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ASTHMA

Asthma is when a person has repeated episodes where they have difficulty
breathing. During these episodes, their bronchioles contract, and this narrowing causes
breathing difficulties with a characteristic wheezing noise. These contractions tend to be
triggered by certain irritants that the individual is particularly sensitive to such as animal
hair. In addition to the contractions, the bronchiole lining becomes inflamed and an excess
of mucus is produced, both of which increase the narrowing (and resulting breathing
problems).

















Peak Flow Meter
Peak Flow Meters basically tell
you how open/obstructed your airways are and
can therefore be helpful in managing and
monitoring your asthma. They measure your air
flow out of your lungs (your peak expiratory
flow rate).
-Introduce yourself, check the patients
identity, explain why you are doing this
procedure, and gain the patients consent
-Attach the mouthpiece, slide the marker to
zero and hold the meter horizontally being
careful not to obstruct the slider with your
fingers
-Stand or sit upright, take a deep breath in
and firmly seal lips around the mouthpiece
-Blow out as hard and as fast as you can
(keeping the tongue away from the
mouthpiece)
-Repeat twice more and take the best of the
three (then look up the results on the chart)
-Ask the patient to demonstrate, and check
that they dont have any questions/concerns
etc. Then say thank you!

Inhalers
There are two types of pMDIs (pressurised metered dose
inhalers); preventers and relievers. Preventers are brown in the UK and
contain a steroid (Beclometasone), and should be used morning and
evening to prevent inflammation in the airways and therefore reduce
the likelihood of an asthma attack. [side effects: oral candidiasis (wash
mouth out after use)]
Relievers are blue in the UK and contain Salbutamol which relaxes the
airways, reducing shortness of breath and wheezing. If you need to use
them both together, use the reliever first to open the airways, followed
by the preventer. [side effects: tachycardia, headaches, tremor]
-Introduce yourself, check the patients identity, explain why you
are doing this procedure and gain the patients consent
- Check the inhaler type and that it is in date
-Shake the inhaler with the cap on
-Remove the cap and breathe slowly in and out
- Put the inhaler in your mouth and form a tight seal with the lips
- Take a slow breath in and press the canister down firmly during
this breath
-Hold your breath for ten seconds (you can remove the inhaler
from your mouth at this point)
- Wait for 30 seconds, and if the symptoms persist, repeat the
above steps
-Ask the patient to demonstrate, and check they dont have any
questions/concerns etc. Then say thank you!
DIABETES
Diabetes is a disease where the body is unable to control blood sugar
levels properly. There are two major types of diabetes: type 1 and type 2. In type 1 diabetes,
the immune system attacks the -cells of the pancreas that create insulin. This means that
there is insufficient insulin to deal with the glucose in your body, causing a dangerous rise in
blood glucose levels. In type 2 diabetes, the body becomes insulin resistant (it either does
not produce enough insulin, or the insulin receptors do not react properly to the insulin that
is produced).


















Urine analysis

-Introduce yourself, check the patients identity, explain the
procedure and gain their consent
-Wash your hands, put on gloves and an apron (if present)
-Ask the patient to clean their genital area
-Tell them that in order to gain a mid-stream urine sample,
they need to begin urinating, and then collect enough urine
to reach the line of the cup
-When you have the sample, check that it is the correct
patients sample and that it is a fresh sample (eww)
- Check the sample for colour, odour (double eww) and
clarity
- Put a piece of tissue if you want to on the table to put the
strip on
-Check the bottle of strips is in date and take one out and
dip it into the sample
-Keep the strip horizontal for as long as the manufacturer
recommends and then compare it to the colours on the
bottle
-Discard the strip, remove the gloves and wash your hands
(see next page for more details on the results)
BMI assessment
This is an
indicator of body fat
-Introduce yourself, check the
patients identity, explain the
procedure and gain their consent
-Wash your hands (they seem to
be OK with just alcohol gel)
-Position the patient on the
stadiometer (erect, without
footwear, heels to the wall, head
positioned so that the external
auditory meatus is on the same
horizontal as the lateral canthus
(the outer corner of the eye)
-Put the arm of the stadiometer
on the patients head and record
-Position the patient on the
scales (correctly zeroed!) without
outer clothing or footwear and
record
BMI = Mass (Kg)
Height
2
(m
2
)
Some more information about the components of the urine test:

