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648 Cards in this Set

  • Front
  • Back
bilateral anorchia
vanishing testes syndrome - normal external genetalia but no mullerian structures (resorption of testes before birth)
methimazole and PTU SE
agranulocytosis, halt meds and start rHg-CSF
salt secreted
95% of that ingested
internal capsule
receives blood from lenticulostriate arteries, prone to rupture in HTN
int capsule anterior limb
fronto pontine fibers
int capsule genu
corticobulbar fibers
int capsule post limb
corticospinal fibers to contralateral arm and leg
nitroprusside cyanide test
cystinuria --> renal staghorn radioopaque stones, alkanize urine
familial iminoglycinuria
inpared renal tubular resorptino of proline, hydroxyproline, glycine
hypophosphatemic rickets
decreased PT reabsorption of phosphate and bony abnormalities
chediak higashi Dx
large inclusions in all nucleated blood cells
alpha granules
growth factors, PF4, thrombospondin and fibronectin, deficiency --> grey platelet syndrome
dense granules
ADP and ATP, Ca, histamine, serotonin, epinephrine
CGD tests
nitroblud tetrazolium negative or DHR flow cytomoetry
myeloperoxidase deficiency
normal enzyme test, generally clinically silent, may get candida in diabetics
liver findings:
fatty change, mallory bodies (eosinophilic cytoplasmic inclusions)
a1 antitrypsin def
PAS positive cytoplasmic granules
Hep A
think daycare and kids
copper in liver and keyser fleisher rings
aminoglycoside mechanism of action
misreading at translation initiation
inhibits ribosomal peptidyl transferase
think RA treatment with low risk of GI probs and 50 hr half-life
endodermal diverticulum of the yolk sac, becomes part of urogenital sinus
embryonic kidney
urogenital ridge
intermediate mesoderm give rise to the embryonic and adult kidneys and gonads
most common site for volvus in elderly
sigmoid colon (poorly supported)
wood tick transmits
rickettsia rickettsiae and francisell tularenis
lower motor neurons in anterior horn, UMN in motor area of cerebral cortex
cerebellar damage in
spinocerebellar degenerative diseases like friedrichs ataxia and olivopontocerebellar atrophy (both have ataxia as prominent sx)
globus pallidus lost in
striatonigral degeneration (resembles parkinsons)
selective IgA deficiency
most common hereditary immunodeficiency, failure of heavy chain switching
hyper IgM
CD40 ligand mutation
foramen ovale
mandibular nerver may be injured by fracture
superior orbital fissure
abducens, ophtalmic division of trigeminal
foramen rotundum
maxillary division of the mandibular nerve
internal auditory meatus
chordae tympani
friedrich's ataxia
degeneration of DRG and oters presents with ataxia, dysarthria, loss of highly discriminatory sensory modalities
pontine nuclei
afferents from cerebral cortex to pons, pons to cerebellar cortex via the middle cerebellar peduncles
RNA dependent DNA polymerase (acts like a reverse transcriptase) and is thus inhibited by lamivudine and stavudine
PGE1 analog to maintain a patent ductus arteriosus
alpha glucosidase inhibitor
non-sulfonylurea moiety of glyburide
DMD spontaneous arising
recombinatino event in the dystrophin gene that gave rise to a frameshift mutation leading to an untraslatable mRNA
ATP from one glucose in anaerobic oxidation
dissolves cholesterol gallstones in some patients
somatostatin analogue used to treat diarrhea in endocirne disorders and variceal bleeding and acromegaly
spasmolytic used for diseases such as cerbral palsy, MS, stroke
first pharyngeal cleft
external ear canal
palatoglossal/pharyngeal folds
glossal in front
caffeine medical use
for infants for treatment of apnea of prematurity and adjuvant for analgesic formulations
biceps tendon origin
supraglenoid tubercle above the glenoid fossa of the scapula and passes into the bicipital groove between the greater and lesser tuberosities of the humerus
papillary necrosis etiology
DM, analgesic abuse, UT obstruction, sickle cell disease
thromboemboli to the kidney
result in wedge shaped infarcts and pale coagulative necrosis of the cortex
toxin producing e coli
enterohemorrhagic (shiga-like toxin causing bloody diarrhea and HUS), enterotoxigenic (activated intestinal adenylate or guanylate cyclase leading to cAMP overproduction and diarrhea)
used to treat HSV but not in immunocompromised becaues it can be associated with TTP-HUS which seem to occur in this population and can be fatal
bacteria associated with human bites
elkenella corrodens
IVDU with osteomyelitis
pseudomonas and candida
sickle cell osteomyelitis
treatment of dracunculus medinensis which causes skin ulceration and inflammation
mediator of complement and shock in gram negative bacteremia
released by macrophages, in response to endotoxin, causes fever an dhemorrhagic tissue necrosis
hageman factor in shock
endotoxin can directly activate it leading to coag cascade and DIC
nitric oxide in shock
released by macrophages activated by endotoxin causes hypotension
IL-1 in shock
realeased by macrophages causes fever
rubella congenital infection
PDA, pulmonary stenosis, cataracts, microcephaly, deafness
hepatitis G
transmissible flavivirus, not been shown to cause liver disease
Positive during the window period
CD4 cell count < 200/mm3 and one or more defining opportunistic infections
amebas with ingested RBCs
entamoeba histolytics
opportunistic infections and cell counts
<400: Herpes simplex and zoster oral thrush; <200 cryptococcal meningitis; <100 toxoplasmosis; <50 MAI
chronic wasting, prophylaxis is with azithromycin
granulovacuolar degeneration and hirano bodies
intracytoplasmic inclusion bodies in hippocampal pyramidal neurons in alzheimer's patients
lafora bodies
neurons glia sweat glands liver skeletal muscels with lafora dz
marinesco bodeis
dopaminergic neurons of SN - intranuclear and not associated with parkinsons
calcium pyrophosphate dihydrate
pseudogout, weakly positive
calcium oxalate
oxalosis and bipyramidal, positively birefringent
calcium phosphate
apatite-associated arthropathy and produces spherical clumps nonbirefringment
rheumatic disease
type II hypersensitivity
amino acids involved in ammonia transport in blood
alanine and glutamate
nikolsky's sign
separation of the epidermis upon manual stroking with pemphigus vulgaris
rupture of AV malformation in brain
subarachnoid hemorrhage
deep perineal space
middle layer of the urogenital diaphragm, two skeltal muscles, sphincter urethrae and deep transverse perineal, and the cowper gland, membranous urethra passes through the urogenital diaphragm
