"<img src=""79de421ec4f74933cc84a118699d1fcf.

png"" />" "<img src=""f07f43fbe3ec

4bdb4ca8ab5b2f36d626.png"" />" Neck Marked
"<img src=""ca17a534a1e05160d3839d7febb1336f.png"" />" "<img src=""fb1bdb0fbf8c
38295c5e70ebad8b3bf5.png"" />" Marked Neck
"<img src=""f28f351305703a9caf60db2c643b1bfe.png"" />" "<img src=""56fb92dd2f2f
b93f50bbe7ee8eb21d79.png"" />" Neck Marked
"<img src=""72d8ce139c7830585497913756984875.png"" /><br>What is the vertebral l
evel of the hyoid bone?"
"<img src=""d256bfbf19d69b74f4995c1b7b8a5f0e.png
"" />" Neck Marked
Name 3 organs contained in the neck <br><br>
"<img src=""a899b2476972292fb2a5
0d17b3f71737.png"" />" Neck Marked
What may fracture of the hyoid result in?
"<img src=""6318c99e1f6c4ba4eec5
190aa2847c10.png"" />" Neck Marked
Describe the superficial fascia of the neck <br><br>what 3 things does it contai
n?<br>what muscle is anterior? "<img src=""0256dcbea0750a606333efc840cd6370.png
"" />" Neck Marked
Platysma <br><br>What is the nervous supply?<br>origin?<br>insertion?<br><br>fun
ction? "<img src=""b0d8ea889a7d902b76d08c65ff21e126.png"" />" Neck Marked
Deep fascia of the neck<br /><br />3 layers:<br /><br />What is contained in the
carotid sheath? (6)<br /><br />what is the retropharyngeal space - and its func
tion? "<img src=""24353de5ce61bded789e1bd8692baa01.png"" />" Marked Neck
Name and define the 4 regions of the neck
"<img src=""5e7332e4ac87b0bea271
6259788d573c.png"" />" Neck Marked
Define the borders of the lateral cervical region (3) "<img src=""d6dc283d90c7
7b320f514966edd96c2f.png"" />" Neck Marked
"<img src=""a990ddf059eb1e7d0f7c77ff8c3c1365.png"" />" "<img src=""3161e81b8e40
941fca7b2db2cc5f1209.png"" />" Neck Marked
"<img src=""4fad8f44827b0b93cd7c2e88e51121b8.png"" />" "<img src=""72a027c71efd
5b6c6428c3fa027c6015.png"" />" Neck Marked
"<img src=""c537a7466064296e3712b9942bf33d23.png"" />" "<img src=""f00f05a96793
a66645812f78e41b2d88.png"" />" Neck Marked
"What is happening here?<br><br>Describe: <br><br>method being used - describe p
osition of thumb and index finger<br>3 reasons why this procedure may be done<br
>2 complications <br><br><img src=""c380aa2e6fa2d1d0c459246fe864fae1.png"" />"
"<img src=""bbc4b76d8154905359373b714ad2c5c6.png"" />" Neck Marked
Assessment of EJV<br><br>prominent jugular vein may indicate (4):
"<img sr
c=""82366ce1ea08ee4b64e4091d49f9810f.png"" />" Neck Marked
"<img src=""961c33f8d8842b0ef7f80a542e4b59aa.png"" /><br><br>Name the nerve, nam
e the roots " "<img src=""708f4d043e60ff94db789be9780075f3.png"" />" Neck Mar
ked
"What provides motor supply to SCM? sensory?<br>function?<br><br><img src=""0798
ab24146b6cc8b3dcb7dd35b0960b.png"" />" "<img src=""bd7a2d90df4c7b02690630785776
68f6.png"" />" Neck Marked
What is torticollis?
"Loss of tonic contraction in neck unilaterally (SCM ste
rnocleidomastoid) results in slanted position of head <br><br><img src=""705d1ec
fa01cac7d925af3118f7ac5de.png"" />"
Neck Marked
"Reference: <br><br><img src=""6d3b735487fb14c373a456aa9efd8d1e.png"" />"
Neck Marked
"Reference: <br><br><img src=""ce0fde4ec83e6f08860931cd97d0f0cf.png"" />"
Neck Marked
"<img src=""351cb69db67fb25a5bd61f6a8a26d904.png"" /><img src=""c9b73730ee63beea
df0ef84d6191080e.png"" />"
"<img src=""9c2b06966f94fef9c70d86123336ab48.png
"" />" Neck Marked
"<img src=""6ca6ea81121549a3c3ffa48019794a4e.png"" />" "<img src=""dfa28cfb0d29
128276283a6d708b8fa2.png"" />" Neck Marked
"<img src=""80de096662475057d5faf2ef89851e9c.png"" />" "NOTE: C1 and c2 both fr
om posterior (rather than anterior) rami <br><br><img src=""aa8f3ab426ab5f8e769d
127cad164cbc.png"" />" Neck Marked
"<img src=""64707df04970c5673211f974eb193d0c.png"" /><br><br>Describe the route
of travel for each division of this named artery "
"<img src=""32d81ec84545

e5bac632c23a72204393.png"" />" Neck Marked

"<img src=""d735f80bb4b089d3b37c75c604f182c1.png"" />" "<img src=""9b5a142bb857
9eed3dc98dc470a2c8f6.png"" />" Neck Marked
"<img src=""d31b01dde04092edb3c19a85787435f9.png"" /><br><br>What is the functio
n of these?"
"<img src=""ea41edfab2775234dc98005c72ab4c96.png"" />" Neck Mar
ked
"Name the muscle and its nerve supply <br><br><img src=""9cc3934f116c58af3efcca6
0c6052474.png"" />"
"<img src=""f873ce194b105e1e59c68954f8355294.png"" />"
Neck Marked
"<img src=""307f4c1a9dd7a67cca350402afe3d677.png"" />" "<img src=""5d59b7ecc487
988b0d54e1c55170b453.png"" />" Neck Marked
"<img src=""4137bab8f5ef2a8c3be6319669a99bbd.png"" />" "<img src=""78cf9ca6595e
5e2dbb12f52168709119.png"" />" Neck Marked
"Reference: <br><br><img src=""c91954e4e6c5bae7aeb1fb1f1f405637.png"" />"
Neck Marked
"<img src=""ebc3a565a8e1214941727ae3f54a0fae.png"" />" "<img src=""c00aef1c3a54
457affa1dd5a318fa637.png"" />" Marked Neck
"<img src=""e4ad5a946e68d784907f1c1e10e9a1f0.png"" />" "<img src=""d439ab4829f8
a2c23e572279ac7bf875.png"" />" Neck Marked
"<img src=""99ce371a019b37ce6329345019b24e9a.png"" />" "<img src=""d506b5366e92
92713cc90ec9991e2cc9.png"" />" Neck Marked
"<img src=""3513129a1b45a54da2fc9003706714b8.png"" />" "<img src=""6a0387bcc551
c609e33a4af14b217e4f.png"" />" Neck Marked
"What do you see?<br><br><img src=""cd9a34b3446e2f6fd73719def09525bd.png"" />"
"<img src=""6889d5045d2e1a28743b1cb665c7d2e1.png"" />" Neck Marked
"Reference:<br /><br /><img src=""073d566411cbb21859ac38102f2deee7.png"" />"
Neck Marked
"Reference: Jugular <br><br><img src=""2ca98694cc8782b3c109124645f933a6.png"" />
"
Neck Marked
"Anterior Cervical Region Triangles <br><br><br><img src=""60fb8c1dc6239dcfe928f
68412f9ffe7.png"" />" "<img src=""2ab3251503c96a142600fd581dd69963.png"" />"
Neck Marked
"<img src=""171807aafb2a7ad187a701923a2265ed.png"" />" "<img src=""a2984bebacef
29465e8d5f945d63adf5.png"" />" Neck Marked
"<img src=""e424856a058510eb99dd354144c4526f.png"" />" "<img src=""f1e174360f78
57e2a3b630e81bc71287.png"" />" Neck Marked
"<img src=""bbd3c932fe300c0634c5cbeb5485a938.png"" />" "<img src=""4bfaa07fd90c
4aee4cf3d0810fb796bb.png"" />" Neck Marked
"<img src=""f833773fdf6bc6e7b4e6362a758da5f4.png"" />" "<img src=""88eeb3d0b7ae
cf84a089ccbea2a8cb8e.png"" />" Neck Marked
"Reference: <br /><br><img src=""d9ddcd7729ce5d04ad611c85acb71a3d.png"" /><br />
"
Neck Marked
"<img src=""463e6f3c43ff0070c7d3a0516fea6133.png"" />" "<img src=""5d2e1186a0ff
d963f2caf8c44f6a9dcb.png"" />" Marked Neck
"<img src=""b88097a2763102b6350be03eab4cd61a.png"" />" "<img src=""57bbf6cf272e
903fe9215e66f00af50b.png"" />" Neck Marked
"<img src=""f0423a735b82af3f570b8144d9611d49.png"" />" "<img src=""ee2d1cddaad7
357d00fa10e81ebf5bd8.png"" />" Neck Marked
"Reference: <br><br><img src=""02cd49ab6e37b92be0482f2032cd5e98.png"" />"
Neck Marked
What is:<br><br>miosis<br>ptosis<br>enophthalmos<br>anhydrosis<br><br>what syndr
ome are these 4 symptoms often associated with? "<img src=""5b1ea7d9708c841494b2
b3eddc576ae1.png"" />" Neck Marked
Viscera of the neck<br /><br />What is in the:<br /><br />Endocrine layer (2)<br
/>Respiratory layer (2)<br />Alimentary layer (2)<br /><br /> <b>Endocrine lay
er
</b><br>Thyroid<br>Parathyroid<br><b>Respiratory layer</b><br>Larynx<b
r>Trachea<br><b>Alimentary layer</b><br>Pharynx<br>Esophagus<br>
Neck Mar
ked
"Reference:<br><br><img src=""d719f6f732774fb47f7dee62f752c565.png"" />"
Neck Marked

"Reference: <br><br><img src=""bcc778c5a3071a02cf2cb924c4d09af2.png"" />"

Neck Marked
"Reference: <br><br><img src=""8dbfcf0384e843c8d3877eb3de1cdd48.png"" />"
Neck Marked
"<img src=""d5977473e5d1f80d6aedafd4eaac4946.png"" />" "<img src=""59ffbe2b3497
cf51236eacbfa130e245.png"" />" Neck Marked
"Reference: <br><br><img src=""aed167cc5b03028d795991229786d08f.png"" />"
Neck Marked
"<img src=""f14a1ca1ad28a2de96a628813032a330.png"" />" "<img src=""16c7eda3e409
e6ed44fc07d790f57a60.png"" />" Neck Marked
"<img src=""02a999c2d7fa1b1be96d224256d8f846.png"" />" "<img src=""5b1bd995de60
743ada52583d5a466ac6.png"" />" Marked CRANIALCAVITY
"<img src=""69c6513bd3756bee2271e7510f02db2a.png"" />" "<img src=""f1bc20042ef6
ce7790bb57dd0013b907.png"" />" Marked CRANIALCAVITY
"<img src=""13a6401dad2b60db322ed7a8a355916f.png"" />" "<img src=""0e524d971044
07bb790e6d361d65c406.png"" />" Marked CRANIALCAVITY
"<img src=""5b532793817a480e6b082ea27c3fcd69.png"" />" "<img src=""720385a233f3
4d45238cf7ad2bc53589.png"" />" Marked CRANIALCAVITY
"<img src=""d28ca288a38df090e5da58dbd206171b.png"" />" "Pteriod blow to this re
gion may result in underlying artery this is a weak spot in the skull. <br><br><
img src=""459528ec0d41657e6052ad09b16a3ef7.png"" />"
Marked CRANIALCAVITY
"<img src=""2f2ef6ca402e4524d605b18157a9818d.png"" />" "<img src=""5bf4947d446d
5341cc968cbc27c94b95.png"" />" Marked CRANIALCAVITY
"<img src=""f41104f78796ac962f9ff48e73feaaa2.png"" />" "<img src=""7ce94853584c
622a8ccfbfde5e5be137.png"" />" Marked CRANIALCAVITY
"<img src=""7beedd6ec6f042587a42febd178b020e.png"" />" "<img src=""dac932305905
241577667f88e783db46.png"" />" Marked CRANIALCAVITY
"<img src=""40a62d963ecef39932e2e248b99ade53.png"" />" "<img src=""32699e3e7273
42b0978d9e80df5462a6.png"" />" Marked CRANIALCAVITY
"<img src=""285694ebae3c67f77af743d6e6a8b703.png"" />" "<img src=""b6461aa09cf7
ed9952f3d0c2c04d98bd.png"" />" Marked CRANIALCAVITY
"<img src=""789e3228622448a25e5ff0c1bd841c5c.png"" />" "<img src=""7fd6f746d870
7aca23909a0cbf8280e9.png"" />" Marked CRANIALCAVITY
"<img src=""f3f2dbad53548e9a87e7179302892c97.png"" />" "<img src=""e3a01ba8c3c2
bb3222aadb5b7a6b52e5.png"" />" Marked CRANIALCAVITY
"<img src=""d6edcdcd7e83b5def049a59c1cc3a145.png"" />" "<img src=""9c180d2e3639
71c4aea9f25624fbd037.png"" />" Marked CRANIALCAVITY
"<img src=""82d6e1c2b4202e1c973a9cebafabe379.png"" />" "<img src=""190d36debc38
b320a16aae68a5b9fc9d.png"" />" Marked CRANIALCAVITY
"Reference: <br><br><img src=""8a5291d293f5c3b5610b24405cdf8166.png"" />"
Marked CRANIALCAVITY
"Reference :<br><br><img src=""79e3071a57d7ab5bff2c6957a2a74399.png"" />"
Marked CRANIALCAVITY
"<img src=""bf9739c6f6e6db13dc791afa1e2ed551.png"" />" "<img src=""44e7bdda88bb
d761cb216b467e22d244.png"" />" Marked CRANIALCAVITY
"<img src=""99b674b3aef0b580f9de77e21664ee0e.png"" />" "<img src=""d4a7c0b8da43
919053d381ff13fc0be7.png"" />" Marked CRANIALCAVITY
"<img src=""6052a1c6c9c48b66461644dd97b366bc.png"" />" "<img src=""51a5848a48e8
0403babe0147272b2b0c.png"" />" Marked CRANIALCAVITY
"<img src=""b5bcf45ac179cc2949972b51eb792162.png"" />" "<img src=""c1be13a13bd0
152a1868c95f6c7c4343.png"" />" Marked CRANIALCAVITY
"<img src=""55faccccfedca81c0edfe102da64ff66.png"" />" "<img src=""fbc40efaadde
48b6a8b2b8e722e7342e.png"" />" Marked CRANIALCAVITY
"Reference: <br><br><img src=""6c1a2a35573eec283fa081429c2335f4.png"" />"
Marked CRANIALCAVITY
"<img src=""80d54986ed861603b7d14821b43e75d7.png"" />" "<img src=""9f8cf006d3ae
acdeee6fd26a9f959b73.png"" />" Marked CRANIALCAVITY
"Reference <br><br><img src=""1c92aa43a9b4f1b3bc31dfd91cfcfe0f.png"" />"
Marked CRANIALCAVITY
"Reference: <br><br>Name or numeral both acceptable <br><br><img src=""3c03456d9

754d3aecd73b2ce7687cdb3.png"" />"
Marked CRANIALCAVITY
"<img src=""39e01a6154c93758508c9722a1acf91d.png"" />" "<img src=""11a877435792
f1a1cfed81f43b768968.png"" />" Marked CRANIALCAVITY
"<img src=""76af5f66b200b4039f2fe3aaaf49f370.png"" />" "<img src=""563a47f61122
31ccc3dc1f062188f8b4.png"" />" Marked CRANIALCAVITY
"<img src=""47baf34f8f4ea73bd935830d7af46b9b.png"" />" "<img src=""251f6f78059f
d3b962d38e354fa71b3e.png"" />" Marked CRANIALCAVITY
"<img src=""6458f041a215029b787b27d08d06c16f.png"" />" "<img src=""c5eb03048efc
202110c153e672085279.png"" />" Marked CRANIALCAVITY
"<img src=""01b6ed87914fa008fd89e428ddfe5da6.png"" />" "<img src=""e7a4b63fdfbc
8c7443b630bbc696935f.png"" />" Marked CRANIALCAVITY
"Which cranial nerves exit each opening? and name each opening<br><br><img src="
"89b2afbd4af6ca9e14aab1151b2aac12.png"" />"
"<img src=""ba918488f82efeb1157a
728a871ef4cc.png"" />" Marked CRANIALCAVITY
"Reference: <br><br><img src=""da96cf2f5ea28c8c4accd5301418371a.png"" />"
Marked CRANIALCAVITY
"Reference:<br><br><img src=""a7c5ae4fcc7c570fc0432e01aff4e402.png"" />"
Marked CRANIALCAVITY
"<img src=""0a8da49406e8825807ab9e81bc963bff.png"" />" "<img src=""4fcfebd5cfe6
03ce89464bf21cdbf66b.png"" />" Marked CRANIALCAVITY
"<img src=""52bd0dab5bdfc334e0ab3860c8bd4946.png"" />" "<img src=""5c23a734ea95
b9b8123db645cfce8092.png"" />" BackandVertebrate Marked
"Define:<br>Lordosis<br>Kyphosis<br>Scoliosis<br><br>Where is each seen in the s
pinal column?<br>Also, label the arrow <br><br><img src=""c4414382e09f05e8bb42d8
5c29b28c5f.png"" />"
"Kyphosis - convex curvature of the spine with bulging a
t the back. seen in thoracic region<br><br>Lordosis - concave curvature of the s
pine with bulding in the front. seen in cervical and lumbar regions. <br><br>Sci
oliosis - lateral bending of spine - pathologic<br><br><img src=""db2c8f20c59e7c
a08f1925e14f6febcd.png"" />"
BackandVertebrate Marked
"What muscles are responsible for holding up the head (2)<br>what muscles are ke
y for standing and walking? (2)<br><br><img src=""d478a1f3e3eced9a1e4289136abbf9
e7.png"" />"
"Image Name: Cl. Box 1.200 A - The characteristic curvatures of
the adult spine appear over the course of postnatal development, being only part
ially present in a newborn. The newborn has a ""kyphotic"" spinal curvature; lum
bar lordosis develops later and becomes stable at puberty.<br><br><img src=""031
3fe4a5d2aa21f1487b176b04ea057.png"" />" BackandVertebrate Marked
"Reference: <br><br>Image Name: Fig. 1.2 A - The line of gravity passes through
certain anatomical landmarks, including the inflection points at the cervicothor
acic and thoracolumbar junctions. It continues through the center of gravity (an
terior to the sacral promontory) before passing through the hip joint, knee, and
ankle.<br><br>When joints like the hip / knee are out of alignment you can get
back problems. Brain works to keep eyes level and head over the pelvis so scolio
sis you will see compensatory curvature brain attempts to put the head over the
pelvis. <br><br><img src=""fbbf999c21b6c6413c7652c2a4749aca.png"" />"
BackandVertebrate Marked
"Name the spinous level and landmark <br><br><img src=""61af8800f4eb96a2e681702d
a032bd38.png"" />"
"Image Name: Fig. 1.4 - The easily palpated spinous proc
esses provide important landmarks during physical examination.<br><br><br><img s
rc=""2d98acf1789731fa8eca8a519bed75da.png"" />" BackandVertebrate Marked
"<img src=""1ebb1f63cadeb17d92a76d8400b681c6.png"" />" "<img src=""a6c4219fb5a5
5831623eb64a3ea14917.png"" />" BackandVertebrate Marked
"<img src=""04f3f9c3de9ad9fd51bb8594b38727da.png"" />" "<img src=""1b08228324c5
af4900cf01dfb3504f6c.png"" />" BackandVertebrate Marked
"<img src=""650d24169f9fcd808a35fddc51e9b848.png"" />" "<img src=""7756a50d6e64
b31216aedeff2cb22863.png"" />" BackandVertebrate Marked
"<img src=""bc65af1ecedd1e0db9d0be69338eade3.png"" />" "<img src=""f72e718a7bf1
be626b202e0e84cbfbbf.png"" />" BackandVertebrate Marked
"<img src=""0094abf2b9c2fe8e202131bba29ef1ad.png"" />" "<img src=""e483f37b9319
4433f5752586d3fcafd1.png"" />" BackandVertebrate Marked
"<img src=""848fe321ab1ee74616090e698f7f659f.png"" />" "<img src=""371112e832b0

e60fd8895f8f2174a5f1.png"" />" BackandVertebrate Marked

"<img src=""4ddc9de2e6907a4f6998bc28ad93fe99.png"" />" "<img src=""a898f4e6c64a
b6de29d98bd44c4d76ab.png"" />" BackandVertebrate Marked
"<img src=""fe40c27be850932e833b4d378012fe15.png"" />" "<img src=""33f6bb4b7471
f96a573e45801352ee1b.png"" />" BackandVertebrate Marked
"<img src=""526c040c5f0dfe0f1b211515572b2c5f.png"" />" "Image Name: Fig. 1.22 A
- The orientation of the zygapophyseal joints differs between the spinal region
s, influencing the degree and direction of movement.The zygapophyseal joints lie
45 degrees from the horizontal.<br><br><br><img src=""ea648ee69b1e154913a9e6f42
441dfee.png"" />"
BackandVertebrate Marked
"Define laminectomy<br><br><img src=""67db9cd1003da61cb24bcaaa043b8b6e.png"" />"
"Laminectomy - the surgical removal of part of the posterior arch of a vertebra
to provide access to the spinal canal, as for the excision of a ruptured disk. <
br><br><img src=""ce1f4e96102ace2199955f7a23b622b8.png"" />"
BackandVertebrat
e Marked
"<img src=""7df2e7423471aecfd4cad9333f6f3510.png"" />" "The dimples are the pos
terior superior iliac spines <br><br><img src=""5e5e133f62fa185760b0043745cfc61d
.png"" />"
BackandVertebrate Marked
"what is spondylosis <br />what is spondylolitshesis<br />what is lordosis?<br /
>define spondylo <br /><br /><img src=""20cdec59d0e294468037866329c27695.png"" /
>"
"spondylosis - Spondylosis is a term referring to degenerative osteoarth
ritis of the joints between the centra of the spinal vertebrae and/or neural for
aminae<br /><br />spondylolisthesis - Spondylolisthesis is a condition in which
a bone (vertebra) in the lower part of the spine slips forward and onto a bone b
elow it.<br /><br />Lordosis - excessive lumbar swayback <br /><br />spondylo of or referring to the spinal cord<br /><img src=""226e08fe7f5735e889176d10de418
85e.png"" />" BackandVertebrate Marked
"For reference: <br /><br /><img src=""d71d2d712aad64ac2e89a0958df0a308.png"" />
<br><br>L4 and L5 are the most commonly damaged discs due to lumbosacral angle.<
br>"
BackandVertebrate Marked
List 3 functions of the ligaments of the vertebrale column
Bind vertebrae t
ogether<br>Structural support<br>Limit range of motion<br>
BackandVertebrat
e Marked
"<img src=""39393567f31ff7d0303bccfecbebb973.png"" />" "<img src=""6df9bd8af1eb
16afca47fa6c34d0f099.png"" />" BackandVertebrate Marked
"<img src=""385d298a1cbda5e7475c933e4bbeaf7e.png"" />" "<img src=""bb0e2ebd6ef4
3bd8561d4b548deae0dc.png"" />" BackandVertebrate Marked
"<img src=""b9bfbfbff25bdad6bbaa3f076cb4710e.png"" />" "<img src=""9f844946aa09
9a2ff38bea2d81c55c56.png"" />" BackandVertebrate Marked
"For reference: <br><br><img src=""73df593bfeb9d17fcb64cd047b144634.png"" />"
BackandVertebrate Marked
"<img src=""4166a23b22fe277ffb07c159afb9b886.png"" />" "<img src=""542b1ea31535
6f69f12813e3e3c3ae47.png"" />" BackandVertebrate Marked
"<img src=""c11a48cb8aaeea9ef36bccfa99e02e2c.png"" />" "<img src=""348ab54befbb
7278161ff8560fb5201e.png"" />" BackandVertebrate Marked
"<img src=""2dd7e17f69285eba1c609a926cfc0d7e.png"" />" "<img src=""d2321e63525d
167b88aae3b3eb0ab480.png"" />" BackandVertebrate Marked
"<img src=""4a022834842f8eec80c8154e44902f2d.png"" />" "<img src=""cd8416b4daaa
c2435434bb00a9d8505e.png"" />" BackandVertebrate Marked
"<img src=""f4ba3cf3f422b76d8bc53bb6024f672b.png"" />" "<img src=""26427d1c67cc
1abbc3180905334e4eec.png"" />" BackandVertebrate Marked
"<img src=""f29102ea708458eb5d12d92ad6961011.png"" />" "<img src=""49c3752464c9
e6fafcf5c25b81d70327.png"" />" BackandVertebrate Marked
"<img src=""81b90bae9d8a48d8b9cd36461e191634.png"" />" "<img src=""fa8777072747
c37809cc4c1c515f0627.png"" />" BackandVertebrate Marked
"<img src=""139f5508ccac807a9fa644a3d498734f.png"" />" "<img src=""9c950bc4c5f6
068d6743a564054e98ac.png"" /><br><br><br><br>Straight on force results in trauma
to vertebrate<br>Force applied with neck bent trauma to discs<br>" BackandV
ertebrate Marked
"<img src=""ad3aa3eeea24dcee6478d996757d1c57.png"" />" "<img src=""7ee1ae6b0a1a

3db7e91f6da4a0a127fc.png"" />" BackandVertebrate Marked

"<img src=""ddba6027b2c0d33490ce891212ea896f.png"" />" "lig flava - yellow colo
r due to elastic fibers <br><br><img src=""cf97c13ffb6902329b87846640d2de13.png"
" />" BackandVertebrate Marked
"<img src=""9b10094830bdb4d4278e3dbf45bc703b.png"" />" "<img src=""d85c93b425b3
d21d45a46d5ca76a9872.png"" /><br /><br />Anterior side of disc is very strong du
e to overlapping angles etween each ring. Weakens as you move to posterior aspec
t of the disc. <br />" BackandVertebrate Marked
"<img src=""b9e50ecdab0b594c33df1dc1c41fda6e.png"" />" "<img src=""03b2441c1c5b
d197ac3032a83b67eaf4.png"" />" BackandVertebrate Marked
"<img src=""c6686d1b1d1c6b20ba6a1fc472b45e9a.png"" />" "<img src=""84be41053465
65dcd51b79fbeefe4dda.png"" />" BackandVertebrate Marked
"<img src=""f34cf821568a3dc50f34a5ee60845ed6.png"" />" "<img src=""305c1063a35e
2af52f1c27bfd016d5f2.png"" /><br><br>Image Name: Cl. Box 1.203 C - A posterolate
ral herniation may compress the spinal nerve as it passes through the interverte
bral foramen. If more medially positioned, the herniation may spare the nerve at
that level, but impact nerves at inferior levels.As the stress resistance of th
e anulus fibrosus declines with age, the tissue of the nucleus pulposus may prot
rude through weak spots under loading. If the fibrous ring of the anulus rupture
s completely, the herniated material may compress the contents of the interverte
bral foramen (nerve roots and blood vessels). These patients often suffer from s
evere local back pain. Pain is also felt in the associated dermatome. When the m
otor part of the spinal nerve is affected, the muscles served by that spinal ner
ve will show weakening. It is an important diagnostic step to test the muscles i
nnervated by a nerve from a certain spinal segment, as well as the sensitivity i
n the specific dermatome. Example: The first sacral nerve root innervates the ga
strocnemius and soleus muscles; thus, standing or walking on toes can be affecte
d.<br>" BackandVertebrate Marked
"<img src=""c8b8891b1b0297e85f90f007eae7ad24.png"" />" "<img src=""99c7d65de565
3a3f0f5a8625e7d524cf.png"" /><br><br><img src=""140a73a95cf8e0b6bd0379ecc723d046
.png"" /><br><br>Image Name: Cl. Box 1.203 D - A posterolateral herniation may c
ompress the spinal nerve as it passes through the intervertebral foramen. If mor
e medially positioned, the herniation may spare the nerve at that level, but imp
act nerves at inferior levels.As the stress resistance of the anulus fibrosus de
clines with age, the tissue of the nucleus pulposus may protrude through weak sp
ots under loading. If the fibrous ring of the anulus ruptures completely, the he
rniated material may compress the contents of the intervertebral foramen (nerve
roots and blood vessels). These patients often suffer from severe local back pai
n. Pain is also felt in the associated dermatome. When the motor part of the spi
nal nerve is affected, the muscles served by that spinal nerve will show weakeni
ng. It is an important diagnostic step to test the muscles innervated by a nerve
from a certain spinal segment, as well as the sensitivity in the specific derma
tome. Example: The first sacral nerve root innervates the gastrocnemius and sole
us muscles; thus, standing or walking on toes can be affected.<br>"
BackandV
ertebrate Marked
"Reference: <br><br><img src=""cc4366271cd8a95461e8666faab00082.png"" />"
BackandVertebrate Marked
"Reference: <br><br><img src=""eec2faa41f0feaf25d61471bfa49932b.png"" />"
BackandVertebrate Marked
"Reference: <br><br><img src=""cc8f6c0fce38e2d0abe42a9bdf1419f7.png"" />"
BackandVertebrate Marked
"Reference:<br /><br />Deep Postvertebrale muscles<br /><br /><img src=""23de8e6
ae6f41d7c64fe503fe8452592.png"" />"
"<br /><br />Be able to identify <b>Ilio
costalis, Longissimus, spinalis, and multifidis</b><br />Attachment level define
s terminal descriptor<br />such as longissimus lumborum <br /><br /><img src=""b
afb2fe3a641834a2e3fe2c34fa70a93.png"" />"
BackandVertebrate Marked
"<img src=""8c23e711ef46a4611fe3db732906435e.png"" />" "<img src=""92d14249f306
1e18744f556089724c8d.png"" />" BackandVertebrate Marked
"<img src=""8f228e064e41e1c3540328ce2f818af6.png"" />" "<img src=""33146f1fd4f1
81e676d6338c9c64ed69.png"" /><br /><br />Image Name: Fig. 2.5 B - Removed: Thora

columbar fascia (left). Revealed: Erector spinae and splenius muscles.Sequential

dissection of the thoracolumbar fascia, superficial intrinsic muscles, intermed
iate intrinsic muscles, and deep intrinsic muscles of the back.<br /><br>I = Ili
ocostalis<br>L = Longissimus <br>S = Spinalis<br>M= Multifidus "
BackandV
ertebrate Marked
"<img src=""184a136305e6002198f83359566b05d8.png"" />" "<img src=""a931768245d9
b447f794f4ccf01ca182.png"" /><br>SS=semisinalis (ie semispinalis capitis) "
BackandVertebrate Marked
"<img src=""055a4152626feb9987095a303a5aec56.png"" />" Left splenius cervisis<b
r>
BackandVertebrate Marked
"Reference: <br><br><img src=""228f4b753a78248dc336526298522542.png"" />"
BackandVertebrate Marked
"Reference: <br><br><img src=""6c52355a7f764fd72b324e30635721b6.png"" />"
BackandVertebrate Marked
"3 layers of the spinal cord; what are they collectively referred to as?<br /><b
r /><img src=""a1f9ca4d5ed2e573480c3779cf164134.png"" />"
"<img src=""a727
e2292de0122ec94df4937e57ccf9.png"" />" BackandVertebrate Marked
"Reference: <br /><br /><img src=""fac292d350836274c190dd6a1a13a469.png"" />"
"The conus medullaris (""medullary cone"") is the terminal end of the spinal cor
d. It occurs near lumbar vertebral levels 1 (L1) and 2 (L2). After the spinal co
rd tapers out, the spinal nerves continue as dangling nerve roots called cauda e
quina<br><br>The pia mater of the spinal cord has 21 pairs of denticulate ligame
nts which attach it to the arachnoid and dura maters. Named for their tooth-like
appearance, the denticulate ligaments are traditionally believed to provide sta
bility for the spinal cord against motion within the vertebral column. <br /><br
/>The filum terminale (""terminal thread""), is a delicate strand of fibrous ti
ssue, about 20 cm. in length, proceeding downward from the apex of the conus med
ullaris. It gives longitudinal support to the spinal cord and consists of two pa
rts:" BackandVertebrate Marked
"Reference: <br /><br /><img src=""881ad52a504b7da56bebeb5a849da14f.png"" />"
BackandVertebrate Marked
"Reference Webs<br /><br /><img src=""256b9f9627ea68e534b8a4e8538b1d7a.png"" />"
1 Lecture Marked
"Reference Webs: <br /><br /><img src=""d5c03cd1be9316f7b162359f52d28783.png"" /
>"
1 Lecture Marked
Type I hypersensitivity:<br /><br />Describe symptoms (2-3+)<br />describe cause
s (2-3)<br />T/F asc'd with anaphylaxis?
Allergies to pollen (hay fever), f
ood, drugs, bee stings<br /><br /><b>ACUTE anaphylaxis:</b><br />~150-1500 death
s/year in USA<br />20% recurrence within 2-12 hr of first attack (so carry 2 epi
pens)<br />10% recurrence per year<br /><br /><b>symptoms</b>: <br />onset can
be within SECONDS of exposure<br />difficulty breathing due to airway obstructio
n, angioedema, bronchoconstriction, circulatory collapse (bee stings) death 1-2% (
higher in asthma patients)<br />tachycardia, flushing, urticaria (hives) [ somet
imes vomiting &amp; diarrhea]<br />
1 Lecture Marked
Describe 4 clinical syndromes classified as type I hypersensitivity disorders ie name the syndrome and describe the pathologic manifestations "<img src=""9649
31db1e636ebc429d8b2e4a2a88ec.png"" />" 1 Lecture Marked
Describe the symptoms of anaphylaxis (12)
Skin rash or flushing (wheals/fl
ares)<br>Watering eyes<br>Swelling and itching of mouth and throat<br>Swelling o
f skin, soft tissue<br>Difficulty swallowing or speaking<br>Difficulty breathing
=&gt;asphyxia<br>Abdominal cramps<br>Nausea and vomiting<br>Feeling of impending
doom<br>Hypotension=&gt;shock<br>Syncope<br>Death <br>
1 Lecture Marked
"What is this? What causes it?<br><br><img src=""61af500a5913bdf96ade2be8226350e
0.png"" />"
Dermatographism is caused by pressure, not IgE<br><br>This is a
nervous response rather than an immune response. Trigger may be nervous response
caused by pressure / pain receptors in skin <br>
1 Lecture Marked
"What is seen in each picture?<br /><br /><img src=""9e2bc257f7de9b2e6e010d3714b
317b5.png"" /><img src=""0009d06d23a57d44f7d7bdb1925c8f76.png"" /><img src=""ee2
a042f5c83b531f808d896352154e8.png"" /><img src=""efaa00f4bcd2898b3488adf6e0ac4e9
5.png"" />"
"3 stages<br />1. injury=&gt;redness<br />2. flare aka erythema

<br /><br /><b>3. histamine release </b><br />edema, swelling<br />Wheal = welt,
weal<br />Urticaria (&lt;L. nettle; burning, stinging) hives<br />Pruritis itching<b
r />dermal edema<br /><br /><img src=""8957461612f515532f8e8874883b0283.png"" />
<img src=""ff2d9644fc21e55b7b4570bb71800bb1.png"" /><img src=""e8911ef146332a147
310ce577b40e0ee.png"" /><img src=""d1d6c4fe68b0fa12acc7b8fb72d72fea.png"" />"
1 Lecture Marked
"Geha Case 32: Acute Systemic Anaphylaxis&nbsp;&nbsp;- Read this in the book for
much more discussion<br /><br /><img src=""d8f19c55b4fcea1e80b33548fbf5ab36.png
"" /><br /><br />John Mason. 22 m.o. child whose lips swell after eating peanut
butter cookies<br /><br />1 month later, after eating the same food his symptoms
were more severe:<br />Vomiting<br />Hoarseness<br />Wheezing <br />Facial swel
ling<br />Lethargy, then unconsciousness (syncope)<br /><br />Physical Exam show
s a child under cardiopulmonary stress:<br />BP 40/0 mm Hg<br />Pulse 185<br />R
espiration 76<br />Though not mentioned, he would have looked blue because he wa
s hypoxemic<br /><br>How should this pt. be treated?" A<br>Subcu epinephrine (
adrenaline) <br>IV saline<br>25 mg Anti-histamine (Benadryl)<br>25 mg methypredn
isolone<br>B after 30 min (2X, 30 minutes between)<br>Epinephrine<br>Aeresol albu
terol (2-adronergic agonist)<br>C. <br>Long-acting epinephrine (Susphrine)<br>met
hylprisolone<br><br>Saline up the volume to increase bp<br>Antihistamines / cort
isones are always given&nbsp;&nbsp;- not useful for treating acute episode. <br>
1 Lecture Marked
Define:<br /><br />Allergy<br />Atopy Allergy:<br /> other-responsive <br />&nbsp
;&nbsp;all-ergy=&gt;responsive to unexpected things<br />Atopy / atopic disease a
strange disease<br />&lt; -
s u
f l ce, unusu l <br />(unusu l in
he sen

we exec
immuni
y
 be r
ec
in, n

hgenic)<br /> 1 Lec
ure M rked
Define:<br><br>An hyl xis<br><br>cm re
 rhyl xis
1902: Riche
& m
; Pr
ier<br>immunizing dgs g ins
m rine
xins <br><b> cu
e sensi
ivi
y ins

e d f r
ec
in</b><br> n hyl xis = g ins
r
ec
in<br>Cm re<br>Prhyl xis
, rhyl c
ic rm
ing r
ec
in<br>&l
;Greek hyl x = gu rd; r
ec
in<br>P
hyl c
ery- (r
ec
ive) mule
,
efillin <br> 1 Lec
ure M rked
Lis
&nbs;&nbs;5 cmmn
riggers fr n hyl xis
Inh l n
s <br>Anim l d n
der, llens, huse dus
<br><br>Insec
s
ings <br>eseci lly hymen
er , bees,
w ss, e
c. <br>R rely msqui
es,
icks<br><br>N
ur l rubber l
ex<br>B
h c
1 Lec
ur
n
c
llergen nd n inh l n
<br><br>Medic
ins <br><br>Fds<br>
e M rked
Wh
n
ibdy cl ss medi
es llergic re c
ins?<br><br>Wh
is
he Fc rece
r
fr
his n
ibdy cl ss?<br><br>
Pllen, fds, drugs, llergies<br>Dzen
s
 hundreds f differen
llergens
h
c n
rigger llergy<br>Medi
ed by
he
n
ibdy <b>cl ss IgE</b> ( nd IgG)<br><br><b>IgE is </b><br>A f mily f r
ei
ns e ch wi
h unique n
igen-secifici
y<br>Hundreds f millins differen
secif
ici
ies in e ch ersn<br><b>All f
hem bind
rece
r c lled FcR (=psilon=Grk )
</b><br>
1 Lctur Markd
Dscrib th cascad that lads to an allrgic raction (approx 6 stps from bg
inning until symptoms ar sn)
"<img src=""60acd26709ba2a45545c6a60910
f666.png"" />" 1 Lctur Markd
List causs of mast cll dgranulation (7)
"Dgranulation of mast clls cau
sd by<br>Crosslinking FcR dgranulats mast clls.<br><br>Othr agnts includ:<
br>C5a/C3a<br>chmokins<br>polybasic pharmacologicals <br>nuropptids<br>cold
tmpratur (ractiv airway disas)<br>Exrcis<br>Complmnt protins C5a/C3
a<br><br><img src=""5c1b03af43735673cc84af4add0af.png"" />" 1 Lctur Markd
"Rfrnc: <br><br>Mast cll dgranulation <br><br><img src=""34482388d3f610
419a51a25a3544.png"" />"
1 Lctur Markd
Nam 7 anaphylactics
"<b>Anaphylactic</b><br><span styl="" font-wight:600;"
"></span><br>1. Drug allrgis (.g. pnicillin)<br>2. Allrgic rhinitis/asthma:
<br>a. Sasonal (trs, grass, or wd pollns), <br>b. prnnial (.g. dust mi
ts)<br>3. Food allrgis<br>4. Atopic drmatitis (.g., inhald, ingstd or ab
sorbd allrgns)<br>5. Stinging insct allrgis (.g., fir ants, wasps)<br>6.
Allrgic urticaria (.g., inhald, ingstd or absorbd allrgns)<br>7. Systm
ic anaphylaxis (.g., airway obstruction, hypotnsion)<br>"
1 Lctur Markd
Nam th thrapy and mchanism of action for th following syndroms:<br><br>ana

phylaxis<br>bronchial asthma<br>various allrgis

"<img src=""f45c3c909c6a
b5cc39b3c2148a77bfd.png"" />" 1 Lctur Markd
Dscrib th tratmnt for anaphylaxis in som dtail <br><br>i how to trat a
pt. in anaphylactic shock
Glucocorticoids<br>mild: antihistamins<br>lgs
up=&gt;incras vnous rturn, cardiac output<br>Airway managmnt<br>2 minut t
ourniqut to slow absorption of injctd antigns; no mor than 30 minuts<br>EP
INEPHRINE (EPIPEN) intramuscular *****<br>Intravnous fluids<br>
1 Lctur
 Markd
som long trm prophylactic tratmnts for allrgis ...
<b>Allrgy shots
</b><br>ffctiv for many popl &amp; allrgns<br>NOT an option for food all
rgis<br><b>Food allrgis</b><br>Avoidanc is th only option<br>Patints shoul
d b givn (2) Epi-pns and taught how to us thm.<br>Eat only food prpard un
dr patints suprvision. <br> 1 Lctur Markd
"<img src=""2d9a0bc87fc24735225cb73a328466a.png"" />" "<img src=""29b1c1339a7d
98d3c417bc283ba3ba.png"" />" Lctur 2 Markd
"For rfrnc: - and not th affinity of th FCR is vry high for ig - so th
 fcr is always saturatd <br><br><img src=""bc73ca9a1295653af67d6b462d40.p
ng"" /><br><br>"
Lctur 2 Markd
"Fill in th chart: <br /><br /><img src=""8725c417857c735498679459b27968.png"
" />" "<img src=""c83434530f1842b0677ba2d93bd419d.png"" />" Lctur 2 DidntC
ovr Markd
"Rfrnc: <br><br><img src=""794f02ddac848c3c318f9d69331679.png"" />"
Lctur 2 Markd
Dscrib how FEV may chang during an asthmatic rspons to inhald allrgn
"Lat phas rspons is mor typical of asthmatic rspons. asthma can b st of
f by allrgns, but also othr things <br><br><img src=""6d69fc320a1fa5c260929f
70d69a40.png"" /><br>" Lctur 2 Markd
dscrib 4 common thrapis for allrgis<br><br>2 common thrapis for bronchia
l asthma<br><br>and th most common thrapy for anaphylaxis <br><br>dscrib mc
hanism of action for ach
"<img src=""f45c3c909c6ab5cc39b3c2148a77bfd.png
"" />" Lctur 2 Markd
Dscrib th mchanisms that may xplain th fficacy of allrgy shots<br><br>
<b>Allrgy shots</b><br>ffctiv for many popl &amp; allrgns<br>NOT an opti
on for food allrgis<br>Mchanisms<br>Chronic vs. acut dgranulation<br>Shift
of IgE to othr classs of antibodis<br>Othr supprssiv mchanisms???<br><br>
<b>Rfrnc</b><br>Food allrgis<br>Avoidanc is th only option<br>Patints s
hould b givn (2) Epi-pns and taught how to us thm.<br>Eat only food prpar
d undr parnt or patints suprvision. <br> Lctur 2 Markd
"<b>Cas</b><br><br>Gha &amp; Rosn cas 34: Atopic dtrmatitis<br>2 YO Tom Joa
d th itch that rashs<br><br><b>Symptoms</b><br>Worsning czma<br>Opn skin ls
ions (rosions) with&nbsp;&nbsp;clar fluid oozing &amp; crusting<br>Incrasd i
tching (pruritis)<br>Rdnss (rythma)<br>Swlling (dma)<br><br><b>History:</
b><br>2 months: 24 hours aftr cow milk formula, vomiting, scratching skin<br>9
months: whz, TX with bronchodilators<br>2 Y: hivs aftr ating panut buttr
<br>Fathr has atopic drmatitis<br>Mothr has hay fvr<br><br><b>Exam</b><br>T
mp 37.9o<br>Puls 96<br>Rspiratory rat 24<br>Bp: 95/58<br>Wight 12 kg (10%il
)<br>Hight 90 cm (25%il<br><br>Infctd skin lsions<br>Pustuls<br>Lichnifi
cation (thicknd plaqus)of joints<br>&nbsp;&nbsp;<img src=""a09c8b52f393f30473
6204b7cad545.png"" /><br><br><b>Labs</b><br>+ for Staphyloccus aurus and Str
ptococcus pyogns<br>WBC 9600 /uL<br>41% polys = polymorphonuclar lukocyts = n
utrophils (normal)<br>26% lymphocyts (normal)<br>25% osinophils (normal 0-5%)<
br>High IgE (32,400 IU/ml)&nbsp;&nbsp;(normal 0-200)<br><br>Not: BEN = basophils,
osinophils and nutrophils.&nbsp;&nbsp;Ths ar th thr major typs of gran
ulocyts (clls with larg granuls) found chifly in th blood xcpt in cass
of local infctions.&nbsp;&nbsp;Basophils in th tissus bcom mast clls.&nbsp
;&nbsp;<br><br>Labs: <br><br>Blood volum 4.7L<br><br>Cll
clls
total
total&nbsp;&nbsp;&nbsp;<br>
p
in blood
in body
<br>RBC
5 E6
r uL
2.5 E13
2.5 E13
<br>platlts
2.5 E
5
1.3 E12
1.3 E12<br>lukocyts
7300

3.4 E10
3.4 E10
<br><br>lymphocyts
3000
1.4 E10
7&nbsp;&nbsp;&nbsp;&nbsp;E11<br>nutrophils
4000
1.9 E10
1.9 E10<br>basophils&nbsp;&nbsp;&nbs
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;0-5%<br>osinophils
0-5%<br><
br><b>Dscrib Diagnosis and tratmnt</b><br><span styl="" font-wight:600;"">
</span><br><br>"
<b>Hospital:</b><br>I.V. antibiotics <br>Anti-histamins
<br>Topical&nbsp;&nbsp;stroids (corticostroids) <br>Skin mollints (coal tar, 
tc) <br><br><b>Follow-up</b><br>Skin mollints improv skin barrir<br>Topical
stroids to rduc inflammation<br>Anti-histamins to rduc itching<br>(Tacroli
mus (FK506) as an immunosupprssant)<br>Doubl-blind skin tst for allrgns inc
luding&nbsp;&nbsp;mits, molds, animal dandr, pollns and food allrgns<br><br
><b>Bhavior Changs:</b> <br><br>Rducd xposur to allrgns in hom<br>Avoid
prfumd soaps, doubl-rinsing cloths, cotton cloths<br><br><b>Commnts / Com
plxitis:</b><br><br>Family history of atopic drmatitis<br>20% of patints hav
 mutant fillagrin<br>Undrlying problm with drmis<br>Chronic czma<br>80% of
patints hav dfctiv immunity to viruss, fungi and bctria, spcially in a
ffctd skin.<br>Skin lsions <br>Accumulation of T cll and macrophags<br>High
lvls of&nbsp;&nbsp;cytokins and chmokins that<br>Driv xprssion of IgE<b
r>Attract T clls<br>Irritat drmis<br><br><br>
Lctur 2 Markd
"For Rviw <br /><br /><img src=""bf85a90488126a6ff49291702d5d8.png"" />"
Lctur 3 Markd
What is atopic drmatitis?<br>what is:<br><br>rosion<br>pruritis<br>rythma<br
>dma<br><br> 2 YO Tom Joad th itch that rashs<br>Symptoms<br>Worsning czma
<br>Opn skin lsions (rosions) with&nbsp;&nbsp;clar fluid oozing &amp; crusti
ng<br>Itching (pruritis)<br>Rdnss (rythma)<br>Swlling (dma)<br> Lctur
3 Markd
"<img src=""a7aaa158b1c9c10c99154c28f1819b.png"" />" "<img src=""58cf09b1705
89c0800d0ad4b119f02.png"" />" Lctur 3 DidntCovr Markd
What is a dnni-morgan fold and what dos it indicat? "xtra lin undrnath 
y du to dma in atopic drmatitis - usually indicats allrgy<br><br><img src
=""152dca3f14f57982a04ab155b71c7bc.png"" />" Lctur 3 Markd
"For rfrnc - th structur of sIgG<br><br>not: igE binds fc psilon prtty
much th only function<br><br>Igg is mor gnral it can band 4 diffrnt fc rc
ptors (gamma primarily) it can also bind complmnt protins to activat th co
mplmnt cascad. Binding of igg to its antign will rsult in conformational ch
ang that will mak th fc rgion hav highr affinity for fc. Igg is found at c
oncntrations 100,000x gratr than ig but ig has way highr affinity for its
rcptor. <br><br><img src=""82027014a733c1aa66fbbba854829a6.png"" />"
Lctur 3 Markd
"rfrnc: <br><br>Not that ths antigns ar singl so thy hav bound th a
ntibody but hav not rsultd in a conformational chang. Antigns found on th
surfac of a bactrium will likly rsid nxt to ach othr and dual binding by
an antibody will rsult in conformational chang. <br><br>Igg foldd structur
<br><br><img src=""6f092cc6f6c162d5c47202189ba9a6b1.png"" />"
Lctur
3 Markd
"<img src=""3644020131a6f22973264bbf793b.jpg"" /><br><br>Fill in th chart f
or IGA" "<img src=""2b592c9d4f8834360a202218fd21665.jpg"" /><br><br><img src=""
3b2f97c26115fc9441fdbc269786f45.jpg"" />"
Lctur 3 Markd
"<img src=""3644020131a6f22973264bbf793b.jpg"" /><br><br />Fill in th chart
for IgD"
"<img src=""3644020131a6f22973264bbf793b.jpg"" /><br><br><im
g src=""013139a579f58cd00821c91ab0773610.jpg"" />"
3 Lctur
"Fill in th chart for IgE<br><br><img src=""27f6c83322cba1c6cb51d01cb663da1.jp
g"" />" "<img src=""27f6c83322cba1c6cb51d01cb663da1.jpg"" /><br><br><img src=""
722f9368383c2da6022155d38c838a2.jpg"" />"
3 Lctur
"Fill in th chart for IgG<br><br><img src=""a96c382319904c422f6c46a2f48.jp
g"" />" "<img src=""a96c382319904c422f6c46a2f48.jpg"" /><br><br><img src=""
dfa4a858bcac3d4b7d7b0685dc2c1.jpg"" />"
Lctur 3 Markd
"Fill in th chart for IgM<br><br><img src=""52400889ffb41fdb35925391d502c83.jp
g"" />" "<img src=""52400889ffb41fdb35925391d502c83.jpg"" /><br><br><img src=""
5d70a47ac9869483c54d88f052.jpg"" />"
Lctur 3 Markd

Dfin <br><br>Opsonization
Opsonization<br>&lt;Opson- (Grk): rlish, spc
ial food/ fish<br>Opsoniz- mak somthing apptizing for phagocyts to at!<br>
Lctur 3 Markd
What is:<br><br>phagocytosis<br>pinocytosis<br>ndocytosis<br>phyllophagocytosis
<br>autophagocytosis<br><br>what changs ar rquird as far as cll cytosklta
l componnts go?<br>what dos this lad to - i what is th fat of th ingstd
matrial?
spcializd form of ndocytosis<br>Pinocytosis (small)<br>Endoc
ytosis<br>Phagocytosis<br>Phyllophagocytosis (apoptotic bodis)<br>Autophagocyto
sis&nbsp;&nbsp;(aka. Autophagy)<br>Rapid changs in microtubuls, actin filamnt
s, mmbran gomtry<br>Lads to ndosom fusion, acidification<br>
Lctur
3 Markd
What is th phagocytic cup?<br><br>
"(probably not to mmoriz)<br><br> Th
phagocytic cup. <br>
Psudopod xtnsions drivn actin polymrization (no
t shown) and facilitatd by local phosphatidic acid (PA) from phosphatidylcholin
 by phospholipas D (PLD). PA is a con-shapd&nbsp;&nbsp;lipid, allowing it to f
acilitat local ngativ curvatur. In th xampl shown, PLD is activatd by si
gnals from FcR.<br><br><im src=""9a931e470cd199ae06ca5a7be3e82120.pn"" />"
Lecture 3 Marked
Principal fxns of phaocytes<br><br>name 6
Removal of dead cells<br>Wound r
epair<br>Inestion and destruction of bacteria<br>Antibody-dependent cellular cy
totoxicity (ADCC)<br>Immune reulation: cytokines and chemokines<br>Antien proc
essin and antien presentation to T cells<br> Lecture 3 Marked
name 3 specialized types of phaocytes<br><br> Neutrophils-&nbsp;&nbsp;&nbsp;fi
rst responders<br>Macrophaes- tissue resident; second responders<br>Dendritic c
ells- specialists in immune reulation and antien presentation<br><br>Almost an
y cells- uptake of neihborin apoptotic cells<br><br>To note:<br><br><br><br>Ne
utrophils activated by wound. First on scene release chemokines to attract macro
phaes. They die soon after inestin prey macs clean up dead neutrophils. <br>D
endritic cells rare but very important for communication with T cells. <br>
Lecture 3 Marked
tissue resident macs - name the ones present in the:<br><br>liver<br>lun<br>spl
een<br>kidney liver- <b>Kupffer</b> cells&nbsp;&nbsp;[AKA sternzellen; stellat
e macrophaes]<br>lun- <b>interstitial</b> and <b>alveolar</b> macrophaes<br>s
pleen- <b>splenic</b> macrophaes<br>kidney <b>interstitial</b> macrophaes<br>
Lecture 3 Marked
"name 3 antien receptors found on - NK cells / macs / antibodies?<br><br><im s
rc=""69f0221a0e832c63a8b6dceaaa9e2717.pn"" />" "CD16 relatively low affinity FC
receptor for i but very common. Important in ADCC. Hih affinity cd64 importa
nt for phaocytosis. <br><br><im src=""e60d82e1d06d6f4427dad817a44bb6ef.pn"" /
>"
Lecture 3 Marked
Killin bacteria <br><br>name 5 thins phaocytes / the immune system uses to ki
ll bacteria
<b>Cationic Proteins</b>&nbsp;&nbsp; a and b defensins. These are
active at neutral pH<br><b>Hydroen ion</b> pH drops to 3.5 to 4.0 in the phao
lysosome by means of an enery dependent process<br><b>Proteolytic enzymes</b> a
ctive at acid pH These diest bacterial proteins, complex carbohydrates, and nuc
leic acids<br><b>Reactive oxyen</b> O2-, H2O2, OCl-, NO and others, enerated b
y NADPH oxidases. <br><b>Nutritional competitors</b> - lactoferrin and vitamin B
12 bindin protein sequester critical nutrients<br>
Lecture 3 Marked
"For reference: <br><br>note: C1q - part of the complement cascade. Binds at the
'top' of the fc reion <br><br><im src=""4c2063a58f4e047bdc3efe871fd72228.pn"
" />"
Lecture 3 Marked
What is frustrated Phaocytosis?<br><br>What is released and what is the effect?
<br><br>When may this pathway be activated besides durin an infection? "<b>Part
icles too bi to inest or inestion blocked.</b><br><span style="" font-weiht:
600;""></span><br><b>Release of lysosomal contents:</b><br>Enzymes<br>Reactive o
xyen intermediates<br>Hydroen ions<br>Host tissue injury<br><br><b>Intracellul
ar effect</b><br>Activation of inflammasome<br>Release of interleukin-1<br><br>N
ote that this pathway is often active in autoimmune disorders as macrophaes att
empt to phaocytose endothelium coated in autoantibodies <br><br>"
Lecture
3 Marked

The complement cascade<br><br>what are the 3 initiatin pathways?<br><br>what is

the common midpoint?<br>what enerates the MAC?<br>what components act as anaph
ylatoxins?<br>what is an anaphylatoxin?<br>where are complement receptors found
and what is their function?<br><br>what test has traditionally been used to test
for complement proteins in serum?<br><br>
<b>Three initiatin pathways</b>
<br>Classical pathway activated by IG1, IG3 and IM<br>Alternative pathway<br>
Lectin pathway<br><br>C3 is common mid-point<br><br>C5-9 enerate membrane attac
k complex (MAC)<br><br>C3a and C5a framents are anaphylatoxins.<br><br>The C3a,
C4a and C5a components are referred to as anaphylatoxins. they cause smooth mus
cle contraction, histamine release from mast cells, and enhanced vascular permea
bility.[5] They also mediate chemotaxis, inflammation, and eneration of cytotox
ic oxyen radicals<br><br>Complement receptors on phaocytes opsonize.<br><br>Re
ulatory mechanisms at almost every point.<br><br>Test for complement sheeps bloo
d coat with antibody thn s if MAC can lys RBCs (mac from pt blood sampl) us
d to tst for complmnt activity / dpltion <br><br><br>
Lctur 3 Markd
"Rfrnc: <br><br><img src=""ab5a45c8947ab65b1fa282a9bfbcd.png"" />"
Lctur 3 Markd
"<img src=""28344488acb671019857610333c1d4a.png"" />" "<img src=""8694c4bd2
823ffa3968cb3783f58.png"" />" Lctur 3 Markd
"Stps in th complmnt cascad - important <br /><br /><img src=""4335d619519
b25c8aa71a1b9bccc75.png"" /><br><br><img src=""561ccadf6a399b7b6d139b186a19d
.png"" />"
Lctur 3 Markd
"<img src=""015df5d66c4fd992677561390dbd5c5.png"" />" "<img src=""56a63db1af97
dd1797108dfc491182.png"" />" Lctur 3 Markd
"To not <br><br><img src=""5a189cb540834ff2022f31a90523c6.png"" />"
Lctur 3 Markd
Cas 6<br><br>Dolly Obionsky, collg frshman<br>Rports cough, diarrha, hada
ch, stiff nck<br>Exam<br>BP&nbsp;&nbsp;74/40<br>Puls 123<br>Rspiration 24<br
>Tmp&nbsp;&nbsp;39.2oC<br>Ptchial rash on chst<br>Rd throat with nlargd t
onsils<br><br><br>Actions:<br>IV Cphtriaxon (suspcting bactrial mningitis)<
br> Assays:<br>Lumbar punctur CSF grows out N. mningitidis<br> History<br>Doll
y rports mningococcal mningitis two yars prviously Tip-off rar to gt mni
ngitidis twic. So think dfct in MAC somwhr in c5-c9<br><br>On sistr had
mningitis th prvious yar.<br><br> CH50 assay rports ZERO complmnt-fixing
activity in Dollys blood.&nbsp;&nbsp;This assay masurs th ability of patints b
lood to lys shp rd blood clls coatd with anti-shp RBC antibodis (from r
abbits). Th assay taks about 15 onc th dilutions ar mad and th ragnts mi
xd.<br><br>Thr sistrs hav zro activity, including th sistr who had mnin
gitis.<br>On sistr has normal lvls.&nbsp;&nbsp;<br>Mothr has CH50 of 50% no
rmal<br>Affctd sistrs all lack C8<br>Mothr has half-normal lvl of C8.<br><
br>
Gha Cas 6&nbsp;&nbsp;Complmnt Factor 8 dficincy<br><br>Tak-homs:
<br>Dfctiv formation of th MAC (mmbran-attack complx) =&gt;unabl to punc
h hols in bactria<br>Patints ar charactristically snsitiv to infction by
Nissria sp.:<br>N.&nbsp;&nbsp;mningitids&nbsp;&nbsp;(bactrial mningitis)<
br>N. gonorrhoa<br> Lctur 3 Markd
Nam 5 ffctor functions of antibodis
"Antibody ffctor functions<br>
<br><img src=""4f7a0fccdac5d02dc48d272bb48f.png"" />"
Lctur 4 Markd
Brifly dscrib th procss of ADCC<br><br>what rcptors ar important?<br>wha
t clls?<br>
"<img src=""08a5fdfd9985a39f3cda36a9cf94c37.png"" />" Lctur
4 Markd
Nam 3 pathways that may initiat th complmnt cascad. <br><br>What molcul
is at th common convrgnc of ths pathways?<br /><br>what ar anaphylotoxins
?<br><br>what disas is associatd with rrors in th classical pathway?
"<img src=""0bcc149494b8b588f63b2b851ac5d5a.png"" /><br><br>Classic pathway- an
tibody mdiatd<br>Altrnativ pathway clavag of c3 initiats th cascad (ind
pndnt of microb) also, c3 can spontanously clav. C3 is critical to this p
athway classical pathway is not narly as important as th altrnativ pathway.
Lupus and lupus-lik syndroms ar associatd with rrors in th classical pathw
ay. <br><br>Lctin pathway can rcogniz sugars on bactria. <br><br>C3 clavag
rsults in 2 pics c3a and c3b c3b opsonizs targt cll via covalnt binding;

c3a mdiats inflammation. C5a is also an anaphalyotoxin (lik c3a). C5b aids i
n rcruitmnt of MAC to targt. <br>" Lctur 4 Markd
Dscrib th c3 convrtas in th:<br><br>altrnativ pathway<br>classical pathw
ay<br>lctin pathway<br><br>
"Study and know this diagram<br><br><img src=""a
0017188279cd17ad58a98bfd7bccf.png"" />"
Lctur 4 Markd
Dscrib svral pathogns and nonpathogns that can initiat th complmnt cas
cad via th altrnativ pathway<br><br>pathogns (8)<br>nonpathogns (6)<br>
"Altrnativ pathway: many activators<br><br>A surfac for covalnt dposition o
f spontanously formd C3b.<br>Ig complxs th altrnativ pathway, too.<br><br
>This list isnt so important- but you must know that th altrnativ pathway is V
ERY rsponsiv to many triggrs including Ig (just not through C1q).&nbsp;&nbsp;
This hlps xplain why dfcts in th classical pathway hav a pculiar pattrn
of autoimmun pathology- systmic lupus rtythmotosus, in particular,&nbsp;&nbs
p;rathr than a profound immun dficit.&nbsp;&nbsp;Wll discuss SLE in anothr s
ssion.<br><br><img src=""a04f759bf9311728ad14d6d708f68d.png"" />"
Lctur
4 Markd
What forms th MAC?<br><br>what dos ach componnt do? "8-6 Th MAC attack<br><
br>C5 initiats<br>C6, 8 assist<br>C7 anchors<br>C9 forms por<br><br><img src="
"52d133ca4607d10202360354d20227.png"" />"
Lctur 4 Markd
Rfrnc: <br><br>som sid ractions of complmnt:<br><br>C2a is clavd by
plasmid to gnrat C2 kinin, causing dma<br>C3b binds CR1 on phagocyts<br>C3
d (from C3b) binds CR2 (=CD21) on B clls activation<br>C5a&nbsp;&nbsp;100X&gt; C3
a (1000X&gt;C4a) ar chmoattractants for lukocyts<br>
Lctur
4 Markd
For rfrnc: (important)<br><br>Complmnt inhibitors<br><br>Complmnt is a v
ry fast fd-forward systm<br>Inhibitors at vry phas provid chcks<br>Inhi
bitors of ach of th thr initiation mchanisms<br>Inactivation of C3b<br>Inhi
bitors of C5b and MAC formation<br>Location of many inhibitors on host clls&nbs
p;&nbsp;prvnts attack on slf.<br>
Lctur 4 Markd
What is th function of Factor H and factor I?<br /><br />What maks up th c3 c
onvrtas?
"Factor H and I clav C3b<br />iC3b inactivatd c3b. It can sti
ll b involvd in opsonization, but is not activ in th fd forward systm. <b
r /><br /><img src=""39205225c65db399270af6880b8f8.png"" /><br /><br /><img s
rc=""313b90b15098d9578ac52af16da7b.png"" />" Lctur DidntCovr 4 Markd
"Rfrnc: <br><br>important, and complicatd. undrstand what is going on. <br
><br>Takhoms varity of inhibitory mchanisms if thy go awry thr ar probl
ms. <br><br>Dcay Acclrating Factor, C1 INH<br><br><img src=""22598f5819c9dd
1db7cf7237f646dd.png"" />"
Lctur 4 Markd
"Fill in th chart.<br /><br /><img src=""58957647073713678f0f4cc9539c1.png""
/>"
"Th point hr is that thr ar many ways of supprssing th complmn
t cascad, which would othrwis&nbsp;&nbsp;caus lthal damag to slf.&nbsp;&n
bsp;This focusss th ffctor function of complmnt on non-slf.<br /><br /><b
r /><img src=""16c6265bf5b6621cfb181f8dfa5a.png"" />"
Lctur 4 Markd
Complmnt dfcts: <br /><br />what may dfcts in th positiv mchanisms of c
omplmnt rsult in?<br />what may dfcts in th inhibitory mchanisms of compl
<b>Dfcts in positiv mchanisms</b><br />Rar ~.03% ho
mnt rsult in?
mozgyosity for all dfcts combind<br />Classical pathway- SLE, with incrasd
infction.&nbsp;&nbsp;&nbsp;<br />C3 dficincy lthal<br />MAC Nissria infcti
ons spcially<br /><br />Must liminat antign-antibody complxs failur to d
o so will rsult in typ 3 hyprsnsitivity raction i systmic lupus rythmato
us (SLE). RBCs scavng antibody-antign complxs complmnt mdiats loading o
f complxs onto RBCs to clar ths complxs from th body. Failur of this sy
stm can rsult in lupus (chif rsult). this is a rsult of dfct in classical
pathway. <br /><br /><br /><b> fcts in inhibitory mchanisms</b><br />Inhibit
ory mchanism<br />Hrditary angionurotic dma dficint in C1 INH<br />Parox
ysmal noctural hmoglobinuria- dficint in DAF<br /> Lctur DidntCovr 4 Mar
kd
"Rfrnc: <br><br>Rad chaptr 11 of Abbas for dtails<br><br>Typs i-iii anti
bodis ar chif mdiators typ I is igg; typ ii,iii usually igg or igm. Diffr
nc btwn ii and iii has to do with who is doing th acut pathology in typ

iii it is clls th clls could b nutrophils / othr phagocyts frustratd pha
gocytosis is th pathologic mchanism. In typ ii, th pathology is initiatd by
th antibodis- complmnt activation and activation of phagocytosis. <br><br>G
ll and Coombs classification of hyprsnsitivity<br><br><img src=""35b115630952
15845273ab96f041.png"" />"
Lctur 4 Markd
Contrast typ II and typ III Gll and Coombs snsitivity
"<img src=""37d
fbf5a195d3ca9c1548f87ffd07.png"" /><br /><br />Diffrnt mchanisms and&nbsp;&
nbsp;sit of raction<br /><br />Typ iii larg dposits of complxs can prcip
itat out of th bloodstram activating complmnt and rsulting in frustratd p
hagocytosis. Typ iii rcruits othr clls which thn caus damag. Typ iii lot
s of bystandr damag. <br />" Lctur DidntCovr 4 Markd
Myasthnia Gravis <br /><br />Adult onst diplopia<br />Ptosis of ylids and li
mitd xtraocular movmnts<br />Myasthnia gravis. ~0.5-5/100,000 prvalanc<br
/><br />Anti-actylcholin rcptor=&gt;paralysis ;problms with gait, fatigu,
&nbsp;&nbsp;&nbsp;(; normal rflxs<br />3 mchanisms of Ab ffct<br />Incras
d ndocytosis and dstruction of ACh rcptors<br />fix complmnt nrv dstruc
tion<br />rcptor blockad<br />transplacntal ffct on ftus<br /><br />Somo
n should ask: why is thr a transplacntal ffct on th ftus?<br /><br />Aut
oantibody against actylcholin rcptor (igg or igm or both) it can inhibit th
rcptor in svral ways can bind and rsult in inactivation of rcptor / can
caus conformational chang of rcptor that inactivats it; it can caus ndocy
tosis of rcptor, tc. nd rsult is that thr is not a propr rspons to ac
tylcholin this rsults in nrv dstruction and rcptor blockad. <br /><br />
Thr is a transplacntal ffct on ftus baby is born with myasthnia gravis-li
k symptoms. This is mdiatd by igg igg is th only antibody that can cross th
placnta. This systm is important for arly immun systm function igg is also
in milk, iga is in milk as wll, but iga dos nt go through th placnta. <br /
><br />Igg cross placnta mdiatd by FCRn n=nonatal FCRn xprssd in gut, for
transcllular trafficking of igg. Clls can also stor igg intracllularly thy
uptak th igg using fcrn this is on of th primary rasons iggs half lif is s
o long (i 20-23 days) <br /><br /><br /><b>Contrast a normal NMJ to an NMJ in M
yasthnia gravis</b>
"<img src=""b079352606089185d48f2cbfd43d05f2.png"" />"
Lctur DidntCovr 4 Markd
Cas study: <br /><br />May 1991.&nbsp;&nbsp;Vry fit 66 yo, whit mal faints w
hil jogging around Camp David, Maryland. <br />shortnss of brath, tightnss i
n chst, xtrm fatigu.&nbsp;&nbsp;tachycardia. Pt. admittd to Bthsda Naval
Hospital.<br />Pt. admits fling incrasingly tird 2 wks prior. Lost 9 obs.
in two months; hands shak svrly. <br />Diagnosis <br />Hyprthyroidism; Grav
s disas.<br />Curiously, his wif also has Gravs disas.<br /><br />Facts a
bout Gravs disas<br /><br />Incidnc&nbsp;&nbsp;~1/1000<br />familial trnd
s<br />associatd with bactrial infctions (molcular mimicry?)<br />infiltrati
on of activatd lymphocyts into thyroid<br />Antibodis binding thryoid-stimula
ting hormon rcptor (TSHR)<br />TSHR ovr-stimulation<br />xcssiv productio
n of thyroid hormon<br />Tratmnt: block thryoid hormon production/action<br
/><br />Cytokins gnratd by infiltrats&nbsp;&nbsp;in th gland may also caus
 pathology, but th antibodis sm to b th chif&nbsp;&nbsp;culprit in th m
ajor symptomotology.<br /><br />Ths ar agonistic TSHrcptor antibodis<br />
<br /> Lctur DidntCovr 4 Markd
Autoimmun thyroid disas<br /><br /><b>Gravs&nbsp;&nbsp;disas</b><br /><br /
><b>Hashimotos lymphocytic thyroiditis</b><br />3-4% prvalnc. <br />antibodis
against thyroglobulin and thyroid proxidas (TPO)--&gt; block production of th
yroid hormon--&gt;HYPOthryodism<br />--&gt;inflammation, might hav CTL-mdiat
d dstruction.<br /><br /><b>postpartum thyroiditis</b><br />5-8% incidnc with
in 6 mo. post-partum<br />complmnt-fixing anti-TPO antibodis<br />
Lctur DidntCovr 4 Markd
"Cas<br /><br />Gwndolyn Fairfax, 34 yo, no significant history<br />Prsnts
with fvrish cough, worsning.<br />Signs &amp; Symptoms<br />palms of skin whi
t (Whit palms anmic )<br />38.5oC, rspiration 30 (vs. 20)<br />Scattrd rho
nchi at bas of ach lung<br /><br />Hmatocrit 26% (vs. 38-46)<br />Hb 9.5 g/dl
(13-15)&nbsp;&nbsp;&nbsp;<br />WBC&nbsp;&nbsp;11,300/uL vs 7300<br />Platlts&

nbsp;&nbsp;180,000/uL&nbsp;&nbsp;(150,000 to 450,000) <br />X-ray : patchy infil

trats in lowr lungs<br /><br /><img src=""46ddf07d260bfcb2fc11b05d7099138.png
"" /><br /><br />Cll
clls
total
total&nbsp;&nbsp;
&nbsp;<br />
pr uL
in blood
in body
<br />R
BC
5 E6
2.5 E13
2.5 E13
<br />platlts
2.5 E5
1.3 E12
1.3 E12<br />lukocyts
7300
3.4 E10
3.4 E10
<br /><br />lymphocyts
3000
1.4 E10
7&nbsp;&nbsp;&nbsp;&nbsp;E11<br />nutrophils
4000
1.9 E10
1.9 E10<br />basophils&nbsp;&nbsp;&nbsp;&nb
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;0-5%<br />osinophils
0-5%<br /><b
r />Not: th patints platlts ar mrly on th low nd of normal. Critical v
alus for platlts: worrisom whn this valu drops blow ~100,000 pr uL at wh
ich point clotting bcoms impaird and patints may bld intrnally.&nbsp;&nbs
p;Indirct approachs can b usd to incras platlts. Valus blow 10,000 pr
uL rprsnt a CRISIS rquiring immdiat infusion of platlts. <br /><br /><b
r /><br />Rvrsibl agglutination: Chilling causs blood to clot but this is quic
kly rvrsd on warming to 37o<br />Ngativ dirct and indirct Coombs tst for
anti-RBC antibody<br />RBC did agglutinat in prsnc of anti-C3.<br />RBC fro
m a typ O prson ar agglutinatd by patints plasma.<br />" "Cas 39 Autoimm
un Hmolytic anmiaTX<br /><br />Tratmnt of pnumonia with antibiotic sms to
rliv anmia as wll. So what was causing th anmia? Think autoimmun hmoly
tic anmia <br /><br />Cold agglutination that is rvrsibl this indicats unus
ual igm antibody this is a frqunt finding in autoimmun conditions. <br />Igm
antibodis (dcavalnt) ar crosslinking th RBCs forming larg blood clots not
vry tight sinc igm is rlativly low affinity. So th crosslinks brak on hat
ing. <br /><br />Erthyromycin to trat pnumonia<br />3 days in hospital- Hb at
12 g/dl and continud to ris to normal aftr discharg<br /><br />Commnts:<br
/><br />Why dos th anmia improv? <br />At tims / in som disas stats aut
oantibodis go abov baslin lvl which may rsult in pathology just as in thi
s cas. Rsults in manifstation of autoimmun disas symptoms. Can b svr <
br /><br />An antign on th surfac of mycopasma sms to crossract with an an
tign on our own RBCs. mor than dcay acclrating factor can handl and w gt
autolysis of RBCs. <br /><br /><br />~30% of pts with Mycoplasma infction dv
lop transint incras in an autoantibody to RBC antigns,<br />In a small fract
ion of ths, ths Ab caus C-mdiatd lysis.= autoimmun hmolytic anmia.<br /
>Ths Ab ar oftn IgM, many of which rvrsibly agglutinat RBC at cold tmpr
aturs.&nbsp;&nbsp;<br />Compar: <br /> chronic cold agglutinin disas<br />Wa
ldnstroms macroglubulinia<br />Compar:<br />Othr post-infction autoimmunity<
br /><br /><img src=""a4ad49a6bc8a48cfd69011bb096d3.png"" /><br /><br /><img
src=""dd415b5999ca6d2ab919ffba25f5bf.png"" /><br /><br />Post-infction cold a
gglutinins sn aftr&nbsp;&nbsp;Mycoplasma,&nbsp;&nbsp;Epstin-Barr virus<br />
<br />" Lctur DidntCovr 4 Markd
Dfin inflammation<br>List and dscrib th 5 signs of inflammation; brifly sp
cify thir caus(s)
"A localizd, protctiv rspons licitd by injury or d
struction of tissus,which srvs to dstroy, dilut or wall off both th injur
ious agnt and th injurd tissu. Dorlands Mdical Dictionary 26th dn.<br><br><i
mg src=""dc20db4dd9fb9faa3c920f6096d939a.png"" />"
Lctur 5 Markd
Mchanisms of inflammation: tissu damag<br /><br />complmnt:<br />what ar t
h 2 primary anaphylatoxins?<br />mast cll dgranulation rsults in th rlas
of what 3 substancs?<br /><br />infction - complmnt is fixd, phagocyts ar
 activatd - list 3 spcific substancs to activat phagocyts as wll as 3 cla
sss of substancs that activat phagocyts<br /><br />ndothlial damag - list
a condition and substanc in th inflammatory rspons that may caus tissu da
mag
<b>complmnt-activation </b><br />anaphylatoxins: C5a, C3a, [C4a, C5b67
]<br /><br /><b>mast cll dgranulation</b><br />histamin<br />prostaglandins,
lukotrins<br /><br /><b>infction</b><br />complmnt-fixation<br />phagocyt
activation (PMN and macrophags)<br />[IL-1, IL-6],TNF, chemkines, rs
gl ndi
ns,leuk
rienes<br /><br /><br /><b>end
heli l d m ge</b><br />cl

ing<br />br
dykinin, [fibrine
ides]<br />
Lec
ure 5 M rked
"Fr Reference&nbs;&nbs;- n
e medi
ing f c
rs nd key cells: <br /><br />c

mlemen
- c
iv
in <br /> n hyl
xins: C5 , C3 , [C4 , C5b67]<br />m s
cell
degr nul
in<br />his
mine<br />rs
gl ndins, leuk
rienes<br />infec
in<br
/>cmlemen
-fix
in<br />h gcy
e c
iv
in (PMN nd m crh ges)<br />[IL1, IL-6],TNF, chemkines, rs
gl ndins,leuk
rienes<br />end
heli l d m ge<br
/>cl

ing<br />br dykinin, [fibrine
ides]<br /><br /><img src=""fd31bc 32488
62671c8d999dfd1c9eb2.ng"" /><br />"
Lec
ure 5 M rked
Wh
subs
nce c n direc
ly blck his
mine rele se? wh
is i
bichemic lly? <
br /><br />Wh
is
he c
in f n
ihis
mines?<br /><br />Wh
is
he effec

f gluccr
ics
erid dminis
r
in?<br /><br />Wh
is
he br d func
in f N
SAIDs?<br /><br />
<b>Einehrine (2- drenrece
r gnis
) </b>blcks his

mine rele se, ver-rides m ny effec
s f his
mines<br /><b>An
ihis
mines </b>
c
n his
mine rece
rs n
rge
cells DO NOT ffec
his
mine rele se. Pr
hyl c
ic <br /><b>Gluccr
ics
erids </b>Immunsuress n
s. suress
he r
duc
in f ALL liid medi
rs nd cy
kines.<br /><b>NSAIDS (Nn-S
erid l n
i
-Infl mm
ry Drugs) </b>blck
he syn
hesis f rs
gl ndins.&nbs;&nbs;(wn

cver
d y) <br />
Lec
ure 5 M rked
Wh
is
he gener l c
in f lh rece
rs in
he v scul
ure? wh
is
he ge
ner l c
in f be
rece
rs in
he v scul
ure? <br /><br />Wh
will lw ds
e gluccr
icids gener lly d reg rding v scul
ure regul
in?<br />wh
will
high dse gluccr
icids gener lly d reg rding v scul
ure regul
in?
"<img src=""5deb04c91b1ef5 53e4dbdf690fcdb99.ng"" /><br /><br />Lwer dses: c

iv
e b2--&g
; v sdil
in.<br />higher dses: c
iv
es 1--&g
; v scns
ric

in<br /><br />High dse gluccr
icids c n resul
in r l
hrush (ye s
infec

in f mu
h/
hr
) high dse gluccr
icids c n ls c use 
ien

 n
be
ble
 m ke cr
isl s 
ien
mus
be
ered ff f gluccr
icids gr du l
ly s
h
endgenus cr
isl rduc
in c n r m u. <br /><br /><br /><br />"
Lec
ure 5 M rked
B2 selec
ive gen
s<br><br>wh
is
he urse f
re
men
? (wh
des dminis

r
in resul
in?<br>n me shr

erm drug<br>n me
w lng
erm drugs <br><br>
wh
re
hese drugs gener lly delivered wi
h?<br>why?<br><br> Less c rdi c c

ivi
y
h n nn-secifics<br><b>Sys
emic lly, rel x/v sdil
e skele
l nd brnc
hi l sm
h muscle.</b><br>Aersl, brnchdil
in<br>Rescue gen
s: brnchdil

in is m xim l by 30 min.<br><br>Shr
-
erm: lbu
erl, e
c.<br><br>Lng-
erm
[S lme
erl, frm
erl.]<br>lng- c
ing b2-selec
ive gnis
s [(~12 h)]<br><br>
lms
lw ys,
hese gen
s re delivered wi
h <b>gluccr
icids</b><br><b>
re


he infl mm
in</b>


em

 blck
he cycle.<br>N
fr rescue.&nbs;&n
bs;T kes lnger
 brnchdil
e.<br> Lec
ure 5 M rked
His
mine<br /><br />n me 4 rles; describe i
s rece
r
Neur
r nsmi

er
/regul
r.<br />S
imul
es g s
ric cid scere
in.<br />P r
ici
es in inn
e
nd cquired immuni
y.<br />Lc lly regul
es bld flw nd
issue erfusin<br
/><br />4
yes r rece
rs ll G-culed rece
rs bu
use differen
G r
ei
ns<br />
Lec
ure 5 M rked
Tye I his
mine rece
r - where is i
lc
ed? (3) Wh
re i
s dis
inc
ive c

ins? (3)<br />Tye II his
mine rece
r - where is i
lc
ed? (5) Wh
re i

s dis
inc
ive c
ins (6)<br /><br />Wh
re cmmn fe
ures f b
h f
hese
rece
rs (7) "<img src=""92d8de4c6 1397d30c7f f7 2277 10d.ng"" />" Lec
ure
5 M rked
His
mine 1 rece
r:<br><br> c
iv
in in
he selec
ed
issue c uses wh
?<br><
br>end
helium<br>sm
h muscles (differen
i
e skin vs. resir
ry) end
hel
ium--&g
;cn
r c
in<br>Sm
h muscles<br>v scul r sm
h muscle f skin, e
c. -&g
; NO rele se by muscles --&g
; muscle rel x
in<br>V scul r sm
h muscle 
f resir
ry.<br>NO&nbs;&nbs;NO rduc
in<br>--&g
; cn
r c
in<br><br><br>G
d side c n ge
n
ibdies u
f blds
re m (end
helium cn
r c
s; smc rel xes
) <br>B d side edem <br>
Lec
ure 5 M rked
3 effec
s f r l n
ihis
mines
Suress H1-medi
ed v s c
ive c
ivi
i
es<br>Suress MOST H1-medi
ed cn
r c
in f nn-v scul r sm
h muscle.<br>Su
Lec
ure 5 M rked
ress H1-medi
ed incre se in v scul r erme bili
y.<br>.
Wh
is dminis
ered
 reven
his
mine rele se rhyl c
ic lly?
Crmlyn
Sdium<br>Mde f c
in unknwn bu
i
is
hugh

h
crmlyn sdium s
bili
zes
he m s
cell membr ne,
hereby inhibi
ing m s
cell degr nul
in.<br>Mus

be used rhyl c
ic lly, fr sever l weeks befre effec
ive.<br>

Lec
ure
5 M rked
N me nd describe 2 mech nisms f gluccr
ics
erid c
in
1) <b>Genmic re
gul
in</b>: Mdify
r nscri
in f mRNA fr cy
kines nd 
her&nbs;&nbs;r

eins
h
rm
e r suress v rius cell func
ins. <br><br>2) <b>Nn-genmi
c regul
in</b>:&nbs;&nbs;Here GCs exer
direc
effec
n cell membr nes n
d in
r cy
l smic r
eins.<br><br> ) In
erc l
e in l sm nd mi
chndri l m
embr nes, ch nging
heir hysicchemic l rer
ies nd l
ering
he flux f in
s crss
hese membr nes.<br><br>b) Dissci
e regul
ry r
eins frm in
r cy

l smic GC binding r
eins. <br><br>c) In
er c
wi
h cell membr ne GC rece
r
s.&nbs;&nbs;One effec
f
his is
 reduce hshryl
in f mlecules
h

medi
es sign ling by CD4, CD8 nd CD3 mlecules. This reduces sign ls rduced
by c
iv
ing T cell rece
rs.<br>
Lec
ure 5 M rked
Visu lize
ye II nd
ye III hyersensi
ivi
y<br /><br />wh
c uses
he injur
y nd wh
cells re invlved? wh
si
es re cmmn? wh
is
he
iming?
"<img src=""409 6809 1263b8bc04576b485368158.ng"" /><br /><br />Tye III<br /><
br /> Sluble n
igen
h
c n frm cmlexes<br />Bys
nder injury wherever IC
desi
<br />Ch r c
eris
ic si
es f desi
in<br />(skin, kidney, jin
s, fil

er si
es)<br />Timing minu
es
 hurs deending n hw quickly Ab ge
s

issu
e n
igen<br />"
Didn
Cver 5 M rked Lec
ure
Wh
is
he r
hus re c
in?<br /><br />wh
cl ssific
in (
ye) <br />
"This is
ye III re c
in - frm kuby &qu
;injec
in f n n
igen in
r derm
lly r subcu
neusly in
 n nim l
h
h s high levels f circul
ing n
ib
dy secific fr
h
n
igen le ds
 frm
in f lc lized immune cmlexes, w
hich medi
e n cu
e r
hus re c
in wi
hin 4-8 hurs.<br /><br /><img src=""99
0 4d 384d21c99d0377307107570fc.ng"" /><br /><br />Figure: cmlemen
c
iv
in
ini
i
ed by immune cmlexes (cl ssic l 
hw y) rduces cmlemen
in
ermedi

es
h
<b>1</b> medi
e m ss cell degr nul
in, <b>2 </b>chem
c
ic lly


r c
neu
rhils, nd <b>3</b> s
imul
e rele se f ly
ic enzymes frm neu
rhi
ls
rying
 h gcy
se C3b-c
ed immune cmlexes <br /><br />IC= Immune cm
lex. <br />The Ar
hus re c
in c n be
es
ed lc lly- in nim ls.&nbs;&nbs;I

c n c use severe re c
ins including g ngrene. <br />Ab frm cmlexes wi
h n
ige
n<br />Ab:Ag cmlexes fix cmlemen
;<br />C5 &nbs;&nbs; nd 
her n hyl
x
ins

r c
neu
rhils (PMN)<br />PMN&nbs;&nbs;c rry u
&nbs;&nbs;frus
r
ed
h gcy
sis<br />rele se f neu
rhil enzymes
issue d m ge, necrsis<br />Lc

in<br />Lc l
issues<br />Circul
ing cmlexes ldge in kidneys, jin
s, <br
/>Sm ll cmlexes subei
helium<br />L rge cmlexes&nbs;&nbs;b semen
membr n
es v culi
is<br /> I
c n ls be c used by v ccin
in<br />" Didn
Cver 5 M r
ked Lec
ure
Think bu
rim ry resnse&nbs;&nbs;- ie
ns f freign serum r
ein<br>
<br>visu lize:<br>
he level f n
ibdy freign serum r
eins<br>
he level f
n
igen: n
ibdy cmlexes<br><br>
he sym
ms scd wi
h n
igen: n
ibdy cm
lexes "<img src=""f49367720 2472d7b668d183b81c558 .ng"" />" Lec
ure 5 M rked

he si
e f immune cmlex desi
in is ssci
ed wi
h resul
ing dise se<br />
<br />fr e ch si
e - lis

he dise se<br /><br />F rmers lung<br /> r
hus re c
"<img src=""4482497cdc39

in<br /> r
hri
is<br />nehri
is<br />v sculi
is
8e7028210d41c433ff91.ng"" />" Didn
Cver 5 M rked Lec
ure
"Tye III Dise ses<br /><br /><img src=""802 f5d0674e2c94 7590e0e 2b0c29 .ng""
/>"
"<img src=""4f4c6949c 942f05221e66d 6 67de0 .ng"" />" Didn
Cver 5 M r
ked Lec
ure
"Geh c se 35 <br /><br />Gregry B rnes, 12 YO<br />Brugh

 ER wi
h high fev
er 39.5C (2 d ys), cugh, shr
ness f bre
h <br />Ex m:<br />P le, dehydr
ed
, r id bre
hing, fl ring ns
rils<br />Resir
in 62/min&nbs;&nbs;vs 20<br
/>Pulse 120 bm vs 60-80<br />B 90/60 nrm l<br />cr ckles ver lwer lef
lbes<
br />X-r y: lb r neumni <br /><br /><br />WBC 19,000/uL (4000-7500)<br />Diff
eren
i l: PMN (lymrhnucle r&nbs;&nbs;cells = neu
rhils) re 87% f


l. = neu
rhili <br />Imm
ure neu
rhils<br />Su
um si
ive fr Gr m-si
i
ve ccci =&g
;S
re
cccus neumni e<br /><br />Cell
cells
in bl


l


l&nbs;&nbs;&nbs;<br />
er uL
in bdy
<br />RBC
5 E6
2.5 E13
2
d

.5 E13
<br />l
ele
s
2.5 E5
1.3 E12
1.3 E1
2<br />leukcy
es
7300
3.4 E10
3.4 E10
<br /
><br />lymhcy
es
3000
1.4 E10
7&nbs;&nbs;&nbs;
&nbs;E11<br />neu
rhils
4000
1.9 E10
1.9 E10<br
/>b shils&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;0-5%<br
/>esinhils
0-5%<br /><br /><br />N his
ry f llergy
 enicillin ,
s IV micillin

re
infec
in, l
er ch nged
 enicillin. <br />On D y 9
, re dy fr disch rge n nex
mrning.<br />D y 10<br />Puffy eyes,&nbs;&nbs;l
rge hives n bdmen<br />Tx wi
h Ben dryl&nbs;&nbs; nd discn
inue enicilli
n<br />2 hrs l
er, swllen f ce, widesre d hives,
igh
ness in
h
, wheezing
<br />Tx wi
h lbu
erl<br /><br />Th
evening: fever, swllen  inful nkles,
hives incre sed<br /><br /><img src=""7545b0749b917148c1d98b874 3689fe.ng"" /><
br /><br />D y 10 (cn
)<br />Enl rged sleen, jin
s  inful<br />Aler
nd neu
rlgic l is OK<br />Blds: WBC
 19,800 wi
h 72% lymhcy
es<br /> l sm cel
ls (
ye f B cell) resen
<br />Ery
hrcy
e sedimen

in r
e : 30 mm/hr (vs
. 20 mm/hr).<br />Serum cmlemen
, C1q nd C3 decre sed <br /><br /><img src=""
51b7f0e 5 6974682b0bef4b42f02 cf.ng"" /><br /><br />Drug-induced ur
ic ri <br /
><br />TX: Ben dryl nd n rxen

re
infl mm
in.<br /><br />D y 11<br />P

. gi

ed, disrien
ed.&nbs;&nbs;Elec
renceh lgr m shws decre sed circul

in in s
erir br in<br />WBC
23,700/uL ESR
54 mm/hr<br />RBC nd r

ein in urine<br />Skin bisy: edem in dermis; eriv scul r lymhcy
e&nbs;&nb
s;infil
r
es<br />Immunflurescence micrscy:&nbs;&nbs;IgG nd C3 eriv s
cul r desi
in<br /><br /><br />"
TX:&nbs;&nbs;rednisne =&g
; imrvem
en
in ll sym
ms<br />Disch rged 7 d ys f
er nse
f serum sickness<br />T
ered decre se f red.<br /><br />Ins
ruc
ins never
 use enicillin r deriv

ives ,ceh lsrins<br /><br />Very imr
n

 use
ered ds ge f 
en

cr
ics
erids.&nbs;&nbs;Imr
n

 imress 
ien
s/ ren
s f
his. <br
/>Geh s ys slwly decre sing curse f rednisne nd Ben dryl.&nbs;&nbs;&nb
s;This wuld be n INeffec
ive ins
ruc
in
 
ien
!<br /><br /><b>N
hing
wrng wi
h
ering Ben dryl, bu
ne MUST use slwly decre sing dse f red&
nbs;&nbs;BECAUSE HIGH CORTICOSTEROID SUPPRESSES PRODUCTION OF NATURAL CORTISOL
!&nbs;&nbs;If yu
ke
he 
ff
 quickly,
hey will n
be ble
 m ke

heir wn cr
isl, wi
h 
en
i lly le
h l cnsequences!!!</b><br />
Didn
Cv
er 5 M rked Lec
ure
"Geh C se<br><br><br>Gwendlyn F irf x, 34 y, n signific n
his
ry<br>Presen

s wi
h neumni .<br>Di gnsed wi
h hemly
ic nemi due
 crss-re c
ive n
i
bdy resnse
 Mycl sm n
igen nd RBC n
igen <br><br>Reversible gglu
in

in: Chilling c uses bld
 cl
bu

his is quickly reversed n w rming
 37
<br>Neg
ive direc
nd indirec
Cmbs
es
fr n
i-RBC n
ibdy<br>RBC did g
glu
in
e in resence f n
i-C3.<br>RBC frm

ye O ersn re gglu
in
ed b
y 
ien
s l sm .<br><br>Cell
cells


l


l&nbs
in bld
in bdy
<
;&nbs;&nbs;<br>
er uL
br>RBC
5 E6
2.5 E13
2.5 E13
<br>l
ele
s
2.5 E5
1.3 E12
1.3 E12<br>leukcy
es
7300
3.4 E10
3.4 E10
<br><br>lymhcy
es
3000
1.4 E10
7&nbs;&nbs;&nbs;&nbs;E11<br>neu
rhils
4000
1.9 E10
1.9 E10<br>b shils&nbs;&nbs;&nbs;&nbs;&nbs
;&nbs;&nbs;&nbs;&nbs;&nbs;0-5%<br>esinhils
0-5%<br><br>Cri
ic l v
lues fr l
ele
s: wrrisme when
his v lue drs belw ~100,000 er uL
wh
ich in
cl

ing becmes im ired. V lues belw 10,000 er uL reresen
CRIS
IS.&nbs;&nbs;&nbs;<br><br><br>~30% f 
s wi
h Mycl sm infec
in devel

r nsien
incre se in n u
 n
ibdy
 RBC n
igens usu lly I n
igen<br>These
Ab re f
en IgM, m ny f which reversibly gglu
in
e RBC
cld
emer
ures.
&nbs;&nbs;<br><br><img src=""749680e86c1d5ccf072969 9906752 9.ng"" /><br><br>
<br>Reversible gglu
in
in: Chilling c uses bld
 cl
bu

his is quickly re
versed n w rming
 37<br>Neg
ive direc
nd indirec
Cmbs
es
fr n
i-RB
C n
ibdy<br>RBC did gglu
in
e in resence f n
i-C3.<br>RBC frm

ye O 
ersn re gglu
in
ed by 
ien
s l sm .<br>**RBC frm crd bld did n
gglu
Lec
ure M rked 6

in
e wi
h 
ien
s l sm <br><br><br><br><br><br><br>"
"Describe
he direc
nd indirec
cmbs
es
.<br><br>wh
is si
ive
es
r

esul
?<br>wh
cmnen
s re required fr e ch?<br><br><img src=""ee 6947862254

0433e34e394173ee9c6.ng"" />"
Lec
ure M rked 6
B cell develmen
<br><br>Describe
he 4 s
es f B cell develmen
<br>where d
es e ch ccur<br><br>(
his is
grss simlific
in f
he rcess)<br><br>
"<img src=""e417 7f57b5356549 503e8443d4b4f4.ng"" />" Lec
ure M rked 6
Wh
cmnen
s re necess ry fr
he sign l
r nsduc
in f wh
n
ibdy
h

is bund

he surf ce f B cells?
"N
e
h
Ig lh
nd be
ch ins nch
r
he Ig nd re resnsible fr sign l
r nsduc
in<br>N
e
h
IgD is bund

 membr ne f imm
ure B cells<br><br><img src=""66cbe8e228c5c206eb7de664e439 2
d6.ng"" />"
Lec
ure M rked 6
Wh
is
he rim ry difference be
ween membr ne bund vs secre
ed immunglbulin
?<br><br>wh
mech nism underins
his difference?
" Al
ern
ive RNA slici
ng cn
rls membr ne-bund vs. secre
ed Ig<br><br>difference is l
ern
ive C
e
rminus <br><br><img src=""3dd90f5852f671b067f32d82b81dd619.ng"" />"
Lec
ure
M rked 6
Visu lize
he c
iv
in f B cell ll
he w y
 l sm cell<br><br>un
e
rmin l differen
i
in - wh
2
yes f cells will be rduced - nd wh
is is

ye swi
ching / ffini
y m
ur
in? "2
yes f cells - effec
r cells (whic
h re l sm b cells) nd memry cells - fr d 
ive memry<br><br>is
ye swi

ching - ch nging
he Fc regin f
he n
ibdy fr higher ffini
y m
ur
in ie rducing IgG ins
e d f IgM s
he d
ive resnse ccurs<br><br><img src=
""5c0d405418852d0b059f842f15f82d27.ng"" />"
Lec
ure M rked 6
Visu lize
he difference be
ween rim ry nd secnd ry immune resnse <br><br
>wh
is ul
im
ely resnsible fr
he differences?
"yu lre dy h ve memry
cells nd sm ll mun
f n
ibdy fr
he n
igen
h
yu h ve been reviu
sly exsed
 - s
he 2nd ry resnse is much f s
er nd much mre rbus
<br><
br><img src=""69 56b 11f0c7d0d 42cd cb6682c0e9.ng"" />"
Lec
ure M rked 6
The rle f cmlemen
in b cell s
imul
in:<br><br>wh
cmlemen
r
ein bin
ds
 micrbes nd wh
is i
s rece
r n B cells?<br><br>
"C3d binds micr
be - B cell is c c
iv
ed vi in
er c
in wi
h
he bund immunglbulin rece

r s well s
he CR2 ( k CD21) rece
r<br><br><img src=""ffcce c88d7ce094dfc25
82e7431674e.ng"" />" Lec
ure M rked 6
"Cnsequences f B cell c
iv
in<br /><br />wh
re
he 3 rim ry cnsequence
s?<br /><br /> ls, fill in
he
ble: <br /><br /><img src=""5ff73f3455943b4480
bf296b 1929b 8.ng"" />"
"Cln l ex nsin<br />Ureg IgM rduc
in nd
mdes
secre
in<br />Cl ss swi
ching<br />( nd 
her
hings
 be discussed l

er)<br /><br /><br /><img src=""66242481d1ce9fd396510905dc238 c6.ng"" />"
Lec
ure M rked 6
describe
he rcess f b cell c
iv
in by
cells<br><br>wh resen
s
he n

igen
 wh?<br>wh
is
he CD in
er c
in - nd wh exresses
he rece
r / wh
 exresses
he lig nd/<br><br>wh rele ses cy
kines nd wh
des
his d?
"1. - B cell resen
s n
igen
 T cell - which
hen exresses CD40lig nd - whic
h binds
 nd c
iv
es CD40 n
he b cell. nex
, T cell rele ses cy
kines nd

he B cell is c
iv
ed - rlifer
in nd differen
i
in <br><br><br><img sr
c=""fe678e66f690b7 5247 379cb 081480.ng"" />" Lec
ure M rked 6
"in is
ye swi
ching - wh
cy
kine m y ush
he cl ss swi
ch
:<br><br>igg?<
br>ige?<br>ig ?<br><br> ls, fill in
his ch r
.<br><br><img src=""4 e5c75fb0f09
b9f0875c93b3fb90 1e.ng"" />" "<img src=""7f1 4d94766e0329f 181324cd57b277.ng
"" />" Lec
ure M rked 6
On ver ge - which immunglbulin will lw ys be highes
cncen
r
in in
he se
rum?<br><br>which immunglbulin is rduced

he highes
r
e n ny given d
y?<br><br>reslve
his discre ncy.
"Igg - ms
in serum <br>Ig - ms
rd
uced er d y - bu
i
is secre
ed n
 mucs l surf ces - nd is
herefre fund
in bld l sm

lw cncen
r
in. <br><br><img src=""94420 bd78c3 30 60ccb1
e933 d0443.ng"" />"
Lec
ure M rked 6
Why des Igg h ve such lng h lf life cm red
 ll 
her cl sses f secre
e
d Ig?<br>
FCRnen
l rece
r - cells
ke u igg nd h rbr i
wi
hin
he
cell cy
l sm - i
is even
u lly rele sed - cell des n
degr de i
, nd i
i
s r
ec
ed frm
he we r nd
e r
h
wuld be ssci
ed wi
h
r fficking
hr
ugh
he bld ll d y Lec
ure M rked 6

"This is
erribly useful reference. n
e
h
ll igs s
r
s M nd cl ss sw

i
ch mus
be invked <br><br><img src=""8387b51b0e c805b5d4bebf5820 b1e5.ng"" /
>"
6 Lec
ure
The cl ss swi
ch:<br /><br />wh
is i
ex c
ly?
gene
ic level?<br /><br />
wh
is
he urse?<br />when c n i
ccur?<br />wh
enzyme is necess ry?<br /
>reversible?<br />wh
cn
rls i
?
" A single cln
ye f n
ibdy wi
h si
ngle n
igen secici
y c n be exressed in mdul r f shin wi
h differen
func
i
n l he vy ch ins<br />Prvides flexibili
y nd fine-
uning f Ab resnse.<br /
>C n ccur during b
h 1 r 2 resnses<br />DNA re rr ngemen
medi
ed by
he
enzyme Ac
iv
in-induced De min se&nbs;&nbs;(AID) <br />Prgressive nd irre
versible.<br />Cn
rlled by cl ss-secific cy
kines nd T cells ( nd
 sme d
egree by cmlemen
). <br /><br><img src=""4506cce07bcee1c56066368c39 9b9fc.ng"
" /><br><br>CD40L&nbs;&nbs;induces AID<br>Cy
kines c
iv
es swi
ch regin f

rge
Ig cns
n
regin.<br>AID mdifies DNA in swi
ch elemen
s <br>Recmbin

in m chinery dele
es regin be
ween
he swi
ch regin mving
he v ri ble regi
Lec
ure M rked 6
n
 &nbs;&nbs;new cns
n
regin.&nbs;&nbs;<br>"
"Flw!<br><br><img src=""43e7c0183 656c c5423f9305003b0e5.ng"" />"
Lec
ure M rked 6
"Wh
is
he signific nce? <br><br><img src="" ef4d1 f629b3585e15325644531 267.
ng"" />"
Ligh
Sc

er<br>Frw rd Sc

er ~cell size. The l rger
he cell
,
he mre frw rd sc

er.<br>Side sc

er&nbs;&nbs;&nbs;&nbs;~gr nul ri
y.
&nbs;&nbs;The mre gr nul ri
y,
he mre
he side sc

er. <br><br><br>Flures
cence (n
n ic
ure)<br>cells re l beled wi
h flurescen
n
ibdies r dyes
r r
eins*, exci
ed by
he l ser ligh

 induce flurescence.&nbs;&nbs;Flu
rescence ligh
in
ensi
y er cell is rr
in l

he number f mlecules er
cell. <br>
Lec
ure M rked 6
n me nd describe
he
w me
hds f flw cy
me
ric d
n lysis
Tw Me
h
cn
rl- jus
% f cells
ds f An lysis:<br><br>Percen
si
ive rel
ive


h
exress m rker bve sme rbi
r ry
hreshld (cu
ff).<br><br>Me n&nbs;&n
bs;(line r) flurescence in
ensi
y (MFI)<br>2X MFI me ns
wice s m ny mlecule
s er cell..<br>
Lec
ure M rked 6
"<img src=""9dc5583 4 f749d46eddb3f4c900c968.ng"" /><br><br><img src=""83224113
1fc6 e 473b299de2e02366 .ng"" />"
Lec
ure M rked 6
"C se 12 <br><br>3 YO D isy Miller dmi

ed wi
h neumni <br>Sym
ms: <br>T =
40.1C<br>Resir
in 40/min (20)<br>Bld xygen s
ur
in 88% (98%)<br>Enl rg
ed cervic l nd xill ry lymh ndes<br>His
ry<br>Pneumni
25 mn
hs<br>10
eisdes f 
i
is medi requiring n
ibi
ics&nbs;&nbs;& m;
ubes<br><br>Bl
d:<br>13,500 WBC/uL (nrm l 7300)<br>81% neu
rhils&nbs;&nbs;14% lymhcy
es
<br>Bld cul
ure: S
re
cccus neumni e<br>Immunglbulins<br>IgM 470 mg/dl&
nbs;&nbs;(40-240)<br>IgA&nbs;&nbs;unde
ec
ble (70-312)<br>IgG 40 (639-1344)
<br>N secific n
ibdies fr
e
nus
xid, H emhilus influenz e n
igens<b
r><br>I.V. n
ibi
ics=&g
;hme wi
h r l n
ibi
ics<br>In
r venus immunglbu
lin (IVIG)
her y.<br><br>Fllwu:&nbs;&nbs;dr m
ic decre se in frequency 
f infec
ins<br><br>Immune n lysis<br>Nrm l CD40L n T cells<br>Nrm l CD40 n
B cells<br>Hwever, n secre
in f IgE r IgE by 
ien
s B cells s
imu
ed by
gnis
ic n
i-CD40 n
ibdy lus IL-4.<br><br>Immune n lysis<br>Nrm l CD40L 
n T cells<br>Nrm l CD40 n B cells<br>Nrm l B cell rlifer
in
 n
i-CD40
+ Il-4<br><br><img src=""d805784b27b7c57149911c56 fdb 61c.ng"" /><br><br>Gene
i
c wrk-u<br>cDNAs fr CD40 nd AID were sequenced<br>Nrm l sequence fr CD40<b
r>S
 cdn in exn 5 f AID.<br><br>N secre
in f IgE r IgE by 
ien
s B ce
lls s
imul
ed by gnis
ic n
i-CD40 n
ibdy lus IL-4.<br><br><img src="" e5
199ff07 6549523b7ccd2fc9dc 4.ng"" /><br><br>" Geh 12 Ac
iv
in-induced Cy
id
ine De min se (AID) Deficiency<br><br>Cmmen
ry<br>Phen
ye is less severe
h
n CD40L deficiency <br>CD40L r CD40 deficiency<br> ffec
s dendri
ic cells s w
ell s B cells<br>Blcks B cell ex nsin, T cell ex nsin in
he germin l cen

ers f lymh ndes.<br>N swllen lymh ndes.<br>AID deficiency ffec
s B cells
exclusively.&nbs;&nbs;<br> Lec
ure M rked 6
"Reference:<br><img src=""3c7c19 0 bbc4 60dfb789 99b46db6f.ng"" /><br><br>Remem
ber frw rd sc

er fr size, side sc

er fr gr nules <br>"
Lec
ure
M rked 7

Wh
is AID deficiency?<br>Wh
cell
ye(s) des
his effec
? Il4 induces IgE,
bu
in
his c se c nn
c use swi
ching
 due
 l ck f AID <br>AID deficienc
y ffec
s B cells exclusively.&nbs;&nbs;<br> Lec
ure M rked 7
Wh
is CD40 r CD40 L deficiency?<br><br>wh
cells re ffec
ed?
"CD40L 
r CD40 deficiency<br> ffec
s dendri
ic cells s well s B cells<br>Blcks B cel
l ex nsin, T cell ex nsin in
he germin l cen
ers f lymh ndes.<br>N swl
len lymh ndes.<br><br><br><img src=""fe678e66f690b7 5247 379cb 081480.ng"" />
"
Lec
ure M rked 7
Wh
is <br><br>m l
<br>g l
<br>n l
<br><br>which ig is
he ms
rduced n n
y given d y?<br>which ig h s
he highes
serum level n ny given d y?<br><br>ex
mle f e ch MALT=mucs - ssci
ed lymhid
issue<br>GALT = Gu
- ssci
ed<
br>NALT n s l- ssci
ed :
nsils<br><br>IgA is
he ms
rduced ig n ny giv
en d y. (bu
since ig is secre
ed, igg is highes
in
he l sm

ny given
i
me)<br>MALT/GALT/NALT 2nd ry lymhid rg n. Cn
r s

 rim ry lymhid rg n
<br>
Lec
ure M rked 7
Wh
is CD103<br>Wh
is LPAM<br><br>where des e ch hme?
Seci lized in
e
grins<br>e.g.E7 = CD103 --&gt; lamina propria<r>e.g. 47 = LPM--&gt;Peyers patches<
r>
Lecture Marked 7
5 effector mechanism of intestinal epithelium? Transport Ig<r>Secrete mucous
(golet cells)<r>Secrete defensins (anti-acterial)<r>Recruit neutrophils<r>S
ecrete nitric oxide to kill microes <r>
Lecture Marked 7
Gross organization of GLT<r /><r />what is in the epithelium?<r />what are p
eyers patches?<r />what are M cells?<r />what is in M cells?<r />what is in
the lamina propria?<r />where is the lamina propria?<r />what is the purpose o
f lymphatics?<r />what is in the sumucosa?
"<img src=""df9e009a2dc591d34
cd0c60234f1.png"" /><r><r><img src=""20262a57165176d017c18950ac6.png"" /
><r><r><img src=""2ce8447058c87e249dfa9d83f1184d.png"" /><r><r>Epithelium:
<r />M cells and villus epithelial cells<r />Intra-epithelial lymphocytes<r /
>Peyers patches:&nsp;&nsp;structures eneath the M cells containing lymphocytes
<r />Lamina propria- eneath the epithelium. Lamina propria lymphocytes<r />Ly
mphatics capillaries originating in lamina propria remove fat; DC; fluids<r />S
umucosa- capillaries; venules<r />" Lecture Marked 7
Name 2 major producers of Ig?<r>
"Bone marrow and lamina propria of small
intestine major producers of Ig<r><r><img src=""eac012272c764e500e27c1418c
6ec6.png"" />" Lecture Marked 7
"Reference: Ig cells / synthesis<r><r><img src=""813826d6869f3c19731551300
fe64.png"" />"
Lecture Marked 7
"Reference - comparision of Ig molecules <r><r>note J chain on Ig and IgM <r
><r><img src=""92d6d36183ece757d44df21d34158a8.png"" />"
Lecture
Marked 7
What is Poly Ig receptor?<r>what is FCRn?<r><r>Descrie the roles of each
"Serum Ig is a normal dimer without J chain<r>Secreted Ig has one-to three copi
es ound to J chain = polymeric Ig.<r>transported rapidly y<> poly Ig recept
or (polyIgR) into sweat, saliva, milk, lungs, gut, genital mucosa</><r><>Frag
ment of polyIgR ecomes stailizing Secretory fragment</><r>Secretory componen
t stailizes siga (protects from degradation); also keeps it stuck in the mucus
to prevent premature shedding <r><>Note that IgG must e transported y FCRN&n
sp;&nsp;</><r><span style="" font-weight:600;""></span><r>The neonatal Fc r
eceptor is an Fc receptor which is similar in structure to MHC class I. It was f
irst discovered in rodents as a unique receptor capale of transporting IgG from
mothers milk across the endothelium of neworn rodents gut. Further studies r
evealed a similar receptor in humans. In humans, however, it is found in the pla
centa to help facilitate transport of mothers IgG to the growing fetus and it h
as also een shown to play a role in monitoring IgG turnover.<r><r>There is al
so evidence that this receptor also plays a role in adult salvage of IgG through
its occurrence in the pathway of endocytosis in endothelial cells. Fc receptors
in endosomes ind to IgG internalized through pinocytosis, recycling it to the
cell surface and preventing it from undergoing lysosomal degradation. This mecha
nism may provide an explanation for the greater half-life of IgG in the lood co
mpared to other isotypes.[3] It has een shown that conjugation of some drugs to

the Fc domain of IgG significantly increases their half-life, likely through th

is mechanism.[4]<r><r><img src=""0a238129ca7287518ac172084d658.png"" />"
Lecture Marked 7
Mucosal Ig secretion<r><r>what is the major ig?<r><r>what are the minor ig(s
)?<r><r>descrie the roles of the major ig secreted mucosally (5)
Ig<r>M
ajor form; does not fix complement through classical pathway; anti-inflammatory a
nti-phlogistic<r>Has minor opsonic activity via IgR<br>Tr nsr
ed by lyIgR whi
ch is cle ved
 becme secre
ry cmnen
<br>Secre
ry cmnen
in gu
r
ec

s IgA frm b c
eri l r
e ses.<br>Neu
r lizes lumen l 
hgens<br>IgM<br>Min
r cns
i
uen
, uns
ble<br>Tr nsr
ed by lyIgR <br>IgG<br>Minr-
r nsr
ed
by FcRn (FcR-nen
l)<br><br>N
e: FcRn rigin lly described in
he nen
l gu

f mice bu
ersis
s
hrugh dul
hd nd fund in m ny
issues.<br>FcRN
r n
sr
s IgG crss l cen

 fe
us, crss gu
frm milk
 fe
l bld; frm
dul
bld in
 dul
gu
; nd s
res serum IgG in in
r cellul r de
. <br><br>
Lec
ure M rked 7
Inges
in f n
igens
yic lly sign ls wh
TH resnse? wh
re 3 scd cy
k
ines?<br><br>wh
is n djuv n
? n me 2?
Inges
ed n
igens simul
e lc l
resnse,
yic lly TH2=&g
;IL-4; IL-5 + TGFbe
=&g
;IgA secre
in<br>C n indu
ce sys
emic immune resnse<br>Micrbes nd n
igens culed wi
h mucs l dju
v n
s such s chler
xin subuni
B (CTB)<br>An
igens in bsence f djuv n
s=
&g
;r l
ler nce<br> Lec
ure M rked 7
"Describe wh
is h ening here: <br /><br /><img src=""1 f41e35f9988648 371725
e 96f6939.ng"" />"
s
imul
in f r l
ler nce Lec
ure M rked 7
Wh
is
he serum level
which ersn wuld be di gnsed wi
h ig deficiency
?
Prev lence ~1/300
 1/500<br><b>IgA level &l
; 10 mg/dL wi
h nrm l IgG
nd IgM.</b><br>C uses f
en unknwn; sme
imes f mili l<br>sme frms c n be

r nsmi

ed wi
h bne m rrw
r nsl n
<br>Usu lly lss f b
h IgA1 nd IgA2<br>
Onse
: children bu
n
di gnsed un
il f
er 4 ye rs bec use i

kes while f
Lec
ure M rked 7
r serum IgA levels
 build u<br>
describe
he sym
ms / ssci
ins f IgA deficiency<br><br>n me sme recurren

infec
ins<br>wh

her deficiency is ssci
ed?<br>wh
en
eric dise ses r
e ssci
ed? Recurren
muc l infec
ins: sinusi
is, 
i
is medi , brnchi
is
, neumni s<br>IgG2 deficiency, m y rgress
 CVID<br>Acu
e di rrhe due
 v
iruses, b c
eri , Gi rdi <br>Allergies, s
hm , eczem <br>Glu
en llergy<br>Celi
c dise se (10X higher in IgA def 
ien
s; 2.3% f IgA deficien

s h ve celi
c dise se)<br>Au
immuni
y <br> Lec
ure M rked 7
describe sme c uses f ig deficiency (2)<br><br>wh
drugs re used

re


his dise se?
F mili l ssci
ins sugges
gene
ic redissi
ins<br><br>Cn
geni
l in
r u
erine infec
in wi
h rubell ,
xl smsis, r cy
meg lvirus <
br><br>Drugs=&g
;
r nsien
IgA deficiency <br> n
i-seizure drugs heny
in nd h
yd n
in<br>Penicill mine fr Wilsn dise se&nbs;&nbs;(cer cle r nce dise s
e 1/100,000)<br>
Lec
ure M rked 7
"<img src=""f 4bfdd985296d56d6d 00fc47f21b24.ng"" />" Answer is A<br><br><br>B
MT&nbs;&nbs;- exensive<br>IVIG - is rim ry fr Igg<br><br> n
i-ifn g mm - n
.<br> Lec
ure M rked 7
Wh
is ly-ig rece
r nd wh
is i
s rle?<br><br>where is i
fund?
"Serum IgA is nrm l dimer wi
hu
J ch in<br>Secre
ed IgA h s ne-

hree ci
es bund
 J ch in = lymeric IgA.<br>
r nsr
ed r idly by ly Ig rece
r
(lyIgR) in
 swe
, s liv , milk, lungs, gu
, geni
l mucs <br>Fr gmen
f 
lyIgR becmes s
bilizing Secre
ry fr gmen
<br><br><img src=""0 238b12b9c b7287
518 c172084d658.ng"" />"
9 Lec
ure M rked
Selec
ive IgA deficiency <br><br>T/F
his dise se is lw ys sym
m
ic <br><br>
T/F
his dise se is ssci
ed wi
h CVID<br><br>
Absen
serum + mucs l
n
ibdy (dimeric frm + secre
ry iece)<br>Usu lly ( rx66%) sym
m
ic<br>
G s
rin
es
in l, resir
ry infec
ins<br>F mili l ssci
ins, CVID link ges
<br>Allergy, u
immuni
y ssci
ins<br>
9 Lec
ure M rked
Hyg mm glbulinemi s<br><br>n me 6 c uses<br> "<b>Secnd ry
 
her cndi
in
s</b><br><s n s
yle="" fn
-weigh
:600;""></s n><br>chrmsm l bnrm li
ies<
br><br>Lymhm & m;
hymm <br><br>Asleni <br><br>Drugs (rescribed nd illic
i
) <br><br>r
ein-lsing en
er
hy<br>celi c dise se, Crhns dise se<br>sh

r
bwel syndrme in
es
in l lymh ngiec
si , mylidsis, en
er
hy c used b

y NSAIDs nd gi rdi sis.<br><br>nehr
ic syndrme (minimi l ch nge dise se, e
c
)<br>" 9 Lec
ure M rked
Hyg mm glbulinemi s re gener lly secnd ry cndi
ins<br><br>n me 3 cndi

ins in which
hey m y be cnsidered rim ry<br><br> g mm glbulinemi s m y be c
used by? nd n me 3 ex mles hyg mm glbulinemi s:<br><br>(  ren
ly) Prim
ry<br>Tr nsien
hyg mm glbulinemi f inf ncy;childhd (THI;THC)<br>IgA def
iciency<br>CVID ( dul
nse
)<br><br><br>Ag mm glbulinemi s c used by high ene

r
ing gene
ic defec
s<br>Bru
ns kin se defec
<br>X-SCID<br>CD40L deficiency, e

c<br> 9 Lec
ure M rked
Ig deficiency - sym
ms / ssci
ins:<br><br>hw m ny 
ien
s deficien
in
ig m nifes
sym
ms? (%)<br><br>sym
ms m y include (6): - lis

hem<br><br>
2/3 f 
ien
s few
 minr sym
ms<br><br>1/3 : <br>Recurren
mucs l infec
i
ns: sinusi
is, 
i
is medi , brnchi
is, neumni s, g s
ren
eri
is nd/r cm
rbid u
immuni
y<br>IgG2 deficiency, m y rgress
 CVID<br>Acu
e di rrhe du
e
 viruses, b c
eri , Gi rdi <br>Allergies, s
hm , eczem <br>Glu
en llergy<b
r>Celi c dise se (10X higher in IgA def 
ien
s; 2.3% f IgA deficien

s h ve
celi c dise se)<br>
9 Lec
ure M rked
fr reference: <br><br>IgA deficiency: sme c uses&nbs;&nbs;<br><br>Gene
ic f
c
rs<br>sme frms
r nsmi

ed wi
h bne m rrw
r nsl n
<br>Cngeni
l in
r u

erine infec
in wi
h rubell ,
xl smsis, r cy
meg lvirus <br>Drugs=&g
;

r nsien
IgA deficiency <br> n
i-seizure drugs heny
in nd hyd n
in<br>Penici
ll mine fr Wilsn dise se&nbs;&nbs;(cer cle r nce dise se 1/100,000)<br>L
ck f secre
ry iece<br>
9 Lec
ure M rked
Reference: <br><br>IgAD: gene
ic f c
rsFerreir e
l. 2010. N
ure Gene
ics Ass
ci
in f IFIH1 nd 
her wi
h selec
ive IgA deficiency<br><br>HLA <br>Risk:HL
A-DRB1*0301 <br>Pr
ec
in: HLA-DRB1*1501<br><br>IFIH1 k MDA-5<br>Als ssci

ed wi
h di be
es nd SLE<br>Encdes n in
erfern-inducible RNA helic se invlv
ed in virus de
ec
ins; v ri n
s ssci
ed wi
h u
immuni
y. <br><br>O
her gen
es ssci
ed wi
h u
immuni
y<br>Hy
hesis:<br> u
immune mech nisms m y cn

ribu
e

he 
hgenesis f IgA: <br> u
 n
ibdies
h
blck cl ss swi
ching


he IgA lcus in B cells r
h
selec
ively im ir surviv l f IgA-rducin
g cells. <br>
9 Lec
ure M rked
"Fr reference: CVID / Ig n
ibdy levels:<br><br>D

ed red ver slid blue n
rm l 
. <br>Slid blue CVID r ig def<br><br><img src=""0d6 1d312e8b7 f8 27f17
fd079d7457.ng"" />"
9 Lec
ure M rked
Tre
men
fr Severe IgA-deficiency?<br>(which nswer?)<br><br><br>An
ibi
ics<b
r>Me
h
rex
e
 suress u
immuni
y<br>Bne m rrw
r nsl n
(hem
ie
ic
s
em cell
r nsl n
HSCT)<br>IVIG (in
r venus immunglbulin)<br>High dse rec
<>ntiiotics</><r>Methotrexate to su
mbin n
cy
kine (TGF, IL-5, IL-6)<r>
ppress autoimmunity<r>Bone marrow transplant (hematopoietic stem cell transplan
t HSCT)<r>IVIG (intravenous immunogloulin)<r>High dose recominant cytokine (T
GF, IL-5, IL-6)<r><r>@@see review y Yel 2010 Iga Def can e transferred y BMT
. diagnosis is after 4 years ecause Ig levels are sometimes slow to rich high
levels in lood. <r>&nsp;&nsp;&nsp;IVIG is used if associated with other def
iciencies.&nsp;&nsp;<r><r>Note IVIG is IgG mostly (Ig is mostly depleted)<
r>Not one marrow transplant extremely dangerous procedure<r>Not E expensive, m
ay not e effective. <r><r>Correct answer is antiiotics <r> 9 Lecture Marked
What is CVID?<r><r>what are 4 symptoms? (road)
Common variale immunode
ficiency:<r><r>Low IgG<r>Often deficiencies in other Ig classes<r>Infections
<r>autoimmunity<r><r>prevalence ~1:25,000 among Caucasians <r>~1:half a mill
ion among <r>ge 20 to 40; 20% in childhood<r>&nsp;&nsp;~<r> 9 Lectur
e Marked
CVID<r>How is this diagnosed confirmed?<r><r>Compare CVID to:<r><r>X-linked
agammagloulinemia<r>multiple myeloma<r><r>what marker is diagnostic for the
presence of B cells? Diagnosis of CVID<r><r>familial clustering of autoimmu
ne disorders<r><>confirmed</> y measuring<r>serum Ig&nsp;&nsp;(IgG&lt; 50
0 mg/dL ~50% of normal)<r>antiody titers to protein and polysaccharide vaccine
antigens<r><r> B cell quantification y flow cytometry <r>CVID vs.<r> X-lin
ked agammagloulinemia (<>no B cells</>)<r>multiple myeloma &amp; chronic lym

phocytic leukemia (CLL)&nsp;&nsp;(monoclonal gammopathy)<r> Serum protein ele

ctrophoresis&nsp;&nsp;monoclonal gammopathies (eg, myeloma) -&nsp;&nsp;&nsp
;<r><r>If patients are treated with IVIG efore testing, serologic tests have
no value<r><r>Normal ranges for adult human Ig<r>IgM&nsp;&nsp;40-240 mg/dL&
nsp;&nsp;&nsp;(6-fold range)<r>IgG&nsp;&nsp;639-1344&nsp;&nsp;&nsp;&ns
p;(2-fold range)<r>Ig&nsp;&nsp;&nsp;70-312 (4-fold)<r><r><>CD19 is diagn
ostic for B cells </><r><r> 9 Lecture Marked
Define prevalence<r>Define Incidence<r><r> <>Prevalence</><r>The fractio
n of a population that has the syndrome or condition. Expressed as fraction, per
centage, life-time measurement<r>The prevalence of Ig Def. is 1/300 among adults <
r><r><>Incidence</><r>The annual rate of diagnosis of the condition<r>Diag
nosed cases of H1N1 in 2009<r>nnual rate of new occurrence of the condition<r
>(extrapolated) incidence of H1N1 in 2009<r> 9 Lecture
Differentiate a primary from a secondary immunodeficiency?
IMMUNODEFICIENCY
DISESES<r>RESULT FROM BSENCE OR MLFUNCTION OF COMPONENTS OF IMMUNE SYSTEM<
r>CUSED BY GENETIC MUTTIONS (<>PRIMRY IMMUNODEFICIENCIES</>)<r>CUSED BY E
XTERNL FCTORS (<>SECONDRY IMMUNODEFICIENCIES</>)<r>
Lecture Marked S
hearer
"fill in this chart <r><r><img src=""61506c69fec55f53c47951545eac.png"" />
"
"<img src=""01d291fc3c37a369950483f573d47d51.png"" />" Lecture Marked S
hearer
Reference:<r><r>TYPES OF IMMUNODEFICIENCY<r>&gt;150 GENETICLLY DEFINED IMMUN
ODEFICIENCIES<r>ESTIMTED GENERL INCIDENCE 1:10,000 (EXCEPT FOR IG DEFICIENCY
1:500)<r>SERIOUS IMMUNODEFICIENCIES 1:100,000 LIVE BIRTHS<r>X-LINKED, RECESSI
VE, ND DOMINNT INHERITNCE<r>
Lecture Marked Shearer
"Lymphoid development and genetic lesions leading to immunodeficiency.<r><r>Lo
ss of Enzyme / Protein can lock developmental pathway (ie D loss can e SCID)
<r><r><img src=""11a772a79f04f179490e3eac4e530aa.png"" />"
Lecture
Marked Shearer
Clinical features of immunodeficiency: <r><r>Name 2 ig prolems?
<>INCRE
SED SUSCEPTIBILITY TO INFECTION:</><r>INCRESED FREQUENCY<r>INCRESED SEVERI
TY<r>PROLONGED DURTION<r>UNEXPECTED COMPLICTION<r><r><>SSOCITED UTOIMM
UNE DISESES ND CNCER</><r> Lecture Marked Shearer
Descrie the immunodeficiencies symptomatic of <r><r>X-linked (Brutons) gamm
agloulinemia (X-L)<r><r>Descrie B Cells<r>Descrie infection onset and why
?<r>what infections are common?
"
X-LINKED (BRUTONS) GMMGLOBULI
NEMI (X-L):<r><>NO SERUM IGS, NO B CELLS (test)</><r>INFECTIONS BEGIN T 69 MONTHS OF GE (maternal a protection wears off(<r>INFECTIONS WITH PNEUMOCOCC
US, STPHYLOCOCCUS PROMINENT<r>PNEUMONI, SINUSITIS, OTITIS PREVLENT<r>VOID
LIVE VIRL VCCINES<r><r>PTIENT WITH X-L<r><r><img src=""aac91c683fd96a58
cdea9e2fc5163fe.png"" />"
Lecture Marked Shearer
X-LINKED GMMGLOBULINEMI<r><r>What is the mutation?<r>Why are males affect
ed and females carriers?<r>What fails to occur?
RFLP: PREFERENTIL INCT
IVTION OF FFECTED X-CHROMOSOME IN FEMLE CRRIERS SUGGESTS INTRINSIC B-CELL DE
FECT<r><r>GENE DEFECT (Xq21.3-22): <>MUTNT BRUTONS TYROSINE KINSE</> (CYTOP
LSMIC SIGNL TRNSDUCTION PROTEIN)<r><r>PRE-B-CELL DEVELOPMENT RREST<r><r>
Defective signal transduction enzyme common cause of deficiency <r> Lecture
Marked Shearer
Descrie CVID<r /><r />when is the onset? <r />what is low?<r />what disease
s / infections are common?<r />what are 2 associations?<r /> "ONSET 15-35 YE
RS: LOW IGG, IG, IGM<r /><r />PNEUMONI, BRONCHIECTSIS, SINUSITIS, GSTROINT
ESTINL INFECTIONS<r /><r />CELLULR IMMUNITY WEKENS<r /><r />SSOCITED U
TOIMMUNITY, MLIGNNCY<r /><r />SUSCEPTIBILITY GENE, CLSS II MHC REGION, 6TH
CHROMOSOME<r /><r><r>CHEST X-RY IN CVID<r><r><img src=""fefe71fc05152447
75cfd2d53df46.png"" />"
Lecture Marked Shearer
T/F - immunizations result in low IgM antiodies and no Igg switching in CVID
True. <r><r>CVID Immune asis: <r><r>IMMUNIZTIONS RESULT IN LOW IGM NTIBOD
IES, NO IGG SWITCHING<r>decreased B-CELL PRODUCTION OF NTIBODY<r>INDUCIBLE CO
-STIMULTOR (ICOS) 5% GENE DEFECT (2q 33)<r>TCI 15% GENE DEFECT (17 p11.2)<r>
Lecture Marked Shearer

Hyper IGM<r><r>Which sex has higher prevalence?<r>What infections are associa

ted?<r>Descrie this patients serum IG profile<r>what is the asis for this p
rofile?<r><r> MOSTLY MLES, RRELY FEMLES<r>SEVERE RESPIRTORY INFECTIONS, S
INUSITIS<r>SERUM IGG, IG VERY LOW, IGM HIGH, 7S IGM OCCSIONLLY<r>NO IGG SWI
TCHING, T-CELL IMMUNITY WEKENS WITH TIME<r>BNORML GERMINL CENTERS IN LYMPH
NODES<r>SSOCITED UTOIMMUNITY, MLIGNNCY<r><r>High IgM, low IgG/Ig<r>T c
ell prolem manifests as antiody deficiency<r>Prolem with class switch <r>
Lecture Marked Shearer
What is NEMO?<r><r>How does it present?<r><r>what aout carrier presenation?
"<img src=""70ef32fd3a9429caff465ca53d5f11.png"" />" Lecture Marked Shearer
"Reference:<r /><r />FETURES OF HYPER-IgM SYNDROMES - 1<r /><r />Note there
are many different sites that could cause this.<r /><r /><img src=""97f97fc9
8ea69777c0ea3d59379ae.png"" /><r><r><img src=""d894568181e607a89c328a40472
6d.png"" />"
Lecture Marked Shearer
What is Wiskott ldrich syndrome?<r><r>
"Wiskottldrich syndrome (WS) is
a rare X-linked recessive disease characterized y eczema, thromocytopenia (lo
w platelet count), immune deficiency, and loody diarrhea (secondary to the thro
mocytopenia). It is also sometimes called the eczema-thromocytopenia-immunodef
iciency syndrome in keeping with ldrichs original description in 1954.[1] The
WS-related disorders of X-linked thromocytopenia (XLT) and X-linked congenital
neutropenia (XLN) may present similar ut less severe symptoms and are caused 
y mutations of the same gene.<r><r><img src=""9fc7d14895d73993ec2a0801369f92
.png"" /><r><r><img src=""739c0dcff51292996c50ef08c85fcf.png"" /><r><r>"
Lecture Marked Shearer
What is DiGeorge Syndrome?<r><r>Name some symtpoms
"T-CELL DEFICIENCY<r><
r>DIGEORGE SYNDROME:<r><>DEFECT IN EMBRYOGENESIS: HERT, PRTHYROIDS, THYMUS<
/><r>HYPOCLCEMIC SEIZURES <r>BNORML FCIES<r>CHEST X-RY: BSENT THYMUS<
r>OPPORTUNISTIC INFECTIONS<r>FREQUENCY 1/4,000<r><r><img src=""7928695c682a7
c9f18746af3ea9fc23.png"" /><r><r>CHROMOSOME DELETIONS: 22q11*, 10p13 IN 95%<r
>PRT OF SPECTRUM OF VELOCRDIOFCIL SYNDROME*<r>FULL VS PRTIL DIGEORGE SYND
ROME (1/50 RTIO)<r>T CELLS LOW: CD3+, CD4+, CD8+FEW HVE OLIGOCLONL T CELLS<r
>B CELLS PRESENT, SERUM IGS NORML BUT BSENT FUNCTION<r><r>Lack of communicati
on etween B and T cells <r><r>"
Lecture Marked Shearer
What is SCID?<r><r>How does it manifest / what are findings?<r><r>How is it
classified? what classifications are there?
"X-LINKED SEVERE COMBINED(T/B CEL
L) IMMUNODEFICIENCY (SCID)<r><r>LIFE THRETENING INFECTIONS SOON FTER BIRTH<
r>WSTING, FILURE-TO-THRIVE<r>LCK OF THYMIC SHDOW<r>LCK OF CD3+, CD4+, CD8
+ T CELLS ND LCYTE RESPONSE TO NTIGENS<r>MUTNT IL-2R CHIN<r><r><img src=""1
31344d8d821a96f949c9c9001901d.png"" /><r><r>T(-)B(+)NK(-)<r>MUTTION IN COM
MON gamma CHIN (gammac), IL2RG GENE, X-LINKED<r>MUTTION IN JK3 ENZYME, JK3
GENE, R&nsp;&nsp;<r>T(-)B(+)NK(+) <r>MUTTION IN alpha CHIN OF IL-7 RECEPT
OR, IL7R GENE, R<r> CD3 DEFICIENCY, AR<br>" Lecture Marke Shearer
What is eficient in a:<br><br>monocyte eficiency (what receptor)<br>T cell ef
ieciency (what receptor)<br>what infection is asc' with the above 2 states?<br>
<br>NK cell eficiency (name 2 consequences?) OTHER CELL-DERIVEDCOMBINED IMMUNO
DEFICIENCIES<br><br>MONOCYTES/MACROPHAGES<br>IFN-gammaR DEFICIENCY (MONOCYTE)<br
>IL-12R DEFICIENCY (T CELL)<br>ATYPICAL MYCOBACTERIAL&nbsp;&nbsp;&nbsp;&nbsp;&nb
sp;&nbsp;&nbsp;&nbsp;INFECTION<br>NK CELL DEFICIENCY<br>T/B CELL DEFENSES OVERWH
ELMED<br>CHRONIC VIRAL INFECTION<br>
Lecture Marke Shearer
What oes phagocyte eficiency result in?<br><br>what is the genetic pattern?<br
><br> "PHAGOCYTE DEFICIENCY: <b>CHRONIC GRANULOMATOUS DISEASE</b><br><span sty
le="" font-weight:600;""></span><br>SKIN, LYMPH NODE, LUNG INFECTIONS <br>X-LINK
ED, AUTOSOMAL RECESSIVE<br><b>HIGH WBC, NO INTRACELLULAR KILLING/H2O2</b><br>MEM
BRANE/CYTOSOLIC PARTS OF CYTOCHROME B<br>DIAGNOSIS: NBT, DHR ASSAYS<br><span sty
le="" font-weight:600;""></span><br><img src=""1aaf31a61ac2f 847ee086aa37e3e0b2.
png"" /><br><br>For reference: <br><br><img src=""833 53915130617bf8 9084b685c6
6b.png"" /><br><br><img src=""5 1a585a478115 75401 4 8577b78b .png"" /><br>"
Lecture Marke Shearer
Leukocyte a hersion eficiency<br /><br />what is not expresse (2 things)<br />
<br />what are fin ings?
"GINGIVOSTOMATITIS, SKIN INFECTIONS <br />VERY H

IGH WBC<br />AUTOSOMAL RECESSIVE INHERITANCE (21q22.3)<br /><b>BETA INTEGRIN (CD

18) NOT EXPRESSED</b><br /><b>COMPLEX OF CD11A,B,C NOT CO-EXPRESSED</b><br />SEV
ERE AND MODERATE FORMS<br /><br /><img src=""70c176b9a0983af60ae271e109a8a96c.pn
g"" /><br />" Lecture Marke Shearer
Toll receptors an complement eficiencies<br><br>which TLRs are pathogen recogn
ition receptors?<br> escribe the complement system<br>what inheritance patterns
are at work?<br><br>what is a common TLR eficiency<br>what is eficiency in C1/
2/4 associate with?<br>what is eficiency in C5-9 associate with?
"PATHOGE
N RECOGNITION RECEPTORS TLR-2,3,4,5,9<br>31 PROTEINS: 20 PLASMA, 5 MEMBRANE, 7 R
ECEPTORS COMPROMISE CLASSICAL ALTERNATE, LECTIN PATHWAYS <br>AUTOSOMAL CO-DOMINA
NT, DOMINANT, X-LINKED INHERITANCE<br><br>IRAK-4 DEFICIENCY TLR/IL-1<br>C1, C2,
C4 DEFICIENCIES: PYOGENIC INFECTIONS, AUTOIMMUNE DISEASES<br>C5-C9 DEFICIENCIES:
MENINGOCOCCAL, GONOCOCCAL INFECTIONS<br><br><img src=""e2 5699296 0a7a77 f5c108
bf3 e720.png"" />"
Lecture Marke Shearer
treatment for RX antibo y (B cell) isor ers? REPLACE IGG DEFICIENCIES WITH IV
IG<br>GENERAL SUPPORTIVE CARE (FREQUENT ANTIBIOTICS)<br>AVOID LIVE VIRAL VACCINE
S<br>RX COMPLICATIONS -- AUTOIMMUNE DISEASES MALIGNANCIES<br> Lecture Marke S
hearer
RX CELLULAR immunity (T/B, M ) DISORDERS (6)
BONE MARROW/PLACENTAL STEM CELL<
br>IVIG IF NECESSARY <br>GENERAL SUPPORTIVE CARE<br>GENE THERAPY, IF POSSIBLE<br
>AVOID LIVE VIRAL VACCINES<br>CMV-/IRRADIATED/ WBC BLOOD TRANSFUSION<br>
Lecture
Marke Shearer
"For reference:<br><br>DONOR<br>HLA-MATCHED SIBLING<br> ecrease &nbsp;&nbsp;CD3
CELL + 1/2 MATCHED<br>MUD (matche unrelate onor)<br>PLACENTAL<br>95% SURVIVAL
&lt; 3 MONTHS<br>NEWBORN SCREEN<br><br><img src=""2356c29aae41a4f9ee0e43 f 0 78
Lecture Marke Shearer
27.png"" />"
"Reference: <br><br><img src=""ccb 592a0b5e92b265 17 16 4b26bcc.png"" />"
Lecture Marke Shearer
Treatments for phagocyte eficiency? (3)<br>tratement for complement eficiencie
s (1) RX PHAGOCYTE DEFICIENCY<br>IFN-gamma FOR CGD<br>GENERAL SUPPORTIVE CARE<
br>BONE MARROW STEM CELLS&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;WHERE POSSIBLE<br>RX COMP
LEMENT DEFICIENCIES<br>GENERAL SUPPORTIVE CARE (FREQUENT ANTIBIOTICS)<br>
Lecture Marke Shearer
"<img src=""b966ff26411b144f77c8e5 8740be42b.png"" /><br><br><img src=""658e2ef9
595ce 0 0ca1bc2 725 ee2.png"" />"
D is the correct answer<br><br>D.
Other is correct since all of the in ivi uals in the pictures carry one efective
chromosome in an X-linke inheritance pattern.<br>
Lecture Marke Shearer
"Question 2<br />The image shows a phagocyte reaching out to engulf a bacterium.
&nbsp;&nbsp;In which immune eficiency is this action impaire ?<br /><img src=""
a03399c3425e6b31f4 146f812472 b.png"" /><br /><br />A Chronic granulomatous is
ease of chil hoo <br />B IFN- receptor deficiency<br />C IL-12 receptor deficienc
y<br />D Leukocyte adhesion deficiency<br />" D is the correct answer<br /><br
/>D.
Leukocyte adhesion deficiency lacks the CD18CD11A,B,C complex of lyc
oproteins that enable the leukocyte extend pseudopods to attach to and enulf ba
cteria.<br /> Lecture Marked Shearer
"A lun biopsy of an infant with pneumonia showed these oranisms present in the
tissue.&nbsp;&nbsp;Flow cytometry showed this historam of peripheral blood mon
onuclear cells.&nbsp;&nbsp;What dianosis is applicable to this patient?<br><br>
<im src=""99a17d97a76314f205797c9c93591a65.pn"" /><br><br>A Complement compone
nt C3 deficiency<br>B Hyper IM disease<br>C Severe combined immunodeficiency<br
>D Selective IA deficiency<br>"
C is the correct answer<br><br>C.
The infant has severe combined immunodeficiency and cannot kill the Pneumocystic
jerveci funus that causes severe pneumonia.&nbsp;&nbsp;A total lack of T cells
in quadrant #1 of the historam compared to the control subject is dianostic.<b
r>
Lecture Marked Shearer
"A 28-year old male has a wasted appearance with hyperexpanded&nbsp;&nbsp;luns
filled with ranulomas and scarrin.&nbsp;&nbsp;He was perfectly well until he w
as 20 when he developed recurrent pneumonias.&nbsp;&nbsp;Pneumococcal immunizati
ons show no antibody responses.&nbsp;&nbsp;There are normal numbers of B cells i
n his blood.&nbsp;&nbsp;What is the most likely dianosis? <br><br><im src=""bf

4d337f07177722aeae32d6e78bb8ef.pn"" /><br><br>A Common variable immunodeficienc

y<br>B Complement component C9 deficiency<br>C DiGeore syndrome<br>D X-linked a
ammalobulinemia<br>" A is the correct answer<br><br>A.
Common variable
immunodeficiency.&nbsp;&nbsp;This patient was well until his third decade of life
when his severe immunolobulins became very low and T cells decreased as well.&
nbsp;&nbsp;The other choices would cause illness from the beinnin of life.<br>
Lecture Marked Shearer
"In 2009, 7 cases of severe, life-threatenin diarrhea and dehydration in infant
s iven the FDA-approved live attenuated rotavirus vaccine were reported to the
Centers for Disease Control.&nbsp;&nbsp;All of these infants had a profound abse
nce of T cells in the blood requirin bone marrow transplantation.&nbsp;&nbsp;A
Public Health Officer is dispatched to investiate these cases.&nbsp;&nbsp;What
were his findins likely to reveal?<br><br><im src=""438ca5697ab43f920a8873dd9b
866a83.pn"" /><br><br>A Given the rare nature of these side effects, the diarrh
ea and rotavirus vaccination are probably not related.<br>B Screenin of all inf
ants at birth for severe immunodeficiency would have avoided these accidents.<br
>C The benefit/cost ratio of childhood immunization is so reat that unqualified
immunizations are necessary.<br>D Infants are prone to frequent bouts of diarrh
ea as part of normal childhood illnesses.<br>" B IS THE BEST ANSWER<br>B.
Infants with severe combined immunodeficiency should be screened for SCID at b
irth as part of the rare diseases screenin of all children currently in operati
on.&nbsp;&nbsp;Havin this information would prevent such infants the to avoid t
he complications of receivin live viral vaccines.<br> Lecture Marked Shearer
A one-month-old boy develops severe respiratory syncytial virus infection and re
quires ventilator support.&nbsp;&nbsp;His father is healthy, but his 21-year-old
mother has never enjoyed ood health since bein 15 years of ae.&nbsp;&nbsp;Hi
s T and B cell phenotypin and function are normal.&nbsp;&nbsp;His phaocyte fun
ction and complement function are normal.&nbsp;&nbsp;His serum IM and IA level
s are normal, but his serum IG level is almost zero.&nbsp;&nbsp;How would you e
xplain this childs illness? <r><r> The child has selective IgG deficiency.<r>
B The child has hyper IgM syndrome.<r>C CVID is eing expressed at an early age
.<r>D The mother has an immuno-deficiency.<r> D IS THE CORRECT NSWER<r><r>D
.
lthough this child is very sick, all of his laoratory tests except fo
r IgG prove to e normal.&nsp;&nsp;His illness is the result of the lack of ma
ternal antiody transfer due to the mothers immunodeficiency (Common Variale Imm
unodeficiency).<r>
Lecture Marked Shearer
 16-year-old girl develops recurrent fevers and a red fixed rash over her nose
and upper cheeks that resemles a utterfly.  diagnosis of autoimmune disease (
systemic lupus erythematosus) is made y the clinical immunologist. Which additi
onal test is likely to e anormal? <r /><r /> DHR <r />B IG <r />C C9&ns
p;&nsp;<r />D CD18 <r />
B is the correct answer<r />B.
T and B c
ell forms of immunodeficiency all commonly attended y defects in immunoregulato
ry diseases such as systemic lupus erythematosis.&nsp;&nsp;In this case the on
ly choice of answers that targets a T or B cell deficiency is an Ig test.&nsp;
&nsp;Thus the patient has oth systemic lupus erythimatosis and Ig deficiency.
<r /> Lecture Marked Shearer
 2-year oy was found to have repeated infections, easy ruisaility, and mucos
al leeding.&nsp;&nsp;His platelet count was 10,000/ L (low) and his antiody is
otype failed to switch from IgM to IgG upon oosting with a de novo polysacchari
de antigen ( X-174 acteriophage).&nsp;&nsp;What test would lead to a definitiv
e diagnosis? <r><r> Lymphoproliferation to X-174. <r>B Flow cytometry test f
or intracellular WSP.<r>C Delayed hypersensitivity test for TB. <r>D Superoxi
de generation y neutrophils. <r>
B is the correct answer<r>
<r>B
.
Recurrent leeding episodes, low platelets, and recurrent infections is
a sign of Wiscott-ldrich syndrome.&nsp;&nsp;The correct and definitive test
is to look for the WSP protein inside of T cells y flow cytometry.<r>
Lecture Marked Shearer
 one-year-old girl is rought to the pediatrician ecause of a deep and painful
perirectal ascess.&nsp;&nsp;Her white lood cell count (WBC) (mostly neutrop
hils) is greater than 50,000 (normal less than 10,000), and her spleen is greatl

y enlarged.&nsp;&nsp;Mother, father, and two silings are healthy.&nsp;&nsp;

Lymphocyte function, antiody formation, DHR test, and complement function are n
ormal.&nsp;&nsp;What would you tell the anxious parents?<r /><r /> The chil
d has an intercurrent illness that requires antiiotics. <r />B The WBC is too
high and needs reduction y splenectomy. <r />C nother white lood cell test i
s necessary. <r />D IFN-gamma therapy will eliminate the infection. <r />
C is the correct answer<r />C.
The nature of deep infections and extreme
ly high white lood cell counts would indicate that the child has leukocyte adhe
sion deficiency and needs another lood cell test (CD18) in view of a normal tes
t for chronic granulomatosis disclose (DHR).<r />
Lecture Marked Shearer
n 18-year-old student who has een well all of his life develops three outs of
gonococcal infections in his first year at college.&nsp;&nsp;How would you re
spond? <r><r> There might e a defect in the C5-C9 complement pathways. <r>B
The patient needs intravenous IgG to remain infection free. <r>C The IFN- R on h
is antigen-presenting cells is defective. <r>D The exuerance of youth explains
 is the correct answer<r>.
this prolem.<r>
Neisserial (gonococ
cal) infection in young adults can e the result of a deficiency of late acting
complement components that form the memrane attack complex pore in acteria cau
sing its contents to e extruded with acterial cell death.&nsp;&nsp;Meningiti
s is another form of neisserial disease that affects teenagers.<r>
Lecture
Marked Shearer
Primary Ojectives - Orit and Eye <r /><r />Descrie the ony orit and its w
eaknesses<r>List the muscles that control the eye<r>Descrie&nsp;&nsp;the se
nsory innervation of the eye and orit<r>Descrie the lacrimal apparatus<r>Def
ine direct and consensual pupillary light reflex, accommodation<r>Explain how g
aze and convergence differ <r>List the contents of the cavernous sinus<r>Descr
ie the pathway and distriution of II,III, IV, V,VI<r>Descrie the muscles tha
t are tested and when they are tested in the extraocular muscle clinical exam <
r><r />
OritandEye Marked
"<img src=""pasteknfat.png"" />"
"<img src=""pastewz6m5h.png"" /><r />Bl
ue circle = palatine one<r />GW - Greater Wing<r />LW - Lesser Wing" Oritand
Eye Marked
"<img src=""f84c0649107c235577fc506e96c6fe.png"" />" "<img src=""e7c21f6822
9ddc81ef8e5e03906ec1.png"" />" OritandEye Marked
"<img src=""7133c988f838d0632f3e380ce79e586.png"" />" "<img src=""22364890
9fd457e5ac6976d0e789.png"" /><r /><r />Blowout fracture - eye goes through on
e at this region<r />Diplopia - doule vision" OritandEye Marked
"<img src=""473473201500e461caf63d168f3.png"" />" "<img src=""pastehq4plz.
png"" />"
OritandEye Marked
"<img src=""e1145d1a2d6f9edc40ad58c08373800.png"" />" "<img src=""a16ea71d483
a10803523ad645a816e.png"" /><r><r>Image Name: Fig. 33.14 - Removed: Orital s
eptum (partial). Divided: Levator palperae superioris (tendon of insertion).<r
>"
OritandEye Marked
"<img src=""fefc8cfd932cd337cad49985eee1e4d.png"" />" "<img src=""230ca666c02
151f482ed2a6977a02c2.png"" />" OritandEye Marked
"<img src=""pasteffasf.png"" />"
"<img src=""pastey4zjep.png"" />"
OritandEye Marked
"<img src=""fc45014636d371643731d7e6d859d.png"" />" "<img src=""6ce58e4da0
af2e07808286cc9c49.png"" />" OritandEye Marked
"<img src=""d46edfa5a7da3e7f9ed842672d28e20.png"" />" "<img src=""479f1e5dad4
932df508d3f3c5ad84c.png"" />" OritandEye Marked
"<img src=""31f08a9ada65102e0493753c76e6.png"" />" "<img src=""48dcaeda541
644580a741613a1a44d.png"" /><r />The optic fundus is the only place in the od
y where capillaries can e examined directly. Examination of the optic fundus pe
rmits oservation of vascular changes that may e caused y high lood pressure
or diaetes. Examination of the optic disk is important in determining intracran
ial pressure and diagnosing multiple sclerosis.<r />" OritandEye Marked
"<img src=""e3a700daf1e2917f71a3c4efef71af.png"" />" "<img src=""f78a4e4ff65
98d26e10f812d54d4453.png"" />" OritandEye Marked
"<img src=""073455325790c84d781757381c8a1299.png"" />" "<img src=""8429d6a7af

774cc7d6a41c7416f7a.png"" /><r /><r /><r /><r /><r />"

OritandEye Mark
ed
"<img src=""3eda1e7549ca40261dcf1224148f950.png"" />" "<img src=""707e6f85cc6
e5c48a3c798ec02f30.png"" /><r><r>Image Name: Fig. 33.2 B - The eyeall is mo
ved y six extrinsic muscles: four rectus (superior, inferior, medial, and later
al) and two olique (superior and inferior).<r>"
OritandEye Marked
"<img src=""6c5f67148c3d9caff81aa4d4ce68e03.png"" />" "<img src=""6d47ae054d06
dfeea2a8107335f6cad.png"" />" OritandEye Marked
"<img src=""cd4cfe7d02dc493690a584416da031.png"" />" "<img src=""84e6451d77c
1884396102d939c356dd.png"" />" OritandEye Marked
"<img src=""9cc2882c047fac3529e71793e93c01.png"" />" "<img src=""130ac79a7862
ff12c261ff9a55850fd.png"" />" OritandEye Marked
"<img src=""395f767c8d36d30c3544a3f84aa53de.png"" />" "<img src=""0506402314e9
7fc047041a393175772.png"" />" OritandEye Marked
Define <r><r>Gaze<r>Convergence
Gaze oth eyes moving together following
a finger what happens to the muscles of each eye is opposite to the other eye<
r><r>Convergence cross-eyed oth eyes looking medially <r>
OritandEye Mark
ed
"<img src=""f8a29c8f503090e15874ef035d9e7.png"" />" "<img src=""626956ac808a
2314c6c0c55643288a.png"" />" OritandEye Marked
"<img src=""cc5e47456e81c19a130d8e85a94d174.png"" />" "<img src=""2ac35dde9633
54a3331dd371c0e940d8.png"" />" OritandEye Marked
"<img src=""1fe966465686c2f6ae92f8c81353f.png"" />" "<img src=""e7424787c783
f12dc7a40c7898936a23.png"" /><r><r>Image Name: Cl. Box 33.200 D - Oculomotor p
alsies may result from a lesion involving an eye muscle or its associated crania
l nerve (at the nucleus or along the course of the nerve). If one extraocular mu
scle is weak or paralyzed, deviation of the eye will e noted. Impairment of the
coordinated actions of the extraocular muscles may cause the visual axis of one
eye to deviate from its normal position. The patient will therefore perceive a
doule image (diplopia).<r>" OritandEye Marked
"<img src=""79e39cf5c80c2693fe808d103349.png"" />" "<img src=""d306d97e0a9d
c8289e739308748e307.png"" /><r><r>Image Name: Fig. 33.8 - Removed: Cavernous
sinus (lateral and superior walls), orital roof, and periorita (portions). The
trigeminal ganglion has een retracted laterally.<r>" OritandEye Marked
"<img src=""cd8595837ee746568f6e0815edac.png"" />" "<img src=""e88175895a9f
9da6c37def4d17ceec1e.png"" />" OritandEye Marked
"<img src=""de885698d370260a141d35a5f1e2762.png"" />" "<img src=""40a57f23c90
3a5e663528685f72d24.png"" /><r><r>Image Name: Fig. 33.7 - Removed: Temporal 
ony wall.<r>" OritandEye Marked
"<img src=""0e593605130f20c30feea783d17a86c.png"" />"
OritandEye Mark
ed
"<img src=""5ffd72636cdfff8c0e91a9d99aa19.png"" />" "<img src=""19ec82a144e6
24e3d6614ecd47976544.png"" /><r><r>Image Name: Fig. 33.5 - Removed: Lateral or
ital wall. Opened: Maxillary sinus.<r>"
OritandEye Marked
"<img src=""e6e7730667de278fa2fc886328e4cc3.png"" />"
OritandEye Mark
ed
"<img src=""7f6aaaf787a360843a7d871d8e58d.png"" />" "<r><r><img src=""d53e
a9c20cfaf0d316267610c84f7.png"" />" OritandEye Marked
"<img src=""2568f015a3887809d7d12a0e1aa890.png"" />" "<img src=""83318d11e27
cd1ea70d43c639dfe70.png"" /><r><r>Image Name: Fig. 33.11  - Removed: Bony ro
of of orit, peritorita, and retro-orital fat.<r><r>NFL <r>Nasociliary n /
art<r>F Frontal N <r>L lacrimal N and art<r>"
OritandEye Marked
"<img src=""5086c092928dc5a8f87327c1fa9d36a.png"" />" "<img src=""951118fa0a5e
32a541da5afefa905ac.png"" />" OritandEye Marked
"<img src=""95978848cd419a414ad69f91d82ff8e0.png"" />" "<img src=""2a118fde183
09847ea507664f9c0a4.png"" /><r><r>Image Name: Fig. 33.6 - Opened: Optic canal
and orital roof.<r>" Marked OritandEye
"<img src=""40aa71919ddd28c5ec50d3c7d470.png"" />" "<img src=""551ec569f9
399c73d9747ad1cfac2.png"" />" OritandEye Marked
"<img src=""7d97e2d9f76dc87481dcf22f915.png"" />" "<img src=""fef76889e5

2af394e6e3f86989f.png"" /><r><r>Cornea&nsp;&nsp;itself / medial of conjun

ctiva nasociliary<r>Lateral half conjunctiva y lacrimal n of V1<r><r>Sneeze
response constriction of pupil parasympathetic rain may interpret as originatin
g from the nose <r>Corneal reflex scrape cornea w/ qtip linking reflex<r>"
OritandEye Marked
"<img src=""2d0a6c82fff2c7d029025fc5a4739aff.png"" />" "<img src=""11081d6763
9320899869e0d75fd0.png"" /><r><r>Image Name: Fig. 33.19  - Pupil size is re
gulated y two intraocular muscles of the iris: the pupillary sphincter, which n
arrows the pupil (parasympathetic innervation), and the pupillary dilator, which
enlarges it (sympathetic innervation).<r><r>Shining light on one side causes
opposite side to constrict consensual reflex<r>Direct pupillary reflex shine li
ght on eye and it constricts<r><r>" OritandEye Marked
kretzer eye learning ojectives<r /><r />Learning Ojectives:<r /><r /><r /
>OCULR STRUCTURE ND THE OPEN GLOBE<r /><r />Know the three layers of the eye
(sclera-limus-cornea; choroid-ciliary ody-iris; RPE (retinal pigment epitheli
um)-neural retina and their anterior projections at the ora serrata.<r /><r />
Define the oundaries of the anterior chamer, the posterior chamer, and the vi
treous.<r /><r />Descrie the angle and the exact surgical lateral oundaries
of the cornea.<r /><r /> What are the functions and neural innervation of the
three smooth muscles within the gloe?<r /><r /> What is the near synkinesis r
eflex?<r /><r /> What are the three components of the uveal tract?&nsp;&nsp;
How does this explain the clinical shape of the pupil after an open gloe?<r /><
r />What steps do you take as a non-ophthalmologist when you see a peaked pupil?
<r /><r />Define PERRL.<r /><r />Explain how the eye is a fantastic photogr
aphic darkroom.<r /><r />Explain why alinos have poor vision. <r /> THE LENS
ND CTRCTS<r /><r />How does the histology and anatomy of the lens explain
the current state-of-the-art cataract extraction? (l.5 million/year)<r /><r /
>What is presyopia?&nsp;&nsp;Give its cellular explanation.&nsp;&nsp;<r />
<r /><r />THE CORNE<r /> ND<r />ENDOTHELIL OR PENETRTING KERTOPLSTY<r
/><r />How does the histology and anatomy of the cornea explain the surgical s
teps in a penetrating keratoplasty (PK) or endothelial keratoplasty (EK)? (40,00
0/year)<r /> EyeHisto Marked
What are the 9 functions of the eye?
Nine Functions of the Eye<r><r>(1) Day
vision (photopic vision) due to 6.8 million cone photoreceptors (color, high re
solution, central vision)<r>(2) Night vision (scotopic vision) due to 125 milli
on rod photoreceptors (lack/white, low resolution, peripheral vision)<r>(3) Co
ntrol the amount of light entering the eye (pupil size)(miosis and mydriasis)<r
>(4) Keep the visual world in focus (from distance to near)(accommodation)<r>(5
) Keep your eyes focused on a point during head movements (vestiular input).<r
>(6) Sense light cycles for circadian rhythms (suprachiasmatic nucleus of the hy
pothalamus).<r>(7) Keep your eyes aligned on oject of regard (fusion) (sensory
lim of CN II and motor lim via CN III, IV, Vi)<r>(8) Create depth perception
(stereopsis)<r>(9) Create a perfect camera (darkroom with flat lack walls so
no light scattering and no light streaming in through cracks in the walls)<r>
EyeHisto Marked
What are the 3 layers of the gloe?
Outer layer: <>sclera</> (lamina crir
osa, nasally), limus, cornea<r><r> Middle layer (<>uveal tract</>): choroid,
ciliary ody with ciliary processes, and iris stroma.&nsp;&nsp;Has invasion o
f melanocytes of neural crest origin.<r><r> Innermost layer:&nsp;&nsp;RPE (<
>retinal pigment epithelium</>) neural retina ora serrata anterior projections
across ciliary processes and across the posterior aspect of the iris.<r>
EyeHisto Marked
List the components of the Outer layer of the gloe (3) Outer layer: <>sclera</
EyeHisto Marked
> (lamina crirosa, nasally), <>limus</>, <>cornea</>
List the components of the middle layer of the gloe (3)
Middle layer (uv
eal tract): <>choroid</>, <>ciliary ody</> with <>ciliary processes</>, a
nd <>iris stroma</>.&nsp;&nsp;Has invasion of melanocytes of neural crest or
igin. EyeHisto Marked
List the components of the innermost layer of the gloe Innermost layer:&nsp;&n
sp;RPE neural retina ora serrata anterior projections across ciliary processes

and across the posterior aspect of the iris.

EyeHisto Marked
What does PERRL mean? PERRL means a normal pupil which means the <r><>p</>
upils are <>e</>qual, <>r</>ound, <>r</>eactive to <>l</>ight and <>a</
>ccommodation&nsp;&nsp;&nsp;
EyeHisto Marked
The open gloe - what do you do if you diagnose a peaked pupil?<r><r>10 steps
The Open Gloe<r>Now you can understand the anatomy which explains the diagnost
ic feature of a peaked pupil in an open gloe.&nsp;&nsp;&nsp;PERRL means a norma
l pupil which means the pupils are equal, round, reactive to light and accommoda
tion&nsp;&nsp;&nsp;Whenever you see a peaked pupil, you and the patient must
do the following (which you must memorize now and never forget): <r><r>(1) you
call ophthalmology immediately<r>(2) you cut nothing <r>(3) you clean nothing
<r>(4) you administer no topical antiiotics,&nsp;&nsp;IV antiiotics are OK
<r>(5) you administer no topical anesthetics <r>(6) the patient must e NPO e
cause they are going to the OR <r>(7) the patient just sits still&nsp;&nsp;<
r>(8) the patient is foridden to end over, lay down,&nsp;&nsp;lift anything,
or perform any valsalva activities like even having a owel movement<r>(9)&ns
p;&nsp;you apply no pressure on the eye even to test for intraocular pressure <
r>(10) you cover the eye with a lose patch or a styrofoam cup&nsp;&nsp;<r>
EyeHisto Marked
List the 3 chamers of the eye The Three Chamers of the Eye<r><r><> nterior
chamer</> posterior surface of cornea, to angle, across anterior iris, over a
nterior capsule of the lens in the pupil; contains aqueous humor (0.4ml). You ma
ke 4ml of aqueous humor per day.<r><r><> Posterior chamer</> across posterio
r iris, ciliary processes, zonule fiers of firillin, anterior capsule of lens,
to anterior surface of vitreous ody; contains aqueous humor<r><r> <>Vitreous
ody</>&nsp;&nsp;(4ml) consistency of raw egg whites, mostly water with stra
nds of collagen type I and polymers of hyaluronic acid; from inner surface of th
e stratified neural retina to posterior capsule of lens.&nsp;&nsp;With normal
aging, the vitreous ecomes liquefied so that retinal detachments are more preva
lent in the elderly.<r>
EyeHisto Marked
The anterior chamer of the eye - what is it? what does it contain?
nterior
chamer posterior surface of cornea, to angle, across anterior iris, over anter
ior capsule of the lens in the pupil; contains aqueous humor (0.4ml). You make 4
ml of aqueous humor per day.
EyeHisto Marked
What ocular chamer contains aqueous humor and how much is made per day?

nterior chamer posterior surface of cornea, to angle, across anterior iris, ov

er anterior capsule of the lens in the pupil; contains aqueous humor (0.4ml). Yo
u make 4ml of aqueous humor per day.
EyeHisto Marked
Descrie the posterior chamer of the eye; what does it contain / where is it lo
cated? Posterior chamer across posterior iris, ciliary processes, zonule fier
s of firillin, anterior capsule of lens, to anterior surface of vitreous ody;
contains aqueous humor EyeHisto Marked
The vitreous ody of the eye - what is it composed of? what does aging do?

Vitreous ody&nsp;&nsp;(4ml) consistency of raw egg whites, mostly water with

strands of collagen type I and polymers of hyaluronic acid; from inner surface o
f the stratified neural retina to posterior capsule of lens.&nsp;&nsp;With nor
mal aging, the vitreous ecomes liquefied so that retinal detachments are more p
revalent in the elderly.
EyeHisto Marked
List the 3 smooth muscles cells inside the eye<r><r> <>Constrictor</> muscl
e circular muscle in iris stroma, around pupil margin, when contracts, pupil ec
omes smaller, called miosis (under parasympathetic control of CN III)<r><r> <>
Dilator</> muscle radial muscles in iris stroma, when radial muscles contract,
pupil ecomes larger, called mydriasis (under sympathetic control)<r><r> <>Cir
cumferential</> muscle in ciliary ody of uveal tract When relaxed, circumferen
ce of circle created y the ciliary ody is at its largest size, pulls on the zo
nule fiers, keeps the lens flat.&nsp;&nsp;When contracts y parasympathetic i
nnervation of CN III, circumference of circle created y the ciliary ody is at
its minima, releases tension on the zonule fiers, lens is freed from tension, l
ens gets fatter due to its inherent elasticity, and ecomes a more powerful lens
for near vision.&nsp;&nsp;This is called accommodation.<r> EyeHisto Marked

The contstrictor muscle of the eye<r>where is it?<r>what does it do?<r>who co

ntrols it?
Constrictor muscle circular muscle in iris stroma, around pupil
margin, when contracts, pupil ecomes smaller, called miosis (under parasympathe
tic control of CN III) EyeHisto Marked
Dilator muscle - where is it, what does it do, who controls it? Dilator muscle r
adial muscles in iris stroma, when radial muscles contract, pupil ecomes larger
, called mydriasis (under sympathetic control) EyeHisto Marked
Circumferential muscle - where is it, what does it do, what controls it?

Circumferential muscle in ciliary ody of uveal tract When relaxed, circumferenc

e of circle created y the ciliary ody is at its largest size, pulls on the zon
ule fiers, keeps the lens flat.&nsp;&nsp;When contracts y parasympathetic in
nervation of CN III, circumference of circle created y the ciliary ody is at i
ts minima, releases tension on the zonule fiers, lens is freed from tension, le
ns gets fatter due to its inherent elasticity, and ecomes a more powerful lens
for near vision.&nsp;&nsp;This is called accommodation.
EyeHisto Marked
What is presyopia?
Lens loses elasticity after 40 years of age, this is a no
rmal aging process, so even though the tension on the lens is released y contra
ction of the smooth circumferential muscle in the ciliary ody, the lens does no
t get fatter (called presyopia) and such patients need a stronger refraction wi
th reading glasses. Presyopia is normal, nonpathologic aging of the eye.
EyeHisto Marked
List the 3 events of the near synkinesis reflex<r>what is the control of each?
<>accommodation</> (parasympathetic CN III)<r> <>convergence</> (CN III on m
edial recti muscles)<r> <>miosis</> (pupil gets smaller to reduce depth of foc
us) (parasympathetic CN III)<r>
EyeHisto Marked
List the 7 ocular muscles controlled y CNIII You&nsp;&nsp;now know all SEVE
N ocular muscles controlled y CNIII:&nsp;&nsp;the four skeletal extraocular m
uscles of the<r><r>medial rectus<r>superior rectus<r>inferior rectus<r>infe
rior olique<r>the skeletal levator muscle of the upper eye lid<r>two smooth m
uscles of the ciliary ody <r>circular constrictor muscle of the iris EyeHisto
Marked
Melanin in the eye<r><r>Where do melanocytes invade (2)<r>Where is melanin sy
nthesized? (2)<r>How do the aove relate to the visual prolems of the alino?
melanocyte invasion into the <>iris stroma</> (lue eyed aies ecome rown e
yed within the first five months of life)<r><r> melanocyte invasion into the <
>choroid</><r><r> melanin synthesis&nsp;&nsp;in the <>retinal pigment epith
elium and its anterior projection</><r><r> <>melanin in the single layer of u
ndifferentiated neural retina over the posterior aspect of the iris </>(two lay
ers of lackness so no light can enter the eye across the iris, ut only through
the diameter of the pupil).<r><r> Now you can appreciate the visual prolems o
f the alino and of those individuals with neural crest suppression of melanocyt
e migration into the uveal tract (choroid) and iris stroma - they make a poor da
rkroom!<r>
EyeHisto Marked
Choroid is massively vascularized and melanoma often metastasizes. why is metast
asis less common than one might think? Since the choroid is massively vasculari
zed, melanoma of the eye has a great potential for metastasis.&nsp;&nsp;The lu
cky thing is that people are so aware of slight changes in their visual acuity,
that they seek help when the tumor is tiny.&nsp;&nsp;Very often, these tumors
are killed with radioactive gold seeds, chemotherapy, and NOT total enucleation
of the gloe.&nsp;&nsp;
EyeHisto Marked
The lens<r><r>whats the derivative?<r>whats the collagen?<r>how does it ex
pand during life? what does this do to the angle?<r>what is presyopia?<r>what
is the gross shape of the lens?
&nsp;&nsp;an epithelial derivative with
an anterior and posterior capsule (asement memrane of type IV collagen), ante
rior epithelium, and epithelial cells differentiating into lens fiers at the eq
uator throughout life (so that the lens is slowly getting larger and larger and
pressing on the iris so that the angle is getting smaller and smaller with norma
l aging)<r><r> iconvex&nsp;&nsp;with elasticity that decreases with age (pre
syopia)<r>
EyeHisto Marked
The lens <r><r>descrie the lens fiers; what is the cytoplasm filled with?<r

>when does the lens ecome avascular?<r><r>The lens is transparent. <r>name 7

factors to account for this. lens fiers are highly differentiated epithelial
cells with no nuclei, no organelles, ut whose cytoplasm is filled with solule
, non-aggregated homogeneous proteins called crystallins<r><r> after developmen
t at 40 weeks gestational age, the lens is totally avascular<r><r> transparent
due to the:<r>shape and arrangement of the lens fiers<r>regular intercellular
interdigitations<r>small amount of interstitial fluid<r>crystallin protein di
striution within the lens fiers<r>asence of all organelles within mature len
s fiers<r>smooth surface of the lens capsule<r>uniformity of the single layer
of anterior epithelial cells<r>
EyeHisto Marked
The lens<r><r>What cells are metaolically active?<r>what aspect of the capsu
le eventually gets thicker? why?<r><r>What holds the lens in place? <r><r>
The metaolically active anterior epithelial cells continuously produce asement
memrane material which is dragged posteriorly&nsp;&nsp;during lens fier dif
ferentiation so that ultimately, the posterior capsule is thicker than the anter
ior capsule.&nsp;&nsp;There is always a reservoir of epithelial cells at the e
quator which are in the process of differentiating from epithelial cells to lens
fiers. <r><r> Lens held in place y zonule fiers (firillin) that attach fro
m the lens equator capsule to the inner nonpigmented cells over the ciliary proc
esses<r>
EyeHisto Marked
What triggers a cataract (4)?<r>How may a cataract present?<r>what is leukocor
ia?<r>T/F a cataract is the major cause of world lindness<r>what is most dei
litating aout a cataract?
cataract is loss of lens transparency triggered
y:<r>UV light<r>steroids<r>diaetes<r>normal aging<r><r>-can present as a
white pupil (leukocoria)<r><r>-can result in pronounced visual acuity decreas
e ut most deilitating is the glare from lights and impossiility to drive at n
ight<r><r>-the major cause of world lindness.<r>
EyeHisto Marked
Cataract surgery<r><r>descrie incision / procedure -&nsp;&nsp;as well as an
y complications / risks <r><r>
small incision (self-sealing)<r><r>re
move the anterior capsule and epithelial cells<r><r>lamellar dissection with s
aline injection so that the entire lens fier core is floating on a thin veneer
of fluid and is rotatale<r><r>fragmentation and suck out the lens fragments 
y phacoemulsification ut leave the sulcus of the capsule at the equator intact
<r><r>polish posterior capsule<r><r>put a foldale intraocular lens (IOL) (o
ptic/haptic, optic can e ifocal or trifocal) in the ag of the posterior capsu
le, minimal post-operative induced astigmatism<r><r> there always is the possi
ility of a secondary opacification due to proliferation of remnant epithelial c
ells in sulcus which migrate over the posterior capsule.&nsp;&nsp;Treated with
&nsp;&nsp;a single laser urn on the optic axis as an office procedure.<r>
EyeHisto Marked
The cornea <r><r>what is its major role?<r><r>what are two procedures for co
rneal transplant and why is the cornea so easily transplanted?<r><r>how does i
t receive its nutrition?
major focusing power of the eye (curvature and a
stigmatism)<r><r> avascular so no prolem for corneal transplants called penetr
ating keratoplasty (PK) and endothelial keratoplasty (EK)<r><r> receives nutrit
ion from the tear film, lateral diffusion from the limus vasculature, and the a
queous humor in the anterior chamer<r>
EyeHisto Marked
List and descrie the 5 layers of the cornea
five layers:<r>(1) stratified,
squamous, nonkeratinized epithelium on which your contact lens floats with tons
of pain fiers from CN V one; epithelium rests as a asal lamina<r>&nsp;&nsp;
<r>(2) Bowmans layer (emryonic type I collagen fiers)&nsp;&nsp;<r>(3) strom
a (very uniform collagen type I fiers secreted y firolasts called keratocyte
s with precise fier spacing running in two directions alternating in each lamel
la<r> <r>(4) Descemets layer (type IV collagen asement memrane which gets nor
mally thicker as age)<r><r>(5) one million post-mitotic endothelial cells whic
h secrete a asement memrane called Descemets layer.&nsp;&nsp;The endothelial
cells have complex pumps driven y TP to pump water out of the matrix etween t
he collagen fiers to keep the spacing perfect for total clarity.&nsp;&nsp;Wit
h normal aging, there is a decrease in the numer of endothelial cells and the r
emaining cells spread over a greater surface area. <r> EyeHisto Marked

List and descrie in detail the first 3 layers of the cornea (what collagen?)
(1) stratified, squamous, nonkeratinized epithelium on which your contact lens f
loats with tons of pain fiers from CN V one; epithelium rests as a asal lamina
<r />&nsp;&nsp;<r />(2) Bowmans layer (emryonic type I collagen fiers)&nsp
;&nsp;<r />(3) stroma (very uniform collagen type I fiers secreted y firol
asts called keratocytes with precise fier spacing running in two directions alt
ernating in each lamella<r /> EyeHisto Marked
List and descrie in detail layers 4 and 5 of the cornea (what collagen?)
(4) Descemets layer (type IV collagen asement memrane which gets normally thick
er as age)<r><r>(5) one million post-mitotic endothelial cells which secrete a
asement memrane called Descemets layer.&nsp;&nsp;The endothelial cells have
complex pumps driven y TP to pump water out of the matrix etween the collagen
fiers to keep the spacing perfect for total clarity.&nsp;&nsp;With normal ag
ing, there is a decrease in the numer of endothelial cells and the remaining ce
lls spread over a greater surface area. <r>
EyeHisto Marked
Differentiate the sclera and the cornea histologically Differs from the sclera
in that sclera has type I collagen fiers of all diameters, with variale spacin
g, running in all directions, so that the sclera&nsp;&nsp;is opaque ut also a
vascular.
EyeHisto Marked
What is Optisol GS media?<r>how long can a cornea e stored efore it is transp
lanted? Now stand in awe of this movie of a penetrating keratoplasty Optisol-GS
preservation media (essential amino acids, dextrose, pH uffers, antiiotics ge
ntamicin and streptomycin) (up to 14 day maintenance so world distriution of co
rneal tissue possile, ut US ophthalmologists prefer 7-10 days as upper limit a
nd many demand an upper limit of 5 days), trephination, Healon injection, suture
s (running versus interrupted), no introduction of post-surgical astigmatism.
EyeHisto Marked
What are 4 signs of delayed tissue rejection (post-corneal transplant) Once a p
erson has had a PK and they are years post-surgery, you must refer them immediat
ely ack to an ophthalmologist when your patient has any of the following four o
servations or comments ecause they are in the early stages of delayed tissue r
ejection:<r><r>ocular pain<r>scleral redness<r>corneal haze<r>mentions halo
s around lights<r>
EyeHisto Marked
What is the 2nd leading cause of lindness worldwide?<r><r>what pathogen is as
sociated?
World wide, the second cause of world lindness is corneal scari
ng with regular type I collagen fiers in the stromal lamellae eing replaced y
random type III collagen fiers due to inversion of the eye lids and lashes due
to the acterial infection, Trachoma. EyeHisto Marked
Criteria for corneal donations - knowing 5-8 should e good (list has 13)
Criteria for corneal donations (procurement of corneas with scleral rims through
the Lions Eye Banks around the world with collaoration of Life Gift in the Uni
ted States).&nsp;&nsp;No tissue typing is required ecause corneas are avascul
ar.<r>2 to 74 years of age of donor<r>18 hours post mortem o
r 24 hours post mortem with refrigeration<r>Negative serology for hepa
titis B, hepatitis C, syphilis, HIV 1, HIV 2<r>No history of IV drug u
se or other high risk ehavior such as prostitution, multiple sexual partners, t
ime in jail<r>Detailed history of past travel, ehavior changes, demen
tia or gait changes&nsp;&nsp;ecause of CJD (Creutzfeld Jako Disease prions)
<r>No leukemia<r>No lymphoma<r>No systemic sepsis<
No previous radial keratotomy<r>Held for 24 hours for the
r>results of acterial cultures and serology<r>Must have at least 2000 e
ndothelial cells/mm2 as determined y specular microscopy in Lions Eye Bank Las
<r>Requires direct consent of next of kin (no longer valid through dri
vers license consent).&nsp;&nsp;You must ecome familiar with the Texas State D
onation Registry.<r>Human tissue cannot e sold, ut each cornea costs
the patients insurance company $2540 ecause of Lions Eye Bank expenses and a ne
w FD mandate for disposale enucleation tools ecause CJD is not destroyed y s
terilization.&nsp;&nsp;There is a gratis cornea potential.<r>
EyeHisto
Marked
Lecture Notes - readthrough <r><r> 1-14-10 Notes<r><r>Eye optic 2; motor 3,4

,6. These control striated muscle that inserts on the sclera. <r><r>Recti musc
les always pull from ehind. Superior elevate the eye <r>Inferior recti depress
the eye; medial recti cause convergence; lateral recti controlled y CN6 (only
function); inferior and superior olique these pull on a pulley in front of the
eye. <r><r>If any nerves are out ie optic nerve lesion loss of vision; paralys
is of 3,4,or 6 then there are characteristic eye deviations from fusion. <r><r
>Stereopsis depth perception. Fine perception in uniform light with no shadows y
ou can still perceive depth. <r><r>Eye entrainment there is relationship here.
He talked aout it. Check notes.<r><r>Eye is a dark room with lack nonscatteri
ng walls accomplished through melanin production from melanocytes in the eye. Pu
pil is (miosis / ) relaxing / contracting to modulate the light that comes throu
gh it. linos / individuals with altered neural crest migration have low visual
acuity ecause they have a crappy dark room <r><r>Slide 1 layers of the eye scl
era scatters light, has tremendous tensile strength; avascular; type I collagen
running in all directions the white of the eye. This is the site of insertion for
extraocular muscles. Retinal neurons leave gloe at the lamina crirosa highly m
odified region of sclera where retinal neurons leave the gloe as CNII. nterior
portion of eye at the limus, the sclera ecomes crystal clear&nsp;&nsp;- the
anterior part of the sclera which changes curvature at limus is called the cor
nea. Type I collagen undles are uniform in diameter and equally spaced to preve
nt the scatter of light (scatters 2%). The cornea is totally avascular. Cornea c
urvature is major refractive player in the eye. Curvature of cornea has high unifo
rm refractive power change in this curvature is astigmatism disruption of curvat
ure from limus to limus. <r><r>Ora serrata all the neurons that exist in the
retina + their interneurons stop. If you cut the eye across the ora serrata you
get slide 1. 3 layers present here 1 white layer is sclera. Middle layer is the
uveal tract. Then inner layer is the neural retina. <r><r>3 components to uve
al tract (inflammation here is uveitis) another word for posterior division of e
ye fundus. 1st part of uveal tract is the coroid (sclera ehind and neural retin
a in front) anterior process of the uveal tract is the ciliary ody. Last , uvea
l tract comes anteriorly as the iris (colored part of eye). This layer is highly
vascularized and invaded y melanocytes lue eyed person has few melanocytes in
the iris; rown eyes = greater migration of melanocytes. Melanocytes invade the
uveal tract within the first 5 months after irth. so lue eyed aies at irth
are not always going to keep their lue eyes. <r><r>3rd layer film neural ret
ina. Starts with retinal pigment epithelium. Single layer of cells adjacent to t
he coroid. Retinal pigment epithelium always has aility to make melanin. it alw
ays makes melanin. It is the 2nd component of a good photographic dark room. t
ora serrata- the retinal pigment epithelium keeps moving anteriorly to the ora s
errata. So it goes over ciliary processes and posterior aspect of iris. So iris
has melanocytes of its own anteriorly + the RPE cells posteriorly this prevents
light leakage. <r><r>t ora serrata, the retina ecomes single layer it is not
pigmented over the ciliary processes of ciliary ody. However, at posterior sur
face of the iris it turns melanin ack on. <r>Iris melanocytes, melanin from RP
E, neural retina after ciliary processes all contriute melanin. <r><r>Optic n
erve look for color - orange healthy white is ischemic / dead red is diaetic re
tinopathy (neovascularization); increased intercranial pressure the optic nerve
will e papillodema indicates high pressure. High intraocular pressure lamina cr
irosa will e pushed in and neurons from the retina will e pressed on and kill
ed you will see white optic nerve head that goes ack/deep opposite of ulging.
This is glaucoma. <r>Color, cupping, and contour it should always have a nice c
lean margin<r><r>Retina should e nice and orange this is healthy. Presence of
red spots indicates lood leakage could e hypertension or dying endothelial ce
lls from diaetic retinopathy. you can also see hard yellow exudates. this is fr
om leakage of plasma lipoproteins. Retina death the retina is all white. White d
ead red leeding yellow lipoproteins. <r>
EyeHisto Marked
Part 2 notes. <r><r>ge related macular degeneration at approx 60. The RPE cel
ls die uniquely under macula and fovea. You need these cells to keep photorecept
ors alive. So you egin to lose cones in the foveala so you have peripheral visi
on ut you cannot see straight forward. New treatment is to cause retinal detach

ment to get in etween and harvest cells from posterior surface of the iris then
put them under the neural retina you can stop death of cones at the fovealis. S
o macular degeneration no central vision. <r><r>3 chamers of the eye <r>1 an
terior chamer touches posterior surface of the cornea. lso touches anterior su
rface of the iris. nterior chamer is filled with aqueous humor. queous humor
is made / secreted into the posterior chamer. Made y lood vessels in the cili
ary ody connective tissue. Then modified y 2 layers of epithelial cells over c
iliary processes. <r><r>Posterior chamer touches the ciliary processes and 2
layers of epithelium over ciliary processes on ciliary ody. Comes up and touche
s vitreous ody (jelly like strands of type I collagen w/ hyaluronic acid helps
to keep the retina attached). .4mls of aqueous humor in the two chamers comine
d. Posterior chamer is the recipient of the aqueous humor that is originally pr
oduced in the anterior chamer where it circulates. <r><r>Traecular meshwork
aqueous humor is made y vascular supply in ciliary ody modified y epithelium
over ciliary proceses travels in posterior chamer makes it into anterior chame
r then flows through traecular meshwork into a veinous structure called the can
al of schlemm. Then into veinous flow. No pinocytosis / transcytosis. <r><r>Fu
nctions of aqueous humor <r>Replaces water for vitreous ody<r>Gives nutrition
to lens (lens is avascular)<r>Gives nutrition to cornea (gets nutrients from:
tears, lateral diffusion from vessels at limus, and aqueous humor in anterior c
hamer)<r>20mmhg pressure in eye. <r><r>Disruption of dura will result in the
open gloe. Whenever you see a non-round pupil this is called a peaked pupil <
r>PERRL pupils equal, round, reactive to light, and accommodate. <r><r>When a
pupil is not round the gloe must e open and intraocular pressure must e push
ing things out. <r>When open gloe can e repaired it is important to leave the
eye undistured. <r>You cannot give topical antiiotic to an open gloe you wi
ll kill RPE and retina. You can give IV antiiotic you cannot give topical anest
hetic&nsp;&nsp;to open gloe. You see a peaked pupil you call ophthmalogy pt.
is NPO until then. <r><r>Tactile tenometry eye should feel like a hard oiled
egg 20mm hg<r>Flaccid eye feels like a dead grape; never do tactile tenometry t
o the open gloe. <r><r>Square pupil result from surgery for cataract replacem
ent of lense. Do not dilate these pupils ecause artificial lens may e disrupte
d. <r><r>Lens surrounded y asement memrane w/ type IV collagen. Epithelial
cells secrete anterior capsule and migrate to the equator. They then differentia
te into lens fiers losing their nucleus and organelle interdigitiations. Secret
e population of solule proteins that fill up their cytoplasm they elongate and
drag asement memrane with them to form a thicker posterior capsule with plenty
of type IV collagen. Normal aging lens gets igger. s lens gets igger, it pus
hes on the iris this decreases the angle, as angle gets smaller, there is less e
asy drainage of aqueous humor which lends to higher risk for glaucoma. So we are
always making new lens fiers from epithelial cells. If the lens is not perfect
it may scatter light this is a cataract. Irregularities of fier / precipitatio
n of crystallins. This is nonmalignant ut is usually taken out when pts visual a
cuity is significantly decreased. <r>
EyeHisto Marked
"<img src=""07e8a035812fa87dd59581d953063e.png"" />" "<img src=""ed1d6f954498
94f50d65a70538cc5f.png"" />" EyeHisto Marked
"<img src=""a2af5874f5061d99a982c950e0285a.jpg"" />" Figure 234.<r>Cornea. Th
e anterior structure of the eye, the cornea has five layers. (a): The micrograph
shows the external stratified squamous epithelium (E), which is nonkeratinized
and five or six cells thick. It is densely supplied with sensory free nerve endi
ngs that trigger the linking reflex and its surface is covered with a tear film
produced y glands in the eyelids and superior orit. The stroma (S) comprises
approximately 90% of the corneas thickness, consisting of some 60 layers of long
type I collagen fiers arranged in a precise orthogonal array and alternating wi
th flattened cells called keratocytes. The stroma is lined internally y endothe
lium (EN). X100. H&amp;E. (): The corneal epithelium rests firmly on the thick
homogeneous Bowmans memrane (arrow). The stroma is completely avascular and nutr
ients reach the keratocytes and epithelial cells y diffusion from the surroundi
ng limus and aqueous humor ehind the cornea. X400. H&amp;E. (c): The posterior
surface of the cornea is covered y simple squamous epithelium (endothelium) th

at rests on another thick, strong layer of collagen and other extracellular mate
rial called Descemets memrane (arrow). Na/K TPase of the endothelial cells is r
esponsile for pumping Na+ and drawing water out of the cornea, maintaining its
proper state of hydration. In this state the cornea is perfectly transparent and
with its curvature is a major refractive structure of the eye. X400. H&amp;E.<
r>
EyeHisto Marked
"<img src=""c8e6e764041e60d3370dc1fdc8c12.jpg"" />" Figure 235.<r>Corneoscle
ral junction (limus) and ciliary ody. t the circumference of the cornea is th
e limus or corneoscleral junction (CSJ), where the transparent corneal stroma m
erges with the opaque, vascular sclera (S). The epithelium of the limus is slig
htly thicker than the corneal epithelium, containing stem cells for the latter,
and is continuous with the conjunctive (C) covering the anterior part of the scl
era and lining the eyelids. The stroma of the limus contains the scleral venous
sinus (SVS), or canal of Schlemm, which receives aqueous humor from an adjacent
traecular meshwork at the surface of the anterior chamer (C). Internal to th
e limus, the middle layer of the eye consists of the ciliary ody and its anter
ior extension, the iris (I). The thick ring of the ciliary ody includes loose c
onnective tissue containing melanocytes, smooth ciliary muscle (CM), numerous ex
tensions covered y epithelium called the ciliary processes (CP), and the ciliar
y zonule (CZ), a system of firillinrich fiers that attach to the capsule of the
lens (L) in the center of the ciliary ody. Pieces of one zonular fier can e
seen (arrow). Projecting into the posterior chamer (PC), the ciliary processes
produce aqueous humor which then flows into the anterior chamer through the pup
il. Changes in tension on the zonular fiers produced y contraction and relaxat
ion of the ciliary muscles change the shape of the lens and allow visual accommo
dation. Behind the ciliary zonule and lens a thin, transparent memrane (not sho
wn) surrounds the vitreous ody and separates the posterior chamer from the vit
reous chamer (VC). X12.5. H&amp;E.<r> EyeHisto Marked
"<img src=""9856705f4c1e933e633d0ce065d3.jpg"" />" Figure 236.<r>Traecular
meshwork and scleral venous sinus. (a): t the corneoscleral junction (CSJ), or
limus, encircling the cornea, the posterior endothelium and its thick underlyi
ng (Descemets) memrane are replaced y a meshwork of irregular channels lined y
endothelium and supported y traeculae of connective tissue. queous humor fro
m the anterior cavity (C) fills the channels of this traecular meshwork (TM) a
nd is pumped y endothelial cells into an adjacent space, the scleral venous sin
us (SVS). X50. H&amp;E. (): The SEM surface view shows that the transition from
corneal endothelium (CE) to traecular meshwork (TM) is gradual and the channel
s formed are large. Movement of aqueous humor into this corner formed y the iri
s (I) and the traecular meshwork-the iridocorneal angle-for removal via the scl
eral venous sinus is of major importance in regulating intraocular pressure. Fac
tors causing impaired aqueous removal lead to glaucoma, a condition in which ele
vated pressure affects proper function of the retina and vision. X300.<r>
EyeHisto Marked
"<img src=""6536380dd3128ce23619f550cccee.jpg"" />" Figure 237.<r>Sclera, ch
oroid, and retina. This section of the wall of an eye shows the dense connective
tissue of the sclera (S) and the loose, vascular connective tissue of the choro
id (C). Melanocytes are prominent in the choroid, especially in its outer region
, the suprachoroidal lamina (SCL). The choroids inner region, the choroidocapilla
ry lamina (CCL), has a rich microvasculature which helps provide O2 and nutrient
s to the adjacent retina. Between the choroid and the retina is a thin layer of
extracellular material known as Bruchs layer (B). The outer layer of the retina i
s the pigmented layer (P) of cuoidal epithelium containing melanin. djacent to
this are the packed photoreceptor components of the rods and cones (R&amp;C), t
he cell odies of which make up the outer nuclear layer (ONL). Junctional comple
xes etween these cells are aligned and can e seen as a thin line called the ou
ter limiting layer (OLL). xons of the rods and cones extend into the outer plex
iform layer (OPL) forming synapses there with dendrites of the neurons in the in
ner nuclear layer (INL). These neurons send axons into the inner plexiform layer
(IPL), where they synapse with dendrites of cells in the ganglionic layer (GL).
xons from these cells fill most of the nerve fier layer (NFL) which is separa

ted y the inner limiting layer (ILL) from the gelatinlike connective tissue of t
he vitreous ody (VB). X200. H&amp;E.<r>
EyeHisto Marked
"<img src=""0624f6821f7ce9d07d73ee4652d528.jpg"" />" Epithelium of ciliary pr
ocesses. This section of ciliary processes shows that their surface epithelium i
s a doule layer of pigmented (PE) and nonpigmented epithelial (NE) low columnar
or cuoidal cells. The two layers are derived developmentally from the folded r
im of the emryonic optic cup, so that the exposed surface of the nonpigmented l
ayer is actually the asal surface of the cells. No true asal lamina is present
, ut instead these cells produce the components that give rise to the fiers of
the ciliary zonule in the emryo. Beneath the doule epithelium is a core of co
nnective tissue with many small lood vessels (V). Fluid from these vessels is p
umped y the epithelial cells out of the ciliary processes as aqueous humor. X20
0. PT.<r>
EyeHisto Marked
"<img src=""36d409fa81a7593c4633dde621ddf93d.png"" />" "<img src=""92c2dd1895
e9a1fefc90152e02650.png"" /><r><r>Production and removal of aqueous humor. q
ueous humor is a continuously flowing liquid that carries metaolites to and fro
m cells and helps maintain an optimal microenvironment within the anterior cavit
y of the eye. Epithelial cells covering the ciliary ody secrete the aqueous int
o the posterior chamer of the anterior cavity (1), from which it flows past the
lens and through the pupil into the anterior chamer of that cavity (2). The fl
uid then drains into the iridocorneal angle and is removed at the scleral venous
sinus (3), which is continuous with veins in the sclera.<r>" EyeHisto Marked
"<img src=""cae82f1e7efdf4f062018764582aaf92.jpg"" />" Iris. The iris regulates
the amount of light to which the retina is exposed. (a): The lowpower micrograph
shows a section of the central iris, near the pupil (P). The anterior surface,
exposed to aqueous humor in the anterior chamer (C), has no epithelium and con
sists only of a matted layer of interdigitating firolasts and melanocytes. X14
0. H&amp;E. The underlying stroma (S) contains many melanocytes with varying amo
unts of melanin. (): The SEM shows the nonepithelial anterior surface of the iri
s. X900. (c): This micrograph shows that the deep stroma also is richly vascular
ized (arrowheads). The epithelium on the posterior side of the iris, adjoining t
he posterior chamer (PC), consists of two layers of cuoidal cells. Cells of th
e external pigmented epithelium (PE) are very rich in melanin granules to protec
t the eyes interior from an excess of light. Cells of the other layer are myoepit
helial, less heavily pigmented, and comprise the dilator pupillae muscle (DPM) w
hich extends along most of the iris. Near the pupil, fascicles of smooth muscle
make up the sphincter pupillae muscle (SPM). Together the two muscles control th
e diameter of the pupil. X100. PT.<r> EyeHisto Marked
"<img src=""2810308a422aedf2e7a42caddc0eaa6.jpg"" />" Lens. The lens is a tran
sparent, elastic tissue that focuses light on the retina. Surrounding the entire
lens, the lens capsule (LC) is a thick, homogenous external lamina formed y th
e epithelial cells and fiers. The anterior surface of the lens, eneath the cap
sule, is covered y a simple columnar lens epithelium (LE). Because of its origi
n as an emryonic vesicle pinching off of surface ectoderm, the asal ends of th
e lens epithelial cells rest on the capsule and the apical regions are directed
into the lens interior. t the equator of the lens, near the ciliary zonule, the
epithelial cells proliferate and give rise to cells that align parallel to the
epithelium and ecome the lens fiers. Differentiating lens fiers (DLF) still h
ave their nuclei, ut are greatly elongating and filling their cytoplasm with pr
oteins called crystallins. The mature lens fiers (MLF) have lost their nuclei a
nd ecome densely packed to produce a unique transparent structure. The lens is
difficult to process histologically and sections usually have cracks or les am
ong the lens fiers. X200. H&amp;E.<r> EyeHisto Marked
"<img src=""6616c59ac043528f426ef06784e12665.jpg"" />" Figure 2313.<r>Pigmented
epithelium of retina. The two distinct layers of the retina are the pigmented e
pithelium and the photosensitive layer, which are derived from the outer and inn
er layers of the optic cup respectively. (a): The light micrograph shows the int
erface etween the two layers. The pigmented epithelium (PE) is of simple cuoid
al cells resting on Bruchs memrane inside the choroid (C). Rod cells and cone ce
lls are neurons with their nuclei collected in the outer nuclear layer (ONL) and

with axons of one end forming synapses in an area called the outer plexiform la
yer (OPL) and modified dendrites at the other end serving as photosensitive stru
ctures. These structures have mitochondriarich inner segments (IS) and photosensi
tive outer segments (OS) with stacks of folded memranes where the visual pigmen
ts are located. The inner segments of the rod and cone cells are attached to elo
ngated glial cells called Muller cells, which are modified astrocytes of the ret
ina. The junctional complexes of these attachments can e seen in light microgra
phs as the outer limiting layer (OLL). X500. H&amp;E.<r>(): The TEM shows an u
ltrastructural view of the interface etween the pigmented epithelial cells and
the outer segments of the photoreceptive cells. Junctional complexes (J) occur 
etween lateral memranes of the epithelial cells. ove these cells are the tips
of five outer segments of rod cells that interdigitate with apical processes (P
) of the epithelial cells. The large vacuoles contain folded memrane stacks (ar
rows) that have een shed from the tips of the rods. Contents of these vacuoles
are digested after fusion with secondary lysosomes (L). lso seen are mitochondr
ia and segments of rough and smooth ER. X24,000. <r> EyeHisto Marked
"<img src=""352fc5a17dd5a5ec9c6c8a21e6e8aca9.jpg"" />" General structure and or
ganization of the retina. The retina is the thick layer of the eye inside the ch
oroid. (a): The diagram shows the central retinal artery and vein that pass thro
ugh the optic nerve and enter the eye at the optic disc. These vessels initially
lie etween the vitreous ody and the inner limiting layer of the retina, ut t
heir smaller lateral ranches penetrate this layer and enter the retina, forming
capillaries that extend as far as the inner nuclear layer. Nutrients and O2 for
the outer retinal layers diffuse from capillaries in the choroid. (): This dia
gram illustrates the major neurons and their general organization. The long glia
l cells that help organize the neurons are not shown.<r>
EyeHisto Marked
"<img src=""4305c33118d019650457025a02954.png"" />" "<img src=""6ecc96c0d27a
7e57873d5d428c334c5.png"" /><r><r>Layers of the retina. Between the vitreous
ody (VB) and the choroid (C), the retina can usually e seen to have ten distin
ct layers. Following the path of the light, these are: the inner limiting layer
(ILL); the nerve fier layer (NFL), containing the ganglionic cell axons that co
nverge at the optic disc and form the optic nerve; the ganglionic layer (GL), co
ntaining cell odies of the ganglion cells and of somewhat variale thickness th
roughout the retina; the inner plexiform layer (IPL), containing fiers and syna
pses of the ganglion cells and the ipolar neurons of the next layer; the inner
nuclear layer (INL), with the cell odies of several types of ipolar neurons wh
ich egin to integrate signals from the rod and cone cells; the outer plexiform
layer (OPL), containing fiers and synapses of ipolar neurons and rod and cone
cells; the outer nuclear layer (ONL), with the cell odies and nuclei of the pho
tosensitive rod and cone cells; the outer limiting layer (OLL), which is a fine
line formed y the junctional complexes holding the rod and cone cells to the in
tervening glia called Mller cells; the rod and cone cell layer (RCL), which conta
ins the outer segments of these cells where the photoreceptors are located; and
the pigmented layer (PL) which is not sensory, ut has several supportive functi
ons important for maintenance of the neural retina. X150. H&amp;E.<r>" EyeHisto
Marked
"<img src=""8d6e8240e1f31aa9496404ee680a.png"" />" "<img src=""5796a663d
568c08a62f21cca0c59.png"" />" EyeHisto Marked
"<img src=""40930710c43c9810a1986f3533eedf.png"" />" "<img src=""a821d3fd45c3
603dce0a63840f64da0.png"" />" EyeHisto Marked
"Descrie <r><r><img src=""586e1fce11e1f27205039a715d3551.png"" />" "<img sr
c=""317323cfa45e3af688f75c18a4291724.png"" />" EyeHisto Marked
"Descrie <r><r><img src=""7688e51d961a963c8472d52160d7c81.png"" />" "<img sr
c=""3c6493266136af8ae9e25ddf0e2d90cf.png"" />" EyeHisto Marked
"<img src=""516ff6fcd90353e740f12d8efd9e2.png"" />" "<img src=""7e77676431c3
ac969f550cf6c0e92c4.png"" />" EyeHisto Marked
"<img src=""715946243aaf4ca9250ac1d38148e8.png"" />" "<img src=""44d3d164af72
73c603e2dd4830ecd91.png"" />" EyeHisto Marked
"<img src=""51f0f812aa9d0e33e0cc1695f96ee49.png"" />" "<img src=""d14cdfdf068
0565855d969a27a20ac.png"" />" EyeHisto Marked

"<img src=""a43d460d24aa1ee3fe0c94302f398.png"" />" "<img src=""a8fdfda4f32a

2d3a78103ae420153015.png"" />" EyeHisto Marked
"<img src=""c8054de07e2cd785a6e870d97c40f49a.png"" />" "<img src=""ef06c5518568
4cca355feae5e87a14.png"" />" EyeHisto Marked
"<img src=""a9fad8d5030389e4421cf5ef5691479.png"" />" "<img src=""ed97493226e1
d3d0904c682f11d09d2a.png"" />" EyeHisto Marked
"<img src=""25a88aa23ec3e16f94dee24448d4d.png"" />" "<img src=""3e1e0c6aeaa
162e48a3e8ae5741a60.png"" />" EyeHisto Marked
"<img src=""ac004d853aeafc0dfa4799c30d5eea.png"" />" "<img src=""7804812cd6c0
218c8df62d5cd24f7f.png"" />" EyeHisto Marked
"<img src=""9c218458d73736ed8d591e13c1c.png"" />" "<img src=""66e67642dcfd
26585afa722cf063659.png"" />" EyeHisto Marked
"<img src=""ccf61166ca68f8042cad3c5f459071.png"" />" "<img src=""759c29393f5
ad36d04d0038805227c.png"" />" EyeHisto Marked
"<img src=""ea867088e8e131f54a3a11659c8e.png"" />" "<img src=""3a55c1cdcfc1
64f888c9f395d59e7de.png"" />" EyeHisto Marked
"<img src=""333e221a25e15ae2a775250e32510d.png"" />" "<img src=""f13c9609d68
45e7d7933161f2770e.png"" />" EyeHisto Marked
"<img src=""75c841e1c856e1636ce24eeddac52ef.png"" />" "<img src=""37c5a422622
4dff96fa582f39ce787c.png"" />" EyeHisto Marked
"<img src=""e18a91a69e31c355d177577f462ec9.png"" />" "<img src=""28c565f7ac96
13a38d32f89a0352fda8.png"" />" EyeHisto Marked
"<img src=""229f41e286874510460605ade7527a.png"" />" "<img src=""7e89541d1
91175da5cc8a71.png"" />" EyeHisto Marked
"<img src=""f46c39f8df1fc398e95aa036219a38c.png"" />" "<img src=""f160c12aaa
6519526fe4f028fa49.png"" />" EyeHisto Marked
"<img src=""10c3a2f88f603163e255777171d0991.png"" />" "<img src=""6164dcca6a
c64aedffe3403513.png"" />" EyeHisto Marked
"<img src=""1e374e43fca281a32977545a07024d51.png"" />" "<img src=""7629a255868
d961ed0732a9f44a67.png"" />" EyeHisto Marked
"<img src=""28c6ee768f4620017f8f1f03942fd.png"" />" "<img src=""2a60dd654fff
8f75a96777914336dd.png"" />" EyeHisto Marked
The ER - Learning Ojectives<r /><r />List the three major portions of the te
mporal one and relate each to the other ones of the skull with which they arti
culate.<r />List two structures that are located along the petrosal ridge and d
escrie the role that the ridge plays in the formation of the cranial fossae.<r
/>Descrie the functions and the distinguishing characteristics associated with
the internal, middle, and external ears.<r />Descrie the course and distriut
ion of the eighth cranial nerve from its origin within the cranial cavity to its
termination in the temporal one<r />Descrie the course of the facial nerve a
s it travels within the facial canal of the temporal one.<r />List the ones t
hat comprise the auditory ossicles and descrie the major features of each.<r /
>List the muscles that are located within the middle ear cavity, descrie their
attachments, nerve supply, and the role that each plays in the process of hearin
g.<r />Compare and contrast the anatomical features present on the lateral and
medial walls of the middle ear cavity. Be sure to include any nerves, muscles, 
ones, or openings that may e present.<r />Compare and contrast the anatomical
features present on the anterior and posterior walls of the middle ear cavity. B
e sure to include any nerves, muscles, ones, or openings that may e present. <
r />Descrie the shape, orientation, and visile anatomical features of the tym
panic memrane.<r />List the sensory nerves which supply the regions of the ext
ernal, middle, and internal ears, and descrie the region supplied y each.<r /
>Descrie the relevant anatomy that would e involved in progression of an upper
respiratory&nsp;&nsp;infection to otitis media and mastoiditis<r />
Ear Marked
"<img src=""0418ae910453e3239413818a0aecc20f.png"" />" "<img src=""cca8fd1561e
9dce0d21e7532e800751.png"" />" Ear Marked
"<img src=""ee75c3341c5faa7e26cd927ee09d.png"" />" "Temporal Bone<r /><img
src=""e9682e3c050d307e0d5f27973528cf.png"" />"
Ear Marked
"<img src=""42c0cc6f8ad8038ace399f0982a0.png"" />" "<img src=""28570211f3e

c283af62a585c96c7.png"" />" Ear Marked

"<img src=""daf308ca5e6e68358d63dfe2f205a9.png"" />" "<img src=""caea98dfdd25
a701d39ccf9c27cde4.png"" />" Ear Marked
"<img src=""678d6707aecc2f5e1c9d7544ae55c.png"" />" "<img src=""a781fd7aa0e3
1677906e6f703d0ae59.png"" />" Ear Marked
"Reference:<r><r><img src=""50879020c6783778379f363c855156d.png"" /><r>Gangl
ia of facial nerve located at genu (flexion at arrow)<r>"
Ear Mark
ed
"<img src=""c51373c3ad8268dd723a852cec80.png"" />" "<img src=""afc4d269eed
7c12d06a3a0096f08.png"" /><r>Temporal loe of the rain is just superior to
tegmen tympani <r>"
Ear Marked
"<img src=""150e82aea617a72caf3a0303cec340.png"" />" "<img src=""596411ed453
0d9058d9df6c8d0df9c.png"" /><r />Tensor tympani flexes the ear drum and decrea
ses viration<r />Stapidius same thing ut attaches to stapes <r />"
Ear Mark
ed
"Lateral Wall of Middle Ear Cavity<r><img src=""88fe57280775c7c3a1cd475049cdc
d.png"" />"
"<img src=""ad6a42e0c0ad2329c75107f63d36e.png"" /><r>CNVII a
t arrow <r>Chorda tympani carries taste fiers <r>" Ear Marked
"Medial Wall of Middle Ear Cavity<r><r><img src=""856d858e809356287c58720
0e7.png"" />" "<img src=""0510d93143e2410a6573e337ac740a0.png"" /><r><r>9 g
ives off lesser petrosal nerve<r>7 gives off greater petrosal nerve <r>"
Ear Marked
"Medial Wall of Middle Ear Cavity <r><r><img src=""3aa8499990a545753cd6c9a5a5
10250.png"" />" "<img src=""9648000e63a9d6c22d9c084fe117f.png"" />" Ear Mark
ed
"Inferior View of Temporal Bone<r><r><img src=""57f4f40986481e066d60c06eaa994
e.png"" />"
"<img src=""83f1d9efe5fe4c7fd95d83d331f6cc9c.png"" />" Ear Mark
ed
"Lateral Temporal Bone <r><r><img src=""5f9e5c61a8ced4f09181ad7270e42c.png""
/>"
"<img src=""94c7478557f1855d12222e780d6065d.png"" /><r><r>Mastoid pro
cess develops over time not present in infant<r>" Ear Marked
"Lateral View of Tympanic memrane<r><img src=""9c7f2c6398f7e86f12fe9e7e64a70
a.png"" />"
"<img src=""fc5977dd3c3f57c921ed982d2e6181df.png"" />" Ear Mark
ed
"Sensory Innervation to the External Ear<r><r>Disregard the little dots on this
diagram <r><r><img src=""f23d149a51fc6872636470a6d60609.png"" />" "<img sr
c=""700f50d2cfa172e5ff50e60f582d5ac.png"" /><r><r><r>Minor contriutions fro
m VII, and X (mostly in external ear canal)<r>"
Ear Marked
"Sensory Innervation to the Middle Ear<r><r><img src=""6c1c56e553e035c57dc53
6dc2e36.png"" />"
<r>Middle ear cavity is lined with mucous memrane and
is continuos with the pharynx.<r><r>Sensory innervation is from IX (tympanic p
lexus) <r>
Ear Marked
"Reference: <r><r><img src=""8533e4686554d5a287326a1ef5f813c.png"" /><r>How
does the ear function in 10 words or less?<r><r>ir-drum-stapes-oval window-(f
luid) cochlea round window<r><r>How does ear malfunction otis media <r>Tensor
tympani ; stapedius <r>"
Ear Marked
"<img src=""a747aa9c81ce07f67fafe458fa110f9.png"" />" 11 Fun Facts aout this
drawing (ecause we just love cranial nerves so much)<r><r>1. CN VIII vestiul
ar and cochlear nerves never exit the skull (more details later from Frank)<r>2
. Tympanic nerve of IX leaves jugular fossa and enters temporal one and middle
ear cavity<r>3. Tympanic plexus of IX supplies sensory to the middle ear cavity
<r>4. Lesser petrosal nerve of IX is parasympathetic to the parotid gland<r>5.
Greater petrosal nerve of VII is parasympathetic to the lacrimal gland<r>6. Th
e geniculate ganglion of VII is a sensory ganglion<r>7. Stapedius is innervated
y VII<r>8. Tensor tympani is innervated y V3 <r>9. Chorda tympani is parasy
mpathetic to sumandiular and sulingual glands and carries taste fiers to the
tongue<r>10. The facial nerve exits the skull through the stylomastoid foramen
<r>11. The carotid plexus carries sympathetic fiers to the eye<r>
Ear Mark
ed
Facial Nerve Ojectives <r /><r />Descrie the course of the facial nerve and

its ranches as it passes etween the internal auditory meatus and the stylomast
oid foramen (tlas figures 31.11)<r />List the skeletal relationships surroundi
ng the parotid gland<r />List the structures passing through the sustance of t
he parotid gland<r />List the ranches of the facial nerve and the muscles whic
h they supply<r />List the functions associated with each ranch of the facial
nerve<r />
FacialN&ParotidGland Marked
"Course of Facial Nerve<r><r><img src=""53924084f8378754a600856f56924c.png""
/>"
"<img src=""36c13fa7ec74ec4e8633e7091e59132.png"" /><r>Genu is a senso
ry ganglion <r>"
FacialN&ParotidGland Marked
"Greater Petrosal Nerve<r><r><img src=""d2f5481955f72209ef5e07ee1cc46da.png""
/>"
"<img src=""e72dc73faec363e3f7da02dec12ad1.png"" />" FacialN&ParotidG
land Marked
"Do the ciliary and otic <r><r><img src=""6d79fcc03daefd9d7a8d26a52cac83.png
"" />" "<img src=""18c1c5ffda40c7ee7545192053740c7.png"" />" FacialN&ParotidG
land Marked
"Do the Pterygopalatine and sumandiular <r><r><img src=""2ff5a191c77828155
6093cce4c1ac6.png"" />" "<img src=""18c1c5ffda40c7ee7545192053740c7.png"" />"
FacialN&ParotidGland Marked
"Do them all <r><r><img src=""2ff5a191c778281556093cce4c1ac6.png"" />"
"3977<r>COPS<r><r>3-ciliary<r>9 oitc<r>7 pterygopalatine<r>7 s sumandiul
ar<r><r>Note that 10 Is not in the head region <r><r><img src=""420aa59f5645
35635319ae3f1cd02d9.png"" />" FacialN&ParotidGland Marked
"Course of Facial Nerve (contd.)<r><r><img src=""5ad6c3906403f942faa40e9022fca
377.png"" />" "<img src=""2520ea5de8a12919a5677f42a49a92.png"" />" FacialN&
ParotidGland Marked
"Chorda Tympani<r><r><img src=""84ea07139621070daf4921546a1d891.png"" />"
"<img src=""1f7c895c6d66dca44f38a521858ee5.png"" /><r>Geniculate ganglia sens
ory ganglion for taste from tongue <r><r>Petrotympanic fissure sight of chorda
tympani exit <r>"
FacialN&ParotidGland Marked
"Course of Facial Nerve (again)<r /><r /><img src=""5ad6c3906403f942faa40e9022
fca377.png"" />"
"<img src=""14950d9238a410e4c2803f05ef2729.png"" /> <i
mg src=""5ad6c3906403f942faa40e9022fca377.png"" />"
FacialN&ParotidGland Mar
ked
"Branches of the Facial Nerve That Supply a Muscle of Facial Expression<r><r><
img src=""8728fd82cf0902cd4f28eef4fd14f6a.png"" />"
"<img src=""69467326268d
011872631724386557e.png"" />" FacialN&ParotidGland Marked
"Course of Facial Nerve (yet again<r><r><img src=""ce259e343e5f4e0ea2c53815
61ec.png"" /><r>If the facial nerve were lesioned at point , and point B. wou
ld the results e the same or different?<r>" Quite different lesion at  woul
d result in: lose inaility to cry lose fiers to lacrimal gland<r>Lesion at B
would result in: not loss of lacrimal gland<r><r>Both locations may result in:
Bells palsy ; (=internal auditory meatus); B = stylomastoid foramen&nsp;&nsp;
<r><r>Note when pinned lesion of nerve will e assumed to e at pin location <
r>
FacialN&ParotidGland Marked
"Branches of the Facial Nerve That Supply a Muscle of Facial Expression<r><r><
img src=""f11d85a148f14887e2596f3a91f1fe7e.png"" />"
"<img src=""d1ca36f4de7d
7d6aa582c617a6ce6c3.png"" /><r><r>Incorrect location of stylomastoid process
should e more posterior <r>" FacialN&ParotidGland Marked
"Skeletal Relationships of the Parotid Gland<r><r><img src=""7e285e3f5dc599d83
496730696ef753.png"" />"
"<img src=""74a75338090006a0cfdd11d8eedffed.png
"" /><r><r><img src=""088c1823f957ede80e41846540ecce6.png"" />"
FacialN&
ParotidGland Marked
"Reference: - relationships of the paraotid gland <r><r><img src=""1115c4e987
87e02e663431653d28f.png"" /><img src=""0fca19936fd4d7ec3f3a44faf7d1e.png""
/><r><r><r>The parotid gland is surrounded y investing fascia of the neck an
d squeezed in-etween the mandile and the mastoid process<r><r>Masseter<r>Ma
ndile<r>Medial pterygoid<r>Stylohyoid<r>Posterior elly of digastric<r><r>
Mumps may cause inflammation of the parotid gland which can then result in squee
ze of facial nerve <r>"
FacialN&ParotidGland Marked
"Reference: <r><r><img src=""48284c2488c19afdf79a706f98259d0.png"" /><r><r>

Structures that Pass Through the Parotid Gland&nsp;&nsp;<>9 carries sympathet

ics to the parotid not 7 </><r><r>Vessels <r>External carotid artery termina
tes as superficial temporal and maxillary<r>Retromandiular vein formed y the
junction of the superficial temporal and maxillary veins <> runs through the par
otid gland make sure you can id this for the practical it is not the external ju
gular</><r>Nerves:<r>Branches of facial to muscles of facial expression<r>u
riculotemporal for sensation to the front of ear<r>Secretomotor parasympathetic
fiers from the otic ganglion (of IX) hitchhiking on auriculotemporal<r>Paroti
d Duct (Stensens Duct)<r>Ends y piercing uccinator opposite the upper 2nd mola
r<r>"
FacialN&ParotidGland Marked
Name 2 vessels, 3 nerves, and 1 duct that all run through the parotid gland
"<img src=""7988a4652a2fdd8041d16359253e5f.png"" /><r /><r /><>Vessels</><
r />External carotid artery terminates as superficial temporal and maxillary<r
/>Retromandiular vein formed y the junction of the superficial temporal and m
axillary veins<r /><>Nerves:</><r />Branches of facial to muscles of facial
expression<r />uriculotemporal for sensation to the front of ear<r />Secretom
otor parasympathetic fiers from the otic ganglion (of IX) hitchhiking on auricu
lotemporal<r /><>Parotid Duct (Stensens Duct)</><r />Ends y piercing uccina
tor opposite the upper 2nd molar<r /><r /><img src=""a2579d01fd1a17c19943f19
a7701.png"" />"
FacialN&ParotidGland Marked
What ranch of facial is responsile for lacrimation
Greater petrosal
FacialN&ParotidGland Marked
"Trigeminal <r /><r /><img src=""343c739d505aaf96c296a3cf33e.png"" />"
"Trigeminal Nerve Sensory<r /><r />V1 = The ophthalmic division of the trigemi
nal nerve <r />(aka the ophthalmic nerve)<r /><r />V2 = the maxillary divisio
n of the trigeminal nerve <r />(aka: the maxillary nerve)<r /><r />V3 = the m
andiular division of the trigeminal nerve <r />(aka: the mandiular nerve) <r
/><r />Important Note: Each of these nerves have many named ranches. Some we
will learn now, others we will learn later.<r /><r /><img src=""a518810cd2f40f
5e558a32f205c0c86.png"" /><r />"
Face&Scalp Marked
"Branches of the Trigeminal Nerve that Supplies the Skin of the Face<r><r><img
src=""3c7daf08175e6adc47ef4238d6206f6.png"" />"
"<img src=""d39864f8752
16af02665769eca65.png"" />" Face&Scalp Marked
"<img src=""131886af625780df50349767779e.png"" />" "<img src=""c0c904746d5
63ffe2d6248e6d6a24.png"" />" Face&Scalp Marked
"Branches of the Trigeminal Nerve that Supplies the Skin of the Face<r><r><r>
<img src=""8423a03524f20a49e18ec5f65661104.png"" />" "<img src=""879f69265e3
5084fd40a5a809ca253.png"" />" Face&Scalp Marked
"Muscles of Facial Expression<r><r><img src=""e93446a0dad6ea7a35d03e071f5da2
.png"" />"
"<img src=""4ff36ff420f9e15f092895d573c41d8.png"" />" Face&Sca
lp Marked
"Muscles of Facial Expression<r><r><img src=""dcc6169f8430d727e9f8ee3c3a3984
.png"" />"
"<img src=""558f571e3973e2e3a60878f781e4d2f.png"" />" Face&Sca
lp Marked
"Reference: <r><r><img src=""1070ee10584a74d3dd5514d0892626.png"" />"
Face&Scalp Marked
"The uccinator - where does sensory come from?<r>what is motor from? <r><r><
img src=""d2013771aa07dc738f998e8f4f91ae.png"" />"
Buccinator<r><r>Sensor
y from uccal ranch of V<r>Motor innervation y uccal ranch of VII<r>Consid
ered muscle of facial expression, ut functions during mastication<r>rises fro
m pterygomandiular raphe<r>Inserts in oricularis oris<r>Surrounded y uccal
fat pad<r>Pierced y parotid duct opposite upper 2nd molar<r>
Face&Sca
lp Marked
What causes Bells Palsy<r><r>What are common presentations? Bells Palsy - Idi
opathic inflammation or compression of VII leading to loss of function.&nsp;&n
sp;<r><r>Depending on segment of VII affected, patient can present with:<r>fa
cial paralysis<r>cannot close eyelid<r>patient drools<r>food gets stuck in ch
eek<r>loss of taste from anterior 2/3 of tongue loss of<r>parasympathetic func
tion to salivary glands<r>hyperacusis (loss of stapedius muscle)<r>Parasympath
etic function to lacrimal gland<r>
Face&Scalp Marked

"Blood Supply to the Face<r><r><img src=""69a89d81c74d1303c6198c213d35a9a5.png

"" />" "<img src=""3192c2950c7fe7c291111ecfe60e3c.png"" />" Face&Scalp Marke
d
"Veins of the Face<r /><r /><img src=""36fcc5d95fde9820115918e2694249.png""
/>"
"<img src=""359ac94339c9d95e6f1170f9e135640.png"" /> <img src=""36fcc5d
95fde9820115918e2694249.png"" />"
Face&Scalp Marked
"Reference - Danger Triangle <r><r><img src=""2083f05961efce44d093f9292a595c2
.png"" />"
Face&Scalp Marked
Learning Ojectives for Outer/ Middle Ear:<r /><r /> What clues are used for th
e localization of sound in space?<r /><r /> Why is the tympanic memrane such a
precise virator?<r /><r /> What are the ravages of otitis media on hearing?<
r /><r />&nsp;&nsp;Contrast conductive deafness versus sensorineural deafness.
<r /><r /> Explain the results of the Weer and the Rinne tests.<r /><r /> Exp
lain the hearing changes descried y a patient with Bells palsy.<r /><r /> Why
should a hunter hum efore he/she pulls the trigger?<r /><r /> Define impedance
matching, presycusis, hyperacusis, SR, prevocalization reflex,&nsp;&nsp;pit
ch, dB, one conduction, air conduction, otosclerosis<r />
Learning Ojecti
ves for Inner Ear:<r /><r /> Compare perilymph and endolymph (sites of synthesi
s, flow pathways, and release mechanisms).&nsp;&nsp;<r /><r />&nsp;&nsp;Wha
t are the six sites where the memranous layrinth is differentiated into hair c
ells and give the function of each.&nsp;&nsp;<r /><r />- cristae in the ampu
lla of the semicircular canals<r />&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&n
sp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&ns
p;&nsp;&nsp;&nsp;&nsp;&nsp;- macula of the utricle<r />&nsp;&nsp;&nsp;&
nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&n
sp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;- macula of the saccule
<r />&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&n
sp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&nsp;&ns
p;- inner and outer hair cells of organ of Corti<r /><r /> What is meant y the
statement that vowels pass over the consonants in the traveling wave along the to
notopic map of the organ of Corti?<r /><r /> How is a depression in Reissners me
mrane yoked to a depression of the asilar memrane which is yoked to a ulging
of the round window out into the air filled middle ear.<r /><r /> Why does an
alino have poor hearing?<r /> EarHistology Marked
Hearing<r><r>How many americans are deaf? <r>How many are hearing impaired?<
r><r>re these numers increasing or decreasing?<r><r>What is the primary pur
pose of the sense of hearing?<r>What is more important - consonants or vowels?
2 million mericans are totally deaf (no perception of sound), 9% of the populat
ion has hearing impairment (20-30 million mericans), and with noise pollution a
nd the Walkman generation, these numers will sky rocket.<r><r> Required for sp
eech understanding (consonants more important than vowels)<r> EarHistology Mar
ked
What is the audile range for humans? <r>what is the range for vowels? <r>what
is the range for consonants? Range in humans (20 to 20,000 Hz), expressed in
cycles per second, sensed as pitch, consonants are 2000 to 5000 Hz, vowels are 5
00-800 Hz
EarHistology Marked
What is loudness?<r><r>What is a deciel? <r><r>What does 0d correspond to?
<r><r>what is 20d relative? 40? 60? 80? 100? 120? 140?<r><r>
Loudness
(amplitude) expressed in deciels (dB = 20 log 10 test pressure divided y refe
rence pressure.&nsp;&nsp;0dB is threshold at 3000Hz which is mans most sensitiv
e, least distorted frequency; 20dB is ten times louder than threshold; 40dB is 1
00 times louder than threshold; 60dB is 1000 times louder than threshold, 80dB i
s 10,000 times louder than threshold; 100dB is 100,000 times louder than thresho
ld; 120dB is 1,000,000 times louder than threshold; and 140d is 10 million time
s louder than threshold and causes physical pain with no sound perception.
EarHistology Marked
What 3 parameters does the rain use to determine sound orientation? <r><r>
Localization of sound in space is critical for the four Fs of life. (feed/fight/fle
e/reproduce)&nsp;&nsp;Localization is calculated y the rain using three para
meters: <r><r>time delay etween the two ears<r> a dB decrease etween the tw

o ears<r>the sound shadow created y the auricles (pinna)<r><r>Using these th

ree parameters, the auditory central nervous system pathways calculate the locat
ion of the sound to one degree sensitivity. There is no space map in the rain o
f the sound world. There is only a tonotopic map of Hz.&nsp;&nsp;(This contras
ts with a space map of the visual world at every place along the visual system.)
EarHistology Marked
Outer Ear<r><r>What are the two components of the outer ear?<r><r>what is th
e greatest frequency for sensitivity?<r><r>name one component related to the o
uter ear that contriutes to age related decrease in hearing acuity
In the h
uman, 3000 Hz has the greatest sensitivity (least distortion)&nsp;&nsp;and dep
ends upon the auditory canal passing through cartilage (outer 1/3) and then one
(inner 2/3).&nsp;&nsp;If this ratio is altered, hearing acuity decreases.&ns
p;&nsp;This cartilage ecomes calcified in normal aging and is one component of
the age-related decrease in hearing acuity.
EarHistology Marked
Descrie the external auditory meatus<r><r>what does it secrete? <r><r>What
are 3 protective mechanisms of the outer ear? The external auditory meatus is
horizontal with a slight S shape, contains hairs, secretes cerumin from modified
sweat glands, and ends at the outer surface of the ear drum (tympanic memrane)
.<r><r>&nsp;&nsp;Three protective mechanisms of the outer ear: sigmoid shape,
hairs, cerumin<r>
EarHistology Marked
Tympanic Memrane<r><r>Where is it located?<r><r>List and descrie its 3 lay
ers <r><r>What attaches to the inner surface?<r><r>What is the purpose of th
e tympanic memrane in regards to hearing?
Tympanic memrane<r><r> Separat
es the outer ear from the middle ear<r><r> Composed of three layers outer thick
skin with no epidermal pegs, a stroma of very, very organized collagen fiers (
outer radial, inner circumferential), and an inner layer of a simple epithelium.
<r> <r> Malleus foot plate attaches to the inner surface of the tympanic memra
ne.<r><r> Sound waves are funneled down the external auditory meatus to virate
the large surface area of the tympanic memrane.<r> EarHistology Marked
The Middle Ear<r /><r />Filled with?<r /><r />What are its oundaries (5)<r
/><r />List its 3 ossicles <r />List its two involuntary skeletal muscles <r
/><r />What type of epithelium covers everything?
ir filled<r /><r /> Bo
undaries tympanic memrane, mastoid processes, ony wall of inner ear containing
the oval and round windows, Eustachian tue (auditory tue), and a ony floor.<
r /> <r /> Contains three ossicles (malleus, incus, stapes), two skeletal invol
untary muscles (tensor tympani innervated y CN V attaches to the malleus and st
apedius innervated y CN VII attaches to the stapes), ligaments holding the ossi
cles in place, a simple ciliated epithelium covering everything.&nsp;&nsp;ll
the ciliated epithelium eat towards the Eustachian tue.<r /> EarHistology Mar
ked
Where does the malleus attach? the stapes?<r><r>Descrie how sound is perceive
d - starting with the viration of the tympanic memrane (supersimplified)<r><
r>what is this called? what is it caused y?
The three ossicles are compact 
one with synovial joints, act as a very efficient lever system, the malleus foot
process attaches to the tympanic memrane, and the stapes foot process covers t
he memrane of the oval window.<r><r> Virations on the large surface area of t
he tympanic memrane are transferred to movements of the ossicles, such that the
stapes creates with reduced piston movements high enery virations into the flui
ds of the inner ear at the small surface area of the oval window.&nsp;&nsp;Vir
ations in these inner ear fluids cause depolarization of the hair cells which lead
to the perception of hearing.&nsp;&nsp;<r><r>This efficient process is call
ed <>impedance matching</> and is the hearing caused y <>IR CONDUCTION.</>
<r>
EarHistology Marked
What would happen if there were no middle ear? If there were no middle ear with
its very efficient impedance matching, sound waves would directly hit oth the
oval and round windows (which would cancel each other out), most of the sound wa
ves would e reflected, and a greater amplitude would e required to cause thres
hold hearing. EarHistology Marked
Two Ways to Rattle the Fluids in the Inner Ear to Impact on Hair Cells in the orga
n of Corti
Bone conduction Rattle the ones of the skull, and this will ran

domly virate the fluids in the inner ear.&nsp;&nsp;Very inefficient.<r><r> ir

conduction Efficient impedance matching (large surface area of the tympanic mem
rane reduced down to the small surface area of the oval window); incredile lev
er system of the ossicles; no movement of the ossicles with head movements due t
o the geometry of the ligaments.<r>
EarHistology Marked
Protective mechanisms of the inner ear<r><r>descrie the acoustic stapedius re
flex<r><r>what nerve / muscle mediates it?<r>what is happening?<r>what is th
e threshold for this response?<r><r>how did it evolve and when will it not wor
k (what condition) what will the patient complain of? (ONE) coustic Stapedius
Reflex (SR)<r> Reflex activation of CN VII contracts the stapedius muscle whi
ch pulls on the stapes so that it pulsates less at the oval window and reduces h
igh energy virations into the fluids of the inner ear which might damage hair cel
ls in the organ of Corti.&nsp;&nsp;Responds to sounds louder than 80dB.<r><r
> Evolved to the crashing sound of lightening.&nsp;&nsp;No protection to the n
oise generated when shooting a gun held adjacent to the shoulder and face when a
iming.&nsp;&nsp;Useless during rock concerts with amplification for hours grea
ter than 160 dB. With the inflammation of CN VII in Bells palsy, VII does not wor
k, the SR is asent, and the patient complains of hyperacusis (a very loud worl
d).<r> EarHistology Marked
Protective Mechanisms of the Inner Ear<r /><r />The prevocalization reflex<r
/><r />who mediates it (what nerves) <r />what do they do?<r />why?<r /><r
/>what does this reflex explain?<r />why should hunters hum efore they shoot?
(TWO) Prevocalization Reflex<r />Before you start to vocalize, CN VII contracts
the stapedius muscle to pull on the stapes, and CN V contracts the tensor tympa
ni to pull on the malleus which tightens the tympanic memrane, simultaneously.&
nsp;&nsp;This dampens down the horrile noises created when a person speaks.<
r /><r />The prevocalization reflex also explains why you sound so different to
yourself when you hear a tape recording of your voice.&nsp;&nsp;You are final
ly hearing yourself without an operant prevocalization reflex. nd patients with
Bells palsy do not have a total prevocalization reflex, so they comment that the
y sound different to themselves than efore the attack.<r /><r />Why should hu
nters hum softly efore they pull the trigger? (to invoke this reflex and protec
t their ears)<r />
EarHistology Marked
Otitis Media <r /><r />Descrie its effect on the tympanic memrane<r />descr
ie its effect on the ossicles<r />descrie 3 additional effects of otitis medi
a <r /><r />who may e at increased risk for otitis media and why?<r /><r />
what surgical intervention may e required?<r><r>Why are children more suscept
ile to otitis than adults?
The Ravages of Otitis Media (Infection in the Mi
ddle Ear)<r /><r /> Causes inflammation and scaring (epidermal pegs, irregular
collagen) of the tympanic memrane so it does not virate so efficiently.<r /><
r /> Erodes the ossicles (reduces the efficiency of impedance matching)<r /><r
/> Destroys the synovial joints (reduces the efficiency of impedance matching)<
r /><r /> Causes early calcification and scaring of the annulus around the stape
s foot process on the oval window (otosclerosis)<r /><r /> Infection has easy a
ccess to the air filled cavities of the mastoid (and into the rain)<r /><r />
Kids with immotile cilia syndrome or laile cilia syndrome have a higher risk of
otitis media ecause cilia do not eat&nsp;&nsp;acteria, pus, and fluids tow
ard Eustachian tue (auditory tue). lso, very&nsp;&nsp;<>prevalent in all k
ids ecause Eustachian tue is very horizontal in orientation as a child</>.&n
sp;&nsp;With growth, the Eustachian tue assumes a greater angular drop for et
ter middle ear drainage. <r /><r /> Surgically can put a tue across the tympanic
memrane for greater ventilation of the middle ear.<r />
EarHistology Mar
ked
List and descrie the two types of deafness
Two Types of Deafness<r><r> Sen
sorineural Deafness dysfunctional hair cells or damaged auditory nerve (CN VIII)
<r><r> Conductive Deafness Compromised middle ear impedance matching<r>
EarHistology Marked
Descrie the Weer test<r><r>If lateralizes to one ear, either have sensorineu
ral deafness in the silent ear or conductive deafness in the louder ear. Why?
Weer put tuning fork on midline, diffuse one conduction (very gross and ineffi

cient) should result in equally loud perception of sound in oth ears if everyth
ing is normal.&nsp;&nsp;If lateralizes to one ear, either have sensorineural d
eafness in the silent ear or conductive deafness in the louder ear. Why?<r><r>
 patient with a unilateral conductive hearing loss would hear the tuning fork l
oudest in the affected ear. This is ecause the conduction prolem masks the am
ient noise of the room, whilst the well-functioning inner ear picks the sound up
via the ones of the skull causing it to e perceived as a louder sound than in
the unaffected ear. nother theory, however, is ased on the occlusion effect d
escried y Tonndorf et al. in 1966. Lower frequency sounds (as made y the 512H
z fork) that are transferred through the one to the ear canal escapes from the
canal. If an occlusion is present, the sound cannot escape and appears louder on
the ear with the conductive hearing loss.
EarHistology Marked
Descrie the Rinne test Rinne Put tuning fork near mastoid ehind the ear pinna.
&nsp;&nsp;If patient hears nothing in that ear, there is sensorineural deafnes
s in that ear.&nsp;&nsp;If patient hears the sound y one conduction (very gr
oss and very inefficient), have them tell you when the sound disappears.&nsp;&n
sp;Now put the tuning fork with its lower energy (that developed over time) in
front of the ear canal.&nsp;&nsp;If they continue to not e ale to hear the s
ound, they have conductive deafness.&nsp;&nsp;If they hear the sound again at
its lower amplitude, the efficiency of the impedance matching of the middle ear
is operant and functioning.&nsp;&nsp;&nsp;<r><r>The Rinne test is performed
y placing a virating tuning fork (512 or 256 Hz) initially on the mastoid pro
cess until sound is no longer heard, the fork is then immediately placed just ou
tside the ear. Normally, the sound is audile at the ear.<r><r>ir conduction
uses the apparatus of the ear (pinna, eardrum and ossicles) to amplify and direc
t the sound whereas one conduction ypasses some or all of these and allows the
sound to e transmitted directly to the inner ear aleit at a reduced volume, o
r via the ones of the skull to the opposite ear.
EarHistology Marked
The inner ear <r><r>Where is it? (what part of what one)<r>what lines it?<r
>what are the 3 major caves?<r>what are the five windows into the caves?<r>wha
t does the perilymphatic duct connect?<r>what is ulkflow?
1.
Bony L
ayrinth<r><r> caves hollowed out in the petrous portion of the temporal one<
r> lined y the periosteum that secretes perilymph<r> three major caves: <>three
semicircular canals</> (anterior, posterior, and horizontal/lateral), <>vesti
ule</>, and the <>spiral cochlea</> (2.5 turns around a spongy central modio
lus with its osseous spiral lamina)<r> five windows into the caves: <>oval wind
ow, round window, perilymphatic duct, endolymphatic duct and sac, internal audit
ory meatus</> (CN VIII with its vestiular and cochlear ranch)<r> perilymph is
continuous with CSF in the suarachnoid space via the perilymphatic duct<r> Per
ilymph&nsp;&nsp;flow is called ulk transport or <>ulk</> <>flow</>.&nsp
;&nsp;CSF pressure anormalities never have a clinical impact on the inner ear
which is explained physically y the ore diameter of the perilymphatic duct and
its length<r> EarHistology Marked
The memranous layrinth<r><r>what is it?<r>where is it located?<r>what is i
t filled with?<r>what fluid is under the asal surface of the epithelial cells?
<r>
2.
Memranous Layrinth<r><r> a complex system of tues and sacs
limited y a single layer of epithelial cells with tight junctions at the apica
l lateral plasma memrane.<r>- memranous layrinth floats in the ony caves<r
> within the lumen of the memranous layrinth there is a unique fluid called end
olymph which is very very high in K+ (very unusual extracellular fluid)<r> The a
pical surface of these epithelial cells with their unique hair undle faces the
lumen which is filled with endolymph, while their lateral and asal surfaces (wi
th a asement memrane) face the perilymph.<r> The two fluids never mix.<r>
EarHistology Marked
The memranous layrinth<r><r>How many semicircular canals?<r>descrie them<
r><r>where are they continuous with the utricle?<r><r>what cells secrete endo
lymph? <r>where does the endolymph reside?<r>what does endolymph release depen
d on? The memranous layrinth consists of three tues in each of the semicirc
ular canals (held in place y connective tissue strands), two alloons floating
within the vestiule, the utricle and the saccule, (joined y a ifurcation of t

he endolymphatic duct), and the scala media (cochlear duct) which comes off the
saccule via the ductus reuniens.<r> The semicircular canals are continuous with
the utricle at only five sites ecause the anterior and posterior semicircular c
anals share a common crus.<r> Endolymph is secreted y cells at the ase of the
cristae in each ampulla of each semicircular canal and y a very specialized epi
thelium (stria vascularis) within the scala media of the cochlea.<r> Endolymph f
reely diffuses throughout the memranous layrinth. Its release occurs across th
e epithelial cells of the endolymphatic sac at a highly vascularized site within
&nsp;&nsp;the sudural space.&nsp;&nsp;Endolymph release depends upon vacuol
ar uptake of endolymph y these epithelial cells, transcytosis of these vacuoles
across the cell, and finally exocytosis and release of endolymph across the as
al plasma memrane.&nsp;&nsp;This contrasts with the ulk flow of perilymph wh
ich involves no endocytosis/exocytosis.<r>
EarHistology Marked
Hair Cells at Six Sites in the Memranous Layrinth<r>List them. descrie them.
<r> On the <>cristae</> (7000 hair cells) across each ampulla in each semi
circular canal&nsp;&nsp;to detect angular accelerations and decelerations.<r>
<r>ccessory structure called the cupula (gelatinous) totally closing off the c
anal.<r><r>Concept is that with low energy endolymph vectors, only the hair ce
lls at the tip of the crista are impacted y movement of the cupula.&nsp;&nsp;
In contrast, with high energy endolymph vectors, the total cupula is deformed, a
nd all the hair cells on the mountain are impacted.&nsp;&nsp;Cells at the ottom
of the cristae (dark cells ecause of their high mitochondrial content) secrete
endolymph.<r><r>(Sites Four and Five)<r> On the <>horizontal wall (1000 hair
cells) of the utricle</> as the 2mm kidney shaped macula to detect linear acce
lerations in the horizontal plane (standing up in a moving us) and on the <>ve
rtical wall (1000 hair cells) of the saccule</> as the 2mm hooked shaped macula
to detect linear accelerations in the vertical plane (going up and down in an e
levator). <r><r>Each macula has a unique shape&nsp;&nsp;and various sized ot
oconia (calcium caronate rocks that are 3 to 19 microns in diameter).<r><r> W
ith endolymph vectors, these otoconia deform the proteinaceous memrane that impac
ts on the hair cells.&nsp;&nsp; high energy endolymph vector can move the lar
ge and small otoconia.&nsp;&nsp; low energy endolymph vector can only move th
e smallest otoconia. <r><r> With normal aging, the otoconia ecome uniformly h
omogenous (uniformly 6 microns at age 60 years) with less alance sensitivity.&n
sp;&nsp;Often some of the otoconia ecome lose from the otolithic memrane of
the macula of the utricle and ecome emedded in the cupula of the lateral (hori
zontal) semicircular canals producing a common positional vertigo in the elderly w
hen they roll to get out or into ed.&nsp;&nsp;Elderly patients talk aout the
cure all the time!<r><r>(Site Six)<r><> In the organ of Corti,</> there is on
e row of 3000 inner hair cells and&nsp;&nsp;three rows of outer hair cells (30
00/row).<r>
EarHistology Marked
3 compartments of the cochlea<r><r>List and descrie them<r><r>
&nsp;&n
sp;Scala vestiuli continuous with the vestiule; separated from the scala media
y Reissners memrane (single layer of tight-junction-linked epithelial cells);
filled with perilymph; egins at the oval window, communicates with the scala ty
mpani at the apex of cochlea via the helicotrema.<r><r>- Scala tympani continu
ous with the scala vestiuli at the apex of the cochlea (helicotrema); terminate
s at the round window; separated from the scala media y the tight junctions of
the cells of the organ of Corti.<r><r> Scala media (35mm long) triangular struc
ture delineated y Reissners memrane, the asilar memrane (suspended from the t
ympanic lip of the osseous spiral lamina to the crest of the spiral ligment) and
the stria vascularis;&nsp;&nsp;filled with endolymph secreted y the stria va
scularis; the asilar memrane is tight, narrow, and rigid at the ase of the co
chlea (mechanically tuned to 20,000 Hz) and progressively ecomes more floppy, w
ide, and flaccid at the apex of the cochlea (mechanically tuned to 20 Hz).&nsp;
&nsp;The stria vascularis is a pseudostratified columnar epithelium uniquely in
vaded y melanocytes (essential for endolymph secretion with its high K concentr
ation and explains the hearing loss in alinos or people with neural crest suppr
ession of melanocyte migration) and y capillaries (the only epithelium in the 
ody where capillaries are not restricted to the lamina propria elow the asal l

amina).<r>
EarHistology Marked
The cochlea<r><r>The scala vestiuli <r><r>descrie it - what is reissners
memrane?<r>what is it filled with?<r><r>The scala tympani<r><r>descrie it
<r>what is it continous with? where?<r>where does it terminate?
&nsp;&n
sp;Scala vestiuli continuous with the vestiule; separated from the scala media
y Reissners memrane (single layer of tight-junction-linked epithelial cells);
filled with perilymph; egins at the oval window, communicates with the scala ty
mpani at the apex of cochlea via the helicotrema.<r><r>- Scala tympani continu
ous with the scala vestiuli at the apex of the cochlea (helicotrema); terminate
s at the round window; separated from the scala media y the tight junctions of
the cells of the organ of Corti.
EarHistology Marked
Cochlea<r><r>the scala media<r><r>what 3 structures delineate it? <r>what i
s the range of Hz?<r>what role do melanocytes play here? <r> Scala media (35m
m long) triangular structure delineated y Reissners memrane, the asilar memra
ne (suspended from the tympanic lip of the osseous spiral lamina to the crest of
the spiral ligment) and the stria vascularis;&nsp;&nsp;filled with endolymph
secreted y the stria vascularis; the asilar memrane is tight, narrow, and rig
id at the ase of the cochlea (mechanically tuned to 20,000 Hz) and progressivel
y ecomes more floppy, wide, and flaccid at the apex of the cochlea (mechanicall
y tuned to 20 Hz).&nsp;&nsp;The stria vascularis is a pseudostratified columna
r epithelium uniquely invaded y melanocytes (essential for endolymph secretion
with its high K concentration and explains the hearing loss in alinos or people
with neural crest suppression of melanocyte migration) and y capillaries (the
only epithelium in the ody where capillaries are not restricted to the lamina p
ropria elow the asal lamina). EarHistology Marked
6.&nsp;&nsp;How You Hear 5000 Hz (a consonant)<r><r>Descrie it - what happe
ns first? (approx 3-4 steps)<r><r>when can you perceive the sound? what must o
ccur?<r><r>what does the asilar memrane act as?
5000 Hz virates the tym
panic memrane<r> The lever system of the middle ear ossicles transfers this 500
0 Hz viration to the perilymph in the vestiule.<r>&nsp;&nsp;The 5000 Hz vir
ation travels up the scala vestiuli and continuously pushes on Reissners memran
e.<r> Only at one unique spot does the rigidity of the asilar memrane match th
e 5000 Hz viration, and then the depression of Reissners memrane is yoked to a
depression of the asilar memrane which ows down into the scala tympani.&nsp;
&nsp;This causes the round window to ulge out into the middle ear.&nsp;&nsp;
When this traveling wave maximally deforms this unique spot from the ase to the
apex of the cochlea, a few inner hair cells on the tympanic lip of the osseous
spiral lamina are impacted y an endolymph, depolarize, and release more neurotr
ansmitter which causes an increased rate of action potentials in the second orde
r afferent neurons synapsing on this inner hair cell. <r> It is only when you yo
ke a depression in Reissners memrane to a depression in the asilar memrane wit
h a round window deflection into the middle ear that you can hear.<r> THE BSIL
R MEMBRNE IS THUS  GROSS FREQUENCY NLYZER ND EXPLINS THE TONOTOPIC MP (PL
CE CODING) OF THE COCHLE (FROM BSE TO PEX).<r>
EarHistology Marked
7.&nsp;&nsp;How You Hear 800 Hz (a vowel)<r><r>How may this e affected in s
omeone suffering from Bells Palsy? why?
800 Hz virates the tympanic mem
rane<r> the lever system of the middle ear ossicles transfers this 800 Hz vira
tion to the perilymph in the vestiule.<r>&nsp;&nsp;The 800 Hz viration trave
ls up the scala vestiuli and continuously pushes on Reissners memrane.&nsp;&n
sp;It passes right over the 5000 Hz spot. <r> t some site more apical than the
5000 Hz, the asilar memrane has ecome more flaccid and floppy, and the 800 Hz
can deform it. Then the depression of Reissners memrane is yoked to a depressio
n of the asilar memrane which ows down into the scala tympani which causes th
e round window to ulge out into the middle ear.&nsp;&nsp;When this traveling
wave maximally deforms this unique spot closer to the apex of the cochlea, a few
inner hair cells on the tympanic lip of the osseous spiral lamina are impacted
y&nsp;&nsp;endolymph, depolarize, and release more neurotransmitter which cau
ses more action potentials in the second order afferent neurons which synapse on
it. <r> Notice that the traveling wave of vowels travels over the tonotopic map
of the consonants.&nsp;&nsp;With the prevocalization reflex and the acoustic

stapedius reflex (SR), you always try to mask down the energy of vowels so that
they do not mess up the very important consonant region where language is reall
y transmitted.&nsp;&nsp;In a person with Bells palsy, this masking of vowels is
not efficient, and the loud vowels mess up the consonant region.&nsp;&nsp;These
patients then report that it is very difficult for them to understand what peop
le are saying (especially women), the world is very noisy (hyperacusis), and the
y sound different to themselves when they talk.<r>
EarHistology Marked
. The Explanation of Presycusis<r /><r />Which hair cells are used the most a
long the organ of Corti?<r /><r />What is presycusis?<r /><r />what 2 physi
ological findings account for presycusis?
Which hair cells are used the mo
st along the organ of Corti?&nsp;&nsp;nswer -The asal hair cells which are t
uned to higher frequencies.&nsp;&nsp;There are five enzymes that maintain and
repair hair cell stereocilia throughout your entire life.&nsp;&nsp;But since a
ll vowels pass over the consonants, the asal hair cells die in normal aging fro
m constant, low grade, non-tonotopic use.&nsp;&nsp;The elderly thus lose their
hearing sensitivity to high frequencies and the consonants.&nsp;&nsp;This nor
mal age related deterioration of hearing acuity is called presycusis.&nsp;&ns
p;This age-related deterioration of hearing acuity is also related to the normal
calcification of the cartilage component of the external auditory canal.
EarHistology Marked
"<img src=""2533e8df11c1ff9ec5d88651032f174.png"" />" "<img src=""6138cf580613
7c1467509304637d6413.png"" />" EarHistology Marked
"<img src=""d700c80250ddefea00441f95d86584a.png"" />" "<img src=""d1f923a63133
a601d08ac124984cc6f.png"" /><r><r>Internal ear. The internal region of the ea
r is composed of a cavity in the temporal one, the ony layrinth, which houses
a fluidfilled memranous layrinth. The memranous layrinth includes the vesti
ular organs for the sense of equilirium and alance (the saccule, utricle, and
semicircular ducts) and the cochlea for the sense of hearing.<r><r>" EarHisto
logy Marked
"<img src=""a1ae566002e7c92f696969e090ead991.png"" />" "<img src=""8953808d8107
fd33d5eeaaf3506045.png"" /><r><r>Vestiular maculae and their cells. (a): Tw
o sensory areas, the maculae, are located in the epithelial walls of the utricle
and saccule in the vestiular complex. Both maculae are similar histologically
and contain mechanoreceptor cells called hair cells which use gravity and endoly
mph movement to detect the orientation of the stationary head and linear acceler
ation of the moving head. ():  detailed view of a macular wall shows that it i
s composed of hair cells, supporting cells, and endings of the vestiular ranch
of the eighth cranial nerve. The apical surface of the air cells is covered y
a gelatinous otolithic layer or memrane and the asal ends of the cells have sy
naptic connections with the nerve fiers. (c):  diagram of a single generalized
hair cell shows the numerous straight stereocilia, which contain undled actin,
and a longer single kinocilium, a modified cilium whose tip may e slightly enl
arged.<r>"
EarHistology Marked
"<img src=""397a78f031d6222a8c7d5a2a8f992a4.jpg"" />" Otoliths. Otoliths are c
rystalline structures in the outer part of the otolithic memrane. Each otolith
is a slightly elongated structure, up to 5 y 10 m in size, and is composed of ca
lcium caronate on a matrix of proteoglycans. Their presence makes the otolithic
memrane consideraly heavier than endolymph alone, which facilitates ending o
f the&nsp;&nsp;kilocilia and stereocilia emedded in this memrane y gravity
or movement of the head. X600. SEM. (With permission, from David J. Lim, House E
ar Institute and Department of Cell &amp; Neuroiology, University of Southern C
alifornia, Los ngeles.)<r>
EarHistology Marked
"<img src=""d5c6a6f3e8371ac52092152f7906826.jpg"" /><r><r>Figure 2326.<r>Hair
cells and hair undles. (a): This diagram shows the two types of hair cells in
the maculae and cristae ampullares. Basal ends of type I hair cells are rounded
and enclosed within a nerve calyx on the afferent fier. Type II hair cells are
columnar and associated with typical outon synaptic connections to their affere
nts. Both types are also associated with efferent fiers.<r>():  more detaile
d diagram of the stereocilia hair undle of the hair cells showing that stereoci
lia occur in rows of increasing height, with the tallest next to the single kino

cilium on one side of the cells apical end. By TEM the end of each stereocilium s
hows an electrondense region containing cation channels and proteins involved in
mechanoelectric transduction (MET) that convert mechanical activity of the stere
ocilia to electric activity within the hair cell. Neighoring stereocilia are co
nnected y various side links composed of proteins; the most wellunderstood of th
ese are the tip links which connect the tips of stereocilia and contain very lon
g types of cadherin proteins. Changes in the tension of the tip links caused y
ending of the hair undle open or close the adjacent cation channels and change
the afferent synaptic activity of the hair cells. <r>"
EarHisto
logy Marked
"<img src=""f34c47e3d83ac7199aad54c2778271.png"" />" "<img src=""f936ed2147
49588fa32fe12158ed99.png"" /><r><r>mpullae and cristae of the semicircular du
cts. Each of the semicircular ducts has an expanded end called the ampulla. The
wall of each ampulla is raised as a ridge called the crista ampullaris, a sectio
n of which is shown here diagrammatically. Hair cells of the crista epithelium r
esemle the two types found in the maculae, with hair undles projecting into a
domeshape overlying layer of proteoglycan called the cupula. The cupula is attach
ed to the wall opposite the crista and is moved y endolymph movement within the
semicircular duct.<r>"
EarHistology Marked
"<img src=""130a68786e2d6153a35155758facad.jpg"" /><r><r>Figure 2328.<r>Mech
anotransduction in hair cells. Hair cells and supporting cells are part of an ep
ithelium with tight junctions. The apical ends of the cells are exposed to endol
ymph with a high concentration of K+ and perilymph with a much&nsp;&nsp;lower
K+ concentration athes their asolateral surface. t rest hair cells are polari
zed with a small amount of K+ entry and a low level of neurotransmitter release
to afferent nerve fiers at the asal ends of the cells. (a): s shown here head
movements that cause the stereocilia undle to e deflected toward the kinocili
um produce tension in the tip links which is transduced to electrical activity 
y opening of adjacent cation channels. Entry of K+ depolarizes the cell, opening
Ca2+ at the asal end of the cell which stimulates release of neurotransmitter.
When this movement stops, the cells quickly repolarize.<r>(): Movements in th
e opposite direction, away from the kinocilium, produce slackness on the tip lin
ks, allowing the apical K+ to close completely, leading to hyperpolarization and
reduced transmitter release. With different numers of afferent and efferent fi
ers on the hair cells and with various hair cells responding differently to end
olymph movements due to their positions within the maculae and cristae ampullare
s, the sensory information produced collectively y these cells can e processed
y the vestiular regions of the rain and used to help maintain equilirium."
EarHistology Marked
"<img src=""d28227a742f5a81752352a4acfff.jpg"" /><r><r>Cochlea and spiral
organ. The auditory portion of the inner ear, the cochlea, has a snaillike spiral
shape in oth its ony and memranous layrinths. (a):  section of the whole c
ochlea shows the cochlear duct cut in several places. (): This diagram shows a
more detailed view of one such turn of the cochlear duct and the adjacent perily
mphfilled spaces, the scala vestiuli and scala tympani. Endolymph is produced in
the stria vascularis, a capillaryrich area of the periosteum associated with the
epithelial lining of the wall. (c): The lower diagram shows the spiral organ in
more detail. (d): The micrograph shows important features, including the asila
r memrane (BM) on which the spiral organ rests and the tectorial memrane (TM)
which extends from cells of the spiral limus (SL) and contacts the stereocilia
of the inner (IHC) and outer hair cells (OHC). Several types of supporting cells
are also present, including inner phalangeal (IP) and outer phalangeal cells (O
P), which are intimately associated with the hair cells and contriute to the ti
ght epithelium separating endolymph from perilymph in the scala tympani. Other s
upporting cells form various structural features of the organ important for conv
erting virations into sutle stimuli to the hair cells. These include the inner
(IPC) and outer pillar cells (OPC) which surround a space called the inner tunn
el (IT) and other supporting cells (SC) which order the outer tunnel (OT). ffe
rent nerve fiers from the hair cells comprise the cochlear nerve (CN), a ranch
of the eighth cranial nerve. X75. H&amp;E.<r>"
EarHistology Mar

ked
"<img src=""24f16022f29259ee2f50c3e623068ea.jpg"" /><r><r>Cochlear duct and s
piral ganglion. The spiral organ (SO) is located on the asal wall of the cochle
ar duct (CD). This duct is filled with endolymph produced in the stria vasculari
s (STV), an unusual association etween the columnar epithelial cells which have
numerous asal infoldings and the capillaries in the periosteum of the one (B)
. On either side of the cochlear duct are the scala vestiuli (SV) and scala tym
pani (ST), which are filled with perilymph and are continuous at the apex of the
cochlea. Cell odies of ipolar neurons in the spiral ganglion (SG) send dendri
tes to the hair cells of the spiral organ and axons to the cochlear nuclei of th
e CNS. X25. H&amp;E.<r>"
EarHistology Marked
"<img src=""f77c5c6815fee9a1f39e52adec57de.jpg"" /><r><r>Stereocilia of coch
lear hair cells. With the tectorial memrane removed, SEM shows the morphology o
f the three rows of outer hair cells (a), and the single row of inner hair cells
() in the middle turn of a cochlea. X2700.&nsp;&nsp;(With permission, from P
atricia . Leake, Epstein Hearing Research Laoratory, University of California
at San Francisco.)<r>"
EarHistology Marked
"<img src=""940d3e9f9a4659cecd9372fe808.jpg"" /><r><r>Sound waves and mov
ements in the ear. Sound waves are funneled to the tympanic memrane y the exte
rnal ear and conducted across the middle ear y movements of the three ossicles.
Movements of the stapes produce pressure waves in the perilymph on the other si
de of the attached oval window. In these diagrams, the spiral shape of the cochl
ea has een straightened to etter show how pressure waves affect the spiral org
an. The pressure waves produce movements within the spiral organ that cause the
mechanoreceptor hair cells to depolarize/hyperpolarize and release neurotransmit
ters to afferents of the cochlear nerve, producing signals interpreted in the CN
S as sounds. Pressure waves crossing the cochlear duct are transferred to the sc
ala tympani and dissipate at the round window. Sounds waves of different frequen
cies are detected y hair cells at specific sites along the spiral organ. Low fr
equency sounds produce pressure waves that move the spiral organ only near the e
nd of the cochlea, near the helicotrema. High frequency sounds affect the organ
close to the oval window and sounds of intermediate frequencies displace the spi
ral organ somewhere in etween the extremes.<r>"
EarHistology Mar
ked
"<img src=""e87f3142d17ed96326120f64f8f9e.png"" />" "<img src=""e7f261c53803
6e552e55549761e61a4.png"" />" EarHistology Marked
"<img src=""04acdeec84aa2ff3c89239e2f3424.png"" />"
EarHistology Mar
ked
"<img src=""0a83d8f795a728d28c04e2199052ec5.png"" />"
EarHistology Mar
ked
"<img src=""925d0e5c5fafd39f96d948207c7.png"" />"
EarHistology Mar
ked
"<img src=""52cf3ce27df576ec45cf2aefde3f405.png"" />" "<img src=""7e71c7ade33
e7d78e886854d8c3113.png"" /><r><r>Know this<r>fferent &amp; efferent equal
on well-mixed Type I &amp; Type II<r>" EarHistology Marked
"<img src=""9dd1fe820c40f0a1133f3963696d0.png"" />" "<img src=""016509958ca
d2031a5f465ace59d055.png"" /><r>Know!" EarHistology Marked
"<img src=""40a59e7c79018616d8aac094a88ea9.png"" />" "<img src=""8825256d9ee7
53fa16f55a85265e9.png"" />" EarHistology Marked
"T/F This is the organ of corti <r><r><img src=""7a96faed3c263fa4046ce7cf3467
931.png"" />" "<img src=""060478f58e1516e8a4800f43ae53d6.png"" /><r><r>Cant
e in organ of corti /c short fat &amp; tall skinny are mixed<r>"
EarHisto
logy Marked
"<img src=""936282d522fcf356feacd92a502c7cc3.png"" />" "<img src=""23294c5a5d3a
5878e68151cf688356f.png"" />" EarHistology Marked
"<img src=""f86ad0c33caf328f3018509ea9d7e8d.png"" />" "<img src=""1d88fc77226
571f3080df1a2efe30d.png"" />" EarHistology Marked
"<img src=""9e2e0cd6c9d8c7ad540218df6c9304.png"" />" "<img src=""fd6e4c98ae2c
126d6929d1f2048de46.png"" />" EarHistology Marked
"<img src=""2e087eca69475c981d17c9d44561.png"" />" "<img src=""1d2cc2c59d37

2ead4d3281919244c15.png"" />" EarHistology Marked

"<img src=""10735e2c851c0f017496998f13a60e60.png"" />" "<img src=""8079c89de276
f729456d92f355a77011.png"" />" EarHistology Marked
"<img src=""d2e2f76a7046cc0c91360cccd84e.jpg"" />"
EarHistology Mar
ked
"<img src=""48519cde050da32dea25fa88140106.jpg"" />"
EarHistology Mar
ked
"<img src=""013aae545e0a1f54dc35e852a821d2.jpg"" />"
EarHistology Mar
ked
"<img src=""5110c103f37da7969581f1fad31c269.jpg"" />"
EarHistology Mar
ked
"<img src=""877036e7ed9c16817a796d399da98.jpg"" />"
EarHistology Mar
ked
"<img src=""09aa3fe87343c999e9e5358c56a60122.jpg"" />"
EarHistology Mar
ked
"<img src=""58e5c341e9953380199c7eea0424d8.jpg"" />"
EarHistology Mar
ked
"<img src=""de33df0d267d1f0061e49fe26acca8.jpg"" />"
EarHistology Mar
ked
"<img src=""6304fa1e97148a532ef4c0d9e122ce.jpg"" />"
EarHistology Mar
ked
Learning ojectives
Descrie the orders and contents of the infratemporal f
ossa and its communications with other neary regions of the head. <r />Descri
e the attachments and functions of the muscles of mastication<r />Descrie the
motions at the temporomandiular joint associated with opening and closing the m
outh.<r />List the ranches of V3 found in the infratemporal fossa and descrie
their functions and regions of distriution.<r />List the ranches of V2 found
in the infratemporal fossa and descrie their functions and regions of distriu
tion.<r />Trace the pathway of parasympathetic innervation from the cranial cav
ity to the sumandiular and sulingual glands.<r />Descrie the pathway of the
maxillary artery from its origin to its termination and list its major ranches
<r />Trace the pathways of parasympathetic innervation from the cranial cavity
to the parotid gland.<r />
InfratemporalFossa Marked SuprahyoidRegion
"<img src=""8ac3cde3e4f04d531880500a826c1.png"" />" "<img src=""a34f99158
ea63634888101e1ccf34.png"" /><r><r>1. Temporal fossa region occupied y the te
mporalis muscle. Lies superior to the zygomatic arch<r>2. Infratemporal fossa l
ies inferior to zygomatic arch, medial to the ramus of the mandile, and lateral
to the pterygoid process of the sphenoid. Communicates with the pterygopalatine
fossa through the pterygomaxillary fissure.<r>"
InfratemporalFossa Marke
d SuprahyoidRegion
"<img src=""878ef35e69a4fdd3c25892823d55.png"" />" "<img src=""2a99cc014e72
a0d65d0c1073da21f3d.png"" /><r /><r /><r />Pterogoid plates are part of the
sphenoid one <r /><r />1. Temporal fossa region occupied y the temporalis mus
cle. Lies superior to the zygomatic arch<r />2. Infratemporal fossa lies inferi
or to zygomatic arch, medial to the ramus of the mandile, and lateral to the pt
erygoid process of the sphenoid. Communicates with the pterygopalatine fossa thr
ough the pterygomaxillary fissure.<r />"
InfratemporalFossa Marked Suprah
yoidRegion
"<img src=""68a49f5a02202386e1ac8d8900238c.png"" />" Pterygo mandiular fissu
re at arrow (?) not sure aout this arrow..<r><r>2. Infratemporal fossa lies i
nferior to zygomatic arch, medial to the ramus of the mandile, and lateral to t
he pterygoid process of the sphenoid. Communicates with the pterygopalatine foss
a through the pterygomaxillary fissure.<r>
InfratemporalFossa Marked Suprah
yoidRegion
"<img src=""4a27f3ef14460985630d5f002e8f8889.png"" />" "Mandile<r><img src=""
5c9a371d164fd2520c3104325fc252.png"" />"
InfratemporalFossa Marked Suprah
yoidRegion
"What is the innervation?<r /><img src=""af38d5cc226a18401520c984fd9e1e.png""
/>"
Muscles of Mastication<r /><r />Temporalis<r /><r />ttachments: Fro
m temporal fossa to coronoid process of mandile<r />ctions: elevation and ret

raction of mandile<r />Nerve supply: Deep temporal nerve V3 (NOT temporal of V

II or auriculotemporal of V3)<r /><r />Elevation and retraction of the muscle
/ temporalis also mediates protraction and retraction <r />
InfratemporalFos
sa Marked SuprahyoidRegion
"<img src=""8199834e5366aa4939709909098f9a6.png"" /><r>Innervation?" Muscles
of Mastication<r><r>Masseter<r><r>From zygomatic arch to angle of mandile<
r>ctions: elevation of mandile<r>Innervation: mandiular N (CNV3)
Infratem
poralFossa Marked SuprahyoidRegion
"Name muscle and structure at red arrow<r><r>what is the nerve supply?<r><r>
<img src=""e7ea5763064af45fa128c80f4057.png"" />" Muscles of Mastication<
r><r>Lateral Pterygoid<r><r>ttachments: from lateral aspect of lateral ptery
goid plate and inferior surface of greater wing of sphenoid to articular disc an
d head of mandile<r>ction: protraction and lateral grinding of mandile <r><
r>White thing in joint articular disc <r><r><r>Nerve supply - mandiular n (
CNV3)<r>
InfratemporalFossa Marked SuprahyoidRegion
"Reference<r><r><img src=""820ecf3d2dedd2f09155e4a2a4ce9c.png"" />"
InfratemporalFossa Marked SuprahyoidRegion
"Name muscle and nerve supply <r><r><img src=""4f3e249229201ef6ca13ec913c568
c.png"" />"
Muscles of Mastication<r><r>Medial Pterygoid<r><r>ttachment
s from medial aspect of lateral pterygoid plate and posterior surface of maxilla
to angle of mandile<r>ctions: elevation and grinding of mandile<r><r>Late
ral and medial pterygoid arise off the lateral pterygoid plate (this one arises
off of the medial aspect of the lateral plate) <r><r>Nerve supply - mandiular
n (CNV3)<r> InfratemporalFossa Marked SuprahyoidRegion
"<img src=""6e6d5c8421255424f1ef537d8a738.png"" /><r>Name each, and what is
the nerve supply?"
Muscles of Mastication<r><r>1. Lateral pterygoid<r>2.
Medial pterygoid<r><r>Both muscles arise from lateral pterygoid plate<r><r>
Both muscles have two head of origin<r><r>Both muscles contriute to protrusio
n and lateral grinding motion of teeth<r><r>Note: the small gap etween the ma
xilla and the pterygoid process of sphenoid one. This is the pterygomaxillary f
issure which is the entrance to the pterygopalatine fossa<r><r>Both supplied 
y mandiular n (CNV3) InfratemporalFossa Marked SuprahyoidRegion
"<img src=""0d92f9975f724913d06c7365dd2a55.png"" />" 1. Masseter<r>2. Mandi
le<r>3. Medial pterygoid<r>4. Lateral pterygoid<r><r>Note: origin of medial
pterygoid from medial aspect of lateral pterygoid plate<r><>Pterygoid muscles
act synergistically to produce movement toward the contralateral</> side, i.e.
the pterygoids on the left, move the mandile toward the right<r>
Infratem
poralFossa Marked SuprahyoidRegion
"Descrie motor and sensory innervation to uccinator too.<r><r><img src=""d2e
ff90c20ce3ff62e35d24d888c93.png"" /><r />Descrie motor and sensory innervati
on to uccinator too." "<img src=""a43d4736d0aae7c7f41a12f8233e74.png"" /><r
/><r />Note motor and sensory supply to uccinator are different&nsp;&nsp;(<
>motor is from VII - uccal ranch; sensory is from V</>) <r /><r />Lingual
general sensory to tongue<r />Inf. lveolar sensation to lower teeth <r />6 fi
ers from v2 supply sensation to upper teeth <r />" InfratemporalFossa Marke
d SuprahyoidRegion
"<img src=""1d220af83316ffe38798690f7ea4a02.png"" />" "<img src=""4f44146a11
3cfe23ff4d923806e.png"" /> <img src=""1d220af83316ffe38798690f7ea4a02.png""
/><r />Chorda tympani taste sensation - arrow<r />" InfratemporalFossa Marke
d SuprahyoidRegion
"<img src=""eedea0d5aaa904284f8804612d94759.png"" />" Red sensory<r>Black arr
ow chorda tympani<r><r>Lingual nerve (CNV3)<r><r>Supplies general sensory to
anterior 2/3 of tongue<r><r>Joined y chorda tympani (carrying taste to anter
ior 2/3 of tongue and preganglionic parasympathetic fiers to sumandiular gang
lion for sumandiular and sulingual glands<r>
InfratemporalFossa Marke
d SuprahyoidRegion
"<img src=""7455a38ec69635f764961226c5a973a.png"" />" "Maxillary artery lood
supply to nasal cavity <r><r><r><img src=""53847d14f4e2296f236dfeec273a64.p
ng"" />"
InfratemporalFossa Marked SuprahyoidRegion
"<img src=""c0c8e6070c9094f7019f29d310780867.png"" />" "Parasympathetics to Par

otid Gland<r><r>Earache IX deep sensory <r>V3 and lesser petrosal through for
amen ovale <r><r><r><img src=""5dae483ea77e3f3736da29dd22de2.png"" />"
InfratemporalFossa Marked SuprahyoidRegion
"<img src=""cc09c6e0cfd6827ec64c078195e69a4.png"" />" "<img src=""e8ae1c2dc9ad
71873f912df2133346.png"" />" InfratemporalFossa Marked SuprahyoidRegion
Learning ojectives - Oral Cavity <r><r>List, in order, the layers of muscles
that form the floor of the mouth<r>Descrie the location of the sumandiular s
alivary gland and the course and termination of the sumandiular duct.<r>Descr
ie the location of the sulingual salivary gland and the course and termination
of its ducts.<r>List and descrie the points of attachment of the suprahyoid m
uscles<r>Descrie the relationships formed y the nerves, arteries, and muscles
of the suprahyoid region<r>List the muscles innervated y the hypoglossal nerv
e and descrie the clinical presentation of a person with a hypoglossal nerve le
sion&nsp;&nsp;<r>Descrie the pattern of sensory nerve supply to the&nsp;&n
sp;surface of the tongue<r>List the anatomical structures visile in the floor
of the mouth<r>Descrie the location of the palatine tonsil<r>
Marked SuprahyoidRegion
" <img src=""e5cd1df14e64a22de748c8c1d8da.png"" /> <img src=""7aa0d0f915078
49a8f38cfa2e034098.png"" />"
"Mandile<r><r><img src=""81554105e3200e0ca63c
ec5af290531a.png"" />" Marked SuprahyoidRegion
"<img src=""561fcec9a792325ef039d6274d3042c8.png"" />" Floor of Mouth: Schemati
c View<r><r>1. Digastric<r>2. Geniohyoid<r>3. Mylohyoid<r> Marked Suprahyoi
dRegion
"<img src=""37d06e57d0d2252932a0161d789e1.png"" />" Floor of Mouth Simple Vi
ew<r><r>1. Genioglossus (the tongue)<r>2. Geniohyoid<r>3. Mylohyoid<r>
Marked SuprahyoidRegion
"<img src=""f009348c24a124835f0a253c143ec.png"" />" "Floor of Mouth<r>More
Complicated View<r><r><img src=""04685aefffc3c8e598f61df0dacc8c2.png"" />"
Marked SuprahyoidRegion
"<img src=""205f86c900fcc121e3d81389a8469384.png"" />" "Suprahyoid Muscles <r>
Simple View<r><r><img src=""7df359e947028dd14da2977c6969a.png"" />"
Marked SuprahyoidRegion
"<img src=""f9e622838c397df747eca7e395e919.png"" />" "Suprahyoid Muscles <r>
More Complicated View<r><r><img src=""a57f8d3cf1477e06512659fc9ce33e.png"" /
>"
Marked SuprahyoidRegion
"<img src=""85724dfd45aa26501cc27ac06735d.png"" />" "Suprahyoid Muscles <r>
<r>Deep View (anterior digastric and mylohyoid have een removed)<r><r><img s
rc=""0cc3e8093e1ca93afcaae499f00582.png"" />" Marked SuprahyoidRegion
"<img src=""7727de9590ac1e4fde663e8010f702.png"" />" "Suprahyoid Muscles <r
/>Deep View with nerves and vessels<r /><r /><img src=""a0f6854eeafdfc2afd1f2
8f05d5ed7e.png"" /><img src=""7727de9590ac1e4fde663e8010f702.png"" /><r />Not
e sumandiular ganglion at green arrow <r />" Marked SuprahyoidRegion
"<img src=""9736022d1e05fc9e2ef31124fd37.png"" />" "<img src=""356ffdecc43a
c18578ccf18574373f.png"" />" Marked SuprahyoidRegion
"<img src=""5fe73189d824fd776d523c286a21f04.png"" />" "Hypoglossal Nerve XII<
r />with ansa cervicalis<r /><r /><img src=""d88818aca45105968e296184f3a2d26.
png"" /> <img src=""5fe73189d824fd776d523c286a21f04.png"" /><r /><r />nsa ce
rvicalis supplies strap muscles check the ook. It is cervical plexus. <r />(Om
ohyoid / sternohyoid / sternothyroid)" Marked SuprahyoidRegion
"<img src=""421293a1cd7718453c73826517df4.png"" />" Mid Sagittal View<r><r
>1. Mylohyoid<r>2. Geniohyoid<r>3. Genioglossus <r> Marked SuprahyoidRegion
What is genioglossus? "<img src=""d2aaf956e3380e878ae90117f09e034.png"" />"
Marked SuprahyoidRegion
"<img src=""3e5686d50fedd688f8e44922c0376e7c.png"" />" "<img src=""e707a147870
73af0c5704372995a1.png"" /><r><r>KNOW FORMEN CECUM - EMBRYOLOGICL REMNNT
"
Marked SuprahyoidRegion
"General sensory to the tongue<r><r>nterior 2/3<r>?<r>Posterior 1/3<r>?<r
>Epiglottis<r>?<r><r><img src=""26d62a793837914fe1487d14a04dda.png"" />"
"nterior 2/3<r><>Lingual nerve of V3</><r>Posterior 1/3<r><>Glossopharyng
eal nerve IX</><r>Epiglottis<r><>Internal laryngeal nerve from Vagus X</><

r><span style="" font-weight:600;""></span>"

Marked SuprahyoidRegion
"Taste to the tongue<r><r>nterior 2/3<r>?<r>Posterior 1/3<r>?<r>Epiglotti
nterior
s<r>?<r><r><img src=""07897f28d8dd9e436dc1ae310d7321.png"" />"
2/3<r><>Chorda tympani of VII (via the lingual nerve of V3)</><r>Posterior
1/3<r><>Glossopharyngeal nerve IX</><r>Epiglottis<r><>Internal laryngeal n
erve from Vagus X</><r>
Marked SuprahyoidRegion
"<img src=""f311aadc243ccd675147fed106356c57.png"" />" "Vallate papillae get ne
rve supply from CN 9 posterior part of the tongue. Other slide indicates papilla
vallate are in the anterior division of the tongue. This is incorrect. <r><r>
CNIX carries sensory and taste to the posterior part of the tongue. <r>Epiglott
is supplied y X<r><r><img src=""fcac5cd8f4a74847c291853e36a1f.png"" />"
Marked SuprahyoidRegion
"What supplies sensory to the cheek?<r><r><img src=""05247f3602f5ac84a1f312e
a8a0d70.png"" />"
"Cheek uccal ranch of v3 for sensory<r><r><img src="
"f2f1e590183d5ed563ac8c41c5dd1f7.png"" />"
Marked SuprahyoidRegion
"<img src=""e9648c6964e32cd57d7095e2fd2d3a.png"" />" 1. Palatoglossal fold<r
/>2. Palatopharyngeal fold<r />3. Palatine tonsil<r />4. Uvula<r /> Marked S
uprahyoidRegion
REVIEW OF ORTIC RCHES - LL IN ONE FLSHCRD THT YOU MUST MEMORIZE NOW ND NE
VER FORGET<r><r>The ranches from the aortic sac (to the pharyngeal pouches) a
re called the aortic arches<r>Ventrally associated with the aortic sac<r>Dorsa
lly associated with the dorsal aortae<r>The ranch associated with the fifth po
uch never completely forms<r>Paired aortic arches I, II, III, IV, VI ecome imp
ortant <r>Form in a craniocaudal sequence and create asket of arteries around th
e pharynx<r><r>1st arch forms?<r>2nd?<r>3rd?<r>4th?<r>5th?<r>6th?
"1st arch - maxillary<r>2nd - hyoid and stapedial<r>3rd - common and proximal
internal carotids<r>4th - right - -right suclavian; left - arch of the aorta<
r>5th - disappears<r>6th - right - right pulmonary artery; left - ductus arteri
osus <r><r><img src=""15cc724e5ca532451ec3f212a129.png"" /><r><r><img sr
c=""ea2e889f1f0a51c12d0016f97568.png"" />" EmryologyI Marked
"for reference;<r /><r><img src=""e7f708e71e8d9939da6d06078c3eaa9.png"" />"
EmryologyI Marked
Emryology - need to know:<r /><r />Understand the origins of the tissues of t
he head and neck<r />Be ale to identify the pharyngeal arch, pouch or cleft or
igin of important structures<r />Descrie a 2nd ranchial cleft sinus<r />Know
why the innervation of the tongue is from multiple nerves<r><r>Understand the
emryologic origin of the thyroid gland <r>Explain the origin of ectopic thyro
id and thyroglossal duct cysts<r>Understand the general concept of how cleft li
ps and palates are formed<r>Know when fontanelles close <r>Explain craniosynos
tosis<r><r />
EmryologyI Marked
4 things that mesencyhme for formation of the head and neck are derived from?
paraxial mesoderm<r>lateral plate mesoderm<r>Neural crest<r>Ectodermal placod
es <r> EmryologyI Marked
"Reference: <r><r><img src=""c70808e7e84efc76e4864dd3a01efcc.png"" />"
EmryologyI Marked
What are the otic placodes and what will they ecome?<r>What are the lens placo
des and what will they ecome? "out the same time as the neural tue is closi
ng, two ilateral ectodermal thickenings appear<r><r><>Otic placodes</><r>W
ill ecome otic vesicles<r>Origin of ear and vestiular structures<r><r><r><
>Lens placodes</><r>Will ecome lens of the eye<r><r><img src=""c70808e7e84
efc76e4864dd3a01efcc.png"" />" EmryologyI Marked
"Reference - what is each area?<r><r><img src=""c122ef442985d3c37dcf65554ead1
7.png"" />"
Lateral edge of primitive node and cranial end of primitive stre
ak - paraxial mesoderm<r><r>Midstreak - intermediate mesoderm<r><r>Caudal st
reak - lateral plate mesoderm<r>
EmryologyI Marked
Paraxial mesoderm will give rise to 5 primary things - name them
Floor of
rain case<r>Small portion of the occipital region<r>ll voluntary muscles of
the craniofacial region<r>Dermis and connective tissue of the dorsal head<r>M
eninges caudal to the prosencephalon<r>
EmryologyI Marked
what does the lateral plate mesoderm form (2)? Laryngeal cartilages (arytenoid

and cricoid)<r>Connective tissue in the region of the laryngeal cartilages<r>

EmryologyI Marked
"Reference - neural crest <r><r>Neural crest<r>cells at lateral order or cre
st of neural fold<r>Migrates away from neuroectoderm<r>Gives rise to a variety
of cells<r><img src=""c36c9dd7a0249f35aa1f70a2c2aa8d.png"" />"
EmryologyI Marked
descrie the neural crests contriution to the head/neck<r /><r />where does
it originate?<r />where does it migrate?<r />what does it make up? (5)
"Originate in the neuroectoderm and migrate <r />ventrally into the pharyngeal
arches<r />Rostrally around the forerain and optic cup into the facial region<
r />Midface and pharyngeal one, cartilage, connective tissue, sensory neurons,
glandular stroma<r /><r /><img src=""3900edaa68f67c2ee91669a740c30.png"" /
><r><r><img src=""e3f2dc28c3611c5282022c772237301.png"" />" EmryologyI Mark
ed
"Reference - <r><r><span style=""color:#0055ff;"">Neural crest is lue;</span>
<r><span style=""color:#a6a600;"">lateral plate mesoderm is yellow</span><r><s
pan style=""color:#ff0000;"">paraxial mesoderm is red </span><r><span style=""
color:#ff0000;""></span><r><img src=""6afa347cd462203e616cd1023977f68e.png"" />
"
EmryologyI Marked
"Reference <r><r><img src=""dc064908cf3791797aa25adac6522.png"" />"
"<img src=""ce3ddecf955c880c4356ef51635.png"" />" EmryologyI Marked
"This diagram is quite important <r><r>note <span style=""color:#a6a600;"">yel
low is endoderm</span>; <span style=""color:#765d54;"">rown is mesenchyme</span
>; <span style=""color:#00007f;"">lue is ectoderm; </span><r><r><r>Pharyngea
l arches appear in the 5th week<r>Bar of mesenchymal tissue covered on the outsid
e y ectoderm and the inside y endoderm<r>Core also contains neural crest cell
s (will ecome skeletal component)<r>Muscular component has unique cranial nerv
e that will migrate with the muscle during development<r><r>rches are ars of
mesenchymal tissue separated y deep clefts = pharyngeal (ranchial) clefts<r>
Simultaneously, pharyngeal pouches form on the lateral wall of the pharygeal gut
<r>The pouches penetrate the mesechyme ut do not connect with the clefts<r><
r><r><img src=""7a4f4d341743415f5dcace93c26098d.png"" />"
Emryolo
gyI Marked
"<img src=""e44cff06071ce3a3ffdc518af471ce2.png"" />" "<img src=""ff5e8c0126e9
3590ce63a1088735dee.png"" />" EmryologyI Marked
1st arch<r><r>- what muscles does it form? (8)<r><r>What nerve?
Muscles<
r>Muscles of mastication (temporalis, masseter, pterygoids)<r>nterior elly o
f the digastric, mylohyoid<r>Tensor tympani and tensor palatini<r><r><r>Nerv
e<r>Trigeminal (V)<r> EmryologyI Marked
"<img src=""221a300a9540690d470f55e349a734.png"" />" "<img src=""5e7a4ec14c79
8ae53602eaf1f39265.png"" />" EmryologyI Marked
2nd pharyngeal arch<r><r>what muscles (4 specific+1 category)<r><r>what nerv
e?
<>Muscles</><r>Stapedius<r>Stylohyoid<r>Posterior elly of the diga
stric<r>uricular<r>Muscles of facial expression<r><r><>Nerve</><r>Facial
(VII)<r>
EmryologyI Marked
3rd arch<r><r>what one?<r>what muscle?<r>what nerve?
<>Bones</><r>
Lower part of the hyoid<r><r><>Muscles</><r>Stylopharyngeus<r><r><>Nerve
</><r>Glossopharyngeal (IX)<r>
EmryologyI Marked
4th and 6th pharyngeal arch<r><r>what cartilages?<r>what muscles?<r>what ner
ves?
<>cartilages</><r>Thyroid, cricoid, arytenoid, corniculate and cuneif
orm cartilages of the larynx<r><r><>Muscles</><r>4th arch:&nsp;&nsp;Crico
thyroid, levator palatini, constrictors of the pharynx <r><r><>Nerve</><r>4
th arch:&nsp;&nsp;Superior laryngeal ranch of the vagus<r>6th arch: recurren
t laryngeal&nsp;&nsp;ranch of the vagus<r> EmryologyI Marked
n easy oversimplification for the pharyngeal arches - know this cold<r><r>Wha
t is 1st?<r>what is 2nd?<r>what is 3rd?<r>What is 4th and 6th?
1st JW
(maxilla, mandile, muscles of mastication, trigeminal nerve)<r>2nd FCE (muscle
s of facial expression, facial nerve)<r>3rd TONGUE glossopharyngeal = taste from p
osterior 1/3 of tongue<r>4th and 6th:LRYNX (laryngeal ranches of the vagus)<
r>
EmryologyI Marked

"Reference:<r><r>Bony structures of the arches<r><r>Maxilla<r>Mandile<r>H

yoid<r>Stapes<r>Malleus<r><r><img src=""e4ae886f969ea77345d3a8acc139f.png
"" />"
EmryologyI Marked
"reference-&nsp;&nsp;cartilagenous structures of the pharyngeal arches <r><r
>Thyroid cartilage<r>Cricoid cartilage<r><r><img src=""8674a267eff224c75e11f0
a4983f280c.png"" />"
EmryologyI Marked
"Pharyngeal pouches!<r><r><r><img src=""ac8efd513746ce53f89576872ae26.png"
" /><r><r><img src=""29a21d401d2a2ddde6465348f35237c.png"" /><r><r><img src
=""0dc2e0afaf448671d68a72949829a94f.png"" />"
EmryologyI Marked
The 1st pharyngeal pouch: <r /><r />what does it ecome?<r /><r />(different
iate proximal and distal)
"Forms a stalk-like diverticulum (tuotympanic r
ecess) which comes into contact with the 1st pharyngeal cleft (ecomes the exter
nal auditory canal)<r />Distal widens primitive tympanic or middle ear cavity<
r />Proximal stays narrow Eustachian tue<r /><r /><img src=""053c939e6f8ad358
31f2af633e99cc3.png"" />"
EmryologyI Marked
2nd pharyngeal pouh<r /><r />what does it form?<r />what is the remnant?<r /
><r /> "Forms uds that infiltrate the mesenchyme and are then invaded themselv
es y mesodermal tissue<r />Palatine tonsil primordium<r />5th month tonsil is
infiltrated y lymphatic tissue<r />Tonsillar fossa is direct remnant of the p
ouch<r /><r /><img src=""053c939e6f8ad35831f2af633e99cc3.png"" />" Emryolo
gyI Marked
3rd pharyngeal pouch<r><r>what does it form (dorsal and ventral?)<r><r>
"Dorsal and ventral wings<r>Dorsal inferior parathyroid<r>Ventral Thymus<r><r>
These wings disconnect from the pharyngeal wall and the thymus migrates ventrall
y, dragging the inferior parathyroid with it<r><r><img src=""053c939e6f8ad3583
EmryologyI Marked
1f2af633e99cc3.png"" />"
4th pharyngeal pouch<r><r>what does it form? (dorsal and ventral?)<r><r>
"Dorsal and ventral wings<r>Dorsal superior parathyroid<r>Ventral ultimoranchia
l ody <r>Infiltrates the thyroid gland as the parafollicular or C cells of the t
hyroid which secrete calcitonin<r><r>When the dorsal (and ventral) wing detach
from the pharynx they attaches to the caudally migrating thyroid <r><r><img s
rc=""053c939e6f8ad35831f2af633e99cc3.png"" />" EmryologyI Marked
"Reference - pouches <r /><r /><img src=""c97543f0ae237f19d7ad1496e2c94c.png
"" />" "<img src=""ad736fce355c85e07d88cfd2df795.png"" />" EmryologyI Mark
ed
Oversimplification to rememer the pouches<r /><r />what is 1,2,3,and4?
1st ER (middle ear, Eustachian tue)<r />2nd TONSILS (fossa, not lymphatic tis
sue) <r />3rd INFERIOR PRTHYROID ND THYMUS<r />4th - SUPERIOR PRTHYROID 
ND CLCITONIN<r />
EmryologyI Marked
Pharyngeal clefts<r><r>What does the 1st, 2nd,3,4 form?
1st ER (auditor
y canal)<r>2nd NOTHING<r>3rd NOTHING<r>4th - NOTHING<r> EmryologyI Mark
ed
Branchial cleft sinuses!<r /><r />Tell me aout 1-4 - what will a cleft in any
of these present as? "1st RRE sinus connecting to external auditory canal (u
sually from preauricular area)<r />2nd MOST COMMON orifice on anterior order o
f SCM, travels through carotid ifurcation to tonsillar fossa<r />3rd RRE same
orifice as 2nd ut lateral to carotid<r />4th PROBBLY DOESNT EXIST<r /><r />
<r />2nd<r /><img src=""11f0e2c3996d9e041c41c9953ad6785e.png"" />"
Emryolo
gyI Marked
"Lael the source (anything with a { is fair game)<r><r><img src=""14632356a52
5df63c4e2542989a55ca.png"" />" "<img src=""f0f11c0cec729140358ea80c4563c.png
"" />" Marked
"Lael<r><r><img src=""4022ddc5ca3a5c8d580f3dc342ae.png"" />"
"<img sr
c=""f0f11c0cec729140358ea80c4563c.png"" />" Marked Leech
Put in order of least to most dense<r><r>Water / ir / Fat / Bone <r><r>What
is white on film, what is lack
Least dense<r>ir (lack)<r>Fat<r>Wat
er<r>Bone (white)<r>Most dense<r>
Marked
Will the following e light or dark on film?<r><r>Cysts<r>Contrast Material<
r>Metal<r>Calcium<r>Edema<r>Blood<r>Gliosis<r> few tumors<r>Demyelination
<r>
<>White </><r><r>Metal<r>Calcium<r>Blood<r>Contrast Material<r>

few tumors<r><r><>Dark</><r><r>Edema<r>Cysts<r>Gliosis<r>Demyelination
<r><r>
Marked
"Just some slides<r><r><r><r>Foramen transversarium<r>nterior/posterior tu
ercles<r>Spinal Canal / Verteral foramina<r>Bifid spinous processes<r><r><
img src=""c7c8fa3f952f72373ec625c398772.png"" />"
Marked
"<img src=""4040a868409eeeed40a7c380a819249.png"" /><r><r><img src=""47f4546
0e904edc1e492df763a8ca.png"" /><r><r>C1 tlas<r>Lateral masses<r>Superior
articular surfaces<r><r>C2 xis<r>Superior articular facets<r>Dens<r><r><i
mg src=""0c2072cfcf3cd9176ecd6e02972d392.png"" /><r><r><r>"
Marked
"Thoracic Spine<r><r><img src=""0018640457600c0d40f9a4ca8ce1276.png"" /><r><
r>Neural foramen/ Interverteral foramen<r>Zygapophyseal jt (facet jt)<r>Pedi
cle <r>Lamina<r>Spinous process<r>Costal facets<r>Transverse process<r><r>
<img src=""17758ae772a5c014d3336a2a33e26e2.png"" />"
Marked
"Lumar Spine<r><r><img src=""049c523151976cd9f9cf197719c88f.png"" /><r><r
>Larger<r>No Ris<r>Degenerative changes common<r>DDD<r>Facet rthropathy<r
>nt Long Ligament<r>Post Long Ligament<r><r><img src=""532fc25429d440e0d489
042de777e5e.png"" /><r><r><img src=""def9d938503cd94a816438272173.png"" />
"
Marked
"Clinical Correlation<r>Hangmans Fracture<r><r><img src=""7c5560a3ad7c5e2748ec
15e414d.png"" /><r><r><r><r>Jeffersons Fracture (ie from diving into a p
ool)<r><r><img src=""4a8f711ea7a3cc23ecce21560d8708.png"" /><r>"
Marked
"Fascia Of The Neck<r><r><img src=""9f4fea207f87966e92cda55aca0.png"" /><
r><r><img src=""0da91f145f431d67a39f846fa00522.png"" /><r><img src=""f81ee3
8a51358f8aaf2a996a7535.png"" /><r><r><img src=""9a6e675335edc00f0756369
096564.png"" /><r><r><img src=""25384ae1cc4c4e7d78a6cfc120d1d6ff.png"" />"
Marked
"Orit<r><r><img src=""42643d705f46aecd5598009443.png"" />"
Marked
"Facial Bones<r /><r />1. Frontal Bone<r />2. Zygomatic <r />3. Sphenoid<r
/>4. Ethmoid<r />5. Vomer<r />6. Inferior concha<r />7. Maxilla<r />8. Mandi
le<r /><r /><img src=""fe67e354ac4eac7986458c96176adef.png"" /> <img src=""
a7ef76284f6f705d3ed7370ef798a.png"" /><r /><r /><img src=""1618d0f4d3226a50
48c2427f74aa42.png"" /> <img src=""a7ef76284f6f705d3ed7370ef798a.png"" /><r
/><r /><img src=""fcfd491776e505d495e9843761425159.png"" /> <img src=""a7ef76
284f6f705d3ed7370ef798a.png"" /><r /><r /><img src=""ee247f2295098237013f53
a52c2fdc.png"" /><img src=""a7ef76284f6f705d3ed7370ef798a.png"" /><r /><r
/><img src=""83302ea7d1d5f601ca748e8f2f4527.png"" /> <img src=""a7ef76284f6f7
05d3ed7370ef798a.png"" /><r /><r /><img src=""6aa15336083659c42a0d812e7183a
50.png"" /> <img src=""a7ef76284f6f705d3ed7370ef798a.png"" /><r /><r /><img
src=""6ec99ca19f660aa2c7462de25cc8f548.png"" /> <img src=""a7ef76284f6f705d3e
d7370ef798a.png"" /><r /><r /><img src=""1872ad2e7737414ecaf910ffd53e.png
"" /> <img src=""a7ef76284f6f705d3ed7370ef798a.png"" /><r /><r /><img src="
"88f8aa329f64977a9e415731eafe8936.png"" /> <img src=""a7ef76284f6f705d3ed7370
ef798a.png"" /><r /><r /><img src=""9ace8a55e2dd1216a847f77997554f7.png"" />
<img src=""a7ef76284f6f705d3ed7370ef798a.png"" /><r /><r /><img src=""71c81
6f65caae12940ae48ad7c4e50a.png"" /> <img src=""a7ef76284f6f705d3ed7370ef798a
.png"" /><r />"
Marked
"Orit/Gloe<r><r><img src=""13dd4fd64447362d47860c8876071d.png"" />"
Marked
"Primary Brain Injuries<r><r><img src=""68df9e02c0e90d4a3c67808a8d7251.png""
/>"
Marked
"INTRCRNIL INJURIES<r><r><img src=""02f4601fc21212ed2441f47fe57aced.png""
/>"
Marked
"Epidural Hematoma<r><r><img src=""7f9d5f81d923117912956f33703d05.png"" />&n
sp;&nsp;<img src=""8c819a79ef368947471520c88fff9e.png"" /><r><r><img src="
"d7190fcaa8c74c79fce1a4f8ae0d.png"" /> <img src=""627509532a768ea8d34f70f1
7257d5.png"" />"
Marked
"Intraparenchymal Hemorrhage<r /><r /><img src=""5c15219cf2fd830765857281c4aa7
1a5.png"" /> <img src=""7a76906c49f63c17de752adfec4d20.png"" />"

Marked
"Suarachnoid Hemorrhage<r><r><img src=""5f68e57939a50344c052c9ee04aae1d.png"
" /><r><r><img src=""c110947fd601a6c1a8d65926e57f6f.png"" /><r><r><img src
=""ef8c5873d09a95e68fd6f16ac193.png"" /> <img src=""7146148a787c553537e55
74047cc2.png"" />"
Marked
"Sudural Hematoma<r><r><img src=""26516a0de1fd1219178fa464420a14d.png"" /><
r><r><img src=""6cfc93596af7fad03d9d49fcd57d6d.png"" /><r><r><img src=""4ce
651701226628c8299ce4549e393.png"" />"
Marked
" Facial Trauma<r><r><img src=""6729cecc29f1a9c3e905aad108964c.png"" /> <img
src=""a308f6ad3fd0ea843103f53de2c2fc.png"" /><r><r><img src=""2ded1dae06f1
0cd45ec784ef018fa0.png"" /> <img src=""68a46a79e4ff345273f5442ccdd45f.png"" /
><r><r><img src=""f2f1395f52a1f15fd3f48373e90104.png"" /> <img src=""073011
0c809d6c4e8186e107fa31da6.png"" /><r><r><r><img src=""31570eca571c84d1da7e0f
77a0a1340.png"" />&nsp;&nsp;<img src=""0418c74f96fe646791103a7489a6180.png""
/><r><r><img src=""21fff82f5c7656ec1ced8566447.png"" /> <img src=""fec31
690f0791c38f3aca43f62ac93.png"" /><r><r><img src=""74f1454ee02e1e648d8c7ac81
01a7f2.png"" /><r><r><r>"
Marked
"Retinolastoma<r><r><img src=""43ee69af279cfa72dd61e2dac815555.png"" /><r><
r><img src=""6d47de8a2550e564399304f9c08cde.png"" /><r><r><img src=""e5309e
d3e796281ed5adc2e99938f.png"" />"
Marked
"Retinal Detachment<r /><r /><img src=""f81ce648f8066c0347caf5d6745.png""
/><r /><r /><img src=""5d03cae28ec7fe6e4f252effeca1e7.png"" />"
Marked
"Thyroglossal duct cyst<r><r><img src=""1ac6cfe9d77112597a911799512.png""
/><r><r><img src=""9e916a38da6c32d1a65766e929ee73.png"" />"
Marked
"Hemangiolastoma <r><r><img src=""328e8a3934741f832145547974fdef.png"" /><
r><r><img src=""c4f32e48a294846a0c76e6fa4aceaefa.png"" />"
Marked
Define Prevalance<r><r>Define Incidence<r><r>
<>Prevalence</><r>The
fraction of a population that has the syndrome or condition. Expressed as fract
ion, percentage, life-time measurement<r>The prevalence of Ig Def. is 1/300 among
adults <r><r><>Incidence</><r>The annual rate of diagnosis of the condition
<r>Diagnosed cases of H1N1 in 2009<r>nnual rate of new occurrence of the cond
ition<r>(extrapolated) incidence of H1N1 in 2009<r> Marked
ll aout CVID<r><r>What may it present as in infant?<r>what aout adolescenc
e?<r>what aout 20-30 year olds?<r>what does it often present with? Infant:
recurrent otitis media that resolves<r>child grows out of it<r>dolescence:&nsp
;&nsp;recurrent respiratory infections <r>Often presents early with Ig Defici
ency<r>20-30s: Full CVID<r> Marked
ll aout CVID<r><r>What Ig classes are primarily affected? "<>IgG4 &gt;IgG
2&gt;IgG1&gt;IgG3</><r><span style="" font-weight:600;""></span><r> (Th2 affe
cted more than TH1)<r>But in order to have diagnosis, IgG1 will e affected sin
ce it accounts for 75% of IgG<r><r>Ig- almost always low<r>IgM and IgE are l
ow in most patients<r>ut IgE is sometimes elevated in IgD<r>"
Marked
ll out CVID <r><r>what kindve infections will e seen?<r><r>specifically
in the gut / respiratory / viral?<r><r>What is ronciectasis? Infections<r>Gu
t: recurrent and chronic&nsp;&nsp;diarrhea ;infections, esp. Giardia&nsp;&ns
p;; acterial overgrowth in intestines<r>Respiratory:RESPI upper respiratory tr
act infection such as ronchitis and sinusitis.<r>Bronchiectasis&nsp;&nsp;lea
ding to shortness of reath.<r> Viral infections:<r>sinusitis, tonsilitis, epi
glottitis, dermatological ascesses/oils (often, ut not exclusively, facial an
d axillary), pneumonia, ronchitis, pleurisy, stomach/intestinal infections, col
ds, influenza, shingles or conjunctivitis.<r><r>Bronchiectasis: lung tissue da
mage as a result of repeated chest infections<r>
Marked
ll aout CVID<r><r>T/F CVID is ascd with chronic swelling of lymph glands /
the spleen<r><r>What type of gut prolems are associated with CVID? (6)<r /><
r>Where does the associated granulomatous disease of CVID originate? True: Ch
ronic swelling of the lymph glands,&nsp;&nsp;enlarged spleen.<r><r><>Gut pr
olems</><r>trophic gastritis with pernicious anemia : antiodies against&ns
p;&nsp;intrinsic factor B-12 vitamin deficiency<r>Nodular lymphoid hyperplasia o

f the intestine. This finding can e mistaken for intestinal lymphoma.<r>Increa

sed intestinal permeaility (i.e. leaky gut).<r>Villous atrophy in the small in
testine, which can resemle coeliac disease and cause diarrhoea and malasorptio
n.<r>IBD inflammatory owel disease.<r>Failure to thrive ;Malasorption ;Weigh
t&nsp;&nsp;loss<r><r>Granulomatous disease- starts in lungs --&gt; poor prog
nosis<r>
Marked
ll aout CVID<r><r>descrie the cvid response to vaccination<r><r>how might
joints e affected in this disease?<r><r>what is ITP?<r><r>Fatigue is assoc
iated with CVID. know it.
Immune deficits:<r><>Poor titer levels in resp
onse to vaccination. </><r>Polysaccharide-coated pathogens (Streptococcus)<r>
Conventional antigens (e.g. tetanus toxoid)<r> coated pathogens (e.g. streptoco
cci and tetanus respectively).<r><r><r>Polyarthritis, or joint pain, spread a
cross most joints, ut specifically fingers, wrists, elows, toes, ankles and kn
ees.<r><r>Immune thromocytopenic purpura (ITP)<r><r>Fatigue.<r> Marked
What likely causes CVID?<r>(e as specific as possile)<r><r>What gain of fun
ction mutations have een characterized? what are these mutations associated wit
h?<r><r>what loss of functions have een identified? HL association: all wea
k and mechanism unknown<r>Identified mutations&nsp;&nsp;in genes that make sen
se presumed dominant ut partial penetrance<r><r><>Dominant/gain of function</
><r>BFF, TCI, BFF-R.<r>These are cytokines/receptors that help induce class
-switching and promote B cell maturation and survival.<r>TCI -18% of CVID pati
ents have mutation. Receptor on B cells and activated T cells.<r><r><r><>Los
s of function</><r>ICOS- inducile costimulator- CD28-like molecule induced on
T cells, responds to ICOS-L on professional PC<r>CD19 co-receptor on B cells<
r>CD19 required for proper B cell function so pt. can still have B cells, ut th
ey can only make IgM no class switch<r><r> Marked
What medications are thought to e environmental factors that may contriute to
CVID or transient iga deficiency? (3)<r><r>what are these medications usually
used to treat? Phenytoin&nsp;&nsp;DilantinTM PhenytekTM <r><r>Seizures, ven
tricular arrhythmias,&nsp;&nsp;digitalis intoxication, prolonged QT interval a
nd surgical repair of congenital heart diseases epidermolysis ullosa (fragile s
irth defects<r>
kin)<r>Contraindications:&nsp;&nsp;pregnancy: phenytoin
Marked
Treatment for CVID?<r><r>ntiiotics and antivirals<r>Bone marrow transplant
(hematopoietic stem cell transplant HSCT)<r>IVIG (intravenous immunogloulin)<r
>High dose recominant cytokine (IFN, IL-5, IL-6) to push isotype switchin<br>
Treatment for CVID<br><br>Antibiotics and antivirals<br>Bone marrow transplant (
hematopoietic stem cell transplant HSCT)<br><b>IVIG (intravenous immunolobulin)<
/b><br>Hih dose recombinant cytokine (IFN, IL-5, IL-6) to push isotype switchin
<br>
Marked
how is CVID enerally treated? (2 proned approarch)<br><br>what is rituximab? what role does it play in treatment?<br><br> "CVID:<br><b>IVIG 400 m/k once
/mo </b><br><b>antibiotics as needed </b><br><span style="" font-weiht:600;""><
/span><br>Associated autoimmunity<br><b>Rituximab</b><br>Anti-CD20- sinalin mo
lecule on B cells depresses B cell function !!<br> <br><b>corticosteroids</b><br>"
Marked
Many patients with IA Def and CVID have antibodies aainst IA<br>--&t; risk o
f anaphylaxis after IVIG<br>Where do they come from?<br>Cause or effect?<br>
Note there is still small dose of IA in IVIG. (thouht IVIG is predominately I
G) - so this is an effect - a side effect. <br> Marked
classic indications for i replacement therapy?<br>list 3 conditions that may qu
alify Severe IA deficiency<br><b>CVID</b><br><b>SCID</b><br><b>Specific I di
fficiencies</b><br>E.&nbsp;&nbsp;V A2 allele.&nbsp;&nbsp;Navajo, Apache, Alas
an
Native Americans- defective recombination signal <br>Cant ma
e protective anti-H
aemophilus influenzae type b (anti-Hib) antibodies&nbsp;&nbsp;<br>510-fold increa
sed incidence of Hib disease&nbsp;&nbsp;<br>
Mar
ed
A history of IVIG: <br><br>Strategy : replicate in patient the normal spectrum o
f immune antibodies<br>Early procedures:<br> intramuscular --&gt;success but man
y complications<br>--&gt; identified ITP (idiopathic thrombocytopenic purpura) a
s unexpected target for Ig replacement<br>Now used in an increasing variety of a

utoimmune disorders<br><br>Contains the whole human repertoire of antigen-binding

sites<br>Produced from pooled plasma of 10,000 to 60,000 donors<br>Screened, cle
aned, complexes removed<br>Treatment modalities<br>intravenous<br>subcutaneous<b
r>in office or at home<br><br>Ris
s&nbsp;&nbsp;modest compared to immunosuppress
ive drugs or plasma exchange therapy<br> tempting to use for diseases with possib
le immune basis for which we have no good therapy (and which also tend to wax an
d wane)<br><br>Cost is ~ $100 per gram<br><br>Immunosuppressive high dose IVIG =
2 g/
g <br><br>= $14,000 per dose<br><br> Loo
for randomized control trials th
at verify efficacy<br><br><br>
Mar
ed
"Geha Case 10<br><br>9 YO Bill Grignard presents with collapsed lung and chronic
cough<br>Examination: normal weight, height. No tonsils (no history of tonsille
ctomy)<br>Labs: normal WBC; monocytes 10% (elevated)<br>T cell responses to PHA
(phytohemagglutinin), conA (concanavalin A), tetanus toxoid, diphtheria toxoidall normal<br>Serum IgG&nbsp;&nbsp;155mg/dL;&nbsp;&nbsp;undetectable IgM, IgA<br
><br>Healthy until 10 months<br>Pneumonia, recurrent otitis media<br>One instanc
e of erysipelas (Streptococcus infection of lung)<br>At 2Y:&nbsp;&nbsp;IgG 80 mg
/dL, no IgA, 10 mg/dL IgM<br>Started on intramuscular Ig<br>Continued cases of p
neumonia and other infections<br>One brother with&nbsp;&nbsp;multiple pneumonia;
low IgG<br><br>IVIG&nbsp;&nbsp;to maintain level of 600 mg/dL<br>=&gt;rales in
lungs disappeared<br>Finished medical school<br>Self-infuses with 10g IVIG per w
ee
<br><br><img src=""452719e650e77012d5e75bd797528e53.png"" /><br><br><img src=
""ae28e7e64193d40fc9fd5395330c3207.png"" /><br>"
"Pt has&nbsp;&nbsp;X-lin

ed Agammaglobulinemia<br><br><img src=""b846cec27a00760517a399b03004ab57.png""
/>"
Mar
ed
Good reference slide - note he put stars on these things too - so you have to
n
ow what
inds of factors may lead to immunodeficiency <br> <br>List 6 things tha
t may screw up adaptive and innate immunity (or 7 )
"<img src=""38a8be3a489c
6cbcf7c1630662a4110d.png"" />" Mar
ed
List 3 congenital conditions associated with deficits in cellular and homoral im
munity -&nbsp;&nbsp;describe each deficit
"<img src=""b6a84ae202be52fb0663
55cb0d9a1a10.png"" /><br><br>LPR, Lymphoproliferative response to mitogens and a
ntigens<br>note importance of SC"
Mar
ed
List / describe 3 metabolic conditions that are associated with autoimmunity<br>
<br>what cellular and humoral deficits are present?
"<img src=""b7e132b8ece9
45e95df6e7caf70ec127.png"" /><br><br>LPR, Lymphoproliferative response to mitoge
ns and antigens<br><br><br>"
Mar
ed
Poor nutrient inta
e, intestinal malabsorption, and protein losses are all assoc
iated with malnutrition - describe the particular deficit associated with each o
f the mentioned conditions - how does each in turn result in poor immune functio
n?
"<img src=""e6d1b21beab9155cede2672941f6c60b.png"" /><br><br>" Mar
ed
"Reference: <br>Role of vitamin D (VitD) in macrophage activation. <br><img src=
""269767bb64efe5d400911703b13db9c0.png"" /><br>cathelicidins - expressed in inna
te immunity during infection- protects us from infection<br>"
Mar
ed
Name 2 immunosuppressive drugs<br><br> "Glucocorticoids:<br><br><img src=""8430
f9d8f08021db86d76e1732cdc2bf.png"" /><br><br>Cyclosporine<br><img src=""4395be51
6c26698934f48072018139d3.png"" />"
Mar
ed
Descirbe 5 effects of trauma and how they may be involved with transient suscept
ibility to infection
"<img src=""bf030ced8ac242f25e5733e3801cc49c.png"" />"
Mar
ed
List 2 environmental conditions that are associated with deficits in immunity be specific on cellular and humoral levels<br><br>
"<img src=""a604dd98113e
afcd02ec3a4bf2207579.png"" />" Mar
ed
"For reference: <br><br><img src=""424f505224dc4ad7a40670341fe223ba.png"" /><br>
<br><img src=""4deeba3b89693bc5b4c6a9218c8b251f.png"" /><br><br>SPACE MICROGRAVIT
Y MODEL<br><br>Prolonged bed-rest with head-down tilt (6o) mimics certain aspect
s of microgravity: caudal fluid shift and disuse of lower extremities.<br>Female
subjects never experienced this model; French Space Agency required this inform
ation.<br>Need to determine de novo antibody (Ab) and cyto
ine responses in micr
ogravity.<br>Need to examine countermeasures program to correct muscle wasting o
f space flight:
<br>exercise,<br>protein supplement diet.<br><br><br>Huma

n model of microgravity: Exercise countermeasure<br><br><img src=""4802f3e780bf0

8f58a6668fcd9a8ab40.png"" /><br><br><img src=""c476ac61b7aad692fc002bb5af6aa75e.
png"" /><br><br><img src=""af3a2c915476ba5e3177eca796143beb.png"" /><br><br><img
src=""abf57edcddba4dc1858f46d99898383f.png"" /><br><br>"
Ta
e home - <br>
<br>fig 1 - dose at 14; 2nd at 42 days - exercise had better response<br>fig 3 loo
ing at cyto
ines - -exercise
ept il r alpha to be stable rather than incre
ase<br><br>overall - space / microgravity / radiation - bad for the immune syste
m
Mar
ed
Extremes of age - how may young/premature vs. old people have cellular / humoral
immunity deficits?
"<img src=""f3f078c7841ae308050cffe9a77eb745.png"" />"
Mar
ed
INFECTIOUS DISEASE CAUSING SECONDARY IDD: E.G., AIDS<br><br>Who showed the great
est increase in AIDS - what demographic in the world? 1930, INTRODUCED INTO HU
MANS FROM ANIMAL VECTOR (CHIMPANZEE)<br>2009, 38 MILLION INFECTED BY HIV<br>WORL
DWIDE, HETEROSEXUAL DISEASE<br><b>USA, YOUNG WOMEN GREATEST INCREASE ****</b><br
>
Mar
ed
Describe the course of AIDS / HIV infection in the context of:<br><br>CD4 T cell
count<br>plasma viral titer<br>
"<img src=""0c4cffdb9ed8853a65bc31b56a4f
9138.png"" />" Mar
ed
DEGREE OF HIV IMMUNOSUPPRESSION<br>(NO. CD4+ T CELLS/microL)<br><br>Who has more
lymphocytes? (CD4T) a 0-1 year old, 1-5 year old, or 6-12 year old?<br>why?<br><
br>
ADULTS (&gt;18 YR) AND ADOLESCENTS (13-18 YR):<br>
&nbsp;&nbsp;&n
bsp;1:&nbsp;&nbsp; 500;
2: 200-499;&nbsp;&nbsp;&nbsp;&nbsp;3: &lt;200<br><
br>CHILDREN DEPENDS UPON AGE:<br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb
sp;0-1 YR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;1-5 YR&nbsp;&nbsp;&nb
sp;&nbsp;&nbsp;&nbsp;6-12 YR<br>
&nbsp;&nbsp;&nbsp;1: 1500
&nbsp;&n
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 1000
&nbsp;&nbsp;&nbsp; 500<br>
&nb
sp;&nbsp;&nbsp;2: 750-1499&nbsp;&nbsp;&nbsp;&nbsp;500-999&nbsp;&nbsp;&nbsp;&nbsp
;&nbsp;&nbsp;200-499<br>
&nbsp;&nbsp;&nbsp;3: &lt;750
&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;500
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp
;&nbsp;&nbsp;&nbsp;&nbsp;&lt;200<br><br>CD4T cell of 500 is totally OK in adults
, but totally NOT OK in pediatrics<br>CD4 count pretty much predicts the surviva
l of the patient
Mar
ed
HOw do we test for HIV infection? (2 tests must be positive for adults, name the
m?)<br><br>What about in children? (2 tests)<br><br>why cant you measure with an
antibody test in a newborn baby?
child is given the mothers antibody - s
o 100% of babies born to HIV + mothers will have IG against HIV - so you must us
e PCR / Culture<br><br>ADULTS: ENZYME IMMUNOASSAY PLUS WESTERN BLOT<br>CHILDREN:
2 NON-ANTIBODY TESTS (DNA PCR, CULTURE<br>NO CORD BLOOD (FALSE POSITIVE)<br>HIV
POSITIVE 48 HR, 1-2, OR 3-6<br>HIV NEGATIVE - &gt;4 MO<br> Mar
ed
how does HIV virus get into cells?<br><br>what 2 receptors are requisite?
"COGNATE RECOGNITION OF HIV GP 120<br><b>CD4 MOLECULE ( + one of the following (
depending on cell type))</b><br>CHEMOKINE RECEPTOR<br><br><b>MONOCYTE/MACROPHAGE
: CCR5</b><br><b>T-CELLS:&nbsp;&nbsp;CXCR4</b><br><br><br><img src=""6a6a74869ed
75ea71e14d1d8b1e9e143.png"" />" Mar
ed
How may a person be naturally resistant to HIV?<br>immune?<br> MUTATIONS IN CCR
5 - DELTACCR5<br><br>DOUBLE ALLELIC MUTATION- CANNOT INFECT<br><br><br>SINGLE AL
LELIC MUTATION SLOW DISEASE<br>
Mar
ed
"Reference - HIV replication -
eep in mind this is a retrovirus <br> - inserts
self into genome and uses reverse transcriptase <br><br><img src=""06a48323e5569
af8ae081e46967c159d.png"" /><br>"
Mar
ed
"Reference: <br><br>LOSS OF CD4+ T CELLS IN GI TRACT<br><br><img src=""16aecce0a
a8c157ce6b617bad8de9e38.png"" />"
Mar
ed
HIV: <br><br>VIRAL BURDEN:ADULTS VS. CHILDREN<br><br><br>compare adult vs. pediat
ric disease onset <br><br>
PCR TEST HIV RNA: PREDICTS HIV DISEASE PROGRESSI
ON<br><br><b>ADULT INFECTION</b><br>
ACUTE RISE AND FALL BY 3-6 WEEKS<br>
ESTABLISH VIRAL SET POINTS<br><br><b>PEDIATRIC (VERTICAL) INFECTION</b><
br>
HIGH RISE 2-4 WEEKS AFTER BIRTH<br>
RNA REMAINS ELEVATED UP TO
3 YR Mar
ed
THERAPY OF HIV/AIDS<br><br>list 3 classes of drugs used to treat HIV / AIDS

DRUGS AND HIV LIFE CYCLE<br><br> REVERSE TRANSCRIPTASE (RT)<br><b>NUCLEOSIDE RT

INHIBITORS</b><br><b>NON-NUCLEOSIDE RT INHIBITORS</b><br> GLYCOSYLATION PACKAGIN
G OF&nbsp;&nbsp;&nbsp;VIRION<br><b>PROTEASE INHIBITORS</b><br><b>INTEGRASE INHIBI
TORS</b><br> ENTRY INHIBITORS<br>
Mar
ed
What is HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) OF HIV/AIDS?<br /><br />wha
t coc
tails are given? "HAART IS DEFINED AS 3 DRUGS IN AT LEAST 2 OF 3 CLASSES:
<br /><br />NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)<br />NON-NUCLEOSI
DE REVERSETRANSCRIPTASE INHIBITORS (NNRTI)<br />PROTEASE INHIBITORS (PI)<br /><br
/>DRUG RESISTANCE IS UNIVERSAL<br /><br /><img src=""af0e245cfcc937d1ebe8b26cce
c5b6ee.png"" /><br><br><img src=""ede0ce32b14c42370122831f01b196ac.png"" /><br /
>"
Mar
ed
Name several viral sanctuaries in each classification:<br><br>barriers (2)<br>lo
ng lived cells (1)<br><br>Why is chronic HAART necessary (2 reasons)
"BARRIER
S<br>
<b>CNS</b><br><b>
SEMEN</b><br><span style="" font-weight:60
0;""></span><br>LONG-LIVED CELLS<br>
<b>CD4+ T CELL (NON-REPLICATING)</b>
<br><span style="" font-weight:600;""></span><br><b>CHRONIC HAART NECESSARY</b><
br>
HIV RNA UNDETECTABLE<br>
HIV DNA PERSISTS<br>"
Mar
ed
What is IRIS? IMMUNORECONSTITUTION INFLAMMATORY SYNDROME (IRIS)<br><br>IRIS IS
A PARADOXICAL DETERIORATION IN CLINICAL STATUS AFTER STARTING THERAPY--ATTRIBUT
ABLE TO THE REACTIVATION OF THE IMMUNE RESPONSE, (E.G., CYTOKINE STORM) TO AN EX
ISTING LATENT OR SUB-CLINICAL PROCESS, (E.G., INFECTION) THAT CAN RESULT IN SIGN
IFICANT MORBIDITY AND MORTALITY.<br>
Mar
ed
When should therapy for HIV / AIDS begin?
CAN DEFER TREATMENT IN ESTABLISH
ED INFECTION WITH LOW VIRAL BURDEN AND PRESERVED IMMUNE FUNCTION (CD4+ T CELL CO
UNT &gt; 500)<br>TREAT ACUTE INFECTIONS IN ADULTS AND MOST INFANTS AND CHILDREN<
br>
Mar
ed
IMMUNOPROPHYLAXIS, IMMUNOTHERAPY, GENE THERAPY<br><br>Vaccines - list 5
inds<br
><br>immunotherapy&nbsp;&nbsp;- list 2 types
<b>VACCINES</b><br>LIVE, ATTENUA
TED VIRUS<br>INACTIVATED VIRUS<br>SUBUNIT PROTEINS<br>RECOMBINANT LIVE VECTOR<br
>DNA<br><br><b>IMMUNOTHERAPY</b><br>CCR5 MONOCLONAL ANTIBODY<br>CD4 BLOCKER MOLE
CULES<br>
Mar
ed
HIV / AIDS AND ALLERGY <br><br>T/F there is increased IGE levels inversely relat
ed to cd4tcell count?<br><br>is the cyto
ine profile in an hiv / aids pt general
ly TH1 or TH2 favored? INCREASED IgE LEVEL INVERSELY RELATED TO CD4+ T CELL COU
NT<br>IgE LEVEL NOT RELATED TO HISTORY OF ALLERGY<br>DRUG-RELATED SKIN RASHES HI
GH IN AIDS<br>IMMUNE HYPERACTIVATION<br>CYTOKINE PROFILES:&nbsp;&nbsp;TH2 &gt; T
H1<br>SINCE HAART ERA, HYPERSENSITIVITYTO ARV HAS INCREASED<br> Mar
ed
TRIMETHOPRIM-SULFAMETHOXAZOLE HYPERSENSITIVITY IN AIDS<br /><br />COMMON IN PREHAART ERA<br />FREQUENCY OF RASHES<br />1-3% IN HIV-NEGATIVE PATIENTS<br />30-50
% IN HIV-POSITIVE PATIENTS<br />MECHANISMS OF HYPERSENSITIVITY<br />MHC-RESTRICT
ED T CELL CLONES<br />HAPTEN PATHWAY:&nbsp;&nbsp;NITROSO-SMX<br />DESENSITIZATIO
N POSSIBLE<br /><br>Aids pts have an immune system that is totally out of whac
.
<br>immune hyperreactivity - th2 cyto
ines - which favor an allergic condition
Mar
ed
HAART HYPERSENSITIVITY<br><br>MULTI-ORGAN, POTENTIALLY LIFE-THREATENING REACTION
<br>APPEARANCE IS UNRELATED TO DOSE<br>ONSET 9-11 DAYS INTO THERAPY<br>SYMPTOMS
:&nbsp;&nbsp;FEVER, RASH, GASTRO-INTESTINAL, RESPIRATORY DISTRESS, HYPOTENSION,
E.G., ABACAVIR REACTION; MECHANISM UNKNOWN<br>RECHALLENGE RESULTS IN RECURRENCE
OF SYMPTOMS WITH HOURS<br>
Mar
ed
Upon a home visit of Child Protective Services, a 2-year-old boy is found to be
lethargic, irritable, moon-faced with dermatitis and generalized edema.&nbsp;&nb
sp;The child has orange-tinted sparse hair and purulent drainage from both ear c
anals and nostrils with fetid breath.&nbsp;&nbsp;This childs condition is li
ely
based upon:<br>A.
Prematurity<br>B.
Exposure to radon<br>C.
Malnutrition<br>D.
Uremia<br> A.
Prematurity<br>B.
Expos
ure to radon<br><b>C.
Malnutrition</b><br>D.
Uremia<br><br>Protein
-energy malnutrition can result from lac
of proteins, and micronutrients, carbo
hydrates (marasmus), or just protein and micronutrients with a high carbohydrate
diet (Kwashior
or) as in this case (C).&nbsp;&nbsp;Fed an adequate diet prematu
re children exhibit growth catch-up (A).&nbsp;&nbsp;Radon radiation in houses re

mains a controversial subject and the object of numerous law suits (B).&nbsp;&nb
sp;Uremia may produce some of the symptoms of this child, but in the context of
suspected child abuse, uremia would remain a diagnosis of exclusion (D).<br>
Mar
ed
A 56-year-old airline pilot with 30 years of experience begins to suffer from re
peated sinus infections and pneumonia on two occasions 3 months apart.&nbsp;&nbs
p;He complains of being tired and without energy, and his urine tests positive f
or protein.&nbsp;&nbsp;An immunoelectrophoresis of his serum protein reveals a s
harp intense band in the gamma globulin region.&nbsp;&nbsp;The cause of this pil
ots medical condition is most li
ely related to:<br><br>His advancing age<br>Ons
et of diabetes mellitus<br>Reactivation of EBV infection<br>Ultraviolet light an
d radiation<br> His advancing age<br>Onset of diabetes mellitus<br>Reactivation
of EBV infection<br><b>Ultraviolet light and radiation</b><br><br>D;<br><br>airl
ine pilots flying at 30
ft. for prolonged period are thought to have much great
er absorption of UV light and radiation and are more susceptible to immunosuppre
ssion and resulting conditions; such as multiple melanoma w/ development of mono
clonal igg antibody. age related immunosuppression usually appears in the sevent
h decade of life and greater. monoclonal gammapathies usually do not appear in d
iabetes mellitus. reactivation of ebv infection is a possible cause, but usually
occurs in post-transplant and immunosuppressive drug conditions.
Mar
ed
A 20 year-old HIV-infected woman being treated for the last year with HAART deve
loped pulmonary lymphoid hyperplasia due to Pneumocystis jirovecii (bronchoalveo
lar lavage). Ten days into treatment of the pneumonia with trimethoprim-sulfamet
hoxazole, the patient developed a generalized rash without peeling or mucous mem
brane involvement. This rash is best explained by:<br><br>Immunoreconstitution i
nflammatory syndrome (IRIS)<br>IgE-mediated allergy to one of the antiretroviral
agents<br>IgE-mediated allergy to sulfamethoxazole<br>Cytotoxic T cells (Steven
s-Johnson Syndrome) <br>
Immunoreconstitution inflammatory syndrome (IRIS
)<br>IgE-mediated allergy to one of the antiretroviral agents<br><b>IgE-mediated
allergy to sulfamethoxazole</b><br>Cytotoxic T cells (Stevens-Johnson Syndrome)
<br><br>C<br><br>drug rashes due to exposure to sulfa medications occur in up t
o 50% of hiv infected pts. iris reactions occurs after starting HAART, not antib
iotics. allergy to antiretroviral agents would be an unusual possibility in pati
ents on stable therapy. cytotoxic t cells causing the s
in rash would be an unus
ual mechanism in the absence of s
in desquamation and mucous membrane involvemen
t
Mar
ed
A 20-year-old soldier receives a shrapnel wound of his abdomen that requires pro
longed abdominal surgery to remove fragments.&nbsp;&nbsp;His post-operative cour
se is difficult with many wound infections and re-operations at the military med
ical center.&nbsp;&nbsp;These repeated abdominal infections are most li
ely due
to:<br><br>A.
Disruption of blood and lymph flow<br>B.
Malnutritio
n: protein and micronutrients<br>C.
Cyto
ine storm from trauma shoc
and
surgery <br>D.
Involution of the thymus from repeated stress<br> <br><b>A
.
Disruption of blood and lymph flow</b><br>B.
Malnutrition: prote
in and micronutrients<br>C.
Cyto
ine storm from trauma shoc
and surgery
<br>D.
Involution of the thymus from repeated stress<br><br>A. extensive
trauma and surgical repair almost always disrupts normal blood and lymph flow du
e to interruption of vascular supply and drainage of gissues. thus favoring over
growth of bacterail pathogens. malnutrition is not usually a problem with soldie
rs in warfare. activation of cyto
ine pathways would be expected in acute abdomi
nal infection. although the stress of wounding / surgical repair, etc. the thymu
s will remain active until at least 30 yrs of age and possibly beyond. <br><br>
Mar
ed
A 15-year-old adolescent male suffers from repeated upper and lower respiratory
tract infections that cultures show to be due to pneumococcal organisms.&nbsp;&n
bsp;The onset of these infections was coincident with a gradual enlargement of h
is spleen beginning at 1-year-of-age.&nbsp;&nbsp;He does not respond with antibo
dy production after immunization with pneumococcal antigens.&nbsp;&nbsp;Which co
ndition does this patient have?<br><br>Down syndrome<br>Turner syndrome<br>Sic
l
e cell disease<br>Cystic fibrosis <br> Down syndrome<br>Turner syndrome<br><b>S

ic
le cell disease</b><br>Cystic fibrosis <br><br>microinfarction of the spleen
due to sludging of misshapen rbcs leads to autosplenectomy in sic
le cell with i
nability of the spleen to produce antibodies. particularly pneumococcal antibodi
es. the other conditions are not associated w/ autosplenectomy. Mar
ed
The clinical importance of chemo
ines and HIV infection is documented by: <br>A.
32 single-allele mutant CCR5 receptors are observed in long-term survivor
s. <br>B.
CCR5 binds to gp120 of T-cell trophic virus.<br>C.
CXCR4
binds to gp120 of macrophage-trophic virus<br>D.
32 double-allele mutant
CCR5 receptors accelerate the progress of HIV disease<br>
<b>A.
32 s
ingle-allele mutant CCR5 receptors are observed in long-term survivors. </b><br>
B.
CCR5 binds to gp120 of T-cell trophic virus.<br>C.
CXCR4 binds
to gp120 of macrophage-trophic virus<br>D.
32 double-allele mutant CCR5 re
ceptors accelerate the progress of HIV disease<br><br>CCR5 binds to monocyte tro
phic virus<br>CXCR4 binds to T-cell trophic HIV<br>32 double-allele mutant inhib
its HIV infection
Mar
ed
A five wee
-old girl born to an HIV-infected mother presented with nodular pulmo
nary infiltrates, failure-to-thrive and wasting. The infants WBC was 33,400, CD4+
T cell count 5,647, CD8+ T cell count 1,686 cells/uL; serum IgG was 714, IgA 34
and IgM 71 mg/dL; and the HIV DNA PCR test was negative.&nbsp;&nbsp;Fine needle
biopsy of the lung showed a granuloma with branching fungal elements.&nbsp;&nbs
p;Which additional laboratory test on the baby would be most li
ely to lead to t
he correct diagnosis?<br><br>HIV ELISA/Western blot test<br>Serum complement fun
ction (CH50 assay)<br>Lymphoproliferation to fungal antigens<br>Neutrophil funct
ion assay <br> <br>HIV ELISA/Western blot test<br>Serum complement function (CH
50 assay)<br>Lymphoproliferation to fungal antigens<br><b>Neutrophil function as
say </b><br><br>D; <br><br>none of the childs lab tests indicate that she has H
IV. the biopsy result showing a granuloma and the wbc count being greatly elevat
ed suggested a WBC defect. the elisa / Western blot test would be positive, but
maternal antibody would confound a diagnosis on the baby. serum complement and f
ungal stimulation test would not yield a specific diagnosis.<br><br>
Mar
ed
Seven of 61 HIV-infected children treated with HAART developed cutaneous herpes
zoster (HZ). All 7 children had a history of previous varicella infection; had l
ower baseline CD4+ and CD8+ T cell counts than those children who did not develo
p HZ; and had a significant rise in CD4+ T cells and significant decrease in HIV
viral RNA levels.&nbsp;&nbsp;Children with HZ had lower varicella protective an
tibodies than those who did not have this complication.&nbsp;&nbsp;What is the m
ost li
ely cause of the development of herpes zoster in these children?<br> <br>
A.
Immunoreconstitution inflammatory syndrome<br>B.
Primary herpes
simplex infection <br>C.
Immune complex disease <br>D.
Type IV hy
persensitivity reaction <br>
<br><b>A.
Immunoreconstitution inflammat
ory syndrome</b><br>B.
Primary herpes simplex infection <br>C.
Imm
une complex disease <br>D.
Type IV hypersensitivity reaction <br><br>alth
ough not often observed in children, iris is li
ely the result of a rapid recons
titution of immunity and rapid hiv depletion due to HAART leading to reactivatio
n of latent herpes viral infection. although these children w/ iris had lower ba
seline anti-herpes antibody levels, they all had evidence of previous herpes inf
ection. immune complexes might participate in this disorder, but cellular cd4tce
ll reconstitution is the
ey immune event. a type IV hypersensitivity reaction m
ay play a role in this disorder, but the reactivation of a latent viral infectio
n is more li
ely due to a sudden change in immune balance of the patient.
Mar
ed
A childless professional couple adopts a 6-month old child from a mid-developed
country.&nbsp;&nbsp;Within a month the infant develops respiratory distress, fev
er, lymph-adenopathy, and hepatosplenomegaly.&nbsp;&nbsp;Serological tests for C
MV and EBV are negative but that for HIV is positive (confirmed in a second test
). The birth mothers HIV test was said to be negative at the time of delivery.&
nbsp;&nbsp;What would be the correct action?<br>Test the mother for HIV infectio
n<br>Perform a third HIV immunoassay on the child at 12 months of age<br>Test th
e child for CD4+ cell percent and number<br>Perform a non-antibody HIV test on t
he infant <br> "Test the mother for HIV infection<br>Perform a third HIV immuno

assay on the child at 12 months of age<br>Test the child for CD4+ cell percent a
nd number<br><b>Perform a non-antibody HIV test on the infant </b><br><span styl
e="" font-weight:600;""></span><br><b>D </b><br><br>a non-antibody test would yi
eld a definitive answer. searching for the mother would ta
e too much time w/ a
symptomatic infant requiring therapy; a third immunoassay would ta
e too long si
nce maternal antibodies can ta
e 12 mos or more to be eliminated from the child
. the cd4tcell assay would reveal if immunosuppression were present, but would n
ot be diagnostic. "
Mar
ed
The elevated serum IgE levels seen in patients with HIV infection are correlated
with?<br>A.
Immediate hypersensitivity s
in test reactivity<br>B.
HIV disease progression<br>C.
History of allergy<br>D.
TH1 &gt; T
H2 cyto
ine profile <br>
"A.
Immediate hypersensitivity s
in test
reactivity<br><b>B.
HIV disease progression</b><br>C.
History of a
llergy<br>D.
TH1 &gt; TH2 cyto
ine profile <br><span style="" font-weight
:600;""></span><br>elevated ige levels in hiv are thought bo be the result of lo
ss of t cell regulation of igE synthesis with disease progression.<br>studies ha
ve shown no correlation with allergy s
in test reactivity<br>a history of allerg
y in the pt. does not explain the increased levels of ige<br>there is a deregula
ted cyto
ine profile in pts. w/ hiv infection, but it is in the reverse directio
n - TH2&gt;TH1 cyto
ine profile<br><span style="" font-weight:600;""></span><br>
"
Mar
ed
What is graves disease?<br>what is hashimotos lymphocytic thyroiditis (and wha
t is its prevalence?)<br><br>what occurs in hashimotos ? what abs are generated
?<br><br>what else is associated?<br><br>what is postpartum thyroiditis?<br><br>
<b>Graves&nbsp;&nbsp;disease: agonistic antibody</b><br><br><br>Hashimotos lymphoc
ytic thyroiditis<br><b>3-4% prevalence. </b><br><b>antibodies against thyroglobu
lin and thyroid peroxidase (TPO) --&gt;bloc
production of thyroid hormone--&gt;
HYPOthryodism</b><br>--&gt;inflammation, might also have CTL-mediated destructio
n.<br><br><br><b>postpartum thyroiditis</b><br>5-8% incidence within 6 mo. postpartum<br>complement-fixing anti-TPO antibodies<br>
Mar
ed
"Reference - normal thyroid <br><br>thyroid epithelial cells (thyrocytes) surrou
nd the follicles.&nbsp;&nbsp;In primitive chordates (sea lampreys) and protochor
dates (tunicates) the thyroid follicles collect into ducts and empty into the gu
t; the thyroid in these organisms is an exocrine organ.&nbsp;&nbsp;In jawed vert
ebrates the thyroid is endocrine; the follicles are closed and serve as temporar
y storage areas for the protienaceous colloid [colloid =any substance in which two
constituents are dispersed within each other:emulsions; aerosols; gels; in desc
riptive biology, typically a mixture of proteins. &lt;Gree

olla = glue and eid
es = form] which contains chiefly thyroglobulin and its processing enzyme TPO. B
asal to the thyrocytes are found calcitonin-producing parafollicular cells, and
the endothelial cells of lymphatic vessels that run as an interconnected plexus
throughout the thyroid gland and its capsule.&nbsp;&nbsp;&nbsp;<br>follicle &lt;
Latin&nbsp;&nbsp;folliculus little bag<br>Not shown here are the circulatory&nbsp;
&nbsp;vessels. <br><br><img src=""3e13671859c0b63247d87dd4e1332aa3.png"" />"
Mar
ed
"thyroid gland - reference<br><br>""the lymphatic vessels run in the interlobula
r connective tissue, not uncommonly surrounding the arteries which they accompan
y,&nbsp;&nbsp;and communicate with a networ
in the capsule of the gland; they m
ay contain colloidal material Grays 28th p1342<br><br><img src=""d33cd8b80c3365350
f74e9d2f8c24795.png"" />"
Mar
ed
"Reference:<br /><br />Here we see the normal follicles; at the interstices ther
e are small lymphatics containing a few lymphocytes and colloid. <br /><br /><img
src=""95dac1abd88b6ad0676c017205261043.png"" /><br><br>In Hashimotos lymphoiditis
,&nbsp;&nbsp;the follicles are hard to find and have been infiltrated by lymphoc
ytes; the lymphatics are enlarged, expanding the size of the thyroid to generate
the goiter.&nbsp;&nbsp;Within the lymphatics germinal centers can form, allowin
g proliferation especially of B cells.&nbsp;&nbsp;Most of the antibodies produce
d are IgG.<br> <img src=""49774208c8a74edae40a755ec7a1f69b.png"" />"
Hashimotos thyroiditis<br><br>What
ind of hypersensitivity reaction?<br>Type I?<
br>Type II?<br>Type III?<br>Type IV?<br>Something else<br>
What
ind of hyp

ersensitivity reaction?<br>Type I?<br>Type II?<br>Type III?<br><b>Type IV?</b><b

r>Something else<br><br>justification: hallmar
of type IV - mediated by T cells
. - there are tons of T cells in the thyroid <br>li
ely a mixture of type II and
type IV - you can transfer t cells <b>or </b>serum to recapitulate the disease<
br><br>Mediated acutely by T cells<br>Inflammatory cyto
ines<br>Cytotoxic T cell
s (CTL) <br>Delayed-type hypersensitivity<br>Usually 24-48 hrs between s
in expos
ure and s
in reaction = time for T cells to accumulate and mediate acute reactio
n.<br>Compare Arthus reaction of Type III - ~8-12 hours for complexes to form in
situ <br><br>poison ivy is a good example of type IV Mar
ed
type IV hypersensitivity<br><br>who mediates it?<br><br>what is it called, what
is the timing of onset? <b>Mediated acutely by T cells</b><br>Inflammatory cyto

ines<br>Cytotoxic T cells (CTL) <br><br>Delayed-type hypersensitivity<br>Usually

24-48 hrs between s
in exposure and s
in reaction = time for T cells to accumula
te and mediate acute reaction.<br><br>Compare Arthus reaction of Type III - ~8-1
2 hours for complexes to form in situ <br>
What is an antigen?<br><br>what molecule may it be?<br><br>what is the max size?
<br>what is the min size?
Antigens an macromolecular structure that can be
bound by the antigen-binding site of antigen receptors.<br>Antigens may be: prote
ins, sugars, lipids, steroids, etc.<br>Epitope the chemical substructure that fo
rms (non-covalent) bonds with the antigen receptor.<br><br>Maximum size of an ep
itope limited by the size of the antigen binding site of the variable region<br>
~6 amino acids<br>~6 hexoses<br><br>Smallest approx 1 hexose / 1 amino acid <br>
Mar
ed
Blood antigens - what are the carbohydrate blood antigens?<br><br>what is the pr
otein antigen?<br><br>who recognizes each respective antigen? <b>Carbohydrate
antigens</b><br>If polyvalent can activate B cells without T cell help (T-indepen
dent antigens)<br>Recognized by IgM<br>ABO blood group <br>O is universal donor<br>
AB is universal acceptor<br><br><b>Protein antigens </b><br>T-dependent<br>T cells
induce class swithcing <br>Recognized by IgG<br>Example Rh (Rhesus factor) <br>
<br><br>A/B blood groups are sugar antigens<br>RH factor is a protein antigen<br
><br>Factor I is a sugar antigen<br><br>Sugar antigens are recognized by IgM the
y are Tcell independent <br>
Mar
ed
"ABO blood antigens - <br><br>What does A enzyme manufacture?<br>what will an ""
A"" blood type individual have antibodies against?<br><br>Compare i/I antigen"
Humans are polymorphic for enzymes that modify sugar molecules found on most tis
sues.<br>A enzyme --&gt;A antigen<br>B enzyme--&gt;B antigen<br>O/O homozyogte i
s null --&gt; neither A nor B.<br>A/B heterozygote --&gt;both A and B antigens<b
r>These sugars resemble sugars found in common enteric bacteria<br><b>We ma
e na
tural IgM antibodies against the enteric antigens </b><br><br><br><br>Compare i/
I antigen<br><br>i/I - he didnt tal
about it...
Mar
ed
"predict yes or no on agglutination<br><br><img src=""beeb88e8d6b3195154adfe3671
99e60e.png"" />"
"<img src=""7d863efb50cfbc34a641649d0ffbbdac.png"" /><br
><br>In blood transfusions donor antibody is usually ta
en out. <br>Also even if
it is a blood to blood transfusion the anti a / anti b antibodies that may be p
resent in the donors serum are usually at a low enough concentration that it is n
ot a problem. <br>"
Mar
ed
Who is the universal donor?<br>who is the universal acceptor? Old school<br>O n
egative is universal donor<br>AB positive is universal acceptor<br><br>But there is o
ther antigenic variation as well (ie RH)<br>Best practice:<br> pac
ed cells, not
blood. <br>Test for compatibility before use<br>
Mar
ed
Transfuse O&nbsp;&nbsp;blood into a B patient: what happens?<br><br>A.&nbsp;&nbs
p;Anti-B antibodies in O&nbsp;&nbsp;attac
patients B antigens acute vascular colla
pse<br>B. B antigens in patient&nbsp;&nbsp;tissues absorb out and neutralize ant
i-B antibodies in donor blood.&nbsp;&nbsp;<br>C. Anti-B antibodies in O blood at
tac
B antigens on B RBC lysis of B RBC<br>D. Anti-A antibodies in recipient attac

donor RBC, which cant absorb them. <br>E. Anti-A antibodies in recipient cant bi
nd to donor RBC, so there is no reaction<br>
A.&nbsp;&nbsp;Anti-B antibodies
in O&nbsp;&nbsp;attac
patients B antigens acute vascular collapse<br>B. B antigens
in patient&nbsp;&nbsp;tissues absorb out and neutralize anti-B antibodies in do
nor blood.&nbsp;&nbsp;<br>C. Anti-B antibodies in O blood attac
B antigens on B

RBC lysis of B RBC<br>D. Anti-A antibodies in recipient attac

donor RBC, which c
ant absorb them. <br><b>E. Anti-A antibodies in recipient cant bind to donor RBC,
so there is no reaction</b><br><br>note that you are transferring blood only - n
ot serum
Mar
ed
What is RH antigen?<br><br>why would an individual be exposed to RH if they are
RH negative? will they mount a response?<br><br>what two conditions are associat
ed?<br><br>how may these conditions be prevented?
"Rh (Rhesus antigen): pr
otein (ion channel on RBC) <br>antigen D ; 15% of pop. is Rh-negative.<br><br><b>Pat
hogenesis:</b><br>Rh-negative mothers exposed to Rh+ fetus, especially during bi
rth --&gt; develop anti-Rh IgG Anti-Rh <br>antibodies are transferred via FcRn t
o subsequent fetus, attac
an Rh+ fetus.<br><b> --&gt; Hemolytic disease of the
newborn (HDN)</b><br><b>Hydrops fetalis (edema): fetal anemia; heart failure;&nb
sp;&nbsp;--&gt;death</b><br><span style="" font-weight:600;""></span><br>Tx: Tre
at 1st time mothers with RhoGam <br>passive immunity bloc
s active immunity<br><br
>IM injection of IgG anti-Rh&nbsp;&nbsp;<br>26 wee
s of pregnancy &amp; within 7
2 hours of birth<br>Coats/lyses fetal cells in maternal circulation- bloc
s immu
ne response<br>"
Mar
ed
"Geha Case 45 <br /><br /> Cynthia Waymarsh, 31 YO, Rh-negative. Husband is Rh+<
br />1st child is a healthy boy<br />2nd pregnancy: positive indirect Coombs 1:1
6 dilution<br />Health baby girl induced at 36 wee
s<br />5 years later: 3rd pre
gnancy<br />14 w
indirect Coombs test titer at 1:8<br />18 wee
s: 1:16&nbsp;&nb
sp;(ris
of hydrops fetalis = 10%<br /><br />Ris
is 75% of titer is 1:128.<br /
><br />Ris
s<br /><br />Hydrops fetalis<br />Titer 1:16&nbsp;&nbsp;10% ris
of h
ydrops<br />Titer 1:128&nbsp;&nbsp;75%&nbsp;&nbsp;ris
of hydrops fetalis<br />L
ess severe ris
s:<br /> brain damage from hyperbilirubinemia<br />Life-threateni
ng anemia<br />Treatments<br />Fluorescent irradiation of jaundiced infants<br /
>Intrauterine or post-partum transfusion<br /><br />Amniotic fluid from 22-29 we
e
s contains increasing bilirubin.<br />Induced labor at 34.5 w
s : healthy baby
girl<br /><br /><img src=""3e425591184b682fe2fc8dc8646c21ff.png"" /><br /><br /
>"
"Hemolytic Disease of the Newborn treatment&nbsp;&nbsp;&amp; diagnosis<br
><br>All Rh-negative women are given RhoGam (anti-Rh antigen antibodies) at 28 w

s gestation and within&nbsp;&nbsp;72 hours of birth<br />One vial of RhoGam has

300 ug of antibody, enough to neutralize 30 ml of fetal serum in maternal blood
.&nbsp;&nbsp;<br />0.1% failure rate<br /><br />Rhogam neutralizes fetal antigen
s insitu and thus prevents an immune response by the mother (a passive immunizat
ion) <br /><br />Direct Coombs test&nbsp;&nbsp;a
a Direct Antibody Test: are the
RBC coated with C3 or antibody to start with?&nbsp;&nbsp;<br />Indirect :&nbsp;
&nbsp;does the serum contain antibodies that could react with the test RBC?<br /
><br /><br /><img src=""c278fa9015f22868f40dc8002870738b.png"" /><br /><br /><im
g src=""c903b870cfb7f1939321561ef474b068.png"" /><br /><br /><img src=""0d9156ce
45c3e002979a563eea1e0acd.png"" /><br /><br /> A rosette of Rh+ RBC.&nbsp;&nbsp;Th
ese are coated with anti-Rh antibodies, which adhere to the Fc receptors on a ma
crophage (central cell).&nbsp;&nbsp;The macrophage is pitting the red blood cell
s and destroying them.-Geha and Rosen<br />" Mar
ed
Describe an endpoint coombs test.<br><br>what is the endpoint titer defined as?
"End-point titer is the highest dilution that yields a perceptible positive resu
lt<br>Useful for<br>virus titers<br>neutralizing Ab titers<br>Coombs assay, etc<
br><br>Note: Direct Coombs Test a
a<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp
;&nbsp;Direct antibody Test (DAT)<br><br><img src=""69095c642d47679f7b5462b150cf
9dbc.png"" /><br><br>" Mar
ed
"Review&nbsp;&nbsp;/ Reference: <br><br><img src=""8035a9d5c5bbbf4d4b2f416c13a22
24b.png"" />"
Mar
ed
Antibody/Antigen interactions<br><br>name and describe 3
"<img src=""5676
697734069d568f127f2d272a7e22.png"" />" Mar
ed
"Reference:<br><br><i>Igg </i><br><span style="" font-style:italic;""></span><br
><img src=""6f092cc6f6c162d5c47202189ba9a6b1.png"" />"
Mar
ed
Where are hypervariable regions located on immunoglobulin?<br><br>what are CDRs?
<br><br>how many CDRs are required to determine specificity?
"Hypervariable r
egions lie in loops of Ag-binding <br><br>Hypervariable regions (HVs) = compleme
ntarity-determining regions (CDRs).<br><br>The variability is in the loops.<br><

br>Framewor
regions (FRs) are the conserved beta-sheets.<br><br>6 CDRs determin
e the specificity<br><br><img src=""35a003b28f3eef3a13eb1ffd0578d9ff.png"" />"
Mar
ed
Variable region genes are constructed from gene segments:<br><br>outline the pat
h from germline DNA to a functional polypeptide chain. there are 5 steps - list
them<br><br>what 4&nbsp;&nbsp;DNA segments are requisite for the light chain?<br
>what 5 dna segments are requisite for the heavy chain? "Events<br><br>- on left
of diagram; <br><br>for light chain - LVJC<br>for heavy LV<b>D</b>JC<br><br><im
g src=""1e99a20b93434a4f7955e295f7e28037.png"" />"
Mar
ed
Somatic recombination <br><br>describe the sequence that flan
s each V/D/J fragm
ent<br><br>what is the purpose of these segments (ie what do they prevent)?<br><
br>What are rag 1 and rag 2?<br><br>How may exonucleases contribute to junctiona
l diversity?
"V, D, J fragments are flan
ed by recombination signal sequences
(RSS) containing a heptamer and a nonamer separated by one (12 bp) or two (23 b
p) helical turns. <br><br>12/23 rule: Fragments flan
ed by 12 bp spacer RSSs can
only pair with fragments flan
ed by 23 bp spacer RSSs and visa-versa.<br><br>Th
us, VH segments only pair with DH segments that only pair with JH segments.<br><
br><br><img src=""3ddc90bd7f4384844745c77477a8799a.png"" /><br><br>12/23 rule ma

es sure that V and J are never adjacent because D is in the middle <br><br><br>
<br>The recombination activating genes encode enzymes that play an important rol
e in the rearrangement and recombination of the genes of immunoglobulin and T ce
ll receptor molecules during the process of VDJ recombination. There are two rec
ombination activating gene products
nown as RAG-1 and RAG-2, whose cellular exp
ression is restricted to lymphocytes during their developmental stages. RAG-1 an
d RAG-2 are essential to the generation of mature B and T lymphocytes, two cell
types that are crucial components of the adaptive immune system.<br><br>While th
e DNA is cut it can be randomly extended or chewed bac
which adds to junctional
diversity. If it rejoins out of frame, the b cell will apoptose due to its faul
ty gene. However, about 1/6th of the time it is successful and adds significantl
y to ab diversity<br>" Mar
ed
"Reference - gist is that out of frame will screw up the wor
s, but triplet dele
tions are o
.<br><br><img src=""556f761322dd813a1a97f2f72f68ec0f.png"" />"
Mar
ed
Define and explain the concept of allelic exclusion<br><br>
One B cell: one
Ig rule:<br><br>Allelic exclusion: only one chromosome each&nbsp;&nbsp;expresses a
n active Immunoglobulin light chain and heavy chain gene<br>Each B cell ma
es on
ly a single
ind of light chain and a single
ind of heavy chain<br>All of the a
ntibodies produced by any one B cell are all ali
e in terms of their antigen-spe
cificity<br>
Mar
ed
"Reference with a question:<br /><br /> Diversity Generated by V(D)J Recombinati
on and H-/L-chain pairing<br /><br /><img src=""f101894d6e96237ae77306ef6f5590e1
.png"" /><br /><br /><img src=""2a85379e6c716689cf6dc07f8b75e41b.png"" />"
Extra diversity <br /><br />junctional complex - exonuclease activity <br />soma
tic hypermutation ((Affects both heavy and light chain<br>Ta
es place in germina
l center<br>AID introduces random mutations chiefly in 5 end of gene, thus affect
ing the variable region<br>Affinity can go up or down<br>Specificity can change.
))<br />VDJC recombination (from above)
Mar
ed
Brief overview - how are monoclonal antibodies made? (4-5 steps)
Fusion p
artner: TK-negative B cell tumor line lac
ing endogenous Ig expression (immortal
ized myeloma cell)<br><br>Immunized B cells<br><br>Fusion=&gt;hybridoma.<br><br>
Grow as ascites tumor or cultured cell line<br><br>Selection and expansion<br><b
r>(Humanization)<br>
Mar
ed
"Genomic organization of Ig chains<br><br>(just
now relative order;
now lambda
/
appa / heavy chains are different loci) <br><br><img src=""495e3487e600234d8
4952ff445d3aac6.png"" />"
Mar
ed
Igm and igd may be simultaneously expressed <br><br>Why isnt this prevented by
allelic exclusion?
allelic exclusion is a genomic event; alternative splici
ng is a postranscriptional event. the two are compatible with one another.<br><b
r>note that this is also why a b cell can manufacture membrane bound as well as
secretory antibodies simultaneously.
Mar
ed

"Reference: <br><br>stages of b cell maturation / differentiation<br><br><img sr

c=""662c8bb4cfcf301001d0ef51f577fda3.png"" />"
Mar
ed
"7-1 phases of immune response<br /><br />This slide is REVIEW and OVERVIEW<br /
>Somatic hypermutation occurs in germinal centers process that aids in driving a
ffinity maturation <br /><br /><br /><img src=""df9acb9647cf2f0205be37b579280234
.png"" />"
Mar
ed
"Mostly review<br><br>7-3 1o&nbsp;&nbsp;&amp; 2o responses<br><br><img src=""69a
56ba11f0c7d0da42cdacb6682c0e9.png"" />"
Mar
ed
The Germinal Center Reaction<br><br>What two cells are interacting here?<br><br>
when b cells are activated - what are 3 events that will occur? "The Germinal Ce
nter Reaction<br><br>T and B cells interact in germinal centers in the spleen or
lymph nodes or mucosal equivalents<br>T cells help B cells and B cells help T c
ells<br>Proliferation of T cells and&nbsp;&nbsp;B cells causing enlargement of n
odes&nbsp;&nbsp;(clonal expansion)<br><b>B cells secrete antibody</b><br><b>B ce
lls switch isotypes</b><br><b>B cells undergo affinity maturation</b><br><span s
tyle="" font-weight:600;""></span>"
Mar
ed
Initiation of B cell activation<br /><br />List 3 ways B cells may be activated
by an antigen<br /><br />for adaptive responses - what cell is mediating the pre
sentation, and what receptors / ligands are important for the interaction?
<b>Cross-lin
ing Ig </b><br /> soluble antigen<br />Antigen presented by Follicu
lar Dendritic CellsCo-stimulation via CD19/CD21<br />CD21 = CR2 binds C3d fragme
nt of complement, attached to microbes. <br /><br /><b>Co-stimulation via CD40L
on Th cells</b><br />Some co-stimulation from C4b receptor on FDC. <br /><br /><
b>Innate activation via TLR</b><br /> Mar
ed
How may complement activate a B cell? "C3d can bind the CR2 receptor on B cell
s; the antigen bound to C3d must also interact with the ig on the surface of the
bcell for activation <br><br><img src=""3c80daa04fc79eba0ae3cb559c89444a.png""
/>"
Mar
ed
How does a T cell activate a B cell?<br><br>What ligands are important for this
interaction?
"<img src=""d25ea2ad45986f1caeb6db88060788d6.png"" /><br><br><im
g src=""fe678e66f690b7a5247a379cba081480.png"" />"
What is somatic hypermuation?<br><br>what enzyme is important?<br><br>whats goi
ng on? "Affects both heavy and light chain<br>Ta
es place in germinal center<br
><b>AID introduces random mutations chiefly in 5 end of gene, thus affecting the
variable region</b><br>Affinity can go up or down<br>Specificity can change. <br
><br>Activation-Induced (Cytidine) Deaminase (AID) is a 24
Da enzyme that creat
es deliberate mutations in DNA.<br><br>7-12 Somatic hypermutation (SHM)<br><br><
img src=""1dd08c67659fd6d759e573047ae477aa.png"" />"
Mar
ed
What is affinity maturation?<br><br>what drives this process? (2 processes are i
mportant)
"Higher affinity binding sites, created by VDJ or somatic hyperm
utation, compete for ever-decreasing quantities of antigen. <br>B cells that can
not compete undergo apoptosis. <br>Thus, average affinity increases with time.<b
r><br><img src=""7607dffb86cfc51ebecebf6f20083e4a.png"" />"
Mar
ed
"What is a thymus dependent antigen (and an example)<br>what is a thymus indepen
dent antigen and an example<br><br>actually, just fill in this chart.<br><br><im
g src=""a61ee6a11ac59233f971e881b035f77a.png"" />"
"<img src=""1b7ffa5780fb
d12d68ee858309656058.png"" />" Mar
ed
"Geha Case 13<br /><br />Mrs. Johnson, 40 YO, referred after lifetime of recurre
nt respiratory and GI infections<br />Otitis, sinusitis, tonsilitis, diarrhea, G
I infections<br />Hospitalized at 39 YO with Giardia infection <br />At 25- thyr
oid insufficiency<br />Exam: <br />Enlarged spleen
<br /><br />Ig levels<
br />IgM 18 mg/dl vs 100-200<br />IgG&nbsp;&nbsp;260&nbsp;&nbsp;vs&nbsp;&nbsp;60
0-1000<br />IgA 24&nbsp;&nbsp;&nbsp;&nbsp;vs 60-200<br />No antibodies detected
for vaccines<br />Normal B and T cell levels<br />Autoantibodies<br /> Zero ANA
(anti-nuclear antibodies) or rheumatoid factor<br />High levels of anti-thyroid
antibodies<br /><br /><span style=""color:#000000;"">[</span><span style=""color
:#ffffff;"">CVID igg is less than half normal that is the definition for diagnos
is of CVID</span><span style=""color:#000000;"">]</span><br /><br /><span style=
""color:#000000;"">Ig levels</span><br /><span style=""color:#000000;"">IgM 18 m
g/dl vs 100-200</span><br /><span style=""color:#000000;"">IgG&nbsp;&nbsp;260&nb

sp;&nbsp;vs&nbsp;&nbsp;600-1000</span><br /><span style=""color:#000000;"">IgA 2

4&nbsp;&nbsp;&nbsp;&nbsp;vs 60-200</span><br /><span style=""color:#000000;"">No
antibodies detected for vaccines</span><br /><span style=""color:#000000;"">Nor
mal B and T cell levels</span><br /><span style=""color:#000000;"">Autoantibodie
s</span><br /><span style=""color:#000000;""> Zero ANA (anti-nuclear antibodies)
or rheumatoid factor</span><br /><span style=""color:#000000;"">High levels of
anti-thyroid antibodies</span><br /><br /><span style=""color:#000000;""> Twin s
ister and mother dead</span><br /><span style=""color:#000000;"">Hypogammaglobul
inemia </span><br /><span style=""color:#000000;"">Sister had recurrent viral an
d bacteria infectiosn</span><br /><span style=""color:#000000;"">Hemolytic anemi
a</span><br /><span style=""color:#000000;"">Granulomatous vasculitis</span><br
/><span style=""color:#000000;"">Died 31 YO from GI cancer</span><br /><span sty
le=""color:#000000;"">Mother died from non-Hodg
ins lymphoma</span><br /><span st
yle=""color:#000000;"">Brother has CVID.</span><br /><br /><br />"
"Diagnos
is with CVID<br />Placed on IVIG&nbsp;&nbsp;&nbsp;35 grams q 2 w
s<br />Heterozy
igous with a mutation in one TACI allele (TACI is a B cell-activating protein, a
member of the TNF f mily f r
eins)<br /><br />CVID ~ 300X&nbs;&nbs;risk f
lymhm <br />50X risk f GI c rcinm <br />TACI- 10% f c ses<br />Why is
here
hen
ye when
he 
ien
is he
erzygus?<br /><br />He
erzygus
he mu


ed llele c n isn
he
rimer
h
TACI ssembles
 fr
he w
frm. s he
er
zygus disl ys dise se hen
ye. <br /><br /><img src=""c469fef08d9b2e7933c7d
942219881 .ng"" /><br /><br /><img src=""1 631578c8ff33b1 26 458276641536.ng"
" /><br /><br /><img src=""d19e1727c5982490d80ffc81213570e2.ng"" />" M rked
Where re
he v s
m jri
y f lymhcy
es lc
ed (ie wh
cm r
men
?)<br><br
>Wh
is CD3 cmmn m rker fr?<br><br>CD4?<br>CD8?<br>CD56?<br>CD19? "<b>Ever
y cell
h
exresses CD3 is c lled T cell</b><br>98% f lymhcy
es re in
i
ssue s ce, n
bld.<br>Nrm l levels in bld<br>Lymhcy
es&nbs;&nbs;
Child
dul
<br>B
6-41%
5-15%<b
r><b>CD3+
(T)</b>
53-84%
75-85%<br><b>CD4
(TH)</b>
32-64%
27-53%<br><b>CD8
(TC)</b>
12-30%
13-23%
<br><b>CD56
(NK)</b>
3-18%
5-15%<br><b>CD 19 is usu lly use
d fr B cell m rker</b><br><s n s
yle="" fn
-weigh
:600;""></s n><br>Nrm lly
2:1 CD4:CD8 (inversin f r
i susec
vir l infec
in)<br>CD8 Tc <br>CD4 Th <
br>CD56 NK (m ny exress CD3 nd re
hus NKT cells)<br>"
M rked
"L bel<br><br><img src=""62d26 72370f 2b59816db635131 c11.ng"" /><br><br>Wh
i
s
he cmmn TCR he
erdimer?<br><br>" "<img src=""4e91999 7 e8d466e6ff2e0e64bb
fb07.ng"" /><br><br>He
erdimer: <br><b> lh /be
</b> (r g mm /del
) <br><br
>Ex
r cellul r dm ins re Ig V- nd C-like <br><br>E ch ch in includes: <br>TM
dm in<br><br>Shr
cy
l smic
il<br>"
M rked
Define MHC Res
ric
in<br><br>Wh
cells re MHC res
ric
ed <br><br> "MHC res

ric
in <br><br>TCR requires b
h MHC nd e
ide secfici
ies fr c
iv
in /
recgni
in<br><br>TCR cnfers b
h MHC nd e
ide secifici
ies:<br>&nbs;&nb
s;MHC- nd n
igen e
ide recgni
in d n
segreg
e indeenden
ly<br>&nbs;
&nbs;s me TCR genes frm T cell clne c n
r nsfer b
h MHC- nd e
ide sec
ifici
ies.<br><br>TCR is MHC nd n
igen res
ric
ed mus
recgnize b
h fr succ
essful c
iv
in. <br><br><img src="" d9611480759d0 1644958e659661620.ng"" /><
br><br>T cells re mhc res
ric
ed; n
e
h
b cells re n
mhc res
ric
ed bec
use
hey re n
recgnizing n
igen bund
 mhc. "
"Reference; <br><br>TCR:Pe
ide-MHC Cmlex<br><br><img src=""3324d4588423 6eee6
42b5621d1816e .ng"" />"
M rked
Lis

he 2 rim ry cmnen
s f
he TCR cmlex
"TCR lh be
he
erdi
mer<br>CD3 he
erdimers <br><br>N
e resence f ITAM n in
r cellul r dm in necess ry fr sign l
r nsduc
in<br><br>CD 3 rvides sign lling mech nism fr
cell c
iv
in f TCR <br><br><img src=""04d7b5f19e373600c6f39 5e2 fbed38.ng""
/>"
M rked
Wh
is
he func
in f CD4 nd CD8?<br><br>Wh
des e ch bind? <br><br>Wh
ce
lls exress Cl ss I MHC?<br>Wh
cells exress cl ss II? <br><br>
"CD4 nd
CD8 s
reng
hen TCR:MHC binding<br><br>CD8 binds MHC1<br>CD4 binds MHC2<br><br>P
re

y much every cell exresses MHC1 nd c n resen

 CTLs <br><br>Br in cells
usu lly d n
exress MHC1 infec
ed neurn is be

er
h n de d neurn<br><br>MH

C2 Prfessin l APCs m crh ges / dendri
ic / B cells<br><br><img src=""dc14e24

48f4 ff9146c7c103ccb6be b.ng"" /><br><br>"
M rked
"Reference:<br>Cm risn be
ween TCR lcus nd Ig H ch in lcus<br><br>N
e - v
ery simil r wi
h few differences in
he TCR Be
lcus - ie simler C regins
nd
w clus
ers f D nd J segmen
s. <br><br><img src=""feb db0c6b7c2c47eec0ffb
d5def12b7.ng"" />"
M rked
Ou
line
he rcess f si
ive nd neg
ive T cell selec
in in
he
hymus<br><
br>hw d duble neg
ive cells becme duble si
ive,
hen single si
ive?<br
><br>wh
is neg
ive selec
in, wh
is si
ive selec
in
"The ms
imm
u
re rgeni
rs re c lled r-T cells r <b>duble-neg
ive T cells bec use
hey
d n
exress CD4 r CD8</b>. These cells ex nd in number m inly under
he in
fluence f IL-7 rduced in
he
hymus. <b>Sme f
he rgeny f duble-neg
iv
e cells underg TCR gene recomination, mediated y the V(D)J recominase</>. I
f successful VDJ recomination takes place on one chromosome and a chain protein
is synthesized, it is expressed on the surface in association with an invariant
protein called pre-T,
 frm
he re-TCR cmlex f re-T cells. If
he cmle

e chain is not produced in a pro-T cell, that cell dies. These signals promote s
urvival, proliferation, and TCR gene recmbin
in, nd inhibi
VDJ recmbin
i
n in
he secnd TCR chain locus (allelic exclusion), much like the signals from
the pre-BCR complex in developing B cells. Failure to express the ch in nd
he
cmle
e TCR g in resul
s in de
h f
he cell. The surviving cells exress b

h
he CD4 nd CD8 c-rece
rs, nd
hese cells re c lled duble-si
ive T cel
ls (r duble-si
ive
hymcy
es). <br><br>Differen
clnes f duble-si
ive
T cells exress differen
TCRs. If the TCR of a T cell recognizes an MHC molecule
in the thymus, which has to e a self MHC molecule displaying a self peptide,<
> that T cell is selected to survive</>. T cells <>that do not recognize an MH
C molecule in the thymus die y apoptosi</>s; these T cells would not e useful
ecause they would e incapale of seeing MHC-displayed cell-associated antigen
s in that individual. This preservation of self MHC-restricted (i.e., useful) T
cells is the process of <>positive</> <>selection</>. During this process, T
cells whose TCRs recognize class I MHC-peptide complexes preserve the expressio
n of CD8, the co-receptor that inds to class I MHC, and lose expression of CD4,
the coreceptor specific for class II MHC molecules. Conversely, if a T cell rec
ognizes class II MHC-peptide complexes, that cell maintains expression of CD4 an
d loses expression of CD8. <>Thus, what emerges are single-positive T cells, wh
ich are either CD8+ class I MHC restricted or CD4+ class II MHC restricted</>.
During positive selection, the T cells also ecome functionally segregated: The
CD8+ T cells are capale of ecoming CTLs on activation, and the CD4+ cells are
helper cells.<r><r>Immature, doule-positive T cells whose receptors strongly
recognize MHC-peptide complexes in the thymus undergo apoptosis. This is the pro
cess of <>negative selection.</>&nsp;&nsp;It may seem surprising that oth p
ositive selection and negative selection are mediated y recognition of the same
set of self MHC-self peptide complexes in the thymus. (Note that the thymus can
contain only self MHC molecules and self peptides; microial peptides are conce
ntrated in peripheral lymphoid tissues and tend not to enter the thymus.) The li
kely explanation for these distinct outcomes is that if the antigen receptor of
a T cell recognizes a self MHC-self peptide complex with low avidity, the result
is positive selection, whereas high-avidity recognition leads to negative selec
tion. s in the case of B cells, the aility to recognize foreign antigens seems
to rely on chance: T cells that weakly recognize self antigens in the thymus ma
y strongly recognize and respond to foreign microial antigens in the periphery.
<r><r><img src=""35202c64acec6f4290ff12213e3a3.jpg"" />" Marked
: V(D)J re rr ngemen
s<br><br>Ou
line Be
selec
in (wh
cells, wh
is firs
re
rr ngemen
, wh
is s

uf f RAG?)<br><br>u
line lh selec
in<br>(wh
cel
ls, wh
is s

us f re-
cr rece
r)<br><br> "<b> selec
in</b><br>Pre-TCR n
DP cells<br>D-J re rr nge firs
in DN cells<br>RAG OFF<br><br><b> selec
in </b><
br>Pre-TCR OFF<br>RAG, CD4 CD8 ON ( DP)<br>dele
es del
genes<br><br><img src="
"723 c1c34610642fd46644f359b83796.ng"" /><br><br><img src=""4515ed8e343b66d82d3
d1fcf3f0 c121.ng"" /><br>"
M rked
"Reference - cm risin f Ig nd TCR<br><br>- N
e B cells ls underg sm
i

c hyermu

in which brings

l diversi
y
 rxim
ely equ l fr BCR nd
TCR n cl ss swi
ch in TCR<br><br><img src=""7735711049c3c3e08f9fbe5b2e4e936e.n
g"" />"
M rked
"M jr Differences be
ween TCR nd Ig<br><br>fill in
he ch r
<br><br><img src="
"127fbc0 7e6756e8068eb18d10cf685e.ng"" />"
"<img src=""f2 954ee 4421f 84f34
84d 898ed4df.ng"" /><br><br>Al
ern
ive slicing membr ne bund vs. secre
ry I
g<br><br>AID n
c
ive in Tcells (remember i
is imr
n
fr cl ss swi
ch nd
hyermu

in) <br>" M rked
"Geh C se 11<br><br>5 YO Dennis F wce

: cu
e infec
in f e
hmid sinuses<br>
His
ry<br>recurren
sinus infec
ins since 1 ye r ld<br>Pneumcys
is c rinii (Pn
eumcys
is jirvecii)&nbs;&nbs; k PCP = PneumCys
is (jirvecii) neumni )

3ye rs<br>Tre
ed successfully wi
h n
ibi
ics<br><br>Thr
cul
ure: -hemly

ic s
e
ccci <br>WBC 4200/uL&nbs;&nbs;vs (5000-9000)<br>Differen
i l<br>26%&
nbs;&nbs;neu
rhils&nbs;&nbs;&nbs;vs.&nbs;&nbs;65%<br>56% lymhcy
es vs
&nbs;&nbs;25%<br>28% mncy
es&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;vs. 8%<br><b
r><br>Neu
reni neu
rhils h ve migr
ed in

issue exl ins
his finding. <
br><br>Cell
cells
<br>
<br>RB
er uL
C
5 E6
<br>l
ele
s
2.5 E5
<br>leukcy
es
7300
<br><br>lymhcy
es
30
00 (25%)
<br>neu
rhils
4000 (65%)
<br>b s
hils&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&n
bs;&nbs;&nbs;0-5%<br>esinhils
&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&
nbs;&nbs;&nbs;0-5%<br>MONOCYTES
&nbs;&nbs;&nbs;&nbs;&nbs;&nbs;&n
bs;&nbs;&nbs;&nbs;&nbs;&nbs;8%<br><br>An
i-s
re
lysin O n
ibdies: zer

i
er<br> Serum Ig:<br>IgG&nbs;&nbs;25 mg/dL&nbs;&nbs;vs. 600-1600<br>IgA u
nde
ec
ble<br>IgM&nbs;&nbs;210 mg/dL vs. 75-150&nbs;&nbs;=&g
; HYPER IGM<br>L
ymh nde bisy:&nbs;&nbs;n germin l cen
ers<br>Bs
er DPT (dih
heri er

ussis
e
nus);
yhid<br>14 d ys l
er- n
i
er<br>Dennis is
ye O<br>An
i-A

i
er is 1/3200&nbs;&nbs;(vs 32-2048)<br>An
i-B
i
er is 1/800&nbs;&nbs;&nb
s;(vs 8-512)<br><br><br> Flw cy
me
ry: <br>11% CD19+&nbs;&nbs;vs. 6-41 <br>
87% CD3+&nbs;&nbs;&nbs;&nbs;vs.53-84<br>2% CD56+&nbs;&nbs;vs.&nbs;&nbs;&
nbs;3-18%<br>All
he CD19+ cells exressed b
h IgM nd IgD (indic
es
h
nn
e f
hese b cells h ve cl ss swi
ched)<br>Nne f
he CD19+ cells exressed IgG
r IgA<br>Ac
iv
ed T cells did n
exress CD40L<br>As de
ec
ed using sluble
CD40 rbe.<br><br>Lymhcy
es&nbs;&nbs;&nbs;Child
dul
<br>B
6
-41%
5-15%<br>T
53-84%
75-85%<br>CD4
32-64%
27-53%<br>CD8
12-30%
13-23%<br>CD56
3-18%
5-15%<br><
br><img src=""070704f88f561 6d1b fdff7866dd063.ng"" /><br><br><br>"
"Geh C
se 11: X-linked Hyer IgM Syndrme&nbs;&nbs;<br><br><img src=""9047eeb1 ce4dcf
b20be3ff91efc199c.ng"" /><br><br>An
i-s
re
lysin O n
ibdies: zer
i
er<br>
Serum Ig:<br>IgG&nbs;&nbs;25 mg/dL&nbs;&nbs;vs. 600-1600<br>IgA unde
ec
bl
e<br>IgM&nbs;&nbs;210 mg/dL vs. 75-150&nbs;&nbs;=&g
; HYPER IGM<br>Lymh nde
bisy:&nbs;&nbs;n germin l cen
ers<br>Bs
er DPT (dih
heri er
ussis
e

nus);
yhid<br>14 d ys l
er- n
i
er<br>Dennis is
ye O<br>An
i-A
i
er is
1/3200&nbs;&nbs;(vs 32-2048)<br>An
i-B
i
er is 1/800&nbs;&nbs;&nbs;(vs 8-5
12)<br><br> he h s incre sed
i
ers fr n
i- nd n
i-b <br>Remember
nd b b
ld n
igens re sug rs<br>Dennis h s incre sed igm<br>S he h s incre sed igm
g ins

hese bld sug rs check dilu
in ss y nex
slide<br>Yu ge
re du
f
1/x
he l rger
he X
he mre sensi
ive
he bld serum nd
hus
he mre n
ib
dy. <br><br><br><img src=""26391cd92d783fd203c91 453 554d8c.ng"" /><br><br>Sh
w hw end-in
dilu
in ss y wrks<br>This ss y 1:8 is
he endin
<br>N
e

h
1:100 is gre
er sensi
ivi
y
h n 1:50<br><br><br><br>IVIG<br>Why n
Bne M
rrw Tr nsl n
?<br><br>P
. h s li

le IgG s rel ce wi
h IVIG n BMT mr
li

y r
es re very high fr BMT<br><br>" M rked
Define/Describe:<br><br>Al
ern
ive slicing in rel
in
 Ig rduc
in<br>Is

ye / Cl ss swi
ch ( nd wh
medi
es i
)<br>Sm
ic hyermu

in ( nd wh
me
di
es i
)<br>Affini
y m
ru
in<br><br>
<b> l
ern
ive slicing</b><br>D
ifferen
i l inclusin r exclusin f exns frm mRNA rim ry
r nscri
s during
RNA slicing.&nbs;&nbs;This c uses differen
i l use f membr ne-bund vs. sec
re
ed Ig.&nbs;&nbs;I
ls cn
rls whe
her IgM r IgD will be gener
ed (bef

re cl ss swi
ching h s ccurred). E sy
 cn
rl, nd ne cell c n m ke b
h ki

nds f
r nscri
s.<br><br><b> is
ye swi
ching k cl ss swi
ching</b><br>AID
c uses dele
ins
 ccur be
ween us
re m nd dwns
re m swi
ch recmbin
in si
gn ls
hereby llwing us
re m VDJ uni
s
 be jined wi
h differen
he vy ch in
cns
n
regins. Irreversible. B cells nly.<br><br><b>sm
ic hyermu

in</
b><br>AID induces in
mu

ins in
he V regins f Ig during
he GC re c
in.
&nbs;&nbs;Cre
es ddi
in l r ndm v ri bili
y in n
igen-binding si
es.<br><
br><b> ffini
y m
ur
in</b>- rduc
f cn
inued selec
in fr high- ffini

y clnes in
he GC re c
ins. <br>
M rked
Imr
n
CDs <br><br>Wh
is CD?<br><br>Wh
cells re ssci
ed wi
h...<br
><br>CD3<br>CD4<br>CD8<br>CD56 <b>CD</b> = clus
er f differen
i
in<br>B sed n


erns f
issue s
ining, nd n
igen iden
ific
in, by huge  nels f mn
cln l n
ibdies.&nbs;&nbs;MAb
h
sh re
he s me&nbs;&nbs;

ern re giv
en
he s me CD #.&nbs;&nbs;Ms
ly we nw knw wh

he CD mlecules re.<br><b
r><b>CD3</b>- we nw knw
his is
he cmlex
h
sur
s
he TCR<br><b>CD4</b
> we nw knw
his is
c-rece
r n sme T cells
h
binds MHC cl ss II<br><
b>CD8</b>;&nbs;&nbs; c-rece
r n sme T cells
h
binds MHC cl ss I.<br><
b>CD56</b>- mlecule n NK cells.&nbs;&nbs;I
is c
u lly NCAM-1 (neur l cel
l dhesin mlecule-1) !<br>
M rked
Define:<br><br>An
igen ( ls u
line size limi

ins)<br>Ei
e ( ls u
line
size limi

ins)<br>Pe
ide Ei
e<br>H 
en<br>H 
en C rrier
<b>An
ig
en</b><br>Any
hing
h
binds n n
igen rece
r
hrugh
he n
igen binding si

e. N size limi

in<br><br><b>Ei
e</b>-&nbs;&nbs;
he lc l mlecul r s
ruc

ure
h
hysci lly eng ges
he n
igen rece
r. Tyic lly n l rger
h n 6 su
g rs r 6 min cids.<br><br><b>Pe
ide ei
es</b><br>T cells
yic lly recg
nize ei
es&nbs;&nbs;
h
re shr
e
ides embedded in MHC mlecules.<br><
br><b>H 
en</b>- sm ll chemic l&nbs;&nbs;mie
y big enugh
 bind n n
ib
dy, bu

 sm ll
 cn
in ei
es fr T cells<br><br><b>C rrier</b>- usu ll
y l rge r
ein
h
rvides T cell ei
es<br>
M rked
"<img src=""2752cc d5e9f
u
line / define
he rcess f cln l selec
in
29e28f530e79677 91b3.ng"" />" M rked
Define:<br><br>Clne<br>Cln
ye<br>Hybridm <br>Cln l Dele
in<br>Cln l Ex
nsin<br><br> "<img src=""4f0e0 86e 54b7fd1 9be77259ce83de.ng"" /><br><br>Bu

n
e
h
, bec use f sm
ic hyermu

in, cln l rgeny c n differ ex nsi
n
hrugh
he Germin l Cen
er Re c
in.&nbs;&nbs;Wi
h r re exce
ins,
hese c
ln l v ri n
s re
in
he rigin l VDJ uni
gener
ed&nbs;&nbs;in
he clnes nce
s
r in
he bne m rrw.<br>" M rked
"Hem
ie
ic line ge (reference)<br><br>Derived frm
he hem
ie
ic (bne m
rrw) s
em cell:<br><br><b>S
em cells</b><br><s n s
yle="" fn
-weigh
:600;""></
s n><br><b>Line ge rgeni
rs</b><br><s n s
yle="" fn
-weigh
:600;""></s n>
<br><b>Differen
i
ed Whi
e bld cells = leukcy
es</b><br>-Myelid cells<br>-L
ymhid cells<br><br><b>Differen
i
ed red bld cells = ery
hrcy
es</b><br><s
n s
yle="" fn
-weigh
:600;""></s n><br><s n s
yle="" fn
-weigh
:600;""></s
n><br>A bne m rrw
r nsl n
(BMT) uses hem
ie
ic s
em cells fund in
he b
ne m rrw
 relenish
he en
ire hem
ie
ic series.<br><br><br>"
M rked
"Yu need
 knw
hese, which line ge nd
discrimin
ing func
in<br><br><img
src=""4934e3812e1997855f00577519cfe55b.ng"" />"
"<img src=""814687006f 3
5077eff961c 76f6e952.ng"" />" M rked
"Reference - rugh u
line, rel
ive numbers re mre imr
n

h n bslu
e<br
><br><img src=""e136e128b8cb57384bd7bde09f9e1e52.ng"" />"
M rked
"S
e dy-s

e nd Kine
ics f T cell flw<br><br>be f mili r wi
h
hese numbers<
br><br><img src=""8447fe241e3f 8297e23093b94f718b9.ng"" />"
M rked
"Mus
knw: cnce
s f nchrs nd cke
s; m
if defines
he secifici
y f
h
e MHC mlecule&nbs;&nbs;CDR3 m kes chief cn
c
wi
h&nbs;&nbs;sever l e
i
de side-ch ins (n
jus
ne).&nbs;&nbs;Plymrhism f MHC is n MHC cn
c

in
s bu
ls in e
ide binding si
e. <br><br><img src=""54bbed17c7fcf2c34d80
f493e2bcb422.ng"" />"
M rked
"wh

he TCR sees<br><br>Remember h
dg mdel; where e
ide
ermini re lc

ed;&nbs;&nbs;exsure
 e
ide vs.
 surf ce f TCR<br><br><img src=""bd0e

ce 779 f36517d8b781c7bd53d75.ng"" />"

