Anatomy Review Flashcards
Presence of hemivertebra
Possible cause of scoliosis
Spinal tap (layers penetrated)
- Skin
- Superficial Fascia
- Supraspinous ligament
- Interspinous ligament
- Ligamentum flavum (first pop)
- Epidural space (stop here for anesthesia)
- Dura mater (second pop)
- Arachnoid mater
- Subarachnoid space
Cleft lip
Failure of fusion of the medial nasal and maxillary processes
Tx: Surgery
Cleft palate
Failure of fusion of the maxillary processes; occur posterior to the incisive foramen
Tx: Surgery
Malformation of nasolacrimal duct
Cords that connect the lacrimal sac to the nasal cavity fail to form
=»Continuous flow of tears down the face
Thyroglossal duct cysts
Cystic tissue develops in the duct that the gland descends thru (from the foramen cecum to the cricothyroid region); presents as a midneck mass that moves with swallowing
Treacher-Collins Syndrome
Failure of neural crest cells to migrate from the first brancial arch
Causes mandibular hypoplasia, conductive hearing loss, and facial malformation
Tx: Surgery
First Branchial Arch Derivatives
CN: V
Bones: Malleus, incus
Ligaments: Anterior ligament of the malleus, sphenomandibular ligament
Muscles: Muscles of mastication, tensor tympani, tensor palati, mylohyoid, anterior belly of the digastric
Second Branchial Arch Derivatives
CN: VII
Bones: Stylohyoid, stapes,
Ligaments: Stylohyoid ligament
Muscles: Muscles of facial expression, stepdius, stylohyoid, posterior belly of the digastric (“S’s)
Third Branchial Arch Derivatives
CN: IX
Bones: Greater horn (upper half) of the hyoid
Muscles: Stylopharyngeus
Fourth Branchial Arch Derivatives
CN: X
Muscles: All the muscles of the larynx, the pharynx (ex. stylopharyngeus), and the soft palate (ex. tensor palati)
Fifth Branchial Arch Derivatives
CN: XI
Muscles: SCM, Trapezius
First branchial cleft/pouch derivatives
Auditory tube, tympanic cavity, the ***tympanic membrane
*Can form cysts near the external auditory meatus anterior to SCN
Second Branchial Cleft/Pouch Derivatives
Crypts of the palatine tonsils
*Cysts near the tonsils (MCC of branchial cysts)
Third Branchial Pouch Derivatives
Inferior parathyroid glands, thymus
Fourth Branchial Pouch Derivatives
Superior parathyroid glands, C-cells of the thyroid
Fracture of the cribiform plate
Produces continuity b/w subarachnoid space and the nasal cavity
=» Leakage of CSF from the nose; possible lose of smell since CN I travels thru the cribiform plate of the ethmoid bone
Fracture of the cribiform plate
Produces continuity b/w subarachnoid space and the nasal cavity
=» Leakage of CSF from the nose; possible lose of smell since CN I travels thru the cribiform plate of the ethmoid bone
Cavernous sinus thrombosis
Structures passing thru include CN III, IV, V1, V2, VI and ICA
- Possible spread of infxn thru this area
- Sx include diplopia and engorged retinal veins
Calcification of the arachnoid villi
Communicating hydrocephalus; usually occurs in the elderly
Damage to superior gluteal nerve
Trendelenburg gait; damaged gluteus medius and minimus
- Hip will fall down towards injured side when noninjured leg is lifted
- think of this if anyone puts a shot in someones butt
Fracture in neck of the femur
Avascular necrosis of the head of the femur (damaged medial circumflex)
-Leg will be rotated laterally and appear shorter; needs hip replacement
Ankle sprain
Excess inversion damages the anterior talofibular ligament and the calcaneofibular ligament
Pott’s Fracture
Excess eversion of the ankle produces a tibia and fibula fracture due to strength of deltoid ligament
Erb-Duchenne Palsy
Damage to the upper trunks of the brachial plexus; possibly due to excess traction on the head during childbirth
-Arm is medially rotated and extended
=»Due to loss of lateral rotators of arm and flexors (musculocutaneous nerve)
Klumpke’s Palsy
Excessive abduction of the arm causing lower trunk damage (C8, T1)
- Pt. will present with a claw hand due to unopposed action of flexors (unopposed median nerve action)
