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Zones of the spleen
- red pulp; macorphages
- white pulp; B cells in the follicles, T cells in the pariarterial lymphoid sheaths
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spleenic contracton
- in response to catacohlamines
- Helps to add volume to the system in case of shock, releases stored RBCs and PLTs
- The capsule contracts, myofibroblasts
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PALs
- mostly B lymphocytes surrounded by T
- Surround the central artery
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Flow through the speen
- trabecular artery
- central artery
- penicillar arteriol
- open into red pulp
- splenic sinus
- trabecular vein
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Macrophage activation in the spleen
- nonspecific; recognize morpholocial and biological changes in RBCs
- specific; opsinization with IgG
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Glucocerebroside
- Sphingosine attached to a glucose
- Sphingosine is a ceramide with a fatty acid
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What is an alpha keto acid
- Intermediate in AA synthesis
- oxaloacetate
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What gives the goucher cells the tissue paper look
periodic acid shift positive material accumulate in fibrils
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Hyper spleenism
inlarged spleen prematurely removes RBC, WBS, and platelets
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B-glucocerebrocidase
acts on Beta 1,4 bonds
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Renin
secreted by the JG cells and causes the activation of angiotensinogen
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Where is ACE secreted from
Pulmonary endothelial cells
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Two function of ACE
- convert angiotensin 1 to 2
- degrade badykinin
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Alglucerase
Modified form of human B-glucocerebrosidace
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Moro reflex
the infant startle reflex
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Babinski sign
- near reflex on that the big toe does when the foot is stimulated
- Baby will be positive until nervous system is fully militated
- positive sign in an assault shows nervous system damage, in the pyramidal tract
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What part of the kidney does aldosterone work on
- distal convoluted tubules
- principle cells, Na/K
- enterocytes, Na/H
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Two function of 21 hydroxyls
- progesterone to 11-deoxycoticosterone
- 17-hydroxyprogesterone to 11-deoxycortisol
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without 17 hydroxyls
only the aldosterone pathway would be active
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Granulosa cells
- respond to FSH and convert androgens to estrogen
- theca internal secrete androgens in response to LH
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DHEA synthesis
adrenal glands
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Vitamin D synthesis
- steroid precurser
- calcitrol most active for of Vit D
- begins in the liver and ends in the kidney
- Cholecalcitrol is formed by the skin and needs UV light
- 7 dehydrocholesterol to cholecalciferal (skin) to hydroxycholecalciferol (liver) to dihydrocycholecalciferol (kidney)
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ACTH
released by the anterior pituitary under control form the Hypothalmus (CRF paraventricular nucleus), Binds to the adrenal cortex and stimulated cAMP, this activates protein kinase A and activated cholesterol dismutase
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Enfamil
based on human milk, undigested proteins and fats
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anemia of chronic disease
- low serene iron and reduced iron binding capacity with abundant iron stores. Hepcidin is released by the liver in response to IL1 and TNF, this inhibits iron release
- TNF and IL1 also inhibit the release of erythropoietin
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Cornyobacteria
gram positive
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psedamonus ariganosa
gram negative, common in neutropenic patients
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alginate
- secreted by pseudomoas aeruginosa
- absorbs water quickly
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Lung damage in CF
- viscid mucus causes the bronchioles to become hyperplascia and hypertrophy.
- The bacteria can for abcesses
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CF modifier locus
influences the severity of CF
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Albuteral
- bronco dilator
- relaxes smooth muscle
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Ceftriaxone
- broad spectrum antibiotic
- affective against pneumonia and staphylococcus auras
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cAMP
turns on protein kinase A that phosphorilates the CFTR R domain
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CFTR on bicarb
- CFTR can regulate the secretion of bicarb
- normal alkaline secretion ran now acidic
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Classes of CF
- synthesis
- folding/transport
- regulation, normal abundance of defective channels
- in efficient
- not enough receptors
- cant control other channels
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liver involvment in CF
bile canuliculi are plugged causing portal inflammation
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CF male infertility
bilateral absence of vas deferens
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S3
- protodiastolic gallop
- LV filling
- not heard till halfway through diastole
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S4
- presystolic gallop
- blood being forced into the ventricle by atrial contraction
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vocal fremitus
vibration felt over the chest when a person talks
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creatine
- produced by the live and used as energy by the muscle
- CPK, transfers a phosphate from ATP to creatine to create phosphocreatine
- phosphocreatine is used as energy and its byproduct is creatinine
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creatinine
a marker used to estimate the muscle mass of an individual
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bleb
- large blister
- collection of air in the cells of the visceral pleura
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position of the trachea
- it is anterior to the esophagus
- the sac aorta is anterior to it and then arches over the left bronchi and descends posterior to it
- right bronchi is ppsterior to pulmonary artery in root and left brooch is lower then pulmonary artery in left root
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mean pulmonary arterial pressure
15mmHg
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length of time blood is in the capillaries
- 0.8 seconds
- can be as short as .3 during exercise
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Enoxyparin
- low weight heparin that is broken down quicker and is less potent
- given during pregnancy because it does not cross the pacenta
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Fundaparinux
enhances AT3 binding to factor X
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Risk factors for DVT
- endothelial injury
- stasis
- hypercoagulable
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paradoxial thromboemboli
venous embolus that crosses a heart defect into the arterial system
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What causes thirst in shock
sympathetic reflexes
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Things that raise PT time
- liver disease
- hereditary factor dificiency
- Vit K deficiency
- bile duct abstraction; vit k is fat soluble
- coumarin
- DIC
- blood transfusion
- saicylate intoxication
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What time is used to monitor heparin therapy
pTT
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lactated ringers
- isotonic with blood
- has calcium in it
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gentamicin
antibiotic used to treat gram negative infection
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clindamycin
- used against anaerobic bacteria
- methacyclin resistant staphlococcus areas
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peritoneal organ placement
- retro; kidneys, aorta, adrenals , asc and dec colon, pancrease
- inter; stomach, spleen, transverse colon, liver, tail of pancrease
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kidney innervation
renal plexus from the celiac plexus,least splancnic nerve
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kidney placement
- left is T12-L3
- right it slightly higher
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Ampacillin
- gram neg and pos
- broad spectrum
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metronidazole
anerobic bacteria
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ranitidine
- histamine H2 receptor antiganist
- blocks the stimulation of HCL from parietal cells in the stomach.
- acid would cause irritation to the already damaged mucosa
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meperidine
- demerol
- interacts with sodium ion channels to block pain
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hydrocodone
opiode derivative
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cephalexin
- used as a replacement for PCN
- used for UTI and respiratory infections
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brainbridge reflex
- increase in venous pressure and return increases heart rate
- stretch receipts in the atria
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Acidosis during shock
poor delivery of oxygen leads to increased anaerobic metabolism and increased production of lactic acid
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