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okay. Our started with some upper limb. And that may So this is the first FDA damage to a different nerves that the break your plexus can cause various sensation and motor loss in function. Damage to nerve five in this diagram causes a specific clinical sign. What is this sign? So have a look at the diagram there. And then out of those five options, uh, submit your answer, and I'll give you 30 seconds or so We're done. This lots of answers coming in. Okay, So free. Close the PPO now, So most of you, but, um see which is great. So I can't seem to make a presentation. Yeah, the answer is cool hand, so I'll give an explanation as to why that is. But first, let's look at the break your plexus. She can see that now. Five on the bottom. That was the only enough on is really important with the break for taxes to remember that it could be spit up into roots, trunks, divisions, cords and brunches. So you can use the acronym read that Damn could have a book on the terminal. Branches are really important to remember. I don't get my laser 0.2 now. So if you follow, my legs are going to You can see that. That's kind of an M A structure here on two of the terminal branches on the, um structure. Also be good with begin with an M. So you got muscular cutaneous on your media as well as your own enough. So you're must look cutaneous. Well, innovate the anterior compartment of your arm on the medium, or can innovate the anterior compartment of your forearm. I'm if anybody wants to pop into the chop, What masters muscles do? The owner? Enough innovate. That's fine. Memory nice. Well done on it. Do you know the other one? So yes, the flexor carpi on ours. And medial half of your flat, sir. Digitorum profundis. So if I carry on so there's a particular clinical signs you want to be aware off and you can use the acronym Doctor Cuma so the drop rest will be radio. Nerve damage beforehand will be all no damage and a Pamela the median nerve damage. You also have your hand benediction, which is as a result of median nerve damage. So it's kind of an active sign. You try and make a fist, but only your 4th and 5th digit can be flexed. So only one to the next SP A to keep moving. So Margaret, 50 69 year old women is no tough osteoporosis. She fell over at home a few weeks ago and try to break on, tried to break her for using her arm. Unfortunately, Margaret Big broke her arm and the area indicated below. After the event, she reported numbness on the top outside part of her arm on an inability to abduct her arm. Past 15 degrees, which brought the brief Your plaques is is most likely to have been injured. So if we could launch the poll on, have a look at the X ray down there and out of the five options submit, which now do you think has been injured? No. What don A lot of you getting the correct answer on this. So if we could share the results of the power, thank you. That's great. See? Yeah, it is your axillary love. That's likely to be damage. So this, um, slide gives gives an explanation short about. So the top image, then quite similar to your x ray on the bottom right on the slide before. So that is a fracture of your surgical neck of your humerus. On your exhilarating of is like, um is gonna be damaged in that kind of fracture. So you were will lose adoption. You find it difficult to abduct on because you've got a loss of innovation to your deltoid. On your Terry's minor on, whenever you see a regimental budge area loss of sensation to the area always think axillary now have damage on another one that always comes up on exams is restaurant. I'm just associate that with radio nerve damage as well. That's gonna car with a mid shaft fracture of your humerus. So that was a whistle. Stop told. We'll leave on to the next. Higher your topic Time of your thigh or ox. So the man is stop from behind through the right posterior Drastic wall deep enough to base the pleura on the lung If the longest pierced of the midpoint between the eight packs of the long on the diaphragmatic in various office of the long which lung lobe is peer. So if we could launch the pole again, take a look at those five options. You can read the, um, question again if need be so more of a mix of responses here, keep them coming in. That's great. So if we could close the pole show the on says thank you who So it's actually the inferior lobe on that will be damaged. So I'll explain this. If you look at the image on the right hand side of that mine, is it winter? And, um, you can see that the oblique fish fissures actually runs quite steeply. So this is the front side of your lung right along. This is the back of your arm posterior of your right lung. So if the knife comes in head actually gonna hit the inferior lobe on, it's important to remember that in you're right long, you have to fish. Is eso your horizontal fissure? And you're a big fisher, then your left lung. You only have your oblique flare, Fisher. Um, so even to the next one, Tessa is a 31 year old lady who has been rushed to a me complaining of breathlessness, chest pain and a tight feeling in her chest. Do toe has stable condition. You send her for an X ray which appears abnormal. Which condition is the following X ray likely to be associated with? So if we could launch the power, please. Thank you. I'll have a look at that X ray. Now, Onda, see if it matches up with any of the five options on the left. So lots of responses here. That's great. Lovely. So free. Close the pole. I show you the answer. So what onto those? You put option D, which was pleural effusion. So explain that in this slide, So first of all, you need to have another standing off your