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1 IMPORTANT POINTS:: U need to memorize some of the important values..like: Serum ca,k,cl,na,hco3,phosphorus,magnesium..anion gap,ph. ABGs(arterial blood gases):Po2,Pco2,O2 saturation. Gh,serum osmolarity,urine osmolarity. BUN,Uric acid,creatinine,albumin,bilirubin(direct,idirect). Protein in urine. Alt,Ast,amylase.cholestrol,glucose. Esr,pt,apt,fibrinogen,platelet count. Mch,mchc,mcv. Hb,retic count,hct and erythrocyte count. CSF R/E ……………………………………. Important topics: -Opening in diaphragm. -Respiratory capacities. -celiac truk and branches -type of hyaline cartilage -cns recepters -epithelium -pharyngeal pouches,clefts -epithelium derivatives -skull foramina -cytochrome inducers and inhibitors. -heart blood supply -page 600 azim shaikh -dna and rna viruses -bones of hand -purines and pyrimidines -ulcerative colitis and crohn’s -tumor markers -type of errors—biostat -reflexes values -age related type of meningitis -cardiac enzymes -carotid sheath content -chemorecepter and baroreceptor -hormones second messengers -T and B cells’ CD numbers -Amino acids derivatives -Glycogen storage diseases -joint classifications. -cartilage types(hyaline,fibrocartilage,elastic ---examples) -bones classifications -thirst is stimulated by: 1. increased ECF osmolarity. 2. decreaded volume of ECF. 3. Angiotensin III -Median nerve: >Descends on Lateral side of axillary and brachial arteries. >Enters palm Behind the flexor retinaculum. >supplies most of the flexors of the forearm(arm flexors supplied by musculocutaneous nerve) >supracondylar fracture cause median nerve injury---------apelike hand deformity 2 -Ulnar nerve: >Descends on Medial side of axillary artery and brachial artery. >passes behind Medial epicondyle of humerous. > enters palm anterior to the flexor retinaculum. >injury leads to claw deformity. Radial nerve: -Descends Infront of lateral epicondyle. -supplies extensors of arm and forearm. -lesion causes wrisr drop. Axillary nerve: -passes through Quadrangular space. -lies against surgical neck of humerus. -lesion wil cause paralyzed deltoid and loss of cutaneous sensation over lower 1/3 of deltoid region. -chlorpromazine can cause parkinsonism -parkinsonism is aggrevated by Haloperidol -Digoxin toxicity can increase by chlorothiazide -centraly acting antihypertensive is methyldopa -Serotonin is secreted from carcinoid tumor which is responsible for sign and symptoms. FOOT everters and inverters: Inverters: -tibialis anterior -tibialis posterior Everters: -peroneus longus,brevis and tertius -Granulation tissue in MI appears within 9-10 days and becomes prominent within 2-3 weeks. Conducting system blood supply: -SA node__RCA(sometimes LCA,but mainly RCA) -AV node__RCA -AV bundle__RCA -RBB__LCA -LBB__RCA+LCA ECG diagnosis of MI: A.Anterior wall(LAD):v1-v4 1.anteroseptal__LAD (v1-v2) 2.anteriolateral__LAD or LCX(v4-v6) B.Lateral wall(LCX)__I,aVL C.Inferior wall(RCA)__II,III,aVF -posterior interventricular artery accompanies middle cardiac vein -Anterior interventricular artery is accompanied by great cardiac vein. _heparin____monitor aptt _warfarin___monitor pt -on contraction of diaphragm the intrathoracic pressure decreases. 3 _Lateral horn is present in T1-L2 _Dorsal colums present only above T5 _Large ventral horn is present in (C5-T1+L2-S2) -Eosinophilia present in: hodgkin lymphoma and polyarteritis nodosa. -PGI2__by endothelial cells -TXA2__by platelets Blood transfusion induced electrolye embalance is as follows: -hypocalcemia -hyperkalemia -hypothermia -metabolic acidosis -left shift of oxy-hem curve *common peroneal nerve injury__loss of everion and dorsiflexion *Tibial nerve injury__loss of inversion and planteflexion. -pelvic parietal peritoneum is supplied mainly by Obturater nerve. Lymph drainage: *labia majora and glans penis---superior inguinal L.N *cervix—internal and external iliac L.N *prostate__internal iliac L.N *Urinary bladder__internal and external iliac L.N -allantois__Urachus__median umblical ligament -Somatotropic (acidophilic) adenoma__gigantisim -corticotropic (basophilic) adenoma__cushing disease -prolactinoma---acidophil(30%) -GH adenoma—acidophil -ACTH adenoma---basophil -TSH adenoma—basophil(chromophobe) *in axila—cords of brachial plexus *base of neck----roots *posterior triangle of neck---trunk and division *detoxification of drugs---ESR -Boat shaped cyst—pneumocystis carnii -Epidural __middle meningeal artery -Subdural__superior cerebral vein TYPHOID fever investigations: -1st week____blood culture -2nd week___antibody/widal -3rd week___stool -4th week___urine culture -vit b12 absorbed from terminal ileum -middle rectal artery remains in true pelvis -renal medullary rays—collecting ducts 4 -Anxiolytic effect by GABA -lipid which does not contain glycerol is sphingomyelin -taste fibers from anterior 2/3 tongue passes thru internal capsule -for controlling tachycardia;; Amiodarone>lidocaine>procainamide -glucose transported mainly by facilitated diffusion -amino acids—Na cotransport -sarcoma—hematogenous -carcinoma—thru lympatic -night terrors happens in NON-REM -nightmares happens in REM -glutamate for fast pain fibers -substance