March 27 - Odds and Ends Flashcards
(64 cards)
Hypogastric nerve
Carries sympathetic fibers from T10 to T12. Responsible for emission prior to ejaculation
Pelvic splanchnic nerves
Carry parasympathetic fibers from S2 to S4. Responsible for bladder, motility in rectum and sigmoid colon, erection
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
Liver pathology in alpha1 antitrypsin def
Polymeraized AAT accumulates in hepatocytes. Stains with PAS and resists digestion by diastase
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.
Cricothyrotomy
Go through skin, superficial and deep cervical fascia, platysma muscle, and cricothyroid membrane. Do not go through cartilages
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
Rat poison
Contains “superwarfarin” - causes mucosal bleeding and ecchymoses
Treat with FFP
How to reduce wrong site surgeries
Independent verification of patient, procedure, and site by two different people
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
Noise induced hearing loss
High frequency hearing loss. Trauma to sterocilia cells in organ of corti
Tympanic membrane damage
Occurs due to infection, trauma, pressure changes, sudden loud noises. Conductive hearing loss
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
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
Nitroprusside
Parenteral vasodilator used for hypertensive emeregency. MEtabolized to NO and cyanide ions. Thus, at high doses, cyanide toxicity can be seen
Treatment of cyanide posioning- three options
- Sodium nitrite: increases methemoglobin
- Sodium thiosulfate: sulfer donor, increases conversion to excretable metabolite
- Hydroxycobalamin: cobalt binds CN- ions
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
Epistaxis anatomy
Most commonly anterior from Kiesselbach plexus in nasal septum.
Milrinone
PDE3 inhibitor used as an inotrope in HF. Increases cAMP in cardiac myocytes. Also causes systemic vasodilation- both arterial and venous
HAART side effect
Fat redistribution from periphery to central
Thiazolinedione MOA
Go to nucleus and activate PPAR gamma. PPAR gamma increases insulin sensitivity
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
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
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
