Mini 3 - week 7-11 Flashcards
What happens if bacteria process UDP-glucuronide?
They remove glucuronic acid and it becomes urobilinogen. This is mostly oxidized to stercobilin, but some is reabsorbed to portal circulation and then converted to yellow urolibin and excreted by the kidneys into urine.
How does somatic hypermutation happen?
AID (activation-induced cytidine deaminase) alterns binding affinity.
Describe the structure of the thymus. How does it stain?
Thin CT capsule from which trabeculae extend into the parenchyma (divided into lobules). Only has efferent lymphatic vessels. Cortex stains dark, medulla light (less thymocytes).
What does the thyroid gland and parathyroid glands produce?
Thyroid hormone - rate of metabolism, Calcitonin - rate of calcium metabolism. Parathyroid produces PTH (parathormone) which controls calcium and phosphate metabolism.
What % of leukocytes are eosinophils?
1-3%
What are the ypypes of calvaria fractures?
Linear (most common, occurs at impact point and radiates out), Depressed, Comminued (bone broken into several pieces), Countercoup/counterblow (fracture at opposite side of blow).
What is inflammation?
The first response to infection or trauma. Cytokines releaed, vasodilation, increaed vascular permeability. Rubor (red), calor (warmth), tumor (swelling), dolor (pain).
Describe the structure of the spleen.
2nd largest immune organ in the body, filters blood of aged and damaged erythrocytes. Enclosed by dense CT capsule from which trabeculae extend into parenchyma. Has only efferent lymph vessels. 75% red pulp and 25% white pulp.
Describe the path of the 3rd part of the duodenum.
Transverse/inferior/horizontal part. It crosses ~L3 posteriorly under SMA and anteriorly over IVC. It’s the longest part of the duodenum.
What is the venous drainage of the liver?
The hepatic portal vein (union of SMV and splenic vein). Hepatic veins drain into the IVC.
What are some suicide risk assessment/warning signs?
Recent threats/actions to harm/kill self, focusing/talking/writing about suicide or death, hopelessness or feeling trapped, reckless behaviour, increased substance use, significant change in behaviour/mood, anxiety, sleep problems.
How is iron transported across membranes? Through blood?
Ferroxidases cooperate with transporters by turning Fe3+ into Fe2+ so it can move across. Through blood it’s transported with transferrin (2 Fe3+s).
What PAMP does TLR2 recognize?
Peptidoglycan.
What are platelets?
Tine 2-4um pieces of a cell. Derived from a megakaryocyte (~10 day lifespan). They have lysosomes, mitochondria, some golgi and ER, an extensive cytoskeleton, and 3 types of granules.
What are the three parts of the muscular part of the diaphragm?
Sternal (2 muscular slips from xiphoid process), Costal (forms domes, interdigitates with transversus abdominis), Lumbar (arises from medial and lateral arcuate ligaments, forms right and left crura - right is bigger).
What is methotrexate?
A competitive inhibitor of DHFR.
What is the insertion of the transversus abdominis?
Pubis via conjoint tendon, linea alba.
Describe the caval opening of the diaphragm.
Most anterior, T8. IVC, liver lymph vessels, right phrenic nerve pass through.
What is the arterial supply and venous drainage to the adrenal glands?
Superiorly from the inferior phrenic arteries, middle from the aorta, inferior from the renal arteries. The right suprarenal vein drains into the IVC, the left into the inferior phrenic vein (which goes into the left renal vein).
What is a deficiency of Factor XI called?
Hemophilia C (no joint bleeding). Autosomal recessive.
What are the axillary LNs?
Pectoral anteriorly, subscapular posteriorly, humeral laterally. Go to central, then to apical, then to supraclavicular. Efferent vessels form the subclavian lymphatic duct.
Where will ovarian cancer usually metastasize to?
The lumbar/lateral aortic lymph nodes. Can eventually spread to supravclavicular.
What is tyroxine binding protein?
It’s the highest affinity T3 and T4 transporter.
Describe the symptoms of beta thalassemia.
Crew-cut appearance, anemia >6-9 months, retardation of growth and sex maturation, iron overload, splenomegaly, skeletal changes. alpha hemoglobin chains aggregate/precipitate and cause hemolysis. Cells are microcytic and hypochromic.
What is the name of the “hilum” of the testes, where the neurovascular structures enter and leave the testes?
Rete testis/mediastinum. It’s on the posterior surface.
What muscle furrows the brow?
Corrugator supercilii.
What are the arteries and veins and lymphatic drainage of the scrotum?
Anterior/posterior scrotal branches of arteries and veins. Drains into superficial inguinal lymph nodes.
How do you do a corrected reticulocyte count?
If there is anemia, multiply by Hct/45. Is there is high polychromasia (presence of immature RBCs), divide by 2 again.
What is leukopenia ?
Low white blood cells in circulation (not marginating or storage pool!)
What are thoracoabdominal nerves?
When spinal nerves pass the costal cartilage they change their names. T7-L1 do this. T12 is subcostal under the 12th rib. L1 divides into the ilioinguinal and ilihypogastric.
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the hindgut?
Lumbar splanchnic nerves L1-L2 and inferior mesenteric ganglion, Vagus nerve, IMV, IM LNs.
What is the HbF % in HbSS genotype?
2-20%.
What are the borders of the muscular triangle? What does it contain?
Superior belly of omohyoid, SCM, neck midline. Infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid).
What is mesentery?
Connects organs to the posterior abdominal wall, double layer of parietal peritoneum.
What is the venous drainage to the diaphragm?
Thoracic surface: pericardiacophrenic, musculophrenic (to internal thoracic), superior phrenic (to IVC or azygos). Abdominal surface: inferior phrenic (right to IVC, left anteriorly to IVC, posteriorly to left renal vein).
Describe the midgut/small intestine embryonic development.
Week 5 the midgut rapidly expands into a U-shaped loop around the SMA. The cranial limb forms the distal duodenum, jejunum, upper ileum. The caudal limb forms the rest of ileum and distal midgut. Week 6 the liver growth causes midgut herniation where it rotates 90 degrees counterclockwise around the SMA. Around week 10, the intestines return to the abdominal cavity and rotate another 180 degrees. In month 2, the small intestine lumen proliferates then recanalizes. The tissue rearranges to yield villi and crypts with stem cells. The different cell types are formed by the end of month 6.
What’s the most common complement deficiency?
C2
What are the types of risk for suicide?
Chronic/static or acute/dynamic.
How do the red and white pulp of the spleen look histologically?
White pulp darker - red/purple.
What is extrophy of cloaca associated with?
More severe than extrophy of bladder. Associated with extrophy of bladder, emphalocele, spinal defect, imperforate anus.
Describe initial and acute appendicitis symptoms.
Initial - secretions trapped, stretch visceral peritoneum. Periumbilical region pain. Acute - parietal peritoneum irritated. Pain in McBurney’s point.
What is a congenital umbilical hernia?
Musculature doesn’t close the umbilical ring. Is most common in preemies, can close spontaneously by age 2.
Where will testicular cancer eventually metabolize to?
The pre-aortic lymph nodes.
Describe the ilohypogastric nerve.
L1. Innervates abdominal muscles and skin of inguinal and pubic region.
What do sickle-cell heterozygotes have an advantage against?
Plasmodium falciparum anemia.
How do people get Cobalamin/Vitamin B12?
It’s made in bacteria, and so it’s only available from animal products. It is the rarest vitamin.
What are the symptoms of having 30-50% methemoglobin?
Fatigue, confusion, dizziness, tachypnea, palpitations.
What is the prothrombin time test?
PT test. It differentiates the extrinsic and common pathways. 12-16s is normal.
What is the innervation of quadratus lumborum?
Anterior rami of T12-L4.
What does the iliolumbar artery supply?
The posterior abdominal and pelvic wall.
Describe hemoglobin alpha and alpha like subunits and where they’re made.