M rked
Fig 3-6&nbs;&nbs;Hum n MHC (HLA)<br><br>Wh
re
he 3 cl ss II MHC lci?<br><
br>wh
re
he 3 cl ss I MHC lci?<br><br>wh
d
he cl ss III mhc lci cde f
"<img src=""7 2848 2654d9773 74f960b3c6555c0.ng
r? (2 cl sses f s
uff)
"" /><br><br>Dn
wrry bu
HLA-G nd E fr
his curse.&nbs;&nbs;<br>"
M rked
Allre c
ivi
y:
erms nd ide s<br><br>Define:<br><br> llgeneic<br>syngeneic<br>
u
lgus<br>xengeneic <br> "<b>All = 
her, ~ llelic</b><br><b>Allgeneic</b>
: h ving differen
se
f (HLA) lleles;<br>Nn-self MHC<br>DR1/DR3=&g
;DR4/DR
7&nbs;&nbs;is n llgeneic cmbin
in<br>DR1/DR3=&g
;DR1/DR14&nbs;&nbs;is
 r
i l m
ch.<br><br><b>Syngeneic</b>- h ving n iden
ic l se
f lleles<br>
r rely used in hum n immunlgy: iden
ic l
wins.<br>A erfec
MHC m
ch is NOT syn
geneic&nbs;&nbs;unless yu secific syngeneic MHC= self-MHC= m
ched MHC. <br>cmmn
y used in muse immunlgy =frm
he s me inbred s
r in. E.g. BALB/c&nbs;&nbs;
C57BL/6<br><br><b>Au
lgus -self</b><br><s n s
yle="" fn
-weigh
:600;""></s
n><br><b>Xengeneic</b>- frm differen
secies.<br>The ig r
w s xeng
eneic gr f
(xengr f
)<br>"
M rked
llre c
ivi
y<br><br>T cells re si
ively selec
ed fr self-MHC-res
ric
in:

hey recgnize n
igen in
he cn
ex
f self-MHC nly.<br><br>why migh

his be
T cells re si
ively selec
ed fr self-MHC-res
ric
in:
hey r
rblem?
ecgnize n
igen in
he cn
ex
f self-MHC nly.<br> An A1-res
ric
ed CTL seci
fic fr flu e
ide X c nn
recgnize even
he s me e
ide resen
ed by A2. <b
r>Abu
5% f clnes re c
wi
h ny 
her ersns ll-MHC mlecules<br>
M rked
"<b>TH1 cells s
imul
e h gcy
e-medi
ed inges
in nd killing f micrbes</b>
, key cmnen
f cell-medi
ed immuni
y (Fig. 5-14). The ms
imr
n
cy

kine rduced by TH1 cells is in
erfern- (IFN-), so called because it was discove
red as a cytokine that inhibited (or interfered with) viral infection. IFN- is a
potent activator of macrophaes. (The type I IFNs [Chapter 2] are much more pote
nt anti-viral cytokines than is IFN-.) IFN- also stimulates the production of anti
body isotypes that promote the phaocytosis of microbes, because these antibodie
s bind directly to phaocyte Fc receptors, and they activate complement, enerat
in products that bind to phaocyte complement receptors. (These functions of an
tibodies are described in Chapter 8.) IFN- also stimulates the expression of clas
s II MHC molecules and B7 costimulators on macrophaes and dendritic cells, and
this action of IFN- may serve to amplify T cell responses. <br /><br /><im src="
"b8d42d2008a7645c277c491e7d7510b8.jp"" />"
"The development of TH2 cells is
stimulated by the cytokine IL-4 (see Fi. 5-17). On face value, this is puzzlin
, because the main source of IL-4 is TH2 cells-so how could the cytokine induce
the cells that produce it? It appears that if an infectious microbe does not el
icit IL-12 production by APCs, as may be the case with helminths, the T cells th
emselves produce IL-4. Also, helminths may activate cells of the mast cell linea
e to secrete IL-4. In antien-stimulated T cells, IL-4 activates transcription
factors that promote differentiation to the TH2 subset.<br /><br /><im src=""a9
4d98d821b4e8aa4e776f322802dd2f.pn"" />"
Marked
The Germinal Center Reaction<br><br>REMEMBER!<br><br>T and B cells interact in 
erminal centers in the spleen or lymph nodes or mucosal equivalents<br>T cells h
elp B cells and B cells help T cells<br>Proliferation of T cells and&nbsp;&nbsp;
B cells causin enlarement of nodes&nbsp;&nbsp;(clonal expansion)<br>B cells se
crete antibody<br>B cells switch isotypes<br>B cells undero affinity maturation
<br>
Marked
Partial review<br><br>complement<br><br>what are the 3 pathways?<br><br>what pro
tein is at the converence of these 3 pathways?<br><br>how does complement activ
ate b cells (name the receptor / complement protein)<br><br>
"<im src=""3c80
daa04fc79eba0ae3cb559c89444a.pn"" />" Marked
"Helper T cells that have been activated to differentiate into effector cells in
teract with antien-stimulated B lymphocytes at the edes of lymphoid follicles
in the peripheral lymphoid orans (Fi. 7-7). Naive CD4+ helper T lymphocytes ar
e stimulated to proliferate and differentiate into cytokine-producin effector c
ells as a result of reconizin antiens on APCs, mainly dendritic cells, in the
lymphoid orans. The process of T cell activation was described in Chapter 5. T

o reiterate the important points, the initial activation of T cells requires ant
ien reconition and costimulation. The antiens that stimulate CD4+ helper T ce
lls are derived from extracellular microbes and proteins that are processed and
displayed bound to class II major histocompatibility complex (MHC) molecules of
APCs in the T cell-rich zones of peripheral lymphoid tissues. T cell activation
is induced best by microbial antiens, and by protein antiens that are administ
ered with adjuvants, which stimulate the expression of costimulators on APCs. Th
e CD4+ T cells may differentiate into effector cells capable of producin variou
s cytokines; the TH1, TH2, and TH17 subsets described in Chapter 5 are examples
of such differentiated effector cells. Differentiated effector T cells bein to
mirate out of their normal sites of residence. As discussed in Chapter 6, some
of these T lymphocytes enter the circulation, find microbial antiens at distant
sites, and eradicate the microbes by the reactions of cell-mediated immunity. O
ther differentiated helper T cells mirate toward the edes of lymphoid follicle
s at the same time as antien-stimulated B lymphocytes within the follicles are
beinnin to mirate outward. This directed miration of the B and T cells towar
d one another depends on chanes in the expression of certain chemokine receptor
s on the activated lymphocytes. Upon activation, T cells reduce expression of th
e chemokine receptor CCR7, which reconizes chemokines produced in T cell zones,
and increase expression of the chemokine receptor CXCR5, which promotes mirati
on into B cell follicles. B cells, upon activation, undero precisely the opposi
te chanes, decreasin CXCR5 and increasin CCR7 expression. As a result, antie
n-activated B and T cells mirate toward one another and meet at the edes of ly
mphoid follicles. The next step in their interaction occurs here. <br /><br /><i
m src=""ecab6809fe050bce2b23681fbd5003ac.jp"" /><br /><br />The interactions o
f helper T cells and B cells in lymphoid tissues. CD4+ helper T cells reconize
processed protein antiens displayed by dendritic cells and are activated to pro
liferate and differentiate into effector cells. These effector T cells bein to
mirate toward lymphoid follicles. Naive B lymphocytes, which reside in the foll
icles, reconize antiens in this site and are activated to mirate out of the f
ollicles. The two cell populations come toether at the edes of the follicles a
nd interact. APC, antien-presentin cell."
Marked
"Helper T lymphocytes that reconize antien presented by B cells activate the B
cells by expressin CD40 liand (CD40L) and by secretin cytokines (Fi. 7-9).
The process of helper T cell-mediated B lymphocyte activation is analoous to th
e process of T cell-mediated macrophae activation in cell-mediated immunity (se
e Chapter 6). CD40L on activated helper T cells binds to CD40 expressed on B lym
phocytes. Enaement of CD40 delivers sinals to the B cells that stimulate prol
iferation (clonal expansion) and the synthesis and secretion of antibodies. At t
he same time, cytokines produced by the helper T cells bind to cytokine receptor
s on B lymphocytes and stimulate more B cell proliferation and I production. Th
e requirement for the CD40L-CD40 interaction ensures that only T and B lymphocyt
es in physical contact enae in productive interactions. As we described previo
usly, the antien-specific lymphocytes are the ones that physically interact, th
us ensurin that the antien-specific B cells also are the ones that are activat
ed. Helper T cell sinals also stimulate heavy chain isotype switchin and affin
ity maturation, which typically are seen in antibody responses to T-dependent pr
otein antiens. <br><br><im src=""45fbcebeda2019983961a151d59ff934.jp"" /><br>
<br>Mechanisms of helper T cell-mediated activation of B lymphocytes. Helper T c
ells reconize peptide antiens presented by B cells and costimulators (e.., B7
molecules) on the B cells. The helper T cells are activated to express CD40 li
and (CD40L) and secrete cytokines, both of which bind to their receptors on the
same B cells and activate the B cells.<br>"
Marked
"Label the interactions<br><br><im src=""41bf85d14a23e31d882661089064688f.pn""
/>"
"T cells help only those B cells that present them antien<br>B cells he
lp T cells <br><br><im src=""4600032b9d2b59fd16a5deaf00d9a9c7.pn"" />"
Marked
The Hapten-Carrier Mechanism<br><br>What is a hapten?<br>what is a carrier?<br><
br>how can one induce an antibody response to a hapten? "Animals immunized with
a small molecule such as histamine do not make antibodies aainst histamine<br>A

nimals immunized with a histamine covalently coupled with a forein protein make
anti-histamine antibodies.<br>The small molecule is called a hapten<br>The protei
n is called the carrier.<br>The carrier provides peptide epitopes for T cells<br>T
cells help B cells specific for the hapten.<br><br><im src=""83feb059b2cf2a35b
3d1e36810a1a8c9.pn"" />"
Marked
"Geha Case 18 <br><br>Helen Burns healthy until 6 MO, then pneumonia with DRY co
uh (no sputum).<br>PCP = Pneumocystis jirovecii;&nbsp;&nbsp;TX with pentamidine
*<br><br><im src=""adb3fa42863710106bd701c834d03d82.pn"" /><br><br> suspect SC
ID (severe combined immunodeficiency)<br><br>*Note: accordin to&nbsp;&nbsp;Bart
lett et al. Johns Hopkins ABX Guide 2010 edition, the preferred ABX for PCP is t
rimethoprim sulfamexathazole (TMP-SMX) = Bactrim=Septra about $10/day.&nbsp;&nbs
p;However, about 3% of patients are alleric to sulfa antibiotics.&nbsp;&nbsp;<b
r><br><im src=""76a673983cede99b6bbc9492c5475579.pn"" /><br><br>Backround: PH
A is an protein extracted from the bean Phaseolus vularis.&nbsp;&nbsp;&nbsp;It
is a lectin, meanin that it belons to the very lare class of proteins that bi
nd to suars.&nbsp;&nbsp;PHA binds to lycoproteins on the surface of many cell
types and throuh mechanisms that arent entirely clear activates the T cells, ind
ucing polyclonal proliferation, release of cyto
ines,
illing by CD8 T cells, et
c.&nbsp;&nbsp;It therefore is called a T cell mitogen.&nbsp;&nbsp;Almost all T cel
ls respond, both CD4 and CD8, irrespective of their antigen-specificity or MHC-r
estriction.&nbsp;&nbsp;&nbsp;It also agglutinates RBC.<br>&nbsp;&nbsp;&nbsp;&nbs
p;There are great many plant lectins and each one can exhibit a different specif
icity for sugars and therefore can often be&nbsp;&nbsp;used in histology for dif
ferential staining of tissues. Not all are mitogenic. Concanavalin A&nbsp;&nbsp;
(ConA) is another T cell mitogen. Wheat germ agglutinin also causes clumping of
leu
ocytes, but is NOT a mitogen.&nbsp;&nbsp;Po
eweed mitogen&nbsp;&nbsp;(PWM) i
s a mitogen for both T and B cells. <br>&nbsp;&nbsp;As a note:&nbsp;&nbsp;Purifi
ed T cells do not respond to PHA unless you add bac
some monocytes.&nbsp;&nbsp;
Usually the assay is run with bul
peripheral blood leu
ocytes (PBL).<br><br><br
><img src=""7fa7a07a4f27a1b0c82908fd00553b60.png"" /><br><br><br><br>T cells res
ponding to allogeneic B cells recognize the foreign MHC molecules on the B cells a
nd a large number of T cell clones (~5%) respond<br>Memory T cells responding to
their cognate antigen- in this case tetanus toxoid- will respond but other cells
will not respond.&nbsp;&nbsp;In a healthy person who has been immunized for TT,
you might get only ~0.01% of T cells responding. <br><br>These assays are extrem
ely variable.&nbsp;&nbsp;<br><br><br>Serum Ig<br>IgG&nbsp;&nbsp;96 mg/dL&nbsp;&n
bsp;vs 600-1400<br>IgA&nbsp;&nbsp;&nbsp;&nbsp;6&nbsp;&nbsp;vs 60-380<br>IgM&nbsp
;&nbsp;30 vs&nbsp;&nbsp;40-345.<br>WBC&nbsp;&nbsp;20,000 /ul vs 4000-7000<br>82%
PMN (neutrophils)<br>10% lymphocytes&nbsp;&nbsp;&nbsp;=&gt;2000/uL vs. 3000 exp
. for age<br>6 % monocytes<br>PMN = polymorphonuclear leu
ocytes = neutrophils<b
r><br><br>Lymphocytes<br>7% CD20+ cells&nbsp;&nbsp;vs. 10-12<br>57% CD3+ <br>34%
CD8&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;228 cells/ul&nbsp;&nbsp;&lt;&lt; normal<
br>20% CD4 <br>Serotyping for DR for Helen: no signal<br>B cells did not express
class II MHC <br><br><img src=""4627ea74916f62923078b05c5925f606.png"" /><br>"
Geha Case 18 MHC class II deficiency&nbsp;&nbsp;Treatment<br><br>Bone marrow tran
splant from mother<br>chemical ablation of Helens own bone marrow (busulfan, cycl
ophosphamide)<br>Deplete mothers bone marrow of T cells to avoid graft-vs. host d
isease<br>Transfuse T-depleted bone marrow cells.<br>Outcome: successful graft a
nd recovery.<br>Bare Lymphocyte Syndrome Type II<br>Recessive mutations in 4 diffe
rent genes are
nown- transcription factors required for class II expression<br>
<br>Why ris
a bone marrow transplant?<br>Why not IVIG?<br>What are alternatives
<br><br>
Mar
ed
who has class I mhc? who has class II?<br><br>what are the structural difference
s between class I and class II? "class I - pretty much all nucleated cells; has
one alpha chain with two subdomains as its peptide binding cleft; has b2 microgl
obulin gene <br><br>class II - apcs only; peptide binding cleft is heterodimer a
lpha 1 beta 1<br><br><img src=""eb385d6f1713d87a6b2d63c8c7fdf128.png"" />"
Mar
ed
MHC properties<br><br>define / ma
e relevant / explain why <br><br>Codominant ex
pression<br>polymorphic genes<br>mhc expressing cell types (differentiate class

I and II) <br><br>

"<img src=""60a1d474bceda5db06dfe36312c264a7.png"" />"
Mar
ed
"Reference - to understand <br><br>Allelic variation (polymorphism) within the p
eptide binding groove of MHC molecules accounts the different peptide motif or sign
ature recogniz^5ed by each allelic form: different alleles recognize different anc
hor residues in the peptide epitopes. Each MHC molecule has specificity for 2 or
3 different amino acid side chains in the anchor positions.&nbsp;&nbsp;The other
anchors are wild-cards.&nbsp;&nbsp;Thus each allele of class I recognizes its p
rivate universe of peptides.&nbsp;&nbsp;Since there are 20 natural amino acids,
of octopeptides, it recognizes 20 ^5 peptides out of a max of 20^8 peptides, or
a total of 3.2 million different peptides.&nbsp;&nbsp;But because of the anchors
, each allele can bind only 1/8000 theoretical peptides. <br><br><br><img src=""
82d324067a0ce6bf10574c4f29edcdac.png"" />"
Mar
ed
"Fig 3-10 features of peptide binding<br><br><img src=""c561720d121e6dd7474ae179
f158854d.png"" />"
"<img src=""407f57b2a31a06be35ba8be7a32420f0.png"" />"
Mar
ed
"<img src=""6aa0f106f41bb9caf51616dfc7eeac86.png"" />" "<img src=""407f57b2a31a
06be35ba8be7a32420f0.png"" />" Mar
ed
"Fig 3-10 features of peptide binding<br><br>Each molecule can bind millions of
different peptides, but still is selected for&nbsp;&nbsp;~1/1000 peptides.&nbsp;
&nbsp;MOST PEPTIDE EPITOPES ARE IGNORED!<br>Peptides MUST BE PROCESSED from nati
ve antigens<br>Any cell can process for class I<br>Professional APC have the app
aratus for processing for class II<br><br><img src=""407f57b2a31a06be35ba8be7a32
420f0.png"" />"
Mar
ed
Fig 3-11 antigen processing <br><br>Describe path I vs. Path II MHC processing /
assembly. - which displays extracellular antigens, which displays intercellular
antigens?<br><br>what cell recognizes each class?<br><br>RAWR "Major pathways
you must learn first!<br>Class I- endogenous pathway using proteins SYNTHESIZED
in the cell itself<br>Class II: major exogenous pathway for processing phagocyto
sed antigens.<br><br><img src=""4afb68ec91b5530eaba771ea85cb533c.png"" />"
Mar
ed
"Compare and contrast:<br><br><img src=""838fc9f84061d671e8f15a4e43d6b360.png""
/>"
"<img src=""d606f9dbde17ce3d44c8975891522b71.png"" />" Mar
ed
"Describe / visualize the class II mhc presentation pathway - from upta
e to dis
play <br><br><img src=""eb65bfdfc3da18d4d8372297204d787f.png"" />"
Mar
ed
"describe the class I mhc pathway from upta
e to presentation<br><br><img src=""
61bc28338c7876c056572e69962cd5ef.png"" />"
Mar
ed
"Read Case 17 in gehas - you should be able to understand the importance of all
of these figures <br><br><img src=""5badcbb8cf25e3569da0106c729bd283.png"" /><br
><br><img src=""4a2a10c0967eb09b00e5887414eaf809.png"" /><br><br><img src=""485e
2f6ba4649d79143d4ab05bfaf948.png"" /><br><br><img src=""12ae9cb48c88049cfd7a4f83
6426ce25.png"" />"
Mar
ed
6-10 Killing by CTL&nbsp;&nbsp;<br /><br />Describe the whole process<br /><br /
>what happens first?<br /><br />what receptors are important in the interaction?
<br /><br />what do perforin and granzyme do?<br /><br />what is the FAS pathway
?<br /><br /> "Form immune synapse with target cell<br /><br />Recognition of
peptide/MHC class I by TCR + CD8. <br /><br />Release of granules containing per
forin and granzyme B (GzB).<br /><br />Perforin translocates GzB into cytoplasm
where it activates caspase cascade, --&gt; apoptosis.<br /><br />FasLigand on CT
L --&gt; apoptosis in Fas+ targets through Fas pathway&nbsp;&nbsp;<br /><br /><i
mg src=""8cc97ae70aa42a84df1e46eb47e36309.png"" />"
Mar
ed
"Geha Case 17 <br><br>Tatiana&nbsp;&nbsp;&amp; Alexander Islayev, 17 &amp; 7&nbs
p;&nbsp;YO<br>Severe brochiectasis, persistent cough with yellow-green sputum <b
r>History: Tatiana and brother had frequent sinusitis, otitis, chronic upper and
lower lung infections from early age (Hemophilus influenza; Steptococcus pyogen
es )<br>Frequent Abx<br>3 siblings- healthy<br>Immunized for diphtheria, pertuss
is, tetanus (DPT), oral polivirus, BCG for TB, multiple X for flu<br><br><br>IgG
&gt;1500 mg/dL (vs. 600-1400)<br>Normal complement, neutrophils<br>WBC&nbsp;&nb
sp;7000;6600 /uL&nbsp;&nbsp;<br>Lymphocytes: 25%<br>CD19+&nbsp;&nbsp;&nbsp;10%<b

r>CD16+&nbsp;&nbsp;4%<br>CD3+ ~86%<br>CD4+&nbsp;&nbsp;&lt;90%<br>CD8+&nbsp;&nbsp
;&lt;10%<br><br><img src=""592e2d22eca4eccb821d1cfb1e32ed05.png"" /><br><br>Adul
t values<br>
in blood
total<br>Type&nbsp;&nbsp;
&nbsp;&nbs
p;&nbsp;&nbsp;per uL
<br> RBC&nbsp;&nbsp;
5.00E+06
2.35E+1
3 <br>platelets
2.50E+05
1.18E+12 <br>leu
ocyte
6000
2.82E+10
100% <br>lymphocytes 1.50E+03
7.05E+09
25%
<br>neutrophils
3.70E+03
1.74E+10
62% <br>monocytes
4.80E+02
2.26E+09
8% <br>eosinophils
1.80E+02
8.46E+08
3% <br>basophils
1.20E+02
5.64E+08
2
% <br>total
2.81E+10
<br><br><br>DTH normal to tuberculi
n and Candida antigen<br><br>High titer antibodies to HSV, CMV, mumps, chic
enpo
x (Herpes zoster) and measles<br>Low titer Ab to&nbsp;&nbsp;several strains of i
nfluenza virus and EBV<br>Normal MHC class II, low class I<br><br><img src=""cdb
fffa379b24fa09dec168f37520f7c.png"" /><br><br> Affected sibs are homozygous for
one HLA haplotype<br><br> implication: something in the MHC is defective<br><br><b
r><img src=""77e95298e08cc3e3c7f9f5ad03cdebec.png"" /><br><br><br><br><br>"
Geha Case 17 BLS I<br>diagnosis and comments <br><br>The pts were homozygous for
a point mutation in TAP2.<br>Other causes of Type I Bare Lymphocyte Syndrome<br
>Defects in TAP1 <br>Defects in 2-microglobulin<br>All are rare<br>Expect partial
defects in NK function <br>Expect secondary problems due to chronic lung inflam
ation.<br>
Mar
ed
"MHC restriction, polymorphism &amp; polygenicity - a reference<br><br><img src=
""7314cafb3774c64daaaadf7b8cbff7d6.png"" />"
Mar
ed
The X-ray vision of the T cell sees inside the cell<br><br>Explain. <br><br>
"The X-ray vision of a T cell.&nbsp;&nbsp;Antibodies detect surface of extracell
ular antigens.&nbsp;&nbsp;T cells see peptides processed inside the cell but pre
sented at the cell surface. This allows a CTL to detect a mutant oncogene produc
t or virus by remote sensing of the peptide epitopes.&nbsp;&nbsp;The function of t
he MHC molecule is to transport the peptide to the cell surface and to hold the c
amerasteady for the x-ray vision of the T cell.<br><br><img src=""bd0ecea779af365
17d8b781c7bd53d75.png"" />"
Mar
ed
" Geha 46<br /><br />Christopher Goodwood, age 35, civil engineer with a history
of type 1 diabetes (juvenile onset IDDM= insulin-dependent diabetes)<br />Eleva
ted blood pressure, proteinuria<br />Serum creatine 7.5 mg/dL vs &lt; 1.0<br />=
&gt;renal complications of IDDM<br />Biopsy reveals glomerulonephritis<br />=&gt
;2X/w
dialysis =&gt;waiting list for
idney transplant<br /><br />Blood group B
, Rh-positive<br />
HLA: A2,24; B50,51; DR3,4<br /><br /><img src=""1c550
3e3fbf49c3c1fd04fad6e639cae.png"" /><br /><br />Note - DR3/4 and DR3 / X and DR4
/X associations with diabetes<br /><br />DR3/4 heterozygote 50X more li
ely to g
et T1 diabetes<br />DR2 is protective<br />Possible mechanisms<br />Direct invol
vement of HLA genes<br />DR2 good presenter of a self-peptide to drive formation
of CD4 regulatory T cells (Treg)<br />DR3/4 good presenters of a molecular mimic=
&gt;activation of suppressed autoimmune clones<br />Indirect<br />Genes tightly
lin
ed to DR control T1D<br /><br />Pt: blood group B, Rh+; HLA: A2,24; B50,51;
DR3,4<br />Donor:<br />20 YO male motorcycle fatality<br />Blood group B, Rh+; H
LA-A2,11; B7,35<br />Serum compatibility test:<br />Christophers serum does not r
eact with donor WBC<br /><br />Day1 <br />Pts
idneys replaced by donor
idney<br
/>100 mg methyprednisolone<br />40 mg anti-ICAM-1 monoclonal antibody (mAb) (IC
AM-1 is ligand for HYM LFA-1=CD11a/CD18)<br />200 ml of urine<br />450 mg cyclos
porin, 100 mg azathioprine, 160 mg methylprednisone and 40 mg anti-ICAM-1<br />D
ischarged after 10 days with normal findings<br /><br />1 w
later:<br /> urine
production down 50%<br />Serum creatine up to 2.5 mg/dL<br />Graft enlarged and
tender<br />Biopsy reveals lymphocyte infiltration=&gt;first-set rejection<br />
500 mg methylprednisone I.V.<br />Csa<br />IV 5 mg anti-CD3 mAb X10 days<br />=&
gt;CD3% to 15% (vs 80%)<br /><br />First set rejection refers to a primary immune
response to alloantigens.&nbsp;&nbsp;Even though many T cells can be alloreactiv
e for the particular mismatch, it still ta
es a while for them to clonally expan
d sufficiently to cause a problem in the presence of the initial round of immuno
suppressives. <br /><br />6 w
s later: fever, severe cough with yellow thic
spu
tum; wheezing and crac
ling in lungs<br />Negative for Mtb, PCP, other bacteria<

br />Positive for Aspergillus fumigatus<br />TX wit ampotericin B.<br />After 1

year- return to job with maintenance immunosuprressives:<br />aziothioprine pred
nisone, cyclosporin A (Csa)<br /><br /><br /><br /><br />"
Geha 46 Kidney
Graft for Complications of Autoimmune Insulin-Dependent Diabetes Mellitus:
Mar
ed
Differentiate Type I vs. Type II diabetes from an immunological perspective <br
/><br />
<b>Type I.</b><br />Autoimmune destruction of islets=&gt;loss of
insulin production =&gt;IDDM<br />HLA-associations; un
nown factors initiate. M
olecular mimicry is a standard HYPOTHESIS but no definite factors is
nown.<br /
><br /><b>Type II adult onset</b><br />Initiated by high fat diet; advanced glycan
endproducts (AGE) of sugar oxidation in bloodstrem =&gt;apoptosis of podocytes;
inflamation=&gt;activation and expansion of T cells in adipose tissue, release
of TNF.<br />AGE-induced 
sis f isle
cells=&g
; h gcy
sis nd n
igen 
resen

in by DC
 T cells=&g
; n
i-isle
T cells.<br />=&g
; u
immune des
ru
c
in f isle
s=&g
;lss f insulin rduc
in=&g
;IDDM<br /><br>Iddm insulin de
enden
di be
es melli
us <br> M rked
"Fr reference:<br><br><img src="" 60ef4063 bb3e7ce917bb bc2435370.ng"" />"
M rked
"Fr reference - lis
mism
ches - mre gr f
surviv l <br><br>MM mism
ch<br>All 
s n immunsuressives <br><br><img src="" c4836ed376f680c1205dc0b3860f71
c.ng"" />"
M rked
Gerg Schnes&nbs;&nbs;L ws f Tr nsl n

in (1912)<br><br>Wh
is ..<br><br>
xengr f
?<br> llgr f
?<br> u
gr f
?<br><br>.. sme f
he rules re irrelev n
Tr nsl n

in in

freign s

-
ke wh
yu will frm
he nswer<br>
ecies lw ys f ils (he
erl s
ic
r nsl n

in&nbs;&nbs;=&g
;xengeneic<br>Tr
nsl n

in in
 unrel
ed members f s me secies usu lly f ils (hml s
ic hm
lgus&nbs;&nbs;=&g
; llgeneic)<br>Au
gr f
s usu lly succeed.&nbs;&nbs;(S
ecifici
y)<br>Prim ry
ke fllwed by del yed rejec
in<br>Acceler
ed rejec
i
n f secnd gr f
r in re-immunized hs
.&nbs;&nbs;(Acquired immuni
y)<br>Su
ccess f
r nsl n
cce
nce crrel
es wi
h clseness f bld rel
inshi<br>
M rked
Differen
i
e
he 3 rim ry mech nisms f gr f
rejec
in.<br><br>G.<br>
"Gr f
rejec
in is cl ssified in
<b> hyer cu
e, cu
e, nd chrnic, n
he b
sis f clinic l nd 
hlgic fe
ures</b> (Fig. 10-9). This his
ric l cl ssif
ic
in w s devised by clinici ns nd h s s
d
he
es
f
ime rem rk bly well
. I
ls h s becme  ren

h
e ch
ye f rejec
in is medi
ed by  r
i
cul r
ye f immune resnse.<br><br><b>Hyer cu
e rejec
in</b> ccurs wi
hin
minu
es f
r nsl n

in nd is ch r c
erized by
hrmbsis f gr f
vessels
nd ischemic necrsis f
he gr f
. Hyer cu
e rejec
in is medi
ed by circul
i
ng n
ibdies, secific fr n
igens n gr f
end
heli l cells,
h
re resen

befre
r nsl n

in. These refrmed n
ibdies m y be n
ur l IgM n
ibdi
es secific fr bld gru n
igens (discussed l
er), r
hey m y be n
ibdie
s secific fr llgeneic MHC mlecules
h
re resen
bec use f exsure

llgeneic cells due
 bld
r nsfusins, regn ncy, r rir rg n
r nsl n


in. These n
ibdies bind
 n
igens in
he gr f
v scul r end
helium nd
c
iv
e
he cmlemen
nd cl

ing sys
ems, le ding
 injury

he end
heliu
m nd
hrmbus frm
in. Hyer- cu
e rejec
in is n
cmmn rblem in clini
c l
r nsl n

in, bec use every reciien
is
es
ed fr bld
ye nd fr n

ibdies g ins

he cells f
he 
en
i l dnr. (The
es
fr n
ibdies is c
lled crss-m
ch.) Hwever, hyer cu
e rejec
in is
he m jr b rrier
 xen

r nsl n

in, s discussed l
er.<br><br><b>Acu
e rejec
in</b> ccurs wi
hin
d ys r weeks f
er
r nsl n

in nd is
he rinci l c use f e rly gr f
f
ilure. Acu
e rejec
in is medi
ed m inly by T cells, which re c
g ins
ll
n
igens in
he gr f
. These T cells m y be CTLs
h
direc
ly des
ry gr f
cell
s, r
he T cells m y re c
g ins
cells in gr f
vessels, le ding
 v scul r
d m ge. An
ibdies ls cn
ribu
e
 cu
e rejec
in, eseci lly
he v scul r c
mnen
f
his re c
in, when injury
 gr f
vessels is c used m inly by cm
lemen
c
iv
in by
he cl ssic l 
hw y. Curren
immunsuressive
her y is
designed m inly
 reven
nd reduce cu
e rejec
in by blcking
he c
iv
i
n f llre c
ive T cells, s is discussed l
er.<br><br><b>Chrnic rejec
in</b

> is n indlen
frm f gr f
d m ge
h
ccurs ver mn
hs r ye rs, le ding

 rgressive lss f gr f
func
in. Chrnic rejec
in m y be m nifes
ed s fi
brsis f
he gr f
nd by gr du l n rrwing f gr f
bld vessels, c lled gr f

r
erisclersis. In b
h lesins,
he culri
s re believed
 be T cells
h

re c
g ins
gr f
ll n
igens nd secre
e cy
kines, which s
imul
e
he r
lifer
in nd c
ivi
ies f fibrbl s
s nd v scul r sm
h muscle cells in
h
e gr f
. As
re
men
fr cu
e rejec
in h s imrved, chrnic rejec
in is bec
ming
he rinci l c use f gr f
f ilure. <br><br><img src=""84fc2959395475770
b63 d61df0f8ff .jg"" /><br><br>Mech nisms f gr f
rejec
in. A, In hyer cu
e
rejec
in, refrmed n
ibdies re c
wi
h ll n
igens n
he v scul r end
hel
ium f
he gr f
, c
iv
e cmlemen
, nd
rigger r id in
r v scul r
hrmbsi
s nd necrsis f
he vessel w ll. B, In cu
e cellul r rejec
in, CD8+ T lymh
cy
es re c
ive wi
h ll n
igens n gr f
end
heli l cells nd  renchym l cell
s c use d m ge

hese cell
yes. Infl mm
in f
he end
helium sme
imes is
c lled ""end
helii
is."" Allre c
ive n
ibdies ls m y cn
ribu
e
 v scul
r injury. C, In chrnic rejec
in wi
h gr f
r
erisclersis, T cells re c
ive
wi
h gr f
ll n
igens m y rduce cy
kines
h
induce rlifer
in f end

heli l cells nd in
im l sm
h muscle cells, le ding
 lumin l cclusin. Thi
s
ye f rejec
in rb bly is
chrnic del yed-
ye hyersensi
ivi
y (DTH) re
c
in
 ll n
igens in
he vessel w ll.<br><br>"
M rked
Wh
is
he mech nism behind v scul r rejec
in in <br><br>hyer cu
e<br> cu
e<b
r>chrnic<br><br>rejec
in?
<b>Hyer cu
e:</b><br> n
ibdies g ins
nnself
n
igens n v scul r end
helium --&g
;cmlemen
fix
in, v scul r cll se<b
r>Org n
r nsl n
s:ABO bld gru<br>Gene
her y
ri l: Jesse Gelsinger/ Phil
delhi Adenvirus vec
r<br><br><b>Acu
e</b><br>End
heli li
is: CD8 T cells


ck&nbs;&nbs;&nbs;v scul
ure<br><br><b>Chrnic</b> Th1 cells secre
e cy
k
ines--&g
;end
heli l rlifer
in, cclusin<br>
M rked
"Wh
ccun
s fr T cell-medi
ed Rxns?<br><br><img src=""19d4fcdcc8c78 d90d08c
44f93f4bcd4.ng"" />" Allre c
ivi
y<br><br>?<br><br> M rked
Describe
he hyer cu
e re c
in <br><br>(wh
4
hings ccur righ
w y?)<br><b
r>
he mech nism - wh
h ens? 1. v sculul r hemrrh ge nd
hrmbsis<br>2. c
mlemen
(cl ssic l nd l
ern
ive)<br>3. MHC dis ri
y rblem if secnd ry re
snse<br>4. ABO ~25% f ren l
r nsl n
s re sensi
ive
 dis ri
y<br><br><b>M
ech nism</b><br>lysis
hrugh MAC n

m jr f c
r<br><br><br><b>
ye I end
he
li l c
iv
in by C =&g
;</b><br>end
heli l re
r c
in<br>c gul
n due
 ls
s f n
i
hrmb
ic f c
rs<br>NO KNOWN TREATMENT ONCE STARTED<br>cbr venm r
e-
re
men
c n dele
e C3<br> M rked
"Hyer cu
e
issue sensi
i
ivi
ies<br><br><img src=""732d03df8 54f f3 c9 472e8c
f257 .ng"" />" "<img src=""98 f53604b3 83f228 f5226e709d3 .ng"" />" M rked
Describe
he rcess f cu
e humr l rejec
in<br><br>wh
is
he
iming?<br>wh

cells re NOT required?<br><br>wh
ccurs?<br><br>wh
is required?<br><br>w
h
2
re
men
s re u
ilized? B1. Acu
e Humr l (Acceler
ed) Rejec
in (~5 d
ys)<br><br>ccurs in bsence f CD8 resnse<br>fibrinid necrsis f dnr r

eriles wi
h in
r v scul r
hrmbsis<br>Tye II end
heli l c
iv
in- requir
es NFB<br>accomodation somehow allows tissues to adapt.<br>treatments:<br>cyclophos
phamide can inhibit<br>plasmapheresis to remove anti-donor Ab<br>
Mar
ed
What is acute cellular rejection / acute GvHD?<br><br>what is timing?<br>what is
the mechanism?<br>what is treatment? B2. Acute cellular rejection and acute G
vHD<br><br>First 3 months<br><br><b>mechanism</b><br>usually T cell-dependent&nb
sp;&nbsp;but not necessarily CD8-dependent<br>endothelialitis probably important
<br>activated macrophages<br>eosinophils important in some Th2 models<br><br>tre
ated and prevented by immusuppressants and anti-lymphocyte Ab.<br>
Mar
ed
What is the timecourse of chronic rejection?<br>what mechanisms may underlie thi
s condition?<br><br>
"<b>time course</b><br>3-5% loss per year after 1st year
of engraftment<br>half-life of
idney is about 10 years even with immunosuppres
sants<br><br><b>mechanisms</b><br>poorly understood non-immune factors<br>immune
factors:<br><b>NK, anti-donor Ab, chronic GvHD</b><br><span style="" font-weigh
t:600;""></span><br><b>experimental chronic rejection</b><br>vascular endothelia
l and smooth muscle hyperplasia<br>concentric fibrosis and vascular occlusion<br
>"
Mar
ed

Describe Type IV hypersensitivity <br><br>what is the classic example?<br><br>wh

at is the timing?<br>what cells respond?<br>
"Robert Koch 1890 tuberculin RXN
<br>Hallmar
s:<br>Delay in response ~24 hrs.<br>Resident macrophages process ant
igen.<br>TH1 cells respond, secrete cyto
ines and chemo
ines to recruite more ma
crophages<br>Macrophages enter, phagocytose microbes. <br>In some cases, CD8 T c
ells are also effectors.<br><br><br><img src=""b42a053981d996048d9305e2c04a15b5.
png"" />"
Mar
ed
Describe the chromium release assay for CTLs<br>
"Cytotoxic T lymphocytes
<br><br>In one form of CTL assay, target cells are loaded with radioactive chrom
ium (51Cr) and washed, then incubated for 4 hours with CTL.&nbsp;&nbsp;If the CT
L
ills the target cell, 51Cr is released into the medium and can be detected by
a gamma radiation counter.&nbsp;&nbsp;This is the chromium release assay.&nbsp;&n
bsp;<br><br><img src=""12ae9cb48c88049cfd7a4f836426ce25.png"" />"
Mar
ed
The high frequency of alloreactivity<br><br>T/F - allogenic MHC will be seen as
foreign and reacted against
True in several ways -- - <br><br>2-5% of T cell
s can respond to any particular non-self&nbsp;&nbsp;(allo; allogeneic) MHC.<br><br
>T cells from an A1/A2 individual will respond strongly to cells from an A1/A3 i
ndividual.<br><br>ANY non-self MHC is allogeneic <br>No need for foreign antigens
(viruses, etc).<br><br>Explanatory formulation<br> Self-MHC+ foreign peptide X =
allo-MHC+ non-foreign peptide Y<br>Self+X = allo +Y<br><b>CDR1 and CDR2 are preadapted to react with allo-MHC</b><br> Mar
ed
"All about alloreactivity <br><br>The induction of T cell-mediated immune respon
ses against tissue transplants has to overcome the same problem as in responses
against tumors: Because a graft may contain many cell types, often including epi
thelial and connective tissue cells, how can the immune system recognize and rea
ct against all these cells? The answer is that T cells in the recipient may reco
gnize donor alloantigens in the graft in different ways, depending on what cells
in the graft are displaying these alloantigens. <br><br><img src=""c758e5a879c0
1378553f271eaff38306.jpg"" /><br><br>Recognition of allogeneic major histocompat
ibility complex (MHC) molecules by T lymphocytes. Recognition of allogeneic MHC
molecules may be thought of as a cross-reaction in which a T cell specific for a
self MHC molecule-foreign peptide complex (A) also recognizes an allogeneic MHC
molecule whose structure resembles that of a self MHC molecule-foreign peptide
complex (B, C). Peptides derived from the graft (labeled ""donor peptides"") may
not contribute to allorecognition (B), or they may form part of the complex tha
t the T cell ""sees"" (C). As discussed later in the chapter, the type of T cell
recognition depicted in B and C is called direct allorecognition."
Mar
ed
Differentiate major vs. minor incompatibility<br><br> Major alloreactivity =ma
jor histo-Incompatibility<br>--&gt; major histocompatibility complex = MHC<br>T ce
ll reactions against MHC-mismatches<br>Antibody reactions against MHC-mismatches
<br>Maternal anti-paternal MHC antibodies are found in multiparous women.<br>Min
or histocompatibility antigens<br>Any allelic difference OTHER than MHC. <br>Can
give rise to graft rejection as well, but much slower, and minor. <br>
Mar
ed
differentiate direct vs. indirect DTH rejection<br><br> "T cells may recognize a
llogeneic MHC molecules in the graft displayed by dendritic cells in the graft,
or graft alloantigens may be processed and presented by the hosts dendritic cel
ls (Fig. 10-8). Many tissues contain dendritic cells, and these APCs are carried
into the recipients with grafts of these tissues. When T cells in the recipient
recognize donor allogeneic MHC molecules on graft dendritic cells, the T cells
are activated; this process is called direct recognition (or direct presentation
of alloantigens). Direct recognition stimulates the development of alloreactive
T cells (e.g., CTLs) that recognize and attac
the cells of the graft. Alloanti
gens can be recognized by the recipient by a second pathway, which is much li
e
that for recognition of any foreign antigen. If graft cells (or alloantigens) ar
e ingested by dendritic cells in the recipient, donor alloantigens are processed
and presented by the self MHC molecules on recipient APCs. This process is call
ed indirect recognition (or indirect presentation) and is similar to the cross-p
resentation of tumor antigens discussed earlier. The dendritic cells that presen
t alloantigens by the direct or indirect pathway also provide costimulators and

can stimulate helper T cells as well as alloreactive CTLs. However, if alloreact

ive CTLs are induced by the indirect pathway, these CTLs are specific for alloan
tigens displayed by self MHC molecules on host APCs, and they cannot recognize a
nd
ill cells in the graft. It is li
ely that when graft alloantigens are recogn
ized by the indirect pathway, the subsequent rejection of the graft is mediated
mainly by alloreactive CD4+ T cells. These T cells may enter the graft together
with host APCs, recognize graft antigens displayed by the APCs, and secrete cyto

ines that injure the graft by a delayed-type hypersensitivity (DTH) reaction. W

e do not
now the relative importance of the direct and indirect pathways of all
orecognition in the rejection of allografts. It has been suggested that the dire
ct pathway is most important for CTL-mediated acute rejection and that the indir
ect pathway plays a greater role in chronic rejection. <br><br><img src=""595c9e
e8c195d0f84ded3c5e3a0da88a.jpg"" /><br><br>Direct and indirect recognition of al
loantigens. A, Direct alloantigen recognition occurs when T cells bind directly
to intact allogeneic major histocompatibility complex (MHC) molecules on profess
ional antigen-presenting cells (APCs) in a graft, as illustrated in Figure 10-7.
B, Indirect alloantigen recognition occurs when allogeneic MHC molecules from g
raft cells are ta
en up and processed by recipient APCs, and peptide fragments o
f the allogeneic MHC molecules are presented by recipient (self) MHC molecules.
Recipient APCs also may process and present graft proteins other than allogeneic
MHC molecules.<br><br><br><br><br><b>Direct recognition of donor allo-MHC</b><b
r>Nave T cells probably dont respond<br>Memory T cells might respond (DTH-li
e)<br
>Donor DC migrate to LN--&gt;alloresponse<br><br><b>Indirect recognition of dono
r MHC</b><br>Recipient APC ta
e up and present donor cell fragments<br>Present p
rocessed donor peptides on self-MHC<br>Might be important in partial mismatches=
partial matches<br>"
Mar
ed
Fetus: the natural allograft (Medawar)<br><br>Why isnt the fetus rejected?<br><
br>what type of environment is present in the uterus?<br><br>what do the trophob
lasts express, what dont they express?<br>what effect does this have? Usually
well-tolerated<br>Maternal anti-paternal Ab and T cells can be detected but dont
seem to have much effect<br><br><b>Uterus provides</b><br>Th2 environment<br> Pr
otective,&nbsp;&nbsp;angiogenic NK cells<br><br><b>Trophoblasts</b><br>Dont expre
ss HLA-A, B<br>Express tolerogenic HLA-G<br>Suppresses NK cell attac
<br>Promote
s angiogenesis<br>Suppresses many T cells<br> Mar
ed
"Immunosuppressants<br><br>Must
now.<br><br><img src=""e604454d0d45d4d32e0974a7
f3c06c3a.png"" />"
"<img src=""f06049c66443f2590e7e3e93db1ef2c1.png"" />"
Mar
ed
"<img src=""bd2919c7de6388c96eebf27e7d260501.png"" />" "<img src=""5d0a000db53b
f00d1ef538da8eac8d22.png"" />" Mar
ed
"<img src=""378203e42d08e8555e680c7aee2c9909.png"" />" "<img src=""e71554250493
2cb7eb908892879dbb3a.png"" />" Mar
ed
"<img src=""29fb55d6deee5e227e7fbb1ba37b2806.png"" />" "<img src=""6b4207936d0c
fb376bfd371f270cc11b.png"" />" Mar
ed
"Label each red dotted line - what rejection time course goes with each?<br><br>
<img src=""525d6bf326b07cf5ee7f5dfbafabffd5.png"" />" "<img src=""ffa37c5853a7
27ce0dee1ce97eb76f8e.png"" />" Mar
ed
Tissue allografts<br><br>What is critical?<br>Is MHC important?<br>What drugs ar
e necessary?
ABO compatibility is critical<br><br>MHC matching very important
but hard to get complete match<br><br>Immunosuppression critical early especial
ly, patients might be able to be weaned off immunosuppressants eventually<br>
Mar
ed
"Geha Case 47 <br><br>John, a previously healthy 7 YO, brought to pediatrician b
ecause his mother noticed he was pale and had petechiae on his arms and legs<br>
Hb&nbsp;&nbsp;7 g/dL vs 10-15<br>Platelets 20,000/uL&nbsp;&nbsp;vs 150,000-200,0
00<br>WBC subnormal.&nbsp;&nbsp;<br>Bone marrow biopsy: precursors for RBC, plat
elets and WBC are very low.<br>Diagnosis: aplastic anemia<br><br>Platelets at 10
K or lower represents a crisis situation in which donor platelets must be suppli
ed immediately.&nbsp;&nbsp;John is right on the cusp of this.&nbsp;&nbsp;<br><br
>rare <br>Aplastic = not forming something<br>Anemia- too few blood cells (too f
ew RBC)<br>Aplastic anemia- too few RBC and WBC with defective production in the

bone marrow.<br>Causes mostly un

nown (idiopathic)<br>Autoimmune attac
on precur
sor cells<br>Drug induced<br>Viral hepatitis (2%)<br>Chloramphenicol 1/40,000<br
>Ionizing radiation<br><br>Chemical ablation (Bisulfan) to destroy endogenous he
matopoietic lineage cells<br> 200,000 nucleated bone marrow cells from the iliac
crests of his HLA-identical brother<br>3 wee
s in hospital<br><br>24 days posttransplant:&nbsp;&nbsp;readmitted with rash &amp; watery diarrhea.<br> No fever,
lungs clear, heartbeat normal.&nbsp;&nbsp;Spleen and liver not enlarged:&nbsp;&
nbsp;Acute&nbsp;&nbsp;&nbsp;GVHD<br>no jaundice (but this is often seen with acu
te GVHD)<br>TX:&nbsp;&nbsp;corticosteroids, FK506 (tacrolimus) (*)<br>Rash faded
but intestinal symptoms worsened.<br><br>*Layered
nowledge: Tacrolimus/FK506 a
nd cyclosporin A inhibit T cell responses by bloc
ing the protein calcineurin, a
n intracellular factor critical for the activation&nbsp;&nbsp;a transcription fa
ctor (NFAT = nuclear factor of activated T cells) required for transcription of
the IL-2 gene among other T cell responses.&nbsp;&nbsp;We will cover immunosuppr
essives later, but you should BEGIN to learn this mechanism.<br>By the descripti
on of its mechanism of action, youd thin
that FK506 and Csa would have few other
side effects. However, Cyclosporine can be very toxic to the
idneys, cause incr
eased hair growth on the body, especially facial hair on women, and on rare occa
sions can result in neurological problems such as seizures, confusion, anxiety,
and changes in thought processes.&nbsp;&nbsp;FYI <br><br><img src=""3d43fa6e8eda3
58242bcd6780e2c7db6.png"" /> <img src=""cfdd1d695b1d52a021b5c75431d583cd.png"" /
><br><br><br>" " Tx with ATS (anti-thymocyte serum)*<br>=&gt;high fever chills
and sha
es: discontinued.<br>Bloody diarhea for 6 wee
s; colonoscopy shows intes
tinal GVHD <br>TX with anti-CD3 antibody, mycophenolate and an inhibitor of inte
stinal vasoactive peptide.<br>No relief<br>TX with anti-CD2,* this relieved symp
toms and was continued for 2 months <br>Pt returned home after 6 months hospital
ization.<br><br>*This is a polyclonal antibody preparation made in animals immun
ized with human thymocytes.&nbsp;&nbsp;How would you obtain human thymocytes eth
ically? As thymocytes are almost purely of the T lineage, such antisera is largel
y T-specific.&nbsp;&nbsp;It is expected to deplete T cells through complement fix
ation.<br>* CD2 is another cell surface protein on T cells.&nbsp;&nbsp;It used t
o be called SRBC receptor.&nbsp;&nbsp;Fortuitously, sheep red blood cells happen
to bind to human CD2 and cross lin
it, leading to T cell activation.&nbsp;&nbs
p;CD2 is important for T cell function, but what it actually does innt so clear.&
nbsp;&nbsp;Please do not remember CD2 for this course.&nbsp;&nbsp;But anti-CD2 s
aved his
ids life. <br><br> This case illustrates acute not chronic GVHD<br>Not
clear why some antibodies wor
ed and others did not.<br>Donor was full HLA match
so there was no apparent need to deplete the bone marrow of mature T cells. Pro
s and cons of T-depletion.<br><br><img src=""71afdb5d14a948a615bcf20a83f12d23.pn
g"" /> <img src=""66e6bc860b94c9087598aeb6c78bc018.png"" /><br>"
Mar
ed
"Reference - GVHD microscopically<br><br><img src=""42e7484cba0ab317180c79aa84a9
4ecb.png"" /><br><br>a. Early gvhd in s
in.&nbsp;&nbsp;Lymphocytes are extravasa
ting from blood vessels (lower arrow) and adhering to basal epidermis (upper arr
ow). B. Basal cells swell and vacuolate. The dar
staining dermal cells in b (ar
row) are apoptotic (dying) basal cells with condensed (and probably fragmenting)
chromatin. This rash is not typical erythema and edema as from Type I HS! Compa
re Geha case 41 Pemphigus vulgaris.&nbsp;&nbsp;Consider similarity /differences
with psoriasis, eczema.&nbsp;&nbsp;C. the Epidermis is peeling (sloughing) off (
arrow). In severe cases, the s
in can peel off in large areas. <br>"
Mar
ed
"Geha Case 47 Graft-vs-Disease (GVHD) comments&nbsp;&nbsp;<br><br><img src=""7c22
019f30050c4915b215d937418e86.png"" />"
Mar
ed
describe the mechanisms underpinning the development of central tolerance in T c
ells. <br><br> "The principal mechanisms of central tolerance in T cells are ce
ll death and, for CD4+ cells, the generation of regulatory T cells (Fig. 9-2). T
he lymphocytes that develop in the thymus consist of cells with receptors capabl
e of recognizing many antigens, both self and foreign. If an immature lymphocyte
strongly interacts with a self antigen, displayed as a peptide bound to a self
major histocompatibility complex (MHC) molecule, that lymphocyte receives signal
s that trigger apoptosis, and the cell dies before it can complete its maturatio

n. This process also is termed negative selection (see Chapter 4), and it is a m
ajor mechanism of central tolerance. Immature lymphocytes may interact strongly
with an antigen if the antigen is present at high concentrations in the thymus a
nd if the lymphocytes express receptors that recognize the antigen with high aff
inity. Antigens that induce negative selection may include proteins that are abu
ndant throughout the body, such as plasma proteins and common cellular proteins.
Surprisingly, many self proteins that are thought to be expressed mainly or exc
lusively in peripheral tissues are actually also expressed in some of the epithe
lial cells of the thymus. A protein called AIRE (autoimmune regulator) is respon
sible for thymic expression of many of these otherwise peripheral tissue-restric
ted protein antigens. Mutations in the AIRE gene are the cause of a rare autoimm
une disorder called autoimmune polyendocrine syndrome. The process of negative s
election affects self-reactive CD4+ T cells and CD8+ T cells, which recognize se
lf peptides displayed by class II MHC and class I MHC molecules, respectively. I
t is not
nown what signals induce apoptosis in immature lymphocytes that recogn
ize antigens with high affinity in the thymus. Defective negative selection is p
ostulated to be a reason why some autoimmunity-prone inbred strains of mice cont
ain abnormally large numbers of mature T cells specific for various self antigen
s. Why deletion may fail in these mice also is not
nown. <br><br><img src=""c6a
d4cf7f26ce887b1d6ec6ad866160e.jpg"" /><br>Central T cell tolerance. Strong recog
nition of self antigens by immature T cells in the thymus may lead to death of t
he cells (negative selection, or deletion). Self antigen recognition in the thym
us also may lead to the development of regulatory T cells that enter peripheral
tissues.<br>" Mar
ed
"Reference - case 20 gehas<br><br>20.2 thymocytes go through several distinct de
velopmental stages, which can e distinguished by the presence or absence of cert
ain cell-surface proteins. the earliest cells to enter the thymus are double neg
ative thymocytes that lac
the TCR (CD3) and the co-receptors CD4 and CD8; as th
ese cells proliferate and mature into double positive thymocites (CD3+CD4+CD8+)
they move deeper into the thymic cortex. finally, the medulla contains only matu
re single positive t cells, which eventually leave the thymus and enter the bloo
dstream. <br><br><img src=""14fa8ae56dc124835fe32f17ee7767d2.png"" />"
Mar
ed
"reference: <br><br>MHC mismatches;Bone Marrow Transplants<br><br><img src=""b0e
394ef533c10fa9a26628538751c56.png"" />"
Mar
ed
Bone marrow grafts - <br><br>what are rejection problems?<br><br>-what role do N
K cells play?<br>-what role does GVHD play?<br>-what about HVG?<br><br>what solu
tions are available?<br><br>dont use immunosuppressants after graft, why not?
<b>Rejection problems&nbsp;&nbsp;</b><br>Hematopoietic cells have activating lig
ands for natural
iller cells (NK cells)<br>NK cells&nbsp;&nbsp;reject&nbsp;&nbs
p;hematopoietic cells lac
ing self-MHC<br>Donor T cells reject host cells: Graft
vs. host disease (GVHD)<br>HVG host: vs. graft RXN: recipient T cells reject do
nor MHC differences<br><br><b>Solutions and TX</b><br>Deplete recipient of activ
e T cells to bloc
HVG<br>Deplete donor bone marrow of mature T cells to bloc
G
VHD<br>Match MHC to minimize NK <br>Inhibit recipient NK cells<br><b>Cant use imm
unosuppressants AFTER graft- why not?</b><br>-you would ablate / suppress the gr
aft.<br>
Mar
ed
Hemopoietic Stem Cell Transplantation <br><br>3
inds? Includes<br>Bone marrow
transplantation<br>Peripheral blood stem cell transplantation<br>Cord blood tran
splantation<br> Mar
ed
Rationale for Transplant<br>of hsct
Treat patient with chemotherapy and/or r
adiotherapy and/or immunotherapy<br>
ablate patients marrow<br>
des
troy malignancy<br><br>Rescue with autologous or normal allogeneic <br>product<b
r>
Mar
ed
What is an<br><br>allogeneic <br>syngeneic <br>autologous <br><br>graft?
Allogeneic<br>Matched sibling<br>Closely matched unrelated donor<br>Haploidentic
al family member<br>Cord blood<br><br>Syngeneic (identical twin)<br><br>Autologo
us<br><br><br>In some cases it is not ideal to use syngeneic donor ie leu
emia w
here you want to induce a donor vs. leu
emia effect. <br>
Mar
ed
Rationale for transplant<br><br>Autologous<br>Allow dose intensification of chem

otherapy<br>Allogeneic<br>Replace defective marrow with normal marrow<br>Graft v

ersus tumor effect<br>
Mar
ed
Current uses Allogeneic Stem Cell Transplantation <br /><br /><b>Hematologic mal
ignancy:</b><br />Acute lymphoblastic leu
emia<br />Acute myeloid leu
emia<br />
Chronic myeloid leu
emia<br />Myeloma<br />Lymphoma<br />Chronic lymphoid leu
em
ia<br /><br><b>Non malignant disorders:</b><br>Aplastic anemia<br>Metabolic stor
age diseases<br>Immunodeficiencies<br>Hemoglobinopathies<br>Auto-immune diseases
<br><br><b>Malignant diseases:</b><br>Lymphoma<br>Hodg
in disease<br>Myeloma<br>
Acute leu
emia<br>Other solid tumors<br>Autoimmune disease<br><br>
Mar
ed
"reference<br><br><img src=""813c338ab12be4775568681803cba345.png"" /><br>green
- allogenic (7300)<br>blue - autologous (9600)<br><br>Slide 6:&nbsp;&nbsp;The mo
st common indications for autologous transplantation in North America in 2003 we
re multiple myeloma and lymphoma, accounting for an estimated 8,000 transplants.
&nbsp;&nbsp;The most common indications for allogeneic transplantation in North
America were leu
emia and myelodysplasia, accounting for an estimated 5,000 tran
splants.<br>"
Mar
ed
Conditioning Regimens<br><br>Aims?
Aims<br>Ablate host immune system to ens
ure engraftment<br>Eradicate malignancy to prevent relapse<br>Minimize toxicity<
br>
Mar
ed
Conditioning Regimens<br><br>Components?
Chemotherapy<br>Radiation<br>Imm
unosuppressive agents <br>ATG
<br>Monoclonal antibodies<br>
Mar
ed
Mini Transplants?
"Reduced conditioning <br />Initial mixed chimerism followed by
conversion to full chimerism allowing graft versus tumor effect<br />Less toxici
ty in older patients<br />Different sensitivity of different tumors<br><br><img
src=""9483e2deaf45f3665a0abaff3465ad66.png"" /><br />" Mar
ed
"<img src=""f553f1230c0b0380e813a80733af6666.png"" />"
Mar
ed
"<img src=""8fbd0f155579d132a3bf4a4cb1b320a0.png"" />"
Mar
ed
"<img src=""a4a3376079d25b140b83f4c4be1cc78a.png"" />"
Mar
ed
Stem cells for transplantation can be harvested directly from the bone marrow in
the operating room, from peripheral blood using a combination of growth factors
and apheresis or from umbilical cord collected immediately after birth.<br><br>
<br>Sources of Stem Cells<br>Marrow<br>Peripheral blood<br>Cord blood<br>
Mar
ed
"<img src=""d439701ba442a4dba2e2fa91bbb4e230.png"" /><br><br>Red - Bone marrow<b
r>blue - peripheral stem cell<br>green - cord blood<br /><br>Since 2000 the NMDP
growth rate has been 12.5% per year.&nbsp;&nbsp;At this rate, we will exceed 9,
000 (9,340) transplants by 2015.<br>"
Mar
ed
Bone Marrow Harvest<br>Filtration<br><br>As the bone marrow is harvested, it is
pooled by passing it through a series of filters and into a collection bag<br>Fi
lters remove bone fragments and platelet clots<br>
Mar
ed
Apheresis<br><br>Give donor g-csf- to stimulate white cell migration into periph
ery then collect cells from peripheral blood <br>
Mar
ed
PBPC Harvest<br><br>Peripheral Blood is removed from the donor, as it passes thr
ough the centrifuge channel a MNC rich portion of the blood is collected while t
he remainder of the plasma and RBCs are returned to the donor.<br>
Abo blood typing is not a consideration for hsct because rbcs are removed from d
onor tissue <br>
Mar
ed
Infusion<br><br>Hemopoietic stem cell product infused into blood stream<br>HSCs
home to marrow and engraft over 10-30 days<br>
Mar
ed
What is the best HSC product to use?
Depends on available choices and clinica
l scenario<br> Mar
ed
"PBPC vs Bone Marrow<br><br><img src=""af3efd048ce669bb419d6d00361575e8.png"" />
"
"<img src=""04aa23f2c78a5a1bca6d9443f5783cff.png"" />" Mar
ed
"<img src=""1dd3142fb7d25c53d3af0016b7f79ae2.png"" />" "<img src=""04aa23f2c78a
5a1bca6d9443f5783cff.png"" />" Mar
ed
Marrow Versus Peripheral Blood <br><br><b>Peripheral Blood</b><br>Faster engraft
ment<br>No increase in acute GVHD<br>Better DFS in poor ris
patients<br>Increas
ed incidence chronic GVHD<br>
Mar
ed
Cord Blood as a Source of Stem Cells<br><br>Available immediately <br>May induce

less GVHD<br>Cell numbers may be limiting for larger patients<br>Initial studie

s on outcome promising but no long term data available yet<br>
Mar
ed
Major Ris
s of Hemopoietic Stem Cell Transplant <b>Autologous and Allogeneic</b>
<br>Relapse of primary disease<br>Regimen related toxicity<br>Infection<br><br><
br><b>Allogeneic only</b><br>Graft versus host disease<br>Graft rejection<br>
Mar
ed
Regimen Related Toxicity
Veno-occlusive disease<br>Pneumonitis<br>Hemorrh
agic cystitis<br>Mucositis<br>Cardiac damage<br>
Mar
ed
Immune System Recovery after Transplant Conditioning regimen destroys recipients
immune and hemopoietic system<br>T cell recovery can be delayed &gt;1 year<br>R
ecovery dependent on engraftment<br>Slower when<br>allogeneic transplant<br>GVHD
and immunosuppression<br>
Mar
ed
"<img src=""69693720d2251901c218f4bccc7f4a50.png"" /><br><br>Pt will be lymphocy
topenic puts them at ris
for viral infection <br>"
Mar
ed
Ris
s Specific to Allogeneic BMT
Complications of alloreactivity<br> Reje
ction<br> Graft versus host disease<br> Mar
ed
Transplantation Antigens
Major Histocompatibility Complex (MHC) antigens<
br>Minor histocompatibility antigens (mHA)<br>MHC and mHA Ag defined by cellular
reactions<br>Other antigens<br>Defined predominantly by antibody reactions<br>
Mar
ed
Major Histocompatibility Complex (MHC)<br><br>MHC&nbsp;&nbsp;is a series of gene
s that code for cell surface proteins which control the adaptive immune response
. <br><br>The system is called H2 in mice and HLA (human lymphocyte antigen) in
humans. <br><br>Class I MHC contains three genes called HLA-A, B, and C; protein
s from these genes are expressed on almost all cells.<br><br>Class II MHC genes
are called HLA-DR, DQ, and DP; their proteins are expressed on antigen-presentin
g macrophages, dendritic cells and B cells.<br>
Mar
ed
Polymorphism<br><br>HLA - most polymorphic of all genes<br>Polymorphism = when a
gene has at least two alleles<br> Antigens/locus (Genotypes)<br>HLA-A&nbsp;&nbs
p;&nbsp;&nbsp;28 (220)
&nbsp;&nbsp;
HLA-DRB1&nbsp;&nbsp;24 (@360)<
br>HLA-B&nbsp;&nbsp;&nbsp;&nbsp;61 (460)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs
p;&nbsp;
HLA-DQB1&nbsp;&nbsp;16 (@96)<br>HLA-C&nbsp;&nbsp;&nbsp;&nbsp;17
(110)<br>HLA-A, B, C 11 million haplotypes<br>Diploid combinations billions; Cha
nce for complete match rare event<br>Best chance patients&nbsp;&nbsp;w/ haplotyp
es frequent in population lin
age disequilibrium<br>
Mar
ed
Why is understanding haplotypes soimportant?
Genes are inherited together<br>
Haplotypes shared via the bloodline are completely identical<br> Useful when sele
cting best mismatches<br>
Mar
ed
Minor Histocompatibility Antigens<br><br>Defined originally by cell-mediated all
ograft reactions between MHC-identical strains of mice <br>Identity of all not y
et
nown<br>Gene for mHA usually outside the MHC and on various chromosomes<br>H
uman - HA-x<br>Murine - H-1 to H-47 (except H-2)<br>Alloreactivity is due to pol
ymorphisms and recognition is MHC-restricted<br>
Mar
ed
HLA Typing and Transplantation<br><br>Why type?<br>Graft Failure/rejection<br>Tr
ansplant related morbidity/mortality<br>Graft vs Host Disease<br>
Mar
ed
Rejection<br><br>Residual recipient immune system rejects donor cells<br>Overall
ris
&lt;5%<br>Higher ris
in cord blood and mini transplants<br>
Mar
ed
Graft versus Host Disease <br><br>Consequence of alloreactivity between donor an
d recipient<br>Immune competent cells recognize alloantigen<br>MHC<br>minor hist
ocompatibility antigens<br>
Mar
ed
Prerequisites for Graft Versus Host Disease
Graft contains immunocompetent c
ells<br>Recipient expresses tissue antigens not present in donor<br>Recipient im
munosuppressed and unable to reject immunocompetent donor&nbsp;&nbsp;cells<br>
Mar
ed
Pathophysiology GVHD
<br><br>Activation T cells by alloantigen<br>Expansi
on alloreactive T cell clones<br>Release cyto
ines<br>TNF<br>IL1<br>Recruitment
other immune system effectors<br>Tissue damage<br>
Mar
ed
"<img src=""cdcb3498498b6b7dd5a21d3ab80a2748.png"" />"
Mar
ed

Target Organs Acute GVHD

S
in<br>GI tract<br>Liver<br> Mar
ed
Prophylaxis GVHD
Bloc
activation and expansion T cells<br />Ster
oids:&nbsp;&nbsp;Lympholytic<br />Methotrexate: Prevent division and expansion<b
r />Cyclosporin/FK506: Bloc
synthesis cyto
ines and prevent activation<br><br>D
eplete mature alloreactive T cells ex vivo<br>CD34 selection (select stem cells)
<br>T cell monoclonal antibodies (deplete T cells)<br>Deplete T cells in vivo<br
>Campath<br>ATG<br><br />
Mar
ed
Therapy GVHD
Less effective than prophylaxis<br>Steroids<br>ATG<br>T cell ant
ibodies<br>Dacluximab<br>Anti cyto
ine antibodies<br>Infliximab<br>MMF<br>
Mar
ed
Chronic GVHDPathophysiology
Shares features with auto-immune diseases<br>Epi
thelial injury<br>Autoantibodies<br>Fibrosis<br>
Mar
ed
Chronic GVHDTreatment Cyclosporin and Prednisone<br>FK560<br>MMF <br>Rapamycin
<br>Azothiaprine<br>
Mar
ed
"Where we have come from - The chronological history<br><br><img src=""3b7a7b095
74fcf5bc619655ebf62f1a6.png"" />"
Mar
ed
Transplant Outcomes<br><br>Varies with indication<br>Disease stage important<br>
Patient co-morbidities<br>New advances such as T cell therapy<br>
Mar
ed
"<img src=""493684dcb2607085c791d89f8f937b05.png"" /><br><br>In addition to pati
ents having more acute diseases, there has been a dramatic increase in older age
patients.&nbsp;&nbsp;This slide shows transplant recipients older than age 55 a
s a percentage of all transplants (open bars, left hand axis) and as an absolute
number (blue bars, right hand axis).&nbsp;&nbsp;One can see that since the late
90s, there has been an increase from less than 5% to more than 20%, and the abso
lute numbers have increased 10-fold.<br><br>A recent loo
at recipients &gt;65 y
/o showed a tripling in numbers from 2006 to 2007. <br><br><br>"
Mar
ed
"<img src=""beda46d547108b3992a950337e551814.png"" />"
Mar
ed
"<img src=""82c376316171953d9bfc492454b24780.png"" />"
Mar
ed
"<img src=""d97a28e3f625769fcba662d26ec1fe2c.png"" />"
Mar
ed
"<img src=""067df4f8c927259d39afb5f26a4a8711.png"" />"
Mar
ed
"<img src=""b5fc54a899b8066aafdf414c4967e725.png"" />"
Mar
ed
Learning Objectives<br>Define the boundaries and contents of the pharynx and sub
divisions<br>Know the constrictor muscles, attachments, function, and innervation
<br>Know the muscles of the styloid process, function, and innervation <br>Know th
e pharnygotympanic&nbsp;&nbsp;tube and its function, <br>Know the muscles of the
soft plate and their function and innervation <br>Describe the ring of Waldeyer a
nd its clinical significance<br>Describe the pathway of CN IX, X, XI, and XII as
it relates to the pharynx&nbsp;&nbsp;
Mar
ed
"<img src=""af3690c72584d1e2fd86f87001f30b65.png"" />" "<img src=""413749428dd9
ffcd0fdd2622e5da9c9b.png"" /><br><br>Choana narrowing in nasal cavity between na
sal cavity and pharynx.<br>"
Mar
ed
"<img src=""c4f496aabf4c00a80c21fa0e056c0d67.png"" />" "<img src=""77c357985e7d
15a3afa4269ef3c97e73.png"" />" Mar
ed
"<img src=""2dadef6439a2895a1a5d4ccb10ba5c9e.png"" />" "<img src=""8e80bb28077b
58f4a7a270097fb60f69.png"" />" Mar
ed
"<img src=""e2670beb372c198e39bb2d1b55735c0b.png"" />" "<img src=""cfe6893cfb87
058ebdae403579c079a2.png"" /><br><br>Esophagus begins at c6 lower edge of the cr
icoid; this figure is incorrect <br>" Mar
ed
"<img src=""5f34878b99fcc1b48a536c3053db1a7b.png"" />" "<img src=""9e17f3cba40c
1aa4c6cf852de9766ae1.png"" />" Mar
ed
"<img src=""73de6d79495719a630a25b4dc7dd1a37.png"" />" "<img src=""3b01fbf0631b
44fccc75f83bcb3d8678.png"" /><br><br>Potential for pharyngeal fistulas<br>"
Mar
ed
"<img src=""5113cf9642cb8a8ea71b4ffc0697a091.png"" />" "<img src=""1cc6b043ad59
687d43ef46d794db372d.png"" /><br><br>?- retropharyngeal space can be site of inf
ection<br>"
Mar
ed
"<img src=""ecdbea9fb92570561a5b7b9347f91ffd.png"" />" "<img src=""a866aa4ad98f
f45e91589de64a642274.png"" /><br><br>Image Name: Fig. 36.29 B - &lt;p&gt;The pha

ryngeal musculature consists of the pharyngeal constrictors and the relatively w

ea
pharyngeal elevators.&lt;/p&gt;<br><br>They are u shaped when they constrict
they flatten the esophagus; BC buccinator <br><br>Innervation all constrictors
by the VAGUS (dont need to
now its the pharyngeal branch)<br>Also
now that vagus
helps to coordinate swallowing <br>" Mar
ed
"<img src=""b17ad4d78c451661d8af19d147cb5255.png"" />" "<img src=""c625d8726718
3705f6718cc2d8464d39.png"" /><br><br>Image Name: Fig. 36.29 A - &lt;p&gt;The pha
ryngeal musculature consists of the pharyngeal constrictors and the relatively w
ea
pharyngeal elevators.&lt;/p&gt;<br><br>Pharyngeal recess potential site for
fistula<br><br>Styloid process- FAVORITE PRACTICAL EXAM QUESTION ID MUSCLE / ID
NERVE SUPPLY KNOW THESE<br><br>Anterior digastric to open the mouth against resi
stance <br><br>? glossopharyngeal nerve taste / sensation to posterior 1/3rd of
tongue <br>"
Mar
ed
"<img src=""c4e6914c0de82466cb4efb6d3357de19.png"" />" "<img src=""9c3b21112620
3e4d6a1396d08b440391.png"" />" Mar
ed
"<img src=""de8369a294e27883c1ff508e30df0d1b.png"" />" "<img src=""7feb9d3a5770
057c7c70f86c08f761a4.png"" /><br><br>Styloid process never stops growing grows t
oward hyoid; in 80s, the styloid process can interrupt the ability of the larynx
to elevate because the styloid will prevent it <br>" Mar
ed
"<img src=""0a8be66f5843a68b89430684893d071a.png"" />" "<img src=""0c3c225a0b3b
9beff603896c0a955725.png"" /><br><br>Note auditory tube is usually closed; when
you swallow, the tensor palati and salpingopharyngeus transiently open the tube
useful for equalizing pressure&nbsp;&nbsp;<br>" Mar
ed
"<img src=""073f4161004629e3a2a398a92a339fe0.png"" />" "<img src=""39a9a24a06fe
52f145b2a585a3dde4b7.png"" /><br><br>Image Name: Fig. 36.30 B - &lt;p&gt;The mus
cles of the fauces form the posterior boundary of the oral cavity.&lt;/p&gt;<br>
<br>Note tp and lp both raise soft palate; tp uses the hamulus as a fulcrum <br>
? superior constrictor <br>" Mar
ed
"<img src=""4d7aa7abe8bec13dfbf35daef5dd9bd6.png"" />" "<img src=""4f5a62182ebd
27d2a93f9015175d8df4.png"" />" Mar
ed
"<img src=""3397d098297fc7ef28aa441d33bfb1b9.png"" />" "<img src=""5a1f4ccaf9ab
087884fa257597d40b34.png"" />" Mar
ed
"<img src=""081905362b81714139dae951adc2e5e7.png"" />" "<img src=""bcba50d069be
fea441c485f524f98cb6.png"" />" Mar
ed
"<img src=""7b805a01777929d90f0c996d39af01d2.png"" />" "<img src=""a3287204abb9
3c07581c607e79aaa424.png"" /><br><br>Bottom question mar
recurrent laryngeal br
anch of vagus <br>"
Mar
ed
"<img src=""5806b34b8a9ff563ae0f1e2caa127f92.png"" />" "<img src=""a8a1fb641302
402cd5e1ae052778681a.png"" /><br><br>Image Name: Fig. 36.33 - CN III = Oculomoto
r n., CN V = Trigeminal n., CN VI = Abducent n., CN VII = Facial n., CN VIII = V
estibulocochlear n., CN IX = Glossopharyngeal n., CN X = Vagus n., CN XI = Acces
sory n., CN XII = Hypoglossal n.<br>" Mar
ed
"<img src=""97bd4df8f99ef81a52731b27e5adffed.png"" /><br><br>Line of tonsils may
swell up and restrict ability to breathe ie, SIDS<br>"
Mar
ed
"<img src=""7bb5a6fff9dfd4da55c40fb4416a53fc.png"" />" "<img src=""8dfee50c2d10
57bca0b3b781c0d45429.png"" /><br><br>Loo
for equality on both sides inequality
may result from a stro
e <br>" Mar
ed
"<img src=""e9fd336a75bb94ea1fada344c7fb8f23.png"" />" "<img src=""d1dc9d73f78a
3a6db14d7116f8669cdb.png"" /><br><br>CNIX runs under the tonsil<br>"
Mar
ed
"<img src=""4738d16e51a637a89225f81c8ce9f1c6.png"" /><br />This sheet is useful.
"
"<img src=""41ccd2d95b840a66146cb38f2b7edf6f.png"" />" Mar
ed
Learning Objectives<br><br>Know the boundaries of the nasal cavities and their c
omposition including the nasal septum<br>Know the location of the paranasal sinu
ses and their drainage path<br>Know the major arteries and nerves that supply th
e nasal cavity<br>Know the pathway and distribution of autonomic nerves to the n
asal cavity and lacrimal gland<br>
Mar
ed
"<img src=""05cb48cf9c4162c750162bbb4d6723c4.png"" />" "<img src=""995cb238d1b7
3563c309c46224b0b8b0.png"" />" Mar
ed
NASAL CAVITY<br><br>describe epithelium<br>describe function (4)<br>runny nose i
s?<br>inflamed nose is?<br>what is epistaxis? NASAL CAVITY<br><br>RESPIRATORY

EPITHELIUM - CILIATED<br>FUNCTION - TRAP DUST, ALLERGENS, HUMIDIFY AND WARM INCO

MING AIR<br>RHINITIS, RHINORHEA<br>NASAL POLYPS<br>EPISTAXIS - NOSEBLEED<br>
Mar
ed
"<img src=""dc2ed3dabb9fde0e4e9ea0497ca88746.png"" />" "<img src=""492d1edb1d91
837dc24f4ec6fe972328.png"" />" Mar
ed
"<img src=""8d489dc7e358320a7d4272688571f20f.png"" />" "<img src=""3592c2b39f16
d86b8ed4bb0f8fc8fea2.png"" />" Mar
ed
"<img src=""341321e56286b66126cc69fd698642e2.png"" />" "<img src=""a0ca314454f1
760f17e8898586eeaa5a.png"" />" Mar
ed
"<img src=""61a5d5718bb3f264645ddc7cd94fc043.png"" />" "<img src=""61a5d5718bb3
f264645ddc7cd94fc043.png"" /><br><br>SMI super / middle / inferior conchae <br>"
Mar
ed
"<img src=""ab09ac63bd660da800a8214a93a7ea57.png"" />" "<img src=""5f6b7b2a8936
941d18cf89a6ee97923a.png"" />" Mar
ed
Nasal Sinuses<br><br>Where?<br>how many? paired? name each?<br><br>T/F - air sin
uses are present in the newborn<br>what is the function of the sinus (3)<br>how
may sinuses be compromised?
Nasal Sinuses<br>WITHIN NAMED SKULL BONE<br>4 SE
TS FRONTAL (2), MAXILLARY (2),<br> SPHENOID (1?), ETHMOID AIR CELLS (3 per side)
<br><br>AIR SINUSES NOT PRESENT IN NEWBORNFXN OF SINUSES - LIGHTEN SKULL, ADD RESO
NANCE, PROTECT BRAIN FROM TEMPERATURE OF INSPIRED AIR SINUSITIS, sinus infections
Mar
ed
"<img src=""ecbff07b702834c7b0344279f9a52ed1.png"" />" "<img src=""33ebf824f6d2
e0c6a7ae512be4136595.png"" /><br><br>Image Name: Fig. 34.3 A - The paranasal sin
uses (frontal, ethmoid, maxillary, and sphenoid) are air-filled cavities that re
duce the weight of the s
ull.<br><br>Ethmoid sinus not actually a sinus its ethm
oid air cells <br>"
Mar
ed
"<img src=""5c2e232c4736cc17bf6afbc511c53adf.png"" />" "<img src=""662bfbcee791
90a0a2413d9d2cd3937c.png"" />" Mar
ed
"<img src=""0bf725ea6610f9250fe8b3a6f52af57d.png"" /><br><br>Image Name: Fig. 34
.5 C <br><br>Sympathetics and parasympathetics switch bac
and forth to alternat
e breathing. From one side of the other in the nasal cavity <br>"
Mar
ed
"<img src=""280ebb4342a86a255489ec469d041a43.png"" />" "<img src=""f5a7c2a81f55
2b6914916c9eaad0961b.png"" /><br /><br />Image Name: Fig. 34.4 B - Mucosal secre
tions from the sinuses and nasolacrimal duct open into the nose.<br />" Mar
ed
"<img src=""b0d214befa93f4c3bc04a0aa66cfd85a.png"" />" "<img src=""e065e4e6cef5
46134aab5c34557b0477.png"" /><br><br>Image Name: Fig. 29.10 A - The sphenoid bon
e is the most structurally complex bone in the human body.<br>" Mar
ed
"<img src=""9bfc0b9ace13dc81ade6eeb577aa39e5.png"" />"
Mar
ed
Paranasal Sinuses and drainage:<br><br>
Frontal&nbsp;&nbsp;&nbsp;--&gt; <
br><br>
Maxillary --&gt; <br><br>
Sphenoid --&gt; <br><br>
Ethmoidal air cells 3 chambers --&gt; <br><br>&nbsp;&nbsp;&lt;--&nbsp;&nbsp;Naso
lacrimal duct from orbit
Paranasal Sinuses and drainage:<br><br>
F
rontal&nbsp;&nbsp;&nbsp;--&gt; anterior semilunar hiatus<br><br>
Maxillar
y --&gt; middle semilunar hiatus<br><br>
Sphenoid --&gt; Sphenoethmoidal
recess<br><br>
Ethmoidal air cells 3 chambers --&gt; semilunar hiatus<br>
<br>Draining into inferior meatus&nbsp;&nbsp;&lt;--&nbsp;&nbsp;Nasolacrimal duct
from orbit<br> Mar
ed
"<img src=""0f0ddb3e7bc6e3b0dfe3e82006bda980.png"" />" "<img src=""be30187af46f
db10c0a0b52bb1bbf90e.png"" />" Mar
ed
"<img src=""46907cecd539dd7f09fe3fbc93924bd4.png"" /><br><br>Image Name: Fig. 34
.4 A - Mucosal secretions from the sinuses and nasolacrimal duct open into the n
ose.<br>"
Mar
ed
"<img src=""b18accd776460c01ac57c8c4d20e1d1c.png"" />" "<img src=""aa2332cfa60f
2a546fb6d886f2e18497.png"" />" Mar
ed
"<br><br><img src=""d4fc059cb4d64a519cc7737e009f6d0a.png"" />" "<img src=""c219
4f567ee8946def2cf0ba279bfdb5.png"" /><br><br>Image Name: Fig. 33.14 - Removed: O
rbital septum (partial). Divided: Levator palpebrae superioris (tendon of insert
ion).<br>"
Mar
ed
"<img src=""ff5cacf42fd1827a04121cca99f3ae1c.png"" /><br><br>Image Name: Fig. 34

.8 A <br>Know v1/v2, dont need the specific branch <br>"

"<img src=""7e1e9f27a7b2
6ed4e807cf1613fb964a.png"" />" Mar
ed
"<img src=""b4ec9917dd833897a5c6bdaccee097e9.png"" />" "<img src=""b6e5a555eed0
59b912dee3b0ceca1e94.png"" /><br><br>Image Name: Fig. 34.9 B <br>Know greater an
d lesser palatine. Also greater and lesser art/vein <br>"
Mar
ed
"<img src=""766d393ce490794847c0e03be7f663fb.png"" />" "<img src=""e7fd559461fa
8d4798ede572f03df8c5.png"" />" Mar
ed
Autonomic innervation of the nasal cavity epithelium<br />(in terms of vasculatu
re)<br />Parasympathetic causes: <br />Sympathetic causes:<br />
Autonomi
c innervation of the nasal cavity epithelium<br /><br />Parasympathetic causes v
asodilation of mucosa <br />Sympathetic causes vasoconstriction<br /> Mar
ed
"<img src=""ee03805ffbd6cdfc45beb70cda3eb6ed.png"" />" "<img src=""18f4e851cd11
600ac02f68671689cac8.png"" />" Mar
ed
"<img src=""a154d719dc82be71264d6db241d97edd.png"" />" "<img src=""eddb9231a7d8
6ca3f92659914b2dcf32.png"" /><br><br>Image Name: Fig. 32.20 - -
now infraorbita
l n. <br>"
Mar
ed
"<img src=""5b1cb0aaf4ef2165ac69ae4727701089.png"" />" "<img src=""748b46594ec8
de382ff74a2a31c51b7b.png"" /><br><br>Image Name: Fig. 29.10 A - The sphenoid bon
e is the most structurally complex bone in the human body.<br>" Mar
ed
"<img src=""94fea4a7377bc1dc2a718a8e0df1fd24.png"" />" "<img src=""94fea4a7377b
c1dc2a718a8e0df1fd24.png"" /><br><br>Transmitting at arrow <br>(breathing throug
h this side)" Mar
ed
"<img src=""1e9e8111d9d72042d7b8a253e500892d.png"" />" "<img src=""0892a5c5d7ac
17213097d98e30aae52b.png"" /><br /><br />Image Name: Fig. 34.7 B - &lt;p&gt;Note
: The venous drainage of the nasal cavity is into the anterior facial and ophtha
lmic veins.&lt;/p&gt;<br /><br />Know sphenopalatine art. <br />"
Mar
ed
"<img src=""664db151ccb6554067cec5efac3a5431.png"" />" "<img src=""6cf8693cd002
95f61ee5d031585a12cb.png"" /><br><br>Cocaine abuse hole in nasal cavity between
nares <br>"
Mar
ed
"This is important. Step test stuff <br>Jugulodigastric is important; <br><br><i
mg src=""ffeb55cff4919654a2ac87965b6f81bd.png"" />"
Mar
ed
Larynx <br><br>Learning Objectives<br><br>List the components of the laryngeal s

eleton and their functions<br>Describe the contents of the glottic region<br>De

scribe the muscles and function of the muscles of the larynx<br>Explain how the
vocal cords wor
<br>Diagram in detail the sensory and motor innervation of the l
aryngeal apparatus<br>Describe the course of the recurrent laryngeal nerves<br>C
ompare and contrast cricothyroidotomy and tracheotomy<br>Know the lymphatic drain
age pathways of the superficial and deep structures the head and nec
<br>
Mar
ed
"<img src=""02c8cbd2701059b933a02dc0bccfecd8.png"" />" "<img src=""a96e417ef3db
f8b23f1a58641f5197bb.png"" />" Mar
ed
"<img src=""fd1722e81258b34724a32397932897b6.png"" />" "<img src=""a5d7da642b49
3500187680b1455a8191.png"" />" Mar
ed
"<img src=""f6af32e934b8582337eaf42b8f144088.png"" />"
Mar
ed
"<img src=""d85e84220824b99d39ced90b6edc1150.png"" />" "<img src=""3262cb4dbad3
d09c0604ba4e2da450cf.png"" /><br><br>Image Name: Fig. 37.16 - The larynx consist
s of five laryngeal cartilages: epiglottic, thyroid, cricoid, and the paired ary
tenoid and corniculate cartilages. They are connected to each other, the trachea
, and the hyoid bone by elastic ligaments.<br>" Mar
ed
"<img src=""dc849d02e1c77e25ad3919cdcb1afa98.png"" />" "<img src=""ee8354fa5633
c0eae2782fc583b58ff4.png"" /><br><br>Image Name: Fig. 37.21 C - Arrows indicate
the directions of movement in the various joints.<br>" Mar
ed
"<img src=""cc169f45b4865faa55414b9f40cc7d92.png"" />" "<img src=""8751d1d3ec58
eb54f442639d394ba098.png"" />" Mar
ed
"<img src=""89e7be15f93e9b55fb1c8453c0a1cdc6.png"" />" "<img src=""593b6fb9565c
1d942a46f5c4284e0387.png"" />" Mar
ed
"<img src=""c21d082891c051edf0111c3176f2ba61.png"" />" "<img src=""26fe0a0626e0
d55ab41697473497cd9a.png"" />" Mar
ed
"<img src=""e0d0577af9699f76dcba90cd57dcf4df.png"" />" "<img src=""34c77f1466a8
1373f0d79844785bd1e7.png"" /><br><br>A cricothyrotomy (also called thyrocricotom

y, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or em

ergency airway puncture) is an incision made through the s
in and cricothyroid m
embrane to establish a patent airway during certain life-threatening situations,
such as airway obstruction by a foreign body, angioedema, or massive facial tra
uma. Cricothyrotomy is nearly always performed as a last resort in cases where o
rotracheal and nasotracheal intubation are impossible or contraindicated. "
Mar
ed
"<img src=""3ecb1ab08b0bad0b1b0a6ea49a18b934.png"" />" "<img src=""dd5fd61da934
ab3dee4209546afbc3d6.png"" />" Mar
ed
"<img src=""4bca0be13bc62621a47e2fb6aae922cc.png"" />" "<img src=""c2585d993b3d
67409830cf691c86a051.png"" /><br><br>Image Name: Fig. 37.21 B - The arytenoid ca
rtilage alters the position of the vocal folds during phonation.<br>" Mar
ed
"<img src=""8a3ea7bb555ec8ef4e80be6be89b842b.png"" />" "<img src=""8f2d1bb05bbd
ab88fa510278894944bb.png"" />" Mar
ed
"<img src=""1a18ebeff852289999d1a314aa6b6d9a.png"" />" "<img src=""5f71fe2d6155
872dbaad754068ad78ad.png"" />" Mar
ed
"<img src=""746950ec67a486de45f0312961f73056.png"" />" "<img src=""7e47627f1cc3
486b19bfc66e3f597f59.png"" /><br><br>Image Name: Fig. 37.22 C - The laryngeal mu
scles move the laryngeal cartilages relative to one another, affecting the tensi
on and/or position of the vocal folds.<br>"
Mar
ed
"<img src=""4c56465fdb8488baf9cb7485c5bbb2ca.png"" />" "<img src=""c986863c2787
ec847ce2c198f28f3c72.png"" /><br><br>Stridor is a high pitched wheezing sound re
sulting from turbulent air flow in the upper airway. It is primarily inspiratory
.[1] It can be indicative of serious airway obstruction from severe conditions s
uch as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor"
Mar
ed
"<img src=""4b54745864779288139ea7ca8f263f67.png"" />" "<img src=""e6a7d5066879
1bb1e7d2ab546a8f912f.png"" /><br><br>Image Name: Fig. 37.22 D - The laryngeal mu
scles move the laryngeal cartilages relative to one another, affecting the tensi
on and/or position of the vocal folds.<br><br><br>In medicine, laryngospasm is a
n uncontrolled/involuntary muscular contraction (spasm) of the laryngeal cords.
The condition typically lasts less than 60 seconds, and causes a partial bloc
in
g of breathing in, while breathing out remains easier. It may be triggered when
the vocal cords or the area of the trachea below the cords detects the entry of
water, mucus, blood, or other substance. It is characterized by stridor and or r
etractions. Some people suffer from frequent laryngospasms, whether awa
e or asl
eep. In an ear, nose and throat practice, it is typically seen in people who hav
e silent reflux disease. It is also a well
nown, infrequent, but serious post-s
urgery complication.<br>"
Mar
ed
"<img src=""5d90542e900350333a6659835245a20a.png"" />" "<img src=""13aed240dc50
1f45507ee498c950a000.png"" /><br><br>Image Name: Fig. 37.22 A - The laryngeal mu
scles move the laryngeal cartilages relative to one another, affecting the tensi
on and/or position of the vocal folds.<br>"
Mar
ed
what is the Only laryngeal muscle not under mucus membrane?<br> "the cricothyroi
d muscle <br><br><img src=""13aed240dc501f45507ee498c950a000.png"" />" Mar
ed
"<img src=""a0c3e0cbcbafb18be35b51cbf3e422eb.png"" />" "<img src=""3602936ccda8
35fb3ccbed783529b26f.png"" /><br><br>Image Name: Fig. 37.22 B - &lt;p&gt;Removed
: Thyroid cartilage (left half). Revealed: Epiglottis and external thyroarytenoi
d muscle.&lt;/p&gt;&lt;p&gt;The laryngeal muscles move the laryngeal cartilages
relative to one another, affecting the tension and/or position of the vocal fold
s.&lt;/p&gt;<br><br>" Mar
ed
"<img src=""bffcb5071e5769b7db4ec1fa6b172398.png"" />" "<img src=""52250ed9c87d
c54b3c9d666abeff87e9.png"" />" Mar
ed
"<img src=""6309fc7e5b83a4f0bb140a42d7b604fc.png"" />"
Mar
ed
"<img src=""ae94e8233b8fe05a85c110bf6a79d249.png"" />" "<img src=""bb13080f080d
b0ea15dbe16acb38b2af.png"" /><br><br>Image Name: Fig. 37.28 A - Note: The inferi
or thyroid vein generally drains into the left brachiocephalic vein.<br>"
Mar
ed
"<img src=""bc06404671cbaa78ce5f40b59ddc8221.png"" />" "<img src=""481bba253855
9a0dec790dc305c47901.png"" /><br><br>Image Name: NLNVLarynx - Removed: Cricothyr

oid muscle and left lamina of thyroid cartilage. Retracted: Pharyngeal mucosa.<b
r>"
Mar
ed
"<img src=""1ac461704475e1a357839b20f3b36e71.png"" />" "<img src=""fa74c4288242
f92360e0a04311375e22.png"" /><br><br>Image Name: Fig. 36.33 - CN III = Oculomoto
r n., CN V = Trigeminal n., CN VI = Abducent n., CN VII = Facial n., CN VIII = V
estibulocochlear n., CN IX = Glossopharyngeal n., CN X = Vagus n., CN XI = Acces
sory n., CN XII = Hypoglossal n.<br>" Mar
ed
"<img src=""22d9b8c846358ec8c99dc9ad7b1c9c31.png"" />"
Mar
ed
"<img src=""5a255c33f53235fcf5e288ea7c0db269.png"" />" "<img src=""12ee03151f50
7909ecfd4b68879e2765.png"" />" Mar
ed
"<img src=""779b773c5751c13d39c7b9c5c7d55f71.png"" />" "<img src=""77de670813e2
5f000e78f460fb00f6fa.png"" />" Mar
ed
"<img src=""97828491f28699fb7f3807013ea19c8d.png"" />" "<img src=""cf49c989c39d
124ea0a7ed845d4838d9.png"" />" Mar
ed
"<img src=""37ed1f9a7a546e6b5f9e09793241db1d.png"" />" "<img src=""251d5c57df82
35c0aabc43dc7321ddfc.png"" />" Mar
ed
"<img src=""8a2918ca84322023e1b5beb150e24855.png"" />" "<img src=""4218244065de
4de14c16af706c0ace85.png"" />" Mar
ed
"<img src=""ffeb55cff4919654a2ac87965b6f81bd.png"" />"
Mar
ed
where does the sphenoid sinus drain?
Above the superior concha is a narrow re
cess, the <b>sphenoethmoidal</b> <b>recess</b>, into which the sphenoidal sinus
opens.<br><br>Sphenoidal sinus and posterior ethmoidal air cells open into this
recess. Mar
ed
where do nosebleeds originate
iesselbachs area
Mar
ed
Leptin protein hormone released by adipocytes/satiety (food is enough) signal;
leptin deficient mice are obese Hormone Immunology Common Mar
ed HYM
IL-8 / CXCL-8 Chemo
ine: Attracts leu
ocytes with ligand receptor (CXCR1/2 or
CXCL8R) which are predominately neutrophils and lymphocytes.
Immunology HYM M
ar
ed
CD3 / TCR
T-Cell Receptor: Expressed on T-Cells. Facilitates T-cell signal
transduction (CD3 mediates signaling);<br>antigen recognition (TCR recognizes M
HC + peptide antigen). Immunology HYM Mar
ed
Ig / Immunoglobulin / Antibody / B-Cell Receptor
Binds antigens, can opso
nize or activate complement system when free floating or activates B-Cells when
membrane bound. Immunology HYM Mar
ed
CD4
Expressed on Helper T (Th2); co-receptor that binds MHC II + antigen (on
APC). Helps with signal transduction - costimulation<br>strengthens binding bet
ween T-cell and target Immunology HYM Mar
ed
CD8
On CTLs or Cytotoxic T-cells. Binds MHC I + antigen (expressed on all n
ucleated cells). Leads to signal transduction. Strengthens binding between T-cel
l and target
Immunology HYM Mar
ed
CD80 (B7.1)<br>CD86 (B7.2)
Found on: B-Cells, Dendritic Cells, and macropha
ges. CD28 Co-stimulator &amp; CTLA-4 inhibitor (found on T-cells). Important T-c
ell activator. Immunology HYM Mar
ed
CD28
Found on T-Cells. Activated by CD80/86 (on APCs). Activates T-Cells as a
Co-stimulator and second signal.
Immunology HYM Mar
ed
CD40
Found on B-Cells, Macrophages, and dDendritic cells. Interacts with CD40
L (ligand) on Helper T-Cells and Platelets. Induces B-cell --&gt; plasma cell wi
th isotype change (activate AID). Also activates macrophages. Immunology HYM M
ar
ed
CD11a = LFA-1 integrin (with CD18)
Found on Macrophages, T-Cells, and NK ce
lls. Binds with I-CAM1 on endothelial cells, lymphocytes, monocytes, and APCs to
induce cell-cell adhesion (Egress from blood).
Immunology HYM Mar
ed
CD11b =MAC-1 integrin / CR3
Found on Macrophages, PMNs, NK cells, and T-Cell
s. Binds with iC3b and I-CAM1. Induces phagocytosis of iC3B coated bacteria and
immune complexes; PMN and Monocyte adhesion to endothelium and ECM.
Immunolo
gy HYM Mar
ed
CD11c / CR4
Found on Dendritic Cells. Binds fibronectin and iC3b. Phagocytos
is of iC3B coated bacteria;<br>mar
er on myeloid dendritic cells;<br>cell-to-cel
l adhesion
Immunology HYM Mar
ed

CD18&nbsp;&nbsp; chain<br>for CD11a,b and c

Found on T-Cells and NK Cells. B
inds iC3b. Lin
ed to CD11a,b,c. Immunology HYM Mar
ed
CD19
Found on all B-Cells. Binds C3d and leads to activation of B-Cells (with
CD21 co-stimulation) through a T-Cell independent path.
Immunology HYM M
ar
ed
CD20
The classic mar
er for B-Cells (not on pro-B or plasma cells). Immunolo
gy HYM Mar
ed
Fas / CD95
Found on many cells, bind FasL (Fas ligand) which is also found
on many cells. Induces apoptosis.
Immunology HYM Mar
ed
IFN- <u>Sources</u>: T-Cells, NK Cells, and macrophaes<br /><br /><u>Functio
ns</u>: <br />1. Induces isotype switchin in B Cells. <br />2. Makes <b>macroph
aes anry</b>. <br />3. Activates <b>MHC II and B7</b> (Co-stim) on <b>APCs</b>
. <br />4. Leads to CD4+ (<b>TH1</b>) cell differentiation.<br>5. Inhibits the T
h2 axis.
Immunoloy HYM Marked
IL-2
<u>Cellular sources</u>: CD4+ T cells, NK cells in lare amounts; CD8+ T
cells just enouh for themselves<br /><br /><u>Functions</u>: T cell rowth fac
tor: survival, proliferation, and differentiation of effector and reulatory T c
ells. Immunoloy HYM Marked
IL-4
<u>Cellular sources</u>: TH2 (Helper, CD4+ T Cells), basophils, and mast
cells<br /><u>Functions</u>:<br />1. Prominent cytokine for the development of
naive T cells into TH2 cells. Also promotes development of NK2 and M2 cells.<br
/>2. Mast cells perpetuation: when these are activated, immediately release hist
amine, then a few hrs later start releasin IL-4. IL-4 activates IE isotype swi
tchin (production) on B cells.<br />3. Promotes production of IG2 and 4<br />4
. Inhibits the Th1 axis<br /> Immunoloy HYM Marked
IL-5
A cytokine produced by CD4+ TH2 cells and mast cells. Stimulates rowth,
differentiation, maturation and activation of eosinophils.
Immunoloy HYM M
arked
IL-6
A cytokine produced by many cell types (e.. innate immunity cells, macr
ophaes, and dendritic cells) important for acute phase response. Stimulates inf
lammation; development of TH17 T-cells; febrile response (release of PGE2 from b
rain to stimulate hypothalamus sinalin). Increases rowth of B-Cells.
Immunoloy HYM Marked
IL-7
Released by Stromal cells of the bone marrow and thymus. Acts on T-Cells
and pre-T-Cells. Leads to proliferation of the earliest lymphocyte precursors b
efore antien receptors expressed.
Immunoloy HYM Marked
IL-10 Released by: TH2 cells and T-res. Inhibits macrophae activation and ac
ts as an anti-inflammatory.
Immunoloy HYM Marked
IL-12 Released by activated macrophaes, B-cells, and Dendritic Cells. Causes
NK cells to produce IFN-amme, and TH1 cell differentiation.
Immunoloy HYM M
arked
IL-17 Sources: Th17 cells, other CD4+ helper T cells<br><br>Function: Stimulat
e <b>acute inflammation</b> by activatin neutrophils. Immunoloy HYM Marked
TGF / Tumor Growth Factor
Sources: mucosal lymphoid tissue
, phaocytes, helper T cells, Tres, and other cells. <br />Functions:<br />1. I
nhibits further T cell activation (Th1 and Th2 responses), <br>2. Inhibits the a
ctivation of macrophaes<br>3. Acts as an anti-inflammatory aent<br>4. Leads to
isotype switchin to IA on B-cells.<br>5. Stimulates the development of Tres
Immunoloy HYM Marked
TNF
A cy
kine rele sed by M s
Cells nd T-Cells. Prm
es neu
rhil nd e
sinhil infl mm
in (M s
cells, TH1); rm
e 
sis (CD8);<br>incre sed
exressin f dhesin mlecules n leukcy
es nd end
heli l cells during infl
mm
in;<br>febrile resnse (rele se f PGE2 frm br in
 s
imul
e hy
h l
mus sign ling) Immunlgy HYM M rked
TLR4 & m; CD14 (m rker fr m crh ges)
Ex
r cellul r rece
r n
he su
rf ce f m crh ges nd dendri
ic cells. Binds
 LPS, b c
eri l end
xins, fu
ng l m nn ns, vir l envele r
eins. Cnfers inn
e immuni
y g ins
cnserved
m
ifs. C uses endcy
sis nd rduc
in f IFN-g mm (TH1), TNF- , IL-6, nd
exressin f c-s
imul
ry rece
rs. Immunlgy HYM M rked
TLR9
In
r cellul r rece
r fr dendri
ic cells (in endsmes). Binds CG nd

unme
hyl
ed DNA frm b c
eri . Cnfers inn
e immuni
y g ins
cnserved m
if
s. C uses endcy
sis nd rduc
in f IFN-g mm (TH1), TNF- , IL-6, nd exres
sin f c-s
imul
ry rece
rs.
HYM Immunlgy M rked
FcR
Receptor found on macrophaes, neutrophils, and eosinophils. Fc receptor
for IG-phaocytosis and macrophae activation. Involved in ADCC (Antibody-Depe
ndent Cell-Mediated Cytotoxicity).
Immunoloy HYM Marked
FcR
Found on Mast clls, Basophils, and Eosinophils, this rcptor for IgE l
ads to dgranulation (think allrgic rspons).
Immunology HYM Markd
RAG
Gn found in B and T clls, it is ncssary for VDJ rcombination (part
of VDJ rcombinas). If it is missing --&gt; SCID
Immunology HYM Markd
FMLP Chmotactic rcptor / N-formyl-mthionin-lucin-phnylalanin rcptor
Found on nutrophils and macrophags. Binds to bactrial formyl-pptids --&gt;
causs migration of nutrophils / MACs (rmmbr intgrin) to ara with FMLP pro
tins (chmotaxis)
Immunology HYM Markd
VLA4 (CD49/CD29)
Found in activatd T-Clls, intracts with VCAM1 (intgr
in rcptor) of inflamd ndothlial clls. Causs tight binding of T-Clls to i
nflamd tissu. Immunology HYM Markd
P-Slctin / CD62P
Found on platlts and ndothlial clls. Binds to Sialy
l Lwis (SLX) on activatd lukocyts. Inducs wak adhsion for &quot;rolling&q
uot; along ndothlial vssls at priphral sits.
Immunology HYM Markd
L-Slctin / CD62L
Found on naiv T-Clls and othr lukocyts. Binds to CA
Ms, SLX, and CD34. Rcruits naiv T-Clls to HEVs in lymph nods via GlyCAM.
Immunology HYM Markd
Adalimumab
Fully human MAB against TNF-alpha<br />Fixs complmnt Immunolo
gy HYM Markd
-omab mous mAb
Immunology HYM Markd
-ximab Chimric mAb
Immunology HYM Markd
-zumab humanizd mAb Immunology HYM Markd
-umab human antibody Immunology HYM Markd
What dos Hamophilus look lik on gram stain? "fin gram ngativ coccobaccili
<div><img src=""HI.jpg"" /></div>"
3/18Hamophilus SassinHIB
How dos hamophilus adhr to host tissus?
pilli lik othr gram(-)
3/18Hamophilus Dicky SassinHIB
Dos Hamophilus hav LPS or LOS?&nbsp;<div><br /></div><div>How ar thy diffr
nt?</div><div><br /><div>What is th function?</div></div>
LOS<div>(Lipo<b>
oligo</b>saccharid; not poly)</div><div>- damags tissus and stimulats inflam
matory rspons</div><div><br /></div><div>LOS has a much shortr sid chain tha
n lipopolysaccharid</div>
3/18Hamophilus Dicky SassinHIB
PAGE. What is it usd to idntify for Hamophilus?
polyacrylamid gl lct
rophorsis; idntifis outr mmbran protins of Hamophilus 3/18Hamophilus
Dicky SassinHIB
polyribosyl ribitol phosphat <u>typ b capsul</u> of hamophilus (HITB); maj
or caus of <b>virulnc</b>
3/18Hamophilus Dicky SassinHIB
What is targtd in th HIB vaccin?
polyribosyl ribitol phosphat of th typ
 b capsul of Hamophilus
3/18Hamophilus Dicky SassinHIB
Dos Hamophilus hav a capsul? What nams ar involvd in ths?
som of
thm<br><br>capsul == HITB (typ B)<br>non-capsul == NTHI (non typabl)<br><br
>thr ar som othr minor forms of hamophilus
3/18Hamophilus Dicky S
assinHIB
Which hamophilus ar virulnt? (giv ordr)
HITB &gt;&gt; NTHI &gt; Moraxll
a &gt; H. parainfllunz
3/18Hamophilus Dicky SassinHIB
H. influnza biogroup agyptius
part of typ B gnom <u>+ plasmid</u> m
aking it virulnt; causs <u>Brazillian hmorrhagic fvr</u> 3/18Hamophilus
Dicky SassinHIB
Hamophilus ducryi
"causs <u>vnral chancr</u>; sprad via sx<div><br /
></div><div><img src=""past-173138721636455.jpg"" /></div>"
3/18Hamophilus
Dicky SassinHIB
painful vnral chancr, dfinition and caus "<u>painful shaggy inflammd vn
ral ulcr</u> causd by <b>Hamophilus ducryi</b><div><img src=""chancr.jpg
"" /></div><div><img src=""past-173143016603751.jpg"" /></div>"
3/18Ham

ophilus Dicky SassinHIB

Caus of Brazillian hmorrhagic fvr "causd by Hamophilus influnza biogro
up agyptius<div><br /><div><img src=""past-173112951832706.jpg"" /></div></div
>"
3/18Hamophilus Dicky SassinHIB
Do Abs and complmnt work on Hamophilus?
ys; ths ar inffctiv again
st gram(+) only; Abs bind to <u>PRP capsul</u> and to an xtnt <u>LOS</u> and
outr mmbran protins 3/18Hamophilus Dicky SassinHIB
How do you slct for O157 EHEC on cultur vs. non O157? (sorbitol)
<div>Mac
Conky agar</div><div>O157 is sorbitol ngativ</div><div>non-O157 is sorbitol p
ositiv&nbsp;</div>
3/17Diarrha
dysphoric mood an unplasant, somwhat sad mood<div><br /></div><div>mood: prol
ognd motional ton</div>
dfctiv virus virus which cannot rplicat
5/12IntroToViruss
How dos th nvolop contribut to virus stability?
nvlopd ar mor fragil
 than non-nvlopd viruss
5/12IntroToViruss
What is th function of th nvlop? contains glycoprotins which incorporat
into th host cll mmbran and aid rlas of matur virions. (i.. hmaggluti
nin and nuraminidas of influnza)
5/12IntroToViruss
What ar th structural pattrns of a virus?
"ithr <u>icosahdral</u> w 20
sids (cubic) or <u>hlical</u>. som ar calld complx<div><img src=""icosa.jp
g"" /></div>" 5/12IntroToViruss
How dos rassortmnt in viral mutation occur? two viruss w <u>sgmntd gnom
s</u> infct th sam host cll and swap sgmnts (i.. influnza rapid mutatio
ns)
5/12GnralPrinciplsofViruss
What ar th diffrnt ways to classify viruss? (taxonomy)
"1. family --&gt
; Nuclic acid typ, siz, shap, rplication<br />2. gnus --&gt; physiochmica
l proprtis, gntic organization<br />3. typ --&gt; srologic<br />4. strain
--&gt; spcific to a prson<div><img src=""xampls.jpg"" /></div>"
5/12Intr
oToViruss
What is th typical rplication tim for DNA and RNA viruss? "DNA == <b>12</b
>-24 hrs<br />RNA == <b>6</b> - 24 hrs<div><br /></div><div><img src=""past-328
144091349381.jpg"" /></div>"
5/12IntroToViruss
Whr dos rplication of DNA and RNA viruss occur in th cll? (giv xcption
)
"DNA == nuclus (xcpt pox)<br />RNA == cytoplasm (xcpt influnza)<di
v><br /></div><div><img src=""past-328139796382085.jpg"" /></div>"
5/12Intr
oToViruss
What is th rplication tim of CMV virus?
"&gt;40 hours<div><br /></div><d
iv><img src=""past-328139796382085.jpg"" /></div>"
5/12IntroToViruss
What ar thr potntial outcoms from a viral infction (cllular lvl)?
"1. no apparnt ffct<br />2. cytopathology w cll dath (i.. intranuclar (DN
A), cytoplasmic (RNA) inclusion bodis)<br />3. hyprplasia (can lad to cancr)
<div><br /></div><div><img src=""cyto.jpg"" /></div>" 5/12IntroToViruss
Which organ systms ar usually affctd by viruss?
"GI and rspiratory; som
 skin and som CNS<div>(mucosal)<br /><div><img src=""apparnt.jpg"" /></div><
/div>" 5/12IntroToViruss
Which organ systms infctd by viruss hav a high prvalnc of disas?
"skin and CNS; 2/3 in rspiratory; most inapparant in GI<div><br /></div><div><
img src=""apparnt.jpg"" /></div>"
5/12IntroToViruss
What is th squnc of infction of a virus? (grossly) What is th xcption?
1. acquisition<br />2. incubation<br />3. illnss<br />4. rcovry<br />5. rsis
tanc (<b>xcpt for acut</b>) 5/12IntroToViruss
"<img src=""pastDITOt5.png"" />"
acut infction 5/12IntroToViruss
"<img src=""pastpgfkgx.png"" />"
latnt infction
5/12IntroToVirus
s
"<img src=""pastBAo8XT.png"" />"
chronic/prsistnt infction
"<img src=""past8zL8zh.png"" />"
chronic/progrssiv infction (i.. HIV)
Non-prsistnt infctions ar dividd into what two classs?
"surfac/local v
s. systmic<div><br /></div><div><img src=""past-329501301014891.jpg"" /></div>
<div><br /></div><div><img src=""past-329681689641297.jpg"" /></div>" 5/12Intr
oToViruss

How do intrfrons work? Giv biochm pathway "JAK/STAT pathway activation ind
ucs production of nw cllular protins which may <u>block viral rplication</u
> at any stp<div><img src=""jak.jpg"" /></div><div><br /></div><div><img src="
"past-330368884408676.jpg"" /></div>" 5/12IntroToViruss
Whn is IgM and IgG scrtd wrt virus dfns? IgM == initial rspons<br>IgG =
= latr rspons or w rpatd infction
5/12IntroToViruss
How do viruss inhibit th host immun rspons? (4)
1. cllular rgulation (
virokins, virocptors, intracllular protins)<br />2. antign prsntation (MH
C, complmnt, Abs)<br />3. infct immun clls<br />4. antignic protin modifi
cation 5/12IntroToViruss
virokins
viral <b>cytokin</b> <b>agonists</b> or <b>antagonists</b> that
<u>altr host dfns</u>
5/12GnralPrinciplsofViruss
virocptors
viral rcptors which altr host dfns
5/12IntroToVirus
s
What immunopathologic vnts may occur w viral infction?
1. T3H == immun
complxs (i.. hp B)<br />2. T4H == cll mdiatd (i.. chronic hpatitis)<br
/>3. autoimmunity == i.. ntroviral cardiomyopathy 5/12IntroToViruss
Is purifid viral nuclic acid infctious?
usually not --&gt; nd th whol
 virion
5/12IntroToViruss
snsation vs. prcption
dtcting vs. undrstanding a stimulus; prcpti
on is a construction of th brain
5/16CorticalEaglman
What is th input of primary, scondary and trtiary cortx?
1. primary == th
alamic rlay nucli from snsory organs<br>2. scondary == from primary cortx<b
r>3. trtiary == association cortx rciving info from multipl snss, usually
from scondary cortx 5/16CorticalEaglman
Whr is th visual cortx locatd (V1, V2, V3)?
"primary (V1) == <u>post
rior occipital lob</u> (calcarin fissur)<br />scondary (V2) == <u>prstriat
 cortx</u> around V1 and <u>infrotmporal cortx</u><br />trtiary == various
aras but largst is <u>postrior parital cortx</u><div><u><br /></u><div><u>
<img src=""visual.jpg"" /></u></div></div><div><u><br /></u></div><div><u><img
src=""past-73010149064902.jpg"" /></u></div>" 5/16CorticalEaglman
Why is a scotoma not always noticd?
"<div>""compltion"" of th fild by th
brain -- filling in th spot</div><div><img src=""comp.jpg"" /></div>"
5/16CorticalEaglman
agnosia failur of rcognition of objcts du to damag in scondary/trtiary co
rtx
5/16CorticalEaglman
What kinds of visual agnosia is thr? (3)
1. objct<br>2. motion (akintop
sia)<br>3. color (achromatopsia)
5/16CorticalEaglman
akintopsia. Lsion?
motion agnosia; dorsal visual stram
5/16CorticalEagl
man
achromatopsia. Lsion? color agnosia; <u>vntral visual stram</u>
5/16Cort
icalEaglman
associativ agnosia. Lsion?
"cannot plac a word to an objct, but can copy;
scondary visual cortx<div><br /></div><div><b>vntral what stram lsion</b><
br /><div><img src=""2 xampls.jpg"" />,</div></div>" 5/16CorticalEaglman
aprcptiv agnosia. Lsion?
"can idntify what objcts ar but cannot match
or copy drawings; scondary visual cortx<div><br /></div><div><b>dorsal whr s
tram lsion</b></div><div><br /></div><div><img src=""2 xampls.jpg"" /></div
><div><br /></div><div><br /></div><div><br /></div>" 5/16CorticalEaglman
What is th dorsal stram? What cortx dos it connct to?
"""whr""/contr
ol of<b> bhavior</b> pathway V1 connctions to V2 in<b> postrior parital</b><
div><img src=""stram.jpg"" /></div>" 5/16CorticalEaglman
"What is in th ""vntral stram""? (2) what cortx dos it connct"
"""what"
"/conscious <b>prcption </b>pathway nurons from V1 to V2 in th<b> infrotmp
oral cortx</b><div><img src=""stram.jpg"" /></div>" 5/16CorticalEaglman
prosopagnosia; whr is th lsion?
"inability to rcogniz facs -- lsion
in th vntral stram at <b>antrior infrotmporal lob</b><div><img src=""stra
m.jpg"" /></div><div>Dorsal stram intact, so <i>unconscious</i> fac rcogniti
on intact</div>"
5/16CorticalEaglman
apraxia; whr is th lsion? dficit in xcuting <u>larnd purposful movm

nts</u> dspit dsir and physical ability -- lsion is in th <u>dorsal stra
m</u> 5/16CorticalEaglman
slctiv attntion
ability to focus in on objcts in our visual fild w lac
k of dtail of background
5/16CorticalEaglman
Damag to slctiv attntion mans a lsion whr?
dorsal stram (involvd
in localizing objcts in spac) 5/16CorticalEaglman
hmi-nglct, lsion? "lsion in <u>right parital associativ cortx</u>--&gt
; ignor lft sid of th world. lsion is usually in th <u>right</u> parital
lob maning that th lft is ignord<div><img src=""RT.jpg"" /></div>"
5/16CorticalEaglman
"<img src=""past_7_j8.png"" />"
hmi-nglct
5/16CorticalEaglman
Balints syndrom
"bilatral damag to <b>postrior parital lobs </b>rs
ults in complt inability to scan th visual fild or pic togthr what you s
5/16CorticalEaglman
<div><img src=""balint.jpg"" /></div>"
simultanagnosia. Lsion is?
"can only prciv on objct at a tim, not th
ntir visual fild; cannot dscrib a complx scn; <b>difficulty drawing</b>
bc thy cannot s both th pn and th papr simultanously<div><br /></div><d
iv>Balints syndroms: Lsion in bilatral&nbsp;<u>dorsal visual stram du to <b
>postrior parital damag</b></u><br /><div><img src=""simultan.jpg"" /></div>
</div>" 5/16CorticalEaglman
optic ataxia? Lsion? dficit in <u>raching</u> undr visual guidanc == lsi
on in <u>dorsal</u> stram
5/16CorticalEaglman
What is th input to SI and SII?
"SI == contralatral snsation from pri
phry<br />SII == bilatral input from SI<div><img src=""SI.jpg"" /></div>"
5/16CorticalEaglman
Whr is somatic association cortx?
"postrior parital lob<div><img src=""
association.jpg"" /></div>"
5/16CorticalEaglman
astrognosia inability to rcogniz objcts by touch 5/16CorticalEaglman
asomatognosia. associatd with what?
failur to rcogniz parts of ons own
body (i.. throwing th lg out of th bd); oftn associatd w anosagnosia
5/16CorticalEaglman
anosagnosia
"patint dos rcogniz his symptoms -- gos togthr with asoma
tognosia<div><img src=""anosag.jpg"" /></div><div><i>nosos=&nbsp;</i>disas;<i
> gnosis=</i>knowldg&nbsp;</div>"
5/16CorticalEaglman
What to primary/scondary/trtiary auditory cortx rspond to? primary == pur
tons<br />scondary == monky calls, tc.<br />trtiary == languag comprhnsi
on
5/16CorticalEaglman
Which hmisphr is usually important for languag comprhnsion?
LEFT
5/16CorticalEaglman
aphasia languag dficits
5/16CorticalEaglman
Brocas aphasia "cannot spak or xprss thmslvs dspit normal intllignc<
div><img src=""aphasia.jpg"" /></div>" 5/16CorticalEaglman
Whr is Brocas ara? "<u><b>lft</b> infrior prfrontal cortx</u> right nx
t to th <u>motor cortx</u><div><img src=""ara.jpg"" /></div><div><img src=""
3 ara.jpg"" /></div><div>3. 1 is prmotor ara</div>" 5/16CorticalEaglman
Wrnicks aphasia
"<div>do not undrstand othrs and just produc a word s
alad, writ gibbrish, sign random, tc.</div><div><img src=""sampl.jpg"" /></
div><div>Frnch and sign languag too</div>"
5/16CorticalEaglman
What is th diffrnc in motional status of Brocas and Wrnicks patints?
"Brocas ar upst (raliz impairmnt), Wrnicks dont rally car (dont kno
w why popl ar not undrstanding)<div><img src=""both.jpg"" /></div>"
5/16CorticalEaglman
Whr is Wrnicks ara?
"right nxt to auditory cortx<div><img src=""w
rnick.jpg"" /></div><div><img src=""3 ara.jpg"" /></div><div>6</div>"
5/16CorticalEaglman
What ar som common causs of Wrnicks, Brocas aphasia? (4) "<div>1. Intrna
l or common&nbsp;<u>carotid</u>&nbsp;artry occlusions<br /></div>2. <u>MCA</u>
vnts<br />3. <u>PCA</u> vnts<br />4. tumors, abscsss, focal TBIs<div><img
src=""tio.jpg"" /></div><div>Carotid--&gt;MCA/PCA</div>"
5/16CorticalEagl
man

conduction aphasia; lsion?

"damag to th <u>arcuat fasciculus </u>== unab
l to rpat phrass<div><img src=""conduction.jpg"" /></div>" 5/16CorticalEagl
man
arcuat fasciculus; lsion?
"conncting tissu btwn Brocas and Wrnick
s aras. lsion rsults in inability to rpat phrass<div><img src=""arcuat.jp
g"" /></div>" 5/16CorticalEaglman
global aphasia. Caus? "Brocas + Wrnicks. cannot spak, comprhnd, or rp
at phrass. usually causd by <u>MCA infarct</u><div><u><br /></u><div><img src=
""Global aphasia.jpg"" /></div></div>" 5/16CorticalEaglman
lsion to lft angular gyrus: "alxia + agraphia (rading + writing)<div><img
src=""alxia.jpg"" /></div><div><img src=""17.jpg"" /></div><div>17</div>"
5/16CorticalEaglman
Whr is th lft angular gyrus?
"postrior to Wrnicks ara<div><img s
rc=""3 ara.jpg"" /></div><div>Bhind 6</div><div><img src=""17.jpg"" /></div>
<div>17</div>" 5/16CorticalEaglman
Is spch cntr latrality diffrnt wrt handdnss? right handd == lft hm
isphr in narly all<br>lft handd == lft hmisphr in most<br><br>so not r
ally
5/16CorticalEaglman
How do w dtrmin th dominant hmisphr wrt auditory/languag comprhnsion?
1. <u>sodium amytal (Wada) tst</u> (ansthtiz 1 hmisphr, chck lnguag fu
nction)<br />2. <u>fMRI</u> (s which is activ during languag tst) 5/16Cort
icalEaglman
sodium amytal (Wada) tst
ansthtiz on hmisphr and chck for languag
 function to dtrmin which hmisphr is dominant
5/16CorticalEaglman
What ar th 3 divisions of th frontal lob? What is associatd w lsions of a
ch?
"1. primary motor cortx == contra waknss/paralysis<br />2. pr-motor
cortx == incoordination<br />3. pr-frontal cortx == impaird dcision making<
div><img src=""full frontal.jpg"" /></div><div><img src=""prmotor.jpg"" /></d
iv>"
5/16CorticalEaglman
What damags th frontal lob? strss + obvious rasons lik stroks 5/16Cort
icalEaglman
What happns phnotypically w a frontal lob lsion?
prson sms normal but
thy do not considr long trm goals, planning, working mmory, motional impair
mnts, tc.
5/16CorticalEaglman
dorsolatral PFC function.(3) &nbsp;Damag can b dtcd in what tst? "Functio
n: holds ""cold"" rasoning ability, working mmory, important for larning from
mistaks;<div>Lsion: thy cannot chang ruls in th card sorting gam (<u>dor
solatral syndrom</u>--&gt;<u>inrtia</u>)<div><img src=""DPFC.jpg"" /></div><
/div>" 5/16CorticalEaglman
orbitofrontal PFC function. Damag (3)? "Function: putting asid attractiv thin
gs to furthr a longr trm stratgy. Putting asid ""hot"" motions<div><div>L
sion:&nbsp;<u>Disinhibition</u>, <u>impulsiv</u>,&nbsp;<u>nvironmntal dpnd
ncy syndrom&nbsp;</u>(patints w damag s a hammr and nail and MUST us it)<
/div><div><div><img src=""OPFC.jpg"" /></div><div><img src=""gag.jpg"" /></di
v></div></div>" 5/16CorticalEaglman
orbitofrontal syndrom (3)
-motional disinhibition --&gt; do not s cons
quncs<br />-sxual aggrssion<br />-shoplifting, irrsponsibl w mony, immatu
r, tc.<br /><br />-lik a <u>drunkn adolscnt</u><div>Phinas Gag</div>
5/16CorticalEaglman
vntromdial PFC. Lsion? Ovractivity? "connction and maning, dcision making
,&nbsp;<div><br /><div>Lsion: inducs <u>dprssion</u> and maninglss xistn
c</div><div>Ovractivity: inducs <u>mania</u> or paranoia;&nbsp;</div><div><i>
this is th targt in dprssd patints for DBS</i><div><img src=""vntro (1).j
pg"" /></div></div></div>"
5/16CorticalEaglman
frontotmporal lobar dgnration 3 clinical syndroms<div>&lt;65, &gt;65 MCC?</
div>
1. frontotmporal dmntia<br />2. smantic dmntia<br />3. progrssiv
nonflunt aphasia<br /><br />&lt;65 == 2nd MCC dmntia<br />&gt;65 == 4th MCC
dmntia<br><br>-patints know actions ar wrong but thy cannot hlp it; 57% ar
 sociopathic 5/16CorticalEaglman
Which influnza causs pandmics? Why? A -- only this infcts aquatic <u>watr

fowl</u>, undrgos <u>mutation</u>, and can infct a larg sgmnt of th popul
ation
What is influnza pathognsis (acquisition, local/systmic sxs)? Incubation?
1. airborn acquisition<br />2. Local symptoms: surfac infction (cll dstruct
ion)<br />3. Systmic symptoms: cytokin production<br /><br />2-3 day incubatio
n, abrupt onst
What ar th atypical flu symptoms in th ldrly?
Symptoms ar not typical
:<div>fvr (&gt;99)</div><div>lassitud (sns of warinss)</div><div><u>confu
sion</u></div><div>nasal obstruction</div>
What is th pathognsis of low path and high path avian influnza?
"low pat
h == rsp local infctions, fw basic AAs<br />high path == virmic systmic inf
ction, many basic AAs; high path strains hav a highly clavabl HA<div><img sr
c=""avain.jpg"" /></div>"
Whr is H5N1 avian influnza? china
Which pair of symptoms suggsts a diagnosis of influnza whn th virus is circu
lating? fvr + cough
What is th principal rsrvoir for antignic shift variants of influnza A?
"aquatic watr fowl<div><img src=""pandmic.jpg"" /></div>"
What is th frquncy of schizophrnia? Whn dos it occur?
1% in th lat t
ns or arly 20s (collg agd)
5/21ThoughtDisordrs
What ara of th world is mor pron to schizophrnia? global prvalnc
5/21ThoughtDisordrs
What is th diagnostic critria for schizophrnia? What is th timfram?
At last two of th following for <u>ovr a month</u>&nbsp;(activ):<br />1. hal
lucinations<br />2. bizarr dlusions<br />3. disorganizd spch<br />4. grossl
y disorganizd or catatonic bhavior<br />5. ngativ symptoms -- flat affct, a
logia, avolition<br /><br />--symptoms, including <u>prodromal</u>, should b pr
snt for <u>at last 6 months</u><br />--dcrasd functioning in th world<br
/>--no mood symptoms<br />--no mdical causs/not substanc inducd
5/21Thou
ghtDisordrs
What ar th xclusion critria for schizophrnia?
1. mdical caus<br>2. s
ubstanc inducd<br>3. mood symptoms
5/21ThoughtDisordrs
What ar th positiv symptoms of schizophrnia?
hallucinations, dlusion
s, disorganizd bhavior
5/21ThoughtDisordrs
schizophrnic thought insrtions
"voics ar tlling th patint to do so
mthing, <b>vry important to inquir about</b><div><b><font color=""#ff0000""><
br /></font></b></div><div><font color=""#ff0000""><b><u>Can b thinking about k
illing othrs, slf</u></b></font></div>"
5/21ThoughtDisordrs
What ar th ngativ symptoms of schizophrnia?
flat affct, poor hygin
, lack of initiativ/nrgy, tc.
5/21ThoughtDisordrs
What ar th rats of suicid in schizophrnic patints?
"50% attmpt, 10
% succd<div><br /></div><div><font color=""#ff0000""><b>VERY IMPORTANT TO ASK<
/b></font></div>"
5/21ThoughtDisordrs
<u>proccupation w dlusions</u>&nbsp;(frquntly auditory) and othr symptoms a
r not prominnt; bst prognosis; latr onst&nbsp;
<u>Paranoid Schizophrni
a</u> 5/21ThoughtDisordrs
Which typ of schizophrnia has th bst prognosis?
paranoid
5/21Thou
ghtDisordrs
ithr xcssiv movmnt or immobility, ngativ or mut, cholalia or choprax
ia
catatonic schizophrnia 5/21ThoughtDisordrs
Schizophrnia whr all ar prominnt: disorganizd spch, disorganizd bhavio
r, flat/inappropriat bhavior disorganizd schizophrnia
5/21ThoughtDisor
drs
What ar som mdical conditions that caus thought disordrs? (6)
1. Parki
nsons<br />2. Wilsons<br />3. Huntingtons<div><br />4. Hpatic Encphalopathy
<br />5. Hypo/Hyprthyroid<br />6. B12 dficincy</div> 5/21ThoughtDisordrs
What ar som substancs that can induc thought disordrs? (mdications, abus,
withdrawal)
-mdications --&gt; <b>stroids, anti-ACh, IFNs</b><br />-abusd
--&gt; alcohol and drugs<br />-withdrawal --&gt; alcohol, sdativs, hypnotics,
anxiolytics
5/21ThoughtDisordrs

"How is schizophrniform diffrnt from schizophrnia? <b><font color=""#ff0000"

">ON TEST</font></b>" 1) Th total duration of illnss (including prodromal, a
ctiv, and rsidual phas) <u>1 &lt; x &lt; 6 months</u><div><u><br /></u>2)impa
ird functioning in socity is <u>NOT rquird</u><div><u><br /></u></div><div>S
chizophrnia is prodrom at last 6 months</div></div> 5/21ThoughtDisordrs
What indicats a good prognosis for schizophrniform disordr? (4)
1. onst
of <b>psychotic symptoms</b> <b>within first four wks</b> of chang of bhavi
or<br />2. confusion at hight of pisod<br />3. good functioning bfor disas
<br />4. absnc of flat affct
5/21ThoughtDisordrs
What prcntag of schizophrniform patints rcovr within th 6 months?
33%; th rst go on to schizophrnic or schizoaffctiv disordr
5/21Thou
ghtDisordrs
dscrib brif psychotic disordr. What is th timing? <u>suddn onst</u> of t
hought disordr and lasts <b>1 day &lt; x &lt; 1 month</b>; oftn <u>prcdd by
a strssor</u>, onst in 20s-30s
5/21ThoughtDisordrs
<u>non-bizarr</u>&nbsp;dlusions for at last&nbsp;<u>on month</u>&nbsp;(rmm
br bizarr is dfind by cultur); functioning is fin; mor common in fmals;
onst in mid-lat lif&nbsp; <u>Dlusional Disordr<br /></u><div><br /></div
><div><br /></div><div>Non-bizzar: could happn in ral lif: bing followd, p
oisond, infctd, lovd at a distanc, dcivd by spous or lovr, having dis
as</div><div><br /></div><div><br /></div><div><i>50 yr old Lady who thought n
ighbors with thin wall wr listning in on hr, burnd hous down. Dnis think
ing any illusion</i></div>
5/21ThoughtDisordrs
Schizoaffctiv Disordr, dfin and prognosis psychotic symptoms + mood sympto
ms (dprssd, manic);&nbsp;<div><br /></div><div>DSM5: major <b>mood pisod</b
> must b prsnt for th majority of th total disordrs duration</div><div><d
iv><br /><div>bttr prognosis than schizophrnia but wors than mood disordrs;
rlativs at highr risk</div></div><div><br /></div><div>Not schizophrnia nor
a mood disordr</div></div>
5/21ThoughtDisordrs
Shard Psychotic Disordr
on prson taks on th othrs dlusion in a cl
os rlationship; RARE<div><i><br /></i></div><div><i>Foli a Dux = shard madn
ss</i></div> 5/21ThoughtDisordrs
mood disordr + som psychosis but not that much
Mood Disordr with Psych
otic Faturs (not th diffrnc from schizoaffctiv)
5/21ThoughtDisor
drs
What causs a thought disordr? biological prdisposition and psychosocial facto
rs (<u>strss-diathsis</u> modl)
5/21ThoughtDisordrs
Which ara of th brain is involvd in th positiv symptoms of thought disordr
s?
"msolimbic dopamin pathway (too much)<div><img src=""schizo.jpg"" /><
/div>" 5/21ThoughtDisordrs
Which ara of th brain is involvd in ngativ symptoms of thought disordrs?
"msocortical dopamin pathway (too littl)<div><img src=""schizo.jpg"" /></div
>"
5/21ThoughtDisordrs
What is th vidnc for dopamin involvmnt in psychosis?
1. D agonists (a
mphtamins) produc psychosis<br />2. D rcptor blockrs (anti-psychotics) rd
uc psychosis 5/21ThoughtDisordrs
<div>Though th amphtamin/antipsychotic action of dopamin hypothsis supports
dopamin pathway in psychosis, what do th following show?</div><div><br /></di
v><div>1. LSD and PCP produc psychosis and act at glutamat rcptors<br />2. a
nti-psychotics tak 2-10 wks<br />3. dopamin rcptors ar not abnormal in ps
ychosis<br />4. ngativ symptom link to dopamin not clar</div>
Evidnc
<u>against</u> dopamin involvmnt in psychosis
5/21ThoughtDisordrs
Glutamat hypothsis of psychosis? Evidnc?
-glutamat <u>hypractivity</u>
rsults in <u>xcitotoxicity</u><div><br /></div><div>PCP--&gt;xcits glutamat
rcptors--&gt; psychosis</div><div>DLPFC--&gt; glutamat activity sms undra
ctiv in psychosis</div>
5/21ThoughtDisordrs
Nurodvlopmnt Hypothsis of schizophrnia? What is th vidnc for this?
schizophrnia ariss from abnormal dvlopmnt and prsnts in adulthood:<br /><
br />1. OB/prgnancy complications<br />2. &quot;soft&quot; nurological signs<b
r />3. mor clls in dp cortical layrs, lss in outr layrs<br />4. cortical

atrophy and vntricular nlargmnt

5/21ThoughtDisordrs
What ar som in vivo changs in th schizophrnic brains? (3) 1. vntriculomg
aly<br />2. abnormal functional scans of FTP lobs<br />3. chmical changs of F
T lobs on MRI spc
5/21ThoughtDisordrs
What ar som post-mortm changs in th schizophrnic brain? 1. <u>vntriculo
mgaly</u>&nbsp;and&nbsp;<u>tmporal lob</u> atrophy<br />2. <u>no gliosis</u>
== no post natal brain injury<br />3. <u>abnormal nural migration</u> in FT lob
s
5/21ThoughtDisordrs
Whr is thr abnormal brain dvlopmnt in schizophrnic brains?
FPT lob
s only 5/21ThoughtDisordrs
How do w trat psychotic disordrs?
1. hospitaliztion --&gt; valuation, saf
ty, pt. cannot car for slf<br>2. mdications<br>3. patint and familial duca
tion<br>4. advocacy groups<br>5. psychothrapy --&gt; improv rality tsting, i
mprov complianc, idntify strssors 5/21ThoughtDisordrs
Classify <i>Paramyxovirada</i>:<br /><br />1. DNA or RNA<br />2. Icosahdral vs
. Hlical<br />3. Singl-strandd (if RNA, giv + or - sns) vs. Doubl-strand
d<br />4. Envlopd vs. Non-nvlopd (nakd) "1. RNA<br />2. Hlical<br />3.
Singl-strandd (-) sns<br />4. Envlopd<div><br /></div><div><i>para- bsid
propr</i></div><div><br /></div><div><div>Hlical capsidnvlopd, linar, (-)
sns ssRNA paramyxoviruss</div></div><div><br /></div><div><img src=""past-60
5714942788050.jpg"" /></div>" 5/13Paramyxovirus RNA Viruss paramyxo
List 3 ways <i>Paramyxovirida</i> ar diffrnt from <i>Orthomyxovirida</i>
In <i>Paramyxovirida</i><br />1. Both ar ssRNA but para is not sgmntd<br />
2. HA and NA ar part of th sam glycoprotin (1 spik)<br />3. Fusion (F) prot
in on surfac causs host clls to fus togthr --&gt; multinuclatd giant c
lls (syncitium)<br /> 5/13Paramyxovirus Paramyxo RNA Viruss
Causs Parotitis
"Mumps<br /><br /><div>(<i>Paramyxovirida Rubulavirus <
/i>mumps virus)</div><div><img src=""parotitis.jpg"" /></div>" 5/13Paramyxoviru
s Buzz Paramyxo RNA Viruss
What ar th cll walls of fungi mad of?
chitin fungi fungi_lftovrsBr
nt
ukaryotic
Ar fungi ukaryotic or prokaryotic?
fungi fungi_lftovrsBr
nt
"Moulds or yasts ar singl small oval clls that rproduc by simpl budding.<
br /><img src=""A01_yast (1).png"" />" yasts<br /><br />(A01_yast) fungi fu
ngi_lftovrsBrnt picturs
"Moulds or yasts ar mad up of filamntous strands calld hypha that ar ith
r sptat or non-sptat.<br /><img src=""A02_Mould.png"" /><img src=""A03_Moul
d.png"" />"
moulds<br><br>(A02_mould)(A03_mould)
fungi fungi_lftovrsBr
nt picturs
How do most fungi rproduc?
by forming spors throught mitosis
fungi fu
ngi_lftovrsBrnt
Th unicllular growth form of fungi
yast fungi fungi_lftovrsBrnt
"Multicllular colonis composd of intrtwind branching hypha<br /><img src="
"A05_myclium.png"" /><br /><br />"
moulds<br><br>(A05_myclium)
fungi fu
ngi_lftovrsBrnt picturs
Th rproducing bodis of moulds.
spors fungi fungi_lftovrsBrnt
"Th ssntial strol found in fungi plasma mmbrans<br /><img src=""A04_cllwa
ll.png"" />"
rgostrol<br><br>(A04_cllwall)
fungi fungi_lftovrsBr
nt picturs
What ar th 3 common drmatophyts?
microsporum, trichophyton, and pidrmop
hyton--ths fungi scrt an nzym calld kratinas which digsts kratin; th
 digstion of kratin manifsts as scaling of th skin, loss of hair, and crumb
ling of nails fungi fungi_lftovrsBrnt
"Main symptom is itching.&nbsp;&nbsp;Th skin cracks and small clustrs of blist
rs may form on th sol of th foot.&nbsp;&nbsp;Can also b sn as a moccasinlik distribution of dry skin.<br /><img src=""A06_TinaPdis.png"" /><br />"
tina pdis (athlts foot)<br /><br />(A06_tinapdis)
cas fungi fungi
_lftovrsBrnt picturs
"Infction common bgins btwn th tos and causs cracking/pling of th ski

n.&nbsp;&nbsp;Gnrally starts in latral intrdigital spacs of th foot.<br />

<img src=""A07_tinapdis.png"" />"
tina pdis (athlts foot)<br /><br />
(A07_tinapdis)
cas fungi fungi_lftovrsBrnt picturs
5 clinical syndroms causd by drmatophyts. tina pdis (athlts foot), on
ychomycosis, tina cruris (jock itch), tina corporis (ringworm), tina capitis
fungi fungi_lftovrsBrnt
Nail infction causd by drmatophyts. onychomycosis fungi fungi_lftovrsBr
nt
"Nails ar thicknd, discolord, and brittl.<br /><img src=""A09_tinaunguim.p
ng"" />"
onychomycosis (drmatophyts) - spcifically distal subungual on
ychomycosis<br /><br />(A09_tinaunguim)
fungi fungi_lftovrsBrnt pictu
rs
"Young mn most commonly involvd.&nbsp;&nbsp;Thy dvlop itchy rd patchs on
th groin and scrotum.<br /><img src=""A11_tinacruris.png"" />"
tina cr
uris (jock itch)<br /><br />(A11_tinacruris) fungi fungi_lftovrsBrnt pictu
rs
"Most oftn sn in childrn in tropical climats.&nbsp;&nbsp;Following invasion
of th skin, th fungi sprads, forming a ring shap with a rd raisd bordr.<
br /><img src=""A12_ringworm.png"" />" tina corporis (ringworm) - calld this
sinc it looks lik a ring-shapd worm undr th skin<br /><br />(A12_ringworm)
cas fungi fungi_lftovrsBrnt picturs
"Primarily occurs in childrn.&nbsp;&nbsp;Th infcting organisms grow in th ha
ir and scalp, rsulting in scaly rd lsions with loss of hair.&nbsp;&nbsp;<br /
><img src=""A15_tinacapitis.png"" />" tina capitis<br /><br />(A15_tinacapit
is)
cas fungi fungi_lftovrsBrnt picturs
This organism is diagnosd by putting skin scrapings in potassium hydroxid (KOH
).&nbsp;&nbsp;Th KOH digsts th kratin.&nbsp;&nbsp;Microscopic xamination wi
ll rval branchd hypha.
drmatophyts fungi fungi_lftovrsBrnt
"Idntifid by th powdry, vlvty/cottony apparanc of colonis.&nbsp;&nbsp;T
h hypha ar sptat and branch at acut angls.<br /><img src=""A16_asprgillu
s.png"" />"
asprgillus<br /><br />(A16_asprgillus)
fungi fungi_lft
ovrsBrnt picturs
Invasiv disas du to asprgillus occurs in what typ of patint populations?
B spcific (4) 1) lukmic patints/bon marrow transplant rcipints<br />2) s
olid organ transplant rcipints on corticostroids<br />3) patints with CGD<br
/>4) patints with lat-stag AIDS (vry low CD4 clls)
fungi fungi_lft
ovrsBrnt
Asprgillus causs 3 major typs of disas in humans.&nbsp;&nbsp;What ar thy?
1) allrgic asprgillus<br />2) asprgilloma<br />3) invasiv pulmonary asprgil
losis fungi fungi_lftovrsBrnt
Patint dvlops malais, chills, fvr, cough, and myalgias 4-8 hours aftr inh
alational antign xposur.&nbsp;&nbsp;H/sh is using th hatr for th first
tim this sason.&nbsp;&nbsp;Fungal.
allrgic asprgillus (allrgic alvoliti
s--<u>hyprsnsitivity pnumonia</u>) cas fungi
Occurs in prsons with p<b>rxisting asthma </b>and is charactrizd by <b>osi
nophilia, flting pulmonary infiltrats</b>.&nbsp;&nbsp;Manifsts as difficult
to control asthma.
"allrgic bronchopulmonary asprgillosis (ABPA)<div><br
/></div><div><br /></div><div>1. Fvr</div><div>2. Whzing</div><div>3. Migrat
ory Pulmonary infiltrats</div><div><img src=""past-43215960932733.jpg"" /></di
v>"
Dicky fungi
Manifsts as difficult to control asthma.&nbsp;&nbsp;Charactrizd by osinophil
ia and flting pulmonary infiltrat. "allrgic bronchopulmonary asprgillosis
(ABPA)<div><br /></div><div><br /></div><div><div>1. Fvr</div><div>2. Whzin
g</div><div>3. Migratory Pulmonary infiltrats</div><div><br /></div><div><img s
rc=""past-43215960932733.jpg"" /></div></div>" Dicky fungi
Manifsts as prxisting asthma thats difficult to control.&nbsp;&nbsp;Srum Ig
E/IgG ar lvatd.
allrgic bronchopulmonary asprgillosis (ABPA) fungi fu
ngi_lftovrsBrnt
"Fungal infction that occurs in patints with som othr <b>prxisting lung di
sas </b>that has lft th patint with <b>rsidual cavitis. </b><br /><img sr

c=""A18_Asprgilloma.png"" /><div><br /></div><div><br /></div>"

"asprgi
lloma: fungus balls that ar gravity dpndnt and oftn occur in pts with TB or
Klbsilla bfor<div><br /></div><div><img src=""past-43220255900029.jpg"" />
</div>" Dicky fungi picturs
CT scan dmonstrats a mobil round/oval mass on a stalk within a cavity that ha
s a crscnt of air around it. asprgilloma
cas fungi fungi_lftovrsBrnt
Fungal infction whr patint occasionally dvlop hmoptysis.&nbsp;&nbsp;Pati
nt has a prxisting lung disas that has lft thm with rsidual cavitis.
asprgilloma (fungus ball)
cas fungi fungi_lftovrsBrnt
A woman undrgoing chmothrapy for acut myloid lukmia alarms hr physician
whn sh dvlops fvr, xprincs chst pains, and cough up blood.&nbsp;&nbsp
;CXR shows pulmonary infiltrats and subsqunt biospy rvals branchd hypha.&
nbsp;&nbsp;Physician bgins trating patint with antifungals including amphotr
icin B. "invasiv pulmonary asprgillosis (asprgillus)<div><br /></div><div>(br
anchd hypha, immunocompromisd)</div><div><br /></div><div>1. Pts with nutrop
nia from lukmia or lymphoma</div><div>2. fvr, hmoptysis</div><div><br /></
div><div><br /></div><div><img src=""past-43443594199421.jpg"" /></div>"
Dicky cas fungi
"Disas causd by asprgillus in th immunocompromisd individual.<br /><img sr
c=""A19_invasivasprgillus.png"" />" invasiv pulmonary asprgillosis<br /><b
r />(A19_invasivasprgillus) fungi fungi_lftovrsBrnt picturs
Fungus ball associatd with hmoptysis. asprgilloma
fungi fungi_lftovrsBr
nt
Fungal organism has a prdisposition to invad blood vssls producing infarctio
n with ncrosis. Patint prsnts with pluritic chst pain, fvr, hmoptysis.
asprgillus
fungi fungi_lftovrsBrnt
Patint populations at risk for mucormycosis. 1) poorly controlld diabtics w
ith ktoacidosis<br>2) patints with rnal failur that ar rciving dsfrriox
amin chlation thrapy<br>3) lukmic patints or bon marrow transplant rcipi
fungi fungi_lftovrsBrnt
nts
"Organism has broad, vry irrgular, non-sptat hypha that branch at right angl
s.<br /><img src=""A22_zygomycosis.png"" />" mucorals<br /><br />(A22_zygomy
cosis) fungi fungi_lftovrsBrnt picturs
"Mould that producs rd pigmnt in vitro<br /><img src=""A25_pnicillium.png""
/>"
pnicillium marnffi<br /><br />(A25_pnicillium)
fungi fungi_lft
ovrsBrnt picturs
"Found almost xclusivly in patints from Southast Asia usually in individuals
with AIDS<br /><img src=""A23_PnicilliumMarn.png"" />"
pnicillium marn
ffi<br /><br />(A23_pnmarn) fungi fungi_lftovrsBrnt picturs
"45 dgr angl branching with sptat hypha.<br /><img src=""A17_asprgillus.
png"" />"
asprgillus<br /><br />(A17_asprgillus)
fungi fungi_lft
ovrsBrnt picturs
Tru or fals: clinical symptoms of fungal infctions clustr around lungs, skin
s, and mucus mmbrans. tru--surfacs xposd to th outsid world
fungi fu
ngi_lftovrsBrnt
Infctions by this fungus may involv ft, nails, body, hair, or groin drmatop
hyts--diagnosis dpnds on clinical apparanc, microscropy, and cultur scrapi
ngs
fungi fungi_lftovrsBrnt
Microsporum, trichophyton and pidrmophyton blong to what largr group?
drmatophyt
fungi fungi_lftovrsBrnt
Starts btwn 4th/5th or 3rd/4th tos of foot and main symptom is itching.<br>
tina pdis (athlts foot)
fungi fungi_lftovrsBrnt
fungal infction of th skin that causs scaling, flaking, and itching of affct
d aras. It is causd by fungi in th gnus Trichophyton and is typically trans
mittd in moist aras whr popl walk barfoot
tina pdis (athlts f
oot)
fungi fungi_lftovrsBrnt
drmatophyt fungal infction of th groin rgion in ithr sx tina cruris (jo
ck itch)
fungi fungi_lftovrsBrnt
Inhalation of asprgillus spors in an individual with undrlying asthma or cyst
ic fibrosis is likly to dvlop what? allrgic bronchopulmonary asprgillosis

(ABPA) fungi fungi_lftovrsBrnt

Poorly controlld <b>diabtics with ktoacidosis</b>, patints with <b>rnal fai
lur that ar rciving dsfrrioxamin chlation thrap</b>y, and <b>lukmic p
atints</b> ar likly to dvlop what fungal infction?
"mucormycosis<di
v><br /></div><div><img src=""past-43860206027125.jpg"" /></div>"
Dicky f
ungi
Nam a filamntous fungi that branchs at acut angls. asprgillus
fungi fu
ngi_lftovrsBrnt
Moulds that invad th stratum cornum of th skin or othr kratinizd tissu d
drmatophyts fungi fungi_lft
rivd from pidrmis (hair &amp; nails).
ovrsBrnt
Proximal or distal subungual onychomycosis in immunocompromisd individuals?
"proximal<br /><img src=""A29_proximaloncy.png"" /><br />(A29_proxoncy)"
fungi fungi_lftovrsBrnt picturs
Occurs in groin and antrior things of young mn.&nbsp;&nbsp;Itching and scaling
of skin
tina cruris (jock itch)
fungi fungi_lftovrsBrnt
Occurs on trunk and lgs of childrn in tropical aras.&nbsp;&nbsp;Inflammation
may occur
tina corporis (ringworm)
fungi fungi_lftovrsBrnt
Occurs in childrn only.&nbsp;&nbsp;Brakag of hair
tina capitis (hair inf
ction) fungi fungi_lftovrsBrnt
Ubiquitous mould that has low intrinsic virulnc but causs invasiv disas in
immunocompromisd patints (i DM, lukmia, rnal failur)
mucorals
fungi fungi_lftovrsBrnt
Morphology shows: sptat hypha that branch at acut angls
asprgillus (&qu
ot;A&quot; for acut) fungi fungi_lftovrsBrnt
Immun status of th host dtrmins th svrity of th disas.&nbsp;&nbsp;Ris
k factors for invasion includ--lukmia, granulocytopnia, CGD, lat AIDS
asprgillus
fungi fungi_lftovrsBrnt
Occurs aftr inhaling a larg numbr of asprgillus (i whn using hatr for th
allrgic alvolitis (hyprsnsitivity pnumonia)
 first tim during wintr).
fungi fungi_lftovrsBrnt
Occurs in prxisting asthma patints with chronic asprgillus coloniziation
allrgic bronchopulmonary asprgillosis (ABPA) fungi fungi_lftovrsBrnt
Causs lvatd IgG, IgE, osinophilia, and prsnts as difficult-to-control ast
hma.
allrgic bronchopulmonary asprgillosis (ABPA) fungi fungi_lftovrsBr
nt
Occurs in patints with prxisting lung disas with rsidual cavitis (TB, sar
coidosis, bronchictasis). Fungal.
asprgilloma
fungi fungi_lftovrsBr
nt
Morphology: non-sptat hypha that branch at right angls
mucorals
fungi fungi_lftovrsBrnt
Fungal infction in poorly controlld diabtics with ktoacidosis.
mucormyc
osis (spcifically rhinocrbral mucormycosis) fungi fungi_lftovrsBrnt
Mucormycosis infction in DM patints with diabtic ktoacidosis
"rhinoc
rbral mucormycosis<br /><img src=""A31_rhinocrbral.png"" /><br />(A31_rhinoc
rbral)"
fungi fungi_lftovrsBrnt picturs
Occurs in lukmic patints or bon marrow transplant rcipints who hav prolon
gd granulocytopnia.&nbsp;&nbsp;Sam symptoms as invasiv pulmonary asprgillos
is.
pulmonary mucormycosis fungi fungi_lftovrsBrnt
Associatd with agd bird droppings and acquird by inhalation. cryptococcus no
formans fungi fungi_lftovrsBrnt
Associatd with agd bird droppings and causs mningoncphalitis (involving th
 basilar mnings).
cryptococcus noformans fungi fungi_lftovrsBrnt
Broad-basd budding and distributd in woodd ara along Mississippi rivr in ac
idic soil
blastomycs drmatitidis (&quot;B&quot; for broad-basd budding)
fungi fungi_lftovrsBrnt
Exposur to acidic soil in a woodd aquatic nvironmnt. Fungal.
blastomy
cs drmatitidis
fungi fungi_lftovrsBrnt
Infcts &quot;normal&quot; popl who happn to b in th wrong plac at th wro
ng tim.&nbsp;&nbsp;Broad basd budding blastomycs drmatitidis (&quot;B&quot;

for broad-basd budding)

fungi fungi_lftovrsBrnt
"A man from Missouri dvlops waknss and night swats.&nbsp;&nbsp;His physicia
n nots sors on th patints skin.&nbsp;&nbsp;Biopsy of th skin lsions rva
ls larg budding yasts.&nbsp;&nbsp;Doctor bgins cours of antifungals includin
g amphotricin B.<br /><img src=""A34_broadbasdbudding.png"" />"
blastomy
cs drmatitidis<br /><br />(A34_broadbasdbudding)
cas fungi fungi_lftov
rsBrnt picturs
Producs a rd pigmnt in vitro and rsrvoir is possibly th bamboo rat.
pnicillium marnffi fungi fungi_lftovrsBrnt
Producs a rd pigmnt in vitro and found almost xclusivly in patints from SE
Asia, usually in individuals with AIDS pnicillium marnffi fungi fungi_lft
ovrsBrnt
Prsnts with larg vrrucous warty ulcrs, subcutanous noduls (cold abscsss
). Fungal.
blastomycs drmatitidis
fungi fungi_lftovrsBrnt
Acut pulmonary infction is oftn unrcognizd, and chronic/rcurrnt infction
is charactrizd by chronic pnumonia and skin involvmnt with larg vrrucous
warty ulcrs. blastomycs drmatitidis
fungi fungi_lftovrsBrnt
"San Joaquin Vally Fvr<br /><img src=""A36_coccidioids.png"" />"
coccidio
ids<br /><br />(A36_coccidioids)
fungi fungi_lftovrsBrnt picturs
Most common caus of community acquird pnumonia in studnts in Arizona.&nbsp;&
nbsp;Exist in th soil in a myclial phas
coccidioids
MCC fungi fungi_
lftovrsBrnt
Producs rd pigmnt in cultur and occurs in AIDS patints from SE Asia (i Tha
iland, Vitnam) pnicillium marnffi fungi fungi_lftovrsBrnt
Distributd in dsrts in SW Unitd Stats.&nbsp;&nbsp;Found in archologists an
d univrsity of AZ studnts.&nbsp;&nbsp;Morphology shows sphruls with ndospor
s
coccidioids
fungi fungi_lftovrsBrnt
"Worldwid distribution and found in agd pigon droppings<br /><img src=""A211_
cryptococcus.png"" />" cryptococcus noformans<br /><br />(A211_cryptococcus)
fungi fungi_lftovrsBrnt picturs
Soil is th natural habitat in aras whr avian and bat xcrmnt accumulats.&
nbsp;&nbsp;Fungal.
histoplasma capsulatum fungi fungi_lftovrsBrnt
Grows on plant dbris, sphagnum moss, hay and soil on th bark of trs.&nbsp;&n
bsp;Acquird by traumatic inoculation sporothrix schnckii
fungi fungi_lft
ovrsBrnt
Cigar shapd and acquird by traumatic inoculation. Fungal.
sporothrix schn
ckii
fungi fungi_lftovrsBrnt
Associatd with substantial hilar adnopathy. Fungal. Found in South Amrica.
paracoccidioids brasilinsis fungi fungi_lftovrsBrnt
Somtims acquird from nw kittn, can caus athlts foot, nail infction, ri
ngworm and jock itch
drmatophyts fungi fungi_lftovrsBrnt
Filamntous fungi, branch at acut angls
asprgillus (&quot;A&quot; for a
cut angls)
fungi fungi_lftovrsBrnt
Inhalation of this fungis spors in a patint with ithr asthma or CF causs a
llrgic bronchopulmonary ________
asprgillosis (ABPA)
fungi fungi_lft
ovrsBrnt
Inhalation of a larg antignic load of asprgillus causs a hyprsnsitivity pn
umonia calld ____
allrgic alvolitis
fungi fungi_lftovrsBrnt
Allrgic asprgillus occurs in 2 varitis: nam thm 1) allrgic alvolitis<b
r>2) allrgic bronchopulmonary asprgillosis (ABPA)
fungi fungi_lftovrsBr
nt
Gains ntry to th body through th rspiratory tract, causs rhinocrbral path
ology in diabtics with ktoacidosis. mucorals
fungi fungi_lftovrsBr
nt
Dimorphic, broad bas budding, xposur to acidic soil in a woodd aquatic nvir
onmnt. blastomycs drmatitidis
fungi fungi_lftovrsBrnt
Fungi xist as two lif forms, yast and/or moulds.&nbsp;&nbsp;Which is unicllu
lar and rproduc by budding? yast fungi fungi_lftovrsBrnt
Fungi cll walls contain what instad of pptidoglycan and what strol xists in
thir mmbrans?
chitin; rgostrol
fungi fungi_lftovrsBrnt

Ros gardnrs disas.

sporothrix schnckii
cas fungi fungi_lftov
rsBrnt
Man prsnts with small raisd ulcrations xtnding proximally from his lft in
dx fingr.&nbsp;&nbsp;Th physician larns that th man njoys gardning as a h
obby.&nbsp;&nbsp;Upon furthr qustioning th patint rports that h only start
d using glovs 3 months ago following a painful thorn prick rcivd whil wd
ing his ros gardn.
sporothrix schnckii
cas fungi fungi_lftovrsBrnt
found in soil, plants --&gt; introducd subcutanously by trauma (i ros thorn
prick) sporothrix schnckii
fungi fungi_lftovrsBrnt
horticultur, farming, brry picking prdispos to xposur.&nbsp;&nbsp;inoculat
d through trauma
sporothrix schnckii
fungi fungi_lftovrsBrnt
Cigar shapd organism that gts inoculatd bnath th skin by trauma. sporothr
ix schnckii
fungi fungi_lftovrsBrnt
An old man and his grandson visit Dath Vally National Park in th dsrts of S
outhrn California.&nbsp;&nbsp;Upon rturning from thir visit, th man dvlops
brathing difficultis along with arthralgias, priarticular swlling, and ryt
hma nodosum.&nbsp;&nbsp;X-rays rval a pnumonic infiltrat as wll as granulo
mas.&nbsp;&nbsp;A diagnosis is confirmd by obsrving sphruls containing indiv
idual ndospors in tissu spcimns. "coccidioids (C. immitis)<div><br /></d
iv><div>Buzz words: Southrn California, arthralgia, rythma nodosum, sphruls
with ndospors<br /><div><br /></div><div><img src=""past-102039833018837.jpg
"" /></div></div>"
Dicky cas fungi
An amatur bird kpr prsnts with hadach and a stiff nck.&nbsp;&nbsp;Fari
ng som form of mningitis, th physician ordrs a CT scan which rvals wll-ci
rcumscribd ringlik lsions in th brain.&nbsp;&nbsp;Subsqunt CSF analysis r
vals ncapsulatd budding yast with India ink stain.&nbsp;&nbsp;Th patint is
administrd amphotricin B and flucytosin. cryptococcus noformans cas fun
gi fungi_lftovrsBrnt
Causs mningoncphalitis and pnumonia.&nbsp;&nbsp;Somtims found in pigon d
roppings
cryptococcus noformans fungi fungi_lftovrsBrnt
Most common caus of fungal mningitis. cryptococcus noformans MCC fungi fungi_
lftovrsBrnt
Of th drmatophyts, tina ___ is most common in childrn
capitis fungi fu
ngi_lftovrsBrnt
An ldrly cav xplorr in Ohio complains to his physician of waknss in th l
ast fw months.&nbsp;&nbsp;A physical xam rvrals sors in his mouth, and X-ra
y shows small calcifications throughout th body.&nbsp;&nbsp;A lung biopsy rva
ls small budding clls within macrophags.&nbsp;&nbsp;Physician bgins th pati
nt on oral amphotricin B
histoplasma capsulatum--rcall that it typically
occurs in &quot;whit, middl-agd mals who ar havy smokrs&quot; cas fun
gi fungi_lftovrsBrnt
Infction occurs by inhalation which prolifrats in macrophags that thn migra
t to various parts of th body.&nbsp;&nbsp;Can rsult in old calcifid granulom
as.&nbsp;&nbsp;Organism is dimorphic and fungal.
histoplasma capsulatum
fungi fungi_lftovrsBrnt
This fungus gts its nam bcaus it is found in histiocyts (macrophags).
histoplasma capsulatum fungi fungi_lftovrsBrnt
Inhald spors can dposit in lung cavity formd from prvious tubrculosis or t
umor --&gt; th hypha grow within th cavity but do not invad asprgillus (asp
fungi fungi_lftovrsBrnt
rgilloma)
Rstrictd gographic distribution, &quot;South Amrican Blastomycosis&quot;.&nb
sp;&nbsp;Causs hilar adnopathy.
paracoccidioids brasilinsis fungi fu
ngi_lftovrsBrnt
Nam 4 dimorphic fungi <div><b>B</b>ody&nbsp;<b>H</b>at&nbsp;<b>C</b>hangs&nb
sp;<b>S</b>hap</div><div><br /></div><div>blastomycs, histoplasma, coccidiods
, sporothrix (also paracocci)</div>
Dicky fungi
Individuals with major clinical infctions du to _____ usually suffr from sign
ificant undrlying illnsss such as uncontrolld diabtic ktoacidosis, lukmi
a, or chronic kidny disas rciving iron chlation thrapy mucorals
fungi fungi_lftovrsBrnt

Can infct lungs, skin, bons, GU tract.&nbsp;&nbsp;Exposur to acidic soil in a

woodn aquatic nvironmnt (i Wisconsin)
blastomycs drmatitidis
fungi fungi_lftovrsBrnt
Is gnrally asymptomatic in immunocomptnt patints but dissminatd &amp; fat
al disas ar mor common in prgnant womn, immunocompromisd hosts, and darkskinnd racs. Basilar mningitis is probably not curabl.
coccidioids
fungi fungi_lftovrsBrnt
Fungus communicabl by airborn rout.&nbsp;&nbsp;Causs intrstitial pnumonia
in dbilitatd infants and immunocompromisd patints. 80% of AIDS patints wr
affctd bfor prophylaxis. pnumocystis jirovcii fungi
80% of patints with AIDS usd to dvlop what kind of pnumonia?
pnumocy
stis pnumonia fungi
Charactristic foamy (looks lik foam in alvoli), osinophilic alvolar xudat
.&nbsp;&nbsp;Fungal.
pnumocystis jirovcii fungi
foamy osinophilic alvolar xudat, hypoxmia with incrasd A-a gradint and d
crasd CO2 diffusion pnumocystis jirovcii fungi
ABG shows rspiratory alkalosis with hypoxia, significant undrlying A-a gradin
t, intrstitial plasma cll pnumonia in dbilitatd infants and immunocompromis
d hosts. Fungal.
pnumocystis jirovcii cas fungi
&quot;tar drop&quot; narrow-basd budding, pink polysaccharid capsul, distrib
utd worldwid in agd-pigon droppings cryptococcus noformans fungi fungi_lft
ovrsBrnt
#1 caus of mningitis in AIDS patints cryptococcus noformans MCC fungi fungi_
lftovrsBrnt
"morphology: foamy alvoli<br /><img src=""A43_pnumocystis.png"" />" pnumocy
stis jirovcii fungi picturs
Cramy whit curdy-lik patchs on th tongu and oral mucosa. Fungal. "candida
(psudommbranous thrush)<br /><img src=""A45_candida.png"" /><br />(A45_candid
a)"
fungi picturs
In th absnc of spcific prophylaxis, up to 80% of patints with AIDS dvlop
d this typ of pnumonia
pnumocystis jirovcii fungi
"On pathology, th principl finding is th formation of a charactristic foamy
osinophilic alvolar xudat. Fungal.<br /><img src=""A44_pnumocystis.png"" />
"
pnumocystis pnumonia<br />
fungi picturs
Physiologic changs sn with pnumocystis pnumonia. Nam 2
"1) <b>hypoxmia
</b> with an <b>incrasd alvolar-artrial</b> (A-a) gradint (normal is 5-10 m
mHg)<br />2) <b>impaird CO2 diffusion capacity</b><div><img src=""physiologic.j
pg"" /></div><div><img src=""gradint.jpg"" /></div>" fungi
Thrapy of choic for pnumocystosis. oral trimthoprim/sulfamthoxazol
antifungals fungi
#1 caus of odynophagia, dysphagia
candida<div><br /></div><div>odynophagia
= painful swallowing</div>
MCC fungi
Causs diffus intrstitial pnumonia.&nbsp;&nbsp;Most infctions ar asymptomat
ic.&nbsp;&nbsp;Immunosupprssion prdisposs to disas.&nbsp;&nbsp;Tratmnt wi
th TMP-SMX
pnumocystis jirovci fungi
Dimorphic fungus that livs on vgtation.&nbsp;&nbsp;Whn traumatically introdu
cd into th skin, typically by a thorn, causs local pustul or ulcr with nodu
ls along draining lymphatics. sporothrix schnckii
fungi fungi_lftovrsBr
nt
Havily ncapsulatd yast.&nbsp;&nbsp;Found in soil, pigon droppings.&nbsp;&nb
sp;Cultur on Sabourauds agar. Stain with India ink. cryptococcus noformans
fungi fungi_lftovrsBrnt
Bird or bat droppings.&nbsp;&nbsp;&quot;Hids&quot; within macrophags. histopla
sma capsulatum fungi fungi_lftovrsBrnt
S mold hypha in KOH prp, not dimorphic
drmatophyts (microsporum, tric
hophyton, pidrmophyton)
fungi fungi_lftovrsBrnt
Latx agglutination tst dtcts polysaccharid capsular antign and is spcific
.&nbsp;&nbsp;Sabourauds agar, India Ink.&nbsp;&nbsp;Fungal.
cryptococcus no
formans fungi fungi_lftovrsBrnt
Mould with sptat hypha that branch at acut angls Asprgillus (Think &quot

;A&quot; for Acut Angls in Asprgillus)

fungi fungi_lftovrsBrnt
Total srum IgE an IgG antibodis to asprgillus ar lvatd. Has osinophilia
and flting pulmonary infiltrats.&nbsp;&nbsp;Manifstd as difficult-to-contro
l asthma.&nbsp;&nbsp;Prson had prxisting asthma
allrgic bronchopulmonar
y asprgillosis (ABPA) cas fungi fungi_lftovrsBrnt
Patint has th occasional hmoptysis and CT scan rvals a round oval mass with
in a cavity.
asprgilloma (fungus ball)
cas fungi fungi_lftovrsBrnt
What kind of patints (in gnral) dvlop invasiv pulmonary asprgillosis?
immunocompromisd patints
fungi fungi_lftovrsBrnt
Patints with lss svr immocompromising illnss (i DM) can somtims dvlop
what asprgillus infction that is simiar to TB?
chronic ncrotizing asp
rgillosis (its apical in location and cavitary, lik TB)
cas fungi fungi
_lftovrsBrnt
Disas mostly in ktoacidotic diabtic and lukmic patints.&nbsp;&nbsp;Causs
rhinocrbral, hadach facial pain, black ncrotic schar on fac.
mucoral
s (rhinocrbral mucormycosis) cas fungi fungi_lftovrsBrnt
irrgular broad, nonsptat hypha that branch at right angls mucorals
fungi fungi_lftovrsBrnt
Southwstrn US, California.&nbsp;&nbsp;Causs pnumonia and basilar mningitis.
coccidioids (C. immitis)
fungi fungi_lftovrsBrnt
Latx agglutination cryptococcal polysaccharid antign tst prformd on srum,
CSF or plural fluids in vry snsitiv.&nbsp;&nbsp;Larg polysaccharid capsul
 that stains pink with mucicarmin.
cryptococcus noformans fungi fungi_lft
ovrsBrnt
Extrapulmonary _______ occurs rarly and almost xclusivly in patints with lat
 stag AIDS who hav rcivd arosolizd pntamidin as prophylaxis. pnumocy
stosis fungi
Svral months ago, a patint prsntd to a fr clinic with a thick, whit mm
bran covring th roof of his mouth.&nbsp;&nbsp;Now, h rvisits to th clinic
complaining of painful swallowing and svr chst pains.
"candida<div><im
g src=""mouth (1).jpg"" /></div>"
cas fungi
A homlss man arrivs to th clinic complaining of difficulty brathing.&nbsp;&
nbsp;His mdical history is not obtainabl, but th man dos rport incrasing f
atigu and wight loss ovr th past fw months.&nbsp;&nbsp;Physical xam rval
s lymphadnopathy, tachypna, and bilatral rals in th lung bass.&nbsp;&nbsp;
CXR shows diffus infiltrats bilatrally.&nbsp;&nbsp;Stain shows numrous cysts
containing svral dark oval bodis.&nbsp;&nbsp;Doctor bgins th patint on TM
P-SMX and ordrs and HIV tst. pnumocystis jirovcii cas fungi
Usd to b th #1 opportunistic infction in AIDS patints, but trimthoprim pro
phylaxis has changd this.
pnumocystis pnumonia MCC fungi
Occupational hazard for gardnrs. Dimorphic fungi
sporothrix schnckii
fungi fungi_lftovrsBrnt
Not found in th blood, ubiquitous in th nvironmnt and normally found on skin
/oral cavity/GI/fmal gnital tract, causs oral thrush, diapr rash candida
fungi
Dfinition: protin coat that ncass th nuclic acid gnom. capsid 5/12Gn
ralPrinciplsofViruss Gnral_virus
Dfinition: morphologic units sn by lctron microscopy on th surfac of icos
ahdral virus particls<br /><br />
"capsomr<br /><div><img src=""capso.jp
g"" /></div><div><img src=""A51_virus.png"" /></div>" 5/12GnralPrinciplsofV
iruss Gnral_virus picturs
Dfinition: th protin/nuclic acid complx containing th packagd form of th
viral gnom.&nbsp;&nbsp;May b th ntir viral particl or a substructur of
a mor complx virus
"nuclocapsid<div><img src=""nuclocapsid.jpg"" /></div
>"
5/12GnralPrinciplsofViruss Gnral_virus
Tru or fals: nvlopd viruss ar gnrally lss stabl compard to nonnvlo
pd viruss
tru
5/12GnralPrinciplsofViruss Gnral_virus
Th complt virus particl is known as th ___.
virion 5/12GnralPrinc
iplsofViruss Gnral_virus
Loss of infctivity by xposur to <u>thr</u> indicats what charactristic ab

out th virus. its nvlopd 5/12GnralPrinciplsofViruss Gnral_virus

Envlopd viruss contain surfac projctions, usually glycoprotins.&nbsp;&nbsp
;Ar thy ncodd by th host cll or virus?
virus ncodd--thyr incorpora
td into th host cll mmbran prior to virion maturation and rlas by buddin
g procss (i hmagglutinin, nuraminidas)
5/12GnralPrinciplsofViruss G
nral_virus
Functions of virus coat protin (nam 4)
1) <u>protct</u> gnom from nu
class<br />2) <u>attach</u> virus particl to suscptibl cll<br />3) <u>stru
ctural symmtry</u>, dtrmins antignic charactristics<br />4) may xhibit so
m <u>spcific</u> activity (i ability to hmagglutinat RBCs) 5/12GnralPrinc
iplsofViruss Gnral_virus
Popular xampl of an RNA virus that has sgmntd gnom. <b>How many sgmnts?
</b>
Influnza viruss. <b>8 sgmnts&nbsp;</b>
5/12GnralPrinciplsofV
iruss Gnral_virus
Mutation of viral gnoms--Exchang of information btwn RNA molculs.
"rcombination (thrs homologous and nonhomologous)<div><img src=""rcomb.jpg
"" /></div>"
5/12GnralPrinciplsofViruss Gnral_virus
Only occurs in clls infctd with 2 viruss that both hav sgmntd gnoms.&n
bsp;&nbsp;
"rassortmnt<br><br><img src=""A52_rassortmnt.png"" /><br>(A5
2_rassortmnt)"
5/12GnralPrinciplsofViruss Gnral_virus picturs
Th bst dfns against viruss.
vaccins (i polio and masls) 5/12Gn
ralPrinciplsofViruss Gnral_virus
"Tru or fals: Viral protins synthsizd ""arly"" gnrally function in <u>r
plication</u> whil thos synthsizd ""lat"" ar usually <u>structural</u>."
tru
5/12GnralPrinciplsofViruss Gnral_virus
"Would you suspct that <b>viral capsid protins</b> would b mad ""arly"" or
""lat""?"
Lat; structural&nbsp;protins ar mad latr 5/12GnralPrinc
iplsofViruss Gnral_virus
DNA or RNA viruss? Th gnom is rplicatd in th cll nuclus and host cll 
nzyms ar usd. Nam an xcption.
DNA (xcption is poxviruss) 5/12Gn
ralPrinciplsofViruss Gnral_virus
DNA or RNA viruss? Th gnom is rplicatd in th cytoplasm. Nam an xcption
.
RNA; xcption is th influnza virus 5/12GnralPrinciplsofViruss G
nral_virus
Tru or fals: Matur virions ar rlasd from clls by a procss of budding fr
om th plasma mmbran or th nuclar mmbran for nvlopd viruss and by cll
lysis for cubic viruss.
tru
5/12GnralPrinciplsofViruss Gnral_v
irus
Tru or fals: In gnral, intranuclar inclusions ar producd by RNA viruss a
nd intracytoplasmic inclusions by DNA viruss. Fals; DNA producs intranuclar
, RNA producs intracytoplasmic 5/12GnralPrinciplsofViruss Gnral_virus
Dfinition: ability of virus to infct or damag spcific clls/tissus.
tropism; disas manifstations ar influncd by tropism
5/12GnralPrinc
iplsofViruss Gnral_virus
Dfinition: cytokins producd by ukaryotic clls during virus infction that l
intrfrons
5/12GnralPrinc
ad to inhibition of nw viral synthsis.
iplsofViruss Gnral_virus
Way that infrons mostly inhibit viral rplication.
inhibit viral <u>protin
synthsis</u> (translation); inhibitory nzyms ar stimulatd 5/12GnralPrinc
iplsofViruss Gnral_virus
Whats th major nonspcific cllular dfns against viruss? Which ar mor po
tnt? intrfrons--thyr producd by clls during viral infction that lad
to inhibition of viral synthsis.&nbsp;&nbsp;<b>Alpha</b> and <b>bta</b> intrf
rons ar mor potnt than <b>gamma</b> 5/12GnralPrinciplsofViruss Gnral_v
irus
Nuclic acid proprtis of th influnza viruss. sns, strand, if sgs
"RNA singl strandd, ngativ sns (-), sgmntd<br /><div><img src=""Scrn
Shot 2014-06-20 at 8.32.00 AM.jpg"" /></div>" influnza
Attachmnt to th cllular rcptor (sialic acid) is mdiatd by what protin fo
r influnza?
hmagglutinin influnza

Which virus? Nuclocapsid consists of a nucloprotin and a gnom of singl-str

andd RNA in svn or ight sgmnts.&nbsp;&nbsp;Th nvlop carris a hmagglu
tinin protin and a nuraminidas
influnza
5/12GnralPrinciplsofV
iruss Gnral_virus
What protin srvs as a proton channl for influnza A strain only? Catch?
M2 protin, but thos currntly circulating ar rsistant
influnza
For influnza virus, whr dos nuclocapsid rplication and assmbly occur?
nuclus influnza
For influnza virus, whr dos virion assmbly occur? cytoplasm
influnz
a
Influnza viruss contain two particularly important protins, on that promots
viral ntry and anothr that promots progny virion rlas.&nbsp;&nbsp;What a
r thy?
hmagglutinin, nuraminidas
influnza
Catalyzs th nzymatic rmoval of th NANA rsidus to disrupt/prvnt th occu
rrnc of aggrgats and thrby incras th numbr of fr infctious viral pa
rticls.
nuraminidas
influnza
Dscrib influnzal syndrom
most prominnt symptoms ar hadach, muscl ach
influnza
s, malais, cough, fvr
Most common srious complication of acut influnza.
pnumonia--can gt prima
ry influnza virus pnumonia, mixd viral-bactrial pnumonia, post influnza ba
ctria pnumonia
influnza
What is th most common pnumonia pattrn with influnza? Dscrib it. <u>Post
influnza bactrial pnumonia</u>--hav acut influnza and thn ntr a phas o
f apparnt improvmnt for a fw days.&nbsp;&nbsp;Thn thy suddnly dvlop ons
t of anothr rspiratory disas.<div><br /></div><div><i>Biphasic</i></div>
influnza
Bactria most oftn causing mixd viral-bactria pnumonia during influnza
S. aurus
MCC influnza
Bactria most oftn causing post-influnza bactrial pnumonia S. pnumonia
MCC influnza
Why is it that popl with influnza oftn dvlop pnumonia? Thrs influnz
a-inducd <u>impairmnt of normal dfns mchanisms</u> that protct th lung (
i disruptd mucociliary claranc and impaird phagocytotic capability of macro
phags and nutrophils) influnza
What ar th two nurologic complications of influnza? Rys syndrom, ncpha
litis/ncphalopathy
influnza
Nurologic complication of influnza.&nbsp;&nbsp;Its an ncphalopathy associat
d with impaird livr function that may follow influnza in childrn. Rys s
yndrom influnza
Whats a major risk factor for Rys syndrom that follows influnza? us of a
spirin influnza
Occurs during wintr months, causing pidmic rspiratory disas and rsulting
in xcss school and industrial absntism
influnza
influnza
Antignic variation in th influnza viruss occurs in what two viral protins?
hmagglutinin and nuraminidas influnza
In th arly phass of an influnza pidmic, infction and illnss occur prdom
inantly in what ag group?
<b>school-agd childrn</b>--ths childrn brin
g th virus hom whr pr-school childrn and adults acquir infction influnz
a
Th highst attack rats of illnss during influnza typ A infctions ar what
ags? 5-19 yar olds influnza
Why is thr rcurring suscptibility of populations to influnza?
bcaus
thrs <u>antignic changs of th surfac antigns</u> of th influnza virus
s--whn surfac antigns chang, a proportion (or all) of th population lacks i
mmunity to th nw virus.&nbsp;&nbsp;Th magnitud of th nsuing pidmic is di
rctly proportional to th dgr of antignic chang
influnza
Whats th primary mchanism of immunity to rinfction with influnza? antibody
(IgG, and to a lssr dgr IgA)
influnza
What protin must antibody b dirctd to on th influnza virus so that th ind
ividual is protctd? hmagglutinin influnza

Antibody dirctd against th protin _____ of influnza rducs th numbr of <
u>infctious units</u> and thus th <u>intnsity of disas.</u>
nuramin
idas influnza
Amantadin and Rimantadin ar what kind of drugs?
M2 inhibitors ID_pharm
influnza
Whats th mchanism of action of Amantadin and Rimantadin? Which strain?
blocks th virion M2 ion channl of <u>typ A </u>influnza viruss and thus th
RNP complx is not rlasd and thus not transportd to th nuclus--&gt; trans
cription dos not occur ID_pharm influnza
Tru or fals: Amantadin and Rimantidin hav no ffct on typ B influnza vir
uss. Tru, typ A only
ID_pharm influnza
Zanamivir and Osltamivir inhibit what influnza nzym?
nuraminidas
ID_pharm influnza
Do Zanamivir and Osltamivir inhibit both typ A and B influnza viruss?
ys
ID_pharm influnza
Who should rciv a flu vaccin? (i what ags)
all prsons &gt; 6 month
s
influnza
Fbril illnss of th uppr and lowr rspiratory tract charactrizd by suddn
onst of fvr, cough, myalgia, and malais. Pnumonia is th most common srio
us complication influnza
cas influnza
Changs in _____ and ______ surfac antigns ar rsponsibl for th apparanc
of antignically novl strains that vad host immunity and caus rinfction of
influnza.
hmagglutinin, nuraminidas
influnza
Binds sialic acid on clls and allows th virus to b ndocytosd
hmagglu
tinin influnza
Associatd with aspirin tratmnt for influnza in childrn
Rys syndrom
influnza
All DNA viruss rplicat in th nuclus xcpt ______. poxvirus
5/12Gn
ralPrinciplsofViruss Gnral_virus
All RNA viruss rplicat in th cytoplasm xcpt _____.
influnza
5/12GnralPrinciplsofViruss Gnral_virus
"An african amrican girl with sickl cll anmia visits th doctor aftr dvlo
ping waknss, fatigu, and pallor.&nbsp;&nbsp;Sh tlls hr physician that sv
ral days bfor, sh flt a fvr, hadach, and muscl aching.&nbsp;&nbsp;Sh a
lso bgan to fl joint pain and dvlopd a rash that had a ""slappd fac"" ap
paranc on hr fac.&nbsp;&nbsp;A blood tst rvals svr anmia, as wll as
a dclin in nutrophils and lymphocyts.&nbsp;&nbsp;" "rythrovirus (Parvoviru
s B19)<div><br /></div><div>- slappd fac</div><div>- sickl cll anmia: aplas
tic anmia<br /><div><br /></div><div><img src=""past-506015866946015.jpg"" /><
/div></div>"
5/16DickyCantAnki 5/16PoxandFrinds B19 Dicky cas
Infctd ftuss may dvlop svr anmia and hydrops ftalis "rythrovirus (P
arvovirus B19)<div><br /></div><div><img src=""past-506011571978719.jpg"" /></d
iv>"
5/16DickyCantAnki 5/16PoxandFrinds B19 Dicky
Primary infction of prgnant womn may rsult in ftal loss (arly) or hydrops
ftalis (ftal congstiv hart failur) and stillbirth (lat) "rythrovirus (P
arvovirus B19)<div><br /></div><div><img src=""past-506011571978719.jpg"" /></d
iv>"
5/16DickyCantAnki 5/16PoxandFrinds B19 Dicky
In prsons with undrlying hmolytic anmia (i sickl cll) lytic infction of
RBC prcursors lads to rapid fall in hmatocrit and th dvlopmnt of transin
t aplastic crisis (TAC) "rythrovirus (Parvovirus B19)<div><br /></div><div><img
src=""past-506011571978719.jpg"" /></div>"
5/16DickyCantAnki 5/16PoxandFri
nds B19 Dicky cas
Virus can cross th placnta and infct ftus; rplication of virus occurs in f
tal rythroid prcursors and cardiac myocyts "rythrovirus (Parvovirus B19)<d
iv><br /></div><div><img src=""past-506011571978719.jpg"" /></div>"
5/16Dick
yCantAnki 5/16PoxandFrinds B19 Dicky
Illnss may b prcdd by a prodromal flu-lik illnss (virmia) followd by d
vlopmnt of rash and arthralgia or arthritis.&nbsp;&nbsp;<div><br /></div><div>
Transint aplastic crisis and hydrops ftalis ar also common complications.</di
v>
"rythrovirus (Parvovirus B19)<div><br /></div><div>Biphasic: 1. Virmia

2. Arthritis<br /><div><br /></div><div><img src=""past-506011571978719.jpg""

/></div></div>" 5/16DickyCantAnki 5/16PoxandFrinds B19 Dicky
Group of patints plagud by vsicls all ovr thir bodis.&nbsp;&nbsp;Th vsi
cls ar oozing and viscious causing th body surfacs to stick togthr.&nbsp;&
nbsp;Th patints got thir frinds sick and most of thm did. "small pox<div><
br /></div><div><img src=""past-509447545815533.jpg"" /></div>"
5/16Dick
yCantAnki 5/16PoxandFrinds 5/16PoxnFrinds Dicky cas poxvirus
Flsh colord dom lsions with cntral dimpl "molluscum contagiosum<div><br /
></div><div><img src=""past-509559214964987.jpg"" /></div>"
5/16DickyCantAn
ki 5/16PoxandFrinds 5/16PoxnFrinds Dicky poxvirus
Most commonly occurs in childhood.&nbsp;&nbsp;Symptoms includ pharyngitis, pnu
monia, and conjuctivitis.&nbsp;&nbsp;Doubl strandd DNA virus "adnovirus<div>
<br /></div><div><img src=""past-509700948885974.jpg"" /></div>"
5/16Dick
yCantAnki 5/16PoxandFrinds 5/16PoxnFrinds Dicky adnovirus
Cidofovir and donor lukocyt infusions appar to b promising thrapis for tr
atmnt this infction in bon marrow transplant patints.
"adnovirus<div>
<br /></div><div>adnovirus infctions ar associatd with childrn aftr bon m
arrow transplantation<br /><div><br /></div><div><img src=""past-50969665391867
8.jpg"" /></div></div>" 5/16DickyCantAnki 5/16PoxandFrinds 5/16PoxnFrinds Dic
ky adnovirus
Modifid vrsions of ths viruss ar bing usd as vctors for vaccination and
gn thrapy for a varity of conditions.
"adnovirus<div><br /></div><div
><img src=""past-512161965146582.jpg"" /></div>"
5/16DickyCantAnki 5/16P
oxandFrinds 5/16PoxnFrinds Dicky adnovirus
Most common sxually transmittd virus papillomavirus 5/16DickyCantAnki 5/16P
oxandFrinds Dicky HPV MCC
Producs a varity of bnign mucosal and cutanous lsions, including warts, con
dyloma. "Human papillomaviruss (HPVs)<div><br /></div><div><img src=""past-510
306539274704.jpg"" /></div>"
5/16DickyCantAnki 5/16PoxandFrinds Dicky HPV
Typs of HPV most frquntly causing cancr.
"typs 16 and 18<div><br /></div
><div><img src=""past-510302244307408.jpg"" /></div>" 5/16DickyCantAnki 5/16P
oxandFrinds Dicky HPV
22 yar old sxually activ mal complains of warts on his pnis.&nbsp;&nbsp;H
dos not rport pain, but h is concrnd that h might sm to b sprading th
m to his fmal partnr.&nbsp;&nbsp;Th doctor, diagnosing th warts as condylom
a acuminata, trats th patint by ablating th warts.&nbsp;&nbsp;
"papillo
mavirus<div><img src=""accum.jpg"" /></div>" 5/16DickyCantAnki 5/16PoxandFri
nds Dicky HPV cas
Virus 16 and 18 caus gnital warts that can progrss to crvical carcinoma.
HPV
5/16DickyCantAnki 5/16PoxandFrinds Dicky HPV
5 y/o boy is brought to th pdiatricians offic for bumps on his arm.&nbsp;&nb
sp;His mothr rports that a classmat had similar skin lsions 2 months arlir
.&nbsp;&nbsp;Th doctor nots flsh colord parly nods with cntral cratrs.
"molluscum contagiosum<div><br /></div><div><img src=""past-510607186985225.jpg
"" /></div>"
5/16DickyCantAnki 5/16PoxandFrinds 5/16PoxnFrinds Dicky cas
poxvirus
JC and BK viruss prsist in th kidny. Giv family
"polyomavirus<div><br />
</div><div><b>Julius Casar</b></div><div><b><br /></b></div><div><b>Brutus kni
f</b></div><div><b><br /></b></div><div><b><img src=""past-510718856135143.jpg
"" /></b></div>"
5/16DickyCantAnki 5/16PoxandFrinds 5/16PoxnFrinds Dic
ky polyomavirus
BK virus is oftn ractivatd in immunosupprssd patints and is xcrtd in th
 urin of rnal transplant patints and prsons on immunosupprssiv drugs. (Wh
ats th family?)
"polyomavirus<div><br /></div><div><img src=""past-5107
14561167847.jpg"" /></div>"
5/16DickyCantAnki 5/16PoxandFrinds 5/16PoxnFri
nds Dicky polyomavirus
Prsumd caus of progrssiv multifocal lukoncphalopathy (PML) in HIV
JC (polyomavirus)
polyomavirus
Immunocompromis (i AIDS) allows latnt virus to activat --&gt; infcts mylin
ating oligodndrocyts in whit mattr throughout th CNS causing dmylination

and thus impairs coordination, spch, mmory (PML)

"JC virus (polyomavirus)
<div><br /></div><div><img src=""past-510714561167847.jpg"" /></div>" 5/16Dick
yCantAnki 5/16PoxandFrinds 5/16PoxnFrinds Dicky polyomavirus
Middl-agd man, diagnosd with AIDS, prsnts complaining of sing doubl. Phy
sician prforms a complt nurological xamination and futhr discovrs problm
s in talking, coordinatd movmnt, and rmmbring things.&nbsp;&nbsp;Imaging o
f th brain rvals dp dnsitis localizd to th whit mattr that span th f
ront, parital, and tmporal lobs.
"JC virus (polyomavirus)<div><br /></div
><div><img src=""past-510714561167847.jpg"" /></div>" 5/16DickyCantAnki 5/16P
oxandFrinds 5/16PoxnFrinds Dicky cas polyomavirus
umbilicatd skin lsions
"molluscum contagiosum<div><img src=""moll.jpg"
" /></div>"
poxvirus
Causs acut rspiratory disas syndroms, including pharyngitis, kratoconjunc
tivitis, pnumonia, gastrontritis, cystitis "adnovirus<div><br /></div><div
><img src=""past-511062453518806.jpg"" /></div>"
5/16DickyCantAnki 5/16P
oxandFrinds 5/16PoxnFrinds Dicky adnovirus
Progrssiv multifocal lukoncphalopathy in immunocompromisd hosts "JC viru
s (polyomavirus)<div><img src=""PML.jpg"" /></div><div><img src=""past-5116680
43907559.jpg"" /></div>"
5/16DickyCantAnki 5/16PoxandFrinds 5/16PoxnFri
nds Dicky polyomavirus
Prfrntially rplicats in rapid dividing clls lik RBC prcursors.&nbsp;&nbs
p;Lytic infction of RBC prcursors causs anmia in prsons with conditions ass
ociatd with shortnd RBC survival (i sickl cll). Virus can cross placnta
"rthyrovirus (Parvovirus B19)<div><br /></div><div><img src=""past-50601157197
8719.jpg"" /></div>"
5/16DickyCantAnki 5/16PoxandFrinds B19 Dicky
Utrin ultrasound to dtct hydrops, amniocntsis for PCR sampl, and ftal bl
ood sampling should b considrd for valuation in prgnant womn who might hav
 what particular virus?
"rythrovirus (Parvovirus B19)<div><br /></div><
div><img src=""past-506011571978719.jpg"" /></div>"
5/16DickyCantAnki 5/16P
oxandFrinds B19 Dicky
What is th most common thought disordr?
schizophrnia 5/21ThoughtDisor
drs
Which gndr mor commonly gts thought disordrs (schizophrnia)? Mood disordr
s?
mn and womn qually gt thought disordrs; womn mor frquntly gt m
ood disordrs 5/21ThoughtDisordrs
How can w trat RSV? "1. <u>ribavirin</u> by arosoal may b ffctiv if giv
n arly<br />2. prophylaxis w <u>mAB against F protin&nbsp;</u> in high risk g
roups (<b>palivizumab)</b><div><br /></div><div><br /></div><div><img src=""past
-603296876200402.jpg"" /></div>"
What did Lashly discovr?
"<u>lsions</u> in rat brains did <u>NOT caus m
mory loss</u> --&gt; mmory is diffusly stord; howvr som aras ar critica
l for laying down mmoris<div><br /></div><div><b><u><font color=""#ff0000"">M
mory is distributd</font></u></b></div><div><i><b><u><br /></u></b></i></div><d
iv><i><img src=""lash.jpg"" /></i></div>"
5/19Nuroplasticity1
Discuss th HM Cas
<div>Epilptic --&gt;&nbsp;Bilatral rmoval of mdial t
mporal lob (<b>hippocampus</b> + othr aras)</div><div><br /><div>Short trm
mmory was fin, long trm mmory was fin.</div><div><br /></div><div>H <u>cou
ld not form nw long trm mmory</u>; his <u>implicit</u> mmory smd to still
b working though (<u>improvd at tasks</u> ovr tim but did <u>not rmmbr t
h practicing</u>)<div><br /></div><div>Couldnt consolidat nw mmoris into l
ong trm mmoris</div></div></div>
5/19Nuroplasticity1
What kind of mmory is th hippocampus ssntial for laying down?
"long t
rm, <b>xplicit</b> mmory<div><img src=""mmory chart.jpg"" /></div><div><br /
></div><div><img src=""hippocampus.jpg"" /></div>"
5/19Nuroplasticity1
What is th procss of short trm --&gt; long trm mmory calld?
"consoli
dation (hippocampus)<div><img src=""conso.jpg"" /></div>"
5/19Nuroplastic
ity1
What is th physical diffrnc btwn short and long mmory? "short == hld i
n nuronal firings<br />long == cmntd into brain structur<br /><br />it is l
ik RAM vs. hard driv<div><img src=""conso.jpg"" /></div>"
5/19Nuroplastic

ity1
post traumatic amnsia (concussion) mmory ffcts
<u>rtrograd</u> amnsi
a and <u>antrograd</u> amnsia (priod <u>qual to duration</u> of unconscious
nss) aftr a traumatic vnt. shows us that it taks a whil for mmoris to b
cmntd in<div><br /></div><div>Havnt had tim for ram (nuron firing) to b
consolidatd.</div>
5/19Nuroplasticity1
What is th job of th hippocampus?
"runs cortx through <u>practic routin
s</u> which <u>cmnt</u> down usd nural pathways. <u>inducs long trm potnt
iation</u> and th nural ntwork<div><img src=""hippocampus.jpg"" /></div>"
5/19Nuroplasticity1
long trm potntiation "incrasd dpolarization of a rpatd stimulus; shows
strongr activity onc a connction is formd<div><br /></div><div><div>FYI: Mm
oris ar stord as modifications of brain structur;&nbsp;Mainly changs in syn
aptic strngth --&gt; LTP &nbsp;--&gt; also allows various mmoris to b consol
idatd togthr in a consolidation.</div></div><div><br /></div><div><br /><div>
<img src=""LTP.jpg"" /></div></div>" 5/19Nuroplasticity1
Alzhimrs may b rlatd to dpltion of what NT?
ACh (also not thr is
probably a rol in xcitotoxicity caus by Glu xcss) 5/19Nuroplasticity1
scopalamin. Low and High dos us
anti-ACh drug usd for <u>motion sickns
s</u>;&nbsp;<div>at high dosags it&nbsp;<u>blocks&nbsp;</u><u>mmory formation
(antrograd amnsia)</u> --&gt; dat rap drug</div> 5/19Nuroplasticity1
How do popl w Alzhimrs brain atrophy (old nuns) show no symptoms? <b>cogni
tiv rsrv</b>- (i.. crossword puzzls) traind th brain to hav roundabout
pathways<div><br /></div><div>-vry old nuns w/Alzhimrs wr staying cognitiv
ly fit dspit physical dgnration of brain</div>
5/19Nuroplasticity1
Ribots Law
<u>oldr mmoris ar mor stabl</u> bc thy gt mor cmntd
w tim 5/19Nuroplasticity1
Rconsolidation <div>Accssd mmoris must b rconsolidatd again by protin s
ynthsis</div><div><u>rcalling</u> a long trm mmory brings it up to th short
trm tmporarily making it <u>suscptibl to loss</u> w trauma</div> 5/19Nur
oplasticity1
anisomycin
<u>protin synthsis inhibitor</u> which can <u>prvnt rconsol
idation</u> of mmory 5/19Nuroplasticity1
What typs of mmoris ar stord in th hippocampus? "spatial locations<div><
img src=""hippo.jpg"" /></div>"
5/19Nuroplasticity1
What mmoris ar stord in th infrotmporal cortx? "objct rcognition<div>
<img src=""infro.jpg"" /></div>"
5/19Nuroplasticity1
What mmoris ar stord in th amygdala?
"motional mmoris<div><img src
=""hippo.jpg"" /></div>"
5/19Nuroplasticity1
What mmoris ar stord in th PFC?
"<b>tmporal ordring</b> of vnts, <u>
tasks involving a sris of stps</u><div><u><img src=""hippo.jpg"" /></u></div
>"
5/19Nuroplasticity1
What mmoris ar stord in th crbllum?
snsorimotor tasks (i.. riding
a bicycl, piano)
5/19Nuroplasticity1
<div>Not Discussd:</div><div><br /></div>Bsid strnghthning synapss how ls
 can w stor changs? "-grow nw nurons<br />-chang gn xprssion<br /><br
/>not th rol of <u>pigntics</u>, th modification of th gnom basd on
xprincs<div><img src=""pi (2).jpg"" /></div>"
5/19Nuroplasticity1
How do mnminists rmmbr stuff so wll?
rich synsthsia <u>incorporatin
g many snss</u> (i.. digits of pi hav color, prsonality, smll, tc.)
5/19Nuroplasticity1
How do autistic savants do a skill so wll?
"<div>dvot <u>mor cortx to a
spcific skill</u> -- thats why thy lack othr skills lik social skills, tc
.</div><div><img src=""autim.jpg"" /></div>" 5/19Nuroplasticity1
"What is this?<br /><img src=""A08_tinapdis (1).png"" /><br />"
tina p
dis (athlts food) - with moccasin lik distribution<br /><br />(A08_tinapdi
s)
fungi fungi_lftovrsBrnt picturs
"What is this? What kind of prson gts this?<br /><img src=""A10_proximaloncy.p
ng"" />"
proximal subungal onychomycosis; popl with immunodficincy (i
 AIDS)<br /><br />(A10_proximaloncy) fungi fungi_lftovrsBrnt picturs

"What is this?<br /><img src=""A13_tinacorporis.png"" />"

tina corporis (
ringworm)<br /><br />(A13_tinacorporis)
fungi fungi_lftovrsBrnt pictu
rs
"What is this? Who primarily gts it?<br /><img src=""A14_tinacapitis.png"" />"
tina capitis; childrn<br /><br />(A14_tinacapitis) fungi fungi_lftovrsBr
nt picturs
"What organism is this? How can you tll?<br /><img src=""A17_asprgillus.png""
/>"
asprgillus--hypha ar sptat and branch at ACUTE angls
fungi fu
ngi_lftovrsBrnt picturs
"What fungus is causing this?<br /><img src=""A20_crsntsignasprg.png"" />"
asprgillus--sn in invasiv asprgillus with rcovry<br /><br />Normally, a h
alo sign = invasiv asprgillosis<br />Crscnt sign = asprgilloma<br /><br />(
A20_crscntasp)
fungi fungi_lftovrsBrnt picturs
"What is this and what patint population most commonly gts this?<br /><img src
=""A21_rhinomucomycosis.png"" />"
rhinocrbral mucormycosis--occurs most
commonly in diabtics with ktoacidosis<br /><br />(A21_rhinomucomyc) fungi fu
ngi_lftovrsBrnt picturs
"What is this?<br /><img src=""A23_PnicilliumMarn.png"" />"
Pnicillium marn
ffi<br /><br />(A23_pnilliummarn)
fungi fungi_lftovrsBrnt picturs
"What is this? Whr is this normally found in th world?<br /><img src=""A24_p
nmar.png"" />" Pnicillium marnffi; SE Asia<br /><br />(A24_pnmarn) fungi fu
ngi_lftovrsBrnt picturs
"A patint with AIDS/HIV has just rturnd from rmot aras of Thailand.&nbsp;&
nbsp;H dvlopd fvr and umbilicatd skin lsions bgan to crop up all ovr h
is body.&nbsp;&nbsp;Hrs a biopsy, what dos h hav?<br /><img src=""A26_pni
cillium.png"" />"
Pnicillium marnffi<br /><br />(A26_pnicillium)
cas fungi fungi_lftovrsBrnt picturs
"Which fungus is this?<br /><img src=""A27_asprgillus.png"" />"
asprgil
lus (acut angls sn)<br /><br />(A27_asprgillus)
fungi fungi_lftovrsBr
nt picturs
"What dos this patint hav?<br /><img src=""A28_tinapdis.png"" />" tina p
dis<br /><br />(A28_tinapdis) fungi fungi_lftovrsBrnt picturs
"Is this proximal or distal onychomycosis? What dos this imply about th invidi
dual?<br /><img src=""A30_Proximaloncy.png"" /><br />" proximal; invididual is
immunocompromisd (i AIDS)<br><br>(A30_proximaloncy)
fungi fungi_lftovrsBr
nt picturs
"What fungal infction dos this patint hav?<br /><img src=""A32_blastomycs.p
ng"" />"
blastomycs drmatitidis<br /><br />(A32_blastomycs) fungi fu
ngi_lftovrsBrnt picturs
"This fungal skin lsions frquntly occurs on coolr parts of th body.<br /><i
mg src=""A33_blastomycs.png"" />"
blastomycs drmatitidis<br /><br />(A33
_blastomycs) fungi fungi_lftovrsBrnt picturs
"Is this broad or narrow basd budding? Nam th fungus.<br /><img src=""A34_bro
adbasdbudding.png"" />"
broad basd; blastomycs drmatitidis<br /><br /
>(A34_broadbasdbudding)
fungi fungi_lftovrsBrnt picturs
"Which fungus is ndmic to this part of th US?<br /><img src=""A35_blastomycs
.png"" />"
blastomycs drmatitidis<br /><br />(A35_blastomycs) fungi fu
ngi_lftovrsBrnt picturs
critical priod tim priod in which plasticity still xists in <b>full</b>
Infction can rsult from vry transint xposur such as a brif stopovr in th
 LA airport, or with fomits coming from an ndmic ara.&nbsp;&nbsp;Nw foci o
f soil infctions hav bn discovrd bcaus of archology studnts digging fo
r artifacts.
coccidioids
fungi fungi_lftovrsBrnt
What ar th rprcussions of hmisphrctomy? "NOT MUCH if th child is lss t
han 8 or so<div><img src=""hmi.jpg"" /></div>"
Commnt on how th brain gts wird up with so fw gns and nurodvlopmnt:
natur builds a <b>sloppy brain</b> w fw gns and xprinc (th world) dos
th rst. th gambl is that th nvironmnt could b impovrishd (Gnis stor
y)
"Patint can prsnt with <b>rythma nodosum</b> (sn blow) or <b>hilar adno

pathy</b> with infiltrats.&nbsp;&nbsp;Which fungus?<br /><img src=""A37_rythm

anodosum.png"" />"
"acut coccidioids<br /><div><img src=""past-102361955
565804.jpg"" /></div><div><img src=""past-102460739813845.jpg"" /></div>"
Dicky fungi picturs
Growth of th brain aftr birth is du to what (3)? (xplains why young brains a
r mor plastic)
1. nw synapss<br />2. mylination<br />3. incrasd d
ndritic branching<div><br /></div><div><i>not nw nurons</i></div>
How long dos ntrovirus viral shdding occur in th body? (rsp, GI) rsp ==
7-14 days<br>GI == 3-4 months
Which picornavirus causs diarrha?
Aichi virus (Kobuvirus)
Who ar at risk for dissminatd &amp; fatal disas from coccidioids? prgnant
womn, immunocompromisd (i AIDS, transplant rcipints), and dark skinnd rac
s.&nbsp;&nbsp;&quot;Dont go to Arizona if your prgnant&quot;
fungi fu
ngi_lftovrsBrnt
Plurodynia; what is it causd by?
acut pluritis w svr chst pain on b
rathing. causd by <u>Coxsacki B</u>
"Which fungus is this? Shows sphruls containing ndospors.<br /><img src=""A3
8_coccidioids.png"" />"
coccidioids<br /><br />(A38_coccidioids)
fungi fungi_lftovrsBrnt picturs
Causs pulmonary infction and mningoncphalitis (frquntly involving th bas
ilar mnings).&nbsp;&nbsp;Found in agd-bird droppings.
cryptococcus no
formans fungi fungi_lftovrsBrnt
"This organism stains pink with mucicarmin.<br /><img src=""A39_cryptococcus.pn
g"" />" cryptococcus (mucicarmin stains th capsular polysaccharid)<br /><br /
>(A39_cryptococcus)
fungi fungi_lftovrsBrnt picturs
"Narrow basd budding shown.&nbsp;&nbsp;What fungus is this?<br /><img src=""A40
_cryptococcus.png"" />" cryptococcus<br /><br />(A40_cryptococcus)
fungi fu
ngi_lftovrsBrnt picturs
"Typical phnotyp of a patint with this fungus: havy smoking, wrinkly, whit
man with mphysma.<br /><img src=""A41_histoplasma.png"" />" histoplasma caps
ulatum <br /><br />(A41_histoplasma)
fungi fungi_lftovrsBrnt picturs
"45 y/o man participatd in Arbor Day activitis 1 month ago.&nbsp;&nbsp;Rcntl
y has dvlopd noduls on his arm.&nbsp;&nbsp;What dos h hav?<br /><img src=
""A42_sporothrix.png"" />"
sporothrix schnckii<br /><br />(A42_sporothrix)
fungi fungi_lftovrsBrnt picturs
arthropod born viruss <div>Arboviruss</div> 5/23ArbovirusRD
What is th nuclic acid of togavirida? Uniqu fatur?
"lipid nvlopd
, +ssRNA w <u><b><font color=""#ff0000"">polyA tail and 5 cap</font></b></u><di
v><u><b><font color=""#ff0000""><br /></font></b></u></div><div><u><b><font colo
r=""#ff0000""><img src=""past-211965225992822.jpg"" /></font></b></u></div>"
5/23ArbovirusRD
What is th antignic rlationship of th alphavirus class?
"all hav srolo
gic cross-ractivity<br /><br />--nd a spcial lab for diagnosis du to this<d
iv><br /></div><div><img src=""past-211965225992822.jpg"" /></div>"
5/23Arbo
virusRD
What is th tratmnt of alphavirus?
"supportiv, no anti-virals availabl<di
v><br /></div><div><img src=""past-211965225992822.jpg"" /></div>"
5/23Arbo
virusRD
What is th nuclic acid of flavivirida? uniqu fatur?
"lipid nvlopd
, +ssRNA, w <font color=""#ff0000""><b>5 cap</b></font> but <u><b>no polyA tail
</b></u><div><u><b><br /></b></u></div><div><u>fla</u>mrs cant gt any tail</d
iv><div><br /></div><div><img src=""past-210848534495862.jpg"" /></div>"
5/23ArbovirusRD
Dscrib th progrssion of yllow fvr disas:
"Phas 1 == non spcific
fbril illnss<br />Priod of rmission on 3rd or 4th day<br />Phas 2 == ""in
toxication"" w hpatic and rnal disfunction and blding<div><br /></div><div><
img src=""past-210848534495862.jpg"" /></div>" 5/23ArbovirusRD
How ar flaviviruss diagnosd? "<b>srology</b> is th main on<div><br /></div
><div><img src=""past-210848534495862.jpg"" /></div>" 5/23ArbovirusRD
What is th tratmnt and prvntion of flavivirus?
"Tx: mainly supportiv;

hp C can b tratd though (ribavirin/protas inhibitors);&nbsp;<div><br /></d

iv><div><br /><div>Prvntion: control vctors; vaccinat for JEV and Yllow fv
r</div></div><div><br /></div><div><img src=""past-197323682480758.jpg"" /></d
iv><div><img src=""past-197336567382646.jpg"" /></div>"
5/23ArbovirusRD
What ar th 2 important viruss in th Bunyavirus <u>gnus</u>? Whr ar ths
found? "1. <b><font color=""#008040"">California ncphalitis</font></b>; wst
rn US and Canada<br />2. <b><font color=""#008040"">LaCross</font></b>; midwst
and astrn US and Canada<div><br /></div><div><img src=""past-201171973177882
.jpg"" /></div>"
5/23ArbovirusRD
What is causd by Bunyavirida--&gt;Nairovirus? Vctor?<div><br /></div><div><br
/></div>
"criman-congo hmorrhagic fvr --&gt; fbril illnss followd
by multi organ failur; it is <b>tick</b> born<div><img src=""nairo.jpg"" /><
/div><div><br /></div><div><img src=""past-203113298395674.jpg"" /></div>"
5/23ArbovirusRD
Hantavirus Pulmonary Syndrom --&gt; what do you s on CXR?
"bilatral <u>in
trstitial</u> infiltrats and <u>alvolar</u> infiltrats, <u>plural ffusion<
/u><div><img src=""cxr hanta.jpg"" /></div><div><br /></div><div><img src=""pas
t-201837693108854.jpg"" /></div>"
5/23ArbovirusRD
What ar th gnra of Filovirida?
"1. Marburg virus<br />2. Ebolavirus<div
><br /></div><div><img src=""past-203821967999606.jpg"" /></div>"
5/23Arbo
virusRD
What is th rsrvoir of Filoviruss? "fruit bats<div><br /></div><div><img sr
c=""past-203821967999606.jpg"" /></div>"
5/23ArbovirusRD
"Which fungus causs this?<br /><img src=""A46_candida.png"" />"
Candida
fungi picturs
"Occurs in individuals who hav frqunt immrsion of th thir hands in watr (
i dishwashrs, laundry workrs). (BE <font color=""#ff0000"">SPECIFIC</font>)<b
r /><img src=""A47_candida.png"" />"
Candida paronychia<br />
fungi pi
cturs
"Which fungus?<br /><img src=""A48_candida.png"" />"
candida albicans (forms
grm tubs)
fungi picturs
"Which fungus?<br /><img src=""A49_candida.png"" />"
Candida fungi picturs
"What dos this child hav?<br /><img src=""A50_candida.png"" />"
chronic
mucocutanous candidiasis
fungi picturs
What typ of viral gnom acts as mRNA? +RNA
5/12GnralPrinciplsofViruss G
nral_virus
Which intrfrons hav th most antiviral ffct?
alpha and bta 5/12Gn
ralPrinciplsofViruss Gnral_virus
"<img src=""A53_virusQ.png"" />"
Answr = D<br /><br />(A53_virusQ)
classQ
"<img src=""A54_virusQ.png"" />"
Answr = C<br /><br />(A54_virusQ)
classQ
"<img src=""A55_virusQ.png"" />"
Answr = A<br /><br />(A55_virusQ)
classQ
"<img src=""A56_virusQ.png"" />"
Answr = B<br /><br />(A56_virusQ)
classQ
"<img src=""A57_virusQ.png"" />"
Answr = D<br /><br />(A57_virusQ)
classQ
Whr dos Alzhimrs usually start? Whr ls may it start? <u>Hippocampal a
ra</u>&nbsp;but it is a focal start maning it will sprad vntually (lading
to mmory problms)<br /><br /><u>Brocas ara</u>&nbsp;(lads to progrssiv ap
hasia)
What bug: iron chlator dfroxamin incrass risk, and apparnt acut appndic
itis
Yrsinia ntrcolitica<div><br /></div><div>Yrsinia ntrocolitica dos
not mak a sidrophor but can us host-chlatd iron or iron bound to xognou
s chlating agnts</div>
3/13Entrobactriaca3
Strp A immunologic squla, suprantign stimulation of T clls by xotoxin C
"guttat psoriasis<div><img src=""supr.jpg"" /></div><div>Slctiv accumulati
on of V2 + T-cells&nsp;</div>"
3/4Streptococci
True or false: Inflammation, not toxic damage to tissues, is largely responsile

for pneumococcocal pneumonia. "True; WBC, plasma constituents and RBC collect
in alveoli and fill up the alveolar spaces. This is called <u>infiltrate</u> and
this is what is seen on the chest X-ray<div><img src=""infilt.jpeg"" /></div>"
3/3IntrotoID
S. mutans most commonly causes what?
dental caries
Whats the most common cause of adult pneumonia?
pneumococcus
Pneumococci are catalase positive or negative? catalase negative
3/3Intro
toID
What are the symptoms of pneumococcal pneumonia?
Often preceded y viral
illness (iphasic)<div><r /><div>Cough (90%), fever (90% young adults, 50-70% e
lderly), sputum production, chest pain (50-75%)&nsp;</div><div><r /></div><div
>Sometimes sudden onset of shaking chill/fever; note: some elderly may have NONE
of these</div><div><r /></div><div>normal chest exam physical, Chest X ray i
s proper diagnosis</div></div> 3/3IntrotoID
Whats significant aout a PMN count elow 6000 in a person with pneumonia?
indicates OVERWHELMING infection and a very ad prognosis (2/3 mortality)
What is Binax? its a urine test that tests for cell wall polysaccharide (ie fo
r pneumococcus)
What pathogen causes MOPS?
streptococcus pneumoniae; MOPS = meningitis, oti
tis media, pneumonia, sinusitis 3/3IntrotoID
56 y/o homeless man was admitted to BTGH with fever and seizures. CT of the head
demonstrated an enhancing mass. Blood cultures show a gamma-hemolytic gram posi
tive cocci in chains that is not solule in ile.
"milleri group (ie S. in
termedius); they cause collections of pus<div><img src=""gamma (1).jpeg"" /></di
v>"
3/4Streptococci2
Pneumococcus colonies collapse in the center due to what toxin? autolysin
3/3IntrotoID
What provides the strongest immunity to pneumoccocus? antiody to capsule; thi
s allows opsonization for phagocytosis; normal people make antiody within 2-3 w
eeks of colonization
3/3IntrotoID
S. pyogenes <>pharyngitis</> left untreated resulting in cross-reaction of ant
i-strep s with antigen of joints and heart tissue
rheumatic fever 3/4Strep
tococci
Characterize the vaccine for pneumococcus required y 2 y/o and younger.
Protein-conjugated vaccine --&gt; chemical conjugation of polysacchardie to prot
ein (ie tetanus toxoid); this alters the mode of presentation<div><r /></div><d
iv>Pneumovax (capsular polysaccharide &nsp;stimultes T cell ind. immune reactio
n ut is not protective efore 2 yrs ecause of immature immune response)</div><
div><r /></div><div>**&nsp; conjugate vaccine is created y covalently attach
ing a poor (polysaccharide organism) antigen to a carrier protein (preferaly fr
om the same microorganism), therey conferring the immunological attriutes of t
he carrier on the attached antigen. The polysaccharide antigen will not e loade
d onto the MHC complex, which can only ind peptides, and thus will not e prese
nted to a T cell for activation of the presenting B cell. In the case of a conju
gate vaccine, the carrier peptide linked to the polysaccharide target antigen is
ale to e presented on the MHC molecule. <>The T cell that recognizes the car
rier peptide will activate that B cell, causing it to produce antiodies to the
polysaccharide antigen that it had originally ound. </>This technique for the
creation of an effective immunogen is most often applied to acterial polysaccha
rides for the prevention of invasive acterial disease.</div> 3/3IntrotoID
Clinical presentation of ETEC watery diarrhea, nausea, cramps, stool does NOT
contain lood/mucus/leukocytes
Whats an effect that limits the usefulness of Prevnar13?
increases preval
ence of colonization and disease y non-vaccine strains --&gt; called<> <u>act
erial replacement strains</u></>
3/3IntrotoID
How do viral infections and cigarette smoke predispose to pneumococcal infection
?
damage clearance mechanisms
3/3IntrotoID
Increases pH of urine, struvite stones, swarming growth proteus mirailis
3/13Enteroacteriaceae2
How are pneumococcus and strep viridans differentiated? optochin test; OVRPS; ca

n also e distinguished ased on <u>sensitivity to lysis y ile</u><div><u><r

/></u></div><div>pnuemococcus is susceptile to optochin</div> 3/4Streptococci
Incidence of pneumococcus greater in elderly or younger?
elderly (and it
s usually more serious)
Would an encapsulated acteria show and (+) or (-) quellung test?
positive
; causes capsule to swell
What test allows differentiation etween staph and strep?
catalase
3/6Staphylococcus1
n old man develops a UTI 5 days after admission to the hospital. Hes receiving
x treatment including cephalosporins for an unrelated infection. ppears vanc
omycin resistant.
Enterococcus faecalis 3/4Streptococci2
Elderly woman presents with a cough producing rusty-colored sputum. Complains of
sharp right-sided chest pain, chills, and fevers. Physical exam reveals increas
ed fremitus, dullness to percussion. CXR shows right lower loe consolidation, a
nd gram stain shows gram (+) diplococci.
pneumococcus
Pneumococci are or are not susceptile to optochin?
"susceptile; OVRPS - op
tochin: viridans resistant pneumococci susceptile<div><img src=""optochin.jpeg"
" /></div>"
3/3IntrotoID
Spread y ticks, damages endothelium, rash on palms and soles Rocky Mountain S
potted Fever (Rickettsia rickettsii)
3/17Zoonotic
Mnemonic for gram stain procedure.
"VIS; violet stain, iodine fix, alcohol
/acetone wash, safranin stain<div><r /></div><div><img src=""gram.jpeg"" /></di
v><div><r /></div><div>-Crystal violet stains proteins and carohydrates. &nsp
;</div><div>-Iodine fixes it in peptidoglycan. &nsp;</div><div>-lcohol or acet
one removes crystal violet (ut less readily from peptidoglycan after fixing y
iodine). &nsp;</div><div>-Safranin stains everything red, ut wont cover up the
lue. &nsp;</div><div><r /></div><div>Bacteria with thick <>peptidoglycan</>
layer in cell wall (streptococci, staphylococci) retain lue color and are call
ed Gram positive; those with thin peptidoglycan layer (E. coli, Klesiella) appe
ar red and are called Gram negative.</div>"
3/3IntrotoID
Young girl rought to her doctor ecause of rough-appearing rash on her trunk an
d neck that spread to her arms. Her parents say that she has een suffering from
fever and sore throat. La studies reveal her serum is SO+
scarlet fever
 young man enters the ER dehydrated, aferile, and complaining of nausea and vo
miting. He rememers eating a dish with fried rice at an sian restaurant severa
l hours ago.
Bacillus cereus 3/21DiptheriaListeria
86 y/o man in nursing facility had a cold for a few days and then just didnt se
em to e himself. He deteriorated, staying in ed for 48 hours. No cough, sputum
, fever. Brought to V where careful exam revealed rales in the right lung. Lots
of infiltrate noted in lungs and sputum had PMNs and acteria. Cause? Pneumoco
ccus
3/3IntrotoID
ETEC toxin that activates cMP. What is it related to? "LT; NOTE: Related to ch
olera toxin<div><img src=""ETEC.jpeg"" /></div>"
3/13Enteroacteriaceae2
Most common cause of meningitis in 60+ y/o
pneumococcus
ntigen for SO antiody. What is it used to diagnose? streptolysin O from S. p
yogenes<div><r /></div><div>(antistreptolysin O titers) Diagnostic for <u>rheum
atic feve</u>r, less useful for skin infections ecause <>streptolysin O is ou
nd to cholesterol in skin</></div>
3/4Streptococci
Most pathogenic streptococcus group  strep (S. pyogenes)
3/4Streptococci
Name two alpha hemolytic organisms
viridans strep and pneumococcus 3/4Strep
tococci
Which strep is selectively lysed y ile salts? pneumococcus
3/17LegionellaMy
coplasmaChlamydia
Whats the most important group D strep? Important quality? What type of hemolys
is?
S. gallolyticus (ovis); they are <u>VERY sensitive to penicillin</u><di
v><r /></div><div>either&nsp;- r -hemolytic and identified by their ability to
row in the presence of 40% bile and to hydrolyze esculin</div> 3/4Streptococci2
Enterococci (E. faecalis &amp; faecium) were placed in a separate enus from ro
up D strep. What makes them particularly different?
"they're resistant/toler
ant to penicillin<div>i.e., MIC &t;1 /ml&nbsp;<u>M</u>inimal <u>I</u>nhibitory

<u>C</u>oncentration</div><div><im src=""MBC.jpe"" /></div>" 3/4Streptococci2

Youn irl was bitten by a cat earlier in the day, develops redness, heat, and t
enderness around the site of the bite. Culture of wound shows ram neative cocc
obacilli.
"Pasteurella multocida<div><im src=""cat.jpe"" /></div>"
3/10SkinandSoftTissueInfections
A youn child presents with fever and skin rash localized around lips and arms.
The rash appears pustular with yellow crusts. Cultures from the impetio show r
am (+) cocci in chains that are beta-hemolytic. S. pyoenes<div><br /></div><div
>Acute supprative disease: Pyoderma</div>
3/4Streptococci
Name some extracellular products of S. pyoenes.
pyroenic exotoxin A/B/C
(supertoxins),&nbsp;<div><br /></div><div>streptolysin O (dianostic rheumatic
fever),&nbsp;</div><div><br /></div><div>Streptokinase (activates plasminoen, t
herapeutically useful for lysin blood clots)&nbsp;</div><div><br /></div><div>h
yaluronidase (anti-hyaluronidase ab are dianostic),&nbsp;</div><div><br /></div
><div>DNAse (anti-DNAse titers dianostic)</div>
3/4Streptococci
What common rash does pyroenic exotoxin from strain of S. Pyroene produce? Wha
t do these rashes look like?
"scarlet fever rash: strawberry tonue; sandpape
r rash<div><im src=""straw.jpe"" /></div>"
3/4Streptococci
Chronic lun disease and otten worse over 5-6 days. Fever. Couhs up lare amou
nt of sputum that has PMNs and coccobacilli. Pneumonia. Sputum is streaked and i
dentified on chocolate aar.
Haemophilus influenza 3/18Haemophilus Dickey
Scarlet fever caused by what oranism? S. pyoenes
Immunity to pneumococcus (ab to what 3 thins) "acquired immunity is larely fr
om <b>antibody</b> to <u>capsule</u>; also antibody to <u>PspA</u> or <u>pneumol
ysin</u><div><u><br /></u></div><div><u>PspA</u>- pneumococcal surface protein A
.&nbsp;</div><div>Pneumolysin- major virulence factor</div><div><br /></div><div
><im src=""paste-631776804340828.jp"" /></div>"
3/3IntrotoID
ASO titers used dianostically for ____.
Rheumatic fever; they're less us
eful for skin infections because streptolysin O is bound by cholesterol in the s
kin
3/4Streptococci
What three titers can you et for a strep infection?
ASO, anti-DNAse, anti-hy
aluronidase
3/4Streptococci
Inflammation of tonsils w/ exudate, fever, and cervical lymphadenopathy.
strep throat from S. pyoenes 3/4Streptococci
Discrete skin lesions with honey colored exudate.
"impetio from S. pyoen
es/S. aureus<div><im src=""impetio.jpe"" /></div>" 3/4Streptococci
What's a form of cellulitis that is spreads alon lymphatics with redness and pa
in at advancin marins and is well-demarcated. "erysipelas (S. pyoenes)<div><i
m src=""erysipela.jpe"" /></div>"
3/4Streptococci
5 day old infant was delivered from 16 y/o G1P1 who was in labor for 22 hours an
d had no prenatal care. The baby now has lethary and bulin fontanels. You sus
pect meninitis due to what?
S. aalactiae (roup B strep) 3/4Streptococci2
64 y/o man suffered from head trauma 2 years ao and has had a persistent CSF le
ak as a result. Last year, he had an episode of meninitis from which he recover
ed. He was admitted to Ben Taub this mornin with headache, stiff neck, and feve
r.
pneumococcus
Name two toxin associated diseases from S. pyoenes
"scarlet fever and toxic
strep syndrome<div><im src=""scarlet.jpe"" /></div><div>(rheumatic is an immu
ne response disease)</div>"
3/4Streptococci
Causes atypical pneumonia and associated with fountains and water habitats
Leionella
3/17LeionellaMycoplasmaChlamydia
Outermost layer that allows pneumococcus to escape phaocytosis polysaccharide c
apsule 3/6Staphylococcus1
Hypotension alon with multiple oran failure. Individual has strep throat.
toxic strep syndrome<div><br /></div><div>(derived from pharyneal strains)</div
>
3/4Streptococci
Inherent carbapenem resistance Stenotrophomonas maltophilia
3/14Pseudomonasa
ndFriends
Delayed nonsuppurative inflammatory disease that follows roup A strep <b>pharyn
itis</b> and involves the heart, joints, CNS, skin
acute rheumatic fever

3/4Streptococci
What's the old standard for dianosin strep throat? throat culture 3/4Strep
tococci
Name 3 disease resultin from the immune response to roup A strep.
"acute r
heumatic fever, lomerulonephritis, uttate psoriasis<div><br /><div><im src=""
uttate ps.jpe"" /></div><div><im src=""utt pic.jpe"" /></div><div><br /></d
iv></div>"
3/4Streptococci
Diarrhea-causin oranism associated with Guillain-Barre
campylobacter je
juni
3/17Diarrhea
What often precedes pneumonococcal pneumonia? viral illness
Most common symptom of acute rheumatic fever
arthritis
3/4Streptococci
Edema of face, hypertension, hematuria, decreased complement, and just had strep
throat "acute lomerulonephritis<div><im src=""lom.jpe"" /></div>" 3/4Strep
tococci
Mnemonic for bacitracin susceptibility. B-BRAS; Bacitracin: roup B resistant, 
roup A susceptible
HUS (hemolytic uremic syndrome) triad thrombocytopenia, hemolytic anemia, neph
ropathy
48 y/o man with COPD is admitted with LLL pneumonia. His sputum rows an alpha-h
emolytic strep on blood aar plates. What laboratory test will be used to identi
fy the oranism?
"optochin (nearly all pneumococci are susceptible to opt
ochin)<div><im src=""strep.jpe"" /></div>"
3/3IntrotoID
E. coli 0157:H7 is neative or positive for sorbitol fermentation?
neative
3/17Diarrhea
Specific E. coli serotype that's MCC of hemolytic uremic syndrome
E. Coli
O157 (it's an EHEC strain)
3/13Enterobacteriaceae2
Appearance of new heart murmur, joint pain, and fever. acute rheumatic fever
3/4Streptococci
Why is an individual's pCO2 reduced that has pneumonia? Their O2 saturation is l
ow and thus they're breathin faster to try to compensate.
URI (upper respiratory infection) and atypical pneumonia. Smallest free livin o
ranism Mycoplasma pneumoniae 3/17LeionellaMycoplasmaChlamydia
Adolescent presents to clinic complainin of brownish urine. Two weeks earlier,
he had a sore throat that resolved. Physical exam yields hih BP. Serum studies
show elevated BUN and Cr, ASO+, and diminished levels of C3. Urinalysis indicate
lomerulonephritis
s RBC casts.
Gram neative rods are enerally motile except for which two? Shiella and Kle
bsiella<div><br /></div><div>orilla chained</div><div>klebsiella (dinosaur)</di
v>
3/13Enterobacteriaceae2
roup B strep (S. aalactiae)
Beta hemolytic and resistant to bacitracin.
3/4Streptococci2
Patholoy: Redness, inflammation of skin and subcutaneous tissue, tissue edema.
cellulitis
3/6Staphylococcus1
Define aspiration, and inhalation
Aspiration: mouth contents <u>bypass the
lottis</u> and end up in the trachea. Occurs durin sleep in normal people, es
pecially the elderly.<div>Inhalation: Breathin in aeosolized oranisms. Sticky
walls and laminar flow make this less important</div><div><br /></div><div>Aspir
ated or inhaled material is normally expelled by ciliary action and couh but if
these mechanisms are not operative then bacteria can reach distal brochioles an
d alveoli.</div>
3/3IntrotoID
EHEC bacteria enterotoxins
"they produce shia-like enterotoxins: Stx1 and
Stx2<div><br /></div><div>*Stx2 can cross the intestine and disseminates in the
bloodstream, bindin to and damain the endothelial cells in the kidneys, brain
, colon, and other orans (ischemia). This results in HUS.</div><div><im src=""
delivery.jpe"" /></div>"
3/13Enterobacteriaceae2
H antien?<b> Not</b> found in what 2 species? flaella<div>(not found in klebs
iella and shiella)</div>
Occurs in neonates and post-partum women
roup B strep
Associated with adenocarcinoma of the colon and need for colonoscopy
"S. all
olyticus (bovis)<div><br /></div><div>""Bovus in blood, cancer in bowel""<br /><

div><im src=""colon (2).jpe"" /></div></div>" 3/4Streptococci2

Strep that causes abscesses (ie in brain)
Milleri roup (ie S. intermedius
)<div><br /></div><div>Milleri roup: S. aninosus, S. intermedius, S. constella
tus</div><div><br /></div><div>CIA</div>
3/4Streptococci2
Pieon breeder presents with non-specific pneumonic illness
Psittacosis (C.
psittaci)
3/17LeionellaMycoplasmaChlamydia
Soon after birth, infant develops seizures, marked irritability, and fever. The
infant's birth records note a proloned labor with premature rupture of membrane
s. LP was done and infant was started on Abx
S. aalactiae (roup B) 3/4Strep
tococci2
Are pneumococci alpha or beta hemolytic?
alpha 3/3IntrotoID
Pneumococcus is the most common cause of meninitis at all aes except for who?
newborns
2nd most common cause of traveler's diarrhea
EAEC<div><br /></div><div>'Enter
oareative E. Coli'</div><div><br /></div><div>(ETEC is the 1st most common)</
div>
3/13Enterobacteriaceae2
Elderly man develops low-rade fever and sins of endocarditis over a period of
2 weeks. Followin blood culture, his doctor also becomes concerned about possib
le colon cancer.
S. allolyticus (bovis); because S. bovis bacteremia inv
ades throuh GI lesions it oftentimes sinals colonic carcinomas
3/4Strep
tococci2
Blood cultures of S. intermedius indicate presence of what in the body? abscess
3/4Streptococci2
What's the lancefield antien of pneumococcus? it doesn't have one<div><br /></
div><div>initially developed for the -hemolytic streptococci</div><div><r /></di
v><div>Groups , B, C, D, F &amp; G are medically important.</div>
3/4Strep
tococci
Sexually promiscuous acteria that are transferred on the hands of health care p
ersonnel. Resistant to many antimicroial agents like vancomycin.
"Enteroc
occus<div><img src=""enteroc.jpeg"" /></div>" 3/4Streptococci2
Define suclinical disease:
if organisms are proliferating and <u>disease is
present</u> ut theyre <u>no symptoms</u>. Incuation period or latent disease
as well.&nsp; 3/3IntrotoID
Highly motile and swarms on lood agar plates. Produces a rapid-acting urease.
"Proteus<div><img src=""proteus.jpeg"" /></div>"
3/12Enteroacteriaceae
lpha hemolytic streptococci that are a normal part of human oral and owel flor
a. They normally adhere to teeth, uccal mucosa, and tongue. Name the 4 groups
"Viridans strep<div><r /></div><div>(S. mitis, S. sanguis, S. salivarious, S. m
utans)<r /><div><img src=""viridan.jpeg"" /></div></div>"
3/4Streptococci
2 major disease caused y viridans strep
dental caries and infective endo
carditis (involving anormal heart valves)
3/4Streptococci2
"<>pairs</> or chains of elong
ppearance of pneumococcus on gram stain.
ated cocci and gram positive<div><img src=""pneumo gram.jpeg"" /></div>"
3/3IntrotoID
Which strep acteremia requires susequent colonoscopy to screen for colon malig
nancy? S. gallolyticus (ovis) 3/4Streptococci2
How reliale is sputum for diagnosis of pneumococcal pneumonia? What is window?
90% reliale if a good specimen is otained less than 6 hours after x given
3/3IntrotoID
Most common infectious disease worldwide
dental caries
erosol transmission from environmental water source haitat. Gram stains poorly
Legionella
3/17LegionellaMycoplasmaChlamydia
Veterinary school student complains to the doctor of diarrhea an adominal tende
rness. He admits that he plays with his pet turtle a lot
gastroenteritis
caused y non-typhoidal salmonella
3/13Enteroacteriaceae3
20 y/o oy is admitted to LDH Hospital with fever and joint swelling. The pediat
rician suspects acute rheumatic fever. What test is appropriate?
SO tite
r
3/4Streptococci
Occurs especially in people who have a compromised lymphatic drainage (ie follow
ing CBG or axillary node dissection) "cellulitis/erysipelas<div><img src=""ca

g.jpeg"" /></div><div><img src=""reast.jpeg"" /></div>"

3/4Streptococci
73 y/o woman is admitted with low-grade fevers and a murmur of mitral insufficie
ncy that has not een previously noted. She had had some iron deficiency anemia
with a positive stool for occult lood. Two sets of lood cultures are positive
for group D strep.
infective endocarditis due to S. gallolyticus (ovis)<di
v><r /></div><div>Strong correlation of gallolyticus and endocarditis and colon
ic neoplasms</div>
3/4Streptococci2
When EHEC spreads to kidneys
"Hemolytic uremic syndrome (HUS)<div><r /></div
><div>Children under age 5 and the elderly are the most likely to develop hemoly
tic&nsp;uremic syndrome (HUS), a triad of thromocytopenia, hemolytic anemia, a
nd <span class=""pple-ta-span"" style=""white-space:pre""> </span>nephropathy.
&nsp;HUS is a common cause of renal insufficiency in children</div>" 3/13Ente
roacteriaceae2
Where does pneumonoccus colonize?
nasopharynx, children >>> adults
3/3IntrotoID
Define quiescent or latent disease:
if proliferation is not occurring at pre
sent
Major acterial cause of respiratory tract disease and meningitis? Exception?
streptococcus pneumoniae; NOTE: not major cause of meningitis in the neworn
3/3IntrotoID
What protrudes into the capsule of pneumococcus and staph that mediates attachme
nt and stimulates inflammatory responses? By what pathway?
teichoic acid--i
nflammatory via TLR2 >> 4
3/6Staphylococcus1
Lack the enzymes required to neutralize H202 and oxygen free radicals (ie C. per
fringens)
oligate anaeroes
Woman complains of vaginal discharge and admits to multiple sexual partners. Pel
vic exam reveals cervical motion tenderness ut las show no organisms on gram s
tain. PCR yields a definitive answer. Chlamydia trachomatis<div><r /></div><d
iv>Key point- hard to diagnose/PCR is impractical&nsp;</div> 3/17LegionellaMy
coplasmaChlamydia
34 y/o man works at meat department of Kroger and cut his hand while cutting up
tilapia yesterday.
S. iniae
3/4Streptococci2
Two silings presented with sore throats accompanied y tonsillar exudates and a
<i>diffuse sandpaper rash</i>. scarlet fever due to group  strep (S. Pyogenes)
3/4Streptococci2
dhesion/anchoring in gram + organisms teichoic acid/lipoteichoic acid 3/3Intro
toID
"alpha-hemolysin (they a
ll pneumococci produce what toxin that lyses RBCs?
re thus alpha-hemolytic)<div><r /></div><div>(Partial hemolysis, as opposed to
eta-hemolysis)</div><div><img src=""alpha hemolysis.jpeg"" /></div>" 3/3Intro
toID
Causes legionnaires disease and pontiac fever Legionella; NOTE: Legionnaires
more serious than Pontiac fever 3/17LegionellaMycoplasmaChlamydia
Selective agar that contains ile salts to suppress growth of gram (+) organisms
, as well as lactose and a pH indicator "MacConkeys; colonies that <u>ferment l
actose</u> create an acidic environment and turns them <u><font color=""#ff00ff"
">fuschia</font></u>; <u>non-lactose</u> fermenters are <u><font color=""#c2a98a
"">tan</font></u> or grey<div><img src=""macconkey.jpeg"" /></div><div><img src=
""lactose.jpeg"" /></div>"
3/12Enteroacteriaceae
Mnemonic for naeroes "Cant Breathe ir; Clostridium, Bacteroides, ctinomyce
s<div><r /><div><img src=""paste-383252816724191.jpg"" /></div></div>" 3/14nae
roes Dickey
CXR looks worse than symptoms suggest. Bacteria has no cell wall and exhiits co
ld hemagglutination. Walking/atypical pneumonia suspected.
Mycoplasma pneum
oniae 3/17LegionellaMycoplasmaChlamydia
Strawerry tongue and sandpaper rash
scarlet fever (group , S. pyogenes)
3/4Streptococci
Major virulence factor produced y pneumococci pneumolysin--thus <u>antiody to
pneumolysin is highly protective</u><div><u><r /></u></div><div>1. activates c
omplement</div><div>2. damages ciliated cells and PMN</div><div>3. reproduces ch

anges of pneumonia</div><div><u><r /></u></div>

3/3IntrotoID
Major cause of acterial pneumonia and meningitis in adults and otitis media in
children
pneumococcus
3/3IntrotoID
site of respiration in acteria cytoplasmic memrane
Major cause of dental caries
viridans strep 3/4Streptococci2
Favors moist environments and causative agent of endocarditis in IV drug users.
Serratia marcescens
3/12Enteroacteriaceae
Causes watery diarrhea similar to cholera. Leading cause of travelers diarrhea.
ETEC<div><r /></div><div>Enterotoxigenic E. coli</div><div><r /></div><div>C
auses a disease with pathogenesis similar to cholera although the <u>illness is
less severe</u>; it is a major cause of <u>childhood diarrhea in developing coun
tries</u>, and the leading cause of travelers diarrhea.</div> 3/13Enteroacter
iaceae2
13 y/o presents with sore throat, fever, cervical adenopathy, and tonsillar exud
ates. La confirmed presence of eta-hemolytic organism on the lood agar plates
from throat swa. What diagnostic test will they run to differentiate different
eta-hemolytics?
"acitracin susceptiility<div><img src=""acitracin.jpe
g"" /></div>" 3/4Streptococci2
K antigen
capsules
3/12Enteroacteriaceae
Whats the vaccine to pneumococcus called for children under 2y/o?
Prevnar1
3
O antigen
<div>most external component of LPS of gram negative acteria. <
>O for Outer</></div><div>(confers resistance to phagocytosis and to killing 
y complement)</div>
3/12Enteroacteriaceae
E. Coli with K1 capsule invades lood-rain arrier to cause neonatal meningitis
Toxic moiety of LPS
"lipid <div><img src=""Lipid .jpeg"" /></div>"
3/12Enteroacteriaceae
Virulence factors of enteroacteriaceae (8)
<div>1. Exotoxins (i.e. hemolysi
n)</div><div>2. Endotoxin (LPS, LOS)</div><div>3. H ntigen</div><div>4. O ntig
en</div><div>5. K antigen</div><div>6. dhesins (i.e. fimrae/pilli)</div><div>7
. Siderophores (iron acquisition)</div><div>8. Plasmids</div><div><r /></div>
3/12Enteroacteriaceae
Descrie normal pathogenesis of pneumococcus? Ie how did disease come aout most
likely.
attachment in <>nasopharynx</> followed y proliferation. It w
as then proaly carried y secretions to spaces from which clearance was poor 
ecause of <>damage to the clearance mechanism</>. Organism carried to trachea,
ronchi, and lungs. Organism induces inflammation and disease results. 3/3Intro
toID
Beta hemolytic fish pathogen
strep iniae
3/4Streptococci2
E. coli type 1 fimriae/pilli adhere to ladder cells resulting in <u>cystitis
</u>
4/17UTI
Iron inding molecule synthesized y acteria "siderophore<div><img src=""side
rophore.jpeg"" /></div>"
3/12Enteroacteriaceae
Invade intestinal epithelial cells and is similar to shigellosis
EIEC; I
= invasive<div><r /></div><div><div>Enteroinvasive E. coli</div></div><div><
r /></div><div>Not seen in US, except in travelers returning from countries wher
e disease is endemic</div>
3/13Enteroacteriaceae2
Major cause of acterial septicemia in the neworn
S. agalactiae (group B)
3/4Streptococci2
"Whats the ""proper"" way to diagnose pneumonia?"
chest x-ray
How are they connected: iron overload and yersinia
Iron overloaded states,
such as <u>hemochromatosis</u>&nsp;and <u>thalassemias</u> increase susceptiil
ity to infection with Yersinia ecause <u>yersinia doesnt make siderophores</u>
3/12Enteroacteriaceae
Most common extra-intestinal infection caused y E. coli
UTI
Name some factors predisposing a person to pneumococcal pneumonia.
1. Mutli
factorial (extremes of life, malnutrition, hospitalization, alcoholism)<div><r
/><div>2. decreased pulmonary clearance (smoking, alcohol/opiates, pollution, vi
ral infection)</div><div><r /></div><div>3. diminished neutrophil function</div
><div><r /></div><div>4. defective IgG production (congenital, acquired, HIV)</

div><div><r /></div><div>5. asence of a spleen (therefore cant remove -coat

ed organisms)</div></div>
3/3IntrotoID
Most common cause of community acquired and nosocomial UTI
E. coli; account
s for up to 90% of cases
3/12Enteroacteriaceae
Second most frequent site of extraintestinal infection y E. coli
adomina
l/pelvic infections
Who can withstand more pressure, gram (+) or (-)?
gram (+)
Causative agent of classic loar pneumonia and affects compromised hosts
klesiella
Produces urease resulting in precipitation of crystals (struvite) onto the cathe
ter.
"<div>Proteus</div><div><r /></div><div><img src=""urease.jpeg"" /></di
v>"
3/12Enteroacteriaceae
Strong propensity to cause ascesses
milleri group strep (S. intermedius)
3/4Streptococci2
Leading cause of travelers diarrhea and childhood diarrhea in developing countr
ies.
ETEC; T = Enterotoxigenic (think <u>travelers</u>)
3/13Enteroacter
iaceae2
ETEC toxins
ST (heat stale) and LT (heat laile); oth cause hypersecretion
of electrolytes into the intestinal lumen and water follows
65 y/o male in St. Lukes with indwelling IV catheter develops low grade fever, 
lood cultures with gram (+) cocci in clusters &gt;15 colonies on semi-quantitati
ve culture plate. Give the 2 most likely culprits.
"coagulase negative stap
h, S. aureus (which is coagulase +)<div><img src=""chart (2).jpeg"" /></div>"
3/6Staphylococcus1
"CF patient dies of respiratory failure, culture reveals lots of ""slime"""
"pseudomonas<div><img src=""slime (1).jpeg"" /></div>" 3/14PseudomonasandFriend
s
"n alcoholic presents with fever, pleuritic chest pain, dyspnea, and cyanosis.
His cough produces a lood ""currant jelly"" sputum. CXR shows inflammation invo
lving right upper loe."
"klesiella pneumoniae<div><img src=""currant.jp
eg"" /></div>" 3/13Enteroacteriaceae2
ETEC toxin that activates cGMP "ST (heat stale)<div><img src=""ETEC.jpeg"" /><
/div>" 3/13Enteroacteriaceae2
65 y/o man is admitted to the hospital with an acute myocardial infarction. Emer
gency angiography demonstrates occlusion of the LD. Which streptococcal enzyme
could e used therapeutically in this man?
streptokinase<div><r /></div><d
iv>Cleaves plasminogen, <i>hypersensitivity can occur if prior exposure</i></div
>
3/4Streptococci
Major cause of outreaks of loody diarrhea (ie O157:H7)
EHEC
3/13Ente
roacteriaceae2
Flattening of intestinal villi (effacement) and no toxin produced. Commonly caus
es diarrhea in children.
EPEC<div>Enteropathogenic E. coli&nsp;</div>
3/13Enteroacteriaceae2
 woman returns to the doctor ecause of an annoying and persistent UTI. The wom
ans workup shows the presence of large radioplaque stones in the urinary tract.
The woman also provides several urine samples, which are consistently high pH.
<>Why stones and why high pH?</>
Proteus<div><r /></div><div><div>Produc
e a rapid-acting <u>urease</u>, which <>converts urea to ammonia</>. &nsp;The
<>alkaline urine</> results in <>precipitation of <u>crystals</u></>on the c
atheter, in the renal calyxes, and in the ladder. &nsp;</div><div><r /></div>
<div>The <u>stones</u> can ostruct the urinary tract, resulting in pyelonephrit
is and acteremia&nsp;</div></div>
3/12Enteroacteriaceae
Patient presents with exudative pharyngitis with scarlet fever. strep pyogenes
Cause of acillary dystentery Shigella
3/13Enteroacteriaceae3
Patient walks in with community acquired pneumonia. States that other memers in
his family have recently een ill. He appears etter than his chest x-ray would
suggest.
Mycoplasma pneumoniae 3/17LegionellaMycoplasmaChlamydia
Deposition of immune complexes in glomeruli following strep  pharyngitis
acute glomerulonephritis
3/4Streptococci
Definition: Frequent passage of stool containing lood and mucus, accompanied y

straining and painful defecation

dysentery
3/17Diarrhea
Cause of dysentery with a very low infectious dose. Common in overcrowded situat
ions such as military camps and day care centers.
"Shigella<div><img src="
"shigella.jpeg"" /></div>"
3/13Enteroacteriaceae3
Two types of infections caused y Salmonella
gastroenteritis and enteric/typh
oid fever
3/13Enteroacteriaceae3
True or false: Bloody diarrhea with fecal leukocytes are a sign of invasive dise
ase
"True; ie shigella<div><img src=""fecal leukoc.jpeg"" /></div>" 3/13Ente
roacteriaceae3
"Used in ""operation seaspray"" ecause it was thought to e non-pathogenic"
serratia marcescens
3/13Enteroacteriaceae2
Organisms causing typhoid fever pass through the intestinal epithelial layer and
then multiply within what kind of cells?
macrohages; infected macrophages
then disseminate throughout the ody
Gradual onset of malaise, fevers, adominal pain and hepatosplenomegaly. Diarrhe
a can e asent, and constipation can e present instead.
typhoid fever
Biliary anormality, enlarged spleen, fever, malaise, and constipation. Recently
traveled to South merica.
typhoid fever; NOTE: gall stones often serve as
reservoir for the disease (especially in asymptomatic carriers like Typhoid-Mary
)
3/13Enteroacteriaceae3
Causes gastroenteritis or typhoid fever.
Salmonella
3/13Enteroacter
iaceae3
Most common cause of osteomyelitis in most people.
S. aureus
3/6Staph
ylococcus1
How does one acquire pneumococci?
close contact; ie intimate facial contac
t (<>kissing</>), <>hand to hand</> contact or <>aerosol</> (sneezing, cou
ghing) 3/3IntrotoID
Persistent acteremia that infected atherosclerotic plaque
non-typhoidal Sa
lmonella
3/13Enteroacteriaceae3
Two major diseases caused y Yersinia entercolitis and plague 3/13Enteroacter
iaceae3
Person presents with RLQ pain and hemochromocytosis.
Yersinia entercolitica;
recall that an iron overload state is a risk factor for yersinia entercolitica 
ecause <i>they dont make siderophores</i>
3/13Enteroacteriaceae3
Hot tu folliculitis
Pseudomonas aeruginosa 3/14PseudomonasandFriends
Most common cause of osteomyelitis
S. aureus
3/6Staphylococcus1
Bloody diarrhea resemling appendicitis. Iron overload status. Yersinia enterco
litica 3/13Enteroacteriaceae3
"Resemle ""safety pins"" with ipolar uptake of stain. Domestic rats are the ma
jor reservoir." Yersinia pestis
Transmitted y the flea ites. Sudden onset of fever, chills, headache, and appe
arance of intensely painful uo (inflamed lymph nodes) uonic plague (Y. pesti
s)
3/13Enteroacteriaceae3
Rapid onset of respiratory failure accompanied y lood sputum. Organism exhiit
s gram-negative stain resemling &quot;safety pins&quot;.
Pneumonic plaque
(Y. pestis)
Large family of <u>gram-negative rods</u> acteria that include salmonella, E. c
oli, Y. pestis, klesiella, and shigella
enteroacteriaceae
3/12Ente
roacteriaceae
 traveler returning from New Mexico presents with fever, dark lack skin patche
uonic
s, and enlarged pain lymph nodes in his groin. Flea ites are noted.
plague (Yersinia pestis)
3/13Enteroacteriaceae3
Name 4 NFGNB that cause human disease. "Pseudomonas aeruginosa, stenotrophomona
s, acinetoacter, urkholderia cepacia<div><img src=""memorize 4.jpeg"" /></div>
<div>*Non-Fermenting Gram-Negative Bacteria</div>"
3/14PseudomonasandFriend
s
Physically attached to the outer memrane of gram negative acteria and highly p
yrogenic (name the molecule). endotoxin
3/4Streptococci
Help acteria colonize ladder ecause there isnt much iron in urine. sideroph
ore
3/12Enteroacteriaceae

Causes loar pneumonia in alcoholics and diaetics when aspirated. lso causes n
osocomial UTIs klesiella
3/13Enteroacteriaceae2
Student hangs around a fountain all day and ecomes ill. He is told he has &quot
;atypical&quot; pneumonia y his physician
Legionella
3/17LegionellaMy
coplasmaChlamydia
True or false: pneumococci dissolve in ile salts.
true
3/3IntrotoID
Opportunistic pathogen that colonize individuals in long-term care settings or h
ospitals. Carries inducile chromosomal gene encoding eta-lactamase that emerge
s during treatment.
"enteroacter<div><img src=""enteroacter pt.jpeg"" /></
div>" 3/13Enteroacteriaceae2
60 y/o male with 1 day history of fever and loody sputum. Decreased O2 saturati
on, respiratory distress, hypotensive. Chest CT shows loar pneumonia. klesiel
la
Which E. coli strain causes dysentery? EHEC<div><r /></div><div>Clinical prese
ntation of EHEC infection: <u>loody diarrhea</u>, severe adominal cramps, ofte
n without high fever. &nsp;Some antiiotics can increase toxin release and incr
ease the risk of developing HUS.&nsp;</div>
3/13Enteroacteriaceae2
Name the organism ased on this pathogenesis: fimriae adhere to intestinal muco
sa, elaorate ST, LT, or oth which act on CFTR to cause secretion of chloride i
nto lumen.
"ETEC<div><img src=""ETEC (1).jpeg"" /></div>" 3/13Enteroacter
iaceae2
Produces Stx1 and Stx2 that are encoded on a acteriophage. Has LEE pathogenicit
y island.
EHEC
3/13Enteroacteriaceae2
P-pilli of E. coli
adhere to kidney cells and result in <u>pyelonephritis</
u>
4/17UTI
Severe cause of watery diarrhea in aies. Results in loss of microvilli.
EPEC<div><r /></div><div>(Breastfeeding is protectivefactors in reast milk inhi
it adherence)</div>
3/13Enteroacteriaceae2
dominal cramping, watery and loody diarrhea. Hemolytic uremic syndrome
EHEC
3/13Enteroacteriaceae2
Stacked rick adherence pattern and 2nd most common cause of travelers diarrhea
EEC<div><r /></div><div>(Enteroaggregative E. Coli)&nsp;</div><div><r /></di
v><div>Name derives from aggregative pattern of adherence to tissue culture cell
s (stacked rick)</div> 3/13Enteroacteriaceae2
Causes ocular trachoma--the leading preventale cause of lindness world-wide
C. trachomatis
Infection after injury in rackish water
"Virio vulnificus<div><img src=
""virio.jpeg"" /></div>"
3/10SkinandSoftTissueInfections
Microial proteins take over the host actin filament assemly and makes cells re
arrange their cytoskeletons. Similar to shigella pathogenesis EIEC
3/13Ente
roacteriaceae2
No fecal leukocytosis, no fever, LT and ST toxins causing watery diarrhea
ETEC
3/13Enteroacteriaceae2
True or false: Shigella is a normal part of intestinal flora. False; its <u>a
lways a pathogen</u>
3/13Enteroacteriaceae3
22 y/o presents with nonproductive cough and fever. CXR demonstrates diffuse int
erstitial infiltrate. Sputum gram stain shows no organisms, ut a different diag
nostic test shows intracytoplasmic inclusions. "Chlamydia pneumoniae (TWR-Taiw
an acute respiratory agent)<div><img src=""inclusion.jpeg"" /></div>" 3/17Legi
onellaMycoplasmaChlamydia
Shigella pathogenesis <>Invade</> colonic epithelial cells, followed y intr
acellular multiplication, spread to adjacent cells, severe <u>inflammation</u> a
nd <u>ulceration</u> leading to adominal pain and dysentery.&nsp;<div><r /></
div><div>Invasiveness more important than shiga toxin</div>
3/13Enteroacter
iaceae3
ssociated risk of reactive arthritis (from enteric infection); think human leuk
ocyte antigen "HL-B27<div><img src=""reactive arthritis.jpeg"" /></div><div>U
sed to e called Reiters syndrome</div>"
3/13Enteroacteriaceae3
Why were small turtles anned in the US?
small turtles end up in <u>child
rens mouths</u> and cause <u>salmonella</u>
3/12Enteroacteriaceae

Lettuce and spinach was the source of a recent outreak of STEC. What is the mos
t likely route of pathogenesis? contaminated manure at the farm that got into th
e irrigation water<div><r /></div><div>(shiga toxin-producing E. coli, similar
to EHEC)</div> 3/13Enteroacteriaceae2
Common cause of UTI, diarrhea, adominal/pelvic infections, neonatal meningitis
E. coli 4/17UTI
60 y/o microiology researcher thats diaetic and very high iron saturation lev
els. 1 week history of shortness of reath. Experienced rapid deterioration and
died within 13 hours. Y. pestis
Morphology and gram stain of staph
"clusters of gram positive cocci; look l
ike unch of grapes<div><img src=""aureus.jpeg"" /></div>"
3/6Staphylococcu
s1
Differentiates etween S. aureus and other staph
"coagulase test<div><img
src=""chart (2).jpeg"" /></div>"
3/6Staphylococcus1
3 components that make up capsule for staph
microcapsule (asis for serotypi
ng, just external to cell wall), capsule, slime (most external) 3/6Staphylococcu
s1
Staph : Incorporated into outer peptidoglycan layer and inds Fc portion of IgG
; antiphagocytic.
"protein <div><img src=""paste-17042430230882.jpg"" /><
r /><div><img src=""protein .jpeg"" /></div><div><r /></div></div>" 3/6Staph
ylococcus1
"catalase positive<div><
re staph catalase positive or catalase negative?
r /></div><div><img src=""paste-17553531339048.jpg"" /></div>" 3/6Staphylococcu
s1
Young woman develops 102 degree fever 2 days after menses. She reports using tam
pons. fter several days, the fever is accompanied y dizziness, hypotension, my
algias.  desquamation of the palms is oserved.
S. aureus (toxin mediate
d); toxic shock syndrome
3/6Staphylococcus1
Toxin responsile for scalded skin syndrome
"exfoliatin (from S. aureus)<div
><img src=""exfoliatin.jpeg"" /></div>" 3/6Staphylococcus1
<>Superantigen</> associated with tampon use "TSST-1 from S. aureus<div><img
src=""toxins staph.jpeg"" /></div>"
3/6Staphylococcus1
S. aureus toxins (name 5)
",,, and toxins isrupt cell membranes< iv>Panton-v
alentine leukoci in</ iv>< iv>Enterotoxins</ iv>< iv>TSST-1</ iv>< iv>Exfoliatin
s</ iv>< iv><br />< iv><img src=""toxins staph.jpeg"" /></ iv></ iv>" 3/6Staph
ylococcus1
People likely to carry S. aureus
those who have <u>breaks in skin</u> (at
opic ermatitis or eczema) an those who <u>use nee les</u> ( rug a icts, iabe
tics, hemo ialysis, allergy shots)
3/10Skinan SoftTissueInfections
Skin infection types (5) ue to irect invasion by S. aureus
"<b>folliculitis
</b> (inf. hair follicle)< iv><b>furuncles</b> ( eep-seate inf. follicle)</ iv>
< iv><b>carbuncles</b> (boils, coalescence of follicles)&nbsp;</ iv>< iv><b>impe
tigo</b> (pus can settle)</ iv>< iv><b>cellulitis/abscess</b></ iv>< iv><img src
=""skin probs.jpeg"" /></ iv>" 3/6Staphylococcus1
Right si e (tricuspi valve) en ocar itis in IV rug user. Gram positive an co
agulase positive organism
"S. aureus< iv><br /></ iv>< iv>_{shown: Tric
uspi e valve en ocar itis in IV rug, Gram (+), coagulase (+)}</ iv>< iv><i
mg src=""paste-27122718475292.jpg"" /></ iv>" 3/6Staphylococcus1
3 syn romes from toxins pro uce by S. aureus scal e skin syn rome (exfoliati
n) an toxic shock syn rome (TSST-1), foo poisoning (enterotoxins)
3/6Staph
ylococcus1
2n most common cause of UTI in young women
"S. saprophyticus (after E. coli
)< iv><img src=""chart (2).jpeg"" /></ iv>"
3/6Staphylococcus1
Infections associate with in welling foreign evices (prostheses). Often mistak
en for contaminates.
coagulase negative staph (S. epi ermi is)
3/10Stap
hylococci2
Sexually active young woman evelops ysuria, pyuria an fever suggestive of UTI
. Urine cultures show gram (+) bacteria in clusters that are catalase (+), coagu
lase (-).
"S. saprophyticus< iv><br /></ iv>< iv>Shown: S. saprophyticus,
UTI, Gram(+), catalase (+), coagulase (-)<br />< iv><img src=""paste-13610751362

012.jpg"" /></ iv>< iv><br />< iv><img src=""chart (2).jpeg"" /></ iv></ iv></ i
v>"
3/6Staphylococcus1
Mnemonic for Novobiocin "NO StRES: Novobiocin - Saprophyticus Resistant, Epi erm
i is is Sensitive< iv><img src=""cchahrt.jpeg"" /></ iv>"
Type of bacteria that form a green ring aroun colonies on bloo agar "alpha-h
emolytic (ie pneumococcus, viri ans)< iv><img src=""alpha h.jpeg"" /></ iv>"
3/3IntrotoID
Type of bacteria that form a clear area of hemolysis on bloo agar? Name the gro
ups
beta-hemolytic (staph + group A, B, C an G, iniae)
Smallest free living organism with no cell wall Mycoplasma pneumoniae 3/17Legi
onellaMycoplasmaChlamy ia
Alpha-hemolytic bacteria that cause infective en ocar itis on abnormal heart val
ves
Viri ans (S. sanguis) 3/4Streptococci2
3 superantigens of S. aureus
exfoliatins, TSST-1, enterotoxins
3/6Staph
ylococcus1
Explosive onset within 2-6 hours following ingestion of contaminate foo s.
Preforme toxin (enterotoxin) ingeste of S. aureus
3/6Staphylococcus1
< iv>Effects patients lacking pre-forme antibo y to TSST-1</ iv>
"toxic s
hock syn rome of S. aureus< iv><img src=""toxins staph.jpeg"" /></ iv>" 3/6Staph
ylococcus1
Screen pregnant women at 35-37 weeks (rectovaginal swab). If positive for this o
rganism begin prophylatic Abx "group B strep (S. agalactiae), common is post-p
artum women< iv><img src=""group B.jpeg"" /></ iv>"
3/4Streptococci2
Nosocomial an associate with prosthetic evices. Catalase (+).
"coagula
se (-) staph; ie S. epi ermi is< iv><img src=""paste-640963739386322.jpg"" /></
iv>"
3/10Staphylococci2
Why is iagnosis of coagulase (-) staph potentially ifficult/problematic?
because it's <u> ifficult to ifferentiate true infection from contamination</u>
; nee to see if the patient has <b>&gt;1 positive bloo culture</b> an a <b>cl
inical scenario</b> consistent with coagulase (-) staph 3/10Staphylococci2
Common bloo culture contaminates
"coagulase (-) staph< iv>_{- Staph ep
i ermi is}</ iv>< iv>_{<br />}</ iv>< iv>_{<img src=""paste-6409
59444419026.jpg"" />}</ iv>"
3/6Staphylococcus1
Result of altere penicillin bin ing protein 2a "it has a <u> ecrease affinity
for the beta-lactam antibiotics</u> --&gt; results in methicillin resistance (MR
SA)< iv><img src=""MSRA.jpeg"" /></ iv>"
3/10Staphylococci2
Risk factors for acquisition of hospital associate MRSA
prolonge hospit
al stay, exposure to multiple previous Abx, burn patients, iabetics
3/10Stap
hylococci2
Which have more Abx resistance, hospital associate or community associate MRSA
?
hospital associate
3/10Staphylococci2
mec gene
"<u>enco es penicillin bin ing protein 2A</u> that results in th
e strain MRSA; PBP2A has a <u>low affinity for beta-lactam Abx</u> <b>allowing t
he bacteria to persist in the presence of beta-lactams</b>< iv><b><img src=""b l
actam.jpeg"" /></b></ iv>"
3/10Staphylococci2
Umbilical cor infection in newborn resulting in scal e skin syn rome. What bug
is responsible?
S. aureus
3/6Staphylococcus1
What allows pneumococci to eva e phagocytosis in the alveoli? Their capsule
3/3IntrotoID
Most common cause of infections of prosthetic har ware. "coagulase (-) staph< iv
>- S. epi ermi is<br />< iv><br /></ iv>< iv><img src=""paste-13567801688428.jpg
"" /><br />< iv><img src=""chart (2).jpeg"" /></ iv></ iv></ iv>"
3/6Staph
ylococcus1
Eight months ago a 65 y/o man un erwent right hip arthroplasty. Over the last 34 months, he has experience increasing pain with ambulation, but no other sympt
oms. A ra iograph shows periprosthetic irregularity of the bone suggestive of in
fection. What's the most likely causative organism?
S. epi ermi is
Causes non-gonococcal urethritis an PID. Can't make its own ATP
C. trach
omatis; remember that it's obligate intracellular b/c it can't make its own ATP
In June, you atten e a family reunion where you at some potato sala that unfor

tunately was colonize with an enterotoxin-pro ucing S. aureus. What is the like
ly clinical scenario that followe ?
nausea an vomiting within 2-6 hours
"What oes a positive ""D"" test in icate?"
"Erythromycin will in uce the bu
g to have resistance to clin amycin< iv><img src=""D test.jpeg"" /></ iv>"
3/10Staphylococci2
What test qualifies strains of S. aureus as VISA? How i these strains emerge?
"MIC for vancomycin of 8 ug/ml above. How they came about: most ha <u>in wellin
g catheters</u>, all ha receive <u>prolonge vancomycin therapy</u>. We shoul
have taken out the prosthetic evices an not treate with Abx< iv><img src=""V
ISA (1).jpeg"" /></ iv>< iv>=Vancomycin interme iate strains of S. aureus</ iv>"
3/10Staphylococci2
How i truly vancomycin resistant S. aureus orginate? acquisition of van A gen
e by conjugation with resistant strain of enterococcus
overpro uction of cell wall precursors that bin up vancomycin--type of S. aureu
s? What gene? "VRSA ue to acquisition of van A gene< iv><img src=""VANA.jpeg"
" /></ iv>"
3/10Staphylococci2
Which bacteria have capsules? Mnemonic: Some Nasties Have KapsuleS; Strep pneu
mo, Neisseria meningiti is, Haemophilus, Klebsiella, Salmonella< iv><br /></ iv>
< iv>BE</ iv>< iv>Strep B, E. coli,&nbsp;</ iv> 3/12Enterobacteriaceae
Which patients shoul receive conjugate vaccines?
ki s un er 2
3/3Intro
toID
Differentiate between S. epi ermi is an S. saprophyticus with what test?
Novobiocin
Catalase (+) bacteria often infect people with what un erlying con ition?
chronic granulomatous isease (CGD)< iv><br /></ iv>< iv>_{A e explanation
(Tim):}</ iv>< iv>_{CGD = neutrophils lack NADPH oxi ase --&gt; efect i
n ROS --&gt; our neutrophils can't kill phagocytose bacteria}</ iv>< iv><s
ub>However, CGD patients are often still resistant to Catalse (-) bacteria becau
se host cells can use H2O2 pro uce by Catalase (-) to carry on ROS. Catalse (+)
bacteria break own H2O2 that they pro uce, meaning we lack H2O2 --&gt; no ROS -&gt; CGD patients are infecte by Catalase (+) bacteria</sub></ iv>
3/6Staph
ylococcus1
Grows at 4 egrees Celsius, iron overloa state, an resembles appen icitis (RLQ
pain) Yersinia entercolitica< iv><br /></ iv>< iv>*so refrigeration oesn't he
lp, oesn't make own si erophores, in istinguishable from acute appen icitis&nbs
p;</ iv>
3/13Enterobacteriaceae3
Gram (+) cocci in pairs, often prece e by viral illness, inflammation is causin
g the isease pneumococcus
Aminoglycosi es require <i>oxygen</i> to kill bacteria. Which kin of bacteria a
re aminoglycosi es ineffective in treating?
anaerobes
3/14Anaerobes Di
ckey
Mnemonic for obligate aerobes. Nagging Pests Must Breathe; Nocar ia, Pseu omona
s, Mycobacteria, Bacillus
3/21DiptheriaListeria
What's the a ult vaccine for pneumococcus? Why not ki s?
Pneumovax; this
vaccine is not protective before age 2 because of <u>immature immune response to
polysacchari es</u>.< iv><br />< iv>Protection not as goo in isease an el e
rly.&nbsp;</ iv></ iv> 3/3IntrotoID
3 causes of atypical pneumonia Mycoplasma, legionella, chlamy ia
3/17Legi
onellaMycoplasmaChlamy ia
Name the risk factors for acquiring NFGNB
contact with the healthcare syst
em (especially ICU), receipt of broa -spectrum Abx, immunocompromise state, bre
ak own of typical barriers, break own of infection control practices
Mannose-sensitive bin ing pilli type I pilli
Mnemonic for Obligate intracellular
Stay insi e when it's Really Col ; Ricke
ttsia, Chlamy ia
3/17LegionellaMycoplasmaChlamy ia
Mneumonic for facultative intracellular "Some Nasty Bugs May Live FacultativeLY;
<b><font color=""#ff0000"">S</font></b>almonella, <b><font color=""#ff0000"">N<
/font></b>eisseria, <font color=""#ff0000""><b>B</b></font>rucella, <b><font col
or=""#ff0000"">M</font></b>ycobacterium,<font color=""#ff0000""><b> L</b></font>
isteria, <b><font color=""#ff0000"">F</font></b>rancisella,<b><font color=""#ff0

000""> L</font></b>egionella, <b><font color=""#ff0000"">Y</font></b>ersinia"

3/17Zoonotic
Simplest treatment of isease being cause by S. epi ermi is (most common)
remove the prosthetic evice
Causes acute en ocar itis an osteomyelitis. Patients with chronic granulomatous
S. aureus
3/6Staphylococcus1
isease are particularly vulnerable
Gram positive iplococci, alpha hemolytic, optochin sensitive pneumococcus
3/4Streptococci
Gram positive cocci in chains, beta hemolytic, bacitracin resistant (give name t
oo)
group B strep (S. agalactiae) 3/4Streptococci2
40 y/o male presents with fever of 102, hea ache, nuchal rigi ity, an confusion
. What is the most likely infecting organism? pneumococcus (meningitis)
Disrupts bloo clots. S. pyogenes extracellular enzyme streptokinase 3/4Strep
tococci
En ocar itis/sepsis + a enocarcinoma of the colon
S. gallolyticus (bovis)
3/4Streptococci2
54 y/o iabetic man comes to the ER with a swollen ten er foot. Incision an ra
inage is one an the culture grows S. aureus. Patient is on vancomycin for seve
ral ays an bacterial susceptibility test is complete yiel ing a iscor ance b
etween susceptibility of clin amycin an erythromycin. What is the most appropri
ate next step? Do a D-test
3/10Staphylococci2
A young woman thinks she has a col an goes to her octor. She complains of mal
aise, chills, sore throat, an ry cough. CXR shows interstitial infiltrate more
severe than suggeste by her symptoms. Laboratory tests in icate that the woman
's serum was capable of aggulinating erythrocytes when incubate at 4 egrees ce
lsius. Mycoplasma pneumoniae 3/17LegionellaMycoplasmaChlamy ia
Amoebas provi e intracellular locale for replication. Warm water is optimal for
growth Legionella
3/17LegionellaMycoplasmaChlamy ia
Causes genital isease, neonatal pneumonia, an corneal scarring.
C. trach
omatis
Legionella, Mycoplasma, an Chlamy ia are linke by what treatment? Like by wha
t iagnostic techniques?
Z-pack; they also <u>lack the usual cell wall</u
> an are very ifficult to culture thus requiring alternative iagnostic techni
ques
3/17LegionellaMycoplasmaChlamy ia
Obligate intracellular bacteria that causes ocular trachoma, among other things.
Chlamy ia
3/17LegionellaMycoplasmaChlamy ia
Most likely causative agent of bullous impetigo S. aureus
3/4Streptococci
Most frequent cause of bacterial STD in the US an most frequent cause of preven
table blin ness worl wi e.
C. trachomatis
33 y/o man was a mitte to Ben Taub with fever. The only set of bloo cultures t
hat was rawn is growing gram (+) cocci in clusters. In or er to etermine the a
ppropriate therapeutic mo alities, you ask the laboratory to perform what test?
"coagulase< iv><img src=""chart (3).jpeg"" /></ iv>"
3/10Staphylococci2
26 y/o patient from New Mexico who lives in a flea-infecte househol presents w
ith bubo
"bubonic plague (Y. pestis)< iv><img src=""plague.jpeg"" /></ iv
>"
3/13Enterobacteriaceae3
Malignant otitis externa
Pseu omonas Aeruginosa 3/14Pseu omonasan Frien
s
Diabetic osteomyelitis following nail injury through sneakers "P. Aeruginosa<
iv><img src=""when to think PA.jpeg"" /></ iv>" 3/14Pseu omonasan Frien s
Major cause of respiratory failure an eath in CF patients
P. Aeruginosa
3/14Pseu omonasan Frien s
Common infection at MD An erson but not at BTGH. Hot spots inclu e Spain, Latin
American, an Japan
"Stenotrophomonas maltophilia< iv><img src=""MDACC.jpeg"
" /></ iv>< iv>Oncology patients are susceptible</ iv>" 3/14Pseu omonasan Frien
s
High profile recently ue to presence in hospitals treating sol iers from Iraq
Acinetobacter 3/14Pseu omonasan Frien s
Pneumonia in patients with CF an CGD. CF patients often become socially isolate
by their peers.
"Burkhol eria Cepacia< iv><img src=""BCC use.jpeg"" /></

 iv>" 3/14Pseu omonasan Frien s

An el erly woman recently began swimming to control her weight an comes to the
octor complaining of painful ischarge from her left ear. A swab culture of the
ear reveals blue-green colonies.
"Pseu omonas aeruginosa< iv><img src=""P
A green.jpeg"" /></ iv>< iv>Smells sweet</ iv>" 3/13Enterobacteriaceae2
What are 5 major gram-negative bacteria causing zoonotic infections in the US?
Rickettsia, Pasturella, Brucellosis, Francisella tularensis, Yersinia
31 y/o man comes to Ben Taub with complaints of fever, malaise, an severe hea a
ches for 3 ays. States a recent camping trip to Missouri. On ay 3 he gets a ge
neralize rash (<b>vasculitis</b>).
Rickettsia
3/17Zoonotic
10 y/o boy in Tennessee presents with rash, fever, an severe hea aches that beg
an several ays ago. The rash began on his palms an soles an has now sprea to
his trunk. The boy's history is significant for a hike in the woo s a week ago.
Rocky Mountain Spotte Fever (Rickettsia rickettsii)
3/17Zoonotic FA_micro
Obligate intracellular organism that causes thrombocytopenia an leukopenia
Ehrlichia; NOTE: leukopenia is an important clue b/c it's <u>infecting WBCs</u>
rather than en othelium (like RMSF) an thus <u>rash is rare</u>< iv><br /></ iv
>< iv>(similar to rickettsia)</ iv>
3/17Zoonotic
What are the beta hemolytic organisms? group A, B, C &amp; G, an strep iniae,
staph 3/4Streptococci2
Cat bite infection/cellulitis pasturella multoci a
3/10Skinan SoftTissueInf
ections
True or false: both the M proteins an the capsule of group A strep are antiphag
ocytic "True< iv><img src=""paste-528826438255888.png"" /></ iv>"
3/4Strep
tococci
65 y/o ventilator-assiste cancer patient has been hospitalize for 2 months an
treate with <b>carbapenems</b> in MD An erson evelops pneumonia.
Stenotro
phomonas maltophilia
3/14Pseu omonasan Frien s
What components of pneumococci cause intense activation of inflammatory response
? Name the response pathways (3)
"<b>-pepti oglycan</b> an <b>pneumolysi
n</b>&nbsp;activate the <i>alternative</i> complement pathway, generating C5a< i
v><u><br /></u></ iv>< iv><u>-antibo y</u> to <b>cell wall</b> activates <i>clas
sical</i> complement pathway</ iv>< iv><br /></ iv>< iv>-pneumococci are also ta
ken up by en rites an macrophages, activating&nbsp;<u>TLR2&gt;&gt;4, </u>upreg
ulating TNFalpha, IL1, IL6< iv><u><img src=""pneu.jpeg"" /></u></ iv>< iv><u><br
/></u></ iv></ iv>"
3/3IntrotoID
Rash on palms an soles (migrating to wrists, ankles, then trunk), hea ache, fev
er an en emic to the East Coast.
"Rocky Mountain Spotte Fever< iv><img s
rc=""RMSF.jpeg"" /></ iv>"
3/17Zoonotic
Colonizes upper respiratory track of &gt;90% of cats
Pasturella multoci a
3/10Skinan SoftTissueInfections
Dog bite cellulitis
capnocytophagia canimorsus
3/10Skinan SoftTissueInf
ections
Non-specific febrile illness, linke to hoove animals Brucellosis
3/17Zoon
otic
Ingestion of unpasteurize airy pro ucts
Brucellosis
3/17Zoonotic
7 y/o male presents with pain in right toe after stepping on a rusty nail while
wearing tennis shoes (not tetani)
osteomyelitis (Pseu omonas)
3/14Pseu
omonasan Frien s
A octor is struggling to iagnose a woman's flu-like illness. She complains of
un ulating fever an states that she trie goat cheese at a local French village
a month before the onset of her symptoms.
Brucellosis
3/17Zoonotic
"43 y/o man comes to your office with 3 ays of neck swelling an fever. Recentl
y on hunting trip to eastern Oklahoma with lots of ""bites"". Has ulcerate lesi
on on neck with lympha enopathy."
"tularemia (Francisella tularensis)< iv>
<img src=""tuleremia neck.jpeg"" /></ iv>< iv><img src=""tul epi.jpeg"" /></ iv>
"
3/17Zoonotic
A woman from Arkansas presents to the octor with a small but persistent black u
lcer on her arm. The area near the ulcer is erythematous an ten er. Her axillar
y lymph no es on the same si e are enlarge . She believes the ulcer may be relat

e to a tick bite that occurre on her arm while ten ing to her rabbit farm.
"tularemia (Francisella tularensis)< iv><img src=""ulcer t.jpeg"" /></ iv>"
3/17Zoonotic
Name 2 low ose (high virulent) microbes responsible for iarrhea.
Shigella
< iv>Norovirus</ iv>< iv>low ose means they're easily sprea person to person</
3/17Diarrhea
iv>
Name 4 interme iate ose bacterial causes of iarrhea. Salmonella, STEC, giar i
a, cryptospori ium
3/17Diarrhea
Name four high ose bacterial causes of iarrhea
ETEC&nbsp;< iv>EIEC</ iv
>< iv>vibrio cholera</ iv>< iv>Campylobacter</ iv>< iv><br /></ iv>< iv>high os
e means they're not sprea person to person (instea have to grow in high number
s in foo /water)</ iv> 3/17Diarrhea
Virulence relate to colonization fimbriae an heat labile (LT) an heat stable
(ST) enterotoxins
ETEC
3/13Enterobacteriaceae2
Low ose pathogen, bloo y iarrhea, O157:H7
EHEC/STEC
3/13Enterobacter
iaceae2
AIDS associate chronic iarrhea, stacke brick arrangement
EAEC
3/13Ente
robacteriaceae2
Vomiting as primary symptom. 3 possibilities
preforme toxin of S. aureus, B.
cereus, or viral
3/21DiptheriaListeria
Persistent iarrhea. 3 possibilities
Brainer iarrhea (unpasteurize milk),
IBS, parasites
Organism causing iarrhea after host recently receive antimicrobial therapy
clostri ium ifficile 3/14Anaerobes Dickey
"The two ""big guns"" causing the majority of skin infections." S. pyogenes an
S. aureus
Organism causing bullous impetigo
S. aureus
3/4Streptococci
Infection within an obstructe hair follicle. What bug? "folliculitis ue to S.
aureus< iv><img src=""follic.jpeg"" /></ iv>" 3/6Staphylococcus1
Cellulitis ue to cat bite
pasturella multoci a
3/10Skinan SoftTissueInf
ections
Cellulitis w/ pus
S. aureus
3/4Streptococci
Necrotizing soft tissue infection associate w/ malignancy (ie cancer) Clostri
ium septicum
3/10Skinan SoftTissueInfections
Spontaneous myonecrosis in 68 y/o man with colon cancer C. septicum
3/10Skin
an SoftTissueInfections
Recent antimicrobial therapy in hosptial (ie clin amycin) an now has iarrhea
C. ifficile
3/14Anaerobes Dickey
15 y/o male with recent history of iarrhea 3 weeks ago presents with bilateral
lower extremity paralysis
Guillan Barre ( ue to campylobacter)
3/17Diar
rhea
76 y/o female in hospital evelops iarrhea after 2 weeks of IV clin amycin
"C. ifficile< iv><br /></ iv>< iv><img src=""paste-385838387036480.jpg"" /></ i
v>"
3/14Anaerobes Dickey
Brain abscesses, gram (+) an catalase (-)
"S. interme ius (milleri group)<
iv><img src=""milleri group.jpeg"" /></ iv>< iv><img src=""g stain.jpeg"" /></
iv>"
3/4Streptococci2
Causes clostri ial myonecrosis C. perfringens 3/10Skinan SoftTissueInfections
Infection after ingestion of ina equately cooke oysters
Vibrio vulnificu
s
3/10Skinan SoftTissueInfections
Water skier infection from injury in fresh water
"aeromonas hy rophilia<
iv><img src=""aerom.jpeg"" /></ iv>"
3/10Skinan SoftTissueInfections
Infection cause by me icinal leeches utilize uring a surgery "aeromonas hy ro
philia< iv><img src=""aerom.jpeg"" /></ iv>"
3/10Skinan SoftTissueInfections
Most important cause of infection in iabetic foot
polyneuropathy 3/10Skin
an SoftTissueInfections
28 y/o man returne last night from a 3 ay trip in Aspen. Yester ay he began to
evelop a rash confine to his chest an below. He spent a lot of time rinking
beer in the hot tub. "hot tub folliculitis ue to pseu omonas aeruginosa< iv>
<img src=""hot tub.jpeg"" /></ iv>"
3/10Skinan SoftTissueInfections

25 y/o man injure his leg while waterskiing on Lake Conroe. What's the causativ
e organism?
aeromonas hy rophila
3/10Skinan SoftTissueInfections
Fissure an itching between 4th an 5th toes of an avi runner athlete's foot
Necrotizing cellulitis in a cirrhotic man who injure himself while fishing in G
alveston Bay
vibrio vulnificus
3/10Skinan SoftTissueInfections
Perineal infections in iabetics
"Fournier's gangrene (polymicrobial)< iv
><br /></ iv>< iv><img src=""polymicrobial.jpeg"" /></ iv>"
3/10Skinan SoftT
issueInfections
Polymicrobial infection of subman ibular an submental spaces. Bacteriology refl
ects oral flora.
"Lu wig's angina< iv><img src=""lu wig.jpeg"" /></ iv>"
3/10Skinan SoftTissueInfections
Type of iabetic neuropathy that causes Charcot foot
"autonomic< iv><img src=
""charcot.jpeg"" /></ iv>"
3/10Skinan SoftTissueInfections
Type of iabetic neuropathy resulting in claw-toe eformity
"motor (extensor
loss)< iv><img src=""claw.jpeg"" /></ iv>"
3/10Skinan SoftTissueInfections
The han surgeons consulte you to help with management of an infection in a 34
y/o man who ha amputate his right in ex finger in a snow blower 5 ays ago. Th
ey reattache his finger, but it is now re , ten er, swollen, an a culture is g
rowing an aerobic gram (-) ro . Causative organism?
aeromonas hy rophilia fr
om me icinal leeches
3/10Skinan SoftTissueInfections
Here itary hemochromatosis an pseu oappen icitis.
Y. enterocolitica
Most common organism causing nosocomial UTIs
E. coli 3/13Enterobacteriaceae2
True or false: gloves shoul be worn when examining patients with C. ifficile c
olitis True
3/14Anaerobes Dickey
You have remove the central IV catheter from a febrile patient in the ICU. A se
mi-quantitative culture of the catheter tip is performe . What is the minimum cu
toff for a significant number of colonies on the plate? greater than or equal to
15
What are the appropriate proce ures when examining a patient with ocumente C.
ifficile infection?
onning a gown, wearing isposable gloves, an washing h
an s with soap an water afterwar s; NOTE: no mask nee e b/c it's not a respira
tory pathogen 3/14Anaerobes Dickey
What's the most common site of nosocomial infection?
catheter associate UTI
Most common pathogen causing nosocomial lower respiratory tract infections
S. aureus
Host factors that pre ispose to nosocomial pneumonias a vance age, obesity, p
oor nutrition, smoking, alcoholism, prior surgery, severe un erlying illness
The 2 primary pathogens causing nosocomial (hospital-acquire ) bloo stream infe
ctions coagulase negative staph (CONS), S. aureus
3/6Staphylococcus1
Where to culture for bug causing leg cellulitis/erysipelas if bloo culture is n
egative skin between toes
3/4Streptococci
Type of vascular catheter with highest risk of nosocomial bloo stream infection
hemo ialysis catheter
What bo y site can be avoi e to ecrease the risk of intravascular cathether-as
sociate bloo stream infections femoral site
Necrotizing infection of perineum in poorly controlle iabetic Fournier's gangr
ene
3/10Skinan SoftTissueInfections
Top 3 pathogens causing <i>nosocomial</i> UTI "E. coli &gt; enterococcus &gt;
pseu omonas aeruginosa< iv><img src=""a uti.jpeg"" /></ iv>" 3/13Enterobacter
iaceae2
In urate infection of subman ibular space in woman who recently ha a tooth pul
le
Lu wig's angina 3/10Skinan SoftTissueInfections
For asymptomatic bacteruria, what's the bacteria count in the urine in men?
10⁵&nbsp;cfu/mL, single catch 1 species
4/17UTI
Fever, chills, flank pain, WBC casts in the urine
upper tract: pyelonephri
tis
4/17UTI
Term for infection of the bla er in sexually active women
cystitis
4/17UTI
Term for infection confine to the urethra ue to a STD urethritis
Stones that trap bacteria an serve as a ni us for recurring infection struvite

stones 4/17UTI
Host factor associate with risk of UTI in ol er men
enlarge prostates (caus
es obstruction an incomplete emptying of bla er)
4/17UTI
Reason why OB oes lots of UAs uring pregnancy.
risk of pyelonephritis i
n pregnancy
4/17UTI
Term escribing increase number of WBCs in urine
pyuria
Host efenses protecting against UTI (7)
1. mechanical barrier by urethra
< iv>2. irrigation by urine</ iv>< iv>3. phagocytosis by epithelial cells in bla
er</ iv>< iv>4. complete emptying</ iv>< iv>5. Tamm-Horsfall protein (blocks t
ype I pilli)</ iv>< iv>6. ureterovesical valve (prevents ascent of infection fro
m bla er)</ iv>< iv>7. local antibo y pro uction</ iv> 4/17UTI
68 y/o female in nursing home with in welling foley catheter evelops bla er sp
asms, confusion, an fever. Most likely iagnosis an bug.
UTI; E. coli
4/17UTI
How many WBCs in high power microscopic fiel in icate presence of UTI? >8; NOTE
: <3-5 is consi ere uninfecte 4/17UTI
What to think of: positive urine culture with normal UA?
bogus, iscar i
t; urine is often contaminate by women an small chil ren
4/17UTI
Casts that contain WBCs in urine
pyelonephritis 4/17UTI
Mi stream urine with &gt;10^2 bacteria/mL in a woman &amp; &gt;10 WBCs in UA. Is
it a UTI?
Yes, woman only nee s 10^2
4/17UTI
Dysuria, frequency, urgency, without fever.
acute UTI
4/17UTI
True of false: positive urine culture (+ bugs) without abnormal urinalysis (-WBC
s) shoul not be use . True
S. aureus in urine?
bacteremia --> treat imme iately!!!
3/6Staphylococcu
s1
Recurrent UTIs in premenopausal female. What to tell them?
Ceasing use of s
permici e, post-coital voi ing, post-coital antibiotics, prophylactic antibiotic
s
4/17UTI
In up to 1/3 of cases of healthy young women with UTI, infection is confine to
the ______.
urethra; in these cases a mi stream sample (the conventional one
) may wash out bacteria an WBC an leave small numbers of bacteria; therefore 1
0^2 is acceptable along with UTI symptoms to iagnose her with a UTI
4/17UTI
Mannose-resistant bin ing pilli type II pilli or P pilli; E. coli with this type
of pilli cause pyelonephritis 4/17UTI
Chil ren with recurrent UTIs. Check for what? anatomical abnormalities, reflux
4/17UTI
Extrachromosomal autonomously replicating circular DNA molecules
plasmi s
; <u>common in hospital environments</u>; can be transferre to other bacteria b
y means of conjugation, transformation, an trans uction
3/12Enterobacter
iaceae
Not self-replication genetic elements that hop aroun
transposons
DNAse-sensitive metho of gene uptake that oes not require cell-to-cell contact
transformation
Bacteriophage-me iate transfer of genetic material from one bacteria to another
.
trans uction
Replicative cycle marke by integration of phage DNA into the bacterial chromoso
me.
lysogenic
3/21DiptheriaListeria
Strep A extracellular enzyme that helps it sprea through tissues
hyaluron
i ase 3/12Enterobacteriaceae
Antibo y iagnostic for rheumatic fever that's not neutralize by cholesterol in
skin anti-DNAse
3/4Streptococci
Gol en cruste lesions "impetigo (cause staph/strepA)< iv><img src=""impet.jpe
g"" /></ iv>" 3/4Streptococci
ASO titer negative in patient with glomerulonephritis. Can you exclu e post-stre
p sequelae?
No, coul be from skin infection
3/4Streptococci
Follows <b>pharyngitis</b>--subcutaneous no ules, polyarthritis, erythema margin
atum, chorea, car itis "rheumatic fever; mnemonic = RHEUM for SPECCulation< iv>
<img src=""jones.jpeg"" /></ iv>"
3/4Streptococci
CAMP test
use to i entify group B strep--group B strep make CAMP factor t

hat enhances staph beta hemolysis

Hypertension, e ema, hematuria, elevate BUN/creatinine, recently ha skin infec
tion. <b>Disease, an from what bug?</b>
glomerulonephritis from group A
strep 3/4Streptococci
Presents with ysuria, frequency, urgency, suprapubic pain, an WBCs (but not WB
C casts) in urine
UTI
4/17UTI
Presents with fever, flank pain, CVA ten erness, hematuria, an WBC casts
pyelonephritis 4/17UTI
Lab test (2) ifferentiating enterococci from group D strep
<b>Enterococci</
b> <u>growth in 6.5% NaCl</u>; enterococci is har ier than than nonentercoccal g
roup D an thus can grow in 6.5% NaCl an bile; <b>gallolyticus</b> is also <u>s
ensitive to penicillin</u> vs <b>enterococcus</b> which is <u>resistant</u>
3/4Streptococci2
Normal flora of oropharynx an cause subacute bacterial en ocar itis usually inv
olving abnormal heart valves? Which specific strains? viri ans group strep; en
ocar itis cause by S. sanguis, ental caries cause by S. mutans
3/4Strep
tococci2
Pro uces CAMP factor which enlarges the area of hemolysis forme by S. aureus
group B strep (S. agalactiae) 3/4Streptococci2
Can cause bacteremia an subacute en ocar itis in colon cancer patients.
S. gallolyticus (bovis) 3/4Streptococci2
Promiscuous bacteria that may carry vancomycin resistance.
Entercocci
3/14Anaerobes Dickey
Foo poisoning from reheate rice
B. cereus
3/21DiptheriaListeria
Antibo y to this may cause rheumatic fever
M proteins
3/4Streptococci
Use for rheumatic fever iagnosis following throat infection (2 things).
ASO titer, anti-DNAse 3/4Streptococci
Use for post-strep glomerulonephritis iagnosis following skin infection.
Anti-DNAse
3/4Streptococci
Sepsis in asplenic patient.
encapsulate organism 4/17Sepsis
Me ium use for lactase (+) enterobactericae
"MacConkey's< iv><img src=""lact
ose.jpeg"" /></ iv>"
3/12Enterobacteriaceae
En ocar itis in a patient with mitral valve prolapse that ha a ental proce ure
.
viri ans strep (S. sanguis)
3/4Streptococci2
Pneumonia with currant jelly sputum
Klebsiella< iv><br /></ iv>
3/13Ente
robacteriaceae2
ICU patient becomes septic, cultures have a cherry re coloration
"serrati
a marcescens< iv><img src=""serratia re .jpeg"" /></ iv>"
3/12Enterobacter
iaceae
Most common cause of UTI in postmenopausal woman
E. coli 4/17UTI
Most common cause of acute exacerbation of bronchitis in people with chronic lun
g isease
non-typable Haemophilus influenzae
3/18Haemophilus Dickey
lipooligosacchari e stimulates a strong inflammatory response. Secon only to pn
eumoccocus in frequency of causing pneumonia
nontypable H. influenzae
Causes chancroi , a venereal ulcer that looks like a syphilitic chancre Haemophi
lus ucreyi
3/18Haemophilus Dickey
Fine, gram (-) coccobacilli that has LOS (lipooligosacchari e) an nee s extra g
rowth requirements like X factor an V factor Haemophilus influenzae 3/18Haem
ophilus Dickey
Capsule has polyribosyl ribitol phosphate (PRP) "Haemophilus influenzae type B;
this material is use in the H. influenzae type B (""HIB"") vaccine"
3/18Haem
ophilus Dickey
Gram (-), requires hemin (X factor) an NAD (V factor) on chocolate agar. Has (+
) quellung test Haemophilus influenzae 3/18Haemophilus Dickey
Another name for X factor
hemin 3/18Haemophilus Dickey
Another name for V factor
NAD
3/18Haemophilus Dickey
1 y/o infant evelops a fever but really begins to alarm her parents when she se
ems unusually rowsy. The parents bring her to the hospital an the octor notic
es neck rigi ity an occasional seizures. The octor i entifies an organism in t
he infant's CSF that requires both hemin an NAD to grow.
Haemophilus infl

uenzae type B 3/18Haemophilus Dickey FA_micro

Grows better in CO2 rich environement (ie can le jar), has LOS that stimulates i
mmune response, grows on chocolate agar an requires X an V factors
Haemophi
lus influenzae type B 3/18Haemophilus Dickey
Who is more virulent, NTHI or HITB? Which causes more isease? HITB;&nbsp;< iv>
<br /></ iv>< iv>although NTHI causes far more infections than HITB</ iv>< iv>1.
HITB is more virulent because it's not frequently foun as a colonizing organis
m</ iv>< iv>2. Can rapi ly inva e epithelial layers once it colonizes</ iv>< iv>
3. A high proportion of those with isease have serious isease</ iv>< iv><br />
</ iv>< iv>&nbsp;NTHI is relatively nonvirulent</ iv>< iv>1. 25% of a ults colon
ize </ iv>< iv>2. local invasion oesn't occur</ iv>< iv>3. most that are coloni
ze on't evelop isease</ iv> 3/18Haemophilus Dickey
Use to be the major cause of meningitis in chil ren age 6 months to 4 years
Haemophilus influenzae type B (HITB)
3/18Haemophilus Dickey
Principal cause of epiglottitis H. influenzae type B
Probably no longer secon to pneumococcus as most common cause of otitis me ia
nontypable H. influenzae
3/18Haemophilus Dickey
Most common reason for visits to physicians
otitis me ia
3/18Haemophilus
Dickey
2n most common cause of bacterial pneumonia lea ing to hospitalization nontypab
le haemophilus influenzae< iv>(2n to pneumococcus)</ iv>
3/18Haemophilus
Dickey
puerperal fever an sepsis of newborn. biotype IV
nontypable haemophilus i
nfluenzae
3/18Haemophilus Dickey
3r most common bacterial cause of otitis me ia Moraxella catarrhalis< iv><br />
</ iv>< iv>Tra itionally:</ iv>< iv>S. pneumoniae = H. influenzae (nontypable) &
gt;&gt; Moraxella catarrhalis&nbsp;</ iv>
3/18Haemophilus Dickey
2n most common cause of exacerbation of chronic obstructive pulmonary isease secon only to nontypable Haemophilus Moraxella catarrhalis 3/18Haemophilus
Dickey
2 y/o girl returns to her pe iatrician with fevers, recurrent ear pain, an new
onset yellow ischarge from right ear. She ha been iagnose earlier in the wee
k with right otitis me ia an gram stain yiel s a gram negative iplococci
"Moraxella catarrhalis< iv><img src=""morax.jpeg"" /></ iv>"
3/18Haemophilus
Dickey
Causes meningitis, otitis me ia, epiglottitis, an pneumonia. Gram negative cocc
obacilli
"Haemophilus influenzae (type B)< iv><br /></ iv>< iv><img src="
"paste-174865298489682.jpg"" /></ iv>" 3/18Haemophilus Dickey
Capsule gives it high resistance to phagocytosis, outbreak in Minnesota 2 years
ago with eaths of ki s whose parents ha refuse vaccination. Requires unique g
rowth me ia
H. influenzae type B
Material use in HIB vaccine
polyribosyl ribitol phosphate (PRP)
3/18Haem
ophilus Dickey
List the or er of virulence for the following organisms-< iv><br /></ iv>< iv>Mo
raxella, H. parainfluenzae, NTHI, HITB</ iv>
HITB > NTHI > moraxella > H. par
ainfluenzae
3/18Haemophilus Dickey
3 most common causes of meningitis in the newborn
Group B strep, E. Coli,
Listeria
3/21DiptheriaListeria
70 y/o man with in welling foley catheter for 4 weeks evelops UTI. 3 Most likel
y bugs E. coli &gt; enterococcus &gt; pseu omonas
3/13Enterobacteriaceae2
Common iarrheal antece ent to Guillain-Barre campylobacter jejuni
3/17Diar
rhea
From ingesting raw oysters or open woun contamination with seawater. V. vulni
ficus 3/10Skinan SoftTissueInfections
3 bacterial causes of watery iarrhea. ETEC, V. cholerae, C. perfringens
Causes 90% of seafoo -relate eaths in US. Sepsis an necrotizing woun infecti
on
V. vulnificus; most cases occur in warm months 3/10Skinan SoftTissueInf
ections
Abrupt onset of fever, hypotension, cutaneous hemorrhagic bullae. Recently ate r
aw oysters
V. vulnificus 3/10Skinan SoftTissueInfections

Risk enhance with CagA+ strains

peptic ulcer isease
Rosy spots on ab omen w/ recent travel to In ia "typhoi fever from S. typhi< iv
><img src=""typhoi .jpeg"" /></ iv>"
3/13Enterobacteriaceae3
Meningitis in 3- ay ol infant. What's the most likely organism?
group B
strep (S. agalactiae) 3/4Streptococci2
31 y/o recently returne from a trip to Syria where he recalle eating goat chee
se for lunch every ay. Now complains of perio ic hea aches an spiking fevers to
101 egrees
Brucella
3/17Zoonotic
18 y/o swimmer with chief complaint of 2 ays of severe right ear pain. otitis e
xterna from Pseu omonas aeruginosa
3/14Pseu omonasan Frien s
Causative agent of whooping cough
Bor etella pertussis
3/21Bor etellaNe
isseria
Causative agent of mil er form of whooping cough
Bor etella parapertussis
3/21Bor etellaNeisseria
Dry paroxysmal cough, whoop, post-cough emesis Whooping cough (B. pertussis)
3/21Bor etellaNeisseria
Age group with highest attack rate of whooping cough. I thought mothers coul tr
ansfer antibo ies?
infants <6 months; b/c anti-FHA antibo y pro uction ecl
ines 15 years after vaccination, most mothers cannot transfer protective antibo
ies to their infants thus making them more susceptible 3/21Bor etellaNeisseria
Small gram negative coccobacilli an grows on Regan-Lowe agar, iffucult to grow
B. pertussis< iv><br /></ iv>< iv>Also&nbsp;<u>Bor et-Gengou</u> me ia (potato)
<u>Bor et</u> for <u>bor et</u>ella&nbsp;</ iv> 3/21Bor etellaNeisseria
An infant born in a rural area is brought to the hospital with severe bouts of c
oughing throughout the ay. During the visit, the baby appears cyanotic an suff
ers an attack of many coughs on a single expiration followe by a eep inspirati
on. Further history reveals that the infant has not been vaccinate .
B. pertu
ssis
3/21Bor etellaNeisseria
3 exotoxins of B. pertussis an mechanism
"<b>Pertussis toxin</b> (PT) (<u
>A-B toxin</u>, transfers ADP-ribose to <b>Gi</b>, increase <b><font color=""#ff
0000"">cAMP</font></b>, <u>intoxicates macrophages through ADP ribosilation of G
proteins--&gt; antiphagocytic</u>. &nbsp;Causes <u>lymphocytosis</u>)< iv><b><b
r /></b></ iv>< iv><b>A enylate cyclase toxin</b> (CyaA) enters neutrophils, cat
alyzes <u>excessive pro uction of <b><font color=""#ff0000"">cAMP</font></b></u>
--&gt; intoxicates cells, phagocytosis compromise . Also hemolysin activity.&nbs
p;</ iv>< iv><b><br /></b></ iv>< iv><b>Dermonecrotic toxin</b> (DNT) heat labil
e, necrosis in vitro</ iv>"
3/21Bor etellaNeisseria
Vaccine for whooping cough
DTap
3/21Bor etellaNeisseria
Toxin-me iate isease causing extreme lymphocytosis, local peribronchial hyperp
lasia, leukocyte infiltration in lower respiratory tract an increase mucus pro
uction. Has special culture requirements an infants <6 months have highest mor
tality an rates of attack.
B. pertussis
3/21Bor etellaNeisseria
Causes lymphocytosis by inhibiting G(i) an thus increasing cAMP.
pertussi
s toxin of B. pertussis 3/21Bor etellaNeisseria
Causes meningococcemia an meningitis. Vaccines exist for certain serotypes, but
not all
Neisseria meningiti is; there's no vaccine for serotype B
3/21Bor etellaNeisseria
Which N. meningiti is serotypes cause 2/3 of cases in a olescents/a ults? 2/3 in
infants/young chil ren?
"A olescents/a ults: C, Y, W-135< iv>Infants/you
ng chil ren: B<br />< iv><img src=""nei epi.jpeg"" /></ iv></ iv>"
3/21Bor
etellaNeisseria
Which N. meningiti is serotypes cause 50-60% of cases in infants an young chil
ren?
serotype B (no vaccine) 3/21Bor etellaNeisseria
Which bacteria pro uces a blue-green pigment? Pseu omonas aeruginosa 3/14Pseu
omonasan Frien s
Which bacteria pro uces a re -pigment? Serratia marcescens
3/12Enterobacter
iaceae
Which staphylococci pro uces a yellow pigment? S. aureus (aureus = gol )
Co-infection with chlamy ia trachomatis is common.
Neisseria gonorrhea
3/17LegionellaMycoplasmaChlamy ia

Sexually transmitte Neisseria species. "N. gonorrhoeae< iv><img src=""gono.jpeg

"" /></ iv>"
3/21Bor etellaNeisseria
Teenager complains of pain uring sex an irregular menstrual blee ing. She's al
so experiencing lower ab ominal pain. Pelvic exam yiel s yellow mucopurulent is
charge an reveals gram (-) iplococci. One of her sexual partners comes to the
same clinic complaining of ysuria an profuse yellow urethral ischarge.
N. gonorrhoeae 3/21Bor etellaNeisseria
Which Neisseria species has no vaccine? N. goNOrrhoeae< iv><br /></ iv>< iv>NO v
accine, NO maltose fermentation (but oes ferment glucose)</ iv>
3/21Bor
etellaNeisseria
Which vaccine contains purifie filamentous hemagglutinin, pertactin, fimbriae,
an inactivate toxin? DTap for pertussis
3/21Bor etellaNeisseria
A Mexican immigrant presents with thickene cheeks an a eforme nose. Physical
exam shows sensory losses in han s an legs as well as testicular atrophy. Post
erior tibial an ulnar nerves are palpable. What's the organism?
"Mycobac
terium leprae< iv><img src=""paste-85938000626149.jpg"" /></ iv>< iv><img src=""
palp nerves.jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Strong immune response to mycobacterium leprae. Granuloma formation limits sprea
of microorganism.
"tuberculoi leprosy; immunologic response with TH1 cell
s< iv><img src=""chart lepro.jpeg"" /></ iv>< iv><img src=""paste-83691732730287
.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Weak immune response to mycobacterium leprae. What class of immune cells?
"lepromatous leprosy; poorly organize immunologic response with TH2 cells< iv><
img src=""chart lepro.jpeg"" /></ iv>< iv><img src=""paste-83661667959204.jpg""
/></ iv>< iv><br /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Requires prolonge an intimate contact for transmission. Aci -fast positive. Ar
ma illos are possible carriers. "Mycobacterium leprae< iv><br /></ iv>< iv><img
src=""paste-85933705658853.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dic
key
Two bacteria classes that are aci -fast positive.
"Mycobacteria an Nocar
ia< iv><img src=""aci fast nocar ia.jpeg"" /><img src=""aci fast lepro.jpeg""
/></ iv>< iv><img src=""paste-86165633892707.jpg"" />&nbsp;<img src=""paste-8626
4418140441.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Multiple skin lesions, obvious involvement of peripheral nerves, no granulomas,
IL-4, IL-5, IL-10
"Lepromatous leprosy< iv><img src=""chart lepro.jpeg"" /
></ iv>< iv><img src=""paste-83880711291365.jpg"" /></ iv>"
3/31Mycobacteria
Tuberculosis Dickey
Few skin lesions, well-forme granulomas, abun ant T lymphocytes, IL-2, IL-12
Tuberculoi leposy
3/31MycobacteriaTuberculosis Dickey
Can get mal perforans ulcers, skin lesions can be hypoesthetic/anesthetic, wellforme granulomas (which specific type) "Tuberculoi leprosy< iv><img src=""past
e-83880711291365.jpg"" /></ iv>< iv><br />< iv><img src=""anesthetic.jpeg"" /><i
mg src=""mal perforans.jpeg"" /></ iv></ iv>" 3/31MycobacteriaTuberculosis Dic
key
Leprosy type with high bacillary count. "Lepromatous leprosy< iv><img src=""loa
.jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Leprosy type with low bacillary count. Tuberculoi leprosy
3/31Mycobacteria
Tuberculosis Dickey
Associate with arma illos
"mycobacterium leprae< iv><img src=""paste-83734
682403301.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Leonine facies, loss of eyebrows, oubling time is 11-13 ays "mycobacterium l
eprae< iv><br /></ iv>< iv><img src=""paste-83764747174275.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
25 y/o woman presents with painful urination, increase frequency, without fever
or flank pain. 2 possible organisms
acute UTI ue to either E. coli or S. sa
prophyticus
4/17UTI
38 y/o woman with DM an has ha 2 weeks of ysuria an urgency, now complains o
f recent onset of fever an lower back pain; lab reveals WBC casts. Diagnosis an
most likely organism? pyelonephritis likely ue to E. coli with type II pilli
4/17UTI

Upper lobe isease most commonly in el erly male smokers with chronic pulmonary
symptoms
"MAC (mycobacterium avium complex)< iv><img src=""avium.jpeg"" /
></ iv>"
3/31MycobacteriaTuberculosis Dickey
Most frequently in nonsmoking women ol er than 50 years ol who have scoliosis,
pectus excavatum, an mitral valve prolapse.
"MAC (mycobacterium avium comple
x); ""La y Win ermere Syn rome"", will relapse with sensitive organisms, so its
easier to treat than the cavitary isease< iv><img src=""win ermere.jpeg"" /></
iv>"
3/31MycobacteriaTuberculosis Dickey
68 y/o non-smoker Caucasian woman presents with lingular infiltrate an chronic
cough "MAC (mycobacterium avium complex); ""La y Win ermere Syn rome""< iv><im
g src=""win ermere.jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
68 y/o male who is a chronic smoker presents with upper lobe cavitations an fib
rosis "MAC< iv><img src=""MAC fibro.jpeg"" /></ iv>" 3/31MycobacteriaTubercul
osis Dickey
54 y/o man with AIDS, low CD4 count (22), fever, anemia, iarrhea, weight loss,
elevate AST/ALT
"Disseminate MAC< iv><img src="" isseminate mac.jpeg""
/></ iv>"
3/31MycobacteriaTuberculosis Dickey
55 y/o male from Louisiana complains of numbness in fingers an likes to kill ar
ma illos
"peripheral neuropathy ue to M. leprae< iv><br /></ iv>< iv><im
g src=""paste-83885006258661.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dic
key
Swimming pool or fish tank granulomas "Mycobacteria marinum< iv><img src=""fis
h tank.jpeg"" /></ iv>" 3/31MycobacteriaTuberculosis Dickey
Gram positive, bea e , branching filaments, weakly aci fast
"Nocar ia< iv><i
mg src=""bea e .jpeg"" /></ iv>< iv><br /></ iv>< iv><img src=""paste-8702033238
4726.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Nocar ia species causing pulmonary infection
"N. asteroi es< iv><br /></ iv><
iv><img src=""paste-87200721011158.jpg"" /></ iv>"
3/31MycobacteriaTubercul
osis Dickey
Arm no ules in man who injure himself in a fish tank. "M. marinum< iv><img src
=""marinum han .jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
No ular pulmonary infiltrate an seizures in a renal transplant patient "Nocar i
a asteroi es (CNS-pulmonary symptoms)< iv><img src=""nocar ia.jpeg"" /></ iv>< i
v>Gram positive ro s, forms long, branching hyphae (same as Actinomyces)</ iv>"
3/31MycobacteriaTuberculosis Dickey
Pulmonary-CNS syn rome in an immunocompromise patient. "Nocar ia< iv><br /></ i
v>< iv><img src=""paste-87428354277846.jpg"" /></ iv>" 3/31MycobacteriaTubercul
osis Dickey
3 y/o girl presents with chronic painless anterior cervical a enopathy. Diagnosi
s an most likely cause?
"Lympha enitis ""Scrofula""; MAC is 80% in ki s,
M. scrofulaceum is the rest< iv><img src=""scrofula.jpeg"" /></ iv>" 3/31Myco
bacteriaTuberculosis Dickey
Causative agent of Hansen's isease
"Mycobacterium leprae< iv><img src=""pas
te-83880711291365.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Hispanic male is referre to the ermatology clinic. On physical examination, th
e man has several isfiguring lesions on his face an there is loss of cutaneous
sensation to fine touch, pain, an temperature. An aci -fast organism is observ
e .
"Mycobacterium leprae< iv><br /></ iv>< iv><img src=""paste-838807112913
65.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Immunosuppresse patient with altere mental status. Hea CT shows multiple absc
esses an CXR shows infiltrate. "Nocar ia< iv><img src=""pulm cns.jpeg"" /></ iv
>< iv><img src=""paste-87424059310550.jpg"" /></ iv>" 3/31MycobacteriaTubercul
osis Dickey
Patient with horrible foot injury after traumatic injury. Multiple sinus tracts
note
N. brasieliensis
Gene that enco es penicillin bin ing protein 2A that results in the strain MRSA
mec gene
3/10Staphylococci2
5 bacterial toxins enco e by a lysogenic phage "mnemonic ABCDE; Shig<b><font co
lor=""#ff0000"">A</font></b>-like toxin, <b><font color=""#ff0000"">B</font></b>
otulinum toxin, <b><font color=""#ff0000"">C</font></b>holera toxin, <b><font co

lor=""#ff0000"">D</font></b>iphtheria toxin, <b><font color=""#ff0000"">E</font>

</b>rythrogenic toxin of S. pyogenes" 3/21DiptheriaListeria
Segment of DNA that can jump (excise an reincoporate) from one location to anot
her.
transposon
Increases cAMP by inhibiting G(i), inhibits chemokine receptor an thus causes l
ymphocytosis. B. pertussis toxin< iv><br /></ iv>< iv>FC: A-B exotoxin</ iv><
iv>ADP-ribosylates Gi by removing the ADP-ribosyl group from NAD an covalently
attaching it to Gi Gi inactivation cAMP secretion of Na+, Cl-, H2O from cells e
ema, neutrophil ysfunction</ iv>
3/21Bor etellaNeisseria
A heres to apical surface of intestinal epithelium an flattens villi. Causes i
arrhea usually in chil ren
EPEC; P = pe iatrics
3/13Enterobacteriaceae2
Causes fever, iarrhea, rose spots on ab omen. Can remain in gall bla er chroni
cally Salmonella typhi (typhoi fever)
3/13Enterobacteriaceae3
What oes a (+) tuberculin skin test in icate? that <i>infection</i> with M. tu
berculosis has occurre < iv>not just exposure*</ iv>
3/31MycobacteriaTubercul
osis Dickey
Which mycobacteria is niacin (+)?
"M. tuberculosis< iv><img src=""niacin.j
peg"" /></ iv>" 3/31MycobacteriaTuberculosis Dickey
Homeless man enters the hospital with wasting an fever. He has ha a chronic co
ugh for several months pro ucing bloo y sputum as well as night sweats. CXR reve
als cavitations with air-flui levels in the apex of his left lung. Diagnosis is
confirme by an aci -fast stain of sputum
M. tuberculosis 3/31Mycobacteria
Tuberculosis Dickey
Grows on Lowenstein-Jensen agar.
"< iv>M. tuberculosis</ iv>< iv><br /></
iv>< iv><img src=""paste-87784836563212.jpg"" /></ iv>< iv><br /></ iv>< iv><im
g src=""lowenstein.jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Causes pneumonia in immunocompromise patients with un erlying lung isease such
as those with CF an CGD.
Burkhol eria cepacia
3/14Pseu omonasan Frien
s
Disease cause by rickettsia rickettsii Rocky Mountain Spotte Fever
3/17Zoon
otic
Serpentine cor ing an requires Lowenstein-Jensen agar "M. tuberculosis< iv><im
g src=""jensen.jpeg"" /></ iv>< iv><br /></ iv>< iv><img src=""paste-89116276425
000.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Initial focus of infection is mi -lung zone. Causes caseous necrosis. "M. tube
rculosis< iv><img src=""mi le lobe.jpeg"" /></ iv>< iv><br /></ iv>< iv><img sr
c=""paste-89227945574839.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dic
key
Why is long-term survival of TB note in posterior apical lung an renal cortice
s?
because these areas have high oxygen tension
Definition: results from failure of timely evelopment of a sufficient immune re
sponse to limit bacillary growth of TB. "Primary Progressive tuberculosis< iv><i
mg src=""primary.jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Presence of &gt; WBCs in UA with negative culture. AFB+ "<u>sterile pyruia</u> f
rom tuberculosis sprea to genitourinary system< iv><br /></ iv>< iv>Ask for ""f
irst morning urine"" 3x in a row</ iv>< iv><br /></ iv>< iv><img src=""paste-130
99650253211.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
True or false: The vast majority of immunocompetent a ults with untreate TB inf
ection will evelop TB isease uring their life.
False; only about 10% wi
ll--half of these (5% total) will evelop isease within the first 3 years after
infection
How is TB transmitte ? "through inhalation of <b> roplet nuclei</b>--most impor
tant eterminants of infection are closeness of contact an the infectiousness o
f a case. The bacilli then eposit in alveoli an <u>escape clearance mechanisms
</u>. The TB then replicate unimpe e <u>within the phagosomes of non-immune al
veolar macrophages</u> an then estroy them.< iv><img src="" roplet nuc.jpeg""
/></ iv>< iv><br /></ iv>< iv><img src=""paste-89399744266672.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
What is a Ghon complex? "calcifie mi -lung no ule + calcifie hilar lymph no e;
&nbsp;< iv><br /></ iv>< iv>from wiki: lesion seen in the lung that is cause by

tuberculosis. The lesions consist of a calcifie focus of infection an an asso

ciate lymph no e. These lesions are particularly common in chil ren an can ret
ain viable bacteria, so are sources of long-term infection an may be involve i
n <u>reactivation</u> of the isease in later life< iv><img src=""ghon.jpeg"" />
</ iv></ iv>< iv><img src=""paste-89567247991066.jpg"" /></ iv>"
3/31Myco
bacteriaTuberculosis Dickey
Example of in ivi uals that evelop progressive primary TB.
very young, el e
rly, immuno eficient (HIV)
Name for extrapulmonary TB that eposits in the vertebral bo ies.
"Pott's
isease< iv><br /></ iv>< iv><img src=""paste-4934917423272.jpg"" /><br />< iv><
img src=""potts.jpeg"" /><img src=""veert.jpeg"" /></ iv></ iv>"
3/31Myco
bacteriaTuberculosis Dickey
Type of TB that refers to all forms of progressive, isseminate , hematogenous T
B.
"miliary< iv><br /></ iv>< iv><img src=""paste-11098195493017.jpg"" /><b
r />< iv><img src=""miliary.jpeg"" /></ iv>< iv><br /></ iv>< iv><img src=""past
e-5007931867441.jpg"" /></ iv></ iv>" 3/31MycobacteriaTuberculosis Dickey
In young chil ren, it is frequently the initial presentation of TB.
"meninge
al TB - usually cause by rupture of subepen ymal tubercle into subarachnoi spa
ce< iv><br /></ iv>< iv><img src=""paste-10557029613789.jpg"" /><br />< iv><img
src=""meningeal.jpeg"" /></ iv>< iv><br /></ iv></ iv>" 3/31MycobacteriaTubercul
osis Dickey
True or false: skin TB testing cannot istinguish between remote asymptomatic in
fection an current isease
true
Ghon complex on CXR
"M. tuberculosis< iv><br /></ iv>< iv><img src=""paste-9
998683865255.jpg"" /></ iv>< iv><br /></ iv>< iv><img src=""paste-10020158701870
.jpg"" />&nbsp;<img src=""paste-10033043603825.jpg"" /></ iv>" 3/31Mycobacteria
Tuberculosis Dickey
When to rea tuberculin skin test an what exactly to measure. "rea reaction 4
8-72 hours after injection,&nbsp;< iv><br /></ iv>< iv>measure only iameter of
in uration.&nbsp;</ iv>< iv><br /></ iv>< iv>NOTE: interpretation of the skin te
st results iffers accor ing to your risk< iv><br /></ iv>< iv>5mm (high risk),
10mm (health care), 15mm (no risk factors)</ iv>< iv><img src=""in uration.jpeg"
" /></ iv></ iv>"
3/31MycobacteriaTuberculosis Dickey
34 y/o immigrant work with fever, night sweats, an anterior collapse of thoraci
c vertebrae.
"Pott's isease (extrapulmonary TB)< iv><br /></ iv>< iv><img sr
c=""paste-5287104741532.jpg"" /></ iv>" 3/31MycobacteriaTuberculosis Dickey
6mm PPD in asymptomatic patient with AIDS. Do they have TB infection? "Yes, ha
s TB infection< iv><br /></ iv>< iv><img src=""paste-10660108828841.jpg"" /></ i
v>"
3/31MycobacteriaTuberculosis Dickey
8mm PPD in wife of a TB patient with normal CXR. Does she have TB infection?
"Yes, has TB infection< iv><br />< iv><img src=""paste-10664403796137.jpg"" /></
3/31MycobacteriaTuberculosis Dickey
iv></ iv>"
12mm PPD in asymptomatic me ical stu ent at Ben Taub who was vaccinate with BCG
as a chil in In ia. Does he have TB infection?
"Yes, has TB infection<
iv><br /></ iv>< iv><img src=""paste-10660108828841.jpg"" /></ iv>"
3/31Myco
bacteriaTuberculosis Dickey
10mm PPD in a 1st year me ical stu ent from TX. Does he have TB infection?
"Yes, evi ence of TB infection< iv><img src=""10mm.jpeg"" /></ iv>"
3/31Myco
bacteriaTuberculosis Dickey
11mm PPD in an ex-prisoner. Does he have TB infection? "Yes, has TB infection<
iv><br /></ iv>< iv><img src=""paste-10660108828841.jpg"" /></ iv>"
3/31Myco
bacteriaTuberculosis Dickey
What is the booster effect?
"tuberculin can <u>restimulate or enhance</u> re
motely establishe an subsequently eteriorate hypersensitivity. Most commonly
occurs in the el erly< iv><img src=""booster.jpeg"" /></ iv>" 3/31Mycobacteria
Tuberculosis Dickey
Another way to test for TB without the nee to return to rea the result.
"Interferon-gamma release assays (IGRAs)--base on measurement of interferon-gam
ma pro uction by lymphocytes stimulate by specific M. tuberculosis antigens< iv
><img src=""quanti.jpeg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey

How many months o we treat for latent TB infection?

9 months--this substanti
ally re uces the risk that TB infection will progress to isease
The glycolipi s in the cell make of mycobacteria (ie TB) impervious to usual sta
ining proce ures. What are the 2 alternative options? "Aci -fast stain (Kinyou
n) or fluorescent Auramine-rhoa amine< iv><br /></ iv>< iv>Aur-rho stain is abou
t 100x more sensitive than the Kinyoun stain</ iv>< iv><img src=""kinyoun.jpeg""
/></ iv>"
3/31MycobacteriaTuberculosis Dickey
From Hamill: Chil with mi le lobe collapse. progressive primary TB
Results from hematogenous see ing uring primary TB infection to lymph no es in
hea in neck. "Scrofula (TB lympha enitis)< iv><img src=""tb scrof.jpeg"" /></
iv>" 3/31MycobacteriaTuberculosis Dickey
"Kinyoun stain emonstrating ""re snappers""" "M. tuberculosis< iv><img src=""
snap.jpeg"" /><img src=""snappers.jpeg"" /></ iv>"
3/31MycobacteriaTubercul
osis Dickey
45 y/o RN from In ia ha a PPD of 11mm in uration. She receive BCG vaccination
when she was 3 y/o. What's your interpretation of her PPD?
it's a true (+);
give her INH preventative therapy
3/31MycobacteriaTuberculosis Dickey
A sexually active man seeks me ical attention for a wart-like lesion eveloping
on his genitals. He recalls a painless ulcer on his genitals over a month ago, b
ut now is concerne because <b>papules</b> are appearing in his arm pits an pal
ms as well. A ark-fiel analysis confirms the octor's suspicion.
Treponem
a palli um (syphilis) 3/28Spirochetes
Shape like a corkscrew, istinctive motility, an iagnose with arkfiel micr
oscopy. (genus species) Treponema palli um
3/28Spirochetes
Hansen's isease presents with 2 forms, what are they? "lepromatous an tubercu
loi < iv><br /></ iv>< iv><img src=""paste-91783451116005.jpg"" /></ iv>"
3/31MycobacteriaTuberculosis Dickey
Treponemal antibo y tests (3). Limitation?
MHA-TP, EIA, TPPA< iv><br /></ i
v>< iv>90% sensitive in primary, 100% in secon ary</ iv>< iv><br /></ iv>< iv><
iv><b>M</b>icro<b>H</b>emagglutinating <b>A</b>ntibo y to <b>T</b>reponema <b>P<
/b>alli um (MHA-TP), <b>TPPA</b> (T. palli um particle agglutinating antibo y) o
r <b>ELISA</b>; &nbsp;these tests not quantitate &nbsp;</ iv></ iv>< iv><br /></
iv>< iv>Once positive, positive for life. <u>Not useful to iagnose in in ivi u
al case</u>. Only useful to rule out if <b>negative</b>*** (Or show RPR biologic
false positive)</ iv> 3/28Spirochetes
Has car iolipin in its cell membrane
Treponema palli um; it's <u>incorporate
from mammalian host rather than synthesize </u> --&gt; it's then altere so tha
t the host makes antibo y to it an etection of this antibo y is a mainstay in
iagnosis of syphilis 3/28Spirochetes
Nontreponemal antibo y tests. Detect what
<b>VDRL</b> an <b>RPR</b>; they
etect <u>car iolipin</u>< iv><br /></ iv>< iv>Venereal Disease Research Labora
tory [of CDC])</ iv>< iv>or RPR (rapi plasma reagin test);&nbsp;</ iv> 3/28Spir
ochetes
Specific component etecte by VDRL or RPR
antibo ies to phosphati ylcholin
e car iolipin (T. palli um). When measure by these tests it's reporte with a t
iter level that in icates the activity of the isease --&gt; high titer in icate
s high level of activity< iv><br /></ iv>< iv>eg 1:2, <b>1:32</b></ iv> 3/28Spir
ochetes
Detection of this &quot;autoantibo y&quot; is a mainstay in iagnosis of syphili
s
car iolipin (ma e by mammallian host an then altere by T. palli um)
3/28Spirochetes
Painless lesion (chancre) at inoculation site. Disappears in 3-4 weeks without t
reatment (give stage) Primary syphilis
3/28Spirochetes
Disseminate spirochetes proliferate causing lesions to appear on skin. Rash on
trunk, extremities, an involves palms of han s an soles of feet.< iv>(give sta
ge)</ iv>
"Secon ary syphilis< iv><img src=""secon ary.jpeg"" /></ iv>"
3/28Spirochetes
Name two iseases that result in rashes on palms an soles.
Syphilis an Roc
ky Mountain Spotte Fever
3/17Zoonotic
"Describe the ""rule of thir s"" as it pertains to syphilis"
Once latency is

reache , with no treatment &gt; rule of thir s: one-thir <b>era icate</b> isea
se, one-thir remain with <b>latent isease</b>, one-thir evelop <b>tertiary
isease</b>
3/28Spirochetes
Most reliable way to iagnose primary syphilis " etection of treponemes in chan
cre (painless lesion) exu ate by arkfiel exam (too narrow too be seen by light
microscope)< iv><img src="" arkf.jpeg"" /></ iv>"
3/28Spirochetes
Ascen ing aortic aneurysm (RARE), gummas (VERY RARE), tabes orsalis, strokes,
ementia, paresis
"tertiary syphilis (occurs 6-40 years after initial infe
ction)< iv><br /></ iv>< iv>Gumma</ iv>< iv><img src=""gumma.jpeg"" /></ iv>"
3/28Spirochetes
What is the Jarisch-Herxheimer reaction?
lysis of treponeme causes the re
lease of en otoxin-like factors that causes ~4 hours of fever 3/28Spirochetes
Argyll Robertson pupil "also calle ""Prostitute's pupil""; associate with ter
tiary syphilis< iv><br />< iv>They <u>accommo ate</u>, but <u> o not constrict</
u> when expose to bright light&nbsp;</ iv></ iv>< iv><br /></ iv>< iv>Tertiary
Syphyllis : emylinatino of Dorsal Column--&gt;argyll robertson pupil</ iv>"
3/28Spirochetes
Always positive in secon ary syphilis, usually &gt;1:32 (high titer)
antibo y
to car iolipin 3/28Spirochetes
Positive in 80% of persons with primary syphilis, usually <1:16 because it's sti
ll on its way up
antibo y to car iolipin 3/28Spirochetes
Causes relapsing fever. Diagnose by arkfiel exam of the bloo .
Borrelia
recurrentis; relapsing fever ue to the ability of the organism to changer oute
r membrane proteins which stimulates new immune response
3/17Zoonotic
A man comes to the octor with a fever. He assures the octor that he woul not
or inarily seek me ical attention simply for a fever, but that he has ha two ep
iso es of fever over the past 3 weeks. The fever worsens over 2 ays an abruptl
y spikes on the 3r ay, but then just as abruptly rops to normal temperature.
Doctor notes spirochetes on bloo culture.
Borrelia recurrentis
3/17Zoon
otic
Causes Lyme isease
Borrelia burg orferi
3/17Zoonotic
"Presents with erythema migrans (an expan ing ""bull's eye) re rash. Also cause
s arthritis, car itis, an is transmitte by tick Ixo es which is common in nort
heastern US." "Lyme isease from Borrelia burg orferi< iv><img src=""lyme.jpeg
"" /></ iv>"
3/17Zoonotic
Carries vancomycin resistance enterococcus
3/4Streptococci2
Meningitis in the newborn. Gram (+), catalase negative S. agalactiae 3/4Strep
tococci2
Dental cavity viri ans group strep (S. Mutans)
3/4Streptococci2
New onset sepsis + history of bloo in stool for 6 months
S. gallolyticus
3/4Streptococci2
UTI + bla er stone
Proteus 3/13Enterobacteriaceae2
Swarms proteus 3/13Enterobacteriaceae2
Painful buboes Y. pestis
Secretes the toxins: enterotoxin, TSST-1, exfoliatin
S. aureus
3/6Staph
ylococcus1
Toxins responsible for acting at the stratum granulosum in ki s.
exfoliat
in (scal e skin syn rome) - S. aureus 3/6Staphylococcus1
Acute tricuspi valve en ocar itis, attacks <i>normal</i> valves
S. aureu
s
4/15InfectiveEn ocar itis
Most common cause of osteomyelitis/septic arthritis
S. aureus
3/6Staph
ylococcus1
S. aureus iseases (exclu ing skin infections) "acute en ocar itis, osteomyelit
is/septic arthritis, <b>pneumonia </b>(although somewhat unusual)&nbsp;, bactere
mia< iv><br /></ iv>< iv>_{shown: acute en ocar itis, osteomyelitis, septic a
rthritis, pneumonia, foo poisoning}</ iv>< iv><img src=""paste-23733989278
510.jpg"" /></ iv>"
3/6Staphylococcus1
Component of normal skin flora, contaminates bloo cultures, infects prosthetic
evices S. epi ermi is
S. aureus toxin me iate iseases
scal e skin syn rome, toxic shock syn r

ome, rapi -onset foo poisoning ( ue to preforme toxin)

3/6Staphylococcu
s1
Lab sen s back the following susceptibility: bug is resistant to erythromycin an
susceptible to clin amycin. What's the next step?
"Perform a D-test. If it
's positive (looks like a ""D"") then there's in ucible resistance to clin amyci
n so we can't use clin amycin. If the D-test is negative then we can use clin am
ycin." 3/10Staphylococci2
Name 3 staph superantigens.
TSST-1, enterotoxins, exfoliatins
3/6Staph
ylococcus1
Bugs that o not gram stain well. List them an their mnemonic "These Rascals M
ay Microscopically Lack Color: <font color=""#ff0000""><b>T</b></font>reponema,<
font color=""#ff0000""><b> R</b></font>ickettsia, <font color=""#ff0000""><b>M</
b></font>ycoplasma, <font color=""#ff0000""><b>M</b></font>ycobacteria, <b><font
color=""#ff0000"">L</font></b>egionella,<font color=""#ff0000""><b> C</b></font
>hlamy ia"
3/17LegionellaMycoplasmaChlamy ia
Eaton's agar, sterol membrane, walking pneumonia with coughing, ba CXR, associa
te with col agglutinin isease
Mycoplasma pneumoniae 3/17LegionellaMy
coplasmaChlamy ia
Causes Pontiac fever, enters lung via aerosolize water (ie super-market sprayer
s, fountains, AC units) Legionella
3/17LegionellaMycoplasmaChlamy ia
Facultative intracellular parasite for amoebas Legionella
3/17LegionellaMy
coplasmaChlamy ia
Neonatal conjunctivitis, involute eyeli s w/ corneal scarring Chlamy ia tracho
matis 3/17LegionellaMycoplasmaChlamy ia
Pneumonia w/ bir exposure
C. psittaci
3/17LegionellaMycoplasmaChlamy i
a
15 y/o presents with severe cough of a week uration, bilateral infiltrates on C
XR, family member was sick last week
Mycoplasma
3/17LegionellaMycoplasma
Chlamy ia
Most common cause of respiratory failure in CF patients Pseu omonas aeruginosa
3/14Pseu omonasan Frien s
Inci ence has increase with carbepenem use an cancer Stenotrophomonas maltoph
ilia
3/14Pseu omonasan Frien s
Increasing inci ence w/ quinolone use, sol iers in Iraq acinetobacter 3/14Pseu
omonasan Frien s
Swimmer's ear, UTI, pneumonia Pseu omonas
3/14Pseu omonasan Frien s
Rash after being in hot tub?
hot tub folliculitis (Pseu omonas aeruginosa)
3/10Skinan SoftTissueInfections
Sol ier who is sick in Iraq
acinetobacter 3/14Pseu omonasan Frien s
Blue-green coloration, ue to what pigments?
"Pseu omonas; pyover in, pyocyan
in< iv><img src=""PA green.jpeg"" /></ iv>"
3/13Enterobacteriaceae2
Quinolone use pre isposes to? Acinetobacter 3/14Pseu omonasan Frien s
Necrotizing granulomatous pneumonia in CF patients
"Burkhol eria cepacia co
mplex ""cepacia syn rome""< iv><img src=""Cepacia syn rome.jpeg"" /></ iv>"
3/14Pseu omonasan Frien s
Bug you' see at MD An erson, but likely not at BTGH
Stenotrophomonas Maltoph
ilia - cause alot of problems in oncology patients hence the MD thing 3/14Pseu
omonasan Frien s
Soil in Iraq an Quinolone
Acinetobacter 3/14Pseu omonasan Frien s
Lonely CF patients an CGD
burkhol eria
3/14Pseu omonasan Frien s
Rash on palms an soles. Obligate intracellular. Infects en othelial cells
Rocky Mountain Spotte Fever (Rickettsia rickettsii)
3/17Zoonotic
Cat an og bites
Pasturella multoci a
3/10Skinan SoftTissueInfections
Fever, myalgia, hea ache, leukopenia, obligate intracellular
Erlichia (they'r
e obligate intracellular b/c they're consi ere part of Rickettsia)
3/17Zoon
otic
Tick bites or irect contact with rabbits
Fracisella tularensis
What causes Q fever?
Coxiella burnetii
Hoove animals an back pain
Brucellosis
3/17Zoonotic
Aerosolize poop, pneumonia, negative Weil-Felix
Coxiella burnetii

Transmitte by fleas
Y. pestis (bubonic plaque)
Goat cheese, back pain Brucella
3/17Zoonotic
35 y/o farmer with shortness of breath, ry nonpro uctive cough, febrile. Sympto
ms starte 2 ays after he witnesse one of his cows giving birth.
Q fever
(Coxiella burnetii)
42 y/o female with a history rheumatic fever as a chil has 102 egree fever an
a new heart murmur on physical exam several ays after ental proce ure.
"viri ans strep (en ocar itis of abnormal heart valve)< iv><img src=""en oc.jpeg
"" /></ iv>< iv><img src=""viri.jpeg"" /></ iv>"
3/4Streptococci
26 y/o female with ysuria an urinary frequency. Urine samples isplay growth o
f re pigment-pro ucing bacteria
UTI from Serratia Marcescens
3/12Ente
robacteriaceae
20 y/o male complains of iscomfort upon urination an of a purulent urethral i
scharge. A sample of the ischarge is gram staine an yiel s multiple pairs of
bean shape gram negative iplococci. "N. gonorrhoeae< iv><img src=""gonor.jpe
g"" /></ iv>< iv>Syphillis oesn't show up, Chlamy ia oesn't stain well</ iv>"
3/21Bor etellaNeisseria
A mother presents with her 2 y/o aughter who has a 1 week history of runny nose
an experiences coughing fits an fever. During your examination, the chil exh
ibits paroxysmal fits of coughing. An inspiratory whoop follows the coughing spe
lls.
B. pertussis
3/21Bor etellaNeisseria
52 y/o male employe as an air con itioning maintenance specialist evelope sev
ere pneumonia. During the previous 2 weeks he ha been cleaning an recon itioni
ng a cooling tower at his work site. Results of gram stain of his sputum specime
n were unclear. Legionella
3/17LegionellaMycoplasmaChlamy ia
A young woman presents with malaise an a rash all over her bo y. Upon further q
uestioning, she remembers a blister-like lesion on her labia about a month ago,
but she i n't think it was serious because it i n't hurt. Most likely organism
?
Treponema palli um (syphilis) 3/28Spirochetes
A patient at Ben Taub evelops iarrhea while in the hospital following antibiot
ic treatment. Examination of the colon shows the presence of a pseu omembrane.
"C. ifficile< iv><img src=""C iff.jpeg"" /></ iv>< iv><img src=""paste-3860144
80695539.jpg"" /></ iv>"
3/14Anaerobes Dickey
Rapi ly progressing cellulitis in a cirrhotic patient who ate raw oysters.
V. vulnificus 3/10Skinan SoftTissueInfections
35 y/o businessman evelops a watery iarrhea one ay after returning from a bri
ef trip to Guatemala. He recovers after 4 ays without seeing a physician
ETEC
Which species of Neisseria is most often associate with CNS isease? N. menin
giti is 3/21Bor etellaNeisseria
Bacteria grow most rapi ly uring with phase of the growth curve?
exponent
ial phase
12 y/o boy is a mitte with acute arthritis, car itis, an fever. He is thought
to have rheumatic fever. What iagnostic test shoul be run?
ASO titer
3/4Streptococci
47 y/o male with 15,000 WBC an 25RR, bloo culture grows E. coli
sepsis:
infection + &gt;2 SIRS (systemic inflammatory response syn rome)< iv><br /></ iv
>
4/17Sepsis
56 y/o male presents with gra e IV neutropenia (&lt;500 WBC), fever (40 egrees)
, an hypotension. Bloo culture grows E. coli septic shock< iv><br /></ iv>< i
v>= sepsis+hypotension (systolic &lt;90) that is unresponsive to IV</ iv>
4/17Sepsis
"LPS is recognize by what two things on monocytes that lea to severe sepsis? <
font color=""#ff0000"">What is mechanism of the sepsis</font>?" CD14 an TLR4 -&gt; this lea s to a casca e of events that ultimately results in genes being tr
anscribe an <u>nitric oxi e pro uction</u> which causes <u>vaso ilation</u>
3/21DiptheriaListeria
Most frequent lab abnormality in DIC
increase <b>D- imers</b> or <b>fibrin s
plit pro ucts</b>
4/17Sepsis
15 y/o male with recent history of iarrhea 3 weeks ago who presents with bilate

ral lower extremity paralysis. Guillain-Barre syn rome (from campylobacter jeju
ni)
3/17Diarrhea
29 y/o male has a collection of tropical fish. He cut his han while cleaning ou
t one of the tanks recently an now has a raging cellulitis with aci fast stain
ing organisms. Mycobacterium marinum 3/31MycobacteriaTuberculosis Dickey
Currant jelly sputum, alcoholic klebsiella pneumonia
3/13Enterobacteriaceae2
Neonatal pneumonia (3 causes) E. coli, group B strep, listeria
3/4Strep
tococci2
Respiratory failure in CF patient
Pseu omonas aeruginosa 3/14Pseu omonasa
n Frien s
Pneumonia + bir s
Chylam ia psittaci
3/17LegionellaMycoplasmaChlamy i
a
Young patient, lots of coughing, CXR looks better than patient looks, sister jus
t ha it
mycoplasma pneumoniae 3/17LegionellaMycoplasmaChlamy ia
Squash racket appearance, toxin taken up by motor en plate, vaccine preventable
Clostri ium tetani
3/14Anaerobes
Toxin bin s irreversibly to Renshaw neurons an inhibits the release of GABA an
glycine, results in isinhibition of neurons "C. tetani< iv><img src=""tetani
neurons.jpeg"" /></ iv>< iv><img src=""paste-393852796010927.jpg"" /></ iv>< iv
><br /></ iv>" 3/14Anaerobes Dickey
A teenage girl enters the ER suffering from painful muscle spasms. Throughout he
r examination, she sustains a facial sneer, stiff arche back, an clampe palms
. Her father is anxious about the fact that she experience ifficulty eating, p
robably ue to a stiff jaw. She playe a soccer game last week after falling on
a nail in the fiel .
C. tetani
3/14Anaerobes Dickey
Risus sar onicus an lock jaw "C. tetani< iv><img src=""risus.jpeg"" /></ iv><
iv><img src=""paste-393968760127715.jpg"" /></ iv>"
3/14Anaerobes Dickey
Most potent toxin known to man. Prevents release of ACh C. botulinum
3/14Anae
robes
Woman comes to ER with a marke paralysis of her upper bo y. The paralysis began
in her neck an sprea to her arms. Although she has no fever, she appears quit
e izzy an her eye li s are rooping. The ay before, she returne from a campi
ng trip where she limite her iet to canne foo s only.
"C. botulinum< i
v><br /></ iv>< iv><img src=""paste-348863013585364.jpg"" /></ iv>"
3/14Anae
robes Dickey
Pro uces hy rogen an nitrogen gas in vivo. Causes gas gangrene (myonecrosis) an
crepitant cellulitis "C. perfringens< iv><img src=""c perf.jpeg"" /></ iv>< i
v><br /></ iv>" 3/10Skinan SoftTissueInfections
Causes myonecrosis an is associate with un erlying GI malignancy
C. septi
cum
3/10Skinan SoftTissueInfections
Most common cause of nosocomial iarrhea
C. ifficile
Clin amycin use pre isposes to this type of hospital acquire iarrhea C. iffi
cile
3/14Anaerobes Dickey
"Densely fibrotic lesions, sinus tracts form, ""lumpy jaw"", sulfur granules"
"Actinomyces<br />< iv><br /></ iv>< iv><img src=""paste-397344604422471.jpg"" /
></ iv>"
3/14Anaerobes Dickey
Sulfur granules are iagnostic, sinus tracts
"Actinomyces< iv><img src=""acti
no sulfur.jpeg"" /></ iv>"
3/14Anaerobes
Toxin taken up by motor en plate, retrogra e axonal transport to the CNS, vaccin
e preventable C. tetani
3/14Anaerobes Dickey
Toxin inhibits release of GABA an glycine, bin s irreversibly to Renshaw neuron
s
C. tetani
3/14Anaerobes
Descen ing pattern of involvement, opisthotonos, risus sar onicus, autonomic ins
tability
C. tetani
3/14Anaerobes Dickey
Toxin prevents the release of ACh, exhibits escen ing symmetric weakness
C. botulinum
3/14Anaerobes Dickey
Gram positive, branche , filamentous ro s, sinus tracts form, sulfur granules,
oesn't respect tissue planes
"actinomyces< iv><img src=""paste-39734460442247
1.jpg"" /></ iv>< iv><img src=""tissue plane.jpeg"" /></ iv>" 3/14Anaerobes Di
ckey

Sulfur granules are iagnostic of what anaerobic organism?

