*

What is the difference between leukemia and leukocytosis?

ANS:There are 2 ways of understanding this difference.
1) Firstly, one of the causes of leucocytosis could be leukemia. But there are several other less-severe
causes of leucocytosis such as infection,hemorrhage, corticosteroid treatment etc.
So, leukemia is one of the types of leucocytosis.
2) Secondly, leukemia is when large number of IMMATURE WBC's are in circulation.
In leucocytosis, the WBC's are normal and mature. This is a very important point of difference.

* Why does emphysema produce polycythemia?

Answer:When

there is inadequate ability of the lungs to absorb oxygen (due to pulmonary

conditions such as emphysema/COPD), the body compensates by producing more red blood cells (with
which to carry oxygen). Polycythemia means
"high red blood cell count"

* endemic, epidemic ,pandemic diff ?

example:The initial disease originating in New York and remaining solely among New York cab drivers is
the "endemic".
The epidemic is created when the NY cab drivers leave and spreads the disease in New Jersey.
And finally, the pandemic is when the disease travels across the US and affects ALL cab drivers.

* absence of C1 component of complement is seen as in patient

with leakage of angioneurotic enema because
fluid from blood vessels into connective tissue. Deficiency of C1-inhibitor permits plasma kallikrein
activation, which
leads to the production of the vasoactive peptide bradykinin.

cor pulmonale (Latin cor, heart + New, of the lungs) or

pulmonary Latin pulmonale heart disease
known as right sided heart failure

is enlargement of the right ventricle of the heart as a response to increased resistance

or high blood pressure in the lungs (pulmonary hypertension).

* Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include
mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss
of hormonal support, loss of nerve supply to the target organ, excessive amount of apoptosis of cells,
and disuse or lack of exercise or disease intrinsic to the tissue itself. Hormonal and nerve inputs that
maintain an organ or body part are referred to as trophic in medical practice . Trophic describes the
trophic condition of tissue. A diminished muscular trophic is designated as atrophy.

* There are five distinct morphological patterns of necrosis:

1)Coagulative necrosis is characterized by the formation of a gelatinous (gel-like) substance in
dead tissues . Coagulation occurs as a result of protein denaturation, causing the albumin in protein to
form a firm and opaque state. This pattern of necrosis is typically seen in hypoxic (low-oxygen)
environments, such as infarction. Coagulative necrosis occurs primarily in tissues such the kidney, heart
and adrenal glands. Severe ischemia most commonly causes necrosis of this form.

2)Liquefactive

necrosis (or colliquative necrosis), in contrast to coagulative necrosis, is

characterized by the digestion of dead cells to form a viscous liquid mass. This is typical of bacterial, or
sometimes fungal, infections because of their ability to stimulate an inflammatory response. The
necrotic liquid mass is frequently creamy yellow due to the presence of dead leukocytes and is
commonly known as pus. Most common in heart.

3)Caseous necrosis can be considered a combination of coagulative and liquefactive necroses,

typically caused by mycobacteria (e.g. tuberculosis), fungi and some foreign substances. The necrotic
tissue appears as white and friable, like clumped cheese. Dead cells disintegrate but are not completely
digested, leaving granular particles. Microscopic examination shows amorphous granular debris
enclosed within a distinctive inflammatory border.

4)Fat necrosis is specialized necrosis of fat tissue,resulting from the action of activated lipases on
fatty tissues such as the pancreas. In the pancreas it leads to acute pancreatitis, a condition where the
pancreatic enzymes leak out into the peritoneal cavity, and liquefy the membrane by splitting the

*
triglyceride esters into fatty acids through fat saponification. Calcium, magnesium or sodium may bind
to these lesions to produce a chalky-white substance. The calcium deposits are microscopically
distinctive and may be large enough to be visible on radiographic examinations.

5)Fibrinoid necrosis is a special form of necrosis usually caused by immune-mediated vascular

damage. It is marked by complexes of antigen and antibodies, sometimes referred to as immune
complexes deposited within arterial walls together with fibrin.

*Diff between Dystrophic and metastatic calcification

dystrophic is deposition of calcium in necrotic tissue.
metastatic is deposition of calcium in normal tissue.
Metastatic calcification, or deposition of calcium in previously normal tissue, is caused by
hypercalcemia. In this patient, tumor metastases to bone with increased osteolytic activity caused
mobilization of calcium and phosphate, resulting in hypercalcemia. Metastatic calcification should be
contrasted with dystrophic calcification, in which the serum calcium concentration is normal and
previously damaged tissues are the sites of deposition.

* Depending upon the type of dust, the disease is given

different names:
Coalworker's

pneumconiosis (also known as miner's lung, black lung or anthracosis) - coal,

carbon
Asbestosis - asbestos
Silicosis (also known as "grinder's disease" or Potter's rot) - silica (most serious type)
Bauxite fibrosis - bauxite
Berylliosis - beryllium
Siderosis - iron
Byssinosis - cotton
Silicosiderosis - mixed dust containing silica and iron
Labrador lung (found in miners in Labrador, Canada) - mixed dust containing iron, silica and
anthophyllite, a type of asbestos

* hypersensitivity types
Type
# I(Allergy (immediate)
Atopy ,Anaphylaxis ,Asthma
IgE

# II

Cytotoxic, antibody-dependent

Autoimmune hemolytic anemia

Thrombocytopenia
Erythroblastosis fetalis
Goodpasture's syndrome
Membranous nephropathy
Graves' disease
Myasthenia Gravis
IgM or IgG
(Complement)

# III

Immune complex disease

Serum sickness
Arthus reaction
Rheumatoid arthritis
Post streptococcal glomerulonephritis
Lupus Nephritis
Systemic lupus erythematosus (SLE)
Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)
IgG

*
(Complement)

# IV
Delayed-type hypersensitivity(DTH), cell-mediated immune memory response, antibodyindependent
Contact dermatitis
Mantoux test
Metal joint replacement
Chronic transplant rejection
Multiple sclerosis [4]
T-cells

* Arterial system.
-Normally arteries carry oxygenated blood and veins carry oxygen-poor blood, except for the pulmonary
circulation which is reversed.
-Arteries can be divided into three groups: 1. elastic arteries 2. muscular arteries 3. Arterioles

#(AORTA)Elastic arteries are large, thick-walled vessels near the heart, such as the aorta and its major
branches. They are the largest and most elastic. Their large-diameter lumen allows them to serve as lowresistance conduits. The elastic arteries contain more elastin than any other vessel type. The abundance
of elastin enables these arteries to withstand and smooth out large pressure fluctuations by expanding
when the heart forces blood into them, and then recoiling to propel blood onward into the circulation
when the heart relaxes. The alternating expansion and recoil of elastic arteries during each cardiac cycle
creates a pressure wave called a pulse. The arterial pulse rate reflects heart rate.

#(LARGE ARTERIES) Muscular arteries, (distributing arteries), deliver blood to specific body organs and
account for most of the named arteries. Their diameter ranges from that of a little finger to that of a
pencil lead. They have the thickest tunica media of all vessels. Their tunica media contains relatively
more smooth muscle and less elastic tissue. They are more active in vasoconstriction and are less
distensible.

#Arterioles have a lumen smaller than 0. 3 mm and are the smallest of the arterial vessels. The largest of
the arterioles exhibit all three tunics, but the tunica media is with chiefly smooth muscle with few

*
elastic fibers. Blood flow into the capillary beds is determined by alterations in arteriole diameter in
response to changing neural stimuli and local chemical influences. When arterioles constrict the tissues
served are largely bypassed. When arterioles dilate, blood flow into the local capillaries increases
dramatically.

*FORAMEN CEACUM
The dorsum of the tongue is convex and marked by a median sulcus, which divides it into symmetrical
halves; this sulcus ends behind, about 2.5 cm from the root of the organ, in a depression, the foramen
cecum (or foramen caecum), from which a shallow groove, the sulcus terminalis, runs lateral and
anterior on either side to the margin of the tongue.
The foramen cecum is the point of attachment of the thyroglossal duct and is formed during the
embryological descent of the thyroid gland.
-

FORAMEN CEACUM OF THE FRONTAL BONE TRANSMIT THE EMISSARY VEIN.

*Contents of inguinal canal :

in males : the spermatic cord and its coverings + the ilioinguinal nerve.
in females : the round ligament of the uterus + the ilioinguinal nerve.
*The classic description of the contents of spermatic cord in the male are:
3 arteries: artery to vas deferens (or ductus deferens), testicular artery, cremasteric artery;
3 fascial layers: external spermatic, cremasteric, and internal spermatic fascia;
3 other structures: pampiniform plexus, vas deferens (ductus deferens), testicular lymphatics;
3 nerves: genital branch of the genitofemoral nerve (L1/2), autonomic and visceral afferent fibres,
ilioinguinal nerve (N.B. outside spermatic cord but travels next to it)
The ilioinguinal nerve passes through the superficial ring to descend into the scrotum, but does not
formally run through the canal.

*Cytoplasmic inclusion
Inclusions are considered to be nonliving components of the cell that do not possess metabolic activity
and are not bounded by membranes. The most common inclusions are glycogen, lipid droplets, crystals
and pigments.

*Keratan sulfate (KS), also called keratosulfate,

is any of several sulfated glycosaminoglycans (structural carbohydrates) that have been found especially
in the cornea, cartilage, and bone. It is also synthesized in the central nervous system where it
participates both in development and in the glial scar formation following an injury. Keratan sulfates are
large, highly hydrated molecules which in joints can act as a cushion to absorb mechanical shock.

Reflex aftr-discharge can be explained in terms of the

properties of
que*

1.ant horn cells

2.afferent nerve fibres
3.neuro muscular junctions
4.internuncial pool circuits (ans)
5.none of above
Internuncial pool: Reflexes initiated in the spinal cord are spread via the interconnecting pool of
neurons.

*Tetrahydrofolic acid (B9

It is a coenzyme in many reactions, especially in the metabolism of amino acids and nucleic acids. It acts
as a donor of a group with (one carbon atom.) It gets this carbon atom by sequestering formaldehyde
produced in other processes. A shortage in THF can cause megaloblastic anemia.

*temperature regulating mechanisms:

The temperature of the body is regulated by neural feedback mechanisms which operate primarily
through the hypothalmus. The hypothalmus contains not only the control mechanisms, but also the key
temperature sensors. Under control of these mechanisms, sweating begins almost precisely at a skin
temperature of 37C and increases rapidly as the skin temperature rises above this value. The heat
production of the body under these conditions remains almost constant as the skin temperature rises.
-If the skin temperature drops below 37C a variety of responses are initiated to conserve the heat in the
body and to increase heat production. These include:
-Vasoconstriction to decrease the flow of heat to the skin.
-Cessation of sweating.
-Shivering to increase heat production in the muscles.
-Secretion of norepinephrine, epinephrine, and thyroxine to increase heat production
-In lower animals, the erection of the hairs and fur to increase insulation.

DIFF BETWEEN GRANULATION TISSUE AND GRANULOMA:*Granulation tissue is new connective tissue and tiny blood vessels that form on the surfaces of a
wound during the healing process. Granulation tissue typically grows from the base of a wound and is
able to fill wounds of almost any size it heals.
Granulation tissue is composed of tissue matrix supporting a variety of cell types:
-Fibroblasts
-capillary buds
-endothelial cells
Newly formed collagen
An excess of granulation tissue (caro luxurians) is informally referred to as "proud flesh

*Granuloma (plural granulomas or granulomata) is an inflammation found in many diseases. It is a

collection of immune cells known as macrophages. Granulomas form when the immune system
attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances
include infectious organisms such as bacteria and fungi as well as other materials such as keratin and
suture fragments.
-All granulomas, regardless of cause, may contain additional cells and matrix. These include
lymphocytes, neutrophils, eosinophils, multinucleated giant cells, plasma cells. The additional cells are
sometimes a clue to the cause of the granuloma. For example, granulomas with numerous eosinophils
may be a clue to coccidioidomycosis or allergic bronchopulmonary fungal disease, and granulomas with
numerous neutrophils suggest blastomycosis, Wegener's granulomatosis, aspiration pneumonia or catscratch disease.

