1. COT/COMT Review
General Medical

2. General Medical The body has 4 basic parts
Cells
Tissues
Organs
Organ systems
Cells and tissue form the basic substance of the human body
Organs and their systems derive structure from their cells and tissue makeup

3. Cells Smallest living functional unit in the body
Cells are the “concrete” that make up the “building blocks” of tissue
4 activities characterize all cells
Produce energy
Reproduce
Interact with their environment
Regulate themselves internally

4. Cells Cells divide through 2 processes
Mitosis
Cytokinesis
Approximately 1% of body cells die each day
Cell death is call apoptosis
Cells continually reproduce in order to keep the body alive

5. Tissue Body has 4 types of tissue Nerve Muscle Epithelial Connective
Transmits messages in the form of electrical impulses
Brain, spinal cord, nerve fibers
Muscle
Movement
Epithelial
Protection, absorption, secretion
Skin, salivary glands
Connective
Fat tissue, connective tissue proper, bone and cartilage, blood

6. Cardiovascular System
Heart, blood vessels, blood
Purpose is to carry life-sustaining nutrients to all parts of the body
Arteries
Large blood vessels that carry blood from the heart
Veins
Blood vessels that bring blood from the capillaries back to the heart
Capillaries
Smallest of blood vessels, connect arterioles to venules

7. Heart The heart has 4 chambers
2 upper chambers= right and left atria
2 lower chambers= right and left ventricles
Blood coming into the heart is received by the atria, pumped to the ventricles, which pump it out again to the lungs and the rest of the body

8. Circulation Arteries carry blood away from the heart
Aorta carries blood from the left ventricle to all parts of the body
Pulmonary artery carries blood from the right ventricle to the lungs
Veins carry blood back to the heart
Pulmonary veins bring blood to the left atrium
Superior/inferior vena cava bring blood to the right atrium

9. Circulation Blood circulates through the heart in a very organized way
Blood from all parts of the body comes into the right atrium from the superior and inferior vena cava
Blood is then pumped into right ventricle, then through pulmonary arteries, where it enters the lungs to receive oxygen
Blood then returns to left atrium via the pulmonary veins
Blood is then pumped to the left ventricle, which contracts to pump blood through the aorta to all parts of the body

10. Circulation
The coronary arteries supply blood to the heart muscle itself
Blockage of these arteries result in a heart attack
The superior aspect of the aorta separates into branches, including the right and left carotid arteries
Right carotid supplies blood to brain, right eye
Left carotid supplies blood to brain, left eye

11. Blood Blood is composed of plasma and cells
Plasma is mostly water and contributes to the liquidity of blood
Plasma also contains electrolytes, glucose, fats, and proteins
Cells are the solid component of blood
Cells include white blood cells (leukocytes) red blood cells (erythrocytes) and platelets

12. Blood
Leukocytes form a major part of the body’s defense against disease
Erythrocytes are the reason for blood’s red color
Erythrocytes have hemoglobin, which transport oxygen from the lungs
Carbon dioxide produced by tissues is carried by erythrocytes to lungs, where it is exhaled
Platelets help stop bleeding

13. Cardiovascular Diseases
Atherosclerosis
Build up of fat in the arteries
Can block vessels and weaken the vessel wall
Can form clots (emboli) that can migrate to other parts of the body and cause damage (strokes, heart attacks, retinal artery occlusions)
High cholesterol, smoking, high blood pressure are major causes of atherosclerosis

14. Cardiovascular Disease
Hypertension (High Blood Pressure)
Considered high when greater than 140/90
Top number is systolic reading (maximum pressure in arteries)
Bottom number is diastolic reading (minimum pressure in arteries)
Blood pressure that remains chronically high can damage organs, especially heart, brain, kidneys
Symptoms of high blood pressure may include headaches, dizziness, nose bleeds

15. Cardiovascular Disease
Retinal blood vessels can be damaged by hypertension
Vessels narrow and may become twisted (tortuous)
Vessel walls develop fibrous tissue, which gives a copper or silver wire appearance
Retinal veins may be compressed by the arteries crossing over them, causing them to appear squeezed or cut (AV nicking)
Retinal hemorrhages may occur
Areas of the retina may have blood supply cut off, resulting in cotton wool spots

16. Cardiovascular Disease
Carotid artery disease
Carotid arteries are the main source of blood to the brain
They also provide primary blood supply to the eyes
When carotids are blocked, the blood supply and the oxygen to the brain is reduced
Can result in stroke
Plaque from the arteries may break off, resulting in blockage to the vessels in the retina
Retinal artery occlusions cause a sudden, painless loss of VA
Temporary retinal artery blockage causes a few minutes of VA loss (amaurosis fugax)

