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572 Cards in this Set
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- Back
Membrane phospholipids and asymmetry
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Phosphatidyl choline, Phosphatidyl Ethanolamine, Phosphatidyl inositol
Phosphatidyl serine Sphingomyelin(Also a glycolipid) Choline containing lipids such as Sphingomyelin and Phosphatidyl choline are usually on outside Amine containing phospholipids phosphatidyl Serine and Phosphatidyl Ethanolamine are primarily in inner leaflet |
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Membrane fluidity
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Fluidity is reduced by long chain saturated fatty acids and cholesterol
However, cholesterol prevents actual freezing of the membrane |
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Exocytosis
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Regulated - Secretion of hormones require a special signal before the secretory vesicle will fuse to the plasma membrane.
Constitutive - Vesicles not coated with clathrin are continuously fusing with the plasma membrane ** Constitutive pathway is the default pathway. All other destinations intra or extracellularly require additional signals. Without the signals, protein will just be secreted from cell |
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Nuclear lamina
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Intermediate filaments containing 3 types of proteins known as Laminins A, B, and C. Allows chromatin to be connected to the inner membrane of the nuclear envelope and are essential for the breakdown and reformation of the nuclear envelope.
Phosphorylation of the Nuclear lamina during prophase of mitosis initiates nuclear disassembly into small vesicles |
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Nucleolus
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Site of RNA polymerase I-mediated transcription of rRNA and site of large ribosomal subunit assembly. rRNA is the most abundant RNA in the cell.
Granular zone at periphery consting of ribosomal precursor particals at various stages of assembly Fibrillar zone containing ribonuclear protein fibrils Pale-staining fibrillar center that contains DNA not being transcribed Size of nucleolus depends on its activity |
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RIbosome synthesis
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80S from 60S and 40S in humans
70S from 50S and 30S in bacteria Large subunit synthesized in nucleolus and small subunit is synthesized in the nucleus. Then pass into the cytoplasm to form ribosome. Can congregate to form Free polysomes that synthesize proteins for the Nucleus, Mitochondria, or Peroxisomes Membrane associated polysomes synthesize secretory and membrane proteins |
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Protein synthesis and modification
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Small 40S subunit binds first then 60S on the 5' end of the mRNA.
- Protein synthesis for cotosolic, mitochondrial, nuclear, and peroxisomal proteins is completed in the cytosol For protein synthesis in the RER, the mRNAs contain a 30 hydrophobic AA signal peptide - Once signal peptide is released, it is bound by a signal recognition particle which binds both the ribosome and the signal sequence - Protein synthesis pauses and SRP binds to SRPR or docking protein which displaces SRP from ribosome and inserts signal sequence into the RER memb - Ribosomal receptor is made of Ribophorins I and II, and the signal sequence interacts with a protein called Signal sequence receptor (SS) - Initial step of N-linked glycosylation occurs during translation. All O-linked glycosylations are post-translational - If protein stays in RER membrane, there is an associated Halt-transfer signal along with insertion signal. |
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Smooth ER
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Detox:
Phase 1 hydroxylation can result in toxic intermediates which is harmful unless modified by a phase 2 conjugation Glucose 6 phosphatase is a SER membrane protein Lipid metabolism begins in the SER with the release of a fatty acid from triglyceride. Also where lipoprotein particles are made *- Smooth ER thus aids in carbohydrate and lipid metabolism Forms sarcoplasmic reticulum in muscle |
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Modification of glycoproteins
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Phosphorylation of mannose targets proteins to lysosomes
Sulfation of oligosaccharide chains of proteoglycans occurs in the golgi Limited proteolysis of precursor proteins like proinsulin occurs in the Golgi |
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I-cell disease
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Lack of phosphotransferase in golgi results in lack of mannose conversion to Mannose-6-Phosphate.
Lysosomal Enzymes just get secreted out of the cell, and lysosomes accumulate undegrated glycoconjugates |
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Hyperinsulinemia
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Elevated levels of proinsulin in the serum resulting from deficiency in the peptidase associated with the secretory granules that contain proinsulin
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Peroxisomes
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Transfers hydrogen atoms from organic substrates like urate, AA, LCFA, to O2 with the formation of H2O2. Catalase in the peroxisome then degrates H2O2 to hwater and oxygen
- Starts the B-oxidation of very long chain fatty acids >C24 to a length of C10 and then completed in mitochondria Phospholipid exchange reactions Bile acid synthesis |
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Microtubules structure and diseases
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Composed of one alpha and one beta tubulin assembled in microtubule organizing centers with Tau proteins and Microtubule associated proteins. Negative towards center, plus end is where the assembly and disassembly occurs and points toward the periphery.
- Chromosomal movement during division - Intracellular vesicle and organelle transport - Ciliary movement produced by Axoneme Chediak-Higashi syndrome - Defect in ability of microtubules to polymerize in leukocytes. Delay in fusion of phagosomes with lysosomes and preventing phagocytosis. Recurrent pyogenic infections, Partial Albinism, Peripheral Neuropathy. Kartagener syndrome - Caused by immotile cilia in respiratory cilia leading to Bronchiectiasis which is an irreversible dilation of the bronchial tree, and male and Female infertility |
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Intermediate filaments
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Primarily function in structural roles
Keratin filaments - Found in epithelial tissue. Form tonofilaments that connect desmosomes in epithelial cells Vimentin-containing filaments - in nonepithelial cells such as fibroblasts, chondrocytes, endothelial cells, and macrophages Neurofilaments - Found in most neurons of the CNS and PNS. Extends along axon and forms cytoskeleton of nerve cells |
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Microfilaments and movements
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aka Actin filaments or F-actin consists of two strands of actin twisted into a helical pattern with 13.5 molecules of globular actin or G-actin per turn of helix.
- Local movement associated with polymerization and depolymerization of microfilaments. Sliding filament generated by interaction between actin and myosin. |
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Accesory proteins of myofibril
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a-Actinin - binds and anchors actin filaments to Z line
Desmin - Found at Z line and holds myofibrils in place Myomesin - Cross-links adjacent myosin filaments at the M line Titin - Large fibrous protein that covers half of the sarcomere to keep myosin thick filaments centered Nebulin - Large protein attached to Z line to extend the length of the thin filament |
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Control of muscle calcium
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T tubules extend from sarcolemma and surround each myofibril at Z line
- Depolarization of sarcolemma is relayed to the sarcoplasmic reticulum which then releases calcium Once contraction is done, calcium is pumped back into the SR and bound in the SR by calsequestrin |
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Anchoring junctions
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Desmosomes - Connect groups of intermediate filaments
Adherens junctions - Connect groups of actin filaments |
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Adherens junctions
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Couple cells with other cells or the extracellular matrix
Composed of two major proteins - Intracellular attachment proteins and transmembrane linger glycoproteins IAP & TLG Cell to cell adhesion junctions form an adhesion belt know as zonula adherens found between cells in epithelial sheets and are located in the apical region of the cells. Intercalated discs of the heart are composed of adhesion junctions Cell to matrix junctions connect cells and their actin filaments to the extracellular matrix know as adhesion plaques |
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Desmosomes
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Bind to intermediate filaments and the type of filaments are dependent on cell type.
Intracellular attachment proteins appear as dense plaques known as desmoplakins. Transmembrane linger proteins are desmoglenins. Autoimmune destruction of desmosomes cause pemphigus |
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Maintenence of Gap junctions
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Increase cAMP increases function of gap junctions
Increases in intracellular Calcium decreases permeability of gap junctions to prevent death of once cell from killing it's neighbors |
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Adhesive proteins
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Fibronectin - Necessary for formation of fibroblast adhesion plaques and for fibroblast movement. Held together by disulfide bonds.
Laminin - major glycoprotein in the basal lamina where it forms mats of polypeptide underlying all cell sheets. Mediates the attachment of cells to connective tissue |
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Bilaminar disc
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Epiblast separate from cytotrophoblast to form amnionic cavity
Hypoblast consist of low cuboidal cells adjacent to the blastocyst cavity to form the lining of the primary yolk sac |
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Trophoblast
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Outer epithelial layer that surrounds the embryoblast and blastocele and implants into the uterus to form the placenta. Secretes hCG after implantation
After implantation, forms cytotrophoblast and a syncytiotrophoblast |
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Ectodermal derivatives
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CNS
- Neural tube formed in the region of future neck and proceeds in cephalic and caudal directions - Brain and spinal cord - Neural crest cells form dorsal root ganglia, sensory ganglia of cranial nerves, autonomic ganglia, meninges, schwann cells, adrenal medulla and melanocytes - Otic placode and Lens placode - Others including integument, mammary glands, pituitary, and enamel |
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Mesodermal derivatives
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Paraxial mesoderm
- Begins as somites and divides into sclerotome and dermamyotome. Dermamyotome further differentiates to form the dermatome and myotome regions. - Sclerotome form bones, cartilage, ligaments of the vetebral column and base of skull - Dermatomes migrate under ectoderm to form dermis and subcutaneous tissues of the skin - Myotome cells give rise to skeletal muscles Intermediate mesoderm form the nephrogenic cord which then gives rise to portions of the urogenital system Lateral mesoderm. Somatic or parietal mesoderm with the overlying ectoderm for body wall. Splanchnic or visceral mesoderm and underlying endoderm form wall of gut - Also form striated, cardiac, and smooth muscle, cartilage, bone, lymph, kidneys, gonads, adrenal cortex, and spleen |
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Endoderm derivatives
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GI tract
Thyroid Parathyroid Thymus Liver Pancreas Lining of respiratory tract, bladder and urethra |
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Trisomy 18
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Edward syndrome
- Mental retardation, syndactyly/fused fingers and skeletal defects |
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Trisomy 13
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Patau syndrome
- Mental retardation, clefts of lip and palate, deafness and eye defects. Extra fingers/Polydactyly |
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Klinefelter syndrome
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XXY
- Sterility, small testes, gynecomastia and sometimes mental retardation - Barr body can be found. |
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Turner syndrome
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XO
- Webbed neck, absence of ovaries, dysmenorrhea, lymphadema, infantile external genetalia and mammary glands, Coarctation of aorta |
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Cri-du-chat
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Deletion on chromosome 5
- Children have a high pitched catlike cry, mental retardation, and congenital heart defects |
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Fragile X syndrome
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Most common single gene cause of autism and most common inherited cause of mental disability
- Due to expansion of single trinucleotide sequence on X chromosome |
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Some teratogenic drugs
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Thalidomide - Absent or defective long bones
Tetracycline - Intrinsic tooth staining and skeletal abnormalities Chloramphenicol - Gray baby syndrome Isotretinoin - Ear brain and heart malformations Aminopterin and the derivative methotrexate |
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Ehler-Danlos syndrome
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Deficient type 3 collagen and faulty lysine hydroxylation resulting in decrease in procollagen peptidase activity
- Cannot cleave Procollagen to form Tropocollagen outside of Cell - Cross-linking of collagen cannot occur outside of cell Increased skin elasticity and articular mobility |
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Osteogenesis imperfecta
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Single base substitution in gene for type 1 collagen
- Preventing Glycosylation and Formation of Triple helix Pro-collagen Spontaneous fractures, cardiac insufficiency Blue Sclera |
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Elastic fibers
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AA composition is similar to collagen in terms of proline and glycine
Contains two specific lysine derivatives: Desmosine and Isodesmosine Implicated in Marfan syndrome by Fibrillin-1 protein defect |
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Ground substance
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Proteoglycans
- Glycosaminoglycans with core proteins - Chondroitan Sulfate is most abundant GAG, and other GAGs are heparan sulfate, heparin, keratan sulfate, Hyaluronic acid, and dermatan sulfate Glycoproteins - Protein portion is most abundant. - Fibronectin synthesized by fibroblasts that contain binding domains for cells, collagen and GAGs - Thrombospondin - Also synthesized by fibroblasts and binds cells, collagen, heparin and fibronectin |
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Cords
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Lateral cord
- Lateral pectoral nerve - Branches into Musculocutaneous nerve and lateral head of median nerve Medial cord - Medial pectoral nerve, brachial cutaneous nerve, medial antebrachial cutaneous nerve - Medial head of anterior median nerve - Ulnar nerve Posterior - Upper subscapular nerve to supply subscapularis, middle subscapular nerve aka thoracodorsal nerve to supply latissimus dorsi, and lower subscapular nerve to supply teres major - Radial nerve and axillary nerve |
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Tetrology of Falot
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Pulmonary stenosis
Right ventricular hypertrophy secondary to pulmonary stenosis Ventricular septal defect usually in membranous IV septum Overriding aorta |
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Intrinsic muscles of larynx
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Posterior cricoarytenoid - Abducts vocal cords
Lateral cricoarytenoid - Adducts vocal cords Cricothyroid - Tenses vocal cord Thyroarytenoid including vocalis - Relaxes vocal cord Thyroepiglotticus - Opens laryngeal inlet Aryepiglotticus - Closes inlet Oblique and transverse arytenoids - Closes inlet |
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Staph Aureus virulence factors
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Virulence factors include protein A, binding protein, coagulase, DNAse, Staphylokinase, hyaluronidase, lipase and various exotoxins
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Staph Epidermis
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Most commonly a Nosocomial pathogen
- Grows on surface of IVs, catheters, and prosthetic valves - Treat with Vancomycin - Major virulence factor is viscous exopolysaccharide biofilm |
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Staph Saprophyticus
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Causes urinary tract infection in women
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Strep Pneumoniae characteristics, virulence, transmission, diseases
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aka Pneumococci - Grows in pairs, alpha hemolytic, and inhibited by optochin and bile
Major virulence factor is its carbohydrate capsule - Lives in nasopharynx and transmitted via aerosol droplets - Most common cause of bacterial pneumonia and most common cause of meningitis in elderly - Also causes otitis media, sinusitis, bronchitis, and bacteremia |
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Strep Pyogenes characteristics, transmission, virulence factor, diseases
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beta hemolytic and distinguised from Group B strep by bacitracin inhibition
- Obligate human parasite spread person to person by respiratory secretion via droplets. -Most important virulence factor is the M protein which is antiphagocytic and disables complement - Pharyngitis, otitis media, erysipelas, pyoderma, scarlet fever, glomerular nephritis, and rheumatic fever |
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Strep Agalactiae characteristics, virulence factor, diseases, treatment
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Group B strep which is part of normal vaginal and intestinal flora in 25% of a population
- Major virulence factor is Antiphagocytic polysaccharide capsule - Infants are more susceptible and inhale them while traveling through birth canal - Cause pneumonia, sepsis, and meningitis |
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Enterococcus members, characteristics, disease, treatment
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Includes enterococcus faecalis and Enterococcus Faecium
- Both are part of normal fecal flora and can cause infection when spread to the urinary tract - may also cause subacute endocarditis - Exhibit penicillin tolerance because they are only inhibited and not killed by penicillin |
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Listeria transmission, disease
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Transmission via contaminated meat or unpasteurized dairy products
LIST - Pregnant women, neonates, and meningitis in elderly and immunocompromised |
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Corynebacterium Diphtheriae characteristics, virulence, disease, prevention
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Non motile gram positive rod
- Virulence factor is the diphtheria toxin encoded by a lysogenic phage - Clinical manifestations include an upper respiratory infection resulting in a tonsillar grayish pseudomembrane that may spread and obstruct airway. - Diphtheria toxin is also toxic to heart and brain by inhibiting protein synthetis. |
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Bacillus Anthracis characteristics, virulance factors, transmission and disease, and treatment
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Gram positive spore forming rods with a antiphagocytic capsult composed of D-glutamate instead of polysaccharide
- Virulence factors are the antiphagocytic capsule, protective antigen, lethal factor, and edema factor - Transmission via skin cuts or abrasions, or inhalation - Cutaneous anthrax is 95% of infections with edema as the major complicaion - Systemic anthrax is acquired through the respiratory tract and is almost always fatal |
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Bacillus cereus transmission and disease
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Produces two enterotoxins and usually grow in foods like cereal grains and left over rice
- Short incubation food poisoning of 1-6 hours causing severe nausea and vomiting - Long incubation of 10-24hrs and is observed by abdominal cramps and diarrhea |
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Clostridium perfringens virulence, disease
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Alpha toxin aka Lecithinase which causes lysis of erythrocytes and other cells
- Transmitted via infection of disrupted skin, bowel or other epithelial tissues. - Gas gangrene characterized by muscle and connective tissue necrosis causing Crepitation. |
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Clostridium difficile virulance factor, cause, disease
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Component of normal bowel flora
- Produce two heat-labile toxins Exotoxin A aka enterotoxin and Exotoxin B aka cytotoxin - Causes antibiotic-associated diarrhea and pseudomembranous colitis - Percipitated by Clindamycin and Ampicillin |
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Clostridium Tetani virulence, disease
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- Virulence factor is tetanospasmin, a plasmin encoded neurotoxin that blocks inhibition of motor neurons
- Can cause local infection, cephalic infection, generalized tetanus infection resulting in lockjaw and 60% mortality, and neonatal tetanus |
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Clostridium perfringens virulence, disease, treatment
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Alpha toxin aka Lecithinase which causes lysis of erythrocytes and other cells
- Transmitted via infection of disrupted skin, bowel or other epithelial tissues. - Gas gangrene characterized by muscle and connective tissue necrosis causing Crepitation. Treat with surgical debridement plus penicillin |
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Clostridium difficile virulance factor, cause, disease, treatment
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Component of normal bowel flora
- Produce two heat-labile toxins Exotoxin A aka enterotoxin and Exotoxin B aka cytotoxin - Causes antibiotic-associated diarrhea and pseudomembranous colitis - Percipitated by Clindamycin and Ampicillin - Treat with oral vancomycin or metronidazol |
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Clostridium Tetani virulence, disease, treatment,
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- Virulence factor is tetanospasmin, a plasmin encoded neurotoxin that blocks inhibition of motor neurons
- Can cause local infection, cephalic infection, generalized tetanus infection resulting in lockjaw and 60% mortality, and neonatal tetanus - Treat with respiratory support, curare like drugs, and metronidazole - Immunization with tetanus toxoid with booster ever 10 years |
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As of Klebsiella
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Alcoholics
Abcesses in the lungs Aspiration Pneumonia - Often described as Currant jelly Speutum |
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Chancroid
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Caused by Haemophilus Ducreyi
- Painful nonindurated ragged ulcers confined to genitalia and perianal areas |
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Legionella
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Transmission through Aerosols from air-conditioning equipment
- **Not transmitted person to person - Pontiac fever is a mild febrile illness without pneumonia - Legionnaire disease is a severe and often fatal pneumonia |
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Cord factor
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Associated virulance factor of Mycobacterium tuberculosis
- Inhibits PMN migration, granuloma formation, and attacks mitochondrial membranes |
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Q fever
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Caused by Coxiella Burnetti
- Only Rickettsiaceae not transmitted via arthropod vector - Transmitted via infected hides or tissues or by drinking infected milk - No skin rash, with mild pneumonia |
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Chlamydiae
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Obligate intracellular parasites like Rickettsiae
- Cell walls lack muramic acid. Thus, its resistant to Beta-Lactams C. Trachomatis - Infects only humans and develop vacuolar inclusions that contain glycogen and will stain with iodine. Most common STD. C. Psittaci - Transmitted via inhalation from bird droppings C. Pneumoniae - Human only pathogen that causes pharyngitis, bronchitis, and mild atypical pneumonia |
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Cannot be cultured
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Troponema Pallidum and Mycobacterium Leprae
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Lyme disease
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Caused by Borrelia burgdorferi through tick (Ixode) Vectors
- Classical finding is erythema chronicum migrans. Bull's eye |
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Walking Pneumonia
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Caused by Mycoplasma Pneumoniae
- The smallest bacteria infecting humans |
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Virus special facts
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All RNA viruses are single stranded except Reovirus/Rotavirus
All DNA viruses are double stranded except parvovirus All RNA viruses are enveloped except Picorna, Calci, Reo All DNA viruses are enveloped except PAP. Papova, Adeno, Parvo All RNA replicate in cytoplasm except Orthomyxo influenza and Retroviruses All DNA replicate in nucleus except Pox |
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Picornaviruses
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Enteroviruses: Polio, Coxsakie A&B, Echovirus, Enterovirus. Are acid resistant and survive in GI
Rhinovirus. Sensitive to acid |
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Retrovirus genome proteins
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Pol - Reverse transcriptase and Integrase
Env - Envelope proteins Gag - Viral core proteins |
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B cell types
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CD b5 Positive cells - Produce IgM to soluble polysaccharides and self-antigens. Stimulated by T-cell independent antigens and does not confer memory
CD b5-negative cells produce IgG, IgA or IgE. Stimulated by T-cell dependent antigens and confers memory |
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White pulp histology and Lymph node histology
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White Pulp:
T cells are located around the central arteries and form a sheath - Called the periarteriolar lymphoid sheath B cells are in pal staining germinal centers - Found in marginal zone and nodules Node: B cells are in lymphatic nodules, T cells in lymphatic tissue network, and macrophages are in subcapsular and peritrabecular sinuses - B cells to cortex and T cells to paracortical zone |
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Idiotype, Allotype, and Isotype
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Idiotype - Area of the variable regions responsible for antigen specificity
Allotype - Different allels at a specific site in the constant region of heavy chain that may be detected as an antigen by another member of the same species. Used to resolve paternity disputes. Isotype - Subclass of immunoglobulins encoded by heavy chains |
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Hypersensitivity reactions
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I - IgE, Hayfever, Insect venom, anaphylaxis to drugs, asthma
II Cytotoxic- IgM, IgG, Complement, HDNB, Hyperacute graft rejection, Goodpasture disease, rheumatic fever **II Non-cytotoxic or Type V - IgG with no complement, Myasthenia gravis, graves, type 2 diabetes. Because antibodies activate TSH receptors in Graves, and blocks Ach receptors in NMJ of Myasthenia gravis III - IgG, IgM complement, SLE, Rheumatoid arthritis, serum sickness, post-strep glomerularnephritis. Immune complex deposition IV- No antibody and no complement. Tuberculin test, Hashimoto's thyroditis, contact dermatitis or poison ivy, Graft vs host disease |
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Antigen processing
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Exogenous - Antigen is engulfed and found in endosomes where they are digested into small peptide fragments.