- Loss of cutaneous innervation of the arm and forearm (damaged ulnar nerve)
Radical mastectomy OR Knife wound to lateral chest
Winged Scapula
- Pts. can also not raise their arm over their head
- Damaged long thoracic nerve
Fracture of the neck of the humerus
Axillary nerve damage
-Loss of sensation over shoulder; inability to abduct arm past 15 degrees
Damage to radial nerve in the axilla
Saturday Night Palsy
-Loss of extension at elbow (damage to triceps), loss of extension at wrist (wrist drop), loss of sensation on the posterior arm and forearm
Fracture of the midshaft of the humerus
Pure wrist drop with lost of sensation of the posterior hand
-May also have damage to the brachial artery
Supracondylar fracture of the humerus
Weak flexion of the wrist due to damage to the median nerve; loss of finger flexion of the first 3 digits; thenar atrophy
-Loss of pronator teres as well =» supinated hand
“Hand of benediction”
Damage to the ulnar nerve at the medial epicondyle
Loss of sensation in lateral 2 fingers, loss of interosseus muscles, some loss of finger flexion (Claw-hand)
Corpus cavernosum
Contains deep artery of the penis and becomes engorged with blood mediating erection
Ejaculation
A sympathetic action, unlike erection, that compresses the ductus deferens, seminal vesicle, and prostate gland to eject semen into the urethra
-Mediated by the pudendal nerve
Pudendal nerve block
Palpate ischial spine thru the vaginal wall and insert the anesthetic just medial to it
-But, you can damage the inferior pudendal artery so careful ya dingus
Problems with urination and defecation after childbirth
Torn perineal body/ episiotomy gone wrong
Cystocele
Herniation of pelvic organs due to damaged pelvic floor muscles
Varencicline
Partial Nicotinic agonist that doesnt cause euphoric effects but also prevents withdrawal
High altitude adjustments
Decreased PaO2 ➡️ Increased firing of the carotid body stimulating respiration
-Will eventually cause a metabolic alkalosis (compensated after 48hrs)
Decreased PaO2 will remain tho
Other findings: ⬆️ 2,3 DPG
⬆️Hb prod.
⬆️ VEGF
Hemoconcentration
DOC for PTSD
SSRIs
Slow pain nerve fibers
IV (c)
-un myelinated
Fast pain nerve fibers
A-delta
-touch, pressure, temperature, fast pain
Merkel discs
Unencapsulated, light touch receptors
MC spinal cord tumor
Ependymoma; look for the perivascular pseudo rosettes on histo
failure of the choroid fissure to close
Coloboma iridis
Hydrocephalus ex vacuo
Appearance of the ventricles following degeneration of the caudate nuclei
(In Huntington’s usually)
Subfalcine herniation
Herniation of the brain under the falx cerebri
-May cause headache or compression of the ACA
RCC origin
Proximal tubular cells
MC GI abnormality assoc. w/ Down’s
Duodenal atresia
Aneurysm of the PCA
Second most common site in the circle of Willis
=» decreased perfusion of the thalamus and hypothalamus
Lenticulostriate arteries
MC arteries involved in stroke; are branches of the MCA
-Would damage…
The interior capsule
Caudate nucleus
Putamen
Globus pallidus
Blood supply to the internal capsule
Lenticulostriate arteries and the anterior choroidal arteries
Great cerebral vein of Galen
Drains to the straight sinus
Foramen spinosum
Opening in the skull which allows the passage of the middle meningeal artery
Calcarine artery
Branch of the PCA that supplies the visual cortex
Interomedial cell column
Fond from T1-L3 and contain the synapses for sympathetic fibers
Projection
Attributing undesirable/unacceptable feelings or thoughts to others
Man who wants to have an affair thinks his wife is cheating on him
Social smile
3 months
6 months
Sits up unassisted, turn over, recognize faces
8-12 months
Crawls, stranger anxiety, pincer grasp, simple instruction
12-15 months
Walks, say first words, separation anxiety, object permanence
1.5 years (Ainsley mostly)
10 words, knows name, uses mom as base
2 years
Kick ball, understanding “no”, 2 word sentences and 250 words, parallel play
3 years old
Boy/girl sense, bladder control, talks in understandable sentences