*PULMONARY ATELECTESIS:
-Atelectasis is defined as the collapse or closure of the lung resulting in reduced or absent gas exchange.
It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from
pulmonary consolidation.

*THYMIC HYPOPLASIA (di George's syndrome)

A developmental failure of the thymus and parathyroid leading to an absence of *T cells and defective
cell-mediated immunity. ...

*ASCENDING INFECTION:

*
When harmful bacteria enter the bladder and cause a bladder infection, these germs can ascend up
the ureters and infect the kidney. In pregnant women, ascending infection almost always affects the
right kidney.

*What is Bennett movements in teeth?

Answer:
the movement of mandible toward lateral causes movement in both right and left condyles. For
example, if one moves one's mandible (lower jaw) toward right, the right conlye moves laterally and the
left goes downward, forward, and medially, so the left condyle is defined as nonworking and the right
condyle as working. the movement of nonworking condyle,in this example left condyle, forms an angle
between sagittal plan and direction of nonworking condyle, which is called Bennett angle.

. Non-working side: goes downward, forward and medially

Working side:moves laterally (generally rotates about a vertical axis and translates laterally.) Arrows
point posteriorly.

*BIOTIN(B7)
In humans, biotin is involved in important metabolic pathway such as gluconeogenesis, fatty acid
synthesis, and amino acid catabolism. Biotin regulates the catabolic enzyme propionyl-CoA carboxylase
at the posttranscriptional level whereas the holo-carboxylase synthetase is regulated at the
transcriptional level.

Biotin functions as a cofactor that aids in the transfer of CO2 groups to various target macromolecules.
Biotin has nine host enzymes with which it is associated. Humans only have four of these enzymes:

-Pyruvate carboxylase (formation of oxaloacetate from pyruvate)

-beta-Methylcrotonyl-CoA carboxylase
-Propionyl-CoA carboxylase (conversion of propionyl-CoA to succinyl-CoA)
-Acetyl-CoA carboxylase (carboxylation of acetyl-CoA to malonyl-CoA)
Biotin's other target enzymes include Steptividin, Avidin, homocitrate synthetase, and isopropylmalate
synthase.

*Serum albumin
-Serum albumin is the most abundant blood plasma protein and is produced in the liver and forms a
large proportion of all plasma protein. The human version is human serum albumin, and it normally
constitutes about 50% of human plasma protein.
-Serum albumins are important in regulating blood volume by maintaining the oncotic pressure (also
known as colloid osmotic pressure) of the blood compartment.They also serve as carriers for molecules
of low water solubility this way isolating their hydrophobic nature, including lipid soluble hormones, bile
salts, unconjugated bilirubin, free fatty acids (apoprotein), calcium, ions (transferrin), and some drugs
like warfarin, phenobutazone, clofibrate & phenytoin. For this reason, it's sometimes referred as a
molecular "taxi". Competition between drugs for albumin binding sites may cause drug interaction by
increasing the free fraction of one of the drugs, thereby affecting potency.
-Low albumin (hypoalbuminemia) may be caused by liver disease, nephrotic syndrome, burns, proteinlosing enteropathy, malabsorption, malnutrition, late pregnancy, artefact, genetic variations and
malignancy.
-High albumin (hyperalbuminemia) is almost always caused by dehydration. In some cases of retinol
(Vitamin A) deficiency the albumin level can be elevated to high-normal values (e.g., 4.9 g/dL). This is
because retinol causes cells to swell with water (this is also the reason too much Vitamin A is toxic). In
lab experiments it has been shown that All-trans retinoic acid down regulates human albumin
production
Normal range of human serum albumin in adults (> 3 y.o.) is 3.5 to 5 g/dL. For children less than three
years of age, the normal range is broader, 2.9-5.5 g/dL.
Albumin binds to the cell surface receptor Albondin.

DIABETES AND POLYURIA:

Diabetes comes from the Greek word which means siphon. There are two distinct disorders that share
the first name diabetes: diabetes mellitus and diabetes insipidus. This is because both disorders cause
polyuria, or excessive urine output. Diabetes insipidus is a disorder of urine concentration.

Diabetes mellitus is a disorder of blood glucose regulation, which results from a deficiency in the action
of the hormone insulin. This may be due to autoimmune destruction of the insulin-secreting cells of the
pancreas (type 1 diabetes mellitus) or it may result from a problem in the responsiveness of tissues to
insulin, known as insulin resitance (type 2 diabetes mellitus). With either disorder, the result is
hyperglycemia, or high levels of glucose in the plasma.

How does hyperglycemia cause excessive urine production? To answer this, we need to understand a
little bit about how the kidney works. Each kidney contains about a million functional units called

*
nephrons . The first step in the production of urine is a process called filtration . In filtration, there is
bulk flow of water and small molecules from the plasma into Bowmans capsule (the first part of the
nephron). Because of the nonspecific nature of filtration, useful small molecules such as glucose, amino
acids, and certain ions end up in the forming urine, which flows into the kidney tubules. To prevent the
loss of these useful substances from the body, the cells lining the kidney tubules transfer these
substances out of the forming urine and back into the extracellular fluid. This process is known as
reabsorption .

Under normal circumstances, 100% of the glucose that is filtered is reabsorbed. Glucose reabsorption
involves transport proteins that require specific binding. In a diabetic that has hyperglycemia, the
filtered load of glucose (amount of glucose filtered) can exceed the capacity of the kidney tubules to
reabsorb glucose, because the transport proteins become saturated. The result is glucose in the urine.
Glucose is a solute that draws water into the urine by osmosis. Thus, hyperglycemia causes a diabetic to
produce a high volume of glucose-containing urine.

*HEART FAILURE CELLS

-Heart failure cells are siderophages (hemosiderin-containing macrophages) generated in the alveoli of
patients with left heart failure or chronic pulmonary edema, when the high pulmonary blood pressure
causes red cells to pass through the vascular wall. Siderophages are not specific of heart failure. They
are present wherever red blood cells encounter macrophages.

*MILIARY TUBERCULOSIS:
-Miliary tuberculosis is characterized by a chronic, contagious bacterial infection caused by
Mycobacterium tuberculosis that has spread to other organs of the body by the blood or lymph system.

*GRAFT VERSUS HOST REACTION:

-Graft-versus-host disease (GVHD) is a complication that can occur after a stem cell or bone marrow
transplant in which the newly transplanted donor cells attack the transplant recipient's body.
-CAUSES:
GVHD may occur after a bone marrow or stem cell transplant in which someone receives bone marrow
tissue or cells from a donor (called an allogeneic transplant). The new, transplanted cells regard the
recipient's body as foreign. When this happens, the newly transplanted cells attack the recipient's body.
GVHD does not occur when someone receives his or her own cells during a transplant (called an
autologous transplant).

*
Before a transplant, tissue and cells from possible donors are checked to see how closely they match the
person having the transplant. GVHD is less likely to occur, or symptoms will be milder, when the match
is close. The chance of GVHD is:
Very low when a person receives bone marrow or cells from an identical twin
Around 30 - 40% when the donor and recipient are related
Around 60 - 80% when the donor and recipient are not related

*IMPETIGO:
-Impetigo is a highly contagious bacterial skin infection most common among pre-school children.
People who play close contact sports such as rugby, American football and wrestling are also
susceptible, regardless of age. Impetigo is not as common in adults
-It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes. According
to the American Academy of Family Physicians, both bullous and nonbullous are primarily caused by
Staphylococcus aureus, with Streptococcus also commonly being involved in the nonbullous form

*PEPTIC ULCER:
-A peptic ulcer, also known as peptic ulcer disease (PUD),is the most common ulcer of an area of the
gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions
equal to or greater than 0.5 cm.
- Ulcers can also be caused or worsened by drugs such as aspirin, ibuprofen, and other NSAIDs.
-Four times as many peptic ulcers arise in the duodenumthe first part of the small intestine, just after
the stomachas in the stomach itself. About 4% of gastric ulcers are caused by a malignant tumor, so
multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign.
-A major causative factor (60% of gastric and up to 90% of duodenal ulcers) is chronic inflammation due
to Helicobacter pylori that colonizes the antral mucosa.

*CELLULAR IMMUNITY VS HUMORAL IMMUNITY:

-In humoral immunity, T helper 2 cells activate B cells which in turn activate immunoglobulins. In cellmediated, T helper 1 cells activate cytotoxic T cells and macrophages. Basically humoral is extracellular
and cell-mediated is intracellular.

*BROAD SPECTRUM ANTIBIOTICS:

*
-The term broad-spectrum antibiotic refers to an antibiotic that acts against a wide range of diseasecausing bacteria. A broad-spectrum antibiotic acts against both Gram-positive and Gram-negative
bacteria, in contrast to a narrow-spectrum antibiotic, which is effective against specific families of
bacteria. An example of a commonly used broad-spectrum antibiotic is ampicillin.
-EXAMPLES:
In medicine:
Amoxicillin
Imipenem
Levofloxacin, gatifloxacin, moxifloxacin, Ciprofloxacin

Others:
Streptomycin
Tetracycline
Chloramphenicol
Slightly broad:
Ampicillin.

*CARDIAC TEMPONADE:
-Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space
between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).
-most likely to cause a sudden arrest of heart function.

*SUBSTANTIA GELATINOSA:
-The substantia gelatinosa is one point (the nucleus proprius being the other) where first order neurons
of the spinothalamic tract synapse.
C fibers terminate at this layer. Thus the cell bodies located here are part of the neural pathway
conveying slowly conducting, poorly localized pain sensation. However, some A delta fibers (carrying
fast, localized pain sensation) also terminate in the substantia gelatinosa, mostly via axons passing
through the area of the nucleus proprius. Thus, THIS IS THE GATE CONTROLLER IN THE PAIN GATE
THEORY.

*PEYER'S PATCHES:
-Peyer's patches (or aggregated lymphoid nodules) are organized lymphoid nodules. They are
aggregations lymphoid tissue of that are usually found in the lowest portion of the small intestine, the
ileum, in humans; as such, they differentiate the ileum from the duodenum and jejunum. The
duodenum can be identified by Brunner's glands. The jejunum has neither Brunner's glands nor Peyer's
Patches.
-Peyer's patches are observable as elongated thickenings of the intestinal epithelium measuring a few
centimeters in length. About 30 are found in humans. Microscopically, Peyers patches appear as oval or
round lymphoid follicles (similar to lymph nodes) located in the lamina propria layer of the mucosa and
extending into the submucosa of the ileum. Non capsulated.
In adults, B lymphocytes are seen to predominate in the follicles' germinal centers. T lymphocytes are
found in the zones between follicles.

*PHARYNGEAL TONSILS(ADENOIDS):
-The adenoid, also known as a pharyngeal tonsil or nasopharyngeal tonsil, is a mass of lymphatic tissue
situated posterior to the nasal cavity, in the roof of the nasopharynx, where the nose blends into the
throat. Normally, in children, it forms a soft mound in the roof and posterior wall of the nasopharynx,
just above and behind the uvula.
-The adenoid, unlike other types of tonsils, has pseudostratified columnar ciliated epithelium. It also
differs from the other tonsil types by lacking crypts.(HAS NO LYMPH SINUSES & IS PARTLY SURROUNDED
BY CONNECTIVE TISSUE & PARTLY BY EPITHELIUM & LATTER FORMING DEEP INFOLDINGS) .The adenoid
is often removed along with the palatine tonsils.