"actinomyces< iv
><br />< iv><img src=""paste-397348899389767.jpg"" /></ iv></ iv>"
3/14Anae
robes Dickey
Name 2 organisms that grow on chocolate agar
H. influenzae, N. meningiti is
Bacteria that ferment lactose pro uce pink/re colonies on what type of agar?
"McConkey's< iv><img src=""lactose.jpeg"" /></ iv>"
3/12Enterobacteriaceae
Definition: lowest amount of antibiotic that inhibits growth
"MIC (minimum in
hibitory concentration); usually just nee MIC because bo y's host efenses will
clean up the mess if we just inhibit the bacterial growth< iv><img src=""MIC.jp
eg"" /></ iv>" 3/4Streptococci2
Definition: lowest concentration that kills 99.9% of the organisms uring 24 hou
rs of incubation
MBC (minimum bacterici al concentration); nee MBC ose
for neutropenic host (cancer patients that have no PMNs)
Antibiotic susceptibility test: put own isks of Abx an see if there's a clear
zone aroun it. Measures inhibition, not bacterici al "Kirby Bauer< iv><img sr
c=""kirby ba.jpeg"" /></ iv>"
Antibiotic susceptibility test: has high concentration at one en an there's a
gra ient so that there's low concentration at the other en . It's a refinement t
echnique of Kirby Bauer.
"e strips< iv><img src=""E strip.jpeg"" /></ iv>
"
In a ults why o you always get two bloo cultures?
because by getting bloo
from two ifferent sites you can rule out contamination; bloo bloo cultures w
ill give you a positive result if the patient has bacteremia< iv>_{- e.g. Sta
ph epi ermi is: present as normal skin flora, so often foun as a contaminant. H
owever, if you fin it in 2 ifferent places, then it is likely to be bacteremia
.}</ iv> 3/6Staphylococcus1
True or false: Chlamy ia antibo y tests aren't reliable True
3/17LegionellaMy
coplasmaChlamy ia
How goo is the rapi strep test?
Rapi strep test is 80% sensitive; 95% s
pecific< iv><br /></ iv>< iv>Definition: How often a test is positive in cases w
here isease is proven to be present. = sensitivity</ iv>
3/4Streptococci
Definition: measures the proportion of negatives which are correctly i entifie
as such (e.g. the percentage of healthy people who are correctly i entifie as n
ot having the con ition)
specificity; true negative&nbsp;
3/10Stap
hylococci2
What phosphati ylcholine is foun in the cell membrane of T. palli um that is in
corporate from the mammalian host an then altere ?
car iolipin
3/28Spir
ochetes
Innoculation through unrecognize breaks in the skin uring sexual intercourse.
T. palli um
3/28Spirochetes
What are the non-treponemal antibo y tests actually testing for?
car ioli
pin
3/28Spirochetes
"What isease is associate with the ""rule of thir s""?"
syphilis (T. pal
li um) 3/28Spirochetes
Once positive, remains so for life
antibo y to treponemal (outer membrane)
proteins--thus <b>not useful to iagnose infection</b>. <i>Only useful to exclu
e iagnosis if negative</i>
3/28Spirochetes
Vector is the har tick, causative agent of Lyme isease
Borrelia burg or
feri
3/17Zoonotic
tick associate erythema migrans
Lyme isease (B. burg orferi) 3/17Zoon
otic
Definition: presence of circulating viable bacteria in the bloo stream as confir
me by culture of a sample of bloo .
<u>bacteremia</u> or hematogenous sprea
3/3IntrotoID
Define: infection + 2 or more SIRS criteria (systemic inflammatory response syn
rome) "sepsis< iv><img src=""venn.jpeg"" /></ iv>"
4/17Sepsis
Definition: presence of sepsis + hypotension AND is unresponsive to IV flui the
rapy
septic shock
4/17Sepsis
An ol woman comes to the octor with a fever an loose bowels. Her iarrhea occ
urs in tremen ous volumes, shoe complains, although she oes not remember ever s

eeing bloo . She has an unremarkable recent past me ical history, except for an
infection a few weeks earlier that was treate with clin amycin.
"C. iff
icile< iv><img src=""paste-386134739779998.jpg"" /></ iv>"
3/14Anaerobes Di
ckey
Applie to treat strabismus, muscle spasticity, an facial wrinkles.
botulinu
m toxin (C. botulinum) 3/14Anaerobes Dickey
Which mycobacterium species is niacin (+)?
M. tuberculosis
Requires prolonge an intimate contact for transmission. Clinical manifestation
s inclu e hypoesthesia an peripheral neuropathy. Prolonge oubling time of 1113 ays.
"M. leprae< iv><br /></ iv>< iv><img src=""paste-83880711291365.
jpg"" /></ iv>" 3/31MycobacteriaTuberculosis Dickey
How is the pathology of leprosy similar to that of a iabetic foot?
"both ex
hibit nerve amage resulting in loss of sensation, lack of sweating, ry skin, a
n pre isposition to injuries an infection< iv><img src=""mal perforans.jpeg""
/></ iv>"
3/31MycobacteriaTuberculosis Dickey
True or false: any organism can cause severe sepsis.
true
4/17Sepsis
Most common (2) organisms causing severe sepsis?
"S. aureus, E. coli< iv>
<img src=""common.jpeg"" /></ iv>"
4/17Sepsis
What's the most common site of infection causing severe sepsis? "lung< iv><img s
rc=""lung.jpeg"" /></ iv>"
4/17Sepsis
True or false: virtually all of the biologic effects of en otoxin are in the lip
i A moiety of LPS.
True
3/12Enterobacteriaceae
What two cell surface molecules on mononuclear phagocytes (monocytes an macroph
ages) me iate the LPS/LBP complex bin ing?
CD14 an TLR-4 3/12Enterobacter
iaceae
What in ucible molecule is responsible for the vascular smooth muscle relaxation
an vaso ilation that results in shock?
nitric oxi e (NO)
4/17Seps
is
True or false: Microbial toxin an PAMPs stimulate the pro uction by mononuclear
phagocytes of TNF-alpha an IL-1 which in turn promotes pro uction of NO. In se
psis there en s up being increase fibrin-split pro ucts (D- imers), increase p
rothrombin time, an ecrease platelets.
"True< iv><img src=""15 ago.jpeg
"" /></ iv>"
4/17Sepsis
True or false: Septic patients show an increase in D- imers.
"True, an ecre
ace protein C< iv><img src=""paste-89219355639811.jpg"" /></ iv>"
4/17Seps
is
What's the ifference between a patient with sepsis an severe sepsis? sepsis w
ith <u>acute organ ysfunction</u> is involve with = severe sepsis
4/17Seps
is
What's the preferre vasopressor for severe sepsis?
Norepinephrine (NOT opa
mine) 4/17Sepsis
Crystalloi or colloi for severe sepsis hemo ynamic support? crystalloi is p
referre (an it's cheaper)
4/17Sepsis
Sepsis is a highly catabolic state that requires a equate nutrition for the pati
ent. How is it best to a minister their nutrition?
using their own enteric
tract (ie, NOT PARENTERAL)
4/17Sepsis
In provi ing ventilatory support uring severe sepsis, is 6ml/kg or 12ml/kg pref
erre ? 6ml/kg. 12 causes barotrauma
4/17Sepsis
What's the most common manifestation that elicits suspicion of sepsis? fever
4/17Sepsis
Why oes hematogenous osteomyelitis frequently involve the metaphysis of long bo
nes?
"metaphyseal capillary loops have <u>inefficient phagocytic cells</u>, t
he flow is sluggish, thrombosis/infarction provi e an <u>avascular environment</
u> well-suite for bacterial growth< iv><img src=""metaphy.jpeg"" /></ iv>"
3/6Staphylococcus1
Why o infants less than one year of age get osteomyelitis an septic arthritis
together oftentimes?
"<u>transphyseal vessels</u> connect the <u>metaphyseal
vessel loops</u> with the <u>epiphyseal vessels</u>; epiphyseal growth plate es
truction may result< iv><img src=""trans (2).jpeg"" /></ iv>" 4/16OsteoMan Sep
ticA

Transphyseal vessels atrophy by the age of 6 months. What oes that mean for a c
hil with osteomyelitis?
"infection beginning in the metaphysis stays the
re (is localize ) an <u> oesn't affect the growth plate</u> so normal growth is
usually not impaire . However, it <u>sprea s laterally an ruptures through the
cortex </u>but <u>not usually the periosteum</u>. Probably nee to rain some p
us un er the bone< iv><img src=""trans (2).jpeg"" /></ iv>< iv><img src=""bone k
i s.jpeg"" /></ iv>"
4/16OsteoMan SepticA
What part of the a ult is most likely affecte by osteomyelitis?
"interve
rtebral isk an a jacent vertebral bo ies. Will present with low back pain ofte
n< iv><br /></ iv>< iv><img src="" isk.jpeg"" />&nbsp;</ iv>< iv><br /></ iv>< i
v><img src=""pet scan.jpeg"" /></ iv>< iv>< iv>PET scan reason*</ iv></ iv>"
3/6Staphylococcus1
Most common site of hematogenous osteomyelitis in chil ren
long bones (90%)
- femur > tibia > humerus, etc 3/6Staphylococcus1
25 y/o male with raining sinus tract on si e of face after ental surgery
"actinomyces< iv><img src=""actino face.jpeg"" /></ iv>"
3/14Anaerobes Di
ckey
6 month ol baby presents with iffuse inflammation, swelling, an ecrease mot
ion. What pathology?
osteomyelitis an septic arthritis (via hematogenous spr
ea )
3/6Staphylococcus1
60 y/o male presents with fever, erythema, an swelling 1 week after has ha un
ergone a hip fracture surgery. What <b>pathology</b>? osteomyelitis (secon ari
ly sprea from an a jacent site)
3/6Staphylococcus1
Bug most commonly associate with hematogenous sprea in neonate, chil , an a u
lt.
S. aureus
3/6Staphylococcus1
30 y/o female presents an complains of low back pain an not feeling well. Bloo
culture grows S. aureus
osteomyelitis (hematogenous sprea to verterbral
bo ies in a ults)
3/6Staphylococcus1
State of the art imaging mo ality for iagnosis of osteomyelitis. Sensitive even
early in the isease an may reveal pus collections
"MRI< iv><img src=""MRI.
jpeg"" /></ iv>"
4/16OsteoMan SepticA
What's the uration of therapy for hematogenous osteomyelitis of long bones infe
cte by S. aureus?
4-6 weeks (note: a less virulent bug may take less time)
3/6Staphylococcus1
Definition: invasion of the joint space by an infecting agent septic arthritis
3/6Staphylococcus1
Most common bug associate with septic arthritis in all age groups.
S. aureu
s
3/6Staphylococcus1
Most common joint affecte by septic arthritis in chil ren
knee
3/4Strep
tococci
Most common cause of septic arthritis in sexually active people N. gonorrhoeae
3/21Bor etellaNeisseria
Causes acute en ocar itis, osteomyelitis, an septic arthritis S. aureus
3/6Staphylococcus1
62 y/o male with iabetes for the last 10 years presents with swelling an eryth
ema of right right foot along with ulcers. After examination the orthope ic surg
eon tells the patient that the bones in his toes are infecte an requires amput
ation. "osteomyelitis ( ue to vascular insufficiency)< iv><img src=""osteo vasc
ular.jpeg"" /></ iv>" 4/16OsteoMan SepticA
What's the gol stan ar for iagnosis en ocar itis?
positive bloo cultures
4/15InfectiveEn ocar itis
What's the pathogenesis of infective en ocar itis?
1. the <u>valve surface
must be altere </u> to pro uce a suitable site for bacterial attachment (ie exis
ting abnormal heart valve or un erlying heart isease)< iv>2. pro uction of a no
n-bacterial thrombotic en ocar itis (<u>NBTE</u>) lesion (<u>trauma to en otheli
um</u> exposes collagen an platelet eposition occurs, etc)</ iv>< iv>3. &nbsp;
<u>hemo ynamic factors</u> that pro uce mechanical stress on the valve (<u> owns
tream from regurgitant flow</u>)</ iv>< iv>4. portal of entry for bacteria (ie b
rushing teeth)</ iv>< iv><br /></ iv>< iv>5.&nbsp;<u>transient bacteremia</u> wi
th an appropriate organism</ iv>
4/15InfectiveEn ocar itis

What are the two most common sites of infective en ocar itis? How can this be ex
plaine ?
mitral (86%) an aortic (55%); there's lots of <u>mechanical str
ess</u> on these valves which contributes to the propensity to evelop en ocar i
tis
4/15InfectiveEmitral vn ocar itis
What's a common portal site for entry for infective en ocar itis?
ental
4/15InfectiveEn ocar itis
Does viri ans strep pro uce an acute or subacute infective en ocar itis?
subacute (mortality is low, vegetations are small, <u>symptoms last weeks to mon
ths</u>)
3/4Streptococci2
What's more common: gram positive or gram negative en ocar itis?
gram pos
itive 4/15InfectiveEn ocar itis
What are the best organisms at a hering to the NBTE?
Enterococcus > viri ans
> S. aureus
63 y/o woman with mitral stenosis an 6 week history of fever an fatigue
subacute en ocar itis (viri ans)
3/4Streptococci2
28 y/o IV rug user presents to BTGH with fever, pleuritic chest pain an hemopt
ysis
S. aureus on tricuspi valve (acute en ocar itis)
4/15InfectiveEn
ocar itis
You receive 2 positive bloo cultures of viri ans. What are your initial thought
s about iagnosis?
patient has en ocar itis until proven otherwise 3/4Strep
tococci2
From the oral cavity an usually causes a subacute process on abnormal valves
viri ans
3/4Streptococci2
45 y/o alcoholic man with acute aortic insufficiency an meningitis
"acute e
n ocar itis ( ue to <b>pneumococcus</b>--40% are alcoholics an 70% have coexist
ing meningitis)< iv><b><font color=""#ff0000"">Tria </font></b>: meningitis, en
ocar itis, alcoholism</ iv>"
4/15InfectiveEn ocar itis
El erly man with benign prostatic hypertrophy, fever, aortic insufficiency, an
conjunctival petechiae en ocar itis ue to entercoccus (ol man with GU abnorma
lity) 4/15InfectiveEn ocar itis
Most common cause of acute en ocar itis S. aureus
3/6Staphylococcus1
Prosthetic valve en ocar itis S. epi ermi is< iv><br /></ iv>< iv>(native valv
e in IVD, an patients w/mitral prolapse)</ iv> 4/15InfectiveEn ocar itis
Bloo cultures (+) for S. aureus an an absence of an obvious focus, first thoug
ht?
acute en ocar itis
3/6Staphylococcus1
Bacteremia an en ocar itis have been associate with a enocarcinoma
S. gallo
lyticus (bovis) 3/4Streptococci2
En ocar itis with obligatory colonoscopy following
S. gallolyticus (bovis)
3/4Streptococci2
55 y/o man presents with 3 month history of weight loss an growing vegetation o
n heart valve S. gallolyticus (bovis) 3/4Streptococci2
32 y/o man, sexually active with several partners an ha urethral ischarge 2 w
eeks ago. Now has acute onset of shortness of breath an lou iastolic murmur.
N. gonorrhoea (most occur in young men an are BAD--20% mortality)
3/21Bor
etellaNeisseria
Pseu omonas in Detroit cause tricuspi valve en ocar itis in IV rug users the
re
3/14Pseu omonasan Frien s
Common cause of en ocar itis in San Francisco Serratia. marcescens
3/17Zoon
otic
Most common physical fin ings for en ocar itis fever an heart murmur 3/4Strep
tococci
Fever, Osler's no es, petechiae, mumur "en ocar itis< iv><img src=""osler.jpeg"
" /></ iv>< iv><img src=""petechiae.jpeg"" /></ iv>"
4/15InfectiveEn ocar iti
s
Infective en ocar itis in rug a icts S. aureus (an pre ominantly right-si e
, tricuspi )&nbsp;
3/6Staphylococcus1
Major extra-car iac complication of infective en ocar itis (3) emboli (patient
presents with cerebral emboli/blee )< iv><br /></ iv>< iv>pleuritic chest pain</
iv>< iv><br /></ iv>< iv>&nbsp;bloo -streake sputum</ iv>
4/15InfectiveEn
ocar itis

Abscess of which heart valve can cause con uction efects an ultimately heart b
lock? "aortic valve (abscess isrupts Bun le of His)< iv><img src=""AV.jpeg""
/></ iv>"
4/15InfectiveEn ocar itis
57 y/o male presents with col , bloo cultures (+) for staph, elevate ST segmen
t on ECG
pericar itis
Gol stan ar for iagnosis of en ocar itis
bloo cultures (there's continuo
us bacteremia); echocar iograms cannot rule in or rule out the iagnosis of infe
ctive en ocar itis but shoul be use to assess complications 3/6Staphylococcu
s1
How to manage infective en ocar itis (what to give, who to call?)
use <b>b
acterici al</b> agents in high serum levels; prolonge therapy (<b>4-6 weeks</b>
); shoul <b>3x consult</b> the car iologist, ID specialist, an CV surgeon. Nee
combo of rugs for enterococcus
4/15InfectiveEn ocar itis
When is prophylaxis treatment for en ocar itis in icate for ental proce ures?
ental proce ures that manipulate gingival tissue, periapical region, perforate
mucosa, if patient has ha <b>previous en ocar itis</b>, if patient has <b>conge
nital heart isease</b>, if there's a <b>prosthetic valve repair</b>, history of
<b>heart transplant</b>
4/15InfectiveEn ocar itis
7 y/o boy with nephrotic syn rome evelops ascites, <b>bug?</b> "primary periton
itis ( ue to <b>pneumococcus</b>--primary means lack of perforation or obvious s
ource of infection)< iv><img src=""primary perotonitis.jpeg"" /></ iv>" 3/14Anae
robes Dickey
16 y/o boy with 3 ay history of anorexia an RLQ pain, now has iffuse ab omina
l pain with reboun ten erness on examination appen icitis ( ue to obstruction
from normal GI flora like E. coli)
49 y/o alcoholic man with ascites secon ary to portal hypertension has iffuse a
b ominal pain an fever primary peritonitis ( ue to E. coli most likely)
3/14Anaerobes Dickey
This pathology usually locate in the sigmoi an escen ing colon. Pathogenesis
analogous to that of appen icitis
iverticulitis
40 y/o man walks in off the street with LUQ ab ominal pain an is foun to have
a splenic abscess. What 2 bugs are most likely? "<b>S. aureus</b> (although most
intrab ominal abscess are polymicrobial, splenic abscesses are unique where the
majority is ue to bacteremic sprea of S. aureus or <b>pneumonoccus</b>)< iv><
img src=""splenic.jpeg"" /></ iv>"
3/14Anaerobes Dickey
Best imaging mo ality for iagnosing intraab ominal infections. "CT scan< iv><im
g src=""CT.jpeg"" /></ iv>"
3/14Anaerobes Dickey
68 y/o man presents with fever an fatigue. Physical examination shows 101 fever
, a murmur of mitral insufficiency an guaiac (+) stools. Laboratory evaluation
emonstrates iron eficiency anemia
S. gallolyticus (bovis) 3/4Streptococci2
75 y/o woman presents to the ER with colicky RUQ pain, jaun ice, fever an confu
sion. On examination, she has jaun ice an a 102.6 fever with mo erately severe
RUQ ten erness to palpation. What's her iagnosis an what bug? cholecystitis (
ue to E. coli) 3/14Anaerobes Dickey
45 y/o man presents with multiple sinuses on the left si e of his face. The sinu
ses ischarge pus an are painless. His past me ical history is insignificant ex
cept for a ental surgery one a few weeks ago for a ental infection. His octo
r examines the pus un er the microscope an fin s filamentous organisms an note
s sulfur granules.
"Actinomyces israelii< iv><br /></ iv>< iv><img src=""pa
ste-397344604422471.jpg"" /></ iv>"
3/14Anaerobes Dickey
Appearance often escribe as Chinese letters "Corynebacterium iphtheriae< iv
><img src="" iphtheria chinese.jpeg"" /></ iv>" 3/21DiptheriaListeria
Why are 53% of US a ults susceptible to iphtheria even with the a vent of vacci
nes?
the vaccination <u> oesn't provi e life-long protection</u> so you have
to stay up-to- ate on your immunizations
3/21DiptheriaListeria
Club shape an appearing as Chinese letters or V an L palisa es
Diphther
ia
3/21DiptheriaListeria
Requires Lowenstein-Jensen agar M. tuberculosis 3/31MycobacteriaTuberculosis
Requires Eaton's agar M. pneumoniae
Requires Loeffler's me ia an Tellurite (re uce tellurite to metallic tellurium)

bloo agar
C. iphtheriae 3/21DiptheriaListeria
Only known virulence factor of C. iphtheriae? What enco es? What inhibits it?
<b> iphtheria toxin</b> (an exotoxin)--toxin is enco e by a<u> lysogenic bacter
iophage</u>. Toxin gene expression is inhibite by <u>high iron concentration.</
u>
3/21DiptheriaListeria
"Sore throat, fever, ""pseu omembrane"" pharyngitis"
"C. iphtheriae< iv><img
src=""membrane bullneck.jpeg"" /></ iv>"
3/21DiptheriaListeria
pseu omembrane pharyngitis, vaccine preventable "C. iphtheriae< iv><img src=""m
embrane bullneck.jpeg"" /></ iv>"
3/21DiptheriaListeria
A young immigrant girl goes to the octor complaining of a sore throat an iffi
culties in breathing an swallowing. He notices a large gray mucous film in her
oropharynx. The patient also exhibits ST wave changes on an EKG an a slight par
alysis of her tongue. Physician or ers a potassium tellurite culture. C. ipht
heriae 3/21DiptheriaListeria
pseu omembarne, airway obstruction, myocar itis C. iphtheriae 3/21DiptheriaLis
teria
Mechanism of iphtheria toxin? How oes it enter the cell?
"<u>Receptor me
iate en ocytosis*</u>< iv><u><br /></u></ iv>< iv><u>Inhibits protein synthesis
</u> through <u>ADP-ribosylation of elongation-factor 2</u>. Toxin results in mu
cosal necrosis. Toxin gene carrie on a bacteriophage< iv><br /></ iv>< iv>Toxin
transfers ADP (ADP-ribosylation) to the iphthami e resi ue of elongation facto
r 2--this prevents transfer of aa- tRNA from A to P site</ iv>< iv><img src=""AD
P.jpeg"" /></ iv></ iv>"
3/21DiptheriaListeria
What oes DTaP stan for?
Diphtheria-tetanus-acellular-pertussis 3/21Dipt
heriaListeria
Associate with col cuts, hot ogs, cheeses. When pregnant women get infecte i
t can cross the placenta
Listeria monocytogenes 3/21DiptheriaListeria
Resistant to high salt a bile concentrations, can multiple in col temperatures
, can cause meningitis an <u>humoral immunity will not eliminate it</u>
L. monocytogenes (recall that it's a facultative intracellular pathogen)
3/21DiptheriaListeria
The only gram (+) with en otoxin
Listeria monocytogenes 3/21DiptheriaLis
teria
A mother brings her 2-month-ol infant to the hospital because he exhibits fever
, convulsions, irritability an poor eating. Pe iatrician notes a stiff neck an
or ers a spinal tap that reveals increase PMNs, increase protein, an gram (+
) ro s. Mother a mits that she oesn't breastfee an uses fresh cow's milk inst
ea .
"meningitis ue to L. monocytogenes< iv><img src=""list (1).jpeg"" /></
iv>< iv>(brucella are gram -)&nbsp;</ iv>"
3/21DiptheriaListeria
Gram stain shows white spots in the center of the bacteria (aka spores visible)
"B. anthracis< iv><img src=""anthrax.jpeg"" /></ iv>" 3/21DiptheriaListeria
What's unique about the capsule of B. anthracis "it's the only bacteria with a <
u>polypepti e capsule</u> (D-glutamate). It's one of its virulence factors< iv><
br /></ iv>< iv>< iv>Anti-phagocytic capsule: <b>poly--D-glutamic</> acid polype
ptide</div><div>capsule-pOX2</div></div><div><r /></div><div><img src=""anthrax
capsule.jpeg"" /></div>"
3/21DiptheriaListeria
Cutaneous innoculation produces lack eschar
"B. anthracis<div><img src=""esc
har.jpeg"" /></div>"
3/21DiptheriaListeria
Exhiits mediastinal widening on X-ray "B. anthracis<div><img src=""paste-16939
351015427.jpg"" /></div>"
3/21DiptheriaListeria
 33 y/o woman presents with an ulcerous lesion on the neck. The ulcer has a la
ckened necrotic eschar surrounded y edema. On the occupational history, the pat
ient reveals that she works in the imported wool and hides industry
B. anthr
acis
3/21DiptheriaListeria
Bioterrorism agent, unique protein capsule
B. anthracis
3/21DiptheriaLis
teria
Triparite toxin on pOX1 "Virulence factor of B. anthracis; 2 Toxic + 1 inding u
nit; Lethal Factor (<>LF</>) + Edema Factor (<>EF</>) + Protective nitgen (
<>P</>)<div><img src=""anthrax capsule.jpeg"" /></div>"
3/21DiptheriaLis
teria

B. anthracis virulence factors "protein capsule + 3-part toxin (P, EF, LF--pOX
1)<div>Non-toxic without P!<r /><div><img src=""anthrax capsule.jpeg"" /></div
></div>"
3/21DiptheriaListeria
Black skin lesions caused y lethal factor and edema factor
B. anthracis
3/21DiptheriaListeria
ETEC produces what two toxins that act on the CFTR channel resulting in chloride
secretion?
ST (activates cGMP) and LT (activates cMP)
3/13Enteroacter
iaceae2
Preferentially enters M cells, is invasive, and causes typhoid fever. Salmonel
la
3/13Enteroacteriaceae3
True or false: only humans carry Salmonella typhi
True
3/13Enteroacter
iaceae3
For unknown reasons, this organism has a propensity for infection of vascular si
tes--like atherosclerotic plaques or aortic aneurysms. non-typhoid Salmonella
3/13Enteroacteriaceae3
out 30-50% of normal people are colonized in the nose and throat. Persons who
have reaks in the skin for any reason are likely to carry it. S. aureus
MCC of osteomyelitis and septic arthritis (major contriuting cause)
"S. aure
us<div><r /></div><div><img src=""paste-25396141621616.jpg"" /></div>" 3/6Staph
ylococcus1
Causes scalded skin syndrome, toxic shock syndrome, and food poisoning S. aureu
s
3/6Staphylococcus1
Have exopolysaccharide (slim) that allows them to adhere to prosthetic devices.
Common lood culture contaminates
S. epidermidis
What ug: pneumolysin stimulates inflammation, has choline inding proteins for
adherence?
Pneumococcus
3/3IntrotoID
Get cold agglutinin disease, atypical pneumonia Mycoplasma pneumonia
3/17Legi
onellaMycoplasmaChlamydia
Free-living amoea in water supports its intracellular growth legionella
3/17LegionellaMycoplasmaChlamydia
Causes eye disease, genital disease, and neonatal pneumonia
C. trachomatis
CF patients ecome social outcasts
BCC
Causes human granulocytotropic anaplasmosis. Infects <u>WBCs</u> rather than end
othelium causing <u>leukopenia</u>
ehrlichia
3/17Zoonotic
Most common clinical sign of tularemia (Franceilla)
"ulceroglandular (75%)<d
iv><img src=""ulcer t.jpeg"" /></div>" 3/17Zoonotic
molecular mimicry and Guillian Barre
Campyloacter jejuni
3/17Diarrhea
What was the first anti-psychotic drug? chlorpromazine -- physicians accidentall
y noticed it calmed patients w psychosis and decreased their hallucinations and
delusions<div><r /></div><div>was actually a TB drug</div>
5/23ntipsychoti
csRD
<div>What would you give for:&nsp;</div><div><r /></div><div>1. schizophrenia
+ thought disorders<r />2. mood disorders (1st line tx in BP, augmentation in r
efractory MDD)<r />3. aggression<r />4. delirium<r />5. dementia<r />6. tour
ettes</div>
antipsychotic medications
5/23ntipsychoticsRD
What are the side effects of typical anti-psychotics in the 4 dopaminergic neura
l pathways? (mesolimic, mesocortical, nigrostriatal (short and long term), tue
roinfundiular) "Mesolimic: decreased <>reward/pleasure centers with apathy, s
ocial withdrawal</>, etc. <>secondary negativism </>w ""<i>neurolepsis</i>""
(ie, why antipsychotics are called neuroleptics<div><r />Mesocortical: may alre
ady e deficient, ut <>cognitive and emotional </>symptoms may worsen</div><d
iv><r />Nigrostriatal: <>Short term</>- Parkinsonism, dystonia, akathesia; <
>Long term</>- Tardive dyskinesia&nsp;</div><div><r />Tueroinfundiular: rem
emer D inhiits proloctin. So if you lock D, you increase&nsp;<>prolactin<
/> resulting in <u>galactorrhea</u>, <u>amenorrhea</u>, <u>infertility</u>, <u>
one loss</u></div><div><u><r /></u></div><div><r /></div>" 5/23ntipsychoti
csRD
What does long term usage of typical anti-psychotics cause in nigrostriatal trac
t?
tardive dyskinesia --&gt;long term lockade leads to increased sensitivi
ty of dopamine receptors and tremors/chorea/athetosis<div><r /></div><div>Tardi

ve dyskinesias (TDs) are involuntary movements of the tongue, lips, face, trunk,
and extremities that occur in patients treated with long-term dopaminergic anta
gonist medications</div>
5/23ntipsychoticsRD
What percent of patients on typical anti-psychotics develop tardive dyskinesia?
(give per year) 5% chance every year (i.e. 25% chance after 5 years)
5/23nti
psychoticsRD
What age of patients are at risk of developing tardive dyskinesia?
Elderly
5/23ntipsychoticsRD
Is tardive dyskinesia reversile?
YES -- if treatment is stopped early
5/23ntipsychoticsRD
What is neuroleptic malignant syndrome and what are its characteristics?
"a rare reaction to typical anti-psychotics;&nsp;<div><r /><div><div><><font
color=""#ff0000"">F</font></>ever&nsp;</div><div><><font color=""#ff0000"">E<
/font></>ncephalopathy&nsp;</div><div><><font color=""#ff0000"">V</font></>i
tals unstale (autonomic instaility)</div><div><><font color=""#ff0000"">E</fo
nt></>levated <>CPK</> and leukocytosis</div><div><><font color=""#ff0000"">
R</font></>igidity of muscles and myogloinuria</div></div><div><r /></div><di
v>+ confusion, high liver enzymes from class</div></div><div><r /></div><div>(M
nemonic is from Firecracker)</div>"
5/23ntipsychoticsRD
How do we treat neuroleptic malignant syndrome? "1. give muscle relaxants (<><f
ont color=""#ff0000"">dantrolene</font></>)<r />2. stop drug and try a differe
nt agent after 2 weeks" 5/23ntipsychoticsRD
What is an example of a high potency vs. low potency typical antipsychotic? Sfx?
High == <>haloperidol</> == higher affinity for dopamine receptors (low dose)-&gt; <u>low anti-cholinergic side effects + high EPS risk and TD, NMS</u><div><
u><r /></u></div><div><u><r /></u>Low == c<>hlorpromazine </>== lower affini
ty for dopamine receptors (high dose)--&gt; <u>high anti-cholinergic side effect
s + Low EPS risk, lower TD, lower NMS</u><r /></div> 5/23ntipsychoticsRD
What is the mechanism of atypical antipsychotics in psychotic and non-psychotic
symptoms in mania?
-dopamine lockade decreases <u>psychotic symptoms</u> i
n mania<r />-5HT2 antagonism decreases <u>non-psychotic symptoms</u>&nsp;in&n
sp;mania (serotonergic neurons innervate domaminergic neurons) 5/19Moodstailiz
er
How do <>atypical antipsychotics</> temper side effects?
"1. <>shorter&n
sp;</>inding time at D2<r />2. 5HT2 antagonism<div><r /></div><div><img sr
c=""paste-117548959924629.jpg"" /></div>"
5/23ntipsychoticsRD
What is the downside of atypical antipsychotics?
1. weight gain<r />2. d
yslipidemia<r />3. diaetes mellitus<r />4. acceleration of cardiac risk<r />
5. possile premature death<div><r /></div><div>(Mnemonic: think fat people, th
ey have all of these risks too)&nsp;</div><div><r /></div><div>These rain on t
he parade of a once thought ideal medication</div>
5/23ntipsychoticsRD
clozapine class first atypical antipsychotic that was recognized
5/23nti
psychoticsRD
What is the key side effect of clozapine? What is the result of this? "<><fon
t color=""#ff0000"">agranulocytosis</font></>&nsp;(0.5-2%)--&gt; &nsp;CBC mus
t e taken every two weeks (four weeks if normal for 6 months)<div><r /></div><
div>Extremely inconvenient drug for the patient</div>" 5/23ntipsychoticsRD
What is the order of atypical antipsychotics wrt weight gain and cardiometaolic
risk? <div>MOST</div>1. clozapine<r />2. olanzapine<r />3. quetiapine<r />4
. risperdone/paliperidone<r />5. ziprasidone<r />6. aripiprazole<div>LEST</di
v><div><r /></div><div>COQRZ</div>
5/23ntipsychoticsRD
What are the other side effects of clozapine? "(<font color=""#ff0000"" style=
""font-weight: old; "">agranulocytosis</font>)<r />""Ss"" == seizures, sedati
on, salivation<r /><div>Myocarditis<r />Weight gain / cardiometaolic</div>"
5/23ntipsychoticsRD
What are the side effects of olanzapine?
1. VERY sedating (used for patie
nts who cant sleep)<r />2. weight gain + cardiometaolic risk<div><r /></div>
<div><r /></div><div>Hola= fattening mexican food</div><div>zzzapine= sedatin
g</div> 5/23ntipsychoticsRD
Risperidone class. Give high and low dose effects.
atypical antipsychotic a

t <u>low doses</u> (at high doses acts more like a typical antipsychotic w EPS a
nd increased prolactin) 5/23ntipsychoticsRD
Which atypical antipsychotic is availale as a slow depot injection? (oily comi
nation in gluteus)
risperidone<div><r /></div><div>please sper my acksid
e! I done want it!</div>
5/23ntipsychoticsRD
Which atypical antipsychotic is approved for kids?
"risperidone<div><r /><
/div><div>""whisper to kids""</div>"
5/23ntipsychoticsRD
Paliperidone- it is similar to what, and etter how? What side effects? Similar
to risperidone with etter dosing (sustained release) and lower EPS; <r /><r /
>increases the <u>QT interval</u> though
5/23ntipsychoticsRD
What is the unique side effect associated with Paliperidone (Invega)? Increase
d QT interval 5/23ntipsychoticsRD
Which atypical antipsychotics have strong antidepressant activity?
"quetiap
ine (seroquel) and aripiprazole<div><r /></div><div><r /></div><div>""quiet""
and ""pipe"" down that depression</div>"
5/23ntipsychoticsRD
What unique side effect does ziprasidone (Geodon) have? QT elevation
5/23nti
psychoticsRD
ripiprazole (ailify) class and enefit
typical antipsychotic with very
low cardiometaolic risk or weight gain (least of the 7)
5/23ntipsychoti
csRD
What unique side effects can aripiprazole cause?
gitation or akathesia<d
iv><r /></div><div>causes <></>kathesia &amp; grants <></>gitated&nsp;<
>aility</> to depressed pt</div>
5/23ntipsychoticsRD
an internal feeling state that influences self and environmental perception
mood
5/13cyclingmood
<u>sustained distressing mood state</u>&nsp;which alters&nsp;<u>functioning</u
>&nsp;and causes&nsp;<u>impairment&nsp;</u> <u>mood disorder</u>
5/13cycl
ingmood
2 weeks or more of depressed mood with prolems of:<r /><r />-sleep<r />-appe
tite<r />-fatigue<r />-psychomotor agitation or retardation<r />-concentratio
n<r />-guilt or worthlessness<r />-suicidal thinking&nsp;
Major Depressive
Episode
mildly depressed mood for most of the time for at least two years
dysthymi
a
manic episode distinct period of at least <u>one week</u> of a persistently el
evated, expansive, or irritale mood w 3+ (or 4+ if irritale)<r /><r />1. inf
lated self esteem or grandiosity<r />2. decreased need for sleep<r />3. pressu
red speech<r />4. flight of ideas<r />5. distractaility<r />6. increased goa
l directed activity even w high potential for painful consequences<r /><r />-the mood disorder <u>must cause impairment</u> 5/13cyclingmood
Hypomanic episode classification/timeframe
distinct period of <u>at least o
ne week</u> of a persistently elevated, expansive or irritale mood with three o
r more or the following (four if mood is only irritale)<r /><r />1. Inflated
self esteem or grandiosity<r />2. Decreased need for sleep<r />3. Pressured sp
eech more talkative than usual<r />4. Flight of ideas or feeling of thoughts ra
cing<r />5. Distractiility<r />6. Increased goal directed activity<r />7. Ex
cessive involvement in goal directed activity with high potential for painful co
nsequences<r /><r />The represents and oservale change from previous functio
ning ut is <>not severe enough to cause marked impairment in functioning</> o
r necessitate hospitalization<r />
5/13cyclingmood
<u>only requires mania</u>&nsp;ut most patients have mania + depression&nsp;
<u>Bipolar I disorder diagnosis</u>
5/13cyclingmood
re there hallucinations w Bipolar I disorder? hallucinations and delusions may
5/13cyclingmood
e present
What is rapid cycling Bipolar I Disorder?
more than 4 mood disturances in
12 months
5/13cyclingmood
re men or women more likely to get Bipolar I Disorder? equal 5/13cyclingmood
What is the age of onset for Bipolar I Disorder?
15 -34 (20 mean); risk g
oes down after 50; increasing numer of pediatric cases 5/13cyclingmood
t what age does the risk of Bipolar I Disorder go down?
50
5/13cycl

ingmood
What is the association of socioeconomic status and Bipolar I Disorder? mixed da
ta
5/13cyclingmood
What social conditions predispose to Bipolar I Disorder?
single, widowed,
divorced --&gt; this is true for all mood disorders
5/13cyclingmood
What % of people with Bipolar I Disorder w a manic episode have another one?
90%
5/13cyclingmood
What % of manic episodes in Bipolar I Disorder occur right around a depressive e
pisode? 65%; the order of which one comes first is constant for a given patient
5/13cyclingmood
What uniquely may spur an episode in patients with Bipolar I Disorder? disrupti
on in sleep wake cycle (i.e. new time zone)
5/13cyclingmood
What other disorders are often comorid w Bipolar I Disorder? (4)
1. anxie
ty (92%)<r>2. sustance ause (71%)<r>3. conduct disorder in childhood (60%)<
r>4. antisocial in adulthood (30%)
5/13cyclingmood
What are the genetics of Bipolar I Disorder?
first degree relatives at risk f
or all mood disorders (4-24%) 5/13cyclingmood
<>oth</>&nsp;hypomanic&nsp;<>and</>&nsp;major depressive episode&nsp;
<>&nsp;Bipolar II Disorder</>
5/13cyclingmood
How does a patient w Bipolar II Disorder often present? patient comes in w a maj
or depressive episode and the history of hypomania is revealed (patients rarely
come in for hypomania) 5/13cyclingmood
Is rapid cycling more common in Bipolar I Disorder or Bipolar II Disorder?
Bipolar II Disorder
5/13cyclingmood
re women or men more likely to get Bipolar II Disorder?
proaly women
5/13cyclingmood
How are patients etween episodes in Bipolar II Disorder?
fully functional
5/13cyclingmood
Patients w Bipolar II Disorder have what % chance of having a manic episode?
5-15% --&gt; after which they would e classified as Bipolar I 5/13cyclingmood
<u>&gt; 2 years</u>&nsp;of oth&nsp;<u>hypomania</u>&nsp;and&nsp;<u>dysthymi
a</u><div><r /></div><div><r /></div> <u><div>cyclothymia</div><div></div></u>
<u><r /></u>cannot e w/o symptoms for more than 2 months<div><r /></div><div>
NOTE: may <u>NOT</u>&nsp;have experienced any <i>manic episodes</i> nor <i>majo
r depressive episodes</i> during 2 years</div>
What is the prevalence of Bipolar I?
1-2%<div><r /></div><div><r /></div><d
iv>in order of prevelance: Bipolar I, cyclothymia, Bipolar II</div>
5/13cycl
ingmood
What is the prevalence of Bipolar II? 0.1 - 0.5%<div>in order of prevelance: B
ipolar I, cyclothymia, Bipolar II</div> 5/13cyclingmood
What is the prevalence of cyclothymia? 0.4 - 1%<div><r /></div><div>in order o
f prevelance: Bipolar I, cyclothymia, Bipolar II</div> 5/13cyclingmood
When is the onset of cyclothymia?
adulthood
5/13cyclingmood
What is course of cyclothymia? chronic course that is slow and hard to identify
5/13cyclingmood
criteria for oth a&nsp;<u>manic episode</u>&nsp;+&nsp;<u>major depressive ep
isode</u>&nsp;are present for&nsp;<u>one week&nsp;</u>
<u>&nsp;</u>mix
ed episode
5/13cyclingmood
What is the role of serotonin and norepinephrin in mania or hypomania? no role
5/13cyclingmood
What neurotransmitter may e involved in mania? dopamine (amphetamines can cause
manic symptoms)
5/13cyclingmood
Blocking what NT can help mania?
dopamine
5/13cyclingmood
What endocrine organs are disfunctional w ipolar disorder? (2) <u>thyroid</u> (
more common w rapid cycling) and <u>male hypothalamic-pituitary-gonadal</u> axis
hormones
5/13cyclingmood
What conditions can cause manic symptoms? (5) 1. <>neurologic</> (seizure, M
S, stroke, TBI etc.)<r />2. <>infections</> (neurosyphilis, IDS)<r />3. <>
neoplasms</> (CNS, paraneoplasms)<r />4. <>endocrine disorders</> (hyperthyr
oidism, hypercortisolemia, diaetes, B12/folate deficient etc.)<r />5. <>infla

mmatory</> (collagen vascular disorders)

5/13cyclingmood
What sustances (3) can cause manic symptoms? 1. psychostimulants (cocaine, am
phetamine, etc.)<r>2. CNS drugs (amatadine, aclofen, romocriptine)<r>3. syst
emic drugs (steroids, isoniazid, theophylline) 5/13cyclingmood
How do we think lithium works? 1. second messengers (inhiits inositol monophos
phate)<r />2. modulation of G proteins<r />3. gene expression (for growth fact
ors and neuronal plasticity--inhiition of glycogen synthetase kinase 3 and prot
ein kinase C) 5/19Moodstailizer
What do we use lithium for?
1. treatment and prevention of <u>manic episodes
</u><r />2. helps treat <u>depressive phase of ipolar disorder</u> too<div><r
/></div><div>Sometimes used as <u>augmentation agent</u> in depressive illness<
/div> 5/19Moodstailizer
How is lithium metaolized? What is implication and what to avoid
"In kidn
ey along with <u>sodium</u><div><r /></div><div><><font color=""#ff0000"">Hypo
natremia</font></> is a risk for <><font color=""#ff0000"">lithium toxicity</f
ont></>--&gt; void <u>dehydration</u>, <u>diuretics</u>, <u>low sodium diets</
u>,&nsp;<u>NSIDS</u></div>" 5/19Moodstailizer
What are the side effects of lithium? (9, ut give the 4 important)
"1. <>f
ine tremor (not coarse, which would e toxicity)</><r />2. nausea, diarrhea, v
omiting<r />3. <>diaetes insipidus (lithium competes with DH receptors in ki
dney)</><r />4. <>hypothyroidism (Li reduces activity of TH)</><r />5. weig
ht gain<r />6. alopecia<r />7. enign interference of conduction of S node<r
/>8. <>Esteins anomaly (tricuspid valve) in first trimester- women need irt
h control</><r />9. enign leukocytosis<div><img src=""estin.jpeg"" /></div>"
5/19Moodstailizer
What should e done efore starting lithium? (5)
"1. check kidney functio
n<r />2. EKG<r />3. pregnancy test<r />4. thyroid function<r />5. aseline C
BC<div><r /></div><div><><font color=""#ff0000"">Could e test question&nsp;<
/font></></div>"
5/19Moodstailizer
What should e monitored while giving lithium? (4)
1. <>renal</> funciton
<r />2. <>thyroid</> function<r />3. possile <>pregnancy</><r />4. drug
<>levels</> 5/19Moodstailizer
1. Coarse tremor<r />2. Vomiting<r />3. taxia<r />4. Dysarthria<r />5. Conf
usion<r />6. Seizures Symptoms of <u>lithium toxicity</u>
5/19Moodstailiz
er
How is mania similar to a seizure?
"episodes may ""<u>kindle"" future episo
des</u>; anti-convulsants sometimes work for mania"
5/19Moodstailizer
valproic acid class and use
<u>anti-convulsant</u> which can treat mood diso
rders 5/19Moodstailizer
What is valproic acid useful for? (3) 1. <u>acute phase</u> of mania<r />2. <
u>prevent recurrence</u> of mania<r />3. pretty good w <u>rapid cycling</u><r
/><r />--<>not effective for depression </>(ut lithium is)<div><r /></div><
div>nticonvolsant, so anti-mania</div> 5/19Moodstailizer
Where is valproic acid metaolized?
liver (inhiits cP450) 5/19Moodstailiz
er
Which patients should NOT get valproic acid?
1. liver disease (Hepatotoxicity
)<r />2. clotting anormalities (Thromocytopenia)<r />3. pregnant (3-4% chanc
e of <u>neural tue defects</u> in the first trimester of pregnancy)
5/19Mood
stailizer
Before starting valproic acid what should we check?
1. Liver function tests<
r />2. lood count<r />3. pregnancy 5/19Moodstailizer
What should e monitored while on valproic acid?
<div>1. Liver function t
ests</div>2. lood counts<r />3. pregancy<r />4. drug levels 5/19Moodstailiz
er
Lamotrigine (Lamictal) class and use
<u>anticonvulsant</u> that can treat moo
d disorders
5/19Moodstailizer
What is the mechanism of action of lamotrigine? 1. inhiits voltage <>Na+</> c
hannels<r />2. inhiits Glu release<r />3. possile locking <>Ca2+</> chann
els
5/19Moodstailizer
What is lamotrigine useful for? Depressed phase of ipolar disorder (maintenance

phase) (off lael)<r /><r />--not appropriate for mania

5/19Moodstailiz
er
What is the metaolism of lamotrigine? hepatic 5/19Moodstailizer
How are levels of lamotrigine affected y other drugs in this class? (give 2 spe
cific drugs)
increased y <u>valproic acid</u><r />decreased y <u>caramaze
pine</u>
5/19Moodstailizer
What are the side effects of lamotrigine?
few except <u>sedation</u>; rare
Stevens Johnson syndrome (1/1000) and toxic epidermal necrolysis (TEN- a more s
ever SJS)
5/19Moodstailizer
What should we monitor w lamotrigine? no las to monitor! great for patients,
they hate las! 5/19Moodstailizer
caramazepine and oxcaramazepine class and use anticonvulsants which can treat
mood disorders (mania) 5/19Moodstailizer
What is the mechanism of caramazepine? 1. locks voltage Na+ channels<r>2. enh
ances GB
5/19Moodstailizer
What are the uses of caramazepine?
<u>Treatment and prevention</u> of mania
<r /><r />--<u>not</u> studied for ipolar depression<div><r /></div><div>Use
d to treat seizures, so used to treat mania</div>
5/19Moodstailizer
What is the metaolism of caramazepine? What special property does it have?
hepatic --&gt; it induces hepatic enzymes, increasing its own metaolism decreas
ing dosages of other drugs (i.e. lamotrigine) 5/19Moodstailizer
Which patients should NOT get caramazepine?
1. liver disease (makes elevated
liver enzymes)<r />2. neutropenia<r />3. pregnant women (neural tue defects,
craniofacial defects and microcephaly in pregnancy)
5/19Moodstailizer
What are the side effects of oxcaramazepine? mainly <u>sedation</u> and <u>SI
DH</u><div><u><r /></u></div><div>Ox eating cars gets sleepy and dilutes loo
d</div> 5/19Moodstailizer
What needs to e monitored efore starting caramazepine? (7) <div><div>1. ren
al function</div></div><div>2. Thyroid Function</div><div>3. Liver Function</div
><div>4. EKG</div><div>5. Pregnancy</div><div>6. CBC</div><div>7. Electrolytes</
div><div><r /></div><div><r /></div> 5/19Moodstailizer
What needs to e monitored during oxcaramazepine therapy?
nothing 5/19Mood
stailizer
Why are anti-depressants usually avoided in cycling mood disorders? (4) 1. may i
nduce <u>mania</u><r />2. may induce <u>rapid cycling</u><r />3. may worsen <u
>staility</u><r />4. may increase <u>suicidality</u> 5/19Moodstailizer
Do ipolar disorders usually need one drug or multiple drugs? often multiple d
rugs are required
Measles, Mumps, oth, or neither:<r /><r />Fever, Koplik spots (pathognomonic)
, cough, coryza, conjunctivitis, and erythematous maculopapular rash that starts
on face
"Measles<r />(<i>Morillivirus</i>)<div><r /></div><div><img s
rc=""paste-603614703780306.jpg"" /></div>"
5/13Paramyxovirus Viruses paramy
xo
Measles, Mumps, oth, or neither:<r /><r />Fever, headache, malaise and swelli
ng of parotid glands
"Mumps<r />(<i>Ruulavirus</i>)<div><r /></div><div><i
mg src=""paste-603610408813010.jpg"" /></div>" 5/13Paramyxovirus Viruses paramy
xo
The 5 memers of paramyxoviridae are differentiated y their proteins.<r /><r
/>Which 2 have hemagluttinin-neuraminidase and F (fusion) protein?<r /><r />(G
ive virus and infection)
"Paramyxovirus (parainfluenza)<r /><r />Ruula
virus (mumps)<div><r /></div><div><img src=""paste-603610408813010.jpg"" /></di
v>"
5/13Paramyxovirus Viruses paramyxo
The 5 memers of paramyxoviridae are differentiated y their proteins.<r /><r
/>Which 1 has Hemagglutinin and F protein?<r /><r />(Give virus and infection)
"Morillivirus (Measles)<div><r /></div><div><img src=""paste-603610408813010.j
pg"" /></div>" 5/13Paramyxovirus Viruses paramyxo
The 5 memers of paramyxoviridae are differentiated y their proteins.<r /><r
/>Which 2 have ttachment (G) and F (fusion) protein, ut no H or N glycoprote
ins?<r /><r />(Give virus and infection)
"Pneumovirus (RSV - Respiratory
Syncytial Virus)<r /><r />Metapneumovirus (HMPV - Human Metapneumovirus)<div><

r /></div><div><img src=""paste-603610408813010.jpg"" /></div>"

5/13Para
myxovirus Viruses paramyxo
&quot;ill humor&quot; irritale hyperactive state that is a mood disorder<div>
<r /></div><div>Pathological mood states: depression, elation, ill humor (produ
ces the instaility of interpersonal relationships)</div>
What are the depressive disorders not otherwise specified? (5) 1. premenstrual
dysphoric disorder<r />2. minor depressive disorder<r />3. recurrent rief dep
ressive disorer<r />4. postpsychotic depression of schizophrenia<r />5. major
depression superimposed on other psychiatric disorder
What are psychological factors predisposing to depression? (5)<div><r /></div><
div>Psychodynamic (3)</div><div>Cognitive (2)</div>
"<div><>Psychodynamic:&
nsp;</></div><div>a) unresolved, unconscious conflict</div><div>) loss, disru
ption of significant attachments (esp losing parents efore 18)</div><div>c) Tra
umatic disillusionments regarding self--&gt;suicide risk</div><div><r /></div><
div><>Cognitive:&nsp;</></div><div>a) negative cognitive triad</div><div>) N
egative Cognitive Style (excessive recall of neg, catastrophizing, dismissive of
positive experience, personlize failures, rigidity of expectations)</div><div><
r /></div><div><>Interpersonal Stressors</></div><div><r /></div><div><>Lea
rned Helplessness</></div><div><r /></div><div><>Trauma</></div><div><r /><
/div>1. <>intrapsychic conflict</> == unresolved conflicts, ""anger turned inw
ard""<r />2. <>losses</> == parent up to age 18, jo, spouse, etc.<r />3. <
>depressive cognition</> == ""negative cognitive triad"" demeaning view of self
, world, and future<r />4. <>learned helplessness</> == outcome is independen
t of response<r />5. <>trauma</>"
"""negative cognitive triad""" negative view of <u>self</u>, the <u>world</u>,
and the <u>future</u>
ipolar disorder
What is the one disorder where socioeconomic status matters?
Blacks show what mood disorder? paranoia (from depression, not schizophrenia)&n
sp;
Hispanics show what psychiatric disorder?
somatic complaints
What jos have high risk for depression?
medicine for women and air traff
ic controllers
What % of depressed patients actually seek treatment? 25%
Do men or women more likely get depression?
women
What are the suicide attempt rates for ipolar, major depression, and dysthymia?
1. ipolar == 24%<r />2. depression == 18%<r />3. dysthymia == 17%<div><r /><
/div><div><>suicide attempts are highest for ipolar disorder</></div>
What disease was shown to occur in depressed patients? cardiovascular illness
melancholia
loss of pleasure in nearly all activities with depression<r><r
>3 of 6:<r>a. distinctly perceived difference from other sad moods<r>. regula
rly worse in morning<r>c. early morning awakening<r>d. marked psychomotor reta
rdation or agitation<r>e. significant anorexia or weight loss<r>f. excessive,
inappropriate guilt<r>
seasonal pattern of depression correlation of onset of depression at <u>same ti
me of year</u>
How long does a depression episode last untreated?
6 months average
Is depression increasing or decreasing? increasing
What % of patients w depression commit suicide? 10-15%
When is the usual age onset of major depression?
20s - 40s
re depression symptoms the same for all ages? NO -- symptoms differ for differ
ent ages
What is the largest time without depression a patient can have to e diagnosed w
dysthymia?
2 months
<u>Maladaptive reaction to social stressor&nsp;</u>(marital, jo, illness, deve
lopment), impaired social/ occupational function plus excessive symptoms, not a
pattern, occurs&nsp;<u>within 3 months of stressor</u>&nsp;and does&nsp;<u>no
t last longer than 6 months</u><div><r /></div><div><r /></div>
<u>djus
tment Disorder with Depressed Mood</u>
What is the time constraint on adjustment disorder w depressed mood?
<u>withi
n </u>3 months of stressor; does <u>not last longer</u> than 6 months

Depressive symptoms occurring with the&nsp;<u>first two months</u>&nsp;after t

he loss of a loved one even if meeting criteria for major depressive episode&ns
p;<u>unless</u>&nsp;associated with marked functional impairment, morid preocc
upation with worthlessness, suicidal ideation, psychotic symptoms or psychomotor
retardation&nsp;
Bereavement
What is the time constraint for ereavement?
it occurs within the first 2 mon
ths after the loss
What overrides recent grief ereavement to e classified as major depressive dis
order? 1. preoccupation worthlessness<r />2. &nsp;suicidal ideation<div>3. ma
rked functional impairment<r />4. psychomotor retardation</div>
What are some common medical conditions that cause mood disorders?(5) <>viral
syndromes</>, especially hepatitis and mononucleosis;&nsp;<div><>tumors</>,
especially pancreatic and lung;&nsp;</div><div><>multiple sclerosis</>;&nsp
;</div><div><>hyperthyroidism</> or <>hypothyroidism</>;</div><div><>stroke
</><r /><r /></div>
What  is serotonin synthesized from? tryptophan
5/14TreatmentDepression1
What is rain serotonin metaolized y and into?
<u>MO-</u> metaolizes
serotonin into <u>5H1</u> (5 hydroxyindolacetic acid)
5/14TreatmentDep
ression1
What happens to serotonin once release into the synaptic cleft? "taken ack up 
y the serotonin transporter (SERT)<div><img src=""sert.jpeg"" /></div>" 5/14Trea
tmentDepression1
Which serotonin receptors are relevant to mood disorders in the rain? 5HT1, 5
HT2, 5HT4, 5HT6 and 5HT7
5/14TreatmentDepression1
Patients w low 5 HI do what? impulsive, violent suicidal acts (ut the findin
g is not specific to mood disorders)
5/14TreatmentDepression1
What choromosome is the SERT gene on? 17
5/14TreatmentDepression1
Talk aout the genetics of the SERT gene and its influence on depression
"individuals either have a 44 ase pair insertion or deletion;&nsp;<div>inserti
on == ""long"" l, and deletion == ""short"" s;</div><div>people with the ss
genotype are more likely to experience <u>depression w repeated stress</u></div>
"
5/14TreatmentDepression1
What happens to patients w diets deficient in tryptophan?
depression, even
if on SSRIs
5/14TreatmentDepression1
What NT is involved in the acquisition of emotionally arousing memories?
NE
5/14TreatmentDepression1
What NT is involved in the process of working memory to regulate ehavior and at
tention?
NE
5/14TreatmentDepression1
What happens to patients if you give propranolol vs. nadolol with relation to me
mory? Propranolol <u>crosses the BBB</u> and can <u>prevent NE from storing em
otionally charged memories.&nsp;</u><div>Nadolol does <u>not</u> cross the BBB
and does not have this effect</div>
5/14TreatmentDepression1
What do NE depletion studies show?
it is not feasile to deplete NE w/o aff
ecting dopamine<div><r /></div>
5/14TreatmentDepression1
Where are dopaminergic cell odies?
"<div>in the ventral mesencephalon (i.e.
sustantia nigra and the VT)</div><div><img src=""VT (1).jpeg"" /></div>"
5/14TreatmentDepression1
What dopamine receptors are found in limic areas?
"<div>D3 + D4</div><div>
<img src=""limic.jpeg"" /></div>"
5/14TreatmentDepression1
What dopamine receptors are found in the striatum?
"D1 + D2<div><img src=""
striatum.jpeg"" /></div>"
5/14TreatmentDepression1
What is the role of dopamine in each of the relevant cortical areas?<div>nigrost
riatal ==&nsp;<r />mesolimic ==&nsp;<r />mesocortical ==&nsp;<r />mesolim
ic to nucleus accumens ==&nsp;</div> nigrostriatal == movement<r />mesolimi
c == reward and motivation<r />mesocortical == memory and attention<r />mesoli
mic to nucleus accumens == reinforcing properties of a variety of <u>drugs of
ause</u> and <u>pleasurale activities</u>
5/14TreatmentDepression1
What NTs are involved in depression?
NE, Ser, Dopa 5/14TreatmentDepression1
What endocrine disorder often causes a reversile mood syndrome?
Cushing
s (high cortisol)
5/14TreatmentDepression1

Patients w Cushings are also likely to develop what? More than 50% develop a
reversile mood syndrome
5/14TreatmentDepression1
How does cortisol change in patients w major depressive disorder? 3
1. eleva
ted cortisol (plasma, CSF, urine)<r>2. resistant to cortisol lockage y dexame
thasone<r>3. adrenal gland hypertrophy / increased sensitivity to corticotropin
5/14TreatmentDepression1
What are the symptoms of hypothyroidism?
"1. Fatigue<r />2. Memory impai
rment<r />3. Irritaility<r />4. Decreased liido<r />5. Psychosis, delirium,
and suicidality have also een reported<r /><div><img src=""hypo.jpeg"" /></di
v><div><r /></div>"
5/14TreatmentDepression1
What % of mood disorder patients have thyroid dysfunction?
25%
5/14Trea
tmentDepression1
How do patients w hypothyroid do w antidepressant treatment?
poor response an
d earlier recurrence
5/14TreatmentDepression1
What is the thyroid status of most depressed patients? euthyroid
5/14Trea
tmentDepression1
Reduction in neuronal intensity of what areas of cereral cortex is correlated w
mood disorders? (4)
"1. heteromodal association cortex<r />2. Dorsolateral
Prefrontal cortex<div><r />3. Oritofrontal cortex<r />4. ant. cingulate corte
x</div><div><img src=""dlpfc (1).jpeg"" /><img src=""or.jpeg"" /><img src=""ant
.jpeg"" /></div>"
5/14TreatmentDepression1
How is the hippocampus related to depression? Bipolar? hippocampal <u>atrophy</
u> == depression;&nsp;<div>atrophy <u>correlates with duration</u> of depressio
n<r /><r />also fMRI shows <u>less activity</u> in the hippocampus in ipolar
patients</div> 5/14TreatmentDepression1
What chemical marker is used on fMRI to measure neuronal viaility?
N-acetyl
aspartate
5/14TreatmentDepression1
How do antidepressants affect gene expression in the CNS? (2) significant effe
cts:<r /><r />-<u>second messenger</u> systems (cMP)<r />-<u>neurotropins</u
> including BDNF (rain derived neurotropic factor)
5/14TreatmentDepression1
How long does it take for clinical changes when an anti-depressant is given? Wha
t does this mean?
2-3 weeks --&gt; raising the NTs is proaly just a step
along an unknown pathway&nsp;<div>(proaly gene upregulation c the time is a
ppropriate)</div>
5/14TreatmentDepression1
What are the anti-depressant classes? 1. SSRIs&nsp;(Selective Serotonin Reupt
ake Inhiitors)<r />2. SNRIs&nsp;(Serotonin-Norepinephrine Reuptake Inhiitors
)<r />3. SRIs&nsp;(Serotonin ntagonism and Reuptake Inhiitors)<r />4. NDRI
s&nsp;(Norepinephrine-Dopamine Reuptake<div>Inhiitors)</div>5. a2 antagonists<
r />6. TCs<r />7. MOIs
5/14TreatmentDepression1
What side effect is common to all antidepressants in terms of metaolism?
inhiit cP450 --&gt; 2D6, 33, 34 systems
5/14TreatmentDepression1
What are some side effects of SSRIs? 3 1. <u>anxiety</u>, restlessness, sleep d
isturance, nausea, loose stools<r />2.<u> sexual dysfunction</u> or delayed ej
aculation (can e used for ED)&nsp;and anorgasmia in women. loss of liido&nsp
;<r />3. rare <u>serotonin syndrome</u> --&gt; fever, delirium, hyper/hypotensi
on, NM excitation<r /><r />--also headache, tremor, perspiration, dry mouth
5/14TreatmentDepression1
Which is the only SSRI w a half life over 24 hours?
fluoxetine
5/14Trea
tmentDepression1
serotonin discontinuation syndrome
unpleasant non-dangerous nausea, irrita
ility, tearfulness,&nsp;<div>fatigue, dizziness if an SSRI is aruptly stopped
(esides fluoxetine)</div>
5/14TreatmentDepression1
What is the half life of fluoxetine?
2-3 days (weekly formulation availale)<
div>(Most SSRIs 24 hrs)</div> 5/14TreatmentDepression1
fluoxetine
SSRI w a <u>longer half life</u>
5/14TreatmentDepression1
sertraline
<div>SSRI w some <u>dopamine</u> activity (may e useful for <u>
rain injured patients</u>)</div><div><r /></div><div>a sir whose rain is tras
hed should e given Sertraline (used for rain injured pts)</div>
5/14Trea
tmentDepression1
rain injury (dopamine)
Sertraline may e useful for which class of patients?

w depression<div><r /></div><div>a sir whose rain is trashed should e given S

ertraline (used for rain injured pts)</div>
5/14TreatmentDepression1
paroxetine class, sfx <>SSRI</> that is <u>sedating</u> (good for anxiety pa
tients); significant <u>2D6 inhiition</u> and <u>anticholinergic side effects</
u><div><u><r /></u></div><div>imagine treating an <>anxious</> dog (tx anxiet
y disorders) <>salivating</> for water (parotid gland =&gt; parox) ut eats <
>rat toxin</> instead (significant drugdrug interactions)</div>
5/14TreatmentDep
ression1
What class of patients may paroxetine e useful for?
depression + anxiety (ha
s sedative side effect) 5/14TreatmentDepression1
What are some specific side effects of paroxetine? (3) 1. sedation (use for anx
iety patients)<r>2. anti-cholinergic (dry mouth, diploplia, etc.)<r>3. 2D6 inh
iition w drug interactions
5/14TreatmentDepression1
Which suclass of patients is citalopram good for?
patients on lots of medi
cations (has little cP450 effect, few drug interations)<div><r /></div><div>cit
a = appoitment, imagine someone who has multiple appts with a doctor must e rea
lly sick and is on&nsp;multiple drugs, so its usually safe to give them citalo
pram (few drugdrug interactions)</div> 5/14TreatmentDepression1
What is fluvoxamine approved for treating?
OCD (it is an SSRI so also good
for depression)<div><r /><div>imagine someone with a flu, of course you wont g
ive him antiiotics /c Musher taught you well, so remind yourself that Fluvox i
s the odd one in the family that doesnt tx depression ut rather OCD</div></div
>
uproprion class
anti-depressant <u>NDRI</u> which increases dopamine and
NE w <u>fewer side effects than SSRIs</u><div><r /></div><div><>Wellutrin</
> is the only antidepressant that increases D &amp; NE without changing 5HT (so
you can live<> well</> &amp; have a great <>sex life</>). Buproprion reminds
me of <>prion</> =&gt; rain =&gt; seizure, so the one major contraindication
of Buproprion is seizure)</div>
What is main side effect w uproprion? <div>Electrolyte imalance--&gt;increase
d seizure risk</div><div><r /></div><div>always ask aout <u>seizure history</u
> or <u>electrolyte imalances</u></div><div><u><r /></u></div><div><>Wellutr
in</>&nsp;is the only antidepressant that increases D &amp; NE without changi
ng 5HT (so you can live&nsp;<>well</>&nsp;&amp; have a&nsp;<>great sex life
</>). Buproprion reminds me of&nsp;<>prion</>&nsp;=&gt; rain =&gt; seizure
, so the one major contraindication of Buproprion is seizure)</div>
Why is uproprion often given w an SSRI?
can decrease sexual side effects
of SSRI<div>no sexual side effects on its own</div><div><r /></div><div><>Wel
lutrin</> is the only antidepressant that increases D &amp; NE without changi
ng 5HT (so you can live <>well</> &amp; have a <>great sex life</>). Bupropri
on reminds me of <>prion</> =&gt; rain =&gt; seizure, so the one major contra
indication of Buproprion is seizure)</div>
What else esides depression is uproprion good for? (2)
1. smoking cessa
tion<r />2. DHD<div><r /></div><div>with no sexual side effects, after I fin
ish Ill smoke and get fidgity</div>
nefazodone class and action
<u>SRI</u> anti-depressant that <u>locks serot
onin presynaptic reuptake</u> and also <u>antagonizes 5HT2 postsynaptic</u> rece
ptors<div><r /></div><div><i>SRI- serotonin antagonist and reuptake inhiitor<
/i></div><div><i><r /></i></div><div><i><div>Ne<>faz</>odone can&nsp;<>faze
</>&nsp;you out with its impressiveness, it has oth SSRI activity (tx depress
ion) &amp; 5HT2&nsp;locker activity (tx anxiety). Its unfortunate that it carr
ies a lack ox warning of&nsp;<>hepatic failure</>&nsp;so it&nsp;<>fazed<
/>&nsp;itself out of the market instead</div></i></div>
What are the side effects of nefazodone?
1. sedating<r />2. hepatic fail
ure<div><r /><div>Ne<>faz</>odone can&nsp;<>faze</>&nsp;you out with its
impressiveness, it has oth SSRI activity (tx depression) &amp; 5HT2&nsp;locker
activity (tx anxiety). Its unfortunate that it carries a lack ox warning of&
nsp;<>hepatic failure</>&nsp;so it&nsp;<>fazed</>&nsp;itself out of the
market instead</div></div>
venlafaxine class
anti-depressant SNRI (serotonin-norepinephrine reuptake

inhiitor)<div><r /></div><div><>Venting</>&nsp;with&nsp;<>Venla</>faxine
will only increase your BP, grandma! (<>doserelated increased in BP</>)</div>
What are the side effects of venlafaxine, in addition to SSRI effects? 1. <u>in
crease in lood pressure</u><r />2. other SSRI-like side effects (sexual dysfun
ction, anxiety, GI, etc.)<div><r /></div><div><>Venting</>&nsp;with&nsp;<>
Venla</>faxine will only increase your BP, grandma! (<>doserelated increased in
BP</>)</div>
Which patients are good candidates for venlafaxine? (2) 1. numerous medications
(does not effect cP450)<r />2. generalized anxiety disorder<div><r /></div><di
v><r /></div><div>you need to relax with velafax</div>
desvenlafaxine class and use
anti-depressant SNRI (more NE than venlafaxine)<
div><r /></div><div>(D drugs=SNRI)</div>
For whom is desvenlafaxine desirale? "pain conditions such as firomyalgia<di
v><r /></div><div>the only 2 antidepressants that egin with letter&nsp;<>D s
tands for ""Doping away the pain""</>&nsp;(used to relieve&nsp;pain condition
s via controlling the descending pain pathways y increasing 5HT &amp; NE)</div>"
Duloxetine class, use "anti-depressant <u>SNRI</u> which may e good for <u>pa
in</u> (diaetic neuropathic pain, others)<div><r /><div>the only 2 antidepress
ants that egin with letter&nsp;<>D stands for ""Doping away the pain""</>&n
sp;(used to relieve&nsp;pain conditions via controlling the descending pain pat
hways y increasing 5HT &amp; NE)</div></div>"
Which patients is duloxetine good for? "depression + pain<div><r /></div><div>
the only 2 antidepressants that egin with letter&nsp;<>D stands for ""Doping
away the pain""</>&nsp;(used to relieve&nsp;pain conditions via controlling t
he descending pain pathways y increasing 5HT &amp; NE)</div>"
mirtazapine. Mechanism? anti-depressant; locks PRESYNPTIC alpha2 adrenergic au
toreceptors<div><><r /></></div><div><>Mir</>tazapine is a&nsp;<>Mir</>a
cle drug, it is the only one that&nsp;<>locks presynaptic alpha2 receptor&ns
p;</>to increase 5HT&nsp;&amp; NE &amp; it allows edridden dying pts to&nsp;<
>gain weight &amp; sleep etter</>&nsp;(side effects), what a miracle!</div>
What are the side effects of mirtazapine (3)
1. VERY sedating<r />2. anti-hi
stamine = huge weight gain (massive appetite shift)<r />3. agranulocytosis (rar
e, ut still monitor the CBC)<r /><r />--note this is <u>good</u> for patients
who dont want to eat<div><r /></div><div><r /></div><div><>Mir</>tazapine
is a&nsp;<>Mir</>acle drug, it is the only one that&nsp;<>locks presynapti
c alpha2 receptor&nsp;</>to increase 5HT&nsp;&amp; NE &amp; it allows edridden
dying pts to&nsp;<>gain weight &amp; sleep etter</>&nsp;(side effects), wh
at a miracle!</div>
trazodone use <u>rarely</u> used anti-depressant, used for <u>insomnia</u> in
low doses<div><r /></div><div>Trazodone is&nsp;<>NOT</>&nsp;an alpha2 lock
er, ut it is listed here /c like Mirtzapine, Trazodone also&nsp;<>helps inso
mniac pts to sleep etter</>. It is rarely used today &amp; you might get&nsp;
<>tried in court for using Trazodone</>&nsp;(TRZOdone causes PRIpism or pai
nful prolonged erection, it rhymes!)</div><div><r /></div><div>zzzzodoned out=
insomnia tx</div>
What is the major side effect of trazodone?
<u>priapism</u> w potential perm
anent erectile dysfunction<div><r /></div><div>Rarely used</div>
TCs action
anti-depressants which <u>lock reuptake</u> of <u>Ser</u> and <
u>NE</u><r />
What are the side effects of TCs? (3) <u>anticholinergic</u> == dry mounth, l
urred vision, constipation, urinary retention<r /><u>anti-a1</u> == orthostatic
hypotension<r /><u>anti-histamine</u> == sedation, appetite + weight gain<r /
>
What must e done prior to administration of a TC?
"<><font color=""#ff000
0"">EKG</font></> -- TCs may cause elevation of QT interval"
Which anti-depressant is lethal in overdose?
TCs
If a MOI is stopped, how long efore NTs go ack to normal?
2 weeks- irrever
sile inhiition
selegiline class, use MO-B inhiitor used for Parkinsons; &quot;off lael&qu
ot; used for depression

What is the major concern w selegiline? <u>hypertensive crisis</u> --&gt; avoid

tyramine containing foods<div><r /></div><div>(with all MOI)</div>
Patients on selegiline need to e careful aout eating what?
tyramine contain
ing foods --&gt; aged meats and cheeses, tap eers, fava ean pods, yeast extrac
t, sauerkraut, soyeans, pickled herring, etc.
How is postpartum depression diagnosed? Timeframe?
more severe and longer s
adness than the <u>7-10 day postpartum</u> sadness ut <u>within 4 weeks</u>
Do we give anti-depressants to new mothers? Which?
<u>sertraline</u> is pre
ferale since exposure through reast milk is possile
what is the lack ox warning on anti-depressants? give risk % "<div>""increase
d suicidal thinking &amp; ehavior in children &amp; adolescents during the firs
t few months of treatment""</div><>suicidal risk</> --&gt; <>4% </>as oppose
d to 2% placeo in young patients"
How does ECT work?
induces a <u>ilateral generalized tonic-clonic seizure
for 30-90 seconds</u> involving deep rain structures. this induces changes whic
h help depression
What happens in the minute after ECT? postictal suppression on EEG
What NT changes are seen w ECT? 1. down-regulation <u>B-adrenergic receptor</u>s
<r />2. changes <u>serotonin</u> receptors and presynaptic release<div><r />3.
changes <u>cholinergic</u> and <u>dopaminergic</u> systems<r />4. changes in <
u>second messenger systems</u></div>
When is ECT indicated? 1. <>MDD</> == 70% who dont respond to drugs; especia
lly good if suicidal, refuse to eat, psychotic features<r />2. <>manic</> ==
as effective as lithium; good for pregnancy since many of the mania drugs are te
ratogenic<r />3. <>schizophrenia</> == +catatonic or mood symptoms; especiall
y good for malignant catatonia; NOT good for chronic schizophrenia<r /><r />
malignant catatonia. Tx?
form of catatonic schizophrenia for which ECT is
live saving
5/21ThoughtDisorders
What must e checked efore ECT is given?
asically EVERYTHING. full exam
w scans and tests. we are worried aout CV, neurologic, and orthopedic events<di
v><r /></div><div><r /></div><div>Physical exam, lood counts and chemistries,
urinalysis, EKG, chest X-ray, EEG, dental exam for loose teeth, spinal X-rays,
and a CT or MRI of the head</div>
What is the premedication for ECT?
1. <u>muscarinic anticholinergics</u> wh
ich minimize oral secretions, radycardia, asystole<r />2. anesthetics<r />3.
muscle relaxants (ScCh)
How many electrodes are used w ECT?
1 or 2 --&gt; ilateral is etter therap
eutically overall, ut unilateral may prevent early cognitive effects
What are side effects of ECT? 1. headache<r />2. confusion<r />3. delirium<
r />4. some muscle soreness (just increase succinylcholine for tx)<r /><r /><
r />--shortly after seizures and go away
transcranial magnetic stimulation- what happens and where
"new treatment f
or depression --&gt; C on a coil <u>induces a current</u> in the rain in the <
u>DLPFC</u><div><img src=""dlpfc.jpeg"" /></div>"
What part of the rain is targeted w transcranial magnetic stimulation? "Dorsola
teral PFC<div><img src=""dlpfc.jpeg"" /></div>"
deep rain stimulation use? Where does it stimulate?
"highly experimental, on
ly for severe depression. Electrodes go to the sugenual area of anterior cingul
ate cortex (VMPFC)<div><img src=""su.jpeg"" /></div><div><img src=""ant cing.jp
eg"" /></div>"
What is a good treatment for seasonal affective disorder? What is it doing?
light therapy. Bright light supresses <u>human nocturnal melatonin</u>. Light ex
posure to eyes &gt; skin, longer duration = stronger treatment
What are the side effects of light therapy?
headache, eyestrain, nausea, agi
tation
What is a risk factor for neonatal varicella? maternal disease 2-5 days efore
irth Dickey
Found on soil, plants--introduced sucutaneously y trauma (ie rose thorn prick)
.
sporothrix schenckii
fungi fungi_leftoversBrent
Deposit in the lung cavity formed from previous tuerculosis or tumor.&nsp;&ns

p;Hyphae grow within the cavity ut do not invade. Which fungus?
aspergil
lus
fungi fungi_leftoversBrent
Invades lung tissue and loodstream in immunocompromised hosts.&nsp;&nsp;Occlu
des lood vessels and can cause pulmonary infarction. Which fungus?
aspergil
lus
fungi fungi_leftoversBrent
Causes ringworm dermatophytes fungi fungi_leftoversBrent
What are two systemic mycoses endemic to the Mississippi River area?
Histopla
sma capsulatum, astomyces dermatitidis fungi fungi_leftoversBrent
Budding yeasts are found within macrophages in a tissue sample.&nsp;&nsp;
histoplasma capsulatum (this disease is named ecause the fungi are found in his
tiocytes/macrophages) fungi fungi_leftoversBrent
Mycoses endemic to Southwest US coccidioides
fungi fungi_leftoversBrent
MCC of fungal meningitis
crytococcus neoformans MCC fungi fungi_leftover
sBrent
Used to e the numer one opportunistic infection in IDS patients, ut TMP-SMX
prophylaxis has limited this
pneumocystis jirovecii fungi
 man from Missouri develops weakness and night sweats.&nsp;&nsp;His physician
notes sores on the patients skin. Biopsy of the skin lesions reveals road-as
lastomyces dermatitidis
ed udding yeast.
case fungi fungi_leftove
rsBrent
Causes yeast infection in women candida fungi
Is normal flora in mucous memranes of respiratory, GI, and female genital tract
s.&nsp;&nsp;Overgrowth may occur in warm moist areas and cause: oral thrush, v
aginitis, rash under reasts. candida fungi
Found in at or ird droppings.&nsp;&nsp;&quot;Hides&quot; within macrophages
histoplasma capsulatum fungi fungi_leftoversBrent
&quot;Valley fever&quot;; found in SW United States
coccidioides
fungi fu
ngi_leftoversBrent
Proximal suungual infection is seen in individual with what underlying disease?
fungi fungi_leftoversBrent
IDS
Scaling and irritation of the groin.&nsp;&nsp;Young male athletes.&nsp;&nsp;
Well demarcated order tinea cruris (jock itch)
fungi fungi_leftoversBre
nt
Septate hyphae that ranch at acute angles.&nsp;&nsp;Powdery colonies.
spergillus
fungi fungi_leftoversBrent
Septate, acute angles, angioinvasive
aspergillus
fungi fungi_leftoversBre
nt
"Which fungus?<r /><img src=""58_aspergillus.png"" />"
aspergillus <r
/><r />(58_aspergillus)
fungi fungi_leftoversBrent pictures
Farmer is feeding hay to his horses and is exposed to a large amount of antigen.
&nsp;&nsp;4-8 hours later gest malaise, fever, chills, SOB.&nsp;&nsp;Self li
mited allergic alveolitis (hypersensitivity pneumonia)
case fungi fungi
_leftoversBrent
Colonization in a patient with underlying asthma/lung disease.&nsp;&nsp;Result
s in eosinophilia, fleeting lung infiltrates
allergic ronchopulmonary asperg
illosis (BP) fungi fungi_leftoversBrent
Round or oval mass on a stalk within a cavity.&nsp;&nsp;Crescent sign oserved
aspergilloma (fungus all)
fungi fungi_leftoversBrent
Fungal infection seen in diaetics with ketoacidosis
rhinocereral mucormycos
is (mucorales) fungi fungi_leftoversBrent
"Patient is diaetic w/ ketoacidosis.&nsp;&nsp;What does he have ased on this
clinical picture?<r><img src=""59_rhinocereral.png"" />"
rhinocereral mu
cormycosis<r /><r />(59_rhinocereral)
fungi fungi_leftoversBrent pictu
res
"Broad, irregular, non-septate hyphae that ranch at right angles.<r /><img src
=""60_mucorales.png"" />"
mucorales<r /><r />(60_mucorales)
fungi fu
ngi_leftoversBrent pictures
Red pigment in SE sia IDS patient
penicillium marneffei fungi fungi_left
oversBrent
Farmer who develops fever, chills, and cough after moving hay allergic alveoli

tis (aspergillus)
fungi fungi_leftoversBrent
Dimorphic road ased uds. Fungus
Blastomyces dermatitidis
fungi fu
ngi_leftoversBrent
Epidemiology: soil in wooden environment.&nsp;&nsp;OH and MS River valleys; as
sociated with eavers
lastomyces dermatitidis
fungi fungi_leftoversBre
nt
Spherules w/ endospores seen on microscropy.&nsp;&nsp;Found in SW US Coccidio
ides
fungi fungi_leftoversBrent
Risk factors for this fungal infection: dark-skinned, immunocompromised, pregnan
t
coccidioides
fungi fungi_leftoversBrent
Causes asilar meningitis.&nsp;&nsp;Diagnosed y seeing spherule w/ endospores
coccidioides
fungi fungi_leftoversBrent
"Which fungus is endemic to this region?<r /><img src=""51_coccidioides.png""
/>"
coccidioides<r /><r />(51_coccidiodes)
fungi fungi_leftoversBre
nt pictures
"Which fungus is displayed here?<r /><img src=""61_coccidioides.png"" />"
coccidioides<r /><r />(61_coccidioides)
fungi fungi_leftoversBrent pictu
res
ged pigeon droppings; meningoencephalitis
cryptococcus neoformans fungi fu
ngi_leftoversBrent
Spelunking is a risk factor
histoplasma capsulatum fungi fungi_leftoversBre
nt
"Large polysaccharide capsule that stains pink with mucicarmine. Thin ased ud<
r /><img src=""62_crytococcus.png"" />"
crytococcus neoformans<r /><r
/>(62_crytococcus)
fungi fungi_leftoversBrent pictures
Gardener traumatically inoculates elow skin
sporothrix schenckii
fungi fu
ngi_leftoversBrent
"Got a splinter.&nsp;&nsp;Which fungus?<r /><img src=""63_sporothrix.png"" /
>"
sporothrix schenckii<r /><r />(63_sporothrix)
fungi fungi_left
oversBrent pictures
"These are cigar shaped.<r /><img src=""64_sporothrix.png"" />"
"Sporoth
rix schenckii<r /><div><r /></div><div><img src=""paste-107344117629399.jpg""
/></div>"
Dickey fungi pictures
"ppearance is &quot;captains wheel&quot;.&nsp;&nsp;Found geographically in C
entral and South merica<r /><img src=""65_paracoccidioides.png"" />" paracocc
idioides<r /><r />(65_paracoccidioides)
fungi fungi_leftoversBrent pictu
res
Foamy eosinophilic alveolar exudate.&nsp;&nsp;Disease depends on cellular immu
nity--HIV pts w/ CD4 &lt; 200 at risk for disease.&nsp;&nsp;Fungal. pneumocy
stis jiroveci (PCP pneumonia) fungi
Causes painful swallowing and dysphagia (difficulty swallowing) in immunocomprom
ised hosts.
candida fungi
Thick vaginal discharge (cottage cheese) and itching. "vaginitis (Candida)<div
><img src=""vaginitis.jpeg"" /></div>" fungi
Causes intertrigo (where skin folds touch) under reasts.
"candida<div><im
g src=""fat.jpeg"" /></div>"
fungi
ssRN genome and is segmented. Common. influenza virus influenza
Immunity to influenza is related to antiodies against what memrane protein?
hemagglutinin influenza
Enzymatic activity is necessary for release of the virion from the surface of an
infected cell.&nsp;&nsp;What enzyme is this? Which virus?
"neuraminidase;
influenza virus<r /><img src=""NI.jpeg"" />" influenza pictures
Serves as a proton channel for the influenza virus.
M2 protein
influenz
a
Mild viral pneumonia following influenza? Risk factors for extensive pneumonia?
primary influenza virus pneumonia (major risk factors for the extensive pneumoni
a are underlying <u>heart or lung disease</u>) mortality of extensive is 50%
influenza
What acteria is implicated in mixed viral-acteria pneumonia of influenza?
S. aureus
influenza

What acteria is implicated in post influenza acteria pneumonia?

S. pneum
oniae influenza
What the term for a MJOR shift change in the hemagglutinin or neuraminidase of
influenza?
antigenic shift (all human populations are susceptile; arises f
rom reassortment of genes from avian or animal viruses) influenza
What is the term from MINOR changes in the hemagglutinin or neuraminidase of inf
luenza? antigenic drift (proportion of population is susceptile)
influenz
a
Highest illness rates of influenza are in what age group?
school aged chil
dren
influenza
Highest hospitalization rates due to influenza are in what age groups? very you
ng and very old influenza
Highest mortality rates due to influenza are in what age group? geriatric age gr
oup
influenza
What are two antivirals for influenza that target M2? amantadine, rimantadine;
NOTE: only works for  strains, not B ID_pharm influenza
What are antivirals for influenza that target neuraminidase? Effective against <
Zanamivir (nasal spray), Oseltamivir (oral- etter for k
>what strains</>?
ids); NOTE: works for <>oth</> type  and B influenza viruses
ID_pharm
influenza
This influenza enzyme promotes the release of virions from infected cells and th
us prevents the formation of viral aggregates. neuraminidase influenza
What are influenza vaccine recommendations in terms of age?
all persons exce
pt children &lt;6 months of age influenza
"<img src=""67_virusQ.png"" />"
nswer = C<r /><r />(67_virusQ)
classQ
nswer = D<r /><r />(68_virusQ)
"<img src=""68_virusQ.png"" />"
classQ
"<img src=""69_virusQ.png"" />"
nswer = C<r /><r />(69_virusQ)
classQ
nswer = D<r /><r />(70_virusQ)
"<img src=""70_virusQ.png"" />"
classQ
Which influenza virus type causes the common cold?
influenza <>C</>= <>C
</>ommon
influenza
H and N undergo antigenic variation, allowing new outreaks resistant to previ
ous vaccinations. Which virus is eing descried?
influenza virus influenz
a
Occur aout every 20 years--exchange of RN segments etween human and animal vi
ruses.&nsp;&nsp;Radically new H or N acquired resulting in pandemics.
antigenic shifts (influenza virus)
influenza
Occur every year--spontaneous mutations resulting in slightly altered H or N.&
nsp;&nsp;Causes endemic infections. antigenic drifts (influenza virus)
influenza
The two influenza sutypes that are not responsive to amantadine and rimantadine
influenza B and C<div><r /></div><div>(M2 are only effective against !)</div>
influenza
Causes erythema infectiosum, arthropathy, and transient aplastic crisis parvovir
us B19 5/16DickeyCantnki 5/16PoxandFriends B19 Dickey
Can cause congestive heart failure in infant after crossing the placenta
parvovirus B19 5/16DickeyCantnki 5/16PoxandFriends B19 Dickey
"Notice the cheeks.&nsp;&nsp;What virus causes this?<r /><img src=""71_slapp
edcheeks.png"" />"
"parvovirus B19 (this is erythema infectiosum --&gt; sla
pped cheeks)<div><r /></div><div><img src=""paste-506011571978719.jpg"" /></div
>"
5/16DickeyCantnki 5/16PoxandFriends B19 Dickey pictures
nswer = B
"<img src=""73_questionB19.png"" />"
5/16DickeyCantnki 5/16P
oxandFriends B19 Dickey classQ
Which virus? Erythema is called &quot;fifth disease&quot; ecause it is one of t
he five most common pediatric diseases with rash.
"parvovirus B19<div><r
/></div><div><img src=""paste-506011571978719.jpg"" /></div>" 5/16DickeyCantn
ki 5/16PoxandFriends B19 Dickey

Virus infects and lyses erythroid precursor cells in the one marrow.&nsp;&nsp
;Immune complexes form and deposit causing rash with slapped cheek appearance
parvovirus B19 5/16DickeyCantnki 5/16PoxandFriends B19 Dickey
"Vesiculopustular rash with residual scarring.&nsp;&nsp;Which virus?<r /><img
src=""74_smallpox.png"" />" smallpox
5/16DickeyCantnki 5/16PoxandFri
ends 5/16PoxnFriends Dickey pictures poxvirus
"Immunization against this virus requires multiple punctures using a ifurcated
needle.<r /><img src=""75_smallpoxvaccine.png"" />" smallpox
5/16Dick
eyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey pictures poxvirus
"Causes umilicated papules.<r /><img src=""76_molluscum.png"" />"
"mollusc
um contagiosum<r /><r /><img src=""paste-513536354681102.jpg"" />"
5/16Dick
eyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey pictures poxvirus
"<img src=""77_question.png"" />"
nswer = D<r /><r />(77_question)
classQ
"Binds to host cells via the CR-inding domain on the kno at the end of the fi
er.<r /><img src=""78_adenovirus.png"" />" "adenovirus<div><r /></div><div
><img src=""paste-512157670179286.jpg"" /></div>"
5/16DickeyCantnki 5/16P
oxandFriends 5/16PoxnFriends Dickey adenovirus
Clinical manifestations of this virus are predominantly respiratory (ie URI, pha
ryngitis, pneumonia), ocular (ie keratoconjunctivitis), gastroenteritis, and hem
orrhagic cystitis.
"adenovirus<div><img src=""paste-512157670179286.jpg"" /
></div>"
5/16DickeyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey aden
ovirus
"What causes this keratoconjunctivitis?<r /><img src=""79_keratoconjunct..png"
" />" "adenovirus<div><r /></div><div><img src=""paste-512157670179286.jpg""
/></div>"
5/16DickeyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey aden
ovirus
n oral live virus vaccine (serotypes 4 &amp; 7) was approved in 2011.&nsp;&ns
p;pproved for prevention of acute respiratory disease in military recruits
"adenovirus<div><r /></div><div><img src=""paste-512157670179286.jpg"" /></div>
"
5/16DickeyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey adenovirus
nswer = D<r /><r />(80_adenovirusQ)
"<img src=""80_adenovirusQ.png"" />"
classQ
This virus is a potential vector for gene therapy.&nsp;&nsp;Serotypes 4 &amp;
7 are currently used to vaccinate military recruits.
adenovirus
5/16Dick
eyCantnki 5/16PoxandFriends 5/16PoxnFriends adenovirus
Most commonly sexually transmitted virus.&nsp;&nsp;Has a tropism for epithelia
l cells.
papillomavirus HPV
Causes warts (cutaneous, genital) and epithelial neoplasia (ie laryngeal, cervic
al, esophageal) "papillomavirus<div><r /></div><div><img src=""paste-5137382181
44209.jpg"" /></div>" 5/16DickeyCantnki 5/16PoxandFriends Dickey HPV
Which HPV types are most frequent causes of cancer?
types 16 &amp; 18
HPV
Which HPV types are associated with anogenital condylomas and laryngeal papillom
as?
"types 6 &amp; 11<div><r /></div><div><img src=""paste-513901426901347.
jpg"" /></div>" 5/16DickeyCantnki 5/16PoxandFriends Dickey HPV
This virus is tropic for oligodendrocytes.&nsp;&nsp;Produces progressive multi
focal leukoencephalopathy and/or ureteral stenosis
"polyomavirus (JC)<div><
r /></div><div><img src=""paste-511663748940263.jpg"" /></div>"
5/16Dick
eyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey polyomavirus
Symptoms incude: cognitive changes, hemiparesis, gait anormalities, speech impa
irment (ie aphasia), visual impairment.&nsp;&nsp;What does he/she have <>and<
/> what virus causes it?
"progressive multifocal leukoencephalopathy (PML
); caused y JC virus<div><r /></div><div><img src=""paste-514034570887655.jpg"
" /></div>"
5/16DickeyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey poly
omavirus
"<img src=""81_BKquestion.png"" />"
nswer = <r /><r />(81_BKquestion)
classQ
"Patient presents with cognitive and speech defects, visual defects, and gait a
normalities.&nsp;&nsp;Histopathology shows inclusions.&nsp;&nsp;Which virus?

<r /><img src=""82_PMLinclusions.png"" />"

"JC virus; person has PML<div><
r /></div><div><img src=""paste-514030275920359.jpg"" /></div>" 5/16DickeyCantn
ki 5/16PoxandFriends 5/16PoxnFriends Dickey pictures polyomavirus
 virus that causes the common cold was exposed to acid and lost its infectivity
.&nsp;&nsp;Which virus is it? rhinovirus (its acid laile) 5/14Picornavirus
es picornavirus
Most common cause of aseptic meningitis.&nsp;&nsp;<>CSF shows high lymphocyte
s, normal glucose</> enteroviruses 5/14Picornaviruses MCC picornavirus
"cute onset of fever, severe headache, nausea, vomiting with presence of a stif
f neck due to paraverteral muscle spasm. Most commonly seen in children.&nsp;&
nsp;Spinal fluid exhiits increased numers of mononuclear cells and normal glu
cose.&nsp;&nsp;What does this individual have and what virus causes it? How to
distinguish from <font color=""#ff0000"">acterial</font>?"
"aseptic meningi
tis (most commonly caused y enteroviruses)--NOTE: <font color=""#ff0000"">acte
rial</font> meningitis usually has <font color=""#ff0000"">low glucose</font>"
5/14Picornaviruses picornavirus
Can cause aseptic meningitis ut shows a unique cellular preference for the ante
rior horn cells of the spinal cord
paralytic poliomyelitis (due to poliovir
us)
5/14Picornaviruses picornavirus
Causes flaccid paralysis.&nsp;&nsp;Risk increases with age, pregnancy, tonsill
ectomy, and excessive exercise.&nsp;&nsp;Which virus? paralytic poliomyelitis
(due to poliovirus)
5/14Picornaviruses picornavirus
"Which virus caused this girls muscle wasting?<r /><img src=""83_poliomyeliti
s.png"" />"
poliovirus
5/14Picornaviruses picornavirus pictures
"What virus caused this mans focal paralysis and muscle wasting?<r /><img src=
""84_poliovirus.png"" />"
poliovirus
5/14Picornaviruses picornavirus
pictures
Which enterovirus causes myocarditis &amp; pericarditis?
coxsackie B<div>
<r /></div><div>B looks like a heart &lt;3</div>
5/14Picornaviruses picor
navirus
 woman in India complains of fever, muscle pains, and weakness of her trunk, a
domen, and legs.&nsp;&nsp;This morning, she notes difficulty in swallowing and
neck pain.&nsp;&nsp;Physical exam reveals fasciculations and flaccid paralysi
s of the lower lims and trunk.&nsp;&nsp;Breathing seems to e trouled.&nsp;
&nsp;CSF analysis reveals lymphocytosis, PMNs, and normal glucose.&nsp;&nsp;
poliovirus
5/14Picornaviruses case picornavirus
Binds receptors of anterior horn motor neurons--replicates, lyses motor neurons
innervating distal muscles and proximal muscles.&nsp;&nsp;Which virus?
poliovirus
5/14Picornaviruses picornavirus
Patient presents with chest pain, cardiac friction ru, and ST elevation through
out on his EKG.&nsp;&nsp;&nsp;Physician diagnoses pericarditis.&nsp;&nsp;Wh
ich picornavirus causes this? coxsackie B
5/14Picornaviruses picornavirus
Young man presents with chest pain, dyspnea, and early signs of heart failure.&n
sp;&nsp;His history shows that he had an URI 3 weeks ago.&nsp;&nsp;Examinati
on reveals tachycardia and an S3 gallop, while ECG shows evidence of a conductio
n defect with nonspecific ST changes.&nsp;&nsp;Doctor makes a viral diagnosis-what is is?
coxsackie B
5/14Picornaviruses picornavirus
Causes viral pericarditis, myocarditis, and pleurodynia.
coxsackie B
5/14Picornaviruses picornavirus
Two viruses that cause ferile exanthems and enanthems. Enterovirus--&gt;coxsack
ie  and echovirus
5/14Picornaviruses picornavirus
Primary virus causing hand-foot-mouth disease coxsackie 
5/14Picornavirus
es picornavirus
True or false: all enteroviruses cause acute upper and lower respiratory disease
.
true
5/14Picornaviruses picornavirus
"This is hand-foot-mouth disease. What causes it?<r /><img src=""85_handfootmo
uth.png"" />" coxsackie  (predominantly)
5/14Picornaviruses picornavirus
pictures
Virus that causes 50% of common colds. rhinovirus
5/14Picornaviruses picor
navirus

Primarily causes herpangia and hand-foot-mouth disease. "coxsackie <div><img sr

c=""herpangina.jpeg"" /></div>" 5/14Picornaviruses picornavirus
"Vesicles on hands, feet, and mouth and typically occurs in young children. Whic
h <font color=""#ff0000"">disease </font>and&nsp;virus?"
hand-foot-mouth
disease (from coxsackie )
5/14Picornaviruses picornavirus
"What causes this?<r /><img src=""86_herpangia.png"" /><img src=""87_herpangi
a.png"" />"
coxsackie  (this is herpangina)
5/14Picornaviruses picor
navirus pictures
"What virus is predominatly responsile for this herpangina?<r /><img src=""87
_herpangia.png"" />"
coxsackie  <r /><r />(87_herpangia) 5/14Picornavirus
es picornavirus pictures
"This is hemorrhagic conjunctivitis.&nsp;&nsp;What two enteroviruses are impli
cated?<r /><img src=""88_hemorrconjunct.png"" />"
coxsackie  an (enterovi
rus)
5/14Picornaviruses picornavirus
Patient presents with fever, malaise, nausea, and anorexia.&nsp;&nsp;Patient h
as tender enlarged liver and is slightly jaundiced.&nsp;&nsp;Liver function te
sts show enzyme and iliruin elevations.&nsp;&nsp;Patient eventually makes a
full recovery in 4 to 10 weeks. hepatitis  virus
5/14Picornaviruses case
hepatitis picornavirus
 oy scout troop master calls the doctor asking aout symptoms that have develo
ped in several of his scouts shortly after a camping trip.&nsp;&nsp;The oys c
omplain of fever, nausea, loss of appetite, and vomiting.&nsp;&nsp;The scout m
aster also notes a yellow hue in some of the oys, especially visile in their e
yes.&nsp;&nsp;Their urine is noted to e dark and their feces pale.&nsp;&nsp
;Liver enzyme assays reveal elevated LT and ST levels.&nsp;&nsp;Physicians c
onfirms the diagnosis with an assay of serum IgM and then assures the oys that
the illness will completely go away in several weeks. hepatitis  virus
5/14Picornaviruses case hepatitis picornavirus
cquired y ingestion usually from contaminated food or water.&nsp;&nsp;Virus
spreads to the liver where growth of the virus occurs in hepatocytes.&nsp;&nsp
;It eventually resolves several weeks later.
hepatitis  virus
5/14Pico
rnaviruses hepatitis picornavirus
How is hepatitis  diagnosis made?
detection of anti-HV IgM antiody
5/14Picornaviruses hepatitis picornavirus
Recently joined the enterovirus genus.&nsp;&nsp;Infects respiratory epithelium
and its most common clinical syndrome is the cold (upper respiratory illness).
rhinovirus
5/14Picornaviruses MCC picornavirus
Most common respiratory virus isolated.&nsp;&nsp;Estimated average of 1 infect
ion per person per year.&nsp;&nsp;
rhinovirus
5/14Picornaviruses MCC p
icornavirus
"<img src=""89_question.png"" />"
nswer = C<r /><r />(89_question)
classQ
nswer = C<r /><r />(90_question)
"<img src=""90_question.png"" />"
classQ
"<img src=""91_question.png"" />"
nswer = <r /><r />(91_question)
classQ
nswer = D<r /><r />(92_question)
"<img src=""92_question.png"" />"
classQ
"<img src=""93_question.png"" />"
nswer = D<r /><r />(93_question)
classQ
What time of the year is rhinovirus most prevalent?
"prevalent seasons are <
u>fall</u> and <u>spring</u><r /><img src=""94_rhinovirus.png"" /><r />"
5/14Picornaviruses picornavirus
9 yr old girl was rought to TCH ER on 7/24 ecause of 2 days of fever and sever
e H.&nsp;&nsp;She had vomited twice. Her temp was 103.8 F.&nsp;&nsp;Her PE
was negative except for a stiff neck.&nsp;&nsp;The U and lood counts were nl
.  LP revealed nl glucose, slightly elevated protein and 125 lymphocytes per mm
3
aseptic meningitis (from enterovirus) 5/14Picornaviruses case picornav
irus
"4 yr old oy was rought to TCH ER on 8/9 ecause of high fever and rash.&nsp;

&nsp;His temp was 103.6 F.&nsp;&nsp;He looked ill ut his PE was negative exc
ept for a maculopapular red rash scattered on his ody (mostly his trunk).  U
and lood count were nl. Which <font color=""#ff0000"">disease</font> and virus?
"
acute ferile exanthem (likely from <u>enterovirus</u>- Cox , Echo)
5/14Picornaviruses case picornavirus
24 yr old truck driver came to the office with c/o fever, weakness, SOB that had
developed over sevl days.&nsp;&nsp;PE = temp 100.4 F, pulse 118, BP 96/80.&ns
p;&nsp;He had distended neck veins, rales at oth lung ases, and an S4. CXR sh
ows cardiomegaly and EKG shows NS ST-T changes. acute myocarditis (coxsackie B v
irus) 5/14Picornaviruses case picornavirus
Your 33 yr old secretary come to work on 9/12 saying she had caught a cold over
the weekend form her 10 yr old son.&nsp;&nsp;She c/o slight H, scratchy throa
t, mod. nasal ostruction and sign. watery rhinorrhea.&nsp;&nsp;Temp 99.4 F; f
requent sneezing &amp; constant sniffing.&nsp;&nsp;You send her home ecause h
er cold could e ad for your patients. common cold (proaly due to rhinovirus)
5/14Picornaviruses case picornavirus
 report on TV says a hepatitis outreak has een traced to raw oysters at a loc
al seafood restaurant.&nsp;&nsp;You ate raw oysters there at aout that time a
nd you missed work for 2 days with fever, nausea, and vomiting.&nsp;&nsp;You s
ee your physician, who after an exam and lood test tells you that you have acut
e hepatitis.
hepatitis  virus
5/14Picornaviruses case hepatitis picorn
avirus
What makes a virus a retrovirus?
reverse transcription that leads to inse
rtion of viral DN into the host DN and estalishes a latent, life-long infecti
on
5/27HIVRetroRD HIV
For HIV infection to occur, the virion gp120 inds to a CD4 receptor and one of
2 co-receptors.&nsp;&nsp;What are they?
"CCR5 or CXCR4<r /><img src=""
95_HIVinfection.png"" /><r />(95_HIVinfection)"
5/27HIVRetroRD HIV pictu
res
Persons lacking _____ receptor have relative resistance to HIV infection.
CCR5 (need oth deletions)
5/27HIVRetroRD HIV
Long-lived cells (ie memory, monocytes, dendritic cells) serve as cellular reser
voirs for virus and are the reason why we cant eliminate this infection.&nsp;&
nsp;Which infection? HIV
5/27HIVRetroRD HIV
Whats the prevalence of HIV in the US?
0.6%
5/27HIVRetroRD HIV
True or false: 25% of people with HIV do not know they are infected.
True
5/27HIVRetroRD HIV
Whats the prevalence of HIV in su-saharan frica?
6%
5/27HIVRetroRD H
IV
Whats the prevalence of HIV in South frica? 16% (not considered su-saharan)
5/27HIVRetroRD HIV
Whats the prevalence of HIV in Washington DC? 2-3%
5/27HIVRetroRD HIV
How are most males infected with HIV? "male-to-male sexual contact (77%)<div><
img src=""receptive.jpeg"" /></div>"
5/27HIVRetroRD HIV
How are most females infected with HIV? "heterosexual contact (86%)<div><img src
=""86.jpeg"" /></div>" 5/27HIVRetroRD HIV
Which minority populations are disproportionately affected y HIV in the US?
"lacks (theyre aout 50% of persons with HIV)<div><img src=""lacl.jpeg"" /></
div>" 5/27HIVRetroRD HIV
"<img src=""96_HIV.png"" />"
nswer = B; the higher the viral load the more l
ikely the transmission<r /><r />(96_HIV)
classQ
Transmission of HIV is directly related to what factor? viral load
5/27HIVR
etroRD HIV
True or false: HIV positive women in developed countries should not reast feed.
true; developing countries follow different programs
5/27HIVRetroRD HIV
What are the characteristic symptoms of acute retrovirus syndrome?
main one
s = fever, rash, lymphadenopathy, pharyngitis; its descried as a <i><>mononuc
leosis-like illness</></i>
5/27HIVRetroRD HIV
Whats the definition of IDS in terms of CD4 count?
CD4 &lt;200
5/27HIVR
etroRD HIV

Where is HIV 2 mainly found in the world?

West frica
5/27HIVRetroRD H
IV
How does standard enzyme immunoassay (EI) work for testing for HIV?
"HIV ant
igens on a surface, add patients serumif anti HIV as present they will ind the s
urface.&nsp;&nsp;Then enzyme laelled antihuman IgG addedif they attach human 
s they will change color and give a positive reaction<div><img src=""sampl.jpeg
"" /></div>"
5/27HIVRetroRD HIV
Western lot is used to confirm EI HIV diagnosis.&nsp;&nsp;How does the Weste
rn lot work? "viral proteins lotted onto a strip of paper and separated into
ands with an electric current.&nsp;&nsp;dd patients serum.&nsp;&nsp;If pat
ient has HIV, they will have antiodies that ind the viral proteins.&nsp;&nsp
;These antiodies are detected y adding anti-human antiodies linked to an enzy
me<div><img src=""97_westernlot.png"" /></div>"
5/27HIVRetroRD HIV
If enzyme immunoassay (EI) test for HIV is reactive, what is the next step for
diagnosis?
"confirmatory test is done with a Western lot<r /><img src=""
97_westernlot.png"" /><r />(97_westernlot)<r />" 5/27HIVRetroRD HIV
True or false: Prevention of nosocomial HIV transmission one should avoid situat
ions that put you at risk when handling lood filled needles. true
5/27HIVR
etroRD HIV
"Which one has HIV? ie which lane?<r /><img src=""97_westernlot.png"" />"
Lane C (we see ands at p24, gp120/160, also p55); lane  is negative, lane B is
indeteriminate; lthough patient B may have antiodies directed against p24, p6
6 and p55, the serum contains no antiodies against HIV envelope glycoproteins,
gp160, 120. Therefore this test is indeterminate for patient B. Patient C is HIV
positive ecause the serum shows reactivity to gp160, 120, p24, 66 and 55
5/27HIVRetroRD HIV pictures
nswer = D<r /><r />(98_HIVtesting)
"<img src=""98_HIVtesting.png"" />"
classQ
True or false: CD4 count is the most important marker for determining prognosis
and the immune status of a patient regarding their HIV infection.
true
5/27HIVRetroRD HIV
What happens if you get a positive EI ut a negative viral load and negative We
stern lot? Does it necessarily mean its a false positive EI? It could e HIV
2 that the patient has.&nsp;&nsp;Recall that the EI may detect oth HIV 1 and
HIV 2 ut <u>Western lots are specific for HIV 1</u>--also HIV 1 <u>viral load
misses HIV 2</u>.&nsp;&nsp;Therefore, we need to know if the patient has een
to West frica or een in contact with someone from West frica
5/27HIVR
etroRD HIV
nswer = D; CD4 isnt diagnostic<r /><
"<img src=""99_HIVquestion.png"" />"
r />(99_HIVquestion) classQ
"Patient had unprotected sexual encounter with partner of unknown HIV status 5 m
onths ago.&nsp;&nsp;She is worried of HIV infection. 2 weeks after the encount
er her HIV ELIS was negative. She has een asymptomatic and has een astinent
since. She is still worried. Which test would you order now.<r /><img src=""10
0_HIVquestion.png"" />" D
5/27HIVRetroRD HIV case classQ
"Student is drawing lood for lood cultures and&nsp;&nsp;accidentally punctur
es him/herself with the needle.&nsp;&nsp;Patient has a CD4 of 14 and HIV 1 vir
al load of &gt;750,000. Which of the following will not e an appropriate next s
tep? <r /><img src=""101_HIVquestion.png"" /><r />" nswer = B<r /><r />(
101_HIVquestion)
5/27HIVRetroRD HIV case classQ
True or false: children have on average 3 to 8 colds per year. true--children a
re the main reservoir of respiratory viruses<div><r /></div><div>adults have 1/
2 this</div>
5/14URIs URI URIDickey
Name 3 common viruses that cause the common cold.
<>Rhinovirus </>(100 t
ypes), coronavirus, parainfluenza virus<div><r /></div><div><div>Etiology:&nsp
;</div><div>Rhinovirus (responsile for aout ~50% of colds)</div><div>RSV, infl
uenza, parainfluenza, coronavirus, ocavirus</div><div>denovirus, enterovirus</
div><div><r /></div><div>&nsp;</div><div>Symptoms: nasal congestion, sneezing,
rhinorrhea, sore throat, cough, fever (more commonly in infants)</div></div><di
v><r /></div><div><r /></div> 5/14URIs URI URIDickey

Do you treat the common cold with antiiotics? No, its usually caused y a vir
us
5/14URIs URI URIDickey
How does the clinical presentation of common cold differ etween children and ad
ults? <div><r /></div><div>&nsp;&nsp;<u>Few adult patients have fever.</u><
/div><div><r /></div><div><r /></div>nasal discharge and ostruction, sneezing
, sore or scratchy throat, malaise, headache, cough, myalgias.<div><r /></div>
5/14URIs URI URIDickey
Purulent infection of the mucosal lining of one or more of the paranasal sinuses
.&nsp;&nsp;Usually follows rhinitis due to viral infection (theres een disru
ption of the normal mucociliary clearance mechanisms and thus acterial invasion
occurs)
sinusitis
5/14URIs URI URIDickey
Clinical manifestations: facial pain, purulent nasal drainage, headache, cough.&
nsp;&nsp;<>Tenderness over sinus</> sinusitis
5/14URIs URI URIDickey
Whats the est way to prevent the common cold? hand hygiene
5/14URIs URI URI
Dickey
Causes pharyngitis in young infants.
respiratory viruses
URI
Causes pharyngitis in older children and adolescents. Two likely possiilities.
adenovirus or EBV and group  strep
5/14URIs URI URIDickey
"True or false: The asence of purulent exudate on the tonsils does not rule out
a acterial infection. The presence of exudate does not rule in a acterial inf
ection<r /><img src=""102_pharyngitis.png"" /><div><r /></div><div><img src="
"paste-717822179148062.jpg"" /><r /><div><r /></div></div>" True; aove is g
roup  strep causing pharyngitis<div><r /></div><div>Below is EBV (mono)</div>
5/14URIs URI URIDickey pictures
"Causes pharyngitis and this sand paper rash.<r /><img src=""103_grouprash.pn
g"" />" group  strep 5/14URIs URI URIDickey pictures
"Is eta-hemolytic, causes pharyngitis, and sand paper rash.<r /><img src=""10
4_etahemolytic.png"" />"
group  strep<r />
5/14URIs URI URIDickey p
ictures
Name virus infection with purulent tonsilar exudate
"<u>EBV has exudate</u><
r /><img src=""105_EBV.png"" /><img src=""EBV.jpeg"" />"
5/14URIs URI URI
Dickey
Is this caused y group  strep or coxsackie pharnygitis? cute onset of fever,
sore throat, headache, anorexia, nausea, vomiting, no coryza
group  strep (t
heres no nasal congestion in group ) 5/14URIs URI URIDickey
Whats the illness? Presents with hoarseness and aphonia.
laryngitis
5/14URIs URI URIDickey
"Diagnose this patient.<r /><img src=""106_steeplesign.png"" /><div><r /></di
v><div><r /></div>"
"""croup"" laryngotracheitis; notice the steeple sign<di
v><r /></div><div><img src=""paste-603610408813010.jpg"" /></div>"
URI pict
ures
"Diagnose this young patient.<r /><img src=""107_steeplesign.png"" />"
"""<u>croup</u>"" larnygotracheitis; notice the steeple sign" 5/14URIs URI URI
Dickey pictures
2 y/o presents with croupy cough followed y inspiratory stridor.&nsp;&nsp;P
and lateral imaging of the neck helps to distinguish it from epiglottitis y sho
wing steeple sign.
"""croup"" laryngotracheitis<div><img src=""steeple.jpeg
"" /></div>"
5/14URIs URI URIDickey
What is the etiology of Croup? Season? Parainfluenza types 1 and 2<div><r /></
div><div>Fall: Parainfluenza 1, 2</div><div>Spring: parainfluenza 3</div>
5/14URIs URI URIDickey
Patient presents with a history of URI in the preceding 1-2 weeks followed y an
acute rapid deterioration.&nsp;&nsp;High fever and severe respiratory distres
s.&nsp;&nsp;What does he/she have?
"acterial tracheitis<div><r /></div><d
iv>(lmost always preceded y a viral infection that leads to mucosal damage)</d
iv><div><r /></div><div><img src=""paste-718934575677792.jpg"" /></div>"
5/14URIs URI URIDickey
This illness is extremely rare since the institution of H. influenza immunizatio
n in 1988.
epiglottitis
5/14URIs URI URIDickey
ntecedent URI followed y an arupt onset of fever, drooling, respiratory distr

ess.&nsp;&nsp;Rare these days.

"epiglottitis<div><img src=""thum.jpeg"
" /></div>"
5/14URIs URI URIDickey
"What rare condition does this person have?<r /><img src=""108_epiglottitis.pn
g"" />" epiglottitis
5/14URIs URI URIDickey pictures
Ear itches and is painful with purulent drainage. What illness? otitis externa
5/14URIs URI URIDickey
Patient presents with ear that is edematous and erythematous around the external
auditory canal.&nsp;&nsp;Theres pain with manipulation of the pinna, itching
of the canal, and purulent drainage. otitis externa 5/14URIs URI URIDickey
"Diagnose this man.<r /><img src=""109_otitisexterna.png"" />"
otitis e
xterna 5/14URIs URI URIDickey pictures
Severe necrotizing infection associated with P. aeruginosa.&nsp;&nsp;Severe pa
in, tenderness, swelling of the tissues around the ear and mastoid with pus drai
ning from the canal.
"malignant otitis externa<div><img src=""externa.jpeg""
/></div>"
5/14URIs URI URIDickey
"Diagnose this man.<r /><img src=""110_malignantotitis.png"" />"
malignan
t otitis externa
5/14URIs URI URIDickey pictures
Most common infectious disease of childhood
otitis media
5/14URIs MCC URI
URIDickey
Most common indication for antimicroial therapy in children
otitis media
5/14URIs MCC URI URIDickey
Pathogensis of what infection? ntecedent URI viral infection that causes conges
tion of the respiratory epithelium.&nsp;&nsp;Congestion of the mucosa of the e
ustachian tue results in ostruction and creates negative pressure in the middl
e ear and the development of middle ear effusion.
otitis media
URI
"Diagnose this child.<r /><img src=""111_otitismedia.png"" />"
otits me
dia<r /><r />(111_otitismedia)
5/14URIs URI URIDickey pictures
Inspection of the tympanic memrane shows inflammation, uldging, and fluid ehi
nd it.&nsp;&nsp;Patient exhiits ear pain, hearing loss, vertigo, irritaility
, vomiting.
otitis media
5/14URIs URI URIDickey case
Is a complication of otitis media ecause of the continuity of the mucoperiostea
l lining.
mastoiditis
5/14URIs URI URIDickey
"Diagnose this individual<r /><img src=""112_mastoiditis.png"" />"
mastoidi
tis
5/14URIs URI URIDickey pictures
"Diagnose this child.<r /><img src=""113_mastoiditis.png"" />"
mastoidi
tis
5/14URIs URI URIDickey pictures
"Diagnose this patient.<r /><img src=""114_mastoiditis.png"" />"
mastoidi
tis
5/14URIs URI URIDickey pictures
Patient presents with fever, ear pain, postauricular swelling mastoiditis
URI
Patient presents with fever, ear pain, and displaced pinna
"mastoiditis<div
><r /><img src=""113_mastoiditis.png"" /></div>"
5/14URIs URI URIDickey
re acute respiratory tract infections more commonly caused y viruses or acter
ia?
viruses (this is why you dont usually treat with antiiotics) 5/14URIs
URI URIDickey
"Inflammation and ostruction of the osteomeatal complex.&nsp;&nsp;What does t
his patient have?<r /><img src=""115_sinusitis.png"" /><img src=""osteom.jpeg"
" />" sinusitis
5/14URIs URI URIDickey pictures
"Diagnose this patient.<r /><img src=""116_sinusitis.png"" />"
sinusiti
s - inflammation and ostruction of the osteomeatal complex can lead to the accu
mulation of secretion and acterial proliferation within the space.&nsp;&nsp;
5/14URIs URI URIDickey pictures
What are the key surface proteins of HIV?
"gp41 and gp120 (gp160)<div><img
src=""p24.jpeg"" /></div>"
5/27HIVRetroRD
What is the capsid (core) of HIV made of?
"p24<div><img src=""p24.jpeg"" /
></div>"
5/27HIVRetroRD
What is the most important factor in sexual transmission of HIV?
<u>viral
load&nsp;</u><div><r /></div><div>Other factors that do matter include:&nsp;
Type of sexual encounter,&nsp;Presence of sexually transmitted disease, Type of
virus,&nsp;Host genetic factors</div> 5/27HIVRetroRD

Do we screen for HIV? Do we treat HIV? YES --&gt; <u>universal testing</u>, uni
versal treating 5/27HIVRetroRD
How do we prevent perinatal HIV transmission? 1. LL pregnant women <u>tested<
/u> for HIV<r />2. HIV <u>treatment</u> for women w HIV (if not prenatal, then
do it intrapartal)<r />3. infants receives <u>6 weeks of ZT</u><r />4. electi
ve <u>C-section</u><r />5. <u>avoid reastfeeding</u> (developed world)
5/27HIVRetroRD
What happens clinically in primary HIV infection? Comment symptoms and viral loa
d
"non specific symptoms, <>high viral load</>, massive destruction of C
D4 cells, transient low CD4 count<div><img src=""nat hist.jpeg"" /></div><div>Hi
ghest viral load in course of disease is in the acute retrovirus syndrome</div>"
5/27HIVRetroRD
What are the features of chronic HIV infection? Sx and length "<>suclinical<
/> disease w constitutional symptoms --&gt; fatigue, fever, night sweats. lasts
aout 10 years<div><img src=""latency.jpeg"" /></div>" 5/27HIVRetroRD
"What are two types of ""entry inhiitors"" used for HIV treatment?"
"<u>CCR5
antagonists</u> (inhiit the inding of the virus to the co-receptor), <u>fusio
n inhiitors</u> (inhiit fusion fo viral and cellular memranes)<div><img src="
"drug targ.jpeg"" /></div>"
5/27HIVTreatmentRD HIV ID_pharm
What types of reverse transcriptase inhiitors (RTI) are there for HIV treatment
?
"nucleoside analogue (NRTI) and non-nucleoside analogues (NNRTI)<r /><
r />NRTI - compete with the natural enzyme sustrates (deoxynucleoside triphosph
ates) leading to premature DN chain termination<r />NNRTI - ind to RT enzyme
(allosteric) and inhiit its function<div><img src=""drug targ.jpeg"" /></div>"
5/27HIVTreatmentRD HIV ID_pharm
Name the four classes of antiretroviral drugs used for HIV treatment. "entry i
nhiitors, reverse transcriptase inhiitors, integrase inhiitors, protease inhi
itors<div><r /></div><div><img src=""drug targ.jpeg"" /></div>"
5/27HIVT
reatmentRD HIV ID_pharm
Whats the main goal of HIV treatment? Viral suppression
5/27HIVRetroRD H
IV
Which class of HIV antiretroviral drugs are only indicated in patients on whom t
he tropism tests yields no CXCR4 tropic viruses.
CCR5 antagonists (ie vir
us is only using the CCR5 co-receptor) 5/27HIVTreatmentRD HIV ID_pharm
This class of antiretroviral drugs compete with natural enzyme sustrates (deoxy
nucleoside triphosphates) leading to premature DN chain termination. nucleosi
de analogue RTIs (NRTIs)
5/27HIVTreatmentRD HIV ID_pharm
This class of antiretroviral drugs ind allosterically to the reverse transcript
ase enzyme and therey inhiit its function.
non-nucleoside RTIs (NNRTIs)
5/27HIVTreatmentRD HIV ID_pharm
This class of antiretrovirals inhiits incorporation of viral ds DN into host c
ellular DN.
"integrase inhiitors<div><img src=""drug targ.jpeg"" /></div>"
5/27HIVTreatmentRD HIV ID_pharm
This class of antiretrovirals inhiits viral protease (enzyme that cleaves viral
polyproteins to produce mature proteins).
protease inhiitors
5/27HIVT
reatmentRD HIV ID_pharm
Lactic acidosis, secondary to mitochondrial toxicity, is a side effect of which
class of antiretrovirals?
nucleoside analogue RTIs (NRTI inhiit the enzym
e responsile for mito DN synthesis and therey causes mitochondrial dysfunctio
n resulting in lactic acidosis) 5/27HIVRetroRD HIV ID_pharm
"Reduction of HIV mortality after eginning HRT can est e attriuted to what
?<r /><img src=""117_HRT.png"" />" reduction of opportunistic infections
5/27HIVRetroRD HIV ID_pharm pictures
True or false: Maximal suppression of viral replication does not allow for emerg
ence of resistance
True; suppressed virus cannot generate the mutations nee
ded to produce resistance to drugs included in the regimen.&nsp;&nsp;dherence
to treatment is the most important factor to prevent resistance!
5/27HIVR
etroRD HIV
What is the ritonavir-ooster effect? "low-dose ritonavir inhiits metaolism
of other protease inhiitors.&nsp;&nsp;Protease inhiitor serum levels achieve

d with ritonavir-oosted regimens are much higher than those achieved with un-o
osted regimens.<r /><img src=""118_ritonavir.png"" /><r />" 5/27HIVTreatment
RD HIV ID_pharm
Which HIV antiretroviral is teratogenic and contraindicated in pregnancy?
efavirenz
5/27HIVRetroRD HIV ID_pharm
Definition: viral load &gt;200 after 24 weeks of starting treatment or an increa
sed viral load to &gt;200 afer initial suppression to non-detectale levels
"virologic failure--virologic failure is an indication for careful assessment of
adherence to treatment, careful assessment of toleraility to antiretrovirals a
nd drug interactions, and otaining resistance testing<r /><img src=""failure (
1).jpeg"" /><r /><r />"
5/27HIVRetroRD HIV ID_pharm
True or false: Oropharyngeal cultures taken from ill, hospitalized patients show
a striking increase in the incidence of colonization of gram-negative acilli.
True--colonization increases as the duration of hospitalization increases and as
the severity of illness increases
LRI
Name 3 ways that acteria gain access to the <u>pulmonary parenchyma</u>. give a
n example for each.&nsp;
1) <u>endogenous aspiration</u> (50% of ppl aspi
rate contents in their sleep, <i>S. pneumo</i>)<r />2) <u>inhalation</u> of <u>
aersolized acterial</u> particles (ie <i>TB</i> droplet nuclei, <i>Legionella</
i>&nsp;in neulizer)<r />3) <u>hematogenous</u> spread from extrapulmonary sou
rce (ie right sided <i>S. aureus</i> endocarditis)
LRI
True of false: tactile fremitus (sound transmission) increases with consolidatio
n, ut decreases if pleural fluid is present
true
LRI
Whats the most important initial laoratory test to otain for lower respirator
y tract infections?
"<u>gram stain of sputum</u> (it must e a ""<u>good</u>
"" one which means a ratio of at least 20 PMN: 1 epithelial cell in a lower powe
r field)--specimens that dont fulfill this criterion shouldnt e e interprete
d"
LRI
"Is this a good or ad sputum sample? Why?<r /><img src=""120_sputumsample.png
"" />" Good; see lots of neutrophils LRI pictures
What are some common acteria that cause community-acquired lower respiratory tr
act infections? "<div><div>Streptococcus pneumoniae</div><div> Nontypeale Haemoph
ilus influenzae&nsp;</div><div> Moraxella catarrhalis</div> Chlamydophila pneumon
iae (????)&nsp;</div><div> Influenza virus (during outreak periods)&nsp;</div>
<div> Legionella sp. (in certain geographic areas)&nsp;</div><div> Mycoplasma pne
umoniae</div><div><r /></div><div><img src=""common (1).jpeg"" /></div>"
LRI
True or false: 30-60% of pneumonias are of unknown etiology.
True
LRI
What are the 2 most common (gram neg, gram pos) acteria causing nosocomial lowe
r respiratory tract infections? "(-) Pseudomonas aeruginosa (17%), (+) S. aureus
(14%)<div><img src=""noso.jpeg"" /></div>"
LRI
What are the 3 major aspiration syndromes?
1) chemical pneumonitis (seconda
ry to gastric acid urns)<r />2) ronchial ostruction (secondary to particular
matter)<r />3) acteria aspiration
LRI
Most common locations of pneumonitis in the lung.
<u>posterior segments of
the upper loes</u> and <u>apical segment of the lower loes</u>, with the <u>r
ight</u> more frequently involved than the left ecause of the angle the right m
ain stem ronchus comes off
LRI
"Patient was intuated with ET tue for operation and also had impaired gastric
emptying.&nsp;&nsp;Diagnose this patient.<r /><img src=""121_aspirationpneum
.png"" />"
aspiration pneumonia (the risks aove predispose for aspiration
pneumonia)<r />
LRI pictures
Patient presens with low grade fever, malaise, weight loss, and poor dental hygi
ene.&nsp;&nsp;Has large amounts of sputum that have foul taste. The odor of th
e patients reath is offensive.&nsp;&nsp;Diagnose this patient.
anaeroi
c pleuropulmonary infection
LRI
Pleural effusion (fluid in the pleural cavity) can e divided into transudates a
nd exudates.&nsp;&nsp;What are some causes of transudates.
result from alte
red <u>plasma oncotic pressure</u> or elevated systemic or pulmonic <u>hydrostat
ic pressure</u> (ie NOT inflammatory); causes include: congestive heart failure,

cirrhosis, hypoproteinemia
LRI
Pleural effusion (fluid in the pleural cavity) can e divided into transudates a
nd exudates.&nsp;&nsp;What are some characteristics of exudates.
Exudates
result from <u>inflammatory&nsp;disease of the pleural surface</u>&nsp;<div>a
t least one of:</div><div><div>has high amount of pleural <u>fluid protein</u>,
high amount of <u>pleural fluid LDH</u>, high amount of <u>pleural fluid WBC</u>
</div></div>
LRI
Whats the significant of exudate pleural fluid with a pH &lt; 7.3? Correlates w
ith?
"suggests an <u>empyema</u>&nsp;(purulent, inflammatory collection in p
leural cavity) or loculated collection and strongly <u>correlates with the need
for a chest tue</u> for successful resolution<div><img src=""chest tue.jpeg""
/></div>"
LRI
Definition: purulent, inflammatory collection in the pleural cavity.
empyema
LRI
Most common cause of chronic viral hepatitis
Hepatitis C virus
MCC hepa
titis
Common vaccine preventale disease among unprotected travelers to developing cou
ntries. Causes jaundice. &gt;95% of infections resolve completely
hepatiti
s  virus
5/14Picornaviruses hepatitis picornavirus
Which hepatitis viruses are spread y fecal-oral?
"hepatitis  and hepatit
is E<div><r /></div><div>Smaller size</div><div><img src=""fecal oral.jpeg"" />
</div>" hepatitis
"<img src=""122_hepQ.png"" />" "nswer = <div><r /></div><div><img src=""a (1
).jpeg"" /></div>"
classQ hepatitis
How is most HV excreted?
"in the stool<r /><img src=""123_HV.png"" /><
r />" hepatitis
How long is the incuation period for HV?
"~1 month; entry via the GI trac
t is followed y viremia with spread to the liver<r /><img src=""124_HV.png""
/><r />(124_HV)"
hepatitis
If you are infected with HV, are you more likely to develop symptoms if youre
young or old? "older; the risk of jaundice and fatal hepatitis increase with a
ge<r /><img src=""125_HV.png"" /><r /><div><r /></div><div><u></u>=Older <
u></u>dults</div>"
hepatitis
For diagnosis of HV, do we use IgM or IgG?
"IgM (indicates active or recent
infection); whereas IgG anti-HV does not distinguish etween acute and past in
fection<div><r /></div><div><img src=""patho .jpeg"" /></div>"
hepatiti
s
"<img src=""126_hepQ.png"" />" nswer = C<r /><r />(126_hepQ)
classQ
Major cause of sporadic and water-orne hepatitis in SE &amp; Central sia, Midd
le East, N &amp; W frica and Mexico.&nsp;&nsp;Low rate of person-to-person sp
read
"Hepatitis E<div><img src=""E map.jpeg"" /></div>"
hepatitis
Hepatitis virus that poses a serious threat to pregnant women. hepatitis E viru
s
hepatitis
cute, self-limiting hepatitis is most common.&nsp;&nsp;&nsp;Persistent infec
tion leading to cirrhosis can happen in immunocompromised organ transplant recip
ients.&nsp;&nsp;n unsually high mortality in pregnant women. hepatitis E viru
s
hepatitis
"<img src=""127_hepQ.png"" />" nswer = D; spread y fecal-oral<r /><r />(12
7_hepQ) classQ
Hepatitis virus whose replication involves an RN intermediate. "hepatitis B vir
us<div><img src=""replication B.jpeg"" /></div>"
hepatitis
Hepatitis virus whose replication cycle includes an RN intermediate that is rev
erse transcried to virion DN. "hepatitis B virus<div><img src=""replication B.
jpeg"" /></div>"
hepatitis
DN virus with RN intermediate. In the family Hepadnaviridae hepatitis B viru
s
hepatitis
In the US, more than half of the chronic carriers of this virus are of sian des
cent. "hepatitis B virus<div><img src=""map B.jpeg"" /></div><div><img src=""a
sian.jpeg"" /></div><div>B- asian</div>"
hepatitis
ntigen that correlates with HBV replication and infectivity; associated with in

creased risk of liver cancer. "HB e antigen (areviated <u>HBeg</u>)<div><

r /></div><div><img src=""antigen (1).jpeg"" /></div><div>HBeg is extracellula
r form of HBcg (core)</div>" hepatitis
True or false: for HBV theres an increased risk of neonatal infection when moth
er is ______-positive and when maternal infection occurs in the ________ trimest
er.
"<div>HBeg; 3rd trimester or early postpartum</div><div><r /></div><im
g src=""maternal neo.jpeg"" />" hepatitis
Is someone more likely to develop chronic HBV infection if they are infected in
infancy/childhood or adulthood? "infancy/childhood<r /><img src=""128_HBV.png"
" /><r /><r /><div>H<u>B</u>V= <u>B</u>ay</div>"
hepatitis
"<img src=""129_hepQ.png"" />" nswer = B<r /><r />(129_hepQ)
classQ
What if just the anti-HBc is positive for HBV? What are the 4 possiilites?
"1) resolved infection (most common)<r />2) false-positive anti-HBc<r />3) ""l
ow level"" chronic infection<r />4) resolving acute infection<div><r /></div><
div><img src=""HBV.jpeg"" /></div>"
hepatitis
ntiody to what indicates resolution of HBV infection? "HB surface antigen (HBs
g)<div><img src=""HBV.jpeg"" /></div>" hepatitis
Hepatitis virus that has HBsg-coated exterior and is not HBV. "Hepatitis D vir
us--recall that replication requires helper function of HBsg for entry of the v
irus into cells<div><r /></div><div><img src=""delta.jpeg"" /></div>" hepatiti
s
Hepatitis virus whose replication requires helper functions of HBV (HBsg) for e
ntry into cells.
hepatitis D virus
hepatitis
Two ways for HDV aquisition.
"coinfection (with HDV and HBV at same time), or
superinfection (infxn with HDV in a patient who is persistently infected with H
BV)<div><img src=""co and super.jpeg"" /></div>"
hepatitis
Definition: acute infection with HDV and HBV at the same time coinfection
hepatitis
Definition: infection with HDV of a patient who is persistently infected with HB
V.
superinfection hepatitis
Coinfection or superinfection? Low risk of chronic hepatitis infection coinfect
ion<r><r>&gt;95% of HDV infections occuring as a result of co-infection solve<
r>&gt;70% of superinfections ecome chronic
hepatitis
Coinfection or superinfection? high risk of severe chronic liver disease
superinfection hepatitis
&gt;95% of infections occurring as a result of coinfection resolve.&nsp;&nsp;&
gt;70% of superinfections ecome chronic.&nsp;&nsp;Which hepatitis virus?
HDV
hepatitis
True or false: prevention of HBV infection with vaccine will prevent co-infectio
n with HDV
True (ecause D requires Bs machinery) hepatitis
"<img src=""130_hepQ.png"" />" nswer = B<r /><r />(130_hepQ)
classQ
Most common cause of chronic viral hepatitis in the US Hepatitis C virus
MCC hepatitis
"<img src=""131_hepQ.png"" />" nswer = B<r /><r />(131_hepQ)
classQ
Highest risk factor for acquiring HCV "injection drug use<div><img src=""injec
tion drug.jpeg"" /></div>"
hepatitis
Major screening test for HCV infection ELIS for anti-HCV a
hepatitis
Confirmatory assay for HCV infection
RIB/MTRIX (done after ELIS) hepatiti
s
Treatment for HCV infection
interferon plus riavirin<div><r /></div><div>T
HERE IS NO VCCINE</div><div><r /></div><div>(changing as we speak)</div>
hepatitis treatments
Curiously associated with improved IDS-related outcomes in HIV-infected patient
s.&nsp;&nsp;Which virus?
hepatitis G virus
hepatitis
ltered forms of anormal host protein (PrP) is the infectious agent.
Prions;
spongiform encephalopathies
prions
Pathogenesis of prion disease prions reproduce y recruiting normal cell prion
proteins (PrP^c) and stimulating their conversion to the disease caus
ing isoform (PrP^Sc).&nsp;&nsp;this form is protease-resistant and r
ich in eta sheets
prions

Characteristics of spongiform encephalopathies (ie transmission, incuation peri

od, <>inflammation</>, etc) "<img src=""132_prion.png"" /><r />" prions
"Brain iopsy.&nsp;&nsp;Note asence of associated inflammtory changes.&nsp;&
nsp;Diagnose this person (disease and cause)<r /><img src=""133_prion.png"" /
>"
<u>spongiform encephalopathy</u> (prion disease)<r /><r />Products of
normal cellular genes, which explains lack of inflammatory response
pictures
prions
nswer = D<r /><r />(134_prion)
"<img src=""134_prion.png"" />"
classQ
What 2 hepatitis viruses are spread fecal oral? HV, HEV
hepatitis
What 3 hepatitis viruses are spread via parenteral-intimate contact?
"HBV, HD
V, HCV<div><img src=""dc.jpeg"" /></div>"
hepatitis
Which hepatitis virus poses a serious risk for pregnant women? hepatitis E viru
s
hepatitis
" middle-aged immigrant from China presents with right upper quadrant pain and
a ""full stomach"" despite recent history of weight loss.&nsp;&nsp;He rememer
s have outs of turning yellow since childhood and recalls many in his family--i
ncluding his mother--having similar experiences.&nsp;&nsp;Immunization records
are unavailale, and la values show elevated LT levels and alpha-fetoprotein
levels.&nsp;&nsp;Further imaging reveals the presence of hepatocellular carino
ma."
HBV
case hepatitis
Feeling fatigued, a man visits his doctor.&nsp;&nsp;On physical examination, t
he patient has reduced liver size.&nsp;&nsp;fter a thorough history, the doct
or learns that the patient had jaundice 5 years ago following a car accident for
which he was hospitalized and received a lood transfusion.&nsp;&nsp;The doct
or is not surprised to see an elevated serum level of ST in his lood workup an
d awaits an ELIS to differentiate the cause of this illness. hepatitis C viru
s
case hepatitis
HBV carriers who ecome superinfected with ___ have a much poorer prognosis, wit
h a greater chance of fulminant hepatitis and liver failure.
HDV
hepatiti
s
Contains an RN genome, delta antigen, and HBsg
"hepatitis D virus<div><
img src=""delta.jpeg"" /></div>"
hepatitis
Defective virus that requires HBsg in its envelope.&nsp;&nsp;Can co-infect wi
th HBV or superinfect (the latter has a worse prognosis).
HDV
hepatiti
s
Resemles HV in course, severity, and incuation.&nsp;&nsp;High mortality rat
e in pregnant women
HEV
hepatitis
Homozygous CCR5 mutation gives one immunity to ____.
HIV
5/27HIVRetroRD H
IV
Which herpesvirus sufamily lies latent in sensory ganglia?
"alpha (which in
cludes the viruses HHV1, HHV2, HHV3)<r /><img src=""213_herpes.png"" /><r />"
6/20HHVDickey herpes
nswer = <r /><r />(135_virusQ)
"<img src=""135_virusQ.png"" />"
classQ
Most common clinical manifestation of HSV infection
"painful vesicular skin
rash<div><img src=""intra ves.jpeg"" /></div>" 6/20HHVDickey Herpes
"gB and gD are required for infectivity; gG is type-specific.&nsp;&nsp;Which v
irus is eing referred to?<r /><img src=""136_HSV.png"" />" herpes simplex v
irus (HSV)
6/20HHVDickey Herpes pictures
Which HSV ecomes more prevalent after puerty, HSV 1 or HSV 2? HSV 2 6/20HHVD
ickey Herpes
Which HSV is more prevalent in lower socioeconomic groups and occurs early in li
fe, HSV 1 or HSV 2?
HSV 1 6/20HHVDickey Herpes
"Which virus pathogenesis is eing descried--following inoculation of virus in
to skin or mucus memrane, productive infection occurs with spread of virus to a
djacent cells and to sensory and autonomic nerves.&nsp;&nsp;Virus then moves t
o the ganglia via retrograde axonal flow, where latent infection is estalished.
<r /><img src=""137_HSVpathogenesis.png"" />" HSV
6/20HHVDickey Herpes pic
tures

"Which common virus exhiits this pathogenesis?<r /><img src=""138_HSVpath.png

"" />" HSV
6/20HHVDickey herpes pictures
Causes gingivostomatitis, keratitis, whitlow. "HSV 1<div><img src=""whitlow.jp
eg"" /></div>" 6/20HHVDickey Herpes
"Clinical feature is grouped vesicles on an erythematous ase.<r /><img src=""
139_HSV.png"" />"
HSV
6/20HHVDickey Herpes pictures
"What is the diagnosis?<r /><img src=""140_HSV.png"" />"
herpetic gingivo
stomatitis (from HSV 1) 6/20HHVDickey Herpes pictures
"What is the diagnosis?<r /><img src=""141_HSV.png"" />"
herpetic gingivo
stomatitis (HSV 1)
6/20HHVDickey Herpes pictures
nswer = B<r /><r />(142_virusQ)
"<img src=""142_virusQ.png"" />"
classQ
In its latent stage, viral DN persists as an episome and a latency-associated t
ranscript encodes microRN that is anti-apoptotic
HSV - at variale interv
als after primary infection, HSV can reactivate from sites of latent infection.&
nsp;&nsp;During latency, virus cannot e cultivated directly from the ganglia.
&nsp;&nsp;The sole latency-associated transcript (LT) encodes a microRN that
exerts anti-apoptotic effects therey facilitating persistence of HSV 6/20HHVD
ickey Herpes
Hallmark is grouped vesicles on erythematous ase.
HSV
6/20HHVDickey He
rpes
"Reactivation from the trigeminal ganglia causes this ""cold sore"". <>Name</>
the cold sore<r /><img src=""143_coldsore.png"" />" HSV 1; cold sore is also
called <i>Herpes Laialis</i> 6/20HHVDickey herpes pictures
"One of the most frequent causes of corneal lindness is the US.&nsp;&nsp;sso
ciated with pain, lurred vision, and conjunctivitis. Whats the <>diagnosis</
>, and ug? <r /><img src=""144_keratitis.png"" />" "herpetic keratitis (fro
m HSV 1)<div><r /></div><div><img src=""paste-174989852541558.jpg"" /></div>"
6/20HHVDickey herpes pictures
"Whats the diagnosis, and ug?<r /><img src=""145_whitlow.png"" />" herpetic
whitlow (HSV 1)
6/20HHVDickey herpes pictures
"Whats the diagnosis?<r /><img src=""146_whitlow.png"" />" herpetic whitlow
(from HSV 1) 6/20HHVDickey herpes pictures
Most common cause of acute, sporadic viral encephalitis in the US.&nsp;&nsp;Ma
nifestations include fever, headache, and focal neurologic symptoms and signs. N
ame disease <>and </>virus
"Herpes simplex encephalitis; HSV<div><img src="
"hsv.jpeg"" /></div><div><r /></div><div><r /></div><div>HSV1- sporadic viral
encephalitis</div><div>HSV2-aseptic meningitis</div>" 6/20HHVDickey MCC herpes
"Whats the diagnosis?<r /><img src=""147_HSV2.png"" />"
genital HSV 2 in
fection 6/20HHVDickey herpes pictures
"ssociated with pain, itching, inguinal adenopathy, vaginal &amp; urethral disc
harge.&nsp;&nsp;cute urinary retention and aseptic meningitis may develop.&n
sp;&nsp;Diagnosis and virus?<r /><img src=""148_HSV2.png"" /><r />" genital
HSV 2 infection 6/20HHVDickey herpes pictures
Which herpes virus causes gingivostomatitis?
HSV 1 6/20HHVDickey herpes
Which herpes virus causes genital/neonatal herpes?
HSV 2 herpes
Painful hand vesicle that can occur when a health care worker comes in contact w
ith herpetic lesions
herpetic whitlow (from HSV 1) 6/20HHVDickey herpes
Primary infection resolves after 2-3 weeks, virus enters local sensory nerve end
ings, axonal transport proximally to sensory ganglion cell odies where it lies
latent until there is stress that promotes viral reactivation, axonal transport
of virus from ganglia to nerve endings HSV
6/20HHVDickey herpes
Typically, does HSV 1 or HSV 2 infect aove the waist (ie eye and mouth lesions)
?&nsp; HSV 1 6/20HHVDickey herpes
Typically, does HSV 1 or HSV 2 infect elow the waist (ie genital lesions)?
HSV 2 6/20HHVDickey herpes
t a preterm evaluation, a 31-year old pregnant mother reports pain on urination
and a urning, itching sensation in the genital area.&nsp;&nsp; careful exam
of her vagina yields a vesicular rash.&nsp;&nsp;The physician confirms the di
agnosis with a Tzanck smear of the lesions.&nsp;&nsp;The mother is informed th

at should the infection persist, her child will have to e delivered y cesarean
section
"HSV 2<div><img src=""hsvgene.jpeg"" /></div>" 6/20HHVDickey ca
se herpes
"which virus is exhiited using Tzanck prep that is also the most common cause o
f acute sporadic viral encephalitis in the US<r /><img src=""215_tzanck.png""
/>"
HSV 1 6/20HHVDickey herpes pictures
nswer = D<r /><r />(149_virusQ)
"<img src=""149_virusQ.png"" />"
classQ
Common name for varicella
chickenpox
6/20HHVDickey herpes
"Diagnose this oy.<r /><img src=""150_varicella.png"" />"
varicella (chick
enpox)<r /><r />(150_varicella)
6/20HHVDickey herpes pictures
"Whats the diagnosis?<r /><img src=""151_varicella.png"" />" varicella (chick
enpox) - HHV 3<r /><r />(151_varicella)
6/20HHVDickey herpes pictures
Reactivation disease associated with varicella zoster virus (VZV)
herpes z
oster 6/20HHVDickey herpes
"Diagnose this patient<r /><img src=""152_herpeszoster.png"" />"
herpes z
oster (Varicella-zoster virus - HHV 3) 6/20HHVDickey herpes pictures
6/20HHVDickey herpes
nother name for herpes zoster shingles
Results from reactivation of VZV from latently infected ganglia herpes zoster
6/20HHVDickey herpes
Skin lesions are similar to varicella, although their distriution is dermatomal
, not generalized
herpes zoster 6/20HHVDickey herpes
nswer = C<r /><r />(153_virusQ)
"<img src=""153_virusQ.png"" />"
classQ
"<img src=""154_virusQ.png"" />"
answer = C<r /><r />(154_virusQ)
classQ
72 y/o woman complains to her doctor of a urning, painful rash on her chest.&n
sp;&nsp; physical exam reveals fever and a vesicular, erythematous rash limite
d to the right side of her chest and overlapping the dermatomal area T7-T8.&nsp
;&nsp;The physician confirms a diagnosis y a Tzanck smear of the lesions.&nsp
;&nsp;The physician administers acyclovir and explains that though the rash wil
l likely ameliorate, the regional pain might persist longer (post herpetic neura
lgia). herpes zoster (from HHV 3)
6/20HHVDickey case herpes
Varicella zoster is what herpes virus? herpes virus 3 (HHV 3) 6/20HHVDickey he
rpes
Which herpes virus most commonly causes the fever lister?
HSV 1 6/20HHVD
ickey herpes
Which herpes virus is most commonly implicated in genital herpes?
HSV 2
6/20HHVDickey herpes
Most common cause of sporadic encephalitis in the US
HSV 1 6/20HHVDickey MC
C herpes
Gingivostomatitis, keratitis, temporal loe encephalitis
HSV 1 6/20HHVD
ickey herpes
Causes genitalis, neonatal herpes
HSV 2 6/20HHVDickey herpes
Causes chicken pox, shingles
Varicella Zoster Virus (HHV 3) 6/20HHVDickey he
rpes
mphotericin B containing products are the drugs of choice for many invasive myc
oses ecause amphotericin B is ______. fungicidal
ID_pharm antifungals
The azole antiiotics have a good safety profile and are fungistatic through inh
iition of what enzyme? "14-alpha-demethylase<div><img src=""anti mechanism.jpeg
"" /></div>"
ID_pharm antifungals
ctive against ringworm (dermatophytes) y inhiiting nucleic acid synthesis and
cell mitosis.&nsp;&nsp;Mostly of historical interest these days
"Griseof
ulvin (inhiits microtuules)&nsp;<div><img src=""griseofulvin.jpeg"" /></div>"
ID_pharm antifungals
Therapy for vaginal candidiasis (yeast infection)
fluconazole
ID_pharm
antifungals
n allylamine that inhiits ergosterol synthesis.&nsp;&nsp;Concentrates in the
stratum corneum /c its lipophilic.&nsp;&nsp;Drug levels <>persist 2-3 week
s</> terinafine
ID_pharm antifungals

mphoteric properties (functions as acid and ase), is aliphatic, forms channels

/pores through plasma memranes of fungi
"amphotericin B<div><img src=""a
cid ase.jpeg"" /></div>"
ID_pharm antifungals
nti-fungal drug that must e mixed with D5W (5% dextrose in water)
amphoter
icin B ID_pharm antifungals
Inserts into the fungal plasma memrane and several molecules of the drug form a
cylindrical channel that penetrates the memrane
"amphotericin B<div><img
src=""ampho.jpeg"" /></div>" ID_pharm antifungals
The pores formed y this antifungal result in memrane permeaility so that smal
l molecules can leak out of the fungal cell resulting in fungal death amphoter
icin B ID_pharm antifungals
Upon IV injection, this antifungal inds LDL and tissues therey allowing it to
have a long half life of ~15 days
amphotericin B ID_pharm antifungals
"dverse affects include ""shake and ake"""
"amphotericin B<div><r /></div>
<div>""30 - 45 min after the first amphotericin B infusion, over 50% of patients
will develop nausea, chills, <>fever</>, <>rigors</>, headache and tachypne
a;""</div><div><img src=""ampho.jpeg"" /></div>"
ID_pharm antifungals
30 minutes after infusion, 50% of patients develop nausea, chills, fever, headac
he, tachypnea.&nsp;&nsp;this is mediated through PGE2/cytokines
amphoter
icin B ID_pharm antifungals
dverse effects of this antifungal drug include: <u>renal</u> toxicity, renal tu
ular acidosis, thromophleitis, and normochromic/normocytic <u>anemia</u>. <>
What is specifically acted upon?</>
"amphotericin B--within minutes of a dos
e there is a decrease in GFR &amp; RBF due to the effects on the <>efferent glo
merular arteriole</>.&nsp;&nsp;GFR falls approximately 40% in most patients w
ithin 2 weeks of initiation. nemia due to <>impairment of erythropoietin relea
se</>.<div><img src=""efferent.jpeg"" /></div>"
ID_pharm antifungals
True or false: We need to give a &quot;test dose&quot; efore administering amph
otericin B
false; this is historical--premedicate with tylenol/acetaminophe
n
ID_pharm antifungals
"Descrie the new ""etter amphotericin"". What are enefits?" "mixed with lipi
ds or within liposomes in order to decrease toxic effects&nsp;<div><>reduced n
ephrotoxicity</></div><div><>directly to reticuloendothelial cells</></div><d
iv><r /></div><div><div><img src=""etter.jpeg"" /></div></div>"
ID_pharm
antifungals
Bind to heme iron of cytochrome P-450 and therey inhiit demethylation of methy
lsterols to ergosterols.&nsp;&nsp;Fungistatic.&nsp;&nsp;Which drug class?
azoles ID_pharm antifungals
Which has a higher affinity for the fungal cytochrome P-450, imidazoles (e.g., k
etoconazole)&nsp;or triazoles (e.g., fluconazole, itraconazole &amp; voriconazo
le)?
triazoles<div><r /></div><div>trident=navy seal higher affinity&nsp;</
div>
ID_pharm antifungals
n azole that has an asolute requirement for gastric acid for asorption.&nsp;
&nsp;No IV preparation availale. 1/10,000 develop hepatic failure. adrenal sup
pression
"ketoconazole<div><img src=""keto.jpeg"" /></div>"
ID_pharm
antifungals
zole that is excreted in urine, penetrates CSF, no need for gastric acid, commo
nly used in clinics
fluconazole
ID_pharm antifungals
zole that you need to administer with food or Coca Cola.&nsp;&nsp;Can cause a
drenal excess syndrome (edema, hypokalemia), diarrhea itraconazole
ID_pharm
antifungals
"zole with a possiility of fluoride toxicity (periostitis).&nsp;&nsp;Causes
vision prolems.&nsp;&nsp;Good for candida and aspergillus. 3 fluorides&nsp;<
voriconazole<r /><r /><r />
r /><img src=""216_voriconazole.png"" />"
ID_pharm antifungals
Side effects of this particular azole: anormal electroretinograms, visual distu
rances like eing on an LSD trip with altered color discrimination, possile fl
uoride intoxication
voriconazole
ID_pharm antifungals
Only azole that covers zygomyces (mucormyces) posaconazole
ID_pharm antifun
gals

Inhiitor of thymidylate synthetase that interferes with DN synthesis 5-FC (5fluorocytosine)<div><r /></div><div><r /></div><div>Flucytosine is converted t
o 5-fluorouracil</div> ID_pharm antifungals
Used with amphotericin B in candida and cryptococcal meningitis 5-FC (5-fluorocy
tosine) ID_pharm antifungals
Beta-1,3-glucan synthase inhiitor that acts on fungal cell wall and therey cau
ses osmotic fragility.&nsp;&nsp;<>Fks1 gene is the target</>
"echinoc
andins<div><img src=""echinocandin.jpeg"" /></div><div><img src=""ergo.jpeg"" />
</div><div><img src=""fungal memrane.jpeg"" /></div>" ID_pharm antifungals
Mechanism: inds ergosterol, forms memrane pores that allow leakage of electrol
ytes
"amphotericin B--amphotericin ""tears"" holes in the fungal memrane y
forming pores<div><img src=""ergo.jpeg"" /></div>"
ID_pharm antifungals
Mechanism: act on eta-1,3-glucan cell wall linkages
"echinocandin<div><img s
rc=""echinocandin.jpeg"" /></div>"
ID_pharm antifungals
Causes &quot;shake and ake&quot; as an adverse reaction
amphotericin B
ID_pharm antifungals
"True or false: amphotericins adverse reaction of ""shake and ake"" is mediate
d through histamine." FLSE; it is mediated through PGE2 and cytokines...NOT h
istamine<div><r /></div><div>Therefore, anti-histamines will have no effect</di
v>
ID_pharm antifungals
dverse effect includes renal tuular acidosis resulting in loss of HCO3, K+, an
d Mg2+.&nsp;&nsp;ntifungal therapy. amphotericin B<div><r /></div><div><r
/></div><div><r /></div><div>electrolyte replacement is another important adjun
ct of amphotercin B since amphotercin B causes increase in urinary excretion of
potassium, magnesium, and icar</div> ID_pharm antifungals
"ketoconazole<di
zole that has requirement for gastric H+ for asorption
v><img src=""keto.jpeg"" /></div>"
ID_pharm antifungals
zole with significant excretion in the urine fluconazole
ID_pharm antifun
gals
Know the mechanisms of azoles, echinocandins, amphotericin B, allylamines
"<div>zole- lock synthesis ergosterol, <u>14-a-demethylase</u></div><div>Echin
ocandins- inhiits&nsp;<u>eta1,3 glucan</u> synthesis</div><div>mphotericine
B- pores in memrane (inds formed&nsp;<u>ergosterol</u>, makes it more permea
le)</div><div>llylamine (terinafine)- inhiits <u>squalene epoxidase</u>, part
of the ergosterol synthesis pathway</div><img src=""paste-206781200466460.png""
/><div><img src=""ergo.jpeg"" /><r /><div><img src=""155_antifungals.png"" />
</div></div>" ID_pharm antifungals
When determining the risk for opportunistic infections in an HIV patient what is
the est predictor of susceptiility to OIs? CD4 count
5/27HIVRetroRD H
IV
Whats the est OI prevention strategy for HIV? <>early</> diagnosis and treat
ment of HIV
5/27HIVRetroRD HIV
True or false: 40% of newly diagnosed HIV patients have a CD4 &lt;200 true
5/27HIVRetroRD HIV
What 3 diseases particularly ecome an issue when an HIV patients CD4 is &lt;20
0?
Pneumocystis (PCP), thrush, and esophagitis<div><r /></div><div>CD4 &lt
;400/500 : vaginal</div><div><r /></div><div>CD4 ~200 : oral thrush</div><div><
r /></div><div>CD4 &lt;200: Esophagitis</div> HIV
True or false: t the same CD4 cell count, individuals who are receiving treatme
nt and viral suppression have a lower risk of OIs than the indvidual that isnt
receiving treatment.
true
5/27HIVRetroRD HIV
"White, curd-like plaques that can e scraped off.&nsp;&nsp;What is this and w
hat is it a good marker for?<r /><img src=""156_thrush.png"" />"
oral can
didiasis (thrush); good marker for immune suppression (ie HIV) 5/27HIVRetroRD H
IV pictures
Good marker for immunosuppression.&nsp;&nsp;Tends to e present as CD4 approac
hes &lt;200. Fungal.
candidiasis (ie angular chelitis, thrush, atrophic eryth
ematous plaques)
5/27HIVRetroRD HIV
"This is a good marker for immunosuppression.&nsp;&nsp;What does this individu
al have?<r /><img src=""157_candidiasis.png"" />"
angular chelitis (caused

y candida)<r />
HIV pictures
Thrush in a non-diaetic person who is not taking corticosteroids should promptl
y e tested for ____. HIV
5/27HIVRetroRD HIV
"Diagnose this individual.<r /><img src=""158_hairyleukoplakia.png"" />"
oral hairy leukoplakia (caused y EBV)--frequently seen in HIV+ individuals
5/27HIVRetroRD HIV pictures
45 y/o woman presents, HIV positive, CD4 190, not on treatment.&nsp;&nsp;Fever
of 102 for 3 days, with cough productive of green phlegm, pleuritic chest pain.
&nsp;&nsp;What is the most likely cause of her acterial pneumonia? S. pneum
oniae 5/27HIVRetroRD HIV case
Most common pathogen for acterial pneumonia in HIV patients. S. pneumoniae
5/27HIVRetroRD HIV MCC
Patient with HIV and hypoxia presents with diffuse, ilateral pulmonary infiltra
tes.&nsp;&nsp;Fungal. PCP (pneumocystis pneumonia)--Infection with pneumocysti
s is almost universal in the United States and occurs early in life. It causes a
cute disease in immunocompromised patients and is the most frequent IDS-definin
g diagnosis
HIV
Insidious onset of fever, cough, dyspnea (2-3 weeks) with oxygenation impairment
in an HIV positive individual.&nsp;&nsp;Oxygenation is markedly impaired on e
xertion.&nsp;&nsp;La indicates <>elevated LDH</> PCP (pneumocystis pneumo
nia)
HIV case
First line therapy for Pneumocystis carinii Pneumonia TMP/SMX (aka actrim)
HIV ID_pharm antifungals fungi
"CXR shows ilateral diffuse interstitial infiltrates and ronchealveolar lavage
is shown elow.&nsp;&nsp;Diagnose this patient.<r /><img src=""159_pneumocy
stis.png"" />" PCP
HIV case fungi pictures
56 year old HIV infected man, not on Rx, homeless, admitted with a 3 month histo
ry of weight loss (30 pounds), fever, progressive cough, hemoptysis, pleuritic c
hest pain, SOB.&nsp;&nsp;<r />PE: Ferile, tachypneic.&nsp;&nsp;Decreased B
S left upper lung.<r />Las: CBC 10,000. CD4 cell count 250.<r />CXR showed&n
sp;&nsp;a small infiltrate right upper loe; extensive opacification left upper
loe as well as some infiltrate in the superior segment of the lingula.
M. tuerculosis (TB)--pical localization of pulmonary tuerculosis is character
istic of adult infection. This localization has een attriuted to the hyperoxic
environment of the apices
5/27HIVRetroRD HIV case
HIV patient presents with fever, night sweats, weight loss, cough, loody sputum
, and cavity upper loe infiltrates on CXR.
TB--HIV dramatically increases t
he risk of activation of latent TB
5/27HIVRetroRD HIV case
What must the PPD induration e for an HIV positive individual to e considered
positive?
at least 5mm
5/27HIVRetroRD HIV
"Man presents with fever, night sweats, weight loss, loody sputum, and cavitary
upper loe infiltrates. CD4 is 185.&nsp;&nsp;Stain shows red snappers<r /><i
mg src=""160_TB.png"" />"
TB<r /><r />(160_TB) 5/27HIVRetroRD HIV case
pictures
<>TB</> presentation changes ased CD4 count.&nsp;&nsp;What are individuals
with CD4 &lt;200 more likely to present with <>clinically for TB</>? "lymphad
enopathy<r /><img src=""217_HIV.png"" /><r />(217_HIV)"
5/27HIVRetroRD H
IV
True or false: HIV-infected close contacts of proven TB should e treated regard
less of PPD.
true
5/27HIVRetroRD HIV
Most common cause of acterial diarrhea in HIV. C. difficile
5/27HIVRetroRD H
IV MCC
"Man presents with fever, MS, seizures.&nsp;&nsp;CT scan shows multiple ringenhancing lesions.&nsp;&nsp;Patient is HIV positive<r /><img src=""161_toxo.
png"" />"
toxoplasmosis encephalitis<r /><r />(161_toxo)
5/27HIVR
etroRD HIV case pictures
"HIV woman with CD4 of 39 presents with headaches, fever for 2 weeks.&nsp;&nsp
;LP shows the following:<r /><img src=""162_cryptneo.png"" />"
cryptoco
ccus neoformans meningitis--generally presents when CD4&lt;50<r /><r />(162_c
rypneo) 5/27HIVRetroRD HIV case fungi

Space occupying lesions in HIV patient (2)

1) toxoplasmosis (multiple lesio
ns)<r />2) lymphoma (generally one lesion)
5/27HIVRetroRD HIV
Suacute meningitis in HIV patient.&nsp;&nsp;Name 2 possiilities.
1) Crypt
ococcus neoformans<r>2) TB
5/27HIVRetroRD HIV
Encephalopathy in HIV patient.&nsp;&nsp;Name 3 possiilities. 1) PML<r>2) CMV
encephalitis<r>3) HIV encephalitis
5/27HIVRetroRD HIV
"Which virus causes this disease thats sometimes seen in HIV patients.&nsp;&n
sp;Usually present with no fever, no headache, and no increased intracranial pre
ssure.<r /><img src=""163_PML.png"" />"
JC virus (this is PML) 5/16Dick
eyCantnki 5/16PoxandFriends 5/16PoxnFriends Dickey HIV pictures polyomavirus
Patient with CD4 &lt;100, neurologic disease, no fever, no headache, no increase
d intracranial pressure.&nsp;&nsp;MRI shows hypodense white matter lesions wit
hout enhancement.
PML (from JC virus)
5/16DickeyCantnki 5/16PoxandFri
ends 5/16PoxnFriends Dickey HIV case polyomavirus
Common mycoacterial disseminated diseases in HIV. Name (2)
1) TB<r />2) M
C
5/27HIVRetroRD HIV
Common fungal disseminated disease in HIV endemic to Ohio and Mississippi River
valleys.
histoplasmosis 5/27HIVRetroRD HIV
Cause of cat scratch disease in immonocompetent persons Bartonella
5/27HIVR
etroRD HIV
Causes fungal disseminated disease in HIV persons.&nsp;&nsp;Endemic to Ohio an
d Mississippi river valleys.&nsp;&nsp;Mucosal ulcerations along GI suggest dia
gnosis. histoplasmosis 5/27HIVRetroRD HIV
nswer = B; positive in &gt;95% of cases
"<img src=""164_histoQ.png"" />"
of disseminated histoplasmosis<r /><r />(164_histoQ)
classQ
Uiquitous organism, disease occurs when CD4 &lt;50.&nsp;&nsp;Treatment is mac
rolide (ie azithro or clarithro)
MC
5/27HIVRetroRD HIV
Prodrome of pain followed y a unilateral vesicular eruption with a dermatomal d
istriution.
herpes zoster (caused y varicella-zoster virus - HHV 3)
6/20HHVDickey herpes
Causes oral hairy leukoplakia Epstein-Barr Virus (HHV 4)
6/20HHVDickey HI
V herpes
"Herpes virus found in HIV patients.<r /><img src=""165_kaposi.png"" />"
HHV 8 (Kaposis sarcoma associated herpesvirus) 6/20HHVDickey HIV herpes picture
s
What virus causes primary CNS lymphoma in end stages IDS patients?
EpsteinBarr Virus (HHV 4)
6/20HHVDickey HIV herpes
Infection with this virus manifest when CD4 &lt;50.&nsp;&nsp;Causes retinitis,
esophagitis, polyradiculitis.&nsp;&nsp;&gt;90% of persons with HIV have serop
ositivity
CMV
5/27HIVRetroRD HIV
Definition: paradoxical worsening as a result of immune recovery after starting
immune reconstitution inflammatory syndrome (IRIS)--the immune system wa
RT
kes up and reacts to antigens to which it was not properly reacting efore.&nsp
;&nsp;theres significant inflammation against oth <u>known pathogen</u> and a
lso exhiits <u>unmasking</u> of previously unknown pathogen. 5/27HIVRetroRD H
IV
"Pictures shows lymphadenitis due to MC.&nsp;&nsp;What does the lymphadenitis
exhiit?<r /><img src=""166_IRIS.png"" />" IRIS--Inflammatory complications
of chronic infections in HIV-infected individuals following the initiation of p
otent antiretroviral therapy have een recently descried. The development of M
C lymphadenitis was among the first of these complications to e reported
5/27HIVRetroRD HIV pictures
"<img src=""167_question.png"" />"
nswer = B<r /><r />(167_question)
classQ
"Which virus causes this retinitis in HIV patients?<r /><img src=""168_retinit
is.png"" /><div><r /></div><div><r /></div>" "CMV (HHV 5)--CMV retinintis is
associated with advanced immunosuppression (ie new HIV infection--person will co
mplain of visual disturances)<div><r /></div><div><img src=""paste-17413085908
2358.jpg"" /></div>"
6/20HHVDickey HIV herpes pictures
Intrauterine infection may e associated with&nsp;&nsp;microcephaly, ocular an

d auditory nerve damage.

CMV (HHV 5)
Dickey herpes
"<img src=""169_CMV.png"" />" nswer = C<r /><r />(169_CMV)
classQ
"This ay has hepatosplenomegaly, jaundice, and severe chorioretinitis. What do
es he have?<r /><img src=""170_CMV.png"" />" Congential CMV infection (HHV 5)
Dickey herpes pictures
Clinical sequelae include sensorineural hearing loss, low IQ, chorioretinitis. V
iral. congenital CMV infection (HHV 5)
Dickey herpes
Most common cause of <u>congenital infection</u>&nsp;+ &nsp;virus-induced ment
al retardation and deafness in the US CMV (HHV 5)
Dickey MCC herpes
True or false: For CMV, for infants orn to women experiencing primary infection
during pregnancy they are more likely to e affected. True
Dickey herpes
In older children and adults this virus produces a mononucleosis-like illness (s
imilar to EBV mono)
"CMV (HHV 5)<div><img src=""paste-174130859082358.jpg""
/></div>"
6/20HHVDickey herpes
"ffects neurosensory retina producing necrotizing retinitis; associated with ad
vanced immunosuppression (ie HIV).&nsp;&nsp;If untreated will progress to lin
dness<r /><img src=""218_CMVretinitis.png"" />"
CMV retinitis 6/20HHVD
ickey HIV herpes pictures
"Diagnose this patient.&nsp;&nsp;Patient has new HIV infection.<r /><img src=
""171_CMVretinitis.png"" />" CMV retinitis<r /><r />(171_CMVretinitis)
6/20HHVDickey HIV herpes pictures
"Which virus causes ""owls eyes"" inclusions<r /><img src=""172_CMV.png"" />"
CMV (HHV 5)
6/20HHVDickey herpes pictures
"Shows characteristic ""owls eyes"" inclusions on histopathology."
"CMV (HH
V 5)<div><img src=""cmv cyto.jpeg"" /></div>" 6/20HHVDickey herpes
"<img src=""173_question.png"" />"
nswer = D<r /><r />(173_question)
classQ
Virus implicated in frican Burkitts lymphoma, some B cell lymphomas, and nasop
haryngeal carinoma. Most adults (90-95%) have antiodies to this virus. EpsteinBarr Virus (HHV 4)
6/20HHVDickey herpes
Causes infectious mononucleosis.
Epstein-Barr Virus (HHV 4)
6/20HHVD
ickey herpes
Causes oral hairy leukoplakia in HIV infected persons. Epstein-Barr Virus (HHV
4)
6/20HHVDickey HIV herpes
Causes fatal infection in patients with X-linked lymphoproliferative syndrome wh
ere a genetic mutation results in ineffective T cell responses against virus inf
ected B cells "Epstein-Barr Virus (HHV 4)<div><img src=""Tcel.jpeg"" /></div>"
6/20HHVDickey herpes
What are the MIN clinical manifestations of EBV mononucleosis? "fever, sore thr
oat and posterior cervical lymphadenopathy (Elevated LFTs)<div><img src=""ev (1
).jpeg"" /></div><div><r /></div><div><img src=""paste-175689932210806.jpg"" />
</div>" 6/20HHVDickey herpes
"Diagnose this patient.<r /><img src=""174_leukoplakia.png"" />"
oral hai
ry leukoplakia (only seen in highly immunosuppressed patients) - caused y Epste
in-Barr Virus (HHV 4) 6/20HHVDickey HIV herpes pictures
"This development of rash is particularly common among patients treated with amp
icillin.&nsp;&nsp;Diagnose this patient.<r /><img src=""175_EBV.png"" />"
"EBV mononucleosis<div><r /></div><div>Similar to this girl, rememer:</div><di
v><img src=""rash (1).jpeg"" /></div>" 6/20HHVDickey herpes pictures
Lymphadenopathy, pharyngitis, &quot;kissing disease&quot;<r /> "EBV mononucleos
is (HHV 4)<div><img src=""ev (2).jpeg"" /></div>"
6/20HHVDickey herpes
CBC with differential often reveals asolute &amp; relative lymphocytosis and at
ypical lymphocytes.&nsp;&nsp;Heterophile antiodies commonly appear "Epstein
-Barr Virus (HHV 4)<div><img src=""aty.jpeg"" /></div><div><img src=""hetero a.
jpeg"" /></div>"
6/20HHVDickey herpes
"Diagnose this child<r /><img src=""176_urkitss.png"" />"
EBV-associated B
urkitts lymphoma
6/20HHVDickey herpes pictures
"Descried as ""starry night"" on histopathology<r /><img src=""177_urkitts.p
ng"" />"
EBV-associated Burkitts lymphoma
6/20HHVDickey herpes pic
tures

"typical lymphocyte shown elow.&nsp;&nsp;Heterophile antiodies are also a r

esult of this viral infection.<r /><img src=""178_ev.png"" />"
EBV mono
nucleosis<r /> 6/20HHVDickey herpes pictures
True or false: IgG-VC antiodies appear early in the illness (EBV) ut persist-thus their presence indicates acute or prior infection.&nsp;&nsp;ntiodies t
o EBN indicate past infection (IgG-EBN).
"True<div><img src=""profile.jpe
g"" /></div>" 6/20HHVDickey herpes
Which antivirals prescried for EBV mononucleosis?
None, they show no clini
cal enefit.--&gt; instead give <>steroids</>. Most manifestations are a resul
t of host immune response to the virus. 6/20HHVDickey herpes
nswer = B<r /><r />(179_question)
"<img src=""179_question.png"" />"
classQ
"<img src=""180_question.png"" />"
nswer = B; cell mediated immune respons
e is most important<r /><r />(180_question) classQ
Causes roseola, has two variants&nsp; HHV 6 (6 and 6B)
6/20HHVDickey he
rpes
What is another name for &quot;sixth disease&quot;?
Roseola (caused y HHV 6
)
6/20HHVDickey Herpes
"Patient presents with high fever, irritaility, inflamed tympanic memranes.&n
sp;&nsp;Fever then resolves and patient gets diffuse rash<r /><img src=""181_
roseola.png"" />"
roseola (HHV 6B)
6/20HHVDickey herpes pictures
"Child has ferile illness for 3-5 days followed y development of a diffuse ras
h as the fever aates.<div><img src=""hhv.jpeg"" /></div>"
Roseola (HHV 6B)
6/20HHVDickey herpes
"<img src=""182_question.png"" />"
nswer = D<r /><r />(182_question)
classQ
Patient presents with fever that resolves ut a maculopapular rash then appears.
HHV 6B (roseola)
6/20HHVDickey Herpes
Which herpes virus is associated with Kaposis sarcoma? HHV 8 (Kaposis Sarcomassociated Herpesvirus) 6/20HHVDickey herpes
Infects endothelial and spindle cells in vascular tumor tissue of Kaposis sarco
ma.&nsp;&nsp;Genome encodes proteins associated with proliferation, mitogenic
activity, and anti-apoptotic activity. HHV 8 (infection with HHV 8 precedes KS)
6/20HHVDickey herpes
Causes multicentric Castlemans disease (angiofollicular lymph node hyperplasia)
HHV 8 6/20HHVDickey herpes
"Diagnose this patient.&nsp;&nsp;What virus causes this?<r /><img src=""183_
kaposis.png"" />"
Kaposis sarcoma (HHV 8)
6/20HHVDickey herpes pic
tures
nimal handler is itten y a monkey, gets fatal encephalitis Herpes simiae (H
erpes B)
6/20HHVDickey herpes
Common pathogen of old world monkeys.&nsp;&nsp;Highly pathogenic for humans, w
hat do humans get?
"Herpes simiae (Herpes B)<div><img src=""monkey.jpeg"" /
></div><div><r /></div><div>People invarialy get encephalitis&nsp;</div>"
6/20HHVDickey herpes
"Ferile illness for 4 days followed y this rash<r /><img src=""184_roseola.p
ng"" />"
Roseola (HHV 6B)
6/20HHVDickey herpes pictures
Causes primary effusion lymphomas and Castlemans disease
"HHV 8<div><r /
></div><div><img src=""paste-351719166837366.jpg"" /></div>"
6/20HHVDickey he
rpes
Definition: inflammation of the stomach and intestine. gastroenteritis 5/23GIvi
rusRD GI_virus
nother name for loody diarrhea.
dysentery
5/23GIvirusRD GI_virus
True or false: Diarrhea is the 3rd leading cause of death worldwide, with most v
ictims eing children true
5/23GIvirusRD GI_virus
Most common cause of diarrhea requiring hospitalization of infants and younger c
hildren in all areas of the world.
rotavirus
5/23GIvirusRD GI_virus M
CC
nswer = C<r /><r />(185_vira
"<img src=""185_viraldiarrhea.png"" />"
ldiarrhea)
classQ

This virus is a memer of the family <>reoviridae</> and has a segmented dsRN
genome (thus co-infection of cells with more than one virus results in reassort
ment of gene segments and new properties).&nsp;&nsp;Seven groups identified a
sed on core antigen VP6 (-G) rotavirus
5/23GIvirusRD GI_virus
Seven groups identified ased on core antigen VP6.&nsp;&nsp;Group  is most co
mmon in humans rotavirus
5/23GIvirusRD GI_virus
Outer capsid proteins ____, _____ &nsp;define serotypes, and antiodies to thes
e proteins can neutralize rotavirus
<div>VP4 (P type) and VP7 (G type)</div>
5/23GIvirusRD GI_virus
Most important cause of severe diarrhea in infants and young children worldwide.
&nsp;&nsp;Most infections occur within the first 3 years of life (give group o
f virus)
Group  rotavirus
5/23GIvirusRD GI_virus
Which virus--enterocyte destruction results in malasorption; secondary crypt hy
perplasia leads to secretory diarrhea.&nsp;&nsp;Toxic effects of a nonstructur
al viral protein (NSP4) "rotavirus<div><img src=""patog.jpeg"" /></div>"
5/23GIvirusRD GI_virus
What shouldnt you drink milk after diarrhea from a rotavirus? ecause the <u>e
nterocytes are where you metaolize lactose</u> and (since theres destruction o
f the enterocytes) thus theres a temporary lactose intolerance seen after diarr
hea
5/23GIvirusRD GI_virus
Child presents with vomiting, diarrhea, adominal pain, fever, and dehydration.&
nsp;&nsp;ELIS assay of stool detects VP6 protein.
group  rotavirus
5/23GIvirusRD GI_virus
Which virus--two new vaccines recently have een licensed y the FD for use in
infants etween the ages of 6-32 weeks. rotavirus
5/23GIvirusRD GI_virus
What should e included in the drinking solution for oral rehydration therapy in
treating viral diarrheal illness?
adding sugar to a salty solution facilit
ates asorption of the salt and water across the gut epithelium 5/23GIvirusRD GI
_virus
<>Reovirus</> that causes fever, myalgia, encephalitis.&nsp;&nsp;Vector is t
he tick.
Colorado Tick Fever (Colti)
5/23GIvirusRD GI_virus
"Most common cause of <><font color=""#ff0000"">acute gastroenteritis</font></
> in the US." norovirus
5/23GIvirusRD GI_virus MCC
Gastroenteritis outreaks on cruise ships, planes, rafting trips, restaurants, c
atered events.&nsp;&nsp;Consider who? norovirus
5/23GIvirusRD GI_virus
Identical inoculum of what virus can produce widely divergent clinical manifesta
tions. "<div>norovirus</div><div><img src=""norwalk.jpeg"" /></div>" 5/23GIvi
rusRD GI_virus
Serotypes 40 and 41 are associated with diarrhea. Viral.
enteric adenovir
us
5/23GIvirusRD GI_virus
2nd most common cause of severe diarrhea in infants
enteric adenovirus
5/23GIvirusRD GI_virus
Know the <>inflammatory</>, non-inflammatory, parasites of infectious diarrhea
.<r /><r /> "<div><img src=""187_diarrhea.png"" /></div>SSC E.C.E.<div><r
/>Noninflammatory diarrhea: symptomatic treatment.&nsp;&nsp;Fluid and electrol
yte therapy is cornerstone of managment.<r />Inflammatory diarrhea: cutlure of
stool (+/- cytotoxin assay); consider empire antiiotic therapy (except if you s
uspect EHEC)<r />Parasitic diarrhea: specific antiparasitic therapy is indicate
d</div>"
5/23GIvirusRD GI_virus pictures
"<img src=""188_question.png"" />"
nswer = C<r /><r />(188_question)
classQ
nswer = C<r /><r />(189_question)
"<img src=""189_question.png"" />"
classQ
"<img src=""190_question.png"" />"
nswer = C; had een on a ackpacking tr
ip drinking water from the streams<r /><r />(190_question) classQ
"1 day old term infant orn to a 15 y/o primagravida y spontaneous vaginal deli
very.&nsp;&nsp;Prenatal care 6 weeks prior to delivery.&nsp;&nsp;Maternal la
s: RPR, HepB, HIV negative, Ruella immune.&nsp;&nsp;pgars 7 and 9.&nsp;&n
sp; &quot;lueerry muffin&quot; rash was noted. Weight &lt;10%, length &lt;10%
. Intrauterine growth retardation (IUGR).&nsp;&nsp;Exhiits petechial and purp

uric skin lesion, microcephaly, distended adomen, decreased tone. Most likely v
irus?<r /><img src=""191_CMV.png"" />"
CMV (HHV 5)<r /><r />(191_CMV
)
Congenital_infxns Dickey case classQ herpes pictures
Most common virus, acteria, and protozoa that cause transplacental infections?
1) CMV<div>2) Treponema pallidum</div><div>3) Toxoplasma gondii</div> Congenit
al_infxns Dickey
Incidence of CMV infection per live irths in US.
1%
Congenital_infxn
s Dickey herpes
Of the 1% of irths infected with CMV, are they usually symptomatic or asymptoma
tic?
"asymptomatic (0.1%)<r /><img src=""192_congenitalCMV.png"" /><r />(
192_congenitalCMV)"
Congenital_infxns Dickey herpes
1% of all infants are infected at irth, ut 90% asymptomatic, 10% symptomatic a
t irth CMV (HHV 5)
Congenital_infxns Dickey herpes
"Which congenital infection is most likely?<r /><img src=""193_CMV.png"" /><r
/>"
CMV (HHV 5) - chorioretinitis shown in the picture
6/20HHVDickey Co
ngenital_infxns herpes pictures
"Which congenital infection?<r /><img src=""194_owlseye.png"" />"
CMV (HHV
5) - owls eye shown 6/20HHVDickey Congenital_infxns herpes pictures
"Infant has<div>jaundice<div>microencephaly</div><div>hepatosplenomegaly.&nsp;&
nsp;</div><div><r /></div><div>Most likely congenital infection?<r /><img src
=""195_CMV.png"" /></div></div>"
CMV (HHV 5)<r />
Congenital_infxn
s Dickey herpes pictures
Infant orn exhiits intracranial calcifications, ophthalmic exam shows choriore
tinitis, BER yields sensorineural deafness.&nsp;&nsp;What congenital infectio
n does this child have? CMV (HHV 5)
Congenital_infxns herpes
Infant shows:&nsp;<div>- elevated ST/LT<div>- thromocytopenia</div><div>- CT
scan shows punctate calcifications adjacent to the left lateral ventricle</div>
<div>- optho exam exhiits chorioretinitis of the right eye.&nsp;&nsp;</div><d
iv><r /></div><div>What congenital infection does this infant have?</div></div>
CMV (HHV 5)
Congenital_infxns Dickey case herpes
"Viral cultures show the following.&nsp;&nsp;What congenital infection does th
is exhiit?<r /><img src=""196_CMV.png"" /><img src=""cmv line.jpeg"" />"
CMV (HHV 5) - when cells ecome infected they heap up 6/20HHVDickey Congenital
_infxns herpes pictures
Most common congenital CMV sequelae.
hearing loss
Congenital_infxns Dickey
MCC herpes
"Male infant orn 37 weeks, thick meconium, poor tone and respiratory effort, ap
gars 3/6/8, multiple petechiae on the chest/ack/extremities, round 0.3-1cm lesi
ons on the palms and soles with desquamation.&nsp;&nsp;Has ilateral axillary
lymphadenopathy.&nsp;&nsp;Which congenital infection does he have?<r /><img s
rc=""197_syphilis.png"" />"
syphilis&nsp; Congenital_infxns Dickey case pi
ctures
Transmission is transplacentally during any trimester of pregnancy and is greate
st with secondary stage of the disease in the mother. Bacterial.
"<div>co
ngenital syphilis</div><div><img src=""syph.jpeg"" /></div>"
Congenital_infxn
s Dickey
Bacterial congenital infection that presents with&nsp;<div>- mucocutaneous lesi
ons</div><div>- hepatosplenomegaly</div><div>- lymphadenopathy</div><div>- osteo
chondritis</div><div>- hemolytic anemia</div> congenital syphilis
Congenit
al_infxns Dickey
"Which congenital infection?<r /><img src=""198_syphilis.png"" />"
syphilis
<r /><r />(198_syphilis)
Congenital_infxns Dickey pictures
Which congenital infection is eing evaluated for? Serology: RPR, MHTP, CSF eva
luation for VDRL, long one films, liver function test congenital syphilis
Congenital_infxns Dickey
Maternal RPR 1:256, TP-P positive, Bay RPR 1:16 and TP-P positive, ay CSF V
DRL positive, liver function tests elevated.&nsp;&nsp;Xrays show fraying of me
taphyses.&nsp;&nsp;What does the ay have? congenital syphilis
Congenit
al_infxns Dickey case
"X-ray of infant shows fraying at the ends of the femur and tiia. What congenit

al infection does the child have?<r /><img src=""219_syphilis.png"" />"

congenital syphilis<r />(osteochondritis)<r />
Congenital_infxns Dickey
pictures
"What common congenital parasitic infection is this?<r /><img src=""200_toxopl
asma.png"" />" toxoplasma gondii<r /><r />(200_toxoplasma) Congenital_infxn
s pictures
"2 day old infant orn at 37 weeks gestation.&nsp;&nsp;Maternal las show RPR,
HepB, HIV negative. &nsp;Mother was ill during 2nd and 3rd month of pregnancy
with a ""flu-like"" illness. Ultrasound at 29 weeks gestation showed hydrocephal
us and hepatosplenomegaly.&nsp;&nsp;What congenital infection does the ay ha
ve?"
toxoplasma gondii
Congenital_infxns Dickey case
Fetus may contract this disease through the placental connection with its infect
ed mother.&nsp;&nsp;The mother may e infected y improper handling of cat lit
ter or ingesting contaminated meat.
toxoplasma gondii
Congenital_infxn
s Dickey
"Which congenital infection is characterized y a ""punched-out"" retinal and ch
oroidal lesion?<r /><img src=""201_toxo.png"" />"
toxoplasma gondii<r />
Congenital_infxns Dickey pictures
Congenital infection transmitted to mother through undercooked meat and/or cat f
eces. toxoplasma gandii
Congenital_infxns Dickey
"<img src=""202_question.png"" />"
nswer = C<r /><r />(202_question)
classQ
nswer = B<r /><r />(203_question)
"<img src=""203_question.png"" />"
classQ
"<img src=""204_question.png"" />"
nswer = C; each year in the US aout 1
in 750 children are orn with or develop disailities as a result of CMV infecit
on.<r /><r />(204_question) MCC classQ
nswer = D; toxoplasma<r /><r />(205_
"<img src=""205_question.png"" />"
question)
classQ
"<img src=""206_question.png"" />"
nswer = E<r /><r />(206_question)
classQ
Which congenital infection causes patent ductus arteriosus and pulmonary artery
stenosis?
"congenital ruella<div><img src=""ruella.jpeg"" /></div>"
Congenital_infxns Dickey
What is the most common cause of hospitalization in pediatrics under 1 year of a
ge?
"respiratory viruses (respiratory syncytial viruses)<div><r /></div><di
v><img src=""paste-603610408813010.jpg"" /></div>"
5/13Paramyxovirus MCC pa
ramyxo
#2 cause of common cold in adults
"coronavirus<div><r /></div><div><img s
rc=""paste-605246791352791.jpg"" /></div>"
5/13Paramyxovirus corona
Parainfluenza type 1 and 3 elong to the genus _____. Paramyxovirus 5/13Para
myxovirus paramyxo
Parainfluenza virus type 2 and 4 elong to the genus ______
Ruulavirus (mum
ps virus also elongs to ruulavirus) 5/13Paramyxovirus paramyxo
Respiratory syncytial viruses elong to the genus _____.
"Pneumovirus<div
><r /></div><div><img src=""paste-607359915262418.jpg"" /></div>"
5/13Para
myxovirus paramyxo
 graduate student, while vacationing in India, is itten y a wild dog.&nsp;&n
sp;When he returns to the US, a few months later, the student is admitted to th
e university hospital complaining of pain on swallowing, increased muscle tone,
and hallucinations.&nsp;&nsp;He appears agitated, confused, and sensitive to 
right light.&nsp;&nsp; neurological exam reveals cranial nerve dysfunction an
d upper motor neuron prolems.&nsp;&nsp;Despite intensive supportive measures,
the patient falls into a coma and soon dies. lyssa virus (raies)
5/13Para
myxovirus case rhado
Bullet shaped, enveloped with surface projections. &nsp;Give family
"Rhadov
iridae--lyssa virus (raies virus)<div><r /></div><div><img src=""paste-6067757
99710162.jpg"" /></div>"
5/13Paramyxovirus rhado
"""foaming at the mouth"" is a classic sign, reflecting the inaility to clear s
aliva ecause of painful spasms of the pharyngeal muscles on swallowing"

"lyssa virus (raies virus)<div><r /></div><div><img src=""paste-60677150474286

6.jpg"" /></div>"
5/13Paramyxovirus rhado
Negri odies seen in neurons
"lyssa virus (raies virus)<div><img src=""negri
.jpeg"" /></div>"
5/13Paramyxovirus rhado
Only vaccine administered after viral exposure and works y oosting the immune
system during the long viral incuation period raies<div><r /></div><div>pass
ive immunization: preformed antiody</div><div>ctive immunization: killed vacci
ne</div>
5/13Paramyxovirus rhado
Virus is present in saliva and, after a ite, spreads up a nerve sheath to the C
NS
lyssa virus (raies virus)
5/13Paramyxovirus rhado
Post-exposure prophylaxis includes local wound care and vaccine on days 0, 3, 7,
and 14 lyssa virus (raies)
5/13Paramyxovirus rhado
Whats the primary raies vector in Houston?
skunk 5/13Paramyxovirus rhado
Saliva introduced through reak in the skin.&nsp;&nsp;Centripetal spread from
peripheral nerve to CNS. 75% ecome ill within 90 days after exposure (most with
in 6 days to 1 year).&nsp;&nsp;Results in progressive encephalitis--uniformly
fatal. raies 5/13Paramyxovirus rhado
"Seen in rain tissue. Diagnose this person<r /><img src=""207_negriody.png""
/>"
lyssa virus (raies)--shown is a Negri ody<r /><r />(207_negriody)
5/13Paramyxovirus pictures rhado
Causes 10-20% of common colds, second only to rhinovirus infections.
coronavi
rus
5/13Paramyxovirus corona
Major viral cause of the common cold
rhinovirus
MCC
Causes the common cold and diarrhea in infants coronavirus
5/13Paramyxoviru
s corona
Causes 20% of all colds, lower respiratory illness, and SRS
coronavirus
5/13Paramyxovirus corona
Type 229E has a metalloprotease human aminopeptidase receptor. coronavirus
5/13Paramyxovirus corona
Whats the receptor for SRS? angiotensin-converting enzyme 2 (CE2) 5/13Para
myxovirus corona
 mother calls her pediatrician, concerned aout her sons &quot;cold&quot;.&ns
p;&nsp;Her son has developed a runny nose and a headache.&nsp;&nsp;By the tim
e she rings her son to the doctor--a week after the onset of the symptoms--the
son has recovered completely.&nsp;&nsp;Its not rhinovirus. coronavirus
5/13Paramyxovirus case corona
responsile for severe acute respiratory syndrome
SRS coronavirus (SRS-C
oV)
5/13Paramyxovirus corona
Clinical manifestations: fever, Koplik spots, cough, coryza, erythematous maculo
papular rash
measles 5/13Paramyxovirus measles paramyxo
"These are Koplik spots.&nsp;&nsp;Diagnose this child.<r /><img src=""208_me
asles.png"" />" measles <r /> 5/13Paramyxovirus measles paramyxo pictures
"Diagnose this child.<r /><img src=""209_measles.png"" />"
measles<r /><r
/>\\ 5/13Paramyxovirus measles paramyxo pictures
n 11-month old who attends day care presents with rashes that lanch upon press
ing as well as fever, conjunctivitis, and runny nose.&nsp;&nsp;The rashes have
spread from the hairline to the trunk and then to extremities over time and hav
e ecome right red and raised.&nsp;&nsp;While the symptoms resolve over a wee
k, the doctor wonders whether the child will ever have neurological prolems fro
m a latent recurring infection, and whether other children in the day care will
have the same illness.&nsp;&nsp;He writes a note to the day care center remind
ing them that all children ages 12-15 months should receive a vaccination for th
is illness.
measles (morillivirus)<div><r /></div><div>Hes concerned aout
SSPE (encephalitis) = sclerosing of rain c of persistent measles infection</d
iv>
5/13Paramyxovirus case measles paramyxo
Suacute sclerosing panencephalitis (SSPE) is a late complication resulting from
a persisting infection that progressively destroys neuronal function leading ev
entually to death
measles 5/13Paramyxovirus measles paramyxo
Patient presents with fever and malaise and luish-white spots on the uccal muc
osa
measles (luish-white spots are Koplik spots) 5/13Paramyxovirus measle

s paramyxo
Infection characteristically involves the parotid glands.&nsp;&nsp;Fever, head
ache, and malaise are present mumps 5/13Paramyxovirus mumps paramyxo
16 y/o male requests the private attention of a doctor for testicular pain.&nsp
;&nsp;He explains that his left testis ecame tender and enlarged yesterday.&n
sp;&nsp; few days efore, he recalls suffering from a mild fever and muscle ac
hes.&nsp;&nsp;The doctor also notes a remarkale swelling of oth parotid glan
ds.&nsp;&nsp;The doctor confirms a diagnosis after seeing the teenagers vacci
nation records. "<div>mumps</div><div><img src=""orch.jpeg"" /></div>" 5/13Para
myxovirus case mumps paramyxo
Causes parotitis, orchitis
mumps 5/13Paramyxovirus mumps paramyxo
"What vaccine-preventale disease causes this manifestation?<r /><img src=""21
0_orchitis.png"" />"
mumps<r />
5/13Paramyxovirus mumps paramyxo
"What vaccine preventale disease does this child have?<r /><img src=""210_mum
ps.png"" />"
mumps 5/13Paramyxovirus mumps paramyxo pictures
Clinical manifestations: parotitis, orchitis, pancreatitis
mumps 5/13Para
myxovirus mumps paramyxo
Cause of acterial tracheitis. "S. aureus<div><r /></div><div><img src=""paste
-718930280710496.jpg"" /></div>"
5/14URIs URI URIDickey
Most common predisposing factor for otitis externa<r> swimming
5/14URIs
URI URIDickey
Bacterial causes of otitis media
S. pneumoniae, H. influenza, Moraxella c
atarrhalis, group  strep
5/14URIs URI URIDickey
The major secondary site of infection of C. neoformans is the meninges &amp; ra
in, causing a __________.
meningoencephalitis (frequently involving asila
r meninges)
fungi fungi_leftoversBrent
ssociated with aplastic crisis in sickle cell anemia patients and erythema infe
ctiosum parvovirus B19 5/16DickeyCantnki 5/16PoxandFriends B19 Dickey
Isolated from patients with progressive multifocal leukoencephalopathy JC virus
polyomavirus
Certain strains cause carcinoma of the cervix and others cause warts on certain
ody sites
"HPV<div><r /></div><div><img src=""paste-514343808532945.jpg""
/></div>"
5/16DickeyCantnki 5/16PoxandFriends Dickey HPV
Fungus that causes thrush, vaginitis, esophagitis, diaper rash candida candida
________ antiodies are simply markers for HBV infection; they do not protect ag
ainst infection "nti-HBcg<div><img src=""HBV.jpeg"" /></div>" hepatitis
RN genome is a riozyme, which is an RN particle ale to cleave and ligate its
elf.
HDV
hepatitis
Replicates and released only from those hepatocytes also infected with HBV, sinc
e HBV surface antigen is required to form infectious particles HDV (HDV cannot
replicate alone)
hepatitis
Whats the only hepatitis DN virus?
hepatitis B virus
hepatitis
Infectious protein adopts an anormal conformation, forming a seed that induces
normal cellular versions of the protein to adopt the aerant form.
prions
prions
Proteinaceous infectious particles
prions prions
True or false: In general, the presence of IgG antiodies to hepatitis viruses i
ndicates past or present infection, and IgM antiodies indicate recent, acute or
active infection
True
hepatitis
What are the las for chronic hepatitis? (4)
Hypoaluminemia<div>prolonged pr
othromin time</div><div>hyperammonemia</div><div>altered glucose metaolism</di
v>
hepatitis
What virus is in the picornavirus family and hepatovirus genus? "HV<div><img sr
c=""fecal oral.jpeg"" /></div><div>pico= small</div><div><r /></div><div>PERCH
on a Pico</div>"
hepatitis
Which hepatitis virus is in the hepevirus family?
"HEV<div><img src=""feca
l oral.jpeg"" /></div>" hepatitis
Hepatitis virus with a pregnancy risk of 10-30%.
HEV
hepatitis
Hepatitis virus with partially dsDN genome.
HBV
hepatitis
Primary way of spread for HBV. (sex)
"heterosexual<r /><img src=""212_HBVsp

read.png"" /><r />"

hepatitis
Which hepatitis virus is in the flavivirus family?
"hepatitis C virus<div><
img src=""dc.jpeg"" /></div><div><r /></div><div>flaming gay C</div>"
hepatitis
Differentiation etween HSV-1 and HSV-2 is ased on <>type-specific</> antiod
ies to ____
"gG (one of the glycoproteins on the envelope)<div><img src=""en
velope.jpeg"" /></div>" 6/20HHVDickey herpes
"Which virus (specifically) causes this presentation?<r /><img src=""214_herpe
slaialis.png"" />"
HSV-1 (this is Herpes Laialis, or a cold sore) 6/20HHVD
ickey Herpes pictures
For HIV patients with CD4&lt;50 what prophylaxis should e started?
macrolid
es for prevention of disseminated MC 5/27HIVRetroRD HIV
For HIV patients with CD4&lt;200 what prophylaxis should e started?
trimethr
oprim/sulfamethoxazole for prevention of PCP
5/27HIVRetroRD HIV
Which virus? Symptoms are thought to e the result of CTL responses directed aga
inst proliferating B cells.&nsp;&nsp;The virus uses normal B cell iology to e
nter and persist in the memory B cell compartment.
Epstein-Barr Virus (HHV
4)
6/20HHVDickey herpes
The serologic profile of an individual suspected of EBV-mononucleosis yields: Ig
M-VC(-), IgG-VC(+), IgG-EBN(+).&nsp;&nsp;What can e said aout the timecou
rse of his/her infection?
"it occured sometime in the past--IgM-VC antio
dies indicate primary infection, IgG-VC are a marker for infection at some time
, IgG-EBN appear late after several months<div><r /></div><div>IgM-VC- acute<
/div><div>IgG-VC- ever infected</div><div>IgG-EBN- appears after several month
s</div><div><img src=""profile.jpeg"" /></div>" 6/20HHVDickey herpes
Complications of this disease include: encephalitis, oophoritis, pancreatitis, t
hyroiditis
mumps 5/13Paramyxovirus mumps paramyxo
Negri odies are characteristic cytoplasmic inclusions in neurons infected y th
is virus
raies 5/13Paramyxovirus rhado
Rash egins at head and moves down.&nsp;&nsp;Rash is preceded y cough, coryza
, conjunctivitis, and lue-white spots on uccal mucosa measles 5/13Paramyxoviru
s measles paramyxo
You are called to see a 23 y/o illegal immigrant from northern Mexico with seizu
res.&nsp;&nsp;The 2 men who rought him to the emergency room say he has een
&quot;nervous&quot; for days.&nsp;&nsp;On the previous day, he refused to eat
or drink ecause of &quot;pain in the throat&quot;.&nsp;&nsp;They also say he
has een &quot;sloering&quot;.
raies--causes encephalitis
5/13Para
myxovirus case rhado
20 y/o woman is seen in the emergency room for left sided parotitis, sore throat
, jaw pain and low grade fever.&nsp;&nsp;Later that day several unrelated coll
ege students present with glandular swelling, sore throat and fever.
mumps--i
ts an acute viral infection characterized y non-specific prodrome (myalgia, ma
laise, headache, fever) followed y acute onset of unilateral or ilateral tende
r swelling of the parotid or other salivary glands.
5/13Paramyxovirus case m
umps paramyxo
8 y/o oy was rought to your office in pril with a history of runny nose, coug
h, and fever for 2 day efore development of a diffuse maculopapular skin rash.&
nsp;&nsp;The temperature is 101.2 and you note luish-white spots on the ucca
l mucosa as well as presence of conjunctivitis. "measles<div><img src=""measle.j
peg"" /></div>" 5/13Paramyxovirus case measles paramyxo
"What virus is shown elow?<r /><img src=""220_raies.png"" />"
raies (
note the ullet shaped appearance)<div>silver ullet</div>
5/13Paramyxoviru
s pictures rhado
Big complication is suacute sclerosing panencephalitis measles 5/13Paramyxoviru
s measles paramyxo
SRS is a rapidly progressing respiratory illness caused y what virus? coronavi
rus
5/13Paramyxovirus corona
Transfers to humans via animal ite, inds to acetylcholine receptors and enters
peripheral nerves, travels proximally to CNS and infects neurons of the rainst
em and rain.&nsp;&nsp;Cytoplasmic inclusions called Negri odies form

raies 5/13Paramyxovirus rhado

Measles virus is part of what genus?
morillivirus 5/13Paramyxovirus measle
s paramyxo
Mumps virus is part of what genus?
ruulavirus
5/13Paramyxovirus mumps
paramyxo
Major viral cause of group-related or institutional diarrhea
norovirus
5/23GIvirusRD GI_virus
 man goes to India on a hiking trip in the Himalayas.&nsp;&nsp;Upon returning
, he develops nausea, vomiting, malaise, and headache.&nsp;&nsp;His doctor not
ices jaundice and hepatomegaly on physical exam, and las detect increased ST,
LT and direct serum iliruin levels.&nsp;&nsp;Immunization records show that
the man had received HV and HBV vaccines efore leaving.&nsp;&nsp;The sympto
ms are traced ack to a shared water supply along the hiking route
HEV (tra
nsmitted fecal-oral route)<div><r /></div><div>NO VCCINE</div>
case hep
atitis
Organism causing syphilitic chancre.
treponema pallidum
STD
Ulcer is clearly demarcated, raised margin, painless. Regional lymph nodes enlar
ged.
syphilitic chancre
STD
Because the chancre is painless, the disease is usually not recognized in women
or homosexual men.
syphilis (treponema pallidum) Dickey STD
Causes chancroid.&nsp;&nsp;Jagged margin, purulent ase, painful.
Haemophi
lus ducreyi
STD
Regional lymph nodes greatly enlarged, painful ulcer with jagged margin chancroi
d (Haemophilus ducreyi) STD
Multiple small, painful vesicles that often ulcerate ecause of friction from un
derwear.
HSV 2 (causes 80+%)
STD
Venereal warts are caused y what serotypes of HPV?
6 &amp; 11
STD
What stage is syphilis in which its typically diagnosed in women and homosexual
men? secondary--this is ecause the painless primary lesion is often hidden
STD
Widespread maculopapular rash that involves the palms and soles.&nsp;&nsp;Iden
tifying diagnosis for women and homosexual men. secondary syphilis (generalized
rash) STD
True or false: Theres CNS invasion during secondary syphilis true--setting th
e stage for neurosyphilis
STD
How is the clinical manifestation of syphilis in HIV patients different (if at a
ll)?
suprisingly <u>little difference</u> in clinical manifestations of early
infection (primary, secondary).&nsp;&nsp;<div>However, the real prolem is ap
pearance of <u>early neurosyphilis</u>.</div> STD
Wartlike eruptions of vulva, perineum or anus (especially in homosexual men). Hi
ghly contagious. Generally part of secondary syphilis "condyloma lata: these a
re more flat topped whereas HPV condyloma acuminata are more wart like<div><img
src=""condy.jpeg"" /></div>"
STD
How do you diagnose syphilitic chancres?
darkfield exam STD
Once positive remains so for life.&nsp;&nsp;Not useful to diagnose active case
of syphilis
MH-TP; a positive test indicates present or prior infection.&n
sp;&nsp;Only useful to exclude a diagnosis.
STD
 sexually active man seeks medical attention for a wart-like lesion developing
on his genitals. He recalls a painless ulcer on his genitals over a month ago, 
ut now is concerned ecause papules are appearing in his arm pits and palms as w
ell.  dark-field analysis confirms the doctors suspicion.
syphilis (trepon
ema pallidum) STD
 young woman presents with malaise and a rash all over her ody. Upon further q
uestioning, she rememers a lister-like lesion on her laia aout a month ago,
ut she didnt think it was serious ecause it didnt hurt. Most likely organism
?
Treponema pallidum (syphilis) STD
lways positive in secondary syphilis, usually &gt;1:32 (high titer). ntiody t
o ______
antiody to cardiolipin STD
rgyll Roertson pupil also called &quot;Prostitutes pupil&quot;; associated w
ith tertiary syphilis STD

Causes chancroid, a painful venereal ulcer that looks like a syphilitic chancre
Haemophilus ducreyi
STD
Detection of this &quot;autoantiody&quot; is a mainstay in diagnosis of syphili
s
cardiolipin
STD
Disseminated spirochetes proliferate causing lesions to appear on skin. Rash on
trunk, extremities, and involves palms of hands and soles of feet. Be specific
secondary syphilis (treponema pallidum) STD
Has cardiolipin in its cell memrane
Treponema pallidum; its incorporated fr
om mammalian host rather than synthesized --&gt; its then altered so that the h
ost makes antiody to it and detection of this antiody is a mainstay in diagnos
is of syphilis STD
Most reliale way to diagnose primary syphilis detection of treponemes in chanc
re exudate y darkfield exam
STD
Painless lesion (chancre) at inoculation site. Disappears in 3-4 weeks without t
reatment
primary syphilis
STD
How to diagnose herpes (4)?
"<div><>Culture</> from needle aspiration</div
><div><>RN rapid detection</></div><div><>Serology</></div><div>Histopathol
ogy</div><div><div>Tzanck prep (not used much)</div></div><div><img src=""tzanck
.jpeg"" /></div><div><r /></div><div>Serodiagnosis (PCR of lood and CSF)</div>
<div>Primary (sig. rise)</div><div>Recurrent (no change)</div><div>Encephalitis
(4x titer)</div><div><r /></div><div><img src=""sero hsv.jpeg"" /></div><div><i
mg src=""histro.jpeg"" /></div>"
6/20HHVDickey STD herpes
Do STDs generally occur singly? No, exposure to one implies exposure to several.
Must evaluate for other STDs STD
Bacteria that causes gonorrhea. neisseria gonorrhea
STD
Exuerant purulent discharge with pain. Neisseria gonorrhea
STD
Main causative agent of non-gonococcal urethritis.
chlamydia trachomatis
STD
Urethritis without exuerant exudate.&nsp;&nsp;Most likely cause?
chlamydi
a trachomatis STD
True or false: gonococcal and nongonococcal urethritis tend to coexist. Implicat
ion?
True; we <u>always treat for oth</u> STD
Gonococcal or nongonococcal? Painful symptoms, copious urethral discharge, many
WBC
gonococcal
STD
Gonococcal or nongonococcal? Irritating, scanty urethral discharge, few WBC.
nongonococcal STD
In diagnosing urethritis, is a gram stain of pus useful in oth men and women? W
hat to use then?
Men only (very useful); other acteria in women may conf
use result. &nsp;We can use <>PCR</> or <>Thayer-Martin</> medium (chocolat
e agar with suppressive x)
STD
x treatment for gonorrhea.
3rd generation cephalosporin--cefixime, ceftriax
one
STD treatments
Female presents with lower adominal tenderness, tenderness when cervix is moved
, and adnexal tenderness.
pelvic inflammatory disease (gonococci most comm
on in inner cities, chlamydiae most common in university clinics)
STD
Postive in 100% of people with secondary syphilis
RPR (antiody to cardiol
ipin) STD
"Most common helminth infection of the ""ottom illion""."
"ascariasis<div>
<img src=""geo.jpeg"" /></div>" Helminths
"Soil-transmitted helminth infections. K ""unholy trinity""&nsp;"
"1. sca
riasis<r />2. Trichuriasis<r />3. Hookworm<r /><img src=""geo.jpeg"" /><r />
Note: people are poly-parasitized (comination of the 3 aove, especially childr
en)"
Helminths
t what age are most individuals in the ottom illion affected with worms?
"school age (5-15years); this is the peak of their worminess<r /><img src=""22
1_helminths.png"" /><r />(221_helminths)"
Helminths
True or false: Hookworm and other soil-transmitted helminth infections stunt gro
wth, impair memory, and decrease school performance.
true
Helminths
True or false: Hookworm leads to 40% reduction in future earnings.
"True<di
v><img src=""wage.jpeg"" /></div>"
Helminths

"Which worm type is this?<r /><img src=""222_helminths.png"" />"

Trichuri
s (aka whip worms ecause they look like whips); the fat part is the posterior p
art of the worm.&nsp;&nsp;These thread through columnar epithelium cells and t
he posterior part just &quot;flaps&quot; in the wind.&nsp;&nsp;The worm thus l
eads oth an extracellular and intracellular existence.<r /><r />(222_helmint
hs)
Helminths pictures
Where (in the GI tract) are whip worms found? colon (therefore they cause coli
tis)
Helminths
"If this is the colon, what kind of worm is this?<r /><img src=""223_whipworm.
png"" />"
whipworm (trichuris)--posterior part is just &quot;flapping&quot
; in the wind.&nsp;&nsp;Cause colitis.
Helminths pictures
Which worm is eing descried? n individual ecomes infected when they swallow
eggs in the soil.&nsp;&nsp;Larvae hatch in the small intestine and then the wo
rm goes and matures in the colon where it exhiits its specific tropism.
"whipworm<div><img src=""trich.jpeg"" /></div>" Helminths
Colloquial name for trichuris. whipworm
Helminths
Which worm causes this clinical sequelae: dysentery syndrome, colitis, rectal pr
olapse. "Trichuris (whipworm)<div><img src=""prolaps.jpeg"" /></div>" Helminth
s
"Which worm causes this clinical sequelae?<r /><img src=""224_rectalprolapse.p
ng"" />"
whipworm (trichuris)--shown is rectal prolapse. Helminths pictur
es
Which worm life-cycle is eing descried? Eggs are ingested, larvae hatch in sma
ll intestine and enter lood stream (extraintestinal migration) and go to liver,
they also migrate to the heart and reach lung capillaries where they enter alve
olar spaces and elicit eosinophils and IgE.&nsp;&nsp;Larvae migrate up trachea
and are swallowed.&nsp;&nsp;dults mature in the small intestine where they c
ause pathology. "ascaris lumricoides<div><img src=""a lumri.jpeg"" /></div>"
Helminths
Which worm causes Loefflers syndrome? scaris<div><r /></div><div><i>Loeffler
s syndrome is when eosinophils accumulate in the lung in response to a parasiti
c infection</i></div> Helminths
Which worm causes acute intestinal ostruction, pancreatitis, cholangitis, and h
epatitis?
"<div>ascaris</div><div><img src=""ascar.jpeg"" /></div>"
Helminths
Which worm causes Loefflers syndrome (eosinphilic infiltrate) and iliary tract
ostruction? "ascaris<div><img src=""lumri.jpeg"" /></div>" Helminths
"Which worm?<r /><img src=""225_ascaris.png"" />"
ascaris <r /><r />fte
r a single dose of alindozole Helminths pictures
Very important &quot;dog version&quot; of ascaris.
toxocara canis (causes T
oxocariasis)
Helminths
Which worm: Dogs defecate on playground and children acquire the eggs. Eggs hatc
h in small intestine, larvae migrate to liver, lung, and CNS via the loodstream
.&nsp;&nsp;Causes eosinophilic pneumonitis or asthma, hepatitis, and seizures
(if it goes to rain). "toxocariasis (caused y Toxocara canis)<div><img src=""
toxo ca.jpeg"" /></div>"
Helminths
Which worm causes visceral larva migrans and ocular larva migrans?
toxocara
canis (toxocariasis) Helminths
Worm that causes straismus (ocular larva migrans) when it migrates to the eye.
toxocara canii (toxocariasis) Helminths
Worm implicated in the rise of asthma in the inner cities. Potentially most comm
on in the US. &nsp;ffects 1 in 4 frican mericans living in poverty. toxocari
asis
Helminths
"Which worm life-cycle is eing shown?<r /><img src=""226_helminths.png"" />"
toxocara canis (toxocariasis)<r /><r />(226_helminths)
Helminths pictur
es
Which worm: Humans are incidental hosts when they eat fish containing these larv
ae that urrow into our stomachs, causing acute urning ulcers. anisakiasis
Helminths
Name the &quot;unholy trinity&quot;
1. ascariasis<r>2. trichuriasis<r>3. h

ookworm Helminths
85% of hookworm causes are caused y which species?
Necator americanus
Helminths
"Worm exhiits ""questing"" where it stands on its feet on lades of grass and
waves." "necator americanus (hookworm)<div><img src=""quest.jpeg"" /></div>"
Helminths
Larvae penetrate the skin and go the right side of the heart.&nsp;&nsp;Then to
pulmonary artery to lung capillaries.&nsp;&nsp;They enter alveolar spaces (dr
y cought, not really infiltrate), migrate up trachea, get swallowed, and then ad
ults mature in the small intestine and produce eggs.&nsp;&nsp;Eggs pass out fe
ces and larvae hatch and develop in the soil. "necator americanus (hookworm)<d
iv><img src=""quest.jpeg"" /></div>"
Helminths
dult worm injures host y causing intestinal lood loss.&nsp;&nsp;Results in
iron deficiency anemia and protein malnutrition.
"hookworm (necator ameri
canus)<div><img src=""hook.jpeg"" /></div>"
Helminths
Worm secretes anticoagulants--Factor Xa and Tissue Factor VIIIa inhiitors.&nsp
;&nsp;Causes intestinal lood loss
"hookworm (necator americanus)<div><img
src=""hook.jpeg"" /></div>"
Helminths
25 worms can cause 1mL lood loss.
"hookworm (necator americanus)<div><img
src=""hook.jpeg"" /></div>"
Helminths
dult worm injures host y causing intestinal lood lood loss. Secretes anticoa
gulants as well.
hookworm (necator americanus) Helminths
Worm contains hemolysins to reak down RBCs. Ros children of their daily iron i
ntake and results in iron deficiency anemia.
"hookworm<div><img src=""hook.jp
eg"" /></div>" Helminths
"Worm has hemolysins and hemagloinases (highlighted on the CT scan elow).<r
/><img src=""226_hookworm.png"" />"
hookworm (necator americanus)<r /><r /
>(226_hookworm)
Helminths pictures
True or false: theres a direct association etween amount of hookworms one has
and loss of IQ points. "true<div><img src=""iq.jpeg"" /></div>"
Helminth
s
Which worms of the &quot;unholy trinity&quot; are found more commonly early in l
ife? nd late in life? "<img src=""227_helminths.png"" /><r />(227_helminths
)"
Helminths
Who are at risk populations for hookworm disease?
"women (menstruation, pr
egnancy) and children (physical growth stunting, cognitive deficits)<div>Women a
nd children have low iron stores<r /><div><img src=""at risk.jpeg"" /></div></d
iv>"
Helminths
True or false: The World Health ssemly made a formal goal to teach school teac
hers and other non-healthcare professionals how to administer Benzimidazoles in
low-income countries. true
Helminths
"Which is strongyloides?<r /><img src=""228_helminths.png"" />"
ottom o
ne; its thinner and sleeker than hookworm<r /><r />(228_helminths) Helminth
s pictures
"Which worm causes larva currens?<r /><img src=""228_strongyl.png"" />"
"strongyloides; larva currens = <>autoinfection</> with strongyloides filarifo
rm larvae<r /><r /><img src=""life strong.jpeg"" />" Helminths pictures
What factors contriute to the development of strongyloides hyperinfection?
immunosuppressive drugs (ie<> steroids</>) and diseases such as <>HTLV-1</><
div>ie. post transplant</div> Helminths
When diagnosing strongyloides, are we looking for larvae or eggs in the stool?
"larvae--might take <u>multiple fecal exam</u>s looking for larvae<r /><img src
=""229_strongyl.png"" /><r />(229_strongyl)" Helminths
Worm that lives in the colon, migrates out of rectum an deposits eggs in periana
l area.&nsp;&nsp;Causes perianal itching.&nsp;&nsp;Diagnosed y putting a pi
ece of tape on utt and look for eggs. "pinworm (enteroiasis)<div><img src=""e
nteroiasis.jpeg"" /></div>"
Helminths
Which worm: gravid female nocturnally deposits eggs onto perianal skin.&nsp;&n
sp;Eggs adhere to Scotch tape which is how its diagnosed.
pinworm (Entero
ius vermicularis)
Helminths

Major causative agent of lymphatic filariasis (LF)

Wuchereria ancrofti
Helminths
Causes swelling of lims (lymphoedema) and genitals (hydrocoele).&nsp;&nsp;In
its more chronic state it causes the skin to e enormously thickened, rough, har
d, and fissured. Give common name
lymphatic filariasis
Helminths
"Which helminth exhiits this life cycle?<r /><img src=""230_filiariasis.png""
/>"
Wuchereria ancrofti<r /><r />(230_filiariasis)
Helminths pictur
es
Microfilaria come out etween 10pm-4am when mosquitos ite.&nsp;&nsp; "Wuchere
ria ancrofti<div><img src=""Screen Shot 2014-06-11 at 10.06.20 PM.jpg"" /></div
>"
Helminths
Modified eggs that allow them to circulate in lood vessels.&nsp;&nsp;Theyre
ingested y insect vectors during lood meals and exhiit periodicity, enter per
ipheral circulation at night. (e specific)
"microfilariae<div><img src=""mi
cro (1).jpeg"" /></div>"
Helminths
"What do these people have?<r /><img src=""231_elephantiasis.png"" />"
elephantiasis (caused y Lymphatic filariasis)<r />
Helminths pictures
"What does this man have?<r /><img src=""232_elephantiasis.png"" />" elephant
iasis--has hydrocoele of the scrotum<r /><r />(232_elephantiasis)
Helminth
s pictures
When should a diagnosis of lymphatic filariasis e suspected? when an individu
al resides in an endemic region, is eyond the first decade of life, and has lym
phoedema in the extremities or genitalia
Helminths
When diagnosing lymphatic filariasis, when should a lood collection e taken?
at night ecause W. ancrofti exhiits nocturnal periodicity
Helminths
China ecame the first country to eliminate<> lymphatic filariasis</>.&nsp;&n
sp;It did this y administering which drug?
"diethylcaramazine (DEC) (inter
rupted transmission)<div><img src=""mao.jpeg"" /></div><div>&nsp;</div>"
Helminths treatments
Colloquial name for onchocerciasis
River lindness Helminths
Black flies transmit the disease
river lindness Helminths
Which disease is eing descried: 3rd stage larvae injected into skin and stays
in the sucutaneous tissues where it develops nodules.&nsp;&nsp;dults worms d
evelop in the nodules and shed microfilaria.&nsp;&nsp;These microfilaria go to
the head and crawl into the anterior chamer of the eye where they form opaciti
es.
River lindness Helminths
Chronic infection of the sucutaneous tissues.&nsp;&nsp;Can manifest as prurit
is (itching) and sucutaneous nodules.&nsp;&nsp;Causes ocular lesions that pro
gress to lindness. Found in Central and Susaharan frica mostly.
River l
indness (onchocerciasis)
Helminths
"Nodules encase worms that shed microfilaria. What does he have?<r /><img src="
"233_riverlindness.png"" />" River lindess<r /><r />(233_riverlindness)
Helminths pictures
"Sucutaneous nodules encase worms.<r /><img src=""234_riverlindness.png"" />
"
"<div>River lindness</div><div><img src=""nodules.jpeg"" /></div>"
Helminths pictures
"Which helminth infection leads to sclerosing keratitis?<r /><img src=""235_ri
verlindness.png"" />" River lindness<r /> Helminths pictures
Drug of choice for onchocerciasis.
ivermectin (dont use DEC ecause it wil
l exacerate itching!!) Helminths treatments
Which drug targets the onchocerca microfilariae in the sucutaneous tissues?
ivermectin--it thus reduces mf load and prevents lindness
Helminths treatm
ents
"Diagnose this patient.<r><img src=""236_loa.png"" />"
Loiasis (african
eye worm)<r><r>(236_loa)
Helminths pictures
"Which helminth is responsile?<r /><img src=""237_loa.png"" />"
Loa Loa
(Loiasis; frican eye worm)<r /><r />(237_loa)
Helminths pictures
Which worm: causes ocular conjunctivae, calaar swellings
"Loa Loa (Loiasi
s)<div><img src=""loa life.jpeg"" /></div>"
Helminths
"Where are the worms comprising the ""unholy trinity"" found specifically within

the GI tract? Give anatomy too"

duodenum/jejunum: hookworms<r>jejunum/i
leum: ascaris<r>colon: whipworms
Helminths
 traveling physician visits a remote riverside village in a South merican coun
try and discovers that most of the older village inhaitants are lind.&nsp;&n
sp;On physical exam of some of the memers, she notes skin nodules and hyperpigm
ented rashes.&nsp;&nsp;To prevent other village memers from ecoming lind, s
he administers donated <u>__________</u> to many people in the village. Onchocer
ca volvulus (River lindness)<div><r /></div><div><r /></div><div><>Iver</>m
ectin (ivermectin for r<>iver</> lindness)</div>
Helminths case
Transmitted y lack flies.
"River lindness (Onchocerciasis)<div><img src="
"oncho life.jpeg"" /></div>"
Helminths
Causes skin nodules and lindness.&nsp;&nsp;Treated with ivermectin. River l
indness (onchocerciasis)
Helminths
 patient from a tropical village has an enormously swollen scrotum and lower ex
tremity.&nsp;&nsp;The skin around the swelling has ecome scaly and thick.&ns
p;&nsp;The patient rememers feeling enlarged nodes in the groin months efore
the swelling egan, ut ecause of poor health resources in the area, he never s
aw a physician.&nsp;&nsp;Samples of his lood drawn at night show wormlike org
anisms.&nsp;&nsp; visiting doctor strongly recommends that the patient and ot
her villagers sleep with a mosquito net to prevent more infections.
Elephant
iasis (Wuchereria ancrofti)
Helminths case
What is the vector of elephantiasis transmission?
"mosquito<div><img src="
"wuch.jpeg"" /></div>" Helminths case
Name 2 fungi that are endemic to the areas draining into the Mississippi river.
Histoplasma and Blastomyces--visualize a fungi pilot firing a rocket that HITS a
nd BLSTS a hole in the Mississippi River
fungi fungi_leftoversBrent
Fungi endemic to the states rizona, New Mexico, and Southern California.&nsp;&
nsp;Causes systemic infection Coccidioides--visualize Mr. Fungus as he COCKS h
is pistol in the old SOUTHWEST fungi fungi_leftoversBrent
Present in ird and at droppings.&nsp;&nsp;Not encapsulated, despite its name
.
Histoplasma capsulatum fungi fungi_leftoversBrent
Outreaks of pneumonia occur when cleaning chicken coops or spelunking.&nsp;&n
sp;Fungal.
histoplasma capsulatum fungi fungi_leftoversBrent
Polysaccharide encapsulated yeast whose major clinical manifestation is meningoe
ncephalitis.
Cryptococcus neoformans fungi fungi_leftoversBrent
Fungus causing diaper rash or rash in the skin folds of oese individuals.
"<div>candida</div><div><img src=""diaper.jpeg"" /><img src=""fat.jpeg"" /></div
>"
fungi
Forms a complex with ergosterol and disrupts the fungal plasma memrane, leading
to leakage of the cytoplasmic contents and fungal cell death amphotericin B
antifungals
Which antifungal is a glucan synthesis inhiitor?
"echinocandins<div><img
src=""echinocandin.jpeg"" /></div>"
antifungals
ntifungal that causes r<>enal toxicity, acute ferile reaction, anemia, and in
flammation of the vein at the IV site (phleitis).</> amphotericin B antifung
als
Inhiit the cytochrome P-450 enzyme system (14--s
erl-deme
hyl se) which is inv
lved in ergs
erl syn
hesis
zles
n
ifung ls
True r f lse: Viruses d n
h ve rg nelles r ribsmes.

rue--viruses c
n
in ll f
he gene
ic infrm
in, bu
n

he enzymes, needed
 build milli
ns f relic s f
he rigin l virus 5/12Gener lPrincilesfViruses Gener l_v
irus
True r f lse: Hum n cells h ve n RNA-deenden
RNA lymer se s
h
(-) s
r
nded RNA viruses c n
r nscribe nd relic
e. f lse;
herefre
he (-) s
r nde
d RNA viruses mus
c rry
heir wn
5/12Gener lPrincilesfViruses Gener l_v
irus
Ms
cmmn c use f infec
ius crne l blindness in
he US
"here
ic ker
i
6/20HHVDickey MCC heres

is (HSV 1)<div><img src=""her eye.jeg"" /></div>"
Ms
cmmn c use f vir l enceh li
is in
he US
HSV 1 6/20HHVDickey MC
C heres

Af
er reslu
in f
he ini
i l dise se,
he virus rem ins l
en
nd l
er in l
ife re c
iv
in c n c use
he secnd dise se zs
er
V ricell Zs
er Virus (
HHV 3) 6/20HHVDickey heres
Ms
cmmn vir l c use f men
l re
rd
in CMV (HHV 5)
6/20HHVDickey MC
C heres
C uses mnnuclesis, Burki

s lymhm , nd n sh rynge l c ncers. Es
einB rr Virus (HHV 4)
6/20HHVDickey heres
P inful eru
in f vesicles isl
ed

single derm
me dis
ribu
in
Zs
er (Shingles) - c used by V ricell Zs
er Virus (HHV 3)
6/20HHVDickey he
res
Bld wrk reve ls
high whi
e bld cell cun
wi
h
yic l lymhcy
es seen
n
he bld sme r.&nbs;&nbs;The bld ls h s he
erhile n
ibdy mnnucl
esis (c used by Es
ein-B rr Virus - HHV 4)
6/20HHVDickey heres
C uses ex n
hem subi
um/&qu
;six
h dise se&qu
;
HHV 6 6/20HHVDickey he
res
Mnemnic fr DNA viruses.

hey re HHAPPPy viruses<br />Heres<br />He dn
<br />Aden<br />P ilm <br />P rv<br />Px 5/12Gener lPrincilesfViruses G
ener l_virus
Ms
DNA viruses re duble s
r nded, shw ics hedr l symme
ry nd relic
e in

he nucleus where DNA cus
m rily relic
es.&nbs;&nbs;Which 2 DNA viruses br
e k
hese rules?
1. P rv - nly h s single s
r nd f DNA; i
is sim
le s l ying
ONE PAR hle in glf<br />2. Px - i
h s duble s
r nded DNA bu

des n
h ve ics hedr l symme
ry;
he DNA is surrunded by cmlex s
ruc
ur
l r
eins much like bx (POX IN A BOX);
he virus ls relic
es in
he cy

l sm 5/12Gener lPrincilesfViruses Gener l_virus
Which 3 DNA viruses h ve enveles?
heres, he dn , x<div><br /></div><di
v><b>Heres<br />He dn </b><br />Aden</div><div>Plym <br />P illm <br />P
rv<br /><b>Px</b></div>
5/12Gener lPrincilesfViruses Gener l_virus
Which 4 DNA viruses re n ked? P rv, Aden, P v , lym ( illm )<br /><
br />mnemnic - wm n mus
be n ked fr
he PAP sme r ex m
5/12Gener lPrinc
ilesfViruses Gener l_virus
Defini
in: r
z ns wi
h
single fl gellum nd
kine
l s
(m ss f circul
r DNA wi
hin l rge mi
chndrin). kine
l s
id
6/16Pr
z ns2 Pr
z
ns
Tr nsmi

ed by
he bi
e f
he fem le s ndflies (Phleb
mus)-- describe 2 s
ge
s f
r nsfrm
in
"Leishm ni sis--s ndflies injec

he infec
ive s
ge (<b
>rm s
ig
es</b>) during bld me ls, nd
hese re h gcy
sed by m crh ge
s<br /><br />wi
hin m crh ges, rm s
ig
es
r nsfrm in
 <b> m s
ig
es</b>
&nbs; nd re rele sed
 inv de
issues.<div><img src="" s
e-5875515260929.jg
"" /></div>"
6/16Pr
z ns2 Pr
z ns
Wh
re
he 4 m jr 
hgens in
he genus Leishm ni ? L.
ric , L. mexic n ,
L. dnv ni, L. br ziliensis 6/16Pr
z ns2 Pr
z ns
Wh
re
he 4 m in
yes f dise se c used by Leishm ni ?
1. cu
neus<br
/>2. diffuse cu
neus leishm ni sis<br />3. muccu
neus leishm ni sis<br />4.
viscer l leishm ni sis 6/16Pr
z ns2 Pr
z ns
"Wh

ye f leishm ni sis dise se is deic
ed belw?<br /><img src=""A238_leis
h.ng"" />"
cu
neus leishm ni sis--skin ulcers n exsed re s like f ce,
rms, legs<br /><br />(A238_leish)
6/16Pr
z ns2 Pr
z ns ic
ures
"Wh

ye f leishm ni dise se is deic
ed belw?<br /><img src=""A239_leish.
ng"" />"
diffuse cu
neus leishm ni sis--resembles lerm
us lersy<b
r /><br />(A239_leish) 6/16Pr
z ns2 Pr
z ns ic
ures
Which
ye f dise se c used by leishm ni m y lk like lerm
us lersy?
"diffuse cu
neus leishm ni sis<br /><img src=""A239_leish.ng"" /><br />(A239_
leish)" 6/16Pr
z ns2 Pr
z ns
"Wh

ye f dise se c used by leishm ni is deic
ed belw?<br /><img src=""A2
40_leish.ng"" />"
muccu
neus leishm ni sis--des
ruc
in f
he mucus m
embr nes f
he nse, mu
h,
hr
(
ngue s red)<br /><br />(A240_leish)
6/16Pr
z ns2 Pr
z ns ic
ures
"Wh

ye f dise se c used by leishm ni is deic
ed belw?<br /><img src=""A2
41_leish.ng"" />"
viscer l leishm ni sis--fever, weigh
lss, he
slen

meg ly<br /><br />(A241_leish) 6/16Pr
z ns2 Pr
z ns ic
ures

"Wh

ye f dise se c used by leishm ni is deic
ed belw?<br /><img src=""A2
42_leish.ng"" />"
viscer l leishm ni sis<br /><br />(A242_leish) 6/16Pr

z ns2 Pr
z ns ic
ures
Which r
z n c uses Ch g s dise se?
ry nsm cruzi
6/16Pr
z ns2
Pr
z ns
Tr nsmi

ed
hrugh bldsucking reduviid bugs Try nsm &nbs;cruzi (c using
Ch g s dise se) 6/16Pr
z ns2 Pr
z ns
Which dise se--bug
h

r nsmi
s lives in crevices nd cr cks in lw incme hu
sing (ie s
ick nd mud w lled hme wi
h
h
ched rm).&nbs;&nbs;L rgely
dis
e se f rur l r ele
Ch g s dise se 6/16Pr
z ns2 Pr
z ns
The infl mm
ry lesin

he si
e f en
ry f
he  r si
e (like ch ncre in
ch gm 6/16Pr
z ns2 Pr
z ns
rim ry syhilis).
"Dise se c n resen
wi
h Rm n sign (see belw) if
he  r si
e en
ers
hrugh

he cnjunc
iv .<br /><img src=""A243_leish.ng"" />" Ch g s dise se ( cu
e ch
g s)<br /><br />(A243_leish) 6/16Pr
z ns2 Pr
z ns ic
ures
Wh
rg n is rim rily ffec
ed in
he chrnic dise se f Ch g s?
he r

6/16Pr
z ns2 Pr
z ns
In i
s chrnic dise se frm i
c uses c rdimeg ly nd GI meg dise se. ch g s
6/16Pr
z ns2 Pr
z ns
Cmmn n me fr Afric n
ry nsmi sis Afric n sleeing sickness
6/16Pr

z ns2 Pr
z ns
Tr nsmi

ed by
he
se
se fly Afric n sleeing sickness (Afric n
ry nsmi s
is)
6/16Pr
z ns2 Pr
z ns
Af
er n infec
ive bi
e,
he  r si
e is ini
i lly cnfined

he hemlymh
ic
sys
em, bu
i
dv nces

he CNS
Afric n
ry nsmi sis (Afric n sleein
g sickness)
6/16Pr
z ns2 Pr
z ns
Infec
in wi
h T. brucei ______ rgresses mre insidiusly.
g mbiense
6/16Pr
z ns2 Pr
z ns
Infec
in wi
h T. brucei ______
yic lly le ds
 cu
e dise se wi
h r id inv
lvemen
f
he CNS.&nbs;&nbs;De
h usu lly ccurs wi
hin weeks.
rhdesie
nse
6/16Pr
z ns2 Pr
z ns
Which secies c using Afric n Sleeing Sickness is fund in E s
Afric ?
T. brucei rhdesiense 6/16Pr
z ns2 Pr
z ns
Which secies c using Afric n Sleeing Sickness is fund in Wes
Afric ?
T. brucei g mbiense
6/16Pr
z ns2 Pr
z ns
P
ien
resen
s wi
h enl rged cervic l lymh ndes (ie Win
erb

ms sign).&nb
s;&nbs;Recurren
fever nd l
er cm .
Afric n Sleeing Sickness (ms

cmmnly T. brucei g mbiense) 6/16Pr
z ns2 Pr
z ns
Tre
men
fr
he hemlymh
ic s
ge is IV sur min, where s CNS invlvemen

he
r y is mel rsrl.
Afric n Sleeing Sickness<br /><br />N
e: mel rsrl i
s nly
he effec
ive drug fr l
e-s
ge dise se in b
h frms f Afric n
ry n
6/16Pr
z ns2 Pr
z ns
smi sis bec use
he drug crsses
he BBB
Preven
in f wh
dise se is ccmlished
hrugh
se
se cn
rl wi
h L ncien n
e
s?
Afric n Sleeing Sickness
6/16Pr
z ns2 Pr
z ns
CNS dise se is resume when  r si
es re seen in
he CSF r when
lymhcy
ic
lecy
sis f &g
;5 cell/mL is n
ed in
he bsence f  r si
es.&nbs;&nbs;U
Afric n Sleeing Sickness
n CNS invlvemen
, mel rsrl is given.
6/16Pr
z ns2 Pr
z ns
Why is s
ging f Afric n
ry nsmi sis cri
ic l?
bec use f ilure

re


ien
wi
h CNS invlvemen
will le d inevi
bly
 de
h; ls in rri

e CNS
re
men
in n e rly-s
ge 
ien c rries high risk f unnecess ry drug
6/16Pr
z ns2 Pr
z ns

xici
y
An E s
Afric n m n is sked
 le ve his jb f
er ree
edly f lling slee.&n
bs;&nbs;He visi
s
he dc
r hing
 cure his smnlence, s well s ccm
nying he d che nd dizziness.&nbs;&nbs;During
he in
erview,
he 
ien
exl
ins
h
he h d suffered recurring bu
s f fever nd enl rged lymh ndes befr
e
he sleeiness s
r
ed.&nbs;&nbs;The dc
r decides
 erfrm lumb r unc

ure, nd f
er finding fl gell
ed r
z n in
he CSF, he l ns
 s
r

h
e 
ien
n mel rsrl.<div><br /></div><div>Wh
re
he enl rged cervic l ly

mh ndes c lled?</div><div><br /></div><div>If
he CNS sym
ms beg n jus
week
s f
er infeci
n wh
wuld
his me n vs sym
ms mn
hs f
er infec
in?</div>
<div><br /></div><div>If he is being
re
ed wi
h Mel rsrl, wh
des
his in
dic
e bu

he
ye nd s
ge f
he dise se?</div> "Afric n Sleeing Sickne
ss<div><br /></div><div><div>Win
erb

ms cervic l denh
hy</div></div><div><
br /></div><div>Rhdesi n Hum n Afric n Try nsmi sis --+ weeks un
il sym
ms
</div><div><div>G mbi n HAT --+ mn
hs, ye rs un
il sym
ms</div></div><div><br
/></div><div>Tx:</div><div><u>Sur min</u> --+ E rly S
ge Rhdesi n HAT</div><d
iv><u>Pen
midine</u> --+ E rly S
ge G mbi n HAT</div><div><fn
clr=""#ff000
0""><u>Mel rsrl</u> --+ L
e S
ge CNS dise se</fn
></div><div><u>Eflrni
hi
ne</u> --+ L
e S
ge G mbi n HAT</div>"
6/16Pr
z ns2 Pr
z ns c se
Which
ye f Afric n Sleeing sickness is c used by T. brucei g mbiense?
Wes
Afric n Sleeing Sickness 6/16Pr
z ns2 Pr
z ns
Which
ye f Afric n Sleeing Sickness is c used by T. brucei rhdesiense?
E s
Afric n Sleeing Sickness 6/16Pr
z ns2 Pr
z ns
Which
ye f Afric n sleeing sickness ccurs slwly? Wes
Afric n Sleeing Si
ckness (c used by T. brucei g mbiense) 6/16Pr
z ns2 Pr
z ns
Which
ye f Afric n Sleeing Sickness ccurs quickly? E s
Afric n Sleeing si
ckness (c used by T. brucei rhdesiense)
6/16Pr
z ns2 Pr
z ns
Hum ns re
he m in reservir fr which secies c using Afric n Sleeing Sicknes
s?
"<img src="" s
e-10037338570753 (1).jg"" />" 6/16Pr
z ns2 Pr
z
ns
"A wm n devels enl rged lymh ndes nd smnlence f
er ge

ing bi
by fly
nd develing
his r sh.&nbs;&nbs;Di gnse her.<br /><img src=""A244_sleein
gsickness.ng"" />"
Afric n Sleeing Sickness;
he fly w s
he
se
se fly n
d
he lc l re c
in is

ry nsm l ch ncre<br /><br />(A244_sleeingsickness
)
6/16Pr
z ns2 Pr
z ns ic
ures
"Wm n devels
his
ry nsm l ch ncre 6-8 weeks f
er
he nse
f her illne
ss.&nbs;&nbs;Wh
s her di gnsis?<br /><img src=""A245_sleeingsickness.ng""
/>"
Afric n Sleeing Sickness<br /><br />(A245_sleeingsickness)
6/16Pr

z ns2 Pr
z ns ic
ures
Is
he life cycle f Afric n
ry nsmes in
r cellul r r ex
r cellul r? Hw d

hey divide nd where? "ex
r cellul r<div><br /></div><div>bin ry fissin/bdy
fluidsd (bld/lymh/sin l fluid)</div><div><br /></div><div><img src=""
ry li
fe.jeg"" /></div>"
6/16Pr
z ns2 Pr
z ns
A Mexic n m n cml ins
 his dc
r f wrsening cns
i
in nd s
m ch  in
s.&nbs;&nbs;On hysic l ex m,
he dc
r is surrised
 find n enl rged he r

n uscul

in nd mder
e rrhy
hmi .&nbs;&nbs;Fllwing n bdmin l X-r
y reve ling meg cln,
he dc
r exl ins
h
he c n nly ffer sur
ive
r
e
men
.
Ch g s dise se (T. cruzi) (due
 chrnic dise se)
6/16Pr

z ns2 Pr
z ns c se
C uses meg esh gus, meg cln, myc rdi
is. Pr
z n Ch g s Dise se (T. cruzi
)
6/16Pr
z ns2 Pr
z ns
Reservir in L
in Americ ,
r nsmi

ed by reduviid bug Ch g s Dise se (c used b
y T. cruzi)
6/16Pr
z ns2 Pr
z ns
Infl mm
ry lesin c used by T. cruzi Ch gm 6/16Pr
z ns2 Pr
z ns
P
ien
resen
s wi
h Rm n sign nd ch gm
Ch g s dise se (T. cruzi)
6/16Pr
z ns2 Pr
z ns
True r f lse: Mr
li
y ssci
ed wi
h chrnic Ch g s dise se is lms
exclus
ively due
 c rdiv scul r invlvemen
.
True
6/16Pr
z ns2 Pr
z
ns
P
ien
resen
s wi
h ch l si , dysh gi nd is shwn
 h ve meg esh gus.&n
bs;&nbs;P
ien
ls h s cml in
s f cns
i
in nd bdmin l  in.&nbs;&
nbs;EKG exhibi
s dysrhy
hmi s. Ch g s Dise se (T. cruzi)
6/16Pr
z ns2
Pr
z ns
Tre
men
fr wh
dise se is nifur
imx nd benznid zle?
Acu
e Ch g s Dis
e se; chrnic
re
men
is simly sur
ive
6/16Pr
z ns2 Pr
z ns
"This is
he reduviid bug.&nbs;&nbs;Wh
dise se des i

r nsmi
?<br /><img s
rc=""A246_reduviid.ng"" />"
Ch g s dise se<br /><br />(A246_reduviid)
6/16Pr
z ns2 Pr
z ns ic
ures

Chrnic h se f wh
dise se le ds
 c rdi c rrhy
hmi s, meg cln, dysh gi

(frm meg esh gus)? Ch g s dise se 6/16Pr
z ns2 Pr
z ns
"This is
he s ndfly.&nbs;&nbs;Wh
dise se des i

r nsmi
?<br /><img src=""
A247_s ndfly.ng"" />" Leishm ni sis<br /><br />(A247_s ndfly) 6/16Pr
z ns2
Pr
z ns ic
ures
The dise se is rim rily seen in rur l re s bec use
he reduviid bug lives in

he w lls f rur l hu
s. Ch g s dise se 6/16Pr
z ns2 Pr
z ns
Which secies f Leishm ni c uses viscer l Leishm ni sis? (3) L. dnv ni --&g

; Asi /Afric <div>L. Inf n
um --&g
; su
hern Eure</div><div>L ch g si --&g
;
Br zil</div><div><br /></div><div>
hink: Indi , B ngl desh, Br zil, nd Sud n</
div>
6/16Pr
z ns2 Pr
z ns
Which secies f Leishm ni c uses muccu
neus Leishm ni sis? L. br ziliensis
6/16Pr
z ns2 Pr
z ns
A recen
immigr n
frm

ric l cun
ry resen
s wi
h weigh
lss nd fever.&
nbs;&nbs;A hysic l ex m reve ls m ssive he
slenmeg ly nd ssci
ed ede
m , s well s hyerigmen
ed skin 
ches.&nbs;&nbs;The dc
rs rders CBC
nd sleen bisy.&nbs;&nbs;CBC reve ls
hrmbcy
eni , nemi , nd leuken
i , while sleen bisy shws m crh ges cn
ining r
z . Leishm ni sis (L
. dnv ni)
6/16Pr
z ns2 Pr
z ns c se
Als c lled &qu
;k l z r&qu
;
Viscer l leishm ni sis 6/16Pr
z ns2
Pr
z ns
Dissemin
ed chrnic skin lesins resembling lerm
us lersy.&nbs;&nbs;H r
d

re
.&nbs;&nbs;Which
ye f Leshm ni dise se? diffuse cu
neus leishm
ni sis 6/16Pr
z ns2 Pr
z ns
Des
ruc
in f mucus membr nes f
he nse, mu
h,
hr
nd surrunding
issu
es.&nbs;&nbs;Which
ye f Leishm ni dise se?
Muccu
neus leishm ni
sis
6/16Pr
z ns2 Pr
z ns
Lks like lerm
us lersy.&nbs;&nbs;Usu lly ssci
ed wi
h defec
in

he cell medi
ed immune resnse.
"diffuse cu
neus leishm ni sis<br><img
src=""A239_leish.ng"" />"
6/16Pr
z ns2 Pr
z ns
Assci
ed wi
h L. br ziliensis, ls knwn s &qu
;esundi &qu
;.&nbs;&nbs;
muccu
neus leishm ni sis
6/16Pr
z ns2 Pr
z ns
C used by secies f L. dnv ni
Viscer l leishm ni sis (k l z r)
6/16Pr
z ns2 Pr
z ns
"P
ien
resen
s wi
h m ssive he
slenmeg ly.&nbs;&nbs;Bisy f sleen s
hws m crh ges cn
ining r
z (belw).<br /><img src=""A248_leish.ng"" /
>"
Leishm ni sis (L. dnv ni)<br /><br />(A248_leish)
6/16Pr
z ns2
Pr
z ns ic
ures
True r f lse: Liid frmul
ins f Amh
ericin B re incre singly used in
re

men
f viscer l leishm ni sis due
 emergence f drug resis
nce. True
6/16Pr
z ns2 Pr
z ns
Which n
ifung l is being used

re
viscer l leishm ni sis? mh
ericin B
6/16Pr
z ns2 Pr
z ns
An
her n me fr Americ n
ry nsmi sis
Ch g s dise se 6/16Pr
z ns2
Pr
z ns
An
her n me fr Afric n
ry nsmi sis
Afric n Sleeing Sickness
6/16Pr
z ns2 Pr
z ns
Wh
imr
n
 r si
es re fund in
he hylum icmlex ? l smdium seci
es, nd Txl sm gndii
6/17Pr
z ns3 Pr
z ns
I
s n me is derived frm i
s crescen
sh e.
Txl sm (
xn = rc)
6/17Pr
z ns3 Pr
z ns
Pregn n
m
hers, eseci lly
hse wi
hu
revius exsure, re encur ged

vid c
s
 reven
cngeni
l infec
in
6/17Pr


xl sm gndii
z ns3 Pr
z ns
An AIDS 
ien
is brugh


he ER suffering gr nd m l seizure.&nbs;&nbs;T
he m n infrms
he hysici n
h
he h s suffered ersis
en
he d che in
he 
s
few weeks bu
denies ny sensry rblems r we kness.&nbs;&nbs;Fe ring
br in
umr,
he hysici n rders CT sc n.&nbs;&nbs;Hwever,
he sc n ins
e
d reve ls sever l ring-enh ncing m sses in
he 
ien
s br in.&nbs;&nbs;The 
hysici n cnfirms his susicins when he le rns
he 
ien
h s m ny c
s
hm

e.&nbs;&nbs;He exec
s
h

he br in bisy wuld shw crescen
-sh ed
rh

zi
es.
xl sm gndii
6/17Pr
z ns3 Pr
z ns c se
Cngeni
l infec
in c uses in
r cerebr l c lcific
in, chrire
ini
is, hydrc
eh ly, micrceh ly, seizures, men
l re
rd
in

xl sm gndii
6/17Pr
z ns3 Dickey Pr
z ns
Hum ns becme infec
ed by: e
ing undercked me
r cnsuming fd/w
er cn

min
ed wi
h c
feces r by cn
min
ed envirnmen
l s mles (ie ch nging
he
li

er bx).
6/17Pr
z ns3 Dickey Pr
z ns

xl sm gndii
True r f lse: cngeni
l
xl smsis is ms
severe when m
ern l infec
in 
ccurs e rly in regn ncy.
6/17Pr
z ns3 Dickey Pr
z ns

rue
Fr cngeni
l
xl smsis, is fe
l dise se mre severe if
he wm n is infec
e rly 6/17Pr
z ns3 Dickey Pr
z n

ed e rly r l
e in her regn ncy?
s
"M
her h s c
s.&nbs;&nbs;Child is brn is im ired visin nd fundscic ex
ms shws
he fllwing.<br><img src=""A249_
x.ng"" /><br>" cul r
xl sm
6/17Pr
z ns3 Dickey Pr
z n
sis (chrire
ini
is)<br><br>(A249_
x)
s ic
ures
In immuncme
en

ien
s: sym
m
ic, mn-like illness.<br />In immuncm
rmised 
ien
s: enceh li
is, chrire
ini
s.<br />Cys
s inges
ed frm underc
6/17Pr
z ns3 Dickey Pr
z n
ked me
r c
feces
xl sm gndii
s
"HIV+ 
ien
wi
h CD4&l
;100 resen
s wi
h hemi resis nd seech bnrm li
y.<
br /><img src=""A250_
x.ng"" />"

xl sm gndii<br /><br />(A250_
x)
6/17Pr
z ns3 Pr
z ns ic
ures
Tre
men
fr
xl smsis, immuncmrmised nd cme
en

<b>sulf di zine
+ yrime
h mine (bne m rrw suressin) + </b>flinic cid (fr bne m rrw su
ressin<b>&nbs;(chice, 68-95%)<br /></b>OR<br />clind mycin + yrime
h mine
+ flinic cid<br /><br />Tre
men
is in
ended fr cmrmised hs
s, regn n

wmen, nd newbrns.&nbs;&nbs;In nrm l hs
s, dise se is self-limi
ed nd de
s n
require
re
men
.
6/17Pr
z ns3 Pr
z ns
re
men
s
"Wh
secies f m l ri is ch r c
erized by &qu
;duble rings&qu
;?<br /><img
src=""A251_m l ri .ng"" />" "f lci rum<br /><br /><div><br /></div><div><im
g src="" s
e-311217625235615.jg"" /><br />(A251_m l ri )</div>"
6/17Pr

z ns3 Pr
z ns ic
ures
"Which secies f m l ri is shwn belw?<br /><img src=""A252_m l ri .ng"" />"
"v le<div><br /></div><div><img src="" s
e-311213330268319.jg"" /><br /><br /
>(A252_m l ri )</div>" 6/17Pr
z ns3 Pr
z ns ic
ures
"Which secies f m l ri is shwn belw?<br /><img src=""A253_m l ri .ng"" />"
"m l rie<div><br /></div><div><img src="" s
e-311213330268319.jg"" /><br /><br
/>(A253_m l ri )</div>"
6/17Pr
z ns3 Pr
z ns ic
ures
"Which secies f m l ri is shwn belw?<br><img src=""A254_m l ri .ng"" />"
knwlesi<br><br>(A254_m l ri ) 6/17Pr
z ns3 Pr
z ns ic
ures
"Wh
secies f m l ri is shwn belw?<br><img src=""A255_m l ri .ng"" />"
"viv x<div><br /></div><div><img src="" s
e-311213330268319.jg"" /><br /><div>
<br /></div><div>Schuffner d
s<br /><br />(A255_m l ri )</div></div>" 6/17Pr

z ns3 Pr
z ns ic
ures
Ms
cmmn  r si
ic c use f hum n de
h
m l ri 6/17Pr
z ns3 MCC Pr

z ns
Wh
re
he ms
cmmn imr
ed m l ri c ses? (ie wh
2 secies f
he 4)
P. f lci rum (nly ne c using severe/f
l), P. viv x (ms
rev len
)<br /><b
r />NOTE: ms
f
hese imr
ed c ses re frm visi
ing f mily rel
ives (VFRs)
--1/2 re frm Afric
6/17Pr
z ns3 Pr
z ns
Life cycle: (sexu l/ sexu l) m
ur
in in
he msqui
, (sexu l/ sexu l) m
ur
"m l ri <div><br /></div><div><u>sexu l</u> m
ur
in i

in in
he hum n.
n
he msqui
, <u> sexu l</u> m
ur
in in
he hum n.</div><div><img src=""cdc
c r
n.jeg"" /></div>"
6/17Pr
z ns3 Pr
z ns
<div>M l ri life cycle:&nbs;</div><div>Describe
ye f msqui
e, srzi
es,
merzi
es,
rhzi
es, schizn
s</div><div><br /></div><div><br /></div>
"<div><b>Fem le Anheles</b>&nbs;msqui
 bi
e h lid srzi
es in msqui

s liv en
er blds
re m &nbs;<u>srzi
es infec
he
cy
es</u>&nbs; srz

i
es divide in
 merzi
es, burs
ing
he he
cy
e &nbs;<u>merzi
es infec

RBCs</u>&nbs; nd devel in
 ch r c
eris
ic&nbs;<b>
rhzi
es</b>&nbs;
r
hzi
es m
ure in
&nbs;<b>schizn
s</b>, which&nbs;<u>ru
ure
he RBC</u>&nb
s;
 rele se merzi
es, which
hen sre d
 infec

her RBCs</div><div><div>
<br /></div><div><img src=""cdc c r
n.jeg"" /></div><div><br /></div><div><br
/></div><div>A fem le Anheles msqui
 c rrying  r si
es feeds n hum n n
d injec
s
he  r si
es in
he frm f srzi
es in

he blds
re m. The&nbs
;<u>srzi
es</u>&nbs;
r vel

he liver nd inv de liver cells. Over 5-16
d ys,
he srzi
es grw, divide, nd rduce
ens f
hus nds f h lid fr
ms, c lled&nbs;<u>merzi
es</u>, er liver cell. Sme  r si
e secies rem in
drm n
fr ex
ended erids in
he liver, c using rel ses weeks r mn
hs l
e
r. The&nbs;<u>merzi
es</u>&nbs;exi

he liver cells nd re-en
er
he blds

re m, beginning cycle f inv sin f red bld cells, sexu l relic
in, nd
&nbs;<u>rele se</u>&nbs;f newly frmed merzi
es frm
he red bld cells re
e
edly ver 1-3 d ys</div></div><div><b><img src="" s
e-186667868618753.jg""
/></b></div>" 6/17Pr
z ns3 Pr
z ns
Srzi
es en
er individu l he
cy
es nd rduce 10,000
 30,000 merzi
es

h
emerge
 inv de red cells. This blds
re m h se ( sexu l bld cycle) i
s resnsible fr
he signs, sym
ms, nd cmlic
ins f
his disese; g me
c
y
es in red cells nd
he liver infec
in i
self c use n dise se. Ms
infec
i
ns rduce rim ry

ck wi
hin
w
 fur weeks f
er
he msqui
 bi
e cc
urs
m l ri 6/17Pr
z ns3 Pr
z ns
_____________ rele sed frm hs
cell in resnse
 ru
ure f infec
ed red cel
ls.&nbs;&nbs;Sym
ms f
his dise se (ie chills, fever, swe
s, he d che) c n
be mimicked by injec
ing
hese.
Prinfl mm
ry cy
kines, m l ri
6/17Pr
z ns3 Pr
z ns
"L b resul
s shw srzi
es in
he bld s
re m.&nbs;&nbs;Liver bisy shws
m l ri <br><br>(A256_m l

he fllwing<br><img src=""A256_m l ri .ng"" />"
ri ) 6/17Pr
z ns3 Pr
z ns ic
ures
Infec
ed RBCs re cvered wi
h knbs
h
cn
in  r si
e n
igens n
heir sur
f ce.&nbs;&nbs;P r si
e mlecules bind
 rece
rs n hs
v scul r end
heli
l cells resul
ing in lc lized sludging f bld flw which c uses
issue hyx
i , free r dic l rele se, nd rduc
in f ni
rus xide.
m l ri 6/17Pr

z ns3 Pr
z ns
P rxysms f chills, fever, nd he d che ssci
ed wi
h synchrnus rele se f
merzi
es frm RBCs
m l ri 6/17Pr
z ns3 Pr
z ns
Which m l ri secies shws n l
ency nd n recurrences?
P. f lci rum
6/17Pr
z ns3 Pr
z ns
A s
uden
rer
s
 his cllege clinic cml ining f
he &qu
;flu&qu
;.&nbs
;&nbs;He exl ins
h
he h s been suffering frm in
ermi

en
he d ches, fever
, nd muscle ches.&nbs;&nbs;Assuming
he flu,
he hysici n sends
he s
uden

hme wi
h ce
minhen.&nbs;&nbs;Nw, d ys l
er,
he s
uden
re
urns

he
clinic wi
h chills, ex
reme fever, nd debili

ing f
igue.&nbs;&nbs;Physic
l ex m ls reve ls yellw scler nd severe slenmeg ly.&nbs;&nbs;CBC reve l
s lw hem
cri
, nd urin lysis shws hemglbinuri .&nbs;&nbs;Al rmed,
he d
c
r ques
ins
he s
uden
bu
recen

r vels nd le rns
h
he h s jus
re

urned frm visi

 Indi .&nbs;&nbs;A bld sme r shwing ring sh es cnfir
ms
he di gnsis.
m l ri 6/17Pr
z ns3 Pr
z ns c se
Bld sme r shws sm ll rings nd
b n n -like sh e "P. f lci rum<div><img
src=""b nn .jeg"" /></div>"
6/17Pr
z ns3 Pr
z ns
Msqui
 bi
e rele ses srzi
es in

he blds
re m.&nbs;&nbs;These re c
rried
 liver nd infec
he
cy
es.&nbs;&nbs;In
he he
cy
es,
he srz
i
es divide i
 merzi
es.&nbs;&nbs;The liver cells burs
nd rele se
he me
rzi
es which
hen inv de RBCs.
m l ri 6/17Pr
z ns3 Pr
z ns
Wh
secies c uses
he ms
severe frm f m l ri ?
P. f lci rum 6/17Pr

z ns3 Pr
z ns
"Which frm f m l ri ?<br><img src=""A257_m l ri .ng"" />"
Viv x<br><br>(A2
57_m l ri )
6/17Pr
z ns3 Pr
z ns ic
ures
"Which frm f m l ri ?<br><img src=""A258_m l ri .ng"" />"
f lci rum; b n
n
hing = g me
cy
e<br><br>(A258_m l ri )
6/17Pr
z ns3 Pr
z ns ic
u

res
Hum ns he
erzygus fr sickle cell nemi ssess selec
ive dv n
ge ver in
dividu ls wi
h nrm l hemglbin fr wh
dise se?
M l ri 6/17Pr
z ns3
Pr
z ns
gene
ic deficiency in _________ c
ivi
y in RBCs cre
es n inhsi
ble envirn
men
fr m l ri l  r si
es.
G6PDH<div><br /></div><div><b>sickle cell
r i
,

h l ssemi , nd G6PD deficiency cnfers r
ec
in g ins
P. F lci rum!</b><
/div> 6/17Pr
z ns3 Pr
z ns
An
her n me fr beef
ewrm "
eni s gin
<div><img src=""s gin
.jeg""
/></div><div><br /></div><div><img src="" s
e-83528523973238.jg"" /></div>"
DickeyPr
 Helmin
hs
An
her n me fr rk
ewrm "
eni slium<div><img src=""slium ig.jeg""
/></div><div><br /></div><div><img src="" s
e-83528523973238.jg"" /></div>"
DickeyPr
 Helmin
hs
Tre
men
f b
h beef nd rk
ewrms
"r ziqu n
el<div><br /></div><d
iv><img src="" s
e-83532818940534.jg"" /></div>"
DickeyPr
 Helmin
hs
r
e
men
s
Risk f c
r: e
ing rk r h m
h
is undercked r r w
"rk
ewrm (

eni slium)<div><br /></div><div><img src="" s
e-83528523973238.jg"" /></di
v>"
DickeyPr
 Helmin
hs
Le ding c use f <b>eilesy </b> mng His nic children nd in Ls Angeles Cun
"Neurcys
icercsis&nbs;<div><br /></div><div>Firecr cker: T. Slium is

y.
ne f
he ms
cmmn c uses f cquired eilesy<br /><div><br /></div><div><
img src="" s
e-83528523973238.jg"" /></div></div>"
DickeyPr
 Helmin
hs MC
C
A cw r ncher rrives

he ER
errified f
er discvering wrmlike s
ruc
ure
r
ruding frm his nus.&nbs;&nbs;Af
er re ssuring
he m n nd
king r
er his
ry nd hysic l,
he dc
r ex mines
he s
l s mle.&nbs;&nbs;As ex
ec
ed,
he dc
r finds rec
ngul r <b>rgl

id segmen
s</b> wi
h
he n ked ey
e nd uses lw-wer micrsce
 de
ec
<b>eggs.</b>&nbs;&nbs;The dc
r i
ns
ruc
s
he 
ien

 vid <b>rly cked beef</b> in
he fu
ure. "
eni
s gin
(beef
ewrm)<div><br /></div><div><div><br /></div><div><img src=""
s
e-83528523973238.jg"" /></div></div>"
DickeyPr
 Helmin
hs c se
Cys
icerci re inges
ed wi
h r w r uncked rk.&nbs;&nbs;Adul
s m
ure nd
live in
he sm ll in
es
ine where
hey grw u
 10m in leng
h.&nbs;&nbs;Prg
l

ids  ss in feces nd igs inges
eggs which h
ch nd migr
e

issues wh
ere
hey devel <b>cys
icerci</b>
"
eni slium (rk
ewrm)<div><img
src=""slium ig.jeg"" /></div><div><br /></div><div><img src="" s
e-835285239
73238.jg"" /></div>" DickeyPr
 Helmin
hs
Neurcys
icercsis is c used by ne r mre _________________ in
he br in.&nbs
;<div><br /></div><div>Neurcys
icercsis is c used by inges
ing
eni eggs r
l rv e/cys
s?</div>
"Cys
icerci (l rv l s
ge f
eni slium)<div><br /></
div><div>Neurcys
icercsis is c used by inges
ing eggs<br /><div><img src=""cys
DickeyPr
 Helmin
hs

i.jeg"" /></div></div>"
"Belw is
eni slium egg.&nbs;&nbs;Wh

hlgy ssci
ed wi
h seizure
s des i
c use?<br /><img src=""A259_neurcys
.ng"" />"
"neurcys
icerc
sis--<b>eggs h
ch in sm ll in
es
ine</b> nd ene
r
e in
es
in l w ll nd
r v
el
 
her
issues.&nbs;&nbs;They frm <b>cys
icerci</b> (ie in br in)<br /><
br /><img src=""cys
i.jeg"" />"
DickeyPr
 Helmin
hs ic
ures
"M n resen
s
 BTER seizing.&nbs;&nbs;Dc
r erfrms CT sc n which shws <b
>ring enh ncing lesin</b> nd dc
r
hen rescribes <b>r ziqu n
el nd s
eri
ds</b>
 reduce
he infl mm
in f
he dying cys
s.<br /><img src=""A260_neur
cys
.ng"" />" neurcys
icercsis (
eni slium)<br /><br />(A260_neurcys
)
DickeyPr
 Helmin
hs ic
ures
A Vie
n mese immigr n
f 10 ye rs resen
s wi
h severe he d ches nd seizures.&
nbs;&nbs;A hysic l ex m reve ls sever l ndules crss her bdy.&nbs;&nbs;C
ncerned bu
neurlgic dise se,
he dc
r firs
rders he d CT sc n
h

shws <b>five c lcified cys
s.&nbs;&nbs;</b>This bserv
in, lng wi
h high
esinhils n
CBC, rm
s
he dc
r
 erfrm
bisy f ndule.&nbs;
&nbs;A di gnsis is m de f
er
he dc
r finds <b>cys
s in
he ndule</b>, nd

neurcys
icercs

he 
ien
is begun n <b>r ziqu n
el nd s
erids.</b>
is (
eni slium)
DickeyPr
 Helmin
hs c se
C us
ive gen
f
he hyd
id cys

"Echincccus gr nulsus ( dul
 r si
e
f dgs)<div><img src=""echin.jeg"" /></div><div><br /></div><div><br /></div
><div><img src="" s
e-83528523973238.jg"" /></div>" DickeyPr
 Helmin
hs
"Adul
 r si
e f dgs<div><img src=""dg.jeg"" /></div><div><br /></div><div>
<br /></div>" "Echincccus gr nulsus<div><br /></div><div><img src="" s
e-8
3528523973238.jg"" /></div>" DickeyPr
 Helmin
hs
C uses liver nd lung cys
s when hum n becmes cciden
l in
ermedi
e hs
s
hyd
id cys
(c used by Echincccus gr nulsus)<div>Liver 60%, Lungs 20%</div><
div><br /></div><div><b>Dgs re defini
e hs
. Shee re in
ermedi
e hs</b></
div>
DickeyPr
 Helmin
hs
"R digr hic im ge f
he liver.&nbs;&nbs;C used by Echincccus gr nulsus<b
r /><img src=""A261_hyd
id.ng"" />" hyd
id cys

DickeyPr
 Helmin
hs i
c
ures
"A wm n resen
s wi
h bdmin l discmfr
.&nbs;&nbs;The discmfr
begins s
mild sens
in in
he RUQ bu
h s becme rgressively mre  inful.&nbs;&nb
s;Physic l ex m reve ls he
meg ly.&nbs;&nbs;The dc
r decides
 erfrm
n bdmin l CT, which shws
l rge circul r m ss in
he liver wi
h mul
ile d
ugh
er cys
s enc sul
ed by ""eggshell"" c lcific
ins.&nbs;&nbs;<br /><img
src=""A262_hyd
id.ng"" />"
hyd
id cys
(c used by Echincccus gr nulsus)
DickeyPr
 Helmin
hs c se ic
ures
"C uses
he hyd
id cys
.<br><img src=""A263_echincccus.ng"" />"
echinc
ccus gr nulsus<br><br>(A263_echincccus)
DickeyPr
 Helmin
hs ic
ures
"Which r
z n?<br /><img src=""A264_gi rdi .ng"" />"
"gi rdi l mbli
<br /><br />(A264_gi rdi )<div><br /></div><div><img src="" s
e-84559316124278.
jg"" /></div>" DickeyPr
 Pr
z ns ic
ures
"Describe gi rdi nuclei nd mi
chndri ?<div><img src=""A265_gi rdi .ng"" /><
/div>" "2 nuclei, n mi
chndri <div><br /></div><div><img src="" s
e-8455502
1156982.jg"" /></div>" DickeyPr
 Pr
z ns ic
ures
A s
uden
cu
s shr
n ex
ended b ck cking
ri
 Ysemi
e P rk f
er devel
ing di rrhe .&nbs;&nbs;He exl ins
 his dc
r
h

he di rrhe is <b>nnbl
dy bu
smells very b d.</b>&nbs;&nbs;On fur
her ques
ining,
he s
uden
s
e
lls
he dc
r
h
he h s been drinking w
er frm fresh w
er sring.&nbs;&
nbs;A di rrhe s mle reve ls <b>2-nuclei m
ile meb wi
h 4  irs f fl gell
.&nbs;</b>&nbs;The s
uden
is given me
rnid zle. "gi rdi l mbli <div><br
/></div><div><img src="" s
e-84555021156982.jg"" /></div>" DickeyPr
 Pr

z ns c se
C uses s
e
rrhe , cr ming, bl
ing, n use , nd grw
h re
rd
in in edi

rics. "gi rdi l mbli <div><br /></div><div><img src="" s
e-84555021156982.j
g"" /></div>" DickeyPr
 Pr
z ns
"Oblig
e in
r cellul r  r si
e
h
c uses w
ery di rrhe , eseci lly mng H
IV 
ien
s.&nbs;&nbs;The r
z infec
s g s
ric ei
helium. Di gnsed n c
id f s
s
in.<br /><img src=""A266_cry
sridium.ng"" />" "cry
sridium
 rvum<br /><div><br /></div><div><img src="" s
e-84679575208566.jg"" /></div
>"
DickeyPr
 Pr
z ns ic
ures
An HIV 
ien
becmes l rmed f
er develing ersis
en
di rrhe .&nbs;&nbs
;He
ells his hysic n
h

he di rrhe is w
ery nd wi
hu
bld.&nbs;&nbs
;Un le rning
h

he 
ien
visi
ed v c
in f rm befre his di rrhe s

r
ed,
he dc
r rders n cid-f s
s
in f
he 
ien
s s
l s mle.
"cry
sridium  rvum<div><br /></div><div><img src="" s
e-84675280241270.jg
"" /></div>"
DickeyPr
 Pr
z ns c se
"Piggy b cks n
 surf ce f <b>inwrms</b>.&nbs;&nbs;Assci
in wi
h en
er
bius infec
in (<b>inwrm</b>).&nbs;&nbs;Linked
 chrnic bdmin l  in/g s

ren
eri
is.<br /><img src=""A267_fr gilis.ng"" />" dien
meb fr gilis
DickeyPr
 Pr
z ns ic
ures
A
een ge girl cml ins f v gin l i
ching nd burning.&nbs;&nbs;Sexu l his

ry reve ls numerus sexu l  r
ners.&nbs;&nbs;Her gyneclgis
erfrms elv
ic ex m nd finds greenish, ful-smelling
hin disch rge frm
he v gin .&nbs
;&nbs;A we
mun
f
he disch rge reve ls m
ile meb , e ch wi
h 1 nucleus

nd 5 fl gell .&nbs;&nbs;The 
ien
is s
r
ed n me
rnid zle.

"
richm
n s v gin lis<div><br /></div><div><img src="" s
e-127040837649014.jg"" /></d
iv>"
DickeyPr
 Pr
z ns c se
"10X higher in
he US in Afric n Americ n wmen.&nbs;&nbs;C-f c
r in HIV/AID
S.<br /><img src=""A268_
richmn s.ng"" />"

richmn s v gin lis<br /><br /
>(A268_
richmn s)
DickeyPr
 Pr
z ns ic
ures
"L rge glycgen-like v cules.<br /><img src=""A269_bl s
cys
is.ng"" />"
bl s
cys
is hminis<br /><div><br /></div><div><i>P
hgenici
y is cn
rversi
l</i></div>
DickeyPr
 Pr
z ns ic
ures
C us
ive gen
f hum n mebi sis
"<div>En
meb his
ly
ic </div><div><b
r /></div><div><img src="" s
e-85263690760822.jg"" /></div>" DickeyPr
 Pr

z ns
"Ms
cmmn in
ric l re s where crwded living cndi
ins nd r s ni

i
n exis
s.&nbs;&nbs;H s bike wheel wi
h skes e r nce.<br /><img src=""A
270_en
meb .ng"" />" "en
meb his
ly
ic <div><br /></div><div><img src=""
s
e-85263690760822.jg"" /></div>"
DickeyPr
 Pr
z ns ic
ures
Af
er c ming
ri
 Mexic, 
ien
visi
s her dc
r cml ining f lse
s
ls nd bdmin l cr ms.&nbs;&nbs;The 
ien
describes
he s
ls s h v
ing flecks f bld nd l
s f mucus.&nbs;&nbs;The dc
r rders s
l sec
imen in which she finds <b>m
ile meb wi
h inges
ed RBCs</b>.&nbs;&nbs;She
s
r
s
he 
ien
n me
rnid zle nd cnsiders CT sc n
 de
ec
ny liver
bscesses.
"en
meb his
ly
ic <div><br /></div><div><img src="" s
e-852
67985728118.jg"" /></div>"
DickeyPr
 Pr
z ns c se
C uses mebic dysen
ery, mebic cli
is, liver bscess
"en
meb his

ly
ic <div><img src=""en
life.jeg"" /></div><div><br /></div><div><img src=""
s
e-85263690760822.jg"" /></div>"
DickeyPr
 Pr
z ns
"C uses mebic cli
is.<br /><img src=""A271_en
meb .ng"" />"
"en
me
b his
ly
ic <br /><br />(A271_en
meb )<div><br /></div><div><img src="" s
e
-85263690760822.jg"" /></div>" DickeyPr
 Pr
z ns ic
ures
"Shwn belw is sir
in f mebic liver bscess.&nbs;&nbs;Wh
c used
his?
<br /><img src=""A272_en
meb .ng"" />"
"en
meb his
ly
ic --describe
d s nchvy  s
e liver bscess<div><br /></div><div><img src="" s
e-852636907
60822.jg"" /></div>" DickeyPr
 Pr
z ns ic
ures
"W
er-brne infec
in.&nbs;&nbs;Oblig
e sn il in
ermedi
e hs
<br /><img sr
c=""A273_fluke.ng"" />"
fluke--
hey h ve m le nd fem le rg ns (herm h
rdi
ic)<br /><br />(A273_fluke)
Helmin
hs ic
ures
Orien
l liver fluke
r nsmi

ed
hrugh uncked fish.&nbs;&nbs;H s sn il in

ermedi
e hs
. Fund in Chin (Gu ngdng) nd Kre
"Clnrchis sinensis<div
><img src=""clnr life.jeg"" /></div>"
Helmin
hs
"Orien
l liver fluke
r nsmi

ed
hrugh uncked fish.&nbs;&nbs;C uses bile
duc

hlgy (ie fibrsis f
he bile duc
).<br /><img src=""A274_fluke.ng""
/>"
clnrchis sinensis
Helmin
hs ic
ures
Fluke
h
c uses recurren
scending chl ngi
is,  ncre
i
is, fibrsis, nd c
hl ngic rcinm in i
s chrnic s

e. "chlnrchis sinensis<div><img src=""Scr
een Sh
(10).jeg"" /></div>" Helmin
hs
Orien
l lung fluke
" r gnimus wes
erm ni<div><img src="" r gn life.jeg
"" /></div>"
Helmin
hs
Tre
men
fr ms
ll flukes. Exce
in? Mech nism
hugh
?&nbs;
r ziqu
n
el--in
erferes wi
h C 2+ in ch nnels

he surf ce f
he  r si
e<div><br /
></div><div>Exce
f scil he
ic , F scil gig n
ic &nbs;(give
ricl bend z
Helmin
hs
re
men
s
le)</div>
Orien
l lung fluke
h
h s been shwn
 be fund in Missuri cr wd ds nd Ben
g l
igers
" r gnimus wes
erm ni<div><img src="" r gn life.jeg"" /></d
iv>"
Helmin
hs
Ms
imr
n
fluke infec
in Schis
smi sis Helmin
hs
Fluke infec
in
h
is
he m jr c use f in
es
in l nd bili ry dise se.&nbs;
&nbs;N me 2 secies. Schis
sm m nsni, Schis
sm j nicum
Helmin
h
s
Fluke infec
in
h
is
he m jr c use f urin ry
r c
dise se (ie squ mus ce
ll c rcinm f
he bl dder), fem le urgeni
l dise se, nd ren l f ilure.

Schis
sm h em
bium Helmin
hs

Schis
sm secies
h
reside in Afric (2) S. m nsni, S. h em
bium
Helmin
hs
Schis
sm secies in Asi
S. j nicum
Helmin
hs
"M le nd fem le flukes live
ge
her.<br /><img src=""A274_flukes.ng"" />"
Schis
sm secies<br /><br />(A274_flukes)
Helmin
hs ic
ures
"This <i>s
ge</i> f
he schis
sme c n direc
ly ene
r
e hum n skin (ie when
yure w ding
hrugh w
er r b
hing).&nbs;&nbs;Wh
s i
c lled?<br /><img
src=""A275_schis
m s.ng"" />"
"cerc ri <div><img src=""schis
 life.j
eg"" /></div>" Helmin
hs ic
ures
An Afric n wm n visi
s her dc
r f
er urin
ing bld.&nbs;&nbs;In her his

ry, she s

es
h
she wrked in freshw
er rice fields befre cming

he U
S.&nbs;&nbs;Cy
scic ex min
in f
he bl dder shws infl mm
ry lesins,
nd urin lysis demns
r
es eggs.&nbs;&nbs;Im ging reve ls hydrnehrsis f

he righ
kidney nd m ss ex
ending frm
he righ
ure
er in

he bl dder.&nbs
;&nbs;She is s
r
ed n r ziqu n
el. Schis
sm h em
bium Helmin
hs c se
Ch r c
erize
he ge rfile fr schis
sme infec
in. Wh
ge des infec
in
e k? "
ends
 be lder kids, dlescen
s, yung dul
s<br /><img src=""A276_
schis
.ng"" /><br />(A276_schis
)" Helmin
hs
"Eggs h ve sines
h
llw
hem
 bre u
f bld vessels nd c use mul
il
e gr nulm s nd infl mm
in (ie in bl dder).<br /><img src=""A277_schis
.ng"
" /><img src=""A278_schis
.ng"" />" Schis
sme--lef
shws egg, righ
shws
gr nulm <br /><br />(A277_schis
)(A278_schis
)
Helmin
hs ic
ures
C uses K
y m fever. Schis
sm j nicum Helmin
hs
Occurs redmin n
ly in Afric
nd Middle E s
.&nbs;&nbs;C uses urin ry gr nul
m s, hem
uri , squ mus cell c rcinm f
he bl dder, nd ren l f ilure.
S. h em
bium Helmin
hs
"Which schis
sm secies exhibi
s
his 
hgenesis?<br /><img src=""A279_schi
s
.ng"" /><br />"
S. h em
bium<br /><br />(A279_schis
)<br /> Helmin
h
s ic
ures
"Which fluke is resnsible fr
his hem
uri ?<br><img src=""A280_hem
uri .ng
"" />" S. h em
bium<br><br>(A280_hem
uri ) Helmin
hs ic
ures
Which schis
sm secies is resnsible fr fem le geni
l schis
smi sis (FGS
) nd fem le urgeni
l schis
smi sis (FUS)? S. h em
bium Helmin
hs
Argu bly
he ms
cmmn gyneclgic l dise se in Afric .
Fem le Geni
l S
chis
smi sis (FGS)--c used by S. h em
bium Helmin
hs
Eggs ldge in bl dder w ll c using bl dder infl mm
in nd subsequen
hem
uri
nd bl dder c rcinm . S. h em
bium Helmin
hs
H s high rev lence f gyneclgic sym
ms (ie bdminelvic  in, menrrh gi
), sexu l dysfunc
in, nd deressive sym
ms.&nbs;&nbs;Is ssci
ed wi
h HI
V infec
in nd ge &l
;30 (yung wmen). (give syndrme)<div><br /></div>
"fem le urgeni
l schis
smi sis (FUS)<div><img src=""gu (1).jeg"" /></div><d
iv><img src=""rev.jeg"" /></div>"
Helmin
hs
Tre
men
fr fem le urgeni
l schis
smi sis r ziqu n
el (
x fr ll flukes)
Helmin
hs
re
men
s
True r f lse: R id im c
 ck ge cs
s 50 cen
s er ersn er ye r
rue--r
vides
re
men
fr
he 7 ms
cmmn neglec
ed
ric l dise ses (NTDs) fr n
en
ire ye r
Helmin
hs
"Secies c using schis
smi sis in Chin .<br /><img src=""A281_schis
.ng"" />
"
S. j nicum<br /><br />(A281_schis
) Helmin
hs ic
ures
N me 4 DNA viruses ssci
ed wi
h c ncer.
HBV, EBV, HHV-8,  illm viruse
s
6/18Viruses ndC ncer Virus_c ncer
N me 2 RNA viruses ssci
ed wi
h c ncer.
HCV, HTLV-1
6/18Viruses ndC
ncer Virus_c ncer
Wh
re r
-ncgenes?
nrm l cellul r genes whse r
ein rduc
s inf
luence <u>grw
h</u> nd <u>differen
i
in</u> f
he cell
6/18Viruses ndC
ncer Virus_c ncer
True r f lse: If
he func
in f 53 r Rb re disru
ed,
hen gene
ic lly d m
ged cells c n underg mi
sis. True
6/18Viruses ndC ncer Virus_c ncer
"<img src=""A282_virusQ.ng"" />"
nswer = C<br /><br />(A282_cl ssQ)

6/18Viruses ndC ncer Virus_c ncer cl ssQ

"RNA ncgenic virus. Ch r c
erized by widesre d cu
neus leukemic infil
r
es
.&nbs;&nbs;P ules, ndules, l ques, 
ches, nd ery
hrderm .&nbs;&nbs;<b
r /><img src=""A283_HTLV.ng"" />"
HTLV-1 ssci
ed ATL ( dul
T-cell leuk
emi )<br /><br />(A283_HTLV)
6/18Viruses ndC ncer Virus_c ncer ic
ures
M ss f hyh e is c lled
______
mycelium
fungi fungi_lef
versBre
n

Wh
l yer f
he skin d derm
hyes inv de? s
r
um crneum fungi fungi_lef

versBren

Trunk nd legs. Kids in
ric l clim
es

ine crris<br><br>N
e: T. r
ubrum less infl mm
in.&nbs;&nbs;M. c nis nd T. verrucsum mre infl mm
in
w/ us
ules
fungi fungi_lef
versBren

Ar
hrsres n u
side f h ir sh f
.&nbs;&nbs;H ir bre ks bve skin surf ce
ec

hrix (
ine c i
is)
fungi fungi_lef
versBren

Ar
hrsres wi
hin h ir sh f
.&nbs;&nbs;H ir bre ks
skin level. end
hri
x (
ine c i
is)
fungi fungi_lef
versBren

Se

e hyh e
h
br nch
cu
e ngles.
Asergillus-- re se

e, cu
e
ngles, ngiinv sive fungi fungi_lef
versBren

CT f ches
shws rund r v l m ss n
s
lk wi
hin
c vi
y wi
h crescen

fungi fungi_lef
versBren

f ir. sergillm
S
ge f sergillus
h
inv des bld vessels.
inv sive ulmn ry ser
gillsis
fungi fungi_lef
versBren

Asergillus in 
ien
s wi
h less severe immuncmrmising cndi
ins (ie di be
chrnic necr
izing sergillsis<br><br>Dn
frge
:

es).&nbs;&nbs;
sergillus c n ls c use e r infxn, sinus infxn, endc rdi
is, nd cu
neus in
fxn
fungi fungi_lef
versBren

A
risk 
ien
s include: di be
ics wi
h ke
 cidsis, ren l f ilure 
ien
s wi

h desferri mine chel
in, leukemic 
ien
s, r bne m rrw
r nsl n
recii
en
s. mucrmycsis
fungi fungi_lef
versBren

Inv des br in nd seen in DKA. Fung l. rhincerebr l mucrmycsis
fungi fu
ngi_lef
versBren

Br d, irregul r, nn-se

e hyh e
h
br nch
righ
ngles.
mucr le
s
fungi fungi_lef
versBren

Chrnic neumni , w r
y ulcers, cld bscesses, lng bnes / ver
ebr e / ribs /
GU
r c
infxns
bl s
myces
fungi fungi_lef
versBren

B sil r meningi
is in d rk-skinned 
ien
s
cccidiides
fungi fungi_lef

versBren

Devel sherule w/ endsres cccidiides
fungi fungi_lef
versBren

Meningenceh li
is + ged igen drings
cry
cccus nefrm ns fungi fu
ngi_lef
versBren

l rge lys cch ride c sule
h
s
ins ink wi
h mucic rmine,
hin b sed buddi
ng
cry
cccus nefrm ns fungi fungi_lef
versBren

In sil where vi n / b
excremen
ccumul
es his
l sm
fungi fungi_lef

versBren

Whi
e, middle- ged m le smkers.&nbs;&nbs;P
ien
s wi
h s
ruc
ur l defec
s in
lung.&nbs;&nbs;Sym
ms mimic TB w/ fever, nigh
swe
s, weigh
lss, c vi
ry
x-r y his
l sm
fungi fungi_lef
versBren

Acquired by
r um
ic incul
in in
 nd bene
h skin frm l n
s.&nbs;&nbs;
Tensynvi
is sr
hrix schenckii
fungi fungi_lef
versBren

HIV 
ien
s wi
h CD4 &l
; 200
risk.&nbs;&nbs;Ms
he l
hy children infec
e
d by ge 4.&nbs;&nbs;F my esinhilic lvel r exud
e
PCP neumni
fungi fungi_lef
versBren

Hyxemi (eseci lly n exercise), hyerc ni , bil
er l diffuse in
ers
i
i l
infil
r
es, ABG shws resir
ry lk lsis wi
h hyxi
PCP
fungi fu
ngi_lef
versBren

Tre
men
is r l b c
rim; life-lng rhyl xis in AIDS 
ien
s wi
h CD4 &l
;
200
PCP
fungi fungi_lef
versBren

Di gnsis nd c use: Frequen
immersin f h nds in H20;  inful redness rund
n ils&nbs;
" rnychi (c used by c ndid )<div><img src="" rn.jeg"" /></
div>" fungi

C uses esh gi
is, v gini
is, ngul r cheli
is c ndid fungi

Tre
men
fr v gin l mycses flucn zle
fungi fungi_lef
versBren

Tre
men
fr r l mycses infec
in
nys

in (swish nd sw llw)
fungi fu
ngi_lef
versBren

Inhibi
s ergs
erl syn
hesis, cncen
r
es in s
r
um crneum "
erbin fine (L
misil)<div><img src=""fung l membr ne.jeg"" /></div>" n
ifung ls
Tre
s rigrs resul
ing frm mh
ericin B
meeridine
n
ifung ls
Which zle? Need g s
ric cid fr bsr
in s give r lly
"ke
cn zle<di
v><img src=""ke
.jeg"" /></div>"
n
ifung ls
Which zle? Excre
ed in urine, en
ers CSF
flucn zle
n
ifung ls
Which zle? C uses dren l excess (edem nd hyk lemi ), give w/ fd r cc
-cl
i
r cn zle
n
ifung ls
Which zle? C uses visin rblems like LSD
vricn zle
n
ifung ls
Which zle? Cvers mucr les secies s cn zle
n
ifung ls
Inhibi
r f
hymidyl
e syn
he
se
h
in
erferes w/ DNA syn
hesis
5-FC
n
ifung ls
M y c use l s
ic nemi b/c i
s cnver
ed by gu
b c
eri in
 chem drug
5-FC
n
ifung ls
Which fungi is di gnsed using cmlemen
fix
in
i
er?
sr
hrix schen
ckii
fungi fungi_lef
versBren

Frms germ
ubes when incub
ed in serum
37 degrees celsius "c ndid lbic n
s<div><img src=""germ
ube.jeg"" /></div>"
fungi
Di gns
ic
es
: ELISA fr g l c
m nn n r be
gluc n sergillus
fungi fu
ngi_lef
versBren

Di gns
ic
es
: cmlemen
fix
in
i
er
sr
hrix schenckii
fungi fu
ngi_lef
versBren

Di gns
ic
es
: Indi ink, l
ex gglu
in
in
i
er cry
cccus nefrm ns
fungi fungi_lef
versBren

Di gns
ic
es
: GMS r immunflurescen
s
in f su
um b
ined by BAL
PCP
fungi fungi_lef
versBren

An
ifung l side-effec
: bnrm l ERG
vricn zle
n
ifung ls
An
ifung l side effec
: decre sed GFR, rigrs
mh
ericin B
n
ifung ls
An
ifung l side effec
: dren l excess i
r cn zle
n
ifung ls
An
ifung l side effec
: l s
ic nemi 5-FC
n
ifung ls
_____ DNA s
r nd is re d nd
r nscribed
 mRNA.&nbs;&nbs;The _____ s
r nd is
ignred.
&nbs;neg
ive; si
ive
5/12Gener lPrincilesfViruses G
ener l_virus
Vir l c sids m y be ics hedr l r helic l.&nbs;&nbs;Which ne cn
ins build
ing blcks c lled c smeres? "ics hedr l<br /><br />Helic l c sids re nly
fund in RNA viruses--
hey re bund
 RNA<div><br /></div><div><img src=""A51
_virus.ng"" /></div>" 5/12Gener lPrincilesfViruses Gener l_virus
DNA virus
h
is n
ics hedr l, relic
es in
he cy
l sm x
5/12Gene
r lPrincilesfViruses Gener l_virus
Hw re
hese DNA viruses like: heres, he dn , x?
hey re enveled
5/12Gener lPrincilesfViruses Gener l_virus
Hw re
hese DNA viruses like? P v , den,  rv, lym nnenveled (n
ked PAP sme r) 5/12Gener lPrincilesfViruses Gener l_virus
RNA virus
h
is sh ed like bulle
Rh bd 5/12Gener lPrincilesfViruses G
ener l_virus
Duble s
r nded RNA virus
"revirid e<div><br /></div><div><fn
clr=""#
ff0000""><b>Asked n ll
es
s</b></fn
></div><div><fn
clr=""#ff0000""><b><
br /></b></fn
></div><div>""Re gr nde h s 2 shres""</div>" 5/12Gener lPrinc
ilesfViruses Gener l_virus
Nnenveled RNA viruses (4)
c lici, icrn , revirid e nd herevirus<div><
br /></div><div>CPR + herevirus</div> 5/12Gener lPrincilesfViruses Gener l_v
irus
An
igenic ____ le ds
 glb l  ndemics.
shif

5/12Gener lPrincilesfV
iruses Gener l_virus
Viruses wi
h segmen
ed genmes
h
llw re ssr
men
. "<b><fn
clr=""#ff000
0"">BOAR</fn
></b>: Buny , Or
hmyx, Aren , Revirid e<div><br /></div><div>B

r in
he ren by
he re gr nde. Or
h will wrk his buns</div>"
5/12Gene
r lPrincilesfViruses Gener l_virus
Glycr
eins
h
le d

he inhibi
in f vir l syn
hesis in he l
hy cells by
de-reressing n
ivir l hs
r
eins in
erferns
5/12Gener lPrincilesfV
iruses Gener l_virus
Influenz virus
h
c uses cmmn cld syndrme
Influenz C
influenz
Influenz virus A/B/C belng
 wh
f mily?

r
hmyxvirid e

influenz

H s rece
r binding c
ivi
y--binds si lic cid rece
rs

hem gglu
inin
influenz
Ac
ivi
y blcked by sel
mivir neur minid se influenz
Prm
es rele se f virins frm infec
ed cells neur minid se influenz
Immuni
y
 influenz rim rily rel
ed
 n
ibdies g ins
_____
hem gglu

inin influenz
Tw membr ne sike r
eins f influenz
hem gglu
inin & m; neur minid s
e
influenz
Cmbin
in f resir
ry sym
ms (ie dry cugh, h ryngi
is) nd sys
emic sym

ms (ie fever, my lgi , m l ise).&nbs;&nbs;High illness r
es in schl- ged
kids, highes
hsi
liz
in in very yung nd ld, highes
mr
li
y in ld.
influenz
influenz
Kids wh receive sirin fr cu
e vir l infec
ins f
en devel
his neurlgi
c cmlic
in f
he influenz .
Reyes syndrme influenz
Resul
f m jr ch nge in
he HA r NA (ie g frm H3N1
 H1N1)
n
igeni
c shif
=  ndemic; rises frm re ssr
men
f genes frm vi n r nim l virus
es.&nbs;&nbs;All ele re susce
ible--influenz A nly!! influenz
Preven
s unc
ing f
he virus in
he hs
cell.&nbs;&nbs;Only effec
ive g i
ns
influenz A, n
B "M2 in ch nnel inhibi
rs-- m n
dine, rim n
dine<div>
<img src=""mech nism.jeg"" /></div><div><br /></div>" influenz
Blcks NA, wrks wi
h flu A nd B
neur minid se inhibi
rs (sel
mivir, z
n mivir)
influenz
Triv len
v ccine, recmmended fr 50+ ye rs ld, children 6 mn
hs
 18 ye rs,
influenz
regn n
wmen, ersns wi
h chrnic c rdiulmn ry dise se flu
True r f lse: Sever l viruses encde ncr
eins
h
c

 disru

he cn
r
l f
he cell cycle by cri
ic l
umr suressr r
eins, including Rb nd 53
.&nbs;&nbs;If
he func
ins f 53 r Rb re disru
ed,
hen gene
ic lly d m g
ed cells c n underg mi
sis. True
6/18Viruses ndC ncer Virus_c ncer
Wh
des HTLV-1 c use?&nbs; C uses <u> dul
T-cell leukemi /lymhm </u> (AT
L) in <u>1-4%</u> f c rriers 6/18Viruses ndC ncer Virus_c ncer
C rries &qu
;
x&qu
; gene llwing i

 uregul
e cell grw
h by in
erferin
g wi
h 53/Rb nd c use dul
T-cell lymhm
HTLV-1 6/18Viruses ndC ncer Vir
us_c ncer
"Infec
in c uses cirrhsis nd he
cellul r c rcinm (HCC).&nbs;&nbs;Le di
ng infec
ius c use f chrnic liver dise se in
he US<br /><img src=""A284_hcc.
HCV--
hgenesis e rs
 be rel
ed
 chrnic infl mm
in.
ng"" />"
&nbs;&nbs;Dise se devels f
er 2 r mre dec des f infec
in.<br /><br />(A
284_hcc)
6/18Viruses ndC ncer MCC Virus_c ncer ic
ures
HCV is ssci
ed wi
h wh
m lign ncies?
<div>C uses <u>he
cellul r c
rcinm </u> nd <u>slenic lymhm wi
h villus lymhcy
es (B cell lymhm )</
u></div>
6/18Viruses ndC ncer Virus_c ncer
"<img src=""A285_cl ssQ.ng"" />"
Answer = A<br><br>(A285_cl ssQ) 6/18Viru
ses ndC ncer Virus_c ncer cl ssQ
True r f lse: Theres huge incre se risk f he
cellul r c rcinm in 
ie
n
s wh re _______ si
ive
"HBsAg+ (risk 223x gre
er)<div><img src=""risk.
jeg"" /></div>"
6/18Viruses ndC ncer Virus_c ncer
C uses n sh rynge l c rcinm , fric n burki

s lymhm , sme Hdgkins lym
hm
EBV
6/18Viruses ndC ncer Virus_c ncer
"Wh
is
his? Wh
DNA virus c used
his?<br /><img src=""A286_burki

.ng"" />
"
Afric n Burki

s Lymhm ;&nbs;EBV
6/18Viruses ndC ncer Virus_c nce

r ic
ures
"P
hlgis
describes i
s sm ll nn-cle ved m lign n
cells in
ersersed wi
h
m crh ges.&nbs;&nbs;Wh
s yur di gnsis?<br /><img src=""A287_s
rry.ng"
" />" "burki

s lymhm (frm EBV); ""s
rry sky""" 6/18Viruses ndC ncer Vir
us_c ncer ic
ures
"<img src=""A288_cl ssQ.ng"" />"
Answer = D<br><br>(A288_cl ssQ) 6/18Viru
ses ndC ncer Virus_c ncer cl ssQ ic
ures
C uses k sis s rcm , C s
lem ns dise se, nd rim ry effusin lymhm
HHV-8 6/18Viruses ndC ncer Virus_c ncer
"P
ien
resen
s wi
h widesre d skin lesins.&nbs;&nbs;Bisy shws
h

he
lesins cnsis
f sindle cells wi
h sli
-like v scul r s ces.<br><img src=""
A289_ks.ng"" /><img src=""A290_ks.ng"" />"
K sis s rcm (HHV8)<br><br>(
A289_ks)<br>(A290_ks) 6/18Viruses ndC ncer Virus_c ncer ic
ures
Nnenveled dsDNA virus
h
c uses cervic l c rcinm , n l c ncer in m les,
nd vulv r c ncer
HPV--cervic l nd n l re ms
cmmn 6/18Viruses ndC
ncer Virus_c ncer
"Wh
c uses
his
ye f c ncer?<br><img src=""A291_hv.ng"" />"
HPV
6/18Viruses ndC ncer Virus_c ncer ic
ures
"<img src=""A292_cl ssQ.ng"" />"
Answer = B; s
ill susce
ible
 HPV 18<
br><br>(A292_cl ssQ)
6/18Viruses ndC ncer Virus_c ncer cl ssQ
"<img src=""A293_cl ssQ.ng"" />"
Answer = A<br /><br />(A293_cl ssQ)
6/18Viruses ndC ncer Virus_c ncer cl ssQ
Defini
in: diffuse infl mm
ry rcess invlving
he le
meninges ( r chni
d nd i m
er) f
he br in nd sin l crd meningi
is--c n be c used by ei

her b c
eri , viruses, cid-f s
b c
eri , r fungi
Meningi
is
When is
he e k susce
ibili
y fr meningi
is? (ie wh
ge) 6-24 mn
hs--inc
re sed in nen
es nd elderly (ex
remes f ge)
Meningi
is
Wh
re 3 immunlgic defici
s
h
redisse smebdy
 meningi
is? 1) <b> s
leni </b>--bec use
he sleen cle rs rg nisms frm
he bld during b c
eremi
(func
in l, cngeni
l, cquired)<br />2)<b> n
ibdy dysfunc
in--&nbs;</b>c
ngeni
l, cquired (HIV), rir
 n
ur l cquisi
in (&l
;2yr), r decline wi
Meningi
is

h ge<div>3) <b>cmlemen
deficiency</b></div>
Wh

ye f n
mic l defec
s redisse ne
 meningi
is infec
ins?
"Cngeni
l: dermid sinus r myelmeningcele (ie sin bifid )<br />Acquired:

r um , neursurgery, inv sive
umrs<br /><br /><img src=""A294_bifid .ng"" />
<div><img src=""dermid.jeg"" /></div>"
Meningi
is
"This n
mic l defec
in
his child redisses
hem
 wh
infec
in?<br /><
img src=""A295_meningi
is.ng"" />"
"meningi
is<br /><br /><img src=""dermi
d.jeg"" />"
Meningi
is ic
ures
Age 2 mn
hs
 60 ye rs cquire meningi
is infec
ins frm
he hem
genus ru

e where b c
eri en
er in

he bld s
re m nd relic
e in sufficien
qu n
i

ies
 inv de
he meninges.&nbs;&nbs;Hw is
he ru
e f cquisi
in differen

fr nen
es? "c n cquire frm m
ern l geni
l
r c
r sir
e mni
ic fl
uid<div><br /><div><img src=""m
hern l.jeg"" /></div></div>" Meningi
is
Wh
s
he ms
cmmn c use f meningi
is in
he nen
e?
"gru B s
re<d
iv><img src=""ne.jeg"" /></div>"
MCC Meningi
is
Ms
cmmn c use f b c
eri l meningi
is in dul
s nd children
S. neum
Meningi
is
--f
li
y r
e 13-30%, u
 80% in
he elderly
H s 5 sergrus nd c uses meningi
is
h
m y rgress r idly

f
l u
c
meningccc l me
me (wi
hin hurs). <b>Wh
re ms
cmmn in
he US?</b>
ningi
is--required
 ge
v ccine befre ging
 cllege.&nbs;&nbs;Ser
yes<
b> B, C, Y </b>ms
cmmn in
he US
Meningi
is
"Which c use f meningi
is ls c uses e
echi e nd urur ?<br><img src=""A296
_meningi
is.ng"" />" Neisseri <br><br>(A296_meningi
is)
Meningi
is ic
u
res
Wh
v ccine reven
ble c use f meningi
is h s 5 ser
yes,
he ms
cmmn b
eing B/C/Y?
Meningcccus (N. Meningi
idis) Meningi
is
"Wh
kind f meningi
is is
his?<br><img src=""A297_neisseri .ng"" />"
meningccc l meningi
is<br><br>(A297_neisseri )
Meningi
is ic
ures
Which c use f meningi
is? Incidence h s decre sed 98% since in
rduc
in f v c

cine in 1987. H. influenz
ye B

Meningi
is
Cmmn rg nisms c using nen
l (&l
;2 mn
hs) meningi
is
gru B s
re, E
. cli, Lis
eri
Meningi
is
9 d y ld resen
ed

he emergency rm wi
h fever nd decre sed r l in
ke.&
nbs;&nbs;On ex m
he inf n
w s ill- e ring, irri
ble nd wi
h incre sed

ne.&nbs;&nbs;WBC 10,000. CSF WBC 31,750 (88% neu
rhils).&nbs;&nbs;Glucse
&l
;20, r
ein 731.&nbs;&nbs;Gr m s
in shws gr m neg
ive rds.&nbs;&nbs;
Wh
s
he di gnsis? E. cli meningi
is
c se meningi
is
Ms
cmmn c use f meningi
is in
he firs

w mn
hs f life.
gru B
s
re
Meningi
is
Cl ssic
ri d seen in dul
s wi
h meningi
is
fever, nuch l rigidi
y, ch nge i
n men
l s

us Meningi
is
Wh
s
he n me f
his hysic l finding cmmn in meningi
is?<br />Severe neck
s
iffness c uses
he 
ien
s his nd knees
 flex when
he neck is flexed
"Brukzinskis sign<br /><img src=""A298_brud.ng"" />" Meningi
is
Wh
s
he n me f
he hysic l finding cmmn in meningi
is?<br>Severe s
iffnes
s f
he h ms
rings c uses n in bili
y
 s
r igh
en
he leg when
he hi is fl
exed
 90 degrees
"Kernigs sign<br><img src=""A299_kernig.ng"" /><br>(A2
99_kernig)<br>" Meningi
is
Wh

ye f meningi
is b sed n
hese l b findings?<br>Incre sed ening ressu
re, incre sed WBC wi
h redmin n
ly PMNs, incre sed r
ein, decre sed glucse
b c
eri l meningi
is
Meningi
is
Wh

ye f meningi
is b sed n
hese l b findings?<br>Nrm l ening ressure,
sligh
incre se in WBC wi
h lymhcy
es redmin n
ly, incres sed r
ein, nrm
l glucse
vir l meningi
is
Meningi
is
Wh
re sme 
en
i l cmlic
ins ssci
ed wi
h meningi
is?
"seizure
s, hydrceh lus, inf rc
in, herni
in<div><img src=""cm (1).jeg"" /></div>
"
Meningi
is
Defini
in: infl mm
in c used by inv sin nd relic
in f n infec
ius ge
n
in
he br in nd/r sin l crd. Infl mm
in f
he  renchym
enceh l
i
is
Meningi
is
Wh
re sme viruses imlic
ed in enceh li
is ?
"Hum ns:HSV1 & m; 2, v
ricell zs
er, EBV, En
erviruses, denvirus,&nbs;<div>Anim ls:&nbs;r bies</
div><div>Insec
s: rbviruses</div><div><img src=""se sn.jeg"" /></div>"
Meningi
is
Px virus c using umbilic
ed skin lesins
mlluscum cn
gisum xvirus
55 y/ m n is hsi
lized fr recen
nse
f high fever, he d ches, nd sr
dic sens
ins f smelling s us ges.&nbs;&nbs;Physic l ex m reve ls neck s
if
fness, rm
ing
he hysici n
 erfrm
lumb r unc
ure.&nbs;&nbs;CSF v lu
es indic
e elev
ed lymhcy
es, elev
ed r
ein, nd nrm l glucse.&nbs;&nb
s;A CT im ge cnfirms enceh li
is lc lized

he
emr l lbes.&nbs;&nbs;
The hysici n begins
re
men
wi
h cyclvir. HSV 1 6/20HHVDickey Heres c s
e
ker
cnjunc
ivi
is +
emr l lbe enceh li
is + cld sres HSV 1 6/20HHVD
ickey Heres
"A 34 y/ kidney
r nsl n

ien
is curren
ly n immunsuress n
s cml ins
f shr
ness f bre
h nd cughing.&nbs;&nbs;Physic l ex m reve ls fever nd
bnrm l lung sunds while ches
X-r y indic
es in
ers
i
i l infil
r
es in
h
e lungs.&nbs;&nbs;N cys
s re de
ec
ed n silver s
in f brnch lvel r l v
ge fluid, ruling u
PCP infec
in.&nbs;&nbs;The dc
r m kes di gnsis f

er viewing
s mle f
he 
ien
s lung
issue, which shws bnrm l gi n
cel
ls wi
h ""wls eye"" in
r nucle r inclusins." "CMV (HHV 5)<div><br /></div><di
v><img src="" s
e-114125870989942.jg"" /></div>"
Dickey c se heres
De fness, he
slenmeg ly, micrenceh ly in newbrns
CMV (HHV 5)
Dickey heres
MCC f vir l men
l re
rd
in CMV
6/20HHVDickey Heres MCC

yic l lymhcy
es + he
erhile n
ibdies "EBV (HHV 4)<div><br /></div><di
v><img src="" s
e-352840153301622.jg"" /></div>"
6/20HHVDickey heres
HIV 
ien
s wi
h CD4&l
;200
risk.&nbs;&nbs;F my esinhilic lvel r exu
d
e
PCP neumni
5/27HIVRe
rRD HIV

Ther y fr fung l r l infec
in

nys

in
ID_h rm n
ifung ls fun
gi
Which n
ifung l medic
in? Adren l excess is side effec

"i
r cn zle<di
v><img src=""i
r .jeg"" /></div><div>Needs Cke= umed u dren l!</div>"
ID_h rm n
ifung ls fungi
Which n
ifung l medic
in? Visins rblems re side effec
"vricn zle<di
v><br /></div><div>100% f 
ien
s devel bnrm l <u>ERGs</u>; u
 33% ge


r nsien
visu l dis
urb nces described
 be like n LSD
ri wi
h l
ered cl
r discrimin
in, blurred visin, e r nce f brigh
s
s & m; h
hbi :<
/div><div><img src=""vri sh e.jeg"" /></div>"
ID_h rm n
ifung ls fun
gi
Which n
ifung l medic
in? Al s
ic nemi is side effec

5-FC ( mh
eric
in wuld be nrmcy
ic)<div>( ffec
s bne m rrw nd gu
)</div> ID_h rm n
ifun
g ls fungi
"Wh
d yu give
 reven

he ""sh ke nd b ke"" side effec
f mh
ericin?
"
meeridine (n rc
ic, bu
quiz s ys NSAID is given nd c n c use GI blee
ding) ID_h rm n
ifung ls fungi
Which n
ifung l medic
in? Side effec
s include decre sed GFR, rigrs mh
er
icin
ID_h rm n
ifung ls fungi
blcked by sel
mivir neur minid se ID_h rm influenz
Firs
sign f
his dise se is
h
kids re missing schl, nd being subsequen

ly di gnsed wi
h neumni nd 
i
is medi .&nbs;&nbs;Then dul
s miss wrk
nd ge
secnd ry neumni
influenz
influenz
During
flu u
bre k, neumni is cmmn cmlic
in. Wh

w bugs d yu
need
 m ke sure nd cver in yur
re
men
? S. neum, S. ureus
influenz
Only ffec
ive g ins
influenz A, nly
kes single nucle
ide ch nge
 bec
M2 in ch nnel inhibi
r
me resis
n
<u>s resis
nce emerges quickly</u>
s ( m n
dine/rim n
dine)
ID_h rm influenz

his virus is n me bec use vir l fusin (F) surf ce r
eins c use infec
ed cell
s
 fuse nd frm syncy
i in
he resir
ry
r c

"resir
ry syncy
i l v
irus (RSV)--in f c
, ll viruses f
he f mily <u>P r myxvirid e</u> h ve F(fus
in) r
eins<div><img src=""sync
.jeg"" /></div>"
5/13P r myxvirus  r my
x
#1 edi
ric c use f vir l neumni
RSV
5/13P r myxvirus MCC  r myx
Binds
 hs
cells vi
he CAR-binding dm in n
he knb

he end f
he fib
er.
denvirus
5/16DickeyC n
Anki 5/16Px ndFriends 5/16PxnFriends de
nvirus
Which lym virus c uses ure
er l s
ensis nd hemrrh gic cys
i
is?<div><br />
</div><div>Fund in
r nsl n

ien
s</div> "BK virus - lym virus<div><b
r /></div><div><img src="" s
e-511663748940263.jg"" /></div>" 5/16DickeyC n
An
ki 5/16Px ndFriends 5/16PxnFriends Dickey lym virus
Which  r myxviruses c uses cru?
5/13P r
 r influenz virus 1 nd 2
myxvirus  r myx
Wh
re
he differen
genuses nd subcl sses f  r myxvirid e?
"<u>P r
myxvirus</u> -  r influenz 1 & m; 3<br /><u>Rubul virus</u> -  r influenz
2 & m; 4, <b><fn
clr=""#ff0000"">mums</fn
></b><br /><u>Mrbillivirus</u>
- me sles<br /><u>Pneumvirus</u> - RSV<br /><u>Me
neumvirus</u> - hum n me

neumvirus" 5/13P r myxvirus  r myx
Wh
surf ce r
ein d ll  r myxvirid e sh re?
"fusin (F) r
ein--ind
uces gi n
cell frm
in = synci
ium<div><img src=""sync
.jeg"" /></div>"
5/13P r myxvirus  r myx
True r f lse:
ch r c
eris
ic fe
ure f infec
in wi
h  r myxvirid e is
he
frm
in f syncy
i . Wh
medi
es i

"True;
he F r
ein medi
es
h
is func
in.&nbs;&nbs;An
ibdy
 b
h
he

chmen
nd F r
eins will rev
en
infec
in<div><img src=""sync
.jeg"" /></div>"
5/13P r myxvirus  r my
x
Child resen
s wi
h running nse, red
hr
, nd &qu
;b rking&qu
; cugh.
 r influenz virus 1 5/13P r myxvirus  r myx
Cmlic
ins f
his dise se include enceh li
is, rchi
is, hri
is,  ncre

mums ( rubul virus) 5/13P r myxvirus  r myx

i
is,
hyridi
is
16 y/ m le reques
s
he riv
e

en
in f dc
r fr
es
icul r  in.&nbs
;&nbs;He exl ins
h
his lef

es
is bec me
ender nd enl rged yes
erd y.&nb
s;&nbs;A few d ys befre, he rec lls suffering frm mild fever nd muscle c
hes.&nbs;&nbs;The dc
r ls n
es
rem rk ble swelling f b
h  r
id gl n
ds.
mums ( rubul virus) 5/13P r myxvirus c se  r myx
Affec
s s liv ry gl nd nd c n c use rchi
is mums 5/13P r myxvirus  r my
x
Fever, m l ise, nd Klik s
s
me sles ( mrbillivirus)
5/13P r
myxvirus  r myx
Cmlic
ins include sub cu
e sclersing  nenceh li
is (SSPE).
me sles
5/13P r myxvirus  r myx
P r influenz viruses ___ nd ____ belng
  r myxvirus;  r influenz viruse
s ___ nd ___ belng
 rubul virus
1, 3; 2, 4
5/13P r myxvirus  r my
x
Which virus in  r myxvirid e c uses brnchili
is?
RSV
5/13P r myxviru
s  r myx
Brnchili
is is usu lly c used by ________. Secnd ms
cmmn c use is _______
.
RSV (resir
ry sync
i l virus). Rhinvirus. 5/13P r myxvirus  r my
x
Wh
re
he sys
emic  r myxvirid e? me sles (mrbillivirus) nd mums (rubul
virus) viruses 5/13P r myxvirus  r myx
C uses se
ic meningi
is nd h s
rism fr n
erir hrn m
r neurns.
5/14Picrn viruses icrn virus
livirus
MCC vir l meningi
is
en
erviruses 5/14Picrn viruses MCC icrn virus
<i><u>fec l-r l sre d</u></i>
 CNS&nbs;under cndi
ins f r s ni

in
nd crwding
5/14Picrn viruses icrn virus
li
her ngin + h nd-f
-mu
h dise se
cxs ckie A virus
5/14Picrn virus
es icrn virus
MCC f cmmn cld
rhinvirus
5/14Picrn viruses MCC icrn virus
Helmin
hs re mul
icellul r  r si
es versus _____ which re unicellul r  r si

es.
6/16Pr
z ns2 Pr
z ns
r
z
Wh
re
he 3 br d clinic l syndrmes ssci
ed wi
h rbviruses?
CNS dise
se (ie enceh li
is, sec
ic meningi
is), fever, hemrrh gic dise se 5/23Arb
virusRD rbvirus
C uses cngeni
l rubell syndrme wi
h infec
in during regn ncy. Is
his n
rbvirus?
"Tg virid e rubivirus (rubell virus)<br /><br />NOT n rbvir
us - sre d ersn
 ersn<div><br /></div><div><img src="" s
e-2119652259928
22.jg"" /></div>"
5/23ArbvirusRD rbvirus
A wm n ges
 her dc
r cml ining f red r sh n her f ce.&nbs;&nbs;She
rer
s h ving
fever
h
reslved jus
befre
he r sh e red.&nbs;&nbs;
&nbs;During hysic l ex m,
he dc
r n
es
h

he r sh sre d

he rms.
&nbs;&nbs;Swllen lymh ndes re fel
in
he cervic l regin nd behind
he e
rs.&nbs;&nbs;The dc
r inquires bu

he wm ns v ccin
in recrd nd m k
es di gnsis
 be cnfirmed by serlgic s
udies.&nbs;&nbs;The dc
r ls
m kes sure
h

he wm n is n
regn n
.
"Rubivirus (rubell virus)<div><
br /></div><div><img src="" s
e-112867445572214.jg"" /></div>"
Dickey
rbvirus c se
Unlike 
her Tg virid e, ____ is n
n rbvirus bec use is is n

r nsmi

ed
by n
hrd.
"rubell <div><br /></div><div><img src="" s
e-211969520
960118.jg"" /></div>" 5/23ArbvirusRD rbvirus
Msqui
 brn virus f genus Tg virid e (new wrld)
"Alh virus (c uses EEE,
WEE, VEE)<div>E s
ern, Wes
ern, nd Venezuel n equine enceh li
is</div><div><i
mg src="" lh .jeg"" /></div><div><br /></div><div><img src="" s
e-21196522599
2822.jg"" /></div>"
5/23ArbvirusRD rbvirus
C use WEE, EEE, VEE
"
g virid e lh virus<div><br /></div><div><img src=""
 s
e-211965225992822.jg"" /></div>" 5/23ArbvirusRD rbvirus
v ccine reven
ble
g virus "rubivirus (rubell )<div><br /></div><div><img s
rc="" s
e-211965225992822.jg"" /></div>"
5/23ArbvirusRD rbvirus
Genus: c uses wes
nile fever "fl vivirus<div><br /></div><div><img src="" s

e-204139795579418.jg"" /></div><div><br /></div><div><img src="" s
e-211965225

992822.jg"" /></div>" 5/23ArbvirusRD rbvirus
Wh
genus: yellw fever + dengue
"<div>fl vivirus</div><div><br /></div><
div><img src="" s
e-204135500612122.jg"" /></div><div><br /></div><div><img sr
c="" s
e-211965225992822.jg"" /></div>"
5/23ArbvirusRD rbvirus
fl vivirus
h
c uses cu
e nd chrnic he
i
is
"he
i
is C virus<div><
br /></div><div><img src="" s
e-212712550302326.jg"" /></div>"
5/23Arb
virusRD rbvirus
C uses mild febrile ex n
hem in children nd dul
s.&nbs;&nbs;C n c use c
r
c
s, c rdi c bnrm li
ies, nd de fness if i
infec
s
he fe
us during 1s

rim
es
er "Rubivirus (rubell )<div><br /></div><div><img src="" s
e-1128717405395
10.jg"" /></div>"
Dickey rbvirus
"C n c use cngeni
l c
r c
s nd mild febrile ex n
hem<br /><img src=""A300_r
ubell .ng"" />"
rubivirus (rubell )<br />
Dickey rbvirus ic
ure
s
genus: J  nese enceh li
is viruses, dengue viruses, yellw fever viruses
"fl vivirus<div><br /></div><div><i>l
in fr yellw</i></div><div><i><br /></i>
</div><div><i><img src="" s
e-204135500612122.jg"" /></i></div><div><i><img sr
c="" s
e-212849989255798.jg"" /></i></div>" 5/23ArbvirusRD rbvirus
l rge gru f enveled RNA viruses
r nsmi

ed by r
hrds.&nbs;&nbs;&nbs
;Usu lly sym
m
ic bu
c n c use fever nd enceh li
is. Als give i
s f mili
es
" rbviruses--divided in
 3 f milies:
g virid se ( lh viruses, like
WEE nd EEE, nd rubell viruses--n
n rbvirus bu
s
ill

g virus), fl vi
virid e, buny virid e<div><br /></div><div><img src="" s
e-201176268145178.jg"
" /></div>"
5/23ArbvirusRD rbvirus
L
e July, f
her brings his d ugh
er

he ER fr fever, vmi
ing, nd s
r n
ge beh vir
h
develed
he d y befre.&nbs;&nbs;The hysici n n
es
h


he d ugh
er h s he d nd neck  ins nd is h
hbic.&nbs;&nbs;The hysici n
sks
he f
her bu
ny recen
msqui
 bi
es she m y h ve h d, nd
he f
he
r ffirms
h

hey re sw rmed by msqui
s in
he Flrid hme.&nbs;&nbs;Di
gnsis is cnfirmed by de
ec
in f virus, PMN lecy
sis, nrm l glucse, nd
slighly elev
ed r
ein in
he CSF
"
g virid e lh virus (EEE)<div><br />
</div><div><img src="" s
e-213021787947638.jg"" /></div>"
5/23ArbvirusRD
rbvirus c se
One f
he infec
ins
r nsmi

ed in regn ncy (eseci lly 1s

rimes
er).&nbs;
&nbs;C uses&nbs;<div>- c
r c
s</div><div>- de fness</div><div>-c rdi c defec

s</div><div>- blueberry muffin r sh.&nbs;&nbs;</div><div><br /></div><div>V c
cine reven
ble</div> "rubivirus (rubell )<div><img src=""rubell .jeg"" /></d
iv><div><br /></div><div><img src="" s
e-112867445572214.jg"" /></div>"
Dickey rbvirus
"C uses signific n
b ck nd jin
 in, r sh nd fever.&nbs;&nbs;Als c lled
""bre kbne fever"". Vec
r?" "dengue fever (fl vivirus), edes msqui
<div><
img src=""r sh (2).jeg"" /></div><div><br /></div><div><img src="" s
e-2131549
31933814.jg"" /></div>"
5/23ArbvirusRD rbvirus
S
r
s nnsecific, remissin n d y 3-4,
hen high fever, bl ck vmi
us, nd j
undice.&nbs;&nbs;
r nsmi

ed by edes msqui
s
"yellw fever (fl viviru
s)<div><br /></div><div><img src="" s
e-205484120343158.jg"" /></div>"
5/23ArbvirusRD rbvirus
blueberry muffin r sh + v ccine reven
ble
rubivirus (rubell )
Dickey
rbvirus
fund in erslized r
excremen
, hemrrh gic fever wi
h ren l syndrme
"h n
virus (buny virid e)<div><br /></div><div>hemrrh gic fever, ulmn ry syn
drme, ren l syndrme<br /><div><br /></div><div><img src="" s
e-20606394092811
8.jg"" /></div></div>" 5/23ArbvirusRD rbvirus
"v ccine reven
ble, mild febrile ex n
hem in children nd dul
s, regn n
wm
en screened fr i
<br /><img src=""A301_rubell .ng"" />"
rubivirus (rubel
l )<br />
Dickey rbvirus ic
ures
sym
ms: high fever, bl ck vmi
us, j undice "yellw fever (fl vivirus)<div><
br /></div><div><img src="" s
e-206291574194806.jg"" /></div>"
5/23Arb
virusRD rbvirus

Tg virus
h
c uses 3-d y (Germ n) me sles. "rubell <div><br /></div><div><i

mg src="" s
e-206536387330678.jg"" /></div>" 5/23ArbvirusRD rbvirus
fever, scler l ic
erus, bl ck vmi
us "yellw fever<div><br /></div><div><img
src="" s
e-206802675303030.jg"" /></div>"
5/23ArbvirusRD rbvirus
"nn-secific febrile illness --&g
; erid f <b>remissin</b> n d y 3-4 --&g

; ""<b>in
xic
in</b>"" he
ic nd ren l dysfunc
in; 50% c se f
li
y r
e
fr severe frm"
"yellw fever<div><br /></div><div><img src="" s
e-2067
98380335734.jg"" /></div>"
5/23ArbvirusRD rbvirus
A recen
cllege gr du
e h s been c ming in Arizn in wded re he vily 
ul
ed wi
h deer mice.&nbs;&nbs;He cu
s his v c
in shr
, hwever, when he
devels fever nd begins vmi
ing.&nbs;&nbs;By
he
ime he rer
s

he h
si
l 3 d ys ly er, he is hy
ensive, cy n
ic, nd
chyneic.&nbs;&nbs;Fe
ring shck, hysici ns begin
 dminis
er fluids bu
s

his
re
men
when C
XR reve ls in
ers
i
i l ulmn ry edem .&nbs;&nbs;The 
ien
devels resir

ry f ilure wi
hin 24 hurs nd dies by
he 2nd d y in
he hsi
l. "h n
vi
rus (sin nmbre virus)<div><br /></div><div><img src="" s
e-207292301574774.jg
"" /></div>"
5/23ArbvirusRD rbvirus c se
secific lly c uses h n
virus ulmn ry syndrme
"sin nmbre virus<div><b
r /></div><div><img src="" s
e-207288006607478.jg"" /></div>" 5/23ArbvirusRD
rbvirus
flu-like illness fllwed by c ill ry le k syndrme: n me syndrme nd virus&nb
s;(hemrrh ge n

m jr  r
f clinic l syndrme) "h n
virus ulmn ry sy
ndrme (sin nmbre virus)<div><br /></div><div><img src="" s
e-207288006607478.
jg"" /></div>" 5/23ArbvirusRD rbvirus
hemrrh gic fever wi
h ren l syndrme "h n
virus<div><br /></div><div><img sr
c="" s
e-207288006607478.jg"" /></div>"
5/23ArbvirusRD rbvirus
in erslized r
excremen
, c uses hemrrh gic fever wi
h ren l syndrme, nd
ulmn ry syndrme ch r c
erized by c ill ry le k nd r id rgressin
"h n
virus<div><br /></div><div><img src="" s
e-207288006607478.jg"" /></div>
"
5/23ArbvirusRD rbvirus
"buny virid e
r nsmi

ed by deer muse<br /><img src=""A302_h n
virus.ng"" />
"
"h n
virus<br /><div><br /></div><div><img src="" s
e-207288006607478.
jg"" /></div>" 5/23ArbvirusRD rbvirus ic
ures
ren virid e + hemrrh gic fever, c ill ry le k +
r nsmi

ed by ersliz
in
f rden
excre
ins +endemic
 re s f Wes
Afric l ss fever (l ss virus
)
5/23ArbvirusRD rbvirus
34 y/ wm n, during visi

 Nigeri , devels fever ver
he curse f her
fif
h week f her visi
.&nbs;&nbs;The fever rgresses
 he d che, n use ,
nd di rrhe .&nbs;&nbs;By
he
ime she rrives

hsi
l, her hysici n n

es signs f eric rdi l effusin.&nbs;&nbs;Fur
hermre,
di rrhe s mle cn

ins bld indic
ing GI hemrrh ge.&nbs;&nbs;The hysici n is qui
e f mili r w
i
h
he sym
ms in
h
regin f Nigeri .&nbs;&nbs;He exl ins
h
she like
ly cn
r c
ed her illness frm rden
s L ss virus ( ren virus)<div><br /></div
><div><br /></div><div>L ss fever <b>hemrrh gic</b> fever, <b>c ill ry</b> <b
>le k</b>.<b> W Afric </b>, mul
im mm
e <b>r
</b>, M s
mys secies- cmlex; gi
ve rib virin</div>
5/23ArbvirusRD rbvirus c se
"Which virus?<br /><img src=""A303_ebl .ng"" />"
"ebl virus--c uses hem
rrh gic fever<div><br /></div><div><img src="" s
e-213464169579126.jg"" /></d
iv>"
5/23ArbvirusRD rbvirus ic
ures
An n
hrlgis
is brugh


he ER ne evening fr high fever, vmi
ing, he
d che, cnfusin, nd bldy di rrhe .&nbs;&nbs;He exl ins
h
he h d cu
n
exedi
in in Z ire shr
nd re
urned

he US when he develed
he high fev
er.&nbs;&nbs; "ebl virus (filvirid e)<div><br /></div><div><img src="" s
e
-213459874611830.jg"" /></div>"
5/23ArbvirusRD rbvirus c se
MCC f vir l meningi
is.&nbs;&nbs;CSF shws high lymhcy
es, nrm l glucse
en
ervirus
MCC
"he
i
is A<br /><br />
icrn virus c uses cu
e he
i
is, never chrnic
IgM n
i-HAV = c
ive r recen
infec
in; IgG = curren
r  s
HAV infxn r v
ccine<div><img src=""fec l r l.jeg"" /></div>"
he
i
is
Sr dic nd w
erbrne he
i
is in develing wrld; cu
e he
i
is, c se f

li
y r re exce
in regn ncy he
i
is E virus (heevirus) he
i
is
cn
ins DNA genme, cre n
igen = HBcAg, c
r
ein = HBsAg He
i
is B (he
dn virus)
he
i
is
incre sed risk f nen
l infec
in when m
her is HBeAg(+); risk f ersis
en

infec
in decre ses wi
h ge he
i
is B
he
i
is
Children given sirin when
hey h ve influenz c n devel
severe liver nd b
r in dise se c lled ____
reyes syndrme<br /><br />
herefre, give <u> c
e
minhen</u> fr fever in children, n
sirin
influenz
sm ll mu

ins resul
ing in minr ch nges in
he n
igenici
y f HA r NA.&nbs
;&nbs;resul
s in eidemics
n
igenic drif
influenz
re ssr
men
, m jr ch nges f
he HA r NA, resul
s in  ndemics
n
igeni
c shif
influenz
T becme immunized
 sme
hing, wh
mus
h en cellul rly? <u> c
iv
in f
APCs</u>; differen
i
in f <u>T nd B cells</u> nd gener
in f <u>memry</
u> cells; n
igen mus
ersis
<br /><br />Mech nisms f r
ec
in: serum nd mu
cs l <u> n
ibdies</u>, <u>cell-medi
ed</u> immune resnse.&nbs;&nbs;Ms
v
ccines r
ec
us vi n
ibdies.
immuniz
in
Is
his c
ive r  ssive immuniz
in-- dminis
r
in f Ig-cn
ining m
eri l
in rder
 reven
r mdify dise se.&nbs;&nbs;Pr
ec
in cnferred immedi

ely, nd is gener lly shr
lived.
P ssive; useful fr s
exsure rhyl
xis r when v ccine n
v il ble/indic
ed
immuniz
in
Ac
ive r  ssive immuniz
in--s
imul
in f r
ec
ive hs
immune resnses
by me ns f dminis
r
in f v ccine c
ive--weeks
 mn
hs gener lly requir
ed fr resnses
 devel; r
ec
in gener lly lng lived
immuniz
in
Which is s fer--relic
ing r nnrelic
ing v ccine? Which is fewer dses?&nbs
"nnrelic
ing (ie killed v ccine, urified r
ein, de d virus)<div>re
;
lic
ing<br /><div><img src=""nnre.jeg"" /></div></div><div><br /></div>"
immuniz
in
True r f lse: yung inf n
s resnd very rly
 urified lys cch ride v cc
ines

rue--if yu cv len
ly link i

 r
ein
hen i
s rcessed differen

ly nd inf n
s resnd well (ie neumcccus) immuniz
in
If
he in
erv l be
ween v ccine dses h s been exceeded, is
here
need
 ree
n
immuniz
in

dses?
True r f lse: simul
neus dminis
r
in f ll recmmended v ccines is encur
ged.
immuniz
in

rue
True r f lse: in gener l, n
ibdy-cn
ining rduc
s nd LIVE v ccines shuld
n
be given s
imul
neusly (excluding live
yhid nd yellw fever v ccines)
True; bu
n
ibdy cn
ining rduc
s nd INACTIVATED v ccines c n be given sim
ul
neusly
<u>differen
si
es</u> immuniz
in
Wh
re sme TRUE cn
r indic
ins
 immuniz
in? hyersensi
ivi
y
 cm
nen
<div>mder
e r severe illness (del y)<div>enceh l
hy wi
hin 7 d ys f
DTP dse</div></div> immuniz
in
Are
hese cn
r indic
ins fr receiving v ccines?<br />1) mild cu
e illness 
r cv lescence<br />2) mild
 mder
e lc l re c
in<br />3) curren
n
imicr
bi l
her y<br />4) rem
uri
y<br />5) recen
exsure
 infec
ius gen
<br
/>6) nnsecific/enicillin llergies<br />7) f mily his
ry f llergies/cnvul
sins/seizures
hese re cmmn my
hs<br /><br />seci l cnsider
ins: regn
ncy, f mily his
ry f immundeficiency s

es immuniz
in
"<img src=""A304_cl ssQ.ng"" />"
Answer = C<br />
cl ssQ immuniz

in
"<img src=""A305_cl ssQ.ng"" />"
Answer = B; yu jin
he schedule<br><br
>(A305_cl ssQ) cl ssQ immuniz
in
"<img src=""A306_cl ssQ.ng"" />"
Answer = C<br><br>(A306_cl ssQ) cl ssQ i
mmuniz
in
"<img src=""A307_cl ssQ.ng"" />"
Answer = D<br><br>(A307_cl ssQ) cl ssQ i
mmuniz
in
Prim ry immuniz
in recmmended fr ll inf n
s & m; children.&nbs;&nbs;Td r
ecmmended fr rim ry nd bs
er immuniz
in f lder children nd dul
s
DT P (dih
heri ,
e
nus, er
ussis) immuniz
in
Univers l immuniz
in fr inf n
s, used
 be
he MCC f b c
eri l meningi
is

HIB cnjug
e v ccine (i
s r
ein-lys cch ride cnjug
e) immuniz
in
True r f lse: Bec use f
he risk f develing v ccine- ssci
ed li in
he
US is gre
er
h n
he risk f infec
in, ru
ine use f OPV is n lnger recm
mended
rue
immuniz
in
Univers l immuniz
in f inf n
s nd children wi
h IPV; cnsider 1
ime bs

er dse fr dul

r velers
 endemic re s
li (IPV is
he v ccine)
immuniz
in
Univers l immuniz
in f inf n
s wi
h 2 dses
12-15 mn
hs.&nbs;&nbs;Preve
n
s Klik s
s
MMR v ccine<br /><br />Als n
e: 2 dses re recmmende
d fr ele brn f
er 1956 wh l ck evidence f immuni
y
immuniz
in
high dse v ricell v ccine.&nbs;&nbs;Single dse is recmmended fr immuncm
Shingles v ccine
immuniz
e
en
ersns wh re
le s
60 ye rs ld

in
recmmended fr univers l immuniz
in f he l
hy inf n
s 6
 32 weeks f ge.&
nbs;&nbs;reduces di rrhe hsi
liz
ins in
he US r
virus v ccine
immuniz
in
PCV13 is recmmended fr univers l immuniz
in f inf n
s 2-23 mn
hs neumc
ccus
immuniz
in
urified lys cch ride f 23 ser
yes indic
ed fr
he elderly nd ersns v
er
he ge f 2 wh re
high risk (ie he r
/lung dise se, sleni , cmlemen
immuniz
in

deficiency) neumccc l lys cch ride v ccine (PPSV23)
Wh
re
he 2
yes f influenz v ccines?
TIV (in c
iv
ed) nd LAIV (live
immuniz
in


enu
ed)
Which influenz v ccine is recmmended fr he l
hy ele 2-49 ye rs ld?
"Live

enu
ed (LAIV)--n s l sr y<div><img src=""LAIV.jeg"" /></div>"
immuniz
in
Which influenz v ccine is recmmended fr he l
hy nd high risk &g
;6 mn
hs f
ge? "in c
iv
ed (TIV)--injec
in<div><img src=""LAIV.jeg"" /></div>"
immuniz
in
MnCV recmmended fr ll children
ge 11-12 ye rs nd g in
16 ye rs; c
c
h-u fr HS s
uden
s nd cllege freshm n living in drms.&nbs;&nbs;Curren
in
fec
ins d n
r
ec
g ins
ser
ye B infec
ins meningccc l v ccine
immuniz
in
True r f lse: He
i
is A v ccine recmmended fr ll children be
ween 1 nd 2
ye rs f ge, nd fr m ny 2-18 ye r ld children in Tex s

rue; indic
ed
fr 
her high-risk ele
h

r vel
 endemic re s r h ve chrnic liver di
se se<br><br>Ps
-exsure rhyl xis is recmmended fr ersns 1-40ye rs ( dm
inis
er single dse wi
hin 14 d ys); less
h n 1 ye r ld r &g
; 40 shuld rece
ive ISG immuniz
in
recmbin n
HBsAg v ccine
h
is univers lly dminis
ered fr ll inf n
s nd c
hildren; recmmended fr cer
in high risk grus (ie DM)
he
i
is B v cc
ine
immuniz
in
2 v ccines: gen
yes 16 & m; 18, nd gen
yes 6, 11, 16 & m; 18
HPV<br><
br>16 & m; 18: 70% f cervic l c ncer c ses<br>6, 11, 16, nd 18: geni
l w r
s
nd ms
cervic l c ncers
immuniz
in
Indic
ins fr v ccine: nn-regn n
fem les wh re 9-26 ye rs ld; m les wh
re 9-21 ye rs ld
HPV v ccine
immuniz
in
Which
w v ccine-reven
ble dise ses  r
icul rly require l rge crude herd i
mmuni
y
hreshld?
"me sles nd er
ussis<div><img src=""herd immuni
y.jeg
"" /></div><div><br /></div>" immuniz
in
"<img src=""A308_cl ssQ.ng"" />"
"Answer = C<br /><br /><img src=""v ccin
e.jeg"" />"
cl ssQ immuniz
in
"<img src=""A309_cl ssQ.ng"" />"
"Answer = A<br /><br /><img src=""r
.j
cl ssQ immuniz
in
eg"" />"
"<img src=""A310_cl ssQ.ng"" />"
Answer = D<br><br>(A309_cl ssQ) cl ssQ i
mmuniz
in
"<img src=""A311_cl ssQ.ng"" />"
nswer = A; bec use i
s n in c
iv
ed
v ccine<br><br>(A311_cl ssQ)
cl ssQ immuniz
in
in
r cellul r + ex
r cellul r exis
ence; rec
l rl se

richuri sis
Helmin
hs

dysen
ery syndrme + cli
is + rec
l rl se
richuri sis (whiwrm) Helmin
h
s
Lefflers syndrme + cu
e in
es
in l bs
ruc
in + bili ry
r c
bs
ruc
in (
ie  ncre
i
is, chl ngi
is)
sc ris Helmin
hs
very imr
n
dg v ri n
f sc ris + c uses esinhilic neumni
is r s
hm
Helmin
hs

xc ri sis
rise f s
hm in ur inner ci
ies?
Helmin
hs

xc ri sis
sm lles
member f
he uhly
rini
y, rmed wi
h
ee
h/cu

ing l
es hkwrm
--ms
ly nec
r meric nus
Helmin
hs
injure hs

hrugh in
es
in l bld lss, rb childs d ily irn in
ke, secre

e n
ic gul n
s
hkwrm
Helmin
hs
"c uses l rv currens ( u
infec
in)<div><img src=""currens.jeg"" /></div>"
s
rngylides Helmin
hs
c uses en
erbi sis
inwrm Helmin
hs
c uses n l ruri
us (sc
ch
e
es
) "inwrm<div><img src=""sc
ch.jeg"" />
</div>" Helmin
hs
eri n l i
ching
inwrm (en
erbi sis) Helmin
hs
cmmn n me fr En
erbius vermicul ris inwrm Helmin
hs
lives in cecum/ endix, gr vid fem les nc
urn lly desi
eggs n
 eri n l s
kin
inwrm Helmin
hs
lbend zle
Helmin
hs
re
men
s

re
men
f inwrm
Wuchereri b ncrf
i is
he c us
ive gen
f _____
lymh
ic fil ri sis (LF
)
Helmin
hs
"Infec
ed l rv e re desi
ed wi
h
he bi
e f msqui
.&nbs;&nbs;G
 lym
h
ics lng inguin l re nd c use dil

in.&nbs;&nbs;Micrfil ri re r
duced nd en
er bld s
re m (be
ween 10m-4 m) nd re
ken u by msqui
 n
d

new hs
<div><img src=""life.jeg"" /></div>"
Wuchereri b ncrf
i (ly
mh
ic fil ri sis)
Helmin
hs
The micrfil ri e re mdified eggs
h
exhibi
eridici
y
lymh
ic fil ri
sis (due
 W. b ncrf
i)
Helmin
hs
dise se c used by dul
wrms, scr
l hydrcele is h llm rk lymh
ic fil ri
sis (W. b ncrf
i)
Helmin
hs
Unlike LF, micrfil ri c using
he dise se.&nbs;&nbs;Tr nsmi

ed by bl ck fli
es
River blindness (nchcerc vlvulus) Helmin
hs
Adul
wrms becme enc sed in subcu
neus ndules in
he skin,
hey rduce mic
rfil ri
h
g

he he d nd cr wl in
 n
erir ch mber f
he eye nd fr
m  ci
ies
River blindness (nchcerc vlvulus) Helmin
hs
Di gnsis f&nbs;river blindess? Tx? "<div><b>skin snis</b>
 lk fr micr
fil ri . n she
h n mf &nbs;Tre
men
is ivermec
in</div><div><img src=""sni
Helmin
hs
.jeg"" /></div>"
fix
 sm ll in
es
ine nd feed n bld, c use irn deficiency nemi hkwrm
(nec
r meric nus) Helmin
hs
dul
wrms m
ure in subcu
neus
issues c using c l b r swelling, dul
wrm
c n ls cr wl crss eyeb ll L l Helmin
hs
"cu
neus l rv migr ns--""creeing eru
ins""<br /><img src=""A312_hkwrm.
ng"" />"
hkwrm (Ancyls
m )<br /><br />(A312_hkwrm)
Helmin
h
s ic
ures
Leishm ni infec
in
h
resembles &qu
;cheese izz &qu
;
cu
neus leishm
ni sis 6/16Pr
z ns2 Pr
z ns
A recen
immigr n
frm
ric l cun
ry resen
s wi
h weigh
lss nd fever.&n
bs;&nbs;A hysic l ex m reve ls m ssive he
slenmeg ly wi
h ssici
ed ed
em .&nbs;&nbs;CBC reve ls
hrmbcy
eni , nemi , while sleen bisy shw
s m crh ges cn
ining r
z .&nbs;&nbs;The dc
r begins
he 
ien
n
n n
imny cmund
Leishm ni dnv ni (k l - z r) 6/16Pr
z ns2 Pr
z
ns c se
"Pr
z n infec
in wi
h
he fllwing micrscic e r nce.<br><img src=""A3
13_leish.ng"" />"
leishm ni sis--see
he r
z ns in
he m crh ges<br>
<br>(A313_leish)
6/16Pr
z ns2 Pr
z ns ic
ures
Tre
men
fr viscer l leishm ni sis
mh
ericin B (lism l re r
ins)
6/16Pr
z ns2 Pr
z ns

A m n in Luisi n devels cughing, fever, nd bdmin l  in.&nbs;&nbs;His

dc
r rders
series f X-r ys
h
shws ulmn ry infil
r
es ch r c
eris
ic
f neumni , s well s in
es
in l im ges cnsis
en
wi
h bs
ruc
in.&nbs;&n
bs;On CBC,
he 
ien
h s incre sed esinhils
sc ris lumbricides
Helmin
hs c se
c us
ive gen
f meric n
ry nsmi sis
T. cruzi--fund
hrughu
L
in
Americ n, few c ses in
he US
6/16Pr
z ns2 Pr
z ns

r nsmi

ed by
he bldsucking reduviid bugs Americ n
ry nsmi sis (ch g s
dise se)
6/16Pr
z ns2 Pr
z ns
ch gm , Rm n sign
T. cruzi (Ch g s dise se)
6/16Pr
z ns2 Pr
z
ns
In
he cu
e s
ge c uses: Rm n sign, myc rdi
is, ch gm
T. cruzi (ch g s
dise se)
6/16Pr
z ns2 Pr
z ns
In
he chrnic s
ges c uses: c rdimeg ly nd GI meg dise se T. cruzi (ch g s
dise se)
6/16Pr
z ns2 Pr
z ns
Reduviid bug le ves r
z n cn
ining feces
bi
e si
e nd hs
scr
ches 
r
z n in
 skin
T. cruzi (ch g s dise se)
6/16Pr
z ns2 Pr
z
ns
Meg esh gus + meg cln (le ding
 chrnic cns
i
in/ bdmin l  in/m lnu

ri
in) T. cruzi (ch g s dise se)
6/16Pr
z ns2 Pr
z ns
Tre
men
fr Ch g s dise se
Nifur
imx nd Benznid zle
6/16Pr
z ns2
Pr
z ns
T. brucei _____ fund redmin n
ly in E s
Afric .
rhdesiense
6/16Pr

z ns2 Pr
z ns
T. brucei _____ fund redmin n
ly in Wes
Afric .
g mbiense
6/16Pr

z ns2 Pr
z ns
Sre d by
se
se flies; dise se ini
i lly cnfined
 hemlymh
ic sys
em bu

dv nces
 CNS fric n
ry nsmi sis ( fric n sleeing sickness)
6/16Pr

z ns2 Pr
z ns
T. brucei _____
yic lly le ds
 cu
e dise se wi
h r id invlvemen
f
he C
NS (de
h wi
hin weeks).&nbs;&nbs;In cn
r s
, infec
in wi
h T. brucei _____
rhdesiense; g mbiense 6/16Pr
z ns2 Pr
z
rgresses mre insidiusly.
ns
Ex
r cellul r life cycle--Americ n f Afric n
ry nsmi sis? Afric n 6/16Pr

z ns2 Pr
z ns
Cm re
he m in reservirs fr T. brucei g mbiense vs rhdesiense.
Hum n g mbiense<br>Wild g me - rhdesiense
6/16Pr
z ns2 Pr
z ns
Tre
men
fr l
e-s
ge (CNS invlvemen
) Afric n
ry nsmi sis
mel rs
rl
6/16Pr
z ns2 Pr
z ns
ene
r
es like hkwrm + di gnsed de
ec
ing l rv e in s
l, n
eggs (like h
s
rngylides--
ien
s
kwrm), migh
need
 reques
sever l fec l ex ms
n big dses f s
erids re
risk fr hyerinfec
in Helmin
hs
A Su
h C rlin wm n visi
s her dc
r f
er develing di rrhe .&nbs;&nbs;T
he dc
r erfrms bld
es
nd finds elev
ed esinhils.&nbs;&nbs;Susce

ing  r si
e infec
in,
he dc
r ex mines s
l secimen.&nbs;&nbs;Af

er finding l rv e wi
hu
eggs,
he dc
r slidifies his di gnsis un le rnin
g
h

he 
ien
frequen
ly w lks bu
her huse b ref
. Di gnsis nd <b>

re
men
</b>
"s
rngylides;
re
ed wi
h <b>ivermec
in </b>(n
lbind zle)
<div><img src=""iver.jeg"" /></div><div><img src=""es.jeg"" /></div>"
Helmin
hs c se
A child frm Al b m resen
s wi
h severe we kness nd  llr.&nbs;&nbs;A CBC
shws reduced hem
cri
s well s incre sed esinhils.&nbs;&nbs;T inves
i
g
e
he ssibili
y f  r si
es,
he hysici n rders s
l s mle in which
she finds numerus eggs.&nbs;&nbs;The hysici n rescribes mebend zle nd ir
n
ble
s
hkwrm (nec
r meric nus) Helmin
hs c se
irn deficiency nemi + eggs in s
l nec
r meric nus (hkwrm) Helmin
h
s
P
ien
frm

ric l vill ge h s n enrmusly swllen scr
um nd lwer ex
r
emi
y.&nbs;&nbs;The skin rund
he swelling h s becme sc ly nd
hick.&nbs;
&nbs;The 
ien
remembers feeling enl rged lymh ndes in
he grin mn
hs bef

re
he swelling beg n, bu
bec use f r he l
h resurces in
he re , he nev
er s w hysici n.&nbs;&nbs;S mles f his bld dr wn
nigh
shw wrmlike
W. b ncrf
i (eleh n
i sis)
rg nisms under micrsce.&nbs;&nbs;
Helmin
hs c se
Wh
cl ss f helmin
hs h ve n blig
e sn il hs

flukes Helmin
hs
rien
l liver fluke
r nsmi

ed
hrugh uncked fish clnrchis sinensis
Helmin
hs
undercked fish; c uses infl mm
in f
he bili ry
r c
; ssci
ed wi
h chl
ngic rcinm
clnrchis sinensis
Helmin
hs
lung fluke infec
in + hem
ysis
" r gnimus wes
erm ni<div><img src=""
r gn life.jeg"" /></div>"
Helmin
hs
undercked cr b me
/cr wd ds + hem
ysis
 r gnimus wes
erm ni Helmin
h
s
Tre
men
fr ll flukes? ( r gnimus, clnrchis, schis
sm ). Wh
bu
liv
er fluke f scili sis--wh
s
he
re
men
?
"
ricl bend zle (c n

re
wi
Helmin
hs
re
m

h r ziqu n
el!!)<div><img src=""
x fluke.jeg"" /></div>"
en
s
Which schis
sme is m jr c use f urin ry
r c
dise se?
schis
sm h em

bium Helmin
hs
cerc ri e rele sed by sn ils in fresh w
er --&g
; ene
r
e hum n flesh nd en

er bld s
re m schis
smi sis Helmin
hs
fluke infec
in in J  n
Schis
sm j nicum Helmin
hs
Fluke infec
ins in Afric (2) S. h em
bium, m nsni Helmin
hs
An Afric n m n cmes

he hsi
l f
er vmi
ing bld.&nbs;&nbs;He ls re
r
s
h
his s
ls h ve been d rk fr
he l s
few ye rs.&nbs;&nbs;In
he h
is
ry,
he 
ien
denies lchl use nd s

es
h
freshw
er fishing is h
bby.&nbs;&nbs;Endscy shws esh ge l v ries, nd s
l secimens cn
in
eggs.&nbs;&nbs;The 
ien
is s
r
ed n r ziqu n
el.
schis
smi sis
Helmin
hs c se
K
y m fever S. j nicum
Helmin
hs
hem
uri + squ mus cell c rcinm f bl dder "S. h em
bium<div><img src=""h
em sec.jeg"" /></div>"
Helmin
hs
siny eggs ldge in bl dder w ll nd c use infl mm
in nd cnsequences (hem
u
ri nd bl dder c rcinm )
S. h em
bium Helmin
hs
"Sn ils re hs
s, cerc ri e ene
r
e skin nd c use gr nulm s, fibrsis nd i
nfl mm
in f liver/in
es
ine (<b><fn
clr=""#0000ff"">r
l hyer
ensin</
fn
></b>) (2)" S. j nicum, S. m nsni
Helmin
hs
Wmen in Afric wi
h
his fluke infec
in h ve
3-4X incre se in
r nsmissin 
f HIV S. h em
bium Helmin
hs
True r f lse: FUS is gegr hyic lly clus
ered signific n
ublic he l
h rb
lem
h
disrr
in
ely ffec
s yung wmen nd is ssci
ed wi
h HIV infec
Helmin
hs

in

rue
Fish
ewrm, c uses vi
min B12 deficiency resul
ing in nemi
Dihyll
b
hrium l
um Helmin
hs
Helmin
hs
re
men
s

re
men
f
eni s gin
/slium
r ziqu n
el
inges
cys
ercerci frm uncked beef

eni s gin
Helmin
hs
cys
ercerci re inges
ed wi
h r w r undercked rk

eni slium Helmin
h
s
If yu h ve clse ssci
in wi
h smene wh h d n dul
rk
ewrm rduc
ing eggs nd yu if cciden
lly e

he eggs
hen yure
he in
ermedi
e hs

ins
e d f
he ig.&nbs;&nbs;These h
ch nd
he l rv e g
 yur muscles, br
in, r eye.
cys
icercsis (
issue infec
in)
Helmin
hs
c used by ne r mre cys
icerci (l rv l s
ge f
he rk
ewrm
eni sliu
m) in
he br in neurcys
icercsis--le ding c use f eilesy mng His nic chi
ldren Helmin
hs
Frequen
ly f mily member in
he hme h rbrs
he dul
rk
ewrm
eni s
lium.&nbs;&nbs;C used by ne r mre cys
icerci in
he br in. neurcys
icercs
is
Helmin
hs
hum ns inges
eggs frm infec
ed feces, eggs h
ch in sm ll in
es
ine nd ene
r

e in
es
in l w ll nd
r vel
 
her
issues, frm cys
icerci in br in, skele

cys
icercsis (
eni slium) Helmin
hs

l muscle, nd eye
P
hgenesis f neurcys
icercsis
s cys
icercus (s ce ccuying lesin)
dies i
elici
s n infl mm
ry resnse; infl mm
in se
s ff seizure fcus
Helmin
hs
neurcys
icercsis
re
men

lbend zle, r ziqu n
el + s
erids (
 reduce
infl mm
in frm dying cys
s) Helmin
hs
re
men
s
imr
n
c use f eilesy in L
in Americ nd Tex s; ssci
ed wi
h dying cy
s
icerci in br in
neurcys
icercsis
Helmin
hs
A Vie
n mese immigr n
f 10 ye rs resen
s wi
h severe he d ches nd seizures.&
nbs;&nbs;A hysic l ex m reve ls sever l ndules crss her bdy.&nbs;&nbs;C
ncerned bu
neurlgic dise se,
he dc
r rders he d CT
h
shws five c
lcified cys
s.&nbs;&nbs;This bserv
in, lng wi
h high esinhils n CB
C, rm
s
he dc
r
 erfrm
bisy f ndule.&nbs;&nbs;A di gnsis is
m de f
er
he dc
r finds cys
s in
he ndule, nd
he 
ien
is begun immed
i
ely n r ziqu n
el nd s
erids.
neurcys
icercsis
Helmin
hs c se
eggs frm dg feces re inges
ed by hum ns, eggs h
ch in
 l rv e in
he sm ll
in
es
ine nd ene
r
e
he in
es
in l w ll nd g
 
her
issues (ie liver)
nd frm hyd
id cys
s echincccus gr nulsus Helmin
hs
rele se f cys
cn
en
s (ie in liver/lung m inly) c uses n hyl c
ic s
rm nd
de
h hyd
id cys
(frm echincccus gr nulsus)
Helmin
hs
cmmn in sheeherders wh cquire
he
ewrm frm shee dg feces;
he shee
dgs becme infec
ed f
er e
ing r w shee me

echincccus gr nulsus
Helmin
hs
medic l nd surgic l in
erven
in f echincccus gr nulsus
" lbend zle + s
urgic l (<b>PAIR</b> - unc
ure cys
, sir
in, injec
in f chemci ls, re si
r
in)<div><img src=""hyd
id.jeg"" /></div>" DickeyPr
 Helmin
hs
re
men
s
"me
rnid zle<div><br /></div><div><img src=""

re
men
fr gi rdi l mbli
s
e-85491324027510.jg"" /></div>"
DickeyPr
 Pr
z ns
lks like hrseshe cr b + linked
 d yc res nd w
er surces
"gi rdi
l mbli <div><br /></div><div><img src="" s
e-85487029060214.jg"" /></div>"
DickeyPr
 Pr
z ns
m y be ms
cmmn  r si
ic infec
in in
he US,<b> lse ful-smelling s
ls,
s
e
rrhe </b>, n bld in s
ls,
re
w/ me
rnid zle
"gi rdi l mbli
<div><br /></div><div><img src="" s
e-85487029060214.jg"" /></div>" DickeyPr

 Pr
z ns
blig
e in
r cellul r r
z n
h
c uses severe di rrhe , cid f s
, r
u
nis
ic infec
in in HIV 
ien
s
cry
sridium  rvum Pr
z ns
An HIV 
ien
becmes l rmed f
er develing ersis
en
di rrhe .&nbs;&nbs
;He
ells his hysici n
h

he di rrhe is w
ery nd wi
hu
bld.&nbs;&nb
s;Un le rning
h

he 
ien
visi
ed
v c
in f rm befre
he di rrhe s

r
ed,
he dc
r rders n cid-f s
s
in f
he 
ien
s s
l s mle
cry
sridium  rvum Pr
z ns c se
cys
ru
ures
 rele se srzi
es in sm ll in
es
ine,
hese srzi
es dif
feren
i
e nd

ch
 in
es
in l w ll nd c use w
ery nn-bldy di rrhe
"cry
sridium  rvum<div><img src=""exlde.jeg"" /><br /><div><br /><div><i
mg src=""cry.jeg"" /></div></div></div><div><br /></div><div><img src="" s
e-8
5547158602358.jg"" /></div><div><br /></div><div><br /></div>" DickeyPr
 Pr

z ns
"fec l ex m cid f s
s
in lking fr cys
, immunflurescence&nbs;<br /><i
mg src=""A314_cry
.ng"" />" "cry
sridium  rvum<br /><br />(A314_cry
)
<div><br /></div><div><img src="" s
e-85542863635062.jg"" /></div>" DickeyPr

 Pr
z ns ic
ures
c uses hum n mebi sis En
meb his
ly
ic
DickeyPr
 Pr
z ns
m kes fl sk-sh ed hle in
he cln, c uses mebic cli
is nd dysen
ery; sec
nd ry inv sin c uses he
ic bscesses " mebi sis (E. his
ly
ic )<div><img src
=""A315_his
ly
ic .ng"" /></div>"
DickeyPr
 Pr
z ns
"Wh
c used
his fl sk-sh ed ulcer in
he cln resul
ing in cli
is nd dysen
en
meb his
ly
ic <br

ery?<br /><img src=""A315_his
ly
ic .ng"" />"
/><br />(A315_his
ly
ic )
DickeyPr
 Pr
z ns ic
ures
True r f lse: E. his
ly
ic c uses liver bscesses in men
 wmen in 9:1 r
i

"
rue (remember MSM)<div><br /></div><div><img src="" s
e-8560728814450


2.jg"" /></div>"
DickeyPr
 Pr
z ns
C se: Af
er c ming
ri
 Mexic, 
ien
visi
s her dc
r cml ining f
lse s
ls nd bdmin l cr ms.&nbs;&nbs;The 
ien
describes
he s
ls
s h ving flecks f bld nd l
s f mucus.&nbs;&nbs;The dc
r rders s

l secimen in which she finds m
ile meb wi
h inges
ed RBCs.&nbs;&nbs;She s

r
s
he 
ien
n me
rnid zle nd cnsiders CT sc n
 de
ec
ny liver
bscesses.
E. his
ly
ic Pr
z ns c se
regn n
m
hers, eseci lly
hse wi
hu
revius exsure, re encur ged

vid c
s
6/17Pr
z ns3 Dickey Pr
z ns

xl sm gndii
cys
s inges
ed frm undercked me
r c
feces

xl sm gndii
6/17Pr
z ns3 Pr
z ns
br in bscess in HIV seen s ring-enh ncing lesin; cys
s in me
r c
feces
6/17Pr
z ns3 Pr
z ns

xl sm gndii
crescen
sh e r
z + crsses
he l cen
+ ring-enh ncing lesin in HIV 
6/17Pr
z ns3 Pr
z ns

ien


xl sm gndii
If
his crescen
sh ed r
z n c uses c
ive infec
in in regn n
m
her i
nd c use men
l re
rd
in, chrire
ini
is, nd 
he

c n crss
he l cen

r bir
h defec
s
xl sm gndii
6/17Pr
z ns3 Dickey Pr
z ns
AIDS 
is brugh


he ER suffering seizure.&nbs;&nbs;The m n infrms
he
hysici n
h
he h s suffered frm ersis
en
he d che in
he  s
few weeks
bu
denies ny sensry rblems r we kness.&nbs;&nbs;Fe ring
br in
umr,

he hysici n rders CT sc n f
he 
ien
.&nbs;&nbs;The sc n reve ls sever
l ring-enh ncing m sses in
he 
ien
s br in.&nbs;&nbs;The hysici n cnfir
ms his susicins when he le rns
h

he 
ien
h s m ny c
s
hme.&nbs;&n
bs;He exec
s
he br in bisy wuld shw crescen
-sh ed
rhzi
es.
6/17Pr
z ns3 Pr
z ns c se

xl sm gndii
AIDS CD4 &l
;100, c uses neurlgic bnrm li
ies, ring enh ncing lesins, r

z n
6/17Pr
z ns3 Pr
z ns

xl sm gndii
sir mycin
6/17Pr
z ns3

re
men
fr
xl smsis in regn ncy
Pr
z ns
ms
cmmn  r si
ic c use f hum n de
h
m l ri 6/17Pr
z ns3 Pr
z
ns
duble rings in eriher l bld sme r + high  r si
emi
l smdium f lci
 rum 6/17Pr
z ns3 Pr
z ns
msqui
 injec
s srzi
es in

he blds
re m --&g
;
r vel
 liver nd inv
de he
cy
es --&g
; grw/divide nd rduce h lid merzi
es --&g
; exi
s
liver nd begins cycle f inv sin f RBC, sexu l relic
in, nd rele se frm
RBCs 
hgenesis f m l ri 6/17Pr
z ns3 Pr
z ns
RBCs infec
ed wi
h l smdium _____ re cvered wi
h knbs which cn
in  r si

e n
igens n
heir surf ce.&nbs;&nbs;Knbs bind
 v scul r end
heli l cells
resul
ing in lc lized sludging f bld flw, c using
issue hyxi . f lci r
um
6/17Pr
z ns3 Pr
z ns
P rxysms f chills/fever/HA ssci
ed wi
h synchrnus rele se f merzi
es f
rm RBCs.&nbs;&nbs; m l ri 6/17Pr
z ns3 Pr
z ns
duble rings + b n n -like bjec
;  r si
e
"l smdium f lci rum<br /><br
/>b n n
hing = g me
cy
e<div><img src=""b n n .jeg"" /></div>"
6/17Pr

z ns3 Pr
z ns
Which l smdium secies infec
s ll ges f RBCs,
hus c using
he ms
severe
m l ri l dise se?
f lci rum
6/17Pr
z ns3 Pr
z ns
MCC cu
e vir l meningi
is
en
ervirus
MCC
True r f lse:
re
men
des n
elimin
e r cure l
en
vir l infec
ins

rue

re
men
6/4
re
men
s
Which drug--Preven
in nd
re
men
f influenz A virus infec
ins; resis
nce
ssci
ed wi
h mu

ins in
he M2 r
ein
Am n
dine (rim n
dine is simil
r, exce

h
i
is me
blized by
he liver)
re
men
6/4
re
men
s

re
men
nd rhyl xis f influenz A nd B viruses (2); inhibi
vir l neur m
inid ses
sel
mivir nd z n mivir--b
h re neur minid se inhibi
rs<br>
<br>Z n mivir = inh led<br>Osel
mivir = r l; b
h h ve &qu
;O&qu
;
re
men

6/4
re
men
s

Used in severe RSV dise se f inf n
s + <b>chrnic HCV</b>

rib virin (gu n
sine n lg)

re
men
6/4
re
men
s
gu nsine n lg, ersl
re
men
f severe RSV infec
ins in children rib viri
n

re
men
6/4
re
men
s
An 
herwise he l
hy 6-mn
h ld by resen
s during n RSV eidemic wi
h severe
brnchili
is requiring hsi
liz
in. Wh
s
he
re
men
? rib virin

re
men
6/4
re
men
s
rib virin

re
men
f brnchili
is

re
men
6/4
re
men
s
rib virin

re
men
f vir l hemrrh gic fevers such s l ss virus

re
men
6/4
re
men
s
cyclvi

re
men
f geni
l, erin
l, nd CNS HSV; v ricell nd zs
er
r

re
men
6/4
re
men
s
"which drug--inhibi
s <b><fn
clr=""#ff0000""><i>vir l</i></fn
></b> TK nd
DNA lymer se (
hereby le ding
 ch in
ermin
in)" cyclvir<br><br>A-cycl
vir = s
es CYCles f DNA elng
in

re
men
6/4
re
men
s
cyclvir

re
men
f HSV enceh li
is

re
men
6/4
re
men
s
Previusly he l
hy 23-ye r ld fem le h d her firs
eisde f  inful geni
l u
lcer
ins 1 ye r g.&nbs;&nbs;She nw re
urns cml ining
h
her geni
l l
esins recur rxim
ely nce mn
h.&nbs;&nbs;Wh

re
men
?
cyclvi
r

re
men
6/4
re
men
s
Wh shuld be
re
ed fr v ricell ?
"<b>immuncmrmised</b> 
ien
s nd 
ssibly <b>regn n
</b> wmen<div><b> dlescen
s</b> nd <b> dul
s</b>;&nbs;</d
iv><div> ny 
ien

<b>high risk fr cmlic
ins</b><br /><br />N
e: Acycl
vir fr <fn
clr=""#ff0000"">nrm l
ddlers nd children &l
;10 is n
nece
ss ry</fn
></div>"

re
men
6/4
re
men
s
r l bi v il bili
y gre
er
h n cyclvir; rved fr
re
men
f shingles
nd fr
re
men
/suressin f geni
l HSV.&nbs;&nbs;N me 2 drugs f mcicl
vir nd v l cyclvir<div><br /></div><div>F mily in
he V lley</div>

re
men

6/4
re
men
s
MCC f meningi
is in firs
2 mn
hs f life
gru B s
re
MCC
MCC f b c
eri l meningi
is in kids/ dul
s
S. neum
MCC
Ms
cmmn erm nen
neurlgic l sequel e f b c
eri l meningi
is
CN VIII
defici
s
MCC
Re lly high ening ressure n LP, lw glucse.&nbs;&nbs;Is
his b c
eri l, v
ir l, r TB meningi
is? TB

re
men
s
Re lly high whi
e cun
&g
;1000, elev
ed r
ein, decre sed glucse. Is
his b
c
eri l, vir l, r TB meningi
is?
b c
eri l

re
men
s
Elev
ed r
ein, nrm l ening ressure, nrm l glucse.&nbs;&nbs;Is
his vi
r l, b c
eri l, r TB meningi
is?
vir l

re
men
s
Wh is mre likely
 h ve nrm l men
l s

us--
ien
wi
h vir l r b c
eri l
meningi
is?
vir l--sin l
 cures
he sym
ms (which were l rgely due

incre sed ICP);
hey ge

remendus relief<br><br>vir l meningi
is = MCC f se

ic meningi
is
re
men
6/4
re
men
s
MCC f cu
e sr dic vir l enceh li
is
HSV--
here will be RBCs in
he C
SF bec use f
he
emr l lbe bleeding c used by HSV enceh li
is
MCC
3 ms
cmmn c uses f newbrn meningi
is
gru B s
re, E. cli, lis
eri
MCC Meningi
is
Ms
cmmn c uses f meningi
is 6-60 ye rs (4, give
 2)
<b>S. neum</b>
, <b>Neisseri </b>, en
ervirus, HSV
MCC Meningi
is
Elderly 60+ 
ien
s--wh
c uses meningi
is? N me 3. "S. neum, GNR, lis
eri
<div><img src="" ge gru eld.jeg"" /></div>" Meningi
is
Cmlemen
deficiency c uses smebdy
 be mre susce
ible
 wh
c use f me
ningi
is?
neisseri
Meningi
is
Meningi
is w/ clsed he d
r um (ie fr c
ure f cribrifrm l
e nd CSF rhinr
rhe ) neumcccus
Meningi
is
Meningi
is bug in en he d
r um
S. ureus
Meningi
is
Which c uses f meningi
is is seen wi
h e
echi e r urur ? meningccc l
Meningi
is
Why des rim n
idine h ve less side effec
s
h n m n
dine?
bec use i
desn

crss
he BBB

re
men
6/4
re
men
s

2 gd chices fr shingles
re
men

F mciclvir nd V l cyclvir<br><br>Jus

remember FAMILY in
he VALLEY
h
ll h ve SHINGLES (zs
er)

re
men

6/4
re
men
s
Tre
men
f CMV (3 drugs)
"<b>G nciclvir</b>, Cidfvir, <b>Fsc rne
</b>
<br /><br />""Cid"" (cidfvir) g ined (g nciclvir) his sigh
(sigh
-meg lvir
us) s nw he c n drive f s
c r (fs-c rne
)<div><br /></div><div><div><b><f
n
clr=""#ff0000"">NOT cyclvir bec use CMV desn
h ve necess ry vir l kin se
</fn
></b></div></div><div><br /></div>"

re
men
6/4
re
men
s
True r f lse: CMV is susce
ible
 cyclvir FALSE; mus
ei
her give cidfvi
r, fsc rne
, r g nciclvir

re
men
6/4
re
men
s
hshryl
ed by CMV r
ein UL97; <b>bes
drug fr CMV rhyl xis nd
re
me
n
</b> including CMV re
ini
is nd cngeni
l CMV
g nciclvir

re
men

6/4
re
men
s
Tre
men
f HIV 
ien
s wi
h CMV re
ini
is
cidfvir<div><br /></div><div>C
id ge
s his sigh
(sigh
-meg lvirus) b ck</div>

re
men
6/4
re
men
s
yrhsh
e n lg indic
ed in
re
men
f CMV re
ini
is in HIV 
ien
r
cyclvir resis
n
HSV fsc rne
<br /><br />FOSc rne
= yrFOSh
e n lg; y
r = fire, which m kes me
hink f elec
rici
y = elec
rly
e bnrm li
ies re s
ide effec
s

re
men
6/4
re
men
s
40 y/ m le wi
h knwn HIV infec
in resen
s wi
h visu l im iremen
.&nbs;&nbs
;Oh
h lmscic ex m reve ls severe re
ini
is.&nbs;&nbs;Wh

w 
ins wu
ld be bes
?
"cidfvir, fsc rne
<br /><br />M ybe g nciclvir
<div><img
src=""cmv drugs.jeg"" /></div>"

re
men
6/4
re
men
s
induces n
ivir l s

e vi induc
in f cellul r genes INF- lh including egy
l
ed IFN<br><br>indic
ed in chrnic HBV, HCV, HPV, nd HHV8 infxns

re
men

6/4
re
men
s
referred ini
i l
re
men
f HBV (2)
enfvir, en
ec vir

re
men
6/4
re

men
s
cv len
ly

ched
 lye
hylene glycl (eg-in
erfrn) in rder
 rlng i
IFN- lh

s n
ivir l effec


re
men
6/4
re
men
s
l mivudine, en
ec vir,
elbivudine, give cl ss nd wh
is i
used fr? . SFX?
"Nucle
ide n lgs fr HBV
re
men
;
hese c n c use l c
ic cidsis<div><img
src=""l mi.jeg"" /></div>"

re
men
6/4
re
men
s
Which 2 drugs c n
re
b
h HBV nd HIV?
l mivudine (nucleside n lg)
nd
enfvir (nucle
ide n lg)&nbs;
re
men
6/4
re
men
s
rib virin + egyl
ed in
erfern + r
e se inhi

re
men
f chrnic HCV
bi
r<br><br>r
e se inhibi
rs =
el revir, bcerevir

re
men
6/4
re

men
s
Tw r
e se inhibi
rs used in HCV
re
men


el revir, bcerevir
re
men

6/4
re
men
s
Tre
men
f cirrh
ic 
ien
s wi
h ____ h s been shwn
 inhibi

he develm
en
f HCC nd imrve surviv l.
IFN

re
men
6/4
re
men
s
Tic l
re
men
f geni
l w r
s (HPV) nd skin c ncer. immune resnse mdul

r (TLR7 gnis

h
induces rele se f cy
kine frm skin) imiquimd

re
men
6/4
re
men
s
Tre
men
f CMV re
ini
is in AIDS 
s when 
her
her ies h ve f iled; inhibi

s CMV relic
in by binding
 mRNA
r nscri
s
fmivirsen<div><br /></d
iv><div>firs
n
isense lignucle
ide!</div>
re
men
6/4
re
men
s
"<img src=""A316_cl ssQ.ng"" />"
Answer = A<br><br>(A316_cl ssQ) cl ssQ

re
men
6/4
re
men
s
"<img src=""A317_cl ssQ.ng"" />"
Answer = C<br /><br />Indic
ed rib viri
n ersl
re
men
f severe RSV infec
in in children.
cl ssQ
re
men

6/4
re
men
s
"<img src=""A318_cl ssQ.ng"" />"
"Answer = C<br /><br /><img src=""f m.j
eg"" />"
cl ssQ
re
men
6/4
re
men
s
"<img src=""A319_cl ssQ.ng"" />"
"Answer = C<br /><br /><img src=""wh sh
cl ssQ
re
men
6/4
re
men
s
uld be
re
ed.jeg"" />"
"<img src=""A320_cl ssQ.ng"" />"
Answer = D<br /><br />F mciclvir nd v
l cyclvir= rved fr shingles. Gre
er bi v il bili
y
h n cyclvir.
cl ssQ
re
men
6/4
re
men
s

"<img src=""A321_cl ssQ.ng"" />"

Answer = A<br><br>(A321_cl ssQ) cl ssQ

re
men
6/4
re
men
s
"<img src=""A322_cl ssQ.ng"" />"
Answer = C; 
hers used fr HBV<br /><br
/>(A322_cl ssQ)
cl ssQ
re
men
6/4
re
men
s
c
ive g ins
sexu l ery
hrcy
ic s

e f ll l smdium secies<br />L
s f
side effec
s: cinchnism, hyglycemi , s
imul
es u
erine cn
r c
ins nd m y
induce br
in, myc rdi l deressin "quinine<div><img src=""quinine.jeg"" /
></div>"

re
men
s
syn
he
ic quinine n lg
h
inhibi
s heme lymer se (inhibi
s syn
hesis f DN
A nd RNA in
he l smdium), incre ses H f v cules in
he  r si
e
 reven


he u
iliz
in f ery
hrcy
e Hb<br />side effec
s = re
in l degener
in ss
"chlrquine<br /><br />l ""C
ci
ed wi
h lng
erm/high dse
her y
HLORINE"" re lly hur
s my eyes when Ive been in
he l fr lng
ime <div><
br /></div><div><img src=""chlrquine.jeg"" /></div>"
re
men
s
inhibi
s
he  r si
es heme lymer se, wrks g ins

he <u>ery
hrcy
ic s
ge
</u> f sensi
ive l smdium secies, s fe in regn ncy "chlrquine<div><img sr
c=""chlrquine.jeg"" /></div>"

re
men
s
c
ive g ins
sexu l ery
hrcy
ic s
ge f ll l smdium secies; used fr r
hyl xis r cu
e nn-severe m l ri <br />Side effec
s: insmni , vivid dre ms,
rrhy
hmi s; cn
r dindic
ed in 
s wi
h his
ry f seizure/sychi
ric disrd
er
"meflquine<div><img src=""mefl.jeg"" /></div>"

re
men
s
c
ive g ins
liver s
ges f m l ri including hynzi
es f P. viv x nd P.
v le in
he liver<br />Txici
y: severe hemly
ic nemi in 
ien
s wi
h G6PD
deficiency, me
hemglbinemi , cn
r indic
ed in regn ncy
"Prim quine<br /
><br />rim QUEEN: lng LIVE
he queen! Viv l queen! Viv x nd v le living in

he liver!<br /><div><img src=""rim .jeg"" /></div>"
re
men
s
Sequen
i l blck de f
w s
es in flic cid 
hw y, includes dihydrfl
e
reduc
se inhibi
r<br />Side effec
s: bne m rrw suressin, llergic re c
i
"f nsid r (yrime
h mine/sulf dxine)<div><img src=""f ns.jeg""
ns, r sh
/></div>"

re
men
s
c
ive g ins
dividing liver s
ge f m l ri nd g ins
chlrquine-resis
n

P. f lci rum<br />
"m l rne (
v qune/rgu nil)<div><img src=""m l rne
.jeg"" /></div>"

re
men
s
br d sec
rum
e
r cyline bx used fr m l ri nd is c
ive g ins
ll l sm
dium secies<br />Side effec
s: di rrhe , cncen
r
ed in bnes/
ee
h c using de
n
l s
ining; cn
r indic
ed in regn ncy nd children &l
; 8 "dxycycline<div
><img src=""dxy.jeg"" /></div>"

re
men
s
kills ery
hrcy
ic frms, IV drug f chice fr severe P. f lci rum m l ri , in
cre ses effec
s f meflquine nd
e
r cycline, mus
be given in cmbin
in wi

h meflquine r dxycycline
 vid resis
nce/rel se " r
emisinins<br /><br /
>
hink f f be u
iful wrk f r
( r
emisinin) wi
h l
s f differen
clrs.
I
wuld be bring
 use nly ne clr, nd i
wuld be bring/b d
 use jus

ne drug!<br /><div><img src="" r
e.jeg"" /></div>"
re
men
s
fr m l ri : br d sec
rum
e
r cycline n
ibi
ic + n
im l ri l effec
s slw
+ used wi
h quinine r r
emisinin
"dxycyline<div><img src=""dxy.jeg"" /
></div>"

re
men
s
fr m l ri : c
ive g ins
dividing liver s
ges s rhyl xis c n be s
ed
sner
h n 
her gen
s; hwever i
s very exensive "M l rne (
v qune/r
gu nil)<br /><br /><br />K rl MALONE h d 
erni
y sui
in
he 90s
h
lms

DIVIDED his f mily bu
he w s ble
 PAY his l wyer l

 s

he l wsui

re lly SOON<div><img src=""m l rne.jeg"" /></div>"

re
men
s
fr m l ri : sequen
i l blck de f
w s
es in flic cid 
hw y + c n be use
d in regn ncy "f nsid r (yrime
h mine/sulf dxine)<br /><br />blcks mul
ile
s
es in flic cid 
hw y AND c n be used in regn ncy--
h
s FANSI!!<div><i
mg src=""f ns.jeg"" /></div>"
re
men
s
fr m l ri : used fr <u>SEVERE m l ri </u> + ismer f quinine when r l Rx n

v il ble<br />Side effec
s: hyglycemi , hy
ensin, rrhy
hmi s
"quinidi
ne<div><img src=""quinidine.jeg"" /></div>"

re
men
s
"<img src=""A323_cl ssQ.ng"" />"
Answer = C<br><br>(A323_cl sQ) cl ssQ

re
men
s

"<img src=""A324_cl ssQ.ng"" />"

Answer = C; i
s f lci rum<br><br>(A324
_cl ssQ)
cl ssQ
re
men
s
wh shuld receive
xl smsis
re
men
?
regn n
wmen nd immuncmrm
ised hs
s

re
men
s

re
men
f chice fr
xl smsis yrime
h mine/sulf di zine<br><br>
xici

y: bne m rrw suressin (mus
give flinic cid), skin r sh
re
men
s

re
men
fr cry
sridium ni
r zx nide<br /><br />
hink f cry
sridiu
m s being suerm n bec use i
is h rd

re
(rck h rd bs!) nd is re lly F
AST ( cid f s
); bu
suerm n is susce
ible
 kry
ni
e (CRYPTO- NITAZOXANIDE
) <br />

re
men
s
b c
rim (
rime
hrim/sulf me
hx zle)
re
men

re
men
f neumcys
is

s
Ni
r zx nide is cnsidered &qu
;m gic bulle
&qu
; fr  r si
es in
h
i

h s br d sec
rum n
i r si
ic func
in.&nbs;&nbs;Besides cry
sridium, w
h

her r
z , helmin
hs, nd b c
eri des i
ls
re
? gi rdi l mbli ,
helmin
hs (chrnic f scil ), nd C. diff

re
men
s
me
rnid zle (inv sive) + idq

re
men
fr mebi sis (E. his
ly
ic )
uinl r  rmmycin (b
h lumen l)<br /><br />remember: if
he 
ien
is sym

m
ic (inv sive infec
in) yu mus

re
wi
h BOTH lumin l gen
(idquinl
r  rmmycin) nd sys
emic gen
(me
rnid zle)
re
men
s
lumin l gen
s c
ive g ins

he cys
s
ges f E. his
ly
ic (2)
idquin
l,  rmmycin
re
men
s
drug f chice fr ms
in
es
in l/v gin l r
z ns me
rnid zle<br /><br /
>Pr
z (GET n
he me
r)--Gi rdi , E. his
ly
ic , T. v gin lis

re
men

s
me
rnid zle r
inid zle

re
men
fr gi rdi

re
men
s
s
nd rd recmmended
her y fr cu
neus, muccu
neus, nd viscer l leishm n
i sis en
v len
n
imni ls, mh
ericin B (being incre singly used)<br /><
br /> ls: mil
efsin, en
midine<br /><br />
hink f Dn v ni (L. dnv ni) wh
 is rich nd lives in en
huse (en
v len
n
imni ls r en
midine) in
L
in Americ nd Dn v ni is rich, s he ls likes
 we r FEAUX FUR ( mFEAUX

ericin). He likes

ke his dg

he be ch (remember
h
dgs re
he reser
vir in L
in Americ ). A

he be ch,
here re s ndflies everywhere . If Dn v
ni desn
kee his dg n le sh,
here will be MANIA (LEISHMANIA)! <br /><br />

re
men
s
incre singly being used fr
re
men
f viscer l leishm ni sis mh
ericin B (
lism l re r
ins)
re
men
s
Fr fric n
ry nsmi sis, wh
is used fr bld brne dise se (hemlymh
ic
s
ge)? Wh
bu

he CNS dise se?
bld dise se - sur min<br />CNS - mel r
srl
re
men
s
Tre
men
: Afric n
ry nsmi sis CNS dise se mel rsrl

re
men
s
Tre
men
f Americ n Try nsmi sis Nifur
imx nd Benznidzle<br /><br />im
gine rich guy we ring FUR (niFUR
imx) nd driving
mercedes BENZ (benznid z
le) wh
kes TRYP n CRUZ (
ry nsm cruzi)
 cen
r l meric (ch g s i
s endemic
hrughu
much f Mexic, Cen
r l Americ , nd Su
h Americ ). He dri
nks
 much

he en b r n
he shi nd ends u KISSING&nbs;&nbs; girl w
i
h RED lis
ick (REDuvid bug- k kissing bug). He ls e
s

n (i
s cruise
, f
er ll) which m kes him h ve&nbs;&nbs;MEGACOLON. He f lls in lve wi
h
h
e girl wi
h
he red lis
ick (Reduvid bug), which gives him
brken he r
(CARD
IOMYOPATHY). <br /><br />

re
men
s
Tre
men
f Afric n
ry nsmi sis hemlymh
ic s
ge (bld s
ge) nd CNS i
nfec
in
IV sur min - bld s
ge<br />Mel rsrl - CNS<br /><br />SUR m
in fr bld brne dise se r MELArsrl fr CNS ene
r
in (i
SURe is nice

 g
 slee; MELA
nin hels wi
h slee) <br />

re
men
s
Tre
men
fr Asc ris, Trichuri sis, Pinwrm, Hkwrm lbend zle, benznid zl
e

re
men
s
DEC (desn
kill dul
wrms) + lbend

re
men
fr lymh
ic fil ri sis
zle (fr dul
wrms)
re
men
s
DEC

re
men
f l l

re
men
s
ivermec
in (kills micrfil ri )
re
men
s

re
men
f River blindness

ivermec
in

re
men
f s
rngylides

re
men
s

re
f ll flukes exce
f scil
r ziqu n
el<br><br>
re
f scil wi
h
ni
zx nide

re
men
s
lbend zle, surgery (PAIR)

re
men
fr echincccus

re
men
s
True r f lse:&nbs;&nbs;An
ibdies nd in c
iv
ed v ccines c n be given simul

neusly.&nbs;&nbs;An
ibdies nd live v ccines shuld n
be given simul
ne
immuniz
usly
rue<br><br>n
e: dn
give live v ccines
 regn n
wmen

in
Befre s
r
ing 
ien
frm
he develing wrld n s
erids, yu check
he s

l fr wh
? s
rgylides

re
men
s
Tre
men
s f HSV 1, 2, nd VZV cyclvir

re
men
6/4
re
men
s
Hw des cyclvir wrk? cl ss? "<u>gu nsine n lg</u>, hshryl
ed by <b><
fn
clr=""#ff0000"">vir l TK</fn
></b>, incr
ed in
 DNA ch in , which l
e ds
 <b>DNA ch in
ermin
in</b><br /><div><b><img src="" n
ivir l.jeg"" />
</b></div>"

re
men
6/4
re
men
s
rib virin nd in
erfern

re
men
f HCV

re
men
6/4
re
men
s
CMV drug ssci
ed wi
h elec
rly
e bnrm li
ies nd seizures fsc rne
<div><b
r /></div><div>C 2+ Mg2+ w s
ing --&g
; seizures</div>
re
men
6/4
re
men
s
The fregu
is
he regin f
he GI
r c
frm ______
 _______
"The fr
egu
is
he regin f
he GI
r c
frm <fn
clr=""#FF0000"">
he lwer esh
gus</fn
>
 <fn
clr=""#FF0000"">2nd s
ge f dudenum</fn
>"
Fregu

"The midgu
is
he regin f
he GI
r c
frm&nbs;<fn
clr=""#FF0000"">____
__</fn
>&nbs;
&nbs;<fn
clr=""#FF0000"">_________</fn
>"
"The mid
gu
is
he regin f
he GI
r c
frm&nbs;<fn
clr=""#FF0000"">
he secnd s

ge f
he dudenum</fn
>&nbs;
&nbs;<fn
clr=""#FF0000"">
he rxim l 2/
3 f
he cln</fn
>" Fregu

"The hindgu
is
he regin f
he GI
r c
frm&nbs;<fn
clr=""#FF0000"">___
___</fn
>&nbs;
 <fn
clr=""#FF0000"">______</fn
>"
"The hindgu
is

he regin f
he GI
r c
frm&nbs;<fn
clr=""#FF0000"">dis
l 1/3 f
he c
Fregu

ln</fn
>&nbs;
&nbs;<fn
clr=""#FF0000"">
he rec
um</fn
>"
N me
he r
ery/vein
h
sulies:<div>Fregu
?</div><div>Midgu
?</div><div>Hin
dgu
?</div>
<div>Fregu
= celi c
runk</div><div>Midgu
= suerir mesen
er
ic</div><div>Hindgu
= inferir mesen
eric</div>
Fregu

"<img src="" s
e-8950711844868.jg"" /><div>N me
he 2 lbes nd
he lig men
.<
/div>" 1. Righ
lbe<div>2. Lef
lbe</div><div>3. F lcifrm lig men
</div>
Fregu

"<img src="" s
e-9216999817220.jg"" /><div>N me
he fur lbes n
he s
eri
r liver. (
his is
he nrm l n
erir view flied uw rd
 see
he s
erir)<
/div>" 1. Righ
lbe<div>2. Lef
lbe</div><div>3. C ud
e lbe</div><div>4. Qu
dr
e lbe</div>
Fregu

"<img src="" s
e-9994388897796.jg"" /><div>Iden
ify
hese
w fissures. Wh
f
Red: Righ
s gi

l fissure frmed by
he IVC nd g llbl
rms e ch?</div>"
dder<div>Green: Lef
s gi

l fissure frmed by
he rund lig men
f
he liver
nd lig men
um vensum</div> Fregu

"<img src="" s
e-10320806412292.jg"" /><div>Wh
is
his s
ruc
ure c lled? Wh
Pr
he
is<div>Fund in
he he
du

lig men
is i
fund in?</div>"
den l lig men
</div>
Fregu

Func
in lly,
he qu dr
e nd c ud
e lbes f
he liver re  r
f
he (rig
h
/lef
) lbe "Func
in lly,
he qu dr
e nd c ud
e lbes f
he liver re
 r
f
he <fn
clr=""#FF0000"">lef
</fn
> lbe" Fregu

"<img src="" s
e-10754598109188.jg"" /><div>Iden
ify.</div>" 1. Rund lig men

f
he liver<div>2. F lcifrm lig men
</div><div>3. Suerir crn ry lig men

</div><div>4. B re re f
he liver</div><div>5. Righ

ri ngul r lig men
</div
><div>6. Lef

ri ngul r lig men
</div> Fregu

"<img src="" s
e-11098195492868.jg"" /><div>Wh
is
he embrylgic l rigin 
f
his s
ruc
ure?</div>"
Rund lig men
f
he liver -&g
; umbilic l vein
Fregu

"<img src="" s
e-11394548236292.jg"" /><div>If in were l ced here, wh
w
uld be
he firs
l yer
h
i
 sses
hrugh?</div>" Liver! This is
he b re
re f
he liver nd is NOT cvered by viscer l eri
neum!
Fregu

"<img src="" s
e-11553462026244.jg"" /><div>Iden
ify
hese brders f
he live

r.</div>"
1. Suerir crn ry lig men
<div>2. Inferir crn ry lig men
<
/div><div>3. Lef

ri ngul r lig men
</div><div>4. Righ

ri ngul r lig men
</di
v><div>5. Oening fr he
ic veins</div>
Fregu

"<img src="" s
e-11862699671556.jg"" /><div>Iden
ify
hese brders f
he live
r.</div>"
<div>1. Suerir crn ry lig men
</div><div>2. Inferir crn r
y lig men
</div><div>3. Lef

ri ngul r lig men
</div><div>4. Righ

ri ngul r l
ig men
</div><div>5. Oening fr he
ic veins</div><div><br /></div> Fregu

Which brder f
he sleen is n
ched? "<div>The n
erir brder is n
ched. Th
is is useful in de
ermining
he 3 surf ces (likely in n
he r c
ic l).</div><
img src="" s
e-12579959209988.jg"" />"
Fregu

"<img src="" s
e-12781822672900.jg"" /><div>Iden
ify
he surf ces f
he slee
n.</div>"
"<img src="" s
e-12872016986116.jg"" />"
Fregu

The sleen is r
ec
ed by ribs ____
"The sleen is r
ec
ed by ribs <fn
c
lr=""#FF0000"">9-11</fn
>" Fregu

The lng xis f
he sleen runs lng rib ___ "The lng xis f
he sleen run
s lng rib <fn
clr=""#FF0000"">10</fn
>" Fregu

Which lig men
cnnec
s
he sleen

he s
erir w ll? Wh
is fund in
his
lig men
?
Lienren l lig men
<div>Cn
ins
he slenic vessels nd
he
i
l f
he  ncre s</div> Fregu

Which lig men
cnnec
s
he sleen

he s
m ch? Wh
is fund in
his lig men
"Cnnec
ed
 s
m ch vi <fn
clr=""#FF0000"">g s
rslenic lig men


?
&nbs;</fn
><div>Cn
ins
he <fn
clr=""#FF0000"">shr
g s
ric, nd lef
g
s
reilic r
eries</fn
></div>"
Fregu

"<div><img src="" s
e-14405320310788.jg"" /></div>N me
his l ne.<div>Wh
is
fund lng
his l ne?</div><div>Wh
is
he sin l level?</div>"
Tr nsyl
ric l ne<div>Cn
ins: ylric shinc
er, g llbl dder, hilum f LEFT kidney, b
dy f  ncre s</div><div>A
ver
ebr l level L1</div> Fregu

"<img src="" s
e-14701673054212.jg"" /><div>N me
he regins f
he s
m ch.</
div>" "<div>1.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n
>Esh gus</div><div>2.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re"">
</s n>C rdi c r
in</div><div>3.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e
-s ce:re""> </s n>Fundus</div><div>4.<s n cl ss=""Ale-
b-s n"" s
yle=""w
hi
e-s ce:re""> </s n>Bdy</div><div>5.<s n cl ss=""Ale-
b-s n"" s
yle="
"whi
e-s ce:re""> </s n>Gre
er curv
ure</div><div>6.<s n cl ss=""Ale-
b
-s n"" s
yle=""whi
e-s ce:re""> </s n>Lesser curv
ure</div><div>7.<s n cl
ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Angul r n
ch ( ngul r i
ncisure)</div><div>8.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> <
/s n>Pylric n
rum</div><div>9.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s
ce:re""> </s n>Pylric c n l</div><div>10.<s n cl ss=""Ale-
b-s n"" s
yl
e=""whi
e-s ce:re""> </s n>Dudenum</div><div><br /></div>" Fregu

"<img src="" s
e-15204184227844.jg"" /><div>N me
he regins f
he in
ern l s

m ch.</div>" "<div>11.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re"
"> </s n>Rug e</div><div>12.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:
re""> </s n>Pylric shinc
er</div><div>13.<s n cl ss=""Ale-
b-s n"" s
yl
e=""whi
e-s ce:re""> </s n>C rdi c shinc
er</div><div><br /></div>" Fregu

"<img src="" s
e-15560666513412.jg"" /><div>N me
hese br nches f
he celi c

runk.</div>" "<div>1.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""
> </s n>Celi c
runk</div><div>2.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s
 ce:re""> </s n>Cmmn He
ic r
ery</div><div>3.<s n cl ss=""Ale-
b-s
n"" s
yle=""whi
e-s ce:re""> </s n>Slenic r
ery</div><div>4.<s n cl ss=""A
le-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Shr
g s
rics</div><div>5.<s
n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Lef
g s
reili
c</div><div>6.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>G
s
rduden l&nbs;</div><div>7.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s
ce:re""> </s n>He
ic rer</div><div>8.<s n cl ss=""Ale-
b-s n"" s
yle
=""whi
e-s ce:re""> </s n>Righ
g s
ric&nbs;</div><div>9.<s n cl ss=""Ale
-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Lef
g s
ric</div><div>10.<s n cl
ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Righ
g s
reilic&nb
s;</div><div>11.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s

n>Suerir  ncre
ic-duden l ( n
erir nd s
erir br nches)</div><div><br

/></div>"
Fregu

"<img src="" s
e-15857019256836.jg"" /><div>N me
hese
w u
nmics ssci

ed wi
h
he fregu
. Wh
is e ch ne rby?</div>"
"<div>1.<s n cl ss=""A
le-
b-s n"" s
yle=""whi
e-s ce:re""><fn
clr=""#FF0000""> </fn
></s n>
<fn
clr=""#FF0000"">V g l
runks</fn
> n <fn
clr=""#FF0000"">esh gus
</fn
> c rrying  r sym
he
ic fibers</div><div>2.<s n cl ss=""Ale-
b-s n
"" s
yle=""whi
e-s ce:re""> </s n><fn
clr=""#FF0000"">Celi c g nglin</f
n
> send s
g nglinic sym
he
ic fibers wi
h
he br nches f
he <fn
clr=
""#FF0000"">celi c
runk</fn
></div><div><br /></div>" Fregu

"<img src="" s
e-16402480103428.jg"" /><div>N me
hese regins f
he he
ic
1. He
ic r
l vein<div>2. Slenic vein</div><div>3.
r
l vein.</div>"
Suerir mesen
eric vein</div><div>5. IVC</div> Fregu

"<img src="" s
e-2559800508420.jg"" /><div>N me
hese five regins f
he  nc
re s.</div>"
1. He d<div>2. Neck</div><div>3. Uncin
e rcess</div><div>4. B
Fregu

dy</div><div>5. T il</div>
"<img src="" s
e-3277060046852.jg"" /><div>N me
hese fur s
ges f
he dude
num.</div>"
A. 1s
s
ge<div>B. 2nd s
ge</div><div>C. 3rd s
ge</div><div>D
. 4
h s
ge</div>
Fregu

Which s
ge f
he dudenum is sur
ed by lig men
f Trei
z? 4
h s
ge
Fregu

Which s
ge f
he dudenum is recieves
he bile duc
? 2nd s
ge
Fregu

Which s
ge f
he dudenum is crssed by
he suerir mesen
eric vessels?
3rd s
ge
Fregu

Which s
ge f
he dudenum is fund in
he
r nsylric l ne? 1s
s
ge
Fregu

"Which regin f
he  ncre s lies wi
hin
he "" rms"" f
he dudenum?"
He d
Fregu

Which regin f
he  ncre s lies n
erir

he suerir mesen
eric vessels?
Neck
Fregu

Which regin f
he  ncre s lies s
erir

he suerir mesen
eric vessels?
Uncin
e rcess
Fregu

Which regin f
he  ncre s lies in
he s
erir w ll f men
l burs ?
Bdy
Fregu

Which regin f
he  ncre s lies in
he lienren l lig men
? T il
Fregu

Where d
he bile duc
s em
y? Em
y

he m jr duden l  ill
Fregu

Where des
he ccessry  ncre
ic duc
em
y? IF resen
will dr in in
 minr
duden l  ill
Fregu

"<img src="" s
e-7159710482436.jg"" /><div>N me
hese
w duc
s f
he  ncre
s.</div>"
6. M in  ncre
ic duc
<div>7. Accessry  ncre
ic duc
</div>
Fregu

"<img src="" s
e-7348689043460.jg"" /><div>Iden
ify.</div>" 1. M jr duden
l  ill <div>2. Amull f V
er</div><div>4. Minr duden l  ill </div>
Fregu

Wh
m kes u
he mull f V
er?
"I
is
he dil
ed r
in f
he <fn

clr=""#FF0000"">cmmn bile duc
</fn
> f
er
he junc
in wi
h
he <fn
cl
r=""#FF0000"">m in  ncre
ic duc
</fn
>"
Fregu

Wh
is
he shinc
er f Oddi? "Circul r muscul
ure surrunding
he ening f
mull f V
er<img src="" s
e-7898444857348.jg"" />"
Fregu

"<img src="" s
e-8014408974340.jg"" /><div>N me
hese duc
s.</div>" ##. Acce
ssry  ncre
ic duc
<div>**. M in  ncre
ic duc
</div>
Fregu

Which regin f
he dudenum c
ins
he m jr duden l  ill ?
2nd s
g
e f
he dudenum
Fregu

Wh
frms
he m jr duden l  ill ? C used by
he shinc
er f Oddi surrund
ing
he mull f V
er
Fregu

Which ne is suerir: m jr r minr duden l  ill ? Minr (bu
n
lw ys r
esen
) Fregu

"<img src="" s
e-9032316223492.jg"" /><div>Iden
ify
hese r
ins f
he ue
r bil ry sys
em.</div>" 1. Righ
nd lef
he
ic duc
s<div>2. Cmmn he
ic du
c
s</div><div>3. Cys
ic duc
</div><div>4. G llbl dder</div><div>5. Cmmn bile d

uc
</div>
Fregu

"The cmmn bile duc
em
ies in
 <fn
clr=""#FF0000"">______</fn
>"
"The cmmn bile duc
em
ies in
 <fn
clr=""#FF0000"">2nd s
ge f dudenum
</fn
>"
Fregu

Wh
frms
he brders f
he
ri ngle f C l
?
"Cmmn he
ic duc
, cy
s
ic duc
, surf ce f
he liver<div><img src="" s
e-9573482102788.jg"" /></div
>"
Fregu

Wh
is fund in
he
ri ngle f C l
? Cn
ins cys
ic r
ery Fregu

"<img src="" s
e-9848360009732.jg"" /><div>Iden
ify
he bld suly

he 
ncre s.</div>" 1. Slenic<div>2. P ncre
ic br nches</div><div>3. G s
rduden
l</div><div>4.An
erir/s
erir suerir  ncre
icduden l</div><div>5. Sueri
r mesen
eric</div><div>6. An
erir/s
erir inferir  ncre
icduden l</div>
Fregu

"<img src="" s
e-10213432229892.jg"" /><div>Iden
ify
hese s
ruc
ures.</div>"
1. Ar
<div><div>2. Celi c
runk</div><div>3. Suerir mesen
eric</div><div>4.
Neck f
he  ncre s</div><div>5. Uncin
e rcess f
he  ncre s</div><div>6.
3rd s
ge f dudenum</div></div>
Fregu

Where des
he he
icr
l vein recieve venus dr in ge frm? Sys
emic sys
em?
"He
ic r
l: diges
ive
r c
<div>Sys
emic sys
em: bdmin l rg ns
h
re
<fn
clr=""#FF0000"">NOT</fn
>&nbs; r
f
he diges
ive
r c
</div>"
Fregu

Wh
re
he fur n s
msis resen
in c se
he he
ic r
l vein becmes c
mrmised?
<div>In c ses f he
ic r
l cmrmise bld&nbs;c n be rer
revers l f&nbs;bld flw
hrugh enl rged veins.</div>
u
ed

he IVC vi
<div><br /></div><div>1. Arund esh gus:&nbs;Vi esh ge l veins in
 zygu
s veins</div><div>2. Arund umbilicus:&nbs;Vi  r umbilic l veins in
 sueri
r nd inferir eig s
ric veins</div><div>3. Arund re
reri
ne l bwels:&nbs
;Vi veins f
he bdy w ll (lumb r, zygus, nd hemi zygus)</div><div>4. Aru
nd nus:&nbs;Vi rec
l veins in
 ili c veins</div><div><br /></div> Fregu

Give
he 4 l yers f
he gu
w ll frm lumen u
.<div><br /></div><div>Give ll
f
he subl yers f e ch, if ny.</div><div><br /></div><div>Give ll f
he v r
i
ins in e ch crss
he GI</div>
"<img src="" s
e-1460288881061.jg"" />
<div><br /></div><div>My ddi
ins re in blue.</div>" His
lgyGu
Overview
Wh
is e ch f
hese fd mlecules diges
ed in
 befre bsr
in by
he gu
?
<div><br /></div><div>Pr
ein</div><div>S
rch</div><div>Triglycerides</div>
Pr
ein--&g
; min cids, die
ides,
rie
ides<div><br /></div><div>S
rch--&
g
;m l
se, m l

rise, lh -limi
dex
rins</div><div><br /></div><div>Triglyc
erides--&g
;2-mnglycerides, 2-free f

y cids where
he 2 secifies bnd
si
in, n
n mun
.</div> His
lgyGu
Overview
Give 6 bsr
ive func
ins f
he gu
. "U
ke f...<div><br /></div><div><img
src="" s
e-2503965934176.jg"" /></div>"
His
lgyGu
Overview
Give
he 12 cns
i
uen
s f GALT.
"<img src="" s
e-2950642533344.jg"" />
"
His
lgyGu
Overview
Define me
blism, c
blism, nd n blism. "<div><div>
l;dr:&nbs;</div><di
v>me
blism: in
egr
ed bichemis
ry f
he bdy</div><div>c
blism: bre king
dwn fd in
 simler mlecules</div><div> n blism: building u new/cmlex m
lecules wi
h simler me
bli
es</div></div><div><br /></div><div>Me
blism
h
e in
ercnversin f fd, s
r ge mlecules nd energy
hrugh highly regul
ed
chemic l re c
ins
h
d 

 ch nges in fd suly nd energy dem nds. &nb
s;</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n><
/div><div>C
blism
he cnversin f cmlex fd nd s
r ge mlecules (cml
ex c rbhydr
e, r
ein nd f
) in
 simler cmnen
s (mns cch rides, f


y cids, min cids)
h
c n be u
ilized fr energy.</div><div><br /></div><div
>An blism The use f simle me
bli
es (simle sug rs, f

y cids nd min
cids)
 gener
e mre cmlex mlecules fr s
r ge (glycgen,
riglycerides,
nd r
ein) nd fr m in
en nce nd grw
h (new r
eins, membr nes). &nbs;</di
v><div><br /></div>"
Me
blismGIMNER Me
blismOverviewFed10.29.12
Define birduc
me
blism
<div>Birduc
me
blism
he bisyn
hesis f s
eci lized mlecules
h
re required
 erfrm rle 
her
h n energy me
b
lism r s
r ge. &nbs;In GIMNER we will use heme, chles
erl, nd urines/yr

imidine bisyn
hesis s ex mles.&nbs;</div><div><br /></div><div>
l;dr: n bl

ic syn
hesis f nn-energe
ic mlecules</div> Me
blismGIMNER Me
blismOverv
iewFed10.29.12
Define
he fed, f s
ed, nd s
ressed s

e. Fr e ch s

e, cmmen
n
he fd
in
ke nd s

us f s
r ge mlecules. "<div><div>
l;dr: c
u lly, re

y cnci
se defini
ins; shuld be e sy
 recgnize n MCQs</div></div><div><br /></div>
<div>A.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Fed s


e during nd shr
ly f
er e
ing. &nbs;P
en
i l energy in fd nd i
s sm ll
mlecule me
bli
es exceeds wh
is needed fr energy dem nds. &nbs;In
he Fed
S

e fd is diges
ed nd s
r ge mlecules re syn
hesized.</div><div><br /><
/div><div>B.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>F s

ed s

e n fd in
ke. &nbs;Energy dem nds exceed wh
is v il ble frm sm
ll mlecule me
bli
es. &nbs;S
r ge mlecules re degr ded fr m in
ining en
ergy.</div><div><br /></div><div>C.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
es ce:re""> </s n>S
ressed s

e n fd in
ke nd
he requiremen
fr l rge
nd immedi
e exendi
ure f energy. &nbs;S
r ge mlecules re degr ded fr m
in
ining energy.</div>"
Me
blismGIMNER Me
blismOverviewFed10.29.12
Give
he lc
in nd func
in f e ch f
hese mvemen
s f
he gu
.<div><br />
</div><div><br /></div>
His
lgyGu
Overview
"<img src=""me
blismhrmness
em.ng"" />"
"<img src=""me
blismhrmneske
y.ng"" />"
Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>Liver s
res _____, ____ nd <b>sme</b> ____. &nbs;I
func
ins
 m in

in bld levels f _____ during
he f s
ed nd s
ressed s

e nd
 syn
hesize
_____ frm _____ nd ____ during
he fed s

e. &nbs;I
is m jr si
e f ____
___ nd rcessing be
ween
he in
es
ines nd 
her rg ns.</div><div><br /></di
v>
<div>Liver s
res glycgen, r
ein nd sme f
. &nbs;I
func
ins

m in
in bld levels f glucse during
he f s
ed nd s
ressed s

e nd
 syn

hesize f
frm c rbhydr
e nd min cids during
he fed s

e. &nbs;I
is
m jr si
e f bisyn
hesis nd rcessing be
ween
he in
es
ines nd 
her rg
ns.</div><div><br /></div><div>bisyn
hesis: glucnegenesis, liid syn
hesis,
glycgenesis</div>
Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>Muscle is
he m jr s
r ge si
e fr ___ nd ____. &nbs;Muscle l cks ___
nd c nn
m ke ____ fr 
her rg ns. &nbs;Bec use f i
s ____ s
res, muscle c
n func
in n erbic lly fr shr

ime.</div><div><br /></div>
<div>Mus
cle is
he m jr s
r ge si
e fr r
ein nd glycgen. &nbs;Muscle l cks gluc
se-6-hsh
se nd c nn
m ke glucse fr 
her rg ns. &nbs;Bec use f i
s
glycgen s
res, muscle c n func
in n erbic lly fr shr

ime.</div><div><
br /></div><div>glucse-6-hsh
se: l s
enzyme f glucnegenesis,
r ns-ERlumen r
ein fr excy

ic exr
</div>
Me
blismGIMNER Me
blismOverv
iewFed10.29.12
<div>Kidney is seci lized fr _____ me
blism nd
he excre
in f _____.</div
><div><br /></div>
<div>Kidney is seci lized fr ni
rgen me
blism nd

he excre
in f ure . I
h s
 m ny
r nsr
ers.</div><div><br /></div><div>P
enguins.</div><div><br /></div> Me
blismGIMNER Me
blismOverviewFed10.29.12
Give
he 3 gl nds wi
h bic rbn
e-rich secre
ins
h
em
y in

he gu
lumen
.<div><br /></div><div>Give
he cn
en
s f e ch secre
in.</div>
A.&nbs;
<b>S liv ry gl nds</b> ( r
id, subm ndibul r, sublingu l):<div>1. Mur mid se</
div><div>2. sIgA</div><div>3. L c
ferrin</div><div>4. S liv ry li se (secific
lly frm vn Ebners gl nds in
he
ngue)</div><div><br /></div><div>5. Acquir
ed ellicle r
ein</div><div>6. Amyl se</div><div>7.&nbs;Lyszyme</div><div>8.
Mucus (mucin r
ein)</div><div><br /></div><div>mnemnic: MILL PALM</div><div>
<br /></div><div>B.&nbs;<b>Liver</b>:&nbs;</div><div>1. Bile s l
s</div><div>2
. Bilirubin</div><div><br /></div><div>C.&nbs;<b>Excrine  ncre s:</b></div><d
iv>1. Pr
e ses</div><div>2. Amyl se</div><div>3. Li se</div><div><br /></div><
div>Mnemnic: PAL</div> His
lgyGu
Overview
<div>Red Bld Cells (ery
hrcy
es) re seci lized fr xygen delivery. &nbs;H
ving n mi
chndri ,
hey rely exclusively n ______ &nbs;by
he ____ fr ene
rgy.</div>
<div>Red Bld Cells (ery
hrcy
es) re seci lized fr xygen d
elivery. H ving n mi
chndri ,
hey rely exclusively n n erbic me
blism b
y
he hexse mnhsh
e shun
(en
se hsh
e 
hw y) fr energy.</div><d

iv><br /></div> Me
blismGIMNER Me
blismOverviewFed10.29.12

"Br in nrm lly uses ____ fr i
s fuel nd me
blizes li

le____. &nbs;During
f s
ing, br in c n d 

 use ____ fr fuel.<s n cl ss=""Ale-
b-s n"" s
y
le=""whi
e-s ce:re""> </s n>"
"Br in nrm lly uses glucse fr i
s fue
l nd me
blizes li

le f
. &nbs;During f s
ing, br in c n d 

 use ke
n
e bdies fr fuel.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s
n><div><br /></div><div><br /></div>" Me
blismGIMNER Me
blismOverviewFed10
.29.12
M jr si
es f glycgen s
r ge re ___ nd ____. &nbs;Only ___ hr suly is
v il ble s
h

her mech nisms fr gener
ing glucse mus
be fund n r
lnged f s
.
<div>M jr si
es f glycgen s
r ge re muscle nd liver. &nbs
;Only 24 hr suly is v il ble s
h

her mech nisms fr gener
ing glucs
e mus
be fund n rlnged f s
.</div>
Me
blismGIMNER Me
blismOverv
iewFed10.29.12
M jr s
r ge si
es f r
ein re ____, &nbs;fllwed by ____.
M jr s

r ge si
es f r
ein re muscle, fllwed by liver. Me
blismGIMNER Me
bl
ismOverviewFed10.29.12
F
is m jr s
r ge f energy lc
ed rinci lly in _____. &nbs;F

y cid
me
blism c nn
be used
 gener
e ____.
F
is m jr s
r ge f energy
lc
ed rinci lly in dicy
es. &nbs;F

y cid me
blism c nn
be used

 gener
e glucse.<div><br /></div><div><b>N
e: c rbhydr
es c n be used ( l
ng wi
h min cids)
 gener
e f
, bu
n

he reverse.</b></div>
Me
bli
smGIMNER Me
blismOverviewFed10.29.12
Give
he 3 w ys
h
g s
ric cidi
y in
he dudenum is neu
r lized.
Secre
i
ns frm
he...<div>1. <b>P ncre s</b></div><div>2. <b>Liver</b></div><div>3. <b>
Bunners gl nds</b> in
he submucs f
he dudenum</div>
His
lgyGu
Over
view
Thrugh
he s
m ch nd sm ll in
es
ine, glycgen nd 
her cmlex sug rs re u
l
im
ely diges
ed
 _____
mns cch rides (glucse, g l c
se)
Me
bli
smGIMNER Me
blismOverviewFed10.29.12
In
he fed s

e, f
er bsrb
in in
he sm ll in
es
ine, glucse circul
ing i
n
he bld is s
red s glycgen in ____, nd in
he liver is cnver
ed
 ____
nd s
red s ___ &nbs;in ___ nd ___ In
he fed s

e, f
er bsrb
in in
h
e sm ll in
es
ine, glucse circul
ing in
he bld is s
red s glycgen in mus
cle, nd in
he liver is cnver
ed
 f

y cids nd s
red s
riglycerides in
dise
issue nd
he liver. Me
blismGIMNER Me
blismOverviewFed10.29.12
In gener l, r
eins re brken dwn in
 ____ by ____. In gener l, r
eins re
brken dwn in
 min cids by r
e ses nd e
id ses<div><br /></div><div>P
r
e ses cle ve l rge r
eins f m ny AA. Pe
id ses cle ve sm ll lige
ides
. Terminlgy is
rivi l.</div> Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>_____ nd 
her grw
h-like f c
rs resen
in
he fed s

e s
imul
e r

ein ____ in
he
issues.</div><div><br /></div> <div>Insulin nd 
her grw
h-li
ke f c
rs resen
in
he fed s

e s
imul
e r
ein syn
hesis in
he
issues.<
/div><div><br /></div><div>Tissues: br in, liver, muscle, dise, kidney, e
c.<
/div><div><br /></div> Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>Triglycerides re brken dwn
 ____ nd ______ in
he in
es
in l lumen by
_____.</div><div><br /></div> <div>Triglycerides re brken dwn
 f

y cid
s nd mn cyl glycerides in
he in
es
in l lumen by li ses.</div><div><br /></
div><div>Sme li se resen
in mu
h s well; mre imr
n
in newbrn.</div><
div><br /></div>
Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>The in
es
in l ____ cell
kes u
he f

y cids nd mnglycerides nd re
ssembles
he ______ lng wi
h 
her ___ nd ___ in

l rge, liid-rich  r
i
cle (____) nd secre
es
hem in

he ____ sys
em fr u
ke by
he ____.&nbs;<
/div><div><br /></div> <div>The in
es
in l mucs l cell
kes u
he f

y cid
s nd mnglycerides nd re ssembles
he
riglyceride lng wi
h 
her r
eins
nd liids in

l rge, liid-rich  r
icle (chylmicrns) nd secre
es
hem in


he lymh
ic sys
em fr u
ke by
he liver.&nbs;</div><div><br /></div><di
v>Why re TGs brken dwn nd
hen re ssembled?</div><div><br /></div><div>Peder
sen ( nd  r
ly me): TGs re rly sluble in H2O cm red
 FAs nd MGs (whic
h h ve mre exsed l r func
in l grus). Mvemen
lng
he in
es
in l lume

n is e sier s sluble FAs nd MGs. Yu risk ggreg
in f TGs due

heir hyd
rhbici
y, hence
heir
r nsr
by chylmicrns.</div><div><br /></div>
Me
blismGIMNER Me
blismOverviewFed10.29.12
The chylmicrns rduced by
he in
es
ine re
ken u rim rily by
he ____ wh
ere
hey re cnver
ed
 _____. &nbs;The lir
eins, rich in ____ nd ____,
circul
e in
he bld nd rvide ____

he eriher l
issues
hrugh
he c

in f lc l li ses (<b>lir
ein li se!)</b>&nbs;which hydrlyze
he
rig
lycerides
 f

y cids
h
re
ken u by
he
issues (rinci lly ____).
The chylmicrns rduced by
he in
es
ine re
ken u rim rily by
he liver w
here
hey re cnver
ed
 lir
eins. &nbs;The lir
eins, rich in
riglyc
erides nd chles
erl, circul
e in
he bld nd rvide f

y cids

he e
riher l
issues
hrugh
he c
in f lc l li ses which hydrlyze
he
riglyc
erides
 f

y cids
h
re
ken u by
he
issues (rinci lly dise).
Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>In
he liver:</div><div><br /></div><div>Glucse frm
he bld is direc
ed

w rd ____ nd ____ syn
hesis where
he newly syn
hesized
riglyceride is ex
r
ed vi
he lir
ein, ____ &nbs;
 
her
issues, rinci lly ____.</div>
<div>Glucse frm
he bld is direc
ed
w rd glycgen nd f
syn
hesis where

he newly syn
hesized
riglyceride is exr
ed vi
he lir
ein, VLDL (very-l
w densi
y lir
ein)
 
her
issues, rinci lly dise.</div><div><br /><
/div> Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>Muscle me
blic 
hw ys direc
excess ____ in
 s
r ge s ____, nd min
 cids re direc
ed
 resyn
hesize ny liver ____
h
m y h ve been ls
due

 ____ during
he f s
ing s

e. &nbs;In
he fed s

e, skele
l muscle relies
l rgely n ____ fr energy l
hugh
here is sme b s l me
blism f ____ fr
energy.</div><div><br /></div> <div>Muscle me
blic 
hw ys direc
excess glu
cse in
 s
r ge s glycgen (GLY) , nd min cids re direc
ed
 resyn
hesi
ze ny liver r
ein
h
m y h ve been ls
due
 r
ein degr d
in during

he f s
ing s

e. &nbs;In
he fed s

e, skele
l muscle relies l rgely n gluc
se fr energy l
hugh
here is sme b s l me
blism f f

y cids fr energy
.</div> Me
blismGIMNER Me
blismOverviewFed10.29.12
<div>C rdi c muscle refers ____ s n energy surce nd will cn
inue
 refer
en
i lly u
ilize
hem even when glucse is v il ble.</div>
<div>C rdi c mus
cle refers f

y cids s n energy surce nd will cn
inue
 referen
i lly
u
ilize
hem even when glucse is v il ble.</div><div><br /></div><div>Hence
h
e m ny mi
chndri resen
be
ween s rcmeres fr FA me
blism.</div> Me
bli
smGIMNER Me
blismOverviewFed10.29.12
(T/F) De nv FA syn
hesis is signific n
in dise
issue.<div><br /></div>
F; sme, bu
n
much de nv FA syn
hesis. Ms
FA re imr
ed frm
he liver.
Me
blismGIMNER Me
blismOverviewFed10.29.12
In _____ nd _____, insulin induces
he
r nsr
f ____ frm
he endsme


he l sm membr ne nd
hereby incre ses
he u
ke f ____.
"In <fn
clr=
""#ff1f0f"">MUSCLE</fn
> nd <fn
clr=""#ff1f0f"">ADIPOSE</fn
>, insulin in
duces
he
r nsr
f <fn
clr=""#ff1f0f"">GLUT4</fn
> frm
he <fn
clr
=""#070000"">endsme</fn
>

he <fn
clr=""#070000"">l sm </fn
><fn
c
lr=""#ff1f0f""> </fn
><fn
clr=""#070000"">membr ne</fn
> nd
hereby inc
re ses
he u
ke f <fn
clr=""#ff1f0f"">glucse</fn
>." Me
blismC rbFe
d10.30.12 Me
blismGIMNER
Wh
re
he
w m in func
ins f glucse me
blism? Glucse me
blism serve
s
w m in func
ins:
 mee

he needs f immedi
e energy cell nd
 cn
ri
bu
e
 energy s
r ge
 mee
fu
ure needs.&nbs;
Me
blismC rbFed10.30.1
2 Me
blismGIMNER
Glycgen - ___ lymer m de by ____. &nbs;I
is br nched s
ruc
ure cnsis
i
ng f b
h ____ nd &nbs;____ glycsidic bnds. &nbs;Br nches ccur rxim

ely every 8-10 residues.
"Glycgen - <fn
clr=""#ff1f0f"">glucse</f
n
> lymer m de by <fn
clr=""#ff1f0f""> nim ls</fn
>. &nbs;I
is br nc
hed s
ruc
ure cnsis
ing f b
h <fn
clr=""#ff1f0f""> lh -1,4-</fn
> nd &
nbs;<fn
clr=""#ff1f0f""> lh -1-6 &nbs;</fn
>glycsidic bnds. &nbs;Br n
ches ccur rxim
ely every 8-10 residues." Me
blismC rbFed10.30.12 Me
b
lismGIMNER

<div>S
rch cnsis
s f mix
ure f ____ line r glucse lymer m de by l

n
s wi
h ll &nbs;____ link ges nd mylec
in, ____ lymer wi
h b
h ____nd &nbs;____ &nbs;glycsidic bnds. &nbs;Br nches ccur rxim
ely every
12-20 residues.</div> "<div>S
rch cnsis
s f mix
ure f<fn
clr=""#ff1f
0f""> mylse</fn
> - line r glucse lymer m de by l n
s wi
h ll &nbs;<f
n
clr=""#ff1f0f""> lh -1,4</fn
> link ges nd <fn
clr=""#ff1f0f""> myl
ec
in</fn
>, br nched lymer wi
h b
h <fn
clr=""#ff1f0f""> lh -1,4-<
/fn
> nd &nbs;<fn
clr=""#ff1f0f""> lh -1-6</fn
> &nbs;glycsidic bnds
. &nbs;Br nches ccur rxim
ely every 12-20 residues.</div><div><br /></div
><div> mylec
in is seen s l n
glycgen n lgue</div><div><br /></div>"
Me
blismC rbFed10.30.12 Me
blismGIMNER
Cellulse - lymer f glucse m de by wdy l n
s
 m in
in s
ruc
ure. &nb
s;I
is ____ lymer f ____ glycsidic bnds. &nbs;The ___ bnds c nn
be
brken dwn by hum ns s
h
cellulse serves s
surce f die
ry fiber.&nbs
"Cellulse - lymer f glucse m de by wdy l n
s
 m in
in s
ruc
;

ure. &nbs;I
is <fn
clr=""#ff1f0f"">line r</fn
> lymer f <fn
clr
=""#ff1f0f"">be
-1,4 </fn
>glycsidic bnds. &nbs;The <fn
clr=""#ff1f0f""
>be
-1,4</fn
> bnds c nn
be brken dwn by hum ns s
h
cellulse serves
s surce f die
ry fiber." Me
blismC rbFed10.30.12 Me
blismGIMNER
<div>C rbhydr
e me
blism begins in
he ____. &nbs;The enzyme ____, secre
ed
by
he ____, diges
s b
h s
rch (l n
) nd glycgen ( nim l) cmlex c rbhyd
r
es nd cnver
s
hem
 glucse. &nbs;The diges
in cn
inues in
he in
es
i
nes wi
h _____. &nbs;The glucse is cncen
r
ed in

he in
es
in l ei
heli l
cells

he exense f
he in
r cellul r N gr dien
nd
hen  ssed in

he
bld.&nbs;</div>
"<div>C rbhydr
e me
blism begins in
he <fn
clr=
""#ff1f0f"">mu
h</fn
>. &nbs;The enzyme <fn
clr=""#ff0000"">s liv ry</fn

>&nbs;<fn
clr=""#ff1f0f""> myl se</fn
>, secre
ed by
he <fn
clr=""#f
f1f0f"">s liv ry gl nds</fn
>, diges
s b
h s
rch (l n
) nd glycgen ( nim l
) cmlex c rbhydr
es nd cnver
s
hem
 glucse. &nbs;The diges
in cn
in
ues in
he in
es
ines wi
h <fn
clr=""#ff1f0f""> ncre
ic myl se</fn
>. &n
bs;The glucse is cncen
r
ed in

he in
es
in l ei
heli l cells

he exe
nse f
he in
r cellul r N gr dien
nd
hen  ssed in

he bld.&nbs;</div>
"
Me
blismC rbFed10.30.12 Me
blismGIMNER
<div>&nbs;In
he Fed S

e, sme glucse is direc
ed
hrugh ____ fr immedi
e
energy needs in e ch
issue. &nbs;In ____ nd ___,
he glucse is ls direc
e
d
w rd
he syn
hesis f ____ fr energy s
r ge.&nbs;</div> "<div>&nbs;In

he Fed S

e, sme <fn
clr=""#ff1f0f"">glucse</fn
> is direc
ed
hrugh <f
n
clr=""#ff1f0f"">glyclysis</fn
> fr immedi
e energy needs in e ch
issu
e. &nbs;In <fn
clr=""#ff1f0f"">liver</fn
> nd <fn
clr=""#ff1f0f"">mus
cle</fn
>,
he glucse is ls direc
ed
w rd
he syn
hesis f <fn
clr=""#
ff1f0f"">glycgen</fn
> fr energy s
r ge.&nbs;</div>"
Me
blismC rbFe
d10.30.12 Me
blismGIMNER
Wh
is
he func
in f cquired ellicle r
ein? Wh
secre
es i
?
<b>S liv
ry gl nds</b> secre
e i
<div>&nbs;</div><div>T <b>reven
dec lcific
in</b>
His
lgyGu
Overview
f
he
ee
h</div>
(T/F) The in
es
ine requires ex
rinsic inu
in rder
 func
in.
F lse!<d
iv>The in
es
ine c n func
in qui
e well wi
hu

he ex
rinsic nervus sys
em.</
div>
Neurhysilgy
Wh
re
he
hree m jr subdivisins f
he ex
rinsic innerv
in f
he gu
?
P r sym
he
ic, sym
he
ic, nd sensry
Neurhysilgy
Wh
re
he
w rles f
he ex
rinsic innerv
in f
he gu
? "<div>1.<s n cl
ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Serve n imr
n
rle

 mdify
he c
ivi
y f
he in
rinsic nervus sys
em nd
he m
r func
in 
f
he in
es
ine.</div><div>2.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:
re""> </s n>Serve
 in
egr
e nd crdin
e widely se r
e regins f
he g
s
rin
es
in l
r c

hrugh i
s wn reflexes.</div><div><br /></div>" Neurhy
silgy
Wh
re fur
hings
h

he innerv
in f
he gu
cn
rls? Muscle cn
r c
i
Neurhysilgy
n, bld flw, secre
in, nd bsr
in
"The  r sym
he
ic sys
em

he in
es
ine is lms
en
irely en
irely by <fn

"The  r sym
he
ic sys
em

he in
es

clr=""#FF0000"">______</fn
>"

ine is lms
en
irely en
irely by <fn
clr=""#FF0000"">
he
en
h cr ni l ne
rve,
he v gus</fn
>" Neurhysilgy
The v gus is m de u f wh
fur
yes f nerve fibers?
exci

ry reg
nglinic chlinergic nerves, inhibi
ry reg nglinic chlinergic nerves, sym

he
ic fibers frm
he cervic l g ngli , nd fferen
fibers frm
he in
es
in l
w ll. Neurhysilgy
"The efferen
nerve cell bdies f
he v gus nerve rise in <fn
clr=""#FF000
0"">______</fn
>, nd
heir xns  ss direc
ly
 syn se m inly wi
h <fn
c
lr=""#FF0000"">______</fn
>" "The efferen
nerve cell bdies f
he v gus ner
ve rise in&nbs;<fn
clr=""#FF0000"">
he drs l m
r nucleus f
he v gus (
DMV)</fn
>, nd
heir xns  ss direc
ly
 syn se m inly wi
h&nbs;<fn
cl
Neurhysilgy
r=""#FF0000"">
he en
eric g ngli .</fn
>"
Wh
nerve sulies  r sym
he
ic innerv
in

he uer GI
r c
? Lwer?
Uer: V gus (CN X)<div>Lwer: Pelvic nerves (frm S2-S4 f
he sin l crd)</di
v>
Neurhysilgy
Where d exci

ry reg nglinic  r sym
he
ic neurns rise frm? Inhibi
ry
?
"Exci

ry: Rs
r l<div>Inhibi
ry: C ud l</div><div><img src="" s
e-4
2314017800196.jg"" /></div>" Neurhysilgy
Wh
NT d exci

ry reg nglinic  r sym
he
ic neurns secre
e? Inhibi
ry?
Ps
g nglinic?
"<div>Preg nglinic: BOTH secre
e Ach</div><div>Ps
g ng
linic:</div>Exci

ry: Ach nd Pr
ein S<div>Inhibi
ry: NO, VIP, ATP</div><di
v><br /></div><div><img src="" s
e-43787191582724.jg"" /></div>"
Neurhy
silgy
Where re
he sym
he
ic reg nglinic neurns fund in
he sin l crd?
"In
he in
ermedil
er l cell clumn f
he l
er l hrn<div><img src="" s
e-4
4530220924932.jg"" /></div>" Neurhysilgy
"Sin l r
s <fn
clr=""#FF0000"">_____</fn
> rvide
he m in sym
he
ic
suly

he in
es
ine."
"Sin l r
s&nbs;<fn
clr=""#FF0000"">T9 n
d T10</fn
>&nbs;rvide
he m in sym
he
ic suly

he in
es
ine."
Neurhysilgy
N me
he
hree rever
ebr l g ngli which suly
he gu
. Wh
regin f
he gu

des e ch suly?
Celi c, suerir mesen
eric, inferir mesen
eric<div>S m
e s r
eries nd veins.&nbs;</div><div>Celi c: fregu
</div><div>Suerir mese
n
eric: midgu
</div><div>Inferir mesen
eric: hindgu
</div><div><br /></div>
Neurhysilgy
Wh
d
he s
g nglinic sym
he
ic neurns secre
e un
he gu
?
NE
Neurhysilgy
"<div>As gener liz
in  r sym
he
ic inu
resul
s in <fn
clr=""#FF0000
"">______</fn
>. This ccurs in erids during nd immedi
ely fllwing</div><
div><fn
clr=""#FF0000"">_______.</fn
></div><div><br /></div>"
"<div>As
gener liz
in  r sym
he
ic inu
resul
s in&nbs;<fn
clr=""#FF0000"">
n incre se in m
ili
y&nbs;</fn
></div><div><fn
clr=""#FF0000""> nd GI se
cre
ins</fn
>. This ccurs in erids during nd immedi
ely fllwing</div><d
iv><fn
clr=""#FF0000"">&nbs;
he inges
in f
me l.</fn
></div><div><fn

clr=""#FF0000""><br /></fn
></div>" Neurhysilgy
"<div>Sym
he
ic inu
resul
s in <fn
clr=""#FF0000"">_______</fn
>. Fr e
x mle,
his ccurs during <fn
clr=""#FF0000"">_________</fn
><s n s
yle="
"clr: rgb(255, 0, 0);"">.</s n></div><div><br /></div>"
"<div>Sym
he
i
c inu
resul
s in&nbs;<fn
clr=""#FF0000"">decre sed m
ili
y nd&nbs;</f
n
></div><div><fn
clr=""#FF0000""> decre sed vlume f secre
ins</fn
>. F
r ex mle,
his ccurs during&nbs;<fn
clr=""#FF0000""> s
ress</fn
></div
><div><fn
clr=""#FF0000"">&nbs;resnse r during exercise.</fn
></div><di
v><fn
clr=""#FF0000""><br /></fn
></div>" Neurhysilgy
Wh
is
he effec
f sym
he
ic innerv
in f
nn-shinc
er muscle? Shinc

er muscle? Wh
rece
rs re invlved? "<div>On nn-shinc
er muscle: NE is <f
n
clr=""#FF0000"">inhibi
ry</fn
>
hrugh c
iv
in f <fn
clr=""#FF00
00"">Be
</fn
> drenergic rece
rs</div><div>On shinc
er muscle: NE <fn
c
lr=""#FF0000"">s
imul
es</fn
> <fn
clr=""#FF0000"">cn
r c
in</fn
> vi
<fn
clr=""#FF0000"">Alh </fn
> drenergic rece
rs</div><div><br /></div

>"
Neurhysilgy
Where is
he myen
eric lexus fund in
he gu
w ll? Wh
is i
s func
in?
"The l rge myen
eric lexus, si
u
ed <fn
clr=""#FF0000"">be
ween
he circul
r nd lngi
udin l l yers f
he muscl ris ex
ern </fn
>, cn
ins
he neurn
s resnsible fr<fn
clr=""#FF0000""> m
ili
y.</fn
>"
Neurhysilgy
Where is
he submucs l lexus fund in
he gu
w ll? Wh
is i
s func
in?
"<div>Fund be
ween
he mucs
nd circul r muscle</div>The sm ller submucs l 
lexus <fn
clr=""#FF0000"">cn
ins sensry cells
h

lk

he m
r neur
ns f
he myen
eric lexus</fn
> s well s <fn
clr=""#FF0000"">m
r fibe
rs
h
s
imul
e secre
in frm ei
heli l cry
cells in

he gu
lumen</fn

>."
Neurhysilgy
Whree is
he subei
heli l lexus fund?
In
he l min rri f
he muc
Neurhysilgy
s
Des
he en
eric nervus sys
em require ex
ern l inu
frm
he br in? Ne
Neurhysilgy
Wh
d
he secre
m
r (efferen
) cells f
he en
eric nervus sys
em influenc
e?
Sm
h muscle cells, ei
heli l cells
h
secre
e r bsrb fluid nd e
lec
rli
es, nd en
eric endcrine cells
Neurhysilgy
Wh
d
he in
erneurns cells f
he en
eric nervus sys
em influence? Exci


ry r inhibi
ry effec
s
Neurhysilgy
Wh
d
he sensry ( fferen
) cells f
he en
eric nervus sys
em influence?
Mech nrece
rs, chemrece
rs, smrece
rs Neurhysilgy
Where d
he  r sym
he
ic nerves syn se? Sym
he
ic?
P r sym
he
ic
nerves syn se wi
hin
he rg n<div>Sym
he
ic nerves syn se wi
hin g ngli
(rever
ebr l r  r ver
ebr l) rir
 en
ering
he rg n</div>
Neurhy
silgy
Describe
he en
eric reflex. Is i
shr
r lng r nge? Wh
is i
s rle?&nbs;
"<div>I
c
s ver <fn
clr=""#FF0000"">shr
r nge</fn
> nd frms
he <f
n
clr=""#FF0000"">b sis f eris
l
ic mvemen
</fn
>.&nbs;</div><div>I
s
ms
imr
n
fe
ure is
h

he sensry neurns feed infrm
in&nbs;</div><
div>in
 ch ins f <fn
clr=""#FF0000"">exci

ry in
erneurns</fn
>
h

re linked in n <fn
clr=""#FF0000""> b-r lly</fn
>&nbs;</div><div>direc
i
n, nd ls in
<fn
clr=""#FF0000""> inhibi
ry in
erneurns</fn
>,
h

re linked <fn
clr=""#FF0000""> b- n lly</fn
>.&nbs;</div><div><br /></div>
<div>As resul
, c
iv
in f sensry fibers, ini
i
e cn
r c
in&nbs;</di
v><div>behind
he si
e f s
imul
in nd rel x
in in frn
 f
he si
e
f s
imul
in.</div><div><br /></div>" Neurhysilgy
Describe
he secre
ry reflex. Is i
shr
f lng r nge? Wh
is i
s func
in?
"<div><fn
clr=""#FF0000"">Shr
r nge</fn
> reflex. The secre
ry reflex f
llws
he s me rincile f
he en
eric &nbs;reflex,&nbs;wi
h
he m in differe
nce
h

he <fn
clr=""#FF0000"">u
u
(m
r) 
hw ys
rge

he secre
r
y&nbs;cells f
he gu
, r
he bld vessels.</fn
></div><div><br /></div>"
Neurhysilgy
Wh
is
he func
in f
he lng r nge reflexes?
<div>Invlve c-rdin
e
d resnse f ne regin f
he gu
w ll fllwing c
iv
in&nbs;</div><div>in

her  r
s f
he GI.</div><div><br /></div> Neurhysilgy
Are shr
r nge reflexes in
rinsic, ex
rinsic r b
h? In
rinsic
Neurhy
silgy
The shr
r nge en
eric reflex resul
s in ch nges in _____,______, nd _______
<div>muscle c
ivi
y, fluid nd elec
rly
e exch nge be
ween
issue nd lumen,&n
bs;v scul r cn
rl&nbs;</div><div><br /></div>
Neurhysilgy
Describe
he g s
r-en
eric reflex. Is i
exci

ry r inhibi
ry?
<div>Exc
i

ry</div>G s
r-en
eric reflex - dis
ensin f s
m ch incre se
he exci
bi
li
y (m
r nd secre
ry) f
he sm ll in
es
ine.
Neurhysilgy
Describe
he g s
r-ile l reflex. Is i
exci

ry r inhibi
ry?
<div>Exc
i

ry</div>G s
r-ile l reflex - dis
ensin f s
m ch in
esifies
he c
ivi
y
Neurhysilgy
f
he
ermin l ileum nd ens
he ile-cec l shinc
er
Describe
he g s
r- nd duden-clic reflex. Is i
exci

ry r inhibi
ry?
<div>Exci

ry</div>G s
r- nd duden-clic reflexes (wi
h  r
ici
in f e
x
rinsic innerv
in nd ls hrmn l (g s
rin)`). Dis
ensin f s
m ch r du

denum ini
i
e m ss mvemen
s f
he cln. Neurhysilgy

Describe
he ile-g s
ric reflex. Is i
exci

ry r inhibi
ry?
Inhibi

ry<div>Ile-g s
ric reflex - dis
ensin f n ile l segmen
inhibi
s g s
ric m

ili
y.</div>
Neurhysilgy
Describe
he in
es
in-in
es
in l reflex. Is i
exci

ry r inhibi
ry?
Inhibi
ry.<div><div>In
es
in-in
es
in l reflex - cess
in f in
es
in l m
il
i
y un excessive dis
en
in ( dyn mic ileus), r rugh h ndling (surgery) r 
eri
ni
is (severe irri

in)</div><div><br /></div></div>
Neurhysilgy
Wh
is n ileus?
"Ineffec
ive in
es
in l rulsin<fn
clr=""#FF0000"
"> in
he bsence</fn
> f mech nic l bs
ruc
in" Neurhysilgy
Wh
re
he cnsequences ssci
ed wi
h n ileus?
"<div><s n cl ss=""Ale
-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Accumul
in f g s nd secre
ins
</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Overg
rw
h f sm ll in
es
in l b c
eri &nbs;</div><div><s n cl ss=""Ale-
b-s n""
s
yle=""whi
e-s ce:re""> </s n>Ischemi nd necrsis&nbs;</div><div><s n cl
ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Dehydr
in&nbs;</div>
<div><br /></div>"
Neurhysilgy
Hw c n yu minimize
he sym
ms f n ileus? <div>Thr cic eidur l blck de
wi
h lc l nes
he
ic</div><div>Oiid-s ring n lgesic
echniques&nbs;</div><
div>Nn-s
erid l n
i-infl mm
ry&nbs;</div><div>L  rscic surgery</div><d
iv><br /></div> Neurhysilgy
Why d iid-s ring n lgesic
echniques reduce
he sym
ms f ileus?
<div>Oiids c
ins include incre sed n l shinc
er
ne, reduced eris
lsis
in
he sm ll in
es
ine nd cln, incre sed elec
rly
e nd w
er bsr
in, n
d im ired defec
in resnse. Oiid rece
rs re lc
ed n gu
sm
h muscl
e nd h ve
he l rges
rle in g s
rin
es
in l m
ili
y bu

here re iid re
ce
rs ls in
he myen
eric lexus.</div><div><br /></div>
Neurhysilgy
Wh
regins f
he GI
r c
re sulied by V gus? Pelvic nerve?
<div>V g
us nerve ges

he level f
he
r nsverse cln, Pelvic nerve sulies
he re
s
f
he cln, rec
um, nus</div><div><br /></div>
Neurhysilgy
Wh
re
he
hree  r sym
he
ic syn 
ic
r nsmi

ers f
he gu
?
<div>Pre
-g nglinic n

he g nglin cells: ACh</div><div>Ps
-g nglinic n
 neurns
in
he ENS: ACh nd e
ides</div><div>Ps
-g nglinic n
 sm. muscle, end nd
secre
ry cells: ACh & m; e
ides</div><div><br /></div>
Neurhysilgy
Which h s s
rnger influence n GI m
ili
y,  r sym
he
ic r sym
he
ic?
P r sym
he
ic Neurhysilgy
<div>The s
-g nglinic sym
he
ic fibers re drenergic nd syn se in
w l
ces:&nbs;</div><div><br /></div>
<div>1. On
he g ngli f
he myen
eric
nd submucs l lexus (m jr)</div><div>2. T rge
secre
ry cells nd muscle</di
v><div><br /></div>
Neurhysilgy
Wh
re
he
hree sym
he
ic syn 
ic
r nsmi

ers f
he gu
?
<div>Pre
-g nglinic n

he g nglin cells: ACh</div><div>Ps
-g nglinic n
 neurns
in
he ENS: ACh nd e
ides</div><div>Ps
-g nglinic n
 sm. muscle, end nd
secre
ry cells: ACh & m; e
ides</div><div><br /></div>
Neurhysilgy
<div>GENERALLY: ___ exci
es GI c
ivi
y nd&nbs;___ is inhibi
ry</div><div><br
/></div>
"GENERALLY: <fn
clr=""#FF0000"">ACh</fn
> exci
es GI c
ivi
Neurhysilgy

y nd&nbs;<fn
clr=""#FF0000"">NE</fn
> is inhibi
ry"
Wh
re fur c
ins rduced when
he myen
eric lexus is s
imul
ed? "<div><s
n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Incre ses gu
w ll

ne</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>
Incre ses r
e nd s
reng
h f gu
w ll cn
r c
ins</div><div><s n cl ss=""Al
e-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Incre ses cnduc
in velci
y f
exci

ry w ves, s seeds eris
l
ic w ves</div><div><s n cl ss=""Ale-
b-s
 n"" s
yle=""whi
e-s ce:re""> </s n>Is n
en
irely exci

ry: inhibi
s cn

r c
in ylric shinc
er nd shinc
er f
he ilecec l v lve,
hus f cili

e
s gu
cn
en
mvemen
</div><div><br /></div>" Neurhysilgy
Give ll f
he gu
mvemen
s ssci
ed wi
h
he esh gus
"<img src="" s

e-2589865279732.jg"" />"
His
lgyGu
Overview
Give ll f
he gu
mvemen
s ssci
ed wi
h
he s
m ch
"<img src="" s

e-2680059593008.jg"" />"
His
lgyGu
Overview

Give ll f
he gu
mvemen
s ssci
ed wi
h
he sm ll in
es
ine

"<img sr
c="" s
e-2705829396844.jg"" />"
His
lgyGu
Overview
Give ll f
he gu
mvemen
s ssci
ed wi
h
he cln.
"<img src="" s

e-2757369004276.jg"" />"
His
lgyGu
Overview
Give
he neurns we knw
hus f r
h
re f neur l cres
rigin. (3) 1. Ps
g
nglinic sym
he
ics nd  r sym
he
ics<div>2. En
eric nervus sys
em</div><
div>3. Pseudunil r sensry neurns frm
he drs l r
g ngli </div>
His
lgyGu
Overview
Gu
m
ili
y is linked
 secre
ins frm wh
4 rg ns?
1. S liv ry gl n
ds<div>2. Excrine  ncre s</div><div>3. Liver</div><div>4. G llbl dder</div>
His
lgyGu
Overview
Wh
is
he n me f
he huge glycc lyx in
he sm ll in
es
ine? The en
eric c

His
lgyGu
Overview
f
he en
ercy
es
Give
he 5 secre
ins f
he s
m ch gl nds.
Mnemnic: MILPH<div><br /></div>
<div><b><u>M</u></b>ucus f
he g s
ric mucs l b rrier</div><div><div>g s
ric <
b><u>I</u></b>n
rinsic f c
r</div></div><div>g s
ric <b><u>L</u></b>i se</div>
<div><b><u>P</u></b>esingen</div><div><b><u>H</u></b>ydrchlric cid</div>
His
lgyGu
Overview
Cn
r s
exfli
in nd desqu m
in.<div><br /></div><div>Where lng
he gu

des e ch rcess ccur?</div> <div><b>Desqu m
in</b>:
 l yer f ei
heli
l cells h ve desmsme xid
in nd slugh ff in

he lumen.</div><div><b>Occ
urs in
he</b> <b>esh gus nd n l c n l </b>(
hink de-<b>squ me</b>-
in nd
remember
hese 2 s
s re
he nly nes wi
h squ mus ei
heli )</div><div><br
/></div><div><b>Exfli
in</b>: simle ei
helium lses i
s hemidesmsmes nd
fc l cn
c
s nd ris w y frm
he b semen
membr ne.</div><div><b>Occurs ev
erywhere else</b>&nbs;besides
he esh gus nd n l c n l.</div>
His
lg
yGu
Overview
Wh
re 2 
her n mes fr en
erendcrine cells?
DNES (diffuse neurendc
rine cells) nd GEPP (g s
r, en
eric,  ncre
ic, ulmn ry) His
lgyGu
Over
view
Give
he hrmn l secre
in rduc
ssci
ed wi
h e ch f
hese cell
yes:<di
v><br /></div><div>G cells</div><div>S cells</div><div>I cells</div><div>D cells
</div><div>M cells</div><div>Brunners gl nd cells</div>
<div>G cells: g
s
rin</div><div>S cells: secre
in</div><div>I cells: chlecys
kinin (CCK)</div>
<div>D cells: sm
s

in</div><div>M cells: m
ilin</div><div>Brunners gl nd
cells: urg s
rne</div>
His
lgyGu
Overview
Wh
is c
in f myl se?
Diges
s sug rs
lh -1,4 glycsidic bnds in

 sm ller sug rs nd limi
dex
r ns (shr
, br nched sug rs). Me
blismC rbFe
d10.30.12 Me
blismGIMNER
T incre se
he u
ke f glucse nd i
s s
r ge s glycgen nd f
, ____ nd
____
issue exress n ___-resnsive glucse
r nsr
er (___) in ddi
in
 G
LUT1, which dr m
ic lly incre ses glucse u
ke in
he resence f insulin.&nb
s;
"T incre se
he u
ke f glucse nd i
s s
r ge s glycgen nd f
,
<fn
clr=""#ff1f0f"">muscle</fn
> nd <fn
clr=""#ff1f0f""> dise</fn
>

issue exress n <fn
clr=""#ff1f0f"">insulin</fn
>-resnsive glucse
r
nsr
er (<fn
clr=""#ff1f0f"">GLUT4</fn
>) in ddi
in
 GLUT1, which dr m
Me
bli

ic lly incre ses glucse u
ke in
he resence f insulin.&nbs;"
smC rbFed10.30.12 Me
blismGIMNER
GLUT2 h s high Km, rel
ive

he hysilgic l bld glucse cncen
r
in.
This llws i
s c
ivi
y
 be mre deenden
un ______.<div><br /></div><div>
GLUT3 h s lw Km, rel
ive

he hysilgic l bld glucse cncen
r
in. T
his llws i
s c
ivi
y
 be mre deenden
un ______.</div> "GLUT2 h s hig
h Km, rel
ive

he hysilgic l bld glucse cncen
r
in. This llws i
s
c
ivi
y
 be mre deenden
un <fn
clr=""#ff1f0f"">bld glucse cncen

r
in</fn
>.<div><br /></div><div>GLUT3 h s lw Km, rel
ive

he hysil
gic l bld glucse cncen
r
in. This llws i
s c
ivi
y
 be mre deenden

un <fn
clr=""#ff1f0f"">
r nsr
er cncenr
in</fn
>.</div>" Me
bli
smC rbFed10.30.12 Me
blismGIMNER
Which cells efrm glyclysis nd xid
ive hshryl
in? Why? Wh
is
he ex
ce
in nd why?
All cells erfrm glyclysis nd xid
ive hshryl
i

n fr nrm l func
in nd immedi
e energy needs f
he cell. The RBC is
he ke
y exce
in, relying un
he hexse mnhsh
e shun
(en
se hsh
e 
h
w y). Me
blismC rbFed10.30.12 Me
blismGIMNER
Hexkin se is fund in ____
issue nd h s ____ Km, m king i
s c
ivi
y mre d
eenden
un ____.<div><br /></div><div>Gluckin se is fund in ____
issue&nbs
; nd h s ____ Km, m king i
s c
ivi
y mre deenden
un ____.</div>
"Hexkin se is fund in <fn
clr=""#ff1f0f""> ll</fn
>
issue nd h s <fn

clr=""#ff1f0f"">lw</fn
> Km, m king i
s c
ivi
y mre deenden
un <fn

clr=""#ff1f0f"">
r nsr
er ul
in</fn
>.<div><br /></div><div>Gluckin
se is fund in <fn
clr=""#ff1f0f"">liver</fn
>
issue&nbs; nd h s <fn

clr=""#ff1f0f"">high</fn
> Km, m king i
s c
ivi
y mre deenden
un <fn

clr=""#ff1f0f"">glucse bld cncen
r
in</fn
>.</div>"
Me
blismC rbFe
d10.30.12 Me
blismGIMNER
Wh

w
issues erfrm n erbic me
blism? When?
RBC: cns
i
u
ively, due

 l ck f mi
chndri ; use hexse mnhsh
e shun
(en
se hsh
e 
h
w y).<div><br /><div>Muscle: under lw O2 cndi
ins, un which l c

e fermen

Me
blismC rbFe

in is used
 regener
e NAD+ fr glyclysis.</div></div>
d10.30.12 Me
blismGIMNER
<div>An erbic
issues me
blize glucse
 _____, ge

ing ___ ATP er glucse
by ____ hshryl
in in ____. In
he Fed S

e
he ____ c n be icked u by 

her
yes f cellsn
bly
he ____ nd
hen ___ fr energy, s
red s energy in
h
e frm f ____ r ___, r cnver
ed
 ____ fr r
ein syn
hesis.&nbs;</div>
"<div>An erbic
issues me
blize glucse
 <fn
clr=""#ff1f0f"">l c

e</f
n
>, ge

ing <fn
clr=""#ff1f0f"">
w</fn
> ATP er glucse by <fn
clr=
""#ff1f0f"">subs
r
e</fn
>-<fn
clr=""#ff1f0f"">level</fn
> hshryl
i
n in <fn
clr=""#ff1f0f"">glyclysis</fn
>. In
he Fed S

e
he <fn
clr
=""#ff1f0f"">l c

e</fn
> c n be icked u by 
her
yes f cellsn
bly
he <
fn
clr=""#ff1f0f"">liver</fn
> nd
hen&nbs;<fn
clr=""#ff1f0f"">xidized
</fn
> fr energy, s
red s energy in
he frm f&nbs;<fn
clr=""#ff1f0f""
>
riglycerides</fn
> r <fn
clr=""#ff1f0f"">glycgen</fn
>, r cnver
ed

&nbs;<fn
clr=""#ff1f0f""> min</fn
> <fn
clr=""#ff1f0f""> cids</fn
>
fr r
ein syn
hesis.&nbs;</div><div><br /></div>" Me
blismC rbFed10.30.1
2 Me
blismGIMNER
<div><div>&nbs;In
he Fed S

e, sme glucse is direc
ed
hrugh ___ fr immed
i
e energy needs in e ch
issue. &nbs;In ___ nd ___,
he glucse is ls dire
c
ed
w rd
he syn
hesis f ____ fr energy s
r ge.&nbs;</div></div><div><br
/></div>
"<div><div>&nbs;In
he Fed S

e, sme glucse is direc
ed
hr
ugh&nbs;<fn
clr=""#ff1f0f"">glyclysis</fn
>&nbs;fr immedi
e energy nee
ds in e ch
issue. &nbs;In
he&nbs;<fn
clr=""#ff1f0f"">liver</fn
>&nbs;
nd&nbs;<fn
clr=""#ff1f0f"">muscle</fn
>
issue
he glucse is ls direc
e
d
w rd
he syn
hesis f&nbs;<fn
clr=""#ff1f0f"">glycgen</fn
>&nbs;fr
energy s
r ge.&nbs;</div></div><div><br /></div>"
Me
blismC rbFed10.30.1
2 Me
blismGIMNER
<div>T frm
he line r b ckbne f glycgen, individu l glucse mlecules re dd
ed ( s ___)
 n exis
ing glycgen lymer by _____ in (n) ____-glycsidic lin
k ge.</div>
"<div>T frm
he line r b ckbne f glycgen, individu l glucse
mlecules re dded ( s <fn
clr=""#fe1304"">UDP glucse</fn
>)
 n exis
i
ng glycgen lymer by <fn
clr=""#fe1304"">glycgen</fn
> <fn
clr=""#fe
1304"">syn
h se</fn
> in (n) <fn
clr=""#fe1304""> lh -1,4</fn
>-glycsid
ic link ge.</div>"
Me
blismC rbFed10.30.12 Me
blismGIMNER
The c
iv
ed frm f glucse is ____, which is m de frm glucse-1-hsh
e n
d ____. &nbs;T elng
e
he glycgen mlecule, new glycsidic bnd is frmed
be
ween
he 1-hydrxyl gru nd ei
her
he ___ gru (line r ch in) r
he n

he ____ gru (br nch in
). "The c
iv
ed frm f glucse is <fn
clr=""
#fe1304"">uridine dihshglucse (UDP-glucse)</fn
>, which is m de frm gluc
se-1-hsh
e nd <fn
clr=""#fe1304"">UTP</fn
>. &nbs;T elng
e
he gl
ycgen mlecule, new glycsidic bnd is frmed be
ween
he 1-hydrxyl gru n
d ei
her
he <fn
clr=""#fe1304"">4-hydrxyl</fn
> gru (line r ch in) r

he n
he <fn
clr=""#fe1304"">6-hydrxyl</fn
> gru (br nch in
)."
Me
blismC rbFed10.30.12 Me
blismGIMNER

<div>The regul
in f glyclysis is such
h
___ energy (ex: ___) sign ls s
im
ul
e glycgen s
r ge nd slw
he syn
hesis f yruv
e, while ____ energy sig
n ls (ex: ____) h ve
he reverse effec
s.</div> "<div>The regul
in f glyclys
is is such
h
<fn
clr=""#fe1304"">high</fn
> energy (<fn
clr=""#fe130
4"">ATP, ci
r
e, F-2,6-P</fn
>) sign ls s
imul
e glycgen s
r ge nd slw
h
e syn
hesis f yruv
e, while <fn
clr=""#fe1304"">lw</fn
> energy sign ls
(<fn
clr=""#fe1304"">AMP, C +2, cAMP</fn
>) h ve
he reverse effec
s.</div
>"
Me
blismC rbFed10.30.12 Me
blismGIMNER
vn Gierke dise se defec
in _____ r
he glucse
r nsr
sys
em
h
rev
en
s effec
ive ____ frm kidney r liver. The resul
is _____ ccumul
in nd m
ssive _____ enl rgemen
.
"vn Gierke dise se - defec
in <fn
clr=""
#fe1304"">glucse 6-hsh
se</fn
> r
he glucse
r nsr
sys
em
h
rev
en
s effec
ive <fn
clr=""#fe1304"">glucnegenesis</fn
> frm kidney r liv
er. The resul
is <fn
clr=""#fe1304"">glycgen</fn
> ccumul
in nd m ssi
ve <fn
clr=""#fe1304"">liver</fn
> enl rgemen
." Me
blismC rbFed10.30.1
2 Me
blismGIMNER
Andersen Dise se - defec
in
he ____ f glycgen syn
hesis resul
ing in bnr
m lly ____ ch ins wi
h ____ br nches. Gener lly f
l by ge
w.
"Anderse
n Dise se defec
in
he <fn
clr=""#fe1304"">br nching</fn
> <fn
clr
=""#fe1304"">enzyme</fn
> f glycgen syn
hesis resul
ing in bnrm lly <fn
c
lr=""#fe1304"">lng</fn
> ch ins wi
h <fn
clr=""#fe1304"">fewer</fn
> br
nches. Gener lly f
l by ge
w."
Me
blismC rbFed10.30.12 Me
blismGIMN
ER
McArdle Dise se nd Hers dise se, defec
s in muscle nd liver _____ c
ivi
y, re
sec
ively. Re
rds
he bili
y f glycgen
 be u
ilized s n energy surce 
r surce f glucse.
"McArdle Dise se nd Hers dise se, defec
s in muscle nd
liver <fn
clr=""#fe1304"">glycgen</fn
>&nbs;<fn
clr=""#fe1304"">hs
hryl se</fn
> c
ivi
y, resec
ively. Re
rds
he bili
y f glycgen
 be u
Me
blismC rbFed10.30.1

ilized s n energy surce r surce f glucse."
2 Me
blismGIMNER
<div>_____ In
ler nce:&nbs;in bili
y
 diges
milk sug r, ____, in gu
. In
es

in l</div><div>b c
eri use i

 gener
e CO2.</div> "<div><fn
clr=""#fe1
304"">L c
se</fn
> In
ler nce:&nbs;in bili
y
 diges
milk sug r, <fn
cl
r=""#fe1304"">l c
se</fn
>, in gu
. In
es
in l</div><div>b c
eri use i

 g
ener
e CO2.</div><div><br /></div><div><b>N
e: b c
eri c
iv
e
he <i>l c </
i>ern
 me
blize l c
se bec use glucse
heir referred fd.</b></div>"
Me
blismC rbFed10.30.12 Me
blismGIMNER
<div>Fruc
se In
ler nce:&nbs;gene
ic l ck f enzyme
 bre k ____ in
 ____ (
ldl se B). ____ ccumul
es nd inhibi
s ____ nd ____ in
he liver resul
ing
in severe _____ when fruc
se is inges
ed.</div>
"Fruc
se In
ler nce:&n
bs;gene
ic l ck f enzyme
 bre k <fn
clr=""#fe1304"">fruc
se-1-hsh
e
</fn
> in
 <fn
clr=""#fe1304"">glycer ldehyde DHAP</fn
> ( ldl se B). <f
n
clr=""#fe1304"">Fruc
se 1-hsh
e</fn
> ccumul
es nd inhibi
s <fn

clr=""#fe1304"">glucnegenesis</fn
> nd <fn
clr=""#fe1304"">glycgenl
ysis</fn
> in
he liver resul
ing in severe <fn
clr=""#fe1304"">hyglyceim
</fn
> when fruc
se is inges
ed."
Me
blismC rbFed10.30.12 Me
blismGIMN
ER
<div>The NADH frm
he xid
in f yruv
e is gener
ed in
he mi
chndri , b
u

he NADH frm glyclysis is gener
ed in
he cy
sl. &nbs;The ____ shu

le
effec
ively
r nsfers
he reducing wer f cy
slic NADH in
 mi
chndri l NA
DH.&nbs;</div> "<div>The NADH frm
he xid
in f yruv
e is gener
ed in
h
e mi
chndri , bu

he NADH frm glyclysis is gener
ed in
he cy
sl. &nbs;
The <fn
clr=""#fe1304"">m l
e- s r

e</fn
> shu

le effec
ively
r nsfer
s
he reducing wer f cy
slic NADH in
 mi
chndri l NADH.&nbs;</div>"
Me
blismC rbFed10.30.12 Me
blismGIMNER
Which is less efficien
,
he m l
e- s r

e shu

le r
he DHAP - glycerl-3-
hsh
e shu

le? Why? The&nbs;DHAP - glycerl-3-hsh
e shu

le
r nsr
s
reducing equiv len
s in

he mi
chndri in
he frm f FADH2, which h s less
reducing wer
h n NADH by
he m l
e- s r

e shu

le. FADH2 h s less reducin
g wer bec use i
is xidized by succin
e dehydrgen se (Cmlex II f
he ETC

), which l cks H+ um func
in.