Alpha is made starting in the embryonic period but the stem cell location changes from the yolk sac to the liver to the gut to the bone marrow. Zeta bubunits are made in the yolk sac only.
What is a hapten?
Something that must be conjugated to a protein carrier to provoke an immune response. Generally only has one epitope.
What does the lumbar lymphatic trunk drain and drain into?
The lower limb, pelvis, kidneys, most of abdominal viscera. Enters cisterna chyli (dilated sac at inferior thoracic duct) at L1/L2.
What are the anastomoses within the artieres branching from the celiac trunk?
The left and right gastric arteries, also the right and left gastro-omental arteries.
What provides cutaneous innervation to the posterior head?
Spinal nerves C2-C3.
What are the specific arterial supplies to the different parts of the stomach?
Right and left gastric arteries to lesser curvature, right and left gastro-omental arteries to greater curvature, short/posterior gastric arteries to fundus.
What is methemoglobin? What is it used to treat?
Hemoglobin found to ferric iron - cannot bind oxygen, is a deep bluish chocolate brown. Sometimes hemoglobin turns into MetHb spontaneously. An NADH dependent reductase is needed to get it back to Hb. It’s used as a treatment for cyanide poisonind (binds cyanide with high affinity, poorly reversible).
Describe an epidural hemorrhage.
Often caused bu the meningeal arteries. Blood accumulates uickly. Hematoma is biconvex/disc shaped, and bounded by sutures. Presents s headache, lucid interval for some hours, then drowsiness and coma.
Describe all hemolytic anemias.
Ineffective erytoropoiesis (iron absorption increased), increased EPI, erythroid hyperplasia in bone marrow (bony deformities), decreased hemoglobin, increased reticulocytes (if well nourished),
What is the parasympathetic innervation to the lacrimal gland?
Stimulates production of fluid.
CN VII has a branch called the greater petrosal nerve (joins with deep petrosal nerve) and branches into nerve of pterygoid canal. THis synapses in the pterygopalatine ganglion. Then the fibers join with the CN V2 zygomatic branch and get to the lacrimal gland.
What are thymus-independent antigens?
Stimulate B cells without signal from T cells. LPS, polysaccharide. There is no class switching or affinity maturation so response is limited.
What does testosterone do to RBCs?
Increases oxygen carrying capacity.
What is a shift to the left?
Increased immature neutrophils in the blood, large # of band cells. Indication of bacterial infection.
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the midgut?
T9-T12 splanchnic nerves and superior mesenteric ganglion, Vagus nerve, SMV, SM LNs.
Describe a hematocele.
A collection of blood in the tynica vaginalis (possibly from a ruptured testicular artery). Opaque on transillumination.
Where do the ovaries descend to in development?
They descend inferior to the pelvic brim.
What are the two types of beta-thalassemia?
Minor/trait (one normal allele), or major/Cooley’s Anemia (no normal alleles).
What are the retroperitoneal organs? Which of those are secondary?
Only partially wrapped in visceral peritoneum. Suprarenal glands, Aorta and IVC, Duodenum (2nd, 3rd, 4th parts), Pancreas (all but tail), Ureters, Colon (ascending and descending), Kidneys, Esophagus, Rectum (proximal 2/3). The secondary retroperitoneal organs are the Duodenum, Pancreas, Colon.
What does the seminal gland/vesicle develop from embryonically?
A later outbudding of the mesonephric duct.
Describe the intrinsic pathway of clotting.
Platelets bind to exposed vollagen via glycoprotein Ia/IIa. vwF binds glycoprotein Ib/X/V complex to further anchor platelets. Glycoprotein VI binds collagen and initiates integrin binding the platelet to collagen, and integrin activation stimulates degranulation (release of vWF, ADP, PAF, TxA2, platelet factor 4, polyphosphates). Polyphosphates activate Factor XII (autocleaves). XIIa cleaves XI and prekallikrein. XIa cleaves IX. IXa activates X in the presence of platelet phospholipids, Factor VIII, and Ca2+). Xa activates prothrombin and it becomes thrombin. Thrombin activates Factor XIII and fibrinogen (-> fibrin). Head to tail non covalent fibrin assembly happens via Factor XIIIa which is a transgluaminase that crosslinks fibrins.
Where does breast lymph drain into?
The subareolar lymphatic plexus. 75% to pectoral LNs, 25% to parasternal or subdiaphragmatic.
How is deferoxamine administered and excreted?
IM, IV, or SQ. Excreted in urine.
How is thrombin involved in fibrinolysis?
it activates the thrombin-activatable fibrinolysis inhibitor.
Around what level is the horseshoe kidney?
L3, IMA blocks ascent.
How is B12 taken up?
Initially bound to transcobalamin I (TCI) secreted by salivary glands. Then it binds IF secreted by the parietal cells of the stomach. The B12/IF complex is absorbed in the ileum (recovered B12 excreted in bile). In blood B12 is transported in complex with TCII.
What is contained by the prevertebral layer of the deep fascia?
Paraspinous muscles, phrenic nerve. It extends laterally as axillary sheath, the anterior extension is the Alar fascia.
What is drug efficacy?
Largest effect that a drug can produce, regardless of dose.
What is the insertion of the internal obliques?
Pubic via conjoint tendon, ribs 10-12, linea alba.
What is myoglobinuria?
Muscle damage, drug abuse, and malignant hypothermia causes myoglobin in blood and urine.
What does Th2 secrete?
IL-4, IL-5, IL-13.
How is a retrograde urethrogram done?
Contrast shot into the urethra.
What does the round ligament of the uterus do?
Holds the fundus forward. Goes through the inguinal canal, inserts into the subcutaneous labia majora.
How does hemoglobin stain on a wright stain?
Pink/red.
What are the Interstitial cells of Leydig? What are they derived from?
Found between the testis cords, they make testosterone by week 8. They are derived from the mesoderm of genital ridges.
What are the branches of CN V1 (Opthalmic division).
Supraorbital, supratrochlear, lacrimal, infratrochlear, external nasal.
Describe the lesser omentum.
Double layered structure of visceral peritoneum that connects the transverse colon to the lesser curvature of the stomach. It is divided into the thin membranous hepatogastric ligament and the thick hepatoduodenal ligament, the free edge of which contains the portal triad.
What does the deep facial vein drain?
The pterygoid venous plexus.
Which kidney is lower?
The right kidney - left is also slightly under rib 11 and they’re both under 12.
What are the common swollen lymph nodes?
Cervical, axillary, inguinal. Deep ones - jugulodigastric (often associated with tonsilitis), jugulo-omohyoid (often associated with tongue cancer), supraclavicular (the left ones are Virchow’s nodes).
Describe follicular hyperplasia.
Lymphadenitis with enlarged secondary follicles (activated B-cells, macrophages). Occurs in rheumatoid arthritis, early HIV, toxoplasmosis.
What is the action of the transversus abdominis?
Maintains posture and supports abdominal viscera.
What’s the major change from basophilic erythroblast to polychromatophlic erythroblast?
The polyribosomes decrease the hemoglobin comes in which is acidophilic.
How is vWF normally found?
Attached to VIII.
What organs comprise the midgut?
2nd, 3rd, 4th part of duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of transverse colon.
What is the insertion of psoas major?
Lesser trochanter of femur.
What is a congenital inguinal hernia?
Descent of intestine into scrotum because the connection between the peritoneal cavity and processus vaginalis is not obliterated.
What does the lateral sacral artery supply?
The skin and muscle posterior to the sacrum. It travels alonf the posterior pelvic wall.
When do blood cells begin developing embryologically? Where do they develop?
3-4th week of gestation blood precursor cells arise from the yolk sac mesoderm. 5th week the liver and spleen are in charge of hematopoiesis. By the 5th month of gestation the blood cells are derived from stem cells in the bone marrow.
What is the formed fraction?
All the cells and platelets of blood. 37-54%.