- Fuse with exocytic vesicles with Class II MHC molecules and are bound and expressed Endogenous - Tumor and viral antigens are broken down into peptide fragments and transported to Endoplasmic Reticulum. - Go through the TAP peptide transporter complex into the ER and are associated with MHC I molecules - Transported through the golgi to the cell surface |
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T helper cells
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Th1 - Secretes interferon gamma and TNFalpha to stimulate macrophages.
- Also IL-2 to stimulate cytotoxic T cells Th2 - IL4-6 to stimulate B-cell proliferation and antibody class switching. |
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Complement Pathways and important Complement proteins
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Classical - C1q, C1r, then C1s, C4,C2, and then C3
Alternative - Depends on interaction of small amount of spontaneously preformed C3b with protective surfaces. Slow and less effective and requires Factor B Lectin pathway - Similar to classical. Mannose binding lectin binds mannose residues on bacteria which activates MASP 1 and MASP 2 which is similar to C1r and C1s C2a and C4a are weak anaphylatoxins C3a and C5a are strong anaphylatoxins C5a is a potent chemotaxin C3b is a potent opsonin |
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Histamine Receptors
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H1 - Causes smooth muscle contraction, Increases vascular permeability, and elevates intracellular GMP
H2 - Gastric acid secretion, Respiratory mucous secretion, and elevates intracellular AMP H3- Found in the CNS and functions in negative feedback inhibition of histamine release and synthesis |
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Kinin
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Polypeptides, Fibrin Split peptides formed from precursors in the plasma
Bradykinin - Major kinin and functions as a vasodilator by increasing capillary permeability and producing erythema and edema |
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Interleukins
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1- Produced by macrophages to stimulate T helper cells. Stimulates IL-2 secretion and is PYROGENIC
2- Produced by activated T cells especially Th1 cells and causes T cell stimulation 3- Secreted by Activated T cells and stimulates bone marrow stem cells 4,5,6 - Produced by Th2 cells and stimulates B cell proliferation and class switching. 4 Increases IgG and IgE and causes differentiation of Th into Th2 cells. 5 increases IgA and Eosinophils 7- Stimulates Pre-B and Pre-T cells 8- Stimulates chemotaxis and adhesion of neutrophils along with IL1 10 - Produced by monocytes and lymphocytes. Anti-inflammatory cytokine along with IL4 and IL13. Inhibits cytokine release from macrophages and inhibits interferon synthesis by Th1. 12- Activates Natural killer cells, Induces Th cell differentiation to Th1 |
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30S inhibitors
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Aminoglycosides/Streptomycin - Block initiation of protein synthesis
Tetracycline/Doxycyclin - Inhibit binding of tRNA Spectomycin - Blocks initiation |
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50S inhibitors
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Erythromycin - Macrolide that blocks release of uncharged tRNA from the 50S subunit. Prescribed for pts with allergy to penicillin. **Bacteriostatic
Clindamycin - Similar to erythromycin but with broader coverage including anaerobes Chloramphenicol - Bacteriostatic that inhibits peptidyltransferase action. |
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Beta Lactams
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Inhibites Transpeptidase
Penicillin Cephalosporin Carbopenem Monobactam |
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Other cell wall synthesis inhibitors
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Works within cell cytoplasm so must penetrate cell membrane to be effective
Vancomycin - Blocks growing end of polypeptide Bacitracin - Blocks dephosphorylation of lipid carrier Cycloserine - Blocks D-alanine additions to form pentapeptides |
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Folate antagonists
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Sulfonamides - Structural analogues of Para-amino Benzoic acid. PABA
Trimethoprim - Competitive inhibitor dihydrofolate reductase that converts dihydrofolate to tetrahydrofolate(Folic Acid) |
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Anti-Fungals
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Amphotericin B - Binds ergosterol-altering cell membrane
Nystatin - Same mechanism as amphotericin Azoles - Inhibit ergosterol synthesis |
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Nucleic Acid synthesis inhibitors
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Flouroquinolones like Ciprofloxacin, Nalidixic acid inhibit DNA gyrases necessary for supercoiling of DNA
Rifampin - Binds to and inhibits DNA-dependent RNA polymerase present in bacteria |
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Penicillins
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Penicillin G - Benzyl penicillin
- Given IM or IV and good for all gram Positives, Neisseria, and Troponema Pallidum Penicillin V - Less active especially against gram negative. But can be used as a oral form |
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Clavulanic Acid and Sulbactam
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Both are inhibitors of Beta Lactamase and can greatly broaden spectrum of penicillins
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Penicillinase resistant penicillins
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Methicillin, Oxacillin, Dicloxacillin, Cloxacillin, Nafcillin
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Aminoglycosides and Tetracyclins general characteristics
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Aminoglycosides: All have Ototoxicity and Renal impairment as side effects and are dose dependent
Tetracyclins - Tetracyclin can stain teeth - Doxycycline and Minocycline can be used to treat STDs and side effects include dizziness and nausea |
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Erythromycin as first line treatment
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First line for Legionares disease and Mycoplasma Pneumoniae
May be used as secondary for Syphillis |
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Treatment of Mycobacteria
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Isoniazid(INH), Rifampicin, Pyrazinamide, and Ethambutol
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Antivirals
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Acyclovir, Vidarabine, Gangcyclovir, and Foscarnet
- All inhibit viral DNA polymerase Acyclovir is used for various herpes such as VZV, HSV, EBV, but NOT against CMV - For CMV, use Gangcyclovir - Foscarnet for CMV retinitis Amantadine & Rimantadine block M2 channels and used for Influenza A but not B - Amantadine is also used for Parkinson's by causing release of dopamine and preventing its reuptake - Ribavirin for RSV |
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Treatment of HIV
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- Zidovudine - Bone marrow supression is most serious side effect
- Dideoxycytidine & Dideoxyinosine - 3-Thiacytidine - Protease inhibitors |
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Antifungals
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Polyenes - Used againt filamentous and yeast like fungi. No activity against dermatophytes or bacteria
- Amphotericin B which can only be given parenterally - Nystatin More toxic and used as topical preparations and for oral/esophageal candidiasis Imidazones - Block synthesis of fungal cell membrane ergosterol - Miconazole and Clotrimazole, are topically acvity - Ketoconazole, Itraconazole, and Fluconazole administered orally. |
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Causes of Meningitis
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Within 3 months - Listeria, Ecoli, Group B strep
After 3 months - Neisseria, Haemophilus Adults - Neisseria Meningitidis Elderly - Strep Pneumoniae |
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Natural Transformers/Competence
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HIGS
Streptococcus Haemophilus Neisseria Gonorrhea Helicobacter Pylori |
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Liquifactive necrosis
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Cellular destruction by hydrolytic enzymes
- Occurs in Brain infarcts and Pancreatic necrosis - Liquefaction by leukocyte enzymes is suppuration and resultant fluid is called pus |
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Caseous necrosis & Fat necrosis
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Caseous: Characteristic of tuberculosis & Center of some malignancies
Fat Necrosis: Caused by action of lipases, characteristic of tissues adjacent to acute pancreatic necrosis |
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Most important chemotactic factors for neutrophil
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C5a and IL-8
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Prostaglandins & Leukotrienes
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Prostaglandins: Mediate vasodilation & Pain
Leukotrienes: Mediate Vascular Permeability & Chemotaxis |
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Causes and sign of Granulomatous inflammation
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Occurs if a substance cannot be removed like Asbestos, Silica, or Tuberculosis.
Epithelioid cells which are modified macrophages that abundant eosinophilic cytoplasm with large amounts of ER, Golgi, and vesicles, indicating a secretory rather than digestive function. May form multinucleated giant cells. Hallmark of Granulomatous inflammation |
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Stable cells
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Replicate at a low level throughout life and are dormant unless stimulated by initiating event
- Liver, pancrease, kidney, vascular endothelium, Smooth muscle |
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Clotting tests
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CiTT TeK
Intrinsic & Common pathway - PTT - Heparin Extrinsic - PT - Vitamin K |
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Tumor markers AFP, CEA, hCG, PSA, CA125, LSA, Desmin, Enolase
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AFP - Hepatoma, malignant teratoma
Carcinoembryonic antige (CEA) - Any tumor from gut epithelia or intra-abdominal inflammation like ulcerative colitis. Adenocarcinomas Beta human chorionic gonadotropin (hCG) - Elevated in choriocarcinoma, germinoma and pregnancy Prostatic acid phosphatase & PSA elevated in prostate cancer CA125 - Ovarian cancer LSA - Lymphoma Desmin - Rhabdomyosarcoma Enolase - Neuroblastoma |
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Ectopic hormone production
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Carcinoid tumors - Tumors of Neuroendocrine cells may produce 5-Hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin
Oat cell tumors of lung/Small cell carcinoma - Derived from neuroendocrine cells and may produce ectopic hormones ADH or ACTH Squamous cell carcinoma of lung sometimes produce PTH |
|
Plubism
|
Lead poisoning
- Inhibits enzymes involved in hemoglobin synthesis and inhibits adenyl cyclase in brain & pancreas - Hypochromic and microcytic anemia - Ecephalopathy - Peripheral neuropathy often affecting radial nerve causing wrist drop - Abdominal colic |
|
Mercury poisoning
|
- Inactivates enzymes, especially cytochrome oxidases and damages membranes
Acute - Necrosis of gastric and colonic epithelium, acute renal tubular necrosis Chronic - Excessive salivation, gingivitis, gastritis, renal tubular basement membrane thickening and cerebral and cerebellar atrophy |
|
Wilms' Tumor
|
Embryonal tumor
- One of the most common solid tumors in children under 4 involving one or both kidneys |
|
Glycogen storage diseases
|
Inherited via autosomal-recessive pattern
Type 1 - Von Gierke Disease, caused by enzyme deficiency in glucose-6-phosphatase Type 2 - Pompe disease, acid alpha-glucosidase which is essential for degradation of glycogen. Affects all organs Type 3 - Cori disease. Defect in glycogen debranching enzyme. Affects all organs Type 4- Anderson disease Due to defect in branching enzymes leading to percipitation of long unbranched gycogen Type 5- McArdle disease - Defect in striated muscle phosphorylase Type 6 - Hers disease Defect in liver phosphorylase |
|
Sphingolipidoses
|
Tay-Sachs - Hexominadase A deficiency leading to accumulation of GM2 ganglioside affecting brain, retina, PNS
Gaucher's - Defect in Beta-glucocerebrosidase. Affects reticuloendothelial cells and CNS Niemann-Pick disease - Defect in sphingomyelinase leading to accumulation of sphingomyelin and cholesterol in a variety of organs |
|
Phenylketouria
|
Disorder from an absense of phenylalanine hydroxylase which halts conversion of Phenylalanine to Tyrosine
- Minimal melanin production, blue eyes, Phenylalanine in the urine. - Must avoid Aspartame because it contains phenylalanine |
|
Cystic fibrosis
|
Abnormality in chloride channels
- Diagnose via detecting elevated chloride and sodium in sweat - Hyperviscous secretions causing steatorrhea, pulmonary obstruction, and pneumonia |
|
Alpha-1-Antitrypsin deficiency
|
Emphysema of lower lobes of lungs
Contrast to upper lobe emphysema in smokers |
|
Edward syndrome
|
Trisomy 18
- Severe mental retardation - Micrognathia - 2 to 3 month avg life span |
|
Patau syndrome
|
Trisomy 13
- Microcephaly, severe retardation, Cleft lip and palate, polydactyly - Death in neonatal period |
|
Cri-du-chat
|
Deletion in short arm of chromosome 5
- Cat-like cry up to 1 year of age and severe mental retardation |
|
Mallory weiss tears
|
Small mucosal tears at the gastroesophageal junction secondary to recurrent forceful vomiting resulting in hematemesis
|
|
Esophageal varices
|
Dilated tortuous vessels of the esophageal venous plexus resulting from portal hypertention
|
|
Plummer vinson syndrome
|
*Do not confuse with Plummer's disease aka Toxic multinodular goiter which is hyperthyroidism from long standing simple goiter
Dysphagia Atrophic glossitis Anemia - Webs found in the upper esophagus and associated with iron deficiency anemia. - Patients are at risk for carcinoma of pharynx or esophagus |
|
Gastritis types
|
Fundal - Type A, Autoimmune and associated with pernicious anemia
Antral - Type B is most common type and caused by Helicobacter Pylori |
|
Krukenberg tumor
|
Ovarian metastasis from cancer in Gastrointestinal tract or breast
|
|
Virchow Node
|
Left supraclavicular lymph node
- Presence suggests metastatic stomach carcinoma |
|
Crohn & Ulcerative Colitis
|
Together are called Inflammatory bowel disorders
Crohn - Anywhere along GI tract and skips - Transmural - Slight cancer risk Ulcerative Colitis - Continuous involvement from rectum proximally - Limited to mucosa and submucosa - Greater risk of developing colon adenocarcinoma than in Crohn's disease |
|
Familial polyposis
|
Due to deletion of gene on Chromosome 5q
- Show autosomal dominant inheritance and appearance of polyps during adolescence. Virtully all develop cancers - Gardner syndrome refers to colonic polyps associated with other neoplasms - Peutz-Jeghers syndrome presents with polyps in entire GI tract associated with melanin pigmentation of buccal mucosa, lips, palms, and soles. Not premalignant Turcot syndrome - Colonic polyps associated with brain tumors. |
|
Hepatitis E
|
Self-limited and does not evolve into chronic hepatitis
*Pregnant women may develop fulminant disease - Used to be Calcivirus, now classified as HEPEvirus in its own category |
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Marasmus vs Kwashiorkor
|
Marasmus: Insufficient caloric intake leading to failure to thrive but no edema
