Flashcards in test #34 4.22 Deck (113)
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
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)
where is CCK made
I cells of duodenum and jejuneum.
increase pancreatic enzyme secretion and gallbladder contraction
decrease gastric emptying
where is vasoactive intestinal peptide made?
pancreas & parasympathetic ganglia
stimulates intestinal water secretion, counteracts gastrin, promotes bicarb secretion for pancreas
classic galactosemia is inherited as..
lack galactose-1-phosphate uridyltransferase
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.
difficulty swallowing "felt at the throat"
cricopharyngeal muscle dysfunction. diminished relaxation of pharyngeal muscles during swallowing.
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
mediastinal lymphadenitis (TB, fungal) can lead to what esophagus problem
scarring & traction --> true diverticula, mid portion of esophagus
hemoglobin synthesis in fetus (4)
yolk sac, liver, spleen, bone marrow.
liver begins HbF 10-12 wks of gestation --> spleen --> bone marrow.
when does HbF transition to HgA?
HbF (a2y2) --> HbA (a2b2) during first 6 months.
normal variant of human hemoglobin. 2-5% of adult hemoglobin
hemoglobin gower (z2e2)
earliest hemoglobin in fetus.
synthesized in yolk sac, replaced by hemoglobin portland --> hemoglobin gower 2 --> hemoglobin F (10-12 wks)
no alpha made.
high affinity for oxygen, never gives it up, get hydrops fetalis
muscles that attach to clavicle
-pec major (inferomedial)
-sternocleidomastoid (superior medial aspect)
where does sternocleidomastoid articulate
manubrium, medial clavicle, and mastoid
rhomboid muscle articulation
vertebral bodies to medial border of scapula
pec minor articultation
3-4th rib, insert on coracoid process
1-8th rib, insert on medial border of scapula
originates on 1st rib, inserts on inferolateral aspect of clavicle
floor of anatomical snuff box
scaphoid and trapezium
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
celiac comes out at what vertebral level? SMA & renal artery? IMA?
SMA & renal: L1
transverse duodenum lies at what vertebral level?
L3, between aorta and SMA (can be compressed)
ligament of treitz
suspensory ligament of duodenum (connect right crus of diaphragm to duodenal jejunal flexure)
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
filtration fraction =
usu = .2 (1/5th of RPF is filtered)
how much of renal plasma flow is filtered
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
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!