Me
blismC rbFed10.30.12 Me
blismGIMN
ER
<div>Br nches re in
rduced by n
her c
ivi
y,
he br nching enzyme. &nbs;Gl
ycgen br nching enzyme dds
he c
iv
ed glucse mlecule (___)

____ gru
 f n exis
ing glycgen mlecule.&nbs;</div> "<div>Br nches re in
rduced by
n
her c
ivi
y,
he br nching enzyme. &nbs;Glycgen br nching enzyme dds
h
e c
iv
ed glucse mlecule (<fn
clr=""#fe1304"">UDP-glucse</fn
>)

<
fn
clr=""#fe1304"">6-hydrxyl</fn
> gru f n exis
ing glycgen mlecule.
&nbs;</div><div><br /></div>" Me
blismC rbFed10.30.12 Me
blismGIMNER
Wh
re
he in
rinsic nd ex
rinsic innerv
ins f
he gu
?<div><br /></div><d
iv>Wh
4
hings des
he innerv
in f
he gu
cn
rl?</div> "<img src="" s

e-14611478741808.jg"" /><div><br /></div><div>Ex
rinsic ls includes sensry f
unc
in</div>" Gu
Neurhysilgy
Wh

ye f nerves re ms
rev len
in
he v gus?
"<img src="" s
e-155993
21219184.jg"" />"
Gu
Neurhysilgy
"Fill in fr  r sym
he
ics.<div><br /></div><div><img src="" s
e-16196321673
735.jg"" /></div>"
"<img src="" s
e-16217796510210.jg"" />"
Gu
Neur
hysilgy
Wh
is glycgenin nd wh
is i
s rle in glycgen syn
hesis? I
is sm ll r

ein wi
h Tyr residue fr sug r binding. I
re c
s wi
h UDP-glucse (binding

he sug r

he Tyr) nd ini
i
es glycgen syn
hesis by linking
w glucse m
lecules befre glycgen syn
h se
kes ver.
Me
blismC rbFed10.30.12 Me
b
lismGIMNER
N me
he 3 sym
he
ic g ngli
h
innerv
e
he gu
.<div><br /></div><div>Give

he re f
he gu

h
e ch innerv
es.</div><div><br /></div><div>Wh

ye
"<img src="" s
e-16660178142000.jg"" />"
f g ngli re
hese?</div>
Gu
Neurhysilgy
"Fill
his in fr sym
he
ics.<div><br /></div><div><img src="" s
e-1756212127
3873.jg"" /></div>"
"<img src="" s
e-17725330031121.jg"" />"
Gu
Neur
hysilgy
Wh
re
he 3 lexi surrunding
he gu
?<div><br /></div><div>Wh
nervus sys

em re
hese  r
f?</div>
"<img src="" s
e-17905718657558.jg"" /><div><b
r /></div><div>P r
f
he en
eric (in
rinsic) NS</div>"
Gu
Neurhysil
gy
Wh
re
he effec
s f cu

ing
he u
nmics

he gu
?
"<img src="" s

e-18137646891081.jg"" />"
Gu
Neurhysilgy
Hw m ny neurns re in
he ENS?
10^8. Shi
.
Gu
Neurhysilgy
Wh
re
he 3 cellul r cmnen
s f
he en
eric nervus sys
em?
<b>Secre

m
r (efferen
) cells:</b><div>Sm
h muscle, ei
heli l secre
rs nd bsrb
ers, en
erendcrine cells</div><div><br /></div><div><b>In
erneurns:</b></div>
<div>Exci

ry, inhibi
ry</div><div><br /></div><div><b>Sensry ( fferen
) neu
rns:</b></div><div>Mech n, chemi, smrece
rs</div>
Gu
Neurhysil
gy
Bre k dwn
he  r sym
he
ic fferen
sensry neurns in
he gu
:<div><br /></
div><div>1. Tye f neurn?</div><div>2. Where is
he nucleus?</div><div>3. Wher
e is
he u
u
?</div> 1. Pseudunil r<div>2. Ndse g nglin</div><div>3. Nu
cleus
r cu
s sli
rius in
he br in s
em</div>
Gu
Neurhysilgy
Bre k dwn
he in
rinsic rim ry fferen
sensry neurns in
he gu
:<div><br />
</div><div>1. Tye f neurn?</div><div>2. Where is
he nucleus?</div><div>3. Wh
ere is
he u
u
?</div>
"1. Mul
il r<div>2. Submucs l nd myen
eric 
lexi</div><div>3. Submucs l nd myen
eric lexi</div><div><br /></div><div>&nbs
Gu
Neurhysilgy
;<img src="" s
e-19512036425780.jg"" /></div>"
Bre k dwn
he sym
he
ic fferen
sensry neurns in
he gu
:<div><br /></div>
<div>1. Tye f neurn?</div><div>2. Where is
he nucleus?</div><div>3. Where is
1. Pseudunil r<div>2. Drs l r
g nglin</div><div>

he u
u
?</div>
3. Drs l hrns f
he sin l crd</div>
Gu
Neurhysilgy
The en
eric reflex:<div><br /></div><div>1. Wh
s i
s r nge?</div><div>2. Wh

s i
s func
in? Bre k dwn hw i
ccmlishes i
.</div>
1. Shr
r nge.<
div><br /></div><div>2. <b>Peris
lsis</b>. <b>Sensry</b> fibers s
imul
e...</
div><div> . <b>exci

ry</b> <b>in
erneurns</b>
 fire frm
he mu
h dwn (<

b> b-r lly</b>)</div><div>b. <b>inhibi
ry</b> <b>in
erneurns</b>
 fire frm

he nus u (<b> b- n lly</b>)</div><div>Resul
: <b>cn
r c
in behind</b>
he
blus; <b>rel x
in in frn
</b> f i
.</div> Gu
Neurhysilgy
Secre
ry reflex:<div><br /></div><div>1. Give i
s r nge.</div><div>2. Wh
s i

s func
in? Bre k i
dwn.</div>
1. <b>Shr
</b> r nge<div>2. M ke sure s
ecre
ins nd v scul r erfusin re 
imized behind nd in frn
f fd bl
us. S me mech nism s en
eric reflex?</div>
Gu
Neurhysilgy
Wh
s
he difference be
ween shr
- nd lng-r nge gu
reflexes?
Invlvem
en
f
he CNS Gu
Neurhysilgy
N me
he 4 exci

ry nd 2 inhibi
ry lng-r nge en
eric reflexes.
"<img sr
c="" s
e-21122649162114.jg"" />"
Gu
Neurhysilgy
Dr w u

he full l f v g-v g l reflex. Give ll neurns invlved nd
he
lc
ins f
heir sm s.
"<img src="" s
e-21607980466998.jg"" />"
Gu
Neurhysilgy
Prvide
he de
il n
hese 5 lng-r nge reflexes.<div><br /></div><div>Ile-g s

ric</div><div>In
es
in-in
es
in l</div><div>G s
r-en
eric</div><div>G s
r-il
e l</div><div>G s
r- nd duden-clic reflexes</div> "<img src="" s
e-219472
82883376.jg"" />"
Gu
Neurhysilgy
Wh
is ileus?<div><br />Wh
re
he cnsequences f ileus?</div>
"<img sr
c="" s
e-22204980921142.jg"" />"
Gu
Neurhysilgy
Ps
-er
ry ileus:<div><br /></div><div>Hw lng des i
l s
?</div><div><br
/></div><div>Give gener l ic
ure f i
s 
hhysilgy.</div>
"<img sr
c="" s
e-22269405430576.jg"" />"
Gu
Neurhysilgy
Give 2 w ys
 minimize
he likelihd nd sym
ms f s
-er
ive ileus.
"<img src="" s
e-22398254449462.jg"" />"
Gu
Neurhysilgy
Where d
he  r sym
he
ic re-g nglinic nerves

he gu
&nbs;
ermin
e?<di
v><br /></div><div>Where d
he s
-g nglinic  r sym
he
ic xns rjec
?</
div>
"<img src="" s
e-22763326669948.jg"" />"
Gu
Neurhysilgy
"P r sym
he
ic:&nbs;<img src="" s
e-23158463660288.jg"" />"
"<img sr
c="" s
e-23145578758400.jg"" />"
Gu
Neurhysilgy
Sym
he
ic innerv
in f
he GI
r c
is m inly frm which
ye f g nglinic
fibers? Ps
-g nglinic frm g ngli u
side
he GI w ll
Gu
Neurhysil
gy
Sym
he
ic c
iv
in h s wh
2 func
ins in
he gu
? "<img src="" s
e-235707
80520522.jg"" />"
Gu
Neurhysilgy
Wh
re
he 2 l ces where
he sym
he
ic drenergic s
-g nglinic fibers sy
n se? "<img src="" s
e-23648089931850.jg"" /><div><br /></div><div><img src=
"" s
e-24142011170855.jg"" /></div>" Gu
Neurhysilgy
"<img src="" s
e-24528558227712.jg"" />"
"<img src="" s
e-24515673325760
.jg"" />"
Gu
Neurhysilgy
Which gu
nervus sys
em h s
he ms
diverse neur
r nsmi

ers?
"En
eric
. Lk, shi

ns:<div><img src="" s
e-24717536789020.jg"" /></div>" Gu
Neur
hysilgy
Give
he 4 func
ins f
he myen
eric lexus. "<img src="" s
e-24958054957508
.jg"" />"
Gu
Neurhysilgy
Give
he 2 func
ins f
he submucs l lexus. "<img src="" s
e-25065429139529
.jg"" />"
Gu
Neurhysilgy
Wh
is
he embrynic rigin f
he gre
er men
um?
The drs l mesen
ry
Gu
Neurhysilgy
Wh
is remving
he g llbl dder c lled?
Chlecys
ec
my Gu
Neurhysil
gy
"If
heres n bs
ruc
in here
1, wh
h ens? Wh
is
his c lled?<div><br
/></div><div><img src="" s
e-8602819494444.jg"" /></div>"
Obs
ruc
in r c
ns
ric
in f
he <b>he
ic r
l vein</b> le ds
 m ssive <b>enl rgemen
f

he  r umbilic l veins</b>
h
si
righ
nex


he lig men
um
eres he
is
fr cll
er l circul
in. The enl rgemen
is c lled <b>c u
medus .</b>
Gu
Neurhysilgy
Give
he s
i l rel
inshis f
he sleen

he...<div>Di hr gm</div><div>L
ef
clic flexure</div><div>Kidney</div><div>T il f
he  ncre s</div> "<img sr
c="" s
e-9942849290366.jg"" />"
Gu
Neurhysilgy

Which germ l yer frms
he whle f
he gu
?

Endderm
GIEmbrylgy
Wh
2
yes f flding des gu
develmen
deend n?<div><br /></div><div>Wh
1. Cr ni l-c ud l frm lngi
udin l neur l grw
h.<div>2

c uses e ch?</div>
. L
er l frm grw
h f
he smi
es.</div>
GIEmbrylgy
The rimi
ive mu
h is c lled
he ______ membr ne.<div><br /></div><div>The rim
i
ive nus is c lled
he ________ membr ne.</div>
Bucch rynge l<div><br
/></div><div>Cl c l</div>
GIEmbrylgy
"Fill in where
he mesen
ries exis
in
his di gr m.<div><br /></div><div><img
src="" s
e-12060268167529.jg"" /></div>"
"<img src="" s
e-12223476924678
.jg"" /><div><br /></div><div>Whle gu
h s drs l mesen
ry</div><div>S
m c
h ls h s ven
r l mesen
ry.</div>" GIEmbrylgy
Hw is
he eri
ne l c vi
y frmed?
"<div><img src="" s
e-12644383720240.j
g"" /></div><div><br /></div>Smi
e grw
h--&g
;L
er l flding--&g
;l
er l l

e mesderm brugh

ge
her--&g
;c lescence f
he celmic c vi
ies."
GIEmbrylgy
Wh
des
he drs l mesen
ry give rise
? The ven
r l?
Drs l: Gre
er
men
um, mesdudenum,
r nsverse nd sigmid mescln,
he mesen
ry rer (
f
he sm ll in
es
ine)<div>Ven
r l: He
g s
ric lig men
</div>
GIEmbry
lgy
G
hrugh weeks 4-8 fr s
m ch develmen
. Week 4: Whle s
m ch enl rges<d
iv><br /><div>Week 5: Drs l nd suerir r
ins f
he s
m ch enl rge</div><
div><br /></div><div>Week 7-8: 90<su></su>&nbs;r

in lng
he suerir-i
nferir xis...</div><div>Drs l--&g
;lef
(gre
er curv
ure)</div><div>Ven
r l
--&g
;righ
(lesser curv
ure)</div><div>Lef
v gus--&g
; n
erir</div><div>Righ
GIEmbrylgy

v gus--&g
;s
erir</div></div>
R

in nd enl rgemen
f
he s
m ch ush
he dudenum in wh
3 w ys?<div><b
r /></div><div>Wh
s
ruc
ure des
his mvemen
cre
e?</div> 1. Ps
erirly-&g
;becmes re
reri
ne l<div>2. In
 i
s C-l sh e</div><div>3. T
he ri
gh
</div><div><br /></div><div>Cre
es
he lesser s c</div>
GIEmbrylgy
"This is
view f
he develing fregu
, lking inferirly (s
he embrys h
e d wuld be cming u
f
he screen
yu;
he si
e f MRI).<div><br /></
div><div>Fill in
he bxes nd rvide
he direc
in f r

in f
he s
m ch.
</div><div><br /></div><div><img src="" s
e-15161234555429.jg"" s
yle=""m x-wi
d
h: 90%; "" /></div>" "<img src="" s
e-15285788607020.jg"" />"
GIEmbry
lgy
Q: Wh
lexus is fund in
he submucs ?
A: meisseners lexus Bren
sQ
s
Q: The muscul ris is cmsed f sm
h muscle cells nd re divided in

w su
bl yers. &nbs;Wh
re
he rien

ins f
he in
ern l nd ex
ern l? A: in
er
n l is circul r, ex
ern l is lngi
udin l
Bren
sQs
Q: Wh
lexus lies be
ween
he circul r nd lngi
udin l l yers f muscul ris e
x
ern ? A: Auerb chs lexus
Bren
sQs
Q: Wh
is
he
hin l yer f lse CT
h
is cn
inuus wi
h
he mesen
eries?
sers Bren
sQs
Q: Wh
is
he DNES f
he diges
ive sys
em?
GEPP
Bren
sQs
Q: The  r sym
he
ic innerv
in f
he in
es
ine is lms
en
irely
he _____
.
A: V gus (CN X) Bren
sQs
Q: Where d
he efferen
cell bdies f
he v gus rise frm? A: drs l m
r
nucleus (DMN) Bren
sQs
Q: Describe
he  r llel exci

ry nd inhibi
ry 
hw ys
h
rise frm
he
DMN.
Q: 1) exci

ry 
hw y wi
h chlinergic reg nglinic neurns frm
he
rs
r l drs l m
r nucleus (DMN) nd chlinergic s
g nglinic neurns in
h
e en
eric g ngli ; 2) inhibi
ry 
hw y wi
h chlinergic reg nglinic neurns
frm
he c ud l DMN nd ni
rergic s
g nglinic neurns in
he en
eric g ngli .
Sm
h muscle
ne is deenden
n
he b l nce be
ween
he 2 
hw ys. NO, ni
r
ic xide; SP, subs
nce P.
Bren
sQs
Q: Wh
rever
ebr l g ngli send xns

he gu
?
A: celi c, suerir mese
n
eric, inferir mesen
eric
Bren
sQs
Q: As gener liz
in  r sym
he
ic inu
resul
s in n ____ in m
ili
y nd
GI secre
ins. &nbs;This ccurs in erids during nd immedi
ely fllwing m

e l.
A: incre se
Bren
sQs
Q: As gener liz
in sym
he
ic drive resul
s in ____ m
ili
y nd ____ vlum
e f secre
ins. &nbs; A: decre sed, decre sed;
his ccurs during
s
ress res
Bren
sQs
nse r during exercise
Q: Wh

w g nglin
ed lexi re
here fr
he en
eric nervus sys
em?
"A: myen
eric lexus (be
ween
he circul r nd lngi
udin l l yers f
he muscul
ris ex
ern ) nd
he submucs l lexus;
heres ls
he subei
heli l lexus in

he l min rri bu

his isn
g nglin
ed<div><img src="" s
e-11660836208644
.jg"" /></div>"
Bren
sQs
Q: Wh
lexus cn
rls
he mvemen
f
he in
es
in l villi? A: subei
heli l
lexus Bren
sQs
Q: Wh
re
he 3 neurn l cmnen
s f
he en
eric nervus sys
em?
A: secre
Bren
sQ

m
r (efferen
) cells, in
erneurns, sensry ( fferen
) cells
s
Q: The bdies f v g l rim ry fferen
neurns re in
he ______ g ngli .
A: ndse; in cn
r s

he cell bdies f sin l sym
he
ic rim ry fferen
ne
urns re in drs l r
g ngli ; b
h re PSEUDOUNIPOLAR
Bren
sQs
Q: Discuss
he shr
r nge en
eric reflex.
A: i
frms
he b sis f eris

l
ic mvmen
. &nbs;I
s ms
imr
n
fe
ure is
h

he sensry neurns feed
infrm
in in
 ch ins f exci

ry in
erneurns
h
re linked in n b-r l
ly direc
in, nd ls in
 inhibi
ry in
erneurns
h
re linked b- n lly. &
nbs;As resul
, c
iv
in f sensry fibers ini
i
e cn
r c
in behind
he s
i
e f s
imul
in nd
rel x
in in frn
f
he si
e f s
imul
in
Bren
sQ
s
Q: Wh
des b-r l me n?
A: w y frm
he mu
h Bren
sQs
Q: Wh
des b- n l me n?
A: w y frm
he nus Bren
sQs
Q: N me 2 inhibi
ry lng r nge gu
reflexes. A: ile-g s
ric reflex (dis
ensi
n f n ile l segmen
inhibi
s g s
ric m
ili
y) nd in
es
in-in
es
in l refle
x (cess
in f in
es
in l m
ili
y un excessive dis
ensin r rugh h ndling
(surgery) r eri
ni
is (irri

in) Bren
sQs
Q: Hw d iids ffec
g s
ric m
ili
y nd n l shinc
er
ne?
A:
hey
incre se n l shinc
er
ne, reduce eris
lsis in
he sm ll in
es
ine nd cl
r, incre se elec
rly
e nd w
er re bsr
in, nd im ir
he defec
in resn
se
Bren
sQs
Q: Which lexus c uses incre sed gu
w ll
ne, incre sd r
e nd s
reng
h f gu
A: myen
eric; rec ll
h
i
lies be
ween
he circul r n

w ll cn
r c
ins?
d lngi
udin l muscle l yers
Bren
sQs
Q: Which lexus f
he ENS is resnsible fr lc l secre
in nd bsr
in?
A: submucs l lexus
Bren
sQs
Q: Wh
 r
f
he cln des
he v gus nerve innerv
e?
A: ll
he w y u
Bren
sQs


he
r nsverse r
in
Q: Wh
nerve innerv
es
he dis
l r
in f
he cln, rec
um, nd nus?
A: elvic nerve Bren
sQs
Q: Wh
lbe exis
s be
ween
he g ll gl dder nd f lcifrm lig men
?
A: qu dr
Bren
sQs

e lbe
Q: True r f lse: Pren
lly,
he sleen is hem
ie
ic rg n.
A:
rue
Bren
sQs
Q: Wh
is
he g
ew y

he liver be
ween
he qu dr
e nd c ud
e lbes
h

r
nsmi
s
he he
ic duc
s, he
ic r
eries, nd he
ic r
l vein? A: r

he
is
Bren
sQs
Q: Wh
lig men
s n
he lef
nd righ
m rgins f
he liver

ch
he liver


he di hr gm? A: righ
nd lef

ri ngul r lig men
s; NOTE:
he b re re
uc
hes
he di hr gm
Bren
sQs
Q: N me
he brders f
he b re re f
he liver.
"A: suerir crn ry li
g men
, inferir crn ry lig men
, lef

ri ngul r lig men
, righ

ri ngul r l
ig men
<div><img src="" s
e-14040248090628.jg"" /></div>"
Bren
sQs
Q: Wh
vessel dr ins
he liver? Where des
his vessel dr in in
?
A: he

ic veins (very shr
vessels); dr ins in
 IVC Bren
sQs
Q: (Frm cl ss) Lis

he 5 s
ruc
ures
h
lie dj cen


he sleen. A: di h
r gm, s
m ch, lef
clic flexure, kidney, nd
il f  ncre s Bren
sQs

Q: Fr c
ured ribs r severe blws

he lef
hychndrium culd c use wh


hlgy? A: ru
ured sleen
Bren
sQs
Q: Wh
lig men
s re cn
ined wi
hin
he lesser men
um?
A: he
g s
ric
lig men
nd he
duden l lig men

Bren
sQs
Q: The ylrus is divided in
 _____ nd ________.
A: ylric n
rum nd y
lric c n l
Bren
sQs
Q: Wh
re
he flds in
he s
m ch c lled?
A: rug e
Bren
sQs
Q: Wh

runk ff
he r
sulies
he s
m ch?
A: celi c
runk Bren
sQ
s
Q: The celi c
runk br nches in

he _____ nd ______ nd ________.
A: cmm
n he
ic r
ery; slenic r
ery; lef
g s
ric r
ery Bren
sQs
Q: The _____ r
ery ff
he celi c
runk curses lng
he suerir brder f
h
e  ncre s nd en
ers
he lienren l lig men
. A: slenic r
ery
Bren
sQ
s
Q: Wh
r
ery gives rise

he shr
g s
ric r
eries?
A: slenic r
er
y; shr
g s
ric g
 fundus f s
m ch
Bren
sQs
Q: Wh
br nch ff
he slenic r
ery runs lng
he gre
er curv
ure? A: lef

g s
reilic r
ery Bren
sQs
Q: The cmmn he
ic r
ery gives rise
 wh
3 r
eries?
A: he
ic re
r, righ
g s
ric r
ery, nd g s
rduden l r
ery
Bren
sQs
Q: The he
ic rer scends in
he free edge f
he lesser men
um nd divides
in

he ____ nd _____.
A: righ
nd le
he
ic r
eries
Bren
sQ
s
Q: ______ r
ery rises frm
he cmmn he
ic nd runs

he ylrus nd
hen
lng
he lesser curv
ure f
he s
m ch nd n s
mses wi
h
he ____ r
ery.
A: Righ
g s
ric r
ery; lef
g s
ric Bren
sQs
Q: The g s
rduden l r
ery gives rise
 wh

w br nches? A: righ
g s
re
Bren
sQs
ilic r
ery nd
he suerir  ncre
icduden l r
ery
Q: Des
he celi c g nglin suly sym
he
ic r  r sym
he
ic fibers?
A: sym
he
ic Bren
sQs
Q: The
il f
he  ncre s lies in
he ______ lig men
.
A: lienren l
Bren
sQs
Q: Where des
he m in  ncre
ic duc
em
y in

he dudenum
?
A: m jr
duden l  ill
Bren
sQs
Q: Wh
shinc
er surrunds
he mull f V
er?
A: shinc
er f Oddi
Bren
sQs
Q: _____ is dil
ed r
in f
he cmmn bile duc
f
er
junc
in wi
h
he m
in  ncre
ic duc
.
A: Amull f V
er
Bren
sQs
Q: Wh
duc
en
ers
he dudenum mre suerirly, ccessry  ncre
ic duc
r m
in  ncre
ic duc
?
A: ccessry  ncre
ic duc

Bren
sQs
Q: Wh
 r
f
he bili ry sys
em is fund in
he
r nsylric l ne? A: g ll
gl dder Bren
sQs
Q: Wh
duc
llws bile
 en
er nd le ve
he g ll bl dder? A: cys
ic duc

Bren
sQs
Q: _____ is frmed by
he unin f
he cmmn he
ic duc
nd
he cys
ic duc
.
A: Cmmn bile duc
(em
ies in

he 2nd s
ge f
he dudenum)
Bren
sQ
s
Q: True r f lse: The  ncre s is simly n endcrine gl nd.
A: f lse, i
s b

h n endcrine nd excrine gl nd
Bren
sQs
Q: Wh
m jr r
eries give ff br nches
h
suly
he  ncre s?
A: slen
ic (gives ff  ncre
ic br nches), g s
rduden l (gives f n
erir/s
erir
suerir  ncre
icduden l) nd suerir mesen
eric (gives f n
erir/s
eri
Bren
sQs
r inferir  ncre
icduden l)
Q: The uncin
e rcess lies ____

he suerir mesen
eric r
ery, while
he n
eck lies _____
 i
. A: s
erir, n
erir Bren
sQs
Q: The inferir mesen
eric vein merges wi
h
he ______ vein.
A: slenic
Bren
sQs
Q: Pr
l hyer
ensin c n cmrmise bld flw nd c use bld
 be reru
ed
revers l in bld flw
hrugh enl rged veins. &nbs;Which vein


he IVC vi
s?
A: esh ge l veins,  r umbilic l veins (c using c u
medus ), veins i

n
he bdy w ll, rec
l veins Bren
sQs

Q: Wh
c uses c u
medus ?
A: liver cirrhsis which c uses r
l hyer
ens
in
Bren
sQs
Q: Wh
l yer is
he GI
r c
derived frm?
A: endderm
Bren
sQs
Q: Discuss wh
r
ins f
he endderm give rise

he fregu
, hindgu
, nd
midgu
. A: fregu
is frmed frm
he n
erir r
in f
he endderm,
he hind
gu
is frmed frm
he s
erir r
in f
he endderm, nd
he midgu
is be
w
een
he
w
Bren
sQs
Q: Wh
s
ruc
ures re ssci
ed wi
h
he bucch rynge l nd cl c l membr ne
resec
ively? A: mu
h, nus Bren
sQs
Q: Describe
he r

in f
he s
m ch
h
ccurs during 7
h-8
h week.
A: 90 degree r

in rund cr ni l-c ud l xis resul
s in drs l r
in f s

m ch nw n
he lef
frming
he gre
er curv
ure,
he ven
r l r
in n
he
righ
nw frming
he lesser curv
ure, ls
he v gus nerve (which s
r
ed lef

nd righ
) ls r

es s
h

he lef
nerve nw becmes ANTERIOR nd
he rig
h
nerve becmes POSTERIOR; during
his r

in
he rigin l s
erir w ll f

he s
m ch grws f s
er
h n
he n
erir r
in, frming
he gre
er nd less
er curv
ures Bren
sQs
Q: In wh
f shin nd direc
in des r

in/enl rgemen
f
he s
m ch ush

he dudenum?
A: s
erirly (becmes re
reri
ne l), in

C-l, nd

Bren
sQs

he righ

Q: The s ce be
ween
he s
m ch nd
he dudenum f
er r

in becmes
he ___
_.
A: lesser s c Bren
sQs
Q: The ____ grws f s
er
h n
he res
f
he in
es
ine nd buckles u
in
he umb
ilic l crd.
A: ileum
Bren
sQs
"<div>Midgu
r

in:</div><div><br /></div><div>1. Wh
drives
he frm
in 
f
he rim ry in
es
in l l shwn in yellw?</div><div><br /></div><div>2. Ide
n
ify ll f
he bxes in
his di gr m.</div><div><br /></div><div><img src=""
s
e-17703855194652.jg"" /></div><div><br /></div>3. G
hrugh
he 3-s
e mech
nism f midgu
r

in wi
h
he T i Chi mve." "<div>1. Grw
h f
he ileum c u
ses i

 buckle u
nd frm
he rim ry in
es
in l l.</div><div><br /></div
><div>2.</div><img src="" s
e-16810501997360.jg"" /><div><br /></div><div>3.&n
bs;[sund:FliedT iChi.mv]</div><div>This vide is in
he s me rien

in s

he dr wings. The
humb is
he endix,  r
f
he c ud l limb.</div><div><br
/></div><div>S
ge I:&nbs;</div><div><img src="" s
e-18287970746697.jg"" /><
/div><div><br /></div><div>S
ge II:</div><div><img src="" s
e-18133351923936.j
g"" /></div><div><br /></div><div>S
ge III: Fix
in f
he r

ed in
es
ine<
/div>" GIEmbrylgy
Q: Describe
he differen
s
ges f gu
r

in nd even
u l fix
in. A: s

e
1 - herni
in f
he bwel frm
he bdmen wi
h 90 degree cun
erclckwise r


in; s
ge 2 re
urn f
he bwel

he bdmen wi
h ddi
in l 180 degree c
un
erclckwise r

in; s
ge 3 fix
in f
he r

ed in
es
ine
Bren
sQ
s
Q: Wh

hlgy is ssci
ed wi
h f ilure
 rgress
 s
ge II (r

in
wi
h re
urn

he bdmen)? A: mh lcele; ccurs in e rly develmen
syndr
mes nd 
her ssci
ed defec
s re cmmn (35-81%) c rdi c 20% nd syndrmes 2
0%
Bren
sQs
Q: Hw is mh lcele differen
frm g s
rschisis?
A: mh lcele is defe
c

hrugh
he umbilic l crd, usu lly h s cvering ver
he in
es
ines (unles
s i
s ru
ured), nd ssci
ed nm lies re cmmn. &nbs;G s
rschisis is
de
fec
l
er l

he umbilic l crd (usu lly n righ
side),
heres n cvering v
er eviscer
ed in
es
ines, nd ssci
ed nm lies re r re wi
h
resi being
ms
cmmn (17%)
Bren
sQs
Q: Wh
s
he Pen
r lgy f C n
rell? A: mh lcele, di hr gm
ic herni , s

ern l clef
, ec
i crdis, in
r c rdi c nm ly
Bren
sQs
Q: Wh
4 s
ruc
ures des
he di hr gm rigin
e frm? A: se
um
r nsversum, 
leureri
ne l membr ne, mesderm f bdy w ll (smi
es C3-5kee yur di hr gm
live!), mesenchyme ssci
ed wi
h
he esh gus
Bren
sQs
Q: Describe wh
h ens in nnr

in f
he gu
.
A:
heres
he ini
i l 90
r

in in

he umbilic l crd, bu

heres n r

in un re
urning

he b

dmen; sm ll bwel will be n
he righ
, cln n
he lef

Bren
sQs
Q: Wh
is L dds b nds?
A: cecum fixes

he l
er l righ
bdmin l w ll nd c
uses duden l bs
ruc
in; is
re
ed surgic lly
hrugh
he L dds rcedure, in
cludes endec
my
Bren
sQs
Q: The vi
elline duc
nrm lly regresses nd dis e rs rund 5
h-8
h weeks. &n
bs;Hwever,
here c n be vi
elline duc
remn n
s. &nbs;Wh
s
he ms
cmmn n
d u
line
he rule f 2s?
A: ms
cmmn is Meckels diver
iculum; rule f 2s 2% f
ul
in, 2 inches lng, 2 fee
frm ilecec l v lve, 2
yes f bnrm l
iss
ue (g s
ric,  ncre
ic)
Bren
sQs
"Give fr mh lcele nd g s
rschisis.<div><img src="" s
e-20663087661360.jg
"" /></div>"
"<img src="" s
e-21603685499025.jg"" />"
GIEmbrylgy
N me
he cmnen
s f
he Pen
r lgy f C n
rell.
Pen
r lgy f C n
rell<d
iv><br /></div><div>Mnemnic: I DOSE</div><div><br /></div><div>In
r c rdi c n
m ly</div><div><br /></div><div>Di hr gm
ic herni </div><div>Omh lcele</div>
<div>S
ern l clef
</div><div>Ec
i crdis</div>
GIEmbrylgy
Hw des cngeni
l di hr gm
ic herni rise? "Befre di hr gm frm
in,
he
se
um
r nsversum nd leureri
ne l c vi
ies divide
he
hr x frm
he bd
men.<div><br /></div><div><img src="" s
e-22557168239408.jg"" /></div><div><b
r /></div><div>The leureri
ne l c n l is
he l s
s
ruc
ure
 clse in
he
develing di hr gm:</div><div><br /></div><div><img src="" s
e-22728966931248
.jg"" /></div><div><br /></div><div>F ilure f
he leur-eri
ne l c n l
 c
lse c uses cngeni
l di hr gm
ic herni .</div>"
GIEmbrylgy
Wh
re
he clinic l cnsequences f cngeni
l di hr gm
ic herni ? (2)
1. Pulmn ry hyl si <div>2. Resir
ry dis
ress</div>
GIEmbrylgy
Nnr

in:<div><br /></div><div>1. Describe
he r

in l nm ly nd
he s
i
ins f
he sm ll in
es
ine nd cln.</div><div><br /></div><div>2. Are
here
clinic l issues ssci
ed wi
h
his r

in l nm ly?</div> Nnr

in: ini

i l 90<su></su> r

in nrm l, bu
<b>re
urn in
 bdmen w/u
r

in</
b>. Sm ll in
es
ine n lef
; cln n righ
. N clinic l issues.
GIEmbry
lgy
M lr

in:<div><br /></div><div>1. Describe
he r

in l nm ly nd
he s
i
ins f
he sm ll in
es
ine nd cln.</div><div><br /></div><div>2. Are
here
clinic l issues ssci
ed wi
h
his r

in l nm ly? If s, wh
re
hey?<
/div> 1. Pre r
eri l l f ils
 r

e. Aendix winds u suerir bec use
ne
180<su></su> r

in ins
e d f 270<su></su>. Cecum fixes suerirly
n
he righ
bdmin l w ll vi L dds b nds.<div><br /></div><div>2. L dds b n
ds c n c use <b>duden l bs
ruc
in</b>. Als, incre sed risk f <b>vlvulus</b
>:
wis
ing f
he bwel c uses bs
ruc
in.</div>
GIEmbrylgy
Wh
re
he 5 cmnen
s f L dds rcedure? "Mnemnic: IV LAB<div><br /></di
v><div>Remve <u s
yle=""fn
-weigh
: bld; "">I</u>n
rinsic duden l bs
ruc
i
n</div><div>Reduce <b><u>V</u></b>lvulus by
urning cun
erclckwise</div><div>
<br /></div><div>Divide <u s
yle=""fn
-weigh
: bld; "">L</u> dds b nds</div><
div><u s
yle=""fn
-weigh
: bld; "">A</u>endec
my</div><div>Widen
he <u s
y
le=""fn
-weigh
: bld; "">B</u> se f
he mesen
ry</div>"
GIEmbrylgy
Give
he 4 s
ge III r

in l nm lies.
Fix
in rblems:<div><br /></d
iv><div>Mnemnic: RUDIC</div><div><br /></div><div>Re
reri
ne l cecum</div><d
iv>Undescended cecum</div><div>Duden l l ck f fix
in w/ in
ern l herni </div
><div>Inver
ed cecum</div><div>Clnic l ck f fix
in wi
h in
ern l herni </di
v><div><br /></div>
GIEmbrylgy
S y whe
her e ch f
hese GI re s re in
r eri
ne l, rim rily re
reri
ne
l, r secnd rily re
reri
ne l.<div><br /></div><div>Thr cic esh gus<div>A
bdmin l esh gus</div><div>S
m ch</div><div>G llbl dder nd bile duc
</div><d
iv>Dudenum</div><div>P ncre s</div><div>Jejunum</div><div>Ileum</div><div>Cecum
</div><div>Aendix</div><div>Ascending cln</div><div>Tr nsverse cln</div><d
iv>Descending cln</div><div>Sigmid cln</div><div>Rec
um</div></div>
"<div>Thr cic esh gus: R<div>Abdmin l esh gus: I</div><div>S
m ch: I</div
><div>G llbl dder nd bile duc
: I</div><div>Dudenum: S</div><div>P ncre s: S</
div><div>Jejunum: I</div><div>Ileum: I</div><div>Cecum: I</div><div>Aendix: I<
/div><div>Ascending cln: S</div><div>Tr nsverse cln: I</div><div>Descending
cln: S</div><div>Sigmid cln: I</div><div>Rec
um: R</div></div><img src=""

s
e-28059021345584.jg"" />"
GIEmbrylgy
"<img src="" s
e-28561532518768.jg"" /><div><br /></div><div>1. L bel
he vi
e
lline duc
.</div><div><br /></div><div>2. Wh
is
he ms
cmmn nm ly wi
h

his s
ruc
ure?</div><div><br /></div><div>3. Wh
rule is ssci
ed wi
h
his
nm ly?</div>" "1.&nbs;<img src="" s
e-29021094019435.jg"" /><div>Ges frm

he
ermin l ileum

he umbilicus.<br /><div><br /></div><div>2. Meckels dive
r
iculum: f ilure f
he vi
elline duc

 regress n
he in
es
in l side:</div>
<div><img src="" s
e-29304561860885.jg"" />&nbs;<img src="" s
e-294119360433
54.jg"" /></div><div><br /></div><div>3. Rule f 2s:&nbs;</div><div>2...</div
><div>% f ul
in</div><div>inches lng</div><div>fee
frm ilecec l v lve<
/div><div>
yes f bnrm l
issue resen
in i
(g s
ric nd  ncre
ic)</div><
/div>" GIEmbrylgy
Wh
re
he mygenic, neurn l, nd hrmn l f c
rs
h
cn
rl gu
m
ili
y?
mygenic: sm
h muscle cells (SMCs) nd
heir slw w ves f de/rel riz
in,
gener
ed by
he in
ers
i
i l cells f C j l (ICC)<div><br /></div><div><div>neu
rn l: b
h ex
rinsic ( u
nmic nd sensry) NS nd in
rinsic (en
eric) NS</div
></div><div><br /></div><div>hrmn l: hrmnes secre
ed by
he gu
i
self</div>
3 Blck GI Gu
M
ili
yI10.31.12
Ms
f
he g s
rin
es
in l
r c
is cmsed f ____ uni
sm
h muscles, wi
h
grus f cells elec
ric lly cnnec
ed by ____ junc
ins
 cre
e cn
r c
ing
segmen
s.
"Ms
f
he g s
rin
es
in l
r c
is cmsed f <fn
clr="
"#ff0000"">single</fn
> uni
sm
h muscles, wi
h grus f cells elec
ric lly
cnnec
ed by <fn
clr=""#ff0000"">g </fn
> junc
ins
 cre
e cn
r c
ing
segmen
s."
3 Blck GI Gu
M
ili
yI10.31.12
Wh
re
he
hree fund men
l gu
m
r 

erns
heir urses?
Peris
l
sis: rulsin<div>Mixing mvemen
s: mixing...(ye h, I knw)</div><div>Accmd

in: reservir func
in</div> 3 Blck GI Gu
M
ili
yI10.31.12
_____ cn
r c
ins h en when
he SMC s rclemm is _____ del rized (
bu

-20 mV). These cn
r c
ins re sus
ined fr minu
es
 hurs, nd ccur in __
__,
he ____, nd 
her  r
s f
he gu

h
require
muscle
ne.
"<fn
c
lr=""#ff0000"">Tnic</fn
> cn
r c
ins h en when
he SMC s rclemm is <f
n
clr=""#ff0000"">cn
inu lly</fn
> del rized (
bu
-20 mV). These cn

r c
ins re sus
ined fr minu
es
 hurs, nd ccur in <fn
clr=""#ff0000
"">shinc
ers</fn
>,
he <fn
clr=""#ff0000"">cln</fn
>, nd 
her  r
s
f
he gu

h
require muscle
ne." 3 Blck GI Gu
M
ili
yI10.31.12
Grss mrhlgy f
he esh gus:<div><br /></div><div>1. Hw lng is i
?</div>
<div>2. Wh
des i
brder suerirly nd inferirly?</div><div>3. Wh
s
ruc
u
re des i
 ss
hrugh in
he di hr gm?</div><div>4. Wh
l yer in i
s w ll c
rries u
i
s werful ers
lsis?</div><div>5. Hw lng des i

ke
 mve
fd blus
hrugh i
fully?</div><div>6. Is diges
in ccuring in
he esh gus
? Wh
bu
bsr
in?</div> 1. 25 cm<div>2. Ph rynx
 c rdi c regin f
he
s
m ch</div><div>3. The lef
crux</div><div>4. Muscul ris ex
ern </div><div>5.
1 minu
e
r nsr

ime</div><div>6. Diges
in, n bsr
in</div>
Esh gu
s
Esh gus ei
helium:<div><br /></div><div>1. Cl ssify
he ei
helium f
he es
S
r
ified squ mus nn-ker
ini
h gus.</div><div>2. Which cells&nbs;</div>
zed
Esh gus
Ch nges lng
he suerir-inferir xis f
he esh gus:<div><br /></div><div>
Give
he ch nges
h
ccur nd
he bund ries fr...</div><div>1. Adven
i
i vs
. sers </div><div>2. Skele
l vs. sm
h muscle f
he muscul ris ex
ern </div>
<div>3. Ex
en
f v scul riz
in</div> 1. Bund ry: nce
he esh gus en
ers

he <b>eri
ne l c vi
y</b> by crssing
he di hr gm.&nbs;<div>Abve, i
h s
n dven
i
i .&nbs;</div><div>Belw, i
h s fl
squ mus cells c lled <b>mes
h
elium</b>
h
m ke i
sers .<div><br /></div><div>2. <b>Uer 1/3</b> is <b>
invlun
ry skele
l</b> muscle.&nbs;</div><div><b>Middle 1/3</b> is
<b>
r ns
i
in l</b> <b>zne</b> wi
h b
h skele
l nd sm
h muscle.</div></div><div><b
>Lwer 1/3</b> is <b>sm
h muscle</b>.</div><div><br /></div><div>3. <b>Ex
ensi
ve v scul riz
in where
he esh gus mee
s
he c rdi c s
m ch</b>. Imr
n

in b
h <b>mel nm </b> s me
s

ic en
ry in
nd r
l hyer
ensin (cm
mnly induced by liver cirrhsis due
 <b>chrnic lchlism</b>) s
si
e f

v ricsi
y frm
in nd burs
ing resul
ing in
rren
i l vmi
ing f bld.</di

v>
Esh gus
Esh gus ei
helium:<div><br /></div><div>Wh
2 mech nisms re in l ce
 de
l
he high mun
s f fric
in nd br sin
h

he esh gus sees? Which ne c
h nges nd hw in resnse

c rse die
?</div><div><br /></div><div>Wh
cn
s
i
u
es c rse die
?</div> C rse die
is <b>vege
ri n</b> die
r ny d
ie
<b>high</b> in <b>fiber</b>.<div><br /></div><div>2 mech nisms:</div><div>1.
L min rri in
erdigi

es wi
h dwngrw
hs f
he ei
helium s
here is n
fl
cle v ge l ne. This is jus
like skin nd desn
ch nge.</div><div><br /
></div><div>2. <b>Incre se in ker
hy lin syn
hesis</b>. This
urns
he ei
hel
ium frm whi
e
 brwn/gr y.</div>
Esh gus
Esh gus ei
helium:<div><br /></div><div>Where re
he s
em cells?</div><div>W
h
is
he
urnver r
e?</div> S
em cells re

he equiv len
level f
he <b
>s
r
um b s le</b> in skin.<div>Turnver r
e is <b>15 d ys</b>.</div> Esh gu
s
N me
he 2
r ce cells in
he esh gus ei
helium.<div><br /></div><div>Give
h
e in
ermedi
e fil men
f e ch nd whe
her e ch is f neur l cres
rigin.</div
>
<b>Mel ncy
es</b>: vimen
in, neur l cres
rigin<div><br /><div><b>En
e
rendcrine</b> ( k DNES, GEPP) <b>cells</b>: cy
ker
in, n
f neur l cres

Esh gus
rigin</div></div>
Describe
he s
ruc
ure-func
in rel
inshis resen
in
he neur l nd muscul r
cn
rl f
he esh gus.
A

enu
in f...<div>1. <b>Mucul ris mucs </b>
bec use n mucs l squeeze r flu

er necess ry.</div><div>2. <b>Meissners</b>
<b> nd Auerb chs lexi</b> bec use
he esh ge l m
r 

erns (re
r-, rim
ry, secnd ry eris
lsis nd re
ching) re rel
ively simle nd culed

h
e sw llw reflex.</div> Esh gus
Give ll f
he cmnen
s f GALT in
he esh gus.
<div>S liv ry gl nd secr
e
ins. Mnemnic: MILL</div><div>1. Mur mid se&nbs;</div><div>2. secre
ry IgA<
/div><div>3. L c
ferrin</div><div>4. Lyszyme</div><div>5. Hy
nici
y f s li
v </div><div><br /></div><div>Esh gus:</div><div>5. Unrg nized lymhcy
e gg
reg
ins rund
he esh ge l mucus gl nds in
he submucs ,
heir duc
s, nd

ei
heli l
e rs.</div><div>6. Ker
hy lin syn
hesized in
he esh ge l ei

helium: n
i-r
e se c
ivi
y.</div><div>7. Diffuse immuncme
en
cells in

he l min rri .</div>
Esh gus
Describe
he dise se rgressin f GERD.
GERD = g s
r-esh ge l reflux
dise se<div><br /></div><div>Reflux f s
m ch cid c uses
he nrm l esh ge l
<b>s
r
ified squ mus nnker
inized ei
helium</b>
 underg&nbs;<b>me
l
si </b>
 becme
<b>simle clumn r ei
helium f surf ce mucus cells</b> jus

like
he s
m ch. This is c lled <b>
r nsi
in l ei
helium</b>.&nbs;</div>
<div><br /></div><div>I
des
w
hings

ry
 r
ec

he esh gus: <b>m k
e mucus</b> nd <b>um u
bic rbn
e</b>. Nei
her wrks. In  r
icul r,
he m
ucus cmrises nly ne f
he fur kinds nd is n
mixed by mucs l flu

er.</
div><div><br /></div><div>Chrnic GERD c n le d
<b> B rre

s esh gus</b>, w
hich is <b>rec ncerus</b> nd is ch r c
erized by 5 sym
ms:</div><div>1. Es
h ge l ulcer frm
in</div><div>2. P in</div><div>3. Swelling</div><div>4. Hy
er
rhy f
he sm
h muscle f
he lwer esh ge l shinc
er (LES).</div><div
>5. As resul
f #4, ch l si : cndi
in in which
he muscles f
he LES f
il
 rel x, which reven
s fd frm  ssing in

he s
m ch.</div><div><br />
</div><div>Chrnic GERD culmin
es in <b>c ncer</b>. Ree
ed swi
ching f
he

ye f ei
helium c uses
he cells
 lse cn
c
inhibi
in, bre k
hrugh
he
b s l l min , nd en
er
he bld vessels f l min rri nd submucs
 me
Esh gus

s
size.</div>
Why is
he lwer
hird f
he esh gus eseci lly rne
 c ncer nd me
s
si
s? (3 re sns) 1. This is
he si
e f me
l si due
 <b>GERD</b>.<div>2. The
re re <b>huge bld</b> <b>vessels</b> in
he submucs ne r
he c rdi c regin
. All
his v scul riz
in incre ses
he likelihd f me
s
sis.</div><div>3.
<b>B c
eri die</b> frm
he s liv ry secre
ins

he highes
r
e in
he dis

l 1/3 f
he esh gus. When
hey die,
hey <b>rele se re c
ive xygen secies<
/b> (O2- r dic ls). These medi
e DNA d m ge
 ll cells. Bec use
hey re neur
l cres
-derived inv ders, <b>mel ncy
es</b> re
he bigges
me
s

ic
hre

Esh gus

h
rises frm
his d m ge.</div>
1. N me
he 2
yes f gl nds in
he esh gus. Give
he &nbs;func
in f e ch.
<div><br /></div><div>2. Give where e ch is fund.</div><div><br /></div><div>3.
Des e ch gl nd h ve myei
heli l cells? Why r why n
?</div>
1. <b>Es
h ge l mucus gl nds</b>&nbs;rvide n <b> dded</b> burs
f <b>mucus</b>

lubric
e
he bulk
r nsr
f rly chewed fd dwn
he esh gus.<div><b>C
rdi c gl nds</b>&nbs;r
ec
g ins
cid reflux frm
he s
m ch.</div><div><b
r /></div><div>2. Esh ge l gl nds re fund in
he <b>submucs </b>. The nly

her l ce in
he gu
where yu find gl nds in
he submucs is
he dudenum wi

h i
s Brunners gl nds.</div><div>C rdi c gl nds re fund in
he l<b> min r
ri ne r
he c rdi c regin</b>.</div><div><br /></div><div>3. <b>Nei
her</b> g
l nd h s myei
heli l cells bec use
he <b>eris
lsis f
he muscl ris ex
ern
is s s
rng</b>.</div>
Esh gus
"1. Fill in
hese bxes.<div><br /></div><div>2. Wh
ccun
s fr
he ch nge in
w ll mrhlgy

he ver
ic l bl ck line is
his figure?</div><div><br /></di
v><div><img src="" s
e-29098403430940.jg"" /></div>" "1.&nbs;<div><img src="
" s
e-29261612188325.jg"" /><div>Where E = esh gus</div><div>C = s
m ch</di
v><div>GP = g s
ric i
</div><div>U rrw = muscul ris mucs </div><div>SM = su
bmucs </div><div><br /></div><div>ECG = Esh ge l c rdi c gl nds</div><div>CG
= mucus c rdi c gl nds</div><div>(B
h ECG nd CG dum mucus)</div><div><br /><
/div><div>2. This is
figure f
he esh ge l-g s
ric junc
in.</div></div>"
Esh gus
"Ann

e
his figure f
he esh gus.<div><br /></div><div><img src="" s
e-29
807073034780.jg"" /></div>"
"<img src="" s
e-29914447217190.jg"" /><div>SS
= s
r
ified squ mus nnker
inized e
helium</div><div>LP = l min rri </d
iv><div>MM = mucul ris mucs </div><div>GL = esh ge l mucus gl nd</div><div>D
= duc
f n esh ge l &nbs;mucus gl nd</div>"
Esh gus
"Ann

e
his Ang Li slide.<div><br /></div><div><img src="" s
e-3100107394289
0.jg"" /></div>"
"<img src="" s
e-31164282700132.jg"" />"
Esh gu
s
"1. Is
his he l
hy esh gus?<div><br /></div><div>2. Ann

e u.</div><div>
<br /></div><div><img src="" s
e-31379031064844.jg"" /></div>"
"<img sr
c="" s
e-31254477013260.jg"" />"
Esh gus
"Is
his he l
hy esh gus?<div><br /></div><div>Why is
he s
m ch brwn?</di
v><div><br /></div><div><img src="" s
e-31520764985839.jg"" /></div>" "<img sr
c="" s
e-31550829756911.jg"" />"
Esh gus
Give ll cmnen
s f GALT in
he s
m ch.
1. MMC<div>2. Lw H (1-2)</div>
<div>3. L c
ferrin</div><div>4. Lyszyme</div><div>5. In
r ei
heli l lymhcy

es</div><div>6. Diffuse immuncme
en
cells in
he l min rri </div>
S
m ch
Which regins f
he esh gus h ve skele
l? Sm
h? Skele
l nly: rxim l
1/3<div>Mixed: middle 1/3</div><div>Sm
h: dis
l 1/3</div>
M
ili
yII
Describe
he sw llwing reflex. Un sw llwing
he in
ern l n res clse,
he l
rynx is elev
ed nd
he gl

is is clsed. Once
he blus f fd  sses
he gl


is,
he eigl

is srings b ck in

he rel xed si
in s
h
we c n bre

he g in. Then s
rng eris
l
ic w ves ush
he blus dwn
he esh gus
M
ili
yII
Lis

he fur
yes f eris
lsis in
he esh gus.
Prim ry eris
lsis<div>
Secnd ry eris
lsis</div><div>Re
ching</div><div>Vmi
ing</div>
M
ili
y
II
Which nucleus is in ch rge f crdin
ing eris
lsis in
he uer r
in f

he esh gus? "Peris
lsis in
he s
ri
ed muscle r
in f
he esh gus is
cen
r lly <fn
clr=""#FF0000"">gener
ed by
he nucleus mbiguus</fn
> nd <
fn
clr=""#FF0000"">medi
ed by v g l m
r neurns</fn
>" M
ili
yII
Lis

he
hree medull ry nuclei ssci
ed wi
h &nbs;
he v gus nerve Nucleus
mbiguus<div>Drs l nucleus f
he v gus</div><div>Sli
ry nucleus</div>
M
ili
yII
Wh
is nucleus mbiguus in ch rge f? Is i
m
r, sensry, r secre
m
r?
M
r nucleus<div>Innerv
es s
ri
ed muscle
hrughu

he neck nd
hr x. Thi
s includes sme muscles f
he  l
e nd h rynx, muscles f
he l rynx, nd
h

e  r sym
he
ic innerv
in f
he he r
.<br /><div><div><br /></div></div></d

iv>
M
ili
yII
Wh
is
he drs l nucleus f
he v gus in ch rge f? Is i
m
r, sensry, r s
ecre
m
r?
Secre
m
r (s
imul
es gl nds)<div>Mucus gl nds f
he h rynx
, lungs, nd gu
, s well s g s
ric gl nds f
he s
m ch</div>
M
ili
y
II
Wh
is
he sli
ry nucleus in ch rge f? Is i
m
r, sensry, r secre
m
r
?
Sensry<div>Recieves
s
e infrm
in, sens
in frm
he b ck f
he

hr
, nd ls viscer l sens
in (bld ressure, bld-xygen, sens
in in

he l rynx nd
r che , nd s
re
ch in
he gu
)</div>
M
ili
yII
Is v gus sym
he
ic r  r sym
he
ic?
Ac
u lly, i
is mixed M
ili
y
II
Hw is eris
lsis crdin
ed in
he uer esh gus? Lwer? "Uer: cen
r ll
y gener
ed by nucleus mbiguus nd medi
ed by v g l m
r neurns<div>Lwer: g
ener
ed by
he ENS wi
h inu
s frm
he v gus. U
ilizes
he rs
r l (exci

ry
) nd c ud l (inhibi
ry) resnse
 cn
r c
/rel x
he skele
l muscle nd mv
e
he fd blus dwnw rds</div><div><img src="" s
e-14057427959812.jg"" /></d
iv><div><br /></div>" M
ili
yII
Exci

ry r inhibi
ry:<div>Rs
r l?</div><div>C ud l?</div> <div>Rs
r l: Ex
ci

ry</div><div>C ud l: Inhibi
ry</div>
M
ili
yII
Wh
re
he
w w ys in which lss f neurns c n resul
in ch l si ? Wh
re

he resul
s f e ch? "1. Ach l si resul
ing frm
he lss f inhibi
ry neur
ns. In
his si
u
in,
he <fn
clr=""#FF0000""> bsence f NO m
r neurns<
/fn
> resul
s in n <fn
clr=""#FF0000"">elev
in in
he b s l LESP</fn
>
(lwer esh ge l shinc
er ressure) nd
he <fn
clr=""#FF0000""> bsence f
sw llw-induced rel x
in f
he LES.&nbs;</fn
><div>2. Ach l si wi
h <fn

clr=""#FF0000"">cmle
e lss f myen
eric neurns</fn
>. Here
he <fn
cl
r=""#FF0000"">b s l LESP is belw nrm l </fn
>due

he bsen
exci

ry ne
urns, nd <fn
clr=""#FF0000"">sw llw-induced rel x
in is bsen
due


he l ck f inhibi
ry neurns.</fn
></div><div><img src="" s
e-15071040241668.
jg"" /></div>" M
ili
yII
Which rece
rs c
iv
e secnd ry eris
lsis? (3)
Mech nrece
rs<div>Aci
d rece
rs</div><div>Osmrece
rs</div>
M
ili
yII
T/F: We ll h ve sme g s
resh ge l reflux True
M
ili
yII
Wh
is GERD? Flw f g s
ric juice frm
he s
m ch

he esh gus M
ili
y
II
In GERD, yu m y h ve reflux f __, ___, nd/r ____
Acid, esin, bile (if
ls ylric shinc
er reflux) M
ili
yII
Wh
re
he nrm l b rriers
 reflux nd d m ge? (4) LES ressure (ms
imr

n
)<div>Resis
nce f esh ge l mucs
 cid</div><div>Cle ring f cid fr
m
he esh gus</div><div>Nrm l g s
ric m
ili
y</div> M
ili
yII
"<img src="" s
e-16698832846852.jg"" /><br /><div>Wh
is wrng here?</div>"
"Ach l si <div>This is wh
i
shuld lk like:</div><div><img src="" s
e-1668
1652977668.jg"" /></div>"
M
ili
yII
Wh
is
he r
c use f B rre

s esh gus? Chrnic g s
resh ge l reflux
M
ili
yII
Why des B rre

s esh gus suck?
When
he ei
helium
r nsi
ins b ck nd
fr
h frm s
r
ified squ mus
 simle clumn r in resnse
 chrnic reflux
,
he ei
helium c n lse cn
c
inhibi
in nd resul
in me
s

ic c ncer
M
ili
yII
M
ili
y wise, hw is
he s
m ch divided?
"Prxim l nd dis
l s
m ch<div
><img src="" s
e-17824114278404.jg"" /></div>"
M
ili
yII
Wh
is
he ms
dil
ed  r
f
he diges
ive
r c
? S
m ch M
ili
yII
A
which ver
ebr l level is
he g s
resh ge l junc
in? Which rib level?
T11<div>7
h cs
l c r
il ge</div>
M
ili
yII
Which ver
ebr l level cn
ins
he ylric shinc
er? L1 (
r nsylric l ne)
M
ili
yII
Wh
re
he n mes f
he s
m chs shinc
ers? C rdi c nd ylric shinc
ers
M
ili
yII
Wh
re
he
w n
ches fund n
he s
m ch? "The s
m ch h s
w n
ches r

incisur e:
he ngul r incisur , r <fn
clr=""#FF0000""> ngul r n
ch</fn
>

, which is
he deees
 r
f
he cnc vi
y frmed by
he lesser curv
ure, nd

he c rdi incisur , r <fn
clr=""#FF0000"">c rdi c n
ch</fn
>, which is

he cu
e ngle frmed when
he lef
brder f
he esh gus mee
s
he gre
er c
urv
ure f
he s
m ch.&nbs;" M
ili
yII
Wh
is
he r
in f
he s
m ch c lled which is n
cvered by
he neighbrin
g viscer ?
s ce f Tr ube (in
he lef
hycndrium)
M
ili
yII
Lis

he 5 m
r func
ins f
he s
m ch. (Frm Gu
M
ili
y II)
MMC<div>
Reservir func
in</div><div>Mixing</div><div>Grinding</div><div>G s
ric em
yin
g</div> M
ili
yII
Wh
is
he frequency f slw w ves in
he s
m ch?
3 cycles/minu
e M
ili
y
II
Which regin f
he s
mm ch h s n rhy
hmic l elec
ric l c
ivi
y?
Fundus<d
iv>This m kes sense bec use
he rle f
he fundus is in rece
ive rel x
in, n

ylric grind</div> M
ili
yII
Wh
im r
s
he m in rhy
hm f
he sm
h muscle in
he s
m ch?
Clus
ers
M
ili
y
f ICC ( cem ker cells) in
he gre
er curv
ure f
he s
m ch
II
Wh

es
me sures elec
ric l exci
bili
y f
he s
m ch?
EGG (elec
rg s

rgr m) M
ili
yII
Hw d
he slw w ves in
he s
m ch ch nge when eris
lsis is ccuring?
"Frequency rem ins
3 cycles/minu
e bu

he mli
ude f
he w ves incre ses
nd c
in 
en
i ls nw ccur in ssci
in wi
h c
in 
en
i ls<div><img sr
c="" s
e-21440476741636.jg"" /></div>"
M
ili
yII
Which m
ili
y 

ern is ssci
ed wi
h
he rxim l s
m ch? Wh
is
he rle
Rece
ive rel x
in<div>Hels m in
in cns
n

f
his m
ili
y 

ern?
in
erg s
ric ressure nd llws
he s
m ch
 ex nd when cce
ing fd. Als
, llws
he s
m ch
 send fd in

he dis
l s
m ch in
imely f shin s
ince i
needs
 h ve
ime
 cme u wi
h secre
ins</div>
M
ili
yII
Wh
is
he func
in f
he ylric shinc
er? Ac
s s sieve in
h
i
llw
s  r
icles sm ll enugh
 en
er
he dudenum M
ili
yII
Wh
re
w ssible resul
s f fd  r
icles during
he ylric grind?
Sm ll enugh -&g
; ges
hrugh
he ylric shinc
er<div>T l rge -&g
; re
r
ulsin (
r vels b ckw rds)</div>
M
ili
yII
Wh
is
he rle f
he fundus-crus regin f
he s
m ch in
erms f m
ili
y
?
Ad 
ive rel x
in<div>Regul
in f in
r g s
ric ressure</div>
M
ili
yII
Wh
sign lling mlecules c uses rece
ive rel x
in? Neurn l rele se f v s
c
ive in
es
in l lye
ide (VIP) nd NO
M
ili
yII
Hw sm ll des fd  r
icle need
 be
 ge

hrugh
he ylric shinc
er?
Abu
1 mm
M
ili
yII
<div>Hw des e ch f c
r ffec
fed s

e g s
ric m
il
y:</div><div>F
?&nbs;
</div><div>C rbhydr
e?</div><div>Pr
ein?</div><div>Amun
f fd?&nbs;</div
><div>Physic l frm?</div><div>Acidic cn
en
?&nbs;</div><div>Hrmn l f c
rs?
</div><div>Ps
ure?&nbs;</div><div><br /></div>
"<div>F
: An incre se i
n
he f
cn
en
<fn
clr=""#FF0000"">decre ses</fn
>
he em
ying r
e.&nb
s;</div><div>C rbhydr
e: An incre se in
he sug r cn
en
<fn
clr=""#FF00
00"">decre ses</fn
>
he em
ying r
e.&nbs;</div><div>Pr
ein: An incre se in

he r
ein cn
en
<fn
clr=""#FF0000"">decre ses</fn
>
he em
ying r
e.
&nbs;</div><div>Amun
f fd: An incre se in
he mun
f fd
ken <fn
c
lr=""#FF0000"">decre ses</fn
>
he em
ying r
e.&nbs;</div><div>Physic l f
rm: An incre se in
he slid cn
en
f
he fd <fn
clr=""#FF0000"">decre s
es</fn
>
he em
ying r
e.&nbs;</div><div>Acidic cn
en
: An incre se in
he
cidic cn
en
<fn
clr=""#FF0000"">decre ses</fn
>
he em
ying r
e. This
is bec use cid h s
 be neu
r lized by  ncre
ic juices, duden l juices nd
in
es
in l secre
in f
er i
is em
ied.&nbs;</div><div>Hrmn l f c
rs:<fn

clr=""#FF0000"">&nbs;Prges
erne incre se GI
r nsi

ime</fn
>, nd <fn

clr=""#FF0000"">decre ses esh ge l shinc
er
ne</fn
>. This is
he m in
re sn sme regn n
wm n h ve higher vmi
ing 
en
i l.&nbs;</div><div>Ps
u
re:&nbs;S
m ch cn
en
s re <fn
clr=""#FF0000"">em
ied f s
er when s
ndi

ng u
h n lying dwn</fn
>. This s
ure effec
m y exl in why bed-s
ricken 

M
ili
y

ien
s
end
 h ve r e
i
es.&nbs;</div><div><br /></div>"
II
Hw des di be
es ffec
:<div>Au
nmic nervus sys
em?</div><div>G s
ric em
yi
ng?</div><div>G s
ric MMC?</div><div>An
r l m
ili
y?</div><div>Rece
ive rel x

in?</div><div>G s
ric elec
ric l r
e nd rhy
hm?</div><div>Over ll diges
in?
</div> Resul
s in u
nmic neur
hy which decre ses g s
ric em
ying, g s
ri
c MMC, decre sed rece
ive rel x
in nd n
r l m
ili
y. Als s resul
f
u
nmic neur
hy, 
ien
s exerience
chyg s
ri nd rry
hmi s. Fur
hermr
e, 
ien
s exerience ileus nd g s
r resis (decre ses bili
y f
he s
m ch

 rele se cn
en
s wi
hu
n bs
ruc
in resen
= ileus f
he s
m ch)
M
ili
yII
Wh
is
he es
blished me
hd fr me suring g s
ric m
ili
y? <div><div>Assess
men
f GI
r c
func
in ru
inely&nbs;&nbs;usu lly invlves r di
in (scin

igr hy wi
h &nbs; 99mTc sulfur cllid, &nbs;me l l belled wi
h 13C, r Singl
e Ph
n emissin cmu
ed
mgr hy (SPECT). I
is ms
ly limi
ed
 ne GI
r
c
regin,requires mul
ile
es
s, nd&nbs;s
nd rdized r
cl re f
en n

v il ble.</div><div><br /></div><div><br /></div></div>
M
ili
yII
Wh
cn
rls rece
ive rel x
in (since
he  cem ker cells d n
)? Fundic r
el x
in is cn
rlled by
he v gus
M
ili
yII
Hw lng des i
nrm lly
ke fd
 em
y
he s
m ch?
3 hurs M
ili
y
II
Wh

w demgr hics h ve rlnged g s
ric em
ying
ime?
Obese 
ien
s
nd regn n
wmen
M
ili
yII
Wh
cn
rls eris
lsis in
he uer
hird f
he esh gus? V g l m
r neur
M
ili
yII
ns
Wh
is
he m jr l yer in lwer 2/3 esh ge l eris
lsis? "ENS<div>V gus "
"versees"" bu
is n
necess ry</div>" M
ili
yII
Sw llwing en
ils crdin
ed ening f ____ nd clsure f _____
"Sw llw
ing en
ils crdin
ed ening f <fn
clr=""#FF0000"">uer esh ge l shi
nc
er</fn
> nd clsure f <fn
clr=""#FF0000"">
he gl

is</fn
>" M
ili
y
II
Wh
is ch l si ?
LES is clsed nd c nn
be ened in crdin
in wi
h
M
ili
y
rim ry eris
lsis. Reflec
s v rius degrees f neurn l d m ge.
II
Wh
hels cle r cid frm g s
ric reflux?
Secnd ry eris
lsis M
ili
y
II
LES func
ining is cn
rlled by ___, ____, nd _____ "LES func
ining is cn

rlled by <fn
clr=""#FF0000"">neurns</fn
>, <fn
clr=""#FF0000"">hrmn
es</fn
>, nd <fn
clr=""#FF0000"">e
ing h bi
s</fn
>"
M
ili
yII
Wh
resul
s if rece
ive rel x
in is n
resen
?
Duming syndrme
M
ili
yII
Hw des nucleus mbiguus exer
i
s effec
s un
he esh gus? Which regin f

he esh gus des i
exer
i
s effec
s un? Gener
es sequen
i l c
iv
i
n f v g l m
r neurns, which, in
urn rduce successive cn
r c
ins in
he
cervic l esh gus in rximdis
l direc
in M
ili
yII
Lis

he 8 m
r func
ins f
he sm ll in
es
ine
Mixing<div>Prulsin</d
iv><div>MMC</div><div>Segmen

in</div><div>Peris
lsis</div><div>Pwer ruls
in</div><div>Vill r um</div><div>Micrvill r
wi
ch</div>
M
ili
yIII
Wh
cn
rls slw w ves in
he in
es
ine? Where is
he r
e
he highes
? Lwes

?
P cem ker regins (ICC)<div>Highes
: dudenum -&g
; 18 w ves/minu
e</div
><div>Lwes
: ileum -&g
; 8 w ves/minu
e</div> M
ili
yIII
Wh
ccurs during e ch f
he
hree h ses f
he MMC? Ph se 1: b sic rhy
hm bu

n cn
r c
ins, n sike 
en
i ls<div>Ph se 2: irregul r sike 
en
i ls
nd cn
r c
ins</div><div>Ph se 3: regul r sike 
en
i ls nd cn
r c
ins cc
m nied by incre sed g s
ric,  ncre
ic nd bili ry secre
in</div> M
ili
y
III
Where des mixing ccur in
he s
m ch? An
r l/ylric regin M
ili
yIII
Where re w ves gener
ed in
he s
m ch? Where d
hey
r vel? Gener
ed in  c
kem ker regin n
he gre
er curv
ure nd
he w ves
r vel
w rds
he ylrus

M
ili
yIII
Hw f
en des MMC ccur?
Abu
every 90 minu
es M
ili
yIII
Wh
is
he urse f MMC?
Cle nses
he diges
ive
r c
f nn- bsrb ble s
ubs
nces, nd rvides n effec
ive em
ying f
he
r c
ll
he w y<div><br /
></div> M
ili
yIII
Wh
is segmen

in in
he in
es
ine? Mixes
he cn
en
s b ck nd fr
h
M
ili
yIII
Where des chyme
r vel slwes
?
Ileum<div>Slwes
frequency f cn
r c
i
n, less frequen
eris
lsis, slwes
mvemen
</div> M
ili
yIII
Hw des dis
ensin effec
eris
lsis? Peris
lsis is induced by dis
ensin<div
>L rge me ls will re ch
he l rge in
es
in in less
ime</div> M
ili
yIII
Hw d f
s ffec
mvemen
f fd lng
he in
es
ine?
Slws
he mveme
n

M
ili
yIII
Wh
is
he urse f segmen

in?
Mix nd churn&nbs;
M
ili
yIII
Wh
is
he urse f eris
lsis?
Gr du l mvemen
s f cn
en
s
w rds
h
e cln M
ili
yIII
Describe
he rel x
in/cn
r c
in f sm
h circul r/lngi
udin l muscle durin
g eris
lsis? In
he rulsive segmen
: rel x lngi
udin l nd cn
r c
circu
l r<div>In
he recieving segmen
: cn
r c
lngi
udin l nd rel x circul r</div>
M
ili
yIII
Describe
he neurn l circui
fr eris
lsis. Which NTs re invlved? Wh
rv
ides
he ini
i l sign lling

he sensry neurns?
"<img src="" s
e-398487
06572292.jg"" /><div>A blus in
he in
es
in l lumen exer
s ressure n
he muc
s
h
c uses ser
nin rele se frm en
erchrm ffin (EC) cells. The his
min
e
riggers cells in
he submucs l lexus which
hen c
iv
es m
r neurns.&nb
s;M
r neurns rel x dwns
re m by secre
ing VIP nd NOS nd cn
r c
us
re m
by secre
ing Ach nd Subs
nce P<div>N
e: The SAME sensry sign l
riggers sim
ul
neus rel x
in nd cn
r c
in</div></div>"
M
ili
yIII
Wh
regul
es fluid flw frm
he sm ll in
es
ine in

he cln nd reven
s c
Ilecec l v lve M
ili
yIII
lile l reflex?
Wh
re
he
hree s
ris f lngi
udin l muscle in
he cln c lled? T eni c
li<div>Envels
he en
ire circumference f
he cln in
he rec
sigmid regi
n</div> M
ili
yIII
"In
r eri
ne l s
ruc
ures re cvered by <fn
clr=""#FF0000"">____</fn
> w
here s re
reri
ne l s
ruc
ures re cvered by <fn
clr=""#FF0000"">_____</
fn
>" "In
r eri
ne l s
ruc
ures re cvered by&nbs;<fn
clr=""#FF0000"">
sers </fn
>&nbs;where s re
reri
ne l s
ruc
ures re cvered by&nbs;<fn

clr=""#FF0000""> dven
i
i </fn
>"
M
ili
yIII
_______ re subsers l f
cllec
ins ssci
ed wi
h
he
eni cli. "<fn
c
lr=""#FF0000"">Aendices eilic e</fn
> re subsers l f
cllec
ins ss
ci
ed wi
h
he
eni cli." M
ili
yIII
Wh
re
he fur func
ins f
he cln?
Mixing<div>Prulsin</div><div>
Absr
in f w
er nd elec
rly
es</div><div>S
r ge f fec l m

er un
il ex
ulsin</div>
M
ili
yIII
Wh
re
he m
r 

erns ssci
ed wi
h
he cln? Mixing nd rulsin, b
u
slwer<div>H us
r
ins</div><div>M ss mvemen
s (wer rulsin)</div>
M
ili
yIII
Wh
re h us
r
ins? "<div>Mixing mvemen
s re circul r segmen
l cn
r c
i
ns simul
neus wi
h lngi
udin l muscle cn
r c
in; simil r

he mixing mve
men
s in
he sm ll in
es
ine. &nbs;</div><div>During
hese cn
r c
ins,
he un
s
imul
ed r
ins f
he l rge in
es
ine b g u
(h us
r ), while s
imul
ed s
egmen
s underg ""h us
r l cn
r c
ins."" &nbs;</div><div><br /></div>"
M
ili
yIII
Hw f
en des m ss mvemen
in
he cln ccur?
A few
imes er d y<div>
<br /></div>
M
ili
yIII
Describe
he c
ins invlved in m ss mvemen
f
he cln.
"<img src="" s

e-44555990728708.jg"" /><div>Ring f cn
ric
in e rs in n re f
he cl
n which h s been dis
ended by diges
-&g
; dis
l segmen
flds u like n cc
rdin -&g
; rels chyme n lw rd</div>"
M
ili
yIII
Which
hree
hings s
imul
e clnic c
ivi
y? Usu lly ini
i
ed by dis
ensin

f
he cln. Als s
imul
ed by dis
ensin f
he s
m ch r dudenum (g s
rc
lic r dudenclic) nd g s
rin
M
ili
yIII
Cm re nd cn
r s
lng-dur
in cn
r c
ins nd high- mli
ude cn
r c
ins
f
he cln. "<img src="" s
e-45354854645764.jg"" /><div><fn
clr=""#FF0
000"">Lng-dur
in cn
r c
ins</fn
> m y be <fn
clr=""#FF0000"">s

in r
y r migr
e ver shr
dis
nces</fn
> (slid lines). In
he righ
nd rxim
l
r nsverse clns, m ny lng-dur
in cn
r c
ins migr
e in n <fn
clr="
"#FF0000"">r d direc
in</fn
>, where s in
he mre dis
l regins f
he cl
n,
hey migr
e in n <fn
clr=""#FF0000""> br l f shin</fn
>. In cn
r s

,<fn
clr=""#5500FF""> high- mli
ude cn
r c
ins </fn
>(d shed line) r
g
e ve<fn
clr=""#5500FF"">r ex
ended dis
nces </fn
>in
he cln in n <
fn
clr=""#5500FF""> br l direc
in, crresnding
 m ss mvemen
s f fece
s.</fn
><br /><div><br /></div></div>" M
ili
yIII
Wh

w f c
rs llw
he cln
 c
s reservir? Shinc
ers nd high cm
li nce f i
s w ll
M
ili
yIII
Wh
reven
s  frm ge

ing u
f
he b
y hle? "<fn
clr=""#FF0000""
>In
ern l nd ex
ern l shinc
ers</fn
>. Als,
he <fn
clr=""#FF0000""> n l
cushins</fn
>, m de u f <fn
clr=""#FF0000"">mucs </fn
>, <fn
clr=
""#FF0000"">hemrrhid l lexuses</fn
>, nd
he <fn
clr=""#FF0000"">subei

heli l-sur
ing
issue</fn
> rvide se l
h
des n
ermi
 ss ge f
liquid m
eri l under res
ing cndi
ins. Fin lly,
he <fn
clr=""#FF0000"">
nrec
l ngle</fn
> cre
ed by
he ubrec
lis muscle rvides func
in l 
bs
ruc
in
 cciden
l lss f s
l
res
."
M
ili
yIII
Skele
l r sm
h muscle:<div>In
ern l n l shinc
er?</div><div>Ex
ern l n l
shinc
er?</div>
In
ern l: sm
h -&g
; invlun
ry<div>Ex
ern l: skele

l -&g
; vlun
ry</div> M
ili
yIII
Describe
he def c
in reflex. "<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s
 ce:re""> </s n>Dis
ensin f
he rec
l w ll ini
i
es fferen
sign ls
h

sre d
hrugh
he myen
eric lexus
 ini
i
e eris
l
ic cn
r c
ins in
he
descending cln, sigmid flexure nd rec
um. &nbs;The in
ern l n l shinc
er
is inhibi
ed by rece
ive rel x
in henmenn. &nbs;Tge
her,
hese henmen
n m ke u
he ""in
rinsic defec
in reflex."" &nbs;This reflex is we k wi
h r
esec

 i
s bili
y
 c use defec
in bu

his we k reflex is fr
ified by

he  r sym
he
ic defec
in reflex, which invlves s cr l elemen
s f
he sin
l crd. &nbs;Sensry fferen
s in
he rec
um le d

he sin l crd nd effer
en
s re
urn

he descending cln, sigmid flexure, rec
um nd nus vi
he ne
rvi erigen
es." M
ili
yIII
Wh
c uses
he urge
 defec
e?
Dis
ensin f
he rec
-sigmid regin
M
ili
yIII
Which nerves cns
ric

he in
ern l n l shinc
er? Rel x?
Cns
ric
in: sy
m
he
ic fibers frm
he lumb r medull
hrugh hyg s
ric nerves nd
he infe
rir mesen
eric g nglin<div>Rel x
in:  r sym
he
ic fibers in
he elvic s
l nchnic nerves (S2-S4)<br /><div><br /></div></div>
M
ili
yIII
Which muscles cn
ribu
e
 clsure f
he nus? Hw? Lev
r ni<div>Incre se
M
ili
yIII

he ngle be
ween
he rec
um nd nus</div>
Which nerve cn
rls
he ex
ern l n l shinc
er?
Pudend l nerve M
ili
y
III
Wh
is
he eri
ne-in
es
in l reflex?
<div>irri

in f
he eri
neu
m c uses in
es
in l  r lysis</div><div><br /></div>
M
ili
yIII
Wh
is
he ren-in
es
in l reflex?
<div>irri

in f
he kidney c uses in

es
in l inhibi
in</div><div><br /></div>
M
ili
yIII
Wh
is
he vesic-in
es
in l reflex? <div>irri

in f
he bl dder c uses in
M
ili
yIII

es
in l inhibi
in</div><div><br /></div>
Wh
is
he sm
-in
es
in l reflex? <div>irri

in f
he skin ver
he bd
M
ili
yIII
men c uses in
es
in l inhibi
in</div><div><br /></div>
Wh
is sign f Hirschrungs dise se shr
ly f
er bir
h?
N bwel mvemen

in
he firs
48 hurs f life M
ili
yIII
Are bys r girls mre f
en effec
ed by Hirschrungs dise se? 4 bys fr every
girl M
ili
yIII
Older children wi
h Hirschrungs dise se resen
wi
h...
Sesis<div>Cns

i
in
h
wrsens ver
ime</div><div>Sm ll, w
ery s
l</div><div>Lss f

e
i
e</div><div>Del yed grw
h</div> M
ili
yIII
Wh
is resul
f Hirschrungs dise se ( n
mic lly)?
"<img src="" s

e-50478750629892.jg"" />"
M
ili
yIII
Hw d yu crrec
Hirschrungs dise se?
Cls
my
M
ili
yIII
"Mu

ins n <fn
clr=""#FF0000"">_____</fn
> re ssci
ed wi
h Hirschru
ngs dise se." "Mu

ins n&nbs;<fn
clr=""#FF0000"">chrmsme 10</fn
>&
nbs; re ssci
ed wi
h Hirschrungs dise se."
M
ili
yIII
"<fn
clr=""#FF0000"">____</fn
> is imr
n
fr
he develmen
f
he ENS
"
"<fn
clr=""#FF0000"">RET r
-ncgene</fn
>&nbs;is imr
n
fr
M
ili
yIII

he develmen
f
he ENS"
Why d 
ien
s wi
h Hirschrungs dise se resen
wi
h en
ercli
is? <div>Ls
s f g ngli in
he gu
in Hirschrungs-&g
; less mucin (r
ec
s
he mucs f

he gu
) nd less defense (GALT) -&g
; b c
eri dhere

he surf ce nw
h


he defense is dwn-&g
; inv de in

he ei
helium -&g
; infl mm
in -&g
; en

ercli
is (infl mm
in f
he cln) -&g
; c n resul
in sesis nd c gul

hy if
he b c
eri re ch
he bld suly</div><div><br /></div>
M
ili
y
III
Wh
is
he func
in f segmen

in? Imr
n
fr diges
in nd bsr
in
M
ili
yIII
Which h s higher frequency f slw w ves: s
m ch r in
es
ine?
In
es
in
e
M
ili
yIII
True/F lse: fequency f slw w ves is cns
n

hrughu

he in
es
ine F lse
M
ili
yIII
Which mvemen
serves
 cm c

he feces?
H us
r
ins nd m ss mvemen

M
ili
yIII
When is m ss mvemen
bserved in
he in
es
ine?
When b c
eri l
xins r
e resen

M
ili
yIII
Wh
c uses Hirshrungs dise se?
Thing g wrng in
he develmen
f ENS
-&g
; n m
ili
y&nbs;
M
ili
yIII
Lis

he 6 func
ins f s liv . Lubric
e nd bind<div>Slubilize dry fd</div>
<div>An
ib c
eri l</div><div>Ini
i l s
rch diges
in</div><div>Ini
i l liid di
ges
in</div><div>Alk line buffering</div>
Gu
Secre
insI
"The b sic secre
ry uni
s f s liv ry gl nds re clus
ers f cells c lled <fn

clr=""#FF0000"">______</fn
>"
"The b sic secre
ry uni
s f s liv ry g
l nds re clus
ers f cells c lled&nbs;<fn
clr=""#FF0000""> n cini</fn
>"
Gu
Secre
insI
N me
he
hree s liv ry gl nds. Wh
des e ch secre
e? P r
id gl nds: serus,
w
ery secre
in<div>Subm xill ry (m ndibul r) gl nds: mixed serus nd mucus s
ecre
in</div><div>Sublingu l gl nds: edmin n
ly mucus secre
in</div>
Gu
Secre
insI
Serus cells secre
e _____<div>Mucus cells secre
e _____</div> "Serus cells se
cre
e <fn
clr=""#FF0000"">w
ery fluid (devid f mucus)</fn
><div>Mucus c
ells secre
e <fn
clr=""#FF0000"">very mucus-rich secre
in</fn
></div>"
Gu
Secre
insI
Serus nd/r mucus cells:<div>P r
id?</div><div>Subm xill ry?</div><div>Subli
ngu l?</div>
<div>P r
id: serus</div><div>Subm xill ry: mucus nd serus</d
iv><div>Sublingu l: mucus</div> Gu
Secre
insI
Hw des
he u
nmic nervus sys
em cn
rl s liv secre
in? Cn
rls b
h
h
e vlume nd
ye f s liv secre
ed
Gu
Secre
insI
Why is i
imr
n

 slubilize fd? S
h
yu c n
s
e i
!
Gu
Secre

insI
"Wh
c uses ""dr gn bre
h"" in
he mrning?" Flw f s liv diminishes cnsid
er bly during slee, llwing ul
ins f b c
eri
 build u in
he mu
h
Gu
Secre
insI
Wh
secre
e lh - myl se?
Serus cin r cells
Gu
Secre
insI
Which s lvi ry gl nd rim rily rduces H2O nd elec
rli
es? Mucin?
H2O nd
elec
rli
es:  r
id<div>Mucin: subm ndibul r nd sublingu l</div>
Gu
Secre

insI
Is
he cinus erme ble
 w
er? Duc
l cells? Yes,
he cinus very erme ble

 w
er nd c
s in fil
ering w
er nd inic cmnen
s frm
he bld. Hwever
, duc
l cells re imerme ble
 w
er.
Gu
Secre
insI
Wh
is
he effec
f incre sed bld flw

he s liv ry gl nds un s liv ry
secre
in?
Incre ses dr m
ic lly Gu
Secre
insI
D s liv ry gl nds cn
in myei
heli l cells? Yes
Gu
Secre
insI
Hy
nic/isn
nic/hyer
nic:<div>S liv in
he lumen f cin r cells?</div><
div>S liv le fing
he gl nd?</div>
Ini
i lly is
nic, bu
is mdified
 b
ecme hy
nic when i
le ves
he gl nd
Gu
Secre
insI
"<div>The cini secre
e fluid simil r
 l sm in i
s cncen
r
in f ins.
As
he fluid mves dwn
he duc
, <fn
clr=""#FF0000"">______</fn
> re re b
srbed nd <fn
clr=""#FF0000"">_______</fn
> re secre
ed in

he s liv .<
/div><div><br /></div>" "<div>The cini secre
e fluid simil r
 l sm in i
s
cncen
r
in f ins. As
he fluid mves dwn
he duc
,&nbs;<fn
clr=""#FF
0000"">N + nd Cl-</fn
>&nbs; re re bsrbed nd&nbs;<fn
clr=""#FF0000"">K
+ nd HCO3-</fn
>&nbs; re secre
ed in

he s liv .</div><div><br /></div>"
Gu
Secre
insI
Hw des s liv flw r
e effec

he
nici
y f
he fin l s liv secre
ed frm
The higher
he flw f
he s liv , less
ime is v il ble fr m

he gl nd?
dific
in, nd
he fin l s liv resembles
he inic m keu f l sm
Gu
Secre

insI
Wh
is
he dv n
ge f rducing hy
nic s liv ?
Serves n n
ib c
eri l
rle since
he hy
nic envirnmen
lyses
he b c
eri l cell membr ne Gu
Secre

insI
"The cmsi
in f s liv is mdified in <fn
clr=""#FF0000"">_____</fn
>"
"The cmsi
in f s liv is mdified in&nbs;<fn
clr=""#FF0000"">
he s
ri

ed nd excre
ry duc
.</fn
>" Gu
Secre
insI
Hw is
he cncen

in f bic rbn
e in
he s liv ffec
ed by incre sed flw
r
e? "Rel
ively indeenden
<div><img src="" s
e-9264244457476.jg"" /></div
>"
Gu
Secre
insI
N me
he 7 r
eins cn
ined in s liv nd
he func
in f e ch.
Mucin: l
ubric
in nd viscsi
y<div>Alh - myl se: cle v ge f lys cch ride ( lh -1,
4 glycsidic bnd)</div><div>Lingu l li se: cle v ge f medium-ch in
riglyceri
des</div><div>Mur mid se: cle v ge f mur mic cid (gr m +)</div><div>L c
ferri
n: binding f Fe ins ( n
ib c
eri l)</div><div>Secre
ry IgA: immuni
ry defens
e</div><div>Grw
h f c
rs: grw
h f mucs
nd u
nmic neurns</div>
Gu
Secre
insI
Wh
secre
es lingu l li se? Ebners gl nds Gu
Secre
insI
Wh
secre
es secre
ry IgA?
In
ers
i
i l immuncy
es
Gu
Secre
insI
S
imul
es r inhibi
s s liv ry secre
in:<div>Sym
he
ic?</div><div>P r sym

he
ic?</div>
BOTH s
imul
e s liv ry secre
in
Gu
Secre
insI
Which nerves
r nsmi
 r sym
he
ic inu


he s liv ry gl nds? Sym
he
ic?
P r sym
he
ic: CN VII, CN IX<div>Sym
he
ic: T1-T3</div>
Gu
Secre
insI
S
imul
es fluid nd/r r
ein secre
in in s liv ry gl nds:<div>P r sym
he
i
c?</div><div>Sym
he
ic?<br /><div><br /></div></div> P r sym
he
ic: fluid s
ecre
in<div>Sym
he
ic: r
ein secre
in</div>
Gu
Secre
insI
Which f c
rs s
imul
e s liv ry secre
in vi
he  r sym
he
ic nervus sys
e
m? Inhibi
?
S
imul
e: cndi
ining, fd, n use , smell<div>Inhibi
: dehydr
Gu
Secre
insI

in, fe r, slee</div>
Hw is
he s
m ch divided by fr secre
ins? C rdi c, xyn
ic, ylric
Gu
Secre
insI
Which gl nds re fund in
he c rdi c gl ndul r regin? Oxyn
ic? Pylric?
C rdi c: mucus cells<div>Oxyn
ic:  rie
l cells, chief cells, mucus cells</di
v><div>Pylric: g s
rin secre
ing cells (G), sm
s

in secre
ing cells (D),
nd mucus cells</div> Gu
Secre
insI
N me
he 6 g s
ric secre
ins nd
he func
in f e ch. Pesin: diges
r
eins<
div>Li se: diges

riglycerides</div><div>HCl: n
imicrbi l c
ivi
y (r
ec
i
n)</div><div>In
rinsic f c
r: n
i nemic func
in</div><div>Bile: s
imul
ry<
/div><div>P ncre
ic juices: s
imul
ry</div> Gu
Secre
insI
Mucins re cnnec
ed by disulfide bnds.
hus
hey re rich in which min cid?
Cys
ine!
Gu
Secre
insI

Wh
junc
in l cmlex is fund in g s
ric ei
heli l cells? Tigh
junc
ins

(hels frm
he g s
ric mucs l b rrier)
Gu
Secre
insI
Which his
lgic l l yer des
g s
ric ulcer ex
end
hrugh? Ex
ends
hrugh
Gu
Secre
insI

he muscul ris mucs
Which f c
rs serve
 r
ec

he g s
rduden l mucs l b rrier?
Bic rbn

e, mucus, bld flw, grw
h f c
rs, cell renew l, nd rs
gl ndins
Gu
Secre
insI
Surf ce ei
heli l cells in
he s
m ch secre
e (6).
Mucus<div>Bic rbn
e</d
iv><div>Prs
gl ndins</div><div>He
shck r
eins</div><div>Trefil e
ides<
/div><div>An
imicrbi l c
helcidins</div>
Gu
Secre
insI
Wh
s
imul
es mucus secre
in in
he s
m ch? Mucus secre
in in
he s
m ch i
s s
imul
ed by g s
rin
es
in l hrmnes, including g s
rin nd secre
in, s we
ll s PGE2 nd chlinergic gen
s
Gu
Secre
insI
Wh
is
he rle f
refil f c
r f mily e
ides (TFFs)?
<div>Trefil f c

r f mily e
ides (TFFs) re n in
egr l  r
f
he in
r cellul r mucus secre

ry vesicles nd l y rle in
he in
r cellul r ssembly nd/r  ck ging f
mucins.</div><div><br /></div> Gu
Secre
insI
Wh
is
he resul
f d m ged mucs l b rrier?
M s
cells re s
imul
e
d which rduce his
mine. As
resul
, mre fluid, bld nd N re secre
ed in
Gu
Secre
insI


he s
m ch lumen
Hw des helicb c
er ylric rduce s
m ch ulcers? Cn
ins ure se which c
nver
s ure
 NH3 nd CO2. The NH3 rduced
hen neu
r lizes
he cid in
he s

Gu
Secre
m ch. In ddi
in,
he b c
eri inhibi
s H+/K+ ATP se
r nscri
in

insI
Hw c n yu
es
fr
he resence f H. ylri in
he s
m ch? Ure bre
h
es

Gu
Secre
insI
r
he r id ure se ss y
Hw des H. ylri rduce infl mm
in?
<div>Ini
i
in f mucs l infl
mm
in by Helicb c
er ylri H. ylri resides in
he mucus l yer verlying
h
e g s
ric ei
helium. In
he l min rri ,
here is lms
lw ys n ssci
e
d infl mm
ry infil
r
e in
he resence f H. Pylri. Bec use
he ei
heli l l
yer (which f lls be
ween H. ylri nd
he infl mm
ry cells) is in
c
, secn
d ry medi
rs ( nd n
H. ylri) evke mucs l infl mm
ry cells. H. ylri s
ecre
es f c
rs, e
ide, nd lilys cch rides (LPS), which re chem
c
ic
fr neu
rhils nd mncy
es. Ch r c
eriz
in f
he e
ide reve ls
h
i

is he
, cid, nd lk li s
ble. I
h s mlecul r weigh
f rxim
ely 300
0. The infl mm
ry cells, nce recrui
ed, will
hen rele se xygen r dic ls, in
ddi
in
 rs
gl ndins, in
erleukin 1 (IL-1), nd
umr necrsis f c
r (TN
F)
h
will fur
her rm
e ddi
in l infl mm
in.&nbs;</div><div><br /></di
v>
Gu
Secre
insI
An
r l g s
ri
is (
ye B) is rim rily lc
ed in which regin f
he s
m ch? W
h
is
his
ye f g s
ri
is ssci
ed wi
h? Cncen
r
ed in
he g s
ric n
r
um.<div>95% f 
ien
s will be infec
ed wi
h H. ylri</div><div>Hwever,
his
frm f g s
ri
is is ch r c
erized his
lgic lly nd is usu lly n
ssci
ed
wi
h grss endscic bnrm li
ies</div>
Gu
Secre
insI
Lis

he 6 d m ging f c
rs

he mucs l b rrier
H+<div>Pesin</div><div>
NSAIDs</div><div>S
ress</div><div>Smking</div><div>Alchl</div>
Gu
Secre

insI
Which cells re fund in
he xyn
ic gl nd f
he crus? Wh
is
he func
in 
f e ch cell?
"<div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re"">
</s n>Ei
heli l cells: secre
es mucus</div><div><s n cl ss=""Ale-
b-s n
"" s
yle=""whi
e-s ce:re""> </s n>Neck mucus cells: secre
es mucus</div><div
><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>S
em cells: s

em cell</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </
s n>P rie
l cells (nxy
ic cells): secre
es HCl nd in
rinsic f c
r</div><div
><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Chief cell: s
ecre
es&nbs;esingen</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
es ce:re""> </s n>En
erchrm ffin like cell: rduces his
mine -&g
; cn
rl
s HCl secre
in</div><div><br /></div>" Gu
Secre
insI
Wh
d en
erchrm ffin cells rduce? En
erchrm ffin like cells?
En
erch
rm ffin cells: ser
nin<div>En
erchrm ffin like cells: his
mine</div>

Gu
Secre
insI
"H. ylri inhibi
s <fn
clr=""#FF0000"">______</fn
>"
"H. ylri inhib
i
s&nbs;<fn
clr=""#FF0000"">
r nscri
in f H+/K+ ATP se</fn
>" Gu
Secre

insI
Describe hw g s
ric  rie
l cells secre
e HCl.
"<img src="" s
e-161920
26705924.jg"" /><div>CO2 is rduced frm cell me
blism -&g
; vi CA, CO2 nd
H2O re cnver
ed
 H2CO3 -&g
; dissci
es in
 H+ nd HCO3- -&g
; H+ le ves

he lumen l surf ce vi H+/K+ n
ir
nd HCO3- le ves b sl
er lly vi HCO3/C
l n
ir
, ls Cl en
ers
he lumen vi le k ch nnels -&g
; H nd Cl jin
 f
rm HCl in
he s
m ch lumen</div>"
Gu
Secre
insI
Which in in
he bld c n be used
 me sure g s
ric secr
ins?
HCO3!
Gu
Secre
insI
Hw is bic rbn
e secre
ed in

he lumen if i
is
r nsr
ed b sl
er lly by
"<div>HCO3 which w s umed in


r nsr
ers by g s
ric  rie
l cells?

he bld en
ers
he lumen vi fenes
r
ed c ill ries</div><div><img src="" s
Gu
Secre
insI

e-16904991277060.jg"" /></div><div><br /></div>"
Which cell secre
es in
rinsic f c
r? P rie
l cells in
he s
m ch Gu
Secre

insI
Describe
he rcess by which vi
min B12 is bsrbed in
he in
es
ine "<div><s
n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Die
ry vi
min B1
2 is rele sed frm inges
ed r
eins in
he s
m ch
hrugh
he c
in f esin
nd cid. I
is r idly bund by h 
crrin (secre
ed in
he s liv ), ne f

w vi
min B12-binding r
eins
h
re resen
in g s
ric juice (
he 
her is

he in
rinsic f c
r);
cid H, h 
crrin &nbs;h s gre
er ffini
y fr

he vi
min
h n des in
rinsic f c
r. In
he sm ll in
es
ine,  ncre
ic r
e
ses diges

he binding r
eins, rele sing vi
min B12 which
hen becmes bund

 in
rinsic f c
r. Fin lly,
here re rece
rs fr in
rinsic f c
r n
he i
le l mucs which bind
he cmlex, llwing vi
min B12
 be bsrbed in
 r

l bld.&nbs;</div><div><img src="" s
e-18094697218052.jg"" /></div>"
Gu
Secre
insI
Wh
des vi
min B12 bind
 in
he s
m ch? H 
crrin
Gu
Secre
insI
Which cell secre
es esin? Wh
2 mech nisms s
imul
e
hese cells?
Chief ce
lls<div>Resnd
:</div><div>-cAMP (rele sed in resnse
 secre
in, VIP, nd
PG)</div><div>-C (rele sed in resnse
 Ach nd CCK)</div> Gu
Secre
insI
En
erchrm ffin like cells re ms
rev len
in which regins f
he s
m ch?
Ms
rev len
in cid-secre
ing regins f
he s
m ch Gu
Secre
insI
Wh
s
imul
es en
erchrm ffin like cells
 secre
e his
mine?
"G s
rin
. Als s
imul
ed by Ach frm s
g nglinic chlinergic musc rinic nerves<div><
img src="" s
e-20298015440901.jg"" /></div>" Gu
Secre
insI
Wh
is
he rle f his
mine nd g s
rin in
he s
m ch?
Tge
her
hey r
e rim ry si
ive regul
rs f cid secre
in frm  rie
l cells
Gu
Secre

insI
"Lnger
erm s
imul
in f ECL cells by g s
rin ls s
imul
es <fn
clr=""#
FF0000"">______</fn
>" "Lnger
erm s
imul
in f ECL cells by g s
rin ls s

imul
es&nbs;<fn
clr=""#FF0000"">signific n
rlifer
in f ECL cells.</f
n
>" Gu
Secre
insI
Hyer
rhy f ECL cells is  r
icul rly eviden
in 
ien
s wi
h ... g s
rinsecre
ing
umrs
Gu
Secre
insI
Q: Wh
is
he func
in f
he esh gus? Where des i
ene
r
e
he di hr gm?
A: ges
hru di hr gm
T10; i
s resnsible fr
he bulk
r nsr
f fd fr
m
he h rynx
 c rdi c regin f
he s
m ch;
heres n bsr
in f nu
rien
s
lng
he w y nd
r nsr
ccurs in ~1 min; nce
he esh gus crsses
he di
hr gm
he dven
i
i -&g
; sers (i
nw h s mes
heli l cells n i
)
Bren
sQs
Q: Wh
kind f ei
helium is fund in
he esh gus? A: s
r
ified squ mus n
n-ker
inized wi
h
r ces f ker
hy lin r
ein, glycgen, nd mel ncy
es
Bren
sQs
Q: Is
here desqu m
in wi
hin
he esh gus? A: Yes,
he
 l yer f cells h
ve xid
in f
heir desmsmes wi
h slughing ff in

he lumen f
he esh
gus;
urnver r
e is bu
15 d ys (kee in mind
h
mi
sis nly ccurs in

he b s l l yer) Bren
sQs
Q: Hw des
he esh gus ei
helium cun
er fric
in nd br sin?
A:
he l
min rri in
erdigi

es wi
h dwngrw
hs f
he ei
helium s
h

here is
n fl
cle v ge l ne Bren
sQs
Q: Why is i
n
unusu l
 ge
mel nm in
he esh gus?
A: bec use
he e
i
helium ls h s mel ncy
es (h ve h ls nd m ke mel nin); when b c
eri die

hey m ke O2- r dic ls nd
hus i
s n
unusu l
 ge
mel nm s in
he dis
l 1/
3 f
he esh gus
Bren
sQs
Q: Wh
enzymes llw diges
in in
he esh gus?
A: s liv ry myl se nd
lingu l li se; remember
h

heres n bsr
in
Bren
sQs
Q: Hw des vege
ri n die
crrel
e wi
h ker
hy lin?
A: The mre yu
re vege
ri n,
he c rser
he die
,
he gre
er
he br sin n
he ei
heli
um. The ei
helium resnds by m king
he r
ein, ker
hy lin. This des n
c
use c ncer, nd
his is cmle
ely nrm l ( l
hugh i
migh
ch nge
he whi
e c
Bren
sQ
lr f
he s
r
ified squ mus ei
helium li

le d rker brwn).
s
Q: When fd ge
s s
uck wh
esh ge l mvemen
mus

ke l ce?
A: secn
d ry eris
lsis
Bren
sQs
Q: &nbs;Is
here rnunced muscul ris mucs wi
hin
he esh gus?
A: N,

heres nly
r ce lngi
udin l sm
h muscle. &nbs; This is bec use
here is n n
eed fr mucs l squeeze r mucs l flu

er
Bren
sQs
Q: The esh gus is n
very well equied
 de l wi
h g s
resh ge l reflux,
nd
hus cid im c
n
he ei
helium f
he esh gus c n c use me
l si . &
nbs;Describe GERD.
A: s
m ch cid irri

es
he ei
helium f
he esh gu
s, nd
he s
r
ified squ mus nnker
inized ei
helium underges me
l si

becme simle clumn r ei
helium f surf ce mucus cells, mimicking
he lini
ng f
he s
m ch. &nbs;This
r nsi
in
 n ei
helium f surf ce mucus cells
des n
effec
ively r
ec

he esh gus frm refluxing cid bec use
he surf
ce mucus cells nly rduce ne
ye f mucus. Fr effec
ive r
ec
in, fur

yes f mucus re needed, nd
hey mus
be mixed by
he mucs l flu

er. Fur
her
mre,
he newly rduced surf ce mucus cells will h ve bic rbn
e um
h


hey will use in n

em

 buffer
he refluxing cid, bu

his um is minim
l wi
h r develmen
f inic ch nnels nd des li

le
 r
ec

he esh g
us g ins
ulcer
in nd cn
inued me
l si . &nbs;Wi
h chrnic GERD, me
l
si c n cn
inue, wi
h
he esh ge l ei
helium ch nging b ck nd fr
h frm s

r
ified squ mus nnker
inized
 simle clumn r un
il
he ei
heli l cells f
in lly lse cn
c
inhibi
in, bre k
hrugh
he b s l l min , nd en
er
he bl
d vessels f
he l min rri nd submucs vi which
hey c n me
s
size

Bren
sQs
 
her  r
s f
he bdy.
Q: Wh
c uses B rre

s esh gus? &nbs;Wh
s
he 
hlgy f B rre

s esh gus?
A: chrnic GERD; i
s ch r c
erized by esh ge l ulcer frm
in,  in, swelling,
nd hyer
rhy f sm
h muscle f
he lwer esh ge l shinc
er (c n c use
ch l si ). &nbs;I
s rgressin
h
desn
jus
h en vernigh
. &nbs;Acid r
eflux firs
c uses

r nsi
in l ei
helium (ch nge in
he esh gus frm nrm l
s
r
ified squ mus nnker
inized ei
helium
 simle clumn r ei
helium). &n
bs;Cn
inued
r nsi
in l ei
heli l ch nges c n le d
 c ncer nd B rre

s es
h gus. Bren
sQs
Q: Where is
here ex
ensive v scul riz
in in
he esh gus? Any 
hlgy here
?
A: lwes
 r
f
he esh gus where i
mee
s
he c rdi c s
m ch. &nbs
;These vessels re rne
 swell nd burs
in 
ien
s wh re chrnic lchl
ics wi
h r
l hyer
ensin bec use n s
mses be
ween
hese vessels nd vesse
ls f
he r
l sys
em.
Bren
sQs
Q: Hw des
he s
m ch func
in s
reservir?
A:
he s
m ch eng ges i
n rece
ive rel x
in nd ex nds
 ccmmd
e incming fd (u
 1 li
er).
Bren
sQs
Q: Wh
 r
f
he s
m ch secific lly eng ges in rece
ive rel x
in?
A: i
s
he rel x
in f
he muscul ris ex
ern in
he fundus nd ms
rxim l c
Bren
sQs
rus regin
Q: Ch r c
erize
he s
m ch ei
helium. A: i
s hmgenus ei
helium me ning
h


he lumin l surf ce f
he s
m ch is cvered by ne cell
ye (
he surf ce m

ucus cell) frm
he c rdi c shinc
er

he ylric shinc
er Bren
sQs
Q: Wh

ye f cell is
he surf ce mucus cell?
A: simle clumn r ei
h
elium Bren
sQs
Q: Describe wh
ges n

he surf ce f
he mucus cells?
A: rele se f mu
cus gr nules
 m ke mucus l yer
h
cvers
he ei
helium f
he s
m ch;
bic rbn
e um nd
ge
her wi
h
he mucus frms
he g s
ric muc

heres ls
Bren
sQs
s l b rrier
Q: Wh
cmrises mucus?
A: cmsed f ms
ly mucin (highly glycsyl
ed
r
ein);
w mucin mnmers frm dimer
hrugh disulfide link ges nd
hese
dimers
hen frm
e
r mer
hrugh ddi
in l disulfide link ges
Bren
sQ
s
Q: Hw d sirin nd e
h nl ffec

he g s
ric mucs l b rrier?
A:
hey
b
h bre k i
dwn nd llw H+ ins
 erde
he mucs ; in severe c ses, regi
ns f exsed mucs will be erded
hrugh
he muscul r mucs ,
he submucs ,
nd even
he muscul ris ex
ern (c n
hen le d
 bleed in

he eri
ne l c vi

y since
he cid will encun
er m ssive v scul
ure) Bren
sQs
Q: Wh
effec
des
he sym
he
ic NS nd smking h ve n
he bic rbn
e um?
A:
hey
urn i
ff resul
in ersin by cid Bren
sQs
Q: Describe
he 
hlgy ssci
ed wi
h Helicb c
er ylri. A: i
s gr m-neg

ive b c
erium
h
lives bene
h
he g s
ric mucs l b rrier nd binds

he
ic l l sm membr ne

he surf ce f mucs l cells; i
secre
es enzymes
h

disru
mucus frm
in nd
he bic rbn
e um nd
hus llws
he disru
i
n f
he g s
ric mucs l b rrier resul
s in
he frm
in f g s
ric ulcers. &nb
s;I
s
re
ed wi
h n
ibi
ics
Bren
sQs
Q: Wh
re sike 
en
i ls in
he gu
sm
h muscle? A: When
he membr ne de
l riz
in exceeds
hreshld level, n
her mre r id series f membr ne de
l riz
ins ccurs during
he l
e u h se f
he slw w ve. These re c lled
c
in 
en
i ls r sike burs
s;
hey re ssci
ed wi
h h sic cn
r c
ins
f
he muscle Bren
sQs
Q: Wh
s n
her n me fr slw w ves in
he gu
?
A: b sic elec
ric rhy
hm (BER)
Bren
sQs
Q: Hw des ce
ylchline ffec
gu
cn
r c
ile c
ivi
y?
A: enh nces (whi
le inhibi
ry gnis
s such s NE r NO c use hyerl riz
in nd
hus less ex
ci

inslw w ves s
ill cn
inue bu

hey d n
chieve
hreshld
 ini
i
e s
ike 
en
i ls nd
hus cn
r c
ins re less likely
 ccur) Bren
sQs
Q: Wh
re slw w ves? A: rhy
hmic scill
ins f
he membr ne 
en
i l f sm

h muscle cells;
hey re NOT ACTION POTENTIALS
heyre jus
simly scill
ing de
l riz
in nd rel riz
in f
he membr ne 
en
i l f
he sm
h muscle c
ells; if

he l
e u r
he e k f
he slw w ve
he membr ne 
en
i l is d
el rized ll
he w y

hreshld
hen APs ccur n
 f
he slw w ve
Bren
sQs
Q: Wh
ins re invlved in
he slw w ves?
A: C 2+ del rizes, K+ rel ri
zes
Bren
sQs
Q: Wh
3
hings c use
he membr ne 
en
i l f gu
sm
h muscle cells
 sci
ll
e clser

hreshld 
en
i l (ie frm -50mV
 -40mV)? "A: S
re
ch, ACh
, r  r sym
he
ic s
imul
in s
he membr ne 
en
i l re ches rxim
ely 40mV sike 
en
i ls begin
 ccur

he e ks f
he slw w ves nd
hese re
sul
in cn
r c
in. The sike frequency incre ses s
he membr ne 
en
i l ris
es fur
her un
il i
re ches bu
-20 mV, where
he membr ne rem ins cn
inuusl
y del rized. &nbs;A

his in
,
he sm
h muscle f
he GIT m y exhibi

n
ic r
her
h n rhy
hmic cn
r c
in<div><img src="" s
e-30030411333636.jg"" />
</div>" Bren
sQs
Q: Hw will sym
he
ic s
imul
in ffec

he gu
TMP? A: hyerl rizes i
b
u
-70mV
Bren
sQs
Q: Wh
h ens when
l rge blus f fd en
ers
he sm ll in
es
ine in
erms 
f membr ne 
en
i l? A:
he blus dis
ends
he gu
(s
re
ches i
s w lls) nd

his s
re
ching s
imul
es nerves in
he w ll f
he gu

 rele se NTs in
 sm

h muscle

he si
e f dis
en
in c using del riz
in

h
sec
in f m
usclewhen slw w ve  sses ver
his re f sensi
ized sm
h muscle sike 

en
i ls frm nd cn
r c
in resul
s. &nbs;The cn
r c
in mves rund nd l

ng
he gu
in
he crdin
ed m nner bec use
he muscle cells re elec
ric lly c
Bren
sQs
uled
hrugh g  junc
ins
Q: Cm re elec
ric l
hreshld
 cn
r c
ile
hreshld.
A: elec
ric l
h
reshld is
which
he fibers gener
e n AP where s cn
r c
ile
hreshld is

he level
which
he incre se in in
r cellul r C 2+ is sufficien

 gener
e
cn
r c
in; in
ensi
y f cn
r c
in crrel
es

he number f sikes
Bren
sQs
Q: Wh
mech nism c uses n incre se in in
r cellul r C 2+ c using gu
cn
r c
i
A: VG C 2+ ch nnels c n
hen c use C 2+ induced C 2+ rele se frm SR (r
n?

here c n be IP3 medi
ed even
s); when SR C 2+ s
res re dele
ed
he SR c n
sign l fr mre C 2+ en
ry

he l sm membr ne
Bren
sQs
Q: Wh
cells re resnsible fr rigin
ing slw w ves?
A: in
ers
i
i l
cells f c j l; cyclic del riz
ins nd rel riz
ins ccur sn
neusly i
n
he ICC nd sre d r idly
 dj cen
sm
h muscle vi g  junc
ins;
he in

ers
i
i l cells c n be cnsidered
he PACEMAKERS fr g s
rin
es
in l sm
h mu
scle
Bren
sQs
Q: True r f lse:
he cn
rl f gu
m
ili
y resides in b l nce be
ween myge
nic (ie slw w ves), neurn l (ie  r sym
he
ic), nd hrmn l f c
rs.
Tru
h Bren
sQs
Q: Wh
GI 
hlgies re ssci
ed wi
h decre sed numbers f ICCs? A: 
ie
n
s wi
h slw
r nsi
cns
i
ins (secific lly in clnm
ili
y is n
u
 
r) nd
he s
m ch f 
ien
s ffec
ed by di be
es melli
us Bren
sQs
Q: True r f lse:
he in
rinsic r
e/frequency f slw w ves is
he s me lng

he GI
r c
.
A: f lse; i
v ries frm 3-12 slw w ves er minu
e; e ch r
i
n f
he GI
r c
h s ch r c
eris
ic frequency; NOTE:
he ch r c
eris
ic frequ
ency f slw w ves is NOT influenced by neur l r hrmn l inu
, l
hugh neur
l c
ivi
y nd hrmn l c
ivi
y d mdule b
h
he rduc
in f APs nd
he s

reng
h f cn
r c
in Bren
sQs
Q: Which r
in f
he GI
r c
h s
he slwes
r
e f slw w ves?
A: s
m
ch (3 w ves er minu
e) Bren
sQs
Q: Which r
in f
he GI
r c
h s
he f s
es
r
e f slw w ves?
A: dude
num (12 w ves er minu
e)
Bren
sQs
Q: Wh
is g s
r resis?
A: fd si
s in
he s
m ch fr m ny hurs undig
es
ed; sner r l
er
he individu l ge
s n use
ed nd vmi
s; m kes i
h rder

 cn
rl bld sug r b/c yu never knwn when
he fd yu e
is ging
 be
bsrbed; G s
r resis m y ccur when
he v gus nerve is d m ged nd
he muscl
es f
he s
m ch nd in
es
ines d n
wrk nrm lly. &nbs;I
is frequen
ly du
e
 u
nmic neur
hy nd m y ccur in ele wi
h
ye 1 r
ye 2 di be
es
Bren
sQs
Q: Hw des hyerglycemi induce di be
ic neur
hy? "Drs l r
g ngli x
ns
h
re subjec
ed
 cu
e incre ses in bld glucse incre se
he mi
chnd
ri l l vi me
blic fissin, in n

em

 cle r excess glucse. Me
bli
c fissin is m rked by n incre se in Dr1 r
ein exressin. Dr1 lc lizes

mi
chndri
 medi
e incre sed me
blic fissin, bu
B x rem ins cy
l smi
c. Prlnged hyerglycemi c uses B x

r nslc
e
 mi
chndri , where i
c
-lc lizes wi
h Dr1 nd f cili

es 

ic fissin. B x i
self medi
es u

er mi
chndri l membr ne erme biliz
in, rele se f cy
chrme c in

he cy

l sm nd c
iv
in f c s ses
h
d m ge neurn l r
eins nd DNA. Tge
he
r,
hese Dr1/B x c
ins c use berr n
fissin f mi
chndri in
 sm ll nnf
unc
in l s
ruc
ures
h
clum
ge
her. Lss f func
in l mi
chndri in
he
xns nd induc
in f lc l 

ic rgr m d m ges
he xn s
ruc
ure nd
ul
im
ely der nges func
in.<div><img src="" s
e-31752693219332.jg"" /></div
>"
Bren
sQs
Q: Wh
re sme key in
s
 knw bu
di be
ic neur
hy? A: DN resul
s fr
m hyerglycemi -induced d m ge

he eriher l nervus sys
em; hyerglycemi
incre ses
he rduc
in nd s
biliz
in f re c
ive xygen secies (ROS)
h

d m ge eriher l neurns ( r
icul rly

he level f
he mi
chndri ); ROS
migh
cmrmise
he in
egri
y f
he mi
 genme nd
hereby cn
ribu
e

he
mi
 dysfunc
in underlying DN;
her ies imed
reserving mi
 s
ruc
ure nd
func
in culd be benefici l
re
men
s fr DN Bren
sQs

Q: Is
he GI
r c
cmsed f single uni
r mul
iuni
sm
h muscle? A: singl

e uni
sm
h muscle, wi
h grus f cells elec
ric lly culed vi g  junc
in
s
Bren
sQs
Q: Wh
cells re
he GI  cem kers?
A: In
ers
i
i l cells f C j l Bren
sQ
s
Q: Wh
re
nic cn
r c
ins wi
hin
he gu
? A:
hey m in
in
cns
n
leve
l f cn
r c
in r
ne wi
hu
regul r erids f rel x
in;
h
is,
hey r
e sus
ined fr minu
es r hurs nd ccur in
he shinc
ers nd s
m ch
Bren
sQs
Q: Des sm
h muscle cn
r c
in deend un
he mun
f C 2+ en
ering
he ce
ll?
A: Yes, jus
like
he gr ded ne we see in c rdi c muscle
Bren
sQ
s
Q: Wh
re h sic cn
r c
ins in
he gu
?
A: eridic cn
r c
ins fllwe
d by rel x
in;
hey re  r
f
he cn
r c
in/rel x
in cycles
h
underli
e GI m
ili
y Bren
sQs
Q: Des gu
sm
h muscle cn
in
he
rnin cmlex? A: N, ins
e d C 2+ bind
s c lmdulin which c
iv
es
he enzyme MLCK which hshryl
es
he ligh
ch i
n f mysin in rder fr c
in nd mysin
 in
er c
nd begin cn
r c
in
Bren
sQs
Q: Thrugh
he s
m ch
here re inv gin
ins f
he ei
helium in

he l min
rri . &nbs;Wh
re
hese inv gin
ins? A: g s
ric i
s ( bu
3 millin
)
Bren
sQs
Q: Ch r c
erize
he g s
ric i
s in
he c rdi c regin f
he s
m ch. A: rel

ively sh llw wi
h sever l ciled c rdi c gl nds

ched
 e ch c rdi c g s
ri
c i
;
he c rdi c gl nds re ure mucus gl nds w/
r ce  rie
l cells;
hey 
rduce unique c rdi c mucus s well s l c
ferrin nd lyszyme
Bren
sQ
s
Q: Ch r c
erize
he g s
ric i
s in
he ylric regin f
he s
m ch. A: dee
g s
ric i
s w/ sever l ciled gl nds

ched
 e ch g s
ric i
;
hese gl nds
re ure mucus gl nds (like c rdi c h s)
h
rduce unique ylric mucus
lng w/ l c
ferrin nd lyszyme
Bren
sQs
Q: Ch r c
erize
he g s
ric i
s in
he bdy f
he s
m ch.
A:
he fundic gl
nds re
ubul r nd s
r igh
nd cn
in sever l cell
yes ( rie
l, chief, n
eck mucus, s
em cells) Bren
sQs
Q: Wh
s n
her n me fr  rie
l cells?
A: xyn
ic cells
Bren
sQ
s
Q: Hw d  rie
l cells s
in? Why is
his?
A: s
in red due

l rge numb
er f mi
chndri
Bren
sQs
Q: Wh
d  rie
l cells secre
e?
A: HCl nd g s
ric in
rinsic f c
r (IF)
Bren
sQs
Q: Wh
re 
her n mes fr chief cells?
A: e
ic r zymgenic cells
Bren
sQs
Q: Hw d chief cells s
in? Why is
his?
A: s
in blue bec use f enrmu
s mun
f RER Bren
sQs
Q: Wh
d chief cells secre
e? A: esingen nd g s
ric li se
Bren
sQ
s
Q: Is
here ne-w y r
w-w y migr
in f s
em cell rduc
s in
he s
m ch?
A:
w-w y; s
em cells si


he neck nd c n differen
i
e in
 ny cell f
h
e fundic gl nd (ie  rie
l, chief, neck, en
erendcrine) r surf ce mucus cel
ls;
hey c n
hen migr
e ei
her u
w rds
he lumen r dwn in

he gl nd
Bren
sQs
Q: Wh
re G cells (en
erendcrine cells)  r
icul rly fund? Wh
d
hey sec
re
e? A: in
he ylrus; g s
rin
Bren
sQs
Q: Wh
re
he 4
yes f mucus fund in
he s
m ch? A: c rdi c mucus, neck c
ell mucus, ylric mucus, nd mucus frm surf ce mucus cells
Bren
sQs
Q: Wh
s
imul
es chief cells? A: g s
rin (frm G cells), ACh (frm  r sym
h
e
ic nd ENS), H+ ins Bren
sQs
Q: G s
ric li se is secre
ed by _____ cells. A: chief; i
bre ks dwn
riglyc
erides in
 2-mnglycerides nd FFAs Bren
sQs
Q: Hw is g s
ric li se differen
frm s liv ry li se?
A: g s
ric li s

e is c
ive
lw H (1-2) where s s liv ry li se becmes in c
ive

hese l

w Hs Bren
sQs
Q: Why d nen
es rely he vily n g s
ric li se nd s liv ry li se? A: bec u
se
heir excrine  ncre s is n
fully func
in

ime f bir
h
Bren
sQ
s
Q: Tubulvesicles huse
he H+/K+ ATP se f  rie
l cells during
he in c
ive s


e. &nbs;Wh
h ens when
he  rie
l cell is s
imul
ed? A:
he
ubulves
icles fuse wi
h
he in
r cellul r c n liculi m king i
very l rge wi
h seud micr
villi;
his huge membr ne surf ce nw cn
ins
he H+/K+ ATP se um n
he sur
f ce
h
will c
ively um H+ in

he s
m ch
Bren
sQs
Q: Where is
he IF/B12 cmlex bsrbed?
A: ileum f sm ll in
es
ine
Bren
sQs
Q: Hw d neck mucus cells e r his
lgic lly?
A: whi
e nd fr
hy cell
s; n
necess rily fund nly in neck regin
Bren
sQs
Q: Wh
is
he ylric grind? A: The ylric grind is series f werful er
is
l
ic w ves
r veling frm
he  cem ker regin f
he s
m ch (n
ch f
he
gre
er curv
ure)

he ylrus. I
ushes chyme u g ins

he ylric shinc

er, c using sm ller fd  r
icles (1 mm)
  ss in

he dudenum (if ermi


ed by
he ylric shinc
er) nd l rger fd  r
icles
 bunce b ck in

he s

m ch (re
rulsin) fr fur
her diges
in nd n
her rund f
he ylric gri
nd.
Bren
sQs
Q: Wh
l yer f
he s
m ch gives is resnsible fr
he ylric grind?
A: muscul ris ex
ern
Bren
sQs
Q: Lis

he 5 s
m ch mvemen
s.
A: mucs l squeeze, mucs l flu

er, rec
e
ive rel x
in, ylric grind, MMC Bren
sQs
Q: Wh
s
he ei
helium f
he en
ire s
m ch? A: hmgenus simle clumn r e
i
helium
hrughu

he en
ire s
m ch Bren
sQs
Q: Wh
is
he
urnver f surf ce mucus cells? A: 4-7 d ys
Bren
sQs
Q: Surf ce mucus cells secre
e mucus
h
is m de frm
he highly glycsyl
ed 
r
ein ______. &nbs;Wh
bnds cnnec

he dimers nd
e
r mers f mucin?
A: mucin; cnnec
ed vi disulfide bnds Bren
sQs
Q: Wh
ATP se is
he
rge
f PPIs? A: H+/K+ ATP se Bren
sQs
Q: Wh

ye f r
e se is esin?
A: endr
e se Bren
sQs
Q: Wh
s
he m in func
in f MMC?
A: swees u
residue nd b c
eri every
~90 min;  r
f GALT Bren
sQs
Q: Which gl nds h ve
he highes
cncen
r
in f en
erendcrine cells?
A: ylric gl nds
Bren
sQs
Q: Wh
re
he cmnen
s f GALT?
A: lw H, l c
ferrin/lyszyme, sIgA (f
rm s liv ), MMC, diffuse lymhcy
es, g s
ric mucs l b rrier Bren
sQs
Q: Wh
lexus medi
es
he mucs l squeeze?
A: Meissners lexus
Bren
sQ
s
Q: Wh
 r
s f
he GI
r c
exerience MMC? A: n
ch f gre
er curv
ure

Bren
sQs
 s

he ilecec l v lve
Q: Wh
lexus medi
es
he mucs l flu

er?
A: Meissners lexus
Bren
sQ
s
Q: Wh
s
he urse f
he mucs l flu

er? A: mix
he 4
yes f mucus in

he s
m ch
Bren
sQs
Q: Wh
s
he urse f
he mucs l squeeze? A: ejec
gl nd cn
en
s in
 s

m ch s
h
we dn
need myei
heli l cells Bren
sQs
Q: N me 3
hings
h
c n s
imul
e  rie
l cells
 secre
e H+.
A: his

mine (vi H2 rece
r), g s
rin, ACh (M3 rece
r)
Bren
sQs
Q: N me 7 c uses f
he bre kdwn f g s
ric mucs l b rrier. A: s
m ch r
e
ly
ic enzymes
h
degr de mucin, chem
her y, sirin/NSAIDs, lchl, sym

he
ic s
imul
in, smking, H. ylri Bren
sQs
Q: Describe
he rcess f sw llwing. A:
ngue frces
blus f fd b ck

w rd
he h rynx;
he sf
 l
e is ulled uw rd
hus cre
ing n rrw  ss g
ew y fr fd
 mve in

he h rynx;
he eigl

is mves
 cver
he enin
g f
he l rynx (reven
fd frm en
ering
he
r che );
he uer esh ge l s
hinc
er rel xes llwing fd
  ss frm
he h rynx

he esh gus; eri
s
l
ic w ve f cn
r c
in is ini
i
ed in
he h rynx nd rels fd
hrugh

Bren
sQs

he en shinc
er
Q: Cn
r s
rim ry versus secnd ry eris
lsis in
he esh gus.
A: rim
ry rels fd dwn
he esh gus; if
he rim ry eris
l
ic w ve des n
cle
r
he esh gus f fd
hen
secnd ry eris
l
ic w ve is ini
i
ed by
he c
Bren
sQs
n
inued dis
en
in f
he esh gus
Q: Wh

ye f eris
lsis is bserved wi
h reflux f s
m ch cn
en
? A: secn
d ry eris
lsis
Bren
sQs
Q: Wh

yes f muscle re fund in
he esh gus?
A: s
ri
ed muscle is
h
e uer 1/3 r
in, sm
h muscle is 2/3 lwer r
in Bren
sQs
Q: Wh
nucleus rduces
he eris
lsis seen in
he s
ri
ed muscle r
in f

he esh gus? A: nucleus mbiguus; The nucleus mbiguus gener
es sequen
i l
c
iv
in f v g l m
r neurns, which, in
urn rduce successive cn
r c
i
ns in
he cervic l esh gus in rximdis
l direc
in; in shr
: v g l m
r
nerves cn
rl eris
lsis in
he uer 1/3 f
he esh gus Bren
sQs
Q: Wh
rduces eris
lsis in
he lwer 2/3 f
he esh gus? A: ENS;
he v gu
s versees bu
isn
necess ry
Bren
sQs
Q: Wh
differen
nuclei c n
he v gus be grued in
? A: nucleus mbiguus (m

r nucleus), drs l nucleus (secre
m
r nucleus), sli
ry nucleus (sensry nu
cleus); b

m line: v gus c n d m ny differen

hings Bren
sQs
Q: True r f lse:
he fundus h s rhy
hmic l elec
ric l c
ivi
y.
A: f lse
, i
h s n slw w ves; rec ll
h
fundic rel x
in (rece
ive rel x
in) is
cn
rlled by
he v gus Bren
sQs
Q: Discuss
he rcess f fd in
he s
m ch. A: The em
ying f fd frm
he
s
m ch is regul
ed by neur l nd hrmn l mech nisms. The rriv l f fd in

he rxim l s
m ch (fundus nd crus) c uses n d 
ive rel x
in medi
ed
by neurn l rele se f v s c
ive in
es
in l lye
ide nd ni
ric xide. The r
el x
in ccmmd
es
he incre sing g s
ric vlume wi
hu
n incre se in
he
ressure gr dien
be
ween
he rxim l nd dis
l s
m ch. The resence f fd
in
he s
m ch ls induces incre sed n
r l eris
l
ic c
ivi
y (grinding) wi

h rulsin nd re
rulsin f fd  r
icles. The cmbined mech nic l nd enz
ym
ic c
ivi
y gr du lly decre se
he size f fd  r
icles un
il
hey re suf
ficien
ly sm ll (1-2 mm)
 llw  ss ge in

he dudenum
Bren
sQs
Q: Wh
is me
clr mides ffec
n
he GI
r c
?
A: Me
clr mide incre
ses eris
lsis f
he jejunum nd dudenum, incre ses
ne nd mli
ude f g s

ric cn
r c
ins, nd rel xes
he ylric shinc
er nd duden l bulb. These g
s
rrkine
ic effec
s m ke me
clr mide useful in
he
re
men
f g s
ric s

sis (e.g. f
er g s
ric surgery r di be
ic g s
r resis), s n id in g s
r
in
es
in l r digr hic s
udies by cceler
ing
r nsi

hrugh
he g s
rin
es

in l sys
em in b rium s
udies, nd s n id in difficul
in
ub
in f
he sm l
l in
es
ine
Bren
sQs
Q: Why des n incre se in cid cn
en
f me l decre se em
ying r
e?
A: bec use
he cid h s
 be neu
r lized by  ncre
ic/duden l juices&nbs;
Bren
sQs
Q: Describe
he 
hhysilgy f di be
ic g s
r
hy.
A: The m jr f c

r invlved in
he 
hgenesis f
he v rius m nifes

ins f di be
ic g s
r
en
er
hy is u
nmic neur
hy; hwever, hyerglycemi m y ls influence
g s
rin
es
in l m
r func
in. In nrm l individu ls, hyerglycemi h s been s
hwn
 decre se
he r
e f g s
ric em
ying, suress
he g s
ric cmnen
f

he migr
ing m
r cmlex, inhibi
n
r l m
ili
y, nd induce g s
ric dysrhy

hmi s nd
chyg s
ri . Ke
 cidsis m y ls be ssci
ed wi
h rfund ile
us, which includes g s
r resis. The inhibi
ry effec
f hyerglycemi n g s

ric em
ying is medi
ed,
le s
in  r
, vi im ired v g l c
ivi
y. The bn
rm li
ies include im ired fundic rel x
in (
hus incre sed g s
ric ressure),
g s
ric dysrhy
hmi s, dil
ed n
rum, n
r l hym
ili
y nd g s
r resis. De
cre sed v g l
ne m y be resen
s well s viscer l hysensi
ivi
y Bren
sQ
s
Q: Exl in why g s
rec
my (usu lly n
rum r  r
f g s
ric bdy) c n c use du
ming syndrme. A: The dis
l n
rum nd
he ylric v lve nrm lly serve s
he
g
ekeeers fr rderly rele se f
ri
ur
ed  r
icles f fd in

he in
es

ine
 id in efficien
diges
in nd bsr
in. When
his func
in is l
ered

by n n
rec
my, l rge chunks f rly fr gmen
ed fd m y sill r idly dwn

he gu
, gener
ing ex gger
ed inhibi
ry feedb ck nd
riggering sym
ms f

he duming syndrme. The duming syndrme is c used by r id em
ying f g s
ric
cn
en
s wi
h sm
ic fluid shif
s, bdmin l dis
en
in nd rele se f v s c

ive subs
nces. The in
es
in l dis
en
in rduces
he  in, n use nd vmi
ing
, where s
he v sm
r nd c rdiv scul r sym
ms re due

he rele se f v
sdil
ing subs
nces such s ser
nin nd br dykinin. Bren
sQs
Q: Wh
cn
rls
he rxim l s
m chs rece
ive rel x
in? A: v gus nerve
Bren
sQs
Q: Wh
s
he urse f segmen

in in
he sm ll in
es
ine? "A:
 mix nd c
hurn diges
nd exse i

  ncre
ic enzymes/secre
ins<div><img src="" s
e
-43538083479556.jg"" /></div>" Bren
sQs
Q: N me sme m
r 

erns bserved in
he cln.
A: segmen

in/mixing (
ssci
ed wi
h h us
r - Mixing mvemen
s re circul r segmen
l cn
r c
ins s
imul
neus wi
h lngi
udin l muscle cn
r c
in; simil r

he mixing mvemen

s in
he sm ll in
es
ine), m ss mvemen
s/rulsin (ccur nly
few
imes
d
y - A ring f cns
ric
in e rs in n re f
he cln which h s been dis
e
nded by diges
in
he
r nsverse r descending cln; Then, 20 r mre cm f c
ln cn
r c
s lms
s
uni
dis
l

he ring f cn
r c
in. &nbs;As
he d
is
l segmen
flds u like n ccrdin,
he chyme is mved n lw rd frm
he 
Bren
sQs
in
f cns
ric
in&nbs;
Q: Wh
re
he s
es f defec
in?
A: filling f
he rec
um, reflex cn
r c

in f rec
um nd rel x
in f in
ern l n l shinc
er, vlun
ry rel x
in 
f ex
ern l shinc
er; During i
s  ss ge
hrugh
he cln, fec l m
eri l becm
es dehydr
ed nd frmed such
h

he s
l
h
re ches
he rec
um is semisli
d
 slid. The rec
um i
self exhibi
s highly cmli n
w ll
h
llws i


serve s reservir fr
he fec l m
eri l un
il i
c n be cnvenien
ly exell
ed. The in
ern l n l shinc
er rvides sufficien

ne
 reven
cciden
l l
ss f fec l m
eri l, where s
he ex
ern l shinc
er muscles vlun
rily cn
r
c
if unw n
ed lss f feces is imending
Bren
sQs
Q: Wh
sys
ems re invlved in
he defec
in reflex? A: requires cncer
ed ef
fr
f ENS ( nd sm
h muscle) nd vlun
ry m
r neurns. &nbs; The in
ern l
n l shinc
er is sm
h muscle (we k shinc
er) nd
he ex
ern l shinc
er is
s
ri
ed muscle (s
rng shinc
er under vlun
ry cn
rl).
Bren
sQs
Q: Wh
s
he 
hlgy f Hirschrungs dise se?
A:
heres n bwel mvemen
in
h
e firs
48 hurs f life; gr du l m rked swelling f
he bdmen, gr du l nse

f vmi
ing, fever; 4 bys ffec
ed fr every girl; Eigh
y ercen
f children w
i
h Hirschsrungs dise se shw sym
ms in
he firs
6 weeks f life; cls
my
crrec
s Hirschrings; frm Wikiedi = Hirschsrungs dise se (HSCR), r cngen
i
l g nglinic meg cln is
serius medic l rblem where
he en
eric nervu
s sys
em is missing frm
he end f
he bwel. The en
eric nervus sys
em is c
mlex ne
wrk f neurns (i.e., g nglin cells) nd gli
h
cn
rls ms
s
ec
s f in
es
in l func
in. When
he ENS is bsen
,
he regin f
he bwel
h

is g nglinic f ils
 rel x c using blck ge in
he bwel[1]. Pele wi
h
Hirschsrung dise se lw ys h ve g nglinsis (l ck f neurns)

he end f

he bwel, bu

he leng
h f bwel
h
is g nglinic v ries; En
ercli
is ffec

s r
in f Hirschrungs 
ien
s; cngeni
l meg cln ch r c
erized by l ck
f g nglin cells/en
eric nervus lexuses (Auerb chs nd Meissners); due
 f il
ure f neur l cres
cell migr
in
Bren
sQs
Q: Wh
mu

in is ssci
ed wi
h Hirschrungs dise se?
A: dele
in in

he lng rm f chrmsme 10 is ssci
ed wi
h Hirschsrungs dise se;
he RET
r
-ncgene e rs
 l y m jr rle in
he develmen
f
he in
es
in l
nervus sys
em nd i
s dele
in is ls fund in 
ien
s wi
h
he mul
ile end
Bren
sQs
crine nel si
Q: Wh
s unique bu

he u
nmic innerv
in f
he s liv ry gl nds?
A: s liv
Bren
sQ
rduc
in is s
imul
ed by b
h  r sym
he
ic nd sym
he
ic
s
Q: Wh
s
he s
ruc
ure f
he s liv ry gl nd? A: e ch h s
he e r nce f b
unch f gr es where single gr e crresnds

single cinus;
he cinus is

he blind end f br nching duc
sys
em nd is lined wi
h cin r cells which 

rduce
he ini
i l s liv when
hen  sses
hrugh n in
erc l
ed duc
nd
hen

hrugh s
ri
ed duc

h
is lined wi
h duc
l cells;
he duc
l cells mdif
y
he ini
i l s liv
 rduce
fin l s liv by l
ering
he cncen
r
ins f
v rius elec
rly
es; myei
heli l cells re resen
in
he cini nd in
erc l

ed duc
s nd cn
r c

 ejec
s liv in

he mu
h Bren
sQs
Q: True r f lse:
he s liv ry gl nds h ve n unusu lly high bld flw.
A:
rue Bren
sQs
Q: Discuss
he frm
in f s liv .
A: When cm red
 l sm , s liv is hy

nic, h s higher K+ nd HCO3, nd h s lwer N + nd Cl-. &nbs;S liv ,
heref
simle ul
r fil
r
in f l sm bu
is frmed in
w-s
e rces
re is n

s. &nbs;The firs
s
e is
he frm
in f n is
nic l sm -like slu
ins by

he cin r cells nd
he secnd s
e is mdific
in f
his l sm like slu
i
n by
he duc
l cells. &nbs;Over ll,
here is bsr
in f N nd Cl nd secr
e
in f K+ nd HCO3. &nbs;Bec use mre N Cl is bsrbed
h n KHCO3 is secre
ed

here is ne
bsr
in f slu
e. &nbs;Bec use duc
l cells re w
er-imerme
ble w
er is n
bsrbed lng wi
h
he slu
e m king
he fin l s liv hy
n
ic
Bren
sQs
Q: Aside frm H20 nd elec
rly
es, wh
else d cin r cells secre
e? A: lh
- myl se, lingu l li se, mucin, IgA
Bren
sQs
Q: A

he highes
flw r
es,
he fin l s liv ms
clsely resembles _____.
A: l sm ;
high flw r
es
he duc
l cells h ve less
ime
 mdify
he s li
v
Bren
sQs
Q: ________ is required fr
he bsr
in f vi
min B12 in
he _____ s i
is

he nly essen
i l cmnen
f g s
ric juice. A: In
rinsic f c
r; ileum
Bren
sQs
Q: Hw d NSAIDs ffec

he g s
ric mucs l b rrier?
A: NSAIDs c use du l
ss ul
n
he GI
r c
:
he cidic mlecules direc
ly irri

e
he g s
ric mucs
, nd inhibi
in f COX-1 nd COX-2 reduces
he levels f r
ec
ive rs
gl n
dins. Inhibi
in f rs
gl ndin syn
hesis in
he GI
r c
c uses incre sed g s

ric cid secre
in, diminished bic rbn
e secre
in, diminished mucus secre
i
n
Bren
sQs
Q: Is H. Pylri gr m (-) r gr m (+) b c
eri ? A: gr m (-)
Bren
sQs
Q: Hw des H. ylri c use g s
ric ulcers?
A: i
clnizes
he g s
ric mucu
s (f
en in
he n
rum),

ches
 g s
ric ei
heli l cells nd rele ses cy


xins
h
bre k dwn
he r
ec
ive mucus b rrier nd
he underlying cells; H.
ylri is llwed
 clnize bec use i
cn
ins
he enzyme ure s which cnver

s ure
 NH3 wi
h lk linizes
he lc l envirnmen
nd
hus ermi
s
he b c
er
i
 survive Bren
sQs
Q: Wh
c
ive
r nsr
er des H. ylri inhibi

he
r nscri
in f? A: H+/K+
ATP se Bren
sQs
Q: True r f lse:
here exis
s fenes
r
ed mucs l c ill ries
h
rvide HCO3
fr
he mucs l b rrier.
A:
rue Bren
sQs
Q: Wh
s n
her n me fr vi
min B12? A: cb l min
Bren
sQs
Q: Describe hw vi
min B12 is bsrbed wi
h
he hel f IF.
A: In
rinsic f c

r is glycr
ein secre
ed by  rie
l (hum ns) &nbs;cells f
he g s
ric m
ucs . In hum ns, i
h s n imr
n
rle in
he bsr
in f vi
min B12 (cb
l min) in
he in
es
ine, nd f ilure
 rduce r u
ilize in
rinsic f c
r res
ul
s &nbs;in
he cndi
in ernicius nemi . Die
ry vi
min B12 is rele sed f
rm inges
ed r
eins in
he s
m ch
hrugh
he c
in f esin nd cid. I
i
s r idly bund by h 
crrin (secre
ed in
he s liv ), ne f
w vi
min B12binding r
eins
h
re resen
in g s
ric juice (
he 
her is
he in
rinsic f
c
r);
cid H, h 
crrin &nbs;h s gre
er ffini
y fr
he vi
min
h
n des in
rinsic f c
r. In
he sm ll in
es
ine,  ncre
ic r
e ses diges

he
binding r
eins, rele sing vi
min B12 which
hen becmes bund
 in
rinsic f
c
r. Fin lly,
here re rece
rs fr in
rinsic f c
r n
he ile l mucs whi
ch bind
he cmlex, llwing vi
min B12
 be bsrbed in
 r
l bld. In
ll m mm ls, vi
min B12 is necess ry fr m
ur
in f ery
hrcy
es, nd defic
iency f
his vi
min le ds
 develmen
f nemi . Since efficien
bsr
in
f vi
min B12 in hum ns deends n in
rinsic f c
r, dise ses which decre se

he secre
in f in
rinsic f c
r (e.g.
rhic g s
ri
is), in
erfere wi
h cle v

ge f
he binding r
eins (e.g. ncre
ic excrine insufficiency) r decre se

binding nd bsr
in f
he in
rinsic f c
r-vi
min B12 cmlex (e.g. ile l d
ise se r resec
in) c n resul
in
his
ye f nemi .&nbs; Bren
sQs
Vlumes ssci
ed wi
h
he s
m ch:<div><br /></div><div>1. Hw much fd vlum
e c n
he s
m ch ccmd
e during
he ylric grind?</div><div><br /></div><di
v>2. Wh
is
he duden l c  ci
y er e ch ylric grind?</div>
1. One l
i
er<div><br /></div><div>2. 5-15 mL</div>
S
m ch
"Ann

e
his Junq im ge:<div><br /></div><div><img src="" s
e-5347234284060.j
g"" /></div>" "<img src="" s
e-5510443041308.jg"" /><div><br /></div><div>Wh
ere...</div><div>M = <b>mucs . </b>Simle clumn r nnker
inized ei
helium, b
s l l min (invisible), l min rri (invisible), muscul ris mucs ). Tubul r
gl nds resen
.</div><div><br /></div><div>SM = <b>submucs </b> (lse cnnec

ive
issue wi
h bld vessels (V) nd lymh
ics)</div><div><br /></div><div>ME
= <b>muscul ris ex
ern </b>&nbs;(sm
h muscle).</div><div><br /></div><div>S =
<b>sers </b>&nbs;wi
h mes
heli l cells.</div>"
S
m ch
"N me nd m rk
he 3 his
lgic l regins f
he s
m ch.<div><br /></div><div><
img src="" s
e-7232724927004.jg"" /></div>" "<img src="" s
e-6412386173468.
jg"" /><div><br /></div><div><fn
clr=""#ff112c"">1. C rdi c regin</fn
></
div><div><fn
clr=""#1bff10"">2 nd 3. Fundic regin</fn
></div><div><fn
c
lr=""#2115ff"">4 nd 5. Pylric regin</fn
></div>" S
m ch
1. Give ll f
he cmnen
s f
he g s
ric mucs l b rrier nd where e ch cme
s frm.<div><br /></div><div>2. Give
he 4
hings
h
bre k dwn
he g s
ric mu
cs l b rrier.</div>
<div>1. I. <b>4
yes f mucus</b> in <b>equ l rr
i
n</b> nd <b>mixed by mucs l flu

er </b>frm...</div><div> . Surf ce mucus cel
ls</div><div>b. C rdi c gl nds</div><div>c. Pylric gl nds</div><div>d. Neck muc
us cells f
he fundic gl nds</div><div><br /></div><div>II. <b>Bic rbn
e um
</b> f
he surf ce mucus cells</div><div><br /></div>2. . Alchl<div>b. Asi
rin</div><div>c. Sym
he
ic nervus sys
em (s
ress nd fe r)</div><div>d. <i>H.
ylri</i>&nbs;infec
in (si
s n ic l l sm membr ne nd disru
s mucus f
rm
in nd
he bic rb um)</div><div><br /></div>
S
m ch
T lk
hrugh
he s
ruc
ure f mucin.
Mucins re<b> highly glycsyl
ed r
ei
ns</b>. 2 <b>mnmers</b> frm <b>dimer</b> vi <b>disulfide link ges</b>. Tw
dimers frm <b>
e
r mer</b>
hrugh mre disulfide link ges. S
m ch
Gl nds:<div>1. Hw m ny g s
ric i
s re
here in
he s
m ch?</div><div>2. Hw
m ny gl nds em
y in

hem?</div>
1. 3 millin i
s<div>2. 15 millin gl n
ds</div>
S
m ch
"1. Ann

e
his ic f c rdi c gl nds.<div><br /></div><div><img src="" s
e-1
0419590660473.jg"" /></div><div><br /></div><div>2. Wh
cell
yes re resen

in c rdi c gl nds?</div><div><br /></div><div>3. Wh
re
he secre
in rduc

s f
his gl nd?</div>" "1.&nbs;<div><img src="" s
e-10595684319609.jg"" /></
div><div><br /></div><div>2. . C rdi c mucus cells</div><div>b.
r ce en
erend
crine nd  rie
l cells (highly esinhilic--gre
fr IDing gl nd
ye)</div
><div>c. s
em cells

he i
/gl nd in
erf ce</div><div><br /></div><div>3. C r
di c mucus, l c
ferrin, lyszyme.</div>"
S
m ch
"Ann

e
hese ics f ylric gl nds.<div><br /></div><div><img src="" s
e-10
728828305949.jg"" /></div><div><br /></div><div><img src="" s
e-11768210391580
.jg"" /></div><div><br /></div><div>2. Give ll
he cell
yes in ylric gl nd
s.</div><div><br /></div><div>3. Give ll
he secre
in rduc
s f ylric gl n
ds.</div>"
"1.<div><br /></div><div><img src="" s
e-11003706212893.jg"" /
></div><div><br /></div><div><img src="" s
e-11944304050716.jg"" /></div><div>
Where...</div><div>P = dee g s
ric i
s</div><div>G = shr
ciled ylric gl n
ds in
he l min rri (LP)</div><div><br /></div><div>2. . Pylric mucus cel
ls</div><div>b.
r ce en
erendcrine G cell</div><div>c. s
em cells

he i
/
gl nd in
erf ce</div><div><br /></div><div>3. Pylric mucus, l c
ferrin, lyszy
me</div>"
S
m ch
Ac
in 
en
i ls (sike burs
s) re ssci
ed wi
h _____ cn
r c
ins f sm

h muscle
h sic Gu
M
ili
yI
Wh
is required fr sike 
en
i l
 be gener
ed? Hw d exci

ry nd inhi
bi
r gen
s ffec

he gener
in f sike 
en
i ls? Threshld mus
be re che
d in rder
 rduce c
in 
en
i ls (sike 
en
i ls). Exci

ry gen
s (e

x: Ach) incre se
he erme bili
y f
he membr ne ch nnels
 ins where s inhib
i
ry gen
s (ex: NE nd NO) hyerl rize
he membr ne Gu
M
ili
yI
De
ermin n
s f membr ne exci
bili
y include...
neur l inu
, mech nic l
influence, humr l subs
nces (drugs, hrmnes, r 
her circul
ing subs
nces
)
Gu
M
ili
yI
Wh
re slw w ves in sm
h muscle? They re rhy
hmic scill
ins f
he me
mbr ne 
en
i l f sm
h muscle cells. NOT neces rily c
in 
en
i ls
Gu
M
ili
yI
Wh

ye f K+ ch nnels c use
he rel riz
in f
he slw w ves?
C lciumdeenden

ssium ch nnels (ened by high c lcium levels)
Gu
M
ili
yI
Wh

ye f c lcium is c using exci

in in sm
h muscle (ex
r cellul r r in
Gu
M
ili
yI

r cellul r)? B
h
Which
hree
hings c use
he membr ne 
en
i l
 rise n sm
h muscle,
hus i
ncre sing
he likelihd f c
in 
en
i ls being gener
ed? S
re
ch, Ach, r
Gu
M
ili
yI
 r sym
he
ic s
imul
in
When d c
in 
en
i ls ccur during
he slw w ves? (Thrughu

he cycle, n
ly

he e ks, e
c.) "Ac
in 
en
i ls nly ccur <fn
clr=""#FF0000"">


he e ks</fn
>,
his is why i
is <fn
clr=""#FF0000"">h sic (rhy
hmic)
</fn
> cn
r c
in"
Gu
M
ili
yI
Wh
h ens

he c
in 
en
i ls s
he membr ne 
en
i l rises even highe
r? Wh
h ens if
he membr ne 
en
i l cn
inues
 becme mre si
ive?
"The sike frequency incre ses s
he membr ne 
en
i l rises fur
her un
il i

rem ins cn
inuusly del rized. A

his in
,
he sm
h muscle f
he GIT m
y exhibi
<fn
clr=""#FF0000"">
nic r
her
h n rhy
hmic cn
r c
in</fn
>"
Gu
M
ili
yI
"<div>Fundic gl nds:</div><div><br /></div><div>1. Ann

e e ch f
hese ics.<
/div><img src="" s
e-13679470838302.jg"" /><div><br /></div><div><img src=""
s
e-13967233647132.jg"" /></div><div><br /></div><div><img src="" s
e-14130442
404380.jg"" /></div><div><br /></div><div>2. Lis

he 5 cell
yes
h
re re
sen
in fundic gl nds. Give
he lc
in f e ch wi
hin
he gl nd.</div>"
"1.<div><img src="" s
e-13842679595550.jg"" /><div><u>Neck f
he fundic gl nd
</u></div><div><img src="" s
e-14147622273564.jg"" /></div><div>Where...</div>
<div>P =  rie
l cell</div><div>MN = neck mucus cell</div><div><br /></div><div
><u>B se f
he fundic gl nd</u></div><div><img src="" s
e-14160507175452.jg""
/></div></div><div>Where...</div><div>C = chief cell</div><div>MM = muscul ris
mucs </div><div><br /></div><div>2. These re rdered lng where
heyre fund
in
he gl nd frm uer
 lwer.&nbs;</div><div><div> .&nbs;<b>S
em</b>&nbs
;cells: si


he neck,

he i
/gl nd junc
in.</div><div></div></div><div>b
. <b>P rie
l</b> cells:
hrughu

he gl nd, mre fund in
he uer h lf. In

ensely esinhilic.</div><div>c. <b>Neck mucus</b>&nbs;cells: MISNOMER--
hese
re fund
hrughu

he gl nd.</div><div>d.&nbs;<b>Chief</b>&nbs;cells: Lwer
h lf f
he gl nd. In
ensely b shilic.</div><div>e. <b>En
erendcrine </b>ce
llls:

he b se f
he gl nd.</div>" S
m ch
"<fn
clr=""#FF0000"">____</fn
> nd <fn
clr=""#FF0000"">____</fn
> f
sike 
en
i ls re ffec
ed by neur
r nsmi

ers nd hrmnes"
"<fn
c
lr=""#FF0000"">Aer nce</fn
>&nbs; nd&nbs;<fn
clr=""#FF0000"">frequenc
y</fn
>&nbs;f sike 
en
i ls re ffec
ed by neur
r nsmi

ers nd hrmnes
"
Gu
M
ili
yI
Wh
c n hyerl rize sm
h muscle membr ne 
en
i l?
NE nd sym
he

ics
Gu
M
ili
yI
Wh
is
he difference be
ween cn
r c
ile
hreshld nd elec
ric l
hreshld?
"Cn
r c
ile
hreshld is
he level
which
he incre se in in
r cellul r C is
sufficien

 gener
e cn
r c
in (bu
n
c
in 
en
i ls ye
)<div>Elec
r
ic l
hreshld is
he level
which
he fibers gener
e n c
in 
en
i l</di
v><div><img src="" s
e-10565619548164.jg"" /></div>" Gu
M
ili
yI
"M ssive del riz
in c n
urn
he <fn
clr=""#FF0000"">_____</fn
> cn
r
c
in in
 <fn
clr=""#FF0000"">____</fn
>&nbs;cn
r c
in"
"M ssive
del riz
in c n
urn
he&nbs;<fn
clr=""#FF0000"">h sic</fn
>&nbs;cn

r c
in in
&nbs;<fn
clr=""#FF0000""> &nbs;
nic</fn
>&nbs;cn
r c
in"
Gu
M
ili
yI

Hw re in
ers
i
i l cells f C j l linked
 sm
h mycy
es? Elec
ric lly vi

g  junc
ins nd mech nic lly vi desmsme-like junc
ins
Gu
M
ili
yI
If yu isl
ed sm
h muscle cells, wuld
hey disl y slw w ves?
NO! The
slw w ves re gener
ed by in
ers
i
i l cells f C j l nd r g
ed

he sm
Gu
M
ili
yI

h muscle cells vi g  junc
ins
Wh
mech nism l ys
key rle in ICC gener
ing slw w ves? Rele se f C fr
Gu
M
ili
yI
m in
ern l IP3-deenden
s
res
ICC in hum n re ___ si
ive&nbs;
Ki
-si
ive<div><br /></div> Gu
M
il
i
yI
Junc
in l cmlexes in sm
h muscle cells?
G  junc
ins nd fc l cn
c
s
Gu
M
ili
yI
Wh
is
he m in difference be
ween elec
ric l nd chemic l syn ses? Elec
ric
l syn ses c n
r nsmi
infrm
in in b
h direc
ins (g  junc
ins), bu
che
mic l syn ses re unidirec
in l (neur l syn se)
Gu
M
ili
yI
Wh
is
he dv n
ge f mul
iuni
sm
h muscle? Single uni
? Mul
iuni
llws
fr finer m
r cn
rl<div>Single uni
ermi
s crdin
ed cn
r c
in</div>
Gu
M
ili
yI
Neurn l cn
rl f gu
m
ili
y includes inu
s frm P r sym
he
ic, sym
h
e
ic, nd ENS neurns Gu
M
ili
yI
Mygenic cn
rl f gu
m
ili
y includes
he cn
ribu
in f&nbs;
slw w v
es
Gu
M
ili
yI
Why des g s
r resis m ke i
h rd
 cn
rl bld sug r?
Bec use yu neve
r knw when
he fd yu e
is ging
 be bsrbed since
he fd is si

ing i
n yur s
m ch fr ex
ended erids f
ime
Gu
M
ili
yI
T/F: gu
sm
h muscle h s T-
ubules
F lse Gu
M
ili
yI
T/F: Gu
sm
h muscle relies he vily n C en
ering frm
he ex
r cellul r s c
e
 r ise cellul r c lcium levels nd s c use cn
r c
in<div><br /></div>
True
Gu
M
ili
yI
T/F: Gu
sm
h muscle h s in
ern l C s
re
h
c n be rele sed in resnse

sme
r nsmi

er subs
nce
True
Gu
M
ili
yI
In very gener l
erms, wh
re
he
hree m in m
r func
in rles f
he gu
?
Mix<div>Mve</div><div>S
re</div>
Gu
M
ili
yI
Chief cells:<div><br /></div><div>1. Wh
is
heir in
ermedi
e fil men
?</div><
div><br /></div><div>2. Where re
hey fund?</div><div><br /></div><div>3. Wh

is
heir secre
in mech nism?</div><div><br /></div><div>4. Wh
d
hey secre

e?</div><div><br /></div><div>5. Wh
s
imul
es
hem? Where des e ch s
imul n

cme frm? (3)</div> 1. Cy
ker
in. Secre
e b s l l min . Fully ei
heli l
.<div><br /></div><div>2. Lwer regin f g s
ric ( .k. . fundic) gl nds.</div><
div><br /></div><div>3. Mercrine regul
ed secre
in.</div><div><br /></div><di
v>4. Pesingen, g s
ric li se</div><div><br /></div><div>5. . G s
rin (frm G
cells)</div><div>b. Ace
ylchline (frm en
eric nd  r sym
he
ic nervus sys

ems)</div><div>c. H+ ins (lw s
m ch H gener
ed by  rie
l cells)</div>
S
m ch
Ms
f
he GI
r c
is single uni
/mul
i uni
sm
h muscle
"Ms
f
he GI
Gu
M
il

r c
is <fn
clr=""#FF0000"">single uni
</fn
> sm
h muscle"
i
yI
Where re
nic cn
r c
ins rim rily fund in
he gu
?
Shinc
ers, s
m
ch nd cc sin lly 
her r
ins f
he GI
r c

Gu
M
ili
yI
Which
ye f cn
r c
in underlies GI m
ili
y?
Ph sic cn
r c
in
Gu
M
ili
yI
Which
ye f cn
r c
in is in ch rge f keeing shinc
ers clsed?
Tnic c
n
r c
in
Gu
M
ili
yI
"When
he membr ne del riz
in ssci
ed wi
h
he slw w ves re ches <fn
c
lr=""#FF0000"">_____</fn
>
here is cn
r c
in" "When
he membr ne del
riz
in ssci
ed wi
h
he slw w ves re ches&nbs;<fn
clr=""#FF0000"">c
n
r c
ile
hreshld (remember: elec
ric l
hreshld is bve cn
r c
ile nd r
duces c
in 
en
i ls in ddi
in
 cn
r c
in; cn
r c
ile is
he minimum r
equired fr cn
r c
in)</fn
>&nbs;
here is cn
r c
in" Gu
M
ili
yI
1. Wh
re
he
w g s
ric diges
ive enzymes?<div><br /></div><div>2. Which cel
l(s) secre
e
hem?</div><div><br /></div><div>3. Wh
is
heir func
in?</div>

1. Pesin nd g s
ric li se<div><br /></div><div>2. Chief cells</div><div><br /

></div><div>3. Diges
in is n

he m jr func
in f
he s
m ch. These enzymes
 rim ry func
ins re rel
ed
 sign lling:</div><div><br /></div><div>Pesin
: bre ks dwn r
eins in

rie
ides, die
ides, nd free min cids.</div>
<div>G s
ric li se: bre ks
rigylcerides in
 2-mnglycerides dn free f

y
cids.</div><div><br /></div><div>All f
hese bre kdwn rduc
s sign l

he <
b>en en
erendrcrine cells</b> f
he dudenum, secific lly <b>I cells secre

ing chlecys
kinin (CCK)&nbs;</b> nd <b>S cells secre
ing secre
in</b>. CCK r
esul
s in
he rele se f  ncre
ic li ses nd bile s l
s frm
he g llbl dder.
</div> S
m ch
Pesingens nd esins:<div><br /></div><div>1. Wh
cnver
s in c
ive esing
ens
 c
ive esins?</div><div><br /></div><div>2. Wh
kind f enzyme is es
in?</div>
1. A H dr lwer
h n 5.<div><br /></div><div>2. Endr
e se<
/div> S
m ch
Which s
m ch enzyme is eseci lly imr
n
in
he nen
e?
G s
ric li se b
ec use
he nen
l excrine  ncre s is n
fully func
in l ye
.
S
m ch
P rie
l cells:<div><br /></div><div>1. Wh
s n
her n me fr
hem?</div><div>
<br /></div><div>2. Prvide 4 ieces f infrm
in bu

heir cellul r mrhl
gy.</div><div><br /></div><div>3. Describe
heir secre
in mech nism. Include i
"1. Oxyn

s s
imul n
s nd where e ch is frm, mech nism, nd rduc
s.</div>
i
ic cells<div><br /></div><div>2. . Ei
heli l cell: BL, cy
ker
in +</div><d
iv>b. Cen
r l nucleus&nbs;</div><div>c. Prminen
nuclelus</div><div>d. Esin
hilic:
ns f mi
chndri
 drive i
s in ums</div><div><br /></div><div>3
. S
imul n
s:&nbs;</div><div> . Ms
imr
n
: <b>his
mine</b> frm <b>en
er
chrm ffin-like cells in
he l min rri .</b></div><div>b. <b>G s
rin</b> fr
m <b>G-cells</b>.</div><div>c. <b>Ace
ylchline</b> frm
he <b> r sym
he
ic
nervus sys
em</b></div><div><b><br /></b></div><div>Prduc
s: Hydrchlric cid
( .k. . <b>HCl</b>) nd g s
ric in
rinsic f c
r ( .k. . <b>GIF</b>)</div><div>
<br /></div><div>Mech nism: regul
ed secre
in by <b>
ubulvesicle</b> (husing
<u>in c
ive</u> <b>H/K ATP se</b>) fusin wi
h inv gin
ins f
he l sm memb
r ne c lled <b>in
r cellul r c n liculi</b>. This gener
es m ny&nbs;<b>""seud
"" micrvilli</b> nd huge membr ne surf ce re wi
h <u> c
ive</u> H/K ATP s
e fr cid uming.</div>"
S
m ch
G s
ric in
rinsic f c
r (GIF):<div><br /></div><div>1. Wh
is i
s func
in?</d
iv><div><br /></div><div>2. Deficiency c uses wh
dise se?</div>
1. Glyc
r
ein frm  rie
l cells
h
binds vi
min B12
 be re bsrbed in
he ileum
.<div><br /></div><div>2. M crcy
ic nemi . Vi
min B12 rm
es mi

ic divisi
ns during ery
hriesis, s i
s l ck c uses &g
;9 micrn m crcy
es.</div>
S
m ch
Give
he 3 cmnen
s f GALT er n
in
he s
m ch nd
he lc
in f e ch.
1. <b>Lw s
m ch H </b>frm  rie
l cells<div>2. <b>L c
ferrin</b> frm c rd
i c nd ylric mucus gl nds</div><div>3. <b>Lyszyme</b> frm c rdi c nd ylr
ic mucus gl nds</div> S
m ch
Neck mucus cells:<div><br /></div><div>1. Give
heir cellul r mrhlgy by 4 
r me
ers.</div><div>2. Which slughing rcess d
hey underg in resnse
 wh
ich s
m ch mvemen
?</div>
1. . Whi
e fr
hy cells<div>b. Irregul r sh e<
/div><div>c. Nucleus
b se</div><div>d. Secre
ry gr nules
ex</div><div><
br /></div><div>2. Exfli
in vi mucs l squeeze</div>
S
m ch
Describe
he rcess f s
em cell differen
i
in in
he s
m ch. Include
urnv
er r
es.
S
em cells

he i
/gl nd in
erf ce f ll gl nd
yes underg
<b>bidirec
in l migr
in</b>.<div><br /></div><div>U: rel ces <b>surf ce mu
cus cells</b>. <b>4-7 d y
urnver</b>.</div><div>Dwn: rel ces&nbs;<b>P rie

l, chief, neck mucus, nd en
erendcrine cells</b>. <b>30 d y
urnver.</b></di
v>
S
m ch
Pylric grind:<div><br /></div><div>1. Where des i
s
r
? End?</div><div><br /
></div><div>2. Wh
kind f m
in is i
?</div><div><br /></div><div>3. Wh
his

lgic l fe
ure f which gu
w ll l yer en bles i
?</div><div><br /></div><div
>4. Wh
h ens

he chyme? (2 u
cmes)</div>
1. P cem ker regin f

he s
m ch

he n
ch f
he gre
er curv
ure

he ylrus.<div><br /></div
><div>2. Series f werful eris
l
ic w ves</div><div><br /></div><div>3. Uniq

uely
hick nd m ssive muscul ris ex
ern </div><div><br /></div><div>4. Pushed u

 g ins
ylric shinc
er where...</div><div> . &l
;1 mm fd  r
icles m y bu
rs

hrugh in

he dudenum</div><div>b.
he res

 bunce b ck in

he s
m
ch vi <b>re
rulsin</b></div>
S
m ch
G s
rin:<div><br /></div><div>1. Wh
s
imul
es i
s rele se?</div><div><br /></
div><div>2. Which cell
ye(s) secre
e i
? Where re
hey lc
ed?</div><div><br
/></div><div>3. Wh
re i
s effec
s?</div><div><br /></div><div>4. Wh
2 rc
esses in
he s
m ch des i
yke?</div>
1. Pylric grind nd resence f
fd in
he s
m ch<div><br /></div><div>2. G en
erendcrine cells in
he n
r
um nd ylrus</div><div><br /></div><div>3. Ac
s n  rie
l nd chief cells

incre se secre
in f H+ nd GIF nd esingens nd g s
ric li se, resec
ive
ly.</div><div><br /></div><div>4. Mech nic l nd chemic l diges
in</div>
S
m ch
Which regins f
he dudenum re included in
he fregu
? Midgu
?
<div>Tr
nsi
in is

he 2nd dudenum</div>Fregu
: 1s
nd 2nd<div>Midgu
: 2nd, 3rd n
d 4
h</div>
Midgu
&Hindgu

Which r
eries d
he vessels
urn rund during gu
r

in? Suerir mesen
e
ric r
ery ( ls rund
he vi
elline duc
)
Midgu
&Hindgu

"The cecum nd endix is rigin lly lc
ed in
he <fn
clr=""#FF0000"">___
__</fn
> qu dr n
nd
hrugh grw
h will migr
e

he <fn
clr=""#FF0000"
">____</fn
> qu dr n
" "The cecum nd endix is rigin lly lc
ed in
he&nbs
;<fn
clr=""#FF0000"">uer righ
h nd</fn
>&nbs;qu dr n
nd
hrugh grw

h will migr
e

he&nbs;<fn
clr=""#FF0000"">lwer righ
</fn
>&nbs;qu d
r n
" Midgu
&Hindgu

"<img src="" s
e-4754528796676.jg"" /><div>Iden
ify
hese mesen
eries</div>"
1. The mesen
ery f
he sm ll in
es
ine<div>2. Tr nsverse mescln</div><div>3.
Sigmid mescln</div>
Midgu
&Hindgu

Which regins f
he dudenum re re
reri
ne l? Prim ry r secnd ry?
2nd, 3rd, nd 4
h (n
1s
)<div>Secnd ry</div> Midgu
&Hindgu

Which s
ruc
ures f
he gu

ube re re
reri
ne l? Dudenum (2nd, 3rd, nd
4
h s
ges)<div>Ascending cln</div><div>Descending cln</div><div>Rec
um</div
>
Midgu
&Hindgu

Hw c n yu
ell
r nsverse mescln frm mesen
ery f
he sm ll in
es
ine?
Lk

he fe
ures f
he bwel i
is

ched
 in rder

ell if i
is sm
ll r l rge in
es
ine Midgu
&Hindgu

"<img src="" s
e-6408091205636.jg"" /><div>Iden
ify
hese re
reri
ne l s
ru
c
ures.</div>" A. Dudenum<div>B. Ascending cln</div><div>C. Desending cln<
/div><div>D. Rec
um</div>
Midgu
&Hindgu

"<img src="" s
e-6820408066052.jg"" /><div>Iden
ify
hese mesen
eries.</div>"
1. The mesen
ery f
he sm ll in
es
ine<div>2. Tr nsverse mescln</div><div>3.
Sigmid mescln</div>
Midgu
&Hindgu

A mesen
ery is lc
ed where ...

w l yers f
he eri
neum cme very c
lse
ge
her nd re nly se r
ed by
he neur v scul
ure ( nd f
)
h
su
Midgu
&Hindgu

lies
h
r
in f
he gu

ube.
"<img src="" s
e-7490422964228.jg"" /><div>N me
he surgic l l ndm rk indic
e
d by
he s
erisk. Wh
is
he clinic l signific nce f
his s
ruc
ure?</div>"
Whi
e line f Tld
(in
he  r clic gu

ers)<div>The medi l (rigin lly mesen

eric) edge cn
ins cnsider ble number f r
eries nd veins. In cn
r s
,
h
e l
er l (rigin lly n
imesen
eric) edge is devid f v scul
ure. Surgens c
n
ke dv n
ge f
his si
u
in nd m ke
surgic l incisin in
he  r clic
gu

er, lng
he whi
e line f Tld
, nd h ve rel
ively bldless l ne f
incisin. They c n
hen reflec

he l rge in
es
ine ( nd i
s ssci
ed v scul

ure)

he si
e side nd h ve rel
ively free ccess

he re
reri
ne
l s
ruc
ures (ure
ers, IVC, r
, e
c)</div> Midgu
&Hindgu

Which mesen
ery se r
es gre
er frm lesser s c?
"Tr nsverse mescln<di
v><img src="" s
e-8598524526596.jg"" /></div>"
Midgu
&Hindgu

Wh
des
he f lcifrm lig men
cnnec
? Which s
ruc
ures re cn
ined wi
hin
i
?
Liver
 n
erir bdmin l w ll<div>Lig men
um
eres (rund lig men
f
Midgu
&Hindgu


he liver)</div>
Wh
des
he he
duden l lig men
cnnec
? Which s
ruc
ures re cn
ined wi

Liver
 dudenum<div>Pr
l
ri d: he
ic r
ery, r
l vein,

hin i
?
cmmn bile duc
</div> Midgu
&Hindgu

Wh
des
he g s
riche
ic lig men
cnnec
? Which s
ruc
ures re cn
ined wi
Liver
 lesser curv
ure f s
m ch<div>G s
ric r
eries</div>

hin i
?
Midgu
&Hindgu

Wh
des
he g s
rclic lig men
cnnec
? Which s
ruc
ures re cn
ined wi
hi
n i
? Gre
er curv
ure nd
r nsverse cln<div>G s
reilic r
eries</div>
Midgu
&Hindgu

Wh
des
he g s
rslenic lig men
cnnec
? Which s
ruc
ures re cn
ined wi

hin i
? Gre
er curv
ure nd sleen<div>Shr
g s
rics</div> Midgu
&Hindgu

Wh
des
he slenren l lig men
cnnec
? Which s
ruc
ures re cn
ined wi
hi
n i
? Sleen
 s
erir bdmin l w ll<div>Slenic r
ery nd vein</div>
Midgu
&Hindgu

"<img src="" s
e-10213432229892 (1).jg"" /><div>Iden
ify
hese r
eries.</div>
"
1. Inferir  ncre
icduden l<div>2. Jejun l br nches</div><div>3. Ile
l br nches</div><div>4. Ilecec l (ileclic)</div><div>5. Righ
clic</div><di
v>6. Middle clic</div> Midgu
&Hindgu

Wh
d
he inferir  ncre
icduden l r
eris suly?
Suly
he secn
d nd
hird s
ges f
he dudenum nd
he uncin
e rcess f
he  ncre s
Midgu
&Hindgu

Wh
d
he suerir  ncre
icduden l r
eries br nch ff f? Inferir  ncre

icduden l? Suerir: g s
rduden l (celi c
runk -&g
; cmmn he
ic -&g

; g s
rduden l -&g
; suerir)<div>Inferir: suerir mesen
eric</div>
Midgu
&Hindgu

Hw c n yu
ell ile l br nches frm jejun l br nches? "1. Rel
ive lc
in: <
fn
clr=""#FF0000"">jejun l</fn
> br nches will be he ding in
he direc
in
f
he <fn
clr=""#FF0000"">uer lef
qu dr n
</fn
>, while <fn
clr=""#
0000FF"">ile l</fn
> br nches will be he ding in
he direc
in f
he <fn
cl
r=""#0000FF"">lwer righ
qu dr n
</fn
><div>2. Br nching 

ern: <fn
clr
=""#FF0000"">jejun l</fn
> br nches h ve <fn
clr=""#FF0000"">few nd l rge
v scul r rc des nd lng v s rec
</fn
> (h rd

ell in
he l b, while <fn

clr=""#0000FF"">ile l</fn
> br nches h ve <fn
clr=""#0000FF"">m ny nd
shr
v scul r rc des nd shr
v s rec
</fn
></div>"
Midgu
&Hindgu

Ar
eries re n med b sed n where
hey re ging
. Wh
is
he n me f
he r

ery which sulies
he scending cln? Firs
2/3 f
he
r nsverse cln? Wh

re
hese vessels br nches f? Ascending cln: righ
clic<div>Firs
2/3 f
r
ns. cln: middle clic</div><div>B
h re br nches f suerir mesen
eric -&g

; suly
he midgu
</div>
Midgu
&Hindgu

"<img src="" s
e-14607183773700.jg"" /><div>N me
hese n
mic l fe
ures. Is

his ileum r jejunum?</div>" 1. V scul r rc des<div>2. V s rec
</div><div>
Jejunum (few nd l rge v scul r rc des nd lng v s rec
)</div>
Midgu
&H
indgu

"<img src="" s
e-15092515078148.jg"" /><div>Is
his ileum r jejunum?</div>"
Ileum -&g
; m ny nd shr
v scul r rc des nd shr
v s rec

Midgu
&H
indgu

Cm re
he in
ern l surf ce f
he jejunum wi
h
h
f
he ileum?
The jeju
num h s numerus nd l rge circul r flds while
he circul r flds (lic e circu
l ris) f
he ileum re few nd sm ll. In ddi
in, Peyers 
ches c n be seen
in
he ileum (hwever, yu c nn
see
hese in
he c d vers)<div><br /><div><br
/></div></div> Midgu
&Hindgu

Which surf ce f
he ileum cn
ins Meckels diver
iculum?
"<fn
clr=""#
FF0000"">An
imesen
eric</fn
> <fn
clr=""#FF0000"">surf ce</fn
> f
he ile
um<div><img src="" s
e-16501264351236.jg"" /></div>" Midgu
&Hindgu

Wh
c uses Meckels diver
iculum?
Persis
en
vi
elline duc

Midgu
&H
indgu

Wh
c uses
wis
ing nd s
r ngul
ins f
he ls f
he sm ll in
es
ine in M
eckels diver
iculum? 25% f
he diver
iculum m y be

ched

he umbilicus
nd m y serve s
he surce f
wis
ing r s
r ngul
ins
Midgu
&Hindgu

"<img src="" s
e-17235703758852.jg"" /><div>Iden
ify
hese fe
ures f
he cl
1. Teni cli<div>2. H us
r (s ccul
ins)</div><div>3. Aendi
n.</div>"

x eilic </div><div>4. Vermifrm endix</div><div>5. Mes endix</div>

Midgu
&Hindgu

Wh
re h us
r (s ccul
ins)?
Mul
ile uches in
he w ll f
he l rg
e in
es
ine; c n be visu lized in
b rium enem
Midgu
&Hindgu

Wh
re
eni cli?
3 b nds f lngi
udin l sm
h muscle n
he surf ce f
Midgu
&Hindgu


he l rge in
es
ine<div><br /></div>
Wh
re endices eilic ? F
filled end n
s f eri
neum rjec
ing fr
m
he surf ce f
he l rge in
es
ine
Midgu
&Hindgu

Wh
is
he difference be
ween diver
iculus nd diver
iculi
is? Diver
iculus is

he resence f diver
icul . Diver
iculi
is is
he infec
in f
he diver
icul .
Midgu
&Hindgu

Which mesen
ery cn
ins
he v scul
ure f
he endix?
Mes endix
Midgu
&Hindgu

Describe
he  in ssci
ed wi
h e rly endici
is. Dull, ching, viscer l 
in in
he midline ne r
he umbilicus Midgu
&Hindgu

Describe
he  in ssci
ed wi
h l
e endici
is.
Irri

es surrunding 
rie
l eri
neum f bdmin l w ll. Becmes sh r, lc lized sm
ic  in
Midgu
&Hindgu

Wh
is fund

he rxim l junc
in f
he
eni cli?
Vermifrm end
ix
Midgu
&Hindgu

Wh
is McBurneys in
? Where is
his in
? Surf ce rjec
in f
he lc
i
n f
he endix.<div>1/3
he dis
nce be
ween
he ASIS nd
he umbilicus</div
>
Midgu
&Hindgu

Rebund
enderness
McBurneys in
indic
es ...
Midgu
&H
eri
ni
is
indgu

Cm re viscer l nd sm
ic  in.
"Viscer l: dull, "" ching"", v gue, r
ly lc lized,
yic lly midline<div>Sm
ic: ""sh r"", well lc lized nd e sy
Midgu
&Hindgu


 inin
</div>"
P in fibers ( fferen
s) f
he viscer
r vel wi
h ... sym
he
ics
Midgu
&H
indgu

The gu
nly senses ____ nd ____
"<fn
clr=""#FF0000"">dis
ensin</fn

> nd <fn
clr=""#FF0000"">ischemi </fn
>" Midgu
&Hindgu

Sm
ic  in is ssci
ed wi
h ...
Midgu
&Hindgu

eri
ni
is
Sm
ic  in is c used by ... "irri

in f  rie
l eri
neum nd i
s ssc
i
ed <fn
clr=""#FF0000"">sm
ic</fn
> nerve fibers"
Midgu
&Hindgu

Fregu
deriv
ives refer  in
 which regin? Which sin l derm
me? "<div>E
ig s
ric regin nd T8</div><img src="" s
e-20637317857281.jg"" /><div><img sr
c="" s
e-20774756810753.jg"" /><br /><div><br /></div></div>" Midgu
&Hindgu

Midgu
deriv
ives refer  in
 which regin? Which sin l derm
me? "<div>Pe
riumbilic l regin nd T10</div><img src="" s
e-20637317857281.jg"" s
yle=""m
x-wid
h: 90%; "" /><div><img src="" s
e-20774756810753.jg"" s
yle=""m x-wid
h:
90%; "" /><br /></div><div><br /></div>"
Midgu
&Hindgu

Hindgu
deriv
ives refer  in
 which regin? Which sin l derm
me? "<div>Hy
g s
ric regin nd L1</div><img src="" s
e-20637317857281.jg"" s
yle=""m x-w
id
h: 90%; "" /><div><img src="" s
e-20774756810753.jg"" s
yle=""m x-wid
h: 90
%; "" /><br /></div><div><br /></div>" Midgu
&Hindgu

Which sym
he
ic nerves suly
he fregu
? Midgu
? Hindgu
? Fregu
nd midg
u
:
hr cic sl nchnics<div>Hindgu
: lumb r sl nchnics</div> Midgu
&Hindgu

Which  r sym
he
ic nerves suly
he fregu
? Midgu
? Hindgu
?
Fregu

nd midgu
: V gus (CNX)<div>Hindgu
: Pelvic sl nchnics (S2-4)</div>
Midgu
&H
indgu

"<img src="" s
e-24434068946948.jg"" /><div>Iden
ify
hese br nches f
he su
erir nd &nbs;inferir mesen
eric r
ery. Wh
des
he red line indic
e?</di
v>"
1. Ilecec l (ileclic)<div>2. Righ
clic</div><div>3. Middle clic</d
iv><div>4. Lef
clic</div><div>5. Sigmid l br nches</div><div>6. Suerir rec

l br nches</div><div>7. M rgin l r
ery (f Drummnd)</div><div>Red line: divis
in be
ween midgu
nd hindgu
(Remember: midgu
= suerir mesen
eric nd hingu

= &nbs;inferir mesen
eric,
his is cle rly visu lized in
his im ge)</div>
Midgu
&Hindgu

Which sin l level is
he celi c
runk fund? Suerir mesen
eric?
Celi c

runk: T12<div>Suerir mesen
eric: L1</div>

Midgu
&Hindgu

"<img src="" s
e-25220047962116.jg"" /><div>Iden
ify
hese vessels.</div>"
1. Ilecec l (ileclic)<div>2. Righ
clic</div><div>3. Middle clic</div><div>
4. Lef
clic</div><div>5. Sigmid l br nches</div><div>6. Suerir rec
l</div>
<div>7. M rgin l r
ery (f Drummnd)</div>
Midgu
&Hindgu

Hw d yu
ell
he difference be
ween m rgin l r
ery f Drummnd nd rc f Ri
"The h llm rk f
he me
l n (me ndering mesen
eric r
ery f Mskwi
z)?
ndering mesen
eric r
ery f Mskwi
z ( .k. . rc r Ril n) is
h
i
is r
h
er shr
when cm red

he m rgin l r
ery f Drummnd. The m rgin l r
ery i
s r
her clse

he l rge in
es
ine, while
he rc f Ril n is n reci ble
dis
nce w y frm
he bwel.<div><img src="" s
e-25975962206212.jg"" /></div
>"
Midgu
&Hindgu

"Ar
eries re n med b sed un <fn
clr=""#FF0000"">____</fn
>. Veins re n
med b sed un <fn
clr=""#FF0000"">_____</fn
>." "Ar
eries re n med b se
d un&nbs;<fn
clr=""#FF0000"">where
hey g</fn
>. Veins re n med b sed
un&nbs;<fn
clr=""#FF0000"">where
hey re cming frm</fn
>." Midgu
&H
indgu

The he
ic r
l vein is
yic lly frmed by
he junc
in f ... . Where des

his junc
in
yic lly ccur? "
he slenic vein nd
he suerir mesen
eric ve
in<div>This junc
in
yic lly ccurs s
erir

he neck f
he  ncre s</div
><div><img src="" s
e-26641682137092.jg"" /></div>" Midgu
&Hindgu

The slenic vein
yic lly dr ins in
...
inferir mesen
eric (hwever, v
ri
in is ssible!) Midgu
&Hindgu

Define m cr- nd micrnu
rien
s.
<div>M cr- nd micr- refer
 inges
i
n qu n
i
ies.</div><div><br /></div>M crnu
rien
s: r
ein, f
, c rbhydr
es.
&nbs;<div>Micr: every
hing else.</div>
S
m ch
Wh
is nu
r ceu
ic l?
Fd cl imed
 h ve
benefi
beynd b sic nu
r
i
in. Of
en refers
 fds wi
h secific ssci
ed he l
h cl ims.
S
m ch
Give
he dv n
ges nd dis dv n
ges ssci
ed wi
h nim l mdels fr nu
ri
i
n l s
udies.
"<img src="" s
e-1151051235898.jg"" />"
S
m ch
Give
he dv n
ges nd dis dv n
ges ssci
ed wi
h hum n feeding s
udies.
"<img src="" s
e-1370094567992.jg"" />"
S
m ch
Give
he dv n
ges nd dis dv n
ges ssci
ed wi
h bserv
in l s
udies.
"<img src="" s
e-1932735283542.jg"" /><div><img src="" s
e-1945620185454.jg"
" /></div>"
S
m ch
Give
he dv n
ges nd dis dv n
ges ssci
ed wi
h nu
ri
in l eidemilgy s
S
m ch

udies. "<img src="" s
e-2083059138992.jg"" />"
Lis
ff
he 5 DRI v lues nd bbrevi
ins
h
we need
 knw.
"<img sr
c="" s
e-3320009720624.jg"" /><div><img src="" s
e-4148938408027.jg"" />&nbs
seci lized EAR fr energy (c lric) cnsum
in.</div
;EER is b sic lly jus

>"
AngLiGre
ness
"Fill in
he crrec
DRI me sure in e ch bx.<div><img src="" s
e-3530463117817
.jg"" /></div>"
"<img src="" s
e-3693671875382.jg"" />"
AngLiGre

ness
In sm
h muscle fibers,
here is n imr
n
difference be
ween
he ____
hres
hld (
which
he fibers gener
e n c
in 
en
i l) nd
he ____
hreshld (

he level
which
he incre se in in
r cellul r ___ is sufficien

 gener
e
cn
r c
in). "<div>In sm
h muscle fibers,
here is n imr
n
difference
be
ween
he <fn
clr=""#ff0000"">elec
ric l</fn
>
hreshld (
which
he fi
bers gener
e n c
in 
en
i l) nd
he <fn
clr=""#ff0000"">cn
r c
ile</
fn
>
hreshld (
he level
which
he incre se in in
r cellul r <fn
clr=""
#ff0000"">C </fn
> is sufficien

 gener
e cn
r c
in).</div><div><br /></
div>" 3 Blck GI Gu
M
ili
yI10.31.12
"Fill in
his bx.<div><br /></div><div><img src="" s
e-4226247819769.jg"" /><
/div>" "<img src="" s
e-4239132721968.jg"" />"
AngLiGre
ness
Wh
ublic
in is
he u
hri

ive surce f dvice fr ele ge 2 nd lde
r bu
hw gd die
ry h bi
s c n rm
e he l
h nd reduce risk fr m jr chr
nic dise ses?<div><br /></div><div>Hw f
en is ublic
in ud
ed?</div>
Die
ry Guidelines fr Americ ns<div><br /></div><div>Every 5 ye rs</div>
S
m ch

"When isl
ed, gu
sm
h myfibers ____ (d/dn
) disl y slw w ves. Ins
e d
,
he slw w ves re gener
ed by seci lized ul
in f ____ cells, knwn
s
he ________. Cllqui lly c lled
he ""_____ cells,""
hey gener
e
he ers
is
en
slw w ves f undul
ing membr ne 
en
i l.&nbs;They re fund wi
hin

he sm
h muscle l yers nd in
he en
eric lexi. They ls c
s in
ermedi ry
be
ween neurns nd sm
h muscle."
"When isl
ed, gu
sm
h myfibers <f
n
clr=""#ff0000"">DO NOT</fn
> disl y slw w ves. Ins
e d,
he slw w ves
re gener
ed by seci lized ul
in f <fn
clr=""#ff0000"">sm
h muscl
e cells</fn
>, knwn s
he <fn
clr=""#ff0000"">in
ers
i
i l cells f C j l
(ICC)</fn
>. Cllqui lly c lled
he ""<fn
clr=""#ff0000""> cem ker</fn

> cells,""
hey gener
e
he ersis
en
slw w ves f undul
ing membr ne 
en

i l. They re fund wi
hin
he sm
h muscle l yers nd in
he en
eric lexi. Th
ey ls c
s in
ermedi ry be
ween neurns nd sm
h muscle.&nbs;" 3 Blck
GI Gu
M
ili
yI10.31.12
Dr w u

he MyPl
e.gv l
e. "<img src="" s
e-4810363372336.jg"" /><div><br
/></div><div>D mn insidius d iry lbby...</div>"
S
m ch
1. Wh
re
he dul
cce
ble m crnu
rien
dis
ribu
in r nges (AMDR) fr...
<div><br /></div><div>C rbs</div><div>F
</div><div>Pr
ein</div><div><br /></di
v><div>2. Wh
ch nges in yung children?</div> <div>C rbs: 45-65%</div><div>F

: 20-35%</div><div>Pr
ein: 10-35%</div><div><br /></div><div>Yung kids: f
sh
S
m ch
uld be 30-40%</div><div>Pr
ein nly 5-20%</div><div><br /></div>
Give
he 6 func
ins f
he sm ll in
es
ine.
1. M jr diges
in<div>2. Absr

in, hence
he l rge surf ce re .</div><div>3. M
ili
y</div><div>4. Hrmne f
unc
in</div><div>5. Mucus rduc
in</div><div>6. GALT</div> Sm ll in
es
ine
<div>EC Culing P Quiz</div><div><br /></div>Al
hugh EC culing de
ils f

he in
ers
i
i l cells f C j l re s
ill fr
hy, i
is cle r
h
dwns
re m,

he cnversin f ___
 ___ by
he ___-r
ein rece
r-linked _______ &nbs;
ri
ggers
he rele se f____ frm
he ______, which
hen binds _____, c
iv
ing ___
_____ , which hshryl
es _____, rele sing i
frm
he _____ binding si
e n

he ____ ch in, nd s
r
ing
he wer s
rke. "Al
hugh EC culing de
ils f

he in
ers
i
i l cells f C j l re s
ill fr
hy, i
is cle r
h
dwns
re m,

he cnversin f <fn
clr=""#ff0000"">PIP2</fn
>
 <fn
clr=""#ff0000""
>IP3</fn
> by
he <fn
clr=""#ff0000"">Gq</fn
>-r
ein rece
r-linked <f
n
clr=""#ff0000"">hshli se</fn
> <fn
clr=""#ff0000"">C-g mm </fn
>

riggers
he rele se f <fn
clr=""#ff0000"">C +2 </fn
>frm
he <fn
cl
r=""#ff0000"">SR</fn
> <fn
clr=""#ff0000"">vesicles</fn
>, which
hen bind
s <fn
clr=""#ff0000"">c lmdulin</fn
>, c
iv
ing <fn
clr=""#ff0000"">
mysin ligh
ch in kin se (MLCK)</fn
>, which <fn
clr=""#ff0000"">hshry
l
es c ldesmn</fn
>, rele sing i
frm
he <fn
clr=""#ff0000"">mysin</f
n
> binding si
e n
he <fn
clr=""#ff0000""> c
in</fn
> ch in, nd s
r
ing

he wer s
rke.<div><br /></div><div>Remember, infrm
in is in
egr
ed fr

he ex m, nd cumul
ive. S I wuldn
be surrised if Fr nk m kes green d
A
n in
ers
i
i l cell f C j l r sm
h muscle
uf
in
he l min rri nd
sks us fr
he EC culing.</div>"
3 Blck GI Gu
M
ili
yI10.31.12
Wh
re
he 5 me ns
 incre se sm ll in
es
ine surf ce re ? 1. Leng
h f SI
is 20 fee
.<div>2. V lves f Kerckring ( .k. . lic e circul ris)</div><div>3. V
illi</div><div>4. Micrvilli</div><div>5. Glycc lyx ( .k. . en
eric c
)&nbs;
</div> Sm ll in
es
ine
Bre k dwn
he leng
h subuni
s f
he sm ll in
es
ine. T
l: 20 fee
<div>Dude
num: 1 f
</div><div>Jejunum: 8 fee
</div><div>Ileum: 12 fee
</div><div><br /><
/div><div>N
sure where
h
ex
r f
in
he

l c me frm, bu
well g wi
Sm ll in
es
ine

h i
.</div>
"Syn 
ic
r nsmissin c n be chemic l nd elec
ric l. Where s <fn
clr=""#09
0000"">chemic l</fn
>
r nsmissin is _____ (uni-/bi-direc
in l), _____ syn s
es be
ween cells usu lly  ss sign ls equ lly well in _____ direc
ins.&nbs;"
"Syn 
ic
r nsmissin c n be chemic l nd elec
ric l. Where s <fn
clr=""#09
0000"">chemic l</fn
>
r nsmissin is <fn
clr=""#ff0000"">unidirec
in l</f
n
>, <fn
clr=""#ff0000"">elec
ric l</fn
> syn ses be
ween cells usu lly 
ss sign ls equ lly well in <fn
clr=""#ff0000"">b
h</fn
> direc
ins.&nbs
;<div><br /></div><div>n
es: iss-r wrding</div>" 3 Blck GI Gu
M
ili
yI1

0.31.12
<div>When
he ______
hreshld is re ched
he sm
h muscle cell fires n c
in

en
i l. As
he _____ ge
s s
rnger mre c
in 
en
i ls re fired nd
he
gre
er
he ____ f
he cn
r c
in.&nbs;The lnger
he ____ f
he slw w ve,

he lnger
he ____ f
he cn
r c
in.&nbs;Neur
r nsmi

ers, hrmnes nd ___
___ subs
nces c n ll influence sm
h muscle cn
r c
ili
y by influencing
he
membr ne 
en
i l nd ____ f
he slw w ve.</div>
"<div>When
he <fn
cl
r=""#fe0000"">elec
ric l</fn
>
hreshld is re ched
he sm
h muscle cell fir
es n c
in 
en
i l. As
he <fn
clr=""#fe0000"">del riz
in</fn
> ge

s s
rnger mre c
in 
en
i ls re fired nd
he gre
er
he<fn
clr=""#fe
0000""> frce</fn
> f
he cn
r c
in.&nbs;The lnger
he <fn
clr=""#fe00
00"">dur
in</fn
> f
he slw w ve,
he lnger
he <fn
clr=""#fe0000"">du
r
in</fn
> f
he cn
r c
in.&nbs;Neur
r nsmi

ers, hrmnes nd <fn
cl
r=""#fe0000""> r crine</fn
> subs
nces c n ll influence sm
h muscle cn
r
c
ili
y by influencing
he membr ne 
en
i l nd dur
in f
he slw w ve.</d
iv><div><br /></div><div>
l;dr: <b>frce</b> f cn
r c
in is <b>deenden
</b>
un <b>s
reng
h</b> f del riz
in, <b>dur
in</b> f cn
r c
in is <b>de
enden
</b> un <b>dur
in</b> f slw w ve.</div>"
3 Blck GI Gu
M
ili
yI1
0.31.12
Abnrm l ICCs re being discvered in sever l gu
m
ili
y disrders such s ___
__ nd _____. "Abnrm l ICCs re being discvered in sever l gu
m
ili
y dis
rders such s <fn
clr=""#fe0000"">slw
r nsi
cns
i
in</fn
> nd <fn

clr=""#fe0000"">di be
ic g s
r
hy</fn
>.<div><br /></div><div>Slw
r nsi

cns
i
in: lnger in
erv ls be
ween bwel mvemen
s, seen mre f
en in eld
erly. C n be c used by m ny 
her 
hlgies (nerve d m ge, sign ling f ilure,
e
c.)</div><div><br /></div><div>Di be
ic g s
r
hy (g s
r resis nd di rrhe
): fd si
s in s
m ch, undiges
ed; h rder
 cn
rl bld sug r; lss f rec

l func
in nd incn
inence.</div><div><br /></div><div>
l;dr: bnrm l ICCs c
n be shi

y. ;)</div>" 3 Blck GI Gu
M
ili
yI10.31.12
Drs l r
g ngli xns ccess
he nerve bld suly nd re subjec

 l
er
ed bld _____ levels. Axns
h
re subjec
ed
 cu
e _____ (incre se/decre s
e) in bld glucse ______ (incre se/decre se)
he mi
chndri l l vi me
b
lic fissin, in n

em

 cle r excess glucse.&nbs;Prlnged hyerglycemi
even
u lly c uses n 

ic sign ling c sc de resul
s in m ny sm ll unfunc
i
n l _____. Lss f func
in l _____ in
he xns nd induc
in f lc l 


ic rgr m d m ges
he xn s
ruc
ure nd ul
im
ely der nges func
in.
"Drs l r
g ngli xns ccess
he nerve bld suly nd re subjec

 l
e
red bld <fn
clr=""#fe0000"">glucse</fn
> levels. Axns
h
re subjec
e
d
 cu
e <fn
clr=""#fe0000"">incre ses</fn
> in bld glucse <fn
clr
=""#fe0000"">incre se</fn
>
he mi
chndri l l vi me
blic fissin, in n


em

 cle r excess glucse.&nbs;Prlnged hyerglycemi even
u lly c uses
n 

ic sign ling c sc de resul
s in m ny sm ll unfunc
in l <fn
clr="
"#fe0000"">mi
chndri </fn
>.&nbs;Lss f func
in l <fn
clr=""#fe0000"">
mi
chndri </fn
> in
he xns nd induc
in f lc l 

ic rgr m d m
ges
he xn s
ruc
ure nd ul
im
ely der nges func
in."
3 Blck GI Gu
M

ili
yI10.31.12
Hw lng des
given me l rem in in
he sm ll in
es
ine?<div><br /></div><div>W
h
bu

he cln?</div>
<div>Sm ll in
es
ine: 12 hurs</div><br /><div>C
in
es
ine
ln: 2 d ys</div>
Give
he m jr func
ins f
he dudenum, jejunum, nd ileum. Dudenum: diges

nd bsrb <b>r
ein nd c rbhydr
es</b><div><br /></div><div>Jejunum: diges

nd bsrb <b>f
</b></div><div><br /></div><div>Ileum:&nbs;</div><div>1. bs
rb <b>bile s l
s</b> nd <b>vi
min B12 bund
 g s
ric in
rinsic f c
r</b></
div><div>2. Figh
b c
eri l b ckflw frm
he cln: <b>M cell n
igen resen


in</b> ver Peyers 
ches.</div>
in
es
ine
"Fr e ch, iden
ify
he s
ruc
ure. Addi
in lly, nswer
he fllwing ques
ins.
<div><br /></div><div><img src="" s
e-2637109920236.jg"" /></div><div><br /></
div><div>1. Wh
re 2 n mes fr
his s
ruc
ure?</div><div>Wh
cmrises i
s e
rm nen
cre?</div><div>Hw big is i
?</div><div><br /></div><div>2. Wh
cmri
ses
his s
ruc
ures cre?</div><div>Wh
is
he b

m f
his s
ruc
ure c lled

? Wh
em
ies here?</div><div><br /></div><div>3. Wh
re
his s
ruc
ures sec

re
in rduc
s?</div><div><br /></div><div>4. This ic is f which gu
regin?<
/div>" "<img src="" s
e-3328599654892.jg"" /><div><br /></div><div>1. V lves
f Kerckring: One cen
ime
er rjec
ins s visible by
he n ked eye. Villi re
1 mm nd ccun
fr velve
y e r nce crss
he v lves.</div>"
in
es
in
e
"1. Wh
is
his ic shwing?<div><br /></div><div>2. Des i
h ve myei
heli l
cells? Why r why n
?</div><div><br /></div><div>3. In wh
l yer f
he gu
w
ll is
his s
ruc
ure lc
ed? Where else in
he GI d yu find
his
ye f s
r
uc
ure in
his l yer?</div><div><br /></div><div>4. Wh
re i
s secre
in rdu
c
s?</div><div><br /></div><div><img src="" s
e-3697966842396.jg"" /></div>"
1. Brunners gl nd<div><br /></div><div>2. N b/c eris
lsis, segmen

in, nd

he MMC frce i
s cn
en
s u
in

he cry
s f Lieberkuhn.</div><div><br /><
/div><div>3. Submucs . Esh ge l mucus gl nds re
he nly 
her gl nd
ye f
und here.</div><div><br /></div><div>4. Alk line mucus (H 8.1-9.3) nd en
erg
s
rne frm invisible en
erendcrine cells.&nbs;</div>
in
es
ine
"L bel e ch f
hese l yers f
he gu

ube in
he sm ll in
es
ine.<div><br /></
div><div>Fr
he secnd

he righ
, give ll f i
s cmnen
s.</div><div><div
><br /></div><div><img src="" s
e-4312147165659.jg"" /></div></div>" "<img sr
c="" s
e-4380866642395.jg"" /><div><br /></div><div>Submucs :&nbs;</div><div
>1. Cnnec
ive
issue (lks lse rel r, bu
n
sure)</div><div>2. Bld ves
sels</div><div>3. Lymh vessels</div><div>4. Lymhid cells</div><div>5. M crh
ges</div><div>6. M s
cells</div>"
in
es
ine
"LM f micrvillus<div><br /></div><div><img src="" s
e-5617817223660.jg"" /
></div><div><br /></div><div>1. . Cl ssify
his ei
helium</div><div>b. Give
h
e cell
yes fund in
his ei
helium nd hw
heir rel
ive mun
s ch nge
hr
ughu

he in
es
ines.</div><div><br /></div><div>2. . Wh
s
ruc
ures nd crr
esnding gu
l yers re resen
here? (5) Wh
cell
yes frm e ch?&nbs;</div
><div>b. Describe
he gu
m
in
h

his s
ruc
ure c rries u
, i
s frequency,
nd i
s func
in.</div>"
1. . Simle clumn r<div><br /><div>b. Gble
c
ells (ligh
cells): very few in
he dudenum <b>incre sing</b>

ns in
he c
ln.</div><div>En
ercy
es (ink cells): Tns in
he dudenum <b>decre sing</b>

 very few in
he cln.</div><div><br /></div><div>2. .&nbs;<b>Diffuse immun
cme
en
</b> cells f
he <b>l min rri </b>.</div><div><b>Sm
h muscle</b
> cells (inner circumferen
i l nd u
er lngi
udin l) ex
ending u frm
he <b>
muscul ris mucs .</b></div><div>A <b>c ill ry bed</b> (denses


he
i)</di
v><div>A single cen
r l <b>l c
e l</b> (1 er villus)</div><div><b>Nerve fibers<
/b> frm Meissners lexus</div><div><b><br /></b></div><div>b. <b>Vill r um</
b>.&nbs;</div><div>Func
in: <b>mix</b> chyme,  ncre
ic enzymes, nd bile s l

s rund
he villi.</div></div><div>Frequency: <b>~6x/min</b></div><div>Descri

in: l<b>ngi
udin l cn
r c
in </b>ushes
he
riglycerides in
he cen
r l l
c
e l dwn
w rd
he l min rri .</div><div><b>Circumferen
i l cn
r c
in</
b>: c uses
he villi
 sh
b ck u in

he lumen s ce.</div>
in
es
in
e
"<img src="" s
e-7911329759724.jg"" /><br /><div><br /></div><div>1. . Why d

he
is f
hese villi s
in d rkes
?</div><div>b. Wh

ye f c ill ry bed
exis
s here?</div><div><br /></div><div>2. Wh

ye f c ill ry bed exis
s her
e?</div>"
1. . This is s
in
 shw c ill ry densi
y, s
he d rk vill
r
is h ve ex
remely dense c ill ry beds. &nbs;This is s bec use en
ercy
e
m
ur
in is culed

heir migr
in frm
he cry
s f Lieberkuhn

he

i;
hey re nly fully effec
ive
bsrbing nu
rien
s

he very
i f
he
villi. This mmen
f bsr
ive erfec
in requires
ns f v scul
ure
 mve

he nu
rien
s in
.<div>b. Cn
inuus fenes
r
ed wi
h di hr gm.</div><div><br
/></div><div>2. Cn
inuus nnfenes
r
ed</div>
in
es
ine
"1. Wh
re ll f
hese s
ruc
ures?<div><br /></div><div>2. Which segmen
f

he gu

ube des e ch crresnd
?</div><div><br /></div><div>3. Hw is
his d
ifference in e r nce clinic lly relev n
?</div><div><br /></div><div><img src
="" s
e-9934259356140.jg"" /></div><div><br /></div><div><img src="" s
e-9947
144258028.jg"" /></div><div><br /></div><div><img src="" s
e-10011568767516.j
g"" /></div><div><br /></div>" "1. nd 2.<div><img src="" s
e-10033043603948.j

g"" /><div><br /></div><div><img src="" s
e-10045928505842.jg"" /></div><div>

<br /></div><div><img src="" s
e-10058813407772.jg"" /></div></div><div><br />
</div><div>3. In child wi
h f ilure

hrive,
heir dudenum nd ileum re bi
sied
 check if
he rcess f differen
i
in be
ween le f nd finger s
ruc

ures is ccurring. If i
isn
,
he clinici n migh
susec
n en
eric nervus s
ys
em bnrm li
y r e rly glu
en llergy.</div>"
in
es
ine
"<img src="" s
e-12515534700952.jg"" /><div><br /></div><div>1. Wh
cell
ye
is
his? Hw c n yu
ell?</div><div><br /></div><div>2. Is i
b shilic r e
sinhilic?&nbs;</div><div><br /></div><div>3. Wh
is i
s func
in? Wh
re i

s secre
in rduc
s?</div><div><br /></div><div>4. Where is i
fund in
he cr
y
s f Lieberkuhn? Why?</div><div><br /></div><div>5. This cell
ye is
defin
i
ive m rker fr which gu
segmen
?</div><div><br /></div><div>6. Wh
m
ili
y
mech nism is resnsible fr
he rele se f
his cells secre
in rduc
s in

1. P ne
h cell. C n
ell by
he eriher l h ls rund

he lumen?</div>"
i
s esinhilic secre
ry vesicles nd i
s ex
ensive RER.<div><br /></div><div>
2. Bec use i
s r
ein secre
r, yud
hink b shilic. Bu
n: I
s secre
i
n rduc
s re s si
ively ch rged
h
i
s <b>esinhilic</b>.</div><div><b
r /></div><div>3. Func
in: immune defense</div><div>Secre
in rduc
s: L c
fe
rrin, lyszyme, defensins (zinc cf c
r necess ry), erfrin, hshli se A2.
</div><div><br /></div><div>4. A

he <b>b

m</b> f
he cry
s
 <b>r
ec
<
/b>
he immedi
ely verlying <b>s
em cells</b>.</div><div><br /></div><div>5. T
he <b>sm ll in
es
ine</b>. N
fund in
he cln bec use b c
eri l grw
h
here
is necess ry fr micrnu
rien
rduc
in.</div><div><br /></div><div>6. <b>Muc
s l squeeze</b> (in
he sm ll in
es
ine, .k. . <b>micrvill r um</b>)</div>
in
es
ine
"<img src="" s
e-14452564951532.jg"" /><div><br /></div><div>1. Wh
cell
ye
is likely hiding

his blue line? Where des i
reside in
he cry
in
he sm
ll in
es
ine? Wh
bu
in
he cln?</div><div><br /></div><div>2. Wh
cell

yes des i
rduce mving <b>u</b>
he villus? Wh
s
heir
urnver r
e?</
div><div><br /></div><div>3.&nbs;Wh
cell
yes des i
rduce mving <b>dwn
</b>
he villus? Wh
s
heir
urnver r
e?</div><div><br /></div><div>4. Wh

is

her eu
ic cnsequence f
he difference be
ween nswers 2 nd 3?</div>"
1. S
em cell fund in
he lwer <b>h lf</b> f
he cry
s f Lieberkuhn in
he <
b>sm ll in
es
ine</b>. In
he cln, i
s fund in
he lwer <b>
hird</b>.<div><
br /></div><div>2. Gble
nd en
erendcrine cells. 2-3 d y
urnver.</div><div
><br /></div><div>3. P ne
h nd en
erendcrine cells. 30 d y
 1 ye r
urnver
.</div><div><br /></div><div>4. The <b>uw rd</b> migr
in is
he <b>ms
sensi

ive
 chem
her y</b> drugs in
he bdy :( while
he dwnw rd migr
in is l
rgely un ffec
ed.</div> in
es
ine
Micrvilli numbers:<div><br /></div><div>1. Hw
ll is
single micrvillus?</d
iv><div><br /></div><div>2. Hw
ll is n en
ercy
e?</div><div><br /></div><di
v>3. Hw m ny micrvilli er en
ercy
e?</div> 1. 1 micrn<div><br /></div><div
>2. 25 micrns</div><div><br /></div><div>3. 3000 micrvilli/en
ercy
e</div>
in
es
ine
Wh
re
he 4 cell
yes in
he bdy
h
h ve rngr hic lly lng micrvilli
?
1. En
ercy
e micrvilli<div>2. Ruffled brder f s
ecl s
s</div><div>
3. Prxim l cnvlu
ed
ubule simle clumn r ei
heli l cells</div><div>4. Brus
h cells f
he resir
ry ei
helium</div>
in
es
ine
"<div>Give
he r
ein(s) resen

e ch f
hese si
es.&nbs;</div><div><br />
</div><div>Fr #1, rvide
he n lgus r
ein in muscle.</div><div><br /></di
v><div>Wh
m
r 

ern des ll f
his llw? Wh
s i
s func
in?</div><div
><br /></div><img src="" s
e-16978005721580.jg"" />" 1. <b>Villin</b>. An lg
us
 <b>c Z</b>.<div><br /></div><div>2. <b>Fimbrin</b> nd <b>f scin</b> hl
d dense, rigid <b> c
in cres</b> f
he micrvilli
ge
her. <b>R di l links</b
>

he l sm membr ne hld ll
he diges
ive enzymes nd
r nsr
ers in l c
e
here.</div><div><br /></div><div>3. <b>Adherens junc
ins</b>&nbs;n
he l

er l l sm membr ne cre
e <b>
ermin l web</b> f c
in fil men
s in
 which

he fr yed, nn-bundled c
in fil men
s f
he micrvilli inser
.</div><div><br
/></div><div>4.<b>&nbs;Side l r mysin fil men
s </b>sliding lng&nbs;
he
c
in rduce
he...</div><div><br /></div><div>r ndm <b>micrvill r
wi
ch</b>,

which func
ins
 incre se
he r
e
which
he glycc lyx c 
ures diges
f
in
es
ine
r fin l diges
in nd bsr
in.</div>
"Wh
mech nism is ccuring in
hese ics? Describe i
fully.<div><br /></div><d
iv><img src="" s
e-9380208575004.jg"" /></div><div><br /></div><div><img src="
" s
e-9586367005163.jg"" /></div><div><br /></div><div><img src="" s
e-940168
3411436.jg"" /></div><div><br /></div><div><img src="" s
e-9423158247916.jg""
/></div>"
"<div><img src="" s
e-9650791514652.jg"" /></div><div><br /></
div><div><img src="" s
e-9672266351083.jg"" /></div><div><br /></div><div><img
src="" s
e-9693741187567.jg"" /></div><div><br /></div><div><img src="" s
e9753870729711.jg"" /></div><div><br /></div><img src="" s
e-5841155523103.jg"
" /><br /><div><br /></div><div><div>1.<s n cl ss=""Ale-
b-s n"" s
yle=""wh
i
e-s ce:re""> </s n>Triglycerides emulsified by bile s l
s, nd
hen hydrly
zed
 FFA, 2-mnglycerides, nd glycerl.</div><div><br /></div><div>2.<s n c
l ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>FFA , 2- mnglyceride
, nd glycerl diffuse  ssively crss l sm membr ne (r mre curren
ly h ve
secific c rriers).</div><div><br /></div><div>3.<s n cl ss=""Ale-
b-s n""
s
yle=""whi
e-s ce:re""> </s n>Bund in en
ercy
e cy
l sm by FFA c rrier 
r
eins.</div><div><br /></div><div>4.<s n cl ss=""Ale-
b-s n"" s
yle=""whi

e-s ce:re""> </s n>Delivered
 ic l vesicles where recns
i
u
ed in

ri
glycerides in vesicle lumen.</div><div><br /></div><div>5.<s n cl ss=""Ale-

b-s n"" s
yle=""whi
e-s ce:re""> </s n>P ss
hrugh Glgi  r
us nd
ke
n lir
eins.</div><div><br /></div><div>6.<s n cl ss=""Ale-
b-s n""
s
yle=""whi
e-s ce:re""> </s n>Chylmicr (devid f membr nes) rele sed in

 ex
r cellul r s ce be
ween en
ercy
es f
he jejunum by excy
sis.</div><di
v><br /></div><div>-Ms
FFA gre
er
h n 12 c rbns en
er l c
e ls nd lymh
i
c sys
emic dis
ribu
in.</div><div>-Ms
sm ll FFA (less
h n 10 c rbn mlecule
s) g direc
ly in
 c ill ries.</div><div><br /></div></div>" in
es
ine
"<img src="" s
e-19636590477853.jg"" /><div><br /></div><div>1. Wh
s
ruc
ure
is
his? Fill in
he bxes.</div><div><br /></div><div>2. Where lng
he GI
r
c
re
hese s
ruc
ures lc
ed? Hw m ny f
hem re
here?</div><div><br /></
div><div>3. Wh
s
he func
in f
his s
ruc
ure?</div><div><br /></div><div>4.
Give
he gu
l yers in which
his s
ruc
ure resides.</div><div><br /></div><div
>5. If yu s w SEM im ge lking dwn n
his s
ruc
ure,
hered be blbs nd
se nemne-like
hings (srry, I culdn
fr
he life f me find ic). Wh

re e ch f
hse s
ruc
ures?</div>"
"<div><img src="" s
e-20061792240157.j
g"" /></div><div><br /></div>1. This is n M cell verlying lymhid ndule in
Peyers 
ch.<div><br /></div><div>2. An
i-mesen
eric side f
he ileum. The
re re 10-200 lymhid ndules er Peyers 
ch. And bu
30 Peyers 
ches


l.</div><div><br /></div><div>3. An
igen resen

in cen
er. The micrfld (
.k. . M) cell is <b>cy
ker
in + n
igen resen
ing cell </b>
h
icks u l
umen l n
igens,
r ffics
hem
hrugh i
self nd i
s discn
inuus BL, nd res
en
s
hem in <b>l
er l cke
s</b>
 <b>m crh ges.</b>&nbs;These&nbs;
hen
resen

hem
 lymhcy
es.</div><div><br /></div><div>4. S
r
s in
he <b>l mi
n rri </b>. Burs
s crss
he muscul ris mucs in

he <b>submucs </b>.</
div><div><br /></div><div>5. Blbs re villi wi
h cn
inuus BL. Anemne
hings
re M cells wi
h discn
inuus BL.</div>"
in
es
ine
Give ll f
he si
es in
he bdy nd
he cell
yes
here
h
syn
hesize sIgA.
sIgA c n nly be secre
ed u
f <b>simle ei
helium</b>.<div>T be <b>dimeri
c</b>, i
mus
cme frm <b>l sm cells</b>.</div><div><br /></div><div><u>Res
ir
ry
ree</u></div><div>1. Serus cells in sermucus gl nds</div><div>2. Pl s
m cells in
he
ermin l nd resir
ry brnchiles</div><div>3. Pl sm cells i
n
he
hick lvel r w ll</div><div><br /></div><div><u>GI</u></div><div>1. Ser
us cells f
he s liv ry gl nds</div><div>2. In
r ei
heli l lymhcy
es f
he
c rdi c nd ylric regins</div><div>3. Diffuse immuncme
en
cells in
he l
min rri </div>
in
es
ine
Give
he mech nism by which sIgA is m de nd secre
ed in

he lumen. "<div>2
IgA mnmers +
J-iece
 hld
hem
ge
her s dimer re syn
hesized nd s
sembled in
he l sm cell.</div><div><br /></div><div>Excy
sis rele ses
his
IgA dimer. I
binds

rece
r n
he b s l side f n en
ercy
e (r 
her e
i
heli l cell) nd underges endcy
sis.</div><div><br /></div><div>During
r

fficking

he ic l PM,
he rece
r is cle ved bu
 r
f i
s
y bund


he IgA dimer nd is c lled
he secre
ry cmnen
. Once secre
ed in

he gu

lumen,
his r
ec
s
he r
ein frm den
ur
in in
he highly cidic s
m ch
envirnmen
nd frm r
elysis by diges
ive enzymes.</div><div><br /></div><di
v>The resence f
he secre
ry cmnen
bund

he dimer m rks
he n
ibdy
s <u>secre
ry</u> IgA, s sed
 regul r ld IgA.</div><div><img src="" s
in
es
ine

e-3216930505760.jg"" /></div>"
Why is
he n me surf ce bsr
ive cell n
s rri
e s en
ercy
e?
Bec use
hese cells re n
exclusively bsr
ive;
heyre ls secre
ing sIgA.
in
es
ine
G ver
he f
es f
hese n
ibdies in
he gu
.<div><br /></div><div>Als give
whe
her
heir mul
imeric nd if
hey re, which ___mer.<br /><div><br /></div><
div>IgM</div><div>IgA</div><div>IgG</div><div>IgE</div></div> "<div>IgM: <b>e
n
mer</b>
h
ls ge
s in

he lumen, bu
n
ne rly s effec
ively s IgA b
ec use IgM underges <b>incy

ic u
ke nd rele se by
he en
ercy
e</b>, n

rece
r-medi
ed endcy
sis wi
h cle v ge like IgA. <b>This is
he nly n
i
bdy cl ss
h
desn
g in

he lymh
ic c ill ries.</b></div><div><br /><
/div><div>IgA: becmes sIgA vi rece
r-medi
ed endcy
sis in
he en
ercy
e.
Als ge
s in

he lymh
ic c ill ries s regul r ld IgA.</div><div><br /></
div><div>IgG: In

he lymh
ic c ill ries.</div><div><br /></div><div>IgE: S

imul
es m s
cells nd ge
s in

he lymh
ic c ill ries.</div><div><br /></d
iv><div><img src="" s
e-4565550236704.jg"" /></div>" in
es
ine
"Wh
cell
ye re e ch f
hese?<div><br /></div><div>Wh
s
he difference be

ween
hem?</div><div><br /></div><div>Wh
s
imuli cn
rl e ch f
hese cells?
</div><div><br /></div><div><img src="" s
e-6760278524396.jg"" /></div><div><b
r /></div><div>vs.</div><div><br /></div><div><img src="" s
e-6773163426284.jg
"" /></div>"
"<img src="" s
e-6786048328175.jg"" /><div><br /></div><div><i
mg src="" s
e-6798933230060.jg"" /></div><div><br /></div><div>B sics n en
er
endcrine cells:</div><div><br /></div><div>-<b>One cell</b> secre
es <b>ne h
rmne</b>.</div><div>-<b>Oen cnfigur
in</b> sees
he lumen. Senses me
blic
rduc
s frm s liv ry myl se, esins, nd g s
ric li se. Als resnds
 m

r 

erns.</div><div>-<b>Clsed cnfigur
in</b>: secre
in cn
rlled nly
by m
r 

erns.</div><div>-<b>All hrmnes h ve en cnfigur
in cells.</b
></div><div><br /></div>"
in
es
ine
"Ann

e
his ic frm
he benevlen
Ang.<div><br /></div><div><img src="" s

e-8074538516975.jg"" /></div>" "<img src="" s
e-8237747274223.jg"" /><div><br
/></div><div>Heres n even be

er view f
he glycc lyx:</div><div><br /></di
v><div><img src="" s
e-8658654069276.jg"" /></div>" in
es
ine
"Wh
gu
segmen
is
his ic f? Wh
cri
eri did yu use in m king yur decis
in?<div><br /></div><div><img src="" s
e-10561324581356.jg"" /></div>"
"This lks like v lve f Kerckring, bu
i
s n
. I
s jus
fix
in r
if
c
f
he cn
r c
ing
eni cli. S, even
hugh
he cln h s n v lves f Ker
ckring, i
c n s
ill e r like i
des his
lgic lly.<br /><div><br /></div><
div><img src="" s
e-10587094385132.jg"" /></div><div><br /></div><div>Cri
eri
:</div><div>1. Tns f gble
cells</div><div>2. Dee cry
s f Lieberkuhn (2-3x
lnger
h n
he SI)</div><div>3. ""Shi
ss n
hing"" micrvilli</div><div>4. C
ells highly in
erdigi

ed fr
r nscellul r
r nsr
f w
er</div>" in
es
in
e
Cn
r s
w
er
r nsr
in
he sm ll in
es
ine nd
he cln. Sm ll in
es
ine:
lse
igh
junc
ins llw  r cellul r
r nsr
f w
er.<div><br /></div><d
iv>Cln:
igh

igh
junc
ins. En
ercy
es here um u
ins  r cellul rly.
In
r cellul r w
er fllws. In rder
 vid dehydr
in,
he cells
ke u w

er frm
heir PMs (
r nscellul rly). This h rdens
he fec l m ss.</div>
in
es
ine
The cln desn
h ve
n f
he fe
ures f
he sm ll in
es
ine. Give
he 3
func
ins f
he cln.<div><br /></div><div>Give sme fe
ures f
he sm ll in

es
ine
h
re NOT resen
in
he cln.</div> "<div><u>Func
ins:</u></div><di
v>1. Tr nscellul r bsr
in f w
er</div><div>2. Mucus secre
in</div><div>3.
Pu
ref c
in f b c
eri fr micrnu
rien
s</div><div><br /></div><div><u>NOT 
resen
</u></div>1. Li

le c rb, r
ein, nd f
bsr
in: n villi, shr
blu

n
micrvilli wi
h n huge glycc lyx, n cre-bund c
in fil men
s, n link r

eins, n micrvill r
wi
ch, few en
erendcrine cells.<div><br /><div>2. Less
immune cn
rl bec use b c
eri re imr
n
fr fiber bre kdwn
 shr
-ch i
n f

y cids nd fr rducing micrnu
rien
s: N P ne
h cells, sIgA, l c
ferr
in, lyszyme, erfrins, defensins, few M cells. In f c
,
he nly cmnen
f
GALT in
he cln is <b>diffuse lymh
ic ndules</b> (l min rri
 submuc
s ).</div></div><div><br /></div><div><img src="" s
e-15423227560428.jg"" /></
div>" in
es
ine
Q: Give
he 6 func
ins f
he sm ll in
es
ine. A: m jr diges
in, bsr
in,
m
ili
y, hrmne func
in, mucus rduc
in, GALT
Bren
sQs
Q: Wh
s n
her n me fr
he V lves f Kerckring?
A: lic e circul ris
Bren
sQs
Q: Wh
re
he differen
frms f m
ili
y fund in
he sm ll in
es
ine?
A: micrvill r
wi
ch, mucs l flu

er, vill r um, eris
lsis, segmen

in,
MMC, nd 
hlgic wer rulsin
Bren
sQs
Q: Where re
he V lves f Kerckring ms
rminen
?
A: jejunum
Bren
sQ
s
Q: Where re gble
cells mre bund n
,
he dudenum r ileum? A: ileum
Bren
sQs
Q: Wh
re Brunners gl nds?&nbs;
A: mucus gl nds
h
rduce lk line mu
cus (H 8.1-9.3)
 neu
r lize cidic chyme nd llw 
imiz
in f  ncre
ic
enyzmes;
hey h ve n myei
heli l cells bec use GI mvemen
is sufficien
&nbs
Bren
sQs
;
Q: In wh
l yer f
he gu
re Brunners gl nds fund? Why is
his signific n
?
A: fund in submucs ;
he nly 
her gl nds in
he gu

h
re in
he submucs
re
he esh ge l gl nds; ll 
her gl nds cme
 n bru
h l


he musc
ul ris mucs
Bren
sQs
Q: Wh

ye f bsr
in
kes l ce in
he ileum?
A: bile s l
bsr
in,
B12+IF Bren
sQs
Q: Wh
sec
in f
he sm ll in
es
ine re Brunners gl nds fund?
A: dude
num
Bren
sQs
Q: Wh
h ve erm nen
cre f submucs nd rjec
1 cm in

he gu
lumen?
A: v lves f Kerckring (lic e circul ris)
Bren
sQs
Q: Wh
h ve cre f l min rri nd rjec
1mm in

he gu
lumen?
A: villi
Bren
sQs
Q: Where re M cells lc
ed in
he gu
?
A: ileum
Bren
sQs
Q: Hw des gble
cell densi
y ch nge frm dudenum

he ileum?
A: incre
se, nd
heres
ns in
he cln
Bren
sQs
Q: Hw des en
ercy
e densi
y ch nge frm dudenum

he ileum?
A: decre
ses; highes
in dudenum nd li

le in ileum; very few in cln
Bren
sQ
s
Q: Where re cry
s f Lieberkuhn fund?
A: be
ween villi
Bren
sQ
s
Q: Where re
he s
em cells fund wi
hin
he cry
s f Lieberkuhn?
A: in l
wer h lf;
hey exhibi
unidirec
in l migr
ry 

ern wi
h exfli
in; diff
eren
i
in nd m
ur
in incre se
w rd
he ex f
he villi (
hus migr
in
culed
 differen
i
in nd m
ur
in)
Bren
sQs
Q: Wh
cells re fund

he b

m f
he cry
s f Lieberkuhn?
A:  ne

h cells ( r
f GALT) Bren
sQs
Q: Wh
re
he func
ins f  ne
h cells?
A: syn
hesize l c
ferrin, lysz
yme, defensins Bren
sQs
Q: Why ren
 ne
h cells fund in
he cln? A: bec use we w n
b c
eri
 g
rw in
he cln
Bren
sQs
Q: Wh
s his
lgic lly signific n
reg rding  ne
h cell secre
ry gr nules?
"A:
he secre
ry gr nules h ve eriher l h ln 
her lks
his w y!!<div><i
mg src="" s
e-65274912964609.jg"" /></div>" Bren
sQs
Q: Wh
s
he vill r um nd hw des i
wrk? A:
he lngi
udin l nd circul r
sm
h muscle inside
he villus rm
es
he mixing f chyme,  ncre
ic enzyme
s, nd bile s l
s rund
he villi;
he lngi
udin l shr
ens villus wi
h
he ci
rcul r elng
es
he villus;
his hels ush l c
e l cn
en
s dwn
Bren
sQ

s
Q: N me s
ruc
ures fund wi
hin
he villus?
A: e ch villus h s circul r nd
lngi
udin l sm
h muscle frm
he inner circul r l yer f
he muscul ris mucs
, c ill ry bed, l c
e l, nd sensry nd m
r unmyelin
ed nerve fibers f
rm Meissners lexus Bren
sQs
Q: Wh

ye f secre
in d P ne
h cells underg?
A: mercrine regul
ed s
ecre
in
Bren
sQs
Q: Wh
rjec
ins re 1 micrn
ll nd re fund n en
ercy
es?
A: micr
villi Bren
sQs
Q: Where else d we see ex
remely lng/develed micrvilli?
A: ruffled brde
r f s
ecl s
s nd micrvilli f PCT nd n brush cells f resir
ry ei
hel
ium
Bren
sQs
Q: The micrvilli require n c
in cre
 reven
cll se. &nbs;Give de
ils
A:
heres rigid bundled c
in fil men
s in
he cre bund
n
his s
ruc
ure.
by fimbrin nd f scin wi
h r di l links

he l sm membr ne in rder
 
c
h nd hld
he diges
ive enzymes nd
r nsr
ers;

he
i f e ch micrvillu
s is villin
Bren
sQs
Q: Wh
r
ein in skele
l muscle is villin n lgus
?
A: Z-line lh
c
inin Bren
sQs
Q: Where is
he bigges
glycc lyx in
he hum n bdy? A: en
eric c
Bren
sQ
s
Q: Wh
s
he urse f
he micrvill r
wi
ch?
A: incre ses
he rb bili
y
h

diges
is brugh
in

he glycc lyx
 be mixed wi
h
he  ncre
ic enzymes
fr
he
ermin l s
es f diges
in s
h

ched
r nsmembr ne enzymes nd c
rriers c n e sily u
ke min cids (4 cl sses), die
ides,
rie
ides, e
c
Bren
sQs
Q: Are
he  ncre
ic diges
ive enzymes fund redmin n
ly in
he GI lumen?
A: N,
heyre fund in
he glycc lyx
herefre
he lumen is lw in enzyme nd dige
s
cn
en
;
he fin l s
es f diges
in re cmle
ed ne r
he micrvilli l s
m membr ne
 f cili

e efficien
bsr
in Bren
sQs
"Wh
culd
his SEM be shwing? (2)<div><br /></div><div><img src="" s
e-15453
292331500.jg"" /></div>"
"<img src="" s
e-15466177233388.jg"" />"
in
es
ine
Q: Wh

ye f in
ermedi
e fil men
is fund in M-cells?
A: cy
ker
in
Bren
sQs
Q: Wh
s
he func
in f M-cells?
A:
hey selec
ively endcy
se n
igens
nd
r nsr

hem

he underlying m crh ges nd lymhcy
es which
hen migr

e
 lymh ndes where immune resnses
 freign n
igen re ini
i
ed; M ce
lls
hus serve s s mling s

ins where m
eri l in
he lumen f
he gu
is
r
nsferred
 immune cells
Bren
sQs
Q: Wh
s
he s
ruc
ure f M-cells?
"A:
hey re highly inv gin
ed n fr
gmen
ed sieve-like b semen
membr ne,
king u n
igen nd resen
ing i
in


he l
er l cke
s
 m crh ges&nbs;<div><img src="" s
e-67491116089345.jg"
" /></div>"
Bren
sQs
Q: Where re M cells ms
cncen
r
ed? A: ileum
Bren
sQs
Q: Wh
 r
f
he sm ll in
es
ine des ms
f
bsr
in
ke l ce?
A: jejunum
Bren
sQs
Q: Hw re liids rcessed nd bsrbed in
he en
ercy
e?
A: bile cmnen

s in
he lumen emulsify f
in
 liid drle
s which re brken dwn fur
her i
n
 FFA, 2-mnglycerides nd glycerl;
hese cmnen
s diffuse crss membr ne
(m y h ve secific c rriers);
hey re
hen resyn
hesized in

riglcyerides n
d rcessed
hrugh
he RER nd glgi where
hey ick u r
eins; nw
heyre
chylmicrns nd re
r nsferred

he l
er l cell membr ne, secre
ed by excy

sis, nd flw in

he ex
r cellul r s ce where
hey en
er l c
e ls Bren
sQ
s
"Wh
is
his muscle in
he cln? Be secific bu
i
s l yers.<div><br /></div
><div><img src="" s
e-15792594747884.jg"" /></div>" Muscul ris ex
ern :<div>
<br /></div><div>Inner circul r like usu l</div><div><b>Ou
er lngi
udin l is 3
b nds f
eni cli</b></div> in
es
ine
Q: FFAs gre
er
h n ____ c rbns en
er l c
e ls nd lymh
ic sys
emic dis
ribu


in. A: 12 Bren
sQs
Q: Ms
sm ll FFAs less
h n ___ c rbns d direc
ly in
 c ill ries. A: 10
Bren
sQs
Q: Is
here exfli
in r desqu m
in

he
is f villi? exfli
in
Bren
sQs
"Wh
gu
segmen
is
his ic shwing?<div><br /></div><div><img src="" s
e-161
87731739116.jg"" /></div>"
"Cln<div><br /></div><div><img src="" s
e-162
00616641007.jg"" /></div>"
in
es
ine
"Wh
m
r 

ern is
his exerimen
demns
r
ing?<div><br /></div><div><img
src="" s
e-16591458664988.jg"" /></div>"
"<img src="" s
e-16604343566876
.jg"" />"
in
es
ine
"1. Wh
s
ruc
ure d b
h f
hese ics shw? Wh
is
he difference be
ween
h
em?<div><div><br /></div><div>2. Wh
infl mes
his s
ruc
ure? Wh
s
he risk
ssci
ed wi
h
his infl mm
in?</div></div><div><br /></div><div><img src=""
s
e-16973710754284.jg"" /></div><div><br /></div><div><img src="" s
e-16986595
656172.jg"" /></div>" "<img src="" s
e-17008070492655.jg"" /><div><br /></di
v><div><img src="" s
e-17033840296431.jg"" /></div><div><br /></div><div>3. A
endici
is</div><div>Yu
h: usu lly cln l ex nsin f
er vir l infec
in</div>
<div>Adul
: usu lly iece f shi
in
he lumen ( .k. . fec l en
r men
)</div><d
iv>Risk: ru
ure--&g
;b c
eri ge
u
in

he eri
neum--&g
;eri
ni
is.</di
v>"
in
es
ine
Q: Wh
re
he 5 me ns
 incre se surf ce re in
he sm ll in
es
ine?
A: leng
h (20 fee
), v lves f Kerckring, villi, micrvilli, glycc lyx Bren
sQ
s
Q: Which m
ili
y 

ern is
mdified mucs l squeeze
h
hels ge

riglycer
ides u
f l c
e ls? A: vill r um<div><br /></div> Bren
sQs
Q: Which m
ili
y 

ern func
ins in GALT?
A: MMC<div><br /></div> Bren
sQ
s
Q: Which cells secre
e sIgA in
he sm ll in
es
ine?
A:
he IgA dimer is syn

hesized by l sm cells f
he l min rri ;
he secre
ry cmnen
is syn
he
sized by
he ei
heli l cell s

r nsmembr ne glycr
ein nd serves s rec
e
r n i
s b sl
er l surf ce fr binding
he IgA dimer;
he secre
ry cmn
en
-IgA cmlex en
ers
he cell nd is exsed

he ic l surf ce;
he  r

f
he secre
ry cmnen

h
is bund

he IgA dimer is
hen cle ved frm i

s
r nsmembr ne
il nd
his rele ses
he IgA dimer in

he in
es
in l lumen;

he IgA wi
h i
s secre
ry cmnen
nd dimeric J iece m ke i
INERT
 des
ru
c
in by diges
ive enzymes
Bren
sQs
Q: Wh
s
he shr
es
sec
in f
he sm ll in
es
ine? A: dudenum
Bren
sQ
s
Q: Wh
sec
in f
he sm ll in
es
ine h s M cell n
igen resen

in bve Pey
ers 
ches? A: ileum
Bren
sQs
Q: Wh
seci l gl nds re fund wi
hin
he dudenum? A: Brunners gl ndssecre
es
lk line mucus
 neu
r lize nd lubric
e cidic chyme
Bren
sQs
Q: Where re en
erendcrine cells (EEC) fund nd wh
d
hey secre
e?
A: fund
b

m f cry
s f Lieberkuhn;
he secre
e secre
in, CCK, sm
s

Bren
sQs

in, m
ilin
Q: Wh
is
he
urnver r
e fr en
ercy
es nd gble
cells? A: 2-3 d ys -&g

;
hus h ve high susce
ibili
y
 chem
her y
Bren
sQs
Q: Cm re
he c ill ry beds fund in
he
i f
he villus nd
he cry
s.
A: c ill ry is densi
y

i nd is cn
inuus, fenes
r
ed w/ di hr gm ( bs
r
in f nu
rien
s) where s c ill ry is le s
dense in cry
s nd is cn
inuu
s nn-fenes
r
ed (m in
ins  ne
h nd EEC cells)
Bren
sQs
Q: Wh
r
eins bundle c
in in
he micrvilli?
A: fimbrin nd f scin
Bren
sQs
"N me
his cell<div><img src="" s
e-72314364362753.jg"" /></div>"
A:  ne

h cells Bren
sQs
Q: N me
w 
her l ces (besides GI) where sIgA is rduced? A: s liv ry gl n
ds, resir
ry
ree
Bren
sQs
Q: N me 7 cmnen
s f GALT in
he sm ll in
es
ine.
A: M cells ( n
igen res
en
ing cells), diffuse lymhcy
es (receive n
igen resen

in frm M cells; P

eyers 
ches), P ne
h cell, MMC, IgG/IgE/IgA (frm l sm cells), IgM, sIgA
Bren
sQs
Q: Wh
hrmne is secre
ed by
he G cells in
he n
rum f
he s
m ch?
A: g s
rin
Bren
sQs
Q: Hw lng is li

le g s
rin? When is i
secre
ed?
A: 17 min cids; i
s
h
e frm f g s
rin secre
ed in resnse

me l
Bren
sQs
Q: Hw lng is big g s
rin? &nbs;When is i
secre
ed? A: 34 min cids lng;
i
s secre
ed be
ween me ls
Bren
sQs
Q: Wh
hrmne is
he m jr hysilgic l regul
r f g s
ric secre
in?
A: g s
rin; I
ls h s n imr
n

rhic r grw
h-rm
ing influence n
h
e g s
ric mucs . G s
rin is syn
hesized in G cells, which re lc
ed in g s
ri
c i
s, rim rily in
he n
rum regin f
he s
m ch nd binds rece
rs fund
Bren
sQ
redmin n
ly n  rie
l nd en
erchrm ffin-like cells.&nbs;
s
Q: Describe
he rduc
in nd subsequen
mdific
in f g s
rin.
"<div>A:
G s
rin is line r e
ide
h
is syn
hesized s rerhrmne nd is s

r nsl
in lly cle ved
 frm f mily f e
ides wi
h iden
ic l c rbxy
ermi
ni.</div><div>The redmin n
circul
ing frm is g s
rin-34 (""big g s
rin""),
bu
full bilgic c
ivi
y is resen
in
he sm lles
e
ide (g s
rin-14 r min
ig s
rin); G s
rin rece
rs re fund n  rie
l cells, nd binding f g s
rin
, lng wi
h his
mine nd ce
ylchline, le ds
 fully-s
imul
ed cid secre
i
n by
hse cells. En
erchrm ffin-like (ECL) cells ls be r g s
rin rece
rs
, nd recen
evidence indic
es
h

his cell m y be
he ms
imr
n

rge

f g s
rin wi
h reg rd
 regul
ing cid secre
in. S
imul
in f ECL cells by
g s
rin le ds
 his
mine rele se, nd his
mine binding
 H2 rece
rs n 
rie
l cells is necess ry fr full-blwn cid secre
in. In ddi
in

he  ri
e
l nd ECL cell
rge
s, g s
rin ls s
imul
es  ncre
ic cin r cells vi b
inding
 chlecys
kinin rece
rs. Prm
in f g s
ric mucs l grw
h h s bee
n demns
r
ed by dminis
r
in f g s
rin
 r
s. This
re
men
s
imul
ed D
NA, RNA nd r
ein syn
hesis in g s
ric mucs
nd incre sed numbers f  rie

l cells;
his effec
w s blcked by
g s
rin/CCK n
gnis
. An
her bserv
i
n sur
ing
his func
in is
h
hum ns wi
h hyerg s
rinemi cnsis
en
ly sh
w g s
ric mucs l hyer
rhy. &nbs; &nbs; &nbs; &nbs; &nbs; &nbs; &nbs;
&nbs; &nbs; &nbs; &nbs; &nbs; &nbs;&nbs;</div><div><br /></div>" Bren
sQ
s
Q: Wh

hlgy is ssci
ed wi
h excessive g s
rin secre
in?
A: Exces
sive secre
in f g s
rin, r hyerg s
rinemi , is
well-recgnized c use f
severe dise se knwn s Zllinger-Ellisn syndrme, which is seen
lw frequen
cy in m n nd dgs. The h llm rk f
his dise se is g s
ric nd duden l ulcer

in due
 excessive nd unregul
ed secre
in f g s
ric cid. Ms
cmmnly, h
yerg s
rinemi is
he resul
f g s
rin-secre
ing
umrs (g s
rinm s), which d
evel in
he  ncre s r dudenum.&nbs;
Bren
sQs
Q: Ch r c
erize
he rele se f g s
rin frm G cells.
A: Rele se f g s
rin fr
m
he G-cells is regul
ed by
hree m jr 
hw ys : 1) Lumin l nu
rien
s (i.e.
min cids, eseci lly rm
ic), die
ry mines nd C 2+, s
imul
e secre
in
f g s
rin frm G-cells resum bly by c
ing direc
ly n rece
rs lc
ed n

he lumin l side f
he G-cells. 2) G s
ric nerves, which in resnse
 lc l n
d cen
r l sign ls rele se g s
rin-rele sing e
ide nd ce
ylchlin, b
h subse
quen
ly induce g s
rin secre
in frm
he G-cells
hrugh in
er c
in wi
h
heir
resec
ive rece
rs. 3) Sm
s

in, which rele sed in  r crine m nner fr
m
he n
r l D-cells when
he g s
ric H is belw 2-3 nd le ds
 inhibi
in f
g s
rin rele se
Bren
sQs
Q: The minim l fr gmen
fr necess ry bilgic l c
ivi
y f g s
rin is hw m ny
min cids lng?
"A: 4; i
s
he C-
ermin l
e
r e
ide; ls n
e
he cm
mn sequences be
ween g s
rin nd CCK (
heres rece
rs
h
bind b
h f
hem bu

wi
h differen
ffini
ies)<div><img src="" s
e-26869315403780.jg"" /></div>"
Bren
sQs
Q: Wh
re
he
w m jr c
ins f g s
rin? <div>A: i
s
imul
es H+ secre
i
n by
he g s
ric  rie
l cells nd i
s
imul
es grw
h f
he g s
ric mucs ;
fr ex mle in ersns wi
h g s
rin-secre
ing
umrs (Zllinger-Ellisn syndrm

e)
he H+ secre
in is incre sed nd
he g s
ric mucs hyer
rhies</div><div>

<br /></div><div><br /></div><div>N
e
h
his
mine (H2) rece
r c uses H+ se
cre
in s well s direc
ACh s
imul
in</div><div><br /></div>
Bren
sQ
s
Q: Wh
s
he 
hhysilgy f Zllinger-Ellisn syndrme?
A: c used by g
s
rin-secre
ing
umr ( k g s
rinm ); c uses incre sed H+ secre
in f  rie

l cells nd hyer
rhy f
he g s
ric mucs nd duden l ulcers frm
he unre
len
ing secre
in f H+;
re
men
includes dminis
r
in f H2 rece
r blcki
ng drugs (ie cime
idine) r dminis
r
in f inhibi
rs f
he H+ um (mer z
Bren
sQs
le) r remv l f
he
umr
Q: Hw re CCK(b) nd CCK( ) differen
? A: CCK(b) is
he rece
r fr g s
rin, w
hile CCK( ) refers CCK Bren
sQs
Q: Wh
hrmne suresses secre
in f g s
ric cid nd esin? &nbs;Wh
else
?
A: Sm
s

in; i
ls lwers
he r
e f g s
ric em
ying, reduces sm

h muscle cn
r c
in, nd decre ses bld flw wi
hin
he in
es
ine; i
m inl
y inhibi
s
he secre
in f m ny 
her hrmnes (ie g s
rin, CCK, secre
in, nd
VIP); frm Cs
nz: sm
s

in is secre
ed by D cells (b
h endcrine nd  r
crine) f
he GI mucs in resnse
 decre sed lumin l H; in
urn i
inhibi

s secre
in f
he 
her GI hrmnes nd inhibi
s g s
ric H+ secre
in Bren
sQ
s
Q: Wh
secre
es sm
s

in? A: s
m ch,  ncre s, sm ll in
es
ine nd hy
h
l mus Bren
sQs
Q: Wh
re
he differen
h ses f g s
ric cid secre
in?
A: res
ing (in
e
rdiges
ive), ceh lic (hysic nd gus


ry), g s
ric (lc l reflexes), in
es
i
n l (duden l) Bren
sQs
Q: Wh
re
he 2 secre
ry rduc
s f  rie
l cells? A: HCl nd in
rinsic f c
Bren
sQs

r
Q: Wh
secific um is in ch rge f secre
ing H+ in

he s
m ch lumen?
A: H+-K+ ATP se n
he ic l membr ne f  rie
l cells; Hw H+ is m de wi
hin

he cell: in
he in
r cellul r fluid CO2 cmbines wi
h H20
 rduce H2CO3 vi

he enzyme c rbnic nhydr se;
he H+ is secre
ed lng wi
h Cl- (vi Cl ch nnel
s) in

he lumen f
he s
m ch nd
he HCO3 is re bsrbed in

he bld (vi
HCO3-Cl exch nger);
his HCO3 is resnsible fr
he lk line
ide
h
c n be 
bserved in g s
ric venus bld f
er me l
Bren
sQs
Q: N me 3 subs
nces
h
s
imul
e H+ secre
in by g s
ric  rie
l cells.
A: ACh (neurcrine), his
mine ( r crine), g s
rin (endcrine) Bren
sQs
Q: Wh
rece
r des ACh bind
 incre sed H+ secre
in?
A: ACh frm
he
v gus nerve binds
 musc rinic (M3) rece
rs n
he  rie
l cells resul
ing i
n H+ secre
in Bren
sQs
Q: Wh
rece
r des his
mine bind
 incre se H+ secre
in? A: his
mine is
rele sed frm ECL (en
erchrm ffin-like cells) in
he g s
ric mucs
nd diffuse
s vi  r crine

he ne rby  rie
l cells where i
binds
 H2 rece
rs
Bren
sQs
Q: Hw des g s
rin effec
H+ secre
in?
A: g s
rin is secre
ed in

he
circul
in frm G cells in
he s
m ch n
rum nd re ches
he  rie
l cells vi
n endcrine mech nisms; g s
rin binds
 CCK(b) rece
rs n
he  rie
l cel
ls; rec ll
h
g s
rin secre
in is s
imul
ed by dis
en
in f
he s
m ch, r
esence f sm ll e
ides nd min cids, nd s
imul
in f
he v gus nerve
Bren
sQs
Q: Ch r c
erize
he ceh lic h se f g s
ric cid secre
in. A:
he s
imuli f
r HCl secre
in re smelling nd
s
ing, chewing, sw llwing, nd
he n
ici

in f fd;
his c uses v g l s
imul
in f
he  rie
l cells
 secre
e HCl
nd v g l s
imul
in f
he G cells (vi GRP) which c uses g s
rin
 en
er ci
rcul
in nd s
imul
e
he  rie
l cells
 secre
e HCl
Bren
sQs
Q: Ch r c
erize
he g s
ric h se f g s
ric cid secre
in.
A: s
imuli is
h
e dis
en
in f
he s
m ch nd resence f bre kdwn rduc
s f r
ein (ie AA
s nd sm ll e
ides); dis
en
in c uses direc
s
imul
in f  rie
l cells n
d indirec
s
imul
in f  rie
l cells vi g s
rin rele se; dis
en
in f
he
n
rum c uses
lc l reflex nd
he rele se f g s
rin Bren
sQs
Q: Which rece
r, CCK( ) r CCK(b), h s higher ffini
y fr CCK?
A: CCK(

)
Bren
sQs
Q: Wh
medi
es
he in
es
in l h se f g s
ric cid secre
in?
"A: rd
uc
s f r
ein diges
in ( min cids)<div><img src="" s
e-30859340021764.jg"
" /></div>"
Bren
sQs
Q: Hw des sm
s

in ffec
H+ secre
in? A: i
inhibi
s H+ secre
in
hr
ugh b
h direc
nd indirec

hw ys; direc
sm
s

in binds
 rece
rs n
 rie
l cells
h
re culed
 G(i) nd
hus cAMP levels re reduced; indir
ec
i
inhibi
s his
mine rele se frm
he ECL cells nd g s
rin rele se frm
h
e G cells
Bren
sQs
Q: Discuss
he lng-
erm risks f cid suressin.
"A: hychlrhydri (lw
levels f HCl) nd hyerg s
rinemi (l
s f g s
rin). As illus
r
ed, hychl
rhydri , which is resnsible fr
he hyerg s
rinemi , c n direc
ly le d
 im
ired bsr
in f irn nd vi
min B12 nd
wrsening f Helicb c
er ylri
g s
ri
is. Hychlrhydri ls le ds
 b c
eri l vergrw
h, which incre ses 
rduc
in f g s
ric ni
rs mines,
knwn c rcingen nd risk f c
r fr g s
ri
c den c rcinm . Hyerg s
rinemi is shwn
 resul
in benign g s
ric fundic
lys nd en
erchrm ffin cell hyerl si .&nbs;<div><img src="" s
e-3107838
3353860.jg"" /></div>" Bren
sQs
Q: Wh
hrmne is rele sed in resnse
 H+ in
he sm ll in
es
ine? A: secre

in; i
rm
es
he secre
in f  ncre
ic nd bili ry HCO3 nd i
inhibi
s g
s
ric em
ying; neu
r liz
in f H+ is essen
i l fr f
diges
in since  ncre

ic li ses h ve H 
imums be
ween 6 nd 8 nd
hey re in c
iv
ed/den
ured
when H is less
h n 3; frm cl ss - The sm ll in
es
ine is eridic lly ss ul

ed by fld f cid frm
he s
m ch, nd i
is imr
n

 u
u

h
fir
e in hurry
 vid cid burns. Secre
in func
ins s

ye f firem n: i
is
rele sed in resnse
 cid in
he sm ll in
es
ine, nd s
imul
es
he  ncre
s
 rele se fld f bic rbn
e b se, which neu
r lizes
he cid; Secre
in i
s secre
ed in resnse
 ne knwn s
imulus: cidific
in f
he dudenum, whi
ch ccurs ms
cmmnly when liquified inges
frm
he s
m ch re rele sed in


he sm ll in
es
ine. The rinci l
rge
fr secre
in is
he  ncre s, which
resnds by secre
ing bic rbn
e-rich fluid, which flws in

he firs
 r

f
he in
es
ine
hrugh
he  ncre
ic duc
. Bic rbn
e in is b se nd serv
es
 neu
r lize
he cid,
hus reven
ing cid burns nd es
blishing H cnd
ucive

he c
in f 
her diges
ive enzymes. A simil r, bu
qu n
i

ively le
ss imr
n
resnse
 secre
in is elici
ed by bile duc
cells, resul
ing in
ddi
in l bic rbn
e being dumed in

he sm ll gu
. As cid is neu
r lized by
bic rbn
e,
he in
es
in l H rises
w rd neu
r li
y, nd secre
in f secre

in is
urned ff.&nbs; Bren
sQs
Q: ____ is secre
ed in resnse
 f

y cids nd min cids in
he sm ll in
e
s
ine. "A: CCK; CCK ensures
h

he rri
e  ncre
ic enzymes nd bile s
l
s re secre
ed
 id in diges
in nd re bsr
in; Fds
uffs flwing in


he sm ll in
es
ine cnsis
ms
ly f l rge m crmlecules (r
eins, lys cch r
ides nd
riglyceride)
h
mus
be diges
ed in
 sm ll mlecules ( min cids,
mns cch rides, f

y cids) in &nbs;rder
 be bsrbed. Diges
ive enzymes f
rm
he  ncre s nd bile s l
s frm
he liver (which re s
red in
he g llbl d
der) re cri
ic l fr such diges
in. Chlecys
kinin is
he rincile s
imulus
fr delivery f  ncre
ic enzymes nd bile in

he sm ll in
es
ine. The ms


en
s
imuli fr secre
in f chlecys
kinin re
he resence f  r
i lly-dig
es
ed f
s nd r
eins in
he lumen f
he dudenum (  r
icul rly 
en
s
im
ulus is ic
ured bve)<div><img src="" s
e-31460635443204.jg"" /></div>"
Bren
sQs
Q: The C-
ermin l five min cids f CCK re iden
ic l

hse f ______.
g s
rin Bren
sQs
Q: Wh
re
he c
ins f CCK? A: cn
r c
in f
he g ll bl dder w/ simul
ne
us rel x
in f
he shinc
er f Oddi ejec
bile frm
he g llbl dder in

he
sm ll in
es
ine; secre
in f  ncre
ic enyzmes (ie li ses, myl ses, r
e s
es); secre
in f HCO3 frm
he  ncre s; inhibi
in f g s
ric em
ying (
hus i
ncre ses g s
ric em
ying
ime which is cri
ic l fr
he rcesses f f
diges

in nd bsr
in)
Bren
sQs
Q: Wh
s
he func
in f GIP? A: inhibi
s cid secre
in nd g s
ric em
ying;

n
her func
in f GIP is
 induce insulin secre
in, which is s
imul
ed ri
m rily by hyersml ri
y f glucse in
he dudenum
Bren
sQs
Q: ____ is secre
ed in
 circul
in during
he f s
ed s

e
in
erv ls f ru
ghly 100 minu
es.
"A: M
ilin; These burs
s f m
ilin secre
in re
em
rily rel
ed

he nse
f ""husekeeing cn
r c
ins"", which swee
he s
m
ch nd sm ll in
es
ine cle r f undiges
ed m
eri l ( ls c lled
he migr
ing
m
r cmlex).&nbs;" Bren
sQs
Q: True r f lse: P ncre
ic myl se nd li ses re secre
ed s c
ive enzymes
while  ncre
ic r
e ses re secre
ed in in c
ive frms.
A:
rue; fr ex
mle
he  ncre s secre
es
rysingen which is cnver
ed in
he in
es
in l lume
n

rysin;
he  ncre
ic enzymes re m de in
he cin r cells
Bren
sQ
s
Q: Which cells f
he excrine  ncre s re resnsible fr HCO3 secre
in?
A: duc
l ei
heli l cells
Bren
sQs
Q: N me sme  ncre
ic cin r secre
ins.
A: rec ll
h

he cin r cells
secre
e
he enzym
ic r
in f
he  ncre
ic secre
in; r
ely
ic
rysing
en, chym
rysingen, rc rbxye
id se, r mine
id se; mylli
ic lh
myl se; lili
ic li se, hshli se, cli se; nuclely
ic ribnucle se, de
xyribnucle se Bren
sQs
Q: Why des
he  ncre s n
ge
u
diges
ed? "A: V rius r
ec
ive mech nism
s reduce
he likelihd f rem
ure c
iv
in f
rysingen

rysin wi
hin

he  ncre
ic  renchym nd ini
i
in f u
diges
in f
he  ncre s. Thes
e include
he secre
in f ms
diges
ive enzymes in
heir in c
ive recursr f
rms ( s zymgens [eg,
rysingen]) in ddi
in

he  ck ging f secre
ry r

eins in membr ne-bund s
r ge cm r
men
s (zymgen gr nules). Addi
in lly,

rysin inhibi
rs resen
in  ncre
ic
issue, nd in  ncre
ic secre
ins, c
n in c
iv
e sm ll mun
s f
rysin, if resen
. Fur
hermre,
he ressure gr
dien
be
ween
he  ncre
ic duc
nd
he bile duc
r dudenum f vrs
he flw
f  ncre
ic secre
ins u
f
he gl nd in

he dudenum, which mi
ig
es g
ins
reflux f bile r duden l juice in

he  ncre s.<div><img src="" s
e-3
2628866547716.jg"" /></div>" Bren
sQs
Q: Hw d cin r nd duc
l secre
ins differ in
he  ncre s? "A: Acin r secre

in is l sm -like fluid
h
is redmin n
ly sdium chlride,where s duc
ul
r secre
in is redmin n
ly sdium bic rbn
e<div><img src="" s
e-3274483066
4708.jg"" /></div>"
Bren
sQs
Q: Wh
s
he mech nism f bic rbn
e secre
in by  ncre
ic cells? "A: Bic
rbn
e is derived frm c rbnic cid which is frmed frm c rbn dixide nd w

er diffusing in frm
he in
ers
i
i l side. C rbnic nhydr se c
lyzes
he r
duc
in f HCO3- nd H+ frm c rbnic cid. HCO3- is
hen
r nsr
ed crss
h
e lumin l l sm membr ne by HCO3-/Cl- exch nger. &nbs;The m in surce f lum
in l Cl- in is
he cys
ic fibrsis
r nsmembr ne regul
r (CFTR), which is def
ec
ive in 
ien
s ffec
ed by cys
ic fibrsis. &nbs;Pr
ns gener
ed during

he rduc
in f HCO3 mus
be r idly
r nsr
ed u
f
he cells, nd
his cc
urs
hrugh
w differen
mech nisms. &nbs;One invlves N +/H+ exch nge,
he 

her invlves
he resence f H+/K+ ATP se (r
n um) in
he b sl
er l mem
br ne. &nbs;This r
n um is differen
frm
he ne fund in
he s
m ch nd
resembles func
in lly
he ne fund in kidneys nd dis
l cln. A N +/K+ ATP
se is ls resen
in
he b sl
er l membr ne, necess ry fr
he rduc
in f

he f vr ble elec
rchemic l gr dien
fr Cl- secre
in. N +, sme K+, nd w

er ccm ny HCO3 secre
in, ms
ly en
ering
he duc
lumen by  ssive  r cell
ul r diffusin.<div><img src="" s
e-32938104193028.jg"" /></div>"
Bren
sQ
s
Q: Wh
rg ns re ffec
ed by cys
ic fibrsis? A: irw ys (clgging nd infec
i
n f brnchi l  ss ges), liver (lugging f sm ll bile duc
),  ncre s (cclus
in f duc
s reven
s delivery f diges
ive enzymes), sm ll in
es
ine, rerduc

ive
r c
; P ncre
ic insufficiency le ding
 m l bsr
in nd f ilure

hri
ve is cmmn mde f resen

in f cys
ic fibrsis. 85% f CF 
ien
s suffe
r frm  ncre
ic insufficiency. The isl
in f
he cys
ic fibrsis gene h s s
hwn
h
 ncre
ic insufficiency is ssci
ed wi
h cer
in mu

ins nd n

wi
h 
hers -
he henyl l nine 508 dele
in mu
n
is frequen
ly ssci
ed wi

h  ncre
ic insufficiency. &nbs;Tre
men
is wi
h  ncre
ic enzyme sulemen

s, nd effr
s shuld be m de
 ensure high c lrie nd r
ein levels in
he d
ie
,
ge
her wi
h dded vi
mins
Bren
sQs
Q: Describe hw cys
ic fibrsis le ds
  ncre
ic insufficiency.
"A: The
 ncre s ffec
ed by cys
ic fibrsis is ms
vulner ble
 lumen l cncen
r
in
defec
s c used by
he high r
ein cn
en
f cin r secre
ins nd deendence
n duc
l cys
ic fibrsis
r nsmembr ne cnduc
nce regul
r fr nin (chlrid
e nd bic rbn
e) nd fluid secre
in. When duc
l w
er flw is reduced wing

 defec
ive nin secre
in, r
ein cncen
r
in in
he duc
rises. High r

ein cncen
r
in c uses recii

in f r
ein nd lugging f duc
lumin . I
n cn
r s
,
he swe
duc
is un ffec
ed 
hlgic lly bec use f lw r
ein l
 d nd high flw r
e<div><img src="" s
e-33303176413188.jg"" /></div>"
Bren
sQs
Q: Discuss
he h ses nd regul
in f
he excrine  ncre s func
in. "A: like
g s
ric secre
in,  ncre
ic secre
in is divided in
 ceh lic, g s
ric nd i
n
es
in l h ses;
he in
es
in l h se is BY FAR
he ms
imr
n
; briefly,
h
e ceh lic h se is ini
i
ed by smell/
s
e/e
c nd is medi
ed by
he v gus ne
rve (ACh);
he g s
ric h se is ini
i
ed by dis
en
in f
he s
m ch nd ls
medi
ed by v gus nerve;
he in
es
in l h se ccun
s fr ~80% f  ncre
ic se
cre
in nd resul
s in b
h enzym
ic nd queus secre
ins<div><img src="" s

e-34153579937796.jg"" /></div>"
Bren
sQs
Q: Discuss
he in
es
in l h se f  ncre
ic secre
in in de
h.
"A: The
in
es
in l h se f  ncre
ic secre
ins is hysilgic lly nd qu n
i

ively

he ms
imr
n
. I
begins wi
h en
ry f g s
ric chyme in

he in
es
ine, n
d is rim rily medi
ed by chlinergic reflexes nd
he rele se f CCK nd secre

in; n
e shwn in ic
ure, bu
CCK incre ses rele se f ACh frm nerve
ermin l
ins
e d f c
ing direc
ly n
he cin r cells; rec ll
h
secre
in is
he m j
r s
imul n
f HCO3 secre
in nd is secre
ed in resnse
 H+ in
he lumen f

he in
es
ine which sign ls
he rriv l f cidic chyme frm
he s
m ch<img sr
c="" s
e-34299608825860.jg"" />"
Bren
sQs
1. Which cell
ye c uses 90-95% f
umrs f
he diges
ive sys
em?<div><br /></
div><div>2. Amng c ncers in
he US, wh
s i
s r nk in
erms f mr
li
y?</div
>
1. G s
ric r in
es
in l <b>ei
heli l cells, usu lly in
he cln</b>.
M lign n

umrs f
he cln re derived lms
exclusively frm i
s gl ndul r
ei
helium nd re c lled <b> denc rcinm s</b>.<div><br /></div><div>2. Secnd
ms
cmmn c use f c ncer de
hs in
he US.</div>
in
es
ine
"M jr GI hrmnes frm Junq:<div><br /></div><div>Give wh
yu c n.</div><div>
<br /></div><div><img src="" s
e-20654497726985.jg"" /></div>"
"<img sr
c="" s
e-20817706484233.jg"" />"
in
es
ine
Q: Are
here villi in
he l rge in
es
ine?
A: N
Bren
sQs
Q: Des
he l rge in
es
ine h ve higher r lwer densi
y f gble
cells
h n
A: higher
Bren
sQs

he sm ll in
es
ine?
Q: True r f lse:
here re  ne
h cells in
he l rge in
es
ine.
A: f lse
Bren
sQs
Q: Why re
here n secre
ins f sIgA, l c
ferrin, lyszyme in l rge in
es
ine
?
A: bec use we w n
b c
eri
 grw here
Bren
sQs
Q: Hw re
he cry
s differen
in
he l rge in
es
ine
h n sm ll in
es
ine?
Bren
sQs
Q: Are
igh
junc
ins be
ween en
ercy
es
igh
er in
he sm ll in
es
ine r l r
ge in
es
ine? A: mre
igh
in l rge in
es
ine;
hus
heres
r nscellul r mvem
en
f w
er in
he l rge in
es
ine s sed

he  r cellul r mvemen
seen
in
he sm ll in
es
ine due

heir le ky
igh
junc
ins
Bren
sQs
Q: Ch r c
erize
he micrvilli fund n
he en
ercy
es f
he l rge in
es
ine.
A: shr
blun
micrvilli wi
h n en
eric c
, n cre c
in bund micrfil men

s, n link r
eins, nd n micrvill r
wi
ch Bren
sQs
Q: Wh
re
he m jr func
ins f
he cln? A: bsr
in f w
er (
r nscel
lul r), mucus secre
in, nd u
refec
in f b c
eri fr micrnu
rien
s
Bren
sQs
Q: Wh
mvemen
s re resen
in
he l rge in
es
ine? A: mucs l squeeze (
 g
e
gble
cell mucus u
f cry
s), eris
lsis, h us
r
in, m ss mvemen
(2-

3X/d y) Bren
sQs
Q: True r f lse:
here is mucs l flu

er, vill r um, nd micrvill r
wi
ch
in
he l rge in
es
ine. A: f lse;
heres nne f
hese Bren
sQs
Q: Wh
is segmen

in c lled in
he l rge in
es
ine? A: h us
r
in Bren
sQ
s
"Wh

r nsi
in is ccurring

he bl ck rrw?<div><br /></div><div><img src=
"" s
e-20933670601196.jg"" /></div>" "<img src="" s
e-20946555503085.jg"" /
>"
in
es
ine
Q: Hw des di be
es melli
us c use cns
i
in?
A: in DM
here is de
h
f
he in
ers
i
i l cells f C j l which resul
s in slw m
ili
y cns
i
in
Bren
sQs
Q: Wh
s
he 
hlgy f Hirschrungs dise se??
A: h ens if
heres n Meissners
(submucs l) r Auerb chs (myen
eric) lexus develed (suressed neur l cres
i
nv sin in
 dis
l cln); bisy shws ACh is dis
ribu
ed
hrughu

he en
ir
e l min rri nd submucs b/c
he reg nglinic  r sym
he
ic h ve n
r
ge
cell n which
 syn se (RET r
-ncgene n chrmsme 10 w s iden
ified
s ne f
he genes invlved); frm wiki: is
serius medic l rblem where
h
e en
eric nervus sys
em is missing frm
he end f
he bwel. Bren
sQs
Q: Wh
s
ruc
ure des
he endix rjec
ff frm? A: cecum
Bren
sQ
s
Q: Wh
s
ruc
ur l fe
ures re ch r c
eris
ic f
he endix? A: lng cry
s 
f Lieberkuhn, n villi, gble
cell rich, sc rce M cells, n en
erendcrine cel
ls, cnfluen
lymh
ic ndules in yu
h wi
h hy liniz
in in dul

Bren
sQ
s
Q: True r f lse:
he endix h s n
eni cli r endices eilic e.
A:
rue Bren
sQs
Q: Wh
mvemen
is fund in endix? A: nne Bren
sQs
Q: Cm re/cn
r s
endici
is in yu
h nd dul
.
A: in yu
h, endici
i
s usu lly fllws vir l infec
in wi
h incre sed size f lymh
ic ndules. &nbs
;In dul
s, endici
is usu lly fllws fec l en
r men
in sm ll lumen&nbs;
Bren
sQs
Q: Bile is rduced nd secre
ed by
he ____, s
red in
he ______, nd ejec
ed
in

he lumen f
he sm ll in
es
ine when
he g llbl dder is s
imul
ed
 cn

r c
. A: liver; g llbl dder; in
he lumen f
he in
es
ine bile s l
s emulsify
liids
 re re
hem fr diges
in Bren
sQs
Hw is
he s
m ch divided ccrding
 secre
ins?
C rdi c, xyn
ic, ylri
c
Gu
Secre
insII
G s
rin is m jr hysilgic l regul
r f ______
cid secre
in Gu
Secre

insII
Which cells m ke g s
rin? Where re
hey lc
ed?
Syn
hesized in G cells i
n g s
ric i
s in
he n
rum regin f
he s
m ch
Gu
Secre
insII
Which cells bind g s
rin rim rily?
P rie
l nd en
erchrm ffin-like cells
Gu
Secre
insII
Wh
des g s
rin d 
her
h n regul
e cid secre
in?
Als h s n im
r
n

rhic (grw
h-rm
ing) influence n
he g s
ric mucs
Gu
Secre

insII
Which frm f g s
rin is
he redmin n
circul
ing frm?
Big g s
rin (G s
Gu
Secre
insII

rin-14)
Wh
is
he sm lles
frm f g s
rin which cn
ins full bi c
ivi
y? Pen
g s
Gu
Secre
insII

rin: sequence f five C-
ermin l min cids n g s
rin
Wh
is
he rim ry s
imulus fr
he secre
in f g s
rin?
Presence f fd
s
uffs (eseci lly e
ides, cer
in min cids, nd c lcium) in
he g s
ric lu
men
Gu
Secre
insII
Cmunds in ___, ___, nd ____ re 
en
s
imul n
s fr g s
rin secre
in
Cffee, wine, nd beer Gu
Secre
insII
Describe
he s
imul
ry 
hw y fr g s
ric (HCl) secre
in. "<img src="" s

e-13795434954756.jg"" />"
Gu
Secre
insII
Which rece
r des Ach use in rder

rigger H+ secre
in? Wh

hw y is in
vlved? Wh
drug blcks
his rece
r? M3<div>Gq -&g
; IP3 -&g
; C <br /><div>A
Gu
Secre
insII

rine</div></div>

Which rece
r des g s
rin use in rder

rigger H+ secre
in? Wh

hw y i

s invlved?&nbs;
CCKB<div>Gq -&g
; IP3 -&g
; C </div>
Gu
Secre
insII
Which rece
r des his
mine use in rder

rigger H+ secre
in? Wh

hw y
is invlved? Wh
drug blcks
his rece
r? H2 rece
r<div>Gs -&g
; cAMP</d
iv><div>Cime
idine</div>
Gu
Secre
insII
Wh

hree
hings s
imul
e H+ secre
in frm  rie
l cells? Where des e ch c
me frm?
Ach vi
he v gus nerve nd ENS<div>G s
rin vi G cells</div><di
v>His
mine vi ECL cells (rele se is ls
riggered by g s
rin)</div> Gu
Secre

insII
Which cmunds inhibi
H+ secre
in? Wh

hw y d
hey use?&nbs; Sm
s


in nd rs
gl ndins<div>Gi -&g
; decre se cAMP (inhibi

he effec
s f his

mine since i
uses Gs
 incre se cAMP)</div> Gu
Secre
insII
Wh
des mer zle d?
Inhibi
s H+ secre
in frm
he H+/K+ ATP se
Gu
Secre
insII
Which cells secre
e sm
s

in?
D cells Gu
Secre
insII
Sm
s

in inhibi
s
he secre
in f ... (4) G s
rin, CCK, secre
in, VIP
Gu
Secre
insII
Lis
fur effec
s f sm
s

in secre
in.
Suresses secre
in f g s
ric
cid nd esin<div>Lwers
he r
e f g s
ric em
ying</div><div>Reduces sm
h
muscle cn
r c
in</div><div>Decre ses bld flw wi
hin
he in
es
ine</div>
Gu
Secre
insII
Which 
hw y des sm
s

in use
 ffec
i
s
rge
? (endcrine r  r crin
e)
Uses b
h
Gu
Secre
insII
If ne h d
 summ rize
he effec
s f sm
s

in in ne hr se, i
wuld be .
..
sm
s

in inhibi
s
he secre
in f m ny 
her hrmnes
Gu
Secre

insII
Describe
he 
hw y
h
hrmnes secre
ed by endcrine cells f
he GI
r c
h
ve

ke in rder
 re ch
heir
rge
.
Secre
in -&g
; r
l circul
i
n -&g
; liver -&g
; sys
emic circul
in -&g
;
rge
Gu
Secre
insII
Which cells secre
e m
ilin?
Secre
ed by endcrincy
es in
he mucs f
he
Gu
Secre
insII
rxim l sm ll in
es
ine
When is m
ilin secre
ed?
Secre
ed during
he f s
ed s

e every 100 minu

es
Gu
Secre
insII
Wh
re
he
w b sic s

es f m
ili
y f h
e s
m ch nd sm ll in
es
ine?
Fed s

e: fds
uffs re resen
<div>In
erdiges
ive s

e: be
ween me ls</div>
Gu
Secre
insII
N me
he fur h ses f g s
ric cid secre
in. Res
ing<div>Ceh lic</div><div>G
s
ric</div><div>In
es
in l</div>
Gu
Secre
insII
Describe
he ceh lic h se f g s
ric cid secre
in. "Sigh
, smell,
s
e, ch
ewing, sw llwing, nd hyglycemi c n ll s
imul
e
he v gus nerve
 s
imul

e
he G cells vi GRP (g s
rin rele sing e
ide) -&g
; G cell secre
es g s
rin
in resnse -&g
; G s
rin
riggers HCl rele se direc
ly frm  rie
l cells nd
ls indirec
ly by s
imul
ing ECL cells
 rele se his
mine which
hen s
imul

es  rie
l cells
 rele se HCl<div>In ddi
in, Ach ls s
imul
es G cells,
ECL cells, nd  rie
l cells</div><div><img src="" s
e-20701742366724.jg"" />
</div>" Gu
Secre
insII
Describe
he g s
ric&nbs;h se f g s
ric cid secre
in.
"<div>Dis
ensin
f
he s
m ch s
imul
es
he lc l ENS reflexes nd VAGOv g l reflex -&g
; v g
v g l reflex rele ses GRP nd Ach nd ENS rele ses Ach</div><div>In ddi
in, d
iges
in f r
ein rduces e
ides nd min cids which s
imul
es
he rele
se f g s
rin frm G cells</div><div>This 
hw y is very simil r

he ceh li
c h se exce

he s
imuli re differen
nd here
he ENS is invlved s well.</
div><img src="" s
e-21212843474948.jg"" />" Gu
Secre
insII
Wh

riggers
he lc l ENS reflex in
he g s
ric h se?
Dis
ensin f
h
e n
rum
Gu
Secre
insII
Which h se cn
ribu
es
 mre HCl secre
in? G s
ric Gu
Secre
insII
Describe
he in
es
in l h se f g s
ric cid secre
in.
"<div>N
e: en
e
r-xyn
in is en
g s
rin-like e
ide (remember: en
g s
rin is
he ms
b
sic func
in l uni
f g s
rin)</div><img src="" s
e-21874268438532.jg"" />"
Gu
Secre
insII

Wh
re
he lng
erm risks ssci
ed wi
h cid suressin? "<div><div>Lng
erm risks f cid suressin Lng-
erm risks f cid suressin. Lng-
erm ri
sks, which include cid suressin,  r
icul rly wi
h m in
en nce r
n um i
nhibi
r (PPI)
her y, re rel
ed

heir bili
y
 rduce hychlrhydri
nd hyerg s
rinemi . As illus
r
ed, hychlrhydri , which is resnsible fr

he hyerg s
rinemi , c n direc
ly le d
 im ired bsr
in f irn nd vi
m
in B12 nd wrsening f Helicb c
er ylri g s
ri
is. Hychlrhydri ls le
ds
 b c
eri l vergrw
h, which incre ses rduc
in f g s
ric ni
rs mines,
knwn c rcingen nd risk f c
r fr g s
ric den c rcinm . Hyerg s
rinemi
is shwn
 resul
in benign g s
ric fundic lys nd en
erchrm ffin cell h
yerl si .&nbs;</div><div><br /></div></div><div><img src="" s
e-220117073920
04.jg"" /></div>"
Gu
Secre
insII
<div>Ne rly ll chemic l diges
in nd nu
rien
bsr
in ccurs in _____</div>
<div><br /></div>
Gu
Secre
insII

he sm ll in
es
ine
Wh

riggers
he rele se f secre
in? Wh
des secre
in
rigger?
Acid in

he dudenum&nbs;<div>Triggers
he rele se f HCO3 frm excrine  ncre s AND i
nhibi
s g s
ric em
ying</div><div>(exl n
in: cid in
he dudenum is d nger
us, s secre
in senses
his nd
riggers
he rele se f bic rb
 neu
r lize
he
cid; i
ls inhibi
s g s
ric em
ying s
h

he curren
cid c n be neu
r l
ized befre mre cid is rele sed)</div>
Gu
Secre
insII
Wh

riggers
he rele se f CCK? Wh
des secre
in
rigger? AAs nd FAs -&g

; CCK<div>Triggers
he rele se f enzymes frm
he excrine  ncre s AND g llbl
dder cn
r c
in
 secre
e bile fr f
emulsific
in</div> Gu
Secre
insII
Wh

riggers
he rele se f GIP? Wh
des secre
in
rigger? Glucse nd FAs<
div>Inhibi
s g s
ric em
ying AND cid secre
in</div> Gu
Secre
insII
Secre
in is rel
ed
 ____, ___ nd _____
gluc gn, VIP, nd GIP Gu
Secre

insII
The rinci l
rge
fr secre
in is ...

he  ncre s, which resnds by
secre
ing bic rbn
e-rich fluid, which flws in

he firs
 r
f
he in
es
Gu
Secre
insII

ine
hrugh
he  ncre
ic duc
.
Wh

urns ff secre
in f secre
in? When
he in
es
in l H rises
w rds neu

r li
y Gu
Secre
insII
<div>_____ is
he rincile s
imulus fr delivery f  ncre
ic enzymes nd bile
in

he sm ll in
es
ine.&nbs;</div><div><br /></div> Chlecys
kinin Gu
Secre

insII
Wh

urns ff secre
in f CCK?
Turned ff when bsr
in is cmle
ed
Gu
Secre
insII
Wh
is
he rle f m
ilin?
M
ilin  r
ici
es in cn
rlling
he 

ern
f sm
h muscle cn
r c
ins in
he uer g s
rin
es
in l
r c
.<div><br /></d
iv>
Gu
Secre
insII
Which hrmne is ssci
ed wi
h MMC? M
ilin Gu
Secre
insII
Wh
d we
hink
riggers
he rele se f m
ilin?
S
udies sugges

h
n
lk line H in
he dudenum s
imul
es i
s rele se
Gu
Secre
insII
Hw des ery
hrmycin ffec

he MMC? <div>An in
eres
ing sec
f
he m
ili
n s
ry is
h
ery
hrmycin nd rel
ed n
ibi
ics c
s nne
ide m
ilin
gnis
s, nd re sme
imes used fr
heir bili
y
 s
imul
e g s
rin
es
in l
m
ili
y. Adminis
r
in f lw dse f ery
hrmycin will induce migr
ing m

r cmlex, which rvides ddi
in l sur
fr
he cnclusin
h
m
ilin
secre
in
riggers
his 

ern f GI m
ili
y, r
her
h n resul
s frm i
.&nbs
Gu
Secre
insII
;</div><div><br /></div>
Wh
inhibi
s
he secre
in f g s
rin in gener l?
When
he lumen l H f

he s
m ch becmes very lw
Gu
Secre
insII
Which cells cn
in g s
rin rece
rs? P rie
l cells, ECL cells, nd  ncre
i
c cin r cells (vi CCK rece
rs)
Gu
Secre
insII
Wh
c uses Zllinger-Ellisn syndrme? Wh
is
he rim ry sym
m?
Excessiv
e secre
in f g s
rin (hyerg s
rinemi ).<div>G s
ric nd duden l ulcer
in d
ue
 excessive nd unregul
ed secre
in f g s
ric cid</div> Gu
Secre
insII
Wh
re g s
rinm s? G s
rin secre
ing
umrs
Gu
Secre
insII
Desribe
he
hree m jr 
hw ys which regul
e g s
rin secre
in frm G cells.
<div>Rele se f g s
rin frm
he G-cells is regul
ed by
hree m jr 
hw ys :&

nbs;</div><div>1) Lumin l nu
rien
s (i.e. min cids, eseci lly rm
ic), di
e
ry mines nd C 2+, s
imul
e secre
in f g s
rin frm G-cells resum bly by
c
ing direc
ly n rece
rs lc
ed n
he lumin l side f
he G-cells.&nbs;<
/div><div>2) G s
ric nerves, which in resnse
 lc l nd cen
r l sign ls rele
se g s
rin-rele sing e
ide nd ce
ylchlin, b
h subsequen
ly induce g s
rin
secre
in frm
he G-cells
hrugh in
er c
in wi
h
heir resec
ive rece
rs.
&nbs;</div><div>3) Sm
s

in, which rele sed in  r crine m nner frm
he
n
r l D-cells when
he g s
ric H is belw 2-3 nd le ds
 inhibi
in f g s
r
in rele se&g
;</div><div><br /></div> Gu
Secre
insII
Wh
d CCK rece
rs bind? Wh
des CCKA bind referen
i lly? CCKB? CCK nd
g s
rin<div>CCKA: CCK &g
; g s
rin</div><div>CCKB: G s
rin &g
; CCK</div>
Gu
Secre
insII
Which cen
r l reflexes re ssci
ed wi
h
he ceh lic h se f g s
ric cid se
cre
in? G s
ric h se? Ceh lic h se: V g l nd v g- n
r l<div>G s
ric h se:
V g-v g l nd n
r l</div>
Gu
Secre
insII
Which GI hrmne is rkine
ic gen
? M
ilin Gu
Secre
insII
Describe wh

riggers HCl secre
in. Als, describe
he neg
ive feedb ck invl
ved.
1.) V gus nerve secre
es Ach un  rie
l cells which
riggers HCl secr
e
in<div>2.) V gus nerves secre
es GRP un G cells + dis
ensin f
he s
m ch

riggers ENS
 rele se Ach un G cells + min cids s
imul
e G cells -&g
;

riggers g s
rin secre
in -&g
; g s
rin s
imul
es  rie
l cells
 secre
e HC
l</div><div>Neg
ive feedb ck:</div><div>1.) G s
rin binds
 CCKB rece
rs n
D cells + H+ ins in
he lumen s
imul
e D cells -&g
; rele se f sm
s

in &g
; neg
ive feedb ck</div>
Gu
Secre
insII
Lng
erm cid suressin c uses hychlrhydri . Wh
re
he effec
s f hyc
hlrhydri ?
"<div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> <
/s n>Hychlrhydri : lw hydrchlric cid levels in
he s
m ch</div><div>&nb
s;&nbs; &nbs; <s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s
n>Incre sed H. ylri infec
in</div><div>&nbs;&nbs; &nbs; &nbs; &nbs; &nb
s;&nbs;<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Uses ur
e se
 lwer
he H vi NH4+ rduced</div><div>&nbs;&nbs; &nbs; <s n cl s
s=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Decre sed B12 nd irn b
sr
in</div><div>&nbs;&nbs; &nbs; <s n cl ss=""Ale-
b-s n"" s
yle=""w
hi
e-s ce:re""> </s n>B c
eri l vergrw
h -&g
; &nbs;incre sed risk f g s

ric c ncer since
he b c
eri l infec
ins re rinfl mm
ry -&g
; ersis
en
i
nfl mm
in = incre sed risk f c ncer</div><div><br /></div>" Gu
Secre
insII
Lng
erm cid suressin c uses hychlrhydri which
hen c uses hyerg s
rin
emi . Wh
re
he effec
s f hyerg s
rinemi ? "<img src="" s
e-31907312041985
.jg"" />"
Gu
Secre
insII
G s
ric cid secre
in frm  rie
l cells is regul
ed by endcrine (____),  r
crine (______) nd neur l (_____) f c
rs
"G s
ric cid secre
in frm  r
ie
l cells is regul
ed by endcrine (<fn
clr=""#FF0000"">g s
rin</fn
>),
 r crine (<fn
clr=""#FF0000"">lc lly delivered his
mine nd sm
s

in<
/fn
>) nd neur l (<fn
clr=""#FF0000"">Ach</fn
>) f c
rs"
Gu
Secre

insII
Sm
s

ins m jr effec
s n inhibi
ing cid secre
in re exer
ed n ....

he inhibi
in f his
mine nd g s
rin rele se (ges direc
ly

he surce)
Gu
Secre
insII
Which hrmne is in ch rge f
ermin
ing me l size?
CCK c
s n v g l ffere
n
nerve fibers nd sends sign ls

he drs l hindbr in

ermin
e me l size
Gu
Secre
insII
CCK ssesses five min cid sequence

he c rbxyl
erminus
h
is iden
i
c l

h
f _____
g s
rin Gu
Secre
insII
Lis

he
hree gener l func
ins f
he  ncre s
(1) neu
r lizing
he ci
d chyme en
ering
he dudenum frm
he s
m ch;&nbs;<div>(2) syn
hesis nd secr
e
in f diges
ive enzymes f
er me l; nd&nbs;</div><div>(3) sys
emic rele s
e f hrmnes
h
mdul
e me
blism f c rbhydr
es, r
eins, nd liids. &
nbs; &nbs;</div>
Gu
Secre
insIII
Lis
ll 10  ncre
ic cin r secre
ins nd
he cl ss
hey belng
. "<div>Pr

ely
ic:</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> <

/s n>-Trysingen</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:

re""> </s n>-Chym
rysingen</div><div><s n cl ss=""Ale-
b-s n"" s
yle="
"whi
e-s ce:re""> </s n>-Prc rbxye
id se</div><div><s n cl ss=""Ale-

b-s n"" s
yle=""whi
e-s ce:re""> </s n>-Pr mine
id se</div><div>Amylli

ic</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>- myl se</div><div>Lyli
ic</div><div><s n cl ss=""Ale-
b-s n"" s
yle=""wh
i
e-s ce:re""> </s n>-Li se</div><div><s n cl ss=""Ale-
b-s n"" s
yle="
"whi
e-s ce:re""> </s n>-Phshli se</div><div><s n cl ss=""Ale-
b-s n
"" s
yle=""whi
e-s ce:re""> </s n>-Cli se</div><div>Nuclely
ic</div><div><
s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-Ribnucle se</d
iv><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-Dexyr
ibnucle se</div><div><br /></div>"
Gu
Secre
insIII
N me
he li ses invlved in diges
in. Lingu l li se, g s
ric li se,  ncre

ic li ses
Gu
(li
Secre
 se,

insIII
hshli se, cli se)
Why desn

he  ncre s diges
i
self? -Secre
in f ms
diges
ive enzymes in

heir in c
ive recursr frms ( s zymgens [eg,
rysingen])&nbs;<div>-P ck g
ing f secre
ry r
eins in membr ne-bund s
r ge cm r
men
s (zymgen gr nul
es).&nbs;</div><div>-Addi
in lly,
rysin inhibi
rs resen
in  ncre
ic
is
sue, nd in  ncre
ic secre
ins, c n in c
iv
e sm ll mun
s f
rysin, if 
resen
.&nbs;</div><div>-Fur
hermre,
he ressure gr dien
be
ween
he  ncre

ic duc
nd
he bile duc
r dudenum f vrs
he flw f  ncre
ic secre
ins 
u
f
he gl nd in

he dudenum, which mi
ig
es g ins
reflux f bile r du
den l juice in

he  ncre s. &nbs;&nbs;</div>
Gu
Secre
insIII
Wh
is
he difference be
ween s liv ry secre
ins nd  ncre
ic secre
ins?
"<fn
clr=""#FF0000"">P ncre
ic</fn
> secre
ins re <fn
clr=""#FF0000"
">is
nic</fn
> while <fn
clr=""#FF0000"">s liv ry</fn
> secre
ins re <
fn
clr=""#FF0000"">hy
nic</fn
>"
Gu
Secre
insIII
Cm re inic cmsi
in be
ween cin r nd duc
ul r secre
ins in
he  ncre s
.
"<div>Acin r secre
in is l sm -like fluid
h
is redmin n
ly sdi
um chlride,where s duc
ul r secre
in is redmin n
ly sdium bic rbn
e.</div
><div><img src="" s
e-35274566402053.jg"" /></div><div><br /></div><div><br />
</div>" Gu
Secre
insIII
Where is c rbnic nhydr se imr
n
in
he gu
?
Used in
he s
m ch
 
rduce HCl secre
ins<div>Used in
he s liv ry nd  ncre
ic gl nds
 secre
e
bic rbn
e</div>
Gu
Secre
insIII
Acid
ide is ssci
ed wi
h? Alk line
ide?
Acid
ide:  ncre
ic secre
ins
<div>Alk line
ide:  rie
l cell c
iv
in</div>
Gu
Secre
insIII
Describe
he rcess f bic rbn
e secre
in by  ncre
ic cells
"<img sr
c="" s
e-36283883716612.jg"" /><div><div>Bic rbn
e is derived frm c rbnic
cid which is frmed frm c rbn dixide nd w
er diffusing in frm
he in
ers

i
i l side. C rbnic nhydr se c
lyzes
he rduc
in f HCO3- nd H+ frm c r
bnic cid. HCO3- is
hen
r nsr
ed crss
he lumin l l sm membr ne by HC
O3-/Cl- exch nger. The m in surce f lumin l Cl- in is &nbs;
he cys
ic fibrs
is
r nsmembr ne regul
r (CFTR), which is defec
ive in 
ien
s ffec
ed by cy
s
ic fibrsis.</div><div>Pr
ns gener
ed during
he rduc
in f HCO3 mus
be
r idly
r nsr
ed u
f
he cells, nd
his ccurs
hrugh
w differen
mec
h nisms. &nbs;One invlves N +/H+ exch nge,
he 
her invlves
he resence f
H+/K+ ATP se (r
n um) in
he b sl
er l membr ne. &nbs;This r
n um
is differen
frm
he ne fund in
he s
m ch nd resembles func
in lly
he 
ne fund in kidneys nd dis
l cln. A N +/K+ ATP se is ls resen
in
he b s
l
er l membr ne, necess ry fr
he rduc
in f
he f vr ble elec
rchemic
l gr dien
fr Cl- secre
in. N +, sme K+, nd w
er ccm ny HCO3 secre
in,
ms
ly en
ering
he duc
lumen by  ssive  r cellul r diffusin.</div><div>The
recycling f Cl- is
herefre m jr f c
r in de
ermining HCO3- secre
in. In
hibi
in f Cl- ch nnel c
ivi
y will decre se HCO3- secre
in. This m y exl in
why  ncre
ic insufficiency devels in sme cys
ic fibrsis 
ien
s, s i
r
esul
s frm defec
ive duc
ul r secre
in. Pr
ein ceus cin r secre
ins becme
cncen
r
ed nd
heir recii

in c n 
en
i lly c use blck ge nd des
ruc

in f  ncre
ic duc
s.</div><div><br /></div></div>" Gu
Secre
insIII
The nrm l  ncre s h s (high/lw) flw nd
(high/lw) r
ein cncen
r
in.

Wh
bu
in cys
ic fibrsis? "The nrm l  ncre s h s <fn
clr=""#FF0000""

>high</fn
> flw nd
<fn
clr=""#FF0000"">lw </fn
>r
ein cncen
r
in
. In cys
ic fibrsis, flw decre ses, nd high r
ein cnce
r
ins ccur. In
ddi
in,
he duc
cn
ins r
ein lugs.<div><img src="" s
e-37099927502852.j
g"" /></div>" Gu
Secre
insIII
Why d 
ien
s wi
h cys
ic fibrsis h ve  ncre
ic disrders? <div>The  ncre
s ffec
ed by cys
ic fibrsis is ms
vulner ble
 lumen l cncen
r
in defec

s c used by
he high r
ein cn
en
f cin r secre
ins nd deendence n duc

l cys
ic fibrsis
r nsmembr ne cnduc
nce regul
r fr nin (chlride nd b
ic rbn
e) nd fluid secre
in. When duc
l w
er flw is reduced wing
 defe
c
ive nin secre
in, r
ein cncen
r
in in
he duc
rises. High r
ein cn
cen
r
in c uses recii

in f r
ein nd lugging f duc
lumin . In cn
r
s
,
he swe
duc
is un ffec
ed 
hlgic lly bec use f lw r
ein l d nd
high flw r
e.&nbs;</div><div><br /></div> Gu
Secre
insIII
Describe
he in
es
in l h se f excrine  ncre s secre
in
"<div><img src="
" s
e-38182259261441.jg"" /></div><img src="" s
e-38070590111748.jg"" />"
Gu
Secre
insIII
"The  ncre s mus
deliver n rri
e <fn
clr=""#FF0000"">_____</fn
>,


he <fn
clr=""#FF0000"">_____</fn
>, nd

he <fn
clr=""#FF0000"">
_____</fn
> fr
he efficien
diges
in f nu
rien
s delivered frm
he s
m ch
"The  ncre s mus
deliver n rri
e&nbs;<fn
cl


he dudenum"
r=""#FF0000"">qu n
i
y f enzymes</fn
>,

he&nbs;<fn
clr=""#FF0000"">
rri
e
ime</fn
>, nd

he&nbs;<fn
clr=""#FF0000"">
im l H</fn

>&nbs;fr
he efficien
diges
in f nu
rien
s delivered frm
he s
m ch

h
e dudenum"
Gu
Secre
insIII
Which h se f excrine  ncre
ic func
in wuld be ms
ffec
ed by v g
my
?
CEPHALIC PHASE<div>This h se is m inly cn
rlled by chlinergic fibers
nd wuld be blished by v g
my</div>
Gu
Secre
insIII
The g s
ric h se f  ncre
ic excrine func
in is ini
i
ed by ... g s
ric
dis
ensin nd by e
ides nd min cids in
he g s
ric lumen which c
iv
e v
gv g l reflexes
Gu
Secre
insIII
Wh
re
he chief s
imul n
s f
he in
es
in l h se f  ncre
ic secre
in?
H+, min cids, nd f

y cids
Gu
Secre
insIII
Describe
he in
es
in l h se f  ncre
ic secre
in. <div>G s
ric chyme in
h
e sm ll in
es
in l lumen s
imul
es v g l fferen
s, nd ini
i
es
he rele se 
f CCK nd secre
in frm secific mucs l endcrine cells. Diges
in rduc
s f
f
s (f

y cids cn
ining mre
h n
welve c rbn
ms, mn-glycerides) nd
sm ller ex
en
, glucse rm
e CC
r
ein ( min cids nd e
ides) nd,

K rele se. G s
ric H+ (lw H) nd

lesser ex
en
, f

y cids, nd bile ci
ds rm
e rele se f</div><div>secre
in. While secre
in m inly s
imul
es duc

l secre
in f bic rbn
e, nd CCK m inly s
imul
es cin r secre
in f enzyme
s, 
en
i
in be
ween
hese
w hrmnes ccurs s
h n n enzyme nd bic rbn
Gu
Secre
insIII

e-rich juice is secre
ed.</div>
Hw des CCK ffec
 ncre
ic secre
in?
CCK rm
es  ncre
ic secre
i
n by s
imul
ing v g l nd in
r - ncre
ic nerves. Un
il recen
ly, bec use CCK
rece
rs re resen
n r
 ncre
ic cini, i
w s resumed
h
CCK, rele se
d in

he blds
re m, circul
es

he  ncre
ic cin r cells nd ffec
s
h
ese cells direc
ly
hrugh CCK rece
rs. Hwever, i
e rs
h
CCK rece
rs
m y n
be exressed n hum n cin r cells. I
is nw rsed
h
CCK m y in

er c
wi
h fferen
v g l neurns
 s
imul
e secre
in
hrugh efferen
v g l
neurns. This mdel is cnsis
en
wi
h
he finding
h

he effec
s f hysilg
ic cncen
r
ins f CCK n  ncre
ic enzyme secre
in re blcked by
rine.
Gu
Secre
insIII
Describe feedb ck inhibi
in f  ncre
ic secre
in
One inhibi
ry feedb ck
l invlves
rysin. Diversin f  ncre
ic juice frm
he in
es
ine incre se
s  ncre
ic secre
in, n effec
medi
ed by remving feedb ck inhibi
in f
r
ysin. During me l,
rysin is ccuied wi
h inges
ed r
eins nd is n
v i
l ble fr feedb ck inhibi
in. Hwever, f
er die
ry r
ein h s been diges
ed,

rysin
hen diges
s e
ide CCK-rele sing f c
r, which is el br
ed by end
crine cells in
he dudenum. Less CCK is rele sed s
he mun
f CCK-rele sin

g f c
r in
he lumen decre ses.

Gu
Secre
insIII
Give
he in
es
in l enzymes
h
reside in
he brush brder.<div><br /></div><di
v>Give
hse
h
reside n
he en
ercy
e l sm membr ne.</div><div><br /></di
v><div>Then lis
sme f
he
r nsr
ers n
he en
ercy
e PM frm Be vers.</di
v>
"<img src="" s
e-4303557230826.jg"" /><div><br /><div><img src="" s
e
-5119601016976.jg"" /></div></div>"
Regul
inFedS

e
A

he 10
h week f ges

in,
he liver ccun
s fr wh
% weigh
f
he embry
10%

he
en
h week<di
?<div><br /></div><div>Wh
bu

bir
h?</div>
v><br /></div><div>5%
bir
h</div>
GIEmbrylgyII
A

he 10
h ges

in l week, wh
2 cell
yes rim rily m ke u
he liver?<div
><br /></div><div>When des ne f
hese dis e r?</div>
<b>He
cy
es</
b>&nbs; nd&nbs;<b>hem
ie
ic cells</b><div><br /></div><div>Liver s
s bein
g
he rim ry rg n f hem
iesis in
he <b>l s
2 mn
hs</b> f ges

in.</
div><div><br /></div><div>Remember, e rly in ges

in hem
iesis h ens in
GIEmbrylgyII

he ylk s c. Then
he liver. Then
he bne m rrw.</div>
1. In
he 3rd week f ges

in, wh
des
he r idly rlifer
ing liver rim
rdium ene
r
e?<div><br /></div><div>2. Describe
his s
ruc
ure.</div><div><br
/></div><div>3. Wh
will i
becme? (3)</div> "<b>1. The se
um
r nsversum</b
><div><br /></div><div>2. I
s <b>l yer f mesenchyme</b>
h
frms where
he
di hr gm will be, bu
des n
c
u lly becme
he di hr gm.</div><div><br />
</div><div>3. . The <b>eri
ne l surf ce f
he liver</b>, <u>exce
</u> fr

he <b>cen
r l
endn f
he di hr gm</b> nd
he<b> b re re </b>.</div><div>b.
The <b>f lcifrm lig men
</b></div><div>c. The <b>lesser men
um</b></div><div>
<b><br /></b></div><div><b><img src="" s
e-2834678416176.jg"" /></b></div>"
GIEmbrylgyII
Wh
s n
her n me fr
he g s
rhe
ic lig men
?
The lesser men
um
GIEmbrylgyII
Wh
4
hings h en
 frm
he cmmn bile duc
nd
he g llbl dder?<div><br /
></div><div>Wh
is
he ms
cmmn nm ly in
he frm
in f
he bili ry sys

em?</div>
1. The <b>cnnec
in</b> be
ween
he liver rimridum nd
he f
regu
<b> n rrws</b> frm
he
ube.<div>2. A sm ll ven
r l u
grw
h ( .k. . <b>
diver
iculum</b>) in
his cnnec
in becmes
he <b>g llbl dder</b>.</div><div>3
. Thes cnnec
in <b>bifurc
es</b> in

he lef
nd righ
he
ic duc
s.</div>
<div>4. The dis
l cmmn bile duc
h s
 <b>jin</b>
he develing <b> ncre
s</b>.</div><div><br /></div><div>Ms
cmmn nm ly: <b>dulic
ed g llbl dder
</b></div>
GIEmbrylgyII
1. Thes develing sleen lies in which mesen
ry?<div><br /></div><div>2. Is
h
e sleen in
r -, rim rily, r secnd rily re
reri
ne l?</div>
1. Drs
l mesen
ry<div><br /></div><div>2. <b>In
r eri
ne l</b>, bu


ched

he
re
reri
ne l kidney vi
he slenren l lig men
</div>
GIEmbrylgyII
Wh
re
he
w ms
cmmn develmen
l bnrm li
ies f
he sleen? <b>W nde
ring sleen</b>: f ilure
 fuse wi
h
he eri
neum f
he s
erir bdmin l
w ll.<div><br /></div><div><b>Accessry sleens</b>: mre
h n 1 frmed.</div>
GIEmbrylgyII
Wh
is
he clinic l resen

in f w ndering sleen? (3)
1. Abdmin l m s
s<div>2. P in</div><div>3. Trsin</div>
GIEmbrylgyII
1. Wh
% f
he ul
in h s ccessry sleens?<div><br /></div><div>2. Wh

re
he 3 ms
cmmn l ces
 find ccessry sleens?</div> 1. 10%<div><br /
></div><div>2. . <b>Hilum f
he rigin l sleen</b></div><div>b. <b>Gre
er m
en
um</b></div><div>c. <b>Anywhere n
he 
h f gn d l descen
</b>--even *g s
*
he scr
um. The rigin l
issue
h
frms
he sleen ls frms
he gn ds.
</div> GIEmbrylgyII
Wh
is
he in
erns rule?
1. E
when yu c n.<div>2. Slee when yu c n.<
/div><div>3. Dn
FUCK wi
h
he  ncre s.</div>
GIEmbrylgyII
Describe
he develmen
f
he  ncre s, including where e ch bud frms nd wh

i
becmes. "P ncre s frms frm 2 se r
e buds ff
he develing dudenum
.<div>R

in f
he s
m ch brings
hese
ge
her.</div><div><br /></div><div>
Ven
r l bud:</div><div>S
r
ing si
in: ne r
he develing bili ry sys
em</di
v><div>Frms:&nbs;</div><div>1. Uncin
e rcess<br />2. Inferir  r
f
he h
e d f
he  ncre s.</div><div>3. M in  ncre
ic duc
(f Wirsung)</div><div><b

r /></div><div>Drs l bud&nbs;</div><div>S
r
ing si
in: drs l mesen
ry</d

iv><div>Frms:&nbs;</div><div>1. Rem inder f gl nd</div><div>2. Accessry  nc
re
ic duc
(f S n
rini)</div><div><br /></div><div><img src="" s
e-678175336
1206.jg"" /></div>"
GIEmbrylgyII
Wh
re
he
w ms
cmmn cngeni
l bnrm li
ies f
he  ncre s?<div><br /
></div><div>Hw des e ch frm?</div> "1. <b>Annul r  ncre s. </b>S
r
wi
h
bilbed ven
r l  ncre
ic bud
h
wr s fully rund
he dudenum
 jin
h
e drs l bud. C n c use n rrwing f
he dudenum.<div><br /></div><div><img src
="" s
e-7112465842992.jg"" /></div><div><br /></div><div>2. <b>P ncre s divisu
m:</b></div><div><br /></div><div><img src="" s
e-7133940679472.jg"" /></div>"
GIEmbrylgyII
Is
he  ncre s in
r -, rim rily, r secnd rily re
reri
ne l?
<b>Secn
d rily re
reri
ne l</b><div><br /></div><div>C n rgue
he
il f
he  ncre
s is in
r eri
ne l b/c i
s nes
led in
he slenren l lig men
.</div>
GIEmbrylgyII
Wh
des
he wrd cl c me n? Li
er lly sewer. I
s
he rigin l cmbined en
ing f
he n l nd GU sys
ems. GIEmbrylgyII
Give
he rigin l divisins,
heir f
es, nd
he divider f
he cl c .
An
erir urgeni
l sinus--&g
;bl dder nd GU
r c
.<div><br /></div><div>Ps
er
ir rimi
ive nrec
l c n l--&g
; nus nd rec
um.</div><div><br /></div><div>
Divider: urrec
l se
um.</div>
GIEmbrylgyII
Give
he embrynic -derm l yer ssci
ed wi
h e ch f
hese s
ruc
ures.<div><br
/></div><div>Lining f
he cl c <div>Urrec
l se
um</div><div>Tissue u
side
"Lining f
he cl c : <b>endderm</b><d

he cl c l membr ne</div></div>
iv>Urrec
l se
um: <b>mesderm</b></div><div>Tissue u
side
he cl c l membr
ne: <b>ec
derm</b></div><div><b><br /></b></div><div><b><img src="" s
e-973669
0860414.jg"" /></b></div>"
GIEmbrylgyII
Wh
h ens

he cl c l membr ne in
he 7
h week?<div><br /></div><div>Wh

des
his llw?</div> Ru
ures<div><br /></div><div>Nw
here re enings fr

he urgeni
l sinus nd rimi
ive n l c n l.</div> GIEmbrylgyII
Describe
he develmen
f
he nrec
l c n l frm
he 7
h-9
h weeks.<div><br
/></div><div>Give
he dividing line nd
he bld suly ch nge bve nd belw
i
.</div>
"7
h week: <b>ec
derm rlifer
es</b>
 clse
he n l c n l
wi
h n <b> n l membr ne

he ec
in
e line</b>.<div><br /></div><div>9
h wee
k: n l membr ne ens nd ges w y ( .k. . <b>c n lizes</b>).</div><div><br />
</div><div><u>Inferir
 ec
in
e line</u></div><div>Embrylgic rigin: ec
de
rm l i
</div><div>N me:&nbs;
he <b>rc
deum.</b></div><div>Bld suly: <b>
Inferir</b> <b>rec
l</b> r
eries ff f
he <b>uden
i l</b> r
ery</div><div
><br /></div><div><u>Suerir
 ec
in
e line</u></div><div>Embrylgic rigin
:&nbs;<b>endderm</b></div><div>Bld suly: <b>suerir rec
l</b> r
ery ff
f
he <b>inferir</b> <b>mesen
eric</b> r
ery</div><div><br /></div><div><img
src="" s
e-11106785428278.jg"" /></div>"
GIEmbrylgyII
<div>Give 3 ex mles f e ch imerfr
e n l lesin.</div><div><br /></div>
"<div><u>Ex mles f high lesins</u></div><div><u><img src="" s
e-118584047050
72.jg"" /></u></div><div><u><br /></u></div><div><div s
yle=""
ex
-decr
in:
underline; ""><u>Ex mles f lw lesins</u></div><div s
yle=""
ex
-decr
in:
underline; ""><img src="" s
e-11635066405680.jg"" s
yle=""m x-wid
h: 90%; "" /
></div><div><u><br /></u></div></div>" GIEmbrylgyII
Describe
he surgic l rcess fr high imerfr
e n l lesins.<div><br /></div
><div>D
he s me fr lw lesins.</div>
"<div><div><u>High lesin rced
ures:</u></div></div><div>1. Cls
my:
w sm ll hles re m de in
he b by`s
bdmen nd
he descending cln is cu
. This llws:</div><div> . Shi

 be ke

u
f
he GU
r c
.</div><div>b. Im ging wi
h cn
r s
befre re ir.</div><d
iv>c. Buying
ime un
il
he kid ge
s big enugh
 m ke surgic l re ir f
he
nus e sier.</div><div><br /></div><div><img src="" s
e-13700945674617.jg"" s
y
le=""m x-wid
h: 90%; "" /></div><div><br /></div><div><img src="" s
e-137138305
76416.jg"" s
yle=""m x-wid
h: 90%; "" /></div><div><br /></div><div>2. Once
he
kid is 6-8 weeks ld, d n<b>...</b></div><div><b>Anl s
y&nbs;</b>(surgic l
cns
ruc
in f new nus
h
cnnec
s

he rec
um)</div><div>r s
ers g
i

l nl s
y .k. .&nbs;<b>Pen rcedure</b></div><div><b><br /></b></div><

div>3. Once #2 h s he led,
heres surgery
&nbs;<b>clse</b>&nbs;
he cls

my.</div><div><u><br /></u></div><div><u>Lw lesin rcedures:&nbs;</u></div
><div>-N cls
my necess ry bec use
he defec
is e sy enugh
 surgic lly re
 ir in
he newbrn.</div><div><br /></div><div>1.&nbs;<b>Dil

in</b>&nbs;(
widening)</div><div>2.&nbs;<b>Simle nl s
y&nbs;</b></div><div>3.&nbs;<b>L
imi
ed</b>&nbs;s
ers gi

l nl s
y ( .k. .&nbs;<b>Pen rcedure</b>)</d
iv>"
GIEmbrylgyII
M ke lis
f ll
he si
es in
he hum n bdy where lyszyme, l c
ferrin, defe
nsins, nd erfrins cn
rl b c
eri l grw
h. (5)
"<div>1.<s n cl ss=""A
le-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>S liv ry gl nds</div><div>2.<s
n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Sermucus gl nds 
f
he resir
ry
ree</div><div>3.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
es ce:re""> </s n>C rdi c gl nds</div><div>4.<s n cl ss=""Ale-
b-s n"" s

yle=""whi
e-s ce:re""> </s n>Pylric gl nds</div><div>5.<s n cl ss=""Ale-

b-s n"" s
yle=""whi
e-s ce:re""> </s n>P ne
h cells</div><div><br /></div>"
in
es
ine
Lis
ll
he
urnver r
es f ll
he ei
heli l cells lng
he gu
frm esh
gus
 cln.<div><br /></div><div>Give
he lc
in f ll
he s
em cells.</di
v><div><br /></div><div>Wh
cells d
he s
em cells m ke?</div>
<div>Es
h gus:</div><div><u>Lc
in</u>: S
em cells re

he equiv len
level f
he
&nbs;s
r
um b s le&nbs;in skin.<div><u>Turnver r
e</u>:&nbs;<b>15 d ys</b>
.</div></div><div><br /></div><div>S
m ch:</div><div><u>Lc
in</u>: S
em cell
s

he i
/gl nd in
erf ce f ll gl nd
yes.<div><u>Uw rd</u>: rel ces&nbs
;surf ce mucus cells.&nbs;<b>4-7 d y
urnver</b>.</div><div><u>Dwnw rd</u>:
rel ces&nbs;P rie
l, chief, neck mucus, nd en
erendcrine cells.&nbs;<b>30
d y
urnver.</b></div></div><div><br /></div><div>Sm ll in
es
ine nd cln:</
div><div><u>Lc
in:</u>&nbs;B s l 1/2 (sm ll in
es
ine) r 1/3 (cln) f cry

s f Lieberkuhn.</div><div><u>Uw rd:</u>&nbs;Gble
nd en
erendcrine cell
s.<b> 2-3 d y
urnver.</b></div><div><u>Dwnw rd:&nbs;</u>P ne
h nd en
erend
crine cells. <b>30 d y
 1 ye r
urnver.</b></div> in
es
ine
Aendix:<div><br /></div><div>1. Wh

her lymhid
issue invlu
es wi
h ge?
</div><div><br /></div><div>2. In wh
4 w ys des
he endix disl y nn-cl
nic his
lgy?</div>
1. Thymus.<div><br /></div><div>2. . <b>N
eni cli</
b></div><div>b. <b>N endices eilic e</b></div><div>c. <b>N clnic mvem
en
s </b>(h us
r
in, eris
lsis, m ss mvemen
, mucs l squeeze r flu

er)</
div><div>d. <b>Cnfluen
lymh
ic ndules</b> s sed
 diffuse lymh
ic n
in
es
ine
dules in
he cln</div>
Give
he lc
in f
he in
ers
i
i l cells f C j l. "<img src="" s
e-256538
39659045.jg"" />"
Gu
M
ili
yI
Give
he mdel f wh
h ens
 neurns in resnse
 hyerglycemi . "<img sr
c="" s
e-26800595927763.jg"" />"
Gu
M
ili
yI
Discuss hw
he s
reng
h f del riz i
n ( mli
ude?) nd dur
in f
he slw
w ve ffec
cn
r c
in.
S
reng
h: higher--&g
;mre del riz
in--&g
;m
re c
in 
en
i ls--&g
;gre
er
he frce f cn
r c
in.<div><br /></div><di
v>Dur
in:
he lnger
he w ve,
he lnger
he dur
in f cn
r c
in.</div>
Gu
M
ili
yI
Wh
3 cl sses f sm ll mlecules c n ll influence sm
h muscle cn
r c
ili
y?
Neur
r nsmi

ers<div>Hrmnes</div><div>P r crine subs
nces</div>
Gu
M
il
i
yI
Wh
m
r 

erns hels
 cun
er c
GERD? "<img src="" s
e-32547262169107
.jg"" />"
M
ili
yII
Fr
he rxim l s
m ch:<div><br /></div><div>Give
he m
r 

ern nd innerv

in.</div><div>Wh
s i
s func
in?</div><div>Are slw w ves resen
?</div><di
v>Wh
s
he dise se ssci
ed wi
h
his regin c lled?</div> "<img src="" s

e-33702608371731.jg"" />"
M
ili
yIIessen
i l
Fr
he dis
l s
m ch:<div><br /></div><div>Wh
nervus sys
em is resnsible
fr i
s mvemen
s?</div><div>Are slw w ves resen
?</div><div>Wh
3 mvemen
s
reduce  r
icle size
 1 mm?</div><div>Wh
des
he ylric shinc
er c
s?<
/div> "<img src="" s
e-34269544054857.jg"" />"
M
ili
yIIessen
i l
Wh
dise se rfundly ffec
s g s
ric m
ili
y?
Di be
ic neur
hy

M
ili
yIIessen
i l
Give
he 4 esh ge l m
ins,
heir lc
ins nd
heir descri
in/func
in.
"<img src="" s
e-57101590200426.jg"" />"
Esh gus
Give
he 5 m
ins ssci
ed wi
h
he s
m ch.<div><br /></div><div>Give
heir
lc
ins.</div><div><br /></div><div>Give descri
in nd
heir func
in.</di
v>
"<img src="" s
e-57127360004187.jg"" />"
S
m ch
Give
he 7 mvemen
s ssci
ed wi
h
he cln.<div><br /></div><div>Give
heir
lc
in.</div><div><br /></div><div>Give
descri
in f e ch nd i
s func
in
.</div> "<img src="" s
e-57316338565241.jg"" />"
in
es
ine
Give
he 5 mvemen
s ssci
ed wi
h
he cln.<div><br /></div><div>Give
heir
lc
ins.</div><div><br /></div><div>Give descri
in nd func
in f e ch.</
div>
"<img src="" s
e-57428007714907.jg"" />"
in
es
ine
Wh
is
he gener l s
ruc
ure f l sm liid  r
icles?
"Hydrhbic cr
e f
riglycerides (TGs) nd chles
erl es
ers (CEs), u
er mhi
hic <i s
yl
e=""fn
-weigh
: bld; "">mnl yer</i>&nbs;f hshliids nd lir
eins
fr sign ling urses.<div><br /></div>"
LiidsI Me
blismGIMNER
In
erms f chles
erl, wh

he
w bigges
indeenden
risk f c
rs fr crn
ry he r
dise se (CHD)?
"1. high ""lusy"" LDL: lng h lf-life, lw dens
i
y 
en
i
es cl

ing f vessels<div>2. lw ""he l
hy"" HDL: less recvery f
lef
ver chles
erl, less
r nsr
f LDLs
 liver</div>" LiidsI Me
bli
smGIMNER
Wh

he m jr func
ins f f

y- cid liids? "<div>1. Surce f energy (bes

surce)</div><div>2. S
ruc
ur l ( r
f cell membr ne)</div><div>3. Insul
r (
shingmyelin)</div><div>4. Cell sign ling (di cylglycerl r DAG)</div><div>5.
Lc l hrmnes (rs
gl ndins, leuk
rienes)</div><div>6. Reduce surf ce
ensi
n (lung surf c
n
)</div><div><br /></div><div>Mre likely
 be sked s ""whic
h f
he fllwing is NOT
liid func
in""</div>"
LiidsI Me
blismGIMNER
In ddi
in
 mder
ing membr ne fluidi
y (reven
ing excess fluidi
y
high

ems nd excess rigidi
y
lw
ems), chles
erl is
he syn
he
ic recursr
bile cids, s
erid hrmnes
LiidsI Me
blismGIMNER

 ____ nd ____.
If

riglyceride h s n uns
ur
ed f

y cid,
 which c rbn will i
be bun
d?

he 2nd c rbn f
he glycerl b ckbne LiidsI Me
blismGIMNER
There re
hree imr
n
li ses.<div><br /></div><div><div>____ rele ses r ch
idnic cid frm cell membr ne; inhibi
ed by s
erids (like rednisne).&nbs;</
div><div><br /></div><div>___-sensi
ive li se inside dise cells. S
imul
ed
by ___ bre ks dwn f
</div><div><br /></div><div>___ li se n end
heli l cell
membr nes / c ill ry lumen. Mves f

y cids frm ___ nd ___ in

issues (l
ike dise).&nbs;</div></div> "There re
hree imr
n
li ses.<div><br /></
div><div><div><fn
clr=""#ff1922"">Phshli se A2</fn
> rele ses r chidn
ic cid frm cell membr ne; inhibi
ed by s
erids (like rednisne)</div><div><b
r /></div><div><fn
clr=""#ff1922"">Hrmne</fn
>-sensi
ive li se inside d
ise cells. S
imul
ed by <fn
clr=""#ff1922"">nreinehrine</fn
> bre ks
dwn f
</div><div><fn
clr=""#ff1922"">Lir
ein</fn
> li se n end
hel
i l cell membr nes / c ill ry lumen. Mves f

y cids frm <fn
clr=""#ff19
22"">VLDL</fn
> nd chylmicrns in

issues (like dise).&nbs;</div></div>
"
LiidsI Me
blismGIMNER
Hw des Orlis

(Xenic l in Eure, Alli in
he US) func
in s n n
i-besi

y drug? I
inhibi
s in
es
in l li ses, reven
ing u
ke f liids.<div><br /><
/div> LiidsI Me
blismGIMNER
Hw des Ac rbse func
in s di be
ic
re
men
?
Inhibi
in f myl se

LiidsI Me
blismGIMNER
reven
glucse u
ke.
Eze
imibe (Ze
i )
re
s high chles
erl by ___.
Inhibi
in f chles
er
l u
ke ch nnels in
he jejunum.<div><br /></div><div>Thus, i
c n be used in c
njunc
in wi
h s

in drugs
h
wrk by cme
i
ive inhibi
in f HMG-CA redu
c
se, key enzyme in de nv chles
erl syn
hesis.</div>
LiidsI Me
bli
smGIMNER
(T/F) The m jr surce f ur chles
erl is vi
he die
. Why (n
)? F; 30% d
ie
ry, 70% de nv (in
he liver).<div><br /></div><div>Thus ne ls h s
 c
nsume less TGs nd c rbs bec use
hey re chles
erl recursrs.</div><div><br
/></div><div>Chles
erl is rim rily excre
ed vi bile nd
hen feces due
 i

s hydrhbici
y, nd
hus i
s in bili
y
 be c rried in
he blds
re m nd ex

cre
ed by
he kidneys.</div>
LiidsI Me
blismGIMNER
Essen
i l f

y cids re ___ f

y cids.&nbs;Our cells c nn
m ke
hem. We n
eed essen
i l f

y cids: 1.
 m ke lc l hrmnes, like ___, ___, e
c., 2. In
cre se ___.&nbs;Vege
ble ils, fish il re rich in ___ f

y cids. "<div>Es
sen
i l f

y cids re <b><fn
clr=""#ff1922"">cis</fn
></b> -<fn
clr="
"#ff1922"">lyuns
ur
ed</fn
> f

y cids.&nbs;Our cells c nn
m ke
hem.
We need essen
i l f

y cids: 1.
 m ke lc l hrmnes, like <fn
clr=""#ff
1922"">rs
gl ndins</fn
>, <fn
clr=""#ff1922"">leuk
rienes</fn
>, e
c.,
2. Incre se membr ne fluidi
y.&nbs;Vege
ble ils, fish il re rich in <fn

clr=""#ff1922"">lyuns
ur
ed</fn
> f

y cids.</div>"
LiidsI Me
bli
smGIMNER
Why re
r ns-f

y cids ( nd s
ur
ed f
s) b d? Hw re
hey frmed?
They re line r nd
hus  ck mre e sily, frming slid ggreg
es
lwer
em
er
ures, 
en
i
ing cl

ing. They re ls me
blized slwly by
he bdy.<
div><br /></div><div>Tr ns-f
s re frmed by high he
, c using n ismeriz
i
n f
he duble bnd f cis-uns
ur
ed f
. S
ur
ed f
s c n be frmed by h
ydrgen
in, r
ifici lly reducing
he duble bnds f uns
ur
ed f
s.</div><
div><br /></div><div>Why indus
ry des
his, beynd djus
ing
ex
ure r cnsis

ency f r
ifici l liids (r s ving mney), is rb bly
he wrk f
he Chinese
slwly killing us.&nbs;</div> LiidsI Me
blismGIMNER
Wh

he
w m in liid
r nsr
 r
icles in
he bdy? Where re
hey
r nsr
Chylmicrns: frm
he sm ll in
es
ine
 eriher l
issues nd

he

ed?
liver.<div>Lir
eins: frm
he liver
 eriher l
issues.</div>
LiidsI
Me
blismGIMNER
HDL is cnsidered benefici l bec use... 1.
r nsfers sign ling lir
eins

 chylmicrns nd VLDLs. These lir
eins re cri
ic l sign ling nd
r ff
icking mlecules.<div>2. HDL
r nsr
s chles
erl b ck

he liver.</div><div
>3. HDL re
urns FAs frm VLDL b ck

he liver.</div> LiidsI Me
blismGIMNER
Fr e ch f
he fur liid
r nsr
ers, wh
re
heir rel
ive TG nd CE cn
e
n
s? Their func
ins nd f
es? "<img src=""Screen Sh
2012-11-12
1.37.17 AM
.ng"" />"
LiidsI Me
blismGIMNER
<div>Regul r e
ing rduces cycles f feeding nd f s
ing
hrughu

he d y bu


he ___-hr slee erid rvides lw- c
ivi
y f s
ing s

e.</div><div><br /
></div><div>Glycgen s
res in muscle nd liver
h
re build u in
he fed s


e, re dele
ed in
he f s
ed s

e. &nbs;Wi
hin bu
___ hr f
er e
ing, li
ver ___ s
res re dele
ed nd l
ern
ive mech nisms fr gener
ing energy mus

be sugh
.</div><div><br /></div><div>Wi
h rlnged f s
ing,
he nly 
her s
"<div>Re
urces f energy nd glucse
h
c n be used re ___ nd ___.</div>
gul r e
ing rduces cycles f feeding nd f s
ing
hrughu

he d y bu

he<f
n
clr=""#ff1922""> 8</fn
>-hr slee erid rvides lw- c
ivi
y f s
ing
s

e.</div><div><br /></div><div>Glycgen s
res in muscle nd liver
h
re b
uild u in
he fed s

e, re dele
ed in
he f s
ed s

e. &nbs;Wi
hin bu
<
fn
clr=""#ff1922"">24</fn
> hr f
er e
ing, liver <fn
clr=""#ff1922"">
glycgen</fn
> s
res re dele
ed nd l
ern
ive mech nisms fr gener
ing en
ergy mus
be sugh
.</div><div><br /></div><div>Wi
h rlnged f s
ing,
he nly

her surces f energy nd glucse
h
c n be used re <fn
clr=""#ff1922"
">f
</fn
> nd <fn
clr=""#ff1922"">r
ein</fn
>.</div>" Me
blismGIMNER
Regul
inF s
edS

e
As
he bdy rceeds in
 f s
ed s

e,
he fllwing gener l even
s ccur:<div>
1. liver ___ mbiliz
in</div><div>2. lilysis f ___ incre ses</div><div>3. _
__ incre ses f
er
he bsr
ive erid.</div><div>4. r
ein degr d
in cn
r
ibu
es
 ___ nd ___ 
hw ys.</div><div>5. ___ s
res dele
e f
er 1 d y</div
><div>6. ___ se
s in f
er sever l d ys</div> "As
he bdy rceeds in
 f s
e
d s

e,
he fllwing gener l even
s ccur:<div>1. liver <fn
clr=""#ff1922"
">glycgen</fn
> mbiliz
in</div><div>2. lilysis f <fn
clr=""#ff1922""
>FAs</fn
> incre ses</div><div>3. <fn
clr=""#ff1922"">glucnegenesis</fn

> incre ses f
er
he bsr
ive erid.</div><div>4. r
ein degr d
in cn
ri
bu
es
 <fn
clr=""#ff1922"">glucgenic</fn
> nd <fn
clr=""#ff1922"">k
e
genic</fn
> 
hw ys.</div><div>5. <fn
clr=""#ff1922"">glycgen</fn
> s


res dele
e f
er 1 d y</div><div>6. <fn
clr=""#ff1922"">ke
genesis</fn

> se
s in f
er sever l d ys</div>"
Me
blismGIMNER Regul
inF s
edS

e
During
he f s
ed s

e, which hrmnes will incre se c
ivi
y nd which will de
cre se in c
ivi
y?
NE, cr
isl, nd gluc gn will incre se s
he rim ry
sign ling hrmnes. Insulin c
ivi
y will decre se.
Me
blismGIMNER Regul

inF s
edS

e
<div>In
he F s
ed S

e me
blism shif
s frm deendence n ex
ern l surces 
f fuel
 in
ern l nes: glycgen in ___,
riglyceride in ___, nd r
ein m inl
y in ___.&nbs;The shif

 in
ern l s
res is sign led by
f ll in
he circul

ing levels f ___, which
riggers hrmn l decline in ___ nd rise in ___. In
hum ns ___ ffec
s nly
he liver. The f ll in glucse ls s
imul
es bre kdw
n f
riglycerides in dise by rele se f ___ frm nerves .</div><div><br /></
div>
"<div>In
he F s
ed S

e me
blism shif
s frm deendence n ex
ern l
surces f fuel
 in
ern l nes: glycgen in<fn
clr=""#ff1922""> liver</fn

>,
riglyceride in <fn
clr=""#ff1922""> dise</fn
>, nd r
ein m inly i
n <fn
clr=""#ff1922"">muscle</fn
>.&nbs;The shif

 in
ern l s
res is si
gn led by f ll in
he circul
ing levels f <fn
clr=""#ff1922"">glucse</f
n
>, which
riggers decline in <fn
clr=""#ff1922"">insulin</fn
> nd ris
e in <fn
clr=""#ff1922"">gluc gn</fn
>. In hum ns <fn
clr=""#ff1922"">
gluc gn</fn
> ffec
s nly
he liver. The f ll in glucse ls s
imul
es bre
kdwn f
riglycerides in dise by rele se f <fn
clr=""#ff1922"">nreine
hrine</fn
> frm nerves&nbs;</div><div><br /></div>" Me
blismGIMNER Regul

inF s
edS

e
<div>When signific n
min cids frm r
ein degr d
in ccumul
e in
he bl
d, kidney begins
 cver
___
 glucse by glucnegenesis. ___ frm r
ein
degr d
in is sen


he liver fr ___.</div> "<div>When signific n
min ci
ds frm r
ein degr d
in ccumul
e in
he bld, kidney begins
 cver
<f
n
clr=""#ff1922"">glu
mine</fn
>
 glucse by glucnegenesis. <fn
clr
=""#ff1922"">Al nine</fn
> frm r
ein degr d
in is sen


he liver fr <f
n
clr=""#ff1922"">glucnegenesis</fn
>.</div><div><br /></div>" Me
bli
smGIMNER Regul
inF s
edS

e
<div>During rlnged f s
(___ d ys),
he liver begins rducing ___. &nbs;T
he me
blism f by
he res
f
he bdy, including
he br in rvides
new su
rce f energy frm f
s
res. ___ frm
in in
he liver ls gener
es CASH
nd incre ses
he c  ci
y f f

y xid
in in
he liver. &nbs;</div> "<div>Du
ring rlnged f s
(<fn
clr=""#ff1922"">&g
;2</fn
> d ys),
he liver beg
ins rducing <fn
clr=""#ff1922"">ke
ne</fn
> <fn
clr=""#ff1922"">bdi
es</fn
>. &nbs;The me
blism f <fn
clr=""#ff1922"">ke
ne</fn
> <fn
c
lr=""#ff1922"">bdies</fn
> by
he res
f
he bdy, including
he br in rv
ides new surce f energy frm f
s
res. &nbs;Ke
ne bdy frm
in in
he
liver ls gener
es <fn
clr=""#1d0203"">CASH</fn
> nd incre ses
he c 
ci
y f f

y xid
in in
he liver. &nbs;</div><div><br /></div><div><br /></
div>" Me
blismGIMNER Regul
inF s
edS

e
Why use ke
ne bdies when f
s
res ls l s

very signific n

ime?
The br in c nn
me
blize f

y cids nd
hus relies un ke
ne bdies when
glycgen s
res re dele
ed.<div><br /></div><div>Mre cmlex:&nbs;&nbs;Bec
use f
he high level f ce
yl CA resen
in
he cell,
he yruv
e dehydrgen
se cmlex is inhibi
ed, where s yruv
e c rbxyl se becmes c
iv
ed. High l
evels f ATP nd NADH <b>inhibi
</b>
he enzyme isci
r
e dehydrgen se in<b>

he TCA cycle</b> nd s resul
c use n incre se in
he cncen
r
in f m l

e (due

he equilibrium be
ween i
self nd x l ce

e). The m l
e
hen le v
es
he mi
chndrin nd underges glucnegenesis. The elev
ed level f NADH
nd ATP resul
frm -oxidation of fatty acids. <>Unale to e used in the citric
acid cycle, the excess acetyl-Co is therefore rerouted to ketogenesis.</></div
>
MetaolismGIMNER RegulationFastedState
<div>In metaolic pathways, a few steps will provide ottlenecks to flow. &nsp;
These are called the ___ steps of the pathway. &nsp; <>Only the regulation of
these slow steps </>will affect the overall flux through the pathway, regardles
s of the type of regulation.</div>
"<div>In metaolic pathways, a few steps
will provide ottlenecks to flow. &nsp;These are called the <font color=""#f0

f18"">rate</font>-<font color=""#f0f18"">limiting</font> steps of the pathway.

