cardiac output blood flow hypoxia

1st Brachial arch

Cartilage:
Meckel' s (Mandible, Malleus, Mandibular)
Muscles:
Muscles of mastication (Masseter, medial pterygoids, Mylohyoid)
Neves:
CN V2, V3
-Chew
1st Brachial Pouch
Middle ear cavity
Eustachian tube
Mastoid air cells
2nd Brachial arch
Cartilage:
Reichert' s (Stapes, Styloid, Stylohyoid)
Muscles:
Stapedius, Stylohyoid
Nerves:
CN VII
-Smaile
2nd Brachial Pouch Epithelial lining of palatine tonsil
3rd Brachial arch
Cartilage:
Greater horn of hyoid
Muscles:
Stylopharyngeus
-Stylopharyngeus innervated by glossopharyngeal nerve
Nerves:
CN IX
-Swallow stylishly
3rd Brachial Pouch
Dorsal wings
-Inferior parathyroids
Ventral wings
-Thymus
3 structures
Thymus, right & left parathyroids
4th Brachial Pouch Dorsal wings
-Superior parathyroid
4th-6th Brachial arches
Cartilage:
Thyroid, cricoid,
Muscles:
4 = pharynheal constrictors
6 = intrinsic muscles of larynx
Nerves:
4 = CN X (superior laryngeal branch)
-Simply swallow
6 = CN X (recurrent laryngeal branch)
-Speak
A-a gradient
Used to compare causes of hypoxemia
PAo - Pao
Normal < 10
-O normally equilibrates between alveolar gas and arterial blood (PAo ~ Pao) (High altitude, hypoventilation)
If > 10
-O does not equilibrate between alveolar gas and arterial blood (diffusion defect, V/Q defect, right to left shunt)
Absence seizure
Brief (usually less than 20 seconds), generalized epileptic seizures of sudden onset and
termination
Clinically, the impairment of consciousness (absence)
Electroencephalography (EEG) shows generalized spike-and-slow wave discharges ~3Hz
Affinity column chromatography
Method of separating biochemical mixtures
-Based on a highly specific interaction such as that between antigen and antibody, enzyme and substrate, or receptor and
ligand.
Can be used to.
1. Purify and concentrate a substance from a mixture into a buffering solution
2. Reduce the amount of a substance in a mixture
3. Discern what biological compounds bind to a particular substance
4. Purify and concentrate an enzyme solution.
Albinism
Congenital deficiency in:
Tyrosinase
Defective tyrosine transporter ( tyrosine melanin)
Can result from lack of migration of neural crest cells
Lack of melanin results in risk of skin cancer
Alveolar ventilation The volume of gas per unit time that
reaches the alveoli
Ammoniagenesis
Occurs within proximal tubular cells
Glutamine made in the liver, is received from peritubular capillaries and is metabolized into
1. Alpha-keto glutarate (Metabolized further into two HCO3- ions, which then leave the cell and enter
systemic circulation by crossing the basolateral membrane)
2. NH4+ (Secreted into renal tubules)
Anabolic steroids
Leads to sex-hormone binding globulin
free testosterone
-Gynecomastia results
Anemia Hb concentration causes O content
of blood hypoxia
Aplasia Lack of growth
Arches 3 & 4 Posterior 1/3 of tongue
ARDS
Inflammation of the lung parenchyma leads to impaired gas exchange with systemic release of inflammatory mediators,
causing:
Inflammation
Hypoxemia
Frequently multiple organ failure.
Condition has a 90% death rate in untreated patients. With treatment, usually mechanical ventilation in an intensive care
unit, the death rate is 50%.
A less severe form is called acute lung injury (ALI)
3 main clinical causes
1. Sepsis (most important)
2. Severe multiple trauma
3. Aspiration of saliva / gastric contents
Any cardiogenic cause of pulmonary edema should be excluded
-Done by placing a pulmonary artery catheter for measuring the pulmonary artery wedge pressure
Avoidant Personality Disorder
Display a pervasive pattern of social inhibition, feelings of inadequacy, extreme
sensitivity to negative evaluation, and avoidance of social interaction
Consider themselves to be socially inept or personally unappealing and avoid
social interaction for fear of being ridiculed, humiliated, rejected, or disliked
Bacillus subtilis
Gram-positive, catalase-positive bacterium
Rod-shaped
Has the ability to form a tough, protective endospore, allowing the organism
to tolerate extreme environmental conditions
Only known to cause disease in severely immunocompromised patients
Bacteroides fagilis
Gram-negative bacillus bacterium species
Involved in 90% of anaerobic peritoneal infections
Predominates in bacteremia associated with intraabdominal infections,
peritonitis and abscesses following rupture of viscus, and subcutaneous
abscesses or burns near the anus
Brachial Arches (Pneumonic)
When at the golden arches,
1. Chew
2. Smile
3. swallow stylishly or 4. simply swallow
6. speak
There is no 5!
