CBL

Question 1

why do paramedics need CPR

Answer 1

• paramedics ability to perform CPR can directly affect the patient’s outcome of survival after cardiac arrest
• survival rates double after rapid initiation of CPR

Question 2

what is the relevance of cell proliferation to paramedics

Answer 2

• shows how different tissues are affected by cell death and trauma
• knowing which cells will be able to rapidly proliferate will help paramedics make informed decisions of necessary treatments
• help reduce any long-term problems

Question 3

what cellular process uses oxygen

Answer 3

aerobic respiration - use of oxygen and glucose to make water Co2 and ATP
- oxygen is the final electron acceptor
- needed in the continuation of the cycle

Question 4

what cellular processes produce CO2

Answer 4

• only released in aerobic respiration
• waste product for the breakdown of glucose when creating pyruvate and NADH

Question 5

is oxygen always good for a cell

Answer 5

• O2 binds to haemoglobin to transport it around the body to supply oxygen to body cells
• necessary for cellular respiration
• too much leads to oxygen toxicity, too high a partial pressure leads to hyperoxia
• too high a concentration at high partial pressure, becomes toxic and cells die
• abnormal partial pressures and concentration can be detrimental to cells

Question 6

what are the consequences of having too much carbon dioxide in the blood

Answer 6

• too high a blood co2 level triggers the body that there is not enough o2, causing the urge to breath
• leads to hypercapnia, which can result in seizures and death
• also causes a rise in blood ph levels making it more acidic this is academia which can trigger acidosis (can’t balance pH so damages cells)

Question 7

show an understanding of the gross anatomy of the lungs and the lower respiratory tract

Answer 7

• trachea is medial in the body, anterior to the oesophagus
• bronchi originate from the trachea and feed the lungs entering the medial portion of the lungs
• bronchopulmonary segments are areas of the lung that are supplied by segmental bronchus at the tertiary stage of division
• apex of lung above clavicle
• lung has a double membrane - parietal pleura and visceral pleura, providing lubrication to reduce friction
• right lung in 3 lobes, left lung in 2 lobes

Question 8

describe the anatomy of the chest wall including osteology, joints, muscles and the neurovascular

Answer 8

• bones in thorax: 12 pairs of ribs, 12 vertebrae
• sternum: body, manubrium, xiphoid process, sternal angle and xiphisternal joint
• costovertebral joints connects the ribs and vertebrae
• muscles in thorax aid movement or ribs and provide strength and support in the thorax
• main muscles are the 3 types of intercostal
• diaphragm used in breathing lies under the lungs
• left common carotid artery and left subclavian artery, internal thoracic and pulmonary veins

Question 9

identify the safest location in which a chest drain could be inserted

Answer 9

• inserted into the safe triangle: mid-axillary line, lateral boarder of pec major, imaginary horizontal line from the nipple (usually at the 4th/5th/6th intercostal space)
• done here to minimise risk to surrounding structures, it prevents drain being placed too low which could damage spleen and liver, reduces risk to intercostal vessels and nerves inferior to the ribs

Question 10

describe the anatomical differences of a paediatric and adult airway

Answer 10

• similar by there are some differences
• child’s airway is smaller in diameter and shorter in length.
• if child has minor injury or slight swelling this can make it very hard for them to breath
• child’s larynx is higher and more anterior
• child’s is made of more soft tissue so there is a higher chance that it will collapse
• epiglottis in child is horseshoe shaped, shorter and stiffer

Question 11

describe the normal values of respiration from neonates to adults

Answer 11

• tidal volume: 4-6ml/kg (neonates), 5-10ml/kg (toddlers + children), 6-10ml/kg (teens), 6-8ml/kg (adults + geriatric)
• respiratory rates: 30-60 (neonates), 20-40 (toddlers), 15-30 (children), 15-20 (teens), 12-20 (adults), 15-20 (geriatric)
• vital capacity: 120ml (neonates), 500ml-1.15L (toddlers), 800ml-2.8L (children), 1.3-4L (teens), 3-5L (adults), decrease 0.2L a decade (geriatric)
• peak expiratory flow rate: 87L (neonates), 87-141L (toddlers), 157-254L (children), 276-540L (teens), 400-700L (adults), 300-560L (geriatric)

Question 12

explain whether the cells of an infant or the elderly would be more likely to have mutations

Answer 12

• age can be associated with the increase in mutations
• can be due to: sun exposure, higher rates of radiation, ‘somatic mutations accumulate with ageing in normal tissue, even in individuals who are cancer free’

Question 13

what are the consequences of DNA mutation

Answer 13

• harmful mutations, beneficial mutations, neutral mutations
• their effect is dependent on size, location and nature
• can lead to genetic disorders, uncontrolled cell division, abnormalities in rates of apoptosis, hypermethylation or hypomethylation - effect gene expression and lead to cancer, affect tumour suppressor gene

Question 14

which body tissues have the greatest cell proliferation? which tissues proliferate the least?

Answer 14

• cardiac muscle: in embryonic development differentiate and then retained throughout life of the organism. they cannot be replaced
• skin fibroblasts, smooth muscle cells, endothelial cells that line blood vessels, epithelial cells of internal organs - all proliferate fast
• least proliferation: blood cells, epithelial cells of the skin and epithelial cells of the digestive tract
• most proliferation: intestinal epithelium, turnover of 3-5 days

Question 15

does cell proliferation differ between infants, young adults and the elderly?