&nsp;<>Only the regulation of these slow steps</> will affect the overall flu
x through the pathway, regardless of the type of regulation.</div>"
Metaoli
smGIMNER RegulationFastedState
<div>___ such as TP, ND+ and HSCo, which are used in several pathways of ener
gy metaolism, link the pathways together and provide a coarse control that oper
ates on a second-to-minute time scale. The necessity for ___ ensures that the ox
idation of foodstuffs is in sync with the regeneration of their ___.</div><div><
r /></div>
"<div><font color=""#f0f18"">Cofactors</font> such as TP, ND+
and HSCo, which are used in several pathways of energy metaolism, link the pa
thways together and provide a coarse control that operates on a second-to-minute
time scale. The necessity for <font color=""#f0f18"">cofactor</font> <font col
or=""#f0f18"">cycling</font> ensures that the oxidation of foodstuffs is in syn
c with the regeneration of their <font color=""#f0f18"">cofactors</font>.</div>
<div><r /></div>"
MetaolismGIMNER RegulationFastedState
Define reciprocal regulation. "<div>Opposing pathways (i.e. glycolysis/glucneo
genesis, fatty acid synthesis/oxidation, etc) <font color=""#ff0015""><>have co
mmon steps that are </><>rate limiting/slow</></font><font color=""#0d0001"">
. &nsp;The forward and reverse reactions are</font> <font color=""#0d0001"">not
</font> catalyzed y the same enzymes and when one enzyme activity goes up, the
opposing enzyme goes down.</div><div><r /></div><div><div>Bules of opposing rea
ctions like we see in glycolysis/gluconeogenesis are generally regulated in a co
ordinated fashion. &nsp;In addition to changing the flux through the ule, th
e coordinate regulation <><font color=""#ff0015"">enhances the systems responsiv
eness to regulation and amplifies the signals effect.</font></></div></div>"
MetaolismGIMNER RegulationFastedState
Signaling cascades ___ the effects of a single molecule. Certain steps involving
direct interaction etween signaling molecules (ex: hormone and G-protein) are
___ in a ___ fashion.&nsp;Steps in which one ___ activity is use to activate an
other ___ activity and so on, serves as a massive ___ of the signal since any on
e enzyme will turnover many of its sustrates which, in turn, will turn over man
y of their sustrates. "Signaling cascades <font color=""#ff0015"">amplify</fon
t> the effects of a single molecule. Certain steps involving direct interaction
etween signaling molecules (ex: hormone and G-protein) are <font color=""#ff001
5"">stoichiometric</font> in a <font color=""#ff0015"">1:1</font> fashion.&nsp;
Steps in which one <font color=""#ff0015"">enzyme</font> activity is use to acti
vate another <font color=""#ff0015"">enzyme</font> activity and so on, serves as
a massive <font color=""#ff0015"">amplification</font> of the signal since any
one enzyme will turnover many of its sustrates which, in turn, will turn over m
any of their sustrates.<div><r /></div>"
MetaolismGIMNER RegulationFaste
dState
"<img src=""paste-2796023709700.jpg"" /><div>What is wrong here?</div>" Leiomyom
a
ProteinsFastedState
"<img src=""paste-3642132267012.jpg"" /><div>What is wrong here?</div>" chalasi
a
ProteinsFastedState
"<img src=""paste-3882650435588.jpg"" /><div>What is wrong here?</div>" Nothing!
This is the normal appearance. ProteinsFastedState
"<img src=""paste-4170413244420.jpg"" /><div>What is wrong here?</div>" GERD<div
>Reflux from the stomach into the upper GI</div>
ProteinsFastedState
"<img src=""paste-4750233829380.jpg"" /><div>What is this?</div>"
Normal r
ugae of the stomach
ProteinsFastedState
"<img src=""paste-4909147619332.jpg"" /><div>Identify.</div>" <div>Stages of t
he duodenum</div>. 1st stage&nsp;<div>B. 2nd stage</div><div>C. 3rd stage</div
><div>D. 4th stage</div>
ProteinsFastedState
____ stage of the duodenum is supported y the ligament of Treitz
"<font c
olor=""#FF0000"">4th stage</font> stage of the duodenum is supported y the liga
ment of Treitz" ProteinsFastedState
____ stage of the duodenum is crossed y the superior mesenteric vessels
"<font color=""#FF0000"">3rd</font>&nsp;stage of the duodenum is crossed y the
superior mesenteric vessels" ProteinsFastedState

____ stage of the duodenum is in the transpyloric plane "<font color=""#FF0000""

>1st</font> stage of the duodenum is in the transpyloric plane" ProteinsFastedSt
ate
"<img src=""paste-5647881994244.jpg"" /><div>What is the arrow pointing at? How
do you know?</div>"
"Jejunum since it contains valvulae conniventes (valves
of Kierkring)<div><img src=""paste-5862630359044.jpg"" /></div>"
Proteins
FastedState
"<img src=""paste-6253472382980.jpg"" /><div>What is the arrow pointing at?</div
>"
Jejunum ProteinsFastedState
"<img src=""paste-6515465388036.jpg"" /><div>Identify.</div>" Ileum Proteins
FastedState
"<img src=""paste-6708738916356.jpg"" /><div>What are these dark los?</div>"
Gas in the intestine
ProteinsFastedState
"<img src=""paste-7026566496260.jpg"" /><div>Is this upright or supine?</div><di
v>How can you tell?</div>"
Upright film<div><div>Note air/fluid levels and
diaphragms included</div><div><r /></div></div>
ProteinsFastedState
"<div><img src=""paste-7876970020868.jpg"" /></div><div>Is this upright or supin
e?</div><div>How can you tell?</div>" <div>Supine</div><div>Note pelvis includ
ed and upper adomen not included.</div><div><r /></div>
ProteinsFastedSt
ate
"<div><img src=""paste-8551279886340.jpg"" /></div>Identify"
"<img src=""past
e-8340826488836.jpg"" />"
ProteinsFastedState
"<img src=""paste-8774618185732.jpg"" /><div>What is wrong here?</div>" Constipa
tion
ProteinsFastedState
"<img src=""paste-8959301779460.jpg"" /><div>What is wrong here?</div>" "<img sr
c=""paste-9156870275076.jpg"" />"
ProteinsFastedState
How can nuclear medicine e used to find a GI leed?
"<div>Tc-99m laeled RBC
s are injected into patient. &nsp;Uptake in the small owel indicates a GI lee
d</div><div><img src=""paste-9796820402180.jpg"" /></div>"
ProteinsFastedSt
ate
"<img src=""paste-9942849290244.jpg"" /><div>What is wrong here?</div>" "<img sr
c=""paste-10097468112900.jpg"" /><div>Free air under the diaphragm (pneumoperito
neum)</div>"
ProteinsFastedState
What imaging modalities are used for the liver? CT, MRI, ultrasound
Proteins
FastedState
"<img src=""paste-10462540333060.jpg"" /><div>What is wrong here?</div>"
Liver cirrhosis ProteinsFastedState
"<img src=""paste-10746008174596.jpg"" /><div>Identify</div>" 1. Hepatic porta
l vein<div>2.Splenic vein</div><div>3. Superior mesenteric vein</div> Proteins
FastedState
"<img src=""paste-11029476016132.jpg"" /><div>What is wrong here?</div>"
Engorged paraumilical veins (caput medusa) due to portal hypertension Proteins
FastedState
"<img src=""paste-11209864642564.jpg"" /><div>Identify.</div>" 1. Right and lef
t hepatic ducts<div>2. Common hepatic duct</div><div>3. Cystic duct</div><div>4.
Gallladder</div><div>5. Common ile duct</div>
ProteinsFastedState
Common ile duct empties into...
2nd stage of the duodenum
Proteins
FastedState
"<img src=""paste-11703785881604.jpg"" /><div>What is this?</div>"
Galllad
der<div><r /></div>
ProteinsFastedState
"<img src=""paste-11918534246404 (1).jpg"" /><div>What is this?</div>" Galllad
der<div><r /></div>
ProteinsFastedState
"<img src=""paste-12184822218756.jpg"" /><div>Identify</div>" <div>Pancreas</d
iv>1. Head<div>2. Neck</div>
ProteinsFastedState
"<img src=""paste-12313671237636.jpg"" /><div>Identify.</div>" <div>Pancreas</d
iv>4. Body<div>5. Tail</div>
ProteinsFastedState
"<img src=""paste-12489764896772.jpg"" /><div>What is wrong here?</div>"
Pancreatic adenocarcinoma
ProteinsFastedState
"<img src=""paste-12713103196164.jpg"" />"
Spleen ProteinsFastedState
"<img src=""paste-12914966659076.jpg"" />"
Spleen ProteinsFastedState

"<img src=""paste-13142599925764.jpg"" /><div>Identify.</div>" drenal glands<d

iv><r /></div> ProteinsFastedState
What is a leiomyoma?
Smooth muscle tumor
ProteinsFastedState
What does an upper GI study oserve?
Esophagus and stomach ProteinsFastedSt
ate
"<img src=""paste-14181982011396.jpg"" /><div>What type of study was used to cre
ate this image?</div>" Doule contrast arium enema
ProteinsFastedState
"<img src=""paste-14297946128388.jpg"" /><div>Identify.</div>" Stomach Proteins
FastedState
"<img src=""paste-14607183773700 (1).jpg"" /><div>Identify.</div>"
Jejunum
ProteinsFastedState
Gallstones are est seen using ____
ultrasound
ProteinsFastedState
"<img src=""paste-15199889260548.jpg"" />"
Liver ProteinsFastedState
"<img src=""paste-15354508083204.jpg"" />"
Spleen ProteinsFastedState
Which structures are found at T12?
"<div>T12 aorta passes posterior to diap
hragm, celiac trunk</div><div><img src=""paste-16024522981380.jpg"" /></div>"
ProteinsFastedState
Which structures are found at L1?
"<div>Superior mesenteric artery, hilum
of left kidney, ody of pancreas, pylorus, 1st stage of duodenum, fundus of gall
ladder, root of transverse mesocolon, duodenal jejunal junction&nsp;</div><di
v><img src=""paste-16282221019140.jpg"" /></div>"
ProteinsFastedState
Which structures are found at L2?
"<div>Hilum of right kidney, second stag
e of duodenum, gonadal vessels</div><div><img src=""paste-16531329122308.jpg"" /
></div>"
ProteinsFastedState
Which structures are found at L3?
"<div>3rd stage of duodenum, inferior me
senteric artery</div><div><img src=""paste-16883516440580.jpg"" /></div>"
ProteinsFastedState
Which structures are found at L4?
"<div>Bifurcation of aorta, supracristal
plane</div><div><img src=""paste-17270063497220.jpg"" /></div>"
Proteins
FastedState
Which structures are found at L5?
"Formation of the IVC<div><img src=""pas
te-18975165513732.jpg"" /></div>"
ProteinsFastedState
Which structures are found at S1?
"Sacral promontory<div><img src=""paste19091129630724.jpg"" /></div>" ProteinsFastedState
Which verteral level contains the umilicus? "L3/L4<div><img src=""paste-1920
7093747716.jpg"" /></div>"
ProteinsFastedState
"<img src=""paste-19520626360324.jpg"" /><div>Identify.</div>" "<div>1.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Central tendon</div><di
v>2.<span class=""pple-ta-span"" style=""white-space:pre""> </span>perture fo
r IVC (T8)</div><div>3.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>ortic aperture (T12)</div><div>4.<span class=""pple-ta-span"" style="
"white-space:pre""> </span>Right crus</div><div>5.<span class=""pple-ta-span""
style=""white-space:pre""> </span>Left crus</div><div>6.<span class=""pple-ta
-span"" style=""white-space:pre""> </span>Median arcuate ligament</div><div>7.<s
pan class=""pple-ta-span"" style=""white-space:pre""> </span>Medial arcuate li
gament</div><div>8.<span class=""pple-ta-span"" style=""white-space:pre""> </s
pan>Lateral arcuate ligament</div><div>9.<span class=""pple-ta-span"" style=""
white-space:pre""> </span>Psoas major and minor</div><div>10.<span class=""pple
-ta-span"" style=""white-space:pre""> </span>Quadratus lumorum</div><div>11.<s
pan class=""pple-ta-span"" style=""white-space:pre""> </span>Transversus adom
inus</div><div>12.<span class=""pple-ta-span"" style=""white-space:pre""> </sp
an>Esophageal aperture (T10)</div><div><r /></div>"
ProteinsFastedState
"<img src=""paste-19756849561604.jpg"" />"
"<div>1.<span class=""pple-taspan"" style=""white-space:pre""> </span>Common iliacs (egin at L4)</div><div>2
.<span class=""pple-ta-span"" style=""white-space:pre""> </span>External iliac
(ecomes femoral)</div><div>3.<span class=""pple-ta-span"" style=""white-spac
e:pre""> </span>Internal iliac (supplies pelvis)</div><div>4.<span class=""pple
-ta-span"" style=""white-space:pre""> </span>Celiac</div><div>5.<span class=""
pple-ta-span"" style=""white-space:pre""> </span>Superior mesenteric</div><div>
6.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Inferior mese

nteric</div><div>7.<span class=""pple-ta-span"" style=""white-space:pre""> </s

pan>Renal</div><div>8.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>Suprarenal</div><div>9.<span class=""pple-ta-span"" style=""white-space
:pre""> </span>Testicular/ovarian</div><div>10.<span class=""pple-ta-span"" st
yle=""white-space:pre""> </span>Inferior phrenic</div><div>11.<span class=""ppl
e-ta-span"" style=""white-space:pre""> </span>Lumar</div><div>12.<span class="
"pple-ta-span"" style=""white-space:pre""> </span>Median sacral (unpaired)</di
v><div><r /></div>"
ProteinsFastedState
t which verteral level do the common iliacs egin?
L4
ProteinsFastedSt
ate
"<img src=""paste-20723217203204.jpg"" /><div>Male or female?</div>"
Male
ProteinsFastedState
"<img src=""paste-20860656156676.jpg"" /><div>Identify.</div>" "<div>1.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Common Iliac Veins (pos
terior to arteries)</div><div>2.<span class=""pple-ta-span"" style=""white-spa
ce:pre""> </span>Union of common iliac veins (at L5)</div><div>3.<span class=""
pple-ta-span"" style=""white-space:pre""> </span>Lumar veins&nsp;</div><div>4
.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Right renal ve
in</div><div>5.<span class=""pple-ta-span"" style=""white-space:pre""> </span>
Left renal vein (anterior to aorta, ut posterior to SM)</div><div>6.<span clas
s=""pple-ta-span"" style=""white-space:pre""> </span>Right ovarian/testicular
vein</div><div>7.<span class=""pple-ta-span"" style=""white-space:pre""> </spa
n>Left ovarian/testicular vein</div><div>8.<span class=""pple-ta-span"" style=
""white-space:pre""> </span>Right adrenal vein</div><div>9.<span class=""pple-t
a-span"" style=""white-space:pre""> </span>Left adrenal vein</div><div>10.<span
class=""pple-ta-span"" style=""white-space:pre""> </span>Hepatic veins</div><
div>11.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Phrenic
veins</div><div><r /></div><div><r /></div>" ProteinsFastedState
t which verteral level do the common iliac veins merge?
L5
Proteins
FastedState
Which veins drain the ody wall in the lumar region? Which veins connect them v
ertically?
"Lumer veins connected vertically y ascending lumar veins<div
><img src=""paste-22574348107780.jpg"" /></div>"
ProteinsFastedState
<div>T/F:Lumar and azygous veins are not connected. These are two separate syst
ems.</div><div><r /></div>
"<div><font color=""#FF0000"">False</font>: Ther
e are connections etween lumar veins and azygous veins</div><div><r /></div>"
ProteinsFastedState
How is lood rerouted to the IVC when the hepatic portal circulation is compromi
sed?
"<div>In cases of hepatic portal compromise lood&nsp;can e rerouted t
o the IVC via a reversal of&nsp;lood flow through enlarged veins.</div><div>1.
<span class=""pple-ta-span"" style=""white-space:pre""> </span>round esophagu
s</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span>Via
esophageal veins into azygous veins</div><div>2.<span class=""pple-ta-span"" s
tyle=""white-space:pre""> </span>round umilicus</div><div><span class=""pple-t
a-span"" style=""white-space:pre""> </span>Via paraumilical veins into superio
r and inferior epigastric veins</div><div>3.<span class=""pple-ta-span"" style
=""white-space:pre""> </span>round retroperitoneal owels</div><div><span class=
""pple-ta-span"" style=""white-space:pre""> </span>Via veins of the ody wall
(lumar, azygous, and hemiazygous)</div><div>4.<span class=""pple-ta-span"" st
yle=""white-space:pre""> </span>round anus</div><div><span class=""pple-ta-spa
n"" style=""white-space:pre""> </span>Via rectal veins into iliac veins</div><di
v><r /></div>" ProteinsFastedState
Name the portal-systemic anastomosis that exist.
"<div>round the:</div><
div>-esophagus</div><div>-umilicus</div><div>-retroperitoneal owels</div><div>
-anus</div><img src=""paste-23888608100356.jpg"" />"
ProteinsFastedState
What is a general sign of portal hypertension? Varicosities in the region of th
e anastomosis etween the systemic and portal circulation (ex: caput medusa)
ProteinsFastedState
"<img src=""paste-24653112279044.jpg"" /><div>What is wrong here? Why is this da
ngerous?</div>" Esophageal varicies<div>Caused y portal hypertension rerouting

lood via the anastomosis which exists around the esophagus. This is dangerous s
ince the vessels can rupture and results in hemorraging lood from the esophagus
into the stomach</div> ProteinsFastedState
"<div>Left renal vein passes etween&nsp;<font color=""#FF0000"">___</font>&ns
p;and<font color=""#FF0000"">&nsp;___</font><r /></div>"
"<div>Left renal
vein passes etween&nsp;<font color=""#FF0000"">aorta</font>&nsp;and<font col
or=""#FF0000"">&nsp;SM</font></div><div><font color=""#FF0000""><r /></font><
/div>" ProteinsFastedState
<div>Left renal vein receives drainage from ....</div><div><r /></div> left ova
rian/testicular vein and left adrenal vein
ProteinsFastedState
Where does the right ovarian/testicular vein drain? Right adrenal?
Both dra
in into the aorta (left drain into the left renal vein) ProteinsFastedState
Which structure supplying the kidney is most anterior? Posterior?
"nterio
r: renal vein<div>Posterior: ureter and renal pelvis</div><div><img src=""paste26590142529540.jpg"" /></div>" ProteinsFastedState
Name the three constriction points of the ureters. What is the clinical signific
ance of this? t junction with renal pelvis<div>t ifurcation of common iliac
s</div><div>t entry into urinary ladder</div><div>It is at these locations tha
t kidney stones may get stuck</div>
ProteinsFastedState
Which vessel(s) supply the ureters?
"Renal, gonadal, common iliacs, and inte
rnal iliacs. It just depends upon the location on its route.<div><img src=""past
e-27139898343428.jpg"" /></div>"
ProteinsFastedState
"Ureters are found posterior to <font color=""#FF0000"">______</font>, anterior
to <font color=""#FF0000"">______</font>, and cross the pelvic rim at <font col
or=""#FF0000"">_____</font>"
"Ureters are found posterior to&nsp;<font color
=""#FF0000"">renal&nsp;and ovarian/testicular vessels</font>, anterior to&nsp;
<font color=""#FF0000"">psoas muscle</font>, and cross the pelvic rim at&nsp;<
font color=""#FF0000"">ifurcation of common iliacs</font>"
ProteinsFastedSt
ate
"<img src=""paste-27672474288132.jpg"" /><div>Identify these structure in contac
t with the anterior surface of the kidneys.</div>"
"<div>1.<span class=""p
ple-ta-span"" style=""white-space:pre""> </span>Liver</div><div>2.<span class="
"pple-ta-span"" style=""white-space:pre""> </span>Right colic flexure</div><di
v>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Duodenum</d
iv><div>4.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Stoma
ch</div><div>5.<span class=""pple-ta-span"" style=""white-space:pre""> </span>
Spleen</div><div>6.<span class=""pple-ta-span"" style=""white-space:pre""> </s
pan>Pancreas</div><div>7.<span class=""pple-ta-span"" style=""white-space:pre"
"> </span>Descending colon</div><div>8.<span class=""pple-ta-span"" style=""wh
ite-space:pre""> </span>Jejunum</div><div>9.<span class=""pple-ta-span"" style
=""white-space:pre""> </span>Small intestine (ileum)</div><div><r /></div>"
ProteinsFastedState
"<img src=""paste-28123445854212.jpg"" /><div>What structure lies in relationshi
p to the kidney at each point?</div>" "<div>1.<span class=""pple-ta-span"" s
tyle=""white-space:pre""> </span>Liver</div><div>2.<span class=""pple-ta-span"
" style=""white-space:pre""> </span>Right colic flexure</div><div>3.<span class=
""pple-ta-span"" style=""white-space:pre""> </span>Duodenum</div><div>4.<span
class=""pple-ta-span"" style=""white-space:pre""> </span>Stomach</div><div>5.<
span class=""pple-ta-span"" style=""white-space:pre""> </span>Spleen</div><div
>6.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Pancreas</di
v><div>7.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Descen
ding colon</div><div>8.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>Jejunum</div><div>9.<span class=""pple-ta-span"" style=""white-space:p
re""> </span>Small intestine (ileum)</div><div><r /></div>"
ProteinsFastedSt
ate
"<img src=""paste-28587302322180.jpg"" />"
"<img src=""paste-28802050686980
.jpg"" />"
ProteinsFastedState
"<img src=""paste-29149943037956.jpg"" /><div>Identify the posterior relationshi
ps of the kidney.</div>"
"<div>1.<span class=""pple-ta-span"" style=""w
hite-space:pre""> </span>Transversus adominus</div><div>2.<span class=""pple-t

a-span"" style=""white-space:pre""> </span>Quadratus lumorum</div><div>3.<span

class=""pple-ta-span"" style=""white-space:pre""> </span>Psoas Major (and min
or)</div><div>4.<span class=""pple-ta-span"" style=""white-space:pre""> </span
>Diaphragm</div><div><r /></div>"
ProteinsFastedState
Which vessels supply the adrenals?
"Blood supply from the aorta directly, r
enal arteries, and inferior phrenic arteries<div><img src=""paste-29626684407812
.jpg"" /></div>"
ProteinsFastedState
"<img src=""paste-29764123361284.jpg"" /><div>Identify</div>" "<div>1.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Renal pyramids</div><di
v>2.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Renal corte
x&nsp;</div><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </
span>Renal column (cortical tissue within medullary region)&nsp;</div><div>4.<s
pan class=""pple-ta-span"" style=""white-space:pre""> </span>Renal papilla</di
v><div>5.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Calyx
(minor calyx)</div><div>6.<span class=""pple-ta-span"" style=""white-space:pre
""> </span>Infundiulum (Major calyx)</div><div>7.<span class=""pple-ta-span""
style=""white-space:pre""> </span>Renal pelvis</div><div>8.<span class=""ppleta-span"" style=""white-space:pre""> </span>Ureter</div><div>9.<span class=""p
ple-ta-span"" style=""white-space:pre""> </span>Renal vein&nsp;</div><div>10.<
span class=""pple-ta-span"" style=""white-space:pre""> </span>Renal artery</di
v><div><r /></div>"
ProteinsFastedState
Region of the kidney deep to the cortex = ?
Medulla ProteinsFastedState
"<img src=""paste-30429843292164.jpg"" /><div>Identify these nerves coming off o
f the sacral plexus</div>"
"<div>1.<span class=""pple-ta-span"" style=""w
hite-space:pre""> </span>Sucostal (T12- immediately inferior to 12th ri)&nsp;
</div><div>2.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Il
ioinguinal (and Iliohypogastric) nerves (L1) near iliac crest&nsp;</div><div>3.<
span class=""pple-ta-span"" style=""white-space:pre""> </span>Lateral femoral
cutaneous (near SIS)</div><div>4.<span class=""pple-ta-span"" style=""white-s
pace:pre""> </span>Femoral nerve (L2,3,4)</div><div>5.<span class=""pple-ta-sp
an"" style=""white-space:pre""> </span>Genitofemoral nerve (L1, L2) (on psoas) i
nnervates cremaster muscle</div><div>6.<span class=""pple-ta-span"" style=""wh
ite-space:pre""> </span>Oturator nerve (L2,3,4)&nsp;</div><div><r /></div>"
ProteinsFastedState
Which nerve innervates the cremaster muscle?
Genitofemoral nerve
Proteins
FastedState
Which spinal nerves are found in:<div>Ilioinguinal and iliohypogastric?</div><di
v>Femoral?</div><div>Genitofemoral?</div><div>Oturator?</div> <div>Ilioinguina
l and iliohypogastric: L1</div><div>Femoral: L2-4</div><div>Genitofemoral: L1-2<
/div><div>Oturator: L2-4</div> ProteinsFastedState
Where is the sucostal nerve found?
Immediately inferior to the 12th ri
ProteinsFastedState
Which nerve is found near the iliac crest?
Ilioinguinal and iliohypogastric
nerves ProteinsFastedState
"<img src=""paste-31357556228100.jpg"" />"
"<div>Note: Glen said that you c
an put preverteral ganglion for these and you do not have to e as specific as
possile since they are so close to one another</div><div>1.<span class=""ppleta-span"" style=""white-space:pre""> </span>Thoracic splanchnics</div><div>2.<s
pan class=""pple-ta-span"" style=""white-space:pre""> </span>Celiac ganglion</
div><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Supe
rior mesenteric ganglion</div><div>4.<span class=""pple-ta-span"" style=""whit
e-space:pre""> </span>orticorenal ganglion</div><div>5.<span class=""pple-taspan"" style=""white-space:pre""> </span>Sympathetic chain</div><div>6.<span cla
ss=""pple-ta-span"" style=""white-space:pre""> </span>Lumar splanchnics</div>
<div>7.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Inferior
mesenteric ganglion</div><div>8.<span class=""pple-ta-span"" style=""white-sp
ace:pre""> </span>Superior hypogastric plexus</div><div>9.<span class=""pple-ta
-span"" style=""white-space:pre""> </span>Grey rami communicans</div><div><r /
></div>"
ProteinsFastedState
"<img src=""paste-32186484916228.jpg"" />"
"<img src=""paste-32293859098628

.jpg"" />"
ProteinsFastedState
Descrie the sensory supply to each visceral organ.
"<img src=""paste-325687
37005572.jpg"" />"
ProteinsFastedState
"<img src=""paste-32783485370372.jpg"" />"
"<div>1.<span class=""pple-taspan"" style=""white-space:pre""> </span>Thoracic Splanchnics</div><div>2.<span
class=""pple-ta-span"" style=""white-space:pre""> </span>Sympathetic chain</di
v><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Rami c
ommunicans (white and grey; Rememer: white goes from T1-L2)</div><div><r /></d
iv>"
ProteinsFastedState
"<img src=""paste-33500744908804.jpg"" />"
"<div>1.<span class=""pple-taspan"" style=""white-space:pre""> </span>Sympathetic chain</div><div>2.<span cla
ss=""pple-ta-span"" style=""white-space:pre""> </span>Lumar splanchnics (L1,
L2)</div><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span
>Superior hypogastric plexus</div><div>4.<span class=""pple-ta-span"" style=""
white-space:pre""> </span>Hypogastric nerve</div><div>5.<span class=""pple-taspan"" style=""white-space:pre""> </span>Inferior hypogastric plexus&nsp;</div>
<div>6.<span class=""pple-ta-span"" style=""white-space:pre""> </span><font co
lor=""#FF0000"">Grey</font>&nsp;Rami Communicans</div><div>7.<span class=""ppl
e-ta-span"" style=""white-space:pre""> </span>Pelvic Splanchnics</div><div><r
/></div>"
ProteinsFastedState
"<img src=""paste-33852932227076.jpg"" /><div><r /></div>"
"<div>1.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Superior mesenteric ple
xus</div><div>2.<span class=""pple-ta-span"" style=""white-space:pre""> </span
>Inferior mesenteric plexus&nsp;</div><div>3.<span class=""pple-ta-span"" sty
le=""white-space:pre""> </span>Superior hypogastric plexus&nsp;</div><div>4.<sp
an class=""pple-ta-span"" style=""white-space:pre""> </span>Hypogastric nerves
(right and left)</div><div>5.<span class=""pple-ta-span"" style=""white-space
:pre""> </span>Pelvic Splanchnics</div><div><r /></div>"
ProteinsFastedSt
ate
What is the clinical significance of the supracristal plane? Which verteral lev
el is it found? Used as a landmark for lumar punctures<div>L4</div>
Proteins
FastedState
"<img src=""paste-34458522615812.jpg"" />"
1. Liver<div>2. Right crus</div>
<div>3. Left crus</div><div>4. orta</div><div>5. Pancreas</div><div>6. Splenic
vessels</div><div>7. Spleen</div>
ProteinsFastedState
What are the three general methods y which the ody can go from the fed state t
o the fasted state? What is their time scale? 1. signal metaolites that allos
terically in/activate enzymes; typically fast<div>2. phosphorylation (covalent m
odification) of enzymes; longer lasting than metaolites due to covalent modific
ation and need to activate reciprocal phosphatases</div><div>3. enzyme level mod
ification: delivery to the target organelle or memrane, increased transcription
/translation, etc; generally, the slowest</div> MetaolismGIMNER RegulationFaste
dState
What is the clinical significance of the lumar arteries?
They supply the
terminal part of the spinal cord and can lead to paralysis if they are lost
ProteinsFastedState
Which regions of the intestine contain anastomoses etween systemic and portal c
irculation?
Retroperitoneal portions: ascending and descending colon
ProteinsFastedState
<div>Identify the following <>___&nsp;</>as either low-energy or high-energy.
Which ones are specific to muscle?</div><div><r /></div><div>ND+</div>TP<div
>NDH</div><div>MP</div><div>citrate</div><div>DP</div><div>Pi</div><div>acety
l-Co</div><div>glucose-6-phosphate</div><div>NH4+</div><div>Ca+2</div><div>phos
phocreatine</div><div>fructose-2,6-isphosphate</div> "<div>Identify the follo
wing&nsp;<><font color=""#ff0015"">signal metaolites&nsp;</font></>as eithe
r low-energy or high-energy. Which ones are specific to muscle?</div><div><r />
</div><div>ND+ <font color=""#ff0015"">low</font></div>TP <font color=""#ff001
5"">high</font><div>NDH <font color=""#ff0015"">high</font></div><div>MP <font
color=""#ff0015"">low</font></div><div>citrate <font color=""#ff0015"">high</fo
nt></div><div>DP <font color=""#ff0015"">low</font></div><div>Pi <font color=""

#ff0015"">low</font></div><div>acetyl-Co <font color=""#ff0015"">high</font></d

iv><div>glucose-6-phosphate <font color=""#ff0015"">high</font></div><div>NH4+ <
font color=""#ff0015"">low</font></div><div>Ca+2 <font color=""#ff0015"">low; mu
scle-only</font></div><div>phosphocreatine <font color=""#ff0015"">high; muscleonly</font></div><div>fructose-2,6-isphosphate<font color=""#ff0015"">&nsp;low
</font></div>" MetaolismGIMNER RegulationFastedState
"<div>In the fasted state liver:</div><div><r /></div><div>1. &nsp;Glycogen de
gradation is ____ and gylcogen synthesis is ___</div><div>2. Gluconeogenesis is
___ and glycolysis is ___.</div><div>3. Fatty acid oxidation is ___ and fatty ac
id synthesis is ___</div><div>4. Triglyceride lipolysis of liver fat pools is __
_&nsp;</div><div>5. ___ production is stimulated after 2-4 days</div><div><r /
></div><div><><font color=""#ff0015"">The result is that fat is urned for ener
gy in liver while other glucose precursors are spared so that they can e used t
o make glucose for other tissues that require it.</font></></div><div><r /></d
iv>"
"<div>In the fasted state liver:</div><div><r /></div><div>1. &nsp;Gly
cogen degradation is <font color=""#ff0015"">activated</font> and gylcogen synth
esis is <font color=""#ff0015"">deactivated</font></div><div>2. Gluconeogenesis
is <font color=""#ff0015"">activated</font> and glycolysis is <font color=""#ff0
015"">inhiited</font>.</div><div>3. Fatty acid oxidation is <font color=""#ff00
15"">activated</font> and fatty acid synthesis is <font color=""#ff0015"">inhii
ted</font></div><div>4. Triglyceride lipolysis of liver fat pools is <font color
=""#ff0015"">enhanced</font>&nsp;</div><div>5. <font color=""#ff0015"">Ketone</
font> <font color=""#ff0015"">ody</font> production is stimulated after 2-4 day
s</div><div><r /></div><div><><font color=""#ff0015"">The result is that fat i
s urned for energy in liver while other glucose precursors are spared so that t
hey can e used to make glucose for other tissues that require it.</font></></d
iv>"
MetaolismGIMNER RegulationFastedState
Caput medusa is due to varicosities in which vessels? Superior and inferior ep
igastric veins ProteinsFastedState
What is a varicocele? What causes this? Because the left testicular vein drains
into the left renal vein, a case of left renal hypertension may result in varico
sities of the left pampiniform plexus of veins in the left spermatic cord. Varic
osities of the pampiniform plexus of veins is called a varicocele.
Proteins
FastedState
"<div>In the fasted state muscle:</div><div><r /></div><div>1. Glycogenolysis i
s <font color=""#ff0015"">___</font> and glycogen synthesis is <font color=""#ff
0015"">___</font>.</div><div>2. Fatty acid oxidation is <font color=""#ff0015"">
___</font> sparing glucose utilization for energy.</div><div>3. ___ utilization
is stimulated after 2-4 days</div><div>4. Hormonal regulation through removal of
___ due to lack of ___ receptors.</div><div><r /></div><div>The result is that
switching to fat utilization and later ketone ody utilization energy needs in
muscle decreases the overall demand for ___</div><div><r /></div><div>The large
numer of signal metaolites in muscle, allows the metaolism to change not onl
y to accommodate feeding/fasting ut the e <><font color=""#ff0015"">regulated
very quickly in responds to work output needs.</font></></div>"
"<div>In
the fasted state muscle:</div><div>1. Glycogenolysis is <font color=""#ff0015""
>activated</font> and glycogen synthesis is <font color=""#ff0015"">inhiited</f
ont>.</div><div>2. Fatty acid oxidation is <font color=""#ff0015"">activated</fo
nt> sparing glucose utilization for energy.</div><div>3. <font color=""#ff0015""
>Ketone</font> <font color=""#ff0015"">ody</font> utilization is stimulated aft
er 2-4 days</div><div>4. Hormonal regulation through removal of <font color=""#f
f0015"">insulin</font> due to lack of <font color=""#ff0015"">glucagon</font> re
ceptors.</div><div><r /></div><div>The result is that switching to fat utilizat
ion and later ketone ody utilization energy needs in muscle decreases the overa
ll demand for<font color=""#ff0015""> glucose</font>.</div><div><r /></div><div
>The large numer of signal metaolites in muscle, allows the metaolism to chan
ge not only to accommodate feeding/fasting ut the e<font color=""#ff0015""> <
>regulated very quickly in responds to work output needs.</></font></div>"
MetaolismGIMNER RegulationFastedState
s you are dissecting th
Descrie the layers of fat surrounding the kidney.

e posterior adominal wall and removing the fat, you may find a separate layer (
or memrane) that reminds you of a second layer of peritoneum. This is Gerotas (r
enal) fascia. Deep to Gerotas fascia you will find a second layer of fat. This
is the perinephric fat. Gerotas fascia and perinephric fat serve to stailize and
protect the kidney
ProteinsFastedState
"<div>The renal artery, vein and ureter can e found within the fat filled space
known as the <font color=""#FF0000"">_______</font></div><div><r /></div>"
"<div>The renal artery, vein and ureter can e found within the fat filled space
known as the&nsp;<font color=""#FF0000"">renal sinus</font></div><div><font co
lor=""#FF0000""><r /></font></div>"
ProteinsFastedState
"<div>Upper pole of the kidney sits adjacent to <font color=""#FF0000"">_____</f
ont></div><div><r /></div>"
"<div>Upper pole of the kidney sits adjacent to&
nsp;<font color=""#FF0000"">the diaphragm</font></div><div><font color=""#FF000
0""><r /></font></div>"
ProteinsFastedState
"<font color=""#FF0000"">________</font> are cortical tissue that lies within th
e region of the renal medulla." "<font color=""#FF0000"">The renal columns (of B
ertini)</font>&nsp;are cortical tissue that lies within the region of the renal
medulla."
ProteinsFastedState
"<div>The renal artery, vein and ureter can e found within the fat filled space
known as <font color=""#FF0000"">_______</font></div><div><r /></div>"
"<div>The renal artery, vein and ureter can e found within the fat filled space
known as&nsp;<font color=""#FF0000"">the renal sinus</font></div><div><font co
lor=""#FF0000""><r /></font></div>"
ProteinsFastedState
"<div>The <font color=""#FF0000"">_________</font> lies lateral to&nsp;the psoa
s muscle</div><div><r /></div>"
"<div>The <font color=""#FF0000"">femora
l nerve</font> lies lateral to&nsp;the psoas muscle</div><div><font color=""#FF
0000""><r /></font></div>"
ProteinsFastedState
<div>In the fasted state adipose tissue:</div><div><r /></div><div>1. Lipolysis
of triglyceride stores is ___ to produce fatty acids and glycerol</div><div>2.
Fatty acid oxidation is ___ to provide energy</div><div><r /></div><div>___, pr
oduced in the fasting state, activates the ____ lipase of adipose (via cMP) res
ulting in fatty acid moilization for use in other tissues and energy metaolism
in the adipose is fueled y fat as well. &nsp;</div> "<div>In the fasted stat
e adipose tissue:</div><div><r /></div><div>1. Lipolysis of triglyceride stores
is <font color=""#ff0015"">activated</font> to produce fatty acids and glycerol
</div><div>2. Fatty acid oxidation is <font color=""#ff0015"">activated</font> t
o provide energy</div><div><r /></div><div><font color=""#ff0015"">Norepinephri
ne</font>, produced in the fasting state activates the <font color=""#ff0015"">h
ormone</font>-<font color=""#ff0015"">sensitive</font> <font color=""#ff0015"">l
ipase</font> of adipose (via cMP) resulting in fatty acid moilization for use
in other tissues and energy metaolism in the adipose is fueled y fat as well.
&nsp;</div>" MetaolismGIMNER RegulationFastedState
"<div>The <font color=""#FF0000"">_______</font> lies anterior to the psoas musc
le</div><div><r /></div>"
"<div>The&nsp;<font color=""#FF0000"">genitofem
oral nerve</font>&nsp;lies anterior to the psoas muscle</div><div><r /></div>"
ProteinsFastedState
"The <font color=""#FF0000"">______</font> lies medial to the psoas muscle"
"The&nsp;<font color=""#FF0000"">oturator nerve</font>&nsp;lies medial to the
psoas muscle" ProteinsFastedState
"The<font color=""#FF0000"">&nsp;______</font>&nsp;is formed y the presynapti
c fiers of the lumar splanchnics. These fiers are destined to <font color=""#
FF0000"">_______</font>"
"The<font color=""#FF0000"">&nsp;superior hypog
astric plexus</font>&nsp;is formed y the presynaptic fiers of the lumar spla
nchnics. These fiers are destined to&nsp;<font color=""#FF0000"">supply sympat
hetics to the pelvic viscera (and genitalia).</font>" ProteinsFastedState
<div>In response to ____ in the liver, the activation of ___ results in phosphor
ylation of glycogen synthase and glycogen phosphorylase. &nsp;The consequences
of phosphorylation, however, are reciprocal. &nsp;Phosphorylation in response t
o glucagon ____ glycogen phosphorylase and ___ glycogen synthase. &nsp;The resu
lt is a stimulation of ____ and an inhiition of ___.&nsp;</div><div><r /></di

v>
"<div>In response to <font color=""#ff0015"">glucagon</font> in the live
r, the activation of <font color=""#ff0015"">PK</font> results in phosphorylati
on of glycogen synthase and glycogen phosphorylase. &nsp;The consequences of ph
osphorylation, however, are reciprocal. &nsp;Phosphorylation in response to glu
cagon <font color=""#ff0015"">activated</font> glycogen phosphorylase and <font
color=""#ff0015"">inhiits</font> glycogen synthase. &nsp;The result is a stimu
lation of <font color=""#ff0015"">glycogenolysis</font> and an inhiition of <fo
nt color=""#ff0015"">glycogen</font> <font color=""#ff0015"">synthesis</font>.&n
sp;</div><div><img src=""Screen Shot 2012-11-12 at 3.02.28 PM.png"" /></div>"
MetaolismGIMNER RegulationFastedState
Which levels in the lumar region will contain oth types of rami communicans?
L1 and L2<div>Further down is just grey</div> ProteinsFastedState
"<div>The right and left lumar splanchnic nerves will form <font color=""#FF000
0"">______&nsp;</font>which will then&nsp;divide <font color=""#FF0000"">_____
___</font>, as the fiers descend into the pelvis and lie on either side of the
retroperitoneal rectum (posterior to the pararectal fossae).&nsp;</div><div><r
/></div>"
"<div>The right and left lumar splanchnic nerves will form&nsp
;<font color=""#FF0000"">the superior hypogastric plexus&nsp;</font>which will
then&nsp;divide&nsp;<font color=""#FF0000"">into right and left hypogastric ne
rves</font>, as the fiers descend into the pelvis and lie on either side of the
retroperitoneal rectum (posterior to the pararectal fossae).&nsp;</div><div><
r /></div>"
ProteinsFastedState
<div>The liver can stop fat cataolism from inhiition ecause of uildup of TP
/NDH that negatively feedacks the TC cycle.</div><div><r /></div><div>lthou
gh malonyl Co is the signal metaolite, its concentration drops ecause ___ and
ultimately PK phosphorylates ___ and inactivates it. &nsp;This not only direc
ts leftover ___ toward the synthesis of ___, it also decreases the de novo synth
esis of fatty acids in the liver.&nsp;</div><div><r /></div> "<div>The liver
can stop fat cataolism from inhiition ecause of uildup of TP/NDH that nega
tively feedacks the TC cycle.</div><div><r /></div>lthough malonyl Co is th
e signal metaolite, its concentration drops ecause <font color=""#ff0015"">glu
cagon</font> and ultimately PK phosphorylates <font color=""#ff0015"">acetyl-Co
 caroxylase</font> and inactivates it. &nsp;This not only directs leftover <f
ont color=""#ff0015"">acetyl-Co</font> toward the synthesis of <font color=""#f
f0015"">ketone odies</font>, it also decreases the de novo synthesis of fatty a
cids in the liver.&nsp;<img src=""Screen Shot 2012-11-12 at 3.06.07 PM.png"" />
"
MetaolismGIMNER RegulationFastedState
"<font color=""#FF0000"">________</font> will deliver presynaptic sympathetic fi
ers to small scattered ganglia within the pelvis for the pelvic viscera (ladde
r, prostate, uterus).&nsp;"
"<font color=""#FF0000"">The right and left hypo
gastric nerves</font>&nsp;will deliver presynaptic sympathetic fiers to small
scattered ganglia within the pelvis for the pelvic viscera (ladder, prostate, u
terus).&nsp;" ProteinsFastedState
What do the pelvic splanchnics do? Where do they come from?
"<div><span class
=""pple-ta-span"" style=""white-space:pre""> </span>On the left side of the o
dy, scattered among the ranches of the inferior mesenteric artery and vein, the
re will e small parasympathetic fiers arising from the pelvic splanchnics (S2,
S3, and S4) which are rising up and out of the pelvis to supply the hindgut reg
ions of the digestive tract that are normally supplied y the inferior mesenteri
c artery (sigmoid colon, descending colon, and distal 1/3 of transverse colon).<
/div><div><img src=""paste-43031277338628 (1).jpg"" /></div>" ProteinsFastedSt
ate
What forms the inferior hypogastric plexus?
"<div><span class=""pple-ta-spa
n"" style=""white-space:pre""> </span>The right and left lumar splanchnic nerve
s will send presynaptic sympathetic fiers to the small scattered inferior mesen
teric ganglia that are associated with the inferior mesenteric artery. The posts
ynaptic fiers from the small scattered inferior mesenteric ganglia will hitchhi
ke on the outside of the inferior mesenteric arteries as inferior hypogastric pl
exus fiers.</div><div><r /></div>"
ProteinsFastedState
"In liver, adipose, and muscle, insulin controls the level of ___ indirectly thr

ough its effects on ____ , the key regulated enzyme in the iosynthesis of fatty
acids from acetyl Co.&nsp;In the fasted state, ___ is <><font color=""#ff001
5"">phosphorylated</font></> and <><font color=""#ff0015"">inhiited</font></
>, resulting in <><font color=""#ff0015"">lower</font></> concentrations of __
_. The carnitine shuttle that transports fatty acyl Cos into the mitochondria is
not inhiited y ___ and<><font color=""#ff0015""> fatty acid oxidation increa
ses</font></>."
"<div>In liver, adipose, and muscle, insulin controls th
e level of <font color=""#ff0015"">MalCo</font> indirectly through its effects
on <font color=""#ff0015"">acetyl</font> <font color=""#ff0015"">Co</font> <fon
t color=""#ff0015"">caroxylase</font> (<font color=""#ff0015"">CC</font>), the
key regulated enzyme in the iosynthesis of fatty acids from acetyl Co.&nsp;I
n the fasted state, <font color=""#ff0015"">CC</font> is <><font color=""#ff00
15"">phosphorylated</font></> and <><font color=""#ff0015"">inhiited</font></
>, resulting in <><font color=""#ff0015"">lower</font></> concentrations of <
font color=""#ff0015"">malonyl</font> <font color=""#ff0015"">Co</font>. The ca
rnitine shuttle that transports fatty acyl Cos into the mitochondria is not inhi
ited y <font color=""#ff0015"">malonyl</font>-<font color=""#ff0015"">Co</fon
t> and fatty acid oxidation increases.<img src=""Screen Shot 2012-11-12 at 3.21.
41 PM.png"" /></div>" MetaolismGIMNER RegulationFastedState
"The hormone ____ directs phosphorylation and alters the alance etween glycoly
sis and gluconeogenesis in the liver.&nsp;Here the major regulation is through
the levels of _____, which ___ PFK1 and ____ FBP1. &nsp;Therefore, ____ is an a
ctivator of glycolysis and the overall signaling pathways that activate gluconeo
genesis must effectively decrease the ____ levels. &nsp;This is achieved throug
h a <><font color=""#ff0015"">cMP dependent kinase (PK) phosphorylation of th
e ifunctional protein PFK2/FBP2</font></> which stimulates its fructose-2,6- 
isphosphatase activity, lowering ____. &nsp;This regulation occurs only in live
r/kidney ut not ___." "The hormone <font color=""#ff0015"">glucagon</font> dir
ects phosphorylation and alters the alance etween glycolysis and gluconeogenes
is in the liver.&nsp;Here the major regulation is through the levels of<font co
lor=""#ff0015""> Fructose-2,6-isphosphate (2,6FBP)</font>, which <font color=""
#ff0015"">activates</font> PFK1 and <font color=""#ff0015"">inhiits</font> FBP1
. &nsp;Therefore, <font color=""#ff0015"">2,6FBP</font> is an activator of glyc
olysis and the overall signaling pathways that activate gluconeogenesis must eff
ectively decrease the <font color=""#ff0015"">2,6FPB</font> levels. &nsp;This i
s achieved through a<font color=""#ff0015""><> cMP dependent kinase (PK) phos
phorylation of the ifunctional protein PFK2/FBP2 </></font>which stimulates it
s fructose-2,6- isphosphatase activity, lowering <font color=""#ff0015"">2,6FBP
</font>. &nsp;This regulation occurs only in liver/kidney ut not <font color="
"#ff0015"">muscle</font>.<div><r /></div><div>nd here is the same story in thr
ee different figures:</div><div><img src=""Screen Shot 2012-11-12 at 3.26.22 PM.
png"" /><img src=""Screen Shot 2012-11-12 at 3.26.07 PM.png"" /><img src=""Scree
n Shot 2012-11-12 at 3.26.14 PM.png"" /></div>" MetaolismGIMNER RegulationFaste
dState
"<div>Effects on protein synthesis:</div><div><r /></div><div>In the fasted sta
te, the synthesis of several enzymes that function in gluconeogenesis is ___. &n
sp;Transcriptional regulation is provided y <><font color=""#ff0015"">cMP-re
sponsive</font></> elements in the promoter that are induced as cMP levels ris
e.</div><div><r /></div><div>The transcriptional regulation is complex; however
, the ___ synthesis of phosphoenolpyruvate caroxy kinase along with a(n) ____ i
n the levels glucose-6-phosphatase. &nsp;Glucokinase levels in the liver ____</
div><div><r /></div><div>Changes in protein levels are ___ (faster/slower) than
changes in response to signal metaolites or hormones.</div>" "<div>Effects on
protein synthesis:</div><div><r /></div><div>In the fasted state, the synthesi
s of several enzymes that function in gluconeogenesis is <font color=""#ff0015""
>increased</font>. &nsp;Transcriptional regulation is provided y cMP-responsi
ve elements in the promoter that are induced as cMP levels rise.</div><div><r
/></div><div>The transcriptional regulation is complex; however, the <font color
=""#ff0015"">increased</font> synthesis of phosphoenolpyruvate caroxy kinase al
ong with an <font color=""#ff0015"">increase</font> in the levels glucose-6-phos

phatase. &nsp;Glucokinase levels in the liver <font color=""#ff0015"">decrease<

/font>.</div><div><r /></div><div>Changes in protein levels are <font color=""#
ff0015"">slower</font> than changes in response to signal metaolites or hormone
s.</div>"
MetaolismGIMNER RegulationFastedState
What are the three ways in which we excrete cholesterol?
1. free choleste
rol via feces; insolule cholesterol is not filtered y the kidney<div>2. as il
e acids in the feces</div><div>3. as steroid hormones in urine (small amount)</d
iv>
LipidsII MetaolismGIMNER
What is the function of a CT enzyme? Name two prominent examples.
Choleste
rol cyl Transferases convert cholesterol into cholesterol esters (CEs).&nsp;<d
iv><r /></div><div><div>CT = cyl Coenzyme : Cholesteryl cyl Transferase, i
s mainly in liver. Helps store excess cholesterol.</div><div><r /></div><div>LC
T = Lecithin Cholesteryl cyl Transferase</div></div><div><r /></div> LipidsII
MetaolismGIMNER
Can cholesterol e otained from plant sources? What is eneficial aout the pla
nt analogue of cholesterol?
No, plants dont make it. They make sistosterol,
which contain an extra ETHYL (not methyl; poor Uncle Reddy) group. Sistosterol
is not asored y humans and inhiits cholesterol asorption, LipidsII Metaol
ismGIMNER
Descrie the sequential pathology of high LDL in the plasma.
1. aggregation o
f large LDL particles at damaged endothelium<div>2. oxidation of LDL cholesterol
</div><div>3. recruitment of macrophages, which ecome foam cells</div><div>4. a
plaque forms from dead foam cells and platelets; this can rupture and create an
emolus or can occlude an artery and cause ischemia.</div>
LipidsII Metaol
ismGIMNER
What are gall stones? Hardened deposits of primarily insolule cholesterol and
some ile salts.
LipidsII MetaolismGIMNER
What is the primary location of ile salt reasortion? jejunum LipidsII Metaol
ismGIMNER
How can ile acid <>inding resins</> (aka ile<> </>acid<> sequestrants</
> and ile<> </>acid<> chelators</>) lower LDL?
They ind ile acids and
prevent their re-uptake, requiring the use of more cholesterol to replace them.
LipidsII MetaolismGIMNER
What the two mechanisms y which statins lower LDL?
1. cholesterol synthesis
decreased y competitive inhiition of HMG-Co reductase<div>2. less cellular c
holesterol stimulates increased LDL receptors, increasing uptake of LDL</div>
LipidsII MetaolismGIMNER
What is the effect of niacin on plasma lipid levels?
Inhiition of hormone-se
nsitive lipase prevents release off Fs into the lood. LipidsII MetaolismGIMNE
R
What is the effect of firates on plasma lipid levels? ctivation of lipoprotei
n lipase stimulates uptake of lipids into cells, decreasing plasma lipid levels.
LipidsII MetaolismGIMNER
How does Proucol prevent cholesterol-related plaques and ischemia?
It preve
nts oxidation of LDLs, preventing uptake y macrophages/foam cells.
LipidsII
MetaolismGIMNER
What is possile mechanism of omega-3 fatty acids (fish oils) on lowering plasma
lipid levels? They are possily transcription factors that inhiit F synthesi
s and promote F oxidation.
LipidsII MetaolismGIMNER
How does ileal ypass surgery decrease cholesterol levels?
Bypassing the il
eum prevents uptake of ile salts, requiring more cholesterol to e used.
LipidsII MetaolismGIMNER
Give 6 pharmaceutical (non-lifestyle) methods of lowering cholesterol. 1. stati
ns: inhiit HMG-Co reductase cholesterol synthesis, increase LDL receptors and
uptake<div>2. ile acid chelators/sequestrants/inding resins: prevent re-uptake
of ile acids in ileum</div><div>3. niacin: inhiits hormone-sensitive lipase i
n adipose tissue</div><div>4. Ezetime (Zetia): prevents cholesterol asorption
in jejunum y inhiiting transporters</div><div>5.Orlistat (Xenical/lli) inhii
ts intestinal lipases to prevent digestion</div><div>6. Proucol: prevents oxida
tion of LDL to prevent plaques</div>
LipidsII MetaolismGIMNER

What 3 food products cant folks with gluten allergy have?<div><r /></div><div>
Whats their diet called?</div><div><r /></div><div>What CN they eat?</div>
No wheat<div>Rye</div><div>Barley</div><div><r /></div><div>GFD: gluten free di
et (or good fuckin dick, depending on who you talk to)</div><div><r /></div><d
iv>They can eat wild rice and rice</div>
intestine
"<div><img src=""paste-4668629451228.jpg"" style=""max-width: 90%; "" />&nsp;</
div><div><r /></div><div>VERSUS</div><div><r /></div><div><img src=""paste-481
0363372012.jpg"" style=""max-width: 90%; "" /></div><div><r /></div>1. Name the
duct in each of these pics.<div><r /></div><div>2. Classify the epithelium of
each duct.</div><div><r /></div><div>3. Give the 8 structures/cell types found
in the ottom pic (the real image; not the cartoon).</div><div><r /></div><div>
4. lso in the real image, classify the type of connective tissue surrounding th
e duct. What type does it change into in firosis?</div>"
"<div>1. Cartoon
: <>intraloular</> (a.k.a. <>intercalated</>) <>duct</></div><div>Real im
age: <>interloular</> duct. Each are surrounded y connective tissue represen
ts a loule.</div><div><r /></div><div>2. Cartoon: simple low cuoidal epitheli
um</div><div>Real image: simple columnar epithelium</div><div><r /></div><div>3
.<u> 8 structures:</u></div>1. Blood vessels<div>2. Lymph vessels</div><div>3. P
arasympathetic ganglia (unmyelinated, multipolar, postganglionic neurons)</div><
div>4. Pacinian corpuscles</div><div>5. Excretory ducts</div><div>6. Golet cell
s surrounding all ducts; mucus glands around larger ducts</div><div>7. Enteroend
ocrine cells (one of the Ps in GEPP)</div><div>8. Firolasts secreting type I
II collagen</div><div><r /></div><div>4. <>Loose areolar</> connective tissue
. With firosis, ecomes <>dense irregular </>connective tissue. This transiti
on can occlude the interloular ducts.</div><div><r /></div><div>Heres a pic o
f a parasympathetic ganglion, just for a visual of #3 aove:</div><div><r /></d
iv><div><img src=""paste-15543486644716.jpg"" /></div>" Pancreas
"<img src=""paste-1705102017004.jpg"" /><div><r /></div><div>1. What is this st
ructure?</div><div><r /></div><div>2. How many of these are there in the pancre
as? What % of pancreatic volume is this?</div><div><r /></div><div>3. What is t
he intermediate filament of all of its cells?</div><div><r /></div><div>4. How
does it develop?</div><div><r /></div><div>5. What type of capillary provides i
ts lood supply?</div><div><r /></div><div>6.&nsp;Give its 5 cell types, the h
ormone they secrete, and their position in the structure.</div>"
"1. Isle
t of Langerhans<div><r /></div><div>2. ~1 million; 1.5%</div><div><r /></div><
div>3. Cytokeratin</div><div><r /></div><div>4. Develops as an epithelial ud o
ff the duct system of the exocrine pancreas</div><div><r /></div><div>5. Contin
uous fenestrated with diaphragms (just like all endocrine glands--to allow hormo
ne diffusion into the lood)</div><div><r /></div><div>6.&nsp;<img src=""paste
-3298534883692.jpg"" /></div><div>VIP = vasoactive intestinal peptide</div>"
Pancreas
Exocrine function of the pancreas:<div><r /></div><div>1. Give all 12 of the pa
ncreatic enzymes and whether theyre secreted in active or inactive form.</div><
div><r /></div><div>2. Give the mechanism y which the proteases are activated.
</div><div><r /></div><div>3. One of these enzymes is secreted in active form,
ut has a special mechanism y which its inactivated while in the pancreas. Wha
t is this enzyme and whats the mechanism?</div><div><r /></div><div>4. What ad
ditional protein is present in the zymogen granules and whats its function?</di
v><div><r /></div><div>5. Why do we need to know all of these?</div> 1. .&n
sp;<u>Proteases</u>: all <>inactive</><div>Trypsinogen</div><div>Chymotrypsino
gen</div><div>Proelastase</div><div>Procaroxypeptidase  and B</div><div>Proami
nopeptidase  and B</div><div><r /></div><div>B. <u>Lipases</u></div><div>Pancr
eatic lipase: active</div><div>Cholesterol esterase: active</div><div>Procolipas
e: inactive</div><div>Prophospholipase 2: inactive</div><div><r /></div><div>C
. <u>mylase</u>: active</div><div><r /></div><div>D. <u>Nucleases</u>: all <>
active</></div><div>Rionuclease</div><div>Deoxyrionuclease</div><div><r /></
div><div>2. ll of this occurs in the enteric coat.&nsp;</div><div>a. <>Entero
peptidase</>, a transmemrane protein cleaves trypsinogen to trypsin.</div><div
>. Then <>trypsin</> cleaves all the inactive enzymes listed aove to their a
ctive forms.</div><div><r /></div><div>3. <>Bile salts inactivate pancreatic l

ipase</> u<>ntil activated colipase replaces them</> on emulsion droplets com

ing in contact with the enteric coat.</div><div><r /></div><div>4. <>Trypsin i
nhiitor</> to protect against spontaneous trypsinogen--&gt;trypsin</div><div><
r /></div><div>5. In acute pancreatitis, these get into the lood. So when you
re looking for this, youll get a lood work-up featuring levels of these protei
ns.</div>
Pancreas
What are the 5 possile causes of acute pancreatitis? 1.<> SPINK 1</> gene m
utation so its encoded protein in zymogen granules of acinar cells cant ind an
d stailize trypsinogen. This increases the proaility of spontaneous trypsinog
en activation.<div><r /><div>2. Mutation to&nsp;<>trypsin inhiitor</>&nsp;
so it cant inactivate trypsin. This inhiitor is present in zymogen granules at
low concentration in case of accidental trypsinogen activation.&nsp;</div><div
>This mutation also results in <>genetic emphysema</> in nonsmokers ecause Cl
ara cells secrete this protein to neutralize trypsin secreted y alveolar macrop
hages.</div></div><div><r /></div><div>3. Mutation in <>trypsinogen</> itself
called cationic trypsinogen. This increases the proaility of spontaneous acti
vation in the asence of enteropeptidase.</div><div><r /></div><div>4. Mutation
in the <>CFTR</> gene <>reduces the icaronate wash</> from the centroacin
ar cells. It also causes the golet cells and mucus glands around the interloul
ar ducts to secrete a <>thick, viscous mucus</> that can lock the ducts.</div
><div><r /></div><div>5. Self-digestion or reakdown of <>tight junctions</>
along the acinar cell apical surface. This allows active lipases and proteases i
nto the tissue.</div> Pancreas
"<div>SEM of the ase of a normal pancreatic acinar cell</div><div><r /></div><
img src=""paste-1211180777964.jpg"" /><div><r /></div><div>1. What type of coll
agen is this?&nsp;</div><div><r /></div><div>2. a. What cell type makes it?&n
sp;</div><div>. What pathologic change is associated with this cell type?</div>
<div>c. What are two causes of this pathologic change?</div><div><r /></div><di
v>3. Name 5 other instances of this pathology that weve seen.</div>" <div>1.
Type III reticular fiers</div><div><r /></div><div>2. <>Firolast</>. Patho
logic switch to <>type I</> huge undled undle secretion.</div><div><r /></d
iv>3. a. <>Cellulite</> in <>adipose</> tissue<r />. Denervated and/or dam
aged <>skeletal muscle</> (can e in response to <>Duchennes muscular dystro
phy</>)<div>c. Firotic scar in <>cardiac muscle</> after infarct<r />d. Fi
rosis due to rare firolasts in the <>endoneurium of peripheral nerves</><div
>e. <>Interstitial firosis</> of the lung in response to smoking.&nsp;</div>
<div>(Mechanism: Smoking--&gt;</div><div>more golet cells high in the respirato
ry tree--&gt;</div><div>more mucus that falls down so more ciliated cells to dea
l with it =</div><div>less Clara cells =</div><div>less antitrypsinogen secretio
n--&gt;</div><div>trypsin and lysosomal enzymes secreted y alveolar macrophages
digest the alveolar wall--&gt;</div><div>firolasts switch from type III to ty
pe I collagen to protect the lung--&gt;</div><div>interstitial firosis and emph
ysema)</div></div>
Pancreas
"<img src=""paste-373662155275.jpg"" /><div><r /></div><div>1. nnotate this Ju
nq image.</div><div><r /></div><div>2. Junqs cartoon doesnt reflect the asop
hilia and/or eosinophilia of the pancreatic acinar cells. What colors do they ac
tually stain and why?</div><div><r /></div><div>3. What is the secretion mechan
ism of the zymogen granules from the acinar cells?</div><div>When would you see
high amounts of zymogen granules in these cells? When would the lumen e small?<
/div><div><r /></div><div>4. What is the function of the yellow colored cells i
n the cartoon? What stimulates that function?</div>"
"1.&nsp;<img src=""past
e-932007903755.jpg"" /><div><r /></div><div>2. cinar cells are highly polarize
d, with <>asal asophilia</> (tons of RER) and <>apical eosinophilia</> (zy
mogen granules).</div><div><r /></div><div>3. <>Merocrine regulated secretion<
/>. Both answers: the <>fasted state</>. Tons of apical zymogen granules /c
these havent een released in response to CCK and acetycholine. Lumen small /c
not filled with zymogen granules.</div><div><r /></div><div>4. Centroacinar ce
lls secrete the <>icaronate wash</>. <>Secretin </>secreted y open config
uration S cells of the duodenum.</div>" Pancreas
"<img src=""paste-2121713844716.jpg"" /><div><r /></div><div>1. How long did it

take the laeled zymogen granule to mature? Break down the length of time along
each of the 4 steps of its journey.</div><div><r /></div><div>2. What kind of
experiment allowed us to determine these times?</div>" 1. a. Zymogens in contai
ned phase of the RER: 7 minutes.<div>. cis Golgi: 17 minutes.</div><div>c. Tran
s-Golgi network: 47 minutes.</div><div><>d. Mature: 60 minutes.<r /></><div><
r /></div><div>2. Noel Prize winning&nsp;<>Pulse-chase</> experiment using
radiolaelled leucine.</div></div>
Pancreas
Give the 5 step sequence of ductal structures that the pancreatic digestive enzy
mes pass through once they are secreted as zymogen granules.
1. Intraloular
(a.k.a. intercalated) duct<div>2. Interloular duct</div><div>3. Major duct of W
irsung</div><div>OR</div><div>3. Minor duct of Santorini</div><div>4. mpulla of
Vater (if major and unfused)</div><div>5. Duodenum</div>
Pancreas
"<img src=""paste-11660836209132.jpg"" /><r /><div><r /></div><div>1. Give the
3 mechanisms of control of secretion for the cell at the lue arrow.</div><div>
<r /></div><div>2. Give the stimulus for secretion for the cell at the green ar
row.</div>"
1. <>cinar cell.&nsp;</><div><u>Control:</u></div><div>. St
imulatory: Unmyelinated fiers from the <>parasympathetic</> vagus nerve follo
w interloular connective tissue, penetrate the asal lamina of the acinar cells
, and release <>acetylcholine</>&nsp;onto <>M3 receptors</>. This causes di
rected vesicle migration so the zymogen granules fuse with the apical plasma mem
rane.<div>B. Stimulatory: Free fatty acids, small peptides, and amino acids dig
ested y salivary lipase and pepsin stimulate open configuration I cells to secr
ete CCK. This <>CCK inds to the parasympathetic nerve terminals at the asal l
amina of the acinar cells and increases acetylcholine release there</>. This ag
ain causes directed vesicle migration so the zymogen granules fuse with the apic
al plasma memrane.</div><div>C. Inhiitory: lood to the pancreas flows first i
nto the islets of Langerhans, which secrete <>pancreatic polypeptide</> (F cel
ls) and <>somatostatin</> (D cells). These hormones flow directly to acinar ce
lls and parasympathetic nerve terminals in their BL. Once there, <>oth hormone
s antagonize CCK</>. <>Somatostatin also antagonizes secretin and acetylcholin
e.</></div><div><r /></div><div>2. <>Centroacinar cell.</> When acidic chyme
reaches the duodenum, S enteroendocrine cells in open configuration sense the H
+ and secrete secretin in response. This makes its way to the centroacinar cells
and stimulates the icaronate wash.</div></div>
Pancreas
What is Kwashiokor?
<>Malnutrition/starvation/low caloric intake</> that r
esults in <>atrophy of the pancreatic acinar cells</>. This <>massively reduc
es the production of pancreatic digestion enzymes</> and thus diminishes digest
ion and ultimate asorption :( Pancreas
"<div>Ignore the annotations.</div><div><r /></div><div><img src=""paste-134604
27506118.jpg"" /></div><div><r /></div>1. Why does this structure exist in the
pancreas?<div><r /></div><div>2. Does the pancreatic duct system feature myoepi
thelial cells? Why or why not?</div>" 1. <>Pacinian corpuscles</> exist in t
he pancreas ecause the huge <>icaronate wash </>that starts in the intercal
ated/intraloular duct <>is so violent</> and the <>loose connective tissue o
f the pancreas is so thin</> that &nsp;there needs to e a <>negative feedac
k loop to turn off secretin</>.<div><r /></div><div>2. <>No myoepithelial cel
ls</> ecause the icaronate wash is so forceful that they arent necessary.</
div>
Pancreas
T/F: sorption occurs in the stomach FLSE! Esophagus
What is the intermediate filament of nearly everything we have covered in GIMNER
?
cytokeratin + Esophagus
What is the purpose of glucose, glycerol and free fatty acids in the stomach?
Trigger the release from enteroendocrine cells in the stomach Esophagus
What causes achalasia? When the lower esophageal sphincter fails to open
Esophagus
What is the turnover rate of the epithelium in the esophagus? 15 days Esophagu
s
Descrie the epithelium of the esophagus
Stratified squamous non-keratini
zed&nsp;
Esophagus
Does desquamation or exfoliation occur in the esophagus?
Desquamation (ex

foliation is the reaking of hemidesmosomes and focal contacts) Esophagus

What is the result of having more fier in the diet (vegetarian diet) upon the e
sophagus?
Increases the amount of keratohyalin produced and will appear gr
eyish Esophagus
"<img src=""paste-71412421230593.jpg"" /><div>What gives the esophagus its froth
y appearance?</div>"
Glycogen
Esophagus
"<img src=""paste-16372415332844.jpg"" /><div><r /></div><div>This capillary is
NOT going to an islet of Langerhans. Its going to pancreatic acinar cells.</di
v><div><r /></div><div>What type of capillary is it?</div>"
Continuous nonfe
nestrated
Pancreas
Which region of the esophagus contains melanocytes? Why?
Distal 1/3<div>L
actoferrin, lysozyme and secretory Ig are killing acteria -&gt; as the acteri
a die they produce O2 radicals -&gt; melanin is protecting the esophagus in this
region form the dangerous O2 radicals</div>
Esophagus
Which movements are controlled y Meissners plexus?
Mucosal squeeze and muco
sal flutter
Esophagus
Which plexus drives the peristaltic waves of the esophagus?
uerachs plexu
s (myenteric plexus)
Esophagus
The esophagus extends from ____ to ____ pharynx to cardiac region of the stomach
Esophagus
Where does the esophagus cross the diaphragm?
t the left crux
Esophagu
s
What causes the adventitia to transition to a serosa? The adventitia now has m
esothelial cells on it once it crosses the diaphragm
Esophagus
Is there a mucosal squeeze in the esphagus? Mucosal flutter?
Neither Esophagu
s
What is the difference etween exfoliation and desquamation?
Desquamation: ox
idation of desmosomes<div>Exfoliation: losing hemidesmosomes and focal contacts
and comes away from the asement memrane</div> Esophagus
Which region of the esophagus can have melanomas?
Distal 1/3 (contains mel
oncytes)
Esophagus
When do salivary lipases and amylases stop working?
Function while travellin
g down the esophagus and during the receptive relaxation phase in the stomach. S
top working once the pH drops in the stomach
Esophagus
Is there a pronounced muscularis mucosa in the esophagus?
Nope
Esophagu
s
Where are lymphocyte aggregations found in the esophagus?
Lymphocyte aggre
gations around the esophageal glands in the sumucosa (an added urst of mucus t
o luricate the ulk transport of poorly chewed food down the esophagus), around
their ducts which empty out on the lumen surface, &nsp;and where ever there ha
s een an epithelial tear due to friction and arasion. Esophagus
Desrie uerachs plexus in the esophagus.
<div>uerachs plexus (etween th
e muscle layers of the muscularis externa) is very attenuated, ecause the motor
patterns are so simple (mere primary peristalsis, secondary peristalsis, revers
ed peristalsis, and retching).</div><div><r /></div> Esophagus
Where is the vascularization highest in the esophagus? Why is this clinically si
gnificant?
"<div>There is extensive vascularization around the <font color=
""#FF0000"">lowest part of the esophagus where it meets the cardiac stomach.</fo
nt> These vessels are prone to swell and urst in patients who are chronic alcoh
olics with portal hypertension ecause of anastomoses etween these vessels and
the vessels of the portal system.</div><div><r /></div>"
Esophagus
What happens to the esophageal epithelium during GERD? "<div><span class=""pple
-ta-span"" style=""white-space:pre""> </span>In GERD, stomach acid irritates th
e epithelium of the esophagus, and the stratified squamous nonkeratinized epithe
lium undergoes metaplasia to ecome a simple columnar epithelium of surface muco
us cells, mimicking the lining of the stomach.</div><div><span class=""pple-taspan"" style=""white-space:pre""> </span>This transition to an epithelium of sur
face mucus cells does not effectively protect the esophagus from refluxing acid
ecause the surface mucus cells only produce one type of mucus. For effective pr
otection, four types of mucus are needed, and they must e mixed y the mucosal

flutter. Furthermore, the newly produced surface mucus cells will have a icaro
nate pump that they will use in an attempt to uffer the refluxing acid, ut thi
s pump is minimal with poor development of ionic channels and does little to pro
tect the esophagus against ulceration and continued metaplasia.</div><div><span c
lass=""pple-ta-span"" style=""white-space:pre""> </span>With chronic GERD, met
aplasia can continue, with the esophageal &nsp;epithelium changing ack and for
th from stratified squamous nonkeratinized to simple columnar until the epitheli
al cells finally lose contact inhiition, reak through the asal lamina, and en
ter the lood vessels of the lamina propria and sumucosa via which they can met
astasize to other parts of the ody.</div><div><span class=""pple-ta-span"" sty
le=""white-space:pre""> </span>Chronic GERD can lead to Barretts esophagus, which
is characterized y esophageal ulcer formation, pain, swelling, and hypertrophy
of the smooth muscle of the lower esophageal sphincter (can cause achalasia). B
arretts esophagus does not happen overnight ut is a progression. cid reflux fir
st causes a transitional epithelium (change in the esophagus from normal stratifie
d squamous nonkeratinized epithelium to simple columnar epithelium). Continued t
ransitional epithelial changes can lead to cancer and Barretts esophagus.</div><d
iv><r /></div>"
Esophagus
How much chyme is squirted into the duodenum each time? 5-15 mL Stomach
Which region of the stomach participates in receptive relaxation?
Proximal
stomach
Stomach
What is the status of the enzymes during receptive relaxation? They continue to
work (salivary amylase and lipase, lactoferrin, lysozyme, and secretory Ig)
Stomach
Pepsin is an (endo/exo) peptidase
endopeptidase Stomach
Parietal cells are also called oxyntic cells Stomach
Which region of the stomach takes up vitamin B12?
Ileum Stomach
What is the purpose of the mucosal flutter?
To mix the four types of mucus a
nd the icaronate
Stomach
Where are surface mucous cells found in the stomach?
Found throughout the sto
mach
Stomach
What is the purpose of the mucosal squeeze? Which plexus facilitates this action
?
Squeezes the glandular contents out<div>Meissners plexus</div> Stomach
Which actions in the stomach are controlled y the muscularis externa (uerach
s plexus)?
pyloric grind, receptive relaxation, and MMC
Stomach
Descrie the configuration of mucins. <div>Mucus is composed mostly of a highl
y glycosylated protein, mucin. Two mucin monomers form a dimer through disulfide
linkages. Two of these dimers then form a tetramer through additional disulfide
linkages.</div><div><r /></div>
Stomach
Most of gastric ulcers are caused y ...
reflux of ile salts into the st
omach Stomach
Where are the stem cells found in the stomach? In the neck region&nsp;
Stomach
Which direction do the stem cells in the stomach migrate? What do they ecome?
"<img src=""paste-77150497538049.jpg"" />"
Stomach
Does exfoliation or desquamation occur in the stomach? Exfolation since it is a
simple epithelium
Stomach
Why do we have pepsin? Shouldnt the intestinal proteases degrade all of the pep
tides? Dont need pepsin for protein digestion. You use the free amino acids to
stimulate enteroendocrine cells in the open configuration
Stomach
What is the function of the microvilli in the stomach? Help glue and hold down
the gastric mucosal arrier in place so that it does not slide around Stomach
Descrie the secretion of mucins
Constitutive merocrine secretion (consta
ntly eing replenished since the acids are degrading them)
Stomach
Descrie the cells found in fundic glands as you go down
Neck mucous cell
s<div>Parietal cells</div><div>Chief cells</div><div>Enteroendocrine cells</div>
Stomach
Parietal cells are (eosinophilic/asophilic)
Eosinophilic<div>Rememer: Parie
tal cells secrete HCl (eosinophilic)</div>
Stomach
How do parietal cells egin to secrete HCl?
The parietal cells hold the H/K

TPase in vesicle and then fuse them with the intracellular canaliculus upon sti
mulation (dont have to wait around for the synthesis of new pumps)
Stomach
Which canaliculi do we know so far?
Intracellular canaliculus in parietal ce
lls<div>Open canalicular system in platelets</div><div>pical canaliculi in the
PCT&nsp;</div><div>Canaliculi in osteoclasts for one resorption</div> Stomach
Chief cells aka ____ aka ____ peptic cell; zymogenic cell
Stomach
Chief cells are (eosinophilic/asophilic)
"<font color=""#5500FF"">Basophi
lic</font>"
Stomach
How do neck mucous cells appear?
"Frothy<div><img src=""paste-79306571120
641.jpg"" /></div>"
Stomach
How thick is the mucosal arrier in the stomach?
1 mm thick
Stomach
Which cells pump icaronate into the lumen of the stomach?
Surface mucous c
ells
Stomach
What forms gastric pits?
Invaginations of the epithelium (surface mucous
cells) into the lamina propria Stomach
Which cells produce mucus in the fundic region of the stomach? Neck mucous cell
s
Stomach
Where are enteroendocrine cells in highest concentration in the stomach?
In the pylorus Stomach
What is the primary function of gastral digestive enzymes?
<div>Importance
of gastral digestive enzymes: to reak down proteins into free amino acids and d
ipeptides and tripeptides and triglycerides into 2-monoglycerides and free fatty
acids that will act as signals for the open &nsp;enteroendocrine cells that re
lease CCK (I cells) and secretin (S cells) in the duodenum.</div><div>Gastric pr
otein digestion plays the important role of providing small peptides and free am
ino acids which then enter the duodenum and &nsp;signal open enteroendocrine ce
lls (I cells) to secrete CCK.</div><div><div>dults do not depend heavily on gas
tric lipase to reak down the majority of their triglycerides (this task is perf
ormed instead y the powerful pancreatic lipases and ile salts). However, gastr
ic lipase plays an important role ecause its preliminary digestion of triglycer
ides makes some free fatty acids availale in the duodenum which can stimulate o
pen enteroendocrine cell (I cell secreting CCK) to activate the release of pancr
eatic lipases and ile salts from the gallladder.</div><div><r /></div></div><
div><r /></div>
Stomach
What are the stimulators of chief cells?
<div>Stimulants for chief cells:
gastrin (G-cells), acetylcholine (enteric nervous system and parasympathetic ne
rvous system), H+ ions (lower pH).</div><div><r /></div>
Stomach
Why do neonates rely on gastric lipase? Becuase their exocrine pancreas is not f
ully functional at the time of irth
Stomach
What are the stimulants of parietal cells?
"histamine (<font color=""#FF000
0"">most important</font>) secreted y enterochromaffin-like cells in the lamina
propria, gastrin (G-cells), and acetylcholine from the vagus nerve (parasympath
etic nervous system)." Stomach
T/F: Neck mucous cells are exfoliated during the mucosal squeeze
True
Stomach
Name the five stomach movements. Which are controlled y the sumucosal plexus?
Myenteric plexus?
Sumucosal plexus:<div>-Mucosal flutter</div><div>-Mucos
al squeeze</div><div>Myenteric plexus:</div><div>-MMC</div><div>-Pyloric grind</
div><div>-Receptive relaxation</div>
Stomach
MMC travels from ____ to _____ notch in the greater curvature to the ileocecal
valve Stomach
Name a variety of general stress responses. What is the general purpose?
"<div><div>&nsp;increased lood pressure and heart rate</div><div> &nsp;increas
ed alertness</div><div> &nsp;increased respiratory rate</div><div> &nsp;increase
d gluconeogenesis &nsp;increased lipolysis</div><div> &nsp;appetite suppression
</div><div> &nsp;acute growth stimulation</div><div> &nsp;chronic growth inhiit
ion</div><div> &nsp;inhiition of digestion</div><div> &nsp;decreased inflammato
ry respons</div></div><div><r /></div><div><div>Theyre designed to provide a r
apid response that will occur despite the current metaolic state and a slower r
esponse that returns the ody to homeostasis.</div></div><div><r /></div><div><

r /></div><div><r /></div><div>nd here is a reward:</div><div><img src=""past

e-1155346203306.jpg"" /></div>" MetaolismGIMNER StressedState
What four organs are involved in stress and what are some of their general respo
nses? "Brain: detect stress and initiate response, use Force to defeat enemies
(Jedi/Sith only)<div><r /><div>Liver: glycogen reakdown, gluconeogenesis</div
><div><r /></div><div>Muscle: glycogen reakdown, <>initially</> stimuates pr
otein synthesis (acute stress) and reakdown (chronic), fight or GTFO (not meta
olic)</div></div><div><r /></div><div>dipose: lipolysis, asor ullets</div><
div><r /></div><div>nd here is a stress reliever:</div><div><img src=""paste-2
057289335321.jpg"" /></div>"
MetaolismGIMNER StressedState
What three hormones compose the stress response?
epinephrine (adrenaline)
, cortisol, growth hormone
MetaolismGIMNER StressedState
"During an acute stress response,&nsp;<span class=""pple-ta-span"" style=""wh
ite-space: pre; ""> </span>___ neural stimulation from the ___ stimulates the __
_ gland to secrete ___, the fight or flight signal. &nsp;This is a rapid (seconds
) response.&nsp;"
"During an acute stress response,&nsp;<span class=""pp
le-ta-span"" style=""white-space:pre""> </span><font color=""#ff0015"">sympathe
tic</font> neural stimulation from the <font color=""#ff0015"">hypothalamus</fon
t> stimulates the adrenal gland to secrete <font color=""#ff0015"">epinephrine</
font>, the fight or flight signal. &nsp;This is a rapid (seconds) response.&nsp;
<div><r /></div><div>Note that there is no intermediate hormone.</div><div>Keep
scrolling!<img src=""Screen Shot 2012-11-13 at 9.28.24 PM.png"" /></div><div><i
mg src=""paste-2877628088920.jpg"" /></div>"
MetaolismGIMNER StressedState
<div>During the acute stressed state, the <>hypothalamus</> stimulates the rel
ease of <>cortisol</> the following pathway:</div><div>1. <>hypothalamus</>
releases ___</div><div>2. ___ stimulates the <>anterior pituitary</></div><div
>3.<> anterior pituitary</> releases ___</div><div>4. ___ stimulates the <>ad
renal gland</></div><div>5. <>adrenal gland</> secretes cortisol</div><div><
r /></div><div><r /></div>
"<div><div>During the acute stressed state, the
<>hypothalamus</> stimulates the release of <>cortisol</> the following path
way:</div><div><div>1. <>hypothalamus</> releases <font color=""#ff0015"">cort
icotropin-releasing hormone (CRH)</font></div><div>2. <font color=""#ff0015"">CR
H</font> stimulates the <>anterior pituitary</></div><div>3.<> anterior pitui
tary </>releases <font color=""#ff0015"">adrenocorticotropic hormone (CTH)</fo
nt></div><div>4. <font color=""#ff0015"">CTH</font> stimulates the <>adrenal g
land</></div><div>5. <>adrenal</> <>gland</> secretes <>cortisol</></div>
</div><div><r /></div><div><r /></div><div><img src=""Screen Shot 2012-11-13 a
t 9.28.24 PM.png"" /></div></div><div>You deserve this after such a long card:<i
mg src=""paste-4234837754493.jpg"" /></div>"
MetaolismGIMNER StressedState
s its name implies, ___ promotes growth and protein synthesis. &nsp;Its releas
e from the ____ is stimulated y the release of GHRH from the hypothalamus. Howe
ver, it also promotes the utilization of ___ y stimulating ___ in adipocytes. &
nsp;It is also has an anti-___ activity y suppressing the aility of ___ to st
imulate glucose uptake. "s its name implies <font color=""#ff0015"">growth</fon
t> <font color=""#ff0015"">hormone</font> promotes growth and protein synthesis.
&nsp;Its release from the <font color=""#ff0015"">anterior</font> <font color=
""#ff0015"">pituitary</font> is stimulated y the release of GHRH(<font color=""
#ff0015"">growth hormone releasing hormone</font>) from the hypothalamus However
, it also promotes the utilization of <font color=""#ff0015"">fat</font> y stim
ulating <font color=""#ff0015"">TG reakdown</font> in adipocytes. &nsp;It is a
lso has an <font color=""#ff0015"">anti-insulin</font> activity y suppressing t
he aility of<font color=""#ff0015""> insulin</font> to stimulate glucose uptake
.<img src=""Screen Shot 2012-11-13 at 9.28.24 PM.png"" />"
MetaolismGIMNER
StressedState
What is the time scale of epinephrine compared to growth hormone and cortisol?
Epinephrine is fast, growth hormone and cortisol are slow.
MetaolismGIMNER
StressedState
What is the overall effect of cortisol and why is it slow?
<div>While the a
ppearance of cortisol in the lood is rapid, most of the cortisol effect require
s protein synthesis and alteration of protein levels so it is slower (hours). &n

sp;The overall effect of cortisol is to increase the degradation of proteins.</

div><div><r /></div><div>Cortisol is lipid solule and enters the nucleus to af
fect gene transcription, hence the slow time scale.</div>
MetaolismGIMNER
StressedState
<div>In response to insulin-induced ___, plasma levels of ___, ___ and ___ rise
along with the expected rise in glucagon in response to ___ lood glucose.</div>
"<div>In response to insulin-induced <font color=""#ff0015"">hypoglycemia</font>
, plasma levels of <font color=""#ff0015"">epinephrine</font>, <font color=""#ff
0015"">growth</font> <font color=""#ff0015"">hormone</font> and <font color=""#f
f0015"">cortisol</font> rise along with the expected rise in glucagon in respons
e to <font color=""#ff0015"">low</font> lood glucose.</div>" MetaolismGIMNER
StressedState
What are the competing effects of cortisol and growth hormone? Why does the ody
have this mixed signal?
"<div>t the onset of stress, the release of <fo
nt color=""#ff0015""><>cortisol will stimulate protein reakdown </></font>whi
le the release of additional <><font color=""#ff0015"">growth hormone will incr
ease protein synthesis</font>.</> &nsp;The idea is that this mixed signal <i>pre
pares</i> the ody to <i>either</i> <i>degrade</i> proteins for energy or to <i>
resynthesize</i> proteins that might e needed for wound healing or other damagi
ng stresses.</div><div><r /></div><div>tl;dr: increase protein turnover with co
mpeting effects.</div><div><img src=""Screen Shot 2012-11-13 at 9.52.34 PM.png""
/></div><div><div><r /></div></div>" MetaolismGIMNER StressedState
(T/F) Hormonal effects are individual and additive.
F; theyre synergistic a
nd help regulate each other, ecause it has to e more complicated..,or ya know,
provide added homeostatic mechanisms. MetaolismGIMNER StressedState
"<img src=""Screen Shot 2012-11-13 at 10.03.36 PM.png"" /><div><div>Ponder this
image until you see it in your dreams. Forget those eautiful kodachrome light m
icrographs and positively elegant electron micrographs in Junq. This is the powe
r of MS Paint.&nsp;</div></div>"
"<div><img src=""Screen Shot 2012-11-13
at 10.03.36 PM.png"" /></div><div>Done yet?</div><div><r /></div><div>He cant
e set free until you are. When is ""done""? I dont know; its a ad zen riddle
. &nsp;</div><div><img src=""paste-8181912700176.jpg"" /></div><div>He just wan
ts to infect you with diseases...lovingly.</div>"
MetaolismGIMNER Stresse
dState
"<div>In the stressed state, storage molecules are moilized. &nsp;ll three si
gnals (epinephrine, cortisol, GH) stimulate <><font color=""#ff0015"">release o
f fatty acids from stored triglycerides. &nsp;&nsp;</font></></div><div><r /
></div><div>Epinephrine stimulates ___ reakdown in the liver.</div><div><r /><
/div><div>___ and ___ stimulate <><font color=""#ff0015"">gluconeogenesis</font
></> in the liver.</div><div><r /></div><div>Muscle, in response to ___, initi
ally degrades ut overall, the turnover increases to prepare for synthetic/reak
down work due to the competing anaolic effect of ___.</div>" "<div><div>In th
e stressed state, storage molecules are moilized. &nsp;ll three signals (epin
ephrine, cortisol, GH) <><font color=""#ff0015"">stimulate release of fatty aci
ds from stored triglycerides. &nsp;&nsp;</font></></div><div><r /></div><div
>Epinephrine stimulates <font color=""#ff0015"">glycogen</font> reakdown in the
liver.</div><div><r /></div><div><font color=""#ff0015"">Cortisol</font> and <
font color=""#ff0015"">Epinephrine</font> stimulate <font color=""#ff0015""><>g
luconeogenesis</></font> in the liver.</div><div><r /></div><div>Muscle, in re
sponse to <font color=""#ff0015"">cortisol</font>, initially degrades ut overal
l, the turnover increases to prepare for synthetic/reakdown work due to the com
peting anaolic effect of<font color=""#ff0015""> growth hormone.</font></div></
div><div><font color=""#ff0015""><r /></font></div><div><font color=""#ff0015""
><img src=""Screen Shot 2012-11-13 at 10.03.36 PM.png"" /><img src=""paste-95648
92168672.jpg"" /></font></div>" MetaolismGIMNER StressedState
<div><r /></div><div><div>In the stressed muscle, there are three mechanisms to
activate glycogen phosphorylase to reak down glycogen stores:</div><div>1. ___
activates a eta-2 adrenergic receptor which triggers a ___ cascade to phosphor
ylate and activate glycogen phosphorylase</div><div>2. __ release from the SR wh
ich inds/activates ___ without the need to phosphorylate it.</div><div>3 (onus

). (extreme conditions, anoxia, TP depletion) MP activates glycogen phosphoryl

ase without needing to phosphorylate it.</div></div><div><r /></div> "<div>In
the stressed muscle, there are three mechanisms to activate glycogen phosphoryl
ase to reak down glycogen stores:</div><div>1. <font color=""#ff0015"">epinephr
ine</font> activates a eta-2 adrenergic receptor which triggers a <font color="
"#ff0015"">Gs-cMP/PK</font> cascade to phosphorylate and activate glycogen pho
sphorylase</div><div>2. <font color=""#ff0015"">Ca+2</font> release from the SR
which inds/activates <font color=""#ff0015"">glycogen phosphorylase kinase</fon
t> without the need to phosphorylate it.</div><div>3 (onus). (extreme condition
s, anoxia, TP depletion) MP activates glycogen phosphorylase without needing t
o phosphorylate it.</div><div><r /></div><div><img src=""Screen Shot 2012-11-13
at 10.27.44 PM.png"" /></div><div><r /></div><div><r /></div>"
Metaoli
smGIMNER StressedState
1. Name the 3 salivary glands and the % saliva that each secretes.<div><r /></d
iv><div>2. Give where each empties.</div><div><r /></div><div>3. Give the gland
type(s) in each.</div> 1. Sumandiular: 70%<div>Parotid: 25%</div><div>Suling
ual: 5%</div><div><r /></div><div>2. Sumandiular and sulingual oth empty in
to the floor of the oral cavity on either side of the frenulum, often through th
e same duct.</div><div><r /></div><div>Parotid empty y the upper secondary mol
ars.</div><div><r /></div><div>3. Sumandiular: acinar serous glands and tuul
ar mucous glands with serous demilune caps.</div><div><r /></div><div>Parotid:
Nearly all acinar serous glands.</div><div><r /></div><div>Sulingual: Nearly a
ll tuular mucus glands.</div> SalivaryGlands
Give the 8 functions of saliva very riefly.
1. <>Moisten food </>for solu
ility in taste uds and esophageal transport<div><><r /></><div>2. Luricate
the oral cavity for <>speech</></div><div><><r /></></div><div>3. <>Saliva
ry amylase </>to reak starch into maltose, maltotriose, and alpha-limit dextri
ns</div><div><r /></div><div>4. <>Immune defense</> (lysozyme, muramidase, la
ctoferrin, defensins, perforins, sIg)</div><div><r /></div><div>5. <>K+ rich
hypotonic</> solution also for acterial control</div><div><r /></div><div>6.
<>cquired pellicle protein</> to protect tooth enamel</div><div><r /></div><
div>7. <>Bicaronate</> to neutralize gastric acid content in case of regurgit
ation</div><div><r /></div><div>8. <>Lingual lipase</>&nsp;from Von Eners
glands that converts TGs to 2-monoglycerides and FFs at pH 6.5-6.9</div></div><
div><r /></div><div>Mnemonic: PIB FLSK</div><div><r /></div><div>cquired <>
P</>ellicle protein</div><div><>I</>mmune defense</div><div><>B</>icaronat
e</div><div><r /></div><div><>F</>ood moisten</div><div><>L</>ipase</div><d
iv><></>mylase</div><div><>S</>peech</div><div><>K</>-rich, hypotonic</di
v><div><r /></div>
SalivaryGlands
Give the function of each of these immune molecules:<div><r /></div><div>Lysozy
me</div><div>Muramidase</div><div>Defensins/perforins</div><div>sIg</div>
Lysozyme: reaks wall of gram<> negative</> acteria<div><r /><div>Muramidase
: reaks wall of gram <>positive </>acteria</div><div><r /></div><div>Defens
ins and perforins: form <>pores</> in acterial memranes to disrupt ion gradi
ents</div></div><div><r /></div><div>sIg: <>agglutinates</> acteria into la
rge masses that cant cross any epithelial arrier</div>
SalivaryGlands
Give the 3 mechanisms y which salivary secretion is modulated. "1. <>Sympathet
ics</> from T1-T3 release norepinephrine on B receptors to cause typical Gs ele
vation in cMP. This leads to dry mouth with high protein content and low water
volume.<div><r /><div>2. <>Parasympathetics</> from CN VII and IX release ace
tylcholine on M3 receptors to cause typical Gq elevation in IP3 and DG. This le
ads to copious watery saliva with low protein content via activation of&nsp;<>
kallikrein</>.<>&nsp;</>This forms<> radykinin, </>which is a <>potent v
asodilator.&nsp;</>See mechanism:&nsp;</div><div><r /></div><div><img src=""
paste-30352533881888.jpg"" /></div><div><r /></div><div>3. <>ldosterone</> r
esults in Na retention.</div></div><div><r /></div>" SalivaryGlands
<div>In stressed adipose tissue, ___ increases cMP levels stimulating PK which
phosphorylates and activates ___. &nsp;The net result is the activation of lip
olysis, the conversion of triglycerides to fatty acids and glycerol.</div><div><
r /></div>
"<div>In stressed adipose tissue, <font color=""#ff0015"">epinep

hine</font> increases cMP levels stimulating PK which phosphorylates and activ
ates <font color=""#ff0015"">hormone sensitive lipase.</font> &nsp;The net resu
lt is the activation of lipolysis, the conversion of triglycerides to fatty acid
s and glycerol.</div><div><r /></div>" MetaolismGIMNER StressedState
In the stressed liver, epinephrine can ind to two receptors to activate glycoge
n phosphorylase:<div>1. ___ adrenergic receptors stimulate the activation of ade
nylate cyclase resulting in ___ activation of glycogen phosphorylase.&nsp;</div
><div>2. ___ adrenergic receptors in liver activate the ___ signaling pathways l
eading to the release of ___ from the endoplasmic reticulum. &nsp;</div><div><
r /></div><div><r /></div>
"In the stressed liver, epinephrine can ind to
two receptors to activate glycogen phosphorylase:<div>1. <font color=""#ff0015""
>eta-2 </font>adrenergic receptors stimulate the activation of adenylate cyclas
e resulting in <font color=""#ff0015"">PK</font> activation of phosphorylase.&n
sp;</div><div>2. <font color=""#ff0015"">alpha-1 </font>adrenergic receptor in
liver activates the <font color=""#ff0015"">inostitol</font> signaling pathways
leading to the release of <font color=""#ff0015"">calcium</font> from the endopl
asmic reticulum. &nsp;<img src=""Screen Shot 2012-11-13 at 11.17.00 PM.png"" />
</div>" MetaolismGIMNER StressedState
"<img src=""paste-21487721382380.jpg"" /><div><r /></div><div>ll 3 components
of the salivary glands are present in this image. Blue oxes all indicate the sa
me structure.</div><div><r /></div><div>1. List these 3 components in the order
that the salivon sees them. Which comprise the intraloular duct system?</div><
div><r /></div><div>2. Give the type of epithelium for two of the three compone
nts.</div><div><r /></div><div>3. Give whether each component has myoepithelial
cells. Descrie them at each component.</div>" "1. <font color=""#1c13ff"">Blue
</font>: serous <>acinus</>. Myoepithelial (a.k.a. asket) cells.<div><><r /
></></div><div>2. <font color=""#ff790e"">Orange</font>: <>Intercalated duct</
>. Myoepithelial cells: spindle-shaped with common asal lamina. Simple <u>cuo
idal</u> epithelium.</div><div><><r /></></div><div>3. <font color=""#21ff1d"
">Green</font>: <>Striated duct</>. No myoepithelial cells. Simple <u>columnar
</u> epithelium.</div><div><r /></div><div><>Intercalated and striated ducts <
/>comprise the intraloular duct system.</div><div><r /></div><div><img src=""
paste-27535035335712.jpg"" /></div>"
SalivaryGlands
"<div>Salivary gland acini</div><img src=""paste-23454816403948.jpg"" /><div><r
/></div><div>1. What 3 possiilities for cell types can acini have? Which types
do the arrows point to on this image?</div><div><r /></div><div>2. a. What str
ucture do the cells at the orange and green arrows posses? Whats its function?<
/div><div>. Name the other 4 instances of this structure that weve studied.</d
iv>"
"1.&nsp;<img src=""paste-23708219474412.jpg"" /><div><r /></div><div>a
. Round serous cells<r /><div>. Tuular mucus cells</div><div>c. Both present
in the same gland: serous demilune (means half-moon) at the lind end and tuula
r mucous cells nearer to the transition to intercalated duct.</div><div><r /></
div><div>2. a. Serous cells have <>intercellular canaliculi</>. These increase
their surface area availale for exocytosis.</div><div><r /></div><div>. <u>H
ere we go:</u></div><div>1.&nsp;<>pical canaliculi</>&nsp;etween the micro
villi of the&nsp;<>proximal convoluted tuule</>&nsp;low columnar epithelium
. These just&nsp;<>phagosomes</>&nsp;of proteins and small peptides that are
digested y the extensive lysosomal system within these cells.</div><r />2.&n
sp;&nsp;<>Bone</>&nsp;canaliculi:&nsp;<>osteocytes in their lacuna send cy
toplasmic processes through the one matrix</>, communicating to each other and
osteolasts via gap junctions to maintain the one and know when to respond to
injury.<r /><r />3.&nsp;<>Open canalicular system</>&nsp;of the&nsp;<>pl
atelet</>:&nsp;<>invagination of platelet PM</>&nsp;so can get contents of
the alpha, delta, and lamda&nsp;<>vesicles out quickly.</><div><><r /></>
</div><div>4. Invaginations of the<> parietal cell </>plasma memrane called&n
sp;<>intracellular canaliculi</>. These generate many&nsp;<>""pseudo"" micr
ovilli</>&nsp;and a huge memrane surface area with&nsp;active&nsp;H/K TPas
e for merocrine regulated acid secretion.</div></div>" SalivaryGlands
"<img src=""paste-26869315404268.jpg"" /><div><r /></div><div>1. List 3 structu
res you see in this image.</div><div><r /></div><div>2. What 3 places in the o

dy could this e taken from?</div>"

1. Basal infoldings of the PM<div>Fenest
rated capillary with diaphragm</div><div>Tons of asal mitochondria</div><div><
r /></div><div>2. PCT of the nephron</div><div>DCT of the nephron</div><div>Stri
ated duct of the salivary gland</div> SalivaryGlands
"<img src=""paste-27732603830764.jpg"" /><div><r /></div><div>1. Identify the s
tructure at the green arrow.</div><div><r /></div><div>2. Whats its function i
n the salivary gland?</div><div><r /></div><div>3. Final saliva salt concentrat
ions relative to plasma are dependent on what 2 things?</div>" 1. Striated duct
<div><r /></div><div>2. Ion pumping that creates a hypotonic saliva rich in K,
low in Na and Cl, and high in Ca. Rememer, these cells have asal infoldings an
d tons of mitochondria just like the PCT and DCT.</div><div><r /></div><div>3.
a. Rate of saliva formation</div><div>. Time the primary saliva is exposed to t
he striated ducts</div> SalivaryGlands
Interloular salivary gland ducts:<div><r /></div><div>1. Where within a crosssection of the salivary glands do these ducts travel?</div><div><r /></div><div
>2. Descrie the changes to their epithelium as these progress toward the oral c
avity.</div>
1. In connective tissue septa etween loules.<div><r /></div><
div>2. a. Initially, stratified <>cuoidal</></div><div>. stratified <>colum
nar</></div><div>c. stratified <>squamous</> nonkeratinized <>with patches o
f ciliated simple columnar</>&nsp;to keep acteria out of the salivary glands.
These patches explain why people with immotile or laile cilia syndromes have h
igher risks of salivary gland infections.</div> SalivaryGlands
Compare acute and chronic stress in terms of protein synthesis/reakdown and the
related hormones.
"<div>cute stress: &nsp;The initial effect on protein
degradation (cortisol) / synthesis (growth hormone) in muscle is to <><font col
or=""#ff0015"">stimulate oth in preparation for an unknown outcome</font></>.
&nsp;If the stress is relieved soon, protein synthesis may e stimulated to rep
air damage.</div><div><r /></div><div>Chronic stress: &nsp;If the stress and a
ssociate high levels of cortisol persist for a longer period, the <><font color
=""#ff0015"">cortisol inhiition of growth hormone release </font></>and the in
hiition of its action in stimulating protein synthesis will diminish protein sy
nthesis. <><font color=""#ff0015"">Protein degradation dominates.</font></></d
iv>"
MetaolismGIMNER StressedState
"nnotate this image from Kretzer. Sorry its so dense.<div><r /></div><div><im
g src=""paste-30816390349350.jpg"" /></div>"
"<img src=""paste-30979599106596
.jpg"" />"
SalivaryGlands
"Identify this structure in the salivary gland.<div><r /></div><div><img src=""
paste-31078383354348.jpg"" /></div>"
"<img src=""paste-31108448125420.jpg"" /
>"
SalivaryGlands
"Identify the cell at the green arrow.<div><r /></div><div><img src=""paste-314
04800868844.jpg"" /></div>"
"<img src=""paste-31417685770732.jpg"" /><div><
r /></div><div>Myoepithelial cell = flat cell surrounding this serous gland</div
>"
SalivaryGlands
"<div><div>In the stressed state, growth hormone works on ___ and ___ tissue, NO
T ___ tissue.</div><div><r /></div><div>The growth hormone receptor is a ___ re
ceptor. Binding of growth hormone &nsp; triggers the Tyr Janus Kinase (JK2) to
&nsp;<><font color=""#ff0015"">dimerize</font></>&nsp;and&nsp;<><font colo
r=""#ff0015"">autophosphorylate</font></>&nsp;(yes, thats kinky) at certain T
yr residues. The following three road cascades result:</div><div><r /></div><d
iv>1. RS inding which triggers the MPK (mitogen-activated protein kinase...ki
nase....and kinase) pathway to increase transcription of ___-promoting genes and
___-like growth factor 1 (IGF-1) in the liver.</div><div>2. inhiition of the _
__ protein cascade, restoring the cMP/PK cascade that activates ___.</div><div
>3. insulin-like effects through the insulin receptor sustrate (IRS) and phosph
oinositide (PI3K) pathways which increase the transport of low kM ___ transport
ers to the cell memrane.</div></div>" "<div>In the stressed state, growth horm
one inds works on <font color=""#ff0015"">adipose</font> and <font color=""#ff0
015"">muscle</font> tissue, NOT <font color=""#ff0015"">liver</font> tissue.</di
v><div><r /></div><div>The growth hormone receptor is a tyrosine kinase recepto
r. Binding of growth hormone &nsp; triggers the Tyr Janus Kinase (JK2) to <><

font color=""#ff0015"">dimerize</font></> and <><font color=""#ff0015"">autoph

osphorylate</font></> (yes, thats kinky) at certain Tyr residues. The followin
g three road cascades result:</div><div><r /></div><div>1. <font color=""#ff00
15"">RS</font> inding which triggers the MPK (mitogen-activated protein kinas
e...kinase....and kinase) pathway to increase transcription of <font color=""#ff
0015"">growth</font>-promoting genes and <font color=""#ff0015"">insulin</font>like growth factor 1 (IGF-1) in the liver.</div><div>2. inhiition of the <font
color=""#ff0015"">G-inhiitory (Gi)</font> protein cascade, restoring the cMP/P
K cascade that activates <font color=""#ff0015"">lipolysis</font>.</div><div>3.
insulin-like effects through the insulin receptor sustrate (IRS) and phosphoin
ositide (PI3K) pathways which increase the transport of low kM <font color=""#f
f0015"">GLUT4</font> transporters to the cell memrane.</div><div><r /></div><d
iv>The whole mess:</div><img src=""Screen Shot 2012-11-14 at 1.01.22 M.png"" />
"
MetaolismGIMNER StressedState
"What are the cells at the red arrows?<div><r /></div><div><img src=""paste-315
25059953132.jpg"" /></div>"
"<img src=""paste-31537944855020.jpg"" />"
SalivaryGlands
<div>Cortisol is a ___ steroid. &nsp;Its main effects, like other steroid hormo
nes, is mediated y inding a specific receptor, the ___ receptor.</div><div>Whe
n cortisol is ound, the receptor moves to the ___ and exerts effects on ___.</d
iv>
"<div>Cortisol is a <font color=""#ff0015"">cataolic</font> steroid. &n
sp;Its main effects, like other steroid hormones, is mediated y inding a spec
ific receptor, the <font color=""#ff0015"">glucocorticoid</font> receptor.</div>
<div>When cortisol is ound, the receptor moves to the <font color=""#ff0015"">n
ucleus</font> and exerts effects on <font color=""#ff0015"">transcription</font>
.</div>"
MetaolismGIMNER StressedState
<div>In the stressed state...</div><div><r /></div><div>___ induces the express
ion of more phosphoenolpyurvate caroxy kinase in the liver, stimulating ___.</d
iv><div><r /></div><div>___, y an unknown mechanism increases ___ synthesis an
d increases the levels of cMP, activating ___</div>
"<div>In the stressed st
ate...</div><div><r /></div><div><font color=""#ff0015"">Cortisol</font> induce
s the expression of more phosphoenolpyurvate caroxy kinase in the liver, stimul
ating <font color=""#ff0015"">gluconeogenesis</font>.</div><div><r /></div><div
><font color=""#ff0015"">Growth hormone</font>, y an unknown mechanism increase
s <font color=""#ff0015"">protein</font> synthesis and increases the levels of c
MP, activating <font color=""#ff0015"">hormone sensitive lipase</font>.</div>"
MetaolismGIMNER StressedState
"In the stressed state...<div><r /></div><div><div>In the adipose, ___ increase
s the synthesis of hormone sensitive lipase while ___, through its inhiitory ef
fect on the inhiitory G-protein, Gi, increases the concentration of cMP, activ
ating PK and increasing the activity of hormone sensitive lipase. &nsp;</div><
div><r /></div><div><><font color=""#ff0015"">Both signals cause the adipose t
o export more fatty acids and glycerol to the lood for use in other tissues.</f
ont></></div></div>" "In the stressed state...<div><r /></div><div><div>In t
he adipose, <font color=""#ff0015"">cortisol</font> increases the synthesis of h
ormone sensitive lipase while <font color=""#ff0015"">growth hormone</font>, thr
ough its inhiitory effect on the inhiitory G-protein, Gi, increases the concen
tration of cMP, activating PK and increasing the activity of hormone sensitive
lipase. &nsp;</div><div><r /></div><div><><font color=""#ff0015"">Both signa
ls cause the adipose to export more fatty acids and glycerol to the lood for us
e in other tissues.</font></></div></div>"
MetaolismGIMNER StressedState
<div>In muscle, the effects of ___ and ___ oppose each other. &nsp;Cortisol sti
mulates protein ____ while growth hormone increases protein ____. &nsp;In the s
hort term, the effects oppose each other; however, in the long term, chronic rel
ease of ___ inhiits the synthesis of ___ so that a long-term protein wasting ef
fect is oserved due to stress.</div> "<div>In muscle, the effects of <font co
lor=""#ff0015"">cortisol</font> and <font color=""#ff0015"">growth</font> <font
color=""#ff0015"">hormone</font> oppose each other. &nsp;Cortisol stimulates pr
otein <font color=""#ff0015"">degradation</font> while growth hormone increases
protein <font color=""#ff0015"">synthesis</font>. &nsp;In the short term, the e

ffects oppose each other; however, in the long term, chronic release of<font col
or=""#ff0015""> cortisol</font> inhiits the synthesis of <font color=""#ff0015"
">growth</font> <font color=""#ff0015"">hormone</font> so that a long-term prote
in wasting effect is oserved due to stress.</div>"
MetaolismGIMNER Stresse
dState
The summary of epineprhines effects on liver tissue in the stressed state follo
w:<div><r /><div>1. phosphorylation and ___ (activation/deactivation) of ___ to
trigger glycogen reakdown; phosphorylation and ___ (activation/deactivation)&n
sp;of glycogen synthase</div><div><r /></div><div>2. phosphorylation and ___ (
activation/deactivation)&nsp;of fructose-2,6-isphosphatase (FBP2) and phosphor
ylation-___ (activation/deactivation)&nsp;of phosphofructokinase 2 (PFK2) lower
levels of ___, inhiiting glycolysis and stimulating gluconeogenesis.</div><div
><r /></div><div>3. phosphorylation and ___ (activation/deactivation)&nsp;of a
cetyl-Co caroxylase, preventing increase in ___ and decreasing fatty acid synt
hesis, stimulating fatty acid oxidation.</div></div>
"The summary of epineprh
ines effects on liver tissue in the stress state follow:<div><r /><div>1. phos
phorylation and <font color=""#ff0015"">activation</font> of <font color=""#ff00
15"">glycogen</font> <font color=""#ff0015"">phosphorylase</font> to trigger gly
cogen reakdown; phosphorylation and <font color=""#ff0015"">inactivation</font>
of glycogen synthase</div><div><r /></div><div>2. phosphorylation and <font co
lor=""#ff0015"">activation</font> of fructose-2,6-isphosphatase (FBP2) and phos
phorylation-<font color=""#ff0015"">deactivation</font> of phosphofructokinase 2
(PFK2) lower levels of<font color=""#ff0015""> fructose-2,6-isphosphate (F26P)
</font>, inhiiting glycolysis and stimulating gluconeogenesis</div><div><r /><
/div><div>3. phosphorylation and <font color=""#ff0015"">inactivation</font> of
acetyl-Co caroxylase, preventing increase in <font color=""#ff0015"">malonyl-C
o</font> and decreasing fatty acid synthesis, stimulating fatty acid oxidation<
/div></div>"
MetaolismGIMNER StressedState
<div>Epinephrines major effect in adipose is to activate ___ through the PK-medi
ated phosphorylation of ___</div><div><r /></div>
"<div>Epinephrines major
effect in adipose is to activate <font color=""#ff0015"">lipolysis</font> throug
h the PK-mediated phosphorylation of <font color=""#ff0015"">hormone-sensitive
lipase.</font></div><div><r /></div>" MetaolismGIMNER StressedState
<div>In muscle, activation of PK y epinephrine enhances glycogen reakdown thr
ough activation of ___. &nsp;Fatty acid oxidation is also stimulated y phospho
rylation of ____ which results in a drop in ___ and an increase in the activity
of the ___ shuttle. ___ is unaffected. Muscle does not perform ___</div>
"<div>In muscle, activation of PK y epinephrine enhances glycogen reakdown th
rough activation of <font color=""#ff0015"">glycogen phosphorylase</font>. &nsp
;Fatty acid oxidation is also stimulated y phosphorylation of <font color=""#ff
0015"">acetyl-Co caroxylase</font> which results in a drop in <font color=""#f
f0015"">Malonyl-Co</font> and an increase in the activity of the <font color=""
#ff0015"">carnitine</font> shuttle. <font color=""#ff0015"">Glycolysis</font> is
unaffected. Muscle does not perform <font color=""#ff0015"">gluconeogenesis</fo
nt>.</div>"
MetaolismGIMNER StressedState
Explain why sustained cortisol levels in chronic stress is dangerous. "<div>Th
e chronic stress response causes a large numer of conditions, includin<font col
or=""#ff0015"">g <>suppression of the immune response, hyperglycemia, growth in
hiition, and the redistriution of ody fat</></font>. &nsp;The hyper secreti
on of cortisol is oserved in a variety of psychological disorders.</div><div><
r /></div>"
MetaolismGIMNER StressedState
Q: List the layers of the GI wall from lumen to lood. <div>: there a mucosal
layer (consists of epithelial cells, lamina propria, and muscularis mucosa the s
mooth muscle), eneath mucosal layer is the sumucosal layer, inner circular, ou
ter longitudinal, serosa</div><div>The list: epithelium, lamina propria, muscula
ris mucosa, sumucosa, Meissners plexus, muscularis externa (inner circular muscl
e), uerachs plexus, muscularis externa (outer longitudinal muscle), serosa</div
><div><r /></div>
BrentsQs
Q: What is little and ig gastrin? : little 17  form of gastrin secreted in resp
onse to a meal; ig 34  form of gastrin secreted etween meals (interdigestive

period)
BrentsQs
Q: What stimulates gastrin secretion? : products of protein digestion, disten
sion of stomach, vagal stimulation
BrentsQs
: inhiits
Q: How does low pH affect the secretion of gastrin?
BrentsQ
s
Q: What is Zollinger-Ellison syndrome and why does it cause the gastric mucosa t
o hypertrophy? : its a gastrin-secreting tumor causing H+ to increase and the t
rophic effects of gastrin cause the gastric mucosa to hypertrophy; duodenal ulce
rs usually result from the unrelenting secretion of H+ BrentsQs
Q: Why would gastric antrum resection cause the gastric mucosa to atrophy?
: removing the antrum removes the source of gastrin (G cells) and thus theres no
trophic affects on the gastric mucosa BrentsQs
Q: The C-terminal 5 amino acids of CCK are identical to what other hormone?
: gastrin; this includes the tetrapeptide that is minimally necessary for gastr
in activity and thus CCK has SOME gastrin activity
BrentsQs
: contraction of gallladder w/
Q: What are the specific actions of CCK?
simultaneous relaxation of sphincter of Oddi, secretion of pancreatic enzymes s
ecretion of HCO3 from pancreas, growth of exocrine pancreas and gallladder (tro
phic effects), inhiition of gastric emptying (thus increases gastric emptying t
ime)
BrentsQs
Q: What do K cells of the duodenum and jejunum secrete? : GIP BrentsQs
Q: Whats the major physiological action of GIP?
 stimulation of insulin secreti
on y pancreatic eta cells
BrentsQs
: incre
Q: How does histamine affect H+ secretion of the parietal cells?
ases
BrentsQs
Q: Is histamine a hormone or paracrine? : paracrine
BrentsQs
Q: True or false: even without the occurrence of Ps the smooth muscle of the GI
tract is exhiits tonic contractions. : true; even su-threshold slow waves p
roduce a weak contraction
BrentsQs
Q: Whats the difference etween segmentation contractions and peristalsis?
: segmentation serves to mix the chyme and expose it to pancreatic enzymes and
secretion; peristalsis is designed to propel the chyme along the small intestine
BrentsQs
Q: Whats the only essential component of gastric juice?
: intrinsic factor (its
needed for B12 asorption in the ileum) BrentsQs
: at th
Q: Why is there an alkaline tide in gastric venous lood after a meal?
e asolateral surface of parietal cells theres a Cl-HCO3 exchanger that allows HC
O3 to e asored
BrentsQs
Q: What enzyme is present within parietal cells that allows for the net HCl secr
etion and net HCO3 asorption? : caronic anhydrase (converts CO2 from aeroic
metaolism to H+ and HCO3)
BrentsQs
Q: What receptor does Ch ind to on parietal cells to stimulate H+ secretion?
: muscarinic (M3) receptor activates Gq IP3/Ca2+ BrentsQs
Q: How can vagal stimulation directly and indirectly stimulate parietal cells?
: vagus nerve innervates parietal cells directly (with Ch) or vagal stimulatio
n onto G cells releases gastrin which goes through circulation and then activate
s parietal cells
BrentsQs
Q: Descrie the structural configuration of the small intestine that allows a 60
0-fold increase in surface area.
": the surface of the large intestine i
s arranged in longitudinal folds called the folds of Kerckring; fingerlike villi
project from these folds; the surfaces of the villi are covered with epithelial
cells (enterocytes) and the apical surface of these cells contain microvilli (a
ka the rush order)<div><img src=""paste-15191299325956.jpg"" /></div>"
BrentsQs
Q: Where does starch digestion egin? &nsp;Where else does it occur? ": in t
he mouth with salivary amylase; pancreatic amylase digests as well; the reakdow
n leads to: alpha-limit dextrin, maltose, and maltotriose; these are further dig
ested to monosaccharides y the intestinal rush order enzymes alpha-dextrinase
, maltase, and sucrase<div><img src=""paste-15393162788868.jpg"" /></div>"
BrentsQs

Q: What 3 disaccharides found in food must e hydrolyzed y specific enzymes to

": trehalose (glucose + glucose), lactose (glucose + galactose)
e asored?
, and sucrose (glucose + fructose)<div><img src=""paste-15509126905860.jpg"" /><
/div>" BrentsQs
Q: How is glucose/galactose asorption different from fructose asorption?
": The apical memrane contains the sodium-glucose cotransporter SGLUT1, which
allows the cell to take up glucose and galactose y cotransport with sodium, and
GLUT5, which mediates asorption of fructose. On the asolateral plasma memran
es is GLUT2, which allows diffusion of all three of these hexoses out of the cel
l into extracellular fluid and ultimately, into lood. &nsp;In other words, glu
cose and galactose are asored y mechanisms using Na+-dependent transport whil
e fructose is asored via facilitated diff.<div><img src=""paste-15822659518468
.jpg"" /></div>"
BrentsQs
Q: Which race has the least amount of lactose intolerance?
": Caucasian; w
e rely on lots of diary in our diet; dults with non persistance of lactase freq
uently develop adominal pain, cramping, distension, flatulence and diarrhea. Th
ese symptoms are caused y malasored lactose which draws water into the intest
inal lumen producing osmotic diarrhea, and y the intestinal flora that metaoli
zes unasored lactose to H2, methane and CO2<div><img src=""paste-1599445821030
8.jpg"" /></div>"
BrentsQs
Q: Name the pancreatic proteases. &nsp;
BrentsQs
Q: How are proteins asored in the small intestine?
"<div>: there are 4 sep
arate Na+-amino acid cotransporters for the different neutral, asic, acidic, a
nd imino; they are then transported across the asolateral side via facilitated
diffusion; most ingested protein is asored in the dipeptide and tripeptide for
ms and theres separate H+-dependent cotransporters in the apical surface that uti
lize the H+ gradient thats estalished y the Na+-H+ exchanger; Once inside the e
nterocyte, the vast ulk of di- and tripeptides are digested into amino acids y
cytoplasmic peptidases and exported from the cell into lood. Only a very small
numer of these</div><div>small peptides enter lood intact</div><div><img src=
""paste-16376710299652.jpg"" /></div><div><r /></div><div><img src=""paste-1638
9595201540.jpg"" /></div>"
BrentsQs
Q: What is PEP1?
": PEPT1 is a prototype transporter of the so called PO
T (proton-oligopeptide transporter); Integrated model depicting the generation o
f di- and tripeptides from the hydrolysis of luminal proteins and the pathways i
nvolved in cellular uptake of peptides mediated y PEPT1 in the apical memrane
of intestinal epithelial cells. Following apical influx, di- and tripeptides are
sequentially hydrolyzed y multiple cytosolic hydrolases followed y asolatera
l efflux of the amino acids via different amino acid-transporting systems; theres
a kinetic advantage and PEP1 is responsile<div><img src=""paste-16604343566340.j
pg"" /><div><r /></div></div>" BrentsQs
Q: Can the enterocytes asor intact protein? If so, when does this occur?
: for a very few days after irth, neonates have the aility to asor intact p
roteins. This aility, which is rapidly lost, is of immense importance ecause i
t allows the neworn animal to acquire passive immunity y asoring immunoglou
lins in colostral milk BrentsQs
Q: What evidence suggests that PEP1 is essential to life?
"<div>: In oth
Hartnup disease and cystinuria intestinal asorption of certain amino acids is
lacking or is markedly reduced y the malfunction of the underlying transporters
.&nsp;</div><div>In Hartnup patients with impaired asorption of amino acids su
ch as histidine, tryptophan, and phenylalanine, asorption rates in vivo are far
greater when the amino acids are provided in dipeptides than when perfused in f
ree form. This clearly estalishes that PEPT1 is important or even essential to
life in humans suffering from inherited gene defects causing malfunctions of ind
ividual amino acid transporters</div><div><img src=""paste-16823386898436.jpg""
/></div><div><r /></div>"
BrentsQs
Q: What are pancreatic enzymes in charge of lipid digestion?
": pancreatic l
ipase, cholesterol ester hydrolase, phospholipase 2, colipase; Lipid digestion
proceeds at a rapid pace in the duodenum, where lipid emulsion droplets are atta
cked y pancreatic lipolytic enzymes that are secreted at a maximum rate followi

ng cholecystokinin stimulation. The four lipolytic enzymes are lipase, colipase,

phospholipase 2, and cholesterol esterase. Colipase is an oligate cofactor fo
r lipase action. Colipase first attaches to a triglyceride (TG) molecule on the
surface of an emulsion droplet and serves as an anchor for lipase<div><img src="
"paste-17051020165124.jpg"" /></div>" BrentsQs
Q: How are lipids asored in the small intestine?
: the products of lipid
digestion (cholesterol, monoglycerides, FFs) are soluilized in the intestinal
lumen in micelles (core of micelle contains the products of lipid digestion and
the exterior is lined with ile salts); the micelle diffuses to the apical mem
rane (rush order) of intestine where the pH is more acidic due to Na-H exchang
er this causes destailization of the micelle and the lipids are thus released a
nd diffuse into the cell; the ile salts are left ehind in the lumen to e aso
red downstream in the ileum; inside the intestinal epithelial cells the product
s of lipid digestion are reesterified to form the original TGs, cholesterol est
ers, and phoshpolipids
these are packaged with apoproteins to form chylomicrons
(TGs and cholesterol at the core and phospholipids/apoproteins on the surface);
the chylomicrons are packaged into secretory vesicles where the migrate to the
BrentsQ
asolateral surface and are released via exocytosis into lacteals
s
Q: How are micelles used to soluilize lipids? ": Mixed micelles carry lipids
across the unstirred water layer to the enterocytes. The molecules of the lipid
aggregates are so oriented that their polar groups face the surrounding watery m
edium which enales them to e widely dispersed or ""dissolved"" within the lumi
nal contents. Their nonpolar interiors can dissolve lipids such as cholesterol a
nd the fat-solule vitamins (D, , K and E). Thus these lipid aggregates are veh
icles to transport water-insolule molecules (lipids) in the watery luminal cont
ents, as well as carry them through the unstirred water layer to the microvillou
s memrane of the asorptive cell, through which the lipid molecules are asore
d"
BrentsQs
Q: What is olestra?
: a non-digestile molecule that is used as fat sustit
ute; may cause intestinal distress, diarrhea, and flatulence; may prevent asorp
tion of vitamins , D, E, K; Olestra is not hydrolyzed or asored and so passes
through the ody unchanged.&nsp;
BrentsQs
Q: What is digestive and asorptive process is the colon?
: The large ow
el has a special role in carohydrate digestion and asorption. Indigestile car
ohydrates are partially roken down y enzymes in colonic acteria to short-cha
in fatty acids (acetate, propionate, and utyrate), which are efficiently asor
ed y the colonic mucosa . The short-chain fatty acids are important metaolic s
ustrates for the mucosal cells in the colon. In addition, the colon may serve i
n a reserve capacity for carohydrate salvage in patients with carohydrate mala
sorption &nsp;
BrentsQs
Q: By what mechanism is Ca2+ asored in the small intestine? ": it depends u
pon the presence of the active form of vitamin D; Ca2+ enter via a channel and 
inds calindin, which uffer intracellular Ca levels.  Ca pump nad a Na-Ca exch
anger on the asolateral memrane of the duodenal cell extrude &nsp;Ca in the i
nterstitial space. Vit D, through genomic effects controls the synthesis of vari
ous proteins involved in Ca asorption<div><img src=""paste-17652315586564.jpg""
/></div>"
BrentsQs
Q: By what mechanism is iron asored in the small intestine? ": either asor
ed as free iron (Fe2+) or heme iron<div><img src=""paste-17781164605444.jpg"" /
></div>"
BrentsQs
Q: What vitamin is only asored in the ileum? : vitamin B12; note that ileum
also takes ack the ile salts BrentsQs
Q: True or false: only monosacchardies can enter the asorptive cell of intestin
: true; The oligosaccharides and the disaccharides must e hydrolyzed t
e.
o monosaccharides y oligosaccharidases which are located on the microvillous me
mrane. The rush order enzymes insure rapid hydrolysis, ut lactase acts relat
ively slowly and disappears at age 7 to 10 years in 60-90% of most ethnic groups
that do not come from northern or central Europe
BrentsQs
Q: Who are asored more easily, free s or di-/tri- peptides? : di-/tri- pept

ides; There is a memrane carrier for the transport of di- and tripeptides which
is the main way that amino acids from dietary protein enter the asorptive cell
BrentsQs
Q: Pancreatic lipase, together with the protein _____, act at the oil-water inte
rface to hydrolyze insolule, nonpolar, triglyceride to somewhat solule FFs an
d monoglyceride.
BrentsQs
: colipase
: decreased rec
Q: What are some side effects of resection of the ileum?
irculation of ile acids to the liver and decreased asorption of the intrinsic
factor/B12 complex; in a patient who has had a ileectomy most of the secreted i
le acids are lost in the feces and thus puts a demand on the liver for synthesis
of new ile acids; ecause the pool of ile acids decreases over time (since li
ver cant meet increased demands) there are inadequate quantities secreted into th
e small intestine resulting in poor emulsification and asorption of lipids; pat
ient gets steatorrhea BrentsQs
: in the duodenum where
Q: Where are villi longest in the small intestine?
most digestion and asorption occurs; they are shortest in the terminal ileum;
the surfaces of the villi are covered with epithelial cells (enterocytes) inters
persed with mucus-secreting cells (golet)
BrentsQs
Q: Pancreatic amylase digests interior 1,4-glycosidic onds in starch and yields
what 3 disaccharides? : alpha-limit dextrins, maltose, maltotriose BrentsQ
s
Q: How are glucose and galactose asored y intestinal epithelial cells?
: via Na+-dependent cotransporter (SGLT1); this is secondary active transport
BrentsQs
Q: What transporter transports glucose and galactose across the asolateral surf
ace?
BrentsQs
: GLUT2
: its tr
Q: How is fructose handled differently than glucose and galactose?
ansported y facilitated diffusion via GLUT5
BrentsQs
Q: Descrie lactose intolerance.
: caused y a lactase deficiency in the
rush order and thus lactose is not digested to glucose and galactose; lactose
is nonasorale and thus holds water in the lumen causing osmotic diarrhea
BrentsQs
Q: True or false: Pancreatic and rush order proteases alone can adequately dig
est ingested protein.
: true; even people with stomachs removed can have norm
al protein asorption BrentsQs
: Na+-a
Q: How are amino acids asored y the intestinal epithelial cells?
mino acid contransporters; there are 4 separate cotransporters for the different
amino acids (neutral, asic, acidic, imino)
BrentsQs
Q: True or false: most ingested protein is asored y intestinal epithelium in
: true;
the dipeptide and tripeptide forms rather than as free amino acids.
theres H+ dependent cotransporters; once inside the cell most of the di and trip
eptides are hydrolyzed to s y cytosolic peptidases BrentsQs
Q: What protein is needed for pancreatic lipase to do its jo in the small intes
: colipase; it displaces ile salts at the lipid-water interface and i
tine?
nds to pancreatic lipase so it can proceed with its digestive function BrentsQ
s
: they
Q: Where are apoproteins synthesized and why are they important?
are synthesized y the intestinal epithelial cells and are essential for the as
orption of chylomicrons BrentsQs
Q: What are the fat-solule vitamins?
BrentsQ
: vitamins , D, E and K
s
Q: Whats the effect of gastrectomy on B12 asorption? : loss of source of int
rinsic factor (from parietal cells of stomach) results in patients not eing al
e to asor B12 BrentsQs
: HCO3 and K+; results
Q: What two ions are especially lost in diarrhea?
in hyperchloremia metaolic acidosis and hypokalemia
BrentsQs
Q: How does emulsification help fat digestion and asorption?
: Emulsificatio
n increases oil-water interface. With the aid of the detergent action of ile sa
lts, a whole spectrum of sizes of multimolecular particles are formed. Emulsific
ation promotes lipolysis y increasing the area of oil-water interface where lip

olysis occurs ut it does not provide adequate dispersion in luminal water to pr
omote asorption. n adequate concentration of conjugated ile salts (critical m
icellar concentration - CMC) and a pH uffered to near neutrality is necessary f
or formation of micelles.
BrentsQs
Q: What exchanger is present on the luminal surface of pancreatic ductal cells t
hat explains the aqueous icaronate secretion of the pancreas? : Cl-HCO3 excha
nger
BrentsQs
: conti
Q: What kind of capillary ed resides inside the islet of Langerhans.
nuous fenestrated with diaphragms and a continuous asal lamina; note that capil
laries go from the core to the outside so insulin can act on other cells
BrentsQs
Q: What intermediate filament is found in the cells of the islets of Langerhans?
: cytokeratin BrentsQs
Q: Name the 5 hormones secreted y the islets of Langerhans.
: insulin, gluc
agon, somatostatin, VIP, pancreatic polypeptide BrentsQs
Q: ____ cells secrete the sum total of all the digestive enzymes that empty into
the duodenum at the ampulla of Vater across the sphincter of Oddi.
: cina
r
BrentsQs
: true
Q: True or false: all the proteases are secreted in inactive form.
BrentsQs
Q: Name 7 proteases secreted y the pancreas.
: trypsinogen, chymotrypsinogen
, proelastase, procaroxypeptidase  and B, proaminopeptidase  and B BrentsQ
s
: FFs and 2-mo
Q: Pancreatic lipase cleaves triglycerides into _______.
noglyceride
BrentsQs
Q: Cholesterol esterase cleaves cholesterol esters into ______. : free choleste
rol and FF
BrentsQs
Q: What exists within the zymogen granules of the acinar cells that keeps the pa
ncreas from digesting itself?
: trypsin inhiitor prevents accidental activat
ion of proteases
BrentsQs
Q: What pathology is associated with premature activation of proteases in pancre
: acute pancreatitis BrentsQs
as?
Q: List 3 major causes of a familial pre-disposition to pancreatitis.
: mutat
ion in trypsinogen called cationic trypsinogen which increases the likelihood of
spontaneous activation, mutation in SPINK-1 (trypsin inhiitor) which inhiits
its inding to trypsinogen and allows it to spontaneously active, a mutation in
the CFTR gene so that the chloride channel does not work resulting in a reduced
icaronate wash and thick viscous mucous and a locked pancreatic duct resultin
g in protein aggregation
BrentsQs
Q: Prior to a meal, the acinar cells have tons of apical zymogen granules. &nsp
;How does this change after a meal?
: the zymogen concentration decreases 
ecause of exocytosis of the digestive enzymes into the lumen; NOTE: the lumen is
large when the acinar cells are actively secreting and is small in the fasting
state BrentsQs
Q: Would you expect the acinar cells to have tight junctions or looser junctions
?
: VERY tight junctions ecause you would never want the potentially act
ive digestive enzymes to have access to the intercellular space for self-digesti
on
BrentsQs
Q: What are the intercalated cells that extend down into the acinar lumen called
?
: centroacinar cells BrentsQs
: cytok
Q: What is the intermediate filament found in centroacinar cells?
eratin BrentsQs
Q: What do centroacinar cells secrete upon stimulation y secretin?
: icar
BrentsQs
onate wash
Q: True or false: there are parallel centroacinar cells found in salivary glands
: false; they dont need them ecause salivary enzymes arent as caustic
.
BrentsQs
Q: What two major ducts due the interloular ducts empty into? : accessory duc
t of Santorini or into the major duct of Wirsung
BrentsQs
: ecause they
Q: Why dont acinar cells normally cause pancreatic cancer?

are too differentiated to e in the cell cycle; theyre in G(o) BrentsQs

Q: What are the major stimuli of pancreatic secretions? : unmyelinated fiers f
rom the vagus nerve release Ch cause vesicle fusion with the plasma memrane (z
ymogens are then immediately washed away y secretion of centroacinar cells), se
cretin (from enteroendocrine cells of intestine), and CCK
BrentsQs
Q: What is the effect of secretin on the pancreas?
: stimulates the centro
acinar cells and the intercalated duct cells to secrete a icaronate rich wash
BrentsQs
Q: Malnutrition, starvation, and low caloric intake causes Kwashiorkor. &nsp;Ho
w does this pathology affect pancreatic acinar cells?
: results in the atroph
y of pancreatic acinar cells which massively reduces the production of pancreati
c digestive enzymes which further diminishes digestion and asorption BrentsQ
s
Q: What do the delta cells of the pancreas secrete?
: somatostatin BrentsQ
s
Q: What do the F cells of the pancreas secrete? What does this inhiit? : pancr
eatic polypeptide; inhiits CCK BrentsQs
Q: What do the D1 cells of the pancreas secrete?
: VIP BrentsQs
Q: Where are eta cells found within the islets of Langerhans clusters? : eta
cells are at the core, other cells are at the periphery BrentsQs
Q: By pulse-chase experiments its possile to detect where acinar zymogens are wi
thin the cell. &nsp;Name the times and associated locations.
: RER (7min) go
lgi (17-47min) mature zymogen granule (60min) BrentsQs
: true BrentsQ
Q: True or false: pancreatic acini lack myoepithelial cells.
s
Q: What are the 8 functions of saliva? : moisten food for soluility in taste
uds and for transport down esophagus, wets and luricates oral cavity for speec
h, initiates digestion of starch (salivary amylase), controls oral acteria, mod
ifies primary saliva and makes it hypotonic, secretes Ca2+ inding protein to pr
eserve teeth enamel, secretes icaronate to neutralize regurgitation, secretion
is modulated y sympathetic/parasympathetic and kallikrein and aldosterone
BrentsQs
Q: Initial saliva passes through a ____ duct and then through a ____ duct.
BrentsQs
: intercalated; striated
Q: ______ cells are present in the acini and intercalated ducts. &nsp;When stim
ulated y neural input, they contract and eject saliva into the mouth. : myoep
ithelial
BrentsQs
Q: The ____ cells modify the initial saliva to produce the final saliva y alter
ing the concentrations of various electrolytes. : ductal
BrentsQs
Q: _____ is an enzyme that cleaves high molecular weight kininogen into _______.
: Kallikrein; radykinin
BrentsQs
Q: What transporters allow for the modification of saliva y ductal cells?
: Na-H exchanger, Cl-HCO3 exchange, and H-K exchange BrentsQs
: lysozyme, muramidase,
Q: Whats secreted in saliva that controls oral acteria?
lactoferrin, defensins, perforins, sIg and the acteria are also killed y the
hypotonic nature of the final saliva BrentsQs
Q: Whats the function of kallikrein? : its secreted asally and is a potent v
asodilator via the formation of radykinin
BrentsQs
Q: What glands secrete lingual lipase? : von Eners glands of the tongue
BrentsQs
Q: If theres cancer of the salivary glands requiring surgical removal and/or radi
: ecause lingual lipas
ation why is there no decrease in lingual lipase?
e is made y glands in the tongue; recall that lingual lipase converts triglycer
ides into 2-monoglycerides and FFs
BrentsQs
: sumandiular
Q: Which salivary gland produces 70% of the saliva?
BrentsQs
Q: Where do sumandiular glands empty into the oral cavity?
: on the floor
on either side of the frenulum BrentsQs
: parotid, theyre located in fro
Q: Which salivary glands swell with mumps?
nt of the ears BrentsQs

Q: What gland is predominantly found in the parotid glands?

: serous glands
; they contriute 25% of saliva volume BrentsQs
: oth
Q: What glands are predominantly found in the sumandiular glands?
serous and mucus
BrentsQs
Q: What salivary glands are located under the tongue? Whats their contriution?
BrentsQs
: sulingual; they contriute 5% salivary volume
: myoepithelial cells
Q: What are asket cells in the salivary glands?
BrentsQs
Q: In a mixed gland with oth serous and mucus cells which cells are nearest to
the intercalated duct? : mucus cells are nearest to the intercalated duct and
the serous cells are distal as a serous demilune cap
BrentsQs
Q: True or false: intercalated ducts have myoepithelial cells. : true BrentsQ
s
Q: How are the intercalated duct cells different from the striated duct cells?
: intercalated has cuoidal cells, striated has columnar cells BrentsQs
Q: True or false: striated ducts contain myoepithelial cells. : false, they n
ever do BrentsQs
Q: Whats the function of the striated ducts? : critical in ion pumping that
creates a hypotonic saliva rich in K+, low in Na+, and high in Ca2+
BrentsQ
s
Q: How are infections prevent within the salivary glands?
: at the openin
g to the oral cavity theres patches of ciliated columnar cells which eat toward
the oral cavity and thus keep out infection; in people with immotile or laile c
ilia syndromes there is an increased incidence of salivary gland infections
BrentsQs
Q: List the order of ducts in the saliva glands.
: acinar (secretory) ce
lls drain into the intercalated ducts
striated ducts interloular ducts (excreto
ry ducts)
BrentsQs
Q: What enzyme converts kininogen to radykinin resulting in vasodilation and in
creased capillary permeaility in the salivary glands? : kallikrein BrentsQ
s
Q: Even though oth parasympathetic and sympathetic regulation of the salivary g
lands are excitatory, they differ in certain ways. How so?
: sympathetic r
esults in increased protein and decreased water (causes dry mouth) whereas parasym
pathetic causes copious saliva with low protein BrentsQs
Basic liver morphology:<div><r /></div><div>1. How many loes does the liver ha
ve?&nsp;</div><div><r /></div><div>2. Name its connective tissue capsule.</div
><div><r /></div><div>3. Descrie its dual lood supply, what each component ca
rries, and the 4-part course of lood through the organ.</div> 1. 4 incompletel
y separated loes<div><r /></div><div>2. Glissons capsule</div><div><r /></di
v><div>3. a. Hepatic portal vein:&nsp;</div><div>-<>80%</> of loodflow</div>
<div>-<>Nutrient</> rich</div><div><u>Carries</u>:</div><div><>Duodenum</></
div><div>-mino acids</div><div>-Glucose, fructose, galactose</div><div><>Splee
n</></div><div>-Biliruin</div><div><>Pancreas</></div><div>-Hormones</div><d
iv><>Ileum</></div><div>-Vitamin B12</div><div>-Unconjugated and dehydroxylate
d ile salts</div><div><>Lymphatics from the jejunum</></div><div>-Chylomicra<
/div><div><r /></div><div>. Hepatic artery:</div><div>-<>20%</> of loodflow
</div><div>-<>Oxygen</> rich</div><div><r /></div><div><u>Course</u>:&nsp;</
div><div>1. Mix in distriuting and inlet vessels in the liver sinusoids.</div><
div>2. Purging y the periloular then centroloular hepatocytes.</div><div>3. I
nto the collecting/central/hepatic venules.</div><div>4. These come together to
form the valveless hepatic vein that drains into the IVC.</div> Liver
"<img src=""paste-6270652252655.jpg"" /><div><r /></div><div>1. a. Name this a
stracted structure of the liver.</div><div>. What lies at the hexagons center?
</div><div>c. What 6 structures lie at each of the 6 points of the hexagon?</div
><div>d. Trace the flow of lood through this structure.</div><div><r /></div><
div>2. a. Name this astracted structure.</div><div>. What lies at the triangle
s center?</div><div>c. What lies at the 3 points of the triangle?</div><div>d.
Trace the flow of ile through this structure.</div><div><r /></div><div>3. a.
Name this astracted structue.</div><div>. What are its 4 oundaries?</div><div

>c. Trace the flow of lood through it in 3 steps.</div>"

"1. a. <>Classi
c liver loule</><div><r /><div>. <>Collecting venule</></div><div><r /></
div><div>c. <u>Portal canal</u></div><div>1. Portal venule</div><div>2. Hepatic
arteriole</div><div>3. Bile duct</div><div>4. Space of Moll surrounded y plate
of terminal hepatocytes</div><div>5. Lymphatic vessel (invisile)</div><div>6. U
nmyelinated nerves</div><div><r /></div><div>d. Blood flows <>toward the cente
r</> from the portal canals to the collecting venule.</div></div><div><r /></d
iv><div>2. a. <>Portal loule</></div><div><r /></div><div>. Center is a <>
portal canal</> and surrounding structures</div><div><r /></div><div>c. Each p
oint is a <>collecting venule</></div><div><><r /></></div><div>d. Bile flo
ws in ile canaliculi <>toward the triangles center</> from adjacent the coll
ecting venules to the ile duct in the portal canal. This is <>opposite</> the
direction of <>lood</> <>flow</>.</div><div><r /></div><div>3. a. <>Hepa
tic acinus of Rappaport</></div><div><><r /></></div><div>. Boundaries: 2 c
ollecting venules and 2 portal canals</div><div><r /></div><div>c. See pic:</di
v><div><img src=""paste-8340826489390.jpg"" /></div><div><r /></div><div>Zone 1
: <>periloular</> hepatocytes, <>high&nsp;</>oxygenation</div><div><r /><
/div><div>Zone 2: <>mid-central</> hepatocytes, intermediate oxygenation</div>
<div><r /></div><div>Zone 3: <>centroloular</> hepatocytes, <>low</> oxyge
nation</div>" Liver
"1. nnotate this liver SEM image from ng.<div><r /></div><div><img src=""past
e-8714488644079.jpg"" /></div><div><r /></div><div>2. Classify the type of capi
llary.</div><div><r /></div><div>3. What 4 cell types/structures fill the space
at the red arrows? Give the function(s) of each.</div>"
"1.&nsp;<img sr
c=""paste-8877697401327.jpg"" /><div><r /></div><div>2. Fenestrated with no dia
phragms nor asal lamina</div><div><r /></div><div>3. 4 cell types/structures i
n the space of Disse:</div><div>-<>Hepatocyte microvilli</>: to increase PM su
rface area to purge the lood of toxins and regulate nutrient levels.</div><div>
-<>Trace firolasts secreting...</></div><div>-<>Reticular fiers</>:</div>
<div>a. support hepatocytes</div><div>. keep sinusoids open</div><div>c. provid
e scaffolding upon which orderly, rapid hepatocyte regeneration can occur</div><
div>-<>Ito cells </>(a.k.a. lipocytes):&nsp;</div><div>a. lso secrete reticu
lar fiers</div><div>. Store fat-solule vitamins , D, E, and K</div><div>c. O
rganize hepatocytes into radial spokes</div>" Liver
"SEM of a liver sinusoid:<div><img src=""paste-10720238371308.jpg"" /></div><div
><r /></div><div>What 5 morphologic features increase the interaction etween t
he hepatocyte microvilli and the sinusoidal lood?</div>"
1. <>Gaps</> 
etween the discontinuous endothelial cells<div>2. Endothelial fenestrae arranged
into extensive <>sieve plates</></div><div>3. <>No diaphragms</></div><div>
4. <>No asal lamina</></div><div>5. Scarce Ito cells and firolasts <>dont
secrete</> enough reticular fiers to form a <>arrier</>.</div>
Liver
1. What are the 5 sites in the liver where there is connective tissue proliferat
ion in cirrhosis?<div><r /></div><div>2. What commonly causes liver cirrhosis?<
/div> 1. . <>round the periphery of the classic liver loule</><div>B. <>
Within the space of Disse</>&nsp;(oliterates Ito cells--&gt;fat solule vitam
in deficiency;</div><div>oliterates interaction of hepatocyte microvilli with s
inusoidal lood--&gt;diminished asorption of illiruin--&gt;jaundice)</div><di
v>C. <>round the ile duct in the portal space</></div><div>D. <>Oliteratio
n of the space of Moll</></div><div>E. <>round the collecting veins</>--&gt;
portal hypertension</div><div><r /></div><div>Mnemonic: BCM CD</div><div>Bile d
uct</div><div>Collecting veins</div><div>Moll</div><div>Classic liver loule</di
v><div>Disse</div><div><div><r /></div><div>2. <>Chronic alcoholism</></div><
/div> Liver
"<img src=""paste-12017318494748.jpg"" /><div><r /></div><div>1. What is this c
ell type?</div><div><r /></div><div>2. What % of the liver cell population does
it comprise?</div><div><r /></div><div>3. What morphological structure does th
is cell type form?</div><div><r /></div><div>4. long the peripheral-central ax
is of a given plate, what do these cells exhiit?</div><div><r /></div><div>5.
What happens to these cells with &nsp;normal aging? (3)</div><div><r /></div><
div>6. What is the normal lifetime of these cells?</div>"
"1. Hepatocyte<d

iv><r /></div><div>2. 80%</div><div><r /></div><div>3. Single layer of epithel

ial cells surrounded on either side y sinusoids:</div><div><img src=""paste-128
41952215535.jpg"" /></div><div><r /></div><div>4. Hepatocyte heterogeneity: str
ucture and iochemistry change</div><div><r /></div><div>5. a. Decreased # of h
epatocytes per unit volume</div><div>. Increased cell size</div><div>c. Increas
ed polyploidy and inucleation</div><div><r /></div><div>6. 150 days</div>"
Liver
Random intracellular hepatocyte structures:<div><r /></div><div>1. Give the 3 t
hings that a given hepatocytes plasma memrane lies adjacent to.</div><div><r
/></div><div>2. What two sources of energy are visile in the hepatocyte?&nsp;<
/div><div>Which undergoes daily changes? Descrie them.</div><div><r /></div><d
iv>3. Give the junctional complexes present in hepatocytes. (2)</div><div><r />
</div><div>4. Compared to the average cell, does a hepatocyte contain few or man
y mitochondria?</div> 1. a. Space of Disse<div>. djacent hepatocytes</div><d
iv>c. Bile canaliculi</div><div><r /></div><div>2. Dark glycogen granules and l
ipid droplets that are not memrane ound.</div><div>Glycogen granules change to
mirror the nutritional state; regulated y insulin and glucagon.</div><div><r
/></div><div>3. Desmosomes, tight junctions</div><div><r /></div><div>4. Lots o
f mitochondria</div>
Liver
Give the 6 functions of peroxisomes in hepatocytes.<div><r /></div><div>Give th
e disease state associated with one of these functions.</div> 1. B-oxidation o
f fatty acids<div>2. Cholesterol synthesis</div><div>3. Bile acid iogenesis</di
v><div>4. Myelin lipid synthesis</div><div>5. Purine (MP, GMP) degradation to u
ric acid</div><div>6. Hydrogen peroxide (H<su>2</su>O<su>2</su>) reakdown 
y catalase</div><div><r /></div><div>Mnemonic: BCM BCP(?)</div><div><r /></div
><div><>drenoleukodystrophies</> = defects in B-oxidation</div>
Liver
Hepatocyte endoplasmic reticulum:<div><r /></div><div>RER: 1. What % of lood p
lasma proteins are synthesized here?</div><div>2. Give the 9 lood plasma protei
ns synthesized here.</div><div>3. Give their secretion mechanism.</div><div><r
/></div><div>SER: 4. Give its 3 functions.</div><div>5. What is its significance
in the neonate?</div><div>6. What drug increases its prevalence?</div> 1. 95%<d
iv><r /><div>2. a. Complement cascade proteins</div><div>. angiOtensinogen</di
v><div>c. Kininogen</div><div>d. Firinogen</div><div>e. lumin</div><div>f. Pr
othromin</div><div>g. Plasminogen</div><div>h. Transferrin</div><div>i. Vldl</d
iv><div><r /></div><div>Mnemonic: see capitalized letters :)</div><div><r /></
div><div>3. Merocrine constitutive secretion</div><div><r /></div><div><r /></
div><div><r /></div><div>4. a. <>Drug detoxification </>y conjugation to glu
curonic acid, methylation, and oxidation.</div><div>.<> De novo synthesis of 
ile acids</> from cholic acid conjugated to glycine or taurine.</div><div>c. <
>Glucuronyl transferase conjugates iliruin to glucuronic acid to form ilirui
n glucuronide</>. This is transported into the ile canaliculi.</div><div><r /
></div><div>5. SER is often <>underdeveloped</> in the neonate, resulting in <
>hyperiliruinemia</></div></div><div><r /></div><div>6. <>Bariturates</>
</div> Liver
"<img src=""paste-16514149253615.jpg"" /><r /><div><r /></div><div>1. nnotate
this image.</div><div><r /></div><div>2. What is the function of the structure
at the red arrow and lue ox?</div><div><r /></div><div>3. What are the 4 pro
ducts secreted into the lumen indicated y the orange ox?</div>"
"1.&nsp
;<img src=""paste-17012365459951.jpg"" /><div><r /></div><div>2. <>ctin and m
yosin filaments</> around the cytoplasmic side of the ile canaliculus PM <>co
ntract in a wave from the collecting venule to the ile duct in the portal area<
/> to yield unidirectional movement of ile opposite the flow of lood.</div><d
iv><r /></div><div>3. a.&nsp;Maximally hydroxylated and conjugated to taurine
and glycine&nsp;<>ile acids</></div><div>. <>Biliruin glucuronide</></di
v><div>c. <>Bicaronate</></div><div>d. <>Cholesterol</></div>"
Liver
Give the sequence of movement through the ody of ile salts.<div><r /></div><d
iv>Do the same for iliruin.</div>
"<div>a. Maximally hydroxylated and conj
ugated to taurine and glycine&nsp;<>ile acids</>&nsp;from 2 sources:&nsp;<
/div><div>-<>90% recycled&nsp;</>out of the gut lumen in the ileum, through t
he portal circulation,<>&nsp;</>from the sinusoid lood ack into the ile ca

naliculi. This can happen up to 6x to deal with a fatty meal!</div><div>-<>10%

de novo synthesis&nsp;</>in the hepatocyte&nsp;<>SER</>.</div><div><img src
=""paste-2744484103200.jpg"" /></div><div><r /></div><div>.&nsp;<>Biliruin<
/>: Breakdown product of old RBCs released y Kupffer cells in the liver and ma
crophages in the&nsp;spleen and one marrow. Conjugated to glucuronic acid in t
he hepatocyte SER and secreted into the ile canaliculi as iliruin glucuronate
. If this process is deficient, jaundice and pale stools result.</div><div><r /
></div><div><img src=""paste-2985002271776.jpg"" /></div>"
Liver
Give the 5-step flow of ile from the hepatocytes into the duodenum.
1. Unidi
rectional pulsations of the ile canaliculi from <>central vein toward portal a
rea</>.<div><r /></div><div>2. Cross the terminal plate of hepatocytes in ile
ductules a.k.a. <>canals of Hering</></div><div><r /></div><div>3. These can
als empty into the <>ile duct in the portal area</></div><div><><r /></></
div><div>4. Bile ducts form <>right and left hepatic ducts</> and <>join the
cystic duct</>&nsp;to form the <>common ile duct</></div><div><><r /></>
</div><div>5. Common ile duct enters the duodenum at the <>ampulla of Vater </
>across the <>sphincter of Oddi.</></div>
Liver
"<img src=""paste-19881403613676.jpg"" /><div><r /><div><img src=""paste-199243
53286636.jpg"" /></div><div><r /></div><div>1. Whats the cell type indicated i
n these 2 pics?</div><div><r /></div></div><div>2. What is its cellular origin?
Give all of the cells of this origin that we know.</div><div><r /></div><div>3
. What are its 2 functions?</div>"
1. Kupffer cell<div><r /></div><div>2.
Monocyte origin.</div><div>There are 11:</div><div><>1. Macrophage</><r /><>
2. PC/Follicular dendritic cells</>: lymphoid organs<r /><>3. Langerhans</>
&nsp;cell: skin<r /><>4. Osteoclast</>: one<r /><>5. Microglia</>: CNS<
r /><>6. Perivascular macrophage</>: CNS<r /><>7. lveolar macrophage</>: l
ung<r /><>8. Mesangial cell</>: kidney<r /><>9. Type B synoviocyte</>: joi
nts</div><div><>10. Kupffer cell</>: liver</div><div><>11. Ito cell</>: live
r</div><div><r /></div><div>3. a. Synthesizes 5% of plasma protein</div><div>.
Degrade aged erythrocytes and convert hemogloin to iliruin</div><div><r /><
/div> Liver
Gallladder:<div><r /></div><div>1. What morphological structure is unique to t
he gallladder?</div><div><r /></div><div>2. What is the function of this struc
ture?</div><div><r /></div><div>3. What pathology occurs in this structure?</di
v><div>Most often to what (entertaining) demographic?</div>
1. <>Spiral val
ves of Heister</><div><><r /></></div><div>2. To <>concentrate ile</></di
v><div><r /></div><div>3.<> Bile stones</>.&nsp;</div><div>Most common in th
e 4 Fs:</div><div>Fat</div><div>Fertile</div><div>Forty-year-old</div><div>Fema
les</div>
Liver
"Canals of Hering:<div><r /></div><div><img src=""paste-3418793968156.jpg"" /><
r /><div><r /></div><div>1. nnotate this figure.</div><div><r /></div><div>2
. Classify the epithelium.</div><div><r /></div><div>2. What hormone do these e
pithelial cells respond to? How?</div></div>" "<div>1.&nsp;<img src=""paste-3
723736646172.jpg"" /></div><div><r /></div>2. <>Simple cuoidal epithelium</>
of cells called <>cholangiocytes</>.<div><r /></div><div>3. <>Secretin</>
triggers <>icaronate</> secretion.</div>" Liver
Liver stem cells:<div><r /></div><div>1. What are they called?</div><div><r />
</div><div>2. Where are they found?</div><div><r /></div><div>3. What induces m
itotic activity in these cells? What is this process called?</div>
1. <>Ov
al cells</><div><r /></div><div>2. Mostly where the <>hepatocyte plates touch
the terminal plates of hepatocytes around the space of Moll</> where ile cana
liculi ecome the canals of Hering with cholangiocytes.</div><div><r /></div><d
iv>3. <>Compensatory hyperplasia</>: Extensive damage to hepatocytes causes re
lease of <>chalones</> and communication through <>gap junctions </>to incre
ase mitotic rates.</div>
Liver
"<img src=""paste-4964982194668.jpg"" /><div><r /></div><div>1. Identify each v
essel in the liver.</div><div><r /></div><div>2. Give the 3 names of the green
vessel.</div>" "<div>1.&nsp;<img src=""paste-5269924872687.jpg"" /></div><div>
<r /></div>2. Collecting/central/hepatic venule"
Liver
Give the 8 symptoms associated with the chronic alcoholic.
1. Pale stools t

hat float<div>2. Jaundice</div><div>3. Macocytic anemia</div><div>4. Vitamin ,

D, E, and K deficiencies</div><div>5. Torrential esophageal leeding and vomitin
g</div><div>6. Gastric ulcers</div><div>7. Digestive enzyme insufficiencies</div
><div>8. Bacterial overgrowth in the stomach</div>
Liver
Give the endocrine and exocrine functions of the liver.<div><r /></div><div>Whi
ch other organ has oth exocrine and endocrine functions?</div> 1. Endocrine: l
ood plasma proteins synthesized on the hepatocyte RER.<div><r /><div>Exocrine:
ile salts, cholesterol, iliruin glucuronate, and icaronate secretion.<r />
<div><r /></div><div>2. Pancreas</div></div></div>
Liver
Give the 6 multinucleated cells in the human ody.
1. Skeletal myofier<div
>2. Cardiac myofier</div><div>3. Osteoclast</div><div>4. Urothelium</div><div>5
. Hepatocyte</div><div>6. Syncytiotropholast</div>
Liver
Give the 3 polyploid cells in the ody. 1. Megakaryocyte<div>2. Urothelium</div>
<div>3. Hepatocyte</div>
Liver
Give the 2 cell types in the ody that are oth multinucleate and polyploid.
Urothelium and hepatocyte
Liver
Contrast an intact and damaged mucosal arrier. "<img src=""paste-22424024253232
.jpg"" /><div><r /></div><div>VERSUS</div><div><r /></div><div><img src=""past
e-22436909155120.jpg"" /></div>"
GutSecretionsI
How can aspirin give you stomach prolems?<div><r /></div><div>How can this eff
ect e mitigated?</div> COX1 and 2 inhiitors like aspirin inhiit synthesis of
PGE2 and PGI2, which normally maintain the gastric mucosal arrier.<div><r /></
div><div>Mitigation: enterically coated pills so the aspirin doesnt dissolve in
the stomach. However, will still see a systemic effect.</div> GutSecretionsI
What is the capsule called that covers the liver?
Glissons capsule
Liver
What does the liver recieve lood from? 80%: nutrient rich lood via the portal
vein from the intestine<div>20%: oxygen rich via the hepatic artery of the adom
inal aorta</div>
Liver
What is found at the apices of the classic liver loule? t the center? pices:
six portal canals each containing a triad of a portal venule, hepatic arteriole,
and a ile duct<div>Center: collecting venule</div>
Liver
What is contained within the space of Moll?
Portal venule, hepatic arteriole
, ile duct, lymphatic vessel, and unmyelinated nerves Liver
Descrie the endothelial cells which make up the sinusoids in the liver.
Discontinuous (lateral plasma memrane do not interact and have no junctional co
mplexes) fenestrated with no diaphragms and have no asal lamina
Liver
What is the space of Disse? What is found here? It is the space etween the sinu
soidal endothelium and the hepatocytes<div>Filled with the microvilli of hepatoc
ytes and trace reticular fiers</div> Liver
What are the stem cells of the liver? Where are they found?
Oval cells<div>E
nriched where the hepatocyte plates touch the terminal plates of hepatocytes</di
v>
Liver
What is the function of Ito cells?
store fat solule vitamins (KDE) in cha
rge of migration of new cells from ito cells and are also pivotal in organizing
hepatocytes into radial spokes with organized sinusoids Liver
Name the five morphological features that increase the interaction etween the h
epatocyte microvilli and the sinusoidal lood. <div>(1) gaps etween the discon
tinuous endothelial cells&nsp;</div><div>(2) &nsp;endothelial fenestra arrange
d into extensive sieve plates</div><div>(3) no diaphragms.&nsp;</div><div>(4) n
o asal lamina (terrile error in Junq on page 288 where the asal lamina is sai
d to e discontinuous. &nsp;This is asolutely NOT true in the human.)&nsp;</d
iv><div>(5) &nsp;Ito cells aka lipocytes (monocyte origin) and firolasts secr
eting the reticular scaffolding in the space of Disse are scarce and do not form
a arrier.</div><div><r /></div>
Liver
List the five sites in the liver where there is connective tissue proliferation
in cirrhosis
"<div>1.<span class=""pple-ta-span"" style=""white-space:pre""
> </span>round the periphery of the classic liver loule&nsp;</div><div>2.<spa
n class=""pple-ta-span"" style=""white-space:pre""> </span>Within the space of
Disse oliterating Ito cells which store vitamins (the vitamin deficiency of al

coholics) and the interaction of hepatocyte microvilli with sinusoidal lood (ja
undice)</div><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </
span>round the ile duct in the portal space</div><div>4.<span class=""pple-ta
-span"" style=""white-space:pre""> </span>Oliteration of the space of Moll</di
v><div>5.<span class=""pple-ta-span"" style=""white-space:pre""> </span>round
the central (collecting or hepatic) vein (venule) oliterating hepatic lood fl
ow creating portal hypertension &nsp;</div><div><r /></div>" Liver
What is the life span of a hepatocyte? 150 days
Liver
What is the origin of Kupffer cells? What is their function?
"Monocyte origin
<div><div>Functions:</div><div><span class=""pple-ta-span"" style=""white-space
:pre""> </span>Fixed macrophages with no permanent attachments to the endothelia
l cells of the liver sinusoids or to the microvilli of hepatocytes&nsp;</div><d
iv><span class=""pple-ta-span"" style=""white-space:pre""> </span>5% of the pro
tein exported y the liver (plasma proteins) is synthesized y Kupffer cell&nsp
;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span>They
can also degrade aged erythrocytes and degrade hemogloin to iliruin which is
taken up y hepatocytes and converted to iliruin glucuronide&nsp;</div><div>
<r /></div></div>"
Liver
Central vein aka ____ aka _____ collecting vein; hepatic vein Liver
How can you distinguish hepatic arteriole from portal vein from ile duct in LM?
"<div><span class=""pple-ta-span"" style=""white-space:pre""> </span>Hepatic ar
teriole: endothelial cell with smooth muscle around it</div><div><span class=""p
ple-ta-span"" style=""white-space:pre""> </span>Portal vein (venule): thin wall
ed structure</div><div><span class=""pple-ta-span"" style=""white-space:pre"">
</span>Bile duct: cuoidaly lined with distinct connective tissue sheath around
it</div><div><img src=""paste-57243324121089.jpg"" /></div>"
Liver
re lymphatics normally seen? No, only seen when there is cancer of the liver
(characteristic of hepatatis C) Liver
What is the wall around the portal triad made up of? What is it called? Wall of
hepatocytes surround the portal triad. Called the terminal plate of hepatocytes
Liver
Hepatocytes are very homogenous/heterogenous. Heterogenous (they are exposed t
o different environments)<div>You have periloular (close to the portal space) a
nd centroloular hepatocytes (close to the central vein)</div> Liver
List all multinucleated cells. Skeletal muscle<div>Cardiac muscle</div><div>Ost
eoclast</div><div>Urothelial cell</div><div>Hepatocyte</div>
Lists
T/F: Hepatocytes ecome more and more inucleate and polyploid as you age
True
Lists
"<img src=""paste-59176059404289.jpg"" /><div>Identify the nuclei in the white s
paces</div>"
Kupffer cells Lists
Name the three major sites monitoring RBCs
spleen, kupffer cells in the liv
er, one marrow in the erythrolastic islands Lists
What is the intermediate filament of hepatocytes?
Cytokeratin
Liver
Which cells can e found within the space of Disse?
Ito cells and trace fir
olasts&nsp; Liver
Descrie the intercalated ducts and striated ducts of the salivary glands. Which
comes first? Is this interloular or intraloular duct system? Intercalated (si
mple cuoidal w/ myoepithelial cells around them) -&gt; striated (simple columna
r; eosinophilic)<div>Intraloular</div> Liver
Descrie the interloular duct system in salivary glands
<div>Interloula
r ducts are lined y stratified epithelium - stratified cuoidal to stratified c
olumnar to stratified</div><div>nonkeratinized squamous as the duct approaches t
he oral cavity. Patches of simple columnar ciliated epithelium are found where t
he largest of</div><div>the interloular ducts (excretory ducts) dump into the o
ral cavity at the frenulum. Such ciliated cells are important in generating curr
ents which</div><div>wash invading acteria ack into the oral cavity.</div>
Liver
Descrie the three types of salivary glands.&nsp;<div>Where are they located?</
div><div>What do they secrete?</div><div>What percentage of total saliva do they
secrete?</div> Parotid: near second molar; mainly serous; 25%<div>Sumandiular

: near frenulum; mixed serous and mucous; 70%</div><div>Sulingual: near frenulu

m; mainly mucous; 5%</div>
Liver
Name the GLT components of saliva.
<div> Muramidase: Gram pos</div><div> Lyso
zyme: Gram neg</div><div> Lactoferrin: ind iron</div><div> sIg-sc:  for aggluti
nate, secreted y all epithelial cells of salivon, dimeric Ig w/ secretory comp
onent (SC) that prevents degradation</div>
Liver
What is the function of aquired pellicle protein?
Protect your teeth
Liver
Descrie the final saliva composition. <div>- Hypotonic (after modification y
striated duct)</div><div>- High in K, HCO3, Ca (secreted)</div><div>- Low in Na,
Cl (reasored)</div><div>- Modulated y aldosterone &amp; flow rate</div>
Liver
What is the function of kallikrein?
- Kallikrein: asally secreted, converts
kininogen (hepatocyte) to radykinin (potent vasodilator &amp; increased capill
ary permeaility)
Liver
Which region of salivary glands are most susceptile to cancer? <div>- cinar ce
lls are in Go</div><div>- Ducts (intra &amp; inter) are mitotic &amp; more susce
ptile to cancers</div> Liver
Where are intercellular canaliculi found? What is there function?
On serou
s cells of salivary glands<div>Increase surface area for secretion</div>
Liver
List the 3 cells with asal infoldings on TEM PCT, DCT, striated duct of saliv
ary glands
Lists
What type of endothelial cells are found within islets of Langerhans? Continuo
us fenestrated with diaphragms Pancreas
Which cells are found within islets of Langerhans?
<div>alpha-cells (glucag
on), eta-cells (insulin), D-cells</div><div>(somatostatin), D1-cells (VIP), and
F-cells (pancreatic polypeptide).</div>
Pancreas
re there striated ducts in the pancreas? Why or why not?
<div>No striated
component ecause pancreatic juice is&nsp;isotonic.</div>
Pancreas
What type of epithelium makes up the intraloular ducts in the pancreas? Interlo
ular? Intraloular: simple cuoidal<div>Interloular: simple columnar</div>
Pancreas
What is the function of pacinian corpuscles in the pancreas?
monitor the inte
nsity of the icaronate wash Pancreas
Does the pancreas contain myoepithelial cells? Why or why not? No since the ic
aronate wash is strong enough to flush out the contents of the lumen Pancreas
Descrie pancreatic acinar cells on TEM.
" Basophilic, asal nucleus, apic
al zymogen granules<div><img src=""paste-7069516169217.jpg"" /></div>" Pancreas
Name the enzymes secreted y the pancreas.
<div>ctive enzymes:</div><div>lpha amylase</div><div>- DNase</div><div>- RNse</div><div><r /></div><div>In
active enzymes:</div><div>- Proteases: trypsinogen, chymotrypsinogen, proelastas
e, procaroxypeptidase  &amp; B, proaminopeptidase</div><div>- Lipases: procoli
pase, prophospholipase, procholesterol esterase</div> Pancreas
Descrie centroacinar cells
"<div>- Continuation of intercalated duct that "
"dips"" into the acinar cells</div><div>- Secrete HCO3 to wash away dangerous lu
menal content SP</div><div>- Stimulated y secretin &amp; Pacinian corpuscle (
stim y PS, inh y S)</div><div><img src=""paste-8186207666177.jpg"" /></div>"
Pancreas
Which region of the pancreas is more susceptile to cancer?
Ducts since they
are mitotic (acinar cells are in G0) Pancreas
Where do the lood vessels go after leaving the Islets of Langerhans? fferent
lood vessels first enter islets then travel to exocrine pancreas
Pancreas
What is characteristic aout interloular ducts of the pancreas?
"<div>Su
rrounded y lots of connective tissue</div><img src=""paste-8787503087617.jpg""
/>"
Pancreas
Which cell secretes pancreatic polypeptide? What is the function of this hormone
?
F cells in the Islets of Langerhans in the pancreas<div>Inhiits CCK and
secretin</div> Pancreas
What percentage of the total pancreas is made up of islets of Langerhans?

1.5%
Pancreas
What type of endothelial cells surround the exocrine pancreas? Continuous nonfe
nestrated
Pancreas
Where are alpha cells found within the islet? Beta cells?
"<div><span class
=""pple-ta-span"" style=""white-space:pre""> </span>Each cell type has its uni
que spatial distriution within the islet (alpha cells are mostly in the periphe
ry, eta cells are more central). &nsp;</div><div><r /></div>"
Pancreas
Which cell(s) secrete the digestive enzymes of the pancreas?
<div>cinar cell
s secrete the sum total of all the digestive enzymes that empty into the duodenu
m at the ampulla of Vater across the sphincter of Oddi&nsp;</div><div><r /></d
iv>
Pancreas
Descrie all of the enzymes secreted y the pancreas
"<img src=""paste-106429
28959489.jpg"" />"
Pancreas
List the three major causes of familial pre-disposition to pancreatitis.
"<div>1.<span class=""pple-ta-span"" style=""white-space:pre""> </span> mutat
ion in trypsinogen called cationic trypsinogen which increases its proaility o
f spontaneous activation in the asence of enteropeptidase.</div><div>2.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span> mutation in SPINK I w
hich inhiits its inding to trypsinogen and allows it to spontaneously activate
in the asence of enteropeptidase.&nsp;</div><div>3.<span class=""pple-ta-sp
an"" style=""white-space:pre""> </span> mutation in the CFTR gene so that the c
hloride channel does not work and there is a reduced icaronate wash, thick vis
cous mucus, and locked pancreatic ducts with mucus plugs and protein aggregates
that can self-destroy the pancreas. &nsp;</div><div><r /></div>"
Pancreas
Descrie the zymogen concentration in acinar cells of the pancreas efore and af
ter meals
"<div><span class=""pple-ta-span"" style=""white-space:pre""> <
/span>Prior to a meal, the acinar cells have tons of apical zymogen granules, u
t after a meal, the zymogen granule concentration decreases ecause of exocytosi
s of the digestive enzymes into the lumen (regulated merocrine exocrine secretio
n) triggered y CCK and acetylcholine.&nsp;</div><div><r /></div>"
Pancreas
Descrie the central lumen of the pancreatic ducts.
"<div><span class=""pple
-ta-span"" style=""white-space:pre""> </span>The size of the central lumen depe
nds on activity of the organ: the lumen is large when the acinar cells are activ
ely secreting, and it is small in the fasting state.&nsp;</div><div><r /></div
>"
Pancreas
How tight are the tight junctions in the pancreas? re they apical or asal?
"<div><span class=""pple-ta-span"" style=""white-space:pre""> </span>By TEM, th
e tight junctions are very very tight and are in a typical apical position adjac
ent to the lumen ecause you would never want the potentially active digestive e
nzymes to have access to the intercellular space for self-digestion. (loosening
of these tight junctions is another cause of acute pancreatitis) &nsp;&nsp;</d
iv><div><r /></div>" Pancreas
re there centroacinar cells in salivary glands? Why or why not?
There is
no such parallel centroacinar cells in the salivary glands ecause the salivary
enzymes are not as caustic as the pancreatic zymogens (amylase, acquired pellic
le protein, lactoferrin, lysozyme, and muramidase).&nsp;
Pancreas
What is found in the connective tissue around the interloular ducts of the panc
reas? <div>The interloular ducts are simple columnar cells surrounded y conn
ective tissue. &nsp;The interloular ducts have some golet cells for protectio
n against the digestive enzymes (even though they are supposed to e in an inact
ive form), there are some enteroendocrine cells (the concept of GEPP), and the l
arger interloular ducts even have some mucous glands in the surrounding connect
ive tissue.&nsp;</div><div><r /></div>
Pancreas
How does CCK trigger the release of zymogen granules from acinar cells in the pa
ncreas? CCK amplifies the effects of acetylcholine on the M3 muscarinic receptor
s.&nsp;
Pancreas
"Pancreatic polypeptide is antagonistic to <font color=""#FF0000"">_____</font>
while somatostatin is antagonistic to <font color=""#FF0000"">______</font>"
"Pancreatic polypeptide is antagonistic to <font color=""#FF0000"">CCK</font> wh
ile somatostatin is antagonistic to <font color=""#FF0000"">CCK, secretin, and 

ch</font>"
Pancreas
What causes Kwashiokor? What are the effects? <div>World wide malnutrition, st
arvation, and low caloric intake produces Kwashiokor which also results in atrop
hy of the pancreatic acinar cells which massively reduces the production of panc
reatic digestion enzymes which further diminishes digestion and ultimate asorpt
ion.&nsp;</div><div><r /></div>
Pancreas
People with celiac disease (gluten enteropathy) cannot ingest ____
no wheat
, rye, arley Pancreas
Does the intraloular duct system of the pancreas have CT around it? Interloula
r?
Intraloular: NO<div>Interloular: Yes</div>
Pancreas
Whats the root cause of pancreatitis?<div><r /></div><div>What are 4 pathologi
cal consequences of it?</div> Digestive enzymes activating in acinar cells<div
><r /></div><div>1. utodigestion</div><div>2. Inflammatory mediators</div><div
>3. Ischemia</div><div>4. Secondary infection</div>
Liver
What are 3 reasons why acid gastric chyme needs to e neutralized?
1. So pa
ncreatic enzymes can operate at their optimal pHs.<div><r /></div><div>2. To p
revent damage to the duodenal mucosa</div><div><r /></div><div>3. To favor ile
salt soluility</div> Liver
1. Give the tonicity of ile.<div><r /></div><div>2. Name as many of the 10 mai
n components of ile as you can.</div> <div>1. Isotonic</div><r /><div>2. a. I
norganic electrolytes</div><div>. Bile acids</div><div>c. Lecithin a.k.a. phosp
hatidylcholine (a phospholipid)</div><div>d. Cholesterol</div><div>e. Biliruin
glucuronide conjugates</div><div>f. lumin</div><div>g. sIg</div><div>h. Mucin
s</div><div>i. Detoxified xenoiotics</div><div>j. Hormones</div>
GutSecre
tionsIVessential
1. How does ile formation start? Dont give the stimulus, just the mechanism.<d
iv><r /></div><div>2. What are the 2 susequent points of modification of ile?
Descrie the 2 changes that happen in each.</div>
1. ctive secretion of 
ile salts and other organic anions from hepatocytes into iliary canaliculi.<div
><r /></div><div>2. . <>Cholangiocyte</> modification:</div><div>i. <>Reas
or</> some ile salts</div><div>ii. Secrete icaronate to <>alkalinize</> t
he ile</div><div><r /></div><div>B. Gallladder modification:</div><div>i. s
orption of water and electrolytes to <>concentrate</> the ile</div><div>ii. E
xchange of Na for H to <>acidify</> the ile</div>
GutSecretionsIVessential
1. When is ile flow the greatest?<div><r /></div><div>2. Name the 6 positive c
ontrols on ile secretion. State whether each contriutes to canalicular ile fo
rmation, ductular icaronate secretion, or oth.</div><div><r /></div><div>3.
Name the negative control for oth canalicular ile formation and ductular icar
onate secretion.</div> 1. <>During and shortly after eating</> (a.k.a. eginn
ing of the postprandial period)<div><r /></div><div>2. <u>Canalicular ile form
ation</u>:</div><div>a. <>Rate at which ile salts recirculate</> from the int
estine via the enterohepatic circulation</div><div>. <>Vagal stimulation</> (
weak)</div><div>c. <>Cholecystokinin</> (weak)</div><div>d. <>Gastrin</> (we
ak)</div><div><r /></div><div><u>Ductular icaronate secretion:</u></div><div>
e. <>Secretin</></div><div><u>Both ile and icaronate:</u></div><div>f. <>G
lucagon</>: moderately increases oth</div><div><r /></div><div>3. <>Somatost
atin</>&nsp;inhiits oth processes.</div>
GutSecretionsIVessential
1. What are the 2 primary ile salts?<div><r /></div><div>2. How are they modif
ied efore secretion into the ile?</div><div><r /></div><div>3. What ecomes o
f them after secretion into the duodenum? (2 fates and their consequences)</div>
1. <>Cholic acid</> and <>chenodeoxycholic acid</><div><r /></div><div>2. C
onjugated to <>glycine</> or <>taurine</></div><div><r /></div><div>3. a. M
ost:&nsp;<>reasored in the distal ileum </>and returned to the liver via th
e <>enterohepatic circulation</></div><div><><r /></></div><div>. Small am
ount: anaeroic ileocolonic acteria deconjugate and dehydroxylate cholic acid t
o deoxycholate and chenodeoxycholic acid to lithocholate.</div><div><r /></div>
<div><>Deoxycholate</>: <u>readily</u> asored; <u>keeps circulating</u></div
><div><>Lithocholate</>: <u>poorly</u> asored. The small amount that is take
n up goes to the liver, gets re-conjugated, re-secreted, and then is <u>lost in
the feces.</u></div>
GutSecretionsIVessential

1. What % of ile salts undergo enterohepatic circulation?<div><r /></div><div>

2. What kind of transporter mediates ile salt reasorption?</div><div><r /></d
iv><div>3. How many times are ile salts recirculated per day?</div><div><r /><
/div><div>4. a. How ig is the normal total ody pool of ile salts?</div><div>
. How much is lost in feces per day?</div><div>c. Then how dont we gradually lo
se ile salts over time?</div> 1. <>95%</><div><r /></div><div>2. <>TP-dep
endent </>intestinal ile acid transporter in the apical memrane of ileal ente
rocytes</div><div><r /></div><div>3. <>6-10x</>, especially during meals</div
><div><r /></div><div>4. a. <>6</> millimoles</div><div>. <>0.4-1.2</> mil
limoles</div><div>c. Rate of liver ile salt <>synthesis</> = rate of fecal <
>loss</></div> GutSecretionsIVessential
Is ile that goes into the duodenum all from the gallladder? No, its a <>mi
x</> of<> diluted hepatic</> ile and <>concentrated gallladder</> ile.
GutSecretionsIV
Define the sphincter of Oddi and its relationship to the ampulla of Vater.
<u>Definition</u>: The <>smooth circular muscle</> surrounding the end of the
common ile duct (<>iliary sphincter</>) and main pancreatic duct (<>pancrea
tic sphincter</>) <><u>fuse</u></> at the level of the ampulla of Vater to e
come the sphincter of Oddi.<div><r /></div><div>Relationship: Sphincter of Oddi
<>relaxes and contracts</> to change the dimensions of the ampulla of Vater.<
/div> GutSecretionsIV
Run through the synthesis pathway of the two most common ile salts.<div>Be sure
to:</div><div>1. Distinguish etween ile acids and ile salts.</div><div>2. Pr
ovide where each synthetic step occurs.</div><div>3. Give the rate-limiting step
in this synthesis.</div><div>4. Gie the % aundance of each of teh two ile sal
ts.</div>
"1 and 2.&nsp;<img src=""paste-30210799960597.jpg"" /><div><r
/></div><div>3. 7-alpha hydroxylase reaction</div><div><r /></div><div>4. Choli
c acid: 31%</div><div>Chenodeoxycholic acid: 45%</div>" GutSecretionsIV
Give the 4 stops that ile salts encounter along the enterohepatic circulation.
"1. Liver&nsp;<div>2. Gallladder&nsp;</div><div>3. Intestines&nsp;</div><div
>4. Portal venous system</div><div><r /></div><div><img src=""paste-31735513350
649.jpg"" /></div>"
GutSecretionsIV
Contrast the uptake mechanisms of ile acids conjugated to glycine/taurine vs. u
nconjugated ones.
"Conjugated: <>Secondary active transport coupled to Na
uptake</><div><r /></div><div>Unconjugated: <>Diffusion</> (doesnt say whe
ther simple or facilitated...)</div><div><r /></div><div><img src=""paste-32018
981191973.jpg"" /></div>"
GutSecretionsIV
Give the 5 functions of ile acids.
1. <>Emulsify TGs</> to make them acc
essile to pancreatic lipases<div>2. Faciliate asorption of <>fat-solule vita
mins</> (, D, E, and K)</div><div>3. <>Soluilize gallladder cholestero</>l
--&gt;prevent gallstones</div><div>4. Excretion is the odys only significant m
echanism of <>excess&nsp;cholesterol elimination</>.</div><div>5. ct like <
>steroid</>&nsp;<>hormones</>: ind to the FRX nuclear receptor to provide n
egative feedack on their own synthesis</div> GutSecretionsIV
Run through the ion channels involved in icaronate secretion in cholangiocytes
.
"<img src=""paste-33380485825070.jpg"" />"
GutSecretionsIV
Give CCKs two effects on ile secretion.
"<img src=""paste-33479270072661
.jpg"" /><div><r /></div><div><>Via effects on parasympathetic efferents</></
div>" GutSecretionsIV
Go through the control of gallladder contraction in the fasting state. Provide
<>mechanisms, timing, and extent of emptying</>&nsp;where appropriate.<div><
r /></div><div>Do the same for the fed state.</div>
<u><>Fasting</></u><di
v>Mechanism: <>Motilin</> acts on <>vagal cholinergic nerves</></div><div>Ex
tent of emptying: <>25%</></div><div>Timing: <>every 120 minutes</></div><di
v><r /></div><div><u><>Eating</></u></div><div>Total extent of emptying for a
ll 3 phases: <>75%</></div><div><><r /></></div><div><u>1. Cephalic phase</
u>:&nsp;</div><div>Mechanism: <>Vagal</>&nsp;</div><div>Extent of emptying:
<>15-25%</></div><div><r /></div><div><u>2. Gastric phase</u>:</div><div>Mech
anism: <>gastroduodenal reflex </>mediated y stomach <>distention</></div><
div><><r /></></div><div><u>3. Intestinal phase</u>:</div><div>Mechanism: CCK

(hormonal)</div>
GutSecretionsIV
How does sympathetic stimulation affect ile secretion? Relaxes the gallladder
to inhiit ile secretion
GutSecretionsIV
What are the 2 main types of gallstones? What is each made of? 1. <>Cholestero
l stones</>: yellow-green, make up 80% of stones<div><r /></div><div>2. <>Pig
ment stones</>: smaller, darker, made of <>iliruin</></div>
GutSecre
tionsIV
What are the 8 risk factors for getting gallstones?
"<img src=""paste-358715
66856901.jpg"" /><div><r /></div><div>Mnemonic: C DOG SWER</div><div><r /></d
iv><div>Cholesterol</div><div><r /></div><div>Diaetes</div><div>Oesity</div><
div>Genetics</div><div><r /></div><div>Sex (gender; more common in women)</div>
<div>Weight loss (rapid)</div><div>Estrogen (high levels; pregancy)</div><div>g
e (older)</div><div>Race (Native mericans, Mexicans)</div>"
GutSecretionsIV
What are the 2 techniques used to treat gallstones?<div><r />Briefly descrie e
ach.</div><div><r /></div><div>Give the relative frequency that each is adminis
trated.</div><div><r /></div><div>How many nights in the hospital does the pati
ent spend for each?</div>
"1.&nsp;<>Laparoscopic cholecystectomy </>(<
>80</>%): Instruments, light, and a camera passed into small adominal incision
s. <>One</> night in the hospital.<div><r /></div><div>2. <>Open cholecystec
tomy</>&nsp;(<>20</>%): Bigger incisions into the adomen to directly remove
the gallladder. <>Several</> nights in the hospital.</div><div><r /></div><
div><img src=""paste-37538014167288.jpg"" /></div>"
GutSecretionsIV
What is the main effect of gallladder removal? Bile released y liver in a cont
inuous, slow trickle.<div><r /></div><div>So, with a high-fat meal, get:</div><
div><r /></div><div>1. <>Diarrhea</> (osmotic pull of fat)</div><div>2. <>Bl
oating</> (acteria metaolize fat, producing gas)</div>
GutSecretionsIV
"Fill in this tale.<div><r /></div><div><img src=""paste-41051297415708.jpg""
/></div>"
"<img src=""paste-41064182317872.jpg"" />"
StatisticsII
"Fill in this ox.<div><r /></div><div><img src=""paste-41111426957852.jpg"" />
</div>" "<img src=""paste-41132901794608.jpg"" />"
StatisticsII
T or F: all statistical tests follow normal distriutions.
False; statistic
s follow <>known</> distriutions, ut these need not e a normal distriution
StatisticsII
"Fill in the oxes.<div><r /></div><div><img src=""paste-41553808589340.jpg"" /
></div>"
"<img src=""paste-41669772706332.jpg"" />"
StatisticsII
State a null hypothesis aout two treatment groups.<div><r /></div><div>State a
n alternative/research hypothesis aout the same two groups.</div>
Null hyp
othesis: there are <>no differences</> in the outcomes of the two groups.<div>
<r /></div><div>There <>are differences</> in the outcomes of the two treatme
nt groups.</div>
StatisticsII
Logic of hypothesis testing:<div><r /></div><div>We oserve a difference in the
outcomes of 2 treatment groups.&nsp;</div><div><r /></div><div>1. What do we
do to determine how likely it is that this difference occurred y chance alone?<
/div><div><r /></div><div>2. How do we interpret what we did?</div>
1. Conve
rt the data to a statistic and determine the proaility of the statistic. ll s
tatistics are computed assuming the null hypothesis is true.<div><r /></div><di
v>2. If the value indicates the difference etween groups has a high proaility
of occurring from chance alone, we accept the null hypothesis that theres no d
ifference etween the groups.&nsp;</div><div><r /></div><div>Conversely, we re
ject the null hypothesis that the differences are due to chance alone if we ota
in a low proaility value from the statistic.</div>
StatisticsII
What are the two common standards for p-values? In medical literature, p &lt; .<
>05</> or p &lt; .<>01</> StatisticsII
"Fill in the oxes.<div><r /></div><div><img src=""paste-42876658516508.jpg"" /
></div>"
"<img src=""paste-43039867273756.jpg"" />"
StatisticsII
What are the usual choices for alpha and eta in the following situations?<div><
r /></div><div>1. Common choices</div><div>2. Exploratory study</div><div>3. Co
nfirmatory study</div> 1. Common: a = <>5</>%;  = <>20</>%<div><r /></div
><div>2. Exploratory: a = <>10</>%;  = <>10</>%</div><div><r /></div><div>
3. Confirmatory: a = <>1</>%;  = <>10</>%</div>
StatisticsII

Small p values do indicate significant differences etween treatment groups, ut

what dont they indicate?
The <>size</> of that effect.<div><r /></div>
<div>So, you can otain a very small, ut statistically significant effect.</div
>
StatisticsII
Planning a study:<div><r /></div><div>1. What are the two statistical analyses
you should do efore running any study?</div><div><r /></div><div>2. Define eac
h.</div>
1. <>Sample size calculations</>: estimates the numer of pati
ents needed to accomplish study goals.<div><r /></div><div>2. <>Power analysis
</>: estimates the aility to detect specified differences etween groups given
a particular sample size.</div>
StatisticsII
Reporting a study:<div><r /></div><div>1. What 3 pieces of data should you repo
rt along with any statistically computed numer?</div><div><r /></div><div>Defi
ne each.</div> 1. a. <>Point estimate</>: a sample value like a mean<div><r
/><div>. <>Confidence interval</>: the interval over which youre 95% certain
the true population value lies.</div><div><r /></div><div>c. <>p-value</>: 
measure of the likelihood that the oserved differences in etween treatment gr
oup(s) are due solely to chance.</div></div>
StatisticsII
1. Contrast internal and external validity.<div><r /></div><div>2. What two wor
ds should make you think of a threat to external validity, rather than to intern
al validity?</div>
"1.&nsp;<u>Internal validity</u>:  property of scienti
fic studies which reflects <>the extent to which a causal conclusion ased on a
study is warranted</>. Such warrant is constituted y the extent to which a st
udy <>minimizes systematic error</>.<div><r /></div><div><u>External validity
</u>: <>The extent to which the results of a study can e generalized to other
situations and to other people</>.</div><div><r /></div><div>2. Threats to ext
ernal validity: ""<>Treatment</>"", ""<>Sensitization</>"".</div><div><r />
</div><div><img src=""paste-45702746997552.jpg"" /></div>"
StatisticsII
What happens to acid and mucus secretion...<div><r /></div><div>1. Between meal
s</div><div>2. fter meals</div><div><r /></div><div>3. Name a regulator of #1.
</div><div><r /></div><div>4. Name an inhiitor of #3 and give its effect on ac
id and mucus secretion.</div> 1. cid <>down</>, mucus <>up</><div><r /><
/div><div>2. cid <>up</>, mucus <>down</></div><div><r /></div><div>3. <>
Prostaglandin E2</> decreases acid and increases mucus.</div><div><r /></div><
div>4. <>spirin</> and other NSIDs lock PGE2 and thus increase acid and dec
rease mucus.</div>
GIDrugs
You are in the ER and realize the patient has hyperkalemia (K &gt; 6 mM). Normal
K levels are 3.5-5 mM.<div><r /></div><div>You decide to lower serum K levels
to normal. Your choice will e an infusion of an IV solution containing:</div><d
iv><r /></div><div>. Saline and glucose</div><div>B. Insulin</div><div>C. Sali
ne with icaronate</div><div>D. Insulin and glucose</div><div>E. Epinephrine an
d glucose</div> <>D. Insulin and glucose</><div><r /></div><div>Insulin stimu
lates uptake of more than just glucose--K too. Have to counteract its lowering p
lasma glucose y adding glucose.</div><div><r /></div><div>Epinephrine is also
used to lower plasma K. But E isnt right ecause epinephrine increases glucose
levels on its own. dding glucose to it would risk hyperglycemia.</div> GIDrugs
What negative symptom can hypokalemia lead to?<div><r /></div><div>What aout h
yperkalemia?</div>
Both can lead to <>cardiac arrhythmias</>.
GIDrugs
 diaetic patient who is on insulin therapy is feeling dizzy and faints due to
hypoglycemia.<div>Injection of which hormone (drug) will help?</div><div><r /><
/div><div>. Glucagon</div><div>B. Insulin</div><div>C. Gastrin<r />D. Cortisol
</div><div>E. CCK</div> <>. Glucagon</><div><r /></div><div>Glucagon promote
s glycogenolysis and gluconeogenesis.</div>
GIDrugs
In which of the following conditions would aspirin e contraindicated?<div><r /
></div><div>. Myalgia<div>B. Fever</div><div>C. Rheumatoid arthritis</div><div>
D. Peptic ulcer</div><div>E. Unstale angina</div></div>
D. Peptic ulcer<
div><r /></div><div>spirin inhiits PGE2 synthesis. PGE2 decreases acid secret
ion and increases mucus secretion.</div>
GIDrugs
Of the following drugs, which will inhiit acid secretion y parietal cells?<div
><r /></div><div>. cetylcholine<div>B. Muscarine</div><div>C. Gastrin</div><d
iv>D. Histamine</div><div>E. Somatostain</div></div><div><r /></div><div>Which

other hormone not given in these choices will do the same thing?</div> <>E. So
matostatin<r /></><div><r /></div><div><>PGE2</> also</div>
GIDrugs
Name 4 factors that contriute to higher incidence of stomach ulcers. 1. Genet
ic<div>2. Stress</div><div>3. NSIDs</div><div>4. Bacteria (H. pylori)</div>
GIDrugs
"Which of these oxes depicts etween meals? Which after meals?<div><r /></div>
<div><img src=""paste-949187772823.jpg"" /></div>"
"<img src=""paste-970662
609286.jpg"" />"
GIDrugs
1. What are antacids?<div><r /></div><div>2. Whats the difference etween syst
emic and nonsystemic anacids?</div><div><r /></div><div>3. a. Name the 4 most c
ommon antacids.&nsp;</div><div>. Give whether theyre systemic or nonsystemic.
</div><div>c. Give a negative side-effect of each.</div>
"1. Weak ases t
hat neutralize gastric acid<div><r /></div><div>2. Systemics get from the stoma
ch into the lood stream and cause alkalosis. Nonsystemics dont get into the l
ood.</div><div><r /></div><div>3.&nsp;<img src=""paste-1644972474672.jpg"" /><
/div>" GIDrugs
Mucosal protective agents:<div><r /></div><div>1. What are their two potential
mechanisms of action?</div><div><r /></div><div>2. Give two examples and the me
chanism of each.</div> 1. a. Cover gastric surface with artificial mucus<div>.
Stimulate mucus secretion</div><div><r /></div><div>2. <>Sucralfate</>: l(O
H)<su>3</su>&nsp;sulfated sucrose complex forms a protective arrier</div><di
v><r /></div><div><>Colloidal ismuth</>: inds and coats ulcer tissues</div>
GIDrugs
"Fill in these 5 drugs related to gastric acid production.<div><r /></div><div>
<img src=""paste-2770253906437.jpg"" /></div>" "<img src=""paste-2783138808325.
jpg"" />"
GIDrugs
Which drug is used to help patients on NSID therapy with unacceptale GI prole
ms?
Misoprostol
GIDrugs
H2 lockers:<div><r /></div><div>1. Which of these drugs was the first to e in
troduced? Give 2 of its downsides that susequent drugs improved on.</div><div><
r /></div><div>2. Which of these susequent drugs is preferred in patients with
liver impairment?</div>
1. <>Cimetidine</>. Short half-life, many drug
interactions.<div><r /></div><div>2. <>Nizatidine</> /c its excreted mostl
y through the kidney.</div>
GIDrugs
Which is more effective at locking gastric acid secretion: H2 lockers or PPIs?
PPIs
GIDrugs
Give the mechanism y which PPIs work their magic. (3 important parameters)
Theyre given as <>prodrugs</> that are activated in the acidic environment of
the stomach.&nsp;<div><r /></div><div>They <>covalently</> ind to proton p
umps, <>irreversily</> <>inhiiting</> them.</div> GIDrugs
"<img src=""paste-3990024618280.jpg"" />"
.<div><r /></div><div>Gastric
juice is rich in H+, Cl-, and K+</div> GIDrugs
Profuse diarrhea will result in which of the following?<div><r /></div><div>.
Hypervolemia, metaolic alkalosis, hypokalemia</div><div>B. Hypovolemia, metaol
ic acidosis, hypokalemia</div><div>C. Hypovolemia, metaolic alkalosis, hypokale
mia</div><div>D. Hypovolemia, metaolic acidosis, hyperkalemia</div>
B. Hypov
olemia, metaolic acidosis, hypokalemia<div><r /></div><div>Losing icaronate
and K+</div>
GIDrugs
 patient comes to you with GERD and you decide to treat him/er with a histamine
locker to reduce acid secretion. Out of the following, which drug works y lo
cking histamine (H2) receptors?<div><r /></div><div>. Omeprazole (****prazole)
</div><div>B. Cimetidine (****tidine)</div><div>C. Misoprostol</div><div>D. Sodi
um Bicaronate</div><div>E. Dicyclomine</div> B. Cimetidine (****tidine)
GIDrugs
 patient comes to you with GERD. You decide to treat him/her with a proton pump
inhiitor to reduce acid secretion. Out of the following, which would e an app
ropriate drug?<div><r /></div><div>. Omeprazole<div>B. Cimetidine</div><div>C.
Misoprostol</div><div>D. Sodium icaronate</div><div>E. Dicyclomine</div></div
. Omeprazole GIDrugs
>
<div>1. What are prokinetic drugs used for? (1)</div><div>2. Give an example and

its mechanism of action.</div> 1. Used to improve gastric emptying<div><r /></

div><div>2. <>Metoclopramide</>: dopamine locker (D2&gt;&gt;D1 receptor)</div
><div><r /></div><div>D2 receptor locker: Increases ch release form parasympa
thetic nerve terminals to increase motility.</div><div><r /></div><div>D1 recep
tor locker: inhiits receptive relaxation.</div>
GIDrugs
1. How do anti-diarrheal drugs work?<div><r /></div><div>2. Whats an example a
nd its mechanism of action?</div>
1. By decreasing GI motility<div><r /><
/div><div>2. <>Loperamide</>: opioid derivative that stays in the GI, inds to
G<su>i</su> receptors to slow down GI motility.</div>
GIDrugs
Which of these is an anti-diarrheal drug?<div><r /></div><div>. Omeprazole</di
v><div>B. Famotidine</div><div>C. Larzepam&nsp;</div><div>D. Loperamide</div><d
iv>E. Colloidal ismuth</div> D. Loperamide GIDrugs
Give an example of an anti-emetic and its mechanism of action. <>Scopalamine</
> is a <>muscarinic antagonist</> that inhiits ch to lock throwing up. It
s used prophylactically to prevent motion sickness.
GIDrugs
: TRH, sort of.<div><r /></div
Q: Whats the smallest hormone in the ody?
><div>TRH is the smallest <>peptide</> hormone ecause we conveniently ignore
the Tyr derivatives (T3, T4) and catecholamines (NE and EPI) with their chimaeri
c/hermaphroditic* neurotransmitter/hormone nature.</div><div><r /></div><div>*c
himaeric if youre Bala, hermaphroditic if youre Frank</div><div><r /></div><d
iv>TRH was discovered at BCM in 1969 y&nsp;Roger Guillemin, who later shared t
he 1977 Noel Prize in Medicine and Physiology. <i>No one cares ecause earlier
that year Star Wars came out.</i></div> PrinciplesofEndocrinology
: peptides, glycoproteins (glycosylated
Q: What types of hormones are there?
peptides) steroid, amine (catecholamines and Tyr derivatives) PrinciplesofEndo
crinology
: tyrosine<div>
Q: mine hormones are most commonly derivatives of ______.
<r /></div><div>Note: Trp (serotonin) and His (histamine) derivatives exist as
well.&nsp;</div>
PrinciplesofEndocrinology
Q: Whats a preprohormone?
: its the first protein product that contains th
e signal peptide; when the signal peptide is removed in the endoplasmic reticulu
m it is converted to a prohormone; the prohormone is transferred to the golgi wh
ere it is packaged in secretory vesicles and in these vesicles proteolytic enzym
es cleave peptide sequences from the prohormone to produce the final hormone
PrinciplesofEndocrinology
: amine
Q: What kind of hormone are catecholamaines (epi, NE, dopamine)?
, Tyr derivatives
PrinciplesofEndocrinology
Q: What are two road mechanisms that regulate hormone secretion?
: neura
l mechanisms (ie secretion of catecholamines from adrenal medulla via synapse of
preganglionic sympathetic nerve fiers) and feedack mechanisms (negative and p
ositive)<div><r /></div><div>Note: neural can e divided further into neural-sp
ecific regulation (adrenergic, cholinergic, etc.) and chronotropic (pulsatile, m
enstrual, etc.)</div> PrinciplesofEndocrinology
Q: Opening of neuron Na+ channels during the upstroke of the action potential (
P) is an example of what type of feedack?
: positive; depolarization open
s voltage sensitive Na+ channels and causes Na+ entry into the cell which leads
to more depolarization and more Na+ entry
PrinciplesofEndocrinology
: dilation of the cervi
Q: How is oxytocin involved in positive feedack?
x causes the posterior pituitary to secrete oxytocin; in turn oxytocin stimulate
s uterine contraction which causes further dilation of the cervix
Principl
esofEndocrinology
: a mechanism in which a hormone decreases the
Q: What is down-regulation?
numer or affinity of its receptors in a target tissue; may occur y decreasing
the synthesis of new receptors, y increasing the degradation of existing recept
ors or y inactivating receptors; the purpose of down regulation is to reduce th
e sensitivity of the target tissue when hormone levels are high for an extended
period of time PrinciplesofEndocrinology
What are the three main mechanisms of hormone action on target cells? Consider t
he consequences of the different hormone types inding to their appropriate rece
ptors. Do not e overly concerned aout the details.
"<font color=""#ff0a1a""

>Tyr (or Ser or Thr) receptor kinase</font>: 1) receptor proteins dimerize, 2) a

utophosphorylate at Tyr/Ser/Thr residues, 3) use phospho-Tyr/Ser/Thr to recruit
downstream enzymes/messengers. Diverse responses include kinase, PLC, and G-prot
ein pathways.<div><r /><div><div><div><font color=""#ff0a1a"">G-proteins:</font
> 1) replace GDP with GTP (on alpha suunit), 2) transduce signal to neighoring
eta and gamma suunits, 3) activate diverse downstream enzymes and messengers.
</div></div></div></div><div><r /></div><div>Gs (G-stimulatory): standard adeny
late cyclase/cMP/PK phosphorylation cascade</div><div>Gi (G-inhiitory): oppos
es Gs y downregulating adenylate cyclase/cMP/PK cascade</div><div>Gq (G-queer
): PLC-gamma converts PIP2 to IP3 and DG; IP3 triggers intracellular Ca+2 relea
se, DG activates PKC phosphorylation cascade</div><div><r /></div><div><font c
olor=""#ff0a1a"">Nuclear receptors:</font> ind mostly steroid hormones and then
function as transcription factors; may e found in the cytosol or nucleus</div>
"
PrinciplesofEndocrinology
Q: True or false: thyroid hormones use a steroid hormone mechanism of action.
: true, they ind nuclear thyroid hormone receptors.<div><r /></div><div>Note:
thyroid hormones require specific (and sometimes TP-dependent) channels to ent
er the cytosol due to their ovious hydrophilicity.</div>
PrinciplesofEndo
crinology
: Phospholipase
Q: ______ catalyzes the lieration of DG and IP3 from PIP2.
C-gamma
PrinciplesofEndocrinology
Q: Which is identical in all glycoproteins, alpha or eta suunit?
: alpha
is identical; examples are FSH, LH, HCG, TSH PrinciplesofEndocrinology
: catecholamines and thyroid ho
Q: Tyrosine is a precursor to which hormones?
rmones (iodothyronines) PrinciplesofEndocrinology
Q: What type of hormone is cortisol?
"steroid<div><img src=""paste-9439908619
8788.jpg"" /></div>"
PrinciplesofEndocrinology
Q: Compare/contrast preprohormone, prohormone, hormone. : preprohormone has the
copeptide and signal sequence attached; prohormone has the copeptide attached;
hormone has copeptide cleaved off
PrinciplesofEndocrinology
Q: The degree of protein inding in the lood varies greatly etween hormones. &
: amount of in
nsp;How does inding times affect half-life of the hormone?
ding determines half-life; thus ound hormones have greater half-lives; NOTE: i
nding also determines the reservoir functionfor example if we remove the thyroid
we still function normally for a few days ecause theres so much thyroid hormone
ound to protein (~99.9%); its the amount of unound hormone thats active
Principl
esofEndocrinology
Q: Is insulin ound to protein in the lood? How does this affect the half-life?
: Its not ound to protein and thus its half-life is very short; therefore, if w
e were to knock out our pancreatic eta cells, we would notice right away ecaus
e theres no reservoir function with insulin. PrinciplesofEndocrinology
Q: True or false: LH and GH exhiit pulsatility.
": true; in fact, virtu
ally every hormonal axis has a rhythm of certain frequency and amplitude. These
rhythms can change with age.<div><img src=""paste-94837172862980.jpg"" /></div>"
PrinciplesofEndocrinology
Q: What kind of kinase is the insulin receptor? : tyrosine kinase on the cytoso
lic intracellular domain
PrinciplesofEndocrinology
: No, effect is delayed
Q: re steroid hormone effects fast and temporary?
and prolonged; hormone inds to nuclear receptor and alters transcription/trans
lation PrinciplesofEndocrinology
Descrie the neural and endocrine response to hypoglycemia.
"<img src=""past
e-95588792139777.jpg"" />"
PrinciplesofEndocrinology
Compare and contrast hormones vs. neurotransmitters
Hormones are secreted in
to the lood whereas NTs are not<div>NTs are stimulated y action potentials. Ho
wever, a numer of endocrine cells are also stimulated y electrical potentials
(ex: eta cells in the pancreas)</div><div>Some molecules are ifunctional and c
an work as a NT or a hormone (ex: epinephrine and dopamine)</div><div>NTs and ho
rmones can e co-transcried, co-translated, and co-secreted. Ex: POMC (proopiom
elanocortin)</div>
PrinciplesofEndocrinology
What do all glycoproteins have in common?
"lpha suunit is the same, eta

suunit gives them their character<div><img src=""paste-96422015795204.jpg"" />

</div>" PrinciplesofEndocrinology
preprohormone = ?
signal peptide + copeptide + hormone
PrinciplesofEndo
crinology
prohormone = ? copeptide + hormone
PrinciplesofEndocrinology
Descrie the production of insulin
Preproinsulin -&gt; proinsulin (insulin
+ copeptide) -&gt; insulin (copeptide has een cleaved off)
PrinciplesofEndo
crinology
T/F: cleavage of the signal hormone and copeptide is not necessary for function
of a hormone
FLSE! Cleavage of the signal hormone and copeptide is necessary
!
PrinciplesofEndocrinology
What are the two types of central endocrine regulation?&nsp;<div>Hint: central
endocrine regulation refers to hormonal regulation at the top of the axis in the
rain.</div> Neural and chronotropic PrinciplesofEndocrinology
What are the types of neural regulation of hormone secretion? "drenergic, cho
linergic, dopaminergic, serotoninergic, endorphinergic, gaaergic<div><r /></di
v><div>Note the nomenclature: ""nergic,"" indicative of their neural effects.</d
iv>"
PrinciplesofEndocrinology marked
What are the types of feedack regulation of hormone secretion? hormone-hormone<
div>sustrate-hormone</div><div>mineral-hormone</div> PrinciplesofEndocrinolog
y
Descrie the two perspectives of feedack signals.
"<img src=""paste-984707
15195396.jpg"" /><div><img src=""paste-99011881074689.jpg"" /></div>" Principl
esofEndocrinology
Is carrier-ound hormone active?
No, the hormone needs to e free in orde
r to e active. Carrier-ound hormones serve as a functional reservoir Principl
esofEndocrinology
T/F: The endocrine response is all-or-none like an action potential
False! C
an have graded responses
PrinciplesofEndocrinology
In vivo, a scatcard analysis measures two receptors constants and two K values.
t different times, the ody can have different amount o
How is this possile?
f receptors and different affinities of the receptors.<div>Can change the amount
y adding or removing the receptors from the memrane</div><div>Can change the
affinity y switching the GPCR from active (GTD) &lt;--&gt; inactive (GDP).</div
>
PrinciplesofEndocrinology
What does a scatcard analysis tell you? "Numer of receptors on a certain protei
n and the affinity of a certain sustrate for it, Ka.<div><r /></div><div>Note:
Ka may e written as Ki for an inhiitors affinity, Km for a sustrates catal
ytic affinity, etc. Broadly speaking, any Ka merely descries the inding streng
th of a particular molecule.<r /><div><div><div><img src=""paste-10082435727360
4.jpg"" /></div></div></div></div>"
PrinciplesofEndocrinology
List the different types of plasma memrane receptor systems. "<div><span class
=""pple-ta-span"" style=""white-space:pre""> </span>Peptide and catecholamine
receptors</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </s
pan>Coupling to G-proteins</div><div><span class=""pple-ta-span"" style=""white
-space:pre""> </span>Second messengers:&nsp;</div><div>o<span class=""pple-ta
-span"" style=""white-space:pre""> </span>-cMP-mediated phosphorylation&nsp;</
div><div>o<span class=""pple-ta-span"" style=""white-space:pre""> </span>-noncMP-mediated signaling&nsp;</div><div>o<span class=""pple-ta-span"" style=""
white-space:pre""> </span>-Ca-mediated signaling</div><div>o<span class=""ppleta-span"" style=""white-space:pre""> </span>-lipid-mediated signaling</div><div
><r /></div>" PrinciplesofEndocrinology
Descrie calcium-mediated second messenger signaling. "<div>The hormone activa
tes a Gq (G-queer) receptor cascade.</div><img src=""paste-101966818574340.jpg""
/>"
PrinciplesofEndocrinology
Where are the receptors for steroid hormones? Peptide hormones? Steroid hormones
are lipid solule and their receptors are within the cell. The receptors are tr
anscriptional factors that activate or repress the expression of targeted genes.
They may e found within either the cytosol or already within the nucleus, depe
nding on which hormone they ind.<div><r /><div>Peptide hormones are water solu

le and their receptors are on the cell surface. They are usually coupled to G-p
roteins or Tyr kinases.</div></div>
PrinciplesofEndocrinology
Compare the response rate and duration of peptide and steroid hormones. Steroid
hormones are delayed, ut long acting<div>Peptide hormones are quick, ut short
acting</div>
PrinciplesofEndocrinology
Descrie nuclear receptors
"Contain three domains: amino terminal extension
, DN inding region, and hormone inding region<div>ll are transcription facto
rs</div><div><img src=""paste-102842991902724.jpg"" /></div>" PrinciplesofEndo
crinology
Q: What is the effect of acetylcholine on GI motility and secretions?
: incre
ase
GutSecretionsIV
: decrease
Q: Whats the effect of Epi/NE on GI motility and secretions?
GutSecretionsIV
Q: Whats the effect of opiods (ie morphine) on the GI tract?
: decrease GI m
otility GutSecretionsIV
Q: How does dopamine affect the release of Ch? : decreases; relaxes smooth mus
cle and largely mediates receptive relaxation GutSecretionsIV
Q: Is insulin cataolic or anaolic?
: anaolic; moves nutrients from outsid
e to inside cells
GutSecretionsIV
: incre
Q: The hunger signal glucagon has what effect on gluconeogenesis?
ase; also increases glycogenolysis
GutSecretionsIV
Q: How does gastrin affect acid secretion?
GutSecretionsIV
: increases
: incre
Q: How does CCK effect the release of pancreatic and ile juices?
ases
GutSecretionsIV
Q: Histamine, via its H2 receptor, increases or decrease acid secretion?
GutSecretionsIV
: increases
: inhi
Q: How does prostaglandin (PGE2) affect acid and mucus secretion?
its acid secretion, increases mucus secretion GutSecretionsIV
Q: Between meals how are mucus and acid amounts changed?
: acid decrease
s, mucus increases
GutSecretionsIV
: acid increase
Q: fter meals what happens to the amounts of acid and mucus?
s, mucus decreases
GutSecretionsIV
Q: What does aspirin inhiit the synthesis of? Whats the effect on the GI tract?
: prostaglandin; therefore acid increases and mucus decreases, causing ulcers
GutSecretionsIV
Q: (From class) You are in the emergency room and realize that the patient has h
yperkalemia with K+ levels over 6mM (normal is 3.5-5mM). &nsp;You decide to low
er the serum K+ levels to normal levels. &nsp;Your choice will e infusion of a
n IV solution containing what? : insulin and glucose (insulin alone will cause
hypoglycemia); NOTE: insulin and epinephrine are routinely used to lower plasma
K+ levels; epinephrine y itself will cause hyperglycemia so you dont want to in
clude additional glucose
GIDrugs
: acido
Q: Metaolic ____ and excessive cell lysis will cause hyperkalemia.
sis
GutSecretionsIV
Q: Both hyperkalemia and hypokalemia can lead to cardiac arrhythmias. &nsp;How
does hyperkalemia affect RMP?
: depolarizes GutSecretionsIV
: hyperpolarizes
Q: How does hypokalemia affect RMP?
GutSecretionsIV
Q: (From class)  diaetic patient who is on insulin therapy is feeling dizzy an
d faint due to hypoglycemia. &nsp;Injection of what hormone (drug) will help?
: glucagon; glucagon is a hormone that raises the level of glucose in the lood
; the alpha cells of the pancreas (islets of Langerhans) make glucagon; patients
who use insulin should have a glucagon emergency kit on hand at all times to co
unteract severe hypoglycemia
GutSecretionsIV
Q: (From class) In which of the following conditions would aspirin e contraindi
cated? : peptic ulcer; ecause aspirin inhiits prostaglandin synthesis; recal
l that prostaglandins decrease acid secretion and increase mucus secretion; thus
patients on aspirin/NSIDs secrete more acid and less mucus
GutSecretionsIV
Q: (From class) Out of the following drugs, which one will inhiit acid secretio
: somatostatin GutSecretionsIV
n y parietal cells?
"Q: Do you know this diagram?<div><img src=""paste-115392886341636.jpg"" /></div

>"
Good! GutSecretionsIV
Q: What is the organization of cells within the gastric pits? "<img src=""past
e-115745073659908.jpg"" />"
GutSecretionsIV
Q: Oxyntic cells are also called ____ cells. &nsp;They secrete _____ and _____.
": parietal; HCl &amp; intrinsic factor<div><img src=""paste-115873922678788.jp
g"" /></div>" GutSecretionsIV
Q: Peptic/zymogenic cells are also called ____ cells. They secrete ________.
: chief; pepsinogen
GutSecretionsIV
Q: Insulin signaling rings glucose transporters to the cell memranes. &nsp;Ho
w is this similar to activated parietal cells? : the activated parietal cells
dramatically increase surface area; canaliculi come out to surface in activated
cells GutSecretionsIV
Q: Sodium icaronate and magnesium hydroxide are examples of _____ antacids.
": systemic<div><img src=""paste-116196045225988.jpg"" /></div>"
GutSecre
tionsIV
Q: Calcium caronate and aluminum hydroxide are examples of ____ antacids.
": nonsystemic<div><img src=""paste-116367843917828.jpg"" /></div>"
GutSecre
tionsIV
: hypernatremia
Q: What are side effects of the antacid sodium icaronate?
, high BP, alkalosis
GutSecretionsIV
Q; What are side effects of the antacid calcium caronate?
: hypercalcemia
, cardiac arrhythmias GutSecretionsIV
: diarrhea
Q: What are side effects of the antacid magnesium hydroxide?
GutSecretionsIV
Q: What are side effects of the antacid aluminum hydroxide?
: constipation;
NOTE; if we were to couple this antacid with magnesium hydroxide then the diarr
hea/constipation would e eliminated
GutSecretionsIV
: forms a protective a
Q: What is the purpose of the medication sucralfate?
rrier over the gastric surface; its a mucosal protective agent GutSecretionsIV
Q: Whats the purpose of colloidal ismuth (Pepto-ismol)?
: inds and coa
ts ulcer tissues
GutSecretionsIV
: proton pump inhiitors; ie om
Q: What class of drugs ends in *****prazole?
eprazole
GIDrugs
Q: What class of drugs ends in ****tidine?
: H2 (histamine2) receptor loc
kers; ie cimetidine (Tagamet); theyre structural analogs of histidine GIDrugs
: decreases; its
Q: Misoprostol has what effect on gastric acid production?
a prostaglandin (PGE2) analog; its used to help patients on NSID therapy with u
nacceptale GI prolems GIDrugs
Q: What are more effective drugs at lowering gastric acid production, PPIs or H2
lockers?
": PPIs are superior; recall that PPIs are prodrugs that get ac
tivated in the acidic environment; it forms a covalent ond with the proton pump
and irreversily inhiits<div><img src=""paste-117630564302852.jpg"" /></div>"
GIDrugs
Q: (From class) Prolonged and profuse vomiting will result in which of the follo
wing? : hypokalemic, hypochloremic, metaolic alkalosis
GIDrugs
Q: (From class)  patient comes to you with GERD and you decide to treat him wit
h a histamine locker to reduce acid secretion. &nsp;What would e an appropria
: Cimetidine GIDrugs
te drug?
Q: (From class)  patient comes to you with GERD. &nsp;You decide to treat him
with a proton pump inhiitor to reduce acid secretion. &nsp;What would e an ap
propriate drug? : Omeprazole GIDrugs
: motility prom
Q: What are prokinetic drugs used for? &nsp;Give an example.
oting; used to improve gastric emptying; ie metoclopramide (Reglan)
GIDrugs
Q: How does metoclopramide work?
: its a dopamine locker (locks type 2
receptor); increases acetylcholine release from parasympathetic nerve terminal a
nd thus increases GI motility GIDrugs
Q: How does loperamide (imodium) affect GI motility?
: decreases GI motility
; its thus an anti-diarrheal; Binds to mu receptors (Gi type) and slows down GI m
otility.Stays inside GI tract; this minimizes systemic side effects
GIDrugs
: decreases
Q: How does dopamine effect Ch release?
GIDrugs

Q: What is the function of metoclopramide (reglan)?

: its a dopamine locker
GIDrugs
Q:  couple celerating their fortieth wedding anniversary is given a trip to Pe
ru to visit Machu Picchu. Due to past experiences, while traveling , they ask th
eir doctor to prescrie an agent for diarrhea. Which of the following will e ef
fective?
: loperamide (imodium) GIDrugs
Q: Does acetylcholine promote or anatgonize emesis? &nsp;What path is prescrie
d to prevent motion sickness? ": Ch promotes peristalis and thus throwing up
; scopalamine (muscarinic antagonist) patch is used to prevent motion sickness;
Scopalamine also acts in the rainstem / CNS; decreases parasympathetic output.<
div><img src=""paste-119052198477828.jpg"" /></div>"
GIDrugs
: adenohyophysi
Q: What is the glandular portion of the pituitary called?
s (anterior pituitary) BrentsQs Hypothalamus&PosteriorPituitary
Q: What is the neural portion of the pituitary called? : neurohypophysis (post
erior pituitary); the pituitary is functionally connected to the hypothalamus y
the median eminence via the stalk (infundiulum); posterior pituitary secretes
two peptide hormones (DH and oxytocin) BrentsQs Hypothalamus&PosteriorPituita
ry
Q: True or false: the pituitary is extremely vascular. : true; most endocrine
organs have a rich lood supply Hypothalamus&PosteriorPituitary
Q: Which portion of the pituitary is involved in the hypothalamic-hypophseal por
tal system?
": anterior pituitary<div><img src=""paste-119932666773508.jpg"
" /></div>"
Hypothalamus&PosteriorPituitary
Q: What are the functions of the hypothalamus and where does it receive inputs f
rom?
": central relay for collecting and integrates diverse signals and chan
nels them to the pituitary (its like a funnel)it relays to the pituitary via porta
l lood and neurons; receives inputs from higher rain centers<div><r /></div><
div><img src=""Screen Shot 2012-11-25 at 5.35.13 PM.png"" /></div>"
Hypothal
amus&PosteriorPituitary
Q: True or false: the hypothalamus releases oth inhiitory and releasing hormon
: true; feedack inhiition on releasing hormon
es that act on the pituitary.
es is same as activating inhiitory hormones
Hypothalamus&PosteriorPituitary
Q: Compare/contrast the terms tropic and trophic.
": tropic stimulates re
lease of a hormone; trophic refers to growth and nurishment of a gland<div><r /
></div><div>Both terms come from the Greek:</div><div>trophikos or trophos, whic
h mean ""nutrition""</div><div>tropikos, which means ""turn(ing)""</div>"
Hypothalamus&PosteriorPituitary
Q: Name 6 hypothalamic hormones.
: TRH, GnRH, CRH, GHRH, somatostatin, p
rolactin inhiiting factor (dopamine) Hypothalamus&PosteriorPituitary
Q: What does GnRH cause the release of? : LH and FSH Hypothalamus&PosteriorPi
tuitary
Q: Whats the effect of somatostatin on GH release?
: it lunts (inhiits)
GH release
Hypothalamus&PosteriorPituitary
: prolactin, in
Q: t excessive levels of TRH, what hormone can e released?
addition to TSH
Hypothalamus&PosteriorPituitary
Q: What are the two posterior pituitary hormones?
: DH and oxytocin; the
yre neuropeptides ecaues theyre synthesize in cell odies of neurons and released
from neuron terminals in the posterior pituitary
Hypothalamus&PosteriorPi
tuitary
Q: Whats the origin of DH and oxytocin within the hypothalamus?
: supraoptic an
d paraventricular nuclei; magnocellular neurons; these hormones are manufactured a
s prohormones with neurophysin (carrier protein) and are cleaved within the axon
(stalk) so that theyre active in the posterior pituitary
Hypothalamus&Pos
teriorPituitary
Q: True or false: the posterior pituitary is a collection of nerve axons whose c
: true Hypothalamus&PosteriorPi
ell odies are located in the hypothalamus.
tuitary
Q: True or false: DH and oxytocin has very similary primary structures.
: true Hypothalamus&PosteriorPituitary
Q: ____ is secreted from the posterior pituitary in response to increased serum

osmolarity
: DH; increased plasma osmolarity is most important stimulus
Hypothalamus&PosteriorPituitary
Q: DH has two actions, one of the kidney and one on vascular smooth muscle. Exp
lain. : DH increases water permeaility in the principal cells of the kidney
via the V2 receptor (this ultimately allows water to e reasored); DH also c
auses contraction of vascular smooth muscle via the V1 receptor which results in
the constriction of arterioles and increased total peripheral resistance
Hypothalamus&PosteriorPituitary
Q: Descrie the neural circuitry regulating DH release.
": theres osmore
ceptors that guage osmolarity y sampling the plasma; these cells can distort an
d then send neural signals to paraventricular and supraoptic nuclei; arorecepto
rs can also sense changes in lood volume and therey cause the release of DH a
s well; from Costanzo: Ps are initiated in cell odies of neary DH neurons an
d propagate down the axons and cause the secretion of DH from nerve terminals i
n the posterior pituitary<div><img src=""paste-121508919771140.jpg"" /></div>"
Hypothalamus&PosteriorPituitary
Q: DH is primarily associated with _____ nuclei, and oxytocin is primarily asso
ciated with ____ nuclei.
: supraoptic; paraventricular Hypothalamus&Pos
teriorPituitary
Q: Graphically characterize the effect of plasma osmlarity on DH release.
"<img src=""paste-121895466827780.jpg"" /><div>Note that the turn on point is extr
emely specific (280 mOsm) and the effect thereafter is linear; the threshold whe
re you ecome thirsty is slightly right of the turn on point meaning that water co
nservation is automatic and kicks in efore thirst does.</div><div><r /></div><
div>Most of these systems have arupt release.</div>" Hypothalamus&PosteriorPi
tuitary
Q: Graphically characterize DH release as a result of plasma volume. ": not
linear as seen in osmolarity change; there needs to e a rather large lood loss
efore DH is released ut it will increase significantly after a certain level
of lood volume depletion<div><img src=""paste-122312078655492.jpg"" /></div>"
Hypothalamus&PosteriorPituitary
Q: DH acts via V2 receptors on the kidney to cause what effect?
": inse
rtion of aquaporin 2 and retention of water<div><img src=""paste-122569776693252
.jpg"" /></div>"
Hypothalamus&PosteriorPituitary
Q: Whats the overall regulation of concentrationof ody fluids?
": loss of wate
r rise in serum tonicity
causes DH release (increases tuular reasorption of w
ater) and thirst (increased water intake)
dilution of ody fluid
inhiition of 
DH release and inhiition of thirst loss of water<div><r /></div><div><img src=
""Screen Shot 2012-11-25 at 6.33.56 PM.png"" /></div>" Hypothalamus&PosteriorPi
tuitary
Q: What component of the RS system can also activate thirst? : angiotensin I
I; hypovolemic thirst Hypothalamus&PosteriorPituitary
: NF (
Q: What hormone is in charge of hypervolemic water excretion with sodium?
atrial natriuretic factor); acts on renal tuules, potentiated y oxytocin
Hypothalamus&PosteriorPituitary
Q: What is the principal physiological effect of oxytocin?
: cause contrac
tion of myoepithelial cells that the line the ducts of the reast thus causing mi
lk ejection
Hypothalamus&PosteriorPituitary
Q: Whats the MJOR stimulus for oxytocin secretion?
: suckling of the reas
t; sensory receptors in the nipple transmit impulses via afferent neruons and go
es to the paraventricular nuclei of the hypothalamus and causes the secretion of
oxytocin.
Hypothalamus&PosteriorPituitary
Q: ____ causes lactogenesis. &nsp;____ causes milk ejection.
: Prolactin; ox
ytocin Hypothalamus&PosteriorPituitary
Q: Is oxytocin secreted at parturition? : yes, it causes contraction of the ute
rus and exhiits positive feedack; it can e used in pharmacological doses to i
nduce laor
Hypothalamus&PosteriorPituitary
Q: What hormones are released y the hypothalamus?
: GRHR, somatostatin, T
RH, CRH, GnRH, dopamine nteriorPituitary
: GH, TSH, prol
Q: What hormones are released y the anterior pituitary?

actin, CTH, FSH, LH, MSH; from Costanzo: MSH has little activity in humans
nteriorPituitary
Q: What does TRH cause the release of? : TSH and it can drive prolactin releas
nteriorPituitary
e at high concentrations
Q: What is the effect of dopamine on prolactin? : inhiits<div><r /></div>
nteriorPituitary
: inhiits the release
Q: What does somatostatin affect the release of?
of GH and TSH<div><r /></div><div>t very high doses, it can inhiit any hypoth
alamic hormone.</div>
nteriorPituitary
Q: What are some implications of the portal lood supply to the anterior pituita
: hypothalamic hormones can e delivered to the anterior pituitary dire
ry?
ctly and in high concentrations ND the hypothalamic hormones do not appear in t
he systemic circulation in high concentrations nteriorPituitary
How are hypothalamic hormones delivered to the anterior pituitary?
"<div>Th
ere are two portal systems present:&nsp;</div><div>1) The superior hypophyseal
arterys capillary ed in the median eminance</div><div>2) The inferior hypophys
eal arterys capillary ed in the posterior pituitary</div><div><r /></div><div
>Short and long neurons that produce the hypothalamic hormones travel down towar
ds the two capillary eds. Fires from the shorter neurons will release their ho
rmones into the superior hypophyseal capillary ed. Fires from the longer, onto
inferior hypophyseals...</div><div><r /></div><div>The capillary eds dearor
ize and carry the hypothalamic hormones to specific portions of the anterior pit
uitary, where they are released, and stimulate or inhiit the release of susequ
ent hormones in their particular axis.</div><img src=""Screen Shot 2012-11-25 at
5.40.18 PM.png"" />"
nteriorPituitary
True or false: LH and FSH are made/secreted y the same cell type in the anterio
nteriorPituitar
r pituitary.
True, they are made y the gonadotrophs.
y
Q: What do TSH, FSH, HCG and LH have in common? : theyre all glycoproteins secre
ted y the anterior pituitary; they thus have identical alpha suunits and diffe
nteriorPituitary
rent eta suunits
Q: CTH is derived from what precursor? : POMC -&gt; this is cleaved y endopep
tidases to produce CTH, eta-endorphin, etc
nteriorPituitary
Q: What are some stimuli of CTH?
: stress, hypoglycemia, surgery, fever
(pyrogens), adrenolytic drugs (lock adrenal function, thus decreasing negative
nteriorPituitary
feedack)
Q: What anterior pituitary hormone stimulates the secretion of glucocorticoids,
androgens, and mineralcorticoids?
: CTH nteriorPituitary
: true nteriorPituitar
Q: True or false: CTH exhiits a diurnal secretion.
y
Q: What anterior pituitary hormone acts on leydig cells of the testes? : LH
nteriorPituitary
Q: What anterior pituitary hormone stimulates sertoli cells and controls gametog
enesis? : FSH nteriorPituitary
Q: How does inhiin (from sertoli cells) affect FSH secretion? : inhiits
nteriorPituitary
: LH an
Q: What hormones do gonadotrophs secrete in the anterior pituitary?
nteriorPituitary
d FSH
Q: What hormone do somatotrophs of the anterior pituitary secrete?
: growt
h hormone
nteriorPituitary
: stimulate
Q: How does hypoglycemia and starvation affect GH secretion?
nteriorPituitary
Q: How do GHRH and SRIF (somatostatin) regulate GH release?
": GHRH stimula
tes while SRIF inhiits; note that GHRH inds to a receptor that is coupled to G
(s) and ends up acting through adenylyl cyclase (thus incresing cMP) and PLC (t
hus increasing IP3/Ca2+); SRIF locks GHRH y stimulating G(i) which inhiits ad
enylyl cyclase and decreases cMP; NOTE: theres an immediate release of pre-forme
d hormone and theres also an induction of transcription of the GH gene to promote
synthesis as well<div><img src=""paste-134002979635204.jpg"" /></div>" nterior
Pituitary

Q: How do somatomedins affect GH release?

: inhiit y negative feedack<
div><r /></div>
nteriorPituitary
Q: Somatomedins are also called ______. : insulin-like growth factors (IGFs)
nteriorPituitary
Q: How does ghrelin affect growth hormones secretion?<div><r /></div> : stimu
lates nteriorPituitary
Growth hormone secretory rates are not constant over a lifetime. &nsp;How do th
ey change with age and during sleep?
"GH is secreted in a pulsatile pattern w
ith ursts occurs approximately every 2 hours. In young children and infants, th
e large midnight peak is tied to sleep and growth-directed.&nsp;<div><r /></di
v><div>fter puerty, the rate of GH secretion declines to a stale level, ecom
ing more metaolically-directed (to prevent hypoglycemia) than growth-directed,
and finally in senescence, GH secretory rates and pulsatility decline to their l
owest levels.&nsp;<div><r /></div><div>Thus GH has a diurnal pattern and a dev
elopmental pattern of secretion.<div><img src=""paste-134509785776132.jpg"" /></
nteriorPituitary
div></div></div>"
Q: What is the effect of GH on adipose tissue? Comment upon the diaetogenic eff
ect.
": decreases glucose uptake and increases lipolysis; this is a diaetog
enic effect since GH causes insulin resistance and decreases glucose uptake and
produces an increase in lood glucose concentration<div><r /></div><div><img sr
c=""Screen Shot 2012-11-25 at 2.24.35 PM.png"" /></div>"
nteriorPituitar
y
Q: What is the effect of GH on muscle? : decrease glucose uptake, increase 
uptake, increase protein synthesis, increase lean ody mass
overall increase in
organ size
nteriorPituitary
Q: True or false: GH antagonizes insulin in adipose and muscle with respect to g
: true nteriorPituitary
lucose metaolism.
With respect to protein metaolism, is GH synergistic or antagonistic to insulin
?
Synergistic; results in protein synthesis<div><r /></div><div>Otherwise
, GH antagonizes insulin due to its cataolic effects upon fat and glucose meta
nterior
olism, favouring lipolysis and increased lood glucose levels.</div>
Pituitary
Q: When GH acts on the liver what factor is produced? : IGF-1
nterior
Pituitary
: protein synthesis, gluconeoge
Q: What are the effects of GH on the liver?
nteriorPituitary
nesis, and release of IGF-1
Q: What are the effects of IGF-1 on chondrocytes and other organs?
": nucl
eic acid and protein synthesis; proliferation of chondrocytes<div><img src=""Scr
nteriorPituitary
een Shot 2012-11-25 at 3.09.35 PM.png"" /></div>"
: increases
nteriorPituitar
Q: How does GH affect lood glucose levels?
y
Q: How does IGF-1 affect GH secretion? : decreases via negative feedack
nteriorPituitary
: liver; IGF-1 is produced primarily y the liv
Q: What organ secretes IGF?
er as an endocrine hormone as well as in target tissues in a paracrine/autocrine
fashion
nteriorPituitary
: stimulate
nterior
Q: How do stress and exercise affect GH secretion?
Pituitary
Q: How does FF decrease affect GH secretion?
: increases; recall that GH sti
mulates lipolysis
nteriorPituitary
: increases; GH increases gluco
Q: How does hypoglycemia affect GH secretion?
se levels in the lood nteriorPituitary
Q: How do increases in glucose and FF affect GH secretion?
": inhiit<div>
<r /></div><div><img src=""Screen Shot 2012-11-25 at 1.47.21 PM.png"" /></div>"
nteriorPituitary
: increases; GH
Q: How does an increase in s in lood affect GH secretion?
stimulates protein synthesis nteriorPituitary
Q: How does starvation affect GH secretion?
": increases<img src=""Screen S
hot 2012-11-25 at 3.56.35 PM.png"" />" nteriorPituitary
Q: What kind of receptor does IGF have? : tyrosine kinase like insulin nterior

Pituitary
Q: What stimulates IGF-1 secretion?
: GH (with facilitation y insulin); no
nteriorPituitary
te that insulin only facilitates if GH is present!
: fasting, protein deprivation,
Q: What factors inhiit IGF-1 secretion?
and insulin deficiency; NOTE: these factors may override the stimulatory effect
of GH nteriorPituitary
Q: Excessive GH causes what pathology? : acromegaly; causes increase hand/foot
size, enlargement of tongue, etc; NOTE: the effects of GH depend on whether the
excess occurs efore or after puerty nteriorPituitary
Q: Excessive GH efore puerty causes what specific pathology? : gigantism; in
tense hormonal stimulation of the epiphyseal plates<div><r /></div><div>In cont
nteriorPituitary
rast, acromegaly occurs after puerty.</div>
Q: What hypothalamic hormone inhiits prolactin?
: dopamine; in persons
who are not pregnant or lactating, prolactin secretion is tonically inhiited y
dopamine (prolactin inhiiting factor) from the hypothalamus; thus, the inhiit
ory effect of dopamine dominates and overrides the stimulatory effect of TRH.
nteriorPituitary
Q: What are the effects of prolactin?
: milk production (lactogenesis) and de
nteriorPituitary
velopment of reasts
: TRH nteriorPituitar
Q: What hypothalamic hormone stimulates prolactin?
y
Q: Whats the neuroendocrine milk reflex?
: during suckling, afferent fiers from
the nipple carry information to the hypothalamus and inhiit dopamine secretion
; y releasing the inhiitory affect of dopamine, prolactin secretion is increas
ed
nteriorPituitary
Q: What hormone causes milk ejection?
: oxytocin; causes contraction of myoep
nteriorPituitary
ithelial cells lining the milk ducts
The efficient asorption of any sustance depends upon (4):
<div>a) adequate
form of asorption (i.e., digestion must e adequate).&nsp;</div><div>) adequ
ate surface of asorption (large margin of safety, since up to 50% of small inte
stine may e removed, and still have adequate asorption).&nsp;</div><div>c) ad
equate rate of transit through the intestine.&nsp;</div><div>d) specific co-fac
tors and/or carriers eing availale for certain sustances.</div><div><r /></d
iv>
sorption
The efficiency of asorption in the small intestine is increased y increasing .
.
the availale surface area (length, Valves of Kerkring (circular folds),
villi, microvilli)
sorption
Which nutrient is the major energy source in the diet? Carohydrates (more than
50% of the calories consumed per day) sorption
Starch is composed of ...
amylose and amylopectin sorption
What does salivary amylase cleave? Pancreatic amylase? "The two amylases are ve
ry similar in chemical composition. They are endoglucosidases and attack only al
pha-1,4 onds. <font color=""#FF0000"">They do not attack onds next to an -1,6 l
inkage.</font>" sorption
Products of starch digestion y salivary amylase include:
"Maltose, maltot
riose, alpha-limit dextrins, and oligosaccharides<div><img src=""paste-142983756
251140.jpg"" /></div>" sorption
Descrie starch digestion and asorption in the small intestine "<div><span class
=""pple-ta-span"" style=""white-space:pre""> </span>The products of starch dig
estion and the two dietary disaccharides, sucrose and lactose, are readily water
solule and diffuse from the intestinal lumen up to the rush-order memrane,
where further digestion proceeds y the three major disaccharidases inserted in
the memrane, as illustrated in this figure. Sucrase-isomaltase (SI) and maltase
-glucoamylase (MG) are dimers whereas lactase (L) is a monomer as indicated y t
he circles. Sucrose and lactose are split to their respective monosaccharides y
sucrase and lactase, respectively. Maltose, maltotriose, and short oligosacchar
ides are digested y maltase-glucoamylase, ut can also e digested y sucrase a
nd isomaltase. The -1,6 ond in -limit dextrin can only e hydrolyzed y isomaltas
e. The final digestive products are three monosaccharides: glucose, galactose, a
nd fructose.</div><div><img src=""paste-143404663046148.jpg"" /></div>" sorpti

on
Trehalose is formed y ____ onds. Which enzyme digests trehalose? What happens
if you are deficient in this enzyme?
1-1 alpha ond<div>Trehalase</div><div>D
sorpti
iarrhea when you eat food with high trehalose (ex: mushrooms)</div>
on
Descrie how glucose, galactose and fructose are taken from the intestinal lumen
into the lood supply. "<div>Glucose and Galactose use SGLT1 (secondary active
transport) apically which is a glucose/galactose symprter with sodium</div><div>
Fructose uses GLUT5 apically</div><div>Both use GLUT2 asolaterally which is not
associated with sodium</div><img src=""paste-144023138336773.jpg"" />" sorpti
on
Compare SGLT and GLUT transporters
"<div>Hexose transporters have een iden
tified and classified ased on their dependence on cellular energy:&nsp;</div><
div>o<span class=""pple-ta-span"" style=""white-space:pre""> </span> -Transpor
t hexoses down a concentration gradient (GLUT1, GLUT2, GLUT3, GLUT4 and GLUT5).<
/div><div>o<span class=""pple-ta-span"" style=""white-space:pre""> </span>- Tr
anport hexoses against a concentration gradient using energy provided y an elec
trochemical gradient of sodium, which is cotransported (SGLT1).&nsp;</div><div>
sorption
<r /></div>"
How does insulin affect glucose transport in the small intestine? How does this
affect diaetics?
"<div>Insulin inds to its enterocyte receptor (IR), res
ulting in rapid trafficking of <font color=""#FF0000"">GLUT2</font> <font color=
""#FF0000"">away from oth apical and asolateral memranes&nsp;</font></div><d
iv><font color=""#FF0000""><img src=""paste-145483427217412.jpg"" /></font></div
><div><font color=""#FF0000""><div><font color=""#000000"">Lack of insulin in hu
man diaetic patients results &nsp;in large amounts of GLUT2 permanently locate
d in the apical memrane, so that fructose &nsp;asorption is mediated y oth
GLUT5 and GLUT2 .&nsp;</font></div><div><font color=""#000000"">Thus a high rat
e of sugar asorption is maintained despite anormally elevated lood glucose.</
font></div><div><r /></div></font></div><div><r /></div>"
sorption
What are the symptoms of lactose intolerance? How do you diagnose lactose intole
rance? "<div>Symptoms:</div><div><span class=""pple-ta-span"" style=""white-sp
ace:pre""> </span>Nausea</div><div><span class=""pple-ta-span"" style=""white-s
pace:pre""> </span>adominal pain/cramps&nsp;</div><div><span class=""pple-taspan"" style=""white-space:pre""> </span>loating&nsp;</div><div><span class=""
pple-ta-span"" style=""white-space:pre""> </span>gas/flatulence&nsp;</div><div
><span class=""pple-ta-span"" style=""white-space:pre""> </span>diarrhea</div><
div><r /></div><div><div><>Diagnosis</>: Hydrogen Breath Test to measure H2 l
sorption
evels&nsp;in the reath.&nsp;</div><div><r /></div></div>"
What type of diarrhea results from lactose intolerance? Osmotic diarrhea
sorption
What type of inheritance pattern does lactose intolerance follow?
utosoma
sorption
l recessive
How does lactose intolerance result in osmotic diarrhea, flatulence, distension,
cramping, and adominal pain? "These symptoms are caused y malasored lactos
e which draws water into the intestinal lumen producing osmotic diarrhea, and y
the intestinal flora that metaolizes unasored lactose to H2, methane and CO2
.<div><img src=""paste-146793392242692.jpg"" /></div><div>SCF: Short chain fatt
y acids</div><div>Note: H2 is used in diagnosis</div>" sorption
Which enzymes secreted y the pancreas are endopeptidases? Exopeptidases?
Three of the enzymes are endopeptidases (trypsinogen, chymotrypsinogen, proelast
sorption
ase) and two are exopeptidases (procaroxypeptidase  and B).
What converts trypsinogen to trypsin? Enterokinase (in the rush order) and a
ctivated trypsin&nsp; sorption
Do the asolateral amino acid transporters rely on sodium gradients?&nsp;
sorption
Nope
There is virtually no asorption of peptides longer than ___amino acids Three
sorption
Why is it important for neworns to asor whole proteins?
This aility, wh
ich is rapidly lost, is of immense importance ecause it allows the neworn anim

al to acquire passive immunity y asoring immunogloulins in colostral milk.

sorption
Which transporter is in charge of asoring oligopeptides in the small intestine
?
PEPT1 (proton-oligopeptide transporter) sorption
Descrie protein asorption in the small intestine.
"<img src=""paste-148592
983539716.jpg"" />"
sorption
Which is faster: transport of oligopeptides or amino acids?
"<div>Oligopepti
sorption
des</div><img src=""paste-148743307395076.jpg"" />"
What causes Hartnups disease? What are the symptoms? "In Hartnup patients wit
h impaired asorption of amino acids such as histidine, tryptophan, and phenylal
anine, asorption rates in vivo are far greater when the amino acids are provide
d in dipeptides than when perfused in free form.<div>Hartnup disease symptoms in
clude a red, scaly rash and sensitivity to sunlight. One of the amino acids that
is not well asored is tryptophan, which the ody uses to make its own form of
niacin. This causes symptoms similar to those of pellagra. The diagnosis of Har
tnup disease is confirmed y a laoratory test of the urine which will contain a
n anormally high amount of amino acids (aminoaciduria).</div><div><img src=""pa
ste-149688200200196.jpg"" /></div>"
sorption
What causes cystinuria disease? What are the symptoms? "<div>Cystinuria is a di
sorder of the small intestine. In addition, there is a defect of the proximal tu
ules reasorption of filtered cystine and diasic amino acids (lysine, ornithine
, arginine). Cystinuria accounts for 1% of kidney stones and is produced y a va
riety of missense and frameshift mutations that cause the malfunction of the two
proteins that mediate transport of diasic and neutral amino acids in kidney. P
atients suffering from cystinuria lack sufficient intestinal transport of cystin
e and amino acids such as arginine and lysine. The latter is as an essential ami
no acid ut, surprisingly, the patients do not develop a lysine deficiency ecau
se they receive the essential lysine from the diet via the peptide transporter P
EPT1.&nsp;</div><div><img src=""paste-150482769149956.jpg"" /></div>" sorpti
on
Which ond in triglycerides is cleaved y lipases?
"Ester onds<div><img sr
sorption
c=""paste-151066884702212.jpg"" /></div>"
Which macronutrient has the highest energy content?
Triglycerides
sorpti
on
The major chemical constituents of dietary fat are _____
triglycerides
sorption
Why doesnt gastric lipase work in the duodenum? Why does it work in patients wi
th chronic pancreatitis?
Gastric lipase is denatured at neutral pH, thus
losing its activity in the duodenum. It may, however, attain a larger role in tr
iglyceride digestion in patients with chronic pancreatitis ecause duodenal pH i
s lower ecause of decreased pancreatic icaronate secretion. sorption
What does cleavage of triglycerides y gastric lipase produce? F and diglyceri
sorption
de
sorption
____ is the cofactor of lipase Colipase
List the pancreatic lipases
Lipase<div>Caroxyl ester lipase (esterase)</div
><div>Phospholipase 2</div><div>Colipase</div> sorption
____ is oligatory for the activation of pancreatic lipase
Colipase
sorption
What does colipase do? Lipase? Phospholipase 2? Cholesterol esterase? Colipase
is an oligate cofactor for lipase action. Colipase first attaches to a triglyc
eride (TG) molecule on the surface of an emulsion droplet and serves as an ancho
r for lipase, which then hydrolyzes ester onds and releases fatty acids (F) an
d monoglyceride (MG).&nsp;<div>Phospholipase 2 acts on phospholipids, principa
lly lecithin, to produce lysolecithin and fatty acids.&nsp;</div><div>Cholester
sorpti
ol esterase (CE) hydrolyzes fatty acid from cholesterol ester.</div>
on
T/F: loss of motility would have a ig effect upon asorption true
sorpti
on
Fat asorption from micelles across the memrane of the enterocyte is much ette
r if you have ______
"an alkaline/acidic interface<div><img src=""paste-15367

3929850884.jpg"" /></div>"
sorption
Descrie chylomicron synthesis in enterocytes. "The end products of lipid asor
ption in the enterocytes are chylomicrons and VLDL (very light density lipoprote
ins). poproteins -I, -IV, and B48 are synthesized in the endoplasmic reticulu
m (ER) and added to the surface of the lipid vesicles containing triglycerides (
TG), phospholipids (PL), and cholesterol ester (CE). The lipid vesicles are tran
sported to the Golgi, where the chylomicron &nsp;are formed and incorporated in
to secretory vesicles. These vesicles diffuse to the asolateral memrane where
the chylomicron particles are released y exocytosis. The particles diffuse to t
he central lacteal of the villus and are transported y lymphatics to the vascul
sorpti
ar compartment.<div><img src=""paste-154047592005636.jpg"" /></div>"
on
What is Olestra? What are some side effects?
<div> non-digestile polyol fat
ty acid polyester used as fat sustitute (contains sucrose instead of glycerol)<
/div><div><r /></div><div>May cause intestinal distress, OSMOTIC diarrhea, flat
ulence and&nsp;may prevent asorption of vitamins , D,E, K (since you have les
s fat in your diet which is needed to make the fat solule vitamins)</div><div><
r /></div>
sorption
What happens to the indigestile carohydrates once they reach the colon?
Indigestile carohydrates are partially roken down y enzymes in colonic acte
ria to short-chain fatty acids (acetate, propionate, and utyrate), which are ef
ficiently asored y the colonic mucosa. The short-chain fatty acids are import
sorption
ant metaolic sustrates for the mucosal cells in the colon.
Calcium asorption is active ____ and passive _____
"Calcium asorption is a
ctive <font color=""#FF0000"">only in the duodenum</font> and passive <font colo
r=""#FF0000"">throughout the small intestine</font>"
sorption
Duodenal active asorption of Ca is under the control of ____ Vitamin D
sorption
Descrie calcium asorption.
"Ca2+ enter via a channel and inds calindin, w
hich uffer intracellular Ca levels.  Ca pump nad a Na-Ca exchanger on the aso
lateral memrane of the duodenal cell extrude &nsp;Ca in the interstitial space
. Vit D, through genomic effects controls the synthesis of various proteins invo
lved in Ca asorption.<div><img src=""paste-156280974999556.jpg"" /></div>"
sorption
Descrie iron asorption.
"<img src=""paste-156521493168132.jpg"" />"
sorption
How does cholera cause SECRETORY diarrhea? How do you treat this?
"<img sr
c=""paste-156762011336705.jpg"" />"
sorption
Which vitamins and minerals are asored where along the GI tract?
"<img sr
sorption
c=""paste-156942399963141.jpg"" />"
___ is asored in the jejunum only. Whereas, ___ is asored in the ileum only.
(minerals/vitamins)
<div>Folate: jejunum only</div>Vitamin B12 (Coalamin):
sorption
ileum only
1. Whatre the first 2 things youll do when you enter the room?<div><r /></div
><div>HPI</div><div>1. Give each of the questions youll ask. (12)</div>
1. Wash hands and introduce yourself<div><r /></div><div>2. CC: 1. What rings
you in today?</div><div>OLD CRTS</div><div>2. When did it start? O</div><div><d
iv>3. Where is the pain? L</div></div><div>4. How long have you had the pain? D<
/div><div>5. Whats the pain like--shooting, staing, dull? C</div><div>6. What
makes it worse? </div><div>7. What makes it etter? R</div><div>8. How does it
change over the course of the day? T</div><div>9. Can you rate it on a scale of
1-10? S</div><div><r /></div><div>Their views:</div><div>10. What do you think
is the cause of the pain?</div><div>11. m I right in saying your expectations
for treatment are x....?</div><div>12. Whats your iggest concern with this pai
n? nything in particular you havent een ale to do?</div>
HXPE
PMH: what are its 6 components? 1. Other chronic medical prolems&nsp;(cancer,
asthma, diaetes, heart disease, high lood pressure, high cholesterol, GI prol
ems)<div>2. Major illnesses (serious infection, viral or acterial illness?)</di
v><div>3. Hospitalizations</div><div><r /></div><div>Dates, outcome, level of c
ontrol</div><div><r /></div><div><r /></div><div>4. Medications: dose, frequen

cy, route of administration.</div><div>5. ny over the counter medications, vita

mins, heral supplements?</div><div>6.. llergies: what happens?</div><div>7.. M
enstrual/OB history for women:&nsp;</div><div>-re you on your period?</div><di
v>-When was your last period?</div><div>-Do you have your period regularly?</div
><div>-How many days do they last?</div><div>-Do you have any spotting or irregu
lar leeding in etween periods?</div> HXPE
Personal/social history: Give 9 questions to ask.
<div>1. Do you smoke or
use any toacco products? How many cigarettes per day?</div><div>2. Do you drink
alcohol? How many drinks per week?</div><div>3. Do you use any recreational dru
gs? Have you ever used any recreational drugs or prescription drugs for non medi
cal reasons?</div><div><r /></div><div><r /></div>1. re you married? In a rel
ationship? ny kids?<div>2. Who do you live with? Do you feel comfortale and sa
fe where you live?</div><div>3. What do you do? Education?</div><div>4. Tell me
aout your diet.</div><div>5. Do you exercise? How much?</div><div>6. re you un
der a lot of stress lately? Have you recently experienced feelings of anxiety or
depression?</div><div>7. Do you have any spiritual eliefs you want us as your
health care providers to e aware of?</div><div><r /></div><div>1. Have you tra
veled out of the country recently or had any exposure to anyody who was sick?</
div><div>2. Do you if you work in an environment that might exposure you to toxi
c or hazardous chemicals?</div><div><r /></div><div><r /></div><div><div>1. to
acco</div><div>2. alcohol</div><div>3. rec drugs</div><div>4. married/single</d
iv><div>5. living situation</div><div>6. occupation</div><div>7. exercise diet</
div><div>8. spiritual eliefs</div><div>9. mood</div></div><div><r /></div>
HXPE
Family history:<div><r /></div><div>1. Who do you need to cover?</div><div>2. W
hat 2 pieces of information on each?</div>
1. Grandparents, parents, silin
gs, kids.<div><r /></div><div>2. ge (of death), cause of death/ongoing illness
</div> HXPE
What are the 3 components of vital signs?<div><r /></div><div>What are you goin
g to do all along as you go?</div>
1. Radial pulse 15 seconds<div>2. Respir
atory rate 15 seconds</div><div>3. Blood pressure</div><div><r /></div><div>TEL
L PTIENT WHT YOURE DOING ND THEIR VLUES</div>
HXPE
Cardiovascular exam: what are its 6 components? 1. Palpate carotid pulse<div>2.
Listen to carotid artery with BELL</div><div>3. Look at neck veins at 30 degree
angle.</div><div>4. Inspect chest with patient supine</div><div>5. Feel for PMI<
/div><div>6. Listen to heart valves. SY WHICH. USE BOTH DIPHRGM ND BELL ON T
RICUSPID ND MITRL.</div>
HXPE
Lung exam: give its 4 components.
1. Inspect chest. VERBLLY CKNOWLEGE.<d
iv>2. Excursion symmetry (3 reaths!)</div><div>3. Percuss ilaterally at 3 leve
ls</div><div>4. uscultate ilaterally ehind 4 levels, in front 4 levels</div>
HXPE
dominal exam: give its 9 components. 1. Expose adomen from xyphoid to puis-drape appropriately<div>2. Inspect adomen VERBLIZE. sk if any tenderness!</d
iv><div>3. Listen to 4 quadrants</div><div>4. Light palpation 4 quadrants (STTE
ND WTCH FCE)</div><div>5. Deep palpation 4 quadrants (STTE ND WTCH FCE)<
/div><div>6. Palpate liver edge (start low and go up)</div><div>7. Palpate splee
n edge</div><div>8. Percuss liver span</div><div>9. Percuss CV tenderness</div>
HXPE
"<img src=""Screen Shot 2012-11-21 at 9.21.33 PM (2).png"" />" "<img src=""Scre
en Shot 2012-11-21 at 9.21.33 PM.png"" />"
MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.23.11 PM (2).png"" />" "<img src=""Scre
en Shot 2012-11-21 at 9.23.11 PM.png"" />"
MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.25.59 PM (1).png"" />" "<img src=""Scre
en Shot 2012-11-21 at 9.25.59 PM.png"" />"
MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.26.48 PM (1).png"" />" "<img src=""Scre
en Shot 2012-11-21 at 9.26.48 PM.png"" /><>Notes at top</>" MetaolismGIMNER
Review
"<img src=""Screen Shot 2012-11-21 at 9.35.03 PM (2).png"" />" "<img src=""Scre
en Shot 2012-11-21 at 9.35.03 PM.png"" />"
MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.36.40 PM (1).png"" />" "<img src=""Scre

en Shot 2012-11-21 at 9.36.40 PM.png"" />"

MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.40.55 PM (1).png"" />" "<img src=""Scre
en Shot 2012-11-21 at 9.40.55 PM.png"" />"
MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.48.30 PM (1).png"" />" "Relatively impo
rtant chart.&nsp;<img src=""Screen Shot 2012-11-21 at 9.48.30 PM.png"" />"
MetaolismGIMNER Review
"<img src=""Screen Shot 2012-11-21 at 9.56.59 PM (1).png"" /><img src=""Screen S
hot 2012-11-21 at 9.57.17 PM (1).png"" />"
"Dont osess too much aout thi
s card. Be ale to identify the most ovious hormone/organ effects for multiple
choice question purposes. No need to memorize the whole chart.<img src=""Screen
Shot 2012-11-21 at 9.56.59 PM.png"" /><img src=""Screen Shot 2012-11-21 at 9.57.
17 PM.png"" />" MetaolismGIMNER Review
What is the tl;dr of the fed state?
"- glucose asored from intestines and
used y errthang, transported to liver to make glycogen and F<div>-  transpo
rted to muscle to make protein and to liver to make F&nsp;</div><div>- F tran
sported to liver as chylomicrons and from liver; F exported from liver as VLDL;
adipose makes TG from F and glucose</div><div>- insulin is primary hormone</di
v><div><img src=""Screen Shot 2012-11-21 at 10.55.02 PM.png"" /></div>" Metaoli
smGIMNER Review
What is the tl;dr of the post-asortive and fasted (3 to 24 hr) states?
"- glycogen roken down to glucose to fuel rain and RBCs ecause they cant use
fat<div>- muscle degrades protein and exports la and Gln<r /><div>- lactate f
rom RBCs, glycerol from adipose TG, la and Gln from muscle used in gluconeogene
sis to maintain healthy plasma glucose concentration</div><div>- gluconeogenesis
mainly done in liver using la, glycerol, and lactate</div><div>- gluconeogenes
is done somewhat (10%) in kidney using Gln</div><div>- everyone thats not rain
/RBC uses F through eta-oxidation for energy, sparing glucose</div></div><div>
- glucagon (glycogen reakdown) and norepinephrine (TG reakdown) are primary ho
rmones<img src=""Screen Shot 2012-11-21 at 11.02.47 PM.png"" /><img src=""Screen
Shot 2012-11-21 at 11.02.55 PM.png"" /><img src=""Screen Shot 2012-11-21 at 11.
03.05 PM.png"" /><img src=""Screen Shot 2012-11-21 at 11.03.14 PM.png"" /></div>
"
MetaolismGIMNER Review
What is the tl;dr of the prolonged starved (&gt;2 days) state? "- glycogen stor
es depleted<div>- liver uses acetyl-Co to make ketone odies to retain stores o
f CoSH for use in TC cycle and F oxidation</div><div>- most organs use ketone
odies in addition to F for prolonged starvation</div><div>- gluconeogenesis c
ontinues to supply rain and RBCs, and prevent hypoglycemia</div><div>- rain an
d RBCs use de novo glucose and ketone odies instead of F</div><div>- glucagon
and norepinephrine continue to e primary hormone<img src=""Screen Shot 2012-1121 at 11.12.12 PM.png"" /></div>"
MetaolismGIMNER Review
What is the tl;dr of the stressed state?
"- fuel storage molecules moili
zed for immediate energy<div>- TG roken down and F moilized from adipose y c
ortisol, EPI, and GH</div><div>- glycogen stores moilized y EPI (glucagon is n
ot significant in stressed state)</div><div>- gluconeogenesis stimulated y cort
isole and EPI</div><div>- muscle protein turnover increased through competition
of GH and cortisol<img src=""Screen Shot 2012-11-21 at 11.18.55 PM.png"" /></div
>"
MetaolismGIMNER Review
What is the tl;dr of the exercising state?
"- fuel storage molecules moili
zed for immediate energy<div>- TG roken down and F moilized from adipose y c
ortisol, EPI, and GH</div><div>- glycogen stores moilized y EPI</div><div>- gl
uconeogenesis stimulated y cortisole and EPI</div><div>- muscle protein turnove
r increased through competition of GH and cortisol</div><div><font color=""#ff00
15"">-<>&nsp;ody prefers F to glycogen long-term</></font></div>" Metaoli
smGIMNER Review
"<img src=""547_1067063469207_7981_n.jpg"" />" "Oh, Im sorry, did I reak your
concentration?<div><img src=""Jules.jpg"" /></div><div>I really am sorry. Here
is a kitty:</div><div>&nsp;<img src=""paste-3337189589712.jpg"" /></div>"
MetaolismGIMNER Review
nterior pituitary aka ...
adenohypophysis Hypothalamus&PosteriorPituitary
Posterior pituitary aka ...
Neurohypophysis Hypothalamus&PosteriorPituitary

Descrie regulation of the adenohypophysis y the hypothalamus. "<div>The hypoth

alamus secretes hormones into the portal system which is then picked up y the a
nterior pituitary. The hypothalamus projects long and and short axons down to th
e anterior pituitary. Short secretes into superior hypophyseal artery (long port
al vessels) while long secretes into the inferior hypophyseal artery (short port
al vessels).</div><img src=""paste-4213362917380.jpg"" />"
Hypothalamus&Pos
teriorPituitary
Descrie regulation of the neurohypophysis y the hypothalamus. "<div>Neurons in
the hypothalamus are making the hormones and then send them down the axon to e
released into the systemic circulation in the posterior pituitary. The posterio
r pituitary acts as a storage center fo the hypothalamic hormones efore they ar
e released. <font color=""#FF0000"">NOT  PORTL SYSTEM!</font></div><div><font
color=""#FF0000""><r /></font></div><div><font color=""#FF0000"">side: It is n
ot a portal system ecause the neurohypophysis is an emryological downgrowth of
the hypothalamus itself, and thus not a true gland unlike the adenohypophysis.
Communication of the two organs is primarily neural.</font></div><div><font colo
r=""#FF0000""><r /></font></div><div>nother aside: These neurons are called <f
ont color=""#ff0a1a"">magnocellular</font> <font color=""#ff0a1a"">neurons</font
>. They are very large, hormone-specific (i.e. DH-only or oxytocin-only) neuroe
ndocrine neurons whose large axonal fires arorize into over 10.000 neurosecret
ory terminals within the neurohypohysis. These terminals release the nascent hor
mones for storage until later release.</div><img src=""paste-5153960755204.jpg""
/>"
Hypothalamus&PosteriorPituitary
The hypothalamus receives inputs from ...
Higher rain centers<div>Diurnal
rhythms</div><div>djacent functional nuclei</div><div>utonomic nervous system
</div><div>Feedack</div>
Hypothalamus&PosteriorPituitary
Descrie regulation of the hypothalamic-pituitary-end organ axis.
"<div>Ev
erything feeds ack to everything aove it.</div><div>X can feedack y turning
off the release of XRH (stimulates the release of XTH) or turning on the release
of XIH (inhiits the release of XTH)</div><div>XTH: X trophic hormone</div><div
>XIH: X inhiiting hormone</div><div>XRH: X releasing hormone</div><div><img src
=""paste-7511897800708.jpg"" /></div>" Hypothalamus&PosteriorPituitary
What type of hormones does the hypothalamus secretes?
ll are peptide hormones
<div><r /></div>
Hypothalamus&PosteriorPituitary
List the hormones secreted y the hypothalamus. TRH<div>CRH</div><div>GnRH</div>
<div>GHRH</div><div>Somatostatin</div><div>Dopamin (prolactin inhiiting factor)
</div> Hypothalamus&PosteriorPituitary
List the hormones secreted y the anterior pituitary. FSH<div>LH</div><div>CT
H</div><div>TSH</div><div>Prolactin</div><div>Growth hormone</div><div>MSH</div>
Hypothalamus&PosteriorPituitary
List the hormones secreted y the posterior pituitary. Oxytocin<div>DH</div><d
iv><r /></div><div>Note: The posterior pituitary merely secretes them. It does
not synthesize them; the hypothalamus does.</div>
Hypothalamus&PosteriorPi
tuitary
List the hormones secreted y the thyroid.
T3<div>T4</div><div>Calcitonin</
div>
Hypothalamus&PosteriorPituitary
List the hormones secreted y the parathyroid. PTH
Hypothalamus&PosteriorPi
tuitary
List the hormones secreted y the kidney.
<div>calcitriol (proximal convol
uted tuule)</div><div><div>renin (juxtaglomerular cells of the afferent arterio
le)&nsp;</div><div>erythropoietin and thromopoietin (proximal convoluted tuul
es)</div><div>prostaglandins/prostacyclins (medullary interstitial cells with li
pid vesicles)</div></div><div><r /></div>
Hypothalamus&PosteriorPituitary
List the hormones secreted y the placenta.
HCG<div>Estriol</div><div>Proges
terone</div><div>hPL</div>
Hypothalamus&PosteriorPituitary
TRH stimulates the release of ...
TSH and prolactin (at high levels)
Hypothalamus&PosteriorPituitary
GnRH stimulates the release of ...
FSH and LH
Hypothalamus&PosteriorPi
tuitary
Name the two receptors which ind DH. Where is each found?
V1: endothelial

cells<div>V2: renal tuules</div>

Hypothalamus&PosteriorPituitary
Descrie the processing of posterior pituitary hormones (rememer: posterior pit
uitary hormones are from the projection of hypothalamic axons). Start in the hyp
othalamus as a prohomone ound to a neurophysin. They need to remain together in
order to e transported down without eing cleaved. s the transverse down the
stalk within the axons of the magnocellular neurons, the prohormone is cleaved f
rom the neurophysin. By the time they reach the posterior pituitary, they are co
mpletely separated (hormone + neuorphysin).
Hypothalamus&PosteriorPituitary
What is the origin of the posterior pituitary hormones (specifically)? Supraopt
ic nuclei: DH<div>Paraventricular nuclei: Oxytocin</div>
Hypothalamus&Pos
teriorPituitary
Compare the structure of DH and oxytocin? What aout their functions? Very sim
iliar structures, ut very different functions Hypothalamus&PosteriorPituitary
Descrie the two stimuli for DH release.
"<div>The osmotic stimulus is mo
re physiological and thus, more important. Only a small change in osmolality/osm
olarity is needed for a dramatic change in DH secretion, whereas the major poin
t of volume-dependent DH secretion is a loss of ~15%. The volume-dependent secr
etion of DH is usually a desperate countermeasure during trauma.</div><img src=
""paste-12519829667841.jpg"" /><div><img src=""paste-12605729013764.jpg"" /></di
v>"
Hypothalamus&PosteriorPituitary
How does plasma [DH] correleate with plasma osmolarity? What aout thirst?
"<div>More concentrated plasma -&gt; more release of DH (linear correlation). H
owever, DH levels do no rise at low plasma osmolarities. In addition, the thres
hold for thirst lags ehind the secretion of DH. Thirst acts as a ackup system
for controlling plasma osmolarity (Let the automatic system, DH, take control
first)</div><img src=""paste-13374528159748.jpg"" />" Hypothalamus&PosteriorPi
tuitary
Graphically descrie the control of plasma volume y DH.
"It takes a LRG
E amount (~15%) of lood volume depletion efore DH egins to kick in. Therefor
e, DH is more important in plasma osmolarity control than lood volume control.
&nsp;<div><r /></div><div>Use of DH for volume retention is a desperate count
ermeasure against volume loss during trauma.<r /><div><img src=""paste-14027363
188740.jpg"" /></div></div>"
Hypothalamus&PosteriorPituitary
How is DH ale to regulate plasma osmolarity via the kidneys? "<div>DH inds
to the V2 receptor on renal tuular cells. These are &nsp;Gs receptors which re
sults in -&gt; adenylate cyclase -&gt; cMP -&gt; PK -&gt; aquaporin-4 insertio
n into the lumenal memrane. s a result, water flows out of the renal tuules a
nd into the lood. This decreases the osmolarity of the lood (returns it ack t
o normal).</div><img src=""paste-14242111553540.jpg"" />"
Hypothalamus&Pos
teriorPituitary
Descrie the overall regulation of concentration of ody fluids.
"<img sr
c=""paste-14547054231556.jpg"" />"
Hypothalamus&PosteriorPituitary
"How does the ody respond to ""hypovolemic thirst""?" TII -&gt; stimulates th
e release of DH<div><r /></div><div>Other hypovolemic responses include the re
lease of aldosterone (retain H2O via Na+ reasorption) and cortisol (to reasor
H2O and Na+). These are all SNS responses.</div>
Hypothalamus&PosteriorPi
tuitary
NF -&gt
"How does the ody respond to ""hypervolemic"" water excretion?"
; stimulates the renal tuules to excrete more water<div>This pathway is potenti
ated y oxytocin</div> Hypothalamus&PosteriorPituitary
What are the major actions of oxytocin? Stimulates milk ejection from reasts an
d uterine contraction Hypothalamus&PosteriorPituitary
What are the major actions of DH?
Stimulates water reasorption in princip
al cells of collecting ducts (V2 receptors) and contriction of arterioles (V1 re
ceptors)
Hypothalamus&PosteriorPituitary
What is the affect of somatostatin release from the hypothalamus?
Inhiits
the release of GH and TSH (high levels)
Hypothalamus&PosteriorPituitary
What is the effect of dopamine release from the hypothalamus? Inhiits the rel
ease of prolactin<div>Note: dopamine is also called prolactin inhiiting factor
(ut I dout they would call it this on the exam)</div> Hypothalamus&PosteriorPi

tuitary
What is the neural and hormonal response to low lood volume (hypovolemia)?
1. ctivation of the SNS.<div>2. Hypothalamus releases CRH, anterior pituitary r
eleases CTH.&nsp;</div><div>3. Hypothalamus stimulates DH release from poster
ior pituitary.</div><div><div>4. CTH stimulates the adrenal glands to release c
ortisol from ZF of adrenal gland and aldosterone&nsp;from the ZG.</div></div><d
iv>5. The three final hormones (cortisol, DH, and aldosterone) increase lood v
olume through fluid retention (and also increase BP).</div>
PrinciplesofEndo
crinology
What road features differ endocrinology than standard physiology?
1. Many
endocrine organs scattered throughout the ody, sometimes within other organs (e
x: kidney or pancreas)<div>2. The structure/function anatomical paradigm usually
falls apart due to the decentralized synthesis, action, regulation, and physiol
ogy of hormones.</div><div>3. Hormones usually function at targets distal to the
ir synthetic origin.</div>
PrinciplesofEndocrinology
With regards to peptide and glycoprotein hormones, how important is their primar
y structure?
Not as important their secondary, tertiary, or quaternary confor
mations, although oviously the primary structure dictates their final superstru
cture. PrinciplesofEndocrinology
Descrie the overall process of hormone synthesis. Note which organelles are res
ponsile for which step of processing. Hint: their synthesis/processing is very
similar to other exocytotic pathways. "<img src=""Screen Shot 2012-11-23 at 3.
31.46 PM.png"" />"
PrinciplesofEndocrinology
Upon which cells do FSH and LH act?
LH: Leydig cells in men, ovarian interst
itial cells in women<div>FSH: Sertoli cells in men, follicular cells in women</d
iv>
nteriorPituitary
What is SRIF? Somatotrophic release inhiiting factor: it inhiits the release
of GH. nteriorPituitary
List a variety of homeostatic effects of Ca and P.
"<img src=""Screen Shot
2012-11-26 at 9.15.33 M.png"" />"
CalciumMetaolism
Why can Ca and P e considered hormones?
<div>Not inappropriate to consid
er these minerals hormones:</div><div>1. Signal transduction</div><div>2. Blood
transport</div><div>3. Homeostatic effects</div><div>4. Small molecules*</div><d
iv>5. Effects distal from site of uptake/processing</div><div><r /></div><div>*
small molecules are traditionally defined as non-macromolecular species, althoug
h peptide hormones are strangely exempt...</div>
CalciumMetaolism
"<div>History uilding requires(choose the est answer)</div><div><r /></div><di
v>. the physician to listen to and proe the patients story and context while men
tally organizing the iomedical pieces of the history&nsp;</div><div><span clas
s=""pple-ta-span"" style=""white-space:pre""> </span></div><div>B. the physicia
n to spend more time with each visit to foster the patient/physician interaction
</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></di
v><div>C. the physician to allow the patient to guide the encounter and focus on
the information the patient thinks is the most relevant.</div><div><r /></div><
div>D. ...the physician to otain the iomedical information from the patient th
rough a series of standard questions</div>"
KnowledgeExam
.
"<div>n empathic response to a patient distraught aout a new diagnosis of rea
st cancer might e</div><div><r /></div><div>. I can understand; this news is
devastating for you. How are you feeling?</div><div><r /></div><div>B. Its all p
art of Gods plan</div><div><span class=""pple-ta-span"" style=""white-space:pre
""> </span></div><div>C. Im sure everything will turn out OK.</div><div><span c
lass=""pple-ta-span"" style=""white-space:pre""> </span></div><div>D. My grand
mother had reast cancer.</div>"
.
KnowledgeExam
"<div>Mr. Jordan comes to your office for an insurance physical examination. &n
sp;s you perform auscultation of his chest, you think aout the lung anatomy an
d what loes are located in the various areas of the chest. &nsp;Which of the f
ollowing statements is accurate regarding your exam?</div><div><span class=""pp
le-ta-span"" style=""white-space:pre""> </span></div><div>. s you listen over
the anterior chest areas, you know that the upper loes of oth the left and ri
ght lungs are located under most of the anterior chest in ascially equal amount

s.</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></

div><div>B. s you listen over the posterior chest, you know you are listening o
ver the upper loes of the lungs in the upper part of the ack on each side and
to the lower loes of the lungs in the lower part of the ack on each side, with
the majority of the posterior chest wall overlying the upper loes.</div><div><
span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>C. s
you listen directly over the anterior chest areas, you know the right chest ove
rlies the upper loe in the upper area and the middle loe in the lower area, wh
ereas on the left, the majority of the left anterior chest wall overlies the lef
t upper loe.&nsp;</div><div><span class=""pple-ta-span"" style=""white-space
:pre""> </span></div><div>D. s you listen over the posterior areas, you know th
e upper loes are separated from the lower loes y the olique (major) fissure,
which starts in the midline approximately at the T10 spinous process.</div>"
"C.<div><img src=""paste-3886945404438.jpg"" /><r /><div><r /></div><div><r /
></div></div>" KnowledgeExam
"<div>Mr. Hernandez comes to you for a complete check up. He reports he is in go
od general health and says there are no particular prolems. You perform a cardi
ovascular examination. Which finding would e considered anormal in a healthy p
atient.</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </sp
an></div><div>. S4 was heard on examination</div><div><span class=""pple-ta-s
pan"" style=""white-space:pre""> </span></div><div>B. No S3 heard on examination
&nsp;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </spa
n></div><div>C. Neck: carotid pulsations were palpale ut the jugular pulsation
s were not palpale&nsp;</div><div><span class=""pple-ta-span"" style=""white
-space:pre""> </span></div><div>D. No ruits heard over carotid arteries&nsp;</
div>" .
KnowledgeExam
"<div>Mr. G. tells you that he has een coughing for ""a while."" &nsp;He used
to smoke ut reports that he stopped aout seven years ago. &nsp;You perform a
thorough exam. &nsp;Which of the following is a correct description of a compon
ent of the exam?</div><div><r /></div><div>. Percussion: You place your left h
and flat on the patients chest or ack. &nsp;The tip of the middle finger of t
he right hand is used to hit the MCP joint of the left hand to transmit sound th
rough the chest wall.&nsp;</div><div><span class=""pple-ta-span"" style=""whi
te-space:pre""> </span></div><div>B. Tactile fremitus: You place your stethoscop
e on the patients ack and ask them to say the word ninety nine. &nsp;You list
en for virations transmitted through the chest wall.&nsp;</div><div><span clas
s=""pple-ta-span"" style=""white-space:pre""> </span></div><div>C. Test chest
expansion: When checking for chest expansion, you place the thums at aout the
level of the 10th ris with your fingers loosely grasping and parallel to the ri
s.</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span><
/div><div>D. uscultation of the posterior chest: Standing to the right of the p
atient, you listen to a full reath sound at the right apex, then the right ase
, then the left apex, then the left ase, comparing top to ottom. &nsp;</div>"
C.
KnowledgeExam
"<div>Which is the most accurate statement regarding measurement of lood pressu
re?</div><div><r /></div><div>. Systolic pressure should e estimated first y
palpation of the radial artery while inflating the cuff.&nsp;</div><div><span
class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>B. The sys
tolic pressure y palpation is equal to the systolic pressure y auscultation.&n
sp;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span>
</div><div>C. For the average person, the lood pressure cuff should e inflated
to 200mmHg and then slowly deflated until the first Korotkoff sounds are heard.
&nsp;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </spa
n></div><div>D. The cuff should e deflated quickly (5mmHg/second) to avoid pati
.
ent discomfort</div>"
KnowledgeExam
"<div> 50 year old frican-merican woman comes to see you, and tells you, my ch
est hurts. &nsp;She descries the pain severity as 3 out of 10 and says it is no
t relieved y anything. s you examine her heart, you place the stethoscope appr
opriately to auscultate each heart valve. Which of the following statements est
descries your examination?&nsp;</div><div><span class=""pple-ta-span"" styl

e=""white-space:pre""> </span></div><div>. Place the stethoscope in the right 2

nd intercostal space for the mitral valve, left 2nd intercostal space for the tr
icuspid valve, lower left sternal order for the pulmonic valve, and apex for th
e aortic valve&nsp;</div><div><span class=""pple-ta-span"" style=""white-spac
e:pre""> </span></div><div>B. Place the stethoscope in the right 2nd intercostal
space for the aortic valve, left 2nd intercostal space for the pulmonic valve,
lower left sternal order for the tricuspid valve, and apex for the mitral valve
&nsp;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </spa
n></div><div>C. Place the stethoscope in the right 2nd intercostal space for the
pulmonic valve, left 2nd intercostal space for the tricuspid valve, lower left
sternal order for the mitral valve, and apex for the aortic valve&nsp;</div><d
iv><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>D
. Place the stethoscope in the right 2nd intercostal space for the pulmonic valv
e, left 2nd intercostal space for the aortic valve, lower left sternal order fo
r the tricuspid valve, and apex for the mitral valve&nsp;</div>"
B.
KnowledgeExam
"<div> middle-aged-man complains of persistent headaches for the past few weeks
. You take a careful history, perform an extensive physical exam focusing on neu
rological function, and order screening laoratory tests. ll findings and resul
ts are normal. fter you convey this good news, your patient continues to look w
orried. He is convinced he has something serious. He asks, How can you e positiv
e that these headaches are not related to a rain tumor? Which of the following s
tatements would e the most empathic response to your patient?</div><div><span c
lass=""pple-ta-span"" style=""white-space:pre""> </span></div><div>. You look
worried. I know that you are concerned aout the possiility of a rain tumor. C
an you help me understand the reason for your unease?</div><div><span class=""pp
le-ta-span"" style=""white-space:pre""> </span></div><div>B. You want to e posi
tive there isnt a rain tumor. While Im sure there is nothing to worry aout, I ca
n arrange for a CT and MRI for confirmation.</div><div><span class=""pple-ta-sp
an"" style=""white-space:pre""> </span></div><div>C. Let me reassure you once aga
in. There is no evidence of a rain tumor.</div><div><span class=""pple-ta-span
"" style=""white-space:pre""> </span></div><div>D. The chances of your having a 
rain tumor are extremely low. I think we should move on to treating your headach
e pain.</div>" .
KnowledgeExam
"<div> high-profile lawyer comes to see you for various prolems that seem to 
e related to recent stress in her work. &nsp;She is concerned aout her heart,
and you decide to perform a careful cardiovascular exam. &nsp;Which of the foll
owing statements est descries your exam?</div><div><r /></div><div>. You lis
ten to the left 2nd intercostal space with the ell to est hear split S2 and at
the lower left sternal order with the diaphragm to est hear split S1</div><di
v><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>B.
You listen to the right 2nd intercostal space with the ell to est hear split
S2 and at the apex to est hear S3</div><div><span class=""pple-ta-span"" styl
e=""white-space:pre""> </span></div><div>C. You listen to the left 2nd intercost
al space with the diaphragm to est hear split S2 and at the lower left sternal
order or apex to est hear S1</div><div><span class=""pple-ta-span"" style=""
white-space:pre""> </span></div><div>D. You listen to the left 2nd intercostal s
pace with the diaphragm to est hear split S1 and at the apex with the diaphragm
to est hear S3 and S4</div>" C.
KnowledgeExam
"<div>When measuring lood pressure, how long should the inflatale ladder of t
he lood pressure cuff e?</div><div><r /></div><div>. out 80% of the upper
arm circumference</div><div><span class=""pple-ta-span"" style=""white-space:p
re""> </span></div><div>B. out 60% of the upper arm circumference</div><div><s
pan class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>C. o
ut 20% of the upper arm circumference</div><div><span class=""pple-ta-span"" s
tyle=""white-space:pre""> </span></div><div>D. out 40% of the upper arm circum
ference</div><div><r /></div>" .
KnowledgeExam
"<div>Which of the following is the LEST appropriate reason to estimate lood p
ressure y palpation?</div><div><span class=""pple-ta-span"" style=""white-spa
ce:pre""> </span></div><div>. It saves time and is as accurate as listening for

Korotkoff sounds</div><div><span class=""pple-ta-span"" style=""white-space:p

re""> </span></div><div>B. It can prevent underestimating the systolic lood pre
ssure due to an auscultatory gap.</div><div><span class=""pple-ta-span"" style
=""white-space:pre""> </span></div><div>C. It provides an estimate of how high t
o raise the cuff pressure.</div><div><span class=""pple-ta-span"" style=""whit
e-space:pre""> </span></div><div>D. Using the estimate pressure and adding 30 mm
Hg pressure to it as the target for inflation prevents discomfort from unnecess
.
arily high cuff pressures.</div><div><r /></div>"
KnowledgeExam
"<div>Which of the following statements aout measuring a persons temperature i
s CORRECT?</div><div><r /></div><div>.  persons oral temperature remains rel
atively stale throughout the day.</div><div><r /></div><div>B. Rectal temperat
ures are higher than oral temperatures y an average of 0.4 to 0. 5 degrees Cesi
us</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></
div><div>C. xillary temperatures are generally higher than oral temperatures y
approximately 1 degree Celsius.</div><div><span class=""pple-ta-span"" style=
""white-space:pre""> </span></div><div>D. xillary temperatures are the easiest
and most reliale measurements of temperature.</div>" B.
KnowledgeExam
"<div> 17 year old varsity asketall player comes to see you for his annual sp
orts physical. &nsp;s you examine his heart, which of the following est descr
ies the correct use of the stethoscope?</div><div><span class=""pple-ta-span"
" style=""white-space:pre""> </span></div><div>. Use the diaphragm in all 4 val
ve areas and the ell at the left lower sternal order and the apex</div><div><s
pan class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>B. Use
the diaphragm only along the right and left sides of the sternum and the ell i
n all other areas</div><div><span class=""pple-ta-span"" style=""white-space:p
re""> </span></div><div>C. Use only the diaphragm in all areas</div><div><span c
lass=""pple-ta-span"" style=""white-space:pre""> </span></div><div>D. Use only
.
the ell in all areas</div>"
KnowledgeExam
"<div>The process of interviewing differs significantly from the format often us
ed to record the health history. Which of the following is the most accurate?</d
iv><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><
div>. sking a series of direct questions (onset, location...) is the most effi
cient way of otaining information aout a patients chief complaint.</div><div>
<span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>B. I
nterviewing requires not only knowledge of the data you need to otain, ut also
the aility to elicit accurate information using skills that allow you to respo
nd to the patients feelings and concerns.</div><div><span class=""pple-ta-spa
n"" style=""white-space:pre""> </span></div><div>C. When presenting orally to an
attending, you should try to tell the story exactly as the patient told it.</di
v><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><d
iv>D. ll questions asked to a patient should e open ended to avoid manipulatin
g the story.&nsp;</div>"
B.
KnowledgeExam
"<div>What is the patients explanatory model?</div><div><span class=""pple-ta
-span"" style=""white-space:pre""> </span></div><div>. The patients ideas aou
t what is wrong, how it came to happen and what ought to e done aout it.</div>
<div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div
>B. The patients explanation of who he is and what his interests are.&nsp;</di
v><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><d
iv>C. The diagram or model used to explain a iomedical illness to a patient.</d
iv><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><
div>D. The patients explanation of why she has not een compliant with treatmen
.
t recommendations.</div>"
KnowledgeExam
"<div>Which of the following influences inform the the scope and detail of the h
ealth history you would elicit from a patient?</div><div><span class=""pple-ta
-span"" style=""white-space:pre""> </span></div><div>. The nature of the patien
ts concerns</div><div><span class=""pple-ta-span"" style=""white-space:pre"">
</span></div><div>B. The amount of time availale</div><div><span class=""pple
-ta-span"" style=""white-space:pre""> </span></div><div>C. The clinical setting
(i.e. inpatient vs. outpatient)</div><div><span class=""pple-ta-span"" style=
""white-space:pre""> </span></div><div>D. The clinicians goals for the encounte

r</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></d

iv><div>E. ll of the aove</div>"
E.
KnowledgeExam
"<div>Which of the following is NOT one of the seven key attriutes of a symptom
?</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></d
iv><div>. Location</div><div><span class=""pple-ta-span"" style=""white-space
:pre""> </span></div><div>B. Quality</div><div><span class=""pple-ta-span"" st
yle=""white-space:pre""> </span></div><div>C. Severity</div><div><span class=""
pple-ta-span"" style=""white-space:pre""> </span></div><div>D. Patient perspect
ive</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span><
/div><div>E. Timing</div>"
D.
KnowledgeExam
"<div>Your preceptor, Dr. Edward Wilson, asks you to interview an adult patient
named Sue Ellen Connor who has come into the office. Which of the following stat
ements est descries how you should introduce yourself to the patient?</div><di
v><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>.
""Hi there. Im working with Dr. Smith today and Id like to ask you a few ques
tions.""</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </s
pan></div><div>B. ""Hi Ms. Connor. My name is John Smith, and I am a first-year
medical student working with Dr. Wilson. Id like to talk with you aout why you
ve come for your visit today.""</div><div><span class=""pple-ta-span"" style=
""white-space:pre""> </span></div><div>C. ""Hi Sue Ellen. My name is John Smith,
and I am a first-year medical student working with Dr. Wilson. Id like to talk
with you aout why youve come for your visit today.""</div><div><span class=""
pple-ta-span"" style=""white-space:pre""> </span></div><div>D. ""Hi Ms. Connor
. Im a first-year medical student working with Dr. Wilson. Id like to talk wit
h you aout why youve come for your visit today.""</div>"
B.
Knowledg
eExam
"<div>Mr. Lan comes to your clinic for evaluation of some vague adominal discom
fort that he has een experiencing. You ask him to show you where it hurts and h
e points to an area in his mid adomen. &nsp;You rememer that clinicians divid
e the adomen y imaginary lines into sections. Which statement est descries t
hese divisions?</div><div><span class=""pple-ta-span"" style=""white-space:pre
""> </span></div><div>. The adomen is often divided into 4 sections or can e
divided into 9 sections</div><div><span class=""pple-ta-span"" style=""white-s
pace:pre""> </span></div><div>B. The adomen is often divided into 4 sections or
can e divided into 8 sections</div><div><span class=""pple-ta-span"" style="
"white-space:pre""> </span></div><div>C. The adomen is often divided into 2 sec
tions or can e divided into 6 sections</div><div><span class=""pple-ta-span""
style=""white-space:pre""> </span></div><div>D. The adomen is often divided in
to 4 sections or can e divided into 3 sections</div><div><r /></div>" .
KnowledgeExam
"<div>Ms. Kay comes to your preceptors office for a general examination. Your p
receptor asks you to talk with Ms. Kay and perform an examination. During the a
dominal examination, several normal structures may e palpale. Which of the fol
lowing statements accurately descries possile normal findings?</div><div><span
class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>. Patien
ts distended ladder is palpale aove the symphysis puis and the liver edge i
s palpale in the right upper quadrant.</div><div><span class=""pple-ta-span""
style=""white-space:pre""> </span></div><div>B. The duodenum and pancreas are p
alpale in the upper adomen</div><div><span class=""pple-ta-span"" style=""wh
ite-space:pre""> </span></div><div>C. The sigmoid colon is palpale in the the l
eft lower quadrant &nsp;and the appendix is palpale in the right lower quadran
t.</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></
div><div>D. ortic pulsations are palpale in the left lower adomen and the gal
lladder is palpale in the right upper quadrant.</div>"
Knowledg
.
eExam
"<div>You are asked y your preceptor to examine Mr. Sosa, who reports he has e
en having some adominal pain for aout two days. Which of the following is a co
mponent of a thorough adominal exam?</div><div><span class=""pple-ta-span"" s
tyle=""white-space:pre""> </span>&nsp;</div><div>. Palpate the adomen with o
th light and deep palpation over entire adomen examining an area of known disco

mfort last.</div><div><span class=""pple-ta-span"" style=""white-space:pre"">

</span></div><div>B. Palpate the adomen with oth light and deep palpation over
entire adomen except for the liver (RUQ) and ladder &nsp;(suprapuic) areas
where only light palpation should e used to avoid patient discomfort.</div><div
><span class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>C.
Measure the liver span y percussing for dullness in the midsternal line.&nsp;<
/div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div
><div>D. Palpate the adomen in all four quadrants and then auscultate in those
same four areas.&nsp;</div>"
.<div><r /></div><div><div>uscultation should
e done efore palpation. &nsp;Light and deep palpation should e performed in
all four quadrants. It is preferale to palpate a known area of pain last to av
oid patient discomfort and guarding. The liver span is measured in the midclavic
ular line.&nsp;</div></div>
KnowledgeExam
"<div>Which of the following statements est descries examination of a normal l
iver?</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span
></div><div>. Place your left hand ehind the patient, parallel to and supporti
ng the right 11th and 12th ris. &nsp;Palpate with your right hand while the pa
tient exhales.&nsp;</div><div><span class=""pple-ta-span"" style=""white-spac
e:pre""> </span></div><div>B. Measure the vertical span of liver dullness at the
anterior axillary line</div><div><span class=""pple-ta-span"" style=""white-s
pace:pre""> </span></div><div>C. The ""hooking"" technique may e helpful for pa
lpation of the liver, especially when the person is very oese.</div><div><span
class=""pple-ta-span"" style=""white-space:pre""> </span></div><div>D. When pe
rcussed at the midclavicular line, the liver span would e expected to e 4-8 cm
.&nsp;</div>" "C.<div><r /></div><div><div>By convention, the vertical span o
f the liver should e measured in the mid-clavicular line. The normal liver span
at the mid-clavicular line is 6-12 cm. The hooking technique is especially usef
ul when the patient is oese. Pressing the left hand forward in the descried lo
cation can assist with palpation of the liver, however, the patient should inhal
e and ""reathe with the adomen"" to facilitate palpation.</div></div>"
KnowledgeExam
"<div>Mr. Vuletich comes to your office complaining of intermittent adominal pa
in and nausea. s you prepare to examine his adomen, you think aout what you m
ight expect to find when percussing the adomen. Which of the following statemen
ts est descries a normal adominal exam?</div><div><span class=""pple-ta-spa
n"" style=""white-space:pre""> </span></div><div>. s you percuss the adomen,
you expect to find tympany over areas of gas in the adomen</div><div><span clas
s=""pple-ta-span"" style=""white-space:pre""> </span></div><div>B. s you perc
uss the adomen, you expect to find tympany over the liver.</div><div><span clas
s=""pple-ta-span"" style=""white-space:pre""> </span></div><div>C. s you perc
uss the adomen, you expect to find flatness over areas of gas in the adomen.</
div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span></div>
<div>D. s you percuss the adomen, you expect to find resonance over all areas
of the adomen.</div>" .
KnowledgeExam
1. Visualize the lung loes in your head.<div><r /></div><div>2. Whats another
name for the major fissue? What does it run from and to?</div><div><r /></div>
<div>3. The majority of the posterior chest wall overlies which loes of the lun
gs?</div>
"<div>1.&nsp;<img src=""paste-3886945404438.jpg"" /></div><div>
<r /></div><div>2. The <>olique (major) fissure</>, which may e approximate
d y a line that runs <>from the T3 spinous process oliquely down and around t
he chest to the 6th ri at the midclavicular line</>. &nsp;</div><div><r /></
div><div>3. The majority of the posterior chest wall overlies the <>lower</> l
oes of the lungs.</div>"
KnowledgeExam
1. When relative to S1 and S2 do you hear S3? S4?<div><r /></div><div>2. What d
oes S3 indicate? (normal and pathologic)</div><div><r /></div><div>3. What does
S4 indicate?</div><div><r /></div><div>4. Which heart sounds can e split?</di
v>
<div>1. S3: just after S2;&nsp;</div><div>S4: just efore S1</div><div>
<r /></div><div>2.Normal in children:<>&nsp;rapid deceleration of the column
of lood against the ventricular wall;</>&nsp;Pathologic in adults:&nsp;&nsp
;<>change in ventricular compliance.</></div><div><r /></div><div>3. S4 signi

fies <>forceful contraction of the atria against an anormally stiff ventricle.

&nsp;</></div><div><r /></div><div>4. <>Both S1 and S2</> may e slightly s
plit, although splitting of <>S1</> is much <>less common</>.&nsp;</div>
KnowledgeExam
1. Descrie the parts of your hands you use for chest percussion.<div><r /></di
v><div>2. How is tactile fremitus tested?</div> "1. Place <>only the DIP of you
r left middle finger </>on the area to e percussed. &nsp;You then aim the tip
of your <>right middle finger</> to percuss at the <>DIP joint</>.&nsp;<di
v><r /></div><div>2.&nsp;<>Tactile fremitus</> is tested y feeling the the
virations of a patient saying ""<>ninety nine</>"" with the all or <>ulnar
surface </>of your hand on the chest wall.</div>"
KnowledgeExam
When measuring lood pressure, the cuff should e deflated slowly at approximate
ly ___ mmHg/second.
2-3 mmHg/second KnowledgeExam
Where should you listen for each of these sounds? With the diaphragm or ell?<di
v><r /></div><div>S1 louder than S2</div><div>S2 louder than S1</div><div>S2 sp
litting</div><div>S3 and S4</div>
<div>S1 louder than S2: <>apex</></div
><div>S2 louder than S1: <>ase</></div><div>S2 splitting: <>Pulmonic valve</
> (left 2nd intercostal space)</div><div>S3 and S4: <>pex</> or<> left lowe
r sternal order </>with the&nsp;<>ell</></div>
KnowledgeExam
Give the recommended <>length</> and <>width</> of the inflatale ladder on
the lood pressure cuff.
Length: <>80</>% of upper arm circumference<di
v><r /></div><div>Width: <>40</>% of upper arm circumference</div> Knowledg
eExam
1. What is the average ody temperature in Celsius?<div><r /></div><div>2. How
does it vary throughout the day?</div><div><r /></div><div>3. Compare axillary
temperature and rectal temperatures to oral temperatures.</div> 1. <>37<sup>o</
sup>C</><div><r /></div><div>2. Early morning: as low as <>35.8^oC<
/></div><div>Late afternoon/evening: as high as <>37.3^oC.</></div>
<div><><r /></></div><div>3. xillary: <>1^oC lower</> than oral;
<>less accurate</> than other measures</div><div>Rectal: <>0.4 to 0.5<sup>o<
/sup>C higher</> than oral</div>
KnowledgeExam
1. What pitch of sounds is the diaphragm good at picking up? Give the specific s
ounds it should e used for.<div><r /></div><div>2. What aout the ell?&nsp;G
ive the specific sounds it should e used for.</div>
1. Diaphragm: <>High</
>-pitched; <>S1, S2</>, some murmurs.<div><r /></div><div>2. Bell: low-pitche
d; <>S3, S4</>, murmurs like <>mitral stenosis</>.</div>
KnowledgeExam
Give 3 adominal organs that are commonly palpale in patients. Give their locat
ions.<div><r /></div><div>Give 2 that are sometimes palpale.</div><div><r /><
/div><div>Give 4 that arent typically palpale.</div> Common:&nsp;<div>1. Liv
er edge (RUQ)</div><div>2. Sigmoid colon (LLQ)</div><div>3. ortic pulsations (u
pper adomen; thin patients)</div><div><r /></div><div>Sometimes:</div><div>1.
Distended uterus (during pregnancy)</div><div>2. Distended ladder</div><div><r
/></div><div>Not normally palpale:</div><div>1. Pancreas</div><div>2. Duodenum
</div><div>3. Gallladderr</div><div>4. ppendix</div><div><r /></div> Knowledg
eExam
What is a normal liver span at the midclavicular line? 6-12 cm KnowledgeExam
Which predominates when percussing the adomen: tympany or dullness?
<>Tympa
ny usually predominates </>ecause of gas in the gastrointestinal tract, ut <
>scattered areas of dullness from fluid and feces are also typical</>. Therefor
e, it is most accurate to say that tympany is expected over areas of gas or air.
&nsp;<div><r /></div><div>Dull percussion notes are expected over masses, such
as the liver.</div>
KnowledgeExam
From which germ layer do the primordial germ cells originate? What do they do?
Endoderm; induce development of gonad into ovary or testis<div><r /></div>
ReproductiveTractI
When is sex assigned and what is the genetic determinant?
Morphological ch
aracteristics appear at 7 weeks (germ cell invasion at 6 weeks) and the Y-chromo
some determines differentiation into male. The father determines the gender.
ReproductiveTractI
Descrie in detail how the Y-chromosome determines sex. SRY gene at Yp11 produce

s testis-determining factor (TDF) to alter default female sex to male sex.

ReproductiveTractI
What happens after the primordial germ cells invade the gonadal/genital ridges i
n the 6th week? "Epithelium penetrates underlying mesenchyme to form irregular p
rimitive sex cords, cordlike masses of epithelial tissue that later form the sem
iniferous tuules and rete testes in the male, and the primary ovarian follicles
and rete ovarii in the female.<img src=""Screen Shot 2012-11-26 at 6.20.42 PM.p
ng"" />"
ReproductiveTractI
Descrie the differentiation of the primitive gonad into the primitive ovary.
"The germinal/coelomic epithelium thickens and the mesenchyme involutes.<div> &ns
p;Primitive medullary cords dissociate and are replaced y stroma<div> &nsp;Surfa
ce epithelium continues to proliferate giving rise to a second generation of cor
tical cords</div><div><img src=""Screen Shot 2012-11-26 at 6.24.11 PM.png"" /><i
mg src=""Screen Shot 2012-11-26 at 6.24.19 PM.png"" /> &nsp;\</div></div>"
ReproductiveTractI
Descrie the differentiation of the primitive gonad into the primitive testis wi
th the effect of TDF. "The epithelium thins out and the mesenchymal sex cords
ecome more complex and tortuous.<img src=""Screen Shot 2012-11-26 at 6.24.11 PM
.png"" /><img src=""Screen Shot 2012-11-26 at 6.24.19 PM.png"" />"
Reproduc
tiveTractI
In the testis, what separates the testis cords from the surface epithelium?&nsp
;<div>Hint: in the adult, it separates the loules of seminiferous tuules.</div
>
Tunica aluginea
ReproductiveTractI
From where do the Sertoli and Leydig cells originate? Sertoli cells from surfa
ce epithelium<div>Leydig cells from mesenchyme</div>
ReproductiveTractI
From where do the vas deferens originate?
Mesonephric duct (mesoderm)
ReproductiveTractI
When do the seminiferous tuules acquire lumens?
Puerty, solid eforehan
d.
ReproductiveTractI
From what does the fallopian tue derive?
Paramesonephric (Mullerian) duct
ReproductiveTractI
What are the two genital duct systems and in which genders do they persist?
Mesonephric or Wolffian duct: male<div>Paramesonephric or Mullerian duct: female
</div> ReproductiveTractI
How does the SYR gene transform the female duct system to the male duct system?
Sertoli cell sceretes of MIS (Mullerian inhiitory sustance), which causes Mull
erian/paramesonephric ducts to involute.
ReproductiveTractI
What are the developmental roles of testerone and dihydrotesterone?
<div> &n
sp;Testosterone mediates virilization (masculinization) of the mesonephric duct.
</div><div> &nsp;DHT acts on the external genitalia.</div><div><div>In the asenc
e of androgens, external genitalia are&nsp;stimulated y maternal estrogens.</d
iv><div> &nsp;differentiate into a clitoris, laia majora, laia minora, and dis
tal vagina</div><div> &nsp;In the asence of MIS, the mullerian ducts develop in
to uterus and uterine tues.</div></div>
ReproductiveTractI
fter the paramesonephric (Mullerian) duct atrophies in the male, what are its r
emnants?
prostatic utricle and appendix testis ReproductiveTractI
How does the uterus form?
"Paramesonephric (Mullerian) ducts swing anterio
rly and medially and fuse and expand cavity at fusion point.<img src=""Screen Sh
ot 2012-11-26 at 7.34.13 PM.png"" />" ReproductiveTractI
From what structures does the vagina derive?
"<div>distal 2/3 of vagina from
paramesonephric tuercle of urogenital sinus (endoderm)</div><div>proximal 1/3 f
rom Mullerian/paramesonephric duct<img src=""Screen Shot 2012-11-26 at 7.38.44 P
M.png"" /></div>"
ReproductiveTractI
Compare and contrast Ca and P levels in the loodstream.
Both are tightly
regulated.&nsp;<div><r /><div>Ca has a very narrow [Ca] range in the loodstr
eam and faithfully reflects Ca homeostasis in the ody.</div></div><div><r /></
div><div>P has wider range due to the difficulty of measuring it.</div> CalciumM
etaolism
Why do P levels appear to vary more than Ca levels?
Phosphorus levels<div>1)
are more dependent upon dietary intake</div><div>2) are not as easily measured<

/div><div>3) are present in multiple isoforms due to the multiprotic nature of p

hosphoric acid (H3PO4, H2PO4(-), HPO4(-2), PO4(-3))</div>
CalciumMetaolis
m
"Descrie how protein levels, as a ""crude"" non-hormonal method, can regulate 
lood [Ca]."
50% of lood Ca is free as Ca+2, 50% is ound to proteins (alum
in or prealumin for example).<div><r /></div><div>These protein levels can cha
nge in pathologies such as&nsp;</div><div>1) hepatitis: increase in lood prote
ins, more Ca inding, transient decrease in [Ca]</div><div>2) cirrhosis: decreas
e in protein levels, less Ca inding, transient increase in [Ca]</div><div><r /
></div><div>These changes are transient due to overriding hormonal regulation.</
div>
CalciumMetaolism
Descrie how pH can regulate lood [Ca].
Protein charge states are depend
ent upon the surrounding pH due to laile protons (with certain pKas).<div><r /
><div>lkalemia will deprotonate proteins, rendering them more negative and faci
ltating inding with Ca+2.</div><div><r /><div>cidemia will protonate proteins
, adding more positive charges and precluding Ca+2 inding.</div></div></div>
CalciumMetaolism
Descrie the relationship etween Ca and P levels in the lood. What happens if
this relationship deviates from normal? Both have roughly reciprocal lood conce
ntration activity, represented y the Ca-P product that is usually ~40 mg/dL.<di
v><r /></div><div>n increase in one will decrease the other to ensure the Ca-P
product remains at ~40 mg/dL.</div><div><r /></div><div>Failure to control thi
s could lead to excess levels of the ions, leading to excess complexation etwee
n them, and formation of salts that could calcify and damage tissue.</div>
CalciumMetaolism
Why does the Ca and P turnover in one must e perfectly alanced?
Depositi
on and resorption must e alanced to avoid anormal net change in one mass and
to prevent one death. CalciumMetaolism
What organ is responsile for most of Ca regulation?
kidney CalciumMetaolis
m
Which organ(s) give a fixed contriution to extracellular Ca levels?
Dead cel
ls give a fixed amount of Ca. CalciumMetaolism
With regards to whole-ody turnover etween different organ systems, why is P tu
rnover looser than that of Ca? P asorption is more variale due to variations
in the diet.
CalciumMetaolism
Which hormones are involved in Ca regulation? PTH<div>1,25-(OH)2 D3 (activated
Vit D)</div><div>calcitonin</div><div>FGF-23</div>
CalciumMetaolism
Graphically descrie the reciprocal regulation of lood [Ca] y PTH and calciton
in. Which hormone is more potent?
"lthough they have acute reciprocal eff
ects on [Ca], PTH is much more potent than CT.<img src=""Screen Shot 2012-11-26
at 9.39.50 PM.png"" />" CalciumMetaolism
Descrie the Ca-sensing receptor (CaSR) and how it increases PTH secretion in re
sponse to a drop in lood [Ca]. Present in the parathyroids chief cells and cer
tain renal tuular cells, the Ca-sensing receptor (CaSR) is highly modified Gq r
eceptor complex. side from the standard seven transmemrane domains, its C-term
inus sticks out into the lumen as a trap for divalent ions and inds Ca+2 normal
ly.<div><r /></div><div>When Ca+2 levels drop, the Gq/PLC/IP3 cascade is activa
ted and PTH is secreted. This response can e turned off y an increase in Ca+2
levels (negative feedack) or activated vitamin D.</div>
CalciumMetaolis
m
Descrie the effects of PTH. This is an important concept.
"<div>Direct eff
ects:</div>1) resorption of Ca from one<div>2) reasorption of Ca from distal r
enal tuules</div><div>3) less reasoprtion of PO4(-3) in PCT</div><div>Indirect
effect:</div><div>4) activate 1-alpha-hydroxylase, which converts 25-OH D3 to 1
,23-(OH)2-D3 (activated vitamin D), goes to the intestine to increase Ca asorpt
ion</div><div><r /></div><div>Net effect: increase plasma [Ca], decrease [P].</
div><div><r /></div><div>This is a very important figure.</div><div><img src=""
Screen Shot 2012-11-26 at 9.44.47 PM.png"" /></div>"
CalciumMetaolism
Upon which organ(s) does PTH have the most acute effects?
"Kidneys and res
orption of Ca and excretion of P.<img src=""Screen Shot 2012-11-26 at 10.07.21 P

M.png"" />"
CalciumMetaolism
Descrie the effects of calcitonin. s with PTH, this is an important concept.
"1) decrease one resorption of Ca<div>2) decrease distal renal reasorption of
Ca</div><div>3) decrease phosphate renal reasorption</div><div>Net effect: decr
ease oth phosphate and Ca plasma levels.<img src=""Screen Shot 2012-11-26 at 10
.11.06 PM.png"" /></div>"
CalciumMetaolism
Why is it not useful to consider PTH and CT as antagonistic hormones? Principa
lly, they are oth trying to achieve the same goal of homeostasis.<div><r /></d
iv><div>The other reasons are:</div><div>1) CT is much less potent than PTH at a
ffecting lood [Ca]</div><div>2) oth work to decrease plasma [P]</div><div>3) o
nly PTH affects the intestines</div>
CalciumMetaolism
How can vitamin D ecome more potent? "D3 can y hydroxylated at C25 (in the l
iver) and again at C1 (in the kidney) to form activated vitamin D, 1,25-(OH)2-D3
.<div><r /></div><div>Each hydroxylation step adds another hydroxyl group* that
dramatically increases the potency of vitamin D (~10x per OH).</div><div><r />
</div><div>*more OH groups allow additional H-onds that facilitate tighter ind
ing of vitamin D to its receptor.<img src=""Screen Shot 2012-11-26 at 10.25.31 P
M.png"" /></div>"
CalciumMetaolism
What is the significance of 1-alpha-hydroxylase and what regulates it? It is th
e kidney enzyme that converts 25-OH D3 to 1,25-(OH)2 D3, activated vitamin D.&n
sp;<r /><r />It is activated y&nsp;<div>1) PTH stimulation, which then allow
s it to go to the intestine and increase Ca asorption</div><div>2) decreased pl
asma phosphate levels</div><div>3) (least important) lower plasma Ca levels</div
><div><r /></div><div>It is deactivated y FGF 23.</div>
CalciumMetaolis
m
What are the gloal physiological effects of thyroid hormones? -rates of growth
<div>-rates of metaolism</div><div>-thermogenesis (maintain optimal core ody t
emperature)</div>
ThyroidPhysiology
From what germ layer do the primitive sex cords derive? mesoderm
Reproduc
tiveTractII
What are the two remnants of the mesonephric (Wolffian) duct in the female?
Epoophoron and Gartners cyst.<div><r /></div><div>The former can develop into
a paraovarian cyst.</div><div><r /></div>
ReproductiveTractII
Descrie the Wolff-Chaikoff and Jod Baselow phenomena. Which one is pathological
?
Wolff-Chaikoff: uptake of excess iodine will cause the thyroid to decrea
se synthetic activity to prevent hyperthyroidism (from excess thyroid hormone se
cretion). It is normal ut does have limits to how much excess iodine uptake it
can handle.<div><r /></div><div>Jod Baselow: <>pathological</>&nsp;hyperthyr
oidism following high uptake of iodine. The thyroid cannot compensate y decreas
ing its synthetic activity (as in Wolff-Chaikoff) and too much thyroid hormones
are secreted.</div>
ThyroidPhysiology
Briefly descrie the thyroids autoregulation. Initial iodine uptake (given a l
ot of iodine) is moderate (10-15%), ut susequent infusions have higher uptake
(~90%), ut <>there</> <>is no shift in the hypothalamic-pituitary-thyroid ax
is</>. No higher regulation is required.
ThyroidPhysiology
How are the external genitalia formed? <div> &nsp;Formed y mesenchymal cells a
round the cloacal memrane (which is endodermal)</div><div> &nsp;Undifferentiate
d y the 6th week</div> ReproductiveTractII
What is primary genetic determinant of male external genitalia? DHT
Reproduc
tiveTractII
What forms the scrotum? What is the analogous strucuture in the female? Laioscr
otal swellings that form the laia majora in the female.
ReproductiveTrac
tII
What forms the laia minora in the female? Their anaologous structure(s) in the
male? Urogenital folds that close to form the penile urethra and penile raphe
in the male.
ReproductiveTractII
From what does the distal portion of the penile (spongy) urethra derive?
Endodermal lower part of the urogenital sinus. ReproductiveTractII
What forms the glans penis?
<div>Ectodermal cells from the tip of the glans
penetrate to form a solid epithelial cord</div> ReproductiveTractII

With hypospadias or epispadias, why should these oys not e circumcised?

The extra tissue of the foreskin is used to replace the urethral wall. Reproduc
tiveTractII
From where does the clitoris derive?
Primitive glans of genital tuercle elon
gates slightly. ReproductiveTractII
From where do the laia minora derive? Non-fusion of the urethral/urogenital fo
lds.
ReproductiveTractII
From where do the laia majora derive? Enlargement of laioscrotal swellings.
ReproductiveTractII
What forms the female vestiule?
The open urogenital groove.
Reproduc
tiveTractII
What are the consequences of a karyotype with 47 XXY? Klinefelter syndrome: st
ill male due to Y chromosome.<div><r /></div><div><div> &nsp;Infertile</div><di
v> &nsp;Gynecomastia</div><div> Impaired sexual maturation <r /> &nsp;underandro
genization</div></div> ReproductiveTractII
What are consequences of 45 XO karyotyping?
Turner syndrome:<div><div> &nsp;
Short stature, weed neck, high arched palate, shield chest, cardiac and renal
anomalies, inverted nipple</div><div><> &nsp;Phenotypic female</></div><div> &n
sp;sence of sexual&nsp;maturation</div><div> &nsp;Increased oocyte loss</div
></div> ReproductiveTractII
Descrie the mechanism and consequences of female pseudo-hermaphrotism. Deficien
cy in the steroid production hormones (21-OHase is most common) shunts estrogen
production towards androgen production, yielding females with androgenized exter
nal genitalia, and<> life-threatening electrolye anormalities.</>
Reproduc
tiveTractII
Before using a slow karyotype, what is the quickest method of checking ones sex
when confronted with possile female pseudohermaphroditism?
Check for Barr 
odies.<div><r /></div><div>(XXY Klinefelter will have Barr odies ut normal ex
ternal genitalia.</div> ReproductiveTractII
What is androgen insensitivity syndrome?
Failure of external genitalia to
respond to DHT.<div><r /></div><div><div> &nsp;46 XY, ut normal female appear
ance</div><div> &nsp;Failure of tissues to respond to DHT</div><div> &nsp;Testes
present, MIS present, no uterus</div><div> &nsp;Short lind vagina (only distal
2/3)</div><div> &nsp;Undescended testes- malignant risk</div></div> Reproduc
tiveTractII
Descrie testicular descent.
"Pulled y guernaculum through deep inguinal ri
ng down into scrotum.<img src=""Screen Shot 2012-11-28 at 8.56.44 M.png"" />"
ReproductiveTractII
"The tl;dr of urogenital and genital development:<img src=""Screen Shot 2012-1128 at 8.57.44 M.png"" /><div><img src=""Screen Shot 2012-11-28 at 8.57.50 M.pn
g"" /></div>"
ReproductiveTractII
Compared to other endocrine axes, how tightly regulated is the thyroid axis?&ns
p;<div><r /></div><div>Yes, this question is a it specious.</div>
"It is t
he most tightly and chronically regulated endocrine axis. Measurement of one por
tion of it gives the health of the entire axis.<img src=""Screen Shot 2012-11-29
at 2.27.56 PM.png"" />"
ThyroidPhysiology
Descrie the molecular cascade that TRH initiates to cause the release of TSH.
"TRH acts upon a classic Gq-receptor pathway, causing two major downstream event
s.<div>1) The release of intracellular Ca+2 aids in the release of pre-formed TS
H granules (similar to Ca+2s role in neurotransmitter release)</div><div>2) PKC
activating a nuclear pathway for the transcription of more TSH.<img src=""Scree
n Shot 2012-11-29 at 2.32.05 PM.png"" /></div>" ThyroidPhysiology
What two hormones does the thyroid make? Descrie them riefly. "Scroll down fur
ther.<img src=""Screen Shot 2012-11-29 at 2.33.24 PM.png"" /><div>Of the thyroid
hormones produced, 90% is T4, and 10% is T3. <>However, only T3 is the effecti
ve hormone, converted from T4 at the target organ.</></div>" ThyroidPhysiolog
y
Which of the thyroid hormones is the true effector molecule?
T3, the hormone
produced y the thyroid in minority (~10%). It must e converted from the larger
T4 reservoir at the target organ.
ThyroidPhysiology

Differentiate etween trophic and tropic hormones.

"Trophic hormones are im
portant for the nutrition and cell cycle regulation of the target organ itself.&
nsp;<div><r /></div><div>Tropic hormones direct the synthesis of the next down
stream hormone.</div><div><r /></div><div><font color=""#ff0a1a"">Cheap mnemoni
c: Tropic hormones act ""tropically,"" ""down south (in the Tropics,"" or furthe
r down the (North-South) ""axis.""</font></div>"
ThyroidPhysiology
If one stops making T4 (hypothyroidism), what clinical manifestation will e see
n in the neck area?
Goiter.<div><r /></div><div>Pretty much every thyroid i
ssue causes goiter. In some cultures, goiter is even seen as a sign of eauty. 
www yeah, looks that could kill.... LITERLLY.</div>
ThyroidPhysiology
Briefly descrie the histology of the thyroid follicle. "Follicular cells: cuoi
dal when quiescent, columnar when synthetic, surround colloid.<div>Colloid: eosi
nophilic, contains large Tyr-rich protein called thyrogloulin</div><div>Parafol
licular cells (C cells): make calcitonin, nothing to do with thyroid function.&n
sp;<img src=""Screen Shot 2012-11-29 at 2.53.17 PM.png"" /></div>"
ThyroidP
hysiology
What two methods does the ody have to make T3? De novo within the thyroid folli
cular cells or at the target organ, converted from T4. ThyroidPhysiology
How does I- get into thyroid follicular cell? Na/I symporter.&nsp;This is a s
econdary active transporter that utilises the concentration gradient of Na+ to m
ove I- against its concentration gradient.
ThyroidPhysiology
"What is ""organification"" in the context of thyroid hormone synthesis?"
The oxidation of I- to I0 (atomic iodine) y thyroid peroxidase (TPO), coupled t
o the reduction of H2O4.&nsp;<div><r /></div><div>(this is immediately followe
d y iodination)</div> ThyroidPhysiology
What is the process of iodination y thyroid peroxidase (TPO)? "Using the newly
created and highly reactive atomic iodine (I0), TPO iodinates two Tyr residues
on thyrogloulin inside the colloid.<div><r /></div><div>The iodinations happen
at the 3 and 5 carons ecause OH is an ortho/para director and activator of th
e phenyl ring.<img src=""Screen Shot 2012-11-29 at 3.19.27 PM.png"" /></div>"
ThyroidPhysiology
fter iodination of the Tyr residues on the colloid thyrogloulin, what happens
to form the (ound to thyrogloulin) T3 and T4? Ether ond coupling of adjacent
mono- or di-iodinated Tyr residues.
ThyroidPhysiology
How are T4 and T3 transported from the colloid thyrogloulin to the loodstream?
Pseudopods of the follicular cells endocytose the colloid and transport it to ly
sosomes for release of T3/4 and recycling of mono-iodinated and di-iodinated Tyr
(MIT, DIT).
ThyroidPhysiology
What are the three road steps of thyroid hormone synthesis catalyzed y thyroid
peroxidase (TPO)?
1. Organification of I- to I0<div>2. Iodination of Tyr r
esidues on the colloid thyrogloulin</div><div>3. Ether ond coupling of the mon
o-iodinated and/or di-iodinated Tyr (MIT, DIT)</div>
ThyroidPhysiology
Roughly how much of thyroid hormones are protein-ound in the loodstream? What
is the consequence of this?
Nearly all (99.7%) to thyroid inding gloulin (
TBG, made y liver), TBP, or alumin. Thus, there is circulating reservoir with
a longer half-life.
ThyroidPhysiology
Descrie the activation of thyroid hormones y deiodination.
"Removal of 5 I
( = on the outer ring) y deiodinase. This converts T4 to T3.<img src=""Screen
Shot 2012-11-29 at 3.40.48 PM.png"" />"
ThyroidPhysiology
How can de-iodination y deiodinase of a thyroid hormone e deactivating?
"1) T3 at the 5 caron to 3,3-DIT.<div>2) T4 at the 5 caron to form reverse T3.
<img src=""Screen Shot 2012-11-29 at 3.40.48 PM.png"" /></div>" ThyroidPhysiolog
y
With regards to thyroid hormone metaolism, which cells have deiodinase?
Nearly all ecause nearly all cells are targets of thyroid hormones.
ThyroidP
hysiology
Descrie the primary method of action for T3 inside the cell. T3 displaces its
receptor from a heat shock protein (HSP) and goes to the nucleus to affect tran
scription.
ThyroidPhysiology
What are some road transcriptional and metaolic effects of T3?
"1) upre

gulation of Na/K TPase mitochondrial respiratory enzymes*<div>2) higher O2 cons

umption and metaolic rate</div><div>3) thermogenesis via uncouplers**</div><div
><r /></div><div>*otherwise, 30% deficient</div><div>** T3 is the most importan
t regulator of rown adipose tissue (BT)</div><div><img src=""Screen Shot 201211-29 at 3.51.55 PM.png"" /></div>"
ThyroidPhysiology
Give some road growth and development effects of T3. "<img src=""Screen Shot
2012-11-29 at 3.56.43 PM.png"" />"
ThyroidPhysiology
What are some cardiovascular effects of T3?
"<img src=""Screen Shot 2012-1129 at 4.09.11 PM.png"" />"
ThyroidPhysiology
What are some CNS developmental effects of T3? Why is this so important?
"Despite only small amounts making it from the mother to the developing foetus,
T3 is critical in CNS development; lack of it would lead to complete distortion
of rain architecture (""What can go wrong?"" from emryo lectures...)<div><img
src=""Screen Shot 2012-11-29 at 4.09.58 PM.png"" /></div>"
ThyroidPhysiolog
y
"ll three patients elow are given 200 ug TRH IV. B is normal and oth  and C
are clinically hypothyroidic. Define primary and secondary hypothyroidism and id
entify which patient is which.<img src=""Screen Shot 2012-11-29 at 4.17.36 PM.pn
g"" />" "Primary hypothyroidism is a prolem in the thyroid gland itself. Second
ary hypothyroidism refers to a prolem in the pituitary gland.&nsp;<div>Primary
/secondary <i>hyperthyroidism</i>&nsp;use similar definitions. <><font color="
"#ff0a1a"">Note that primary disorders are further down the axis and secondary o
nes are upstream.</font></></div><div><><font color=""#ff0a1a""><r /></font><
/></div><div><font color=""#060000"">B is normal.</font></div><div><font color=
""#060000""> has </font><><font color=""#fa0000"">secondary</font></> <><fon
t color=""#fa0000"">hypothyroidism</font></><font color=""#060000""> ecause de
spite stimulation with TRH, the pituitary gland is not responding with an increa
se in TSH.</font></div><div><font color=""#060000"">C has <>primary hypothyroid
ism </>ecause stimulation with TRH gives an exaggerated response of TSH secret
ion ecause there is </font><font color=""#fa0000"">no negative feedack from th
e downstream T3/T4</font><font color=""#060000"">. Thus, the defect is in the th
yroid itself and its aility to synthesize T3/T4 to negatively feedack the upst
ream TSH stimulus on the itself.</font></div><div><><r /></></div>" ThyroidP
hysiology
What are the four main functions of the adrenal cortex? -metaolism (especially
when fasting)<div>-NaCl/fluid volume homeostasis</div><div>-immune modulation</d
iv><div>-minor sex steroids (not less important, just lower amounts)</div>
drenalGlands
drenalGlands
What CTH made from?
POMC
What are the three main enzyme (or enzyme classes) in the adrenal axis? CRH, CT
H, and glucocorticoids (cortisol).
drenalGlands
Because the primary role of the adrenal axis is stress management, descrie the
rhythm of its release. "Its release is ased on sleep/wake and light cycles, gi
ving a diurnal rhythm. There are two large ursts in the early morning and after
noon. These ursts are a metaolic of consequence of cortisols effort to preven
t hypoglycemia.<img src=""Screen Shot 2012-12-01 at 4.34.23 PM.png"" />"
drenalGlands
Descrie the regulation of CTH synthesis and release y CRH. "-Gs cascade<div
>-release of pre-formed CTH from cleaved POMC</div><div>-transcription of more
POMC and cleavage</div><div><img src=""Screen Shot 2012-12-01 at 4.41.21 PM.png"
drenalGlands
" /></div>"
What two anterior pituitary hormnes are cleaved from POMC?
"CTH and MSH<im
g src=""Screen Shot 2012-12-01 at 4.43.43 PM.png"" />" drenalGlands
Upon dissection, why are adrenal glands yellow? Rich in lipid and cholesterol
drenalGlands
How does adrenocortical steroid synthesis and release deviate from other hormone
synthetic pathways?
"- synthesis in the mitochondria (with tuular cristae)<
div>- synthesis in the SER (not RER)</div><div>- cholesterol starting material i
n lipid droplets (with no memrane)</div><div><><font color=""#fa0000"">- very
drenalGlands
little preformed hormone, mostly de novo</font></></div>"

Because most adrenocortical steroid synthesis is de novo after receptor activati

on, how does the cell speed up the process?
Chronic rhythm of CTH primes th
e synthesis of the synthetic enzymes y:<div>-having constant anks of mRN avai
lale for transcription</div><div>-constant turnover of the synthetic enzymes</d
iv>
drenalGlands
What are the three layers of the adrenal cortex? What hormones are synthesized i
n them? From outside in:<div>Zona glomerulosa (ZG): aldosterone</div><div>Zona f
asciculata (ZF): cortisol, (and corticosterone and dehydroepiandrosterone (DHE)
)</div><div>Zona reticularis (ZR): same as ZF</div>
drenalGlands
Compare the regulation of the three layers of the adrenal cortex.
"- inner
two layers mostly y CTH alone; cortisol negative feedack<div>- outer ZG y 
CTH, K, and RS<img src=""Screen Shot 2012-12-01 at 5.38.11 PM.png"" /></div>"
drenalGlands
What are the the compartments of adrenal steroid synthesis?<r />Bonus: what his
tological characteristics would you see?
-cytosol, mitochondria, SER<r /
>-would see little RER, no vesicles (due to no preformed release), mitochondria
with tuular cristae, lipid droplets w/o memranes, and SER
drenalGlands
Realistically, no one needs to memorize &nsp;the structures of the adrenal ster
oid hormones. However, what are the most important sites of modification?
"Carons 3, 17, and 18.<div>The C17 side chain is also important.<img src=""Scre
en Shot 2012-12-01 at 5.59.57 PM.png"" /></div>"
drenalGlands
"What is the significance of this slide?<img src=""Screen Shot 2012-12-01 at 6.1
0.47 PM.png"" />"
Hormones have multiple and mixed functions...yeah, I kno
drenalGlands
w.
What are the major actions of glucocorticoids like cortisol?
"""Exact opposit
e actions as insulin to survive a fast."" - shok "" Balla "" Balasuramanyam<d
drenalG
iv><img src=""Screen Shot 2012-12-01 at 6.13.33 PM.png"" /></div>"
lands
What causes Cushings and ddisons disease?
"Cushings: excess of cortisol<d
iv>ddisons: lack of cortisol</div><div><r /></div><div>Fun fact: JFK had ddi
sons giving him a persistent tan ""golden glow"" that allowed him to eat Nixon
on their first televised deate and seduce a unch of married women, despite th
at grating ""Bahstun"" accent.</div>" drenalGlands
What are digestile and metaolizale energy? "<img src=""Screen Shot 2012-1201 at 6.42.20 PM.png"" />"
Macronutrients
How and why does one do indirect calorimetry? <div>- respiratory gases and uri
nary N2</div>-ecause you cant do om calorimetry on people*<div>-relatively a
ccurate despite ovious thermogenic loss</div><div><r /></div><div>*I had to ma
ke that joke. Desperate oredom in lecture.</div>
Macronutrients
Given fat, car, and protein, order them in descending energy density. fat (~9
kcal/g) &gt; car (~4 kcal/g) = protein (~4 kcal/g)<r /><r /><div>Units may e
converted to Mkal/kg for merican diets.<r /><div><r />EtOH, although not a m
acronutrient, is ~7 kcal/g.<div><r /></div><div><r /></div></div></div>
Macronutrients
Define the respiratory quotient (RQ). CO2 production/O2 consumption.<div><r /
></div><div>llows us to estimate sustrate utilization ased on fuel.&nsp;</di
v>
Macronutrients
Differentiate etween essential, non-essential, and conditionally essential amin
o acids.
"Essential: cant makeem. Eatem.<div>Non-essential: can make t
hem;<> still vital to life</></div><div>Conditionally essential: can make them
ut not enough; infants have several of these.</div><div><r /></div><div><><f
ont color=""#fa0000"">The essential amino acids are TV FILM HWK:</font></></div
><div><><font color=""#fa0000"">Thr, Val, Phe, Ile, Leu, Met, His, Trp, Lys</fo
nt></></div>" Macronutrients
T/F: Plant protein is etter than animal protein.
F: animal protein is et
ter, although soy and quinoa arent ad alternatives for the non-carnivorous fol
k.
Macronutrients
What is a limiting amino acid? Exactly what it sounds like: you need all s (
ound to tRNs) to make certain proteins. The limiting amino acid is the least av
ailale one.<div><r /></div><div>...gen-chem level difficulty: LOL, limiting re

agent ut with a redudantly specific nutrition term.*</div><div><r /></div><div

>*I enjoyed this lecture, clearly.</div>
Macronutrients
Descrie the use of complentary protein sources.
"Using foods that rich i
n certain s to complement foods that are poor in others.<div><r /></div><div>
Now I am hungry. Fun fact: the lecture suddenly switches from comic sans to a fo
nt worth living for after this slide!<img src=""Screen Shot 2012-12-01 at 7.00.5
0 PM.png"" /></div>"
Macronutrients
What is lactose? Where is it found? What cleaves it and how do we develop lactos
e intolerance? "<img src=""Screen Shot 2012-12-01 at 7.02.48 PM.png"" />"
Macronutrients
What is sucrose?
"Commonly known as ""tale sugar,"" its a disaccharide
of glucose and fructose."
Macronutrients
What is fructose?
n isomer of glucose that is a lot sweeter than sucrose
(and smaller ecause its a monosaccharide).* People argue a lot aout high-fruc
tose corn syrup.<div><r /></div><div>*fructose has ~3.14x Wonkas/g sweetness de
nsity as sucrose. What am I doing with my life?</div> Macronutrients
"Oh look, a feele attempt at humor (like my cards for this lecture):&nsp;<img
src=""Screen Shot 2012-12-01 at 7.18.15 PM.png"" />"
Macronutrients
Given F nomenclature, interpret this:&nsp;18:26
"total carbons:double bo
nds carbon of first double bond<div><br /></div><div>Second and third numbers fr
om terminal methyl carbon.<img src=""Screen Shot 2012-12-01 at 7.21.47 PM.png""
/></div>"
Macronutrients
"What is ""classic"" essential fatty acid deficiency?" Lack of&nbsp;linoleic ac
id (18:2n-6), the precursor for most of our bodies' polyunsaturated fatty acids.
Macronutrients
What are some general guidelines ith regards to omega fatty acids?
-fish-ba
sed is preferable to plant-based, but plant-based is still decent; still need su
stainable alternatives to allo increased mass consumption of fish.<div>-pregnan
t omen are advised to eat fish ith omega fatty acids, despite risk of heavy me
tals. Thus they should consume fish lo in the latter and high in the former, li
ke Pacific salmon, as opposed to Atlantic tuna.</div> Macronutrients
What is the most important monounsaturated fat? oleic acid (18:1n-9), found in o
live oil
Macronutrients
Why are saturated and trans fatty acids evil and nasty? They stack on top of eac
h other better and form stronger hydrophobic interactions, solidifying them at h
igher temperatures than unsaturated fats. Thus, they can clog arteries and are h
arder to digest.
Macronutrients
Rank the different pancreatic islet cells in descending order. "beta&gt; alpha
&gt; D (delta) = F<img src=""Screen Shot 2012-12-02 at 11.48.15 PM.png"" />"
EndocrinePancreas
In the pancreatic islet, hich cells form the core, and hich form the mantle?
"<img src=""Screen Shot 2012-12-02 at 11.48.54 PM.png"" />"
EndocrinePancrea
s
With regards to the islet architecture, hy is glucagon much less potent than in
sulin? "Blood enters the core first (as continuous fenestrated / diaphragms ca
pillaries) and then drains the mantle as collecting venules. Thus the insulin ha
s immediate effect upon alpha cells and glucagon, hereas the glucagon has to tr
avel through the rest of venous and arterial circulation before returning back t
o affect the islet cores.<img src=""Screen Shot 2012-12-02 at 11.52.08 PM.png""
/>"
EndocrinePancreas
Why do e use C-peptide instead of insulin to measure beta cell function?
1) blood from arm or other peripheral veins is no very diluted of insulin due t
o it first seeing the liver and then other organs along the ay<div>2) c-peptide
is carried by other proteins and is stable.</div>
EndocrinePancreas
What glucose transporter is present in the beta cell? Describe its coupling ith
glucokinase. GLUT2, hich has a relatively high km. The glucokinase saturatio
n regulates the rate of GLUT2. EndocrinePancreas
After glucose is uptaken by beta cell, hat happens to stimulate insulin release
?
"1) metabolism of glucose increases ATP/ADP ratio<div>2) ATP-dependent K
+ channel inactivated; intracellular K+ rises, cell depolarizes</div><div>3) dep

olarization activates voltage-gated Ca+2 channel</div><div>4) influx of Ca+2 sti

mulates insulin release<img src=""Screen Shot 2012-12-03 at 12.27.48 AM.png"" />
</div>" EndocrinePancreas
Why is insulin secretion biphasic?
"preformed insulin and then nely transc
ribed insulin<img src=""Screen Shot 2012-12-03 at 6.55.21 PM.png"" />" Endocrin
ePancreas
What are incretins and hat do they do? "Glucagon-like peptide 1 (GLP1) and gast
ric inhibitory polypeptide (GIP).<div>Both are hormones responsible for stimulat
ing insulin release.</div><div><img src=""paste-751619278520.jpg"" />&nbsp;</div
>"
EndocrinePancreas
What is the insulin receptor's structure and ho does it transduce its signal.
"Classic Tyr kinase: dimer of to alpha and beta subunits.<div>1) Insulin binds
to alpha subunit.</div><div>2) Alpha-beta units dimerize and link up to form str
ucture belo.</div><div>3) Autophosphorylation at select Tyr residues.</div><div
>4) Phospho-Tyr attracts other proteins (like insulin receptor substrate, IRS) t
o transduce signal or recruit second messengers.*</div><div>*These other protein
s have SH1, SH2, and SH3 binding regions.<img src=""Screen Shot 2012-12-03 at 6.
59.01 PM.png"" /></div>"
EndocrinePancreas
What is insulin receptor substrate?
"IRS is exactly hat it sounds like: it
is the substrate of the insulin receptor.<div>After the insulin receptor autopho
sphorylates at certain Tyr residues,</div><div>1) it recruits IRS to bind</div><
div>2) the receptor phosphorylates the IRS as ell, also at certain Tyr residues
</div><div>3) IRS activates many, many donstream 2nd messenger pathays like MA
P kinase, etc.<img src=""Screen Shot 2012-12-03 at 7.02.17 PM.png"" /></div>"
EndocrinePancreas
Ho does adipose tissue uptake glucose in response to insulin? "More GLUT4 is t
ranslocated to the membrane upon insulin stimulation.<img src=""Screen Shot 2012
-12-03 at 7.10.37 PM.png"" />" EndocrinePancreas
What are the organs most affected by insulin and hat are its major metabolic ef
fects? "Muscle, liver, fat.<div>1) glycogen storage favoured</div><div>2) just
enough energy usage via glucose oxidation only</div><div>3) FA oxidation is blun
ted</div><div>4) uptake of nutrients for storage (carb, fat, protein)</div><div>
Overall: anti-lipolytic, anti-ketotic, pro-synthetic.<img src=""Screen Shot 2012
-12-03 at 7.11.27 PM.png"" /></div>"
EndocrinePancreas
In muscle, ho does insulin affect glucose and fat metabolism? Stimulation of g
lucose uptake and storage as glycogen, the rest being oxidized for energy.&nbsp;
<div>Inhibition of lipoprotein lipase since byproducts of fat storage and oxidat
ion can be toxic.</div> EndocrinePancreas
What metabolic effects does insulin have on adipose tissue?
Glucose uptake a
nd conversion to alpha-glycerol-phosphate to form the backbone of TGs.<div>Activ
ation of lipoprotein lipase to uptake FAs and inhibition of hormone-sensitive li
pase.&nbsp;</div><div>Overall goal: synthesize and store TGs.</div>
Endocrin
ePancreas
Describe insulin's role in protein metabolism. Anabolic and anti-catabolic. Sim
ilar to GH, synergizes ith GH to upregulate IGF-1.
EndocrinePancreas
"Ho does the dosing of insulin differ for:<div>1) hypoglycemia?</div><div>2) an
abolism?</div><div>3) hypolipemia""</div>"
"1) tiny amounts needed to corre
ct<div>2) larger amounts needed</div><div>3) tiny amounts</div><div><b><font col
or=""#fa0000"">Insulin does not do all of its actions equally ell or else it o
uld result in futile cycles.</font></b><img src=""Screen Shot 2012-12-03 at 10.2
0.07 PM.png"" /></div>" EndocrinePancreas
Ho does glucagon compare to insulin ith regards to its target organs and funct
ions? Much more restricted in function than insulin and its actions are mostly
confined to the liver. GlucoseHomeostasis
What are major metabolic effects of glucagon? 1) release of nutrients (glucose
and fat) during fasted state<div>2) liver glucose production: both glycogenolys
is and gluconeogenesis</div><div><br /></div> GlucoseHomeostasis
Why is glucagon not a mere antagonist of insulin ith regards to protein?
Both are stimulated by AAs in the blood, but for different reasons.<div>Insulin
uses AAs to make proteins.</div><div>Glucagon uses AAs (Gln in kidney, Ala in li

ver) for gluconeogenesis to prevent hypoglycemia.</div> GlucoseHomeostasis

Although primarily confined to ____, hat other tissue does glucagon have a mino
r role in? What is it? "liver; adipose for permissive effect of FA release in r
esponse to catecholamines.<img src=""Screen Shot 2012-12-03 at 10.26.14 PM.png""
/>"
GlucoseHomeostasis
Describe the reciprocal regulation of the bi-functional enzyme, fructose-2,6-bis
phosphatase/phosphofructokinase-2, by glucagon and insulin.
"Glucagon: stimu
lates phosphorylation of the enzyme, activating the phosphatase activity. Fructo
se-2,6-bisphosphate (F-2,6-P) ill decrease and phosphofructokinase-1 (PKF1) act
ivity ill decrease, sloing don glycolysis, and favouring gluconeogenesis.<div
><br /><div>Insulin: stimulates dephosphorylation of the enzyme, activating the
kinase activity, increasing F-2,6-P, hich activates PFK1 and favouring glycolys
is.&nbsp;<img src=""Screen Shot 2012-12-03 at 10.29.30 PM.png"" /></div></div>"
GlucoseHomeostasis
Describe the maintenance of euglycemia in the fasted state. Which organs receive
hat % of glucose? What are the sources of glucose?
"<div>rate of glucose po
ol flux: 10 umol/kg/min</div><div>tight rate</div><div><br /></div><div>influx f
rom glycolysis and gluconeogenesis</div><div><br /></div><div>outflux</div><div>
50% to brain</div><div>20% to oxidative tissues</div><div>10% RBCs</div><div>20%
muscle --&gt; lactate</div><div><span class=""Apple-tab-span"" style=""hite-sp
ace:pre""> </span>longer fast, more lactate</div><div><span class=""Apple-tab-sp
an"" style=""hite-space:pre""> </span>Cori cycle</div><div><img src=""Screen Sh
ot 2012-12-03 at 10.35.14 PM.png"" /></div>"
GlucoseHomeostasis
Describe maintenance of euglycemia in the fed state. What organs receive hat %
of available glucose? What are the inputs of glucose? "<div>20 umol/kg/min con
stant flux of glucose</div><div><br /></div><div>inputs</div><div>mostly from gu
t</div><div>glycogenolysis gone</div><div>gluconeogenesis sloed don greatly</d
iv><div><br /></div><div>outputs</div><div>25% brain (50% of 10 umol/kg/min)</di
v><div>75% oxidation or storage</div><div><img src=""Screen Shot 2012-12-03 at 1
0.45.48 PM.png"" /></div>"
GlucoseHomeostasis
Graphically describe the levels of glucose, insulin, and glucagon folloing a me
al.
"<img src=""Screen Shot 2012-12-03 at 10.47.17 PM.png"" />"
GlucoseH
omeostasis
<div>What are the to fast hormones that respond to hypoglycemia?</div>What are
the three slo hormones that respond to hypoglycemia? Ho they compare time-ise
?
"<div>Fast: epinephrine and norepinephrine</div>Glucagon: slo<div>Corti
sol: sloer</div><div>GH: sloest, but most sustained<img src=""Screen Shot 2012
-12-04 at 8.06.05 AM.png"" /></div>"
GlucoseHomeostasis
What some crude markers of Type I diabetes mellitus?
"In addition to the belo
:<div>1) constant state of severe malnourishment</div><div>2) high glucagon lev
els due to no insulin brake</div><div><img src=""Screen Shot 2012-12-04 at 8.08.
02 AM.png"" /></div>" GlucoseHomeostasis
What causes diabetes insipidus? lack of ADH (and aldosterone/Ang II) that preven
ts ater reabsorbtion or there is an osmotic force that promotes excretion
GlucoseHomeostasis
What hormonal imbalance can cause accelerated ketogenesis and potentially diabet
ic ketoacidosis (DKA)? "Note that insulin normally inhibits hormone-sensitive l
ipase and that glucagon is excessively deactivating acetyl-CoA carboxylase (part
of FA synthesis).<img src=""Screen Shot 2012-12-04 at 8.10.14 AM.png"" />"
GlucoseHomeostasis
What are different broad mechanisms of Type II diabetes mellitus? Which one is (
much) more common?
1) insulin resistance from knocking out the receptor (ve
ry rare, only ~18 patients orldide)<div>2) relative lack of insulin secretion:
mysterious decline in secretion</div> GlucoseHomeostasis
What are some crude descriptors of Type II diabetes mellitus? "In addition to
the ones belo:<div>1) insulin secretion may be higher than normal but not enoug
h to counteract hyperglycemia</div><div>2) obesity is a component because abnorm
al fat storage in muscle or liver can trigger a variety of inflammation pathays
.</div><div>3) ketosis can be blocked ith a tiny amount of insulin, hich is al
ready available.<img src=""Screen Shot 2012-12-04 at 8.13.40 AM.png"" /></div>"

GlucoseHomeostasis
In the obese and the lean, ho do glucose and insulin levels compare ith insuli
n resistance? "Despite glucose levels being equal, obese people need 2-3 times
more insulin to maintain euglycemia:<img src=""Screen Shot 2012-12-04 at 9.23.5
2 AM.png"" />" GlucoseHomeostasis
What to types of insulin are tradtionally given to type I diabetics? Why?
-short-acting before meals to mimic spike of fed state<div>-long-acting (NPH, in
sulin complexed to fish protein) for slo release that mimixs the basal levels t
o prevent hypoglycemia, severe lipolysis and DKA.</div> ClinicalCorrelation Gluc
oseHomeostasis
What key severe reaction occurs in Type I DM patients but not Type II? diabetic
ketoacidosis (DKA)
ClinicalCorrelation GlucoseHomeostasis
Ho does insulin demand change ith age?
Increases, especially in puberty
, due to GH effects of preventing glucose uptake and favouring lipolysis. Additi
onally, insulin resistance may develop.&nbsp; ClinicalCorrelation GlucoseHomeo
stasis
In addition to measuring insulin (via C-peptide) and glucose, hat major blood m
etabolilte can be used as a measure of glucose homeostasis?
HbA1C Clinical
Correlation GlucoseHomeostasis
What components feed into the male reproductive-hypothalamic axis and hy are th
ey important? 1) total amount of fat: extra energy for puberty and cholesterol
for steroid synthesis<div>2) relative state of nutrition (both chronic and acut
e)</div><div>3) light cycle and sleep cycle*</div><div>*particularly important f
or amplitude and frequency of the axis's pulsatility/rhythmicity</div> MaleRepr
oductionEndocrinology
"What hypothalamic nucleus serves as the main ""clock"" for reproduction and met
abolism?"
suprachiasmatic nucleus MaleReproductionEndocrinology
What is the role of kisspeptin? What neurons make it? "It is a neurotransmitte
r secreted by the mediobasal nuclei, hich synapse ith the GnRH neurons, making
kisspeptin the <font color=""#fa0000"">most important/proximal signal to GnRH.<
/font>" MaleReproductionEndocrinology
What cells have receptors for LH and FSH?
LH - Leydig cells<div>FSH - Sert
oli cells</div> MaleReproductionEndocrinology
Describe the feedback regulation of LH. "1) testosterone produced by the Leydig
cells has positive feedback on those cells cells<div>2) negative feedback higher
up in the adenohypophysis and hypothalamus</div><div>3) positive/negative feedb
ack higher up in certain chronotropic centres (depend on time of day)<img src=""
Screen Shot 2012-12-04 at 2.09.35 PM.png"" /></div>"
MaleReproductionEndocrin
ology
Describe the feedback regulation of FSH.
"Negative feedback through inhib
in (part of TGF-beta superfamily) and higher up the axis.<div>Positive feedback
through activin (also of TGF-beta)</div><div>Positive feedback through folliculo
statin (despite its name).<img src=""Screen Shot 2012-12-04 at 2.09.35 PM.png""
/></div>"
MaleReproductionEndocrinology
Describe the concept of entrainment. Consider the etymology.
Each pulse of st
imulation along an axis is faithfully transduced to the next point in the axis,
like a train of multiple linked cars, carrying a larger net signal through many
smaller linked signal transductions.
MaleReproductionEndocrinology
Why is tonic stimulation preferred to pulsatile stimulation for feedback regulat
ion?
It's more steady and basal and constant feedback is required to prevent
unanted episodes of stimulation. In general, it is safer to have lo levels of
circulating end product/hormone.
MaleReproductionEndocrinology
"In the chart belo, the FSH curve ould mimic the other to in general rhythm b
ut&nbsp;<img src=""Screen Shot 2012-12-04 at 2.50.56 PM.png"" />have a smaller a
mplitude than LH. Why?" Many more factors govern FSH secretion than LH: inhibin,
activin, folliculostatin, feedback, etc.
MaleReproductionEndocrinology
Ho does tonic feedback occur at the cellular level ithin gonadotrophs?
"In addition to a stimulatory Gq cascade, the GnRH receptor also stimulates the
influx of extracellular Ca+2 that negatively feedbacks LH release/production.<di
v>***Bala himself said that the picture belo is simplified and that intracellul

ar Ca+2 release isn't only stimulatory. Plus, e don't really kno. And this is
in LH, not the really complex FSH system.<img src=""Screen Shot 2012-12-04 at 2.
58.48 PM.png"" /></div>"
MaleReproductionEndocrinology
What to periods of life see high releases of testosterone?&nbsp;
Gestatio
nal development for testicular descent and virilization of mesonephric (Wolffian
) duct.<div><br /></div><div>Puberty for secondary sex characteristics.</div>
MaleReproductionEndocrinology
What hormone is responsible for the development of external male genitalia?
DHT, converted from testosterone by 5-alpha-reductase, at the target organs.
MaleReproductionEndocrinology
What are the broad secretory roles of Sertoli and Leydig cells? That is, hat ar
e their to different secretory product types? Sertoli cells make mostly peptid
e hormones (MIH, inhibin, ABP).&nbsp;<div>Leydig cells are steroid producers.</d
iv>
MaleReproductionEndocrinology
Describe LH's regulation of sex steroid production in the Leydig cell. Focus on
the folloing:<div>-hich organelles produce hat major intermediates/products</
div><div>-hat type of signaling cascade</div><div>-hat major differences there
are compared to protein secretors</div>
"-Gs cascade<div>-mitochondria (
ith tubular cristae) converts cholesterol to pregnenolone</div><div>-SER (very
little RER) converts pregnenolone to sex steroids; 17-hydroxylase is the key enz
yme</div><div>-no preformed testosterone; nely synthesized testosterone<img src
=""Screen Shot 2012-12-04 at 3.07.23 PM.png"" /></div>" MaleReproductionEndocrin
ology
"Explain the ""to cell - to hormone"" concept."
"Leydig cells produces t
estosterone...but Sertoli cell needs to bind it to ABP and ship it out to lumen
of semiferous tubule.<div>Leydig cells need estradiol (E2 estrogen)...but only S
ertoli cells can convert testosterone to estradiol.</div><div>Thus, the to cell
share enzymatic machinery on either side of a capillary.</div><div><img src=""S
creen Shot 2012-12-04 at 9.43.22 PM.png"" /></div>"
MaleReproductionEndocrin
ology
What are the three molecular derivatives of testosterone?&nbsp; itself, DHT, est
radiol MaleReproductionEndocrinology
What is SHBG? What increases or decreases its concentration?
Sex hormone bind
ing globulin.<div>Increased by T4, estrogen.&nbsp;</div><div>Decreased by obesit
y and androgens.</div> MaleReproductionEndocrinology
Compare free and bioactive testosterone.
Free testosterone is not bound t
o any protein, neither albumin nor SHBG. Bioactive testosterone only needs to be
freed of SHBG, so it can still be bound to albumin.
MaleReproductionEndocrin
ology
What enzyme converts testosterone to estradiol? Where is it found?
aromatas
e in the Sertoli cell MaleReproductionEndocrinology
What are the final breakdon products of the male sex steroids? What are they cl
inically useful for?
17-ketoacids: useful as a urine measurement of sex stero
id production MaleReproductionEndocrinology
What are the target organs of testosterone, DHT, and estradiol? testosterone: te
stes, pituitary, muscle, and ductal system<div>DHT: prostate, scrotum, penis, bo
ne (lack --&gt; osteoporosis)</div><div>estradiol: fat, liver, CNS, skin, hair</
div>
MaleReproductionEndocrinology
What is male andropause?
It is the slo, but not dramatic, decline in and
rogen production. It never completely terminates as in female menopause.
MaleReproductionEndocrinology
What ould happen if a male had a defect in the testosterone receptor? "<div>Co
mplete androgen insensitivity.</div>Inability to convert testosterone to DHT.<di
v>No male external genitalia, female appearance.</div><div>But MIH still made, s
o no female reproductive tract.<img src=""Screen Shot 2012-12-04 at 11.03.40 PM.
png"" /></div>" MaleReproductionEndocrinology
What ould result in a XY male ith a defect in 5-alpha-reductase?
"Externa
l genitalia of female but other male secondary sex characteristics.<img src=""Sc
reen Shot 2012-12-04 at 11.06.58 PM.png"" />" MaleReproductionEndocrinology
"<img src=""paste-627065226032.jpg"" />"
A
Bioproduct metabolism

Heme = _____ + ______ Iron + porphyrin

Bioproduct metabolism
Human hemoglobin has ho many heme groups?
4
Bioproduct metabolism
Name 4 molecules that have heme.
Hemoglobin<div>Myoglobin</div><div>Catal
ase</div><div>Cytochromes (drug detox P450 and ox phos)</div> Bioproduct metab
olism
Which oxidation state of Fe binds O2 in heme? Ferrous (2+)<div><br /></div><di
v>Ferric doesn't</div> Bioproduct metabolism
Ho does pulse oximetry ork?<div><br /></div><div>What's one draback?</div>
"<img src=""paste-1116691497782.jpg"" />"
Bioproduct metabolism
What's the structure of porphyrin?
"4 pyrrole rings, each / acetate and pr
opionate<div><br /></div><div><img src=""paste-1756641624880.jpg"" /></div>"
Bioproduct metabolism
Where do e get our porphyrins? Synthesize them ourselves;<div><br /></div><div>
dietary is degraded</div>
Bioproduct metabolism
Heme biosynthesis:<div><br /></div><div>1. Start molecules?</div><div>2. RDS enz
yme?</div><div>3. Control mechanisms? (3)</div><div>4. If non-functional enzyme,
hat's the disease called?</div><div>5. Which organs does heme synth occur in?<
/div> 1. Glycine and succinyl CoA<div>2. ALA synthase</div><div>3. Heme and ir
on product inhibition on ALA synthase; lead negatively regs 2 steps</div><div>4.
Porphyrias</div><div>5. Bone marro and liver</div>
Bioproduct metabolism
<div>Give 2 symptoms of porphyrias.</div><div><br /></div>Give 3 treatments of p
orphyrias.
1. Treat ith <b>Hemin</b> (heme but ferric Fe3+ so no oxygen bi
nding)<div><br /></div><div>2. Avoid sunlight (photosensitive)</div><div><br /><
/div><div>3. Take B-carotene (free radical scavenger)</div><div><br /></div><div
>Symptoms:&nbsp;</div><div>1. red urine b/c no product inhibition on enzymes;&nb
sp;</div><div>2. photosensitivity</div> Bioproduct metabolism
Heme degradation:<div><br /></div><div>1. Give the pathay.</div><div>2. Ho muc
h hemoglobin degradation per day are e talking?</div><div>3. What about bilirub
in excretion per day?</div><div>4. In a CBC, ho ill this be expressed?</div>
"1-3.<div><img src=""paste-2946347565872.jpg"" /></div><div><br /></div><div>4.
<b>Soluble/direct/conjugated</b> bilirubin&nbsp;</div><div>and <b>total</b> bili
rubin reported</div><div>So <b>subtract</b> for <b>insoluble/indirect/unconjugat
ed.</b></div><div>Conjugation increases <b>solubility</b></div>"
Bioprodu
ct metabolism
"<img src=""paste-3307124818736.jpg"" />"
D
Bioproduct metabolism
Jaundice:<div>1. What's another name for it?</div><div>2. What's normal plasma b
ilirubin conc?</div><div>3. What's the threshold for jaundice?</div>
"<img sr
c=""paste-3367254360880.jpg"" />"
Bioproduct metabolism
Give the 4 types of jaundice and the cause of each.<div><br /></div><div>Give ho
 the bilirubin ould look on CBC for each.</div>
"<img src=""paste-340161
4099248.jpg"" /><div><br /></div><div>Obstructive just = obstructed bile duct</d
iv><div><br /></div><div>Hemolytic: <b>high</b> indirect; <b>normal</b> direct (
high influx from blood; normal liver)</div><div><br /></div><div>Hepatocellular:
<b>normal</b> indirect; <b>lo</b> direct (normal blood influx; little liver co
njugation)</div><div><br /></div><div>Neonatal: same as hepatocellular</div><div
><br /></div><div>Obstructive: <b>normal</b> indirect, <b>high</b> direct (norma
l blood influx; liver enzyme orking, just can't get into the GI for excretion)<
/div>" Bioproduct metabolism
Give the intermediates and output of each of these (e.g. lung, feces, urine)<div
><br /></div><div>Carbs</div><div>TGs</div><div>Cholesterol</div><div>AAs</div><
div>Nucleic acids</div><div>Heme</div><div>Creatine phosphate</div>
"<img sr
c=""paste-4011499455280.jpg"" />"
Bioproduct metabolism
"<img src=""paste-4290672329520.jpg"" />"
B
Bioproduct metabolism
Creatine:<div><br /></div><div>What enzyme is used as biomarker for MI?</div>
CK-MB Bioproduct metabolism
Prostaglandins, thromboxanes, and leukotrienes:&nbsp;____crine? Mechanism?
Paracrine; G-protein
Bioproduct metabolism
Ho do e make arachidonic acid?<div>Where does it hang out normally?</div>
1. Add 2 C's to linoleic acid (C18 to C20)<div><br /></div><div>2. Stored in pho
spholipids of the cell membrane</div> Bioproduct metabolism

Give the full arachidonic acid pathay, including regulation. "<img src=""past
e-5553392714544.jpg"" />"
Bioproduct metabolism
"<img src=""paste-5566277616432.jpg"" />"
D
Bioproduct metabolism
"<img src=""paste-5600637354800.jpg"" />"
E
Bioproduct metabolism
What's aspirin's mechanism of action? Acetylates serine on COX1 and 2, irrever
sibly inhibiting them. Prostaglandin and TXA2 inhibition result.
Bioprodu
ct metabolism
Why is aspirin, but not naproxen, good for reducing cardiovascular incidents?<di
v><br /></div><div>Why develop specific COX2 inhibitors?</div><div><br /></div><
div>Why have these been removed from the market no?</div>
Balance beteen
TXA2 and PGI2 (aka prostacyclin) in clotting initiation.<div>TXA2 in platelets i
s pro-clot.</div><div>PGI2 from endothelium is anti-clot.</div><div><br /></div>
<div>In platelets, aspirin irreversibly inhibits TXA2 synthesis. Platelets have
no nucleus so they can't resynthesize this. They are thus inhibited from clottin
g for their 10 day lifespan.</div><div><br /></div><div>Aspirin inhibits PGI2 sy
nthesis as ell, but the endothelial cells just quickly make more enzyme b/c the
y have transcriptional/translational machinery.</div><div><br /></div><div>COX1:
houskeeping</div><div>COX2: disease, inflammation</div><div><br /></div><div>CO
X2 inhibitors (aka COXIBs: Vioxx, bextra, celebrex) thus desirable b/c less side
-effects.</div><div><br /></div><div>BUT</div><div><div>Platelets only have COX1
;</div><div>Endothelium has COX1 and 2.</div></div><div>Thus COXIBs tip the bala
nce in favor of TXA2 and clotting :(</div>
Bioproduct metabolism
Which one of the folloing diabetes has to do ith ater balance?<div><br /></di
v><div>A. Juvenile</div><div>B. Mellitus</div><div>C.&nbsp;Type I</div><div>D. T
ype II</div><div>E. Insipidus</div>
E
GlucoseDrugs
Besides glucose, hat does insulin cause cellular uptake of? (2)
AAs<div>
K+</div>
GlucoseDrugs
Besides nutrient uptake, hat are 3 other effects of insulin? Groth factor (c
ell division up)<div>Up synthesis of TG, glycogen, protein</div><div>Don degrad
ation of these</div>
GlucoseDrugs
Which transporter does insulin cause to move to the membrane? GLUT4 GlucoseD
rugs
What are the 3 major complications of diabetes?<div><br /></div><div>Give 2 othe
rs.</div><div><br /></div><div>Why do these complications crop up?</div>
"<b>Neuropathy</b><div><b>Nephropathy</b></div><div><b>Retinopathy</b></div><div
><br /></div><div>Microvascular</div><div>Macrovascular: heart disease; stroke</
div><div>Peripheral vascular disease: ulcers, gangrene &amp; amputation</div><di
v>Infection</div><div>Metabolic problems</div><div>Impotence</div><div>Pregnancy
problems</div><div><br /></div><div><img src=""paste-13189844566832.jpg"" /></d
iv><div><br /></div><div>Also, some hematopoietic cells start making lo levels
of insulin and inflammatory molecules and undergo cell fusion ith neurons! See
research by Dr. Chan at Baylor.</div>" GlucoseDrugs
Which part of the hemoglobin molecule is preferentially glycosylated? N termin
us of B-globin chain
GlucoseDrugs
What's a normal blood sugar? HbA1C?
"<img src=""paste-8242042241846.jpg"" />
"
GlucoseDrugs
What is the clinical use of hemoglobin A1c levels?
"Gauge patient complianc
e ith diabetes therapy<div>Associated ith complications</div><div><br /></div>
<div><img src=""paste-8327941587760.jpg"" /></div>"
GlucoseDrugs
Diabetes drugs are of limited value unless complemented by ____ and ____.<div><b
r /></div><div>Why?</div>
"<b>Diet and exercise</b><div><br /></div><div>M
echanism: These increase metabolism and glucose uptake into cells. <b># of GLUT4
transporters can double ith exercise!</b></div><div><b><br /></b></div><div><b
><img src=""paste-8817567859334.jpg"" /></b></div><div><b><br /></b></div><div>A
naerobic exercise is especially protective against type II diabetes.</div>"
GlucoseDrugs
Insulin as a drug:<div><br /></div><div>1. Why can't it be given orally?</div><d
iv>2. Used to treat hat 2 symptoms?</div><div>3. Give 2 side effects.</div><div
>4. Ho is it excreted?</div><div>5. Preferred agent in hat clinical situation?
</div> 1. It's a polypeptide so it'd be degraded before crossing the gut all.<

div><br /></div><div>2. Hyperglycemia</div><div>Hyperkalemia (ith glucose)</div

><div><br /></div><div>3. Hypoglycemia</div><div>Lipodystrophy</div><div><br /><
/div><div>4. Renally, so have to adjust dose for patients / renal insufficiency
</div><div><br /></div><div>5. Pregnancy b/c doesn't get across placenta to F up
glycemic control in baby.</div>
GlucoseDrugs
Give hether each of these are ultra-short, short, intermediate, or long acting.
<div><br /></div><div>Detemir</div><div>Insulin</div><div>Glargine</div><div>Lis
pro</div><div>Aspart</div><div>NPH</div><div>Glulisine (LAG)</div>
<div>Det
emir: long</div><div>Insulin: short</div><div>Glargine: long</div><div>Lispro: u
ltra-short</div><div>Aspart: ultra-short</div><div>NPH: intermediate</div><div>G
lulisine (LAG): ultra-short</div>
GlucoseDrugs
What is the mechanism of action of acarbose?<div><br /></div><div>What's its sid
e effect?</div> "<img src=""paste-9569187136304.jpg"" />"
GlucoseDrugs
Give mechanism of action and side effects of sulfonylureas.
"<img src=""past
e-9698036155184.jpg"" />"
GlucoseDrugs
Metformin:<div><br /></div><div>1. Mechanism?</div><div>2. Drug of choice for h
o?</div><div>3. To advantages?</div><div>4. Contraindication? Why?</div>
"<img src=""paste-9985798964016.jpg"" />"
GlucoseDrugs
Thiazolinediones (TZDs)<div><br /></div><div>1. Mechanism? (1) Effects (3)?</div
><div>2. 3 side effects?</div> "<img src=""paste-10346576216880.jpg"" />"
GlucoseDrugs
"<img src=""paste-10453950399280.jpg"" />"
C.<div><br /></div><div>Pregnanc
y!</div>
GlucoseDrugs
"<img src=""paste-10479720203056.jpg"" />"
B. ****ide
GlucoseDrugs
"<img src=""paste-10505490006832.jpg"" />"
E.
GlucoseDrugs
Metformin is an insulin sensitizer and is the most frequently prescribed drug to
treat type II diabetes.<div><br /></div><div>After prescribing Metformin, you 
ill closely monitor the functioning of:</div><div><br /></div><div>A. Liver</div
><div>B. Kidney</div><div>C. Pancreas</div><div>D. Muscle</div> B. Kidney<div><b
r /></div><div>Can't give it if GFR of &gt;60</div>
GlucoseDrugs
"<img src=""paste-10939281703728.jpg"" />"
"Incretins! Like GLP-1 and GIP<d
iv><br /></div><div><img src=""paste-11553462027056.jpg"" /></div>"
GlucoseD
rugs
What are the 2 drugs related to incretins?<div><br /></div><div>What's the strat
egy of each?</div><div><br /></div><div>Which has higher market share?</div>
Sitagliptin: more market share b/c oral<div>Inhibits dipeptidyl peptidase IV, h
ich inactivates incretins</div><div><br /></div><div>Exenatide: less market shar
e b/c injection</div><div>Incretin mimetic</div>
GlucoseDrugs
"Give the drug names.<div><br /></div><div><img src=""paste-11849814770204.jpg""
/></div>"
"<img src=""paste-11862699672092.jpg"" />"
GlucoseDrugs
"Give the mechanisms.<div><br /></div><div><img src=""paste-11909944312348.jpg""
/></div>"
"<img src=""paste-11922829214236.jpg"" />"
GlucoseDrugs
"Give the effect on plasma insulin and risk of hypoglycemia.<div><br /></div><di
v><img src=""paste-12021613462044.jpg"" /></div>"
"<img src=""paste-120344
98363932.jpg"" />"
GlucoseDrugs
Which of the folloing drugs orks by targeting an enzyme responsible for degrad
ing incretins?<div><br /></div><div>A. Exenatide<div>B. Glyburide</div><div>C. M
etformin</div><div>D. Acarbose</div><div>E. Sitagliptin</div></div>
E.
GlucoseDrugs
What do e use nucleosides/tides for? (5)
"<img src=""paste-13821204759344
.jpg"" />"
PurinePyrimidine
Ho are purines excreted? Pyrimidines? "Purines: Uric acid in the urine<div>Pyr
imidines: CO2, H2O, urea in lungs and urine</div><div><br /></div><div>Here's Re
ddy's hole big chart:</div><div><img src=""paste-13894219203376.jpg"" /></div>"
PurinePyrimidine
Break don hich organ systems excrete compounds that are:<div><br /></div><div>
Volate</div><div>Soluble/polar</div><div>Insoluble/hydrophobic</div>
"<img sr
c=""paste-14117557502768.jpg"" />"
PurinePyrimidine
Which nucleotides are purines?<div>Pyrimidines?</div> Purines = adenine and gu
anine (PUR As Gold or AGgies are PUR)<div><br /></div><div>Pyrimidines = cytosin

e, uracil, thymine (CUT the PY)</div> PurinePyrimidine

What % of the folloing nutrients do e derive from the diet?<div><br /></div><d
iv>Carbs</div><div>TG</div><div>Protein</div><div>Cholesterol</div><div>Nucleic
acids</div><div>Porphyrins</div>
<div>Carbs: 100%</div><div>TG&nbsp;100%<
/div><div>Protein&nbsp;100%</div><div>Cholesterol ~30%</div><div>Nucleic acids 2
-4%</div><div>Porphyrins 0%</div>
PurinePyrimidine
Which 3 AAs are necessary for <b>purine</b> synthesis?<div><br /></div><div>Whic
h 2 AAs are necessary for <b>pyrimidine</b> synthesis?</div>
Purines: glycine
<div>Aspartate</div><div>Glutamine&nbsp;</div><div>(GAG: glide as glue)</div><di
v><br /></div><div>Pyrimidines: Aspartic acid, glutamine</div> PurinePyrimidine
Run through Reddy's extremely simplified purine synthesis scheme.<div><br /></di
v><div>4 inputs</div><div>2 ultimate outputs</div>
"<img src=""paste-151311
69784138.jpg"" />"
PurinePyrimidine
What's the pathogenic mechanism in Lesch-Nyhan syndrome?<div><br /></div><div>Gi
ve 4 symptoms.</div>
Enzyme <b>HGPRT</b> <b>scavenges</b> purines from lysed
cells so e don't have to synthesize as many.<div><br /></div><div>HGPRT doesn't
ork in this disease.</div><div><br /></div><div>So e have to do <b>de novo sy
nthesis </b>of a lot of purines.</div><div><br /></div><div>The breakdon produc
t of purines is <b>uric acid</b>. This is insoluble and forms crystals in joints
that hurt. This is called <b>gouty arthritis</b>.</div><div>Also: <b>Self-mutil
ation (lip biting), motor dysfunction, cognitive defects</b></div>
PurinePy
rimidine
<div>What does ribonucleotide reductase do?</div><div><br /></div>What are the 2
regulators of ribonucleotide reductase?
Ribonucleotides to deoxyribonucl
eotides<div><br /></div><div>ATP stimulates</div><div>dATP inhibits</div>
PurinePyrimidine
Give the pathophysiology of SCID.
<b>Severe combined immune deficiency</b>
<div><br /></div><div><b>Adenosine deaminase (ADA)&nbsp;deficiency</b> &nbsp;lea
ds to <b>lots</b> of <b>dATP</b>, hich i<b>nhibits ribonucleotide reductase</b>
.</div><div><br /></div><div>Thus, <b>shittons of dATP but lo levels of all oth
er nucleotides </b>so <b>can't make DNA</b>.</div><div><br /></div><div><b>Rapid
ly dividing cells--B and T lymphocytes--affected</b>.</div>
PurinePyrimidine
Give the pathophysiology of gout.
Hyperuricemia: <b>underexcretion</b> of
uric acid (end product of purine metabolism) or overproduction<div><br /></div><
div>Deposition of insoluble monosodium urate crystals</div><div><br /></div><div
>Acute arthritic joint inflammation</div>
PurinePyrimidine
Give the treatments for gout. (3)
1. Eat foods lo in nucleic acids.<div>2
. Stay hydrated</div><div>3. Stay arm (crystals form at loer temps)</div><div>
4. Avoid aspirin, alcohol, other diuretics</div><div>5. Give <b>allopurinol</b>:
inhibits xanthine oxidase so the more soluble xanthine/hypoxanthine accumulates
instead of uric acid.&nbsp;</div><div>6. Drain fluid from joints via <b>arthroc
entesis</b>.</div><div>7. Acute: give indomethacin, colchicine, steroids.</div>
PurinePyrimidine
Give the 2 anti-cancer drugs that F ith pyrimidine synthesis and ho each does
so.
"<img src=""paste-18352395256624.jpg"" />"
PurinePyrimidine
"<img src=""paste-18386754994992.jpg"" />"
B
PurinePyrimidine
"<img src=""paste-18412524798768.jpg"" />"
D
PurinePyrimidine
"<img src=""paste-18511309046576.jpg"" />"
E
PurinePyrimidine
"Panel B caused by hat 2 things?<div><br /></div><div><img src=""paste-18537078
850214.jpg"" /></div>" Lack of <b>folate</b> and/or <b>vitamin B12</b> PurinePy
rimidine
Folate is converted to hat in cells? Then to hat?<div><br /></div><div>Give so
me of the reactions that folate is necessary for.</div> Folate to DHF to THF (di
and tetrahydrofolate)<div><br /></div><div><b>One-carbon metabolism:</b></div><
div>synthesis of...</div><div>Formylmethionine tRNA</div><div>Purines</div><div>
dTMP</div><div><br /></div><div>...and via methionine then S-adenosylmethionine
(SAM):</div><div>RNA</div><div>DNA methylation</div><div>Histone methylation</di
v><div>Phosphatidyl choline</div>
PurinePyrimidine
Folate and vitamin B12 are both necessary for hat processes? (2)
<b>One-c
arbon transfer</b> reactions via <b>SAM (S-adenosylmethionine) regeneration</b><

div><b>Nucleic acid synthesis</b></div> PurinePyrimidine

What's the mechanism of action of sulfonamides? <b>Humans</b> take up <b>folate<
/b> from the <b>diet</b>.<div><b>Bacteria</b> <b>make their on</b> from para-am
inobenzoic acid.</div><div><br /></div><div>In the bacterial synthesis pathay,
<b>sulfonamides inhibit the enzyme dihydropteroate synthetase</b>. Without folic
acid, bacteria can't make nucleotides and thus can't replicate.</div> PurinePy
rimidine
Differential diagnosis beteen folate and B12 deficiencies:<div><br /></div><div
>What ill both deficiencies present ith?</div><div>Ho do you tell?</div>
Both ith <b>macrocytic anemia</b><div><b><br /></b></div><div><b>Vitamin B12 re
quired for metabolism of fatty acids ith odd numbers of carbons</b>. So, ithou
t it, <b>abnormal fatty acids go into membranes</b>. This manifests as <b>neurop
sychiatric symptoms</b>.</div><div><br /></div><div>Folate is just associated i
th neural tube defects.</div> PurinePyrimidine
The body has a store of vitamin B12 that lasts ho long?
6+ months
PurinePyrimidine
"<img src=""paste-21981642621744.jpg"" />"
B.
PurinePyrimidine
Recommended intake forms for adults:<div><br /></div><div>Give them for...</div>
<div>Fats</div><div>Carbs</div><div>Sodium</div><div>Potassium</div>
Fats: no
trans fat, lo sat fat<div>Carbs: eat fiber-rich fruits, veggies, hole grains<
/div><div>Sodium: limit it</div><div>Potassium: eat your potatoes and bananas</d
iv>
AngLiGreatness
Energy values in kcal/g:<div><br />Give them for...</div><div><br /></div><div>F
at</div><div>Carbs</div><div>Protein</div><div>Ethanol</div>
<div>Fat: <b>9</
b> kcal/g</div><div>Carbs: <b>4 </b>kcal/g</div><div>Protein: <b>4 </b>kcal/g</d
iv><div>Ethanol: <b>7 </b>kcal/g</div> AngLiGreatness
What is respiratory quotient (RQ)?<div><br /></div><div>Give it for...</div><div
>Carbs</div><div>Protein</div><div>Fat</div>
RQ = (CO2 production)/(O2 consum
ption)<div>So, higher RQ = more CO2 production. This is bad for folks ith COPD.
</div><div><br /></div><div>Carbs: <b>1.0</b></div><div>Protein: <b>0.9</b></div
><div>Fat: <b>0.7</b></div>
AngLiGreatness
What does 'essentiality' mean in the context of AAs?
Can't synthesize these A
As in the body; <b>have to get them through the diet</b>.
AngLiGreatness
Protein compositions:<div><br /></div><div>1. ___-derived protein most closely m
imics bodily needs and is thus the highest quality.</div><div><br /></div><div>2
. Rate of protein synthesis is limited by hat?</div> 1. <b>Animal</b>-derived
<div><br /></div><div>2. <b>Limiting AA</b>: loest available AA limits the rate
of protein synthesis</div>
AngLiGreatness
"1. What are the 2 essential fatty acids?<div><br /></div><div>2. What do they s
erve as precursors for?</div><div><br /></div><div>3. Which one presents as the
""classic"" essential FA deficiency?</div><div><br /></div><div>4. Give its one
symptom.</div>" 1. Linoleic (18:26)<div>Alpha-linolenic (18:33)</div><div><br
/></div><div>2. Other cis-polyunsaturated FA's (aka PUFAs)</div><div><br /></div
><div>3. Linoleic acid</div><div><br /></div><div>4. Dry skin; desquamation</div
>
AngLiGreatness
Acceptable macronutrient distribution ranges:<div><br /></div><div>Give the % ra
nges for...</div><div><br />Carbs</div><div>Fat</div><div>Protein</div> <div>Car
bs: 45-65%</div><div>Fat: 20-35%</div><div>Protein: 10-35%</div>
AngLiGre
atness
Should GH be given in the aftermath of major trauma to prevent protein catabolis
m?
NO! In clinical trials, it increased mortality :(
AngLiGreatness
<div>A 62-year-old man ith <b>chronic obstructive pulmonary disease </b>undergo
es abdominal surgery and is being given parenteral&nbsp;nutrition. Energy intake
is ~135% of estimated energy requirements. <b>Protein constitutes 20%, fat 10%
and glucose 70% of energy</b></div><div><b>intake.</b> There has been difficulty
eaning the patient from the ventilator because of <b>unacceptably high arteria
l pCO2 </b>values hen</div><div>this is attempted.&nbsp;</div><div><br /></div>
<div>What should be done?</div> Decrease the amount of glucose given b/c of its
high R/Q and thus high CO2 production. AngLiGreatness
Give 4 dietary antioxidants.
Vitamins A, C, and E<div>B-carotene</div>

AngLiGreatness
_____ leads to a ____% reduction in average risk of neural tube defects.<div><br
/></div><div>What's the recommended dose of this nutrient?</div>
Folate;
78%!<div><br /></div><div>400 micrograms</div> AngLiGreatness
Ho do you calculate BMI ith the metric system?<div><br /></div><div>What about
Metric: [eight (kg)/[(height (m)]²<d
ith US measures?</div>
iv><br /></div><div>US:&nbsp;&nbsp;(703)[mass (lb)]/[height (in)]²</d
iv>
AngLiGreatness
What are the BMI ranges for each of these eights:<div><br /></div><div>Underei
ght</div><div>Healthy</div><div>Overeight</div><div>Obese</div><div>Morbidly ob
ese</div>
<div>Undereight: <b>&lt;19</b></div><div>Healthy: <b>19-25</b><
/div><div>Overeight: <b>25-30</b></div><div>Obese: <b>30-35</b></div><div>Morbi
dly obese: <b>&gt;35</b></div> AngLiGreatness
Difficulties in curing obesity:<div><br /></div><div>(This asn't highlighted, b
ut I think it's important)</div><div><br /></div><div>Give 3.</div>
1: BMI i
s an imperfect surrogate for body fat; muscle vs. fat<div><br /></div><div>2. Do
n't kno if it's more commonly a problem ith too much intake or too little outp
ut.</div><div><br /></div><div>3. People consume more food than they think they
do. To become obese, you have to be overfeeding by hundred of calories per day.<
/div><div><br /></div><div>4. Eating a Big Mac in 3 min = vigorously exercising
for 60 min. LOL</div><div><br /></div><div>5. Role of genetics in predisposing t
o obesity</div><div><br /></div><div>6. Polygenicity of obesity</div><div><br />
</div><div>7. Internal feedback to maintain the same eight once obese</div><div
><br /></div><div>8. Changing macronutrient ratios isn't a magic bullet (suck it
, Atkins)</div><div><br /></div><div>9. Fat mass, insulin, ghrelin, and leptin a
ction are all inherited and thus <b>not modifiable</b> :( Serving sizes result i
n more food intake regardless of hunger level.</div><div><br /></div><div>10. Kn
oledge&nbsp; behavior</div> AngLiGreatness
Decreased levels of hat hormones lead to increased incidence of hip fractures?
Vitamin D and Ca
AngLiGreatness
Which is the most important in providing nutritional information during pregnanc
y and lactation?<div><br /></div><div>A. History (age, pregnancy #, drugs)</div>
<div>B. Physical exam (height and eight)</div><div>C. Lab tests (Hct, serum glu
cose)</div><div>D. Dietary assessment (appetite, meal patterns, vegetarianism, c
ravings)</div> B.
AngLiGreatness
What's the normal eight gain during pregnancy in pounds?
30 lbs AngLiGre
atness
These atheletes ill be biased toard more of hich type of muscle fibers per mu
scle unit?<div><br /></div><div>Anaerobic exercisers</div><div>Aerobic exerciser
s</div> Anaerobic: Type II aka fast titch (red)<div><br /></div><div>Aerobic: T
ype I, aka slo titch (hite)</div>
AngLiGreatness
________ is the gold standard for measuring cardiovascular fitness.
Maximal
oxygen uptake<div><br /></div><div>Higher O2 consumption =&gt; higher aerobic en
ergy delivery =&gt; higher CV fitness</div>
AngLiGreatness
What is the important effect of aerobic training on muscle?
<div>Groth of t
ype I slo titch</div><div> Increase capillary density</div><div> Increase myoglo
bin, oxidative enz.</div><div><br /></div><div><b>Traditionally, aerobic trainin
g doesn't change the % of ST to FT fibers, but some exp sho that Type II =&gt;
Type I is&nbsp;possible / intense training.</b></div> AngLiGreatness
_________ is important for sprint runners
Creatinine load AngLiGreatness
In order to maximize aerobic performance, hat and hen should you eat? <div><b>
Glycogen load </b>is the key</div><div><br /></div><div>-Eat lots of carbo immed
iately before &amp; after exercise to maximize glycogen storage</div><div>-You'l
l healthily, temporarily gain eight</div><div>(~3 lb)&nbsp;</div><div>Examples
for hom this is important:</div><div>1. Marathon runners</div><div>2. Simmers&
nbsp;</div><div>3. Triathletes</div><div>4. Stop/go sports</div><div><br /></div
><div>NOT for&nbsp;sedentary individuals</div> AngLiGreatness
If you're ay sore b/c of lactic acidosis, hat drug can help? Bicarbonate<div>
<br /></div><div>So take some Alka-Seltzer or Tums!</div>
AngLiGreatness
Calorie requirements are calculated based on hat parameter ith respect to exer

cise? <b>Intensity</b><div><br /></div><div>We're just supposed to kno that s

pecific calculations exist to figure out recommended caloric intakes for particu
lar individuals.</div> AngLiGreatness
"<img src=""pastesroutt.png"" />"
1. Calvaria<br>2. Cranial Base<br>
Marked CRANIALCAVITY
What are the to divisions of the cranium?
"Neurocranium and viscerocranium
<br><img src=""pastekjia8.png"" />"
Marked CRANIALCAVITY
"<img src=""pastes2pfhd.png"" />"
1. Frontal Bone<br>2. Zygomatic <br>3. S
phenoid<br>4. Ethmoid<br>5. Vomer<br>6. Inferior conchae<br>7. Maxilla<br>8. Man
dible<br>
Marked CRANIALCAVITY
"<img src=""pastetubgts.png"" />"
1. Superior/Inferior Orbital Fissure<br>
2. Supraorbital foramen<br>3. Infraorbital foramen<br>4. Mental foramen<br>5. Pi
riform aperature<br>
Marked CRANIALCAVITY
What is contained ithin the piriform aperture? Nasal septum and nasal conchae
Marked CRANIALCAVITY
"<img src=""pasteppvsv8.png"" />"
1. Frontal <br>2. Parietal<br>3. Tempora
l<br>4. Occipital<br>5. Sphenoid<br>6. Zygomatic<br>7. Maxilla<br>8. Mandible<br
>
Marked CRANIALCAVITY
"<img src=""pasteqihe2.png"" />"
1. External acoustic opening<br>2. Masto
id process<br>3. Styloid process<br>4. Zygomatic arch<br>5. Pterion<br>6. Lambdo
id suture<br>7. Coronal suture<br>
Marked CRANIALCAVITY
"<img src=""pastekrqg5b.png"" />"
1. Parietal<br>2. Occipital<br>3. Mandib
le<br> Marked CRANIALCAVITY
"<img src=""pastev4yuyc.png"" />"
1. External occipital protuberance<br />
2. Inion<br />3. Superior/Inferior nuchal line<br />4. Sagittal suture<br />5. L
ambdoid suture<br />6. Lambda<br />
Marked CRANIALCAVITY
"<img src=""paste9th6yg.png"" />"
1. Frontal<br>2. Parietal<br>3. Occipita
l<br> Marked CRANIALCAVITY
"<img src=""pastezzjzye.png"" />"
1. Coronal suture<br>2. Sagittal suture<
br>3. Bregma<br>4. Lambda<br> Marked CRANIALCAVITY
"<img src=""pastehixabs.png"" />"
1. Occipital <br>2. Temporal<br>3. Zygom
atic<br>4. Maxilla<br>5. Palatine<br>6. Sphenoid<br>7. Vomer<br>
Marked C
RANIALCAVITY
"<img src=""pastej8y5tz.png"" />"
1. Incisive fossa<br>2. Greater/Lesser P
alatine foramen<br>3. Lateral/Medial pterygoid plates<br>4. Jugular foramen<br>5
. Carotid canal<br>6. Stylomastoid foramen<br>7. Inferior/Superior Nuchal line<b
r>8. Occipital condyle<br>9. Foramen Magnum<br> Marked CRANIALCAVITY
"<img src=""paste5onue6.png"" />"
1. Frontal<br>2. Ethmoid<br>3. Sphenoid<
br>4. Temporal<br>5. Occipital<br>
Marked CRANIALCAVITY
"<img src=""pastevg740j.png"" />"
1. Crista galli<br>2. Cribriform plate o
f the ethmoid<br>3. Sella turcica<br>4. Prechiasmatic sulcus<br>5. Anterior/Post
erior Clinoid processes<br>6. Clivus<br>7. Internal occipital protuberance<br>
Marked CRANIALCAVITY
"<img src=""pastegrrasi.png"" />"
1. Cribriform foramina <br>2. Optic cana
ls<br>3. Superior orbital fissure<br>4. Foramen rotundum<br>5. Foramen ovale<br>
6. Foramen spinosum<br>7. Foramen lacerum<br>8. Internal auditory meatus<br>9. J
ugular foramen<br>10. Hypoglossal canal<br>
Marked CRANIALCAVITY
"Reference:<br><img src=""pastedrudx.png"" />"
Marked CRANIALCAVITY
Where does each cranial nerve exit the skull? Cribriform foramina (I)<br>Optic
canals (II)<br>Superior orbital fissure (III, IV, V1, VI)<br>Foramen rotundum (
V2)<br>Foramen ovale (V3)<br>Internal auditory meatus (VII, VIII)<br>Jugular for
amen (IX, X, XI)<br>Hypoglossal canal (XII)<br><br>
Marked CRANIALCAVITY
What exits through foramen spinosum? <br>
Middle meningeal artery Marked C
RANIALCAVITY
What exits through foramen lacerum?
Foramen lacerum:&nbsp;&nbsp;nothing
Marked CRANIALCAVITY
Which cranial nerves carry special senses? Sensory? Motor? Parasympathetic?
"<img src=""pasteddxyn.png"" />"
Marked CRANIALCAVITY
Which cranial nerves contain parasympathetic axons?
III, VII, IX, and X
Marked CRANIALCAVITY

Where are the nuclei of the cranial nerves found?

Cranial nerve nuclei loc
ated in brainstem (except for CNI and CNII hich have extensions in the forebrai
n)<br> Marked CRANIALCAVITY
Cranial nerves are covered by _____
sheaths derived from meninges<br>
Marked CRANIALCAVITY
List the outside covering of the scalp "<img src=""pastelkkukj.png"" /><br>S=sk
in<br>C=connective tissue<br>A=aponeurosis<br>L=loose areolar tissue<br>P=pericr
anium<br>"
Marked CRANIALCAVITY
List the three types of intracranial hemorrhages and hat causes each. "<span s
tyle=""color:#ff0000;"">Extradural (epidural) hemorrhage</span><br>Rupture of mi
ddle meningeal artery<br>Follos hard blo to the head<br>Blood strips dura from
cranium<br>Arterial in origin<br><img src=""pastetekutg.png"" /><br><br><span s
tyle=""color:#ff0000;"">Subdural hemorrhage</span><br>Separates dura/arachnoid j
unction<br>Follos blo to the head that jerks the brain inside the cranium<br>V
enous in origin<br><img src=""pastexprh4l.png"" /><br><br><span style=""color:#f
f0000;"">Subarachnoid hemorrhage</span><br>Occurs as a result of a aneurysm<br>A
rterial in origin<br><img src=""paste7ujlfo.png"" />" Marked CRANIALCAVITY
Where does the middle meningeal artery enter the neurocranium? Through foramen
spinosum
Marked CRANIALCAVITY
What is the clinical correlation associated ith the middle meningeal artery?
Anterior division is found behind the pterion Marked CRANIALCAVITY
"<img src=""pasteo5oktt.png"" />"
1. Straight sinus<br>a. Great cerebral v
ein of Galen<br>2. Confluence of sinuses<br>3. Transverse sinus<br>4. Sigmoid si
nus<br>5. Cavernous sinus<br>6. Superior petrosal sinus<br>7. Inferior petrosal
sinus<br>
Marked CRANIALCAVITY
"<img src=""paste9sa6d0.png"" />"
1. Superior sagittal sinus<br>2. Inferio
r sagittal sinus<br>3. Straight sinus<br>4. Confluence of sinuses<br>5. Transver
se sinus<br>6. Sigmoid sinus<br>7. Cavernous sinus<br>8. Superior/Inferior petro
sal sinus<br> Marked CRANIALCAVITY
"<img src=""paste_d43hg.png"" />"
1. Falx cerebri<br>2. Tentorium cerebell
i<br>A. Tentorial notch<br>3. Falx cerebelli<br>4. Diaphragma sellae<br>
Marked CRANIALCAVITY
What are the layers of the dura mater and here are they found? Periosteal layer
and internal meningeal layer.<br>Periosteal layer attaches along suture lines,
is continuous ith periosteum on calvaria and is NOT present in the spinal cord<
br>Internal meningeal layer is fused ith the periosteal layer except in dural s
inuses/infoldings.
Marked CRANIALCAVITY
What are the functions of the cranial meninges? Protect and nourish brain and fo
rm a frameork for vasculature<br>
CRANIALCAVITY
Where is the CSF found?
In the subarachnoid space
Marked CRANIALCA
VITY
What forms dural infoldings?
Meningeal layer of the dura mater
Marked C
RANIALCAVITY
What keeps the arachnoid mater held against the meningeal dura? Pressure of the
CSF
Marked CRANIALCAVITY
What gives the brain its shiny surface? Pia mater
Marked CRANIALCAVITY
What is the function of the granulations in the arachnoid mater?
To trans
fer CSF to the venous system
Marked CRANIALCAVITY
What makes up the trabeculae in the arachnoid mater?
They consist of fibrobla
sts hich bridge the subarachnoid space Marked CRANIALCAVITY
List eh fontanelles.
Anterior, posterior, sphenoid, and mastoid
Marked C
RANIALCAVITY
What is the function of the fontanelles?
Allos the calvaria to change (m
old) during birth and accommodates the rapid groth of the brain during the firs
t to years of life<br> Marked CRANIALCAVITY
Why do physicians palpate the fontanelles in infants? (3)
Enables the prog
ress of groth to be monitored<br>Allos determination of hydration status<br>Ca
n indicate the level of intracranial pressure<br>
Marked CRANIALCAVITY
What is the most common symptom associated ith a traumatic brain injury?
Disturbances in the level of consciousness
Marked CRANIALCAVITY

Traumatic brain injuries (TBI): <br><br>1. a. Ho many people in the USA sustain
a TBI per year? <br>b. What % of all USA deaths are caused by TBI's?<br><br>2.
a. TBI is lumped into hat broader category of causes of death?<br>b. Where does
this category rank on the list of causes of death?<br>c. TBI is a contributing
factor to hat fraction of these deaths?<br><br>3. What is the most common sympt
om associated ith TBI?<br><br>4. Name one complication from TBI.<br> 1. a. 1.
7 million people <br>b. 10% of all USA deaths<br><br>2. a. Injury-related deaths
<br>b. 5th<br>c. 1/3<br><br>3. <b>Disturbances in the level of consciousness</b>
<br><br>4. a. Hemorrhage<br>b. Infection<br>c. Brain injury<br>d. Cranial nerve
injury Marked CRANIALCAVITY
"Cranial meninges:<br /><br />Name and characterize each by one parameter.<br />
<br /><img src=""paste8yhpzv.jpg"" />" 1. <b>Dura</b> mater<br />Thick external
fibrous layer<br /><br />2. <b>Arachnoid</b> mater<br />Thin intermediate layer
<br /><br />3. <b>Subarachnoid</b> space<br />Contain cerebral spinal fluid<br /
><br />4. <b>Pia</b> mater<br />Delicate internal vascular layer
Marked C
RANIALCAVITY
Compare the extent of <b>vascularization</b> in the <b>arachnoid</b> mater versu
s the <b>pia</b> mater. Arachnoid: <b>avascular</b><br />Pia: <b>highly vascular
</b>
Marked CRANIALCAVITY
Give a mnemonic to remember the names of the 12 cranial nerves. OOO To Touch And
Feel Virgin Girls' Vaginas and Hymens<br><br>I Olfactory<br>II Optic<br>III Ocu
lomotor<br>IV Trochlear<br>V Trigeminal<br>VI Abducent<br>VII Facial<br>VIII Ves
tibulocochlear<br>IX Glossopharyngeal<br>X Vagus<br>XI Accessory<br>XII Hypoglos
sal
Marked CRANIALCAVITY
Which organs are found in the neck?
Thyroid, parathyroid, and larynx
Neck Marked
"<img src=""pastetabqo_.png"" />"
1. Cervical vertebrae<br>2. Hyoid bone<b
r>3. Manubrium<br>4. Clavicle Neck Marked
Which region of the spinal cord contains the smallest vertebrae? Greatest range
of movement?
Cervical vertebrae!
Neck Marked
"<img src=""pastethrusi.jpg"" /><br>What is 4?" Foramen transversarium Neck Mar
ked
What is unique about the spinous process of cervical vertebrae? "Bifid spinous p
rocess<br><img src=""pastethrusi.jpg"" />"
Neck Marked
"<img src=""paste39km5b.png"" /><br>What are these to unique features of cervic
al vertebrae?" Anterior and posterior tubercles<br>
Neck Marked
"<img src=""pasteimmbed.png"" />"
1. Superior articular surfaces<br>2. Gro
ove for vertebral artery
Neck Marked
"<img src=""pastebyysa6.png"" />"
A. Superior articular facets<br>B. Dens
Neck Marked
Name 4 unique properties of atlas.
No body or spinous process<br>Lateral ma
sses<br>Widest cervical vertebrae<br>No disc<br>
Neck Marked
Nodding your head (saying yes) requires movement beteen ___ and ___
skull an
d atlas Neck Marked
Shaking your head (saying no) requires movement beteen ___ and ___
atlas an
d axis Neck Marked
"<img src=""pastecdpobd.png"" />"
A. Anterior atlanto-occipital membrane<b
r>B. Posterior atlanto-occipital membrnae<br>C. Anterior longitudinal ligament<b
r>D. Ligamentum flavum Neck Marked
"<span style=""font-eight:600; color:#0000ff;"">[...]</span> is a continuation
of the anterior longitudinal ligament." "<span style=""font-eight:600; color:#0
000ff;"">Anterior atlanto-occipital ligament</span> is a continuation of the ant
erior longitudinal ligament." Neck Marked
"<span style=""font-eight:600; color:#0000ff;"">[...]</span> is a continuation
of ligamentum flavum." "<span style=""font-eight:600; color:#0000ff;"">Posteri
or atlanto-occipital ligament</span> is a continuation of ligamentum flavum."
Neck Marked
Which ligaments make up the atlanto-axial joint?
Cruciate ligament of the
atlas, alar ligaments, and tectorial membrane Neck Marked
"<img src=""paste_qsu_g.png"" />"
1. Cruciate ligament of the atlas <br>2.