How do you get a bifid and an ectopic ureter?
Early splitting of ureteric bud and 2 ureteric buds, respectively. The ectopic uterer may move more caudally and drain outside of the urinary bladder.
What is iron a cofactor in in the body?
Heme, cytochromes, catalase, nitrogenase, transferrin, ferritin, lipooxygenases, IRE-BP.
What is the location and function of the epididymis?
Posterior surface and superior pole of the testes. It stores sperm until maturation occurs, the tail is continuous with the vas deferens.
What do you call a kidney infection?
Pyelonephritis.
What % of leukocytes are basophils?
0-0.75%
What makes up the reactive part of MCHII?
alpha1 and beta1 subunits.
Which IJV is better for a needle/catheter?
The right one, it’s straighter.
What organs does the H1 receptor work on and what type of receptor is it?
Smooth muscle, Gq
What is infectious mononucleosis?
EBV or CMV (causes IM-like illness). Kissing disease. Fever, sore throat, gray-white membrane on tonsils, hepato.splenomegaly, lymphadenopathy in posterior cervical, axillary, and groin LNs. Lab tests in the Paul-Bunnel test show heterophile (nonspecific) IgMs. Few patients may test negative in the first week, is a self-limited issue and will resolve in 4-6 weeks. Potential complication splenic rupture.
Where can the urine leak into in a ruptured urethra in males?
Into the peritoneum and accumulate deep to Colles’ Fascia and spread under Dartos/Scarpa’s fascia. A straddle injury can cause this.
How much blood does an average adult have?
5-6L, ~7% of body weight.
What is the insertion of the external obliques?
The pubic tubercle, anterior ilac crest, linea alba.
List the intrinsic muscles of the eye.
Ciliary muscles (adjust lens thickness), dilator pupillae, sphincter pupillae.
How can a testicular carcinoma spread?
Through the lumbar LNs or through the valveless internal venous plexus. Can reach spine, brain, liver.
What are some morphological changes in neutrophils due to sepsis or severe inflammation?
Toxic granules (coarser and darker than normal), Dohle bodies (dull grey inclusions that are patches of ER), cytoplasmic vacuoles (phagolysosomes).
What is the origin of the external obliques?
Ribs 5-12.
What are the contraindications of deferasirox?
Hypersensitivity, impaired renal function, platelet counts below 50,000/mm, advanced malignancies, high-risk myelodysplastic syndromes.
What does a2-macroglobulin do?
AKA transcuprein. It is a protease inhibitor of plasmin, thrombin, and kallikrein, also is a carrier of cytokines and growth factors, and is a Zn and Cu transporter.
What are selectins?
Adhesion molecules, heterophilic - binds cell to carbo of other cell. Lymphocytes have L-selectins, Endothelial cells have P/E selectins (carb on leukocytes).
What is the pelvic floor/diaphragm responsible for?
Supports viscera, resists increases in intraabdominal pressure, controls anal opening, vagina, urethra, raises floor on contraction.
Which secondary lymphoid organs are encapsulated?
All of them except MALT and some of tonsils.
What are the potential causes of neutropenia?
Inadequate/ineffective granulopoiesis, accelerated destruction or sequestration of PMNs, megaloblastic anemia, drug toxicity (most comomn MCC, alkylating agents, antimetabolites).
What is the half-life and dosing schedule of darbepoietin alfa?
21-49 hours, weekly/biweekly.
Where does CN I exit the head? What’s it called?
Cribiform plate. Olfactory Nerve.
What does the superficial epigastric artery branch from? Is it deep to the rectus sheath?
The femoral artery (distal to the inguinal ligament). It is superficial to the rectus sheath.
Describe the perineal membrane.
Strong fascia perforated by urethra and vagina, provides attachment for superficial external genitalia.
Describe IgG.
Secreted as monomer, 2nd Ig to be secreted in immune response, most abundant type in blood and lymph. Activates classical complement, opsonizes (triggers phagocytosis and ADCC), neutralizes. Can cross the placenta.
When does the embryological development of the stomach epithelium take place?
In the late embryonic period. Rugae then pits. Cell type differentiation occurs in the early fetal period, HCl production begins before birth.
When does delayed inflammation occur?
Chronic liver disease, all acute phase of inflammation proteins elevate, albumin elevates, gamma globulins elevate.
Do the facial veins have valves?
No
What vessels are embedded in the parotid gland?
External carotid a., retromandibular v.
If basophils and mast cells look basically the same, how do you tell them apart through a microscope?
Generally, if it’s in CT its a mast cell, if it’s in blood its a basophil.
What is the cause of X-SCID?
Defect in gamma chain of several cytokine receptors - IL-7R defect prevents DN thymocyte maturation.
What are the anastomoses between the SMA and IMA?
The middle colic and left colic arteries. Form the marginal artery of Drummond.
What is the general arterial supply to the pelvic cavity?
The internal iliac artery, but abdominal arteries enter the pelvic cavity (superior rectal (IMA), gonadal (aorta), median sacral (aorta).
What does electrophoresis look like in protein losing conditions e.g. nephrotic disease?
All peaks decreased, large proteins lost less than smaller ones. a2-macroglobulin is big (720kDa), lost less.
What is Hesselbach’s triangle?
A weak area in the posterior inguinal canal between the medial and lateral peritoneal folds. Medial border - lateral wall of rectus abdominis Lateral border - inferior epigastric vessels Inferior border - inguinal ligament
What are follicular DCs?
Found in germinal centers, have processes that trap the antigen. Are not antigen presentinc cells. WHen lymphocytes bind the antigens they have on their processes, they suck up GFs to stay alive.
How can scalp infections get to the brain?
Layer 4 has a direct route to the cranial cavity via the emissary vein. Bacteria can go to the eye but not the neck because occipitalis inserts into bone.
What does a1-antichymotrypsin do?
Inhibits cathepsin G (neutrophils) and chymases (mast cells).
How is albumin produced?
In the liver as preproalbumin. In the ER the N-term tail is cleaved, then it is sent to the golgi where there is another N-term cleavage.
What are the vestibular glands of the genitals?
Greater/Bartholin’s is in the superficial perianal pounch on either side of the vestibule of vagina, and they secrete mucus in arousal. Lesser/Shene’s are paraurethral glands on either side of vestibulr of vagina, open into vestibule near urethra and secrete mucus to moisten labia and vestibule.
What is the blood supply and lymphatic drainage of the duodenum?
Pancreaticoduodenal arteries, drainage to hepatic portal vein. Lymphatic drainage to celiac and SM LNs.
Are there any LNs in the scalp?
No
Describe a varicocele.
A dilated pampiniform plexus in the testicles. Common on left (nutcracker syndrome). Looks like a bundle of worms, usually disappears when lying down.
What factors use platelet lipids as cofactors?
IX and X.
How do you identify reticulocytes on a PBS?
WIth supravital stains. Their presence signifies erythropoiesis.
Describe a subarachnoid hemorrhage.
Caused by cerebral arteries. Can result from berry aneurysms. Blood found in the CSF.
What is a deficiency of Factor VIII called?
Hemophilia A (x-linked recessive).
What does the vaginal artery supply?
Just in women, the inferior bladder and the vagina. Usually branches from the uterine artery.
What is Renal Vein Entrapment Syndrome?
The left renal vein becomes trapped between the aorta and SMA. Causes renal venous hypertension and left varicocele.
What cytokine induces production of secreted PRRs?
IL-16. Macrophages make it, induced by bacteria. Some examples are SP-A, SP-A, mannose binding lectin, fibrinogen, serum amyloid protein, C-reactive protein.
Describe acute iron toxicity and how to treat it.
Almost exclusively seen in young kids that ingest ora tablets. Leading cause of accidental poisoning death in kids <6. Gastroenteritis, voiting, shock, lethargy, abdominal pain, bloody diarrhea, dyspnea, acidosis, coma, death. Induce vomiting and give iron antidote.