Brachial pouch pneumonic
Ear, tonsils, bottom to top
1(ear)
2(tonsils)
3 dorsal (bottom for inferior thyroid)
3 ventral (to = thymus)
4 (top = superior parathyroids)
Branchial apparatus
CAP Covers outside from inside
Clefts = ectoderm
Arches = mesoderm
Pouches = endoderm
Broca's aphasia Nonfluent aphasia with intact
comprehension.
Carbaminohemoglobin
CO bound to hemoglobin
-Account for very small amount of CO in
blood
Carbon monoxide poisoning O content of blood hypoxia
Carnitine deficiency
Inability to transport LCFA (Long chain fatty acids) into
mitochondria
Results in toxic accumulation in the cytoplasm
Causes weakness, hypotonia, hypoketotic hypoglycemia
Case Control
Two existing groups differing in outcome
are identified and compared on the basis of
some supposed causal attribute
Case series
Medical research descriptive study that:
1. Tracks patients with a known exposure given similar treatment
2. Examines their medical records for exposure and outcome
Can be retrospective or prospective
Usually involves a smaller number of patients than more powerful case-control studies or randomized controlled trials
May be consecutive or non-consecutive
-Depends on whether all cases presenting to the reporting authors over a period were included, or only a selection
May be confounded by selection bias
-Limits statements on the causality of correlations observed
-Physicians who look at patients with a certain illness and a suspected linked exposure will have a selection bias in that they
have drawn their patients from a narrow selection (Their hospital)
Chronic myelogenous leukemia (CML)
30 - 60 year olds
Myeloid stem cell proliferation
- neutrophils, metamyelocytes, basophils
t(9;22)
Low leukocyte alkaline phosphatase (as opposed to leukemoid reaction)
Clostridium perfringens
Gram-positive, rod-shaped, anaerobic, spore-forming bacterium
Infections show evidence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene
Toxin involved in gas gangrene is known as -toxin
-Inserts into the plasma membrane of cells, producing gaps in the membrane that disrupt normal cellular
function
CN III Palsy eye is "down and out" with ptosis and pupil
dilation
Complete hydatidiform mole
Caused by a single (90%) or two (10%) sperm
combining with an egg which has lost its DNA
The genotype is typically 46,XX (diploid)
Complex partial seizure
Often preceded by a seizure aura.
-A simple partial seizure.
Aura may manifest itself as a feeling of dj vu, jamais vu, fear, euphoria or depersonalization.
Seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or
micropsia).
Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing.
There may also be loss of memory (amnesia) surrounding the seizure event.
Person may still be able to perform routine tasks such as walking, although such movements are not purposeful or planned.
Witnesses may not recognize that anything is wrong.
Congentio pharyngo-cutaneous fistula Persistence of cleft and pouch fistula
between tonsillar area, cleft in lateral neck
Cyanide poisoning O utilization by tissues hypoxia
Cytarabine
Pyrimidine analog inhibition of DNA polymerase
Used with:
Leukemia, lymphomas
Toxicity:
Leukopenia
Thrombocytopenia
Megaloblastic anemia
Density Gradient Centrifuge
Used to separate certain organelles from whole cells for further analysis of specific parts of cells
1. A tissue sample is first homogenised to break the cell membranes and mix up the cell contents.
2. The homogenate is then subjected to repeated centrifugations, each time removing the pellet
and increasing the centrifugal force.
3. Finally, purification may be done through equilibrium sedimentation, and the desired layer is
extracted for further analysis.
Deoxyhemoglobin
Better buffer for H than oxyhemoglobin
-Advantageous that hemoglobin has been
deoxygenated by the time it reaches the venous end of
the capillaries
Diabetic neuropathy symptoms
Numbness and tingling of extremities
Dysesthesia (abnormal sensation to a body part)
Diarrhea
Erectile dysfunction
Urinary incontinence (loss of bladder control)
Facial, mouth and eyelid drooping
Vision changes
Dizziness
Muscle weakness
Difficulty swallowing
Speech impairment
Fasciculation (muscle contractions)
Anorgasmia
*Burning or electric pain*
Diaphoresis Excessive sweating
DiGeorge syndrome
Aberrant development of 3rd & 4th pouches:
T-cell deficiency (thymic aplasia)
Hypocalcemia (failure of parathyroid development)
Dysostosis multiplex
Hereditary disease (autosomal recessive) consisting of an error is
mucopolysaccharide metabolism
Characterized by severe abnormalities in development of skeletal
cartilage and bone and mental retardation
Dysthymic disorder
Mood disorder consisting of the same cognitive and physical problems as in depression, with less severe but
longer-lasting symptoms, which may persist for at least 2 years
A serious state of chronic depression, which persists for at least 2 years; it is less acute and severe than major
depressive disorder
Sufferers may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all
Erythropoietin
Its primary effect on red blood cell progenitors and
precursors (which are found in the bone marrow in
humans) is promoting their survival through
protecting these cells from apoptosis
Excess lymphoblasts
Age < 15
Found in acute lymphoblastic leukemia (ALL)
TdT+ (Marker of pre-t & pre-b cells)
CALLA+
t(12;21) = good prognosis
Increased incidence in people with Down Syndrome
Ferrochelatase
Lead poisoning
Accumulates:
Protoporphyrin, -ALA
Microcytic anemia, GI and kidney disease.