*TRANSITIONAL EPITHELIUM:
-Transitional epithelium (also known as urothelium) is a type of tissue consisting of multiple layers of
epithelial cells which can contract and expand. These cells, part of the epithelium, are found in the
urinary bladder, in the ureters, and in the superior urethra and gland ducts of the prostate. IN RELAXED
STATE TRANSITIONAL EPITHELIUM CAN BE DISTINGUISED FROM THE STRATIFIED SQUAMOUS
EPITHELIUM BECUASE TRANSITIONAL EPITHELIUM CONTAINS DOME SHAPED SUPERFICIAL
CELLS.(CUBOIDAL)

*POSTERIOR CRICOARETYNOID MUSCLE funNCTION:

*
-The posterior arytenoids are called safety muscle because paralysis of the posterior cricoarytenoid
muscles may lead to asphyxiation as they are the only laryngeal muscles to open the true vocal folds,
allowing inspiration and expiration.

*DIFF BETWEEN THICK SKIN & THIN SKIN:

-Thick skin ( contains five layers: startum basala, spinosum, granulosum, lucidum and corneum)
It has prominent stratum corneum and well- developed stratum granulosum. In addition ,it has
additional epidermal layer which is named as stratum lucidum. On the top of this ,thick layer lacks
integumentary appendages: hair follicles, sebaceous glands and arrector pili muscles. Generally, thick
skin is located to those aeas subjected to wear and tear and mainly on the palms of the hand and soles
of the feet.

-Thin skin ( contains only four layers: startum basala, spinosum, granulosum, and corneum)
It has less prominent stratum corneum than thick skin and less developed stratum granulosum. But, it is
without clear epidermal layer, stratum lucidum. Unlike the thick skin, thin skin has hair follicles,
sebaceous glands and arrector pili muscles . Such type of skin is dominant and lines most of the body
surface.

*CYCLIC DNA OR CIRCULAR DNA:

-Circular DNA is a form of DNA that is found in viruses, bacteria and archaea as well as in eukaryotic cells
in the form of either mitochondrial DNA or plastid DNA.
While the individual strands of a linear double helix represent two distinct and separable molecules, this
need not be true for circular DNA.

*STRIATED DUCT OF SALIVARY GLANDS:

-A striated duct is a gland duct which connects an intercalated duct to an interlobular duct. It is
characterized by the basal infoldings of its plasma membrane, characteristic of ion-pumping activity by
the numerous mitochondria. Along with the intercalated ducts, they function to modify salivary fluid by
secreting HCO3- and K+ and reabsorbing Na+ and Cl- using the Na-K pump and the Cl-HCO3 pump.
-Their epithelium can be simple cuboidal or simple columnar
-Striated ducts are part of the intralobular ducts.

*
-They are found in the submandibular gland and the parotid gland.
-They are not present in pancreas.

*INTERLOBULAR DUCTS:
-An intralobular duct is the portion of an exocrine gland inside a lobule, leading directly from acinus to
interlobular duct. It is composed of two subdivisions, the intercalated duct and the striated duct.
-In the human mammary gland, the intralobular duct is a part of the glandular system that resides within
the lobules. Lobules contain clusters of ducts whose secretory alveolies are drained by the intralobular
duct. The intralobular ducts are usually lined with simple cuboidal epithelial cells that are lined by
myoepithelial cells as well.
-The intralobular ducts of the lobules drain into the interlobular ducts between lobules.
-They can be seen in:
pancreas
salivary glands

*INTERCALATED DUCTS:
-The intercalated duct, also called intercalary duct, is the portion of an exocrine gland leading directly
from the acinus to a striated duct. The intercalated duct forms part of the intralobular duct. This duct
has the thinnest epithelium of any part of the duct system, and the epithelium is usually classified as
"low" simple cuboidal.
-They are found in both the pancrea and in salivary glands.

*HEART SOUNDS( S1 & S2):

-In healthy adults, there are two normal heart sounds often described as a lub and a dub (or dup), that
occur in sequence with each heartbeat. These are the first heart sound (S1) and second heart sound
(S2), produced by the closing of the AV valves and semilunar valves, respectively
-S1 :The first heart tone, or S1, forms the "LUB" of "lub-dub" . It is caused by the sudden block of
reverse blood of the flow due to closure atrioventricular valves, i.e. tricuspid and mitral (bicuspid), at the
beginning of ventricular contraction, or systole. When the ventricles begin to contract, so do the
papillary muscles in each ventricle. The papillary muscles are attached to the tricuspid and mitral valves
via chordae tendineae, which bring the cusps or leaflets of the valve closed; the chordae tendineae also
prevent the valves from blowing into the atria as ventricular pressure rises due to contraction. The
closing of the inlet valves prevents regurgitation of blood from the ventricles back into the atria. The S1
sound results from reverberation within the blood associated with the sudden block of flow reversal by
the valves.

*
-S2 :The second heart tone, or S2, forms the "DUB" of "lub-dub" . It is caused by the sudden block of
reversing blood flow due to closure of the semilunar valves (the aortic valve and pulmonary valve) at the
end of ventricular systole and the beginning of ventricular diastole. As the left ventricle empties, its
pressure falls below the pressure in the aorta. Aortic blood flow quickly reverses back toward the left
ventricle, catching the pocket-like cusps of the aortic valve, and is stopped by aortic valve closure.
Similarly, as the pressure in the right ventricle falls below the pressure in the pulmonary artery, the
pulmonary valve closes. The S2 sound results from reverberation within the blood associated with the `
-Splitting of S2, also known as physiological split, normally occurs during inspiration because the
decrease in intrathoracic pressure increases the time needed for pulmonary pressure to exceed that of
the right ventricular pressure. A widely split S2 can be associated with several different cardiovascular
conditions, including right bundle branch block, pulmonary stenosis, and atrial septal defect.

*RECIPROCAL INHIBITION : when stretch reflex stimulates the stretched muscle to contract ,
antagonistic muscles ( tendon reflex) that oppose the contraction are inhibited. This occurrence is called reciprocal
inhibition and the neuronal mechanism that causes this reciprocal relationship is called reciprocal innervation.
* TWO TYPE

MUSCLE FIBERS:

1) EXTRAFUSAL FIBER : ( skeletal muscle)

* fibers that make up the bulk of the muscle
* Innervated by alpha motor neurons( efferent neuron)
* Provide the force of muscle contraction

2) INTRAFUSAL FIBER ( muscle spindle)

* Are encapsulated in sheaths to form muscle spindles
* Innervated by gamma motor neurons( efferents neurons)

TWO TYPE OF INRTAFUSAL FIBER

1. Nuclear bag fibers

*detect fast, dynamic changes in muscle length and tension
* innervated by group Ia afferents fastest in the body
2. Nuclear chain fibers
*detect static changes in muscle length and tension
*innervated by the slower group II afferents as well as the group Ia afferents
(muscle spindles sense muscle length.
golgi tendon organs sense muscle tension

( *MUSCLE TONE IS FINE- TUNED BY TWO SENSORY ORGAN:

1) MUSCLE SPINDLE: ( MEASURE MUSCLE LENGTH) -3 COMPONENTS:

*
1. Specialized muscle fibers: intrafusal fibers
2. Sensory terminalis: group Ia and II afferents
3. Motor terminalis: gamma motor ( efferents) neurons.
Activate the alpha motor neuron when stretched.
2) GOLGI TENDON ORGAN ( MEASURE MUSCLE TENSION) : innervated by single group Ib sensory (
afferent) fiber.
Inhibits alpha motor neuron.
* motor neuron ( efferent) can be further classified as alpha & gamma motor neurons. Alpha motor
neurons innervate and stimulate skeletal muscle. Gamma motor neuron innervate the muscle spindle.
*finer the movement required , the greater the number of muscle spindles in muscle.)
*MOST REFLEXES HAVE SIX BASIC ELEMENTS (reflex arc):
A receptor, sensory (afferent) neuron, integration center (CNS) , interneuron, motor (efferent) neuron &
effector ( muscle)

*GASTRIC MOTILITY:
-Segmentation contractions (or movements) are a type of gastric motility.
- Unlike, peristalsis ( propulsive movement) which predominates in the esophagus, segmentation
contractions occur in the large intestine and small intestine, while predominating in the latter.
-While peristalsis involves one-way motion in the caudal direction, segmentation contractions move
chyme in both directions, which allows greater mixing with the secretions of the intestines.
-Segmentation involves contractions of the circular muscles in the digestive tract, while peristalsis
involves rhythmic contractions of the longitudinal muscles in the GI tract. Unlike peristalsis,
segmentation actually can slow progression of chyme through the system.

*RQ (RESPIRATORY QUOTIENT) OR RESPIRATORY COEFFICIENT:

-The respiratory quotient (or RQ or respiratory coefficient), is a dimensionless number used in
calculations of basal metabolic rate (BMR) when estimated from carbon dioxide production. Such
measurements, like measurements of oxygen uptake, are forms of indirect calorimetry. It is measured
using Ganong's Respirometer.
-The respiratory quotient (RQ) is calculated from the ratio:
RQ = CO2 eliminated / O2 consumed
-where the term "eliminated" refers to carbon dioxide (CO2) removed ("eliminated") from the body.

*
In this calculation, the CO2 and O2 must be given in the same units, and in quantities proportional to the
number of molecules. Acceptable inputs would be either moles, or else volumes of gas at standard
temperature and pressure (time units may be included, but they cancel out since they must be the same
in numerator and denominator).

*OSMOTIC DIURESIS:
-Osmotic diuresis is increased urination caused by the presence of certain substances in the small tubes
of the kidneys. The excretion occurs when substances such as glucose enter the kidney tubules and
cannot be reabsorbed (due to a pathological state or the normal nature of the substance). The
substances cause an increase in the osmotic pressure within the tubule, causing retention of water
within the lumen, and thus reduces the reabsorption of water, increasing urine output (i.e. diuresis). The
same effect can be seen in therapeutics such as mannitol, which is used to increase urine output and
decrease extracellular fluid volume.
-Substances in the circulation can also increase the amount of circulating fluid by increasing the
osmolarity of the blood. This has the effect of pulling water from the interstitial space, making more
water available in the blood and causing the kidney to compensate by removing it as urine. In
hypotension, often colloids are used intravenously to increase circulating volume in themselves, but as
they exert a certain amount of osmotic pressure, water is therefore also moved, further increasing
circulating volume. As blood pressure increases, the kidney removes the excess fluid as urine.
Sodium, chloride, potassium are excreted in Osmotic diuresis, originating from Diabetes Mellitus (DM).
Osmotic diuresis results in dehydration from polyuria and the classic polydipsia (excessive thirst)

*PHARYNX & LARYNX NERVE SUPPLY:

The STYLOPHARYNGEUS MUSCLE receives its motor innervation from the GLOSSOPHARYNGEAL NERVE
(TX) Note that this is the ONLY muscle innervated by this nerve.

Most of the muscles of the larynx receive their innervation via the RECURRENT LARYNGEAL BRANCH of
the inferior laryngeal nerve .

Exception: The CRICOTHYROID MUSCLE, which receives its innervation via the EXTERNAL LARYNGEAL
NERVE of superior laryngeal nerve.
Larynx: via branches of the VAGUS NERVE . Above the vocal folds the sensory innervation of the larynx
is via the INTERNAL LARYNGEAL NERVE. Below the vocal folds it is by way of branches of the RECURRENT
LARYNGEAL NERVE.

*
PARASYMPATHETIC INNERVATION OF THE LARYNX AND PHARYNX is mainly by way of branches of the
vagus nerve.

*What Is Sickle Cell Trait?

