Summary McTimoney College of Chiropractic - Biomedical Sciences II
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McTimoney - Biomedical Sciences
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University Of Ulster
This is a full summary of all lecture notes and slide decks from Biomedical Sciences II. This summary can be purchased together with potential exam questions provided by the lecturer with my own answers for each question for the same price! With these notes you are guaranteed for a high grade!
4.2 Mechanism of asthma & COPD........................................................................................................................................................................................................................................................ 29
4.3 Drugs used in treatment of respiratory conditions .......................................................................................................................................................................................................................... 30
4.3.1 Asthma drug treatment ........................................................................................................................................................................................................................................................ 30
4.3.2 COPD drug treatment ........................................................................................................................................................................................................................................................... 31
6.1 Classification of renal disease .......................................................................................................................................................................................................................................................... 45
6.2 Mechanisms of acute & chronic renal failure ................................................................................................................................................................................................................................... 45
6.2.1 AKI pathogenesis .................................................................................................................................................................................................................................................................. 45
6.3 Complications of chronic renal failure ............................................................................................................................................................................................................................................. 49
6.4 Major forms of GU disease .............................................................................................................................................................................................................................................................. 49
7 – Bone & joint pathology ........................................................................................................................................................................................................................................................................... 52
7.1 Assessment of bone disease............................................................................................................................................................................................................................................................ 52
7.2 Classification of common bone pathology ....................................................................................................................................................................................................................................... 52
7.3 Mechanisms of major metabolic bone diseases ............................................................................................................................................................................................................................... 53
7.4.3 OA vs RA ............................................................................................................................................................................................................................................................................... 57
8.1 Scope of common endocrine diseases ............................................................................................................................................................................................................................................. 61
8.2 Clinical features of major endocrine disorders................................................................................................................................................................................................................................. 62
,MAN Y2 2021 BMS2 McTimoney College of Chiropractic Michael Verouden
1 – Cardiovascular pathology
Stroke = disruption in blood supply to brain ➔ 3 types:
1) Ischaemia = blockage of an artery
o Response = infarction = necrosis
2) Haemorrhage = bleeding from a ruptured blood vessel
3) Transient ischaemic attack (TIA) = mini stroke due to temporary disruption in blood supply
to brain
Aneurysm = ballooning at weak spot in an artery wall ➔ increases stroke/haemorrhage risk
1.1 Cardiovascular diseases
Cardiovascular disease (CVD) = interlinked group of diseases that affect the structure & function of
the heart and/or blood vessels:
• Major forms:
o Hypertension = persistently high BP in the arteries
o Atherosclerosis = build-up of fats, cholesterol & other substances in/on artery walls
(plaques) which can restrict BF ➔ arterial wall thickening & loss of elasticity