superficial perineal space
bulbospongiosus (skeletal muslce that covers the bulb of the penis), crus of penis (erectile body that is continuous with the corpus cavernosum of penis), ischiocavernosus (covers the crus of the penis)
C3 nephritic factor
IgG autoantibody that binds C3 convertase making it resistant to inactivation, presistently low serum complement levels and associated with type II membranoproliferative glomerulonephritis
cervical plexus
longus colli and capitis muscles
breast feeding with HIV
should not occur because it can transmit the disease
ischemic necrosis of brain
sterile liquefactive necrosis
porto-caval shunt
splenic vein to left renal vein (splenic vein drains into portal vein and renal into IVC)
Sup mesenteric vein drainage
into the portal vein
components of microvilli
actin, myosin
hemidesmosome associated (cell to cell connection)
movement of cilia and flagella
wiskott aldridge genetics
x linked
cytokine in development of anaphylaxis
IL4 - makes IgE
hyaluronidase organism
strep a
catalase positive organisms
"SPACE cat": staph, pseudomonas, aspergillus, candida, enterobacteriaceae
malignant melanoma genetics
p16 tumor suppressor gene loss
excessive fluoride
direct injury to ameloblasts leading to inadequate production of tooth enamel
multikinase inhibitor for renal cell carcinoma with hypertension rash diarrhea fatigue and shouldnt be taken with doxorubicin
jigsaw pussle appearance of bone lamellae
pathognomonic for paget's dz
congenital skeletal probs with syphilis
saddle nose and shaber shin
ankylosing spondyltis findings
begins in sacroiliac crests then moves up into spine causing destruction of the posterior vertebral bodies, fusion, decreased range of motion, atrophy osteoporosis, look at spinal x ray for diagnosis, rheumatoid factor generally negative, HLA-B27 positive (As are all spondyloarthropathies)
severe magnesium deficiency
associated with alcoholism, acute decrease in Mg causes increase in PTH, prolonged decrease in Mg causes decrease in PTH, admin of Mg results in prompt rise in PTH and restoration of normal serum Ca levels, absence of Mg decreases function of PTH leading to "functional" hypoparathyroidism
hypoparathyroidism and bone density
decreased bone density
cuboidal epithelium
kidney peritoneal lining pleural lining
lacunar cells
specifically suggest the nodular sclerosing variant of hodgkins disease
some AD diseases
NF, ehlers danlos, huntingtons, osteogenesis imperfecta
vagina in women of childbearing age
lactobacillus, candida, strep
vagina of children
staphylococcus epidermidis
urease producing bacteria
"N CUP" : Nocardia, cryptococcus, Ureaplasma, Proteus
h pylori
SO dismutase (As does bacillus anthracis), catalase (as staph aureus), flagella (as with E coli), mucinase (as with v cholera)
aspirin and EtOH in ulcers
more linked to gastric than duodenal
cystic medial degeneration
fragmentation of elastic laminae with accumulation of myxoid materiloa in aortic media
Muscles in legs
flexor digitorum longus
from posterior middle of tibia, four tendons on sole of foot that insert on distal phalanges act to flex toes and foot and invert foot at ankle
peroneus tertius
originates at distal 1/3 of anterior fibula - extend foot at ankle joint and evert foot
peroneus brevis
originates at distal 2/3 of lateral fibula, plantar flex and evert foot
peroneus longus
originates at head and proximal 2/3 of lateral fibula, plantar flex and evert foot
extensor hallucis longus
originates at middle 1/2 of anteror fibula, extend great toe and extend foot at ankle
SCC of esophagus
smoking, alcohol, and spicy foods
adult parvovirus infection
arthralgias and arthritis, no rash usually, symmetric joints 3-4 weeks post exposure
fibroblastic-like cells in a storiform pattern
dermatofibrosarcoma protuberans, a slow growing fibrosarcoma
horn cells
seborrheic keratosis
pautrier microabscesses
mycosis fungoides
sawtooth dermal/epidermal junction
lichen planus
arterial supply to distal lesser curvature of stomach
right gastric
ZES postprandial gastrin change
don’t expect much of an increase in gastrin levels
psoas action at hip
neisseria and chlamydia
induce endocytosis
might increase INR from warfarin
urinary tract analgesic that changes color of urine to orange/red
friedrich's ataxia sites
spinocerebellar tracts, CST, posterior columns
retropharyngeal space
fascial plane between buccopharyngeal fascia and prevertebral fasciea, allows spread of infections between neck and thorax
aspirin and uric acid
causes uric acid levels to increase
nutmeg liver
chronic CHF
male pseudohermaphrodite
XY but look femaie
female pseudohermaphrodite
XX bu look male
rapidly progressive GN
membranoproliferative GN
tram track and thickening of the glomerular capillary walls
juvenile polyposis and peutz jeghers
polyps don’t predispose to cancer
osteosarcoma in pagets
usually jaw pelvis or femur
only antidiuretic that acts upstream of macula densa
acetazolamide, and therefore increases NaCl at MD and increases afferent arteriole constriction
most common cause of death in preeclampsia
cerebral hemorrhage and ARDS
fibroelastic hyperplasia
reduplication of the elastic lamina and fibrosis of the media secondary to HTN
sciatic nerve
common peroneal and tibial nerves
WASP protein function
participates in the reorganiation of the hematopoietic cell cytoskeleton in response to external stimuli
trisomy 8
some cases of olfactory neuroblastoma
direct thrombin inhibitors
lepirudin, bivalirudin, other derivatives of hirudin
amyloid in the thyroid
medullary thyroid carcinoma
both mutations in dystrophin, worse mutations in DMD
laminin deficiency
x linked emery-dreifuss Muscular dystrophy
emerin deficiency
AD emery deridfuss MD
how to see keyser fleischer ring
slit lamp examination of the eyes
excessie bleeding, HSM, pancytopenia, markedly enlarged cells containing a fine fibrillar materil resmebling tissue paper in BM, deficiency in beta D glucosidase
most common site of oral SCC
floor of the mouth>tip of tongue>hard palate>base of tongue
zn finger trx factor, "housekeeping" gene
four areas where 15-17 year old can make decision without parental notification
STD tx, substance abuse tx, birth control, prenatal care
mercaptopurine activation
by HGPRT, allopurinol raises 6-MP levels
estrogen antagonist to treat breast cancer
desensitization procedures with allergy
goal: promote Th1 response and therefore IFN-gamma to shut off the Th2 response
Wermer syndrome
Sipple syndrome
neurosyphilis: PARESIS