Alar ligaments<br>3. Tectorial membrane<br>4. Posterior longitudinal ligament

Neck Marked
"<span style=""font-eight:600; color:#0000ff;"">[...]</span> is a continuation
of the posterior longitudinal ligament."
"<span style=""font-eight:600;
color:#0000ff;"">Tectorial membrane</span> is a continuation of the posterior lo
ngitudinal ligament." Neck Marked
What is the function of the alar ligaments?
Check ligaments to prevent exces
sive rotation Neck Marked
What is the function of the cruciate ligament of the atlas?
Holds the dens u
p against the atlas
Neck Marked
Which spinal level contains the hyoid bone?
C3
Neck Marked
What are the functions of the hyoid bone?
Anchor for neck muscles and assi
sts in keeping the airay open Neck Marked
"<img src=""pasteqi5ies.png"" /><br>Which bone is this?"
Hyoid bone<br>1.
Body<br>2. Greater horn<br>3. Lesser horn
Neck Marked
The hyoid bone is found beteen ___ and ____
mandible and the thyroid cartila
ge
Neck Marked
What is a clinical sign of a hyoid fracture?
Inability to elevate the hyoid b
one makes salloing and separation of the esophagus and trachea difficult<br>
Neck Marked
What can cause a hyoid fracture?
Occurs resulting from strangulation by c
ompression of the throat<br>
Neck Marked
"<img src=""pastephckpf.png"" />"
Platysma
Neck Marked
"<img src=""pastecfmgyr.png"" />"
Superficial fascia
Neck Marked
What structures are found ithin the superficial fascia of the neck?
-fatty c
onnective tissue<br>-contains cutaneous nerves and lymphatic and blood vessels<b
r>-anteriorly contains platysma <br>
Neck Marked
Which nerve supplies platysma? CNVII Neck Marked
Platysma arises from ___ and ____
deltoid and pectoralis major fascia
Neck Marked
"<img src=""pasteay_ctj.png"" /><br>Identify the three deep layers of neck fasci
a"
Black: Investing<br>Blue: Pretracheal<br>Red: Prevertebral
Neck Mar
ked
"<img src=""pastez6_og9.png"" />"
1. Investing<br>2. Pretracheal<br>3. Pre
vertebral
Neck Marked
Which structures are found ithing the carotid sheath? "Carotid arteries<br>Int
ernal jugular vein<br>Vagus nerve (CNX)<br>Lymph nodes<br>Nerve to the carotid s
inus<br>Sympathetic nerve fibers (carotid plexus)<br><img src=""paste8ulcp8.png"
" />" Neck Marked
"<img src=""pasteysy7f1.png"" /><br>Identify this space."
Retropharyngeal
space Neck Marked
"<img src=""pastehafppm.png"" /><br>Identify the 4 regions of the neck."
1. Sternocleidomastoid<br>2. Posterior cervical<br>3. Lateral cervical<br>4. Ant
erior cervical Neck Marked
"<img src=""pastegqlh4a.png"" /><br>Identify the four regions of the neck."
1. Sternocleidomastoid<br>2. Posterior cervical<br>3. Lateral cervical<br>4. Ant
erior cervical Neck Marked
"<img src=""paste7xk1a6.png"" /><br>Identify this muscle"
Sternocleidomast
oid
Neck Marked
What is the innervation of sternocleidomastoid? Where does it attach? What is it
s function?
Innervation: CNXI (motor)<br />Attachments: Sternal/clavicular h
eads to the skull<br>Function: Tonic contraction functions to maintain position
of cervical vertebrae<br>
Neck Marked
"<img src=""pastevq3dh0.png"" /><br />Identify this blood vessel."
Superior
portion of external jugular vein<br /> Neck Marked
"<img src=""pastejfre5h.png"" /><br>Identify these nerves. What are they branche
s of?" These are sensory branches of the cervical plexus<br>A. Greater auricula
r nerve<br>B. Transverse cervical nerve Neck Marked
What causes the external jugular vein to become prominent? What is this a diagno
stic sign of? Rising venous pressure causes vein to become prominent<br>Diagno

stic signs of:<br>-Heart failure<br>-SVC obstruction<br>-Enlarged lymph nodes<br

>-Increased intrathoracic pressure<br> Neck Marked
"<img src=""pastekpyk3.png"" /><br>What is rong here?"
External jugular
vein distension
Neck Marked
List the barriers of the lateral cervical region
Borders: sternocleidomas
toid, trapezius, clavicle<br>Roof: investing layer of deep fascia<br>Floor: prev
ertebral layer of deep fascia Neck Marked
"<img src=""pastez1nyg5.png"" />"
1. Sternocleidomastoid<br>2. Trapezius<b
r>3. Clavicle Neck Marked
"<img src=""pastehfscm.png"" />"
1. Omohoid muscle<br>2. Occipital triang
le<br>3. Subclavian (omoclavicular) triangle
Neck Marked
What are the attachments of omohyoid? Superior scapular border to hyoid bone
Neck Marked
What is the significance of the subclavian (omoclavicular) triangle?
Can feel
the pulsations of the subclavian artery here Neck Marked
"<img src=""pastexe4jdj.png"" />"
1. Vertebral artery (cervical portion)<b
r>2. Internal thoracic (cervical portion)<br>3. Thyrocervical trunk<br>a. Inferi
or thyroid<br>b. Transverse cervical<br>c. Suprascapular
Neck Marked
"<img src=""pastenlgcky.png"" /><br>Identify these veins"
1. External jugu
lar vein<br>2. Subclavian vein Neck Marked
Where does the external jugular vein pierce the investing fascia?
At the p
osterior border of sternocleidomastoid Neck Marked
Ho can you tell internal from external jugular vein? "External jugular vein i
s on top of sternocleidomastoid hereas as internal is belo<br><img src=""paste
qzva8.png"" />"
Neck Marked
What the purpose of a subclavian vein puncture? Ho is it performed?
Used for
central line placement (fluids, medicine, measure venous pressure)<br>To insert
line:<br>-Thumb on clavicle<br>-Index finger on jugular notch<br>-Needle is ang
led toard index finger inferior to the thumb<br>
Neck Marked
What are some complications associated ith a subclavian vein puncture? Puncture
of the pleura/lung -&gt; pneumothorax<br>Entry of the subclavian artery
Neck Marked
"<img src=""pasteusjbsx.png"" /><br>Identify these nerves"
A. Spinal access
ory nerve (CN XI)<br>B. Sensory branches of the cervical plexus (C1-4) Neck Mar
ked
"<img src=""pasteuby_aq.png"" /><br />Identify these nerves. What spinal nerves
are contained ithin each?"
1. Lesser occipital nerve (C2-3)<br />2. Greater
auricular nerve (C2-3)<br />3. Transverse cervical nerve (C2-3)<br />4. Supracl
avicular (C3-4) Neck Marked
"<img src=""pastel2ety4.png"" /><br>What is rong here? What is the cause?"
Torticollis: tisted neck/slanted head<br>Contraction or shortening of cervical
muscles (ex: fibrous tissue tumor or torn sternocleidomastoid) Neck Marked
What is the function of the extrinsic back muscle? Intrinsic? Extrinsic: contr
ol the upper limbs<br />Intrinsic: maintain posture and control vertebral column
movement
Neck Marked
What is the innervation of the extrinsic back muscle? Intrinsic?
"Extrins
ic: <span style=""color:#ff0000;"">Anterior</span> rami of cervical nerves<br>In
trinsic: <span style=""color:#0000ff;"">Posterior</span> rami of cervical nerves
"
Neck Marked
Which portion of the cervical nerves contribute to the cervical plexus? (anterio
r rami/posterior rami/both)
Anterior rami Neck Marked
Cervical nerves are formed from (sensory, motor, both) roots
Both sensory and
motor -&gt; myotomes and dermatomes
Neck Marked
The suboccipital triangle is found underneath Trapezius, sternocleidomastoid,
and intrinsic back muscles
Neck Marked
"<img src=""pastem_g3z.png"" />"
1. Trapezius<br>2. Sternocleidomastoid<b
r>3. Intrinsic back muscles<br> Neck Marked
"<img src=""pasteqdrut_.png"" />"
A. Rectus capitis posterior major<br>B.
Rectus capitis posterior minor<br>C. Obliquus capitis inferior<br>D. Obliquus ca
pitis superior Neck Marked

What forms the floor of the suboccipital triangle? Roof?

Floor: posteior
atlanto-occipital membrane and posterior arch of C1<br>Roof: intrinsic back musc
les
Neck Marked
Which structures are found ithin the suboccipital triangle?
Vertebral artery
and suboccipital nerve (posterior rami of C1) Neck
"<img src=""pasterg3ljq.png"" />"
Muscles:<br>1. Rectus capitis posterior
major<br>2. Rectus capitis posterior minor<br>3. Obliquus capitis inferior<br>4.
Obliquus capitis superior<br>Floor<br>5. Posterior atlanto-occipital membrane a
nd posterior arch of C1<br>Roof<br>6. Intrinsic back muscles<br>Contents<br>7. V
ertebral artery<br>8. Suboccipital nerve (posterior rami of C1)<br>
Neck Mar
ked
"<img src=""paste_vtdac.png"" />"
5. Suboccipital nerve (posterior rami of
C1)<br />6. Greater occipital nerve (posterior rami of C2)
Neck Marked
"<img src=""paste4nndgv.png"" /><br>Identify the regions of the vertebral artery
"
1. Cervical part<br>2. Vertebral part<br>3. Suboccipital part<br>4. Cran
ial part
Neck Marked
What is found ithin the transverse foramen of the cervical vertebrae? Vertebra
l artery (vertebral part)
Neck Marked
"The vertebral artery enters the cranial caivty through <span style=""font-eigh
t:600; color:#0000ff;"">[...]</span>" "The vertebral artery enters the cranial
caivty through <span style=""font-eight:600; color:#0000ff;"">foramen magnum</
span>" Neck Marked
"The vertebral artery pierces through <span style=""font-eight:600; color:#0000
ff;"">[...]</span> as it travels toards the cranium" "The vertebral artery pi
erces through <span style=""font-eight:600; color:#0000ff;"">posterior atlantooccipital membrane</span> as it travels toards the cranium"
Neck Marked
The vertebral arteries (left and right) join to form ____ and subsequently _____
basilar artery<br>vertebral arterial circle
Neck Marked
Describe the mechanism alloing acute hypersensitivity reactions to take place i
n seconds rather than minutes. IgE bind to FcR1 on Mast clls prcding xposur
to antign.&nbsp;&nbsp;Antign binding fraction of IgE facs outwards, allowing
binding to th antign which triggrs th rlas of granul contnts from th
Mast cll.
Chaptr1A Markd
What ar th four primary functions of th immun systm?
Dfns against
infctions (immunodficincy and vaccinations altr suscptibility to infction)
<br />Dfns against tumors <br />Rcogniz and rspond to tissu grafts and n
wly introducd molculs (barrir to transplantation, gn thrapy, and protin
thrapy)<br />Injur clls and induc pathologic inflammation (acts in allrgic,
autoimmun, and inflammatory disass) Chaptr1A Markd
Ar vaccins awsom?&nbsp;&nbsp;Did thy rduc incidnc of major disass suc
h as dipthria, masls, mumps, paralytic polio, rublla, ttanus, and mor by 9
9.99%? Ys.&nbsp;&nbsp;But notabl failurs includ malaria, HIV, tubrculosis,
and hookworm. Chaptr1A Markd
Compar and contrast acquird and innat immunity along th following dimnsions
: Spcificity, Divrsity, Mmory, Clonal xpansion, Spcialization, Contraction
and Homostasis, Timing, and Nonractivity to slf.&nbsp;&nbsp;Hav fun.
"<img src=""past5yxrar.jpg"" /><br>Additionally, Innat immunity typically rac
ts within th first 6-12 hours, whras adaptiv immunity rsponds ovr svral
days to wks but has mor rapid rsponss upon rpatd rcptors."
Chaptr1
A Markd
"Epithlial barrirs, phagocyts, dndritic clls, complmnt, and NK clls ar
part of <span styl=""font-wight:600; color:#0000ff;"">[...]</span>." "Epithl
ial barrirs, phagocyts, dndritic clls, complmnt, and NK clls ar part of
<span styl=""font-wight:600; color:#0000ff;"">Innat Immunity</span>."
Chaptr1A Markd
"B lymphocyts, antibodis, T lymphocyts, and ffctor T clls ar part of <spa
n styl=""font-wight:600; color:#0000ff;"">[...]</span> Immunity."
"B lymph
ocyts, antibodis, T lymphocyts, and ffctor T clls ar part of <span styl=
""font-wight:600; color:#0000ff;"">Adaptiv</span> Immunity." Chaptr1A Markd
"<span styl=""font-wight:600; color:#0000ff;"">[...]</span> xposur occurs wi

th naiv B clls and has a slowr tim scal." "<span styl=""font-wight:600;

color:#0000ff;"">Primary</span> xposur occurs with naiv B clls and has a slo
wr tim scal.&nbsp;&nbsp;<br />"
Chaptr1A Markd
"<span styl=""font-wight:600; color:#0000ff;"">[...]</span> xposur occurs wi
th mmory B clls and happns mor rapidly."
"<span styl=""font-wight:600;
color:#0000ff;"">Scondary</span> xposur occurs with mmory B clls and happn
s mor rapidly.&nbsp;&nbsp;Rpatd xposurs rducs tim and incrass mmory
prsnc."
Chaptr1A Markd
"Mylocyts and lymphocyts ar both <span styl=""font-wight:600; color:#0000f
f;"">[...]</span>."
"Mylocyts and lymphocyts ar both <span styl=""fontwight:600; color:#0000ff;"">Lukocyts</span>."
Chaptr1A Markd
"B clls, T clls, NK clls, and som dndritic clls ar <span styl=""font-wi
ght:600; color:#0000ff;"">[...]</span>.&nbsp;&nbsp;What prcntag ar prsnt i
n th blood?" "B clls, T clls, NK clls, and som dndritic clls ar <span
styl=""font-wight:600; color:#0000ff;"">Lymphocyts</span>.&nbsp;&nbsp;<br><br
>2% in th blood.&nbsp;&nbsp;Mostly locatd in lymph and tissus."
Chaptr1
A Markd
"Granulocyts (basophils, osinophils, and nutrophils), mgakaryocyts, and mon
ocyts ar all <span styl=""font-wight:600; color:#0000ff;"">[...]</span>.&nbs
p;&nbsp;Whr ar thy locatd?<br><br>"
"Granulocyts (basophils, osino
phils, and nutrophils), mgakaryocyts, and monocyts ar all <span styl=""fon
t-wight:600; color:#0000ff;"">mylocyts</span>.<br><br>Thy ar primarily loca
td in th blood."
Chaptr1A Markd
"Mast cll macrophags and dndritic clls ar <span styl=""font-wight:600; co
lor:#0000ff;"">[...]</span>.&nbsp;&nbsp;Ar thy locatd primarily in th tissu
s or th blood?"
"Mast cll macrophags and dndritic clls ar <span sty
l=""font-wight:600; color:#0000ff;"">mylocyts</span>.&nbsp;&nbsp;<br><br>Th
y ar locatd in tissus."
Chaptr1A Markd
"B lymphocyts, T lymphocyts, and NK lymphocyts mdiat <span styl=""font-wi
ght:600; color:#0000ff;"">[...]</span>immunitis, rspctivly. (3)"
"B lymph
ocyts, T lymphocyts, and NK lymphocyts mdiat <span styl=""font-wight:600;
color:#0000ff;"">humoral, cll-mdiatd, and innat </span>immunitis, rspcti
vly." Chaptr1A Markd
Nam antign prsnting clls for cll-mdiatd immunity and humoral immunity.
B clls and dndritic clls prsnt antign to T clls.<br>Follicular dndritic
clls display antigns to B lymphocyts in humoral immun rsponss.&nbsp;&nbsp;
(FDC ar NOT hmatopoitic linag)
Chaptr1A Markd
List 6 ffctor clls (dirct mdiators of immunity rathr than rgulating othr
clls).
hlpr T clls and cytotoxic T lymphocyts<br>macrophags and mo
nocyts (clls of th mononuclar phagocyt systm)<br>Nutrophils and Eosinophi
ls (granulocyts)
Chaptr1A Markd
Dscrib th stags and locations of maturation of lymphocyts (T and B).
"<img src=""pastwwc_ay.jpg"" />"
Chaptr1A Markd
Rcall, if you plas, th following rlvant paramtrs of lymphocyt flow kin
tics. <br><br>Avrag dwll tim in blood bfor r-ntry into tissu.<br>Efflu
nt from thoracic lymph duct.<br>Avrag dwll tim in tissus<br>Fraction of lym
phocyts in blood at on tim. Avrag dwll tim in blood -- 30 min.&nbsp;&nbs
p;Sinc blood flow is 5L/min and blood volum is 5 L, that is 30 passs through
th hart.<br><br>Efflunt from thoracic lymph duct is 4L/day.&nbsp;&nbsp;Not t
his is much lss than blood turnovr.<br><br>Avrag dwll tim in tissus is ab
out 1 day.<br><br>2% of lymphocyts in blood at on tim.&nbsp;&nbsp;<br><br>As
a rsult, th lymphocyts sampld from th blood ar not truly rprsntativ of
th lymphocyts in tissu and lymph. Chaptr1A Markd
"A molcul rcognizd by (ar ligands for) th antign-binding domains of antig
n rcptors is an <span styl=""font-wight:600; color:#0000ff;"">[...]</span>.
&nbsp;&nbsp;Contrast ths rcptors with th ligand rcognizd by all oth rc
ptors in th body including innat immunity and hormon rcptors.&nbsp;&nbsp;"
"A molcul rcognizd by (ar ligands for) th antign-binding domains of antig
n rcptors is an <span styl=""font-wight:600; color:#0000ff;"">antign</span
>.&nbsp;&nbsp;<br><br>Th gns for antign rcptrs ar gnratd during our li

ftim, whras w ar born with comlt gns for othr rcptors.&nbsp;&nbsp;"
Markd Chaptr1B
"A substanc that can induc a primary acquird immun rspons to it and can in
duc clonotypic xpansion to a moity in it is an <span styl=""font-wight:600;
color:#0000ff;"">[...]</span>."
"A substanc that can induc a primary a
cquird immun rspons to it and can induc clonotypic xpansion to a moity in
it is an <span styl=""font-wight:600; color:#0000ff;"">immunogn</span>."
Markd Chaptr1B
"A chmical that can b usd to modify anothr protin and induc a novl antig
n spcificity for antibodis is a <span styl=""font-wight:600; color:#0000ff;"
">[...]</span>."
"A chmical that can b usd to modify anothr protin a
nd induc a novl antign spcificity for antibodis is a <span styl=""font-wi
ght:600; color:#0000ff;"">haptn</span>."
Markd Chaptr1B
"A protin to which haptns can b attachd, forming a complt immunognic, is
a <span styl=""font-wight:600; color:#0000ff;"">[...]</span>."
"A prot
in to which haptns can b attachd, forming a complt immunognic, is a <span
styl=""font-wight:600; color:#0000ff;"">carrir</span>."
Markd Chaptr1B
"Th minimal structur of an antign rcognizd by th antign rcptor is an <s
pan styl=""font-wight:600; color:#0000ff;"">[...]</span>.&nbsp;&nbsp;"
"Th minimal structur of an antign rcognizd by th antign rcptor is an <s
pan styl=""font-wight:600; color:#0000ff;"">pitop</span>.&nbsp;&nbsp;"
Markd Chaptr1B
"Th progny of a singl cll ar all calld <span styl=""font-wight:600; colo
r:#0000ff;"">[...]</span>.&nbsp;&nbsp;Th implication is that thy ar gntical
ly idntical.<br>"
"Th progny of a singl cll ar all calld <span styl
=""font-wight:600; color:#0000ff;"">clons</span>.&nbsp;&nbsp;Th implication i
s that thy ar gntically idntical.<br>"
Markd Chaptr1B
"Th particular antign rcptor xprssd by any onc cll is its <span styl="
"font-wight:600; color:#0000ff;"">[...]</span>."
"Th particular antign
rcptor xprssd by any onc cll is its <span styl=""font-wight:600; color:
#0000ff;"">clonotyp</span>." Markd Chaptr1B
"A clon drivd by fusing a singl B cll with a plasmacytoma is a <span styl=
""font-wight:600; color:#0000ff;"">[...]</span>.&nbsp;&nbsp;This clon maks ju
st on clonotyp."
"A clon drivd by fusing a singl B cll with a plasma
cytoma is a <span styl=""font-wight:600; color:#0000ff;"">hybridoma</span>.&nb
sp;&nbsp;This clon maks just on clonotyp." Markd Chaptr1B
"Loss of a parntal cll causs loss of an ntir clon, calld <span styl=""fo
nt-wight:600; color:#0000ff;"">[...]</span>" "Loss of a parntal cll causs
loss of an ntir clon, calld <span styl=""font-wight:600; color:#0000ff;"">
clonal dltion.</span>"
Markd Chaptr1B
"Stimulation of a singl cll gnrats many progny.&nbsp;&nbsp;This procss is
calld <span styl=""font-wight:600; color:#0000ff;"">[...]</span>." "Stimula
tion of a singl cll gnrats many progny.&nbsp;&nbsp;This procss is calld
<span styl=""font-wight:600; color:#0000ff;"">clonal xpansion</span>."
Markd Chaptr1B
Which of th following dsignat innat vs acquird immunity?&nbsp;&nbsp;<br>hom
ostatic<br>mmory-forming<br>anamnstic<br>antign-indpndnt<br>antign-spci
fic
"<img src=""pastng92oh.jpg"" /><br>Th qustion marks in th graph ar
usd to indicat nams that ar not fully appropriat.&nbsp;&nbsp;For xampl, i
nnat immunity is not mal-adaptiv, although acquird immunity was historically
trmd adaptiv.&nbsp;&nbsp;" Markd Chaptr1B
Compar and contrast humoral immunity and cll-mdiatd immunity pathways (both
phagocytsd micrbs and intracllular microbs) w/r/t microb, rsponding lympho
cyts, ffctor mchanism, and functions.
"<img src=""past_20yoq.jpg"" />
"
Markd Chaptr1B
Dscrib th migration, frquncy of clls rsponsiv to particular antign, and
ffctor functions of <b>T lymphocyts</b> as thy progrss from naiv clls th
rough activatd/ffctor lymphocy to mmory lymphocyt.
Naiv clls xp
rinc prfrntial migration to priphral lymph nods, and hav vry low frqu
ncy of rspons to particular antign with no ffctor functions.&nbsp;&nbsp;<b

r /><br />Activatd/ffctor lymphocyt migrat prfrntially to inflamd tissu

s, whr thy hav high rspons to particular antign and ngag in cytokin s
criton and cytotoxic activity.<br /><br />Mmory lymphocyts undrgo htrogn
ous migration to lymph nods, mucosa, and inflamd tissus.&nbsp;&nbsp;Thy hav
 low (but highr than naiv) rspons to antign and no ffctor functions.<br
/>
Markd Chaptr1B
Dscrib th mmbran immunoglobulin isotyp, affinity of Ig producd, and ffc
tor functions of <b>B lymphocyts</b> as thy progrss from naiv clls through
activatd/ffctor lymphocy to mmory lymphocyt.
Naiv B lymphocyts hav
IgM and IgD mmbran immunoglobulin with rlativly low affinity and no ffcto
r functions.<br><br>Activatd or ffctor lymphocyts typically hav IgG, IgA or
IgE mmbran immunoglobulin, with incrasd affinity during immun rspons rs
ulting in antibody scrtion.<br><br>Mmory clls also hav IgG, IgA, and IgE m
mbran immunoglobulin, with rlativly high affinity but no ffctor function.
Markd Chaptr1B
Dscrib th migration pattrns of granulocyts, monocyts, dndritic clls, and
lymphocyts btwn blood, tissu, and lymph. Granulocyts (BEN) migrat from
blood to tissus<br>Monocyts bcom macrophags in tissus<br>Dndritic clls r
sid in tisss and migrat to lymph nods<br>Lymphocyts ngag in complx mov
mnts in and out of tissus. <br><br> Markd Chaptr1B
At this point, it may b a good ida to rcall th gnral histologicl structur
of th spln.&nbsp;&nbsp;For xampl, do you rmmbr th dirction of lymph f
low?&nbsp;&nbsp;How about th composition of grminal cntrs?&nbsp;&nbsp;Dirct
ion of blood flow?
"<img src=""pastflnpv.jpg"" />"
Markd Chaptr1B
What is th significanc and location of th mting of B clls and T clls?
Ths clls ach nd signals from th othr to prform full function.&nbsp;&nbs
p;Thy mt at th dg of th follicls (B cll zon) and paracortx (T cll zo
n).<br>
Markd Chaptr1B
Dscrib th signalling involvd in rolling adhsion, tight binding, diapdsis,
and migration of whit blood clls.<br />
Rolling adhsion taks plac as&
nbsp;&nbsp;sylyl lwis X (sLX) wakly intracts with E-slctins dcorating th
lumn of capillary ndothlium.&nbsp;&nbsp;Analagous to brushing fingrs along
wall.<br /><br />Tight binding occurs as IL-8 rlasd from th local ndothliu
m binds to CSCL8R, triggring th cll to bind to Intrcllular adhsion molcul
 1 (ICAM-1) on th ndothlium via Lymphocyt Function Associatd antign 1 (LF
A-1).&nbsp;&nbsp;This &quot;suprglus&quot; th travlling cll to th surfac,
stopping rolling and allowing th cll to diapdsis btwn clls.<br /><br />
Aftr diapdsis if migrats through th xtracllular matrix.&nbsp;&nbsp;What,
you wantd mor dtail than that?<br /> Markd Chaptr1B
What animals jump highr than a hous? All of thm.&nbsp;&nbsp;Houss cant jum
p.
Chaptr1B
At your convninc, dscrib th typical symptoms/faturs, mchanism of disas
, lab rsults, and tratmnt of Lukocyt Adhsion Dficincy Syndrom (LADS).
Typical symptoms/faturs:<br>Dlayd sparation of umbilicus, gingivitis and s
vr priodontitis, rcurrnt bactrial infctions, dfctiv nutrophil function
s, dfctiv complmnt-mdiatd bactrial killing, dfctiv T cll rsponss i
n lymph nods, and dfctiv NK activity.<br><br>Mchanism of Disas:<br>dfct
in CD18 on autosom 21, which is rquird for LFA-1 (CD11a) rquird for lympho
cyt grss from blood, and Mac-1 (CD11b), a complmnt rcptor CR3 on macropha
gs, NK clls, and nutrophils, causing dfcts in opsonization of pyognic bact
ria.<br><br>Posibl Lab rsults:<br>CD3 positiv clls ar CD18 ngativ in flo
w cytomtry<br>Rbuck Skin Window tst (surgical abrasion histologically monitor
d for arrival of WBC) shows no WBC<br>T cll rsponss to PHA and ConA (Stimula
nts)slightly dprssd <br><br>Tratmnt:<br>Bisulfan, cyclophosphamid, and Ant
i-thymocyt srun for tn days to ablat<br>T-dpltd bon marrow transplant wi
th short cours of immunosupprssivs.<br><br> Markd Chaptr1B
What ar th bordrs of th antrior crvical rgion of th nck?
"1. Mdi
an lin of th nck<br>2. Antrior bordr of SCM<br>3. Infrior bordr of th ma
ndibl<br>Subcutanous tissu containing platysma (roof)<br>Pharynx, larynx, thy
roid gland (floor)<br><br><img src=""pastn_vjys.png"" />"
Nck2 Markd

What is th function of th suprahyoid muscls? Infrahyoid?

"Suprahyoid:Elv
ats hyoid and larynx whn swallowing <br>Infrahyoid: Dprss hyoid and larynx w
hn swallowing and spaking<br><img src=""pastpyx3ow.png"" /><br>"
Nck2 Ma
rkd
"<img src=""pastnq_9nx.png"" /><br>Idntify ths muscls and thir nrv suppl
y."
1. Mylohyoid: CNV3<br>2. Gniohyoid: C1
Nck2 Markd
"<img src=""pastnyqa1p.png"" /><br>Idntify ths muscls and thir nrv suppl
y."
1. Mylohyoid: CNV3<br>3. Stylohyoid: CNVII<br>4. Digastric:<br>-Antrior
blly: CNV3<br>-Postrior blly: CNVII Nck2 Markd
"<img src=""pastguqx10.png"" /><br>Idntify ths muscls."
1. Strnohyoid<b
r>2. Omohyoid<br>3. Strnothyroid<br>4. Thyrohyoid
Nck2 Markd
"<img src=""past_a7fch.png"" /><br>Idntify ths artris." A. Common caroti
d<br>B. Intrnal carotid<br>C. Extrnal carotid Nck2 Markd
"<img src=""pastp_3act.png"" /><br>Idntify ths structurs." 1. Carotid sinus
<br>2. Carotid body
Nck2 Markd
What nrv innrvats th carotid sinus? Carotid body? Both ar innrvatd by C
N IX and CN X Nck2 Markd
What is th function of th carotid sinus? Carotid body?
Carotid sinus: b
arorcptor (masurs prssur)<br>Carotid body: chmorcptor (masurs oxygn
lvls) Nck2 Markd
"Absnc of a carotid puls indicats <span styl=""font-wight:600; color:#0000
ff;"">[...]</span>"
"Absnc of a carotid puls indicats <span styl=""font
-wight:600; color:#0000ff;"">cardiac arrst</span>"
Nck2 Markd
Which spinal nrvs ar containd within th transvrs crvical nrv? C2-3
Nck2 Markd
Nam th branchs of th vagus nrv (CN X)
Pharyngal Nrv<br>Suprior lar
yngal nrv<br>Intrnal/Extrnal branchs<br>Rcurrnt laryngal nrv <br>Inf
rior laryngal nrv<br>Cardiac Branchs<br>Prsynaptic parasympathtic fibrs a
nd viscral affrnt fibrs to th cardiac plxus<br> Nck2 Markd
Suprficial branchs of th crvical plxus ar ____, whras dp branchs ar
_____ "Suprficial branchs of th crvical plxus ar <span styl=""color:#ff
0000;"">snsory</span>, whras dp branchs ar <span styl=""color:#ff0000;""
>motor</span>" Nck2 Markd
Th crvical plxus is mad up of _____ antrior rami of C1-4 Nck2 Markd
Which spinal nrvs ar containd within th suprior root of th crvical plxu
s? Infrior root?
Suprior root: C1-2<br>Infrior root: C2-3
Nck2 Ma
rkd
Which nrv supplis th infrahyoid muscls?
Infrior root of th crvical pl
xus (C2-3)
Nck2 Markd
What is th ky landmark for finding th phrnic nrv in th nck?
Passs b
twn th subclavian vin and artry to ntr th thorax
Nck2 Markd
What is containd within th submandibular triangl?
Submandibular Gland<br>H
ypoglossal nrv (CNXII)<br>Facial artry and vin<br> Nck2 Markd
What is containd within th carotid triangl? Common carotid artry<br>Intrna
l carotid<br>Extrnal carotid<br>Intrnal jugular vin<br>Ansa crvicalis lis o
n top of th shath<br>Dp crvical lymph nods<br>Vagus nrv<br>
Nck2 Ma
rkd
What is containd within th viscral compartmnt of th nck? Vascular? Vrtbr
al?
<b>Viscral</b><br>Tracha<br>Esophagus<br>Thyroid<br>Parathyroid<br><br
><b>Vascular</b><br>Intrnal jugular vin<br>Common carotid/branchs<br>Vagus n
rv<br><br><b>Vrtbral</b><br>Crvical vrtbra<br>Muscls<br>Sympathtic chai
n<br>Roots of crvical plxus<br>
Nck2 Markd
"<img src=""pastylc9br.png"" />"
"<img src=""past9iuy2.png"" />"
Nck2 Markd
What is th function of th scalns, splnius capitis, and lvator scapula?
Flxion of th had and nck
Nck2 Markd
"Th crvical portion of th sympathtic trunk is containd within <span styl="
"font-wight:600; color:#0000ff;"">[...]</span>"
"Th crvical portion of
th sympathtic trunk is containd within <span styl=""font-wight:600; color:
#0000ff;"">th prvrtbral fascia</span>"
Nck2 Markd

"<img src=""past23cxds.png"" /><br>Idntify th ganglia of th sympathtic chai

n in th nck." Suprior (C1/C2)<br>Middl (C6)<br>Infrior (C7, Stllat gangli
on)<br> Nck2 Markd
T/F: Thr ar no whit rami communicants in th nck. Tru
Nck2 Markd
What causs hornrs syndrom? Lsion of th sympathtic trunk Nck2 Markd
"Th thyroid gland is nclosd within <span styl=""font-wight:600; color:#0000
ff;"">[...]</span>"
"Th thyroid gland is nclosd within <span styl=""font
-wight:600; color:#0000ff;"">th prtrachal layr of dp crvical fascia</spa
n>"
Nck2 Markd
How many parathyroid glands ar thr? 4
Nck2 Markd
"Voic box aka <span styl=""font-wight:600; color:#0000ff;"">[...]</span>"
"Voic box aka <span styl=""font-wight:600; color:#0000ff;"">larynx</span>"
Nck2 Markd
"Th larynx is found at spinal lvls <span styl=""font-wight:600; color:#0000
ff;"">[...]</span>"
"Th larynx is found at spinal lvls <span styl=""font
-wight:600; color:#0000ff;"">C3-6</span>"
Nck2 Markd
What is th diffrnc btwn xtrinsic and intrinsic laryngal muscls?
Extrinsic muscls: Mov th larynx as a whol<br>-Ex: Suprahyoid-lvats,Infrah
yoid-dprsss<br>Intrinsic muscls:Mov th laryngal cartilags<br> Nck2 Ma
rkd
Nam th thr parts of th pharynx
Nasopharynx, oropharynx, laryngopharynx
Nck2 Markd
Which rgions of th sophagus ar striatd? Smooth?
Uppr 1/3:&nbsp;&nbsp;st
riatd<br>Middl 1/3:&nbsp;&nbsp;mixd<br>Lowr 1/3:&nbsp;&nbsp;smooth<br>
Nck2 Markd
What is an antign?
uniqu structurs rcognizd by th adaptiv immun syst
m (sp. antibodis)
Chaptr1A
What ar th two typs of adaptiv immunity and what typs of microbs do ths
adaptiv immun rsponss combat?
oHumoral: antibodis from B lymphocytsat
tack xtracllular microbs<br>oCll-mdiatd: T lymphocytsdstroy intracllular
microbs (hlpr T clls activat macrophags to dstroy phagocytosd pathogns
; cytolytic T clls dstroy infctd clls)<br> Chaptr1A
How dos innat immunity diffr from adaptiv immunity (diffrncs in timing, t
yps of ffctor mchanisms, divrsity of antigns, gnration of mmory, scond
ary rsponss)? oInnat: pithlial barrirs, phagocyts, complmnt, natural ki
llr cllsfast, rcogniz structurs gnral to microbs<br>oAdaptiv: lymphocyt
s and products (antibodis)slowr, rcogniz spcific antigns, us spcializd m
chanisms (killr T clls for infctd clls, antibodis for xtracllular fluid
s), maintains mmory of prior xposur to pathogns<br> Chaptr1A Markd
How dos passiv immunity diffr from activ immunity? Patint rcivs antibod
is/clls from an immun individualrsults in short-trm immunity bcaus thr i
s no nativ immun rspons
Chaptr1A Markd
What is clonal slction and how dos this contribut to th diffrncs btwn
primary and scondary immun rsponss?
oLymphocyts ar clonally xprs
sd (i.., thr xist numrous clons of lymphocyts, ach with a crtain spci
ficity and dscndd from a singl prognitor cll); xposur to an antign rsu
lts in clonal xpansion of th (prxisting) clls spcific to it<br>oTh first
tim an individual is xposd to a pathogn, th rlvant lymphocyts ar nav; t
hy undrgo clonal xpansion in rspons, and som mmory lymphocyts ar lft bh
ind, nsuring a scond ncountr with th pathogn will triggr a fastr and str
ongr immun rspons<br>
Chaptr1A Markd
What ar th principal classs of lymphocyts, how do thy diffr in function, a
nd how may thy b idntifid and distinguishd?
oHlpr (CD4) T clls: a
ssist B clls in production of antibodis, macrophags in phagocytosis of microb
s (scrt cytokins)rcogniz antigns bound to MHCs<br>oCytotoxic (CD8) T cll
s: kill infctd cllsrcogniz antigns bound to MHCs<br>oB clls: produc antib
odisrcogniz fr and surfac-bound antigns (but do not rquir MHCs)<br>oNatu
ral killr clls: mdiat innat immunity (do not hav clonal antign rcptors)
<br>oClls ar morphologically similar but can b diffrntiatd by immunohistoc
hmistry<br>
Chaptr1A Markd

What ar important diffrncs among nav, ffctor, and mmory B and T lymphocyt
"<img src=""past9srvqa.png"" />"
Chaptr1A Markd
s?
What ar th gnrativ or primary lymphoid organs and what ar scondary or pr
iphral lymphoid organs? Which priphral lymphatic tissus handl invasions of
pathogns in ach of th following aras: skin, mucosa (rspiratory, gnitourina
ry, GI tracts), bloodstram?
oGnrativ/primary: thymus (T clls), bon marr
ow (B clls)<br>oPriphral/scondary: lymph nods, spln, mucosal/cutanous im
mun tissus<br>oSkin, rspiratory, gnitourinary, GI tracts ar all srvd by l
ymphatic drainag, but also contain nativ lymphatic tissu of varying dgrs o
f organization (Pyrs patchs, pharyngal tonsils ar highly structurd; SALT l
ss so)<br>oBloodstram: spln<br>
Chaptr1A Markd
Whr ar T and B lymphocyts locatd in lymph nods and how is thir anatomic s
paration maintaind? oB clls: in follicls (found in cortx; may hav grmin
al cntrs if rsponding to antign)<br>oT clls: in paracortx<br>oSgrgation
is maintaind by scrtion of chmokins from clls found in th rlvant aras
(for xampl, B clls ar attractd by chmokins scrtd by follicular dndrit
ic clls)chmokin rcptors ar numrous in nav clls; xprssion dclins in ac
tivatd clls, which allows T and B clls to intract<br>
Chaptr1A Markd
How do nav and ffctor T lymphocyts diffr in thir pattrns of migration?
oNav T clls migrat to priphral lymphoid organs (whr thy can b xposd to
antigns); ffctor clls migrat to sits of infction (whr thy can fight p
athogns)<br>oEffctor B lymphocyts scrt antibodis and do not nd to migra
t<br> Chaptr1A Markd
Sphingosin-1-phosphat "<span styl=""color:#ff0000;"">Constitutivly high conc
ntrations in blood; low lvls in tissus. GCPR S1P rcptor is rgulatd to co
ntrol lukocyt grss from&nbsp;&nbsp;tissus </span>" Markd
H202
"<span styl=""color:#ff0000;"">Producd by nutrophils and macrophags.
Inhibits PTEN, lading to nutrophil rcruitmnt.&nbsp;&nbsp;Dos NOT us GPCR
mchanism</span>"
Markd
fMtLuPh (fMLF)
"<span styl=""color:#ff0000;"">N-formyl (bactrial and
mitochondrial) pptids activat fMLF rcptor on nutrophils, macrophags, uss
GPCR</span>" Markd
CXCR4 "<span styl=""color:#ff0000;"">GCPR rcptor on T clls, B clls and h
matpoitic stm clls for chmokin SDF-1 (stroma-drivd factor aka CXCL12); an i
mportant co-rcptor for HIV lat in infction. </span>"
Markd
CCR5
"<span styl=""color:#ff0000;"">GCPR chmokin rcptor on T clls and m
acrophags for chmokins RANTES (aka CCL5) and macrophag inflammatory protin
MIP1, ;&nbs;&nbs;m jr c-rece
r fr HIV.&nbs;&nbs;___ 32 homozygous individu
als are virtually immune to HIV infection. </span>"
Mar
ed
C3aR; C5aR
"<span style=""color:#ff0000;"">GCPR receptors for complement-de
rived anaphylatoxins.&nbsp;&nbsp;Activate migration and phagocytosis in macropha
ges and neutrophils. </span>" Mar
ed
CD21
"<span style=""color:#ff0000;"">Complement receptor CR2. Binds C3d and C
3dg degradation productions of C3.&nbsp;&nbsp;Entry receptor for EBV. </span>"
Mar
ed
IFN, (Tye I In
erfern)
"<s n s
yle=""clr:#ff0000;"">An
i-vir l cy
kines ind
uced in ms
cell
yes by virus infec
in, eseci lly RNA viruses.&nbs;&nbs;M
jr rduc
f l sm cy
id Dendri
ic Cells (DC).&nbs;&nbs;&nbs;S
imul
es
n
i-vir l defenses in ms
cell
yes.&nbs;&nbs;</s n>"
M rked
IFN- (amma) "<span style=""color:#ff0000;"">___ is secreted by TH1 cells&nbs
p;&nbsp;and NK cells and sometimes by macrophaes.&nbsp;&nbsp;___ maintains the
Th1 differentiated state and suppresses Th2 cells; it also upreulates killin a
ctivity by CD8 T cells and NK cells, and phaocytosis and killin activity by ma
crophaes.&nbsp;&nbsp;It also upreulates class I MHC expression on most cell ty
pes and a variety of innate anti-viral activities in most cell types.&nbsp;&nbsp
;The interferons are so-named because theu interfere with viral replication. ___ a
lso activates Immunolobulin class switchin to the cytolytic human odd IGs (IG1
&amp; 3). Hence, IFNamma can be seen as drivin a cytolytic lymphocyte respons
e by T, B and NK cells. </span><br />A cytokine produced by T-Cells and NK Cells
. Activates B-Cells, macrophaes and other T-Cells. Induces isotype switchin (B

-Cells). Activates macrophaes. Activates MHC II and B7 (Co-stim) on APCs. Leads

to CD4+ (TH1) cell differentiation." Marked
TLR2
"<span style=""color:#ff0000;"">Surface receptor for molecules from fun
i and other pathoesn. </span>" Marked
NALP3 "<span style=""color:#ff0000;"">Intracellular receptor for ATP.&nbsp;&nb
sp;Activates its caspase-1 subunit to cleave pro-IL1 to enerate active IL1</span>
"
Marked
RIG-1 "<span style=""color:#ff0000;"">RNA helicase; intracellular receptor for
dsRNA.Activates NFB</span>" Mar
ed
"RAGE (<span style=""color:#ff0000;"">Receptor for advanced glyosylation interme
diates)</span><br />" "<span style=""color:#ff0000;"">Recognizes a variety of
danger signals including oxidized sugars. </span>"
Mar
ed
C1q
"<span style=""color:#ff0000;"">___ is the first discovered member of th
e complement system and binds to cross-lin
ing IgM, IgG1 and IgG3: triggering __
_ thus activates the classical complement pathway. </span>"
Mar
ed
C3
"<span style=""color:#ff0000;"">___ is the central player in the complem
ent cascade.&nbsp;&nbsp;It is cleaved into C3b and C3a by each of the three init
iating pathways. C3a binds to its G-coupled protein receptor on mast cells and m
acrophages.&nbsp;&nbsp;C3b forms a covalent bond to target membranes and protein
s and helps form both a C3 convertase to cleave C3 and and a C5 convertase to cl
eave C5.&nbsp;&nbsp;C3b is a ligand for CR1 on RBC and other cell types.&nbsp;&n
bsp;C3 is converted by inhibitory factors to iC3b which no longer can activate a
dditional C3 or C5, and is a poor ligand for CR1.However,&nbsp;&nbsp;&nbsp;iC3b
binds tightly to CR3 (= Mac1=CD11b/CD18) on macrophage and thus is a
ey player
in the car wash mechanism of clearing RBC of immune complexes. C3d&nbsp;&nbsp;is a
cleavage product of iC3b which binds to CD21 on B cells to help stimulate them
(in conjunction with CD19).&nbsp;&nbsp;Given this wide array of functions, it is
clear why defects in C3 lead to profound immunodeficiency.</span>"
Mar
ed
C5
"<span style=""color:#ff0000;"">___ is activated by C3b (as part of the
C5 convertase enzyme) by cleavage to produce C5b and C5a.&nbsp;&nbsp;C5a is an a
naphaxatoxin binding to G-coupled protein receptors on mast cells and macrophage
s (thus wor
ing li
e a chemo
ine and opsonin). C5b recruits C6 and the rest of t
he membrane attac
complex (MAC; C6, C7, C8, C9). </span>"
Mar
ed
C9
"<span style=""color:#ff0000;"">___ is the terminal factor in the comple
ment cascade; a ring of ___ are assembled by C5678 to form a membrane spanning c
hannel, punching a hole in cellular membranes. </span>" Mar
ed
FcRn
"<span style=""color:#ff0000;"">This was not on your original HYM list b
ut Ive covered it so much that you
now it is HYM.&nbsp;&nbsp;Id be surprised to h
ear that it is on the STEP ONE, but I teach it because it explains so many criti
cal properties of IgG.&nbsp;&nbsp;It binds equivalently to both even and odd hum
an IgGs.&nbsp;&nbsp;It is expressed in the placenta, mammary gland epithelia, mu
cosal epithelia, and endothelial cells. Is a bidirectional IgG transporter, tran
scytosing IgG from mother to fetus through the placenta, into the mil
, and from
the gut to the neonatal blood stream, and from the adult blood stream into the
gut.&nbsp;&nbsp;It stores IgG in endothelial cells which acts as buffers or depo
ts for storing and stabilizing IgG, explaining its very long half-life (~23 days
; three wee
s) compared to other IgG (~1 wee
in the blood).&nbsp;&nbsp;</span>"
Mar
ed
"AID <span style=""color:#ff0000;"">Activation-induced (cytosine) deaminase. </s
pan>" "<span style=""color:#ff0000;"">An important enzyme for B cell function
but with no direct role on T cells.&nbsp;&nbsp;___ is expressed only in germinal
centers, not the bone marrow.&nbsp;&nbsp;___ is turned on by activation of CD40
, which can be induced by CD40L (very important) and by complement C4 binding pr
otein (a minor role in most of us). ___ deaminates cytosines in DNA, creating le
sions recognized by DNA repair enzymes.&nbsp;&nbsp;&nbsp;___ has three main func
tions in immunoglobulin gene modification</span><br /><span style=""color:#ff000
0;"">1.
Random point mutation of the V region of expressed immunoglobulin
genes, leading to somatic hypermutation which allows affinity maturation. </spa
n><br /><span style=""color:#ff0000;"">2.
Concentrated mutation of the sw
itch elements upstream of heavy chain segments initiates switching: deletion of

the DNA between activated switch elements and thereby causing class switching.</
span><br /><span style=""color:#ff0000;"">3.
[FYI: Mutation of the V regi
on can also initiate a
ind of recombination called gene conversion , through wh
ich germline V genes can donate their sequences to the expressed immunoglobulin lo
cus, thus wor
ing much li
e RAG-dependent editing radically to change antigen sp
ecificity.&nbsp;&nbsp;___-mediated gene conversion of the type is the preferred
mechanism (relative to RAG) for immunoglobulin gene rearrangement in rabbits and
camels and the ONLY mechanism in chic
ens, facts which are admittedly of little
use to the healer of humans. Bottom line: DNA deaminaton=&gt;mutation [=&gt;DNA
repair =&gt;DNA recombination.]</span><br />" Mar
ed
Differentiate between monoclonal and polyclonal antibodies.
"Monoclonal anti
bodies bind to the same epitope of the same antigen. They are made by hybridomas
.<br><br>Polyclonal antibodies are made by the body and recognize <span style=""
font-weight:600; color:#ff1a1b;"">different epitopes of the same antigen.</span>
"
1 Mar
ed
What two signals are required to trigger an immune response?
-stranger (forei
gn) signals generated by pathogens<br>-stress/danger signals generated by human
cells<br>
2 Mar
ed
What are pathogen associated molecular pattern (PAMPs)? They are molecular motif
s that are recognized by the innate immune system. <br /><br />More generalized
and larger than the epitopes recognized by the clonotypes of acquired immunity l
eu
ocytes, they include motifs such as N-formyl-methionine, mannose, and lipopol
ysaccharides (LPS).<br><br>They are shared between various classes of microbes (
e.g. gram+ bacteria, gram- bacteria, fungi, viruses, etc)
2 Mar
ed
"Reference card<br /><img src=""Screen Shot 2013-01-07 at 4.47.02 PM (1).png"" /
>"
2 Mar
ed
"Reference card<br />Note that both foreign/stranger signals AND&nbsp;&nbsp;dang
er/injury signals are required for an immune response.<br /> <img src=""Screen S
hot 2013-01-07 at 4.47.48 PM.png"" />"
2 Mar
ed
"Reference card<br /><br /><img src=""Screen Shot 2013-01-07 at 4.49.04 PM.png""
/>"
2 Mar
ed
What is the inflammasome and what role does it play in responding to influenza?
"It is a large multi-protein complex that responds to the virions interaction w
ith the cell surface.<br><br>1. Viral binding distorts cell surface<br>2. Inflam
masome detects surface change (through un
nown mechanism)<br>3. NALP3 (NLRP3) bi
nds ATP and zymogenically cleaves pro-caspase-1, activating caspase-1<br>4. Casp
ase-1 cleaves pro-IL-1-beta to IL-1-beta<br>5. The released IL-1-beta is a poten
t pro-inflammatory molecule<br><img src=""Screen Shot 2013-01-07 at 4.49.04 PM.p
ng"" />"
2 Mar
ed
What is the role of TLR-7 in responding to influenza? "1. Inside in the endoso
me, it recognizes ssRNA (a viral motif).<br />2. It activates a signaling cascad
e that increases the transcription of pro-IL-1-beta and IFN-alpha/beta<br />3. p
ro-IL-1-beta is eventually cleaved by caspase-1 of the inflammasome and released
extracellularly as a potent pro-inflammatory agent<br>4. IFN-alpha/beta are int
erferons which warn nearby cells of the viral infection and trigger their antivi
ral response<br /><img src=""Screen Shot 2013-01-07 at 4.49.04 PM.png"" />"
2 Mar
ed
What is the role of RIG-1 in responding to the flu virus?
"1. recognition
of viral 5-PPP-RNA, common motif used for protection and ribosome loading for t
ranslation<br />2. Activation of signaling cascade that leads to increased trans
cription of pro-IL-1-beta and IFN-alpha/beta<br>3. Pro-IL-1-beta cleaved by casp
ase-1 (on inflammasome) to IL-1-beta and is a pro-inflammatory agent<br>4. IFN-a
lpha/beta warn nearby cells of viral infection and triggers antiviral response<b
r><img src=""Screen Shot 2013-01-07 at 4.49.04 PM.png"" />"
2 Mar
ed
"Reference card<br><img src=""Screen Shot 2013-01-07 at 5.20.19 PM.png"" />"
2 Mar
ed
What are NKT cells?
From Wi
ipedia:<br>Natural
iller T (NKT) cells are a he
terogeneous group of T cells that share properties of both T cells and natural

iller (NK) cells. Many of these cells recognize the non-polymorphic CD1d molecul
e, an antigen-presenting molecule that binds self- and foreign lipids and glycol

ipids. They constitute only approximately 0.1% of all peripheral blood T cells.
2 Mar
ed
What is the role of the N-formyl peptide receptor and its ligand, N-formyl-methi
onine, in innate immunity?
All bacteria begin translation with N-formyl-met
hionine, ma
ing it a good pathogen associated molecular pattern (PAMP) for recog
nition by the innate immune system.<br><br>It is also used in mitochondrial tran
slation (because they were bacteria under the endosymbiotic theory). It is relea
sed when cells die and their mitochondria also lyse.<br><br>The receptor thus ca
n detect both bacterial and mitochondrial N-formyl-methionine, the stranger and
danger signals, respectively. 2 Mar
ed
What is a scavenger receptor? (From lecture): they recognize apoptotic cells<b
r><br>Hence, the name scavenger receptor.<br><br>From glossary of Abbas:<br>A fa
mily of cell surface receptors expressed on macrophage, originally defined as re
ceptors that mediate endcytosis of oxidized or acecylated low density lipoprotei
n particles but that also bind and mediate phagocytmis of a variety of microbes.
<br>
2 Mar
ed
What is a CpG island? CpG sites &quot;CpG&quot; is shorthand for &quot;Cphosphat
eG&quot;, that is, cytosine and guanine separated by only one phosphate; phosphate
lin
s any two nucleosides together in DNA. <br><br>Theyre bacterial motifs rec
ognized by TLR-9.
2 Mar
ed
"Reference card<br><img src=""Screen Shot 2013-01-07 at 5.49.15 PM.png"" />"
2 Mar
ed
"Toll-li
e receptors (reference card):<br>Note the two different sets, an extern
al set responsive to the bacteria and fungi and one responsive to viruses<br /><
img src=""Screen Shot 2013-01-07 at 6.07.29 PM.png"" />"
2 Mar
ed
There are (3) different locations of innate immune receptors. Name them and some
examples.
"extracellular, cytosolic, endosomal<br><br>NOD-li
e receptor: N
ALP3 as example<br>RIG-li
e: RIG-I as example<br><img src=""Screen Shot 2013-0107 at 6.10.49 PM.png"" />"
2 Mar
ed
How do neutrophils
ill pathogens? How do they contribute to fibrosis in the lun
g?
"In addition to the [two slides] below, their apoptosis releases a very
stic
y (due to negative charge) net of DNA that traps pathogens.<br>Unfortunatel
y, in lung tissue, this apoptosis releases elastase that digests the elastin, tr
iggering &quot;compensatory&quot; fibrosis.<br><img src=""Screen Shot 2013-01-07
at 6.14.24 PM.png"" /><br><img src=""Screen Shot 2013-01-07 at 6.14.37 PM.png""
/>"
2 Mar
ed
"Unique features of cervical vertebrae:<br><br><img src=""paste7hsiOT.png"" />"
1. Foramen transversarium<br><br>2. Anterior/posterior tubercles<br><br>3. Enlar
gement of vertebral foramina<br><br>4. Bifid spinous processes<br>
Nec
Mar

ed Nec
PKFinal
T or F: the hyoid does NOT articulate with any other bone, only muscle. True.
Nec
Mar
ed Nec
PKFinal
"Activation of phagocytes (reference card)<br><img src=""Screen Shot 2013-01-07
at 6.25.20 PM.png"" />"
2 Mar
ed
What are the (4) functions of H2O2 and other reactive oxygen species (ROS) in ne
utrophils and other phagocytes? 1. Kill the ingested microbe as a ROS<br>2. acti
vate elastase and other
illing enzymes stored in intracellular granules<br>3. t
rigger the specialized apoptosis that forms the neutrophil DNA net<br>4. chemota
xis to recruit more neutrophils and macrophages (to eat dead neutrophils)
2 Mar
ed
"Macrophage activate pathways (reference card)<br><img src=""Screen Shot 2013-01
-07 at 6.25.20 PM.png"" />"
2 Mar
ed
What are the purpose and components of the &quot;odd pathway&quot; of macrophage
activation?
"Purpose: phagocytose,
ill, stimulate other microbicidal cells;
also anti-tumor and inflammatory<br><br>TH1 cells are inflammatory T-cells: res
pond to IL-12, microbicidal<br>CTL: cytotoxic T lymphocytes<br><img src=""Screen
Shot 2013-01-07 at 7.23.53 PM.png"" />"
2 Mar
ed
What are the purpose and components of the &quot;even pathway&quot; of macrophag
e activation? "Purpose: angiogenic, pro-tumor, anti-inflammatory, wound repair
, fibrosis<br>Responds to even antibodies, secretes VEGF, stimulates NK2 (useful

for mother to &quot;defend&quot; against fetus)<br><img src=""Screen Shot 201301-07 at 7.23.53 PM.png"" />" 2 Mar
ed
"Complement system (reference card)<br><img src=""Screen Shot 2013-01-07 at 7.35
.15 PM.png"" />"
2 Mar
ed
What are the three phases of the complement system and which factors are part of
them? "Activation: C1-4<br>Integration: C3,5<br>MAC (membrane attac
complex):
6-9<br><img src=""Screen Shot 2013-01-07 at 7.35.15 PM.png"" />"
2 Mar
ed
What is the MAC (membrane attac
complex)?
Formed by C6-9, it forms a tube
structure that penetrates the microbe, damaging its integrity and allowing other
2 Mar
ed

illing proteins to enter.

What are the three different pathways of initiating the complement cascade?
Classical<br>Alternative<br>Lectin
2 Mar
ed
Describe the steps of the classical pathway of the complement system. "http://
www.youtube.com/watch?v=vbWYz9XDtLw<br />1. IgG3,1 and M opsonize the microbe<br
/>2. C1 binds to the aggregated antibodies<br />3. C1 cleaves C4 to C4b (which
attaches covalently to the microbe in <b>fixation)</b> and C4a (an anaphylatoxin
)<br />4. C2 attaches to C4b and is cleaved by C1, forming C4bC2a, <b>C3 convert
ase</b><br />5. C3 convertase binds and cleaves C3 to C3a (anaphylatoxin) and C3
b, which attaches to C3 convertase to form C4bC2aC3b, <b>C3/C5 convertase</b><br
/>6. Many C3 cleaved by C3/C5 convertase, which further fix to the microbe<br /
>7. C5 is cleaved by C3/C5 convertase to C5a (<b>most important chemotactic mole
cule of complement cascade)</b> and C5b<br />8. C5b does not bind to the membran
e, but recruits C6,7,8, C7 starting the <b>membrane attac
complex (MAC) formati
on</b><br />9. Many C9 molecules are recruited to form MAC pore<br />10. Lysis o
f microbe<br /><img src=""Screen Shot 2013-01-07 at 7.35.15 PM.png"" /><br />"
2 Mar
ed
Describe the steps of the alternative complement cascade.
"1. C3 spontaneo
usly activates in an autocatalytic fashion, forming the anaphylatoxic C3a, and t
he C3b<br />2. C3b binds to the microbe membrane and recruits Factor B<br />3. F
actor B is cleaved, leaving C3bBb, <b>C3 convertase</b><br /><b>Classical pathwa
y continues</b><br /><img src=""Screen Shot 2013-01-07 at 7.35.15 PM.png"" />"
2 Mar
ed
Describe the lectin pathway of the complement cascade. "1. Mannose binding lect
in (MBL) binds to mannose residues on the microbial surface<br>2. MBL recruits M
BL-associated serine proteases, MASP-1 and MASP-2 (similar to C1)<br>3. The prot
eases cleave C4 and C2 to form <b>C3 convertase</b><br>4. <b>Classical pathway c
ontinues</b><br><img src=""Screen Shot 2013-01-07 at 7.35.15 PM.png"" />"
2 Mar
ed
What is iC3bs role in the complement cascade? iC3b is a proteolytically inacti
ve product of the complement cleavage fragment C3b that still opsonizes microbes
, but cannot associate with factor B (in alternative pathway). Thus, it prevents
amplification of the complement cascade or activation through the alternative p
athway.<br><br>This molecule shuts down the complement cascade because it can at
tac
our own cells due to the spontaneous cleavage of C3 in the alternative path
way.
2 Mar
ed
"Complement Receptors (reference card)<br><img src=""Screen Shot 2013-01-07 at 8
.39.27 PM.png"" />"
2 Mar
ed
What is the &quot;car wash&quot; mechanism of cleaning RBCs of complement molecu
les?
1. RBCs get coated in iCb3 as a sideproduct of the alternative complemen
t pathway, but dont get lysed due to iCb3s inhibition of the cascade.<br>2. RB
Cs travel to spleen for &quot;cleaning&quot;<br>3. Macrophages express CR3 (Mac1
=CD11b/CD18), which have a higher affinity for iCb3 than the RBC<br>4. iCb3 remo
ved and RBC is &quot;clean&quot;
2 Mar
ed
What is RAGE? "The emotional product of your immunology education.<br><br>The
sciencey fancy pants definition:<br>Receptor for Advanced Glycation Endproducts<
br><br>Recognizes a variety of danger signals including oxidized sugars from a <
b>spi
e in blood sugar.</b><br><span style="" font-weight:600;""></span><br>Foun
d on lots of macrophages. Found also on podocytes and beta-islet cells which apo
ptose (contributing to renal failure and Type II diabetes).<br><span style="" fo
nt-weight:600;""></span>"
2 Mar
ed

Where do you palpate to ta

e a carotid pulse? a. In the groove between trachea
and infrahyoid muscles...<br><br>b. Deep to anterior border of SCM at the level
of the superior border of the thyroid cartilage<br>
Nec
Mar
ed Nec
PKFinal
"Which of these is normal?<br>What is the pathology in the other?<br><br><img sr
c=""paste4A52FU.png"" />"
"<img src=""pastegBtx8S.png"" />"
Nec
Mar

ed Nec
PKFinal
"Identify.<br /><br /><img src=""pasteF1w41d.png"" />" A. Internal carotid<br /
><br />B. External Carotid:<br />1. Ascending pharyngeal<br />2. Occipital<br />
3. Posterior auricular<br />4. Superior thyroid<br />a. Superior laryngeal arter
y<br />5. Lingual<br />6. Facial:<br />-Passes under digastric and stylohyoid <b
r />-Over the angle of the mandible<br />
Nec
2 Mar
ed
Why is the complement system (via the mannose-lectin pathway) useful in fighting
bacterial meningitis? N. meningitidis has a codon that is very difficult to re
cognize by the acquired immune system, and thus can avoid detection.<br><br>Howe
ver, its mannose residues ma
e it easily fought by the complement system.
2 Mar
ed
"1. Name this vein.<br /><br />2. Where does it receive blood from?<br /><br />3
. Within which fascia is it located?<br /><br />4. What does it pass deep to?<br
/><br />5. With which vein does it merge?<br /><br />6. What prevents venous ba
c
flow from it into the brain when upside down?<br /><br /><img src=""pasteEGObH
E.png"" />"
1. Internal jugular<br /><br />2. A. Brain<br />B. Anterior face
<br />C. Cervical viscera<br />D. Deep nec
muscles<br /><br />3. In carotid she
ath<br /><br />4. Passes deep to SCM<br /><br />5. Merges with subclavian vein t
o form bracheocephalic vein<br /><br />6. Valve prevents bac
flow when standing
on your head
Nec
2 Mar
ed
"Identify.<br /><img src=""pasteGf7H0O.png"" />"
1. Transverse cervical n
erve (C2/C3)<br />2. Hypoglossal nerve (CNXII)<br />3. Glossopharyngeal nerve (C
NIX)<br />4. Vagus nerve (CNX)<br />
Nec
2 Mar
ed
"Innate cyto
ines (reference card) <br><b>two slides</b><br><img src=""Screen Sh
ot 2013-01-07 at 9.31.03 PM.png"" /><br><img src=""Screen Shot 2013-01-07 at 9.3
1.27 PM.png"" />"
2 Mar
ed
"Roots of the cervical plexus: <br /><br />1. Label:<br />1. <br />2.<br />Yello
w<br />Green<br />Blue<br />Red<br /><br />2. Anterior rami of C__ to __?<br /><
br /><img src=""paste8YA9i3.png"" />" "Both <span style=""color:#17c8ff;"">mot
or</span>:<br />1. Roots of the phrenic nerve<br />2. Ansa cervicalis<br /><br /
><span style=""color:#ffce28;"">Irregular nerve loops and branches</span><br />E
ach ramus (except 1st) divides into ascending and descending branches that unite
with branches of adjacent spinal nerves<br /><br /><span style=""color:#2cff18;
"">Superficial branches are sensory</span><br /><br />2. Anterior rami of C1-C4<
br /><br /><img src=""paste272ggM.png"" /><br />"
Nec
2 Mar
ed
Phrenic nerve:<br><br>1. Which cervical nerve principally gives rise to it?<br><
br>2. Whats an important landmar
for it as it passes into the thorax?<br><br>3
. What
ind(s) of fibers does it carry?<br><br>4. What does it supply? (3)
1. Originates from <b>C4</b> with contributions from C3 and C5<br><br>2. Passes
between subclavian vein and subclavian artery to enter thorax<br><br>3. <b>Motor
</b>, <b>sensory</b> fibers<br><br>4. a. Diaphragm<br>b. Mediastinal pleura <br>
c. Pericardium<br>
Nec
2 Mar
ed
Submental triangle:<br><br>1. Give its boundaries (4).<br><br>2. Give its conten
ts (2).<br>
"1.<br> <img src=""pasteA
_iUM.png"" /><br>1. Hyoid bone<br>2. A
nterior bellies of the digastric<br>3. Mylohyoid muscles/fibrous raphe<br>4. Man
dibular symphysis<br><br>2. a. Small submental lymph nodes<br>b. Veins<br>"
Nec
2 Mar
ed
Submandibular triangle:<br><br>1. Give its 3 boundaries.<br>2. Give its 3 conten
ts.<br><br>
"<img src=""pasteQdhyzx.png"" /><br><br>1. A.&nbsp;&nbsp;Inferio
r border of the mandible<br>B.&nbsp;&nbsp;Anterior and posterior bellies of the
digastric<br>C.&nbsp;&nbsp;Mylohyoid muscle<br><br>2. Contains:<br>a. Submandibu
lar Gland<br>b. Hypoglossal nerve (CNXII)<br>c. Facial artery and vein<br>"
Nec
2 Mar
ed
Carotid triangle:<br><br>A. Give its 3 boundaries.<br>B. Give its 7 contents.
"<img src=""pastelI3pcG.png"" /><br><br>A. Bounded by:<br>1. Superior belly of t

he omohyoid<br>2. Posterior belly of the digastric<br>3. Anterior border of SCM<

br><br>B. Contains:<br>4. Common carotid artery<br>5. Internal carotid<br>6. Ext
ernal carotid<br>7. Internal jugular vein<br>8. Ansa cervicalis lies on top of t
he sheath<br><br>9. Deep cervical lymph nodes<br>10. Vagus nerve<br>" Nec
2 Ma
r
ed
Muscular triangle:<br><br>A. Give its 3 boundaries.<br>B. Give its 3 contents.
"<img src=""pasteTX1CyB.png"" /><br>A. Bounded by:<br>1. Superior belly of omohy
oid<br>2. Anterior border of SCM<br>3. Median plane of the nec
<br><br>B. Contai
ns:<br>1. Infrahyoid muscles<br>2. Thyroid gland<br>3. Parathyroid gland<br>"
Nec
2 Mar
ed
"Name these 3 compartments of the nec
<br><br><img src=""pasteJfV1Qg.png"" />"
1. Visceral<br>2. Vascular<br>3. Vertebral
Nec
2 Mar
ed
Vertebral compartment muscles:<br /><br />1. Name the two groups.<br />2. Name t
he muscles that comprise each.<br />3. Give the function of each group. "1. <b>A
nterior</b> and <b>lateral</b> groups<br /><br />2. Anterior: anterior/middle/po
sterior <b>scalene</b><br />Lateral: <b>splenius capitis</b>, <b>levator scapula
e</b><br /><br />3. Both groups responsible for <b>flexion of the head and nec
<
/b>.<br /><br /><img src=""pasteOtLs6x.png"" />"
Nec
2 Mar
ed
Cervical sympathetic trun
:<br><br>1. Located within what?<br><br>2. What are it
s 2 branches?<br><br>3. Give its 3 ganglia and their vertebral levels.<br><br>4.
Which type(s) of rami comunicantes does it have?
"1. <b>Prevertebral fasc
ia</b><br><br>2. Cephalic arterial branches: (<b>vertebral</b> and <b>carotid</b
> arteries)<br><br>3. a. Superior (C1/C2)<br>b. Middle (C6)<br>c. Inferior (C7,
Stellate ganglion)<br><br>4. No white rami communicantes<br><br><img src=""paste
Rmp1wK.png"" />"
Nec
2 Mar
ed
1. Lesion of the sympathetic trun
causes what syndrome?<br><br>2. Give its 4 sy
mptoms.<br><br>3. Give its 5 possible etiologies.
"1. Horners syndrome<br
><br>2. a. Contraction of the pupil (<b>miosis</b>)<br>b. Drooping of superior e
yelid (<b>ptosis</b>)<br>c. Sin
ing of the eye (<b>enophthalmos</b>)<br>d. Vasod
ilation and absence of sweating on face and nec
(<b>anhydrosis</b>)<br><br>3. a
. Aortic aneurysm<br>b. Thyroid carcinoma<br>c. Trauma<br>d. Congenital<br>e. La
trogenic (due to drugs)<br><br><img src=""pastexExbey.png"" />" Nec
2 Mar
ed
Visceral compartment:<br /><br />1. What are its 3 subdivisions?<br />2. What ar
e the 2 specific organs within each?
1 and 2.<br /><br />1. Endocrine:
<br />a. Thyroid<br />b. Parathyroid<br /><br />2. Respiratory<br />a. Larynx<
br />b. Trachea<br /><br />3. Alimentary <br />a. Pharynx<br />b. Esophagus<br /
><br /><br /> Nec
2 Mar
ed
Larynx:<br><br>1. Give its gross morphology.<br>2. What is its function?
1. S
eleton consists of nine cartilages connected by membranes and ligaments<br>
<br>2. To maintain a patent airway<br> Nec
2 Mar
ed
"Identify.<br><br><img src=""pastevLqEgj.png"" />"
1. Thyroid cartilage<br>
A. Thyrohyoid membrane<br>B. Laryngeal prominence<br><br>2. Cricoid cartilage<br
>C.&nbsp;&nbsp;&nbsp;&nbsp;Cricothyroid membrane<br><br>3. Trachea<br> Nec
2 Ma
r
ed
Tracheostomy:<br><br>1. Why do it?<br><br>2. What two layers does the incision g
o through?<br><br>3. What two structures does the procedure have to deal with? W
hat does it do with each?<br><br>4. Where is the actual hole made?
1. To es
tablish an airway in patients with an obstruction or respiratory failure<br><br>
2. S
in and anterior wall of trachea<br><br>3. a. Infrahyoid muscles are retract
ed laterally<br>b. Isthmus of thyroid divided or retracted superiorly<br><br>4.
Opening in trachea made between 1st and 2nd tracheal rings or through the 2nd th
rough 4th rings<br><br> Nec
2 Mar
ed
"Identify.<br><br><img src=""pasteCN09
j.png"" />"
1. Pharynx<br>2. Esophag
us
Nec
2 Mar
ed
Chemotactic factors of innate immunity (reference card)<br>
"<img src=""Scre
en Shot 2013-01-07 at 10.45.35 PM.png"" />"
2 Mar
ed
"Extravasation of WBC into tissues (reference card)<br><img src=""Screen Shot 20
13-01-08 at 1.17.19 AM.png"" />"
2 Mar
ed
Once inside the cell, how does the leu
ocyte find and travel to the site of infe
ction? Detection of chemo
ines released by the macrophage or other leu
ocyte an

d movement towards it by crawling along fibronectin.

2 Mar
ed
"Bacterial
illing components of a phagocyte (reference card)<br><img src=""Scre
en Shot 2013-01-08 at 1.23.37 AM.png"" />"
2 Mar
ed
What is frustrated phagocytosis?
"Very similar to how many feel absorbing
immunology lectures. <br><br>The phagocyte cannot complete the phagocytic cup a
round the microbe, but lysosomal fusion occurs anyways.* Thus the lysosomal cont
ents are released into the partially formed endosome, spilling extracellularly a
nd damaging nearby tissue.<br><br>*Youd thin
that with the bodys fetish for r
egulation, there would be a regulatory step that confirms the completion of the
phagocytic cup and endosome, but one hasnt been discovered yet.<br><img src=""S
creen Shot 2013-01-08 at 1.28.28 AM.png"" />" 2 Mar
ed
"Types of natural
iller (NK) cells (reference card)<br><img src=""Screen Shot 2
013-01-08 at 1.29.48 AM.png"" />"
2 Mar
ed
Despite their strong cytocidal tendencies, natural
iller (NK) cells do not
ill
our own cells. How do they do this?
"Our bodys cells express (major histoco
mpatability complex 1) MHC1, which presents a self antigen. This self antigen is
recognized by the inhibitory receptor on the NK cell, serving as a &quot;passpo
rt&quot; that prevents destruction by it.<br><br>Our own cells also express acti
vating ligands for recognition by the activating receptors of NK cells. These ac
tivating ligands are stress signals and upregulated in situations li
e viral inf
ection.<br><br>Whether the NK cell
ills or spares a cell is dependent upon the
signal competition between the inhibitory and the activating receptors.<br> <img
src=""Screen Shot 2013-01-08 at 1.30.41 AM.png"" />" 2 Mar
ed
"Activating and deactivating signals between NK cell and target cell (reference
card)<br><img src=""Screen Shot 2013-01-08 at 1.40.24 AM.png"" />"
2 Mar
ed
"Microbrial innate immunity evasion methods (reference card)<br><img src=""Scree
n Shot 2013-01-08 at 1.42.58 AM.png"" />"
2 Mar
ed
How can cytomegalovirus (CMV) evade death by the innate immune system? It expre
sses the NK inhibitory factor, disguising itself as a human cell.
2 Mar
ed
In patients, with X-lin
ed lymphoproliferative disease (XLP), what is the defect
that leads to their immunodeficiency? "Their NK cells lac
a functional SLAM-a
ssociated protein (SAP) that is part of the intracellular signaling cascade that
activates the cell.<br><img src=""Screen Shot 2013-01-08 at 1.46.28 AM.png"" />
"
2 Mar
ed
How does the specificity of innate immunity differ from that of adaptive immunit
y (features recognized, receptors involved)?
o
innate immunity recogni
zes families of structures that are unique to invading bacteria, e.g. lipopolysa
ccharides, terminal mannose, dsRNA, unmethylated CpG, N-formyl methioninereceptor
s are coded for in the germline<br>o
adaptive immunity recognizes more sp
ecific structures that may or may not be microbial<br>o
structures recogn
ized by innate receptors are often essential to the function of the pathogens an
d therefore cannot be mutated aroundnot necessarily true of adaptive receptors<br>
Chapter2A Mar
ed
What are the three mechanisms by which the epithelium of the s
in prevents entry
of microbes? o
physical obstruction (continuous epithelia)<br>o
intraepithelial lymphocytes (
T cells)<br>o
peptide antibiotics<br>
Chapter2A Mar
ed
What is the difference between a monocyte and a macrophage? What are names given
to macrophages in the brain, liver, and lung? o
monocytes are circulati
ng phagocytic cells; macrophages are found in tissue and are descended from mono
cytes<br>o
brain: microglia<br>o
liver: Kupffer cells<br>o
lung: alveolar macrophages<br> Chapter2A
How do leu
ocytes leave the circulation and move into sites of infection?
o
macrophages at the site of infection phagocytose microbes and release T
NF, IL-1, and chemo
ines<br>o
TNF and IL-1 stimulate expression of E- and
P-selectins and integrin ligands on the luminal face of endothelial cells<br>o
carbohydrate mar
ers on circulating leu
ocytes recognize selectins and be
gin to roll along endothelial wall<br>o
this exposes leu
ocytes to chemo
in
es, which are bound to the luminal face of the endothelium on proteoglycans<br>o

chemo
ines signal leu
ocyte integrins to shift from low- to high-affinit
y configuration<br>o
high-affinity integrins bind integrin receptors on e
ndothelium and allow firm binding and structural flattening of leu
ocytes<br>o
chemo
ines activate migration across endothelial wall; leu
ocytes follow t
he chemo
ine gradient to the site of infection<br>
Chapter2A Mar
ed

How do phagocytes ingest and

ill microbes?
o
phagocytes reco
gnize pathogens using various receptors (including Toll-li
e receptors, f-Met re
ceptors, mannose receptors plus receptors for complement and antibodies)<br>o
pathogens are engulfed in phagosomes, which fuse with lysosomes<br>o
microbicidal enzymes used by phagocytes include phagocyte oxidase (generates RO
S), inducible nitric oxide synthase (generates NO), and proteolytic enzymes<br>
Chapter2A Mar
ed

How do activated macrophages contribute to immune responses? o

produce TNF, IL-1, and chemo
ines to recruit other immune cells<br>o
pro
duce IL-12 which activates NK cells (which produce IFN- , which in turn activates
macrophages)<br>o
stimulate T cells<br>o
secrete growth factors an
d enzymes (remodeling of damaged tissue)<br>
Chapter2A Mar
ed
What is the role of MHC molecules in the recognition of infected cells by NK cel
ls, and what is the physiologic significance of this recognition?
o
NK cells are regulated both positively (by stress mar
ers) and negatively (by M
HC I)<br>o
in the absence of negative regulation, NK cells will
ill even
cells not expressing stress mar
ers<br>o
many viruses evade CTLs by supp
ressing MHC I expression; NK cells are adapted to find and destroy such cells<br
>
Chapter2A Mar
ed
What are the roles of the following cyto
ines in defense against infections: TNF
, IL-12, type I interferon?
o
TNF (from macrophages, T cells): trigge
rs inflammation, recruits/activates leu
ocytes; prothrombotic; lowers blood pres
sure<br>o
IL-12 (from macrophages, dendritic cells): stimulates cytotoxic
activity, secretion of IFN- by NK and T cells<br>o
type I IFN (from macro
phages, fibroblasts): inhibits viral reproduction, activates NK cells<br>
Chapter2A Mar
ed
What are the three ways that complement helps innate responses to microbes?
o
deposition of C3b promotes phagocytosis of microbes (opsonization)<br>o
complement chemoattracts phagocytes and stimulates inflammation<br>o
insertion of pore complex into microbial membranes<br>o
complement ca
n be activated by adaptive (classical) or innate (alternative and lectin) pathwa
ys<br> Chapter2A Mar
ed
What are acute phase reactants and how do they contribute to immunity? o
plasma proteins whose levels increase in acute infection<br>o
mannose-bi
nding lectin (MBL): stimulates complement<br>o
C-reactive protein (CRP):
stimulates phagocytosis<br>
Chapter2A Mar
ed
How do innate immune responses enhance adaptive immunity?
o
innate
responses can serve as second signals for T and B cellstype of adaptive response is
tailored by the innate stimulus<br>o
IFN- (from NK cells) stimulates prod
uction of costimulators and IL-12 in macrophages and dendritic cells (activation
and maturation of T cells)<br>o
C3d (part of complement) serves as a sec
ond signal for B cells<br>
Chapter2A Mar
ed

Patients with infections often have fever, their muscles ache, they feel
tired, and they arent hungry. What cyto
ines account for these symptoms?
o
primarily due to TNFcauses inflammation, fever (hypothalamus), cachexia<br>o
IL-1 also contributes to inflammation and fever<br> Chapter2A Mar
ed

What is septic shoc

and what immunologic factors are involved?
o
shoc
(low blood pressure) due to excessive levels of TNFproduced by macrophages
in response to bacterial LPS Chapter2A Mar
ed
Cyto
ines of innate immunity:<br>o
TNF (macrophages): inflammation, recru
itment of leu
ocytes, fever, cachexia, low BP, acute phase proteins<br>o
IL-1 (macrophages, endothelium): inflammation, recruitment of leu
ocytes, fever,
acute phase proteins<br>o
IL-12 (macrophages): activation of NK and T ce
lls and IFN-gamma production<br>o
chemo
ines (macrophages, fibroblasts, e
ndothelium): chemotaxis and activation of leu
ocytes<br>o
type I IFN (mac

rophages, fibroblasts): inhibits viral reproduction<br>o

IFN-gamma (NK ce
lls): activation of macrophages<br>
Chapter2A Mar
ed
Mechanisms of resistance to innate immunity:<br>o
resistance to phagocyto
sis (Pneumococcus)<br>o
resistance to ROS (staphylococci)<br>o
res
istance to alternative complement pathway (Neisseria meningitides, Streptococcus
)<br>o
resistance to peptide antibiotics (Pseudomonas)<br>
Chapter2A Mar
ed
Why do most T cells not recognize carbohydrates, lipids, or nucleic acids?
o
T cells only recognize antigens bound to MHC molecules; MHC molecules o
nly bind peptides (8-11mers for MHC I, 10-30mers for MHC II)
Chapter3A Mar
ed
When antigens enter through the s
in, in what organs are they concentrated? What
cell types play important roles in this process of antigen capture?
o
concentrated in lymph nodes for exposure to lymphocytes<br>o
most impota
nt cells are dentritic (Langerhans) cells, which are professional APCsphenotypica
lly immature until they capture antigens, then mature while en route to lymph no
des<br> Chapter3A Mar
ed
What are MHC molecules? What are human MHC molecules called? How were they disco
vered, and what is their function? What is meant by calling MHC genes polymorphi
c?
o
membrane surface proteins which present antigens for recognitio
n by T cells (T cells cannot recognize free antigen, only that bound to MHC)<br>
o
human MHCs = HLA (Human Leu
ocyte Antigen)<br>o
HLAs were discov
ered as a principal cause of graft rejection in tissue transplantation<br>o
certain regions of the MHC genes vary among individuals (=polymorphic)these in
clude both antigen-binding regions and recognition regions for T cells<br>
Chapter3A
Which cells display class I and and which display class II MHC molecules? How ma
ny different HLA-A antigens are expressed on your cells? How many different MHC
class I antigens are expressed on your cells? o
MHC I: all nucleated ce
llsthree genes (HLA-A, -B, -C), two copies of each, six possible MHC I molecules<
br>o
MHC II: professional APCsthree genes (HLA-DR, -DQ, -DP), two copies o
f each, alpha and beta chains both polymorphic, 10-20 possible MHC II molecules<
br>
Chapter3A Mar
ed
What are the differences between the antigens that are displayed by class I and
II MHC molecules?
o
MHC I: peptides of 8-11 amino acids derived fro
m products of intracellular protein degradation; loaded during MHC synthesis in
ER<br>o
MHC II: peptides of 10-30 amino acids derived from phagocytosed m
icrobes; loaded after fusion of MHC-containing exocytic vesicles with lysosomes<
br>
Chapter3A Mar
ed
Describe the sequence of events by which class I and II MHC molecules acquire an
tigens for display. What
eeps MHC class II molecules from pic
ing up peptides i
n the endoplasmic reticulum?
o
MHC I: cytoplasmic proteins are flagged
with ubiquitin for degradation by the proteasome; the proteasomal degradation f
ragments are pumped into the ER by TAP (transporter associated with antigen proc
essing) and loaded into new MHC II molecules there<br>o
MHC II: MHC is pr
oduced and while still in the ER is loaded with CLIP (class II invariant chain p
eptide), preventing it from binding antigen in the ER; it is shipped in exocytic
vesicles to lysosomes containing the degradation products of phagocytosed micro
bes; CLIP is removed by DM in the fused vesicle and peptide fragments are loaded
into MHC II there<br> Chapter3A Mar
ed
Where are proteins degraded into peptides for loading into MHC class I molecules
and what molecule tags them for degradation? How does that differ from the site
where peptides are generated for loading into MHC class II molecules? o
MHC I: cytoplasmic proteins (including phagocytosis products that are transloca
ted to the cytosol) are tagged for degradation with ubiquitin and degraded by th
e proteasome<br>o
MHC II: phagocytosed microbes are degraded in lysosomes
by lysosomal enzymes <br>
Chapter3A Mar
ed

Which subsets of T cells recognize antigens presented by class I and II M

HC molecules? What molecules in T cells contribute to their specificity for eith
er class I or II MHC-associated peptide antigens?
o
MHC I: CD8 (cyt
otoxic) T cells<br>o
MHC II: CD4 (helper) T cells<br>o
specificity

is determined by the CD4 and CD8 T cell coreceptors<br>

Chapter3A Mar
ed

What is the second signal delivered by APCs and how does this communicate
to lymphocytes which antigens are dangerous? What types of molecules can provide
second signals? o
costimulatorsproduced by APCs in response to stimuli (e.
g. bacterial LPS or IFN-gamma from NK cells) specific to pathogens
Chapter3
A Mar
ed
How does cross-presentation allow APCs to provide second signals to nave CD8 cell
s?
o
CD8 cells only recognize antigens presented on MHC I molecules
because their major purpose is to clear infected cellsto improve the efficiency o
f the immune reaction (i.e., to avoid having to wait until significant numbers o
f somatic cells are infected before stimulating CD8 T cells), APCs will transfer
some of the microbial degradation products from the lysosome to the cytoplasm f
or display on MHC I molecules Chapter3A
What are the functionally distinct domains of antibody and T cell receptor molec
ules? What features of the amino acid sequences in these regions are important f
or their functions?
o
antibodies are composed of heavy (alpha, gamma,
delta, epsilon, mu) and light chains (
appa, lambda), each of which contains a
single variable and one (light) or more (heavy) constant domains, all held toget
her by disulfide bonds<br>o
antibody variable domains are responsible for
binding antigen (each variable region has three hypervariable CDRs); effector f
unctions and other interactions occur through the constant domains (which are co
nserved in all antibodies of a given serotype)<br>o
TCRs are heterodimers
of alpha and beta chains; each chain contains a variable region (with three CDR
s) and a constant region<br>o
as in antibodies, TCR variable domains are
responsible for antigen binding, and constant domains (which are conserved in al
l TCRs) are responsible for structure and interaction<br>o
in both cases,
the binding specificity of the molecule is determined by the variable region, w
hich varies from clone to clone, and in particular on the hypervariable CDRs<br>
Chapter4A Mar
ed
What are the differences in the types of antigens recognized by antibodies and T
cell receptors? What is a linear antigenic determinant and how is it different
from a conformational determinant?
o
antibodies recognize a variety
of antigens, including peptides, polysaccharides, lipids, small molecules, and n
ucleic acids; antigens can be either linear or conformational<br>o
TCRs r
ecognize only peptides in complex with MHCs; epitopes are linear only, and acces
sory binding (CD4 or CD8) is required as well<br>o
linear epitopes are se
quential fragments of a single peptide chain, whereas conformational epitopes ar
e three-dimensional structures that are not necessarily sequential residues of a
chain<br>
Chapter4A Mar
ed
What are the five classes of immunoglobulin molecules and what effector function
s do they mediate? Which cross the placenta?
o
IgA (dimeric): secreted
from mucosa (aggregates pathogens), neonatal passive immunity<br>o
IgD:
nave B cell receptor<br>o
IgE: mast cell activation<br>o
IgG: prima
ry circulating formopsonization, complement, Ab-dependent cell-mediated cytotoxic
ity, neonatal immunity, feedbac
inhibition of B cells<br>o
IgM (pentamer
ic): nave B cell receptor, complement<br>
Chapter4A Mar
ed
What are some of the chec
points during lymphocyte maturation that ensure survi
val of useful cells?
o
pro-B/T cells initially grow under IL-7 stimula
tion<br>o
cells failing to express pre-lymphocyte receptor are culled by
apoptosis<br>o
pre-B/T cells produce a single receptor chain (mu for B ce
lls, beta for T cells) by V-D-J recombination and express it on the surface as p
art of a pre-BCR/TCR complex; cells failing to do so are culled by apoptosis<br>
o
T cells are selected for low-affinity binding to MHC and at the same ti
me are selected to be CD4 or CD8 T cells; those failing to recognize MHC are cul
led<br>o
T and B cells with high affinity for self antigens (numerous in
both thymus and bone marrow) are culled to avoid autoimmunity<br>
Chapter4
A Mar
ed
What mechanisms contribute to the diversity of antibody and TCR molecules? Which
of these mechanisms contributes the most to diversity? At what stage of cell de
velopment do they occur?
o
the locus coding for each chain contain

s ~30-50 different variable domain genes and varying numbers of J (all chains) a
nd D (heavy and beta chains only) gene segmentsthese are randomly combined to pro
duce combinatorial diversity<br>o
to produce the initial chain (mu for B
cells, beta for T cells), each pre-lymphocyte randomly selects a V, D, and J gen
e segment and splices them together (at the DNA level) to produce a single varia
ble domain gene<br>o
the second (light for B cells, alpha for T cells) ch
ain is produced by V-J recombination after the cell passes the single-chain (pre
-lymphocyte) selection point<br>o
V(D)J recombination occurs at the DNA l
evel; splicing of the variable and constant domains at the RNA level<br>o
overlaid on the recombination process is junctional diversity, which is respons
ible for most antibody diversity<br>o
junctional diversity involves chang
es in sequence at the junction points during recombinationthere are three mechani
sms:<br>
exonuclease deletion of nucleotides at the ends<br>
additio
n of random nucleotides by terminal deoxytransferase (TdT)<br>
filling in
of overhanging ends with P-nucleotides<br>
Chapter4A Mar
ed
What is the phenomenon of negative selection and what is its importance?
o
refers to the culling of B and T cells with strong affinity for self an
tigenseliminates cells that might cause an autoimmunity
Chapter4A Mar
ed

Does the thymus select against T cells able to react with allogenic MHC?
How does this influence the host response to transplants?
o
no, bec
ause only self-reactive MHCs are
illed in negatively selectionso a transplanted
organ may express allogenic MHC complexes that resemble self MHC-foreign peptide
complex that strongly activate T cell to attac
allogenic tissues
Chapter4
A Mar
ed

Would T cells from peripheral blood be able to function if transplanted i

nto an allogenic repicient? What about T cells from bone marrow? Why are they di
fferent?
o
T cells from donor peripheral blood may recognize host
antigens and cause havoc in host (if not
illed first by hosts immune response)<b
r>o
Stem T cells from bone marrow will undergo positive &amp; negative se
lections so it will act li
e self-T cells<br> Chapter4A Mar
ed
Why are lymphocytes unusually prone to malignant transformation?
o
lymphocyte precursors are continuously dividing and are subject to massive expa
nsion at several stages of development<br>o
mature lymphocytes are design
ed to be capable of massive reproduction (i.e., when stimulated by antigen) and
so have the machinery in place<br>o
active machinery exists for rearrangi
ng chun
s of genome (?)<br>o
cells are circulating, so probably not prone
to contact inhibition (?)<br> Chapter4A Mar
ed
Why are pathogen-specific lymphocytes not deleted in the thymus or bone marrow?
o
there are (hopefully) no pathogen antigens in either the thymus or bone
marrow, so those lymphocytes capable of recognizing pathogens will not be negat
ively selected due to strong interactionsput another way, the system presupposes
that any strong receptor interaction in the germinative tissue will be self
Chapter4A Mar
ed
T cell accessory proteins at different stages of maturity:<br>o
pro-T cel
ls express neither CD4 nor CD8 (double-negative) and are mostly dependent on IL7 stimulation for growth<br>o
after selection for production of both CD4
and CD8 chains, they express both CD4 and CD8 (double-positive)<br>o
duri
ng positive selection (for recognition of self MHCs), cells recognizing MHC I ar
e stimulated to become CD8+
iller cells, and those recognizing MHC II become CD
4+ helper cells<br>
Chapter4A Mar
ed
B cell surface receptors:<br> o
cells express IgM on surface as immatur
e B cells<br>o
mature B cells (i.e., capable of responding to antigens) e
xpress both IgM and IgD on surfacerandom splicing of variable domains to mu and d
elta mRNA<br> Chapter4A Mar
ed
Note: V(D)J recombinase recognizes sequences flan
ing V, D, and J gene segments
Chapter4A Mar
ed
Note: avidity refers to strength of antibody binding to multiple antigen molecules
(greater than affinity for a single molecule)antibodies have between 2 (in monom
eric antibodies) and 10 (in IgM) binding sites
Chapter4A Mar
ed
What are the components of the TCR complex? Which of these components are respon

sible for antigen recognition and which for signal transduction?

o
TCR (heterodimer of alpha, beta chains): antigen binding<br>o
CD3 (trime
r): signal transduction<br>o
Zeta (homodimer): signal transduction<br>o
(these three ma
e up the TCR complex proper)<br> Chapter5A Mar
ed
What are ITAMs and what are their biological effects? What are ITIMs and what is
their biological effect?
o
ITAM (=immunoreceptor tyrosine-based ac
tivation motifs): found on intracellular domains of CD3 and Zeta; with activatio
n are phosphorylated by Lc
and serve as a binding site for ZAP-70lead to downstr
eam production of transcription factors (NFAT, NF-
appaB, AP-1)<br>o
ITIM
(=immunoreceptor tyrosine-based inhibition motifs): similar to ITAMs, but serve
an inhibitory function<br>
Chapter5A Mar
ed
What are some of the accessory molecules that T cells use to initiate their resp
onse to antigens, and what are the functions of these molecules?
o
CD3, zeta: lie at the top of an intracellular signaling cascade (via ZAP-70) le
ading to activation/clonal expansion of T cells<br>o
CD4, CD8: strengthen
binding interaction between TCR and MHC to allow recognition and are also invol
ved in intracellular signaling (via Lc
)<br>o
LFA-1: integrin (binds ICAM
-1 on APCs) which assists in maintaining the interaction between T cell and APC
long enough for activation to occurchemo
ines (produced at sites of infection) in
crease binding affinity of LFA-1 for ICAM-1<br> Chapter5A Mar
ed
What is costimulation? What is the physiologic significance of costimulation? Wh
at are some of the ligand receptor pairs that are involved in costimulation? Wha
t receptors do the B7 family of molecules bind to? What upregulates their expres
sion? What happens if a nave T cell encounters antigen without costimulation?
o
costimulation is a second signal required for activation of T lymphocytes
<br>o
B7 costimulators (B7-1, B7-2) are expressed by professional APCs af
ter encountering microbesinteract with CD28 on T cells to allow activation<br>o
CD40L (on T cells) interacts with CD40 (on professional APCs) to upregulat
e B7 and IL-12 expression<br>o
without costimulation, T cell responses wi
ll actually decreasethis is part of a mechanism to prevent autoimmunity<br>
Chapter5A Mar
ed
What is the principal growth factor for T cells? Why do antigen-specific T cells
expand more than other (bystander) T cells on exposure to antigen? o
principal growth factor is IL-2 (produced by activated lymphocytes)<br>o
effects are autocrine/paracrine and so are concentrated in the antigen-specific
cells (which will be clustered together on the antigen)<br>o
activation
by exposure to antigen increases IL-2 receptor affinity for IL-2, further ensuri
ng that signaling effects will be confined to the antigen-specific cells<br>
Chapter5A Mar
ed
What are the major subsets of CD4+ helper T cells, and how do they differ? What
influences whether TH1 or TH2 responses predominate?
o
TH1 cells: prod
uce IFN-gamma (stimulates macrophages, upregulates MHC II and B7 expression); in
hibit differentiation to TH2tailor response to bacteria/viruses (stimulate phagoc
ytosis)<br>o
TH2 cells: produce IL-4 (stimulates isotype switching to IgE
and also acts in autocrine fashion to stimulate TH2 differentiation) and IL-5 (
activates eosinophils); inhibit differentiation to TH1tailor response to helminth
ic parasites<br>o
predominance of TH types is determined (initially) by p
resence or absence of IL-12, which is produced by APCs in response to microbes;
presence of IL-12 encourages differentiation to TH1 and absence of IL-12 to TH2;
choice is self-reinforcing because each type produces cyto
ines which suppress
differentiation to the other<br>
Chapter5A Mar
ed
What signals are required to induce the responses of CD8+ T cells?
o
activation requires costimulation as for CD4+ T cells<br>o
CD8+ cells do
not produce large amounts of IL-2; presence of CD4+ cells may be necessary to s
timulate expansion of CD8+ cells<br>o
CD8+ cells undergo much greater exp
ansion than CD4+ cells<br>
Chapter5A Mar
ed
Summarize the lin
s between antigen recognition, the major biochemical signaling
pathways in T cells, and the production of transcription factors. What are the
three major transcription factors?
o
TCR complexes aggregate when re
cognizing MHC-antigen complexes<br>o
clustering of CD4/8 (as part of TCRC

s) activates Lc
(an intracellular tyrosine protein
inase)<br>o
Lc
phos
phorylates ITAMs on intracellular domains of CD3 and Zeta and also phosphorylate
s ZAP-70<br>o
ZAP-70 binds ITAMs and activates downstream signaling prote
ins<br>o
signaling proteins activate intracellular signaling cascades (ph
ospholipase C-gamma1 to DAG/IP3; Ras/Rac to MAPKs)<br>o
specific transcri
ption factors:<br>
NFAT (nuclear factor of activated T cells): Ca2+ releas
e (via Cam/calmodulin) activates calcineurin, which dephosphorylates/activates N
FAT<br>
AP-1 (activating protein 1): Ras/Rac-MAPK pathways activate AP-1 (
pathways converge)<br>
NF-
appaB (nuclear factor
appaB): PKC (via PLC) ac
tivates NF-
appaB<br>o
transcription factors (AP-1, NFAT, NF-
appaB) acti
vate production of cyto
ines, cyto
ine receptors, cell cycle inducers, effector
molecules<br> Chapter5A Mar
ed
There are drugs (cyclosporines) that interfere with the function of the calcineu
rin molecule. What happens if calcineurin is inhibited? inhibition of calcineuri
n results in inhibition of NFAT activation and suppression of the T cell respons
e
Chapter5A Mar
ed
What are microbial superantigens and how do they affect the host response and ca
use disease?
o
polyclonal activators are molecules that can activate m
any or all T cells, regardless of their antigen specificity (e.g. antibodies aga
inst CD3); superantigens are a category of polyclonal activators produced by bac
teria<br>o
superantigens can cause excessive T cell activation and cyto
i
ne release (cyto
ine storm?)<br>
Chapter5A Mar
ed
What are the three consequences of MHC restriction?
"1. T cells only interac
t with antigen presented on MHCs by self-cells. They do not interact with antige
ns themselves (lest they evolve ways to tric
our T cells).<br />2. The interact
ion must be accompanied by costimulatory molecules or cyto
ines from the antigen
presenting cell (APC).<br />3. Effector functions of T-cells are mediated throu
gh self-cells, without direct action against the microbe.<br><img src=""Screen S
hot 2013-01-13 at 4.05.58 PM.png"" />" Chapter4A 4 Mar
ed
What are some major differences between MHCs and antigen (Ag) receptors?
"Additional notes to table below:<br>1. T cell receptors made entirely by chance
, have only one cognate receptor, and thus are exquisitely sensitive<br>2. T cel
ls from a bone marrow transplant express the MHC of the donor, but during thymic
&nbsp;&nbsp;education have their TCRs become restricted by the host MHCs. Thus,
the T cells own MHCs dont matter, only the cells interaction with the hosts
MHCs.<br><img src=""Screen Shot 2013-01-13 at 4.08.11 PM.png"" />"
Chapter4
A 4 Mar
ed
What are some major differences between te two classes of antigen receptor: anti
bodies and T cell receptors?
"In addition to the <b>two slides below</b>:<br>
1. Antibody is bivalent (can bind two identical antigens) and TCR is monovalent<
br>2. The TCR itself does not perform effector functions, but signal transductio
n is mediated by its associated CD4(8) molecule and cytosolic proteins li
e Lc
<
br><img src=""Screen Shot 2013-01-13 at 4.13.05 PM (1).png"" /><br><img src=""Sc
reen Shot 2013-01-13 at 4.13.28 PM (1).png"" />"
Chapter4A 4 Mar
ed
"IgG and IgM (reference card)<br>1. Fc: &quot;crystallizable fragment&quot; beca
use its constant among all antibodies of the same class (can form repeating cry
stals in solid state)<br>2. Blue and red heavy chains are identical, green light
chains are identical, hence two identical antigen-binding sites<br><img src=""S
creen Shot 2013-01-13 at 4.20.29 PM.png"" />"
Chapter4A 4 Mar
ed
What is the initial class of antibody produced by the body? Name some examples o
f cyto
ines that induce class switching.
"-at birth, ma
e only IgM that i
snt secreted<br>-IFN gamma made by Th1 cells induces Fc switching to cytolytic Ig
G<br>-IL-4 made by Th2 cells induce non-cytolytic pathways<br><img src=""Screen
Shot 2013-01-13 at 4.23.07 PM.png"" />" Chapter4A 4 Mar
ed
"Antibody classes (reference card)<br><img src=""Screen Shot 2013-01-13 at 4.26.
55 PM.png"" />"
Chapter4A 4 Mar
ed
"Antibody classes <b>(two slides)</b>. Praise Rowley! (reference card)<br><img s
rc=""Screen Shot 2013-01-13 at 4.27.58 PM.png"" /><br><img src=""Screen Shot 201
3-01-13 at 4.27.45 PM.png"" />"
Chapter4A 4 Mar
ed
What are monoclonal antibodies and what is their major benefit? "They are immort

al cells that produce a single type of antibody forever. <br><img src=""Screen S

hot 2013-01-13 at 4.29.52 PM.png"" />" Chapter4A 4 Mar
ed
"TCR structure (reference card)<br><img src=""Screen Shot 2013-01-13 at 4.52.56
PM.png"" />"
Chapter4A 4 Mar
ed
How do antibodies and TCRs differ in their affinity for antigens?
antibodi
es can increase their affinity during immune responses; TCRs cant<br><br>Becaus
e theyre specific for a single antigen each, they have very high affinity compa
red to MHCs (which can bind 3.2 million peptides each). Chapter4A 4 Mar
ed
"B/T cell maturation (reference card)<br><img src=""Screen Shot 2013-01-13 at 4.
55.46 PM.png"" />"
Chapter4A 4 Mar
ed
What is a pre-B/T cell and what is its receptor composed of?
An maturing cell
that expresses a pre-receptor, composed of a complete heavy chain (that is synt
hesized first) and a surrogate light chain (for stability).<br><br>Heavy chains
are made before light chains in B and T cell maturation.
Chapter4A 4 Mar

ed
What are
ey principles of expressing the many different possible antibodies and
TCRs? "-each locus is composed of many independent genes with their own promot
ers, coding regions, etc.<br>-DNA recombination arranges the DNA such that the f
inal VDJ or TCR is together and transcribed<br>-completely random recombination
of different subunits: the loci transcribe a random V, a random D, a random J, a
nd then the constant region<br>-recombination occurs in the bone for B cells and
thymus for T cells<br>-class switching of antibodies occurs in peripheral lymph
tissue: lymph nodes and spleen<br>(<b>two slides below for reference)</b><br><i
mg src=""Screen Shot 2013-01-13 at 5.05.22 PM.png"" /><br><img src=""Screen Shot
2013-01-13 at 4.58.28 PM.png"" />"
Chapter4B 4 Mar
ed
In addition to combinatorial diversity, how does junctional diversity increase t
he number of potential antibodies and TCRs made?
"During the process of D
NA recombination, DNA is bro
en and religated multiple times. RAG (recombination
activating gene) mediates this ligation and randomly adds or deletes nucleotide
s in the process.<br><img src=""Screen Shot 2013-01-13 at 5.08.59 PM.png"" />"
Chapter4B 4 Mar
ed
Sources of antibody diversity (reference card) "<img src=""Screen Shot 2013-0113 at 5.09.37 PM.png"" />"
Chapter4B 4 Mar
ed
What is the principle of allelic exclusion in antigen receptor production?
"Two alleles compete against each other for expression by the cell. Successful f
ormation of a receptor product from one allele shuts down the action of RAG on t
he other allele. Also called &quot;first to the ball&quot; principle.<br /><img
src=""Screen Shot 2013-01-13 at 5.10.31 PM.png"" />"
Chapter4B 4 Mar
ed
What is the one B cell, one Ig rule?
"<img src=""Screen Shot 2013-01-13 at 5.
13.03 PM.png"" />"
Chapter4B 4 Mar
ed
What are the different fates of thymocyte education?
"Positive selection: wea

recognition of self-peptide on MHC, assisted by either CD4 or 8. The unused CD

is downregulated.<br><br>Negative selection: strong interaction with self-pepti
de on APCs MHC. Apoptosis to prevent autoimmune response<br><br>Failure of posi
tive selection (death by neglect): unable to find any cognate MHC and self-pepti
de. Death by apoptosis.<br><br>Treg formation (rare): strong interaction with cl
ass II MHC and self-peptide (via CD4) leads to Treg development. Tregs release T
GFbeta (potent anti-inflammatory) and suppress autoimmune responses.<br><img src
=""Screen Shot 2013-01-13 at 5.16.42 PM.png"" />"
4 Chapter4B
What are the two main functions of CD4 and 8? "1. Strengthen binding of the TC
R for its MHC/peptide<br>2. Mediate signal transduction (through Lc
) because th
e TCR itself has no effector functions (unli
e the Fc region of antibodies)<br><
img src=""Screen Shot 2013-01-13 at 5.34.52 PM.png"" />"
Chapter4B 4 Mar

ed
"The lacrimal fossa is found between <span style=""font-weight:600; color:#0000f
f;"">[...]</span>"
"The lacrimal fossa is found between <span style=""fontweight:600; color:#0000ff;"">lacrimal bone and maxilla</span>" OrbitandEye Mar

ed
"<img src=""pastes8fqln.png"" />"
"<img src=""paste4dzyt7.png"" />"
OrbitandEye Mar
ed

"Increase in CSF pressure compresses optic nerve resulting in <span style=""font

-weight:600; color:#0000ff;"">[...]</span><br>" "Increase in CSF pressure compre
sses optic nerve resulting in <span style=""font-weight:600; color:#0000ff;"">pa
pilledema</span><br>" OrbitandEye Mar
ed
"<img src=""pasteo4nu6u.png"" />"
"<img src=""pasteldrulj.png"" />"
OrbitandEye Mar
ed
List the muscles which control the eyeball
The eyeball is moved by six extr
insic muscles: four rectus (superior, inferior, medial, and lateral) and two obl
ique (superior and inferior). OrbitandEye Mar
ed
What is the difference between gaze and convergence?
"<span style=""color:#ff
0000;"">Gaze</span> both eyes moving together following a finger what happens to
the muscles of each eye is opposite to the other eye<br><br><span style=""color
:#ff0000;"">Convergence</span> cross-eyed both eyes loo
ing medially <br>"
OrbitandEye Mar
ed
Describe the test used to measure the function of extrinsic muscles which move t
he eye. "<img src=""pastegtsnqm.png"" /><br>Note: This is DIFFERENT from the dir
ection produced by the contraction of these muscles!" OrbitandEye Mar
ed
Which nerves exit through the superior orbital fissure?<br>
CN III,IV,V1,VI
<br>
OrbitandEye Mar
ed
Which branches of CNV are motor? Sensory? Both?<br>Name each branch (V1, V2, V3)
V1 only sensory - ophthalmic div <br>V2 sensory only -&nbsp;&nbsp;maxillary div<
br>V3 motor and sensory mandibular div<br> OrbitandEye Mar
ed
Which nerve is in charge of pupil constriction and accomadation?
Ciliary
ganglion with short ciliary nerves <br>from CN III :&nbsp;&nbsp;Parasympathetics
-&gt;pupil constriction; accommodation<br>
OrbitandEye Mar
ed
What supplies autonomic innervation to the lacrimal gland?
CN VII Orbitand
Eye Mar
ed
What is the ris
associated with the cavernous sinus? Which structures are affec
ted? Which structure is most vulnerable?
"If an infection drains thru vei
ns to cavernous sinus -&nbsp;&nbsp;all contained structures vulnerable<br>Nearby
structures include: pituitary gland, internal carotid artery, CN III, CN IV, CN
V1, CN V2, <span style=""color:#ff0000;"">CN VI</span> (most vulnerable since i
t is found inside the sinus)<br><br>" OrbitandEye Mar
ed
List the branches of CN V1
From medial to lateral<br>NFL: Nasociliary, Fron
tal, Lacrimal OrbitandEye Mar
ed
What does the nasociliary nerve innervate?
"Supplies <span style=""color:#0
000ff;"">sensory</span> innervation to the <span style=""color:#ff0000;"">extern
al and internal nose, cornea, and medial half of conjunctiva</span>"
Orbitand
Eye Mar
ed
What supplies sensory innervation to the medial half of the conjunctiva? Lateral
half? Medial: nasociliary<br>Later: Lacrimal OrbitandEye Mar
ed
What does the frontal nerve innervate? Sensory to the forehead<br>
Orbitand
Eye Mar
ed
What supplies sympathetic innervation to dilator pupillae?
Long ciliary ner
ves =&nbsp;&nbsp;&nbsp;sympathetics to dilator pupillae muscle <br>
Orbitand
Eye Mar
ed
List the bones of the orbit:
Frontal bone: roof<br /> Zygomatic <br /> Maxilla<
br /> Sphenoid<br />
Greater wing<br />
Lesser wing<br />
Su
perior orbital fissure between them<br /> Ethmoid <br /> Lacrimal <br /> Palatine<b
r />
OrbitandEye Mar
ed
What forms the roof of the orbit? Medial wall? Floor? Roof: frontal bone<br>Me
dial wall: ethmoid<br>Floor: maxilla
OrbitandEye Mar
ed
"Optic nerve travels through <span style=""font-weight:600; color:#0000ff;"">[..
.]</span>"
"Optic nerve travels through <span style=""font-weight:600; colo
r:#0000ff;"">optic foramen</span>"
OrbitandEye Mar
ed
"Infraorbital nerve comes out of <span style=""font-weight:600; color:#0000ff;""
>[...]</span><br>"
"Infraorbital nerve comes out of <span style=""font-weig
ht:600; color:#0000ff;"">the infraorbital foramen</span><br>" OrbitandEye Mar

ed
T/F: frontal and maxillary sinuses are not present in babies
True
Orbitand

Eye Mar
ed
"Infraorbital nerve, artery and vein travel through the <span style=""font-weigh
t:600; color:#0000ff;"">[...]</span><br>"
"Infraorbital nerve, artery and
vein travel through the <span style=""font-weight:600; color:#0000ff;"">infraorb
ital canal</span><br>" OrbitandEye Mar
ed
What causes a blowout fracture? What is the clinical sign?
Trauma to the ey
eball directly -&gt; can fracture through the ethmoid air cells or maxillary sin
us = blowout fracture<br> Fat drops into the space -&gt; one eyeball falls into t
he cavity -&gt; misaligned eyes <br>
OrbitandEye Mar
ed
What does lac
of sensation in a patients chee
signify?
Infraorbital ner
ve may have been damaged
OrbitandEye Mar
ed
Which direction does fluid from the lacrimal gland travel across the eye?
Fluid travels form lateral upper part to medial lower part <br> OrbitandEye Mar

ed
What is the function of the caruncle? Seals the medial area when the eyelids a
re closed<br> OrbitandEye Mar
ed
What are the two types of conjunctiva? What is the transitional area called?
Bulbar: attaches to the eye<br>Palpebrale: attaches to eyelid<br>Transitions at
superior/inferior conjunctival fornix<br>
OrbitandEye Mar
ed
What is the holein the superior/inferior papilla called?
puncta Orbitand
Eye Mar
ed
What is a manifestation of anorexia/malabsorption upon vision? Double vision (s
un
en eyes) in anorexic because the fat is unevenly absorbed, but this is one of
the last fats to be absorbed in the body<br> OrbitandEye Mar
ed
What is the fluid called in the anterior chamber? Posterior chamber?
Anterior
: aqueous humor<br> Posterior: vitreous humor<br>
OrbitandEye Mar
ed
"Levator palpebrae blends into <span style=""font-weight:600; color:#0000ff;"">[
...]</span><br>"
"Levator palpebrae blends into <span style=""font-weight
:600; color:#0000ff;"">the tarsal plate</span><br>"
OrbitandEye Mar
ed
What innervates the superior tarsal muscle?
Innervated by the sympathetic ne
rvous system and CNIII. Loss of sympathetic outflow -&gt; eyelid droops (ptosis)
<br>
OrbitandEye Mar
ed
What causes occulomotor palsies? What is the clinical sign?
Oculomotor palsi
es may result from a lesion involving an eye muscle or its associated cranial ne
rve (at the nucleus or along the course of the nerve). If one extraocular muscle
is wea
or paralyzed, deviation of the eye will be noted. Impairment of the coo
rdinated actions of the extraocular muscles may cause the visual axis of one eye
to deviate from its normal position. The patient will therefore perceive a doub
le image (diplopia).<br>
OrbitandEye Mar
ed
Seeing double images = ?
diplopia
OrbitandEye Mar
ed
Where are the sympathetic fibers to the eye coming from?
Fibers on the su
rface of the carotid -&gt; give off branches which supply sympathetic innervatio
n to the eyeball. From the superior cervical ganglion -&gt; jump onto the intern
al and external carotid arteries and supply sympathetic innervation to areas nea
r the internal and external carotid (this is one of the examples)<br> Orbitand
Eye Mar
ed
"Long ciliary nerve fibers contain primarily <span style=""font-weight:600; colo
r:#0000ff;"">[...]</span><br>" "Long ciliary nerve fibers contain primarily <sp
an style=""font-weight:600; color:#0000ff;"">sympathetic fibers</span><br>"
OrbitandEye Mar
ed
Which muscles control pupil diameter? Nerves? Pupil size is regulated by two i
ntraocular muscles of the iris: the pupillary sphincter, which narrows the pupil
(parasympathetic innervation), and the pupillary dilator, which enlarges it (sy
mpathetic innervation).<br>
OrbitandEye Mar
ed
"Superior tarsal muscle is innervated by <span style=""font-weight:600; color:#0
000ff;"">[...]</span>" "Superior tarsal muscle is innervated by <span style=""f
ont-weight:600; color:#0000ff;"">sympathetics.</span><br><span style=""font-weig
ht:600; color:#0000ff;"">Loss of innervation (Horners syndrome) -&gt; drooping
of eyelid</span>"
OrbitandEye Mar
ed
"Levator palpebrae is innervated by <span style=""font-weight:600; color:#0000ff

;"">[...]</span>"
"Levator palpebrae is innervated by <span style=""font-w
eight:600; color:#0000ff;"">sympathetics</span>"
OrbitandEye Mar
ed
Give the 4 varieties of type I hypersensitivity reactions and the main symptoms
of each.
"<img src=""pasteec5eXJ.png"" />"
TypeIHypersensitivity Ma
r
ed
Give a more comprehensive (12 point) list of symptoms of anaphylaxis. "<img sr
c=""paste0Lus2Q.png"" />"
TypeIHypersensitivity Mar
ed
Give an example of a type I hypersensitivity reaction that does not require alle
rgens. Dermatographism only requires pressure TypeIHypersensitivity Mar
ed
Give the 3 stages of s
in reactions in type I hypersensitivity. "<img src=""past
eWaJC4J.png"" />"
TypeIHypersensitivity Mar
ed
Give 5 general classes of allergens in type I hypersensitivity reactions.
"<img src=""paste8oXJ6b.png"" />"
TypeIHypersensitivity Mar
ed
"An epi pen contains <span style=""font-weight:600; color:#0000ff;"">[...]</span
> mg of epinephrine." "An epi pen contains <span style=""font-weight:600; colo
r:#0000ff;"">0.3</span> mg of epinephrine."
TypeIHypersensitivity Mar
ed
Long-term treatment of type I hypersensitivity:<br><br>1. What strategy wor
s fo
r most forms of the disease?<br><br>2. Whats the exception to this and its prev
ention strategy?
"<img src=""paste8F171d.png"" />"
TypeIHypersensit
ivity
Give the 7 step mechanism for type I hypersensitivity reactions.
"Cross-l
in
ing of Fc(epsilon)R1 degranulates mast cells:<br><img src=""pastezlKbPm.png""
/>"
TypeIHypersensitivity Mar
ed
Give 3 of the &quot;other agents&quot; that can induce mast cell degranulation.
"<img src=""pasteVy0NBW.png"" />"
TypeIHypersensitivity Mar
ed
1. T or F: primary and secondary exposures to various antigens can occur simulta
neously.<br /><br />2. About what proportion of activated B and T cells from an
initial infection survive to become memory cells?
"1. True<br /><br />2. ~
1 in 100<br /><br /><img src=""paste6f5qPV.png"" />"
Chapter1A Mar
ed
Which APC type is NOT of hematopoietic origin?<br><br>What cell type does it pre
sent antigen to?
Follicular dendritic cells<br>Present to B cells
Chapter1A Mar
ed
"Fill in.<br><br><img src=""pastevcpIT4.png"" />"
"<img src=""pasteK_
1UY.
png"" />"
Chapter1A Mar
ed
"Define each.<br><br><img src=""paste1g_qmJ.png"" />" "<img src=""pasteB5qr
E.
png"" />"
Chapter1A Mar
ed
"<img src=""pasteVbc8xa.png"" />"
"<img src=""paste6fANoz.png"" />"
2 Mar
ed Chapter2
TLRs:<br /><br />1. Found as ___mers on membranes.<br /><br />2. Which one respo
nds to fungi?<br /><br />3. What signalling pathway do all TLRs use?<br /><br />
4. Whats the cellular location of the TLRs that detect foreign nucleic acids?
"1. Homo and heterodimers<br /><br />2. TLR2<br /><br />3. MyD88 pathway<br /><b
r />3. On the membranes of endosomes<br><br><img src=""pasteIvu62X.png"" />"
2 Mar
ed Chapter2
"Fill in for phagocyte activation.<br><br><img src=""paste6bv4jE.png"" />"
"<img src=""pasteLIAlhU.png"" />"
2 Mar
ed Chapter2
"<img src=""paste8iiD_F.png"" />"
"<img src=""pasteEfpfaZ.png"" />"
2 Mar
ed Chapter2
You see a patient with recurrent bacterial meningitis. What do you immediately s
uspect is the problem? <b>Defect in the complement cascade</b><br><br>The Geha
case from this lecture lac
ed complement <b>factor 8</b>. She had recurrent <i>N
. meningiditis</i> infections. 2 Mar
ed Chapter2
"<img src=""paste0LgWRx.png"" />"
"<img src=""pasteev
wmR.png"" />"
2 Mar
ed Chapter2
"<img src=""pastennZqRV.png"" />"
"<img src=""pastelCcnQ2.png"" />"
2 Mar
ed Chapter2
"<img src=""pasteh_M4lm.png"" />"
"<img src=""pastel2JrXa.png"" />"
2 Mar
ed Chapter2
Run through the function and mechanism type I interferons.
"<img src=""past
efuAdFp.png"" />"
2 Mar
ed Chapter2

Contrast the 2 functions of NK1 and NK2 cells. "<img src=""pastere8MuA.png"" />
<br><br><u>NK1 cells:</u><br><span style="" text-decoration: underline;""></span
><br><img src=""pasteQ_0XXg.png"" />" 2 Mar
ed Chapter2
"Give how these microbes evade innate immunity:<br><br><img src=""paste8hNC_I.pn
g"" />" "<img src=""pasteoPKwQc.png"" />"
2 Mar
ed Chapter2
Explain why MHC matching is necessary in solid organ transplantation. <b>2-5</
b>% of T cells can respond to any particular non-self&nbsp;&nbsp;(a.
.a. allogen
eic) MHC.<br><br>In other words, T cells demonstrate <b>promiscuity</b> <b>for n
on-self MHC molecules</b>, even when these are loaded with self peptides.
Chapter5 Mar
ed
"Intracellular microbes are inaccessible to <span style=""font-weight:600; color
:#0000ff;"">[...]</span><br><span style="" font-weight:600; color:#0000ff;""></s
pan><br>Give 3 exceptions to this statement." "Intracellular microbes are inac
cessible to <span style=""font-weight:600; color:#0000ff;"">antibodies</span><br
><span style="" font-weight:600; color:#0000ff;""></span><br><span style=""fontweight:600; color:#0000ff;"">Abs can target them...</span><br><span style=""font
-weight:600; color:#0000ff;"">1. During initial infection</span><br><span style=
""font-weight:600; color:#0000ff;"">2. During movement from one cell to the next
</span><br><span style=""font-weight:600; color:#0000ff;"">3. If infected cells
express characteristic membrane proteins</span>"
Chapter5 Mar
ed
Examples of intracellular microbes:<br><br>In <b>phagocytes</b>:<br>1. Give 3 ba
cteria.<br>2. Give 1 fungus.<br>3. Give 2 protozoa.<br><br>In <b>non-phagocytic<
/b> cells<br>4. Give 4 pathogens.
"1. a. <b>Mycobacteria</b> (TB and lepro
sy)<br>b. <span style=""font-weight:600; font-style:italic;"">Listeria monocytog
enes</span> (burrows out of phagosomes and lives in the cytosol)<br>c. <span sty
le=""font-weight:600; font-style:italic;"">Legionella pneumophila</span><br>2. <
span style=""font-weight:600; font-style:italic;"">Cryptococcus neoformans</span
><br>3. a. <span style=""font-weight:600; font-style:italic;"">Leishmania</span>
<br>b. <span style=""font-weight:600; font-style:italic;"">Trypanosoma cruzi</sp
an><br><span style="" font-weight:600;""></span><br>4. a. All <b>viruses</b><br>
b. All <b>ric
ettsiae</b><br>c. <span style=""font-weight:600; font-style:italic
;"">Plasmodium falciparum</span> (malaria parasite)<br>d. <span style=""font-wei
ght:600; font-style:italic;"">Cryptosporidium parvum</span>"
Chapter5 Mar
ed
Give 3 ways the immune system can detect intracellular pathogens.
1. NK ce
lls detect upregulation of stress indicators or loss of non-stress indicators<br
><br>2. Infected cells present bacterial peptides from the cytoplasm on MHC clas
s I molecules to T cells. This is true for <i>Listeria monocytogenes</i>.<br><br
>3. HLA-E, a specific class I MHC allele, binds a nearly identical peptide that
comes from either:<br>a. A mitochondrial heat shoc
protein thats induced by st
ress or...<br>b. A bacterial heat shoc
protein<br><br>The HLA-E peptide complex
is then presented to NK and T cells<br><br>On NK cells, it engages both an acti
vating (CD94/NKG2C) and an inhibiting (CD94/NKG2A) receptor.<br><br>On T cells,
it engages an HLA-E restricted T-cell receptor.<br><br>So, in sum, this single <
b>HLA-E + peptide tells both the innate and acquired immune systems that the cel
l is either stressed or bacterially infected</b>.
Chapter5 Mar
ed
"Refer to the white #s in the figure.<br /><br />1. In what organs does antigen
recognition occur? (2)<br /><br />2. What is the cyto
ine that box 2 is obscurin
g? Do CD8+ cells also ma
e this in large amounts?<br /><br />3. Fill in the effe
ctor functions for each cell type.<br /><br /><img src=""pasteIzZlS
.png"" />"
"<img src=""pasteg3Tm8Q.png"" />"
Chapter5 Mar
ed
"Immunological synapse:<br /><br />Give each protein and its function.<br /><br
/><img src=""pastegLuv92.png"" />"
"<img src=""paste_oWZFX.png"" />"
Chapter5 Mar
ed
"Signal 1 in the immunological synapse:<br><br>1. What is the protein mar
ed by
the &quot;?&quot;? Whats its function?<br><br>2. Without signal 2, what state w
ould this induce in the T cell?<br><br><img src=""pasteBpY2_v.png"" />" 1. <b>Lc

</b>, which is a
inase carried by CD4. It is necessary to phosphorylate the IT
AMs&nbsp;&nbsp;of CD3 and its zeta chains.<br><br>2. <b>Anergy</b>
Chapter5
Mar
ed
Immunological synapse formation:<br><br>1. What is the mechanism by which a stro

ng immunological synapse is formed? <br><br>2. What two signals induce it?

"1. <b>Affinity</b> of <b>integrins</b> on the T cell surface <b>increases</b>,
forming a <b>ring</b> around a signalling and secretory domain...<br><br>2. ...i
n response to <b>chemo
ines</b> and <b>antigen recognition:</b><br><br><img src=
""pasteljqX2Z.png"" />" Chapter5 Mar
ed
1. Where do <b>naive</b> T cells typically diapedese from the blood? What about
<b>activated</b> T cells?<br><br>2. Compare and contrast the 3 receptor-ligand p
airs that mediate T cell stoppage at these two sites. "1. Naive T cells diaped
ese through lymph node HEVs.<br>Activated T cells diapedese through inflamed vas
culature.<br><br>2. Both interactios use LewisX to E-selectin. Additionally,<br>
Naive: <br><b>L-selectin</b> to <b>CD34</b><br><b>LFA-1</b> to <b>ICAM</b><br><b
r>Activated:<br>Activated <b>VLA-4 </b>to <b>VCAM-1</b><br>Activated <b>LFA-1</b
> to <b>ICAM</b><br><span style="" font-weight:600;""></span><br><img src=""past
eMRjZtg.png"" />"
Chapter5 Mar
ed
"CD1 presents on <span style=""font-weight:600; color:#0000ff;"">[...]</span>.&n
bsp;&nbsp;What type of molecule does it present?"
"CD1 presents on <span s
tyle=""font-weight:600; color:#0000ff;"">CD8 negative, CD4 negative NK-T cells</
span>.&nbsp;&nbsp;Its presents endogenous and bacterial glycolipids.&nbsp;&nbsp;
<br><br>Cd 1 is a nearly monomorphic class 1-b molecule not encoded within the M
HC."
Mar
ed Chapter3
"Antigens for B cells include <span style=""font-weight:600; color:#0000ff;"">[.
..]</span>."
"Antigens for B cells include <span style=""font-weight:600; col
or:#0000ff;"">peptides, carbohydrates, lipids, complex molecules, etc</span>."
Mar
ed Chapter3
What are the antigens presented by MHC class I and II?&nbsp;&nbsp;What are the g
enes encoding these receptors?<br />
MHC class I present peptides 8-10 amino
acids in length.&nbsp;&nbsp;They are encoded by HLA-A, HLA-B, and HLA-C.<br /><b
r />MHC class II present peptides 12-15 amino acids in length (can be up to 50 a
mino acids, but the long tails into the water phase are usually trimmed).&nbsp;&
nbsp;They are encoded by HLA-DR, HLA-DP, and HLA-DQ.
Mar
ed Chapter3
"Chemoattraction and adhesion molecules control T cell traffic
ing:<br><br>1. Fi
ll in the levels (high or low) of each protein for each T cell state in this tab
le:<br><img src=""pasteDzB9aK.png"" /><br><br>2. Explain the changing levels in
each protein." "1. <br><img src=""pastenRdFOY.png"" /><br><br>2. <b>CCR7</b> is
a receptor for a chemo
ine that helps T cells home to dendritic cells. So, the
T cell wants it high after thymic egress to home to the lymph nodes where APCs w
ill present antigen to it. Then, once its found the dendritic cells, it doesnt
want to home toward them anymore, so its downregulated.<br><br><b>CD62</b> is
enriched on the HEVs, so high levels of it in naive T cells helps them find the
lymph nodes.<br><br><b>CD69</b> and <b>S1P1</b> are reciprocally controlled. S1P
is found in high concentrations in the blood. So, naive T cells coming out of t
he thymus want it high to lead them into the bloodstream. During activation in l
ymph nodes, they want to stay put, so it will be low. After activation, they nee
d to travel through the bloodstream to get to infected tissue, so it will be hig
h again.<br><br>Pictorially:<br><br><img src=""pasteTBLxhL.png"" /><br>"
Chapter5 Mar
ed
"The major elements of MHC/peptide interaction are <span style=""font-weight:600
; color:#0000ff;"">[...]</span>.<br /><br />Where is the polymorphism of the MHC
located?"
"The major elements of MHC/peptide interaction are <span style="
"font-weight:600; color:#0000ff;"">anchors of the peptide present in poc
ets of
the MHC</span>.<br /><br />Each allelic form of the MHC molecule recognizes its
own motif of two or three amino acids recognized by two or three poc
ets.&nbsp;&
nbsp;<br /><br />Polymorphism of MHC is on TCR contact points but also in peptid
e binding site.&nbsp;&nbsp;Each allele recognizes a different set of peptides an
d loo
s different to the T cell receptor.&nbsp;&nbsp;The TCR sees about 90% MHC,
10% epitope.&nbsp;&nbsp;"
Mar
ed Chapter3
Give the 2 ways that CD8+ T cells can be activated.
"Fig 5-7A is &quot;<b>cr
oss</b>-<b>presentation</b>&quot; because the bodys own infected cell is being
phagocytosed and peptides from it are being presented on <b>class II MHC</b>.<br
>Im wondering if its an error that theres no co-stimulation in A...<br><br><i

mg src=""pastefPPsVg.png"" /><br>"
Chapter5 Mar
ed
Elaborate on the &quot;surveillance tape model&quot; of antigen capture discusse
d in class.
Immature dendritic cells in tissues are actively phagocytic, con
stantly presenting current antigens on the surface.&nbsp;&nbsp;This is analogous
to constantly running the surveillance tape in a store, recording over previous
surveillance where no crime was committed. <br /><br />Activation of dendritic
cells by a &quot;stranger or danger&quot; signal stops phagocytosis to allow it
to remember its last meal and mobilizes it to the nearest lymph duct as it upreg
ulates MHC II and costimulatory molecules.&nbsp;&nbsp;Upregulation of CCR7 (the
same receptor as T cells) draws it to T cell populations in the lymph node for p
resentation.&nbsp;&nbsp;This process is li
e running the tape from the camera to
the crime lab.&nbsp;&nbsp;
Mar
ed Chapter3
"Fill in each of these proteins that are part of the T cell activation programme
at various times. There is one that is not pictured.<br><br>Give the function o
f each.<br><br><img src=""paste69fTeo.png"" />" "<b>CTLA-4 </b>goes up within ho
urs. Its an inhibitory receptor for B7 that inhibits T cell responses.<br><br><
img src=""pastee54dgb.png"" />" Chapter5 Mar
ed
Describe the role of antigen presenting cells in the spleen.
Red blood cells
coated with antigen from the blood (attached by complement) are scraped clean by
macrophages and dendritic cells.&nbsp;&nbsp;These APCs then present these antig
ens to T cells in the spleen.&nbsp;&nbsp;<br /><br />Good at pic
ing up antigens
that are already in the blood, as opposed to antigens from cuts and other entry
that go to the lymph nodes.
Mar
ed Chapter3
Contrast ITIM and ITAM. ITIM: immunoreceptor tyrosine-based <b>inhibitory</b> mo
tif: [from Wi
i] a conserved sequence of amino acids that is found in the cytopl
asmic tails of many inhibitory receptors of the immune system. After ITIM-posses
sing inhibitory receptors interact with their ligand, their ITIM motif becomes p
hosphorylated by enzymes of the <b>Src
inases</b>, allowing them to recruit oth
er enzymes such as the phosphotyrosine phosphatases SHP-1 and SHP-2, or the inos
itol-phosphatase called SHIP. These phosphatases <b>decrease the activation of m
olecules involved in cell signaling</b>.<br><br>ITAM: immunoreceptor tyrosine-ba
sed <b>activation</b> motif
Chapter5 Mar
ed
Describe the surface mar
ers, major location, expression of TLR, major cyto
ines
, and postulated major functions of conventional dendritic cells.
Conventi
onal dendritic cells are of myeloid lineage, and express high CD11c and CD11b.&n
bsp;&nbsp;CD11c helps form iC3b complement receptor 4 (CR4).&nbsp;&nbsp;It can s
crape antigen from RBC. CD11b helps form CR3, binding C3b and C4b.&nbsp;&nbsp;Bo
th CR3 and CR4 have the Beta-2 integrin subunit (CD18), which is deficient in Le
u
ocyte Adhesion Deficiency Syndrome (LADS).&nbsp;&nbsp;<br><br>Conventional den
dritic cells are located mostly in tissues, and express TLR 4, 5, and 8. These a
re sensitive to lipopolysaccharides, flagellin, and G-rich oligonucleotides, res
pectively.&nbsp;&nbsp;<br><br>Conventional dendritic cells produce Tumor Necrosi
s Factor (TNF), IL-6, and IL-12.&nbsp;&nbsp;Major function is the induction of T
cell responses against most antigens.&nbsp;&nbsp;
Mar
ed Chapter3
1. What are the 4 signalling pathways stemming from signal 1 and 2 binding follo
wed by -chain phosphorylation and ZAP-70 recruitment that T cells use in activati
on?<br><br>2. Give the 3 transcription factors that these pathways upregulate.<b
r><br>3. Give, in Roger's words, &quot;enough details to differentiate&quot; bet
ween these three pathways.
"1. a. <b>Calcium-NFAT</b> pathway<br>b. <b>Rasand Rac-MAP kinase</b> pathway<br>c. <b>PKC NF-B </b>pathway<br>d. <b>PI-3
inase<
/b> pathway<br><br>2. a. <b>NFAT</b><br>b. <b>NF-B </b><br>c.<b> AP-1</b><br><spa
n style="" font-weight:600;""></span><br>3. How's this for detail, bitch:<br><im
g src=""pasteU1uunP.png"" />" Chapter5 Mar
ed
Describe the surface mar
ers, major location, expression of TLRs, major cyto
ine
s, and major functions of plasmacytoid dendritic cells. Plasmacytoid dendritic c
ells have low to negative CD11c and CD11b, but have high B220.&nbsp;&nbsp;<br />
<br />These cells are located in both blood and tissue, and express TLRs 7 and 9
, which are sensitive to ssRNA and DNA CpG motifs in endosomes. <br /><br />They
produce Type 1 Interferons (IFNalpha and IFNbeta), and their major function is
antiviral innate immunity and induction of T cell response against viruses. <br>

<br>Derived from same lineage as B cells.

Mar
ed Chapter3
Compare and contrast the expression of Class II MHC, costimulators, and principa
l function of three major antigen presenting cells.
Virtually any cell can p
resent, since they all have class I MHC.&nbsp;&nbsp;Here we mean professional ce
lls -- dendritic cells, macrophages, and B lymphocytes.&nbsp;&nbsp;<br /><br />D
endritic cells have constituitive Class II MHC and costimulator expression, but
these increase with maturation and can be increased by IFN gamma exposure.&nbsp;
&nbsp;Costimulator expression can also be induced by TLR ligands and T cells (CD
40-CD40L interactions).&nbsp;&nbsp;The principal function is to initiate cell re
sponses to protein antigens.&nbsp;&nbsp;These cells are more potent than macroph
ages due to targeted presentation (maturation and migration), but are 100x less
common than macrophages. <br /><br />Macrophages have low or negative Class II M
HC and costimulator expression, but this can be increased by IFN-gamma.&nbsp;&nb
sp;Again, costimulator expression can be increased by TLR ligands and T cells (C
D40-CD40L interactions).&nbsp;&nbsp;The major APC function of antigen is to acti
vate effector phase or cell-mediated immune responses.&nbsp;&nbsp;<br /><br />B
lymphocytes express constituitive Class II MHC, which can be increased by IL-4.&
nbsp;&nbsp;Costimulator expression (CD80, CD86) is induced by T cells (CD40-CD40
L) and antigen receptor cross-lin
ing. Antigen presentation is mostly to CD4+ he
lper T cells in humoral immune responses (cognate T-B interactions).&nbsp;&nbsp;
Produces a highly specific and effective immune response.&nbsp;&nbsp;<br /><br /
>Deficiency in the CD40 pathway can lead to Hyper-IgM syndrome.<br /> Mar
ed C
hapter3
Immature dendritic cells in the periphery are phagocytic, sessile, and incompete
nt for antigen presentation even with low B-7 (a
a CD80, CD86).&nbsp;&nbsp;Becau
se of this, what effect do they have on T cells?
They have a suppressive
effect, anergizing the T cells.
Mar
ed Chapter3
What are the genes of class II MHC, class I MHC, &uot;class III&uot; MHC loci?
&nbsp;&nbsp;Include both class 1-a and class1-b.&nbsp;&nbsp;What other genes are
present on the sixth chromosome?&nbsp;&nbsp; Class I-a loci are polymorphic - HLA-A, B, and C<br>Class I-b loci are oligomorphic, virtually monomorphic -- H
LA-G, E<br>Class II loci are all polymorphic, and listed in order of activity -HLA-DR, DP, DQ<br>Class II - li
e includes DM, which transfers peptides to clas
s II MHC in endosomes by dissociating class II-associated invariant chain peptid
(CLIP).&nbsp;&nbsp;TAP molecules, which pump class I peptides into the endoplas
mic reticulum, also are class-II li
e.&nbsp;&nbsp;<br>Class III loci includes C4
, Factor B, and C2, as well as cyto
ines Lyphotoxin and TNF.
Mar
ed Chapter3
For all to hear, declare the differences in molecular structure between class I
and class II MHC molecules.&nbsp;&nbsp; Class 1 MHC consists of an alpha chain w
ith three domains (alpha 1, 2, and 3).&nbsp;&nbsp;Alpha-1 and 2 form the peptide
binding cleft at the amino terminal, and alpha-3 forms the transmembrane region
of the peptide and the CD8 ligand.&nbsp;&nbsp;A Beta-2-microglobin molecule is
reuired for the &uot;loc
ing&uot; of the class I structure into place, and wi
thout this molecule the MHC will not present on the surface.&nbsp;&nbsp;Some tum
ors lose Beta-2-m which helps evade detection.&nbsp;&nbsp;Beta-2-m is not part o
f the HLA gene, and associates with other class I-li
e molecules<br />.<br />Cla
ss II MHC consist of an alpha and beta chain but no Beta-2-m.&nbsp;&nbsp;The bin
ding cleft is made up of the amino terminals of alpha-1 and beta-1, while alpha2 and beta-2 form transmembrane domains.&nbsp;&nbsp;Beta-2 binds the CD4 corecep
tor.&nbsp;&nbsp;Class II MHC has two transmembrane domains, while Class I has on
ly one transmembrane domain.<br /><br />Additionally, Class I binding of the pep
tide reuires the N and C termini of the peptide to be &uot;tuc
ed in&uot; or
anchored to the protein, restricting length to 8 amino acids.&nbsp;&nbsp;Class I
I is a longer peptide, and the ends of the chain can float in the watery phase u
p to 50 amino acids (but is usually cleaved to 12-15).&nbsp;&nbsp;The part bound
by Class II is about the same as for Class I. Mar
ed Chapter3
Explain the significance of the following features of MHC expression:&nbsp;&nbsp
;Co-dominant expression, polymorphic genes, and MHC-expressing cell types.
Co-dominant expression allows both parental allels of each MHC gene to be expres
sed, increasing the number of different MHC molecules that can present peptides

to the T cells.&nbsp;&nbsp;<br /><br />Polymorphic genes in the population (over

5000) allow many different alleles to respond to different microbial peptides,
and helps promote a species response to emerging threats.&nbsp;&nbsp;Variety ma

es homozygous individuals rare, meaning that most people have 21 different allel
es.&nbsp;&nbsp;<br /><br />Class II MHC are expressed on Dendritic cells, macrop
hages, and B cells -- all T cell APCs.&nbsp;&nbsp;Class I MHC are present on all
nucelated cells, allowing CTL to
ill any virus infected cell.
Mar
ed C
hapter3
IL-2 signalling:<br><br>1. What are its two stages? What protein (and lac
there
of in stage 1) is responsible for them?<br><br>2. Give the full 4 step mechanism
of IL-2 signalling incorporating these stages.<br><br>3. What rare disease is d
ue to a defect in this pathway? What cell types does it affect? Where in the pat
hway does the defect reside?<br><br>4. Give one way the IL-2 pathway is suppress
ed.
"1. Within 24 hours of T cell activation, there is no <b>CD25</b> a.
.a.
<b>IL2Ralpha</b>. Expression of this chain of the IL-2 receptor after 24 hours
increases the affinity of IL-2 binding to its receptor.<br><br>So, inside 24 hrs
. the activated cell is ma
ing lots of IL-2, but only wea
ly binding to its own
secretions.<br>After 24 hrs., it ma
es only low levels of IL-2, but responds gre
atly to it.<br><br>2. <br><img src=""paste25EBnb.png"" /><br><br>3. <b>X-lin
ed
SCID</b><br>Affects <b>B, T, and NK cells</b><br>Defect in the <b>common gamma c
hain</b> of the IL-2 receptor complex, which is responsible for <b>signalling</b
>.<br><br>4. <b>Tregs constitutively express a ton of CD25 to gobble up IL-2</b>
so it can't activate naive T cells." Chapter5 Mar
ed
Ma
ing use of your superlative grasp of numbers, explain why each person can onl
y detect 6/8000 possible peptides each for class I and class II MHC.&nbsp;&nbsp;
Chec
this out.&nbsp;&nbsp;The antigen binding cleft on MHC is only, li
e 8 amin
o acids, yeah?&nbsp;&nbsp;Cool. <br /><br />Now, since there are 20 natural amin
o acids, that means there are 20^8 possible different octopeptides, assuming bio
logy is o
with random assortment.&nbsp;&nbsp;Cool.<br /><br />Since each alleli
c form typically has about three poc
ets, that means that three out of the eight
amino acids is limited to only one possible amino acid (that the poc
et will ac
cept).&nbsp;&nbsp;So each allelic form recognizes 3.2 million different peptides
(20^5), but that is only 1/8000 out of the possible peptides.&nbsp;&nbsp;<br />
<br />Since you have 6 class I and 6 class II alleles, each person can detect on
ly 6/8000 with each class.&nbsp;&nbsp;<br><br>Because of the math, most peptides
are ignored by any one individual, but the extreme polymorphism for HLA alleles
means the human species has a better chance of responding to critical peptides,
such as epidemics.&nbsp;&nbsp;(As an aside, genes lin
ed to the critical surviv
ing allele can also be amplified as the species goes through a bottlenec
.)
Mar
ed Chapter3
CD4+ helper T cell roles:<br><br>1. Give CD4+ T cell's role in activating <b>cel
l-mediated immunity</b>.<br><br>2. Do the same for <b>humoral immunity</b>.
"<img src=""pasteFvNmwJ.png"" />"
Chapter5 Mar
ed
Give the 4 different lineages of T cells and the following parameters of each:<b
r><br>1. Signature cyto
ine(s)<br>2. Immune reactions they cause<br>3. General t
ype(s) of microbes they combat<br>4. Type(s) of host-based diseases in which the
y're implicated "<img src=""pasteT2cdTQ.png"" /><br>Not pictured: <b>Treg</b> ce
lls. <br><br><u>Signature cyto
ine</u>: TGFbeta<br><br><u>Immune reactions</u>:
suppress immune responses, particularly autoimmunity<br><br><u>Host-based diseas
es:</u> cancer; they suppress anti-cancer T cells via TGFbeta" Chapter5 Mar
ed
Run through the 5 effects of Th2 cells on the immune system.
"<img src=""past
e9TTsv.png"" />"
Chapter5 Mar
ed
Run through the 3 effects of Th17 cells on the immune system. "<img src=""past
eCFZuzA.png"" />"
Chapter5 Mar
ed
"Fill in the boxes about helper T cell differentiation into lineages.<br><br><im
g src=""paste27zoIW.png"" />" "<img src=""pastervg7Wp.png"" />"
Chapter5
Mar
ed
"Contrast:<br><br><img src=""paste
duh0r.png"" />"
"<img src=""paste59ROnE.
png"" />"
Chapter4A Mar
ed Ch4AWORK
"Hypervariable regions in the immunoglobulin gene a.
.a. <span style=""font-weig

ht:600; color:#0000ff;"">[...]</span>" "Hypervariable regions in the immunoglob

ulin gene a.
.a. <span style=""font-weight:600; color:#0000ff;"">complementary d
etermining regions (CDRs).</span>"
Chapter4A Mar
ed Ch4AWORK
1. Where are the hypervariable segments in the light-chain immunoglobulin gene?<
br /><br />2. What are the other segments called? What secondary structure do th
ey form in the protein?<br /><br />3. How many CDR's determine the antibody's sp
ecificity?
"<img src=""pastetV6tLF.png"" />"
Chapter4A Mar
ed Ch4AWOR
K
Give 3 possible descriptors for how antibodies can bind antigens.
"<img sr
c=""pastephKcR.png"" />"
Chapter4A Mar
ed Ch4AWORK
"1. Give the cyto
ine behind each box.<br /><br />2. What are the 3 differences
between IgG1 and 3 vs. IgG2 and 4?<br /><br /><img src=""paste
b2WN_.png"" />"
"1. <br /><img src=""pasteQEMQTe.png"" /><br /><br />2. IgG1 and 3 are <b>cytoly
tic</b>; they <b>bind Fc receptors,</b> can <b>fix complement</b>, and can <b>op
sonize</b>. <br />IgG2 and 4 are non-cytolytic and can't do either of those thin
gs. " Chapter4A Mar
ed Ch4AWORK
"Give the plasma concentrations and half-lives of these antibodies:<br><br><img
src=""pastedHjHbG.png"" />"
"<img src=""pastewIa1p5.png"" />"
Chapter4
A Mar
ed Ch4AWORK
1. Why is the half-life of IgG so long in the plasma at 23 days?<br><br>2. How i
s this so?
1. In short, because of its <b>fetal importance</b>.<br>It's pro
tective for about <b>10 months</b> after birth.<br><u>Mechanism</u>:<br>Maternal
IgG is transported across the placenta and through breastmil
via <b>FCRN</b> (
Fc receptor for neonates). <br>FCRN is also in the neonate gut to transport IgG
into the bloodstream.<br><br>2. <b>FCRN</b> greatly increases IgG's half-life by
causing endothelial cells to ta
e up IgG, stabilize and store it, and release i
t later.<br>
Chapter4A Mar
ed Ch4AWORK
"Give the Ig type behind each box.<br><br><img src=""pasteVSuFNz.png"" />"
"<img src=""paste4xwDQ.png"" />"
Chapter4A Mar
ed Ch4AWORK
Give the Nobel Prize winning scheme for how monoclonal antibodies can be made in
large amounts. "<img src=""paste8Cp3A4.png"" />"
Chapter4A Mar
ed Ch4AWOR
K
TCR protein characteristics:<br /><br />1. TCR resembles what?<br /><br />2. TCR
is a ____mer.<br /><br />3. TCR extracellular domains resemble what?<br /><br /
>4. Each chain contributes to the antigen binding site and contains what other 2
domains?<br /><br />5. TCRs are ____valent
"1. A membrane-bound Ig Fab frag
ment<br /><br />2. Heterodimer (alpha-beta or lambda-delta)<br /><br />3. Li
e t
he V and C domains of Ig's.<br /><br />4. Transmembrane domain<br />Short cytopl
asmic tail<br /><br />5. Monovalent<br /><br /><img src=""pasterodHYo.png"" />"
Chapter4A Mar
ed Ch4AWORK
What are the two meanings of MHC restriction? First, it means that T cells hav
e a dual specificity, for both the cognate antigen but also the MHC presenting i
t.&nbsp;&nbsp;For example, if you are HLA-A2 and have a T cell that can recogniz
e a certain flu peptide, that T cell would recognize flu infected cells from ano
ther person only if they were also HLA-A2.&nbsp;&nbsp;<br><br>Second, it refers
to the molecular mechanism by which T cell receptors are activated, in that it c
an only recognize its cognate antigen when it is presented on the MHC receptor.&
nbsp;&nbsp;
Mar
ed Chapter3
"Contrast antibody and TCR.<br><br><img src=""pasteXChZV
.png"" />"
"<img sr
c=""paste2gIjdp.png"" />"
Chapter4A Mar
ed Ch4AWORK
"Fill in the boxes for B and T cell maturation. They all have to do with why the
re's such a high amount of attritition before generating mature B and T cells.<b
r /><br /><img src=""pasteuiwpWh.png"" />"
"<img src=""pastemgOf57.png"" />
"
Ch4AWORK Mar
ed Chapter4A
"In the discussion of HLA-disease association in class, it was revealed that ind
ividuals with DR3/4 alleles and DR2 allele each had<span style=""font-weight:600
; color:#0000ff;"">[...] ris
of type 1 diabetes</span>, respectively. <br><br>W
hat are the possible conclusions we can draw from this data?" "In the discussi
on of HLA-disease association in class, it was revealed that individuals with DR
3/4 alleles and DR2 allele each had<span style=""font-weight:600; color:#0000ff;

""> increased and decreased</span>, respectively. <br><br>Perhaps, DR2 is a good

presenter of a self peptide to drive formation of CD4 regulatory T cells (&uot
;Treg&uot;), ma
ing its presence protective.&nbsp;&nbsp;(30% present in control
, 0% in diabetes patients.)<br><br>Perhaps the DR3/4 genotype is a good presente
r of a molecular mimic, which leads to activation of suppressed autoimmune clone
s leading to diabetes.&nbsp;&nbsp;(leading to the observed 50 fold increase in r
is
of type one diabetes.)<br><br>Lastly, these genes may only be correlative, a
nd are tightly lin
ed to another gene controlling Type 1 diabetes.&nbsp;&nbsp;"
Mar
ed Chapter3
Compare the &uot;vision&uot; of CTL and TH cells in the body.&nbsp;&nbsp;
T cells have x-ray vision that can see inside cells and inside proteins to detec
t even single amine acid shifts, because the proteins inside the cell are sample
d and presented via MHC.&nbsp;&nbsp;<br><br>Any cell can process for class I MHC
, giving CTL vision throughout the body.&nbsp;&nbsp;<br><br>Professional APC hav
e the apparatus for processing peptides for both class I and class II MHC.<br><b
r>
Mar
ed Chapter3
"T cell traffic
ing:<br><br>Fill in the CD4 and CD8 status (positive or negative
) of cells in each thymic region.<br><br><img src=""pasteA
WYC.png"" />"
"DN = double negative<br>DP = double positive (for CD4 and CD8)<br>SP = single p
ositive<br>Leave thymus as mature but nave T cells<br><br><img src=""paste6HpvG0.
png"" />"
Chapter5 Mar
ed
What is the exception to the rule that T cells reuire one of either CD4 or CD8
as a coreceptor?<br><br>What is the function of these cells?
<b>CD4- CD8- cel
ls</b> are found in the <b>gut</b>, where they function as <b>anti-inflammatory<
/b> cells preventing inflammatory bowel disease.
Chapter5 Mar
ed
Describe six important properties about the binding of peptides to MHC. Broad sp
ecificity -- approximately 3 million peptides can bind to the same allelic form
of MHC.<br><br>Display of only one peptide at a time. <br><br>Binding primarily
to peptides.&nbsp;&nbsp;(two important exceptions:&nbsp;&nbsp;CD1 can present gl
ycolipids, and MHC can also present modified peptides.&nbsp;&nbsp;Peptides that
are glycosylated, methylated, or covalently bound to urushiol (poison ivy) are c
leaved and can be presented with moifications intact, ma
ing native proteins app
ear foreign.)<br><br>Peptides are acuired during intracellular assembly, specif
ically from transport into the ER (Class I) or from endocytic vesicles (Class II
).<br><br>Stable surface expression of MHC moleceule reuires bound peptide.&nbs
p;&nbsp;(exception, class II MHC can present on the surface.)<br><br>Very slow o
ff rate allows MHC to display bound peptide for long enough to be located. <br><
br>
Mar
ed Chapter3
What are the products of activated neutrophils, monocytes, eosinophils, mast cell
s, and basophils that contribute to an inflammatory response? o
neutrop
hils: ROS, proteases, nucleases<br>o
monocytes: cyto
ines (TNF, IL-1, che
mo
ines, IL-6), proteases, nucleases, ROS<br>o
eosinophils: IL-5, IL-3, I
L-10, MBP, leu
otrienes, ECP, peroxidases, hydrolases, lysophospholipases<br>o
mast cells/basophils: histamine, prostaglandins, leu
otrienes, platelet-ac
tivating factor, TNF, tryptamines<br> Mar
ed Immunopharmacology1
Mast cell activation has two phases, an immediate and a late phase. Over what tim
e interval do these occur? What pharmacologic agents target the resulting inflam
mation? o
immediate: release of granule contents (histamine, tryptamine)tr
eated with antihistamines<br>o
delayed: arachidonic acid derivatives and
cyto
inestreated with NSAIDs, glucocorticoids, leu
otriene antagonists)<br>
Mar
ed Immunopharmacology1

What are the targets and the effects of antihistamines?

oantihistamines
bind and bloc
histaminergic (H) receptorsthey are best given before exposure to
an allergen
Mar
ed Immunopharmacology1
What is the essential difference in the pharmacologic effects of the first-genera
tion and second-generation antihistamines?
o
both are very effective
as antihistamines, but first-generation antihistamines cause drowsiness because
they are capable of crossing the blood-brain barrier Mar
ed Immunopharmacolog
y1
What are the two major pathways of arachidonic acid metabolism?
o
product

ion of prostaglandins and thromboxanes (by cyclooxygenase)<br>o

productio
n of leu
otrienes (by 5-lipoxygenase)<br>
Mar
ed Immunopharmacology1
What are the targets of NSAIDs? Specifically, what are COX-1 and COX-2? What do t
hey do? o
NSAIDs bloc
the action of cyclooxygenase (COX) and thus the pr
oduction of prostaglandins and thromboxanes<br>o
COX-1 is constitutively
expressed and involved in production of thromboxane A2 (TxA2); COX-2 is constitu
tive in some tissues and inducible in inflamed tissues, produces prostaglandin I
2 (PGI2)<br>o
specific inhibitors of COX-2 (e.g. Vioxx/rofecoxib, Celebre
x/selecoxib) were intended to reduce inflammation without increasing ris
of GI
bleedthey had the unintended effect of bloc
ing PGI2 production relative to TxA2,
resulting in thrombotic events (stro
e, MI)<br>
Mar
ed Immunopharmacolog
y1
What does it mean that NSAIDs interfere with platelet activation? Is this an adve
rse side effect or is it beneficial?
o
irreversible inhibition of COX1 prevents platelets from synthesizing TxA2, whereas endothelial cells can produ
ce more COX-1 and continue to produce PGI2results in a shifting towards PGI2 and
inhibition of clotting<br>o
can be a beneficial side effect, e.g. in prev
enting and treating acute MI<br>
Mar
ed Immunopharmacology1

Why were leu

otriene receptor antagonists developed and what do they do?
o
developed because leu
otrienes (LTC4, LTD4, LTE4) are the major broncho
constrictors in asthma<br>o
leu
otriene production is not affected by NSA
IDs and so the only treatment option was corticosteroids until LTRAs were develo
ped<br> Mar
ed Immunopharmacology1
What does sodium cromolyn do? o
inhibits mast cell degranulation (effec
tive in treatment of respiratory/ocular allergies)<br>o
nedocromil sodium
has similar effect<br> Mar
ed Immunopharmacology1
Why dont glucocorticoids have an immediate effect on inflammatory responses?
o
function by binding intracellular receptors and activating transcriptio
n factors to alter protein synthesisprocess ta
es 4-6 hours at a minimum
Immunoph
armacology1
Discuss the signal transduction pathways affected by glucocorticoids. o
leads to transcription of I
Balpha, which bloc
s NF-
B and AP-1 (thereby bloc
i
ng production of inflammatory proteins) Mar
ed Immunopharmacology1

What is the difference between the effects of glucocorticoids and NSAIDs

on arachidonic acid metabolism? o
glucocorticoids bloc
the entire arachi
donic acid pathway (by bloc
ing phospholipase A2); NSAIDs bloc
only the COX (-&
gt;thromboxane and prostaglandin) pathway
Mar
ed Immunopharmacology1
Describe the process by which class I and II MHC acquire antigen for presentatio
n on the cell surface. Bascially, for class II the cell is all li
e, &quot;whoa
, endocytosis,&quot; then its all li
e, &quot;might as well stic
some class II
MHC (associated with invariant chains) from the endoplasmic reticulum into this
endosome.&quot;&nbsp;&nbsp;<br>Then, BOOM, Class II invariant chain peptide (CLI
P) gets clipped and dissociates on the behest of frea
ing DM, so the Class II MH
C is all li
e, &quot;I dont need this shit&quot; and grabs an little peptide pi
ece because oh yeah that endocytosed material got TOTALLY WRECKED by some endoso
mal/lysosomal enzymes.&nbsp;&nbsp;<br><br>In Class I MHC, antigenic and innate p
roteins are targeted for destruction by the proteasome, transported by transport
er associated with antigen processing (TAP) into the ER, where MHC associated wi
th TAP (bridged by tapasin) captures an antigen and presents it on the cell surf
ace.
Mar
ed Chapter3
Yeah, Im going to need you to go ahead and compare and contrast Class I and II
MHC pathways, including the cells that express them, the responsive T cells, the
source of antigens, enzymes responsible for peptide generation, site of peptide
loading MHC, and molecules involved in transport of pepties and loading of MHC.
Class I MHC are on all nucleated cells, are more directed at CD8+ T cell
s, and present cytosolic proteins (either from cell or invading from phagosomes)
.&nbsp;&nbsp;Antigenic proteins are digested by cytoplasmic proteasome and trans
ported into the ER for loading.<br><br>Class II MHC are on dendrtic cells, monon
uclear phagocytes, B lymphocytes, endothelial cells, and the thymic epithelium.&
nbsp;&nbsp;They are directed at CD4+ cells, and present endosomal/lysosomal prot

eins.&nbsp;&nbsp;Antigenic proteins are digested by endosomal/lysosomal protease

s, and loaded onto MHC from the ER in specialized vesicles.&nbsp;&nbsp;This proc
ess involves the invariant chain and DM.<br>
Mar
ed Chapter3
This is a enucleated human globe cut across the ora serrata.<br><br>1. Name the
structures at A. <br>2. Name the structure at B. <br>3. Name the structure at th
e arrows labeled C. <br>4. Name the structure at the arrow labeled D. <br>5. Nam
e the structure at the arrow labeled E. <br>
"A. Extraocular muscles<br>B. Op
tic nerve of CN II<br>C. Neural retina<br>D. Choroid of uveal tract<br>E. Sclera
<br><br><img src=""pastehNgIMd.png"" />"
Mar
ed VisionI
Layers of the globe:<br><br>1. Give the 3 contents of the outer layer.<br><br>2.
Give the 3 contents of the middle layer.<br><br>3. Give the 3 contents of the i
nnermost layer.<br><br>4. Which layer is invaded by melanocytes of neural crest
origin? 1. Sclera (lamina cribrosa, nasally)<br>Limbus<br>Cornea<br><br>2. Middl
e layer (uveal tract): <br>Choroid<br>Ciliary body with ciliary processes<br>Iri
s stroma. <br><br>3.&nbsp;&nbsp;Retinal pigment epithelium (RPE)<br>Neural retin
a<br>Ora serrata (anterior projections across ciliary processes and across the p
osterior aspect of the iris)<br><br><br>4. Middle layer a.
.a. uveal tract
Mar
ed VisionI
"What is the clinical diagnosis here?<br />Based on what symptom?<br /><br /><im
g src=""pasteMCfAup.png"" />" Diagnosis: open globe<br />Symptom: pea
ed pupil
<br><br>From wi
i: Globe rupture occurs when the integrity of the outer membrane
s of the eye is disrupted by blunt or penetrating trauma. Any full-thic
ness inj
ury to the cornea, sclera, or both is considered an open globe injury. Mar
ed V
isionI
What does the acronym PERRLA mean?
<b>P</b>upil is totally normal as apprai
sed by the fact that the pupils are <b>E</b>qual in size, <b>R</b>ound, <b>R</b>
eactive to <b>L</b>ight and <b>A</b>ccommodation
Mar
ed VisionI
1. Whenever you see a pea
ed pupil, you must do what 5 things?<br><br>2. The pat
ient must do what 5 things?
(1) you call ophthalmology immediately<br />(2)
you cut nothing <br />(3) you clean nothing<br />(4) you administer no topical a
ntibiotics,&nbsp;&nbsp;IV antibiotics are OK <br />(5) you administer no topical
anesthetics<br> <br />(6) the patient must be NPO (nil per os--nothing by mouth
) because they are going to the OR <br />(7) the patient just sits still&nbsp;&n
bsp;<br />(8) the patient is forbidden to bend over, lay down,&nbsp;&nbsp;lift a
nything, or perform any valsalva activities li
e&nbsp;&nbsp;having a bowel movem
ent<br />(9)&nbsp;&nbsp;you apply no pressure on the eye even to test for intrao
cular pressure <br />(10) you cover the eye with a lose patch or a styrofoam cup
&nbsp;&nbsp;<br />
Mar
ed VisionI
Tell me about cross-presentation.&nbsp;&nbsp; Cross-presentation chiefly refer
s to exogenous peptides acquired by phagocytosis and re-reouted into the class I
presentation pathway.&nbsp;&nbsp;They do this by escaping the phagosome into th
e cytoplasm for proteasome degradation, before entering the rest of the typical
class I presentation pathway.<br><br>Typically in dendritic cells, the DC has ab
out a day to activate CTL&nbsp;&nbsp;This ensures that intracellular signals tha
t require the CTL response, but are encountered through phagocytosis, are able t
o stimulate the class I (and simultaneous class II) signaling.&nbsp;&nbsp;
Mar
ed Chapter3
Describe the process of B cell antigen presentation.
Although B cells are not
phagocytic, they can endocytose their cognate antigen and immunoglobulin, enabl
ing class II MHC presentation T cells for activation.&nbsp;&nbsp;This allows eff
icient memory responses.&nbsp;&nbsp;<br><br>B cell and T cell help each other pr
oliferate.
Mar
ed Chapter3
In Geha Case 17, Tatiana and Alexander Islayev are siblings with severe bronchie
ctasis, persistent cough with yellow green sputum, and a history of multiple bac
terial infections.&nbsp;&nbsp;<br><br>Of what significance are their three healt
h siblings?<br>The lab findings are normal except a 9:1 ratio of CD4 to CD8 T ly
mphocytes.&nbsp;&nbsp;What is the normal ratio?<br>Tatiana has 1/100th the MHC c
lass 1 presentation on white blood cells of her healthy father.&nbsp;&nbsp;The a
ffected siblings are homozygous for one HLA haplotype (one copy from each parent
), implying that a defect in the HLA is preventing class I MHC presentation.&nbs

p;&nbsp;What two defective proteins (on and off the HLA) have we learned that mi
ght be interrupting this pathway?<br><br>What defects are causing their symptoms
?<br> Healthy siblings suggests that the repetitive infections are not caused
by environment. <br><br>The normal ratio of CD4 to CD8 is 2:1.&nbsp;&nbsp;The pa
tiens have very low CD8 count.&nbsp;&nbsp;<br><br>The two proteins are TAP (the
defect in this case, since it is on the HLA) and Beta-2-microblogulin.&nbsp;&nbs
p;<br><br>Defects in CTL function and partial defects in NK function prevent the
m from responding adequately to infection.&nbsp;&nbsp;Additionally, secondary re
spiratory infections occur due to chronic lung inflammation, similar to infectio
ns present in patients with cystic fibrosis. <br>
Mar
ed Chapter3
There are four significant features that ma
e MHC innate receptors.&nbsp;&nbsp;R
ecall them please.
They are encoded in the germline.<br>They are invariant
during our lifetime.<br>Expression regulated by innate signals.<br>Selectivity i
s very wea
, with little ability to distinguish between self/non-self, and safe/
dangerous<br><br>They also act as the bridge between innate and acquired immunit
y.
Mar
ed Chapter3
"Fill in for the 3 smooth muscles within the eye.<br><br><img src=""pasteQ1bzPB.
png"" />"
"<img src=""pasteZslu1V.png"" />"
Mar
ed VisionI
What is accomodation? When the circumferential muscle contracts, the circumfer
ence of the circle created by the ciliary body is at its <b>minimum</b>.<br>It <
b>releases tension</b> on the zonule fibers, freeing the lens from tension.<br>T
he lens gets <b>fatter</b> due to its inherent elasticity and becomes a more pow
erful lens for <b>near vision</b>.
Mar
ed VisionI
What is miosis?<br>What is its function?
Miosis: pupil contraction<br><u>
Function</u>: <b>reduce depth of focus</b>
Mar
ed VisionI
Neural retina:<br /><br />1. Give its 3 orders of neurons.<br /><br />2. Give th
e 2 names for its interneurons.<br /><br />3. Describe its blood supply.<br /><b
r />4. What are two consequences of it being an outgrowth of the CNS?<br /><br /
>5. Give its topology from posterior to anterior in the eye.
1. Photoreceptor
s<br />Bipolar cells<br />Ganglion cells<br /><br />2. Horizontal cells<br />Ama
crine cells<br /><br />3. Two blood supplies: <br /><b>Choroidal vessles</b>: ou
ter retina (photoreceptors)<br /><b>Inner retinal vessels:</b> entire inner reti
na<br /><br />4. Presence of:<br />a. <b>Blood-retina barrier</b><br />b. GFAP+
<b>Muller cells</b> (astrocyte analogues)<br /><br /><br /><br />
Mar
ed V
isionI
The neural retina is attached to the apical surface of the retinal pigment epith
elium (RPE) by what 5 parameters?
1. <b>Interdigitation</b> between the ph
otoreceptor outer segments and the microvilli of the RPE cells.<br /><br />2. <b
>Mucopolysaccharide glue</b> in the subretinal space.<br /><br />3. Extra <b>muc
us condensation</b> at the tip of cone outer segments.<br /><br />4. <b>Viscosit
y of the vitreous body</b> (which liquefies with normal aging)<br /><br />5. A <
b>water flux</b> across the retina from the vitreous to the choroidal vessels dr
iven by ion pumping of the RPE<br />
Mar
ed VisionI
With your direct ophthalmoscope across a dilated pupil, you can see what 4 struc
tures? 1. <b>Fundus</b><br><br>2.<b> Optic nerve</b> (nasally) with its color,
contour, and cupping (Three Cs)<br><br>3. <b>Arcades of inner retinal veins and a
rteries</b> (veins are larger diameter than arteries)<br> <br>4. <b>Foveola</b>
(in the middle of the macula) Mar
ed VisionI
What 4 things can you see with your direct ophthalmoscope in the case of patholo
gy?<br><br>Give the pathological mechanism behind each. 1. <b>Red spots</b> (blo
od), <br>2. <b>Yellow exudates</b> (lipid and plasma proteins lea
ing from compr
omised inner retinal capillaries)<br>3. <b>White retina</b> (dead and swollen an
d ischemic so that you cannot see the orange color created by the RPE and choroi
dal vessels)<br>4. <b>Dilated and tortuous vessels </b>(due to inflammation?)<br
>
Mar
ed VisionI
Retinal detachment:<br><br>1. Usually starts where? Progresses where?<br><br>2.
What 3 things will the patient say they see?<br><br>3. Give 5 treatment possibil
ities to reattach.
"1. Starts at <b>ora serrata</b><br>Progresses <b>centra
lly</b><br><span style="" font-weight:600;""></span><br>2. <u>The 3 Fs</u><br><
b>Floaters</b><br>Firewor
s (<b>flashes of light</b>)<br>Falling curtain of blin

dness (<b>field defect</b>)<br><br>3. a and b. <b>Expandable gas</b> or <b>silic

one oil</b> in the vitreous body<br><br>c. <b>Scleral buc
le with laser burns</b
><br><br>d. <b>Mucagen</b> (increases water flux across the retina from the vitr
eous to the choroidal vessels driven by ion pumping of the RPE)<br><br>e. <b>Ava
stin</b>: angiogenesis inhibitor"
Mar
ed VisionI
"Label up.<br><br><img src=""pasteRYIW5j.png"" />"
"<img src=""pasteCV2MFD.
png"" />"
Mar
ed VisionI
"1.&nbsp;&nbsp;Name the structure at arrow A.&nbsp;&nbsp;<br />2.&nbsp;&nbsp;Nam
e the structure at arrow B.&nbsp;&nbsp;<br />3.&nbsp;&nbsp;Name the structure at
arrow C. <br />4.&nbsp;&nbsp;What exactly is happening within the circle? (5)<b
r /><br /><img src=""pasterVNJgI.png"" />"
A. anterior capsule<br /><br />B
. lens epithelial cells<br /><br />C. posterior capsule<br /><br />4. A reservoi
r of lens epithelial cells at the equator are proliferating and differentiating
into lens fibers by this 5 step process...<br />a. losing their nuclei and organ
elles, <br />b. forming soluble, non-aggregated, homogeneous crystallin proteins
, <br />c. elongating as they move posteriorly,&nbsp;&nbsp;<br />d. forming homo
geneous lateral uniform interdigitations with adjacent lens fibers, <br />e. dra
gging type IV collagen basement membrane produced by the metabolically active an
terior epithelium<br /><br />...so that the lens is slowly getting larger and la
rger and pressing on the iris so that the angle is getting smaller and smaller w
ith normal aging
VisionII Mar
ed
"1. What is this?<br /><br />2. What pathology is associated with it?<br><br>3.
What are 5 possible triggers for that pathology?<br /><br /><img src=""pastev6Qt
Pp.png"" />"
1. Incredibly regular <b>lens fibers</b><br /><br />2. Irregular
ity in them is the source of <b>cataracts: loss of lens transparency</b>.<br><br
>3. 1. UV light<br>2. steroids<br>3. diabetes<br>4. normal aging<br>5. physical
injury (dart or
nife penetration)<br> VisionII Mar
ed
"After development at <span style=""font-weight:600; color:#0000ff;"">[...]</spa
n> wee
s gestational age, the lens is totally avascular"
"After developme
nt at <span style=""font-weight:600; color:#0000ff;"">40</span> wee
s gestationa
l age, the lens is totally avascular" VisionII Mar
ed
"Transparency of this structure is due to what 7 morphologic factors?<br><br><im
g src=""pastewRx1_s.png"" />" 1. shape and arrangement of the lens fibers<br><
br>2. regular intercellular interdigitations<br><br>3. small amount of interstit
ial fluid<br><br>4. crystallin protein distribution within the lens fibers<br><b
r>5. absence of all organelles within mature lens fibers<br><br>6. smooth surfac
e of the lens capsule<br><br>7. uniformity of the single layer of anterior epith
elial cells<br> VisionII Mar
ed
"1. What are the filaments indicated by the red arrows? (hint: the CB stands for
ciliary body)<br><br>2. What protein are they made of?<br><br>3. What do they a
ttach to what?<br><br><img src=""pasteBYQ_4A.png"" />" 1. Zonule fibers<br><br>
2. Fibrillin<br><br>3. Attach from the lens equator capsule to the inner nonpigm
ented cells over the ciliary processes to hold the lens in place
VisionII
Mar
ed
"This patient has been dilated and you are loo
ing at the pupil with penlight il
lumination.<br />1. What is your clinical diagnosis? <br />2. Use one word to de
scribe this pupil. <br />3. What are 3 other other causes of the answer to #2?<b
r>4. What are two debilitating aspects of this pathology?<br /><br /><img src=""
pasteQQ9BY2.png"" />" 1. Cataract<br><br />2. Leu
ocoria (white pupil)<br><br
/>3. 1. Retinoblastoma<br />2. Detached retina<br />3. Vitreous scar<br><br>4. 1
. Pronounced visual acuity decrease<br>2. Glare from lights and impossibility to
drive at night VisionII Mar
ed
What pathology represents the major cause of world blindness? Cataracts
VisionII Mar
ed
A. List the sequential steps in the current state-of-the-art cataract extraction
. (6)<br><br>B. What minimal immediately post-operative condition do patient dev
elop? Define this.<br><br>C. What post-operative condition can patients develop
over a few months?<br>What is the mechanism of this pathology?<br>How is it trea
ted?
A. 1. Ma
e a <b>small incision</b> (self-sealing) and <b>one small hole<
/b><br><br>2. <b>Remove</b> the anterior capsule and epithelial cells<br><br>3.

Do <b>lamellar dissection</b> with saline injection so that the entire lens fibe
r core is <b>floating</b> on a thin veneer of fluid and is <b>rotatable</b><br><
br>4. Fragmentation and suc
out the lens fragments by <b>phacoemulsification</b
> (def: using sound waves to emulsify the lens) but leave the sulcus of the caps
ule at the equator intact.<br><br>5. <b>Polish</b> posterior capsule<br><br>6. <
b>Put a foldable intraocular lens (IOL) in the bag of the posterior capsule</b>.
The IOL consists of two parts: the optic and haptics. The optic is the actual p
lastic lens. The haptics are the side struts that anchor it to the zonule fibers
.<br><br>B. <b>Astigmatism</b>: difficulty seeing fine detail due to some compli
cated optics...<br><br>7. <b>Secondary opacification </b>due to proliferation of
remnant epithelial cells in the sulcus at the equator which migrate over the po
sterior capsule.&nbsp;&nbsp;<br>Treated with a single laser burn on the optic ax
is as an office procedure.<br> VisionII Mar
ed
"LM (H&amp;E stained, paraffin section) of human cornea<br /><br />1. Name the s
tructure under A. <br />What is its neural sensory innervation?<br /> <br />2. Name
ructure under B.&nbsp;&nbsp;<br />What is its function? <br />What type of collag
en exists here?<br /> <br />3. Name the structure under C. <br /> <br />4. Name the
t arrow D. <br /> <br />5. What is the normal collagen type secreted by the cell at a
rrow D? <br /> <br />6. What happens to this secretion after ocular trachoma infectio
n?<br />What is the only cure?<br /><br />7. 5. List the three sources of nutrient
s for the human cornea.<br /><br /><img src=""pasteDCvlcX.png"" />"
1. Strat
ified, squamous, non
eratinized epithelium w/ BM<br /> pain fibers from CN V one
<br /><br />2. Bowmans layer<br />Curvature of cornea; major determinant of refra
ction and astigmatism<br />Embryonic type I collagen<br /><br />3. Anterior stro
ma<br /><br />4. Keratocytes<br /><br />5. Type I collagen with precise fiber sp
acing running in two directions alternating in each lamella<br /><br />6.&nbsp;&
nbsp;Corneal scarring: regular type I collagen replaced by <b>type III collagen
secretion with random spacing</b>. <br>This is due to<b> inversion of the eye li
ds and lashes</b> due to the bacterial infection.<br>It results in a <b>totally
opaque cornea.</b><br />The only <b>cure</b> is a penetrating
eratoplasty (<b>P
K</b>)<br /><b>2nd</b> leading cause of world blindness<br /><br />7. Tear film,
<br />lateral diffusion from vessels at the limbus, <br />aqueous humor in the a
nterior chamber Mar
ed VisionIII
"LM of a human cornea<br><br>1. What is layer A?<br>What type of collagen does i
t contain?<br>What happens to it with aging?<br><br>2. What is layer B?<br>What
do the cells of this layer secrete?<br>How many cells are there during youth?<br
>What molecular mechanism do they use to maintain total clarity through the corn
ea?<br>What happens to these cells with aging?<br><img src=""pasteh4f8by.png"" /
>"
1. <b>Descemets layer </b><br>Type IV collagen BM <br>Nonpathologically g
ets thic
er<br /><br />2.<b> Endothelial cells</b><br>BM called Descemets layer
<br>One million<br>Complex pumps driven by ATP pump water out of the matrix betw
een the collagen fibers to
eep the spacing perfect for total clarity<br>Non-pat
hologic decrease in the number of endothelial cells; the remaining cells spread
over a greater surface area
Mar
ed VisionIII
Give and explain the 3 basic steps of a penetrating
eratoplasty (PK). 1. <b>Tr
ephination</b>: cut the cornea out in a circle.<br /><br />2. <b>Healon</b> <b>i
njection: </b>Healon is a sterile, nonpyrogenic, viscoelastic preparation of a h
ighly purified, noninflammatory, high molecular weight fraction of sodium hyalur
onate.<br /><br />3. <b>Sutures</b> (running versus interrupted): Interrupted su
tures are preferred in corneas that are:<br />a. vascularized<br />b. inflamed <
br />c. thinned<br />d. pediatric<br /> Mar
ed VisionIII
1. What are the two surgeries that are used to correct corneal curvatures?<br><b
r>2. What are the two vision problems that these surgeries resolve?<br><br>3. Wh
ich one of these surgeries has largely supplanted the other?
1. Radial
erato
tomy (RK) and laser-assisted in situ
eratomileusis (LASIK)<br><br>2. Myopia (ne
arsightedness) and astigmatism<br><br>3. LASIK has largely supplanted RK
Mar
ed VisionIII
Give the 6 complications of radial
eratotomy procedures.
1. <b>Vascular i
nvasion</b> along the incision lines,<br><br>2. <b>Epithelial downgrowth</b> int
o the anterior chamber, angle, and bloc
ing the trabecular meshwor
<br><br>3. <b

>Cyst</b> formation<br><br>4. <b>Refractive</b> changes with <b>humidity</b> cha

nges <br><br>5. Very <b>wea
ened</b> eye (no pilot license possible)<br><br>6. <
b>Ocular blowout</b> in car crashes<br> Mar
ed VisionIII
Give a one sentence description of the procedure of a radial
eratotomy. (4)
<b>Radial incisions</b> made that penetrate <b>deep</b> into the <b>stroma.</b><
br>These start at the <b>ora serrata</b> towards the <b>central cornea.</b><br>
Mar
ed VisionIII
LASIK:<br><br>1. What 3 layers comprise the
ey structure in this surgery?<br><b
r>2. Give the 3 step process of this surgery. 1. <b>Flap</b>: a. Corneal epith
elium<br>b. Bowmans layer<br>c. Anterior stroma<br><br>2. a. Flap <b>cut</b> ac
ross the anterior stroma.<br>b. <b>Laser contouring</b> of the new anterior surf
ace to change curvature and remove astigmatism.<br>c. Flap <b>returned</b> to ne
w contoured surface<br> Mar
ed VisionIII
In LASIK, what
eeps the flap attached once its returned to the contoured surfac
e?
A water flux driven by the ion pumping of the corneal endothelial cells.
Mar
ed VisionIII
Give 3 reasons why LASIK is superior to RK.
1. No deep stromal incisions,<br
>2. No possibility of epithelial downgrowth<br>3. Stroma strength left intact
Mar
ed VisionIII
Give the 4 parameters that determine the success or failure of LASIK surgery.
1. Pupil size must cover the flap margins otherwise complain of halos<br />2. No
tear film dysfunction<br />3. No connective tissue system diseases<br />4. A su
fficiently thic
stroma to support the new contoured stromal surface on which th
e flap lays<br />
Mar
ed VisionIII
"<span style=""font-weight:600; color:#0000ff;"">[...]</span> people in the Unit
ed States have glaucoma _____&nbsp;&nbsp;
now about it, _____ million have no id
ea."
"<span style=""font-weight:600; color:#0000ff;"">5</span> <span style=""
font-weight:600; color:#192aff;"">million</span> people in the United States hav
e glaucoma 2 million
now about it, 3 million have no idea." VisionIV Mar
ed
"1. Name the muscle at A.<br>What is its function?<br>What is its innervation?<br>
<br>2. Name the structure under the letter B.<br>List four of its functions.<br>
<br><img src=""pasteMlFhu_.png"" />"
1. <b>Radial muscle</b><br>Dilation (myd
riasis)<br>Sympathetic nervous system<br><br>2. <b>Ciliary process off of ciliary
body</b><br>-Contains capillaries that secrete aqueous humor, <br>-Increases su
rface area, <br>-Lined by two layers of epithelium that secrete aqueous humor, <
br>-binding site for zonule fibers from equator of lens for accommodation
VisionIV Mar
ed
"1. Name this entire structure. <br>2. If the patient had a neural crest suppresi
on of melanocytes, what would be the sources of melanin? <br>3. If the patient h
ad a mutation in tyrosinase, what would be the sources of melanin? <br><br>4. Nam
e the cells at A. <br>5. Name the space at B. <br>6. Name the muscle at C.<br>7.
Name the muscle at D. <br>8. The cells at arrow E are the anterior projection o
f what fundus structure?<br>9. The cells at arrow F are the anterior projection
of what fundus structure?<br>10. Name the space at G.<br><br><img src=""pasteJBt
G1Z.png"" />" "1. Iris<br>2. The anterior projection of the RPE <span style=""f
ont-weight:600; text-decoration: underline;"">or</span> the outer layer of epith
elial cells, and...<br>...the anterior projection of the neural retina <span sty
le=""font-weight:600; text-decoration: underline;"">or</span> the inner layer of
epithelial cells.<br>3. NONE<br><br>4. Endothelial cells of cornea<br>5. Anteri
or chamber<br>6. Radial (dilator) muscle<br>7. Circumferential (constrictor) mus
cle<br>8. Retinal pigment epithelium<br>9. Neural retina<br>10. Posterior chambe
r"
VisionIV Mar
ed
"<br /><img src=""paste
E8JNX.png"" /><br />How increased intraocular pressureimp
acts optic nerve in glaucoma: the connective tissue plates slide past each other
constricting the ganglion axons that pass through the columns stopping axonal tr
ansport and
illing the neurons irreversibly<br />Name the scotoma it produces. c
ircular peripheral<br />What three surgical interventions are utilized to reduce
intraocular pressure. cryoablation of the ciliary body and processes, laser tra
beculectomy, filtration tube from angle of the anterior chamber to venous spaces
under the conjunctiva.<br />"
VisionIV Mar
ed

"1. Where was the incision made and how large was it? <br />2. List 4 problems wi
th this protocol.<br /><br /><img src=""pastebpe6Ix.png"" />" 1. At least 260
degrees at the limbus<br /><br />2.&nbsp;&nbsp;1. There was creation of terrible
post-surgical astigmatism. <br />2. The patient had no lens so without their hea
vy bottle glasses, they saw nothing and tripped and fell. <br />3. There was a hu
ge void left in the eye where the vitreous would flow into the anterior chamber
and cause vitreous touch syndrome or death of corneal endothelial cells. <br />4.
There was an increased incidence of post-surgical retinal detachments VisionIV
Mar
ed
"Slit lamp photograph of anterior surface of a patients eye three years post-su
rgery.<br>1. What surgical procedure has this patient had? <br>2. If the patient
ma
es any four of these statements, you must refer them bac
to an ophthlamolog
ist ASAP because they are starting a delayed tissue rejection. What are thesefour
statements? <br><br><img src=""pastetE87cU.png"" />" 1. PK (penetrating
erat
oplasty)<br>2. 1. I have pain in my eye. <br>2. I see halos around lights. <br>3.
When I loo
in the mirror, my cornea is cloudy and not crystal clear. <br>4. I ha
ve a red eye. VisionIV Mar
ed
1. What is normal intraocular pressure?<br><br>2. What are the two players in sy
nthesizing aqueous humor?<br><br>3. Give the 5 step flow of aqueous humor throug
hout the eye. 1. &gt;20 mmHg<br><br>2. a. <b>Two layers of epithelial cells</b
> over the ciliary processes <br>b. <b>Blood flow</b> within the vessels of the
ciliary body <br><br>3. 1. Diffuses throughout the <b>posterior chamber </b>and
nourishes the lens and replaces fluid in the vitreous<br>2. Moves through the <b
>pupil</b><br>3. Meanders throughout the <b>anterior chamber</b> and nourishes t
he cornea and iris stroma<br>4. Moves across the resistance of the <b>trabecular
meshwor
in the angle</b><br>5. Exits in the <b>canal of Schlemm to venous flow
</b><br>
VisionIV Mar
ed
What is the molecular mechanism by which aqueous humor exits through the canal o
f Schlemm? (1) <b>Bul
flow through resistance channels </b>(no pinocytosis, ph
agocytosis, transcytosis, or exocytosis)
VisionIV Mar
ed
A. Give the 3 step mechanism of glaucoma pathogenesis.<br><br>B. What is the res
ult of untreated glaucoma? What is the regeneration potential? A. 1. With aging
, the <b>trabecular meshwor
gets clogged with the crap of life</b>. This causes i
ncreased <b>resistance to outflow,</b> so pressure builds within the eye (greate
r than 20mm Hg).<br><br>2. This intraocular pressure increase is transmitted to
the wea
est point in eye, the <b>lamina cribrosa</b>.<br><br>3. The lamina cribr
osas <b>connective tissue scaffolding sheets slide and strangle nerves</b> whic
h are leaving the neural retina to form CN II.&nbsp;&nbsp;<br><br>B. Peripheral
circular scotoma<br>The nerves have been painlessly
illed and can <b>never rege
nerate</b><br> VisionIV Mar
ed
Give the 5 possible glaucoma treatment options. (1) Modify autonomic nervous sys
tem to <b>slow down blood flow in the ciliary body so less aqueous humor produce
d.</b><br><br>(2) Modify autonomic nervous system to <b>induce parasympathetic m
iosis and parasympathetic accommodation to pull on uveal tract to open the trabe
cular meshwor
and allow as much drainage as possible.</b><br><br>(3) <b>Slow do
wn production of aqueous humor by the two layers of epithelial cells</b> over th
e ciliary processes (carbonic anhydrase inhibitors or cryo-freeze parts of the c
iliary body or modify the autonomic nervous system).<br><br>(4)&nbsp;&nbsp;<b>Cl
ean out </b>(vaporize)<b> the trabecular meshwor
</b> (laser trabeculectomy) to
increase the possibility of fluid drainage.<br><br>(5) Put in a <b>filtration tu
be </b>that carries aqueous humor from the anterior chamber directly into venous
spaces in the bulbar subconjunctival space.<br>
VisionIV Mar
ed
What are the three broad phases of T cell activation by an APC? 1) synapse forma
tion: interaction of T cells TCR&nbsp;&nbsp;APCs MHC, T cells CD28 with APCs
B7 (CD80/86), stabilization of interaction by CD4/CD8, stabilization of TCR wit
h CD3, clustering of ICAMs and LFA-1s (integrins) around signaling complex<br><b
r>2) acute triggering of TCR: CD4/8 uses Lc
to phosphorylate ITAMs on CD3, furt
her signal transduction<br><br>3) secretion and/or effector mechanism:
illing,
cyto
ine release, chemo
ine release, etc.<br><br>
Chapter6 Mar
ed
Name the three T cells involved in
illing and their
illing mechanisms.

"Th1 (CD4+): macrophage activation (part of the &quot;odd&quot; pathway of macro

phage activation and microbial
illing)<br><br>Th17 (CD4+): release of IL-17 and
triggering of inflammatory
illing mechanisms<br><br>CTL (CD8+):
illing of inf
ected cell<br><img src=""Screen Shot 2013-01-21 at 8.14.50 PM.png"" />" Chapter6
Mar
ed
"Review of Naive and Effector T cell migration<br><img src=""Screen Shot 2013-01
-21 at 8.18.38 PM.png"" />"
Chapter6 Mar
ed
Describe how&nbsp;&nbsp;naive* T cells enter lymph nodes.<br /><br />*already ma
tured in thymus, naive to antigen
1. Nave T cells enter via HEV using their
LFA-1(integrin)/ICAM(endothelial cell) and CD62L (selectins). Down-regulates sp
hingosine-1-phosphate receptor (to avoid chemotaxis bac
into blood). Go to T ce
ll zone using CCR7.<br><br>2.DC enter via afferents. Use CCR7 to locate T cell z
one. <br><br>3.Activated T cells differentiate (TH1/2 etc) after being presented
antigen.<br><br>4. Activated T cells downregulate CCR7 and CD62L, then upregula
te S1PR, VLA-4 (receptor for VCAM-1 produced by stressed endothelial cells), reenter blood <br>
Chapter6 Mar
ed
(T/F) Entry of T cells into tissues is antigen dependent.
F; T cells scour
all tissues and because theyre lymphocytes, only 2% of them spend time in the
blood; the rest stay in lymph or tissues.<br><br>This also explains the minor T
cell response to the TB s
in test.
Chapter6
How does the body fight an intracellular infections such as <i>Listeria monocyto
genes or Mycobacteria tuberculosis?</i> "Antibodies from B cells are useless bec
ause the antigen moves from cell to cell without leaving it (via the cells divi
sion).<br /><br />Thus, NK cells and T cells of all sorts respond. Predominantly
, CD4+ cells respond, either by activating macrophages (via IFN-y) or by trigger
ing inflammatory response methods. Innate methods from the NK cells assist. CD8+
CTLs
ill infected cells.<br><img src=""Screen Shot 2013-01-21 at 8.36.40 PM.pn
g"" />" Chapter6 Mar
ed
How do activated T cells and macrophages cooperate to
ill phagocytosed antigen?
"1) macrophages present bacterial peptide via MHC Class II to CD4+ T cell*<br />
2) CD4+ T cell detects foreign peptide<br />3) CD4+ releases IFN-y and uses CD40
L to activate macrophage (<span style=""color:#ff1a1b;"">TWO activation signals<
/span>)<br />4) macrophage
ills ingested bacterium<br />5) upregulates Class II
MHC and secretes cyto
ines and chemo
ines to recruit more T cells and trigger T
cell clonal expansion<br><br>*B7/CD28 is not critical here- the T cell is alrea
dy activated- it just needs to be acutely re-activated, for which it needs only Si
gnal One (antigen). <br /><img src=""Screen Shot 2013-01-21 at 8.41.46 PM.png""
/>"
Chapter6 Mar
ed
"Delayed Type Hypersensitivity s
in test (reference card)<br><img src=""Screen S
hot 2013-01-21 at 8.42.25 PM.png"" />"
Chapter6 Mar
ed
"CD8+ CTL
illing mechanism (reference card)<br><img src=""Screen Shot 2013-01-2
1 at 8.44.52 PM.png"" />"
Chapter6 Mar
ed
What is the role of FAS and FASL?
FAS is a death receptor in the TFN recepto
r family that is expressed on most hematopoietic lineage cells and some others i
ncluding high expression in the liver.&nbsp;&nbsp;CTL can still
ill FAS-express
ing targets even if they cant express perforin.&nbsp;&nbsp;<br><br>FASL is upregu
lated on activated CTLs and upon binding to FAS, triggers apoptosis.
Chapter6
Mar
ed
What is the role of perforin and granzyme in CTL
illing?
Perforins ma
e h
oles in the infected cells membrane, destroying membrane integrity and allowing
granzyme to lea
in.<br><br>Granzyme is a protease that cleaves caspases into t
heir active form to induce apoptosis. Chapter6 Mar
ed
"Pathogen death escape mechanisms (three slides below) (reference card)<br><img
src=""Screen Shot 2013-01-21 at 8.55.40 PM.png"" /><br><img src=""Screen Shot 20
13-01-21 at 8.55.48 PM.png"" /><br><img src=""Screen Shot 2013-01-21 at 8.55.56
PM.png"" />"
Chapter6 Mar
ed
How do granulomas form? "In addition to the steps below,<br>6) giant cells and e
pitheloid histiocytes form ring around indigestible material (which could become
caseous necrosis)<br>7) inflammatory cells form around giant cells and histiocy
tes<br>(<b>TWO SLIDES)</b><br><img src=""Screen Shot 2013-01-21 at 9.00.20 PM.pn

g"" /><br><img src=""Screen Shot 2013-01-21 at 8.59.59 PM.png"" />"

Chapter6
Mar
ed
What are some consequences of IFN-y deficiency (Geha case 21 in Ch. 6 slides)?
Inability to activate macrophages for
illing of ingested pathogens.<br><br>Inab
ility to form granulomas.
Chapter6 Mar
ed
When faced with a hapten-carrier complex, what does the B cell form antibodies a
gainst? Every possible combination to increase the li
elihood of secondary respo
nse:<br>1) hapten itself: small molecular modification, maybe as small as six ca
rbons or larger as an oligopeptide)<br>2) carrier protein itself: many different
peptides can be formed from from the carrier<br>3) carrier peptides modified by
hapten<br><br>The
ey point is that the APC (macrophage, DC, etc) will chop up
the hapten-carrier complex into many different peptides to maximize a future sec
ondary response. The peptides are randomly cleaved and presented from the digest
ed complex.
Chapter7 Mar
ed
What cells respond to the hapten-carrier complex?
T cells respond to the c
arrier peptide (which can be modified by the hapten if small enough)<br><br>B ce
lls form antibodies against whatever the T cell sees, and also against the hapte
n by itself (even if its non-peptide). Chapter7 Mar
ed
What is antigen cross-lin
ing? The antigenic microbe is large enough to engage
multiple receptors on a B cell and trigger clonal expansion and differentiation.
<br /><br />Thus, only signal 1 is necessary (the stranger signal) and no signal
2 (danger/costimulatory) is needed. In addition, the B cell engages the microbe
directly and does not need to be presented the antigen by an APC.
Chapter7
Mar
ed
Differentiate between B-2 (&quot;follicular&quot;), B-1 and MZ (marginal zone) B
cells. "Two slides below:<br /><img src=""Screen Shot 2013-01-21 at 9.36.02 PM.
png"" /><br><img src=""Screen Shot 2013-01-21 at 9.38.26 PM.png"" />" Chapter7
Mar
ed
Differentiate between T cell memory types: central memory and memory efffector.
Central memory: slow acting, not used for
illing, used to activate other T cell
s, higher capacity for self-renewal<br>Memory effector: loaded with perforin, ca
n
ill within minutes Chapter7 Mar
ed
"B cell signal transduction (reference card)<br>Compare with very simular T cell
signal transduction<br><img src=""Screen Shot 2013-01-21 at 9.57.10 PM.png"" />
"
Chapter7 Mar
ed
"Complement co-stimulation of B-cells if no T-cells present (reference card)<br>
<img src=""Screen Shot 2013-01-21 at 9.58.16 PM.png"" />"
Chapter7
Mar
ed
Describe some ways that B cells can be activated.
"<img src=""Screen Shot
2013-01-21 at 10.09.24 PM.png"" />"
Chapter7 Mar
ed
Describe the follicular dendritic cell and its role in B-cell mediated immunity.
"Non-hematopoietic origin. Does not express class II. Is NOT a professional APC&nb
sp;&nbsp;for T cells. Presents antigens to B cells on iccosomes. <br><br>FDCs ha
ve long dendrites with Fc receptors that are loaded with antibodies (made by nea
rby B cells) that present antigens to activate naive B cells. They can also reac
tivate memory B cells during repeat infection.<br><br>In essence, FDCs serve as
reservoirs of antigen for B cells and they maintain the structure of the lymph n
ode follicle.<br><img src=""Screen Shot 2013-01-21 at 10.09.49 PM.png"" />"
Chapter7 Mar
ed
How do B cells serve as early warning cells for secondary response?
Memory B
cells are also APCs. They can bind antigen by itself and then present it via Cl
ass II to CD4+ Th cells to trigger a secondary response via the T cells themselv
es or by activating the B cells. This can be done in the lymph or in the lymph n
ode. The T cell does not have to wait for a dendritic cell to detect the infecti
on and migrate to the lymph node.
Chapter7 Mar
ed
(T/F) class switching of antibodies changes both heavy chains and light chains
F; only the heavy chain is changed (via alternative splicing). The light chains
stay the same, providing the same antigen specificity, but now with different ef
fector functions.
Chapter7 Mar
ed
"Antibody classes (reference card)<br>See also Bloc
One immune histology slides

by Dr. Rowley<br><img src=""Screen Shot 2013-01-21 at 10.18.50 PM.png"" />"

Chapter7 Mar
ed
"Antibody class switching (reference card)<br>Two slides<br><img src=""Screen Sh
ot 2013-01-21 at 10.20.23 PM.png"" /><br><img src=""Screen Shot 2013-01-21 at 10
.24.20 PM.png"" /><br>"
Chapter7 Mar
ed
Describe the signaling mechanism that mediates Ig class switching.
"Note: A
ID &quot;damages&quot; DNA enough to trigger DNA repair via recombination and re
transcription.<br><img src=""Screen Shot 2013-01-21 at 10.25.30 PM.png"" />"
Chapter7 Mar
ed
Describe the process of antibody affinity maturation. "AID deaminates randomly
in second exon (antigen-recognition domain), but not enough damage to induce re
combination (and thus class switching).<br><br>Random mutations alter specificit
y, sometimes increasing specificity.<br><br>Only the highest affinity B cells wi
ll be able to proliferate with each round.<br><img src=""Screen Shot 2013-01-21
at 10.27.10 PM.png"" />"
Chapter7 Mar
ed
"Mechanisms of antibody diversity (reference card)<br><img src=""Screen Shot 201
3-01-21 at 10.42.28 PM.png"" />"
Chapter7 Mar
ed
Compare and contrast thymus-dependent and independent antigens. "Note: the thymu
s-independent antigens are polymeric non-proteins and therefore, can mediate cro
ss-lin
ing. This induces a B cell response without requiring T cell presentation
of the antigen (since its impossible if theyre not peptides).<br><b>Two slide
s:</b><br><img src=""Screen Shot 2013-01-21 at 10.45.28 PM.png"" /><br><img src=
""Screen Shot 2013-01-21 at 10.45.33 PM.png"" />"
Chapter7 Mar
ed
Describe IgG-mediated negative feedbac
.
"Note: this can be used as an au
toimmune therapy<br><img src=""Screen Shot 2013-01-21 at 10.46.09 PM.png"" />"
Chapter7 Mar
ed
"Interpret the following results of a patient with X-lin
ed hyper IgM syndrome,
where grey is the unactivated cells and blac
is the activated cells.<br><img sr
c=""Screen Shot 2013-01-21 at 10.47.20 PM.png"" />"
The patient has function
al CD-25, the IL-1 receptor, but a defective CD40L on their T cells, impairing a
ntibody class switching and B cell memory response. <br><br>B cells can still re
spond via their innate complement co-stimulatory mechanism.
Chapter7 Mar
ed
"<img src=""pastezWc9ET.png"" />"
"<img src=""pasteL55s7y.png"" />"
Ear Mar
ed
"1. Name e<br /><br />2. e represents the attachment site for what 2 muscles
?<br /><br />3. When does e develop?<br /><br><img src=""paste1vGJhg.png"" />"
1. <b>Mastoid process</b><br><br>2. <b>Sternocleidomastoid</b><br><b>Posterior b
elly of digastric</b><br><br>3. The mastoid process is <b>not present at birth a
nd develops later as the infant gains the ability to support the weight of the h
ead</b> by using SCM and the other nec
muscles.<br>
Ear Mar
ed
"1. What is this portion of the temporal bone?<br /><br />2. It articulates with
what 3 other bones to form the region of the pterion?<br /><br /><img src=""pas
teyfRXFW.png"" /><br /><br /><br />"
1. <b>Squamous</b> portion<br /><br />2.
<b>Greater wing of the sphenoid</b><br /><b>Frontal</b><br /><b>Parietal</b>
Ear Mar
ed
"<img src=""paste_SK23C.png"" />"
"<img src=""paste8qwQpJ.png"" />"
Ear Mar
ed
"The <span style=""font-weight:600; color:#0000ff;"">[...]</span> is a rather ho
rizontal tunnel through the petrous portion of the temporal bone."
"The <sp
an style=""font-weight:600; color:#0000ff;"">carotid canal</span> is a rather ho
rizontal tunnel through the petrous portion of the temporal bone."
Ear Mar

ed
"1. Name A, B, 1, and 2.<br /><br />2. What is the red arrow pointing to?<br />W
hich nerve is located here?<br><br>3. Name the yellow and blue portions of the t
emporal bone.<br /><img src=""paste6IDpy3.png"" />"
1. A. Foramen lacerum<br
/>B. Jugular foramen<br />1. Groove for sigmoid sinus<br />2. Groove for petros
al sinus<br /><br />2. Hiatus of facial canal <br />location of greater petrosal
nerve<br><br>3. Yellow: Petrous<br>Blue: Squamous<br />
Ear Mar
ed
"The <span style=""font-weight:600; color:#0000ff;"">[...]</span> normally rests
within the middle cranial fossa. <br>" "The <span style=""font-weight:600; colo

r:#0000ff;"">temporal lobe of the brain</span> normally rests within the middle

cranial fossa. <br>"
Ear Mar
ed
Give these boundaries of the middle cranial fossa:<br>Anterior<br>Lateral<br>Flo
or
"Anterior: <b>greater and lesser wings of the sphenoid</b> (posterior su
rface of the orbit)<br><br>Lateral: <b>squamous portion of the temporal bone </b
>(blue, with grooves for branches of the middle meningeal artery)<br><br>Floor:
<b>petrous portion of the temporal bone</b> (yellow)<br>Contains the organs for
hearing and balance (cochlea and semicircular canals indicated by blac
lines)<br
><br><img src=""pastej2Q3HM.png"" /><br>"
Ear Mar
ed
"1. Name B.<br><br>2. B receives venous drainage from what 2 sources?<br><br>3.
Which cranial nerve(s) run through B?<br><img src=""paste
DJfBb.png"" />"
1. Jugular foramen<br><br>2. Sigmoid sinus<br>Inferior petrosal sinus<br><br>3.
CN IX, X, and XI
Ear Mar
ed
Trace the path of the greater petrosal nerve up to the pterygoid canal in 4 step
s.<br><br><br> "1. Arises from the facial nerve within the depths of the petrou
s portion of the temporal bone.<br><br>2. Leaves the protection of the petrous p
ortion of the temporal bone and reenters the middle cranial fossa at the hiatus
of the facial canal (red arrow). <br><br>3. Slides along a groove on the surface
of the petrous portion of the temporal bone and heads toward foramen lacerum. <
br><br>4. Goes horizontally across the top half of foramen lacerum (as opposed to
traversing it vertically) to head toward the pterygoid canal. <br><br><img src="
"pasteMlTNhi.png"" />" Ear Mar
ed
"Identify.<br><br><img src=""pasteLb
wNX.png"" />"
"<img src=""paste64
YRP.
png"" /><br><img src=""pasterahGnG.png"" />"
Ear Mar
ed
"Refer to the numbers on the pic.<br /><br />1-3. What part of the brain is norm
ally found here?<br /><br />4. a. What attaches along this structure? <br>b. Wha
t other structure is located here?<br /><img src=""pasteeimTei.png"" />"
1. Frontal lobe<br />2. Temporal lobe<br />3. Cerebellum<br />4. a. Tentorium ce
rebelli<br>b. Superior petrosal sinus Ear Mar
ed
"Identify.<br><img src=""pasteyJSLVT.png"" />" 1. Anterior cranial fossa<br>2.
Middle cranial fossa<br>3. Posterior cranial fossa<br>4. Petrosal ridge Ear Mar

ed
"This is a superior view of the ear.<br><br>Identify all, then answer referring
to the image:<br><br>1. What are its 2 portions?<br>Its filled with ____<br>It
s lined by _____<br>Its glands produce what?<br><br>2. What does it contain? <b
r>Filled with ____<br>Lined by ____<br>Continuous with what 3 structures?<br><br
>3. Contains organs organs of _____ and ______<br>Filled with ______<br><br><img
src=""pasteUtQmfW.png"" />"
"<img src=""pastehU0l4G.png"" />"
Ear Mar

ed
"The <span style=""font-weight:600; color:#0000ff;"">[...]</span> separates the
external ear from the middle ear<br>" "The <span style=""font-weight:600; colo
r:#0000ff;"">ear drum</span> separates the external ear from the middle ear<br>"
Ear Mar
ed
"The <span style=""font-weight:600; color:#0000ff;"">[...]</span> ear cavity is
connected to the bac
of the throat (nasopharynx) via the ____________.<br>"
"The <span style=""font-weight:600; color:#0000ff;"">middle</span> ear cavity is
connected to the bac
of the throat (nasopharynx) via the pharyngotympanic (Eus
tachian) tube.<br>"
Ear Mar
ed
" The internal ear is within the <span style=""font-weight:600; color:#0000ff;""
>[...]</span> portion of the temporal bone.<br>"
" The internal ear is wi
thin the <span style=""font-weight:600; color:#0000ff;"">petrous</span> portion
of the temporal bone.<br>"
Ear Mar
ed
"Which cranial nerve is this?<br /><br />Refer to the #s in the pic:<br /><br />
1. Where does it exit the cranial cavity?<br /><br />2 and 3. Which portion of t
he nerve is this?<br />Which direction does it travel?<br />Which organ does it
receive info from?<br /><br />4. T or F: it exits the s
ull.<br /><img src=""pas
tesGaAfC.png"" />"
"<img src=""pastedCRCbD.png"" />"
Ear Mar
ed
"Sensory innervation to the inner ear is from the vestibular and cochlear portio
ns of VIII. <br><br>Each of these will have an associated <span style=""font-wei
ght:600; color:#0000ff;"">[...]</span>.<br><br>Hint: the red arrow depicts one o

f these structures:<br><br><img src=""pasteN8Wwlu.png"" /><br>" "Sensory innerva

tion to the inner ear is from the vestibular and cochlear portions of VIII. <br>
<br>Each of these will have an associated <span style=""font-weight:600; color:#
0000ff;"">sensory ganglion</span>.<br><br>Hint: the red arrow depicts one of the
se structures:<br><br><img src=""pasted7QLhM.png"" /><br>"
Ear Mar
ed
"Give the portion of the path of the facial nerve associated with each letter.<b
r><br><img src=""pastejJeHwH.png"" />" "<img src=""pasteUNVby_.png"" />"
Ear Mar
ed
"Identify.<br><br><img src=""paste6b7t6o.png"" />"
"<img src=""pasteaSEeWj.
png"" />"
Ear Mar
ed
"Identify all. Then refer to the figure:<br><br>4. This structure leads to what?
<br><br>a. Where does this structure lie?<br><br>c. What crosses this structure?
<br><br>e-g. To what does this structure attach?<br><img src=""pastetbF5Sr.png""
/>"
"<img src=""paste46HK4F.png"" />"
Ear Mar
ed
"Identify #1.<br><br><img src=""pastesOwZJY.png"" />" Incus Ear Mar
ed
"Identify L and M, then answer:<br><br>1. Where does L attach?<br><br>2. From wh
ere does M arise?<br><br><img src=""pasteRfisWx.png"" />"
L. <b>Base of st
apes </b>(attaches at oval window)<br>M. <b>Tendon of stapedius muscle</b> (aris
ing from posterior wall of middle ear cavity)<br>
Ear Mar
ed
"Identify all. Then, answer referring to the figure:<br><br>2. Opens into what?<
br><br>3. Travels toward what?<br><br>4. Attaches to what?<br><br>7. Attaches to
what? <br><img src=""pasteSWCl3w.png"" />"
"<img src=""paste2b_R36.png"" />
"
Ear Mar
ed
The middle ear cavity is continuous with ________ posteriorly and _____ anterior
ly.<br> Mastoid air cells posteriorly<br>Nasopharynx (through the pharyngotympan
ic tube) anteriorly
Ear Mar
ed
"<span style=""font-weight:600; color:#0000ff;"">[...]</span>is the last branch
of the facial nerve before it exits the s
ull through the stylomastoid foramen.<
br>"
"<span style=""font-weight:600; color:#0000ff;"">Chorda tympani </span>i
s the last branch of the facial nerve before it exits the s
ull through the styl
omastoid foramen.<br>" Ear Mar
ed
What
ind of nerve fibers wrap around the outside of internal carotid artery?<br
>
Sympathetic fibers of the carotid plexus
Ear Mar
ed
A. Which two structures lie in the posterior wall near the facial nerve?<br><br>
B. Give a clinical correlation associated with one.
A. 1. Stapedius muscle<b
r>2. Mastoid air cells <br><br>B. Mastoiditis may endanger the facial nerve
Ear Mar
ed
What innervates the stapedius muscle? The facial nerve
Ear Mar
ed
"Identify all, then answer referring to the figure:<br><br>1. Covered by what?<b
r><br>2, 6, 7. What type of fibers does this contain? Associated with which cran
ial nerve?<br><img src=""pasteSeqwxe.png"" />" "<img src=""pasteGgrGLh.png"" />
"
Ear Mar
ed
"On the surface of the promontory can be found the tympanic plexus of IX that su
pplies <span style=""font-weight:600; color:#0000ff;"">[...]</span> fibers to th
e mucosa of the middle ear cavity. <br>"
"On the surface of the promontor
y can be found the tympanic plexus of IX that supplies <span style=""font-weight
:600; color:#0000ff;"">general sensory (pain)</span> fibers to the mucosa of the
middle ear cavity. <br>"
Ear Mar
ed
"An ear ache arising from a middle ear infection (otitis media) is carried by cr
anial nerve<span style=""font-weight:600; color:#0000ff;"">[...]</span><br>"
"An ear ache arising from a middle ear infection (otitis media) is carried by cr
anial nerve<span style=""font-weight:600; color:#0000ff;""> IX. </span><br>"
Ear Mar
ed
"As the fibers of IX progress through the middle ear cavity (from inferior to su
perior) they will continue into the petrous portion of the temporal bone as the
<span style=""font-weight:600; color:#0000ff;"">[...]</span>. <br>"
"As the
fibers of IX progress through the middle ear cavity (from inferior to superior)
they will continue into the petrous portion of the temporal bone as the <span st
yle=""font-weight:600; color:#0000ff;"">lesser petrosal nerve</span>. <br>"
Ear Mar
ed

"Identify 4-6.<br><img src=""pastevcepJV.png"" />"

"<img src=""pasteVVqObu.
png"" />"
Ear Mar
ed
"This is a view of the lateral wall of the middle ear cavity (tympanic membrane)
as if you were a very tiny person standing inside the middle ear cavity loo
ing
outward. <br><br>Identify.<br><br><img src=""pasteBybLXy.png"" />"
"<img sr
c=""paste_epBhV.png"" />"
Ear Mar
ed
What two structures are found in the epitympanic recess?<br>
The head of the
malleus and the body of the incus
Ear Mar
ed
"1. Identify the lime green oval.<br><br>2. _____ is continuous with ______ thro
ugh it.<br><br><img src=""pasteChPeHI.png"" />" 1. The aditus<br><br>2. The mast
oid air cells are continuous with the epitympanic recess through it.<br>
Ear Mar
ed
1. What 3 directional descriptors describe the orientation of the concavity of t
he tympanic membrane?<br><br>2. However, it is necessary to pull the pinna (auri
cle) of the ear in what two directions to see the tympanic membrane? Why?
"1. Anteriorly, laterally and inferiorly (towards the ground in front and to the
sides of you)<br><br>2. Superiorly and posteriorly<br>Because of the bends betw
een the cartilaginous and osseous portions of the external auditory canal<br><br
><img src=""pasteZffmBH.png"" />"
Ear Mar
ed
"Identify all, then answer referring to the figure:<br><br>a. Where is this loca
ted? (2)<br><br>c. Superior to what?<br><br>d. Located in which quadrant?<br><br
>III. What can be seen here?<br><br>IV. What can be seen here?<br><img src=""pas
teuYyfnl.png"" />"
"<img src=""pasteuXUr9O.png"" />"
Ear Mar
ed
The external acoustic meatus is straightened in infants by pulling the auricle i
n what 2 directions?
Inferoposteriorly (down and bac
)
Ear Mar
ed
"Normal tympanic membrane:<br><br>Identify.<br><br><img src=""pastemyfQ4Z.png""
/>"
1. Cone of light<br>2. Handle of malleus<br>3. Umbo<br>4. Long limb of i
ncus<br>5. Posterior limb of stapes
Ear Mar
ed
What is a myringotomy? A surgical procedure in which an incision into the tympa
nic membrane is made posteroinferiorly to release pus from a middle ear abscess.
Ear Mar
ed
What are 4 causes of tympanic membrane perforation?
1. Otitis media<br>2. Fo
reign bodies in the external acoustic meatus<br>3. Trauma<br>4. Excessive pressu
re (e.g. scuba diving) Ear Mar
ed
Special sensory innervation to the inner ear is from which portion(s) of CN VIII
?
Vestibular and cochlear<br />Each has an associated sensory ganglion
Ear Mar
ed
"<img src=""pasteZCavLH.png"" />"
"<img src=""pastebZUErW.png"" />"
Ear Mar
ed
What is the function of the nerves of the tympanic plexus of IX?<br>
General
sensory innervation of the mucous membrane of the middle ear cavity
Ear Mar

ed
"Identify 1 and 2.<br><br><img src=""pastewoQ_VB.png"" />"
"<img src=""past
eWJ37FS.png"" /><br><img src=""pasteGPrCUn.png"" />"
Ear Mar
ed
"Identify.<br><br><img src=""pastei_AmEe.png"" />"
"<img src=""pastenNedN8.
png"" />"
Ear Mar
ed
1. Why do children commonly develop otitis media (middle ear infections)?<br><br
>2. If these go unchec
ed, what condition can they progress to?<br><br>3. Give 3
examples of locations where this can invade?<br><br> 1. Because the middle ea
r and the mastoid air cells are air filled spaces that are continuous with the p
osterior aspect of the nasopharynx. Bacteria from there get all up in it.<br><br
>2. <b>Mastoiditis</b>: severe infection that&nbsp;&nbsp;involve the mastoid air
cells.<br><br>3. <b>Facial nerve</b><br><b>Dura</b><br><b>Cranial cavity</b> th
rough the tegmen tympani
Ear Mar
ed
"<img src=""pasteYmYU
f.png"" />"
"<img src=""pastej4lD
3.png"" />"
OrbitandEye Mar
ed
"<img src=""pastesbxfmg.png"" /><br>Basically, I need you to tell me what sensor
y nerves supply the peach, tan, and pin
regions.&nbsp;&nbsp;<br>Additionally, o
ut of these nerves, which also provides motor innervation to 8 muscles?"
Peach is V1, the ophthalmic division of the trigeminal nerve<br>Tan is V2, the m

axillary division of the trigeminal nerve. <br>Pin

is V3, the mandibular divisi
on of the trigeminal nerve<br><br>V3 is the nerve that also supplies 8 muscles.&
nbsp;&nbsp;
Mar
ed Face
"<img src=""paste_63q8i.png"" /><br>Go wild.&nbsp;&nbsp;Remeber to classify each
of the numbered nerves as a branch of V1, V2, V3, or C2/C3. " "<img src=""past
e1g_o9v.png"" />"
Mar
ed Face
There are two buccal nerves.&nbsp;&nbsp;Oh no!&nbsp;&nbsp;What are their origins
and functions? There is a buccal of V3, which supplies sensory to the inside an
d outside of the chee
. <br>There is a buccal of CNVII, which supplies motor to
the buccinator muscle. Mar
ed Face
"<img src=""pastewct7sh.png"" /><br>Isnt labeling facial nerve regions fun?&nbs
p;&nbsp;Good thing there is a lateral view to label as well!&nbsp;&nbsp;Remember
to label their origins.&nbsp;&nbsp;Origin pinnings with &quot;what innervates t
his area&quot; questions are fair game on the practical -- if you dont
now, at
least say V1, V2, V3, etc. <br>"
"<img src=""pastempt_np.png"" />"
Mar
ed Face
What are the muscles of the ears?
Tric
question!&nbsp;&nbsp;We dont give
a shit!
Mar
ed Face
Factoid: Besides the muscles of the face, what other muscle attaches to s
in?
Dartos Muscle.&nbsp;&nbsp;
Mar
ed Face
"<img src=""pastedesd6x.png"" /><br>Label the muscles.&nbsp;&nbsp;Asterics are l
ess important." "<img src=""pasteldf5zq.png"" />"
Mar
ed Face
What is the most important muscle of facial expression?&nbsp;&nbsp;(according to
glenn) Orbicularis Oculi.&nbsp;&nbsp;Protects the corneal, wipes the lacrimal s
ecretions across the eye.&nbsp;&nbsp; Mar
ed Face
What are two nerves relating to the platysma? 1.)&nbsp;&nbsp;Transverse Cervic
al<br>2.)&nbsp;&nbsp;Cervical Portion of Facial nerve (provides innervation)<br>
<br>Relevance:&nbsp;&nbsp;dont cut these nerves during operations,
? Mar
ed F
ace
Newborns lac
a mastoid process.&nbsp;&nbsp;What is the clinical correlation?
Without the mastoid process, forceps use during delivery may damage the facial n
erve as it exits the stylomastoid foramen.&nbsp;&nbsp;This happened to sylvester
stallone, the italian stalian.
Mar
ed Face
So, imagine a close relative calls you and tells you that another close relative
now has Bells palsy.&nbsp;&nbsp;Whats up with that? (causes, effects)
Two major causes -- idiopathic inflammation and compression of VII, both leading
to loss of function.&nbsp;&nbsp;Examples include extreme cold causing idiopathi
c inflammation, or an acoustic neuroma in the internal auditory meatus causing c
ompression.<br><br>Bells Palsy patients have a range of symptoms, depending on
which segment of VII is affected.&nbsp;&nbsp;<br>- facial paralysis (cant close
eyelids, drools, food gets stuc
in chee
)<br>- loss of taste from the anterior
2/3 of the tongue<br>- loss of parasympathetic function to salivary glands<br>hyperacusis (loss of stapedius muscle)<br>- loss of parasympathetic function to
the lacrimal gland
Mar
ed Face
"<img src=""pastelh7_fw.png"" />Loo
, its a s
ull with numbers.&nbsp;&nbsp;What
do you want from me?" "<img src=""paste4pxjrt.png"" /><br>Not shown means not
shown on this picture.&nbsp;&nbsp;Best find another picture if you care to see 
em.&nbsp;&nbsp;"
Mar
ed Face
"<img src=""pastees9yis.png"" />"
1. Facial<br />2. Ophthalmic <br />3. Ca
vernous sinus<br />4. Pterygoid plexus <br /><br />emissary veins from the ptery
goid plexus enter foramen in the base of the s
ull, including a few holes we did
nt learn (because all they have is a boring vein)<br />emissary veins are valve
less (?)<br /><br />emissary veins are all paths in and out of the s
ull, includ
ing ophthalmic veins.<br />
Mar
ed Face
"<img src=""pasten7141o.png"" /><br>Do your thing. "
1. Facial<br>2. Ophthalm
ic <br>3. Cavernous sinus<br>4. Pterygoid plexus <br>5. Retromandibular vein<br>
6. Superficial temporal<br>7. Maxillary (deep to mandible)<br>8. Common facial v
ein<br>9. Internal jugular vein<br>
Mar
ed Face
"<img src=""pasteuitlx0.png"" /><br>Yes, there are three slightly varying pictur
es of veins for labeling.&nbsp;&nbsp;" 1.&nbsp;&nbsp;Retromandibular vein<br>&n

bsp;&nbsp;a. Anterior division<br>&nbsp;&nbsp;b. Posterior division<br>2.&nbsp;&

nbsp;Facial vein<br>3.&nbsp;&nbsp;Common facial vein<br>4.&nbsp;&nbsp;External j
ugular vein<br>5.&nbsp;&nbsp;Anterior jugular vein<br>6.&nbsp;&nbsp;Communicatin
g branch
Mar
ed Face
1. Give the 6 ways antibodies
ill pathogens.<br><br>2. Which of these doesnt r
equire any effector functions? "1. <br><img src=""pasteYa1lAf.png"" /><br><br>2
. Neutralization doesnt require any effector functions."
EffectorMechsHum
oral Mar
ed
"Abs help fix complement via the <span style=""font-weight:600; color:#0000ff;""
>[...]</span> pathway.<br>"
"Abs help fix complement via the <span style=""f
ont-weight:600; color:#0000ff;"">classical</span> pathway.<br>" EffectorMechsHum
oral Mar
ed
Opsonization:<br /><br />1. What two stimuli greatly increase its efficiency? Gi
ve the mechanism of each.<br /><br />2. Give an example in which it is actually
quite maladaptive.
"1. <b>Fc receptors:</b><br><span style="" font-weight:6
00;""></span><br><img src=""pasteKq01pj.png"" /><br><br><b>Complement:</b><br />
<br><img src=""pastecrmnii.png"" /><br><br />2. Antibodies against <b>HIV</b> dr
ag it right into the <b>dendritic cells</b> and <b>macrophages</b> it wants to i
nfect :(<br />" EffectorMechsHumoral Mar
ed
T or F: FcRn mediates the upta
e of IgG into endothelial cells. This accounts fo
r its long half-life. "<b>False</b>. FcRn doesnt upta
e IgG. <br>It meets up
with it in the <b>acidic</b> endosome where it stabilizes and sequesters it. <br
>When the endosome is recycled to the membrane, it is exposed to neutral pH. Thi
s causes the IgG to dissociate from FcRn.<br><br><img src=""pasteNG0GGC.png"" />
"
EffectorMechsHumoral Mar
ed
Bare lymphocyte syndrome (BLS):<br><br>1. What are the two possible defects that
cause it?<br><br>2. Whats the difference between them?
1. 1) <b>Defect
in TAP</b>: <br>-Inability to transport cytoplasmic peptides into the ER for loa
ding onto MHC class I<br><br>2) <b>Defect in Beta2 microglobulin</b>: <br>-Inabi
lity to bind antigen on class I MHC<br>-<b>FcRn</b> has a Beta2 microglobulin su
bunit because it is closely related to MHC class I molecules. So, these patients
cant transport and store IgG effectively.
EffectorMechsHumoral Mar
ed
Give 3 differences between the poly-Ig transporter and FcRn.
"<img src=""past
eil_
BB.png"" /><br><br><img src=""paste
DO299.png"" />"
EffectorMechsHum
oral Mar
ed
Give the 4 ways that antibodies neutralize.
"<img src=""pastePLLwwD.png"" />
"
EffectorMechsHumoral Mar
ed
"<img src=""paste8CDhKL.png"" />"
"<img src=""pasteHl7usO.png"" />"
EffectorMechsHumoral Mar
ed
A single mast cell displays IgE antibodies against one or many different antigen
(s)?
Each mast cell displays IgE antibodies against<b> many </b>different ant
igens. EffectorMechsHumoral Mar
ed
ADCC:<br><br>1. What does this abbreviation stand for?<br><br>2. Which type(s) o
f antibody is/are involved?<br><br>3. Which receptor is involved?<br><br>4. What
cell type(s) do(es) the
illing?
"1. Antibody-dependent cellular cytotoxi
city<br><br>2. IgG1 and IgG3<br><br>3. Fc(gamma)RIIIA a.
.a. <b>CD16</b><br><spa
n style="" font-weight:600;""></span><br>4. NK cells and macrophages<br><br><img
src=""paste2oBHix.png"" /><br><br>"
EffectorMechsHumoral Mar
ed
"<img src=""paste1didze.png"" />"
"<img src=""paste8JHbgc.png"" />"
EffectorMechsHumoral Mar
ed
"Summary of B cell effector mechanisms (reference card)<br><img src=""Screen Sho
t 2013-01-22 at 10.58.28 PM.png"" />"
8 Chapter8 Mar
ed
Review of old/easy stuff: describe the main features of plasma cells. "For pat
hology/histology: eccentric nucleus, larger and more eosinophilic cytoplasm<br><
br>For immunology: terminally differentiated B cells, <span style=""color:#ff1a1
b;"">ARE NOT memory cells </span><span style=""color:#000000;"">although they do
have a long life-span, depend upon CD40L from Th cells for activation.</span>"
8 Chapter8 Mar
ed
"<img src=""pasteiYJcZr.png"" />"
"Properdin and factors B and D are all r
equired for efficient production of the C3 convertase.<br><br><img src=""pasteHF

XxY6.png"" />" EffectorMechsHumoral Mar

ed
"C4b,C3b bind covalently to antigens and membranes via <span style=""font-weight
:600; color:#0000ff;"">[...]</span> bonds. <br>"
"C4b,C3b bind covalently
to antigens and membranes via <span style=""font-weight:600; color:#0000ff;"">t
hioester</span> bonds. <br>"
EffectorMechsHumoral Mar
ed
"Once activated, the thioester of C4b and C3b is short-lived. It is inactivated
by <span style=""font-weight:600; color:#0000ff;"">[...]</span> (2)<br>"
"Once activated, the thioester of C4b and C3b is short-lived. It is inactivated
by <span style=""font-weight:600; color:#0000ff;"">water and amines</span> (2)<b
r>"
EffectorMechsHumoral Mar
ed
Describe somes roles of FcRn in IgG-mediated immunity. "FcRn explains so much a
bout IgG: transport across placenta; into mil
and gut; from gut to blood of neo
nate; storage in body and consequent 3 wee
half-life. <br><img src=""Screen Sho
t 2013-01-22 at 11.04.20 PM.png"" />" 8 Chapter8 Mar
ed
Give the 4 functions of complement.
"<img src=""pasteJ75ggz.png"" /><br><br>
D. <b>B cell stimulation via CD21</b> (a.
.a. CR2)"
EffectorMechsHumoral Mar

ed
Patients who lac
a functioning MAC attac
are frequently infected with what pat
hogen? <i>Neisseria meningiditis</i> EffectorMechsHumoral Mar
ed
Describe the transcytosis of IgA as it becomes sIgA.<br>Focus on the following:
the directionality of the transporter, modifications to the IgA, half-life and a
bundance of sIgA.
"-<span style=""color:#ff1a1b;"">unidirectional</span> t
ransporter<br>-receptor attaches a <span style=""color:#ff1a1b;"">polymeric secr
etory component </span>to IgA to ma
e it sIgA, <span style=""color:#ff1a1b;"">st
abilizing it against proteolysis</span> in the gut<br>-IgA has <span style=""col
or:#ff1a1b;"">high stability</span> in the gut, even in acid pH, and is <span st
yle=""color:#ff1a1b;"">constitutively secreted, ma
ing it the most produced Ig</
span><br><img src=""Screen Shot 2013-01-22 at 11.11.09 PM.png"" />"
8 Chapte
r8 Mar
ed
Give 3 examples of complement inhibitors on human cells.<br><br>Give the mechani
sm of each.
"<img src=""pasteNJTzlL.png"" /><br><br><img src=""pastextjgf
.p
ng"" />"
EffectorMechsHumoral Mar
ed
"Methods of antibody neutralization (reference card)<br><span style=""color:#ff1
a1b;"">Note that ALL ANTIBODIES can do this</span><br><img src=""Screen Shot 201
3-01-22 at 11.14.20 PM.png"" />"
8 Chapter8 Mar
ed
How do antibodies inactivate pathogens upon binding to them?
Binding induces
a conformational change of the pathogen membrane or protein coat (if virion) and
disrupts internal signaling and/or membrane integrity.<br>
8 Chapter8 Mar
e
d
"Describe how antibodies neutralize pathogens by <span style=""font-weight:600;
color:#ff1a1b;"">bloc
ing</span><b>.</b>"
"<img src=""Screen Shot 2013-0122 at 11.14.20 PM.png"" />"
8 Chapter8 Mar
ed
"How do antibodies neutralize pathogens by <span style=""font-weight:600; color:
#ff1a1b;"">clearance?</span>" Ab:antigen complexes can be removed by the
idne
ys<br> 8 Chapter8 Mar
ed
"What is the antibody phenomenon of <span style=""font-weight:600; color:#ff1a1b
;"">facilitated upta
e?</span> What virus uses this mechanism?" Facilitated upta

e: Fc portion of antibody facilitates upta

e into target cells, enhancing infec
tion.<br><br>HIV uses this to infiltrate its target cells.<br> 8 Chapter8 Mar
e
d
"Antibody opsonization and Fc receptors (reference card)<br>Important ideas new
for this class bloc
ed in red.&nbsp;&nbsp;Remember that complement also opsonize
s (via iC3b and iC4b binding CR3/MAC-1 (CD11b/CD18) and CR4 (CD11c/CD18)&nbsp;&n
bsp;on phagocytes.<br>All CDs are multiples of 16.<br><img src=""Screen Shot 201
3-01-22 at 11.19.55 PM.png"" />"
8 Chapter8 Mar
ed
Describe ADCC: antigen-dependent cellular cytotoxicity.<br>-what cells are invol
ved?<br>-what is the antibody?<br>-what Fc receptor is involved?
"<img sr
c=""Screen Shot 2013-01-23 at 12.01.39 AM.png"" />"
8 Chapter8 Mar
ed
How does IgE mediate
illing of worms?<br>Specifically,<br>-what cells are invol
ved?<br>-what cyto
ines are secreted?<br>-what receptors?<br>-what
illing mecha

nism? "-Th2 (non-cytolytic) cells secrete IL-5 to stimulate eosinophils<br>-eo

sinophils have their Fc-epsilon-RI receptors loaded with IgE<br>-IgE binds to wo
rms, triggering granule release<br>-granules cause inflammation and
illing (and
collateral damage)<br><img src=""Screen Shot 2013-01-23 at 12.23.53 AM.png"" />
"
8 Chapter8 Mar
ed
"Complement pathway initiation (reference card)<br><img src=""Screen Shot 2013-0
1-23 at 12.24.27 AM.png"" />"
8 Chapter8 Mar
ed
What is the role of Factor I in the complement pathway? Factor I (inhibitory, no
t &quot;one&quot;) binds to C3b, generating iC3b which cannot further mediate th
e complement pathway. 8 Chapter8 Mar
ed
Describe the chemical bonding of C3b and C4b to their target membranes. Covalent
bonding via thioesters. These thioesters form on amines and hydroxyl groups, al
lowing fixation to virtually any membrane. Theyre short-lived, easily deactivat
ed by water, and thus limit C3b effects to nearby membranes.
8 Chapter8 Mar
e
d
"Complement activation proteins (reference card)<br><img src=""Screen Shot 201301-23 at 12.28.16 AM.png"" />"
8 Chapter8 Mar
ed
Once C3 convertase is formed by C4bC2b, what proteins are required to activate i
t?
"Factor B, Factor D, and Properdin<br><img src=""Screen Shot 2013-01-23
at 12.29.42 AM.png"" />"
8 Chapter8 Mar
ed
Describe the proteins involved and the steps of the MAC attac
(Membrane Attac

Complex...Attac
)
"<br /><img src=""Screen Shot 2013-01-23 at 12.30.12 AM.
png"" />"
8 Chapter8 Mar
ed
Aside from the MAC atttac
, how else does the complement pathway
ill microbes?
"<img src=""Screen Shot 2013-01-23 at 12.33.58 AM.png"" />"
8 Chapter8 Mar
e
d
"Complement receptors:
now everything (unfortunately) (reference slide)<br><img
src=""Screen Shot 2013-01-23 at 12.35.11 AM.png"" />"
8 Chapter8 Mar
e
d
"Complement inhibition proteins (reference card)<br /><span style=""font-weight:
600; color:#ff1a1b;"">DAF is important because all of our cells have it and are
constantly deactivating complement to prevent autoimmune death.</span><br><b>Two
slides below</b><br /><img src=""Screen Shot 2013-01-23 at 12.38.10 AM.png"" />
<br><img src=""Screen Shot 2013-01-23 at 12.40.43 AM.png"" />"
8 Chapte
r8 Mar
ed
What is evolutionary benefit to having an incredibly complex complement cascade?
Microbes evolve ways to counter it but due to the complement systems complexity
, microbial resistance is slowed down. 8 Chapter8 Mar
ed
What type of neural map is present in the brain with respect to sound? <br><br
>How does this differ from the neural map of the visual world?
Auditory
: <b>tonotopic (sound pitch) map</b> of Hz.&nbsp;&nbsp;<br>Vision: <b>retinotopi
c</b> <b>(spatial) map</b> of the visual world at every place along the visual s
ystem Mar
ed MiddleEarHisto
1. What is the process of impedance matching?<br><br>2. This accounts for hearin
g caused by what?
1. 1. Vibrations on the large surface area of the tympan
ic membrane are transferred to movements of the ossicles.<br>2. The stapes creat
es with reduced piston movements high energy vibrations into the fluids of the inn
er ear at the small surface area of the oval window.<br>3. Vibrations in these i
nner ear fluids cause depolarization of the hair cells which lead to the perceptio
n of hearing.<br /><br />2. Hearing caused by <b>AIR CONDUCTION.</b>
Mar
ed M
iddleEarHisto
What is the function DAF, decay-accelerating factor?
-membrane protein in all
cells<br>-inhibits all complement pathways but shutting down the C3 convertases
8 Chapter8 Mar
ed
(T/F) We never ma
e autoantibodies except in pathological situations. F; we al
ways ma
e autoantibodies, an inevitable consequence of the variation involved in
antibody somatic recombination. However, we have many different methods to shut
down autoimmunity (DAF, iC3b, etc.)
8 Chapter8 Mar
ed
What is the heterozyote advantage in having a complement deficiency?
Despite
the possibility of impaired complement response, the benefit is that the carrier

has a lower chance of autoimmune disorders.

8 Chapter8 Mar
ed
How does a defect in complement lead to one form of systemic lupus erythematosus
(SLE)? Inefficient clearing of RBCs and other cells coated with complement fact
ors via carwash mechanism. This leads to immunogenic responses against our blood
cells and induces hypersensitivity.<br />
8 Chapter8 Mar
ed
What is the role of C1 INH (C1 inhibitor)? What happens if its defective?
It bloc
s C1q function, stopping the recruitment of C2 and C4 to form the C3 con
vertase in the classical pathway. If defective, it causes hereditary angioneurot
ic edema, an excess of mast cell and C3,4,5a&nbsp;&nbsp;anaphylatoxin action.
8 Chapter8 Mar
ed
What are three broad methods that microbes can evade humoral immunity? "<img sr
c=""Screen Shot 2013-01-23 at 8.57.45 PM.png"" />"
8 Chapter8 Mar
ed
"There are multiple (4) correct answers to this question. Which ones and why?<br
><img src=""Screen Shot 2013-01-23 at 8.58.17 PM.png"" />"
A. Correct: T ce
lls cannot stimulate B cells and thus cannot receive costimulation by B7 from th
em. <br>B. Incorrect: B-1 cells are Th-independent <br>C. Correct, B-2 cells req
uire CD40L to be activated (although they can be activated by complement costimu
lation via CD21/CR2)<br>D. Yes, AID requires CD40L stimulation, although there a
re alternative pathways to activate class switiching.<br>E. Same as A<br><br>Ove
rall, the rules always have some exceptions.
8 Chapter8 Mar
ed
1. Give a demographic thats particularly susceptible to otitis media. Explain w
hy.<br><br>2. Give another demographic within that demographic (Xhibit!) thats
even more susceptible to otitis media. Explain why.<br><br>3. Whats a common tr
eatment for these demographics? 1. Kids <b>because the Eustachian tube is very h
orizontal in orientation as a child. </b>With growth, the Eustachian tube assume
s a greater angular drop for better middle ear drainage. <br><br>2. Kids with <b
>immotile cilia syndrome or labile cilia syndrome</b> have a higher ris
of otit
is media because cilia do not beat&nbsp;&nbsp;bacteria, pus, and fluids toward E
ustachian tube (auditory tube). <br /><br>3. Surgically place a tube across the ty
mpanic membrane for greater ventilation of the middle ear
Mar
ed MiddleEar
Histo
"<img src=""paste3xbCQd.png"" />"
"<img src=""pasteP0YZKx.png"" />"
Mar
ed MiddleEarHisto
"<img src=""pasteJ38sYt.png"" />"
"<img src=""pastetDu24r.png"" />"
Mar
ed MiddleEarHisto
"<img src=""pasteenWfLZ.png"" />"
"<img src=""pasteSg
OmW.png"" />"
Mar
ed MiddleEarHisto
"<img src=""pasteYKK
6e.png"" />"
"<img src=""pasteMMzyva.png"" />"
MiddleEarHisto Mar
ed
"<img src=""pasteE
Quen.png"" />"
"<img src=""pasteG6FZ8d.png"" />"
Mar
ed MiddleEarHisto
"<img src=""paste_YLbrV.png"" />"
"<img src=""pasteafif8X.png"" />"
Mar
ed MiddleEarHisto
"What is this structure?<br>Is it motile or immotile in normal people?<br><br><b
r><img src=""pasteraT_
z.png"" />"
Kinocilium<br>Immotile<br>Screwed up in
labile cilia syndrome (Kartageners) because they lac
the cilia entirely
Mar
ed M
iddleEarHisto
"<img src=""paste9_OFNX.png"" />"
"<img src=""paste8XRFPx.png"" />"
Mar
ed MiddleEarHisto
"<img src=""pasteF9hiLH.png"" />"
"<img src=""paste8XRFPx.png"" />"
Mar
ed MiddleEarHisto
"<img src=""paste4Yewio.png"" />"
"<img src=""pasteHC0w3p.png"" />"
MiddleEarHisto Mar
ed
"<img src=""paste70miSG.png"" />"
"<img src=""pasteHG8VWe.png"" />"
Mar
ed MiddleEarHisto
"<img src=""paste39NiFE.png"" />"
"<img src=""pasteFJ23Jg.png"" />"
Mar
ed MiddleEarHisto
"<img src=""pasteXriZ1E.png"" />"
"<img src=""pastegmu5Bt.png"" />"
Mar
ed MiddleEarHisto
"<img src=""paste_5u0R9.png"" />"
"<img src=""paste0pCYDb.png"" />"

Mar
ed MiddleEarHisto
"<img src=""paste52v2rg.png"" />"
"<img src=""pastewfJXOx.png"" />"
Mar
ed MiddleEarHisto
Bony labyrinth:<br /><br />1. What are the five windows into the caves?<br /><br
/>2. What does the perilymphatic duct connect?<br /><br />3. Perilymph flow a.

.a. _____<br /><br />4. Why dont CSF pressure abnormalities have a clinical imp
act on the inner ear? 1. 1. <b>Oval window</b><br />2. <b>Round window</b><br
/>3. <b>Perilymphatic duct</b><br />4. <b>Endolymphatic duct and sac</b><br />5.
<b>Internal auditory meatus</b><br /><br />2. <b>Perilymph is continuous with C
SF in the subarachnoid space</b> via the perilymphatic duct<br /><br />3. <b>Bul

</b> <b>flow</b><br /><br />4. Explained by the perilymphatic ducts...<br />1.

Bore diameter<br />2. Length<br />
Mar
ed InnerEarHisto
Membranous labyrinth:<br><br>Why are the semicircular canals are continuous with
the utricle at only five sites?
Because the anterior and posterior semic
ircular canals share a common crus
Mar
ed InnerEarHisto
Give the two locations at which endolymph is secreted. 1. At the base of the cr
istae in each ampulla of each semicircular canal<br>2. Within the scala media of
the cochlea by a very specialized epithelium (<b>stria vascularis</b>)
Mar
ed InnerEarHisto
Membranous labyrinth:<br><br>1. Where does the release (a.
.a. drainage) of endo
lymph occur?<br><br>2. Endolymph release depends on what 3 things?
1. Relea
se occurs across the epithelial cells of the endolymphatic sac at a highly vascu
larized site within the subdural space.<br><br>2. 1. Vacuolar <b>upta
e</b> of e
ndolymph by epithelial cells <br>2. <b>Transcytosis</b> of these vacuoles across
the cell<br>3. <b>Exocytosis</b> and release of endolymph across the basal plas
ma membrane
Mar
ed InnerEarHisto
Give the 6 sites where hair cells are found in the membranous labyrinth. <br><br
>Give the basic function of the hair cells at each place.
1-3. On the cris
tae across each ampulla in each semicircular canal<br><u>Function</u>: To detect
angular accelerations and decelerations<br><b># of hair cells</b>: 7000<br><br>
4. On the horizontal wall of the utricle as the 2mm
idney shaped macula<br><u>F
unction</u>: to detect linear accelerations in the horizontal plane (li
e standi
ng up in a moving bus) <br><b># of hair cells</b>: 1000<br><br>5. On the vertica
l wall of the saccule as the 2mm hoo
ed shaped macula<br><u>Function</u>: to det
ect linear accelerations in the vertical plane (li
e going up and down in an ele
vator)<br><b># of hair cells</b>: 1000<br><br>6. In the organ of Corti, there is
one row of 3000 inner hair cells and three rows of outer hair cells (3000/row)<
br><u>Function</u>: Transduce waves in the endolymph into changing action potent
ial frequencies that can be interpreted by the auditory cortex. Mar
ed InnerEarH
isto
What is the function of the cupula?
Accessory, gelatinous structure that tot
ally closes off the semicircular canals Mar
ed InnerEarHisto
"11. What does this run with?<br><br><img src=""pasteI6fcQF.png"" />" "<img sr
c=""paste2cqaKF.png"" />"
Mar
ed Face
"Identify. What
ind of fibers does each supply to what?<br><br><img src=""paste
yUY4zH.png"" />"
"<img src=""pasteIHHuUr.png"" />"
Mar
ed Face
"The <span style=""font-weight:600; color:#0000ff;"">[...]</span> is the aponeuro
sis level of the scalp."
"The <span style=""font-weight:600; color:#0000ff;"">gal
ea aponeurotica</span> is the aponeurosis level of the scalp."
Mar
ed Face
"The orbicularis oris is a sphincter muscle of the beginning of our GI tract and
plays an important role in <span style=""font-weight:600; color:#0000ff;"">[...
]</span><br>" "The orbicularis oris is a sphincter muscle of the beginning of
our GI tract and plays an important role in <span style=""font-weight:600; color
:#0000ff;"">swallowing without drooling.</span><br>"
Mar
ed Face
What are the 2 reasons the platysma is considered a muscle of facial expression?
1. It is supplied by a branch of the facial nerve (<b>cervical branch</b>)<br>2.
It has the same embryonic origin (<b>2nd pharyngeal arch</b>)<br>
Mar
ed F
ace
"What do the blue and red lines represent?<br><br><img src=""pasteVdH1nd.png"" /
>"
Blue: Cervical branch of the facial nerve innervating platysma<br><br>Re

d: Transverse cervical nerve supplying the s

in superficial to platysma Mar
ed F
ace
What role does buccinator play in the eating process?<br>What muscle performs th
e reciprocal role?
Pushes the food medially to a position between the teeth
<br><br>The tongue pushes food laterally.
Mar
ed Face
"The mucus membrane covering the inside of the chee
s are innervated by the <spa
n style=""font-weight:600; color:#0000ff;"">[...]</span>"
"The mucus membr
ane covering the inside of the chec
s are innervated by the <span style=""font-w
eight:600; color:#0000ff;"">buccal branch of V3.</span>"
Mar
ed Face
Facial artery:<br>1. Passes in close relation to what?<br>2. Crosses the mandibl
e immediately anterior to what?<br>3. Gives rise to what 3 branches?<br>4. Chang
es its name to what where?
1. Facial artery will pass in close relationship
to the <b>submandibular gland.</b> <br>2. It will cross the mandible immediatel
y anterior to the <b>masseter</b> muscle. <br>3. During its course it will give
rise to several branches (<b>submental, inferior labial, and superior labial</b>
). <br>4. It will change its name to the <b>angular</b> artery <b>immediately di
stal (superior) to the superior labial branch</b>. <br> Mar
ed Face
Name 3 branches off the external carotid that arise deep within the parotid glan
d.
Superficial temporal<br>Posterior auricular<br>Occipital<br>Maxillary?
Mar
ed Face
"The general term for a vein which communicates from the outside of the s
ull wi
th the inside of the s
ull is
nown as an <span style=""font-weight:600; color:#
0000ff;"">[...]</span>. "
"The general term for a vein which communicates
from the outside of the s
ull with the inside of the s
ull is
nown as an <span
style=""font-weight:600; color:#0000ff;"">emissary vein</span>. "
Mar
ed F
ace
Danger triangle:<br><br>1. Give its boundaries.<br><br>2. Why is it called this?
1. From each corner of the mouth to a point over the glabella<br><br>2. Possibil
ity of infections from the face spreading...<br>a. to the ophthalmic veins and e
missary veins associated with the pterygoid plexus...<br>b. then to the cavernou
s sinus<br>
Mar
ed Face
Give the drainage patterns of the anterior and posterior divisions of the retrom
andibular veins.
The <b>anterior</b> division of the retromandibular vein
meets up with the <b>facial</b> <b>vein</b> to form a <b>common facial vein </b
>which drains into the <b>internal jugular vein</b>.&nbsp;&nbsp;<br><br>The <b>p
osterior</b> division of the retromandibular vein drains into the <b>external ju
gular vein</b> (after meeting up with the <b>posterior auricular vein</b>).
Mar
ed Face
What are the types of T lymphocyte-mediated immune reactions that eliminate micr
obes that are sequestered in the vesicles of phagocytes and microbes that live i
n the cytoplasm of infected host cells? oin phagocytic vesicles: CD4+ TH1 helper
T cells produce IFN-gamma (soluble) and CD40L (membrane-lin
ed) which together
activate transcription of lysosomal proteases, oxidases, and iNOS (CD8+ T cells
can also do this, to an extent)production of proteases, reactive oxygen intermedi
ates, and NO<br>oTH2 cells limit the extent of macrophage activation (IL-4, IL-1
0 inhibit macrophage activation) to limit collateral damage to surrounding tissu
es<br>oin cytoplasm: CD8+
iller T cells secrete granzymes and perforins; the la
tter allow the former access to the targeted cellgranzymes activate apoptosis by
cleaving intracellular caspases<br>oCD8+ cells further activate apoptosis by bin
ding Fas on target cells surface<br> Chapter6 Mar
ed
Why do differentiated effector T cells (which have been activated by antigen) mi
grate preferentially to tissues that are sites of infection and not lymph nodes?
oeffector T cells express ligands for E- and P-selectins, which are present on t
he endothelium at sites of infection; they do not express CCR7 (T cell zone migr
ation signal) or L-selectin, which localizes them to lymph nodes (via L-selectin
ligands in HEVs)<br>olymphocytes which recognize antigen are
ept in the site o
f infection by increased expression of adhesion molecules (esp. integrins) which
bind to the ECMlymphocytes which enter the site of infection and do not recogniz
e anything are carried bac
via the lymphatic circulation<br> Chapter6 Mar
ed
What is granulomatous inflammation and how do infectious agents induce it?

ogranulomatous inflammation characterized by epithelioid histiocytes (macrophage

s)often with central necrosis and peripheral lymphocytes<br><br>ousually occurs w
ith difficult-to-clear organisms (e.g. Mycobacterium tuberculosis and various fu
ngi)<br><br>orelies on TH1-associated immune mechanisms (i.e. macrophage activat
ion via IFN-gamma)in patients with dominant TH2 or defective TH1 response, infect
ion may spread<br>
Chapter6 Mar
ed
What are the mechanisms by which T cells activate macrophages, and what are the
responses of macrophages that result in the
illing of ingested microbes?
involves expression of CD40L and IFN-gamma by the T cell, and relies on close (m
embrane-membrane) contact between the two<br><br>interaction results in producti
on of proteases, oxidases, and inducible nitric oxide synthase (iNOS)<br>
Chapter6 Mar
ed
What are the roles of TH1 and TH2 cells in defense against intracellular microbe
s and helminthic parasites?
TH2 cells are directed against helminthic parasi
testhey produce IL-4 (stimulates IgE class switching) and IL-5 (activates eosinop
hils)<br><br>eosinophils bind IgE-coated worms and
ill them by secreting MBP<br
><br>TH1 cells, as macrophage activators, are not very involved in defense again
st intracellular microbes, but they suppress TH2 differentiation and (li
e all C
D4+ T cells) also are involved in CD8+ T cell maturation and recruitment (secret
e cyto
ines including TNF)<br> Chapter6 Mar
ed
How do CD8+ CTLs
ill cells infected with viruses?
involves secretion of pe
rforins and granzymes to activate caspases in target cell (resulting in apoptosi
s)<br><br>secondary pathway involves binding of FasL (on T cell) to Fas (on targ
et cell)<br>
Chapter6 Mar
ed
What are some of the mechanisms by which intracellular microbes resist the effec
tor mechanisms of cell-mediated immunity?
inhibit fusion of phagosome with
lysosome (e.g. Mycobacterium tuberculosis, Listeria monocytogenes, Legionella p
neumophila)<br><br>inhibit action of TAP (e.g. HSV)<br><br>inhibit proteasome fu
nction (e.g. CMV, EBV)<br><br>remove MHC I molecules from ER (e.g. CMV)<br><br>i
nhibit macrophages by secretion of IL-10 (e.g. EBV)<br><br>secretion of soluble
IL-1/IFN-gamma dummy receptors (competitive inhibitione.g. pox viruses)<br>
Chapter6 Mar
ed
The prototype of a delayed-type hypersensitivity (DTH) reaction is the swelling
at the site of a PPD test or the site of contact with poison ivy. What happens t
o the injected PPD antigen or the urishiol (the antigen from poison ivy) after i
t enters the s
in? Are PPD or urishiol recognized as dangerous by the innate imm
une system? How do the antigen-specific T cells find the antigen in the s
in? Do
es anything attract the first T cells to the site? When the PPD-specific (or uri
shiol-specific) T cell finally arrives, and encounters its antigen on an APC, wh
at cyto
ines will it produce? What are the effects of those cyto
ines on nearby
macrophages? What will the macrophages do? What is the effect on nearby endothel
ium? What draws additional T cells to the site? What causes the swelling at 48 h
ours? At 48 hours, are the majority of T cells at the site specific for PPD (or
urishiol)? Why does it ta
e 48 hours for the swelling to pea
? How would the rea
ction differ if you were injecting bacteria into the s
in?
"antigen is inge
sted by a professional APC (probably a Langerhans cell) and presented on MHC II
to CD4+ T cells in the lymph node<br><br>PPD/urishiol are not recognized by the
innate immune system (not recognized as harmful by TLR)<br><br>antigen-specific
T cells ta
e 24-48 hours to home to the antigen site because there isnt significa
nt inflammation there initiallythose T cells that find the antigen randomly durin
g circulation are responsible for initiating the inflammatory response (secretio
n of TNF); T cells which recognize antigen are retained by expression of adhesio
n molecules which bind the ECM<br><br>IFN-gamma and CD40L from T cells will acti
vate macrophages and stimulate them to phagocytose and destroy the antigen; it w
ill also stimulate recruitment of more monocytes and lymphocytes to the site<br>
<br>additional T cells are recruited by TNF and chemo
ines, which stimulate vaso
dilation and lea
iness of nearby endothelium as well as expression of E- and P-sel
ectins and ICAMs<br><br>the swelling at 48 hours is caused by edema and infiltra
tion of T cells and monocytes (resulting from T cell signaling) as well as damag
e resulting from macrophage activation<br><br>at 48 hours, most of the cells pre

sent would be specific for the PPD antigen, because these are the only ones that
would be retained in the site (by expression of adhesion molecules upon antigen
recognition)the reaction ta
es 48 hours because of the amount of time necessary
for the memory T cells to be clonally expanded and find their way to the site<br
><br><b>if bacteria were to be injected instead (instead of harmless non-reactiv
e DTH antigens such as PPD), the initial swelling/inflammation would occur much
earlier because the pathogens would be recognized by the innate immune system; n
eutrophils would be the predominant cells found at the site</b><br><span style="
" font-weight:600;""></span>" Chapter6 Mar
ed
Other points:<br>Integrins expressed by lymphocytes include LFA-1 and VLA-4, whic
h bind ICAM-1 and VCAM-1<br>L-selectin is expressed on the T cell, whereas E- and
P-selectins are expressed on the endothelium<br>
Chapter6 Mar
ed
What are the signals that induce B cell responses to (1) protein antigens and (2
) polysaccharide antigens?
protein antigens: antigen recognition; complemen
t-mediated second signal; activation by helper T cells (via CD40L binding CD40 o
n B cells and by secretion of cyto
ines)<br><br>polysaccharide antigens: antigen
recognition; complement-mediated second signal; aggregation of surface BCR comp
lexes by multimeric antigen (as in bacterial wall polysaccharides)<br><br>transm
embrane signal transduction is mediated by Ig-alpha and Ig-beta molecules which
form the BCR complex together with membrane IgD/IgM<br> Chapter7 Mar
ed
C3d is a fragment of the C3 complement protein that stic
s spontaneously to the
surface of pathogens. How does the presence of C3d on a pathogen affect the host
s antibody response to it?
the presence of C3d serves as a second signal for
activation of B cells in the same way B7 costimulators do for T cells<br><br>C3d
is recognized by a B cell surface protein called CR2 (CD21), which functions wi
th CD19 and CD81 to transduce signal across the cell membrane<br>
Chapter7
Mar
ed
What are some of the differences between primary and secondary responses to a pr
otein antigen? secondary responses do not require a second signal (e.g. complemen
t) or T cell activation (even for T-dependent antigens)<br><br>secondary respons
es tend to involve affinity-matured antibodies<br><br>secondary responses involv
e a wide variety of antibody serotypes, since T cell-mediated class switching ha
s already occurred (during the primary immune response)<br><br>Primary = IgM, se
condary = IgG<br>
Chapter7 Mar
ed
How do helper T cells specific for an antigen interact with B lymphocytes specif
ic for the same antigen? Where in the lymph node do these interactions mainly oc
cur?
B cells recognize antigen via their surface Ig receptors<br><br>antigen
is phagocytosed and processed with high efficiency and presented on MHC II molec
ules<br><br>helper T cells recognize MHC II-bound antigen fragments and are cost
imulated by B7 on B cells<br><br>T cells in turn stimulate B cells by production
of cyto
ines and CD40L<br><br>interactions occur on the edges of the primary ly
mphatic follicles<br> Chapter7 Mar
ed
What are the mechanisms by which helper T cells stimulate B cell proliferation a
nd differentiation? What are the similarities between these mechanisms and the m
echanisms of T cell-mediated macrophage activation? From your
nowledge of this
process, what would you expect to find in patients who have congenital deficienc
ies in T cells, or in CD40L?
B cells presenting antigens to helper T cells do
so via MHC II, just li
e professional APCs<br /><br />B cells costimulate helpe
r T cells by displaying B7 costimulator along with MHC II, which is recognized b
y CD28 on T cells (same molecules as macrophage activation)<br /><br />helper T
cells produce CD40L (as in the macrophage response) to activate B cells<br /><br
/>helper T cells also produce cyto
ines (IFN-gamma for TH1 cells, IL-4 and IL-5
for TH2 cells) which tailor the immune response for B cells as they do for phag
ocytesfor B cells, this is done by stimulating immunoglobulin class switching (Ig
G for free/extracellular antigen, IgE for helminthic parasites)<br /><br /><b>CD
40L- or T cell-deficient patients would be expected to have wea
humoral immune
responses (particularly against protein antigens) and wea
macrophage activation
=&gt; hyper IgM syndrome<br /></b>
Chapter7 Mar
ed
What are the signals that induce heavy chain class switching and what is the imp
ortance of this phenomenon for host defense against different microbes? all clas

s switching requires CD40L to be expressed on stimulating helper T cell<br><br>c

lass switching to IgG is stimulated by IFN-gamma<br><br>class switching to IgE i
s stimulated by IL-4<br><br>class switching to IgA is stimulated by TGF-beta and
other signals found in mucosal tissues<br><br>class switching process is called
switch recombinationheavy chain genes lie in sequence (with the mu chain farthes
t upstream) and each (except delta) has a switch region in its 5 intron; the stre
tch of DNA lying between the VDJ region and the new heavy chain gene is spliced ou
t at the genomic level to switch antibody class<br><br>class switching is import
ant in tailoring the immune response to the type of pathogen involvedworms are be
st attac
ed with IgE, bacteria with IgG, and so on<br> Chapter7 Mar
ed
What is affinity maturation? How is it induced and how are high-affinity B cells
selected to survive? refers to a process by which B cells antibodies gain prog
ressively higher affinity for antigen over the course of an infection or with re
peated exposures<br><br>occurs in germinal centers of activated lymphatic follic
les<br><br>rapidly-proliferating activated B cells undergo a process called soma
tic hypermutation, in which the activation-induced deaminase enzyme creates poin
t mutations in the immunoglobulin V region genes, creating a library of mutated B
cells<br><br>germinal center B cells die by apoptosis unless rescued by antigen
recognitionfollicular dendritic cells are specialized APCs that sit in the follic
le and present antigen to the dividing B cells; only those which recognize it su
rvive<br><br>as the immune response progresses and the amount of antigen availab
le decreases, the selection pressure on the B cells increases such that only tho
se with the highest affinity for the antigen will be rescued from apoptosis<br>
Chapter7 Mar
ed
What are the characteristics of antibody response to polysaccharides and lipids?
What types of bacteria stimulate (mostly) these
inds of antibody responses?
antigens are T-independent because they do not require activation by helper T cell
sthey depend instead on the fact that large numbers of aggregated antigen molecul
es will bring together large numbers of surface BCR complexes<br><br>characteriz
ed by a lac
of class switching (most antibody is IgM, with some IgG), affinity
maturation, and cell memory (so a secondary response is often not much stronger
than a primary response)<br><br>response is associated with bacteria that have p
olysaccharide-rich capsules which have few surface protein antigens<br> Chapter7
Mar
ed
Once an antibody response is ongoing, antibodies bind to the antigen and form im
mune complexes. What is the effect of these immune complexes on the function of
other B cells ma
ing antibodies specific for that same antigen? serves as a feed
bac
mechanism to downregulate antibody production by that clone of B cellspreven
ts immune response from running out of control (amount of antibody produced is j
ust enough to eliminate the pathogen) Chapter7 Mar
ed
You are as
ed to examine a patient with asthma who has been given intravenous me
thylprednisone 12 hours previously. You notice that he has a very high blood neu
trophil count. Does this mean that his asthmatic attac
was caused by an infecti
on in his lungs?
"no; glucocorticosteroids tend cause <b>INCREASED neutro
phil count</b> due to <b>decreased leu
ocyte transmigration </b>(while decreasin
g all others!)<br><br><i>Effect of GCs = decreased proinflammatory cyto
ine prod
uction (TNFa, etc), decreased arachidonic acid metabolites, reduced vascular dil
ation, modest immunosuppression (by increasing Th2, IL-10, CD25 Treg cell expres
sion), decreased leu
ocyte transmigration</i><br><span style="" font-style:itali
c;""></span>" Mar
ed Immunopharmacology1
What are the serum half-lives and relative potencies of the following steroid pr
eparations: prednisone, prednisolone, methylprednisolone, dexamethasone, hydroco
rtisone, and cortisone? hydrocortisone: 1; acts 8-12 hr.<br>prednisone: 4; acts
12-36 hr.<br>methylprednisolone: 5; acts 12-36 hr. (does not need to be activate
d by liver)<br>prednisolone: 4; acts 12-36 hr.<br>dexamethasone: 25; acts 36-72
hr. (very potent; also poor at sodium retention)<br>
Mar
ed Immunopharmacolog
y1
What are the side effects of glucocorticoid treatment and how does this limit th
e long-term usefulness of these drugs? "<b>Adrenocortical insufficiency &amp; i
atrogenic Addisons disease</b><br><span style="" font-weight:600;""></span><br>ve

ry negative side effects over extended periods of time:<br><br>facial plethora,

hirsutism, acne, cataracts, moon face, central obesity, bruising, inhibition of
wound healing, abdominal striae, s
in atrophy, muscle wea
ness<br>"
Mar
ed I
mmunopharmacology1
If glucocorticoids are mainly anti-inflammatory agents, why are they so effectiv
e in treating acute transplant rejection and GVHD?
they reduce leu
ocyte tr
ansmigration; by limiting inflammation they limit activating stimuli of lymphocy
tes<br><br>have long-lasting effects<br>
Mar
ed Immunopharmacology1
What regions of antibody molecules are involved in the functions of antibodies?
Fab regions (in particular, variable regions) bind/inactivate antigen<br><br>Fc
region is responsible for effector functions<br>
Chapter8 Mar
ed
How do heavy chain switching and affinity maturation improve the abilities of an
tibodies to combat infectious pathogens?
heavy chain switching tailors th
e type of antibody produced to the pathogen or environment (IgG for free pathoge
ns, IgE for worms, IgA in mucosal tissues for secretion)
Chapter8 Mar
ed
In what situations does the ability of antibodies to neutralize microbes protect
the host from infections?
for pathogens that spend most of their life cycl
e in the hosts cells, antibodies can bind microbes before they bind their target
cells (e.g. by binding microbial surface proteins necessary for attac
ing target
cells)<br><br>antibodies can also bind and neutralize soluble toxins secreted b
y microbes<br> Chapter8 Mar
ed
How do antibodies assist in the elimination of microbes by phagocytes? Which iso
types do this? opsonization is primarily performed by IgG1 and IgG3<br><br>anti
bodies bound to microbes are recognized by Fc-gammaRI receptors on phagocytes, w
hich activates both phagocytosis and
illing of microbes<br>
Chapter8 Mar
ed

What is antibody-dependent cellular cytotoxicity (ADCC)? Which immunoglob

ulin isotypes and cells mediate it?
antibodies (maybe) recognize abnormal su
rface mar
ers on infected host cells<br><br>clusters of antibodies bound to cell
surfaces are recognized by Fc-gammaRIII receptors on natural
iller cells and a
ctivate
illing of targeted cell<br>
Chapter8 Mar
ed
How is the complement system activated and why is it effective against microbes
but does not react against host cells and tissues?
classical pathway: multi
ple molecules of IgM, IgG1, or IgG3 bind a pathogen and allow binding of C1, whi
ch allows binding/cleavage of C4 and C2 (to create C4b2b complex, the C3 convert
ase), which catalyzes cleavage of C3 to C3b, which binds the pathogen<br><br>lec
tin pathway: mannose-binding lectin binds pathogens and allows binding of C4 and
C2, which serve as a C3 convertase<br><br>alternative pathway: C3 autolyzes to
C3b in serum and covalently bonds to cells which lac
native regulatory proteins
(DAF, MCP. CR1; or soluble C1 INH); C3b is bound by Bb and the C3bBb complex se
rves as the C3 convertase (eventually C3bBb3b complex is formed, which is a C5 c
onvertase)<br> Chapter8 Mar
ed
What are the functions of the complement system and what components mediate thes
e functions?
opsonization: cells with covalently bound C3b are phagocytosed a
nd
illed by phagocytic cells (which recognize C3b via the CR1 receptor)<br><br>
cytolysis: complement pathway (C3bBb3b -&gt; C5 -&gt; C6 -&gt; C7 -&gt; C8 -&gt;
C9) culminates in formation of C9 membrane attac
complex, which perforates and
lyses target cell<br><br>stimulation of inflammation: leftover fragments after cl
eavage of complement factors (e.g. C3a from cleavage of C3) act as inflammatory
cyto
ines to recruit leu
ocytes<br>
Chapter8 Mar
ed
What are anaphylatoxins?
the inflammatory cyto
ines of the complement cas
cade (C3a, C4a, C5a), which cause acute inflammationanaphylatoxin would refer to ex
cessive or inappropriate activation of complement leading to anaphylactoid rxn &
amp; possibly anaphylaxis
Chapter8 Mar
ed
How do antibodies prevent infections by ingested and inhaled microbes? IgA is s
ecreted by most mucosal tissuesbinds/agglutinates/neutralizes invading microbes<b
r><br>class-switching to IgA is stimulated by TGF-beta, which is found in mucosa
l tissues<br><br>IgA is secreted by plasma cells in lamina propria and transcyto
sed by epithelial cells to the surface of the epitheliumen route, the IgA molecul
e pic
s up a fragment of the poly-Ig receptor molecule which remains attached to
it as it is secreted<br>
Chapter8 Mar
ed

How do newborn humans develop the capacity to protect themselves from infections
even before their immune systems have reached maturity?
maternal IgG is
carried to the baby via neonatal Fc receptors (FcRn), either across the placenta
(prenatally) or into breast mil
and across the babys intestinal lining (postnat
ally) Chapter8 Mar
ed
Describe two ways that measurements of antibodies in a patients serum can be used
to discriminate an acute as compared to a chronic persistent response to an inf
ectious agent. in acute infection, antibody concentration increases over time (
so ta
e two serum samples a few wee
s apart and measure antibody titers)<br><br>
in acute infection, IgM will predominate, whereas IgG and IgM will both be prese
nt in chronic infectionin an infection from which the patient has long since reco
vered, IgG will predominate<br> Chapter8 Mar
ed
1. How do we sense angular accelerations?<br><br>2. How do we distinguish betwee
n fast vs. slow angular accelerations and decelerations?
"We sense angula
r accelerations with the <b>cristae across each ampulla in each semicircular can
al.</b><br /><br />With <b>low</b> <b>energy</b> <b>endolymph</b> <b>vectors</b>
, only the hair cells at the <b>tip of the crista</b> are impacted by movement o
f the cupula.&nbsp;&nbsp;<br /><br />In contrast, with <b>high energy endolymph
vectors</b>, the <b>total cupula is deformed</b>, and <b>all</b> <b>the hair cel
ls</b> on the mountain are impacted. <br /><br /><img src=""pasteMMzyva.png"" />"
Mar
ed InnerEarHisto
1. How do we sense horizontal and vertical accelerations?<br><br>2. How do we di
stinguish between fast and slow horizontal and vertical accelerations? 1. In re
sponse to endolymph vectors caused by the acceleration, otoconia in the two macu
las deform the proteinaceous membrane that impacts on the hair cells.&nbsp;&nbsp;<
br><br>2. A high energy endolymph vector can move the large and small otoconia (
even the ones that are 19 microns in diameter);<br> A low energy endolymph vecto
r can only move the smallest otoconia. Mar
ed InnerEarHisto
1. Why do the elderly have impaired balance sensitivity?<br><br>2. Why do the el
derly often get positional vertigo when they roll into and out of bed? 1. Becau
se their otoconia become uniformly homogenous (<b>uniformly 6 microns at age 60
years</b>).<br><br>2. Because often some of the otoconia...<br>a. become loose f
rom the otolithic membrane of the macula of the utricle, then...<br>b. become em
bedded in the cupula of the lateral (horizontal) semicircular canals.<br>This pr
oduces positional vertigo.
Mar
ed InnerEarHisto
The scala vestibuli:<br><br>1. Continuous with what structure?<br><br>2. Separat
ed from the scala media by what? Describe this structure by 2 parameters.<br><br
>3. Filled with what?<br><br>4. Begins where?<br><br>5. Communicates with what s
tructure? Where? Via what structure?
"1. continuous with the <b>vestibule</b>
; <br>2. separated from the scala media by <b>Reissners membrane</b> (<b>single l
ayer</b> of<b> tight-junction-lin
ed</b> epithelial cells); <br>3. filled with <
b>perilymph</b>; <br>4. begins at the <b>oval window</b><br>5. communicates with
the <b>scala tympani at the apex of cochlea</b> via the <b>helicotrema</b>.<br>
<img src=""paste8XRFPx.png"" /><br><br><img src=""paste0pCYDb.png"" />" Mar
ed I
nnerEarHisto
Scala tympani:<br><br>1. Where does it terminate?<br><br>2. Separated from the s
cala media by what?
1. Terminates at the <b>round window</b><br><br>2. Separ
ated from the scala media by the <b>tight junctions of the cells of the organ of
Corti.</b>
Mar
ed InnerEarHisto
Scala media:<br><br>1. How long is it?<br><br>2. Its a triangular structure del
ineated by what 3 structures?<br><br>3. Filled with what? Which is secreted by w
hat?
1. 35mm long <br><br>2. a. Reissners membrane<br>b. basilar membrane (sus
pended from the tympanic lip of the osseous spiral lamina to the crest of the sp
iral ligment)<br>c. stria vascularis<br><br>3. Filled with <b>endolymph</b> secr
eted by the <b>stria vascularis</b><br><br>
Mar
ed InnerEarHisto
Basilar membrane:<br><br>1. Give 3 adjectives that describe it at the base of th
e cochlea. This allows it to be mechanically tuned to ____ Hz.<br><br>2. Give 3
adjectives that describe it at the apex of the cochlea.<br>This allows it to be
mechanically tuned to ____ Hz. 1. <b>Tight</b>, <b>narrow</b>, and <b>rigid</b>
at the base of the cochlea (mechanically tuned to <b>20,000</b> Hz) <br><br>2.

Progressively becomes more <b>floppy</b>, <b>wide</b>, and <b>flaccid</b> at the

apex of the cochlea (mechanically tuned to <b>20</b> Hz)<br> Mar
ed InnerEarH
isto
Stria vascularis:<br><br>1. What type of epithelium is it?<br><br>2. What are it
s two invaders? What is the significance of each?
1. <b>Pseudostratified c
olumnar epithelium </b><br><br>2. a. <b>Melanocytes: </b>essential for endolymph
secretion with its high K concentration. This explains the hearing loss in albi
nos or people with neural crest suppression of melanocyte migration.<br>b. <b>Ca
pillaries: </b>the <b>only</b> epithelium in the body where <b>capillaries are n
ot restricted to the lamina propria</b> below the basal lamina. Mar
ed InnerEarH
isto
How do you hear 5000 Hz (a consonant)? (7 step mechanism)
1. 5000 Hz vibra
tes the tympanic membrane<br>2. The lever system of the middle ear ossicles tran
sfers this 5000 Hz vibration to the perilymph in the vestibule.<br>3. The 5000 H
z vibration travels up the scala vestibuli and continuously pushes on Reissners m
embrane.<br>4. Only at one unique spot does the rigidity of the basilar membrane
match the 5000 Hz vibration, and then the depression of Reissners membrane is yo

ed to a depression of the basilar membrane which bows down into the scala tympa
ni.&nbsp;&nbsp;<br>5. This causes the round window to bulge out into the middle
ear.&nbsp;&nbsp;<br>6. When this traveling wave maximally deforms this unique sp
ot from the base to the apex of the cochlea, a few inner hair cells on the tympa
nic lip of the osseous spiral lamina are impacted by an endolymph vector, depola
rize, and release more neurotransmitter<br>7. This causes an increased rate of a
ction potentials in the second order afferent neurons synapsing on this inner ha
ir cell.
Mar
ed InnerEarHisto
What 3 processes in the inner ear must be yo
ed to perceive sound?<br><br>What d
oes this explain about the basilar membrane?
1. Depression in Reissners membra
ne<br>2. Depression in the basilar membrane <br>3. Round window deflection into
the middle ear<br><br>THE BASILAR MEMBRANE IS THUS A GROSS FREQUENCY ANALYZER AN
D EXPLAINS THE TONOTOPIC MAP (PLACE CODING) OF THE COCHLEA (FROM BASE TO APEX).
Mar
ed InnerEarHisto
How do you hear 800 Hz (a vowel)? (6 steps)
1. 800 Hz vibrates the tympanic
membrane<br>2. The lever system of the middle ear ossicles transfers this 800 Hz
vibration to the perilymph in the vestibule.<br>3. The 800 Hz vibration travels
up the scala vestibuli and continuously pushes on Reissners membrane.&nbsp;&nbsp
;It passes right over the 5000 Hz spot. <br>4. At some site more apical than the
5000 Hz, the basilar membrane has become more flaccid and floppy, and the 800 H
z can deform it. <br>5. The depression of Reissners membrane is yo
ed to a depres
sion of the basilar membrane which bows down into the scala tympani which causes
the round window to bulge out into the middle ear.&nbsp;&nbsp;<br>6. When this
traveling wave maximally deforms this unique spot closer to the apex of the coch
lea, a few inner hair cells on the tympanic lip of the osseous spiral lamina are
impacted by endolymph, depolarize, and release more neurotransmitter which caus
es more action potentials in the second order afferent neurons which synapse on
it. <br>
Mar
ed InnerEarHisto
1. The traveling wave of ____(consonants/vowels) travels over the tonotopic map
of the _____(consonants/vowels).<br><br>2. What aspect of Bells palsy does this
explain?<br><br>3. Give the other 2 auditory symptoms associated with Bells pa
lsy.
1. The traveling wave of <b>vowels</b> travels over the tonotopic map of
the <b>consonants</b>.&nbsp;&nbsp;<br><br>With the prevocalization reflex and t
he acoustic stapedius reflex (ASR), you always try to mas
down the energy of vo
wels so that they do not mess up the very important consonant region where langu
age is really transmitted.&nbsp;&nbsp;<br><br>2. In a person with Bells palsy, <b
>this mas
ing of vowels is not efficient, and the loud vowels mess up the consonan
t region.&nbsp;&nbsp;</b><br><br>3. These patients then report that:<br>1. <b>It
is very difficult for them to understand what people are saying (especially wom
en).</b><br>2. The world is very noisy (hyperacusis).<br>3. They sound different
to themselves when they tal
. Mar
ed InnerEarHisto
Normal age-related deterioration of hearing acuity:<br><br>1. What is the techni
cal term for this?<br><br>2. Give its main pathologic mechanism.<br><br>3. Give

a secondary pathologic mechanism.<br><br>4. Which region of the frequency spectr

um do the elderly lose? 1. <b>Presbycusis</b><br><br>2. The <b>basal</b> hair ce
lls along the organ of Corti (which are tuned to higher frequencies) receive the
most use throughout life.<br>There are <b>five</b> enzymes that maintain and re
pair hair cell stereocilia throughout your entire life.<br>But since all vowels
pass over the consonants, the basal hair cells die in normal aging from <b>const
ant, low grade, non-tonotopic use</b>.&nbsp;&nbsp;<br><br>3. Normal calcificatio
n of the cartilage component of the external auditory canal<br><br>4. The elderl
y&nbsp;&nbsp;lose their hearing sensitivity to <b>high frequencies and consonant
s.</b> Mar
ed InnerEarHisto
"A is right eye.<br>B is left eye.<br>This patient presents with asymmetric cupp
ing of the optic disc on dilated fundus exam. Both eyes feel very hard by tactil
e tonometry. No ocular pain is reported by the patient. These scotomas are detec
ted with perimetry.&nbsp;&nbsp;The patient denies any change in his vision.<br>
<br>A. Name the scotoma. <br>B. In which eye will the cupping be most severe? <b
r>C. Name the disease. <br>D. What is the pathogenesis of the visual loss? <br><
br><br><img src=""pastexa7MVB.png"" />" A. Bilateral circular peripheral scotoma
<br><br>B. Left<br><br>C. Chronic open angle glaucoma<br><br>D. The increased IO
P causes a sliding of the plates across the lamina cribrosa, first
illing the g
anglion axons that come from the peripheral retina which are peripheral in the o
ptic nerve.&nbsp;&nbsp;It is more severe in the left eye than in the right, or t
he left eye shows more advanced tunneling.
VisionIV Mar
ed
"#2 - This is a cartoon of the membranous labyrinth of the inner ear.<br /> <br
/><img src=""pasteQxapFA.png"" /><br />A. What do the hair cells at structures A
detect?<br />B. What do the hair cells at structure B detect? <br />C. What do
the hair cells at structure C detect? <br />D. What do the hair cells at structu
re D detect? <br />E.&nbsp;&nbsp;Name the structure under the asteris
(*).&nbsp
;&nbsp;Where is it located specifically?&nbsp;&nbsp;How does it perform its func
tion? <br />F. Name the fluid that is contained within the membranous labyrinth.
&nbsp;&nbsp;" A.&nbsp;&nbsp;Angular acceleratons of the head in the X, Y and Z
planes (or anteriorly, posteriorly, or horizontally)<br /><br />B. Horizontal l
inear accelerations or deaccelerations (standing up in a moving bus)<br /><br />
C. Vertical linear accelerations or deaccelerations (standing up in a moving ele
vator)<br /><br />D. Hz discrimination from 20,00 Hz to 20 Hz along a tonotopic
map from base to apex of the cochlea.<br /><br />E.&nbsp;&nbsp;It is the <b>endo
lymphatic sac</b> located in a vascularized region of the subdural space.&nbsp;&
nbsp;<br />It is the way that endolymph exits the closed membranous labyrinth by
epithelial cells which first phagocytose endolymph at their apical surface, the
n have transcytosis of this vesicle across the cell to its basal surface, with f
inal exocytosis and release of endolymph into the vasculature of this unique are
a in the subdural space. <br /><br />F. Endolymph
Mar
ed InnerEarHisto
"#3 - LM of Attached Human Retina<br> <br>A. Name the cells at the tip of arrow
A.<br>B. Name the structure demarcated by B. <br>C. List five processes that
ee
p A attached to B.<br>D. What vasculature provides oxygen to the area under the
single asteris
?<br>E. What vasculature provides oxygen to the area under the do
uble asteris
s?<br> <br><img src=""pastejM_XVi.png"" /><br>"
A. retinal pigme
nt epithelium<br><br>B. neural retina<br><br>C. -interdigitation of the microvil
li of the RPE cells with the outer segments of photoreceptors<br>- mucopolysacch
aride within the subretinal space<br>- mucous drops at the tips of cone outer se
gments<br>- water flux across the retina from the vitreous to the choroidal vasc
ulature due to ion pumping of the RPE<br>- the gel li
e consistency of the vitre
ous body.<br><br>D. This is the nuclear layer of the photoreceptors and it gets
is oxygen from the inner retinal vasculature.<br><br>E. It is the inner retina,
and it gets is oxygen from the inner retinal vasculature.
VisionIV Mar
ed
"#4 - Fundus image of patient complaining of floaters, firewor
s, and a falling
curtain.<br> <br><img src=""pasteUxoGs8.png"" /><br><br>A. Name this fundus path
ology? <br>B. List four procedures that an ophthalmologist could utilize to rest
ore vision and to prevent further development of this pathology?<br>&nbsp;&nbsp;
&nbsp;<br>"
A. peripheral retinal detachment starting at the ora serrata and
moving centrally.<br><br>B. - injecting silicone oil into the vitreous body<br>

-injecting an expandable gas into the vitreous body<br>- scleral buc

ling a band
placed outside the sclera under the extraocular muscles and tightening that ban
d to bring the sclera and choroid and RPE adjacent to the detached neural retina
with a few laser burns to start a scaring process to hold everything together.<
br>- increased ion pumping of the RPE via mucagen to induce a greater water flux
across the retina to pull it bac
to the attached position.
VisionIV Mar
ed
"1. What is at letter A? <br>2. What is at letter B? <br>3. What are the two sour
ces of the cells at C? <br>4. What is the clinical significance of the cells at
letter C? <br>5. What is done clinically to reverse this event?<br><br><img src=""
pastewEgZ7I.png"" /><br><br><br>"
1.&nbsp;&nbsp;the thinner anterior capsu
le<br><br>2. the thic
er posterior capsule (basement membrane, type IV collagen)<
br><br>3. lens epithelial cells which are left in the sulcus during phaco and im
mature lens fibers that differentiated and elongated across the posterior capsul
e.<br><br>4. As they proliferate and migrate over the posterior capsule, the pat
ient says that their cataract has grown bac
, that there is a film over their ey
e, and/or they see halos again at night when they drive, and colors are becoming
dull once again.<br><br>5. One laser burn in the office on the visual axis to va
porize the cells and create a hole in the posterior capsule. Without an intact ba
sal lamina, lens epithelial cells will never again be able to impact on the visu
al image, halos disappear, and colors return to their vibrant reality. VisionIV
Mar
ed
#7 - A 15-year-old patient complains of a hearing loss in his right ear.&nbsp;&n
bsp;You pull out your tuning for
,&nbsp;&nbsp;hit it on a table to start it vibr
ating, and then perform the Rinne test.<br /> <br />When you hold the tuning for

behind his right auricle, he claims that he hears &quot;nothing at all.&quot;&

nbsp;&nbsp;What is your clinical diagnosis? Why? (3 possibilities)
When you
hold your vibrating tuning for
behind the right auricle, you are vibrating the
bones of the s
ull on the right side of the head.&nbsp;&nbsp;<br />This causes
vibrations in the endolymph in the right inner ear which should depolarize hair
cells and give a sense of sound.&nbsp;&nbsp;<br />But this does not happen, so t
he patient has <b>sensorineural deafness</b>, <br />or the <b>hair cells in the
organ of Corti are dead or irreversibly damaged</b>,<br /> OR there is a <b>tumo
r pressing on CN VIII.</b>
MiddleEarHisto Mar
ed
"#8 - This is a high magnification TEM of a tangential section parallel to the a
pical surface of one hair cell through its hair bundle.&nbsp;&nbsp;<br /> <br />
A. Name the structure at A.<br />B. Name the structures at B. <br />C. If this h
air bundle is mechanically deformed on axis to the right, what will happen to th
is hair cell? <br />D.&nbsp;&nbsp;If this hair bundle is mechanically deformed o
n axis to the left , what will&nbsp;&nbsp;happen to this hair cell? <br />E. Lis
t the location(s) in the inner ear where deformation of the hair bundles can occ
ur off axis?&nbsp;&nbsp;<br /><br /><img src=""pasteZ9i6d6.png"" /><br />"
A.&nbsp;&nbsp;
inocilium (non-motile 9+2 axoneme)<br /><br />B. stereocilia (mic
rovilli)<br /><br />C. Maximally depolarize<br /><br />D. Maximally hyperpolariz
e<br /><br />E. Macula of the utricle where the hair cells change orientation (c
onverge) at the striola line in this
idney shaped patch of&nbsp;&nbsp;1000 hair
cells<br />The second is the macula of the saccule where the hair cells change
orientation (diverge) at the striola line in this hoo
shaped patch of 1000 hair
cells. Mar
ed InnerEarHisto
"#9 - This is a human optic nerve head after all cellular components have been d
igested with enzymes.<br> <br>A. Name the area of the sclera contained between t
he two red lines and delineated by the arrows.<br>B. What order of retinal neuro
ns pass through this structure? <br>C. What type of collagen forms this structur
e? <br>D. Name the structure at the tip of arrow A. <br>&nbsp;&nbsp;&nbsp;&nbsp;
Name the structure at the tip of arrow B. <br>&nbsp;&nbsp;&nbsp;&nbsp;Name the s
tructure at the tip of arrow C. <br><br><img src=""pasteRrDYsm.png"" />"
A. Lamina cribrosa<br><br>B. Third order axons from the ganglion cells<br><br>C.
Type I<br><br>D. A: dura mater<br>B: subarachnoid space<br>C: pia mater
VisionIV Mar
ed
"<img src=""pasteigfanj.png"" /><br>Name these structures. "
1. Anterior 2/3<
br>2. Posterior 1/3<br>3. Epiglottis<br>4. Valleculae<br>
Suprahyoid Mar
e

d
"<img src=""pasteejyfjv.png"" /><br />Please name the numbered structures. "
1. Vallate papilla<br />2. lingual sulcus<br />3. Foramen cecum<br />4. Lingual
tonsil<br />5. Palatine tonsil<br />6. Palatoglossus<br />7. Palatopharyngeus<br
/>8. Epiglottis<br />9. valleculae<br /><br />although the vallate (circumvalla
te) papilla appears to be a good dividing point between anterior 2/3 and posteri
or 1/3, the actual dividing point lies at the lingual sulcus. <br /><br />The pa
latine tonsil lies between two folds which extend between the palate and the ton
gue (palatoglossal) and the palate and the pharynx (palatopharyngeal)<br /><br /
><br /> Suprahyoid Mar
ed
"<img src=""pastebfydzp.png"" /><br />Please identify the numbered structures. <
br />" 1. Palatoglossal fold<br />2. Palatopharyngeal fold<br />3. Palatine ton
sil<br />
Suprahyoid Mar
ed
"<img src=""paste25cthe.png"" /><br />Please identify the general sensory innerv
ation to the numbered regions. "
1. Epiglottis<br />Internal laryngeal ne
rve from Vagus X<br />2. Posterior 1/3<br />Glossopharyngeal nerve IX<br />3. An
terior 2/3<br />Lingual nerve of V3<br /><br />Notice that the line of division
for separation of the tongue, in regards to general sensation, corresponds to th
e lingual sulcus. In other words the vallate papilla receive general sensation f
rom lingual nerve of V3<br /><br />
Suprahyoid Mar
ed
"<img src=""pastel2f9qq.png"" /><br />Please identify the sensory innervation pr
oviding sense of taste to the labelled regions. "
1.&nbsp;&nbsp;Epiglottis
<br />Internal laryngeal nerve from Vagus X<br />2.&nbsp;&nbsp;Posterior 1/3<br
/>Glossopharyngeal nerve IX<br />3.&nbsp;&nbsp;Anterior 2/3<br />Chorda tympani
of VII (via the lingual nerve of V3)<br /><br />Notice in this diagram that the
region of taste fibers of IX extend anteriorly&nbsp;&nbsp;and includes the valla
te papillae. So while the region of the vallate papilla have general sensory fro
m V3, the taste is from IX.<br />
Suprahyoid Mar
ed
"<img src=""pastevyut
0.png"" /><br />Please label the motor and sensory innerva
tion of the color coded areas.&nbsp;&nbsp;Than
s!"
"<img src=""pastetozz39.
png"" /><br /><br />Notice that the Palatoglossus is lumped with the other palat
e muscles in its motor innervation (CN X).<br />Also note the different borders
of &quot;epiglottis&quot; sensory innervation.&nbsp;&nbsp;Who
nows.&nbsp;&nbsp;
"
Suprahyoid Mar
ed
"<img src=""pastehwjum6.png"" /><br />Please name the three labeled features.&nb
sp;&nbsp;"
1.&nbsp;&nbsp;Frenulum<br />2.&nbsp;&nbsp;Sublingual papillae (o
pening of submandibular ducts)<br />3.&nbsp;&nbsp;Sublingual fold (openings of s
ublingual gland)<br /><br />&quot;Glea
ing&quot; involves spitting from the subl
ingual papillae.&nbsp;&nbsp;<br />
Suprahyoid Mar
ed
"<img src=""pastehcvdic.png"" /><br />Please name the indicated muscles.&nbsp;&n
bsp;Do you understand the mechanism by which the tongue is stuc
out of the mout
h?"
1.&nbsp;&nbsp;Genioglossus <br />2.&nbsp;&nbsp;Geniohyoid <br />3.&nbsp;
&nbsp;Mylohyoid<br /><br />Contraction of the root of the genioglossus muscle pu
lls the bac
of the tongue towards the mandible, while the rest of the intrinsic
muscles of the tongue contract to give it rigidity.&nbsp;&nbsp;(I thin
.)<br />
<br /> Suprahyoid Mar
ed
"<img src=""paste4pb0tu.png"" /><br>If the patients tongue is stuc
in this posi
tion, what might by the cause?" CN XII provides motor innervation to the tongue.
&nbsp;&nbsp;If the tongue deviates away from the midline, wea
ened contractions
on one side may be the result of a lesion to XII.&nbsp;&nbsp;The tongue will poi
nt to the side of the lesion.&nbsp;&nbsp;<br><br>In this case, the right glossal
muscles are wor
ing properly and the left glossal muscles are wea
ened.<br>
Suprahyoid Mar
ed
"<img src=""pastessmvo
.png"" /><br>Do me a solid, bro, and label this diagram o
f the floor of the mouth (simple view).&nbsp;&nbsp;"
1.&nbsp;&nbsp;Geniogloss
us<br>2.&nbsp;&nbsp;Geniohyoid<br>3.&nbsp;&nbsp;Mylohyoid<br>4.&nbsp;&nbsp;Hyogl
ossus<br>
Suprahyoid Mar
ed
"<img src=""pasteoqd5fq.png"" /><br>Here is the simple view of the suprahyoid mu
scles.&nbsp;&nbsp;Do your thing.&nbsp;&nbsp;" 1.&nbsp;&nbsp;Hyoglossus <br>2.&
nbsp;&nbsp;Mylohyoid <br>3.&nbsp;&nbsp;Anterior digastric<br>4.&nbsp;&nbsp;Poste

rior digastric<br>5.&nbsp;&nbsp;Stylohyoid<br> Suprahyoid Mar

ed
"<img src=""pastejnbbgw.png"" /><br>Oh goodness!&nbsp;&nbsp;This view certainly
is more complicated.&nbsp;&nbsp;Please, tell me what all these numbers mean!"
1. Genioglossus<br>2. Geniohyoid<br>3. Mylohyoid<br>4. Submandibular gland<br>5.
Submandibular duct<br>6. Sublingual papilla (and openings of the submandibular
duct)<br>7. Sublingual gland<br>8. Sublingual fold (and openings of the sublingu
al ducts)<br>9. Hyoglossus<br>10. Stylohyoid<br>11. Lingual artery (passing medi
al/deep to hyoglossus)<br>
Suprahyoid Mar
ed
"<img src=""pastezednah.png"" /><br>Label please.&nbsp;&nbsp;Bonus for the poste
rior unlabeled nerve.&nbsp;&nbsp;"
1. Submandibular duct<br>2. Sublingual g
land<br>3. Lingual nerve<br><br>The unlabeled nerve is CN IX, brah. <br>
Suprahyoid Mar
ed
"<img src=""pasteoz1mtj.png"" /><br>Identify. " 1. Anterior digastric<br>2. Mylo
hyoid<br>3. Hyoglossus<br>4. Styloglossus<br>5. Stylohyoid<br>6. Stylopharyngeus
<br>7. Superior pharyngeal constrictor<br>8. Buccinator <br>9. Posterior digast
ric<br> Suprahyoid Mar
ed
"<img src=""pastehxnjm
.png"" />"
1. Hypoglossal nerve<br>2. C1 (and C2)<b
r>3. Superior root of ansa cervicalis<br>4. Inferior root of ansa cervicalis (C2
and C3)<br>5. Ansa Cervicalis<br>6. Nerve to Thyrohyoid (C1 and C2)<br>7. Nerve
to geniohyoid(C1 and C2)<br>8. Nerves to genioglossus, hyoglossus, and styloglo
ssus (XII)<br>9. Lingual nerve (V3)<br> Suprahyoid Mar
ed
"<img src=""pastexdxlsb.png"" /><br>These features have lost their identity.&nbs
p;&nbsp;Can you identity-fy them?"
Structures passing deep to hyoglossus<br
>&nbsp;&nbsp;1. Lingual artery<br>&nbsp;&nbsp;2. Glossopharyngeal nerve IX (to b
e seen later)<br><br>Structures passing superficial to hyoglossus<br>&nbsp;&nbsp
;3. Lingual nerve (and submandibular ganglion)<br>&nbsp;&nbsp;4. Hypoglossal ner
ve<br><br>5. Styloglossus<br>6. Stylopharyngeus <br>7. Hyoglossus<br>8. Genioglo
ssus<br>9. Geniohyoid<br><br><br>
Suprahyoid Mar
ed
"<img src=""pastecn2otu.png"" /><br>Mandible features.&nbsp;&nbsp;Go. " 1. Head<
br>2. Nec
<br>3. Coronoid process<br>4. Mandibular foramen<br>5. Mental foramen<
br>6. Groove for nerve to mylohyoid<br>7. Mylohyoid line<br>8. Location of Subma
ndibular gland <br>9. Location of Sublingual gland<br>10. Genial tubercle<br>
Suprahyoid Mar
ed
Some questions from my notes:<br><br>1.&nbsp;&nbsp;The transition between what t
wo germ layers occurs on the tongue? <br><br>2.&nbsp;&nbsp;When they refer to ge
tting your tonsils out, which tonsils are they tal
ing about?&nbsp;&nbsp;Do they
still do this?<br><br>3.&nbsp;&nbsp;Do we have taste receptors for fat in addit
ion to sweet, sour, umami, etc?<br><br>4.&nbsp;&nbsp;What duct does the lingual
nerve sort of duc
around?<br><br>5.&nbsp;&nbsp;What is the implication for vari
ability of lingual nerve position for dental implants? 1.&nbsp;&nbsp;The endode
rm (internal lining) and ectoderm (external lining).<br><br>2.&nbsp;&nbsp;They d
ont remove the palatine tonsils nearly as much as they used to, because they ha
ve since been found to have immunological functions (surprise). <br><br>3.&nbsp;
&nbsp;Can you taste the difference between whole mil
and s
im mil
?&nbsp;&nbsp;
You bet you have fat receptors.&nbsp;&nbsp;<br><br>4.&nbsp;&nbsp;Submandibular d
uct. <br><br>5.&nbsp;&nbsp;If you have a high lingual nerve, it may get damaged
by shoddy dental implants, perhaps costing you taste receptors and ma
ing food l
ess fun.&nbsp;&nbsp;
Suprahyoid Mar
ed
"<img src=""pasteg
hhzm.png"" /><br>HEY YOU.&nbsp;&nbsp;WHATS THIS MUSCLE CALLE
D.&nbsp;&nbsp;WHAT ARE ITS ATTACHMENTS AND WHAT IS ITS FUNCTION.&nbsp;&nbsp;"
Masseter muscle.&nbsp;&nbsp;<br><br>Spans from the zygomatic arch to the angle o
f the mandible.&nbsp;&nbsp;<br><br>Elevates the mandible.&nbsp;&nbsp;<br><br>Com
ments:&nbsp;&nbsp;This is the muscle you feel on your face when you &quot;clench
your teeth&quot;.
InfratemporalFossa Mar
ed
"<img src=""pastehqlho7.png"" /><br />OH YEAH WISEGUY WHATS THE MUSCLE WITH THE
BIG NUMBER TWO ON IT.&nbsp;&nbsp;Also what are its attachments, actions, and ner
ve supply. "
Temporalis<br /><br />Attachments: from temporal fossa to corono
id process of mandible.<br /><br />Action : elevation and retraction of the mand
ible. <br /><br />Nerve Supply:&nbsp;&nbsp;Deep temporal nerve V3 (not temporal
of VII or auriculotemporal of V3)<br /><br />Comments:&nbsp;&nbsp;<br />This is

the muscle you feel in the temporal region when you &quot;clench your teeth.&quo
t;&nbsp;&nbsp;<br />Only muscle of mastication that can retract the mandible.&nb
sp;&nbsp;<br />In lab, you will see that the fibers to the coronoid surface also
extend downward on the medial surface of the mandible to a region very near the
rear molar teeth -- attachment is more broad than is represented here.
InfratemporalFossa Mar
ed
"<img src=""pasterqzvpy.png"" /><br /><br />Identify the labelled regions.&nbsp;
&nbsp;" 1. Temporal fossa region occupied by the temporalis muscle and temporali
s fascia (and not much else). Lies superior to the zygomatic arch<br /><br />2.
Infratemporal fossa lies inferior to zygomatic arch (and greater wing of the sph
enoid) AND medial to the ramus of the mandible, AND lateral to the lateral ptery
goid plate of the sphenoid. Communicates medially with the pterygopalatine fossa
through the pterygomaxillary fissure.<br /><br />Erratum: the two should be beh
ind the corocoid process of the mandible.&nbsp;&nbsp;<br />
InfratemporalFos
sa Mar
ed
"<img src=""paste9jxrum.png"" /><br>Ah, but can you identify the same region FRO
M A DIFFERENT ANGLE?" 2.&nbsp;&nbsp;Infratemporal Fossa
InfratemporalFos
sa Mar
ed
"<img src=""pastexw5og9.png"" /><br>Please identify the two labeled regions. "
2. Infratemporal Fossa<br><br>3.&nbsp;&nbsp;Pterygopalatine fossa<br>between the
maxilla and the pterygoid process of the sphenoid bone (accessed by passing thr
ough the pterygomaxillary fissure)<br><br><br>In this image we can also see the
medial pterygoid muscle which arises from the medial aspect of the lateral ptery
goid plate (and the posterior aspect of the maxilla)<br>
InfratemporalFos
sa Mar
ed
"<img src=""pastepf3yj0.png"" /><br>Identify these regions of the mandible. "
1. Head<br>2. Nec
<br>3. Ramus<br>4. Coronoid process<br>5. Angle<br>6. Body<br>
7. Mandibular foramen<br>8. Groove for nerve to mylohyoid<br>9. Mental foramen<b
r>10. Genial tubercle<br>
InfratemporalFossa Mar
ed
"<img src=""paste2jcxne.png"" /><br />Yo theres only one muscle this time.&nbsp
;&nbsp;I
now you can do it. Attachments and actions, please.&nbsp;&nbsp;Also, i
nnervation while you are at it. "
Lateral Pterygoid<br /><br />Attachments
: from lateral aspect of lateral pterygoid plate and inferior surface of greater
wing of sphenoid to articular disc and head of mandible<br /><br />Action: prot
raction and lateral grinding of mandible <br /><br />Innervation: Lateral Pteryg
oid nerve of V3 (wi
i)<br /><br />Comments: relatively horizontal orientation -head of the mandible to the articular disc of the temporomandibular joint (TMJ)
<br /> InfratemporalFossa Mar
ed
"<img src=""paste24qcdv.png"" /><br><br>Lolz.&nbsp;&nbsp;Guess where the head of
the mandible is going as it protracts.&nbsp;&nbsp;Picture it IN YOUR MIND!"
"<img src=""paste7qwbds.png"" /><br>Its so wac
y.&nbsp;&nbsp;<br><br>Lateral pt
erygoid moves articular disc and head of mandible forward. Head of mandible come
s to lie inferior to the&nbsp;&nbsp;articular tubercle<br><br>" InfratemporalFos
sa Mar
ed
"<img src=""pastexr4mt0.png"" /><br />Please identify the muscle shown, as well
as its attachments, actions, and innervation. " Medial Pterygoid<br /><br />Atta
chments from medial aspect of lateral pterygoid plate and posterior surface of m
axilla to angle of mandible<br /><br />Actions: elevation and grinding of mandib
le<br /><br />Innervation: anterior root of the mandibular branch of V3 (wi
i)<b
r /><br />Comments: <br />The medial pterygoid muscle lies in a more vertical or
ientation. <br />Similar position to the masseter muscle but only deeper. <br />
<br /> InfratemporalFossa Mar
ed
"<img src=""pastehb5yjm.png"" /><br>Identify, then compare and contrast, the ind
icated muscles. "
1. Lateral pterygoid<br>2. Medial pterygoid<br><br>Both
muscles arise from lateral pterygoid plate<br><br>Both muscles have two head of
origin<br><br>Both muscles contribute to protrusion and lateral grinding motion
of teeth<br><br>* Note: the small gap between the maxilla and the pterygoid proc
ess of sphenoid bone. This is the pterygomaxillary fissure which is the entrance
to the pterygopalatine fossa<br>
InfratemporalFossa Mar
ed
List, and picture in your mind, the muscles of mastication.&nbsp;&nbsp;Picture t

hem from a posterior view of the mandible, because you better believe that shit
is coming up in just a moment.&nbsp;&nbsp;
"<img src=""pastefn
b95.png"" />
<br />Told you bro<br /><br />1. Masseter<br />2. Mandible<br />3. Medial pteryg
oid<br />4. Lateral pterygoid<br /><br />Not really shown is the temporalis.<br
/><br />Of Note: <br />Origin of medial pterygoid from medial aspect of lateral
pterygoid plate.<br /><br />Pterygoid muscles act synergistically to produce mov
ement toward the contralateral side, i.e. the pterygoids on the left, move the m
andible toward the right<br /><br />By alternating between right side and left s
ide contraction of the pterygoid muscles we are able to achieve a lateral grindi
ng motion of the mandible. <br /><br />To maintain a centralized neutral positio
n of the mandible and simply move it up and down as we chew (and spea
) then bot
h sets of pterygoid muscles must contract in a balanced fashion.&nbsp;&nbsp;<br
/>"
InfratemporalFossa Mar
ed
"<img src=""pastegfhil5.png"" /><br /><br />Please identify and give the functio
n of each of the indicated nerves. "
1. Buccal <br />&nbsp;&nbsp;- general se
nsory to outside chee
and inner chee
mucosa<br />2. Lingual<br />&nbsp;&nbsp;general sensory fibers to anterior 2/3 tongue<br />&nbsp;&nbsp;- carries hitch
hi
ing chorda tympani with taste and parasympathetic fibers<br />3. Inferior alv
eolar<br />&nbsp;&nbsp;- general sensory to teeth of the mandible<br />&nbsp;&nb
sp;- terminates by exiting mandible through mental foramen to supply general sen
sory to chin s
in<br />4. Auriculotemporal (passes posterior to nec
of mandible
)<br />&nbsp;&nbsp;- general sensory to upper auricle as well as neighboring tem
ple<br />&nbsp;&nbsp;- hitch hi
ing parasympathetic fibers from otic ganglion to
parotid gland<br />5. Deep temporal (deep to temporalis)<br />&nbsp;&nbsp;- mot
or to temporalis<br />6. Posterior superior alveolar (V2)<br />&nbsp;&nbsp;- gen
eral sensory to upper teeth in maxilla<br /><br /><br /> <br /> InfratemporalFos
sa Mar
ed
"<img src=""pastezymsfv.png"" /><br />Identify all the nerves...again!&nbsp;&nbs
p;Bwa hahahaha. <br /><br /><br />In this diagram the muscle fibers of the later
al pterygoid have been removed so that you can see the branches of V3 as it exit
s the s
ull through what foramen?. "
1.&nbsp;&nbsp;Buccal<br />2.&nbsp;&nbsp;
Lingual (joined by chorda tympani)<br />3.&nbsp;&nbsp;Inferior alveolar (gives o
ff nerve to mylohyoid which also supplies anterior belly of digastric)<br />4.&n
bsp;&nbsp;Auriculotemporal (forms loop around middle meningeal artery)<br />5.&n
bsp;&nbsp;Deep temporal (motor to temporalis muscle)<br />6.&nbsp;&nbsp;Posterio
r superior alveolar (from V2)<br /><br />V3 also sends motor branches to tensor
palati and tensor tympani<br /><br />In this diagram the muscle fibers of the la
teral pterygoid have been removed so that you can see the branches of V3 as it e
xits the s
ull through foramen ovale. <br />
InfratemporalFossa Mar
ed
"<img src=""pastezzu0ij.png"" /><br><br>What nerve is depicted in yellow in the
diagram?"
Lingual Nerve<br><br>Supplies general sensory to anterior 2/3 of
tongue<br><br>Joined by chorda tympani (carrying taste to anterior 2/3 of tongu
e and preganglionic parasympathetic fibers to submandibular ganglion for submand
ibular and sublingual glands<br><br>
InfratemporalFossa Mar
ed
"<img src=""paste5oyu2v.png"" /><br /><br />Please label the features indicated
in the diagram. "
1. Tympanic nerve of IX<br />2. Tympanic plexus in middl
e ear cavity<br />3. Lesser petrosal nerve in middle cranial fossa<br />4. V3 in
foramen ovale<br />5. Otic ganglion<br />6. Auriculotemporal nerve forms loop a
round middle meningeal artery<br />7. Parotid gland<br /><br />Otic ganglion con
tains cell bodies and synapses.&nbsp;&nbsp;Presynaptic parasympathetic fibers fr
om IX synapse in the ganglion and travel on auriculotemporal to the parotid glan
d, where they have a secretomotor effect. <br /><br />Once auriculotemporal ma
e
s its way up to the s
in, it is once again purely general sensory.
Infratem
poralFossa Mar
ed
"<img src=""pasteb1ysdn.png"" />"
1. External carotid<br />2. Superficial
temporal<br />3. Maxillary<br />4. Inferior alveolar<br />5. Middle meningeal<br
/>6. Dives through pterygomaxillary fissure to give several branches within pte
rygopalatine fossa and terminate as the sphenopalatine artery to supply the nasa
l cavity<br /><br />Maxillary artery begins in the parotid gland, travels medial
ly through the infratemporal fossa giving off several branches (including middle

meningeal and inferior alveolar), passes through the pterygopalatine fossa, and
enters the nasal cavity to supply the mucosa of the nasal cavity.<br /><br />Th
e&nbsp;&nbsp;origin for the infraorbital artery is the maxillary artery.<br />
InfratemporalFossa Mar
ed
"<img src=""pastehjs
eu.png"" /><br />This is an extra picture!&nbsp;&nbsp;Who

nows what that means.&nbsp;&nbsp;Identify. "

1. Otic ganglion<br />2. Chorda
tympani<br />3. Lingual nerve<br />4. Inferior alveolar<br />5. Nerve to mylohyo
id (and anterior belly of digastric)<br />6. Auriculotemporal<br />7. Nerve to t
ensor tympani <br />8. Lesser petrosal nerve<br /><br />&quot;This extra picture
attempts to show how V3 fibers are going bac
to innervate tensor tympani in th
e middle ear cavity. This image ma
es it loo
li
e the fibers are coming off the
otic ganglion, but in my opinion I believe this to be misleading and not accura
te. But in any case this level of detail is not important. Just
now that tensor
tympani is innervated by V3. It is not important the exact pathway it ta
es to
get there.&quot;<br /><br />This diagram also illustrates chorda tympani as it i
s exiting the petrotympanic fissure to join up with the lingual branch of V3 <br
/>
InfratemporalFossa Mar
ed
What are some major differences between inflammatory vs non-inflammatory arthrit
is (aside from the obvious)?<br><br>
Inflammatory (rheumatoid): systemic, get
s better with usage of joint, redness, swelling, heat (three classic signs of in
flammation)<br><br>Non-inflammatory (osteo): localized, gets worse with joint us
age
Osteoarthritis Mar
ed
(T/F) Osteoarthritis is associated with a variety of bad things li
e disability,
pain, and mortality. T<br><br>-Captain Obvious
Osteoarthritis Mar
ed
What is the OARSI definition of osteoarthritis?<br><br>-progressive or sudden on
set?<br>-joint damage or something more?<br>-damage to cartilage only?<br>-one j
oint or many? "Basically:<br>-progressive<br>-joint damage <span style=""fontweight:600; color:#ff1a1b;"">AND FAILURE TO REPAIR</span><br>-damge to cartilage
, bone, ligaments, nerves, muscle, synovium, etc. everything.<br>-can be one joi
nt (compared to RA) but many joints can be affected individually <br><br>From th
e slides:<br>OA is usually a progressive disease of synovial joints that represen
ts failed repair of joint damage..<br>joint damage that results from stresses th
at may be ini/ated by an abnormality in any of the synovial joint /ssues,<br>inc
luding ar/cular car/lage, subchondral bone, ligaments, menisci, periar/cular mus
cles, peripheral nerves or synovium<br>The process ul/mately results in brea
down
of car/lage and bone, leading to symptoms of pain, s/ffness and func/onal disabi
lity.<br>Abnormal intra-ar/cular stress and failure of repair may arise as a res
ult of biomechanical, biochemical and/or gene/c factors.<br>This process might b
e localized to a single joint, a few joints or generalized, and the factors that
ini/ate OA li
ely vary depending on the joint site." Osteoarthritis Mar
ed
What are the most common joints damaged by osteoarthritis?
DIP, PIP,
nees,
hips, shoulders, and spine<br><br>Final two less common.
Osteoarthritis M
ar
ed
What is an osteophyte (hyperdense node)?
"deformity of bone in which bone
grows along the joint margins where cartilage would be<br><br>Below: see excess
bone growth at the DIPs<br><img src=""Screen Shot 2013-01-28 at 10.58.18 PM.png
"" />" Osteoarthritis Mar
ed
What are some mostly obvious ris
factors for osteoarthritis? -Age<br>-Female:
maybe estrogen deficiency (as in osteoporosis)<br>-genetic: significant enough
to influence genes for joint repair and growth<br>-biomechanical<br>-BMI: inflam
mation, load of weight<br>-environment: EtOH, smo
ing, nutrition<br>
Osteoart
hritis Mar
ed
What are the roles of MMPs and TIMPs in osteoarthritis? What about IL-1 and NO?
TGF-beta?
MMPs are matrix metalloproteinases, involved in collagen brea
do
wn.<br><br>TIMPs are tissue inhibitors of metalloproteinases, preventing the upr
egulation of active MMPs.<br><br>TIMP and MMP levels are in delicate balance and
their disruption (less TIMPs, more MMPs) can lead to collagen degradation.<br><
br>IL-1 and NO upregulate chondrocyte degradation of cartilage, countering the a
ction of TIMPs.<br><br>TGF-beta has some un
nown protective mechanism. Osteoart
hritis Mar
ed

(T/F) use of glucosamine is recommended for osteoarthritis

F; trial results
that show significant therapeutic effect are funded by industry.
Osteoart
hritis Mar
ed
Which hypersensitivity does NOT involve antibodies in its effector mechanisms<br
/><br />A. Type I<br />B. Type II<br />C. Type III<br />D. Type IV
<b>D. Ty
pe IV</b><br /><br />Type IV is T-cell mediated.<br /><br />The other 3 are anti
body mediated. Just transferring Abs between people recapitulates the diseases.
Hypersensitivity
What is an anaphylactoid?<br />An anaphylactic?<br />An anaphylatoxin?<br /><br
/>In which type of hypersensitivity rxns are all of these involved?
<u>Anaph
ylactoids</u>: <b>Drugs</b> that induce type I hypersensitivity responses<br /><
br /><u>Anaphylactics</u>: <b>Environmental</b> stimuli that induce type I hyper
sensitivity responses. Bee stings, cedar pollen, etc.<br /><br /><u>Anaphylatoxi
ns</u>: <b>C3a, C4a</b> and <b>C5a</b>. These alone can induce type I hypersensi
vity. This fact explains <b>dermatographism</b>.<br /> Hypersensitivity Mar
ed
Reactions to poison ivy and metals and the tuberculin s
in test are all examples
of which type of hypersensivity rxns?<br><br>A. Type I<br />B. Type II<br />C.
Type III<br />D. Type IV
<b>D. Type IV</b>
Hypersensitivity Mar
ed
Give the basic mechanism of each of the types of hypersensitivities.
<u>Type
I:</u> IgE binding to antigen causes mast cell <b>degranulation</b>, releasing h
istamine and other inflammatory molecules<br><br><u>Type II:</u> <b>Antigen-spec
ific</b>. Abs bind to self antigens and induce complement fixation, opsonization
, and frustrated phagocytosis just li
e type III.<br>If Abs are directed against
a receptor, may demonstrate <b>neutralization</b> or <b>activation</b>.<br><br>
Type III: Antigen-irrelevant. <b>Immune complexes</b> made of Abs fix complement
, opsonize, and induce frustrated phagocytosis. Also demonstrates <b>leu
ocyte a
ctivation</b>.<br><br>Type IV: <b>T-cell mediated</b>. Involves macrophage activ
ation, cyto
ines, and CTLs.
Hypersensitivity Mar
ed
"Do what it do.<br><br><img src=""pastes00NFB.png"" />" "<img src=""paste4EjJ8D.
png"" />"
Hypersensitivity Mar
ed
Run through the 7-step sequence of events in type I hypersensitivity, starting w
ith initial exposure to antigen.
"<img src=""pastep2zQGH.png"" />"
Hypersensitivity Mar
ed
"Fill in for type I hypersensitivity.<br><br><img src=""pasteK2YecR.png"" />"
"<img src=""pastetKt
N7.png"" />"
Hypersensitivity Mar
ed
List the 4 types of receptors on which you find ITAMs. BCRs<br>TCRs<br>Cyto
ine
receptors<br>Fc receptors
Hypersensitivity Mar
ed
Give the inciting event, 3 classes of downstream mediators, and 5 ultimate effec
ts of mast cell activation in type I hypersensitivity. "<img src=""pasteg_KJ9w.
png"" />"
Hypersensitivity Mar
ed
"Provide the 4 classes of symptoms associated with type I hypersensitivity. Also
provide the second column.<br><br><img src=""pasteXwYrFC.png"" />"
"<img sr
c=""pasteHmafX1.png"" />"
Hypersensitivity Mar
ed
"Fill in.<br><br><img src=""paste5AS0OJ.png"" />"
"<img src=""pasteMt0n6T.
png"" />"
Hypersensitivity Mar
ed
Vertebral layers of the thyroid?
C5-T1 Mar
ed
With regards to inflammatory arthritis, what does seronegative vs. seropositive
mean? Seronegative or positive refers to whether the inflammation involves rhe
umatoid factor (RF) IgM.
Mar
ed InflammatoryArthritis
What is the definition of seronegative spondyloarthopathy?
Seronegative: do
es not involve rheumatoid factor (RF) IgM<br />spondylo: vertebral column<br /><
br />Thus, an injury to a spinal column joint that does not involve does not inv
olve rheumatoid factor (RF) IgM.
Mar
ed InflammatoryArthritis
What is crystal induced arthritis?
Caused by build up of uric acid crystals
.
Mar
ed InflammatoryArthritis
"Molecular pathophysiology of inflammatory arthritis (reference card)<br><img sr
c=""Screen Shot 2013-01-30 at 1.29.57 AM.png"" />"
Mar
ed Inflammat
oryArthritis
What gene/protein is most commonly indicted as a cause of inflammatory arthritis
?
HLA-DR of MHC Class II<br><br>Other B-T cell interaction genes are also

responsible.
Mar
ed InflammatoryArthritis
During the pathological cellular cascade of inflammatory arthritis, T cells are
activated. What type of T cell predominates and what cyto
ines does it release?
"Th1 cells predominate, releasing IFN-gamma and TNF-alpha.<br><br>TNF-alpha is a
popular drug target to treat inflammatory arthritis.<br><img src=""Screen Shot
2013-01-30 at 1.29.57 AM.png"" />"
Mar
ed InflammatoryArthritis
"<span style=""font-weight:600; color:#0000ff;"">Citrullination</span> is the ch
emical process of using peptidylarginine deaminase and Ca+2 to <span style=""fon
t-weight:600; color:#0000ff;"">convert arginine to citrulline</span>, an amino a
cid commonly found on fillagrin, MBP (of oligodendrocytes), and histones.<br><br
>What inflammatory role does citrulline play?<br><br>What is the role of Cyclic
Citrullinated Peptide Antibody (CCP Ab) in <b>seronegative (why?)</b> inflammato
ry arthritis? " "Normal on other proteins,<span style=""color:#ff1a1b;""> </span
><span style=""font-weight:600; color:#ff1a1b;"">citrulline is found on </span><
span style=""font-weight:600; color:#ff1a1b;"">vimentin of inflammed cells</span
>. These <span style=""font-weight:600; color:#ff1a1b;"">citrullinated proteins
appear as foreign antigens</span> to our immune system. Binding by CCP Abs trigg
ers an immune response against our already inflammed cells.<br><br>Seronegative
inflammatory arthritis does not involve rheumatoid factor IgM.<br><img src=""Scr
een Shot 2013-01-30 at 1.36.01 AM.png"" />"
Mar
ed InflammatoryArthritis
What is the primary drug target in inflammatory arthritis? Why? "TNF-alpha: tell
s fibroblasts to ma
e more RANKL and activate osteoclasts, inhibits osteoblast d
ifferentiation (via D

-1)<br><img src=""Screen Shot 2013-01-30 at 1.29.57 AM.pn

g"" />" Mar
ed InflammatoryArthritis
What is rheumatoid factor?
"Clinical differentiator between seropositive (i
nvolves RF) and seronegative inflammatory arthritis. It is IgM that binds to the
Fc portions of IgG and stimulates the complement pathway.<br><img src=""Screen
Shot 2013-01-30 at 1.36.01 AM.png"" />" Mar
ed InflammatoryArthritis
"What are the
ey indicators of normal joint tissue below?<br><img src=""Screen
Shot 2013-01-30 at 1.51.30 AM.png"" />" Only one or two layers of synovial cells
, fat and collagen loo
normal. Blood vessels are small and norma.
Mar
ed I
nflammatoryArthritis
"What are the
ey features of the slide below of rheumatoid arthritis?<br><img s
rc=""Screen Shot 2013-01-30 at 1.51.35 AM.png"" />"
-Multiple synovial cell
layers (&gt;2)<br>-lots of chronic inflammatory cells (lymphocytes, macrophages,
plasma cells)<br>-endothelial hypertrophy and dont see normal fat and collagen
Mar
ed InflammatoryArthritis
What are some general clinical features of RA (rheumatoid arthritis)? "In addi
tion to the below (two slides), the most commonly affected joints are the MCP an
d PIP.<br><img src=""Screen Shot 2013-01-30 at 1.54.29 AM.png"" /><br><img src="
"Screen Shot 2013-01-30 at 1.54.59 AM.png"" />" Mar
ed InflammatoryArthritis
What are some related pathologies of RA that arent joint-related (extra-articul
ar)?
"<img src=""Screen Shot 2013-01-30 at 1.55.53 AM.png"" />"
Mar
ed I
nflammatoryArthritis
"What are some
ey things to note from the two images below?<br><img src=""Scree
n Shot 2013-01-30 at 1.56.18 AM.png"" /><br><img src=""Screen Shot 2013-01-30 at
1.56.25 AM.png"" />" CXR: fuzziness of lungs, uneven infiltrates, less transp
arent air, edema<br>XRay: on left hand see subluxation of 2nd digit, joints erod
ed and the bone itself is more degraded; carpal bones dont loo
too hot.
Mar
ed InflammatoryArthritis
What have been the two most important treatment innovations in RA?
Steroids
, later followed by antibodies against TNF-alpha, ILs, etc.
Mar
ed Inflammat
oryArthritis
What is the possible role of HLA-B27 in spondyloarthritis?
"Normally, if it
presents self-antigen (as part of MHC Class I), the T cell that has a strong re
action to it apoptoses.<br><br>However, some mutations on the HLA-B27 dont trig
ger apoptosis and instead allow the autoimmune T cell to li<img src=""Screen Sho
t 2013-01-30 at 2.02.54 AM.png"" />ve and proliferate.<br>"
Mar
ed Inflammat
oryArthritis
What is the most common cause of crystal-induced arthropathy?<br>
Kidneys

cant remove uric acid. Mar

ed InflammatoryArthritis
In crystal-induced arthritis, how do the uric crystals trigger inflammation?
"Rather than being inflammogenic themselves (despite being large and sharp), fru
strated phagocytosis by macrophage lyses the cell and releases its
illing molec
ules and inflammatory cyto
ines.<br><img src=""Screen Shot 2013-01-30 at 2.08.53
AM.png"" />" Mar
ed InflammatoryArthritis
What is the most common treatment for crystal-induced arthritis?
Xanthine
oxidase inhibitors li
e allopurinol. They stop a critical step of uric acid syn
thesis. Mar
ed InflammatoryArthritis
What some distinct clinical features of infectious inflammatory arthritis?
-fever<br>-high WBC count and white fluid around joints<br>
Mar
ed Inflammat
oryArthritis
What are the four fontanelles? <br /><br />What information can be obtained by t
heir palpation? Anterior (Frontal), Posterior (Occipital), Mastoid, and Sphenoid
fontanelles.<br /><br />Can determine growth and hydration status.
Mar
ed C
RANIALCAVITY
Give the odds of getting common variable immunodeficiency (CVID). Do the same fo
r IgA deficiency.
IgA deficiency<b> 1 in 500</b><br>Many people who start
w/ this will progress to CVID<br><br>CVID: <b>1 in 50,000</b><br>Always have low
IgG, sometimes low IgM, IgA<br><br>The word common is misleading; IgA deficie
ncy is whats actually common<br><br><br>
Hypersensitivity Mar
ed
What is the primary way the body disposes of immune complexes? The carwash mech
anism Hypersensitivity Mar
ed
Compare and contrast type II and type III hypersensitivity.
"<img src=""past
e519aQl.png"" />"
Hypersensitivity Mar
ed
Give the 3 effector mechanisms of type II hypersensitivity.
"<img src=""past
eJbMrZG.png"" />"
Hypersensitivity Mar
ed
Give 4 specific examples of type II hypersensitivity-related diseases (out of 8)
.
Autoimmune hemolytic anemia<br>Autoimmune (idiopathic) thrombocytopenic
purpura<br>Goodpastures syndrome<br>Graves disease<br>Myasthenia gravis<br>Pem
phigus vulgaris<br>Pernicious anemia<br>Rheumatic fever Hypersensitivity Mar
ed
"<img src=""paste5cP_VH.png"" />"
"I apologize for the cut-offs. For some
reason, my OneNote
eeps messing up the size of only the immuno slides.<br><br><
img src=""pastem4b8b8.png"" />" Hypersensitivity Mar
ed
Name 3 immune complex diseases (of 5). Systemic lupus erythematosus<br>Polyarte
ritis nodosa<br>Poststreptococcal glomerulonephritis<br>Serum sic
ness (clinical
and experimental)<br>Arthus reaction (experimental)
Hypersensitivity Mar
ed
"Fill in for immune complex diseases (type III hypersensitivity).<br><br><img sr
c=""paste0Bs1Nl.png"" />"
"<img src=""pasteGBmwxt.png"" />"
Hypersen
sitivity Mar
ed
You just got bitten by a rattlesna
e. Shit. You go in to the ER. How are you goi
ng to be treated?<br><br>6 months later: You just got bitten by the same damn ra
ttlesna
e. Double shit. You go in to the ER. How are you going to be treated thi
s time? 1. Given sheep anti-venom, which is sheep Abs against the rattlesna
e ve
nom with the Fc part industrially cleaved off.<br>This will inactivate the rattl
esna
e venom. But youll ma
e antibodies against the sheep-li
e Fab regions of t
he antivenom Abs.<br><br>2. If you get the same anti-venom again, your own Abs w
ill bind to the Fab-only sheep antivenom Abs and will ma
e immune complexes, giv
ing you type III hypersensitivity. Clinicians will have to switch you to antiven
om Abs from another species, if theyre even available...<br><br>Good ?: Why not
just avoid all this stupid complexity by ma
ing a human antibody?<br>-Answer: H
uman Abs are definitely safer and we do do that, but its expensive. Also, if we
did that, Rogers couldnt build up these ridiculously complicated clinical scen
arios. Hypersensitivity Mar
ed
In which immune cell type does the
ey to the pathogenesis systemic lupus erythe
matosus occur?<br><br>What is it?
B cells that can ma
e Abs against DNA an
d nucleoproteins are never deleted during their bone marrow education b/c they n
ever see these epitopes as theyre usually hidden inside cells.<br><br><b>T cell
s</b> are necessary to activate those B cells, though. Remember they have X-ray
vision. So, they can see nucleoprotein fragments presented by MHC molecules. Tho

se that react strongly against nucleoproteins should thus be deleted in the thym
us. Except in lupus theyre not.
Hypersensitivity Mar
ed
What are the 3 most common symptoms associated with early myasthenia gravis?<br
/><br />How does the disease progress? Adult onset diplopia<br />Ptosis of eyel
ids<br />Limited extraocular movements<br /><br />Progresses to affect the whole
body if untreated:<br>Paralysis<br>Gait problems<br>Fatigue<br>Normal reflexes
Hypersensitivity Mar
ed
What is the prevalence of myasthenia gravis?
0.5 to 5 in 100,000
Hypersen
sitivity Mar
ed
What are the 4 pathologic mechanisms at wor
in myasthenia gravis?
4 mechan
isms of anti-acetylcholine receptor Ab effects:<br><br>1. Increased endocytosis
and destruction of ACh receptors<br>2. IgG1 and 3 will fix complement --&gt; ner
ve destruction<br>3. Receptor bloc
ade (IgG1, 2, 3, and 4)<br>4. <b>Transplacent
al effects on the fetus via IgG and its transporter FcRn. Babies will often reco
ver from this (remember IgG half-life of ~1 month and about 10 month maternal du
ration after birth).</b><br>
Hypersensitivity Mar
ed
"Fill in.<br><br><img src=""pastewxQx8v.png"" />"
"<img src=""pasteGTBXei.
png"" />"
Hypersensitivity Mar
ed
Graves disease:<br><br>1. What is its prevalence?<br><br>2. What are two ris
f
actors for it? 1. 1 in 1,000<br><br>2. Famial history of it<br>Associated with
bacterial infections (could be molecular mimicry going on)
Hypersensitivity
Mar
ed
Give the 4 step mechanism of Graves disease pathogenesis.<br><br>What is the ge
neral strategy for how Graves disease is treated?
1. <b>Infiltration</b> o
f activated lymphocytes into thyroid. These bastards also convert lymph vessels
in the thyroid into little ectopic lymph nodes w/ dendritic cells and B cells ma

ing autoantibodies right in the thyroid :(<br><br>2. Abs bind the thyroid stimu
lating hormone receptor (<b>TSHR</b>)<br><br>3. Abs act as agonists, inducing TS
HR overstimulation<br><br>4. Excessive production of thyroid hormone (a.
.a. hyp
erthyroidism)<br><br>Treatment: bloc
thyroid hormone production and action
Hypersensitivity Mar
ed
What are the 3 autoimmune thyroid diseases? What is the prevalence of each?
1. Graves disease: 1 in 1,000<br>2. Hashimotos lymphocytic thyroiditis: 3-4%<b
r>3. Postpartum thyroiditis: 5-8% incidence w/in 6 months postpartum
Hypersen
sitivity Mar
ed
What is the difference between prevalence and incidence?
Incidence is # o
f cases per unit time<br>Prevalence is # cumulative cases; li
e total lifetime r
is

Hypersensitivity Mar
ed
What is the 3 step mechanism of disease in Hashimotos lymphocytic thyroiditis?
1. Abs against thyroglobulin and thyroid peroxidase bloc
production of thyroid
hormone.<br>2. This results in hypothyroidism<br>3. If theres an IgG1 and 3 cyt
olytic response, may see CTL-mediated destruction that loo
s li
e type IV HS.
Hypersensitivity Mar
ed
What is the damaging agent in postpartum thyroiditis? Complement-fixing anti-T
PO antibodies<br><br>These affect mom, not baby Hypersensitivity Mar
ed
"Which of these thyroid follicles is normal?<br />Whats the problem in the othe
r?<br><br><img src=""pasteA15dwv.png"" />"
Top left is normal<br>Bottom rig
ht is Hashimotos disease--loo
s li
e type IV HS
Hypersensitivity Mar
ed
"Fill in this graph for Type III HS with the following curves:<br><br>Foreign se
rum proteins<br>Antigen:antibody complexes<br>Antibody to foreign serum proteins
<br><img src=""pastezb3xKO.png"" />"
"<img src=""pasteN6_8ia.png"" />"
Hypersensitivity Mar
ed
What induces the T3HS Arthus reaction?<br /><br />Give the 6 step mechanism of t
he Arthus reaction.<br /><br />Give the locations that it can affect. "1. Subc
utaneous injection of antigen in animals. Also vaccination.<br /><br />2. 1. Ab
form complexes with antigen<br />2. Ab:Ag complexes fix complement;<br />3. C5a an
d other anaphylatoxins attract neutrophils (PMN)<br />5. PMN carry out frustrated
phagocytosis<br />6. Release of neutrophil enzymes causes tissue damage, necrosi
s<br /><br />3. Location of immune complexes:<br />1. Local tissues<br />2. Circ
ulating complexes lodge in
idneys, joints, <br />a. Small complexes subepitheli

um<br />b. Large complexes&nbsp;&nbsp;basement membranes, causing vaculitis<br><

br><img src=""paste8Xcf1j.png"" />"
Hypersensitivity Mar
ed
"Fill in for T3HS.<br><br><img src=""pastegzYVv3.png"" />"
"<img src=""past
eBWEbXR.png"" />"
Hypersensitivity Mar
ed
This bro comes into the clinic for some bad ass pneumonia.<br>You treat him with
penicillin.<br>That ish resolves.<br>But shortly afterward, he develops puffy e
yes and large hives on his abdomen.<br>1. What does he have?<br>2. What 3 things
do you do?<br><br>He gets worse. Nephritis, edema, etc.<br><br>3. Now what do y
ou do? (3)
1. Drug-induced serum sic
ness<br><br>2. 1. Discontinue penicill
in immediately.<br>2. Treat w/ benadryl, albuterol, and naproxen<br>3. Ta
e an R
BC sedimentation rate. Its 30 mm/hr when normal is 20 mm/hr. This means his his
RBCs are overloaded with immune complexes.<br><br>3. After worsening: treat wit
h prednisone to decrease inflammation.<br>He gets better so you <b>taper</b> him
off of it. Carwash mechanism has finally dealt with all penicillin immune compl
exes.<br>Instruct him never to ta
e penicillin again.<br>
Hypersensitivity
Mar
ed
What are the 2 mechanisms of T cell mediated tissue injury in T4HS?
"Angry m
acrophages too<br><br><img src=""pasteDW590z.png"" />" Hypersensitivity Mar
ed
You just touched poison ivy.<br><br>Give the mechanisms by which you can develop
all 4 hypersensitivities at once.
T4HS: CD8 cells specific for erushiol co
valently bound to our own proteins respond to cells w/ these adducts and
ill th
em. CD4 cells activate other inflammatory cells.<br><br>T3 and 2 HS: Can also ha
ve Abs against erushiol adducted proteins; <br>generate immune complexes via Art
hus rxn<br><br>T1HS: typical IgE response to erushiol w/ mast cell degranulation
<br>
Hypersensitivity Mar
ed
"What type of HS is this?<br /><img src=""pasteSwB6NG.png"" />" "<img src=""past
e
Q66li.png"" />"
Hypersensitivity Mar
ed
Name 4 specific T4HS diseases (of 8). Multiple sclerosis<br>Rheumatoid arthrit
is<br>Type 1 diabetes mellitus<br>Crohns disease<br>Contact sensitivity (e.g. p
oison ivy)<br>Chronic infections<br>Viral hepatitis (HBV, HCV)<br>Superantigen-m
ediated diseases (toxic shoc
syndrome) Hypersensitivity Mar
ed
"Fill in for T4HS.<br><br><img src=""pastevKuHRZ.png"" />"
"<img src=""past
eTeaQUV.png"" />"
Hypersensitivity Mar
ed
Compare the time-scales of T3HS (Arthus reaction specifically) and T4HS in the c
ontext of s
in reactions.
Arthus rxn ta
es <b>8-12</b> hrs for immune comp
lexes to form in situ.<br><br>T4HS ta
es<b> 24-48</b> hrs between s
in exposure
and s
in reaction.
Hypersensitivity Mar
ed
What types of antigens may induce immune responses that cause hypersensitivity d
iseases?
environmental anitgens, pathogens, drugsanything the patient has
been previously exposed to
Hypersensitivity Mar
ed
What is the sequence of events in a typical immediate hypersensitivity reaction?
What is the late-phase reaction and what is it caused by?
initial exposure
to an allergen causes production of IgE (TH2 cells release IL-4 and IL-13, stim
ulating class-switching to IgE)<br><br>IgE are bound to FcgammaRI receptors on m
ast cells<br><br>on subsequent exposure, allergen binds and cross-lin
s IgE boun
d to mast cell surface receptors, resulting in degranulation of mast cells (rele
ase of vasoactive amines and proteases) and synthesis by mast cells of prostagla
ndins, leu
otrienes, and cyto
ines<br><br>immediate hypersensitivity reaction du
e to granule contents (vasoactive amines, proteases)vascular dilatation, smooth m
uscle contraction, tissue damage<br><br>late-phase reaction is caused by recruit
ment/activation (by IL-4, IL-5, TNF) of neutrophils, eosinophils, TH2 cells and
by arachidonic acid derivativesvascular dilatation, smooth muscle contraction, in
flammation<br> Hypersensitivity Mar
ed
What are some examples of immediate hypersensitivity disorders, what is their pa
thogenesis, and how are they treated? allergic rhinitisexposure to inhaled anti
gens resulting in mucus secretion and upper airway inflammation<br><br>food alle
rgiesincrease GI peristalsis due to smooth muscle contraction<br><br>bronchial as
thmabronchoconstriction due to smooth muscle contraction; inflammation (treat wit
h corticosteroids, phosphodiesterase inhibitors)<br><br>anaphylaxissystemic fall
in BP, pulmonary edema caused by massive mast cell degranulation (treat with epi

nephrine to inhibit mast cell degranulation and open airways)<br><br>other treat

ments: desensitization, antihistamines, anti-IgE antibodies, cromolyn (inhibitor
of mast cell degranulation)<br>
Hypersensitivity Mar
ed
How do antibodies cause tissue injury and disease? What are some of the differen
ces in the manifestations of disease caused by antibodies against extracellular
matrix proteins and by immune complexes that deposit in tissues?
cause in
jury/disease by fixing complement, opsonizing native cells, bloc
ing or stimulat
ing receptors, and causing inflammation<br><br>antibodies against ECM tend to be
self-reactive and confined to specific target tissues<br><br>antibodies against
soluble antigens tend to produce systemic effects (e.g. vasculitis)often involve
inflammation<br>
Hypersensitivity Mar
ed
What are some examples of diseases caused by antibodies or immune complexes, wha
t is their pathogenesis, and what are their principal clinical and pathologic ma
nifestations? autoimmune hemolytic anemiaantibody against RBC membrane proteins
(causes anemia by opsonization of RBCs)<br><br>autoimmune thrombocytopenic purp
uraantibody against platelets (causes bleeding)<br><br>pemphigus vulgarisantibody
against epidermal cadherins (causes release of proteases, disruption of adhesion
s, blistering)<br><br>Goodpastures syndromeantibody against
idney glomeruli and l
ung alveoli (causes inflammation, nephritis, lung hemorrhage)<br><br>acute rheum
atic feveranti-Streptococcus antibody cross-reacts with myocardium (inflammation,
myocarditis, arthritis)<br><br>myasthenia gravisantibody against ACh receptor (i
nhibits ACh binding and causes muscle paralysis/wea
ness)<br><br>Graves diseaseant
ibody against TSH receptor (stimulates receptor and causes hyperthyroidism)<br><
br>pernicious anemiaantibody against gastric intrinsic factor (neutralizes intrin
sic factor and inhibits B12 absorption, causing anemia)<br>
Hypersensitivity
Mar
ed
What are the four major cyto
ine receptor families, including their mechanisms o
f binding cyto
ines?
hematopoietin receptors (incl. IL-2, 3, 4, 5, 6, 7, 9, 1
3, 15; GM-CSF): heterodimeric, alpha subunit binds ligand and beta subunit trans
mits signal to cytoplasm<br><br>interferon receptors (incl. IFN-alpha, beta, gam
ma; IL-10): homodimeric with third chain in some cases; cyto
ine binds as homodi
mer<br><br>TNF receptors (incl. TNF, LT, NGF): monomeric with single transmembra
ne domain; ligand binds as homotrimer<br><br>chemo
ine receptors: monomeric with
seven transmembrane spans; GTPase-lin
ed<br> Cyto
ineReceptors Mar
ed
What mechanisms are used by cyto
ine receptors to transmit intracytoplasmic sign
als?
Ja
/Ty
protein tyrosine
inases are either recruited to the receptor ar
e are preboundthey phosphorylate various structures including themselves, the rec
eptor, and STAT (signal transducer and activator of transcription) proteins<br><
br>STATs dimerize and translocate to the nucleus, where they bind conserved regu
latory domains in gene promoters and activate transcription (no
nown STATs supp
ress transcription)<br> Cyto
ineReceptors Mar
ed
How is cyto
ine receptor signaling controlled? dephosphorylation of Ja
by phos
phatases (e.g. Shp-1, Shp-2)<br><br>dephosphorylation of STAT by nuclear phospha
tases<br><br>indirect suppression by other transcription factors (e.g. of STAT-6
by BCL-6)<br><br>negative feedbac
by SOCS (inhibits Ja
phosphorylation) and C
IS (bloc
s binding of STAT to cyto
ine receptors)both transcribed by Ja
-STAT pat
hway<br>
Cyto
ineReceptors Mar
ed
How does
nowledge of mechanisms that regulate cyto
ine signaling help you treat
immunologic disease? could be used in rational design of immunosuppressant dr
ugs<br><br>could be used in designing assays to elucidate the mechanism of autoi
mmune and hypersensitivity diseases<br> Cyto
ineReceptors
What is a flow-volume loop and how do you use it to diagnose abnormalities in lu
ng mechanics? graph of patients inspirations and expirations over several respi
ratory cycles (with flow on y axis and volume on x axis)<br><br>can demonstrate
reduced lung airflow (
ey sign of asthma)<br> Asthma Mar
ed
What is acetylcholine and what is methacholine? How are they used to induce spas
m of the bronchial tubes of mice? What is meant by the term airway hyperresponsi
veness (to acetylcholine or methacholine)?
acetylcholine: neurotransmitter
released at synapses between neurons and at motor and parasympathetic nerve endi
ngsstimulates nicotinic and muscarinic receptors<br><br>methacholine: synthetic a

gonist of muscarinic receptors<br><br>can be given to mice (or human patients) t

o stimulate muscarinic receptors in the lung responsible for bronchoconstriction
<br><br>airway hyperresponsiveness refers to excessive bronchoconstriction in re
sponse to cholinergic stimulation<br> Asthma Mar
ed
What is a plethysmograph and how do you use it to measure pulmonary resistance?
device in which subject is placed in a closed booth and inhales/exhales through
a mouthpieceallows measurement of FRC and, when combined with a ventilator, the a
mount of pressure needed to change lung volume a given amount (i.e., lung resist
ance) Asthma Mar
ed
What components of the immune system are missing in a RAG -/- mouse and how does
that deficit ma
e the animal useful to study molecular mechanisms responsible f
or asthma?
RAG -/- animals are deficient in B and T cells<br><br>asthmatic
responses cannot be stimulated in RAG -/- animals (but can be in RAG -/- animals
with T cell reconstitution), indicating that T cells are a
ey part of the asth
matic process<br>
Asthma Mar
ed
What is asthma? an immune hypersensitivity disease of the airways characterized
by excessive bronchoconstriction, mucus secretion (metaplasia of respiratory epi
thelium to goblet cells), and inflammatory infiltration Asthma Mar
ed
What is different about the circular muscles in the bronchial tubes of asthmatic
s?
they are hypersensitive to cholinergic stimulation
Asthma Mar
ed
Is there edema (swelling) of the mucosa and submucosa lining the airways? If so,
is it caused be excessive fluid in the spaces between the cells? Or is it cause
d by leu
ocytes that infiltrate the mucosa and submucosa? If so, which ones?
yes, caused by infiltrate of inflammatory cells in the submucosa (primarily eosi
nophils, but also neutrophils, T cells, B cells)
Asthma Mar
ed
Is there excess mucus production?
yes, and an associated metaplasia of res
ipiratory epithelium to mucus-producing goblet cells
Asthma Mar
ed
What is the meaning of:<br>epithelial hyperplasia (metaplasia?)<br>goblet cells<
br>mucus plug<br>
epithelial hyperplasia (metaplasia?): epithelium undergo
es change to mucus-producing goblet cells<br><br>goblet cells: mucus-producing c
olumnar epithelial cells<br><br>mucus plug: mucus secretions of goblet cells whi
ch obstruct airways during an acute asthma attac
<br> Asthma Mar
ed
Is asthma an immune-mediated disease? If so,<br>is it caused by antibodies? If s
o, which type?<br>is it caused by antigen-specific T cells? If so, which type?<b
r>what cells of the innate immune system infiltrate the asthmatic lung?<br>what
is the lin
between the specific immune responses implicated in asthma and the e
ffector cells of innate and adaptive immunity that are found in the bronchial su
bmucosa?<br><br>
is it caused by antibodies? If so, which type?<br>antibod
ies (IgE) can be involved, but they are not necessary to produce an asthma-li
e
disease<br><br>is it caused by antigen-specific T cells? If so, which type?<br>ye
s; TH2 cells are an absolute requirement (in research animals) to cause asthma-l
i
e disease<br><br>what cells of the innate immune system infiltrate the asthmat
ic lung?<br>eosinophils (largest number)<br>neutrophils<br>T cells (especially TH2)
<br>B cells<br>mast cells<br>macrophages (though some are already present in normal
lung)<br><br>what is the lin
between the specific immune responses implicated
in asthma and the effector cells of innate and adaptive immunity that are found
in the bronchial submucosa?<br>TH2 cells respond to allergens and produce IL-4 an
d IL-13, which are the primary mediators of the asthma phenotype<br>neutrophils a
nd eosinophils (recruited by chemotactic factors) cause tissue damage<br>B cells
may be involved (i.e. by producing IgE) but are not required for the disease phe
notype<br>
Asthma Mar
ed
Which cyto
ines have been implicated in asthma pathophysiology? Describe what th
e implicated cyto
ines do.
IL-4: stimulates differentiation of T cells to T
H2 (required for asthma phenotype)<br><br>IL-13: stimulates development of physi
cal characteristics of asthma phenotype (goblet cell metaplasia, AHR, eosinophil
infiltration)<br><br>IL-4 and IL-13 receptors share the IL-4Ralpha subunit in c
ommon<br>
Asthma Mar
ed
What are the current therapies for asthma? How does each treatment modality affe
ct the pathophysiology of this disease? Beta2 agonists (e.g. albuterol)physically
dilate airways by relaxing smooth muscles<br><br>glucocorticoidssuppress the T c

ell response<br><br>leu
otriene modifiersin some patients, have an anti-inflammat
ory effect (but usually only a mild one)<br><br>omalizumab (antibody against IgE
, wor
s primarily by eliminating respiratory allergies that many asthma patients
have)<br><br>IL-4Ralpha bloc
ers: target the chain common to IL-4 and IL-13 rec
eptors to bloc
the effects of both<br> Asthma Mar
ed
If you feel the need to quiz yourself on the learning objectives of the Pharynx
lecture, there are seven of them on the reverse of this card.&nbsp;&nbsp;
Define the boundaries and contents of the pharynx and subdivisions<br />List the
constrictor muscles, attachments, function, and innervation<br />List the muscl
es of the styloid process, function, and innervation <br />Describe the pharnygo
tympanic tube and its function<br />List the muscles of the soft plate and their
function and innervation <br />Describe the ring of Waldeyer and its clinical s
ignificance<br />Describe the pathway of CN IX, X, XI, and XII as it relates to
the pharynx&nbsp;&nbsp; Mar
ed Pharynx
"<img src=""pasterp
1g4.png"" /><br>I dunno, label the stars or something.&nbsp;
&nbsp;And label the cervical vertebrae with numbers. " "<img src=""pastew4ql54.
png"" /><br>The unlabeled arrow is pointing at the Dens. <br>" Mar
ed Pharynx
"<img src=""paste
do3g8.png"" /><br>Identify." "<img src=""pastewoyscl.png"" />
<br>" Mar
ed Pharynx
What is the clinical name for the palatopharyngeal and palatoglossus arches?
Fauces Mar
ed Pharynx
What cranial nerve(s) supplies the palatoglossus and the palatopharyngeus?
CN X
Mar
ed Pharynx
A deviated uvula and missing arches (especially while the patient is saying &quo
t;aaaaaaaaah&quot;) indicates what?&nbsp;&nbsp;What is the relationship between
uvula deviation and the side of the damage?
indictes nerve palsy or minor st
ro
e.&nbsp;&nbsp;<br><br>Deviation is away from the affected side (inactivity of
the affected muscles, no longer able to oppose the unaffected side)
Mar
ed P
harynx
What is the boundary between the pharynx and oral cavity?
Palatoglossal fo
ld.
Mar
ed Pharynx
"<img src=""pasteuflben.png"" /><br>Label the indicated structures (red arrows)
and the stages of the pharynx (truncated by blac
bars)."
"<img src=""past
eutrxxd.png"" />"
Mar
ed Pharynx
"<img src=""pastefe
hhx.png"" /><br>Guess whats funny about this diagram?"
The way it divides the stages is all
inds of goofy!&nbsp;&nbsp;Best be ignoring
it if it confuses you, and loo
at the other one instead.
Mar
ed Pharynx
"Label the diagram.&nbsp;&nbsp;<br><img src=""pastexu
vbr.png"" /><br>What is th
e posterior boundary of the pharynx?" "<img src=""pastevxjamm.png"" />"
Mar
ed Pharynx
"<img src=""paste1ht
mu.png"" /><br>What structure is indicated by the arrow? Wh
at is its clinical significance?"
"<img src=""pasteui1nma.png"" />Pharynge
al recess is lined by mucus membrane and is bac
ed&nbsp;&nbsp;by 2 fused fascial
layers pharyngobasilar and buccopharyngeal.&nbsp;&nbsp;It is a li
ely place of
fistulas above the pharyngeal constrictors.&nbsp;&nbsp;"
Mar
ed Pharynx
"<img src=""pasteajwhv8.png"" /><br>Identify the structures indicated by the red
arrows.&nbsp;&nbsp;What is the significance of the placement of the tongue in t
his image? "
"<img src=""pastedyquen.png"" /><br>The tongue is elevated up ag
ainst the hard palate.&nbsp;&nbsp;This is an early stage of deglutition (swallow
ing).&nbsp;&nbsp;Note that the uvula is also in place to sequester the nasophary
nx, forcing the food into the oropharynx.&nbsp;&nbsp;" Mar
ed Pharynx
"<img src=""pasteqcyqci.png"" /><br>Identify the features indicated by the red a
rrows.&nbsp;&nbsp;Please also find and label the Pharyngobasilar fascia (PB)."
"<img src=""pastefy9foj.png"" /><br>" Mar
ed Pharynx
Which muscle separates the Superior pharyngeal constrictor from the middle phary
ngeal constrictor?
Stylopharyngeus.
Mar
ed Pharynx
What is the function of the constrictors?
Good peristalsis from the top do
wn, massaging food into the esophagus.&nbsp;&nbsp;<br><br>Once it hits the esoph
agus, it is the point of no return.&nbsp;&nbsp;It does not return to the mouth e
xcept through reverse peristalsis (retching). <br>
Mar
ed Pharynx

Inferior pharyngeal constrictor is located below what bony landmar

?
The grea
ter horn of the hyoid bone.
Mar
ed Pharynx
"The fascia covering the posterior side of the pharyngeal constrictors is the <s
pan style=""font-weight:600; color:#0000ff;"">[...]</span>. " "The fascia cove
ring the posterior side of the pharyngeal constrictors is the <span style=""font
-weight:600; color:#0000ff;"">buccopharyngeal fascia</span>. " Mar
ed Pharynx
"The pharyngeal constrictors are innervated by the <span style=""font-weight:600
; color:#0000ff;"">[...]</span>. "
"The pharyngeal constrictors are innerva
ted by the <span style=""font-weight:600; color:#0000ff;"">vagus nerve</span>. "
Mar
ed Pharynx
"The fascia that loosely anchors the mucosa to the constrictors is the <span sty
le=""font-weight:600; color:#0000ff;"">[...]</span>. " "The fascia that loosely
anchors the mucosa to the constrictors is the <span style=""font-weight:600; co
lor:#0000ff;"">pharyngobasilar fascia</span>. " Mar
ed Pharynx
"The pharyngeal musculature consists of the pharyngeal constrictors and the <spa
n style=""font-weight:600; color:#0000ff;"">[...]</span>. "
"The pharyngeal
musculature consists of the pharyngeal constrictors and the <span style=""font-w
eight:600; color:#0000ff;"">relatively wea
pharyngeal elevators</span>. "
Mar
ed Pharynx
"<img src=""paster5exjp.png"" /><br>Identify the indicated features, as well as
the superior, middle, and inferior pharyngeal constrictors and their attachments
.&nbsp;&nbsp;" "<img src=""pasteqxl7ws.png"" /><br>Superior Constrictor attache
s to pterygomandibular raphe.<br>Middle constrictor attaches to the hyoid bone.
<br>Inferior constrictor attaches to the thyroid and cricoid cartilages. <br>* p
haryngeal recess."
Mar
ed Pharynx
"Constrictors funnel into each other.&nbsp;&nbsp;If wea
or absent, results in <
span style=""font-weight:600; color:#0000ff;"">[...]</span>.&nbsp;&nbsp;"
"Constrictors funnel into each other.&nbsp;&nbsp;If wea
or absent, results in <
span style=""font-weight:600; color:#0000ff;"">pharyngeal fistula</span>.&nbsp;&
nbsp;" Mar
ed Pharynx
"<img src=""pasteft0bfx.png"" /><br>Please label the indicated structures.&nbsp;
&nbsp;" "<img src=""pastef0v5l9.png"" /><br>1. Stylohyoid<br>2. Styloglossus<br>
3. Stylopharyngeus<br>AD = Anterior digastric<br>PD = Posterior digastric<br>SC
= superior constrictor<br>IC = inferior constrictor"
Mar
ed Pharynx
What is the clinical significance of the never ending growth of the stylohyoid l
igament?
In old age, it can impede swallowing by preventing the elevation
of the hyoid.&nbsp;&nbsp;Occasionally remedied by fracture by the HEENT dudes,
otherwise you might suffocate.&nbsp;&nbsp;
Mar
ed Pharynx
"The stylohyoid, styloglossus, and stylopharyngeus are innervated by <span style
=""font-weight:600; color:#0000ff;"">[...]</span>respectively.&nbsp;&nbsp;"
"The stylohyoid, styloglossus, and stylopharyngeus are innervated by <span style
=""font-weight:600; color:#0000ff;"">VII, XII, and IX, </span>respectively.&nbsp
;&nbsp;"
Mar
ed Pharynx
"<img src=""pastea49j1e.png"" /><br>Label the arrows, as well as the tensor pala
tini and levator palatini muscles.&nbsp;&nbsp;Its therapeutic."
"<img sr
c=""pasteehtmmz.png"" /><br>TP -- tensor palatini<br>LP -- levator palatini"
Mar
ed Pharynx
"<img src=""pastehva7pw.png"" /><br>I bet this diagram is super helpful!&nbsp;&n
bsp;Even more helpful if you label these red arrows. " "<img src=""pasteygaohb.
png"" /><br>Loo
it you overcoming adversity and shit.&nbsp;&nbsp;Good job. "
Mar
ed Pharynx
"<img src=""paste
bu5dz.png"" /><br>Label these arrows.&nbsp;&nbsp;See if you ca
nt label the internal carotid and internal jugular as well.&nbsp;&nbsp;(HINT: C
olor coding)" "<img src=""pastev
41m1.png"" />"
Mar
ed Pharynx
"<img src=""paste6
rney.png"" /><br>Label the indicated features, as well as the
palatini muscles.&nbsp;&nbsp;" "<img src=""pastez4tjex.png"" />"
Mar
ed P
harynx
Which one of these muscles is not innervated by cranial nerve X : <br>Levator Pa
latini<br>Tensor Palatini<br>Salpingopharyngeus<br>Palatopharyngeus
Tensor P
alatini is one of the eight muscles innervated by Cranial Nerve V3.
Mar
ed P

harynx
"<img src=""pastesm7qal.png"" /><br>Label on bros
i.&nbsp;&nbsp;Be sure to label
the pharyngeal constrictors as well.&nbsp;&nbsp;Tx bro.&nbsp;&nbsp;" "<img sr
c=""pasteqbh8jt.png"" />"
Mar
ed Pharynx
"<img src=""pastenz8tef.png"" /><br>Please label the following -- the features t
hat define the boundaries of the regions of the pharynx, the names of each of th
e indicated regions, and the cranial nerve providing sensory innervation to each
of these regions.&nbsp;&nbsp;" "<img src=""pastehoyphn.png"" /><br>" Mar
ed P
harynx
"<img src=""pasteiuqvvw.png"" /><br>You
now what to do. "
"<img src=""past
e8ypvxc.png"" />"
Mar
ed Pharynx
"<img src=""pastejvxzle.png"" /><br>Label this shit.&nbsp;&nbsp;You almost done.
"
"<img src=""pastefwjhzw.png"" />"
Mar
ed Pharynx
What is the ring of waldeyer?&nbsp;&nbsp;What is its significance?
The ring
of waldeyer is a series of four tonsils: the pharyngeal, tubal, palatine, and l
ingual tonsils. <br><br>Inflammation in these tonsils can cause passageway occlu
sion in infants resulting in sudden death.
Mar
ed Pharynx
What two tonsils may be removed in a tonsillectomy?
Palatine and adenoid ton
sils only.&nbsp;&nbsp;<br><br>Adenoid tonsils are scraped from the underside of
the sphenoid bone.
Mar
ed Pharynx
"<img src=""paste2zzigb.png"" /><br>Label."
"<img src=""pastedw5mnx.png"" />
"
Mar
ed Pharynx
Greg has some sort of sing song nonsense to remember innervation of the muscles
in the throat.&nbsp;&nbsp;Its posted on the reverse of the card, but since its
an image I imagine you wont be able to read it for shit.&nbsp;&nbsp; "<img sr
c=""pasterbv_ul.png"" /><br>Cheers. " Mar
ed Pharynx
Be warned.&nbsp;&nbsp;On the reverse of this card are the learning objectives fo
r the nasal cavity lecture.&nbsp;&nbsp;It has been said that a mere glimpse of t
hese objectives will burn out a mans mind, such is brilliance of their untouche
d truthiness. <b>Define the boundaries of the nasal cavities and their composi
tion including the nasal septum</b><br /><b>Describe the location of the paranas
al sinuses and their drainage paths</b><br /><b>List the major arteries and nerv
es that supply the nasal cavity</b><br /><b>Describe the pathways and distributi
on of autonomic nerves to the nasal cavity and lacrimal gland</b><br /> NASALCAV
ITY Mar
ed
"<img src=""pasteym1jur.png"" /><br>Label please. "
"<img src=""pasteav3c
v.
png"" />"
NASALCAVITY Mar
ed
"The space between the eyebrows and above the nose is the <span style=""font-wei
ght:600; color:#0000ff;"">[...]</span>.&nbsp;&nbsp;"
"The space between the e
yebrows and above the nose is the <span style=""font-weight:600; color:#0000ff;"
">glabella</span>.&nbsp;&nbsp;(wi
i)" NASALCAVITY Mar
ed
"The intersection of the frontal bone and the two nasal bones on the human s
ull
is the <span style=""font-weight:600; color:#0000ff;"">[...]</span>. " "The int
ersection of the frontal bone and the two nasal bones on the human s
ull is the
<span style=""font-weight:600; color:#0000ff;"">nasion</span>. (wi
i)" NASALCAV
ITY Mar
ed
What type of epithelium lines the naval cavity?&nbsp;&nbsp;<br>What is its funct
ion?
The nasal cavity is lined by ciliated respiratory epithelium.<br>Its fun
ction is to trap dust and allergens, and to humidify and warm incoming air.
NASALCAVITY Mar
ed
"Irritation and inflammation of the mucous membrane in the nose is <span style="
"font-weight:600; color:#0000ff;"">[...]</span>. It can lead to rhinorea, which
is what?"
"Irritation and inflammation of the mucous membrane in the nose
is <span style=""font-weight:600; color:#0000ff;"">rhinitis</span>.&nbsp;&nbsp;(
wi
i)<br><br>Rhinorrhea is a condition where the nasal cavity is filled with a s
ignificant amount of mucous fluid.&nbsp;&nbsp;(wi
i)" NASALCAVITY Mar
ed
"Sac-li
e growths of inflamed tissue lining the nose or sinuses are <span style=
""font-weight:600; color:#0000ff;"">[...]</span>. "
"Sac-li
e growths of inf
lamed tissue lining the nose or sinuses are <span style=""font-weight:600; color
:#0000ff;"">nasal polyps</span>.&nbsp;&nbsp;(pubmed)" NASALCAVITY Mar
ed

Straight from Yahoo! Answers:<br>What is nasal erosion? Nasal erosion means that
the lining of your nose
ind of brea
s down.&nbsp;&nbsp;Its what happens to pe
ople who snort cocain a lot.&nbsp;&nbsp;You bleed and lose tissue.&nbsp;&nbsp;
NASALCAVITY Mar
ed
"Nosebleed = <span style=""font-weight:600; color:#0000ff;"">[...]</span>"
"Nosebleed = <span style=""font-weight:600; color:#0000ff;"">Epistaxis</span>"
NASALCAVITY Mar
ed
"<img src=""paste6riidd.png"" /><br>Label. "
"<img src=""pastedgcmt2.png"" />
"
NASALCAVITY Mar
ed
"<img src=""pasterwn8sf.png"" />"
"<img src=""pasterazyyt.png"" />"
NASALCAVITY Mar
ed
"Go ahead. Label the Palate.&nbsp;&nbsp;I dare you. <br><img src=""paste6
zioq.p
ng"" />"
"<img src=""pasteho94zw.png"" /><br>Oh shit.&nbsp;&nbsp;He actua
lly did it. " NASALCAVITY Mar
ed
So Greg has &quot;Cleft Palate&quot; written on one of his slides.&nbsp;&nbsp;So
, you
now, go for it. "<img src=""pastemcj_lu.jpg"" /><br>This is a more sever
e case.&nbsp;&nbsp;More moderate clefting starts at the posterior palate but doe
snt necessarily extend to the maxilla and lip.&nbsp;&nbsp;Image from wi
i. "
NASALCAVITY Mar
ed
"<img src=""pastej9c_xp.png"" /><br>Label the stars.&nbsp;&nbsp;Indicate the pat
h of air flow through the nasal cavity in normal breathing and in sniffs. "
"<img src=""paste
z7nlj.png"" /><br>Blac
dotted line indicates flow of air thro
ugh the nasal cavity in normal breathing, while the arrow indicates the vector o
f air flow in a sniff.&nbsp;&nbsp;"
NASALCAVITY Mar
ed
"<img src=""pastenf4c
r.png"" /><br>Label, please. "
"<img src=""pastejztybp.
png"" />"
NASALCAVITY Mar
ed
"The space between the concha and lateral wall is termed a <span style=""font-we
ight:600; color:#0000ff;"">[...]</span>. "
"The space between the concha an
d lateral wall is termed a <span style=""font-weight:600; color:#0000ff;"">meatu
s</span>. "
NASALCAVITY Mar
ed
"The term for a conchae and its mucosa is <span style=""font-weight:600; color:#
0000ff;"">[...]</span>. "
"The term for a conchae and its mucosa is <span
style=""font-weight:600; color:#0000ff;"">turbinate</span>. " NASALCAVITY Mar

ed
GREG WRITES ABOUT THE SINUSES IN ALL CAPS.&nbsp;&nbsp;WHAT ARE THE POSSIBLE FUNC
TIONS OF THE SINUSES? LIGHTEN THE SKULL (LESS IMPORTANT).<br>RESONANCE TO THE
VOICE (LACK OF AIR SINUSES IN ALL NEWBORN RESULTS IN UNUSUALLY HIGH PITCHED CRY)
<br>PROTECT BRAIN FROM THE TEMPERATURE OF INSPIRED AIR NASALCAVITY Mar
ed
"An infection of the sinus is <span style=""font-weight:600; color:#0000ff;"">[.
..]</span>. " "An infection of the sinus is <span style=""font-weight:600; col
or:#0000ff;"">sinusitis</span>. "
NASALCAVITY Mar
ed
There are a number of nasal sinuses.&nbsp;&nbsp;Please indicate the four sets of
sinuses and how many sinuses each set includes.
Frontal (2 sets)<br>Maxi
llary (2 sets)<br>Sphenoid (1?)<br>Ethmoid Air Cells (3 per side)<br><br>I dont

now why sphenoid is (1?).&nbsp;&nbsp;I thin

Frontal and Maxillary are each on
e sinus per side (2 sets total).
NASALCAVITY Mar
ed
Are air sinuses present in the newborn? Nope!&nbsp;&nbsp;They would probably be
infected all the time anyway.&nbsp;&nbsp;Why are infant s
ulls so good at becomi
ng infected?
NASALCAVITY Mar
ed
"<img src=""pastegci
d5.png"" /><br>Label please. "
"<img src=""pastead3
q_.
png"" />"
NASALCAVITY Mar
ed
"<img src=""pastexva_sm.png"" /><br>Label please."
"<img src=""paste
vmz1m.
png"" /><br>" NASALCAVITY Mar
ed
What is significant about the placement of the drainage of the maxillary sinus?
Drainage is on top of the sinus, ma
ing it difficult when in the upright positio
n.&nbsp;&nbsp;Patients with superfluous mucus that cannot be swept out against g
ravity by the cilia of the mucosa can improve drainage by learning over a hot so
lvent.&nbsp;&nbsp;The steam will help water the mucus down, and the positioning
will improve drainage.&nbsp;&nbsp;
NASALCAVITY Mar
ed
"<img src=""paste_d5u4f.png"" /><br>Apparently there are two things you should n

ote about this image.&nbsp;&nbsp;Besides the part where it is uber creepy. "
Note the deviated septum (our right, patients left)<br>Note the size of the infe
rior concha.&nbsp;&nbsp;They are large.
NASALCAVITY Mar
ed
"<img src=""pasteuvhray.png"" /><br>Please label. "
"<img src=""paste9a7pcb.
png"" />"
NASALCAVITY Mar
ed
"<img src=""pastefjemzx.png"" /><br>Please label."
"<img src=""pasteyptxm7.
png"" /><br>A sinus ostium is the opening that connectsa sinus to the nasal cavi
ty itself.&nbsp;&nbsp;It is a tight area that tends to have a higher percentage
of cilia than the surrounding mucosa.&nbsp;&nbsp;If the sinus ostium is bloc
ed,
this will cause an accumulation of fluid in the sinus.&nbsp;&nbsp;(wi
i)<br>"
NASALCAVITY Mar
ed
"<img src=""paste_l38sd.png"" /><br>Label please. "
"<img src=""paste5d7ldc.
png"" /><br>Than
you. "
NASALCAVITY Mar
ed
Please list drainage location of each of the sinuses. Frontal -- anterior semi
lunar hiatus<br>Maxillary -- middle semilunar hiatus<br>Sphenoid -- Sphenoethmoi
dal recess<br>Ethmoid air cells -- 3 chambers -- semilunar hiatus<br><br>Maxilla
ry and sphenoid sinuses can only drain when head is in flexed position.
NASALCAVITY Mar
ed
"Nasolacrimal duct from the orbit drains into the <span style=""font-weight:600;
color:#0000ff;"">[...]</span>. "
"Nasolacrimal duct from the orbit drains
into the <span style=""font-weight:600; color:#0000ff;"">inferior meatus</span>
. "
NASALCAVITY Mar
ed
"<img src=""pasteespxdq.png"" /><br>Please label this view of the lateral wall o
f the nasal cavity with turbinates removed.&nbsp;&nbsp;The yellow arrows indicat
ed flow and not nerves.&nbsp;&nbsp;"
"<img src=""pasteu0gw9u.png"" /><br>"
NASALCAVITY Mar
ed
"<img src=""pastefay3qx.png"" /><br>Please label the origin of each of the arrow
s, which represent mucus flow.&nbsp;&nbsp;"
Red arrow is the end of the naso
lacrimal duct. <br><br>Yellow arrow represents the frontal sinus flow. <br><br>B
lue arrow represents sphenoid sinus flow. <br><br>Orange represents maxillary si
nus flow.
NASALCAVITY Mar
ed
"<img src=""pastedxaxdx.png"" /><br>Label one more, I suppose. "
"<img sr
c=""pastej3suhu.png"" /><br>You did it!"
NASALCAVITY Mar
ed
"<img src=""pastevsi80r.png"" /><br>Label the red arrows please.&nbsp;&nbsp;This
slide is mostly review.&nbsp;&nbsp;" "<img src=""paste81ecgb.png"" />"
NASALCAVITY Mar
ed
"<img src=""paste5pbruh.png"" /><br>Please delineate the regions of sensory inne
rvation, and indicate which cranial nerves innervate each area.&nbsp;&nbsp;What
innervates the Pharyngotympatic tube and middle ear cavity?"
"<img src=""past
e4tutqq.png"" />"
NASALCAVITY Mar
ed
"<img src=""pastecz8cnz.png"" /><br>Please identify.&nbsp;&nbsp;"
"<img sr
c=""pastey2c_hp.png"" /><br>We are not required to
now the lateral superior pos
terior nasal branches, the inferior posterior nasal branches, or the lateral nas
al branches.&nbsp;&nbsp;"
NASALCAVITY Mar
ed
"<img src=""pastec_4dsl.png"" /><br>Please label the diagram." "<img src=""past
e9bl
it.png"" />"
NASALCAVITY Mar
ed
"Vasodilation of the mucosal arteries leading to swollen mucosa is caused by <sp
an style=""font-weight:600; color:#0000ff;"">[...]</span> innervation of the nas
al cavity epithelium. " "Vasodilation of the mucosal arteries leading to swollen
mucosa is caused by <span style=""font-weight:600; color:#0000ff;"">parasympath
etic</span> innervation of the nasal cavity epithelium. "
NASALCAVITY Mar

ed
"Vasoconstriction of mucosal arteries leading to shrun
en mucosa is caused by <s
pan style=""font-weight:600; color:#0000ff;"">[...]</span> innervation of the na
sal cavity epithelium.&nbsp;&nbsp;"
"Vasoconstriction of mucosal arteries le
ading to shrun
en mucosa is caused by <span style=""font-weight:600; color:#0000
ff;"">sympathetic</span> innervation of the nasal cavity epithelium. <br><br>Gre
g says the parasympathetic/sympathetic style of innervation in the nasal epithel
ium is similar to that seen in the clitoris and penis.&nbsp;&nbsp;"
NASALCAV
ITY Mar
ed