Kwashiorkor: Inadequate protein intake. Shows Edema, anemia, haptomegaly, growth retardation etc |
|
Clinical features of iron deficiency
|
Hypochromic microcytic anemia
|
|
Tetralogy of Fallot
|
VSD
Patent ductus arteriosus Right ventricle hypertrophy Pulomonic stenosis |
|
Cardiac enzymes
|
CK-MB - Most sensitive and elevated first
- Followed by AST and SGOT elevation, but may indicate liver damange instead - Then LDH |
|
Aschoff bodies
|
Pathognomonic lesions for Rheumatic heart disease
|
|
Most common form of vasculitis
|
Temporal (Giant-cell) Arteritis
- Granulomatous inflammation of small and medium sized arteries |
|
Buerger disease
|
Thromboangiitis obliterans
- Recurrent acute and chronic inflammatory disorder of small and medium sized arteries and veins causing segmental thrombosis in extremeties - Exclusively in cigarette smokers less than 35yrs of age |
|
Virchow Triad
|
Factors involved in thrombus formation
- Endothelial injury - Alterations in blood flow - Hypercoagulability of blood |
|
Von Hippel-Lindau disease
|
Syndrome of multiple cavernous hemangiomas involving cerebellum, brainstem, liver, pancreas, and eyes
- Associated with renal cysts and renal cell carcinoma and transmitted via Autosomal-Dominant fashion |
|
Most common pituitary tumor
|
Hyperprolactinema
-Amenorrhea and Galactorrhea in women - Galactorrhea and infertility in men |
|
Hypothyroidism
|
Cretinism in children
- Skeletal and CNS development problems. Short stature, mental retardation Myxedema in adults - weakness, fatigue, decreased appetitie, weight gain, cold intolerance, hair loss, dry skin, constipation etc |
|
Osteitis Fibrosa Cystica
|
aka Von Recklinghausen disease of bone and occurs as a result of chronic hyperparathyroidism
- Osteoclastic resorption followed by fibrous replacement of resorbed bone leading to a "brown tumor" |
|
Mnemonic of Hypercalcemia
|
MISHAP
Malignancy Intoxication (Vit D) Sarcoidosis Hyperparathyroidism Alkaline syndrome Paget's disease |
|
COPD
|
Chronic Bronchitis - Persistent cough with sputum for 3 months for 2 consecutive years
Emphysema Asthma Bronchiectasis |
|
Kartagener Syndrome
|
Immotile Cilia syndrome
- Absence of pulmonary cilia interferes with bacterial clearance resulting in Bronchiectasis |
|
Goodpasture syndrome
|
Antibodies against glomerular and pulmonary basement membranes. Type 2 hypersensitivity
- hemorrhagic pneumonitis with Hemoptysis and Glomerulonephritis - If you see both Hemoptysis and Hematuria, think Goodpasture |
|
Lung cancer types
|
Adenocarcinoma - Most common, but less association with smoking
Squamous cell carcinoma - Not as common, but more association with smoking Small cell carcinoma - Rapid growth and early dissemination Large cell carcinoma |
|
Signs of ischemic neuronal damage
|
- Nissl substance dissolution
- Cytoplasmic eosinophilia - Nuclear condensation (Pyknosis) |
|
Alzheimer Pathology
|
- Gross cortical atrophy
- Microscopic changes: Neurofibrillary tangles, Senile plaques, Hirano bodies |
|
Parkinson Symptoms
|
Bardykinesia
Resting tremor Dementia - Loss of dopaminergic neurons in substantia nigra which projects to the striatum (Caudate nucleus and Putamen). *- Huntington's is toxic huntington proteins to the striatum itself |
|
Von Hippel-Lindau Disease
|
Retinocerebral Angiomatosis
- Hemangioblastomas - Abdominal masses - Pheochromocytoma - Cysts of kidney, pancreas, liver - Renal cell carcinoma in 50% of patients |
|
Guillain-Barre syndrome
|
Demyelinating illness of autoimmune etiology affecting PERIPHERAL nerves
- May follow certain viral infections of vaccinations - CSF proteins become markedly elevated |
|
B1 Deficiency
|
Thiamine
- Usualy due to malnutrition of chronic alcoholism Beriberi peripheral neuropathy - Axonal degeneration with secondary demyelination Wernicke Encephalopathy - Confusion, ocular disturbance, and ataxia of gait |
|
B12 deficiency
|
Pernicious anemia
- Almost always due to malabsorption rather than dietary deficiency - Also results in pathology in peripheral and optic nerves, as well as in the spinal cord and brain |
|
Mycotic infections
|
Candidiasis - Most often encountered fungal infection at autopsy of CNS
- Appears as mixture of yeast and pseudohyphae. Pathognomonic Aspergillosis - second most common fungal infection of CNS. Inhalation of airborne spores with hematogenous dissemination to the brain Mucormycosis - May occur as regional infection due to uncontrolled diabetes. Causes soft and hard tissue necrosis Histoplasma - Mimics TB Cryptococcosis - 50% of cases occur in immunocompetent individuals |
|
Diethylstilbestrol DES
|
Non-Steroidal estrogen
Diethylstilbestrol therapy in pregnant women will increase the incidence of vaginal neoplasms in their daughters |
|
Polycystic ovaries
|
Three clinical syndromes
- Virilism - Excessive menstrual bleeding - Stein-Leventhal syndrome characterized by amenorrhea, obesity, hirsutism, infertility, and bilaterally enlarged, polycystic ovaries |
|
Glomerulonephritis
|
Acute poststreptococcal glomerulonephritis
- Affects children more frequently and occurs 1-2wks after strep infection more commonly skin. Lab shows elevated anti-streptolysin O and low serum complement Lipoid nephrosis - Minimal change disease. most common cause of nephrotic syndrome in children and associated with food allergy and certain medications. Complete recovery is expected Membranous glomerulonephritis - Most common cause of nephrotic syndrome in adults. Membranoproliferative glomerulonephritis - MPGN - Prognosis is poor and treatment is controversial Focal segmental glomerulosclerosis - Prognosis is poor |
|
Pyelonephritis
|
E.Coli Infection extending into the renal pelvis, tubules, interstitium
- Infection of everything except glomerulus |
|
Urolithiasis
|
Calcium-containing stones - 75%
Magnesium-ammonium phosphate "Struvite" stones - 15%. caused by Proteus urinary infections which splits urea to form ammonia that combines with Magnesium to form stones Uric acid stones 5% - Gout, leukemia, and patients with acidic uring Cysteine stones - 1% due to error of metabolism. Rare |
|
Tumors of kidney
|
Renal cell carcinoma - Adenocarcinomas arising from the Proximal Convoluted tubule
- Classic triad of hematuria, palpable mass, and costovertebral pain Wilms tumor - Nephroblastoma - Drived from mesonephric mesoderm composed of epithelium, bone, cartilage, and muscle. - Rather common childhood malignancy at around age 2 caused by microdeletions in chromosomes 11p - 90% survival rate when treated |
|
Schistosoma Haematobium
|
Causes Urothelium carcinoma of bladder
|
|
Reiter syndrome
|
Triggered by Chlamydia Trachomatis infection resulting in triad of:
Urethritis, Arthritis, and Conjunctivitis |
|
Polycythemia
|
Increase in concentration of circulating erythrocytes
Relative polycythemia - due to loss or sequestration of intravascular volume without loss of RBCs. Can be due to decreased fluid intake, vomiting, diarrhea, etc Polycythemia vera - Myeloproliferative syndrome characterized by low erythropoietin levesl and erythroid hyperplasia with excess normoblasts. Secondary polycythemia - Increased erythropoietin levels. Can be due to high altitude, cigarette smoking, high CO levels, cardiac left to right shunts etc |
|
Defects of platelet adhesion
|
Von willebrand disease & Bernard-Soulier syndrome
Von willebrand - Autosomal dominant defects in Von Willebrand factor inhibits platelet adhesion to collagen. - Since von Willebrand factor is a carrier for factor 8, low factor 8 levels will increase PTT Bernard-Soulier disease - Autosomal Recessive - Defect in GP1B protein on platelets that binds von Willebrand factor |
|
Hereditary clotting deficiencies
|
A and B are X-linked recessive
Hemophilia A - Factor 8:C deficiency Hemophilia B - Christmas disease. Factor 9 deficiency. Hemophilia C - Rare disorder of Ashkenazi Jews caused by deficiency of Factor 11. Autosomal inheriatance and does not bleed into joints. |
|
Hodgekin's vs Non-Hodgekin's lymphoma
|
Hodgkin's disease
- Spread is almost in contiguity with spleen involvement before the liver - Characterized by Reed-Sternberg cells - High cure rate Non-Hodgkin's lymphoma - Characterized by lymphadenopathy and Hepatosplenomegaly. - Generally do not spread in contiguity. - Extra-nodal presentation common - Common in immunosupressed patients |
|
Leukemias
|
ALL - Children
AML - Myeloblasts that may contain Auer rods which are abnormal fused lysosomal structures CML - characterized by Massive splenomegaly. Over 95% of patients have the Philadelphia chromosome (Ph1) as a result of translocation CLL - Elderly |
|
Bence Jones proteins
|
Free light chains found in serum or urine
In Multiple myeloma, the free light chains are monoclonal In Inflammation, liver disease, or glomerulopathy, free light chains are polyclonal |
|
Multiple myeloma vs Waldenstrom Macroglobulineia
|
Multiple myeloma - Excess monoclonal IgG with bone pain, hypercalcemia, and lytic bone lesions
Waldenstrom Macroglobulinemia - Excess monoclonal IgM. No bone erosion *Job's syndrome is hyper IgE |
|
Endochondromatosis
|
Nonhereditary syndrome characterized by multiple cartilaginous masses within the medullary cavity of bone
Maffucci syndrome is a familial association of enchondromas and hemangiomas of the skin |
|
Osteoporosis vs Osteomalacia
|
Osteoporosis - Normal bone but decreased amount of bone. Normal serum calcium, phosphorus and alkaline phosphatase
Osteomalacia - Rickets in children. Normal amount of bone but impaired mineralization of the osteoid matrix causing fractures and bending of bones and widening of osteoid seams. - Lab shows low serum calcium, phosphorousm and alkaline phosphatase. |
|
Paget's disease
|
aka Osteitis Deformans
Excessive bone resorption with replacement by soft poorly mineralized bone - Pain deformity and fractures. - Extremely elevated alkaline phosphatase *- Cotton Wool appearance of bone *- 1% develop into malignant osteosarcoma |
|
Brown tumors
|
Areas of organized hemorrhage in hyperparathyroidism
- As seen in Osteitis Fibrosa Cystica/Von Recklinghausen's disease of bone |
|
Codman triangle
|
Classical xray finding of Osteosarcoma
- Histology reveals anaplastic cells with osteoid, pink, amorphous material that is variably mineralized |
|
Heberden nodes
|
Found in the Distal Interphalangeal Joint in patients with Osteoarthritis
|
|
Gout
|
Deposition of urate crystals leading to acute, painful attacks of arthritis.
- Primary gout is due to dysfunctional purine metabolism while secondary gout is not - Big toe is classically affected - May result from overproduction or underexcretion of uric acid - Tophi, urate deposits surrounded by inflammatory cells is pathognomonic |
|
Erythema Multiforme
|
Hypersensitivity response to drugs causing bullseye erythema of skin
- Type 3 hypersensitivity in which immune complexes are deposited into the skin - Most common predisposing infection is Herpes Simplex - Also associated with drug interactions such as sulfa drugs and penicillin Stevens-Johnson syndrome is the Major form of Erythema Multiforme and can result in fever, respiratory difficulty, sepsis, etc |
|
Auspitz sign
|
Characteristic of Psoriasis
- White or silver scales on lesions - Auspitz sign is seen when removal of scale results in pinpoint areas of bleeding. |
|
Systemic lupus erythematosus & Drug induced Lupus
|
Type 3 Hypersensivity
SLE - Autoantibody directed against double stranded DNA - Antibody complexes formed kidneys, joints, blood vessles and activate complement - Show signs of butterfly rash, raynaud's phenomenon, joint pain, and photophobia Drug induced Lupus - Autoantibodies against histones |
|
Hendersen Hasselbach equation
|
pKa is -log of Ka
Ka = Dissociated base / Acid pH = pKa + log[A-]/[HA] |
|
Buffering systems
|
Intracellular:
- Histidine, Lysine, and Arginine side chains. Mainly Histidine - Phosphate systems H2PO4 - Hemoglobin - Bicarbonate system. pKa =6.1 Extracellular - Bicarbonate system. Most important buffer system in the body. pKa = 6.1 |
|
Degredation of amino acids
|
Occurs by transamination of amino group to glutamate
- Remaining carbon skeletons of amino acids may be oxidized to CO2 and H2O or enter the TCA cycle for gluconeogenesis or Ketogenesis |
|
Michaelis-Menten Equation
|
V = Vmax[S]/Km + [S]
|
|
Reversible inhibitors
|
Competitive:
Km is increased Vmax unchanged Noncompetitive - Allosteric inhibitor - Km is unchanged - Decreased Vmax Uncompetitive - Km is decreased - Vmax is decreased |
|
Carboxylation co-enzyme
|
Biotin
- Participates in Pyruvate carboxylase of gluconeogenesis, Acetyl-CoA carboxylase of fatty acid synthesis, and propionyl-CoA carboxylase of branched chain amino acid catabolism - Biotin deficiency is rare - Excessive consumption of raw egg impairs biotin absorbtion due to presence of biotin-binding protein Avidin in egg whites - Alopecia, Skin and bowel inflammation, and muscle pain |
|
Oxidation reduction Mnemonic
|
OIL RIG
Oxidation is Loss of electrons Reduction is Gain of electrons - Stronger electron donors have more negative reduction potential measured in E |
|
Anaplerotic filling-up reactions
|
- Converts Pyruvate to Oxaloacetate via Pyruvate carboxylase with Biotin co-enzyme
- Requires acetyl-CoA as an allosteric activator |
|
Anabolic functions of TCA substrates
|
Citrate is substrate for fatty acid synthesis
Oxaloacetate is the first intermediate in gluconeogenesis Succinyl-CoA is required for synthesis of heme Oxaloacetate and alpha ketoglutarate are substrates for amino acid synthesis |
|
Key enzymes of TCA
|
Four dehydrogenases
- Isocitrate dehydrogenase, a-ketoglutarate dehydrogenase, Succinate dehydrogenase and Malate dehydrogenase - Isocitrate dehydrogenase catalyzes the first rate limiting reaction |
|
NADH shuttles
|
Malate Aspartate shuttle
- Malate in, to oxaloacetate, and Aspartate out - Generates Mitochondrial NADH a-Glycerol phosphate shuttle - a-Glycerol-Phosphate in, Dihydroxyacetone-phosphate out - Generates Mitochondrial FADH2 |
|
Rate limiting step in glycolysis
|
PosphFructokinase-1 which convertes Fructose-6 phosphate to Fructose 1,6 Bisphosphate
- Strongly regulated by Fructose 2,6 bisphosphate in liver which greatly enhances glycolysis through PFK-1 and inhibits gluconeogenesis. F2,6P concentration is increased by insulin and decreased by glucagon |
|
Energy producing enzymes of glycolysis
|
Glyceraldehyde 3P dehydrogenase generates a NADH and attaches an inorganic phosphate to form 1,3Bisphosphoglycerate
Phosphoglycerate kinase forms ATP Pyruvate kinase forms second ATP |
|
Fates of Pyruvate
|
Cytosol
- Lactate dehydrogenase to form Lactate - Transaminase to form alanine Mitochondria - Pyruvate carboxylase, req biotin, to form Oxaloacetate which can replenish TCA or undergo gluconeogenesis - Pyruvate dehydrogenase complex, which forms Acetyl-CoA which can undergo TCA or fatty acid synthesis |
|
Poisons of glycolysis
|
Flouride complexes with 2-phosphoglycerate and Mg2+, inhibiting Enolase
|
|
Gluconeogenesis
|
1) Pyruvate Carboxylase to form Oxaloacetate, Requires Biotin and presence of Acetyl-CoA
- Oxaloacetate is transported out to mitochondria via Malate shuttle 2) Phosphoenolpyruvate Carboxy kinase PEPCK in cytosol. Cost a GTP 3) Fructose 1,6 Bisphosphatase. Rate limiting step 4) Glucose 6 phosphatase |
|
Precursors for glucose synthesis
|
Lactate from RBC and anaerobic muscle participate in the Cori cycle
Alanine from skeletal muscle by transamination of Pyruvate to conserve carbohydrate All amino acids except Lysine and Leucine are gluconeogenic. Lysine and Leucine are strictly Ketogenic. Nitrogen from A.A degradation is diposed of as urea Glycerol backbone from triacylglycerol degradation is converted to Glycerol-3-phosphate and oxidized to dihydroxyacetone phosphate for gluconeogenesis Oxidation of Odd number fatty acids forming Propionyl CoA, and converted to succinyl-CoA Fructose Galactose |
|
Von Gierke's disease
|
Deficiency of Glucose 6 phosphatase
|
|
Hormonal control of Gluconeogenesis and Glycogenesis
|
Glucagon and Epinephrine increases cAMP and Insulin decreases cAMP
- cAMP activates PKA to cause several effects - Phosphorylation of pyruvate kinase inhibits the enzyme - Stimulates degradation of F-2,6-Bisphosphate - Increased synthesis of key enzymes such as PEPCK, FBPase-1, and G6P - Increased protein degradation - Increased lipolysis - PKA phosphorylates Glycogen phosphorylase, which activates the enzyme to break down glycogen - PKA phosphorylates Glycogen Synthase, which inactivates enzyme |
