.2) | 346 | ||
| Spleen | 347 | ||
| Mucosa-associated lymphoid tissue (MALT) | 347 | ||
| The immune response (summary) | 348 | ||
| Complement | 348 | ||
| Immune deficiency | 348 | ||
| Primary immune deficiency | 348 | ||
| Secondary immune deficiency | 349 | ||
| Hypersensitivity reactions | 349 | ||
| Type I | 349 | ||
| Type II | 349 | ||
| Type III | 349 | ||
| Type IV | 350 | ||
| Type `V´ (not part of the original Gell & Coombs classification) | 350 | ||
| Autoimmunity | 350 | ||
| Possible mechanisms of autoimmunity | 350 | ||
| Genetic factors | 350 | ||
| Antigenic abnormality | 350 | ||
| Immune dysregulation | 350 | ||
| Organ transplantation | 351 | ||
| Types of graft | 351 | ||
| Major histocompatibility complex (MHC) | 351 | ||
| HLA class I: coded at A, B, C loci | 351 | ||
| Class II | 351 | ||
| Immunological pathology of graft rejection (Fig. 19.5) | 351 | ||
| Afferent phase | 351 | ||
| Efferent phase | 352 | ||
| Clinical rejection | 352 | ||
| Hyperacute | 352 | ||
| Accelerated acute | 352 | ||
| Acute rejection | 352 | ||
| Chronic rejection | 352 | ||
| Transplant tolerance | 352 | ||
| Immunosuppression | 352 | ||
| Immunosuppressive drugs | 352 | ||
| Immunosuppressive drugs | 353 | ||
| Corticosteroids | 353 | ||
| Antiproliferative drugs | 353 | ||
| Calcineurin inhibitors (CNI) | 353 | ||
| Other drugs | 353 | ||
| Sirolimus (rapamycin) and everolimus | 353 | ||
| Antilymphocyte globulin (ALG) and antithymocyte globulin (ATG) | 353 | ||
| Monoclonal antibodies | 353 | ||
| Drugs under evaluation | 354 | ||
| Side-effects of immunosuppression | 354 | ||
| Infection | 354 | ||
| Neoplasia | 354 | ||
| Graft-vs-host disease | 354 | ||
| Chapter 20: Haemopoietic and lymphoreticular system | 355 | ||
| Haemopoiesis | 355 | ||
| Red blood cell (erythrocyte) | 355 | ||
| Reticulocytes | 355 | ||
| Anaemia | 355 | ||
| Blood loss | 355 | ||
| Haemolysis | 355 | ||
| Clinical features of haemolytic states | 356 | ||
| Sickle cell anaemia | 356 | ||
| Hereditary spherocytosis (congenital acholuric jaundice) | 356 | ||
| Impairment of red cell formation/function | 356 | ||
| Classification of anaemia | 357 | ||
| Polycythaemia | 357 | ||
| White blood cells (leucocytes) | 357 | ||
| Types of white blood cell | 358 | ||
| Neutrophils | 358 | ||
| Lymphocytes | 358 | ||
| Monocytes | 358 | ||
| Eosinophils | 358 | ||
| Basophils | 358 | ||
| Changes in white cells in disease | 358 | ||
| Leucocytosis | 358 | ||
| Leucopenia | 358 | ||
| Neutropenia | 358 | ||
| Platelets | 359 | ||
| Haemostasis | 359 | ||
| Vasoconstriction | 359 | ||
| Platelet activation | 359 | ||
| Adherence | 359 | ||
| Aggregation | 359 | ||
| Platelet plug | 359 | ||
| Coagulation mechanism | 360 | ||
| Fibrinolytic system | 360 | ||
| Assessment of coagulation system | 361 | ||
| Platelet count | 361 | ||
| Bleeding time | 361 | ||
| Whole-blood clotting time | 361 | ||
| Prothrombin times (PT) | 361 | ||
| Activated partial thromboplastin time (APTT) | 361 | ||
| Kaolin-cephalin clotting time (KCCT) | 361 | ||
| Thrombin time (TT) | 361 | ||
| Fibrin degradation products (FDPs) | 361 | ||
| Disorders of haemostasis | 362 | ||
| Platelet disorders | 362 | ||
| Thrombocytopenia | 362 | ||
