Basic Science for the MRCS: A Revision Guide for Surgical Trainees

✍ Scribed by Andrew T. Raftery; Michael S. Delbridge; Helen E. Douglas

• Publisher: Churchill Livingstone
• Tongue: English
• Leaves: 521
• Series: MRCS Study Guides
• Edition: 2
• Category: Library

✦ Synopsis

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

Front Cover
Basic Sciencefor the MRCS: A revision guide for surgical trainees
Copyright
Preface
Acknowledgements
Contents
Section I: Anatomy
Chapter 1: The thorax
Development
Heart and great vessels
Heart (Fig. 1.1)
Great vessels (Fig. 1.2)
Fetal circulation (Fig. 1.3)
Congenital anomalies
Malposition
Left-to-right shunt
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent ductus arteriosus (PDA)
Eisenmenger's syndrome
Right-to-left shunt (cyanotic)
Fallot's tetralogy
Other congenital anomalies
Coarctation of the aorta
Abnormalities of valves
The diaphragm (Fig. 1.4)
Clinical points
Thoracic cage
Ribs
Atypical ribs
First rib
Second rib
Tenth rib
Eleventh and twelfth ribs
Clinical points
Rib fractures
Coarcation of the aorta
Cervical ribs
Costal cartilages
Sternum
Manubrium
Relations
Body
Relations
Xiphoid
Clinical points
Intercostal spaces (Fig. 1.5)
Clinical points
Trachea (Fig. 1.6)
Relations
In the neck
In the thorax
Bronchi (Fig. 1.6)
Clinical points
Anatomy of tracheostomy
The lungs
Right lung
Left lung
Roots of the lungs
Bronchopulmonary segments (Fig. 1.7)
Blood supply
Right pulmonary artery
Left pulmonary artery
Bronchial arteries
Pleura
Surface anatomy of pleura and lungs
Pleura
Lungs
Clinical points
Nerve supply of pleura
Clinical points
The diaphragm (Fig. 1.8)
Nerve supply
Anatomy of respiration
Thoracic breathing
Abdominal breathing
Inspiration
Expiration
The heart (Fig. 1.9)
Chambers of heart
Right atrium
Right ventricle
Left atrium
Left ventricle
Fibrous skeleton of the heart
Conducting system
Blood supply of heart (see Fig. 1.9)
Right coronary artery
Left coronary artery
Variations
Venous drainage (see Fig. 1.9)
Nerve supply of heart
Clinical point
Pericardium
Fibrous
Relations
Serous
Oblique and transverse sinuses (Fig. 1.10)
Transverse sinus
Oblique sinus
Clinical points
Surface anatomy of heart
Mediastinum (Fig. 1.11)
Superior mediastinum
Anterior mediastinum
Middle mediastinum
Posterior mediastinum
The mediastinal surfaces (Figs 1.13 and 1.14)
The angle of Louis
Chapter 2: The abdomen, pelvis and perineum
Development
Development of the gut
Foregut
Midgut (Fig. 2.2)
Clinical points
Anal canal
The kidneys and ureter (Fig. 2.4)
Development anomalies
Bladder and urethra
Bladder
Urethra
Clinical points
Testis
Clinical points
Anterior abdominal wall
Superficial fascia of abdominal wall
Clinical points
Abdominal wall muscles (Fig. 2.7)
Rectus abdominis
External oblique
Internal oblique
Transversus abdominis
Nerve supply of abdominal muscles
Rectus sheath (see Fig. 2.7)
Clinical points
The anatomy of abdominal incisions
Midline
Subcostal (Kocher's)
Gridiron incision (muscle-splitting)
Paramedian incision
Pararectus incision (Battle incision)
Inguinal canal
Relations
Deep inguinal ring
Superficial inguinal ring
Spermatic cord
Femoral canal
Surgical anatomy of hernias
Peritoneal cavity
Greater sac of peritoneum
Lesser sac (omental bursa)
Relations
Epiploic foramen (Foramen of Winslow; Fig. 2.10)
Clinical points
Subphrenic spaces
Clinical points
Posterior abdominal wall
Outline placeholder
Psoas major
Quadratus lumborum
Iliacus
Clinical points
Abdominal aorta (Fig. 2.11)
Outline placeholder
Common iliac artery
External iliac artery
Internal iliac artery
Inferior vena cava
Lumbar sympathetic chain
Clinical points
Pelvic floor and wall
Outline placeholder
Levator ani
Origin
Insertion
Nerve supply
Actions
Coccygeus
Origin
Insertion
Nerve supply
Action
Pelvic fascia
Perineum
Urogenital triangle (the anterior perineum)
Superficial perineal pouch
Perineal body
The posterior (anal) perineum
Ischiorectal fossa
Clinical points
Penis
Root
Glans
Body
Corpora cavernosa
Corpus spongiosum
Urethra
Male urethra
Prostatic urethra
Membranous urethra
Spongy urethra
Clinical points
Female urethra
The vulva
Scrotum
Clinical points
Testis and epididymis
Blood supply
Lymphatic drainage
Coverings of the testis
Clinical points
Vas deferens (ductus deferens)
Abdominal viscera
Oesophagus
Cervical
Thoracic
Abdominal
Blood supply
Nerve supply
Microscopic structure
Clinical points
Stomach
Relations
Blood supply
Lymphatic drainage (Fig. 2.18)
Nerve supply
Structure of the gastric mucosa (Fig. 2.19)
Clinical points
Duodenum
First part
Second part
Third part
Fourth part
Blood supply of the duodenum
Clinical points
Small intestine
Large intestine
Caecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Taenia coli
Appendices epiploicae
Appendix
Clinical points
Rectum
Relations
Blood supply of the large intestine (Fig. 2.20)
Lymphatic drainage of the large intestine
Anal canal
Anal sphincters
Rectal examination
Liver
Porta hepatis
Peritoneal relations of the liver (Fig. 2.23)
Functional anatomy of the liver
Hepatic veins
Extrahepatic biliary system (Fig 2.26)
Gall bladder
Blood supply (Fig. 2.27)
Clinical points
The portal venous system (Fig. 2.29)
Clinical points
Pancreas
Relations
Structure
Blood supply
Lymphatics
Spleen
Relations
Blood supply
Clinical points
Kidneys
Relations (Figs 2.31 and 2.32)
Blood supply
Lymphatic drainage
Clinical points
Ureter
Blood supply
Clinical points
Suprarenal glands
Relations
Blood supply
Structure
Bladder
Relations
Blood supply
Lymphatic drainage
Nerve supply
Cystoscopy
Prostate
Relations
Blood supply
Seminal vesicles
Uterus (Fig 2.33)
Relations
Blood supply (Fig. 2.34)
Lymphatic drainage
Fallopian tubes
Broad ligament
Vagina
Relations
Blood supply
Lymphatic drainage
Ovary
Relations
Blood supply
Lymphatic drainage
Vaginal examination
Chapter 3: The upper limb and breast
The pectoral girdle
The bones of the upper limb
Scapula (Fig. 3.1)
Clavicle
Humerus (Fig. 3.2)
Radius and ulna (Fig. 3.3)
The carpus (Figs 3.4 and 3.7)
Metacarpals and phalanges
Joints of the upper limb
Shoulder joint (Fig. 3.5)
Muscles acting on shoulder joint
The shoulder girdle
Sternoclavicular joint
Acromioclavicular joint
Rotator cuff
Movements of shoulder girdle
Clinical points
Elbow joint (Fig. 3.6)
Wrist joint (Fig. 3.7)
Joints of the hand
Carpometacarpal joint
Thumb
Metacarpophalangeal joints
Interphalangeal joints
Muscles controlling the hand
Long flexors
Long extensors
Extensor expansion (Fig. 3.8)
Small muscles of the hand
Interossei
Lumbricals
Muscles of the thumb
Long muscles
Short muscles (thenar eminence)
Muscles of the little finger (hypothenar eminence)