o Ischaemic heart disease (IHD) = inadequate BF to myocardium ➔ ischaemia ➔
▪ Angina = chest pain or pressure due to insufficient blood flow to the heart
muscle (myocardium)
▪ Myocardial infarction (MI) / heart attack = decrease/halt in BF to a part of
the heart ➔ permanent damage to the heart muscle
o Heart/cardiac failure = inability of the heart to balance supply & demand for BF ➔
reduced cardiac output ➔ inadequate tissue perfusion
• Stroke (cerebrovascular disease)
• Miscellaneous conditions ➔ rheumatic heart disease, cardiomyopathy, heart arrhythmia,
congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery
disease & thromboembolic disease
Page 3 of 68
,MAN Y2 2021 BMS2 McTimoney College of Chiropractic Michael Verouden
1.1.1 Hypertension
• Commonest cause of cardiac failure & major risk factor for atherosclerosis & cerebrovascular
disease
• Complex multifactorial disease & can be asymptomatic until late in its pathological course
• Major factor in the progression & complications of CVD, but also a risk factor for CVD
• 2 main forms
o Primary (essential) hypertension ➔ 90-95%
▪ Cause – genetic & environment
▪ Mechanism (?) – abnormal Na handling by kidney; abnormal Na/Ca
metabolism in smooth muscle; abnormalities of RAAS
o Secondary hypertension ➔ 5%
▪ Cause – renal disease, endocrine disorders, pregnancy, diabetes, obesity,
medical treatment
▪ Mechanism – disorder leading to Na retention and/or peripheral
vasoconstriction
• Affects blood vessel structure:
o Artery wall thickening & narrowing of lumen ➔ hyaline arteriosclerosis
o Increased endothelial cell proliferation
o Blood vessel necrosis
o Hypertensive effects ➔ left ventricular hypertrophy (cardiac cell growth) ➔ heart
failure
Normal & abnormal:
• Systolic blood pressure (SBP) = force of heart on artery walls each beat
o Normal = <120 mmHg
• Diastolic blood pressure (DBP) = force of heart on artery walls in between beats
o Normal = <80 mmHg
>140/90 ➔ consider GP referral
>180/110 ➔ urgent GP referral
Complications:
• Vascular pathology
o Accelerates atherosclerosis ➔ organ/limb ischaemia
o Necrotic arteriole walls
o Aneurysms of weakened arteries/arterioles ➔ haemorrhage
o Arterial dissection = pressure leeches blood between layers of vessel wall
• Chronic kidney disease
o Narrowed renal arteries ➔ poor perfusion ➔ glomerular sclerosis (hardening) or
necrosis
o Haematuria (blood in urine)
o Uraemia (urea in blood)
o Proteinemia (proteins in blood) & reduced GFR
• Cardiac failure
o Pulmonary oedema (excess fluid in lungs)
o MI
o Left ventricular hypertrophy
• Nervous pathology
o Stroke/TIA
▪ Haemorrhage and/or ischaemia/infarction
▪ Seizures
▪ Vascular dementia (due to reduced BF to brain)
Page 4 of 68
,MAN Y2 2021 BMS2 McTimoney College of Chiropractic Michael Verouden
o Blindness
▪ Hypertensive retinopathy (retinal vascular damage)
▪ Exudates (fluid leakage from blood vessels)
▪ Arteriovenous nicking (arteriole crosses venule leading to vein compression)
▪ Retinal haemorrhage & papilledema
▪ Peripheral neuropathies
1.1.2 Atherosclerosis
• Non-atheromatous = thickening/hardening arterial wall
o Loss of elasticity & reduced BF ➔ ischaemia
o Due to ageing
o Types – hyaline (small arteries/arterioles); hyperplastic (large/medium arteries);
Mönckeberg's (calcification of extremity arteries)
• Atheromatous/atherosclerosis = formation of lipid plaques (atheroma) in medium/large
arteries
o Chronic inflammation, lipid deposition & fibrotic change
o Most common
o Traditional IHD
Key players in development of atheroma:
• Lipids ➔ saturated fats & LDL cholesterol
• Inflammatory response ➔ inflammatory cells & cytokines
• Immune system ➔ macrophages & t-lymphocytes
1.1.3 Ischaemic heart disease
• Coronary blood supply < myocardium O2 demand
• Cause ➔ atherosclerosis blocks >1 coronary arteries
• Clinical types ➔ Angina pectoris, Acute Coronary Syndrome (ACS), sudden cardiac death
• Leads to angina and/or MI
Angina:
• Typified by chest pain (gripping or crushing) ➔ may radiate to neck, jaw or left arm
• Cause is transient & reversible myocardial ischaemia
• Feature of longer term CVD ➔ hypertension, progressive atherosclerosis & cardiac failure
• May be precipitated by the ‘4 Es’:
o Exertion
o Exposure to cold
o Emotion
o Eating (heavy meal)
• 2 classes
o Stable angina (Angina pectoris)
▪ Caused by myocardial ischaemia normally due to atherosclerosis
▪ Central chest pain, discomfort & breathlessness ➔ increased by stress &
reduced by rest
▪ Reversible
▪ Predictable
Page 5 of 68
, MAN Y2 2021 BMS2 McTimoney College of Chiropractic Michael Verouden
o Unstable angina (part of ACS)
▪ New-onset or rapidly worsening angina with minimal effort without
myocardial damage
▪ Pain behind sternum radiating to arm & neck
▪ Erosion of atheromatous plaque ➔ embolus/thrombus
▪ Worsened by exercise/emotion & relieved by rest/Rx
▪ No nausea & vomiting or increased sympathetic activity
▪ Unpredictable
▪ Can be reversed
▪ High risk of MI & death
Angina is followed by ACS = sudden, reduced BF to heart ➔ 3 clinical types:
• Unstable angina
• Non-ST-segment elevation myocardial infarction (NSTEMI)
o Less serious form of heart attack
• ST-segment elevation myocardial infarction (STEMI)
o Serious form of heart attack where coronary artery is completely blocked & large
part of myocardium is unstable to receive blood
NSTEMI vs STEMI differentiated in ECG
MI:
• Severe chest pain, often described as crushing
• May radiate to neck, jaw, epigastrium, shoulder, left arm
• Pain lasts several hours to days & not relieved by rest/Rx
• High levels of patient anxiety
• Pulse rapid and weak
• Dyspnoea (shortness of breath) & cyanosis (skin becomes blue due to lack of O2)
• Nausea & vomiting
• Sympathetic activity increased
• Irreversible
• Survival dependent on infarct size, age, complications & other diseases
Complications:
Page 6 of 68
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