"<img src=""paste4gmo01.png"" /><br>Please label these assorted structures.&nbsp

;&nbsp;Ignore the star in the bottom left corner.&nbsp;&nbsp;I thin
he is lost.
"
"<img src=""pastea26_c0.png"" />"
NASALCAVITY Mar
ed
"<img src=""paste7tts
z.png"" /><br>LABL PLZ." "<img src=""pasten3u4au.png"" />
<br>Sphenopalatine foramen opens from Pterygopalatine fossa into nasal cavity tr
ansmits artery and nerves<br><br>K TX BYE"
NASALCAVITY Mar
ed
"<img src=""pastejyil
f.png"" /><br>We all
now you are just waiting to show off
your
nowledge of the Sphenoid bone.&nbsp;&nbsp;Just get it over with. "
"<img src=""paste6cnw9w.png"" /><br>Feel better?"
NASALCAVITY Mar
ed
"Nobody expects <span style=""font-weight:600; color:#0000ff;"">[...]</span>. "
"Nobody expects <span style=""font-weight:600; color:#0000ff;"">the Spanish Inqu
isition</span>. "
NASALCAVITY Mar
ed
"<img src=""pastednqrzw.png"" /><br>Its a picture!"
On this slide is a singl
e text box -- &quot;Note larger middle and inferior conchae -- resting&quot;.&nb
sp;&nbsp;<br><br>I thin
its code.&nbsp;&nbsp;The blac
cat howls at midnight,
Dr. Duncan.&nbsp;&nbsp;The line is secure.&nbsp;&nbsp; NASALCAVITY Mar
ed
"<img src=""pasteauxemu.png"" /><br>Label please. "
"<img src=""pastehee2gx.
png"" />Dont need to
now the descending palatine and lateral posterior nasal a
rteries.&nbsp;&nbsp;" NASALCAVITY Mar
ed
"The ethmoidal arteries are given off by the <span style=""font-weight:600; colo
r:#0000ff;"">[...]</span>.&nbsp;&nbsp;" "The ethmoidal arteries are given off by
the <span style=""font-weight:600; color:#0000ff;"">nasociliary branch of ophth
almic artery</span>.&nbsp;&nbsp;"
NASALCAVITY Mar
ed
"What is indicated by the orange circle in this diagram?&nbsp;&nbsp;Please label
the arteries. <br><img src=""pasteo5dx_8.png"" />"
"<img src=""pasteswd4eq.
png"" />"
NASALCAVITY Mar
ed
So, I
now you li
e enormous confusing diagrams.&nbsp;&nbsp;So there is one comi
ng up.&nbsp;&nbsp;Its about lymphatic drainage in the nec
.&nbsp;&nbsp;Really,
you are better off learning it off of the other cards.&nbsp;&nbsp;Cheers.
"<img src=""pasteulftlu.png"" />"
NASALCAVITY Mar
ed
This is the card that has all the lymphatic drainage you must
now, according to
nasal cavity and sinus lecture.&nbsp;&nbsp;Im sure you do need to
now more, a
nd it is really just a misnomer.&nbsp;&nbsp;There are 9 items on the reverse.
Tip of the tongue/front lower teeth to submental nodes<br><br>Body of tongue/upp
er teeth /lowerside teeth to submandibular nodes<br><br>Posterior tongue to Jugu
lo-digastric nodes/lingual and palatine tonsils<br><br>Middle ear cavity to tuba
l tonsil<br><br>Nasal Cavity/Pharynx to tonsils and then to cervical nodes<br> <
br>Larynx and Thyroid gland to pre- and paratracheal nodes<br><br>Sentinel node
for head Jugulo-digastric node<br><br>Sentinel node for nec
Jugulo-omohyoid nod
e<br><br>Deep nodes associated with pain when swallowing<br><br><br><br>
NASALCAVITY Mar
ed
"Tip of the tongue and front lower teeth drain to the <span style=""font-weight:
600; color:#0000ff;"">[...]</span> lymph nodes. "
"Tip of the tongue and f
ront lower teeth drain to the <span style=""font-weight:600; color:#0000ff;"">su
bmental</span> lymph nodes. " NASALCAVITY Mar
ed
"Body of tongue, upper teeth, and lowerside teeth drain to the <span style=""fon
t-weight:600; color:#0000ff;"">[...]</span> lymph nodes. "
"Body of tongue,
upper teeth, and lowerside teeth drain to the <span style=""font-weight:600; co
lor:#0000ff;"">submandibular</span> lymph nodes. "
NASALCAVITY Mar
ed
"Posterior tongue drains to the <span style=""font-weight:600; color:#0000ff;"">
[...]</span> lymph nodes, as well as which two tonsils? "
"Posterior tongu
e drains to the <span style=""font-weight:600; color:#0000ff;"">jugulo-digastric
</span> nodes, as well as the lingal and palatine tonsils. "
NASALCAVITY Mar

ed
"The middle ear cavity drains to the <span style=""font-weight:600; color:#0000f
f;"">[...]</span>.&nbsp;&nbsp;" "The middle ear cavity drains to the <span style
=""font-weight:600; color:#0000ff;"">tubal tonsil</span>.&nbsp;&nbsp;" NASALCAV
ITY Mar
ed
"The nasal cavity and pharynx drains to the tonsils and then to the <span style=
""font-weight:600; color:#0000ff;"">[...]</span> lymph nodes. " "The nasal cavit

y and pharynx drains to the tonsils and then to the <span style=""font-weight:60
0; color:#0000ff;"">cervical</span> lymph nodes. "
NASALCAVITY Mar
ed
"The larynx and thyroid gland drain to the <span style=""font-weight:600; color:
#0000ff;"">[...]</span> lymph nodes. " "The larynx and thyroid gland drain to t
he <span style=""font-weight:600; color:#0000ff;"">pre- and paratracheal</span>
lymph nodes. " NASALCAVITY Mar
ed
"The sentinal node for the head is the <span style=""font-weight:600; color:#000
0ff;"">[...]</span> lymph node. "
"The sentinal node for the head is the <
span style=""font-weight:600; color:#0000ff;"">jugulo-digastric</span> lymph nod
e. "
NASALCAVITY Mar
ed
"The sentinal node for the nec
is the <span style=""font-weight:600; color:#000
0ff;"">[...]</span> lymph node. "
"The sentinal node for the nec
is the <
span style=""font-weight:600; color:#0000ff;"">jugulo-omohyoid</span> lymph node
. "
NASALCAVITY Mar
ed
"Pain when swallowing is associated with the <span style=""font-weight:600; colo
r:#0000ff;"">[...]</span> lymph nodes. "
"Pain when swallowing is associa
ted with the <span style=""font-weight:600; color:#0000ff;"">deep</span> lymph n
odes. " NASALCAVITY Mar
ed
Is that the end of the Nasal Cavity and Sinus lecture? Yes it is!&nbsp;&nbsp;Ho
oray, you did it!
NASALCAVITY Mar
ed
Innate immunity involves what five components? Epithelial barriers<br>Phagocyte
s<br>Dendritic Cells<br>Complement<br>NK cells TypeIHypersensitivity Mar
ed
In what order do the aortic arches form?
1st forms first and they continu
e in order
HeadandNec
EmbryoI Mar
ed
What does the first aortic arch become in the adult?
Maxillary artery
HeadandNec
EmbryoI Mar
ed
What does the second aortic arch become in the adult? Small portions persist t
o become the hyoid and stapedial arteries
HeadandNec
EmbryoI Mar
ed
What does the 3rd aortic arch form in the adult?
Common and proximal inte
rnal carotid arteries HeadandNec
EmbryoI Mar
ed
"Distal internal carotid derives from the <span style=""font-weight:600; color:#
0000ff;"">[...]</span>" "Distal internal carotid derives from the <span style=""
font-weight:600; color:#0000ff;"">dorsal aorta</span>" HeadandNec
EmbryoI Mar
e
d
What happens to aortic arches IV and VI through development? (2)
Undergo
asymmetric remodeling<br><br>Supply blood to:<br>upper extremities<br>dorsal aor
ta <br>lungs
HeadandNec
EmbryoI Mar
ed
The mesenchyme for formation of the head and nec
derives from what 4 embryonic
entities?<br><br>Picture the s
eletal structures of the head in your mind. Color
&nbsp;&nbsp;in the mesenchyme corresponding to these structures with each of the
4 embryonic entitities.
"Paraxial mesoderm<br>Lateral plate mesoderm<br>
Neural crest<br>Ectodermal placodes: <br><br>Otic placode is origin of the ear a
nd vestibular structures<br>Lens placode becomes the lens of the eye<br><br><br>
<img src=""pasteI8URgu.png"" />"
HeadandNec
EmbryoI Mar
ed
What are the 4 contents in each pharyngeal arch?
Associated cranial nerve
<br>Artery<br>Cartilage/s
eletal structures<br>Neural crest cells
HeadandN
ec
EmbryoI Mar
ed
Define pharyngeal arches, pouches, and clefts. "Arches: bars of mesenchymal tis
sue<br><br>Pouches: inner endoderm that contacts the arches and penetrates them,
but does not connect with the clefts.<br><br>Clefts: outer ectoderm<br><br><img
src=""pasteMOnocR.png"" />"
HeadandNec
EmbryoI Mar
ed
Give the general region that pharyngeal arches 1-4 and 6 correspond to in the ad
ult.
"<img src=""pasteei1XwE.png"" />"
HeadandNec
EmbryoI Mar
ed
Provide the bones, nerve, and muscles the 1st pharyngeal arch gives rise to.
Bones: dorsal becomes maxilla<br>Ventral&nbsp;&nbsp;becomes mandible, malleus, i
ncus<br><br>Muscles: all mastication muscles<br>Anterior belly of the digastric
and mylohyoid<br>Tensor tympani and palatini<br><br>Nerve: CN V HeadandNec
Embry
oI Mar
ed
Provide the bones, nerve, and muscles the 2nd pharyngeal arch gives rise to.
Bones: stapes, styloid process, upper part of hyoid<br><br>Muscle: stylohyoid, s

tapedius, posterior belly of the digastric, auricular, muscles of facial express

ion<br><br>Nerve: CN VII<br><br>
HeadandNec
EmbryoI Mar
ed
Provide the bones, nerve, and muscles the 3rd pharyngeal arch gives rise to.
Bone: lower hyoid<br><br>Muscle: stylopharyngeus<br><br>Nerve: CN IX
HeadandN
ec
EmbryoI Mar
ed
Provide the bones, nerve, and muscles the 4th and 6th pharyngeal arch give rise
to.
Bones: all cartilages of the larynx<br><br>Muscles: cricothyroid, levato
r palatini, pharyngeal constrictors<br><br>Nerves:<br>4th: superior laryngeal br
anch of CN X<br>6th: recurrent laryngeal branch of CN X HeadandNec
EmbryoI Mar
e
d
Picture in your head the cartilaginous structures that pharnygeal arch 1-4 and 6
give rise to. "<img src=""pasteD4clhX.png"" />"
HeadandNec
EmbryoI Mar
e
d
Give the location of the pharyngeal pouches.
"On the inside of the developing
pharynx (color coded).<br><br><img src=""paste1gmBtu.png"" />" HeadandNec
Embry
oI Mar
ed
Oversimplify the pharyngeal pouches to remember them. "<img src=""paste4E5U6B.
png"" />"
HeadandNec
EmbryoI Mar
ed
Give the 3 structures that the 1st pharyngeal pouch gives rise to.
Tubotymp
anic recess gives rise to the external auditory canal<br><br>Middle ear cavity<b
r><br>Eustachian tube HeadandNec
EmbryoI Mar
ed
What is the only direct remnant of the 2nd pharyngeal pouch?
Palatine tonsill
ar fossa
HeadandNec
EmbryoI Mar
ed
What 2 structures does the 3rd pharyngeal pouch form? "Dorsal: inferior parath
yroid<br /><br />Ventral: thymus<br><br><img src=""pasteV4DJ36.png"" />"
HeadandNec
EmbryoI Mar
ed
What 2 structures does the 4th pharyngeal arch give rise to?
"Dorsal: superio
r parathyroid<br /><br />Ventral: ultimobranchial body (provides C cells to the
thyroid)<br><br><img src=""pasteV4DJ36.png"" />"
HeadandNec
EmbryoI Mar
e
d
What is the only thing you need to remember about pharyngeal clefts?
"The fir
st one gives rise to the auditory canal.<br><br><img src=""pastedm5dtN.png"" />"
HeadandNec
EmbryoI Mar
ed
What is a fistula?<br><br>What is a sinus?
Fistula: abnormal connection bet
ween two epithelia (ecto and endoderm)<br><br>Sinus: blind-ended epithelialized
space HeadandNec
EmbryoI Mar
ed
"Whats wrong w/ little bro?<br><br><img src=""pasteXCdfRN.png"" />"
Little p
iece of cartilage at the cervical sinus HeadandNec
EmbryoI Mar
ed
What is a branchial cleft sinus?<br><br>Why is branchial cleft sinus a misnomer?
Branchial cleft sinus is an abnormal remnant of the 2nd pharyngeal cleft.<br>It
s a tube that runs from the anterior border of SCM in the nec
, through the caro
tid bifurcation, to the tonsillar fossa.<br>So,
ids with this will have saliva
coming out of a hole in their nec
s. Cray.<br>Commonly surgically removed due to
possibility of malignancy and infection.<br><br>Its actually a fistula.
HeadandNec
EmbryoI Mar
ed
"Which is normal?<br>What is the pathology in the other?<br><br><img src=""paste
L2qoXO.png"" />"
"<img src=""pastefjAnyY.png"" />"
Mar
ed HeadandNe
c
RadiologyI
Dar
structures on CT have _____ density.
Low
Mar
ed HeadandNec
Radiol
ogyI
"Identify the cause of the low density regions in each image.<br><br><img src=""
pasteXr5S1L.png"" /><br><br><img src=""pasteiDw_PS.png"" />"
"<img src=""past
e282XrY.png"" /><br><br><img src=""paste2Zu_Yu.png"" />"
Mar
ed HeadandNe
c
RadiologyI
Describe methacholine hyperresponsiveness as it relates to asthma. <br><br>-what
is methacholine?<br>-what is the &quot;responsiveness&quot; that is being measu
red?<br>-why is it diagnostic of asthma?
"Methacholine: Ach mimetic, musc
arinic agonist (via vagus nerve), causes bronchoconstriction via M3<br><br>Respo
nsiveness is % decrease in FEV1.<br><br>Asthmatics show rapid decrease in FEV1 a
t dramatically lower doses of methacholine. <br><span style=""font-weight:600; c

olor:#ff1a1b;"">Caveat: only use in mild cases where asthma is questionable; it

could be lethal otherwise!</span><br><img src=""Screen Shot 2013-02-05 at 9.59.5
5 PM.png"" />" Asthma Mar
ed
"Identify these normal high density structures on CT.<br><br><img src=""pasteo2c
TA
.png"" />" "<img src=""paste9_xUMc.png"" />"
Mar
ed HeadandNec
Radiol
ogyI
"Identify the pathology associated with each of these high density structures.<b
r><br><img src=""pasteK1U
Gd.png"" />" "<img src=""paste1MWmtZ.png"" />"
Mar
ed HeadandNec
RadiologyI
"What accounts for the strea
ing in this image?<br><br><img src=""pasteBOGmwr.pn
g"" />" Metal from a bullet on the scalp scatters the X-rays
Mar
ed HeadandNe
c
RadiologyI
What are the (4) canonical pathological changes in the lung architecture with se
vere asthma?
"A fibrin clot can form within the mucus plug, resulting in &quo
t;plastic bronchitis.&quot; Aint nobody got time fo dat!<br><img src=""Screen
Shot 2013-02-05 at 10.30.59 PM.png"" />"
Asthma Mar
ed
What some common clinical* features of asthma? <br><br>*seen diagnostically with
out using histology (i.e. not pulmonary ultrastructural changes)
"<img sr
c=""Screen Shot 2013-02-05 at 10.33.01 PM.png"" />"
Asthma Mar
ed
What is the appearance of acute blood on CT?<br><br>
"It appears white b/c of
the concentrated hemoglobin of the RBCs that get caught in the clot.<br><br><im
g src=""pastepZsMG_.png"" />" Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br><br><img src=""pasteV95tb8.png"" />" Scalp hematoma
Mar
ed HeadandNec
RadiologyI
"Give the type of fracture that corresponds to each arrow.<br><br><img src=""pas
teNRgUP
.png"" />"
"Comminuted = multiple fragments<br><br><img src=""paste
Y29AGn.png"" />"
Mar
ed HeadandNec
RadiologyI
"Which dural venous sinus is occluded in this image?<br><br><img src=""pasteKhiv
bQ.png"" />"
Right transverse sinus Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br />Give its shape.<br />Describe the damage.<br />Does
it cross sutures?<br />Does it cross the midline?<br />Associated with fractures
?<br />Arterial and/or venous?<br /><br /><img src=""pastev9PhoG.png"" />"
EPIDURAL HEMATOMAS<br />Lens shaped<br />Periosteal dura stripped away from the
bone<br />Does not cross sutures<br />Cross midline<br />Associated with fractur
e<br />90% arterial (from the middle meningeal artery) or 10% venous (dural sinu
s)<br />
Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br />Give its shape.<br>Describe the damage.<br>Does it c
ross sutures?<br>Does it cross the midline?<br>Associated with fractures?<br>Art
erial and/or venous?<br><br><img src=""pasteKYwssN.png"" />"
SUBDURAL HEMATOM
AS<br>Crescentic shaped<br>Ruptured bridging veins<br>Cross sutures<br>Do not cr
oss midline<br>Not associated with fractures<br>Venous: ruptured bridging veins<
br><br> Mar
ed HeadandNec
RadiologyI
(T/F) asthma reactions are B-cell dependent.
"F; asthma is primarily a T-cell
response, thus a special sort of Type IV hypersensitivity.<br><br>As shown belo
w in the bottom right, rats that have T-cells with restored RAG1 function show h
ypersensitivity towards the antigen (Ag), whereas rats with merely RAG1 restored
(presumably restoring B cell function - the graph labeling is lousy) show no ch
ange in PC200 upon antigen induction.<br><img src=""Screen Shot 2013-02-05 at 10
.44.22 PM.png"" />"
Asthma Mar
ed
"Whats the progression shown here?<br><br><img src=""pastebbTtIK.png"" />"
"Subdural hematoma over time.<br>Density decreases over time as hemoglobin is re
sorbed.<br><br><img src=""pastenapjwe.png"" />" Mar
ed HeadandNec
RadiologyI
"Below are the three slides of the important asthmatic cyto
ines. Theyre all HY
Ms.<br><img src=""Screen Shot 2013-02-05 at 10.46.29 PM.png"" /><img src=""Scree
n Shot 2013-02-05 at 10.46.23 PM.png"" /><img src=""Screen Shot 2013-02-05 at 10
.46.17 PM.png"" />"
Asthma Mar
ed
What is a cistern?
A normally widened subarachnoid space<br><br>Blood pools
in these, enlarging them, in subarachnoid hemorrhage. Mar
ed HeadandNec
Radiol
ogyI
"Whats the pathology?<br><br><img src=""paste9ppZSS.png"" />" Acute subarachno

id hemorrhage Mar
ed HeadandNec
RadiologyI
"What is the pathology in all of these images?<br><br><img src=""pasteUww4lr.png
"" />" Subarachnoid hemorrhage Mar
ed HeadandNec
RadiologyI
Which two cyto
ines are most important for inducing an asthma response? "IL-4 an
d IL-13. IL-4 stimulates Th2 proliferation and IgE production. IL-13 is directly
responsible for asthmas clinical symptoms.<br><img src=""Screen Shot 2013-02-0
5 at 10.52.58 PM.png"" /><br><br /><br />Below are some graphs proving it.<br />
<img src=""Screen Shot 2013-02-05 at 10.49.39 PM.png"" /><img src=""Screen Shot
2013-02-05 at 10.49.31 PM.png"" />"
Asthma Mar
ed
"Whats the pathology?<br><br><img src=""paste1uCgC_.png"" />" Parenchymal hema
toma
Mar
ed HeadandNec
RadiologyI
Why is asthma NOT a Type I hypersensitivity?
"Traditionally, asthma was belie
ved to be a simultaneous response of mast cells and eosinophils secreting inflam
matory molecules upon the bronchial epithelium.<br><br>Now we
now that asthma i
s a direct Th2 and IgE response, mediated by IL-4 and IL-13.<br><br>Old hypothes
is:<br><img src=""Screen Shot 2013-02-05 at 10.52.23 PM.png"" />"
Asthma M
ar
ed
"Whats the pathology?<br><br><img src=""pastezBbAO
.png"" />" Meningioma
Mar
ed HeadandNec
RadiologyI
"Whats the pathology (same in both)?<br><br><img src=""paste4MEWWd.png"" />"
Glioblastoma multiforme Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br><br><img src=""pasteV568Qb.png"" />" Metastatic paren
chymal lesions Mar
ed HeadandNec
RadiologyI
Asthma is primarily a Th2 response. What sort of antigen triggers it? Fungal p
roteinases...found everywhere, especially your sin
, the filthiest part of your
home. Asthma Mar
ed
"Whats the arrow?<br><br><img src=""pasteeY1sZF.png"" />"
Subfalcine herni
ation in a subdural hematoma
Mar
ed HeadandNec
RadiologyI
(T/F) Fungal proteinases are sufficient by themselves to cause asthma. F; altho
ugh necessary to induce a response, an infection is necessary. Both the viable s
pore and its secreted proteinase are required for a response. Asthma Mar
ed
"tl;dr of asthma:<br> <img src=""Screen Shot 2013-02-05 at 11.13.22 PM.png"" />"
Asthma Mar
ed
What the intrinsic and extrinsic causes of asthma?
"<img src=""Screen Shot
2013-02-05 at 11.14.08 PM.png"" />"
Asthma Mar
ed
"Th cells and cyto
ines:<br><img src=""Screen Shot 2013-02-05 at 11.14.34 PM.png
"" />" This slide simply reviews T helper effector development.&nbsp;&nbsp;Alth
ough many different types of T helper effector subtypes may exist, the best desc
ribed are Th1 and Th2 cells.&nbsp;&nbsp;Both derive from a common nave, or precur
sor, cell (ThP cell).&nbsp;&nbsp;Th1 cells produce cyto
ines (interleu
in 2, int
erferon gamma, tumor necrosis factor, etc) which together promote activate cellu
lar and humor defense mechanisms that protect us from intracellular pathogens su
ch as Listeria spp., Mycobacium spp., Leishmania spp., etc.&nbsp;&nbsp;Th2 cells
, on the other hand, produce cyto
ines such as IL-4, IL-5, IL-13, etc., that pro
tect us from large, extracellular pathogens such as intestinal worms. Both cell
types also have a dar
side: Th1 cells are associated with autoimmunity whereas
Th2 cells are associated with allergy and asthma.&nbsp;&nbsp; Mar
ed Cyto
ines
What the three primary roles of cyto
ines?
"<img src=""Screen Shot 2013-0205 at 11.15.23 PM.png"" />"
Mar
ed Cyto
ines
"Th1 cyto
ines (all HYMs)<br><img src=""Screen Shot 2013-02-05 at 11.15.52 PM.pn
g"" />"
Mar
ed Cyto
ines
(T/F) Cyto
ines have inherent molecular activity.
False. Theyre biologica
lly inert and require highly specific receptors to mediate their effects.<br>
Mar
ed Cyto
ines
"Cyto
ine familes (reference card)<br>Notes:<br>1) the lac
of common gamma chai
n results in SCID<br>2) TNF receptors are homotrimers<br>3) all chemo
ine recept
ors (mediate chemotaxis instead of effector mechanism) are GPCRs<br><img src=""S
creen Shot 2013-02-05 at 11.17.23 PM.png"" />"
Mar
ed Cyto
ines
What is the important shared moiety between IL-4 and IL-13 receptors? "IL-4R-a
lpha<br><img src=""Screen Shot 2013-02-05 at 11.19.14 PM.png"" />"
Mar
ed C

yto
ines
In which type of hematoma might you see blowing a pupil?
Subdural hematom
a<br><br>Blowing a pupil occurs when a mass of blood compresses V3 ganglion, cut
ting off motor supply to the muscles controlling pupil size.
Mar
ed HeadandNe
c
RadiologyI
"JAK/STAT signaling review (reference card)<br>JAK: Janus-associated
inase<br>S
TAT: Signal Transducer and Activator of Transcription, or Signal Transduction An
d Transcription.<br><img src=""Screen Shot 2013-02-05 at 11.19.40 PM.png"" />"
Mar
ed Cyto
ines
Which type of hematoma should you be thin
ing when the patient says theyre havi
ng the worst headache of their life?
Subarachnoid
Mar
ed HeadandNec
Radiol
ogyI
What are the two most common causes of subarachnoid hematoma? 1. Trauma (most
common? ta
e a history...)<br><br>2. Ruptured aneurysm (if no history of trauma)
Mar
ed HeadandNec
RadiologyI
What major type of receptor class uses JAK/STAT signaling?
Ser, Thr, Tyr
i
nases (from A. Cooneys cell signaling lectures)<br><br>1) ligand binds to recep
tors alpha subunit<br>2) subunits homodimerize<br>3) they autophosphorlyate at
certain Ser, Thr, or Tyr residues<br>4) other proteins are recruited to the phos
pho-Ser/Thr/Tyr and bind to them with their SH1/2/3 domains<br>5) second messeng
er mediation: RAS, MAP
inase, PLC-gamma, PKC, etc... Mar
ed Cyto
ines
"67yo male, acute headache <br>Location of the hematoma is typical of patients wit
h history of what disease?<br><br><img src=""pastebuHGLB.png"" />"
Hyperten
sion
Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br><br><img src=""paste4BjKNd.png"" />" Bleeding due to
coagulopathy<br>shows heterogeneous light areas Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br><br><img src=""paste
wh7DH.png"" />" Gun shot wound
Mar
ed HeadandNec
RadiologyI
"Whats the pathology?<br><br><img src=""pastebdQpRL.png"" />" Stab wound from
left to right Mar
ed HeadandNec
RadiologyI
Describe briefly the JAK/STAT signaling cascade.<br>
"1) ligand binds to alph
a subunit of homodimer receptor<br>2) JAKs phosphorylate Tyr/Ser/Thr residues on
both themselves and the beta subunit of the receptor<br>3) STATs are recruited
by the phospho-Tyr/Ser/Thr signals<br>4) JAKs phosphorylate the STATs<br>5) STAT
s leave as homodimers and then act as transcription factors<br><img src=""Screen
Shot 2013-02-05 at 11.19.40 PM.png"" />"
Mar
ed Cyto
ines
Describe a JAK. Why is called Janus-associated?<br>Which one has the highest spe
cificity?
-large enzymes<br>-called Janus (after Roman god of doorways/dua
lity of time...hence January as beginning of Gregorian calendar!) because it has
&quot;two&quot;
inases but one is functional<br>-JAK3 is the most specific, bi
nding only to IL-2
Mar
ed Cyto
ines
Which STAT protein has the highest specificity? STAT6 is specific for only IL-4
and IL-13, the primary mediators of asthma.
Mar
ed Cyto
ines
Which JAK/STAT pair, if
noc
ed out, would result in extreme immunodeficiency?
"JAK3/STAT6<br><img src=""Screen Shot 2013-02-05 at 11.34.03 PM.png"" />"
Mar
ed Cyto
ines
What are the roles of SOCS and CIS in cyto
ine signaling via JAK/STAT? "SOCS: s
uppression of cyto
ine signaling<br />CIS: cyto
ine inducible signals<br /><br /
>They are inducible negative regulators, responsible for <span style=""font-weig
ht:600; color:#ff1a1b;"">negative feedbac
of JAK/STAT</span> <span style=""font
-weight:600; color:#ff1a1b;"">signaling</span>.<br /><img src=""Screen Shot 2013
-02-05 at 11.34.26 PM.png"" />" Mar
ed Cyto
ines
What are the eight major themes of Immunology? Inflammation<br />Transplantatio
n<br />Cancer<br />Vaccines<br />Infection<br />Immunodeficiency<br />Autoimmuni
ty<br />Allergy and Asthma<br />
TypeIHypersensitivity Mar
ed
What is immunity?
Variety of definitions, but broadly is any mechanism pro
viding resistance or response to poison, disease, infection, misbehaving cells,
non-self, stranger and danger. <br>
TypeIHypersensitivity
What are the statistics on acute anaphylaxis recurrence and deaths?
~150-150
0 deaths/year in USA<br>20% recurrence within 2-12 hours of first attac
<br>10%

recurrence per year

TypeIHypersensitivity Mar
ed
What are the li
ely vital signs on physical exam for acute systemic anaphylaxis?
Hypotension (ex 40/0 mmHg)<br />Tachycardia (ex pulse 185)<br />Hyperventilation
(ex RR 76)<br />Hypoxemia (blue s
in)<br />
TypeIHypersensitivity Mar
ed
Outline the pharmacological treatment of acute anaphylaxis.
Immediately give
subutaneous epinephrine (epi pen, .3 mg)<br>IV saline to increase blood volume<
br>Anti-histamine (25 mg Benadryl)<br>Glucocorticoid (25 mg methylprednisolone)<
br><br>At 30 min and 1 hour:<br>Epinephrine<br>B2-adronergic agonist (Aeresol al
buterol)<br><br>Follow with:<br>Long-acting epinephrine (susphrine)<br>methylpre
dnisolone
TypeIHypersensitivity Mar
ed
Explain why FcR is always saturatd?<br>
FcR has a vry low Kd (~10 pM), which is
asily saturatd at physiological lvls of IgE (~1 nm) TypIHyprsnsitivity Ma
rkd
Dtail th pharmacological and procdural rspons to acut anaphylactic shock c
ausd by drug allrgy to an IV injction.
Most importantly, quickly us .3
mg intramuscular pinphrin (pipn)<br><br>Trat pharmacologically with intra
vnous fluids, glucocorticoids, and mild antihistamins.<br><br>Elvat th lgs
to incras vnous rturn and cardiac output.&nbsp;&nbsp;Apply a tourniqut to
slow absorption of injctd antigns, but no mor than 30 minuts.&nbsp;&nbsp;<b
r><br>Carfully manag rspiration and cardiac prformanc.
TypIHyprsnsit
ivity Markd
What is th normal rythrocyt count in th body?&nbsp;&nbsp;In a microlitr of
blood? 24 trillion clls in th body<br><br>about 4-5 million pr microlitr (m
m^3)<br>
Chaptr1A Markd
What is th normal platlt count in a microlitr of blood (mm^3)?
150,000
to 450,000<br /><br />avrag is 2.5 x 10^5
Chaptr1A Markd
What is th normal total lukocyt blood count?<br>What ar th fractional rpr
sntation of granulocyts, lymphocyts, and monocyts? about 10,000 lukocyts
at homostasis (7300)<br><br>50-70 prcnt ar nutrophils (4000-5000)<br>20-40
prcnt ar lymphocyts (1500-3000)<br>1-6 prcnt ar monocyts (100-440)<br>13 prcnt ar osinophils (100-220)<br>lss than on prcnt is basophils (&lt;1
30)<br><br>Not that whil granulocyts ar mostly prsnt in th blood, lymphoc
yts ar mostly stord in th lymph and tissu and only 2% ar in th blood.&nbs
p;&nbsp;So whil thr may b about 7.5 million in th blood, thr is about 1 t
rillion in th whol body.
Chaptr1A Markd
What is th CRITICAL fatur of &quot;adaptiv&quot; immunity?<br>
Th ACQU
ISITION of novl rcptor spcificitis -- hnc, acquird immunity.
Chaptr1
A Markd
Trac th linag of all th products of th hmatopoitic stm clls.&nbsp;&nbs
p;What APC is not of hmatopoitic origin?
"<img src=""pastaqdgsg.jpg"" />
<br>Follicular dndritic clls ar NOT of hmatopoitic origin."
Chaptr1
A Markd
"Complt.<br><img src=""pastpx5vcy.png"" /><br>"
"<img src=""pasturwdni.
png"" />"
Chaptr1A Markd
David Vttr was th third prgnancy of his mothr.&nbsp;&nbsp;What bcam of th
First child was a girl, his sistr.&nbsp;&nbsp;Not a carrir for
 first two?
SCID<br><br>Scond prgnancy was a boy, also namd David.&nbsp;&nbsp;H bcam
ill at 5 months, didnt rspond to antibiotics, and did at 7 months of pnumoni
a.&nbsp;&nbsp;H had a lat diagnosis of SCID.&nbsp;&nbsp;<br><br>Th parnts ha
d gntic counsling and undrstood th risks of a third prgnancy (50% SCID in
sons, 25% in daughtrs).
BubblBoy Markd
Dscrib th prparation and car for David Vttr arly in his lif. Ftus t
std positiv for SCID.&nbsp;&nbsp;A stril isolator was prpard, and David wa
s born in an laborat grm fr csarian dlivry, baptizd by a doctor with st
rilizd holy watr, and placd in th stril compartmnt.&nbsp;&nbsp;<br><br>A
t th tim of his birth, it was though h would matur out of th SCID.&nbsp;&nb
sp;H wasnt mant to b containd in th bubbl indfinatly. BubblBoy Markd
Dscrib th lmnts of David Vttrs childhood, including his living arrangm
nts and schooling.
David was hom-schoold in his hous aftr bing transpo
rtd from th hospital.&nbsp;&nbsp;A mobil isolator was dvlopd for transport

to and from th hospital.&nbsp;&nbsp;His tratmnt was ntirly fundd by th N

IH, which gaind immns undrstanding of th immun systm through his monitori
ng and tratmnt.&nbsp;&nbsp; BubblBoy Markd
Dscrib th plan for Davids Hmatopoitic Stm Cll Thrapy, what wnt wrong,
and how it lad to his dath.&nbsp;&nbsp;
A nw tchniqu was bing dvlo
pd to allow transplant of half-matchd sororal bon marrow stm clls from his
sistr. David and his family agrd to th tratmnt, although it was though tha
t failur could b asily rvrsd without thratning Davids lif.&nbsp;&nbsp;
<br><br>An unxpctd complication dvlopd, as th Epstin-Barr Virus that is
dormant in much of th population scapd into th waknd immun systm, causi
ng virus-drivn growth and prolifration. This lad to a fatal lymphom, and Davi
d did svral months aftr th transplant.&nbsp;&nbsp; BubblBoy Markd
List four lssons larnd from Davids cas. <br>
Introducd th concpt o
f immunodficincy to scintists and lay prsons alik<br><br>Provd that th IL
-2RG chain mutation was th caus of SCID<br><br>Illustratd th powr of th EB
V to caus cancr.<br><br>Dmonstratd a profil of courag to th world.
BubblBoy Markd
Som insight I found intrsting from th Q&amp;A is on th rvrs of this card
.&nbsp;&nbsp;Fundamntally untstabl, but at som points contradicts th pictur
 paintd by th wikipdia and othr sourcs. It was thought at th tim that
Davids condition might rsolv itslf as h maturd in th chambr -- th chamb
r was not mant to b a prmannt solution.&nbsp;&nbsp;<br><br>Th undrstandin
g of th Epstin-Barr Virus startd with this cas.&nbsp;&nbsp;If th transplant
wnt poorly, th physicians blivd it could b rvrsd.&nbsp;&nbsp;<br><br>N
IH pickd up th tab for th bubbl boy, and on a financial scal it was wll wo
rth th cost.&nbsp;&nbsp;<br><br>Th family had no involvmnt in ithr of th
&quot;Bubbl Boy&quot; movis, although thy did hav an impact on th public aw
arnss as wll as prompt NASA to dvlop a suit allowing David som mobility.&n
bsp;&nbsp;H out grw th fairly xpnsiv suit aftr only a fw uss.&nbsp;&nbs
p;<br><br>H had to bath (largly spong baths, almost impossibl to gt dirty)
and us th bathroom insid th bubbl.&nbsp;&nbsp;<br><br>David knw how to g
t out of th bubbl, but h nvr trid and hlpd prvnt strss to th isolati
on systm.&nbsp;&nbsp;<br><br>David nvr wor shos, som issu with strilizat
ion.&nbsp;&nbsp;<br><br>Mothr touchd David for a fw sconds, Fb. 7th whn h
cam out for th first tim for lymphoma tratmnt.&nbsp;&nbsp;Thy still had h
op up to th last coupl of hours.&nbsp;&nbsp;<br>
BubblBoy Markd
What is immunologic tolranc? What ar som of its important faturs, and why
is it important?
unrsponsivnss to slf antignlymphocyts ractiv to s
lf ithr ignor antign or apoptos<br><br>important bcaus of th possibilit
y of autoimmun disas (.g. rhumatoid arthritis, lupus, tc.)<br><br>cntral
tolranc: limination of slf-ractiv lymphocyts in gnrativ tissu (bon m
arrow, thymus)<br><br>priphral tolranc: anrgy or limination of matur, nav
slf-ractiv lymphocyts in priphral tissus<br>
Chaptr9 Markd
How is cntral tolranc inducd in T lymphocyts and B lymphocyts?
B lympho
cyts that ract strongly with antigns prsnt in bon marrow ar liminatd by
apoptosis or chang rcptor spcificity by changing light chain (rcptor dit
ing)<br><br>T lymphocyts that ract too strongly with antigns prsnt in thymu
s ar liminatd (as ar lymphocyts that dont ract strongly nough, i.., that
dont rcogniz MHC)<br><br>som slf-ractiv T lymphocyts bcom rgulatory T c
lls instad of bing liminatd<br><br>thymus tnds to contain antigns that ar
 abundant throughout th body (xprssion undr control of AIRE transcription f
actor)<br>
Chaptr9 Markd
What is priphral tolranc and how may it b inducd in T lymphocyts and B ly
mphocyts?
rfrs to anrgy or apoptosis of slf-ractiv lymphocyts which
hav lft th gnrativ tissu (i.., occurs in priphral lymphoid tissu)<br
><br>B lymphocyts bcom anrgic if xposd to larg concntrations of slf ant
ign without T cll hlpanrgic B clls ar xcludd from lymphoid follicls and
di (loss of survival signals?)<br><br>T lymphocyts ncountring antign withou
t a scond signal (i.., in th absnc of costimulation) bcom anrgic and wil
l not rspond to furthr xposurs of th sam antign, vn with costimulation<

br><br>som T clls will xprss CTLA-4 (CD152), which is an inhibitory B7 rcp

tordcision about whthr to us CTLA-4 (inhibitory) or CD28 (stimulatory) rcpt
or is not undrstood<br><br>xposur of T clls to antign without costimulation
can also rsult in apoptosisrpatd xposur lads to Fas and FasL xprssion (
involvs IL-2) and also rsults in xprssion of pro-apoptotic protinsslf (as o
pposd to forign) antigns tnd to b prsnt for vry long priods of tim, so
duration of xposur to antign may b important in inducing apoptosis (procss
is calld activation-inducd cll dath, AICD)<br><br>rgulatory (CD25+) T cll
s which rcogniz slf antign can downrgulat othr slf-ractiv T cllsproduc
tion of TGF-bta and IL-10, dirct intractionrgulatory T cll production dpnd
s on FoxP3 transcription factor<br>
Chaptr9 Markd
How is functional anrgy inducd in T clls? How may anrgy b brokn to giv ris
to autoimmun disordrs?
functional anrgy is inducd by rpatd xposur
 to antign in th absnc of costimulationgnrally, anrgy can b brokn by co
stimulation<br><br>microbs can brak functional anrgy by various mchanisms <b
r>
Chaptr9 Markd
Why do chronic bactrial and viral disass triggr autoimmun disas? inflamma
tion involvs an incras in th xprssion of costimulators and othr immun-st
imulatory factors, which incrass th chanc of autoimmunity Chaptr9 Markd
Idntify thr mchanisms by which microbial infctions can induc loss of slftolranc.
innat immun rspons against microbial infction can rsult in
inadvrtnt costimulation of slf-ractiv T clls (bcaus costimulation is no
t spcific to th pathogn/antign causing it; all antigns displayd by an APC
will rciv costimulation if thr is a pathogn prsnt)<br><br>microbs can h
av antigns rsmbling slf antigns (molcular mimicry), rsulting in activati
on of slf-ractiv T clls<br><br>with tissu damag (rsulting from infction
or trauma), slf antigns in immun-privilgd tissu can b xposd to th immu
n systm (.g. tsts, y)<br>
Chaptr9 Markd
What ar som of th gns that contribut to autoimmunity? How do modifications
in th following gns prdispos to autoimmunity: MHC, FoxP3, Fas/FasL, compl
mnt, AIRE?
MHC: som MHC gns ar lss fficint at binding slf antigns,
which rsults in dficint ngativ slction and dficint production of rgul
atory T clls (associatd with risk for a wid varity of autoimmun disordrs)<
br><br>FoxP3: involvd in production of rgulatory T clls (ky componnt of pr
iphral tolranc)<br><br>Fas/FasL: involvd in apoptosis of slf-ractiv T cl
ls (AICD: rpatd xposur to antign without costimulation rsults in xprssi
on of Fas/FasL and subsqunt apoptosis; dficincy causs autoimmun lymphoprol
ifrativ syndrom, ALPS)<br><br>complmnt: involvd in claranc of immun com
plxs and B cll tolranc (associatd with lupus-lik disas)<br><br>AIRE: tr
anscription factor rsponsibl for xprssion of many common slf antigns from
all ovr th body in thymusimportant to ngativ slction of slf-ractiv T cl
ls (dficincy causs autoimmun polyndocrinopathy with candidiasis and ctodr
mal dysplasia, APECED)<br>
Chaptr9 Markd
How is an immun rspons turnd off or downrgulatd whn it is no longr nd
d?
immun complxs downrgulat B clls via Fc gamma RII<br><br>claring o
f antign, rduction of pro-inflammatory factors, incrasd xprssion of anti-i
nflammatory factors rsults in apoptosis of most antign-spcific lymphocyts af
tr infction is clard<br>
Chaptr9 Markd
How do autoantibodis caus disas?
opsonization of nativ clls<br><br>acti
vation of complmnt against nativ clls<br><br>blocking of function of nativ
protins<br><br>stimulat inflammation<br>
Chaptr9 Markd
How do autoractiv T clls caus disas?
dstruction of nativ clls<br><
br>(hlpr clls) hlping of autoractiv CD8+ T clls and B clls<br><br>stimul
at inflammation<br>
Chaptr9 Markd
How may altrnativ splicing of protin transcripts prdispos to autoimmunity?
in slf antigns with multipl allls, som vrsions may b undrxprssd in t
hymus and lad to dficint ngativ slction Chaptr9 Markd
Ky points in immun diffrntiation btwn slf and non-slf:<br>oprsnc in
gnrativ organs (cntral tolranc)<br><br>oprsnc/absnc of scond signals
(costimulation, functional anrgy)<br><br>oprsistnc of antign (rpatd xp

osur in absnc of costimulation lads to AICD; forign antigns mor likly to

b liminatd quickly)<br>
Chaptr9 Markd
What ar th typs of tumor antigns that th immun systm racts against? What
is th vidnc that tumor rjction is an immunologic phnomnon?
Antign
typs:<br>
mutatd slf protins (including oncogns and mutatd tumor-su
pprssor gnsRas, Bcr/Abl, p53)<br>
normal but ovrxprssd slf protins
(tyrosinas, gp100, MAGE, MART)<br>
oncognic virus protins (HPV, EBV)<b
r><br>Evidnc:<br>
lymphocyt infiltration corrlats with bttr prognos
is<br>
tumor transplants ar rjctd by prviously xposd animals<br>
immunity to tumor transplants can b transfrrd by transfusion of lymphocyt
s<br>
immunodficint/immunosupprssd individuals hav incrasd risk of
tumors<br>
Chaptr9 Markd
How do CD8+ T clls rcogniz tumor antigns and how ar ths clls activatd t
o diffrntiat into ffctor clls?
Tumor antigns ar phagocytosd by prof
ssional APCs and prsntd on MHC I (for CD8+ clls) and also on MHC II (for CD4
+ clls)cross-prsntation<br><br>Activatd to diffrntiat by CD4+ T clls (sc
rt cytokins)<br>
Chaptr9 Markd
What ar som of th mchanisms by which tumors may vad th immun rspons to
tumor antigns?
Mutation of tumor antigns (antign loss variants)<br><b
r>Non-xprssion of MHC I (may targt clls for dstruction by NK clls)<br><br>
Production of immunosupprssants (.g. TGF-bta)<br>
Chaptr9 Markd
What ar som of th stratgis for nhancing host immun rsponss to tumor ant
igns? Transfr of monoclonal antibodis against tumor antigns<br><br>Vaccinat
ion against tumor antigns (various stratgis including DNA vaccins, transfr
of antigns with adjuvant, transfr of whol tumor clls with adjuvant, transfr
of tumor clls transformd to xprss B7, tc.)<br><br>Tratmnt with immunosti
mulatory cytokins (.g. IL-2)<br><br>Blocking of immunosupprssant cytokins/r
cptors (.g. CTLA-4)<br>
Chaptr9 Markd
Why do normal T clls, which rcogniz forign pptid antigns bound to slf MH
C molculs, ract strongly against all of th allognic MHC molculs of a graf
t?
Allognic MHC complxs tnd to rsmbl complxs of host MHC with for
ign antign (cross-raction)<br><br>No ngativ slction against rcognition of
allognic MHC in th thymus<br>
Chaptr9 Markd
What ar th principal mchanisms of rjction of allografts? Considr both acut
 and chronic procsss.
Hypracut: occurs within minutshost has circula
ting antibodis that cross-ract with graft antigns and caus activation of com
plmnt<br><br>Acut: occurs within days/wkshost CD8+ T clls (primary mchanis
m) and antibodis (minor mchanism) ract with allognic MHC complxs and caus
damag to parnchymal clls and blood vssls<br><br>Chronic: occurs ovr month
s/yarsT clls scrt cytokins lading to fibrosis, smooth muscl growth, vascu
lar occlusion<br>
Chaptr9 Markd
What is th mixd lukocyt raction and what is its importanc?
Is an in
vitro assay to prdict th succss of an allograftinvolvs culturing T clls of
on individual and lukocyts of anothr and assssing strngth of th T cll r
spons Chaptr9 Markd
What ar th problms associatd with th transplantation of bon marrow clls?
Som of rcipints bon marrow nds to b dstroyd&nbsp;&nbsp;to allow transpla
ntation of allognic bon marrow<br><br>Matur donor T clls can caus graft-vr
sus-host disas<br><br>MHC matching is ssntial (to avoid rjction of graft)<
br><br>Rcipints immun systm is svrly waknd for a priod of tim aftr t
ransplantation<br>
Chaptr9 Markd
Why is it critical to xclud ABO incompatibility whn transplanting parnchymal
organs such as th kidny or hart but not whn transplanting bon marrow stm
clls? On th othr hand, why is nar prfct MHC matching of donor and rcipin
t ndd whn transplanting bon marrow whras incomplt matching of MHC btw
n donor and rcipint is accptabl for solid organ grafts?
Donors bon marro
w stm clls hav not yt bn slctd to rjct non-slf ABO; rcipints ABO ty
p will dtrmin tolranc of th transplantd clls<br><br>Parnchymal organs
xprss ABO antigns on ndothlium and so will provok an immun rspons if tr
ansplantd to an individual with a non-matching ABO typ<br><br>MHC-incompatibl

bon marrow stm clls provok a vigorous immun rspons (bcaus th donors r
maining lymphocyts will cross-ract with thm)<br><br>Incomplt MHC matching i
s accptabl in solid-organ transplants bcaus immunosupprssant drugs (.g. cy
closporin) can b usd to rduc T cll rsponsthis would dfat th purpos of
bon marrow transplantation<br>
Chaptr9
What is th diffrnc btwn incidnc and prvalnc?
Prvalnc: ovr
all rat of disas ovr a liftim (x: birth and dath ar 100%).<br><br>Indic
idnc: occurnc ovr a crtain tim priod, such as a yar or dcad.<br><br>
Chaptr10 Markd
"Explain th shap of this graph.<br>-why fall stply at first?<br>-why thn do
s its slop bcom lss stp?<br>-what ar th implications of this graph?<br>
<img src=""Scrn Shot 2013-02-08 at 8.33.52 PM.png"" />"
-initial stp s
lop du to hypracut and acut rjction<br>-stady dclin aftrwards du to
chronic rjction<br>-vn with complt MHC matching, nw kidnys will b nd
d aftr 12 yars*<br><br>*yt, kidnys can surviv longr with appropriat immun
osupprssion and <b>accomodation</b>, which w dont quit undrstand Chaptr1
0 Markd
What typ of antibodis ar th antibodis against blood glycoprotin antigns?
IgM that dvlop naturally in th first yar of lif bcaus th sam antigns a
r providd by our gut bactria.
Chaptr10 Markd
"Which two answrs ar corrct?<br><img src=""Scrn Shot 2013-02-08 at 8.48.31
PM.png"" />"
B and E.<br><br>C is not tru bcaus th donors blood has rla
tivly low amounts of anti-B antibodis and thyr IgMs that hav short half-li
vs and bind to many non-RBCs (as in choic B). Chaptr10 Markd
Whn w say somon is O- or O+, what do th signs man?
Th prsnc or
lack of Rh (rhsus antign).
Chaptr10 Markd
"Rh disas (rfrnc card)<br><img src=""Scrn Shot 2013-02-08 at 8.52.44 PM.
png"" />"
Chaptr10 Markd
What is th standard of car with rgards to mothrs who ar Rh-? Why is RhoGam
(anti-Rh IgG) a viabl tratmnt if its against th ftus?
Standard procdu
r to assum Rh- mothrs will hav Rh+ baby (vn if th &quot;fathr&quot; is R
h-).<br><br>RhoGam is givn bcaus dspit IgGs ability to cross th placntal
barrir, its mor likly to b busy attacking ftal clls that lak into th m
othr, prvnting th mothr hrslf from making anti-Rh IgG. Chaptr10 Markd
What ar th Coombs dirct and indirct tsts (for anti-Rh Abs*)?<br><br>*Coombs
can b usd to chck for othr typs of autoimmun antibodis as wll "Dirct:
invasivly chcking th ftal circulation to s if ftal RBCs hav bn opsoni
zd with anti-Rh.<br><br>Indirct: chcking th matral srum for anti-Rh.<br><b
r>In both tsts, th anti-Rh must first b bound to a substrat (Rh+ RBCs) to ma
intain its stability (or ls thyll autodgrad). Nxt, bcaus th signal of
dtcting anti-Rh is low (du to low quantitis), a scondary antibody (of antihuman) is ndd to amplify th signal. <br><br>tl;dr: its th sam dtction p
rincipls as a Wstrn blot, asy-pasy. Dr. Rodgrs just rightously faild at
making it as simpl as it rally is.<br><img src=""Scrn Shot 2013-02-08 at 8.5
6.13 PM.png"" />"
Chaptr10 Markd
Diffrntiat btwn major and minor incompatibility. Giv xampls of ach.<br
>
"Major: MHC only (hnc th nam)<br>Minor: mal-fmal diffrncs<br><
img src=""Scrn Shot 2013-02-08 at 9.07.25 PM.png"" />"
Chaptr10 Markd
Diffrntiat btwn dirct and indirct allorcognition. Which is mor ffcti
v?
"Dirct: our T clls s th graft APCs thmslvs; it is mor ffctiv
<br>Indirct: Our APCs us antigns of graft tissu and prsnt thm; not as ff
ctiv sinc our T clls partially s our own MHCs<br><img src=""Scrn Shot 20
13-02-08 at 9.07.45 PM.png"" />"
Chaptr10 Markd
What is hypr-acut graft rjction?
"-basd upon blood typ mismatch<br>-hap
pns within 30 minuts<br>-Typ II (and som Typ III) rsponss<br><b>Two slid
s blow</b><br><img src=""Scrn Shot 2013-02-08 at 9.14.34 PM.png"" /><br><img
src=""Scrn Shot 2013-02-08 at 9.14.58 PM.png"" />"
Chaptr10 Markd
What is acut graft rjction? Diffrntiat btwn acut humoral and acut cl
lular rjctions.<br> "Acut: mixtur of Typ II and Typ IV HS ractions. Hap
pns btwn ~5 days to 3 months latr.<br><br>Acut humoral: fastr Typ II rs

pons, th raction forms a psuo-lymph nod within th graft, and can lad to &
quot;accomodation.&quot;<br> <br>Acut cllular: slowr Typ IV rspons, allor
activ, involvs mostly CD4+ clls<br><br><b>Thr slids blow</b><br><img src=
""Scrn Shot 2013-02-08 at 9.16.28 PM.png"" /><br><img src=""Scrn Shot 2013-0
2-08 at 9.16.35 PM.png"" /><br><img src=""Scrn Shot 2013-02-08 at 9.16.42 PM.p
ng"" />"
Chaptr10 Markd
Dscrib chronic rjction. What ar som ky faturs that distinguish it and a
cut rjction? "Chronic rjction continus aftr acut rjction and involvs
ndothlial hyprplasia until th vssl bcoms occludd. Endothlial clls v
n xprss class II MHC and B7.<br><b>two slids:</b><br><img src=""Scrn Shot 2
013-02-08 at 9.19.41 PM.png"" /><br><img src=""Scrn Shot 2013-02-08 at 9.19.48
PM.png"" />" Chaptr10 Markd
What is &quot;first st rjction?&quot;
First st rjction rfrs to a p
rimary immun rspons to alloantigns.&nbsp;&nbsp;Evn though many T clls can b
 alloractiv for th particular mismatch, it still taks a whil for thm to c
lonally xpand sufficintly to caus a problm in th prsnc of th initial ro
und of immunosupprssivs.
Chaptr10 Markd
How dos th ftus scap matrnal immun rsponss?
"<img src=""Scrn Shot
2013-02-08 at 9.32.28 PM.png"" />"
Chaptr10 Markd
What is th significanc of tumor infiltrating lymphocyts (TILs)?
W usd
to think it was good to s thm, a sign of normal immun rspons against a tum
or. Now w know that thy can also b M2 macrophags, NK2, Trgs that protct tu
mors and ar angiognic.
Chaptr10 Markd
"Typs of tumor antigns (rfrnc card)<br><b>Nots: w nd acquird immun r
spons against ths antigns to fight tumors; succsful rspons to thm radi
cats th tumor</b><br><img src=""Scrn Shot 2013-02-10 at 12.25.57 PM.png"" />
"
Chaptr10 Markd
Bcaus most tumor clls ar not profssional APCs, how ar thir antigns dtc
td by our acquird immun systm to induc an anti-tumor rspons?
"Cross-p
rsntation.<br>Its not shown blow in th cross-priming stp, but th tumor c
ll would b opsonizd with IgG, which is thn bound to th DC by Fc-gamma-RI, in
ducing phagocytosis.<br><img src=""Scrn Shot 2013-02-10 at 12.30.03 PM.png"" /
>"
Chaptr10 Markd
Dscrib som ways by which tumor clls can vad our acquird immun systm.
"TGF-bta is immunosupprssiv of Th1 and&nbsp;&nbsp;promots Trg prolifration
(which maks mor TGF-bta).<br>HLA-G supprsss NK1 clls and convrts thm to
NK2.<br><img src=""Scrn Shot 2013-02-10 at 1.53.20 PM.png"" />"
Chaptr1
0 Markd
Nam and dscrib (2) forms of passiv acquird immunity to fight tumors.
"1. Infusion of tumor-spcific T clls. Not: bttr to us th patints own T
clls and ducat thm in vitro against th tumor, but its xpnsiv.<br>2. Inf
usion of tumor-spcific antibodis. Ths antibodis can b coupld to anti-tumo
r drugs lik doxirubicin.<br><br><b>Two slids blow:</b><br><img src=""Scrn S
hot 2013-02-10 at 1.59.50 PM.png"" /><br><img src=""Scrn Shot 2013-02-10 at 1.
59.56 PM.png"" />"
Chaptr10 Markd
What ar chimric antign rcptors?<br>-what ar thy mad of?<br>-what signali
ng advantags do thy provid?<br>
"Thyr TCRs that hav Ab light chain 
xtraclluar domains and intracllular CD3 (zta-chain) componnts. This allows T
-clls to <span styl=""font-wight:600; color:#ff1a1b;"">dirctly ngag tumor
clls</span> and not hav to wait for MHC prsntation. Additionally, this chim
ric rcptor can b coupld with CD28 (rcptor for B7) so that th rcptor can
rciv and provid to th cll both signals 1 (strangr) and 2 (dangr).<br><i
mg src=""Scrn Shot 2013-02-10 at 2.01.30 PM.png"" />" Chaptr10 Markd
What ar dndritic cll vaccins and how to thy nhanc acquird immun rspons
s?
"Thyr our DCs that ar rmovd and incubatd in vitro with crtain an
tigns. Aftr succssful phagocytosis and prsntation, thyr r-injctd into
us and ar snt to lymph nods for prsntation to T clls.<br><br>This should
happn normally but its slow bcaus of th cross-prsntation rquird, so th
xognous ducation quickns th prorcss.<br><img src=""Scrn Shot 2013-02-10
at 2.12.13 PM.png"" /><br>"
Chaptr10 Markd

Instad of using Abs to targt forign or cancrous antigns, how do w us thm
to nhanc our T-cll rsponss?
"W can crat antigns for th many act
ivation rcptors upon T-clls and stimulat thm whn cytokins and intrlukin
s ar insufficint on thir own. Th Abs can ithr bind to activation rcptors
or block inhibiti<img src=""Scrn Shot 2013-02-10 at 2.12.23 PM.png"" />on rc
Chaptr10 Markd
ptors.<br>"
"Smi-obvious rfrnc card: inhibiting TILs (tumor infiltrating lymphocyts) d
privs tumors of thir protctiv WBCs, making thm asir to kill.<br><img src
=""Scrn Shot 2013-02-10 at 2.22.06 PM.png"" />"
Chaptr10 Markd
"HSCT (rfrnc card)<br><b>Not: bttr to us this trm than bon marrow tran
splant (sinc its only a subst of HSCT)</b><br><img src=""Scrn Shot 2013-0210 at 2.23.20 PM.png"" />"
Chaptr10 Markd
"Bon marrow transplants, a typ of HSCT (rfrnc card)<br><b>Nots: </b><br>NKs can dtct forign clls of any typ but spcially good at dtcting forig
n lukocyts.<br><img src=""Scrn Shot 2013-02-10 at 2.24.31 PM.png"" />"
Chaptr10 Markd
Why is a singl MHC mismatch optimal for bon marrow transplants?
It will
triggr an alloraction that also causs th T clls to scour th body for rmai
ning tumor clls.
Chaptr10 Markd
Dscrib th thr typs of tolranc. "AICD: apoptosis through raction with s
lf-antign, lik ngativ slction but priphrally; it dos not nd inductio
n from anothr cll.<br><img src=""Scrn Shot 2013-02-10 at 5.16.11 PM.png"" />
"
Chaptr9 Markd
If T clls in th thymus dvlop a strong raction with a slf-antign, what ar
th two fats of th cll?
1) Ngativ slction and apoptosis.<br>2) Matur
ation into Trgulatory clls which scrt TGF-bta to inhibit cytolytic rspons
s.
Chaptr9 Markd
What is th rol of autoimmun rgulator (AIRE)? in T cll ngativ slction?
It turns on a varity of xtra-thymic gns in th mdullary thymic pithlial c
lls (MTEC) so that T clls ar ngativly slctd for sing thos antigns (s
uch as pancratic ons). Loss of AIRE can caus autoimmun disas (lik Typ I
DM if thy ract against pancratic antigns). Chaptr9 Markd
"Natural Trgs (rfrnc card)<br><img src=""Scrn Shot 2013-02-10 at 5.32.32
PM.png"" />"
Chaptr9 Markd
Why do Trgs hav lots of CD25? CD25 is th rcptor for IL-2, th IL that induc
s cll-mdiatd killing. Trgs with high constitutiv lvls of CD25 suck up th
 IL-2 to supprss th killing activity.
Chaptr9 Markd
"Mchanisms of T cll priphral tolranc (rfrnc card)<br><img src=""Scrn
Shot 2013-02-10 at 5.34.30 PM.png"" />"
Chaptr9 Markd
Diffrntiat btwn T-cll anrgy and xhaustion.
"Two slids:<br><img src
=""Scrn Shot 2013-02-10 at 5.35.33 PM.png"" /><br><img src=""Scrn Shot 201302-10 at 5.35.44 PM.png"" />" Chaptr9 Markd
What ar th 4 componnts of taking a history? 1. History of prsnt illnss<di
v>2. Past mdical history</div><div>3. Prsonal/social history</div><div>4. Fami
ly history</div>
HistoryTaking
HPI:<div><br /></div><div>Giv its 4 componnts.</div> 1. <b>Chif complaint</b
><div>2. <b>OLDCARTS</b></div><div>3. <b>Patints xplanatory modl</b></div><d
iv>4. <b>Impact of illnss on patint</b></div><div><br /></div>
HistoryT
aking
HPI: Patints xplanatory modl:<div><br /></div><div>Giv th 3 qustions you
should ask about this.</div>
<div>a. What do you think is causing ths sympt
oms?</div><div>b. What ar your xpctations for tratmnt?</div><div>c. Is thr
 anything about this illnss that your particularly worrid about?</div>
HistoryTaking
Giv th 7 componnts of th PMH.
"<div>1. Othr mdical problms</div><di
v>2.<span class=""Appl-tab-span"" styl=""whit-spac:pr""> </span>Major illn
sss</div><div>3.<span class=""Appl-tab-span"" styl=""whit-spac:pr""> </spa
n>Hospitalizations</div><div>4. Surgris</div><div>5.<span class=""Appl-tab-sp
an"" styl=""whit-spac:pr""> </span>Mdications</div><div>6.<span class=""App
l-tab-span"" styl=""whit-spac:pr""> </span>Allrgis</div><div>7.<span clas

s=""Appl-tab-span"" styl=""whit-spac:pr""> </span>Mnstrual/OB history (for

womn)</div><div><br /></div>" HistoryTaking
Prsonal/social history:<div><br /></div><div>Giv 8 of th 12 itms you should
ask about.</div>
1. Living arrangmnt<div>2. Work/daily activitis</div>
<div>3. Dit</div><div>4. Exrcis</div><div>5. Financs</div><div>6. Prsonal r
lationships</div><div>7. Strss</div><div>8. Mood</div><div>9. Halth blifs</
div><div>10. Smoking</div><div>11. Alcohol</div><div>12. Spirituality/rligious
blifs</div> HistoryTaking
Family history:<div><br /></div><div>Ask about disass rlatd to th prsnt i
llnss in what 4 rlativs?</div>
1. Grandparnts<div>2. Parnts</div><div
>3. Siblings</div><div>4. Childrn</div>
HistoryTaking
What ar th 5 qustions that ar ssntial to ask in th <b>contxt and haling
</b> intrviw?<div><br /></div><div>If your particularly motivatd, giv th
3 othr kumbaya qustions you should ask.</div> 1.&nbsp;What <b>causd</b> th p
roblm?<div>2.&nbsp;What kind of <b>tratmnt</b> should you rciv?</div><div>
3. What ar most important <b>rsults</b> you want?</div><div>4.&nbsp;What do yo
u <b>far</b> most about th illnss? What in particular ar you <b>concrnd</b
>&nbsp;with about it?</div><div>5. What <b>problms</b> has th disas causd?<
/div><div><br /></div><div><div>1. What do you <b>call</b> th problm?</div><di
v>2. Why did it start whn it did?</div><div>3. What dos th sicknss do? How?<
/div></div>
HistoryTaking
What ar th two typs of Hamophilus influnza?
<div>-Encapsulatd (A,B,
C,D,E,F)-basd on srological typing</div><div><br /></div><div>-Unncapsulatd
(nontypabl)</div>
3/18Hamophilus Dicky SassinHIB
Whats th morphology of Hamophilus? "<div>Fin, gram ngativ <u>coccobacill
i</u></div><div>-distinctiv in sputum</div><div><img src=""HI.jpg"" /></div><d
iv><img src=""past-172769354449264.jpg"" /></div>"
3/18Hamophilus Dicky S
assinHIB
Dscrib th structural faturs (4) of Hamophilus?
<div>-Pilli: nabls att
achmnt</div><div>-LOS: damag tissu and inflammation</div><div>-Outr mmbran
PRPs: possibl AB rol in immunity</div><div>-Capsul: usd for srological typ
ing, major virulnc factor</div>
3/18Hamophilus Dicky SassinHIB
Uniqu fatur of th typ B hamophilus capsul?
-Contains PRP (polyribos
yl ribot phosphat) and usd in HI typ B vaccin
3/18Hamophilus Dicky S
assinHIB
Growth rquirmnts for Hamophilus Influnza? "<div>-Factor V (NAD) and Factor
X (hmin) and chocolat agar</div><div>NOTE: hmin is a iron binding porphyrin
(hmatin)</div><div><br /></div><div>-Mnmonic: Whn kid is sick, mom gos to th
 fiv (<b styl=""color: rgb(255, 0, 0); "">V</b>)&nbsp;and dim (<b><font colo
r=""#ff0000"">X</font></b>)&nbsp;to by <b><font color=""#ff0000"">chocolat</fon
t></b></div><div><br /></div><div><img src=""past-172606145692020.jpg"" /></div>
"
3/18Hamophilus Dicky SassinHIB
Why dos a Hamophilus influnza typ B disas occur? <div>-<u>Capacity to pro
lifrat</u> (without intrfrnc from host)</div><div><br /></div><div>-intns
 <u>inflammation</u></div>
3/18Hamophilus Dicky SassinHIB
Whr dos Hamophilus influnza coloniz?
<div>Nasopharynx</div><div>-thou
ght to b in 1-2% of childrn prior to vaccin ara</div><div><br /></div><div>(
carriag and disas narly liminatd by widsprad vaccination)</div> 3/18Ham
ophilus Dicky SassinHIB
What is th structur of H. influnza group agyptius? "-Has th typ <u>B gno
m</u> and th <u>plasmid</u> that maks it virulnt<div><br /></div><div><img s
rc=""past-172550311116935.jpg"" /></div>"
3/18Hamophilus Dicky SassinHIB
What disas do nontypabl Hamophilus influnza strains caus? (6, nam 4)
"<div>-<b>Otitis Mdia</b>&nbsp;<font color=""#ff0000"">(now most common caus)<
/font></div><div>-Sinusitis</div><div><b>-Exacrbation of bronchitis/COPD (acut
purulnt trachobronchitis)&nbsp;</b><font color=""#f72316"">(most common caus
)</font></div><div>-<b>Pnumonia </b>(2nd to pnumococcus)</div><div>-<b>Purpr
al fvr and spsis of nwborn (biotyp IV)</b></div><div><b><br /></b></div><di
v>-Mningitis (uncommon)</div><div><br /></div><div>1) MOPS</div><div>2) Exacrb
ation of COPD</div><div>3. Pupral fvr and Spsis&nbsp;</div>"
3/18Ham

ophilus Dicky SassinHIB

How dos Hamophilus Influnza rlat to Pnumococcus? (in rlation to most comm
on causd disass)
<div>-Both ar <u>most common causs</u>&nbsp;of <u>Otit
is Mdia</u> and <u>Sinusitis</u>&nbsp;</div><div>-HI is <u>scond</u>&nbsp;most
common caus of <u>Pnumonia</u></div><div><br /></div> 3/18Hamophilus Dicky S
assinHIB
What is th host rspons to an infction w/ Hamophilus Influnza? (typabl vs.
non-typabl) "<div>Typabl strains:</div><div>-Antibody to th <u>PRP</u> cap
sul (opsonizing and bactricidal)</div><div><br /></div><div>-Antibody to <u>LO
S</u> and outr mmbran protins (bactricidal but lssr)</div><div><img src="
"past-172082159681635.jpg"" /></div><div><br /></div><div>Nontypabl strains:</
div><div>-Childrn will usually <u>initially lack</u> IgGs to <u>outr mmbran
protins</u> but thn <u>dvlop</u> and its protctiv</div><div><br /></div><d
iv>-Normal adults lik chronic bronchitics <u>hav</u> bactricidal and opsonizi
ng ABs but still gt infctd b/c <u>cant clar bronchi</u></div><div><u><img src
=""past-172112224452732.jpg"" /></u></div><div><u><br /></u></div>"
3/18Ham
ophilus Dicky SassinHIB
What disass dos Moraxlla caus? (3) What dos it almost nvr caus? (2)
<div>much lss virulnt vrsion of NTHI</div><div><br /></div><div>- xacrbatio
n of COPD (2nd most common)</div><div><br /></div><div>- otitis mdia and sinusi
tis (3rd most common)</div><div><br /></div><div>-Trachobronchitis and pnumoni
a in ppl w/ prxisting chronic lung disas</div><div><br /></div><div>*almost
nvr mningitis or bactrmia</div><div><br /></div><div>conjunctivitis, bronch
opnumonia, spsis, shock, DIC</div>
3/18Hamophilus Dicky SassinHIB
<div>5 stags of infancy and toddlrhood</div><div><br /></div> <div>prnatal, 0
-2 months, 2-7 months, 7-18 months, 18-36 months</div><div><br /></div>
<div>2 important aspcts of a mothrs bhavior in dvloping attachmnt</div><d
iv><br /></div> <div>rsponsivnss to infant, amount of stimulation sh provid
s</div><div><br /></div>
<div>hormon that stimulats matrnal bhavior</div><div><br /></div> <div>oxy
tocin</div><div><br /></div>
<div>hormon dcrasd in mothrs with postpartum dprssion</div><div><br /></d
iv>
<div>oxytocin</div><div><br /></div>
<div>milston: infant can orint to sounds and facs</div><div><br /></div>
<div>0-2 months</div><div><br /></div>
<div>milston: infant rsponds diffrntly to diffrnt cargivrs and njoys h
uman company</div><div><br /></div>
<div>2-7 months</div><div><br /></div>
<div>milston: spcific attachmnt phas</div><div><br /></div>
<div>7-9
months</div><div><br /></div>
<div>biological foundation for bhavior that is influncd by gns</div><div><b
r /></div>
<div>tmpramnt</div><div><br /></div>
<div>typ of tmpramnt that xprincs distrss in novl situations</div><div
><br /></div> <div>slow to warm up</div><div><br /></div>
<div>3 typs of tmpramnt</div><div><br /></div>
<div>asy, difficult, sl
ow to warm up</div><div><br /></div>
<div>What typ of attachmnt? Cargivr is rsponsiv to infant cus, child is h
appy whn parnt rturns</div><div><br /></div> <div>scurly attachd</div><div
><br /></div>
<div>What typ of attachmnt? Adult is impatint and unrsponsiv cargivr. Th
r is littl distrss in th child whn thrs sparation.</div><div><br /></di
v>
<div>inscur avoidant</div><div><br /></div>
<div>What typ of attachmnt? Inconsistnt cargivr, angry and rjcting runio
n bhavior from infant.</div><div><br /></div> <div>inscur rsistant/ambival
nt</div><div><br /></div>
<div>What kind of attachmnt? Abusiv/dprssd cargivrs. Infant xhibits inco
nsistnt bhavior.</div><div><br /></div>
<div>inscur disorintd/disorg
anizd</div><div><br /></div>
<div>dfin ractiv attachmnt disordr.</div><div><br /></div>
<div>hav
 had attachmnt (9 months or oldr), but youngr than 5 yars</div><div><br /><
/div>

<div>What typ of tmpramnt? activ, irritabl, ractiv to chang, slow to ad

apt</div><div><br /></div>
<div>difficult</div><div><br /></div>
<div>Whn dos strangr anxity occur? Whn dos it pak?</div><div><br /></div>
<div>8 months; paks at 24 months</div><div><br /></div>
<div>milston: walking</div><div><br /></div> <div>12-14 months</div><div><br
/></div>
<div>milston: attachmnt</div><div><br /></div>
<div>7-9 months</div><di
v><br /></div>
<div>milston: sitting with, without support</div><div><br /></div>
<div>6 m
onths; 9 months</div><div><br /></div>
<div>milston: babinski sign</div><div><br /></div>
<div>0-2 months</div><di
v><br /></div>
<div>milston: social rfrncing</div><div><br /></div>
<div>7-10 months
(this is infrnc of motion from othrs xprssions)</div><div><br /></div>
<div>milston: Roug tst</div><div><br /></div>
<div>18-24 months (this
is slf-rcognition using mirror)</div><div><br /></div>
<div>whn dos babinski disappar?</div><div><br /></div>
<div>8-12 months
</div><div><br /></div>
<div>milston: transfrs objcts from hand to hand</div><div><br /></div>
<div>6-7 months</div><div><br /></div>
<div>milston: rachs for objcts</div><div><br /></div>
<div>4-5 months<
/div><div><br /></div>
<div>milston: cooing</div><div><br /></div> <div>4 months</div><div><br /></
div>
<div>milston: objct prmannc</div><div><br /></div>
<div>7-9 months
(out of sight, not out of mind)</div><div><br /></div>
<div>milston: crawls</div><div><br /></div> <div>6-9 months</div><div><br />
</div>
<div>milston: scribbls</div><div><br /></div>
<div>15 months</div><div
><br /></div>
<div>milston: sparation anxity; whn dos it pak?</div><div><br /></div>
<div>6-8 months; paks 14-18 months</div><div><br /></div>
<div>milston: paralll play</div><div><br /></div>
<div>12 months (play alo
n nxt to othrs)</div><div><br /></div>
<div>milston: social play</div><div><br /></div>
<div>15-18 months</div><
div><br /></div>
<div>milston: gndr labling</div><div><br /></div> <div>3 yars</div><div><
br /></div>
<div>milston: catchs ball</div><div><br /></div>
<div>4 yars</div><div><
br /></div>
<div>milston: skips and rids bik</div><div><br /></div>
<div>5 yars</di
v><div><br /></div>
<div>whn dos physical aggrssion finally dcras?</div><div><br /></div>
<div>by 3rd b-day</div><div><br /></div>
<div>whn dos vrbal aggrssion pak?</div><div><br /></div> <div>2-4 yars</
div><div><br /></div>
<div>whn is most all aggrssion rducd?</div><div><br /></div>
<div>5-6
yars</div><div><br /></div>
<div>milston: incrasd fantasy play</div><div><br /></div> <div>3 yars</di
v><div><br /></div>
<div>visual cliff vido dmo</div><div><br /></div>
<div>social rfrncing<
/div><div><br /></div>
<div>t/f: Infants who ar in day car ar usually not lss motionally fit than
thos who ar at hom with a parnt</div><div><br /></div>
<div>tru</div><
div><br /></div>
<div>t/f: Amrican mothrs who took 4 month lavs aftr birth displayd lss n
gativ affct whn rsponding to thir babis than did mothrs whos lavs last
d only 2 months</div><div><br /></div> <div>tru</div><div><br /></div>
<div>t/f: A scur attachmnt to ons fathr may provid som protction agains
t th potntially unfavorabl ffcts of an inscur mothr - child attachmnt</

div><div><br /></div> <div>tru</div><div><br /></div>

<div>milston: thory mind, othrs hav thoughts</div><div><br /></div>
<div>4 yars</div><div><br /></div>
<div>articulation of spch undrstandabl to parnts</div><div><br /></div>
<div>2 yars</div><div><br /></div>
<div>articulation of spch undrstandabl to strangrs</div><div><br /></div>
<div>3 yars</div><div><br /></div>
<div>normal dysfluncy</div><div><br /></div> <div>3-5 yars</div><div><br /><
/div>
<div>languag is adult lik</div><div><br /></div>
<div>5-6 yars</div><div
><br /></div>
<div>baby first uss vocal cords</div><div><br /></div> <div>cooing</div><div><b
r /></div>
<div>baby first uss lips/tongu to modulat sound</div><div><br /></div>
<div>babbling</div><div><br /></div>
<div>milston: baby first xhibits nonvrbal communication (i social smil)</d
iv><div><br /></div>
<div>0-2 months</div><div><br /></div>
<div>smoothnss or flow of spch</div><div><br /></div>
<div>fluncy</di
v><div><br /></div>
<div>motor componnt of communication</div><div><br /></div>
<div>articulatio
n</div><div><br /></div>
"<div>""I s, I s, I s a bird""</div><div><br /></div>"
<div>normal dysf
luncy; 3-5 yars old</div><div><br /></div>
<div>t/f: bilingual nvironmnts ar dtrimntal to languag dvlopmnt</div><d
iv><br /></div> <div>fals</div><div><br /></div>
<div>t/f: spaking arly is a sur sign of suprior intllignc</div><div><br /
></div> <div>fals</div><div><br /></div>
<div>flynn ffct</div><div><br /></div>
<div>ovr tim IQ drifts</div><d
iv><br /></div>
<div>IQ tst good for assssing xtrms</div><div><br /></div> <div>Stanford Bi
nt</div><div><br /></div>
<div>IQ tst usd by schools most oftn</div><div><br /></div> <div>Woodcock-Jo
hnson</div><div><br /></div>
<div>IQ tst culturally unbiasd for minoritis</div><div><br /></div> <div>Dif
frntial ability scals (DAS-II)</div><div><br /></div>
<div>Social risks factors for MR/ID</div><div><br /></div>
<div>povrty, la
ck of prnatal car, domstic violnc, traumatic xposur</div><div><br /></div
>
<div>How many points blow avrag for larning disordr?</div><div><br /></div>
<div>16 pts; Tst scor for an acadmic skill in on or mor ara &lt;85</div><d
iv><br /></div>
<div>DSM-IV-TR diagnosis of MR/ID</div><div><br /></div>
<div>IQ &lt;70,
onst bfor 18, 2 or mor dficits in adaptiv skills (i communication, work,
slf car, tc)</div><div><br /></div>
<div>mild mntal rtardation IQ</div><div><br /></div> <div>50-70</div><div><br
/></div>
<div>modrat mntal rtardation IQ</div><div><br /></div>
<div>35-50</div>
<div><br /></div>
<div>svr mntal rtardation IQ</div><div><br /></div>
<div>25-35</div>
<div><br /></div>
<div>profound mntal rtardation IQ</div><div><br /></div>
<div>&lt;25</div
><div><br /></div>
<div>95% of population IQs</div><div><br /></div>
<div>70-130</div><div><b
r /></div>
<div>milston: rcits alphabt</div><div><br /></div> <div>5-6 yars</div><div
><br /></div>
<div>milston: mylination complt</div><div><br /></div>
<div>7 yars</di
v><div><br /></div>
<div>milston: pruning and mylination incras spd of information procssing
</div><div><br /></div> <div>6-12 yars</div><div><br /></div>

<div>pr-oprational thinking</div><div><br /></div>

<div>5-6 yars</div><div
><br /></div>
<div>concrt oprational thinking</div><div><br /></div>
<div>7-11 yars<
/div><div><br /></div>
<div>formal opration stag</div><div><br /></div>
<div>11-12 yars</div><d
iv><br /></div>
<div>th ability to rcogniz that th proprtis of an objct or substanc dos
not chang whn its apparanc is altrd in som way</div><div><br /></div>
<div>consrvation (7-11 yars)</div><div><br /></div>
<div>th ability to rcogniz rlations among lmnts in a srial ordr (for x
ampl, if A &gt; B and B &gt; C, thn A &gt; C)</div><div><br /></div> <div>tra
nsitivity (7-11 yars)</div><div><br /></div>
"<div>Can ordr a st of stimuli along a quantifiabl dimnsion - Childrn can r
spond to tachrs rqust to ""lin up from tallst to shortst</div><div><br
/></div>"
<div>mntal sriation (tallst to short)</div><div><br /></div>
"<div>milston: ability to ""think about thinking""</div><div><br /></div>"
<div>11-12 yars</div><div><br /></div>
<div>Fin motor skills (dxtrity) - boys or girls?</div><div><br /></div>
<div>girls</div><div><br /></div>
<div>Gross motor skills (flxibility and balanc) - boys or girls?</div><div><br
/></div>
<div>girls</div><div><br /></div>
<div>Slf ratings ar modstly corrlatd with tachr ratings</div><div><br /><
/div> <div>4-7 yars</div><div><br /></div>
<div>Slf ratings ar similar to tachrs in all catgoris xcpt bhavioral co
nduct</div><div><br /></div>
<div>8 yar old</div><div><br /></div>
<div>Positiv accptanc/rsponsivnss (Warm), Positiv dmandingnss/control (
Controlling)</div><div><br /></div>
<div>authoritativ parnting</div><div><
br /></div>
<div>t/f: Prs contribut as much or mor to a child s dvlopmnt</div><div><
br /></div>
<div>tru</div><div><br /></div>
"<div>Any positiv intraction ""frind""</div><div><br /></div>"
<div>3-6
yars old</div><div><br /></div>
<div>Basis for frindship is shard activitis (ons own intrsts)</div><div><
br /></div>
<div>6-8 yars old</div><div><br /></div>
<div>Frinds ar psychologically similar basd on rciprocal rlationships; mutu
al liking</div><div><br /></div>
<div>8-10 yars old</div><div><br /></di
v>
<div>Rciprocal motional commitmnts; trust is a highr priority. What group s
ks this in pr rlationships?</div><div><br /></div> <div>adolscnts</div><d
iv><br /></div>
<div>ag for pr-oprativ anxity (highst risk)</div><div><br /></div>
<div>6m-4yars</div><div><br /></div>
<div>tmpramnt for pr-op anxity (highst risk)</div><div><br /></div>
<div>slow-to-warm up</div><div><br /></div>
"<div>""I got cancr bcaus I didnt tll my mothr th truth.""</div><div><br
/></div>"
<div>immannt justic (proprational)</div><div><br /></div>
"<div>Blif that vnts connctd tmporally ar causally rlatd</div><div>""I
fll down and that mad m gt a cough""</div><div><br /></div>"
<div>pr
-oprational 2-7 yars</div><div><br /></div>
<div>Difficulty rcognizing that apparntly unrlatd symptoms (hadachs and ra
sh) ar part of sam disas procss</div><div><br /></div>
<div>concrt 711 yars</div><div><br /></div>
<div>Capacity to undrstand two unrlatd symptoms can manifst from on conditi
on (i.. migrain hadach and msis)</div><div><br /></div> <div>formal opr
ations (12+)</div><div><br /></div>
<div>At gratst risk for sparation difficultis bfor surgry</div><div><br /
></div> <div>0-2 yars old</div><div><br /></div>
<div>Illnss thratns autonomy, control and bodily intgrity</div><div><br />
</div> <div>adolscnts</div><div><br /></div>
<div>prsons biological idntity</div><div><br /></div>
<div>sx</div><d

iv><br /></div>
<div>a prsons social and cultural idntity as mal or fmal</div><div><br /><
/div> <div>gndr</div><div><br /></div>
<div>ons awarnss of ons gndr and its implications</div><div><br /></div>
<div>gndr idntiy</div><div><br /></div>
<div>a bhavior, valu, or motiv that mmbrs of a socity considr mor typica
l or appropriat for mmbrs of on sx</div><div><br /></div> <div>gndr rol
standard</div><div><br /></div>
<div>th procss by which a child bcoms awar of his/hr gndr and acquirs m
otiv, valus, and bhavior considrd appropriat for mmbrs of that sx</div>
<div><br /></div>
<div>gndr typing</div><div><br /></div>
<div>dvlopmnt vulnrability - boys or girls?</div><div><br /></div> <div>boy
s</div><div><br /></div>
<div>visual/spatial capacity - boys or girls?</div><div><br /></div>
<div>boy
s</div><div><br /></div>
<div>snsitivity - boys or girls?</div><div><br /></div>
<div>both</div><
div><br /></div>
<div>play activ gams in groups; frind through common intrsts - boys or girl
s?</div><div><br /></div>
<div>boys</div><div><br /></div>
<div>play gams in smallr groups; frinds bcaus thy lik ach othr - boys o
r girls?</div><div><br /></div> <div>girls</div><div><br /></div>
<div>xtnsion of dndritic arms of th clls</div><div><br /></div>
<div>arb
orization</div><div><br /></div>
<div>biological or nvironmntal factors mor important in sxual orintation?</
div><div><br /></div> <div>biological</div><div><br /></div>
<div>Brain procssing bcoms fastr as suprfluous connctions ar trimmd</div
><div><br /></div>
<div>pruning</div><div><br /></div>
<div>t/f: Rats in nrichd nvironmnts hav mor nurons, synaptic connctions,
blood capillaris, and mitochondrial activation</div><div><br /></div> <div>tru
</div><div><br /></div>
<div>t/f: Sight of mothrs fac stimulats ndognous opiats and th productio
n of CRF in infants hypothalamus activating sympathtic nrvous systm. CRF als
o stimulats production of dopamin</div><div><br /></div>
<div>tru</div><
div><br /></div>
<div>5 factor modl of prsonality</div><div><br /></div>
<div>opnnss to
xprinc, conscintiousnss, xtravrsion, agrablnss, nuroticism; OCEAN<
/div><div><br /></div>
<div>Rothbarts 3 factor modl of tmpramnt</div><div><br /></div>
<div>ng
ativ affct, surgncy, ffortful control</div><div><br /></div>
<div>positiv motions, liks to sk comfort of othrs; what kind of tmpramn
t?</div><div><br /></div>
<div>surgncy</div><div><br /></div>
<div>slf-disciplind, focuss attntion and is mindful; what kind of tmpramn
t?</div><div><br /></div>
<div>ffortful control</div><div><br /></div>
<div>What dos OCEAN stand for?</div><div><br /></div> <div>opn mindnd, consc
intiousnss, xtravrsion, agrablnss, nuroticism</div><div><br /></div>
<div>3 factor xtrnalizing disordr</div><div><br /></div>
<div>(+) ngativ
 affct, (-) ffortful control...ngativ affct tnding to xprinc ngativ
motions (nuroticism)</div><div><br /></div>
<div>positiv dmandingnss/control, ngativ accptanc/rsponsivnss</div><di
v><br /></div> <div>authoritarian parnting styl</div><div><br /></div>
<div>positiv dmandingnss/control, positiv accptanc/rsponsivnss</div><di
v><br /></div> <div>authoritativ parnting styl</div><div><br /></div>
<div>ngativ dmandingnss/control, positiv accptanc/rsponsivnss</div><di
v><br /></div> <div>prmissiv parnting styl</div><div><br /></div>
<div>ngativ dmandingnss/control, ngativ accptanc/rsponsivnss</div><di
v><br /></div> <div>uninvolvd parnting styl</div><div><br /></div>
<div>t/t: Popl with six or mor ACEs did narly 20 yars arlir on avrag t
han thos without ACEs</div><div><br /></div> <div>tru</div><div><br /></div>
"<div>""as a shift btwn culturs that forcs prsonality chang on th indivi
dual""</div><div><br /></div>" <div>acculturation</div><div><br /></div>

<div>typ of parnting styl that is most commonly found in financially disadvan

tagd familis or thnic minoritis:</div><div><br /></div>
<div>authoritari
an</div><div><br /></div>
Tratmnt for Histoplasma
"Itraconazol; Amphotricin B if svr<div><br
/></div><div><img src=""past-98968931402215.jpg"" /></div>"
Dicky
Tratmnt of svr PCP. IV or Oral?
<u>PO</u> bactrim (trimthoprim, sulfam
thoxazol)<br><br>AIDS with history of PCP or low CD4 - automatic prophylaxis wi
th bactrim
Bhcts disas
Non vnral Chancr:&nbsp;<div><br /></div><div>Autoimm
un, unknown tiology</div><div>Oral and GU ulcrs&nbsp;</div><div>associatd wi
th autoinflammation of small vssl systmic vasculitis</div>
What family of virus has a singl polyprotin clavd into smallr protins?
"Picornavirida<div><img src=""poly.jpg"" /></div>"
Sprad by rat xcrmnt (2)
"Hanta, Arna (Lassa, LCM)<div><br /></div><div>
<img src=""past-207288006607478.jpg"" /></div><div><br /></div><div><img src=""
past-209353885876854.jpg"" /></div>" 5/23ArbovirusRD
HIV antirtroviral tratmnt formula
"ARV combination = (2 NRTI) + (Boostd P
I <b>or</b> NNRTI <b>or</b> intgras inhibitor)&nbsp;<div>NEVER monothrapy (l
ads to rsistanc)<div><div><div><img src=""initial.jpg"" /></div></div></div><
/div>" 5/27HIVTratmntRD
In a patint with IgM anti-HDV, why would you gt an IgM anti-HBc titr? Dont y
ou know automatically that thy hav Hp B?
You nd to dtrmin if it is a
coinfction (acut Hp B, positiv IgM-antiHBc) or a suprinfction (chronic H
p B, ngativ IgM)
Mnmonic for Kintoplasts
KINEToplasts lik KINETic nrgy --> TRYPping (t
rypanosoma) and MANIA (lishmania)
Nam th Sporozoans
Plasmodium<br>Babsia<br>Toxoplasma<br>Cryptosporidium<b
r>Isospora<br>Cyclospora<br><br>Mnmonic : Panut Buttr Tim, Spor, Spor, Spor
(tak it or lav it)
Nam th Flagllats
Diplomonads (Giardia)<br>Trichomonads (Trichomonas)<br>K
intoplasts (TRYPanosoma, LishMANIA)
Dfinitions:<br>1. Trophozoit<br>2. Cyst<br>3. Sporozoit<br>4. Gamtocyt<br>5
. Oocyst
1. Trophozoit - motil form which invads, grows<br>2. Cyst - d
ormant form, dos NOT grow or rplicat<br>3. Sporozoit - product of sxual rp
roduction<br>4. Gamtocyt - fus in sxual rproduction (thus forming a sporozo
it)<br>5. Oocyst - infctiv, has a shll for survival outsid host
Dfinitions<br>1. Dfinitiv host<br>2. Intrmdiat host<br>3. Rsrvoir<br>4.
Incidntal host 1. Dfinitiv host - houss sxual rproduction<br>2. Intrmdia
t host - houss larval or asxual stag<br>3. Rsrvoir - houss a parasit whi
ch can harm othr animals<br>4. Incidntal - host which is accidntally infctd
, this host is not rquird for th parasit lif cycl (man is an incidntal ho
st in zoonoss)
List th Protozoans which infct...<br>1. Viscra<br>2. CNS<br>3. RBCs<br>4. GU
(STDs)<br>5. GI tract 1. Viscra - Kintoplasts (Lishmania, Trypanosoma cruzi
--> Chagas)<br>2. CNS - Trypanosoma bruci (--> slping sicknss), Toxoplasma,
Naglria fowlri<br>3. RBC - Plasmodium (malaria), Babsia (malaria lit)<br>4
. STD - Trichomonas (vaginitis)<br>5. GI - Giardia, Entamoba histolytica, Crypt
osporidium, Cyclospora, Dintamoba fragilis, strongyloids, microsporidium, iso
spora
Transmission by fmal sandflis
"Lishmania<br>(""At th bach (sandfli
s), you nd to kp your dog on a Lish to prvnt Mania"")"
Lishmania - lif cycl Fmal sandfly injcts promastigot into skin<br>Promast
igots invad macrophags<br>Multiplication within macrophags as amastigots
Lishmania - Prsntation
"Cutanous - ulcrs with raisd dgs ""chs p
izza lsion"" on fac, arms, and lgs, may b diffus lik lprosy<br><br>Mucocu
tanous - granulomatous dstruction of mucous mmbran (nasopharynx)<br><br>Visc
ral (Kala-azar, L donovani) - spiking fvr, HSM, pancytopnia, wight loss, po
tntially fatal (sp with AIDS)"
Kala azar
Viscral lishmania (L donovani)<br>Spiking fvr, HSM, pancytop
nia, wight loss, highst fatality among AIDS patints<br>Rsrvoir is humans i

n India (Kala azar), dogs in latin amrica and mditrranan

Spiking fvr Kala azar (Lishmania donovani)<br>Malaria (Plasmodium, sp. fal
ciparum)
Spiking fvr + HSM + pancytopnia
Kala azar (Lishmania donovani)
Lishmania - gnra and associations
"L tropica - old world cutanous (middl
ast, africa), painLESS ""CHEESE PIZZA lsion,"" rsrvoir in RATS<br><br>L mx
icana - nw world cutanous (cntral, south amrica), CHICLEROs ulcrs, rsrvo
ir in forst RODENTS<br><br>L brazilinsis - nw world muco/cutanous (cntral,
south amrica), rsrvoir in tr animals lik SLOTHS<br><br>L donovani - viscr
al (Kala azar), rsrvoir in popl in India but dogs in latin amrica and mdit
rranan"
Lishmania - diagnosis Microscopy - Gimsa (look for macrophags containing ama
stigots)<br>Srology - only for Kala azar
Gimsa stain --> macrophags with amastigots Lishmania
Lishmania - tratmnt Pntavalnt antimonials (.g. sodium stibogluconat)<br>
<br>Liposomal amphotricin - unrsponsiv mucocutanous infction or rsistant v
iscral (kala azar) in India or mditrranan
Chs pizza lsions
Lishmania (cutanous form)
Rduvid bug
Chagas (Trypanosoma cruzi)<br>Livs in th cracks in low incom
housing in impovrishd Latin Amrica
Trypanosoma cruzi - pidmiology, transmission "Latin Amrica<br>Sprad by Rdu
vid ""kissing bug"" (livs in tr trunks, mammal burrows, and cracks in LOW INC
OME HOUSING)<br>Rarly - blood transfusion in ndmic aras, organ transplants,
congnital<br>PREVENT - inscticids, improvd housing"
Kissing bug
Rduvid<br>South Amrica<br>Chagas (Trypanosoma cruzi)
Trypanosoma cruzi - lif cycl "Rduvid ""kissing bug"" dfcats trimastigots
onto human skin<br>Parasit ntrs mucosa or brokn skin (bit)<br>Amastigots
rplicat within macrophags and myocyts"
Trypanosoma cruzi - prsntation
Primary chagoma - lsion at sit of inoc
ulation<br>Acut - oftn asymptomatic or fvr + LAD + HSM in kids, Romana sign
(if ntr via conjunctiva)<br>Latnt - asymptomatic but sropositiv, dcads<br
>Chronic - adult with cardiomyopathy (hart failur, arrhythmia, fatal), mgaso
phagus, mgacolon<br>Ractivation in AIDS patints (CV, CNS, skin)
Mgasophagus and mgacolon
Trypanosoma cruzi (chagas) - chronic form, ract
ivation aftr dcads of latncy
This parasit is fatal via hart failur
Trypanosoma cruzi (chagas)
Trypanosoma cruzi - diagnosis, tratmnt
Acut - blood smar (look for am
astigots in tissu)<br>Chronic - srology, history (whr spnt childhood)<br><
br>Trat with Nifurtimox, bnznidazol<br>NO TREATMENT FOR CHRONIC DISEASE - sup
portiv car is all w hav
Trypanosoma bruci - aka, subspcis, transmission
African Slping Sickns
s<br>T bruci gambins (W africa) - rsrvoir is humans, sprad in rivrs<br>T
bruci rhodsins (E africa) - rsrvoir in wild gam animals<br>Tsts fly vc
tor, bit is painful
Rsrvoir in wild gam animals Trypanosoma bruci rhodsins - East African Sl
ping Sicknss
Trypanosoma bruci - pathognsis, prsntation Tsts fly bit (painful) --> pa
rasit gos to blood and lymphatic --> invads CNS<br><br>Rcurring fvr - blo
od forms covrd with VSF (variabl surfac glycoprotins --> rlapsing)<br>Prim
ary - trypanosomal chancr, flu-lik<br>Transint rash (< 8 wks aftr onst)<b
r>Trypanids = blotchy rythmatous maculs on th trunk<br>Scondary - chronic f
vr, LAD, HSM<br>Lat - CNS disas (somnolnc, insomnia, confusion, hadach,
coma), HIGH MORTALITY
What ar trypanids?
Blotchy rythmatous maculs on th trunk<br>Associatd
with Trypanosoma bruci (african slping sicknss) transint rash
Parasit with VSG (antignic variation) --> rlapsing fvrs
Trypanosoma bruc
i (african slping sicknss)
Trypanosoma bruci - diffrncs (pidmiology, prsntation) btwn subspcis
Gambins - wst africa, rsrvoir in humans, rivr association, insidious onst
, crvical LAD (Wintrbottoms sign)<br><br>Rhodsins - ast africa, rsrvoir

in big gam, acut onst and rapid CNS involvmnt, dath within wks
Romana sign
Swolln y lid if Trypanosoma cruzi (chagas) ntrs via th con
junctiva
Wintrbottoms sign
Trypanosoma bruci gambins (wst african slping sick
nss)<br>Crvical LAD
Trypanosoma bruci - diagnosis Blood smar, lymph smar, CSF --> look for paras
its<br>Staging is critical - untratd CNS infction is fatal but drugs ar sup
r toxic<br>CHECK CSF (LP) FOR TRYPANOSOMES!!! or lymphocytic plocytosis or int
rathcal IgM
Trypanosoma bruci - tratmnt CHECK CSF (LP) FOR TRYPANOSOMES or lymphocytic p
locytosis or intrathcal IgM<br><br>NO CNS INFECTION - IV Suramin (hmolymphati
c stag)<br>CNS INFECTION - trivalnt arsnical mlarsoprol (crosss BBB, 10% ha
v SEVERE post-tratmnt ractiv ncphalopathy...trat with corticostroids)
Toxoplasma gondii - pidmiology, transmission "Worldwid (ys US) high in fran
c (stak tartar) and l salvador (tropical)&nbsp;<div><br /></div><div>Dfiniti
v host - cat (ingst cyst, xcrt oocyst)</div><div>Incidntal host - humans (
ingst oocyst)&nbsp;</div><div><br /></div><div>&nbsp;Transmittd to humans by o
ocysts in cat fcs, tissu cysts in uncookd mat, transplacntal or congnital
, transfusion or transplant</div><div><br /></div><div><img src=""past-14352921
7098358.jpg"" /></div>"
Toxoplasma gondii - lif cycl stags "Oocyst - xcrtd by cats&nbsp;<div><br
/></div><div>Tachyzoit - motil, travls to muscl and nrv tissu&nbsp;</div
><div><br /></div><div>Tissu cyst (bradyzoit; muscl, brain, ys)<div><br /><
/div><div><br /></div><div><img src=""past-143529217098358.jpg"" /></div></div>
"
Toxoplasmosis gondii - prsntation
"Acut (immunoCOMPETENT host) - asymptom
atic or mono-lik (LAD, fvr, malais, rar rtinochoroiditis which rsolvs)<d
iv><br /></div><div>&nbsp;Ractivation (immunoCOMPROMISED, CD4 &lt;100 or transp
lant) - ENCEPHALITIS with RING-ENHANCING LESIONS (on CT with contrast) - fvr,
AMS, sizurs, focal nuro dficits, rar choriortinitis and pnumonitis&nbsp;<
/div><div><br /></div><div>Carful not to confus it with CNS lymphoma</div><div
><br /></div><div><img src=""past-143533512065654.jpg"" /></div>"
Toxoplasmosis gondii - congnital
"Crosss placnta during acut infction
(prgnant womn - no claning littr boxs or ating raw mat)&nbsp;<div><br />
</div><div>&nbsp;Thr Cs = Choriortinitis (blurrd vision, scotoma, blindnss,
may prsnt in adulthood), hydroCphalus, intracrbral Calcifications</div><di
v><br /></div><div>&nbsp;Othr - rash, LAD, HSM, jaundic, sizurs, microphthal
mia, cardiomgaly, MR (mntal rtardation)</div><div><br /></div><div><img src="
"past-143529217098358.jpg"" /></div>"
Ring-nhancing lsions (multipl) in an AIDS patint
"Toxoplasmosis gondii<di
v><br /></div><div><img src=""past-143529217098358.jpg"" /></div>"
Toxoplasmosis gondii - diagnosis
"Srology - high IgM or vry high or ris
ing IgG, tst prgnant womn&nbsp;<div><br /></div><div>Imaging (AIDS) - CT or M
RI of had</div><div><br /></div><div>&nbsp;PCR - CSF for ncphalitis, amniotic
fluid for congnital</div><div><br /></div><div><img src=""past-14352921709835
8.jpg"" /></div>"
Toxoplasmosis gondii - tratmnt
"Non for halthy,&nbsp;non-prgnant po
pl (about half of US is sropositiv)&nbsp;<div><br /></div><div>AIDS, prgnant
, nwborn - <b>Pyrimthamin (with folat) + Sulfadiazin </b>(or clindamycin if
sulfa allrgy).&nbsp;<b>Spiramycin</b> in first trimstr of prgnancy. &nbsp;<
b>Bactrim prophylaxis</b> if CD4 &lt; 100 or sropositiv&nbsp;</div><div><br />
</div><div>&nbsp;Prvnt - cook mat, avoid cat littr</div><div><br /></div><di
v><br /></div><div><br /></div><div><img src=""past-143529217098358.jpg"" /></d
iv>"
Plasmodium spcis (pidmiology, ky facts)
P falciparum - tropics, CEREBRAL
malaria, 2-day spiking fvrs, TWO RINGS within RBC, banana-shapd GAMETOCYTE<b
r><br>P vivax/oval - asia, latin amrica, wst africa, 2-day cycl, latncy, h
patic rcurrnc<br><br>P knowlsi - discrt parasits within RBC<br><br>P mala
ria - worldwid, rar, 3-day cycl
MCC parasitic fatality Malaria (plasmodium falciparum

Plasmodium - pidmiology
Fmal Anophls mosquito = dfinitiv host (sx
ual rproduction)<br>Man = rsrvoir host
Plasmodium - pathognsis within humans Anophls mosquito bit, injction of sp
orozoits into bloodstram<br>Livr stag - sporozoits infct livr clls, matu
r to schizonts, ruptur and rlas mrozoits<br>Blood stag - mrozoits inf
ct RBCs as ring-stag trophozoits which matur to schizonts and again ruptur a
nd rlas mrozoits<br><br>Som mrozoits diffrntiat to gamtocyts (takn
up by mosquito)<br>P vivax and oval - dormant hypnozoits prsist in livr and
can caus rlaps
Plasmodium - prsntation
Symptoms du to rlas of inflammatory cytokin
s from rupturd RBCs (rlas of mrozoits from matur schizonts)<br>Flu-lik a
nd cyclic (paroxysmal SPIKING FEVER, chills, hadach, n/v, achs, malais)<br>S
plnomgaly (phagocytosis of infctd RBCs)<br>Pancytopnia (anmia + thrombo +
lymphocytopnia)<br><br>P vivax/oval - dormal hypnozoits in livr --> rlaps
Fvr + chills + hadach + immigrant from or travlr to tropics
Suspicio
us of malaria (spiking fvr?)
Plasmodium falciparum - pathognsis, svr symptoms Multiplis in blood, inf
ctd RBCs hav KNOBS of parasit antign on surfac and bind ndothlials thus
clogging small vssls in brain (localizd SLUDGING)<br>Occludd capillaris -->
hypoxmia (brain, kidny, lungs)<br><br>Jaundic (hmolytic anmia), hpatomga
ly<br>CEREBRAL malaria - sizurs, AMS, coma<br>Rnal failur, hmoglobinuria, n
phrotic syndrom<br>Pulmonary dma, ARDS<br>Cardiovascular collaps and shock<
br>Hypoglycmia (kids, prgnant womn)
Plasmodium - diagnosis Blood smar --> look for immatur trophozoits (TWO RING
S in RBC) and banana-shapd GAMETOCYTE<br>PCR - givs spcis (if you cant figu
r it out and you happn to hav a half-million dollar PCR machin in th wildr
nss of sub-saharan africa)<br>Antign dtction - BinaxNOW (POC, 15 min)
Plasmodium - prvntion Mosquito nts, DEET<br>Chmoprophylaxis<br>Vaccin (on i
ts way, Phas 3 trials)
Trypanosoma bruci rhodsins - prvntion
Rsrvoir in big gam animals -> control thir trritory, clar brush
Plasmodium - 3 natural immunitis
- Sickl cll htrozygots<br>- RBCs wi
thout duffy antign<br>- G6PD dficincy<br>In ndmic aras, if you rach arly
adulthood, youv gnrally dvlopd immunity, but continud humoral immunity
rquirs continud xposur.
Babsiosis - on slid. "Symptoms - malaria-lik, hmolytic anmia, wors in asp
lnic patints<br>Vctor - Ixods tick (Lym, too), found in NE US<br>Lif cycl
similar to malaria<br>Diagnos - blood smar, ""malts cross""<br>Trat - clin
damycin, quinin"
Malts cross Babsiosis<br>Similar to malaria, Ixods tick vctor
Giardia lamblia - pidmiology, transmission
Par-shapd flagllat protozoan
<br>Worldwid<br>WATERBORNE (contaminatd stram whil camping, .g., downstram
from BEAVER dam), daycar, hikrs and camprs<br><br>Fcal-oral transmission (c
ysts in watr)<br>Also prson-to-prson, day car, LOW infctious dos
Giardia - prsntation Acut - n/v, diarrha (foul smlling, watry, frothy, fa
tty), bloating with foul flatulnc, sulfuric blching<br>Chronic - malabsorptio
n --> statorrha, failur to thriv<br><br>Classic - bulky, frothy, grasy, sti
nky stool in a rcnt hikr
Foul-smlling diarrha and gas<br>Wnt camping two wks ago
Giardia
Giardia - diagnosis, tratmnt Fcal ELISA<br>Stool sampl - look for trophozoi
t (smily fac = par-shapd, 2 nucli, pairs of flaglla)<br><br>Mtronidazol
(GET on th METRO)<br>Nitazoxanid in kids
Smily fac in microscopic stool
Giardia
GET on th METRO
Giardia, Entamoba, Trichomoas --> trat with Mtronidaz
ol
What parasits dos Mtronidazol trat?
GET on th METRO<br>Giardia<br>E
ntamoba<br>Trichomonas
Cryptosporidium - charactristics, pidmiology, transmission C hominis, C par
vum (obligat intracllular)<br>Small (2-6 microns)<br><br>Pak in lat summr<b
r>Daycar, AIDS, watrborn (Milwauk public watr systm), bovin rsrvoir (p

tting zoo)<br>Ingst oocyst, rlas sporozoits which invad intstinal pith

lial clls
Cryptosporidium - prsntation Acut diarrha (mild, watry)<br>Chronic diarrh
a (svr, copious, du to malabsorption, wasting in immunocompromisd)<br>Biliar
y tract disas in AIDS
Watry diarrha in AIDS patint (CD4 < 100)<br>Mayb thy just visitd a ptting
zoo or a town with poor watr sanitation
Cryptosporidium
Cryptosporidium - diagnosis, tratmnt, prvntion
Stool ELISA - antign d
tction<br>Stool xam - ACID FAST oocysts, 2-6 microns<br>Dirct fluorscnt ant
ibody tst<br><br>Nitazoxanid (normal host, kids) - mnmonic = CRYPTO-NIT<br>H
AART + rhydration (AIDS patint)<br>Surgry trats biliary tract disas<br><br
>Prvntion - BOIL watr, rsists chlorination so BOIL
Acid fast organisms
TB<br>Nocardia<br>Cryptosporidium, cyclospora, isospora
Importd raspbrris
"Cyclospora (aka ""big cryptosporidium"")"
Cyclospora - pidmiology, transmission Tropics, dvloping world<br>Contaminat
d watr (boil, rsists chlorination), IMPORTED FRUIT (raspbrris from guatmala
)
Cyclospora - prsntation, diagnosis, tratmnt Watry diarrha, fatigu, fvr<
br>AIDS patint - chronic diarrha, biliary disas<br><br>Stool xam - acid fas
t (8-10 microns)<br>Trat with bactrim
Dintamoba fragilis - vrything. on slid. Amboflagllat<br>Infcts kids
with pinworm infction (ntrobius)<br>Chronic abdominal pain, diarrha, gastro
ntritis<br>Diagnos by fcal O&P, PCR<br><br>Ttracyclin (adults)<br>Mtronida
zol (kids)
Trichomonas vaginalis - on slid.
STD (no cyst form)<br>Womn - vaginitis
(purulnt, stinky, grn discharg) and urthritis<br>Mn - asymptomatic or mild
urthritis<br><br>Diagnos with wt mount for par-shapd trophozoit with flag
lla (corkscrw motility)<br>STRAWBERRY CERVIX on colposcopy<br>PCR of urin<br>
<br>METRONIDAZOLE for all partnrs (prvnt mal from sprading it)
Strawbrry crvix on colposcopy - what is it? how do you confirm diagnosis?
Trichomonas vaginalis<br>Wt mount --> par-shapd trophozoits with flaglla an
d corkscrw motility
"Vaginal discharg : <br>1. ""cottag chs""<br>2. grn and stinky" 1. Candi
da, immunoCOMPETENT patints, too<br>2. Trichomonas vaginalis
Entamoba histolytica - pidmiology, transmission, nam of disas
Tropical
climats, poor sanitation (africa, latin amrica, india)<br>Fcal-oral transmis
sion (cysts in watr or contaminatd food)<br>Ambiasis
Entamoba histolytica - pathognsis, Ambiasis prsntation
"Trophozoits in
vad host tissu (colon) and ingst RBCs<br>90% asymptomatic<br>Intstinal - am
bic colitis (flask-shapd ulcrs in colon, slow-onst dysntry, fvr, abdomina
l pain, wight loss)<br>Extraintstinal - Livr abscss (think mal immigrant or
travlr, RUQ pain, fvr, wight loss, jaundic, HSM, rddish-brown ""anchovy
past"" aspiration), lung and brain abscsss"
Entamoba dispar
Not a human pathogn<br>Found in most humans, but dosn
t caus any symptoms
Flask-shapd ulcr in colon
Entamoba histolytica (intstinal)<br>Dysntry,
abdominal pain, fvr, wight loss
Anchov past aspirat from livr
Entamoba histolytica (livr abscss)<br
>Jaundic, HSM, RUQ pain, fvr, wight loss
MCC and 2nd MCC - dath by protozoa
MCC - malaria (plasmodium falciparum)<br
>2nd MCC - ntamoba histolytica
Entamoba histolytica - diagnosis, tratmnt
Stool xam (cysts with multipl
nucli OR trophozoits with bicycl whl-lik nuclus and ingstd RBCs)<br>Sto
ol antign, PCR<br>Srology (highly snsitiv)<br><br>Tratmnt<br>Luminal agnt
s (iodoquinol, paromomycin) for cyst stag (act in bowl lumn)<br>Systmic (mt
ronidazol) - activ against trophozoits (invasiv)<br>Symptomatic - trat with
BOTH
How would you trat ntamoba histolytica if...<br>1. Trying to kill cysts<br>2.
Trying to kill trophozoits<br>3. Trying to trat symptomatic cas (colitis, li
vr abscss)
1. Luminal agnt (iodoquinol, paramomycin)<br>2. Mtronidazol<b

r>3. BOTH
Viral gastrontritis - agnts Rovirida (Rotavirus, vaccin availabl)<br>Cal
icivirida (Norovirus, aka Norwalk)<br>Entric Adnoviruss (40, 41)<br>Astrovir
us
Rotavirus - charactristics, pidmiology
dsRNA, sgmntd (BOAR can rass
ort), no nvlop<br><br>Dvloping countris, young kids, wintr in th tropics
, fcal-oral transmission<br>Vaccin now availabl
MCC - hospitalization for svr diarrha in kids (worldwid) Rotavirus (Rovi
rida)<br>Vaccin now availabl, so dclining in prvalnc
Rotavirus - pathognsis, prsntation Viral rplication within ntrocyts -->
bluntd villi --> malabsorption and scrtory diarrha<br><br>Young - diarrha,
vomiting, abdominal pain, fvr, dhydration<br>Adults - mild acut diarrha<br
>Immunocompromisd - svr chronic diarrha
Rotavirus - diagnosis, tratmnt and prvntion Stool ELISA or rctal swab (grou
p A rota, only)<br>Stool EM<br>Latx agglutination<br><br>Oral REHYDRATION thra
py<br>Rotavirus IgA is protctiv<br>Liv attnuatd vaccin now availabl (all
kids in US)
MCC - diarrha in US
Norovirus<br>(vaccin has cut down on prvalnc of Rota
in kids)
Norovirus - charactristics, pidmiology, transmission ssRNA, no nvlop, Cali
civirida<br>Worldwid (MCC diarrha and acut gastrontritis in dvlopd worl
d)<br>Food and watr-born outbraks<br>CRUISE ships, nursing homs, schools, po
ol aras<br>Contaminatd food and watr, prson-to-prson sprad, fomits<br>Inc
ubats 2 days
MCC - acut gastrontritis in dvlopd world Norovirus
Norovirus - pathognsis and prsntation
"Transmittd through food and wa
tr (droplt sprad aftr vomiting)--&gt;&nbsp;<u>Shortning of microvilli</u> -&gt; malabsorption, dlayd gastric mptying&nbsp;<div><br /></div><div>MCC dia
rrha and acut gastrontritis in dvlopd world<br>Nausa, vomiting, watry d
iarrha (no blood), cramps, fvr, chills, myalgia, had-ach</div><div><br /></
div><div><img src=""past-257904196190838.jpg"" /></div>"
5/23GIvirusRD
Norovirus - diagnosis, tratmnt, prvntion
RT-PCR, EM, antibody assays<br><
br>Trat - Oral REHYDRATION<br>Vaccin undr valuation<br>Hand washing, watr p
urification
Astrovirus - on slid. ssRNA, nakd<br>Worldwid, sporadic or ndmic, fcal-or
al transmission infants and young kids, outbraks in schools, nursing homs, hos
pitals (ldrly, immunocompromisd)<br>Diarrha and gastrontritis x 4 days (l
ss svr than Rota)<br>Diagnos - EM, ELISA, RT-PCR<br>Trat - REHYDRATE
Adnoviruss 40 and 41 - charactristics, pidmiology dsDNA, non-nvlopd<br>
Worldwid, ndmic in infants and young kids, #3 caus of svr diarrha in infa
nts (aftr Rota and Noro)<br>Diarrha and gastrontritis (similar to Rota)<br>F
cal-oral transmission, incubats 8-10 days<br>Diagnos with EM, ELISA
Adnovirus - srotyp summary 4, 7, 14 - acut rspiratory disas, pnumonia<
br>40 and 41 - diarrha, gastrontritis<br>Othr - kratoconjunctivitis
Infctious diarrha locations...<br>1. Non-inflammatory<br>2. Inflammatory
1. Proximal small bowl<br>2. Distal small bowl or colon (prsnts with dysnt
ry with mucous, mayb WBCs, fvr, abdominal pain, cramps, tnsmus)
Dscrib inflammatory diarrha, list agnts
Dysntry with mucous, mayb WBC
s, fvr, abdominal pain, cramps, tnsmus<br><br>Shiglla, Salmonlla, Campylob
actr, E coli, C diff, E histolytica
3 month old - irritabl, fds poorly and vomits oftn, big had, whit-yllow c
horiortinal lsions in both ys, intra-cranial calcifications on CT Congnit
al toxoplasmosis = Choriortinitis, hydroCphalus, intracrbral Calcifications<
br>Acquirs in utro
38 yr old immigrant from Pru - difficulty swallowing, dilatd sophagus, no pr
istalsis
Trypanosoma cruzi (Chagas) ractivation = mgasophagus, mgacol
on, hart failur<br><br>Chronic form cannot b tratd (supportiv car only)<b
r>Nifurtimox and bnznidazol for acut form
41 yr old mal - sizur, oral thrush, crvical LAD, singl contrast-nhancing l
sion on MRI
Toxoplasmosis (AIDS patint)<br>Trat with sulfadiazin and pyra

mthamin
30 yr old mal - rturnd from hiking trip with diarrha, flatulnc, foul-smll
ing stool, abdominal cramping Giardia<br>Trat with Mtronidazol (GET on th
METRO)<br>ELISA or stool (s happy fac par-shapd flagllat in stool)
Match th disas to its vctor or mod of transmission:<br>1. Plasmodium<br>2.
Lishmania<br>3. Trypanosoma bruci<br>4. Trypanosoma cruzi<br>5. Trichomonas<br
>6. Giardia<br>7. Babsia<br>8. Entamoba<br>9. Toxoplasmosis<br>10. Cryptospori
dia
1. Plasmodium - Anophls mosquito<br>2. Lishmania - Sandfly<br>3. Tryp
anosoma bruci - Tsts fly<br>4. Trypanosoma cruzi - Rduvid bug<br>5. Trichomo
nas - STD<br>6. Giardia - watr-born cysts<br>7. Babsia - Ixods tick<br>8. En
tamoba - cysts in watr (.g. frshwatr lak)<br>9. Toxoplasmosis - cysts in r
aw mat, cat littr, congnital infction<br>10. Cryptosporidia - cysts in watr
Hlminth - pathognsis, immun rspons
Disas is usually du to havy
infction<br>Most hlminths do NOT rproduc in humans<br><br>Infction is usual
ly associatd with osinophilia and IgE rspons
Classification of Hlminths
Nmatods (roundworms) - includs Ascarids (Asca
ris lumbricoids, Toxocara, Anisakis), Trichuris trichiura (whipworm), hookworms
(Ncator amricanus, Ancylostoma), Strongyloids, Entrobius (pinworm), Filaria
ls (Wuchrria bancrofti), Trichinlla spiralis, Onchocrca volvulus, Loa loa<br
><br>Platyhlminths (flatworms) :<br>Trmatods (fluks) - Livr (Clonorchis, O
pistorchis, Fasciola hpatica), Lung (Paragonimus), and Blood (Schistosoma)<br>C
stods (tapworms) - Intstinal (Tania solium, saginatum; Diphyllobothrium lat
um) and Tissu (Tania solium cysticrcosis, Echinococcus)
Nmatods acquird by ingstion (hint: ating) of contaminatd food?
EAT = En
trobius, Ascaris, Trichinlla
Nmatods acquird from ft in th sand?
SANd = Strongyloids, Ancylostom
a, Ncator (hookworms + Strongyloids)
Classification of Nmatods
Nmatods (roundworms) - includs Ascarids (Asca
ris lumbricoids, Toxocara, Anisakis), Trichuris trichiura (whipworm), hookworms
(Ncator amricanus, Ancylostoma), Strongyloids, Entrobius (pinworm), Filaria
ls (Wuchrria bancrofti), Trichinlla spiralis, Onchocrca volvulus, Loa loa
Classification of Platyhlminths
Platyhlminths (flatworms) :<br><br>Tr
matods (fluks) - Livr (Clonorchis, Opistorchis, Fasciola hpatica), Lung (Par
agonimus), and Blood (Schistosoma)<br><br>Cstods (tapworms) - Intstinal (Ta
nia solium, saginatum; Diphyllobothrium latum) and Tissu (Tania solium cystic
rcosis, Echinococcus)
MC parasitic infction worldwid
Ascaris (nmatod)
Nmatod which can b up to a foot long Ascaris
Ascaris lumbricoids - lif cycl
Ingstion of ggs from contaminatd soil
<br>Larva hatch in duodnum and invad gut wall<br>Migrat to portal vins of l
ivr, thn hart, thn pulmonary capillaris<br>Entr alvoli and travl up rsp
iratory tract, swallowd<br>Adults matur in small bowl<br>Eggs ar scrtd in
fcs
Ascaris lumbricoids - siz, sit of infction, transmission, prsntation
Up to 1 ft long (spaghtti-lik)<br>Infcts small intstin (jjunum, ilum)<br>
Fcal-oral transmission<br><br>Child prsnting with ACUTE INTESTINAL OBSTRUCTIO
N (wors in childrn with small bowls) --> impaird nutrition, growth rtardati
on, Lofflrs syndrom (whzing, osinophilia, asthma-lik), cholangitis, panc
ratitis
How ar th filarials diffrnt than all of th othr nmatods (major pidmiol
ogical fatur) Transmission via arthropod vctors (othr nmatods ar sprad b
y fcal-oral transmission...or at th vry last, fcal-skin)
Parasit which prsnts with acut intstinal obstruction
Ascaris lumbrico
ids
Lofflrs syndrom - dscrib, tiologis
Asthma-lik whzing with osino
philia; aka osinophilic pnumonitis<br><br>Occurs in all worms which must migra
t up rspiratory tr to b swallowd again (ASH) :<br>Ascaris<br>Hookworms (N
cator amricanus, Ancylostoma)<br>Strongyloids
"Nam th hlminths which must migrat through alvoli and th bronchial tr an
d thn b swallowd bfor maturing in th gut (""wandring worms"")" ASH : <b

r>Ascaris<br>Hookworms (Ncator amricanus, Ancylostoma)<br>Strongyloids

Ascaris - diagnosis, tratmnt, prvntion
Diagnos - find ggs in stool (r
ound with rough dgs, lipid coat to surviv in nvironmnt<br><br>Trat - ALBEN
DAZOLE or ivrmctin<br><br>Prvnt - sanitation, mass tratmnt with ivrmctin
Haitian patint with abdominal pain
Ascaris until provn othrwis<br>Giv A
lbndazol lik candy!
Kid at sand at a dog park and now has granulomas. What dos h hav? Toxocara
canis/cati (animal ascarid)
Toxocara canis/cati - aka, pathognsis and immun rspons
Animal ascarids<
br><br>Excrtd in animal fcs (.g. sandbox), ingstd by kids (including US),
larva hatch, pntrat intstinal wall, and dissminat (lungs, livr, brain,
ys) forming GRANULOMAS<br>Toxocara nvr nds up in th intstin bcaus thy
arnt dsignd to infct humans
Toxocara - prsntation Viscral larva migrans - hpatitis (hpatomgaly, abdomi
nal pain), whzing (osinophilic pnumonitis aka Lofflrs), crbritis (osin
ophilic mningitis)<br><br>Ocular larva migrans - rtinal lsions lading to str
abismus and blindnss<br><br>Covrt toxocariasis - asthma in innr city african
amrican kids
Larva migrans - thr typs
"Viscral larva migrans - hpatitis (hpatomgal
y, abdominal pain), whzing (osinophilic pnumonitis aka Lofflrs), crbrit
is (osinophilic mningitis)<br>Animal ascarid (toxocariasis)<br><br>Ocular larv
a migrans - rtinal lsions lading to strabismus and blindnss<br>Animal ascari
d (toxocariasis)<br><br>Cutanous larva migrans - pruritic srpntin rash, ""cr
ping ruption""<br>Animal hookworm (Ancylostoma brazilins most commonly)"
Possibl parasitic caus of ris in asthma rats among innr city african amric
an kids in th US
Covrt toxocariasis
"""Crping ruption""" Cutanous larva migrans - pruritic srpntin rash, gn
rally on ft, du to animal or dog hookworm (most commonly Ancylostoma brazili
ns)
Toxocara - diagnosis
Do NOT do a fcal xam (not a human pathogn, so worms d
ont nd up in intstins and ggs ar not xcrtd in fcs)<br><br>SEROLOGY<br
>Fundoscopic xam<br>Larva in granulomas on livr biopsy
Toxocara - tratmnt, prvntion
Trat with Albndazol and Stroids (all
rgic raction; first aid says DEC)<br><br>Prvnt - dworm cats and dogs, kp
an y on kids with pica
Causs of osinophilic mningitis
Toxocara canis/catis (animal ascarid, vi
scral larva migrans syndrom)<br><br>Tania solium (Nurocysticrcosis)
7 yo boy prsnts with Toxocara and viscral larva migrans. What is his likly p
sychological disordr? Pica (wants to at vrything)
Anisakis - aka, pidmiology, transmission, tratmnt Fish ascarid<br>Japan, N
thrlands, South Amrica (cvich)<br><br>Human ats raw safood containing ani
sakid larva and bcoms incidntal host<br>Larva burrows into stomach and caus
s acut burning ulcr<br>Trat - ndoscopic rmoval of worm
Hlminth which causs acut stomach ulcr
Anisakis (fish ascarid, humans a
r incidntal host)<br>Worm must b rmovd ndoscopically
Trichuris trichiura - aka, siz and shap, sit of infction, pathognsis
Whipworm<br>Infcts colonic lumn, 2 in adults (thin antrior mbds in pithli
um ~intracllular, thick postrior sticks into lumn ~xtracllular)<br><br>Ing
stion of ggs from contaminatd soil, larva hatch and migrat to colon whr th
y matur and mak ggs
Rctal prolaps in a child
Trichuris trichiura (whipworm)
Trichuris trichiura - symptoms, diagnosis, tratmnt, prvntion
Affcts
childrn, oftn asymptomatic<br>Colitis<br>High worm burdn (>200) - dysntry +
rctal prolaps<br><br>Diagnos - ggs in stool<br>Trat - Albndazol<br>Prv
ntion - improv sanitation, mass tratmnt
Hookworms - nam thm, sit of infction, pidmiology, pathognsis/lif cycl
Ncator amricanus, Ancylostoma duodnal/brazilins (affcts mostly animals)<b
r><br>Infcts small intstin (duodnum, jjunum)<br>Found in S Amrica, Africa,
East Asia<br><br>Pntrat intact skin (.g. ft in sand or tall grass contami
natd with fcs) --> Larva migrat to lungs, swallowd, matur in intstin<br

>Eggs pass in fcs

Lading caus of anmia in third world Hookworm (Ncator amricanus, Ancylostom
a duodnal)
Ncator amricanus - prsntation
IRON DEFICIENCY ANEMIA<br><br>Fw worms
--> minimal symptoms, Lofflrs (osinophilic pnumonitis) or dry cough<br><br>
Many worms --> anmia (anticoagulants and hmoglobinass incras blding, 25 w
orms can ngat iron intak in a child), high risk in kids and prgnant womn<br
>Protin malnutrition (anasarca), low IQ
Ncator amricanus - diagnosis, tratmnt, prvntion Diagnos - ggs in stool
<br>Trat - Albndazol, Mbndazol<br>Prvnt - sanitation, mass dworming wit
h yarly albndazol<br><br>Vaccin (Hotz) - immun rspons to nzyms for hm
olysis, intrrupts hookworm fding
Anasarca
Protin malnutrition, common with hookworm infction (blood loss
, iron dficincy anmia)
Hotz lab is dvloping vaccins for...
Ncator amricanus (hookworm, ta
rgts nzyms of hmolysis)<br>Schistosoma
Ancylostoma brazilins - pidmiology, transmission, tratmnt Gulf Coast (Cari
bban, Florida, tc.) bachs<br><br>Dogs poop on bach, hookworm larva ntr t
hrough intact skin (.g. bar ft) --> migrat along skin (do not ntr blood o
r lungs, poorly dsignd as a human pathogn) = cutanous larva migrans<br><br>T
rat with Ivrmctin
Cutanous larva migrans "Pruritic srpntin rash, ""crping ruption""<br>Anim
al hookworm (usually Ancylostoma brazilins) undr th skin<br><br>Trat with I
vrmctin"
Pruritic srpntin rash
"Cutanous larva migrans, ""crping ruption""<
br>Animal hookworm (usually Ancylostoma brazilins) undr th skin<br><br>Trat
with ivrmctin"
Strongyloids strcoralis - infction sit, pidmiology, pathognsis/lif cycl

Infcts small intstin<br>Evrywhr (including US, high in Caribban,
Africa, Japan, S Amrica)<br><br>Pntrats intact skin (soil contaminatd with
fcs) --> larva migrat in blood, thn up rspiratory tr, thn swallowd -->
matur to adulthood in small intstin --> ggs hatch and can autoinfct host l
ading to multi-yar infction
Worms that pntrat intact skin (nmatods + platyhlminths) Nmatods = SANd
<br>Strongyloids + hookworms (Ancylostoma, Ncator)<br>Platyhlminth = Schistos
oma (trmatod, fluk)
Larva currns Autoinfction with Strongyloids<br>Larva ar dpositd on pria
nal ara and sprad
Strongyloids - prsntation
Entritis - diarrha, osinophilia<br>Autoinfct
ion - LARVA CURRENS, prianal<br><br>Hyprinfction - worms invad gut wall and
carry bactria with thm --> spsis, pnumonia, mningitis, high mortality<br>P
opl on stroids and with HTLV1 ar at risk
Strongyloids - diagnosis, tratmnt, prvntion
Larva in stool (NOT gg
s), do many fcal xams<br>Charcoal cultur, larval tracts on blood agar<br>Sput
um or biopsy<br><br>Trat with Ivrmctin<br>Prvnt - sanitation, chck stool f
or strongyloids bfor giving stroids to immigrants
You hav an immigrant in your clinic from th Caribban. Bfor you giv thm st
roids, what should you considr?
For any immigrant from anywhr...chck
stool for Strongyloids LARVAE bfor giving stroids.<br><br>In popl infctd
with Strongyloids, stroids incras risk of hyprinfction (as worms invad g
ut wall, thy can carry bactria along with thm --> high mortality)
Entrobius vrmicularis - aka, sit of infction, pidmiology, pathognsis/lif
 cycl Pinworm<br>Infct colon<br>Worldwid, not sanitation-dpndnt, think ki
ds with itchy bottoms and thir familis<br><br>Ingst ggs, adults matur in co
lon<br>Fmals xit anus at NIGHT and lay ggs on PERIANAL ara, causing ITCHING
<br>Kids scratch and infct vryon thy know
Entrobius vrmicularis - diagnosis, tratmnt Scotch tap tst (NOT stool xam
) - put non-frostd tap on prianal ara thn on slids, look for ggs<br><br>A
lbndazol for th ntir family
Pinworm mnmonic
TAPE = <br>(scotch) Tap tst (arly morning)<br>Albnda

zol (for th ntir family)<br>Prianal pruritis du to ggs, night-tim<br>Ent

robius vrmicularis
Lymphatic filariasis - agnts, disas, pidmiology
Wuchrria bancrofti (>9
0%), Brugia malayi<br>Elphantiasis<br><br>Poor tropical countris (sub-saharan,
Papua NG, India, Nigria, Haiti)
LF - pathognsis/lif cycl
Fmal mosquito bits human, dposits filarial la
rva which ntr inguinal lymphatics<br>Adults liv in and obstruct lymphatics<b
r>Adult fmals rlas microfilaria (modifid ggs, longatd and mobil) into
blood at NIGHT<br>Mosquitos ingst microfilaria
LF - prsntation
Acut - LAD, lymphangitis, night fvrs<br><br>Tropical
pulmonary osinophilia - pulmonary symptoms, infiltrats on chst Xray, osinoph
ilia<br><br>Chronic lymphatic obstruction = ELEPHANTIASIS of limbs, brasts, gn
iatlia (hydrocol, swolln scrotum)<br><br>Bactrial suprinfction du to poor
car and hygin of swolln limbs/gnitalia
LF - diagnosis, tratmnt, prvntion Diagnos - microfilaria in priphral t
hick blood smar at NIGHT (10pm-4am), Srology (antign tst), ultrasound of lym
ph drainag (filarial danc sign)<br><br>Tratmnt - DEC (kills adult worms and
mf)<br><br>Prvnt - yarly mass tratmnt (albndazol + DEC or Ivrmctin)
You hav a patint with LF from an ndmic ara. How should you trat? DEC<br>H
owvr, chck if patint is co-infctd with onchocrciasis or loa loa. Aras wh
r all of ths ar ndmic should not b tratd with DEC bcaus it will caus
 a mass di-off of microfilaria and xacrbat hyprsnsitivity ractions.
Onchocrca volvulus - disas, pidmiology, pathognsis
Onchocrciasis =
Rivr blindnss<br>Cntral and W Africa, Latin Amrica<br><br>Black fly bit d
posits<br>Adult worms liv in subcutanous noduls --> produc microfilaria whi
ch migrat to blood and thn to y (SCLEROSING KERATITIS)
Black fly vctor
Onchocrca volvulus, Rivr blindnss
Onchocrca volvulus - prsntation
"Subcutanous painlss nodul of adult w
orms<br><br>Onchocrcal skin disas (hyprsnsitivity raction - pruritis, skin
pigmntation, thickning (""lizard skin"" or ""lichnification"")<br><br>Rivr
blindnss - microfilaria in antrior chambr caus cornal scarring (sclrosing
kratitis)"
Hlminth which causs sclrosing kratitis
Onchocrca volvulus (Rivr blind
nss)
Onchocrca volvulus - diagnosis, tratmnt, prvntion Diagnosis - microfilaria
 in skin biopsy (skin snip)<br><br>Trat - Ivrmction (NOT DEC which will xac
rbat th allrgic skin raction)<br><br>Prvnt - mass tratmnt with ivrmct
in
Loa loa - aka, pidmiology, pathognsis/lif cycl
African y worm<br>Rain
forsts in cntral and coastal wstrn africa<br><br>Larva transmittd by bit
of hors/dr/mango fly<br>Adult worms liv in subcutanous tissu and can migra
t to ys<br>Microfilaria ntr blood during th day
Dr fly vctor Loa loa (african y worm)
Hlminths with daily priodicity
Entrobius (pinworm) - prianal ggs lai
d at NIGHT<br><br>LF (Wuchrria bancrofti) - microfilaria sn in priphral b
lood at NIGHT<br><br>Loa loa - microfilaria in blood during th DAY
Loa loa - prsntation Ey worm - s crawling in conjunctiva<br><br>Calabar sw
lling - allrgic raction and angiodma around migrating worm
Calabar swlling
Allrgic raction and angiodma around migrating worm<b
r>Looks lik Romana sign (Chagas ntring through y)
Loa loa - diagnosis, tratmnt, prvntion
Diagnos - clinical, s microfi
laria in DAYtim blood smar<br><br>Trat - DEC or Ivrmctin (b carful of tox
ic ncphalopathy if high filarial count with ivrmctin us and xacrbation of
allrgic skin ractions of onchocrciasis with DEC)<br><br>Prvnt - mass trat
mnt with DEC
Parasits which migrat to th y
Toxocara (ocular larva migrans)<br><br>O
nchocrca (microfilaria in antrior chambr --> sclrosing kratitis, rivr bli
ndnss)<br><br>Loa loa (african y worm, worm can b sn swimming in conjunct
iva)
Trichinlla spiralis - pidmiology, pathognsis/lif cycl
Worldwid, assoc

iatd with hommad sausag from wild mat (PIGS, bars)<br><br>Ingst uncookd
pork infctd with larva<br>Larva hatch in intstin, matur to adulthood<br>N
w larva migrat to skltal muscls --> MYOSITIS
Trichinlla spiralis - prsntation
Gastrontritis x 1 wk (intstinal pha
s)<br><br>1-3 wks aftr ingstion - myalgia, osinophilia, PERIORBITAL EDEMA,
fvr<br><br>Months - MYOSITIS and muscl swlling, waknss, pain, myocarditis
Trichinlla spiralis - diagnosis, tratmnt
Diagnos - muscl biopsy (look f
or larva), srology<br>Tratmnt - Albndazol + corticostroids
Trmatods - aka, charactristics
Fluks<br><br>Laf-shapd with blind, bi
furcatd gut<br>Hrmaphroditic (xcpt Schistosoma)<br>Food/watr-born (xcpt
Schistosoma)<br>Snail = intrmdiat host<br>Caus osinophilia
Important trmatods
Livr fluks - Clonorchis sinnsis, Opistorchis, Fasciol
a hpatica (actually not all that important)<br><br>Lung fluks = Paragonimus<br
><br>Blood fluks = Schistosoma
Important livr fluks - nams, pidmiology, pathognsis/lif cycl, mnmonics
Clonorchis, Opistorchis<br>ASIA, CHINA, Sibria (Opis)<br><br>Ingst raw fish (
.g. fish past in china)<br>Larva migrat to bil duct, matur to adulthood<br>
<br>Mnmonics:<br>ABC = asia, bil duct, clonorchis<br>Liv fish clons = livr,
fish, clonorchis
Livr fluks - nams, prsntation
Acut - fvr, RUQ pain, hpatomgaly<br
><br>Chronic - pigmntd gall stons, cholangitis, pancratitis, cholangiocarcin
oma
Livr fluks - nams, diagnosis, tratmnt
Clonorchis, Opistorchis<br>Diagn
os - ggs in stool, worms during surgry, CT or MRI<br><br>Trat - Praziquantl
, surgry for biliary obstruction
Vry gnral rul about how to trat diffrnt hlminths<br>(thr ar lots of 
xcptions. only us this if you hav to guss) Nmatods - Albndazol (or DEC,
ivrmctin)<br>Trmatods - Praziquantl
Pigmntd gall stons Clonorchis, Opistorchis (livr fluks, adults matur in
th bil duct, can lad to cholangiocarcinoma)
Important Lung fluks - nams, pidmiology, transmission
Paragonimus<br>A
SIA, CHINA, africa, latin amrica<br><br>Transmission by ingstion of RAW CRABS
or crawfish (crawdads)
Crawfish boil --> hmoptysis
Paragonimus (lung fluk)
Important lung fluk - nam, prsntation
Paragonimus<br>Pulmonary - infla
mmation and scondary bactrial infction (mimics pulmonary TB, HEMOPTYSIS)<br>E
xtra-pulmonary - CNS brain lsions
Important lung fluk - nam, diagnosis, tratmnt
Paragonimus<br>Diagnos
- ggs in stool or sputum, srology<br>Trat - Praziquantl
Important blood fluk - nam, pidmiology, infction sit
Schistosoma<br>H
igh in Africa, associatd with frshwatr infctd with snails (intrmdiat hos
t)<br><br>Liv in vnuls of GI and GU tract (msntric vins, bladdr)
"""Most important hlminth in humans"" says TA ppt"
Schistosoma (200 million
infctd, 100 thousand di annually)
Schistosoma - aka, pathognsis/lif cycl
Blood fluk<br><br>Fr-swimming
crcaria pntrat skin in snail-infstd watr<br>Transform, migrat to porta
l systm, matur to adults<br>Mal and Fmal pair and migrat to Suprior (S ja
ponicum) or infrior (S mansoni) msntric vin or to bladdr (S hamatobium)<b
r>Fmal rlass spiny ggs (can caus granulomas) which bor through vssls i
nto lumn of intstin/bladdr<br>Eggs ar xcrtd in fcs/urin, hatch<br>Mir
acidia invad snails, mrg as crcaria
Schistosoma - most important spcis
S japonicum - East Asia, livs in supri
or msntric vin, Katayama fvr and chronic intstinobiliary disas (livr g
ranuloma, fibrosis --> HSM, portal hyprtnsion), CNS and lung manifstations (c
or pulmonal = R hart failur), round gg with NO horn<br><br>S mansoni - Afric
a and Latin Amrica, livs in infrior msntric vin, Katayama fvr and chron
ic intstinobiliary disas (livr granuloma, fibrosis --> HSM, portal hyprtns
ion), round gg with latral horn<br><br>S hamatobium - Africa and Middl East,
infcts bladdr, urinary granulomas and urinary tract disas (scarring/obstruc
tion, calcifications, hmaturia, hydronphrosis, rnal failur, SQUAMOUS CELL CA

RCINOMA of th bladdr), GU in womn (FGS = fmal gnital schisto = infrtility

, abdominal pain, blding, dysparunia, associatd with HIV)
Schistosoma - prsntation
Crcarial drmatitis - pruritic, maculopapular r
ash whr crcaria pntrat<br><br>Acut (Katayama fvr) - hyprsnsitvity, w
ithin 8 wks aftr infction (whn adults bgin laying ggs), FEVER, cough, DIA
RRHEA, rash, HSM, LAD, EOSINOPHILIA, rarly causd by hamatobium<br><br>Chronic
- trappd ggs caus granulomatous inflammatory rspons, granulomas or fibrosi
s in livr and bladdr
Katayama fvr Acut Schistosomiasis (japonicum and mansoni >>> hamatobium)<br
><br>Hyprsnsitvity, within 8 wks aftr infction (whn adults bgin laying 
ggs), FEVER, cough, DIARRHEA, rash, HSM, LAD, EOSINOPHILIA, rarly causd by ha
matobium
Squamous cll carcinoma of th bladdr Schistosoma hamatobium
Cor pulmonal - what is it? what hlminth can caus it? R hart failur<br>Pulmo
nary manifstation of Schistosoma japonicum
Most common gyncological disas in africa
Schistosoma hamatobium --> <br>
FGS = fmal gnital schisto = infrtility, abdominal pain, blding, dysparuni
a<br>Associatd with HIV
Schistosoma - diagnosis, tratmnt, prvntion Diagnos - osinophilia + histor
y of swimming in frsh watr with snails, ggs in stool or urin or rctal/bladd
r biopsy, srology for acut disas<br><br>Trat - Praziquantl (+ stroids fo
r katayama fvr)<br><br>Prvntion - mass tratmnt (annual praziquantl), Hot
z vaccin, sanitation (kill snails, kp fcs away from frsh watr)
Schistosoma mnmonic
S is for...<br>Snails<br>S(c)rcaria pntrating Skin<b
r>Swimmr<br>(hpato)Splnomgaly<br>Squamous cll carcinoma of th bladdr (S h
amatobium)
Hotzs rapid impact packag - which drugs? which disass?
Albndazol/Mb
ndazol - Ascaris, Trichuris, Hookworm (Ncator, Ancylostoma), LF<br>DEC/Ivrmc
tin - LF, Onchocrca (+strongyloids, scabis)<br>Praziquantl - Schistosoma (+o
thr trmatods)<br>Azithromycin - Trachoma
What is Albndazol/Mbndazol usd for?
Nmatods (xcpt filaria and St
rongyloids) + Tissu Cstods...<br><br>Ascaris lumbricoids, Toxocara canis/ca
ti (+ stroids), Trichuris trichiura, Ncator amricanus, Entrobius vrmiculari
s, Trichinlla spiralis (+ stroids)<br>Cysticrca (Tania solium), Echinococcus
<br><br>Prvntiv for LF (DEC is first choic tratmnt)
What is Ivrmctin usd for?
Filaria (LF, Onchocrca volvulus, Loa loa)<br>+
Ascaris lumbricoids<br>+ Ancylostoma duodnal/brazilins<br>+ Strongyloids<b
r><br>Only usd for prvntion of LF (DEC is first choic tratmnt)
What is Praziquantl usd for? Trmatods + Intstinal cstods + scond choic
for Cysticrcosis<br><br>Livr fluks (Clonorchis, Opistorchis), lung fluk (Pa
ragonimus), blood fluk (Schistosoma)<br>Tania solium and saginatum, Diphyllobo
thrium latum<br><br>For cycsticrcosis (tissu Tania solium), Albndazol is pr
frrd, but Praziquantl works, too
You ar in africa and hav th choic to trat with Ivrmctin or DEC (.g. pati
nt has lphantiasis). Which do you choos?
Ivrmctin<br>Most aras in afri
ca hav ndmic onchocrcosis which maks us of DEC vry dangrous (massiv di
-off of microfilaria xacrbats hyprsnsitivity skin raction)
What is DEC? What is it usd for?
Dithylcarbamazin<br><br>Filaria (xcp
t Onchocrca) + Toxocara (animal ascarid)<br><br>First choic tratmnt for LF,
but b carful in africa (whr onchocrca is ndmic) bcaus massiv di-off o
f microfilaria du to DEC xacrbats onchocrciasis hyprsnsitivity skin ract
ion
Nam th cstods (by classification) and thir charactristics Intstinal - Ta
nia saginatum, Tania solium, Diphyllobothrium latum<br>Tissu - Cysticrcosis (
Tania solium), Echinococcus<br><br>Foodborn<br>Adult dos not caus disas, b
ut larva do
Intstinal cstods - food and rgional associations
Tania saginatum - BEEF
(stak tartar), ast africa<br><br>Tania solium - PORK (cysticrcosis from raw
pork, too), latin amrica, asia (china, indonsia), tanzania<br><br>Diphyllobot
hrium latum - FISH (associatd B12 dficincy), US (sushi)

Intstinal tapworms - charactristics, lif cycl

Had or scolx attachs
to intstin<br>Proglottids (sgmnts containing f/mal rproductiv organs)<br
><br>In intrmdiat host (cow, pig, fish) - ggs ingstd, hatch, larva mrg
and pntrat gut, migrat as cysticrci to tissu (muscl)<br>Human ingsts in
fctd mat (muscl)<br>Adult worms liv in intstin (up to thirty ft long)<b
r>Eggs and Proglottid sgmnts shd in fcs (if ingstd --> nurocysticrcosis
)
Intstinal tapworms...nam and rgion<br>1. Fish<br>2. Bf<br>3. Pig 1. Diphy
llobothrium latum (US, lswhr)<br>2. Tania saginatum (East africa, .g. thi
opia)<br>3. Tania solium (latin amrica, ast asia, tanzania)
Intstinal tapworms - nam thm, prsntation, diagnosis, tratmnt
"Tania
saginatum (bf) and solium (pork), Diphyllobothrium latum (fish)<br><br>Gnral
ly asymptomatic or minor abdominal symptoms<br>Patint coms in and tlls you ""
thr ar worms in my poo!""<br>D. latum causs B12 dficincy (mgaloblastic an
mia, nuropathy)<br>Chck stool for ggs<br><br>Trat - Praziquantl"
Which cstod causs mgaloblastic anmia and nuropathy?
Diphyllobothrium
latum (fish intstinal tapworm)<br>Compts for B12, lading to B12 dficincy
Nuro/Cysticrcosis - agnt, pidmiology, pathognsis/lif cycl, prsntation
Tania solium (pork-associatd intstinal tapworm)<br>Young Hispanic immigrant
with nw onst sizurs<br><br>Ingst T solium EGGS from infctd human fcs (b
com intrmdiat host)<br>Eggs hatch, larva pntrat gut, migrat in blood t
o MUSCLES and BRAIN<br>Larva matur --> cysticrci (ring nhancing lsions in b
rain)<br><br>Asymptomatic for yars, thn nw onst sizurs causd by inflammat
ory rspons as cysticrcus dis and can no longr trick th immun systm<br>Ca
lcifis ovr months
MCC - adult-onst pilpsy in dvloping world Tania solium --> Nurocysticrc
osis
Young hispanic immigrant with nw onst sizurs
Tania solium --> Nuroc
ysticrcosis
What happns if you ingst Tania solium...<br>1. As ggs?<br>2. As cysticrci?
1. Nurocysticrcosis (form ggs in fcs)<br>2. Intstinal tapworm (from atin
g raw mat; cysticrci liv in muscl)
Tissu Tania solium - prsntation
Ingstion of ggs from fcs of infctd
human --> larva migrat to muscl and brain<br><br>Subcutanous cysts - cigarshapd calcifications on Xray of limbs<br>Myositis - muscl cysts, calcification
s<br><br>Nurocysticrcosis - larva in brain, MCC adult-onst pilpsy in dvl
oping world (sp. latin amrica), hadachs also, lvatd ICP and obstructiv h
ydrocphalus, osinophilic mningitis, brain calcifications --> sizur or chron
ic hadach
Cysticrcosis - diagnosis
"Epidmiology/clinical<br>Imaging (MRI > CT) wit
h RING ENHANCING LESION (""swiss chs apparanc""), Xray for myositis<br>Sro
logy"
"MRI with ""swiss chs apparanc""" Nurocysticrcosis<br>...so thy say. wh
atvr.
Cysticrcosis - tratmnt
First - symptoms control (anti-pilptic, vntri
culo-pritonal shunting)<br><br>Thn - anti-parasitics (Albndazol > praziqun
tl for multipl cysts or no ring nhancmnt; NO antiparasitics for patints wi
th only calcifications or a singl lsion) + stroids (prvnt worsning inflamm
ation as cystrcrci di)<br><br>Surgry - ndoscopic cyst rmoval if intravntr
icular
Echinococcus - classification, spcis, pidmiology
Tissu cstod (lik T s
olium --> cysticrcosis)<br><br>E granulosus (Cystic Hydatid Disas) - aras wh
r shp/cattl and dogs raisd togthr (dogs at viscra of slaughtrd anima
ls; .g.China, Africa, S Amrica, Middl East, Cali, Utah, Alaska)<br><br>E mult
ilocularis (Alvolar/multilocular Hydatid Disas) - Alaska and Europ and Japan
Echinococcus - lif cycl
Dog - dfinitiv host<br>Shp, cattl - intrm
diat host<br>Human - accidntal intrmdiat host<br>Humans ingst ggs in dog
fcs (contaminatd watr, produc) --> oncosphrs ntr portal circulation -->
form cysts in livr and lungs
Echinococcus - prsntation
E granulosus - unilocular hydatid cyst = LARGE a

nd slow-growing mass lsion in livr or lungs, cyst ruptur --> ANAPHYLAXIS with
osinophilia and daughtr lsions<br><br>E multilocularis - xpanding infiltrat
iv procss in livr with lots of littl cysts (not on big on)
Echinococcus - diagnosis, tratmnt
Diagnosis - imaging (US, CT) and history
, srology to confirm<br><br>Tratmnt :<br>First - Albndazol<br>Thn - PAIR p
rocdur = Punctur cyst, Aspirat, Injct scolicidal agnt (.g. alcohol), Ras
piration<br>Surgry if cyst is ginormous
PAIR procdur For Echinococcus cyst in livr/lung<br>First Albndazol, thn P
AIR<br><br>PAIR procdur = Punctur cyst, Aspirat, Injct scolicidal agnt (.
g. alcohol), Raspiration<br><br>Dsignd to avoid anaphylactic raction to rl
as of cyst contnts
Congnital Toxoplasmosis
"Mom acquirs through uncookd mat, cat littr&
nbsp;<br><div><br /></div><div>Nonatal manifstations or long aftr birth (30s,
.g.)<br>Rash, LAD, HSM, jaundic, microcphaly, <b>SEIZURES<br>Thr Cs - Cho
riortinitis, hydroCphalus, intracranial Calcifications</b>&nbsp;</div><div><br
/></div><div>Long trm - blindnss, mntal rtardation</div><div><br /></div><d
iv>Diagnos - ring nhancing lsions on MRI, srology, PCR of CSF, ophthalmology
xam, haring tst</div><div><br /></div><div><img src=""past-143529217098358.
jpg"" /></div>"
"Congnital Rublla (""grman masls"")"
Mom - first trimstr 3-day mas
ls<div>suboccipital LAD</div><div>dscnding rash<br><br>Nonat</div><div>intr
autrin growth rtardation (IUGR)</div><div>mntal rtardation</div><div>ftal
dath</div><div>MunCHD on a Blubrry muffin = microcphaly, cataracts, hart (
PDA or pulmonary artry stnosis), dafnss, blubrry muffin rash&nbsp;</div><d
iv>Squla - cardiac, ocular, nuro, ndocrin<br><br>Diagnos - viral cultur,
srology, LFTs, CBC, ophtho, cho&nbsp;</div><div>Prvnt - IMMUNIZATION BEFORE
PREGNANCY (MMR is a liv vaccin)</div>
Prgnancy and vaccins - frindly or not?
Prgnant womn should NOT rciv
 liv vaccins, but killd ar ok.
Congnital CMV "Intrautrin growth rtardation (IUGR)<br>Ptchia (blubrry
muffin rash), HSM, microcphaly, ""pizza pi"" choriortinitis, snsorinural d
afnss<br>&nbsp;<div><br /></div><div>Squla - dafnss, mntal rtardation, c
rbral palsy, dath&nbsp;</div><div><br /></div><div>&nbsp;Diagnos - anmia, L
FTs/bilirubin, PERIVENTRICULAR calcifications on CT, snsorinural dafnss, vir
al cultur, srology, OWLS EYE intranuclar inclusions<div><br /></div><div><im
g src=""past-136584254980726.jpg"" /></div></div>"
MC congnital infction CMV<br>1% of babis ar infctd<br>0.1% ar symptomatic
(so 1/10 of thos infctd)<br>Th asymptomatic babis oftn hav squla lat
r on (.g. low IQ)<br>CMV should b on of th nonatal tsts
MCC viral-inducd mntal rtardation
CMV (congnital)
MCC snsorinural haring loss in th US
CMV (congnital)
Privntricular calcifications on CT
CMV (congnital)
1. Pizza pi buzzword<br>2. Chs pizza buzzword
1. Pizza pi rtinitis =
congnital CMV, rar<br>2. Chs pizza lsion = cutanous Lishmania ulcrs wi
th raisd dgs
Ophthalmic ID findings&nbsp;<div>1. Dndritic lsions on corna in US</div><div>
&nbsp;2. Pizza pi choriortinitis in infant&nbsp;</div><div>3. Rtinal lsions
lading to strabismus and blindnss in a kid who at sand&nbsp;</div><div>4. Cho
riortinitis in infant&nbsp;</div><div>5. Sclrosing kratitis in Africa&nbsp;</
div><div>6. Fluffy whit spots&nbsp;</div><div>7. Choriortinitis or kratoconju
nctivitis in nwborn</div>
1. HSV kratitis (MCC cornal blindnss in US)&n
bsp;<div>2. Congnital CMV</div><div>&nbsp;3. Ocular larva migrans (Toxocara)</d
iv><div>&nbsp;4. Congnital toxoplasma (thr Cs),&nbsp;can also occur in cong
nital CMV&nbsp;</div><div>5. Onchocrca volvulus (Rivr blindnss)&nbsp;</div><d
iv>6. Dissminatd Candida (bad.)&nbsp;</div><div>7. Congnital HSV</div>
Congnital HSV - transmission, risk factors, prvntion "90% transmission is pr
inatal (offr C sction)<div><br /></div><div>Risk with lots of sxual partnrs,
mom with primary lsion during prgnancy&nbsp;</div><div><br /></div><div>Prv
nt - C sction! Acyclovir to prvnt squla</div><div><br /></div><div><img sr
c=""past-137387413865078.jpg"" /></div>"

Congnital HSV - prsntation, diagnosis

Intrautrin triad = <b>SKIN</b>
vsicls + <b>EYE</b> disas (choriortinitis, kratoconjunctivitis) + <b>CNS
disas</b> (hydranncphaly, microcphaly&nbsp;<div><br /></div><div>Intrapartu
m - dissmination, tmporal ncphalitis, vsicular skin lsions&nbsp;</div><div
><br /></div><div>Squla - ys, ars, brain issus, dath</div><div><br /></d
iv><div>&nbsp;Diagnos - LP (lymphocyts, RBCs), LFTs, choriortinitis, ncphal
itis (CT), abnormal EEG, viral cultur or PCR of vsicls or CSF. NO srology</d
iv>
Congnital syphilis - transmission, prsntation, diagnosis, squla, tratmnt
"Transplacntal transmission, any trimstr<div><br /></div><div>&nbsp;Stillbirt
h, hydrops fatalis, mucocutanous lsions, ptchia (thrombocytopnia), jaundic
, HSM, pallor (hmolytic anmia), LAD, ""snuffls"" (rhinitis), ostochondritis
(priostal NEW BONE formation), mningitis</div><div><br /></div><div>&nbsp;Di
agnos - RPR, MHATP, LP, BONE FILM, CBC, LFTs&nbsp;</div><div><br /></div><div>&
nbsp;Squla - intrstitial kratitis (photophobia, lacrimation), dafnss (CN
VIII), bon dformation (sabr shin, saddl nos, hutchinsons tth), mntal r
tardation, hydrocphalus&nbsp;</div><div><br /></div><div>&nbsp;Trat infctd p
rgnant womn with PENICILLIN</div>"
Sabr shin, Saddl nos, Hutchinsons tth
Bon and cartilag manifstation
s of congnital syphilis<br>Gnrally prsnt as squla in childhood
Congnital Variclla (HHV3 or VZV)
"Rar<br>Mom has ""dwdrops on a ros p
tal"" (chickn pox)<br>Infant - microcphaly, LIMB HYPOPLASIA whrvr lsions o
ccur, skin scars, cataracts, choriortinitis<br><br>Diagnos - nuroimaging, oph
tho, cultur lsions, CSF val, biopsy, srology"
Brain cysts, sizurs Tania solium --> Nurocysticrcosis
Livr cysts (hlminth) Echinococcus granulosus<br>(if many cysts...E multilocul
aris)
Hlminth infction with B12 dficincy Diphyllobothrium latum
Hlminth --> biliary tract disas
Clonorchis sinnsis, Opistorchis
Hlminth --> hmoptysis Paragonimus wstrmani (lung fluk)
Hlminth --> portal hyprtnsion
Schistosoma mansoni, japonicum
Hlminth --> hmaturia and bladdr cancr
Schistosoma hamatobium
Hlminth --> microcytic anmia Ncator amricanus, Ancylostoma<br>(hookworms)<b
r>Du to iron/blood loss
Prianal pruritis (parasit)
Entrobius vrmicularis<br><br>Strongyloids als
o has ggs on prianal ara, but not itchy and no pruritis
35 yo avid outdoorsman with muscl swlling and splintr hmorrhags in nail bd
s, mayb som priorbital dma. Which hlminth causs this? How would you diagn
os? How would you trat?
Trichinlla spiralis<br>Diagnos - muscl biopsy
<br>Trat - albndazol + stroids to rduc inflammation of th muscl
"23 yo fmal ""practically livs on sushi."" Labs show B12 dficincy. Whats t
h worm?<br>Bonus: what kind of anmia dos sh hav?" Diphyllobothrium latum (
intstinal tapworm)<br>B12 dficincy --> mgaloblastic anmia
35 yo immigrant with nw onst sizurs. Nam th worm. Nurocysticrcosis (Tan
ia solium, pork tapworm)
Autoinfction is charactristic of which hlminth?
Strongyloids (larva cur
rns = autoinfction, sding of ggs and dposit on prianal ara)<br><br>Risk
factors for hyprinfction (worms burrow through intstinal wall and brings bact
ria with it causing virmia) - stroids, HTLV1 infction<br><br>B carful bfo
r giving an immigrant stroids!!!
Frsh watr crcaria which pntrat skin
Schistosoma (watr must b infs
td with snails)
Labs show iron dficincy. Whats th worm?
Hookworm (Ncator amricanus, An
cylostoma)
Which hlminth prsnts with larva in stool and should NOT b tratd with str
oids? Strongyloids (dangr of hyprinfction, so dont giv stroids)
Viral (and som fungi...) diagnosis mthod compilation (NOT xhaustiv) Ab assay
s (ELISA, HAI, IF, CF, WB) - HBV (HBsAb, HBcAb IgM/total), HAV (IgM/G), HIV, EBV
(VCA/EBNA)<br><br>Ag assays (ELISA, IF) - HBV ( or surfac antigns), histo (u
rinary), crypto (latx agglutination), RSV, Rota<br><br>PCR - Noro, HIV, HCV, Rh

abdo, HSV<br><br>Cultur - HSV, fungi<br><br>EM - Pox, Noro, Rota<br><br>Clinica

l - chickn pox (VZV), fifth disas (parvo), sixth disas (rosola, HHV6)
Livr MRI shows a singl, larg cyst. Th lsion is not infiltrating parnchyma.
PAIR was prformd. Nam th worm.
Echinococcus <br>PAIR = punctur, aspira
t, scolicidal agnt (.g. alcohol), raspiration
Thr worms that migrat through th bronchial tr to b swallowd bfor matur
ing in gut... ASH<br>Ascaris<br>Strongyloids<br>Hookworms (Ncator amricanus
, Ancylostoma)<br><br>All ar associatd with Lofflrs syndrom
6 yo dvlops nw onst nursis (bd-wtting). H wiggls in his chair at dinn
r (scratching). Whats th worm? Whr do you chck for ggs? Entrobius vrmi
cularis (pinworm)<br>Eggs will b prianal in th arly morning, do a scotch tap
 tst
Whil xamining a patints ys, you s a worm swimming. You also s focal sw
lling on th skin. Nam th worm and vctor. Loa loa (african y worm)<br>Tr
ansmittd by dr fly, hors fly, mango fly
Cornal scarring on xam. Skin is hyprpigmntd, thick and dry. Nam th worm a
nd vctor.
Onchocrca volvulus (rivr blindnss)<br>Transmittd by black fl
y
You walk barfoot on th bach in th gulf coast and s lots of dogs. What ar
you worrid about?
Ancylostoma (hookworm)
Walking barfoot on th bach puts you at risk for... SANd<br>Hookworm (Ncato
r amricanus, Ancylostoma)<br>Schistosoma
Spcific food-associations (fish, pork, bf) Fish - Diphyllobothrium latum (i
ntstinal cstod), Anisakis (ascarid), Hp A (shllfish), Clonorchis/Opistorchi
s (livr fluk), Paragonimus (crawfish, lung fluk)<br><br>Pork - Hp E, Trichin
lla spiralis (uncookd sausag), Tina solium (intstinal or nurocysticrcosis
)<br><br>Bf - Tina saginatum (intstinal cstod)
Mningitis agnts by ag
Nonat - Group B strp > E coli > Listria (bac
tria in matrnal GU tract)<br><br>Infant - S pnumo, Nissria, HiB, Entroviru
s (cho, coxsacki)<br><br>Kids and Adults - S pnumo, Nissria (paks in adol
scnc), Entrovirus, HSV<br><br>Eldrly - S pnumo, GNRs, Listria
Mningitis agnts...<br>1. with HIV<br>2. with closd had trauma<br>3. with op
n had trauma 1. HIV - all th normal (S pnumo, Nissria, tc.) + Cryptococc
us, CMV, toxoplasma, JC virus (--> PML)<br><br>2. closd had trauma - nasophary
ngal (ncapsulatd, S pnumo) and oral flora, bactria causing OM/sinusitis/mas
toiditis (S aurus/pidrmidis, GNRs lik psudomonas)<br><br>3. opn had traum
a - skin organisms (S aurus, tc.)
What is th classic triad prsntation of mningitis? What othr symptoms can oc
cur? What about in infants?
Triad - fvr, nuchal rigidity, AMS (not sn in
viral mningitis)<br><br>Othr - photophobia, hadach, ptchia and purpura (
mningococcal), rspiratory dprssion<br><br>Infant - LETHARGY, bulging fontan
lls, vomiting
Mningitis - distinguishing faturs of S pnumo, N mningitidis, Hib S pnumo
- most common, AMS, high mortality, nurologic squla, vaccin availabl<br><
br>N mningitidis - wintr and spring, within PMNs, risk in asplnic patints an
d collg frshmn, rapid progrssion, PETECHIAE, may lad to Watrhous-Fridri
chson ADRENAL HEMORRHAGE, vaccin rquird<br><br>Hib - now rar, s in undrim
munizd kids or kids too young for vaccination, vaccin rquird
Brudzinskis sign
In child with mningitis:<br>Mov thir had forward, an
d thir hips and kns bnd
Krnigs sign In child with mningitis:<br>Flx th hip 90 dgrs, and th kn
 cannot b straightnd
If you suspct a patint has mningitis, ordr th following vnts as you would
us thm (or if you would us thm):<br>LP<br>mpiric antibiotics<br>CT scan<br
>physical xam<br>stains, culturs
Comprhnsiv History and Physical xam
first (travl, trauma; dgr of nuchal rigidity, ptchia, tc.)<br>If mningi
tis suspctd, gt a CT to confirm that thr is NOT a mass lsion BEFORE gttin
g an LP (avoid loss of CSF and hrniation prcipitatd by LP in th cas of a ma
ss lsion)<br>Gt and LP and a GRAM STAIN and cultur to dtrmin th infcting
agnt<br>Trat with an antibiotic spcific for th idntifid organism<br><br>O

nly us mpiric antibiotics if th patint is dtriorating rapidly. If you giv
antibiotics bfor gtting an LP, you will probably knock out th causativ ag
nt and thn hav troubl idntifying and daling with it in th futur.
Empiric thrapy for mningitis Avoid if you can<br><br>Nonat - ampicillin (li
stria) + gntamicin<br>Kids, adults - vancomycin (s pnumo) + 3rd gn cphalosp
orin (nissria)<br>Eldrly - vancomycin (s pnumo) + 3rd gn cphalosporin (ni
ssria) + ampicillin (listria)
CSF profil - bactrial mningitis (and normal) Opning prssur = high (70-180)
<br>WBC >1000, PMNs (non)<br>Protin >100 (15-45)<br>Glucos < 40 (45-80)<br>St
ain - positiv (xcptions - intracllular Nissria, post-mpiric antibiotics,
tc.)<br>Cultur - positiv
CSF profil - viral mningitis (and normal)
Opning prssur = normal (70-18
0)<br>WBC < 300, lymphocyts (non)<br>Protin < 150 (15-45)<br>Glucos = normal
(45-80)<br>Stain - ngativ<br>Cultur - positiv
CSF profil - TB mningitis (and normal)
Opning prssur = supr high, s
purting (70-180)<br>WBC < 500, lymphocyts (non)<br>Protin >100 (15-45)<br>Glu
cos < 50 (45-80)<br>Stain - positiv<br>Cultur - positiv
Viral mningitis - distinguishing faturs from bactrial, agnts, tratmnt
Entrovirus (polio, cho, coxsacki), HSV, HIV, Wst Nil, VZV, undiscovrd<br>
<br>Lss fatal<br>Photophobia, stiff nck, NOT confusd (aka normal mntal statu
s), hadach, vomiting<br><br>Tratmnt is supportiv (LP to rliv ICP, .g.)
Brain abscss - prsntation, risk factors and associatd agnts, tratmnt
Fvr, hadach, n/v, AMS, sizurs, focal nurological dficits<br>Mor AMS and
n/v than mningitis, sick longr<br><br>Sinusitis, OM, pnumonia - Strp<br>Poo
r dntal hygin - oral flora<br>Pntrating had trauma, surgry - S aurus<br>
Endocarditis - viridans, S aurus<br>Congnital hart dfct (R-L shunt) - Strp
<br>GU infction - Psudomonas, ntrobactr<br><br>Trat - antibiotics, surgica
l drainag (mass ffct! CT bfor LP!), anticonvulsants
Encphalitis - prsntation, agnts, CSF findings
Fvr, hadach, signifi
cant AMS (slow onst), altrd consciousnss, plantar rflxs, nw onst sizur
s, CN palsis<br><br>Viral (HSV, VZV, EBV, CMV, ntrovirus, adno, arbo, rabi
s) >> bactria (mycoplasma, syphilis, bartonlla, bruclla, rickttsia) and prot
ozoa (toxoplasma, naglria)<br><br>HSV ncphalitis CSF will hav RBCs
Encphalitis + lsions on lips, palms and sols Coxsacki virus
Encphalitis with RBCs in CSF on LP
HSV (MCC acut sporadic ncphalitis)
Contraindications for vaccination
Anaphylactic raction to a prvious dos
<br>Svr acut illnss (dlay vaccination, not ignor)<br>Encphalopathy withi
n 7 days of prvious DTP/DTaP<br><br>Immunocompromisd and prgnant patints - L
IVE vaccins ONLY (MMR, variclla, liv influnza, OPV)<br>OPV also should not b
 givn to clos contacts of HIV patints (virus is shd in stool)
Spcial nds for vaccination<br>1. childrn undr 2<br>2. immunocompromisd, pr
gnant<br>3. with antibody administration<br>4. coadministration of multipl vac
cins 1. polysaccharids ar not antignic, giv a conjugat vaccin<br><br>2.
no LIVE vaccins. also, for HIV patints, dont giv OPV to thir clos contact
s bcaus th virus is shd in stool<br><br>3. ok for inactivatd vaccins, but
do NOT giv antibodis with LIVE vaccins<br><br>4. gnrally fin unlss contra
indicatd, but usually should wait at last 4 wks btwn administration of 2
of mor LIVE vaccins
Vaccination typs/stratgis
1. Bactrial parts (toxin, polysaccharid) - dip
thria toxin, ttanus toxin, prtussis parts, CONJUGATES - MPH (mningococcus, p
numococcus, Hib)<br><br>2. Wakn th virus (liv, attnuatd) - MMR, VZV, infl
unza, rota, polio (OPV, sabin), BCG, typhoid fvr, vaccinia, yllow fvr<br>3
. Inactivat/Kill th virus - RIP Always = rabis, influnza, Hp A, Polio (IPV,
salK)...also japans ncphalitis virus<br>4. Viral parts - rcombinant viral
antign and protin, Hp B and HPV
Nam th conjugat vaccins
"An ""MPH"" would b a nic CONJUGATE to your MD
dgr<br><br>Mningococcus, Pnumococcus, Hib<br>(anothr mnmonic - thr mai
n causs of bactrial mningitis in infants, all of which happn to b ncapsula
td organisms)"
Nam th killd vaccins
RIP A (rst in pac always<br>Rabis, influnza

, Hp A, polio (IPV, Salk)

What ar th dipthria, ttanus, prtussis vaccin variants?
DTaP - giv to a
ll kids, pdiatric dos of dipthria toxoid, CI (ncphalopathy within a wk of
prvious dos, som nurologic disordrs), AE (fvr, shock, inconsolabl cryin
g, sizurs)<br><br>Td - no prtussis, adult dos of dipthria toxoid, giv to a
dults vry tn yars and for wound managmnt<br><br>Tdap - adult dos of dipht
ria toxoid, rplac on Td boostr with Tdap in adults (spcially thos with i
nfant contacts)
Mningococcus vaccin
Protctiv for all srotyps xcpt B (unfortunatly, th
is is th most common srotyp in th US)<br><br>Purifid capsular polysaccharid
 or CONJUGATE vaccin (boostrs vry 3-5 yars)<br><br>Givn to all kids 11-12
, boostr at 16, collg frshman, military rcruits, halthcar workrs, immuno
compromisd patints (asplnic, complmnt dficincy), travlrs to African mn
ingitis blt
Patint coms in with mningitis. LP rvals gram ngativ diplococci, but pati
nt has proof of mningococcal vaccin. Whats going on?!?
Th mningococca
l vaccin is protctiv for all srotyps xcpt Srotyp B (th most common sr
otyp in th US)<br><br>Bad ractions whn that antign was includd in th vacc
in. sad fac.
Pnumococcus vaccin
CONJUGATE vaccin (13-valnt, for kids ag 2-23 months)
or purifid polysaccharid (23-valnt, for ldrly and high-risk patints ovr a
g 2 such as HIV, smokrs, DM, rnal failur, ASPLENIA, asthma, alcoholism, chro
nic systm disas)
Hamophilus influnza typ B vaccin
CONJUGATE vaccin<br>Prvnts mningitis
, bactrmia, cllulitis, piglottitis (thumbprint sign on xray, drooling, tripo
d position)<br>Giv to ALL infants
Polio vaccins IPV (SalK) - killd, giv to all kids in US, boostr for travl
rs, CI (anaphylaxis to strptomycin, nomycin or polymyxin B), ok for prgnant w
omn<br><br>OPV (Sabin) - liv attnuatd, asily administrd and usd in dvl
oping countris, CI (immunodficint patints and thir clos contacts, prgnanc
y), no longr usd in US bcaus risk of vaccin-prcipitatd disas is highr
hr than risk of contracting polio
MMR vaccin (and rviw of MMR pathology)
Liv attnuatd<br>Giv to all i
nfants, spcially travling to ndmic aras, and suscptibl adults<br>CI - im
mun dficincy, prgnancy, allrgy to nomycin<br><br>Masls - cough, coryza,
conjunctivitis, Koplik spots, rash, pnumonia<br>Mumps - parotitis, orchitis, n
cphalitis<br>Rublla - 3-day grman masls, fvr, blubrry muffin rash
Variclla and Shingls vaccins (VZV, HHV3)
Variclla - liv attnuatd (low
dos), prvnts chickn pox, giv to all halthy infants and suscptibl adults
(womn of childbaring ag, contacts of immunocompromisd), post-xposur proph
ylaxis<br>CI - immunodficincy, prgnancy, allrgy to nomycin or glatin, rc
nt rcipt of ISG<br><br>Shingls - liv attnuatd (HIGH DOSE), giv to immunoC
OMPETENT ldrly, CI (immunodficint, hyprsnsitivity)
Rotavirus vaccin
Liv attnuatd<br>Giv to all infants (was MCC svr,
hospitalizing diarrha in infants)<br>CI - hyprsnsitivity, immunodficincy (f
ailur to thriv, dhydration, prolongd viral shdding)
Influnza vaccins
Inactivatd (trivalnt, TIV) - IM injction, covrs A/H1
N1, A/H3N2, and B<br><br>Liv attnuatd (LAIV) - nasal spray, CI (prgnancy, im
munocompromisd and clos contacts, kids on aspirin, history of GBS)<br><br>Giv
to vryon ovr 6 months, ANNUALLY, spcially high-risk patints (kids, prgn
ant womn, halthcar workrs)<br>CI for both - gg allrgy
History of GBS is a valid contraindication for which vaccin
Influnza vaccin
, LAIV (liv attnuatd)
Egg allrgy is a valid contraindication for which vaccin
Influnza (both
liv attnuatd LAIV and trivalnt inactivatd TIV)
Hp A vaccin
Inactivatd (killd)<br>Giv to all infants and oldr popl who
ar not yt vaccinatd, travlrs to ndmic aras, MSM, IV drug usrs, chronic
livr disas patints<br>Post-xposur prophylaxis in patints 1-40 yars old
(othr ags gt ISG)<br>CI - svr raction to vaccin, aluminum allrgy
Hp B vaccin
Rcombinant viral parts vaccin (purifid rcombinant HBsAg)<br>

Trat all infants, kids, adolscnts and high risk adults (lik halth car work
rs)
Hp B vaccin givs antibody to what xactly? HBsAg
HPV vaccin
Purifid rcombinant L1 capsid protin (viral parts vaccin)<br>
Bivalnt - srotyps 16 and 18 (prvnt crvical cancr)<br>Quadrivalnt - srot
yps 6, 11, 16, and 18 (prvnt gnital warts and crvical cancr)<br><br>Trat
all non-prgnant fmals btwn 9 and 26 (routin at ag 11-12)<br>Trat mals
btwn 9-21 with quadrivalnt vaccin (up to ag 26 in MSM)
Ribavirin dtails
Guanosin analogu - blocks nuclotid pools and RNA lo
ngation<br><br>Us for RSV in infants (arosol), chronic HCV (ribavirin + intrf
ron alpha), viral hmorrhagic fvrs (hanta, lassa, criman congo; IV)<br><br>S
id ffcts - hmolytic anmia (oral/IV), bronchospasm (arosol), tratognic (p
rgnant nurss must b cautious around arosol administration)
Ribavirin mnmonic
RESPCT<br>- RESPiratory syncytial virus, th major rsp
iratory disas in young kids<br>- hp C<br>- Tratogn
Acyclovir (ACV) dtails Guanosin analogu - inhibits viral DNA polymras, caus
s chain trmination<br>CMV is naturally rsistant<br><br>Us for HSV and VZV, 
spcially HSV ncphalitis, HSV rcurrncs, chickn pox<br>No ffct on latnt
forms, rfractory disas<br><br>SE - phlbitis, hadach, nausa, CNS toxicity,
crystal NEPHROPATHY (giv IV fluids to prvnt this)
Drug of choic for RSV in infant
Ribavirin
Drug of choic for HSV ncphalitis
Acyclovir
23 yar old fmal with rcurrnt gnital ulcrs - tratmnt? Acyclovir for r
currnt HSV2<br>Famciclovir and Valacyclovir ar also ffctiv
Which chickn pox patints should b tratd, and with what?
Acyclovir (high
dos)<br>Trat immunocompromisd, prgnant womn, adolscnts and adults, patin
ts at risk for complication<br>Efficacious for kids undr 10, but not ncssary
"16 yar old with 18-hour history of asynchronous ""dwdrop on a ros ptal"" l
sions - should sh b tratd? if so, how?"
Ys, adolscnts with chickn po
x should b tratd.<br>Acyclovir (high dos)
Famciclovir
Highr oral bioavailability and blood lvls than acyclovir<br><
br>Prodrug of pnciclovir (mimics acyclovir)<br>Bttr choic for Shingls<br>Al
so trats mucocutanous HSV in immunocompromisd
Valacyclovir
Highr oral bioavailability and blood lvls than acyclovir<br><
br>Prodrug of acyclovir<br>Bttr for Shingls<br>Also trats primary gnital HS
V (rducs transmission)<br>Associatd with TTP (purpura) and HUS in T cll-dfi
cint patints
Bst tratmnt for shingls
Famciclovir<br>Valacyclovir
CMV - tratmnt Ganciclovir - inhibits viral DNA pol, bst for prophylaxis and t
ratmnt (including CMV rtinitis and congnital CMV), AE (nutropnia, thromboc
ytopnia, do DAILY CBCs)<br>Valganciclovir can b givn PO (thrombocytopnia)<br
><br>Cidofovir - nuclotid analogu, inhibits viral DNA pol, us in HIV PATIENT
S WITH CMV RETINITIS and acyclovir-rsistant HSV, AE (nutropnia, nphrotoxicit
y, priphral nuropathy)<br><br>Foscarnt - pyrophosphat analogu, inhibits DN
A pol AND rvrs transcriptas, us in patints with HHV 1-6 (HSV1/2, ZVZ, EBV,
CMV, HHV6), HBV, HIV and HIV patints with CMV rtinitis or acyclovir-rsistant
HSV, AE (NEPHROTOXICITY, nuro, ELECTROLYTE ABNORMALITIES, tratogn)
Thr drugs which trat CMV or HIV with CMV rtinitis (just nam thm) Ganciclo
vir<br>Cidofovir<br>Foscarnt<br>(all ar givn IV)<br><br>NOT acyclovir (natura
lly rsistant)
Whil on this drug, th patint must rciv daily CBCs Ganciclovir<br>Causs n
utropnia and thrombocytopnia
Indications for...<br>1. Ganciclovir<br>2. Cidofovir<br>3. Foscarnt
1. Ganci
clovir - CMV tratmnt and prophylaxis including rtinitis and congnital CMV<br
><br>2. Cidofovir - HIV patints with CMV rtinitis, acyclovir-rsistant HSV<br>
<br>3. Foscarnt - HIV, HBV, HHV1-6 (includs HSVs, VZV, EBV, CMV, HHV6), HIV pa
tints with CMV rtinitis, acyclovir-rsistant HSV
HBV - tratmnt (lots of options)
Initial - Tnofovir, Entcavir<br>Goal HBAg sroconvrsion (low rplication), ngativ viral load, lowr ALT<br><br>I
FN alpha - inducs antiviral stat via cllular gns, parntral, PEGylatd has

longr half-lif<br>Goal - lowr HBAg<br>SE - FLU-lik (adhrnc is low), nu

tropnia, nurologic<br>Usd for HBV, HCV, HPV, HHV8...hpatitis rlaps is comm
on<br><br>Nuclotid analogus (all xcpt tnofovir caus rar lactic acidosis)
:<br>Lamivudin (HBV and HIV) - hadach, abdominal pain, myalgia, nasal sx, pan
cratitis<br>Adfovir (HBV only, low potncy) - hadach, AP, nphro and hpatot
oxicity<br>Entcavir (lamivudin-rsistant HBV, potnt) - hadach, diarrha, in
somnia<br>Tlbivudin (HBV only) - myopathy (high CPK)<br>Tnofovir (HBV and HIV
, potnt) - n/v/d, nphro and hpatotoxicity
Intrfron alpha - indications, sid ffcts
Usd for HBV (goal is to lowr H
BAg), HCV, HPV, HHV8...hpatitis rlaps is common<br><br>SE - FLU-lik (adhr
nc is low), nutropnia, nurologic
Drugs which trat both HBV and HIV
Lamivudin - nuclosid analogu<br>Tno
fovir - nuclotid analogu<br>Foscarnt - pyrophosphat analogu<br><br>Inhibit
DNA polymras AND rvrs transcriptas
Hp C - tratmnt
Acut - goal is to prvnt progrssion to chronic<br><br
>Chronic - Ribavirin + PEGylatd intrfron + protas inhibitor (Tlaprvir, Bo
cprvir)<br>Tlaprvir - itching, rash, anmia, n/d<br>Bocprvir - anmia, n/v
/d, MYOPATHY in patints on STATINS<br><br>Advancd livr disas - IFN to rduc
 risk of HCC
Imiquimod - dtails
TLR7 agonist (modulats immun rspons, rlas of cyto
kins from skin)<br><br>Topical, us for GENITAL WARTS (HPV) and skin cancr (ac
tinic kratosis in ldrly, basal cll carcinoma)<br><br>SE - local skin ractio
ns
Fomivirsn - dtails
Antisns oligonuclotid (binds and dgrads mRNA, inhi
biting CMV rplication)<br><br>Us for CMV rtinitis in AIDS patints whn othr
thrapis hav faild, intravitral injction<br><br>SE - ocular inflammation
First choic drug (barring rsistanc) for malaria tratmnt
Chloroquin<br>I
f rsistant - atovaquon, proguanil, quinin, quinidin
P vivax, oval - tratmnt
Chloroquin, thn Primaquin (kills latnt hypno
zoits in th livr which can caus rlaps
Chloroquin-rsistant P falciparum - oral tratmnt
Atovaquon/Proguanil<br>
OR<br>Quinin + Doxycyclin OR Famsidar OR Clindamycin
Chloroquin-rsistant P falciparum - parntral tratmnt
Quinidin + Doxy
cyclin or Clindamycin
Chloroquin - mchanism, us, sid ffcts
Inhibits hm polymras which m
aks frriporphyrin IX insolubl, allow inactivation of parasitic nzyms<br><br
>Works on rythrocytic stag of Plasmodium<br>Most P falciparum is rsistant (x
cption - cntral amrica, .g. Haiti)<br><br>SE - GI, CNS, pruritis (trat with
histamins), rtinal damag (if patint has collagn vascular disas)<br><br>S
AFE IN PREGNANCY!
Quinin (oral) and Quinidin (IV)
"Works on asxual rythrocyt stag of P
lasmodium, good for chloroquin-rsistant strains<br><br>SE (""MUCH"") - Cinchon
ism (high doss, n/v, tinnitus, vision disturbancs), hypoglycmia, utrin cont
raction (NOT FOR PREGNANCY), myocardial dprssion (quinin, dangrous) or hypot
nsion and arrhythmias (quinidin)<br><br>Quinidin (IV, usd for svr malaria
) should b givn in ICU du to potntial dangr of cardiac sid ffcts"
Mfloquin - spctrum, sid ffcts, contraindications Works on asxual rythro
cytic stag of Plasmodium<br>Usd for prophylaxis or acut non-svr malaria<br
><br>SE - nuropsychiatric (syncop, insomnia, vivid drams), balanc disturbanc
, arrhythmia<br>CI - patints on cardiac conduction drugs (.g. bta blockrs),
history of sizur or psychiatric disordr, FIRST TRIMESTER prgnancy
Primaquin - spctrum, sid ffcts
Works on livr stags of Plasmodium incl
uding hypnozoits of VIVAX and OVALE (prvnts rlaps)<br><br>SE - hmolytic an
mia in patints with G6PD dficincy, GI, rar mthmoglobinmia, NOT FOR PREGN
ANCY
Dihydrofolat rductas inhibitors
Mthotrxat (chmo drug)<br>Trimthopri
m (part of bactrim, antibiotic, antifungal)<br>Pyrimthamin (part of Fansidar,
anti-malarial)
Fansidar - what is it, mchanism, uss, sid ffcts
Pyrimthamin-Sulfadoxin
 - blocks two stps in folic acid synthsis (including DHF rductas)<br><br>Us

d for chloroquin-rsistant falciparum (but rsistanc is dvloping), uncompli

catd malaria, intrmittnt prvntiv thrapy in PREGNANCY to prvnt ftal was
ting<br><br>SE - GI, allrgic raction, rash, hpatitis, bon marrow supprssion
(mainly a raction to sulfadoxin)
Malaron - what is it, uss, sid ffcts
Atovaquon-Proguanil<br><br>Acti
v against dividing livr stags, including chloroquin-rsistant falciparum...b
ut not good for dormant livr hypnozoits of vivax and oval (add primaquin)<br
>Prophylaxis and tratmnt of uncomplicatd malaria<br><br>SE - rash, fvr...bu
t gnrally wll tolratd<br>$$$
Doxycyclin - us in malaria, sid ffcts
Activ against all Plasmodium, i
ncluding chloroquin-rsistant falciparum<br><br>Prophylaxis and tratmnt (with
quinin or artmisinin)<br><br>SE - diarrha, concntrats in bons and tth l
ading to hypoplasia and impaird growth (NOT FOR PREGNANCY OR KIDS undr 8), ph
otosnsitivity
Artmisinins - nam thm, mchanism, uss, sid ffcts Artsunat, Artmthr<b
r>Kills rythrocytic forms of Plasmodium, incrass ffcts of mfloquin and t
tracyclin (giv all thr togthr to prvnt rsistanc)<br><br>Trats patint
s in US who cant rciv IV quinidin<br>Worldwid - choic IV drug for svr
malaria (must b givn with mfloquin or doxycyclin to prvnt rsistanc)<br>
<br>SE - mild and rar, anmia, lukopnia, high LFTs, abdominal pain, diarrha,
fvr, NOT FOR FIRST TRIMESTER and not grat latr on (mbryotoxicity)
Toxoplasmosis - tratmnt (which patints, how) Trat immunocompromisd and prg
nant womn (rmmbr, vryon is xposd)<br><br>Pyrimthamin/Sulfadiazin (DH
FR inhibitor, activ against rplicating forms, but not cysts)<br>SE - bon marr
ow supprssion (giv folinic acid), diarrha, tratogn in first trimstr, skin
rash, nphrotoxicity<br><br>Pyrimthamin/Clindamycin (DHRF inhibitor + blocks
translation; still not activ against cysts)<br>SE - bon marrow supprssion, t
ratogn, rar rash, C difficil infction<br><br>Last hop - Bactrim (trimthopr
im-sulfamthoxazol)
Bactrim - what is it, mchanism, uss, sid ffcts
Trimthoprim-Sulfamthox
azol - blocks multipl stps in folat synthsis including DHFR<br><br>Prophyla
xis for toxoplasmosis and PCP in AIDS patints<br>Tratmnt for PCP, isospora, c
yclospora<br><br>SE - bon marrow supprssion (pancytopnia), rash (STEVENS-JOHN
SON), high LFTs, intrstitial nphritis, n/v
Nitazoxanid - uss, sid ffcts
"""magic bullt"" for parasits, broad s
pctrum (protozoa and hlminths and bactria)<br><br>Cryptosporidosis (normal ho
st and kids, for AIDS patints giv HAART)...CRYPTO-NIT<br>AIDS diarrha (isosp
ora, cyclospora)<br>Kids with chronic diarrha<br>Giardiasis - kids, rsistant c
ass in adults (fail tratmnt with mtronidazol)<br>Hlminths (ascaris, trichu
ris, chronic fasciola)<br>Som bactria (C difficil)<br><br>SE - no major ons
:)"
Paramomycin - what is it, uss for parasits, sid ffcts
Aminoglycosid a
ntibiotic<br><br>Usd for CYST forms...ntamoba histolytica (luminal agnt agai
nst cyst stag), giardia (during prgnancy), cryptosporidium (som us in AIDS p
atints)<br><br>SE - vrtigo, OK in PREGNANCY
Iodoquinol - uss, toxicity
Luminal agnt usd (with mtronidazol, similar
to paramomycin) to trat cyst form of Entamoba histolytica<br><br>SE - nurotox
icity (mylo-optic nuropathy), THYROID dysfunction (contains iodin), iodin s
nsitivity, rash
Anti-parasitic which causs thyroid dysfunction Iodoquinol (luminal agnt for cy
st form of ntamoba histolytica) - contains iodin
Mtronidazol - mchanism, uss, sid ffcts Elctron sink, forms fr radica
ls which damag DNA<br><br>Bst drug for INTESTINAL and VAGINAL PROTOZOANS - gia
rdia, ntamoba histolytica (systmic agnt for tissu trophozoits, us with io
doquinol or paromomycin luminal agnt), trichomonas (GET on th METRO)<br><br>SE
- GI, mtallic tast, antabus raction to alcohol, sizurs, ataxia, NOT for P
REGNANCY<br><br>Tinidazol - lss toxic, longr half lif, $$$
Lishmania - tratmnt Pntavalnt antimonials (Na stiboglucanat) - first choi
c but must gt from CDC in US, works for all xcpt L donovani (viscral infct
ion) in india<br>SE - pancratitis<br><br>Liposomal amphotricin B - antifungal

and antiparasitic, bst for VISCERAL lishmaniasis (spcially in india with rs
istanc to PAs), unrsponsiv mucocutanous (L brazilinsis), cutanous disas
in US (dont hav to gt it from th CDC)<br>SE - shak and bak (fvr, chills,
rigors), hypotnsion, nphrotoxicity
Pntamidin - uss, sid ffcts
Inhald to prvnt PCP<br>Trat - PCP (a
ltrnativ to bactrim), Lishmania (altrnativ to pntavalnt antimonials and l
iposomal amphotricin), hmolymphatic stag of T bruci (slping sicknss, alt
rnativ to suramin)<br><br>SE - hypoglycmia, diabts (toxic to islt clls, so
rarly usd in US), nphro and hpatotoxicity, cytopnias, hypotnsion
Chagas - bug, tratmnt Trypanosoma cruzi, rduvid bug<br><br>Bnznidazol or Ni
furtimox for primary chagoma, acut and ractivation disas<br><br>Only tratm
nt for chronic disas (organomgaly) is supportiv car (lifstyl changs, hig
h-fibr dit, tc.)
Tryponosoma bruci - tratmnt Hmolymphatic stag - IV suramin (pntamidin is
an altrnativ)<br><br>CNS infction - Mlarsoprol (crosss BBB) is ssntial,
but 10% of patints gt a svr ractiv ncphalopathy so trat with STEROIDS<
br><br>BE SURE OF WHICH STAGE THE DISEASE IS IN to prvnt ithr srious CNS in
fction or unncssary high risk of ncphalopathy
Albndazol - indications
First lin for dworming, worldwid<br><br>Ints
tinal nmatods - Ascaris, toxocara, trichuris, hookworm, ntrobius, trichinll
a<br><br>Tissu tapworms - nurocysticrcosis (Tania solium), cystic hydatid d
isas (Echinococcus)
Thiabndazol - indications, compar to Albndazol
Usd for viscral larva
migrans (toxocara), cutanous larva migrans (animal hookworm, Ancylostoma), Stro
ngyloids<br><br>Highr toxicity than albndazol (n/v, vrtigo)
Mbndazol - indications, compar to albndazol
Usd for Ascaris, trichu
ris, hookworm, ntrobius<br><br>Poor absorption<br>Rar sid ffct - n/d/ap, l
ukopnia
Dithylcarbamazin (DEC) - spctrum, uss, sid ffcts Kills both microfilaria
and adult worms<br><br>Usd for TALL DEC of cards -- toxocara (viscral and ocu
lar larva migrans), animal hookworm (cutanous larva migrans), filaria (LF, loa
loa but NOT ONCHOCERCA du to hyprsnsitivity raction and blindnss causd by
di-off of adult worms)<br><br>SE - du to rlas of antign from dying worms,
fvr, rash, myalgia, osinophilia, ncphalopathy in loa loa (giv singl dos)
Tratmnt for LF
Albndazol + DEC OR Ivrmctin
Ivrmctin - spctrum, uss, sid ffcts
Kills microfilaria (but not adu
lt worms)<br><br>Usd for ONCHOCERCA, STRONGYLOIDES, Scabis, altrnat for fila
ria (LF and loa loa), altrnativ for som nmatods (Ascaris, Ancylostoma)<br><
br>SE - du to rlas of antign from dying worms but not as svr as DEC, can
caus ncphalopathy if trating Loa Loa
Praziquantl - uss, sid ffcts
Usd for fluks/trmatods and intstina
l tapworms/cstods...Schistosoma (blood), Paragonimus (lung), Clonorchis and O
pistorchis (livr), Tania solium (pork), Tania saginatum (bf), Diphyllobothr
ium latum (fish)<br><br>Not that tissu cstods (chinococcus, T solium as nu
rocysticrcosis) ar tratd with Albndazol (and stroids)<br><br>SE - n/v, h
adach, dizzinss
Triclabndazol Trats Fasciola (also nitazoxanid)<br>W didnt rally covr th
is, but th TAs kp mntioning it...
Tratmnt of HSV1/2 and VZV
Acyclovir
Tratmnt of CMV
Ganciclovir, cidofovir, foscarnt or fomivirsn<br><br>C
MV is naturally rsistant to acyclovir
Tratmnt of HCV
Ribavirin + IFN + protas inhibitor (Tlaprvir, Bocpr
vir)
How dos acyclovir work?
Phosphorylatd by TK, guanosin analogu, incorp
oratd into DNA chain causing chain trmination<br><br>CMV is naturally rsistan
t (dosnt us TK)
How dos gancyclovir work?
Still phosphorylatd (not by TK) and addd to gr
owing nuclotid chain (similar to acyclovir), causs chain trmination
HSV drug association with TTP (purpura) and HUS in T cll dficint patints
Valacyclovir<br>Rmmbr - Gancyclovir causs nutropnia and thrombocytopnia a

nd rquirs DAILY CBCs

CMV drug associatd with lctrolyt abnormalitis (scondary to nphrotoxicity)
Foscarnt
Bfor starting a patint from th dvloping world on stroids, you should chc
k for what (and how)? Chck th stool for strongyloids<br><br>Strongyloids c
an burrow through intstinal wall and introduc intstinal bactria to th blood
stram...you dont want to immunocompromis that patint)
Pruritic srpntin rash
Cutanous larva migrans (Ancylostoma)
Nw onst sizurs in an adult from th dvloping world
Nurocysticrcos
is (Tania solium)
Huntr prsnts with muscl pain aftr making hom-mad sausag Trichinlla spir
alis
Rctal prolaps Trichuris trichiura (whipworm)
Hlminth which causs B12 dficincy
Diphyllobothium latum (fish-associatd i
ntstinal tapworm/cstod)
Whzing and osinophilia with intstinal obstruction Lofflrs (Ascaris incl
uding toxocara, Strongyloids, Hookworm)
Hlminth-associatd iron-dficincy anmia
Hookworm (Ncator amricanus, An
cylostoma)
Abrupt onst of fvr and cold-lik symptoms (hits you lik a bus)
Influnz
a virus
What componnt of th influnza virus contains th typ-spcific antign? (Struc
tural) "Nucloprotin<div><img src=""nucl.jpg"" /></div>"
Togavirida - charactristics (strand sns any nvlop), giv its gnra
"+ssRNA, nvlopd&nbsp;<div><br /><div>-Alphavirus (Group A arboviruss)&nbsp;<
/div><div>-Rubivirus (rublla, NOT an arbovirus)</div></div><div><br /></div><di
v><img src=""past-213640263238262.jpg"" /></div>"
5/23ArbovirusRD
Alphavirus - diagnosis "Clinical suspicion (travl, bit xposur)&nbsp;<div><u
><b>Srology</b></u>, mainly ELISA</div><div>Som old worlds can b isolatd fro
m blood in arly stags</div><div><br /></div><div><br /></div><div><img src=""p
ast-213635968270966.jpg"" /></div>"
5/23ArbovirusRD
Viral infctions of th GI tract (2 pattrns of infction)
-<u>Rplicat in
lumn</u>, <u>disas lswhr</u> in body.&nbsp;<div>x: ntrovirus (polio,
cho, kobu/aichi), adnovirus&nbsp;<div><br /></div><div>-<u>Rplication and dis
as</u> of <u>GI tract</u></div><div>x. rota, calici, astro, ntric adnoviru
ss</div></div> 5/23GIvirusRD
In th managmnt of virologic failur, aftr assssing adhrnc, rsistanc t
sting is don (rquirs VL &gt;______). Giv 2 typs
<b><div></div></b><b>&gt
;1000</b><div><b><br /></b></div>Phnotyp: Entails culturing th virus in th p
rsnc of diffrnt concntrations of th drug and dtrmining th IC50.&nbsp;<
div><br /></div><div><b>Gnotyp</b>: Dtcts mutations associatd with viral r
sistanc.</div> 5/27HIVTratmntRD
Acut diarrha in an infant in th US in wintr; big problm globally. Also vomi
ting, abd pain, fvr. Rar ncrotizing ntrocolitis. Rotavirus
5/23GIvi
rusRD
Alphavirus Classification- all with som <b>srologic cross-ractivity</b><div><
div>__________ vry closly rlatd but distinct</div><div>from ach othr</div>
<div><br /></div><div>__________ individual agnts, antignically rlatd but as
ily sparabl (4x or gratr diffrncs btwn homo- &amp; htrologous titrs
of both sra)</div><div><br /></div><div>__________ - (4x or gratr diffrncs
btwn homo- &amp; htrologous titrs of on but not both sra)</div><div><br
/></div><div>__________ spcial tsts to distinguish</div></div>
<div><b>
Antignic complx</b> vry closly rlatd but distinct</div><div><div>from ach
othr</div><div><br /></div><div><b>Spcis lvl</b> individual agnts, antign
ically rlatd but asily sparabl (4x or gratr diffrncs btwn homo- &amp
; htrologous titrs of both sra)</div><div><br /></div><div><b>Antignic sro
typs </b>- (4x or gratr diffrncs btwn homo- &amp; htrologous titrs o
f on but not both sra)</div><div><br /></div><div><b>Antignic varitis</b> s
pcial tsts to distinguish</div></div> 5/23ArbovirusRD
Arnavirida - nvlopd, gntic matrial, sgmnts
"Lipid-nvlopd, ssRNA,

ambisns, bipartit<div><br /></div><div><i>2 fightrs in th arna</i></div><

div><i><br /></i></div><div><i><img src=""past-209349590909558.jpg"" /></i></di
v>"
5/23ArbovirusRD
Filovirida - nvlop status and gntic matrial, sns
"Lipid-nvlopd
, (-)ssRNA virus<div><img src=""bola.jpg"" /></div><div><br /></div><div><img
src=""past-213919436112502.jpg"" /></div>"
5/23ArbovirusRD
Inapparnt viral infxns Most intstinal infxns
Mchanisms of diarrha (3)
"Abnormal lctrolyt and watr transport du to
intstinal scrtion (<b><font color=""#808000"">toxin mdiatd</font></b>)&nbs
p;<div>intraluminal osmotic factors du to&nbsp;<b><font color=""#808000"">malab
sorption</font></b>&nbsp;(oftn du to disaccharidas dficincy such as lactos
intolranc)<div><b><font color=""#808000"">motility</font></b> disordr</div><
/div>" 5/23GIvirusRD
Major pathogns of viral diarrha (4) Rotavirus, Norovirus, Astrovirus, Adnov
irus 40 and 41<div><br /></div><div>RNAA40</div>
5/23GIvirusRD
Top 3 causs of svr infant diarrha in dvloping countris Rotavirus (45%),
Toxignic E. Coli (EHEC) (20%), Adnovirus (5-10%)
5/23GIvirusRD
Top 3 causs of svr infant diarrha in dvlopd countris Norovirus (proba
bly #1 now), Rotavirus (45%), Adnovirus (5-10%),
5/23GIvirusRD
How ar viral diarrhas normally tratd/prvntd?
Fluid/lctrolyt rplac
mnt (no antivirals), good hygin, potntial vaccin 5/23GIvirusRD
What non-structural Rotavirus protin is rsponsibl for th toxic ffct ladin
g to diarrha? "NSP4--&gt; incrasd Cl- scrtion<div><br /></div><div><img sr
c=""past-253519034581622.jpg"" /></div>"
5/23GIvirusRD
Why is Rotavirus mor fatal in dvloping countris?
Kids ar <i>alrady maln
ourishd</i>, and littl rhydration thrapy availabl 5/23GIvirusRD
Diagnosis of Rotavirus group A. Non-group A?
<b>ELISA</b>, latx agglutinatio
n of stool for <b>VP6</b><div><b>Elctron microscopy </b>of stool for non-group
A infctions (TCH dos this)</div>
5/23GIvirusRD
Diagnosis of Rotavirus non-group A
EM of stool
5/23GIvirusRD
Prvntion of Rotavirus. Giv ag
Liv attnuatd vaccin (2 liv attnuat
d vaccins licnsd for us in infants)&nbsp;<div>Ags: 6 wks &lt; x &lt;15 w
ks</div>
5/23GIvirusRD
Tratmnt of Rotavirus Rhydration; no antivirals availabl
5/23GIvirusRD
Disas of Rovirus carrid by ticks
Colorado Tick fvr (colitvirus)
5/23GIvirusRD
Gnra of Calicivirus (2)
Norovirus, Sapovirus
5/23GIvirusRD
What blood group is suscptibl to Norovirus gnogroup 1 infctions?
Blood gr
oup O 5/23GIvirusRD
Diagnosis of Norovirus RT-PCR; cant cultur it
5/23GIvirusRD
Which caus of viral gastrontritis is mor associatd with outbraks: Astrovir
us vs Entric Adnovirus?
Astrovirus
5/23GIvirusRD
Tratmnt for noninflammatory diarrha Symptomatic tratmnt; no furthr valua
tion if rsolution
5/23GIvirusRD
Tratmnt of inflammatory diarrha
Empric antibiotic thrapy
5/23GIvi
rusRD
Diagnosis of inflammatory diarrha
cultur of stool, cytotoxin assay
5/23GIvirusRD
In which patint population is variclla potntiall fatal?
"Immunocompromis
d childrn (SCID, tc.)<div><img src=""fatal.jpg"" /></div>" 6/20HHVDicky
Srious complications (2) of hrps zostr infction
"Post-hrpatic nuralgia
(PHN), ophthalmoplgia&nbsp;<div><img src=""ophthal.jpg"" /></div><div><br /><
/div><div><img src=""past-357706351247990.jpg"" /></div>"
6/20HHVDicky
Who gts pnumonia from ndognous aspiration causd by gram ng bactria?
Hospitalizd patints
How is apical pathology bst sn?
"Apical lordotic CXR<div><img src=""lord
otic.jpg"" /></div><div><img src=""lordotic (1).jpg"" /></div>"
How is plural fluid sn bst sn on CXR?
"Lying down (dcubitus CXR) vs s
itting up: fluid movs<div><img src=""dcubitis.jpg"" /></div><div><img src=""r
t lat d.jpg"" /></div>"

What is th scoring systm usd to rat LRI svrity? Who is tratd inpatint?
"PORT systm<div>Low (I-III) Modrat (IV) High (V)</div><div>Incrasing mortali
ty, &gt;II = inpatint</div><div><img src=""scoring.jpg"" /></div>"
Low risk PORT scors
"Class 1-3; &lt;90<div><img src=""port.jpg"" /></div>"
Modrat risk PORT scor
"Class 4; 91-130<div><img src=""inpatint.jpg""
/></div>"
High risk PORT scor
class 5; >130
What bactria ar likly to caus aspiration pnumonitis?
Mixd anarobic/
arobics from mouth flora
What can occur if aspiration pnumonitis gos untratd?
"Ncrotizing pn
umonia (&lt;1cm in diamtr)<div><img src=""ncro.jpg"" /></div>"
What can occur if ncrotizing pnumonia gos untratd? "lung abscsss (&gt;1 c
m)<div><img src=""abscss (1).jpg"" /></div>"
What thr familis is Arbovirida split into? <b>Togavirida</b><div>-Alpha (W
EE, EEE), rublla&nbsp;<div><b>Flavivirida</b>&nbsp;</div><div><b>Bunyavirida<
/b></div></div> 5/23ArbovirusRD
EEEV, WEEV, and VEEV: old or nw world? Major disass associatd?
"Nw wor
ld; ncphalitis and asptic mningitis<div><br /></div><div><br /></div><div><i
mg src=""alpha.jpg"" /></div><div><img src=""past-214074054935158.jpg"" /></di
v>"
5/23ArbovirusRD
Do old world or nw world alphaviruss caus ncphalitis?
"Nw world<div><
br /></div><div><img src=""alpha.jpg"" /></div>"
5/23ArbovirusRD
Do old or nw world alphaviruss caus fvr and rash syndroms?
"Old wor
ld<div><br /></div><div><br /></div><div><img src=""alpha.jpg"" /><br /><div><b
r /></div><div><img src=""past-214069759967862.jpg"" /></div></div>" 5/23Arbo
virusRD
Chikungunya: Group, Gnus, Family
"Smliki Forst Virus group, Alphavirus
(old world), Togavirida<div><br /></div><div><img src=""alpha.jpg"" /></div>"
5/23ArbovirusRD
Whr is Chikungunya found?
Africa and Asia; now sprad into southrn Europ
5/23ArbovirusRD
"Which spcis of Alphavirus causs a maculopapular rash?<div><img src=""chik.jp
g"" /></div><div><br /></div><div><br /></div>"
"Chikungunya (Simliki Fo
rst virus group, old world)<div><br /></div><div><img src=""alpha.jpg"" /></di
v>"
5/23ArbovirusRD
Which group of Alphavirus (old or nw world) is mor likly to caus virmia
"Old world<div><br /></div><div><img src=""alpha.jpg"" /></div>"
5/23Arbo
virusRD
How ar alphaviruss diagnosd? (giv old and nw world)
Epidmiology, <b
>srology</b> (nw world), <b>blood cultur</b> (old world)<div><br /></div><div
><i>In th old days lots of blood, but nw world has lots of tchnology and sro
logy&nbsp;</i></div>
5/23ArbovirusRD
Prvntion of alphaviruss
Control of arthropod vctors, vaccins 5/23Arbo
virusRD
<div><u>Tick-born ncphalitis</u>, Powassan virus, Omsk hmorrhagic fvr, Kya
sanur forst disas. What family?</div>
"<b>Flavivirus</b> disass caus
d by a tick<div><img src=""tick.jpg"" /></div><div><br /></div><div><img src="
"past-215461329371674.jpg"" /></div>" 5/23ArbovirusRD
"Viruss in Japans Encphalitis virus group (3)<div><img src=""flavi.jpg"" />
</div>" "<b>JEV, St. Louis ncphalitis virus, Wst Nil virus</b><div><img src=
""JEV.jpg"" /></div><div><br /></div><div><img src=""past-215457034404378.jpg"
" /></div>"
5/23ArbovirusRD
Prvntion of Yllow fvr
"Liv attnuatd vaccin; mosquito radication<d
iv><br /></div><div><img src=""past-215766272049782.jpg"" /></div>"
5/23Arbo
virusRD
Is infction with on srotyp of Dngu virus protctiv against othr srotyp
s?
No. Thr is no cross-ractivity<div><br /></div><div>In fact, vaccinati
on against on strain can incras svrity if infctd with diffrnt strain!</
div>
5/23ArbovirusRD
Gntic matrial of Bunyavirus (nvlopd/strand/any sgmnts) "Envlopd (-)ss

RNA, 3 sgmnts (tripartit)<div><br /></div><div><img src=""past-2159208908724

38.jpg"" /></div>"
5/23ArbovirusRD
Caus of Criman-Congo Hmorrhagic fvr
"Bunyavirida--&gt;Nairovirus<di
v><br /></div><div><img src=""past-226486510420506.jpg"" /></div>"
5/23Arbo
virusRD
Disass of Bunyavirida--&gt;Phlbovirus
"Rift vally fvr (sub-Saharan
Africa), sandfly fvr<div><br /></div><div><img src=""past-216148524139034.jpg
"" /></div>"
5/23ArbovirusRD
Major disass causd by Hantavirus gnus
"<b>Hmorrhagic fvr with rnal
syndrom</b> (HFRS) and&nbsp;<div>Hantavirus pulmonary syndrom (HPS- Sin nombr
 virus)</div><div><br /></div><div><img src=""past-209925116527222.jpg"" /></d
iv>"
5/23ArbovirusRD
Gnus and spcis caus of Hmorrhagic fvr with rnal syndrom
"Hantavi
rus; Hantaan and Soul viruss<div><br /></div><div><img src=""past-20992082155
9926.jpg"" /></div>"
5/23ArbovirusRD
Disas causd by Hantaan or Soul virus
Hmorrhagic fvr with rnal syn
drom (HFRS)
5/23ArbovirusRD
Virus carrid by th dr mous or cotton rat "<div>Hantavirus</div><div><img
src=""rat.jpg"" /></div><div><br /></div><div><img src=""past-209920821559926.
jpg"" /></div>" 5/23ArbovirusRD
Old world Arnaviruss "Lymphocytic choro-mningitis (LCM), Lassa fvr<div><i
mg src=""arana.jpg"" /></div><div><br /></div><div><img src=""past-2298451748
46070.jpg"" /></div>" 5/23ArbovirusRD
Nw world Arnavirus
"Junin fvr<div><img src=""arana.jpg"" /></div>"
5/23ArbovirusRD
How is Filovirus diagnosd?
"Antign dtction<div><img src=""antign (2).jp
g"" /></div>" 5/23ArbovirusRD
Which spcis of picornavirus is most likly to caus a rash? Coxsacki virus
Incubation priod for influnza 2-3 days (short)
Dfinitiv diagnosis of influnza
Isolation (cll cultur), srology (not
practical), <u><b>rapid antign dtction</b></u>&nbsp;(using antibody), PCR (mo
st snsitiv, not widly availabl)
Which spcis of influnza is th dirct antign tst most snsitiv to?
Typ A
Which is th only typ of influnza that undrgos antignic shift (and pandmic
s)?
Influnza A
Which populations ar suscptibl to antignic shifts? Entir population
How can you dtrmin which kind of HA (or NA) an influnza virus has? "<u>Sro
logic tsting for cross-ractivity</u>; a particular HA (or NA) only racts with
its spcific antibody (thy ar immunologically distinct)<div>Agglutination wit
h + ab to HA<br /><div><img src=""cross (3).jpg"" /></div></div>"
Which <u>strains</u> of influnza ar high path? What maks an influnza strain
highly pathologic?
H5 or H7; asily clavd into a vry infctious particl
Which strains of influnza (high or low path) caus virma and systmic infctio
n?
High path
Which strains of influnza (high or low path) hav fw basic amino acids?
Low Path
Which strains of influnza (high or low path) hav multipl basic amino acids?
High Path
Which populations ar suscptibl to antignic drift? Only portions of th pop
ulation; caus annual pidmics
What typs of influnza xprinc antignic drift?
Typ A and B
Which antiviral should b usd in a 2yo with acut influnza A? Osltamivir (bc
aus not an inhalnt, which ar not good for kids)&nbsp;<div><br /></div><div><b
>O</b>sltamivir=<b>o</b>ral</div>
What is th cytopathic ffct? "Th physical and obsrvabl changs mad to a c
ll aftr viral infction<div><img src=""CPE.jpg"" /></div>"
What ar antivirals normally aimd at? ssntial stps in viral rplication
What is th clips phas of th viral rplication cycl?
"Th phas whr
viruss ar ntring host clls and rplicating. Dtctabl viral lvls dcra

s<div><img src=""clips.jpg"" /></div>"

5/12GnralPrinciplsofViruss
Phas of viral cycl whr viruss ar ntring host clls and rplicating. Dt
ctabl lvls dcras "Eclips phas<div><img src=""clips.jpg"" /></div>"
5/12GnralPrinciplsofViruss
Ambisns ssRNA virus "Arnavirus<div><br /></div><div><img src=""past-210315
958551158.jpg"" /></div>"
5/23ArbovirusRD
Th only ssDNA virus
Parvovirus<div><br /></div><div>(hol in 1 on a par hol
)</div>
What kind of spcificity do viruss xhibit?
Host, organ, and within an organ
spcificitis
What organ systms produc th most disas from viral infctions?
"Skin an
d CNS<div><img src=""apparnt.jpg"" /></div><div><br /></div><div>Ectodrm</div
>"
What ar quasispcis? What typs typically?
A <u>mixtur</u> of viruss in a
host at a givn tim, sn mor in <u>RNA</u> viruss who ar mor pron to rp
lication rrors/mutations
5/12GnralPrinciplsofViruss
What ar virorcptors? Viral molculs that <u>amplify or countract natural r
cptors</u> to intrfr with cllular rgulation/host immun rspons 5/12Gn
ralPrinciplsofViruss
What should you worry about with Pnumocystis infction and HAART tratmnt?
"Immun rconstitution syndrom<div><br /></div><div>""th immun systm bgins
to rcovr, but thn rsponds to a prviously acquird opportunistic infction w
ith an ovrwhlming inflammatory rspons that paradoxically maks th symptoms
of infction wors""</div>"
What ar th potntial causs of damag to th frontal lob?
Congnital&nbsp;
<div>Strss&nbsp;</div><div>Traumatic brain injury&nbsp;</div><div>Antrior cr
bral artry strok&nbsp;</div><div>Frontotmporal dgnration (FTD)</div>
5/16CorticalEaglman
Dscrib th dtaild stps in th rplication of a typical virus.
"1. Atta
chmnt <br>2. Pntration<br>3. Uncoating of viral nuclic acid<br>4. Transcript
ion of ""arly"" mRNA<br>5. Translation of ""arly"" protins (gnrally nzyms
involvd in gnom <b>rplication</b> and <b>transcription</b>)<br>6. Rplicati
on of viral nuclic acid<br>7. Transcription of ""lat"" mRNA<br>8. Translation
of ""lat"" protins (gnrally <b>structural</b> protins)<br>9. Assmbly (matu
ration of virions)<br>10. Rlas of virions"
What virus is rsponsibl for th most causs of acut gastrontritis in th US
and th majority of US outbraks of acut gastrontritis (food and watrborn)
in oldr childrn and adults in familis, communitis and institutions?
Norovirus
5/23GIvirusRD
What is th diffrnc btwn major dprssion and dysthymia? <b>MDD</b> is <u
>prsistnt</u> and <u>unwavring</u>&nbsp;<div><b>Dysthymia</b> is dprssion <
u>most of th tim for 2 yars</u>, but <u>not fr of mood symptoms for a 2 mon
th</u> priod of tim</div>
What nurotransmittr plays a rol in mmory formation in th prfrontal cortx?
<br>How is this provn? norpinphrin (through a2 rcptor prdominantly)&nbsp;
<div>th phnomnon of rcalling an motionally chargd mmory is blockd whn g
ivn a bta blockr lik propanalol</div>
5/14TratmntDprssion1
What is th half lif of most SSRIs? <br>(What is th xcption?)<br>What dos t
his man if th drug is not taprd?
"Half lif <24 hrs (xcpt fluoxtin)<b
r>Crats unplasant (but not dangrous) ""srotonin discontinuation symptoms""
=> nausa, irritibility, tarfulnss, fatigu, dizzinss"
5/14TratmntDp
rssion1
What is srotonin syndrom?
Charactrizd by <u>fvr</u>, <u>dlirium</u>,
<u>hyprtnsion</u>/<u>hypotnsion</u>, <u>nuromuscular xcitability&nbsp;</u><
div>Uncommon<br>Risk incrass whn using mor than on srotonrgic drug</div><
div><br /></div><div>Cognitiv (dlirium)</div><div>Autonomic (BP crazy)</div><d
iv>Somatic &nbsp;(hyprrflxia, myoclonus)</div>
"Fill in and contrast with bactria.<div><br /></div><div><img src=""past-26976
689586813.jpg"" /></div>"
"Bactria dont hav th clips lowring of p
athogn load<div><br /></div><div><img src=""past-26989574488701.jpg"" /></div>

"
5/12GnralPrinciplsofViruss ViralIntro2
Nam fiv gnral goals of psychothrapy in major dprssiv disordr.&nbsp;
"rduc <u>intrnal conflicts</u><div><br /></div><div>rstor usful <u>attachm
nts</u></div><div><br /></div><div>improv <u>slf-stm</u></div><div><br /><
/div><div>promot ""<u>optimal disillusionmnt</u>"" (giv up magical thinking a
nd pathological optimism)</div><div><br /></div><div>ovrcom ffcts of <u>trau
ma</u></div><div><br /></div><div><br /></div>" dprssion
Dscrib th intraction btwn rligiosity and major dprssion.
<div>If
high importanc, 1/4 risk of dprssion</div><div><br /></div><div>mor <u>pro
tctiv</u> in patints at <u>highr risk</u></div><div><br /></div><div>strong
r <u>protction</u> for <u>rcurrnc</u> than onst</div><div><br /></div><div>
not dsignd to support an intrvntion (?)</div><div><br /></div>
dprssi
on
Dscrib th complications of dysthymia.<div><br /></div><div>Dscrib th pid
miology of dysthymia. (point prvalnc, liftim prvalnc)</div>
<b>compl
ications</b><div>substanc abus</div><div>undrachivmnt</div><div>marital co
nflict</div><div>incrasd risk of major dprssion</div><div>suicid</div><div>
<br /></div><div><b>pidmiology</b></div><div>point prvalnc of 3% and lifti
m prvalnc of 6%, with womn diagnosd to mn in 2:1 ratio</div><div>common a
ssociation with othr mdical/psychiatric diagnoss</div><div><br /></div>
dprssion
What ar som associatd risks, altrations of bravmnt?
incrasd risk f
or <u>cardiovascular disas</u>, <u>suicid</u><div><br /></div><div>Altration
s in<u> immun function</u></div><div><br /></div>
dprssion
History of prsnt illnss
"<img src=""past-108800111543016.jpg"" />"
OSCE
Past mdical history
"<img src=""past-108963320299808.jpg"" />"
OSCE
Social history "<img src=""past-108989090103460.jpg"" /><div><br /></div><div>
1. tobacco</div><div>2. alcohol</div><div>3. rc drugs</div><div>4. marrid/sing
l</div><div>5. living situation</div><div>6. occupation</div><div>7. xrcis d
it</div><div>8. spiritual blifs</div><div>9. mood</div>"
OSCE
Family history "<img src=""past-109014859907196.jpg"" />"
OSCE
Rviw of systms
"<img src=""past-109040629710888.jpg"" />"
OSCE
Gnral tips
"<img src=""past-109148003893772.jpg"" />"
OSCE
Vital signs
"<img src=""past-109255378075896.jpg"" />"
OSCE
Lung xam
"<img src=""past-109281147879632.jpg"" /><div>6 pr sid*</div>
"
OSCE
Cardiovascular xam
"<img src=""past-109306917683736.jpg"" />"
OSCE
Abdominal xam "<img src=""past-109332687487472.jpg"" />"
OSCE
Cranial nrv xam
"<img src=""past-109375637160432.jpg"" /><div><br /></d
iv><div>CN II:&nbsp;</div><div>1. Visual Acuity</div><div>2. Visual Filds</div>
<div>3. Fundoscop</div><div>4. Pupillary rspons</div>"
OSCE
Fundoscopic xam
"<img src=""past-109409996898512.jpg"" />"
OSCE
HENT (ys ar sparat)
"<img src=""past-109667694936476.jpg"" />"
OSCE
Scrning nurologic xam
"<img src=""past-109702054675588.jpg"" />"
OSCE
Giv what all you should includ in your oral prsntation.
"<img src=""past
-109800838924304.jpg"" />"
OSCE
Giv th 5 componnts of th history. HPI<div>PMH</div><div>Social</div><div>F
amily</div><div>ROS</div>
OSCE
{{c1::Srotonin Syndrom}}: fvr, dlirium, hyprtnsion, hypotnsion, nuromus
cular xcitability; risk incr with &gt;1 srotonrgic drug
Psychoac
tivdrugs
"Nam this pathology.<div><br /></div><div><img src=""past-4647154614895.jpg""
/></div>"
MS in th spinal cord rsulting in gry discoloration<div><br />
</div><div>Transvrs mylitis</div>
DmylinatingDisas
What is th lngth and structur of th OSCE? "<div><img src=""past-852465108
91824.jpg"" /></div><div><br /></div><div><img src=""past-85345295139632.jpg""
/></div><div><br /></div><div>You will know which cas youll b doing a prsnt

ation on from th start.</div>" OSCE

"<img src=""past-85564338471728.jpg"" />"
A.
OSCE
7 atypical antipsychotics?
Clozapin<div>Olanzapin</div><div>Qutiapin</d
iv><div>Rispridon</div><div>Aripiprazol</div><div>Palipridon</div><div>Zipr
asidon</div><div><br /></div><div>COQ RAPZ</div>
5/23AntipsychoticsRD
Olanzapin mnmonic
olay oil puts you to slp
5/23AntipsychoticsRD
Which atypical antipsychotic is prfrrd in patints with Parkinsons disas?&
nbsp; "<div>Qutiapin</div><div><br /></div>""us Qtip to test sensation in a
PD pt"""
5/23ntipsychoticsRD
ripiprazole (<>ilify</>) mnemonic causes <></>kathesia &amp; grants <>
aility</> to depressed pt
5/23ntipsychoticsRD
Q: How does the lac operon work?
"<div>When glucose is present theres a re
pressor protein that inds to the operator</div><div>and prevents the transcript
ion of 3 genes needed for lactose metaolism. However, when</div><div>glucose is
asent and lactose is present, lactose inds to the repressor protein causing i
t to</div><div>change shape and therey fall off the operator. Now RN pol is al
lowed to transcrie the</div><div>genes needed to reakdown lactose.</div><div><
img src=""la.jpeg"" /></div>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_0.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__0.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
natomy_Block1 UpperLim
/>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_1.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__1.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
natomy_Block1 UpperLim
/>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_2.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__2.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
/>"
natomy_Block1 UpperLim
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_3.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__3.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
/>"
natomy_Block1 UpperLim
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_4.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__4.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
natomy_Block1 UpperLim
/>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_5.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__5.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
natomy_Block1 UpperLim
/>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_6.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__6.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
/>"
natomy_Block1 UpperLim
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_7.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__7.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
/>"
natomy_Block1 UpperLim
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_8.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__8.svg"" />"
"<img src=""4a75

933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
natomy_Block1 UpperLim
/>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_9.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__9.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
natomy_Block1 UpperLim
/>"
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_10.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__10.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
/>"
natomy_Block1 UpperLim
"<img src=""4a75933a537014271071a38663210f0ca1638_Q_11.svg"" />"
"<img sr
c=""4a75933a537014271071a38663210f0ca1638__11.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_source_svg.svg"" />"
"<img src=""4a75
933a537014271071a38663210f0ca1638_Screen Shot 2013-08-29 at 10.57.27 PM.png""
/>"
natomy_Block1 UpperLim
What is the order of catecholamine synthesis? L-tyrosine--&gt;L-dopa--&gt;dopa
mine--&gt;norepinephrine--&gt;epinephrine
Block2
<div>Q: On the anterior of the lung there are 3 imaginary lines that serve as su
rface markings.</div><div>What are they?</div> ": parasternal line, midclavicu
lar line, and axillary line (through armpit)<div><img src=""Screen Shot 2013-12natomy_Block2 Block2
09 at 3.38.39 PM.jpg"" /></div>"
<div>Q: On the posterior of the lung there are 2 imaginary lines that serve as s
urface markings.</div><div>Name them.</div>
": paraverteral line and scapu
lar line<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
<div>Q: What surface markings (ris) are associated with the right order (paras
ternal) of the</div><div>left lung? (and unique lung features)</div>
": 2nd
ri (superior), 4th ri (cardiac notch), 6th ri (lingula)<div><img src=""Screen
Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>" natomy_Block2 Block2
Q: What is the inferior order along the mid-clavicular line of the right lung?
": 6th ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
Q: What is the inferior order along the mid-clavicular line of the left lung?
": 6th ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
Q: What is the inferior order along the axillary line of oth lungs? ": 8th
ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>" natomy_
Block2 Block2
Q: What is the inferior order along the scapular line of oth lungs? ": 10th
ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
Q: What is the inferior order along the paraverteral line of oth lungs?
": 10th ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
Q: What is the parasternal order of the pleural cavity?
": 2nd ri, 6th
ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
Q: What is the midclavicular order of the pleural space?
": 8th ri<div>
<img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>" natomy_Block2 B
lock2
Q: What is the axillary line of the pleural space?
"<div>: 10th ri</div><
natomy_
div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
Block2 Block2
Q: What is the scapular and paraverteral line of the pleural space?
": 12th
ri<div><img src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
natomy_Block2 Block2
: 4th ri, star
Q: The horizontal fissure extends along what ri anteriorly?

ting from olique fissure

natomy_Block2 Block2
"<img src=""a04945d1aa3e3ff06704f2318c74d80f2ef795_Q_0.svg""
c=""a04945d1aa3e3ff06704f2318c74d80f2ef795__0.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_source_svg.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_tmp4kl4ld.png"" />"
"<img src=""a04945d1aa3e3ff06704f2318c74d80f2ef795_Q_1.svg""
c=""a04945d1aa3e3ff06704f2318c74d80f2ef795__1.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_source_svg.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_tmp4kl4ld.png"" />"
"<img src=""a04945d1aa3e3ff06704f2318c74d80f2ef795_Q_2.svg""
c=""a04945d1aa3e3ff06704f2318c74d80f2ef795__2.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_source_svg.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_tmp4kl4ld.png"" />"
"<img src=""a04945d1aa3e3ff06704f2318c74d80f2ef795_Q_3.svg""
c=""a04945d1aa3e3ff06704f2318c74d80f2ef795__3.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_source_svg.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_tmp4kl4ld.png"" />"
"<img src=""a04945d1aa3e3ff06704f2318c74d80f2ef795_Q_4.svg""
c=""a04945d1aa3e3ff06704f2318c74d80f2ef795__4.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_source_svg.svg"" />"
45d1aa3e3ff06704f2318c74d80f2ef795_tmp4kl4ld.png"" />"
"<img src=""77d51ae19e31244c8a6078a583e4a90cfc38f90_Q_0.svg""
c=""77d51ae19e31244c8a6078a583e4a90cfc38f90__0.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_source_svg.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_tmppfllqk.png"" />"
"<img src=""77d51ae19e31244c8a6078a583e4a90cfc38f90_Q_1.svg""
c=""77d51ae19e31244c8a6078a583e4a90cfc38f90__1.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_source_svg.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_tmppfllqk.png"" />"
"<img src=""77d51ae19e31244c8a6078a583e4a90cfc38f90_Q_2.svg""
c=""77d51ae19e31244c8a6078a583e4a90cfc38f90__2.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_source_svg.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_tmppfllqk.png"" />"
"<img src=""77d51ae19e31244c8a6078a583e4a90cfc38f90_Q_3.svg""
c=""77d51ae19e31244c8a6078a583e4a90cfc38f90__3.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_source_svg.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_tmppfllqk.png"" />"
"<img src=""77d51ae19e31244c8a6078a583e4a90cfc38f90_Q_4.svg""
c=""77d51ae19e31244c8a6078a583e4a90cfc38f90__4.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_source_svg.svg"" />"
51ae19e31244c8a6078a583e4a90cfc38f90_tmppfllqk.png"" />"
"<img src=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00_Q_0.svg""
c=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00__0.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_source_svg.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_tmpy_94gr.png"" />"
"<img src=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00_Q_1.svg""
c=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00__1.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_source_svg.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_tmpy_94gr.png"" />"
"<img src=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00_Q_2.svg""
c=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00__2.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_source_svg.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_tmpy_94gr.png"" />"
"<img src=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00_Q_3.svg""
c=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00__3.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_source_svg.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_tmpy_94gr.png"" />"
"<img src=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00_Q_4.svg""
c=""2ecc1e332d7fe4799f7aa6349aecdaf34a922f00__4.svg"" />"
1e332d7fe4799f7aa6349aecdaf34a922f00_source_svg.svg"" />"

/>"
"<img sr
"<img src=""a049
"<img src=""a049
/>"
"<img sr
"<img src=""a049
"<img src=""a049
/>"
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31d291932822463869049fd7a10c48d9e54d_source_svg.svg"" />"
31d291932822463869049fd7a10c48d9e54d_tmpeuus.png"" />"
"<img src=""0e7931d291932822463869049fd7a10c48d9e54d_Q_2.svg""
c=""0e7931d291932822463869049fd7a10c48d9e54d__2.svg"" />"
31d291932822463869049fd7a10c48d9e54d_source_svg.svg"" />"
31d291932822463869049fd7a10c48d9e54d_tmpeuus.png"" />"
"<img src=""0e7931d291932822463869049fd7a10c48d9e54d_Q_3.svg""
c=""0e7931d291932822463869049fd7a10c48d9e54d__3.svg"" />"
31d291932822463869049fd7a10c48d9e54d_source_svg.svg"" />"
31d291932822463869049fd7a10c48d9e54d_tmpeuus.png"" />"
"<img src=""0e7931d291932822463869049fd7a10c48d9e54d_Q_4.svg""
c=""0e7931d291932822463869049fd7a10c48d9e54d__4.svg"" />"
31d291932822463869049fd7a10c48d9e54d_source_svg.svg"" />"
31d291932822463869049fd7a10c48d9e54d_tmpeuus.png"" />"
"<img src=""08a00f3047e382c069757e97085e0cf0c26981f_Q_0.svg""
c=""08a00f3047e382c069757e97085e0cf0c26981f__0.svg"" />"
0f3047e382c069757e97085e0cf0c26981f_source_svg.svg"" />"
0f3047e382c069757e97085e0cf0c26981f_Screen Shot 2013-10-22 at
/>"
"<img src=""08a00f3047e382c069757e97085e0cf0c26981f_Q_1.svg""
c=""08a00f3047e382c069757e97085e0cf0c26981f__1.svg"" />"
0f3047e382c069757e97085e0cf0c26981f_source_svg.svg"" />"
0f3047e382c069757e97085e0cf0c26981f_Screen Shot 2013-10-22 at
/>"
"<img src=""08a00f3047e382c069757e97085e0cf0c26981f_Q_2.svg""
c=""08a00f3047e382c069757e97085e0cf0c26981f__2.svg"" />"
0f3047e382c069757e97085e0cf0c26981f_source_svg.svg"" />"
0f3047e382c069757e97085e0cf0c26981f_Screen Shot 2013-10-22 at
/>"

/>"
"<img sr
"<img src=""8243
"<img src=""8243
/>"
"<img sr
"<img src=""8243
"<img src=""8243
/>"
"<img sr
"<img src=""8243
"<img src=""8243
/>"
"<img sr
"<img src=""8243
"<img src=""8243
/>"
"<img sr
"<img src=""8243
"<img src=""8243
/>"
"<img sr
"<img src=""8243
"<img src=""8243
/>"
"<img sr
"<img src=""0e79
"<img src=""0e79
/>"
"<img sr
"<img src=""0e79
"<img src=""0e79
/>"
"<img sr
"<img src=""0e79
"<img src=""0e79
/>"
"<img sr
"<img src=""0e79
"<img src=""0e79
/>"
"<img sr
"<img src=""0e79
"<img src=""0e79
/>"
"<img sr
"<img src=""08a0
"<img src=""08a0
11.07.50 PM.png""
/>"
"<img sr
"<img src=""08a0
"<img src=""08a0
11.07.50 PM.png""
/>"
"<img sr
"<img src=""08a0
"<img src=""08a0
11.07.50 PM.png""

"<img src=""08a00f3047e382c069757e97085e0cf0c26981f_Q_3.svg"" />"

"<img sr
c=""08a00f3047e382c069757e97085e0cf0c26981f__3.svg"" />"
"<img src=""08a0
0f3047e382c069757e97085e0cf0c26981f_source_svg.svg"" />"
"<img src=""08a0
0f3047e382c069757e97085e0cf0c26981f_Screen Shot 2013-10-22 at 11.07.50 PM.png""
/>"
"<img src=""08a00f3047e382c069757e97085e0cf0c26981f_Q_4.svg"" />"
"<img sr
c=""08a00f3047e382c069757e97085e0cf0c26981f__4.svg"" />"
"<img src=""08a0
0f3047e382c069757e97085e0cf0c26981f_source_svg.svg"" />"
"<img src=""08a0
0f3047e382c069757e97085e0cf0c26981f_Screen Shot 2013-10-22 at 11.07.50 PM.png""
/>"
"<img src=""d99d94ea62e6789c663eff03f6af7629dcc2e_Q_0.svg"" />"
"<img sr
c=""d99d94ea62e6789c663eff03f6af7629dcc2e__0.svg"" />"
"<img src=""d99d
94ea62e6789c663eff03f6af7629dcc2e_source_svg.svg"" />"
"<img src=""d99d
94ea62e6789c663eff03f6af7629dcc2e_Screen Shot 2013-10-22 at 11.08.36 PM.png""
/>"
"<img src=""d99d94ea62e6789c663eff03f6af7629dcc2e_Q_1.svg"" />"
"<img sr
c=""d99d94ea62e6789c663eff03f6af7629dcc2e__1.svg"" />"
"<img src=""d99d
94ea62e6789c663eff03f6af7629dcc2e_source_svg.svg"" />"
"<img src=""d99d
94ea62e6789c663eff03f6af7629dcc2e_Screen Shot 2013-10-22 at 11.08.36 PM.png""
/>"
"<img src=""7f560a26a2915a3ce29f1cf10e4991c22d513_Q_0.svg"" />"
"<img sr
c=""7f560a26a2915a3ce29f1cf10e4991c22d513__0.svg"" />"
"<img src=""7f5
60a26a2915a3ce29f1cf10e4991c22d513_source_svg.svg"" />"
"<img src=""7f5
60a26a2915a3ce29f1cf10e4991c22d513_Screen Shot 2013-11-18 at 10.02.41 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""7f560a26a2915a3ce29f1cf10e4991c22d513_Q_1.svg"" />"
"<img sr
c=""7f560a26a2915a3ce29f1cf10e4991c22d513__1.svg"" />"
"<img src=""7f5
60a26a2915a3ce29f1cf10e4991c22d513_source_svg.svg"" />"
"<img src=""7f5
60a26a2915a3ce29f1cf10e4991c22d513_Screen Shot 2013-11-18 at 10.02.41 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""7f560a26a2915a3ce29f1cf10e4991c22d513_Q_2.svg"" />"
"<img sr
c=""7f560a26a2915a3ce29f1cf10e4991c22d513__2.svg"" />"
"<img src=""7f5
60a26a2915a3ce29f1cf10e4991c22d513_source_svg.svg"" />"
"<img src=""7f5
60a26a2915a3ce29f1cf10e4991c22d513_Screen Shot 2013-11-18 at 10.02.41 M.jpg""
natomy_Block3 lock3
/>"
Define ischioanal fossa "Large fascia-lined wedge shaped space located etween s
kin and anal region/pelvic diaphragm<div><div><img src=""Screen Shot 2013-11-18
at 2.48.18 PM.jpg"" /></div></div><div><img src=""Screen Shot 2013-11-18 at 2.55
.35 PM.jpg"" /></div>" natomy_Block3 lock3
3 ranches of pudendal nerve? "Inferior rectal nerve, perineal nerve (superior
&amp; deep), dorsal nerve of clitoris/penis<div><r /></div><div><img src=""pud
endal.jpeg"" /></div>" natomy_Block3 lock3
Define location of alcocks canal. Contents?
<div> &nsp;Horizontal passageway
within fascia of medial surface of oturator internus</div><div> &nsp;Below the
tendinous arch of levator ani</div><div> &nsp;Contains internal pudendal artery
/vein and pudendal nerve</div> natomy_Block3 lock3
"<img src=""18c1decf2c0c0a792f4d31e61a2448fcc40e128_Q_0.svg"" />"
"<img sr
c=""18c1decf2c0c0a792f4d31e61a2448fcc40e128__0.svg"" />"
"<img src=""18c1
decf2c0c0a792f4d31e61a2448fcc40e128_source_svg.svg"" />"
"<img src=""18c1
decf2c0c0a792f4d31e61a2448fcc40e128_Screen Shot 2013-11-18 at 10.49.40 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""18c1decf2c0c0a792f4d31e61a2448fcc40e128_Q_1.svg"" />"
"<img sr
c=""18c1decf2c0c0a792f4d31e61a2448fcc40e128__1.svg"" />"
"<img src=""18c1
decf2c0c0a792f4d31e61a2448fcc40e128_source_svg.svg"" />"
"<img src=""18c1
decf2c0c0a792f4d31e61a2448fcc40e128_Screen Shot 2013-11-18 at 10.49.40 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""18c1decf2c0c0a792f4d31e61a2448fcc40e128_Q_2.svg"" />"
"<img sr
c=""18c1decf2c0c0a792f4d31e61a2448fcc40e128__2.svg"" />"
"<img src=""18c1
decf2c0c0a792f4d31e61a2448fcc40e128_source_svg.svg"" />"
"<img src=""18c1
decf2c0c0a792f4d31e61a2448fcc40e128_Screen Shot 2013-11-18 at 10.49.40 M.jpg""

/>"
natomy_Block3 lock3
Urogenital diaphragm is a triangular sheet of muscle composed of
"Superio
r fascia, inferior fascia (perineal memrane)<div><img src=""Screen Shot 2013-11
natomy_Block3 lock3
-18 at 3.41.42 PM.jpg"" /></div>"
Inferior fascia of UG diaphragm also called&nsp;
"perineal memrane<div><
img src=""Screen Shot 2013-11-18 at 10.51.24 M.jpg"" /></div>" natomy_Block3 
lock3
"<img src=""3c9de35c47aad74875c8ef12c467a536728ea_Q_0.svg"" />"
"<img sr
c=""3c9de35c47aad74875c8ef12c467a536728ea__0.svg"" />"
"<img src=""3c9d
"<img src=""3c9d
e35c47aad74875c8ef12c467a536728ea_source_svg.svg"" />"
e35c47aad74875c8ef12c467a536728ea_Screen Shot 2013-11-18 at 10.55.49 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""3c9de35c47aad74875c8ef12c467a536728ea_Q_1.svg"" />"
"<img sr
c=""3c9de35c47aad74875c8ef12c467a536728ea__1.svg"" />"
"<img src=""3c9d
e35c47aad74875c8ef12c467a536728ea_source_svg.svg"" />"
"<img src=""3c9d
e35c47aad74875c8ef12c467a536728ea_Screen Shot 2013-11-18 at 10.55.49 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""f0251d165d7ee75fcf5da7f0583cac3e61e37e_Q_0.svg"" />"
"<img sr
c=""f0251d165d7ee75fcf5da7f0583cac3e61e37e__0.svg"" />"
"<img src=""f025
1d165d7ee75fcf5da7f0583cac3e61e37e_source_svg.svg"" />"
"<img src=""f025
1d165d7ee75fcf5da7f0583cac3e61e37e_Screen Shot 2013-11-18 at 11.18.57 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""f0251d165d7ee75fcf5da7f0583cac3e61e37e_Q_1.svg"" />"
"<img sr
c=""f0251d165d7ee75fcf5da7f0583cac3e61e37e__1.svg"" />"
"<img src=""f025
1d165d7ee75fcf5da7f0583cac3e61e37e_source_svg.svg"" />"
"<img src=""f025
1d165d7ee75fcf5da7f0583cac3e61e37e_Screen Shot 2013-11-18 at 11.18.57 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""c17796f3a97802d903870c980a138c722e3e80_Q_0.svg"" />"
"<img sr
c=""c17796f3a97802d903870c980a138c722e3e80__0.svg"" />"
"<img src=""c17
796f3a97802d903870c980a138c722e3e80_source_svg.svg"" />"
"<img src=""c17
796f3a97802d903870c980a138c722e3e80_Screen Shot 2013-11-18 at 11.19.29 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""c17796f3a97802d903870c980a138c722e3e80_Q_1.svg"" />"
"<img sr
c=""c17796f3a97802d903870c980a138c722e3e80__1.svg"" />"
"<img src=""c17
796f3a97802d903870c980a138c722e3e80_source_svg.svg"" />"
"<img src=""c17
796f3a97802d903870c980a138c722e3e80_Screen Shot 2013-11-18 at 11.19.29 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""9617a891546a24c16c797c22c6c47d292667_Q_0.svg"" />"
"<img sr
c=""9617a891546a24c16c797c22c6c47d292667__0.svg"" />"
"<img src=""9617
a891546a24c16c797c22c6c47d292667_source_svg.svg"" />"
"<img src=""9617
a891546a24c16c797c22c6c47d292667_Screen Shot 2013-11-18 at 11.20.40 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""9617a891546a24c16c797c22c6c47d292667_Q_1.svg"" />"
"<img sr
c=""9617a891546a24c16c797c22c6c47d292667__1.svg"" />"
"<img src=""9617
a891546a24c16c797c22c6c47d292667_source_svg.svg"" />"
"<img src=""9617
a891546a24c16c797c22c6c47d292667_Screen Shot 2013-11-18 at 11.20.40 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""9617a891546a24c16c797c22c6c47d292667_Q_2.svg"" />"
"<img sr
c=""9617a891546a24c16c797c22c6c47d292667__2.svg"" /><div><img src=""penis c
ross section.jpeg"" /></div>" "<img src=""9617a891546a24c16c797c22c6c47d29
2667_source_svg.svg"" />"
"<img src=""9617a891546a24c16c797c22c6c47d29
natomy_
2667_Screen Shot 2013-11-18 at 11.20.40 M.jpg"" />"
Block3 lock3
"<img src=""9617a891546a24c16c797c22c6c47d292667_Q_4.svg"" />"
"<img sr
c=""9617a891546a24c16c797c22c6c47d292667__4.svg"" />"
"<img src=""9617
a891546a24c16c797c22c6c47d292667_source_svg.svg"" />"
"<img src=""9617
a891546a24c16c797c22c6c47d292667_Screen Shot 2013-11-18 at 11.20.40 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""9617a891546a24c16c797c22c6c47d292667_Q_5.svg"" />"
"<img sr
c=""9617a891546a24c16c797c22c6c47d292667__5.svg"" />"
"<img src=""9617

a891546a24c16c797c22c6c47d292667_source_svg.svg"" />"
a891546a24c16c797c22c6c47d292667_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""2459028866144f56eec64752e0e33660f7a_Q_0.svg""
c=""2459028866144f56eec64752e0e33660f7a__0.svg"" />"
028866144f56eec64752e0e33660f7a_source_svg.svg"" />"
028866144f56eec64752e0e33660f7a_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""2459028866144f56eec64752e0e33660f7a_Q_1.svg""
c=""2459028866144f56eec64752e0e33660f7a__1.svg"" />"
028866144f56eec64752e0e33660f7a_source_svg.svg"" />"
028866144f56eec64752e0e33660f7a_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""2459028866144f56eec64752e0e33660f7a_Q_2.svg""
c=""2459028866144f56eec64752e0e33660f7a__2.svg"" />"
028866144f56eec64752e0e33660f7a_source_svg.svg"" />"
028866144f56eec64752e0e33660f7a_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""2459028866144f56eec64752e0e33660f7a_Q_3.svg""
c=""2459028866144f56eec64752e0e33660f7a__3.svg"" />"
028866144f56eec64752e0e33660f7a_source_svg.svg"" />"
028866144f56eec64752e0e33660f7a_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""2459028866144f56eec64752e0e33660f7a_Q_4.svg""
c=""2459028866144f56eec64752e0e33660f7a__4.svg"" />"
028866144f56eec64752e0e33660f7a_source_svg.svg"" />"
028866144f56eec64752e0e33660f7a_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""65fc6d4e1ae94277407e7fdafc2a0c1698_Q_0.svg""
c=""65fc6d4e1ae94277407e7fdafc2a0c1698__0.svg"" />"
c6d4e1ae94277407e7fdafc2a0c1698_source_svg.svg"" />"
c6d4e1ae94277407e7fdafc2a0c1698_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""65fc6d4e1ae94277407e7fdafc2a0c1698_Q_1.svg""
c=""65fc6d4e1ae94277407e7fdafc2a0c1698__1.svg"" />"
c6d4e1ae94277407e7fdafc2a0c1698_source_svg.svg"" />"
c6d4e1ae94277407e7fdafc2a0c1698_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""d3f0ccce1fc7ae848e48cac7917458556d14a9c1_Q_2.svg""
c=""d3f0ccce1fc7ae848e48cac7917458556d14a9c1__2.svg"" />"
ccce1fc7ae848e48cac7917458556d14a9c1_source_svg.svg"" />"
ccce1fc7ae848e48cac7917458556d14a9c1_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""d3f0ccce1fc7ae848e48cac7917458556d14a9c1_Q_3.svg""
c=""d3f0ccce1fc7ae848e48cac7917458556d14a9c1__3.svg"" />"
ccce1fc7ae848e48cac7917458556d14a9c1_source_svg.svg"" />"
ccce1fc7ae848e48cac7917458556d14a9c1_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""fe734fd143d6f2887360c0afc65dc1d290888_Q_3.svg""
c=""fe734fd143d6f2887360c0afc65dc1d290888__3.svg"" />"
34fd143d6f2887360c0afc65dc1d290888_source_svg.svg"" />"
34fd143d6f2887360c0afc65dc1d290888_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""fe734fd143d6f2887360c0afc65dc1d290888_Q_7.svg""
c=""fe734fd143d6f2887360c0afc65dc1d290888__7.svg"" />"
34fd143d6f2887360c0afc65dc1d290888_source_svg.svg"" />"
34fd143d6f2887360c0afc65dc1d290888_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""a1efc4506c025433e4e4112e233990adaf4cc_Q_0.svg""
c=""a1efc4506c025433e4e4112e233990adaf4cc__0.svg"" />"

"<img src=""9617
11.20.40 M.jpg""
/>"
"<img sr
"<img src=""2459
"<img src=""2459
11.22.43 M.jpg""
/>"
"<img sr
"<img src=""2459
"<img src=""2459
11.22.43 M.jpg""
/>"
"<img sr
"<img src=""2459
"<img src=""2459
11.22.43 M.jpg""
/>"
"<img sr
"<img src=""2459
"<img src=""2459
11.22.43 M.jpg""
/>"
"<img sr
"<img src=""2459
"<img src=""2459
11.22.43 M.jpg""
/>"
"<img sr
"<img src=""65f
"<img src=""65f
11.27.07 M.jpg""
/>"
"<img sr
"<img src=""65f
"<img src=""65f
11.27.07 M.jpg""
/>"
"<img sr
"<img src=""d3f0
"<img src=""d3f0
11.29.42 M.jpg""
/>"
"<img sr
"<img src=""d3f0
"<img src=""d3f0
11.29.42 M.jpg""
/>"
"<img sr
"<img src=""fe7
"<img src=""fe7
11.30.19 M.jpg""
/>"
"<img sr
"<img src=""fe7
"<img src=""fe7
11.30.19 M.jpg""
/>"
"<img sr
"<img src=""a1ef

c4506c025433e4e4112e233990adaf4cc_source_svg.svg"" />"
c4506c025433e4e4112e233990adaf4cc_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""a1efc4506c025433e4e4112e233990adaf4cc_Q_1.svg""
c=""a1efc4506c025433e4e4112e233990adaf4cc__1.svg"" />"
c4506c025433e4e4112e233990adaf4cc_source_svg.svg"" />"
c4506c025433e4e4112e233990adaf4cc_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""a1efc4506c025433e4e4112e233990adaf4cc_Q_2.svg""
c=""a1efc4506c025433e4e4112e233990adaf4cc__2.svg"" />"
c4506c025433e4e4112e233990adaf4cc_source_svg.svg"" />"
c4506c025433e4e4112e233990adaf4cc_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""103c1ef805c943de974fc7448ce190ef170_Q_0.svg""
c=""103c1ef805c943de974fc7448ce190ef170__0.svg"" />"
c1ef805c943de974fc7448ce190ef170_source_svg.svg"" />"
c1ef805c943de974fc7448ce190ef170_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""103c1ef805c943de974fc7448ce190ef170_Q_1.svg""
c=""103c1ef805c943de974fc7448ce190ef170__1.svg"" />"
c1ef805c943de974fc7448ce190ef170_source_svg.svg"" />"
c1ef805c943de974fc7448ce190ef170_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""103c1ef805c943de974fc7448ce190ef170_Q_2.svg""
c=""103c1ef805c943de974fc7448ce190ef170__2.svg"" />"
c1ef805c943de974fc7448ce190ef170_source_svg.svg"" />"
c1ef805c943de974fc7448ce190ef170_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_0.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__0.svg"" />"
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_1.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__1.svg"" />"
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_2.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__2.svg"" />"
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_3.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__3.svg"" />"
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at
natomy_Block3 lock3
/>"
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_4.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__4.svg"" />"
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_5.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__5.svg"" />"
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at
/>"
natomy_Block3 lock3
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_6.svg""
c=""07c89e35ed91950f8a80960a559e92f73806__6.svg"" />"

"<img src=""a1ef
11.35.19 M.jpg""
/>"
"<img sr
"<img src=""a1ef
"<img src=""a1ef
11.35.19 M.jpg""
/>"
"<img sr
"<img src=""a1ef
"<img src=""a1ef
11.35.19 M.jpg""
/>"
"<img sr
"<img src=""103
"<img src=""103
11.39.24 M.jpg""
/>"
"<img sr
"<img src=""103
"<img src=""103
11.39.24 M.jpg""
/>"
"<img sr
"<img src=""103
"<img src=""103
11.39.24 M.jpg""
/>"
"<img sr
"<img src=""07c
"<img src=""07c
11.40.48 M.jpg""
/>"
"<img sr
"<img src=""07c
"<img src=""07c
11.40.48 M.jpg""
/>"
"<img sr
"<img src=""07c
"<img src=""07c
11.40.48 M.jpg""
/>"
"<img sr
"<img src=""07c
"<img src=""07c
11.40.48 M.jpg""
/>"
"<img sr
"<img src=""07c
"<img src=""07c
11.40.48 M.jpg""
/>"
"<img sr
"<img src=""07c
"<img src=""07c
11.40.48 M.jpg""
/>"
"<img sr
"<img src=""07c

89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at 11.40.48 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_7.svg"" />"
"<img sr
c=""07c89e35ed91950f8a80960a559e92f73806__7.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at 11.40.48 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_8.svg"" />"
"<img sr
c=""07c89e35ed91950f8a80960a559e92f73806__8.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at 11.40.48 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_9.svg"" />"
"<img sr
c=""07c89e35ed91950f8a80960a559e92f73806__9.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at 11.40.48 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""07c89e35ed91950f8a80960a559e92f73806_Q_10.svg"" />"
"<img sr
c=""07c89e35ed91950f8a80960a559e92f73806__10.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_source_svg.svg"" />"
"<img src=""07c
89e35ed91950f8a80960a559e92f73806_Screen Shot 2013-11-18 at 11.40.48 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""dcfec564a49d760ee72745271355f8950c96f3_Q_0.svg"" />"
"<img sr
c=""dcfec564a49d760ee72745271355f8950c96f3__0.svg"" />"
"<img src=""dcfe
c564a49d760ee72745271355f8950c96f3_source_svg.svg"" />"
"<img src=""dcfe
c564a49d760ee72745271355f8950c96f3_Screen Shot 2013-11-18 at 11.49.53 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""dcfec564a49d760ee72745271355f8950c96f3_Q_1.svg"" />"
"<img sr
c=""dcfec564a49d760ee72745271355f8950c96f3__1.svg"" />"
"<img src=""dcfe
c564a49d760ee72745271355f8950c96f3_source_svg.svg"" />"
"<img src=""dcfe
c564a49d760ee72745271355f8950c96f3_Screen Shot 2013-11-18 at 11.49.53 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""2a8ac06ff01953f2c8999d79220a3aad624c222_Q_0.svg"" />"
"<img sr
c=""2a8ac06ff01953f2c8999d79220a3aad624c222__0.svg"" />"
"<img src=""2a8a
c06ff01953f2c8999d79220a3aad624c222_source_svg.svg"" />"
"<img src=""2a8a
c06ff01953f2c8999d79220a3aad624c222_Screen Shot 2013-11-18 at 11.50.39 M.jpg""
/>"
natomy_Block3 lock3
"<img src=""2a8ac06ff01953f2c8999d79220a3aad624c222_Q_1.svg"" />"
"<img sr
c=""2a8ac06ff01953f2c8999d79220a3aad624c222__1.svg"" />"
"<img src=""2a8a
c06ff01953f2c8999d79220a3aad624c222_source_svg.svg"" />"
"<img src=""2a8a
c06ff01953f2c8999d79220a3aad624c222_Screen Shot 2013-11-18 at 11.50.39 M.jpg""
natomy_Block3 lock3
/>"
"<img src=""2a8ac06ff01953f2c8999d79220a3aad624c222_Q_2.svg"" />"
"<img sr
c=""2a8ac06ff01953f2c8999d79220a3aad624c222__2.svg"" />"
"<img src=""2a8a
c06ff01953f2c8999d79220a3aad624c222_source_svg.svg"" />"
"<img src=""2a8a
c06ff01953f2c8999d79220a3aad624c222_Screen Shot 2013-11-18 at 11.50.39 M.jpg""
natomy_Block3 lock3
/>"
Branches of internal pudendal artery? "<div>Inferior rectal artery, Perineal a
rtery,&nsp;Dorsal arteries of the penis/clitoris</div><div><r /></div><div><im
natomy_Block3
g src=""Screen Shot 2013-11-18 at 3.33.16 PM.jpg"" /></div>"
Contents of alcocks (pudendal) canal "internal pudendal artery/vein and puden
dal nerve<div><r /><div><img src=""Screen Shot 2013-11-18 at 9.13.47 PM.jpg"" /
></div></div>" natomy_Block3
Where is alcocks canal "Within fascia of medial surface of oturator interus, 
elow tendinous arch of levator ani<div><r /><div><img src=""Screen Shot 2013-11
-18 at 9.13.47 PM.jpg"" /></div></div>" natomy_Block3
Detrusor muscle is under control of what?
Parasympathetic y pelvic splanc
natomy_Block3 lock3
hnics&nsp;
What encloses 3 openings of the ladder?
"Trigone (2 for ureters, 1 for u

rethra)<div><img src=""coronal pelvis.jpeg"" /></div>" natomy_Block3 lock3

What is the innervation of the ladder (and 2 places)? "<div>Trigone sympatheti
cally innervated; rest of ladder parasympathetic&nsp;</div><div><img src=""ant
pros.jpeg"" /></div>" natomy_Block3 lock3
What are 3 structures palpale in the lateral fornix? Ischial spine, uterine a
rtery, ureter natomy_Block3 lock3
Lypmh from fundus of uterus drains into what? Helpful for what diagnosis?
"Superficial inguinal lymph nodes; uterine cancer can e easily detected here<di
v><img src=""sup ing lym.jpeg"" /></div>"
natomy_Block3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_0.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__0.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_1.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__1.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_2.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__2.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_3.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__3.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_4.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__4.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_5.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__5.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_6.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__6.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_7.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__7.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_8.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__8.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""02c97ca0dc488c1641df06e6a950117c715cd_Q_9.svg"" />"
"<img sr
c=""02c97ca0dc488c1641df06e6a950117c715cd__9.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_source_svg.svg"" />"
"<img src=""02c9
7ca0dc488c1641df06e6a950117c715cd_vessels uterus.jpeg"" />"
natomy_Block3 lock3
"<img src=""58edfac3ef53408d0a50fa29a38e41e6a32eec52_Q_0.svg"" />"
"<img sr

c=""58edfac3ef53408d0a50fa29a38e41e6a32eec52__0.svg"" />"
"<img src=""58ed
fac3ef53408d0a50fa29a38e41e6a32eec52_source_svg.svg"" />"
"<img src=""58ed
fac3ef53408d0a50fa29a38e41e6a32eec52_prolapse.jpeg"" />"
natomy_Block3 lock3
"<img src=""58edfac3ef53408d0a50fa29a38e41e6a32eec52_Q_1.svg"" />"
"<img sr
c=""58edfac3ef53408d0a50fa29a38e41e6a32eec52__1.svg"" />"
"<img src=""58ed
fac3ef53408d0a50fa29a38e41e6a32eec52_source_svg.svg"" />"
"<img src=""58ed
fac3ef53408d0a50fa29a38e41e6a32eec52_prolapse.jpeg"" />"
natomy_Block3 lock3
"<img src=""58edfac3ef53408d0a50fa29a38e41e6a32eec52_Q_2.svg"" />"
"<img sr
c=""58edfac3ef53408d0a50fa29a38e41e6a32eec52__2.svg"" />"
"<img src=""58ed
fac3ef53408d0a50fa29a38e41e6a32eec52_source_svg.svg"" />"
"<img src=""58ed
fac3ef53408d0a50fa29a38e41e6a32eec52_prolapse.jpeg"" />"
natomy_Block3 lock3
Coccygeus runs anteriorly to what?
"Sacrospinous ligament<div><img src=""co
ccygeus.jpeg"" /></div><div><img src=""sacrosp.jpeg"" /></div>" natomy_Block3 
lock3
Q: What enzyme does allopurinol inhiit?
": xanthine oxidasethis allows t
he more solule xanthine/hypoxanthine to accumulate instead of the uric acid<div
><img src=""GOUT.jpeg"" /></div>"
Block3
"<img src=""0ef9e218d171fa83115a10d8f01481d9561a8_Q_2.svg"" />"
"<img sr
c=""0ef9e218d171fa83115a10d8f01481d9561a8__2.svg"" />"
"<img src=""0ef
9e218d171fa83115a10d8f01481d9561a8_source_svg.svg"" />"
"<img src=""0ef
9e218d171fa83115a10d8f01481d9561a8_lymph nodes female.jpeg"" />"
natomy_Block3 lock3
"<img src=""0ef9e218d171fa83115a10d8f01481d9561a8_Q_3.svg"" />"
"<img sr
c=""0ef9e218d171fa83115a10d8f01481d9561a8__3.svg"" />"
"<img src=""0ef
9e218d171fa83115a10d8f01481d9561a8_source_svg.svg"" />"
"<img src=""0ef
9e218d171fa83115a10d8f01481d9561a8_lymph nodes female.jpeg"" />"
natomy_Block3 lock3
"<img src=""0ef9e218d171fa83115a10d8f01481d9561a8_Q_4.svg"" />"
"<img sr
c=""0ef9e218d171fa83115a10d8f01481d9561a8__4.svg"" />"
"<img src=""0ef
9e218d171fa83115a10d8f01481d9561a8_source_svg.svg"" />"
"<img src=""0ef
9e218d171fa83115a10d8f01481d9561a8_lymph nodes female.jpeg"" />"
natomy_Block3 lock3
Descrie the lymphatic drainage aove and elow pectinate line "ove- to inter
nal iliac lymph nodes<div>Below- to superficial inguinal lymph nodes</div><div><
img src=""pectinate.jpeg"" /></div>"
natomy_Block3 lock3
What are the affects of sympathetic/parasympathetic innervation to the S node?
Increase/decrease HR
"<img src=""065c04124589f8502f68a2404049795773a52e_Q_0.svg"" />"
"<img sr
c=""065c04124589f8502f68a2404049795773a52e__0.svg"" />"
"<img src=""065c
04124589f8502f68a2404049795773a52e_source_svg.svg"" />"
"<img src=""065c
04124589f8502f68a2404049795773a52e_tmp23gej5.png"" />"
"<img src=""065c04124589f8502f68a2404049795773a52e_Q_1.svg"" />"
"<img sr
c=""065c04124589f8502f68a2404049795773a52e__1.svg"" />"
"<img src=""065c
04124589f8502f68a2404049795773a52e_source_svg.svg"" />"
"<img src=""065c
04124589f8502f68a2404049795773a52e_tmp23gej5.png"" />"
"<img src=""065c04124589f8502f68a2404049795773a52e_Q_2.svg"" />"
"<img sr
c=""065c04124589f8502f68a2404049795773a52e__2.svg"" />"
"<img src=""065c
04124589f8502f68a2404049795773a52e_source_svg.svg"" />"
"<img src=""065c
04124589f8502f68a2404049795773a52e_tmp23gej5.png"" />"
"<img src=""401c49c1d457fd4e8521fada481d7f4395cf0_Q_0.svg"" />"
"<img sr
c=""401c49c1d457fd4e8521fada481d7f4395cf0__0.svg"" />"
"<img src=""401c
49c1d457fd4e8521fada481d7f4395cf0_source_svg.svg"" />"
"<img src=""401c
49c1d457fd4e8521fada481d7f4395cf0_tmpkjandc.png"" />"
"<img src=""401c49c1d457fd4e8521fada481d7f4395cf0_Q_1.svg"" />"
"<img sr
c=""401c49c1d457fd4e8521fada481d7f4395cf0__1.svg"" />"
"<img src=""401c
49c1d457fd4e8521fada481d7f4395cf0_source_svg.svg"" />"
"<img src=""401c
49c1d457fd4e8521fada481d7f4395cf0_tmpkjandc.png"" />"

"<img src=""401c49c1d457fd4e8521fada481d7f4395cf0_Q_2.svg""
c=""401c49c1d457fd4e8521fada481d7f4395cf0__2.svg"" />"
49c1d457fd4e8521fada481d7f4395cf0_source_svg.svg"" />"
49c1d457fd4e8521fada481d7f4395cf0_tmpkjandc.png"" />"
"<img src=""401c49c1d457fd4e8521fada481d7f4395cf0_Q_3.svg""
c=""401c49c1d457fd4e8521fada481d7f4395cf0__3.svg"" />"
49c1d457fd4e8521fada481d7f4395cf0_source_svg.svg"" />"
49c1d457fd4e8521fada481d7f4395cf0_tmpkjandc.png"" />"
"<img src=""401c49c1d457fd4e8521fada481d7f4395cf0_Q_4.svg""
c=""401c49c1d457fd4e8521fada481d7f4395cf0__4.svg"" />"
49c1d457fd4e8521fada481d7f4395cf0_source_svg.svg"" />"
49c1d457fd4e8521fada481d7f4395cf0_tmpkjandc.png"" />"
"<img src=""5ed1ec68e7a88687c99d6506213d122214fd972_Q_0.svg""
c=""5ed1ec68e7a88687c99d6506213d122214fd972__0.svg"" />"
ec68e7a88687c99d6506213d122214fd972_source_svg.svg"" />"
ec68e7a88687c99d6506213d122214fd972_tmp1_4vsk.png"" />"
"<img src=""5ed1ec68e7a88687c99d6506213d122214fd972_Q_1.svg""
c=""5ed1ec68e7a88687c99d6506213d122214fd972__1.svg"" />"
ec68e7a88687c99d6506213d122214fd972_source_svg.svg"" />"
ec68e7a88687c99d6506213d122214fd972_tmp1_4vsk.png"" />"
"<img src=""5ed1ec68e7a88687c99d6506213d122214fd972_Q_2.svg""
c=""5ed1ec68e7a88687c99d6506213d122214fd972__2.svg"" />"
ec68e7a88687c99d6506213d122214fd972_source_svg.svg"" />"
ec68e7a88687c99d6506213d122214fd972_tmp1_4vsk.png"" />"
"<img src=""5ed1ec68e7a88687c99d6506213d122214fd972_Q_3.svg""
c=""5ed1ec68e7a88687c99d6506213d122214fd972__3.svg"" />"
ec68e7a88687c99d6506213d122214fd972_source_svg.svg"" />"
ec68e7a88687c99d6506213d122214fd972_tmp1_4vsk.png"" />"
"<img src=""ead8997e9f36d4a11a7778127492e7fae6_Q_0.svg""
c=""ead8997e9f36d4a11a7778127492e7fae6__0.svg"" />"
997e9f36d4a11a7778127492e7fae6_source_svg.svg"" />"
997e9f36d4a11a7778127492e7fae6_tmpqy2an1.png"" />"
"<img src=""ead8997e9f36d4a11a7778127492e7fae6_Q_1.svg""
c=""ead8997e9f36d4a11a7778127492e7fae6__1.svg"" />"
997e9f36d4a11a7778127492e7fae6_source_svg.svg"" />"
997e9f36d4a11a7778127492e7fae6_tmpqy2an1.png"" />"
"<img src=""ead8997e9f36d4a11a7778127492e7fae6_Q_2.svg""
c=""ead8997e9f36d4a11a7778127492e7fae6__2.svg"" />"
997e9f36d4a11a7778127492e7fae6_source_svg.svg"" />"
997e9f36d4a11a7778127492e7fae6_tmpqy2an1.png"" />"
"<img src=""ead8997e9f36d4a11a7778127492e7fae6_Q_3.svg""
c=""ead8997e9f36d4a11a7778127492e7fae6__3.svg"" />"
997e9f36d4a11a7778127492e7fae6_source_svg.svg"" />"
997e9f36d4a11a7778127492e7fae6_tmpqy2an1.png"" />"
"<img src=""986991f8d2f86e00d2ca09443ffd661558e_Q_0.svg""
c=""986991f8d2f86e00d2ca09443ffd661558e__0.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_source_svg.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_tmptwv8d7.png"" />"
"<img src=""986991f8d2f86e00d2ca09443ffd661558e_Q_1.svg""
c=""986991f8d2f86e00d2ca09443ffd661558e__1.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_source_svg.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_tmptwv8d7.png"" />"
"<img src=""986991f8d2f86e00d2ca09443ffd661558e_Q_2.svg""
c=""986991f8d2f86e00d2ca09443ffd661558e__2.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_source_svg.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_tmptwv8d7.png"" />"
"<img src=""986991f8d2f86e00d2ca09443ffd661558e_Q_3.svg""
c=""986991f8d2f86e00d2ca09443ffd661558e__3.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_source_svg.svg"" />"
991f8d2f86e00d2ca09443ffd661558e_tmptwv8d7.png"" />"

/>"
"<img sr
"<img src=""401c
"<img src=""401c
/>"
"<img sr
"<img src=""401c
"<img src=""401c
/>"
"<img sr
"<img src=""401c
"<img src=""401c
/>"
"<img sr
"<img src=""5ed1
"<img src=""5ed1
/>"
"<img sr
"<img src=""5ed1
"<img src=""5ed1
/>"
"<img sr
"<img src=""5ed1
"<img src=""5ed1
/>"
"<img sr
"<img src=""5ed1
"<img src=""5ed1
/>"
"<img sr
"<img src=""ead8
"<img src=""ead8
/>"
"<img sr
"<img src=""ead8
"<img src=""ead8
/>"
"<img sr
"<img src=""ead8
"<img src=""ead8
/>"
"<img sr
"<img src=""ead8
"<img src=""ead8
/>"
"<img sr
"<img src=""986
"<img src=""986
/>"
"<img sr
"<img src=""986
"<img src=""986
/>"
"<img sr
"<img src=""986
"<img src=""986
/>"
"<img sr
"<img src=""986
"<img src=""986

Whats the space just superior to the semilunar valves of the pulmonic
valve called? The sinus of valsalva (good luck finding it on xray)
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_0.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__0.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_1.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__1.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_2.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__2.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_3.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__3.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_4.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__4.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_5.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__5.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""f8aa8809c80248276f9c667a1c27590c96_Q_6.svg"" />"
c=""f8aa8809c80248276f9c667a1c27590c96__6.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_source_svg.svg"" />"
"<img
8809c80248276f9c667a1c27590c96_tmprlh3wp.png"" />"
"<img src=""cae96ec336500115655d3e4a3ac79ee70dc5_Q_0.svg"" />"
c=""cae96ec336500115655d3e4a3ac79ee70dc5__0.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_source_svg.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_tmpazrzd4.png"" />"
"<img src=""cae96ec336500115655d3e4a3ac79ee70dc5_Q_1.svg"" />"
c=""cae96ec336500115655d3e4a3ac79ee70dc5__1.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_source_svg.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_tmpazrzd4.png"" />"
"<img src=""cae96ec336500115655d3e4a3ac79ee70dc5_Q_2.svg"" />"
c=""cae96ec336500115655d3e4a3ac79ee70dc5__2.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_source_svg.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_tmpazrzd4.png"" />"
"<img src=""cae96ec336500115655d3e4a3ac79ee70dc5_Q_3.svg"" />"
c=""cae96ec336500115655d3e4a3ac79ee70dc5__3.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_source_svg.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_tmpazrzd4.png"" />"
"<img src=""cae96ec336500115655d3e4a3ac79ee70dc5_Q_4.svg"" />"
c=""cae96ec336500115655d3e4a3ac79ee70dc5__4.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_source_svg.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_tmpazrzd4.png"" />"
"<img src=""cae96ec336500115655d3e4a3ac79ee70dc5_Q_5.svg"" />"
c=""cae96ec336500115655d3e4a3ac79ee70dc5__5.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_source_svg.svg"" />"
"<img
96ec336500115655d3e4a3ac79ee70dc5_tmpazrzd4.png"" />"
"<img src=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50_Q_0.svg"" />"
c=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50__0.svg"" />"
"<img
4d73f0ec9dea88d6ae6302e8ca090e87a50_source_svg.svg"" />"
"<img
4d73f0ec9dea88d6ae6302e8ca090e87a50_tmppcfqtx.png"" />"
"<img src=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50_Q_1.svg"" />"
c=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50__1.svg"" />"
"<img

and aortic
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""f8aa
src=""f8aa
"<img sr
src=""cae
src=""cae
"<img sr
src=""cae
src=""cae
"<img sr
src=""cae
src=""cae
"<img sr
src=""cae
src=""cae
"<img sr
src=""cae
src=""cae
"<img sr
src=""cae
src=""cae
"<img sr
src=""387c
src=""387c
"<img sr
src=""387c

4d73f0ec9dea88d6ae6302e8ca090e87a50_source_svg.svg"" />"
4d73f0ec9dea88d6ae6302e8ca090e87a50_tmppcfqtx.png"" />"
"<img src=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50_Q_2.svg""
c=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50__2.svg"" />"
4d73f0ec9dea88d6ae6302e8ca090e87a50_source_svg.svg"" />"
4d73f0ec9dea88d6ae6302e8ca090e87a50_tmppcfqtx.png"" />"
"<img src=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50_Q_3.svg""
c=""387c4d73f0ec9dea88d6ae6302e8ca090e87a50__3.svg"" />"
4d73f0ec9dea88d6ae6302e8ca090e87a50_source_svg.svg"" />"
4d73f0ec9dea88d6ae6302e8ca090e87a50_tmppcfqtx.png"" />"
Whats the motor supply of the diaphragm?
Phrenic Nerve
"<img src=""8ac607f9183870710941517755542a531a04462_Q_0.svg""
c=""8ac607f9183870710941517755542a531a04462__0.svg"" />"
07f9183870710941517755542a531a04462_source_svg.svg"" />"
07f9183870710941517755542a531a04462_tmpguifai.png"" />"
"<img src=""8ac607f9183870710941517755542a531a04462_Q_1.svg""
c=""8ac607f9183870710941517755542a531a04462__1.svg"" />"
07f9183870710941517755542a531a04462_source_svg.svg"" />"
07f9183870710941517755542a531a04462_tmpguifai.png"" />"
"<img src=""8ac607f9183870710941517755542a531a04462_Q_2.svg""
c=""8ac607f9183870710941517755542a531a04462__2.svg"" />"
07f9183870710941517755542a531a04462_source_svg.svg"" />"
07f9183870710941517755542a531a04462_tmpguifai.png"" />"
"<img src=""de86d99a27466a4792f1259733936977a1fd93_Q_0.svg""
c=""de86d99a27466a4792f1259733936977a1fd93__0.svg"" />"
d99a27466a4792f1259733936977a1fd93_source_svg.svg"" />"
d99a27466a4792f1259733936977a1fd93_tmpvu2zrx.png"" />"
"<img src=""de86d99a27466a4792f1259733936977a1fd93_Q_1.svg""
c=""de86d99a27466a4792f1259733936977a1fd93__1.svg"" />"
d99a27466a4792f1259733936977a1fd93_source_svg.svg"" />"
d99a27466a4792f1259733936977a1fd93_tmpvu2zrx.png"" />"
"<img src=""de86d99a27466a4792f1259733936977a1fd93_Q_2.svg""
c=""de86d99a27466a4792f1259733936977a1fd93__2.svg"" />"
d99a27466a4792f1259733936977a1fd93_source_svg.svg"" />"
d99a27466a4792f1259733936977a1fd93_tmpvu2zrx.png"" />"
"<img src=""de86d99a27466a4792f1259733936977a1fd93_Q_3.svg""
c=""de86d99a27466a4792f1259733936977a1fd93__3.svg"" />"
d99a27466a4792f1259733936977a1fd93_source_svg.svg"" />"
d99a27466a4792f1259733936977a1fd93_tmpvu2zrx.png"" />"
"<img src=""de86d99a27466a4792f1259733936977a1fd93_Q_4.svg""
c=""de86d99a27466a4792f1259733936977a1fd93__4.svg"" />"
d99a27466a4792f1259733936977a1fd93_source_svg.svg"" />"
d99a27466a4792f1259733936977a1fd93_tmpvu2zrx.png"" />"
"<img src=""1904ce9d109339789ff2d8c8c7651410270c33_Q_0.svg""
c=""1904ce9d109339789ff2d8c8c7651410270c33__0.svg"" />"
ce9d109339789ff2d8c8c7651410270c33_source_svg.svg"" />"
ce9d109339789ff2d8c8c7651410270c33_tmphzwsjj.png"" />"
"<img src=""c64775670a17f39e100713d694f328f521e5ff20_Q_0.svg""
c=""c64775670a17f39e100713d694f328f521e5ff20__0.svg"" />"
75670a17f39e100713d694f328f521e5ff20_source_svg.svg"" />"
75670a17f39e100713d694f328f521e5ff20_tmphylarw.png"" />"
"<img src=""41387a5481f7f2822c777c54363125fa668d_Q_0.svg""
c=""41387a5481f7f2822c777c54363125fa668d__0.svg"" />"
7a5481f7f2822c777c54363125fa668d_source_svg.svg"" />"
7a5481f7f2822c777c54363125fa668d_tmp9tojlw.png"" />"
"<img src=""41387a5481f7f2822c777c54363125fa668d_Q_1.svg""
c=""41387a5481f7f2822c777c54363125fa668d__1.svg"" />"
7a5481f7f2822c777c54363125fa668d_source_svg.svg"" />"
7a5481f7f2822c777c54363125fa668d_tmp9tojlw.png"" />"
"<img src=""41387a5481f7f2822c777c54363125fa668d_Q_2.svg""

"<img src=""387c
/>"
"<img sr
"<img src=""387c
"<img src=""387c
/>"
"<img sr
"<img src=""387c
"<img src=""387c
/>"
"<img sr
"<img src=""8ac6
"<img src=""8ac6
/>"
"<img sr
"<img src=""8ac6
"<img src=""8ac6
/>"
"<img sr
"<img src=""8ac6
"<img src=""8ac6
/>"
"<img sr
"<img src=""de86
"<img src=""de86
/>"
"<img sr
"<img src=""de86
"<img src=""de86
/>"
"<img sr
"<img src=""de86
"<img src=""de86
/>"
"<img sr
"<img src=""de86
"<img src=""de86
/>"
"<img sr
"<img src=""de86
"<img src=""de86
/>"
"<img sr
"<img src=""1904
"<img src=""1904
/>"
"<img sr
"<img src=""c647
"<img src=""c647
/>"
"<img sr
"<img src=""4138
"<img src=""4138
/>"
"<img sr
"<img src=""4138
"<img src=""4138
/>"

"<img sr

c=""41387a5481f7f2822c777c54363125fa668d__2.svg"" />"
7a5481f7f2822c777c54363125fa668d_source_svg.svg"" />"
7a5481f7f2822c777c54363125fa668d_tmp9tojlw.png"" />"
"<img src=""41387a5481f7f2822c777c54363125fa668d_Q_3.svg""
c=""41387a5481f7f2822c777c54363125fa668d__3.svg"" />"
7a5481f7f2822c777c54363125fa668d_source_svg.svg"" />"
7a5481f7f2822c777c54363125fa668d_tmp9tojlw.png"" />"
"<img src=""41387a5481f7f2822c777c54363125fa668d_Q_4.svg""
c=""41387a5481f7f2822c777c54363125fa668d__4.svg"" />"
7a5481f7f2822c777c54363125fa668d_source_svg.svg"" />"
7a5481f7f2822c777c54363125fa668d_tmp9tojlw.png"" />"
"<img src=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872_Q_0.svg""
c=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872__0.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_source_svg.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_tmp7mhu89.png"" />"
"<img src=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872_Q_1.svg""
c=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872__1.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_source_svg.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_tmp7mhu89.png"" />"
"<img src=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872_Q_2.svg""
c=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872__2.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_source_svg.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_tmp7mhu89.png"" />"
"<img src=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872_Q_3.svg""
c=""7019ac0afe5c0a7f5c97f5c38c8d306f5a89872__3.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_source_svg.svg"" />"
ac0afe5c0a7f5c97f5c38c8d306f5a89872_tmp7mhu89.png"" />"
"<img src=""319487896f79e90008a21ea4f2e87a531d48_Q_0.svg""
c=""319487896f79e90008a21ea4f2e87a531d48__0.svg"" />"
87896f79e90008a21ea4f2e87a531d48_source_svg.svg"" />"
87896f79e90008a21ea4f2e87a531d48_tmp1hkhry.png"" />"
"<img src=""319487896f79e90008a21ea4f2e87a531d48_Q_1.svg""
c=""319487896f79e90008a21ea4f2e87a531d48__1.svg"" />"
87896f79e90008a21ea4f2e87a531d48_source_svg.svg"" />"
87896f79e90008a21ea4f2e87a531d48_tmp1hkhry.png"" />"
"<img src=""319487896f79e90008a21ea4f2e87a531d48_Q_2.svg""
c=""319487896f79e90008a21ea4f2e87a531d48__2.svg"" />"
87896f79e90008a21ea4f2e87a531d48_source_svg.svg"" />"
87896f79e90008a21ea4f2e87a531d48_tmp1hkhry.png"" />"
"<img src=""319487896f79e90008a21ea4f2e87a531d48_Q_3.svg""
c=""319487896f79e90008a21ea4f2e87a531d48__3.svg"" />"
87896f79e90008a21ea4f2e87a531d48_source_svg.svg"" />"
87896f79e90008a21ea4f2e87a531d48_tmp1hkhry.png"" />"
"<img src=""319487896f79e90008a21ea4f2e87a531d48_Q_4.svg""
c=""319487896f79e90008a21ea4f2e87a531d48__4.svg"" />"
87896f79e90008a21ea4f2e87a531d48_source_svg.svg"" />"
87896f79e90008a21ea4f2e87a531d48_tmp1hkhry.png"" />"
"<img src=""2f4af65a25d029d17f09ecc3a518f5eeaf34a5_Q_0.svg""
c=""2f4af65a25d029d17f09ecc3a518f5eeaf34a5__0.svg"" />"
f65a25d029d17f09ecc3a518f5eeaf34a5_source_svg.svg"" />"
f65a25d029d17f09ecc3a518f5eeaf34a5_tmp3shdk.png"" />"
"<img src=""2f4af65a25d029d17f09ecc3a518f5eeaf34a5_Q_1.svg""
c=""2f4af65a25d029d17f09ecc3a518f5eeaf34a5__1.svg"" />"
f65a25d029d17f09ecc3a518f5eeaf34a5_source_svg.svg"" />"
f65a25d029d17f09ecc3a518f5eeaf34a5_tmp3shdk.png"" />"
"<img src=""2f4af65a25d029d17f09ecc3a518f5eeaf34a5_Q_2.svg""
c=""2f4af65a25d029d17f09ecc3a518f5eeaf34a5__2.svg"" />"
f65a25d029d17f09ecc3a518f5eeaf34a5_source_svg.svg"" />"
f65a25d029d17f09ecc3a518f5eeaf34a5_tmp3shdk.png"" />"
"<img src=""9a031183f69e08a341a30c4752dd676787eed96_Q_0.svg""

"<img src=""4138
"<img src=""4138
/>"
"<img sr
"<img src=""4138
"<img src=""4138
/>"
"<img sr
"<img src=""4138
"<img src=""4138
/>"
"<img sr
"<img src=""7019
"<img src=""7019
/>"
"<img sr
"<img src=""7019
"<img src=""7019
/>"
"<img sr
"<img src=""7019
"<img src=""7019
/>"
"<img sr
"<img src=""7019
"<img src=""7019
/>"
"<img sr
"<img src=""3194
"<img src=""3194
/>"
"<img sr
"<img src=""3194
"<img src=""3194
/>"
"<img sr
"<img src=""3194
"<img src=""3194
/>"
"<img sr
"<img src=""3194
"<img src=""3194
/>"
"<img sr
"<img src=""3194
"<img src=""3194
/>"
"<img sr
"<img src=""2f4a
"<img src=""2f4a
/>"
"<img sr
"<img src=""2f4a
"<img src=""2f4a
/>"
"<img sr
"<img src=""2f4a
"<img src=""2f4a
/>"

"<img sr

c=""9a031183f69e08a341a30c4752dd676787eed96__0.svg"" />"
"<img src=""9a03
1183f69e08a341a30c4752dd676787eed96_source_svg.svg"" />"
"<img src=""9a03
1183f69e08a341a30c4752dd676787eed96_tmpxqxyxs.png"" />"
"<img src=""9a031183f69e08a341a30c4752dd676787eed96_Q_1.svg"" />"
"<img sr
c=""9a031183f69e08a341a30c4752dd676787eed96__1.svg"" />"
"<img src=""9a03
1183f69e08a341a30c4752dd676787eed96_source_svg.svg"" />"
"<img src=""9a03
1183f69e08a341a30c4752dd676787eed96_tmpxqxyxs.png"" />"
"<img src=""9a031183f69e08a341a30c4752dd676787eed96_Q_2.svg"" />"
"<img sr
c=""9a031183f69e08a341a30c4752dd676787eed96__2.svg"" />"
"<img src=""9a03
1183f69e08a341a30c4752dd676787eed96_source_svg.svg"" />"
"<img src=""9a03
1183f69e08a341a30c4752dd676787eed96_tmpxqxyxs.png"" />"
"<img src=""fa7905d7e142eca5f144de927281e1dc235c4c_Q_0.svg"" />"
"<img sr
c=""fa7905d7e142eca5f144de927281e1dc235c4c__0.svg"" />"
"<img src=""fa79
05d7e142eca5f144de927281e1dc235c4c_source_svg.svg"" />"
"<img src=""fa79
05d7e142eca5f144de927281e1dc235c4c_tmpzjs03z.png"" />"
"<img src=""fa7905d7e142eca5f144de927281e1dc235c4c_Q_1.svg"" />"
"<img sr
c=""fa7905d7e142eca5f144de927281e1dc235c4c__1.svg"" />"
"<img src=""fa79
05d7e142eca5f144de927281e1dc235c4c_source_svg.svg"" />"
"<img src=""fa79
05d7e142eca5f144de927281e1dc235c4c_tmpzjs03z.png"" />"
"<img src=""fa7905d7e142eca5f144de927281e1dc235c4c_Q_2.svg"" />"
"<img sr
c=""fa7905d7e142eca5f144de927281e1dc235c4c__2.svg"" />"
"<img src=""fa79
05d7e142eca5f144de927281e1dc235c4c_source_svg.svg"" />"
"<img src=""fa79
05d7e142eca5f144de927281e1dc235c4c_tmpzjs03z.png"" />"
Whats the sensory supply of the diaphragm?
Phrenic/ intercostal / sucostal
nerves
What spinal levels represent the phrenic nerve? C3,4,5 keep you alive
What are the surface markings of left lung?
(ris) 2 4 6 6 8 10 10
What are the surface markings of the right lung?
(ris) 2 6 6 8 10 10
What are the surface markings for the pleural cavity? (Both lungs)
Ris: 6
8 10 12 12
The horizontal fissure extends along which ri anteriorly?
"4th ri<div><im
g src=""Screen Shot 2013-12-09 at 3.38.39 PM.jpg"" /></div>"
What are the surface markings for the olique fissure? level of T2 verterae po
sterior to 6th costal cartilage anteriorly
The right lung has ___ loes, the left has ___ 3 ; 2
Whats the clever pneumonic for rememering the positioning of the right pulmonar
y artery vs. left?
RLS<div><r /></div><div>Right anterior, left superior
(in relationship to pulmonary veins and mainstem ronchi)</div>
"<img src=""41863750f188d64fa41a235dff1eae7436d155_Q_0.svg"" />"
"<img sr
c=""41863750f188d64fa41a235dff1eae7436d155__0.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_source_svg.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_tmpti1kot.png"" />"
"<img src=""41863750f188d64fa41a235dff1eae7436d155_Q_1.svg"" />"
"<img sr
c=""41863750f188d64fa41a235dff1eae7436d155__1.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_source_svg.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_tmpti1kot.png"" />"
"<img src=""41863750f188d64fa41a235dff1eae7436d155_Q_2.svg"" />"
"<img sr
c=""41863750f188d64fa41a235dff1eae7436d155__2.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_source_svg.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_tmpti1kot.png"" />"
"<img src=""41863750f188d64fa41a235dff1eae7436d155_Q_3.svg"" />"
"<img sr
c=""41863750f188d64fa41a235dff1eae7436d155__3.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_source_svg.svg"" />"
"<img src=""4186
3750f188d64fa41a235dff1eae7436d155_tmpti1kot.png"" />"
"<img src=""4f7f3e8a1248ddf853c2422e04d2547ac1da093_Q_0.svg"" />"
"<img sr
c=""4f7f3e8a1248ddf853c2422e04d2547ac1da093__0.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_source_svg.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_tmpnl0wxt.png"" />"
"<img src=""4f7f3e8a1248ddf853c2422e04d2547ac1da093_Q_1.svg"" />"
"<img sr
c=""4f7f3e8a1248ddf853c2422e04d2547ac1da093__1.svg"" />"
"<img src=""4f7f

3e8a1248ddf853c2422e04d2547ac1da093_source_svg.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_tmpnl0wxt.png"" />"
"<img src=""4f7f3e8a1248ddf853c2422e04d2547ac1da093_Q_2.svg"" />"
"<img sr
c=""4f7f3e8a1248ddf853c2422e04d2547ac1da093__2.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_source_svg.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_tmpnl0wxt.png"" />"
"<img src=""4f7f3e8a1248ddf853c2422e04d2547ac1da093_Q_3.svg"" />"
"<img sr
c=""4f7f3e8a1248ddf853c2422e04d2547ac1da093__3.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_source_svg.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_tmpnl0wxt.png"" />"
"<img src=""4f7f3e8a1248ddf853c2422e04d2547ac1da093_Q_4.svg"" />"
"<img sr
c=""4f7f3e8a1248ddf853c2422e04d2547ac1da093__4.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_source_svg.svg"" />"
"<img src=""4f7f
3e8a1248ddf853c2422e04d2547ac1da093_tmpnl0wxt.png"" />"
What does radial nerve supply? BEST<div>Brachioradialis, extensors, anconeus,
supinator, triceps</div>
Emryology of fossa ovalis
"Septum primum<div><img src=""124a - Interatrial
septum development.JPG"" /></div>"
"<img src=""13381c403adf421dac0a48e0156573c6996e53a_Q_0.svg"" />"
"<img sr
c=""13381c403adf421dac0a48e0156573c6996e53a__0.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_source_svg.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_Emryo origin heart.jpeg"" />"
"<img src=""13381c403adf421dac0a48e0156573c6996e53a_Q_1.svg"" />"
"<img sr
c=""13381c403adf421dac0a48e0156573c6996e53a__1.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_source_svg.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_Emryo origin heart.jpeg"" />"
"<img src=""13381c403adf421dac0a48e0156573c6996e53a_Q_2.svg"" />"
"<img sr
c=""13381c403adf421dac0a48e0156573c6996e53a__2.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_source_svg.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_Emryo origin heart.jpeg"" />"
"<img src=""13381c403adf421dac0a48e0156573c6996e53a_Q_3.svg"" />"
"<img sr
c=""13381c403adf421dac0a48e0156573c6996e53a__3.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_source_svg.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_Emryo origin heart.jpeg"" />"
"<img src=""13381c403adf421dac0a48e0156573c6996e53a_Q_4.svg"" />"
"<img sr
c=""13381c403adf421dac0a48e0156573c6996e53a__4.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_source_svg.svg"" />"
"<img src=""1338
1c403adf421dac0a48e0156573c6996e53a_Emryo origin heart.jpeg"" />"
"<img src=""569a65817c1d7ce23de8308f99a63cde76399_Q_0.svg"" />"
"<img sr
c=""569a65817c1d7ce23de8308f99a63cde76399__0.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_source_svg.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_aortic arch.jpeg"" />"
"<img src=""569a65817c1d7ce23de8308f99a63cde76399_Q_1.svg"" />"
"<img sr
c=""569a65817c1d7ce23de8308f99a63cde76399__1.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_source_svg.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_aortic arch.jpeg"" />"
"<img src=""569a65817c1d7ce23de8308f99a63cde76399_Q_2.svg"" />"
"<img sr
c=""569a65817c1d7ce23de8308f99a63cde76399__2.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_source_svg.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_aortic arch.jpeg"" />"
"<img src=""569a65817c1d7ce23de8308f99a63cde76399_Q_3.svg"" />"
"<img sr
c=""569a65817c1d7ce23de8308f99a63cde76399__3.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_source_svg.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_aortic arch.jpeg"" />"
"<img src=""569a65817c1d7ce23de8308f99a63cde76399_Q_4.svg"" />"
"<img sr
c=""569a65817c1d7ce23de8308f99a63cde76399__4.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_source_svg.svg"" />"
"<img src=""569a
65817c1d7ce23de8308f99a63cde76399_aortic arch.jpeg"" />"
Ventricular septum precursor
endocardial cushion
What lymph duct drains into venous angle?
"Thoracic duct<div><img src=""Sc

reen Shot 2013-12-09 at 6.28.01 PM.jpg"" /></div>"

"<img src=""c3712ad357c5e2f184fa9ae0224a18e397ecc_Q_0.svg"" />"
"<img sr
c=""c3712ad357c5e2f184fa9ae0224a18e397ecc__0.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_source_svg.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_ivc.jpeg"" />"
"<img src=""c3712ad357c5e2f184fa9ae0224a18e397ecc_Q_1.svg"" />"
"<img sr
c=""c3712ad357c5e2f184fa9ae0224a18e397ecc__1.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_source_svg.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_ivc.jpeg"" />"
"<img src=""c3712ad357c5e2f184fa9ae0224a18e397ecc_Q_2.svg"" />"
"<img sr
c=""c3712ad357c5e2f184fa9ae0224a18e397ecc__2.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_source_svg.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_ivc.jpeg"" />"
"<img src=""c3712ad357c5e2f184fa9ae0224a18e397ecc_Q_3.svg"" />"
"<img sr
c=""c3712ad357c5e2f184fa9ae0224a18e397ecc__3.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_source_svg.svg"" />"
"<img src=""c371
2ad357c5e2f184fa9ae0224a18e397ecc_ivc.jpeg"" />"
3
ortic arch of carotids?
ortic arch of ductus arteriosum?
6
ortic arch # of aorta? 4 (Left)
ortic arch proximal right pulmonary artery?
6 (right)
ortic arch proximal suclavian artery? 4 (right)
"<img src=""73d797759a92e1de144a280737435a6c3ee4f9c8_Q_0.svg"" />"
"<img sr
c=""73d797759a92e1de144a280737435a6c3ee4f9c8__0.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_source_svg.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_Emryo origin heart.jpeg"" />"
"<img src=""73d797759a92e1de144a280737435a6c3ee4f9c8_Q_1.svg"" />"
"<img sr
c=""73d797759a92e1de144a280737435a6c3ee4f9c8__1.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_source_svg.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_Emryo origin heart.jpeg"" />"
"<img src=""73d797759a92e1de144a280737435a6c3ee4f9c8_Q_2.svg"" />"
"<img sr
c=""73d797759a92e1de144a280737435a6c3ee4f9c8__2.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_source_svg.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_Emryo origin heart.jpeg"" />"
"<img src=""73d797759a92e1de144a280737435a6c3ee4f9c8_Q_3.svg"" />"
"<img sr
c=""73d797759a92e1de144a280737435a6c3ee4f9c8__3.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_source_svg.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_Emryo origin heart.jpeg"" />"
"<img src=""73d797759a92e1de144a280737435a6c3ee4f9c8_Q_4.svg"" />"
"<img sr
c=""73d797759a92e1de144a280737435a6c3ee4f9c8__4.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_source_svg.svg"" />"
"<img src=""73d7
97759a92e1de144a280737435a6c3ee4f9c8_Emryo origin heart.jpeg"" />"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_0.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__0.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""
/>"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_1.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__1.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""
/>"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_2.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__2.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""
/>"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_3.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__3.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc

2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""

/>"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_4.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__4.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""
/>"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_5.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__5.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""
/>"
"<img src=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a_Q_6.svg"" />"
"<img sr
c=""54dc2a1d735c21aed5c4f3c3d5c06a2f129a2a__6.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_source_svg.svg"" />"
"<img src=""54dc
2a1d735c21aed5c4f3c3d5c06a2f129a2a_Screen Shot 2013-12-10 at 9.41.44 PM.jpg""
/>"
TBI is a contriuting factor to _____ of all injury-related deaths in the US
1/3<div>-Injury related deaths are 5th on list of causes of death in the US prec
eded only y heart disease, cancer, stroke, and chronic lower respiratory diseas
es.</div>
natomy_Block4
"<div>Line etween inferior orit and external acoustic opening in anatomic posi
tion- called what?<div><img src=""Screen Shot 2014-01-06 at 7.27.21 PM.jpg"" /><
natomy_Block4
/div></div>"
Plane of frankfurt
"<img src=""c5307f9084371dc5ed411cf9c398480548c301_Q_0.svg"" />"
"<img sr
c=""c5307f9084371dc5ed411cf9c398480548c301__0.svg"" />"
"<img src=""c530
7f9084371dc5ed411cf9c398480548c301_source_svg.svg"" />"
"<img src=""c530
natomy_
7f9084371dc5ed411cf9c398480548c301_cranium.jpeg"" />"
Block4
"<img src=""c5307f9084371dc5ed411cf9c398480548c301_Q_1.svg"" />"
"<img sr
c=""c5307f9084371dc5ed411cf9c398480548c301__1.svg"" />"
"<img src=""c530
7f9084371dc5ed411cf9c398480548c301_source_svg.svg"" />"
"<img src=""c530
7f9084371dc5ed411cf9c398480548c301_cranium.jpeg"" />"
natomy_
Block4
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_0.svg"" />"
"<img sr
c=""22564595d009a13d47d7a48cc989e96185cf2__0.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at 9.16.14 M.jpg""
natomy_Block4
/>"
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_1.svg"" />"
"<img sr
c=""22564595d009a13d47d7a48cc989e96185cf2__1.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at 9.16.14 M.jpg""
natomy_Block4
/>"
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_2.svg"" />"
"<img sr
c=""22564595d009a13d47d7a48cc989e96185cf2__2.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at 9.16.14 M.jpg""
/>"
natomy_Block4
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_3.svg"" />"
"<img sr
c=""22564595d009a13d47d7a48cc989e96185cf2__3.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at 9.16.14 M.jpg""
/>"
natomy_Block4
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_4.svg"" />"
"<img sr
c=""22564595d009a13d47d7a48cc989e96185cf2__4.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
"<img src=""2256
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at 9.16.14 M.jpg""
natomy_Block4
/>"
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_5.svg"" />"
"<img sr

c=""22564595d009a13d47d7a48cc989e96185cf2__5.svg"" />"
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_6.svg""
c=""22564595d009a13d47d7a48cc989e96185cf2__6.svg"" />"
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""22564595d009a13d47d7a48cc989e96185cf2_Q_7.svg""
c=""22564595d009a13d47d7a48cc989e96185cf2__7.svg"" />"
4595d009a13d47d7a48cc989e96185cf2_source_svg.svg"" />"
4595d009a13d47d7a48cc989e96185cf2_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""7584ecf882907674788a0d2ffc428a97d068877_Q_0.svg""
c=""7584ecf882907674788a0d2ffc428a97d068877__0.svg"" />"
ecf882907674788a0d2ffc428a97d068877_source_svg.svg"" />"
ecf882907674788a0d2ffc428a97d068877_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""7584ecf882907674788a0d2ffc428a97d068877_Q_1.svg""
c=""7584ecf882907674788a0d2ffc428a97d068877__1.svg"" />"
ecf882907674788a0d2ffc428a97d068877_source_svg.svg"" />"
ecf882907674788a0d2ffc428a97d068877_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""7584ecf882907674788a0d2ffc428a97d068877_Q_2.svg""
c=""7584ecf882907674788a0d2ffc428a97d068877__2.svg"" />"
ecf882907674788a0d2ffc428a97d068877_source_svg.svg"" />"
ecf882907674788a0d2ffc428a97d068877_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""7584ecf882907674788a0d2ffc428a97d068877_Q_3.svg""
c=""7584ecf882907674788a0d2ffc428a97d068877__3.svg"" />"
ecf882907674788a0d2ffc428a97d068877_source_svg.svg"" />"
ecf882907674788a0d2ffc428a97d068877_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""7584ecf882907674788a0d2ffc428a97d068877_Q_4.svg""
c=""7584ecf882907674788a0d2ffc428a97d068877__4.svg"" />"
ecf882907674788a0d2ffc428a97d068877_source_svg.svg"" />"
ecf882907674788a0d2ffc428a97d068877_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""7584ecf882907674788a0d2ffc428a97d068877_Q_5.svg""
c=""7584ecf882907674788a0d2ffc428a97d068877__5.svg"" />"
ecf882907674788a0d2ffc428a97d068877_source_svg.svg"" />"
ecf882907674788a0d2ffc428a97d068877_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_0.svg""
c=""6c61302910ccf9913652105dde06009fc6a0__0.svg"" />"
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_1.svg""
c=""6c61302910ccf9913652105dde06009fc6a0__1.svg"" />"
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_2.svg""
c=""6c61302910ccf9913652105dde06009fc6a0__2.svg"" />"
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_3.svg""

"<img src=""2256
"<img src=""2256
9.16.14 M.jpg""
/>"
"<img sr
"<img src=""2256
"<img src=""2256
9.16.14 M.jpg""
/>"
"<img sr
"<img src=""2256
"<img src=""2256
9.16.14 M.jpg""
/>"
"<img sr
"<img src=""7584
"<img src=""7584
9.17.25 M.jpg""
/>"
"<img sr
"<img src=""7584
"<img src=""7584
9.17.25 M.jpg""
/>"
"<img sr
"<img src=""7584
"<img src=""7584
9.17.25 M.jpg""
/>"
"<img sr
"<img src=""7584
"<img src=""7584
9.17.25 M.jpg""
/>"
"<img sr
"<img src=""7584
"<img src=""7584
9.17.25 M.jpg""
/>"
"<img sr
"<img src=""7584
"<img src=""7584
9.17.25 M.jpg""
/>"
"<img sr
"<img src=""6c
"<img src=""6c
9.18.43 M.jpg""
/>"
"<img sr
"<img src=""6c
"<img src=""6c
9.18.43 M.jpg""
/>"
"<img sr
"<img src=""6c
"<img src=""6c
9.18.43 M.jpg""
/>"

"<img sr

c=""6c61302910ccf9913652105dde06009fc6a0__3.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at 9.18.43 M.jpg""
natomy_Block4
/>"
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_4.svg"" />"
"<img sr
c=""6c61302910ccf9913652105dde06009fc6a0__4.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at 9.18.43 M.jpg""
/>"
natomy_Block4
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_5.svg"" />"
"<img sr
c=""6c61302910ccf9913652105dde06009fc6a0__5.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at 9.18.43 M.jpg""
/>"
natomy_Block4
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_6.svg"" />"
"<img sr
c=""6c61302910ccf9913652105dde06009fc6a0__6.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at 9.18.43 M.jpg""
natomy_Block4
/>"
"<img src=""6c61302910ccf9913652105dde06009fc6a0_Q_7.svg"" />"
"<img sr
c=""6c61302910ccf9913652105dde06009fc6a0__7.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_source_svg.svg"" />"
"<img src=""6c
61302910ccf9913652105dde06009fc6a0_Screen Shot 2014-01-06 at 9.18.43 M.jpg""
natomy_Block4
/>"
Where do 4 of the sutures meet, and is also the weakest point of the cranium?
"Pterion; deep is <u>middle meningeal artery</u><div><div><img src=""Screen Shot
2014-01-06 at 9.20.48 M.jpg"" /></div></div><div><img src=""Screen Shot 2014-0
natomy_Block4
1-06 at 7.31.56 PM.jpg"" /></div>"
"<img src=""aa288a09d6477c22325c30f1d005875098f8_Q_0.svg"" />"
"<img sr
c=""aa288a09d6477c22325c30f1d005875098f8__0.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_source_svg.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_Screen Shot 2014-01-06 at 9.20.48 M.jpg""
/>"
natomy_Block4
"<img src=""aa288a09d6477c22325c30f1d005875098f8_Q_1.svg"" />"
"<img sr
c=""aa288a09d6477c22325c30f1d005875098f8__1.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_source_svg.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_Screen Shot 2014-01-06 at 9.20.48 M.jpg""
/>"
natomy_Block4
"<img src=""aa288a09d6477c22325c30f1d005875098f8_Q_2.svg"" />"
"<img sr
c=""aa288a09d6477c22325c30f1d005875098f8__2.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_source_svg.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_Screen Shot 2014-01-06 at 9.20.48 M.jpg""
natomy_Block4
/>"
"<img src=""aa288a09d6477c22325c30f1d005875098f8_Q_3.svg"" />"
"<img sr
c=""aa288a09d6477c22325c30f1d005875098f8__3.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_source_svg.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_Screen Shot 2014-01-06 at 9.20.48 M.jpg""
natomy_Block4
/>"
"<img src=""aa288a09d6477c22325c30f1d005875098f8_Q_4.svg"" />"
"<img sr
c=""aa288a09d6477c22325c30f1d005875098f8__4.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_source_svg.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_Screen Shot 2014-01-06 at 9.20.48 M.jpg""
/>"
natomy_Block4
"<img src=""aa288a09d6477c22325c30f1d005875098f8_Q_5.svg"" />"
"<img sr
c=""aa288a09d6477c22325c30f1d005875098f8__5.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_source_svg.svg"" />"
"<img src=""aa28
8a09d6477c22325c30f1d005875098f8_Screen Shot 2014-01-06 at 9.20.48 M.jpg""
/>"
natomy_Block4
Where sagittal suture and lamdoid suture meet is called?
"Lamda<div><img
natomy_Block4
src=""Screen Shot 2014-01-06 at 9.24.16 M.jpg"" /></div>"

"<img src=""9c869024d55d3a27ea85a36061528c457986e4_Q_0.svg""
c=""9c869024d55d3a27ea85a36061528c457986e4__0.svg"" />"
9024d55d3a27ea85a36061528c457986e4_source_svg.svg"" />"
9024d55d3a27ea85a36061528c457986e4_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""9c869024d55d3a27ea85a36061528c457986e4_Q_1.svg""
c=""9c869024d55d3a27ea85a36061528c457986e4__1.svg"" />"
9024d55d3a27ea85a36061528c457986e4_source_svg.svg"" />"
9024d55d3a27ea85a36061528c457986e4_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""eede659f7a35d6ec92246f40c609efee069f_Q_0.svg""
c=""eede659f7a35d6ec92246f40c609efee069f__0.svg"" />"
659f7a35d6ec92246f40c609efee069f_source_svg.svg"" />"
659f7a35d6ec92246f40c609efee069f_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""eede659f7a35d6ec92246f40c609efee069f_Q_1.svg""
c=""eede659f7a35d6ec92246f40c609efee069f__1.svg"" />"
659f7a35d6ec92246f40c609efee069f_source_svg.svg"" />"
659f7a35d6ec92246f40c609efee069f_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""eede659f7a35d6ec92246f40c609efee069f_Q_2.svg""
c=""eede659f7a35d6ec92246f40c609efee069f__2.svg"" />"
659f7a35d6ec92246f40c609efee069f_source_svg.svg"" />"
659f7a35d6ec92246f40c609efee069f_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""eede659f7a35d6ec92246f40c609efee069f_Q_3.svg""
c=""eede659f7a35d6ec92246f40c609efee069f__3.svg"" />"
659f7a35d6ec92246f40c609efee069f_source_svg.svg"" />"
659f7a35d6ec92246f40c609efee069f_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""eede659f7a35d6ec92246f40c609efee069f_Q_4.svg""
c=""eede659f7a35d6ec92246f40c609efee069f__4.svg"" />"
659f7a35d6ec92246f40c609efee069f_source_svg.svg"" />"
659f7a35d6ec92246f40c609efee069f_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""eede659f7a35d6ec92246f40c609efee069f_Q_5.svg""
c=""eede659f7a35d6ec92246f40c609efee069f__5.svg"" />"
659f7a35d6ec92246f40c609efee069f_source_svg.svg"" />"
659f7a35d6ec92246f40c609efee069f_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""8df37149e9e0a0830d6a2308a01e7ec3eaa0_Q_0.svg""
c=""8df37149e9e0a0830d6a2308a01e7ec3eaa0__0.svg"" />"
37149e9e0a0830d6a2308a01e7ec3eaa0_source_svg.svg"" />"
37149e9e0a0830d6a2308a01e7ec3eaa0_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""8df37149e9e0a0830d6a2308a01e7ec3eaa0_Q_1.svg""
c=""8df37149e9e0a0830d6a2308a01e7ec3eaa0__1.svg"" />"
37149e9e0a0830d6a2308a01e7ec3eaa0_source_svg.svg"" />"
37149e9e0a0830d6a2308a01e7ec3eaa0_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""8df37149e9e0a0830d6a2308a01e7ec3eaa0_Q_2.svg""
c=""8df37149e9e0a0830d6a2308a01e7ec3eaa0__2.svg"" />"
37149e9e0a0830d6a2308a01e7ec3eaa0_source_svg.svg"" />"
37149e9e0a0830d6a2308a01e7ec3eaa0_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""79c6659342fdae84cc90071f31ef0c0448c6f2_Q_0.svg""
c=""79c6659342fdae84cc90071f31ef0c0448c6f2__0.svg"" />"
c6659342fdae84cc90071f31ef0c0448c6f2_source_svg.svg"" />"
c6659342fdae84cc90071f31ef0c0448c6f2_Screen Shot 2014-01-06 at
natomy_Block4
/>"

/>"
"<img sr
"<img src=""9c86
"<img src=""9c86
9.23.18 M.jpg""
/>"
"<img sr
"<img src=""9c86
"<img src=""9c86
9.23.18 M.jpg""
/>"
"<img sr
"<img src=""eede
"<img src=""eede
9.24.16 M.jpg""
/>"
"<img sr
"<img src=""eede
"<img src=""eede
9.24.16 M.jpg""
/>"
"<img sr
"<img src=""eede
"<img src=""eede
9.24.16 M.jpg""
/>"
"<img sr
"<img src=""eede
"<img src=""eede
9.24.16 M.jpg""
/>"
"<img sr
"<img src=""eede
"<img src=""eede
9.24.16 M.jpg""
/>"
"<img sr
"<img src=""eede
"<img src=""eede
9.24.16 M.jpg""
/>"
"<img sr
"<img src=""8df
"<img src=""8df
9.24.54 M.jpg""
/>"
"<img sr
"<img src=""8df
"<img src=""8df
9.24.54 M.jpg""
/>"
"<img sr
"<img src=""8df
"<img src=""8df
9.24.54 M.jpg""
/>"
"<img sr
"<img src=""79
"<img src=""79
9.25.15 M.jpg""

"<img src=""79c6659342fdae84cc90071f31ef0c0448c6f2_Q_1.svg""
c=""79c6659342fdae84cc90071f31ef0c0448c6f2__1.svg"" />"
c6659342fdae84cc90071f31ef0c0448c6f2_source_svg.svg"" />"
c6659342fdae84cc90071f31ef0c0448c6f2_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""79c6659342fdae84cc90071f31ef0c0448c6f2_Q_2.svg""
c=""79c6659342fdae84cc90071f31ef0c0448c6f2__2.svg"" />"
c6659342fdae84cc90071f31ef0c0448c6f2_source_svg.svg"" />"
c6659342fdae84cc90071f31ef0c0448c6f2_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""79c6659342fdae84cc90071f31ef0c0448c6f2_Q_3.svg""
c=""79c6659342fdae84cc90071f31ef0c0448c6f2__3.svg"" />"
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natomy_Block4
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"<img src=""4d432e53854c5f9c84054641f1d7a3f79896946_Q_0.svg""
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"<img src=""4d432e53854c5f9c84054641f1d7a3f79896946_Q_1.svg""
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natomy_Block4
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natomy_Block4
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"<img src=""4d432e53854c5f9c84054641f1d7a3f79896946_Q_4.svg""
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"<img src=""4d432e53854c5f9c84054641f1d7a3f79896946_Q_5.svg""
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natomy_Block4
"<img src=""4d432e53854c5f9c84054641f1d7a3f79896946_Q_6.svg""
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natomy_Block4
"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_0.svg""
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natomy_Block4
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"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_1.svg""
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natomy_Block4
/>"

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"<img sr
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"<img sr
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"<img sr
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"<img sr
"<img src=""4d43
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"<img sr
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"<img sr
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natomy_Block4
"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_3.svg""
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natomy_Block4
"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_4.svg""
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"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_5.svg""
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"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_6.svg""
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natomy_Block4
"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_7.svg""
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natomy_Block4
"<img src=""f7ace76e1e89080447422e7148f8287c97331_Q_8.svg""
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"<img src=""6f6f05906d09022ad70443cfe798a9e0a66_Q_0.svg""
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"<img src=""6f6f05906d09022ad70443cfe798a9e0a66_Q_1.svg""
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natomy_Block4
"<img src=""6f6f05906d09022ad70443cfe798a9e0a66_Q_2.svg""
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natomy_Block4
"<img src=""6f6f05906d09022ad70443cfe798a9e0a66_Q_3.svg""
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/>"
"<img src=""6f6f05906d09022ad70443cfe798a9e0a66_Q_4.svg""
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05906d09022ad70443cfe798a9e0a66_Screen Shot 2014-01-06 at
natomy_Block4
/>"

/>"
"<img sr
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"<img sr
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"<img sr
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"<img sr
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"<img sr
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"<img sr
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"<img sr
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"<img src=""040f7f7197608afd6faf06ca28a1322ad85182_Q_0.svg"" />"

"<img sr
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natomy_Block4
"<img src=""040f7f7197608afd6faf06ca28a1322ad85182_Q_1.svg"" />"
"<img sr
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"<img src=""040f
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natomy_Block4
"<img src=""040f7f7197608afd6faf06ca28a1322ad85182_Q_2.svg"" />"
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natomy_Block4
/>"
"<img src=""040f7f7197608afd6faf06ca28a1322ad85182_Q_3.svg"" />"
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"<img src=""040f
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natomy_Block4
/>"
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"<img src=""040f
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natomy_Block4
"<img src=""040f7f7197608afd6faf06ca28a1322ad85182_Q_5.svg"" />"
"<img sr
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natomy_Block4
"<img src=""040f7f7197608afd6faf06ca28a1322ad85182_Q_6.svg"" />"
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"<img src=""040f
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natomy_Block4
/>"
Separation of the cranial ones in the infant y memranous intervals called? Wh
at are 4 names? "Fontanelle. nterior, posterior, sphenoid, mastoid<div><img src
=""Screen Shot 2014-01-06 at 9.36.35 M.jpg"" /></div>" natomy_Block4
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_0.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__0.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_source_svg.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
natomy_Block4
/>"
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_1.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__1.svg"" />"
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"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
natomy_Block4
/>"
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_2.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__2.svg"" />"
"<img src=""c5f7
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"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
/>"
natomy_Block4
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_3.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__3.svg"" />"
"<img src=""c5f7
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"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
/>"
natomy_Block4
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_4.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__4.svg"" />"
"<img src=""c5f7

65e14aec5fce96c3665de007da7d8aa1c76_source_svg.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
natomy_Block4
/>"
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_5.svg"" />"
"<img sr
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"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
natomy_Block4
/>"
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_6.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__6.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_source_svg.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
/>"
natomy_Block4
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_7.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__7.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_source_svg.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
/>"
natomy_Block4
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_8.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__8.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_source_svg.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
natomy_Block4
/>"
"<img src=""c5f765e14aec5fce96c3665de007da7d8aa1c76_Q_9.svg"" />"
"<img sr
c=""c5f765e14aec5fce96c3665de007da7d8aa1c76__9.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_source_svg.svg"" />"
"<img src=""c5f7
65e14aec5fce96c3665de007da7d8aa1c76_Screen Shot 2014-01-06 at 9.34.01 M.jpg""
natomy_Block4
/>"
Function of fontanelle? llows the calvaria to change during irth and accommoda
te the rapid <u>growth of the rain</u> during first two years of life.&nsp;
natomy_Block4
What can palpation of fontanelle reveal?
-monitor growth<div>-determine h
ydration status</div><div>-indicate intracranial pressure</div> natomy_Block4
Which layer of dura mater is in the spinal cord?
"Internal meningeal laye
natomy_
r<div><img src=""Screen Shot 2014-01-06 at 9.41.32 M.jpg"" /></div>"
Block4
Where does cereral venous thromosis occur?
"Blood clot formation in the <u>
right transverse venous sinus</u><div><u><img src=""Screen Shot 2014-01-06 at 9.
natomy_Block4
51.59 M.jpg"" /></u></div>"
"<img src=""045cecee5c5d59e6c579fa6f76952f50c796e_Q_0.svg"" />"
"<img sr
c=""045cecee5c5d59e6c579fa6f76952f50c796e__0.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_source_svg.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_Screen Shot 2014-01-06 at 9.41.44 M.jpg""
natomy_Block4
/>"
"<img src=""045cecee5c5d59e6c579fa6f76952f50c796e_Q_1.svg"" />"
"<img sr
c=""045cecee5c5d59e6c579fa6f76952f50c796e__1.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_source_svg.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_Screen Shot 2014-01-06 at 9.41.44 M.jpg""
/>"
natomy_Block4
"<img src=""045cecee5c5d59e6c579fa6f76952f50c796e_Q_2.svg"" />"
"<img sr
c=""045cecee5c5d59e6c579fa6f76952f50c796e__2.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_source_svg.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_Screen Shot 2014-01-06 at 9.41.44 M.jpg""
/>"
natomy_Block4
"<img src=""045cecee5c5d59e6c579fa6f76952f50c796e_Q_3.svg"" />"
"<img sr
c=""045cecee5c5d59e6c579fa6f76952f50c796e__3.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_source_svg.svg"" />"
"<img src=""045c
ecee5c5d59e6c579fa6f76952f50c796e_Screen Shot 2014-01-06 at 9.41.44 M.jpg""
natomy_Block4
/>"
"<img src=""790d252205ee75cc8e3ea889c704ff165d8fff_Q_0.svg"" />"
"<img sr

c=""790d252205ee75cc8e3ea889c704ff165d8fff__0.svg"" />"
252205ee75cc8e3ea889c704ff165d8fff_source_svg.svg"" />"
252205ee75cc8e3ea889c704ff165d8fff_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""790d252205ee75cc8e3ea889c704ff165d8fff_Q_1.svg""
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/>"
natomy_Block4
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_0.svg""
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/>"
natomy_Block4
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_1.svg""
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718e7581fe8993c98e6878256878240a6f_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_2.svg""
c=""dc14718e7581fe8993c98e6878256878240a6f__2.svg"" />"
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718e7581fe8993c98e6878256878240a6f_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_3.svg""
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718e7581fe8993c98e6878256878240a6f_Screen Shot 2014-01-06 at
/>"
natomy_Block4
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_4.svg""
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natomy_Block4
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_5.svg""
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natomy_Block4
/>"
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_6.svg""
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natomy_Block4
/>"
"<img src=""dc14718e7581fe8993c98e6878256878240a6f_Q_7.svg""
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natomy_Block4
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natomy_Block4
"<img src=""7a4720af049fe4c404948e958f57575e819eaac_Q_1.svg""
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20af049fe4c404948e958f57575e819eaac_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""7a4720af049fe4c404948e958f57575e819eaac_Q_2.svg""

"<img src=""790d
"<img src=""790d
9.42.28 M.jpg""
/>"
"<img sr
"<img src=""790d
"<img src=""790d
9.42.28 M.jpg""
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"<img sr
"<img src=""dc14
"<img src=""dc14
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"<img sr
"<img src=""dc14
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"<img sr
"<img src=""dc14
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"<img sr
"<img src=""dc14
"<img src=""dc14
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"<img sr
"<img src=""dc14
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"<img sr
"<img src=""dc14
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"<img sr
"<img src=""dc14
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"<img sr
"<img src=""dc14
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"<img sr
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"<img sr
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"<img sr

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natomy_Block4
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"<img src=""7a4720af049fe4c404948e958f57575e819eaac_Q_3.svg""
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natomy_Block4
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natomy_Block4
"<img src=""7a4720af049fe4c404948e958f57575e819eaac_Q_5.svg""
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natomy_Block4
/>"
"<img src=""7a4720af049fe4c404948e958f57575e819eaac_Q_6.svg""
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natomy_Block4
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"<img src=""7a4720af049fe4c404948e958f57575e819eaac_Q_7.svg""
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natomy_Block4
"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_0.svg""
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natomy_Block4
"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_1.svg""
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natomy_Block4
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"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_2.svg""
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d4095e2022964c0f1f0153ce61f7c1a981c_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_3.svg""
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natomy_Block4
"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_4.svg""
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d4095e2022964c0f1f0153ce61f7c1a981c_Screen Shot 2014-01-06 at
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natomy_Block4
"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_5.svg""
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d4095e2022964c0f1f0153ce61f7c1a981c_Screen Shot 2014-01-06 at
natomy_Block4
/>"
"<img src=""1e5d4095e2022964c0f1f0153ce61f7c1a981c_Q_6.svg""

"<img src=""7a47
"<img src=""7a47
9.46.09 M.jpg""
/>"
"<img sr
"<img src=""7a47
"<img src=""7a47
9.46.09 M.jpg""
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"<img sr
"<img src=""7a47
"<img src=""7a47
9.46.09 M.jpg""
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"<img sr
"<img src=""7a47
"<img src=""7a47
9.46.09 M.jpg""
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"<img sr
"<img src=""7a47
"<img src=""7a47
9.46.09 M.jpg""
/>"
"<img sr
"<img src=""7a47
"<img src=""7a47
9.46.09 M.jpg""
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"<img sr
"<img src=""1e5
"<img src=""1e5
9.49.45 M.jpg""
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"<img sr
"<img src=""1e5
"<img src=""1e5
9.49.45 M.jpg""
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"<img sr
"<img src=""1e5
"<img src=""1e5
9.49.45 M.jpg""
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"<img sr
"<img src=""1e5
"<img src=""1e5
9.49.45 M.jpg""
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"<img sr
"<img src=""1e5
"<img src=""1e5
9.49.45 M.jpg""
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"<img sr
"<img src=""1e5
"<img src=""1e5
9.49.45 M.jpg""
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"<img sr

c=""1e5d4095e2022964c0f1f0153ce61f7c1a981c__6.svg"" />"
"<img src=""1e5
d4095e2022964c0f1f0153ce61f7c1a981c_source_svg.svg"" />"
"<img src=""1e5
d4095e2022964c0f1f0153ce61f7c1a981c_Screen Shot 2014-01-06 at 9.49.45 M.jpg""
natomy_Block4
/>"
What is lood supply of Dura Mater?
"Middle meningeal artery<div><img src=""
Screen Shot 2014-01-06 at 7.31.56 PM.jpg"" /></div>"
natomy_Block4
Where does middle meningeal artery enter the neurocranium?
"Foramen spinosu
m<div><img src=""Screen Shot 2014-01-06 at 10.23.53 PM.jpg"" /></div>" natomy_
Block4
What artery is found ehind pterion? (specific) "nterior division of middle men
ingeal artery<div><img src=""Screen Shot 2014-01-06 at 9.54.17 M.jpg"" /></div>
natomy_Block4
"
Which rain layer is avascular? <u></u>rachnoid mater natomy_Block4
"<img src=""9aff69c490804e1fd44c659653463955767dc9_Q_0.svg"" />"
"<img sr
c=""9aff69c490804e1fd44c659653463955767dc9__0.svg"" />"
"<img src=""9aff
69c490804e1fd44c659653463955767dc9_source_svg.svg"" />"
"<img src=""9aff
69c490804e1fd44c659653463955767dc9_Screen Shot 2014-01-06 at 9.54.38 M.jpg""
/>"
natomy_Block4
"<img src=""9aff69c490804e1fd44c659653463955767dc9_Q_1.svg"" />"
"<img sr
c=""9aff69c490804e1fd44c659653463955767dc9__1.svg"" />"
"<img src=""9aff
69c490804e1fd44c659653463955767dc9_source_svg.svg"" />"
"<img src=""9aff
69c490804e1fd44c659653463955767dc9_Screen Shot 2014-01-06 at 9.54.38 M.jpg""
natomy_Block4
/>"
rainste
Cranial nerve nuclei are located in ______, except for ___ and ___
m; CNI and CN II (extensions in the forerain) natomy_Block4
"<img src=""1c09e445275568ae358c5534532ea32195dc_Q_0.svg"" />"
"<img sr
c=""1c09e445275568ae358c5534532ea32195dc__0.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_source_svg.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_Screen Shot 2014-01-06 at 9.56.29 M.jpg""
/>"
natomy_Block4
"<img src=""1c09e445275568ae358c5534532ea32195dc_Q_1.svg"" />"
"<img sr
c=""1c09e445275568ae358c5534532ea32195dc__1.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_source_svg.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_Screen Shot 2014-01-06 at 9.56.29 M.jpg""
natomy_Block4
/>"
"<img src=""1c09e445275568ae358c5534532ea32195dc_Q_2.svg"" />"
"<img sr
c=""1c09e445275568ae358c5534532ea32195dc__2.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_source_svg.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_Screen Shot 2014-01-06 at 9.56.29 M.jpg""
natomy_Block4
/>"
"<img src=""1c09e445275568ae358c5534532ea32195dc_Q_3.svg"" />"
"<img sr
c=""1c09e445275568ae358c5534532ea32195dc__3.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_source_svg.svg"" />"
"<img src=""1c09
e445275568ae358c5534532ea32195dc_Screen Shot 2014-01-06 at 9.56.29 M.jpg""
/>"
natomy_Block4
"<img src=""07d9efdea632c940fef54cf39fcda36329504a_Q_0.svg"" />"
"<img sr
c=""07d9efdea632c940fef54cf39fcda36329504a__0.svg"" />"
"<img src=""07d9
efdea632c940fef54cf39fcda36329504a_source_svg.svg"" />"
"<img src=""07d9
efdea632c940fef54cf39fcda36329504a_Screen Shot 2014-01-06 at 9.57.39 M.jpg""
/>"
natomy_Block4
Which cranial nerves contain contain presyntaptic parasympathetic axons CN III,
VII, IX, X<div><r /></div><div>Oculomotor, facial, glossopharyngeal, vagus</div
>
natomy_Block4
Mnemonic for CN Once One Offers Tequila To  Few Vuluptuous Girls, Virginities 
natomy_Block4
re History
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_0.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__0.svg"" />"
"<img src=""dde5
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
natomy_Block4
/>"

"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_1.svg"" />"

"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__1.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
/>"
natomy_Block4
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_2.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__2.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
/>"
natomy_Block4
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_3.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__3.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
natomy_Block4
/>"
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_4.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__4.svg"" />"
"<img src=""dde5
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
natomy_Block4
/>"
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_5.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__5.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
/>"
natomy_Block4
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_6.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__6.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
/>"
natomy_Block4
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_7.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__7.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
natomy_Block4
/>"
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_8.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__8.svg"" />"
"<img src=""dde5
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
natomy_Block4
/>"
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_9.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__9.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
/>"
natomy_Block4
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_10.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__10.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
/>"
natomy_Block4
"<img src=""dde57e6d66a701908ad8f0eef610f6143c882_Q_11.svg"" />"
"<img sr
c=""dde57e6d66a701908ad8f0eef610f6143c882__11.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_source_svg.svg"" />"
"<img src=""dde5
7e6d66a701908ad8f0eef610f6143c882_Screen Shot 2014-01-06 at 10.03.41 M.jpg""
natomy_Block4
/>"
"<img src=""18932279ca96875ee659acf65958fa292f_Q_0.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__0.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
natomy_Block4
/>"

"<img src=""18932279ca96875ee659acf65958fa292f_Q_1.svg"" />"

"<img sr
c=""18932279ca96875ee659acf65958fa292f__1.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
/>"
natomy_Block4
"<img src=""18932279ca96875ee659acf65958fa292f_Q_2.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__2.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
/>"
natomy_Block4
"<img src=""18932279ca96875ee659acf65958fa292f_Q_3.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__3.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
natomy_Block4
/>"
"<img src=""18932279ca96875ee659acf65958fa292f_Q_4.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__4.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
natomy_Block4
/>"
"<img src=""18932279ca96875ee659acf65958fa292f_Q_5.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__5.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
/>"
natomy_Block4
"<img src=""18932279ca96875ee659acf65958fa292f_Q_6.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__6.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
/>"
natomy_Block4
"<img src=""18932279ca96875ee659acf65958fa292f_Q_7.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__7.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
natomy_Block4
/>"
"<img src=""18932279ca96875ee659acf65958fa292f_Q_8.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__8.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
natomy_Block4
/>"
"<img src=""18932279ca96875ee659acf65958fa292f_Q_9.svg"" />"
"<img sr
c=""18932279ca96875ee659acf65958fa292f__9.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_source_svg.svg"" />"
"<img src=""189
32279ca96875ee659acf65958fa292f_Screen Shot 2014-01-06 at 10.10.16 M.jpg""
/>"
natomy_Block4
Q: Graphic representation of EC50 or K(d).
"<img src=""Screen Shot 2014-0106 at 12.01.30 PM.jpg"" /><r /><div>EC50 stands for efficacious concentration 5
0; Kd measure inding affinity; small Kd equals tight inding</div>"
pharmaco
logy_lock4
Q: True or false: drug dose is usually on a log scale. ": true<div><img src=""
Screen Shot 2014-01-07 at 3.21.11 PM.jpg"" /></div><div>*Might need to draw log
on test</div>" pharmacology_lock4
Q: What is a full agonist?
: a drug capale of producing the maximal effec
t in the system or cell pharmacology_lock4
Q: What is a partial agonist? : produces the effect, ut cannot produce the s
ame maximal effect (less efficacious) pharmacology_lock4
Q: Receptors have two forms, active and inactive. Which does the partial agonist
ind? : partial agonists inds oth, full agonist inds only to the active fo
rm (how it gets its large iological effect)
pharmacology_lock4
: true; they just get i
Q: True or false: antagonists have no effect alone.

n the way of things

pharmacology_lock4
Q: What are two types of antagonists? ": competitive and non-competitive<div>
<img src=""Screen Shot 2014-01-06 at 12.03.30 PM.jpg"" /></div><div><img src=""S
creen Shot 2014-01-07 at 3.25.24 PM.jpg"" /></div>"
pharmacology_lock4
"Q: Characterize curves I, II, and III.<div><img src=""Screen Shot 2014-01-06 at
12.03.53 PM.jpg"" /></div>"
: I agonist alone, II agonist plus low concentr
ation of antagonist, III agonist plus higher concentration of antagonist; appare
nt association constant is changing ut theres no change in maximal effect were dr
iving off antagonist y providing more and more drug
pharmacology_lock4
Representation of non-competitive antagonist. It inds somewhere else and inacti
vates (it poisons the receptor, reducing the numer of functional receptors)
"<img src=""Screen Shot 2014-01-06 at 12.04.22 PM.jpg"" />"
pharmacology_lo
ck4
"Q: Characterize the curve I, II, III.<div><img src=""Screen Shot 2014-01-06 at
12.05.58 PM.jpg"" /></div>"
<div>: I agonist alone, II agonist plus low con
centration of antagonist, III agonist plus higher concentration of antagonist; i
ts as if receptors are ound up and poisoned (taken&nsp;out of the system); Emax
(Vmax) change is characteristic ut there is no change in the apparent affinity
of the agonist for the receptor (theres no rightward shift)</div>
pharmaco
logy_lock4
Q: What is an inverse agonist? ": opposite effect of an agonist; causes fewer
ions flux; resets the equilirium<div><img src=""Screen Shot 2014-01-06 at 12.06
.26 PM.jpg"" /></div>" pharmacology_lock4
Q: True or false: inverse agonists do have an effect alone.
": true; invers
e agonists inds to inactive form<div><img src=""Screen Shot 2014-01-06 at 12.06
.44 PM.jpg"" /></div>" pharmacology_lock4
Q: Commonly used anti-histamine diphenhydramine (Benadryl) is an example of hist
amine type I receptor inverse agonist. "<img src=""Screen Shot 2014-01-06 at 12
.06.57 PM.jpg"" /><div> no agonist and arrows reflect equal populations; B agon
ist and active form predominates; C inverse agonist and inactive form predominat
es</div>"
pharmacology_lock4
Q: (From class) Which of the following drugs is an example of an inverse agonist
?
": answer = Benadryl (anti-histamine)<div><img src=""Screen Shot 2014-0
1-09 at 9.51.00 M.jpg"" /></div>"
pharmacology_lock4
Q: Spare receptors often maximal efficacy can e achieved with only a fraction o
f the receptors occupied. B thru E show increasing concentration of irreversile
antagonist; only at D and E does the effect start decreasing. "<img src=""Scre
en Shot 2014-01-06 at 12.07.53 PM.jpg"" /><div>t curve D weve finally roken int
o the population of receptors that arent spare</div>"
pharmacology_lock4
Q: Compare and contrast potency and efficacy. ": <><font color=""#0000ff"">p
otency</font></> compares the <><font color=""#0000ff"">EC50 </font></>doses
needed to achieve an effect (most potent is one with lowest EC50)--&gt;here  an
d C have the same EC50 and are thus equally potent; <><font color=""#ff0000"">e
fficacy</font></> compares the maximal efficacy of drugs (<font color=""#ff0000
""><>Emax</></font>)--&gt;here  and B are equally efficacious<div><img src=""
Screen Shot 2014-01-06 at 12.08.44 PM.jpg"" /></div>" pharmacology_lock4
Q: Define the therapeutic index.
"<div>: = LD50 / ED50; igger is etter
; we want to give patients doses at ED100 for their size so that everyone respon
ds predictaly; the further the LD curve is to the right the etter ecause we d
ont have to worry aout doses getting lethal at ED100</div><div>If = 1, then LD50
= ED50 and this is ad, drug wouldnt e approved</div><div>For example, digitali
s has a TI = 4</div><div><img src=""Screen Shot 2014-01-06 at 12.09.02 PM.jpg""
/></div>"
pharmacology_lock4
Q: Name some drugs with low therapeutic indices. Give a pneumonic.
<div>:
aminoglycosides, digoxin, lithium, phenytoin, quinine, theophylin, vancomycin, w
arfarin; The Queen Likes to Dig Low Theophylin (asthma), quinine (antimalarial), l
ithium (ipolar), digoxin (cardiac), low therapeutic index</div><div><r /></div
>
pharmacology_lock4
Q: What are the FD use-in-pregnancy ratings? "<div>:  = controlled studies
show no risk, B = no evidence of risk in humans, C = risk cannot e ruled out, D

= positive evidence of risk, X = contraindicated in pregnancy</div><div><img sr

c=""Screen Shot 2014-01-07 at 4.12.56 PM.jpg"" /></div>"
pharmacology_lo
ck4
Mnemonic for CN motor/sensory "Some Say Marry Money But My Brother Says Big Bo
os Matter Most<div><img src=""Screen Shot 2014-01-06 at 1.09.59 PM.jpg"" /></di
v>"
natomy_Block4
"<img src=""351adf42faf1d2a6fc465f93a2c438f0473924_Q_0.svg"" />"
"<img sr
c=""351adf42faf1d2a6fc465f93a2c438f0473924__0.svg"" />"
"<img src=""351
adf42faf1d2a6fc465f93a2c438f0473924_source_svg.svg"" />"
"<img src=""351
adf42faf1d2a6fc465f93a2c438f0473924_Screen Shot 2014-01-06 at 7.46.22 PM.jpg""
natomy_Block4
/>"
Q: What is the total ody water (percentage) of a male? How is this different fr
om females? What % intra, extracellular, plasma <div>: 60% TBW for male, female
s have less (55%) and thus more fat. Therefore a 70kg man will have 42L of water
. 40% of TBW is intracellular, 20% is extracellular. 5% plasma</div>
pharmaco
logy_lock4
Q: What is pharmacokinetics?
: study of how the ody asors, distriutes, m
etaolizes, and excretes drugs (what our ody does to drugs)
pharmacology_lo
ck4
: study of how drugs act on our ody pharmaco
Q: What is pharmacodynamics?
logy_lock4
Q: What is tamsulosin? : Flomax; increases urine flow pharmacology_lock4
Q: What is sildenafil? : Viagra; treats erectile dysfunction pharmacology_lo
ck4
Q: What is nifedipine? (Trade) : Procardia; decreases lood pressure pharmaco
logy_lock4
Q: Molecular and cellular targets for drugs include: ion channels, G-protein lin
ked receptors, memrane receptors that are enzymes, DN-linked receptors that al
ter transcription, and enzymes. Rank fastest acting to slowest acting. ": liga
nd-gated ion channels &gt; G-protein coupled receptors &gt; enzyme linked recept
ors &gt; intracellular receptors<div><img src=""Screen Shot 2014-01-07 at 5.22.1
3 PM.jpg"" /></div>"
pharmacology_lock4
Q: What is the cellular affect of lidocaine?
: locks Na+ channels; local an
esthetic
pharmacology_lock4
Q: How does Nifedipine exert its effects on target cells?
": locks Ca2+
channels; anti-hypertensive<div><img src=""Screen Shot 2014-01-07 at 5.24.52 PM.
jpg"" /></div>" pharmacology_lock4
Q: How does Diazepam (valium) exert its effects on target cells?
": open
s Cl- channels; anti-anxiety drugs<div><img src=""Screen Shot 2014-01-07 at 5.24
.52 PM.jpg"" /></div>" pharmacology_lock4
Q: Sulfonylureas <>locks</> the conduction of what ion across the memrane?
": K+<div><img src=""Screen Shot 2014-01-07 at 5.24.52 PM.jpg"" /></div>"
pharmacology_lock4
Q: Epinephrine inds to eta-1 receptors and increases the level of what second
messenger?
": cMP (via Gs)<div><img src=""Screen Shot 2014-01-07 at 5.51.
20 PM.jpg"" /></div>" pharmacology_lock4
Q: What G-protein sutype does epinephrine utilize upon acting on alpha2 recepto
rs?
": G(i)--&gt;decreases cMP<div><img src=""Screen Shot 2014-01-07 at 5.
51.20 PM.jpg"" /></div>"
pharmacology_lock4
Q: What G-protein sutype does epinephrine utilize upon acting on alpha1 recepto
rs?
": G(q)--&gt;increases Ca2+<div><img src=""Screen Shot 2014-01-07 at 5.
51.20 PM.jpg"" /></div>"
pharmacology_lock4
Q: What amino acid gives rise to nitric oxide? : arginine
pharmacology_lo
ck4
Q: cetate + choline--&gt;_________.
acetylcholine pharmacology_lock4
Q: Give the order of precursors leading up to the production of epinephrine.
: tyrosine--&gt; dopamine--&gt; norepinephrine--&gt; epinephrine
pharmaco
logy_lock4
: tryptophan pharmacology_lo
Q: What amino acid gives rise to serotonin?
ck4

Q: Sildenafil alters the level of what second messenger?

: cGMP pharmaco
logy_lock4
: NP (atrial n
Q: What hormone is released y atria during volume excess?
atriuretic peptide); increases Na+ excretion and decreases volume
pharmaco
logy_lock4
Q: The cytoplasmic domain of the insulin receptor is a _____ kinase.
: tyros
ine; this is an example of a receptor that is an enzyme (along with NP, growth
factors)&nsp; pharmacology_lock4
Q: Give some examples of DN-linked receptors that alter gene transcription. (4)
: steroids (ie cortisol, prednisone), sex hormones, vitamin D, thyroid hormone
pharmacology_lock4
Q: What enzyme does captopril inhiit? : CE; causes a decrease in lood press
ure
pharmacology_lock4
Q: What enzyme does acetazolamide inhiit?
: caronic anhydrase; its a weak
diuretic
pharmacology_lock4
: HMG-Co reductase; decreases choleste
Q: What enzyme does statins inhiit?
rol synthesis in cells pharmacology_lock4
Q: What enzyme does cipro (ciprofloxacin) inhiit?
: gyrase/topoisomerase;
its thus anti-acterial
pharmacology_lock4
: dihydrofolate reductase (DHFR
Q: What enzyme does methotrexate inhiit?
); anti-cancer agent
pharmacology_lock4
Q: What does Castor oil treat? : constipation y stimulating GI tract; can als
o induce laor pharmacology_lock4
: irreversile inhiitor (thus new enzy
Q: What kind of inhiitor is spirin?
me has to e made); it specifically inhiits COX
pharmacology_lock4
Q: What kinds of inhiitors are iuprofen and acetaminophen?
: competitive (
reversile) inhiitors pharmacology_lock4
Q: What enzyme does sildenafil inhiit? <div>: cGMP PDE5 (this enzyme is aunda
nt in corpus cavernosum and thus the drug facilitates penile erection); theres al
so cross-reactions in the heart (increases work load), lood vessels (causes dil
ation leading to hypotension so Viagra is contraindicated in patients on nitrate
s), eyes (lose color perception), and can cause priapism</div> pharmacology_lo
ck4
Q: Where is the effect of theophylline most localized? : its more specific to c
MP PDE in lungs and thus used as a ronchodilator
pharmacology_lock4
Q: What chemical property allows metronidazole and quinolones to penetrate the C
NS?
: lipid soluility
pharmacology_lock4
Q: True or false: inflamed meninges are more permeale to penicillin, permitting
rapid penetration of the drug into the CSF.
"True<div><img src=""Screen Shot
2014-01-07 at 5.05.32 PM.jpg"" /></div>"
pharmacology_lock4
<div>Many molecules act as second messenger in cytoplasm of our cells. One of th
ese is NOT a common second messenger.</div><div><div>Cyclic MP (cMP)</div><div
>Inositol isphosphate (IP2)</div><div>Inositol triphosphate (IP3)</div><div>Cal
cium</div><div>Diacyl Glycerol (DG)</div></div>
<div><div>inositol 2-6 
isphosphate</div></div><div><r /></div><div><div>Common second messengers:</div
><div>cMP, cGMP, IP3, DG and Calcium</div></div>
pharmacology_lock4
"The following are 4 drugs whose mechanism of action is y activating different
classes of receptors. Choose the correct order of drugs starting from fastest on
set of action to the slowest onset.<div><img src=""Screen Shot 2014-01-07 at 5.0
9.12 PM.jpg"" /></div>" C;&nsp;nicotine inds to acetylcholine nicotinic recept
ors and opens Na/K channel
pharmacology_lock4
Nitric oxide, hydralazine work y what? "Open K+ channels (lood vessels) nti-h
ypertensives<div><img src=""Screen Shot 2014-01-07 at 5.24.52 PM.jpg"" /></div>"
pharmacology_lock4
How does mannitol work? <div><>given IV, osmotic diuretic</>, not digested; fr
eely filtered,&nsp;neither reasored nor secreted</div>
Which verterate contain foramen transversarium?
C1-C6
natomy_Block4
"<div>What are  and C?</div><img src=""Screen Shot 2014-01-07 at 6.40.12 PM.jpg
"" />" =anterior atlanto-occipital memrane, continuation of C=longitudinal li
gament natomy_Block4

"<img src=""6361a5283e537045efda17441c10792d259e_Q_0.svg""
c=""6361a5283e537045efda17441c10792d259e__0.svg"" />"
a5283e537045efda17441c10792d259e_source_svg.svg"" />"
a5283e537045efda17441c10792d259e_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""6361a5283e537045efda17441c10792d259e_Q_1.svg""
c=""6361a5283e537045efda17441c10792d259e__1.svg"" />"
a5283e537045efda17441c10792d259e_source_svg.svg"" />"
a5283e537045efda17441c10792d259e_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""6361a5283e537045efda17441c10792d259e_Q_2.svg""
c=""6361a5283e537045efda17441c10792d259e__2.svg"" />"
a5283e537045efda17441c10792d259e_source_svg.svg"" />"
a5283e537045efda17441c10792d259e_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""6361a5283e537045efda17441c10792d259e_Q_3.svg""
c=""6361a5283e537045efda17441c10792d259e__3.svg"" />"
a5283e537045efda17441c10792d259e_source_svg.svg"" />"
a5283e537045efda17441c10792d259e_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""e345171f188679da67998d51dc9cf93f1180_Q_0.svg""
c=""e345171f188679da67998d51dc9cf93f1180__0.svg"" />"
171f188679da67998d51dc9cf93f1180_source_svg.svg"" />"
171f188679da67998d51dc9cf93f1180_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""e345171f188679da67998d51dc9cf93f1180_Q_1.svg""
c=""e345171f188679da67998d51dc9cf93f1180__1.svg"" />"
171f188679da67998d51dc9cf93f1180_source_svg.svg"" />"
171f188679da67998d51dc9cf93f1180_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""e345171f188679da67998d51dc9cf93f1180_Q_2.svg""
c=""e345171f188679da67998d51dc9cf93f1180__2.svg"" />"
171f188679da67998d51dc9cf93f1180_source_svg.svg"" />"
171f188679da67998d51dc9cf93f1180_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""e345171f188679da67998d51dc9cf93f1180_Q_3.svg""
c=""e345171f188679da67998d51dc9cf93f1180__3.svg"" />"
171f188679da67998d51dc9cf93f1180_source_svg.svg"" />"
171f188679da67998d51dc9cf93f1180_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""e71021945fea903055415e59176a343a071914_Q_0.svg""
c=""e71021945fea903055415e59176a343a071914__0.svg"" />"
21945fea903055415e59176a343a071914_source_svg.svg"" />"
21945fea903055415e59176a343a071914_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""e71021945fea903055415e59176a343a071914_Q_1.svg""
c=""e71021945fea903055415e59176a343a071914__1.svg"" />"
21945fea903055415e59176a343a071914_source_svg.svg"" />"
21945fea903055415e59176a343a071914_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""e5054388ac62ddcef7d6fdd2196cc4ccc5_Q_0.svg""
c=""e5054388ac62ddcef7d6fdd2196cc4ccc5__0.svg"" />"
4388ac62ddcef7d6fdd2196cc4ccc5_source_svg.svg"" />"
4388ac62ddcef7d6fdd2196cc4ccc5_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""e5054388ac62ddcef7d6fdd2196cc4ccc5_Q_1.svg""
c=""e5054388ac62ddcef7d6fdd2196cc4ccc5__1.svg"" />"
4388ac62ddcef7d6fdd2196cc4ccc5_source_svg.svg"" />"
4388ac62ddcef7d6fdd2196cc4ccc5_Screen Shot 2014-01-07 at
natomy_Block4
/>"

/>"
"<img sr
"<img src=""6361
"<img src=""6361
6.32.05 PM.jpg""
/>"
"<img sr
"<img src=""6361
"<img src=""6361
6.32.05 PM.jpg""
/>"
"<img sr
"<img src=""6361
"<img src=""6361
6.32.05 PM.jpg""
/>"
"<img sr
"<img src=""6361
"<img src=""6361
6.32.05 PM.jpg""
/>"
"<img sr
"<img src=""e345
"<img src=""e345
6.35.10 PM.jpg""
/>"
"<img sr
"<img src=""e345
"<img src=""e345
6.35.10 PM.jpg""
/>"
"<img sr
"<img src=""e345
"<img src=""e345
6.35.10 PM.jpg""
/>"
"<img sr
"<img src=""e345
"<img src=""e345
6.35.10 PM.jpg""
/>"
"<img sr
"<img src=""e710
"<img src=""e710
6.36.26 PM.jpg""
/>"
"<img sr
"<img src=""e710
"<img src=""e710
6.36.26 PM.jpg""
/>"
"<img sr
"<img src=""e505
"<img src=""e505
6.37.20 PM.jpg""
/>"
"<img sr
"<img src=""e505
"<img src=""e505
6.37.20 PM.jpg""

"<img src=""e5054388ac62ddcef7d6fdd2196cc4ccc5_Q_2.svg"" />"

"<img sr
c=""e5054388ac62ddcef7d6fdd2196cc4ccc5__2.svg"" />"
"<img src=""e505
4388ac62ddcef7d6fdd2196cc4ccc5_source_svg.svg"" />"
"<img src=""e505
4388ac62ddcef7d6fdd2196cc4ccc5_Screen Shot 2014-01-07 at 6.37.20 PM.jpg""
/>"
natomy_Block4
"What are B and D?<div><img src=""Screen Shot 2014-01-07 at 6.40.12 PM.jpg"" /><
/div>" B=Posterior atlanto-occipital memrane; continuation of D=ligamentum fla
natomy_Block4
vum
What verteral level is hyoid one?
"C3<div><img src=""hyoid.jpeg"" /></div>
"
natomy_Block4
Superficial fascial layer of neck--&gt; anteriorly contains what muscle?
"Platysma<div><img src=""Screen Shot 2014-01-07 at 6.47.16 PM.jpg"" /></div>"
natomy_Block4
"<img src=""288efe46358e1fde7817cc625d13e5300f46aa_Q_0.svg"" />"
"<img sr
c=""288efe46358e1fde7817cc625d13e5300f46aa__0.svg"" />"
"<img src=""288e
fe46358e1fde7817cc625d13e5300f46aa_source_svg.svg"" />"
"<img src=""288e
fe46358e1fde7817cc625d13e5300f46aa_Screen Shot 2014-01-07 at 6.43.24 PM.jpg""
/>"
natomy_Block4
"<img src=""288efe46358e1fde7817cc625d13e5300f46aa_Q_1.svg"" />"
"<img sr
c=""288efe46358e1fde7817cc625d13e5300f46aa__1.svg"" />"
"<img src=""288e
fe46358e1fde7817cc625d13e5300f46aa_source_svg.svg"" />"
"<img src=""288e
fe46358e1fde7817cc625d13e5300f46aa_Screen Shot 2014-01-07 at 6.43.24 PM.jpg""
natomy_Block4
/>"
"<img src=""288efe46358e1fde7817cc625d13e5300f46aa_Q_2.svg"" />"
"<img sr
c=""288efe46358e1fde7817cc625d13e5300f46aa__2.svg"" />"
"<img src=""288e
fe46358e1fde7817cc625d13e5300f46aa_source_svg.svg"" />"
"<img src=""288e
fe46358e1fde7817cc625d13e5300f46aa_Screen Shot 2014-01-07 at 6.43.24 PM.jpg""
natomy_Block4
/>"
What innervates platysma?
CNVII--&gt; part of the facial muscles natomy_
Block4
Carotid sheath contains? (6)
"<img src=""Screen Shot 2014-01-07 at 6.52.04 PM
natomy_Block4
.jpg"" />"
"<img src=""05c38d53f9473f119dd2efd9fcc43d601a24_Q_0.svg"" />"
"<img sr
c=""05c38d53f9473f119dd2efd9fcc43d601a24__0.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_source_svg.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_Screen Shot 2014-01-07 at 6.52.04 PM.jpg""
/>"
natomy_Block4
"<img src=""05c38d53f9473f119dd2efd9fcc43d601a24_Q_1.svg"" />"
"<img sr
c=""05c38d53f9473f119dd2efd9fcc43d601a24__1.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_source_svg.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_Screen Shot 2014-01-07 at 6.52.04 PM.jpg""
/>"
natomy_Block4
"<img src=""05c38d53f9473f119dd2efd9fcc43d601a24_Q_2.svg"" />"
"<img sr
c=""05c38d53f9473f119dd2efd9fcc43d601a24__2.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_source_svg.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_Screen Shot 2014-01-07 at 6.52.04 PM.jpg""
natomy_Block4
/>"
"<img src=""05c38d53f9473f119dd2efd9fcc43d601a24_Q_3.svg"" />"
"<img sr
c=""05c38d53f9473f119dd2efd9fcc43d601a24__3.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_source_svg.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_Screen Shot 2014-01-07 at 6.52.04 PM.jpg""
natomy_Block4
/>"
"<img src=""05c38d53f9473f119dd2efd9fcc43d601a24_Q_4.svg"" />"
"<img sr
c=""05c38d53f9473f119dd2efd9fcc43d601a24__4.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_source_svg.svg"" />"
"<img src=""05c3
8d53f9473f119dd2efd9fcc43d601a24_Screen Shot 2014-01-07 at 6.52.04 PM.jpg""
/>"
natomy_Block4
Borders of lateral cervical region?
"SCM, Trapezius, Clavicle<div><img src="
natomy_Block4
"Screen Shot 2014-01-07 at 7.02.00 PM.jpg"" /></div>"
"<img src=""9e9a20101c882cd387c7d28d382fae969fa4acc4_Q_0.svg"" />"
"<img sr

c=""9e9a20101c882cd387c7d28d382fae969fa4acc4__0.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_source_svg.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_Screen Shot 2014-01-07 at 6.56.12 PM.jpg""
natomy_Block4
/>"
"<img src=""9e9a20101c882cd387c7d28d382fae969fa4acc4_Q_1.svg"" />"
"<img sr
c=""9e9a20101c882cd387c7d28d382fae969fa4acc4__1.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_source_svg.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_Screen Shot 2014-01-07 at 6.56.12 PM.jpg""
/>"
natomy_Block4
"<img src=""9e9a20101c882cd387c7d28d382fae969fa4acc4_Q_2.svg"" />"
"<img sr
c=""9e9a20101c882cd387c7d28d382fae969fa4acc4__2.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_source_svg.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_Screen Shot 2014-01-07 at 6.56.12 PM.jpg""
/>"
natomy_Block4
"<img src=""9e9a20101c882cd387c7d28d382fae969fa4acc4_Q_3.svg"" />"
"<img sr
c=""9e9a20101c882cd387c7d28d382fae969fa4acc4__3.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_source_svg.svg"" />"
"<img src=""9e9a
20101c882cd387c7d28d382fae969fa4acc4_Screen Shot 2014-01-07 at 6.56.12 PM.jpg""
natomy_Block4
/>"
"<img src=""f56101859dfd4ea973d477e972a95833c397d37_Q_0.svg"" />"
"<img sr
c=""f56101859dfd4ea973d477e972a95833c397d37__0.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_source_svg.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_Screen Shot 2014-01-07 at 6.56.45 PM.jpg""
natomy_Block4
/>"
"<img src=""f56101859dfd4ea973d477e972a95833c397d37_Q_1.svg"" />"
"<img sr
c=""f56101859dfd4ea973d477e972a95833c397d37__1.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_source_svg.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_Screen Shot 2014-01-07 at 6.56.45 PM.jpg""
/>"
natomy_Block4
"<img src=""f56101859dfd4ea973d477e972a95833c397d37_Q_2.svg"" />"
"<img sr
c=""f56101859dfd4ea973d477e972a95833c397d37__2.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_source_svg.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_Screen Shot 2014-01-07 at 6.56.45 PM.jpg""
/>"
natomy_Block4
"<img src=""f56101859dfd4ea973d477e972a95833c397d37_Q_3.svg"" />"
"<img sr
c=""f56101859dfd4ea973d477e972a95833c397d37__3.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_source_svg.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_Screen Shot 2014-01-07 at 6.56.45 PM.jpg""
natomy_Block4
/>"
"<img src=""f56101859dfd4ea973d477e972a95833c397d37_Q_4.svg"" />"
"<img sr
c=""f56101859dfd4ea973d477e972a95833c397d37__4.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_source_svg.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_Screen Shot 2014-01-07 at 6.56.45 PM.jpg""
natomy_Block4
/>"
"<img src=""f56101859dfd4ea973d477e972a95833c397d37_Q_5.svg"" />"
"<img sr
c=""f56101859dfd4ea973d477e972a95833c397d37__5.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_source_svg.svg"" />"
"<img src=""f561
01859dfd4ea973d477e972a95833c397d37_Screen Shot 2014-01-07 at 6.56.45 PM.jpg""
/>"
natomy_Block4
"<img src=""a546813f8e32750039a838d89263d92f909_Q_0.svg"" />"
"<img sr
c=""a546813f8e32750039a838d89263d92f909__0.svg"" />"
"<img src=""a54
6813f8e32750039a838d89263d92f909_source_svg.svg"" />"
"<img src=""a54
6813f8e32750039a838d89263d92f909_Screen Shot 2014-01-07 at 6.58.26 PM.jpg""
/>"
natomy_Block4
"<img src=""4de79f2f55e2e55ae7514f76596d8454974df5_Q_0.svg"" />"
"<img sr
c=""4de79f2f55e2e55ae7514f76596d8454974df5__0.svg"" />"
"<img src=""4de7
9f2f55e2e55ae7514f76596d8454974df5_source_svg.svg"" />"
"<img src=""4de7
9f2f55e2e55ae7514f76596d8454974df5_Screen Shot 2014-01-07 at 7.00.00 PM.jpg""
natomy_Block4
/>"
T/F: C2 lies within the suoccipital triangle.&nsp;
"False, C1 (suoccipital

n)<div><img src=""Screen Shot 2014-01-07 at 7.22.10 PM.jpg"" /></div>" natomy_

Block4
"<img src=""a538ff51efc2c82d35ec18567a157e492f5f9f_Q_0.svg"" />"
"<img sr
c=""a538ff51efc2c82d35ec18567a157e492f5f9f__0.svg"" />"
"<img src=""a538
ff51efc2c82d35ec18567a157e492f5f9f_source_svg.svg"" />"
"<img src=""a538
ff51efc2c82d35ec18567a157e492f5f9f_Screen Shot 2014-01-07 at 7.02.00 PM.jpg""
natomy_Block4
/>"
"<img src=""a538ff51efc2c82d35ec18567a157e492f5f9f_Q_1.svg"" />"
"<img sr
c=""a538ff51efc2c82d35ec18567a157e492f5f9f__1.svg"" />"
"<img src=""a538
ff51efc2c82d35ec18567a157e492f5f9f_source_svg.svg"" />"
"<img src=""a538
ff51efc2c82d35ec18567a157e492f5f9f_Screen Shot 2014-01-07 at 7.02.00 PM.jpg""
natomy_Block4
/>"
"<img src=""e6d6512ed3ea5cc56a1ca28c904d0693486_Q_0.svg"" />"
"<img sr
c=""e6d6512ed3ea5cc56a1ca28c904d0693486__0.svg"" />"
"<img src=""e6
d6512ed3ea5cc56a1ca28c904d0693486_source_svg.svg"" />"
"<img src=""e6
d6512ed3ea5cc56a1ca28c904d0693486_Screen Shot 2014-01-07 at 7.03.50 PM.jpg""
/>"
natomy_Block4
"<img src=""e6d6512ed3ea5cc56a1ca28c904d0693486_Q_1.svg"" />"
"<img sr
c=""e6d6512ed3ea5cc56a1ca28c904d0693486__1.svg"" />"
"<img src=""e6
d6512ed3ea5cc56a1ca28c904d0693486_source_svg.svg"" />"
"<img src=""e6
d6512ed3ea5cc56a1ca28c904d0693486_Screen Shot 2014-01-07 at 7.03.50 PM.jpg""
/>"
natomy_Block4
"<img src=""e6d6512ed3ea5cc56a1ca28c904d0693486_Q_2.svg"" />"
"<img sr
c=""e6d6512ed3ea5cc56a1ca28c904d0693486__2.svg"" />"
"<img src=""e6
d6512ed3ea5cc56a1ca28c904d0693486_source_svg.svg"" />"
"<img src=""e6
d6512ed3ea5cc56a1ca28c904d0693486_Screen Shot 2014-01-07 at 7.03.50 PM.jpg""
natomy_Block4
/>"
"<img src=""a2839e926efd23f0a523ad3cf6c17e6870d2f_Q_0.svg"" />"
"<img sr
c=""a2839e926efd23f0a523ad3cf6c17e6870d2f__0.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_source_svg.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_Screen Shot 2014-01-07 at 7.05.39 PM.jpg""
natomy_Block4
/>"
"<img src=""a2839e926efd23f0a523ad3cf6c17e6870d2f_Q_1.svg"" />"
"<img sr
c=""a2839e926efd23f0a523ad3cf6c17e6870d2f__1.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_source_svg.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_Screen Shot 2014-01-07 at 7.05.39 PM.jpg""
/>"
natomy_Block4
"<img src=""a2839e926efd23f0a523ad3cf6c17e6870d2f_Q_2.svg"" />"
"<img sr
c=""a2839e926efd23f0a523ad3cf6c17e6870d2f__2.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_source_svg.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_Screen Shot 2014-01-07 at 7.05.39 PM.jpg""
/>"
natomy_Block4
"<img src=""a2839e926efd23f0a523ad3cf6c17e6870d2f_Q_3.svg"" />"
"<img sr
c=""a2839e926efd23f0a523ad3cf6c17e6870d2f__3.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_source_svg.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_Screen Shot 2014-01-07 at 7.05.39 PM.jpg""
natomy_Block4
/>"
"<img src=""a2839e926efd23f0a523ad3cf6c17e6870d2f_Q_4.svg"" />"
"<img sr
c=""a2839e926efd23f0a523ad3cf6c17e6870d2f__4.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_source_svg.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_Screen Shot 2014-01-07 at 7.05.39 PM.jpg""
natomy_Block4
/>"
"<img src=""a2839e926efd23f0a523ad3cf6c17e6870d2f_Q_5.svg"" />"
"<img sr
c=""a2839e926efd23f0a523ad3cf6c17e6870d2f__5.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_source_svg.svg"" />"
"<img src=""a283
9e926efd23f0a523ad3cf6c17e6870d2f_Screen Shot 2014-01-07 at 7.05.39 PM.jpg""
/>"
natomy_Block4
"<img src=""cfc9273d1087f08113a576e314f8de02347fa18_Q_0.svg"" />"
"<img sr
c=""cfc9273d1087f08113a576e314f8de02347fa18__0.svg"" />"
"<img src=""cfc9
273d1087f08113a576e314f8de02347fa18_source_svg.svg"" />"
"<img src=""cfc9

273d1087f08113a576e314f8de02347fa18_Screen Shot 2014-01-07 at

/>"
natomy_Block4
"<img src=""cfc9273d1087f08113a576e314f8de02347fa18_Q_1.svg""
c=""cfc9273d1087f08113a576e314f8de02347fa18__1.svg"" />"
273d1087f08113a576e314f8de02347fa18_source_svg.svg"" />"
273d1087f08113a576e314f8de02347fa18_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""cfc9273d1087f08113a576e314f8de02347fa18_Q_2.svg""
c=""cfc9273d1087f08113a576e314f8de02347fa18__2.svg"" />"
273d1087f08113a576e314f8de02347fa18_source_svg.svg"" />"
273d1087f08113a576e314f8de02347fa18_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""7792de648e7e94fd52605418ccaea96509d783_Q_0.svg""
c=""7792de648e7e94fd52605418ccaea96509d783__0.svg"" />"
de648e7e94fd52605418ccaea96509d783_source_svg.svg"" />"
de648e7e94fd52605418ccaea96509d783_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""7792de648e7e94fd52605418ccaea96509d783_Q_1.svg""
c=""7792de648e7e94fd52605418ccaea96509d783__1.svg"" />"
de648e7e94fd52605418ccaea96509d783_source_svg.svg"" />"
de648e7e94fd52605418ccaea96509d783_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""7792de648e7e94fd52605418ccaea96509d783_Q_2.svg""
c=""7792de648e7e94fd52605418ccaea96509d783__2.svg"" />"
de648e7e94fd52605418ccaea96509d783_source_svg.svg"" />"
de648e7e94fd52605418ccaea96509d783_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""7792de648e7e94fd52605418ccaea96509d783_Q_3.svg""
c=""7792de648e7e94fd52605418ccaea96509d783__3.svg"" />"
de648e7e94fd52605418ccaea96509d783_source_svg.svg"" />"
de648e7e94fd52605418ccaea96509d783_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""7792de648e7e94fd52605418ccaea96509d783_Q_4.svg""
c=""7792de648e7e94fd52605418ccaea96509d783__4.svg"" />"
de648e7e94fd52605418ccaea96509d783_source_svg.svg"" />"
de648e7e94fd52605418ccaea96509d783_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""a01f27dc353d67f67f29f8ee30871e65c284cd_Q_0.svg""
c=""a01f27dc353d67f67f29f8ee30871e65c284cd__0.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_source_svg.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""a01f27dc353d67f67f29f8ee30871e65c284cd_Q_1.svg""
c=""a01f27dc353d67f67f29f8ee30871e65c284cd__1.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_source_svg.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""a01f27dc353d67f67f29f8ee30871e65c284cd_Q_2.svg""
c=""a01f27dc353d67f67f29f8ee30871e65c284cd__2.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_source_svg.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_Screen Shot 2014-01-07 at
natomy_Block4
/>"
"<img src=""a01f27dc353d67f67f29f8ee30871e65c284cd_Q_3.svg""
c=""a01f27dc353d67f67f29f8ee30871e65c284cd__3.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_source_svg.svg"" />"
27dc353d67f67f29f8ee30871e65c284cd_Screen Shot 2014-01-07 at
/>"
natomy_Block4
"<img src=""7fa52c7c7fc522daaae820de331fa953ed0c5_Q_0.svg""
c=""7fa52c7c7fc522daaae820de331fa953ed0c5__0.svg"" />"
2c7c7fc522daaae820de331fa953ed0c5_source_svg.svg"" />"

7.06.56 PM.jpg""
/>"
"<img sr
"<img src=""cfc9
"<img src=""cfc9
7.06.56 PM.jpg""
/>"
"<img sr
"<img src=""cfc9
"<img src=""cfc9
7.06.56 PM.jpg""
/>"
"<img sr
"<img src=""7792
"<img src=""7792
7.09.27 PM.jpg""
/>"
"<img sr
"<img src=""7792
"<img src=""7792
7.09.27 PM.jpg""
/>"
"<img sr
"<img src=""7792
"<img src=""7792
7.09.27 PM.jpg""
/>"
"<img sr
"<img src=""7792
"<img src=""7792
7.09.27 PM.jpg""
/>"
"<img sr
"<img src=""7792
"<img src=""7792
7.09.27 PM.jpg""
/>"
"<img sr
"<img src=""a01f
"<img src=""a01f
7.14.54 PM.jpg""
/>"
"<img sr
"<img src=""a01f
"<img src=""a01f
7.14.54 PM.jpg""
/>"
"<img sr
"<img src=""a01f
"<img src=""a01f
7.14.54 PM.jpg""
/>"
"<img sr
"<img src=""a01f
"<img src=""a01f
7.14.54 PM.jpg""
/>"
"<img sr
"<img src=""7fa5
"<img src=""7fa5

2c7c7fc522daaae820de331fa953ed0c5_Screen Shot 2014-01-07 at 7.17.19 PM.jpg""

/>"
natomy_Block4
"<img src=""7fa52c7c7fc522daaae820de331fa953ed0c5_Q_1.svg"" />"
"<img sr
c=""7fa52c7c7fc522daaae820de331fa953ed0c5__1.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_source_svg.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_Screen Shot 2014-01-07 at 7.17.19 PM.jpg""
natomy_Block4
/>"
"<img src=""7fa52c7c7fc522daaae820de331fa953ed0c5_Q_2.svg"" />"
"<img sr
c=""7fa52c7c7fc522daaae820de331fa953ed0c5__2.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_source_svg.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_Screen Shot 2014-01-07 at 7.17.19 PM.jpg""
natomy_Block4
/>"
"<img src=""7fa52c7c7fc522daaae820de331fa953ed0c5_Q_3.svg"" />"
"<img sr
c=""7fa52c7c7fc522daaae820de331fa953ed0c5__3.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_source_svg.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_Screen Shot 2014-01-07 at 7.17.19 PM.jpg""
/>"
natomy_Block4
"<img src=""7fa52c7c7fc522daaae820de331fa953ed0c5_Q_4.svg"" />"
"<img sr
c=""7fa52c7c7fc522daaae820de331fa953ed0c5__4.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_source_svg.svg"" />"
"<img src=""7fa5
2c7c7fc522daaae820de331fa953ed0c5_Screen Shot 2014-01-07 at 7.17.19 PM.jpg""
/>"
natomy_Block4
"<img src=""e325825210e44f5ff7dd4c8398184fc72d4_Q_0.svg"" />"
"<img sr
c=""e325825210e44f5ff7dd4c8398184fc72d4__0.svg"" />"
"<img src=""e3
25825210e44f5ff7dd4c8398184fc72d4_source_svg.svg"" />"
"<img src=""e3
25825210e44f5ff7dd4c8398184fc72d4_Screen Shot 2014-01-07 at 7.22.10 PM.jpg""
natomy_Block4
/>"
"<img src=""e325825210e44f5ff7dd4c8398184fc72d4_Q_1.svg"" />"
"<img sr
c=""e325825210e44f5ff7dd4c8398184fc72d4__1.svg"" />"
"<img src=""e3
25825210e44f5ff7dd4c8398184fc72d4_source_svg.svg"" />"
"<img src=""e3
25825210e44f5ff7dd4c8398184fc72d4_Screen Shot 2014-01-07 at 7.22.10 PM.jpg""
natomy_Block4
/>"
"<img src=""7c466c2109e76c08c5e93247a4788850271734_Q_0.svg"" />"
"<img sr
c=""7c466c2109e76c08c5e93247a4788850271734__0.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_source_svg.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_Screen Shot 2014-01-07 at 7.23.03 PM.jpg""
/>"
natomy_Block4
"<img src=""7c466c2109e76c08c5e93247a4788850271734_Q_1.svg"" />"
"<img sr
c=""7c466c2109e76c08c5e93247a4788850271734__1.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_source_svg.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_Screen Shot 2014-01-07 at 7.23.03 PM.jpg""
/>"
natomy_Block4
"<img src=""7c466c2109e76c08c5e93247a4788850271734_Q_2.svg"" />"
"<img sr
c=""7c466c2109e76c08c5e93247a4788850271734__2.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_source_svg.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_Screen Shot 2014-01-07 at 7.23.03 PM.jpg""
natomy_Block4
/>"
"<img src=""7c466c2109e76c08c5e93247a4788850271734_Q_3.svg"" />"
"<img sr
c=""7c466c2109e76c08c5e93247a4788850271734__3.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_source_svg.svg"" />"
"<img src=""7c4
66c2109e76c08c5e93247a4788850271734_Screen Shot 2014-01-07 at 7.23.03 PM.jpg""
natomy_Block4
/>"
Name orders of anterior cervical region
"<img src=""Screen Shot 2014-0108 at 9.14.30 M.jpg"" />"
natomy_Block4
Which carotid has ranches in the neck? "external carotid<div><img src=""Screen
natomy_Block4
Shot 2014-01-08 at 9.21.45 M.jpg"" /></div>"
"<img src=""981a8f418aa356c420ae93d0a95995e37dc02c_Q_0.svg"" />"
"<img sr
c=""981a8f418aa356c420ae93d0a95995e37dc02c__0.svg"" />"
"<img src=""981a
8f418aa356c420ae93d0a95995e37dc02c_source_svg.svg"" />"
"<img src=""981a
8f418aa356c420ae93d0a95995e37dc02c_Screen Shot 2014-01-08 at 9.14.57 M.jpg""

/>"
natomy_Block4
"<img src=""981a8f418aa356c420ae93d0a95995e37dc02c_Q_1.svg"" />"
"<img sr
c=""981a8f418aa356c420ae93d0a95995e37dc02c__1.svg"" />"
"<img src=""981a
8f418aa356c420ae93d0a95995e37dc02c_source_svg.svg"" />"
"<img src=""981a
8f418aa356c420ae93d0a95995e37dc02c_Screen Shot 2014-01-08 at 9.14.57 M.jpg""
/>"
natomy_Block4
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_0.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__0.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
natomy_Block4
/>"
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_1.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__1.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
natomy_Block4
/>"
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_2.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__2.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
/>"
natomy_Block4
"<div><img src=""af09580cca20f249600dea3fd497c153afa0_Q_3.svg"" /></div>"
"<img src=""af09580cca20f249600dea3fd497c153afa0__3.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<div><i
mg src=""af09580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16
.19 M.jpg"" /></div>"
natomy_Block4
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_4.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__4.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
natomy_Block4
/>"
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_5.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__5.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
natomy_Block4
/>"
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_6.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__6.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
/>"
natomy_Block4
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_7.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__7.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
/>"
natomy_Block4
"<img src=""af09580cca20f249600dea3fd497c153afa0_Q_8.svg"" />"
"<img sr
c=""af09580cca20f249600dea3fd497c153afa0__8.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_source_svg.svg"" />"
"<img src=""af09
580cca20f249600dea3fd497c153afa0_Screen Shot 2014-01-08 at 9.16.19 M.jpg""
natomy_Block4
/>"
"<img src=""d70c7cfc729da9252d00ca657783cef5470f645_Q_0.svg"" />"
"<img sr
c=""d70c7cfc729da9252d00ca657783cef5470f645__0.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_source_svg.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_Screen Shot 2014-01-08 at 9.20.42 M.jpg""
natomy_Block4
/>"
"<img src=""d70c7cfc729da9252d00ca657783cef5470f645_Q_1.svg"" />"
"<img sr
c=""d70c7cfc729da9252d00ca657783cef5470f645__1.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_source_svg.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_Screen Shot 2014-01-08 at 9.20.42 M.jpg""

/>"
natomy_Block4
"<img src=""d70c7cfc729da9252d00ca657783cef5470f645_Q_2.svg"" />"
"<img sr
c=""d70c7cfc729da9252d00ca657783cef5470f645__2.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_source_svg.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_Screen Shot 2014-01-08 at 9.20.42 M.jpg""
/>"
natomy_Block4
"<img src=""d70c7cfc729da9252d00ca657783cef5470f645_Q_3.svg"" />"
"<img sr
c=""d70c7cfc729da9252d00ca657783cef5470f645__3.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_source_svg.svg"" />"
"<img src=""d70c
7cfc729da9252d00ca657783cef5470f645_Screen Shot 2014-01-08 at 9.20.42 M.jpg""
natomy_Block4
/>"
"<img src=""541e799e5760658f85f08c8805c6dd24745a0a_Q_0.svg"" />"
"<img sr
c=""541e799e5760658f85f08c8805c6dd24745a0a__0.svg"" />"
"<img src=""541e
799e5760658f85f08c8805c6dd24745a0a_source_svg.svg"" />"
"<img src=""541e
799e5760658f85f08c8805c6dd24745a0a_Screen Shot 2014-01-08 at 9.21.45 M.jpg""
natomy_Block4
/>"
"<img src=""541e799e5760658f85f08c8805c6dd24745a0a_Q_1.svg"" />"
"<img sr
c=""541e799e5760658f85f08c8805c6dd24745a0a__1.svg"" />"
"<img src=""541e
799e5760658f85f08c8805c6dd24745a0a_source_svg.svg"" />"
"<img src=""541e
799e5760658f85f08c8805c6dd24745a0a_Screen Shot 2014-01-08 at 9.21.45 M.jpg""
/>"
natomy_Block4
"<img src=""541e799e5760658f85f08c8805c6dd24745a0a_Q_2.svg"" />"
"<img sr
c=""541e799e5760658f85f08c8805c6dd24745a0a__2.svg"" />"
"<img src=""541e
799e5760658f85f08c8805c6dd24745a0a_source_svg.svg"" />"
"<img src=""541e
799e5760658f85f08c8805c6dd24745a0a_Screen Shot 2014-01-08 at 9.21.45 M.jpg""
/>"
natomy_Block4
What type of receptor is carotid sinus? "Baroreceptor<div><img src=""Screen Shot
natomy_Block4
2014-01-08 at 9.22.38 M.jpg"" /></div>"
"<img src=""f8079ddc7671da9232c5cf5a3fd70386171661_Q_0.svg"" />"
"<img sr
c=""f8079ddc7671da9232c5cf5a3fd70386171661__0.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_source_svg.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_Screen Shot 2014-01-08 at 9.22.38 M.jpg""
/>"
natomy_Block4
"<img src=""f8079ddc7671da9232c5cf5a3fd70386171661_Q_1.svg"" />"
"<img sr
c=""f8079ddc7671da9232c5cf5a3fd70386171661__1.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_source_svg.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_Screen Shot 2014-01-08 at 9.22.38 M.jpg""
/>"
natomy_Block4
"<img src=""f8079ddc7671da9232c5cf5a3fd70386171661_Q_2.svg"" />"
"<img sr
c=""f8079ddc7671da9232c5cf5a3fd70386171661__2.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_source_svg.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_Screen Shot 2014-01-08 at 9.22.38 M.jpg""
natomy_Block4
/>"
"<img src=""f8079ddc7671da9232c5cf5a3fd70386171661_Q_3.svg"" />"
"<img sr
c=""f8079ddc7671da9232c5cf5a3fd70386171661__3.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_source_svg.svg"" />"
"<img src=""f807
9ddc7671da9232c5cf5a3fd70386171661_Screen Shot 2014-01-08 at 9.22.38 M.jpg""
natomy_Block4
/>"
What type of receptor is carotid ody? "Chemoreceptor<div><img src=""Screen Sho
t 2014-01-08 at 9.22.38 M.jpg"" /></div>"
natomy_Block4
natomy_Block4
Which CN lies in carotid sheath?
CNX, Vagus n
"<img src=""effe173712f43f8f8308e71ed041aae0a520575_Q_0.svg"" />"
"<img sr
c=""effe173712f43f8f8308e71ed041aae0a520575__0.svg"" />"
"<img src=""effe
173712f43f8f8308e71ed041aae0a520575_source_svg.svg"" />"
"<img src=""effe
173712f43f8f8308e71ed041aae0a520575_Screen Shot 2014-01-08 at 9.24.44 M.jpg""
natomy_Block4
/>"
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_0.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__0.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""

/>"
natomy_Block4
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_1.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__1.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""
/>"
natomy_Block4
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_2.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__2.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""
natomy_Block4
/>"
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_3.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__3.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""
natomy_Block4
/>"
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_4.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__4.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""
/>"
natomy_Block4
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_5.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__5.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""
/>"
natomy_Block4
"<img src=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2_Q_6.svg"" />"
"<img sr
c=""0ce86aefc9ca685830cea7cdd349d8a0a9440d2__6.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_source_svg.svg"" />"
"<img src=""0ce8
6aefc9ca685830cea7cdd349d8a0a9440d2_Screen Shot 2014-01-08 at 9.25.53 M.jpg""
natomy_Block4
/>"
"<img src=""2c6988ea698875d5562a6997f4e1353c654_Q_0.svg"" />"
"<img sr
c=""2c6988ea698875d5562a6997f4e1353c654__0.svg"" />"
"<img src=""2c69
"<img src=""2c69
88ea698875d5562a6997f4e1353c654_source_svg.svg"" />"
88ea698875d5562a6997f4e1353c654_Screen Shot 2014-01-08 at 9.29.35 M.jpg""
natomy_Block4
/>"
"<img src=""2c6988ea698875d5562a6997f4e1353c654_Q_1.svg"" />"
"<img sr
c=""2c6988ea698875d5562a6997f4e1353c654__1.svg"" />"
"<img src=""2c69
88ea698875d5562a6997f4e1353c654_source_svg.svg"" />"
"<img src=""2c69
88ea698875d5562a6997f4e1353c654_Screen Shot 2014-01-08 at 9.29.35 M.jpg""
/>"
natomy_Block4
"<img src=""d2a70f6a0c1f11007f9afcae18595d54380c4_Q_0.svg"" />"
"<img sr
c=""d2a70f6a0c1f11007f9afcae18595d54380c4__0.svg"" />"
"<img src=""d2a
70f6a0c1f11007f9afcae18595d54380c4_source_svg.svg"" />"
"<img src=""d2a
70f6a0c1f11007f9afcae18595d54380c4_Screen Shot 2014-01-08 at 9.31.44 M.jpg""
/>"
natomy_Block4
"<img src=""d2a70f6a0c1f11007f9afcae18595d54380c4_Q_1.svg"" />"
"<img sr
c=""d2a70f6a0c1f11007f9afcae18595d54380c4__1.svg"" />"
"<img src=""d2a
70f6a0c1f11007f9afcae18595d54380c4_source_svg.svg"" />"
"<img src=""d2a
70f6a0c1f11007f9afcae18595d54380c4_Screen Shot 2014-01-08 at 9.31.44 M.jpg""
natomy_Block4
/>"
"<img src=""d2a70f6a0c1f11007f9afcae18595d54380c4_Q_2.svg"" />"
"<img sr
c=""d2a70f6a0c1f11007f9afcae18595d54380c4__2.svg"" />"
"<img src=""d2a
"<img src=""d2a
70f6a0c1f11007f9afcae18595d54380c4_source_svg.svg"" />"
70f6a0c1f11007f9afcae18595d54380c4_Screen Shot 2014-01-08 at 9.31.44 M.jpg""
natomy_Block4
/>"
Deep ranches of cervical plexus include what nerve originating from C4 with con
triutions C3, C5
"<img src=""Screen Shot 2014-01-08 at 9.43.51 M.jpg"" /
natomy_Block4
>"
"<img src=""769898f8c05c21a1addcfe4d45ce1dae5754cf_Q_0.svg"" />"
"<img sr

c=""769898f8c05c21a1addcfe4d45ce1dae5754cf__0.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_source_svg.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_Screen Shot 2014-01-08 at 9.38.03 M.jpg""
natomy_Block4
/>"
"<img src=""769898f8c05c21a1addcfe4d45ce1dae5754cf_Q_1.svg"" />"
"<img sr
c=""769898f8c05c21a1addcfe4d45ce1dae5754cf__1.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_source_svg.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_Screen Shot 2014-01-08 at 9.38.03 M.jpg""
/>"
natomy_Block4
"<img src=""769898f8c05c21a1addcfe4d45ce1dae5754cf_Q_2.svg"" />"
"<img sr
c=""769898f8c05c21a1addcfe4d45ce1dae5754cf__2.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_source_svg.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_Screen Shot 2014-01-08 at 9.38.03 M.jpg""
/>"
natomy_Block4
"<img src=""769898f8c05c21a1addcfe4d45ce1dae5754cf_Q_3.svg"" />"
"<img sr
c=""769898f8c05c21a1addcfe4d45ce1dae5754cf__3.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_source_svg.svg"" />"
"<img src=""7698
98f8c05c21a1addcfe4d45ce1dae5754cf_Screen Shot 2014-01-08 at 9.38.03 M.jpg""
natomy_Block4
/>"
"<img src=""74aa8a4e56327f2036a6648018ae30fd656a1_Q_0.svg"" />"
"<img sr
c=""74aa8a4e56327f2036a6648018ae30fd656a1__0.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_source_svg.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_Screen Shot 2014-01-08 at 9.40.23 M.jpg""
natomy_Block4
/>"
"<img src=""74aa8a4e56327f2036a6648018ae30fd656a1_Q_1.svg"" />"
"<img sr
c=""74aa8a4e56327f2036a6648018ae30fd656a1__1.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_source_svg.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_Screen Shot 2014-01-08 at 9.40.23 M.jpg""
/>"
natomy_Block4
"<img src=""74aa8a4e56327f2036a6648018ae30fd656a1_Q_2.svg"" />"
"<img sr
c=""74aa8a4e56327f2036a6648018ae30fd656a1__2.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_source_svg.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_Screen Shot 2014-01-08 at 9.40.23 M.jpg""
/>"
natomy_Block4
"<img src=""74aa8a4e56327f2036a6648018ae30fd656a1_Q_3.svg"" />"
"<img sr
c=""74aa8a4e56327f2036a6648018ae30fd656a1__3.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_source_svg.svg"" />"
"<img src=""74aa
8a4e56327f2036a6648018ae30fd656a1_Screen Shot 2014-01-08 at 9.40.23 M.jpg""
natomy_Block4
/>"
What muscle lies in etween suclavian artery and vein as a landmark? "nterio
r scalene<div><img src=""Screen Shot 2014-01-08 at 9.51.25 M.jpg"" /></div>"
natomy_Block4
"<img src=""ae227e6d167386c427a8a0946f1410261c9d52_Q_0.svg"" />"
"<img sr
c=""ae227e6d167386c427a8a0946f1410261c9d52__0.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_source_svg.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_Screen Shot 2014-01-08 at 9.44.04 M.jpg""
natomy_Block4
/>"
"<img src=""ae227e6d167386c427a8a0946f1410261c9d52_Q_1.svg"" />"
"<img sr
c=""ae227e6d167386c427a8a0946f1410261c9d52__1.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_source_svg.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_Screen Shot 2014-01-08 at 9.44.04 M.jpg""
natomy_Block4
/>"
"<img src=""ae227e6d167386c427a8a0946f1410261c9d52_Q_2.svg"" />"
"<img sr
c=""ae227e6d167386c427a8a0946f1410261c9d52__2.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_source_svg.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_Screen Shot 2014-01-08 at 9.44.04 M.jpg""
/>"
natomy_Block4
"<img src=""ae227e6d167386c427a8a0946f1410261c9d52_Q_3.svg"" />"
"<img sr
c=""ae227e6d167386c427a8a0946f1410261c9d52__3.svg"" />"
"<img src=""ae22
7e6d167386c427a8a0946f1410261c9d52_source_svg.svg"" />"
"<img src=""ae22

7e6d167386c427a8a0946f1410261c9d52_Screen Shot 2014-01-08 at

/>"
natomy_Block4
"<img src=""0193f5ad7297a77cd720513795a6e8d1ea7d0a_Q_0.svg""
c=""0193f5ad7297a77cd720513795a6e8d1ea7d0a__0.svg"" />"
f5ad7297a77cd720513795a6e8d1ea7d0a_source_svg.svg"" />"
f5ad7297a77cd720513795a6e8d1ea7d0a_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""c8f68981e4e8c23889e1c3cedd46e7d4348_Q_0.svg""
c=""c8f68981e4e8c23889e1c3cedd46e7d4348__0.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_source_svg.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""c8f68981e4e8c23889e1c3cedd46e7d4348_Q_1.svg""
c=""c8f68981e4e8c23889e1c3cedd46e7d4348__1.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_source_svg.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_Screen Shot 2014-01-08 at
/>"
natomy_Block4
"<img src=""c8f68981e4e8c23889e1c3cedd46e7d4348_Q_2.svg""
c=""c8f68981e4e8c23889e1c3cedd46e7d4348__2.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_source_svg.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_Screen Shot 2014-01-08 at
/>"
natomy_Block4
"<img src=""c8f68981e4e8c23889e1c3cedd46e7d4348_Q_3.svg""
c=""c8f68981e4e8c23889e1c3cedd46e7d4348__3.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_source_svg.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""c8f68981e4e8c23889e1c3cedd46e7d4348_Q_4.svg""
c=""c8f68981e4e8c23889e1c3cedd46e7d4348__4.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_source_svg.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""c8f68981e4e8c23889e1c3cedd46e7d4348_Q_5.svg""
c=""c8f68981e4e8c23889e1c3cedd46e7d4348__5.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_source_svg.svg"" />"
8981e4e8c23889e1c3cedd46e7d4348_Screen Shot 2014-01-08 at
/>"
natomy_Block4
"<img src=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19_Q_0.svg""
c=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19__0.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_source_svg.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_Screen Shot 2014-01-08 at
/>"
natomy_Block4
"<img src=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19_Q_1.svg""
c=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19__1.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_source_svg.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19_Q_2.svg""
c=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19__2.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_source_svg.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19_Q_3.svg""
c=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19__3.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_source_svg.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_Screen Shot 2014-01-08 at
/>"
natomy_Block4
"<img src=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19_Q_4.svg""
c=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19__4.svg"" />"
cc4ee3dd4f9dfc2512253754eeaf4cdd19_source_svg.svg"" />"

9.44.04 M.jpg""
/>"
"<img sr
"<img src=""0193
"<img src=""0193
9.44.32 M.jpg""
/>"
"<img sr
"<img src=""c8f6
"<img src=""c8f6
9.45.39 M.jpg""
/>"
"<img sr
"<img src=""c8f6
"<img src=""c8f6
9.45.39 M.jpg""
/>"
"<img sr
"<img src=""c8f6
"<img src=""c8f6
9.45.39 M.jpg""
/>"
"<img sr
"<img src=""c8f6
"<img src=""c8f6
9.45.39 M.jpg""
/>"
"<img sr
"<img src=""c8f6
"<img src=""c8f6
9.45.39 M.jpg""
/>"
"<img sr
"<img src=""c8f6
"<img src=""c8f6
9.45.39 M.jpg""
/>"
"<img sr
"<img src=""1ea0
"<img src=""1ea0
9.46.46 M.jpg""
/>"
"<img sr
"<img src=""1ea0
"<img src=""1ea0
9.46.46 M.jpg""
/>"
"<img sr
"<img src=""1ea0
"<img src=""1ea0
9.46.46 M.jpg""
/>"
"<img sr
"<img src=""1ea0
"<img src=""1ea0
9.46.46 M.jpg""
/>"
"<img sr
"<img src=""1ea0
"<img src=""1ea0

cc4ee3dd4f9dfc2512253754eeaf4cdd19_Screen Shot 2014-01-08 at 9.46.46 M.jpg""

/>"
natomy_Block4
"<img src=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19_Q_5.svg"" />"
"<img sr
c=""1ea0cc4ee3dd4f9dfc2512253754eeaf4cdd19__5.svg"" />"
"<img src=""1ea0
cc4ee3dd4f9dfc2512253754eeaf4cdd19_source_svg.svg"" />"
"<img src=""1ea0
cc4ee3dd4f9dfc2512253754eeaf4cdd19_Screen Shot 2014-01-08 at 9.46.46 M.jpg""
natomy_Block4
/>"
What anterior cervical triangle is ounded y superior elly of omohyoid, anteri
or order of SCM, median plane of neck? "Muscular triangle<div><img src=""Screen
Shot 2014-01-08 at 9.48.58 M.jpg"" /></div>" natomy_Block4
What causes horners syndrome? "Lesion of sympathetic trunk<div><img src=""Scre
natomy_Block4
en Shot 2014-01-08 at 9.54.58 M.jpg"" /></div>"
"<img src=""22cac0353c4056992d82881e2a32f929093d_Q_0.svg"" />"
"<img sr
c=""22cac0353c4056992d82881e2a32f929093d__0.svg"" />"
"<img src=""22ca
c0353c4056992d82881e2a32f929093d_source_svg.svg"" />"
"<img src=""22ca
c0353c4056992d82881e2a32f929093d_Screen Shot 2014-01-08 at 9.48.58 M.jpg""
/>"
natomy_Block4
"<img src=""2e6546e429ef6127ad10221fa1feae5cf75_Q_0.svg"" />"
"<img sr
c=""2e6546e429ef6127ad10221fa1feae5cf75__0.svg"" />"
"<img src=""2e65
46e429ef6127ad10221fa1feae5cf75_source_svg.svg"" />"
"<img src=""2e65
46e429ef6127ad10221fa1feae5cf75_Screen Shot 2014-01-08 at 9.53.34 M.jpg""
/>"
natomy_Block4
"<img src=""2e6546e429ef6127ad10221fa1feae5cf75_Q_1.svg"" />"
"<img sr
c=""2e6546e429ef6127ad10221fa1feae5cf75__1.svg"" />"
"<img src=""2e65
46e429ef6127ad10221fa1feae5cf75_source_svg.svg"" />"
"<img src=""2e65
46e429ef6127ad10221fa1feae5cf75_Screen Shot 2014-01-08 at 9.53.34 M.jpg""
natomy_Block4
/>"
"<img src=""2e6546e429ef6127ad10221fa1feae5cf75_Q_2.svg"" />"
"<img sr
c=""2e6546e429ef6127ad10221fa1feae5cf75__2.svg"" />"
"<img src=""2e65
46e429ef6127ad10221fa1feae5cf75_source_svg.svg"" />"
"<img src=""2e65
46e429ef6127ad10221fa1feae5cf75_Screen Shot 2014-01-08 at 9.53.34 M.jpg""
natomy_Block4
/>"
"<img src=""e069a6d8c64e48c3134e8d6eff985ed245855c6_Q_0.svg"" />"
"<img sr
c=""e069a6d8c64e48c3134e8d6eff985ed245855c6__0.svg"" />"
"<img src=""e069
a6d8c64e48c3134e8d6eff985ed245855c6_source_svg.svg"" />"
"<img src=""e069
a6d8c64e48c3134e8d6eff985ed245855c6_Screen Shot 2014-01-08 at 9.54.58 M.jpg""
/>"
natomy_Block4
What spinal level innervates larynx?
"C3-C6<div><img src=""Screen Shot 2014-0
natomy_Block4
1-08 at 10.04.33 M.jpg"" /></div>"
"<img src=""dd8490aa2326a52f7e972c2270878d76ae466_Q_0.svg"" />"
"<img sr
c=""dd8490aa2326a52f7e972c2270878d76ae466__0.svg"" />"
"<img src=""dd8
490aa2326a52f7e972c2270878d76ae466_source_svg.svg"" />"
"<img src=""dd8
490aa2326a52f7e972c2270878d76ae466_Screen Shot 2014-01-08 at 9.59.23 M.jpg""
natomy_Block4
/>"
"<img src=""dd8490aa2326a52f7e972c2270878d76ae466_Q_1.svg"" />"
"<img sr
c=""dd8490aa2326a52f7e972c2270878d76ae466__1.svg"" />"
"<img src=""dd8
490aa2326a52f7e972c2270878d76ae466_source_svg.svg"" />"
"<img src=""dd8
490aa2326a52f7e972c2270878d76ae466_Screen Shot 2014-01-08 at 9.59.23 M.jpg""
/>"
natomy_Block4
"<img src=""dd8490aa2326a52f7e972c2270878d76ae466_Q_2.svg"" />"
"<img sr
c=""dd8490aa2326a52f7e972c2270878d76ae466__2.svg"" />"
"<img src=""dd8
490aa2326a52f7e972c2270878d76ae466_source_svg.svg"" />"
"<img src=""dd8
490aa2326a52f7e972c2270878d76ae466_Screen Shot 2014-01-08 at 9.59.23 M.jpg""
/>"
natomy_Block4
Where is a tracheostomy made? "Between 1st and 2nd tracheal rings, or through
2nd through 4th rings<div><img src=""Screen Shot 2014-01-09 at 9.21.02 M.jpg""
/></div>"
natomy_Block4
"<img src=""878ded87a46691300867e01ad101d9a937058fd_Q_0.svg"" />"
"<img sr
c=""878ded87a46691300867e01ad101d9a937058fd__0.svg"" />"
"<img src=""878d
ed87a46691300867e01ad101d9a937058fd_source_svg.svg"" />"
"<img src=""878d

ed87a46691300867e01ad101d9a937058fd_Screen Shot 2014-01-08 at

/>"
natomy_Block4
"<img src=""878ded87a46691300867e01ad101d9a937058fd_Q_1.svg""
c=""878ded87a46691300867e01ad101d9a937058fd__1.svg"" />"
ed87a46691300867e01ad101d9a937058fd_source_svg.svg"" />"
ed87a46691300867e01ad101d9a937058fd_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""878ded87a46691300867e01ad101d9a937058fd_Q_2.svg""
c=""878ded87a46691300867e01ad101d9a937058fd__2.svg"" />"
ed87a46691300867e01ad101d9a937058fd_source_svg.svg"" />"
ed87a46691300867e01ad101d9a937058fd_Screen Shot 2014-01-08 at
natomy_Block4
/>"
"<img src=""837fc341f5d942d63f61562ca114c78e95700_Q_0.svg""
c=""837fc341f5d942d63f61562ca114c78e95700__0.svg"" />"
c341f5d942d63f61562ca114c78e95700_source_svg.svg"" />"
c341f5d942d63f61562ca114c78e95700_Screen Shot 2014-01-08 at
/>"
natomy_Block4
"<img src=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e_Q_0.svg""
c=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e__0.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_source_svg.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_Screen Shot 2014-01-09 at
/>"
natomy_Block4
"<img src=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e_Q_1.svg""
c=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e__1.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_source_svg.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_Screen Shot 2014-01-09 at
natomy_Block4
/>"
"<img src=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e_Q_2.svg""
c=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e__2.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_source_svg.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_Screen Shot 2014-01-09 at
natomy_Block4
/>"
"<img src=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e_Q_3.svg""
c=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e__3.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_source_svg.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_Screen Shot 2014-01-09 at
/>"
natomy_Block4
"<img src=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e_Q_4.svg""
c=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e__4.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_source_svg.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_Screen Shot 2014-01-09 at
/>"
natomy_Block4
"<img src=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e_Q_5.svg""
c=""ef3d03ad26a8d79a0d6f4d1f653c9a75550e__5.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_source_svg.svg"" />"
03ad26a8d79a0d6f4d1f653c9a75550e_Screen Shot 2014-01-09 at
natomy_Block4
/>"
"<img src=""fc49c57d49d9c2e5e23713403019f77061808dc3_Q_0.svg""
c=""fc49c57d49d9c2e5e23713403019f77061808dc3__0.svg"" />"
c57d49d9c2e5e23713403019f77061808dc3_source_svg.svg"" />"
c57d49d9c2e5e23713403019f77061808dc3_Screen Shot 2014-01-09 at
natomy_Block4
/>"
"<img src=""fc49c57d49d9c2e5e23713403019f77061808dc3_Q_1.svg""
c=""fc49c57d49d9c2e5e23713403019f77061808dc3__1.svg"" />"
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/>"
natomy_Block4
"<img src=""fc49c57d49d9c2e5e23713403019f77061808dc3_Q_2.svg""
c=""fc49c57d49d9c2e5e23713403019f77061808dc3__2.svg"" />"
c57d49d9c2e5e23713403019f77061808dc3_source_svg.svg"" />"

11.04.07 PM.jpg""
/>"
"<img sr
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natomy_Block4
"<img src=""fc49c57d49d9c2e5e23713403019f77061808dc3_Q_3.svg"" />"
"<img sr
c=""fc49c57d49d9c2e5e23713403019f77061808dc3__3.svg"" />"
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"<img src=""fc49
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/>"
"<img src=""fc49c57d49d9c2e5e23713403019f77061808dc3_Q_4.svg"" />"
"<img sr
c=""fc49c57d49d9c2e5e23713403019f77061808dc3__4.svg"" />"
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c57d49d9c2e5e23713403019f77061808dc3_source_svg.svg"" />"
"<img src=""fc49
c57d49d9c2e5e23713403019f77061808dc3_Screen Shot 2014-01-09 at 9.19.39 M.jpg""
natomy_Block4
/>"
"<img src=""65a48464fa8346a0408c8ac2e2097213614_Q_0.svg"" />"
"<img sr
c=""65a48464fa8346a0408c8ac2e2097213614__0.svg"" />"
"<img src=""65a4
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"<img src=""65a4
8464fa8346a0408c8ac2e2097213614_Screen Shot 2014-01-09 at 9.26.23 M.jpg""
/>"
natomy_Block4
Q: How can alcohol lead to a hypoglycemic coma? ": the metaolism of alcohol us
es up all the ND+ in the liver; the increase in NDH causes the intermediates o
f gluconeogenesis to e diverted into alternate reaction pathways which results
in the decreased synthesis of glucose; therefore the individual only has one sou
rce of glucose and thats glycogen--&gt;in alcoholics low in glycogen this can res
ult in a hypoglycemic coma<div><img src=""Screen Shot 2014-01-09 at 3.01.25 PM.j
pg"" /></div>" pharmacology_lock4
Q: What prescription drug is used to treat alcoholism? Mechanism?
": disu
lfiram--&gt;<font color=""#ff0000"">inhiits aldehyde dehydrogenase</font> (see
image aove); this medication makes you ill and not want alcohol anymore<div><im
g src=""Screen Shot 2014-01-09 at 3.01.25 PM.jpg"" /></div>"
pharmacology_lo
ck4
Q: What is clearance? <div>: <>volume cleared of drug per unit time</>; its
defined as the fixed volume of fluid cleared of a the drug per unit time (note:
this is different from the rate of drug elimination) Units of clearance = volume
/ unit time</div><div><>Clearance = rate of removal of drug (mg/min) / plasma
concentration of drug (mg/ml)</> Cl = renal clearance + hepatic clearance + pul
monary + feces + skin</div><div>Kidney or liver failure decreases total drug cle
arance</div>
pharmacology_lock4
What is the difference etween apoptosis and necrosis? "poptosis is the death
of a single cell<div>Necrosis is the death of multiple cells</div><div><r /></d
iv><div><img src=""paste-45170171052409.jpg"" /></div>" CellularInjury
daption<div>Reversile
What are the 3 cellular responses to harmful stimuli?
injury</div><div>Irreversile injury</div>
CellularInjury
What are the 4 targets for cellular injury?
Cell memrane<div>eroic metao
lism</div><div>Protein synthesis</div><div>DN integrity</div> CellularInjury
What is the general injury model for hypoxia? "Decreased oxygen results in dec
reased oxidative phosphorylation and reduced TP production<div><r /></div><div
>Decreased TP causes:</div><div>1. decreased Na/K pump activity,&nsp;</div><di
v>2.increased glycolysis, and</div><div>3. detachment of riosomes (decreased pr
otein synthesis)</div><div><r /></div><div><img src=""paste-41077067219446.jpg"
" /></div>"
CellularInjury
"<img src=""9e35643831ae5a7f8646079eea673f450a2fa0_Q_0.svg"" />"
"<img sr
c=""9e35643831ae5a7f8646079eea673f450a2fa0__0.svg"" />"
"<img src=""9e35
643831ae5a7f8646079eea673f450a2fa0_source_svg.svg"" />"
"<img src=""9e35
643831ae5a7f8646079eea673f450a2fa0_Screen Shot 2014-01-09 at 3.16.05 PM.jpg""
/>"
natomy_Block4
"<img src=""9e35643831ae5a7f8646079eea673f450a2fa0_Q_1.svg"" />"
"<img sr
c=""9e35643831ae5a7f8646079eea673f450a2fa0__1.svg"" />"
"<img src=""9e35
643831ae5a7f8646079eea673f450a2fa0_source_svg.svg"" />"
"<img src=""9e35
643831ae5a7f8646079eea673f450a2fa0_Screen Shot 2014-01-09 at 3.16.05 PM.jpg""
natomy_Block4
/>"
What are the effects of reduced Na/K pump activity in hypoxic cells? (3)

"1. Influx of sodium and calcium, which increases osmotic pressure causing swell
ing and memrane damage (of cell memrane, ER memrane, and mitochondrial memra
ne)<div><r /></div><div>2. Damage to memrane leads to inappropriate movement a
nd activation of proteins</div><div><r /></div><div>3. Calcium influx disrupts
normal enzymatic processes throughout cell</div><div><r /></div><div><img src="
"paste-41154376630728.jpg"" /></div>" CellularInjury
What are the effects of increased glycolysis in hypoxic cells? "Drop in pH caus
es chromatin to clump<div>Depletion of cellular glycogen</div><div><img src=""pa
ste-41180146434550.jpg"" /></div>"
CellularInjury
What are the effects of detached riosomes in hypoxic cells?
"Decreased prote
in synthesis<div>Increased lipid deposition</div><div><img src=""paste-411758514
67254.jpg"" /></div>" CellularInjury
Why is reperfusion oth ad and good? "Reperfusion will help cells with revers
ile damage return to physiologic state<div><r /></div><div>Cells with irrevers
ile damage will die regardless of perfusion- these cells (and the WBC they attr
act) release toxic metaolites and free radicals that can further damage healthy
tissue</div><div><r /></div><div><img src=""paste-41214506172886.jpg"" /></div
>"
CellularInjury
How do free radicals damage cells?
Lipid peroxidation of the memrane (oxid
ative degredation of lipid memrane)<div>Inactivating enzymes</div><div>Damages
DN</div>
CellularInjury
What are some examples of physiological apoptosis? Pathologic apoptosis?
emryologic involution<r /><div>Hormone dependent involution</div><div>Normal c
ell death in proliferating populations</div><div><r /></div><div>Cell death fro
m chemotherapy</div><div>Destruction due to viral infection</div><div>trophy af
ter duct ostruction</div><div>Death of neutrophils<div>Destruction y killer T
cells</div></div>
CellularInjury
What are the 3 pathways that stimulate apoptosis?&nsp; "Extrinsic pathway-<> F
S or TNF </>directly activate initiator caspases through FDD and TRDD<div><
r /></div><div><img src=""paste-44074954392196.jpg"" /><r /><div><r /></div><d
iv>Intrinsic pathway- Withdrawal of growth factors or hormones cause mitochondri
a to release pro-apoptotic factors (<>BCL-2 </>family) which allow for release
of cytochrome c and susequent activation of initiator caspases</div><div><r /
></div><div><img src=""paste-44440026612371.jpg"" /></div><div><r /></div><div>
Cellular injury- Damages DN which activates <>p53</> which increases pro-apop
totic factors and activates executionor caspases</div></div>" CellularInjury
Draw the general schema of apoptosis
"<img src=""paste-4462471020865.jpg"" />
"
CellularInjury
Descrie hydropic change
Cell swelling.&nsp;<div>Loss of TP--&gt;Loss o
f Na/K pump--&gt; Increased Na, Ca--&gt; Water follows</div>
pathology_lock4
How do initiator and executioner caspases work? "<div>Initiator caspases (8 and
9) (in conjuction with other proteins) activate executioner caspases&nsp;</div>
<div><r /></div>Executioner caspases <>disrupt the cytoskeleto</>n and activa
te <>endonucleases </>which degrade DN&nsp;<div><r /></div><div><img src=""
paste-44667659878871.jpg"" /></div>"
CellularInjury
What are the memers of the Bcl-2 family? What do they do?
"They control th
e permeaility of the mitochondria, which controls the cytosolic concentration o
f molecules (cyt c) that favor apoptosis<div><r /></div><div>Bax and Bad increa
se permeaility</div><div>Bcl-2 and Bcl-XL decrease permeaility</div><div><r /
></div><div><img src=""paste-44697724649931.jpg"" /></div>"
CellularInjury
Descrie the morphology of apoptotic cells
Cell shrinks<div>Nuclear chromat
in condenses</div><div>Cytoplasm ulges out in les and pinches off apoptotic 
odies</div>
CellularInjury
"<img src=""paste-5093831213349.jpg"" /><div>What is the evidence that this cell
is apoptotic?</div>" Halo around it indicates shrinkage<div>Chromatin is dark
and condensed</div>
CellularInjury
"<img src=""paste-5171140624684.jpg"" /><div>What is the evidence this cell is a
poptotic?</div>"
Eosinophilic cytoplasm<div>Nucleus is reaking up and co
ndensed</div> CellularInjury
"<img src=""paste-5291399708890.jpg"" /><div>What is happening in this cell?</di

v>"
Chromatin is condensed and reaking apart<div>poptosis</div> Cellular
Injury
How do cytotoxic T cells induce apoptosis?
They add perforins to the cell m
emrane<div>Granzyme B in the cell activates executioner caspases</div> Cellular
Injury
Briefly descrie the 4 types of cellular adaption to stimuli
Hypertrophy- inc
rease in cell size (through increased protein synthesis)<div>Hyperplasia- increa
se in cell numer (through mitosis)</div><div>trophy- decrease in cell size or
numer</div><div>Metaplasia- change from one adult cell type to another</div>
CellularInjury2
"<img src=""paste-5918464934164.jpg"" /><div>Which of these cardiac myocytes is
anormal? Descrie the process that made it this way</div>"
Left<div>Hypertr
ophy from increased protein production</div>
CellularInjury2
No<div>Uterus undergoes
re hyperplasia and hypertrophy mutually exclusive?
oth during prengnancy</div>
CellularInjury2
"<img src=""paste-6090263625950.jpg"" /><img src=""paste-6103148527751.jpg"" /><
div>Which thyroid is anormal? What type of cell change is it undergoing?</div>"
Top- hyperplastic
CellularInjury2
<div>Descrie the intracellular process of atrophy?&nsp;</div> Increased uiqui
nation and proteasome protein degradation within the cell
CellularInjury2
"<img src=""paste-6206227743038.jpg"" />"
B
CellularInjury2
Why does metaplasia occur? Give 2 examples
It is a response to damage to tr
y and etter protect itself<div><r /></div><div>Happens in cervix due to inflam
mation</div><div>Happens in Barret esophagus due to GERD</div> CellularInjury2
Descrie the 2 main types of reversile cellular injury<div>How do they look dif
ferent microscopically?</div> Hydropic change- increased water in cell (swelli
ng) due to reduced Na pump activity (nuclei will e in the middle of the clear a
rea)<div><r /></div><div>Fatty change- increased fat in cell (steatosis) due to
interference with protein/fat metaolism (nuclei will e pushed to the side of
the clear area)</div> CellularInjury2
"<img src=""paste-6347961663749.jpg"" /><div>What is happening to the cells on t
he right?</div>"
They have undergone hydropic change and are swollen with
water CellularInjury2
"<img src=""paste-6468220748053.jpg"" /><img src=""paste-6481105649811.jpg"" /><
div>What is happening in this tissue? What is the evidence?</div>"
Fatty ch
ange<div>Oil red O stain shows that accumulation are lipids</div>
Cellular
Injury2
What can accumulate inside the cell pathologically?
Triglycerides, cholester
ol, storage lipids<div>Calcium (psammoma odies)</div><div>Immunogloins (russel
l odies)</div><div>Glycogen</div>
CellularInjury2
"<img src=""paste-6725918785803.jpg"" /><div>What is occuring here?</div>"
Cholesterol accumulation (atherosclerosis) with macrophages surrounding it
CellularInjury2
"<img src=""paste-6970731921692.jpg"" /><div>What is the pathologic accumulation
seen here?</div>"
Storage lipids that are phagocytosized y macrophages to
ecome tissue paper cells<div>Gauchers Disease (glucocererosidase)</div>
CellularInjury2
External carotid ranches pnemonic
"Some ncient Lovers Find Old Positions
More Satisfying<div><r /></div><div>(superior thyroid, ascending pharyngeal, li
ngual, facial, occipital, maxillary, superficial temporal)</div><div><r /></div
><div><img src=""paste-202078211277720.jpg"" /></div><div>#accurate</div>"
pathology_lock4
"<img src=""0d8a6dee9a12389838f46d3c2c735556c489_Q_0.svg"" />"
"<img sr
c=""0d8a6dee9a12389838f46d3c2c735556c489__0.svg"" />"
"<img src=""0d8a
6dee9a12389838f46d3c2c735556c489_source_svg.svg"" />"
"<img src=""0d8a
6dee9a12389838f46d3c2c735556c489_Screen Shot 2014-01-09 at 4.23.38 PM.jpg""
/>"
natomy_Block4
"<img src=""paste-7039451398439.jpg"" /><div>What is the pathologica accumulatio
n here?</div>" immunogloins forming Russell odies
CellularInjury2
"<img src=""paste-7099580940522.jpg"" /><div><img src=""paste-7112465842349.jpg"

" />(PS)</div><div>What is the pathologic accumulation here? What is major poin

t of identification?</div>"
Glycogen<div>PS stain is pink</div>
Cellular
Injury2
What are the 2 types of calcification? Dystrophic calcification- deposition in
damaged tissue (heart valves)<div>Metastatic calcification- deposition in health
y tissue due to eleveated serum levels</div>
CellularInjury2
What are psammoma odies?
Calcium depositions that are seen in tumors
CellularInjury2
What are the 4 types of necrosis?
Coagulative&nsp;<div>Liquefaction</div>
<div>Caseous&nsp;</div><div>Fat</div> CellularInjury2
What are the gross and microscopic features of coagulative necrosis? What normal
ly casues it? Gross- tissue looks soft and pale (lack in lung)<div>Micro- Cel
l outline remains, eosinophilic cytoplasm, nondistinct organelles, lack of nucle
i</div><div><r /></div><div>Ischemia to tissue&nsp;</div>
CellularInjury2
"<img src=""paste-7503307866395.jpg"" /><div><r /></div><div><img src=""paste-7
516192768267.jpg"" /></div><div>What type of necrosis is this?</div>" Coagulat
ive necrosis
CellularInjury2
"<img src=""paste-8473970475298.jpg"" /><div><img src=""paste-8486855377171.jpg"
" /></div><div>What type of necrosis is this? What usually casues it?</div>"
Liquefactive necrosis<div>Ischemia to the rain</div> CellularInjury2
What type of necrosis is an ascess?
Liquefactive necrosis CellularInjury2
What are the gross and microscopic features of liquefactive necrosis? Gross- s
oft, full of pus or fluid<div>Microscopic- no cell outlines with empty space</di
v>
CellularInjury2
"<img src=""paste-8564164788534.jpg"" /><div><img src=""paste-8577049690403.jpg"
" /><r /><div>What type of necrosis is this? What is it caused y?</div></div>"
Caseous necrosis<div>Caused y immune response to TB infection of the lung or fu
ngi</div>
CellularInjury2
What are the gross and microscopic features of caseous necrosis?
Gross- c
heese-like sustance<div>Micro- amorphous pink material with no nuclei</div>
CellularInjury2
"<img src=""paste-8632884265157.jpg"" /><img src=""paste-8645769167142.jpg"" /><
div>What type of necrosis is this?</div>"
Fat necrosis
CellularInjury2
What are the gross and microscopic features of fat necrosis?
Gross- gritty ar
eas of calcium deposits<div><r /></div><div>Micro- No nuclei, vague cell outlin
es, caclification, saponification (fatty acids +calcium =soap)</div>
Cellular
Injury2
Define gangrene oth grossly and microscopically
Micro- coagulative necro
sis<div>Gross- lack necrotic tissue</div>
CellularInjury2
What are the important exogenous and endogenous pigments?
Exogenous- caro
n/coal, tatoo pigments<div>Endogenous- lipofuscin, melanin, hemosiderin, iliru
in</div>
CellularInjury2
"<img src=""paste-8843337662648.jpg"" /><img src=""paste-8856222564515.jpg"" /><
nthracosis<div>Caron deposits in lung<
div>What is happening here?</div>"
/div> CellularInjury2
"<img src=""paste-8890582302992.jpg"" /><div>What is at the arrow in this cardia
c tissue?</div>"
Lipofuscin<div>Result of normal wear and tear damage on
plasma memranes</div> CellularInjury2
What is the formal name given to the posterior rami of the C2 spinal nerve?
"Greater occipital nerve<div><img src=""Screen Shot 2014-01-10 at 7.50.12 M.jpg
natomy_Block4
"" /></div>"
What is the name given to the posterior rami of the C1 spinal nerve? What does i
t innervate?
"Suoccipital nerve<div><r /></div><div>Provides motor innervat
ion to all muscles of suoccipital triangle.<r /><div><img src=""Screen Shot 20
natomy_Block4
14-01-10 at 7.50.12 M.jpg"" /></div></div>"
T/F Bound drugs are the only active form of a drug
False, free drugs
pharmacology_lock4
T/F&nsp; drug must e asored and achieve adequate concentration at its site
of action in order to produce its iological effects. T
pharmacology_lo
ck4

Where does major drug metaolism take place?

