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Which hormones (and from where) control the synthesis and release of cortisol?

CRH (from hypothalamus) > ACTH (anterior pituitary) > Cortisol (Adrenal Cortex)


What is cortisol? What are the effects of its release? Which drug administered by EMS mimics the effect of cortisol?

Cortisol is a glucocorticoid.
The effect of cortisol is called the “glucose sparing effect”. An increase in glucose storage in the form of glycogen.
Solu-medrol is the drug that mimics the effects of cortisol.


Which type of hypersensitivity is associated with anaphylaxis?

The type of hypersensitivity associated with anaphylaxis is Type 1. Type 1 is immediate hypersensitivity .Rapid / serve response to presence of antigen.


Which type of immunoglobulin is associated with response to allergens?

*IgE is bound to surfaces of MAST cells and basophils , stimulate release of histamine and other chemicals, accelerates inflammation.


If this patient is displaying severe symptoms, is it likely a first exposure or a second exposure? Why?

Secondary exposure response to the antigen in question. The first exposure resulted in the sensitization of B-cells, which caused an increase in circulating IgE immunoglobulins. However the response is too slow to cause noticeable effects. The second time however, since all of the antibodies and B-cells are all in place, causes an extreme response to the entry to allergens, causing anaphylaxis.


Which structure is responsible for the production of cortisol?

Adrenal Cortex


Which drug administered by EMS should be given first when severe anaphylaxis presents? Where in the body is the analog to this drug synthesized?

Adrenal medulla


What are the stages of the uterine cycle? How do they correspond with the best time to get pregnant?

1) Menses (1-7)
2) Proliferation phase(7-14)
3) Secretory phase(14-28)


Skeletal system

Bones, Cartilage, joints, ligaments


Long bone components

Proximal diaphysis
Distal diaphysis


Closure of epiphyseal plate

*At puberty
* Increased GNRH > Increased FSH/LH > Increased estrogen/ testosterone
* increased rate of bone formation relative to cartilage


Maternal changes during pregnancy

1) Increased RR and Tidal Volume
2) Increased Blood Volume by 50% by end of gestation
3) Increased requirement for nutrients and vitamins by 10-30%
4) Increased GFR by 50%
5) Increased size of uterus and mammary glands


Labor contractions

1)Fetal growth
2) Fetal release of oxytocin
3) maternal release of oxytocin
4) increased prostaglandin production
5) Labor contractions
6) Positive Feedback


Stages of delivery

1) Dilation
2) Expulsion
3) Placental


Post natal development

1) Neonatal Period > Birth > 1month
*Passing through the birth canal squeezes fluid out of lungs
*A powerful inhalation is required to fill thoracic with air
*Changes in thoracic pressure shift to high pressure L heart > leads to closing of fomeamen ovale and ductus arteriousus (within 48hrs)
*Digestive system releases meconium (bile, mucous, epithelial cells)
* Infant can't keep warm
* Colostrum = mammary glands release
-Contain protein, AB, 2-3 days post birth


Fetal circulation

Fetal circulation is almost the opposite of adult circulation. Artery flow in adults carry oxygenated blood away from the heart and in fetal circulation it carries non oxygenated blood away from the fetal heart. Veins in adults carry non oxygenated blood towards the heart and in fetal the veins carry oxygenated blood back to the heart. Gas exchange in adults take place in the lung and in fetal take place in the placenta. Thoracic pressure in adults have increase pressure on the left side of the heart and in fetal they have increase pressure on the right side of the heart.


Hemolytic disease in a new born is only a problem is the mother is



Hemolytic disease can also be a problem if fetus

Is RH+ and mom is RH-


4 types of immunity

1) Active naturally acquired - environmental exposure(bacteria or virus)
2)Active Induced(artificial) acquired - vaccine, 3)passive naturally acquired - mom to fetus
4) passive induced(artificial )- antibiotic .


The role of Ca2+ in muscle contraction

Calcium binds to troponin, causes tropomyosin to move off of actin binding site for myosin - allows for cross-bridge formation. Calcium is released from the sarcoplasmic reticulum and enters from ECF through T-tubules.


Why to use a non depolarizing agent (Roc or Vec)

1)depolarizing agents affect all skeletal muscle at the same time - which is different than normal muscle functioning
2) the ion shift specifically includes efflux of potassium which can take a patient who is already hyperkalemic and put them in a lethal range for plasma potassium
3) non-depolarizing agents function as antagonists - which means they do not cause depolarization but still cause paralysis


ACHE (Acetylcholinesterae)

Breaks down ACH


Actions that stimulate a muscle fiber

1) Somatic motor neuron = release of AcH - binds to nicotinic AcH-R on motor end plate
2) Na+ channels open ...depolarization of sacrolemma