Daily Concept Review 2

Hunger

Destruction leads to anorexia, failure to thrive.

Inhibited by Leptin

Basal ganglia

to

prefrontal, premotor and orbital cotrices

• Cortex inhibits GPe ->
• no inhibition of STN ->
• activation of GPi ->
• Inhibition of the thalamus ->
• inhibition of movement

Acute paralysis, dysarthria, dysphagia, diplopia, and loss of consciousness. Irreversible

Caused by rapid correction of hyponatremia

Posterior inferior cerebellar artery

• Pain and temp loss C/L body
• Pain and temp loss I/L face
• No gag reflex
• Horner's syndrome I/L
• nystagmus
• cerebellar problems I/L
• vertigo

• External carotid ->
• maxillary artery ->
• meningeal artery

• red neurons (12-48 hours)
• necrosis & neutrophils (24-72 hours)
• macrophages (3-5 days)
• reactive gliosis + vascular proliferation(1-2 weeks)
• glial scar (>2 weeks)

Liver to duodenum

• Contains: Portal Triad
• - hepatic artery
• portal vein
• Common bile duct

Contains greater and lesser sacs

• Gastric hypertrophy with protein loss, parietal cell atrophy, and increase mucous cells.
• Precancerous
• Rugae of stomach are so hypertophied that they look like brain gyri

• Parkinsonism with dementia and visual hallucinations
• repeated falls and syncope

HISTO: a-synuclein defect

B amyloid deposits in artery -> weakening -> rupture -> recurrent lobar hemorrhage

Congenital disorder with port-wine stains(aka nevus flammeus), typically in V1 ophthalmic distribution; I/L leptomeningeal angiomas, pheochromocytomas.

Can cause glaucoma, seizures, hemiparesis, and mental retardation.

Occurs sporadically

High solubility in lipid and blood = slow induction but high potency

• EFFECTS:
• myocardial depression
• respiratory depression
• increased cerebral blood flow (inc ICP)

• Toxicity:
• nephrotoxic
• malignant hyperthermia

• Agonize Dopamine receptors:
• - Bromocriptine, ropinirole, pramipexole

• Inc dopamine:
• - l-dopa/carbidopa
• - Amantidine (increase dopamine release)

• Inhibit Dopamine breakdown
• - Selegiline (MAOB-I)
• - entacapone, tolcapone (COMT I)

• Dec ach amount
• - Benztropine

• Memantine- NMDA receptor antagonist
• - S/E: Dizziness, confusion, hallucinations

• Donepezil, galantimine, rivastigmine
• - AChE inhibitors
• - S/E: Nausea, dizziness, insomnia

• Methanol
• Uremia
• Diabetic ketoacidosis
• Paraldehyde
• INH or iron tablets
• Lactic acidosis
• Ethylene glycol
• Salicylates

Causes of anion gap metabolic acidosis

• Celiac trunk- T12
• Superior mesenteric artery - L1
• Renal artery- L1
• Testicular/ ovarian arteries- L2
• Inferior mesenteric artery- L3
• Bifurcation of abdominal aorta- L4

Left gastroepiploic <- splenic artery <- celiac trunk

Right gastroepiploic <- gastroduodenal <- common hepatic <- celiac trunk

Transmural esophageal rupture due to violent retching

Autosomal recessive

dec synthesis of apo B -> inability to generate chylomicrons -> dec synthesis of cholesterol, VLDL into bloddstream -> fat accumulation in enterocytes.

• Presents in childhood with malabsorption and progressive ataxia and retinitis pigmentosa
• RBC acanthocytes

fundus/body

• Autoimmune disorder w/ ab to parietal cells
• pernicious anemia
• achlorhydria

Erosions dont invade the muscularis mucosa

ulcers invade the muscularis mucosa

Persistence of the vitelline duct or yolk stalk

• normal -> (APC)->
• early adenoma -> (KRAS)->
• late adenoma -> (P53, DCC) ->
• adenocarcinoma

• Coma (hepatic encephlopathy)
• Scleral icterus
• Fetor hepaticus
• Spider nevi
• Gynecomastia
• Jaundice
• Testicular atrophy
• asterixis
• Bleeding tendency (dec prothrombin and clotting factors)
• Anemia
• Ankle edema

Requires sustained, long term consumption of alcohol

• Swollen and necrotic hepatocytes with neutrophilic infiltration
• Mallory bodies (intracytoplasmic eosinophilic inclusions)