| Abnormal platelet function | 362 | ||
| Blood vessel wall abnormalities | 362 | ||
| Disorders of coagulation | 362 | ||
| Congenital coagulation disorders | 362 | ||
| Haemophilia A | 362 | ||
| von Willebrand's disease | 362 | ||
| Acquired disorders of coagulation | 362 | ||
| Vitamin K deficiency | 362 | ||
| Liver disease | 362 | ||
| Disseminated intra-vascular coagulation (DIC) | 362 | ||
| Natural anticoagulants | 362 | ||
| Antithrombin III | 362 | ||
| Protein C and Protein S | 363 | ||
| Anticoagulant drugs | 363 | ||
| Heparin | 363 | ||
| Warfarin | 363 | ||
| Lymphoid system | 363 | ||
| Lymph nodes | 363 | ||
| Normal structure and function | 363 | ||
| Cortex | 364 | ||
| Paracortex | 364 | ||
| Medulla | 364 | ||
| Lymphatic system | 364 | ||
| Obstruction to lymphatics (lymphoedema) | 364 | ||
| Primary lymphoedema | 364 | ||
| Secondary lymphoedema | 364 | ||
| Lymphadenopathy | 365 | ||
| Spleen | 365 | ||
| Internal structure (Fig. 20.3) | 365 | ||
| White pulp | 365 | ||
| Red pulp | 365 | ||
| Functions of the spleen | 365 | ||
| Filtering function | 365 | ||
| Immunological function | 365 | ||
| Disorders of the spleen | 365 | ||
| Hypersplenism | 365 | ||
| Primary hypersplenism | 365 | ||
| Splenomegaly | 366 | ||
| Effects of splenectomy | 366 | ||
| Haematological effects | 366 | ||
| Post-splenectomy sepsis | 366 | ||
| Thymus | 368 | ||
| Disorders of the thymus | 368 | ||
| Thymic tumours | 368 | ||
| Blood groups | 368 | ||
| ABO system (Table 20.2) | 368 | ||
| Principles of grouping and cross-matching | 368 | ||
| Rhesus group | 369 | ||
| Rhesus incompatibility | 369 | ||
| Blood products (Fig. 20.4) | 369 | ||
| Whole blood | 369 | ||
| Red cell concentrates | 370 | ||
| Indications for blood transfusion | 370 | ||
| Platelet concentrates | 370 | ||
| Indications for platelet transfusion | 370 | ||
| SECTION IV: APPENDIX | 447 | ||
| Appendix: OSCE scenario answers | 449 | ||
| OSCE Scenario answer 1.1 | 449 | ||
| OSCE Scenario answer 1.2 | 450 | ||
| OSCE Scenario answer 2.1 | 450 | ||
| Initial pain | 450 | ||
| Localised pain | 451 | ||
| OSCE Scenario answer 2.2 | 451 | ||
| OSCE Scenario answer 3.1 | 451 | ||
| OSCE Scenario answer 3.2 | 452 | ||
| OSCE Scenario answer 4.1 | 452 | ||
| OSCE Scenario answer 4.2 | 453 | ||
| OSCE Scenario answer 5.1 | 453 | ||
| OSCE Scenario answer 5.2 | 454 | ||
| OSCE Scenario answer 6.1 | 454 | ||
| OSCE Scenario answer 6.2 | 455 | ||
| OSCE Scenario answer 7.1 | 455 | ||
| OSCE Scenario answer 7.2 | 455 | ||
| OSCE Scenario answer 8.1 | 456 | ||
| OSCE Scenario answer 8.2 | 457 | ||
| OSCE Scenario answer 9.1 | 457 | ||
| OSCE Scenario answer 9.2 | 458 | ||
| OSCE Scenario answer 10.1 | 458 | ||
| OSCE Scenario answer 10.2 | 459 | ||
| OSCE Scenario answer 11.1 | 459 | ||
| OSCE Scenario answer 11.2 | 460 | ||
| OSCE Scenario answer 12.1 | 461 | ||
| OSCE Scenario answer 12.2 | 461 | ||
| OSCE Scenario answer 13.1 | 462 | ||
| OSCE Scenario answer 13.2 | 462 | ||
| OSCE Scenario answer 14.1 | 463 | ||
| History | 463 | ||
| Examination | 463 | ||
| Investigations | 463 | ||
| Management | 463 | ||
| OSCE Scenario answer 14.2 | 464 | ||
| OSCE Scenario answer 15.1 | 465 | ||
| OSCE Scenario answer 15.2 | 465 |