4 years
Cooperative play, imaginary friends, phobias, body curiosity
7-11 years (elementary school)
Identify w/ same gendered parent, same sex play, logical thought, *best age to perform elective surgery
11-14 years
Peers are important influence, personalities become more fleshed, first menses and ejaculation
14-17 years
Body image concerns, identity development, development of abstract thinking
MC age at first intercourse = 16
Difference b/w conditioned and unconditioned response
Unconditioned= natural response (Dwight getting a mint in response to a bell)
Conditioned= Dwight wants a mint when his doorbell rings
Learned helplessness
When someone no longer tries to escape a negative influence
- giving up on escaping new beatings
- famous study was dogs in the pen who got zapped regardless of their actions so they gave up
- is essentially just “being broken”
Most likely ages to engage in risky behavior
14-17; teens
Focus on one part of a toy, impaired communication, lack of fear at the doctor’s office
ASD Level III
Intense interests, abnormal social relationships
Ben Smith (ASD I)
White coat hypertension
HTN in the office but not at home
-Is a type of conditioned response
Inheritable form of Downs Syndrome
46 XX t(14;21)
Robertsonian translocation
Apparent damage to all 3 major spinal tracts
Think Brown-Sequard
Caude equina syndrome
-Usually caused by a nerve root tumor, ependymoma, or even a lipoma of the terminal SC (L3-C0)
Clinical: Distributed in a UNILATERAL, SADDLE-SHAPED AREA
- Severe, unilateral radicular pain
- Unilateral muscle atrophy
***Absent quadriceps (L3-L4) and ankle jerk (S1) reflexes
-Normal continence and sexual fnxn
***Gradual onset
Conus medullaris syndrome
Intramedullary tumor (ependymoma) from ***S3-C0)
Clinical: BILATERAL PAIN and NOT SEVERE in saddle distribution
-No changes in muscles or reflexes
***SEVERELY IMPAIRED SEXUAL FNXN AND INCONTINENCE
***SUDDEN, BILATERAL ONSET
Urachal remnant
May present as urine discharge from the umbilicus (patent urachus), pus and tenderness (urachal sinus), or an intrabdominal cyst
-Results from failure of the duct connecting the bladder and the yolk sac in the developing embryo to completely obliterate
Pancoast Tumor
Tumor on the superior sulcus of the lungs that causes compression of the brachial plexus (arm parasthesias and weakness) and an ipsilateral Horner’s syndrome
SVC Syndrome
Swelling of the face and JVD
-More commonly due to a mediastinal tumor rather than a pancoast tumor)
Opioid painkiller effect
Mu opioid receptors bind to K+ channels and increase their efflux
=»hyperpolarization
Meglitinides
Inhibit pancreatic B-cell K+ channels
=»depolarization and increased release of insulin
-Very similar to sulfonylurea mechanism of action
ANP/BNP signaling
Activates GC =»increased cGMP and vasodilation of the renal artery
=»Increased GFR
Vessel used for CABG when there are multiple blockages
Saphenous vein; commonly accessed in the superficial, medial thigh
-Starts in the femoral triangle (inferolateral to the pelvic tubercle) where it coasts medially down the thigh down anterior to the malleous and along the medial foot
Femoral Triangle
Contains NAVL (nerve not included in sheath)
Borders: Superior= inguinal ligament
Lateral= sartorious
Medial= adductor longus
Fibrous bands connecting the retroperitoneum to the RLQ in a newborn
Obstruct the duodenum and are a sign of midgut malrotation
Aromatase deficiency
Presents in the newborn as ambiguous external genitalia, normal internal (usually female) genitalia
***Also causes MATERNAL VIRILIZATION due to decreased aromatase present in the placenta
GVHD
Immunocomponent donor T-cells attack host MCH-Ags; can occur with liver transplants as well as BM transplants
Clinical: Diffuse maculopapular rash
Diarrhea, abdominal pain
Abnormal liver fnxn tests
Wet beriberi
Chronic malnourishment and decreased thiamine cause
Peripheral neuropathy
AND
Dilated cardiomyopathy (S3, displaced apical pulse, CHF)
Dermatomyositis can indicate what?
