Modules
- Year 1
- Year 2
- Introduction to Year 2 and Year Outcomes
- Cardiorespiratory 2
- Metabolism 2
- Brain and Behaviour 2
- Human Development 2
- Human Sciences and Public Health 2
- Locomotor 2
- Cancer Week
- Moving and Handling Training
- Year 2 Lifesaver Programme
- Clinical Communication Skills
- Medicine in Society 2
- Extended Patient Contact
- Student Selected Component (SSC)
- Year 3
- Introduction to Year 3 and Year Outcomes
- Clinical Science and Professionalism (Weeks 1-3)
- Cardiovascular, Respiratory and Haematology (CR3)
- Gastroenterology and Cancer (MET3A)
- Public Health
- Endocrinology and Renal Medicine (MET3B)
- General Practice and Community Care
- Student Selected Component (SSC)
- Clinical and Communication Skills
- Year 4
- Introduction and Year 4 Outcomes
- Obstetrics and Gynaecology
- Child Health
- HIV & Sexual Health
- Musculoskeletal
- Health Care of the Elderly
- Neuroscience
- Dermatology
- General Practice and Community Care
- Psychiatry
- Ear, Nose and Throat
- Global Health and Ethics
- Ophthalmology
- Clinical & Communication Skills
- Student Selected Component (SSC)
- Year 5
- Introduction to Year 5 and Year Outcomes
- Teaching Week 1
- Teaching Week 2
- Anaesthesia & ITU (AN & ITU)
- Breaking Bad News
- Clinical Pharmacology & Therapeutics
- Community Care
- Doctors as Teachers and Educators (DATE)
- Emergency Medicine (EMERG MED)
- General (Internal) Medicine (G(I)M)
- Immediate Life Support (ILS)
- Student Assistantship
- Simulation
- Surgery
- Student Selected Component (SSC)
- Year GEP 1
Year 2 MET2: Metabolism 2
- Dr Mark Roberts
- mark.roberts@qmul.ac.uk
Teaching Material for this Module
Introduction
Aims of the module
- To consider some fundamentals of nutrition and how nutrient intake can determine health and disease.
- To further define and describe the function and structure of the liver and biliary system in health and some common disorders.
- To describe the role and sources of ‘ non-reproductive ‘ hormones and to understand the pathophysiology of some common endocrine disorders.
- To define and describe the function and structure of the kidney with particular reference to excretory function and salt & water handling in health and some common disorders.
Sessions
- Lecture: Met 2 Introduction
- Lecture: Anterior Abdominal Wall & Inguinal Anatomy
- Lecture: Nutrition in Medicine
Teaching Material for this Session
- Describe how to identify those at risk of malnutrition
- Explain the prevalence and causes of malnutrition in UK
- Describe the physical and psychological consequences of under-nutrition.
- Describe the different methods of nutritional assessment
- Outline the role of doctors and other health professionals in identification of under-nutrition and delivery of nutrition support
- Describe briefly the ethical and medico-legal aspects of artificial nutrition support
- Lecture: Nutrition & Diet
- Lecture: Liver Anatomy
- Lecture: Insulin
Teaching Material for this Session
- Define insulin resistance.
- Describe the main features of the intracellular insulin signalling pathway.
- Describe the main features of the insulin receptor.
- Describe the main structural features of the insulin molecule.
- Outline how insulin secretion is regulated.
- Describe the molecular basis of insulin resistance at the level of the insulin receptor.
- List the major metabolic actions of insulin on the metabolism of the major energy fuels, glucose and lipid, in the postprandial state.
- Describe the structure of the pancreatic islet of Langerhans; list the major cell types and the hormones that they secrete.
- Lecture: Clinical Skills - Abdomen
Teaching Material for this Session
- Demonstrate the appropriate techniques required to perform a holistic clinical examination of a patient with abdominal disease
- How to gain consent to examine a person/patient's abdomen
- The anatomical basis of the abdominal examination
- How to identify the common clinical signs that signal a patient with abdominal disease is unwell.