|
Glycogenolysis
|
Glycogen phosphorylase - Key rate limiting enzyme
- Will degrade glycogen till 4-5 units away from a branch point - Then requires a1,4 Glucan transferase and a1,6 Glucosidase to continue degradation |
|
Glycogen Synthesis
|
Glucokinase in liver and Hexokinase in other tissues to form G6P
- Phosphoglucomutase forms G1P - UDP-Glucose pyrophosphorylase - Glycogen synthase: This is the rate limiting step in glycogen synthesis. Requires Glycogenin to make a primer before it can add UDP glucose to the chain - Branching enzymes break 1,4 linkage and forms 1,6 linkage. Atleast 4 glucose molecules between branch points. Glycogen has more branching than Amylopectin |
|
Glycogen Storage diseases
|
Type
1 - Von gierke: G6Pase deficiency. Severe hypoglycemia, lactic acidosis, hepatomegaly 2 - Pompe disease: Lysosomal a-1,4-glucosidase deficiency. Cardiomegaly, death by 2 yr 3 - Cori disease: Decreased debranching enzyme. Mild hypoglycemia 4 - Anderson's disease: Decreased Branching enzyme. Infantile hypotonia, Cirrhosis, death by 2 5 - McArdle disease: Decreased muscle glycogen phosphorylase. Muscle cramps and weakness during initial phase of excercise 6 - Hers disease: Decreased liver glycogen phosphorylase. Fasting hypoglycemia, hepatomegaly |
|
Hexose Monophosphate Shunt
|
Begins at G6P and returns at Fructose 6 Phosphate
Glucose 6 Phosphate Dehydrogenase is the rate limiting step - 2 Moles of NADPH is produced for every glucose oxidized - Also produces Ribulose-5-phosphate which is isomerized to Ribose-5-Phosphate used for nucleotide synthesis. - Transaldolase and Transketolases catalyze all of the reversible nonoxidative phase reactions |
|
Fructose metabolism
|
1) Fructokinase converts Fructose to Fructose 1 phosphate
2) Aldolase B converts F1P to Dihydroxyacetone phosphate which enters glycolysis and Glyceraldehyde 3) Glyceraldehyde can undergo conversion to Glycerol for Fatty acid synthesis or undergo Glyceraldehyde Kinase to form G3P for glycolysis |
|
Essential Fructoseuria and Hereditary Fructose intolerance
|
Essential Fructoseuria - Deficiency in Fructokinase resulting in intact Fructose in blood and urine
Hereditary Fructose intolerance - Lack of Aldolase B, leading to buildup of F1P which inhibits Glycogen phosphorylase and aldolase. Thus, both Glycogenolysis and Gluconeogenesis are inhibited causing severe hypoglycemia, and vomiting. Reverse symptoms by removing Fructose and Sucrose from diet |
|
Galactose metabolism
|
1- Galactokinase
2- Uridyl transferase to convert UDP glucose to G1P and UDP galactose 3 - UDP-Galactose-4-Epimerase converts UDP galactose to UDP-Glucose |
|
Galactosemia
|
Autosomal recessive
Galactokinase - Galactose accumulates and is converted to Galactitol in the nervous system to cause RETARDATION and in eyes to cause CATARACTS Galactose1Phosphate Uridyl transferase - Galactitol builds up in liver causing SPLENOMEGALY - Treatment includes excluding Galactose and Lactose from diet |
|
Fatty Acid examples
|
Saturated:
Palmitic 16 & Stearic acid 18 Unsaturated: Oleic acid: Mono unsaturated 18. Cholesterol ester synthesis Linoleic: Essential. Precursor for Arachidonic acid with 2 double bonds. Linolenic acid: Essential 18 carbon 3 double bond acid. Precursor for Prostaglandins and Thromboxanes. Cannot for Leukotrienes Arachidonic acid has 4 double bonds and is not essential if Linoleic acid is available in diet |
|
Fatty acid synthesis Preparation
|
Acetyl-CoA is transported to Cytosol via Citrate shuttle
- Citrate out and cleaved by Citrate lyase to form Oxaloacetate and Acetyl-CoA - Oxaloacetate to malate to Pyruvate, generating NADPH, Pyruvate is transported back to mitochondria - NADPH is then used for Fatty acid synthesis |
|
Enzymes in Fatty acid synthesis
|
Acetyl-CoA Carboxylase - Rate limiting step. Forms Malonyl-CoA
- Fatty acid synthase catalyzes rest of reaction adding 2 carbons at a time to form C16 Palmitic acid - Reaction sequence is Condensation, Reduction, Dehydration, Reduction -* Further Elongation and Desaturation occurs in Smooth Endoplasmic Reticulum |
|
Start of Fatty acid oxidation
|
Most Beta oxidation occurs in Mitochondria, but Oxidation of very long chain fatty acid and branched-chain fatty acids occur in Peroxisomes
- Converted to Fatty Acyl-CoA immediately after entering cell to trap fat inside cell. Catalyzed by Fatty Acyl-CoA synthase (Thiolase) - Transfer into mitochondria via Carnitine shuttle. Carnitine Acyl Transferase CAT-1 is on outer surface of the inner mitochondrial membrane forming Fatty-Acyl-Carnitine. ***CAT-1 is rate limiting enzyme in Fatty Acid-oxidation - Carnitine translocase transports fatty acyl carnitine into mitochondria and free carnitine back out - CAT-2 is associated with the inner surface of inner mito membrane and reforms Fatty acyl CoA inside mitochondria |
|
Fatty Acid oxidation
|
Reverse of fatty acid synthesis
- Dehydrogenation producing FADH2 - Hydration - Dehydration to form NADH - Thiolytic cleavage - Odd chain fatty acids results in one Pripionyl-CoA which is carboxylated to methylmalonyl-CoA and becomes Succinyl-CoA which enters TCA - Unsaturated fats are all Cis, so must turn trans by Enoyl-CoA isomerase and then Enoyl-CoA hydratase removes double bond. - Oxidation of Palmitic acid produces 129 ATP |
|
Ketone Synthesis
|
Occurs in liver mitochondria
- Condenses 3 molecules of Acetyl-CoA to form Beta-Hydroxy-butyrate - B-Hydroxy-Butyrate is taken up and converted to acetoacetate. Liver lacks this enzyme - Acetoacetate is converted to Acetoacetyl CoA and cleaved to form 2 Acetyl-CoA *- Rate limiting step is second step using HMG-CoA Synthase |
|
TAG Synthesis
|
Occurs in liver and adipose tissue
- Formed from reduction of Dihydroxyacetone phosphate - Fatty acyl transferase adds Fatty Acyl-CoA to carbons 1 and 2. Hydrolysis of phosphate bond at carbon 3 generates diacylglycerol which is then esterified with third fatty acid to form TAG |
|
Lipoproteins
|
Chylomicron - Least dense. Synthesized in intestinal epithelial cell smooth ER and transport dietary triglycerides to liver, muscle and fat
VLDL - Synthesized in liver and transport mostly TAG from liver to adipose tissue LDL - Transports cholesterol from liver to other cells of body HDL - Collects cholesterol from cells and brings them back to liver |
|
Cholesterol Metabolism
|
Synthesized in the Cytosol
- HMG-CoA is formed from 3 Acetyl-CoA using different enzymes from Ketone synthesis - HMG-CoA Reductase is rate limiting key enzyme that forms Mevalonic acid - Reducing power comes from NADPH from Pentose phosphate pathway |
|
Cholesterol Esters
|
Most common fatty acid esterified to Cholesterol is Oleic Acid
Hydrolysis: Pancreatic cholesterol esterase - Hydrolyzes dietary cholesterol esters in intestinal lumen Intracellular cholesterol esterase - Found in all tissues but highest in liver and steroid hormone producing glands Synthesis of Cholesterol esters: Lechitin Cholesterol transferase (LCAT) - Involved in Leaving of cholesterol via HDL Acyl cholesterol Acyltransferase (ACAT) - Found inside cell and involved in Accumulation of cholesterol for storage |
|
Steroid hormone synthesis
|
All synthesized from cholesterol in adrenal cortex, ovaries, and testes
1) Cleavage of side chain by 20-22 Desmolase/P450scc/Cholesterol Side Chain cleavage enzyme in Mitochondria to generate pregnenolone. Rate limiting step 2) Pregnenolone is converted to Progesterone by action of 3-B-Hydroxysteroid Dehydrogenase - Pregenolone and Progesterone are C21 intermediates for all steroid hormones |
|
Estrogen formation
|
Requires Aromatase which converts androgens to estrogens
- Removes methyl group and makes A ring aromatic |
|
Sphingomyelin
|
Major component of membranes of CNS and is only sphingolipid that contains phosphate
|
|
Phospholipase A2
|
Releases Arachidonic acid from membrane stores
- Inhibited by Glucocorticoids like cortisone |
|
Eicosanoids
|
Prostaglandins - Prostacyclin is major prostaglandin synthesized by endothelial cells. Prostacyclin dilates coronary arteries and antagonizes platelet aggregation
Thromboxanes - Thromboxane A2 is major thromboxane synthesized by platelets and antagonizes Prostacyclin to cause platelet aggregation and vasoconstriction. Leukotrienes - Slow reacting substance of anaphylaxis |
|
Essential Amino Acids
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Pvt Tim Hall
Phe Val Threonine Tryptophan Isoleucine Met Histidine Arginine Leucine Lysine ** Histidine and Arginine is only essential during early childhood |
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Amino acid absorption and diseases
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Specific transport systems absorb amino acids
- Transport across luminal membrane is Na+ dependent and transport across contraluminal membrane is Na+ Independent. Di and Tripeptides are absorbed via H+ transport Cysteinuria - Most common amino aciduria. Autosomal recessive disease caused by defect in COAL transport or positively charged amino acids such as Cysteine, Ornithine, Arginine, Lysine Hartnup disease - Autosomal recessive defect characterized by excretion of large quantities of neutral A.A in urine such as Tryptophan. Causes pellagra like dermatosis because there is no Tryptophan to synthesize Niacin |
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Pyridoxal Phosphate
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- Derivative of Pyridoxine. Vitamin B6
-Cofactor for All Transaminases and many Decarboxylation reactions *** Note that alpha-ketoacid decarboxylations and Pyruvate dehydrogenase complex requires B1 Thiamine as a cofactor |
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Disposal of alpha amino groups
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Transaminases using Pyridoxal phosphate as coenzyme is specific for amino acids and usually transfers amino group to alpha-ketoglutarate to form glutamate
- This funnels all amino groups into glutamate. Glutamate has 2 fates 1) Glutamate dehydrogenase oxidatively deaminates Glutamate to release ammonium ion 2) Aspartate transaminase (AST) transfers amino group to oxaloacetate to form Aspartate. This enzyme is mainly in cytosol of liver cells for urea synthesis. - Alanine cycle is additional way for skeletal muscles to get rid of urea - Urea is formed with one free ammonium and one ammonia from Aspartate |
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Urea cycle
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First two steps are in the mitochondria and rest in cytosol
1) Carbamoyl Phosphate synthetase I 2) Ornothine + Ornithine transcarbomoylase to form Citrulline which exits mitochondria 3) Argininosuccinate synthetase to form arginosuccinate, Arginosuccinate lyase to form Fumarate and Arginine, Arginase, which reforms Ornithine only exists in Brain, LIver and kidney. Ornithine then re-enters mitochondria to continue cycle *- One Amine comes from free ammonia and the other from aspartate *- Hydrolysis of Arginine produces urea *- No known alternative pathway for urea synthesis. So death from advanced liver disease is due to inhibition of urea synthesis |
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Alanine cycle
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Skelatal muscle transfers amino groups of Glutamate to Pyruvate to form Alanine
- Alanine is transported to liver where it uses Pyruvate for gluconeogenesis and the Ammonia for Urea synthesis |
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Disposal of Carbon skeletons
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Can be oxidized to CO2 and H2O for energy or can be converted to glucose or ketones
Strictly Ketogenic - Lysine, Leucine Both Keto and Glucogenic - Phenylalanine, Isoleucine, Tyrosine, Tryptophan, Threonine Strictly Glucogenic - All else |
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Degradation of Branched chain amino acids
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Liver cannot degrade Valine, Leucine, and Isoleucine
- Degradation of branched-chain AA occurs in skeletal muscle - Branched chain amino acid transaminase BCAA transaminase transfers a-amino to a-ketoglutarate - a-ketoacids are decarboxylated by a Branched chain Ketoacid Dehydrogenase BCKA-DH complex, Implicated in Maple Syrum Urine disease |
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Synthesis of amino acids from Essential amino acids
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Tyrosine is formed from Phe via Phenylalanine Hydroxylase
- This enzyme requires Tetrahydrobiopterin(THB) as a cofactor Cystein synthesis requires Serine and Methionine |
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Methionine synthase
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Used in the formation of Cysteine
- Only enzyme to use Tetrahydrofolate as a methylating agent - One of the two reactions in humans that requires Vitamin B12 along with methylmalonyl-CoA mutase to form Succinyl-coA in Propionyl-CoA metabolism |
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Products derived from Amino Acids
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Histamine - Decarboxylation of Histidine
GABA - Decarboxylation of Glutamate Serotonin - Tryptophan Catecholamines, Melanin, Tyroxine - All from Tyrosine. Tyrosine hydroxylase forms Melanin Nitric Oxide - Derived from Arginine in endothelial cells and stimulates cGMP synthesis in smooth muscle cells Heme - Assembly of a porphyrin ring requires glycine and succinyl CoA |
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Heme synthesis
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Initial step catalyzed by AminoLevulinic acid Synthase ALA-Synthase.
- This reaction requires Pyridoxal phosphate and is rate limiting - Reaction procedes to Protoporphyrin-9 before insertion of iron by heme synthase aka ferrochelatase forming heme Porphyria refers to any abnormality in pathway of heme synthesis - Lead poisoning can be considered an acquired Porphyria - Inhibits ALA dehydratase and Heme synthase |
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Heme degradation
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Heme degradation begins in reticuloendothelial cells
- Biliverdin and Carbon Monoxide is generated - Only reaction in human body that generates Carbon monoxide - Biliverdin is converted to Bilirubin - Bilirubin can be glucuronated to form conjugated or direct bilirubin. Can also form Stercobilin or Urobilin |
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Nucleoside & Nucleotide
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Nitrogenous base with Pentose = Nucleoside
Base with Pentose + Phosphate = Nucleotide |
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Important Nucleotide bonds
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1C - Glycosidic bond to base
2C - OH on RNA and Hydrogen on DNA 3C - OH that bonds with phosphate 5C - Phosphate 3,5 phosphodiester bond is most common and forms backbone in DNA and RNA 2,5 Bond involved in RNA splicing 5,5 Bond found in cap structure at 5' end of eukaryotic messenger RNA |
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Stabilizing forces of DNA
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AT and AU pairs have 2 hydrogen bonds
GC pairs have 3 hydrogen bonds and are more stable Base stacking allows for hydrophobic interactions between adjacent bases |
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Types of DNA
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B DNA - Classic right handed antiparallel helix
Z DNA - Rare form of Left handed DNA found in sequences rich in GC bonds or long tracts of alternating purine and pyrimidines. Unknown function A DNA - Bases are not perpendicular to helican axis but tilted 20deg from axis. Anhydrous form of B DNA, but still right handed and antiparallel. Found in DNA-RNA hybrids |
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Metabolism of Purines and Pyrimidines
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Purine - Synthesized from amino acids, bicarbonate, and C1 fragments carried to THF.