lung pleura. And there's two kind of pleura to be aware of your parietal two, which is attached to the internal surface of the chest wall and your visceral pleura, which is attached to the outer surface of the lungs. So I always remember this as puff like point off you so pees on the outside. Parietal I was your kind of serous fluid, which is in between those two pleura on the new of the visceral was on the inside of touch the lungs on the pleural space In between, those two player can either be filled up with fluid or so if it's filled with fluid, you're gonna have a pleural effusion on. You might see um, white pill it on the X ray on. On examination, you'll see dull precaution, reduce breath sounds, energy's chest expansion. And you also see in the bottom kind of corners of your lungs, which is your cost. A frantic angles. They're gonna be blunted, and you might see a meniscus sign of the liquid. If that space is filled with air, it will appear black on the X ray on. On examination, you see increased residence, reduced breath sounds and reduce chest expansion. So you can see that on that X ray. Um, that you have a new myth or ex going on with the rocks because air is filling in those long have cavities. So next we'll move on to the anatomy of the abdomen. So a 70 year old man with the 20 pack your history undergoes an ultrasound of his abdomen. After experiencing weight loss, jaundice, pal stools and dark urine, he is diagnosed with extrahepatic cholangiocarcinoma. The location of the team is described as a proximal toe where the cystic dark means that have had it up what is the most likely location of the tumor. So if we can launch the pot again, thank you. So those five options where well, that she murmurs like the day well done, a lot of you, they're getting the correct. Also, that's great. So if we could close the pole now, so the answer is be your common hepatic duct. So explain this in this slide said, This is a diagram off your biliary tree, so I'll get my visa point again. You can follow me speaking, so they kind of match up between the left and right diagram. So you have a right hepatic duct on a left hip attic duct, and when they joined together, it's called the common hepatic duct. And then the question. Before we were saying there was a team of proximal to the cystic duct, so it's gonna have to be before the cystic duct, so it would be here in your common hepatic duct. So your cystic duct joins onto your common hepatic duct that then formed your colon bile duct. Your pancreas that's in a pancreatic duct and exit into the second part off your descending Judean. Um, try the unplug of Varta and you have a stink to Abadia's Well, here. Actually, that makes that so from me. An elderly grandmother finds a lump on her lower abdomen. It is diagnosed as a split jelly and hernia. This hernia occurs between the rectus abdominus on the lateral muscles at the accurate line. Which artery supplies the abdomen below the accurate line. So Paul should be up now and just, um, have a reader. The question again. That's great looks of answers coming in. Okay, so if we could close the pool now, thank you said is your inferior epigastric artery artery. So here it's important to be aware off the changes that above and below the are create line. Eso below the arcade line is when you have termination off the posterior actors, she, which you can see in the comparison between the top of the bottom image on because of that lack off kind of extra posterior rectus sheet. It's only your transfer, Silas. Faster and back, you're gonna have an increased risk of herniation below your great line. Um, so that kind of relates to the SBA that you guys on said so moving onto anatomy of reproductive in genital urinary system. So a 72 year old female presents to a GP with intermittent. You know, incontinence be a miser. 36. And she has had two previous pregnancies. She reports for urinary incontinence because when she laughs or coughs, what is the most likely underlying pathology? How to get this S p A. Well, don lots of lots of coming in. A lot of you getting this correct. So for 95% of you so well done. So if we could close the pole Thank you. So yeah, it's option be held it for weakness is the underlying pathology. So your pelvic floor muscles are your levator a night and your coccygeus cocky gs you're living toe and I I made up with three other muscles you can see in a bottle left on with a kind of female anatomy. It's also important to be well off are the other, uh, muscle. Also, if I highlight three main ones I think are important to remember is your rescue cavernosa s You'll bob with spongy exists on the sides here on the transverse parent, Your muscles on these two both are kind of constructive venous flow are. So it's important to remember that. Good. Okay, so intraperitoneal organs are enveloped by visceral peritoneum, whereas retroperitoneal organs are noncovered by parietal parity. Me, um, on the anterior surface, Which of the following is a retroperitoneal organ? So how to go this S p I. So I'll give you a hint. There's an acronym that's really useful. Know. Show it to you in the next light. Trying to figure out using I could have issues number swaddle, not sponsors. Course of replace the pole. Thank you. Well, don't those of you he said Hey, which was your adrenal glands glands? So this is operative or imagined. It's sad, Parker. So, um, the only way to know what she gets the slides not just kind of sit down and try to memorize this on the yes. So you can see on the top that stands for C programming. Inclined said that was the correct answer for the SBA. Um, there's kind of three exceptions, like additional things