- How to position a patient/person correctly prior to examining their abdomen
- How to perform a systematic examination of a patient with abdominal disease including some peripheral and central clinical signs
- The associated clinical examination and investigations required to complete a clinical assessment of a patient with abdominal disease.
- Be able to demonstrate the appropriate techniques required to perform an holistic clinical examination of a patient with abdominal disease.
- Clinical Demonstration: Liver Disease
Teaching Material for this Session
- To appreciate the difference between liver failure, portal hypertension and cirrhosis.
- To identify the important causes of acute and chronic liver disease.
- To understand the different effects of alcohol on the liver.
- To understand the natural history of Hepatitis B and C viruses and their presentation with acute and chronic liver disease
- To recognise the features of biliary tract obstruction.
- To understand the link between structure and function of the hepato-biliary tract and link this to clinical presentation
- Lecture: Body Fluid Compartments & Water Balance
Teaching Material for this Session
- Distinguish between the terms 'osmolarity' and 'osmolality' and between the terms 'isosmotic' and 'isotonic'. State a normal value for plasma osmolality
- Name the main fluid compartments of the body, commenting on their volumes and predominant cations.
- Explain how total body water and total body sodium are regulated by mechanisms that are sensitive to plasma volume and plasma osmolality.
- Quantify the factors that contribute to the water balance of the body.
- By means of labelled diagrams, show the changes in volume and osmolality of tubular fluid along the length of the nephron, in the presence or absence of anti-diuretic hormone (ADH).
- Explain how the thick-walled, ascending limb of the loop of Henle plays a key role (in conjunction with ADH) in the production of either dilute or concentrated urine to meet the requirements of water balance.
- State the source, nature and mechanisms of release of ADH. Describe the stimuli for the release of ADH and explain how ADH controls urine volume and osmolality.
- Lecture: Liver Cirrhosis and Metabolism
- Understand the difference between compensated and decompensated cirrhosis.
- Know the main causes of liver cirrhosis.
- Know the symptoms (ascites, portal hypertension)
- Know the tests used to diagnosed cirrhosis (in particular the significance of the metabolites used in the blood test)
- Understand the complications of liver cirrhosis: hepatic encephalopathy and bacterial peritonitis
- Understand the consequences of liver failure on the metabolic state
- Explain the treatments for cirrhosis and their mechanism of action
- Lecture: Insulin - Counter Regulatory Hormones
Teaching Material for this Session
- Describe the hepatic glucoregulatory actions of glucagon.
- Summarise the physiological actions of the glucocorticoids on metabolism.
- Describe the acute metabolic actions of adrenaline and noradrenaline.
- Outline how glucagon opposes insulin action as glucose levels fall.
- Outline the action of glucagon on hepatic lipid homeostasis during fasting.
- List the symptoms, causes and consequences of hypoglycaemia.
- Outline the metabolic effects of thyroid hormones.
- Understand the regulation of thyroid pathophysiology.
- Describe the actions of glucagon on glucose and lipid metabolism in the post absorptive and fasting states.
- Lecture: Clinical Acid / Base
- Lecture: Acid - Base Regulation
Teaching Material for this Session
- Learn the relationship between pH, HCO3 and pCO2
- Learn how cell metabolism and environment are constantly challenging the pH of the human body
- Learn which organs are involved in pH regulation and by which mechanisms
- Learn the four forms of Acid-Base disturbance
- Learn the how to calculate the anion gap and what type of metabolic disorders it is associated with
- Understand why Acid-Base homeostasis is essential for human physiology
- Lecture: Liver Disease
Teaching Material for this Session
- To understand the link between structure and function of the hepato-biliary tract and link this to clinical presentation
- To identify the important causes of acute and chronic liver disease.
- To appreciate the difference between liver failure, portal hypertension and cirrhosis.