Answer 15

• with an increase of age cells become larger so are less able to divide and multiply
• cells function less efficiently in older people which could lead to them functioning abnormally
• aging: tissues lose mass and connective tissue - organs and blood vessels may become ridged
• change to cell membrane making it harder to get nutrients and oxygen as well as being harder to remove CO2

Question 16

Do B-cells and T-cells mature in bone marrow?

Answer 16

• B cells – produce antibodies to destroy bacteria/ viruses, activated by t cells
• T cells – produce cytokines – which active other parts of the immune system
• They both arise from the bone marrow
• B cells continue to mature in the bone marrow, but t cells migrate to the thymus
• Once they are matured, they enter the blood stream

Question 17

In what part of bone are blood cells made?

Answer 17

• Made in the bone marrow
• Bone marrow is made up of stem cells which produce red blood cells, white blood cells and platelets

Question 18

What part/s of bone give long bones their strength?

Answer 18

• Parts of bone: epiphysis and diaphysis
• Epiphysis – at the top, filled with spongy bone
• The epiphysis meets the diaphysis at the metaphysis
• Diaphysis – hollow tubular shaft, medullar cavity which is filled with yellow bone
• Outer wall of diaphysis is composed of dense and hard compacted bone, a form of osseous tissue
• Collagen and calcium add to its strength

Question 19

Identify the two different types of bone tissue and the five different classes of bones?

Answer 19

• Types of bone tissue: compact bone and cancellous bone
• Compact bone tissue – hard outer layer, strong, dense, provides strength
• Cancellous bone tissue – lighter, less dense, aids in bone compression
• Classes of bone: long, short, irregular, flat, sesamoid
• Long bone example – humerous, fibula
• Short bone example – tarsus and carpus
• Flat bone example – cranium, ribs (replace connective tissue)
• Irregular bone example – pelvic and spine bones
• Sesamoid bone – protect tendons, oval shaped

Question 20

With the aid of a diagram, Identify the major features upper respiratory tract including nasal, oral and laryngopharyngeal structures.

Answer 20

• Major features – nose, nasal cavity, mouth, pharynx (throat), larynx (voice box)
• Laryngopharynx: posterior pharyngeal walls, pyriform sinuses, post cricoid area – it allows food to be propelled posteriorly towards the oesophagus
• Epiglottis slops backwards to seal of the larynx
• Upper oesophageal sphincter relaxes allowing entry of food and liquid to the oesophagus
• Oral – lip, hard palate, soft palate, retromolar trigone (behind wisdom teeth), tongue, gums, buccal mucosa, floor of mouth
• Nose – nasal skeleton: vestibule, respiratory region, olfactory region, nasopharynx

Question 21

What is osteoporosis and why is prevalent in older women?

Answer 21

• Osteoporosis – bone loss, making bone brittle, making it easier to fracture bones
• Hormonal changes during the menopause affect the bone density
• Oestrogen levels fall allowing osteoclasts to absorb and break down the bone
• Osteoblasts can’t keep up producing enough bone so bone density decreases
• Messaging chemicals stop the maintenance of bone production to bone breakdown levels

Question 22

Why are the bones of a child less suspectable to fracture?

Answer 22

• More flexible due to chemical composition
• Have a stronger periosteum layer
• Bones can ‘bow’ up to 45 degrees

Question 23

What proportion of cells are erythrocytes and how would this change in dehydration?

Answer 23

• 40-45% of blood volume
• Rest of blood volume is made up of plasma, white blood cells and platelets
• Dehydration – proportion of red blood cells will increase as there is a lower volume of blood plasma
• Levels will appear elevated, but the number of erythrocytes has not changed (only total volume)

Question 24

Identify 11 types of cells derived from haematopoietic stem cells.

Answer 24

• Myeloid cells: monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes, platelets
• Lymphoid cells: t-cells, B-cells, natural killer cells, dendritic cells

Question 25

Erythrocytes have no mitochondria. Why? and how do erythrocytes get ATP to maintain cellular functions?

Answer 25

- Haemoglobin is necessary for the transport of oxygen in erythrocytes - Large quantity of haemoglobin needed means that mitochondria is absent - Get ATP from anaerobic conversion of glucose via pyruvate and lactate

Question 26

What proportion of body mass is water and does this differ between young adults, infants, and the elderly?

Answer 26

- 60% of body mass is water – around 42L for a 70kg person - 25l intracellular fluid, 17l extracellular fluid, 3l plasma, 13l interstitial, 1l transcellular - Increase in age = decrease in proportion of water in body mass - Percentage of lean tissue like muscle mass decreases and fatty tissue increases with age - Fatty tissue contains less water

Question 27

Why are action potentials used for long distance communication in the body (over centimeters and meters) and not graded potentials (which are used over micrometres)?

