MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
Biomedical Sciences I (BMS1) - Summary
Table of contents
Table of contents .................................................................................................................................... 1
1 – What is disease ................................................................................................................................. 4
1.1 Pathology ...................................................................................................................................... 4
1.1.1 Genetic factors ....................................................................................................................... 5
1.1.2 Environmental factors ............................................................................................................ 6
1.2 Disease classification..................................................................................................................... 7
1.2.1 “Official” disease classifications............................................................................................. 7
1.3 Disease diagnosis .......................................................................................................................... 8
1.4 Pharmacology ............................................................................................................................... 8
1.5 Diagnostic resources ..................................................................................................................... 8
1.6 Biomarkers .................................................................................................................................... 9
2 – Epidemiology ................................................................................................................................... 11
2.1 Introduction to epidemiology ..................................................................................................... 11
2.1.1 Forms of epidemiology ........................................................................................................ 11
2.2 Health statistics in epidemiology ................................................................................................ 12
2.2.1 Morbidity statistics .............................................................................................................. 12
2.2.2 Mortality statistics ............................................................................................................... 13
3 – Introduction to basic pharmacology ............................................................................................... 15
3.1 Routes of administration ............................................................................................................ 15
3.2 Pharmacokinetics ........................................................................................................................ 17
3.2.1 Pharmacokinetic concepts ................................................................................................... 18
3.3 Pharmacodynamics ..................................................................................................................... 18
3.3.1 Receptors ............................................................................................................................. 19
3.3.2 Drug dosing & safety ............................................................................................................ 20
3.3.3 Drug Interactions ................................................................................................................. 21
3.4 Drugs ........................................................................................................................................... 21
4 – Cellular tissue injury & repair .......................................................................................................... 23
4.1 Cellular adaptation...................................................................................................................... 23
4.2 Cellular injury .............................................................................................................................. 24
4.2.1 Ischaemia ............................................................................................................................. 25
4.3 Cellular death .............................................................................................................................. 25
4.4 Inflammatory response ............................................................................................................... 26
Pagina 1 van 65
,MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
4.4.1 Acute inflammation ............................................................................................................. 27
4.4.2 Chronic inflammation .......................................................................................................... 29
4.5 Tissue repair & regeneration ...................................................................................................... 29
4.5.1 Tissue repair process............................................................................................................ 30
4.5.2 Wound healing ..................................................................................................................... 31
5 – Pain & analgesia .............................................................................................................................. 33
5.1 Pain classification ........................................................................................................................ 33
5.2 Pain neuroanatomy..................................................................................................................... 34
5.2.1 Nociceptors .......................................................................................................................... 34
5.2.2 Pain pathway........................................................................................................................ 35
5.3 Analgesic pharmacology ............................................................................................................. 36
5.3.1 Local anaesthetics ................................................................................................................ 36
5.3.2 Anti-inflammatory agents .................................................................................................... 37
5.3.3 Opioid analgesics ................................................................................................................. 38
6 – Nausea & vomiting .......................................................................................................................... 40
Not on exam...................................................................................................................................... 40
7 – Infection .......................................................................................................................................... 41
7.1 Normal bacterial flora ................................................................................................................. 41
7.2 How microorganisms cause disease ........................................................................................... 41
