3 star items Flashcards
Forebrain development
Prosencephalons –>
A. Telencephalon –> Cerebral hemispheres
B. Diencephalon –> thalamus
Midbrain development
Mesencephalon –> midbrain
Hindbrain development
Rhombencephalon –>
A. Metencephalon–> cerebellum, pons
B. Myelencephalon –> medulla
Anterior hypothalamus nuclei
Anterior: thermoregulation (cooling) think AC - damage –> hyperthermia
Suprachiasmatic: circadian rhythms
Pre optic area: secretes GnRH
Supraoptic: secretes ADH, damage –> central DI
Paraventricular: secretes oxytocin, CRH, TRH
Tuberal hypothalamus nuclei
Arcuate: secretes GHRH, dopamine, pulsatile GnRH secretion, regulates appetite
Lateral: Regulates hunger, inhibited by Leptin; damage –> anorexia, wt loss
Ventromedial: regulates satiety, stimulated by leptin; damage –> obesity, savage behavior
Dorsomedial: regulates hunger, stimulation –> obesity, savage behavior
Posterior hypothalamus nuclei
Posterior: Thermoregulation - warming; damage –> hypothermia
Mammillary: memory; damage –> Wernicke-Korsakoff syndrome
Acetylcholine Synthesis
Choline acetyltransferase combines Choline + Acetyl CoA forming ACh
(Enzyme blocked by Vesamicol, can’t back ACh into vesicle)
Draw ACh neurotransmission
page 129
Draw out Phenylalanine to Epinephrine pathway
page 130
Draw NE neurotransmission
page 130
Causes of early cyanosis
Persistent truncus arteriosis Transposition of the great vessels Tricuspid atresia Tetraology of Fallot Total anomalous pulmonary venous return
Atrial fibrillation
Irregularly irregular, no p waves
Sx: tachycardia, SOB, fluttering in chest, angina
Cause: left atrial dilation caused by HTN, CVD, HF
Risk clots, PE, stroke, emboli
Tx: new less than 48 hours - synchronized cardioversion
Older than 48 hours - anticoagulation
If asx: digoxin, b-blocker, CCB for rate control
If young and sx: rhythm control - sotalol, amiodarone, flecaimide
Atrial flutter on EKG
saw tooth pattern
First degree AV block on EKG
prolonged PR interval, greater than 1 big box
Likely to go to second degree
Second degree (Mobitz I) AV block on EKG
“Wenckebach”
progressive lengthening of PR before dropping beat
asx, benign
Second degree (Mobitz II) AV block on EKG
no precursor warning of dropped QRS
can progress to 3rd degree block
tx: pacemaker
What bacteria is associated with causing AV nodal block?
Borrelia burgdorferi - Lyme dz
Third degree AV block on EKG
Atria and ventricles beat independently
2/3 are narrow, 1/3 wide QRS
tx: pacemaker
Wolff-Parkinson-White (WPW)
Bundle of Kent, or other, accessory conduction pathway bypasses AV node causing delta wave
can cause reentry SVT
Tx: procainamide or amiodarone
no adenosine when kicks into SVT
definitive tx: ablate pathway
Paroxysmal SVT
at or above AV node
narrow QRS
Premature ventricular contractions
early occurring
widen QRS - bizarre, often notched, greater than 4 boxes
microentry - purkinje fibers
signal originating below AV
Ventricular bigeminy vs trigeminy
bigeminy: PVC after each sinus beat
trigeminy: 2 sinus beats followed by a PVC
Ventricular escape rhythm
failure of SA/AV node
absent p wave, slow
junctional escape rhythm
AV node is the pacemaker
Monomorphic VT
wide QRS, >100/min
non sustained less than 30 sec
sustained greater than 30 sec
can lead to hemodynamic collapse
shock them
Torsades de pointes
shifting sinusoidal waves - amplitude changes
lead to v-fib (no identifiable waves, hemodynamic collapse, defibrillate and do CPR)
tx w/ Mg2+ push
Rotator Cuff Muscles
SItS:
Supraspinatus (first 10-15 degrees of abduction, test with empty can test, positive = pain and weakness)
Infraspinatus - external (lateral) rotation
teres minor - external (lateral) rotation
Subscapularis - internal (medial) rotation
What structures can be damaged with anterior shoulder dislocation?
