Download Insulin deficiency disorder

MICRO:
Gram Positives:
Staph Aureus – Grapes of Staph (clusters)
Scalded skin syndrome (exfoliating)
Impetigo – drinking fountain (a fomite) – crusty honey colored lesion – pruitis (itchy)
Bacillus Antracis
Anthrax, Woolsorter’s Disease – from shearing sheep – other hoofed animals
Clostridium Botulinum
Botulism, flaccid paralysis – A Neurological Disease Cause – boil @ 120 degrees for 20
minutes.
Clostridium Tetani – Rusty Nail
Tetanus (lock jaw (trismus)), spastic paralysis
2/20/04
Food Poisoning:
Staph aureus – gram positive – 2-4 hours
Salmonella – gram negative – 12-48 hours >2000 varieties of salmonella
Pea soup diarrhea
Clostridiums – gram positive – 18-36 hours
Neurological (ptosis of eyelid, lip, face, etc.)
Mycobacterium is rod shaped. Gram positive.
TB is on the rise in the US.
Ghon complex in TB (lung) – single coin lesion
Lowenstein-Jensen Medium
Acid-fast stain.
Streptococcus Pyogenes (group A) – Chain – Hospital staff has staph.
Rheumatic fever – Jones Criteria
SPECS –
Sydenham’s Chorea
Polyarthritis,
Erythema marginatum
Carditis
Subcutaneous nodules
Also affects Kidney
Scarlet fever, DICK test, strawberry tongue
Scarlet O’Hara says to Rhet: “Oh, Rhett, you’re such a DICK…test”
Cornebacterium Dipheria
Aka Babes Ernst bodies, SCHICK Test
DPT vaccine (P has been removed)
Peptidoglycan cell walls in gram positives
Polysacharide cell walls in gram negatives.
Neisseria gonorrhea – diplococci (coffee bean shape)
Copious amounts of discharge – arthritis in the knee – can bee seen on darkfield
Microscope.
Neisseria Meningitidis
Ortho/Neuro tests – Brudzinski and Kernigs
Pseudomonas aeruginosa
Blue/green pus, burn infections – blue happens first, green happens next.
E. Coli – traveler’s diarrhea
Shigella – no fever – tenesmus (painful, ineffective, straining at the stool).
Yersinia Pestis
BUBONIC Plague (Black Death)
Carried on rat fleas.
Brucella abortis – chills, weakness, aching, sweating.
Brucella bordetella (pertussis)
Brucella FRANCISELLA “Rabbit fever” – tularemia
Elmer Francis is a Rabbit hunter
Salmonella typhi – typhoid fever – WIDAL test
Vibrio Cholera – John Snow - ,,, shaped. – rice water stools. Poop in the snow.
Rice water stools are made of mucous and water.
Dehydration.
Haemophilus – meningitis – exception to the us/um rule.
Chlamydia PSITTACI
Ornithosis – birds and parrots – they psittaci on your head.
Chlamydia Trachomatis – most common std in us.
Reiter’s – can’t see, can’t pee, can’t dance with me.
Rickettsia rickettsii – RMSF – tick fever/tick typhus – tick’s name is ixodid.
Rickettsia prowazekki – prolonged high fever, headache, maculopapular rash (pink >
dark > ulcerates) Epidemic typhus.
Rickettsia Typhi – later Brill-Zinsser Disease.
Rickettsia tsutsugamushi – scrub typhus – macular (no ulceration)
Chiggers
Rochalimaea quintana – trench fever
Coxiella Burnetii – carol burnett – Q fever
Treponema pallidum – floureses green
VDRL – vanerial disease research laboratory
FTA-ABS – florescent treponema antibody absorbsionometry
1st stage – Chancre on your wanker
2nd stage – Rash – most contagious stage
3rd stage – Gumma – brain
Tabes dorsalis, Argyll Robertson pupils (accomodates but doesn’t react)
Treponema pertenue – YAWS – causes ulcers on extremitries.
Borrelia REcurrentis - give RE –lapsing fever.
Borrelia Burgdorferi – lyme disease, deer ticks, bull’s-eye rash (erythema migrans)
Joint pain, headaches, for the rest of your life.
Leptospira Interrogans – WEIL’S Syndrome – rats pee on the top of the cans.
Nosocomial – hospital borne
Vector – “thing” that transmitted the bug
Fomite – object that transmits infection.
Ringworm of scalp – tidia capitis
Ringworm of body – tidia corpus
Ringworm of hand – tidia manum
Ringworm of foot - tidia pedis
Ringworm of legs – tidia crura
Ringworm of toenails – tidia ungium
Ringworm of beard – tidia burbur
2/23/04
Mumps virus – paramyxo- SS RNA – Orchitis (testicles) or Oophoritis (ovaries)
Hepatitis B virus – Blood borne – hospital workers
Rubella virus – German Measles – Rubella (Rubella has two Ls, German Measles is two
words). (Pregnant women in first trimester – aka “three day measles”)
Small pox has been irradicated since the 1980s.
Varicella-Zoster – chickenpox, shingles (hides in genome of DRG) – as soon as a month
after chickenpos. Post herpatic neuritis for up to 2 years.