AST > ALT (>1.5)

Occlusion of IVC or hepatic vein with centrilobular congestion and necrosis -> congestive liver disease

No JVD

Associated with hypercoaguable state, polycythemia vera, pregnancy, and hepatocellular carcinoma

• Secondary Biliary Cirrhosis:
• - extrahepatic biliary obstruction -> increase pressure in intrahepatic ducts -> injury/fibrosis and bile stasis

• Primary Biliary Cirrhosis
• - Autoimmune reaction -> lymphocytic infiltrate + granulomas.
• - Inc serum mitochondrial antibody (IgM)

• Primary Sclerosing Cholangitis:
• - Unknown cause of concentric "onion skin" bile duct fibrosis -> alternating strictures and dilation with "beading" of intra and extrahepatic bile ducts on ERCP
• - P-ANCA (60% +)

• DIC
• ARDS
• diffuse fat necrosis
• hypocalcemia (calcium soap deposits)
• pseudocyst formation
• hemorrhage
• infection
• multiorgan failure

• Abdominal pain radiating to back
• Weight loss (malabsorption and anorexia)
• Trousseau syndrome (Migratory thrombophlebitis- redness and tenderness on palpation of extremities)
• Courvoisier's sign (obstructive jaundice with palpable gallbladder)

Reversible blockade of H2 receptors -> dec H+ secretion by parietal cells

• TOXICITY:
• - P 450 inhibitor
• - antiandrogenic effects (prolactin, gynecomastia, impotence)
• - crosses blood brain barrier (confusion)
• - crosses placenta
• - decrease renal excretion of creatinine

PGE1 analog

• - increase production & secretion of gastric mucous barrier
• - decrease acid production
• - maintain patent ductus arteriosus
• - induce labor/ abortion

Sulfapyridine (antibacterial) + 5-aminosalicylic acid (anti-inflammatory)

activated by colonic bacteria

USED: crohns, ulcerative colitis

• TOXICITY: reversible oligospermia and
• skin reactions:
• - erythema multiforme
• - steven johnson syndrome
• - exfoliative dermatitis
• - toxic epidermal necrolysis

Cervix to side wall of pelvis

Contains uterine vessels

Erection- Parasympathetic via pelvic nerve

Emission- Sympathetic via hypogastric nerve

Ejaculation- visceral and somatic via pudendal nerve

Meisosis I is arrested in Prophase for years until ovulation

Meisosis II is arrested in Metaphase until fertilization

Produced in the syncytiotrophoblast of placenta

• Maintains corpus leuteum by acting as LH until placenta makes estriol and progesterone
• Detection of pregnancy (2 weeks in urine)
• Elevated in pathologic states:
• - hydatidiform moles
• - choriocarcinoma
• - gestational trophoblastic tumors

• decrease synthesis of gonadotropin in the anterior pituitary
• anosmia
• lack of secondary sexual characteristics

• Distention of unruptured graafiain follicle.
• Associated with hyperestrinism and endometrial hyperplasia

Malignant

• Abnormal proliferation of both cytotrophoblasts and syncytiotrophoblasts
• no villi are present

• Tumor marker hCG
• inc frequency of theca-lutein cysts

Stromal tumor

• Bundles of spindle-shaped fibroblasts
• Meigs syndrome- ovarian fibroma, ascites and hydrothorax
• Pulling sensation in groin

Firm, fibrous, rock hard mass with sharp margins and small glandular duct like cells.

Worst and most invasive. Most common

Terazosin (a1-antagonist w/ effects on blood vessels)

tamsulosin (a1- antagonist w/ no effect on blood vessels)

finasteride- 5 a reductase inhibitor

Supplies the posterior left ventricle

• B blockade (dec cAMP)
• Systolic heart failure
• Acidosis
• Hypoxia/hypercapnea
• non-dihydropyridine

• polycythemia
• hyperproteinemic state
• hereditary spherocytosis

• DIASTOLIC:
• Aortic regurgitation
• Pulmonic regurgitation

• SYSTOLIC:
• hypertrophic cardiomyopathy

Mitral valve stenosis

Plateau- Ca2+ influx through voltage-gated Ca2+ channels balances K+ efflux

Ca2+ influx triggers Ca2+ release from sarcoplasmic reticulum and myocyte contraction

FASTEST TO SLOWEST

• Purkinje system
• Atrial muscle
• Ventricular muscle
• AV node