MBBS Year 1
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Lecture Notes o
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,MBBS Year 1 Contents Liyang Pan
MBBS Year 1 – Liyang Pan
Contents
Module 1: Foundations of Health and Medical Practice ................................................................................... 1
Background ........................................................................................................................................................ 1
[001] Structure, function and organisation ................................................................................................. 1
[002] Homeostasis ...................................................................................................................................... 2
[006] The Cell and its Contents .................................................................................................................. 3
[020] Cell Differentiation ........................................................................................................................... 4
Genetics, Proteins ............................................................................................................................................... 6
[007] Chromosomes, Genes and the Cell Cycle ......................................................................................... 6
[008] Meiosis, Mitosis, and Inheritance ..................................................................................................... 9
[009] DNA Structure and Replication ...................................................................................................... 11
[011] Transcription and its Control........................................................................................................... 13
[012] Translation: Protein Synthesis ......................................................................................................... 14
[013] Protein structure and function ......................................................................................................... 16
m
[021] Molecular Biology and Medicine .................................................................................................... 20
Haemotology .................................................................................................................................................... 22
o
[029] Blood Components and Blood Groups ............................................................................................ 22
[037] Anaemia .......................................................................................................................................... 24
.c
[040] Blood Coagulation .......................................................................................................................... 27
Histology .......................................................................................................................................................... 30
a
[003] Tissues and Organs ......................................................................................................................... 30
[004] Tissues and Organs ......................................................................................................................... 32
[015] Extracellular matrix and connective tissue ...................................................................................... 34
m
[016] Connective tissue histology............................................................................................................. 37
[023] The importance of skin - an example epithelium ............................................................................ 39
a
[025] Histology of epithelia ...................................................................................................................... 44
Embryology ...................................................................................................................................................... 47
n
[017] Human Embryonic Development 1 ................................................................................................. 47
[018] Human Embryonic Development 2 ................................................................................................. 50
y
[043] Cell Differentiation ......................................................................................................................... 55
Anatomy ........................................................................................................................................................... 56
d
[028] Introduction to Anatomy 1 and 2 .................................................................................................... 56
u
[039] Anatomy of the Lymphatic System ................................................................................................. 58
t
Module 2: Infection and Defence ....................................................................................................................... 61
[003] Intro ................................................................................................................................................. 61
S
Immunology ..................................................................................................................................................... 62
[004] Innate and Adaptive Immunity ........................................................................................................ 62
[009] Complement, phagocytosis and inflammation ................................................................................ 64
[013] The innate/adaptive interface .......................................................................................................... 67
[016] Antigen recognition by lymphocytes .............................................................................................. 67
[017] Humoral Immunity: the Antibody Response ................................................................................... 70
[014] Organs and Tissues of the Immune System; [018] Lymphoid organ histology .............................. 75
[024] Cell-mediated immunity.................................................................................................................. 80
[026] Generation of antigen receptor diversity ......................................................................................... 82
[027] How microbes avoid the immune system ........................................................................................ 84
[030] Mucosal immunity .......................................................................................................................... 85
[031] Healing and repair ........................................................................................................................... 87
[032] Vaccination ..................................................................................................................................... 90
[036] Immunological tolerance ................................................................................................................. 92
[037] Autoimmune disease ....................................................................................................................... 93
[038] Emerging Infectious Diseases ......................................................................................................... 96
[039] Allergy and other immune hypersensitivities .................................................................................. 97
[040] Ageing and immunity ...................................................................................................................... 99
i
Downloaded by Eddie Brown ()
,MBBS Year 1 Contents Liyang Pan
[041] Immunodeficiency ........................................................................................................................ 103
[042] Transplantation.............................................................................................................................. 104
Virology ......................................................................................................................................................... 105
[005] Viruses: Structure & Properties..................................................................................................... 105
[006] How Viruses Multiply ................................................................................................................... 106
[015] Transmission and epidemiology of viruses ................................................................................... 109
[021] How viruses cause disease ............................................................................................................ 111
[028] Laboratory Investigation of Viral Infections ................................................................................. 113
[029] Virological Diagnosis.................................................................................................................... 115
[035] Antivirals....................................................................................................................................... 117
Bacteriology ................................................................................................................................................... 118
[007] Bacteria: structure and properties .................................................................................................. 118
[008] Bacteria: ecology, source and routes of transmission ................................................................... 122
[010] Antibiotics ..................................................................................................................................... 126