Leucocytes = bladder/renal infection
Urobilinogen = indicates a billiary obstruction
pH = it should be 5-6 ish but can vary from 4.8 to 8.5. Too acidic can indicate DKA, too
alkaline can indicate metabolic alkalosis
Specific gravity = this indicates the diluting powers of the kidney and therefore indicates
urine concentration and possible dehydration
Bilirubin = presence of this indicates hepatic/billiary disease- specifically obstructive
jaundice
Nitrites = strongly suggests a gram negative urinary tract infection
Protein = high levels indicate kidney disease, injury or infection. It can also indicate
hypertension and heart failure
Blood = presence indicates renal disease, infection or trauma- note that in women it could
be raised due to menstruation
Ketones = presence indicates starvation or diabetes
Glucose = presence can be due to diabetes (but is NOT a diagnosis in itself on the basis of
one urine test), renal injury/infection, cushings disease or acute pancreatitis











HAND HYGIENE
For the neanderthals who have managed to reach adulthood without working
out how to wash their hands. And yet have somehow got into medical school.
*Discard the first paper towel*
Put your hands under running water
Put soap on your hands
Palm to palm
Back of hands with fingers interlaced
Front of hands with fingers interlaced
Back of fingers with fingers interlaced
Rotate around each thumb
Tips of fingers around palms
Rub wrists
*Close tap with elbows, keep hands pointing upwards and dont touch anything afterwards*
You should dry your hands with a paper towel using dabbing motions that go progressively
down the hand and wrist (no one appears to know quite why this particular drying method
is so necessary for OSCEs but apparently it is)

Soap:
Bog standard soap and water should be used for general patient contact
Hibbiscrub (aqueous chlorhexadine) should be used before surgery, any clinical procedure
and after possible hand contamination
Hibbisol (alcoholic chlorhexadine) should be used on a high dependency unit
Hibbiscrub followed by Hibbisol should be used during outbreaks

Medical professionals should do things like keep their hair tied back, wear
aprons, be bare below the elbows etc
Nasty diseases wandering around hospitals include C. diff, MRSA, norovirus,
E.coli and Klebsiella
Hospital acquired infections can occur as a result of unclean invasive procedures
(e.g.: cannulation, intubation etc), or due to unclean patient contact at other
times.
THE WHOs 5 Moments of Hand Hygiene (2 befores and 3 afters)
Before patient contact & before a clean procedure
After patient contact, after touching something in the patients area & after exposure/a
procedure involving body fluid

BLOOD PRESSURE
Introduce yourself, check the patients identity, explain the procedure and
gain their consent. WASH YOUR HANDS!!!















Report the BP reading to the examiner
Ask the patient whether they have any symptoms of postural hypotension
Say that you would take 3 separate measurements, that if the person was hypertensive you
would repeat 2 weeks later, and that you would do a standing BP test if appropriate
Ask the patient if they have any questions/concerns and thank them. WASH YOUR HANDS!!!
-Explain that it may be slightly uncomfortable
-Check they havent smoked/drunk coffee/run a marathon/fought off a bear in the last half hour
-Tell them to uncross their legs, and sit up straight (but in a relaxed position)
-Place their arm on the table next to you at about mid-sternum level, with the cuff at the level of the heart
-Check that the cuff fits them (it should nearly but not quite wrap around the arm)

-Palpate the brachial artery (this is medial and in the antecubital fossa) using your fingers NOT your thumb
-Put the cuff on about 2.5cm above the antecubital fossa and with the arrow pointing to the brachial artery
-Keeping your fingers on the brachial artery (or the radial if you cant get it), inflate the cuff until you can no
longer feel the pulse. Then deflate and wait 30 seconds. This is your estimate of the systolic pressure
-Put your stethoscope in your ears and place the diaphragm over the brachial artery. Inflate the cuff abut
30mmHg above your estimated systolic pressure

-Deflate the cuff slowly (at about 2-3mmHg per second). Listen for a tapping sound:
Systolic pressure - When you hear a repetitive, sharp tapping sound for at least 2 consecutive beats
Diastolic pressure When the tapping disappears and you just get silence
-Deflate the cuff and remove it