Epstein-Barr Virus (EBV) – Infectious Mononucleosis (Downey cell) “Don’t let Mono
get you Downe”
HIV I & II – AIDS, ARC (AIDS Related Complex) – Ora-Sure test
Two ELISAs and then a Western Blot
Dengue – mosquitoe – “Dang that mosquito”
Yellow Fever – Aedes Aegypti mosquito
Walter Reed
Walter Reed
Molluscum contagiosum – multiple skin tags on the genitals
Poliovirus – Pocorna family – Iron Lung
Rabies virus – Causes rabies, Negri Bodies (post mortem in the brain)
Arboviral Encephalitis Virus – Toga, Bunya families, SSRNA, Eastern or Western
equine, St. Louis, Venezuelan’s, or California group; Vector – mosquito
Tests:
TB
TINE, Mantoux, Calmette-Bacille-Guerin (CBG) test
Scarlet Fever DICK
Diptheria
Schick “Dip our Schick”
Mallory bodies – Alcoholic hepatitis
Lewy bodies – Parkinson’s
Guarnieri Bodies – Small Pox
Wassermann Test – Syphilis
Philadelphia Chromosome is pathogneumonic for CML
Langhan’s Giant Cells – TB
Helminths – Nematodes:
Trichuris trichiura (WHIPWORM) “tricky-tricky whip whip”
Enterobius Vernicularis (Pinworm)
Necator americanus – anemia “hook an american and bleed ‘em dry”
Wcheria Bancrofti – mosquito bite – block lymphatic ducts in lower extremities, elephantitis, filariasis
Onchocera volvulus – River Blindness – Black Fly –
Dracunculus medinesis – Fire Worm
Opisthorchis sinensis – consumption of fish
Paragonimus westermani – consumption of crabs
Taenia Saginata – Sagging Beef
Taenia Solium – pork’s got soul
Echinococcus granuloses – doggy – canine feces
Trophozoite – during the feeding stage
Giardia Lamblia “camper’s diarrhea” – diarrheal disease, malabsorption, flagellates in
stool
E. Coli – traveler’s diarrhea
Pneumocystic carinii (now known as a fungus) – but is a protozoa – AIDS patients
Plasmodium Falciparum – Malignant tertian malaria – anopheles mosquito
Sporozoit from mosquito becomes a marazoit in the liver.
Black-Water Fever – pee is dark red or black
Trypanosoma brucei, rhodesiense, gambiense – African Sleeping Sickness – Tsetse fly
“Tsetse makes it sleepsy”
Trypanosoma Cruzi “Chaga went on a cruize to get a kiss from Reduvid bug”
Toxoplasma gondii – Tosoplasmosis – Cat Feces – could be fatal to fetus.
Epidemiology:
Prevalence - # of cases of disease present in a population at one point in time.
Endemic – present in a community at all times.
FDA: Safety of foods and drugs
EPA: controls drinking water at home.
Most common urban pollutant – CO – generated by car exhaust
Lead poisoning – Pb (lead) – Old paint / Old pipes / Old dishes – person get plumbism
(purple stripe along their gumline).
Sewage: Primary treatment: “Physical” – primary
Screens and filters: For Sedimentation
Anaerobic bacteria: For Sludge “Floculation removes particles”
Secondary Treatment: Microbial
Aerobic bacteria: For Sludge
Tertiary Treatment: Chemical
Turbidity = cloudiness/thickness
Pasteurization: Milk, juice & wine
Autoclave = high temperature + high pressure (dentist cleaning tools).
2/19/04
CHEMISTRY
Enzymes – end in “ase” – most are proteins and most require water.
Function: Speed up reactions
Specific: ONE reaction only
Reaction types:
catabolic: Breakdown, generates energy
anabolic: (Arnold) build-up, NEEDS energy
Binding site: where substrate attaches.
Cofactor (metal ions – Zinc): Enzyme + Cofactor = Holoenzyme (the whole thing)
Enzyme without cofactor = Apoenzyme
 NAD breaks – NADH builds molecules (H builds a House)
*Kinase – Transfers a PHOSPHATE (usually from ATP) eg: Hexokinase
SGPT – same as ALT (alnine aminotransferase)
SGOT – same as F(AST) [go fast] (aspartate aminotransferase)
2/20/04
TCA Cycle
Pyruvate > Acetyl CoA (cookie) > Citrate (cousin) > cis-Aconitic (Clyde) > Isocitrate (is)
> alpha ketoglutarate (always keeping) > Succinyl CoA (Singapore) > Succinate (Slings)
> Fumarate (from) > Malate (Mallory) > Oxaloacetate (our).
Between: Is and Always keeping > NAD+ -> NADH
Between: Always keeping and Singapore = NAD+ -> NADH
Between: Slings and From = FAD ->FADH2
Between: Mallory and Our = NAD+ -> NADH
Add: Water between From and Mallory
Leo goes Ger
LEO = Loses Electrons Oxidized
GER = Gains Electrons Reduced
Carbohydrates are 4 kcal/gram and are glycosidic bonds
Fructose with 6 cabons is a Ketose
Ribose is a 5-carbon and an aldose.
Maltose has 2 peaks like an “M” – glucose plus glucose.
Lactose is glucose plus galactose
Sucrose is glucose plus fructose
Glycogen – highly branched polysaccharide.
In Glycolysis, aerobic conditions turn pyruvate into Acetyl Coa. In anaerobic conditions,
pyruvate becomes lactate. – phosphofructokinase
Glucogenesis – Lucy is the Key
Lipids are 9 kcal/g.
Lipid bilayer – hydrophilic heads / hydrophobic tails.
Bonds: Between glycerol and fatty acids is an Ester bond. “Aunt Ester smells good.”
Essential Fatty Acids: “ALL” – Arachidonic, Linoleic and Linolenic
Arachidonic becomes essential when Linoleic is absent.
C’s
Linoleic
18
Linolenic
18
Arachidonic 20
EPA
20
(Ecopantenoic acid)
Double bonds
2
3
4
5
TAG = 3 fatty acids + glycerol
Phospholipids: (cell membranes) 2 fatty acids, glycerol, and phosphate derivative.
Cholesterol precursors are MASH (Mevalonate, Acetyl CoA, Squalene, & HMG Coa.
Allosteric enzyme is HMG CoA Reductase
Chylomicron transports dietary lipids to the body.
