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87 Cards in this Set
- Front
- Back
- 3rd side (hint)
Patient with very developed muscles presents to ER with new onset seizures. Prior to onset, his workout partner stated that he had seemed lethargic, weak, and irritable. What's going on?
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A: Hypernatremia secondary to steroids use.
- Also happens in patients with fluid loss and those on hypertonic fluids What is the treatment? |
A: Correct underlying cause (pg. 133)
1/2 nml saline or water - Correct 1/2 the water deficit in the first 24 hrs, then second 1/2 over the next 2-3 days |
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76 yo M POD 3 s/p TURP has been under going bladder irrigation. He develops nausea and vomiting, followed by seizures and coma. What's up?
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A: Hyponatremia
- Also found in high-output iliostomy pt, hyperglycemia, adrenal insufficiency What's the Tx? |
A: Determine value status and cause (pg. 132)
- If eu- or hypervolemic, water restrict Correct hyperglycemia For refractory Dz --> hypertonic saline |
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Patient with extensive 2nd and 3rd degree burns. EKG shows flattened P waves, peaked T waves, and a wide QRS before he goes into V-fib and dies. What caused this arrythmia?
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A: Hyperkalemia (>5) secondary to fluid shift
- Also found in DKA, leukocytosis, and crush injuries What's the Tx? |
A: 1) Calcium gluconate (stabilizes the myocardium; onset 2 min, duration 30 min)
2) HCO3- (further stabilizes myocardium w/ duration = 90 min) 3) Glucose and insulin 4) Albuterol and loop diuretics 5) Kayexalate and/or diuresis 6) Address underlying cause AFTER all previous steps! |
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54 yo F POD 3 s/p bowel resection has an NG in place. After her daily digoxin dose, she develops NV, hyper salivation, and sees green halos around objects. EKG finds depressed T waves and prominent U waves. What's up?
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A: Hypokalemia secondary to chronic NG suction
- Also seen in chronic diarrhea and vomiting, diuretic use, met. alkalosis, hyperaldosteronism (Cushing's, Conn's, CHF, RAS), burns, beta-agonist use, and hypomagnesemia - Could go into V-tach - Will have increased sensitivity to digoxin!!! What's the Tx? |
Depends on the cause
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Patient with renal carcinoma develops a kidney stone. Later he gets constipation and AMS. EKG shows shortened QT interval. What's the Dx?
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A: Hypercalcemia
- Also found in bone, kidney, and parathyroid disorders, and acute pancreatitis What's the Tx? |
A: hydration and loop diuretics, bisphosphates, and calcitonin
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After receiving a blood transfusion, and patient's left face twitches when the left jaw angle is tapped (Chvostek's sign) and the hand spasms when a BP cuff is inflated (Trousseau's sign). EKG shows QT prolongation. What's the Dx?
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A: Hypocalcemia secondary to blood transfusion
- Also seen in parathyroid resection, low Mg++, and renal failure What's the Tx? |
A: Calcium gluconate, Vit D
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A CKD patient has decreased DTRs and muscle weakness. When taking her vital signs, the nurse notices that she is bradycardic and has a low BP. EKG shows PR and QT interval prolongation. What's the Dx?
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A: Hypermagnesemia secondary to excessive Mg replacement for CKD
What's the Tx? |
Calcium gluconate
Nml saline infusion with loop diuretics Dialysis |
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Patient presents to the ER in an arrhythmia found to be Torsades and soon dies. The paramedics tell the ER doc that the strip in the ambulance showed widened T waves and QRS, prolonged PR and QT intervals. The family later tells the doctor that the deceased patient was an alcoholic who had suffered a stomach bug with extreme NVD for the past week. What's the Dx?
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A: hypomagnesemia
- found in NVD, malabsorption conditions, aggressive diuresis, alcoholism, and chemoTx What's the Tx? |
MgSO4
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Patient being treated for a malignant villous adenoma c/o hard masses under the skin. Xray shows them to be soft tissue calcifications. EKG shows a new onset heart block. What's the Dx?
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A: High phosphorous
- usually an iatrogenic condition - Also seen in rhabdomyolysis, hypoparathyroidism, and hypocalcemia What is the Tx? |
- Decrease dietary phosphorus (animal products, dark green vegetables)
- Aluminum hydroxide - Hydration and acetazolamide (carbonic anhydrase inhibitor) - Dialysis |
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After a week of NPO feeding and a NG tube, the tube is DCed and the hungry patient consumes a large, high glucose meal. He develops diffuse muscle weakness, followed by flaccid paralysis. What's up?
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Low phosphorus caused by refeeding syndrome.