This trait occurs when a person gets a gene for hemoglobin A from one parent and a gene for
hemoglobin S from the other parent. They have enough hemoglobin A for red blood cells to function
normally. This is nota disease. Other common hemoglobin traits are AD (D trait), AC (C trait) and beta
thalassemia trait. There are also other less common traits. Have no cliniacal dz symptoms

*What Is Sickle Cell Disease?

This disease occurs when a person gets one gene for sickle (S) hemoglobin from one parent and a sickle
(S), C, D, E or beta thalassemia gene from the other parent. This disease can cause serious long term
health problem.

*STEATORRHEA:
-Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may also float due to excess
lipid, have an oily appearance and be especially foul-smelling.[citation needed] An oily anal leakage or
some level of fecal incontinence may occur. There is increased fat excretion, which can be measured by
determining the fecal fat level. The definition of how much fecal fat constitutes steatorrhea has not
been standardized.

*DIFF BETWEEN BACTEREMIA , SEPTICEMIA & SEPSIS:

-Bacteremia
Bacteremia is an invasion of the bloodstream by bacteria. Occurs when bacteria enter the bloodstream.
This may occur through a wound or infection, or through a surgical procedure or injection. Bacteremia
may cause no symptoms and resolve without treatment, or it may produce fever and other symptoms of
infection. In some cases, bacteremia leads to septic shock, a potentially life-threatening condition.

-Septicemia
Septicemia is the presence of bacteria in the blood (bacteremia) and is often associated with severe
disease.Its alternative name is blood poisoning (bacteremia with sepsis).Septicemia is a serious, lifethreatening infection that gets worse very quickly. It can arise from infections throughout the body,

*
including infections in the lungs, abdomen, and urinary tract. It may come before or at the same time as
infections of the bone (osteomyelitis), central nervous system (meningitis), or other tissues.

-Sepsis
Sepsis is a severe illness caused by overwhelming infection of the bloodstream by toxin-producing
bacteria.Its alternative name Systemic inflammatory response syndrome (SIRS).
Sepsis is caused by bacterial infection that can originate anywhere in the body. Common sites include
the following:
The kidneys (upper urinary tract infection)
The liver or the gall bladder
The bowel (usually seen with peritonitis)
The skin (cellulitis)
The lungs (bacterial pneumonia)
The infection is often confirmed by a positive blood culture, though blood cultures may be negative in
individuals who have been receiving antibiotics. In sepsis, blood pressure drops, resulting in shock.
Major organs and systems, including the kidneys, liver, lungs, and central nervous system, stop
functioning normally.

So if bacteremia sometimes don't need medical attention , septicemia and sepsis requires it. Sepsis is
often life-threatening, especially in people with a weakened immune system or other medical illnesses.

*WOUND HEALING TYPES:

-PRIMARY INTENSION:
involves epidermis and dermis without total penetration of dermis healing by process of epithelialization
When wound edges are brought together so that they are adjacent to each other (re-approximated)
Minimizes scarring
Most surgical wounds heal by primary intention healing
Wound closure is performed with sutures (stitches), staples, or adhesive tape
Examples: well-repaired lacerations, well reduced bone fractures, healing after flap surgery
-SECONDARY INTENSION:
The wound is allowed to granulate

*
Surgeon may pack the wound with a gauze or use a drainage system
Granulation results in a broader scar
Healing process can be slow due to presence of drainage from infection
Wound care must be performed daily to encourage wound debris removal to allow for granulation
tissue formation
Examples: gingivectomy, gingivoplasty, tooth extraction sockets, poorly reduced fractures.
-TERTIARY INTENSION:
(Delayed primary closure or secondary suture):
The wound is initially cleaned, debrided and observed, typically 4 or 5 days before closure.
The wound is purposely left open
Examples: healing of wounds by use of tissue grafts.

If the wound edges are not reapproximated immediately, delayed primary wound healing transpires.
This type of healing may be desired in the case of contaminated wounds. By the fourth day,
phagocytosis of contaminated tissues is well underway, and the processes of epithelization, collagen
deposition, and maturation are occurring. Foreign materials are walled off by macrophages that may
metamorphose into epithelioid cells, which are encircled by mononuclear leukocytes, forming
granulomas. Usually the wound is closed surgically at this juncture, and if the "cleansing" of the wound
is incomplete, chronic inflammation can ensue, resulting in prominent scarring.

*ASCHOFF BODY:
-Aschoff bodies are nodules found in the hearts of individuals with rheumatic fever. They result from
inflammation in the heart muscle and are characteristic of rheumatic heart disease.

*CHROMOSOMAL ABNORMALITIES:
-Turner syndrome results from a single X chromosome ( 45 ,X0).
-Klinefelter syndrome, the most common male chromosomal disease, otherwise known as 47, XXY is
caused by an extra X chromosome.
-Edwards syndrome is caused by trisomy (three copies) of chromosome 18.
-Down syndrome, a common chromosomal disease, is caused by trisomy of chromosome 21.
-Patau syndrome is caused by trisomy of chromosome 13.

-A karyotype (Greek karyon = kernel, seed or nucleus) is the number and appearance of chromosomes in
the nucleus of a eukaryotic cell. The term is also used for the complete set of chromosomes in a species,
or an individual organism.
*

PURKINJE is a name attributed to several biological features, so named for their discovery by

Czech anatomist Jan Evangelista Purkyne:

Purkinje cells, located in the cerebellum
Purkinje fibers, located in the heart
The visual Purkinje effect
Purkinje images, reflections of objects from the surface of the cornea, and from the anterior and
posterior surfaces of the lens

*PULMONARY AV SHUNT:
-A pulmonary shunt is a physiological condition which results when the alveoli of the lungs are perfused
with blood as normal, but ventilation (the supply of air) fails to supply the perfused region. In other
words, the ventilation/perfusion ratio (the ratio of air reaching the alveoli to blood perfusing them) is
zero. A pulmonary shunt often occurs when the alveoli fill with fluid, causing parts of the lung to be
unventilated although they are still perfused.
-Intrapulmonary shunting is the main cause of hypoxemia (inadequate blood oxygen) in pulmonary
edema and conditions such as pneumonia in which the lungs become consolidated. The shunt fraction is
the percentage of blood put out by the heart that is not completely oxygenated.

*ALBINISM:
-Albinism is a congenital disorder characterized by the complete or partial absence of pigment in the
skin, hair and eyes due to absence or defect of TYROSINASE, a copper-containing enzyme involved in the
production of melanin. Albinism results from inheritance of recessive gene alleles and is known to affect
all vertebrates, including humans. While an organism with complete absence of melanin is called an
albino an organism with only a diminished amount of melanin is described as albinoid.

*ATRIAL NATRIURETIC HORMONE:

-Atrial natriuretic peptide (ANP), atrial natriuretic factor (ANF), atrial natriuretic hormone (ANH),
Cardionatrine, Cardiodilatine (CDD) or atriopeptin, is a powerful vasodilator, and a protein (polypeptide)
hormone secreted by heart muscle cells. It is involved in the homeostatic control of body water, sodium,
potassium and fat (adipose tissue). It is released by muscle cells in the upper chambers (atria) of the

*
heart (atrial myocytes) in response to high blood pressure. ANP acts to reduce the water, sodium and
adipose loads on the circulatory system, thereby reducing blood pressure. ANP has exactly the opposite
function of the aldosterone secreted by the zona glomerulosa.

*EPINEPHRINE:
-Epinephrine (also known as adrenaline or adrenalin) is a hormone and a neurotransmitter.Epinephrine
has many functions in the body, regulating heart rate, blood vessel and air passage diameters, and
metabolic shifts; epinephrine release is a crucial component of the fight-or-flight response of the
sympathetic nervous system. In chemical terms, epinephrine is one of a group of monoamines called the
catecholamines. It is produced in some neurons of the central nervous system, and in the chromaffin
cells of the adrenal medulla from the amino acids phenylalanine and tyrosine. Monoamine oxidase
inhibit the catecholamines ( epinephrine & norepinephrine)

*ENTROPY:
-Entropy is a measure of the number of specific ways in which a system may be arranged, often taken to
be a measure of disorder, or a measure of progressing towards thermodynamic equilibrium. The
entropy of an isolated system never decreases, because isolated systems spontaneously evolve towards
thermodynamic equilibrium, which is the state of maximum entropy.

*OSMOTIC PRESSURE:
-The osmotic pressure of 0.1 Molarity NaCl will be greater than 0.1 Glucose because
Osmotic pressue is a colligative property and the value depends on the number of particles in solution
the NaCl solution has two particles in solution - Na+ and Cl-. The glucose does not dissociate and has one
particle.

*ISOELECTRIC POINT:
-The isoelectric point (pI), sometimes abbreviated to IEP, is the pH at which a particular molecule or
surface carries no net electrical charge.
-Amphoteric molecules called zwitterions contain both positive and negative charges depending on the
functional groups present in the molecule. The net charge on the molecule is affected by pH of its
surrounding environment and can become more positively or negatively charged due to the gain or loss,
respectively, of protons (H+). The pI is the pH value at which the molecule carries no electrical charge or
the negative and positive charges are equal.
-The pH of an electrophoretic gel is determined by the buffer used for that gel. If the pH of the buffer is
above the pI of the protein being run, the protein will migrate to the positive pole (negative charge is
attracted to a positive pole). If the pH of the buffer is below the pI of the protein being run, the protein
will migrate to the negative pole of the gel (positive charge is attracted to the negative pole). If the

*
protein is run with a buffer pH that is equal to the pI, it will not migrate at all. This is also true for
individual amino acids.
-The pI value can affect the solubility of a molecule at a given pH. Such molecules have minimum
solubility in water or salt solutions at the pH that corresponds to their pI and often precipitate out of
solution. Biological amphoteric molecules such as proteins contain both acidic and basic functional
groups. Amino acids that make up proteins may be positive, negative, neutral, or polar in nature, and
together give a protein its overall charge. At a pH below their pI, proteins carry a net positive charge;
above their pI they carry a net negative charge

COUPLED RESPIRATION:
-Coupled respiration drives oxidative phosphorylation of ADP to ATP mediated by proton pumps across
the inner mitochondrial membrane. Uncoupled respiration, in contrast, does not lead to
phosphorylation of ADP, despite of protons being pumped across the inner mt-membrane. Coupled
respiration, therefore, is the coupled part of respiratory oxygen flux that pumps the fraction of protons
across the inner mt-membrane which is utilized by the phosphorylation system to produce ATP from
ADP and Pi.

KELOID:
A keloid is the formation that a type of scar . It is a result of an overgrowth of granulation tissue at the
site of a healed skin injury .. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from
pink to flesh-coloured or red to dark brown in colour. A keloid scar is benign and not contagious, but
sometimes accompanied by severe itchiness, pain,and changes in texture. In severe cases, it can affect
movement of skin.
Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond
the boundaries of the original wound.

LINGUAL NERVE:-The lingual nerve is a branch of the mandibular division of the trigeminal
nerve (CN V3), which supplies sensory innervation to the tongue. It also carries fibers from the facial
nerve, which return taste information from the anterior two thirds of the tongue.

PARAFOLLICULAR CELL:
-Thyroid follicles consist of a layer of simple epithelium surrounding a gel-like
pinkish material called colloid.

-The principal cell is the most numerous cell present in the simple epithelial layer
and is responsible for secreting the thyroid hormones as well as thyroglobulin, a
glycoprotein.
Thyroid hormones are stored extracellularly as part of the thyroglobulin which is
the main component of the colloid.
-In addition to principal cells there is another type of functional cell in the thyroid
gland. This is the parafollicular cell which may be found as single cells in the
epithelial lining of the follicle or in groups in the connective tissue between
follicles. . They are called parafollicular cells based on their location and clear
cells (C cells) based on their appearance of their cytoplasm.
-Parafollicular cells secrete calcitonin, a hormone that lowers the level of calcium
in the blood.