to remember. So with the duodenum, that's the retroperitoneal organ. Except for the proximal two centimeters. Same with the pancreas. It's the whole of the pancreas. Is rupture a party new except for the tail on the colon, only the ascending and descending parts of retroperitoneal. So I'm meeting on your kidneys as well. It's important to remember that. Just get more, uh, that your left one actually, like slightly higher than right Kidney on the kidneys lie between T 12 and L3 on the suprarenal glands. So you're adrenal glands, actually. Lie on top of your kidney so you can see on the image of lower outside on. They're supplied by your renal artery and veins on. Always remember, it's your ureters. Connect your kidney to your bladder and the new bladder extendedly is your urethra, so you return to your extra. So, uh, this is the last topic for May. So just try and engage with the SBA. So this one says by chemistry. Claire has been fasting for the past few days in a bid to lose weight before holiday. Her body is in a starving state on her liver has switched to gluconate genesis to provide energy for her body as her glycogen stones are depleted, which for the following cannot be used to make me glucose gluconeogenesis. So how to get this one for May, But I'm not so wants is coming in so quite a mix so you can breathe through the question if you need to. This well, we're done. So if I close the pole Thank you. But it'll vary with the onset. Is But the correct answer is a so fat free fatty acids, so free fatty acids cannot be used to make new glucose. But remember that they can be converted into a seat. I'll call a which can then enter your crap cycle on They be used to generate key tones on the right hand side that I left some of the molecules that can be used in relation to the SBA to make blue coasts ast. Those include kind of lap take pyruvate glycerol oxide oxaloacetic an amino acids. Uh, next test be a Peter and Dark. Our second secondary messengers formed from the cleavage of pit to my feet Through it opens calcium channel ligand Gated. Um, Cannell's in the underpass make articular Doc is a nonpolar molecule and therefore stays in the membrane protein kind I see requires dark and I pee three for activation. What is responsible for the cleavage of pit too. So if we could launch the whole exam. That's great. But if you're getting the correct taunts from this one, well, I keep having a guy five. So free. Close the pool. Lovely. Thank you. So Yeah, well, don't Today's of you. Put C, which was quite a lot of you. So it's forceful, like PC on. I'll explain that in, um, the left side. So this is kind of the secondary part messenger with messenger pathway involved to To be aware that pit, too, is in your kind of cell membranes. And it's broken down into dag on by Petri by phospholipase See which was the answer to the question I pee three diffuses into a cytoplasm on combined two calcium channels on your end up as much ridiculous on it releases calcium and this is kind of a positive feedback loop. Involving are key three, Whereas dog is quite it's more. The negative feedback loop on this G protein. Here is the GI Couple printing receptor on this three to be aware off G S t i n g key. In this instance, it would be geeky because activates forceful. I pick see, whereas gs activates the dental Cyclades and G I inhibits the dental type place, so just be aware of the story. So one last question from May a re a husband exercising at the gym leading to the migration of a particular glucose channel to her muscles. Cell membranes. This transporter is up regulated by insulin. In addition to exercise, which transporter is this describing? So if we could launch the whole of them Thank you. So how do you get this one? That's great A lot if you're answering this one to keep them coming. Lovely. So if we can close the pole, then so the correct answer was DC Uh, most of you got that. So it's gluten for receptor on this table. Kind of summarizes it. So when you get the slides in the back on this again, but gluten full in the question is found in your muscle and adipose tissue on with exercise expression is increased because, um, you need more glucose when you exercise. One is fine and all of your tissues as a basal transporter oblique to has high can have a low affinity, so only works well when there's a high concentration of glucose. A flu three is expressed in neurons angry. Absolute five is farm in respondent testing. So just try and remember those as well. So that's great. That's everything from May. But Kiefer, I'm getting involved with the SBA sauce option. Eri, pass it into half now. Thank you, Becky. That was really, really good. So, um great. Great questions on be great explanations as well. Thank you so much. Eso What I was going to suggest is because we've got a longer session today. It was really good before have starts, we just have a five minute break. So if we begin again at, say, 22 7 on double, kick it off with more s case. So if everyone in the meantime have a break, grab a quick drink and everything. I've also popped in the trap. A link for mailing list. A swell if you want to join that so that you get a notification about are on sessions with zoom links on gone. So as these guys have talked about, we're conducting some research as well. I put the link in the chapter, the Google form for that as well. So if you're breaking that to fill those two forms out, that would be fantastic. Thank you so much. Um, I might just start now, so I hope it ruins ready to restart. So I'm going to start off by doing a bit of SPF on the head and neck and back to me. So I was going to start the first one. Um, have everyone