Underlying cancer
-Usually ovarian, lung, or colorectal
Diffuse esophageal spasm
Disorganized, non-peristaltic contractions of the esophagus in response to a bolus due to impaired inhibitory neurotransmission
Clinical: Dysphagia
Chest pain/ heart burn
Regurgitation
Confirmatory test for cholecystitis
Hepatobiliary radionuclide scan
-Gallbladder will not be visualized
4 Rules of the brainstem
- 4 structures in the midline that begin w/ “M”
- Motor pathway (corticospinal tract)
- Medial lemniscus
- Medial longitudinal fasciculus (lesion produces internal opth)
- Motor nucleus and nerve (which ones?) - 4 side structures start w/ “S”
- Spinocerebellar pathway (ipsilateral ataxia)
- Spinothalamic pathway
- Sensory nucleus of CN V (altered pain and temp on face)
- Sympathetic pathway (tiny, tiny nucleus next to CN V) - 4 nuclei below the pons, 4 nuclei in the pons, 4 nuclei above the pons
- 4 motor nuclei in the midline are those that divide evenly into 12 (3,4,6,12)
Uniformly enlarged uterus, hypermenorrhea
Adenomyosis
ALA synthase deficiency
Sideroblastic anemia
-Could also occur due to pyridoxine deficiency since ALA synthase requires this B6
Potential severe ADR of bupropion `
Seizure
-Will not cause the usual weight gain or sexual dysfnxn tho
Location of action of HCTZ
Proximal DCT
Repressor protein in the lac operon binds to…
The operator region
- In high glucose conc., there is decrease cAMP and decreased repression of the operon
- Increased binding of the catabolite activator protein (CAP)
BLABS (Li-fraumeni)
Brain tumors
Leukemia
Adrenocortical carcinoma
Breast cancer
Sarcomas
Pulvinar
Largest Thalami Nucleus that fnxns to integrate sensory, visual, and auditory input
Pure sensory loss on a general area
Thalamic stroke; could be in the anterior Choroidal or PCA
Hypothalamic nuclei that synthesizes ADH and oxytocin
Paraventricular Nucleus (gives rise to Neurohypophysis; destruction produces DI)
and the Supraoptic nuclei
Paneth cells
Cells found at the base of small intestinal glands that secrete lysozyme, TNF-a, and defensins (increase bacterial/parasitic membrane permeability)
Secretin
Secreted by S cells and causes HCO3- release from the pancreas
K cells
Secrete GIP which is responsible for oral glucose producing greater insulin response
L cells
Secrete Glucagon-Like Peptide (GIP) that increases insulin secretion
Meissner’s plexus
Found in the submucosa of the intestines
Gushing of fecal material upon DRE of newborn baby
Probs Hirschsprung’s Disease
Adenomatous polyp histology
Torturous glands w/ multiple mitotic figures
Performance anxiety tx
Alprazolam, Lorazepam (short-acting benzos)
Propanolol
Agoraphobia
Fear of being ALONE IN PUBLIC PLACES where rapid exit is unavailable
Dissociative Fugue
Presents as sudden travel away from home w/ loss of autobiographic memory
-Pts. confused about their identity and often form new ones
Person in car wreck with hurt hip
Posterior hip dislocation; hip is driven through the weak posterior ischiofemoral ligament
-Limb appears shortened and MEDIALLY rotated
Injury to inferior gluteal nerve
Weakened gluteus maximus; most notable when someone is climbing stairs or getting up from a sitting position
Torn hamstrings
Avulsed at the ischial tuberosity; weakened flexion of the knee and extension of the hip
-Could also be due to damaged tibial nerve since it innervates the biceps femoris, semitendinosus, and semimembranosus
Femoral hernia danger
Strangulation possible; during surgical repair, also need to pay attention to location of obturator artery
Achilles tendon
Contains insertions for the gastrocnemius, the soleus, and the plantaris if present
Plantar fasciitis
Tenderness at the attachment of the plantar aponeurosis connection at the medial calcaneus