Muscle actions
Veins of the upper limb
Superficial veins
Cephalic vein
Basilic vein
Veins at the elbow
Clinical points
Deep veins
Arteries of the upper limb (Fig. 3.9)
Axillary
Brachial artery
Radial artery
Ulnar artery
Brachial plexus (Fig. 3.10)
Roots (5)
Trunks (3)
Divisions (6)
Cords (3)
Nerves
Branches of the brachial plexus
Roots
Trunks
Cords
Lateral
Medial
Posterior
Nerves of the upper limb
Axillary
Radial nerve
Musculocutaneous nerve
Median nerve
Ulnar nerve
Anatomy of nerve lesions
Brachial plexus
Erb's (Erb-Duchenne) paralysis
Klumpke's paralysis
Axillary nerve
Radial nerve
Median nerve
Ulnar nerve
Spaces of the hand
Pulp spaces of fingers (Fig. 3.11)
Bursae of the hand and synovial tendon sheaths (Fig. 3.12)
Palmar spaces
Midpalmar space
Thenar space
Palmar aponeurosis
Specialised areas of the arm
Axilla
Antecubital fossa
Carpal tunnel (Fig. 3.13)
Anatomical snuffbox
Structures around the wrist joint
Lymphatics of the upper limb
Axillary lymph nodes
Distribution of dermatomes and cutaneous nerves in the upper limb
The breast
Blood supply
Lymphatic drainage
Male breast
Clinical points
Chapter 4: The lower limb
The pelvic girdle
The hip bone (os innominatum) (Fig. 4.1)
Ilium
Pubis
Ischium
The sacrum (Fig. 4.2)
Coccyx
Joints and ligaments of the pelvis (Figs 4.3 and 4.4)
Symphysis pubis
Sacro-iliac joints
Gluteal region (Fig. 4.5)
Gluteus maximus
Origin
Insertion
Nerve supply
Actions
General points
Gluteus medius
Origin
Insertion
Nerve supply
Action
Gluteus minimus
Origin
Insertion
Nerve supply
Action
Tensor fasciae latae
Origin
Insertion
Nerve supply
Action
Piriformis
Origin
Insertion
Nerve supply
Actions
Obturator internus
Origin
Insertion
Nerve supply
Gemelli (superior and inferior)
Origin
Insertion
Nerve supply
Quadratus femoris
Origin
Insertion
Nerve supply
Greater and lesser sciatic foramina
Greater sciatic foramen
Boundaries
Structures passing through the foramen include:
Lesser sciatic foramen
Boundaries
Structures passing through the foramen include:
Clinical points
Bones of the leg and foot
The femur (Fig. 4.6)
Blood supply of the femoral head
Clinical points
The patella
Clinical points
The tibia (Fig. 4.7)
Clinical points
The fibula (Fig. 4.7)
Clinical points
Bones of the foot (Fig. 4.8)
The tarsal bones
Talus
Calcaneum
Cuboid
Navicular
Cuneiforms
Metatarsals
Femoral triangle (Fig. 4.9)
Outline placeholder
Boundaries
Floor
Roof
Contents
Femoral sheath
Femoral canal
Femoral ring
Inguinal lymph nodes
The adductor canal (subsartorial canal, hunter's canal)
The popliteal fossa (Fig. 4.10)
Arteries of the lower limb (Figs 4.11 and 4.12)
Femoral artery
Profunda femoris
Popliteal artery
Posterior tibial artery
Anterior tibial artery
Clinical points
The veins of the lower limb
Great (long) saphenous vein
Small (short) saphenous vein
Clinical points
Leg compartments
Thigh
Lower leg
Anterior compartment
Posterior compartment of the leg
Lateral compartment of the leg (peroneal compartment)
The nerves of the lower limb
Lumbar plexus (Fig. 4.13)
Femoral nerve
Obturator nerve
Sacral plexus (Fig. 4.14)
Branches:
Muscular
Superior gluteal
Inferior gluteal
Pudendal nerve
Sciatic nerve
Tibial nerve
Common peroneal nerve
Deep peroneal nerve
Superficial peroneal nerve
Cutaneous nerve supply of the leg (Fig. 4.15)
Dermatomes of the leg (Fig. 4.16)
Tendon reflexes of the lower limb
Clinical points
Nerve injuries
Sciatic nerve
Tibial nerve
Common peroneal nerve
Joints
Hip joint (Fig. 4.18)
Articular surfaces
Capsule
Ligaments
Synovium
Nerve supply
Movements
Relations
Clinical points
Knee joint (Figs 4.19 and 4.20)
Articular surfaces
Capsule
Ligaments
Synovium
Intra-articular structures
Nerve supply
Movements
Clinical points
Tibiofibular joint
Ankle joint (Fig. 4.22)
Articular surfaces
Capsule
Ligaments
Movements
Relations
Clinical points
Foot joints
Arches of the foot
Medial longitudinal arch (Fig. 4.24)
Lateral longitudinal arch
Transverse arch
Ligaments
Chapter 5: The head, neck and spine
Development
Branchial arches
The tongue
Development of the face
Cleft lip (hare´ lip; Fig. 5.1) Cleft palate (Fig. 5.2) Inclusion dermoids Development of the thyroid Clinical points Parathyroids Development of the spine Types of spina bifida Spina bifida occulta Spina bifida manifesta Growth of spinal cord and vertebral column Clinical points Head Face Mandible Sensory nerve supply of the face (Fig. 5.5) Dermatomes of the head and neck (Fig. 5.6) Facial musculature The muscles of mastication Muscles of facial expression Clinical points Blood vessels of the face Arteries Veins The scalp Cranial cavity Cranial vault (Fig. 5.7) Cranial fossae (Fig. 5.8) Anterior cranial fossa Middle cranial fossa Posterior cranial fossa Base of the skull Orbit and eyeball The bony orbit (Fig. 5.10) Structures entering and leaving the orbit The contents of the orbit The eyeball (Fig. 5.11) Fibrous coat Vascular coat Choroid Ciliary body Iris Neural Contents of the eyeball (Fig. 5.13) Lens Aqueous humour Vitreous body Orbital muscles Outline placeholder Four recti Superior oblique Inferior oblique Nerve supply Movements of the eyeball Eyelids Conjunctiva Lacrimal apparatus The ear External ear Auricle (Fig. 5.14) External auditory meatus Middle ear Tympanic cavity Lateral wall Medial wall Posterior wall Anterior wall Floor Roof Tympanic membrane (eardrum) (Fig. 5.15) The ossicles Auditory tube (Eustachian tube) Inner ear (Fig. 5.16) Features of the inner ear The nose and paranasal air sinuses The nose External nose (Fig. 5.18) Nasal cavity Roof Floor Medial wall (nasal septum) Lateral wall Conchae Meatuses Openings Mucous membrane Olfactory nerve Blood supply Paranasal air sinuses Maxillary sinus Clinical points Nerve supply Lymphatic drainage Ethmoidal air cells (sinuses) Frontal sinus Sphenoidal sinus The muscles of mastication Outline placeholder Masseter Origin Insertion Action Temporalis Origin Insertion Action Lateral pterygoid Origin Insertion Action Medial pterygoid Origin Insertion Action Temporomandibular joint Clinical points Floor of the mouth and tongue (Fig. 5.20) Floor of the mouth Lingual nerve Hypoglossal nerve The tongue Structure Blood supply Lymphatic drainage Nerve supply Clinical points Salivary glands Parotid gland (serous gland) Relations Parotid duct (Stensen's duct) Submandibular gland (mixed serous and mucous gland) Relations Clinical points The sublingual gland (mucous gland) The neck The fascial compartments of the neck Investing fascia Prevertebral fascia Pretracheal fascia Carotid sheath The triangles of the neck (Fig. 5.21) Anterior triangle