- Purine ring is formed directly on the ribose. - Parent nucleotide is IMP - Cannot be opened up and degraded. So goal is to make as soluble as possible. Product is Uric Acid Pyrimidine - Formed first, and then attached to ribose - Precursors are Cabamoyl phosphate and Aspartate - Parent nucleotide is OMP - Can be opened up and degraded. Thymidine is degraded to Butyrate. Cytosine and Uracil are degraded to B-alanine |
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Nuclear Lamin
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On the inner surface of Nuclear membrane and contains 3 important proteins
- Important in connection between inner nuclear membrane and chromatin during mitosis and meiosis |
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Topoisomerase
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Enzymes that relieve the strain induced by replication fork
Class 1 Topoisomerase - Relax superhelican DNA in front of replication fork. Does not require ATP Class 2 topoisomerase - Introduce negative supercoild in the DNA molecule. Requires ATP and involves transient breaking and resealing of both DNA strands *- DNA Gyrase is a type 2 topoisomerase |
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Bacterial Promoter region and terminators
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Promotor regions
-35 has a TTGACA region for RNA polymerase recognition -10 is the Pribnow box TATATT where transcription begins Terminators Rho-independent: Requires many GC residues that make a hairpin loop followed by a run of 6-8 U residues that form weak bonds to 6-8 A residues Rho-dependent: Rho factor binds to newly formed RNA and moves toward RNA polymerase that has paused at a termination site to displace it |
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Human RNA polymerases
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RNA polymerase 1 - In Nucleolus and transcribes rRNA which is the most abundant RNA in the body
RNA polymerase 2 - In nucleoplasm and transcribes mRNA RNA polymerase 3 - In nucleoplasm and transcribes tRNA |
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Human RNA promotors
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TATA box aka Hogness box - Important in the initiation of transcription and is found in all eukaryotes
- TFIID, the critical transcription factor for RNA polymerase II binds in the TATA box CAAT box - Binding of transcription factors here influences the formation of initiation complexes at other sites |
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hnRNA
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Primary RNA transcript that contains both Introns and Exons
Mature mRNA contains only Exons |
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Hypothalamus and Food
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Lateral hypothalamus is the feeding center
- Damage will cause anorexia Venteromedial nucleus is satiety center - Damage will cause hypothalamic obesity syndrome |
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Majority of saliva
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70% Produced by Submandibular glands even though they are smaller than parotid
Parotid produces 20% Sublingual and minor glands produce other 10% |
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Ptyalin
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Salivary amylase which breaks polysaccharides down to maltose or disaccharides
-**Amylase is Found primarily in serous and not mucous glands |
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Swallowing
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Swallowing is a reflex action carried by CN 9 and 10
- Initiation of swallowing occurs voluntarily as tongue propels food into pharynx - Advancement of bolus into esophagus and contraction of pharynx is involuntary |
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Stomach layers
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Outer longitudinal
Inner circular Inner oblique |
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Pudental nerve
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Originates in Onuf's nucleus in sacral region and branches off the sacral plexus
- Controls external genetalia of both sexes - Also controls sphincters for bladder and rectum |
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Gastrin
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- Synthesized and stored in G cells of dueodenum and pyloric antrum
- Stimulates HCL secretion by parietal cells, pepsinogen by chief cells, increase gastric blood flow, promotes contraction of circular smooth muscle |
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CCK
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- Synthesized and stored in I cells of duodenum and Jejunum and CNS
- Stimulates gall bladder contraction and relaxation of sphincter of oddi - Stimulates pancreatic enzyme secretion - Inhibits gastric emptying |
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Secretin
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-Synthesis and storage takes place in S cells of duodenum
- Stimulates secretion of bicarbonate containing fluid from pancreas and Brunner's glands in the Duodenal Submucosa - Inhibits proton secretion from parietal cells |
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GIP
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- Produced in duodenum and Jejunum by K cells
- Feeds back to inhibit gastric motility and HCL secretion - Stimulates pancreatic insulin release in the presence of hyperglycemia |
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VIP
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Located in the parasympathetic ganglia in sphincters, gall bladder, pancreas and small intestine
- Stimulates water and electrolyte secretion by jejunum, ileum, and colon - Relaxes smooth muscle including sphincters - Stimulates pancreatic bicarbonate secretion - VIPoma is a tumor of non-a non-b islet cells of pancreas that secretes VIP. Causes watery diarrhea |
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Somatostatin
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Released from Pancreatic islet D cells, gastric antrum
- Inhibits both insulin and glucagon release - Inhibits release of gastrin, CCK, and most other gastrointestinal hormones *- Also acts as a hypothalamic inhibitory hormone for GH and TSH |
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Substance P
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Synthesis occurs in enterochromaffin cells of small intestine, colon, and CNS
- Vagal efferents stimulates release of substance P - Stimulates salivary flow and GI motility - Transmits pain in the nervous system |
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Pancreatic secretions
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Exocrine secretions are produced by acinar cells which produce enzymes and ductal cells which produce bicarbonate
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Carbohydrate digestion
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- 20% is digested via Salivary amylase which hydrolyzes only a1,4- linkages to disaccharides and limit dextrins
- Pancreatic amylase has highest concentrations in duodenal lumen and also form disaccharides and a-limit dextrins - Oligosacharide hydrolases that convert disacharides to monosaccharides are found on brush border |
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Hirschsprung disease
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Congenital defect leading to incomplete development of neural innervation of colon
- Myenteric (Auerbach) plexus lies between circular and longitudinal layers from esophagus to anus. Has both Sympathetic and Parasympathetic - Submucosal (Meissner) Plexus lies in submucosa of the gut wall. Has only Parasympathetic - Absence of these two plexi in Hirschsprung disease leads to severe obstruction, constipation, and megacolon |
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Parasympathetic innervation to gut
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Vagal - Originates in dorsal motor nucleus of vagus in floor of fourth ventricle
- Forms esophageal plexus to innervate thoracic structures - Anterior vagal trunk innervates gastric, celiac, hepatic, and pyloric areas - Posterior vagal trunk innervates pyloris, duodenum, pancreas, small intestine, cecum, up to the right transverse colon - Sacral parasympathetics innervate left transverse colon and on |
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Heart sounds
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1st - Coincides with AV mitral and tricuspid valve closure
2nd - Semilunar valve closure 3rd - Rapid ventricular filling. Can be heard in children and young adults normally. 4th - Occurs during atrial systole but typically is not audible in a normal heart |
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When most ventricular filling occurs
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Atrial systole accounts for 20% of ventricular filling
80% of filling occurs during the filling period before atrial systole |
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Mean arterial pressure
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Under normal conditions
1/3systolic + 2/3 Diastolic |
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Poiseuille's law
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Resistance is directly proportional to the length of the blood vessel and inversely proportional to the fourth power of the vessel radius
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Velocity of blood flow and Greatest drop in blood pressure
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Greatest drop in BP occurs across arterioles
Velocity of blood is slowest in capillaries which has the greatest total cross sectional area. This facilitates nutrient exchange |
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Hypothalamic Inhibitory hormones
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Somatostatin - Inhibits both TSH and Growth hormone
Dopamine - Inhibits prolactin secretion |
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Endorphins and Enkephalins
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Natural Opiates
Endorphins - Help regulate limbic system by binding to specific opiate receptors to modulate pain, behavior, and narcotid addiction Enkephalins - Produce transient analgesia |
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Baroreceptors
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Carotid Sinus - CN 9
Aortic Sinus - CN X Atrial receptors - Junction of right atrium and vana cava and left atrium with pulmonary veins - Increase heart rate - Secretion of ANP - Decreased ADH |
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Biosynthesis of Posterior pituitary hormones
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Supraoptic nucleus and Paraventricular nucleus (SON and PVN) of hypothalamus both contain cells that synthesize both ADH and Oxytocin.
*- Some sources say Supraoptic:ADH and Paraventricular:Oxytocin. |
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Glucocorticoid activities
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- Reduce sensitivity to insulin and increase glucagon release
- Promote gluconeogenesis - Increase protein and fat breakdown - Blocks Phospholipase A2 and inhibits release of arachidonic acid - Inhibit release of histamine - Inhibits IL2 |
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ACTH
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Interacts with cell surface receptor and increases cAMP
- Stimulates conversion of Cholesterol to Pregnenolone via 20-22 Desmolase/p450scc |
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Aldosterone
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- Increase sodium retention but K+ and H+ excretion
- Snthesized from Angiotensin II stimulation and directly from increased plasma K+ - Inhibited by ANP |
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Catecholamine degradation
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Catalyzed by Catechol-O-methyltransferase COMT or Monoamine Oxidase MAO
- Local action is also terminated by neuronal reuptake - MAO is located on outer Mitrochondrial membrane. Abnormal levels are implicated in psychiatric disorders. Requires B2 and is classified as a Flavoprotein - COMT is in Postsynaptic tissues. Inhibited with Entecapone to treat Parkinson's. *- COMT is NOT in sympathetic nerves |
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Catecholamine synthesis
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Phenylalanine
Tyrosine L-Dopa Dopamine Norepinephrine. - a1, a2, and b1 Epinephrine - All four |
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Thyroid hormone synthesis
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Regulated by TSH secretion which increases cAMP
Thyroglobulin is synthesized and released by thyroid follicular cell into the colloid space aka follicular lumen - TG is iodinated and taken back from follicular lumen into the cell via endocytosis - Two DIT forms T4 and a MIT with a DIT forms T3. Catalyzed by Thyroid peroxidase - Mainly T4 and less T3 is secreted to the extracellular space - T3 is 20 times more potent. T4 is converted to T3 in cells *- Thyroid hormones are lipid soluble and act on nuclear receptors |
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Calcium regulation
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PTH - Increase plasma calcium, decrease phosphate
Vitamin D - Increase Calcium and Phosphate reabsorbtion Calcitonin - Decrease plasma Calcium and Phosphate |
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Treating Hyperkalemia
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Glycolysis is coupled with influx of K+ into cells
- Thus, Insulin increases cellular uptake of K+ - Can treat hyperkalemia with Insulin and glucose |
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Amino acids and Endocrine function
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Amino acids, Especially Arginine stimulates both Insulin and Glucagon secretion
- Both are inhibited by Somatostatin |
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Limitations of Spirometer
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Cannot measure Residual volume
So any volume that includes RV such as Functional residual capacity or Total lung capacity cannot be measured using Spirometry |
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Obstructive airway disease vs Restrictive airway disease
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In Obstructive: Functional Expiratory volume in 1 second FEV1 to Vital Capacity - FEV1:VC is greatly reduced
In Restrictive: All lung volumes are reduced, so FEV1:VC ration remains the same |
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Minute Ventilation
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Vm = Total amount of air entering respiratory passages each minute
500mL Tidal Volume x 12 breaths per minute = 6Liters |
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Ventilation Perfusion imbalances
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Obstruction of ventilation of a lobe leads to V/Q approaching 0, and alveoli gas partial pressure approaching that of venous blood
Obstruction of arterial vessel leads to V/Q approaching infinity, and alveoli gas pressure approaching that of inspired air V/Q is lower in the lower part of the lung due to perfusion increasing more dramatically than the increase in Ventilation |
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Oxygen dissociation curve shift to the Left
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In Fetal Hemoglobin HbF and in Carbon Monoxide
- HbF has higher affinity than Hba - Binding of one CO molecule enhances oxygen binding at other 3 sites, and thus decreases oxygen delivery to tissues |
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Haldane effect
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Deoxygenation of blood increases binding to CO2
Oxygenation of blood give reduced capacity to bind CO2 |
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Hering-Breuer reflex
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aka Stretch-inflation reflex
- Inflation or stretch receptors in lungs are stimulated during inspiration which increases impulse firing - Impulses travel along vagus and inhibits the apneustic center - Inhibits further inspiration and begins expiration - Important in neonates |
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Chemoreceptors
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Peripheral chemoreceptors - Carotid and Aortic bodies
- Only receptors that respond to decreased arterial pO2. No such receptors exist centrally. ***- Senses pO2 and not O2 content - Also responds linearly to increased pCO2 and decreased pH - Mainly Carotid body via CN 9 and some Aortic body via CN10 Central chemoreceptor - Four localized groups of receptors on ventral surface of medulla - Sensitive to low pH - Does not respond to hypoxia |
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Dipalmitoyllecithin
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aka Dipalmitoylphosphatidylcholine
Surfactant Secreted by type II pneumocytes |
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Normal Neuron voltage difference
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-70mV with inside more negative
-55mV is usual threshold level |
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Refractory Period
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Absolute - When Na+ inactivation gates are ineffect and no impulse will stimulate an action potential
Relative - Period when K+ efflux is causing hyperpolarization so a larger than normal stimulus is required to initiate an action potential |
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Nerve Poisons
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Tetanus - stops neurons from secreting inhibitory GABA or Glycine
Botulinum - Blocks ACh release Black Widow spider venom Latrodotoxin - Cause complete release and depletion of ACh at skeletal NMJ. Causing spasms Tetrodotoxin - Found in Puffer fish and Blocks Sodium channels. No know antidote |
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Postganglionic Sympathetics neurotransmitters
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Mostly Norepinephrine but releases ACh for Sweat glands, Skeletal Muscle vasculature, and Adrenal medulla
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Horner syndrome
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Lesion of superior cervical ganglion causing Ptosis, Miosis, and decreased sweating on affected side
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Nuclei in Thalamus
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VPL - Everything from body
VPM - Everything from face Lateral Geniculate nucleus - Vision Medial Geniculate nucleus - Hearing - Ventral anterior and Ventral lateral nuclei mediates motor function |
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When focusing on a near object
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Lens Accomodates
Pupils constrict Eyes converge |
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Tonotopic organization of sound
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The base is much stiffer so it reacts to higher pitched sounds
Apex free end detects lower pitched sounds |
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Semicircular canals
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Canals contain Crista ampullaris which detects angular acceleration
Utricle and Saccule contain Maculae that detect gravitational pull and Linear acceleration |
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Olfactory pathway
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Unmyelinated hair cells penetrate cribriform plate and form olfactory nerves
- Synapse at the glomeruli on the surface of the olfactory bulb - Olfactory tract project to olfactory cortex and then amygdala ** Olfactory system is only sensory system that does not pass through the Thalamus |
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Steroid hormones
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C21 - Pregnenes such as Progestin and Corticoids. Major progestin is progesterone
C19 - Androgens C18 - Estrogen |
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Transport and Mechanism of sex hormones
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SHBG or Sex hormone binding globulin transports testosterone, dihydrotestosterone DHT, and Estradiol
- Binds to nuclear androgen receptor and activates mRNA transcription Corticosteroid-Binding globulin CBG transports Progesterone |
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DHT
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Prostate must convert testosterone to Dihydrotestosterone DHT before it can be used
- Causes growth and secretion in prostate gland - Becomes a problem in Benign Prostatic Hypertrophy BPH Testes - DHT is responsible for thinning and development of rugation in scrotum for heat transfer Penis - DHT is essential for enlargement of the penis at puberty |
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Anabolic actions of androgens
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Testosterone is most potent anabolic steroid
- Increases protein synthesis in muscles and increases muscle mass - Stimulates growth spurt - Cause acceleration of long bone growth but also stimulates closing of epiphyseal plates - Thus, androgens limit growth |
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Synthesis of Ovarian homones
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LH binds to Theca Interna cells and stimulates conversion of cholesterol to pregnenolone.
- Pregnenolone is converted to androstenedione and transported to granulosa cells Granulosa cells contain receptors for FSH and stimulates aromatase to convert androstenedione from theca interna to estrone which is then converted to estradiol. FSH causes synthesis of LH receptors on granulosa cells Pathway in Corpus luteum - Corpus luteum is derived from both Theca interna and Granulosa cells - Theca interna cells develop aromatase when stimulated by LH and produces estrogens. Also secretes progesterone which is already in the pathway - Granulosa cells forms LH receptors and secretes estrogen |
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Sodium reabsorption
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PCT - 70% via Active resorption. *Contains Na/H+ antiporters to reabsorb sodium regulated by tubule cell carbonic anhydrase.
Ascending loop of henle - 20% NKCC DCT - 5% Na+ Cl- Cotransport. *Aldosterone and PTH regulated Collecting duct 3-5% reabsorbed by electrogenic Na+ channel pumps that are also *Aldosterone regulated |
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Acid base disturbances
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Look at H+, HCO3-, and CO2. If all goes same way, its respiratory. If H+ and HCO3- change in opposite directions, its metabolic.
