test #34 4.22 Flashcards Preview

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Flashcards in test #34 4.22 Deck (113)
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1

3 determinants of malignant potential of an adenomatous polyp

1. size (> 4cm have 40% risk of malignancy

2. histology: villous more prone to be malignant than tubular

3. degree of dysplasia

2

bell curve: what %age of population falls in 1 standard deviation? 2? 3?

1 standard deviation = 68%
2: 95% (2.5 below, 2.5 above)
3: 99.7

3

where is CCK made

I cells of duodenum and jejuneum.

increase pancreatic enzyme secretion and gallbladder contraction

decrease gastric emptying

4

where is vasoactive intestinal peptide made?

pancreas & parasympathetic ganglia

stimulates intestinal water secretion, counteracts gastrin, promotes bicarb secretion for pancreas

5

classic galactosemia is inherited as..

autosomal recessive

lack galactose-1-phosphate uridyltransferase

6

3 steps of deglutition (swallowing)

1. oral: voluntary
food bolus collected at back of mouth, lifted upwards to posterior wall of pharynx

2. pharyngeal, involuntary
pharyngeal muscle contractions propel food bolus to esophagus

3. esophageal phase
- enters & stretches walls. peristalsis begins above site of distention and moves food down.

7

difficulty swallowing "felt at the throat"

cricopharyngeal muscle dysfunction. diminished relaxation of pharyngeal muscles during swallowing.

8

how does cricopharyngeal muscle dysfunction lead to zenker diverticulum?

diminshed relaxation of pharyngeal muscles during swallowing demands more force to move food bolus down.

more intense contraction of pharyngeal muscles --> increase oropharyngeal intraluminal pressure.

eventually, pharyngeal mucosa herniate through muscle fibers in zone of weakness (posterior hypopharynx).

only mucosa --> FALSE / pulsion (as opposed to all walls of organ --> true / traction)\

can lead to aspiration of food -- bc food stuck in diverticulum high up

can be palpated as lateral neck mass

9

mediastinal lymphadenitis (TB, fungal) can lead to what esophagus problem

scarring & traction --> true diverticula, mid portion of esophagus

10

hemoglobin synthesis in fetus (4)

yolk sac, liver, spleen, bone marrow.

liver begins HbF 10-12 wks of gestation --> spleen --> bone marrow.

11

when does HbF transition to HgA?

HbF (a2y2) --> HbA (a2b2) during first 6 months.

12

a2d2 (HbA2)

normal variant of human hemoglobin. 2-5% of adult hemoglobin

13

hemoglobin gower (z2e2)

earliest hemoglobin in fetus.

synthesized in yolk sac, replaced by hemoglobin portland --> hemoglobin gower 2 --> hemoglobin F (10-12 wks)

14

hemoglobin bart

gamma4.
no alpha made.
alpha thalaseemia.

high affinity for oxygen, never gives it up, get hydrops fetalis

15

muscles that attach to clavicle

-pec major (inferomedial)
-deltoid (inferolateral)
-subclavius (inferolateral)
-trapezius (superolateral)
-sternocleidomastoid (superior medial aspect)

16

where does sternocleidomastoid articulate

3 points:
manubrium, medial clavicle, and mastoid

17

rhomboid muscle articulation

vertebral bodies to medial border of scapula

18

pec minor articultation

3-4th rib, insert on coracoid process

19

serratus anterior

1-8th rib, insert on medial border of scapula

20

subclavius muscle

originates on 1st rib, inserts on inferolateral aspect of clavicle

21

floor of anatomical snuff box

scaphoid and trapezium

22

dupuytren's contracture

benign, slowly progressive fibroproliferative disease of palmar fascia.

as scarring progresses, nodules form on palmar fascia, fingers gradually loose flexibility, eventually resulting in CONTRACTURE that draws fingers in FLEXION

23

celiac comes out at what vertebral level? SMA & renal artery? IMA?

celiac: T12
SMA & renal: L1
IMA: L3

24

transverse duodenum lies at what vertebral level?

L3, between aorta and SMA (can be compressed)

25

ligament of treitz

suspensory ligament of duodenum (connect right crus of diaphragm to duodenal jejunal flexure)

26

what can be compressed when mesenteric fat is lost between SMA and aorta?

left renal vein & transverse duodenum

also occurs w/ pronounced lordosis, or surgical correction of scoliosis

27

filtration fraction =

GFR/RPF

usu = .2 (1/5th of RPF is filtered)

how much of renal plasma flow is filtered

28

how does RPF, GFR, and FF change in SEVERE dehydration

RPF falls a lot
GFR falls less (efferent arteriole constricts to maintain some GFR)
FF goes UP

end up compensating to filter a larger amount of the little incoming renal plasma

29

what forms erythema migrans of ixodes bite? how does it look

erythematous macule that enlarges w/ advancing erythematous borders as BACTERIA MIGRATE slowly through skin outward from inoculation site

classically has central clearing, but NOT ALWAYS!

30

scrofula

caused by mycobacterium scrofulaceum.

found in and around environmental water sources.

characterized by lymphadenitis (usu cervical) in kids