7.2.1 Viruses .................................................................................................................................. 41
7.2.2 Bacteria ................................................................................................................................ 43
7.2.3 Bacteriophages..................................................................................................................... 44
7.2.4 Prions ................................................................................................................................... 44
7.3 Impact of infections .................................................................................................................... 44
7.4 Basic principles of infection: transmission & prevention ........................................................... 45
7.4.1 Sepsis.................................................................................................................................... 46
8 – Antimicrobial therapy ..................................................................................................................... 48
8.1 Antimicrobial chemotherapy ...................................................................................................... 48
8.1.1 Anti-viral chemotherapy ...................................................................................................... 48
8.2.2 Anti-bacterial chemotherapy ............................................................................................... 49
8.2 Antibiotic therapy issues ............................................................................................................. 50
8.2.1 Antibiotic resistance ............................................................................................................ 50
8.2.2 Choice................................................................................................................................... 51
9 – Neoplasia......................................................................................................................................... 52
9.1 Cancer epidemiology .................................................................................................................. 52
9.2 Neoplastic disease & cancer ....................................................................................................... 53
Pagina 2 van 65
,MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
9.2.1 Hallmarks of malignant neoplastic cells............................................................................... 54
9.3 Carcinogenesis ............................................................................................................................ 54
9.3.1 Mutation .............................................................................................................................. 55
9.3.2 Growth & differentiation ..................................................................................................... 55
9.3.3 Local invasion ....................................................................................................................... 57
9.3.4 Metastasis ............................................................................................................................ 57
9.3.5 Summary .............................................................................................................................. 58
9.4 Clinical issues in cancer ............................................................................................................... 58
9.4.1 Cancer diagnosis .................................................................................................................. 59
9.4.2 Cancer grading & staging ..................................................................................................... 59
10 – Cancer chemotherapy ................................................................................................................... 60
10.1 Treatment approaches.............................................................................................................. 60
10.1.1 Radiotherapy ...................................................................................................................... 60
10.1.2 Chemotherapy (CRx) .......................................................................................................... 61
10.2 Principles of anti-neoplastic chemotherapy ............................................................................. 61
10.2.1 Kinetics of cancer treatment.............................................................................................. 62
10.2.2 Drug resistance .................................................................................................................. 63
10.3 Chemotherapy agents ............................................................................................................... 63
10.3.1 Traditional anti-neoplastic drugs (cytotoxic drugs) ........................................................... 63
10.3.2 Hormonal Rx....................................................................................................................... 64
10.3.3 Targeted Rx ........................................................................................................................ 64
10.3.4 Immunotherapy ................................................................................................................. 64
Pagina 3 van 65
, MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
1 – What is disease
Basic features of disease & disease development
Factors involved in the cause of disease
Classification of disease, “official” & “unofficial”
Pathway to the diagnosis of disease
Role of pathology in disease diagnosis, monitoring & treatment
Disease = abnormality that negatively affects a structure/function of part/whole organ/organism.
• Medical conditions associated with symptoms & signs
• Occurs when cells are unable to adapt to changes in environment ➔ adaptation = health
• Health & disease are 2 extremes balanced by homeostasis
• Proximate causes & mechanisms ➔ infections, mutations, etc.
• Evolutionary causes ➔ influenced by modern problems
o Infection causes increased T cells to fight pathogens ➔ influenced by medicine
o Micro-organisms evolve faster than humans ➔ antibiotic resistance
o Allergies increase ➔ hypersensitive immune system to innocent agents
o Environmental changes
• Also influenced by age ➔ less response to environmental threats leads to increased
infections, emergence of dormant infections, and increased chronic diseases
• Also influenced by genes ➔ increased risk by having a certain gene – but can also have
beneficial influence
Diseases may differ in nature:
Structural disease (organic) Functional disease
Changes Lesions (= structural change) in Physiological/functional changes, no
cells/tissues lesions
Identifiable Molecular techniques identify Laboratory testing for biomarkers
protein & gene structure changes
Signs & symptoms Unreliable Reliable
Characteristics 3 groups: Results in structural changes over time ➔
Genetic/developmental more important
Acquired injury & inflammatory
Hyperplasia & neoplasia
Examples Tumours Excessive production (mucous, hormones)
Obstructions (asthma, GIT, vascular) Insufficient production (hormones)
Ruptures (perforations) Impaired function (muscle, nerve)
Healthy tissue loss (infarction)
1.1 Pathology
Pathology = science of causes & effects of disease.