17. Cardiovascular Disease
Mitral Valve Prolapse
When left ventricle contracts, the mitral valve normally closes, preventing blood from returning to atrium
With MVP, part of the valve prolapses back into the atrium, allowing some blood to return to atrium
This produces a heart murmur
Patients with MVP are more prone to endocarditis (infection of the heart lining, valves)
This is why MVP patients undergoing surgical procedures may need to be placed on preop antibiotics
MVP patients can have abnormal platelets
Platelets may clump together, causing blockage to blood vessels
MVP patients can have abnormal heart rhythms (arrhythmias)

18. Respiratory System
Responsible for providing oxygen to cells and expelling carbon dioxide from the body
Oxygen is taken in to the body, transferred to the blood, which then transfers it to tissues
Normal adult respirations are 12 breaths per minute

19. Respiratory System Upper respiratory tract Lower respiratory tract
Nasal cavity, sinuses, pharynx
Sinuses
Maxillary = below eyes
Frontal= above eyes
Ethmoid= behind frontal sinuses
Sphenoid= behind nose, just below pituitary gland
Lower respiratory tract
Trachea
Bronchi, bronchioles

20. Respiratory System, Sinuses

21. Respiratory Disease Chronic Obstructive Pulmonary Disease (COPD)
Narrowed breathing passages reduce ability to move air in and out of the lungs
2 disease processes in COPD are chronic bronchitis and emphysema
Chronic bronchitis
Excessive airway mucous production, chronic cough, wheezing, shortness of breath
Emphysema
Results from distention of alveoli and surrounding airways
Compromises the lung’s ability to absorb oxygen, causes shortness of breath, wheezing, and cough with little mucous production

22. Respiratory Disease Asthma
Airways become inflamed and swollen, breathing becomes difficult
Predisposes to chronic inflammation of the lungs
Unlike other forms of COPD, the airway obstruction caused by an asthma attack is reversible
Symptoms of asthma attacks include shortness of breath, wheezing, tightness in chest, increased respiratory rate

23. Endocrine system The body has 2 types of glands Exocrine Endocrine
Secrete products through tube-shaped ducts
Salivary, sweat glands are exocrine
Endocrine
Secrete products directly into the blood
Each endocrine gland secretes unique hormones
Hormones produce powerful effects in the body and their regulation is controlled by negative feedback
5 glands make up the endocrine system
Pituitary, thyroid, parathyroid, pancreas, adrenal glands

24. Endocrine System Pituitary gland Master gland
Directs the action of many other glands in the body
Located close to the optic chiasm
Enlargement of the pituitary gland will compress the optic chiasm, resulting in VF loss

25. Endocrine System Thyroid controls body’s metabolism
Helps regulate body temperature, oxygen use, heart rate
Hypothyroid= low thyroid hormone level
Hyperthyroid=high thyroid hormone level
Graves’ disease
Exophthalmos, DES

26. Endocrine System Pancreas
Both exocrine (secretes digestive enzymes) and endocrine (secretes insulin and glucagon)
Insulin causes cells to draw glucose out of the blood, reducing blood sugar
Glucagon stimulates cells to release glucose, causing blood sugar to increase

27. Endocrine Disease Pituitary Adenoma
Most common pituitary gland disorder
Can cause damage to surrounding structures as they enlarge
Can cause problems from changes in normal hormone secretion from the pituitary
When the adenoma enlarges it can compress the optic chiasm
Results in bitemporal VF defect or junctional scotoma

28. Endocrine Disease Hyperthyroidism
Overactive thyroid gland, secretes high levels of thyroid hormone
Causes anxiety, heat intolerance, increased heart rate and may cause arrhythmias
Can cause inflammation of the extraocular muscles, resulting in exopthlamos
Lid retraction from exophthalmos can lead to corneal dryness, irritation, hyperemia
Eye muscle inflammation can compress optic nerve, resulting in VA loss

29. Endocrine Disease Diabetes
Pancreas does not secrete sufficient insulin, resulting in elevated blood glucose levels
Diabetes severely affects multiple organ systems
Can lead to kidney and blood vessel damage, neuropathy, retinopathy; predisposes to high blood pressure, high cholesterol, and atherosclerosis
Type 1 diabetes
10% of diabetes cases
Typically young people
Requires insulin
Type 2 diabetes
90% of diabetes cases
Occurs later in life
Sometimes requires insulin

30. Endocrine Disease Diabetic retinopathy
Result of microvascular retinal changes
Small blood vessels (such as those in the eye) are particularly susceptible to poor blood sugar control
Nonproliferative diabetic retinopathy
Retinal blood vessel damage leads to microaneurysms, dot/blot hemorrhages, exudates
Proliferative diabetic retinopathy
The hypoxic retina grows new, abnormal blood vessels (neovascularization)
These vessels are weak and can easily break, resulting in vitreous and retinal hemorrhages, fibrovascular proliferation