*Parasympathetic innervation contolling salivation originates

with vii & ix cranial nerve..
*DESMOSOMES:
- Serving as a means for attachment of adjacent cell.
A desmosome , also known as macula adherens is a cell structure specialized for cell-to-cell adhesion.
A type of junctional complex, they are localized spot-like adhesions randomly arranged on the lateral
sides of plasma membranes.
Desmosomes help to resist shearing forces and are found in simple and stratified squamous epithelium.
The intercellular space is very wide (about 30 nm). Desmosomes are also found in muscle tissue where
they bind muscle cells to one another.

TENDONS:
-A tendon (or sinew)

is

tough

band

of fibrous

connective

tissue that

usually

connects muscle to bone and

is
capable
of
withstanding tension.
Tendons
are
similar
to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another
bone, and fasciae connect muscles to other muscles. Tendons and muscles work together to move
bones.

-Histologically, tendons consist

of dense regular connective tissue fascicles encased

in dense irregular connective tissue sheaths. Normal healthy tendons

of parallel arrays of collagen fibers closely packed together

are composed mostly

*SIMPLE EPITHELIA :
Sqamous
Function: barrier, flood exchange, lubrication, transepithelial transport.

Mesothelium

Location: lining body

capsule (kidney).

cavities

(thoracic,

pericardial,

abdominal), Bowman's

Origin: mesoderm: splanchnotom

Endothelium

Location: lining vascular system.

Origin: mesenchyme
Simple cuboidal
Function: barrier, absorption.
Location: ovary, kidney tubules (distal and proximal thick segments)
Origin: mesoderm
Simple columnar
Function: barrier, absorption, and secretion.
Location: lining of stomach, small intestine and colon, gallbladder.
Origin: endoderm

Supporting cells
Secretory cells

Absorptive cells with striated borders

Undifferentiated (stem) cells
Endocrine cells

Pseudostratified
Function: secretion, conduit.
Location: trachea and bronchi, deferens, efferent ductules of epididymis.
Origin: endoderm, mesoderm.

ciliated cells
mucous (goblet) cells
stem (basal) cells
endocrine cells

*bronchi histology:
The hyaline cartilage forms an incomplete ring in the bronchi. Smooth muscle is present continuously
around the bronchi.
-The cartilage and mucous membrane of the primary bronchi are similar to those in the trachea. As the
branching continues through the bronchial tree, the amount of hyaline cartilage in the walls decreases
until it is absent in the bronchioles. As the cartilage decreases, the amount of smooth muscle increases.
The mucous membrane also undergoes a transition from ciliated pseudostratified columnar epithelium to
simple cuboidal epithelium to simple squamous epithelium.
The alveolar ducts and alveoli consist primarily of simple squamous epithelium, which permits rapid
diffusion of oxygen and carbon dioxide.

*Radial nerve is most likely to be injured in mid humeral shaft fracture.

*subclavian vein is anterior to the anterior sclene muscle.

*STUCTURES OPENING INTO THE PTERYGOPALATINE FOSSA:

Direction

Passage

Connection

Posteriorly

foramen rotundum

middle cranial fossa

Posteriorly

pterygoid canal (Vidian)

middle cranial fossa, foramen lacerum

Posteriorly

palatovaginal canal (pharyngeal)

nasal cavity/nasopharynx

Anteriorly

inferior orbital fissure

orbit

Medially

sphenopalatine foramen

nasal cavity

Laterally

pterygomaxillary fissure

infratemporal fossa

oral cavity, lesser palatine canals

Inferiorly

greater palatine canal (pterygopalatine)

Except facial canal

*PREGANGLIONIC NERVE FIBRES:

-In the autonomic nervous system, fibers from

the CNS to the ganglion are known as preganglionic

fibers.
All preganglionic fibers, whether they are in the sympathetic division or in the parasympathetic division,
are both cholinergic (that is, these fibers use acetylcholine as their neurotransmitter) and either
unmyelinated or myelinated. Sympathetic preganglionic fibers tend to be shorter than parasympathetic
preganglionic fibers because sympathetic ganglia are often closer to the spinal cord than are
the parasympathetic ganglia.

*azygous vein left impression over the right lung.

TONGUE INNERVATION:

*buccinators and superior pharyngeal constrictore musle attach

to
the
pterygomandibular
raphe:

*roots of the brachial plexus are derived from ventral rami of

spinal nerve C5 to T1:

COMMON COENZYMES:
Common Coenzymes
Vitamin A
Vitamin A is responsible for transferring light energy to a chemical nerve impulse in the eyeball. Vitamin
A is also used for growing healthy new cells such as skin, bones, and hair, enamel. It maintains the lining
of the urinary tract, intestinal tract, and respiratory system. Additionally, Vitamin A is required for the
reproductive functions such as the growth and development of sperm and ovaries.

Vitamin C
(ascorbic acid) Vitamin C is important as synthesizing collagen. Deficiency leads to a disease
called Scurvy. Vitamin C helps regulate the immune system and relieve pain caused by tired muscles. It
also is needed in the manufacture of collagen and norepinephrine. Vitamin C is also an antioxidant
which can enhance the immune system by stimulating white blood cells in the body. Vitamin C also helps
to benefit the skin, teeth, and bones.

Vitamin B1
Also named Thiamine or Thiamine diphosphate (TPP), Vitamin B1 is a cofactor for oxidative
decarboxylation both in the Kreb's Cycle and in converting pyruvate to acetyl-CoA (an important
molecule used in the citric acid cycle of metabolism). It is widely available in the human diet and
particularly potent in wheat germ and yeast. It's functionality results from a thiazole ring which stabilizes
charge and electron transfer through resonance.

Vitamin B2
Vitamin B2 is known as riboflavin. Vitamin B2 is the precursor of Flavin adenine dinucleotide (FAD) and
flavin mononucleotide (FMN) which are coenzymes used to oxidized substrates. FAD contains
riboflavin and adenine. FMN contains riboflavin that is why it is called mononucleotide.

Vitamin B3
+

Vitamin B3 is Niacin or nicotinic acid . Vitamin B3 is a precursor to NADH, NAD , NADP and NADPH
+
+
which are coenzymes found in all living cells. NAD and NADP are oxidizing agents. NADH and NADPH
are reducing agents.

Vitamin B6
Vitamin B6 is precursor to coenzyme pyridoxal phosphate (PLP) which is required in certain
transformation of amino acids including transamination, deamination, and decarboxylation.

Vitamin B12
Vitamin B12 is the name for a class of related compounds that have this vitamin activity. These
compounds contain the rare element cobalt. Humans can not synthesis B12 and must obtain it from diet.
Enzymes that catalyze certain rearrangement reaction required B12 or its derivatives.

Vitamin H (B7)

Also named Biotin, Vitamin H is a carboxyl carrier; it binds CO2 and carries it until the CO2 is donated in
carboxylase reactions. It is water soluble and important in the metabolism of fatty acids and the amino
acid Leucine. Deficiency leads to dermatitis and hair loss, thus making it a popular ingredient in
cosmetics.

Vitamin K
Vitamin K is needed for the process of clotting of blood and Ca 2+ binding. Vitamin K can be synthesized
by bacteria in the intestines. Vitamin K is needed for catalyzing the carboxylation of the -carbon of the
glutamate side chain in proteins.

Non-enzymatic cofactors
Cofactor is also used widely in the biological field to refer to molecules that either activate, inhibit or are
required for the protein to function. For example, ligands such as hormones that bind to and activate
receptor proteins are termed cofactors or coactivators, while molecules that inhibit receptor proteins are
termed corepressors.
The coactivator can enhance transcription initiation by stabilizing the formation of the RNA polymerase
holoenzyme enabling faster clearance of the promoter.
The corepressor can repress transcriptional initiation by recruiting histone deacetylases which catalyze
the removal of acetyl groups from lysine residues. This increases the positive charge on histones which
strengthens in the interaction between the histones and DNA, making the latter less accessible to
transcription.

*DIFF BETWEEN SLOW TWITCH(type 1) & FAST TWITCHtype 2):

Fast-twitch fibers can deliver a quick burst of power. Slow-twitch fibers can maintain a contraction for
a
longer
time.
Because of the higher energy demands of slow-twitch fibres (due to their more frequent and
prolonged usage) they have a higher density of mitochondria for energy and myoglobin to provide
oxygen. Meanwhile, fast-twitch fibres tend to have larger stores of glycogen so that vast quantities of
energy can be provided at short notice.

*PEPTIDE HORMONES:
-Several important peptide hormones are secreted from the pituitary gland. The anterior pituitary secretes
three: prolactin, which acts on the mammary gland; adrenocorticotropic hormone (ACTH), which acts on
the adrenal cortex to regulate the secretion of glucocorticoids; and growth hormone, which acts
on bone, muscle, and the liver. The posterior pituitary gland secretes antidiuretic hormone, also called
vasopressin, and oxytocin. Peptide hormones are produced by many different organs and tissues,
however, including the heart (atrial-natriuretic peptide (ANP) or atrial natriuretic factor (ANF))

and pancreas (glucagon, insulin and somatostatin), the gastrointestinal tract (cholecystokinin, gastrin),
and adipose tissue stores (leptin).
Some neurotransmitters are secreted and released in a similar fashion to peptide hormones, and some
'neuropeptides' may be used as neurotransmitters in the nervous system in addition to acting as
hormones when released into the blood. When a peptide hormone binds to receptors on the surface of
the cell, a second messenger appears in the cytoplasm, which triggers intracellular responses.

TMJ:
The lower joint compartment formed by the mandible and the articular disc is involved in rotational
movementthis is the initial movement of the jaw when the mouth opens. The upper joint compartment
formed by the articular disk and the temporal bone is involved in translational movementthis is the
secondary gliding motion of the jaw as it is opened widely
The major ligament, the temporomandibular ligament(collateral ligament). The base of this triangular
ligament is attached to the zygomatic process of the temporal bone and the articular tubercle; its apex is
fixed to the lateral side of the neck of the mandible. This ligament prevents the excessive retraction or
moving backward of the mandible

The stylomandibular ligament separates the infratemporal region (anterior) from the parotid region
(posterior), and runs from the styloid process to the angle of the mandible; it separates the parotid
and submandibular salivary glands. It also becomes taut when the mandible is protruded.

The sphenomandibular ligament runs from the spine of the sphenoid bone to the lingula of mandible.
The inferior alveolar nerve descends between the sphenomandibular ligament and the ramus of the
mandible to gain access to the mandibular foramen. The sphenomandibular ligament, because of its
attachment to the lingula, overlaps the opening of the foramen. It is a vestige of the embryonic lower
jaw, Meckel cartilage. The ligament becomes accentuated and taut when the mandible is protruded

Sensory innervation of the temporomandibular joint is derived from the auriculotem

poral and masseteric branches of V3 or mandibular branch of the trigeminal nerve). These are only
sensory innervation.
Its arterial blood supply is provided by branches of the external carotid artery, predominately
the superficial temporal branch. Other branches of the external carotid artery namely: the deep
auricular artery, anterior tympanic artery, ascending pharyngeal artery, and maxillary artery- may
also contribute to the arterial blood supply of the joint.

Gnarled enamel
Gnarled enamel is a description of enamel seen in histologic sections of a tooth underneath a cusp. The
appearance of enamel appears different and very complex under the cusp, but this is not due to a different
arrangement of dental tissues. Instead, the enamel still has the same arrangement of enamel rods. The strange

appearance results from the lines of enamel rods directed vertically under a cusp and from their orientation in a
small circumference.

*Contour lines of Owen:

-Are number of adjoining parallel imbrication lines that are present in stained dentin.
-Demonstrate a disturbance in body metabolism that affect the odontoblast by altering their
formation efforts.
- Appears together as a series of dark bands.