Answer 27

- Graded potential – temporary local changes in membrane potential, potential decreases as it moves from trigger - Action potential – all or nothing, self-propagating meaning as it travels it signals more voltage gated channels to open continuing wave of depolarisation - Action potentials do not decrease in strength along the length - Allow rapid transfer of info as they are transient

Question 28

Explain how a synovial joint such as the plane joint in the chest was might change with age (include fragility and ossification)

Answer 28

- Synovial fluid lubricates and acts as a shock absorbed - Hyaline cartilage decreases friction of the bones making movement more smooth - Aging – production of synovial fluid decreases and cartilage becomes thinner so becomes stiffer - Could be due to ossification – process of bone formation, process slows down so we can see the slow effect of it making out joints more brittle - Plane joint – aging they can’t slide over each other as freely and fast as production of synovial fluid is decrease, more friction and less flexible

Question 29

Relevance learning objective: what is the relevance of red blood function to paramedics

Answer 29

- Oxygen transport is reliant of rbcs - Rbcs can give overview of health and abnormalities eg anaemia, internal bleeding - Signs and symptoms of rbc dysfunction can help paramedics identify illnesses - Can help to assist in appropriate treatment and helps for patients with major blood loss

Question 30

Describe how the composition of fluid compartments differ from children, young adults, and the elderly

Answer 30

- Fluid compartments – extra cellular (17L) and intracellular (25L) - Infant water body mass = 75% - Adult water body mass = 50-60% - Elderly water body mass = 45% - Changes with development as organ, muscle, fat, bone, and other tissue change with age - Fat has the greatest effect on the fluid compartments

Question 31

Explain how the drainage of the portal venous system to the liver leads to varices.

Answer 31

- Portal venous drainage system – main vessel of venous system that returns blood back from GI tract to liver - Where toxins are removed - Varices – veins in distal oesophagus and proximal stomach become permanently dilated due to pressure - How – increased hypertension in portal vein puts pressure on the veins widening them, blood is redirected to the portosystemic system where vessels over dilate

Question 32

Describe the peritoneal relations and reflections associated with the liver and the other accessory organs of the gut?

Answer 32

- Folds of peritoneum reflect off the inferior surface of the diaphragm and attach to the liver - Peritoneum from diaphragm to liver surface leaves a bare area on liver and diaphragm - Liver ligaments are double layered folds of peritoneum that attach the liver to surrounding organs or to abdominal wall - falciform ligament, coronary ligament, right and left triangular ligament - liver is an intraperitoneal organ

Question 33

Define the organs that make up the foregut, what is the neurovascular supply to the foregut.

Answer 33

- Oesophagus – food from pharynx to stomach by peristalsis, mucous membrane - Stomach – main digestion and food break down - Duodenum – receives bile and pancreatic juices - Liver – accessory digestion gland, synthesises bile, stores glycogen, regulates blood sugar, produces clotting factor - Pancreas – secretes enzymes, hormones, pancreatic juices - Supplied by coeliac trunk

Question 34

Explain how the molecules bilirubin and biliverdin are continuously made in the body.

Answer 34

- Made through the constant destroying and generation of red blood cells - RBCs broken into heme and globin - Globin broken down into amino acids - Heme broken down into iron and the waste product biliverdin - Biliverdin becomes bilirubin through biliverdin reductase

Question 35

Explain how the liver prevents bilirubin build up in the blood.

Answer 35

- Recycling of bilirubin > unconjugated bilirubin > conjugated bilirubin - Bilirubin is bound to albumin for transport in blood - Bilirubin is metabolised in the liver so there is no build up in blood

Question 36

What is molecular conjugation any why does the liver perform this function?

Answer 36

- Processes of adding another molecules to molecules that are already there to make them water soluble - Done to ease secretion - Liver does this to secrete conjugated bilirubin by disrupting the hydrogen bonds

Question 37

Explain how bile is made and why it is needed for digestion.

Answer 37

- Bile emulsifies lipids which allow them to be broken down and absorbed - Gets rid of waster products such as haemoglobin - Key role in digesting fats - Mainly needed to break down molecules to be able to be absorbed and to remove toxins and waste products - How – made from the liver and is made due to osmotic gradients of solutes in the liver

Question 38

Why does a blockage of the sphincter of Oddi cause pale stinky floaters?

Answer 38

- Sphincter oddi – muscular valve around the bile duct - If not opening and closing at right time it backs up the digestive juices - Stinky floaters as not enough bile and pancreatic enzymes in the small intestine for break down

Question 39

Explain the consequences of reduced liver mass on the health of elderly people?

Answer 39

- Liver – carries out immune function, controls chemical levels, produces bile - Build-up of bilirubin – reduced mass makes it harder to break down - Bilirubin build up leads to jaundice - Lack of control of blood clotting – can lead to haemorrhaging - More likely to get infections - Can get anaemia as less iron can be stored in the smaller mass of the liver – make elderly more fatigued

Question 40

Identify four changes in gastrointestinal function experienced by the elderly when compared to young adults.

Answer 40

- Mouth – less saliva jaw muscles make it harder to chew - Oesophagus – oesophageal sphincter strength decreases, weaker contractions - stomach – looses flexibility so can’t resist damage increase ulcer risk - Small intestine – decrease in lactase makes it harder to intake calcium - Large intestine – slower movement so harder for food to move - Rectum – enlarges so more likely to be constipated

Question 41

Relevance learning objective: what is the relevance of liver function to drug administration by paramedics

Answer 41

- Liver failure can change the response to drugs - May be harder to take up drugs and break them down - Some drugs might be inactivated by the liver so are not effective if orally given - Signs and symptoms of liver failure – help drug choice, alter what is needed to be given to patient

Question 42

Draw and label detailed diagrams of the liver and gallbladder, describe the anatomical relations of the liver.

