Module 1: Introduction to Common Medical Conditions Glucose Insulin and Diabetes

Every cell in the body needs energy to function Muscles need energy to contract Primary source of energy is glucose Glucose is delivered to cells via blood stream Glucose needs insulin, insulin needs to bind with insulin receptors so the glucose can be taken up by the cell Insulin produced in pancreas Glucose will not be able to enter the insulin receptors if the pancreas does not produce enough insulin, this is known as type 1 diabetes (no energy) Insulin is produced by pancreas however the insulin receptors are desensitized, this is known as type 2 diabetes (too much sugar causes damage to body) Managing type 1 diabetes: Inject insulin

Blood Sugar Levels

Blood Sugar Concentration glucose

Glucose Concentration Conversion

80 MG/DL Decilitre = 1/10th Litre 80*10 = 800mg Milligrams 1/1000th = 1 gram 0.8 G/L 0.8*5 = 4 grams per human (Average glucose) Approx. 1 tsp. per human being

A1C Levels
Red blood cells carries oxygen Haemoglobin makes red blood cells red Haemoglobin and Glucose can bind to each other, this is known as glycated haemoglobin (Haemoglobin A1C) A1C Levels measuring the % of Haemoglobin Average 4-6% > 7 or 8% is considered high (considered more blood sugar than a normal person) 120 day lifespan of Haemoglobin

Heart Disease and Heart Attacks

Heart pumps blood and takes blood in from the rest of the body. Blue gets pumped to lungs and becomes oxygenated which goes back to the heart and gets pumped round the rest of the body as it is now oxygenated. Arteries provide blood to the heart, are the ones that get clogged. (Left Coronary Arteries) Left Coronary Arteries (LCA) Right Coronary Arteries (RCA) Plaques are formed to the arteries (lipids and fat and dead white blood cells) Formation of plaque is called atherosclerosis, narrows the vessel, disrupting the blood flow Schema is the deprivation of blood flow downstream known as coronary artery disease/ heart disease Heart disease is one of the causes to Heart failure Heart failure means it is failing to provide the needs for the person, not providing adequate function for the person Angina Pectoris, strangling feeling in the chest (chest pain) Symptom of heart disease If plaque is unstable it can rupture (turbulent blood flow may stimulate the rupture) this becomes highly thrombogenic (causes blood clots due to ruptured plaque) This obstructs blood flow, this will stop cells downstream getting oxygen causing them to die known as infarction (heart tissue begins to die) **PRIMARY CAUSE OF HEART ATTACK** Cardiac Arrest is actual dying of a heart Enough of an infarction causes it to die from oxygen depravation Heart attack (myocardial infarction) is not a cardiac arrest,

Arterial Thrombo-emboli and Thromboembolisms

Blood clots can form on ruptured plaque Thrombosis is the process of Thrombus (blood clots) forming Embolus is the term of anything that can float around in the blood and can lodge and restrict blood flow. Thrombo-Emboli is clotted material around the released plaque Thromboembolism is the blocking of a blood vessel by a particle that has broken away from a blood clot at its site of formation

Stenosis, ischemia and heart failure

Stenosis the narrowing of a blood vessel The narrowing blood vessel restricts blood supply, this leads to loss of function Ischemia restricting blood supply The restricted blood supply to the muscle means that the muscle is not getting enough oxygen leads to heart failure Heart failure leads to Coronary Artery Disease Coronary Artery Disease, Coronary Heart Disease and Heart Failure lead to the same thing

Strokes
A rapid loss of brain function Ischemic Stroke Lack of blood flow to particular tissues, occurring in a blood vessel in a brain, also known as cerebral infarctions 87% of strokes are Ischemic Haemorrhagic Stroke A situation where a blood vessel breaks 13% of strokes are Haemorrhagic

Normal Colon Tissue

Histology Study of tissues Colon is a piece of the large intestine removed Mucosa is the lining that makes the mucus, keeps the lining of it from drying out Two main cells: Goblet cell Goblet cells function is to secrete mucin, which dissolves in water to form mucus. They use both apocrine and merocrine methods for secretion.

Hyperplasia in Colon Tissue

Hyperplasia means too much growth caused by an irritant

Colon Dysplasia
Abnormal Growth and development in colon cells.
Colon cancer generally develops from colon polyps. Dysplasia can be identified during a colonoscopy.