-Common in runners……………
Erosion of a posterior gastric ulcer
Affects the spleen causing referred back pain and possibly the splenic artery causing internal hemorrhage
Sliding hiatal hernia
Cardia slides thru a widened esophageal hiatus with possible compression of the vagal trunks
➡️ hypochlorydia
Inferior pancreaticoduodenal arteris
Come off the SMA and form anastamoses with the superior pancreaticoduodenal arteries
Right hepatic love necrosis post cholecystectomy
Accidental ligation of the right hepatic artery with the cystic artery
Ulcer at the distal duodenum
ZES
DOC for status epilepticus
Phenytoin
Benzodiazepine
Behcet’s syndrome
Aphthous ulcers, genital ulcers, and uveitis
-Generally arises after nonspecific viral infxn
Erythroplakia
Red, vascularized leukoplakia representative of underlying Dysplasia
Hairy cell leukoplakia
White, rough patch on the lateral tongue seen in IC pts; due to EBV related hyperplasia
Pleomorphic Adenoma
MC tumor of the parotid gland; high rate of recurrence due to incomplete revision
- Can transform to carcinoma w/ CN VII involvement
- Is composed of stromal and epithelial tissue
Warthin tumor
Benign cystic tumor of the parotid w/ abundant lymphocytes and ️Germinal centers
-Looks like a lymph node
Location of the common bile duct
Hepatoduodenal ligament
DOC for Tx. Resistant Schizophrenia
Clozapine
Period representing complete ventricular repolarization
ST segment
Monocular scotoma
Small, pinpoint visual field defect caused by macular degeneration or optic neuritis
Porcelain Gallbladder
Often arises due to chronic cholecystitis or cholelithiasis
Micro: Calcified plaques and spotty calcifications
***Increased risk of adenocarcinoma of the gallbladder
IBD associated colorectal carcinoma
- Younger patients
- Flat, non-polypoid
- Early p53 and late APC mutations
- Multifocal
- Proximal involvement more likely
Perfusion-limited respiration
Will see increased PaO2 and decreased PaCO2
Orotic aciduria tx.
Uridine
Diptheria vaccine
Produces IgG against circulating protein (exotoxin)
PRP capsule
VF for Hib, no matter what the pathologic manifestation is
DOC for Tx. Resistant Schizophrenia
Clozapine
Period representing complete ventricular repolarization
ST segment
Monocular scotoma
Small, pinpoint visual field defect caused by macular degeneration or optic neuritis
Porcelain Gallbladder
Often arises due to chronic cholecystitis or cholelithiasis
Micro: Calcified plaques and spotty calcifications
***Increased risk of adenocarcinoma of the gallbladder
IBD associated colorectal carcinoma
- Younger patients
- Flat, non-polypoid
- Early p53 and late APC mutations
- Multifocal
- Proximal involvement more likely
Perfusion-limited respiration
Will see increased PaO2 and decreased PaCO2
Orotic aciduria tx.
Uridine
Diptheria vaccine
Produces IgG against circulating protein (exotoxin)
PRP capsule
VF for Hib, no matter what the pathologic manifestation is
Both eave syndrome
Rupture of esophagus leading to air in the mediastinum; ️Appears widened on CXR
Blood type with increased risk of gastric adenocarcinoma
A
-Also increased risk with chronic h.pylori and nitrosamines
Chronic AI gastritis
Usually affects the body and Fundus; destruction of parietal cells leads to g-cell hyperplasia, Achlorrydia, B12 deficiency, increased risk for Cancer
Double bubble sign
Duodenal atresia
Myenteric plexus cell origins
Neural crest
Coelomic angiodysplasia
Acquired malformation of mucosal capillary beds.
-Presents as hematochezia; involves the cecum and right colon
Serrated appearing polyp on microscopy
Hyperplastic; benign
Polyps with greater risk for malignant progression
> 2 cm big
Sessile growth pattern
Villous histology
Coelomic angiodysplasia
Acquired malformation of mucosal capillary beds.