Axillary nerve (test sensation of deltoid before and after reduction)
Posterior circumflex artery
Supraspinatus tendon
Anterior glenohumoral ligaments and glenoid labrum separation from articular surface of anterior glenoid neck - Bankart Lesion
Posterolateral humeral head defect - impact against anterior rim of glenoid - Hill-Sachs lesion
Osteoarthritis presentation
wear and tear dz - articular cartilage
–> eburnation, osteophytes
Bouchard’s nodes - osteophytes of PIP
Heberden’s nodes - osteophytes of DIP
Fingers, knees, hips, spine
Cause: age, obesity, joint trauma - repetitive use
Pain in joint AFTER use
Noninflammatory, no systemic sx
Treatment of OA
Acetaminophen - scheduled more effective, COX inhibitor
NSAIDs
COX-2I
topical capsaicin cream
Intraairticular glucocorticoid injections once every 4-6 mo
Intraairticular hyaluronan injections
Opioids - risk of falls/fractures in elderly
Tramadol
Joint replacement
NSAIDs drugs used to tx OA
Aspirin - irreversible inhibitor of COX1
SE: GI bleeds, ulcers, tinnitus, hyperventilation, acute renal failure
Diclofenac Ibuprofen Indomethacin Meloxicam - COX2 more selective Nabumetone Naproxen
COX-1/2 inhibitors
SE: acute renal failure, acute interstitial nephritis, fluid retention, aplastic anemia
MC: Gi upset
Zonula occludens
tight junctions
claudins, occludens
Zona adheres
intermediate junctions
-basal layer
link actin cytoskeleton of neighboring cells
-e-cadherins (Ca2+ dependent)
Macula adherens
desmosome
desmoglein
resist shearing forces
simple and stratified epithelium, muscle cells
gap junctions
cardiac cells
Hemidesmosomes
connect to BM
integrins
HLA-B27
seronegative spondyloarthropathies
“PAIR”
HLA-DR3, -DR4
T1DM - autoimmune destruction of beta cells
Branches of Celiac Trunk
- Left gastric A.
- Splenic A. - large, tortuous
- Common hepatic a.
a. gastroduodenal a.
- -i. right gastro-omental A to greater curvature
- -ii. anterior superior pancreaticoduodenal a. to anterior head of pancreas and proximal duodenum
b. right gastric a.
c. proper hepatic a.
- -i. right hepatic
- —a. cystic a
- -ii. left hepatic
Physiologic Dead space
anatomical dead space - air in airways
Functional dead space (e.g. apices)
-capable of gas exchange but no gas exchange occurs
Vd = Vt x (PaCO2 - PexpCO2)/PaCO2
dead space = tidal volume x percent of tidal volume in dead space
Label lung volumes diagram
page 452
Draw Out Coronary Artery Anatomy
Page 209
Right coronary A branches: -SA nodal branch -R. marginal branch of RCA -80% AV nodal branch, Posterior interventricular branch “right dominant”
Left coronary A branches:
-Anterior interventricular branch (aka LAD)
-Circumflex branch of LCA
-20% AV nodal/Posterior interventricular branch off circumflex
“left dominant”
Potter sequence
Failure of ureteric bud to develop
-> b/l renal agenesis
“POTTER” Pulmonary hypoplasia Oligohydramnios Twisted skin Twisted face Extremity deformities Renal agenesis
Horseshoe kidney
Inferior pole fuses -> U shape
Stuck on IMA – low in abdomen
Assoc w/ turners syndrome