Neoplasia is the abnormal proliferation of cells. Prior to Neoplasia, cells often undergo an abnormal pattern of growth, such as metaplasia or dysplasia. However, metaplasia or dysplasia does not always progress to Neoplasia. The growth of neoplastic cells exceeds that of the normal tissues around it.

Cancerous colon tissue

Diagnosis of colorectal cancer can be made by barium enema or by colonoscopy with biopsy confirmation of cancer tissue Benign tumours are not cancer. They can usually be removed and, in most cases, they do not come back. Most important, cells from benign tumours do not spread to other parts of the body. Benign tumours are rarely a threat to life. Malignant tumours are cancer. Cancer cells can invade and damage tissues and organs near the tumour. Also, cancer cells can break away from a malignant tumour and enter the bloodstream or lymphatic system. This is how cancer spreads from the original (primary) tumour to form new tumours in other parts of the body. The spread of cancer is called metastasis.

Adequacy of the Lateral Cervical Spine X-Ray

Adequate view: see from the first vertebra down to the junction of 7
st th

cervical vertebra and

the 1 thoracic vertebra Thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae Swimmers view: Raise one arm up and lower the other arm Injury for C7 could lead to paralysis as the spinal cord is behind it

Assessing Alignment of the Lateral Cervical Spine (neck) X-ray

Examine the alignment of the columns of the cervical spine. The AVBL, PVL and SLL should have a smooth curve no steps or discontinuities. Anterior vertebral body line (AVBL) Posterior vertebral line (PVL) Spinolaminar Line (SLL) Spinal Process tips

Cervical Spine Protection in Airway Management (not a substitute for formal training)
Airway is blocked e.g. Tongue falls back when conscious as the muscle relaxes Head tilt, chin lift Pulling the tongue out of the way, flexing the neck ** Avoid for trauma victims as it could cause injury ** Jaw thrust Grasping the mandible forward, used for trauma victims Insert a plastic tube to create a passageway directly into the lungs.

Introduction to the Endocrine System

Hormones are chemical messengers from one part of the body to the other Hormones go through the blood stream Small molecules derived from amino acids Endocrine hormones work from a far distance Paracrine hormones regionally active, small distance Autocrine hormones work from a very small distance, right next to that cell Pituitary gland, master gland creates hormones that work on other organs TSH. TSH goes to the thyroid glands (regulate metabolism, hunger) Pituitary gland also makes ACTH for Adrenal gland (sits above of the kidney) (regulates glucose, metabolism) Pituitary gland also makes LH Testicles (Testosterone) and FSH Ovaries (Oestrogen) Pancreas creates insulin

Bacterial Meningitis (Not viral or parasitic meningitis)

Principles of antibiotic choice 1. Site cerebral fluid Altered stage of consciousness e.g. very sleepy or irritable, lethargic (coma) Fever Meningeal signs > Stiff neck > Seizures > Abnormal movements/posture > Asymmetry (reflexes/strengths) Diagnosis Cerebral Spinal Fluid (CSF) Lumbar puncture High White Blood Cells (>0) 1~2000 Low glucose (<40) Gram stain (increases bacteria) 2. Pathogen High Influenzae type B (vaccines from 2 months) Pneumococcus (vaccines from 2 months) Meningicoccus (vaccines from 2 years) 3. Pathogen sensitivity Cethotaxene Ceftriaxone Vancomcyin (resistant) 4. Delivery

Precocious Puberty
Females start from the age of 10 breasts 10.5 hair 12-13 period Precocious puberty before the age of 8 Males start from 11.5 testes 12.5 hair 15 mature Precocious puberty before the age of 9 Variability Genetics Over nutrition > high BMI, high growth, increase puberty Concerns Final height Social Visit Address parental concerns

Childhood Growth

Ritual of the Bedside Exam

Physical exam Fremitus Patient Identity

Systemic Thinking About Cancer

Small changes in temperature and gravity e.g. eggs to chicken Cancering to healthing Study: Breast cancer placebo, osteoporosis cancers love bone Phenotype, what it looks like Phenotype vs Genotype

Vitamin C and the Limeys

Inflammation