What mutations cause deficiency in leukocyte adhesion?
CR3 or CR4 B chain mutation - B chain is shared by CD11 and CD18 family of integrins - lack of adhesion causes neutrophil recruitment deficiency.
Describe the thoracolumbar fascia.
Covers deep back muscles. Posterior sheath is thick, lumbar part of posterior sheath extends between the 12th rib and the iliac crest and attaches laterally to the internal obliques and transversus abdominis. Includes quadratus lumborum and psoas fascia.
What tooth can the fracture of the angle of the mandible involve?
The alveolus of the 3rd molar. The fracture is also usualy oblique.
What does a1-alphatrypsin do?
Inhibits trypsin, elastase (neutrophils), and other proteases.
What are the actions of the inferior oblique of the eye?
Elevation, abduction, extorsion.
When eye abducted, only extorsion. WHen adducted, only elevation.
How do you treat a hernia?
Herniopathy or herniorrhaphy.
What is contained by the Pretracheal/Middle layer of the deep fascia?
Muscular layer has the infrahyoid ‘strap’ muscles, Visceral layer has pharynx, larynx, trachea, esophagus, thyroid, parathyroid glands, buccinator, constrictor muscles of pharynx.
What cells do Th1 cells activate?
Macrophages, increase its killing capacity.
What is the half life and dosing schedule of epoietin alfa?
4-13 hours, 3x/week.
What is the action of the external obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and contralateral trunk rotation?
What happens if the lumen of the Allantois persists?
Urachal cysts or fistulae or sinus. May include leakage of urine from the umbilicus, UTIs, peritonitis.
What organs does the H2 receptor work on and what type of receptor is it?
Stomach, heart, mast cells, Gs
What is the structure of hemoglobin?
Tetramers with 2 alpha and 2 beta subunits - each subunit binds a heme which binds an oxygen and oxygen binds cooperatively.
Describe congenital A1AT deficiency.
Autosomal recessive. Age of onset 20-50 after an illness that stresses the liver or lungs. Most commonly caused by errors in folding/processing. 1/2500 in all europeans, 3% of all COPD. Pleiotropic gene, most common mutation of severe form is Glu342Lys.
What does the bleeding time test identify?
Platelet function disorders.
Describe B cell activation by T cells.
T cells go to follicles, reduce CCR7 expression, increase CXCR5 expression. B cells get activated and increase CCR7 expression, migrate and present Ag to Th, which gives signals to isotype switch.
What is the tentorial notch?
The anterior free edge of the tentorium cerebelli.
Describe basophils.
<1% of the total leukocyte population. S-shaped nucleus not very visible. Contains heparin and histamine like mast cells. Adds to inflammatory process (histamines, serotonin, prostaglandins, leukotrienes).
How are alpha2 macroglobulin and a2 antiplasmin involved in fibrinolysis?
They can inactivate plasmin.
What are some protease inhibitors whose increased concentration can result in bleeding disorders?
antithrombin III, antitrypsin, alpha2 macroglobulin.
What is epistasis?
Interaction between non-allelic genes “modifier genes”. May be underlying reason for some reduced penetrance phenotypes.
How many V/D/J chains does the antibody kappa light chain have?
30, 0, 4
In what state is iron bound to hemoglobin?
Ferrous (Fe2+)
What is formed when the lumen of the Allantois (initiallu continuous with urinary bladder) is obliterated?
The urachus (in adults the median umbilical ligament).
What does properdin do?
Plays a role in alternative pathway of complement activation.
What is the innervation of iliacus?
Femoral nerve (L2-L4).
What is the innocent bystander effect?
When MAC lyses normal cells.
What does the urogenital system derive from embryologically?
The intermediate mesoderm located along the posterior abdominal wall. The mesonephric/Wolffian duct first begins as a longitudinal rod that begins cranially and extends caudally.
What percent of plasma is beta globulin?
13.4%
What is leuvocorin used to treat?
Megaloblastic anemias, palliative treatment of advanced colorectal cancer (with 5-fluorouracil), methotrexate toxicity.
What are the symptoms of having 20-30% methemoglobin?
Anxiety, headache, dyspnea on exertion.
What are the boundaries of the inguinal canal?
Anterior wall - External oblique aponeurosis. Posterior wall - Transversalis fascia. Floor - Inguinal ligament. Roof - Conjoint tendon.
What does orosomucoid do?
AKA acid glycoprotein. Carrier of basic drugs, steroids, protease inhibitors.
What arteries are deep to the rectus abdominis?
The superior and inferior epigastric arteries.
What are the sites of ureter constriction?
The uteropelvic junction (L2), the uterovesical junction, and the point where it crosses anteriorly over the external iliac artery at the pelvic brim/inlet.
What are the potential adverse effects of darbepoietin alfa?
Hypertension, peropheral edema, edema, abdominal pain, dyspnea, cough. Risk for increased mortality/serious cardiovascular events in chronic kidney disease patients, risk for increased mortality and tumour progression in cancer patients.
How is oxygen bound to hemoglobin?
In the deoxygenated form, iron is above the porphyrin plane and is further chelated by a second His, moving the alpha helix and causing the alpha and beta subunits to move away from each other. Salt bridges binding identical subunits break, allowing for the subunits to twist with respect to each other. When oxygen binds, iron is foced back into the porphyrin plane and the subunits are placed together again.
What is the carotid body?
A chemoreceptor that senses oxygen concentration. A small mass of tissue in the septum of the medial side of the common carotid bifurcation.
Describe the classical and alternative complement cascades.
Classical - C1 binds an Ag-Ab complex, splits C2 and C2 into a and b - C4b2b is C3 convertase. It splits C3, C3b joins to form C5 convertase (C4b2b3b). Part of C5 goes to join C6, C7, C8, C9 which creates the MAC (makes holes that lead to lysis). The alternative pathway is when C3 is autocatalyzed (not activated by immunoglobulins).
What innervates the cremasteric muscles?
The GSE fibers of the genitofemoral nerve.
Where is most lost heme from?
85% from erythrocytes with the remainder from hepatic P450 and other cytochromes.
What is arcuatus?
An arcuate uterus. From incomplete fusion of the paramesonephric ducts.
What are the 3 peripheral body compartments?
Tissues/organs you want drug to get to, tissue reservoirs, unwanted sites of action.
Describe the structure of the large intestine.
Cecum, ascending colon, transverse colon, descending colon, sigmoid colon (to rectum). Right colic (hepatic) flexure and left colic (splenic) flexure. Teniae coli are 3 distinct bands of smooth muscle that run longitudinally - contract to form the Haustra (end at rectosigmoid junction). Haustra internally are called semilunar folds/plicae semilunaris. There are omental/epiploic appendices (small fatty projections). Iliocecal valve are 2 semilunar flaps around a slit-like origin.
What are the pros of a bone marrow sapirate and biopsy?
Aspirate - less painful, better cytologic details, report available on the same day.
Biopsy - better architectural details.
How do RBCs and WBCs cross into the blood?
WBCs by reverse diapedesis. RBCs enter via pressure gradient - in red BM, veins leaving are smaller than arteries entering so there is a suction that sucks mature RBCs from the stroma to the capillary.
Detail the embryological development of the female external genitalia.
Stimulated by estrogen. The genital tubercle forms the clitoris, the urethral folds do not fuse and form the labia minora. The genital swellings enlarge to form the labia majora. The urogenital groove is open and forms the vestibule.
What is the origin of the pyramidalis?
Pubic crest.
What is another name for the mouth opening formed by the rupture of the oropharyngeal/buccopharyngeal membrane?
Stomodeum.
What is acquired volvulvus of the sigmoid colon?
Twisting/rotation of mobile loops. Constipation and ischemia, can cause necrosis and immovable collection of compressed feces.
What is blood plasma?
The non-cell components of blood. 46-65% of blood.