Normal = 120/80
Hypertension = > 140/90
Hypotension = < 90/60
BASIC LIFE SUPPORT

























Assess the scene: Is it safe for
you? If so, approach whilst calling for help
Are they responsive? Shake and Shout
Alert?
Voice response? (hello, can you hear me?)
Pain response? (car keys on finger / pinch ear)
Unresponsive? (if none of the above work)
Check airway:
It should be clear and open
If it is not, tilt head back and open mouth by pulling chin down
Check breathing:
Put your ear/cheek to their mouth and listen for 3 normal,
silent breaths in 10 seconds. Watch to see if the abdomen
rises and falls naturally and see if you can feel their breath




























If they are breathing:
Check for blood:
Blood on the floor and 4 more:
Chest bleeding
Retroperitoneal bleeding
Abdominal bleeding
Pelvic/long bone bleeding
Check for injury:
Check head-to-toe for open wounds,
deformities, tenderness and swelling.
Put into recovery position:
- Nearest arm goes straight out at right-
angle to their body
- Furthest away leg is bent up and keep
it there with your right hand
- Hold hands with your left hand and
their furthest away hand
- Pull on the hand and knee you are
holding so they roll towards you. Tuck
their furthest away hand under their
face so that they almost face the floor
CALL 999
If they are not breathing:
CALL 999
Do CPR:
With straight arms and with one hand on top of
the other between the dichrotic notch and the
bottom of the sternum:
- 30 chest compressions
(to the rhythm of Nellie the Elephant),
compressing 1/3
rd
-1/2 of the persons
chest volume

- 2 rescue breaths
(although you dont have to do these in
real life if you think its too gross- in fact
recent evidence suggests that non-stop
compressions are more preferable to
intermittent rescue breaths). You should
tip the persons head back and form a
seal over their mouth. Breath strongly
enough so that you can see the abdomen
rise.
Drowning Casualties:
Give them 5 rescue breaths
Do 30 chest compressions
After 1 minute of the above, call 999
Children:
Go through the same steps as for a drowning casualty BUT:
Rescue breaths must be like blowing out a candle with a seal formed over
the nose AND mouth. Only tilt the airway back slightly.
Chest compressions should be with 2 fingers or one hand in the case of
older children
They should do 4-5 breaths in 10 seconds
CHOKING















SPECIAL CASES:









In Adults
Ask them if they can cough- if they can, encourage them to cough
4-5 Back Slaps: hold the individual, get behind them and lean them slightly forwards. Hit
them in the centre of the shoulder blades with the heel of your hand, getting progressively harder. Check if the
obstruction has dislodged after each one
4-5 Abdominal Thrusts: Get behind them and lean them forward. Put your arms around
them and make a fist with the nearest hand, wrapping the other hand over it. Pull sharply inwards and upwards
just under the diaphragm
CALL 999 and go back to the beginning of the process again
In Pregnant Women / over-weight
people
Do the normal 5 backslaps
If these dont work,
stand the person with their back
against the wall and use hand to do
strong chest compressions (although I
have also read that you can just do the
thrusts under the breast instead)
In Babies
Place them downwards
along your arm and hold them by their
cheeks (DO NOT OBSTRUCT AIRWAYS!)
Put arm and baby on your knee and do 5
backslaps 3 times getting progressively
harder (DONT DO THEM TOO HARD!)
Use 2 fingers to compress chest (if very
young, do this on their back with two
thumbs)
FITTING PATIENT


Remove any surrounding dangers
Loosen any tight clothing to increase their air supply
Otherwise you just need to let them fit it out

Once the seizure is over:
Check they are breathing
Put them in the recovery position

Stay with them until they have fully recovered. IF THEY DO NOT RECOVER: DIAL 999 AND
START CPR







[Check for tags to indicate that they are epileptic]

DO NOT:
Move the patient (unless they are
in danger)
Try to restrain them
Put anything in their mouth or try
to remove an obstruction in their
mouth
ASTHMATIC PATIENT
Keep the patient calm
Put them in an upright position and help them with their inhaler
Advise them to take deep breaths
Call 999 and stay with them until an ambulance arrives