- Also seen in excessive IV glucose use, hyperparathyroidism, and osmotic diuresis - Refeeding syndrome = Low Mg, K, and Phos cause by a large glucose load after long periods of NPO. What's the Tx? |
Potassium phosphate or sodium phosphate
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Vertigo, tinnitus, hearing loss
(-) Dix-Hallpike |
Meniere's Dz
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Syncope lasting 8-15 minutes
Facial numbness Parathesias Visual changes |
Vertibrobasilar insufficiency
Hx arthrosclerosis and CV risk factors |
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AA female
red nodules on legs joint pain vision changes |
Sarcoidosis
Labs: elevated Ca, Vit D, ACE |
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Conditions with erythema multiforme
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HSV
Recent URI mycoplasma |
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Conditions with erythema nodosum
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1. Sarcoidosis
2. Bacterial infections (Streptococcal, TB, Yersinia, Salmonella, Legionella) 3. Fungal infections (Coccidiodomycosis, Histoplasma, Blastomycosis) 4. Drugs: sulfonamides, OCPs 5. Enteropathies such as Crohn’s disease and UC 6. Hodgkin’s lymphoma 7. Behcet disease (= vasculitis w/ recurrent oral ulcers, genital ulcers, and uveitis) 8. Pregnancy |
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Waxy casts
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Advanced CKD
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Hyaline casts
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non-specific
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Granular "muddy brown" casts
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ATN (Causes: persistent hypovolemia, shock, sepsis, severe hemolysis, rhabdomyolysis, amino glycosides, and amphotericin B)
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Red blood cell casts
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Nephritic syndromes (post-streptococcal glomerulonephritis, IgA nephropathy, and rapidly progressive glomerulonephritis),
malignant hypertension. |
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WBC casts
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tubulointerstitial inflammation,
acute pyelonephritis transplant rejection. |
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Tense (hard to rupture) bullae,
Ab against dermo-epidermal junction, anti-epidermal basement membrane antibodies, IF: linear band of inc. eosinophils along BM Characteristics: mucosal involvement rare, typical age 70-80, Nikolsky (-) |
Bullous pemphigoid
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Flaccid blisters
all epidermal surfaces (including mucosal) typical age 30-40, Nikolsky (+) Anti-epithelial cell Ab, anti-keratinocyte Ab IF: "tombstone" pattern around epidermal cells Seen always in toxic epidermal necrolysis and sometimes in scalded skin syndrome |
Pemphigus vulgaris
Seen always in toxic epidermal necrolysis and sometimes in scalded skin syndrome |
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Breast cancer tumor marker
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CEA
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Malabsorption syndrome + joint pain
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Whipple's Disease
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HLA- DR4
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RA
Also ANA, RF, ESR, anti-CCP (anti-cyclic citrullinated peptide; most specific!) |
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Anti-histone Ab
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Drug-induced SLE
SHIP: Sulfas, hydralazine, isoniazid, procainamide |
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Meds the predispose to latent TB reactivation
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Etanercept (TNFa receptor analog)
Infliximab **Both are RA drugs** |
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HLA-DR2
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Multiple sclerosis
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HLA-DR3
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Diabetes mellitus
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HLA-DR5
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JRA
Kaposi's sarcoma Hashimoto's thyroiditis |
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Painless vaginal bleeding during preg
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Placenta previa
Incidence = 1:200 Risk factors: prior c-section, grand multiparity, advanced maternal age, multiple gestation and prior placenta previa Tx: deliver via C-section |
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Painful vaginal bleeding during pregnancy
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Placental abruption
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Head trauma --> lucid interval followed by LOC
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Epidural hematoma
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Head trauma --> ruptured middle meningial artery
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Epidural hematoma
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Head trauma --> ruptured subcortical veins
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Subdural hematoma
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mcc of endocarditis in IV drug users
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Staph Aureus
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mcc endocarditis in prosthetic valves
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steph. epidermidis
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MCC endocarditis in left-sided subacute endocarditis
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strep viridians
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MCC endocarditis in patients long-term indwelling catheters, malignancy, AIDS, or organ transplant (i.e. immunosuppressed)
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Candida albicans
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Endocarditis associated with GI malignancies (like colon cancer)
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Strep bovis
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Innervates biceps brachii, brachialis, and caracobrachialis
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Musculocutaneous N.