What is it called when red blood cells are in a tiny capillary and stack up?
Rouleaux.
What is fibrinogen factor I?
AKA antithrombin I. A trimer of FGA, FGB, FGG gene products. Cleaved by thrombin to active form fibrin, which inhibits thrombin. It mediates clot formation and wound healing (involved in platelet spreading, endothelial cell spreading, fibroblast proliferation, capillary tube formation).
Where does the levator palpebrae superioris originate from and what innervates it?
The sphenoid, CNIII.
What does haptoglobulin do?
Binds free hemoglobin, the complex targets hemoglobin for removal by the spleen.
Describe IgM.
Secreted as Pentamer, first Ig to be secreted in immune response, found mainly in blood. Strong activator of classical complement.
What are antibody isotypes?
Differences in the constant regions of heavy chains.
Describe the pro-B cell.
Early does heavy chain DJ recombination, late does VDJ. Heavy chain expressed with surrogate LC (VpreB+gamma5).
Describe the anal triangle.
From the ischial spines to the coccyx.
How is MHCI processed?
Endogenous antigen binds TAP channel which carries proteins into the R. When it binds TAP, a tapasin binds the antigen onto MHCI. Then the complex is exported to the surface.
What does a JAK3 mutation lead to?
SCID.
What are the infraperitoneal organs?
They are only partly covered by parietal peritoneum. The distal 2/3 of the rectum, urinary bladder.
What cells are in lymphoid tissue besides lymphocytes?
DCs, (APCs derived from monocytes), macrophages (APCs and phagocytes), plasma cells.
What is the arcuate line?
Where the transversus abdominis aponeurotic fibers no longer travel posterior to rectus abdominis. It’s ~1/3 from the umbilicus to the pubic symphysis.
What are protective factors against suicide?
Cultural/religious beliefs/fear of the outcome, future orientation/goals, sense of responsibility to family, impulse control/emotional regulation.
What innervates the parotid gland?
CN V3 via the auricotemporal nerve and great auricular nerve. CN IX gives parasympathetic to the otic ganglion, then to the auricotemporal nerve.
What’s the structure of the rectum/anus?
No mesentery except the appendix. Rectum internally has folds. 3 transverse folds. Anal canal bends 90 degrees posteriorly at penvic diaphragm - anorectal flexure. Divided into upper and lower by pectinate line. There are anal columns (series of longitudinal ridges with superior rectal vessels) with valves at inferior ends. Anal sinuses (small recesses) inferior to valves.
What things can go wrong with esophageal development?
A short esophagus (hiatal hernia). Stenosis if recanalization fails. Congenital Barrett’s Esophagus/CELLO if there’s an arrest in development.
What is DAF?
Prevents binding of C2b to C4b and Bb to C3b. They will displace C2b and Bb.
What are the ways neutrophils can kill pathogens?
NETS, degranulation, phagocytosis.
What does the viscerocranium contain?
Inferior orbit, nasal cavity, oral cavity.
What are all the tonsils?
Lingual (base of tongue), pharyngeal/adenoids (roof of nasopharynx), palatine (lateral wall of oropharynx). The palatine ones have crypts from their stratified squamous epithelium covering. ALso have only efferent lymphatic vessels.
Describe the esophageal hiatus of the diaphragm.
T10. Muscular sphincter. Esophagus, esophageal vessels, and vagus nerve trunks pass through.
What are the adverse effects of epoietin alfa?
Hypertension, fever, headache, puritis, rash, nausea, vomiting, local site injection reaction. Risk for increased mortality/serious cardiovascular events in chronic kidney disease patients, risk for increased mortality and tumour progression in cancer patients.
What type of drug is diphenhydramine?
First-gen H1 blocker, antagonist of H1, antagonist also at muscarinic receptors. Given orally, IM, IV, or topically (the only way that can’t distribute to the CNS).
Where are plasma proteins made? What do globulins do?
In the liver. They do transport, maintain osmotic concentrations, and gamma globulins do immune response.
What is the innervation of the ciliary muscles?
CN III (parasympathetic) to ciliary ganglion to short ciliary nerves.
How does lymph travel into the LN?
Through the endothelial lined subcaprular and peritrabecular sinuses which lead to the meshwork of medullary sinuses, which fuse and become the efferent lymphatic vessels. In the subcapsular sinuses, DCs/macrophages phagocytose things filtered from lymph.
What is the normal adult HbF? What genetic variation makes it persist?
<1%. Genetic variation at position ~158 of G gammaglobin gene.
Describe the the degrees of perianal tears.
Primary- vagina, Secondary - perianal muscles, Tertiary - anal sphincter, Quaternary - rectum.
What are overdose risk factors?
Any prescription for an opioid, high dose opioid prescription, poverty, poly-substance use, age, illness, recent abstinence (e.g. jail/detox/treatment).
After being absorbed into the intestine, what happens to iron?
It exits back through ferroportion, at which point it is converted back to the ferric form by hephaestia or ceruloplasmin.
What percent of plasma is a1 globulins?
5.3%
What is the erectile tissue of the genitals?
Crus of penis/clitoris extends into the corpus cavernosum and blub of penis extends into the corpus spongiosum. Corpus spongiosum terminates at the glans penis, the spongy urethra travels through the corpus spongiosum. Crura covered by ischiocavernosus muscle, bulb covered by bulbospongiosus muscle.
What’s the difference between a full agonist, partial agonist, antagonist, and inverse agonist.
Agonists produce a receptor activation (full to max level, partial to below), antagonists fail to produce activation and also block the effect of agonists, inverse agonists decrease the basal activity of the receptor.
Describe fibrinolysis.
Plasminogen becomes enmeshed in the fibrin matrix. It is converted to plasmin by tissue plasminogen activator (tPA, released by endothelial cells), urokinase, kallikrein, Factos XIIa, or factor XIa. The plasmin cleaves the fibrin clots but also requires fibrin as a cofactor.
What % of leukocytes are monocytes?
3-7%
What is the action of the temporalis?
Anterior part - protraction, posterior part - retraction, whole muscle - closing the mouth.
What is an annular pancreas?
Bifid ventral bud, encircles duodenum and can constrict it.
What cytokines trigger Th0 differentiation into Th17?
EC pathogens (fungi, bacteria) make DCs produce IL-1, IL-6, IL-23, TGFbeta.
What are some causes of ineffective hematopoiesis?
Aplastic anemia, bone marrow cancer.
What is the action of the rectus abdominis?
Flexion of trunk and compression of viscera.
How much of continence is provided by the internal anal sphincter?
80%.
What function does IgD have?
No known function of secreted Ab.
What is the nerve supply to the thyroid?
Superior/middle/inferior cervical ganglion.
How does pyloric stenosis develop and what are the symptoms?
Hypertrophy of the muscle layer of the pylorus. No stool, dehydration, projectile vomiting in week 2, milk-coloured vomit.
Why is stomach cancer difficult to deal with?
Hard to remove all lymph nodes.
What is the immune elimination phase of Ab-Ag response?
Formation and removal of Ag-Ab complex.
What does B12 do that’s related to B9?
B9 is active as THF via DHF reductase (DHFR). B12 is needed for the reaction where methionine synthase turns 5-methyl-THF into THF “folate trap”. - The step generating 5-methyl-THF is irreversible.
What do the epigenital tubules become in embryonic development?
The efferent ductules.
What % of testes descend before birth?
97%. The rest should finish by 3 months of life.
What is the Bohr Effect?
At the tissues, CA in RBCs moves the reaction toward the side of H+ and HCO3- and the decreased pH reduces hemoglobin binding affinity.
What does the obturator nerve course through? Also what are its nerve roots?
L2-4. It travels with the obturator artery and vein through the obturator canal and courses near the ovary.
Describe the red pulp of the spleen.
