March 27 - Odds and Ends Flashcards Preview

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Flashcards in March 27 - Odds and Ends Deck (64):
1

Hypogastric nerve

Carries sympathetic fibers from T10 to T12. Responsible for emission prior to ejaculation

2

Pelvic splanchnic nerves

Carry parasympathetic fibers from S2 to S4. Responsible for bladder, motility in rectum and sigmoid colon, erection

3

Innervation of ear

Cervical spinal cord gives off great auricular n and lesser occipital n which provide sensory to external ear.

V3 of trigeminal gives off auriculotemporal nerve which provides sensory to external auditory canal and external tympanic membrane

CNX supplies posterior part of external auditory canal. Stimulation can cause vasovagal syncope

CNVII provides motor innervation to stapedius

CNVIII provides hearing and vestibular proprioception

4

Liver pathology in alpha1 antitrypsin def

Polymeraized AAT accumulates in hepatocytes. Stains with PAS and resists digestion by diastase

5

Embryology of cleft lip and palate

Lip and palate form in 5th to 6th week. Cleft lip is failure of one of the maxillary prominences to fuse with the intermaxillary segment. Cleft palate is failure of palatine shelves to fuse with one another or with primary palate.

6

Cricothyrotomy

Go through skin, superficial and deep cervical fascia, platysma muscle, and cricothyroid membrane. Do not go through cartilages

7

Anatomy of orbit and imprlications during trauma

Bounded:
-superiorly by thick frontal bone
-laterally by thick sphenoid bone
-inferiorly by thin bone that borders maxillary sinus
-medially by thin bone that borders ethmoid air clels

Trauma most frequently fractures inferior or medial orbit which have thinnest bone. Thus, orbital contencts can herniate down into maxillary sinus or medially into ethmoid air cells

8

Rat poison

Contains "superwarfarin" - causes mucosal bleeding and ecchymoses

Treat with FFP

9

How to reduce wrong site surgeries

Independent verification of patient, procedure, and site by two different people

10

Causes of vertigo: Meniere disease vs benign positional vertigo vs vestibular neuritis

Meniere
-caused by increased endolymph volume/pressure
-recurrent vertigo + unilateral hearing loss/tinnitus

Benign positional vertigo
-otoliths in semicircular canals
-triggered by head movement; no auditory symptoms

Vestibular neuritits
-vestibular nerve inflammation
-single episode lasting days
-no hearing loss

11

Noise induced hearing loss

High frequency hearing loss. Trauma to sterocilia cells in organ of corti

12

Tympanic membrane damage

Occurs due to infection, trauma, pressure changes, sudden loud noises. Conductive hearing loss

13

Lithium toxicity

Presentation: GI, ataxia, tremors, confusion

Causes: coadministration with thiazides, ACE-Is or NSAIDs that impair renal clearance. Lithium similar to Na+ and is reabsorbed in prox tubules of kidney. Thiazides cause mild dehdration, increasig reabsorption of Na+ and lithium in prox tubules

14

ARDS pathogenesis

Primary causes are pulmonary infection and sepsis. In sepsis, inflammatory mediators travel back to heart and first capillary bed they get pumped to is pulmonary, where they can interact with endothelial cells and cause damage.

Results in capillary leak which leads to pulmonary edema and V/Q mismatch/shunting

Inflammation damages type II pneumocytes, decreasing surfactant production and thus decreasing compliance leading to a stiff and difficult to ventilate lung

Scarring decreases diffusion capacity leading to hypoxia

Fibrin deposition causes permanent thickening of alveolar capillary membrane which decreases diffusion capacity and compliance long term

Acute respiratory failure lasts a few days but fibrosis can cause chronic lung disease

15

Nitroprusside

Parenteral vasodilator used for hypertensive emeregency. MEtabolized to NO and cyanide ions. Thus, at high doses, cyanide toxicity can be seen

16

Treatment of cyanide posioning- three options

1. Sodium nitrite: increases methemoglobin
2. Sodium thiosulfate: sulfer donor, increases conversion to excretable metabolite
3. Hydroxycobalamin: cobalt binds CN- ions

17

Leg compartments

Anterior compartment: deep peroneal nerve, anterior tibial artery and vein

Lateral compartment: superficial peroneal nerve

Posterior compartment: tibial nerve, peroneal artery and nerve, posterior tibial artery and vein

18

Epistaxis anatomy

Most commonly anterior from Kiesselbach plexus in nasal septum.

19

Milrinone

PDE3 inhibitor used as an inotrope in HF. Increases cAMP in cardiac myocytes. Also causes systemic vasodilation- both arterial and venous

20

HAART side effect

Fat redistribution from periphery to central

21

Thiazolinedione MOA

Go to nucleus and activate PPAR gamma. PPAR gamma increases insulin sensitivity

22

Hereditary orotic aciduria

AR disorder of de novo pyrimidine synthesis
Presents with: physical and mental retardation, megaloblastic anemia, increaesd urine orotic acid.

Distinguished from ornithing transcarbamylase def by lack of hyperammonemia.

Treat by suppementing uridine which bypasses defective enzyme

23

Ornithine transcarbamylase deficiency

Urea cycle disorder in which carbamoyl phosphate builds up and is converted to orotic acid resulting in high urine orotic acid.