LDL transports cholesterol from liver to the body.
Beta oxidation: Atkin’s diet
Cuts faty acid chain, two carbons at a time, to make acetyl CoA for the TCA
cycle.
Carnitine “drives” fatty acid chain into mitochondria.
Amino Acids cannot be synthesized in humans at an adequate rate, must be ingested!
Histidine and Arginine are required only during rapid growth or illness recovery.
The rest are “essential” all the time.
Glucose-Alanine Cycle
During exercise mucle makes: Amonia from amino acids; Lactate from glucose
Amonia becomes urea and lactate becomes glucose = gluconeogenesis
Urea cycle function: rids body of toxic amonia
Important Intermediates: Fumarate, ARginine, Citruline, Ornithine
Bonds between amino acids are peptide bonds
Structure: Secondary: Alpha Helix and Beta Pleated Sheet and Beta Bend
Glycolysis - AMP, Insulin stimulate glycolysis
Glycogenesis, stimulated by insulin
Nucleotides have three components: phosphate, sugar, nitrogenous base.
Purines: “All (adenine) Gems (guanine) are “pure”.
Watson and Krig discovered DNA
Nucleotides within one strand = phosphodiester bonds
Base Pairs between complimentary strands = Hydrogen bonds
DNA replication – Enzyme: DNA polymerase makes new DNA from the parent DNA
strand
Transcription – Enzyme: RNA Polymerase
DNA sequence is called a code
Translation:
Codon: 3 bases in the mRNA chain to code for one amino acid, this group is
called a codon.
Anticodon: tRNA has 3 bases that is complementary to a specific codon, this
group is called an anticodon.
Amino acid on the tRNa: Peptidyl Transferase
Energy: For translation is provided by GTP
5’AUGAAUUG3’
3’TACTTAAC5’
Purines have two cyclical structures.
Pyrimidines have one cyclical structure.
Hormones:
Peptide – suffix = “-in” (eg insulin)
Posterior pituitary secretes: ADH (vasopressin) and Oxytocin
Epinephrine Formed by amino acid tyrosine
Insulin inhibits: Hormone sensitive lipase ( and therefore inhibs lipolysis)
Glucagon is secreted by alpha cells in pancrease.
Steroid hormones: Derivative: Cholesterol (MASH)
VITAMINS
B1 – deficiency – Beri Beri “Without Thiamine, you’re Beri Beri Thupid”
B2 – Cheilosis – crackin/fissuring of lips – angular stomatits – cracking at angle
of lips.
B3 – Niacin
B6 – Reaction – Transamination and decarboxylation
B12 – Cyanocobalimin – Deficiency – Macrocytic anemia – Combined Systems
Disease (PLS)
Biotin – “Rocky BalBiotin” –
C – Ascorbic Acid – has to have bioflavonoids or only 15% is absorbed.
Anti-oxidants – ACESZ
Vitamins A,C,E, selenium, and zinc
A – deficiency: Night Blindness
D – Absorbs calcium from the gut – to the blood
Skin – to liver – to kidney
E – Antioxidant with selenium
Calcium 9-11 mg in blood Vit D. gut – Blood
Calcitonin: Blood – Bone
PTH: Bone – Blood
Phosphorus – Kidney
Sodium
hypertension
Magnesium – cofactor for kinase
Chromium – Diabetes Mellitus – need increased chromium to help get glucose into cells.
Cobalt – constituent of vitamin B12 – macrocytic (pernicious) anemia
Iodine = thyroid
Iron – Transported as Transferrin, stored as Ferritin (stored in a tin box).
Manganese – Ligamentous Healing
Selenium – Synergistic with Vitamin E
2/19/04
PATHOLOGY
Lost the quiz – got 7 right.
Vasomotor – blood
Pilomotor – hair
Pseudomotor – sweat
> All are sympathetics
Obliterans – distal to the sight of blockage – ischemia and necrosis
Disecting aneurysms – Longitudinal cleavage of the arterial media by a column of blood.
Berry aneurysms – congenital – more common in males – 40% = anterior communicating
artery – 34% = middle cerebral artery
Cerebral Palsy – anoxia at birth – what they got is what they got – don’t get worse or
better.
Cor Pulmonale can include emphysema and bronchitis and other long-standing lung
diseases. Bagososis – sugar factory; vysinosis – cotton factory; asbestosis; TB; silicosis;
asthma; cancer
Tetralogy of Fallot: DRIP = Dextrarotation of the aorta; Right Ventricular Hypertrophy;
Intraventricular septal defect; Pulmonary artery stenosis.
Rheumatic Fever: Most often affects Mitral valve. Second most commonly affected
valve is aortic.
Raynaud’s Disease: affects digits 2,3,4 – women, happens when it’s cold. Painful.
Anemias: (reticulocytes are young RBCs with large nucleus. Mature RBCs lose 90% of
nucleus.)
Microcytic Hypochromic:
Iron Deficiency
Chronic hemorrhage – cancer, ulcers, gastritis – constant drip of blood
GUIAC – test for occult blood in stool
Frank blood – you can see Frank blood.
Macrocytic Normochromic:
Pernicious – B12 – gastritis, ulcers, parietal cells, Intrinsic Factor – absorbs B12
in distal ilium – also matures red blood cells. Combined Systems Disease: Causes
problems in Stomach, Blood and Nervous Systems – PLS (posterolateral sclerosis) –
glove and stocking parasthesia. Doesn’t resolve with vitamin ingestion – must have
shots.
Folate – Blood problem. No neurological effects.
2/20/04
Thrombus – stable/not moving
Embolism – moving
Long bone fractures – the most severe thing that can happen is a fat emboli.
The most common thing is infection.
Miliary emboli – many, many emboli.