conceive my screen. Okay, so the first question is going to be a patient you see is struggling to smile and raise their eyebrows. What else would you suspect the patient to struggle with? So if you just want to put your answer in the poll function, remember, this is, like, anonymous if we can't see what everyone saying, so just put whatever you want. Really? Yeah. We have a lot of answers coming in, which is good to see. Also, if you guys have any questions in the chart, if you put them and I can't see them once I finished presenting as well, but I think I'm going to stop the polls down, maybe on D. So I think a lot of you said option B on the correct answer is person A. So I was going to go through this, So I think the answer pressure like this. You need to know about the cranial nerves because the head and neck and back to me, this is really important topic. So I've just got this table here which basically covers what the nerve does. And then they're modality. So are they a sensory? One other motor one And some of them do both as well on what they do. So a good way to remember this is oh, to touch and feel very good. Valve it. Ah, heaven. So there are a lot of other ones on anyone corroborate however they want, but that's just a good way of remembering them. So Oh, um, I'm staying to use my point, so oh, to touch and feel on the next light has the rest. But, um, to remember the modality. If you're under the order, you can use some say, marry money. But my brother says brains matter ball. So some say marry money. But the base stands for both. My brother says brains about tomorrow. So the next side we'll go through the rest of them. So the question asked you about the sensation off the tongue. So general sensation of the tongue is carried by two parts. So the two thirds anterior by the lingual lingual nerve that's a branch of the mandible. A division of the trigeminal nerve on the third of it is by the glass of her, and you'll never So, um, taste sensation is carried by three cranial nerves. So, um, so the two thirds of it So this diagram you consult, see two thirds of it, um on the soft palate is by the facial nerve. So that special next seven on that kind of merges with the lingual nerve in some areas, and then that carries on your sensation from that region, and then a third of it is of the posterior tongue is by the glossopharyngeal nerve. So if you just look here says the posterior, one third of the tongue on that does general sensation in that same area as well. And, um, also, the vagus nerve is involved here to you also have the hypoglossal nerve and that innovates the intrinsic on extrinsic tongue muscles. Onda the interests intrinsic muscles are basically used to move the tongue into a different shape on the extra sick ones are used to move the tongue as a whole, So you can, like, make its to count and make it stick in. So if you think extrinsic protruding out exit, you know? So there's rumors. Three types of tastes a circumvent late, foley eight and fund you form so so convoluted is like bitter and sour taste and foliage is, um, this, uh, increases the surface area of the tongue and it increases the contact and friction between the tongue and the food on the fund. You from area is for sweet sour, bitter, salty. A new mommy tastes That is the five that it does. Um, so I think I'm gonna move onto the next SBA. So which extra ocular muscles main action is in tajin And what is it's innovation. So you're gonna have to know about the eye muscles in this one. I know I struggle with this invest especially. So just think, which must would it be and what cranial nerves would supply? It is going to give it a few more seconds, having even ended that. Okay, so Ah, the answer to this one Waas truck. Leah nerve on superior oblique. So I made this table and this diagram. So this diagram I used to draw out. And I really recommend that if you want to learn the eye, muscles and directions, it's really useful to draw out. Do you just kind of just draw an ex with the line on down? Inferior oblique kind of does the opposite of what you think it would do. Um, so this is just a table as well with the actions. So in general, really quick summary of the I how it detects light or impulses. The impulse basically travels there. The optic nerve to the Arctic I as um, And then it continues to the optic tract to the lateral geniculate nuclear's, which is kind of looks like a circle on most diagrams on. Then, from that goes along the optic lady a shin all the way to the primary visual cortex, where it will just transducer electrical impulse on. Then we'll process it. But in terms of the actual movement of the motor actions of the eye, you have four rectum muscles. Each of these originate from a tendon tenderness ring, basically a tissue around the optical canal. On the back of the orbit, you have a superior rectus. That attach is to the superior and anterior aspect of the sclera. Then you have, um, the movement of it, which is basically just elevation to have a little adduction on medial rotation. So a good way to remember the difference between addiction and abduction in terms of the eye is when you abduct someone, you take them away from home. Home being the middle. So abduction would go this way and adduction would go this way. Um, So the interferon tests, however, attach this to the inferior aspect of the sclera on the movement would be depression on a little adduction. So that said that way, addiction towards the middle on lateral rotation, too. So down and in, um so medial Rector's attach is to the intermediate, um, aspect off the sclera two. So that's movement is adducts the eyeball towards the nose. Um, the lateral