[012] Bacterial Diagnosis: The Gram stain ............................................................................................ 129
[025] How bacteria cause disease ........................................................................................................... 129
Eukaryotic infections...................................................................................................................................... 134
[019] Fungal Infections ........................................................................................................................... 134
[020] Parasitic Infections ........................................................................................................................ 135
Case Studies ................................................................................................................................................... 137
m
EBV ........................................................................................................................................................ 137
o
Streptococcus pyogenes .......................................................................................................................... 139
Mycobacterium tuberculosis ................................................................................................................... 142
.c
Malaria .................................................................................................................................................... 148
Human immunodeficiency virus and acquired immunodeficiency syndrome ........................................ 152
a
Module 3: Circulation and breathing ............................................................................................................. 158
[001] Intro ............................................................................................................................................... 158
[002] Processes at membranes ................................................................................................................ 158
m
[003] Membrane potential; [010] Excitable cells ................................................................................... 160
Nervous system .............................................................................................................................................. 163
a
[004] Introduction to the nervous system ............................................................................................... 163
n
[007] & [011] The autonomic nervous system 1 & 2 ............................................................................. 164
[054] & [056] Central nervous control of the circulation; significance in health and disease 1 & 2 ...... 168
y
Circulation ...................................................................................................................................................... 171
Cardiac physiology ..................................................................................................................................... 171
d
[005] Cardiac action potentials and excitation-contraction coupling ...................................................... 171
[034] The cardiac cycle .......................................................................................................................... 173
u
[038] Spread of excitation through the heart and an introduction to the Electrocardiogram .................. 175
[040] ECG and heart disease .................................................................................................................. 176
t
[043] & [044] Cardiodynamics and cardiac output 1 & 2 ...................................................................... 178
S
Vascular physiology ................................................................................................................................... 184
[039] Dependence of blood flow on driving pressure and resistance ..................................................... 184
[042] The microcirculation and tissue fluid exchange ............................................................................ 186
[048] Nervous, local and humoral control of vascular resistance and distribution of blood flow .......... 189
[049] Factors influencing coronary, cerebral, skeletal muscle & skin circulations ................................ 193
Blood physiology ........................................................................................................................................ 195
[018] Haemoglobin structure and function ............................................................................................. 195
[019] Structure and function of blood with respect to carriage of gases ................................................. 198
[027] Acid-base balance ......................................................................................................................... 202
Breathing ........................................................................................................................................................ 206
[006] Control of Ventilation ................................................................................................................... 206
[013] Mechanisms of pulmonary ventilation, [014] Pulmonary mechanics ........................................... 208
[017] Gaseous exchange ......................................................................................................................... 215
[020] Factors influencing gas exchange ................................................................................................. 218
Pathology ....................................................................................................................................................... 222
[021] Influence of disease on respiratory function ................................................................................. 222
[033] Immune mediated pathology of the lung ....................................................................................... 223
[036] Pneumonia ..................................................................................................................................... 228
ii
Downloaded by Eddie Brown ()
, MBBS Year 1 Contents Liyang Pan
[037] Viral respiratory infections ........................................................................................................... 232
[050] Heart disease - the modern epidemic ............................................................................................ 235
[058] Asthma - how do we treat it? ........................................................................................................ 239
[059] Hypertension - the action of therapeutics ...................................................................................... 239
Histology ........................................................................................................................................................ 240
[008] Muscles and blood vessels ............................................................................................................ 240
[009] Muscles and blood vessels ............................................................................................................ 246
[016] Respiratory system ........................................................................................................................ 248
Embryology .................................................................................................................................................... 249
[025] Development of the respiratory system ......................................................................................... 249
[047] Development of the heart .............................................................................................................. 254
Anatomy ......................................................................................................................................................... 260
Nervous system....................................................................................................................................... 260
Thoracic cage, lungs, and pleura ............................................................................................................ 262
The heart ................................................................................................................................................. 268
The anterior, superior and posterior mediastinum .................................................................................. 274
Module 4: Fluids, Nutrition, and Metabolism ................................................................................................ 279
Biochemistry .................................................................................................................................................. 279
m
[001] Why eat? ....................................................................................................................................... 279
[002] Enzymes and catalysis................................................................................................................... 281
o
[004] Control of blood glucose ............................................................................................................... 283
[007] Overview of metabolism ............................................................................................................... 283
.c
[008] Enzymes in medicine .................................................................................................................... 285
[013] Formation of ATP ......................................................................................................................... 288