Muscles attached to the hyoid bone Blood vessels of the anterior triangle (Fig. 5.22) Common carotid artery Internal carotid artery External carotid artery Internal jugular vein Internal jugular vein cannulation The thyroid gland Relations (Fig. 5.23) Blood supply Arterial Venous Clinical points Parathyroid glands Clinical points The larynx (Figs 5.24 and 5.25) Epiglottis Thyroid cartilage Cricoid cartilage Arytenoid cartilages Corniculate cartilage Cuneiform cartilage Cricothyroid membrane (cricovocal membrane) Vestibular fold Vocal cord Rima glottidis Three compartments of the larynx Piriform fossa Muscles of the larynx Actions Blood supply Lymphatic drainage Nerve supply Superior laryngeal nerve Recurrent laryngeal nerve Clinical points Pharynx (Fig. 5.25) Nasopharynx Oropharynx Blood supply Lymphatic drainage Clinical points Laryngopharynx (hypopharynx) Structure of the pharynx Mucosa Muscles of the pharynx The constrictor muscles Innervation of the pharynx Posterior triangle Contents Surface marking of accessory nerve Clinical points Cervical plexus (Fig. 5.27) Superficial branches Deep branches Infrahyoid muscles The phrenic nerve Course of the phrenic nerve Root of neck (Fig. 5.28) Suprapleural membrane (Sibson's fascia) Subclavian artery Subclavian vein Brachial plexus Thoracic duct Clinical points Stellate ganglion Clinical points Lymph nodes of the head and neck Superficial nodes Deep lymph nodes Vertical chain Circular chain Clinical points Spine Vertebral column Basic vertebral pattern (Fig. 5.29) Neural arch Body Cervical vertebrae (Fig. 5.30) Thoracic vertebrae (Fig. 5.31) Lumbar vertebrae (Fig. 5.32) Sacrum and coccyx Intervertebral joints (Fig. 5.33) Clinical points Chapter 6: The nervous system The brain Cerebral hemispheres (Figs 6.1 and 6.2) Cerebral cortex (Figs 6.1 and 6.2) Frontal lobe Parietal lobe Temporal lobe Occipital lobe Clinical points Basal ganglia Midbrain Pons Medulla Cerebellum Clinical points Spinal cord Clinical points Internal structure of spinal cord (Fig. 6.7) The tracts of the spinal cord (Fig. 6.8) Descending tracts Ascending tracts Blood supply of the spinal cord Clinical points Outline placeholder Outline placeholder Complete transection of spinal cord Incomplete spinal cord injury (Fig. 6.10) The meninges Dura mater Falx cerebri Tentorium cerebelli Falx cerebelli Diaphragma sellae Arachnoid mater Subarachnoid cisterns Pia mater Production and circulation of CSF Blood supply to the brain (see Fig. 5.22) Vertebral arteries Basilar artery Branches Internal carotid arteries Branches Middle cerebral artery Circle of Willis (Fig. 6.11) Venous drainage of brain Dural venous sinuses (Fig. 6.12) Superior sagittal sinus Inferior sagittal sinus Straight sinus Transverse sinus Sigmoid sinus Confluence of sinuses Occipital sinus Cavernous sinus (Fig. 6.13) Clinical points Cranial nerves I. Olfactory nerve Clinical points II. Optic nerve (Fig. 6.14) Clinical points III. Oculomotor nerve Clinical points IV. Trochlear nerve Clinical points V. Trigeminal nerve Trigeminal ganglion Ophthalmic division Maxillary division Pterygopalatine ganglion Mandibular division Otic ganglion Submandibular ganglion Clinical points VI. The abducent nerve Clinical points VII. Facial nerve Clinical points VIII. Vestibulocochlear (auditory) nerve Clinical points IX. Glossopharyngeal nerve Clinical points X. Vagus nerve Clinical points XI. Accessory nerve Clinical points XII. Hypoglossal nerve Clinical points Peripheral nervous system Spinal nerves and their distribution (Fig. 6.7) Spinal nerves Cervical plexus Brachial plexus Lumbar plexus Sacral plexus Upper and lower motor neurons Dermatomes Motor root values and peripheral nerve supply of important muscle groups Tendon and abdominal reflexes Autonomic nervous system Sympathetic nervous system Origin of sympathetic outflow Sympathetic trunk Distribution of pre- and postganglionic fibres Head and neck Upper limb Lower limb Abdominal and pelvic viscera Parasympathetic nervous system SECTION II: PHYSIOLOGY Chapter 7: General physiology Homeostasis Nervous system Hormonal system Thermoregulation Heat production Heat loss Regulation of body temperature Peripheral thermoreceptors Reflex vasoconstriction Reflex vasodilatation Receptors on internal surfaces Body temperature Core temperature Peripheral temperature Abnormal temperature regulation Fever (pyrexia) Heatstroke Hypothermia Factors affecting thermoregulation Fluid balance and fluid replacement therapy Body water Functions of the kidney Diuresis Water diuresis Osmotic diuresis Water balance Regulation of total body water Disturbances of total body water content Water depletion Water intoxication Electrolyte disorders Sodium Regulation of sodium Renal Extrarenal Sodium excess Sodium depletion Potassium Hyperkalaemia Hypokalaemia Acid-base balance Carbonic acid-bicarbonate system Disturbances of acid-base balance Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Mixed acid-base disorders Interpretation of acid-base changes Anion gap Fluid balance and fluid replacement therapy Fluid balance in the uncomplicated patient Change in fluid and electrolyte requirements in response to surgery and trauma Fluid and electrolyte problems in surgical patients Blood and plasma Gastrointestinal losses Intraperitoneal fluid loss Septicaemia Excessive insensible fluid loss Colloid and crystalloid solutions Types Uses Albumin Dextran Gelatins Hydroxyethyl starch Choice of plasma expanders General problems of plasma expanders Crystalloids Common types Uses Oedema and lymphatic function Causes of oedema Obstruction to lymphatics Chapter 8: Respiratory system Introduction Components Function Airway function Mechanics of Ventilation Pulmonary ventilation Lung pressures (Fig. 8.1) Surfactant and surface tension (Fig. 8.2) Compliance (Fig. 8.3) Respiratory muscles Work of breathing (Fig. 8.4) Regional variations in ventilation (Fig. 8.5) Clinical physiology Pneumothorax Spontaneous (primary) pneumothorax Spontaneous (secondary) pneumothorax Traumatic (closed) pneumothorax Tension pneumothorax Open pneumothorax orsucking´ chest wound
Pulmonary assessment
Lung volumes (Box 8.1)
Dead space and alveolar ventilation rate
Peak expiratory flow rate (PEFR)
Closing capacity
Flow-volume and volume-time curves
Diffusion capacity
Pulmonary blood flow
Structure of the lung
Regulation of pulmonary blood flow
Regional variations in pulmonary blood flow
Cardiac output and pulmonary vascular resistance
Ventilation and perfusion
Clinical physiology
Pulmonary embolus
Pleural effusion
Pulmonary oedema