rector's. Attach this to the interrupt your aspect of the sclera so decide on abducts the I said that way towards the ears. Um, you also have these oblique muscles as well. On day sort of twist, the I can pop a zit directions even from the shape of it. Imagine it like a narrow, but yeah, so these muscles taken angular approach to the eye on they attached to the posture surface of the eyeball. So the superior of leak is from the body off the span I'd bone on, it passes through the proper Leah, and attach is to the sclera off the eye behind the stupid erect as muscle. The movement would be that it depress. Is it on? Abducts it. Remember, abduct is that way on immediately rotates it. So it kind of rolls the eye at would sit down and out so and invariably can just opposite. So it's from the anterior aspect of the orbital floor. Attach this to the square behind the lateral rector's. So just behind this muscle, it would touch on movement would be to elevate on abduct and laterally rotate the eyeball. So up and out. So you can just remember, um, these functions I would really help. This diagram really helped me, so yeah, um, this is just a good way to remember what each of the muscles do. So s so far. A last six rest three. So s so far. Superior oblique. So that would be a superhero belly. And that moves it, um, down and out on Can't remember what? The fourth cranial nerve This I just put it in the top. Yes, sir. I think everyone said probably a So the truck clear never would be this one. So superior oblique trochlea Because the follow um can you see? My point is still where it's going. Yeah. So? So far down and out. L r six lateral lateral rector's that would be are cranial nerve. Six. So that's the Abdusalam is nerve. So that's open out. And then you have, um, the rest all being cranial nerve three cranial nerve is just the ocular motor. You can remember that because Oculus is that kind of I I motor I movement so the rest are all by Cronyn of three. And that would be up in in so s o phone down and out. Um, superior oblique. And then you have open up, open out, which is a natural rectus. And then you have all of the rest of them being up in in. So they did. A movement is up. Histology. This could be quite a hard topic is lower. So I've just got some SPS on that. Um so a 25 year old woman who was sexually active. She doesn't use any barrier contraception. And she presents to your clinic. She has no symptoms that she can remember on the Pap, smear testing reveals cells with enlarged nuclei. And also Perry nuclear halos, which is the following. Best describes the normal histology off the region of the cervix from where the sample was a tent. So you have to think Where is the pap smear taken on? What would it normally look like? Um, if the pole could just be launched. Yeah, I think most of you getting the correct answer. Um, okay, I think we're gonna close it there. Okay, So if it's gonna let me change this slide Uh, yes. So the answer was option. Do transition from squamous to Columbia helium. So we're gonna talk about the Squamocolumnar junction. So in the vagina, you have the cervix region. We have the internal orifice, and then you have the extra or orifice. So this region is often called the Actos cervix, and you have the endo cervix is well on. This diagram kind of shows that this area said the outside of the cervix has lows of cells on top of each other that looked kind of squish. These are squamous epithelium cells, and on the inside they're these columnar like a rectangular looking ones. Um, you can sort of see it Here is well, so you have more squished ones and then more uniform calumnies on this side. I just think if it looks like a bunch of cells part piled on top of each other, it's going this. And if it's just straight rose, it's Columbia. So the Celebrex has a transformation zone on this is called the Squamocolumnar Junction. This is why cells can undergo dysplasia, which is just change from one Celltech to another, which means that it's really high risk for cancer. So pre cancerous, um, scans can be done here so you could have the PAP smear. This may test, um, which is a regular routine checkup for most woman that will just check this transformation zone to check for any cancer cells. Um, these regions here are called for necessities, and they just act like a gutter that's around the vaginal cervix, and they basically drain any excess fluid from, um, the pelvic cavity. So thing to remember is in the Actos cervix you have squamous. And in the end of cervix, you have columnar. So another histology question. This is a respiratory one. So which part of the respiratory tract is this? Slides showing on what type of epithelial is present here. So remember I said a little a cupful. Everyone's doing really well so far, right? But we can't see who said what. So you just honestly, just guess, um, I think I'll end. It may be okay. So mostly you got that right. Um, so pseudostratified columnar in the bronchus, so it's gonna let me change slide? Um, there we go. Okay. So, um so when it comes in from that mysterious into our respiratory tract has to be warm on. It's warmed up by blood vessels because this is really highly vascularized region, and it has to be moist. So the secretions released by sub mucosal Sarah mucosa glands motion up the ad that comes in. So even if you have dry, you still have glands, that moisture in the air that comes in it has to be cleaned. So, um, you have cilia that move any pathogens out and you also have a goblet cells that secrete mucous or sub mucosal glands that also secrete mucous that basically help the cilia toe walk down any pathogens. So if you think about it, the trick