• Injury mechanisms to cells/tissues + how body responds
• Includes:
o Basic structural & functional changes
o Pathophysiology = study of causes leading to changes
o Pathogenesis = events leading from changes to clinical manifestation of disease
Pagina 4 van 65
,MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
For each disease the following characteristics should be known:
Epidemiology Incidence, prevalence & population distribution
Aetiology Cause
Pathogenesis Events in cells/tissues in response to cause
Morphology Structural changes in cells/tissues
Clinical significance Manifestation of changes giving rise to clinical picture
Complication/sequelae Secondary, systemic or remate consequences
Prognosis Anticipated course (cure, remission, fate)
Disease causes:
1) Genetic = inherited or pre-natal acquired gene defects (e.g. cystic fibrosis)
2) Environmental = no genetic components (e.g. traumatic head injury)
3) Multifactorial = interaction of genetic & environmental (e.g. diabetes)
1.1.1 Genetic factors
These factors are inherited or acquired (through conception/embryogenesis).
• Often associated with congenital metabolic abnormalities (cystic fibrosis) or structural
effects (Down’s & Turners syndrome)
• May predispose to tumours (retinoblastoma)
• May be acquired post-natally (cellular mutation)
o Neoplastic changes & tumour development are concealed by presence of larger
quantity normal cells
• Number of defective genes:
o Monogenic = single defective gene (majority)
o Polygenic = >1 defective genes at different places on chromosome (minority)
Inheritance models help show if a disease is autosomal or sex-linked and/or dominant or recessive.
• Dominant alleles already show effect with 1 copy of the allele (heterozygote)
• Recessive alleles only show effect with 2 copies of the allele (homozygote)
• Both dominant alleles = codominance
• Sex-linked disease has genes linked to X chromosome
o Males (XY) & female (XX)
o Boy inherits X chromosome from mother
o Girl inherits X chromosome from either mother or father
o Recessive sex-linked diseases show effect in females with 2 copies but in males
already with 1 copy ➔ more common in males
Pagina 5 van 65
, MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
Non-neoplastic diseases with genetic defects:
• Abnormal chromosome number ➔ problems with gametogenesis & cellular division
o Down’s syndrome: 3x (trisomy) chromosome 21
• Fragile chromosomes = translocation of genetic material between chromosomes (rare)
o Similar to the carcinogenesis model and often associated with tumour development
• Single gene effects ➔ discrete biochemical or structural abnormalities (common)
o Adult structural defects = dominant
o Child biochemical defects = recessive
o Gene deletion, point mutation, insertion/deletion, gene fusion ➔ leading to
functional loss/gene or death
1.1.2 Environmental factors
Infections are the major cause of disease in all age groups internationally:
• Infective agents ➔ viruses, bacteria, fungi, yeasts, helminths, protozoa, prions
• Transmission
o Direct = contact with source
▪ Horizontal (person to person)
▪ Vertical (mother to foetus in-utero)
▪ Droplet spread (coughing, sneezing, talking)
o Indirect = contact with source via intermediate vehicle
▪ Vehicle borne ➔ contact with fomites = object that can transfer disease
when contaminated (food, water, biological products)
▪ Airborne (non-specific)
▪ Vectors borne (e.g. parasite carriers)
• Characteristics determined by host responses & infective agent properties
Non-infectious factors may contribute to disease by:
• Chemical influences
o Due to environmental pollutants, industrial & domestic materials, drugs, etc.