- To understand the different effects of alcohol on the liver.
- To understand the natural history of Hepatitis B and C viruses and their presentation with acute and chronic liver disease
- To recognise the features of biliary tract obstruction.
- Lecture: Diabetes Mellitus
Teaching Material for this Session
- Outline the potential abnormalities of glucose homeostasis in diabetes mellitus.
- Describe the principal forms of diabetes mellitus.
- List mechanisms that can amplify insulin secretion
- Describe advanced glycation end products (AGEs) and AGE receptors (RAGEs)
- Summarise the effects of inadequate insulin secretion or action upon carbohydrate and fat metabolism, including the etiology of diabetic ketoacidosis.
- Outline how increased AGE promote atherosclerosis via low density lipoproteins (LDL).
- Outline how glucose tolerance can be maintained by the balance between insulin secretion and action.
- Describe the Hb A1c test.
- Outline the effects of persistent hyperglycaemia.
- Outline the changes in glucose and insulin during an oral glucose tolerance test in normal, insulin resistant and diabetic subjects.
- Describe how beta-cell mass changes in type 2 diabetes
- Outline the macrovascular complications of diabetes mellitus.
- List the long-term complications of diabetes mellitus.
- Lecture: Nausea and Vomiting
- There are different classes of anti-emetic drugs with different actions; no drug is effective against all types of emesis
- Many different causes (pregnancy, motion, drugs, gastrointestinal/ painful conditions, surgery). Can be especially severe during cancer chemotherapy and palliative medicine
- Antagonists at 5-HT3 and NK1 receptors are used to inhibit severe emesis often in combination with the steroid, dexamethasone
- Old, 'established' anti-emetic drugs are commonly used, often with a 'mixed pharmacology' (antagonise at M1, H1 and/ or D2 receptors) and side-effects
- Emesis (nausea + vomiting) is a normal defensive reflex which becomes a medical issue if induced by drugs or disease
- Nausea is not the same as vomiting and is more difficult to treat
- Lecture: Thyroid
Teaching Material for this Session
- Describe the detection and treatment of hyperthyroidism and hypothyroidism
- Outline the synthesis, storage and release of thyroid hormones
- List the effects of excess and deficiency of thyroid hormones
- Briefly explain the pathophysiology of hypo- and hyperthyroidism
- Outline the actions of thyroid hormones
- Describe the effects of thyroid stimulating hormone on the thyroid gland
- Lecture: Endocrine Anatomy
Teaching Material for this Session
- Understand the anatomy and the blood supply of the adrenal glands.
- Describe the structural and functional relationships between the hypothalamus and the pituitary gland.
- Describe the anatomy and the blood supply of the thyroid gland and surrounding structures.
- Understand the contents and the clinical importance of the cavernous sinus.
- Understand the anatomy and the blood supply of the pancreas and its relations.
- Lecture: Micronutrients
Teaching Material for this Session
- List the principal causes of vitamin deficiencies in developed countries.
- Give examples of the fat-soluble vitamins and describe their function within the context of clinical features of their deficiencies.
- Discuss the role of vitamins (and trace elements) as antioxidants
- Give examples of water-soluble vitamins and list the principal function common to B vitamins
- Describe the clinical syndromes associated with deficiencies of the water-soluble vitamins B1 (thiamin), B6, B12 and folate
- Give examples of important trace elements present in the diet within the context of clinical features of their deficiencies
- Lecture: Diet and Coronary Heart Disease
- Differentiate between types of lipids in relation to protection from and contribution to cardiovascular disease
- List the major risk factors for cardiovascular disease
- Outline evidence that the risk of cardiovascular disease may be modified by environmental influences in early life.
- Review the main dietary factors that influence the development of coronary heart disease and hypertension
- Understand how salt and alcohol influence cardiovascular function
- Be aware of key epidemiological studies of risk factors for cardiovascular disease
- Lecture: Obesity
- Lecture: Appetite Regulation
Teaching Material for this Session
- Outline the role of serotonin in the regulation of appetite.