SHOCKED PATIENT
This is when the blood circulation starts going haywire. It can either be a failure of blood
supply due to bleeding, or a failure of blood pumping due to a heart attack.
The patient will be pale, cold and clammy, have a rapid and weak pulse with rapid and
shallow breathing. They will be weak and nauseous, complaining of thirst and may vomit.
They will start losing consciousness rapidly.
Assess: do DR ABC (danger, response, airways, breathing, circulation). See if there are any
signs of blood loss
Treat: if there is bleeding, treat this bleeding
Position: lie the patient on their back and raise their legs. Give them WARTS- not literally,
that would just be unprofessional- warmth, air, reassurance, treatment (if appropriate) and
put them in a suitable/semi-sitting position
Call 999
Monitor: check ABC frequently





BLEEDING PATIENT
Assess: use DR ABC
Secondary Survey: position them on their back ideally and perform a head to toe
examination. Use gloves if they are available.
If a site of bleeding is found apply direct pressure and elevate the area









Dial 999 if the bleeding is severe or cannot be contained











INDIRECT PRESSURE
Apply indirect pressure if you cannot contain the
bleeding using direct pressure.
To do this, apply pressure to a pulse point (axillary
artery in the arm or femoral artery in the leg for
instance) for 10 minutes MAX
Then release pressure
Do not use a tourniquet
If there are foreign bodies in the wound,
wrap around the bodies without adding to
any direct pressure

HISTORY TAKING
There are two types of history taking: the short history is only 5 minutes long (just
presenting symptoms), the long history is 12 minutes long (everything and anything else)
Introduction: who you are, who they are, their age and their consent
The Presenting Complaint and its History
Family History: has anyone else complained of these symptoms before? Have
there been any major illnesses or conditions in the persons relatives?
Past Medical History: have they ever suffered from any significant conditions or
illnesses? Have they ever been admitted to hospital before?
Systemic Enquiry:


Drugs and Allergies
Social History: Who do they live with? Do they smoke, drink or take drugs?
Conclusion: Summarise (and confirm its correct), check they dont have questions,
say thank you
If it is a short history:
You just ask about any symptoms or medical
history pertinent to that area of the body
If it is a long history:
You go through each area of the body (start with the head
and work your way downwards)
If it is pain it should include:
- Site
- Onset (sudden or gradual? Progressive or regressive?)
- Character (dull, sharp, stabbing etc)
- Radiation
- Association (with other symptoms or factors)
- Timing (when, how frequent, for how long etc)
- Exacerbation/relieving factors
- Severity (on a scale of 1 to 10)

Explore their ideas, concerns and expectations regarding their
symptoms and their consultation. Explore the impact of their condition
on their quality of life.
INJECTIONS
There are 3 different types of injections (although you may only need to know subcut):
























Insulin Injection
Insulin is given with a
special needle that has insulin units
rather than millilitres along the side of
it.
You need to pinch the skin and put the
needle in at 90
0



Subcutaneous Injection
This is administered
using an orange needle (remember
Essex girls are orange skinned!).
You need to pinch the skin and put the
needle in at 45
0


Intramuscular Injection
You should use:
Either a green 21 gauge needle if you are injecting into
some large muscle bulk
Or a blue 23 gauge needle if you are injecting into the
mid-deltoid or into some small muscle bulk (so basically you should be
using this on children and the elderly)
You need to spread the skin, aspirate to check you havent gone into a
blood vessel, and then put the needle in at 90
0
Areas to inject:



The mid-deltoid site (accessible but only 1ml max)

The dorsogluteal site (deep
injection 4ml max but be careful of sciatic
nerve and superior gluteal arteries)

The vastus lateralis site (deep
injection of large volumes- 5ml max- easily
accessible and not dangerous)

The
ventrogluteal site
(not easily
accessible and only
1.24 ml max)

The injection can be
administered in the buttocks,
arms, thighs or abdominal area


Again, this can be administered in
the buttocks, arms, thighs or
abdominal areas



You need to talk the examiner through the process
1. Introduction: who you are, who the patient is and gain their consent
2. Drug chart check:
- Check their name, DOB and hospital number are all correct
- Check that that they dont have any allergies or adverse drug reactions on
the chart and with the patient
- Check that the drug chart says the correct time, drug, dose and route of
administration, and that the doctor has signed it off (many trusts require
you to double check with someone else)
3. Prepare your tray: you want a syringe, the correct needle, two alcohol swabs, gauze,
and both a sharps bin and a clinical waste bin
4. WASH YOUR HANDS and PUT ON GLOVES!!!
5. Prepare medication: check that it is the correct drug and concentration and that it is
in date. Also disinfect the vial with an alcohol swab. Then draw up correct amount
using the red drawing up needle, removing any air bubbles
6. Administer injection: clean the area of skin first with an alcohol swab, say sharp
scratch, hold the needle like a pen, and then put the needle in and out fairly quickly
but inject fairly slowly
7. Dispose of equipment
8. Ensure patient comfort: ask if they have any questions/concerns and any side effects
9. WASH YOUR HANDS (and remove gloves)!!!
10. Record drug administration
11. Say thank you
Fun facts about BINS