Children-exposure to lead paint -+ mental deterioration
Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination
Fluoxetine
SSRI
Use:
Depression, generalized anxiety disorder, panic disorder, OCD,
bulimia, social phobias, PTSD
Generalized tonic clonic
Generalized seizure that affects the entire brain
Divided into two phases, the tonic phase and the clonic phase. Preceded by aura
Tonic = skeletal muscles tense
Clonic = Rapid contraction and relaxation of muscles
Glipizide
Second generation sulfonylurea
Close K+ channel in -cell membrane, so cell depolarizes
+ triggering of insulin release via Ca2+ influx.
Stimulate release of endogenous insulin in type 2 DM. Require some islet function, so useless in type 1 DM
Toxicity: Hypoglycemia
glossoptosis Downward displacement or retraction of
the tongue
Glucokinase
Liver and cells of pancreas
Low affinity (High Km), high capacity (High Vm)
Induced by insulin
It's a *glu*ton has high Vmax b/c it can't be satisfied
At low glucose concentration, hexokinase sequesters glucose in the tissues.
Ah high glucose concentration, excess glucose is stored in the liver
Glucose-6-phosphatase
In ER
Glucose-6-P Glucose
Liver (Not present in muscle)
Probably stimulated by glucacon
Deficient in Von Gierke' s disease
-Severe fasting hypoglycemia
- glycogen in liver
- blood lactate
-hepatomegaly
Glycogen phosphorylase
Rate determining enzyme for glycogenolysis
Skeletal component deficient in McArdle's disease
- glycogen in muscle, but can't break it down
-Painful muscle cramps, myoglobinuria w/ strenuous exercise
H1 (Histamine)
Found on smooth muscle, endothelium, and central nervous system tissue
Causes:
Bronchoconstriction
Bronchial smooth muscle contraction
Vasodilation
Separation of endothelial cells (responsible for hives)
Pain and itching due to insect stings;
the primary receptors involved in allergic rhinitis symptoms and motion sickness;
sleep and appetite suppression.
H2 (Histamine)
Located on parietal cells and vascular smooth muscle cells
Causes:
Primarily involved in vasodilation
Also stimulate gastric acid secretion
Hemispatial neglect
Results most commonly from brain injury to the right cerebral hemisphere, causing visual neglect of the left-hand side of
space
A stroke affecting the right parietal lobe of the brain can lead to neglect for the left side of the visual field, causing a patient
with neglect to behave as if the left side of sensory space is nonexistent (although they can still turn left)
-Extreme case, a patient with neglect might fail to eat the food on the left half of their plate, even though they complain of
being hungry
-Someone with neglect is asked to draw a clock, their drawing might show only numbers 12 to 6, or all 12 numbers on one
half of the clock face, the other side being distorted or left blank
Histone deacetylase
Removes acetyl groups from AA
-Allows histones to wrap DNA more tightly
Actions are opposite to that of histone acetyltransferase
These would affect transcription of DNA!!!!
Holosystolic murmur
Tricuspid insufficiency
-Best heard over the fourth left sternal border, radiates to right sternal border
-Intensity can be accentuated following inspiration
--Due to increased regurgitant flow in right ventricular volume
-most often secondary to pulmonary hypertension
Mitral regurgitation
-Best heard at the apex with diaphragm, radiates toward axilla
-No intensification upon inspiration
-Difference in pressure extends throughout systole and can even continue after the aortic valve has closed
Ventricular septal defect
-Best heard over the left third and fourth intercostal spaces and along the sternal border
-S2 Normal (Distinguish from pulmonary stenosis, which has a wide splitting S2)
-No intensification upon inspiration
Homonymous hemianopsia
Visual field loss that respects the vertical midline, and usually affects both eyes
Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to visual cortex can cause
-If lesion is in optic tract, will be pupillary reflex problem!
