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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.