Respiratory and cardiovascular systems

‘Respiratory and cardiovascular systems’ begins with the anatomy of the thoracic cavity, including the lungs, skeletal tissue, and soft tissue, before consideration of the two main physiological components of the thorax: the pulmonary and cardiovascular systems. The main structures of the pulmonary system are discussed (pleura and pleural cavities, the upper and lower airways), together with respiratory mechanics, the principles of gaseous exchange and gas transport in the blood, the relationships between ventilation and perfusion, and the regulation of breathing. Major respiratory conditions and diseases are also covered, such as cystic fibrosis, pulmonary embolism, asthma, and the effect of altitude. The cardiovascular system topics includes blood physiology (haematology and haemostasis) and the heart in terms of anatomy, its function as a pump, and the nature of the heart as an electrical tissue (the electrocardiogram). The function of the heart is discussed, including during exercise and in diseases such as heart failure and hypertension.

Neuroanatomy and neurophysiology

‘Neuroanatomy and neurophysiology’ covers the anatomy and organization of the central nervous system, including the skull and cervical vertebrae, the meninges, the blood and lymphatic vessels, muscles and nerves of the head and neck, and the structures of the eye, ear, and central nervous system. At a cellular level, the different cell types and the mechanism of transmission across synapses are considered, including excitatory and inhibitory synapses. This is followed by a review of the major control and sensory systems (including movement, information processing, locomotion, reflexes, and the main five senses of sight, hearing, touch, taste, and smell). The integration of these processes into higher functions (such as sleep, consciousness and coma, emotion, memory, and ageing) is discussed, along with the causes and treatments of disorders of diseases such as depression, schizophrenia, epilepsy, addiction, and degenerative diseases.

Infection and immunity

‘Infection and immunity’ considers the response of the body to pathogens, such as bacteria, viruses, prions, fungi, and parasites, which are discussed in terms of their nature, life cycle, and modes of infection. The role of the immune system in defence against infection is discussed, including innate and adaptive (acquired) immunity, antigens, the major histocompatibility complex, and the different cell types involved (antigen-presenting cells, T-cells, and B-cells). The mechanisms and cellular basis of inflammation are considered, as are post-infection repair mechanisms, and pathologies of the immune system such as hypersensitivity, autoimmunity and transplantations, and immunodeficiency (both primary and secondary to other diseases).

Cellular metabolism

‘Cellular metabolism’ addresses the major biochemical pathways and processes of the cells of the body. These include the central metabolic pathways involved in energy production: the tricarboxylic acid or Krebs cycle, and ATP synthesis through the electron transport chain and oxidative phosphorylation (chemiosmotic theory). Metabolism of each of the major fuel sources is considered: lipids, carbohydrates, and proteins, including energy storage as fat and glycogen, and excretion of nitrogen via the urea cycle. The different cellular compartments for metabolism are explored, as is the integration and regulation of the metabolic processes in a number of conditions such as fasting and starvation, exercise, pregnancy, and diabetes. Finally in this chapter the clinical aspects of metabolism are discussed, including energy balance and nutrition, obesity, and inborn errors of metabolism.

Cellular structure and function

‘Cellular structure and function’ covers the roles, structures, and functions of the main four types of macromolecules of the human body, namely proteins, lipids, carbohydrates, and nucleic acids. For these macromolecules, the roles and types of each class are discussed (for proteins this includes their roles as structural proteins and enzymes and their kinetics; for lipids, the roles and types of lipid found in the body are considered; for carbohydrates, their roles including structural and metabolic are discussed; and the structure of nucleic acids is described). Then follows a description of the organization of the cell, including the plasma membrane and its components, and the intracellular organelles. Cell growth, division, and apoptosis are covered, as are the formation of gametes, and finally the principles of how cellular functions can be modulated by pharmacological agents through receptors and signalling pathways are discussed.

Nerve and muscle

‘Nerve and muscle’ begins by describing the different types of cells found in the nervous system. It overviews both the somatic and autonomic nervous systems, how nerves function to initiate and propagate signals, and how anaesthetics work. Mechanisms of transmission are considered at different types of synapse, including neuromuscular and interneuronal synapses, and the use and effects of drugs on the process are discussed. The physiology of skeletal, cardiac, and smooth muscle are compared and contrasted, and the pathology of neuromuscular diseases such as demyelination, myasthenia gravis, motor neuron disease, and spinal cord damage discussed.

Urinary system

The ‘Urinary system’ chapter opens with a description of the urinary tract morphology (kidney, ureters, bladder) and its histology. Renal function is considered, including glomerular filtration, the role and regulation of the renal tubules in producing dilute and concentrated urines, and the mechanisms of action of diuretic drugs. The function of the kidney in body fluid homeostasis (extracellular fluid volume and osmolarity, pH) is then discussed, and the regulation of kidney function explored, including bladder control and urinary continence. Finally, renal failure and obstructive uropathy are discussed as examples of renal pathology.

Medicine and society

‘Medicine and society’ reminds the reader that ‘medicine cannot be practised without considering the societal context within which it exists’, and that there needs to be an overall view of diseases in society. These areas are covered by specialisms in their own right, such as psychology, sociology, epidemiology, and health economics, but this short chapter outlines the very basic principles of measuring and detecting a disease in a society and assessing the effectiveness of treatment, and touches on the sociocultural context of medicine (the doctor–patient relationship, and the patterns of behaviour in patients).

Molecular and medical genetics

‘Molecular and medical genetics’ firstly covers the principles of molecular genetics, including gene structure, gene expression, and how mutations affect the encoded protein sequence. The key mechanisms of gene expression are described, including regulation and RNA transcription, processing, and translation. The organization of the genome is described, followed by the techniques of DNA cloning and sequencing. The second part of the chapter on medical genetics covers the principles of population genetics and genetic diseases, their treatment, and the integration of knowledge of genetic information into pharmacological interventions (pharmacogenetics and pharmacogenomics).

Musculoskeletal system

The chapter entitled ‘Musculoskeletal system’ summarizes the parts of the connective and skeletal tissues—connective tissue, cartilage, and bone—before looking in more detail at the anatomy of the upper and lower limbs and the spine, including the bones, joints, muscles, innervation, and blood vessels. The chapter provides comprehensive summaries of the bones of the skeleton, their function and anatomical arrangement as well as the muscles involved in movements of different joints and their innervation and anatomical arrangement. The pathology of the musculoskeletal system is discussed, including arthritic joint disease, muscular dystrophies, and atrophy due to disuse.