The more posterior the cerebral lesion, the more symmetric (congruous) symptoms will be
1. Person who has a lesion of the right optic tract will no longer see objects on his left side
2. Person who has a stroke to the right occipital lobe will have the same visual field defect, usually more congruent between
the two eyes, and there may be macular sparing
Hydroxyurea
Inhibits ribonucleotide reductase DNA Synthesis (S-phase specific)
Used with:
Melanoma, CML, Sickle cell disease ( HbF)
Toxicity:
Bone marrow suppression
GI upset
Hyperammonia
Can be acquired (e.g., liver disease) or hereditary (e.g., urea cycle enzyme
deficiencies)
excess NH4+ depletes a-ketoglutarate inhibition of TCA cycle
Rx: limit protein in diet
Hyperparathyroidism
Stone, Bones, and Groans
Hypercalcemia
Hypercalciuria (Stones)
Hypophosphatemia
PTH, Alk Phos, cAMP in urine
Hypokinesis Diminished or abnormally slow movement
Hypoxemia Decrease in arterial Po
Hypoxemia Pao causes %saturation of
hemoglobin hypoxia
Hypoxia
Decreased O delivery to tissues
O delivery = Cadiac output x O content of blood
Dependes on:
Hemoglobin concentration
O-binding capacity of hemoglobin
% saturation of hemoglobin by O (Depends on Po)
Can be caused by:
cardiac output
O-binding capacity of hemoglobin
arterial Po
IL-5
From Th cell
Promotes differentiation of B-cell
Enhances class switching of IgA.
Stimulates the growth of and differentiation of eosinophils
Imatinib
A small molecular inhibitor of bcr-abl tyrosine kinase
Treatment of CML
Trade name Gleevec
Immunohistochemistry
Process of detecting antigens (e.g., proteins) in cells
of a tissue section by exploiting the principle of
antibodies binding specifically to antigens in
biological tissues
Incidence Looks at new incidents
inclusion cell disease (I-cell disease)
Inherited lysosomal storage disorder
Failure of addition of mannose-6-phosphate to lysosome proteins
-Enzymes are secreted outside the cell instead of being targeted to the lysosome
Presentation:
Coarse facial features
Clouded corneas
Restricted joint movement
High plasma levels of lysosomal enzymes
Inferior mesenteric lymph nodes
Sigmoid colin Colic
Ends up in these lymph nodes
Insulin secretion
1. Glucose binds Glut2 receptor on -cells
2. Glucose oxidizes to ATP closes K channels in cell membrane
depolarization of -cells
3. Depolerizatino opens Ca channels intracellular [Ca]
[name of this card]
Interferons
Proteins that place uninfected cells in an antiviral state
Induce production of ribonuclease that inhibits viral protein synthesis by degrading viral mRNA (but not host
mRNA)
& : inhibit viral protein synthesis
: MHC I & II expression and antigen presentation in all cells
Activate NK cells to kill virus-infected cells
Internal iliac lymph nodes
Rectum (lower portion) of anal canal (Above
pectenate line)
Ends up in these lymph nodes
Internal iliac lymph nodes
Receive lymphatics from:
All the pelvic viscera
Deeper parts of the perineum
-membranous and cavernous portions of the urethra
Buttock and back of the thigh
Cervix!
Not: Ovary, testis, or superior half of the rectum
Gonads drain to the paraaortic lymph nodes
Superior half of the rectum drains to the pararectal lymph nodes
Internal urethral orifice Opening of the urinary bladder into the
urethra
Irradiated packed RBCs
Destroys DNA in WBCs
-Prevents graft vs host disease occurring from transfusion
Important if transfusion is from:
1. Close family relation
2. Someone who is immunocompromised (Di George Syndrome, Wiskott Aldrich, and SCID)
IB Releases NF-B after undergoing
phosphorylation
Left sided heart failure signs
Tachypnea (increased rate of breathing)
Increased work of breathing (non-specific signs of respiratory distress)
Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields
-Suggest the development of pulmonary edema (fluid in the alveoli)
-Cyanosis which suggests severe hypoxemia, is a late sign of extremely severe pulmonary edema.
Leukemia
Unregulated growth of leukocytes in *bone marrow*
or in # of circulating leukocytes in blood
Marrow failure anemia (RBC), infections (WBC), hemorrhage (platelets)
Infiltrates in liver, spleen, and lymph nodes possible
Leukemoid reaction
Acute inflammatory response to infection
WBC count with neutrophils and neutrophil precursors such as band cells
leukocyte alkaline phosphatase
Leukocidin
Type of cytotoxin created by some types of bacteria
Is a type of pore forming toxin
Get their names by killing ("-cide") leukocytes
Associated with increased virulence of certain strains (isolates) of Staphylococcus aureus
Cause of necrotic lesions involving the skin or mucosa, including necrotic hemorrhagic pneumonia
Listeria monocytogenes
Gram-positive bacterium
Motile via flagella at 30C and below
Can move within eukaryotic cells by explosive polymerization of actin filaments (known as comet tails or actin rockets).