personality, affect, hyperactive reflexes, eyes (pupils), sensorium defects, intellectual decline, speech deficiency
increased risk thyroid lymphoma
hashimotos (by 60-80x)
homogentisate oxidase
role in tyrosine catabolism pathway
uniformly firm thyroid gland, anti thyroid peroxidase or antithryoglobulin Ab
autoimmune HA in SLE
warm agglutinin (IgG)
renal cell CA and renal transplant
associated with PV
analysis of variants
1 nominal (2 or more groups) 1 interval
Chi square
2 nominal
matched pairs t-test
1 nominal (2 matched troups) 1 interval
math liit review
pearson correlation coefficient
2 interval
pooled t test
1 nominal (2 groups) 1 interval
tings counted in groups or categories
data measured along a dimension graded in equal intervals
widal test
diagnose typhoid fever
watson-Schwartz test
detect pophobilinogen in urine and diagnose porphyria
woellner enzyme test
heterophil antibodies in patients with EBV
dorsal scapular nerve
rhomboid innervation
medial pectoral nerve
minor and major pectoralis
lateral pectoral nerve
major pectoralis
suprascapular nerve
supraspinatus and infraspinatus
contraindicated in people with bowel obstructin
anything that stimulates intestinal tract (such as metoclopramide)
giardia look
"face-like" appearance, often times look crescent shaped
desquamative inerstitial penumonitis (DIP)
idiopathic process relatd to idiopathic interstitial fibrosis, lamellar bodies in macrophages contain surfactant
ADCC cells
nk cells, only kill body cells that are coated with antibody
LAK cells
NK cells that have been activated with IL-2, considered superactivated NK cells
charcot leyden crystals
derived from enzymes present in eosinophils
tartrate-tessitant acid phosphatase
hairy cell leukemia
red cell survival measure
major blood supply to intercostals in coarctation
anterograde flow though the intercostal artery via the subclavian artery
systemic amyloidosis
chronic hemodialysis
beta 2 microglobulin
cardiomyopathic hereditary forms
neuropathic hereditary syndromes
local amyloidosis
senile cardiac
atrail natriuretic peptide-related fibrils
vomiting center
floor of the 4th ventricle, vagal afferents receive and send info to the lateral reticular formation in the medullam (vomiting center)
floor of 3rd ventricle
XR of rickets
bony changes at lower ends of radius and ulna, diaphyseal ends become fuzzy, cup shaped and may develop spotty rarefaction
growth plate
epiphyseal plate
between diaphysis and epiphysis
median nerve
Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis, first two lumbricles
bubbly meconinum
meconium ileus when there is bowel obstruction without apparent reason
vitalline duct
embryologically connects the developing gut to the yolk sac
example: mutation carriers or Rb gene get multiple different types of cancers
resistance to quinolones
chromosomally encoded, mutation in structural genes for DNA gyrase and topoisomerase
topoisomerase II inhibit
topoisomerase IV (gyrase) inhibit
oneiroid state
dreamlike state seen in mostly schizophrenic patients
treatment of HTN in diabetics
ACE inhibitors since they have been shown to slow the progression of renal disease
thiazide diuretic
direct acting vasodilater for severe refractory HTN, opens Katp channels leading to arteriolar vasodilation and hyperpolarization of pancreatic beta cells and subsequent decreased release of insulin
"pearly papules"
basal cell carcinoma - would expect to see palisading nuclei
molluscum contagiosum
poxvirus, see viral cytoplasmic inclusions
acute salicylate poisoning
causes acute respiratory alkalosis via stimulation of respiratory centers, initial response often followed by metabolic acidosis
therapy for phobia - progressive steps starting with least fearful
don’t pay attention to a whining kid and try to extinguish the behavior
operant conditioning
increase likelihood of a response by reinforcement (reward desired behavior)
radial traction of airways in restrictive disease
bowen's disease vs SCC
SCC will be frankly invasive
seborrheic keratoses
middle-old aged people, bening growths that histologically show hyperplasia of epidermis
verruca vulgaris
common wart
DNA polymerase proofreading direction
3' to 5' exonuclease activity
chronic granulomatous disease of upper airway, caused by klebsiella rhinoscleromatis, see epistaxis nasal deformity and destruction of nasal cartilage, fibrotic stage of sclerosis and fibrosis, see histiocytes containing K. rhinoscleromatis = Mikulicz cells, treatment of choice tetracycline
shrinking of nucleus and basophilia from DNA condensation
nuclear breakdown
nuclear dissappearance
temporal lobe under the tentorium
uncal herniation --> compression of CN III especially peripheral part of CN III (parasympathetic), leads to mydriasis then loss of the pupillary light reflex, followed by loss of ability to follow flashlight
peripheral vs central CN III
peripheral is parasympathetic, central is sympathetic
tonsillar herniation into the foramen magnum
can compress medulla causing respiratory failure and death
upward herniation of cerebellum
posterior fossa lesion
herniation of the medially located cingulate gyrus under the falx cerebri
subfalcine / cingulate herniation - cerebral hemisphere expansion and can compress anterior cerebral artery
muscle innervated by CN VII that can lead to excessive saliva accumulation between cheek and teeth when paralyzed
bruton agammaglobulinemia
recurrent respiratory infections caused by pyogenic organisms
lyme disease arthritis HLA
increased synthesis of urea
severe burns and prolongued high fever
site of dorsalis pedis pulse
between extensor hallucis longus tendon and extensor digitorum longus
found in bee venom causes mast cell degranulation
things that cause mast cell degranulation
physical injury, heat, cold, type 1 hypersensitivity, C3a, C5a, proteins from leukocytes, substance p, mellitin
eosinophil chemotactic factor-A
multiple substances preformed in mast cells that would be released at site of bee sting
may also get hepatic fibrosis with HTN and splenomegaly
spontaneous abortion association with bacteria
listeria tx: iv amp or penicillin, maybe with AG; brucella
origin of right atrial myxoma
sinus venosus (which gives rise to smooth atria, coronary sinus, oblique vein)
slow developing testicular enlargement
syphilis, also see perivascular cuffing of lymphocytes and plasma cells, testis usually involved before epididymis, may see gummas
SVC syndrome
bronchiogenic carcinomas (small cell and SCC) account for 80%
subependymal giant-cell astrocytoma
tuberous sclerosis
non-enveloped viruses
helical capsid viruses