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Innervates the subscapularis
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Upper subscapular N
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Innervates teres major
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Lower subscapular N
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Muscle increases in length w/ contraction
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Eccentric contraction
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Muscle shortens while contracting
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Concentric contraction
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Muscle is loaded and contracted in rapid sequence
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Plyometric contraction
The short cycle affects the sensory response of the muscles spindles and golgi tendon organs --> greater contraction force than normal strengthening exercises |
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Muscle contraction where veolcity remains constant while the force of contraction varies
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Isokinetic/isovelocity contraction
Never occurs naturally in the body |
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Muscle contracts while maintaining constant length
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Isometric contraction
Ex: pushing against a wall |
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Proximal muscle weakness, depression, myalgias, dysphagia, dysphonia, periorbital heliotrophic rash, Gottron's papules
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Dermatomyositis
Guttron's papules = purple papules on DIP and MCP joints Lab: elevated CK, (+) ANA and anti-Jo-1 Ab (polymyositis has these, too. Be careful!) |
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Proximal muscles tenderness, stiffness, and arthralgias
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Polymalgia rheumatica
**Proximal muscles will be tender, but NOT WEAK (unlike dermatomyositis and polymyocitis) |
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Esophageal wall rupture 2o to excessive vomiting (usually in eating disorders)
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Boerhaave's syndrome
Tx: IVF, broad-spectrum Abx, prompt surgical intervention **Can cause pneumomediastinum -->subcutaneous emphysema, mediastinitis, sepsis |
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Parkinson's tetrad
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Resting tremor, cog-wheel rigidity, bradykinesia, postural instability
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Aniline dye exposure increases risk of which cancer?
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Transitional cell bladder cancer
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Gynecomastia + spider angiomata + asterixis + testicular atrophy
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Cirrhosis
-gyncomastia & spider angiomata from elevated estrogen levels - asterixis (hand flapping) from heptic encephalopathy |
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What PSA level is a positive screen (i.e. suspicious for prostate cancer)?
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PSA > 4 ng/mL
*PSA > 10 --> transrectal US |
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Skin pigmentation + diabetes + arthritis + FHx
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Hemochromatosis
Labs: elevated transferrin saturation |
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Decreased ceruloplasmin seen in?
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Wilson's disease
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Anti-mitochondrial Ab
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Primarily biliary cirrhosis
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Decreased alpha-1 antitrypsin levels indicates?
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Liver disease
emphyseam alpha-1 antitrypsin deficiency |
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the probability of finding a significant statistical association in your study if one truly exists
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Power
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the risk of the disease in people exposed to a given factor
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Relative risk
- determined through cohort studies |
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the null hypothesis is rejected even though it is true
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Alpha error (also known as Type 1)
- aka a false-positive! |
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null hypothesis is not rejected even though it is false
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Beta error (also known as Type 2)
- aka a false-negative! |
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the measure of how far a set of numbers is spread out. It describes how far the numbers lie from the mean.
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Variance
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AA male + HIV + nephrotic syndrome
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Focal segmental glomerulosclerosis
- Also seen in chronic HTN & obesity Bx: sclerosis w/ renal capillary tufts Tx: prednisone, cytotoxic meds, ACEi/ARB |
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MCC nephrotic syndrome in white adults
Hx of HBV, syphilis, malaria, or exposure to gold salts (common in RA meds) |
Membranous nephropathy
Bx: spike and dome appearance d/t granular deposits of IgG and C3 in BM |
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Drug used for CML and GI stromal cell tumors. It's a Philadelphia Chrom bcr-abl tyrosine kinase inhibitor
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Imatinib
SE: fluid retention (use w/ caution in CHF and CKD patients) |
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Monoclonal Ab against HER-2 (erb-B2) used in HER-2 (+) breast cancer
Major SE of cardiotoxicity |
Trastuzumab
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Alkylating agent used in Tx of CML. Can also be used for ablating bone marrow in hematopoietic stem cell transplant patients
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Busulfan
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Head and neck autonomic innervation
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S: T1-T4
P: CN X |
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Heart autonomic innervation
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T1-T6
CN X |
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Lungs autonomic innervation
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T1-T6
CN X |
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Spleen autonomic innervation
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T5-T9
CN X |
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Stomach autonomic innervation
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T5-T9
CN X |
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Liver autonomic innervation
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T5-T9
CN X |
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Gallbladder autonomic innervation
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T5-T9
CN X |
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Proximal duodenum autonomic innervation
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T5-T9
CN X |
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Middle GI (distal duodenum - proximal 2/3 of transverse colon) autonomic innervation
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T10-T11
CN X (from lesser splanchnic nerve all sup. mesenteric ganglion) |
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Kidneys autonomic innervation
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T10-T11
CN X |
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Testes/ovaries autonomic innervation
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T10-T11
CN X |
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Adrenal medulla autonomic innervation
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T10
CN X |
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Leg structure autonomic innervation
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T11-T12
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Arm structure autonomic innervation
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T2-T8
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Lower GI (distal 1/3 of transverse colon - rectum) autonomic innervation
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S: T12-L2 from least splanchnic off inf. mesenteric ganglion
P: S2-S4 via pelvic splanchnic nerve |
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Appendix autonomic innervation
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T12
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Bladder and distal ureter
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S: T12-L2
P: S2-S4 via pelvic splanchnic nerve |
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Clitoral/penile erectile tissue
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S: L2
P: S2-S4 via pelvic splanchnic nerves |
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