Filters blood. Has sinusoids and splenic cords of Bilroth. Cords made of reticular fibers. Sinusoids have no reticular cells, all blood has to enter through slits in the wall. Sinusoids lined with stave cells - incomplete basal laminae so cells can fit (at end of lifespan, RBCs can no longer fit and are phagocytosed by macrophages waiting).
Describe IgA.
Secreted as monomer and also dimer - dimer facilitates transport across epithelia into secretions. Most predominant ty pe in gut, is found in gut lumen, in secretions, on mucous membranes. Main function is neutralization.
What are microfold cells?
Found in GALT/Peyer’s Patches. They transfer antigens from the lumen by phago/pinocytosis and present them to DCs/macrophages lying in invaginations of the basal cell surfaces.
When does liver and biliary apparatus embryonic development begin? How does it go?
End of week 3/beginning of week 4 - ventral foregut outgrowth (hepatic diverticulum/liver bud). Cranial portion forms the liver and caudal forms the bile duct - outpocketing forms the gallbladder and cystic duct. Hepatic cords form, intermingle with vitelline veins and form hepatic sinusoids,
What are abtibody allotypes?
Differences of alleles.
Where are B cells activated?
In the boundary of the T cell zone and follicle of the lymph node.
What is the difference between guarding and rigidity?
Guarding is voluntary and often with a grimace.
How does peritonitis present?
Parietal - sharp, well-localized pain. Visceral - generalized referred pain in dermatome of organ.
What shunts are used to treat portal hypertension?
Hepatic portal vein to IVC. Splenic vein to left renal vein.
Describe CX3C-chemokines.
Function through CX3CR, includes fractalkine.
What are peritoneal adhesions?
Visceral peritoneum abnormally adhering to the parietal peritoneum and the adjacent organ.
Describe the aortic aperture of the diaphragm.
Most posterior, T12. Posterior to median arcuate ligament. Aorta, thoracic duct, sometimes Azygos and hemiazygos veins pass through.
What is important to find when removing the gallbladder?
The cystohepatic triangle to determine if there’s variation in the cystic artery and biliary apparatus. Superior border: liver Medial border: common hepatic duct Lateral border: cystic duct
Describe the lacrimal apparatus.
Lacrimal gland at lateral eye, with superior orbital and inferior palpebral part which are separated by the levator palpebrae tendon. Has 6-10 short ducts. At the medial eyelid there is an elevation called the superior and inferior lacrimal papilla. At each one, the opening is the punctum. A short vessel starting at the punctum is called the caaliculus, and it leads to the lacrimal sac. The lacrimal sac drains into the inferior nasal meatus via the nasolacrimal duct.
How do you diagnose sickle-cell disease?
Lab values: reduced hemoglobin, increased reticulocytes, Howell-Jolly bodies in PBS, possible sickle cells in PBS, increased WBCs. Can do sickling test. Hemoglobin electrophoresis will show normal HbA2, predominant HbS, present HbF. Person will have icteric sclera, frontal bossing (marrow expansion).
Describe M of PK-ADME. What are the major enzymes?
Metabolism - conversion of drug into different chemical substances (metabolites). Mainly in liver and in ER. Major enzymes are CYP (cytochrome P450) and UDP-glucuronosyl transferase (increases soulubility).
Describe the embryological development of the female internal genitalia.
Stimulated by estrogen and the absence of testosterone and AMH. The epithelium longitudinally invades the anterolateral surface of the genital ridges. Caudally, the epithelium crosses the mesonephric duct and grows toward the paramesonephric duct on the opposite side - this will become the uterine tubes. The R+L paramesonephric ducts fuse caudally - the tip of the fused part contacts the posterior urogenital sinus wall and forms the sinus tubercle. This will all become the uterus, cervix, upper vagina. The broad ligament is formed when they fuse. The sinus tbercle gives rise to the 2 sinovaginal bulbs which proliferate to form the vaginal plate (canal forms by month 5). The lumen of the vagina is separated from the urogenital sinus by the hymen.
What are the layers of the scrotum?
Skin, Dartos muscle (continuous with Scarpa’s fascia), 3 spermatic layers.
What do the superior and middle thyroid veins run with?
Superior runs with superior thyroid artery, middle runs with inferior thyroid artery.
Where do the adrenal glands derive from embryologically?
Cortex from the mesoderm, medulla from the neural crest cells.
What does the caudal genital ligament form?
The ovarian ligament and round ligament of the uterus.
Describe a subdural hemorrhage.
Often caused by cerebral/meningeal/bridging veins. Hematoma crescent shaped, ignores sutures, creates subdural space. Precipitating trauma may be considered trivial.
What is the lymphatic drainage of the large intestine and rectum?
Descending, sigmoid colon, proximal rectum -> IM LNs. Distal rectum above pectinate line -> internal iliac LNs. Distal rectum below pectinate line -> superficial inguinal LNs.
What are the iron preparation drugs and how are they administered? What are they used to treat?
Carbonyl iron (oral), Ferrous gluconate (oral), Ferric gluconate (IV), Iron dextran (IV, IM). Treat iron deficiency anemia. Ferric gluconate treats it specifically in people undergoing hemodialysis in conjunction with EPO therapy.
What is HbC?
Glu6Lys mutation in beta chain. SC phenotype worse than AS but better than SS. HbAC and HbCC give some protection from Plasmodium falciparum malaria.
Where is the obturator nerve in relation to psoas major?
Emerges from the medial border.
Do all lymphoid tissue have HEVs?
Yes, except spleen.
What is an opsonin?
Attaches to microbe surface and can be recognized by neutrophils/macrophages.
What is the Berry ligament?
Condensation of pretracheal fascia that attaches the thyroid to the trachea. The recurrent laryngeal nerve also passes through.
What are some things that mess with the pulse oximeter readings?
CO, CN, MetHb, COPD.
What is Meckel’s/Ileal Diverticulum?
Outpocketing of ileum when vitelline duct persists. Can be inflamed and associated with symptoms resembling appendicitis. 2% of population, ~2 inches, usually within 2 feet of iliocecal valve, often in kids under 2, 2x more common in males.
What does the greater auricular nerve innervate?
Skin over parotid gland, mastoid process, interior ear, angle of mandible to mastoid process.
What causes sickle-cell anemia and who does it mainly affect?
A Glu-to-Val mutation at amino acid 6 of the beta chain. Is autosomal recessive (just one is ‘trait’, and affects mostly people of Black African Descent. Must be homozygous to have anemia.
What are some ways that microbes have learned to evade complement?
Thick walls, recruitment of host factors ro prevent activation, production of factors mimicking host proteins, production of inflammation inhibitors (e.g. Staphylococcus and CHIPS - chemokine inhibitory protein).
What’s the major change from polychromatophilic erythroblast to orthochromatophilic erythroblast?
The basophilicity is entirely lost, and the nucleus continues to condense.
What is the pretracheal space?
Between investing layer and pretracheal (buccopharyngeal) layer.
How is fibrinogen turned into fibrin?
Thrombin cleaves of fibrinopeptides A and B and forms insoluble fibrin.
Where are the testes at 12, 28, and 32 weeks into development?
12 - inguinal region. 28 - migrates through inguinal canal. 32 - reaches the scrotum.
What organs comprise the hindgut?
Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum and anal canal above pectinate line.
What phenotype do compound HbS/betathalassemia mutation heterozygotes get?
Sickle cell disease, maybe made a little milder by the reduction in hemoglobin concentration.
Describe T cell development.
Starts in the thymus, goes to cortex where stromal cells give it signals and it proliferates for a week and acquires CD2 (DN thymocyte). Goes to the subcapsular region, beta chain does VDJ rearrangement, gets associated with CD3 and the preT alpha chain. Proliferates, alpha chain does VJ rearrangement, expresses CD4/CD8 (DP). The DP thymocyte goes back to the cortex, thymic cortical epithelial cells presents antigen - undergoes positive selection and becomes SP. Negative selection is done by bone-marrow DCs and macrophages.