the RABID PARAmedic and ORTHOpedist BUNYAn FILled the ARENA with CORONA
circular genome virus
ABP: Arena, Bunya, Papova
migratory skin rash
5 p's of porphyria
painful abdomen, pink urine, precipitated by drugs, polyneuropathy, psychological disturbances
septum transversum, pleuroperitoneal folds, body wall, dorsal mesentary of esophagus; often get hernia due to failure of the pleuroperitoneal membranes to develop properly
informed consent exceptions
emergency, waiver by patient, patient is incompetent, therapeutic privilege
myxedema with thyroid
due to longstanding hypothyroidism in adults, high TSH, low T4, very general term that can result from many causes of hypothyroidism
hashimoto's biopsy findings
infilatration with lymphocytes, macros, plasmas, germinal center formation
subacute granulomatous thyroiditis (de quervian) biopsy
causes hyperthyroidism but can cause transiet hypothyroidism, frequently occurs after a viral infection, may experience fever nd painful enlargement of the thyroid, usually abates in 6-8 weeks biopsy = disruption of thyroid follicles, neutrophilic infiltrate, cellular aggregate, multinucleated giant cells
subacute lymphocytic thyroiditis
can cause transient hyperthyroidism but is generally painless
leydig cell tumor
gynecomastia, golden-brown tumor, large uniform cells, rod-shaped crystals
sertoli cell tumors
cord-like structures resemblin seminiferous tubules
polyadenylation recognition sequence
3' end of the intron has a conserved AG, 5' is GT
streptococcus bovis
bacteremia and endocarditis, distinguished by having a cell wall carbohydrate composed of glycerol teichoic acid
bile solubility
strep pneumo is soluble, strep viridans is not
pyrrolidinyl arylamidase positive
group D and group A strep
CAMP test positive
group B
nerve in tonsillar fossa
glossopharyngeal nerve
recombinant IL2
enhances cell mediated immunity and is used in concert with 5FU in colorectal cancer
mAb against fusion protein of RSV
formation of the pancreas
ventral pancreatic bud normally rotates around duodenum to fuse with dorsal bud - form from the second part of duodenum, normally around the right side
annular pancreas formation
ventral bud rotating around the right and left sides of the second part of the duodenum
sole LDL elevation
type 2a
sole chylomicron elevation
type 1
increased LDL and TG and VLDL
type 2b
increased TG and chylomicron rem
type 3
increased TG and VLDL and chylo
type 5
peak suystolic pressure of ventricles vs aorta
2-3 mmhg higher in the ventricles
NE and Epi
NE is precursor
tyrosine stuff
tyrosine to thyroxine and dopa, dopa to melanin and dopamine
MAOI that also blocks serotonin and NE reuptake that increases energy expenditure and decreases appetite
embryology of syringomyelia
progressive vacitation of the central canal of the spinal cord
common variable immunodeficiency
caused by abnormal B-cell differentiation, decreased numbers of plasma cells and low Ig from all classes; distinguished from agammaglobulinemia (Bruton) by the normal numbers of B cells in the blood and lymphoid organs, in Bruton B cell maturation stops after rearrangment of heavy chains so b cells in the bloodstream are lower
topo I inhibitor, inhibits acetylcholinesterase --> diarrhea, also see neutropenia
pyrimidine analog for first line therapy with pancreatic ovarian dna NSCLC
dupuytren contracture
contracture of palmar fascia caused by interraction of myofibroblasts with collagen fibrils of the fascia; myofibroblsts play a role in the wound healing process
locked in syndrome
completely awake and cognitavely intact with no abnormality of consciousness, they are unable to move extremeties and most of face, limited to vertical eye movements or blinking, large lesions of brainstem particularly base of pons such as with thrombotic stroke to basilar artery
genetic allotypes markers on Ig molecules
can be helpful in paternity cases Ig1 Ig2 Ig3 heavy chains,
response to specific antigens
low T3 syndrome
"euthyroid sick syndrome" occurs with systemic illnesses or problems, characterised by decreased in 5'-monodeiodinase activity in peripheral tissues leading to decreased T4-->T3 conversion, also see increased rT3 since 5'-monoiodo converts rT3 to inactive 3.3'-diiodothyronine
acute myelocytic without differentiation
acute myelocytic with differentiation, may see eosinophils
acute myeloblastic leukemia (monocytic), detect with fluoride-sensitive esterase reaction
vaginal candidiasis
histo form
ringworm (tinea)
carpal tunnel borders
flexor retinaculum anteriorly, carpal bones posteriorly
carpal tunnel contents
4 tendons of flexor dig super, 4 tendons of flexor dig profundus, 1 tendon from flexor pollicus longus, median nerve
percentage of patients with ischemic heart diesease that present with sudden death
beta 2 agonist for acute asthma
immunosuppressive of choice for liver transplant
viral packaging inhibited by
early viral protein synthesis inhibited by
ifn alpha major side effect
non-nucleoside inhibitors
never ever deliver nucleosides: vevirapine, efavirenz, delavirdine
inhibits cell wall by blocking peptidoglycan synthesis
HIV med to decrease risk of maternal-fetal trans
zidovudine (AZT)
inactivation of drugs by phosphorylation
inactiavation by altering ribosome binding site
tetracyclines, chloramphenicol, macrolides
active efflux for resistance
reduced permeability for resistance
first line tx of non MR Staph aureus
cefazolin (first generation cephalo)
filgrastim vs argramostim
abnormal phosphorylation of tau
neurofibrillary tangles (intracytoplasmic inclusions) known as paired helical fragments PHFs
abnormal degradation of APP
formation of Abeta amyloid
hypnopompic hallucination
hallucination upon waking
hypnagogic hallucination
hallucination upon going to sleep
grief vs depression
marked funcitonal impairment after a few months
acts via vagal afferent pathways to stimulate somatostatin inhibition of gastric acid secretion, block CCK--> increased gastric acid secretion, stimulates pancreatic amylase, stimulated pancreatic lipase
werdnig hoffman
spinal muscle atrophy type I, disease of anterior horn cells, see lower motor neuron disease (such as fibrillation potentials on EMG) and fasciculations, die after a year
visualization of chlamydia in cells
iodine, Giemsa, or fluorescent Ab stains
pleomorphic gram negative rods
hemophilus dureyi, causes chancroid
chancroid is painful
chancre is not (primary syphils)
centriacinar emphysema
tobacco and coal dust
panacinar emphysema
alpha 1 antitrypsin
paraseptal emphysema