here by case, into the bronchus and then they buy 50 and into bronchioles. Um, you need that? I had to come in to be warm, moist on glean. You're going to imagine that by the time that it gets to the alveoli in the bronchioles is gonna be Kaleena. So the histology throughout that tract will change so higher up the tracks of the trickier the bronchitis, you're gonna need more cells present like that would secretes, Um um what secretes ceremony? Cozaar glands all would secrete any mucus or would have more silly because you want that to be cleaned before it gets further down. So by the time it gets to a bronchial, it would have less mucosal. Cilia would have less goblet cells because you wouldn't need as men as much pathogen clearance because they've already be cleaned on. Do you'd have less Claris ours. This is meant to be blue as well. Considine grease. Um, so that's why the histology changes cause by the time that are reaches um, further down that tract, there'll be less pathogens to clear, and the air will be in the correct way. Anyway, on it'll be narrow as well. So you can see here there's cartilaginous rings. Where is here? It's much dinner, and you can see the alveolitis well on. That just helps gas itching because there's more room for blood to touch. The blood gas exchange border is well, so now we're gonna be moving on system immunology. So the next SBA would be him out of poetic stem cells. Come, you become any type of blood cell they first differentiate into more specialized themselves, known as my load or lymphoid progenitors. Which of the following cells is a product off the lymphoid progenitor cell differentiation? This is kind of a tricky one that I think, um, some of your getting it. So Okay, I think I'm gonna end the polls. The, um So the answer was, in fact, D if it's gonna change the slide. Yeah, so, D um, So this table is really useful. So if you just learn or practice drawing out, that's a really good way of learning it. So you have, um, this multi put potential hematoma. A poet Tick. Never say that him are two poetic stem cell on these Basically can come from red bone marrow. Right. Um, so bone marrow as well on these a call him a decide to bless. And they give rise to all forms of the elements of blood. Basically. So you can, um they can either go into common name for progenitors or common, my lord. Urgent progenitors on by about day to they can even form red blood cells. So if they do decide to go for my lord, they can become and writer sites and any of these Our question said which one of these is a common one for progenitors, so that would be a natural killer cell. Um, but yeah, this is just really useful to learn, because you can really see what they differentiate into. So which of these are two kinds? Is a camera to tactic factor that recruits neutrophils, serve the poles. Just thank you. This is the last topic. So if you could have everyone just hip hop, his remember cut see is a second to last time. You actually from me? Um, I think that's enough. I think on D has been to So the answer was see, x e l it So I'm going to explain why. So, um if it tends to slide okay, so, side two kinds society kinds. Somebody might be confused as to what side tightness. They're just basically small, really small cell signaling protein molecules on their use In intracellular communication, they're classified as proteins are peptides up like a protein, The different the hormones because they're structurally different. But they're quite similar in that they're also, like, interesting, um, communications between the body so you could have different types of side to kinds. You can have internuclear you can have chemo kinds you can interfere on, so you could have tumor necrosis factors. You've probably heard of these, but just to really quickly summarize what they are so into. Look into lukins would target leukocytes, but they also made by leukocytes a z well, so they're secreted by leukocytes and they target other leukocytes on. They include common inflammatory and anti inflammatory mediators and limb for kinds. You could have chemo kinds, these media chemo attraction between cells. Um, so you also have interferons So, um, here interfere on and why you might have seen that one that's common. One that interfere and have they have antiviral function, and they can act as a pirate. Genesis. Opie Pyrogenic remember? Like, if you have a fever, you can be pirate putting the word piratical. Well, um, TNF tumor necrosis factors they cause long lasting inflammatory effects on fever during a systemic immune response. So, um, it basically can stimulate a really fast acute reaction in the liver as well. On they can be responsible. Much of the system damage so you can have severe infections that can lead to basically septic shock as well from this reaction. But all of these are really important if we have an infection. So if their pro environment tree these the ones that you need to remember that the anti inflammatory these the ones you need to remember, um, going to move onto the next slide. Okay, so TNF alpha on D c X cll Like the question answer was so these are two really common ones that you need to know. So TNF alpha activates and a thelium, so it increases the permeability off the endothelium to allow more leukocytes to basically enter into the site, so it kind of acts as the gate guardian to, like let others in to help, and it creates is increases. Angiogenesis, so induces the acute phase response. So upper up regulates liver proteins on expression and up regulates inflammatory markers on it also increases our body temperature. That's why, if we have really bad infection will get fever type things