- Summarise how hormones from the gut, in particular ghrelin, affect food intake.
- Define the terms anorexigen and orexigen.
- Outline the control of food intake by the hypothalamic leptin-melanocortin pathway.
- Understand the significance of leptin resistance in obesity.
- Describe the role of malonyl-CoA in the hypothalamus as a regulator of food intake.
- Summarise the impact of insulin on satiety.
- Clinical Demonstration: Acromegaly
Teaching Material for this Session
- Anatomical relations of the pituitary gland and the surgical anatomy of a pituitary mass
- Origin and natural history of pituitary adenomas
- Signs and symptoms of acromegaly (consequences of growth hormone over-secretion)
- Social and emotional impact of pituitary disease
- Physiology of the growth hormone axis and the pathophysiology of over-secretion of growth hormone
- Principles of diagnostic endocrine and radiological tests for Acromegaly
- Principles, benefits and risks of medical, surgical and radiotherapy treatments for Acromegaly
- Effect of a pituitary mass on normal pituitary physiology
- Lecture: Steroids
Teaching Material for this Session
- Describe other unwanted effects arising from long-term therapy with glucocorticoids
- Clinical uses of corticosteroids
- Explain how long-term corticosteroid therapy disrupts endogenous corticosteroid secretion
- List some synthetic steroids with mainly glucocorticoid activity. Explain the reason for the development of such compounds.
- Describe the mechanisms of action contributing to anti-inflammatory and immunosuppressive effects of corticosteroids.
- Lecture: Hypothalamus and Pituitary
Teaching Material for this Session
- Describe the structure and origins of the pituitary gland and explain the relationship between the hypothalamus and both the anterior and posterior pituitary.
- Briefly outline the actions of the hormones of the posterior and anterior pituitary.
- Use the concept of negative feedback to explain the principles underlying clinical tests for pituitary hormone secretion
- List the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion
- Lecture: Defecation & Anal Anatomy
- Understand the embryonic development of the anorectum.
- Know the functional anatomy of the anorectum: muscles, vascular and nerve supplies.
- Outline the investigations available to investigate anorectal disorders.
- Understand the physiological mechanisms of defecation.
- Understand how developmental errors lead to anorectal birth defects.
- Lecture: Acid-Base
Teaching Material for this Session
- Know the methods available for the assessment of acid-base balance in patients
- To understand the pathogenesis and common causes of: a) respiratory acidosis b) respiratory alkalosis c) metabolic acidosis d) metabolic alkalosis
- To recognise the biochemical changes associated with the above disorders and how the body attempts to compensate
- Lecture: Renal Excretory Function
Teaching Material for this Session
- Compare the reabsorption of sodium, glucose, amino acids and hydrogencarbonate in the proximal tubule of the nephron.
- Show the effects of molecular size and charge on the composition of glomerular filtrate.
- Outline renal handling of important electrolytes
- With reference to the renal reabsorption of glucose,define the terms:'renal threshold' and 'transport maximum'. What may be the effects of glucose presence in the final urine?
- Clinical Demonstration: Type 1 Diabetes (IDDM)
- Clinical Demonstration: Obesity
Teaching Material for this Session
- Discuss the possible approaches to the treatment of obesity
- Describe the physical, psychological social and emotional problems which may confront obese patients
- Discuss the important problems in obtaining a reliable nutritional history from obese patients
- Enumerate the clinical signs which are relevant to the aetiology or complications of obesity
- Lecture: Renal Anatomy
Teaching Material for this Session
- Describe the gross anatomy of the urinary system and relations of kidneys and adrenal glands
- Describe the course of the ureters and the position and relations of the urinary bladder in both sexes
- Understand the blood supply to the kidneys and adrenals and the distribution of the arteries within the kidney
- Discuss the structure, position and importance of urinary sphincter muscles
- Clinical Skills - Thyroid Exam
Teaching Material for this Session
- Be able to carry out a clinical examination of a patient with reference to thyroid disease, including relevant parts of the general examination: demeanour, feet to face, hands (including pulse), mouth, eyes (including thyroid features), neck, neurology.