Lines of Von Ebner:

-In dentin this line can be linked to the growth rings or incremental lines of the retzius in enamel.
-show incremental nature of the dentinal tubule.

*PULMONARY SADDLE EMBOLISM:

-PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or
pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE). A
small proportion of cases are due to the embolization of air, fat, or talc in drugs of intravenous drug
abusers or amniotic fluid. The obstruction of the blood flow through the lungs and the resultant pressure
on the right ventricle of the heart lead to the symptoms and signs of PE.
-Symptoms of pulmonary embolism include difficulty breathing, chest pain on inspiration,
and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a
rapid heart rate. Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden
death

*NEUROBLASTOMA:
-It

is a neuroendocrine tumor, arising from any neural crest element of the sympathetic nervous

system (SNS). It most frequently originates in one of the adrenal glands,

ANTIGEN BINDING SITE OF ANTIBODY:

The fragment antigen-binding
) is a region on an antibody that binds to antigens. It is
composed of one constant and one variable domain of each of the heavy and the light chain. These
domains shape the paratope the antigen-binding site at the amino terminal end of the monomer.
The two variable domains bind the epitope on their specific antigens.

*Staphylococcus is the most common genera of the bacteria found in the skin.
*Phage conversion is responsible for the production of pyrogenic toxin
*Testing with biological indicator represents best way to verify heat sterilizer.

*MUCORMYCOSIS:
Mucormycosis is any fungal infection caused by fungi in the order Mucorales. Generally, species in
the Mucor, Rhizopus, Absidia, andCunninghamella genera are most often implicated. This disease is
often characterized by hyphae growing in and around vessels.

BACTERIAL PILLI: allowing

bacteria to adhere to the human cells.

*CUSHING SYNDROME:
-Cushing's

syndrome describes the signs and symptoms associated with prolonged exposure to

inappropriately high levels of the hormone cortisol. This can be caused by taking glucocorticoid drugs, or
diseases that result in excess cortisol, adrenocorticotropic hormone (ACTH), or CRH levels.
Cushing's disease refers to a pituitary-dependent cause of Cushing's syndrome: a tumor (adenoma) in
the pituitary gland produces large amounts of ACTH, causing the adrenal glands to produce elevated
levels of cortisol. It is the most common non-iatrogenic cause of Cushing's syndrome, -OBESITY
,STRIAE, BUFFALO HUMP/ MOON FACE & OSTEOPOROSIS ARE COMMON MENIFESTATIONS.

*Thrombosis:

*
Thrombosis is the formation of a intravascular blood clot , obstructing the flow of blood through
the circulatory system. When a blood vessel is injured, the body uses platelets (thrombocytes)
and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots
may form in the body under certain conditions. A clot that breaks free and begins to travel around the
body is known as an embolus.

Glioblastoma multiforme is the common type of astrocytoma(

cancer of brain)
*Bordetella

pertussis:

Bordetella
pertussis is
a Gramnegative, aerobic coccobacillus capsulate of the genus Bordetella, and the causative agent of pertussis or
whooping cough.

*Pannus:

In people suffering from rheumatoid arthritis, pannus tissue eventually forms in

the joint affected by the disease, causing loss of bone and cartilage.

*NEPHROTIC SYNDROME:

Nephrotic syndrome is a nonspecific kidney disorder

characterised by a number of signs of disease: proteinuria, hypoalbuminemia and edema. It is

characterized by an increase in permeability of the capillary walls of the glomerulus leading to the
presence of high levels of protein passing from the blood into the urine .low levels of protein in the blood
(hypoproteinemia orhypoalbuminemia), ascites and
in
some
cases, edema;
high cholesterol (hyperlipidaemia or hyperlipemia) and a predisposition for coagulation.

*ACTINOMYCOSIS:
The disease is characterised by the formation of painful abscesses in the mouth, lungs, or gastrointestinal
tract
In severe cases, they may penetrate the surrounding bone and muscle to the skin, where they break
open and leak large amounts of pus, which often contains characteristic granules (sulphur
granules). The purulent leakage via the sinus cavities contains "sulphur granules," not actually
sulphur-containing but resembling such particles.

*Pancreatic carcinoma- poorest prognosis

*Calcium dipicolinate:
- endospore

consists of calcium dipicolinate within the core, which is thought to stabilize the DNA.
Dipicolinic acid could be responsible for the heat resistance of the spore, and calcium may aid in
resistance to heat and oxidizing agents

*ADRENAL CORTEX HORMONES:

Zona glomerulosa
The outermost layer, the zona glomerulosa is the main site for production of aldosterone,
a mineralocorticoid, Aldosterone is largely responsible for the long-term regulation of blood pressure.
Aldosterone's effects are on the distal convoluted tubule and collecting duct of the kidney where it causes
increased reabsorption of sodium and increased excretion of both potassium (by principal cells) and
hydrogen ions.
Zona fasciculata
Situated between the glomerulosa and reticularis, the zona fasciculata is responsible for
producing glucocorticoids, such as corticosterone, and cortisol in humans. Cortisol is the main
glucocorticoid under normal conditions and its actions include mobilization of fats, proteins, and
carbohydrates, but it does not increase under starvation conditions. Additionally, cortisol enhances the
activity of other hormones including glucagon and catecholamines. The zona fasciculata secretes a basal
level of cortisol but can also produce bursts of the hormone in response to adrenocorticotropic
hormone (ACTH) from the anterior pituitary.
Zona reticularis
The inner most cortical layer, the zona reticularis produces androgens, (the precursor to testosterone) in
humans.

Pathology of adrenal cortex:

Adrenal insufficiency (e.g. due to Addison's disease)

Cushing's syndrome

Conn's syndrome

Adrenal Virilism

*ATTENUATED VACCINES:
An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it
viable (or "live"). Attenuation takes an infectious agent and alters it so that it becomes harmless or less
virulent. These vaccines contrast to those produced by "killing" the virus (inactivated vaccine).
Examples of "live" (example attenuated) vaccines include:

Live/attenuated vaccines:
"Mr.V.Z Mapsy"
Measles , Rubella ,Varicella-Zoster, Mumps ,Adenovirus, Polio(sabin) ,Yellowfever
-Bacterial: BCG vaccine, typhoid vaccine and epidemic typhus vaccine.

Inactivated vaccine:
An inactivated vaccine (or killed vaccine) consists of virus particles which are grown in culture and then
killed using a method such as heat or formaldehyde.
Killed Vaccines:
"RIP always"
Rabies, Influenza, Polio(salk) ,A hepatitis

*Preganglionic parasympathetic ganglia:

*preganglionic parasympatheic fibers that sysnapse in the pterygopalatine
ganglion travel in the greater petrosal nerve.

*Smooth muscle does not contain troponin.

*Adenoid

Vs

Palenttine

tonsils :

-Adenoids; or pharyngeal tonsils are located at the roof of

pharynx, are ciliated pseudostraitified columnar, & have no

crypts.
-Palenttine tonsils; are located at the sides of oropharanx
between
palantoglossal
and palantopharygeal arches, it is non-keratinized straitified
squamous, & have crypts.

*PALATINE TONSILS:
Is partly surrounded by connective tissue and epithelium, contains lymphoid
follicles , has no sinuses & is penetrated by number of crypts.
Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be
seen on the left and right sides at the back of the throat.
Spaulding Classifications:
Body Contact

Disinfection Requirements FDA Device Class

intact skin

low level

non-critical

mucous membranes high level

semi-critical

sterile body cavity

critical

sterilization

*Smooth and rough endoplasmic reticulum function:

-The smooth endoplasmic reticulum (ER) has functions in several metabolic processes, including
synthesis of steroids and lipids, metabolism of carbohydrates, regulation of calcium concentration, drug
detoxification, attachment of receptors on cell membrane proteins, and steroid metabolism.
-The rough endoplasmic reticulum is key in producing lysosomal enzymes, secreted proteins, integral
membrane proteins, and initial glycosylation

allosteric inhibitor

A substance alters the rate of an enzymatic reaction by binding to the

enzyme
at
a
site
other
than
the
active
site
*roDs- Dim light
Cons-Color
* LH versus FSH
L-eydig

fSh-Sperm

* CAROTIDSINUS versus CAROTIDBODY :

carotid=S-inu-S..................pre-SS-ure
carotid=b-O2-dy.................O2
* CarbonMonoxide- CO blocks CO
carbonmonoxide blocks C-ytochrome O-xidase
* Post. Mediastinum has 4 BIRDS :
Esopha-GOOSE
Va-GOOSE
Azy-GOOSE
Thoracic DUCK
*Hypersensitivity reactions:
"ACID":
Anaphylaxis
Cytotoxic
Immune complexes
Delayed Hypersensitivity
*structures found in parotid gland
GRAPES,Food
G-GREATER AURICULAR NERVE
R-RETROMANDIBULAR VEIN
A-AURICULO TEMPORAL NERVE
P-PAROTID DUCT
E-EXTERNAL CAROTID ARTERY
S-SUPERFICIAL TEMPORAL ARTERY & VEIN
F-FACIAL NERVE{MOTOR BRANCHES}
*Cartilage derivatives of 1st pharyngeal arch (mandibular)
"I'M A Super Sexy Guy" (or Girl):
IncusMalleus
Anterior ligament of malleus
Spine of sphenoid
Sphenomandibular ligament
Genial tubercle of mandible
*Serratus Anterior: nerve vs. blood
LoNg thoracic: Nerve
LAteral thoracic: Artery

*viral tropism

*
The specificity of a virus for a particular host tissue, determined in part by the interaction of viral surface
structures with receptors present on the surface of the host cell.

*pyruvate dehydrogenase complex:

-thaiminine pyrophosphatase
-coenzyme A
-FAD,NAD+

*LYMPH NODE MEDULLA:

-There are two named structures in the medulla:

The medullary cords are cords of lymphatic tissue, and include plasma cells, macrophages, and B
cells

The medullary sinuses (or sinusoids) are vessel-like spaces separating the medullary cords. Lymph
flows into the medullary sinuses from cortical sinuses, and into efferent lymphatic vessels. Medullary
sinuses contain histiocytes (immobile macrophages) and reticular cells.

The medulla contains large blood vessels, sinuses and medullary cords that contain plasma cells
secreting antibody.

*beta receptor system:

-Most tissues express multiple receptors. However, the dominant beta receptor in the normal heart is
the beta1 receptor while the beta2 receptor is the dominant regulatory receptor in vascular and non
vascular smooth muscle. Epinephrine activates both the beta1 and beta2-receptors. Norepinephrine
activates only beta1-receptor.
Effect of Beta1 Receptor Activation on the Heart: Activation of the beta1 receptor leads to increases
in contractile force and heart rate. Drugs that activate the beta1 receptor can be used in heart failure to
improve the contractile state of the failing heart. Drugs that activate the beta 1 receptor also increase heart
rate. Indeed, excess stimulation the beta1 receptor can induce significant increases in heart rate
and arrhythmias. Arrhythmias are a major concern with drugs such as epinephrine that can be
absorbed systemically after intra-oral injection.
Effect of Beta2 Receptor Activation on liver &Smooth Muscle: Activation of the beta2 receptor leads
to vascular and nonvascular smooth muscle relaxation. Drugs that activate the beta2 receptor can be
used to treat as asthma (by relaxing airway smooth muscle) and premature labor (by relaxing uterine
smooth muscle).