because our bodies temperature will increase in two more fever like state. So it encourages clotting and repair of small blood vessels as well. So you can have the E g F expression, too. So, in summary, these are just long lasting inflammatory mediators on there, paradigmatic so they can cause a fever on and inflammation from 2 24 hours. So TNF Alpha is released in really high amounts in response to like pop polysaccharide so the's could be found on gram negative bacteria. So if you have a back to your own infection, they'll detect that like a polysacchride in the, um, bacterial structure, and they'll release these TNF alpha psi two kinds on Dave Oscillo Tate. Much of the self destructed immune response, like I said earlier. So like septic shoppers, well, um, it can also cause organ failure as well, because of the tip tissue hyperperfusion because they increase the permeability so it can hyperperfusion on cause tissue damage leading to organ failure as well. On, um, let's talk about the Exelon as well. So cx LCL A is also called islet to on this basically induces, um, chemo Texas in target cells and mainly in neutrophils as well. So it induces D gradient also induces granulocytes to induce d graduation as well, and it causes them to basically migrate towards the site of infection. So see, x e l a is kind of like a massive bacon, kind of like flashing for other ones to come to the site kind of thing. And they stimulate phagocytosis a swell once they have arrived. Once the, um, leukocytes have arrived at the site, okay, said endocrine system questions. So, um, so the first and the question will be growth hormones has there have a varying effect throughout the body, which is the following is an example of one of its indirect effects. I'll give you guys a bit longer pissed. There's bit more reading to do. Okay, um, this is a bit of a trick you in. But hopefully, once you see the tree diagrams I have, it will make things a bit easier sitting. I'm going to end the holes there. Okay, so the answer was actually use a i g f one stimulates increased bone length, so that's an indirect effect of growth hormone. So let's take a look at what growth hormone conduce if the slight changes. There you go. So growth hormone comes from the hypothalamus. So around a flat peg as well. That's a good way to remember what the hypothalamus, pituitary guns conduce. So, um, um, hypothalamus secretes, uh, growth hormone as basically released by somatotrope in the anterior pituitary. And they promote bone muscle. They target the muscle, the bone and the liver so they could have both direct and indirect effects sums going to talk through this to treat diagram. So it promotes the main targets our bone muscle. Eso Did you see my point? Uh, so the bone and muscle is well, so you can have direct and inductive. So this is a direct effect, and this is an indirect effect, So direct effect would be it would in the muscle, it would increase glucose uptake it would increase, um, muscle mass on it. It would decrease. Oh, sorry. Decrease glucose uptake. Increase protein. Animal is, um, on increased muscle mass. Um, in the adipose tissue would also work for increased, like, pollicis decreased glucose uptake and decrease fat deposits in the liver. However, it has in direct on direct effect. So a directive that would be it would increase. Gluconeogenesis is an increase i GF as well, but it would indirectly affects kalitta growths of bone deposits on cartilage formation would be affected on also soft tissue growth would be too. So I'll just run is ah, hormone that caregiver our bodies. BP in which layer of the renal cortex made this be produced. Yeah, we got love, right? Answers here. It's going away. A few more seconds. Yeah, I think most of you got this one. So when and that So So the zonegran morello PSA. So a good way to remember that is salt, sugar and sex. So salt. So you have these different regions of the adrenal cortex. Remember the back? You said earlier. They're dreaming. Cortex found above the kidneys. So this is the kidney. And so the top of it. And this is the dream cortex. And if you look across section, this is just a histological. That diagram. But you have the zonegran Merrill Osa. You have, um, the zone of testicular tha zone of articular s. And then you have the adrenal medulla on a good way to remember what their dreams or cortex. So these three, um, produce or release assault, sugar and sex assault Would be men are mineralocorticoid mineralocorticoid. Sylvia's think salt is like a mineral so you can regulate the mineral balance. So this would be something like aldosterone his. I have sugar as well, so that big gluco cortical corticoid So that's glucose. The regulates glucose metabolism. So it's cortisol, cart cult occur and are cortisone Court is sewn with an end. Um, and you can also have sex a Z Well, so that's androgen. So you might have heard that on the reproductive topic. So this is just a flow chart. So androgens are basically just steroid hormones on day are involved in the bios synthesis off, um, different steroid hormones, too. So you can have this. This process occurs in the drink Odyssey have cholesterol. Um, and that's basically converted by sacrum see 50 to put pregnenolone and then dehydrogenate is is connect. Convert that to progesterone and then you have hydrolase is and like Pilates is that turned that into and just, um and I can never say this androstenedione. And then you have. They can either become Easter gyn or testosterones of dehydrogenase accent that then you have testosterone. I never in aromatase acts on that. You have Easter gyn, and so that's why he's a sex hormone. So that's why that last one is