Answer 42

- Liver parts: right lobe, left lobe, quadrate lobe, caudate lobe, falciform ligament, coronary ligament, triangular ligaments, blood supply: proper hepatic artery and portal vein, 3 hepatic veins - Gallbladder lies of visceral surface of the right liver lobe, anterior end of the right 9th costal cartilage - Major part of fossa is against the transverse colon and superior part of duodenum - Narrow part directed towards porta hepatic - Blood supply – cystic artery from right hepatic artery - Cystic veins drain the biliary duct - Neck of gallbladder drains through hepatic portal into liver - Viens from fundus and body pass into visceral surface of the liver

Question 43

Increased haemolysis will cause the skin to become yellow and will cause there to be an increased proportion of reticulocytes to be found in the blood. Explain how haemolysis caused both features.

Answer 43

- Haemolysis – when RBC get destroyed faster than they can be replaced - Yellow skin – blood cells are destroyed and removed from blood stream before their life is over OR there is partially clotted blood under the skin - Jaundice occurs as bilirubin from the breakdown of blood cells accumulates in the blood - Reticulocytes – bone marrow still functional required components to create reticulocytes - Body responds to anaemia by increasing the synthesis of reticulocytes - Reticulocytes are immature blood cells

Question 44

How does normal liver function prevent oedema and haemolysis?

Answer 44

- Oedema – build-up of fluid in the body causing tissue to swell - Haemolysis – RBCs are destroyed faster than they are able to be replaced - Prevent oedema – there is no excess fluid that could build up as the liver regulates this - Oedema could be caused due to cirrhosis as there is an abnormal regulation of extracellular fluid volume - High blood pressure in portal vein could cause oedema - Oedema could come from liver not producing enough proteins such as albumin if liver is healthy regulation of blood levels of amino acids would take place effectively - Cholesterol produced could prevent oedema as unnecessary fat would not build up - Prevent haemolysis– liver processes haemoglobin to store iron meaning iron levels would be normal making anaemia less likely to happen

Question 45

Highlight the organs that make up the foregut, what is the neurovascular supply to the foregut.

Answer 45

- Oesophagus – food from pharynx to stomach by peristalsis, mucous membrane - Stomach – main digestion and food break down - Duodenum – receives bile and pancreatic juices - Liver – accessory digestion gland, synthesises bile, stores glycogen, regulates blood sugar, produces clotting factor - Pancreas – secretes enzymes, hormones, pancreatic juices - Supplied by coeliac trunk

Question 46

Define the organs that make up the midgut, what is the neurovascular supply to the midgut.

Answer 46

- Duodenum – further digestion of food - Jejunum – absorption of minerals - Ileum – long, where food spends most of its time, thinner and narrower - Caecum – first part of colon, absorbs remaining fluids and salts from digestion - Ascending colon – receives partially digested food from the small intestine - Proximal transverse colon – most mobile section, continues to move food - Colon as a whole – move waste products to the anus and be egested - Supplied by the superior mesenteric artery

Question 47

Differentiate the structure and function of organs within the midgut

Answer 47

- Duodenum – retroperitoneal, continues digestion through digestive enzymes and fluids, major duodenal papilla - Jejunum – intraperitoneal, carries out peristalsis, absorbs sugar, amino acids and fatty acids, highly coiled, thick, larges, wall closely packed plicae circulares, large loos of arterial arcades, long vasa recta, mucous membrane, many villi to increase surface area - Ileum – intraperitoneal, carries out peristalsis, absorbs rest of the minerals that the jejunum didn’t, highly coiled, thin, light, spares plicae circulares, numerous short loops of arterial arcades, short vasa recta - Colon – taenia coli forming haustra which aide moving solid material through the colon, colon absorbs water and electrolytes, produces and absorbs vitamins

Question 48

Define the organs that make up the hindgut, what is the neurovascular supply to the hindgut.

Answer 48

- Transvers colon – longest and most flexible, essential for digestion and excretion, - Descending colon – store remaining food - Sigmoid colon – has a lot of muscle tissue which pushes faeces out - Rectum – temporary storage for faeces – connecting to the anus

Question 49

What is the surface landmark of the appendix? How does pain to this organ present?

Answer 49

- Landmark is called mcburney point – found 2/3 of the way from the umbilicus to anterior superior iliac spine - Can be palpated when inflamed - Pain presentation – this appendicitis, on and off tummy pain, travels to lower right quadrant of abdomen - Symptoms – nausea, high temperature, vomiting, diarrhoea, walking coughing making pain worse

Question 50

Draw and label the rectum and anal canal?

Answer 50

- Rectosigmoid junction - Retal folds - Rectal ampulla - Internal hemorrhoidal veins - Pectinate line - Anal sinuses - Anal columns - External hemorrhoidal veins - Internal anal sphincter - involuntary control (autonomic nervous system) - External anal sphincter - voluntary control (somatic nervous system)

Question 51

What are the four touch receptors in the skin of a paramedic, and what modality (type of touch sensation) does each receptor convey to the brain of the paramedic?