Pradoxical embolus – blockage of a systemic artery by a thrombus originating in a
systemic vein that has passed through a defect in the interartrial or interventricular
septum.
Side effect of HRT is deep vein thrombosis.
Prinzemetal Angina occurs at REST – coronary artery spasm
The most common cause of substernal pain is an esophageal problem – but you have to
rule out a heart problem.
A person with Esophageal varices has Portal Hypertension
Mallory-Weiss – laceration of distal esophagus and proximal stomach during vomiting,
retching, or hiccups – hemorrhage – alcoholics
Gastric ulcers – located along the LESSER CURVE of the stomach. Caused by
helicobacter pylori and NSAIDS (non-steroidal anti-inflammatory drugs.
Stomach Cancer – occurs most frequently at the GREATER CURVITURE –
“unexplained” weight loss, unrelenting pain.
Crohn’s – aka Regional Enterities – SKIP LESIONS in distal ileum and colon – chronic
diarrhea, fever, anorexia. One area is affected, and then it skips a part, and then another
area is affected. – scars form which make the lumen smaller at the area of the skip lesion.
Hirschprungs – “sprung colon” – megacolon.
Celiac Disease – Gluten “Wheat” intolerance
Mr. Whipple who used to work for Charmin, has gone bad – small bowel infections.
Zollinger – Ellison Disease – Aggressive peptic ulcer/ Tumor – Can perforate through the
lining. – fecal material in the peritoneal cavity.
Kidney-Ureter-Bladder Disorders (KUB)
Flat Plate – supine x-ray.
Glomerulo Nephritis: Streptococcal infection, hematuria, RBC casts, proteinuria,
hypertension, and edema.
A RBC cast is pathoneumonic for Glomerulo Nephritis.
Prostate cancer: Posterior lobe. Men over 50, slow, progressive, end process of disease –
urethral obstruction, hematuria, pyuria & blastic metastasis (whiter on x-ray) to the pelvis
and lumbar spine.
Hypospadias: Urethral defect on the ventral surface “boots”
Epispadias: Urethral defect on the dorsal surface “goggles”
Priapism: Painful, persistent, abnormal erection – 24-48-64 hrs.
Varicocele: Varicose veins – Bag of Worms
Cryptorchidism: Undescended testicle – must be removed – high propensity for cancer.
Paraphimosis: “Turtle Neck”
Estrogen: proliferation during the first half of the cycle
Progesterone secretions during the second half of the cycle
FSH: Egg of the month club. 2 or 3 get ready.
LH: Secreted from the pituitary mid cycle to cause ovulation. THE egg of the month.
Pregnancy: HCG is released by chorion and trophoblast early in pregnancy.
HCH spikes at beginning. Progesterone predominates in pregnancy.
Estrogen will spike at the end with parturition.
Endometriosis: sells proliferate, but don’t have anywhere to secrete.
Hydatidiform Mole: Instead of fetus, a disorganized, benign mass develops.
Choriocarcinoma: Instead of fetus, a cancerous mass develops.
2/23/04
Anterior Pituitary aka Adenohypophysis Hormone disorderes:
Acromegaly – protruding forehead, long fingers
Achondroplasia – dwarfism
TSH – Hyperthyroidism aka Grave’s disease.
ACTH – Hypothyroidism aka Cushing’s disease
Hirsutism – hair everywhere.
Kaiser-Fleischer rings – in eyes – aka Wilson’s Disease – Copper metabolism problem.
MSH – No MSH – Albino
Posterior Pituitary
Oxytocin: Stimulates uterine contraction and milk “let down” response
Diabetes Mellitus
Insulin deficiency disorder
Peripheral neuropathies
Diabetes Insipidus
ADH deficiency disorder
Eneuresis – bed wetting @ night
Pneumonia:
Lymphocytes LoVe Viruses
Horner’s syndrome caused by:
Pancose tumor in the apex of the lung
Sympathetic trunk lesion
Whiplash – most common
COPD
Emphysema: “Pink puffer”, enlargement of airspaces – primary cause is smoking
“There’s air in there – emphysema”
Lung cancer: Clubbing of the Nails
Siderosis – Iron dust – “Iron Sides”
Byssinosis – cotton dust
Bagassosis – Sugar cane – “Bag of sugar”
Hyperplasia – increase in number
Metaplasia: Change in one cell type to another – on the way to cancer
Dysplasia: Change in size, shape or function
Anaplasia: Complete disorganization of a cell, indicate malignancy – cancer
Caseous – Cheesy TB
Enzymatic – pancrease (head) degeneration
Wallarian degeneration – always degenerates distal to proximal
Atelectasis – sucks the trachea towards the side of
Pneumothorax: Air in the pleural cavity
Pleurisy – irritation of the pleura
Pleural effusion: fluid in the pleural cavity
Tumors
Malignant: Wide zone of transition – cells are not encapsulated
MOCE: Most common primary bone tumors
Multiple myeloma [old], Osteosarcoma (osteogenic sarcoma) [young],
Chondrosarcoma [old], Ewing’s Sarcoma [young].
Enchondroma: Most common benign tumor of the hand
Multiple enchondromas is called Ollier’s disease.
Hyperparathyroidism: rugger Jersey Spine – stripes on vertebral end plates
Leiomyoma: benign tumor of smooth muscle – leo is smooth
Medu”ll”oblastoma: tumor of the cerebe”ll”um
Multiple Myeloma – reversed albumin/globulin ratio – Bence-Jones proteins.
Osteoid Osteoma: Nocturnal pain relieved by aprin
Rhabdomyoma: Benign tumor of skeletal muscle
Seminoma: Malignant tumor of the testes.
Ivory white vertebrae: (Miles Per Hour) Metastasis – nicely square colored – in, Paget’s
(bone out of phosphorus instead of calcium) – larger, picture frame, Hodgkin’s – C-shape
on anterior portion of vertebrae.