-Presents as hematochezia; involves the cecum and right colon
Serrated appearing polyp on microscopy
Hyperplastic; benign
Polyps with greater risk for malignant progression
> 2 cm big
Sessile growth pattern
Villous histology
Deep perineal pouch
Contains the sphincter urethrae, deep transverse perineal muscle, and the Bulbourethral glands
-Also the membranous part of the urethra
Superficial perineal pouch
Contains:
Ischiocavernosus- related to the crus of the penis/clitoris
Bulbospongiosus
Superficial transverse perineal muscle- related to the perineal body
Strucutre that keeps urine from entering the abdominal wall after rupture of the spongy urethra
Superficial perineal fascia
Ischiorectal abscess
Surgical emergency occurring due to spread of infection thru the external sphincter muscles into the ischiorectal Fossa
-Must be careful not to damage the pudendal nerve or artery
Lepromin skin test
(+)- indicates Tuberculoid type
-Good immune response; lesions show increased IFN-y, IL-1
(-) - indicates Lepromatous type
-Bad response; lesions are filled w/ bacteria
Important steps of TCA
Citrate =» a-ketoglutarate
NADH
a-ketoglutarate =» Succinyl-CoA
NADH
Succinyl-Coa =» Succinate
GTP
Succinate =» Fumarate
FADH
Malate =» Oxaloacetate
NADH
Filtration of a substance (calculation)
Total filtration = (GFR)(plasma conc.)
Child w/ recently resolved abdominal infxn now presenting w/ oliguria, hematuria, and increased Creatinine
HUS
-AKI occurring due to microangiopathic hemolytic anemia
Diltiazem
Nondihydropyiridine CCB
ADRs: Constipation
Decreased inotropy
Cerebellar hemangioblastomas, RCC, Pheochromocytomas
VHL
-altered chromosome 3p
Area always involved in Hirschsprung’s Disease
The rectum
-Neurons migrate caudally
Biopsy showing large, round yeast cells w/ doubly-refractile wall and SINGLE broad-based bud
Blastomyces dermatidis
-Immunocompetent pt. presenting w/ pneumonia-like sx.
What metabolites will build-up in classic galactosemia?
Galactilol
Galactose-1-phosphate (disease is due to deficient G1P-uridyl transferase)
GI site of greatest lipid absorption
Jejunum
Chronic smoker who comes w/ acute exacerbation of SOB
Possible collapsed lung due to centrally located bronchial tumor
Clinical: Tracheal deviation TOWARDS the lung
Hemothorax opacification; loss of all radiolucent air
Decreased breath sounds
Small Intestinal Bacteria Overgrowth
Bacterial proliferation in the GI tract presenting w/ watery diarrhea and upset stomach
-Can happen after gastric bypass due to increased delivery of nutrients to the bacteria
***Pts. have increased Vitamin K and Folate
Specific sign’s assoc. w/ Grave’s (and not just hyperthyroidism)
Pretibial myxedema
Exopthalamos
Drugs w/ increased HEPATIC clearance
Increased lipid solubility; increased volume of distributino
Drugs w/ increased KIDNEY clearance
Increased water solubility; decreased volume of distribution
Homocystinuria tx.
Pyridoxine; somehow increases CBS fnxn
-Also restrict methionine in diet
Inhaled anesthetic characteristics
Increased plasma concentration of drug means….