Answer 51

- Touch receptors – type of neurone, sending info from stimulus to brain neurons - Meissner’s corpuscles – fluid filled neurones, encased in dermal surface, myelinated, also known as tactile corpuscle, Info about light touch and low freq vibrations, good for detecting texture and moving and handling - Pacinian corpuscles – in reticular dermis and hypodermis, encapsulated nerve endings, prevalent in wall of organs, Extremely sensitive to changes in vibration and pressure, lamella deformation sends a receptor potential - Merkel’s disk – never endings in the epidermis, make up of Merkel cells, grouped at the base of the epidermal ridges on fingers, Crucial touch receptors, recognise light touch and sends signals to neurones, Shape, texture info - Ruffini’s corpuscles – encapsulated, deep within skin, tendons, and ligaments, made of ovoid capsules encased in collagen, Sensitive to temp rise, detect skin stretching, movement and finger position - Allows to differentiate between touch and vibration

Question 52

What is the difference between innate and acquired immunity?

Answer 52

- Innate – first response in immunity, barriers already in the blood and tissue - Acquired – use of t and b cells when there is a greater need for defence than the innate response – specific to the pathogen. Can be adaptive or passive - Adaptive – occurs in response to an infection or vaccination - Passive – receiving antibodies rather than creating a response through the immune system

Question 53

What are cytokines and what do they do?

Answer 53

- Proteins that are made by immune and non-immune cells - Used in cell signalling - Control growth and activity of other immune cells – simulate or slow down

Question 54

Compare the digestive functions of the liver and pancreas.

Answer 54

- Liver – producing and releasing bile acids, aiding digestion, bile neutralises stomach acid, where absorbed nutrients from gi tract go, glycogen stored in liver - Pancreas – exocrine tissue which secreted pancreatic juices, enter duodenum through MDP, provide digestive enzymes

Question 55

How does the function of a Natural Killer cell differ from that of a B-Lymphocytes

Answer 55

- Natural killer cell – fast response, kill virally infected cells, detect and control signs of caner, found in placenta (role in pregnancy) - Come from same family as t and b cells, NK cells are classed as group 1 innate lymphocytes - b cells have to wauth for lymphocytes to be produced - NK cells are in innate immunity and B cells are in adaptive - NK cells lead to apoptosis via granules - B cells rely on antibodies

Question 56

What does the abbreviation “COX” mean when referring to inflammation and why is it relevant to paramedics?

Answer 56

- COX – cyclooxygenase - an enzyme that forms prostaglandins, prostacyclin's and thromboxane's - prostanoids are responsible for the inflammatory response - Cox 1 - most of the tissues in the body, in GI tracts it maintains the normal lining of the stomach and intestines, protecting stomach from digestive juices, involved in kidney and platelet function - Cox 2 – primarily found in sites of inflammation - relevant: aspirin and anti-inflammatory drugs block it from working - inhibition of COX1 can cause gastric distress

Question 57

Explain the consequences of elderly people having lower mucociliary apparatus is significantly slower

Answer 57

- Primary defence mechanism for lungs in mucoillary clearance - Healthy – ciliated epithelial cells with airway surface layer – 2 components mucus layer and low viscosity periciliary layer - Cilia move mucus up and out of respiratory tract - Aging – cilia beat frequency slows down, decreasing mucociliary clearance - Causes lung infections or airway disease

Question 58

How and why does gut motility change with age?

Answer 58

- Gut motility – smooth muscle in gi tract cause peristalsis - Age – declines with age, ‘may occur, either in relation to common age-related disorder, or as a result of certain drugs commonly prescribed in the aged’ - Smooth muscle of the GI tract decreases with age in the ability to contract and relax – due to degeneration of neurons and glia

Question 59

How does that structure of the skin change with age and what is the clinical relevance of this to a paramedic?

Answer 59

- Aging – increase incidence of cancer and skin infections - Due to the skin structure changing, thinning of the epidermis and dermis – increases water loss - Skins immune composition is altered - Alterations decrease barrier immunity, increasing susceptibility to cancer and infections - Clinical relevance – ageing people so must consider changes to skin and loss of barrier to prevent injuries to their fragile structure, can be an increase in infection and serious illness

Question 60

Relevance learning objective: which pathogens do paramedics encounter most often?

Answer 60

- Bloodborne pathogens eg hep B, hep c, HIV - Exposures can stem from sharps injuries eg needlesticks, cut from contaminated sharp object, splash to eyes nose or mouth, contact to skin, human bite - Prevent – follow trust precautions, gain training on bloodborne pathogens, dispose of sharps correctly, use PPE, get vaccinated, report exposures

Question 61

What changes take place in infants developing mouth and pharynx to allow for the transition to a solid diet? 

Answer 61

- Larynx is higher up and covered with soft palette. Covering epiglottis. Drops during between birth and 6 months - Larynx and epiglottis are higher so baby can breastfeed and breath at the same time - Infants develop teeth - Example: adding OPA, no turning round as its softer - Changes into solids – possible changes to break down and digestion, emulsification

Question 62

Inflammation in children results in the hypertrophy of which airway tissues?

Answer 62

- Hypertrophy – increase in growth in muscle cells - Adenoid hypertrophy – unusual growth of adenoids - Inflammation occurs due to bacterial and viral infections. Allergens and irritants - Adenoids are part of the lymphatic system and help to fight infection

Question 63

When and why does long bone growth cessation occur?