[017] & [028] Carbohydrate metabolism 1 and 2 ................................................................................... 290
a
[030] Fat digestion and metabolism ........................................................................................................ 294
[031] Disaccharide intolerance ............................................................................................................... 296
[041] Synthesis and storage of fats as an energy reserve ........................................................................ 297
m
[045] Citric acid cycle ............................................................................................................................ 299
[049] Principles of metabolic regulation ................................................................................................. 302
a
[054] & [059] The urea cycle and its control .......................................................................................... 303
Nutrition ......................................................................................................................................................... 305
n
[032] Diet and Health ............................................................................................................................. 305
y
[033] Micronutrients: vitamins and minerals .......................................................................................... 307
[043] Energy balance: overweight and obesity ....................................................................................... 309
d
[046] Cholesterol and plasma lipoproteins ............................................................................................. 313
[047] Undernutrition: protein-energy malnutrition ................................................................................. 315
u
[055] Nitrogen balance and protein requirements ................................................................................... 317
[056] Deamination and transamination of amino acids .......................................................................... 319
t
Physiology ...................................................................................................................................................... 320
S
Gastrointestinal tract ................................................................................................................................... 320
[006] Overview of function; salivary secretion ...................................................................................... 320
[015] Gastric secretion ............................................................................................................................ 324
[018] Pancreas and Liver ........................................................................................................................ 330
[019] & [020] Intestinal absorption ........................................................................................................ 332
[022] Motility ......................................................................................................................................... 337
Renal ........................................................................................................................................................... 340
[052] Body fluid compartments .............................................................................................................. 340
[057] Overview of kidney function ........................................................................................................ 341
[060] Glomerular filtration ..................................................................................................................... 342
[062] Sodium and water transport .......................................................................................................... 344
[066] & [069] Renal clearance ................................................................................................................ 345
[067] & [073] Control of plasma osmolarity and extracellular volume .................................................. 346
[072] & [075] Renal control of electrolytes and acid-base balance ........................................................ 348
Pathology ....................................................................................................................................................... 350
[021] Parasite infections of the GI tract .................................................................................................. 350
[027] Bacterial infections of the GI tract ................................................................................................ 352
[034] Viral infections of the GI tract ...................................................................................................... 355
iii
Downloaded by Eddie Brown ()
m
Lecture Notes o
.c
a
m
a
n
y
d
u
t
S
Downloaded by Eddie Brown ()
,MBBS Year 1 Contents Liyang Pan
MBBS Year 1 – Liyang Pan
Contents
Module 1: Foundations of Health and Medical Practice ................................................................................... 1
Background ........................................................................................................................................................ 1
[001] Structure, function and organisation ................................................................................................. 1
[002] Homeostasis ...................................................................................................................................... 2
[006] The Cell and its Contents .................................................................................................................. 3
[020] Cell Differentiation ........................................................................................................................... 4
Genetics, Proteins ............................................................................................................................................... 6
[007] Chromosomes, Genes and the Cell Cycle ......................................................................................... 6
[008] Meiosis, Mitosis, and Inheritance ..................................................................................................... 9
[009] DNA Structure and Replication ...................................................................................................... 11
[011] Transcription and its Control........................................................................................................... 13
[012] Translation: Protein Synthesis ......................................................................................................... 14
[013] Protein structure and function ......................................................................................................... 16
m
[021] Molecular Biology and Medicine .................................................................................................... 20
Haemotology .................................................................................................................................................... 22
o
[029] Blood Components and Blood Groups ............................................................................................ 22
[037] Anaemia .......................................................................................................................................... 24
.c
[040] Blood Coagulation .......................................................................................................................... 27
Histology .......................................................................................................................................................... 30
a
[003] Tissues and Organs ......................................................................................................................... 30
[004] Tissues and Organs ......................................................................................................................... 32
[015] Extracellular matrix and connective tissue ...................................................................................... 34
m
[016] Connective tissue histology............................................................................................................. 37
[023] The importance of skin - an example epithelium ............................................................................ 39
a
[025] Histology of epithelia ...................................................................................................................... 44
Embryology ...................................................................................................................................................... 47
n
[017] Human Embryonic Development 1 ................................................................................................. 47
[018] Human Embryonic Development 2 ................................................................................................. 50
y
[043] Cell Differentiation ......................................................................................................................... 55
Anatomy ........................................................................................................................................................... 56
d
[028] Introduction to Anatomy 1 and 2 .................................................................................................... 56
u
[039] Anatomy of the Lymphatic System ................................................................................................. 58
t