associated with scaring, may lead to spontaneous pneumothorax
splenectomized patients have low
IgG2 and IgM leading to susceptibility with encapsulated organisms
reason why histo is not communicable person to person
because it is intracellular
alpha actinin
bindds actin microfilaments in networks
moves towards the plus end
moves toward miuns end
sarcomere structure of striated muscle
nitrogen mustard (subcategory of alkylating agent) used for the treatment of CLL and ovarian carcinoma and hodgkins and other lymphomas
lateral nucleus of hypothalamus
destruction results in starvation
gets input from the retina and secretes melotonin for circadian rhythms
first site of change in duchenne's
first site of change in myotonic dystrophy
first site of change in FSH dystrophy
facial and jaw
polyostotic fibrous dysplasia findings
local bony defects containing unmineralized whorls of connective tissue
stop codons
converge but cant adduct eye on lateral gaze
internuclear ophthalmoplegia (INO) from lesion to MLF
sturma ovarii
monodermal teratoma results in increased thyroid hormone and resultant decrese in TSH
RNA pol I
RNA pol II
mRNA, snRNA, miRNA
laron dwarfism
congenital absence of growth hormone receptors, since growth hormone binding protein is the extracellular portion of the receptor, see low levels of GHBP, get low concentration of IGF-1 because there are no GH receptors on hepatocytes
nystatin mechanism of action
like amphotericin B, to punch holes in the membrane
terbinafine MOA
blocks ergosterol synthesis
flucytosine MOA
interferes with thymidylate synthetase
inulin measures
extracellular fluid volume
interstitial volume equals
ECF volume - plasma volume
marker of primitive lymphocytic cells
terminal deoxynucleotidyl transferase (Tdt) the enzyme that is active during VDJ rearrangement of the heavy chain
presence of cytoplasmic mu chains
implies successful VDJ heavy chain rearrangement
type II antiarrhythmic
decreases SA node automaticity, increase AV nodal refractoriness, and decreases AV nodal conduction velocity
lidocaine indication
treatment of acute management of ventricular arrhythmias that occur during periods of cardiac ischemia
pseudomonas alpha toxin
inhibits protein synthesis by acting on EF2 such as with diphtheria toxin, pseudomonas toxin targets liver, diphtheria toxin targets neurons and heart
diabetic foot ulcer bacteria
anthrax toxin
adenylate cyclase causes fluid loss from cells
cholera toxin
increases adenylate cyclase activity by ribosylation of GTP-binding protein
E coli labile toxin
similar to cholera toxin
pertussis toxin
fluid loss by Gi ribosylation
strep erythrogenic toxin
similar to diphtheria via increased cytokines
activates PDH
increased pyruvate concentration
transmembrane linker protein in tight juction that separate apical from basolateral membranes and apical fluid from interstitial fluid but do not provide strong attachments
tumor like submucosal nodules of the tongue
seen in some cases of amyloidosis which more commonly affects the intestines than other places in the GI tract
type II Arnold-Chiari malformatoin
parts of hinbrain, cerebellar vermis, and fourth ventricle herniate into the foramen, commonly associated with meningomyeloceles
severe cleft in brain that allows the ventricles to communicate with the subarachnoid space
most common type of ASD
ostium secundum type
ASD in downs
ostium primum type - often includes MV or TV malformations and result in left to right shunts with late cyanosis
antiarrhythmic to decrease conduction through AV node
digoxin (indicated for treatment of atrial fibrillation especially with elevated ventricular rate)
quinidine autonomic side effect
anticholinergic effect that would increase AV conduction velocity, usually is indicated for conversion of Afib/flutter
brain structures
head to toe: telencephalon (verebral hemispheres and BG and lateral ventricles), diencephalon (thalamus et al), mesencephalon (midbrain), metencephalon (pons and cerebellum), myelencephalon (medulla and fourth ventricle),
teratogenicity of mumps
aqueductal stenosis causing proximal ventricular enlargment and noncommunicating hydrocephalus, cerebral aqueduct is in the midbrain (mesencephalon)
X linked dominant disease
hypophosphatemic rickets: abnormal regulation of vit D3 metabolism and defects in renal tubular phosphate transport, growth retard, osteomalacia, rickets
copper poisoning
second gen cephalo for gram positive and negative
wiskott aldridge comorbidity
12% chance of developing NHL
brush border in kidney
proximal tubule
wound contraction
replicates in cytoplasm so much have its own DNA dependent RNA polymerase, cause of molluscum contagiosum
guarnieri bodies
intracytoplasmic factories for DNA replication
median entry into forearm
between the two heads of the pronator teres
polymerase restricted to nuleolus
pol I for rRNA transcription
intercostal space structures
from top to bottom: vein, artery, nerve (VAN drives down)
cushing disease from pituitary vs ectopic tumor
ectopic tumor ACTH secretion not usually depressed by dexamethasone administration
partial agonist/antagonist and tryptaminergic, dopaminergic, and alpha-adrenergic receptors, treatment of vascular headaches
blocks the action of serotonin and used for prevention of vascular headaches
HACEK bacteria
cause endocarditis: haemophilus aphrophilus, actinobacillus, cardiobacerium, Eikenella, Kingella
oocyte arrested / ovum arrested
prophase / metaphase
warfarin SE
may cuse necrosis of skin bw third and tenth day of therapy, depletion of protein C leads to hypercoaguability in skin
multiple drug resistance plasmids
pengastrin-stimulated calcitonin secretion
marker for medullary carcinoma of thyroid in MEN II
opioid receptor for diarrhea, combined with atropine to decrease abuse potential
"I" antigen
antigen in mycoplasma IgM cold agglutination
reversibly bind to 50S subunit
lincosamides (clindamycin)
irreversibly bind to 50s subunit
superior gluteal nerve
innervates gluteus medius and minimus which allow people to maintain balance with one foot on the ground
first and second sacral nerves
piriformis innfervation (lateral rotator of thigh and hip)
type I Arnold-Chiari malformation
cerebellar tonsils through the foramen magnum, frequently asymptomatic and incidental autopsy finding
Erb palsy in infants
C5-C6, baby delivered in breech position, loss of abductors and external rotators, loss of flexion and supinatino at the biceps causes the phenotype
phenotype of pemphigus vuglaris versus bullous pemphigoid