Yellow bags = clinical waste and body parts
Orange bags = clinical waste
Black/transparent bags = household waste
White bags = used linen
Red bags = soiled linen
Green bags = theatre linen
GROWTH CHARTS
NB: check that you have the correct chart for the correct gender!
Gather patient information:
Name DOB & age Sex Height Weight
Calculate and plot the mid-parental height:
This is the parental average height with either 12.5 added on if
the patient is male, or 12.5 taken away if the patient is female

Calculate the mid-parental centile:
Plot the mid-parental height on the 18
th
year and then look for the nearest centile (this is
the MPC)

Calculate and plot the percentile range:
Find the range: MPH +/- 7
Plot these two values on the 18
th
year
Look for the nearest centiles to these values

Plot the patients height at the age he is now:
The patients height should be within the percentile range
If the patient is >97
th
or <3
rd
centile, further tests should be done







Too short? (crossing centiles)
-Physiological
-Congenital (e.g.: Turners or CF)
-Endocrine issues (e.g.: hypopituitarism)
-Drugs (e.g.: steroid abuse)
-Environmental (e.g.: poor diet or abuse)
-Chronic disease
Too tall?
-Physiological
-Congenital (e.g.: Marfans or Kleinfelters)
-Endocrine issues (e.g.: acromegaly or
pituitary gigantism)
-Precocious puberty
NB for 0-1 yr charts:
If born before 37 weeks, draw a vertical line for their week of
birth and plot from this line
If born after 37 weeks, plot from the bold EDD line
Neuropsychological Assessement

Introduction: who you are, who they are and their date of birth
[A History: the long list indicates you may need to do this so ask about the onset, duration,
episodes, treatment, mood etc]
Assess their general awareness/orientation: what year is it? Where are they?
Explanation: explain that you are going to do a test of their memory and get their consent
Test: explain how the test works, perform the test and record the results
Interpret: indicate to the examiner what the results mean

A Digit Span Test appears to be the one you will probably need to use and you should do
both versions (see below). The patient should be able to repeat back around 7 digits. Less
than 5 indicates some impairment, and they should be successful about 75% of the time at
the first attempt








The main memory tests and the different aspects of memory that they assess
DIGIT SPAN: the psychologist reads out a sequence of digits, and the patient has to
repeat them back to the psychologist. You do 16 trials, starting off with 2 digits, and going
up to 8 digits. This tests auditory memory. You can also do a backwards version where the
patient repeats the digits back in reverse order, which tests working memory. This will be
relatively unimpaired in temporal lobe lesions, but impaired in frontal lobe lesions
PROSE PASSAGE RECALL (LOGICAL MEMORY TEST): the psychologist gives the
patient a short story of 3 or 4 sentences, and the patient has to retell the story from
memory. To score the test, you test their ability to recall the story in a logical sequence and
the themes in the story. They are often unpleasant as these are more relevant. Patients with
temporal lobe damage (in particular damage to the hippocampal formation) show a marked
impairment on this test as it tests declarative memory.
WORD LIST LEARNING: the patient is given a list of 10 words and they have to
remember them (you do about 10 trials).Patients with temporal lobe damage will
demonstrate impairment on this test, in particular those with left temporal lobe lesions,
with primacy generally being more impaired than recency.
REY OSTERRIETH COMPLEX FIGURE: the patient is asked to copy the figure (this acts
as a control test for visual perception). Then you ask them to draw it from memory (either
immediately or after a delay), and you look for specific elements of it (e.g.: the diamond on
the end or the smiley face thing). You find marked impairment in patients with right
temporal lobe lesions. [Specifically, patients will draw the general shape but no details in
diffuse left hemisphere damage, and details but a loss of general shape in patients with
diffuse right hemisphere damage. It is thought that this is because the left is involved in the
processing of details, whereas the right hemisphere is involved in the processing of wholes]
KENDRICK OBJECT LEARNING TEST: you show patients four cards of objects and
patients have to remember as many as possible in 30 seconds. It is simply a test of object
recall, not location. Apart from recording how many they can remember, you also record
perseverative error- how many objects patients persistently record falsely (e.g.: they
persistently recall objects from a previous card). There is marked impairment in bilateral
temporal lobe lesion patients, and patients with early stages of dementia/18lzheimers
disease score badly