Answer 63

- Fusion of epiphysis – stops growth - Ages 16 to 18 – growth is controlled by hormones - Growth controlled by the proliferation of chondrocytes in epiphyseal plate - Chondrocytes become flattened and hypotonic stopping proliferation causing bone growth to stop - Epiphyseal plate becomes epiphyseal line - Growth of bone can still occur in diameter

Question 64

Describe the changes that occur to the layers anterior abdominal wall in older males which can cause weakness.

Answer 64

- Loose elasticity (more fibrous tissue, loss of water) – eating is more of a challenge – can lead to a loose of muscle (replacement of tissue is slower) - Diet is worse – environmental factors, fitted dentures - Conditions - Type 2 diabetes – more common in men as they store more fat in their bellies - More prone to getting certain conditions e.g., high blood pressure – on more meds - Diabetes affecting abdominal wall – bad stomach pains, not want to eat, loose muscle mass - Men are more prone to getting hernias - Male muscle strength in abdomen decreases quickly (faster than females are men are more likely to gain weight – stretching abdomen wall)

Question 65

What are the layers that make up the wall a of the large intestine? Describe the changes that occur with age?

Answer 65

- 4 layers: mucosa, submucosa, muscular layer, serosa - Mucosa – smooth innermost layer, secretes mucus into the hollow lumen to lubricate surfaces - Submucosa – layer of blood vessels, nerves, and connective tissue, supports all other layers - Muscular layer - several layers of visceral muscle, cells move and contract with the intestine - Serosa – outermost layer, thin layer of squamous epithelium tissue, secretes waters serous fluid to lubricate outer surface - With age – they lose elasticity, decrease in size (atrophy), walls thin out (diverticulosis), diverticular form (small bulging pouches in the digestive tract)

Question 66

Describe the progressive effect of peristalsis to the wall of the gut?

Answer 66

- Peristalsis – 2 layers of smooth muscle (circular and longitudinal) – create coordinated contractions to make a wave like movement of food - Sionodial waves through the walls – waves are short, locals, reflexes or long, continuous contractions - Mix up food and propel into the duodenum - Effects of aging – eat less peristatic waves are used less often, difficulty with swallowing so eat less, weakening to the wall of the gut so loss of control of peristalsis - Increased peristalsis leads to hypermotility or hyperperistalsis – lead to diarrhoea - Decreased peristalsis – hypomotility or hypostasis lead to constipation and bacterial growth

Question 67

Why do elderly people have general depression of immune system function?

Answer 67

- More likely to get mutation - Stop making naïve t cells – can’t fight off the infection as you can’t create new immune defence - Reduced rates of production of b and t cells in bone marrow and thymus - Elderly people response to change is reduced – slower immune system

Question 68

Describe how mobility can change with advancing age and what anatomical and physiological changes contribute toward this?

Answer 68

- Mobility – muscle weakness, joint problems, loss of height, pain, disease, neurological difficulties - Age changes: loss of bone mass and density, loss of fluid in spine and becoming thinner, spine curves – intervertebral disc degeneration, bone degradation, joints weak, muscle atrophy, stiff joints, hip and knee joint lose cartilage

Question 69

Why may young and the elderly find it difficult to chew and swallow (Dysphagia)?

Answer 69

- Increase risk in young: born prem, cleft lip, compression of oesophagus, overbite, development delays, diseases affecting nerves and muscles, foreign object stuck in oesophagus, large tongue, large tonsils, problems in bone formation of the mouth and throat - Elderly: muscles in the body get weaker making it harder to chew and swallow, self-select the food, loss of teach which increase chocking

Question 70

Why are high frequency hair cells more likely to be damaged in elderly patients? And why does this mean that grandparents do not recognise plural words?

Answer 70

- Damage hair cells on the cochlea - Hair cells don’t regenerate so once loose they can’t be replaced - Means that they can’t differentiate between letters like s - More hair you lose = less electrical signals - Decrease in the number of neurones in the cochlea - Size of cells reduce - Decline in ability for central auditory system to process sound

Question 71

When and how does menarche occur?

Answer 71

- Menarche – first menstrual cycle - 9-18 - Changes to the hormone levels of oestrogen, androgens, and progesterone - Hormones being to be secreted in increasing amounts from the ovaries and adrenal glands

Question 72

When and how does menopause occur?

Answer 72

- Normally around 40-50 - Symports – hot flushes, night sweats, sleep problems, mood changes, weight gain, thinning hair loss - System begins to slow down as the number of eggs in the ovaries decreases, the slowing down causes oestrogen levels to drop

Question 73

How does oestrogen influence the function of osteocytes, osteoclasts, and osteoblasts?

Answer 73

- Osteocytes – mature cell in the bone matrix - Osteoclasts – cells that degrade bone - Osteoblasts – cells that form bone tissue - Oestrogen – lead to inhibition of bone remodelling, decreased bone resorption, maintenance of bone formation - It also modulates osteoblast/ osteocyte and t cell regulation of osteoclasts

Question 74

Why are children more poikilothermic than young adults?