Facultative anaerobic bacterium (Capable of surviving in the presence of oxygen)
Can grow and reproduce inside the host' s cells
One of the most virulent food-borne pathogens, with 20 to 30 percent of clinical infections resulting in death
Due to its frequent pathogenicity, causing meningitis in newborns (acquired transvaginally), pregnant mothers are often
advised not to eat soft cheeses
-It is the third-most-common cause of meningitis in newborns
Loading dose
Cp x Vd
(mass/volume) x (volume)
Remember:
If volume of distribution is given in L/kg
-Need to multiply by body weight to find actual volume distribution
Lorazepam
Facilitates GABAa action by frequency of Cl channel opening
Use:
Anxiety
Spasticity
Status epilepticus
Detoxification
Lymphoma Discrete tumor masses arising from lymph
nodes.
Lysosomal storage disease
Caused by lysosomal dysfunction usually as a consequence of deficiency of a single enzyme required for the
metabolism of lipids, glycoproteins (sugar containing proteins) or so-called mucopolysaccharides
When a particular lysosomal enzyme exists in too small an amount or is missing altogether, substances
accumulate in the cell.
In other words, when the lysosome doesn't function normally, excess products destined for breakdown and
recycling are stored in the cell.
Maintenance dose
Cp x CL/F
Cp = target plasma concentration
Remember:
If volume of distribution is given in L/kg
-Need to multiply by body weight to find actual volume distribution
Major depressive disorder
Characterized by episodes of all-encompassing low mood accompanied by low
self-esteem and loss of interest or pleasure in normally enjoyable activities
Presence of a severely depressed mood that persists for at least two weeks
Medial Longitudinal faciculus
Pair of tracts that allow for cross talk between CN VI & CN VIII nuclei
Coordinate both eyes to move in the same horizontal direction
Highly myelinated (Communicate quickly so eye' s move at the same time)
Lesion:
Lack of communication such that when CN VI nucleus activates ipsilateral rectus, contralateral CN III nucleus does not
stimulate medial rectus to fire (impaired abduction)
Abducting eye get' s nystagmus (CN VI overfires to stimulate CN III)
Convergence normal
Megaloblastosis (Megaloblastic anemia)
Results from inhibition of DNA synthesis in red blood cell production
-Most often due to hypovitaminosis, specifically a deficiency of vitamin B12 and/or folic acid
Characterized by:
Many large immature and dysfunctional red blood cells (megaloblasts) in the bone marrow
Hypersegmented neutrophils (those exhibiting five or more nuclear lobes ("segments"), with up to
four lobes being normal)
Mesoblastic nephroma
Type of kidney tumor that is usually found before birth by
ultrasound or within the first 3 months of life.
It contains fibroblastic cells (connective tissue cells), and may
spread to the other kidney or to nearby tissue
micrognathia Jaw is undersized
Muscarinic ACh receptor
Receptors that form G protein-receptor complexes in the cell membranes of
certain neurons and other cells
Play several roles, including acting as the main end-receptor stimulated by
acetylcholine released from postganglionic fibers in the parasympathetic
nervous system
Myofibroblast
Cell that is in between a fibroblast and a smooth muscle cell in differentiation
Can contract by using smooth muscle type actin-myosin complex, rich in a form of actin called alpha-smooth muscle actin
-These cells are then capable of speeding wound repair by contracting the edges of the wound
Narcissistic personality disorder
Being excessively preoccupied with issues
of personal adequacy, power, prestige and
vanity
Nephroblastoma (Wilms tumor)
Most common renal malignancy of early childhood (Age 2-4)
Contains embryonic glomerular structure
Presents with huge flank mass / hematuria
Deletion of WT1 on chromosome 11
Can be hypervascular....
NF-B
Activation occurs when it's inhibitor, I-B, is phosphorylated by
specific protein kinase (IKK) & degraded
-Leads to synthesis of prostaglandins and leukotrienes
Nicotinic ACh receptor
Receptors that form ligand-gated ion channels in the plasma membranes of
certain neurons and on the postsynaptic side of the neuromuscular junction
As ionotropic receptors, these are directly linked to ion channels and do not use
second messengers (as metabotropic receptors do).
