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Hand hygiene Introduce Gain consent I've been asked to insert a catheter to allow us to monitor your urine output This will involve putting a thin flexible tube into thebladder Before I put the tube in I will insert some local anaesthetic which should make the procedure as comfortable as possible. One of the staff will be present as a chaperone Chaperone Do you have any allergies at all? Urinary retention? Check in the notes about bladder scan? Assemble equipment: APRON Woundcare pack Saline Catheter Catheter bag Instilagel Sterile gloves (x2 There is one in the pack) Incopad Check patient ID using bracelet Clean trolley Open pack Put in saline and instilagel in field Arrange patient Perform hand hygiene and put on gloves Arrange the sterile towel Retract foreskin Clean head of the penis with saline Wiping away from the urethral meatus How many Use intilagel and wait for up to 3 minutes Inject a bit in ...

Introduce yourself Set agenda and obtain consent Check comfortable Presenting complaint Opening question So could I start by asking you, what problems brought you into hospital today? Summarise and screen So you've told me x and y. Have you noticed anything else? Screen once more or until she says nothing else Have you noticed any other problems? Are there any other problems that you would like to tell me about HPC So can you take me back to the beginning from when the problems first started? Obtain chronology Empathy statement - this sounds like it must have been difficult for you Take each item in  turn Can you tell me more about that? Systems review I'd like to ask you a few more specific questions if that's okay ICE So, before you came in did you have any ideas of what might be going on? Is there anything that’s worrying you at all? What where you hoping to happen by the end of the consultation? PMH I'd l...

This is the general instructions on how to do a cardiovascular exam Before you start you would like to: Wash hands Introduce yourself and gain consent Position the patient at 45 degrees General inspection Look for paraphernalia General state Colour Short of breath? Any scars Make a general statement such as 'Mr X looks alert, well perfused and comfortable at rest  Hands Tobacco staining Peripheral cyanosis Capillary refill time . Nails -  clubbing Splinter haemorrhages  (can be sign of IE) Nailbed pulsation ( a sign of  aortic regurgitation (Quinke's sign)) Tendon xanthomata Janeway lesions (painless) (PROXIMAL IS PAINLESS) Osler nodes (painful) (both signs of IE) Arm Pulse Radio-radial delay Radiofemoral delay (can indicate coarctation of aorta or aortic arch aneurysm) Collapsing pulse or waterhammer (check for pain in arm)(if positive, sign of aortic regurgitation) Can check brachial pulse Wi...

 Inflammation is a stereotypic, non specific response to infection. Its functions are to: ·          Deliver components of the immune system to the site of infection ·          Eliminate pathogen (if present) ·          Repair the damage ·          Return to homeostasis Ideally the inflammatory response should be rapid (acute), destructive, but also localised and self limiting. This essay will describe the events that occur during the acute inflammatory response and discuss its importance with respect to controlling infections. Inititaition/trigger The initiation and/or trigger for the acute response is the afferent arm of the immune system. Its function is to detect dangerous stimuli (which include PAMPs but also ‘self PAMPs’) and subsequently trigger the acute inflammatory response. This serves to eith...

To answer this question first must understand what they are. These are both trypanomastid , protozoan parasites with kinetoplasts. This is an extracellular DNA that consists of maxi and mini circles of DNA which contain enzymes for mitochondria. They both have indirect life cycles where they require 2 hosts. Draw below: Trypanasome: Metacyclic -> long slender -> short stumpy -> procyclic -> epimastigote -> metacyclic Leishmania: Promastigote (infectious) -> Amastigote (back to sand fly) Here it is clear to see that vectors play a part in their transmission. Nature of sandfly vs Tsetse Tsetse is definitive host, takes up parasite on tenerial feed. Within the fly it matures and becomes infective. The actual tsetse fly is not that common as it lays pupae, not eggs. Also it prefers feeding on livestock or game rather than humans. Sandfly is much more common as each fly lays around 100 eggs. They lay them into organic matter such as soil. What is the r...