Answer 74

- Poikilothermic – inability to maintain constant core temperature (thermoregulation) - Children – have less of a fat store, lower muscle mass and metabolic heat production during exercise - They have a smaller total body surface area - Have lower sweating rates so their thermoregulation isn’t as good, so they struggle to regulate temperatures - Produce more heat per unit body mass - Rely on dry heat dissipation - Babies – can’t regulate their own internal temperatures

Question 75

Why are the elderly more poikilothermic than young adults?

Answer 75

- Loss of muscle mass - Calcification of the bones - Loss of weight – loss of fat stores so unable to conserve heat - Blood vessels loose elasticity which means they aren’t as flexible with age – decrease in circulation - Possible medications make it harder to control temperature

Question 76

What is presbyopia and cataracts and why is it/ are they more prevalent in elderly people?

Answer 76

- Presbyopia – can’t focus as the lens losses flexibility so can’t make fine adjustments - Cataracts – clouding of the lens due to a breakdown of proteins and fibres in the lens - Elderly – accumulation of cellular damage, retina degenerates – cells in the eye gets more damaged and aren’t replaced

Question 77

Describe the process of general ‘physical wear and tear’ on: Synovial joints, Cartilaginous joints

Answer 77

- Synovial – decline in fluid, not lubricated, so can’t move as much, lead to arthritis as there is friction between the bones - Cartilaginous – wear away of cartilage, osteoblast and clats, stop producing menopause, there is no cartilage causing wear and tear, these joints have no joint cavity – joined by either hyaline cartilage of fibrocartilage

Question 78

Relevance learning objective: Should the elderly and children be treated in the same way as adults?

Answer 78

No, they are anatomically differently

Question 79

what is the innervation of the liver

Answer 79

- nerve supply from the hepatic plexus - sympathetic fibres from celiac plexus - parasympathetic fibres from the anterior and posterior vagal trunks

Question 80

what is the innervation of the gallblader

Answer 80

- parasympathetic stimulation produces contraction of the gallbladder and secretion of bile into cystic duct - sympathetic fibres from celiac plexus - parasympathetic fibres from the anterior and posterior vagal trunks

Question 81

what is parasympathetic

Answer 81

- 'rest and digest' - during periods of relax, sustain normal functions

Question 82

what is parasympathetic

Answer 82

- 'rest and digest' - in times of relax, continue to sustain normal functions

Question 83

what is sympathetic

Answer 83

- 'fight or flight' - help to conserve

Question 84

parasympathetic innervation of the gut

Answer 84

- increase secretion - increase motility - relax sphincter action

Question 85

sympathetic innervation of the gut

Answer 85

- decrease secretion - decrease motility - contract sphincter action

Question 86

How does normal resting cardiac output vary from childhood to that of a young adult to old age?

Answer 86

- Cardiac output- heart rate and stoke volume - Cardiac output is similar in children and adults - Children have less volume of circulatory blood so cardiac output is dependent on heart - Elderly have a reduced cardiac output - Causes elderly to have reduced circulation so reduced stroke volume - Could be affected by less elastic blood vessels, increases heart problems

Question 87

Why is surfactant lacking in premature babies and what is the consequence of this?

Answer 87

- Surfactant is made by the lungs and gives helps keeps alveoli's structure – mixture of phospholipid and proteins - Pulmonary surfactant is made in the lungs- produced by alveoli type 2 cells of the lungs - In prem babies as they don’t have enough surfactant - starts to be produced at 26 weeks but only enough is made by 34 weeks - Can cause: Newborn Respiratory Distress syndrome, Acidosis, Air leaks, internal bleeding, lung scarring and developmental disabilities

Question 88

Why can someone drown in a spoonful of water? (A spoon full of water can displace the normal composition of fluids from a large area on lung tissue)

Answer 88

- if water goes down the wrong path it can cause dry drowning - closes airway up so can’t breathe – shuts to stop anymore water entering the lungs - breathing in water causes the vocal cords to spasm and close - secondary drowning – water getting into the lungs, irritating the lining and fluid builds u

Question 89

What are the cardiovascular consequences of the age-related loss of nephrons?

Answer 89

- Nephrons are in the kidneys - used in osmoregulation - Regulate the water levels in the plasma - Filters on nephrons called glomerulus and tubule - Glomerulus filter the blood and tubule returns substances to blood and removes waste - Age – can lose half of your nephrons, causes a decrease in the amount of blood that is filtered - Kidneys not working puts a stress on the heart, meaning more blood is needed to be pumped

Question 90

Why is atherosclerosis more prevalent in elderly patients?

Answer 90

- Atherosclerosis – thickening and hardening of arteries by the build-up of plaque - Plaques – causes arteries to become hard and thicker restricting blood flow - plaque comes from a build up of cholesterol in the blood, can also be cause by high blood pressure, lack of exercise (+ other lifestyle factors) - Doesn’t show symptoms at first - Build up of plaque continues over time so gets worse in elderly - Women at risk if they have endometriosis or polycystic ovaries - Changes to the body with age contribute to this - Cellular senescence in the plaque – reduced cell proliferation, irreversible growth arrest and apoptosis - Loss of elasticity with age, weakened vessel walls so easier to build up

Question 91

Why to elderly patient have greater cardiac stiffness and what are the consequences of greater cardiac stiffness?