Osteitis Deformans – aka Paget’s
S/S: Older males, bone deformity, Mosaic layers,
Lab: Increased akaline phosphatase 40 times.
Hemangioma: “corduroy cloth” tumor of vertebrae
Pott’s Disease: TB of the spine.
Most common:
Carpal fracture – Scaphoid – (avascular necrosis)
Carpal dislocation – Lunate
Carpal subluxation – Lunate
Legg Calve Perthes – aka LCP
Osteoarthritis – aka DJD
RA + pneumonia = caplan’s disease – symetrical. – Felty’s syndrome – long standing RA
Juvenile RA – Still’s disease (got it still)
RA latex (positive lab finding)
Reiter’s – Conjunctivitis, urethritis, arthritis (can’t see, can’t pee, can’t dance with me)
Psoriatic arthritis – Pitted Nails, silver scales on extensors
Gout – Tophi (uric acid chrystals in helix of the ear), podagra (big toe pain), destruction
around joint, purine metabolism problem
Pseudogout – aka CPPD – knee
Ankylosing Spondylitis – aka Marie Strumpell disease – HLA-B27 positive test.
DISH – aka Forestier’s Disease. Associated with diabetes mellitus
Liver has Kupffer cells
Humeral immunity: Antibodies B cells
Cellular immunity: Sensitized lymphocyte T cells
IgA: Milk, membranes
IgG: smallest, most numerous, ggggoes across the placenta
IgE: Allergies and parasites
IgM: First response, largest – marines
WBCs:
Neutrophil: Bacterial Infection
Lymphocyte: Viral Infection
Monocyte: Chronic infection
Eosinophil: Parasitic
Basophils: Similar to mast cells, makes heparin and histamine
Hodgkin’s Lymphoma: Reed Sternberg cell, relapsing fever, Ivory White Vertebrae
Reed Sternberg cell is pathogneumonic for Hodgkin’s Lymphoma
AIDS: retrovirus attacks T4 helper cells.
Acute lymphoblastic leukemia: ALL
Acute Myeloblastic leukemia: AML
Chronic Myeloblastic Leukemia: CML
Marasmus presents with broomstick arms and legs
Goodpasture’s disease attacks basement membrane of lungs
Grave’s disease – hyperthyroidism, etc.
SLE aka Lupus – malar (butterfly) rash
Sjogren’s – dry eyes (keratoconjunctavitis), dry mouth (xerostomia), arthritis
CREST sign: in scleroderma (PSS)
Amyotrophic Lateral Sclerosis (ALS) – aka Lou Gehrig’s disease
Syringomyelia – affects lateral spinothalamic tract
Buillain-Barre – aka Landry’s paralysis
Parkinson’s disease – aka paralysis agitans
RSDS – aka sudek’s atrophy
2/19/04
PHYSIOLOGY
Neurophysiology:
Nerve cell body aka: soma, perikaryon, karyon
Myelin increases transmission. Sclerosis attacts the myelin of the nerves.
Nodes of Ranvier – saltatory conduction.
Teledendria – terminal bulb, “boutons” contain Neurotransmitters. Must have Ca 2+ to
release Neurotransmitters.
Action potential: Point of stimulation – axon hillock – influx of Sodium (Na). At resting
state, inside is more negative. Sodium makes it more positive. Depolarization and
sodium influx go together. As action potential propigates, sodium continues to come in,
and potasium goes out (repolarization). Absolute refractory – absolutely not going to
allow the Action potential.
Pain – Nociceptors.
Corpuscles of Ruffini – hot italian receptors – significant other shower. Temperature
perception, pressure, encapsulated and multi branched, 2-5 degrees.
Merkel’s Discs: NOT encapsulated. When grouped together termed Iggo Dome
Receptors – lots of penguins in an igloo. They are named Merkel.
Pacinian Corpuscles: Test question.
Clinical Note: Demyelinating diseases – MS, PLS – hardens the nerve – like a scar.
Rheo base – least volts to fire
Utilization time – least time to stimulate
Chronaxie – 2 times rheo base
ATPase Pump: Pump Potassium In.
P
U
M
P
K
In
Sympathetic:
Preganglionic: Ach
Postganglionic: Epi and NE
Mydriasis has a “d” in it for Dilate!
Parasympathetic:
Smooth muscles – bowel.
Preganglionic: Ach
Postganglionic: Ach
Parasympathetic makes the penis Point (P’s)
Sympathetic makes it Shoot (S’s)
Wernicke’s: Receptive portion of language
Broca’s: Expressive portion of language
Motor is found in the front (of the car).
Mallory is an alcoholic. She messes up her coordination.
Superior colliculus: eyes
Inferior colliculus: ears
Midbrain: origin of CN’s III, IV
Pons: CN’s V, VI, VII, VIII
Medulla: CN’s VIII, IX, X, XI, XII
Injury to the reticular formation = coma.
EKG – Heart
ECG – Heart
EMG – Muscles
EEG – Brain
EEG
Beta waves: REM sleep
Saturation rate of oxygen in arterial blood is 97-98%.
Saturation rate of oxygen in veins is 75%.
2/20/04
Atria are sometimes call primer pumps.
Ventricles are sometimes called power pumps.
Sinus Node 60-80 beats per minute
AV Node 40-60 beats per minute “delay”
Bundle of HIS 20-40 beats per minute
Bundle branches – 0
Purkinje Fibers 0 – 20 beats per minute
Ectopic focus: sinus node dies, AV node takes over.
EKG:
Depolarization = Work
Repolarization = Rest (R and R)
Murmurs: Diastolic murmurs are the most cdlinicaly significant.