What is febrile nonhemolytic transfusion reaction?
Destruction of transfused leukocytes (not completely pure blood sample), causes release of cytokines. Happens up to 2 hours after transfusion. Chills, rigors, fever of over 1 degree C. Mild.
What can cause neutrophilia?
Inflammation (infection, burns, MI), drugs like corticosteroids, adhesion and release from marrow stores.
Describe cloacal differentiation.
Week 4-6. Results in urinary bladder, urogenital sinus (pelvic part - membranous urethra and prostatic part, phallic part - penile urethra, vestibule of vagina). The distal portion of the mesonephric duct is incorporated into the posterior wall of the developing bladder and forms the Trigone (the rest of the bladder is formed from mesoderm).
Where does peritoneum derive from embryologically?
Lateral plate mesoderm. It is made of medothelium.
How are T-cell responses terminated?
T cell expresses CTLA-4 which binds B7 better than CD28.
What’s the first symptom of lymphoma?
Painless swollen lymph nodes.
Describe the greater omentum.
4 layered visceral peritoneal structure, connects transverse colon to greater curvature of the stomach. It can move within the peritoneal cavity, is the abdominal policeman.
What makes the brain dura mater different fron the spine dura mater?
It has 2 layers - periosteal and meningeal. Also has no epidural fat.
What is the superficial lymphatic drainage to the abdominal wall?
Above umbilicus - axillary LNs. Below umbilicus - superfiical inguinal LNs.
What is a gastrochisis?
Ventral abdominal wall doesn’t fuse at the linea alba. Intestines come out not covered by anything.
What is the action of the internal obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and ipsilateral trunk rotation.
What is suicidality?
All suicide related behaviours and thoughts including completing/attempting suicide, suicidal ideation, or communications.
How do blood types work?
Fucose transferase adds L-fucose to precursor (if absent, blood type is Oh), then galactosyl transferase adds either N-acetylgalactosamine (A) or D-galactose (B).
Where is the gallbladder located? How do all the ducts go?
Anterior under the right lobe of the liver. The right and left hepatic duct form the common hepatic duct. The cystic duct joins it at the gallbladder spinal fold and they become the common bile duct.
How do you treat agranulocytosis?
G-CSF, GM-CSF.
What PAMP does TLR5 recognize?
flagellin
What organs are part of innate immunity?
Skin, respiratory tract, GI tract, GU tract.
What are vitamin B12 preparations (including cyacobalamin) used to treat?
Pernicious anemia, vitamin B12 deficiency, increased B12 requirements (pregnancy, thyrotoxicosis, hemorrhage, malignancy, liver or kidney disease).
What treatment do you give for cerebral edema?
25% albumin.
Describe sinus hyperplasia.
Lymphadenitis with prominent sinusoids, many histiocytes. Common in nodes draining a cancer.
What is thromboxane?
The vasoconstrictor that induces vascular spasm.
Where is the deep ring of the inguinal canal?
An opening in the posterior wall lateral to the inferior epigastric vessels.
What are the branches of CN V3 (Mandibular division).
Auriculotemporal, buccal, mental.
Describe embryological development of the stomach.
First appears as fusiform, then dorsal wall undergoes rapid growth to give rapid growth. It then rotates 90 degrees counterclockwise (moving vagus nerves). It also rotates alone the AP axis and the pylorus comes down.
What’s the difference between a plasma cell and a mature B cell?
Plasma cells secrete IgM, no longer express MHCII, long lived, can no longer respond to antigen.
When is LDH elevated?
MI and viral hepatitis.
What is the origin of quadratus lumborum?
Medial 1/2 of rib 12 inferior border, tips of lumbar transverse process.
How is MHCII processed?
EC protein is processed in lysosome, MHCII is made in the ER and is bound by invariant protein/CLIP. MHCII goes to the golgi and is in a vesicle, merges with lysosome. The antigen replaces CLIP with the help of HLA-DM. Then the complex is exported to the surface.
What are stroma?
The site in red BM where cell development occurs. Made of reticular cells/fibers - forms 3D network surrounding discrete hematopoietic cords/islands. The cords contain collagen I and III, fibronectin, laminin, proteoglycans (general ground substance) - thelaminin and fibronectin interact with integrins (the integrins are inactivated when the cell is ready to be released into the bloodstream). Stromal cells produce hematopoietic short-range refulatory molecules induced by colont stimulating factors.
What is the conjoint tendon made of?
The medial fibers of the internal oblique aponeurosis and the deeper fibers of the transversus abdominis aponeurosis.
What cytokines trigger Th0 differentiation into Th1?
IC pathogens/microbes make DCs produce IL-12 and NK cells produce IFNgamma.
What are the lymphatic trunks?
Unpaired intestinal, paired lumbar, bronchomediastinal, subclavian, jugular.
What makes something a better antigen?
Better solubility, bigger side, proteins are the best, polysaccharides are ok, nucleic acids and phospholipids weal.
What is CD59?
Binds C8 to prevent pore formation.
What veins make up the external jugular vein?
The posterior auricular vein and posterior ivision of the retromandibular vein?
Where do cranial nerves IX, X, XI exit the head? What are they called?
Jugular foramen. Glossopharyngeal nerve, Vagus nerve, Accessory spinal nerve.
What is the structure of cobalamin/B12? What does deficiency result in?
Cobalt-containing pyrrole ring system similar to porphyrins, comes in -CN, -CH3, -deoxyadenosyl. Deficiency results in anemia, later stages show neuropsychiatric symptoms.
What is hereditary angioedema?
C1 INH or DAF deficiency. Less serum C3, increase in edema fluid.
Describe phagocytosis PRRs.
Also known as scavenger receptors. Bind to bacteria (high mannose affinity), present pathogen derived proteins to T cells and facilitate phagocytosis.
What is the difference between folic acid and leuvocorin (folinic acid)?
Leuvocorin does not need DHFR to be converted to active THF. It’s unaffected by methotrexate, actively competes with it for transport sites, dusplaces it from intracellular binding sites.
What are the ligaments connected to the ovary?
Mesovarium (attaches to lateral pelvic wall, part of broad ligament), Suspensory ligament (to lateral pelvic wall), Ovarian ligament (to the uterus).
What does the inferior vesical artery supply?
Just in men, the inferior bladder, prostate, and seminal vesicles.
What does a deficiency in folate/B9 result in?
Megaloblastic anemia - common in pregnant women/alcoholics. Loss of appetite, weight loss, weakness, irritability, glossitis. In developing fetuses, it can result in incomplete neural tube closure (spina bifida/anencephaly). This is the most common vitamin deficiency in the US.
What do plasminogen activator inhibitor 1 and 2 do?
They can act on tPA and urokinase to stop fibrinolysis.
Who is beta-thalassemia common in?
Black Americans, Greeks, Italians, East Asians, Indians.
What are the types of anemia?
Aplastic (BM), hemolytic, thalassemia, sideroblastic (inability to use Fe for heme synthesis e.g. B6 deficiency), macrocytic/megaloblastic, anemia of renal disease (low EPO).
What are the actions of the inferior rectus of the eye?
Depression, adduction, extorsion.
When eye adducted, only extorsion. When eye abducted, only depression.
What muscles flare the nostrils?
Alar part of nasalis and the levator labii superioris alaeque nasi.
How does 2,3 BPG affect RBCs?
Is an allosteric regulator - present in RBCs equimolar to hemoglobin. It stabilizes the deoxygenated state and therefore reduces the oxygen binding affinity and induces oxygen offloading.
What is the innervation of sphincter pupillae?
CN III to the ciliary ganglion to the short ciliary nerves.
List all the branches of the external carotid artery.
Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Posterior auricular, Maxillary, Superficial temporal.
What is neutrophil oxidative burst?
In phagocytosis, NADPH oxidase makes H2O2 and superoxide - myeloperoxidase in lysosomes uses H2O2 to form HOCl (bleach).