The main tests of executive function and what capacities they assess
VERBAL FLUENCY: There are two versions of this test. The phonetic version is where
you give patients a letter and tell them to say as many words as they can that begin with
that letter (not including proper nouns and swear words) in a given time limit (usually 60
seconds). Patients will use words that sound the same in order to have a naming strategy. In
the category version of the test, you tell patients to name as many things as they can in a
certain category (e.g.: name as many animals as you can). Patient strategies will include
things like naming mammals, naming reptiles etc. You need to look for clustering that
results from these strategies, as this demonstrates that they have the ability to form
strategies, as well as the ability to switch after they have exhausted a particular category
(so they have flexibility too). This demonstrates integrity of Brocas Area and the
dorsolateral prefrontal cortex.
STROOP TEST: The patient has to say the colour of the word, not the actual word
itself (you have to give them a control of the blocks of colours themselves to check that
there isnt a colour perception/naming deficit). This demonstrates attention- the ability to
inhibit responses to distracting stimuli, specifically demonstrating orbitofrontal cortex
functioning.
TOWER OF LONDON TEST: the patient has to tell you the fewest number of moves
required to move the balls from the initial to the final position. The most direct method,
with fewest movements demonstrates integrity of the dorsolateral prefrontal cortex.
TRAIL MAKING TEST: the patient has to join the numbers in ascending order,
alternating with the letters in alphabetical order, as quickly as they can. It demonstrates the
ability to switch attention, motor speed and working memory, demonstrating dorsolateral
prefrontal functioning and diffuse frontal lobe functioning in general
WINSCONSIN CARD SORTING TEST: you have 64 cards with things on them that vary
in number, colour and shape. They have to learn a rule for placing the cards in order, which
they deduce from the neurologist saying right or wrong. The neurologist will change the
rule periodically (so first its colour, then its shape etc). The patient has to finish 6 runs of 10
correct placements. You specifically look for the number of perseverative errors that the
patient makes indicating deficits in dorsolateral prefrontal functioning and orbitofrontal
cortex functioning, demonstrating the ability to switch easily.
The profiles of memory and executive function/dysfunction found in people with
Alzheimers Disease and Fronto-temporal Dementia
Alzheimers Disease: patients will have impaired word list
learning and some evidence of a reduced primacy effect. They may have general verbal and
visual deficits (so poor delayed recalled on the rey osterrieth complex figure and poor recall
on the Kendrick object learning list). You tend to have evidence of an anterobrain memory
deficit (much like HM) so things like poor memories for events after the onset of the
disease. You wont find a deficit in digit span or executive functions. => MEMORY IS
AFFECTED

Frontotemporal Dementia: in this case
patients will almost have a reversal of AD. They will have some memory deficits (e.g.: poor
passage recall), but that is actually a secondary effect of executive dysfunction because they
cant put things into long term memory without executive function. They will have poor
attention, organisation and planning, so poor performance on verbal fluency, clustering and
switching, stroop and on the Winsconsin Card Sorting Task. They will also show poor motor
speed, problem solving deficits, impulsive behaviour, an inability to track a conversation
(problems using social feedback cues). => EXECUTIVE FUNCTION IS AFFECTED




EXPLAINING
Ask them what they already know
Ask them what their ideas, concerns and expectations are
Explain the condition simply
Check that they understand what you have just explained
Parkinsons Disease: Parkinsons Disease is a disease that affects
the coordination of muscle movements. It tends to occur after middle age and generally
speaking it is not inherited.
There is a small area of the brain called the Substantia Nigra which produces a
neurotransmitter called Dopamine. The brain cells in the Substantia Nigra use dopamine to
send messages to the muscles to tell them what to do.
However in Parkinsons Disease, for some reason the cells in the Substantia Nigra start to
die and the amount of Dopamine starts to decrease. This means that that the messages
travelling to the muscles become slow and abnormal.
Patients with Parkinsons Disease have problems coordinating their movements and making
them smooth. So they develop:
-Slow Movements (bradykinesia): often with a shuffling walk and difficulty starting,
stopping and turning
-Muscle Stiffness (rigidity): the muscles often become quite tense so this can stop the arms
swinging when walking
-Shaking (tremor): this normally affects the hands and arms and can be worse when the
person is anxious or emotional. It is most noticeable when the person is resting and less
noticeable when the person is performing a movement such as picking up an object.

