3 star items Flashcards by Daniel Coquyt

Forebrain development

Prosencephalons –>
A. Telencephalon –> Cerebral hemispheres
B. Diencephalon –> thalamus

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Midbrain development

Mesencephalon –> midbrain

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Hindbrain development

Rhombencephalon –>
A. Metencephalon–> cerebellum, pons
B. Myelencephalon –> medulla

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Anterior hypothalamus nuclei

Anterior: thermoregulation (cooling) think AC - damage –> hyperthermia

Suprachiasmatic: circadian rhythms

Pre optic area: secretes GnRH

Supraoptic: secretes ADH, damage –> central DI

Paraventricular: secretes oxytocin, CRH, TRH

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Tuberal hypothalamus nuclei

Arcuate: secretes GHRH, dopamine, pulsatile GnRH secretion, regulates appetite

Lateral: Regulates hunger, inhibited by Leptin; damage –> anorexia, wt loss

Ventromedial: regulates satiety, stimulated by leptin; damage –> obesity, savage behavior

Dorsomedial: regulates hunger, stimulation –> obesity, savage behavior

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Posterior hypothalamus nuclei

Posterior: Thermoregulation - warming; damage –> hypothermia

Mammillary: memory; damage –> Wernicke-Korsakoff syndrome

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Acetylcholine Synthesis

Choline acetyltransferase combines Choline + Acetyl CoA forming ACh

(Enzyme blocked by Vesamicol, can’t back ACh into vesicle)

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Draw ACh neurotransmission

page 129

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Draw out Phenylalanine to Epinephrine pathway

page 130

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Draw NE neurotransmission

page 130

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Causes of early cyanosis

Persistent truncus arteriosis
Transposition of the great vessels
Tricuspid atresia
Tetraology of Fallot
Total anomalous pulmonary venous return

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Atrial fibrillation

Irregularly irregular, no p waves

Sx: tachycardia, SOB, fluttering in chest, angina

Cause: left atrial dilation caused by HTN, CVD, HF

Risk clots, PE, stroke, emboli

Tx: new less than 48 hours - synchronized cardioversion
Older than 48 hours - anticoagulation

If asx: digoxin, b-blocker, CCB for rate control
If young and sx: rhythm control - sotalol, amiodarone, flecaimide

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Atrial flutter on EKG

saw tooth pattern

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First degree AV block on EKG

prolonged PR interval, greater than 1 big box

Likely to go to second degree

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Second degree (Mobitz I) AV block on EKG

“Wenckebach”

progressive lengthening of PR before dropping beat

asx, benign

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Second degree (Mobitz II) AV block on EKG

no precursor warning of dropped QRS
can progress to 3rd degree block

tx: pacemaker

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What bacteria is associated with causing AV nodal block?

Borrelia burgdorferi - Lyme dz

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Third degree AV block on EKG

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Atria and ventricles beat independently

2/3 are narrow, 1/3 wide QRS

tx: pacemaker

Wolff-Parkinson-White (WPW)

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Bundle of Kent, or other, accessory conduction pathway bypasses AV node causing delta wave

can cause reentry SVT

Tx: procainamide or amiodarone
no adenosine when kicks into SVT

definitive tx: ablate pathway

Paroxysmal SVT

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at or above AV node

narrow QRS

Premature ventricular contractions

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early occurring
widen QRS - bizarre, often notched, greater than 4 boxes
microentry - purkinje fibers

signal originating below AV

Ventricular bigeminy vs trigeminy

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bigeminy: PVC after each sinus beat
trigeminy: 2 sinus beats followed by a PVC

Ventricular escape rhythm

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failure of SA/AV node

absent p wave, slow

junctional escape rhythm

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AV node is the pacemaker

Monomorphic VT

wide QRS, >100/min non sustained less than 30 sec sustained greater than 30 sec can lead to hemodynamic collapse shock them

Torsades de pointes

shifting sinusoidal waves - amplitude changes lead to v-fib (no identifiable waves, hemodynamic collapse, defibrillate and do CPR) tx w/ Mg2+ push

Rotator Cuff Muscles

SItS: Supraspinatus (first 10-15 degrees of abduction, test with empty can test, positive = pain and weakness) Infraspinatus - external (lateral) rotation teres minor - external (lateral) rotation Subscapularis - internal (medial) rotation

What structures can be damaged with anterior shoulder dislocation?