Adult respiratory distress syndrome
Gas diffusion and exchange
Gas diffusion
Gas exchange (Table 8.1)
Gas transport (Fig. 8.11)
Oxygen transport
Carbon dioxide transport
Regulation of Respiration
Neurological regulation
Chemical regulation
Hypoxia and respiratory failure
Hypoxia and hypoxaemia
Respiratory failure
Clinical physiology
Response to hypoxia
Acute
Chronic
Oxygen therapy and mechanical ventilation
Oxygen therapy
Mechanical ventilation
Indications
Intermittent positive pressure ventilation (IPPV)
Complications
Chapter 9: Cardiovascular system
Cardiac muscle
Cardiac action potential (Fig. 9.1)
Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
Excitation/contraction coupling
Generation and conduction of cardiac impulse
Generation of cardiac output
Phases of the cardiac cycle (Fig. 9.2)
Outline placeholder
Phase IVc
Phase I
Phase IIa
Phase IIb
Phase III
Phase IVa
Phase IVb
Intracardiac pressures
Heart sounds
Outline placeholder
First heart sound
Second heart sound
Third heart sound
Fourth heart sound
Venous pulse (Fig. 9.4)
a-wave
c-wave
v-wave
x-descent
y-descent
Coronary circulation
Cardiac output (co)
Regulation of cardiac output
Starling's law of the heart (Fig. 9.5)
Factors modifying cardiac output
1. Contractility
2. Preload
3. Afterload
Measurement of cardiac output
Fick method
Thermodilution
Dye dilution
Doppler ultrasound
Blood pressure
Control of blood pressure (general systemic blood pressure)
Factors determining arterial blood pressure
Control of local blood pressure and blood flow
Peripheral resistance (systemic vascular resistance; SVR)
Monitoring the circulation
ECG
Blood pressure
Central venous pressure
Pulmonary capillary wedge pressure (pulmonary artery occlusion pressure; PAOP)
Pulse oximetry
Cardiac output
Urine output
Echocardiography
Echo Doppler
Cardiovascular support
Outline placeholder
Ventilate
Infusion
Pump
Pharmacological support
Adrenaline
Noradrenaline
Isoprenaline
Dopamine
Dobutamine
Dopexamine
Vasodilators
Phosphodiesterase inhibitors
Chapter 10: Gastrointestinal system
Functions
Nervous and hormonal regulation within the GI tract
Nervous regulation
Hormones and neurotransmitters
Oral cavity, pharynx and oesophagus
Chewing
Saliva
Swallowing
Oesophageal sphincter
Stomach
Gastric mucosa
Gastric secretion
Gastric acid (Fig. 10.1)
Pepsinogen secretion
Mucus secretion
Intrinsic factor secretion
Regulation of gastric secretion
Gastric motility
Storage
Mixing and propulsion
Clinical physiology
Vomiting
Treatment of peptic ulceration
Medical treatment
Surgical treatment
Post-gastrectomy syndromes
Effects of vagotomy
Small intestine
Small intestine mucosa
Absorption (Table 10.1)
Carbohydrates (Fig. 10.3)
Fats (Fig. 10.4)
Protein (Fig. 10.5)
Fluids and electrolytes
Vitamins
Iron
Calcium
Small intestinal motility
Clinical physiology
Physiological effects of duodenal resection
Physiological effects of terminal ileal resection
Pancreas
Exocrine secretions
Fluid component
Enzyme component
Proteolytic enzymes
Amylase
Lipolytic enzymes
Regulation of exocrine secretions
Cephalic
Gastric
Intestinal
Endocrine secretions
Clinical physiology
Physiological effects of pancreatic resection
Liver and gall bladder
Liver
Bile production (Fig. 10.6)
Metabolic functions
Carbohydrate metabolism
Protein metabolism
Lipid metabolism
Protein synthesis
Vitamin D activation
Detoxification
Vitamin and mineral storage
Phagocytosis
Haemopoiesis
Clinical physiology
Jaundice
Prehepatic jaundice
Hepatocellular jaundice
Cholestatic jaundice
Gall bladder
Clinical physiology
Physiological effects of cholecystectomy
Large bowel
Water absorption
Colonic flora
Large intestinal motility
Defecation
Clinical physiology
Diarrhoea
Osmotic
Secretory
Inflammatory
Abnormal motility
Constipation (Box 10.1)
Nutrition
Requirements
Regulation
Chapter 11: Urinary system
Components
Functions
Structure
Renal blood supply
Renal circulation
Regulation of renal blood flow
Glomerulus (Fig. 11.1)
Microscopic structure
Glomerular filtration
Proximal convoluted tubule
Loop of Henle
Countercurrent multiplier mechanism (Fig. 11.2)
Distal convoluted tubule and collecting ducts
Regulation of NA+ and water reabsorption
Antidiuretic hormone
Renin-angiotensin-aldosterone system (RAS)
Atrial natriuretic peptide (ANP)
Ion and nutrient reabsorption
Potassium
Calcium and phosphate
Hydrogen and bicarbonate (Fig. 11.3)
Glucose and amino acids
Urea
Glomerular filtration rate (GFR) and renal plasma flow
Measuring GFR
Measuring renal plasma flow
Micturition
Clinical physiology
Bladder function and spinal injury
Hormone production
Renin
Erythropoietin
1α-hydroxylase
Chapter 12: Endocrine system
Introduction
Pituitary and hypothalamic function
Control of pituitary function
Anterior pituitary
Posterior pituitary
Anterior pituitary hormones
Adrenocorticotrophic hormone (ACTH)
Thyroid-stimulating hormone (TSH)
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
Prolactin
Growth hormone (GH)
Posterior pituitary hormones
Oxytocin
Antidiuretic hormone
Clinical physiology
Pituitary disorders
Increased hormone secretion
Decreased hormone secretion
Thyroid function
Anatomy
Synthesis of thyroid hormone (Fig. 12.1)
Clinical physiology
Antithyroid drugs
Secretion and transport of thyroid hormone
Effects of thyroid hormone
Clinical physiology
Thyroid disorders
Hyperthyroidism
Hypothyroidism
Sick euthyroid syndrome
Calcium and phosphate regulation
Calcium
Regulation of calcium balance
Parathormone
Vitamin D
Calcitonin
Regulation of phosphate balance
Clinical physiology
Disorders of calcium and phosphate balance
Hypoparathyroidism
Hyperparathyroidism
Vitamin D deficiency
Hypocalcaemia
Hypercalcaemia
Hypophosphataemia
Hyperphosphataemia
Adrenal function
Cortex
Synthesis and excretion
Actions of the adrenal cortex hormones
Aldosterone
Cortisol
Androgens
Medulla
Clinical physiology
Disorders of adrenal function
Addison's disease
Hyperaldosteronism
Cushing's disease/syndrome
Adrenogenital syndrome
Phaeochromocytoma
Growth hormone
Clinical physiology
Disorders of growth hormone secretion
Gigantism
Acromegaly
Endocrine function of the pancreas
Insulin
Carbohydrate metabolism
Protein metabolism
Lipid metabolism
Glucagon
Carbohydrate metabolism
Lipid metabolism
Somatostatin
Effects of other hormones on glucose regulation
Glucocorticoids
Growth hormone
Thyroid hormone
Catecholamines
Clinical physiology
Disorders of the endocrine pancreas
Diabetes mellitus
Acute
Chronic
Pancreatic endocrine tumours
Hormonal response to trauma/surgery
Chapter 13: Nervous and locomotor systems
Introduction
Components
Functions
Central nervous system