- Recognise the features of the thyroid diseases named in the lecture so that they can be recognised from the clinical findings & biochemical tests.
- Lecture: Kidney Histology
Teaching Material for this Session
- Describe the vasculature of the kidney, relating its unique features to the physiology of urine production and nourishment of the nephron.
- Identify the components of the juxtaglomerular apparatus and describe its role in regulation of blood and urine volumes and renal homeostasis.
- Outline the general organisation of the urinary system including the kidney, ureter, bladder and urethra.
- Identify the parts of the nephron and describe the role of each component in the physiologic processes involved in urine production.
- Outline the structural components of the urinary passageways and bladder and describe how micturition is controlled.
- Lecture: Kidney Embryology
Teaching Material for this Session
- Know that the kidney is composed of the collecting system and excretory system
- Understand from their knowledge of kidney development how some of the common defects in kidney development can arise
- Describe the ascent of the kidney
- Describe the development of zonation within the adrenal gland
- That the embryonic origin of the collecting system is the ureteric bud
- Appreciate the basic anatomy of the intermediate mesoderm, mesonephric and metanephric systems
- The origin of the excretory system is the metanephric mesoderm
- Appreciate during development how these tissue combine to give rise to the fully developed kidney
- Understand the embryonic origin of the adrenal medulla and cortex and how they give rise to the adrenal gland
- Lecture: Transplantation Immunology
Teaching Material for this Session
- Understanding the difference between types of rejection: hyperacute, acute and chronic.
- Understanding how we can disrupt the immune response to transplanted tissue therapeutically.
- Understanding how the recognition of transplanted tissue is compatible with our understanding of how the immune system differentiates self from non-self.
- Understanding non-immunological processes that damage transplanted organs, including "ischaemia-reperfusion injury".
- Understanding the mechanisms that are important in mediating immunological rejection: lymphocytes, antibodies, complement and coagulation cascade.
- Clinical Demonstration: Renal Dialysis
Teaching Material for this Session
- Be aware of the limitations, advantages and disadvantages of haemodialysis
- Understand the principles and practical aspects of haemodialysis
- Be aware of the limitations, advantages and disadvantages of peritoneal dialysis
- Understand the principles and practical aspects of peritoneal dialysis in its many forms
- Clinical Demonstration: Renal Transplantation
- Lecture: Micturition
Teaching Material for this Session
- Distinguish between urge incontinence, stress incontinence, overflow incontinence and leak incontinence
- Describe the anatomy of the bladder, prostate and urethra
- Explain the most common causes for each of the above.
- Describe treatments available for disorders of micturition.
- Describe the reservoir and emptying functions of the bladder and outline the neurological control of each
- Outline the investigations available to distinguish the cause of incontinence in an individual.
- Lecture: Imaging & Endoscopy of the Urinary Tract
- Lecture: Calcium
Teaching Material for this Session
- Describe the source of parathyroid hormone and explain how its secretion is regulated.
- Explain the relationship between the various forms of circulating calcium in blood
- Briefly explain how the body excretes excess calcium
- Describe the transformation of vitamin D3 into an active hormone and explain how this is regulated
- Recognise the structure of vitamin D3 and describe the sources of this vitamin in the body
- Outline the source and actions of calcitonin and explain its role in calcium metabolism.
- Describe the actions of parathyroid hormone and 1, 25-dihydroxyvitamin D3 and account for the effects of vitamin D3 deficiency, and for hypo- and hyper-secretion of parathyroid hormone.
- Briefly explain the relationship between calcium and phosphate metabolism.