Increased blood/gas partition coefficient which means…
Slow onset
K+ and HCO3- in response to insulin
K+ shifts into cells
HCO3- increases due to decreased ketone production
Main cells Gastrin affects
Enterochromaffin cells
-These then release histamine onto parietal cells to induce acid secretion
Chain of lakes pattern on abdominal contrast study
Chronic pancreatitis; forms due to dilatation and Fibrosis of pancreatic ducts from dystrophic calcification
-Same Pathophysiology as PSC
Damaged cytokeratin filaments within hepatocytes
Mallory bodies
Formed due to damage from acetaldehyde from ALCOHOLIC HEPATITIS
Lateral pterygoid
Protrudes the jaw; deviation towards home damaged side with V3 damage
Tonsillar branch of the facial artery
Supplies the tonsils; can be damaged during tonsillectomy
Gag reflex
Afferent: CN IX
-damage to this nerve results in loss of reflex
Efferent: CN X
Blow out fracture of the floor of the orbit
Damages the inferior rectus muscle, the Infraorbital nerve (V2), and the Infraorbital artery
Dangers of otitis media
Spread posteriorly ➡️➡️ mastoiditis
Spread thru middle cranial Fossa ➡️➡️ temporal lobe abscess, meningitis
Spread inferiorly ➡️➡️ Sigmoid sinus thrombosis
Muscle damaged by recurrent laryngeal nerve damage
Posterior cricoarytenoids
-normally abduct the vocal cords allowing for speech
Axillary sheath
Investing fascia of the brachial plexus and the subclavian artery as they emerge from the scalene muscles and continues until the axilla
-Derived from the prevertebral fascia
Menetrier disease
Hyperplasia of gastric mucosa with excess mucous production
Rugae are enlarged and parietal cells atrophy
⭐️ Stomach looks like a brain on CT
-Precancerous condition
MCC of small bowel obstruction
Adhesions; due to surgeries
Serrated polyp
Possibly pre-malignant
- Mutations in BRAF and via CpG hypermethylation
- Could also just be the histo of a hyperplastic polyp
Zone III of the liver
Affected in alcoholic hepatitis, ischemia, metabolic toxins
-Contains cytochrome p450 system
Host defense against Candida
Superficial infxn: mediated by Tcells
⭐️ Disseminated infxn: Prevented by PMNs
Diplopia, dysphagia, Dysphonia
Symptoms of botulism
-Repeated nerve stimulation will finally cause contraction of muscle
Aspirin OD tx.
Alkalinize the urine; changes aspirin to its A- form trapping it in the tubules
Pt. w/ symptoms of CN III damage BUT have normal pupil size and reflexes
Ischemic nerve damage to CN IIII; only damages the CORE of the nerve
-Autonomic part of CN III that mediates pupillary constriction and accommodation is located PERIPHERALLY
Screening test for hypothyroidism
TSH
Chorda tympani contains what nerves?
V3
Part of the spine involved in RA
Cervical spine
Part of the spine involved in osteoarthritis
Lumbar
Part of the spine involved in HLA-B27 disorders
Sacroiliac
Hydronephrosis changes to the kidney
Produces atrophy and scarring of the parenchyma due to increased hydrostatic pressure
Thyroid Peroxidase
Oxidizes iodide, iodinates TBG, and couples iodized tyrosine residues
-PTU inhibits all of these
Time for irreversible injury in myocardial ischemia
30 mins
- Will see an immediate decrease in contractility tho
- If less than 30 mins, myocardial stunning still occurs so itll take a while to get back into the swing of things
Chronic PPI used can cause…
Osteoporosis
Child with an enlarged tongue, gray-white pharyngeal exudate, circumoral pallor, and rash on the neck spreading to the trunk
Scarlet fever
-Strep. pyogenes
Stenosis of the subclavian artery
Leads to Subclavian Steal Syndrome
-Blood flows up the contralateral vertebral artery and comes back down the ipsilateral artery to supply the limb
Clinical: Arm ischemia
Vertebrovascular insufficiency (vertigo, drop attacks)
Transpeptidase
Bacterial protein that crosslinks D-ala-D-ala residues to form cell walls
-Penicillins mimic D-ala-D-ala in order to bind and inhibit transpeptidase
Reducing Central Venous Catheter Infxns
Use alcohol to sterilize hands
Sterilize site w/ chlorhexidine
Maximal barrier protections
Use subclavian/jugular vein
Prompt removal (doesn’t need switched unless signs of infxn)
Renal Ammoniagenesis
Glutamine =» Glutamate + NH4 + HCO3-
NH4 is excreted and HCO3- is reabsorbed during acidosis
Pulmonary sx. of CREST syndrome
Pulmonary HTN due to increased TGF-B causing intimal fibrosis of the vessels
=»signs of right heart failure
Diabetic pt. w/ severe diuresis and comma
Hyperosmolar non-ketotic coma
-Increased glucose osmotically draws H2O into the tubule
Liddle Syndrome
Decreased degradation of Na+ channels in the collecting tubules
Clinical: HTN, hypokalemia, metabolic alkalosis
Tx: Amiloride; triamterene
***Mimics hyperaldosteronism