Obsessive compulsive disorder
Characterized by intrusive thoughts that produce
uneasiness, apprehension, fear, or worry
Olanzapine
Atypical antipsychotic
Use:
Schizophrenia - both +ve and -ve
Bipolar, OCD, anxiety disorder, depression, mania
Fewer extrapyramidal side effects than traditional antipsychotics
Optic chiasm lesion Bitemporal anopia
Oxytocin
Stimulates labour
Uterine contraction
Milk let down
Controls uterine hemorrhage
Packed RBCs with adenine-saline added Allows the blood to flow readily without
the addition of saline
PaO2/FiO2 ratio
The ratio of partial pressure arterial oxygen and fraction of inspired oxygen
Comparison between the oxygen level in the blood and the oxygen concentration that is breathed
Helps to determine the degree of any problems with how the lungs transfer oxygen to the blood
If equal to or less than 200 mmHg is one criteria for diagnosing ARDS
Parietal lobe lesion Lower quadrantic anopia
Partial hydatidiform mole
Occurs when an egg is fertilized by two
sperm or by one sperm which reduplicates
itself yielding the genotypes of 69,XXY
Parvovirus inclusions
Fifth disease
-Develop the illness after an incubation period of four to fourteen days.
-Fever and malaise while the virus is most abundant in the bloodstream
-Patients are usually no longer infectious once the characteristic rash of this disease has appeared
Parvovirus B19 is a cause of chronic anemia in individuals who have AIDS
Aplastic anemia
-Patients have an arrest of erythropoiesis (production of red blood cells) during infection
-Patients who have sickle cell anemia or hereditary spherocytosis are heavily dependent on erythropoeisis due to the reduced
lifespan of the red cells
Infection in pregnant women is associated with hydrops fetalis due to severe fetal anemia
Peptic ulcers
Chronic inflammation due to Helicobacter pylori that colonizes the antral mucosa
NSAIDs
Some studies have found correlations between smoking and ulcer formation
Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, have not been found to affect ulcers to any
significant exten
Peroxisome
Membrane-enclosed organelle involved in
catabolism of very long fatty acids (VLFA)
& amino acids
Phosphoenolpyruvate carboxykinase Irreversible enzyme in Gluconeogenesis
Phosphorylase kinase An early component of Gluconeogenesis
Phytanic acid
Branched chain fatty acid that humans can obtain through the consumption of
dairy products, ruminant animal fats, and certain fish
Undergoes -oxidation in the peroxisome, where it is converted into pristanic
acid by the removal of one carbon
Pipecolic acid
Accumulates in Pipecolic acidemia
- Very rare autosomal recessive metabolic disorder
that is caused by a peroxisomal defect
Placenta accreta
Abnormally deep attachment of the placenta to the myometrium without penetrating it.
Placenta grows completely through the endometrium
Great risk of haemorrhage during placental removal
-Commonly requires surgery to stem the bleeding and fully remove the placenta
-In severe forms can often lead to a hysterectomy or be fatal
Porphobilinogen deaminase
Acute intermittent porphyria
Accumulates:
Porphobilinogen, -ALA, uroporphyrin
5 P' s
1. Painful abdomen
2. Port wine-colored urine
3. Polyneuropathy
4. Psychological disturbances
5. Precipitated by drugs
Posterior Communicating Artery
Common site ofsaccular (berry) aneurysm.
CN III Palsy: Eye is "down and out" with ptosis and pupil dilation
Lesions are typically aneurysms, not strokes
Prenatal cocaine effects Associated with premature birth, birth
defects, attention deficit disorder
Prevalence Looks at all current cases
PTH
Ca+ resorption from Kidney (Inhibits PO4 resorption)
Stimulates Vit D. synth
-Increased Ca+ absorbed from intestine
Ca+ release from bone
serum calcium
pVHL
An E3 ligase that ubiquitinates HIF1 and causes its degradation by the proteasome.
In low oxygen conditions or in cases of VHL disease where the VHL gene is mutated
-pVHL does not bind to HIF1.
-This allows the subunit to dimerise with HIF1 and activate the transcription of a number of
genes (vascular endothelial growth factor, platelet-derived growth factor B, erythropoietin and
genes involved in glucose upatake and metabolism)
Right Coronary Artery
Supplies blood to right ventricle & 25-30% of left ventricle
In 85% of patients, gives off posterior descending artery
Supplies SA nodal artery in 60% of patients
Give off branch to right marginal artery
If lungs are clear to auscultation, no LVF. Think RVF!