Cerebral blood flow (Fig. 13.1)
Autoregulation
Myogenic
Metabolic
Neural control of cerebral blood flow
Local control of cerebral blood flow
Cerebrospinal fluid
Blood-brain barrier (Fig. 13.2)
Brainstem death
Preconditions for the diagnosis of brainstem death
Exclusion criteria for the diagnosis of brainstem death
Brainstem death tests
Space-occupying lesions and raised intracranial pressure
Raised intracranial pressure (ICP) (Fig. 13.3)
Post-operative confusion
Peripheral nervous system (PNS)
Conduction and transmission
Action potentials (Fig. 13.5)
Propagation of action potentials
Synaptic transmission
Neurotransmitters
Pain and sensation
Drug modulation of pain
Autonomic nervous system (ANS) (Fig. 13.8)
Sympathetic nervous system
Parasympathetic nervous system
Functions of the autonomic nervous system
Locomotor system
Skeletal muscle physiology
Structure of skeletal muscle
Skeletal muscle classification
Sliding filament hypothesis (Fig. 13.9)
Excitation contraction coupling
Neuromuscular transmission
Locomotion
Spinal cord reflexes
Muscle stretch reflex (Fig. 13.10)
Golgi tendon organ reflex
Withdrawal reflex (Fig. 13.11)
Control of locomotion
Cerebral cortex
Brainstem
Cerebellum
Basal ganglia
Bone physiology
Bone formation and reabsorption
SECTION III: PATHOLOGY
Chapter 14: Cellular injury
Mechanisms of cellular injury
Cell death
Necrosis
Coagulative necrosis
Colliquative necrosis
Caseous necrosis
Gangrenous necrosis
Fibrinoid necrosis
Fat necrosis
Apoptosis
Function of apoptosis
Mediators of apoptosis
p53
bcl-2
fas (CD 95)
Caspases
Morphological features of apoptosis
Diseases of increased apoptosis
Diseases of decreased apoptosis
The process of healing
Regeneration and repair
Cell renewal
Repair
Granulation tissue
Clinical problems with organisation and wound contraction
Organisation
Wound contraction
Injuries to specific tissues
Skin
Skin anatomy (Fig. 14.1)
Incised wound (surgical incision)-healing by first intention
Tissue loss-healing by second intention
Abnormalities of skin healing
Keloid
Hypertrophied scar
Anatomy of repair of defects
Reconstructive ladder (Fig. 14.3)
Grafts
Skin grafts
Mechanism of skin graft take
Split-thickness skin grafts (Fig. 14.4)
Full-thickness skin grafts (Fig. 14.5)
Flaps
Classification
Local flaps
Transposition flap (Fig. 14.9A)
Rotation flap (Fig. 14.9B)
Advancement flap (Fig. 14.9C)
Z-plasty (Fig. 14.9D)
Free flaps (Fig. 14.10)
Radial forearm flap
Anterolateral thigh flap
Deep inferior epigastric perforator (DIEP)/transverse rectus abdominis myocutaneous (TRAM) flap
Bone
Factors affecting bone healing
Liver
Kidney
Cardiac muscle
Neural tissue
Peritoneum
Gastrointestinal tract
Mucosal erosions
Mucosal ulcers
Gastrointestinal anastomoses
Factors affecting wound healing
Local
Systemic
Injury due to ionising radiation
Mode of action
Effects on tissues
Effect on individual tissues
Bone marrow
Skin
Intestines
Gonads
Lung
Kidney
Whole body irradiation
Ultraviolet light
Therapeutic irradiation
Radical applications
Adjuvant radiotherapy
Palliative radiotherapy
Fractionation of dose
Response modifiers
Injury due to burns
Types of burn
Thermal
Electrical
Chemical
Causes of burns
Predisposing medical conditions
Burn injury response
Local response (Fig. 14.11)
Systemic response
Carbon monoxide effects
Assessing a burn
The extent of body surface area burnt (Fig. 14.12)
The depth of the burn (Fig. 14.13)
Chapter 15: Disorders of growth, morphogenesis and differentiation
Growth
Cell turnover
Cell cycle
Phases of the cell cycle (Fig. 15.1)
Other factors involved in the cell cycle
Control of cell division
Therapeutic interruptions of cell cycle (Fig. 15.2)
Factors affecting growth
Genetic factors
Hormones
Nutrition
Blood supply
Oxygen supply
Nerve supply
Growth factors
Increased growth
Physiological hypertrophy and hyperplasia
Pathological hypertrophy
Pathological hyperplasia
Atrophy
Physiological (Box 15.1)
Pathological
Decreased growth (hypoplasia)
Differentiation
Control of differentiation
Morphogenesis
Congenital disorders of differentiation and morphogenesis
Chromosomal abnormalities affecting whole chromosomes
Chromosomal abnormalities affecting parts of chromosomes
Single gene alterations
Functional aspects of developmental disorders
Anomalies of organogenesis
Agenesis (aplasia)
Atresia
Hypoplasia
Dysgenesis (dysplasia)
Ectopia (heterotopia)
Acquired disorders of differentiation and growth
Metaplasia
Dysplasia
Polyps
Pathological processes causing polyps
Symptoms of polyps
Examples of polyps
Neoplasia
Chapter 16: Inflammation
Classification
Acute inflammation
Causes of acute inflammation
Macroscopic signs and symptoms of acute inflammation
Stages of acute inflammation
Changes in vessel calibre
Increased vascular permeability
Formation of cellular exudate
Chemical mediators of acute inflammation
Plasma factors
Complement system
Kinin system
Coagulation system
Fibrinolytic system
Role of macrophages
Role of lymphatics
Role of neutrophil polymorphs
Special types of inflammation
Outline placeholder
1. Serous
2. Catarrhal
3. Fibrinous inflammation
4. Haemorrhagic inflammation
5. Suppurative inflammation
6. Membranous inflammation
7. Pseudomembranous inflammation
8. Necrotising inflammation
Effects of acute inflammation
Beneficial effects (exudate)
Harmful effects (release of lysosomal enzymes)
Sequelae of acute inflammation
Resolution
Conditions favouring resolution
Sequence of events leading to resolution
Suppuration
Organisation
Circumstances favouring organisation
Sequence of organisation
Progress to chronic inflammation
Systemic effects of inflammation
Chronic inflammation
Features of chronic inflammation
Causes of chronic inflammation
Primary chronic inflammation
Progression from acute inflammation
Recurrent episodes of acute inflammation
Transplant rejection
Macroscopic appearances of chronic inflammation
Granulomatous disease
Outline placeholder
Epithelioid histiocytes
Types of giant cell
Causes of granulomatous disease
Chapter 17: Thrombosis, embolism and infarction
Thrombosis
Causes of thrombosis
Damage to vessel wall
Arterial thrombosis
Venous thrombosis
Alterations in blood flow
Alterations of the constituents of the blood
Stages in the development of thrombosis
Fate of thrombi
Embolism
Thromboembolism
Venous thromboembolism
Arterial thromboembolism
Gas embolism
Fat embolism
Tumour emboli
Amniotic fluid embolism
Foreign body embolism
Therapeutic embolism
Non-thromboembolic vascular insufficiency
Atheroma
Torsion
Spontaneous vascular occlusion