Module 2: Infection and Defence ....................................................................................................................... 61
[003] Intro ................................................................................................................................................. 61
S
Immunology ..................................................................................................................................................... 62
[004] Innate and Adaptive Immunity ........................................................................................................ 62
[009] Complement, phagocytosis and inflammation ................................................................................ 64
[013] The innate/adaptive interface .......................................................................................................... 67
[016] Antigen recognition by lymphocytes .............................................................................................. 67
[017] Humoral Immunity: the Antibody Response ................................................................................... 70
[014] Organs and Tissues of the Immune System; [018] Lymphoid organ histology .............................. 75
[024] Cell-mediated immunity.................................................................................................................. 80
[026] Generation of antigen receptor diversity ......................................................................................... 82
[027] How microbes avoid the immune system ........................................................................................ 84
[030] Mucosal immunity .......................................................................................................................... 85
[031] Healing and repair ........................................................................................................................... 87
[032] Vaccination ..................................................................................................................................... 90
[036] Immunological tolerance ................................................................................................................. 92
[037] Autoimmune disease ....................................................................................................................... 93
[038] Emerging Infectious Diseases ......................................................................................................... 96
[039] Allergy and other immune hypersensitivities .................................................................................. 97
[040] Ageing and immunity ...................................................................................................................... 99
i
Downloaded by Eddie Brown ()
,MBBS Year 1 Contents Liyang Pan
[041] Immunodeficiency ........................................................................................................................ 103
[042] Transplantation.............................................................................................................................. 104
Virology ......................................................................................................................................................... 105
[005] Viruses: Structure & Properties..................................................................................................... 105
[006] How Viruses Multiply ................................................................................................................... 106
[015] Transmission and epidemiology of viruses ................................................................................... 109
[021] How viruses cause disease ............................................................................................................ 111
[028] Laboratory Investigation of Viral Infections ................................................................................. 113
[029] Virological Diagnosis.................................................................................................................... 115
[035] Antivirals....................................................................................................................................... 117
Bacteriology ................................................................................................................................................... 118
[007] Bacteria: structure and properties .................................................................................................. 118
[008] Bacteria: ecology, source and routes of transmission ................................................................... 122
[010] Antibiotics ..................................................................................................................................... 126
[012] Bacterial Diagnosis: The Gram stain ............................................................................................ 129
[025] How bacteria cause disease ........................................................................................................... 129
Eukaryotic infections...................................................................................................................................... 134
[019] Fungal Infections ........................................................................................................................... 134
[020] Parasitic Infections ........................................................................................................................ 135
Case Studies ................................................................................................................................................... 137
m
EBV ........................................................................................................................................................ 137
o
Streptococcus pyogenes .......................................................................................................................... 139
Mycobacterium tuberculosis ................................................................................................................... 142
.c
Malaria .................................................................................................................................................... 148
Human immunodeficiency virus and acquired immunodeficiency syndrome ........................................ 152
a
Module 3: Circulation and breathing ............................................................................................................. 158
[001] Intro ............................................................................................................................................... 158
[002] Processes at membranes ................................................................................................................ 158
m
[003] Membrane potential; [010] Excitable cells ................................................................................... 160
Nervous system .............................................................................................................................................. 163
a
[004] Introduction to the nervous system ............................................................................................... 163
n
[007] & [011] The autonomic nervous system 1 & 2 ............................................................................. 164
[054] & [056] Central nervous control of the circulation; significance in health and disease 1 & 2 ...... 168
y
Circulation ...................................................................................................................................................... 171
Cardiac physiology ..................................................................................................................................... 171
d
[005] Cardiac action potentials and excitation-contraction coupling ...................................................... 171
[034] The cardiac cycle .......................................................................................................................... 173
u
[038] Spread of excitation through the heart and an introduction to the Electrocardiogram .................. 175
[040] ECG and heart disease .................................................................................................................. 176
t
[043] & [044] Cardiodynamics and cardiac output 1 & 2 ...................................................................... 178
S
Vascular physiology ................................................................................................................................... 184
[039] Dependence of blood flow on driving pressure and resistance ..................................................... 184
[042] The microcirculation and tissue fluid exchange ............................................................................ 186
[048] Nervous, local and humoral control of vascular resistance and distribution of blood flow .......... 189
[049] Factors influencing coronary, cerebral, skeletal muscle & skin circulations ................................ 193
Blood physiology ........................................................................................................................................ 195
[018] Haemoglobin structure and function ............................................................................................. 195
[019] Structure and function of blood with respect to carriage of gases ................................................. 198
[027] Acid-base balance ......................................................................................................................... 202