Ringed sideroblasts
Body has iron available but cannot incorporate it into hemoglobin, which red blood cells need to transport oxygen efficiently
Abnormal nucleated erythroblasts (precursors to mature red blood cells) with granules of iron accumulated in perinuclear
mitochondria
-Seen in aspirates of bone marrow
Most common cause of is excessive alcohol use
Primary pathophysiology = failure to completely form heme molecules (whose biosynthesis takes place partly in the
mitochondrion)
Rouleaux formation
Stacks of red blood cells (RBCs) which form because of the unique discoid shape of the cells in vertebrates
Conditions which cause:
Infections
Multiple myeloma
Inflammatory and connective tissue disorders
Cancers
Occurs in diabetes mellitus (one of the causative factors for microvascular occlusion in diabetic retinopathy)
RTA1 ("distal", Renal tubular acidosis)
Defect in collecting tubule's ability to excrete H+
urine pH >5.5
hypokalemia
risk for calcium phosphate kidney stones as a result of urine pH and bone
resorption
RTA2 ("proximal", Renal tubular acidosis)
Defect in proximal tubule HC03- reabsorption
Fanconi's syndrome
urine pH < 5.5
hypokalemia
risk for hypophosphatemic rickets
RTA4 ("hyperkalemic", Renal tubular
acidosis)
Hypoaldosteronism or lack of collecting tubule response to aldosterone
Resulting hyperkalemia impairs ammoniagenesis in the proximal tubule
buffering capacity and urine pH
S. pyogenes (Group A)
The bacteria behind post-streptococcal glomerulonephritis
PHaryngitis can results in PHever & glomerulonePHritis
Salmonella enterica
Most cases of salmonellosis are caused by food infected with w/ this bacteria, which often infects cattle and poultry
A remarkable large number of fimbrial and non-fimbrial adhesins are present in Salmonella
-Mediate biofilm formation and contact to host cells
Secreted proteins are also involved in host cell invasion and intracellular proliferation
-Two hallmarks of Salmonella pathogenesis
Usually does not need ABs (Only if complicated in people at risk such as infants, small children, the elderly)
-Will lead to prolonged fecal excretion of bacteria
Scaphoid bone
Most commonly fractured carpel bone
Prone to avascular necrosis due to retrograde blood supply
Receives its blood primarily from the distal end
Failure of the fracture to heal ("non-union") can result in loss of blood supply to the proximal pole
- Can result in avascular necrosis of the proximal segment.
Schizoid personality disorder
Characterized by a lack of interest in social relationships, a tendency
towards a solitary lifestyle, secretiveness, emotional coldness and apathy
May simultaneously demonstrate a rich, elaborate and exclusively
internal fantasy world
Schizotypal personality disorder
Characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often
unconventional beliefs
May feel extreme discomfort with maintaining close relationships with people, and therefore they often do not
May display peculiar manners of talking and dressing and often have difficulty in forming relationships.
May react oddly in conversations, not respond or talk to themselves
Frequently misinterpret situations as being strange or having unusual meaning for them; paranormal and superstitious
beliefs are not uncommon
Scurvy
Swollen gums
Bruising
Hemarthrosis
Anemia
Poor wound healing
Simple partial seizures
Consciousness is not impaired
Often precursors to larger seizures, where the abnormal electrical activity
spreads to a larger area of (or all of) the brain, usually resulting in a complex
partial seizure or a tonic-clonic seizure
-In this case they are often known as an aura
SLE Criteria
4 out of 11 of the following
1. Malar rash
2. Discoid rash
3. Serositis: Pleurisy or Pericarditis
4. Oral ulcers
5. Arthritis
6. Photosensitivity
7. Blood disorder: Hemolytic anemia, leukopenia, lymphopenia, thombocytopenia, ~hypocomplementemia
8. Renal disorder
9. ANA +ve
10. Immunologic disorder
11. Neurologic disorder
Slipped-strand mispairing
Denaturation and displacement of the DNA strands, resulting in mispairing of
the complementary bases.
Can result in either insertions or deletions.
Insertions are thought to be self-accelerating: as repeats grow longer, the
probability of subsequent mispairing events increases
SNoW DRoP
Southern = DNA
Northern = RNA
Western = Protein
Southwestern blot Identifies DNA-binding proteins
Staph -toxin
The major cytotoxic agent released by bacterium Staphylococcus aureus and the first identified member of the pore forming
beta-barrel toxin family
Staphylococcus aureus
Facultative anaerobic Gram-positive coccal bacterium
Appears as grape-like clusters when viewed through a microscope, and has large, round, golden-yellow colonies, often with
hemolysis, when grown on blood agar plates
Catalase-positive
-Able to convert hydrogen peroxide (H2O2) to water and oxygen
Virulence factors:
Enzymes
-Coagulase clots plasma and coats the bacterial cell which probably prevent phagocytosis
-Hyaluronidase breakdown hyaluronic acid and help in spreading
Toxins
-Superantigens (TSST-1) induce toxic shock syndrome (TSS), usually from prolonged tampon use. Cause non-specific
activation of T-cells resulting in polyclonal T cell activation and massive cytokine release (IFN)
-Enterotoxin that is the causative of gastroenteritis that is self-limiting, characterized by vomiting and diarrhea one to six
hours after ingestion of the toxin with recovery in eight to 24 hours. Symptoms include nausea, vomiting, diarrhea, and
major abdominal pain.