Answer 91

- Cardiac stiffness – heart muscle thickens due to increased blood pressure - Muscles work harder so gets bigger to overcome this – hypertrophies - Due to high blood pressure - Thickening helps increase the pump function to maintain flow - When pump stiffens pressure builds up - Increase in heart muscle size as you get older – amount of blood that you can hold decreases - Valves become stiffer and thicker which causes heart murmur - Makes heart less able to pump blood and lead to fluid build up in limbs and lungs

Question 92

How can changes in the collagen and elastin protein in the walls of the arteries impact their function? 

Answer 92

- Collagen and elastin – determine mechanical properties (both proteins) - Increases with age - Leads to stiffening of artery walls – induces sclerosis - Can cause aneurysms – fragmenting off the elastin structure - Collagen – provides strength and partial stiffness to the walls - Elastin – provides structural matrix and contributes to arteries reversible extensibility

Question 93

How do the muscles used for normal resting breathing differ between infants and the elderly Infants rely on diaphragmatic breathing?

Answer 93

- Infants use abdominal muscles for diaphragm breathing - Intercoastal muscles aren’t fully developed at the time of birth – develop as child grows to 4/5 yrs - Infants don’t have fully developed respiratory systems, can cause respiratory fatigue, spinal injuries can compromise abdominal muscles - Sarcopenia – age related loss of skeletal muscle mass and strength – affect diaphragm and respiratory muscles, decline in respiratory function causes difficulty breathing

Question 94

Identify 2 cardiovascular effects of menopause.

Answer 94

- Increased blood pressure and high cholesterol - High blood pressure – affect arteries making them less elastic, increasing blood flow and oxygen to the heart - Oestrogen – vasodilates (allows blood to flow more easily) – low levels of oestrogen at menopause can increase the pressure in arteries - Cholesterol – oestrogen levels fall, and hormone is less responsive so build-up of cholesterol, causes a build up of plaque in the blood vessel walls narrowing them – blood flow becomes obstructed

Question 95

Describe how the resting metabolic rate (O2 consumption) varies over the lifespan (quantified in absolute terms and relative to body mass).

Answer 95

- Metabolic rate – measure of how much energy you body burns whilst at rest - Infant – high rate as babies have a high breathing rate, so consume more oxygen and so burn more calories - Adulthood – lower metabolic rate as body mas is higher and gas exchange is more efficient, less O2 consumption so less energy used - Elderly – lowest metabolic rate, breathing rate has declines, body mass declines, oxygen consumption and gas exchange is less efficient so metabolic processes are less efficient

Question 96

Describe the structure of the heart, its chambers, and vessels

Answer 96

- 4 chambers: L+R atria and L+R ventricles – left and right are separated by a wall of muscle – the septum - Aortic valve: on left, opens for flow between left ventricle and aorta - Mitral valve: on left, opens for flow between left atrium and left ventricle - Pulmonary valve: on right, opens for flow from right ventricle to pulmonary artery - Tricuspid valve: on right, opens for flow between right atrium and left ventricle - Vessels: superior vena cava, inferior vena cava, right pulmonary veins, right pulmonary artery, aorta, left pulmonary artery, left superior pulmonary vein, left inferior pulmonary vein - Signal: electrical signal sent from sino-atrial node (in right atrium) across the atria, excitation of atria stimulates the atrio-ventricular node, signal continued down the atrioventricular bundle (down septum), signal divide to the left bundle branch and the right bundle branch at the ventricles (causes a contraction)

Question 97

Describe the structure of the right and left lung detailing the contents of the lung’s hila

Answer 97

- Right lung – three lobes, superior middle, and inferior, oblique, and horizontal fissure - Left lung – two lobes, superior and inferior, oblique fissure - Trachea > primary bronchi > secondary bronchi > tertiary bronchi > bronchioles > terminal bronchioles > respiratory bronchioles > alveolar ducts > alveolar sacs > alveoli - Hila – pulmonary ligament, primary bronchus, pulmonary artery, pulmonary vein, lymphatic vessels, autonomic nerves, bronchial arteries, bronchial veins

Question 98

Illustrate the layers of pleura, describe their relations to the lungs and the consequent plural recesses

Answer 98

- Pleura – reduces the friction of the lungs - Visceral pleura – on the walls of the lungs - Parietal pleura – on the lining of the chest wall - Pleural recess - There is a potential space between the 2 pleura’s – the lung doesn’t fill the potential space, allowing for changes in lung volume in breathing

Question 99

Describe the age-related changes that occur to the layers of the heart.

Answer 99

- Layers: epicardium, myocardium, endocardium (surrounded by pericardium) - Age related changes – fibrous tissue develops, fat deposits develop, SA node loses some cells (lead to slowing of heart rate), heart wall thickness, lipofuscin pigment increases, degeneration of muscle cells in the heart, increased epicardial adipose tissue, pericardial sac loses elasticity - Fibrous tissue – increased collagen, higher growth factors, cardiac dysfunction, and heart failure - Fatty deposits – build up of plaque, restrict blood flow as arteries get narrower, can lead to a blood clot - SA node cell loss – electrical impulse not occurring or is less effective, lead to arrythmia and asystole, lead to cardiac arrest - Heart walls thicken – affect total volume of blood the heart can hold, longer amount of time to fill - Increase in lipofuscin – this is released as red blood cells break down - Thicker and stiffer valves