Alpha receptor:

*
Alpha 1: located in sympathetic postsynaptic nerve terminal increase vascular smooth muscle
contraction.
Alpha 2 : located in sympathetic presynaptic nerve terminals ; beta cell of the pancreatic islets inhibits
NE release ; inhibit insulin release.
Norepinephrine stimulates mainly alpha receptor & epinephrine stimulate both alpha and beta receptors.
Beta blocker block the effect of the adrenaline on the bodys beta receptor

*Chronotropic drugs may change the heart rate by affecting the nerves controlling the heart, or by
changing the rhythm produced by the sinoatrial node. Positive chronotropes increase heart rate; negative
chronotropes decrease heart rate.
*ionotropic agent: is an agent that alters the force or energy of muscular contractions. Negatively
inotropic agents weaken the force of muscularcontractions. Positively inotropic agents increase the
strength of muscular contraction by affecting inotropic state is the level of calcium in the cytoplasm of the
muscle cell. Positive inotropes usually increase this level, while negative inotropes decrease it.

* The trigeminal nucleus complex:

The collection of cells in the brainstem that can be called the trigeminal nucleus is stretches from
midbrain to medulla:

Most of the sensory fibers enter the trigeminal ganglion, regardless of which trigeminal division they
are coming from. Their cell bodies, like those of all somatosensory neurons, lie outside the CNS in the
ganglion, and their proximal processes enter the brainstem in the mid-pons. From there they fan out to
their different targets. Each modality will be described separately below.

A.Discriminative touch:
The large diameter (Ab) fibers enter directly into the main sensory nucleus of the trigeminal (V), also
called the principal nucleus. Just like the somatosensory neurons of the body, they SYNAPSE, then
CROSS. The secondary afferents can then join the medial lemniscus on its way to the thalamus.

B. Pain and temperature:-The small diameter fibers carrying pain and temperature enter at mid
pons, and then do something unusual - they turn down the brainstem. They travel down the pons and
medulla until they reach the caudal medulla, which is where they finally synapse and cross.
-The tract that the descending axons travel in is called the spinal tract of V, and the long tail of a nucleus
that they finally synapse in is called the spinal nucleus of V. These names come from the fact that they
actually reach as far down as the upper cervical spinal cord. The spinal nucleus of V can be divided into
three regions along its length; the region closest to the mouth is called subnucleus oralis, the middle
region is called subnucleus interpolaris, and the region closest to the tail is called subnucleus caudalis.
The pain fibers actually synapse in subnucleus caudalis, so you may hear that term used instead of the
spinal nucleus of V.

The secondary afferents from subnucleus caudalis cross to the opposite side, and join the spinothalamic
tract on its way to the thalamus.

C. Proprioception:
The proprioceptive axons in the trigeminal nerve are the stretch and tendon receptors from the muscles
of mastication., they are located inside the brainstem in a nucleus called the mesencephalic nucleus.
The mesencephalic nucleus is essentially a dorsal root ganglion that has been pushed into the CNS, so

*
there are no synapses within it. The fibers enter the brainstem via a small branch of the trigeminal that
bypasses the trigeminal ganglion, turn up towards the mesencephalic nucleus, pass by the cell body, and
leave the nucleus immediately. Most then synapse in the nearby motor nucleus where they can initiate
the stretch reflexes for the muscles of mastication. The stretch reflex in the face behaves exactly like
that in the body, and tapping on the tendon of the masseter (for example) will produce a twitch.

E. Motor innervation:
Motor or efferent control is not considered a sensory modality, but it is the fourth component of the
extensive trigeminal complex. The motor nucleus of V lies just medial to the main sensory nucleus, and
in it reside the a-motor neurons that control the muscles of mastication. The two principal muscles
involved are the masseter (in your cheek) and the temporalis(over your temple), both of which tighten
when you clench your teeth(monosynaptic jaw closing reflexes). The motor axons leave the mid-pons
and bypass the trigeminal ganglion, and reach their targets via the mandibular division of the trigeminal
nerve.

*GLUT-4: ( glucose transpoters )

-Glucose transporter type 4, also known as GLUT4, is a protein that in humans is encoded by
the GLUT4 gene. GLUT4 is the insulin-regulated glucose transporter found in adipose tissues and striated
muscle (skeletal and cardiac) that is responsible for insulin-regulated glucose transport into the cell. This
protein is expressed primarily in muscle and fat cells, the major tissues in the body that respond to
insulin.

*
*GLUT-1 : mediate the glucose transports into the red cells , and throughout the blood brain barrier. It is
ubiquitously expressed and transports glucose in most cells.
*GLUT-2: provide glucose to liver and pancreatic cells.
*GLUT-3: is the main transporter in neurons.
*GLUT-4: is primarily expresse in muscle and adipose tissue and regulated by insulin.
*GLUT-5 : transports fructose in the intestine and testis.

*nerve fibers:
Nerve fiber of the CNS are not enclosed by the neurilemma ( sheath of the schwann ) . all PNS have a sheath of
schwann cells around them n it becomes myelin sheath..

Right sided lesions of the spinal cord result in loss of the motor activity on the same side and pain and
temperature sensations on the opposite side.

*TASTE BUDS:

*ACUTE HIV IFECTION:

-Acute HIV infection, primary HIV infection or acute seroconversion syndrome is the second stage
of HIV infection. It occurs after the incubation stage, before the latency stage and the
potentialAIDS succeeding the latency stage.
During this period (usually 24 weeks post-exposure) many individuals develop an influenza or
mononucleosis-like illness called acute HIV infection, the most common symptoms of which may
include fever, lymphadenopathy, pharyngitis, rash, myalgia, malaise, mouth and esophageal sores, and
may also include, but less commonly, headache, nausea and vomiting, enlarged liver/spleen,weight
loss, thrush, and neurological symptoms. Infected individuals may experience all, some, or none of these
symptoms. The duration of symptoms varies, averaging 28 days and usually lasting at least a week.

*keton bodies:
-Ketone bodies are three different water-soluble, biochemicals that are produced as by-products when fatty
acids are broken down in the liver for energy.
-The three endogenous ketone bodies, are acetone, acetoacetic acid ,beta-hydroxybutyric acid. Other ketone bodies
such as beta-ketopentanoate and beta-hydroxypentanoate may be created as a result of the metabolism of
synthetic triglycerides such as triheptanoin.

Keton body formation:

BRADYKININ:
-Bradykinin is a potent endothelium-dependent vasodilator, leading to a drop in blood pressure. It also causes
contraction of non-vascular smooth muscle in the bronchus and gut, increases vascular permeability and is also
involved in the mechanism of pain. Bradykinin also causes natriuresis, contributing to the drop in blood pressure.
[4]

Bradykinin raises internal calcium levels in neocortical astrocytes causing them to release glutamate.

Bradykinin is also thought to be the cause of the dry cough in some patients on angiotensin converting enzyme (ACE)
inhibitor drugs.

*Transposons:

*
Transposons are segments of DNA that can move around to different positions in the genome of a single cell. In
the process, they may
-cause mutations
-increase (or decrease) the amount of DNA in the genome of the cell, and if the cell is the precursor of a gamete, in
the genomes of any descendants.
These mobile segments of DNA are sometimes called "jumping genes".

*thyrocervical trunk:
-Inferor thyroid, Transverse cervical artery, suprascapular

*inramemranous ossification v/s endochondral ossification:

-intramembranous ossification [flat bones] & endochondral ossification [long bones].The essential between them is
the presence or absence of cartilaginous phase.
-Intramembranous ossification occurs when mesenchymal precursor cells proliferate & subsequently differentiate
directly into osteoblasts w/c mineralize an immature bone tissue called woven bone,characterize by irregular bundles
of randomly oriented collagen fibers & an abundance of partially calcified immature new bone called asteoid.At later
stages
this
woven
bone
is
progressively
remodeled
to
mature
,lamellar
bone
-Endochondral ossification entails the conversion of a cartilaginous template into bone.Mesenchymal cells condense
& differentiate into chondrocytes w/c secrete the cartilaginous matrix.This embryonic cartilage is avascular,& during
its early development,a ring of woven bone is formed by intramembranous ossification in the future mid shaft
area.This calcified woven bone is then invaded by vascular tissue,& osteoclasts & osteoblasts are recruited to
replace the cartilage scaffold w/ bone matrix & excavate the hematopoietic bone marrow cavity.

*A

restriction enzyme (or restriction endonuclease) is an enzyme that cuts DNA at or near

specific recognition nucleotide sequences known as restriction sites. Restriction enzymes are commonly classified
into three types, which differ in their structure and whether they cut their DNAsubstrate at their recognition site, or if
the recognition and cleavage sites are separate from one another. To cut DNA, all restriction enzymes make two
incisions, once through each sugar-phosphate backbone (i.e. each strand) of the DNA double helix.
-These enzymes are found in bacteria and archaea and provide a defense mechanism against invading viruses.

-southern blotting can be use to identify the DNA restricted fragments.

*TRANSPLANT OPTIONS:
-Autograft, tissue transplanted from one site to another on the same patient. An autograft reduces the risk of rejection
but requires a second surgery site, adding pain, risk and possible longer aftercare.
-Xenograft, a transplant from another species
-Isograft, a transplant from a genetically identical donor, such as an identical twin.

-Allograft, non identicle donor of same species.

*TYPE II PNEUMOCYTE:
-Type II cells are responsible for the production and secretion of surfactant (the majority of
are dipalmitoylphosphatidylcholine), a group of phospholipids that reduce the alveolar surface tension.

*striated muscle has least ability to regenerate.

which

*Tonofilaments:
-Tonofibrils are
cytoplasmic protein structures
at desmosomes and hemidesmosomes.

in epithelial tissues

that

converge

Tonofilaments are also associated with desmosomes (macula adherens), anchoring them to the cytoskeleton.
-They are made of keratin (a type of intermediate filament in the cytoskeleton) tonofilaments. Tonofilaments
are keratin intermediate filaments that make up tonofibrils in epithelial tissue. In epithelial cells, tonofilaments loop
through desmosomes.
The protein filaggrin is believed to have an important role in holding them together as tonofibrils.

*pathognomonic characteristic of a single disease.

*Warfarin:
-Helps to prevent new blood clots from forming, and helps to keep existing blood clots from getting worse. This
medicine is a blood thinner (anticoagulant).

-May treat: Atrial fibrillation, Thrombophlebitis

-May prevent: Stroke, Heart attack, Lung embolism, Blood clot in the vein, Transient ischemic attack, Coronary
thrombosis, Postoperative Complications, Thromboembolism

*PAIN FIBERS IN THE TEETH:

*Because of their higher conduction velocity, A fibers are responsible for the sensation of a quick shallow pain that
is specific on one area, termed as first pain. They respond to a weaker intensity of stimulus. C fibers respond to
stimuli which have stronger intensities and are the ones to account for the slow, but deeper and spread out over an
unspecific area, second pain.

REGIONAL GROUPS OF THE LYMPH NODES:

-PAROTID LYMPH NODES: receive lymph from a strip of the scalp above the parotid gland, from the
anterior wall of the external auditory meatus,& from the lateral parts of the eyelids and middle ear. All these drain into
deep cervical nodes.

-SABMANDIBULAR LYMPH NODES:

located between sabmandibular gland & mandile.receive

lymph from the scalp, nose,adjacent cheek, the upper lip & the lower lip (except the central part), vestibule, the
gingiva. All these drain into deep cervical lymph nodes. paranasal sinuses, the max & mand teeth (except mand
incisors), the ant 2/3 of the tongue( except teeth), the floor of the the mouth and

-SABMENTAL LYMPH NODES:located behind

the chin and on the mylohyoid muscle, receive

lymph from the tip of the tounge , the floor of the mouth beneath the tip of the tongue, the mand incisors and
associated gingiva, the center part of the lower lip and the skin over the chin.. all these drain into the sabmandibular
and deep cervical lymph nodes.