“Die in ARMS and PARTS”
A ortic
R egurgitation
M itral
S tenosis
P
R
T
S
ulmonary
egurgitation
ricuspid
tenosis
Aortic Regurgitation – blood goes back into Left Ventrical
Mitral Stenosis – not allow enough blood from left atrium to left ventrical
Pulmonary Regurgitation – blood goes back into right ventrical
Tricuspid stenosis – hard time getting from right atria to right ventrical
AV node allows for ventricular filling
If you push on the carotid sinus – baroreceptor – decrease heart rate
Bainbridge reflex: increased atrial pressure yields increased heartrate.
Decreased CO2 = O2-hemoglobin shifts to the left.
Heart rate times stroke volume = cardiac output
Cardiac output times total periferal resistance = mean arterial pressure.
Respiratory Physiology
TV: Tidal Volume
Total Lung Capacity – 5-6 Liters
Diaphragm: Inspiration occurs when the diaphragm contracts which decreases pressure
and air moves into the lungs.
Herring-Breuer reflex: Stretch receptors in bronchi prevents over-stretching of lungs.
Genesis of a RBC: HNRE (hemocytoblast – Normoblast – Reticulocyte – Erythrocyte)
Life expectancy: 120 days
WBCs: Never let my engine blow, 60, 30, 8, 3, 0.
Macrophages in liver: Kupffer cells
Endocrinology:
Embryologically, adenohypophysis is Rathke’s pouch.
Hormones in neurohypophysis: Vasopressin (aka ADH)
Oxytocin = contraction
Pancreas – tail – regulates blood sugar.
Parathyroid and thyroid (with vitamin D)
Thyroid makes calciton”in” – (calcium “in” bone)
Calcium and phosphorus are inversely related.
Adrenal cortex – Zona Fasciculata regulates blood sugar
Adrenal Medulla (MEN): Medulla, Norepinephrine, Epinephrinen.
Skeletal Muscle Cells:
Sarcoplasmic reticulum: Stores Calcium to be released.
Actin: Tropomyosin “MOM”: covers F actin’s binding sites.
Organization: H band: Myosin only
Contraction:
Isometric contraction – no joint movement
Isotonic contraction – muscle contracts with constant weight
Isokinetic – muscle contracts with constant speed
Ventral root fibers: Alphe – extrafusal, Gamma – interfusal “GI”
Mouth – ptyalin = salivary amylase
Stomach – chief cels – pepsinogen; g cells – gastrin, parietal cells – HCL/IF
Gall Bladder – CCK = cholecystokinin
Pancreas – secretin
Perirenal fat surrounds the kidney.
Adrenals live on top of the kidney.
Medullary pyramids aka pyramids aka medulla pyramids aka medulla
Pyramids > Minor Calyx > Major Calyx > Renal Pelvis > Ureter
Proximal convaluted tubule = absorption
Ascending loop of Henle is impermeable to water.
Aldosterone is in the distal convaluted tubule.
ADH (vasopressin) in collecting duct (vasodepresson – always depressed because he
lives in urine”
Bowman’s capsule: filtration – has fennestrations (windows)
99% of reabsorption by end of distal tubule
Renal clearance: Filter in 1 minute determins GR: Inulin is used
Liver contains angiotensinogen – Juxtaglomerular cells and renin convert
angiotensinogen to angiotensin I – Lungs and ACE convert Angiotensin I to Angiotensin
II.
Glomerular Filtration Rate
Glomerular Pressure = 60 mm Hg
Bowman’s Capsule Pressure = 18 mm Hg
Colloidal Osmotic Pressure = 32 mm Hg
Aldosterone:
Aldosterone is found in the DCT from the zona glomerulosa. He likes to absorb sodium
babes and secretes potassium bums.
2/19/04
GENERAL ANATOMY:
Pacinian corpuscle – phasic, quick adapting.
Pseudoripherus gland – sweat gland.
Simple squamous allows for GAS exchange
Simple columnar found in GI tract
Pseudostratified Ciliated Columnar: found in respiratory tract
Transitional: for Distention.
Embryo:
Nerve and Skin are Ectoderm
Air and gut are Endoderm
Everything else is Mesoderm
C1 – there is none
C2 – top of the head
C3 – Nape of the neck
C4 – Shoulders
C5 – Deltoid area
C6 – Six-shooter (first and second digit)
C7 – Chiropractic index
C8 – fourth and fifth digits
T1 – Medial Elbow
T2 – Axilla
T4 – Nipples
T7 – Xiphoid
T10 – Umbilicus
L1 – Inguinal Ligament
L2 – Medial thigh
L3 – to the knee
L4 – to the floor medially
L5 – dorsum of the foot and lateral leg
S1 – Little toe, plantar foot, posterior calf
S2 – somewhere around the knee – posterior thigh
S3/4 – anal rings.
Osteology:
Endochondral ossification: Cartilage is replaced by bone
OsteoBlast – makes bone “builds”
Osteoclast – breaks down / reabsorbs bone
Epiphysis – Secondary ossification
Growth plate aka: epiphysial plate; physis
Metaphysis has most metabolic activity that occurs in bone.
Diaphysis – Primary ossification
Bone Marrow – Multiple myeloma
Periosteum – feels pain!!
The motions of the thumb are RUM
Extention: Radial
Adduction: Ulnar
Flexion: Median
2/20/04
Scapula
Inferior angle – seated or standing = T7, prone = T6
Coracoid has a “c” like the Scapula has a “c”
Clavicle – conoid “little bone”
Humerus – “SIT” attachment (Rotator cuff)
Intertubercular Groove – aka bicipital groove
Capitulum is the hat on the head of the radius
Ulna – Coronoid has an “n” like Ulna has an “n”.