Steal´ syndrome External pressure occlusion Ischaemia, infarction and gangrene Ischaemia Causes General Local Severity of ischaemia Infarction Sequence of events Systemic effects of infarcts Low-flow infarction Gangrene Specific forms of gangrene Chapter 18: Neoplasia Classification of tumours Behavioural classification Histogenetic classification Major categories of tumour origin Differentiation Nomenclature of tumours Epithelial tumours Benign tumours Malignant tumours Carcinoma in situ Connective tissue tumours Teratomas Embryonal tumours (blastomas) Apudomas and carcinoid tumours Mixed neoplasm Hamartomas Poorly named tumours (misnomas!) Tumour growth patterns Histological pattern Carcinogenesis Chemicals Radiation Viruses Hormones Bacteria, fungi, parasites Other agents Host factors and carcinogenesis Race Diet Inherited predisposition Age Gender Premalignant disease Carcinogenic process Multistep theory Genetics of cancer Evidence for genetic alterations causing cancer Genetic mechanisms in carcinogenesis Oncogenes Tumour suppressor genes Examples of tumour suppressor genes Rb gene and retinoblastoma p53 tumour suppressor gene Behaviour of tumours Invasion Clinical consequences of local invasion Metastasis Steps in the metastatic cascade Routes of metastasis Lymphatic Haematogenous Transcoelomic Seeding or implantation at surgery Clinical effects of tumours Local Systemic Effects of metastases Paraneoplastic effects Humoral Immunological Metabolic effects Others Tumour markers Tumour dependency Breast Prostate Thyroid Prognosis of tumours Tumour staging Dukes' classification TNM classification Other staging Screening Screening programmes Breast Cervix Chapter 19: Immunology Immunity Innate immunity Adaptive immunity Essential features of the immune system Specificity Diversity Memory Recruitment of other defence mechanisms Antigen Humoral immunity Antibody production Cell-mediated immunity Major histocompatibility complex antigens (MHC) The structure of the immune system Lymph nodes (Fig. 19.2) Spleen Mucosa-associated lymphoid tissue (MALT) The immune response (summary) Complement Immune deficiency Primary immune deficiency Secondary immune deficiency Hypersensitivity reactions Type I Type II Type III Type IV TypeV´ (not part of the original Gell & Coombs classification)
Autoimmunity
Possible mechanisms of autoimmunity
Genetic factors
Antigenic abnormality
Immune dysregulation
Organ transplantation
Types of graft
Major histocompatibility complex (MHC)
HLA class I: coded at A, B, C loci
Class II
Immunological pathology of graft rejection (Fig. 19.5)
Afferent phase
Efferent phase
Clinical rejection
Hyperacute
Accelerated acute
Acute rejection
Chronic rejection
Transplant tolerance
Immunosuppression
Immunosuppressive drugs
Immunosuppressive drugs
Corticosteroids
Antiproliferative drugs
Calcineurin inhibitors (CNI)
Other drugs
Sirolimus (rapamycin) and everolimus
Antilymphocyte globulin (ALG) and antithymocyte globulin (ATG)
Monoclonal antibodies
Drugs under evaluation
Side-effects of immunosuppression
Infection
Neoplasia
Graft-vs-host disease
Chapter 20: Haemopoietic and lymphoreticular system
Haemopoiesis
Red blood cell (erythrocyte)
Reticulocytes
Anaemia
Blood loss
Haemolysis
Clinical features of haemolytic states
Sickle cell anaemia
Hereditary spherocytosis (congenital acholuric jaundice)
Impairment of red cell formation/function
Classification of anaemia
Polycythaemia
White blood cells (leucocytes)
Types of white blood cell
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Changes in white cells in disease
Leucocytosis
Leucopenia
Neutropenia
Platelets
Haemostasis
Vasoconstriction
Platelet activation
Adherence
Aggregation
Platelet plug
Coagulation mechanism
Fibrinolytic system
Assessment of coagulation system
Platelet count
Bleeding time
Whole-blood clotting time
Prothrombin times (PT)
Activated partial thromboplastin time (APTT)
Kaolin-cephalin clotting time (KCCT)
Thrombin time (TT)
Fibrin degradation products (FDPs)
Disorders of haemostasis
Platelet disorders
Thrombocytopenia
Abnormal platelet function
Blood vessel wall abnormalities
Disorders of coagulation
Congenital coagulation disorders
Haemophilia A
von Willebrand's disease
Acquired disorders of coagulation
Vitamin K deficiency
Liver disease
Disseminated intra-vascular coagulation (DIC)
Natural anticoagulants
Antithrombin III
Protein C and Protein S
Anticoagulant drugs
Heparin
Warfarin
Lymphoid system
Lymph nodes
Normal structure and function
Cortex
Paracortex
Medulla
Lymphatic system
Obstruction to lymphatics (lymphoedema)
Primary lymphoedema
Secondary lymphoedema
Lymphadenopathy
Spleen
Internal structure (Fig. 20.3)
White pulp
Red pulp
Functions of the spleen
Filtering function
Immunological function
Disorders of the spleen
Hypersplenism
Primary hypersplenism
Splenomegaly
Effects of splenectomy
Haematological effects
Post-splenectomy sepsis
Thymus
Disorders of the thymus
Thymic tumours
Blood groups
ABO system (Table 20.2)
Principles of grouping and cross-matching
Rhesus group
Rhesus incompatibility
Blood products (Fig. 20.4)
Whole blood
Red cell concentrates
Indications for blood transfusion
Platelet concentrates
Indications for platelet transfusion
Administration
Granulocytes
Fresh frozen plasma (FFP)
Indications for FFP transfusion
Administration
Cryoprecipitate
Indications for cryoprecipitate transfusion
Factor VIII concentrate
Complications of blood transfusion
Haemolytic transfusion reactions
Immediate
Delayed
Reaction to white blood cells
Infection
Complications of massive blood transfusion
Autologous blood transfusion
Chapter 21: Basic microbiology
Sources of surgical infection
Endogenous infection
Normal body flora
Commensal organisms
Prevention of endogenous infection
Exogenous infection
Methods of spread of infection
Sources of wound contamination
Prevention and control of hospital-acquired infection
Control of staphylococcal outbreaks
Methicillin-resistant Staphylococcus aureus (MRSA)
Risk factors for colonisation
Clinical presentation
Infection control
Management
Carriers
Patients with MRSA
Surgically important micro-organisms
Gram-positive cocci
Staphylococci
Antibiotic sensitivity
Streptococci and enterococci
Lancefield group A
Antibiotic sensitivity
Lancefield group D
Antibiotic sensitivity
Viridans streptococci
Streptococcus pneumoniae (pneumococcus)
Antibiotic sensitivity
Gram-positive rods
Outline placeholder
Clostridium difficile
Gram-negative cocci
Gram-negative bacilli
Facultative anaerobes (enterobacteria, coliforms)
Escherichia coli
Klebsiella
Proteus
Salmonella
Shigella
Yersinia
Other enterobacteria
Antibiotic sensitivity