Respiratory acidosis - Hypoventilation causing increase in CO2. Renal compensation by excretion ammonium and phosphate to generate Bicarbonate. Ammonium is excreted with anion like Chloride. Phosphate is excreted with Cation like Na+ Respiratory alkalosis - Hyperventilation. Decreased CO2, so kidney compensates by excreting HCO3- and keep more acid. Metabolic acidosis - Decreased HCO3-. Respiratory compensation by hyperventilation. Metabolic alkalosis - Increased HCO3-. Compensate by hypoventilation |
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Autonomics on kidney
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Autonomics on kidney is solely sympathetic
- Alpha receptors cause constriction of afferent arteriole - Beta receptors cause juxtaglomerular apparatus to release renin. Angiotensin II causes constriction mainly of efferent arteriole - Renal blood flow is reduced but GFR is maintained |
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PAH
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Para-aminohippuric acid
- Substance that is completely secreted into the PCT and excreted into the urine. - So can be used to measure plasma flowing through nephrogenous zone or effective renal plasma flow ERPF. |
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Vitamin K dependent factors
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2,7,9,10 requires vitamin K to form gamma-carboxyglutamate residues
Protein C and Protein S |
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Muscle receptors
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Muscle spindles sense muscle length and changes in length
- Will cause muscle to contract if activated Golgi tendon organs sense muscle tension and stimulate inhibitory interneurons to stop alpha motor neuron from firing |
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Z lines in smooth muscle
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Dense bodies on cell membrane and in the cytoplasm act as Z lines for thin filament insertion in smooth muscle
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Mannitol
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Stays in the extracellular compartment and acts like NaCl
- Mannitol is injected into patients with cerebral edema to extract fluids back out into the ECF |
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Agents used to measure total body water
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Use Tritium or Antipyrine
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Growth hormone effect on blood glucose
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Growth hormone decreases tissue sensitivity to insulin
- Increases blood glucose |
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Moving to high altitudes
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Arterial hypoxia at high altitudes causes hyperventilation and respiratory alkalosis
- Renal compensation by excretion HCO3- |
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Pregnancy and serum thyroxine
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Serum thyroxine is the sum of free T4 and T4 bound to Thyroid binding Globulin
- Free T4 is normal during pregnancy, so TSH is normal - However, there is elevated serum T4 during pregnancy due to increase in TBG |
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Heart compensation during excercise
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First increase Stroke volume, Then increase heart rate at above 50% maximal work
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Penicillin excretion
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Penicillin family drugs are actively secreted in the Distal Convoluted tubule
- One way to prolong effects is to give Probenecid. One use for Probenecid is to inhibit the organic anion transporter OAT which prevents uric acid from being reabsorbed |
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Hormone responsible for constancy in plasma Sodium
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ADH-thirst mechanism is the major way to control extracellular sodium concentration
*- ADH acts at both the DCT and the Collecting ducts |
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Proinsulin
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Normally makes up 20% of plasma immunoreactive insulin but can become 30-90% during insulinoma
- C-peptide is crucial in insulin formation by linking A and B chains of insulin during processing in ER. After cleavage, subunits remain connected by Disulfide bonds *- No disulfide bonds are created or destroyed during this process |
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Troponin types
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Troponin i - Inhibits interaction of Myosin with Actin
Troponin T - Attaches Troponin complex to tropomyosin Troponin C - Binds calcium and permits interaction of actin and myosin |
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Blood compartment calculations
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60% of body weight is water
1/3 of that is extracellular while 2/3 is intracellular Of the extracellular 1/4 is plasma volume and other 3/4 is interstitial volume |
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GABA receptors
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Barbiturates facilitate anesthesia by binding GABA-A ligand gated receptors and increasing Cl- conductance
GABA-B receptors are G protein coupled receptors |
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Magnesium and PTH
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PTH enhances renal reabsorption of Magnesium
- Acute hypoMagnesia causes increased PTH - Chronic hypoMagnesia supresses PTH |
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Brainstem and functions
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Midbrain - Micturation center
Pons - Pneumotaxic center inhibiting respiration Medulla - Respiratory center, vomiting, swallowing, coughing etc Hypothalamus - Temperature regulation, Lateral for hunger ventromedial for satiety. Also involved with regulation of the AUTONOMIC nervous system and connected with the reticular formation and limbic system |
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Cortisol synthesis
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Cholesterol to Pregnenolone - Stimulated by ACTH on Cholesterol Desmolase
Pregnenolone to progesterone to 17-hydroxyprogesterone to 11-deoxycortisol to Cortisol |
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Final component of nephrotic syndrome
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Besides hypoproteinemia, hypoalbuminemia, and massive proteinuria, there is hyperlipidemia
- Causes increased hepatic fat syntehsis, decreased fat catabolism, and increased plasma cholesterol, triglycerides, and lipoproteins |
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Teeth that are Wider FacioLingually
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Maxillary canine, Premolars, Molars
*Maxillary canine has greatest labiolingual measurement of all anterior teeth Mandibular central, lateral, canines and premolars |
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FDI
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Federation Dentaire Internationale
Use quadrants 1-8 with 5-8 being primary teeth - Then second number begins with central incisor counting back. - Maxillary right central incisor would be 11 |
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Standard order of naming teeth
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Set, Arch, Quadrant, Type and class
- Permanent Mandibular right second molar |
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Fundamental Geometric shapes of crowns
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- All teeth are trapazoidal when viewed facially or lingually with long side being occlusal or incisal
- Triangle is for incisors and canines when viewed mesial or distally - Reverse trapazoid is for mesial or distal of maxillary posteriors with longer side facing cervical - Rhomboid is mesial or distal of mandibular posteriors with the facial occlusal and buccal cervical corners acute |
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4 Height of contour general points
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- Generally, Mesial height of contour is more incisal or occlusal than the distal except for mandibular centrals, premolars, and possibly molars
- Lingual height of contour of mandibular posteriors is more occlusal than maxillary posteriors - Facial height of contour of maxillary posteriors is more occlusal than mandibular posteriors - Facial and lingual heights of contour usually have 0.5mm convexity. Lingual of mandibular posteriors may have up to 1mm |
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Heights of contour for Maxillary and Mandibular teeth
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All Facials and Anterior linguals are at Cervical 1/3
Max Posterior lingual - All middle 3rd Mand lingual - All are middle 3rd except lingual of mandibular 2nd premolar which is at occlusal 3rd |
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Contact points of Maxillary and Mandibular teeth
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Maxillary
IJJMJMMMMMMM ix5MMMMM *- Interproximal caries typically forms immediately apical to the contact |
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Faciolingual contacts
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- Anterior teeth are centered faciolingually
- Posterior teeth may be more facial in the buccal 1/3 |
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Embrasures
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- Anteriors: Maxillary Lingual is greater while Mandibular Facial embrasure is greater
- Posteriors: Lingual is greater than facial except for maxillary molars - Incisal embrasure is smaller than gingival and may be missing between mandibular centrals |
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Cervical Line curvatures
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- Mesial curvature is greater than distal curvature but becomes less distinct as you go towards posterior
- Facial and lingual cervical lines irregularly curve towards root apex and is fairly equal except at mandibular central and laterals where lingual curvature is greater *- Greatest curvature is mesial surface of Maxillary central. appx 3.5mm |
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General considerations of pulp
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Pulp chamber extends 1-2mm apical to the CEJ and chamber outlines follows outline of tooth
Pulp horns project into pulp chamber into major cusps of teeth and into Mamelons of young teeth |
|
Pulp canals
|
Most roots have 1 except:
- Maxillary1st premolar - MB root of maxillary 1st - All mandibulars occasionally have 2 roots - Mesial root of molars has 2 and distal root occasionally has 2 |
|
Most distinct lingual anatomy and the incisal edge not perpendicular to labiolingual bisecting line
|
Maxillary lateral Incisor has most distinct lingual anatomy
Mandibular lateral incisors have the incisal edge not perpendicular to labiolingual bisecting line |
|
Incisal edge points
|
Mandibular incisors and canine incisal edge is lingual to midpoint
Maxillary incisors incisal edge is centered labiolingually. Canine tip is slightly facial |
|
Maxillary central vs Lateral
|
Central
- Crown not as round as lateral - Round root on cross section - More distinct mamelons Lateral - Characterized by roundness - More distinct lingual anatomy - Ovoid root on cross section - Memelons not as distinct |
|
Maxillary vs Mandibular Canines
|
- Maxillary is longest tooth in the mouth but Mandibular canine has a longer anatomic crown
- Incisal edge centered labiolingually in maxillary but is tipped lingually in the mandibular canine - Buccal tip in maxillary is centered mesiodistally while cisp tip for mandibular canine is distally placed - Maxillary canine has more prominent marginal ridges and labial surface that has 3 lobed appearance - Both roots have mesial and distal concavities. In Maxillary canine, distal concavity is more distinct |
|
Maxillary premolars
|
1st
- Broad shouldered - Buccal cusp distal and lingual cusp mesial - Prominent mesial concavity with mesial marginal developmental groove - Two roots - Hexagonal occlusal profile with trapezoidal occlusal table 2nd - Narrow shouldered - Buccal and lingual cusps centered - Ovoid to diamond occlusal profile with rectangular occlusal table |
|
Mandibular premolars
|
1st
- Resembles canine - Round root on cross section - Mesiolingual developmental groove - Transverse ridge - Marginal ridge. Distal more prominent - Only premolar with lingually inclined occlusal table 2nd - Equal buccal and lingual surfaces - Rounder root on cross section - May have 3 cusps with ML cusp greater than DL cusp - Central pit - Y pattern for 3 cusp, H pattern for 2 cusp |
|
Maxillary first molar
|
1st
- Pliers handle buccal roots with DB root the smallest - MB root often has 2 canals - Developmental grooves from cervical line to bifurcation from root trunk of Buccal roots. Also a deep vertical depression on lingual surface of lingual root from the cervical line - Rhomboidal occlusal outline - Oblique ridge connectinve ML to DB - ML>MB>DB>DL |
|
Maxillary second molar
|
- Buccal roots distally inclined
- Roots within crown profiles when seen from all angles - Similar to first molar but more exaggerated cusp size difference ML>MB>DB>DL |
|
Mandibular 1st molar
|
- Mesial root largest and has 2 canals
- Two transverse ridges with no oblique ridge - Medial and distal marginal grooves - Largest mandibular teeth |
|
Mandibular 2nd molar
|
Rectangular and has 2 transverse ridges
- Most symmetric of the molars |
|
Tooth development lobes and calcification
|
Maxillary
- All are 4 lobes except 1st molar which is 5 lobes Mandibular - All are 4 lobes except 2nd premolar which is 4.5 lobes and 1st molar which is 5 lobes *- Calcification of permanent teeth begins at birth starting with 1st molars and takes 4-5yrs for complete enamel formation - This period is most succeptible to external sources |
|
Primary teeth general characteristics
|
- Crown to root ratio is smaller
- Crowns also appear fatter - Anterior teeth are constricted at the cervical line, producing a large cervical bulge on facial and lingual - No mammelons - Thinner enamel but is much whiter than permanent teeth - Primary arch is more circular |
|
Isomorphy
|
- Primary maxillary first molars resembles premolars
- Mandibular first primary molar has the most unique buccal cervical bulge or ridge. Also has a prominent transverse ridge |
|
Three points of contact during occlusion
|
Functional outer aspect of the supporting cusp contacting guiding inclines of the opposite guiding cusp
Occlusal slopes contacting each other Guiding incline of the guiding cusp contacting the Functional outer aspect of the opposite supporting cusp |
|
General rule of Maxillary and mandibular holding cusps
|
Maxillary:
Maxillary lingual cusps contact the distal marginal ridge of its class counterpart and the mesial marginal ridge of the tooth distal to its counter part. - Mesiolingual cusps of maxillary molars contact the central fossa of its counterpart - In an ideal occlusion, Lingual cusps of maxillary premolars contact the Distal triangular fossa of its counterpart Mandibular: Mandibular buccal cusps contact the MMR of its counterpart and the Distal marginal ridge of the tooth mesial to its counterpart - Mandibular first premolar only contacts Mesial marginal ridge of the maxillary first premolar. Slightly out of contact with the maxillary canine - Mandibular distobuccal cusps contact the central fossa of the maxillary counterpart - Distal cusp of the mandibular first molar contacts the distal fossa of the maxillary first molar |
|
General rule of Maxillary and Mandibular Guiding cusps
|
Maxillary:
Maxillary buccal cusps occlude in the facial embrasure between its class counterpart and the tooth distal to it - Mesiobuccal cusps occlude in the buccal groove - Distobuccal cusp of Maxillary first molar occludes in the distobuccal groove of the mandibular 1st molar Mandibular: Mandibular lingual cusps contact the lingual embrasures of its class counterpart and the tooth mesial to the counterpart - Distolingual cusps of mandibular molars contact the lingual groove of maxillary molars |
|
Lateral contacting movement and Lateral protrusive movement
- Condyle relationships |
Lateral Contacting movement:
- Working condyle just rotates - Non-working condyle moves forward, downward and medially Lateral protrusive: Working - Condyle rotates, and moves forward and downward Non-working - Condyle moves forward, downward, and medially |
|
Root angulation
|
- Maxillary central incisors have the greatest inclination
- All teeth tilt mesially except incisors which may tilt slightly distally - Maxillary canine has the greatest degree of mesial tilt - All mandibular roots are angled distally and buccaly - All Maxillary roots are angled distally and lingually except distobuccal root of maxillary first molar which is inclined buccally. |
|
Possible paths of mandible in Retruded contact
|
- First is pure rotational movement for the first 20mm or so
- Then followed by Translational movement |
|
Keratinized vs Nonkeratinized Epithelial layers
|
Non-Keratinized
- Stratum Basale - Underdeveloped Stratum Spinosum Keratinized - Stratum Basale - Well developed Stratum spinosum - Stratum granulosum - Stratum Lucidum in thick skin like palm and soles - Stratum Corneum |
|
Masticatory Mucosa and histology
|
Gingiva, Hard Palate, Dorsum of tongue
In Gingiva there is Orthokeratinized - True keratin with no nuclei Parakeratinized - Keratinized cells retain their nuclei *- Gingival mucosa may undergo orthokeratinization after chronic irritation *- Also, Gingiva does not have a definite submucosa whereas the palatal mucosa has a definite submucosa except at the palatine raphe *- Parakeratinized skin is PATHOLOGICAL like in psoriasis |
|
Hard Plate composition
|
Anterior hard palate contains much Adipose tissue
Posterior part is full of glands |
|
Periodontal Ligament fibers
|
Both composed of mainly Collagen 1 and some Collagen 3
Principal group: Does not attach to alveolar bone Dentogingival group - Runs from cementum to free gingiva Dentoperiosteal group - Runs apically and over alveolar crest to attach to the mucoperiosteum Transseptal group - Runs from cementum, over the alveolar crest, and attach to the cementum of adjacent tooth Circular fibers - Not attached in cementum and runs in free gingiva around tooth Periodontal fiber group: Comprise the alveolar dental group Alveolar crestal fibers - Run from supra-alveolar cementum down to alveolar crest Horizontal fibers - Run straight across from cementum to alveolar bone Oblique fibers - Largest group and runs from root to bone in a diagonal fashion coronally. Interadicular fibers - Found between roots of multi-rooted teeth Apical fibers |
|
PDL width, function, and embryo
|
Wider in apical and cervical third
- Narrowest section in the middle 3rd Formative, Supportive, Sensory, Nutritive *- PDL is derived from ectomesenchyme and is a direct derivative of the dental sac |
|
Blood supply to the PDL
|
Major source from periosteal blood supply
Minor source from gingival arteries |
|
PDL during loss of function and occlusal trauma
|
Loss of function:
- PDL narrows - Regular arrangement is lost - Cementum may become thicker Occlusal trauma - Alveolar bone is resorbed - PDL widened - Tooth becomes loose |
|
Salivary ducts
|
Intercalated ducts: Located closer to salivary production
Striated ducts: Located farther toward duct - Striated due to rows of mitochondria necessary for ion transport - Generally columnar epithelium |
|
Tooth bud tissues and derivatives
|
Enamel organ: Produces enamel
Dental papilla: Produces pulp and dentin Dental sac: Produces cementum and periodontal ligament *- Enamel is derived from ectoderm while Dentin and pulp are ectomesenchyme/Neural Crest derivatives |
|
Sequence of Tooth production
|
- Protein factors cross basement membrane into the dental papilla
- Dental papilla differentiate into odontoblasts and lay down predentin - Inner enamel epithelium differentiates into ameloblasts from pre-ameloblasts when touched by odontoblastic processes - Predentin stimulates ameloblasts to lay down enamelin |
|
Cellular vs Acellular cementum
|
Cellular cementum is found in the apical region when cementoblasts become trapped in their own secretions. Cellular cementum is used to replenish super erupted teeth
Acellular cementum is found at the occlusal 2/3 of the root |
|
Enamel structures
|
Incremental lines of Retzius - Incremental pattern of enamel. Compared to growth rings of a tree
Perikymata - Wavelike grooves on surface of enamel. External manifestations of lines of retzius Enamel spindles - Spindle shaped odontoblastic processes that penetrated into the enamel Enamel Lamellae - Structures of organic material extending from surface of enamel toward and into the dentin. Comes from tension between enamel prisms Enamel tufts - Extend from DEF into the enamel. Hypocalcified rods and interprismatic substance |
|
Age changes in enamel
|
- Attrition or wear of occlusal surfaces
- Flattening of perikymata and disappearance of rod ends - Decreased permeability of enamel - Teeth become darker and more resistant to decay |
|
Tooth development 2 phases
|
Matrix formation
- Disturbances will result in enamel hypoplasia Maturation: Disturbances in maturation will result in hypocalcified enamel |
|
Types of Dentin
|
Peritubular dentin - Zone of dentin surrounding the odontoblastic process. More mineralized then intertubular dentin
Intertubular dentin - Main bulk of dentin Mantle Dentin - Hypomineralized early dentin 150 microns thick at the DEJ Interglobular dentin - Hypomineralized regions of dentin in the crown near the DEJ Tomes granular layer - Minute areas of dentin subjacent to the cementum |
|
Tongue Papillae
|
Filiform - Non-vascular, Keratinized, and no taste buds
Fungiform - Anterior only, vascular and has taste buds Circumvallate papillae - V row at border between anterior and posterior tongue and surrounded by Von Ebner's glands Foliate papillae - On lateral tongue and has taste buds. *- Other taste buds can be found on the posterolateral palate, epiglottis, and pharynx |