sex under Jin's are involved in sex hormones. Basically on finally, some urology. So a six year old smoker presents with a severe headache, bradycardia and hypertension on the respect to the rate of eight. He has MRI scan, which reveals a blockage of CSF causing a dilation off the third and lateral ventricles. It's caused by a tumor compressing on a brain structure. Where would we find this tumor? And where is it most likely to be? Basically, this is quite a heavy question. Um, I think I'll give a few more seconds. Okay. Think I'm gonna end it there. Okay, so the answer waas mid brain. It's contained slides again. So Don't worry. If you got this wrong causes quite heavy question, even from the word. And but just to make sense of it, you'd have to think where would it get blocked on two? No blockages. You'd need to know about the flow of CSF. So, CSF, uh, this is just a way of remembering it. So it flows from the, uh pinned in more cells in the lateral ventricle on the Coreg plexus. And then it would go to the third ventricle, and then it would travel to the cerebral aqueduct if you just follow it through this diagram. So to the cerebral aqueduct and then to the fourth ventricle down here and then to the foramen of Majendie and then to the former of Lush Calm and then to the foreman of Mark for know Magnum, and then to the subarachnoid space, which is on the outside. So the cerebral aqueduct is between the 3rd and 4th ventricles, and it's located within the midbrain. So just to talk about here, So the brain stem is comprised of three parts the midbrain, the ponds and the medulla Oblongata Onda, the cerebral architect, is between the 3rd and 4th brain ventricles. Um, and it's located within the midbrain there. So on the region of the bridge, brain behind the cerebral aqueduct is called the tectum, whilst in front is called the tech aumento. So if you guys just learned the flow of CSF, Yeah, that should help. So next SBA. So a woman is stabbed in the back, resulting in a spinal cord injury. She says her right leg is an extreme pain, but she cannot feel any vibration or light touch on her right leg. Um, she is diagnosed with a rare condition called browns A card syndrome. Where there is a heavy where there's a hemisect shin lesion off the spinal cord, which side of her spinal cord is the lesion most likely to be. So which side with the legion be if her right leg has lost the light touch in vibration sensation? Ah, okay. I think I'm gonna stop the polls there. So a lot of you said see on. But I can see why. Because I was going for the opposite as well. But in this case, it's actually the right, um, if it's gonna let me change this like, um there we go. So it's actually the right side, so she can't feel any vibration on the right leg. And you'd and you guys thought is left. So the reason that it's no, it's because in burns the card syndrome. Basically, only it's basically a lesion that effects half of the spinal cord, Um, and because and if it occurs in the thoracic region, so that's this area. The in an open your own lesion, the lower limb so that's supplied by the dorsal con um, column or the car to a spinal tract will lose any proprioception. It's electorally, so it's electorally is the same side. So if you think of I saw cities, same, I anything with I just remember, like, same. So it's actually so the same side. That's why if the lesion was on the right side, should lose that on her right side as well. So vibration, sensation and discriminative touch. But if it's in the lower limb, they'll they'll lose. So that's supplied by the spinal column. It pathway lose pain and temperature sensation contralateral. So the opposite side on that's because you can see here in the lower limb one, um, it does a thing called desiccation where it swaps over to the other side, whereas when it's in this region, it doesn't. It stays on that side, too, though, so if it's a lesion here, the sensation will be lost on the same side. Or as if there's a lesion there. The sensation will be lost on the opposite side. Eso If it's in the brain, then the motor issues would be contralateral a swell so on the opposite side on also semester sense. Symmetric sensory deficit would occur on the same side to the absolute neutral side. Um, so you can see there's different types of tracks along the spinal cord. You have the descending tracks. These are motor, so you have the lateral corticospinal and you have the ventral corticospinal on in the ascending to the sensory. You have dorsal column, lateral spinal, the Lamictal and ventral spinal. The Lamictal backs. So if I suggested, like summarize again of a lesion in the thoracic region occurs and the cortical spinal tract would be interrupted on the absolute actual side because Decker station occurs there in the medulla, causing spastic like paralysis. So in that sense, it it's electoral sensation would be lost. But a way to test where the lesion would be would be to do a pain test so you could do a pin prick along and see where they like, lost their sense of pain. But then also proprioception as well. So if you ask them, can they move that thumb? The report reception is your awareness of your body self without looking. So if you ask them to close their eyes and move there or like Ben Death, um, they should be able to sense that on also find touch. So, um, if you do like a cotton wool testis, well, um, that's it for me, I think. Pass on to Meghan. No, thanks have so much. So it's another great lot of questions and really great explanations as well. We're doing really well for time. Everyone's a great job with answering the questions. I think what I'll do now is give us a break til half past so