Carpals – Pisiform – aka sesamoid
Trapezium articulates with the thumb
RAY sign – sorianic arthritis all three joints of hand
OA – DIP and PIP
RA – PIP and MCP
Nodes: He – Heberdens
Be – Bouchards
Hay – Haygarths
Median Nerve passes through the carpal tunnel. Medial Plantar nerve passes through the
Tunnel of Guyon (Hook of the Hamate). Radial Nerve damage can cause wrist drop.
Ulnar nerve damage can cause claw hand.
Lambdoidal suture separates the parietal bone from the occiput. Coronal suture separates
the frontal bone from the Parietal bone. Squamous suture separates the Parietal from the
Temporal bones.
Synarthosis joints are immoveable
Amphiarthosis joints are slightly moveable
Diarthrosis joints are freely moveable synovial joints.
The thumb is a saddle or sella joint.
The shoulder and hip are ball and socket or spheroid joints.
The acromioclavicular joint is the most commonly injured joint in the shoulder.
The spring joint attaches the Sustentaculum tali (calcaneous) to the navicular and
maintains the longitudinal arch.
The popliteus muscle unlocks the knee.
2/23/04
Most pelvic girdle muscles are innervated by a branch of the pudendal nerve.
The popliteus muscle unlocks the knee by flexing and rotating the leg.
Thigh
Quads: Rectus femoris, vastus lateralis, vastus medius, vastus intermedius,
sartorius
Rectus femoris and sartoris both cross two joings
Hams: Biceps femoris, semitendinous, semimembranous – Tibial Nerve
Gluteus maximus – inferior gluteal nerve.
Tibialis anterior, ext. digitorum longus, ext. hallicus longus – deep peroneal nerve
Peroneus longus and brevis – superficial peroneal nerve.
Linea semilunaris – lateral border of rectus abdominus muscle
Tricuspid valve – between the right atria and right ventricle.
Oscultation: “A Pet Monkey”
Aortic valve
Pulmonary
Erb’s Point
Tricuspid valve
Mitral Valve
Ligamentum anteriosum – was ductus arteriosus – bypassed lung, pulmonary veins, and
left ventricle
Moderator Band – only found in Right Ventricle
Apex of heart is at the 5th intercostal space
Branches off the External Carotid: “Sale-Op-Super-Max”
Superior Thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Posterior
auricular. Terminates: Superficial temporal arteries, and Maxillary
Middle Mediastinum: Contents: Heart, pericardium, phrenic nerve, great vessels, arch of
the azygous vein and main bronchi
Nasal Cavity: Sinuses: FESM (superior to inferior)
Frontal, Ethmoid, Sphenoid, Maxillary
Trachea protects the esophagus
Laryngeal cartilages are alphabetical from inferior to superior.
Esophagus acts as a sphincter for food passage – smooth and skeletal muscle.
Carina marks division of trachea into primary bronchi – cough reflex originates
Cupula – most superior portion of the apex of the lungs.
Horisontal fissure separates superior and middle lobes of right lobes of lungs.
Lingula – inferior portion of the superior lobe on the left side.
Right bronchi is more clinically important. Small children asparate on small objects.
Rugae of stomach serve to increase surface area.
Parietal cells (aka oxyntic cells) secrete HCL and IF
Chief cells (aka zymogenic) secrete pepsinogen
Head of pancreas has a higher propensity for cancer.
McBurney’s point – from umbilicus to ASIS = appendicitis.
More cancer occurs at Sigmoid colon and rectum.
Liver: Filters and detoxifies blood.
Gallbladder: Contracts to expel bile when stimulated by secretion of CCK
Pancreas: Exocrine gland has ducts and endocrine gland is ductless.
Head = Enzymes
Tail = Hormones
The urinal system begins with the kidneys.
Kidneys are at T11-L1
Detrusor muscle squeezes urine from the bladder.
Deep Transverse perineus and sphincter urethrae are the muscles of the urogenital
diaphragm.
Male:
FSH controls spermatogenesis
Cowper’s gland secretes mucous and is also known as bulbo urethral gland.
Female:
Estrogen and progesterone – produced by ovaries
Mesovarium is part of the broad ligament – strongest / main ligament
Estrogen secreted by the corpus luteum in 1st ½ of cycle. Become the corpus atrecia if
non gravid.
Progesterone increases in pregnancy (predominate)
LH stimulates the pre-ovulating follicle causing rupture of the follicle and ovulation.
HCG maintains the corpus luteum.
Normal position of the uterus is “anteverted” or flexed forward.
Most fertilization occurs in the ampula.
Fallopian tube aka salpinx
2/19/04
SPINAL ANATOMY
Neural Plate (If I only had a brain)
I could while away the hours
Grow neurons fast as flowers
With cells my plate contains
Oligo-den-dro-cytes for myelin
And my retinal cells see smilin’
If I only had a brain
I’d have astrocytes for bindin’
Epen-dy-mal cells for linin’
The ventricles that drain
With ma-croglial cells I’m thinkin’
I could be another Lincoln
With the plate of my ol’ brain
Somite cells: Forms the Sclerotome > vertebral column (cartilage and bone) Also forms:
myotome and dermatome
ANS:
Sympathetic:
Short preganglionic, Neurotransmitter = Ach
Long postganglionic, Neurotransmitter = Epi or NE
Cauda Equina Syndrome: S234 help keep it (poo and pee) off the floor.
