test #34 4.22 Flashcards
3 determinants of malignant potential of an adenomatous polyp
- size (> 4cm have 40% risk of malignancy
- histology: villous more prone to be malignant than tubular
- degree of dysplasia
bell curve: what %age of population falls in 1 standard deviation? 2? 3?
1 standard deviation = 68%
2: 95% (2.5 below, 2.5 above)
3: 99.7
where is CCK made
I cells of duodenum and jejuneum.
increase pancreatic enzyme secretion and gallbladder contraction
decrease gastric emptying
where is vasoactive intestinal peptide made?
pancreas & parasympathetic ganglia
stimulates intestinal water secretion, counteracts gastrin, promotes bicarb secretion for pancreas
classic galactosemia is inherited as..
autosomal recessive
lack galactose-1-phosphate uridyltransferase
3 steps of deglutition (swallowing)
- oral: voluntary
food bolus collected at back of mouth, lifted upwards to posterior wall of pharynx - pharyngeal, involuntary
pharyngeal muscle contractions propel food bolus to esophagus - esophageal phase
- enters & stretches walls. peristalsis begins above site of distention and moves food down.
difficulty swallowing “felt at the throat”
cricopharyngeal muscle dysfunction. diminished relaxation of pharyngeal muscles during swallowing.
how does cricopharyngeal muscle dysfunction lead to zenker diverticulum?
diminshed relaxation of pharyngeal muscles during swallowing demands more force to move food bolus down.
more intense contraction of pharyngeal muscles –> increase oropharyngeal intraluminal pressure.
eventually, pharyngeal mucosa herniate through muscle fibers in zone of weakness (posterior hypopharynx).
only mucosa –> FALSE / pulsion (as opposed to all walls of organ –> true / traction)\
can lead to aspiration of food – bc food stuck in diverticulum high up
can be palpated as lateral neck mass
mediastinal lymphadenitis (TB, fungal) can lead to what esophagus problem
scarring & traction –> true diverticula, mid portion of esophagus
hemoglobin synthesis in fetus (4)
yolk sac, liver, spleen, bone marrow.
liver begins HbF 10-12 wks of gestation –> spleen –> bone marrow.
when does HbF transition to HgA?
HbF (a2y2) –> HbA (a2b2) during first 6 months.
a2d2 (HbA2)
normal variant of human hemoglobin. 2-5% of adult hemoglobin
hemoglobin gower (z2e2)
earliest hemoglobin in fetus.
synthesized in yolk sac, replaced by hemoglobin portland –> hemoglobin gower 2 –> hemoglobin F (10-12 wks)
hemoglobin bart
gamma4.
no alpha made.
alpha thalaseemia.
high affinity for oxygen, never gives it up, get hydrops fetalis
muscles that attach to clavicle
- pec major (inferomedial)
- deltoid (inferolateral)
- subclavius (inferolateral)
- trapezius (superolateral)
- sternocleidomastoid (superior medial aspect)
where does sternocleidomastoid articulate
3 points:
manubrium, medial clavicle, and mastoid
rhomboid muscle articulation
vertebral bodies to medial border of scapula
pec minor articultation
3-4th rib, insert on coracoid process
serratus anterior
1-8th rib, insert on medial border of scapula
subclavius muscle
originates on 1st rib, inserts on inferolateral aspect of clavicle
floor of anatomical snuff box
scaphoid and trapezium
dupuytren’s contracture
benign, slowly progressive fibroproliferative disease of palmar fascia.
as scarring progresses, nodules form on palmar fascia, fingers gradually loose flexibility, eventually resulting in CONTRACTURE that draws fingers in FLEXION
celiac comes out at what vertebral level? SMA & renal artery? IMA?
celiac: T12
SMA & renal: L1
IMA: L3
transverse duodenum lies at what vertebral level?
L3, between aorta and SMA (can be compressed)