Ammonia increases resulting in encephalopathy

24

Hydroxyurea MOA and USe

MOA: inhibitis ribonucleotide reductase

Use: polycythemia vera and essential thrombocytopenia to decrease red cell production. Sickle cell disease to increase fetal hemoglobin

25

5-fluorouracil MOA

mimics uracil structure. Inhibits thymidylate synthase

26

Glycerol kinase

Enzyme that converts glycerol to glycerol-3-phosphate which can go to gluconeogenesis or to glycolysis

27

Acetyl coA carboxylate

Converts acetyl coA to malonyl coA in fatty acid synthesis

28

Cholestyramine

Binds to bile acids in GI tract, inhibiting enterohepatic recirculation. Increases trigs as side effect

29

Antithyroid med side effects and MOA

Both: agranulocytosis

Methimazole: teratogenic
PTU: hepatic failure

MOA: inhibits thyroid peroxidase, impairing iodine organification. PTU also decreases T4 to T3 conversion and so is preferred in thyroid storm

30

Neurophysin

Carrier protein for oxytocin and ADH. PRoduced by the hypothalamic nuclei

31

Meglitinidines

Similar MOA to sulfonylureas - closes ATP-dependent K+ channels and increases insulin release. Short half life makes it good for controlling post-prandial hyperglycemia

32

TZD side effects

Fluid retention causing weight gain, edema, and worsened CHF. Also can cause adipose weight gain

33

Modafanil

Non-amphetamine stimulant used to treat narcolepsy

34

Metyrapone stimulation test

Metyrapone inhibits cortisol synthesis by blocking 11-beta hydroxylase. Look for ACTH production and increased 17-OH in the urine (can't be converted to cortisol so builds up)

35

Ethanol and hypoglycemia

Ethanol increases NADH/NAD+ ratio: inhibits gluconeogenesis but not glycogenolysis (can maintain glucose initially after a binge but then goes down)

36

Perchlorate

Inhibits Na+-I- symporter responsible for iodine uptake in thyroid gland

37

Acromegaly presentation

Glucose intolerance
Coarsened facial features
Joint pain
Increased hand and foot size
Macroglossia which can lead to OSA

38

First generation sulfonylureas

Chlorpromide and tolbutamide. Can cause disulfiram like reaction

39

Lower extremity lymphatic drainage

Medial leg drains superficially, following veins to superomedial and superolateral nodes.

Lateral leg drains deep, following arteries to popliteal nodes and then deep inguinal nodes

40

Latissimus dorsi

Extends from the iliac crest to spinous processes and attaches to humerus. Innervated by thoracodorsal nerve. Extends, adducts, and internally rorates arm

41

Trapezius

Muscle in upper back and neck. Elevates, rotates, and stabilizes scapula. Innervated by CNXI

42

Succinylcholine: MOA and ADRs

Depolarizing NMJ blocker. Works in two phases. In phase I, it depolarizes the membrane, holding the channel open. In phase II it gets repolarized but is still unresponsive to ACh.

Opens the nACHR channel which is a non-selective cation channel, so K+ can exit and cause hyperkalemia and arrhythmia. Can cause malignant hyperthremia. Can aaffect symp or parasymp systems leading to increase or decrease in HR.

43

Non-depolarizing NMJ blockers

-curium. Antagonize ACh at nicotinic receptor. Side effects include histamine release and anticholinergic activity

44

Baclofen

Muscle relaxant. Acts at spinal cord GABA receptors

45

Polymyalgia rheumatica

Seen in 50% of those with temporal arteritis. Achy shoulder and hip girdle pain

46

Ulnar nerve injury - locations

Most common is funny bone. Can also be caused by damage in Guyon's canal between hook of hamate and pisiform

47

COX enzymes

COX-1: housekeeping
COX-2: induced by inflammation

48

Colchicine MOA

inhibits MT formation, impairing PMN mitosis and chemotaxis

49

Deep brachial artery

Also called profunda brachii. Branches from brachial artery and travels with radial nerve. Also can be injured with midshaft fracture

50

Thoracic outlet syndrome

Thoracic outlet is space between first rib and clavicle. Lower trunk comppression results in arm numbness/tingling/weakness. Subclavian vein compression results in upper extremity swelling. Subclavian artery comppression causes exertional arm pain. Most often occurs in scalene triangle.

51

ACL and PCL

PCL: posterior intercondylar tibia to anterolateral medial condyle of femur

ACL: anterior intercondylar tibia to posteromedial lateral condyle of femur

52

Blood supply to head of femur

Medial circumflex artery

53

Cyclophosphamide

alkylating agent. Forms DNA crosslinks, interfering with replication

54

MLF lesion

Results in decreased adduction of ipsilateral eye

55

Clotting factor with shortest half life

Factor VII

56

Vital capacity

Max air you can exhale = TV + IRV + ERV

57

pleural pressure

Always negative; gets more negative with inspiration. Alveoli go back and forth between pos during inspiration and neg during expiration

58

Things leaving diaphragm

T8: IVC
T10: esophagus, vagus nerve
T12: aorta, thoracic duct, azygous vein

59

Pulmonary artery anatomy

R ant to R bronchus
L sup to L bronchus

60

Lung compliance: what makes go up and down

Increased: emphysema, aging
Decreased: pneumonia, pulmonary edema, pulmonary fibrosis

61

Causes of crackles

Airways open after collapse. Edema, fibrosis, pneumonia

62

Rhonchi

Caused by secretion in large airways. COPD

63

Bronchophony and egophany

Heard in effusion and pneumonia

64

Fremetius

Increased in pneumonia
Decreased in most other things