|
Anterior pulp chambers
|
Only maxillary incisors have round pulp chambers. Includes Maxillary central and laterals
- Mandibular incisors and both arch canines have ovalish pulp chambers flattened mesiodistally |
|
Cervical Bulge
|
- Anterior teeth has both buccal and lingual cervical bulges
- Posterior teeth only have buccal cervical bulges |
|
Functions of TMJ ligaments
|
Adds Strength, Stability, and Limits excessive movement of the joint
|
|
Origins and Insertions of TMJ ligaments
|
Functional ligaments
Collateral or Discal ligament - Attach medial and lateral borders of the articular disc to poles of the condyle Lateral ligament/Temporomandibular ligament - arises from tubercle of the zygoma and inserts into the posterior lateral condyle. Fibers merge with those of the articular capsule. Contains a outer oblique and inner horizontal portion Capsular ligament - Surrounds the entire TMJ. Attaches from the mandibular fossa and around the neck of the mandible. Encompasses joint and retains synovial fluid. Accesory Ligaments: Stylomandibular ligament - Arise from the styloid process and inserts into the Angle and Ramus of the mandible Sphenomandibular ligament - Arises from a spine of sphenoid bone and inserts into the lingula. *- Sphenomandibular ligament is derived from Meckel's cartilage, and thus the 1st pharyngeal arch |
|
Ratio of primary teeth
|
Primary teeth are often much shorter
- Primary maxillary centrals are wider Mesiodistally than Incisocervically |
|
Primary mandibular first molar cusp sizes
|
MB>ML>DB>DL
*- MB is biggest when viewed from the occlusal. However the ML cusp is highest and sharpest*** |
|
Supernumerary 3rd root on mandibular first molar
|
Usually a second DISTAL root
|
|
Missing teeth
|
Hypodontia - Missing a few teeth. Fairly normal and not associated with any systemic disease
Oligodontia - Missing most but not all teeth Anodontia - Missing all teeth *-Oligodontia and Anodontia are usually associated with ectodermal dysplasia |
|
Most common form of Skin cancer
|
Basal Cell carcinoma
|
|
Lesion that may be confused with lesions of Carcinomas
|
Histoplasma
|
|
Features of Infectious Mono
|
Caused by EBV along with Burkitt's lymphoma and Nasopharyngeal carcinoma
- Necrotizing pharyngitis - Increase in circulating lymphocytes and many are abnormal - Splenomegaly |
|
Most common causes of Trismus
|
Muscle trauma to the Medial pterygoid following a IAB
- Next is a masseteric facial space infection |
|
Facial nerve tract and lesions
|
Upper face receives bilateral innervation from CN7
Lower face receives contralateral innervation and crossover occurs after fibers leave motor area and before they synapse in pons *- Lesions of Upper motor neurons will cause paralysis of the CONTRAlateral lower face *- Lesions of Lower motor neuron will cause ipsilateral weakness. Bell's Palsy |
|
Blood composition
|
55% plasma
- Includes proteins, electrolytes, water. etc Formed elements are 45% - Includes cells like platelets, erythrocytes, leukocytes etc |
|
3 Primitive Germ layers
|
Ectoderm - All superficial epidermis and nervous system. Appendages such as nails, hair, and associated sweat & sebaceous glands
- CNS comes from Neuroectoderm while PNS comes from Neural Crest cells - Neural crest cells also give rise to Head and Neck connective tissues Mesoderm - Epithelial lining for Cardiovascular system and the Urogenital system. All 3 muscles and all connective tissue including cartilage, and blood cells. PDL comes from Mesoderm. Connective tissue of H&N come from Neural Crest Cells Endoderm - Respiratory system, Digestive system, epithelial lining of digestive tract, Thymus, Thyroid, Parathyroids, Terminal portion of urogenital system, LUNGS |
|
Primitive Heart Structures
|
Bulbus Cordis - Forms the smooth part of both ventricles and gives rise to both ventricles along with the primitive ventricle
Sinus Venosus - Forms the Sinus Venerum or the smooth part of the right atrium separated by the crista terminalis. Also forms the SA node and the Coronary sinus Truncus Arteriosus - Forms the pulmonary trunk and ascending aorta |
|
Aortic Arches
|
1st - MAXimal Maxillary Artery
2nd - Hyoid and Stapedial artery 3rd - Carotid arch and gives rise to common carotid and internal carotid 4th - Aortic arch and right Subclavian 5th - Involutes 6th - Pulmonary arteries and ductus arteriosus |
|
Femoral Triangle borders and contents
|
Borders: SAIL
- Satorius: Lateral border - Adductor Longus: Medial border - Inguinal ligament: Superior border Contents Medial to Lateral: VAN. Femoral Vein most medial, then Femoral artery in center, then Femoral Nerve is most lateral |
|
Only cartilage that can calcify
|
Hyaline Cartilage is the precursor for endochondral ossification and is the only cartilage that can calficy
- However, not all hyaline cartilage will calcify |
|
Neosporin components
|
Neomycin - Aminoglycoside
Bacitracin - Inhibits cell wall synthesis Polymyxin B - Increases cell membrane permeability |
|
Most common Autoimmune disorder and process
|
Rheumatoid Arthritis
- First is inflammatory cells in the synovial fluid forming a foci of necrosis and mass of vascularized inflammatory tissue called a PANNUS - Then the Panus erodes into articular cartilage followed by the supporting ligaments - Final stages, Panus erodes into bone and fibrous tissue replaces the joints and mobility is lost Women have 2.5x Predilectation |
|
Tzanck Cells
|
Multinucleated Giant cells
- Tzanck test is also known as chickenpox test or herpes test - Found in HSV, VZV, CMV, and Pemphigus Vulgaris |
|
Anterior Cingulum locations
|
Maxillary central, Mandibular lateral, and Mandibular canines have a cingulum that tips distally
Mandibular central, Maxillary lateral, and Maxillary canine have centered cingulums |
|
Maxillary root lengths
|
Maxillary Canine is longest
Second longest is 2nd Premolar Palatal root of 1st molar is 3rd longest |
|
Concrescence
|
When the cementum of 2 teeth are fused
|
|
Edinger-Westphal nucleus
|
Parasympathetic nucleus of Oculomotor nerve
- Optic nerve fibers synapse there to initiate the pupillary reflex |
|
Testing for patency of trochlear nerve
|
Make the patient look inferior and laterally
|
|
Marcus-Gunn pupils
|
Lesion in the Optic nerve causing a complete lack of response when light is shined into the affected eye
|
|
CIrcle of Willis
|
Posterior cerebral artery
Posterior communicating artery Internal carotid artery Anterior cerebral artery Anterior communicating artery *- Middle cerebral artery is NOT considered part of the circle of willis |
|
TPR equation
|
Mean arterial pressure: MAP = 2/3Diastolic + 1/3 Systolic = BP
Mean Venous Pressure: MVP *- MVP is usually small enough to be neglected from this equation TPR = (MAP - MVP)/CO TPR = BP/CO BP = CO*TPR |
|
Pantothenic Acid
|
Vitamin B5
- Required co-factor for synthesis of Coenzyme A - Deficiency can result in fatigue, apathy, muscle cramps etc |
|
Activation of Smooth muscle
|
- Unlike striated muscle that contains a Troponin/Tropomyosin complex, smooth muscle does not have a troponin complex
- Influx of Calcium binds Calmodulin which activates Myosin light chain Kinase. - MLCK phosphorylates the myosin light chain at serine residue 19 and enable myosin crossbridge to form with actin - To stop contractions, a Myosin Light Chain Phosphatase MLCP is required |
|
Jones Criteria
|
Criteria used to diagnose Rheumatic Fever
- Requires 2 Major or 1 major with 1 minor Major: Carditis, Arthritis, Chorea, Erythema Marginatum, Subcutaneous nodules. CACES Minor: Arthalgia, ECG changes, Fever, History of RF |
|
TGF-B
|
Secreted by Bcells, Tcells, Monocytes and Macrophages
- Acts as an Anticytokine and inhibits inflammatory cells - Stimulates collagen formation and wound healing |
|
Epitactic concept of calculus formation
|
Protein and Carbohydrate complexes with Bacteria induces focal mineralization on teeth that eventually forms a calcified mass
|
|
Pheochromocytoma
|
- Neuroendocrine tumor of adrenal medulla
- Results from gene mutations that are often associated with Neurofibromatosis and Von Hippel-Lindau disease |
|
Von Hippel–Lindau disease
|
Associated with Pheochromocytoma
- Rare autosomal dominant disease that results in hemangioma formation on Cerebellum, Spinal cord, Kidney, and Retinas - Results from a mutation on the VHL tumor supressor gene |
|
Ceroid & Lipofuscin
|
Ceroid - endogenous pigment formed by Auto-oxidation and is indicative of hepatocellular injury
Lipofuscin - Wear and tear pigment and is derived from lipid peroxidation. Builds up in brain, liver, and heart as a person ages. |
|
Point angles
|
All teeth have 4 point angles
|
|
Contact points viewed from occlusal
|
All posterior teeth have contact points towards the buccal 1/3 when viewed from the occlusal
|
|
Heights of Contour
|
All teeth have facial heights of contour on the Cervical 3rd
Anterior teeth have lingual HOC on the Cervical 3rd Posterior teeth have lingual HOC on the Middle 3rd. - Mandibular 1st premolar HOC is at junction of cervical and middle 1/3 |
|
Major Collagen and cell type of PDL
|
Major collagen in principal fibers of PDL is Type 1 and 3
Major cell type in PDL is Fibroblasts which is necessary to produce the ground substance of mainly 70% water, proteoglycans, GAGs etc |
|
Superior and Inferior orbital fissures
|
Superior is between Lesser and greater wings of the sphenoid
- Transmits Eye nerves except optic nerve, Ophthalmic veins * - Optic canal transmits Optic nerve and Ophthalmic artery Inferior orbital fissure is between greater wing of sphenoid and maxilla - Transmits the V2 and its zygomatic branch |
|
Salivary Nuclei
|
Superior Salivary nucleus is the nuclei for the Facial nerve and sends parasympathetics to the Lacrimal gland and Submandibular/Sublingual glands. In Pons
Inferior salivary nucleus is for Glossopharyngeal nerve and provides Parasympathetic innervation to the parotid. In medulla |
|
Nucleus Ambiguus
|
- Located inferior to the Inferior salivary nucleus.
- Sends Efferent Motor fibers to the pharyngeal muscles through the Vagus and the Glossopharyngeal nerves - Controls swallowing |
|
Layers of the neck
|
- Skin
- Superficial/Subcutaneous fascia: Lymph, blood vessels, nerves, fat, and Platysma - Deep Investing layer: Contains Trapezius - Pretracheal fascia: Trachea, esophagus, thyroid - Prevertebral fascia: Spine, Back muscles, and forms a sheath for the Brachial nerves and Subclavian vessels |
|
Nucleus of the solitary tract
|
aka Solitary nucleus
- Receives taste sensations from CN 7, 9, 10 |
|
Pharyngeal plexus
|
Formed by CN9,10 and cranial portion of Accessory nerve CN11
- Innvervates all muscles of the pharynx except stylopharyngeus which is innervated by a direct branch from CN9 - Also carries sensory from the pharynx |
|
Epithelial band
|
Gives rise to the dental lamina and the vestibular lamina
- Vestibular lamina is responsible for separating the cheeks from the jaws in the fetus - Dental lamina gives rise to enamel organ *- Ectomesenchyme of Neural Crest cells gives rise to the dental papilla and sac |
|
Buccopharyngeal membrane
|
Separates the primitive mouth form the pharynx in a developing fetus
|
|
Accessory nerve
|
Comes from the motor rootlets of spinal nerves C1-C5
*- Has a cranial part that immediately joins the Vagus nerve to perform Vagus functions |
|
Ansa Cervicalis
|
Formed from CN1-3 and supplies the infrahyoid muscles except Thyrohyoid
- Sternohyoid, Sternythyroid, Omohyoid - Thyrohyoid is innervated by CN1 along with Geniohyoid |
|
Cervical Plexus
|
Cutaneous Branches
- Lesser occipital - Great auricular - Transverse cervical - Supraclavicular Musclular branches - Ansa cervicalis - Phrenic nerve - Segmental branches to innervate Scalenus muscles |
|
Innervation of the External auditory Meatus
|
Anteriorly by Auriculotemporal Nerve
Posteriorly by Auricular branch of Vagus nerve - Also innervated by Great Auricular nerve from the cervical plexus |
|
Pulp Anatomy
|
Center is the Cell rich zone - Contains fibroblasts and mesenchymal cells
Cell free zone of Weil - Contains Plexus of Rashkow and vascular plexus of the pulp Odontoblastic layer is at the dentin |
|
Phases of Spermatogenesis and Oogenesis
|
Spermatogonium 2N
Primary Spermatocyte 2N Secondary Spermatocyte N Spermatid N Sperm/Spermatozoa N Oogonium 2N Primary Oocyte 2N: Forms Dictyate halted at Prophase 1 for up to 50 yrs Secondary Oocyte N: Halted in Metaphase II until fertilization |
|
Creatine, Heme, and Signal transduction enzyme derivation
|
Creatine is derived from Glycine, Arginine, Methionine
Heme are derived from Glycine and Succinyl CoA Signal transduction enzymes are derived from Serine |
|
Production from 1 turn of the Krebs cycle
|
1 GTP, 3 NADH, and 1 FADH2
- All reduction potentials will then form 12 ATP in the ETC |
|
Most abundant amino acid in Collagen
|
Glycine accounts for 1/3 of all amino acids in Collagen
- Collagen 3 A.A Subunits are arranged Glycine-X-Y |
|
Osmolarity & Osmolality
|
Osmolarity is Osmotic pressure of a solution
- Measured in Osmols/L - Temperature dependent Osmolality is osmoles of solute per Kg of solvent - Temp INdependent |
|
Collecting Duct
|
Responds to Aldosterone and ADH
*- DCT is site of action for PTH |
|
Mallory-Weiss syndrome
|
Weakened Lower esophageal sphincter due to mucosal lacerations from chronic vomiting
|
|
Reid Index
|
Thickness of mucus glands to thickness to Bronchus
- Increased index in Chronic bronchitis |
|
Preeclampsia
|
Form of secondary hypertension in association with Pregnancy
- Also associated with ProteinUria and Edema in the face Can lead to Eclampsia which is characterized by Tonic-Clonic Seizures |
|
Libman-Sacks
|
Non-Bacterial Endocarditis seen in Systemic Lupus Erythematous
- Pericarditis is most common symptom of SLE followed by endocarditis - Mitral valve is most often affected and small vegetations form on leaflet |
|
Splinter Hemorrhaging
|
Tiny lines that run vertically under nails seen in Endocarditis
|
|
Wiskott-Aldrich syndrome
|
X linked recessive disorder characterized by Eczema, thrombocytopenia, bloody diarrhea, and low IgM
- Combined B cell and T cell deficiency - Increased chance of lymphoid cancers |
|
Burton disease
|
Failure of Pre-B cells to develop into mature B cells
|
|
Types of Thrombus
|
Mural Thrombus - Forms in heart after a MI or atrial fibrillation
Agonal Thrombus - Forms in heart from Chronic heart failure |
|
Caisson disease
|
Air embolism due to dissolved gasses coming out of solution in blood from depressurization
|
|
Gaisböck syndrome
|
aka Spurious polycythemia
Apparent or relative polycythemia due to decreased plasma volume |
|
Major side effect of Lithium
|
Renal Diabetes Insipidus can be a result of prolonged Lithium use
|
|
Hyperglycemia blood levels
|
Fasting: greater than 125mg/dl
After meal: Greater than 180mg/dl |
|
HBa1C levels
|
Evaluates long term control of Diabetes
- Reflects the past 2-3months - Non-diabetics is 4-7% |
|
Amyloidosis
|
Variety of diseases in which Amyloids are deposited into tissues such as Alzheimer's disease and Cruetzfeldt-Jakob disease
- Can cause Type 2 Diabetes |
|
Eosinophilic Granuloma
|
One of the Histiocytosis X diseases
- Benign tumor common in males in the 3rd decade - Characterized by abnormal histiocytes - Involves Mobile teeth and periodontal inflammation - MANDIBLE is most commonly affected |
|
Timeline summary of tooth development
|
8wk - Bud
9wk - Cap 11wk - Bell 18wk - Crown formation and active enamel/dentin synthesis Calcification of all primary teeth begins at 4-6 Months/18wks Calcification of the 1st permanent tooth, the mandibular first molar, starts around birth |
|
Four determinants of Occlusion
|
Left and Right TMJ
Neuromusculature Teeth - Dentists can only control 1 determinant. The Teeth |
|
Cervical enamel projections
|
Enamel Pears that occur at furcation areas of molars
Order of incidence: Mand 2nd, Max 2nd, Mand 1st, Max 1st |
|
Primate space
|
Only found in the Primary dentition and close when permanent 1st molar erupts
- Anterior to maxillary canine between canine and lateral incisor - Posterior to mandibular canine between canine and 1st molar |
|
Molar Fossae
|
Maxillary molars have 4
Largest to Smallest: Central, Distal, Mesial triangular, Distal triangular Mandibular molars have 3 fossae: Central, Mesial, Distal |
|
Mandibular molar cusp sizes
|
ML > DL > MB > DB
|
|
Greatest root to crown ratio
|
Mandibular 1st molar followed by Maxillary 1st molar
|
|
Erosion
|
- Cup shaped depressions on facial of maxillary anteriors
- Class 6 lesions on occlusal surfaces of posterior teeth - Restorations extending above tooth structure is indicative of erosion rather than attrition |
|
Teeth Lobes
|
All anteriors and Premolars develop from 4 lobes except for 3-cusped Mand 2nd premolar which develops from 5 lobes
- Posterior teeth develop from 1 lobe per cusp |
|
Most frequently missing teeth
|
3rd molars > Maxillary lateral> Mandibular 2nd premolar
|
|
Apocrine vs Eccrine glands
|
Eccrine glands are sweat glands that function to regulate body temperature
- Apocrine glands produce pheromones via myoepithelial cells - Apocrine glands secrete strictly serous fluid |
|
Sublingual gland ducts
|
Sublingual glands excrete saliva through many ducts of Rivian/Rivinus and some join a major submandibular duct called Bartholin's duct
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Kidney development
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Kidney forms first in the pelvis before ascending into the abdominal region
- Pronephrose forms and regresses - Mesonephrose gives rise to mesonephric/Wolffian duct and uteric bud which forms most of kidney - Metanephrose then forms the Nephrons |
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Mesonephric Duct
|
*- aka Wolffian duct requires testosterone to stay intact
Gardener's SEED - Forms Gartner's duct/cyst in women - In men, Seminal vesicles, Ejaculatory duct, Epididymis, Ductus deferens |
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Leptomeninges and derivatives
|
"Thin Meninges"
Leptomeninges is composed of Pia and Arachnoid mater - Develops from Neural Crest cells *- Dura mater is from mesoderm |
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Embryo cell cleavage sequence and Zona Hatching
|
- Zygote
- First division forms 2 celled Blastomere - Multiple further divisions form 16 cell Morula - Finally forms Blastula or Blastocyst at day 5. Zona pellucida hatching occurs at the Bastula/Blastocyst stage - Implantation occurs at around day 6 at the posterior uterine wall |
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Zona hatching
|
Occurs 5 days after fertilization when the newly formed Blastocyst or Blastula sheds the zona pellucida
|
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Jaw-Jerk reflex
|
aka Masseteric reflex used to test CN V.
- A form of Dynamic stretch reflex - Occurs by way of V3 - Insignificant normally but can be quite pronounced in CN V upper motor neuron lesions |
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Carotid Sheath
|
Lies medial to the Sternocleidomastoid muscle and posterior to the thyroid glands
- Contains Common carotid, Vagus nerve, Internal jugular vein, and lymph nodes |
|
Nystagmus and test
|
Involuntary movement of eyes due to: CN 8 defect, cerebral cortex, cerebellum, and visual system damage
- Use caloric test WOCS - Warm water applied to the external auditory meatus will cause nystagmus to opposite side - Cold water applied to the external auditory meatus will cause nystagmus towards the same side |
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Tectospinal tract
|
Coordinates movements of the eyes and head
|
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Smooth ER
|
- Involved in metabolism of glycogen and lipids, drug detoxification, and steroid synthesis in adrenal cortex and testis
- Also serves as the site of calcium sequestrum in skeletal and cardiac muscle |
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Sphincter of Boyden
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Sphincter of the common bile duct
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Lymphatic drainage of Head & Neck
|
Submental nodes: Tip of tongue
Submandibular nodes: Anterior 2/3 of tongue Deep cervical nodes: Posterior 1/3 of tongue Retropharyngeal nodes: Nasal cavity, Soft palate, middle ear, and External auditory meatus |
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Gland shapes
|
Coiled glands - Eccrine sweat glands
Tubular glands - Intestinal glands TubuloAcinar - major Salivary glands Acinar glands - Gastric mucosa glands |
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Tongue blood supply
|
Mainly from Lingual artery
- Secondary blood supply from Tonsillar branch of Facial artery and Ascending pharyngeal artery |
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Styloglossus
|
Originates from Styloid process and inserts into entire base of tongue
|
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Somites
|
Comprised of mesoderm along the sides of the neural tube and form Dermatomes, Myotomes, and Sclerotomes
Dermatomes - Develops into connective tissue of skin. The Dermis Myotomes - Skeletomuscle of the body Sclerotomes - Forms vertebra and Ribs |
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Maxillary artery divisions
|
Divided into 3 sections by Lateral pterygoid
- 1st part is inferior - 2nd part is on the superficial or deep part crossing lateral pterygoid - 3rd part is past lateral pterygoid |
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Vertebral artery Origin
|
Comes from the subclavian artery and enters at C6 transverse foramina
|
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Blood supply to the Maxillary canines and incisors
|
Infraorbital artery
- Sphenopalatine artery supplies blood to the anterior palate |
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Enamel matrix formation rate
|
4 micrometers/day
|
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Last brain structure to form
|
Temporal lobe, Sulci and Gyri begin to form at the 12th week vs 5th week for most brain structures
|
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Ectomesenchyme
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Developed from Neural crest cells and involved in the formation of of both hard and soft tissues of the head and neck, teeth, and Branchial arches.