o Effects ➔ tissue corrosion, altered metabolic pathways, cell membrane injury,
allergic hypersensitivity reactions, neoplastic changes
o Smoking & alcohol biggest factor
o May have mutagenic effects changing chromosome structure:
▪ Teratogenic = affect embryogenesis & lead to malformations
▪ Carcinogenic = leads to tumorigenesis
• Physical influences
o Obvious & direct tissue damage depending on tissue integrity
o Effects ➔ mechanical, thermal, radiation
▪ Thermal damage is mostly localised (burns, frostbite) but also spread
(hypothermia)
▪ Thermal damage positively used as diathermy in surgery
▪ Radiation has wide spectrum of effects ➔ sunburn to melanoma
Pagina 6 van 65
Biomedical Sciences I (BMS1) - Summary
Table of contents
Table of contents .................................................................................................................................... 1
1 – What is disease ................................................................................................................................. 4
1.1 Pathology ...................................................................................................................................... 4
1.1.1 Genetic factors ....................................................................................................................... 5
1.1.2 Environmental factors ............................................................................................................ 6
1.2 Disease classification..................................................................................................................... 7
1.2.1 “Official” disease classifications............................................................................................. 7
1.3 Disease diagnosis .......................................................................................................................... 8
1.4 Pharmacology ............................................................................................................................... 8
1.5 Diagnostic resources ..................................................................................................................... 8
1.6 Biomarkers .................................................................................................................................... 9
2 – Epidemiology ................................................................................................................................... 11
2.1 Introduction to epidemiology ..................................................................................................... 11
2.1.1 Forms of epidemiology ........................................................................................................ 11
2.2 Health statistics in epidemiology ................................................................................................ 12
2.2.1 Morbidity statistics .............................................................................................................. 12
2.2.2 Mortality statistics ............................................................................................................... 13
3 – Introduction to basic pharmacology ............................................................................................... 15
3.1 Routes of administration ............................................................................................................ 15
3.2 Pharmacokinetics ........................................................................................................................ 17
3.2.1 Pharmacokinetic concepts ................................................................................................... 18
3.3 Pharmacodynamics ..................................................................................................................... 18
3.3.1 Receptors ............................................................................................................................. 19
3.3.2 Drug dosing & safety ............................................................................................................ 20
3.3.3 Drug Interactions ................................................................................................................. 21
3.4 Drugs ........................................................................................................................................... 21
4 – Cellular tissue injury & repair .......................................................................................................... 23
4.1 Cellular adaptation...................................................................................................................... 23
4.2 Cellular injury .............................................................................................................................. 24
4.2.1 Ischaemia ............................................................................................................................. 25
4.3 Cellular death .............................................................................................................................. 25
4.4 Inflammatory response ............................................................................................................... 26
Pagina 1 van 65
,MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
4.4.1 Acute inflammation ............................................................................................................. 27
4.4.2 Chronic inflammation .......................................................................................................... 29
4.5 Tissue repair & regeneration ...................................................................................................... 29
4.5.1 Tissue repair process............................................................................................................ 30
4.5.2 Wound healing ..................................................................................................................... 31
5 – Pain & analgesia .............................................................................................................................. 33
5.1 Pain classification ........................................................................................................................ 33
5.2 Pain neuroanatomy..................................................................................................................... 34
5.2.1 Nociceptors .......................................................................................................................... 34
5.2.2 Pain pathway........................................................................................................................ 35
5.3 Analgesic pharmacology ............................................................................................................. 36
5.3.1 Local anaesthetics ................................................................................................................ 36
5.3.2 Anti-inflammatory agents .................................................................................................... 37
5.3.3 Opioid analgesics ................................................................................................................. 38
6 – Nausea & vomiting .......................................................................................................................... 40
Not on exam...................................................................................................................................... 40
7 – Infection .......................................................................................................................................... 41