PV: widespread painful blisters on skin and oropharynx BP: widespread blistering with pruritis sparing the oral mucosa
s pneumo acquisition of penicillin resistance
rapid clinical course of dementia and neuro probs
creutzfeld-jacob disease
dementia with lewy bodies
lewy bodies in the SN, limbic cortex, subcortical nuclei (like basal nucleus of meynert)
binswanger dz
rarefaction of cerebral white matter caused by HTN-related arteriolosclerosis
PSA usefulness
doesn’t necessarily distinguish BPH from cancer, when cancer is known use to follow tumor progression
urogenital sinus male
urinary bladder, prostatic urethra, prostate, membranous urethra, bulbourethral glands, penile urethra, littre's glands
urogenital sinus female
urinary bladder, urethra, urethral glands, paraurethral glands, vestibule of vagina, greater vestibular glands
corpus spongiosum
singular structure that surrounds the urethra
corpus cavernosum
paired structure superior to corpus spongiosum
vascular rarefaction
loss of capillaries and other blood vessels in muscle with prolongued low metabolic rate (as in a cast)
alkylating agent commonly used in hodgkins disase tx most notable SE are delayed myelosuppression and pulmonary toxicity
cubital tunnel syndrome
paresthesias and numbness in ulnar side due to ulnar compression
monosodium urate crystals (gout)
needle-shaped, yellow when parallel to polarizer (negatively birefringent), blue when perpendicular to polarizer
calcium pyrophosphate crystals (pseudogout)
rhomboid shaped, blue when parallel (positively birefringent), and yellow when perpendicular
positively birefringent
"positively parallel blue"
granulomatous disease, associated with cattle, septic abortion, undulant fevers, can cuase endocarditis (aortic valve), petechiae, visual blurring
covers microvilli to prevent trauma
basal and reticular lamina
components fo the basement membrane
endemic typhus
rickettsia typhi - feces of the rat flea, rat reservoir
epidemic typhus
tickettsia prowazaki - body louse, humans and flying squirrel reservoir
Q fever
coxiella burnetti - acquired by inhalation
rocky mountain spotted fever
rickettsia rickettsi - tick transfer, tick is reservoir
scrub typhus
rickettsia tsutsugamushi - southeast asia, mites transmit, mites and rodents are reservoirs
ITP treatment
immunosuppressants and splenectomy
chorion and amnion
chorion forms before the amnion, so cant have more chorions than amnions, but monochorion with monoamnion or diamnion is possible in identicle twins, having two chorions necessitates two amnions: dichorionic diamnionic is either identical or fraternal twins: fraternal twins must be dichorionic
cicumvallate placenta
extrachorial portion outside insertion of amnionic membranes creating a circumferential groove (vallum), no clinical significance
bipartit placenta
composed of two equal segments, no clinical significance
accelerated idioventricular rhythm
latent pacemaker in ventricles --> accelerated regular rate, unusual QRS, no related p waves
accelerated junctional rhythm
P waves inverted and may be anywhere within regular QRS complexes which occur regularly at rate 60-150
premature ventricular contraction
ectopic ventricular pacemaker inserts an ectopic beat, wide, bizarre QRS
wide and bizarre but recognizable QRS complexes
vfib tx
CPR, defib, IV and intracardiac drugs: epinephrine, lidocaine, procainamide
composed of tuberculin (outer surface protein) and mycolic acid of TB
order of transfer of Hfr
from OriT to tra, closest to oriT (furthest from tra) most likely to be transferred
HPV infects which layer
the bsal layer and causes warts and increasing number of prickle cells, causing skin thickening and epithelial spikes to form
HPV in skin
infection at basal, replication in spinosum, maturation in granulosum and lucidum, release from corneum
lipid precursor to which sugars are added to form gangliosides and galactocerebrosides
dermatan sulfate
glycosaminoglycan involved in formation of proteoglycans
hyaluronic acid
glycosaminoglycan involved in formation of proteoglycans
aneurysm of aortic root
paramyxovirus avoidance of Ab
via spread from cell to cell via syncytia formation
OD on TCA risk
metastatic calcification
think hypercalcemia: hyperparathyroid/thyroidism, addisons disease, chronic renal failur, bone destruction (leukemia, mets, MM)
gonnococcus and joints
monoarticular acute onset arthritis, may see disseminated symptoms, may see skin lesions, may also see migratory arthralgia and tenosynovitis
tinea corporis
ring worm ,often contracted from playing with a cat, treat with an antifungal (azole) cream
antipruritic cream
anti-infective agent for topical treatment of impetigo
obstructive sleep apnea tx
adenotonsillectomy because of adenotonsillar hypertrophy
triazolam (halcion)
combination with behavioral therapy for insomnia
often cause acanthosis nigricans
adenocarcinomas of chest or abdomen
posterior herniation of the nucleus pulposus
most common type of herniation, results in occulsion of intervertebral foramen, spinal nerve between C4 and C5 is C5 spinal nerve
anterior and posterior rami
found lateral to intervertebral foramina
sarcoma botyroides
malignant tumor affects kids usually and is a grape like mass that protrudes from the vagina, neoplastic cells are of skeletal muscle origin
splenorenal ligament
connects spleen to posterior abdominal wall and contains splenic artery and vein
closed and open angle glaucoma
in closed angle claucoma have increased IOP secondary to closure of a preexisting narrow anterior chamber angle,closed angle tx: single dose of acetazolamid followed by oral dose, for open angle tx: CA inhibitor, epinephrine, latanopros (prostaglandin F2), timolol
femoral ring
bounded medially by lacunar ligament and femoral vein laterally, by pubis posteriorly and inguinal ligament anteriorly
rib innervation
intercostal nerve (anterior ramus of the thoracic spinal nerve) after passing angle of the rib it occupies the lower portion of the rib in the costal groove, so inject anesthetic medial to the angle of the rib
associated with tuberous sclerosis
Hfe gene in hemochrom
tightly linked to HLA A3
virilization in male fetus
hCG causes testosterone release from leydig cells for first half of pregnancy, in second half LH from the fetal pituitary is required for continued growth
can be caused by lack of progesterone response to unchecked estrogen, admin and withdrawal of progesterone to check
from face to brain
cavernous sinus as with mucor (think diabetics)
left sided neglect
most often due to parietal lobe damage on the right side
bence jones proteins