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Devidualization
|
aka Decidual reaction
- Occurs during pregnancy under progesterone direction - Results in lipid and glycogen accumulation in the endometrium - Also cause increased vascularity and eosinophils around arterioles |
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Juxtaglomerular cells and Macula densa location and function
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Juxtaglomerular cells are at the Afferent arteriole and detect drops in blood flow and secretes Renin
Macula densa is at the DCT and detects sodium levels due to low BP and decreased GFR. Low sodium levels will cause the release of renin by Juxtaglomerular cells and increase ATII. Angiotensin II will primarily increase efferent arteriole pressure and increase GFR. |
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Magnesium, Chloride, and Calcium cellular concentration
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Magnesium is higher INTRAcellularly
Calcium and Chloride are higher Outside the cell |
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Functional Syncytium
|
Muscle Contracting together
- True of Cardiac and Smooth muscle |
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Common areas of food trap
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Vallecula & Pyriform recess
|
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Entner Doudoroff pathway
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Glycolytic pathway in Aerobic bacteria
- Converts glucose to Pyruvate and Glyceraldehyde-3-phosphate - Yields 1 ATP, 1 NADH, and 1 NADPH per glucose |
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Taste signalling Pathways and Threashold
|
Sour - Production of H+ which closes K+ channels
Sweet - Activates cAMP which closes K+ channels Bitter - IP3 and Calcium Salty - Na+ influx Sweet has highest threshold Bitter has Lowest threshold |
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Transplant rejection
|
Hyperacute - Due to preformed antibodies to the donor such as ABO blood typing. Occurs within minutes
Acute - Takes a week or more to develop due to the delay in T cell activation |
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Hepatitis virus Families
|
A - Picorna
B - Hepadna C - Flavi D - Delta E - Calicivirus |
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Angina types
|
Stable - Most common type, and caused by exertion
Prinzmetal - Seen clinically as intermittent chest pain at rest due to vasospasm Unstable - Occurs even at rest and is the most severe |
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T helper cell types
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Th1
- Main partner is macrophages - Secretes Interferon-gamma and TNF-Beta Th2 - Main partner is B cells - Secretes many interleukins including Interleukin 10 which is anti-inflammatory - Induces proliferation and class switching of B cells |
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Causes of DIC
|
Gram negative Sepsis
Amniotic fluid embolism Major trauma Malignancy |
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Infections and Leukocyte types
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Parasites - Eosinophilia
Bacteria - Neutrophilia Viruse - Lymphocytosis |
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Canal system types
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I - Single canal to apical foramen
II - 2 separate canals leaving chamber but fuse together at the apical foramen III - 2 separate canals leaving pulp chamber and exiting at 2 foramin IV - 1 canal leaving pulp chamber but later split into 2 apical foramina |
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Intrinsic tongue muscles
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Vertical - Run superior inferiorly and broadens and flattens the tongue
Horizontal/Transverse - Runs from median fibrous septum laterally. Narrows and elongates tongue Longitudinal fibers - Run anteroposteriorly. Shortens and curles the tongue |
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Line angles
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Anterior teeth have 6 while posterior teeth have 8 line angles
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Contralateral Excursive movements
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Both Medial and Lateral pterygoids function in Contralateral excursive movements
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Largest permanent premolar
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Maxillary 1st premolar
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Mesial contact more Cervical than Distal contact
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Primary maxillary canine and Permanent mandibular 1st premolar
|
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Calcium Dipicolinate
|
Composes up to 20% dry weight of endospores
- Involved in heat resistance of endospores |
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Pneumonia location classificiation
|
Lobar - Affects one lobe, and typically involves bacteria such as Strep Pneumoniae or Haemophilus Influenza
Bronchiole Pneumonia - Affects patches of lungs around Bronchi or Bronchioles Interstitial pneumonia - involves areas between the alveoli and typically involves Viruses |
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Greatest influence on the lingual concavity of Maxillary incisors and the Groove direction of posterior teeth
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Side shift of mandible/Bennet movement
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Arm vein relationships
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PUB - Pinky, Ulna, Basilic are all medial
Cephalic is lateral Basilic and Cephalic communicate via Median vein |
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Vaccine types
|
Killed: RIP Always. Rabies, Influenza, Salk Polio, Hepatitis A
Attenuated - MMR, VZV, Sabin, yellow fever, Tuberculosis Toxoid - Diptheria, Tetanus, Protein subunit - HBs, Conjugated - Polysaccharide capsular antigens with tetanus toxin, diptheria toxin, or Meningogoccus outer B protein. Hemophilus Influenza type B HiB vaccine |
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Trigeminal nuclei
|
Mesencephalic nucleus - Proprioception from the face. Only CNS nucleus that contains sensory cell bodies. Others are in trigeminal ganglion
Chief sensory nucleus - Cell bodies located in trigeminal ganglion. Receives light touch and discriminative touch which travels to Contralateral VPM. *-Oral cavity sensations travel to IPSILATERAL VPM Spinal Nucleus - Cell bodies located in trigeminal ganglion. Pain and temperature sensation from face as well as from Facial, glossopharyngeal, and vagus. Contains Subnuclei Oralis, Interpol, Caudalis. Subnucleus Caudalis is most inferior and is where the pain fibers SYNAPSE |
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Immersion sterilants
|
Glutaraldehyde and Formaldehyde
- up to 22hrs of immersion is required to sterilize |
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Some Benign vs Cancerous skin lesion
|
Nevus - Benign moles
Verruca Vulgaris - Warts. Benign Seborrheic keratosis - Benign, seen in elderly Actinic Keratosis - Pre-cancerous. Can progress to squamous cell carcinoma |
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Most common STD
|
Chlamydia
|
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Lymph node structure and contents. Activation
|
Cortex
- Outer cortex. Mainly B-cells that may form Germinal centers - Inner cortex has mostly T cells. - Subcortical zone is where T cells interact with dendritic cells Medulla: Medullary cords: Plasma cells, Macrophages, and some B cells Medullary sinus: Where lymph gathers into efferent vessels. Contains reticular cells that synthesize type 3 collagen and histiocytes. *- When activated, B cells migrate to germinal centers and then into medullary cords. T cells migrate to the deep cortex/Paracortex |
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Lymphatic drainage of teeth
|
Maxillary:
- Anteriors and canines drain into Parotid nodes - Posteriors drain into the submandibular nodes Mandibular: - Incisors, anterior lip and tip of tongue drain into SubMental nodes - All mandibular canines and posteriors drain into Submandibular nodes except 3rd molar - Mandibular 3rd molar drain directly into Deep cervical nodes |
|
Nerve supply to the Condylar head
|
Auriculotemporal nerve
- TMJ is supplied by the Auriculotemporal nerve and the Masseteric nerve |
|
Mallory Bodies
|
Found in livers of people suffering from alcoholic hepatitis and alcoholic cirrhosis
|
|
Main source of calcium excretion
|
70-80% of ingested calcium in unabsorbed in the intestines
- Feces is the main source of calcium excretion |
|
Enamel crystal orientation
|
Inorganic crystals in the enamel is parallel at the head/body of enamel rods which is towards the crown
- Deviates towards the tail which is at the DEJ |
|
Lymphatic vessel characteristics
|
All have valves
- Mostly follows arteries in the trunk *- Characteristically follows Veins in the upper limb |
|
Restriction enzyme
|
aka Restriction endonuclease
- Cuts up SS or DS DNA at specific sites - Found in bacteria and archea and cuts out foreign viral DNA |
|
Bilt salts
|
Forms from Cholic acid/Bile acid with Glycine or Taurine
- Forms Taurocholic acid and Glycocholic acid |
|
Insuline Like growth factor
|
- Released by the liver following growth hormone stimulation and promotes cell proliferation and inhibits apoptosis
- IGF-1 is necessary to achieve maximal growth - IGF-2 is primary growth factor for early development |
|
Paraneoplastic syndrome
|
Symptoms due to secretion of cytokines or hormones by cancerous cells in the body
- Small cell carcinoma frequently causes Cushing's disease and SIADH |
|
Causes of Urolithiasis
|
Hypercalcemia
Hyperparathyroidism Gout Renal infection |
|
Dentin Curvatures
|
Primary curvature: S shaped curves in crown dentin which are almost straight in the roots.
Secondary curvatures: Small delicate curves within the primary curvature. Contour lines of owen are formed when secondary curvature of adjacent tubules are matched |
|
TIA
|
Transient ischemic attack aka mini stroke
- Neurological disorders due to ischemia |
|
Prostate cancer metastasis
|
Bone and lymph nodes
|
|
Myelophthisic anemia
|
Normocytic Normochromic anemia due to displacement of hematopoietic bone marrow to the blood.
- Immature RBCs are produced in the blood stream |
|
Eruption sequence
|
Primary: Rules of 6
Incisors - 6mth 1M - 12mth Canine - 18mth 2M - 24mth Permanent: 1M 6yr Mand Central 6-7 Max Central 7-8 Mand Lateral 7-8 Max Lateral 8-9 Mand Canine 9-10 Premolars 1st then 2nd 10-12 Max Canine 11-12 2M 12 3M 16-19 |
|
Lecithins
|
Membrane component composed of Glycerol, Phosphate, Fatty acids, and Choline. Present in cell membranes and yolk
- Phospholipids |
|
Free nerve endings
|
Most common type of nerve ending and readily found in skin
- Penetrates stratum basale and ends at stratum granulosum *- No Capillaries in the epidermis |
|
Tetrodotoxin
|
Toxin found in the pufferfish and has no antidote
- Blocks sodium channels in axons |
|
Atlanto-Axial joint
|
Median: Double joint. One between the Anterior arch of Atlas and one between the back of the odontoid process to the transverse ligament
Lateral: Arthroidal or gliding joint on the lateral masses |
|
Cruciate ligament
|
Consists of the transverse ligament of the atlas with superior and inferior fibers know as longitudinal bands. Attaches to occipital bone superiorly and body of axis inferiorly
|
|
Generator potential
|
aka Receptor potential
- Stationary depolarization of a receptor which is graded according to its intensity. Will result in an action potential if threashold is reached |
|
Humerus articulations
|
Trochlea is medial and articulates with Ulna
Capitulum is lateral and articulates with radius |
|
SVE fibers
|
Special visceral efferent aka branchiomotor or brancial efferent
- Supplies muscles derived from the branchial arches - CN 5,7,9,10,11 *- The Muscles of the head and neck are from the Dermamyotomes/Mesoderm and NOT from neural crest which gives rise to Branchial arch derivatives |
|
Endogenous opiates
|
Endorphin
Enkephalin Dynorphin Endomorphin |
|
Intracellular parasites
|
Faculative:
Fungus: Histoplasma Capsulatum, Cryptococcus Neoformans. Both infect Macrophages Bacteria: Francicella, Legionella, Mycobacterium, Nessieria Meningitidis Obligate: Viruses Bacteria: Chlamydia, Rickettsia, Leprosy, Leshimania, Plasmodia, Trypanosoma Cruzi. CRLLPT |
|
Neural tube
|
Dorsal part is the Alar plate - Sensory axons
Ventral part is Basal plate - Motor axons *- Marginal layer is white matter *- Mantle layer is grey matter |
|
Actinomyces and most common
|
Gram Positive Bacteria
- Normal inhabitant of oral cavity and infects after trauma or extraction - Cervicofacial Actinomycosis is most common* - Causes Pyogenic Abcesses with Sinus Tracts filled with Sulfur Granules |
|
Basilar membrane
|
Base for the stereocilia for hearing
- Farther region from oval window is low frequency - Closer is high frequency |
|
Dorsal Lateral tract
|
Lissaure's tract
- Contains ascending and descending fibers of collateral pain and temp afferents - Possibly for reflex activity |
|
PFK1 regulation
|
- Inhibited by buildup of PEP and Citrate
- Activated by AMP - Most potent activator is F2,6BP |
|
Plateau phase
|
Phase 2 of the cardiac action potential which shows a balance between Calcium inflow and potassium outflow causing prolonged depolarization
- This results in a long refractory period and the inability of cardiac muscle to undergo tetany |
|
Respiratory Alkalosis and Calcium
|
Albumin normally binds protons and calcium
- Alkalinization of blood causes protons to dissociate leaving more room to bind calcium - Thus, respiratory or metabolic alkalosis will cause hypocalcemia |
|
Most often missing teeth in order
|
3rd molars, Mandibular 2nd premolars, and Maxillary lateral incisors
|
|
Primary source of pathogenic microbes in the dental operatory
|
Mouths of patients
|
|
Plasmid
|
Circular DNA
- Extrachromosomal elements that mediate antibiotic resistance and confer conjugal fertility |
|
Flourouracil/Flourodeoxyuridine
|
Suicide inhibitor that inhibits Thymidylate synthase of the pyrimidine synthesis pathway or thymidine
- Used to treat cancer |
|
Pulp canals and pulp chambers of molars
|
Pulp canals in the molars usually join the pulp chamber just apical to the CEJ
|
|
Aseptic meningitis
|
- Bacterial invasion is NOT the cause
- Typically seen in Mumps, Echovirus, Coxsakie virus - Rarely develop permanent neural damage |
|
Bilaminar zone
|
Posterior attachment of the Meiscus of the TMJ and allows condyle to move forward
- Middle zone is vascular - Posterior superior Lamina has very dense organized elastic fibers - Posterior inferior lamina is not so dense |
|
Cartilage types
|
Fibrocartilage - Pubic symphysis, Intervertebral disks, Meniscus of sternoclavicular and acromioclavicular joints of knee and of TMJ, and TMJ
Hyaline cartilage - Ventral ends of ribs, Tracheal and bronchiole rings, and articular surface of most bones.*- Also epithyseal plates Elastic cartilage - Ear, Epiglottis, and larynx |
|
Babinski sign
|
Normal in infants but abnormal in adults
- When stroked on the lateral side toes should curl in. Flexion of toes is a positive babinski sign - A sign of UPPER MOTOR neuron damage of the corticospinal tract |
|
Junction between tooth surface and crevicular epithelium
|
Composed of a basal lamina like structure between enamel and epithelium
- Secreted by epithelial cells and is often confused with a basement membrane *- Basal lamina only has Lamina Densa and Lamina lucida *- Basement membranes also have lamina reticularis |
|
Transferrin vs Ferritin
|
Transferrin a blood glycoprotein for iron transport
Ferritin is the storage form of iron inside cells - No bound iron form is Apoferritin - Complexes of Ferritin forms Hemosiderin |
|
Characteristics of the Genetic Code
|
Non-Overlapping - Each codon is a separate triplet
Unambiguous - Each codon can only code for one AA Degenerate - Each AA can have more than one codon Universal - Nearly all organisms use the same genetic code |
|
Nerve fibers
|
Alpha fibers mostly have large diameters and are all myelinated
B fibers are small but myelinated. Preganglionics fibers of the ANS C fibers are small and unmyelinated. C fibers carry pain sensations from the orofacial region |
|
Canals of Maxillary first molar
|
Orifices form a triangle
- Longest side of triangle is the Mesial canal to Lingual canal |
|
Dens invaginatus
|
aka Dens in Dente
- Tooth invaginates in on itself - Most commonly affects maxillary laterals - Often results in early pulp necrosis |
|
Mandible Axes of rotation
|
Vertical - superior inferior axis through the orbiting condyle which spins as the mandible is moved towards the ipsilateral direction
Horizontal - Line through both condyles which is the axis of opening and CR axis. There may be a separate axis for each condyle Saggital axis - Antero posterior axis through a condyle in which the orbiting condyle turns during vertical motions |
|
Embrasure sizes
|
All lingual embrasures are larger than facial except between the mandibular incisors, and Maxillary 1st molar
- Largest incisal embrasure is between maxillary lateral and canine. Second is Mandibular lateral and canine - Largest overall occlusal embrasure is between maxillary canine and 1st premolar |
|
Most common type of root anomoly in the Mandibular 1st premolar
|
Bifurcation
|
|
Axial inclinations
|
From frontal view, Maxillary posteriors incline facially and mandibular posteriors incline lingually
From saggital view, Maxillary anteriors incline facially |
|
Most common location for Atherosclerotic induced aneurysm
|
Abdominal aorta
- Because Elastin is reduced in the abdominal aorta - Also, abdominal aorta does not contain Vasa Vasorum, which delays healing |
|
Poliomyelitis characteristics
|
- 90% of infections are subclinical
- 3 Serotypes. Type 1 is most common and is the form that causes paralysis - Damages motor neurons, spinal cord, or even brain - Some damaged neurons may repair and regain function *- Spread from person to person Fecal-Oral route |
|
Oral Bacteroides
|
- Forms Black pigments on Agar
- Divided into Porphyromonas family and the Prevotella family - Porphyromonas is Asacchrolytic while Prevotella is Sacchrolytic |
|
No plasmid mediated antibiotic resistance
|
Streptococcus Pyogenes
|
|
Herpangina
|
Disease caused by Coxsakie A virus and leads to lesions limited to palate and posterior oropharyngeal mucosa
|
|
Engaged in mitosis at any given time vs most sensitive to radiation
|
Basal keratinocytes are always undergoing mitosis
However, Lymphocytes are the most radiosensitive |
|
Icterus and Melena
|
Icterus - Jaundice
Melena - Black feces associated with Gastrointestinal Hemorrhage |
|
Most commonly associated with acute pancreatitis
|
Alcohol is most common
- Possibly gallstones and mumps as well |
|
Lobar pnemonia histology
|
Congestion in first 24 hrs
Red hepatization and consolidation Grey hepatization Resolution - Most common cause is Strep Pneumoniae and Haemophilis Influenza |