In order for a pathogenic bacterium to exploit a new host it needs to adapt to the new environment. It needs to acquire the ability to: ·          Invade the host ·          Attatch to and colonise the host tissue ·          Survive within the host avoiding both the hosts innate and adaptive immune system ·          Acquire nutritients within the host ·          Disseminate from the host and allow transmission. Often it is these attributes of the bacteria that cause its virulence (although evolution would favour the bacteria that can complete the above tasks without causing virulence as this would allow for greater transmission) The central dogma of biology states that the characteristics of an organism are determined by the DNA in the following way: DNA->RNA-> Protei...

The role of the spermatozoa is to successfully deliver the paternal DNA to the oocyte to allow for sexual reproduction to occur. In order for this to happen, several events must occur and they which will be outlined in the overview fig 1: 1)     Movement into the epididymus 2)     Spermatozoa maturation 3)     Spermatozoa release during intercourse into female vagina 4)     Overcoming the cervix 5)     Capacitation in the uterus 6)     Activation of the sperm 7)     Binding to the oocyte 8)     Fusion with the oocyte 9)     Syngamy (not discussed) This process is a very difficult task and it serves as a selection process so that only the best sperm will be able to fertilise the egg. We begin with spermatozoa in the seminiferous tubules. In this state the sperm are immature . They do not have proper movement and cannot actually swim...

Define neural crest as the ectodermal cells from the lateral neural plate. They go on to form various parts of the body such as: Skull + teeth, PNS, calcitonin producing cells, parathyroid glands, carotid bodies, spiral septum, adrenal chromaffin cells. They start from the neural tube but during development they migrate . Subsequently the study of these have given greater insight into cell migration mechanisms. Furthermore these neural crest cells are plastic and have allowed for improved understanding into how regulative development occurs. Finally labelling experiments have allowed us to trace the lineage of differentiated cells to form fate maps . This has enabled us to understand the origins of many types of cells are actually neural crest and subsequenty help us to understand why conditions such as DiGeorge’s which causes craniofacial deformities can also cause      thyroid gland agenesis and persistent truncus arteriosus. Neural crest fate mappi...

Segmentation is a key process in animal development defined as the serial repetition of tissue pattern along the axis of the body and allows differentiation of the developing organism. This differentiation in particular is mediated through Hox Genes. This essay will discuss their role and possible mechanisms for how they work. What are the hox genes? The hox genes are a set of genes that determine a segments identity. In the human there are 4 sets of 13 genes. These contain a homeobox domain which allows them to trigger the expression of various genes throughout the tissue. The exact nature of their expression is unknown however their role in patterning can be shown throughout various experiments. Experiments in flies The hox genes were originally discovered in the drosophila by Edward B lewis when he noticed that in some mutant drosphila some segments took the identity of segments above them. For example the drosophila expressed a pair of wings where it should have expressed ...

Discuss the relative importance of respiratory systems and kidney in regulating pH pH is a very tightly controlled parameter in the body 7.35-7.45 It is important to maintain pH to allow functioning of enzymes and ion channels (other proteins e.g haemoglobin bohr effect) Maintenance Buffers Carbonic anhydrase CO2 + H2O <-----> H2CO3 <-----> HCO3-  + H+ Respiration and affects CO2 Kidney excretes and produces HCO3- Kidney excretes H+ H+ can come from metabolism and diet. It varies greatly in diets e.g in vegans low H+ is while in meat eaters there is a high H+ pKa of the buffer system is 6.1 but desired pH is 7.4 so minute by minute control by lungs are required. The HCO3/0.03PCO2 must be set to 20. Repiration so pH changes are detected by the central and peripheral chemo receptors (more central) and altered signals are sent to the medulla to alter respiratory rate Show link between alveolar resp rate and pACO2 (CO2 can also be carried...