kappa light chains
ostium secundum ASD
most common, symptoms absent until later on, systolic ejection murmur from increased right sided volumes, fixed splitting
AV septum
physical separation of the two AV valves, lack of this causes endocardial cushion defects
septum primum
begins septation of the atria with downward growth, the orifice that remains is the ostium primum
ostium secundum
forms in the septum primum after the endocardial cushions have fused with the septum primum
septum secundum
grows downwward and together with the flap of the ostium primum forms the foramen ovale
weak area of internal inguinal ring
transversalis fascia which forms the posterior wall of the inguinal canal with the conjoined tendon
benign essential tremor tx
propranalol (any non-selective beta blocker)
nucleotide excision repair
inability to repair thymine dimers
metastatic potential of carcinoid
site and size (appendix and cecum rarely metastasize to the liver), those of the stomach, ileum, and colon more likely, esp if greater than 2cm in diameter
growth on mannitol
staph aureus
contributes to umbilical cord and placenta
cloacal membrane
persistance causes imperforate anus (covers hindgut)
nucleus pulposis
prechordal plate
buccopharyngeal membrane (cranial end of foregut)
docusate (Colace)
stool softener
muscarinic antagonist used in parkinsons - get anticholinergic side effects
menke's disease
depigmented lustless hair, facial ocular vascular and cerebral manifestations (like seizures), copper deficiency similar to wilsons
chromosome 15 del
prader willi (paternal deletion) or angelman (maternal deletion)
treatment of choice for HACEK
ceftriaxone: SE: eosinophilia, thrombocytosis, leukopenia
erythema multiforme and Stevens johnson pathog
immune complex deposition at the dermal blood vessels
clubbing and hypertrophic pulmonary osteoarthropathy
associated with bronchogenic carcinoma, benign mesothelioma, and diaphragmatic neurilemmoma
hyperplastic low functioning leydig cells cause decreased testosterone and subsequently increased LH which in turn causes increased estrogen secretion
NADPH oxidase
production of H2O2
debranching enzyme releases
free glucose, nonbranched glycogen doesn’t release free Glc
responsible for excitotoxic effects of glumatate
NMDA channel, voltage and ligand gates
ligand gated glutamate channel
AMPA and kainate receptors (both cation channels)
stains gram negatives red
stains acid fast organisms red
crystal violet
stains gram positives blue
methylene blue
secondary stain in acid fast (stains non-acid fast organsisms)
RET proto-oncogene
growth factor receptor
anti-Pol I
marder for diffuse scleroderma
location of Penicillin BP
in the plamsa membrane
staph alpha toxin
pore-forming toxin
pertussis toxin
ribosylates Gi thereby stopping inhibtion of AC--> increased cAMP
EHEC, same mechanism of shiga toxin (60S subunit)
sealing strands
found in tight junctions
von gierke's disease
hypoglycemia, hyperlipidemia, lactic acidosis, ketosis
HbA1c affected by
RBC turnover, low turnover (disproportionately high number of old cells) --> high A1c levels, see this in folate/B12 def
CO poisoning
hypoxia, cherry red lips
chronic lead poisoning
anemia with basophilic stipling, neuropathy, ab pain
chronic mercury poisoning
CNS atrophy, gingivitis, gastritis, renal tubular changes
site of collagen helical formation
RER and golgi apparatus get triple helix self-assembly
cleavage and crosslinking of collagen occur
in the extracellular space
reperfusion injury
free radical damage
unconscious adoptino of the characteristics or activities of another person, used to reduce pain of loss
diversion of unacceptable impulses into acceptable outlets
loop diuretic
alternative pathway of complement
turned on by the surfaces of bacteria, Factor B is an activator protein in this pathway
most abundant complement protein
C3-->C3a (anaphylaxotoxin) and C3b (opsonin and clearance of IC)
classical complement pathway
activated by Ig (C1q binds IgG heavy chain)
AA protein as in RA
represents an enzymatically degraded form of SAA (serum amyloid-associated) protein hich is made in the liver
"cytotoxic disease"
type II hypersensitivity is a form
atopic disease
type I hypersensitivity
contraction alkalosis
loss of ECF with diuretics preferentially loses Na+ and Cl- not HCO3- so you get a proportional increase in HCO3 and thus alkalosis
reiter's (reactive arthritis)
conjunctivitis, arthritis, keatoderma blennorrhagica (papulosquamous skin rash on palms and soles), urethritis, circinate balanitis, occasionally aortitis
osteomyelitis stuff
IVDU = pseudomonas; chronic UTI = staph auresu; multiple sex partners = gonorrhoeae; sickle cell = salmonella; TB = vertebral osteomyelitis (potts)
marker of transmissibility - disappears after a few months
alpha 1 and beta 1 activity, very little beta 2 activity
verapamil and heart failure
verapamil has been associated with exacerbated CHF due to strong negative ionotropic effect
amlodipine and felodipine
most commonly used Ca channel blockers in patients with CHF
iron and the heart
hemochromatosis in heart can lead to cardiac failure
digoxin and WPW Syndrome
can lead to ventricular fibrillation via enhancing accessory conduction pathways
right dominant heart circulation
posterior descending branch originates from RCA which gives rise to the posterior interventricular septum
left dominant heart circulation
posterior descending branch originates from left circumflex a
MV prolapase gender bias
more women than men
fragile X syndrome cardiac comorbidity
MV prolapse and aortic root diilatation (may result in regurgitation)
class IB antiarrhythmics
lidocaine, tocainide, mexiletine
resporption of distal clavicles
scalloping of vertebral bodies
secondary to aortic aneurysm
graft vascular disease
develops years after transplantation and is due to intimal thickening of the coronary arteries without associated atheroma formation of significant inflammation, cannot be prevented with current immunosuppressive therapy
hyaline vs hyperplastic arteriosclerosis
hyaline associated with benign htn vs hyperplastic associated with malignant htn that results in onion-skinning
diabetic ketoacidosis
hypokalemia, hypophosphatemia, negative sodium balance (glycosuria causes increased excretion of sodium in the urine)
fascia where thyroid lies
pretrachial fascia
daycare center diarrhea
shigella if bloody, yersinia enterocolitica also
yersinia enterocolitica
diarrhea (may be bloody in severe cases), vomiting may be present, pseudoappendicitis, reactive arethritis, erythema nodosum, septicemia