7.1 Normal bacterial flora ................................................................................................................. 41
7.2 How microorganisms cause disease ........................................................................................... 41
7.2.1 Viruses .................................................................................................................................. 41
7.2.2 Bacteria ................................................................................................................................ 43
7.2.3 Bacteriophages..................................................................................................................... 44
7.2.4 Prions ................................................................................................................................... 44
7.3 Impact of infections .................................................................................................................... 44
7.4 Basic principles of infection: transmission & prevention ........................................................... 45
7.4.1 Sepsis.................................................................................................................................... 46
8 – Antimicrobial therapy ..................................................................................................................... 48
8.1 Antimicrobial chemotherapy ...................................................................................................... 48
8.1.1 Anti-viral chemotherapy ...................................................................................................... 48
8.2.2 Anti-bacterial chemotherapy ............................................................................................... 49
8.2 Antibiotic therapy issues ............................................................................................................. 50
8.2.1 Antibiotic resistance ............................................................................................................ 50
8.2.2 Choice................................................................................................................................... 51
9 – Neoplasia......................................................................................................................................... 52
9.1 Cancer epidemiology .................................................................................................................. 52
9.2 Neoplastic disease & cancer ....................................................................................................... 53
Pagina 2 van 65
,MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
9.2.1 Hallmarks of malignant neoplastic cells............................................................................... 54
9.3 Carcinogenesis ............................................................................................................................ 54
9.3.1 Mutation .............................................................................................................................. 55
9.3.2 Growth & differentiation ..................................................................................................... 55
9.3.3 Local invasion ....................................................................................................................... 57
9.3.4 Metastasis ............................................................................................................................ 57
9.3.5 Summary .............................................................................................................................. 58
9.4 Clinical issues in cancer ............................................................................................................... 58
9.4.1 Cancer diagnosis .................................................................................................................. 59
9.4.2 Cancer grading & staging ..................................................................................................... 59
10 – Cancer chemotherapy ................................................................................................................... 60
10.1 Treatment approaches.............................................................................................................. 60
10.1.1 Radiotherapy ...................................................................................................................... 60
10.1.2 Chemotherapy (CRx) .......................................................................................................... 61
10.2 Principles of anti-neoplastic chemotherapy ............................................................................. 61
10.2.1 Kinetics of cancer treatment.............................................................................................. 62
10.2.2 Drug resistance .................................................................................................................. 63
10.3 Chemotherapy agents ............................................................................................................... 63
10.3.1 Traditional anti-neoplastic drugs (cytotoxic drugs) ........................................................... 63
10.3.2 Hormonal Rx....................................................................................................................... 64
10.3.3 Targeted Rx ........................................................................................................................ 64
10.3.4 Immunotherapy ................................................................................................................. 64
Pagina 3 van 65
, MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
1 – What is disease
Basic features of disease & disease development
Factors involved in the cause of disease
Classification of disease, “official” & “unofficial”
Pathway to the diagnosis of disease
Role of pathology in disease diagnosis, monitoring & treatment
Disease = abnormality that negatively affects a structure/function of part/whole organ/organism.
• Medical conditions associated with symptoms & signs
• Occurs when cells are unable to adapt to changes in environment ➔ adaptation = health
• Health & disease are 2 extremes balanced by homeostasis
• Proximate causes & mechanisms ➔ infections, mutations, etc.
• Evolutionary causes ➔ influenced by modern problems
o Infection causes increased T cells to fight pathogens ➔ influenced by medicine
o Micro-organisms evolve faster than humans ➔ antibiotic resistance
o Allergies increase ➔ hypersensitive immune system to innocent agents
o Environmental changes
• Also influenced by age ➔ less response to environmental threats leads to increased
infections, emergence of dormant infections, and increased chronic diseases
• Also influenced by genes ➔ increased risk by having a certain gene – but can also have
beneficial influence
Diseases may differ in nature:
Structural disease (organic) Functional disease
Changes Lesions (= structural change) in Physiological/functional changes, no
cells/tissues lesions
Identifiable Molecular techniques identify Laboratory testing for biomarkers
protein & gene structure changes
Signs & symptoms Unreliable Reliable
Characteristics 3 groups: Results in structural changes over time ➔
Genetic/developmental more important
Acquired injury & inflammatory
Hyperplasia & neoplasia
Examples Tumours Excessive production (mucous, hormones)
Obstructions (asthma, GIT, vascular) Insufficient production (hormones)
Ruptures (perforations) Impaired function (muscle, nerve)
Healthy tissue loss (infarction)
1.1 Pathology
Pathology = science of causes & effects of disease.