-Exfoliative toxins implicated in (SSSS), which occurs most commonly in infants and young children. Protease activity of the
exfoliative toxins causes peeling of the skin observed with SSSS.
Other
-Protein A, an IgG-binding protein, binds to the Fc region of an antibody
Stratification
Strata are constructed based on values of prognostic variables and a
randomization scheme is performed separately within each stratum
Put another way:
Achieved by performing a separate randomisation procedure within each of
two or more subsets of participants
Substance Abuse Teratogens
Alcohol:
Leading cause of birth defects and mental retardation; fetal alcohol syndrome
Cocaine:
Abnormal fetal development and fetal addiction; placental abruption
Smoking:
Preterm labor, placental problems, IUGR, ADI-ID
Superficial inguinal lymph nodes
Anal canal (below pectenate line)
Scrotum
Thighs
Ends up in these lymph nodes
Supraspinatus
Abduction of the arm at the shoulder joint
-Main agonist muscle for this movement during the first 10-15 degrees of its arc
Can test:
Shoulder at 90%
Empty can (Wrists pronated)
Tanner stages
I. Childhood (9 and under)
II. Pubic hair appears; breast bud forms
III. Pubic hair darkens and becomes curly; penis size/length ; breast enlarges
IV. Penis width , darker scrotal skin, developed glans; raised areolae
V. Adult; areolae are no longer raised (14 and over)
Temporal lobe lesion Upper quadrantic anopia
Testosterone
Pre-peripubertal:
Causes growth spurt / accelerated bone maturation
Pubertal:
Completion of bone maturation / termination of growth
Transfusion associated GVH
Results from transfusion of immunocompetent T cells capable of engrafting and initiating an immune response against
recipient antigens
The most susceptible patient groups are those who are severely immunocompromised
Gamma irradiation abolishes the proliferative activity of the lymphocytes in the donor blood.
Fresh frozen plasma and cryoprecipitate do not contain viable lymphocytes and thus do not need to be irradiated
Trapezium bone
Forms the radial border of the carpel tunnel
Distal to the Scaphoid
Some might say it is in close proximity to
-Abductor pollicis longus
-Extensor pollicis brevis
That being side, is not the right answer for the question that you seek!
Treacher Collins Syndrome
1st arch neural crest fails to migrate
-Mandibular hypoplasia
-Facial abnormalities
Type I error Stating there is an effect when none exist
Type II error Stating there is not an effect when there is
one
Ubiquitin Tags proteins for destruction by
proteasome
Ureteric orifice
Placed at the postero-lateral angles of the
trigonum vesicae, and are usually slit-like
in form
Uroporphyrinogen decarboxylase
Porphyria cutanea tarda
Accumulates:
Uroporphyrin (tea colored urine)
Blistering cutaneous photosensitivity. Most common porphyria.
Valproic acid
A wide spectrum seizure medication
-1st line for tonic-clonic
Not for status epilepticus
Vitamin C
Required fro the hydroxylation of specific purine and lysine residues
-If deficient, will cause scurvy
--Inadequate hydroxylation of collagen peptides
Washed packed RBCs
RBCs washed in sterile saline to remove:
WBCs
Lytic mediators
Non-self antigens
Most useful in IgA deficient persons who have circulating anti-IgA Abs
-Use febrile, urticarial and anaphylactic reactions
Wernicke's aphasia
Fluent aphasia with impaired comprehension.
Wernicke's area-superior temporal gyrus of temporal lobe.
Wordy, but makes no sense
Whole blood
Blood that is unmodified except for the presence of an anticoagulant
Usually not used because the extra plasma can contribute to transfusion
associated circulatory overload (TACO), a potentially dangerous
complication
Wound healing
1. Inflammatory (immediate)
-Platelets, neutrophils, macrophages
2. Proliferative (2-3 days after wound)
-Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages
-Granulation tissue depostion, angiogenesis, wound contraction (mediated by myofibroblasts)
3. Remodeling (1 week after wound)
-Fibroblasts
-Type III collagen replaced by type I collagen
-ALA dehydratase
Lead poisoning
Accumulates:
Protoporphyrin, -ALA
Microcytic anemia, GI and kidney disease.
Children-exposure to lead paint -+ mental deterioration
Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination
-ALA synthase Sideroblastic anemia