salmonella vs shigella
salmonella has slower onset and more pronounced systemic symptoms
intussesception vs volvulus age groups
volvulus more likely in eldery, intussusception in young
tropical sprue vs celiac sprue anatomy
tropicalsprue is entire small bowel, celiac is proximal small bowel only
blind loop syndrome
obstruction causes bacteria buildup and malnutrition due to bacterial activity
calcium absorption
at the ileum
most common outcome of hep B
subclinical disease followed by complete recovery>acute (most recover)>healthy carriers>chronic infection
from muscular or neurological disorders like stroke, ALS, muscular dystrophy or MG, cough hoarseness nasal regurgitation
acts on crypt cells in intestine
Muscles of mastication
backward movement of jaw
depress lower jaw
lateral pterygoid
move lower jaw forward
depress lower jaw
medial pterygoid
elevate lower jaw
carcinoma of pancreas
very dilated biliary tree terminating in a blunt, nipple like obstruction at the lower end of the common bile duct
gallstone becomes lodged in bile duct leading to charcot triad
charcot triad
RUQ pain, fever, jaundice indicative of cholangitis
stones in gallbladd or cystic duct
do not cause jaundice
stones in cystic duct
febrile, unrelenting RUQ pain and tenderness ,leukocytosis, mild elevations in bilirubin (flow of bile is not impeded)
stones in common duct
cause colicky pain and jaundice (flow of bile impeded)
potentiate secretin-mediate bircarb secretion:
CCK and Ach, but these do not cause bicarb secretion alone
anticholinergic to alleviate postprandial pain in IBS
5-ASA derivative for UC, not drug of choice for flare ups
tumors that cause erythrocytosis
renal cell carcinoma, hepatocellular carcinoma, meningioma, pheochromocytoma, cerebellar hemangioblastoma, adrenal adenoma
eosinophilia in asthma
mediated by IL-5
neutrophilic leukocytosis
mediated by IL-1 and TNF
defects of platelet vesicle release or secondary aggregation
due to storage pool disease and aspirin use
storage pool disease
clawing of ring, forefinger, and little fingers
ulnar nerve lesion
DMD cardiac comorbidity
dilated cardiomyopathy and conduction abnormalities
myotonic dystrophy
trinucleotide expansion
myositis ossificans
ossification following healing in site of muscle trauma, typically in athletic adolescents and young adults
involvement of cervical spine in RA
up to 80% of patients, 25% in atlanto-axial joint, if large amount of subluxation is present then might get quadraplegia and even sudden death
ankhylosing spondylitis complications
AV block, bladder and bowel problems, uveitis, pulmonary fibrosis, psoriasis, IBD
lytic and blastic lesions in bone
breast cancer mets
lytic lesions in bone
kidney, lung, and thyroid cancer mets
muscle innervated by superficial peroneal nerve
peroneus longus, suspect injury when you lose sensation in the dorsum of the foot
skeletal muscle relaxants
centrally acting, structurally related to TCAs, strong anticholinergic side effect profile
centrally acting, inhibition of monsynaptic and polysynaptic reflexes at the spinal level
general CNS depressant
selective cox 2 inhibitor
COX-2 inhibitor and sulfa drug
centrally acting analgesic compound with action at mu opiate receptor, doesn’t cause much respiratory depression, use for moderate to severe pain
dorsal interosseus
abductors of fingers
palmar interosseus
adductors of fingers
most common site for embryonal rhabdomyosarcoma
head and nexk, other sites include GU tract (such as sarcoma botyroides) and extremeties
primary osteoporosis
postmenopausal women
secondary osteoporosis
other causes
myasthenia gravis autoantibodies
anti-nAChR, anti MuSK (muscle specific kinase) in a secondary form which results in decreased NMJ patency
MG exacerbated by antibiotic:
aminoglycosides which have curare like side effects
osteomalacia bone histology
seams of uncalcified osteoid increased osteoblasts
paget dz bone histology
thickening of bony trabeculae with irregularly arranged cement lines (mosaic pattern)
unicameral bone cyst
a long bone contains a cystic space filled with fluid lined with connective tissue granulation tissue collagen and histiocytes
hyperphosphatemia effect on vitamin D
directly inhibits the production of 1,25 dihyrdoycholecalciferol
posterior tibial artery
feeds posterior leg and plantar foot
neurotransmitter for induction of REM sleep
oculomotor nerve
innervates levator palpebrae superioris - elevates the eyelid; oculomotor lso has parasympathetic fibers that synpse in ciliary ganglion to innervate the sphincter pupillae muscle which constricts the pupil - lesion of this causes eyelid drooping and mydriasis
pathognomonic for INO
inability to adduct the right eye on left lateral gaze
stroke in endocarditis
PARIETAL LOBE --> may result in spatial recognition problems
triad of: nuchal rigidity, photophobia, headache
herpes simplex encephalitis
subacute onset with meningismus, headache, personality changes
Cranial Nerve Nuclei
medial nuclei
lateral nuclei
axillary nerve innervation
deltoid and teres minor muscles
DRG contain
nerve cell bodies of primary sensory afferents for proprioception, discriminative touch, and vibration, send axons up ipsilateral dorsal column
primary afferents for pain and temp
cell body in DRG, synapse in ipsilateral dorsal hron, cross in the anterior white commissure, ascend in the contralateral spinothalamic tract
multinucleated giant cells in brain
HIV encephalitis
CMV in brain
tropism for ependymal cells (seen in ependymal and periventricular locations)
vacuolar myelopathy
degeneration of of posterior columns and LCST
site of most arachnoid cysts
sylvian fissure
sylvian fissure
lateral fissure (as opposed to central fissure separating parietal from frontal lobes)
jamais vu
failure to recognize famiiar events that have been encountered before
appendicular ataxia
cerebellar hemispheres
truncal ataxia
cerebellar vermis
inability to recognize faces, bilateral lesion of visual association cortex
deficit of cognition in ones own illness, lesions in nondominant parietal lobe
ganser syndrome
giving approximate answers instead of exact ones, most commonly seen in prison inmates
central chromatolysis
loss of histological staining in lower motor neurons whose axons have been damaged as by injury to ventral roots
lewy body composition
salivation innervation
chorda tympani from VII controls salivation from submandibular and sublingual glands, parotid gland is IX
lacrimal gland
nuclear factor used to measure neoplastic replicative activity