Aerobic Gram-negative bacilli
Outline placeholder
Pseudomonas aeruginosa
Antibiotic sensitivity
Anaerobic Gram-negative bacilli
Outline placeholder
Bacteroides
Antibiotic sensitivity
Other Gram-negative bacilli
Outline placeholder
Campylobacter
Haemophilus influenzae
Antibiotic sensitivity
Pasteurella multocida
Helicobacter pylori
Pathophysiology of sepsis
Systemic inflammatory response syndrome (SIRS)
Systemic inflammatory response syndrome and multi-organ dysfunction syndrome (MODS)
Primary precipitating event
Inflammatory response
Stage I
Stage II
Stage III
Clinical definition of sepsis syndrome
Clinical effects of sepsis syndrome
Septic shock (refractory shock)
Multi-organ dysfunction syndrome
Factors leading to multi-organ failure
Clinical picture of multi-organ dysfunction
Respiratory
Cardiovascular
Renal
Hepatic
Gastrointestinal tract
Cerebral
Haematological
Metabolic
Principles of treatment of sepsis syndrome
Surgical sepsis
Skin infections
Boils, styes and carbuncles
Erysipelas
Cellulitis
Acute pyogenic cellulitis
Anaerobic cellulitis
Fournier's gangrene
Meleney's gangrene
Lymphangitis and lymphadenitis
Gas gangrene
Clinical features
Diagnosis
Treatment
Prevention
Tetanus
Clinical features
Diagnosis
Prevention
Treatment
Preventative
Treatment in suspected case
Abscesses
Surgical site infection (SSI)
Operating environment
Theatre layout
Air flow in theatre
Minimising infection from operating theatre personnel
Prevention of infection
Principles of asepsis and antisepsis
Risk factors contributing to sepsis
Wound infection
Classification of wounds
Factors influencing the development of wound sepsis
Preoperative skin preparation
Skin shaving
Skin preparation
Occlusive adhesive drapes
Disinfection
Efficacy
Examples of disinfectants
Sterilisation
Physical
Heat
Moist heat (autoclave)
Dry heat
Irradiation
Filtration
Chemicals
Ethylene oxide
Glutaraldehyde
Formaldehyde
Modern antibiotic usage
Commonly used antibiotics
Penicillins
Benzyl penicillin
Phenoxymethyl penicillin (penicillin V)
Flucloxacillin
Amoxicillin and ampicillin
Co-amoxiclav (Augmentin)
Piperacillin
Precautions when administering penicillins
Cephalosporins
Cefradine and cefalexin
Cefuroxime
Cefotaxime and ceftazidime
Precautions when administering cephalosporins
Sulphonamides and trimethoprim
Co-trimoxazole (sulfamethoxazole+trimethoprim)
Trimethoprim
Macrolides
Erythromycin and clarithromycin
Aminoglycosides
Gentamicin
Amikacin
Precautions when administering aminoglycosides
Quinolones
Ciprofloxacin
Other antibiotics and microbials
Metronidazole
Tetracycline and doxycycline
Fusidic acid
Vancomycin
Teicoplanin
Carbapenems
Antibiotics in surgery
Principles of antibiotic therapy
Selection of antibiotic
Treatment with a combination of antibiotics
Route of administration
Duration of therapy
Dosage
Penetration of tissue
Hypersensitivity
Drug toxicity
Superinfection
Prophylactic antibiotics
Antibiotic resistance
Acquiring resistance
Spreading resistance
Chromosomal mutation causing an altered protein
Genes on transmissible plasmids
Transposons
Predictable sensitivity
Clinical factors leading to the emergence of resistant strains
Surgery and blood-borne viruses
Outline placeholder
Hepatitis B
Clinical presentation
Serology
Hepatitis C
Clinical presentation
Serology
Outcome
HIV
Natural history
HIV tests
HIV indicator diseases
Precautions in Hepatitis B, Hepatitis C and HIV patients
Universal precautions
Special precautions
Immunisation
Hepatitis B
Management of sharps injuries
Post-exposure prophylaxis
Hepatitis B
Hepatitis C
HIV
CJD and vCJD
Chapter 22: System-specific pathology
Nervous system
Head injury
Missile injury to the brain
Non-missile injury to brain
Primary brain damage
Secondary brain damage
Outcome of non-missile head injury
Intracranial haemorrhage
Extracerebral
Extradural haemorrhage
Subdural haemorrhage
Subarachnoid haemorrhage
Intracerebral haemorrhage
Diffuse petechial haemorrhages
Raised intracranial pressure
Hydrocephalus
Cerebral ischaemia
Brain shift and herniation
Systemic effects
Clinical manifestations of raised intracranial pressure
Cerebral abscess
Complications
Tumours of the nervous system
Outline placeholder
Astrocytoma
Glioblastoma multiforme
Medulloblastoma
Ependymomas
Oligodendrogliomas
Meningiomas
Acoustic neuroma
Secondary tumours
Clinical features of CNS tumours
Pituitary tumours
Secretory tumours (e.g. prolactinoma)
Non-secretory tumours
Spinal cord injuries
Open injuries
Closed injuries
Complete transection of spinal cord
Incomplete spinal cord injury (see Fig. 6.10)
Peripheral nerve injuries
Wallerian degeneration
Musculoskeletal system
Osteomyelitis
Acute osteomyelitis
Chronic osteomyelitis
Septic arthritis
Fractures
Complications of fractures
Immediate
Early
Local
General
Late
Delayed union
Non-union
Mal-union
Reflex sympathetic osteodystrophy
Avascular necrosis of bone
Myositis ossificans
Osteoarthritis
Pathological fractures
General
Local
Compartment syndrome
Arthritis
Osteoarthritis
Rheumatoid arthritis
Gout
Neuropathic arthritis (Charcot's joint)
Bone tumours
Primary malignant tumours
Secondary malignant tumours
Benign tumours
Osteoma (ivory´ osteoma) Osteoid osteoma Chondroma Fibroma and fibrous dysplasia Bone cysts Primary malignant tumours Osteosarcoma (osteogenic sarcoma) Osteoclastoma (giant cell tumour) Ewing's tumour Chondrosarcoma Fibrosarcoma Myeloma Secondary bone malignancy Metabolic bone disease Rickets and osteomalacia Osteoporosis Hyperparathyroidsim Paget's disease of bone Lung tumours Primary carcinoma of the lung Aetiology Classification of lung cancer Clinical features Primary Complications Prognosis Other primary lung tumours Pneumothorax Pleural effusions Lung infections Outline placeholder Mode of infection Predisposing conditions Bronchopneumonia Lobar pneumonia Aspiration pneumonia Atypical pneumonia Legionnaires´ disease Chest infections in the immunocompromised Pneumocystis carinii Fungi Viruses Bronchiectasis Empyema Organisms Complications Lung abscess Breast disorders Benign tumours Fibroadenoma Duct papilloma Adenoma Connective tissue tumours Carcinoma of the breast Risk factors Aetiological mechanisms Non-invasive carcinomas Invasive carcinomas Gross features Paget's disease of the nipple Spread of breast carcinoma Prognostic factors Phylloides tumour Inflammatory conditions Acute pyogenic mastitis Tuberculosis Actinomycosis Mammary duct ectasia Fat necrosis Proliferative conditions of the breast Gynaecomastia Breast cancer in men Cardiovascular system Atherosclerosis Lesions of atherosclerosis Fatty streaks Gelatinous plaques Fibrolipid plaques (Fig. 22.1) Complicated plaques Risk factors Pathogenesis Ischaemic heart disease Outline placeholder Angina of effort Acute coronary syndrome (unstable angina and acute myocardial infarction) Subendocardial (partial thickness or non-Q-wave infarct) Transmural infarction (full thickness or Q-wave infarct) Pathological consequences of acute transmural infarct Sudden cardiac death Ischaemic cardiomyopathy Aneurysms True aneurysms Congenital aneurysmsBerry´ aneurysms