31. Nervous System Nervous system Central nervous system
Brain and spinal cord
Peripheral nervous system
Nerves that travel to and from brain (cranial nerves) and spinal cord (spinal nerves)

32. Nervous System
Brain
Largest and most complex part of the nervous system
3 layers of tissue cover the brain
Dura matter (outermost lining, adheres to inner skull)
Arachnoid (middle layer, below dura)
Pia (innermost layer, adheres directly to brain)

33. Nervous System
Between the arachnoid and the pia is a water-like substance called the cerebral spinal fluid (CSF)
CSF surrounds the entire brain and spinal cord
CSF is replaced 3-4 times in a 24 hour period
After circulating, the CSF is absorbed by the blood stream
CSF produces intracranial pressure (ICP)
Blockage to the normal circulation of CSF results in increased intracranial pressure
Leads to papilledema

34. Nervous System Brain has 3 major divisions
Cerebrum, Cerebellum, Brainstem
Cerebral cortex
Controls speech, critical thinking, personality
Cerebrum is divided into right and left hemispheres
Each hemisphere is further divided into 4 lobes
Frontal, parietal, occipital, temporal

35. Nervous System Cerebellum Coordinates muscle groups
Responsible for smooth motion, balance
Coordinates larger muscles and small muscles for fine movements of arms, legs, hands

36. Nervous System Brainstem
Includes medulla oblongata, pons, midbrain, diencephlon
Regulates the central nervous system
Connects to spinal cord
Controls many involuntary actions, including respiratory and cardiac functions
All cranial nerves except for CN I and CN II originate from the brainstem

37. Nervous System Spinal cord Begins at medulla
Extends 16-17” down the back
Protected by vertebrae
Signals travelling to and from the brain go through the spinal cord
Peripheral nerves connect to spinal cord through 31 pairs of spinal nerves

38. Nervous System 2 types of peripheral nerves Motor nerves
End in muscle
Produce motion or other types of action
Sensory nerves
Enable us to feel pain, touch, temperature, pressure

39. Nervous System
There are 12 cranial nerves, which have both motor and sensory functions
CN II through CN VII are connected with normal eye function
CN II optic nerve
CN III oculomotor nerve
CN IV trochlear nerve
CN V trigeminal nerve
CN VI abducens nerve
CN VII facial nerve

40. Terminology
Aneurysm= A balloon-like bulge in an artery wall caused by weakening of the artery
Microaneurysm= An enlargement of the venous end of a retinal capillary
Hypoxia= Condition in which the body as a whole or a region of the body is deprived of oxygen
Ischemia= Restriction of blood flow
-itis = Suffix used to indicate inflammation (arthritis, vitritis, etc)
Atrophy= Withering of an organ or tissues

41. Terminology
Cyanosis= Bluish discoloration of skin, mucous membranes due to lack of oxygen
Edema= Excessive accumulation of fluid in body tissues causing swelling
Embolus= Free moving blood clot
Fibrosis= Thickening or scarring of connective tissue
Idiopathic= Of unknown cause
Neuralgia= Pain along the route of a nerve

42. The retinal blood vessels of diabetics sometimes develop bulges known as:
Emboli
Microaneurysm
Atheromas
Exudates
Ledford, Daniels & Campbell, 2000

43. The difference between background and proliferative diabetic retinopathy is that PDR exhibits
No appreciable worsening
Only cotton wool spots
Only soft exudates
Neovascularization and venous bleeding
Ledford, Daniels & Campbell, 2000

44. The most common effect of atherosclerosis on the eye is
Artery obstruction
Hemorrhage
Tractional retinal detachment
Formation of microaneurysms
Ledford, Daniels & Campbell, 2000

45. The main cause of unilateral or bilateral exophthalmus in adults is
Pseudotumor
Neuroblastoma
Graves’ disease
Orbital cellulitis
Ledford, Daniels & Campbell, 2000

46. The ocular changes seen in Graves’ disease are mainly due to
Lack of blood supply
Involvement of the extraocular muscles
Macular edema
Associated uveitis
Ledford, Daniels & Campbell, 2000

47. Pituitary tumors affect the
Retina
Optic nerve
Optic chiasm
Visual cortex
Ledford, Daniels & Campbell, 2000

48. The visual field defect generally seen in pituitary tumor is
Binasal hemianopsia
Loss of both right fields
Bitemporal hemianopsia
Loss of both left fields
Ledford, Daniels & Campbell, 2000