Drug treatments such as L-Dopa replace the lost dopamine. There are some surgical
treatments too such as deep brain stimulation.
Tuberculosis: TB is an infection that is normally found in the
lungs. It is caught through breathing in small air droplets after someone with TB has
coughed or sneezed.
There are two types; latent TB is when you have TB germs inside you but your body is
controlling them so you feel fine. Active TB is when your body cant control the TB germs
and you get symptoms.
You tend to get a cough that goes on for more than 3 weeks and gets steadily worse, weight
loss and appetite loss, fever and increased sweating at night, and general feeling of
tiredness and being under the weather.
TB is tested by injecting a small about of a liquid called tuberculin under your skin. This is
known as a Mantoux Test. If after 2 or 3 days the area becomes raised and red, it indicates
that you have TB germs inside your body.
Treatment involves taking a course of 4 different drugs for 2 months, and then after that, a
course of 2 drugs for 4 months.

HIV: HIV is a disease that is transmitted through bodily fluids- for example during
sexual intercourse or through sharing needles to inject drugs. It is a virus that kills off the
immune cells in the body that fight infections. Therefore someone with HIV is more likely to
pick up infections and become quite ill with them- this is known as acquired
immunodeficiency syndrome or AIDS.
Around a month or so after contracting HIV, a person will start to get symptoms that tend to
be fairly general such as a sore throat, headache, diarrhoea and feeling tired and achy. It is
important to recognise an HIV infection as early as possible so treatment can be started to
prevent the person becoming more seriously ill as their bodys defences get weaker and
weaker.
Antiretroviral Therapy (ART) is a very successful treatment. It cannot cure HIV but it can stop
the virus replicating in the body. This means that the persons immune system can be
relatively normal and able to fight most infections.
GENERAL MOVEMENT DISORDER INFORMATION
Dyskinesia: this is an umbrella term for involuntary muscle movements

Hyperkinesia: this is an umbrella term for excessive abnormal and/or excessive normal
movements (as opposed to Hypokinesia which is a loss of normal movement e.g.: PD)

Chorea: this is a type of dyskinesia, and is a rapid, jerky, un-rhythmic movement that
appears to flow from one area of the body to the next. It is described as being dance-like. It
is primarily due to Huntingtons Disease, but can also be due to certain medications such as
L-Dopa or alcohol abuse.

Hemiballism: this is very rare and is characterised by violent, swinging, ballistic limb
movements. It is usually caused by infarction or haemorrhage in the contralateral
subthalamic nucleus.

Ataxia: this is an umbrella term for a lack of voluntary coordination of muscle movements.
So things like coordination, balance and speech can be affected
.
Dystonia: this is when you get twisting, repetitive movements due to sustained muscle
contractions.
Myoclonic tic: this is a brief twitch of a muscle/group of muscles that is entirely involuntary.

Tremor: there are a number of different types of tremor including an intention tremor that
occurs at the end of a purposeful movement, an essential tremor which is benign and tends
to start on one side of the body before moving over to both sides, and a Parkinsonian
tremor that is described as pill-rolling where the thumb and index finger contact each
other and perform a circular movement together.

Myoclonus: this is a quick, involuntary muscle jerk (hiccups are an example!)

BLOOD FILMS


























Iron deficiency anemia will have pencil cells, microcytosis (abnormally small RBCs)
and hyochromia (a lower than normal level of Hb in the cell making it really pale).


Sickle cell disease will produce a blood film characterised by sickled cells,
target cells (they have a round dot in the middle of them) and polychromasia
(an abnormally high number of RBCs)


B12 deficiency is characterised by hypersegmented neutrophils and
macrocytosis (with the macrocytes being oval in shape)










Normacytic Anemia is when there are some large and some small RBCs. This can be due to a
combined deficiency of B12/folate and iron, post-transfusion, or a treated iron deficiency.
