Axillary nerve (test sensation of deltoid before and after reduction) Posterior circumflex artery Supraspinatus tendon Anterior glenohumoral ligaments and glenoid labrum separation from articular surface of anterior glenoid neck - Bankart Lesion Posterolateral humeral head defect - impact against anterior rim of glenoid - Hill-Sachs lesion

Osteoarthritis presentation

wear and tear dz - articular cartilage --> eburnation, osteophytes Bouchard's nodes - osteophytes of PIP Heberden's nodes - osteophytes of DIP Fingers, knees, hips, spine Cause: age, obesity, joint trauma - repetitive use Pain in joint AFTER use Noninflammatory, no systemic sx

Treatment of OA

Acetaminophen - scheduled more effective, COX inhibitor NSAIDs COX-2I topical capsaicin cream Intraairticular glucocorticoid injections once every 4-6 mo Intraairticular hyaluronan injections Opioids - risk of falls/fractures in elderly Tramadol Joint replacement

NSAIDs drugs used to tx OA

Aspirin - irreversible inhibitor of COX1 SE: GI bleeds, ulcers, tinnitus, hyperventilation, acute renal failure ``` Diclofenac Ibuprofen Indomethacin Meloxicam - COX2 more selective Nabumetone Naproxen ``` COX-1/2 inhibitors SE: acute renal failure, acute interstitial nephritis, fluid retention, aplastic anemia MC: Gi upset

Zonula occludens

tight junctions | claudins, occludens

Zona adheres

intermediate junctions -basal layer link actin cytoskeleton of neighboring cells -e-cadherins (Ca2+ dependent)

Macula adherens

desmosome desmoglein resist shearing forces simple and stratified epithelium, muscle cells

gap junctions

cardiac cells

Hemidesmosomes

connect to BM | integrins

HLA-B27

seronegative spondyloarthropathies | "PAIR"

HLA-DR3, -DR4

T1DM - autoimmune destruction of beta cells

Branches of Celiac Trunk

1. Left gastric A. 2. Splenic A. - large, tortuous 3. Common hepatic a. a. gastroduodenal a. - -i. right gastro-omental A to greater curvature - -ii. anterior superior pancreaticoduodenal a. to anterior head of pancreas and proximal duodenum b. right gastric a. c. proper hepatic a. - -i. right hepatic - ---a. cystic a - -ii. left hepatic

Physiologic Dead space

anatomical dead space - air in airways Functional dead space (e.g. apices) -capable of gas exchange but no gas exchange occurs Vd = Vt x (PaCO2 - PexpCO2)/PaCO2 dead space = tidal volume x percent of tidal volume in dead space

Label lung volumes diagram

page 452

Draw Out Coronary Artery Anatomy

Page 209 ``` Right coronary A branches: -SA nodal branch -R. marginal branch of RCA -80% AV nodal branch, Posterior interventricular branch “right dominant” ``` Left coronary A branches: -Anterior interventricular branch (aka LAD) -Circumflex branch of LCA -20% AV nodal/Posterior interventricular branch off circumflex “left dominant”

Potter sequence

Failure of ureteric bud to develop -> b/l renal agenesis ``` “POTTER” Pulmonary hypoplasia Oligohydramnios Twisted skin Twisted face Extremity deformities Renal agenesis ```

Horseshoe kidney

Inferior pole fuses -> U shape Stuck on IMA – low in abdomen Assoc w/ turners syndrome

3 star items Flashcards

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