*RETROPERITONEAL ORGAN:
- Aorta
-Inferior vena cava
-Kidneys
-Adrenal glands
-Pancreas
-Ureters
-Most of the duodenum
-Ascending &Descending part of colon.
-Oeshophagus
-Rectum

*Extracellular and intracellular fluid:

cgfcgfccccccccccccccccccccccccccccccccccccccc *Intracellular fluid: highest body water contain
-2/3 of the body water
-solution of potassium ,organic anions, protein.
-various source of fluids from all the diff cells.
*Extracellular fluid:
-1/3 of the body water. Consist NaCl &NaHCO3
-Subdivided into :
1)Interstitial fluid :surround the cell but does not circulate
2)Plasma: circulate as a extracellular component of the blood
3)Transcellular fluid:is a set of the fluids that are outside the normal
Compartments. CSF, Digestive juices & mucus.

*DURAL FOLDS:
1) FALX CEREBRI: lies in the longitudinal fissure & seperates the cerebral hemispheres. Contains inf and sup
sagittal sinuses .

2)FALX CEREBELLI: seperates the cerebrum & cerebellum.cotains occipital sinus

3)TENTORIUM CEREBELLI:
petrosal sinuses.

seperates the two lobes of the

cerebellum. Contains straight , transverse & sup

*Subdural space: close space with no egress between dura mater & the arachnoid mater.Subdural hematomas are
most often caused by head injury, when rapidly changing velocities within the skull may stretch and tear
small bridging veins. Subdural hematomas due to head injury are described as traumatic

*Epidural space: over the dura mater, become a real space in the presence of pathology.The most common cause
of intracranial epidural hematoma is traumatic, although spontaneous hemorrhage is known to occur. Hemorrhages
commonly result from acceleration-deceleration trauma and transverse forces. The majority of bleeds originate
from meningeal arteries, particularly in thetemporal region.

*In the ventricles of the brain , the pia mater and the ependymal cells contribute to form the formation of
the choroid plexus . it is the these plexus that reglute the intra- ventricular pressure by secretion and
absorption of the cerebrospinal fluid.
*Endosteal layer of dura mater: tightly adheres to the inner surface of the cranium.
*Meningeal layer of dura: forms partitions that descend into the brains fissures.
*The dural venous sinuses are spaces between the endosteal and meningeal layers of the dura.no valves
present. Majority of the venous blood is drain via the internal jugular vein.

*Kiesselbachs plexus:
Kiesselbach's plexus, which lies in Kiesselbach's area, Kiesselbach's triangle, or Little's area, is a
region in the anteroinferior part of thenasal septum where four arteries anastomose to form a vascular
plexus of that name. The arteries are: mnemonic (LEGS)

Anterior Ethmoidal artery (from the ophthalmic artery)

Sphenopalatine artery (terminal branch of the maxillary artery)

Greater palatine artery (from the maxillary artery)

Septal branch of the superior Labial artery (from the facial artery)

*perfusion vs diffusion gas exchange: taken from diff forums

*
1))))))))) for gas transport you need 3 things operating well:
1. ventilation (integrity of breathing physiology)
2. perfusion (blood flow)
3. diffusion (alveolar wall)
let's forget about ventilation, assume that it is constant. you might have 2 situations affecting transport of
gas into and out of blood:
-perfusion limited is when O2 enters blood and CO2 exits along the capillary, you have normal thickness
of alveolar wall and no dead zones in your lung. by this I mean that the only way to increase your gas
exchanges is increasing the blood flow as the other factors remain constant
-diffusion limited let's say that you have pulmonary fibrosis, or ARDS or emphysema and your alveolar
walls are thickened or destroyed. can you imagine gas going through that space? even if blood reaches
well the alveolar wall it cannot be packed with O2 because the gas is not passing through the walls. you
can increase ventilation and perfusion, but your bridge between this 2 is broken so you can't improve gas
exchange. that's why we say it is diffusion limited
*2)))))))) it can be either perfusion or diffusion limited. In a normal healthy lung, O2 is
perfusion limited because you generally breathe in enough O2 for equilibration to occur.
However, in a diseased lung like emphysema, these folks don't get enough O2 across to
equilibrate the amount in the blood to the amount in the alveoli, so it's basically limited by
the amount they are able to get across the damaged membranes, hence diffusion limited.
*3)))))))))))))the difference lies in what is preventing the equilibrium. Take gases crossing the alveolar
membrane into the blood as an example. Some gases cross the membrane very readily, but do not
dissolve well into the blood. In this case, higher rates of blood flow would cause more gas to be picked up
and dissolved. The restriction is the amount of perfusion, so this is an example of perfusion limited.
On the other hand, other gases do not pass the alveolar membrane well, but are readily absorbed into the
blood. In this instance, gas movement is restricted by the rate of diffusion across the membrane, and
therefore, this is an example of diffusion limited.
*
peripheral

located in carotid body and the aortic arch; detect changes in

chemoreceptors

PO2 (not content), PCO2, and pH; respond quickly to breath-tobreath changes

Central chemoreceptors

located in the interstitial fluid of the brain; detect changes in

PCO2 and pH; since it does not detect PO2, hypoxia is not solved
by central chemoreceptors

Hering-Brauer

stimulated by increased lung volume via stretch receptor; upon

Inspiratory-Inhibitory

stimulation inspiration is terminated; activated at high TV and

Reflex

pay prevent excessive work

Hering-Brauer Deflation

stimulated by low lung volume (via stretch receptor); activated by

Reflex

abrupt lung deflation; may increase Ve upon sighing, etc, helps

prevent lung collapse

Hypercapnia or hypercapnea (from the Greek hyper = "above" or "too much" and kapnos = "smoke"),
also known as hypercarbia, is a condition where there is too much carbon dioxide (CO2) in the blood.
Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through
the lungs.

*Internal thoracic artery:

Internal thoracic artery (branch of the thoracic artery) ends in the sixth intercostal space by dividing into
musculophrenic artery & superior epigastric artery.

Branches

Mediastinal branches

Pericardiacophrenic artery - travels with the phrenic nerve

Perforating branches

Twelve anterior intercostal branches, two to each of the top six intercostal spaces.

After passing the sixth intercostal space, the internal thoracic artery splits into the following two terminal
branches:

Musculophrenic artery

Superior epigastric artery

*Abdominal aorta bifurcation at L4 vertebra

*Oxyhemoglobin dissociation curve:

left shift (high affinity for O2) right shift (low affinity for O2)

Temperature

decrease

increase

2.3-BPG

decrease

increase

p(CO2)

decrease

increase

pH (Bohr effect) increase (alkalosis)

decrease (acidosis)

*Hypoxia also increases the formation of BPG( biohosphoglycerate) , which also shifts
the oxyhemoglobin dissociation curve to the right.

*LEFT SHIFT IN HEMATOLOGY: The presence of increased numbers of immature

neutrophils in the circulation is called a left shift. This will be represented by an increased number of
non-segmented or band neutrophils in the bloodstream, and if the left shift is more severe, there can be
metamyelocytes as well as myelocytes present. Two immature neutrophils can be seen in this field: the
metamyelocyte with its elongated, slightly indented nucleus and the myelocyte with its more ovoid
nucleus. It is important not to confuse these young precursors with monocytes.
*COUNTERCURRENT MECHANISM: is a system in the renal medulla that facilitates the
concentration of the urine . The system is responsible for the secretion of the hperosmotic urine in
response to elevate plasma osmolarity. Kidney dialysis machine is example of this. Contercurrent
exchange occur in a region of the peritubular capillary bed called vasa recta.

*BRAINBRIDGE REFLEX ( atrial reflex):

-is an increase in heart rate caused by a rise in pressure of the blood

in the right atrium due to

increased flow and/or pressure in the great veins at right atriums entrance.
-this reflex help to prevent the accumulation of blood in the pulmonary circulation , which could lead to
pulmonary edema.
*HISTAMINE:
Histamine release occurs when allergens bind to mast-cell-bound IgE antibodies. Reduction of IgE
overproduction may lower the likelihood of allergens finding sufficient free IgE to trigger a mast-cellrelease of histamine.

*
-major mediator of allergic response, released by circulating basophils and mast cells.
-causes decreased blood pressure.
-dilates small blood vessels.
-increased capillary permeability.
-contracts bronchial and intestinal smooth muscle.
-stimulates gastric secretion and nasal fluid discharge
- regulates the cells of the immune system.
*POWERFUL PHARMACOLOGIC ACTIONS, WHICH ARE MEDIATED BY TWO SPECIFIC RECEPTO TYPES:
1. H1 receptors : mediate the typical allergic & anaphylactic responses to histamine (
bronchoconstriction, vasodilation & increased capillary permeability)
2. H2 receptors : mediate other responses to histamine , such as the increased secretion of gastic acid &
pepsin.

*CHORISMATE:
anionic form chorismate is precursor of , the aromatic amino acids( phenylalanine, tyrosine, tryptophan)
-tyrosine synthesize the adrenal hormone( epinephrine & norepinephrine) , thyroid hormone ( thyroxine),
neurotransmitter dopamine, melanin.

*MONOSACHHARIDE:
-Examples of monosaccharides include glucose (dextrose), fructose (levulose), galactose, xylose
and ribose. Monosaccharides are the building blocks of disaccharides (such as sucrose)
and polysaccharides (such as cellulose and starch). Further, each carbon atom that supports
a hydroxylgroup (except for the first and last) is chiral, giving rise to a number of isomeric forms all with
the same chemical formula. For instance, galactose and glucose are both aldohexoses, but have different
physical structures and chemical properties.

.Bacteria with Capsules" Some Killers have pretty nice Big capsules "
Strep Pneumonia,Salmonella
Klebsiella
Hemophilus influenza
Psuedomonas,Pasturella
Neiserria
Bacteroides
Cryptococcus

PICORNA virus is PICORNA :

P - Positive sense

ICO - sahedral
RNA - virus

Obligate Anaerobes are ABC :

A - actinomyces

B - bacteroides
C - clostridium

Dimorphic Fungi
"Hello Brother,Cya Sister"
Histoplasma
Blastomyces
Coccidiodes
Sporothrix

Bacteria with IGA proteases:

"HSN"(remember hsn.com!)
Hemophilus
Strep pneumonia
Neiserria

DNA viruses:
" Amma has Pox, Papa has Parvo!"
Adeno
Herpes
Pox
Papova
Hepadna
Parvo

RNA viruses:
Positive sense:
"Call Pico & Flavi to come rightaway"
Calci
Picarno
Flavi
Toga
Corona
Retro
Negative sense:
"Pain results from our bunions always"
Paramyxo
rabies
filo

*
orthomyxo
bunya
arena

*At

birth,Dipalmitoylphosphatidylcholine (DPPtdCho) is a phospholipid (and a lecithin)

consisting of two palmitic acids and is the major constituent of pulmonary surfactant. It is also the only
surface active component of lung surfactant capable of lowering surface tension to near zero levels

*diabetic ketoacidosis is more common in type 1 than type 2.

*stuart groove : that separates the two triangular ridges of the mesiolingual cusp of the maxillary
molars

* IgA is most abundant in oral cavity.

* cervical enamel projections- mandibular second molar
* bile salts are composed of taurine and glycine.
* hepatic artery proper and hepatic portal vein are the main blood supply of liver.
*alpha fetoprotein: AFP is a major plasma protein produced by the yolk sac and the liver during fetal
development. It is thought to be the fetal form of serum albumin. Seen in patient with hepatoma.(elevated

level of AFP)
*wrist drop ( radial nerve palsy) - Wrist drop is also associated with lead poisoning because of the
effect of lead on the radial nerve

ferrochelatase: Ferrochelatase (FECH, protoheme ferrolyase) is an enzyme that catalyses the

terminal (eighth) step in the biosynthesis of heme . ferrochelatase is inhibited by lead.
*

* acetaldehyde dehydrogenase is the rate limiting enzyme in alcohol metabolism.

* ruffini corpuscles : is the most numerous in the periodontal ligament space for
sensing occusal force and load.