Acquired aneurysms
Atheromatous aneurysms
Abdominal aortic aneurysm
Mycotic aneurysms
Syphilitic aneurysms
Dissecting aneurysm (acute aortic dissection)
False aneurysm (pulsating haematoma)
Arteriovenous aneurysms
General complications of aneurysms
Endocrine system
Thyroid disease
Goitre
Hyperthyroidism
Clinical features of thyrotoxicosis
Hypothyroidism
Clinical features of myxoedema
Hashimoto's thyroiditis
Carcinoma of the thyroid gland
Clinical presentation
Adrenal disorders
Medulla
Cortex
Hyperfunction of the adrenal cortex
Cushing's syndrome
Hyperaldosteronism
Conn's syndrome (primary hyperaldosteronism)
Secondary hyperaldosteronism
Hypersecretion of sex steroids
Hypofunction of the adrenal cortex
Acute insufficiency
Chronic insufficiency (Addison's disease)
Tumours of the adrenal cortex
Adenoma
Carcinoma
Genitourinary system
Gynaecological causes of acute abdominal pain
Pelvic inflammatory disease
Acute pelvic inflammatory disease
Sequelae
Chronic pelvic inflammatory disease
Ovarian disease
Ovarian cysts
Ovarian tumours
Epithelial tumours
Germ cell tumours
Sex-cord stromal tumours
Metastatic tumours
Clinical presentation of ovarian tumours
Ectopic pregnancy
Endometriosis
Clinical features
Fibroids
Fibroleiomyoma
Complications
Endometrial carcinoma
Spread
Urinary tract calculi
Types of calculi
Precipitating factors
Sites
Renal pelvis
Bladder
Ureteric and urethral stones
Clinical effects
Urinary tract infections (UTIs)
Acute pyelonephritis
Pathogenesis
Clinical features
Complications
Chronic pyelonephritis
Clinical features
Cystitis
Aetiology
Clinical features
Sterile pyuria
Urinary tract tuberculosis
Clinical features
Tumours of the urinary tract
Kidney
Benign neoplasms
Cortical adenoma
Angiomyolipoma
Malignant renal tumours
Wilms´ tumour
Renal cell carcinoma (hypernephroma, Grawitz tumour)
Aetiology
Clinical presentation
Spread
Prognosis
Transitional cell carcinoma of renal pelvis
Aetiology
Clinicopathological features
Bladder tumours
Aetiology
Transitional cell carcinoma
Clinical features
Staging and grading
Squamous cell carcinoma
Clinicopathological features
Conditions of the urethra
Urethral obstruction
Urethritis
Gonococcal urethritis
Course and complications
Non-gonococcal (non-specific urethritis)
Tumours
Viral condyloma
Transitional cell carcinoma
Conditions of the penis
Congenital lesions
Hypospadias
Epispadias
Inflammation and infections
Balanoposthitis
Phimosis
Paraphimosis
Balanitis xerotica obliterans
Genital herpes
Genital warts
Tumours of the penis
Invasive squamous carcinoma
Conditions of the prostate
Prostatitis
Acute suppurative prostatitis
Chronic non-specific prostatitis
Benign prostatic hypertrophy
Complications
Carcinoma of the prostate
Aetiology
Clinicopathological types
Clinical (symptomatic) carcinoma
Latent (incidental) carcinoma
Spread
Clinical presentation and features
Prognosis
Gastrointestinal system
Carcinoma of the oesophagus
Causes
Types
Spread
Prognosis
Peptic ulcer disease
Acute peptic ulceration
Chronic peptic ulceration
Complications of peptic ulcer
Carcinoma of the stomach
Aetiology
Pathogenesis
Classification
Early
Advanced
Hepatobiliary disorders
Jaundice
Gall bladder
Gallstones (cholelithiasis)
Aetiology
Types of stone
Pathological consequences of gallstones
Acute cholecystitis
Chronic cholecystitis
Mucocoele
Empyema
Cholesterolosis
Pancreatitis
Acute pancreatitis
Pathogenesis
Biochemical changes
Complications
Prognosis
Chronic pancreatitis
Carcinoma of the pancreas
Aetiology
Clinical features
Prognosis
Portal hypertension
Intestinal fistulae
Small bowel fistulae
High-output fistulae
Low-output fistulae
Disorders of colon and rectum
Polyps
Adenomas
Inflammatory polyps (pseudopolyps)
Hamartomas
Metaplastic polyps
Malignant epithelial polyps
Familial polyposis coli (familial adenomatous polyposis-FAP)
Gardner's syndrome
Colorectal cancer
Progression of adenoma to carcinoma (see Fig. 18.1)
Aetiology
Molecular basis for development of colorectal cancer
Site
Spread
Complications
Prognosis
Carcinoid tumours
Carcinoid syndrome
Inflammatory bowel disease
Crohn's disease
Aetiology
Appearances
Macroscopic
Microscopic
Complications
Extra-gastrointestinal manifestations
Ulcerative colitis
Aetiology
Appearances
Macroscopic
Microscopic
Complications
Extragastrointestinal manifestations
Diverticular disease
Pathogenesis
Complications
SECTION IV: APPENDIX
Appendix: OSCE scenario answers
OSCE Scenario answer 1.1
OSCE Scenario answer 1.2
OSCE Scenario answer 2.1
Initial pain
Localised pain
OSCE Scenario answer 2.2
OSCE Scenario answer 3.1
OSCE Scenario answer 3.2
OSCE Scenario answer 4.1
OSCE Scenario answer 4.2
OSCE Scenario answer 5.1
OSCE Scenario answer 5.2
OSCE Scenario answer 6.1
OSCE Scenario answer 6.2
OSCE Scenario answer 7.1
OSCE Scenario answer 7.2
OSCE Scenario answer 8.1
OSCE Scenario answer 8.2
OSCE Scenario answer 9.1
OSCE Scenario answer 9.2
OSCE Scenario answer 10.1
OSCE Scenario answer 10.2
OSCE Scenario answer 11.1
OSCE Scenario answer 11.2
OSCE Scenario answer 12.1
OSCE Scenario answer 12.2
OSCE Scenario answer 13.1
OSCE Scenario answer 13.2
OSCE Scenario answer 14.1
History
Examination
Investigations
Management
OSCE Scenario answer 14.2
OSCE Scenario answer 15.1
OSCE Scenario answer 15.2
History
Examination
Features
Investigations
Management
OSCE Scenario answer 16.1
History
Examination
Investigations
OSCE Scenario answer 16.2
OSCE Scenario answer 17.1
Examination
Investigations
OSCE Scenario answer 17.2
OSCE Scenario answer 18.1
OSCE Scenario answer 18.2
OSCE Scenario answer 19.1
Symptoms
Signs
OSCE Scenario answer 19.2
OSCE Scenario answer 20.1
Questions
Investigations
Possible further investigations
OSCE Scenario answer 20.2
OSCE Scenario answer 21.1
Investigations
Management
OSCE Scenario answer 21.2
OSCE Scenario answer 22.1
Histopathologically
Clinically
OSCE Scenario answer 22.2
Medical
Surgical
OSCE Scenario answer 22.3
Types of pneumothorax
Causes
Treatment
OSCE Scenario answer 22.4
OSCE Scenario answer 22.5
OSCE Scenario answer 22.6
OSCE Scenario answer 22.7
Pre-hepatic jaundice
Hepatic jaundice
Post-hepatic/cholestatic jaundice
Index