What is intussuception?
Telescoping of one bowel segment into a distal one. Common in iliocecal junction of infants. Bowel obstruction can cause “currant jelly” stool.
What is the first-pass effect?
Amount of drug lost in initial metabolism (by liver).
What is the action of psias major?
Flex thigh at hip, balance trunk, flex vertebral column laterally, acts to flex trunk while sitting.
What are the symptoms of having 50-70% methemoglobin?
Coma, seizures, arrhythmias, acidosis.
What are the paired parietal branches of the abdominal aorta?
Branch posterolaterally and supply muscles. Inferior phrenic (T12), Lumbar (L1-L4), Subcostal (visible at L2 but is actually from the thoracic aorta).
What are medullary cords of lymph nodes?
Sites of high antibody production, they have B cells, plasma cells, macrophages.
What is the coccygeal plexus?
Made of S4, S5, coccygeal nerves. Provides skin sensation in the anal region.
What is the carotid sinus?
A baroreceptor - dilation of the internal carotid. The CN IX is afferent, the CN X is efferent.
What is a deficiency of Factor V called?
Parahemophilia.
What’s the institutional review board?
IRB. It determines the ethicality/legitimacy of a research study including humans. Composed of at least 5 members of varying backgrounds, including a scientist, non scientist, and community member. If the study involves the vulnerable group, it must have a member familiar with the group.
What are the layers covering the testes?
Skin, Tunica Dartos, 3 spermatic layers, Tunica vaginalis (parietal and visceral), tunica albuginea.
What is MCV?
Mean corpuscular volume. PCV/#RBCs. Determines if cell is micro/normo/macrocytic.
What are the borders of the omotrapezoid/occipital triangle? What does it contain?
SCM, clavicle, inferior belly of digastric. Floor is anterior middle scalenes, levator scapulae, splenius capitis. CN XI, nerve point, nerves to muscles of floor, occipital artery, transverse cervical artery, cervical LNs.
Briefly describe IgG.
75% of free Igs, has 2 antigen binding sites, has roles in agglutination, opsonization, pathogen recognition, type II and III hypersensitivity.
What is chronic granulomatosis disease?
NADPH Oxidase defect - cannot make superoxide.
Describe the musculotendinous bands of the diaphragm.
Arise from the anterior surfaces of L1-L3, IV discs, and anterior longitudinal ligaments.
What happens if you have delayed anti-Jka antibodies (Kidd blood group)?
Can cause delayed hemolytic transfusion reaction.
When are glucagon and insulin detected?
Glucagon week 15, insulin in month 5.
What is drug affinity?
How tightly the drug binds to the receptor.
Describe an indirect inguinal hernia.
Lateral to the inferior epigastric artery. Originates from deep inguinal ring and goes through the entire inguinal canal - covered by all 3 spermatic cord layers.
How is folic acid administered?
Oral is preferred, deep IM, SQ, IV.
What are the peritoneal folds?
Medial umbilical, medial umbilical (x2), lateral umbilical (x2).
How do the duodenum and head of the pancreas become retroperitoneal?
As the stomach rotates in developmen, they do as well and are pressed against the dorsal body wall.
What is contained within the superficial neck fascia?
Fat, nerves, vessels, platysma.
What are the effects of diphenhydramine?
Reduction in alergic symptoms (nasal, rash), sedation and anti-Parkinsonian effects via antagonism of CNS muscarinic receptors (can be used as an insomnia short-term therapy), inhibition of nausea, vomiting, vertigo via antagonism of histaminergic and cholinergic signals from vestibular system.
What is the type of stem cell all blood cells come from?
PPSC (multipotent hematopoietic stem cell) that switches to myeloid (CFU-GEMM) and lymphoid (CFU-L) progenitors.
What are the types of alpha thalassemia?
Hemoglobin H (3/4 gene copies gone), Hemoglobin Barts (4/4 gene copies gone). Hemoglobin barts is lethal without transfusions, causes hydrops fetalis, treated by bone marrow transplantations. beta and gamma hemoglobin chains can form homotetramers so there’s not much aggregation.
What does the lesser occipital nerve innervate?
Skin of neck and posterosuperior to auricle.
What’s the major change from proerythroblast to basophilic erythroblast?
Loss of nucleoli (proerythroblast has visible one), cytosol becomes more basophilic. Basophilic erythroblast has lots of polyribosomes.
What is the lymph drainage of the pelvic region?
Superior bladder - External Iliac LNs. Inferior bladder and prostate - Internal iliac LNs. Glans penis/clitoris - Deep inguinal LNs. Ovary, uterine tube, fundus of uterus - Lumbar/Aortic LNs.
Describe the MI plasma protein profile.
CK and Myoglobin peak in 1st day. LDH slowly increases for first day or 2 followed by rapid decline beginning day 3. AST peaks in 2nd day. Troponin peaks around 2nd day and stays elevated.
What are the nerves coming from the nerve point?
Lesser occipital n. (C2), Greater auricular n. (C2-C3), Transverse cervical n. (C2-C3), Supraclavicular n. (C3-C4).
How do mandibular fractures usually present - bilaterally or unilaterally?
Bilaterally except for coronoid process ones which are usually singuular?
What treatment do you give for anemia?
Packed RBCs.
What are the sustenacular cells of Sertoli? What are they derived from?
Found in the seminiferous tubules, produces Mullerian inhibiting substance (AKA anti-Mullerian hormone). (suppresses paramesonephric ducts). They are derived from the surface epithelium of genital ridges.
Where is the minor duodenal papilla?
~2cm above the major duodenal papilla.
How is the bladder attached to the umbilicus?
The apex is attached by the median umbilical ligament (urachus remnant).
What is a chemokine on all bacteria? Why does necrosis induce inflammation?
N-formylated start methionine. Ruptured mitochondria also release these (that’s a reason).
What is the extrinsic clotting pathway?
When there is damage to non vascular tissue. Factor III (a tissue factor) is a glycoprotein in subendothelial tissue that does not normally touch blood. It contacts blood, then binds Factor VIIa -> this activates Factor X. Factor Xa + thrombin activates more factor VIIa.
In cryptorchid, what are the 4 degrees of ectopic maldescent?
Scarpa’s fascia above superficial inguinal ring, root of penis, in perineum, in thigh.
What are the borders and floor of the submandibular triangle? What does it contain?
Bellies of digastric, inferior border of mandible. Floor is anterior 2/3 of mylohyoid, post 1/3 of hyoglossus. Submandibular LNs, gland and duct, facial artery and vein, nerve to mylohyoid (via inferior alveolar nerve via V3).
What is folic acid used to treat?
Megaloblastic and macrocytic anemias, prevention of neural tube defects in the developing fetus.
What is a neoplasm?
Monoclonal proliferation as a result of benign things or cancer.
What is a cirrhotic liver?
Hepatocytes replaced by fibrous scar tissue and regenerative nodules.
Describe C-chemokines.
Function through XCR, includes lymphoactins.
What is the sympathetic innervation of the spleen?
The greater splanchnic and lesser splanchnic nerves.
What is the afferent innervation of the anal canal?
Superior - visceral innervation (lumbar splanchnic nerves). Inferior - somatic innervation.
What’s the largest cause of secondary hypertension?
Renal artery stenosis. Common in elderly.
What are NETS?
Neutrophil extracellular traps. Extracellular decondensed DNA in complex with histone/granule proteins expelled to ensnare/kill microbes. Can also serve as the physical barrier to prevent pathogen spread.
Describe A of PK-ADME.
Absorption - how drugs proceed from site of administration to central compartment (systemic circulation). Quantitative measurement is bioavailability. IV availability of all drugs is 100%.
What does pluripotent and multipotent mean?
Pluripotent - can become all intraembryonic cells. Multipotent - can become all cells of a tissue.
Where are lymphocytes usually clustered in MALT?
In the lamina propria.