Breathing ........................................................................................................................................................ 206
[006] Control of Ventilation ................................................................................................................... 206
[013] Mechanisms of pulmonary ventilation, [014] Pulmonary mechanics ........................................... 208
[017] Gaseous exchange ......................................................................................................................... 215
[020] Factors influencing gas exchange ................................................................................................. 218
Pathology ....................................................................................................................................................... 222
[021] Influence of disease on respiratory function ................................................................................. 222
[033] Immune mediated pathology of the lung ....................................................................................... 223
[036] Pneumonia ..................................................................................................................................... 228
ii
Downloaded by Eddie Brown ()
, MBBS Year 1 Contents Liyang Pan
[037] Viral respiratory infections ........................................................................................................... 232
[050] Heart disease - the modern epidemic ............................................................................................ 235
[058] Asthma - how do we treat it? ........................................................................................................ 239
[059] Hypertension - the action of therapeutics ...................................................................................... 239
Histology ........................................................................................................................................................ 240
[008] Muscles and blood vessels ............................................................................................................ 240
[009] Muscles and blood vessels ............................................................................................................ 246
[016] Respiratory system ........................................................................................................................ 248
Embryology .................................................................................................................................................... 249
[025] Development of the respiratory system ......................................................................................... 249
[047] Development of the heart .............................................................................................................. 254
Anatomy ......................................................................................................................................................... 260
Nervous system....................................................................................................................................... 260
Thoracic cage, lungs, and pleura ............................................................................................................ 262
The heart ................................................................................................................................................. 268
The anterior, superior and posterior mediastinum .................................................................................. 274
Module 4: Fluids, Nutrition, and Metabolism ................................................................................................ 279
Biochemistry .................................................................................................................................................. 279
m
[001] Why eat? ....................................................................................................................................... 279
[002] Enzymes and catalysis................................................................................................................... 281
o
[004] Control of blood glucose ............................................................................................................... 283
[007] Overview of metabolism ............................................................................................................... 283
.c
[008] Enzymes in medicine .................................................................................................................... 285
[013] Formation of ATP ......................................................................................................................... 288
[017] & [028] Carbohydrate metabolism 1 and 2 ................................................................................... 290
a
[030] Fat digestion and metabolism ........................................................................................................ 294
[031] Disaccharide intolerance ............................................................................................................... 296
[041] Synthesis and storage of fats as an energy reserve ........................................................................ 297
m
[045] Citric acid cycle ............................................................................................................................ 299
[049] Principles of metabolic regulation ................................................................................................. 302
a
[054] & [059] The urea cycle and its control .......................................................................................... 303
Nutrition ......................................................................................................................................................... 305
n
[032] Diet and Health ............................................................................................................................. 305
y
[033] Micronutrients: vitamins and minerals .......................................................................................... 307
[043] Energy balance: overweight and obesity ....................................................................................... 309
d
[046] Cholesterol and plasma lipoproteins ............................................................................................. 313
[047] Undernutrition: protein-energy malnutrition ................................................................................. 315
u
[055] Nitrogen balance and protein requirements ................................................................................... 317
[056] Deamination and transamination of amino acids .......................................................................... 319
t
Physiology ...................................................................................................................................................... 320
S
Gastrointestinal tract ................................................................................................................................... 320
[006] Overview of function; salivary secretion ...................................................................................... 320
[015] Gastric secretion ............................................................................................................................ 324
[018] Pancreas and Liver ........................................................................................................................ 330
[019] & [020] Intestinal absorption ........................................................................................................ 332
[022] Motility ......................................................................................................................................... 337
Renal ........................................................................................................................................................... 340
[052] Body fluid compartments .............................................................................................................. 340
[057] Overview of kidney function ........................................................................................................ 341
[060] Glomerular filtration ..................................................................................................................... 342
[062] Sodium and water transport .......................................................................................................... 344
[066] & [069] Renal clearance ................................................................................................................ 345
[067] & [073] Control of plasma osmolarity and extracellular volume .................................................. 346
[072] & [075] Renal control of electrolytes and acid-base balance ........................................................ 348
Pathology ....................................................................................................................................................... 350
[021] Parasite infections of the GI tract .................................................................................................. 350
[027] Bacterial infections of the GI tract ................................................................................................ 352
[034] Viral infections of the GI tract ...................................................................................................... 355
iii
Downloaded by Eddie Brown ()