p for slow fibres -glutamate released by rods and cons -blood brain barriers made by astrocytes -fungiform—salty and sweet -foliate---sour taste -circumvillate—bitter taste Stretch reflex: -monosynaptic -Ia fibers affected - alpha motorneurons Inverse muscle stretch reflex: -Disynaptic -Ib fibres -gamma motorneurons -Golgi tendon organs -Horner’s syndrome happens if lesion above T1 -in the cerebellum..granule cells is the only excitatory neurons while all others are inhibitory -trouble going downstairs==Trochlearnerve damage -trigeminal neuralgia—v2+v3 -Glossopharyngeal nerve supplies carotid body and parotid gland -loss of accommodation causd by damage to midbrain -lesion to pretectum leads to loss of reaction to liht but intact accommodation -liquid dysphagia is due to neuromuscular incordination -study brain stem lesions very well..for example medial medullary syndrome..etc -nuclei which lies beneath the fourth ventricular floor: Vestibular,vagal,abducent,hypoglossal. 5 -spinal cord ends: *in infants:L3 *in adults:lower border of L1 -Subarachinoid space ends at (S2-S3) -internal capsule---projection fibres -at the level of superior colliculus—occulomotor nerve nucleus-midbrain—red nucleus -genu+anterior 2/3 of posterior limb-----------------motor -increased plasma osmolarity stimulates osmorecepters in anterior hypothalamaus. -intestinal cells of kajal are the pacemakers of GI smooth muscles. -vommiting and swallowing centres is in the medulla -most colonic water absorption occur in proximal colon -in multiple myeloma,the alkaline phosphatase is not increases. -tight junction in colon -leaky junction in small intestine and gall bladder -cryptsecretion -villiabsorption -ABO incompatability in infants: *O motherA orB baby *A motherB or AB baby *B motherA or AB baby -progesteron is reason behind increased temperature during ovulation -Fibroadenomanot precursor of CAbelow 25 yr -Fibrocystic changesprecursor fro CA20-50 yr -Granulosa cell tumorcall exner bodies -Dysgerminomashriler duval bodies --in renal failure: *early stage—dilute urine *late stage____concentrate urine -fat absorption occur primarily in jejunum -oblique fissure extends from T3—6th costal cartilage on both lungs -groove for subclavian artery is at first rib. -azygos vein enters thorax inlet -right middle lobe has 2 bronchopulmonary segment -diaghragm is not attached to T 10 -Tendon of popletial muscle is intracapsular -DIFFICULTY in: *flexing knee and thighsartorius *flexing knee and extending hipsemitendinous *flexing hip and extending kneerectus femoris -Conus medullaris is pial extension to the coccyx -revise muscles of laryns..narroeing,widening,tensing vocal cord…etc -absorption of short chain FFA happens in colon -osteosarcoma in metaphysis -occulocardiac reflex mediated by trigeminal 6 -thyroid derived from endoderm -albumin has low molecular weight and high concentration -amoebic abcess occur in Cecum>ascending colon>sigmoid >rectum -somites are present in paraxial mesoderm -strongest layer in small bowel in circular layer -embryonic primary vesicle is mesencephalon Lymph drainage of -lateral handinfraclavicular -medial handepitrochlear -lateral ventricle roof formed by body of corpus callosum -dermatome of perineal region is S3S4 -CVAheart sounds in JVP C wave first sound V wave 2nd A wave 4th -in cell cycle: Replicationinterphase Divideprohase Align 2 chromosomesmetaphase -noradrenaline and serotonin metabolized by MAO -adrenaline by COMT -liver makesfactors 1,2,7,9,10 but not 4(calcium) -connections of cerebulum *cerebellum to midbrain through superior cerebellar peduncle<SCP> *cerebellum to pons through MCP<middle> *cerebellum to medulla through ICP<inferior> -narcolepsydefect in hypothalamus -U wave in papillary repplarization Pt had ankle sprain: -if pt can stand on toerupture of plantaris tendon -if cannot stand on toerupture of achiles tendon HEARTSOUNDS ■S1: ●Short pitch///frequency. ●Long duration ====0.14 seconds. ●Formed by===AV VALVES CLOSURE >>>Mitral valve=== Best heard at apex///5th Left ics////9cm left Lateral to Sternum. >>>Tricuspid valve===== 4th left ICS near to Sternum. (Some references say right 4th ics). ●Splitting ===mostly pathologic due to early MV valve closure due to inspiration which delays tricuspid valve closure. 7 ■S2: ● High frequency ////pitch ●Short duration (o.11--.14 second ) ●Sharp sound ●Intensity///sharpness due to Tautness of A & P valves ●Splitting===mostly physiological Due to early Aortic valve closure. ●Aortic valve===Best heard at right 2nd ics. ●pulmonary valve===Best heard at left 2nd ics. ■S3: ●Formed by PASSIVE VENTRICULAR FILLING ●Normal in children, Adolescent, pregnancy ●Abnormal in adults= IHD (MR,TR=== pansystolic murmur )))) ■S4: ●Formed by ACTIVE VENTRICULAR FILLING. ●By atrial contraction against hypertrophic left ventricle in HCM. ● Coincides with A wave of jvp///P wave of Ecg. ●Abnormal mostly ●can't be heart in AF. "Storage of different blood products"! Whole blood is stored at 4° C for 3 weeks. Packed cells (RBCs) are stored at 1-6° C for 35 days. FFP (fresh frozen plasma) and cryoprecipitate can be stored at -40° C for 2 years. Platelets are stored at 22° C for 5 days.