Parasympathetic:
Long Preganglionic; ACh
Short Postganglionic; Ach
Corpus Callosum separates the two hemispheres
Projections – from spine to cortex
Foramen of Monroe aka interventricular foramen
Obstruction of Cerebral Aqueduct of Sylvius causes hydro-encephalus
Lateral aperatures (2): Foramen of Luschka
Median Aperature (1): Foramen of Magendie
CNS
Ependymal cells of the Choroid Plexus produce CSF
Arachnod granulations resorb CSF
Postcentral gyrus – primary sensory cortex
Precentral gyrus – primary motor cortex
Parkinsonism is due to neuronal degeneration of the substantia nigra. “Lewy”
LMNL
UMNL
Decreased DTR
Hypotonicity
Flacidity
Fasciculations (sick and dying
Muscles)
No pathological reflexes
Unilateral superficial reflex
Increased DTR
Hypertonicity
Spacticity
Clonus
Pathological reflexes present
Decreased superficial reflexes bilaterally
Corticospinal tract is also known as the pyramidal tract.
Reticulospinal tract is also known as Pontine and Medullary tracts
Vestibulospinal is the opposite of Rubrospinal.
Lateral Spinothalamic tract – pain and temperature
Dorsal Columns – discriminative touch, vibration, conscious proprioception.
Cortical Interpretation –
graphesthesia – x or zero
Stereognosis – coin or pencil
Barognosis – weight (rock or feather)
Peripheral Nervous System
Greater Auricular Nerve – Ear and parotid gland
Phrenic nerve – 345 keep the diaphragm alive.
Meralgia paresthetica – impingement of the lateral femoral cutaneous nerve.
Sciatic Nerve – L4,5/S123
Inferior Gluteal Nerve – Motor – Gluteus Maximus
Cervical enlargement – C5/6
Lumbar Enlargement – T11/12
Brachial Plexus: Randy Travis Drinks Cold Beer.
Roots, trunks, divisions, cords, branches.
Roots: C5,6,7,8,T1
MARMU:
Musculocutaneous
Axillary
Radial
Median
Ulnar
Cranial Nerves:
Trigeminal nerve – trigeminal neualgia (tic delaureaux)
Opthalmic division goes to the Superior Orbital Fissure
Abducens nerve – through the Superior Orbital Fissure
Glossopharyngeal goes through the Jugular foramen
Vagus goes through Jugular foramen – taste to epiglottis.
Accessory goes through Jugular foramen
Foramen Lacerum – Internal Carotid Artery
Injury to the pterion (junction of sphenoid, temporal, frontal and parietal bones) “hockey
puck” causes damage of middle meningeal artery.
Middle meningeal artery exits – foramen spinosum – “spin the men in the middle”
Special Senses:
Circumvallate (aka vallate)
Posterior 1/3 of tongue (bitter) CN IX and X
Uncus aka medial olfactory stria
Middle ear to nasopharyngeal area = auditory tube (aka eustachian tube)
Osteology: Ethmoid – cribiform plate
Orbit: “Some funny zebras play easy listening music”
Sphenoid, frontal, zygomatic, palatine, ethmoid, lacrimal, maxillary
Sternum aka gladiolus
Angle of Louis aka sternal angle
Hyoid bone: C3
Cornu of thyroid: C4
Body of thyroid: C5
Cricoid cartilage: C6
Carotid tubercle: C6
Axis aka epistropheus
Typical cervicals have an oval body and triangular canal - 45 degree facets
Typical thoracids have a heart body and oval canal
Typical lumbar has kidney shaped body and triangular canal
L5 is lumbar with the most tropism (one coronal, one sagital facing facet)
Boundaries of IVF
Pedicle
Facets
Body
Disc
Orientation of Superior Facets:
“Bum Bul Bum” Cervicle – Thoracic - Lumbar
Bum = back, up, medial (posterior, superior, medial)
Bul = back, up, lateral (posterior, superior, lateral
Anterior Longitudinal Ligament:
Aka anterior atlanto occipital ligament
Alar ligament aka check ligament (limits rotation)
Myology:
Face muscles innervated by CN VII
Elevation of jaw = closing – lateral pterygoid
Depression of jaw = opening – medial pterygoid
Suboccipital triangle contains: suboccipital nerve and vertebral artery
Heart failure vs. MI
Hypertension – systemic, pulmonary, portal.
Congestive Heart Failure:
Left ventricular hypertrophy due to system hypertension – failure occurs when left
ventricle fails to pump all the blood forward – some builds up in lungs – nocturnal
dyspnea and orthopnea.
Right ventricle now has to pump all the fluid in the lungs toward the left ventricle –
jugular distension – pitting edema
Right to left failure starts in lungs, then right, then left.
Cor Pulmonale
Cause: Build up of pressure – hypertension
Result: Fluid backs up – edema
First Sign: Fatigue
CHF: Left side fails first
Cor Pulmonale: Right side fails first.
Visual Fields:
Bi-temporal hemianopsia – tunnel vision
Homo-hemi – can’t see same side
Nerve lesion – blind
Test Taking Skills:
1. Give up and learn it!!
2. Answer what they ask: Underline words like not, except, least likey, most likely,
causes, besults in, etc.
3. Seek and Destroy!! (increases odds 25%) (Cross it Out)
4. Redefine the answer!
5. Redefine the question!
6. Sesame street rule – “Aple, Orange, Banana, Rat!” usually the rat is the answer.
7. Opposites usually both don’t occur at the same time.
8. The same do.
9. 100% always, exclusive, never, only…oh… goose bumps!
10. Don’t change answers. (look for answers in other questions) (one legged man in a
butt-kicking contest).
11. Don’t leave answer blank, (dyslexia)
12. Rules of last resort – Dr. Laura will choose a letter…
PICK B
13. Sleep is a weapon
14. Get adjusted!
15. Relaxation tips for pre-test/mid-test.
16. Food for 1 test, eat a carb; for multiple tests (boards): complex carb, protein, snack.
17. Test anxiety: chew gum, this will stimulate your parasympathetics = relaxation and a
decrease of anxiety.
18. Believe in yourself!! You can do it!! If you have made it this far, you will succeed in
passing your NBCE exams.