- Lecture: Adrenals
- Lecture: Diuretics
Teaching Material for this Session
- Compare the different mechanisms for sodium re-absorption found in different parts of the nephron.
- Explain why diuretics increase potassium excretion, and how this may be reduced.
- Show, by means of a labelled diagram, the proportions of sodium reabsorbed from tubular fluid in: the proximal tubule; the loop of Henle; the distal tubule; the collecting duct.
- List the major clinical indications of the uses of a diuretic.
- Give the primary sites of action of thiazide, loop diuretics, and spironolactone, and rank them in order of their efficacy.
- Explain the use of mannitol as a 'diuretic'.
- Describe the actions of aldosterone on the distal tubule and collecting duct which maintain the sodium balance of the body. State the fraction of the total sodium re-absorption which is subject to regulation by aldosterone.
- Lecture: Formative Assessment Endocrine
- Practical: Urine
- Clinical Demonstration: Nutrition and Diet
- Practical 1: Alimentary Canal
- Describe the general arrangement of the gastrointestinal tract and associated viscera
- Outline the extent and the subdivisions of the peritoneal cavity
- Describe the difference between retroperitoneal organs and intraperitoneal organs
- Describe hiatus hernia and know the common causes of this condition
- Know the anatomy of the inguinal region
- Describe inguinal hernias and know the common causes of these hernias
- Know the anatomy of the sigmoid, rectum, anal canal and sphincter
- Know the symptoms and causes of haemorrhoids
- Practical 2: Endocrine System
- Describe the position and anatomical relationships of the pituitary gland
- Understand the cavernous sinus and its contents
- Describe the position and anatomical relationships of the thyroid gland
- Describe the blood supply to the thyroid gland
- Identify the strap muscles and understand their function.
- Describe the position and anatomical relationships of the pancreas
- Compare the position and anatomical relationships of the suprarenal glands
- Describe the components, course and relations of the biliary tree (tract).
- Describe the termination of the bile duct and pancreatic duct.
- Revise the normal structure and blood supply of the liver.
- Describe some important pathologies of the liver.
- Practical 3: Renal System
- List the components of the urinary system.
- Describe the position and relations of the kidneys
- Describe the blood supply to the kidneys and recognise on CT/MRI
- Describe the structure of the kidney
- Describe the course of the ureters.
- Describe the anatomical relationships of the urinary bladder in both genders
- Describe the course of the urethra in both genders
- Demonstrate the anatomy of kidneys, ureters and bladder using radiological imaging: CT MRI and IV pyelograms
- Microanatomy 1: The Endocrine System
- Describe the general organisation of endocrine tissues in the pituitary gland, thyroid and parathyroid glands, adrenal gland and Islets of Langerhans of the pancreas.
- Recognise and name the cell types found in these endocrine tissues.
- Describe the blood supply to the pituitary gland and its relevance to anterior pituitary function.
- Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system.
- Recognise and describe specific disease processes that affect the glands of the endocrine system.
- Microanatomy 2: The Renal System
- Describe the basic structural organisation of the kidney, including its vasculature.
- Describe the structure of the nephron.
- Relate the structure of the glomerulus to its role in the filtration of blood.
- List the causes of impaired glomerular filtration and the clinical consequences of this.
- Describe the structure and microanatomy of the urinary tract, including the bladder.
- Describe common pathologies involving the urinary tract and be able to recognise them in pathology specimens .
- Microanatomy 3: The Liver
- PBL 1: EXTREMES OF THE FOOD WORLD
- PBL 2: ONE FOR THE ROAD
- PBL 3: UNDERSTANDING YOUR ILLNESS
- PBL 4: GENES & JEANS
- PBL 5: A COMPLICATION OF DIABETES
- PBL 6: A SLOWED-DOWN TEACHER
- PBL 7: SARAH TAYLOR
- PBL 8: NOCTURIA WITHOUT HIGH FLUID INTAKE