• Injury mechanisms to cells/tissues + how body responds
• Includes:
o Basic structural & functional changes
o Pathophysiology = study of causes leading to changes
o Pathogenesis = events leading from changes to clinical manifestation of disease
Pagina 4 van 65
,MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
For each disease the following characteristics should be known:
Epidemiology Incidence, prevalence & population distribution
Aetiology Cause
Pathogenesis Events in cells/tissues in response to cause
Morphology Structural changes in cells/tissues
Clinical significance Manifestation of changes giving rise to clinical picture
Complication/sequelae Secondary, systemic or remate consequences
Prognosis Anticipated course (cure, remission, fate)
Disease causes:
1) Genetic = inherited or pre-natal acquired gene defects (e.g. cystic fibrosis)
2) Environmental = no genetic components (e.g. traumatic head injury)
3) Multifactorial = interaction of genetic & environmental (e.g. diabetes)
1.1.1 Genetic factors
These factors are inherited or acquired (through conception/embryogenesis).
• Often associated with congenital metabolic abnormalities (cystic fibrosis) or structural
effects (Down’s & Turners syndrome)
• May predispose to tumours (retinoblastoma)
• May be acquired post-natally (cellular mutation)
o Neoplastic changes & tumour development are concealed by presence of larger
quantity normal cells
• Number of defective genes:
o Monogenic = single defective gene (majority)
o Polygenic = >1 defective genes at different places on chromosome (minority)
Inheritance models help show if a disease is autosomal or sex-linked and/or dominant or recessive.
• Dominant alleles already show effect with 1 copy of the allele (heterozygote)
• Recessive alleles only show effect with 2 copies of the allele (homozygote)
• Both dominant alleles = codominance
• Sex-linked disease has genes linked to X chromosome
o Males (XY) & female (XX)
o Boy inherits X chromosome from mother
o Girl inherits X chromosome from either mother or father
o Recessive sex-linked diseases show effect in females with 2 copies but in males
already with 1 copy ➔ more common in males
Pagina 5 van 65
, MAN Y2 2021 BMS1 McTimoney College of Chiropractic Michael Verouden
Non-neoplastic diseases with genetic defects:
• Abnormal chromosome number ➔ problems with gametogenesis & cellular division
o Down’s syndrome: 3x (trisomy) chromosome 21
• Fragile chromosomes = translocation of genetic material between chromosomes (rare)
o Similar to the carcinogenesis model and often associated with tumour development
• Single gene effects ➔ discrete biochemical or structural abnormalities (common)
o Adult structural defects = dominant
o Child biochemical defects = recessive
o Gene deletion, point mutation, insertion/deletion, gene fusion ➔ leading to
functional loss/gene or death
1.1.2 Environmental factors
Infections are the major cause of disease in all age groups internationally:
• Infective agents ➔ viruses, bacteria, fungi, yeasts, helminths, protozoa, prions
• Transmission
o Direct = contact with source
▪ Horizontal (person to person)
▪ Vertical (mother to foetus in-utero)
▪ Droplet spread (coughing, sneezing, talking)
o Indirect = contact with source via intermediate vehicle
▪ Vehicle borne ➔ contact with fomites = object that can transfer disease
when contaminated (food, water, biological products)
▪ Airborne (non-specific)
▪ Vectors borne (e.g. parasite carriers)
• Characteristics determined by host responses & infective agent properties
Non-infectious factors may contribute to disease by:
• Chemical influences
o Due to environmental pollutants, industrial & domestic materials, drugs, etc.
o Effects ➔ tissue corrosion, altered metabolic pathways, cell membrane injury,
allergic hypersensitivity reactions, neoplastic changes
o Smoking & alcohol biggest factor
o May have mutagenic effects changing chromosome structure:
▪ Teratogenic = affect embryogenesis & lead to malformations
▪ Carcinogenic = leads to tumorigenesis
• Physical influences
o Obvious & direct tissue damage depending on tissue integrity
o Effects ➔ mechanical, thermal, radiation
▪ Thermal damage is mostly localised (burns, frostbite) but also spread
(hypothermia)
▪ Thermal damage positively used as diathermy in surgery
▪ Radiation has wide spectrum of effects ➔ sunburn to melanoma
Pagina 6 van 65