Thalassemia Syndromes can cause the blood to become microcytic (when RBC production is abnormal and
the MCV is lower than normal
(note the larger zones of central pallor and poikilocytosis)
Blood films associated with asplenia
These will contain Howell Jolly Bodies, acanthocytes, and target cells


Blood films associated with leukemia
Acute Myeloid Leukemia

Acute Lymphoblastic Leukemia

Abnormal Cell Shapes, Colours and Inclusions















Blood films associated with leukemia









Poikilocytes are when the RBCs
are tear-drop shapes




Spherocytes is when the MCV is
normal but the shape is spherical
due to membrane loss (so there is
no pale bit in the middle)


Schistocytes are bite or helmet
cells found in microangiopathy
(small vessel disease)- they are
basically RBC remenants

Pencil cells are long and
hypochromic (found in iron
deficiency)

Target cells have a normal MCV but
have a mexican hat cross section
due to excess membrane (can occur
in splenectomy or iron deficiency)

Echinoctyes are regularly crenated
cells due to anemia or EDTA damage

Acanthocytes are irregularly spikey
cells associated with things like liver
disease

Stomatocytes are associated with
liver disease. They have a central
linear split- a sort of pac man mouth

Malarial parasites are ring formed,
but you may also see free parasites




























Polychromasia is a blue coloration
due to the presence of RNA. The
retic count will be high due to
haemolysis or blood loss


Howell Jolly Bodies are nuclear remnants
found after a splenectomy- they are sort of
dark dots in RBCs


Basophilic stippling is RNA
aggregated caused by iron
deficiency or lead poisoning-
basically lots of darker dots

HISTOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM
Ovarian Follicle


Fallopian Tube


Mucosa of Fallopian Tube

Uterus in proliferative phase


Uterus in secretory phase


Uterus in menses

Vagina


Mammary glands










HISTOLOGY OF THE MALE REPRODUCTIVE SYSTEM
The testes



The epididymis


The vas deferens


The prostate gland


Seminiferous tubules



Sertoli cells

Leydig cells


The penis



ETHICS
Autonomy: you are your own boss
Beneficence: you should be nice to other people
Non-maleficence: you shouldnt do things that are not nice to other people
Justice: you should know what is right and wrong



INFORMATION RETRIEVAL (AKA pretend that you dont use google scholar)
Dont use google scholar.
Instead use Cochrane Review or Medline
Use the PICO approach: problem, intervention, comparison and outcome

SENSORY AWARENESS
Hearing Impairment:
Basically do everything you would do in any patient communication scenario (i.e.: introduce
yourself, gain their consent, be nice and friendly etc).
But there are some additional things to take into account:
-Tap the patient on the shoulder to get their attention
-Maintain eye contact and speak normally (dont try to exaggerate your speech)
-Dont turn your head away or cover your mouth
-Make sure that you are well-lit
-If there happens to be a pen and paper lying around, encourage the patient to use them in
case of communication difficulties
Visual Impairment:
If the person is using a guide dog or a long cane, approach them from the opposite side and
dont make eye contact with the dog or start paying attention to it.
Engaging the person: touch them on the forearm briefly when you start to speak and say
who you are. If you think they need assistance, ask them what they need
Guiding the person:
-ask them if they want your arm or if they want to follow your voice. If they want your arm,
place their hand on your upper arm, putting yourself in front and allowing them to have
contact with your body. If they want to follow your voice, maintain conversation constantly.
-constantly indicate the direction that you are moving in and describe the surroundings
-When you leave them, make sure you tell them. If they are leaving you, make sure you
know where they are going.

Introducing a blind person to something
A seat: put your guiding hand on the seat so that they can find it by sliding their hand down your hand. You should also
indicate the back of the chair.
A bed: the same principle but after you have indicated the middle, also introduce them to the edges before going back to
the middle again
ANATOMY
ANATOMY OF THE HEART








ANATOMY OF THE LUNGS




















ANATOMY OF THE KIDNEYS










ANATOMY OF THE LIVER








ANATOMY OF THE PANCREAS










ANATOMY OF THE DIGESTIVE SYSTEM














ANATOMY OF THE REPRODUCTIVE SYSTEM