Liver pharmacology_lock4
<div>Influence of pH:</div><div>If pH&gt;pka then the _________ form predominate
s. If pH&lt;pka then the _______ form predominates</div>
"<div>unprotonat
ed&nsp;(- or B)</div><div>protonated&nsp;(H or BH+)</div><div><r /></div><d
iv><r /></div><img src=""Screen Shot 2014-01-10 at 10.30.10 M.jpg"" />"
pharmacology_lock4
"<img src=""0f1a27f3c8d99f0342076935fcf91c411f4973e_Q_0.svg"" />"
"<img sr
c=""0f1a27f3c8d99f0342076935fcf91c411f4973e__0.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_source_svg.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_Screen Shot 2014-01-10 at 10.23.45 M.jpg""
/>"
pharmacology_lock4
"<img src=""0f1a27f3c8d99f0342076935fcf91c411f4973e_Q_1.svg"" />"
"<img sr
c=""0f1a27f3c8d99f0342076935fcf91c411f4973e__1.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_source_svg.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_Screen Shot 2014-01-10 at 10.23.45 M.jpg""
/>"
pharmacology_lock4
"<img src=""0f1a27f3c8d99f0342076935fcf91c411f4973e_Q_2.svg"" />"
"<img sr
c=""0f1a27f3c8d99f0342076935fcf91c411f4973e__2.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_source_svg.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_Screen Shot 2014-01-10 at 10.23.45 M.jpg""
/>"
pharmacology_lock4
"<img src=""0f1a27f3c8d99f0342076935fcf91c411f4973e_Q_3.svg"" />"
"<img sr
c=""0f1a27f3c8d99f0342076935fcf91c411f4973e__3.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_source_svg.svg"" />"
"<img src=""0f1a
27f3c8d99f0342076935fcf91c411f4973e_Screen Shot 2014-01-10 at 10.23.45 M.jpg""
/>"
pharmacology_lock4
: pH = pka log (unprotonated/pr
Q: What is the Henderson hasselach equation?
otonated)
pharmacology_lock4
Q: If the quantity (pH-pka) = 2 then what is the ratio of - to H?
: 2 = l
og 100; thus the ratio is - to H is 100 to 1 pharmacology_lock4
Q: If the quantity (pH-pka) = (-3) then what is the ratio of - to H? : -3 =
log .001; so the ratio of - to H is 1 to 1000 pharmacology_lock4
Q: Uncharged form diffuses freely and will e equal in concentration of each sid
e. This is good for administration of drug (oral).
"<img src=""Screen Shot
2014-01-10 at 10.30.49 M.jpg"" />"
pharmacology_lock4
Q: Weak acid such as phenoarital (pka 7.2). Will it e etter asored from th
e stomach or colon? Stomach 1-2, duodenum 5-6, ileum 8, large intestine 8.
: Stomach; in the stomach the pH &lt;&lt;&lt;&lt;&lt; pka so most of it is unio
nized; in the colon the pH &gt; pka so most is ionized<div><r /></div> pharmaco
logy_lock4
Q: nother drug is a weak ase with a pka of 10.5. Will it e asored well from
the GI tract? : Nonowhere in the GI tract. The pH is always &lt; pka so BH+ &g
t; B and the drug is not well asored. pharmacology_lock4
Q: &nsp;Drug is a weak ase with a pka of 10.5. What if digestive enzymes in th
e stomach and duodenum alter the drug to give it a pka of 6? (see aove)
: it will e asored in the colon which has a pH of 8 which is &gt; pka of 6.
pharmacology_lock4
: occurs when the pka of a drug is etween the
Q: What is ion trapping?
pH of two compartments; the drugs gets <>trapped on the side with the higher io
nized fraction</>; for example, a weak acid of pka 6.0 is trapped in the plasma
of pH 7.4
pharmacology_lock4
Where are most drugs PO asored in GI tract? Jejunum pharmacology_lock4
<div>su-lingual drug ypasses?</div> liver Ex: nitroglycerin pharmacology_lo
ck4
Define enteral vs parenteral
from the G.I. Tract; ypassing GI tract pharmaco
logy_lock4
Q: Parenteral ypasses the ______. Give 6 examples of route
: GI tract; ie
<>intravenous</>, <>intramuscular</> (ie epinephrine), <>sucutaneous</> (
ie insulin), <>inhalation</> (ie asthma drugs, general anesthetics), topical a
nd <>transdermal</> (ie nicotine), <>intrathecal</> (into CNS ie anticancer

drugs, antiiotics)
pharmacology_lock4
Q: Does rectal administration cause the medicine to ypass the liver?
: aout
50% ypasses the liver; asorption from the rectum is neither reliale nor pred
ictale (ie Phenergan, Compazine)
pharmacology_lock4
Q: True or false: drugs in an adhesive lend themselves to controlled delivery.
": true (in a sense); through the selection of the two matrices the delivery pr
ofile of a drug through the skin can e selectively modified and controlled<div>
<img src=""Screen Shot 2014-01-10 at 11.33.46 M.jpg"" /></div><div>*The first p
olymeric adhesive matrix can release the drug more quickly or more slowly than t
he second polymeric adhesive matrix. Through the selection of the two matrices,
the delivery profile of the drug through the skin can e selectively modified an
d controlled.</div>"
pharmacology_lock4
Q: What is V(d)?
": V(d) = (dose/plasma concentration); volume of distri
ution (a hypothetical volume); calculated V(d) may or may not correspond to a 
ody water spaceinding of a drug to a storage site can give a value greater than
total ody water (ie drug could e hiding out somewhere)<div><img src=""Screen S
hot 2014-01-10 at 11.48.35 M.jpg"" /></div>" pharmacology_lock4
Q: What is ioavailaility as it pertains to pharmacology?
": a comparison
of the total amount of drug availale to the ody after a <>dose administered
y some other route than intravenous</>; ioequivalent drugs must show similar
ioavailaility (ie generic drugs have to demonstrate ioequivalence)<div><img s
rc=""Screen Shot 2014-01-11 at 1.32.38 PM.jpg"" /></div>"
pharmacology_lo
ck4
Q: Whats the formula for ioavailaility?
": F = UC(oral) / UC (iv); th
e largest value F can e is 1; were comparing with intravenous; elow its 12.8/32
= 0.4<div><img src=""Screen Shot 2014-01-10 at 11.50.01 M.jpg"" /></div>"
pharmacology_lock4
"<img src=""638a44067a4de9f4a57df927f37e8a5c9880237_Q_0.svg"" />"
"<img sr
c=""638a44067a4de9f4a57df927f37e8a5c9880237__0.svg"" />"
"<img src=""638a
44067a4de9f4a57df927f37e8a5c9880237_source_svg.svg"" />"
"<img src=""638a
natomy_
44067a4de9f4a57df927f37e8a5c9880237_occip.jpeg"" />"
Block4
"<img src=""638a44067a4de9f4a57df927f37e8a5c9880237_Q_1.svg"" />"
"<img sr
c=""638a44067a4de9f4a57df927f37e8a5c9880237__1.svg"" />"
"<img src=""638a
44067a4de9f4a57df927f37e8a5c9880237_source_svg.svg"" />"
"<img src=""638a
natomy_
44067a4de9f4a57df927f37e8a5c9880237_occip.jpeg"" />"
Block4
"<img src=""638a44067a4de9f4a57df927f37e8a5c9880237_Q_2.svg"" />"
"<img sr
c=""638a44067a4de9f4a57df927f37e8a5c9880237__2.svg"" />"
"<img src=""638a
44067a4de9f4a57df927f37e8a5c9880237_source_svg.svg"" />"
"<img src=""638a
44067a4de9f4a57df927f37e8a5c9880237_occip.jpeg"" />"
natomy_
Block4
"What is this pathology?&nsp;<div><img src=""path.jpeg"" /></div>"
Hydropic
change. (no TP--&gt; Na/K--&gt; water in)&nsp;
"What is 6? What passes through it?<div><img src=""ase.jpeg"" /></div>"
Superior orital fissure. CN&nsp;III, IV, V1, VI
natomy_Block4
"What is 7? What passes through?<div><img src=""ase.jpeg"" /></div>" Foramen
Rotundum. CN&nsp;V<su>2</su> natomy_Block4
"What is 10? What passes through?<div><img src=""ase.jpeg"" /></div>" Foramen
Ovale. CN&nsp;V<su>3</su>
natomy_Block4
"What is 11? What passes through?<div><img src=""ase.jpeg"" /></div>" Foramen
natomy_Block4
spinosum. Middle meningeal artery
"What is 14? What passes through (CN and vessel)?<div><div><img src=""ase.jpeg"
" /></div></div>"
Jugular foramen. Internal jugular vein, CN&nsp;IX, X, X
natomy_Block4
I
"Name the foramen found at #27.<r /><div><img src=""ase.jpeg"" /></div>"
Foramen lacerum natomy_Block4
"29? What passes through?<div><img src=""ase.jpeg"" /></div>" Internal acousti
natomy_Block4
c meatus. CN&nsp;VII, VIII
"What two structures are found at 2?<div><img src=""INT.jpeg"" /></div>"

<div>Optic chiasma and</div><div>internal carotid artery</div> natomy_Block4

"Structure at 6? 27? What passes through each?<div><img src=""acoustic.jpeg"" />
</div>" 6: Internal acoustic meatus; CN&nsp;VII, VIII<div>27: Hypoglossal canal
natomy_Block4
; &nsp;CN XII</div>
Q: What is loading dose?
": the amount of drug needed to achieve immedia
tely a steady state concentration of drug<div><img src=""Screen Shot 2014-01-11
at 4.46.24 PM.jpg"" /></div>" pharmacology_lock4
: depen
Q: What does the time needed to reach the steady state depend on?
ds ONLY on half-life of the drug
pharmacology_lock4
How many half lives to reach 50% steady state concentration, at constant infusio
n rate? "1<div><img src=""Screen Shot 2014-01-11 at 4.47.08 PM.jpg"" /></div><di
v>*note 4-5 to reach steady state with 1st order kinetics</div>"
pharmaco
logy_lock4
Q: Suppose the average concentration at steady state is outside the therapeutic
window, what do you need to do to make the average fall within the therapeutic w
indow? ": To raise C(ss) increase the dose or more frequent intervals; to lowe
r C(ss) cut the dose or decrease frequency of interval<div><img src=""Screen Sho
t 2014-01-11 at 4.48.02 PM.jpg"" /></div>"
pharmacology_lock4
Compare acute vs. chronic inflammation <div>cute inflammation- 1st 72 hours</d
iv><div>Chronic- starts at 72 hours, <u>with exception of viruses</u></div><div>
<r /></div><div>neutrophils are not involved in viral infections*</div><div><r
/></div><div>cute: characterized y presence of <>neutrophils and edema</></
div>
pathology_lock4
Descrie 3 events of acute inflammation <div>1. <>Vascular changes</> - flow &
amp; permeaility (exudation)&nsp;</div><div>2. Cellular events - <>cells migr
ate to</> affected area (Mast cells)</div><div>3. <>Chemical mediators </>- a
ttract cells, help kill microorganisms, give rise to signs &amp; symptoms of inf
lammation (TLR,  metaolites, Complement, Hageman Factor)</div>
patholog
y_lock4
What is transudate?
transudate - low protein fluid, low specific gravity, fe
w inflammatory cells
pathology_lock4
What is exudate high protein fluid, high specific gravity, many inflamatory cell
s
pathology_lock4
What are 4 outcomes of acute inflammation?
<div>1. Resolve completely (rege
neration) /Heal with scarring (anti-inflammaotry cytokines IL10, TGFeta)</div><
div>2. Become localized - ascess formation (macrophages mediate firosis via fr
irogenic factors and cytokines to create a walled off area of accute inflammati
on)</div><div>3. Continued acute inflmmation (attract more neutrophils with IL-8
)</div><div>4. Progress to chronic inflammation (macrophages present antigen to
activate Th cells)</div>
pathology_lock4
What type of inflammation do viruses promote? Chronic inflammation. However, n
ot chronic as in time, ut in type of inflammation. Goes straight to&nsp;lympho
cytes,&nsp;macrophages pathology_lock4
What is inflammation a response to?
Response in vascularized tissue to injur
y, microorganisms, immune-related injury<div><r /></div><div>cute:&nsp;</div>
<div><>Infection and Tissue necrosis</></div><div><r /></div><div>Chronic:&n
sp;</div><div>persistant infection</div><div>infection with viruses, mycoacteri
a, parasites, fungi</div><div>autoimmune disease</div><div>foreign material</div
><div>cancers</div>
Inflammation
Why is inflammations relaltionship with injury complicated?
Because it is a
response to injury, ut can also cause injury<div><r /></div><div>Chronic infla
mmation is also part of the repair process</div>
Inflammation
What is the time differentiation etween chronic and acute inflammation? What is
the exception? Chronic inflammation lasts longer than 72 hours<div><r /></div>
<div>cute inflammation occurs for less that 72 hours</div><div><r /></div><div
>Viruses cause inflammation that resemles chronic inflammation (B and T cell ac
tivation, not neutrophils), ut happens in the acute time frame</div> Inflamma
tion
Briefly descrie the 3 steps of acute inflammation
1. Vascular change (incr
eased flow and permeaility = exudation)<div><r /></div><div>2. Cellular events

(cells migrate to the affected area)</div><div><r /></div><div>3. Chemical med

iators (attract other cells, kill microes, produce inflammation)</div> Inflamma
tion
What causes the 5 cardinal signs of inflammation? What are the key mediators of
each? Ruor (redness)- increased lood flow-histamine, prostaglandins, radyki
nin<div>Calor (warmth)- increased lood flow-histamine, prostaglandins, radykin
in</div><div>Tumor (swelling)- increased vascular permeaility-histamine</div><d
iv>Dolor (pain)-PGE2, radykinin</div><div>Fever -PGE2</div>
Inflammation
Differentiate etween transudate and exudate
Transudate is asically just wat
er (low protein, low spec. gravity, few inflammatory cells)<div><r /></div><div
>Exudate is fluid with high protein, high spec gravity, many inflammatory cells<
/div> Inflammation
"<img src=""paste-9410273345855.jpg"" /><div>Is this transudate or exudate in th
e CSF? How can you tell?</div>" Exudate- contains many neutrophils (inflammatory
cells) Inflammation
Descrie all the cellular events that occur during the second stage of inflammat
ion
"Margination (cells move to vessel wall)<div><r /><div>Rolling (cell we
akly inds to endothelial cells via selectins)</div><div><r /></div><div>dhesi
on (cell firmly inds to endothelial cells via integrins)</div><div><r /></div>
<div>Transmigration (moves across endothelial cells via diapedesis)</div></div><
div><r /></div><div>Chemotaxis (attracted in connective tissue y complement pr
oteins, cytokines, leukotrienes: C5a, IL-8, LTB4, fMet)</div><div><r /></div><d
iv>Phagocytosis (facilitated y opsonins, anything tagged with IgG or IgM)</div>
<div><r /></div><div>Killing (leukocyte enzymes, oxygen radicals (HOCL)</div><d
iv><r /></div><div><img src=""paste-9444633084240.jpg"" /></div>"
Inflamma
tion
What do neutrophil enzymes do to connective tissue matrix?
They degrade itallow immune cells to move freely to destroy microes Inflammation
What are the 3 stages of phagocytosis? ttachment<div>Engulfment</div><div>Phag
olysosome formation and degranulation</div>
Inflammation
Name 5 classes of Inflammatory mediators
<div>1. TLRs</div><div>2.  met
aolites</div><div>3. Mast Cells</div><div>4. Complement</div><div>5. Hageman Fa
ctor</div><div><r /></div><div>They are present in plasma or in cells<div>Bind
to receptors on other cells, causing release of other mediators</div><div>Can ca
use harmful side effects</div></div><div><r /></div> Inflammation
What are the 4 main types of inflammatory mediators? What aout a few of the oth
ers?
Vasoactive amines (histamine, serotonin)<div>Plasma proteases (complemen
t, kinins, clotting proteins)</div><div>rachidonic acid metaolites (prostaglan
dins, leukotrienes, lipoxins)</div><div>Platelet activating factor</div><div><r
/></div><div>NO</div><div>Lysosomal contents</div><div>Cytokines and chemokines
</div><div>Free radicals</div> Inflammation
How are inflammation and clotting related?
"Very closely- all part of a sin
gle interrelated damage response pathway<div><r /></div><div><img src=""paste-1
79993489441282.jpg"" /></div>" Inflammation
What are the key morphological points of acute inflammation?
Presence of neut
rophils<div>Vascular congestion and edema</div> Inflammation
"<img src=""paste-10462540333371.jpg"" /><div><img src=""paste-10475425235150.jp
g"" /></div><div><img src=""paste-10488310137018.jpg"" /><r /><div>What is wron
g with this lung? Descrie the evidence you see here</div></div>"
Reddish
rown is congestion of RBC from vascular congesion<div>Yellowish rown is necrot
ic tissue</div><div><r /></div><div>Can see fluid in the alveoli, fluid is fill
ed with neutrophils</div><div><r /></div><div>This is acute pneumonitis</div>
Inflammation
How is the inflammatory response turned off? (3)
Degradation of inflammat
ory mediators (short half life)<div><r /><div>Production of lipoxins (from arac
hadonic acid, have anti-inflammatory effects)</div></div><div><r /></div><div>P
roduction of TGFeta</div>
Inflammation
What are the key qualities identifying acute vs chronic inflammation?
cute: r
apid onset, short duration, presence of neutrophils, edema, vasodilation<div><r
/></div><div>Chronic: slow onset, long duration, presence of lymphocytes and ma

crophages, firosis, angiogenesis</div> Inflammation

What TLR recepter is intracellular?&nsp;
"TLR9<div><img src=""Screen Shot
2014-01-13 at 9.57.11 PM.jpg"" /></div>"
Immunology_lock4
ngiogenesis is impaired
Pts with DM1 have a hard time healing ecause why?
&nsp; pathology_lock4
What is firinous inflammation? "more severe, vascular leak-- larger molecules l
eak out<div><img src=""firinous.jpeg"" /></div>"
pathology_lock4
 nicoti
Q: What cholinergic receptor is found at the autonomic ganglion?
nic
pharmacology_lock4
Q: What cholinergic receptor is found at the end organ that is activated y para
: muscarinic pharmacology_lock4
sympathetic?
Q: What happens if there is a lesion along the sympathetic chain supplying (inne
rvating) the eye?
: theres unopposed parasympathetic action (Horners syndro
me), pupils constrict (miosis), drooping eye lids (ptosis), no sweating (anhydro
sis)
pharmacology_lock4
Q: True or false: Spinal anesthesia in cervical region interrupts sympathetic ou
tflow. : true; vagal output is not interrupted
pharmacology_lock4
Q: Whats the rationale of having a short parasympathetic post ganglionic neuron?
: provides good local control pharmacology_lock4
Q: Whats the rationale of having a long sympathetic post ganglionic neuron?
": gives gloal control (diffuse effects)<div><img src=""Screen Shot 2014-01-16
at 5.42.49 PM.jpg"" /></div>" pharmacology_lock4
Q: What type of receptor is the nicotinic receptor? (What does it function as)<d
iv>Q: What type of receptor is the muscarinic receptor? (what does it function a
s)</div>
"ion channel, G-protein. Each can ind Ch ut prefers its own s
ustrate<div><img src=""cholin.jpeg"" /></div>" pharmacology_lock4
Q: What are the different sutypes of nicotinic receptors? Where are they locate
: N1 (or Nm) is found at neuromuscular junction; N2 (or Nn) is found at
d?
ganglion
pharmacology_lock4
Q: What type of muscarinic receptor is found in the heart?
: M2 (rationale
, during rest and digest you maintain a low heart rate) pharmacology_lock4
Q: What type of muscarinic receptor is found in glands (ie salivary)? : M1, M
3, M5 (rationale, during rest and digest you increase secretions)
pharmaco
logy_lock4
"Q: Good image to know: Know all six steps<div><img src=""ach.jpeg"" /></div>"
pharmacology_lock4
Q: True or false: all adrenergic receptors act thru G-proteins. T
pharmaco
logy_lock4
: etaQ: What adrenergic receptor in the heart increases cardiac output?
1
pharmacology_lock4
Q: What adrenergic receptor constricts lood vessels?&nsp;Q: What adrenergic re
ceptor dilates lood vessels?
pharmacology_lock4
: alpha-1, Beta-2
: alpha
Q: What adrenergic receptor in the pancreas inhiits insulin release?
-2 (helps to raise glucose levels)
pharmacology_lock4
Q: Where is the only place epinephrine is made in the periphery?
: adren
al medulla
pharmacology_lock4
Q: Whats a catechol functional group? "<img src=""Screen Shot 2014-01-16 at 5.
50.03 PM.jpg"" />"
pharmacology_lock4
Q: What two enzymes metaolize catecholamines? : COMT and MO pharmacology_lo
ck4
Q: Characterize the termination of the action of norepinephrine at the synapse?
": 80-90% reuptake (look at picture)<div><img src=""Screen Shot 2014-01-16 at 5
.52.32 PM.jpg"" /></div>"
pharmacology_lock4
Q: Whats the intrinsic eat of the heart?
<div>: 100 eats/min--&gt;note
that during fight or flight the cardiac output can go from 5L/min to 25L/min (5-fo
ld increase)</div><div><r /></div>
pharmacology_lock4
Define chronotropy, dromotropy, inotropy, lusitropy
Increased heart rate, in
c conduction velocity (thru V node), inc contractility, inc uptake of Ca2+ into
SR--&gt; decreased duration of diastolic phase pharmacology_lock4
Q: Whats the ratio of eta-1 to eta-2 receptors in the heart? : 2:1 pharmaco

logy_lock4
Q: How does a eta-1 receptor agonist affect I(f) current in the heart? : incre
ased--&gt;causes heart rate to go up
pharmacology_lock4
Q: How does a M2 receptor agonist affect K+ current in the heart?
": incr
eases K+ current (via GIRK channels)--&gt;heart rate goes down<div><img src=""fu
nny.jpeg"" /></div>"
pharmacology_lock4
: have alpha-1 which al
Q: Would veins have alpha-1 or eta-2 receptors?
lows us to shift lood to arterial side during sympathetic activation pharmaco
logy_lock4
Q: What is the effect of eta-1 activation in the pituitary?
: increased DH
secretion (increases H20 reasorption)--&gt;during sympathetic activation we tr
y to hold on to our fluids and keep BP high
pharmacology_lock4
Q: Beta-1 activation in the kidney causes what? : release of renin
pharmaco
logy_lock4
Q: For an overactive ladder, would you prescrie a muscarine locker or agonist
?&nsp;Q: For an atonic ladder, would you prescrie a muscarine agonist or loc
ker?
locker (oxyutynin), agonist (ethanechol)
pharmacology_lock4
Q: What muscle contracts to expel urine? receptor?
: detrusor (smooth musc
le)--&gt;M3 activation causes contraction
pharmacology_lock4
Q: What is the effect of norepinephrine on the internal sphincter of the ladder
? (receptor?) : constricts--&gt;via alpha-1 receptor pharmacology_lock4
Q: What is the effect of CH on the internal sphincter of the ladder? (receptor
: opens (relaxes)--&gt;via M2 receptors
?)
pharmacology_lock4
<div>Q: (From class) drenergic nervous system is generally mediated y NE and e
pi. Name an exception</div><div><div>. temperature control y Ch</div><div>B.
temperature control y angII</div><div>C. DH release y Ch</div><div>D. ldost
, E
erone release y Ch</div><div>E. Sweat glands y Ch</div></div>
pharmacology_lock4
What is the effect of an alpha-2 agonist on lood glucose levels?&nsp; : Incre
ase; alpha-2 on eta cells of pancreas causes decrease in insulin secretion
pharmacology_lock4
What is effect of eta-2 activation of liver? Increases gluconeogenesis, incre
ase glycogen reakdown<div><r /></div><div>(alpha 1 turns off insulin receptors
pharmacology_lock4
y contrast)</div>
What is effect of alpha-1 receptor on liver?
<u>Inactivate insulin receptors<
/u> y dephosphorylation
pharmacology_lock4
ctivation of M3 receptor on eye, what muscle? Miosis, contraction sphincter mu
scle
pharmacology_lock4
ctivation alpha-1 recepter on eye, what muscle?
Mydriasis, contraction r
adial muscle
pharmacology_lock4
Beta-2 receptor activation on detrusor? Relaxation
pharmacology_lock4
Descrie receptors histamine acts on in capillaries?
"<div>H2 receptors on sm
ooth muscle cells dilate arterioles</div><div>H1 receptors constrict endothelial
cells/venules</div><img src=""hist (1).jpeg"" />"
pharmacology_lock4
Q: What are the nicotinic effects of Ch at the NMJ?
: muscle contraction, f
asciculation, tremors pharmacology_lock4
: acetylcholine, ethan
Q: What are some direct acting cholinergic agonists?
echol, carachol, methacholine, pilocarpine
pharmacology_lock4
Q: True or false: Ch is not clinically useful. : True; only has ~5 duration
pharmacology_lock4
Q: Give examples of two direct acting quaternary amines other than Ch. : etha
nechol, carachol
pharmacology_lock4
Q: Whats an example of a direct acting tertiary amine? ": pilocarpine&nsp;<di
v><img src=""pilo.jpeg"" /></div>"
pharmacology_lock4
Q: What is Xerostomia and what drug can we use to treat it?
<div>: dry mout
h due to salivary gland malfunction; ethanechol to treat (stimulates muscarinic
receptors, selective M3)</div> pharmacology_lock4
Q: What drug is used to treat glaucoma? ": pilocarpine--&gt;activates M3 recept
ors (stimulatory) that causes contraction of ciliary muscle--&gt;immediately low
ers intraocular pressure y increases drainage of aqueous humor; <>can also e

accomplished with Ch esterase inhiitor</><div><img src=""glauc.jpeg"" /></div

>"
pharmacology_lock4
: decre
Q: What are the two primary mechanisms of lowering eye pressure?
ase the amount of aqueous humor coming into the eye (reduce the production of aq
ueous humor), or increase the amount of aqueous humor leaving the eye (increase
the outflow of aqueous humor) pharmacology_lock4
"Q: Image show eye treated with pilocarpine vs atropine; note ciliary muscle cha
nges<div><img src=""eyes.jpeg"" /></div>"
pharmacology_lock4
Q: What is atropine an antagonist for? : muscarinic antagonist &nsp;(M3)
pharmacology_lock4
Q: What are some general adverse cholinergic effects? : DUMB BELSS diarrhea,
urination, miosis, ronchoconstriction (careful w/ asthmatics), radycardia, exc
itation (of skeletal muscle and CNS), lacrimation, salivation, sweating pharmaco
logy_lock4
Q: Name 3 reversile cholinesterase inhiitors (aka indirect cholinergic agonist
s)?&nsp;
": edrophonium, neostigmine, pyridostigmine--&gt;inhiits Ch e
sterease and thus raises Ch concentration<div><img src="".jpeg"" /></div>"
pharmacology_lock4
Q: Rank the half lives of the cholinesterase inhiitors from shortest to longest
: edrophonium (5-10 min), neost
: pyridostigmine, edrophonium, neostigmine
igmine (2-4 hrs), pyridostigmine (4-6 hrs)
pharmacology_lock4
<div>Q: **Quaternary amines and caramates do not enter CNS or ganglia and have
less effect at muscarinic (parasympathetic) sites. They show preference for_____
_&nsp;</div> NMJ<div>(charged)</div><div><r /></div><div>Edrophonium</div><d
iv>neostigmine</div><div>pyridostigmine</div> pharmacology_lock4
Q: What cholinesterase inhiitor enters the CNS and is not for peripheral use?
: physostigmine (intermediate half-life of 15-40 min)<div>*tertiary amine and n
ot charged</div>
pharmacology_lock4
Q: What is myasthenia gravis? "ntiodies lock Ch receptors at the postsynap
tic neuromuscular junction<div><img src=""mys.jpeg"" /></div>" pharmacology_lo
ck4
Q: What two cholinesterase inhiitors are used for the treatment of myasthenia g
ravis and open-angle glaucoma? <div>: neostigmine and pyridostigmine; <>oth
dont enter CNS</>--&gt;also for reversal of nondepolarizing neuromuscular locka
de following surgery along with added muscarinic antagonist</div>
pharmaco
logy_lock4
Q: Name two cholinesterase inhiitors that are irreversile. Use?
: isofl
uorophate, echothiophate--&gt;topical in the eye; one application is effective f
or one week (/c you have make more enzyme) and is used in chronic treatment of
glaucoma
pharmacology_lock4
Q: Whats the <>mechanism</> of isofluorophate and echothiophate? pplication fo
r eyes? "<div>: <>phosphorylate</> the esterase and inhiit it, thus raising
the Ch concentration and causing contraction of ciliary muscles--&gt;allows mor
e drainage of aqueous humor</div><div><img src=""Screen Shot 2014-01-16 at 9.25.
58 PM.jpg"" /></div>" pharmacology_lock4
Q: What is the antidote for organophosphorus pesticide poisoning?
": PM
(pralidoxime)--&gt;we still dont know how treatment should e given; many elieve
as soon as possile; if you wait to long it can ecome irreversily inactive<di
v><img src=""PM.jpeg"" /></div>"
pharmacology_lock4
Q: True or false: atropine and PM are effective antidotes to several types of n
: true; atropine is BETTER at peripheral muscarinic sites
erve gas.
pharmacology_lock4
Oricularis oculi innervation? "Branches of CN VII<div><img src=""oric.jpeg""
/></div>"
natomy_Block4
What muscle runs with tendon of levator palperae superioris? &nsp;
Superior
tarsal muscle natomy_Block4
"<img src=""c597308aedea5e916a4a8088df1214212d575_Q_0.svg"" />"
"<img sr
c=""c597308aedea5e916a4a8088df1214212d575__0.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_source_svg.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_Layers of Eyelid.jpeg"" />"

natomy_Block4
"<img src=""c597308aedea5e916a4a8088df1214212d575_Q_1.svg"" />"
"<img sr
c=""c597308aedea5e916a4a8088df1214212d575__1.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_source_svg.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_Layers of Eyelid.jpeg"" />"
natomy_Block4
"<img src=""c597308aedea5e916a4a8088df1214212d575_Q_2.svg"" />"
"<img sr
c=""c597308aedea5e916a4a8088df1214212d575__2.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_source_svg.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_Layers of Eyelid.jpeg"" />"
natomy_Block4
"<img src=""c597308aedea5e916a4a8088df1214212d575_Q_3.svg"" />"
"<img sr
c=""c597308aedea5e916a4a8088df1214212d575__3.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_source_svg.svg"" />"
"<img src=""c597
308aedea5e916a4a8088df1214212d575_Layers of Eyelid.jpeg"" />"
natomy_Block4
Innervation of levator palperae superioris?
CNIII
natomy_Block4
"<img src=""431c59a88841e8dd65788ce6e9f3e584ac4d5c_Q_0.svg"" />"
"<img sr
c=""431c59a88841e8dd65788ce6e9f3e584ac4d5c__0.svg"" />"
"<img src=""431c
59a88841e8dd65788ce6e9f3e584ac4d5c_source_svg.svg"" />"
"<img src=""431c
59a88841e8dd65788ce6e9f3e584ac4d5c_eye.jpeg"" />"
natomy_
Block4
"<img src=""431c59a88841e8dd65788ce6e9f3e584ac4d5c_Q_1.svg"" />"
"<img sr
c=""431c59a88841e8dd65788ce6e9f3e584ac4d5c__1.svg"" />"
"<img src=""431c
59a88841e8dd65788ce6e9f3e584ac4d5c_source_svg.svg"" />"
"<img src=""431c
59a88841e8dd65788ce6e9f3e584ac4d5c_eye.jpeg"" />"
natomy_
Block4
What is a lowout fracture? Symptom other than pain?
"<div>Floor of orit (th
in part of maxilla/roof of maxillary air sinus). Diplopia is symptom. Ethmoid ca
n have one too. Can also lose sensation of cheek via lesion of infraorital NV<
natomy_Block4
/div><img src=""lowout fracture.jpeg"" />"
"<img src=""95fc497dfa328687f67e836134648870d1d6f79_Q_0.svg"" />"
"<img sr
c=""95fc497dfa328687f67e836134648870d1d6f79__0.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_source_svg.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_lacrimal.jpeg"" />"
natomy_Block4
"<img src=""95fc497dfa328687f67e836134648870d1d6f79_Q_1.svg"" />"
"<img sr
c=""95fc497dfa328687f67e836134648870d1d6f79__1.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_source_svg.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_lacrimal.jpeg"" />"
natomy_Block4
"<img src=""95fc497dfa328687f67e836134648870d1d6f79_Q_2.svg"" />"
"<img sr
c=""95fc497dfa328687f67e836134648870d1d6f79__2.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_source_svg.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_lacrimal.jpeg"" />"
natomy_Block4
"<img src=""95fc497dfa328687f67e836134648870d1d6f79_Q_3.svg"" />"
"<img sr
c=""95fc497dfa328687f67e836134648870d1d6f79__3.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_source_svg.svg"" />"
"<img src=""95fc
497dfa328687f67e836134648870d1d6f79_lacrimal.jpeg"" />"
natomy_Block4
"<img src=""da4861e3322955f4f701fe3747f261ce9d_Q_0.svg"" />"
"<img sr
c=""da4861e3322955f4f701fe3747f261ce9d__0.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_source_svg.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_Orit Bones.jpeg"" />"
natomy_Block4
"<img src=""da4861e3322955f4f701fe3747f261ce9d_Q_1.svg"" />"
"<img sr
c=""da4861e3322955f4f701fe3747f261ce9d__1.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_source_svg.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_Orit Bones.jpeg"" />"

natomy_Block4
"<img src=""da4861e3322955f4f701fe3747f261ce9d_Q_2.svg"" />"
"<img sr
c=""da4861e3322955f4f701fe3747f261ce9d__2.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_source_svg.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_Orit Bones.jpeg"" />"
natomy_Block4
"<img src=""da4861e3322955f4f701fe3747f261ce9d_Q_3.svg"" />"
"<img sr
c=""da4861e3322955f4f701fe3747f261ce9d__3.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_source_svg.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_Orit Bones.jpeg"" />"
natomy_Block4
"<img src=""da4861e3322955f4f701fe3747f261ce9d_Q_4.svg"" />"
"<img sr
c=""da4861e3322955f4f701fe3747f261ce9d__4.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_source_svg.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_Orit Bones.jpeg"" />"
natomy_Block4
"<img src=""da4861e3322955f4f701fe3747f261ce9d_Q_5.svg"" />"
"<img sr
c=""da4861e3322955f4f701fe3747f261ce9d__5.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_source_svg.svg"" />"
"<img src=""da4
861e3322955f4f701fe3747f261ce9d_Orit Bones.jpeg"" />"
natomy_Block4
"<img src=""63ccc7f1a766c0f136696c8fa736f7e0916d1_Q_0.svg"" />"
"<img sr
c=""63ccc7f1a766c0f136696c8fa736f7e0916d1__0.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_source_svg.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_Orit Color.jpeg"" />"
natomy_Block4
"<img src=""63ccc7f1a766c0f136696c8fa736f7e0916d1_Q_1.svg"" />"
"<img sr
c=""63ccc7f1a766c0f136696c8fa736f7e0916d1__1.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_source_svg.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_Orit Color.jpeg"" />"
natomy_Block4
"<img src=""63ccc7f1a766c0f136696c8fa736f7e0916d1_Q_2.svg"" />"
"<img sr
c=""63ccc7f1a766c0f136696c8fa736f7e0916d1__2.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_source_svg.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_Orit Color.jpeg"" />"
natomy_Block4
"<img src=""63ccc7f1a766c0f136696c8fa736f7e0916d1_Q_3.svg"" />"
"<img sr
c=""63ccc7f1a766c0f136696c8fa736f7e0916d1__3.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_source_svg.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_Orit Color.jpeg"" />"
natomy_Block4
"<img src=""63ccc7f1a766c0f136696c8fa736f7e0916d1_Q_4.svg"" />"
"<img sr
c=""63ccc7f1a766c0f136696c8fa736f7e0916d1__4.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_source_svg.svg"" />"
"<img src=""63cc
c7f1a766c0f136696c8fa736f7e0916d1_Orit Color.jpeg"" />"
natomy_Block4
Early complaint of myasthenia gravis? Diplopia (fatigue of eye muscles)
natomy_Block4
Lateral rectus innervation
"ducens nerve, VI<div><div>(aducts the eye)</
div></div><div><img src=""lat rectus.jpeg"" /></div>"
natomy_Block4
"<img src=""583730d9facf7affc45756f1fcf227cfed312c_Q_0.svg"" />"
"<img sr
c=""583730d9facf7affc45756f1fcf227cfed312c__0.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_source_svg.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_orit medial.jpeg"" />"
natomy_Block4
"<img src=""583730d9facf7affc45756f1fcf227cfed312c_Q_1.svg"" />"
"<img sr
c=""583730d9facf7affc45756f1fcf227cfed312c__1.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_source_svg.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_orit medial.jpeg"" />"
natomy_Block4

"<img src=""583730d9facf7affc45756f1fcf227cfed312c_Q_2.svg"" />"

"<img sr
c=""583730d9facf7affc45756f1fcf227cfed312c__2.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_source_svg.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_orit medial.jpeg"" />"
natomy_Block4
"<img src=""583730d9facf7affc45756f1fcf227cfed312c_Q_3.svg"" />"
"<img sr
c=""583730d9facf7affc45756f1fcf227cfed312c__3.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_source_svg.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_orit medial.jpeg"" />"
natomy_Block4
"<img src=""583730d9facf7affc45756f1fcf227cfed312c_Q_4.svg"" />"
"<img sr
c=""583730d9facf7affc45756f1fcf227cfed312c__4.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_source_svg.svg"" />"
"<img src=""5837
30d9facf7affc45756f1fcf227cfed312c_orit medial.jpeg"" />"
natomy_Block4
"<img src=""e4ee93de109912c3dc00154e3e24e42d8a1dd4_Q_0.svg"" />"
"<img sr
c=""e4ee93de109912c3dc00154e3e24e42d8a1dd4__0.svg"" />"
"<img src=""e4ee
93de109912c3dc00154e3e24e42d8a1dd4_source_svg.svg"" />"
"<img src=""e4ee
93de109912c3dc00154e3e24e42d8a1dd4_learn this.jpeg"" />"
natomy_Block4
"<img src=""e4ee93de109912c3dc00154e3e24e42d8a1dd4_Q_1.svg"" />"
"<img sr
c=""e4ee93de109912c3dc00154e3e24e42d8a1dd4__1.svg"" />"
"<img src=""e4ee
93de109912c3dc00154e3e24e42d8a1dd4_source_svg.svg"" />"
"<img src=""e4ee
93de109912c3dc00154e3e24e42d8a1dd4_learn this.jpeg"" />"
natomy_Block4
"<img src=""e4ee93de109912c3dc00154e3e24e42d8a1dd4_Q_2.svg"" />"
"<img sr
c=""e4ee93de109912c3dc00154e3e24e42d8a1dd4__2.svg"" />"
"<img src=""e4ee
93de109912c3dc00154e3e24e42d8a1dd4_source_svg.svg"" />"
"<img src=""e4ee
93de109912c3dc00154e3e24e42d8a1dd4_learn this.jpeg"" />"
natomy_Block4
Superior rectus, inferior rectus innervation? "Oculomotor, III<div><img src=""
natomy_Block4
sup rectus.jpeg"" /></div>"
Medial rectus innervation?
"Oculomotor, III<div><img src=""medial rectus.jp
eg"" /></div>" natomy_Block4
Superior olique innervation? "Trochlear nerve, IV (trochlear=pully)<div><img
src=""sup o pic.jpeg"" /></div><div><img src=""sup o act.jpeg"" /></div>"
natomy_Block4
Inferior olique innervation? "Oculomotor, CNIII<div><r /></div><div><img src
=""inf olique pic.jpeg"" /></div><div><div><img src=""inf olique act.jpeg"" />
</div></div>" natomy_Block4
Wisp reflex is through what nerve?
Nasociliary
natomy_Block4
"<img src=""cc7d1c3f2ff0a97a32969a69772ae0808f2c7c_Q_0.svg"" />"
"<img sr
c=""cc7d1c3f2ff0a97a32969a69772ae0808f2c7c__0.svg"" />"
"<img src=""cc7d
1c3f2ff0a97a32969a69772ae0808f2c7c_source_svg.svg"" />"
"<img src=""cc7d
1c3f2ff0a97a32969a69772ae0808f2c7c_olique.jpeg"" />"
natomy_
Block4
"<img src=""cc7d1c3f2ff0a97a32969a69772ae0808f2c7c_Q_1.svg"" />"
"<img sr
c=""cc7d1c3f2ff0a97a32969a69772ae0808f2c7c__1.svg"" />"
"<img src=""cc7d
1c3f2ff0a97a32969a69772ae0808f2c7c_source_svg.svg"" />"
"<img src=""cc7d
1c3f2ff0a97a32969a69772ae0808f2c7c_olique.jpeg"" />"
natomy_
Block4
"<img src=""cc7d1c3f2ff0a97a32969a69772ae0808f2c7c_Q_2.svg"" />"
"<img sr
c=""cc7d1c3f2ff0a97a32969a69772ae0808f2c7c__2.svg"" />"
"<img src=""cc7d
1c3f2ff0a97a32969a69772ae0808f2c7c_source_svg.svg"" />"
"<img src=""cc7d
natomy_
1c3f2ff0a97a32969a69772ae0808f2c7c_olique.jpeg"" />"
Block4
"<img src=""ce2fe2085504f02874479191103adf152f8_Q_0.svg"" />"
"<img sr
c=""ce2fe2085504f02874479191103adf152f8__0.svg"" />"
"<img src=""ce2
fe2085504f02874479191103adf152f8_source_svg.svg"" />"
"<img src=""ce2
fe2085504f02874479191103adf152f8_extorsion.jpeg"" />"

natomy_Block4
"<img src=""ce2fe2085504f02874479191103adf152f8_Q_1.svg""
c=""ce2fe2085504f02874479191103adf152f8__1.svg"" />"
fe2085504f02874479191103adf152f8_source_svg.svg"" />"
fe2085504f02874479191103adf152f8_extorsion.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_0.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__0.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_1.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__1.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_2.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__2.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_3.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__3.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_4.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__4.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_5.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__5.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c_Q_6.svg""
c=""c21f0cd318ad9ac0e8e490a81fd4cd40e3c__6.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_source_svg.svg"" />"
f0cd318ad9ac0e8e490a81fd4cd40e3c_extra muscles.jpeg"" />"
natomy_Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_0.svg""
c=""a04484957dd65f2169caf3637726e583161559__0.svg"" />"
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_1.svg""
c=""a04484957dd65f2169caf3637726e583161559__1.svg"" />"
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_2.svg""
c=""a04484957dd65f2169caf3637726e583161559__2.svg"" />"
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_3.svg""
c=""a04484957dd65f2169caf3637726e583161559__3.svg"" />"
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"

/>"
"<img sr
"<img src=""ce2
"<img src=""ce2
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""c21
"<img src=""c21
/>"
"<img sr
"<img src=""a044
"<img src=""a044
natomy_
/>"
"<img sr
"<img src=""a044
"<img src=""a044
natomy_
/>"
"<img sr
"<img src=""a044
"<img src=""a044
natomy_
/>"
"<img sr
"<img src=""a044
"<img src=""a044
natomy_

Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_4.svg"" />"
"<img sr
c=""a04484957dd65f2169caf3637726e583161559__4.svg"" />"
"<img src=""a044
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
"<img src=""a044
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
natomy_
Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_5.svg"" />"
"<img sr
c=""a04484957dd65f2169caf3637726e583161559__5.svg"" />"
"<img src=""a044
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
"<img src=""a044
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
natomy_
Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_6.svg"" />"
"<img sr
c=""a04484957dd65f2169caf3637726e583161559__6.svg"" />"
"<img src=""a044
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
"<img src=""a044
natomy_
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
Block4
"<img src=""a04484957dd65f2169caf3637726e583161559_Q_7.svg"" />"
"<img sr
c=""a04484957dd65f2169caf3637726e583161559__7.svg"" />"
"<img src=""a044
84957dd65f2169caf3637726e583161559_source_svg.svg"" />"
"<img src=""a044
natomy_
84957dd65f2169caf3637726e583161559_V1.jpeg"" />"
Block4
What is lacrimal nerve function?
Sensory function to region (NOT tears)&n
sp;
natomy_Block4
Ophthalmic artery is a ranch from what?
"Internal carotid<div><img src="
"opth.jpeg"" /></div>" natomy_Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_0.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__0.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
natomy_
Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_1.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__1.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
natomy_
Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_2.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__2.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
natomy_
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_3.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__3.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
natomy_
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_4.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__4.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
natomy_
Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_5.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__5.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
natomy_
Block4
"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_6.svg"" />"
"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__6.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
natomy_
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
Block4

"<img src=""da0247f8ef020fd08e39cff055c21f53f40_Q_7.svg"" />"

"<img sr
c=""da0247f8ef020fd08e39cff055c21f53f40__7.svg"" />"
"<img src=""da0
247f8ef020fd08e39cff055c21f53f40_source_svg.svg"" />"
"<img src=""da0
natomy_
247f8ef020fd08e39cff055c21f53f40_eyes.jpeg"" />"
Block4
"<img src=""22a8339805ee850a0969cf7212c0046c0e113c4_Q_0.svg"" />"
"<img sr
c=""22a8339805ee850a0969cf7212c0046c0e113c4__0.svg"" />"
"<img src=""22a8
339805ee850a0969cf7212c0046c0e113c4_source_svg.svg"" />"
"<img src=""22a8
339805ee850a0969cf7212c0046c0e113c4_Frontal.jpeg"" />"
natomy_
Block4
"<img src=""22a8339805ee850a0969cf7212c0046c0e113c4_Q_1.svg"" />"
"<img sr
c=""22a8339805ee850a0969cf7212c0046c0e113c4__1.svg"" />"
"<img src=""22a8
339805ee850a0969cf7212c0046c0e113c4_source_svg.svg"" />"
"<img src=""22a8
339805ee850a0969cf7212c0046c0e113c4_Frontal.jpeg"" />"
natomy_
Block4
"<img src=""22a8339805ee850a0969cf7212c0046c0e113c4_Q_2.svg"" />"
"<img sr
c=""22a8339805ee850a0969cf7212c0046c0e113c4__2.svg"" />"
"<img src=""22a8
339805ee850a0969cf7212c0046c0e113c4_source_svg.svg"" />"
"<img src=""22a8
natomy_
339805ee850a0969cf7212c0046c0e113c4_Frontal.jpeg"" />"
Block4
"<img src=""22a8339805ee850a0969cf7212c0046c0e113c4_Q_3.svg"" />"
"<img sr
c=""22a8339805ee850a0969cf7212c0046c0e113c4__3.svg"" />"
"<img src=""22a8
339805ee850a0969cf7212c0046c0e113c4_source_svg.svg"" />"
"<img src=""22a8
natomy_
339805ee850a0969cf7212c0046c0e113c4_Frontal.jpeg"" />"
Block4
Opthalmic veins pass through? "Superior orital fissure<div><img src=""opthalm
natomy_Block4
ic veins.jpeg"" /></div>"
Opthalmic veins communicate with?
"Cavernous sinus and facial veins&nsp;(
and pterygoid plexus of veins)<div><img src=""veins.jpeg"" /></div>"
natomy_
Block4
Short ciliary, long ciliary sensory fiers from what CN and ranch?
V1<div><
r /></div><div><r /><div>Long ciliary is from sympathetic plexus of carotid--&
gt;ophthalmic artery</div></div>
natomy_Block4
Short ciliary, long ciliary postsynaptic <>sympathetic</> fiers from?
Carotid plexus from superior cervical ganglion natomy_Block4
Short ciliary postsynaptic parasympathetic from?<div>Short ciliary presynaptic p
arsympathetic from?</div><div>ction of Short ciliary</div><div><r /></div><div
><r /></div> <div>Ciliary ganglion&nsp;</div><div><r /></div><div><r /></d
iv><div>(presynaptic fiers come from III)</div><div><r /></div><div>for pupill
natomy_Block4
ary constriction (M3) and accommodation (M3)</div>
Besides viruses, what other stimuli can cause chronic inflammation without causi
ng acute inflammation? utoimmune disease<div>Persistent infection</div>
Inflammation
What characterizes chronic inflammation?
1. Mononuclear cells (lymphocyte
s, plasma cells, macrophages)<div><r /></div><div>2. Firosis</div><div><r /><
/div><div>3. Eosinophils and mast cells</div> Inflammation
"<img src=""paste-1842540970208.jpg"" /><div><img src=""paste-1855425872083.jpg"
" /></div><div><img src=""paste-1868310773971.jpg"" /><r /><div>What is wrong w
ith this gall ladder?</div></div>"
Gall stones- ig dark circles<div><r />
<div>Chronic inflammation (thickened wall)</div></div><div>Pale part of wall is
firosis scarring</div><div>Infiltrate is full of mononuclear cells</div>
Inflammation
What is granulomatous inflammation (5)? &nsp;What is it caused y? What patient
s will not have this type of inflammation?
"1. Special type of chronic infl
ammation<div>2.&nsp;Focal collection of ""epitheliod"" histiocytes (macrophages
)</div><div>3. Peripheral cuff of lymphocytes</div><div>4. Giant cells (fusion o
f macrophages)</div><div>5. +/- necrosis<r /><div><div><r /></div><div>Caused
y poorly digestile pathogens</div><div><r /></div><div>Requires T cell activa
tion- will not occur in HIV patients</div></div></div>" Inflammation
What diseases cause granulomatous inflammation? <>TB</><div><>Fungal disease<

/><r /><div>Syphillis</div><div><>Cat scratch disease</></div><div>Foreign m

aterial</div></div><div>Sarcoidosis</div><div><r /></div><div>TB, fungal, cat s
cratch are all cause caseating granulomatous inflammation</div> Inflammation
"<img src=""paste-1954210119982.jpg"" /><div>Identify all the little dots</div>"
Granulomas
Inflammation
"<img src=""paste-1988569858256.jpg"" /><div>Identify all the different regions
of this specimen</div>" Top right pinkish area is necrosis<div>Bottom left lue
dots are lymphocytes</div><div>Cords of cells in the middle are epitheliod histi
ocytes</div>
Inflammation
"<img src=""paste-2022929596596.jpg"" /><div>What are the different cells seen h
ere?</div>"
Epitheliod histiocytes on the left<div><r /><div>Giant cells (f
usion of multiple monocytes) in middle</div><div><r /></div><div>Lymphocytes on
the right</div></div> Inflammation
Differentiate regneration and firosis/scarring. what determines which happens?
Regeneration= replacement y cells identical to those lost, implies self-limited
tissue injury<div>Firosis= replacement of lost cells y collagen, implies pers
istent tissue damage</div><div><r /></div><div>Which one occurs depends on the
nature of the cells lost and the extracellular infrastructure that remains</div>
<r>
Inflammation
Differentiate laile, stale, and permanent cells. What does the type of cell ha
ve to do with its repair?
Laile- cells that are always dividing (skin, o
ne marrow, gut epithelia)<div><r /></div><div>Stale- cells that can ecome mit
otic&nsp;</div><div>(Hepatocytes, renal tuular cells, endothelial cells)</div>
<div><r /></div><div>Permanent- cells that can no longer ecome mitotic (neuron
s, myocytes)</div><div><r /></div><div>Cells that are more readily ale to divi
de are going to regenerate more than scar</div> Inflammation
What are the factors that inhiit cell growth? What factors promote it? Inhiitcontact inhiition<div><r /></div><div>Promote-EGF, TGF alpha, PDGF, FGF, VEGF
, TGFeta</div> Inflammation
What are the steps in the repair process?
1. ngiogenesis<div>2. Migration
and proliferation of firolasts</div><div>3. Deposition of extracellular matri
x</div><div>4. Remodling</div> Inflammation
What is granulation tissue? Is this repair tissue or inflammatory tissue?
Loose edematous tissue with few chronic inflammatory cells, firolasts, and man
y small lood vessels<div><r /></div><div>This is repair tissue, ut some infla
mmation is still present (it is a continuum)</div>
Inflammation
"<img src=""paste-3861175599438.jpg"" /><div>Which of these is granulation tissu
e, and which is scar? What are the little lack dots and holes?</div>" Left is
granulation tissue, right is scar<div>Black dots are lymphocytes, holes are loo
d vessels</div> Inflammation
What decides if a wound heals y first or second intention?
If the wound is
small enough that edges can easily e held together- first intention<div><r /><
/div><div>If the edges of the wound cannot e drawn together- second intention</
div>
Inflammation
Descrie the process of healing y first intention
Blood is in the site of
injury<div><r /><div>Sca covers the surface</div><div><r /></div><div>Neutrop
hils come and epithelial cells proliferate</div><div><r /></div><div>Neutrophil
s leave, macrophages arrive, granulation tissue forms</div><div><r /></div><div
>Collagen produced, epithelium restored, inflammation gone, granulation tissue p
resent</div></div><div><r /></div><div>Scar present, inflammation and granulati
on tissue gone</div>
Inflammation
How is healing y second intention different from first intention (specifically)
Wound is larger<div>More inflammation is present and more granulation tissue is
needed to fill the space</div><div>Wound contraction occurs via action of myofi
rolasts</div><div></div>
Inflammation
Define the following terms<div>-Serous inflammation</div><div>-firinous inflamm
ation</div><div>-suppuration</div><div>-ulcer</div><div>-lymphangitis</div><div>
-cellulitis</div>
Serous inflammation- uild up of lots of fluid (listers
)<div><r /><div>Firinous inflammation- severe vascular lear allowing <>firin
to deposit extracellularly</></div><div><r /></div><div>Suppuration- formatio

n of pus</div></div><div><r /></div><div>Ulcer- loss of surface epithelium</div

><div><r /></div><div>Lymphangitis- inflammation of lymphatics</div><div><r />
</div><div>Cellulitis- diffuse inflammation of soft tissue</div>
Inflamma
tion
"<img src=""paste-4312147165454.jpg"" /><div>Identify this</div>"
Serous i
nflammation: lots of fluid, effusions, listers Inflammation
"<img src=""paste-4337916969254.jpg"" /><div>Identify this</div>"
Firinou
s inflammation<div><r /></div><div>Typically pink, acellular</div><div>More ser
vere vascular leak and characterized y deposition of firin on the surface</div
>
Inflammation
"<img src=""paste-4363686772988.jpg"" /><div>identify this</div>"
Suppurat
ion<div>(pus is just neutrophils and deris)</div>
Inflammation
"<img src=""paste-4398046511434.jpg"" /><div>identify what is occuring here</div
>"
Lymphangitis (red line moving up from wound)
Inflammation
What are the local effects of inflammation? (characteristics of inflammed tissue
)
ruor, calor, tumor, dolor (cytokines), loss of function (swelling and p
ain limit motion)
Inflammation
What are the systemic effects of inflammation? What causes them?
"Fever,
chills, somnolence, malaise (caused y cytokines)<div><r /></div><div>Leukocyto
sis (increased WBCs in peripheral lood with ""left shift"")</div>"
Inflamma
tion
re wounds ever as strong as they were efore injury? No, the est they can e
is 70-80%
Inflammation
What are the consequences of wound healing?
Defective scar- dehiscence<div>K
eloid formation</div><div>Contractions- deformities</div><div>dhesions</div><di
v><r /></div><div><div>larger wound, inadequate lood supply, pain, scar forms
across locked lim (unale to straighten arm)</div><div><r /></div><div>adhesio
ns: adominal cavity. remove part of colon, firous and that goes from one end
of peritoneum to the other and may wrap around kidney-may e an unintended conse
quential injury</div></div><div><r /></div>
Inflammation
"<img src=""paste-450971566377.jpg"" /><div>Which one of these livers is anorma
l? Is this damage reversile or irreversile?</div>"
The one on the right<div
>More orange-ish means increased fatty deposits (fatty change is reversile)</di
v>
InjuryLan
"<img src=""paste-910533067061.jpg"" /><img src=""paste-1026497184057.jpg"" /><d
iv>Compare and contrast these two hearts</div>" The first has undergone coagulat
ive necrosis (after ischemia from MI)<div><r /></div><div>The second is hypertr
ophic from chronic high lood pressure</div>
InjuryLa
"<img src=""paste-1069446857034.jpg"" /><div>Descrie what is wrong with this lu
ng</div>"
Caseuos necrosis from granulomas due to TB infection<div><r /><
/div><div>Rest of the lung is lackish- maye from eing a smoker</div> InjuryLa

"<img src=""paste-1571958030628.jpg"" /><div>Is this reversile?</div>" No, fat
necrosis (of the pancreas) is irreversile damage, unlike fatty change<div><r /
></div><div>The acute pancreatitis is treatale though</div>
InjuryLa
"<img src=""paste-1614907703601.jpg"" /><div>Descrie what is normal and what is
anormal in this slide</div>" The right side is normal with defined nucleated
cells (some fat depostion is normal)<div><r /></div><div>The left side has unde
rgone fat necrosis- all cells are pinkish, lack nuclei, and have no clear ounda
ries</div>
InjuryLa
"<img src=""paste-1675037245733.jpg"" /><div>What is the pathology of this lung?
</div>" The white is possily hilar adenopathy<div><r /></div><div>The lack we
dge is coagulative necrosis due to pulmonary emolism</div>
InjuryLa
"<img src=""paste-2345052143943.jpg"" /><div>Is this apoptosis or necrosis? Will
poptosis<div>No- only necrosis has infl
there e inflammation here?</div>"
ammation</div> InjuryLa
"<img src=""paste-2388001816809.jpg"" /><div>What process is occuring here?</div
>"
Metaplasia in the cervix of a woman who suffers from chronic cervicitis
InjuryLa
"<img src=""paste-2430951489847.jpg"" /><div>What is happening in this tissue? W

hat is this tissue?</div>"

Coagulative necrosis of the kidney<div>Can see r
egion of eosinophilia with no nuclei</div>
InjuryLa
"<img src=""paste-2473901162801.jpg"" /><div>This is done with prussian lue sta
in, in a man with liver prolems and diaetes. What is present here?</div>"
Hemosiderin deposition InjuryLa
"<img src=""paste-2602750181664.jpg"" /><div>What is occuring here?</div>"
Firinous necrosis
InjuryLa
"<img src=""paste-2662879723801.jpg"" />"
Neutrophils
InjuryLa
"<img src=""paste-2783138808082.jpg"" />"
Chronic inflammation
InjuryLa

"<img src=""paste-2937757630783.jpg"" /><div>What are all the little lack dots?
</div>" Inflammatory cells (neutrophils) indicating suppuration InjuryLa
"<img src=""paste-2989297238322.jpg"" /><div>What is this?</div>"
Granulom
a
InjuryLa
"<img src=""paste-3058016715049.jpg"" /><div>What is the cell in the middle?</di
v>"
Giant cell
InjuryLa
"<img src=""paste-3092376453405.jpg"" /><div><div>What is the eosinophilic cell
at the arrow?</div></div><div><r /></div><div><img src=""paste-3118146257171.jp
g"" /></div><div>ccount for why this person has more red cells?</div>" Red snap
pers = TB acteria<div><r /></div><div>In normal people, there is a relatively
low urden of TB acteria in the ody</div><div>In immunocompromised people, the
re will e many more acteria</div>
InjuryLa
"<img src=""paste-3272765079917.jpg"" /><div>What does this test show? What dise
ase is present in the patient, and what would you expect to see?</div>" Normally
functioning neutrophils convert dye into lue form<div>Neutrophils with killing
defects do not convert the dye</div><div><r /></div><div>Suggest CGD- patient
will not e ale to kill normal acteria and will form granulomas to contain the
m instead</div><div><r /></div><div>Neutrophils dont have NDPH peroxidase. Can
not digest acteria. (granulomas form from undigestale acteria)</div> InjuryLa

"<img src=""paste-3332894621968.jpg"" /><div>Descrie this infiltrate</div>"
This is exudate, tons of inflammatory cells (neutrophils)
InjuryLa
"<img src=""paste-3410204033249.jpg"" /><div><img src=""paste-3423088935182.jpg"
" /></div><div><img src=""paste-3435973837067.jpg"" /></div>"
InjuryLa


"<img src=""paste-3470333575409.jpg"" /><div><img src=""paste-3483218477323.jpg"
" /></div><div><img src=""paste-3496103379201.jpg"" /></div>" C
InjuryLa

"<img src=""paste-3573412790550.jpg"" /><div><img src=""paste-3586297692427.jpg"
" /></div><div><img src=""paste-3599182594305.jpg"" /></div>" E
InjuryLa

"<img src=""paste-3676492005655.jpg"" /><div><img src=""paste-3689376907525.jpg"
" /></div>"
B
InjuryLa
: cycloplegia pharmacology_lock4
Q: Inaility to focus = _______.
Q: t low doses atropine selectively locks _________ receptors, slowing sinus h
eart rate and decreases cardiac output. : eta-1 adrenergic
pharmacology_lo
ck4
Mechanism of PM? Does it enter CNS?
Regenerates acetylcholinesterase, does n
ot enter CNS
pharmacology_lock4
T/F atropine can enter CNS
Yes
pharmacology_lock4
Ipratropium is an example of what class of drug? luterol is an example of what
class? Cholinergic antagonist, adrenergic agonist
pharmacology_lock4
What is the affect of aluterol on the activity of adenylyl cyclase? What is eff
ect on ronchial smooth muscle? ctivates, causes ronchial smooth muscle dilati
on
pharmacology_lock4
What is effect of theophylline on enzyme PDE? How does this affect ronchial smo
oth muscle?
"Inhiits (causes less reakdown of camp), causes ronchial dila
tion<div><img src=""pic.jpeg"" /></div>"
pharmacology_lock4
How do you treat an overdose of atropine?
Treat symptomatically, provide a
n Ch esterase inhiitor (physostigmine) and use lankets and diazepam for seizu

re control
pharmacology_lock4
What is the mechanism of ganglionic lockers? Work y <u>interfering with post
synaptic action of Ch</u> at nicotinic of all autonomic ganglia --&gt; recall t
hat nicotinic receptors at the ganglia (Nn) are somewhat different from the nico
tinic receptors at the NMJ (Nm) pharmacology_lock4
What is the clinical use of ganglionic lockers?
Treat hypertension in em
ergencies (ie surgery to achieve short term hypotension)
pharmacology_lo
ck4
Q: What are two ganglionic lockers used in the ER?
Mecamylamine, trimethaph
an
pharmacology_lock4
Q: Whats the only depolarizing NMJ antagonist? Whats its mechanism of action?
": succinylcholine--&gt;inds to Nm receptor--&gt;opens the channel--&gt;depola
rizes the end- plate and then gets stuck<div><img src=""phase 1.jpeg"" /></div>"
pharmacology_lock4
Q: Whats the use of succinylcholine? : to produce skeletal muscle relaxation
(ie during surgery)
pharmacology_lock4
Q: What are the specific nondepolarizing neuromuscular antagonists?
: the cu
r drugs--&gt;d-tuocurarine, pancuronium, atracurium; plus gallamine pharmaco
logy_lock4
Q: How would you ring a patient off of one of the nondepolarizing lockers?
: administer a <u>cholinesterase inhiitor</u> along with a <u>muscarinic antag
onist</u> (muscarinic antagonist is needed to protect the heart and lungs from h
igh levels of ch generated from the inhiition of the esterase)
pharmaco
logy_lock4
Q: What is malignant hyperthermia?
<div>:  group of inherited (<>autosom
al dominant</>) disorders that are characterized y a rapid increase in tempera
ture to 39-42oC and rise in serum potassium levels in response to <>inhalationa
l anesthetics</> (e.g.: halothane) or <>muscle relaxants</> (notaly succinyl
choline). The triggering agents release calcium from the memrane of the muscle
cells sarcoplasmic reticulum, which is defective in storing this ion. The resul
t is a sudden increase in myoplasmic calcium. The calcium activates myosin TPas
e and generates heat. Muscular contraction also occurs and adds to the heat.</di
v><div>Dantrolene is the specific pharmacological treatment for malignant hypert
hermia. Dantrolene locks release of calcium from the sarcoplasmic reticulum and
reduces muscle tone and heat production. ggressive cooling with ice packs also
necessary.</div>
pharmacology_lock4
Where is melanin in the eye? 4 (split melanocyte invasion vs. production)
Melanocyte invasion into <u>iris stroma</u>,&nsp;<div>Melanocyte invasion into
<u>choroid</u>,&nsp;</div><div><r /></div><div>melanin synthesis in <u>RPE</u>
,&nsp;</div><div>melanin single layer of neural retina over <u>posterior aspect
of the iris</u></div><div><u><r /></u></div><div><u><r /></u></div><div><u>ch
oroid</u></div><div><u>iris</u></div><div><u>ciliary ody</u></div><div><u>RPE</
natomy_
u></div><div><u>neural retina over posterior aspect of iris</u></div>
Block4 Kretzer_Block4
Where does retina stop aruptly in eye? "t the ora serrata- continues as single
layer of epithelial cells<div><img src=""eye.jpeg"" /></div>" natomy_Block4 K
retzer_Block4
Name 5 ways retina is attached to apical surface of RPE <div><u>Interdigitation<
/u> etween the photoreceptor outer segments and the microvilli of the RPE cells
.</div><div><r /></div><div><u>Mucopolysaccharide glue</u> in the suretinal sp
ace.</div><div><r /></div><div>n extra <u>mucus condensation</u> at the tip of
cone outer segments.</div><div><r /></div><div>The viscosity of the <u>vitreou
s ody</u> (which liquefies with normal aging)</div><div><r /></div><div> <u>w
ater flux across the retina </u>from the vitreous to the choroidal vessels drive
n y ion pumping of the RPE (increased y the drug called mucogen).</div>
natomy_Block4 Kretzer_Block4
3 Fs of retinal detachment
Fireworks (flashes of light), floaters, falling
curtain (field defect) natomy_Block4 Kretzer_Block4
Where does retina detach from? "Suretinal space (RPE from the photoreceptors)<
natomy_Block4 Kretzer_Block4
div><img src=""sur.jpeg"" /></div>"

Which landmark of temporal one of skull is not present in neworn child?

Mastoid process. Pull of SCM creates it over time.&nsp;
natomy_Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_0.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__0.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
natomy_
Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_1.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__1.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
natomy_
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_2.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__2.svg"" /><div><img src=""mandiu
lar .jpeg"" />10 is fossa</div>"
"<img src=""2a12a204ff542273e4ac0dc552
e74a776532_source_svg.svg"" />"
"<img src=""2a12a204ff542273e4ac0dc552
e74a776532_temp.jpeg"" />"
natomy_Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_3.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__3.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
natomy_
Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_4.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__4.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
natomy_
Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_5.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__5.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
natomy_
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_6.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__6.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
natomy_
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
Block4
"<img src=""2a12a204ff542273e4ac0dc552e74a776532_Q_7.svg"" />"
"<img sr
c=""2a12a204ff542273e4ac0dc552e74a776532__7.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_source_svg.svg"" />"
"<img src=""2a12
a204ff542273e4ac0dc552e74a776532_temp.jpeg"" />"
natomy_
Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_0.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__0.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_1.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__1.svg"" />"
"<img src=""4eec
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_2.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__2.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_3.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__3.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec

e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"

natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_4.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__4.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_5.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__5.svg"" />"
"<img src=""4eec
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_6.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__6.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_7.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__7.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
"<img src=""4eece950ad3221e9804458864087f37785aa4_Q_8.svg"" />"
"<img sr
c=""4eece950ad3221e9804458864087f37785aa4__8.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_source_svg.svg"" />"
"<img src=""4eec
e950ad3221e9804458864087f37785aa4_temporal one inf.jpeg"" />"
natomy_Block4
What goes through the upper half of foramen lacerum? Carotid artery natomy_
Block4
"<div>, B, red arrow?</div><img src=""hiatus real.jpeg"" />" Foramen lacerum,
natomy_Block4
jugular foramen, hiatus of facial canal
"<img src=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194_Q_0.svg"" />"
"<img sr
c=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194__0.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_source_svg.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_sup view.jpeg"" />"
natomy_Block4
"<img src=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194_Q_1.svg"" />"
"<img sr
c=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194__1.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_source_svg.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_sup view.jpeg"" />"
natomy_Block4
"<img src=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194_Q_2.svg"" />"
"<img sr
c=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194__2.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_source_svg.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_sup view.jpeg"" />"
natomy_Block4
"<img src=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194_Q_3.svg"" />"
"<img sr
c=""7c041a4e9cd0d62e6ce3d6a6566c4192df8194__3.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_source_svg.svg"" />"
"<img src=""7c0
41a4e9cd0d62e6ce3d6a6566c4192df8194_sup view.jpeg"" />"
natomy_Block4
"Petrous ridge is attachment of?<div><img src=""4 (1).jpeg"" /></div>" Tentoriu
m cereelli
natomy_Block4
Where does CNVIII exit cranial cavity? Does CNVIII exit the skull?
Internal
auditory meatus. No, never exits skull.&nsp; natomy_Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_0.svg"" />"
"<img sr
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__0.svg"" />"
"<img src=""5065
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
"<img src=""5065
natomy_
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4

"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_1.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__1.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_2.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__2.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_3.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__3.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_4.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__4.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_5.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__5.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_6.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__6.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_7.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__7.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897_Q_8.svg""
c=""5065ccd7a9e2f22fc8f0e29693ed9341c9f897__8.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_source_svg.svg"" />"
ccd7a9e2f22fc8f0e29693ed9341c9f897_mid sag.jpeg"" />"
Block4
"<img src=""64673133928e7153d61da90c5127cc77de8_Q_0.svg""
c=""64673133928e7153d61da90c5127cc77de8__0.svg"" />"
3133928e7153d61da90c5127cc77de8_source_svg.svg"" />"
3133928e7153d61da90c5127cc77de8_sup fossa.jpeg"" />"
natomy_Block4
"<img src=""64673133928e7153d61da90c5127cc77de8_Q_1.svg""
c=""64673133928e7153d61da90c5127cc77de8__1.svg"" />"
3133928e7153d61da90c5127cc77de8_source_svg.svg"" />"
3133928e7153d61da90c5127cc77de8_sup fossa.jpeg"" />"
natomy_Block4
"<img src=""64673133928e7153d61da90c5127cc77de8_Q_2.svg""
c=""64673133928e7153d61da90c5127cc77de8__2.svg"" />"
3133928e7153d61da90c5127cc77de8_source_svg.svg"" />"
3133928e7153d61da90c5127cc77de8_sup fossa.jpeg"" />"
natomy_Block4
"<img src=""64673133928e7153d61da90c5127cc77de8_Q_3.svg""
c=""64673133928e7153d61da90c5127cc77de8__3.svg"" />"
3133928e7153d61da90c5127cc77de8_source_svg.svg"" />"
3133928e7153d61da90c5127cc77de8_sup fossa.jpeg"" />"
natomy_Block4

/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""5065
"<img src=""5065
natomy_
/>"
"<img sr
"<img src=""6467
"<img src=""6467
/>"
"<img sr
"<img src=""6467
"<img src=""6467
/>"
"<img sr
"<img src=""6467
"<img src=""6467
/>"
"<img sr
"<img src=""6467
"<img src=""6467

"<img src=""7fd44e3d825231fccad73f1f081cc951aa26ca_Q_0.svg"" />"

"<img sr
c=""7fd44e3d825231fccad73f1f081cc951aa26ca__0.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_source_svg.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_three ears.jpeg"" />"
natomy_Block4
"<img src=""7fd44e3d825231fccad73f1f081cc951aa26ca_Q_1.svg"" />"
"<img sr
c=""7fd44e3d825231fccad73f1f081cc951aa26ca__1.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_source_svg.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_three ears.jpeg"" />"
natomy_Block4
"<img src=""7fd44e3d825231fccad73f1f081cc951aa26ca_Q_2.svg"" />"
"<img sr
c=""7fd44e3d825231fccad73f1f081cc951aa26ca__2.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_source_svg.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_three ears.jpeg"" />"
natomy_Block4
"<img src=""7fd44e3d825231fccad73f1f081cc951aa26ca_Q_3.svg"" />"
"<img sr
c=""7fd44e3d825231fccad73f1f081cc951aa26ca__3.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_source_svg.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_three ears.jpeg"" />"
natomy_Block4
"<img src=""7fd44e3d825231fccad73f1f081cc951aa26ca_Q_4.svg"" />"
"<img sr
c=""7fd44e3d825231fccad73f1f081cc951aa26ca__4.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_source_svg.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_three ears.jpeg"" />"
natomy_Block4
"<img src=""7fd44e3d825231fccad73f1f081cc951aa26ca_Q_5.svg"" />"
"<img sr
c=""7fd44e3d825231fccad73f1f081cc951aa26ca__5.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_source_svg.svg"" />"
"<img src=""7fd4
4e3d825231fccad73f1f081cc951aa26ca_three ears.jpeg"" />"
natomy_Block4
"t genu, descrie what kind of nerve we will find?&nsp;<div><img src=""7.jpeg"
" /></div>"
Soma of pseudounipolar sensory ganglion natomy_Block4
"<img src=""9a30d8261f93129038e17ca5d7fa7f40163899_Q_0.svg"" />"
"<img sr
c=""9a30d8261f93129038e17ca5d7fa7f40163899__0.svg"" />"
"<img src=""9a30
d8261f93129038e17ca5d7fa7f40163899_source_svg.svg"" />"
"<img src=""9a30
natomy_
d8261f93129038e17ca5d7fa7f40163899_cn8.jpeg"" />"
Block4
"<img src=""06d022deea02f416c809ac7e0587030ff90f_Q_0.svg"" />"
"<img sr
c=""06d022deea02f416c809ac7e0587030ff90f__0.svg"" />"
"<img src=""06d0
22deea02f416c809ac7e0587030ff90f_source_svg.svg"" />"
"<img src=""06d0
22deea02f416c809ac7e0587030ff90f_7.jpeg"" />"
natomy_
Block4
Where does CNVII exit the cranial cavity? Does CNVII exit the skull?
Exits cr
anial cavity through internal auditory meatus. Yes, exits skull through the styl
omastoid foramen.
natomy_Block4
Carotid plexus is what type of plexus? postsynaptic sympathetic plexus, from su
natomy_Block4
perior sympathetic ganglion*
"<img src=""e5999aeda2180768d4c656a2aefaac0329d992_Q_0.svg"" />"
"<img sr
c=""e5999aeda2180768d4c656a2aefaac0329d992__0.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_source_svg.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_middle ear cavityy.jpeg"" />"
natomy_Block4
"<img src=""e5999aeda2180768d4c656a2aefaac0329d992_Q_1.svg"" />"
"<img sr
c=""e5999aeda2180768d4c656a2aefaac0329d992__1.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_source_svg.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_middle ear cavityy.jpeg"" />"
natomy_Block4
"<img src=""e5999aeda2180768d4c656a2aefaac0329d992_Q_2.svg"" />"
"<img sr
c=""e5999aeda2180768d4c656a2aefaac0329d992__2.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_source_svg.svg"" />"
"<img src=""e599

9aeda2180768d4c656a2aefaac0329d992_middle ear cavityy.jpeg"" />"

natomy_Block4
"<img src=""e5999aeda2180768d4c656a2aefaac0329d992_Q_3.svg"" />"
"<img sr
c=""e5999aeda2180768d4c656a2aefaac0329d992__3.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_source_svg.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_middle ear cavityy.jpeg"" />"
natomy_Block4
"<img src=""e5999aeda2180768d4c656a2aefaac0329d992_Q_4.svg"" />"
"<img sr
c=""e5999aeda2180768d4c656a2aefaac0329d992__4.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_source_svg.svg"" />"
"<img src=""e599
9aeda2180768d4c656a2aefaac0329d992_middle ear cavityy.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_0.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__0.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_1.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__1.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_2.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__2.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_3.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__3.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_4.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__4.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_5.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__5.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_6.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__6.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
"<img src=""73055c92a0769d89d655216adc673df10c7671_Q_7.svg"" />"
"<img sr
c=""73055c92a0769d89d655216adc673df10c7671__7.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_source_svg.svg"" />"
"<img src=""730
55c92a0769d89d655216adc673df10c7671_ant post wall.jpeg"" />"
natomy_Block4
Greater petrosal is a ranch of ____ lesser petrosal is a ranch of _____.&nsp;
CN VII, IX
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_0.svg"" />"
"<img sr
c=""46a5c2604e331003905fa8cdef789e1850d34ec__0.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_1.svg"" />"
"<img sr

c=""46a5c2604e331003905fa8cdef789e1850d34ec__1.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_2.svg"" />"
"<img sr
c=""46a5c2604e331003905fa8cdef789e1850d34ec__2.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_3.svg"" />"
"<img sr
c=""46a5c2604e331003905fa8cdef789e1850d34ec__3.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_4.svg"" />"
"<img sr
c=""46a5c2604e331003905fa8cdef789e1850d34ec__4.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_5.svg"" />"
"<img sr
c=""46a5c2604e331003905fa8cdef789e1850d34ec__5.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
"<img src=""46a5c2604e331003905fa8cdef789e1850d34ec_Q_6.svg"" />"
"<img sr
c=""46a5c2604e331003905fa8cdef789e1850d34ec__6.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_source_svg.svg"" />"
"<img src=""46a5
c2604e331003905fa8cdef789e1850d34ec_medial middle.jpeg"" />"
natomy_Block4
Sensory nerve to superior portion of ear? Root? "uriculotemporal nerve, ranch
of V3<div><img src=""gen sens.jpeg"" /></div>" natomy_Block4
"<img src=""159f8a4528403d25eaaf8004c91e6c292a87a7_Q_0.svg"" />"
"<img sr
c=""159f8a4528403d25eaaf8004c91e6c292a87a7__0.svg"" />"
"<img src=""159f
8a4528403d25eaaf8004c91e6c292a87a7_source_svg.svg"" />"
"<img src=""159f
8a4528403d25eaaf8004c91e6c292a87a7_lat wall RME.jpeg"" />"
natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_0.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__0.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"
natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_1.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__1.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"
natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_2.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__2.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"
natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_3.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__3.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"
natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_4.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__4.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"

natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_5.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__5.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"
natomy_Block4
"<img src=""9c8e95fad857244765ed127e12f24505e382_Q_6.svg"" />"
"<img sr
c=""9c8e95fad857244765ed127e12f24505e382__6.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_source_svg.svg"" />"
"<img src=""9c8
e95fad857244765ed127e12f24505e382_lat view tym.jpeg"" />"
natomy_Block4
"<img src=""a23dfecfac82316eca69d8cc57cc4846e943c97_Q_0.svg"" />"
"<img sr
c=""a23dfecfac82316eca69d8cc57cc4846e943c97__0.svg"" />"
"<img src=""a23d
fecfac82316eca69d8cc57cc4846e943c97_source_svg.svg"" />"
"<img src=""a23d
natomy_
fecfac82316eca69d8cc57cc4846e943c97_sensory.jpeg"" />"
Block4
"<img src=""a23dfecfac82316eca69d8cc57cc4846e943c97_Q_1.svg"" />"
"<img sr
c=""a23dfecfac82316eca69d8cc57cc4846e943c97__1.svg"" />"
"<img src=""a23d
fecfac82316eca69d8cc57cc4846e943c97_source_svg.svg"" />"
"<img src=""a23d
natomy_
fecfac82316eca69d8cc57cc4846e943c97_sensory.jpeg"" />"
Block4
"<img src=""a23dfecfac82316eca69d8cc57cc4846e943c97_Q_2.svg"" />"
"<img sr
c=""a23dfecfac82316eca69d8cc57cc4846e943c97__2.svg"" />"
"<img src=""a23d
fecfac82316eca69d8cc57cc4846e943c97_source_svg.svg"" />"
"<img src=""a23d
fecfac82316eca69d8cc57cc4846e943c97_sensory.jpeg"" />"
natomy_
Block4
"<div>1</div><img src=""lank.jpeg"" />"
<div>1. CN VIII vestiular and c
ochlear nerves never exit the skull (more details later from Frank)</div>
natomy_Block4
"2<div><img src=""lank.jpeg"" /></div>"
<div>2. Tympanic nerve of IX lea
ves jugular fossa and enters temporal one and middle ear cavity</div> natomy_
Block4
"3- innervation of?&nsp;<div><img src=""lank.jpeg"" /></div>" <div>3. Tympanic
plexus of IX supplies <u>sensory to the middle ear cavity</u></div>
natomy_
Block4
"4- what is it innervating?&nsp;<div><img src=""lank.jpeg"" /></div>" <div>4.
Lesser petrosal nerve of IX is <u>parasympathetic to the parotid gland</u></div>
natomy_Block4
"5- innervation?&nsp;<div><img src=""lank.jpeg"" /></div>"
<div>5. Greater
petrosal nerve of VII is <u>parasympathetic to the lacrimal gland</u></div>
natomy_Block4
"6<div><img src=""lank.jpeg"" /></div>"
<div>6. The geniculate ganglion
natomy_Block4
of VII is a sensory ganglion</div>
"7<div><img src=""lank.jpeg"" /></div>"
<div>7. Stapedius is innervated
y VII</div>
natomy_Block4
"8. Innervation?<div><img src=""lank.jpeg"" /></div>" <div>8. Tensor tympani i
natomy_Block4
s innervated y V3</div>
"9- innervations?<div><img src=""lank.jpeg"" /></div>" <div>9. Chorda tympani i
s <u>parasympathetic to sumandiular and sulingual glands</u> and <u>carries s
ensory taste fiers to the tongue</u></div>
natomy_Block4
"10<div><img src=""lank.jpeg"" /></div>"
<div>10. The facial nerve exits
natomy_Block4
the skull through the stylomastoid foramen</div>
"11<div><img src=""lank.jpeg"" /></div>"
<div>11. The carotid plexus carr
ies sympathetic fiers to the eye</div> natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_0.svg"" />"
"<img sr
c=""df82772975e86adc47d61520fdfc4ccff3c11__0.svg"" />"
"<img src=""df82
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img src=""df82
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_1.svg"" />"
"<img sr

c=""df82772975e86adc47d61520fdfc4ccff3c11__1.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_2.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__2.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_3.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__3.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_4.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__4.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_5.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__5.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_6.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__6.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_7.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__7.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_8.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__8.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_9.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__9.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_10.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__10.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_11.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__11.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_12.svg"" />"
c=""df82772975e86adc47d61520fdfc4ccff3c11__12.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_13.svg"" />"

src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr
src=""df82
src=""df82
"<img sr

c=""df82772975e86adc47d61520fdfc4ccff3c11__13.svg"" />"
"<img src=""df82
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img src=""df82
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""df82772975e86adc47d61520fdfc4ccff3c11_Q_14.svg"" />"
"<img sr
c=""df82772975e86adc47d61520fdfc4ccff3c11__14.svg"" />"
"<img src=""df82
772975e86adc47d61520fdfc4ccff3c11_source_svg.svg"" />"
"<img src=""df82
772975e86adc47d61520fdfc4ccff3c11_Ossicles.jpeg"" />"
natomy_Block4
"<img src=""f6692545c0217ade236c8ad1c257d6d3175d01_Q_0.svg"" />"
"<img sr
c=""f6692545c0217ade236c8ad1c257d6d3175d01__0.svg"" />"
"<img src=""f669
2545c0217ade236c8ad1c257d6d3175d01_source_svg.svg"" />"
"<img src=""f669
2545c0217ade236c8ad1c257d6d3175d01_malleus.jpeg"" />"
natomy_
Block4
What are the factors affecting healing (oth systemic and local)?
Systemic
- nutrient, metaolic status, circulation, hormones<div>Local- Infection, mechan
ical factors, foreign material, size, and location</div>
Inflammation
"What structures are found at 4?&nsp;<div><img src=""rdige.jpeg"" /></div>"
Site of attachment for tentorium cereelli, and location of superior petrosal si
natomy_Block4
nus
"<div>Identify 28, 26, 20&nsp;</div><img src=""nuchal.jpeg"" />"
Inferior
, superior nuchal line, external occipital protuerance natomy_Block4
What three ranches does CNVII give off efore exiting through stylomastoid fora
men?
"Greater petrosal n, chorda tympani, ranch to stapedius muscle (tiny, n
ot shown)<div><img src=""06d022deea02f416c809ac7e0587030ff90f_7.jpeg"" /></d
iv>"
natomy_Block4
General sensory innervation to inferior portion of ear? Root? "Great auricular
nerve; C2,3<r /><div><r /></div><div><img src=""gen sens.jpeg"" /></div>"
natomy_Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_0.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__0.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
natomy_
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_1.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__1.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
natomy_
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_2.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__2.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
natomy_
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_3.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__3.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
natomy_
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_4.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__4.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
natomy_
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_5.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__5.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
natomy_
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_6.svg"" />"
"<img sr

c=""ed6aa338096de38e777d81968a2d0a7634ec793__6.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
natomy_
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
Block4
"<img src=""ed6aa338096de38e777d81968a2d0a7634ec793_Q_7.svg"" />"
"<img sr
c=""ed6aa338096de38e777d81968a2d0a7634ec793__7.svg"" />"
"<img src=""ed6a
a338096de38e777d81968a2d0a7634ec793_source_svg.svg"" />"
"<img src=""ed6a
natomy_
a338096de38e777d81968a2d0a7634ec793_greater.jpeg"" />"
Block4
Branches of the Facial Nerve That Supply a Muscle of Facial Expression Mnemonic?
"To Zanziar By Motor Car, Please<div><img src=""ranches of facial nerve.jpeg""
natomy_Block4
/></div>"
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_0.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__0.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_1.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__1.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_2.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__2.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_3.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__3.svg"" />"
"<img src=""a636
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_4.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__4.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_5.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__5.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""a636dd3ca2c548f5eee7351f108127e53a8521_Q_6.svg"" />"
"<img sr
c=""a636dd3ca2c548f5eee7351f108127e53a8521__6.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_source_svg.svg"" />"
"<img src=""a636
dd3ca2c548f5eee7351f108127e53a8521_Course of fac.jpeg"" />"
natomy_Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_0.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__0.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
natomy_
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_1.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__1.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
natomy_
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_2.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__2.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac

d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
natomy_
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_3.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__3.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
natomy_
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_4.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__4.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
natomy_
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_5.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__5.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
natomy_
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_6.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__6.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
natomy_
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_7.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__7.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
natomy_
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_8.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__8.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
natomy_
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
Block4
"<img src=""71acd10776c018009addc648e6e3260fd78d_Q_9.svg"" />"
"<img sr
c=""71acd10776c018009addc648e6e3260fd78d__9.svg"" />"
"<img src=""71ac
d10776c018009addc648e6e3260fd78d_source_svg.svg"" />"
"<img src=""71ac
natomy_
d10776c018009addc648e6e3260fd78d_chorda.jpeg"" />"
Block4
"<img src=""0c3a580638651cae583319e8ddae54a2299618_Q_0.svg"" />"
"<img sr
c=""0c3a580638651cae583319e8ddae54a2299618__0.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_source_svg.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_ranches of facial nerve.jpeg"" />"
natomy_Block4
"<img src=""0c3a580638651cae583319e8ddae54a2299618_Q_1.svg"" />"
"<img sr
c=""0c3a580638651cae583319e8ddae54a2299618__1.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_source_svg.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_ranches of facial nerve.jpeg"" />"
natomy_Block4
"<img src=""0c3a580638651cae583319e8ddae54a2299618_Q_2.svg"" />"
"<img sr
c=""0c3a580638651cae583319e8ddae54a2299618__2.svg"" />"
"<img src=""0c3a
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_source_svg.svg"" />"
580638651cae583319e8ddae54a2299618_ranches of facial nerve.jpeg"" />"
natomy_Block4
"<img src=""0c3a580638651cae583319e8ddae54a2299618_Q_3.svg"" />"
"<img sr
c=""0c3a580638651cae583319e8ddae54a2299618__3.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_source_svg.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_ranches of facial nerve.jpeg"" />"
natomy_Block4
"<img src=""0c3a580638651cae583319e8ddae54a2299618_Q_4.svg"" />"
"<img sr
c=""0c3a580638651cae583319e8ddae54a2299618__4.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_source_svg.svg"" />"
"<img src=""0c3a

580638651cae583319e8ddae54a2299618_ranches of facial nerve.jpeg"" />"

natomy_Block4
"<img src=""0c3a580638651cae583319e8ddae54a2299618_Q_5.svg"" />"
"<img sr
c=""0c3a580638651cae583319e8ddae54a2299618__5.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_source_svg.svg"" />"
"<img src=""0c3a
580638651cae583319e8ddae54a2299618_ranches of facial nerve.jpeg"" />"
natomy_Block4
What are 5 skeletal relationships of parotid gland
"<img src=""RELTIONSHIP
.jpeg"" />"
natomy_Block4
"Identify 6<div><img src=""retro.jpeg"" /></div>"
Retromandiular vein
natomy_Block4
What type of healing mechanism leaves a more aesthetically pleasing scar? Why?
First intention<div>There is less space to fill with collagen and the wound cont
raction y myofirolasts can e disfiguring</div>
Repair
"<img src=""paste-8478265442712.jpg"" /><div>What is this an image of? How can y
ou tell?</div>" n ulcer<div>Can see epithlium on the ottom, on the right there
is the ase of the ulcer, and on the top there is the side of the ulcer</div><d
iv><r /></div><div>Can tell that the ase and side are much more inflamed to du
e the lighter color = more fluid</div> Repair
"<img src=""paste-8650064134459.jpg"" /><div>Descrie this injury. How will it h
eal?</div>"
Round, red, circumscried, with raised order<div>Central portio
n is depressed and red/yellow in color = granulation tissue<r /><div>Secondary
intention</div></div> Repair
"<img src=""paste-8753143349632.jpg"" /><div>This is the ulcer</div><div><r /><
/div><div><img src=""paste-8766028251523.jpg"" /></div><div>This is a zoomed in
portion of the surface</div><div><r /></div><div><img src=""paste-8778913153392
.jpg"" /></div><div>This is zoomed in on deeper tissue</div><div><r /></div><di
v>Explain the difference etween the superficial and deep tissue</div>" Superfic
ial portion is experiencing repeated injury and thus acute inflammation- tons of
inflammatory cells (neutrophils) and lood vessels<div><r /></div><div>Deep po
rtion is experiencing chornic inflammation and is eginning to heal- less inflam
matory cells, more firosis</div><div><r /></div><div>Surface: firinous exudat
e, then underlying neutrophils, then granulation tissue and deeper firosis as a
ssociated with chronic inflammation</div>
Repair
"<img src=""paste-8873402433856.jpg"" />"
B
Repair
"<img src=""paste-8924942041418.jpg"" /><div>Explain where the sca comes from.
Why are the edges of the wound red and swollen?</div>" Comes from coagulation o
f lood pooled in initial injury<div><r /></div><div>Neovascularization and ede
ma&nsp;</div> Repair
"<img src=""paste-9088150798717.jpg"" /><div><img src=""paste-9101035700592.jpg"
" /></div><div>Same picture just zoomed in</div><div><r /></div><div>What is ha
ppening here?</div>"
Can identify it is skin from epidermis loop<div><r /></
div><div>Whitish region looks like granulation tissue due to lighter coloring/ed
ema</div><div><r /></div><div>Zoomed in photo confirms granulation tissue due t
o elevated inflammatory cells and lood vessels</div> Repair
"<img src=""paste-9393093476712.jpg"" /><div>What part of this skin is anormal?
</div>" The left half<div>No hair follicle or sweat gland + more collagen = scar
tissue</div> Repair
"<img src=""paste-9453223018855.jpg"" /><div>Higher zoom</div><div><img src=""pa
ste-9474697855336.jpg"" /></div><div><r /></div><div>What is happening here?</d
iv>"
Granuloma is forming around sutures (non-digestale foreign material)<di
v><r /></div><div>Identified y tight cluster of inflammatory cells and giant c
ells (no epitheliod histiocytes- exception)</div><div><r /></div><div>In zoomed
image can see giant cells attempting to engulf fiers of suture</div> Repair
"<r /><div><img src=""paste-9620726743410.jpg"" /></div><div>Higher zoom</div><
div><img src=""paste-9676561318264.jpg"" /></div><div><r /></div><div>What is h
appening here?</div>" Keloid scar<div><r /></div><div>Can see intact epitheli
um, ut total lack of dermal appendages, hair, or glands- just collagen</div><di
v><r /></div><div>Zoomed in shows tons of collagen fiers and very few cells</d
iv>
Repair

"<r /><div><img src=""paste-9771050598728.jpg"" /></div>"

C
Repair
"Man with hepatitis<div><r /></div><div><img src=""paste-9891309683059.jpg"" />
</div><div>Zoomed</div><div><img src=""paste-9904194584966.jpg"" /></div><div><i
mg src=""paste-9917079486943.jpg"" /></div><div><r /></div><div>What is happeni
ng here?</div>" Viral hepatitis<div><r /></div><div>Can see inflammation in por
tal region in low zoom</div><div>In high zoom can see lymphocytes and some steat
osis (micro and macro)</div><div><r /></div><div>Immune destruction of virally
infected hepatocytes cause this changes</div> Repair
"Hepatitis liver 6 years after diagnosis<div><img src=""paste-10002978832751.jpg
"" /></div><div><img src=""paste-10041633538431.jpg"" /></div><div>What is seen
here? What stain is used in the second photo?</div>"
Massive firosis due to
chronic inflammation<div>Steatosis also present</div><div><r /></div><div>Trich
rome stain shows collagen as luish and hepatocytes as red- shows that there is
tons of firosis, no way for hepatocytes to regenerate</div>
Repair
"Hepatitis liver 6 years after diagnosis<div><r /></div><div><img src=""paste-1
0157597655334.jpg"" /></div>" "<img src=""paste-10170482557249.jpg"" />"
Repair
What is&nsp;IFN-'s effect on Th1 cells and Th2 cells? "IFN- maintains the Th1 d
ifferentiated state and suppresses Th2 cells<div><br /></div><div>(In contrast,
IL-10 suppresses TH1 and stimulates TH2)</div><div><br /><div><im src=""cd4 dif
ferentiation.jpe"" /></div></div>"
Immunoloy_block4
What is the pathophysioloy of ITP (idiopathic thrombocytopenic purpura)?
Thrombocytopenia caused by antiplatelet antibodies<div><br /></div><div><br /></
div><div>idiopathic thrombocytopenic purpura is a bleedin disorder in which the
immune system destroys platelets, which are necessary for normal blood clottin
. Persons with the disease have too few platelets in the blood. ITP is sometimes
called immune thrombocytopenic purpura.</div> Hemostasis
What are the 3 steps of platelet plu formation?
"Platelet adhesion to ex
posed collaen (VwF + pIb)<div>Granule release (ADP, calcium, TXA)</div><div>A
reation (fibrinoen, pIIb-IIIa)</div><div><br /></div><div><im src=""paste-1
3224204304692.jp"" /></div>" Hemostasis
How does thrombin activate fibrinoen? How does factor 13 cross link fibrin? How
does plasmin derade fibrin? "Thrombin cleaves off fibrinopeptides<div><br />
</div><div>Factor 13 cross links D domains</div><div><br /></div><div>Plasmin de
rades D-E bonds</div><div><br /></div><div><im src=""paste-13245679141092.jp"
" /></div><div><im src=""paste-13258564043089.jp"" /></div>" Hemostasis
What are the two ways neurons 'talk' to each other? Describe each in terms of di
stance, speed, sinal strenth Electrical synapse, Chemical synapse<div><br /><
div>Distance- 3.5 nM for electrical, 30nM for chemical</div><div>Speed- very fas
t electric, slower chemical</div><div>Strenth- electrical sinal strenth can d
issipate, <u>chemical synapses amplify the sinal</u><br /></div></div> pharmaco
loy_block4
What is difference between autoreceptor and reuptake transporter?
"<div>Re
uptake transporters reuptake chemical in synapse (inhibition increases concentra
tion of neurotransmitter in synapse), autoreceptor is presynaptic, Gi hyperpolar
izes and decreases NT release</div><im src=""auto.jpe"" />" pharmacoloy_blo
ck4
What are two main classes of anti-depressants, what is effect of each? "TCAs (t
ricyclic antidepressant), SSRI. Both classes are presynaptic reuptake inhibitors
<div>TCA- increases NE and Serotonin</div><div>SSRI- increases Serotonin<br /><d
iv><im src=""SSRI.jpe"" /></div></div>"
pharmacoloy_block4
Depression is due to? "Decreased <b>serotonin</b>. Also NE and Dopamine<div><i
m src=""SSRI.jpe"" /></div>" pharmacoloy_block4
How do cells/receptors respond to excess neurotransmitter in the short term?
"Short term-&nbsp;<div>1. <u>Desensitize</u> receptors (shown below)<div>2. <u>H
ide</u> (internalize) receptors in the cytoplasm.</div><div>3. <u>Derade</u> re
ceptors</div></div><div><im src=""excess.jpe"" /></div>"
pharmacoloy_blo
ck4
How to cells/receptors respond to excess NT in the lon term? Decreases the nu
mber of receptors (by alterin ene expression) pharmacoloy_block4

What is the reward center in brain, and what is its neurotransmitter? "Nucleus
Accumbens. NT is dopamine.&nbsp;<div><im src=""dopamine.jpe"" /></div>"
pharmacoloy_block4
What is sinalin of lutamate and GABA on dopamine?
Glutamate- excitatory<di
v>GABA- inhibitory</div>
pharmacoloy_block4
T/F dopamine is released by dopamineric neurons when stimulated
False, d
opamine is tonically released by dopamineric neurons pharmacoloy_block4
How does GABA affect dopamine release? "Decreases dopamine<div><im src=""dopa
chart.jpe"" /></div>" pharmacoloy_block4
What do endorphins reulate?
"Reulate <u>GABA neurons</u>. Decreases GABA, i
ncreases dopamine<div><im src=""dopa chart.jpe"" /></div>"
pharmacoloy_blo
ck4
Opioid drus like morphine, heroin, act like what?
"Endorphins.&nbsp;<div><
im src=""dopa chart.jpe"" /></div>" pharmacoloy_block4
Describe mechanism difference between cocaine and amphetamines/methamphetamine o
n dopamine?
<u>Cocaine</u> enters CNS, <u>inhibits dopamine reuptake</u><div
><u>Amphetamines</u> increase <u>release of dopamine</u></div> pharmacoloy_blo
ck4
What happens to dopamine receptors after chronic use of cocaine?
Down re
ulation of receptors due to excess aonist--&t; common theme pharmacoloy_blo
ck4
What receptor/channel is GABA? How do barbiturates act on GABA? Chloride channel
. GABA is natural aonist, barbiturates <u>potentiate</u> GABA aonist activity,
but have <u>little to no aonist activity alone.</u> pharmacoloy_block4
Glutamate works on what type of receptors? How does it work as a channel?
"Ion channels and GPCR. As channel, opens Ca/Na EPSP<div><im src=""lutamate.jp
e"" /></div>" pharmacoloy_block4
What does veranicline bind to? Nicotinic receptor channels preferentially in th
e CNS pharmacoloy_block4
What is specific mechanism of acute alcohol use on CNS? "Alcohol acts as a <u>GA
BA aonist</u> on dopaneric neurons<div>Alcohol acts as <u>NMDA receptor antao
nist</u><br /><div><im src=""alcohol.jpe"" /></div></div>"
pharmacoloy_blo
ck4
What is effect of chronic treatment of beta blockers? <div>Chronic treatment w
ill increase beta receptors in heart--&t;abrupt stoppin will cause tachycardia
.</div><div>In contrast, excess aonist decreases the number of receptors.</div>
pharmacoloy_block4
What is the effect of chronic treatment of prednisone? Abrupt stoppin will caus
e?
<div>Chronic treatment will <u>decrease Cortisol production</u>;</div><d
iv><u>adrenal cortex underoes atrophy</u>--&t;Abrupt stoppin will lead to hyp
otension, hypolycemia,</div><div>difficulty breathin, muscle weakness, etc.</d
iv><div><br /></div><div>Cortisol: its primary functions are to increase blood s
uar throuh luconeoenesis; <u>suppress the immune system</u>; and aid in fat,
protein and carbohydrate metabolism</div><div><br /></div><div>Adrenal suppress
ion will bein to occur if prednisone is taken for loner than seven days. Event
ually, this may cause the body to temporarily lose the ability to manufacture na
tural corticosteroids (especially cortisol), which results in dependence on pred
nisone.</div> pharmacoloy_block4
What is the effect of chronic alcohol consumption?
Liver will increase alco
hol metabolism &amp; brain alters neuronal circuits. Withdrawal symptoms include
delirium tremens (<u>seizures</u>).
pharmacoloy_block4
Heroin addiction is treated with what? "Methadone. Heroin has a short half life
, leads to withdrawal symptoms at low levels. Methadone is not as potent and has
a lon half life.&nbsp;<div>Stratey: <u>treat dru addiction with weak aonist
s with lon half-life</u><br /><div><im src=""methadone.jpe"" /></div></div>"
pharmacoloy_block4
Treatment of opioid addiction by?
"Antaonist (nalaxone) or partial aonis
t (buprenorphine)&nbsp;<div><im src=""addiction op.jpe"" /></div>"
pharmaco
loy_block4
Treatment of nicotine addiction?
"Partial aonist varenicline<div><im sr

c=""addiction op.jpe"" /></div>"

pharmacoloy_block4
Chronic alcoholism or dependence on benzodiasepines once stopped can lead to ___
__? How to prevent?
"Seizures; prevented by Benzos with lon half-life<div><
im src=""benzo.jpe"" /></div>"
pharmacoloy_block4
Pharmacoloical treatment for alcohol? (2)&nbsp;
<div>1. Aversive (<i>Dis
ulfiram / Antabuse)</i> inhibits aldehyde dehydroenase;</div><div>build up of a
cetaldehyde makes you vomit)&nbsp;</div><div>2. <i>Diazepam</i> to prevent / tre
at seizures</div>
pharmacoloy_block4
Pharmacoloical treatment for nicotine? (2)
<div>1. <u>Nicotine transdermal
patch</u> (low dose aonist)&nbsp;</div><div>2. <u>Varenicline</u> (Chantix) </di
v><div>partial aonist for nicotine receptors in CNS</div>
pharmacoloy_blo
ck4
Pharmacoloical treatment for opioids? (3)
<div>Lon-actin aonists - Meth
adone&nbsp;</div><div>Partial aonists Buprenorphine</div><div><div>Antaonists
Naloxone, Naltrexone&nbsp;</div></div> pharmacoloy_block4
Pinpoint pupils in ER can mean pt is under what dru influences? Treatment?&nbsp
;
<b>Morphine, heroin, codeine</b>--&t;naloxone, naltrexone (antaonists)
<div>Oranophosphate--&t; PAM/Atropine</div> pharmacoloy_block4
Dilated pupils in ER mean pt is under influence of what drus? Treatment?
Cocaine, meth, MDMA (ecstasy)--&t; ive benzodiazepines (open Cl- channels to s
low down CNS) pharmacoloy_block4
Name two opioid antaonists?
Naloxone, naltrexone
pharmacoloy_block4
Name an opioid partial aonist? Buprenorphine pharmacoloy_block4
Name an opioid aonist with lon half-life?
Methadone
pharmacoloy_blo
ck4
What produces IL-10? What are 3 of its function?&nbsp; Produced by <u>Tre</u>
amon others; suppresses cytolytic pathway (TH1,CTL and NK cells); promotes TH2;
enhances B cells<div><br /></div><div>*If promotin humoral pathway, necessaril
y suppressin cytolytic pathway. Remember, Tre suppresses T cells.&nbsp;</div><
div><br /></div><div>(also remember EBV uses this to enhance B cells (EBV's home
), an downplay Th1 cells and evade death)&nbsp;</div><div><br /></div><div>1. Pr
omote B cell proliferation</div><div>2. iTre: Inhibit costimulatory molecules o
n APC&nbsp;</div><div>3. Th2: Promote TH2, inhibit Th1</div>
Immunoloy_block
4
Lens held in place by {{c1::zonule fibers (fibrillin)}} that attach from the {{c
2::lens equator capsule}} to the {{c2::inner nonpimented cells over the ciliary
processes}}
"<im src=""nonpi.jpe"" />" Anatomy_Block4 Kretzer_Block4
What is the anle?&nbsp;
"<div>Where the cornea and the sclera come toet
her. Most are 45 derees.&nbsp;</div><im src=""anle.jpe"" />"
Anatomy_
Block4 Kretzer_Block4
Describe flow of aqueous humor "<div> diffuses throuhout the posterior chamber
and nourishes the lens and replaces fluid in the vitreous</div><div><br /></div>
<div> moves throuh the pupil</div><div><br /></div><div> meanders throuhout the
anterior chamber and nourishes the cornea and iris stroma</div><div><br /></div>
<div> moves across the resistance of the trabecular meshwork (in the anle)</div>
<div><br /></div><div> exits in the canal of Schlemm to venous flow</div><div><br
/></div><div> bulk flow throuh resistance channel (no pinocytosis, phaocytosis
, transcytosis, or exocytosis)</div><div>&nbsp;&nbsp;</div><div><im src=""anle
.jpe"" /></div>"
Anatomy_Block4 Kretzer_Block4
What is the typical scotoma associated with chronic open anle laucoma?
Circular peripheral scotoma, painless.&nbsp;<div>(radual loss of outer vision-&t;to inner vision)</div>
Anatomy_Block4 Kretzer_Block4
With increased IOC pressure, what compresses peripheral nerve fibers of optic ne
rve?
"Lamina cribrosa<div><im src=""lamina.jpe"" /></div>" Anatomy_Block4 K
retzer_Block4
Name 3 parameters of sound localization 1. Interaural time difference<div>2. Int
eraural Intensity difference</div><div>3. Head transfer function</div> Anatomy_
Block4 Kretzer_Block4
What is rane of hearin? What are the vowel, and consonant ranes? What hz is p
eak visual acuity?
Rane- 20-20000 hz. Vowel: 500-800, consonant: 2000-5000

hz<div>Peak auditory acuity is 4000hz, riht in middle of CONSONANT rane</div>

Anatomy_Block4 Kretzer_Block4
Describe ratio of cartilae and then bone for auditory canal. Patholoy with ae
?
Ideally, outer 1/3 cartilae, inner 2/3 bone. Calcification with ae cha
nes this ratio and audio acuty Anatomy_Block4 Kretzer_Block4
Histoloy of tympanic membrane. What happens with repeated bouts of otitis media
Composed of three layers outer <u>thick skin with no epidermal pes</u>, a <u>st
roma</u> of very, very<u> oranized collaen fibers</u> (outer radial, inner cir
cumferential), and an inner layer of a <u>simple epithelium</u>.<div><br /></div
><div><br /></div><div>no pes so no irreular distortion. VERY reular orientat
ion of type 1 connective tissue</div><div>These are the very thins that become
patholoic with bouts of otitis media--&t; <b>ain <u>epidermal pes</u> and <u
>randomization</u> of stroma type I collaen fibers&nbsp;</b></div><div><br /></
div>
Anatomy_Block4 Kretzer_Block4
Define&nbsp;Sensorineural Deafness
Dysfunctional <u>hair cells</u> or dama
ed <u>auditory nerve</u> (CN VIII)
Anatomy_Block4 Kretzer_Block4
Define&nbsp;Conductive Deafness Compromised <u>middle ear impedance matchin</u>
Anatomy_Block4 Kretzer_Block4
Describe ASR
"Acoustic Stapedius Reflex- for noises OVER 80dB. Causes <u>stap
edius CNVII to contract to pull on stapes</u> to prevent as much enery as a pis
ton punch.&nbsp;<div><im src=""tensor.jpe"" /></div>" Anatomy_Block4 Kretzer_B
lock4
"Describe Bell's palsy effects of protective mechanisms of inner ear? Name their
<b><font color=""#ff0000"">complaints</font></b>."
Bells--&t; CN VII infla
mmation--&t;No ASR, patient complains of <u>hyperacusis</u> (a very loud world)
&nbsp;&nbsp;<div><br /></div><div>Additionally, prevocalization reflex uses CNVI
I and CNV. <u>1/2 of this mechanism is out</u>, so patients say they <u>'sound d
ifferent' to themselves </u>when they talk</div>
Anatomy_Block4 Kretzer_B
lock4
Define prevocalization reflex? Before you start to vocalize, <b>CN VII contract
s</b> <b>the stapedius muscle</b> to pull on the stapes, and <b>CN V₃
contracts the tensor tympani</b> to pull on the malleus which tihtens the tymp
anic membrane, simultaneously. This dampens down the horrible noises created whe
n a person speaks.
Anatomy_Block4 Kretzer_Block4
Name the 7 ravaes of otitis media
<u>1. Inflammation and scarin</u>&nbsp;
(epidermal pes, irreular collaen) of the tympanic membrane so it does not vib
rate so efficiently<div><br /></div><div>2. Myrinosclrosis (calcification of ty
mpanic membrane)<br /><div><br /></div><div><u>3. Erodes the ossicles</u> (reduc
es the efficiency of impedance matchin)</div><div><br /></div><div><u>4.&nbsp;<
/u><u>Destroys the synovial joints</u> (reduces the efficiency of impedance matc
hin)</div><div><br /></div><div>5. Tympanosclrosis (calcification of ossicles)<
/div><div><br /></div><div>6. Causes early <u>calcification</u> and scarin of t
he <u>annulus</u> <u>around the stapes foot process on the oval window</u> (<b>o
tosclerosis</b>)</div><div><br /></div><div><u>7. Infection</u> has easy access
to the <u>air filled cavities</u> of the <u>mastoid</u> (and into the <u>brain</
u>)</div></div> Anatomy_Block4 Kretzer_Block4
<div>Kids with {{c1::immotile cilia syndrome or labile cilia syndrome}} have a h
iher risk of otitis media because cilia do not beat bacteria, pus, and fluids t
oward the Eustachian tube (auditory tube). Also, very prevalent in all kids beca
use Eustachian tube is {{c2::very horizontal in orientation}} as a child. &nbsp;
With rowth, the Eustachian tube assumes a reater anular drop for better middl
e ear drainae.&nbsp;</div>
Anatomy_Block4 Kretzer_Block4
What is the treatment for otitis media ravae and preventin hearin loss?
"Surically can put a tube across the tympanic membrane (reion 3) for reater ven
tilation of the middle ear.<div><br /></div><div>-causes oxyenation (anaerobic
bacteria)</div><div>-drainae</div><div><im src=""reion 3.jpe"" /></div>"
Anatomy_Block4 Kretzer_Block4
Why hunter must hum before pullin trier
Turns on prevocalization reflex,
CN 5 and 7 to contract muscles (tensor tympani, stapdeius muscle)&nbsp;
Anatomy_Block4 Kretzer_Block4

Describe how we measure loudness&nbsp; Loudness (amplitude) expressed in decibe

ls (dB = 20 lo 10 test pressure divided by reference pressure. &nbsp;<div><b>0d
B</b> is <b>threshold at <u>3000Hz</u></b> which is mans most sensitive, least di
storted frequency; <b>20dB</b> is <b>ten times louder than threshold</b>; <b>40d
B</b> is <b>100 times</b> louder than threshold; <b>60dB is 1000</b> times loude
r than threshold, <b>80dB is 10,000</b> times louder than threshold; 100dB is 10
0,000 times louder than threshold; 120dB is 1,000,000 times louder than threshol
d; and <b>140db is 10 million times louder than threshold and causes physical pa
in with no sound perception.</b></div> Kretzer_Bloc
4
What is rinne tuning for
test? For
near mastoid behind ear pinna.&nbsp;<div>If
patient <u>hears nothing</u>--&gt; <u>sensorineual deafness</u></div><div><br /
></div><div>If patient <u>hears sound</u> by bone conduction, have them tell you
<i>when the sound disappears</i>. &nbsp;Now put the tuning for
with its lower
energy (that developed over time) in front of the ear canal. &nbsp;If <u>they co
ntinue to not be able to hear the sound</u>, they have <u>conductive deafness</u
>. &nbsp;</div><div><br /></div><div>If they hear the sound again at its lower a
mplitude, the efficiency of the impedance matching of the middle ear is operant
and functioning. &nbsp;&nbsp;</div>
Kretzer_Bloc
4
Tip of nose is supplied by what nerve? "V1<div><img src=""trigeminal n.jpeg"" /
></div>"
Anatomy_Bloc
4
Inside of chee
sensory is by? "Buccal branches of V3<div><img src=""branches t
rigeminal.jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""fc9c67e4b86721bf4e6237c4e2de6f83a7b1dd98_Q_0.svg"" />"
"<img sr
c=""fc9c67e4b86721bf4e6237c4e2de6f83a7b1dd98_A_0.svg"" />"
"<img src=""fc9c
67e4b86721bf4e6237c4e2de6f83a7b1dd98_source_svg.svg"" />"
"<img src=""fc9c
67e4b86721bf4e6237c4e2de6f83a7b1dd98_trigeminal n.jpeg"" />"
Anatomy_Bloc
4
"<img src=""fc9c67e4b86721bf4e6237c4e2de6f83a7b1dd98_Q_1.svg"" />"
"<img sr
c=""fc9c67e4b86721bf4e6237c4e2de6f83a7b1dd98_A_1.svg"" />"
"<img src=""fc9c
67e4b86721bf4e6237c4e2de6f83a7b1dd98_source_svg.svg"" />"
"<img src=""fc9c
67e4b86721bf4e6237c4e2de6f83a7b1dd98_trigeminal n.jpeg"" />"
Anatomy_Bloc
4
"<img src=""fc9c67e4b86721bf4e6237c4e2de6f83a7b1dd98_Q_2.svg"" />"
"<img sr
c=""fc9c67e4b86721bf4e6237c4e2de6f83a7b1dd98_A_2.svg"" />"
"<img src=""fc9c
67e4b86721bf4e6237c4e2de6f83a7b1dd98_source_svg.svg"" />"
"<img src=""fc9c
67e4b86721bf4e6237c4e2de6f83a7b1dd98_trigeminal n.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_0.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_0.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_1.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_1.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_2.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_2.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_3.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_3.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_4.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_4.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00

7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"

Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_5.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_5.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_6.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_6.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_7.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_7.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_8.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_8.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_9.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_9.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_10.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_10.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_Q_11.svg"" />"
"<img sr
c=""cb007f5e16f8cfbc4cfe3e9219458fc0451b6587_A_11.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_source_svg.svg"" />"
"<img src=""cb00
7f5e16f8cfbc4cfe3e9219458fc0451b6587_branches trigeminal.jpeg"" />"
Anatomy_Bloc
4
Great auricular and lesser occiptal n. are what
ind of rami? Greater occipital
nerve are what
ind of rami?&nbsp;
"Ventral rami off of C2/C3the cervical p
lexus<div>Dorsal rami of C2<br /><div><img src=""side nerves.jpeg"" /></div></di
v>"
Anatomy_Bloc
4
"<img src=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_Q_0.svg"" />"
"<img sr
c=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_A_0.svg"" />"
"<img src=""0813
a96f668a2e2beafb44f1cd48c214b5a12d8a_source_svg.svg"" />"
"<img src=""0813
a96f668a2e2beafb44f1cd48c214b5a12d8a_side nerves.jpeg"" />"
Anatomy_Bloc
4
"<img src=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_Q_1.svg"" />"
"<img sr
c=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_A_1.svg"" />"
"<img src=""0813
a96f668a2e2beafb44f1cd48c214b5a12d8a_source_svg.svg"" />"
"<img src=""0813
a96f668a2e2beafb44f1cd48c214b5a12d8a_side nerves.jpeg"" />"
Anatomy_Bloc
4
"<img src=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_Q_2.svg"" />"
"<img sr
c=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_A_2.svg"" />"
"<img src=""0813
a96f668a2e2beafb44f1cd48c214b5a12d8a_source_svg.svg"" />"
"<img src=""0813
a96f668a2e2beafb44f1cd48c214b5a12d8a_side nerves.jpeg"" />"
Anatomy_Bloc
4
"<img src=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_Q_3.svg"" />"
"<img sr
c=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_A_3.svg"" /><div>dorsal rami</div>"
"<img src=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_source_svg.svg"" />"
"<img src=""0813a96f668a2e2beafb44f1cd48c214b5a12d8a_side nerves.jpeg"" />"

Anatomy_Bloc
4
Mnemonic for trigeminal nerve branches of face "<div>NFL</div><div>IZZ</div><di
v>MBA</div><div>(GA)</div><img src=""pneumonic.jpeg"" />"
Anatomy_Bloc
4
Palpebral vs orbital portion of orbicularis oculi
"<img src=""ADAM.jpeg""
/>"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_0.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_0.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_1.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_1.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_2.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_2.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_3.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_3.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_4.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_4.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_5.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_5.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_6.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_6.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_7.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_7.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_8.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_8.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_9.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_9.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_Q_10.svg"" />"
"<img sr
c=""cefae3d58c41b1ff7b98fd3725ade4ff7f6ca384_A_10.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_source_svg.svg"" />"
"<img src=""cefa
e3d58c41b1ff7b98fd3725ade4ff7f6ca384_branches real.jpeg"" />"
Anatomy_Bloc
4

"<img src=""645fa7d01b8791b88c8e1c8755c08e93c9c126f0_Q_0.svg"" />"

"<img sr
c=""645fa7d01b8791b88c8e1c8755c08e93c9c126f0_A_0.svg"" />"
"<img src=""645f
a7d01b8791b88c8e1c8755c08e93c9c126f0_source_svg.svg"" />"
"<img src=""645f
a7d01b8791b88c8e1c8755c08e93c9c126f0_vs.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""645fa7d01b8791b88c8e1c8755c08e93c9c126f0_Q_1.svg"" />"
"<img sr
c=""645fa7d01b8791b88c8e1c8755c08e93c9c126f0_A_1.svg"" />"
"<img src=""645f
a7d01b8791b88c8e1c8755c08e93c9c126f0_source_svg.svg"" />"
"<img src=""645f
a7d01b8791b88c8e1c8755c08e93c9c126f0_vs.jpeg"" />"
Anatomy_
Bloc
4
"Blue? Red?<div><img src=""platy.jpeg"" /></div>"
<div>Blue- cervical bran
ch of facial nerve, motor to the platysma.&nbsp;</div>Red- transverse cervical (
superficial to SCM)
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_0.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_0.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_1.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_1.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_2.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_2.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_3.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_3.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_4.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_4.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_5.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_5.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_6.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_6.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_7.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_7.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_Q_8.svg"" />"
"<img sr
c=""62dc0b3a0a482332195fe526f063cd8d02e9bd11_A_8.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_source_svg.svg"" />"
"<img src=""62dc
0b3a0a482332195fe526f063cd8d02e9bd11_facial front.jpeg"" />"
Anatomy_Bloc
4
"<img src=""c52974b65d6f5301bda8ec553fea33822746edf7_Q_0.svg"" />"
"<img sr
c=""c52974b65d6f5301bda8ec553fea33822746edf7_A_0.svg"" />"
"<img src=""c529

74b65d6f5301bda8ec553fea33822746edf7_source_svg.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_side face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""c52974b65d6f5301bda8ec553fea33822746edf7_Q_1.svg"" />"
"<img sr
c=""c52974b65d6f5301bda8ec553fea33822746edf7_A_1.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_source_svg.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_side face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""c52974b65d6f5301bda8ec553fea33822746edf7_Q_2.svg"" />"
"<img sr
c=""c52974b65d6f5301bda8ec553fea33822746edf7_A_2.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_source_svg.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_side face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""c52974b65d6f5301bda8ec553fea33822746edf7_Q_3.svg"" />"
"<img sr
c=""c52974b65d6f5301bda8ec553fea33822746edf7_A_3.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_source_svg.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_side face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""c52974b65d6f5301bda8ec553fea33822746edf7_Q_4.svg"" />"
"<img sr
c=""c52974b65d6f5301bda8ec553fea33822746edf7_A_4.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_source_svg.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_side face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""c52974b65d6f5301bda8ec553fea33822746edf7_Q_5.svg"" />"
"<img sr
c=""c52974b65d6f5301bda8ec553fea33822746edf7_A_5.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_source_svg.svg"" />"
"<img src=""c529
74b65d6f5301bda8ec553fea33822746edf7_side face.jpeg"" />"
Anatomy_Bloc
4
Where does parotid duct pierce buccinator?
Opposite upper 2nd molar
Anatomy_Bloc
4
"<img src=""0c85192c821df004105cce68bdf645ff475c38bc_Q_0.svg"" />"
"<img sr
c=""0c85192c821df004105cce68bdf645ff475c38bc_A_0.svg"" />"
"<img src=""0c85
192c821df004105cce68bdf645ff475c38bc_source_svg.svg"" />"
"<img src=""0c85
192c821df004105cce68bdf645ff475c38bc_buccinator.jpeg"" />"
Anatomy_Bloc
4
Sensory innervation of buccinator?&nbsp;Motor innervation of buccinator?
"<div>Sensory on inside of chee
from buccal branch of V3</div><div>Motor innerv
ation by buccal branch of VII</div><div><img src=""bucc.jpeg"" /></div>"
Anatomy_Bloc
4
What is Bells Palsy? Idiopathic inflammation or compression of VII leading to
loss of function<div><br /></div><div>May present with:</div><div>-hallmar
is
facial paralysis</div><div>-cant close eye</div><div>-pt drools</div><div>-food
gets stuc
in chee
</div><div>-loss of taste from anterior 2/3 of tongue</div><
div>-p/s function to salivary glands</div><div>-hyperacusis (loss of stapedius)<
/div><div>-P/S function to lacrimal gland</div> Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_0.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_0.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_1.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_1.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_2.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_2.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4

"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_3.svg"" />"

"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_3.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_4.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_4.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_5.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_5.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_6.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_6.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
"<img src=""030e00f08962b6bf8e4c944db06fcfecc65e643c_Q_7.svg"" />"
"<img sr
c=""030e00f08962b6bf8e4c944db06fcfecc65e643c_A_7.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_source_svg.svg"" />"
"<img src=""030e
00f08962b6bf8e4c944db06fcfecc65e643c_blood supply to face.jpeg"" />"
Anatomy_Bloc
4
What is danger triangle?
"Area of face where retrograde infections can tr
ansmit to brain through emissary veins<div><img src=""danger.jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_0.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_0.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_1.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_1.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_2.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_2.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_3.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_3.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_4.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_4.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_5.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_5.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_6.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_6.svg"" />"
"<img src=""5864

932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_7.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_7.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_8.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_8.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
"<img src=""5864932ddeabefb15c775a3005631db9a54f4a01_Q_9.svg"" />"
"<img sr
c=""5864932ddeabefb15c775a3005631db9a54f4a01_A_9.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_source_svg.svg"" />"
"<img src=""5864
932ddeabefb15c775a3005631db9a54f4a01_veins face real.jpeg"" />"
Anatomy_Bloc
4
What are some directly acting adrenomimetics? epinephrine, norepineprine, isop
roterenol, dopamine at high conc.
pharmacology_bloc
4
What are 3 indirectly acting adrenergic drugs? Cause release of NE-- tyramine,
ephedrine, amphetamine pharmacology_bloc
4
What are some reupta
e inhibitors for adrenergic compounds?
<div>cocaine, im
ipramine,</div><div>amitriptyline, SSRIs</div> pharmacology_bloc
4
Q: What adrenergic receptor does norepinephrine NOT activate? Beta-2 pharmaco
logy_bloc
4
Whatr particular receptors does epinephrine bind to?
<b>all </b>adrenergic re
ceptors 1, 2, 1, 2, 3
pharmacology_lock4
What receptors does&nsp;Isoproterenol ind to? adrenergic receptors 1, 2, 3 (pure
eta) ut not 1, 2 (Syn
he
ic cmund)
h rm clgy_blck4
Wh
rece
rs des d mine bind
? <div>DBA1</div><div>d mine rece
rs D1, D2, e
c. higher cnc. 1, then 1, bu
n
2</div>
pharmacology_lock4
s group on amine gets larger, what happens to affinity to receptors? "ffinit
y for eta receptors increases as group on the amine nitrogen gets larger.&nsp;
<div><img src=""size.jpeg"" /></div>" pharmacology_lock4
Why do local anesthetics contain epi? Epi inds alpha-1 receptors, to achieve
local vasoconstriction, keeps anesthetic locally for a longer duration.<div><r
/><div>(in contrast, NE is contraindicated, ecause it does not ind eta2, ther
efore increasing lood pressure too much)&nsp;</div></div>
pharmacology_lo
ck4
Q: What happens to heart rate when norepinephrine is infused into whole organism
? Why? : high p, aroreceptors get activated, parasympathetic system releases
acetylcholine on S node, HR goes down, (termed <>reflex radycardia</>)
pharmacology_lock4
Q: What happens to heart rate when NE is added to an isolated heart maintained i
n an organ ath? Why?
pharmaco
: No aroreceptors, no reflex radycardia
logy_lock4
Where is the perilymph synthesized? Where does it flow?&nsp; "Secreted y the
<>periosteum of the ony layrinth</> (high in Na, low in K); perilymph flow
is called ulk flow, continuous with the CSF in the suarachnoid space via the p
erilymphatic duct, flows in vestiule, spiral cochlea, three semicircular canals
. *No exocytosis/endocytosis<div><img src=""vestiule.jpeg"" /></div>" natomy_
Block4 Kretzer_Block4
Where is endolymph secreted?&nsp;
"Endolymph is secreted y cells in the <
u>ampulla</u> of each semicircular canal (y dark cells=lots of mitochondria due
to pumping K+ rich fluid) and y specialized epithelium (<u>stria vascularis</u
>) within the scala media of the cochlea. It freely difuses throughout the memr
anous layrinth.&nsp;<div><img src=""vestiule.jpeg"" /></div>"
natomy_
Block4 Kretzer_Block4
Descrie the flow of endolymph through the memranous layrinth "Secreted y dar

k cells in the ampulla and stria vascularis. Diffuses freely, and is released ac
ross epithelial cells (y vacuolar uptake) of the endolymphatic sac at highly va
scularized site within the sudural space. This depends on transcytosis of the v
acuoles and exocytosis and release of endolymph across asal memrane.&nsp;<div
><r /></div><div>In contrast, oth perilymph and aqueous humor are ulk flow.</
div><div><r /></div><div><img src=""vestiule.jpeg"" />&nsp;</div>"
natomy_
Block4 Kretzer_Block4
Where are the 6 sites where memranous layrinth is modified into hair cells and
give the function of each, and # of hair cells?
"<>3 ampulla of each of
the semicircular canals</> (7000 each)<div>-angular accelerations and decelera
tions in anterior, posterior, horizontal planes<r /><div><>Horizontal wall of
utrical </>(1000)</div><div>-linear accelerations (standing on moving us)</div
><div><>Vertical wall of the saccule</> (1000)</div><div>-acc. in vert plane (
up down in elevator)</div><div><>Organ of corti </>(3000)</div></div><div>-hea
natomy_Block4 Kretzer_B
ring</div><div><img src=""vestiule.jpeg"" /></div>"
lock4
Desrie histology of stria vascularis and comment on why alinos have poor heari
ng (and poor visual acuity.)&nsp;
"The stria vascularis is a <u>pseudostra
tified columnar epithelium</u> <>invaded y <u>melanocytes</u></>&nsp;(essent
ial for endolymph secretion with its high K concentration and explains hearing l
oss of alinos or neural crest suppression)&nsp;<div><img src=""stria v.jpeg""
/></div>"
natomy_Block4 Kretzer_Block4
Q: What presynaptic autoreceptor does NE act on?
": acts on alpha-2 pres
ynaptically--&gt;reduces the release of NE<div><img src=""NE presyn.jpeg"" /></d
iv>"
pharmacology_lock4
Q: Know these charts cold:
"<div><img src=""cold.jpeg"" /></div><div><r />
</div><div><r /></div><div><!--anki--><img src=""col2.jpeg"" /></div><div><r /
></div><div>Left = norepinephrine; middle = epinephrine; right = isoproterenol</
div><div>This will e on test so e ale to explain these graphs and identify th
em.</div>"
pharmacology_lock4
Q: The lood vessels in the skeletal muscle ed contain oth alpha-1 and eta-2
receptors. How does the dose of epinephrine affect the diameter of these vessels
?
: epinephrine acts at oth receptor types and is dose-dependent; low do
ses of epinephrine activate eta-2 receptors causing vasodilation; while higher
doses activate alpha-1 receptors and cause constriction pharmacology_lock4
Q: In switching from parasympathetic to sympathetic innervation, where does loo
d flow increase to in the ody? : heart, lungs, skeletal muscles
pharmaco
logy_lock4
: ecau
Q: Why doesnt isoproterenol have an effect of GI/ladder sphincters?
se it doesnt ind alpha-1 receptors
pharmacology_lock4
Q: What is the affect of epinephrine on lood vessels to skeletal muscle?
: dilation via eta-2, constriction via alpha-1; note that skeletal muscle has
oth alpha-1 and eta-2 receptors; at physiologic concentration theres dilation v
ia eta-2; however at higher concentrations there constriction via alpha-1; the
reason for this is that <>eta-2 are more sensitive to epinephrine than alpha-1
</>
pharmacology_lock4
Q: What is the effect of NE on ronchial smooth muscle? : No effect; doesnt act
on eta-2 receptors
pharmacology_lock4
Which cytokines suppress Th1 pathway? IL-4, IL-10
Immunology_lock4
What is the innervation of temporalis? Deep temporal nerve of V3<div>(not tempo
natomy_Block4
ral of VII or auriculotemporal of V3)&nsp;</div>
"<img src=""f5a11482f2e05544a8826f030360396f13a66_Q_0.svg"" />"
"<img sr
c=""f5a11482f2e05544a8826f030360396f13a66__0.svg"" />"
"<img src=""f5a1
1482f2e05544a8826f030360396f13a66_source_svg.svg"" />"
"<img src=""f5a1
natomy_
1482f2e05544a8826f030360396f13a66_massa.jpeg"" />"
Block4
"<img src=""0f168a76574a78daad5f686590822f280170_Q_0.svg"" />"
"<img sr
c=""0f168a76574a78daad5f686590822f280170__0.svg"" />"
"<img src=""0f1
68a76574a78daad5f686590822f280170_source_svg.svg"" />"
"<img src=""0f1
68a76574a78daad5f686590822f280170_temporalis.jpeg"" />"

natomy_Block4
"<img src=""0f168a76574a78daad5f686590822f280170_Q_1.svg"" />"
"<img sr
c=""0f168a76574a78daad5f686590822f280170__1.svg"" />"
"<img src=""0f1
68a76574a78daad5f686590822f280170_source_svg.svg"" />"
"<img src=""0f1
68a76574a78daad5f686590822f280170_temporalis.jpeg"" />"
natomy_Block4
Where does pterygopalatine fossa lie? "Between <>maxilla</> and the <>ptery
goid process</> of the sphenoid one. (accessed y pasing through the pterygoma
xillary fissure)<div><img src=""infra.jpeg"" /></div>" natomy_Block4
"<img src=""efe4227457d328c107756a7d85a835a371086_Q_0.svg"" />"
"<img sr
c=""efe4227457d328c107756a7d85a835a371086__0.svg"" />"
"<img src=""efe4
227457d328c107756a7d85a835a371086_source_svg.svg"" />"
"<img src=""efe4
227457d328c107756a7d85a835a371086_fossaw.jpeg"" />"
natomy_
Block4
"<img src=""efe4227457d328c107756a7d85a835a371086_Q_1.svg"" />"
"<img sr
c=""efe4227457d328c107756a7d85a835a371086__1.svg"" />"
"<img src=""efe4
227457d328c107756a7d85a835a371086_source_svg.svg"" />"
"<img src=""efe4
227457d328c107756a7d85a835a371086_fossaw.jpeg"" />"
natomy_
Block4
"<img src=""85245306ce89d11d056938af7e7f93845a4_Q_0.svg"" />"
"<img sr
c=""85245306ce89d11d056938af7e7f93845a4__0.svg"" />"
"<img src=""8524
"<img src=""8524
5306ce89d11d056938af7e7f93845a4_source_svg.svg"" />"
5306ce89d11d056938af7e7f93845a4_2.jpeg"" />"
natomy_
Block4
"<div><img src=""6c84edff25463ee93dadfd3dd78fc16057162_Q_0.svg"" /></div><div
><><font color=""#0000ff"">Space</font></></div>"
"<img src=""6c84edff2546
3ee93dadfd3dd78fc16057162__0.svg"" />"
"<img src=""6c84edff25463ee93dad
fd3dd78fc16057162_source_svg.svg"" />"
"<img src=""6c84edff25463ee93dad
fd3dd78fc16057162_infra.jpeg"" />"
natomy_Block4
"<img src=""6c84edff25463ee93dadfd3dd78fc16057162_Q_1.svg"" /><div>Space</div
>"
"<img src=""6c84edff25463ee93dadfd3dd78fc16057162__1.svg"" />"
"<img src=""6c84edff25463ee93dadfd3dd78fc16057162_source_svg.svg"" />"
"<img src=""6c84edff25463ee93dadfd3dd78fc16057162_infra.jpeg"" />"
natomy_Block4
"<img src=""6c84edff25463ee93dadfd3dd78fc16057162_Q_2.svg"" />"
"<img sr
c=""6c84edff25463ee93dadfd3dd78fc16057162__2.svg"" />"
"<img src=""6c84
edff25463ee93dadfd3dd78fc16057162_source_svg.svg"" />"
"<img src=""6c84
edff25463ee93dadfd3dd78fc16057162_infra.jpeg"" />"
natomy_
Block4
Both pterygoid muscles come off of the lateral ptergoid plate. No muscle comes
of the medial pterygoid plate<div><r /></div> natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_0.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__0.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_1.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__1.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_2.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__2.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_3.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__3.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"

natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_4.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__4.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_6.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__6.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_7.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__7.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_8.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__8.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_9.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__9.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""f37a7f320a1989a6d120805c589937a92e43f_Q_12.svg"" />"
"<img sr
c=""f37a7f320a1989a6d120805c589937a92e43f__12.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_source_svg.svg"" />"
"<img src=""f37a
7f320a1989a6d120805c589937a92e43f_mandile.jpeg"" />"
natomy_Block4
"<img src=""a7703701049de3d22dc9120e664e2e985c93a0_Q_0.svg"" />"
"<img sr
c=""a7703701049de3d22dc9120e664e2e985c93a0__0.svg"" />"
"<img src=""a770
3701049de3d22dc9120e664e2e985c93a0_source_svg.svg"" />"
"<img src=""a770
natomy_
3701049de3d22dc9120e664e2e985c93a0_lat pt.jpeg"" />"
Block4
"<img src=""a7703701049de3d22dc9120e664e2e985c93a0_Q_1.svg"" />"
"<img sr
c=""a7703701049de3d22dc9120e664e2e985c93a0__1.svg"" />"
"<img src=""a770
3701049de3d22dc9120e664e2e985c93a0_source_svg.svg"" />"
"<img src=""a770
natomy_
3701049de3d22dc9120e664e2e985c93a0_lat pt.jpeg"" />"
Block4
Descrie protraction of mandile- what muscle(s) protracts it? "<div>Lateral pt
erygoid (and medial pterygoid)</div><div><r /></div><img src=""protraction.jpeg
"" />" natomy_Block4
What does lingual nerve innervate?
"General sensory to anterior 2/3 of tong
ue.<div><>Joined y chorda tympani</> (carrying taste to anterior 2/3 of tongu
e) and preganglionic PS fiers to sumandiular ganglion for sumandiular and s
natomy_
ulingual glands<r /><div><img src=""lingual.jpeg"" /></div></div>"
Block4
"<img src=""4327f1ac31ffc285467fd892fda64aee0d2a39_Q_0.svg"" />"
"<img sr
c=""4327f1ac31ffc285467fd892fda64aee0d2a39__0.svg"" />"
"<img src=""4327
f1ac31ffc285467fd892fda64aee0d2a39_source_svg.svg"" />"
"<img src=""4327
f1ac31ffc285467fd892fda64aee0d2a39_med pt.jpeg"" />"
natomy_
Block4
"<img src=""67d3a5dc3e85cf76a26a423e0e969d3039f2e_Q_0.svg"" />"
"<img sr
c=""67d3a5dc3e85cf76a26a423e0e969d3039f2e__0.svg"" />"
"<img src=""67d3
a5dc3e85cf76a26a423e0e969d3039f2e_source_svg.svg"" />"
"<img src=""67d3
a5dc3e85cf76a26a423e0e969d3039f2e_12.jpeg"" />"
natomy_
Block4
"<img src=""67d3a5dc3e85cf76a26a423e0e969d3039f2e_Q_1.svg"" />"
"<img sr

c=""67d3a5dc3e85cf76a26a423e0e969d3039f2e__1.svg"" />"
a5dc3e85cf76a26a423e0e969d3039f2e_source_svg.svg"" />"
a5dc3e85cf76a26a423e0e969d3039f2e_12.jpeg"" />"
Block4
"<img src=""9a91033572df103c82fa7295d9faf8266d1fd06_Q_0.svg""
c=""9a91033572df103c82fa7295d9faf8266d1fd06__0.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_source_svg.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_muscles mast.jpeg"" />"
natomy_Block4
"<img src=""9a91033572df103c82fa7295d9faf8266d1fd06_Q_1.svg""
c=""9a91033572df103c82fa7295d9faf8266d1fd06__1.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_source_svg.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_muscles mast.jpeg"" />"
natomy_Block4
"<img src=""9a91033572df103c82fa7295d9faf8266d1fd06_Q_2.svg""
c=""9a91033572df103c82fa7295d9faf8266d1fd06__2.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_source_svg.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_muscles mast.jpeg"" />"
natomy_Block4
"<img src=""9a91033572df103c82fa7295d9faf8266d1fd06_Q_3.svg""
c=""9a91033572df103c82fa7295d9faf8266d1fd06__3.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_source_svg.svg"" />"
033572df103c82fa7295d9faf8266d1fd06_muscles mast.jpeg"" />"
natomy_Block4
"<img src=""e2588932323ea09acadd6a1cf35774a02885_Q_0.svg""
c=""e2588932323ea09acadd6a1cf35774a02885__0.svg"" />"
8932323ea09acadd6a1cf35774a02885_source_svg.svg"" />"
8932323ea09acadd6a1cf35774a02885_ranches V3.jpeg"" />"
natomy_Block4
"<img src=""e2588932323ea09acadd6a1cf35774a02885_Q_1.svg""
c=""e2588932323ea09acadd6a1cf35774a02885__1.svg"" />"
8932323ea09acadd6a1cf35774a02885_source_svg.svg"" />"
8932323ea09acadd6a1cf35774a02885_ranches V3.jpeg"" />"
natomy_Block4
"<img src=""e2588932323ea09acadd6a1cf35774a02885_Q_2.svg""
c=""e2588932323ea09acadd6a1cf35774a02885__2.svg"" />"
8932323ea09acadd6a1cf35774a02885_source_svg.svg"" />"
8932323ea09acadd6a1cf35774a02885_ranches V3.jpeg"" />"
natomy_Block4
"<img src=""e2588932323ea09acadd6a1cf35774a02885_Q_3.svg""
c=""e2588932323ea09acadd6a1cf35774a02885__3.svg"" />"
8932323ea09acadd6a1cf35774a02885_source_svg.svg"" />"
8932323ea09acadd6a1cf35774a02885_ranches V3.jpeg"" />"
natomy_Block4
"<img src=""e2588932323ea09acadd6a1cf35774a02885_Q_4.svg""
c=""e2588932323ea09acadd6a1cf35774a02885__4.svg"" />"
8932323ea09acadd6a1cf35774a02885_source_svg.svg"" />"
8932323ea09acadd6a1cf35774a02885_ranches V3.jpeg"" />"
natomy_Block4
"<img src=""e2588932323ea09acadd6a1cf35774a02885_Q_5.svg""
c=""e2588932323ea09acadd6a1cf35774a02885__5.svg"" />"
8932323ea09acadd6a1cf35774a02885_source_svg.svg"" />"
8932323ea09acadd6a1cf35774a02885_ranches V3.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_0.svg""
c=""2f578e1728ccf046e14f72e747f2ea3976d417__0.svg"" />"
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_1.svg""

"<img src=""67d3
"<img src=""67d3
natomy_
/>"
"<img sr
"<img src=""9a91
"<img src=""9a91
/>"
"<img sr
"<img src=""9a91
"<img src=""9a91
/>"
"<img sr
"<img src=""9a91
"<img src=""9a91
/>"
"<img sr
"<img src=""9a91
"<img src=""9a91
/>"
"<img sr
"<img src=""e258
"<img src=""e258
/>"
"<img sr
"<img src=""e258
"<img src=""e258
/>"
"<img sr
"<img src=""e258
"<img src=""e258
/>"
"<img sr
"<img src=""e258
"<img src=""e258
/>"
"<img sr
"<img src=""e258
"<img src=""e258
/>"
"<img sr
"<img src=""e258
"<img src=""e258
/>"
"<img sr
"<img src=""2f57
"<img src=""2f57
/>"

"<img sr

c=""2f578e1728ccf046e14f72e747f2ea3976d417__1.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_2.svg"" />"
"<img sr
c=""2f578e1728ccf046e14f72e747f2ea3976d417__2.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_3.svg"" />"
"<img sr
c=""2f578e1728ccf046e14f72e747f2ea3976d417__3.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_4.svg"" />"
"<img sr
c=""2f578e1728ccf046e14f72e747f2ea3976d417__4.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_5.svg"" />"
"<img sr
c=""2f578e1728ccf046e14f72e747f2ea3976d417__5.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""2f578e1728ccf046e14f72e747f2ea3976d417_Q_6.svg"" />"
"<img sr
c=""2f578e1728ccf046e14f72e747f2ea3976d417__6.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_source_svg.svg"" />"
"<img src=""2f57
8e1728ccf046e14f72e747f2ea3976d417_PS to part.jpeg"" />"
natomy_Block4
"<img src=""490345039fd783fc28d85f9241e5808d5116d79_Q_0.svg"" />"
"<img sr
c=""490345039fd783fc28d85f9241e5808d5116d79__0.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_source_svg.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_maxillary.jpeg"" />"
natomy_Block4
"<img src=""490345039fd783fc28d85f9241e5808d5116d79_Q_1.svg"" />"
"<img sr
c=""490345039fd783fc28d85f9241e5808d5116d79__1.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_source_svg.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_maxillary.jpeg"" />"
natomy_Block4
"<img src=""490345039fd783fc28d85f9241e5808d5116d79_Q_2.svg"" />"
"<img sr
c=""490345039fd783fc28d85f9241e5808d5116d79__2.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_source_svg.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_maxillary.jpeg"" />"
natomy_Block4
"<img src=""490345039fd783fc28d85f9241e5808d5116d79_Q_3.svg"" />"
"<img sr
c=""490345039fd783fc28d85f9241e5808d5116d79__3.svg"" /><div>Will run with infe
rior alveolar nerve into mandiular foramen</div>"
"<img src=""490345039fd
783fc28d85f9241e5808d5116d79_source_svg.svg"" />"
"<img src=""490345039fd
783fc28d85f9241e5808d5116d79_maxillary.jpeg"" />"
natomy_
Block4
"<img src=""490345039fd783fc28d85f9241e5808d5116d79_Q_4.svg"" />"
"<img sr
c=""490345039fd783fc28d85f9241e5808d5116d79__4.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_source_svg.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_maxillary.jpeg"" />"
natomy_Block4
"<img src=""490345039fd783fc28d85f9241e5808d5116d79_Q_5.svg"" />"
"<img sr
c=""490345039fd783fc28d85f9241e5808d5116d79__5.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_source_svg.svg"" />"
"<img src=""490
345039fd783fc28d85f9241e5808d5116d79_maxillary.jpeg"" />"
natomy_Block4

"<img src=""c987518648938894c072707821e828e76a357_Q_0.svg"" />"

"<img sr
c=""c987518648938894c072707821e828e76a357__0.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
natomy_
518648938894c072707821e828e76a357_extra.jpeg"" />"
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_1.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__1.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_extra.jpeg"" />"
natomy_
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_2.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__2.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_extra.jpeg"" />"
natomy_
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_3.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__3.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
natomy_
518648938894c072707821e828e76a357_extra.jpeg"" />"
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_4.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__4.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
natomy_
518648938894c072707821e828e76a357_extra.jpeg"" />"
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_5.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__5.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_extra.jpeg"" />"
natomy_
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_6.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__6.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_extra.jpeg"" />"
natomy_
Block4
"<img src=""c987518648938894c072707821e828e76a357_Q_7.svg"" />"
"<img sr
c=""c987518648938894c072707821e828e76a357__7.svg"" />"
"<img src=""c987
518648938894c072707821e828e76a357_source_svg.svg"" />"
"<img src=""c987
natomy_
518648938894c072707821e828e76a357_extra.jpeg"" />"
Block4
Mnemonic for nerve of origin and ganglion in head
"<div>3977 COPS</div>ll
cranial nerves<div>ciliary, otic, pterygopallatine, sumandiular</div><div><im
g src=""4 (2).jpeg"" /></div>"
What are the different parts of the cell cycle? What is happening in each?
"G0- resting phase<div>G1- presynthetic</div><div>S- DN synthesis</div><div>G2premitotic</div><div>M- mitosis</div><div><r /></div><div><img src=""paste-611
6033429811.jpg"" /></div>"
Neoplasia
utocrine<div>Pa
What are the 3 important types of intercellular signlaing
racrine</div><div>Endocrine</div>
Neoplasia
What are the 3 main types of memrane cellular receptors? How do they work? Give
an example
"Receptors with intrinsic kinase activity- receptor is phosphory
lated and activates cascade (Ras)<div><img src=""paste-6266357285170.jpg"" /></d
iv><div><r /></div><div>Receptors without intrinsic kinase activity- receptor d
irectly activates tyorsine kinases in cytoplasm (cytokine receptor superfamily)<
/div><div><img src=""paste-6279242187131.jpg"" /></div><div><r /></div><div>G p
rotein-linked receptors- activate complex with activates second message (epineph
rine)</div><div><img src=""paste-6292127089048.jpg"" /></div>" Neoplasia
What are the important molecules that regulate cell cycle checkpoints, checking
for and repairing DN damage? "Cyclins, CDKs, CDK inhiitors, R, and p53<div>
<r /></div><div><img src=""paste-6906307412419.jpg"" /></div>" Neoplasia

What do oth over expression of growth-promoting genes and loss of growth inhii
tors cause?
Uncontrolled cell growth -&gt; cancer Neoplasia
Define neoplasia<div>Define desmoplasia</div> Neoplasia- new growth outside no
rmal control mechanisms<div><r /></div><div>Desmoplasia- growth of firous tiss
ue secondary to insult (neoplasia or surgery) It is the reaction of firous stro
ma to invading malignancy, ecomes hard to contain it</div>
Neoplasia
Descrie the nomenclature for enign tumors.<div><r /></div><div>What is a fir
oma?</div><div><r /></div><div>denoma?</div> root word + -oma<div><r /></div
><div>Firoma = enign tumor of firous tissue</div><div>denoma = enign gland
forming tumor</div>
Neoplasia
denoma- enign
Differentiate an adenoma from cystadenoma. What is a polyp?
gland forming tumor<div>Cystadenoma- enign tumor forming cysts</div><div>Polyptumor projecting into a lumen, generally enign</div> Neoplasia
"<div><img src=""paste-136111808577840.jpg"" /></div>What type of neoplasia is t
his?" Papilloma- enign tumor with finger-like projections on surface Neoplasi
a
Descrie the nomenclature for malignant tumors Root word + carcinoma = epitheli
al origin malignant cancer<div><r /></div><div>Root word + sarcoma = mesenchyma
l origin malignant cancer</div> Neoplasia
Define hamartoma and choristoma Hamartoma is a enign tumor composed of indigeno
us tissues that is rather disorganized (excess of normal tissue in normal situat
ion)<div><r /></div><div>Choristoma is a enign tumor composed of ectopic tissu
e (excess of tssue in an anormal location)</div>
Neoplasia
What are some of the key exceptions to cancer naming rules?
Lymphoma = malig
nant cancer of lymphoid cells<div><r /></div><div>Hepatoma = malignant liver tu
mor</div><div><r /></div><div>Neurolastoma = malignant tumor of primitive neur
al tissue</div> Neoplasia
What is the major differentiation etween enign and malignant? Malignant tumors
can metastatize, enign tumors can not Neoplasia
"<img src=""paste-9633611645299.jpg"" /><div>What is this? What are the arrows p
ointing to?</div>"
This is a thromosis<div><r /></div><div>First arrow is
pointing to RBCs and firin</div><div>Second arrow is pointing to the region of
plasma and platelets</div><div><r /></div><div>Together these make lines of Za
hn- characteristic of premortem clots</div><div><r /></div><div>Characteristic
of thromosis:</div><div>Lines of Zahn</div><div>ttachment to lood vessel wall
</div> Hemodynamics
"<img src=""paste-9788230467894.jpg"" /><div>What is wrong with this heart? What
forms here? What is extra dangerous aout it?</div>" Pt had MI, part of the h
eart underwent necrosis and firosis (thin part)<div><r /></div><div>Scar tissu
e ulges out, <>which causes turulence and encourages clot formation</></div>
<div><r /></div><div>Mural thromus forms here- extra dangerous ecause it goes
straight into arterial circulation and often locks carotid and causes stroke</
div>
Hemodynamics
What happens in disseminated intravascular coagulation (DIC)? When does it occur
?
Tons of clotting and firinolysis in microvasculature uses up platelets
and clotting factors<div><r /></div><div>Generates lots of firin split product
s and D-dimers which interfere with normal clotting</div><div><r /></div><div>B
oth factors cause increased leeding</div><div><r /></div><div>Seen in OB, acci
dents, sepsis, some malignancies</div> Hemodynamics
What is an emolus? What aout a saddle emolus?
 detached intravascular
mass (from thromosis or gas, etc) that is carried to a site different than its
origin<div><r /></div><div>Saddle emolus- one that straddles the ifurcation
of main pulmonary artery</div> Hemodynamics
What is an infarction? What are the 2 different types? rea of coagulative necr
osis as a result of ischemia from reduced lood flow<div><r /></div><div>Red in
farct- hemorrhagic, in l<>iver and lungs</>, one lood flow is locked, the ot
her leaks into the area</div><div><r /></div><div>White infarct- arterial occlu
sion in every other tissue except lungs and liver&nsp;</div> Hemodynamics
"<img src=""paste-10045928505626.jpg"" /><div>What makes this a red infarct?</di
v>"
Pulmonary artery is locked, which causes coagulative necrosis<div><r /

></div><div>Blood with inflammatory cells leaks out from <>ronchial artery</>

, makes it red</div>
Hemodynamics
"<img src=""paste-10080288244024.jpg"" /><div>What type of infarct is this? What
makes the order?</div>"
"White infarct (no doule circulation)<div><r /
></div><div>Hemorrhage around area of necrosis (pale) is caused y locked vesse
ls eing damaged and leaking</div><div><r /></div><div><img src=""paste-1009317
3145710.jpg"" /></div>" Hemodynamics
"<img src=""paste-10290741641510.jpg"" /><div>What is happening here?</div>"
Contraction and necrosis in heart<div><r /></div><div>Contraction ands are <
>eosinophilic stripes</> composed of closely packed sarcomeres. Results from ex
aggerated contraction of myofirils when perfusion is reestalished, and interio
r of dead cells with memrane damage are exposed to <>high concentration of Ca+
from plasma&nsp;</></div>
Hemodynamics
Where does medial pterygoid attach?
"Medial aspect of lateral pterygoid plat
e and posterior surface of maxilla to angle of mandile<div><img src=""4327f1ac
31ffc285467fd892fda64aee0d2a39_med pt.jpeg"" /></div>" natomy_Block4
What causes the pain in nutmeg liver? The swelling of liver streches the caspu
sle which causes pain Hemodynamics
"<img src=""paste-11416023073067.jpg"" />"
C
Hemodynamics
Why does heart failure cause pulmonary symptoms?
Decreased cardiac output
-&gt; increased filling pressure for LV -&gt; increased <>hydrostatic pressure
in pulmonary circulatio</>n -&gt; increased fluid moving from vessels to inter
stium Hemodynamics
ir moving through fluid (heard in reath sounds of pulm
What causes rales?
onary edema)
Hemodynamics
What are some of the symptoms of cardiogenic shock?
Hypotension and decrease
d peripheral pulses due to decreased cardiac output<div><r /></div><div>Tachyca
rdia to make up for decreased CO</div><div><r /></div><div>Cool, pale, and mois
t skin- peripheral vasoconstriction and stimulation of sweat glands</div><div><
r /></div><div>Oliguria- decrease renal lood flow</div><div><r /></div><div>La
ctic acidosis- cellular hypoperfusion</div>
Hemodynamics
"<img src=""paste-12167642349666.jpg"" />"
"<img src=""paste-12180527251634
.jpg"" />"
Hemodynamics
"<img src=""paste-12206297055310.jpg"" />"
"<img src=""paste-12219181957291
.jpg"" />"
Hemodynamics
CE inhi
What is captopril? How does it help patients in cardiogenic shock?
itor<div>Decreases lood volume to reduce amount of work on heart??</div>
Hemodynamics
What types of thromi cause pulmonary emolisms and what ones cause ischemic str
okes? Venous thromi (DVTs) usually cause PE after they dislodge and travel to
the pulmonary arteries<div><r /></div><div>Mural thromi usually causes stroke
s ecause they dislodge from L and LV and go straight to carotid</div> Hemodyna
mics
"<img src=""paste-13018045874368.jpg"" /><div><img src=""paste-13030930776260.jp
g"" />\</div><div>What has changed etween these 2 pictures?</div>"
The infa
rcted tissue has een replaced with scar tissue- increased risk for mural throm
us
Hemodynamics
What type of heart failure does RUQ pain and peripheral edema reflect? RV failu
re<div>Increased <>venous pressure causes liver congestion</> (nutmeg liver =
RUQ pain) and congestion of peripheral veins = edema</div>
Hemodynamics
"<img src=""paste-13103945220284.jpg"" /><div>Which is acute and which is chroni
c?</div>"
Left is acute- congestion of vessels causes edema fluid and a fe
w inflammatory cells<div><r /></div><div>Right is chronic- has hemosiderin+ mac
rophages (heart failure cells)</div>
Hemodynamics
ll of the aove
"<img src=""paste-13662290968768.jpg"" /><div><r /></div>"
Hemodynamics
What are the key differences etween use of heparin and warfarin?
Heparinrapid onset, injection only, requires close monitoring<div><r /></div><div>War
farin- slow onset, oral or injection, only periodic monitoring</div><div><r /><
/div><div>Heparin is given immediately in the hospital, patients sent home with

warfarin</div> Hemodynamics
What is the normal PT and PTT value?
PT: 10-15 sec<div>PTT: 25-35 sec</div>
Hemodynamics
What is dysplasia? What does it signify? What are the 2 outcomes
<div>Los
s of uniformity of cells, loss of normal architecture. ove the BM.&nsp;</div>
<div><r /></div>It is a pre-malignant condition, never in enign.&nsp;<div><r
/></div><div>It is <u>reversile</u>, can ecome malignant or resolve&nsp;</di
v>
pathology_lock4
re there dysplasias of sarcomas?
No, we need to have an epithelial surfac
e
pathology_lock4
What is differentiation mean when referring to malignancy? How does differentiat
ion affect prognosis? What aout enign tumors? Differentiation = how closely a
tumor resemles normal tissue<div><r /></div><div>Well differentiated tumor clo
sely resemes normal tissue (etter prognosis)</div><div><r /></div><div>Poorly
differentiated tumor does not resemle normal tissue (worse prognosis)</div><di
v><r /></div><div>Differentiation DOES NOT PPLY TO BENIGN TUMORS (they are as
ically well differentiated)</div>
Neoplasia
What is anaplasia?
Tumor is totally undifferentiated
Neoplasia
What are some key cellular morphologies indicative of malignancy? (7) Pleomorp
hism: variaility in size and shape<div>Hyperchromasia: Increased DN content</d
iv><div>High nuclear:cytoplasmic ratio</div><div>Prominent nucleoli</div><div>Hi
gh mitotic rate, anormal mitotic figures</div><div>Tumor giant cells</div><div>
Loss of normal orientation</div>
Neoplasia
"<img src=""paste-113258287595778.jpg"" /><div>What tumor morphological characte
ristic is this?</div>" Pleomorphism<div>Tumor has many cells of different shape
s and sizes</div>
Neoplasia
"<img src=""paste-113292647334131.jpg"" /><r /><div>What tumor morphological ch
aracteristic is this?</div>"
Hyperchromatism<div>Nuclei are very dense and da
rk due to increased DN content</div> Neoplasia
"<img src=""paste-113327007072552.jpg"" /><r /><div>What tumor morphological ch
aracteristic is this?</div>"
High nuclear:cytoplasmic ratio<div>Nucleus looks
too large for the cytoplasm</div>
Neoplasia
"<img src=""paste-113447266156802.jpg"" /><r /><div>What tumor morphological ch
aracteristic is this?</div>"
Prominent nucleoli<div>Large nucleus with dark n
ucleoli due to high amounts of RN and protein synthesis</div> Neoplasia
"<img src=""paste-113473035960644.jpg"" /><r /><div>What tumor morphological ch
aracteristic is this?</div>"
Increased/anromal mitoses<div>If a tumor has a
normal mitotic figure it is definitely malignant</div> Neoplasia
"<img src=""paste-113593295044845.jpg"" /><r /><div>What tumor morphological ch
aracteristic is this?</div>"
Tumor giant cells<div>Caused y multiple tumor c
ells fusing together</div>
Neoplasia
"<img src=""paste-113619064848681.jpg"" /><r /><div>What tumor morphological ch
aracteristic is this?</div>"
Loss of normal orientation<div>Layers are no lon
ger normal, cells are in different stages all over the place</div>
Neoplasi
a
What is dysplasia? What are the fates of dysplastic tissue?
"Loss of normal
uniformity of cells in epithelial surfaces<div><u style=""font-weight: old; "">
reversile</u>, PRE-malignant</div><div><r /></div><div>They will either progre
ss to malignancy or resolve</div>"
Neoplasia
What is carcinoma in situ? Reversile or irreversile? Severe dysplasia involvi
ng the whole thickness of the epithelium<div><r /></div><div>Contained y the 
asement memrane</div><div><r /></div><div><><u>still reversile</u></></div>
Neoplasia
What is the spectrum of differentiation? What type of growths is this spectrum a
pplied to?
"<img src=""paste-114173115629728.jpg"" /><div>This spectrum is
only applied to malignant tumors</div>" Neoplasia
What is the spectrum of dysplasia? What type of growths is this spectrum applied
to?
"<img src=""paste-114207475368034.jpg"" /><div>Dysplasia is pre-malignan
t tumors</div><div><r /></div><div>Between severe dysplasia and invasive cancer
is invasion through asement memrane</div>" Neoplasia

"<img src=""paste-114259014975785.jpg"" /><div><img src=""paste-114271899877625.

jpg"" /></div><div>What is different etween these 2 tumors?</div>"
First on
e is well differentiated, can still see normal epithelial layers<div><r /></div
><div>Second is anaplastic, cells are very variale, can see anormal mitosis</d
iv>
Neoplasia
"<img src=""paste-114400748896545.jpg"" /><div>What is different etween these t
wo parts of epithelium?</div>" Left part has severe dysplasia, right is normal
Neoplasia
What delineates mild, moderate, and severe (CIS) dysplasia?
"Mild- ottom 1/
3 of epithelium is jumled<div>Moderate- ottom 2/3 of epithelium is jumled</di
v><div>Severe- entire epithelium is jumled</div><div><img src=""dys.jpeg"" /></
div>" Neoplasia
"<img src=""paste-114456583471409.jpg"" /><div>What are the signs this is dyspla
sia?</div>"
There are no clearly define epithelial layers<div>poptosis is o
ccuring at every layer</div><div>Cells are not uniform</div>
Neoplasia
"<div><img src=""paste-114946209743160.jpg"" /></div><div>What is this defined a
s?</div>"
Carcinoma in situ<div>Loss of normal cellular architecture throu
ghout full thickness of epithelium</div><div>Contained within asement memrane<
/div> Neoplasia
"<img src=""paste-114976274514222.jpg"" /><div>What is this?</div>"
Invasive
cancer<div>Dysplastic epithelium has reached asement memrane</div> Neoplasi
a
Compare the rate of growth and style of expansion of enign vs malignant tumors
Benign tumors grow slowly, are a local expanding mass with a pushing order; hav
e firous capsule<div><r /></div><div>Malignant tumors grow quickly, are infilt
rating, invasive, and destructive</div> Neoplasia
What are the 4 ways that malignant neoplasms spread?
Direct extension (spread
s through organs)<div>Body cavities (cells jump onto other organs)</div><div><r
/></div><div>Metastasize through lymphatics</div><div>Metastasize through lood
vessels</div> Neoplasia
"<img src=""paste-115083648696540.jpg"" /><div><img src=""paste-115096533598519.
jpg"" /></div><div>What type of neoplasm is this? How can you tell?</div>"
Benign<div><r /></div><div>Gross- Soft, localized and encapsulated with homogen
ous, pushing order</div><div><r /></div><div>Micro- Well differentiated, surro
unded y capsule</div> Neoplasia
"<img src=""paste-115148073206069.jpg"" /><div><img src=""paste-115160958107945.
jpg"" /><r /><div>What type of neoplasm is this? How can you tell?</div></div>"
Malignant<div><r /></div><div>Firm, infiltrative, heterogeneous surface</div><d
iv>Surrounded y hemorrhage and necrosis</div><div><r /></div><div><r /></div>
<div>Variale differentiation, mitoses, pleomorphism, hyperchromatic, high N:C</
div>
Neoplasia
What types of cancers have the highest incidence in males and females? What aou
t the highest mortality?
<u>Incidence</u><div>Males- Prostate, lung, colo
rectal</div><div>Females- Breast, lung, colorectal</div><div><r /></div><div><u
>Mortality</u></div><div>Males and females- lung cancer</div> Neoplasia
What are acquired preneoplastic disorders?
trophic gastritis<div>Solar ker
atosis</div><div>Ulcerative colitis</div><div>Leukoplakia</div><div><r /></div>
<div>These are enign neoplasms that have a small chance of ecoming malignant</
div>
Neoplasia
How many mutations are required to cause carcinogenesis?
Multiple!<div>Mu
tations in genes for growth factors, growth factor receptors, signal transducers
, transcription factors, cell cycle components, division regulators, tumor supre
ssor genes, genes that regulat apoptosis, genes that regulate DN repair</div>
Neoplasia
What are proto oncogenes?
Genes that promote normal cell growth and develo
pment<div><r /></div><div>Over expression causes neoplasia</div>
Neoplasi
a
"<img src=""paste-115989886796096.jpg"" /><div>What is happening here?</div>"
Translocation of MYC oncogene to Ig gene causes massively increased synthesis of
MYC product
Neoplasia

"<img src=""paste-116118735814975.jpg"" /><r /><div>What is happening here?</di

v>"
Fusion of two genes causes hyrid tyrosine kinase which activates cellul
ar replication Neoplasia
What are some common tumor suppressor genes? What do they do? How is their mecha
nism acked up? Retinolastoma<div>p53</div><div>BRC1/2</div><div><r /></div><
div>They regulate the cell cycle</div><div><r /></div><div>Both copies of these
genes must e lost in order to lose functionality</div>
Neoplasia
How does R work? What aout p53?
R- when activated it <>locks transcri
ption</>&nsp;of genes needed for S phase, ringing the cell cylcle to a halt 
etween <>G1 and S phase</><div><r /></div><div>p53- when activated <>halts D
N transcription</> and <>initiates DN repair</> mechanisms. lso promotes q
uiesence, senescence, and apoptosis</div>
Neoplasia
What happens if Bcl-2 is over expressed?
Cell survival is greatly favored
over apoptosis Neoplasia
"Q: Which graph exhiits reflex radycardia? &nsp;Which exhiits reflex tachyca
: Left graph ex
rdia?<div><img src=""paste-251551939559427.jpg"" /></div>"
hiits reflex radycardia (drug is norepinephrine); right graph exhiits reflex
tachycardia (drug is isoproterenol); drug in the middle is epinephrine and exhi
its no change in MP
Q: True or false: Dopamine is a major neurotransmitter in the CNS where it acts
on specific dopamine receptors (D1, D2, D3, etc). &nsp;In the periphery, dopami
ne receptors are in <>renal, mesenteric, and coronary vascular eds.</>
: true
:<div>1. agonis
Q: What are the cardiovascular effects of dopamine due to?
t dopamine receptors (D1: dilates lood vessels at critical organs)</div><div>2.
release more NE from adrenergic nerve terminals</div><div>3. agonist at eta-1
and then alpha receptors (at higher concentrations)</div>
Beta-3 agonists will do what and are found where?
Cousins of eta-1, found
mainly in adipose: causes increase of TG reakdown
Q: Rank dopamine receptor specificity. : D1, D2 (dopamine receptors) &gt; eta
-1 &gt; alpha receptors; dopamine only reacts with eta and alpha at higher conc
entrationsit does NOT act on eta-2
Q: True or false: Dopamine specificity: dopamine receptors &gt; eta-1 &gt; alph
a
: true
Q: The cardiovascular effects of dopamine is dose-dependent. &nsp;Descrie what
the effects (and what receptors) of dopamine are at the following concentration
s: 0.5mcg, 5mcg, 10-50mcg
<div>: 0.5mcg: via D1 receptors theres <u><>vas
odilation</> of renal, mesenteric, and coronary vascular eds</u> (in the kidne
y, dopamine promotes sodium and water excretion)</div><div>5mcg: dopaminergic do
se; D1 receptors and eta-1 receptors; <u>this dose is used in trauma patients v
ia IV in hospital</u></div><div>10-50mcg: acts on <u>alpha</u> receptors to caus
e <u><>vasoconstriction</></u></div>
:&nsp;<div>1. preserve renal lood flo
Q: What are some uses of dopamine?
w via D1 mediated vasodilation (note that during sympathetic activation, dopamin
e and prostaglandins made within the kidney ensure adequate lood supply to the
kidney)&nsp;</div><div>2. used to treat cardiogenic shock -&gt; increases force
of contraction via eta 1 (more than it increases heart rate) -&gt; <>ecause
dopamine has greater effect on force of contraction than on heart rate, the oxyg
en demand on the heart is not increased significantly</></div>
Q: True or false: Dopamine has a greater effect on force of contraction than on
: true
heart ratetherefore oxygen demand heart is not significantly increased.
Q: t dopaminergic doses, what happens to total peripheral resistance?<div><r /
></div><div>Q: t dopaminergic doses, what happens to systolic and diastolic pre
ssure?</div>
: slightly decreases owing to vasodilator effect (D1 receptors)
(ut note diastolic doesnt decrease as much as when given epinephrine ecause e
pinephreine dilates lood vessels of skeletal muscle, where as D only dilates v
essels to critical organs)<div><r /></div><div>: systolic pressure is increaas
ed due to eta 1 receptors ut diastolic is usually not changed ecause vasodila
tion only occurs in critical organs</div>
Q: Descrie the effect of dopamine acting on its D1 and Beta-1 receptors. (4)

":&nsp;<div>1. some vasodilation causing reduction in peripheral resistance (D

1);</div><div>2. systolic pressure goes up (due to eta-1 activation);</div><div
>3. increased cardiac output w/o &nsp;increasing O2 consumptioncauses lood to 
e<> shifted to critical organs in the ody (not skeletal muscle)</> which is w
hy its used in trauma patients;&nsp;</div><div>4. increase in pulse rate (slight
ly)<r /><div><img src=""paste-252256314195971.jpg"" /></div></div>"
Q: Low amounts of _____ in one of the rain circuits (Nigra--&gt;striatum) cause
s Parkinsons disease. : dopamine
Q: Whats the drug treatment of Parkinsons disease?
": replace dopamine -&g
t; however dopamine doesnt cross BBB -&gt; must give <>L-DOP</> which is a <>
<font color=""#0000ff"">pro-drug</font></> -&gt; L-DOP enters CNS and gets con
verted to dopamine in nerve terminals"
Q: What are the implications of dopamine increasing cardiac output y increasing
Force of contraction &gt;&gt;&gt;&gt; heart rate?
: its important to minim
ize oxygen demand of the heart. &nsp;Increasing CO y increasing HR requires mo
re energy (more oxygen) compared to increasing CO y increasing contractility. &
nsp;Therefore dopamine, while increasing CO, minimizes oxygen consumption which
is good for patients. &nsp;
: eta-2 agonis
Q: What type of agonist is ritodrine? What is it used for?
t; note that it doesnt follow the suffix ****terol. Used to relax uterus for prem
ature deliveries
Q: What type of agonist is doutamine? What is it used for?
: eta-1 agonis
t<div><r /></div><div>Used in cardiogenic and septic shock to increase cardiac
output; also used for cardiac stress test</div>
Q: What alpha-1 agonist is used during surgery to raise BP?<div><r /></div><div
>Q: What other clinical effect does this drug have?</div>
": phenylephrin
e&nsp;<div><r /></div><div>: Raise BP during surgery, nasal decongestant, pri
apism</div><div><r /></div><div><img src=""paste-38779259716131.jpg"" /></div><
div><r /></div><div><img src=""paste-38800734552554.jpg"" /></div>"
Q: What is the alpha-2 agonist of choice for antihypertensives in pregnant women
: alpha-methyldopa--&gt; its a <
?&nsp;<div><r /></div><div><r /></div>
>prodrug</> that gets converted to alpha-methylnorepinephrine in adrenergic ne
rve terminals--&gt;the released drug then inhiits further NE release via presyn
aptic alpha-2 receptors<div><r /></div>
Q: What eta-2 agonist relaxes the uterus and prevents premature deliveries?
: ritodrine
Q: What is the drug of choice to treat anaphylactic shock? Why? Descrie the eff
ect of epinephrine on each receptor
: epinephrine--&gt;&nsp;<div>alpha-1 a
ction <u>constricts lood vessels</u>--&gt;&nsp;</div><div>eta-1 action causes
<u>cardiac output to go up</u>--&gt;&nsp;</div><div>eta-2 action causes <u>r
onchodilation</u> and <u>INHIBITS degranulation</u> of mast cells</div>
Q: What alpha-1 agonist is used as a nasal decongestant?
": Phenylephrin
e (rememer that its also used to increase BP during surgery, and for priapism)<d
iv><r /></div><div><img src=""paste-38341173051882.jpg"" /></div>"
Q: List some general adverse effects of adrenergic agonists.
:&nsp;<div>1.
increased BP (can cause cereral hemorrahges),&nsp;</div><div>2. more load on h
eart (causes tachycardia, nervousness, anxiety)</div><div>3. cardiac arrhythmias
,&nsp;</div><div><>4. hyperglycemia</> (especially in marginal diaetics),&n
sp;</div><div>5. exaggerated effects w/ cocaine and other inhiitors of NE reupt
ake</div>
Q: How does clonidine (alpha-2 agonist) affect glycemic state? : causes hyperg
lycemia y REDUCING insulin secretion
Q: What drug was once used to lose weight and increases NE release indirectly?
: ephedrine
Q: Eating foods rich in ____ is contraindicated when patients are on MO inhiit
: tyramine; it enters nerve terminals and gets converted to NE
ors.
Q: Whats the #1 drug for treating ttention deficit? How does it work? : <>me
thylphenidate</> (Ritalin); methylphenidate works in the treatment of attention
deficit hyperactivity disorder y <u>increasing levels of dopamine in the rain
and NE levels</u>

Q: Whats the #2 drug to treat DD/DHD?

: D-mphetamine (dderall)
Q: Why do drugs used to treat depression (ie tricyclic antidepressants and SSRIs
: they inhiit reuptake of serotonin and LSO i
) also cause tachycardia?
nhiit reuptake of NE in the periphery leading to tachycardia
Q: What type of drug are imipramine and amitryptaline? : tricyclic antidepress
ants
: facilitate the termination of drug ac
Q: Why is drug metaolism necessary?
tion, make drug excretion more efficient
pharmacology_lock4
Q: Whats a pro-drug? : a <u>compound with little or no activity</u> that is
<u>metaolized to an active species</u> in order to promote asorption, prevent
acid destruction, and minimize exposure toxicity
pharmacology_lock4
: foreign sustances that are asored or inges
Q: What are xenoiotics?
ted
pharmacology_lock4
Q: Whats the iological half life of a drug? <div>: that period of time in w
hich half of the amount of drug disappears; a function of its rate of metaolism
and its rate of excretion</div><div><r /></div>
pharmacology_lock4
Q: Whats the first-pass effect?
: occurs <u>when more than half of the amount o
f a drug is metaolized on its 1st pass through an organ (usually the liver);</u
> a requirement is a large drug metaolizing capacity in the 1st pass organ; (Fr
om wiki): fter a drug is swallowed, it is asored y the digestive system and
enters the hepatic portal system. It is carried through the portal vein into the
liver efore it reaches the rest of the ody. The liver metaolizes many drugs,
sometimes to such an extent that only a small amount of active drug emerges fro
m the liver to the rest of the circulatory system. This first pass through the l
iver thus greatly reduces the ioavailaility of the drug.
pharmacology_lo
ck4
:&nsp;<div>1. almost a
Q: What are some general properties of metaolites?
re drugs are metaolized to compounds that are more <u>polar</u> than the parent
compound,&nsp;</div><div><u>2. not as well reasored</u> and therefore more e
fficiently excreted,&nsp;</div><div>3. many will e <u>inactive</u> or <u>less
active</u> than their parent compound</div>
pharmacology_lock4
Q: Hepatic metaolism of pharmacologic compound can have 3 possile outcomes. Wh
at are they and riefly descrie?
<div>: <u>activation</u> (examples are
<>pro-drugs</> that are metaolized into its active moiety, cortisone--&gt;cor
tisol, prednisone--&gt;prednisolone, azathioprine--&gt;6-mercaptopurine), <u>deg
radation into active or inactive metaolites</u> (ie chlordiazepoxide is oxidize
d into active metaolites, oxazepam is conjugated with glucuronic acid to someth
ing thats inactive), <u>degradation to a toxic metaolite including carcinogens</
u> (ie acetaminophen degraded to NPQI)</div> pharmacology_lock4
Q: The ____ is the most important organ for elimination of drugs and their meta
olites. : kidney; NOTE: excretion of drugs and metaolites in urine involves 3
processes (glomerular filtration, active tuular secretion, passive tuular rea
sorption); NOTE: <>when a drug is metaolized to a more polar compound passive
tuular reasorption doesnt generally occur</>
pharmacology_lock4
Q: (From class) Which of the following processes is affected most y drug metao
lism?&nsp;<div><div>-glomerular filtration</div><div>-active tuular secretion<
/div><div>-passive tuular reasorption</div></div>
<div>: answer is passiv
e tuular reasorption</div>
pharmacology_lock4
Q: What type of reactions occur during Phase I metaolism?
: <u>oxidation<
/u>, <u>reduction</u>, <u>hydrolysis</u>; these processes occur in the ER and cy
toplasm and introduces a functional group to the compound
pharmacology_lo
ck4
Q: What type of reaction occurs during Phase II metaolism?
": conjugation
(adding something onto the drug)--&gt;its also thus a synthetic phase<div><img sr
c=""phase II.jpeg"" /></div>" pharmacology_lock4
Q: True or false: Expression of enzymes that metaolize drugs are under inductiv
e regulatory control. <div>: true; the kinetics of drug metaolism reactions
at therapeutic doses is typically first order, and the kinetics at saturation are
at zero order</div>
pharmacology_lock4
Q: What organ is the location of the most drug metaolism in the ody? : liver

(then its lung, kidney, intestine, placenta) pharmacology_lock4

Q: The monooxygenase system is also called __________. : Cytochrome P450 syste
m
pharmacology_lock4
Q: Whats the significance of the cytochrome P450 system?
": its a giant oxidizing
machine that has over 4000 isoforms; it has the iggest appetite for drug meta
olism; from Wiki: The function of most CYP enzymes is to <u>catalyze the oxidati
on of organic sustances.</u> The sustrates of CYP enzymes include metaolic in
termediates such as lipids and steroidal hormones, as well as xenoiotic sustan
ces such as drugs and other toxic chemicals. CYPs are the major enzymes involved
in drug metaolism and ioactivation, accounting for aout 75% of the total num
er of different metaolic reactions<div><img src=""p450.jpeg"" /></div>"
pharmacology_lock4
Q: What are the requirements of the cytochrome p450 system?
<div>: requires
reduced <>NPDH</> and requires <>O<su>2</su></>; note that it has BROD
sustrate specificity and INDUCTIVE regulatory control; part of a supergene fami
ly</div>
pharmacology_lock4
Q: Why was there Seldane P450-ased toxicity? <div>: patients with <u>inadequ
ate cytochrome p450</u> (either due to hepatic impairment from cirrhosis/hepatit
is or co-administration of a drug that compromised p450 function) were suscepti
le to <>cardiac arrhythmias</></div><div><r /></div> pharmacology_lock4
Q: Is cytochrome p450 involved in phase I or phase II reactions?
: phase
I reactions
pharmacology_lock4
Q: What do phase I drug metaolizing reactions do? (4) <div>:&nsp;</div><div>
1. convert lipophilic drugs to more polar compounds</div><div>2.&nsp;<u>frequen
tly involve cytochrome p450</u>,</div><div>3. occur in most ody cells ut are m
ost aundant in the liver,</div><div>4. road and overlapping in enzyme specific
ity; things like oxidation, reduction, hydrolysis</div> pharmacology_lock4
Q: What do phase II drug metaolizing reactions do? (4) : convert lipophilic dr
ugs to more polar compounds, frequently use transferase enzymes, <u>always invol
ve the addition of a donor molecules,</u> occur in most ody cells ut are most
aundant in the liver;<div><r /></div><div>&nsp;they consist of conjugation re
actions in which an endogenous sustance is comined with the drug or drug meta
olite (can create something like a <>glucuronide</> which is a much igger mol
ecules so the drug cant fit in the receptor anymore and its <>more polar</> too)
</div> pharmacology_lock4
Q: What is Crigler-Najjar syndrome and how does it relate to glucuronidation?
<div>: its caused y a <>glucuronidation deficiency</> and is thus characteriz
ed y <u>hyperiliruinemia and jaundice</u></div><div><r /></div>
pharmaco
logy_lock4
Q: What is Gilerts syndrome and how does it relate to glucuronidation?
<div>:
its also known as <>constitutional hepatic dysfunction</> and involves <u>enig
n unconjugated iliruinemia</u> and <u>familial nonhemolytic jaundice</u></div>
<div><r /></div>
pharmacology_lock4
: its developed
Q: Whats different aout the cytochrome p450 in neonates?
ut functions <u>SLOWER</u>; glucuronidation is immature and can cause Gray Bay
syndrome if the ay is given chloramphenicol(antiiotic) ; also note that <u>
ody water is greater in neonates</u> which can affect drug metaolism pharmaco
logy_lock4
Q: What are some factors in the elderly that affect drug metaolism?
: drug
asorption may e less efficient;&nsp;<div>drug distriution can e altered y
hypoaluminemia,&nsp;</div><div>changes in drug-inding sites,</div><div>&nsp;
and changes in the protein/fat mass ratio;&nsp;</div><div>THEY HVE REDUCED HEP
TIC MSS,&nsp;enzyme activity, and lood flow to the liver;&nsp;</div><div>th
eir receptor sensitivity is also reduced;&nsp;</div><div>in a patient with CHF
there is less lood eing delivered to the liver so theres less oxygen eing deli
vered to p450</div>
pharmacology_lock4
Q: How does grapefruit juice affect the ioavailaility and toxicity associated
with felodipine?
: it increases ecause the <>flavonoids</> of the gra
pefruit juice <u>inhiit the metaolism of Ca2+ channel lockers and caffeine</u
> y inhiiting CYP3, a Cyt P450 isoform
pharmacology_lock4

Q: Whats the difference in alcohol metaolism in chronic ethanol ingestion versus

acute ethanol ingestion?
<div>: chronic <u>increases</u> hepatic drug me
taolizing activity, acute <u>inhiits</u> drug metaolism (it overwhelms the sy
stem rather than inducing it)</div>
pharmacology_lock4
<div>Q: How does phenoarital effect the amount of SER and microsomal drug meta
olizing enzymes?</div> Increases oth pharmacology_lock4
<div>Q: True or false: There are genetic factors that contriute to differences
in enzyme metaolizing capacity.</div><div><r /></div> : true pharmacology_lo
ck4
Q: How does CHF affect the amount of metaolism in the liver?
: reduces; cirr
hosis and other diseases of the liver impair hepatic drug metaolism
pharmaco
logy_lock4
<div>Q: (From class) Which of the following drugs will cause an increased metao
lism of comination of pill oral contraceptives?</div><div>-ampicillin</div><div
>-ciprofloxacin</div><div>-erythromycin</div><div>-tetracycline</div> : answe
r = ampicillin and tetracycline pharmacology_lock4
"<img src=""16c3e9fd9ea32dc1cc199acd31c1f998382dda_Q_0.svg"" />"
"<img sr
c=""16c3e9fd9ea32dc1cc199acd31c1f998382dda__0.svg"" />"
"<img src=""16c3
e9fd9ea32dc1cc199acd31c1f998382dda_source_svg.svg"" />"
"<img src=""16c3
natomy_
e9fd9ea32dc1cc199acd31c1f998382dda_ear1.jpeg"" />"
Block4
"<img src=""16c3e9fd9ea32dc1cc199acd31c1f998382dda_Q_1.svg"" />"
"<img sr
c=""16c3e9fd9ea32dc1cc199acd31c1f998382dda__1.svg"" />"
"<img src=""16c3
e9fd9ea32dc1cc199acd31c1f998382dda_source_svg.svg"" />"
"<img src=""16c3
e9fd9ea32dc1cc199acd31c1f998382dda_ear1.jpeg"" />"
natomy_
Block4
"<img src=""16c3e9fd9ea32dc1cc199acd31c1f998382dda_Q_2.svg"" />"
"<img sr
c=""16c3e9fd9ea32dc1cc199acd31c1f998382dda__2.svg"" />"
"<img src=""16c3
e9fd9ea32dc1cc199acd31c1f998382dda_source_svg.svg"" />"
"<img src=""16c3
e9fd9ea32dc1cc199acd31c1f998382dda_ear1.jpeg"" />"
natomy_
Block4
"<img src=""ffca63e7cf2d500880797f1d99c0dcec710a75_Q_0.svg"" />"
"<img sr
c=""ffca63e7cf2d500880797f1d99c0dcec710a75__0.svg"" />"
"<img src=""ffca
63e7cf2d500880797f1d99c0dcec710a75_source_svg.svg"" />"
"<img src=""ffca
natomy_
63e7cf2d500880797f1d99c0dcec710a75_ear2.jpeg"" />"
Block4
"<img src=""ffca63e7cf2d500880797f1d99c0dcec710a75_Q_1.svg"" />"
"<img sr
c=""ffca63e7cf2d500880797f1d99c0dcec710a75__1.svg"" />"
"<img src=""ffca
63e7cf2d500880797f1d99c0dcec710a75_source_svg.svg"" />"
"<img src=""ffca
natomy_
63e7cf2d500880797f1d99c0dcec710a75_ear2.jpeg"" />"
Block4
"<img src=""ffca63e7cf2d500880797f1d99c0dcec710a75_Q_2.svg"" />"
"<img sr
c=""ffca63e7cf2d500880797f1d99c0dcec710a75__2.svg"" />"
"<img src=""ffca
63e7cf2d500880797f1d99c0dcec710a75_source_svg.svg"" />"
"<img src=""ffca
63e7cf2d500880797f1d99c0dcec710a75_ear2.jpeg"" />"
natomy_
Block4
"<img src=""ffca63e7cf2d500880797f1d99c0dcec710a75_Q_3.svg"" />"
"<img sr
c=""ffca63e7cf2d500880797f1d99c0dcec710a75__3.svg"" />"
"<img src=""ffca
63e7cf2d500880797f1d99c0dcec710a75_source_svg.svg"" />"
"<img src=""ffca
63e7cf2d500880797f1d99c0dcec710a75_ear2.jpeg"" />"
natomy_
Block4
What vessels pass through the parotid gland?
"External carotid artery<div>Ret
romandiular vein (junction superficial temporal and maxillary veins)</div><div>
<img src=""vessels parotid.jpeg"" /></div>"
natomy_Block4
What nerves pass through parotid gland? "Branches of facial motor expression<div
><r /></div><div>uriculotemporal (V3) for sensation to front of ear</div><div>
<r /></div><div>Secretomotor (PS fiers from otic ganglion (of IX)-- hitchhikin
g on auriculotemporal)&nsp;</div><div><r /></div><div><img src=""structure.jpe
g"" /></div>" natomy_Block4
What is duct from parotid also called? Where does it end?
"Stensons Duct.

Ends y piercing uccinator opposite the upper 2nd molar.&nsp;<div><r /><div>

<img src=""parotid.jpeg"" /></div></div>"
natomy_Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_0.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__0.svg"" />"
"<img src=""e60
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"<img src=""e60
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
natomy_
Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_1.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__1.svg"" />"
"<img src=""e60
c7f8ae4e137165d19942fe4dca89cee72_source_svg.svg"" />"
"<img src=""e60
natomy_
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_2.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__2.svg"" />"
"<img src=""e60
c7f8ae4e137165d19942fe4dca89cee72_source_svg.svg"" />"
"<img src=""e60
natomy_
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_3.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__3.svg"" />"
"<img src=""e60
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"<img src=""e60
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
natomy_
Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_4.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__4.svg"" />"
"<img src=""e60
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"<img src=""e60
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
natomy_
Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_5.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__5.svg"" />"
"<img src=""e60
c7f8ae4e137165d19942fe4dca89cee72_source_svg.svg"" />"
"<img src=""e60
natomy_
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
Block4
"<img src=""e60c7f8ae4e137165d19942fe4dca89cee72_Q_6.svg"" />"
"<img sr
c=""e60c7f8ae4e137165d19942fe4dca89cee72__6.svg"" />"
"<img src=""e60
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"<img src=""e60
natomy_
c7f8ae4e137165d19942fe4dca89cee72_retro.jpeg"" />"
Block4
"What is 12?<div><img src=""stenson.jpeg"" /></div>"
Stensons duct (parotid
natomy_Block4
duct)&nsp;
What do natural Tregs express (4)?
CD4+ clones with high self-reactivity di
fferentiate into natural Treg.<div><r /></div><div>Express</div><div> <u>Foxp3 </u
>transcription factor&nsp;</div><div> High <u>CD25</u></div><div> Secrete <u>TGF,
IL-10</u></div><div> &nsp;<u>ntigen-specific</u></div>
Immunology_lock4
What do Tregs express to supress activation of T cells? TGFeta and IL-10
Immunology_lock4
What is a legend drug? Drug that requres a prescription c considered potential
ly harmful.&nsp;<div>Lael ears legend :Caution: Federal Law Prohiits Dispensi
ng without a Prescription or Rx only.</div> pharmacology_lock4
<div>NEVER use {{c1::trailing}} zeros</div><div>LWYS use {{c1::leading}} zeros
&nsp;</div><div><r /></div> 5 mg NOT 5.0<div>0.6 NOT .6<r /><div><r /></di
v></div>
pharmacology_lock4
Descrie the vessels created in tumor angiogenesis. Why are these dangerous?
Very leaky vessels<div><r /></div><div>llows cancer cells to get into vessels
to metastasize</div>
Neoplasia
What is the suffix for eta lockers? -olol<div>(Propanolol was 1st)</div>
pharmacology_lock4
What is BEM? "<div>Cardio-selective B1 lockers (B1&gt;&gt;&gt;B2)</div><div>
ceutolol, Betaxolol, Esmolol, tenoll, Metoprolol</div><div><img src=""aeam.j
peg"" /></div>" pharmacology_lock4
Other than htn, CHF, MI, Glaucoma, what can eta lockers e used for? Hyperthy

roidism, performance anxiety, migraines. rememer chelius talked aout that girl
who had graves and was on propanalol and methimazole pharmacology_lock4
What are adverse effects of eta lockers?
"Bronchoconstriction, radycardi
a, RS locked, Hypoglycemia, sexual impairment<r /><div><img src=""adverse 
eta.jpeg"" />&nsp;</div>"
pharmacology_lock4
How to choose one eta locker over another?
Memrane stailizing activity (M
S)<div>-will list MS as how good it is in stailizing action potentials<r /><
div>Intrinsic sympathomimetic activity (IS)</div></div><div>-partial agonist ac
tivity</div>
pharmacology_lock4
Q: Give 2 examples of eta locker partial agonists and explain what they do.
"<div>: <u>Pindolol</u> and <u>aceutolol</u>; they activate eta receptors par
tially in the asence of catecholamines--&gt;these partial agonists are said to
have intrinsic sympathomimetic (IS) activity</div><div><r /></div><div>Think h
ow a partial agonist (like Pindolol, ceutolol) given to a patient with high l
ood pressure can actually reduce cardiac output and decrease work load / oxygen
demand. nswer: <>The heart is under the control of a full agonist; you now giv
e a partial agonist which largely replaces full agonist.</></div><div><><img s
rc=""IS.jpeg"" /></></div>" pharmacology_lock4
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my_
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"<img src=""979387b387e5d3 4f bc176389b376d0e807cf9d_Q_3.svg"" />"
"<img sr
c=""979387b387e5d3 4f bc176389b376d0e807cf9d_A_3.svg"" />"
"<img src=""9793
87b387e5d3 4f bc176389b376d0e807cf9d_surce_svg.svg"" />"
"<img src=""9793
87b387e5d3 4f bc176389b376d0e807cf9d_

.jeg"" />"
An
my_
Blck4
Signific nce f ring f W ldeyer?
"SIDS- c n ll swell u nd die frm n
bre
hing<div><img src=""w ldeyer.jeg"" /></div>"
An
my_Blck4
"<img src=""336415cc c58e1be86fc507b1db2b88333cb93 e_Q_0.svg"" />"
"<img sr
c=""336415cc c58e1be86fc507b1db2b88333cb93 e_A_0.svg"" />"
"<img src=""3364
15cc c58e1be86fc507b1db2b88333cb93 e_surce_svg.svg"" />"
"<img src=""3364
15cc c58e1be86fc507b1db2b88333cb93 e_h rynge l musc.jeg"" />"
An
my_Blck4
"<img src=""336415cc c58e1be86fc507b1db2b88333cb93 e_Q_1.svg"" />"
"<img sr
c=""336415cc c58e1be86fc507b1db2b88333cb93 e_A_1.svg"" />"
"<img src=""3364
15cc c58e1be86fc507b1db2b88333cb93 e_surce_svg.svg"" />"
"<img src=""3364
15cc c58e1be86fc507b1db2b88333cb93 e_h rynge l musc.jeg"" />"
An
my_Blck4
"<img src=""336415cc c58e1be86fc507b1db2b88333cb93 e_Q_2.svg"" />"
"<img sr
c=""336415cc c58e1be86fc507b1db2b88333cb93 e_A_2.svg"" />"
"<img src=""3364
15cc c58e1be86fc507b1db2b88333cb93 e_surce_svg.svg"" />"
"<img src=""3364

15cc c58e1be86fc507b1db2b88333cb93 e_h rynge l musc.jeg"" />"

An
my_Blck4
"<img src=""336415cc c58e1be86fc507b1db2b88333cb93 e_Q_3.svg"" />"
c=""336415cc c58e1be86fc507b1db2b88333cb93 e_A_3.svg"" />"
"<img
15cc c58e1be86fc507b1db2b88333cb93 e_surce_svg.svg"" />"
"<img
15cc c58e1be86fc507b1db2b88333cb93 e_h rynge l musc.jeg"" />"
An
my_Blck4
"<img src=""336415cc c58e1be86fc507b1db2b88333cb93 e_Q_4.svg"" />"
c=""336415cc c58e1be86fc507b1db2b88333cb93 e_A_4.svg"" />"
"<img
15cc c58e1be86fc507b1db2b88333cb93 e_surce_svg.svg"" />"
"<img
15cc c58e1be86fc507b1db2b88333cb93 e_h rynge l musc.jeg"" />"
An
my_Blck4
"<img src=""48ddff472847ecd153f88 e63dbe 049 c94eb05_Q_0.svg"" />"
c=""48ddff472847ecd153f88 e63dbe 049 c94eb05_A_0.svg"" />"
"<img
ff472847ecd153f88 e63dbe 049 c94eb05_surce_svg.svg"" />"
"<img
ff472847ecd153f88 e63dbe 049 c94eb05_h rynx.jeg"" />"
Blck4
"<img src=""48ddff472847ecd153f88 e63dbe 049 c94eb05_Q_1.svg"" />"
c=""48ddff472847ecd153f88 e63dbe 049 c94eb05_A_1.svg"" />"
"<img
ff472847ecd153f88 e63dbe 049 c94eb05_surce_svg.svg"" />"
"<img
ff472847ecd153f88 e63dbe 049 c94eb05_h rynx.jeg"" />"
Blck4
"<img src=""48ddff472847ecd153f88 e63dbe 049 c94eb05_Q_2.svg"" />"
c=""48ddff472847ecd153f88 e63dbe 049 c94eb05_A_2.svg"" />"
"<img
ff472847ecd153f88 e63dbe 049 c94eb05_surce_svg.svg"" />"
"<img
ff472847ecd153f88 e63dbe 049 c94eb05_h rynx.jeg"" />"
Blck4
"<img src=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _Q_0.svg"" />"
c=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _A_0.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _surce_svg.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _nerves.jeg"" />"
Blck4
"<img src=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _Q_1.svg"" />"
c=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _A_1.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _surce_svg.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _nerves.jeg"" />"
Blck4
"<img src=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _Q_2.svg"" />"
c=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _A_2.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _surce_svg.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _nerves.jeg"" />"
Blck4
"<img src=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _Q_3.svg"" />"
c=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _A_3.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _surce_svg.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _nerves.jeg"" />"
Blck4
"<img src=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _Q_4.svg"" />"
c=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _A_4.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _surce_svg.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _nerves.jeg"" />"
Blck4
"<img src=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _Q_5.svg"" />"
c=""41 d93 f79b3d3f10d e50c2d8040f788d3ef f _A_5.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _surce_svg.svg"" />"
"<img
93 f79b3d3f10d e50c2d8040f788d3ef f _nerves.jeg"" />"
Blck4
"<img src=""022d541c3e63051d10d30767e2295951cc722304_Q_0.svg"" />"
c=""022d541c3e63051d10d30767e2295951cc722304_A_0.svg"" />"
"<img
541c3e63051d10d30767e2295951cc722304_surce_svg.svg"" />"
"<img

"<img sr
src=""3364
src=""3364
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src=""3364
src=""3364
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src=""48dd
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my_
"<img sr
src=""48dd
src=""48dd
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my_
"<img sr
src=""48dd
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my_
"<img sr
src=""41 d
src=""41 d
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my_
"<img sr
src=""41 d
src=""41 d
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my_
"<img sr
src=""41 d
src=""41 d
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my_
"<img sr
src=""41 d
src=""41 d
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my_
"<img sr
src=""41 d
src=""41 d
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my_
"<img sr
src=""41 d
src=""41 d
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my_
"<img sr
src=""022d
src=""022d

541c3e63051d10d30767e2295951cc722304_ened.jeg"" />"
An
my_
Blck4
"<img src=""022d541c3e63051d10d30767e2295951cc722304_Q_1.svg"" />"
"<img sr
c=""022d541c3e63051d10d30767e2295951cc722304_A_1.svg"" />"
"<img src=""022d
541c3e63051d10d30767e2295951cc722304_surce_svg.svg"" />"
"<img src=""022d
541c3e63051d10d30767e2295951cc722304_ened.jeg"" />"
An
my_
Blck4
"<img src=""b5e42b0bfeeecee62 0d5d629f405997336 2cb1_Q_0.svg"" />"
"<img sr
c=""b5e42b0bfeeecee62 0d5d629f405997336 2cb1_A_0.svg"" />"
"<img src=""b5e4
2b0bfeeecee62 0d5d629f405997336 2cb1_surce_svg.svg"" />"
"<img src=""b5e4
2b0bfeeecee62 0d5d629f405997336 2cb1_
nsilex.jeg"" />"
An
my_Blck4
"<img src=""b5e42b0bfeeecee62 0d5d629f405997336 2cb1_Q_1.svg"" />"
"<img sr
c=""b5e42b0bfeeecee62 0d5d629f405997336 2cb1_A_1.svg"" />"
"<img src=""b5e4
2b0bfeeecee62 0d5d629f405997336 2cb1_surce_svg.svg"" />"
"<img src=""b5e4
2b0bfeeecee62 0d5d629f405997336 2cb1_
nsilex.jeg"" />"
An
my_Blck4
"<img src=""b5e42b0bfeeecee62 0d5d629f405997336 2cb1_Q_2.svg"" />"
"<img sr
c=""b5e42b0bfeeecee62 0d5d629f405997336 2cb1_A_2.svg"" />"
"<img src=""b5e4
2b0bfeeecee62 0d5d629f405997336 2cb1_surce_svg.svg"" />"
"<img src=""b5e4
2b0bfeeecee62 0d5d629f405997336 2cb1_
nsilex.jeg"" />"
An
my_Blck4
Wh
immunhis
chemic l s
ins re imr
n
fr de
ermining curse f
re
men
me
is rs

ic

fr bre s
c ncer? Wh
s
ins re gd fr cnfirming
h

in rigin?
Prges
ern/es
rgen rece
r s
ins hel de
ermine hw

re

bre s

umrs (dn
hel wi
h rgnsis
hugh)<div><br /></div><div>PSA s
in
s de
ermine if me
is rs

ic</div> Nel si
Wh
is
he c
in f gluccr
ics
erids
"<div>Suress syn
hesis nd rel
e se f ll cl sses f <b>liid medi
rs</b> (<u>rs
gl ndins</u> nd <u>leuk

rienes</u>) nd
he <b>cy
kines</b>&nbs;</div><img src=""gluc.jeg"" />"
Dickey Immunlgy_blck4
Wh
is
he c
in f NSAIDS? Selec
ively blck syn
hesis f <b>rs
gl ndins
</b>
Dickey Immunlgy_blck4
Hw d n
i-infl mm
ries ffec
cy
kines rduced by M s
cells?
"M s
ce
lls re n
ffec
ed<div>&nbs;<img src=""gluc.jeg"" /></div>" Dickey Immunlg
y_blck4
Wh
is
he effec
f cr
isl? (5)
I
is
s
ress hrmne, incre ses glucs
e, liids, N + re
en
in, <u> n
i-infl mm
ry c
ivi
y</u>
Dickey Immunlg
y_blck4
In
erms f rg nic s
ruc
ure, wh
 r
icul r s
ruc
ure is required fr glucc
r
cids
 exer

heir h rm clgic effec
? "Mus
be hydrxyl (-OH) gru

si
in 11, ring C.&nbs;<div>Belw, cr
isne nd rednisne mus
be mdifi
ed by
he liver nd re <b>rdrugs.</b></div><div><br /></div><div><b><img src=
""rd.jeg"" /></b></div>"
Dickey Immunlgy_blck4
Wh
re
w <b>
yes f&nbs;mech nisms</b> f c
in fr gluccr
ics
erids?
<div>1) <b>Genmic regul
in</b>: Mdify <u>
r nscri
in</u> f mRNA fr cy
k
ines nd 
her r
eins
h
rm
e r suress v rius cell func
ins.</div><d
iv>2) <b>Nn-genmic regul
in</b>: Here GCs exer
<u>direc
effec
n cell m
embr nes</u> nd <u>in
r cy
l smic r
eins.</u></div>
Immunlgy_blck
4
Wh
is gluccr
ics
erids effec
n T cell c
iv
in?
<div>In
er c
wi

h cell membr ne GC rece
rs. One effec
f
his is
 reduce hshryl
in 
f mlecules
h
medi
es sign ling frm CD4, CD8 nd CD3 mlecules. This reduce
s sign ls</div><div>rduced by c
iv
ing T cell rece
rs. <b>T cell c
iv
i
n DECREASED</b></div> Immunlgy_blck4
S
erids l
er gene
r nscri
in. M ny r
eins re dwnregul
ed, including cy

kines. Wh
r
eins re uregul
ed? "Syn
hesis f licr
ins ( nnexins)&nbs
Dickey Immunlgy_blck4
;<div><img src="" nnex.jeg"" /></div>"
Hw d s
erids ffec
di edisis nd NFkB?
"Inhibi
b
h<div><img src=""nfk
b.jeg"" /></div>"
Dickey Immunlgy_blck4

Hw d n
i-infl mm
ry s
erids ffec
hshli se A2?

"Inhibi
s hsh
li se A2 <b>by incre sing licr
ins</b><div><img src=""nfkb.jeg"" /></div>"
Dickey Immunlgy_blck4
Hw d n
i-infl mm
ry s
erids ffec
Th cell ul
ins? "Th1--&g
;--&g
;
Th2<div><img src=""nfkb.jeg"" /></div>"
Immunlgy_blck4
Wh
is l
ern
e d y
her y? <div>If
he dise se fr which
he GCs re given
c n be cn
rlled by dminis
ering GCs <u>every 48 hrs</u>,
his mde f
her y
is <u>referred</u>.</div><div><br /></div><div><b>On
he ff d y, GC bld lev
els
yic lly f ll belw
he
hreshld
h
suresses ACTH rduc
in.</b></div
><div><br /></div><div>Cnsequen
ly l
ern
e d y
re
men
<b>reduces
he risk<
/b> f hy
h lmic / i
ui
ry / <b> dren l suressin.</b></div>
Immunl
gy_blck4
Cm re nd cn
r s

he
w isfrms f cyclxygen se?
Cx 1 nd Cx 2
re <u>b
h cns
i
u
ively exressed</u> in m ny
issues. <u>Bu
, <b>Cx 2</b> c
n be uregul
ed by infl mm
in.</u><div><br /></div><div><b>An
iinfl mm
ry
effec
s f NSAID
re
men
deend n
heir bili
y
 suress inducible COX-2.<
/b></div>
Immunlgy_blck4
Wh
c n be used rhyl c
ic lly fr m s
cells?
<b>Crmlyn</b>- m s
ce
ll s
bilizers. Inhibi
s rele se f infl mm
ry medi
rs
Dickey Immunlg
y_blck4
Wh
re 1s
nd 2nd gener
in n
i-his
mines (H1 rece
r blcker)? <div>R i
ses C + inside cell</div>1s
gen. <u>en
ers CNS</u> nd c uses sed
in<div>-(di
henhydr mine ben dryl; rme
h zine)</div><div><br /><div>2nd gen. h s <u>lw
CNS ene
r
in</u>, less sed
ing</div></div><div>- fexfen dine (Allegr )</di
v><div>-lr
dine (Cl ri
in)</div>
Dickey Immunlgy_blck4
Wh
d H1 nd H2 rece
rs in
he cell d?
"H1 incre se C 2+; H2 incre se c
AMP<div><img src=""his
(2).jeg"" /></div>"
Dickey Immunlgy_blck4
Where
he n s l bne mee
s
he gl bell is c lled?
"N sin<div><img src=""s
kele
n.jeg"" /></div>"
An
my_Blck4
Suerir nd middle cnch
re  r
f wh
bne?
E
hmid bne. Inferir c
An
my_Blck4
nch is i
s wn bne&nbs;
"<img src="" b1 e8020829 3c111ebec5042be72d3ceb6cfd_Q_0.svg"" />"
"<img sr
c="" b1 e8020829 3c111ebec5042be72d3ceb6cfd_A_0.svg"" />"
"<img src="" b1
e8020829 3c111ebec5042be72d3ceb6cfd_surce_svg.svg"" />"
"<img src="" b1
e8020829 3c111ebec5042be72d3ceb6cfd_skele
n.jeg"" />"
An
my_Blck4
"<img src=""d1cefc01f3cc59b c84165d2e e4676 397d82d1_Q_0.svg"" />"
"<img sr
c=""d1cefc01f3cc59b c84165d2e e4676 397d82d1_A_0.svg"" />"
"<img src=""d1ce
fc01f3cc59b c84165d2e e4676 397d82d1_surce_svg.svg"" />"
"<img src=""d1ce
fc01f3cc59b c84165d2e e4676 397d82d1_n res.jeg"" />"
An
my_
Blck4
"<img src=""28c457ed84d61 99c3855bf5559 49c38fee93d9_Q_0.svg"" />"
"<img sr
c=""28c457ed84d61 99c3855bf5559 49c38fee93d9_A_0.svg"" />"
"<img src=""28c4
57ed84d61 99c3855bf5559 49c38fee93d9_surce_svg.svg"" />"
"<img src=""28c4
57ed84d61 99c3855bf5559 49c38fee93d9_incisr.jeg"" />"
An
my_
Blck4
"<div>Describe nrm l bre
hing vs. sniff</div><img src=""l
smi.jeg"" />"
Nrm l- d shed<div>Sniff- rrw
 cribifrm l
e</div>
An
my_Blck4
"<img src=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_Q_0.svg"" />"
"<img sr
c=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_A_0.svg"" />"
"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_surce_svg.svg"" />"
"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_crn l cnch .jeg"" />"
An
my_Blck4
"<img src=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_Q_1.svg"" />"
"<img sr
c=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_A_1.svg"" />"
"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_surce_svg.svg"" />"
"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_crn l cnch .jeg"" />"
An
my_Blck4
"<img src=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_Q_2.svg"" />"
"<img sr
c=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_A_2.svg"" />"
"<img src=""e24c

9f 0c65ce43436d 88f5844cb36 70f0f65_surce_svg.svg"" />"

"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_crn l cnch .jeg"" />"
An
my_Blck4
"<img src=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_Q_3.svg"" />"
"<img sr
c=""e24c9f 0c65ce43436d 88f5844cb36 70f0f65_A_3.svg"" />"
"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_surce_svg.svg"" />"
"<img src=""e24c
9f 0c65ce43436d 88f5844cb36 70f0f65_crn l cnch .jeg"" />"
An
my_Blck4
"<img src=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_Q_0.svg"" />"
"<img sr
c=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_A_0.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_surce_svg.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_ r n s l sin.jeg"" />"
An
my_Blck4
"<img src=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_Q_1.svg"" />"
"<img sr
c=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_A_1.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_surce_svg.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_ r n s l sin.jeg"" />"
An
my_Blck4
"<img src=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_Q_2.svg"" />"
"<img sr
c=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_A_2.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_surce_svg.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_ r n s l sin.jeg"" />"
An
my_Blck4
"<img src=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_Q_3.svg"" />"
"<img sr
c=""45515c89fd2f1874212e3dd4b5b341f9fcf58083_A_3.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_surce_svg.svg"" />"
"<img src=""4551
5c89fd2f1874212e3dd4b5b341f9fcf58083_ r n s l sin.jeg"" />"
An
my_Blck4
"<img src=""54f8b20db5d7b94cb2652df384ccc985d486941c_Q_0.svg"" />"
"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_A_0.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_surce_svg.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_ n
n s l sine.jeg"" />"
An
my_Blck4
"<img src=""54f8b20db5d7b94cb2652df384ccc985d486941c_Q_1.svg"" />"
"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_A_1.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_surce_svg.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_ n
n s l sine.jeg"" />"
An
my_Blck4
"<img src=""54f8b20db5d7b94cb2652df384ccc985d486941c_Q_2.svg"" />"
"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_A_2.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_surce_svg.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_ n
n s l sine.jeg"" />"
An
my_Blck4
"<img src=""54f8b20db5d7b94cb2652df384ccc985d486941c_Q_3.svg"" />"
"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_A_3.svg"" /><div>C n be injured in
blwu
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"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_surce_svg.svg"" />"
"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_ n
n s l sine.jeg"" />"
An
my_Blck4
"<img src=""54f8b20db5d7b94cb2652df384ccc985d486941c_Q_4.svg"" />"
"<img sr
c=""54f8b20db5d7b94cb2652df384ccc985d486941c_A_4.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_surce_svg.svg"" />"
"<img src=""54f8
b20db5d7b94cb2652df384ccc985d486941c_ n
n s l sine.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_0.svg"" />"
"<img sr
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_0.svg"" />"
"<img src=""49d1
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
"<img src=""49d1
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_1.svg"" />"
"<img sr

c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_1.svg"" />"

e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_2.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_2.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_3.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_3.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_4.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_4.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_5.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_5.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_6.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_6.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_7.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_7.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""49d1 e23bcdef85471532c 3d1eb45392c f61e_Q_8.svg""
c=""49d1 e23bcdef85471532c 3d1eb45392c f61e_A_8.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_surce_svg.svg"" />"
e23bcdef85471532c 3d1eb45392c f61e_n clr.jeg"" />"
An
my_Blck4
"<img src=""f68c8d55c865cf3 d7c2bb42f44b79173c c84 c_Q_0.svg""
c=""f68c8d55c865cf3 d7c2bb42f44b79173c c84 c_A_0.svg"" />"
8d55c865cf3 d7c2bb42f44b79173c c84 c_surce_svg.svg"" />"
8d55c865cf3 d7c2bb42f44b79173c c84 c_she.jeg"" />"
Blck4
"<img src=""3b c72e30177db489403 ddd2825d53815d890e6_Q_0.svg""
c=""3b c72e30177db489403 ddd2825d53815d890e6_A_0.svg"" />"
72e30177db489403 ddd2825d53815d890e6_surce_svg.svg"" />"
72e30177db489403 ddd2825d53815d890e6_s
ium.jeg"" />"
Blck4
"<img src=""3b c72e30177db489403 ddd2825d53815d890e6_Q_1.svg""
c=""3b c72e30177db489403 ddd2825d53815d890e6_A_1.svg"" />"
72e30177db489403 ddd2825d53815d890e6_surce_svg.svg"" />"
72e30177db489403 ddd2825d53815d890e6_s
ium.jeg"" />"
Blck4
"<img src=""3b c72e30177db489403 ddd2825d53815d890e6_Q_2.svg""
c=""3b c72e30177db489403 ddd2825d53815d890e6_A_2.svg"" />"
72e30177db489403 ddd2825d53815d890e6_surce_svg.svg"" />"
72e30177db489403 ddd2825d53815d890e6_s
ium.jeg"" />"
Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_0.svg""

"<img src=""49d1
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my_
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my_
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"<img sr

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"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_su
rce_svg.svg"" />"
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_dr
in ge.jeg"" />"
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my_Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_1.svg"" />"
"<img sr
c=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_A_1.svg"" /><div><img src=""dr in g
e.jeg"" /></div><div><img src=""l
w ll n s.jeg"" /></div>" "<img src=""7c
8fb443d0c6d2de7c 27d85e464 96b83bc 7_surce_svg.svg"" />"
"<img src=""7c
8fb443d0c6d2de7c 27d85e464 96b83bc 7_dr in ge.jeg"" />"
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my_Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_2.svg"" />"
"<img sr
c=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_A_2.svg"" /><div><img src=""l
w l
l n s.jeg"" /></div><div><img src=""s
eum.jeg"" /></div><div><img src=""dr in
ge.jeg"" /></div>"
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_su
rce_svg.svg"" />"
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_dr
in ge.jeg"" />"
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my_Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_3.svg"" />"
"<img sr
c=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_A_3.svg"" /><div><img src="" r .j
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"<img src=""7c
8fb443d0c6d2de7c 27d85e464 96b83bc 7_surce_svg.svg"" />"
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8fb443d0c6d2de7c 27d85e464 96b83bc 7_dr in ge.jeg"" />"
An
my_Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_4.svg"" />"
"<img sr
c=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_A_4.svg"" /><div><img src=""dr in g
e.jeg"" /><br /><div><img src=""l
w ll n s.jeg"" /></div></div><div><img src
=""bull .jeg"" /></div>"
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83
bc 7_surce_svg.svg"" />"
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83
bc 7_dr in ge.jeg"" />"
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my_Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_5.svg"" />"
"<img sr
c=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_A_5.svg"" /><div><img src=""dr in g
e.jeg"" /></div><div><img src=""bull .jeg"" /></div>" "<img src=""7c 8fb443d0
c6d2de7c 27d85e464 96b83bc 7_surce_svg.svg"" />"
"<img src=""7c 8fb443d0
c6d2de7c 27d85e464 96b83bc 7_dr in ge.jeg"" />"
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my_
Blck4
"<img src=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_Q_6.svg"" />"
"<img sr
c=""7c 8fb443d0c6d2de7c 27d85e464 96b83bc 7_A_6.svg"" />"
"<img src=""7c
8fb443d0c6d2de7c 27d85e464 96b83bc 7_surce_svg.svg"" />"
"<img src=""7c
8fb443d0c6d2de7c 27d85e464 96b83bc 7_dr in ge.jeg"" />"
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my_Blck4
N me fr s
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ll hi
us.jeg"" /></div>"
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my_Blck4
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_Q_0.svg"" />"
"<img sr
c=""41c8ef11121c33b44 dbd61b5c07354de9e07434_A_0.svg"" /><div><img src=""bull .j
eg"" /></div>" "<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_surce_svg.
svg"" />"
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_l
w ll hi
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my_Blck4

us.jeg"" />"
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_Q_1.svg"" />"
"<img sr
c=""41c8ef11121c33b44 dbd61b5c07354de9e07434_A_1.svg"" /><div><img src=""bull .j
eg"" /></div>" "<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_surce_svg.
svg"" />"
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_l
w ll hi
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my_Blck4

us.jeg"" />"
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_Q_2.svg"" />"
"<img sr
c=""41c8ef11121c33b44 dbd61b5c07354de9e07434_A_2.svg"" />"
"<img src=""41c8
ef11121c33b44 dbd61b5c07354de9e07434_surce_svg.svg"" />"
"<img src=""41c8
ef11121c33b44 dbd61b5c07354de9e07434_l
w ll hi
us.jeg"" />"
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my_Blck4
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_Q_3.svg"" />"
"<img sr
c=""41c8ef11121c33b44 dbd61b5c07354de9e07434_A_3.svg"" />"
"<img src=""41c8
ef11121c33b44 dbd61b5c07354de9e07434_surce_svg.svg"" />"
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ef11121c33b44 dbd61b5c07354de9e07434_l
w ll hi
us.jeg"" />"

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my_Blck4
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_Q_4.svg"" />"
"<img sr
c=""41c8ef11121c33b44 dbd61b5c07354de9e07434_A_4.svg"" />"
"<img src=""41c8
ef11121c33b44 dbd61b5c07354de9e07434_surce_svg.svg"" />"
"<img src=""41c8
ef11121c33b44 dbd61b5c07354de9e07434_l
w ll hi
us.jeg"" />"
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my_Blck4
"<img src=""41c8ef11121c33b44 dbd61b5c07354de9e07434_Q_5.svg"" />"
"<img sr
c=""41c8ef11121c33b44 dbd61b5c07354de9e07434_A_5.svg"" />"
"<img src=""41c8
ef11121c33b44 dbd61b5c07354de9e07434_surce_svg.svg"" />"
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ef11121c33b44 dbd61b5c07354de9e07434_l
w ll hi
us.jeg"" />"
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my_Blck4
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kies.jeg"" /></div>"
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my_Blck4
"<img src=""d527d38d70 d687 d3 7941b01b1ded81268 872_Q_0.svg"" />"
"<img sr
c=""d527d38d70 d687 d3 7941b01b1ded81268 872_A_0.svg"" />"
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d38d70 d687 d3 7941b01b1ded81268 872_surce_svg.svg"" />"
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d38d70 d687 d3 7941b01b1ded81268 872_ rrws.jeg"" />"
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my_
Blck4
"<img src=""d527d38d70 d687 d3 7941b01b1ded81268 872_Q_1.svg"" />"
"<img sr
c=""d527d38d70 d687 d3 7941b01b1ded81268 872_A_1.svg"" />"
"<img src=""d527
d38d70 d687 d3 7941b01b1ded81268 872_surce_svg.svg"" />"
"<img src=""d527
d38d70 d687 d3 7941b01b1ded81268 872_ rrws.jeg"" />"
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my_
Blck4
"<img src=""d527d38d70 d687 d3 7941b01b1ded81268 872_Q_2.svg"" />"
"<img sr
c=""d527d38d70 d687 d3 7941b01b1ded81268 872_A_2.svg"" />"
"<img src=""d527
d38d70 d687 d3 7941b01b1ded81268 872_surce_svg.svg"" />"
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d38d70 d687 d3 7941b01b1ded81268 872_ rrws.jeg"" />"
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my_
Blck4
"<img src=""d527d38d70 d687 d3 7941b01b1ded81268 872_Q_3.svg"" />"
"<img sr
c=""d527d38d70 d687 d3 7941b01b1ded81268 872_A_3.svg"" />"
"<img src=""d527
d38d70 d687 d3 7941b01b1ded81268 872_surce_svg.svg"" />"
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d38d70 d687 d3 7941b01b1ded81268 872_ rrws.jeg"" />"
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my_
Blck4
"<img src=""d527d38d70 d687 d3 7941b01b1ded81268 872_Q_4.svg"" />"
"<img sr
c=""d527d38d70 d687 d3 7941b01b1ded81268 872_A_4.svg"" />"
"<img src=""d527
d38d70 d687 d3 7941b01b1ded81268 872_surce_svg.svg"" />"
"<img src=""d527
d38d70 d687 d3 7941b01b1ded81268 872_ rrws.jeg"" />"
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my_
Blck4
"<img src=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_Q_0.svg"" />"
"<img sr
c=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_A_0.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_surce_svg.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_inner.jeg"" />"
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my_
Blck4
"<img src=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_Q_1.svg"" />"
"<img sr
c=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_A_1.svg"" />"
"<img src=""86cc
36b0443153f6482e0 43f3 4b39e0cbe93b3_surce_svg.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_inner.jeg"" />"
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my_
Blck4
"<img src=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_Q_2.svg"" />"
"<img sr
c=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_A_2.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_surce_svg.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_inner.jeg"" />"
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my_
Blck4
"<img src=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_Q_3.svg"" />"
"<img sr
c=""86cc36b0443153f6482e0 43f3 4b39e0cbe93b3_A_3.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_surce_svg.svg"" />"
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36b0443153f6482e0 43f3 4b39e0cbe93b3_inner.jeg"" />"
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my_
Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_0.svg"" />"
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bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
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my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_1.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_1.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
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my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_2.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_2.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
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my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_3.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_3.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
An
my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_4.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_4.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
An
my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_5.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_5.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
An
my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_6.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_6.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
An
my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_7.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_7.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
An
my_Blck4
"<img src=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_Q_8.svg""
c=""b19ebbdc69 fe1672828f0ebbb5b56553ffe 602_A_8.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_surce_svg.svg"" />"
bbdc69 fe1672828f0ebbb5b56553ffe 602_n s l c v l
view.jeg""
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_0.svg""
c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_0.svg"" />"
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_1.svg""
c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_1.svg"" />"
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_2.svg""
c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_2.svg"" />"
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_3.svg""

"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""b19e
"<img src=""b19e
/>"
/>"
"<img sr
"<img src=""e350
"<img src=""e350
/>"
"<img sr
"<img src=""e350
"<img src=""e350
/>"
"<img sr
"<img src=""e350
"<img src=""e350
/>"

"<img sr

c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_3.svg"" />"

"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_4.svg"" />"
"<img sr
c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_4.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_5.svg"" />"
"<img sr
c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_5.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""e3503f 9ee884372436be69f14d1d152313eedd2_Q_6.svg"" />"
"<img sr
c=""e3503f 9ee884372436be69f14d1d152313eedd2_A_6.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_surce_svg.svg"" />"
"<img src=""e350
3f 9ee884372436be69f14d1d152313eedd2_ l
ine.jeg"" />"
An
my_Blck4
"<img src=""00b64fcd90903cc0ce69fb2201b0 8c0cffb1998_Q_0.svg"" />"
"<img sr
c=""00b64fcd90903cc0ce69fb2201b0 8c0cffb1998_A_0.svg"" />"
"<img src=""00b6
4fcd90903cc0ce69fb2201b0 8c0cffb1998_surce_svg.svg"" />"
"<img src=""00b6
4fcd90903cc0ce69fb2201b0 8c0cffb1998_n s l.jeg"" />"
An
my_
Blck4
"<img src=""00b64fcd90903cc0ce69fb2201b0 8c0cffb1998_Q_1.svg"" />"
"<img sr
c=""00b64fcd90903cc0ce69fb2201b0 8c0cffb1998_A_1.svg"" />"
"<img src=""00b6
4fcd90903cc0ce69fb2201b0 8c0cffb1998_surce_svg.svg"" />"
"<img src=""00b6
4fcd90903cc0ce69fb2201b0 8c0cffb1998_n s l.jeg"" />"
An
my_
Blck4
"<img src=""66f4669824eed54e45487cb6f8 3 7 50f 8 795_Q_0.svg"" />"
"<img sr
c=""66f4669824eed54e45487cb6f8 3 7 50f 8 795_A_0.svg"" />"
"<img src=""66f4
669824eed54e45487cb6f8 3 7 50f 8 795_surce_svg.svg"" />"
"<img src=""66f4
669824eed54e45487cb6f8 3 7 50f 8 795_nerve f 
.jeg"" />"
An
my_Blck4
"<img src=""66f4669824eed54e45487cb6f8 3 7 50f 8 795_Q_1.svg"" />"
"<img sr
c=""66f4669824eed54e45487cb6f8 3 7 50f 8 795_A_1.svg"" /><div><img src=""sheni
d hle.jeg"" /></div>" "<img src=""66f4669824eed54e45487cb6f8 3 7 50f 8 795_su
rce_svg.svg"" />"
"<img src=""66f4669824eed54e45487cb6f8 3 7 50f 8 795_ner
ve f 
.jeg"" />"
An
my_Blck4
"<img src=""30d5efce6f15971406f469ed540319d28c945d3 _Q_0.svg"" />"
"<img sr
c=""30d5efce6f15971406f469ed540319d28c945d3 _A_0.svg"" /><div><img src=""sheni
d hle.jeg"" /><br /><div><img src=""
n.jeg"" /></div></div>"
"<img sr
c=""30d5efce6f15971406f469ed540319d28c945d3 _surce_svg.svg"" />"
"<img sr
c=""30d5efce6f15971406f469ed540319d28c945d3 _n 
fs.jeg"" />"
An
my_Blck4
"<img src=""30d5efce6f15971406f469ed540319d28c945d3 _Q_1.svg"" />"
"<img sr
c=""30d5efce6f15971406f469ed540319d28c945d3 _A_1.svg"" /><div><img src=""
n.je
g"" /></div>" "<img src=""30d5efce6f15971406f469ed540319d28c945d3 _surce_svg.
svg"" />"
"<img src=""30d5efce6f15971406f469ed540319d28c945d3 _n 
fs.j
eg"" />"
An
my_Blck4
"<img src=""30d5efce6f15971406f469ed540319d28c945d3 _Q_2.svg"" />"
"<img sr
c=""30d5efce6f15971406f469ed540319d28c945d3 _A_2.svg"" />"
"<img src=""30d5
efce6f15971406f469ed540319d28c945d3 _surce_svg.svg"" />"
"<img src=""30d5
efce6f15971406f469ed540319d28c945d3 _n 
fs.jeg"" />"
An
my_Blck4
"<img src=""30d5efce6f15971406f469ed540319d28c945d3 _Q_3.svg"" />"
"<img sr
c=""30d5efce6f15971406f469ed540319d28c945d3 _A_3.svg"" />"
"<img src=""30d5
efce6f15971406f469ed540319d28c945d3 _surce_svg.svg"" />"
"<img src=""30d5
efce6f15971406f469ed540319d28c945d3 _n 
fs.jeg"" />"
An
my_Blck4

"<img src=""c 7cdfbbedd 0e77356bcd922 66edec649eb 5_Q_0.svg"" />"

"<img sr
c=""c 7cdfbbedd 0e77356bcd922 66edec649eb 5_A_0.svg"" />"
"<img src=""c 7c
dfbbedd 0e77356bcd922 66edec649eb 5_surce_svg.svg"" />"
"<img src=""c 7c
dfbbedd 0e77356bcd922 66edec649eb 5_fr m.jeg"" />"
An
my_
Blck4
"<img src=""c 7cdfbbedd 0e77356bcd922 66edec649eb 5_Q_1.svg"" />"
"<img sr
c=""c 7cdfbbedd 0e77356bcd922 66edec649eb 5_A_1.svg"" />"
"<img src=""c 7c
dfbbedd 0e77356bcd922 66edec649eb 5_surce_svg.svg"" />"
"<img src=""c 7c
dfbbedd 0e77356bcd922 66edec649eb 5_fr m.jeg"" />"
An
my_
Blck4
Wh
cmes
hrugh
he incisive fr men?
"N s l
ine n., shen l
ine
r
ery<div><img src=""neur.jeg"" /></div>" An
my_Blck4
"<img src=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _Q_0.svg"" />"
"<img sr
c=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _A_0.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _surce_svg.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _ r
kies.jeg"" />"
An
my_Blck4
"<img src=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _Q_1.svg"" />"
"<img sr
c=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _A_1.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _surce_svg.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _ r
kies.jeg"" />"
An
my_Blck4
"<img src=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _Q_2.svg"" />"
"<img sr
c=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _A_2.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _surce_svg.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _ r
kies.jeg"" />"
An
my_Blck4
"<img src=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _Q_3.svg"" />"
"<img sr
c=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _A_3.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _surce_svg.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _ r
kies.jeg"" />"
An
my_Blck4
"<img src=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _Q_4.svg"" />"
"<img sr
c=""4d7de6c8d5295dd2d53d61b2cf01e896 0d6 0 _A_4.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _surce_svg.svg"" />"
"<img src=""4d7d
e6c8d5295dd2d53d61b2cf01e896 0d6 0 _ r
kies.jeg"" />"
An
my_Blck4
Wh
ges
hrugh gre
er  l
ine fr men, lesser  l
ine fr men
"<img sr
c=""neur v gre
.jeg"" />"
An
my_Blck4
"<img src=""c87f2be 8129 8938028498e3e3955e5bd644c12_Q_0.svg"" />"
"<img sr
c=""c87f2be 8129 8938028498e3e3955e5bd644c12_A_0.svg"" />"
"<img src=""c87f
2be 8129 8938028498e3e3955e5bd644c12_surce_svg.svg"" />"
"<img src=""c87f
2be 8129 8938028498e3e3955e5bd644c12_ r
.jeg"" />"
An
my_
Blck4
"<img src=""c87f2be 8129 8938028498e3e3955e5bd644c12_Q_1.svg"" />"
"<img sr
c=""c87f2be 8129 8938028498e3e3955e5bd644c12_A_1.svg"" />"
"<img src=""c87f
2be 8129 8938028498e3e3955e5bd644c12_surce_svg.svg"" />"
"<img src=""c87f
2be 8129 8938028498e3e3955e5bd644c12_ r
.jeg"" />"
An
my_
Blck4
Wh
is ms
cmmn s rcm in children nd dlescen
s?
Rh bdmys rcm

hlgy_blck4
Ms
cmmn sf

issue nel sm in fem les?
"Leimym (u
erine w ll, fibri
ds)&nbs;<div><img src=""fib.jeg"" /></div>" 
hlgy_blck4
Wh
is ms
cmmn <i>benign</i> sf

issue lesin in inf n
s nd children?
Hem ngim

hlgy_blck4
"Wh
is rigin fr blue, red, yellw?<div><img src=""blue.jeg"" /></div>"
"Blue- Neur l cres
<div>Red- P r xi l mesderm</div><div>Yellw- L
er l l
e m
esderm&nbs;</div><div><img src=""3 (2).jeg"" /></div>"
An
my_Blck4
Mnemnic fr h rynge l rches? <div>1s
<b>JAW</b> (m xill , m ndible, muscles
f m s
ic
in,
rigemin l nerve)</div><div>2nd <b>FACE</b> (muscles f f ci l ex

ressin, f ci l nerve)</div><div>3rd <b>TONGUE</b> glssh rynge l =
s
e frm 

s
erir 1/3 f
ngue</div><div>4
h nd 6
h:&nbs;<b>LARYNX</b> (l rynge l br n
ches f
he v gus)</div>
An
my_Blck4
Mnemnic fr h rynge l uches rigin? <div>1s
<b>EAR</b> (middle e r, Eus
ch
i n
ube)</div><div>2nd <b>TONSILS</b> (fss , n
lymh
ic
issue)</div><div>3
rd <b>INFERIOR PARATHYROID AND THYMUS</b></div><div>4
h - <b>SUPERIOR PARATHYROI
D AND CALCITONIN (C-Cells)</b></div>
An
my_Blck4
Mnemnic h rynge l clef
s rigin?
<div>1s
EAR ( udi
ry c n l)&nbs;</div
><div>2nd NOTHING</div><div>3rd NOTHING</div><div>4
h - NOTHING</div>
An
my_
Blck4
Wh
is 2nd br nchi l clef
sinus? Hw des
his frm? Where is
he rfice
"Ms
cmmn sinus where 2nd uch s
ys cnnec
ed
 2nd clef
:<div><br /></div
><div>rifice n n
erir brder f SCM,
r vels
hrugh c r
id bifurc
in


nsill r fss <div><img src=""2nd clef
.jeg"" /></div></div><div><img src=""
s
e-43804371452433.jg"" /></div>"
An
my_Blck4
Fr h rynge l rch 1 bnes, wh
d drs l nd ven
r l r
ins f rch becme?
"<div>Drs l- m xill ry bnes (m xill , zygm
ic,  r
f
emr l)</div><div>V
en
r l- m ndibul r bnes (m ndible, bnes f middle e r (m lleus & m; incus))&n
bs;</div><img src=""drs l.jeg"" />" An
my_Blck4
Wh
des m xill ry r
ery
ermin
e s?
"Shen l
ine r
ery
 suly
n s l c vi
y<div><img src=""shen.jeg"" /></div><div><img src=""she.jeg"" /
></div>"
An
my_Blck4
Wh
muscles

ch
 m s
id rcess? "<div>Ps
erir belly f dig s
ric nd S
CM</div><img src=""sdm.jeg"" />"
An
my_Blck4
Wh
rece
r in
he eye c uses mydri sis?
lh -1, r di l muscle h rm c
lgy_blck4
Wh
is  illedem ?
"Swelling f
he 
ic disc c used by incre sed in
r cr
ni l ressure<div><img src="" .jeg"" /></div>"
An
my_Blck4 Kre
zer_B
lck4
Wh
re
he sin l levels f
he gre
er uricul r n? C2/C3 An
my_Blck4 K
re
zer_Blck4
Wh
is sin l level f lesser ccii
l n?
"C2/C3<div><img src=""nerves (1)
.jeg"" /></div>"
An
my_Blck4
Wh
is sin l level f gre
er ccii
l nerve?
"C2 (drs l br nch)<div>
<img src=""nerves (1).jeg"" /></div>" An
my_Blck4
Wh
is
he cn
inu
in f n
erir lngi
udin l lig men
, s
erir lngi
udin
l lig men
, nd lig men
um fl vum

he level f
he
l s/skull?
"ALL- An

erir
l n
-ccii
l membr ne<div>PLL- Tec
ri l membr ne</div><div>LF- Ps

erir
l n
-ccii
l membr ne</div><div><br /></div><div><img src=""lig ver
.
jeg"" /></div><div><img src=""inkl.jeg"" /></div>"
An
my_Blck4
Wh
re
he muscles f
he flr f
he mu
h, s
r
ing frm
he inferir sec
"An
erir belly f dig s
ric, mylhyid, genihyid, geniglssus,&nbs;

?
<div><img src=""neck.jeg"" /></div><div><img src=""mu
h.jeg"" /></div><div><i
mg src=""he d s g.jeg"" /></div>"
An
my_Blck4
"<img src=""e b257158f0cfe681803424126d080724173125 _Q_0.svg"" /><div>Wh
is i

s func
in? (be very recise)</div>"
"<img src=""e b257158f0cfe681803424126d0
80724173125 _A_0.svg"" /><div>Sund w ves which  ss u
he sc l ves
ibuli bu

never use u
heir energy by deressing si
e lng Reissners membr ne, mve u

he sc l ves
ibuli nd re
r nsferred

he sc l
ym ni
 vibr
e in use
less f shin
he rund windw in

he ir filled middle e r. <b>&nbs;I
is

remve useless, r ndm ressure w ves
h
wuld 
herwise dis
r

he
n
ic
m  f Hz.</b></div>" "<img src=""e b257158f0cfe681803424126d080724173125 _su
rce_svg.svg"" />"
"<img src=""e b257158f0cfe681803424126d080724173125 _hel
i.jeg"" />"
An
my_Blck4
Wh
n med nerve innerv
es n
erir belly f dig s
ric?
"<div>Nerve


he mylhyid ( r
f V3)</div><img src="" n
belly.jeg"" />" An
my_Blck4
Wh
ges
hrugh
he m ndibul r fr men?
"<div>Inferir lvel r nerve n
d r
ery&nbs;</div><img src=""f ce dee.jeg"" />"
An
my_Blck4
"Wh
is 5?<div><img src=""5.jeg"" /></div>" Shenm ndibul r lig men
&nbs;
An
my_Blck4

"<img src=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_Q_0.svg"" />"

"<img sr
c=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_A_0.svg"" />"
"<img src=""3359
db7f518f1b07f4e35b17fe2efee4eccb0f04_surce_svg.svg"" />"
"<img src=""3359
db7f518f1b07f4e35b17fe2efee4eccb0f04_glss l.jeg"" />"
An
my_
Blck4
"<img src=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_Q_1.svg"" />"
"<img sr
c=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_A_1.svg"" /><div>Wr ing rund n
d innerv
ing s
ylh ryngeus</div>"
"<img src=""3359db7f518f1b07f4e35b17fe2e
fee4eccb0f04_surce_svg.svg"" />"
"<img src=""3359db7f518f1b07f4e35b17fe2e
fee4eccb0f04_glss l.jeg"" />"
An
my_Blck4
"<img src=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_Q_2.svg"" />"
"<img sr
c=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_A_2.svg"" />"
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db7f518f1b07f4e35b17fe2efee4eccb0f04_surce_svg.svg"" />"
"<img src=""3359
db7f518f1b07f4e35b17fe2efee4eccb0f04_glss l.jeg"" />"
An
my_
Blck4
"<img src=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_Q_3.svg"" />"
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c=""3359db7f518f1b07f4e35b17fe2efee4eccb0f04_A_3.svg"" />"
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db7f518f1b07f4e35b17fe2efee4eccb0f04_surce_svg.svg"" />"
"<img src=""3359
db7f518f1b07f4e35b17fe2efee4eccb0f04_glss l.jeg"" />"
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my_
Blck4
"<img src=""868e3be586 9ce910c76b20f0d70954 6e60bf2 _Q_0.svg"" />"
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c=""868e3be586 9ce910c76b20f0d70954 6e60bf2 _A_0.svg"" />"
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3be586 9ce910c76b20f0d70954 6e60bf2 _surce_svg.svg"" />"
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my_
Blck4
"<img src=""868e3be586 9ce910c76b20f0d70954 6e60bf2 _Q_1.svg"" />"
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c=""868e3be586 9ce910c76b20f0d70954 6e60bf2 _A_1.svg"" />"
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"<img src=""868e
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An
my_
Blck4
"Wh
is 10?<div><img src="" udi
.jeg"" /></div>"
Grve fr udi
ry
ube
An
my_Blck4
Which Th2 cy
kines re required
 ge
s
hm ? "IL-4, <b>IL-13</b><div>(wi
hu

IL-10, ge
much wrse s
hm .)</div><div><img src=""IL.jeg"" />&nbs;</div>"
Immunlgy_blck4
Q: Wh
is ADMET?
<div>A: hw
he drug is <b>A</b>bsrbed in

he bdy,&n
bs;</div><div>hw i
is <b>D</b>is
ribu
ed

he
issues,&nbs;</div><div>hw

he bdy <b>M</b>e
blizes i
,&nbs;</div><div>hw
he bdy <b>E</b>limin
es i

,&nbs;</div><div> nd
he <b>T</b>xic effec
s;&nbs;</div><div><br /></div><di
v>On nim ls,
yes f nim ls selec
ed include r
s, dgs, sm ll rim
es</div>
h rm clgy_blck4
Q: Wh
s
he m in urse f drug
es
ing in nim ls? <div>A: <b>Pr
ec
s
udy
 r
ici n
s</b> in h se 1
ri ls</div><div><br /></div><div>- hence -</div><d
iv><br /></div><div>This is differen
nd se r
e frm v rius l br
ry nim
l mdels</div><div>used in drug discvery rir
 reclinic l
es
ing</div>
h rm clgy_blck4
Q: N me 3
yes f
xici
y.
A: cu
e, subchrnic, chrnic h rm clgy_bl
ck4
Q: Define cu
e
xici
y.
A: usu lly rduced by
he single r sudden in

ke f subs
nce in qu n
i
ies l rge enugh
 c use <u>severe deressin f
vi
l hysilgic l func
in</u>, sym
ms devel shr
ly f
er in
rduc
in f

he subs
nce in

he bdy - exsure

he chemic l ccurs ne r mre
imes
fr <u>less
h n 24 hurs.</u> h rm clgy_blck4
Q: Define subchrnic
xici
y. A: usu lly ccurs frm ree
ed exsure

dr
ug r chemic l ver erid
h
ex
ends frm <u>weeks
 mn
hs</u> h rm c
lgy_blck4
Q: Define chrnic
xici
y.
A: usu lly ccurs frm ree
ed exsure ver l
ng erids

chemic l whse r
e f en
ry in

he bdy exceeds i
s r
e f e
limin
in (rducing <u>cumul
ive
xici
y</u>) - exsure
 chemic l ccurs
fr <u>mre
h n 3 mn
hs.</u> h rm clgy_blck4

Q: Wh
s
he n effec
dse? A:
he m ximum dse
which
xic effec
s re n


seen used
 se

he Ph se I dse h rm clgy_blck4
Q: Wh
re sme limi

ins f reclinic l s fe
y nd
xici
y
es
ing?
A: ex
r l
in f
xiclgy d
frm nim l s
udies
 hum ns is <b>NOT reli
ble</b> nd <b>r re dverse effec
s re NOT de
ec
ed</b>; i
s ls exensive/
im
e cnsuming nd l rge numbers f nim ls re used
h rm clgy_blck4
<div>Q: _______Tri ls serve s
he b sis fr b
ining FDA rv l fr secif
ic drug indic
in nd le d

he gr n
ing f n NDA.</div><div><br /></div><di
v>Q: _______Tri ls differ frm clinic l
ri ls in
h

hey re <u>cm ny sns
red
ri ls</u> n FDA rved drugs -
hese
ri ls r rely serve scientific pur
pose and are primarily used to introduce the concept of a drug or medical interv
ention to physicians (beta testing)</div>
A: Clinical<div>A: Seeding</div>
pharmacology_bloc
4
Cross-over design vs parallel design
"<img src=""cross (1).jpeg"" /><div><img
src=""paral.jpeg"" /></div>" pharmacology_bloc
4
<div>Define:&nbsp;</div><div>Accelerated development Review</div><div><br /></di
v><div>Treatment IND</div><div><br /></div><div>Parallel trac
&nbsp;</div>
"<div>Accelerated development Review - <u>speeds development</u> of drugs for se
rious or life- threatening illnesses <u>for which no therapy exists</u> but manu
facturer must continue testing after approval</div><div><br /></div><div>Treatme
nt IND ma
es promising new drugs available to desperately ill patients <u>as ear
ly as possible</u> (ie AIDS)</div><div><br /></div><div>Parallel trac
patients
with AIDS, whose condition prevents them from participating in controlled clinic
al trials, can receive study drugs</div><div><img src=""ch.jpeg"" /></div>"
pharmacology_bloc
4
What can be used an antidote to beta bloc
er overdose? Glucagon
pharmaco
logy_bloc
4
Q: Drug discovery involves all of the following
inds of testing (4): <div> In
vitro</div><div> In silico</div><div> ADMET on animals</div><div> Human clinical tr
ials</div>
pharmacology_bloc
4
Fracture of the zygomatic arch can lead to what clinical symptom?
Trismusinability to open the mouth. Can show injury to muscles of mastication.&nbsp;
Anatomy_Bloc
4
What structure is actually INSIDE the cavernous sinus? What are the other struct
ures outside and associated with cavernous sinus?
"CN VI is inside. III, I
V, V1, V2, VI, and internal carotid are associated with it.&nbsp;<div><img src="
"cav.jpeg"" /></div>" Anatomy_Bloc
4
What is the intraconal space? "Annulus of Zinn and extending muscles forming a
cone<div><img src=""intra (1).jpeg"" /></div>" Anatomy_Bloc
4
How many bones ma
e up the orbit?
"<div>7. Frontal, maxillary, zygomatic,
ethmoidal, lacrimal, spenoid, <b>palatine</b></div><div><b><br /></b></div><img
src=""7 (1).jpeg"" />" Anatomy_Bloc
4
_______ are&nbsp;paired ectodermal thic
enings which have important roles in dev
elopment of special sensory systems. "Placodes<div><img src=""placodes.jpeg""
/></div>"
Describe embryology of the eye, two steps
"<div>Optic vesicle induces ecto
derm to differentiate into lens--&gt; lens induces ectoderm to differentiate int
o cornea</div><img src=""eye1.jpeg"" />"
What is the function of levator and tensor palati?
"Raise the soft palate a
nd open PT tube at the same time<div><img src=""979387b387e5d3a4fabc176389b376d0
e807cf9d_pt t.jpeg"" /></div>" Anatomy_Bloc
4
What percent of the population is elderly? What percent of the medication use ar
e they? 12% of the population<div>30% of the prescription</div><div><br /></div>
<div>40% of the elderly are using more than 5 medications</div> PrescribingForTh
eElderly
How is distribution <b>and absorption</b> of durgs affected in the elderly? For
distribution, fat, lean body mass, TBW, serum protein Distribution- affected b
y increase in body fat, decrease in lean body mass, decrease in total body water
, decrease in serum protein<div><br /></div><div>Absorption- not changed</div>
PrescribingForTheElderly

What types of drugs might have lower plasma concentration in elderly than in nor
mal people? Why?
Lipid soluble drugs (more fat to be stored in) Prescrib
ingForTheElderly
What types of drugs might have higher plasma concentration in elderly than in no
rmal people? Why?
Drugs that bind tightly to albumin (less albumin means m
ore is free)<div><br /></div><div>Drugs that distribute to <b>body water</b> or
<b>lean body mass</b> (less of both, so will be more concentrated in plasma)</di
v>
PrescribingForTheElderly
What phase of drug metabolism is more affected in the elderly? What drugs will i
ncrease in plasma concentrations due to this change?
Phase 1 (oxidation) is d
ecreased<div>Phase 2 (conjugation) is unchanged</div><div><br /></div><div>Drugs
that have high first-pass effect in liver, or that need to undergo phase 1 meta
bolism to be degraded</div>
PrescribingForTheElderly
How does renal elimination change with age? What about GFR?
Elimination is r
elatively unchanged<div>GFR will decrease</div> PrescribingForTheElderly
How do receptors change with age?
They decrease in number and signaling ef
ficiency
PrescribingForTheElderly
What are the principles of prescribing for older patients?
Start with a low
dose<div>Titrate upward slowly</div><div>Avoid starting 2 drugs at the same tim
e</div><div>Be aware of timing of medication to minimize side effects</div>
PrescribingForTheElderly
What is the ADE prescribing cascade?
"Drug is given for original problem, but
it causes significant side effect<div><br /></div><div>Side effect is misinterp
reted as a new medical condition, and new drug is prescribed to treat it</div><d
iv><br /></div><div>Side effect of the second drug is misinterpreted as new cond
ition and something is prescribed to treat it</div><div><br /></div><div>etc</di
v><div><img src=""ADE.jpeg"" /></div><div><br /></div><div><br /></div>"
PrescribingForTheElderly
What are the specific goals of pharmacological intervention in anaphylactic shoc

? What receptors need to acted on to acheive these? What drug is best choice an
d why? Increase blood pressure (a1, B1)<div>Decrease edema (especially in airwa
ys) (a1)</div><div>Bloc
degranulation of mast cells (B2)</div><div>Bronchodilat
ion (B2)</div><div><br /></div><div>Epinephrine is the best choice because it ac
ts on all of these</div><div>(also stimulates RAAAS pathway to increase blood pr
essure and reduce swelling)</div>
Review
How does epinephrine shift the angiotensin II and brady
inin balance? What degra
des brady
inin? Epinephrine increase angiotensin II and decreases brady
inin<div
><br /></div><div>ACE degrades brady
inin</div> Review
How do
inins wor
? What type of molecule are they?
Peptide that dilates vas
cular smooth muscle (antagonizes a1 in s
in blood vessels)
Review
"<img src=""paste-48902497632509.jpg"" /><div>How is this side effect treated?</
div>" D<div>treated with epinephrine, antihistamines, steroids</div> Review
How does the body respond to bronchoconstriction?
Stressful event -&gt; in
creased heart rate<div>Increased pulmonary resistance decreases cardiac preload,
cardiac output, and systemic blood supply</div><div><br /></div><div>Result: hy
potension, reflex tachycardia, possible arrhythmia</div>
Review
"<img src=""paste-49413598740807.jpg"" /><div>Why?</div>"
1<div>Albuterol
is <b>fast on fast off</b></div><div>LABAs li
e salmeterol ta
e longer to act</d
iv>
Review
"<img src=""paste-49447958479111.jpg"" /><div>Explain each option</div>"
1. WRONG- high levels of agonist will down regulate B2 receptors<div><br /></div
><div>2. WRONG- B2 activation in liver stimulate glucose production, B2 activati
on in pancreas increases glucagon release</div><div><br /></div><div>3. RIGHT</d
iv><div><br /></div><div>4. WRONG- activates some B2 receptors in heart, cross-a
ctivates B1 receptors in heart, causes B2 mediated dilation (reflex tachy)</div>
<div><br /></div><div>5. WRONG- B2 activation and cortisol down regulate immune
system</div>
Review
Why can albuterol cause tachycardia (3 mechanisms)?
activating B2 receptors
in the heart (there are some)<div><br /></div><div>cross-reacting with B1 in the
heart</div><div><br /></div><div>activating B2 receptors in blood vessels, caus

ing decreased blood pressure and reflex tachycardia</div>

Review
Why does ta
ing an over the counter decongestant cause urinary retention in some
people?
Drugs li
e phenylephrine wor
by activating a1 receptors (causin
g vasoconstriction in nose)<div><br /></div><div>It also activates a1 in urinary
sphincter -&gt; urinary retention</div>
Review
What class of drug is used to treat an overactive bladder? What are its side eff
ects? Muscarinic bloc
er (oxybutyn)<div>Side effects are opposite of DUMB BELS
S</div> Review
Glycopyrollate is given to patients preop. Why? Acts as muscarinic antagonist to
decrease secretions to ma
e surgery cleaner<div><br /></div><div>Also <b>
eeps
BP elevated</b></div> Review
Why is succinylcholine a favored drug to use during surgery?
Because it is a
very fast acting depolarizing NMJ with a short half life of minutes<div><br /></
div><div>They will be paralyzed rapidly and will recover rapidly</div> Review
How does atropine help during a vasovagal episode?
It bloc
s the muscarinic
stimulation of the heart which is causing the decreased HR and CO
Review
What are the clinical advantages of **cur** drugs over succinylcholine in the OR
?
"<div>Nondepolarizing vs Depolarizing</div>It is reversible with AchE in
hibitors (just competitive inhibition)<div>Doesnt cause <b><font color=""#aa000
0"">malignant hyperthermia</font></b></div><div>Lasts much longer than succinylc
holine</div>" Review
After anesthesia where a depolarizing NMJ bloc
er was used, what is given to the
patient to bring them bac
? Why?
Both <u>neostigmine</u> AND <u>glycopyro
llate</u><div><br /></div><div>Neostigmine inhibits AchE to increase Ach everywh
ere in the periphery (not just NMJ)</div><div><br /></div><div>Glycopyrollate (o
r atropine) acts as a muscarinic bloc
er to protect the heart, lungs, glands, et
c from increased Ach levels (only want it in the NMJ)</div>
Review
"<img src=""paste-51994874085591.jpg"" />"
D
Review
What is a vasovagal response in surgery?
In response to intubation, there
is a huge parasympathetic outflow onto heart, causes drop in HR and CO Review
Does the epiglottis move down when swallowing liquids? "<div>No, remains in the
vertical position</div><img src=""mid.jpeg"" />"
Anatomy_Bloc
4
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_Q_0.svg"" />"
"<img sr
c=""8839b7b241a04d4e1855b68b8bcf4c193608525e_A_0.svg"" />"
"<img src=""8839
b7b241a04d4e1855b68b8bcf4c193608525e_source_svg.svg"" />"
"<img src=""8839
b7b241a04d4e1855b68b8bcf4c193608525e_mid.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_Q_1.svg"" />"
"<img sr
c=""8839b7b241a04d4e1855b68b8bcf4c193608525e_A_1.svg"" /><div><img src=""vest.jp
eg"" /></div>" "<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_source_svg.
svg"" />"
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_mid.jpeg""
/>"
Anatomy_Bloc
4
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_Q_2.svg"" />"
"<img sr
c=""8839b7b241a04d4e1855b68b8bcf4c193608525e_A_2.svg"" /><div><img src=""vest.jp
eg"" /></div>" "<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_source_svg.
svg"" />"
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_mid.jpeg""
/>"
Anatomy_Bloc
4
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_Q_3.svg"" />"
"<img sr
c=""8839b7b241a04d4e1855b68b8bcf4c193608525e_A_3.svg"" /><div><img src=""vest.jp
eg"" /></div>" "<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_source_svg.
svg"" />"
"<img src=""8839b7b241a04d4e1855b68b8bcf4c193608525e_mid.jpeg""
/>"
Anatomy_Bloc
4
"<img src=""3bd1e73509f25074e1b456b89c20429daec1f77f_Q_0.svg"" />"
"<img sr
c=""3bd1e73509f25074e1b456b89c20429daec1f77f_A_0.svg"" />"
"<img src=""3bd1
e73509f25074e1b456b89c20429daec1f77f_source_svg.svg"" />"
"<img src=""3bd1
e73509f25074e1b456b89c20429daec1f77f_ana.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""3bd1e73509f25074e1b456b89c20429daec1f77f_Q_1.svg"" />"
"<img sr
c=""3bd1e73509f25074e1b456b89c20429daec1f77f_A_1.svg"" />"
"<img src=""3bd1
e73509f25074e1b456b89c20429daec1f77f_source_svg.svg"" />"
"<img src=""3bd1

e73509f25074e1b456b89c20429daec1f77f_ana.jpeg"" />"
Bloc
4
"<img src=""3bd1e73509f25074e1b456b89c20429daec1f77f_Q_2.svg""
c=""3bd1e73509f25074e1b456b89c20429daec1f77f_A_2.svg"" />"
e73509f25074e1b456b89c20429daec1f77f_source_svg.svg"" />"
e73509f25074e1b456b89c20429daec1f77f_ana.jpeg"" />"
Bloc
4
"<img src=""e9ff6280faf00db65e79c526bdb73200ce8010cb_Q_0.svg""
c=""e9ff6280faf00db65e79c526bdb73200ce8010cb_A_0.svg"" />"
6280faf00db65e79c526bdb73200ce8010cb_source_svg.svg"" />"
6280faf00db65e79c526bdb73200ce8010cb_pret.jpeg"" />"
Bloc
4
"<img src=""e9ff6280faf00db65e79c526bdb73200ce8010cb_Q_1.svg""
c=""e9ff6280faf00db65e79c526bdb73200ce8010cb_A_1.svg"" />"
6280faf00db65e79c526bdb73200ce8010cb_source_svg.svg"" />"
6280faf00db65e79c526bdb73200ce8010cb_pret.jpeg"" />"
Bloc
4
"<img src=""e9ff6280faf00db65e79c526bdb73200ce8010cb_Q_2.svg""
c=""e9ff6280faf00db65e79c526bdb73200ce8010cb_A_2.svg"" />"
6280faf00db65e79c526bdb73200ce8010cb_source_svg.svg"" />"
6280faf00db65e79c526bdb73200ce8010cb_pret.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_0.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_0.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_1.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_1.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_2.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_2.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_3.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_3.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_4.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_4.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_5.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_5.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_6.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_6.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_lar.jpeg"" />"
Bloc
4
"<img src=""49328fb3d2af507a9fc16f44bb26315af03220ad_Q_7.svg""
c=""49328fb3d2af507a9fc16f44bb26315af03220ad_A_7.svg"" />"
8fb3d2af507a9fc16f44bb26315af03220ad_source_svg.svg"" />"

Anatomy_
/>"
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Anatomy_
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"<img src=""4932
"<img src=""4932

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Bloc
4
"<img src=""0a42b60aa18079d6ba1a1587b78b2a22737903d9_Q_0.svg""
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Bloc
4
"<img src=""0a42b60aa18079d6ba1a1587b78b2a22737903d9_Q_1.svg""
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Bloc
4
"<img src=""0a42b60aa18079d6ba1a1587b78b2a22737903d9_Q_2.svg""
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Bloc
4
"<img src=""24e1c5ea5a79746e0955ea3ca2adf432a91d461e_Q_0.svg""
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Bloc
4
"<img src=""24e1c5ea5a79746e0955ea3ca2adf432a91d461e_Q_1.svg""
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Bloc
4
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Bloc
4
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Bloc
4
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Bloc
4
"<img src=""1f7a271cb692aa135c4b0cb22ce51e1715d9c894_Q_2.svg""
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Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_0.svg""
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a0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.svg"" />"
a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_1.svg""
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_1.svg"" />"
a0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.svg"" />"
a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_2.svg""
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_2.svg"" />"
a0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.svg"" />"

Anatomy_
/>"
"<img sr
"<img src=""0a42
"<img src=""0a42
Anatomy_
/>"
"<img sr
"<img src=""0a42
"<img src=""0a42
Anatomy_
/>"
"<img sr
"<img src=""0a42
"<img src=""0a42
Anatomy_
/>"
"<img sr
"<img src=""24e1
"<img src=""24e1
Anatomy_
/>"
"<img sr
"<img src=""24e1
"<img src=""24e1
Anatomy_
/>"
"<img sr
"<img src=""24e1
"<img src=""24e1
Anatomy_
/>"
"<img sr
"<img src=""1f7a
"<img src=""1f7a
Anatomy_
/>"
"<img sr
"<img src=""1f7a
"<img src=""1f7a
Anatomy_
/>"
"<img sr
"<img src=""1f7a
"<img src=""1f7a
Anatomy_
/>"
"<img sr
"<img src=""d98c
"<img src=""d98c
/>"
"<img sr
"<img src=""d98c
"<img src=""d98c
/>"
"<img sr
"<img src=""d98c
"<img src=""d98c

a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"

Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_3.svg"" />"
"<img sr
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_3.svg"" /><div><img src=""visc.jp
eg"" /></div>" "<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.
svg"" />"
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_post color.
jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_4.svg"" />"
"<img sr
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_4.svg"" /><div><img src=""visc.jp
eg"" /></div>" "<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.
svg"" />"
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_post color.
jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_5.svg"" />"
"<img sr
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_5.svg"" />"
"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.svg"" />"
"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_6.svg"" />"
"<img sr
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_6.svg"" />"
"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.svg"" />"
"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_7.svg"" />"
"<img sr
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_7.svg"" />"
"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_source_svg.svg"" />"
"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"
Anatomy_Bloc
4
"<img src=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_Q_8.svg"" />"
"<img sr
c=""d98ca0d00b47384bfdaeb47aa165ab710d38f7ec_A_8.svg"" />"
"<img src=""d98c
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"<img src=""d98c
a0d00b47384bfdaeb47aa165ab710d38f7ec_post color.jpeg"" />"
Anatomy_Bloc
4
"<img src=""dd926cd04e6f6bb9badaf4ad1d349efd1ffbd0e3_Q_0.svg"" />"
"<img sr
c=""dd926cd04e6f6bb9badaf4ad1d349efd1ffbd0e3_A_0.svg"" />"
"<img src=""dd92
6cd04e6f6bb9badaf4ad1d349efd1ffbd0e3_source_svg.svg"" />"
"<img src=""dd92
6cd04e6f6bb9badaf4ad1d349efd1ffbd0e3_cri.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""98ad59ea37348b0f49cb66ddbe8acc1af0490cf8_Q_0.svg"" />"
"<img sr
c=""98ad59ea37348b0f49cb66ddbe8acc1af0490cf8_A_0.svg"" /><div><img src=""muscles
(1).jpeg"" /></div>" "<img src=""98ad59ea37348b0f49cb66ddbe8acc1af0490cf8_sou
rce_svg.svg"" />"
"<img src=""98ad59ea37348b0f49cb66ddbe8acc1af0490cf8_lar
y 1.jpeg"" />"
Anatomy_Bloc
4
"<img src=""98ad59ea37348b0f49cb66ddbe8acc1af0490cf8_Q_1.svg"" />"
"<img sr
c=""98ad59ea37348b0f49cb66ddbe8acc1af0490cf8_A_1.svg"" />"
"<img src=""98ad
59ea37348b0f49cb66ddbe8acc1af0490cf8_source_svg.svg"" />"
"<img src=""98ad
59ea37348b0f49cb66ddbe8acc1af0490cf8_lary 1.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""08df459c4d179957ffe7366cfb69008ab9af6858_Q_0.svg"" />"
"<img sr
c=""08df459c4d179957ffe7366cfb69008ab9af6858_A_0.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_source_svg.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_sup.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""08df459c4d179957ffe7366cfb69008ab9af6858_Q_1.svg"" />"
"<img sr
c=""08df459c4d179957ffe7366cfb69008ab9af6858_A_1.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_source_svg.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_sup.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""08df459c4d179957ffe7366cfb69008ab9af6858_Q_2.svg"" />"
"<img sr
c=""08df459c4d179957ffe7366cfb69008ab9af6858_A_2.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_source_svg.svg"" />"
"<img src=""08df

459c4d179957ffe7366cfb69008ab9af6858_sup.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""08df459c4d179957ffe7366cfb69008ab9af6858_Q_3.svg"" />"
"<img sr
c=""08df459c4d179957ffe7366cfb69008ab9af6858_A_3.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_source_svg.svg"" />"
"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_sup.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""08df459c4d179957ffe7366cfb69008ab9af6858_Q_4.svg"" />"
"<img sr
c=""08df459c4d179957ffe7366cfb69008ab9af6858_A_4.svg"" />"
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"<img src=""08df
459c4d179957ffe7366cfb69008ab9af6858_sup.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_Q_0.svg"" />"
"<img sr
c=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_A_0.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_source_svg.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_coronoa.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_Q_1.svg"" />"
"<img sr
c=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_A_1.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_source_svg.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_coronoa.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_Q_2.svg"" />"
"<img sr
c=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_A_2.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_source_svg.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_coronoa.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_Q_3.svg"" />"
"<img sr
c=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_A_3.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_source_svg.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_coronoa.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_Q_4.svg"" />"
"<img sr
c=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_A_4.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_source_svg.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_coronoa.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_Q_5.svg"" />"
"<img sr
c=""a145382a59c2f38db73f61f235e2e9b1a0ed96c7_A_5.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_source_svg.svg"" />"
"<img src=""a145
382a59c2f38db73f61f235e2e9b1a0ed96c7_coronoa.jpeg"" />"
Anatomy_
Bloc
4
What is the only abductor of the larynx?
"Posterior cricoarytenoid<div><i
mg src=""muscles (1).jpeg"" /></div>" Anatomy_Bloc
4
"<img src=""79b5f9be7064811bada6729fba8655b4300629dc_Q_0.svg"" /><div><br /></di
v><div>Lies medial to Thyroarytenoid muscle</div>"
"<img src=""79b5f9be7064
811bada6729fba8655b4300629dc_A_0.svg"" />"
"<img src=""79b5f9be7064811bada6
729fba8655b4300629dc_source_svg.svg"" />"
"<img src=""79b5f9be7064811bada6
729fba8655b4300629dc_lary left.jpeg"" />"
Anatomy_Bloc
4
"<img src=""79b5f9be7064811bada6729fba8655b4300629dc_Q_1.svg"" />"
"<img sr
c=""79b5f9be7064811bada6729fba8655b4300629dc_A_1.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_source_svg.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_lary left.jpeg"" />"
Anatomy_Bloc
4
"<img src=""79b5f9be7064811bada6729fba8655b4300629dc_Q_2.svg"" />"
"<img sr
c=""79b5f9be7064811bada6729fba8655b4300629dc_A_2.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_source_svg.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_lary left.jpeg"" />"
Anatomy_Bloc
4
"<img src=""79b5f9be7064811bada6729fba8655b4300629dc_Q_3.svg"" />"
"<img sr

c=""79b5f9be7064811bada6729fba8655b4300629dc_A_3.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_source_svg.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_lary left.jpeg"" />"
Anatomy_Bloc
4
"<img src=""79b5f9be7064811bada6729fba8655b4300629dc_Q_4.svg"" />"
"<img sr
c=""79b5f9be7064811bada6729fba8655b4300629dc_A_4.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_source_svg.svg"" />"
"<img src=""79b5
f9be7064811bada6729fba8655b4300629dc_lary left.jpeg"" />"
Anatomy_Bloc
4
Muscles of the larynx are all innervated (motor) by _______ EXCEPT ____&nbsp;
"recurrent laryngeal; cricothyroid (via external branch of superior laryngeal ne
rve. Only motor branch*)<div><img src=""visc.jpeg"" /></div>" Anatomy_Bloc
4
What is stridor?&nbsp; High pitched noisy respiration. Occurs when muscles on o
ne side are damaged or paralyzed. Damaged muscle atrophies and stronger side pul
ls the arytenoid into the midline all the time and interferes with vocalizing an
d respiration Anatomy_Bloc
4
What laryngeal muscles function as a sphincter? "<div>Transverse arytenoids pull
arytenoids together to completely close off lungs sphincter function.<i> Extrem
ely important for valsalva functions such defecation and coughing.</i></div><div
><i><img src=""muscles.jpeg"" /></i></div>"
Anatomy_Bloc
4
What is the only laryngeal muscle not under mucus membrane?
"Cricothyroid<di
v><img src=""crico.jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""9760238706345dd5b6ce068368fdd7d8e2770475_Q_0.svg"" />"
"<img sr
c=""9760238706345dd5b6ce068368fdd7d8e2770475_A_0.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_source_svg.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_muscles.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""9760238706345dd5b6ce068368fdd7d8e2770475_Q_1.svg"" />"
"<img sr
c=""9760238706345dd5b6ce068368fdd7d8e2770475_A_1.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_source_svg.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_muscles.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""9760238706345dd5b6ce068368fdd7d8e2770475_Q_2.svg"" />"
"<img sr
c=""9760238706345dd5b6ce068368fdd7d8e2770475_A_2.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_source_svg.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_muscles.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""9760238706345dd5b6ce068368fdd7d8e2770475_Q_3.svg"" />"
"<img sr
c=""9760238706345dd5b6ce068368fdd7d8e2770475_A_3.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_source_svg.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_muscles.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""9760238706345dd5b6ce068368fdd7d8e2770475_Q_4.svg"" />"
"<img sr
c=""9760238706345dd5b6ce068368fdd7d8e2770475_A_4.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_source_svg.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_muscles.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""9760238706345dd5b6ce068368fdd7d8e2770475_Q_5.svg"" />"
"<img sr
c=""9760238706345dd5b6ce068368fdd7d8e2770475_A_5.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_source_svg.svg"" />"
"<img src=""9760
238706345dd5b6ce068368fdd7d8e2770475_muscles.jpeg"" />"
Anatomy_
Bloc
4
What is cricothyroid function? "Roc
the thyroid cartilage downward and forward
s which stretches and thins the vocal ligament<div><img src=""crico.jpeg"" /></d
iv>"
Anatomy_Bloc
4
"<img src=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_Q_0.svg"" />"
"<img sr
c=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_A_0.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_source_svg.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_arye.jpeg"" />"
Anatomy_
Bloc
4

"<img src=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_Q_1.svg"" />"

"<img sr
c=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_A_1.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_source_svg.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_arye.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_Q_2.svg"" />"
"<img sr
c=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_A_2.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_source_svg.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_arye.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_Q_3.svg"" />"
"<img sr
c=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_A_3.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_source_svg.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_arye.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_Q_4.svg"" />"
"<img sr
c=""656b3577d5d88cf10f1ef5a6f0d29e0b807154ed_A_4.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_source_svg.svg"" />"
"<img src=""656b
3577d5d88cf10f1ef5a6f0d29e0b807154ed_arye.jpeg"" />"
Anatomy_
Bloc
4
Where does inferior laryngeal nerve lay in situ?
"Cleft between trachea a
nd esophagus<div><img src=""neuro (1).jpeg"" /></div>" Anatomy_Bloc
4
"<img src=""7119ae3025de1d95917618faa67029daccd89f30_Q_0.svg"" />"
"<img sr
c=""7119ae3025de1d95917618faa67029daccd89f30_A_0.svg"" />"
"<img src=""7119
ae3025de1d95917618faa67029daccd89f30_source_svg.svg"" />"
"<img src=""7119
ae3025de1d95917618faa67029daccd89f30_neuro.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""7119ae3025de1d95917618faa67029daccd89f30_Q_1.svg"" />"
"<img sr
c=""7119ae3025de1d95917618faa67029daccd89f30_A_1.svg"" />"
"<img src=""7119
ae3025de1d95917618faa67029daccd89f30_source_svg.svg"" />"
"<img src=""7119
ae3025de1d95917618faa67029daccd89f30_neuro.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""7119ae3025de1d95917618faa67029daccd89f30_Q_2.svg"" />"
"<img sr
c=""7119ae3025de1d95917618faa67029daccd89f30_A_2.svg"" />"
"<img src=""7119
ae3025de1d95917618faa67029daccd89f30_source_svg.svg"" />"
"<img src=""7119
ae3025de1d95917618faa67029daccd89f30_neuro.jpeg"" />"
Anatomy_
Bloc
4
What is most common source of damage to the recurrant laryngeal n?
"Thyroid
ectomy<div><img src=""neuro (1).jpeg"" /></div>"
Anatomy_Bloc
4
What nerve is vulnerable to sharp objects swallowed?
"<div>Internal branch of
superior laryngeal n</div><img src=""neuro 2.jpeg"" />"
Anatomy_Bloc
4
"<img src=""1577a15e6446abcc0dc5324c317e868fd524794c_Q_0.svg"" />"
"<img sr
c=""1577a15e6446abcc0dc5324c317e868fd524794c_A_0.svg"" />"
"<img src=""1577
a15e6446abcc0dc5324c317e868fd524794c_source_svg.svg"" />"
"<img src=""1577
a15e6446abcc0dc5324c317e868fd524794c_neuro open.jpeg"" />"
Anatomy_Bloc
4
"<img src=""1577a15e6446abcc0dc5324c317e868fd524794c_Q_1.svg"" />"
"<img sr
c=""1577a15e6446abcc0dc5324c317e868fd524794c_A_1.svg"" />"
"<img src=""1577
a15e6446abcc0dc5324c317e868fd524794c_source_svg.svg"" />"
"<img src=""1577
a15e6446abcc0dc5324c317e868fd524794c_neuro open.jpeg"" />"
Anatomy_Bloc
4
"<img src=""7468d365330378b673e2f76dac2717119f9dbc44_Q_0.svg"" />"
"<img sr
c=""7468d365330378b673e2f76dac2717119f9dbc44_A_0.svg"" />"
"<img src=""7468
d365330378b673e2f76dac2717119f9dbc44_source_svg.svg"" />"
"<img src=""7468
d365330378b673e2f76dac2717119f9dbc44_ana1.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""7468d365330378b673e2f76dac2717119f9dbc44_Q_1.svg"" />"
"<img sr
c=""7468d365330378b673e2f76dac2717119f9dbc44_A_1.svg"" />"
"<img src=""7468
d365330378b673e2f76dac2717119f9dbc44_source_svg.svg"" />"
"<img src=""7468
d365330378b673e2f76dac2717119f9dbc44_ana1.jpeg"" />"
Anatomy_

Bloc
4
"<img src=""7468d365330378b673e2f76dac2717119f9dbc44_Q_2.svg""
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d365330378b673e2f76dac2717119f9dbc44_source_svg.svg"" />"
d365330378b673e2f76dac2717119f9dbc44_ana1.jpeg"" />"
Bloc
4
"<img src=""7468d365330378b673e2f76dac2717119f9dbc44_Q_3.svg""
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d365330378b673e2f76dac2717119f9dbc44_source_svg.svg"" />"
d365330378b673e2f76dac2717119f9dbc44_ana1.jpeg"" />"
Bloc
4
"<img src=""7468d365330378b673e2f76dac2717119f9dbc44_Q_4.svg""
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d365330378b673e2f76dac2717119f9dbc44_source_svg.svg"" />"
d365330378b673e2f76dac2717119f9dbc44_ana1.jpeg"" />"
Bloc
4
"<img src=""bd47f480f3283c0fa9faac513d38b65a121a9049_Q_0.svg""
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f480f3283c0fa9faac513d38b65a121a9049_source_svg.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_neuro lary.jpeg"" />"
Anatomy_Bloc
4
"<img src=""bd47f480f3283c0fa9faac513d38b65a121a9049_Q_1.svg""
c=""bd47f480f3283c0fa9faac513d38b65a121a9049_A_1.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_source_svg.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_neuro lary.jpeg"" />"
Anatomy_Bloc
4
"<img src=""bd47f480f3283c0fa9faac513d38b65a121a9049_Q_2.svg""
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f480f3283c0fa9faac513d38b65a121a9049_source_svg.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_neuro lary.jpeg"" />"
Anatomy_Bloc
4
"<img src=""bd47f480f3283c0fa9faac513d38b65a121a9049_Q_3.svg""
c=""bd47f480f3283c0fa9faac513d38b65a121a9049_A_3.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_source_svg.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_neuro lary.jpeg"" />"
Anatomy_Bloc
4
"<img src=""bd47f480f3283c0fa9faac513d38b65a121a9049_Q_4.svg""
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f480f3283c0fa9faac513d38b65a121a9049_source_svg.svg"" />"
f480f3283c0fa9faac513d38b65a121a9049_neuro lary.jpeg"" />"
Anatomy_Bloc
4
"<img src=""8fd52ab37b8e91fdcf0be1293c5867f89780c060_Q_0.svg""
c=""8fd52ab37b8e91fdcf0be1293c5867f89780c060_A_0.svg"" />"
2ab37b8e91fdcf0be1293c5867f89780c060_source_svg.svg"" />"
2ab37b8e91fdcf0be1293c5867f89780c060_lymp.jpeg"" />"
Bloc
4
"<img src=""8fd52ab37b8e91fdcf0be1293c5867f89780c060_Q_1.svg""
c=""8fd52ab37b8e91fdcf0be1293c5867f89780c060_A_1.svg"" />"
2ab37b8e91fdcf0be1293c5867f89780c060_source_svg.svg"" />"
2ab37b8e91fdcf0be1293c5867f89780c060_lymp.jpeg"" />"
Bloc
4
"<img src=""09a08c9cb90e73f6df6a7f0144ccd8448fbc7e5c_Q_0.svg""
c=""09a08c9cb90e73f6df6a7f0144ccd8448fbc7e5c_A_0.svg"" />"
8c9cb90e73f6df6a7f0144ccd8448fbc7e5c_source_svg.svg"" />"
8c9cb90e73f6df6a7f0144ccd8448fbc7e5c_lymp pha.jpeg"" />"
Anatomy_Bloc
4
"<img src=""09a08c9cb90e73f6df6a7f0144ccd8448fbc7e5c_Q_1.svg""
c=""09a08c9cb90e73f6df6a7f0144ccd8448fbc7e5c_A_1.svg"" />"
8c9cb90e73f6df6a7f0144ccd8448fbc7e5c_source_svg.svg"" />"
8c9cb90e73f6df6a7f0144ccd8448fbc7e5c_lymp pha.jpeg"" />"

/>"
"<img sr
"<img src=""7468
"<img src=""7468
Anatomy_
/>"
"<img sr
"<img src=""7468
"<img src=""7468
Anatomy_
/>"
"<img sr
"<img src=""7468
"<img src=""7468
Anatomy_
/>"
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"<img src=""bd47
/>"
"<img sr
"<img src=""bd47
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/>"
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/>"
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"<img src=""bd47
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/>"
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/>"
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"<img src=""8fd5
"<img src=""8fd5
Anatomy_
/>"
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"<img src=""8fd5
"<img src=""8fd5
Anatomy_
/>"
"<img sr
"<img src=""09a0
"<img src=""09a0
/>"
"<img sr
"<img src=""09a0
"<img src=""09a0

Anatomy_Bloc
4
"<img src=""09a08c9cb90e73f6df6a7f0144ccd8448fbc7e5c_Q_2.svg"" />"
"<img sr
c=""09a08c9cb90e73f6df6a7f0144ccd8448fbc7e5c_A_2.svg"" />"
"<img src=""09a0
8c9cb90e73f6df6a7f0144ccd8448fbc7e5c_source_svg.svg"" />"
"<img src=""09a0
8c9cb90e73f6df6a7f0144ccd8448fbc7e5c_lymp pha.jpeg"" />"
Anatomy_Bloc
4
Which laryngeal muscles are adductors? "Lateral crico-arytenoid muscles, combin
ed with transverse and oblique arytenoid muscles<div><img src=""muscles (1).jpeg
"" /></div>"
Anatomy_Bloc
4
Which muscles are abductors in the larynx?
"Posteriod crico-arytenoid muscl
es<div><img src=""muscles (1).jpeg"" /></div>" Anatomy_Bloc
4
What happens when vocal ligaments are adducted, but transverse arytenoid muscles
do not act?
"This is the position of whispering when breath is modified into
voice in the absence of tone.<div><br /></div><div><img src=""paste-14003740868
6362.jpg"" />&nbsp;<div><img src=""muscles (1).jpeg"" /></div></div>" Anatomy_
Bloc
4
What are the spincter muscles of the larynx?
"Contraction of the lateral cric
o-arytenoids, <b>transverse</b>, and oblique arytenoids, and ary-epiglottic musc
les<div><img src=""muscles (1).jpeg"" /></div>" Anatomy_Bloc
4
What are the tensors of the larynx?
"Cricothyroid muscles<div><img src=""mus
cles (1).jpeg"" /></div>"
Anatomy_Bloc
4
What are the relaxer muscles of the larynx?
"Thyro-arytenoid, vocalis muscle
s<div><img src=""muscles (1).jpeg"" /></div>" Anatomy_Bloc
4
What is the function of the vocalis muscles?
"Produce minute adjustments of v
ocal ligaments.&nbsp;<div><img src=""muscles (1).jpeg"" /></div>"
Anatomy_
Bloc
4
How do antimetabolite immunosuppressants wor
? What cells do they have the great
est effect on? What are their side effects?
They bloc
the synthesis and dep
lete nucleotides<div><br /></div><div>Affect rapidly <u>proliferating lymphocyte
s</u> the most because they need lots of nucleotide synthesis</div><div><br /></
div><div>Hair loss, GI issues are common side effects because they are both rapi
dly dividing cells</div>
Immunopharmacology
What are the 3 approaches to treat exposure of poison? Reduce absorption<div>En
hance elimination</div><div>Specific antidotes</div>
Toxicology
What are the 3 non-specific therapies to reduce absorption? What is recommended?
Induced emesis with ipecac- no longer recommended<div><br /><div>Gastric lavagemust be done immediately</div><div><br /></div><div><b>Activated charcoal</b>binds to organic compounds, preventing them from being absorbed</div></div><div>
<br /></div><div>Activated charcoal alone is the recommended treatment for mild
to moderate poisoning</div>
Toxicology
What are the 4 non-specific therapies to enhance elimination of ingested poison?
What are each good for?
Multiple doses of charcoal- poison will get stuc

and charcoal and will be pood out<div><br /></div><div>Al

aline diuresis- caus
es <b>barbs and aspirin </b>to remain charged, increasing its excretion</div><di
v><br /></div><div>Hemodialysis- <b>low mwt soluble molecules (alcohol, amphetam
ines, phenobarbital, lithium, salicylates, theophylline, thiocynate)</b></div><d
iv><br /></div><div>Hemoperfusion- just give them more blood to dilute, not prac
tical-<b>barbituates, salicylates, theophylline</b></div>
Toxicology
What are the specific therapies for the following poisons?<div>Acetaminophen</di
v><div>Carbon monoxide</div><div>Cyanide</div><div>Digoxin</div><div>Narcotics</
div><div>Organophosphates</div> N-acetylcysteine (mucomyst)<div>hyperbaric oxyge
n</div><div>nitrites</div><div>Fab for digoxin</div><div>Naloxone</div><div>Atro
pine + PAM</div>
Toxicology
Compared to the theraputic dose, how much is the toxic and fatal dose of acetami
nophen? Why is this relevant? 10x is toxic<div>20x is fatal</div><div><br /></
div><div>Most commonly ingested drug in overdoses, acetaminophen caused liver fa
ilure is very common</div>
Toxicology
How long does it ta
e for acetaminophen poisoning to develop and resolve/ be fat
al? Why is this the case?
Symptoms only appear 24 hours (nausea, vomiting,
pain, liver function abnormality)<div><br /></div><div>Symptoms worsen through

5 days- after this either resolve or liver fails</div><div><br /></div><div>Ta

e
s this long because toxicity only develops once the glutathione necessary to met
abolize drug is used up</div> Toxicology
How is acetaminophen poisoning treated? Activated charcoal to decrease further a
bsorption<div><br /></div><div>Replace hepatic glutathione (mucomyst)</div><div>
<br /></div><div>Supportive care</div> Toxicology
What is a teratogen?
An agent that causes some abnormality in fetus during pr
egnancy Toxicology
What are the contraindications and complications of ipecac?
<div>Dont use f
or babies &lt;9 months</div>Dont use for corrosive ingestion<div>Dont use with
pregnant women</div><div>Dont use if there is no gag reflex- ris
for aspirati
on</div><div><br /></div><div>Complications:</div><div>a. aspiration pneumonitis
</div><div>b. mallory-weis tear of esophagus</div><div>c. protracted vomiting</d
iv>
Toxicology
What are the contraindications and complications of gastric lavage?
1. Dont
use if there is severe bleeding, or acid/al
ali ingestion<div><br /></div><div>2
. Can cause aspiration pneumonitis or esophageal perforation or CV instability</
div>
Toxicology
Differentiate acute, subchronic, chronic toxicities
Acute- from single inta

e of substance, exposure for less than 24 hours<div><br /></div><div>Subchronicrepeated exposure over wee
s to moths</div><div><br /></div><div>Chronic- repea
ted exposure for more than 3 months</div>
Toxicology
Differentiate direct vs indirect toxicity
Direct toxic effects are due to
the substance itself<div><br /></div><div>Indirect toxic effects are the consequ
ence of direct effects (not due to the chemical)</div> Toxicology
Name 3 types of environmental toxins
Pesticides (DDT: organochlorides, DFP: o
rganophosphate)<div>Metals (any one in excess)</div><div>Air pollutants (CO, SO2
, NO2)</div>
Toxicology
What are the layers of the cornea?
"5 layers:<div><br /><div><u>Stratified,
squamous, non-
eratinized epithelium</u> on which your contact lens floats with
pain fibers from V1, epithelium rests as a basal lamina</div><div><br /></div><
div><u>Bowmans layer</u> (embryonic type I collagen fibers)</div><div><br /></d
iv><div><u>Stroma</u> (very uniform type I collagen secreted by fibroblasts call
ed <b>
eratocytes</b> with precise fiber spacing running in two directions alter
nating in each lamella.&nbsp;</div><div><br /></div><div><u>Descemets layer</u>
- type IV collagen basement membrane which gets thic
er with age</div></div><div
><br /></div><div><u>1,000,000 post-mitotic endothelial cells</u> which secrete
a BM called Descemets layer. The endothelial cells have ATP pumps to pump water
out of matrix between collagen fibers to
eep perfect spacing. With normal agin
g, decrease in number of endothelial cells, and remaining cells spread over a gr
eater surface area.&nbsp;</div><div><br /></div><div><img src=""cornea layers.jp
eg"" /></div><div><img src=""bow.jpeg"" /></div>"
Anatomy_Bloc
4 Kretzer_B
loc
4
How does the cornea differ from the sclera, histologically?
Sclera has type
I collagen fibers of <i>all diameters</i>, variable <i>spacing</i>, running in <
i>all directions</i>, so that sclera is opaque but also avascular
Anatomy_
Bloc
4 Kretzer_Bloc
4
A patient presents with rash around one eye that does not cross midline. Localiz
ed to dermatomes V1,2,3. What is diagnosis?
"Herpes zoster<div><img src=""he
rp.jpeg"" /></div>"
Anatomy_Bloc
4 Kretzer_Bloc
4
Where does the cornea receive its nutrition from?
"Tear film, lateral diff
usion from the limbus vasculature, aqueous humor in the anterior chamber<div><im
g src=""corn.jpeg"" /></div>" Anatomy_Bloc
4 Kretzer_Bloc
4
List some of the screening process for corneal donation (there are several)
<div>Criteria for corneal donations:</div><div><br /></div><div>Can be from 2 to
74 years of age of donor</div><div><br /></div><div>18 hours post mortem or 24
hours post mortem with refrigeration</div><div><br /></div><div>Negative serolog
y for hepatitis B, hepatitis C, syphilis, HIV 1, HIV 2</div><div><br /></div><di
v>No history of IV drug use or other high ris
behavior such as prostitution, mu
ltiple sexual partners, time in jail</div><div><br /></div><div>Detailed history

of past travel, behavior changes, dementia or gait changes &nbsp;because of <u>

CJD</u> (Creutzfeld Ja
ob Disease prions)&nbsp;</div><div><br /></div><div>no le
u
emia</div><div><br /></div><div>no lymphoma</div><div><br /></div><div>no syst
emic sepsis</div><div><br /></div><div>no previous radial
eratotomy</div><div><
br /></div><div>held for <u>24 hours for the results of bacterial cultures and s
erology</u></div><div><br /></div><div>must have at least <u>2000 endothelial ce
lls/mm2</u> as determined by specular microscopy in Lions Eye Ban
Labs</div><di
v><br /></div><div>Requires <u>direct consent of next of
in</u> (no longer vali
d through drivers license consent). &nbsp;You must become familiar with the Texas
State Donation Registry.</div> Anatomy_Bloc
4 Kretzer_Bloc
4
What are the 5 signs and symptoms that require immediate referral bac
to an opt
halmologist following a successful PK or EK?
<div>Early stages of <u>delayed
tissue rejection</u>:</div><div><br /></div><div>ocular pain</div><div><br /></d
iv><div>Blurred Vision</div><div><br /></div><div>scleral redness</div><div><br
/></div><div>neovascularization at limbus</div><div><br /></div><div>corneal haz
e/&nbsp;mentions halos around lights</div><div><br /></div><div><br /></div><div
><br /></div><div><br /></div> Anatomy_Bloc
4 Kretzer_Bloc
4
What is the second major cause of world blindness?
Corneal scaring with reg
ular <u>type I collagen fibers in stromal lamellae being replaced by random type
III collagen</u>. Due to inversion of eye lids and lashes due to bacterial infe
ction, <u>Trachoma</u>.&nbsp;<br /><div><br /></div><div>(First is cataracts)&nb
sp;</div>
Anatomy_Bloc
4 Kretzer_Bloc
4
How does radial
eratotomy wor
?
"Corneal curvature (refractive surgery)
corrected by radial incisions penetrating deep into the stroma starting at the l
imbus towards the central cornea. &nbsp;<div><img src=""
erato.jpeg"" /></div><d
iv><img src=""limbus.jpeg"" /></div>" Anatomy_Bloc
4 Kretzer_Bloc
4
What are some complications from RK? (Radial Keratotomy)
"Vascular invasi
on along incision&nbsp;<div><b><br /></b></div><div><b>Very wea
ened eye</b> (du
e to type III wea
collagen, not type I li
e it was)--&gt; automobile accident o
cular blow outs (and no pilots license)<br /><br /></div><div>Epithelial down g
rowth into anterior chamber/angle--&gt;bloc
ing trabecular meshwor
.&nbsp;<div><
br /></div><div>Cyst formation</div><div><br /></div><div>Refractive changes wit
h humidity</div><div><img src=""down.jpeg"" /></div></div>"
Anatomy_Bloc
4 K
retzer_Bloc
4
Describe the steps in LASIK
"<u>Flap cut</u> across anterior stroma&nbsp;<di
v><br /></div><div><u>Laser contouring</u> of the new anterior surface to change
curvature and remove astigmatism (a condition of unequal curvature)</div><div><
br /></div><div><u>Return flap</u> (corneal epithelium and Bowmans layer and an
terior stroma)</div><div><br /></div><div>Why no suture? <b>Ion pumping of the c
orneal endothelial cells--&gt;&nbsp;Water flux from corneal tear</b> film across
cornea,&nbsp;
eeps flap attached.</div><div><br /></div><div>Superior to RK! No
deep stromal incisions (and no possibility of epithelial down growth, stroma st
rength left intact)&nbsp;<br /><div><div><div><div><br /><div><img src=""lasi
.j
peg"" /></div></div></div></div></div></div>" Anatomy_Bloc
4 Kretzer_Bloc
4
Describe how methotrexate, azathioprine and mycophenolate wor
as immunosuppress
ants
"<div>Methotrexate- inhibits DHFR, reduces levels of ALL purines</div><d
iv><br /></div>Azathioprine- purine analog that bloc
s synthesis of ALL purines,
gets incorporated into nucleic acids<div><br /></div><div>Mycophenolate- inhibi
ts IMP dehydrogenase, reducing GTP levels</div><div><br /></div><div><img src=""
paste-59751585022405.jpg"" /></div>"
Dic
ey Immunopharmacology pharmacology_b
loc
4
What is unique about endothelial cells secreting BM in cornea and water pumping?
"They have ATP pumps that pump water out of matrix between collagen fibers to
e
ep perfect spacing. With aging, these decrease in number and remaining cells spr
ead over greater surface area<div><img src=""mito.jpeg"" /><br /><div><img src="
"spcce.jpeg"" /></div></div>" Anatomy_Bloc
4 Kretzer_Bloc
4
What is
eratoconus? What are the 3 most common corneal pathologies that would h
ave led up to PK surgery?
"Wea
ening/degerneration of the pupil leading to
pupil bulging.<div><br /></div><div>Previous scaring infection in the stroma (<
u>
eratitis</u>), <u>
eratoconus</u> in <b>males mostly</b>, and <u>Fuchs endothe

lial dystrophy</u> in <b>females mostly</b><br /><div><img src=""conus.jpeg"" />

</div></div>" Anatomy_Bloc
4 Kretzer_Bloc
4
What is used to treat methotrexate toxicity? How does it wor
? Folinic acid<div
>Feeds into the purine synthesis pathway just beyond DHFR- s
ips bloc
ed step</d
iv><div><br /></div>
Dic
ey Immunopharmacology pharmacology_bloc
4
How does leflunomide act as an immunosuppressant?
"Inhibits pyrimidine bio
synthesis<div><img src=""paste-4625679778181.jpg"" /></div>"
Dic
ey Immunopha
rmacology pharmacology_bloc
4
How does cyclophosphamide wor
? What is it used to treat? Is it toxic? Prototyp
ical al
ylating agent<div><br /></div><div><u>Cross-lin
s DNA and DNA associated
proteins</u>, bloc
s replication and induces death</div><div><br /></div><div>T
reats autoimmune diseases that arise from <u>excessive B cell responses</u></div
><div><br /></div><div>Its metabolite is acrolein which is toxic- can be neutral
ized by MESNA</div>
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""paste-4698694222095.jpg"" />"
D
Dic
ey Immunopharmacolog
y pharmacology_bloc
4
How do cyclosporin and tacrolimus affect intracellular signaling?&nbsp; "Cyclosp
orin binds to cyclophilin and this complex inhibits calcineurin<div><br /></div>
<div>Tacrolimus binds to FKBP and this complex inhibits calcineurin</div><div><b
r /></div><div><br /></div><div>The both are affecting the <b>""early"" actvatio
n pathway</b></div><div>Loss of calcineurin prevents activation of transcription
factors, leading to decreased transcription of cyto
ines</div><div><img src=""p
aste-5527622910345.jpg"" /></div>"
Dic
ey Immunopharmacology pharmacology_b
loc
4
How does sirolimus affect intracellular signaling?&nbsp;
"Sirolimus binds
to FKBP, and this complex inhibits mTOR<div><br /></div><div>Loss of mTOR bloc

s synthesis of cell cycle proteins, arresting cells in G1 phase</div><div><br />

</div><div>Bloc
s the<b> ""late"" activation pathway</b> (normally stimulated by
IL-2)</div><div><img src=""paste-6025839116681.jpg"" /></div>" Dic
ey Immunopha
rmacology pharmacology_bloc
4
What is the important process that sirolimus bloc
s that cyclosporin and tacroli
mus do not? Why is this the case?
"Sirolimus inhibits <b>T-independent B c
ell activation</b><div><br /></div><div>Because sirolimus inhibits IL-10 product
ion (needed for B cell proliferation) but the others do not</div><div><br /></di
v><div><div>*Sirolimus is has an advantage in treating <u>Epstein-Barr infected
B cell lymphomas</u>. Inhibition of IL-10 will inhibit the growth of these lymph
omas</div></div><div><br /></div><div><img src=""T cell activa.jpeg"" /></div>"
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""paste-6098853560589.jpg"" />"
A
Dic
ey Immunopharmacolog
y pharmacology_bloc
4
What is infliximab? How does it wor
? <u>Chimeric mouse/human MAB</u> against
<b>TNF-a</b><div>Fixes complement</div><div>Neutralizing antibodies may form aga
inst it due to mouse component</div>
Dic
ey Immunopharmacology pharmacology_b
loc
4
What is adalimumab? How does it wor
? <u>Fully human MAB</u> against <b>TNF-a<
/b><div>Fixes complement</div> Dic
ey Immunopharmacology pharmacology_bloc
4
What is etanercept? How does it wor
? <u>Recombinant human</u> <b>TNF-a recept
or bound to IgG</b><div>Binds to <b>TNF-a</b> and removes it form circulation</d
iv>
Dic
ey Immunopharmacology pharmacology_bloc
4
Should entanercept and methotrexate be used together? "yes- combination therap
y is often more effective than either drug alone<div><br /></div><div>Combined d
rugs must have different mechanisms and toxicities though</div><div><img src=""R
A.jpeg"" /></div>"
Dic
ey Immunopharmacology pharmacology_bloc
4
What are the most common sarcomas in adults and children?
Adults- malignan
t fibrous histiocytoma and liposarcoma<div><br /></div><div>Children- rhabdomyos
arcoma</div>
SoftTissue
What is the most common soft tissue tumor of adulthood? Lipoma- they are everywh
ere
SoftTissue
What is a hemangioma? benign neoplasms of blood vessels<div><br /><div>Most co
mmon soft tissue tumor of children</div></div> SoftTissue

"<img src=""paste-12691628359967.jpg"" /><div><img src=""paste-12704513261871.jp

g"" /></div><div>Which one of these Pap smears is abnormal?</div>"
The seco
nd one- can see way bigger nuclei<div>There are also inflammatory cells in the s
econd pap smear</div> Lab7
"<img src=""paste-12738873000233.jpg"" /><div><img src=""paste-12751757902103.jp
g"" /></div><div>Which one of these epithelia are abnormal?</div>"
The seco
nd one is moderately dysplastic<div>The upper layer cells still have nuclei and
have not flattened out</div>
Lab7
"<img src=""paste-12872016986423.jpg"" /><div>Whats going on with these nuclei?<
/div>" Characteristic of HPV infection<div><br /></div><div>Irregular nuclear b
orders = ruffling</div><div>Multiple nuclei with halo</div>
Lab7
"<img src=""paste-12992276070773.jpg"" /><div><img src=""paste-13005160972666.jp
g"" /></div><div><img src=""paste-13018045874503.jpg"" /></div><div><img src=""p
aste-13030930776400.jpg"" /></div><div>Ran
the level of dysplasia seen in these
sections</div>"
Normal<div>Severe (CIS)</div><div>Mild</div><div>Moderat
e</div><div><br /></div><div>Based off how much of the epithelium is abnormal</d
iv>
Lab7
"<img src=""paste-13155484828049.jpg"" /><div>Is this uterine tissue normal or a
bnormal?</div>" Abnormal- the glandular epithelium is too big<div><br /></div><d
iv>Can see normal tissue at bottom arrow</div> Lab7
"<img src=""paste-13215614370112.jpg"" /><div><img src=""paste-13245679141164.jp
g"" /><br /><div>What is happening to these gastric glands?</div></div>"
They are being destroyed by clonal population in infiltrate
Lab7
How is H. pylori induced lymphoma treated?
Antibiotics to treat the H. pylo
ri infection -&gt; if it resolves, the lymphoma will go away
Lab7
What is anorexia, malaise, wea
ness, and weight loss indicative of? What causes
it?
Wasting syndrome of cancer patients (cancer cachexia)<div><br /></div><d
iv>Caused by TNFa, IL-1, and IFNg secreted by macrophages and tumor</div>
Lab7
"<img src=""paste-13340168421704.jpg"" /><div><img src=""paste-13353053323522.jp
g"" /></div><div>Is this is benign or malignant? Why?</div>"
Malignant- new p
olyp forming away form primary lesion and you can see lesion extending through b
owel wall
Lab7
"<img src=""paste-13490492277056.jpg"" /><div><img src=""paste-13503377178944.jp
g"" /></div><div>What type of colon cancer is this?</div>"
Adenocarcinoma<d
iv>can see it is glandular tissue and it is growing through the bowel wall</div>
<div>It is moderately differentiated with some pleiomorphic cells and large nucl
ei</div>
Lab7
What are the features of inherited cancer syndromes?
Early onset of cancer, c
ancer in 2 or more close relatives, multiple/bilateral cancers Lab7
"<img src=""paste-13559211753790.jpg"" /><div>This is from the sputum of a man c
oming in for respiratory problems. Has Pap stain for
eratin. What is notable in
this slide?</div>"
There is a
eratin producing cell in sputum- no epitheli
um in the respiratory tract should be ma
ing
eratin<div><br /></div><div>This c
ell is also very large and has a huge nucleus</div>
Lab7
"<img src=""paste-13559211753790.jpg"" /><img src=""paste-13696650707236.jpg"" /
><div>The man with the above sputum has this in his lung- whats going on?</div>"
There is an island of
eratin production in connective tissue of the lung- must
be a cancer
Lab7
What type of cancers do the following carcinogens cause?&nbsp;<div>Al
ylating ag
ents</div><div>Polycyclic aromatic hydrocarbons</div><div>Aromatic amino &amp; a
zo dyes</div><div>Naturally occuring carcinogens</div><div>Asbestos</div><div>Vi
nyl chloride</div><div>Chromium</div><div>Nic
el</div><div>Arsenic</div>
<div>Al
ylating agents- leu
emia/lymphoma</div><div>Polycyclic aromatic hydrocar
bons- <b>lung and bladder cancer</b></div><div>Aromatic amino &amp; azo dyes- <b
>bladder cancer</b></div><div>Naturally occuring carcinogens- stomach cancer</di
v><div>Asbestos- lung cancer, bladder cancer, mesothelioma</div><div>Vinyl chlor
ide- hepatoangiosarcoma</div><div>Chromium-lung cancer</div><div>nic
el- lung ca
ncer, oropharyngeal</div><div>Arsenic- s
in cancer, lung cancer, hepatoangiosarc
oma</div>
Lab7

What is small cell carcinoma of the lung? What does it do? What is the major ris
Malignancy that ectopically produces hormones, causing paraneopl

factor?
astic syndrome<div><br /></div><div>Smo
ing hugely increases ris
</div> Lab7
"<img src=""paste-15281493639354.jpg"" /><div>Which breast tumor is benign, whic
h is malignant?</div>" First is benign, ducts and lobules are well organized<di
v><br /></div><div>Second is malignant, glandular tissue is invading everything<
/div> Lab7
What is the toxic metabolic from cyclophosphamide? How is it treated? Its meta
bolite is <b>acrolein</b> which is toxic- can be neutralized by MESNA Dic
ey p
harmacology_bloc
4
At what age do cavities stop occuring? 25, unless hygeine is poor.&nbsp;
Anatomy_Bloc
4
How does fluoridation help teeth? How does carbonated/acidic affect teeth?
It replaces the calcium in teeth and ma
es it stronger in the hydroxyapatite cry
stal.&nbsp;<div><br /></div><div>Carbonated/acid wears down enamel</div><div><br
/></div>
Anatomy_Bloc
4
How are teeth numbered?&nbsp; "32 total adult teeth<div>Top right molar- 1, 16
top left</div><div>Bottom left- 17, bottom right 32</div><div><img src=""coding
.jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""e21ee2df3340c9520a6e7c94003a4ff89b831744_Q_0.svg"" />"
"<img sr
c=""e21ee2df3340c9520a6e7c94003a4ff89b831744_A_0.svg"" />"
"<img src=""e21e
e2df3340c9520a6e7c94003a4ff89b831744_source_svg.svg"" />"
"<img src=""e21e
e2df3340c9520a6e7c94003a4ff89b831744_structure.jpeg"" />"
Anatomy_Bloc
4
"<img src=""e21ee2df3340c9520a6e7c94003a4ff89b831744_Q_1.svg"" />"
"<img sr
c=""e21ee2df3340c9520a6e7c94003a4ff89b831744_A_1.svg"" />"
"<img src=""e21e
e2df3340c9520a6e7c94003a4ff89b831744_source_svg.svg"" />"
"<img src=""e21e
e2df3340c9520a6e7c94003a4ff89b831744_structure.jpeg"" />"
Anatomy_Bloc
4
"<img src=""e21ee2df3340c9520a6e7c94003a4ff89b831744_Q_2.svg"" />"
"<img sr
c=""e21ee2df3340c9520a6e7c94003a4ff89b831744_A_2.svg"" />"
"<img src=""e21e
e2df3340c9520a6e7c94003a4ff89b831744_source_svg.svg"" />"
"<img src=""e21e
e2df3340c9520a6e7c94003a4ff89b831744_structure.jpeg"" />"
Anatomy_Bloc
4
"<img src=""053dfa4ce17742a6a36dbb413aa1b5efef041862_Q_0.svg"" />"
"<img sr
c=""053dfa4ce17742a6a36dbb413aa1b5efef041862_A_0.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_source_svg.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_nomen.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""053dfa4ce17742a6a36dbb413aa1b5efef041862_Q_1.svg"" />"
"<img sr
c=""053dfa4ce17742a6a36dbb413aa1b5efef041862_A_1.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_source_svg.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_nomen.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""053dfa4ce17742a6a36dbb413aa1b5efef041862_Q_2.svg"" />"
"<img sr
c=""053dfa4ce17742a6a36dbb413aa1b5efef041862_A_2.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_source_svg.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_nomen.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""053dfa4ce17742a6a36dbb413aa1b5efef041862_Q_3.svg"" />"
"<img sr
c=""053dfa4ce17742a6a36dbb413aa1b5efef041862_A_3.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_source_svg.svg"" />"
"<img src=""053d
fa4ce17742a6a36dbb413aa1b5efef041862_nomen.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""16e0394c273c2a0614f7023a4dd83a429fabe4da_Q_0.svg"" />"
"<img sr
c=""16e0394c273c2a0614f7023a4dd83a429fabe4da_A_0.svg"" />"
"<img src=""16e0
394c273c2a0614f7023a4dd83a429fabe4da_source_svg.svg"" />"
"<img src=""16e0
394c273c2a0614f7023a4dd83a429fabe4da_perm.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""16e0394c273c2a0614f7023a4dd83a429fabe4da_Q_1.svg"" />"
"<img sr

c=""16e0394c273c2a0614f7023a4dd83a429fabe4da_A_1.svg"" />"
"<img src=""16e0
394c273c2a0614f7023a4dd83a429fabe4da_source_svg.svg"" />"
"<img src=""16e0
394c273c2a0614f7023a4dd83a429fabe4da_perm.jpeg"" />"
Anatomy_
Bloc
4
What are complications from a dentist pulling a molar? "Damage to inferior alve
olar nerve, damage to maxillary sinus<div><br /></div><div><br /></div><div><img
src=""max.jpeg"" /><img src=""nerve.jpeg"" /></div>" Anatomy_Bloc
4
"<img src=""06d6bdbf12cdc414437770f8783bc833cfe197a5_Q_0.svg"" />"
"<img sr
c=""06d6bdbf12cdc414437770f8783bc833cfe197a5_A_0.svg"" />"
"<img src=""06d6
bdbf12cdc414437770f8783bc833cfe197a5_source_svg.svg"" />"
"<img src=""06d6
bdbf12cdc414437770f8783bc833cfe197a5_blocl.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""06d6bdbf12cdc414437770f8783bc833cfe197a5_Q_1.svg"" />"
"<img sr
c=""06d6bdbf12cdc414437770f8783bc833cfe197a5_A_1.svg"" />"
"<img src=""06d6
bdbf12cdc414437770f8783bc833cfe197a5_source_svg.svg"" />"
"<img src=""06d6
bdbf12cdc414437770f8783bc833cfe197a5_blocl.jpeg"" />"
Anatomy_
Bloc
4
What is gingivitis? What are the causes?
Irritation of gums from:<div><br
/></div><div>1. Trauma (Brushing too hard)<div>2. Poor hygiene&nbsp;</div><div>
<br /></div><div>Leads to recession of gums from teeth</div></div>
Anatomy_
Bloc
4
What is the periodontal ligament?
"Helps hold tooth in place. Only happy i
f occlusal surface are even and put even pressure on this area.&nbsp;<div><img s
rc=""malocclusion.jpeg"" /></div>"
Anatomy_Bloc
4
<div>Medical or dental problem?&nbsp;</div><div>Abscess confined to one or two t
eeth ______</div><div>Ruptured abscess in mandible or maxilla - ______</div><div
>Once infection halted then reverts to a ______</div><div><br /></div> "<div><d
iv>Abscess confined to one or two teeth <b>dental</b></div><div>Ruptured abscess
in mandible or maxilla <b>medical</b></div><div>Once infection halted then reve
rts to a <b>dental</b> problem</div></div><div><br /></div><img src=""dental.jpe
g"" />" Anatomy_Bloc
4
How to test for tooth pain?
-Push down on suspected tooth, or bite down on t
ongue depressor<div>-Hot/Cold</div><div><br /></div><div><b>Severe</b> pain to a
ny of these is an abscess, <b>mild</b> pain is malocclusion</div><div><br /></di
v>
Anatomy_Bloc
4
When can temporomandibular joint dislocation occur?
"If the head of the mand
ible slides <u>past the articular tubercle</u>. Mandible becomes loc
ed in a pro
truded position.&nbsp;<div>Can be reduced by pressing on mandibular row of teeth
</div><div><img src=""TMJ.jpeg"" /></div>"
Anatomy_Bloc
4
Complications of edentulous patients?&nbsp;
Toothless.<div><br /></div><div>
-Maxilla/mandibular reabsorption</div><div>-Pain &amp; thinning--&gt;exposing in
ferior alveolar nerve, no eating</div><div>-Thinning bone can fracture</div>
Anatomy_Bloc
4
What is the innervation of the TMJ capsule? What is potential clinical presentat
ion?
"V3 (auriculotemporal n., deep temporal n., masseteric n.)<div>Referred
pain along V3 to the brain (intense headache)&nbsp;<br /><div><img src=""teeth.j
peg"" /></div></div>" Anatomy_Bloc
4
What is complication of tooth extraction?
The pit can widen, causing other
teeth to fall in. This is prevented by using dental implants&nbsp;
Anatomy_
Bloc
4
What are the medical complications of gingivitis? What type of patients must rec
eive prophylaxis prior to dental procedures?&nbsp;
Heart attac
and endocar
ditis (infection of inner lining of heart);&nbsp;<div>Prophylaxis of patients wi
th valvular heart problems</div>
Anatomy_Bloc
4
What named nerves contribute to mandibular teeth innervation? "All are branche
s of V3:<div><div>1. &nbsp;Lingual nerve</div><div>2. &nbsp;Inferior alveolar</d
iv><div>3. &nbsp;Nerve to mylohyoid (and anterior belly of digastric)</div><div>
4. &nbsp;Auriculotemporal</div></div><div><img src=""inn.jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""33460a709217eb08bab2d40e7de6f1a43d05e335_Q_0.svg"" /><div>Name this

tooth using numeric and quadrant system</div>" "<img src=""33460a709217eb08bab2

d40e7de6f1a43d05e335_A_0.svg"" /><div>13.&nbsp;Left upper quadrant 2nd premolar.
</div><div><img src=""perm.jpeg"" /></div><div><img src=""coding.jpeg"" /></div>
"
"<img src=""33460a709217eb08bab2d40e7de6f1a43d05e335_source_svg.svg"" />
"
"<img src=""33460a709217eb08bab2d40e7de6f1a43d05e335_molars.jpeg"" />"
Anatomy_Bloc
4
What causes TMJ pain? What pain can it be confused with?
<div><div>Grindi
ng, mal-alignment</div></div><div><br /></div>Confused with otitis externa and m
edia,&nbsp;shingles,&nbsp;impacted wisdom teeth Anatomy_Bloc
4
What are two elements used in contrast and their related modality?
Iodine (
CT), Gadolinium (MRI) Anatomy_Bloc
4
"Suprahyoid or infrahyoid<div><img src=""supra (1).jpeg"" /></div>"
Suprahyo
id
Anatomy_Bloc
4
"Suprahyoid or infrahyoid<div><img src=""infra (1).jpeg"" /></div>"
<div>Inf
rahyoid</div> Anatomy_Bloc
4
"Whats the matter with both of these?<div><img src=""thyroid.jpeg"" /></div><di
v><img src=""parotid (1).jpeg"" /></div>"
Lingual thyroid<div>Parotid mass
</div> Anatomy_Bloc
4
"What is this pathology?<div><img src=""name pathology.jpeg"" /></div>" Mass in
the thyroesophageal groove (PT gland) Anatomy_Bloc
4
"<div>What is the patholgy? Name two common causes</div><img src=""volca.jpeg""
/>"
Vocal cord paralysis (left recurrent laryngeal n.)<div>Causes:</div><div
>1. Lung cancer of the apex</div><div>2. Trauma&nbsp;</div>
Anatomy_Bloc
4
How many vertebrate are there "33.&nbsp;<div><img src=""vert.jpeg"" /></div><d
iv>Picture + 5 fused sacral + 4 fused coccyx</div>"
Anatomy_Bloc
4
"Whats the matter? Bonus: what is the meat of the hamburger<div><img src=""cond
ylar fracture.jpeg"" /></div>" Condylar fracture (occipital condyle)<div>Meat i
s the hypoglossal canal</div> Anatomy_Bloc
4
"What is this called?<div><img src=""jeff.jpeg"" /></div>"
Jefferson fractu
re (fracture of C1)&nbsp;
Anatomy_Bloc
4
"What is this called?<div><img src=""odontoid.jpeg"" /></div>" Odontoid fractur
e (dens=odontoid process)&nbsp; Anatomy_Bloc
4
"Whats this called? What specifically is fractured?&nbsp;<div><img src=""hangma
n.jpeg"" /></div>"
"Hangman fracture; fracture of pars interarticularis of
C2<div><img src=""han.jpeg"" /></div><div><img src=""hang.jpeg"" /></div>"
Anatomy_Bloc
4
"Whats this called?&nbsp;<div><img src=""jumped.jpeg"" /></div>"
Jumped f
acets<div>Caused by extreme force trauma, must be vigilant for spinal cord injur
y</div> Anatomy_Bloc
4
"<div>What is this called?&nbsp;</div><img src=""list.jpeg"" />"
Listhesi
s- anterior displacement of the vertebral body Anatomy_Bloc
4
"What is 24?<div><img src=""24.jpeg"" /></div>" Ventricle of larynx
Anatomy_
Bloc
4
What disease does sirolimus have an advantage in treating
<div>Sirolimus i
s has an advantage in treating <u>Epstein-Barr infected B cell lymphomas</u>. In
hibition of IL-10 will inhibit the growth of these lymphomas</div>
Immunolo
gy_bloc
4
What are the boundries of the femoral canal?
"Inguinal ligament, lacunar liga
ment, pectineal ligament, femoral vein<div><img src=""Gray546.png"" /></div>"
What are the boundries of Hesselbachs triangle?
Inguinal ligament, rectu
s abdominis, epigastric artery
What forms the boundry of the deep inguinal ring?
"Transversalis fascia la
teral to inferior epigastric artery<div><img src=""trans (1).jpeg"" /></div>"
Femoral hernias go through the____?
Femoral canal
<b>Direct</b>&nbsp;inguinal hernias go through ______? Hesselbachs triangle
<b>Indirect</b>&nbsp;inguinal hernias go through ______? This represents a paten
t____? Deep inguinal ring; tunica vaginalis
Name the layers of the abdomen starting from the s
in and going deep. S
in<div
>Campers fascia</div><div>Scarpas fascia</div><div>Aponeurosis of External Obl
ique</div><div>Internal Oblique <i>muscle</i></div><div>Transversus abdominus <i

>muscle</i></div><div>Transversalis fascia</div><div>Peritoneum (parietal)</div>

Name the layers in the scrotum starting from the s
in? S
in<div>Dartos muscle</
div><div>Colles fascia</div><div>External spermatic fascia</div><div>Cremasteric
muscle</div><div>Internal spermatic fascia</div><div>Processes and tunica vagin
alis (visceral and parietal)</div>
Whats the equivalent layer in the scrotum for Campers fascia in the abdomen? H
ow about Transversus abdominus muscle? "None and NONE! (no equivalent layer -&g
t; chart attached for reference)<div><img src=""paste-10037338570753.jpg"" /></d
iv>"
What is the equivalent layer of the dartos muscle in the abdomen?
"None (s
ee chart)<div><img src=""paste-10033043603457.jpg"" /></div>"
Probably a good idea to
now the dermatome of L1 (on the review sheet) "<div>Fo
llows the inguinal ligament basically</div><img src=""dermatomes-netter21.jpg""
/><div><br /></div>"
What spinal nerves and named nerve supply the s
in of the scrotum?
S2,3,4 pudendal (not a very exact answer but its what Glen has on the sheet)
What supplies the cremasteric muscle? Genitofemoral nerve L1/L2
What important structures pass through the inguinal canal? What about in the scr
otum? "<b>Inguinal canal: </b>Testicular artery and vein, visceral afferent T1
0 nerve fibers, ductus deferens<div><br /></div><div><b>Scrotum: </b>Pampiniform
plexus of veins, testicular a., visceral afferent fibers of T10 and ductus defe
rens</div><div><br /></div><div>*<i>Not exactly sure if this is what glen meant
by this, here again is the chart I too
this question from</i></div><div><i><img
src=""paste-11184094838785.jpg"" /></i></div>"
Where does the lesser omentum attach? Lesser curvature of stomach with liver
Where does the greater omentum attach? Greater curvature of the stomach
<div><!--an
i-->What structure spans from greater curvature of stomach to transv
erse colon</div>
Gastrocolic ligament
Where does the gastrosplenic ligament attach? Greater curvature of stomach wit
h spleen
Where does the lienorenal ligament attach?
Spleen with posterior wall
Where does the ligament of Treitz attach?
"At point of transition of 4th s
tage of duodenum and jejunum with posterior wall<div><img src=""trei.jpeg"" /></
div>"
"Where does ""the"" mesentery attach?" Jejunum and ileum with posterior wall
<div>Mesentery of vermiform appendix with posterior wall is called?</div>
Mesoappendix
Mesentery of transverse colon with posterior wall is called what
<div>Tra
nsverse mesocolon</div>
What is the mesentery from sigmoid colon with posterior wall? <div>Sigmoid mes
ocolon</div>
Mesentery of Liver with anterior abdominal wall is called what?&nbsp; <div>Fal
ciform ligament</div>
Where does the round ligament of the liver (<i>ligamentum teres hepatis) </i>att
ach?
Umbilicus with inferior vena cava (via ligamentum venosum
What is the median umbilical ligament a remnant of?
Obliterated urachus
What is the medial umbilical ligament a remnant of?
Obliterated umbilical ar
tery
What does the median umbilical ligament attach to?
Umbilicus with urinary b
ladder
What does the medial umbilical ligament attach to?
Umbilicus with internal
iliac artery
What are the boundries of the epiploic foramen? Hepatoduodenal ligament and port
al triad anteriorly<div>Liver superiorly</div><div>1st stage of duodenum inferio
rly</div><div>IVC posteriorly</div><div>Lesser sac on the left</div><div>Greater
sac on the right</div>
Whats contained in the hepatoduodenal ligament (portal triad)? Hepatic portal v
ein, common bile duct, hepatic artery proper
Name the 5 structures the touch the spleen..
"<b>K</b>idney<div><b>D</b>iaphr
agm (costodiaphragmatic recess)</div><div><b>S</b>tomach</div><div><b>P</b>ancre

as (tail)</div><div><b>C</b>olon (splenic flexure)</div><div><img src=""paste-26

950919782401.jpg"" /></div>"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_0.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_0.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_1.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_1.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_2.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_2.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_3.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_3.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_4.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_4.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_5.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_5.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_6.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_6.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_7.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_7.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_8.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_8.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_9.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_9.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
"<img src=""0fc52adb4c65830031f9ec3c9863e605321a5393_Q_10.svg"" />"
"<img sr
c=""0fc52adb4c65830031f9ec3c9863e605321a5393_A_10.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_source_svg.svg"" />"
"<img src=""0fc5
2adb4c65830031f9ec3c9863e605321a5393_tmp8z3wwj.png"" />"
List some possible clinical manifestations of portal hypertension.
Esophage
al varices, caput medusa, anorectal varices
"<img src=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_Q_0.svg"" />"
"<img sr
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"<img src=""6a9d
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"<img src=""6a9d
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"<img src=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_Q_1.svg"" />"
"<img sr
c=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_A_1.svg"" />"
"<img src=""6a9d
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"<img src=""6a9d
d72c168c7368ca5a196e3fd913ba26769a7d_tmp3_bfbs.png"" />"
"<img src=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_Q_2.svg"" />"
"<img sr
c=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_A_2.svg"" />"
"<img src=""6a9d
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"<img src=""6a9d
d72c168c7368ca5a196e3fd913ba26769a7d_tmp3_bfbs.png"" />"

"<img src=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_Q_3.svg"" />"

"<img sr
c=""6a9dd72c168c7368ca5a196e3fd913ba26769a7d_A_3.svg"" />"
"<img src=""6a9d
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"<img src=""6a9d
d72c168c7368ca5a196e3fd913ba26769a7d_tmp3_bfbs.png"" />"
"<img src=""e204d1479b5a43b6004726079dc3bbba523214a5_Q_0.svg"" />"
"<img sr
c=""e204d1479b5a43b6004726079dc3bbba523214a5_A_0.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_source_svg.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_tmpo_gbu0.png"" />"
"<img src=""e204d1479b5a43b6004726079dc3bbba523214a5_Q_1.svg"" />"
"<img sr
c=""e204d1479b5a43b6004726079dc3bbba523214a5_A_1.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_source_svg.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_tmpo_gbu0.png"" />"
"<img src=""e204d1479b5a43b6004726079dc3bbba523214a5_Q_2.svg"" />"
"<img sr
c=""e204d1479b5a43b6004726079dc3bbba523214a5_A_2.svg"" />"
"<img src=""e204
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"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_tmpo_gbu0.png"" />"
"<img src=""e204d1479b5a43b6004726079dc3bbba523214a5_Q_3.svg"" />"
"<img sr
c=""e204d1479b5a43b6004726079dc3bbba523214a5_A_3.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_source_svg.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_tmpo_gbu0.png"" />"
"<img src=""e204d1479b5a43b6004726079dc3bbba523214a5_Q_4.svg"" />"
"<img sr
c=""e204d1479b5a43b6004726079dc3bbba523214a5_A_4.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_source_svg.svg"" />"
"<img src=""e204
d1479b5a43b6004726079dc3bbba523214a5_tmpo_gbu0.png"" />"
"<img src=""45ba764272d69ef28e2c3b924e80aa7076ccf937_Q_0.svg"" />"
"<img sr
c=""45ba764272d69ef28e2c3b924e80aa7076ccf937_A_0.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_source_svg.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_tmpvjc0cs.png"" />"
"<img src=""45ba764272d69ef28e2c3b924e80aa7076ccf937_Q_1.svg"" />"
"<img sr
c=""45ba764272d69ef28e2c3b924e80aa7076ccf937_A_1.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_source_svg.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_tmpvjc0cs.png"" />"
"<img src=""45ba764272d69ef28e2c3b924e80aa7076ccf937_Q_2.svg"" />"
"<img sr
c=""45ba764272d69ef28e2c3b924e80aa7076ccf937_A_2.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_source_svg.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_tmpvjc0cs.png"" />"
"<img src=""45ba764272d69ef28e2c3b924e80aa7076ccf937_Q_3.svg"" />"
"<img sr
c=""45ba764272d69ef28e2c3b924e80aa7076ccf937_A_3.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_source_svg.svg"" />"
"<img src=""45ba
764272d69ef28e2c3b924e80aa7076ccf937_tmpvjc0cs.png"" />"
List the arterial supply, sympathetic supply and parasympathetic supply of the <
b>Ascending colon.</b> Right colic, thoracic splanchnics, Vagus
List the arterial supply, sympathetic supply and parasympathetic supply of the <
b>Transverse (first 2/3) colon.</b>
Middle colic, thoracic splanchnics, Vagu
s
List the arterial supply, sympathetic supply and parasympathetic supply of the <
b>Transverse (last 1/3) colon.</b>
Left colic, Lumbar splanchnics, pelvic s
planchnics
List the arterial supply of the <b>descending colon, sigmoid colon and rectum</b
>
Left colic, sigmoidal branches, superior rectal
What is the sympathetic and parasympathetic supply of the entire hindgut (last 1
/3 of Transverse colon -&gt; rectum)? Lumbar splanchnics, pelvic splanchnics
T12
At what level is the celiac trun
?
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_0.svg"" />"
"<img sr
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_0.svg"" />"
"<img src=""9431
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
"<img src=""9431
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_1.svg"" />"
"<img sr
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_1.svg"" />"
"<img src=""9431
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
"<img src=""9431

c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_2.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_2.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_3.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_3.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_4.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_4.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_5.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_5.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_6.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_6.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_7.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_7.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_Q_8.svg""
c=""9431c6bfd73553ca8b01f37cb64ae2198e41f8e1_A_8.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_source_svg.svg"" />"
c6bfd73553ca8b01f37cb64ae2198e41f8e1_tmpb31nws.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_0.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_0.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_1.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_1.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_2.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_2.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_3.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_3.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_4.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_4.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_5.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_5.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_6.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_6.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_7.svg""
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_7.svg"" />"
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"

/>"
"<img sr
"<img src=""9431
"<img src=""9431
/>"
"<img sr
"<img src=""9431
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/>"
"<img sr
"<img src=""9431
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/>"
"<img sr
"<img src=""9431
"<img src=""9431
/>"
"<img sr
"<img src=""9431
"<img src=""9431
/>"
"<img sr
"<img src=""9431
"<img src=""9431
/>"
"<img sr
"<img src=""9431
"<img src=""9431
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181
/>"
"<img sr
"<img src=""3181
"<img src=""3181

eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_Q_8.svg"" />"
"<img sr
c=""3181eb7bfacc875d4d3774fc9e425e72f375c29c_A_8.svg"" />"
"<img src=""3181
eb7bfacc875d4d3774fc9e425e72f375c29c_source_svg.svg"" />"
"<img src=""3181
eb7bfacc875d4d3774fc9e425e72f375c29c_tmprhzron.png"" />"
"<img src=""1705019b7b3a3f932398171c41b9f8eaf13a3664_Q_0.svg"" />"
"<img sr
c=""1705019b7b3a3f932398171c41b9f8eaf13a3664_A_0.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_source_svg.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_tmph
ym5a.png"" />"
"<img src=""1705019b7b3a3f932398171c41b9f8eaf13a3664_Q_1.svg"" />"
"<img sr
c=""1705019b7b3a3f932398171c41b9f8eaf13a3664_A_1.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_source_svg.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_tmph
ym5a.png"" />"
"<img src=""1705019b7b3a3f932398171c41b9f8eaf13a3664_Q_2.svg"" />"
"<img sr
c=""1705019b7b3a3f932398171c41b9f8eaf13a3664_A_2.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_source_svg.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_tmph
ym5a.png"" />"
"<img src=""1705019b7b3a3f932398171c41b9f8eaf13a3664_Q_3.svg"" />"
"<img sr
c=""1705019b7b3a3f932398171c41b9f8eaf13a3664_A_3.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_source_svg.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_tmph
ym5a.png"" />"
"<img src=""1705019b7b3a3f932398171c41b9f8eaf13a3664_Q_4.svg"" />"
"<img sr
c=""1705019b7b3a3f932398171c41b9f8eaf13a3664_A_4.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_source_svg.svg"" />"
"<img src=""1705
019b7b3a3f932398171c41b9f8eaf13a3664_tmph
ym5a.png"" />"
At what level does the aorta pass posterior to the diaphragm? T12
Name 10 things that can be found at the level of L1.
<b>T</b>ranspyloric plan
e<div><b>S</b>uperior mesenteric artery</div><div><b>H</b>ilum of left
idney</d
iv><div><b>B</b>ody of pancreas</div><div><b>P</b>ylorus</div><div><b>1</b>st st
age of duodenum</div><div><b>F</b>undus of gall bladder</div><div><b>R</b>oot of
transverse mesocolon <b>D</b>uodenal jejunal junction</div><div><br /></div><di
v>*<i>Two silly hill billies po
ed 1 fat red dog*&nbsp;</i></div><div><i><br /><
/i></div><div><i>- dont judge.</i></div>
Where does the spinal cord end? L1/L2
Name some things that can be found at L2.
Hilum of right
idney, second st
age of duodenum, gondal vessels
Name 2 things found at L3.
3rd stage of duodenum, inferior mesenteric arter
y
What is the <i>vertebral</i>&nbsp;level of the umbilicus?
L3/L4
The bifurcation of the aorta and the supracristal plane are found at what verteb
ral level?
L4
At what level does the IVC form/bifurcate?
"L5<div><img src=""numbers.jpeg"
" /></div>"
At what level does the dural sac end? S2
"What is 10?<div><img src=""23.jpeg"" /></div>" Pudendal nerve and <b>internal p
udendal artery </b>(bifurcating at the anterior end of Alcoc
s canal) Anatomy_
Bloc
4
"<img src=""98a358d9928d3bd7ec170e20f2b45a1ed430ee30_Q_0.svg"" />"
"<img sr
c=""98a358d9928d3bd7ec170e20f2b45a1ed430ee30_A_0.svg"" />"
"<img src=""98a3
58d9928d3bd7ec170e20f2b45a1ed430ee30_source_svg.svg"" />"
"<img src=""98a3
58d9928d3bd7ec170e20f2b45a1ed430ee30_ob in.jpeg"" />"
Anatomy_
Bloc
4
"<div>What artery is 23, 24</div><img src=""pud.jpeg"" />"
23- internal pud
endal artery (left)<div>24- inferior gluteal artery&nbsp;</div><div>(24 is also
pointing to ischial spine, sacrospinal ligament)</div> Anatomy_Bloc
4
"What is 16?<div><img src=""anoco.jpeg"" /></div>"
Anococcygeal ligament<di
v>(fibrous raphe extending between coccyx and margin of the anus)</div> Anatomy_
Bloc
4
What provides sensory innervation of the penis? Pudendal nerve (S2-S4) Anatomy_
Bloc
4

What provides sympathetic innervation of the penis?

Lumbar splanchnics to th
e inferior mesenteric ganglion Anatomy_Bloc
4
What provides parasympathetic innervation to the penis? Pelvic splanchnic (S2-S4
)
Anatomy_Bloc
4
What does the root of the clitoris consist of? "<div>2 crura</div><div><br /></
div><img src=""clit.jpeg"" />" Anatomy_Bloc
4
What does the body of the clitoris consist of? "<div>2 corpora cavernosa and gl
ans</div><img src=""clit.jpeg"" />"
Anatomy_Bloc
4
What is the innervation of the mons pubis and anterior labia? "Lumbar plexus<d
iv><img src=""puden inn.jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""5cfa06b9e523e09c47ab48492b55dc50978efc7d_Q_0.svg"" />"
"<img sr
c=""5cfa06b9e523e09c47ab48492b55dc50978efc7d_A_0.svg"" />"
"<img src=""5cfa
06b9e523e09c47ab48492b55dc50978efc7d_source_svg.svg"" />"
"<img src=""5cfa
06b9e523e09c47ab48492b55dc50978efc7d_bulb.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""5cfa06b9e523e09c47ab48492b55dc50978efc7d_Q_1.svg"" />"
"<img sr
c=""5cfa06b9e523e09c47ab48492b55dc50978efc7d_A_0.svg"" />"
"<img src=""5cfa
06b9e523e09c47ab48492b55dc50978efc7d_source_svg.svg"" />"
"<img src=""5cfa
06b9e523e09c47ab48492b55dc50978efc7d_bulb.jpeg"" />"
Anatomy_
Bloc
4
What is the innervation of female erectile bodies (bulbs and clitoris)? Parasymp
athetic pelvic splanchnics
Anatomy_Bloc
4
"What is 14?<div><img src=""utricle.jpeg"" /></div>"
Prostatic utricle
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_0.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_0.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><img src=""male (1).
jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_1.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_1.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_2.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_2.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_3.svg"" /><div><br /></di
v>"
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_3.svg"" />"
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br
/></div><div><img src=""male (1).jpeg"" /></div>"
Anatomy_
Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_4.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_4.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_5.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_5.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_6.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_6.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4

"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_7.svg"" />"

"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_7.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""ea36471170bb65234ed332ee0cf1d34cac84fb27_Q_8.svg"" />"
"<img sr
c=""ea36471170bb65234ed332ee0cf1d34cac84fb27_A_8.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_source_svg.svg"" />"
"<img src=""ea36
471170bb65234ed332ee0cf1d34cac84fb27_branches.jpeg"" /><div><br /></div><div><im
g src=""male (1).jpeg"" /></div>"
Anatomy_Bloc
4
"<img src=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_Q_0.svg"" />"
"<img sr
c=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_A_0.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_source_svg.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_mes.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_Q_1.svg"" />"
"<img sr
c=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_A_1.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_source_svg.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_mes.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_Q_2.svg"" />"
"<img sr
c=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_A_2.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_source_svg.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_mes.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_Q_3.svg"" />"
"<img sr
c=""acb34bb5fc19c730d2805f6a87345f43fb1724b6_A_3.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_source_svg.svg"" />"
"<img src=""acb3
4bb5fc19c730d2805f6a87345f43fb1724b6_mes.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_Q_0.svg"" />"
"<img sr
c=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_A_0.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_source_svg.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_lig.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_Q_1.svg"" />"
"<img sr
c=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_A_1.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_source_svg.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_lig.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_Q_2.svg"" />"
"<img sr
c=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_A_2.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_source_svg.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_lig.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_Q_3.svg"" />"
"<img sr
c=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_A_3.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_source_svg.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_lig.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_Q_4.svg"" />"
"<img sr
c=""e05485f11fbbb9803979e7f37be29308ba7cfc2a_A_4.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_source_svg.svg"" />"
"<img src=""e054
85f11fbbb9803979e7f37be29308ba7cfc2a_lig.jpeg"" />"
Anatomy_
Bloc
4
"<img src=""f3b082669422766fdad762f2e6c79c86affd4a69_Q_0.svg"" />"
"<img sr
c=""f3b082669422766fdad762f2e6c79c86affd4a69_A_0.svg"" />"
"<img src=""f3b0
82669422766fdad762f2e6c79c86affd4a69_source_svg.svg"" />"
"<img src=""f3b0
82669422766fdad762f2e6c79c86affd4a69_money.jpeg"" />"
Anatomy_
Bloc
4

"<img src=""f3b082669422766fdad762f2e6c79c86affd4a69_Q_1.svg""
c=""f3b082669422766fdad762f2e6c79c86affd4a69_A_1.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_source_svg.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_money.jpeg"" />"
Bloc
4
"<img src=""f3b082669422766fdad762f2e6c79c86affd4a69_Q_2.svg""
c=""f3b082669422766fdad762f2e6c79c86affd4a69_A_2.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_source_svg.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_money.jpeg"" />"
Bloc
4
"<img src=""f3b082669422766fdad762f2e6c79c86affd4a69_Q_3.svg""
c=""f3b082669422766fdad762f2e6c79c86affd4a69_A_3.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_source_svg.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_money.jpeg"" />"
Bloc
4
"<img src=""f3b082669422766fdad762f2e6c79c86affd4a69_Q_4.svg""
c=""f3b082669422766fdad762f2e6c79c86affd4a69_A_4.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_source_svg.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_money.jpeg"" />"
Bloc
4
"<img src=""f3b082669422766fdad762f2e6c79c86affd4a69_Q_5.svg""
c=""f3b082669422766fdad762f2e6c79c86affd4a69_A_5.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_source_svg.svg"" />"
82669422766fdad762f2e6c79c86affd4a69_money.jpeg"" />"
Bloc
4
"<img src=""90acc60a3f79a439853b04f54b31fa23f5e62ab7_Q_0.svg""
c=""90acc60a3f79a439853b04f54b31fa23f5e62ab7_A_0.svg"" />"
c60a3f79a439853b04f54b31fa23f5e62ab7_source_svg.svg"" />"
c60a3f79a439853b04f54b31fa23f5e62ab7_meso.jpeg"" />"
Bloc
4
"<img src=""90acc60a3f79a439853b04f54b31fa23f5e62ab7_Q_1.svg""
c=""90acc60a3f79a439853b04f54b31fa23f5e62ab7_A_1.svg"" />"
c60a3f79a439853b04f54b31fa23f5e62ab7_source_svg.svg"" />"
c60a3f79a439853b04f54b31fa23f5e62ab7_meso.jpeg"" />"
Bloc
4
"<img src=""90acc60a3f79a439853b04f54b31fa23f5e62ab7_Q_2.svg""
c=""90acc60a3f79a439853b04f54b31fa23f5e62ab7_A_2.svg"" />"
c60a3f79a439853b04f54b31fa23f5e62ab7_source_svg.svg"" />"
c60a3f79a439853b04f54b31fa23f5e62ab7_meso.jpeg"" />"
Bloc
4
"<img src=""f88395762a8325280496d4211ecf6e2a048ef168_Q_0.svg""
c=""f88395762a8325280496d4211ecf6e2a048ef168_A_0.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_source_svg.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_prostate.jpeg"" />"
Anatomy_Bloc
4
"<img src=""f88395762a8325280496d4211ecf6e2a048ef168_Q_1.svg""
c=""f88395762a8325280496d4211ecf6e2a048ef168_A_1.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_source_svg.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_prostate.jpeg"" />"
Anatomy_Bloc
4
"<img src=""f88395762a8325280496d4211ecf6e2a048ef168_Q_2.svg""
c=""f88395762a8325280496d4211ecf6e2a048ef168_A_2.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_source_svg.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_prostate.jpeg"" />"
Anatomy_Bloc
4
"<img src=""f88395762a8325280496d4211ecf6e2a048ef168_Q_4.svg""
c=""f88395762a8325280496d4211ecf6e2a048ef168_A_4.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_source_svg.svg"" />"
95762a8325280496d4211ecf6e2a048ef168_prostate.jpeg"" />"
Anatomy_Bloc
4

/>"
"<img sr
"<img src=""f3b0
"<img src=""f3b0
Anatomy_
/>"
"<img sr
"<img src=""f3b0
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"What is 22?<div><img src=""superior cervical ganglion.jpeg"" /></div>" Superior
cervical ganglion
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4
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4
Where does nutcrac
er syndrome occur? "<div>SMA and aorta compressing left ren
al vein</div><img src=""nutcrac
er.jpeg"" />" Anatomy_Bloc
4
"What is 7?<div><img src=""sal.jpeg"" /></div>" Salpingopharyngeal Fold Anatomy_
Bloc
4
How does PTH affect serum phosphate and Ca+ levels?
Decreases phosphate, inc
reases Ca+
Why is gamma-hemolytic a misnomer?
"It means there <u>no</u> hemolysis<div>
<img src=""gamma.jpeg"" /></div>"
3/4Streptococci
What molecule is the lancefield classification based on?
The C-carbohydra
te
3/4Streptococci
Whats another name for peptidoglycan? "Muramyl dipeptide<div><br /></div><div>
(composed of&nbsp;alternating <u>glucosamine</u> and <u>muramic acid</u> in long
chains)</div><div><br /></div><div><img src=""paste-31688268711184.png"" /></di
v>"
3/4Streptococci
What is the typical MIC dose youd li
e to give a patient to effectively treat t
hem?
"<div>4x the MIC</div><div><img src=""MIC.jpeg"" /></div>"
3/4Strep
tococci2
What is the virulence factor in toxic strep syndrome? Pyrogenic exotoxin A
Do you ma
e antibodies against micoorganisms hyaluronic acid? No, because your
own body has a bunch of it
Why dont you give the guy without pyuria and the presence of E. faeculis any ab
x?
Because no pyuria = colonization but not infection, youll just breed mo
re resistant bactera if you u give em abx
What is unique about enterococcus MBC and MIC? "<div>MBC is &gt;32x the MIC, ma

ing it tolerant</div><div><br /></div><div>minimum bactericidal concentration i

s more than 32X the minimum inhibitory concentration!</div><img src=""MBC.jpeg""
/>"
What are two anaeobic streptococci? When do they cause problems Peptococcus, pep

tostreptococcus<div><br /></div><div>Normal part of flora</div><div>Cause proble

ms when they&nbsp;<u>end up in sterile locations</u> (altered anatomy, poor perf
usion, trauma)</div>
What is immunity to group B strep mediated by? Antibody to a <u>type-specific c
arbohydrate</u> (as opposed to group-specific carb li
e S. pyogenes)
What do group C strep do?
Uncommon, but cause infection in <u>animals</u>.
(occasional pharyngitis and possible nephritis in humans)
Do staphylococcus have peptidoglycan in their cell wall?
Yes.
3/6Staph
ylococcus1
Over 80% of staph disease caused by which capsule serotypes?
5 and 8 3/6Staph
ylococcus1
What are MSCRAMMS?
"<b>Adherence ligands</b> that <u>staph</u> can use to b
ind to stuff (help colonize host tissues) - may be pathogenic<div>e.g. Can bind
to Fibronectin, collagen, fibrinogen<br /><div><img src=""mscra.jpeg"" /></div><
/div>" 3/6Staphylococcus1
Didnt see brent question but this seemed important: clues that help you determi
ne if you have a more complicated case of endocarditis. <div>Younger patient wit
hout underlying illnesses;</div><div>Community-acquired (e.g., illicit drugs);</
div><div>No recognizable primary infections;</div><div>S
in evidence of systemic
infection;</div><div>(+) echocardiogram (Transesophageal Echo);</div><div>Failu
re to defervesce by 72 hours on therapy;</div><div>(+) blood cultures at 48-96 h
ours on therapy.</div><div><br /></div> 4/15InfectiveEndocarditis
How can you tell that there is tricuspid valve disease from S. aureus? "Loo
to
see if the lesions (on CT) are peripheral - meaning theyre hematogenous (from
the blood) and originating from the heart<div><img src=""paste-402498565177347.j
pg"" /></div>" 3/10S
inandSoftTissueInfections
"<img src=""paste-343597384488.jpg"" /><div><br /></div><div>Identify 1</div>"
Parietal Lobe
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 2</div>"
Thalamus &amp; Third Ventricle
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 3</div>"
Occipital Lobe
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 4</div>"
Cerebellum
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 5</div>"
Medulla Oblongata
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 6</div>"
Central Sulcus
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 7</div>"
Corpus callosum
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 8</div>"
Frontal lobe
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 9</div>"
Fornix &amp; Anterior Commissure
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 10</div>"
Hypothalamus
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 11</div>"
Midbrain
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 12</div>"
Temporal Lobe
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 13</div>"
Pons
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 14</div>"
Fourth Ventricle
"<img src=""paste-339302417192.jpg"" /><div><br /></div><div>Identify 15</div>"
Spinal cord
"<img src=""paste-730144441108.jpg"" /><div><br /></div><div>Identify 16 (Sorry,
glossed over and missed this one)</div>"
Cerebral aqueduct &amp; (superio
r &amp; inferior) colliculi of the midbrain&nbsp;
"<img src=""paste-816043786942.jpg"" /><div><br /></div><div>Identify 1</div>"

Anterior Cerebral artery

"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 2</div>"
Middle Cerebral artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 3</div>"
Posterior Cerebral artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 4</div>"
Basilar artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 5</div>"
Vertebral artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 6</div>"
Anterior Communicating artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 7</div>"
Superior Cerebellar artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 8</div>"
Anterior Inferior Cerebellar artery
"<img src=""paste-811748819646.jpg"" /><div><br /></div><div>Identify 9</div>"
Posterior Inferior Cerebellar Artery
What are the 5 ethical appeals? Consequences (1st), Rights, Professional Virtues
, Justice, Special obligations &nbsp;<div><br /></div><div>CPR SOJ</div>
Ethics
What are the components of appeals to consequences?
Beneficence- obligation
of clinical goods over harm<div>Non-maleficence- when approaching limits of inte
rvention, prevent only harming the patient</div>
Ethics
What are the components of appeals to rights? <b>Decisional rights</b>- empowe
r patient to exercise <u><b>autonomy</b> in decision ma
ing</u> about clinical c
are, and information needed to participate in decision ma
ing process<div><b>Non
-decisional rights</b>- &nbsp;<u>protection from harm, confidentiality, honest c
ommunication, respect/dignity</u></div> Ethics
What are the 5 components of professional virtues?
<b>Integrity</b>- standa
rds of intelletual and moral excellence<div><b>Compassion</b>- recognizing and a
cting when patient is in/at ris
of suffering</div><div><b>Self-sacrifice</b>- r
esonable ris
s to ones self-interests</div><div><b>Courage</b>- distinguishing
what one ought and ought not to fear</div><div><b>Honesty</b></div><div><b><br /
></b></div><div><b>HICCS</b></div>
Ethics
What are the components of appeals to justice? <div>Justice: treat others fairl
y in light of what is owed to them</div><div><br /></div><div><b>Libertarian</b>
- equal proportion to <u>what one has paid for</u></div><div><b>Egalitarian</b>equal proportion to <u>medical needs</u></div><div><b>Basic decent minimum</b>care in proportion to basic needs, but beyond, what one pays</div><div><br /></
div><div><b>Resource management</b></div><div><b>Social justice</b>- redress unf
air imbalances in access and provision of health care</div>
Ethics
What are conflicts of interest? Conflict between professional responsibility to
patient and individual self-interest
Ethics
What are conflicts of commitment?
Conflict between professional responsibi
lity to patient and <u>obligations to those other than patients</u> in ones lif
e&nbsp; Ethics
"<div><img src=""central.jpeg"" /></div><br /><div>4, 1, 15 and related function
s</div>"
4- central sulcus<div>1- precentral gyrus, somatomotor cortex</d
iv><div>15- postcentral gyrus, somatosensory cortex</div>
Neuro
"<img src=""axial.jpeg"" /><div>3</div>"
Putamen Neuro
"<img src=""axial.jpeg"" /><div>5</div>"
Globus pallidus Neuro
"<img src=""axial.jpeg"" /><div>6</div>"
Third ventricle Neuro
"<img src=""axial.jpeg"" /><div>7</div>"
Thalamus
Neuro
"<img src=""axial.jpeg"" /><div>14</div>"
Anterior limb of internal capsul
e
Neuro
Where does anterior crus of internal capsule lie?
"<div>Between the putame
n and caudate nucleus</div><div><img src=""coronal.jpeg"" /></div><div><img src=
""capsuel.jpeg"" /></div><img src=""axial.jpeg"" /><div><br /><div><br /></div><
div><img src=""capsule.jpeg"" /></div></div>" Neuro
"<img src=""axial.jpeg"" /><div>2</div>"
caudate nucleus Neuro

"<img src=""axial.jpeg"" /><div>18</div>"

Genu of internal capsule
Neuro
"<img src=""axial.jpeg"" /><div>19</div>"
Posterior crus of internal capsu
le
Neuro
"<img src=""coronal.jpeg"" /><div>4</div>"
putamen Neuro
"<img src=""coronal.jpeg"" /><div>2</div>"
Caudate nucleus Neuro
"<img src=""coronal.jpeg"" /><div>5</div>"
Globus pallidus Neuro
Where does the posterior crus of the internal capsule lie?
"<div>Between th
e globus pallidus and thalamus</div><div><img src=""coronal.jpeg"" /></div><div>
<img src=""capsuel.jpeg"" /></div><img src=""axial.jpeg"" /><div><br /><div><br
/><div><br /><div><img src=""capsule.jpeg"" /></div></div></div></div>" Neuro
How do they thin
Vancomyocin resistant S. aureus emerged?
"When it had sex
with a vancomyocin-resistant enterococcus (VRE)<div><img src=""se.jpeg"" /></di
v>"
3/10Staphylococci2
"Useful image:<div><img src=""paste-536703408275457.jpg"" /></div>"
3/10S
inandSoftTissueInfections
whats a common ulcer that diabetics get?
"Malperforans metatarsal ulcer<d
iv><br /><div><img src=""ulcer.jpeg"" /></div></div>" 3/10S
inandSoftTissueInf
ections
Lentiform nucleus consists of? Globus pallidus and Putamen&nbsp;
Name 4 typically lactose positive organisms.
<div>turn Mac<b>C</b>on<b>
ees</
b> PINK</div><div><br /></div><div>Citrobacter</div><div>Klebsiella</div>Enterob
acter<div>E. coli</div><div>Serratia</div><div><br /></div><div><br /></div>
3/12Enterobacteriaceae
Are Staphylococci aerobic or anaerobic? Facultative anaerobes (both)
What is an important biologic/virulence property of peptidoglycan? Elicits produ
ction of? (and name some oters)&nbsp; "a. Elicits production of <b>tumor necro
sis factor</b> from monocytes<div><div>b. toxic for polymorphonuclear leu
ocytes
;</div><div>c.<span class=""Apple-tab-span"" style=""white-space:pre""> </span>e
ndotoxin-li
e activity;</div><div>d.<span class=""Apple-tab-span"" style=""white
-space:pre""> </span>activates complement;</div><div>e.<span class=""Apple-tab-s
pan"" style=""white-space:pre""> </span>elicits opsonic antibody production.</di
v></div>"
What staphylococci gene induces expression of extracellular proteins (exoprotein
s made during stationary phase) while suppressing the expression of surface prot
eins (made during exponential growth) "agr gene. This sequential expression ma
y be important for pathogenesis<div><img src=""growth.jpeg"" /></div>"
What two post-adherence events allow for invasion of Staph?
<b>Phagocytosis<
/b> by <b>non-professional phagocytes</b> (endothelial cells) allow for persiste
nce<div>Stimulation of <b>tissue factor</b> may allow for accumulation of organi
sms</div>
Neutrophil chemotaxis into sites for S. aureus depend on what? "Cell wall and e
xtracellular products. (chemotactic defects result in susceptibility to S aureus
)<div><div><img src=""growth.jpeg"" /></div></div>"
What is required for opsonization of S. aureus? What impairs opsonization of S.
aureus? non-immune subjects-&nbsp;<b>complement</b> is required<div>immune subje
cts-<b> Ig to cell wall</b> and or microcapsule if present</div><div><br /></div
><div>(Deficiencies of C3/5 or Ig impair opsonization)</div><div><b>Capsule</b>
impairs PMN phagocytosis</div><div><b>Protein A </b>impairs phagocytosis by bind
ing to Fc of IgG (causing stoichochemical interference of normal interaction bet
ween Fab of IgG and cell wall components)</div>
What is difference between primary and secondary bacteremia in S. aureus?
Primary- without obvious focus<div>Secondary- to a focus of infection at another
site</div>
What is the most common cause of osteomyelitis and septic arthritis?
S. aureu
s
What are the two pathogenic mechanisms pneumonia can occur?
<b>Aerogenous</b
>- from aspiration of oral flora<div><b>Hematogenous</b>- from another source (I
V, endocarditis, drug users)</div>
What are the two most important coagulase negative staphylococci?
S. epide

rmidis, S. saprophyticus
Do coagulase (-) staph have high or low virulence? How are they aquired?
Low virulence, from hospitals and from brea
s in s
in/prosthetic devices
What is the most important factor for pathogenesis of coag (-) staph? "exopoly
saccharide (slime)<div><img src=""slime.jpeg"" /></div>"
Coagulase (-) staph in patient with urinary catheter
hospital acquired S. epi
dermidis
Describe mechanism of staphylococci penicillin resistance?
"<u>-lactamase</u
> production y S. aureus --&gt; extracellular enzyme that disrupts the&nsp;-lac
tam ring of penicillins y <>hydrolysis</> --&gt; penicillin resistance&nsp;<
div><img src="" lac.jpeg"" /></div>"
What is difference etween MRS hospital associated strains and community associ
ated strains? Hospital associated strains have SCCmec type II and III, <>mult
iple antiiotic resitances</><div>Community associated strains have SCCmec type
IV (smaller) and <>fewer antiiotic resistance</></div>
What is heteroresistance?
<>Resistance</> to certain antiiotics express
ed y a suset of a microial population that is <>considered to e susceptile
to these antiiotics for in vitro testing</>
What are two types of anaeroic soft tissue infections? naeroic cellulitis, cl
ostridial myonecrosis
What causes flesh-eating acteria?
Group  streptococci.&nsp;
Should wounds e closed on animal ite wounds less than 24 hours, more than 24 h
ours? fter 24 hours, DO NOT CLOSE. Before, controversial&nsp;
Human ites consist of what acteria? Polymicroial, anaeroes are prominent
<div>For diaetic foot, what are the two pathophysiologic processes?</div>
<u>Vascular disease:</u><div>Microangiopathy- concept that diaetics have higher
incidence (<>not een confirmed</>)<div>Macroangiopathy- diffuse multisegment
al vascular disease, involves collaterals. Increased ilateral involvement, tend
ency to present more often with gangrene, painful ulcers.&nsp;</div></div><div>
<u>Polyneuropathy</u>: paresthesia and numness, autonomic, motor neuroathy</div
>
What is the eagle effect?
<u>Poor killing activity of penicillin</u> again
st slow growing organisms when they exist in a <u>high inoculum</u>. Some recomm
end clindamycin (inhiit protein synthesis) in addition to antiiotic
Most common extraintestinal diseases from E. coli
UTI, adominal/pelvic in
fections, pneumonia, acteremia 3/13Enteroacteriaceae2
What is all klesiella resistant to? Why?
mpicillin.&nsp;<div><r /></di
v><div>Because they have a <u>chromosomal gene</u> that encodes a <u>-lactamase</
u>. Nosocomial strains often carry <u>MDR</u> (multidrug resistance) or <u>ESBL<
/u> (extended-spectrum -lactamase) <u>plasmids</u>.&nsp;</div>
3/13Enteroacter
iaceae2
What organisms form crystals in caths &amp; at what speed?
"Proteus (fast),
morganella (slow), providencia (slow)<div><img src=""morganella.jpeg"" /></div>
"
3/13Enteroacteriaceae2
What are some aspects of <i>Enteroacter</i>&nsp;antimicroial resistance?
"Inducile eta-lactamase, high aseline mutation rate, MDR and ESBL plasmids, r
esistance my emerge during treatment,&nsp;<div><r /></div><div>MDR= multi drug
resistant</div><div>ESBL=extended spectrum eta lactamase<r /><div><img src=""
enteroac.jpeg"" /></div></div>"
3/13Enteroacteriaceae2
What is the typical pt that has <i>Enteroacter</i>
"Sick patients that have
had lots of ax and have lots of tues in them<div><img src=""sick.jpeg"" /></d
iv>"
3/13Enteroacteriaceae2
What does citroacter diversus cause? (2)
"<u>Brain ascess in neonates</u
> and <u>catheter-associated UTI</u><div><img src=""citro.jpeg"" /></div>"
3/13Enteroacteriaceae2
4 s of Klesiella
"<div><div><><font color=""#ff0000""></font></>spirat
ion pneumonia</div><div><font color=""#ff0000""><></></font>scess in lungs/l
iver</div><div><><font color=""#ff0000""></font></>lcoholics&nsp;</div><div>
di-<><font color=""#ff0000""></font></>-etes</div></div>" 3/13Enteroacter
iaceae2

Mnemonic for pseudomona aeruginosa disease.

BE PSEUDO<div>Burns, Endocarditi
s, Pneumonia, Sepsis, External malignant otitis media, UTI, Diaetic osteomyelit
is<r /><r /><div>(PSEUDDOmonas<div>Pneumonia, sepsis, external otitis, UTI, dr
ug use, diaetes, osteomyelitis)</div></div></div>
3/13Enteroacteriaceae2
Best way to prevent EHEC?
Cook ground eef, wash hands
3/13Enteroacter
iaceae2
What gram- is reastfeeding protective for?
EPEC<div><r /></div><div>(Enter
opathogenic E. coli)</div>
3/13Enteroacteriaceae2
Descrie the&nsp;<i>E. coli </i>virulence factors
<u>Fimriae</u> - cystit
is &amp; pyelonephritis (P&amp; I)<div><u>K capsule</u> - pneumonia, neonatal me
ningitis</div><div><u>LPS</u> (lipid ) - septic shock</div>
3/13Enteroacter
iaceae2
Descrie the steps of shigellosis pathogenesis (6 steps)
Superficial infe
ction of mucosa -&gt; invasion -&gt; intracellular multiplication -&gt; spread t
o adjacent cells -&gt; severe inflammation/ulceration -&gt; destruction of colon
ic mucosa
3/13Enteroacteriaceae3
Why is shigella ale to have such a low infectious dose (10-100 organisms)?
Can survive in low gastric pH 3/13Enteroacteriaceae3
How is shigella similar to EHEC?
They oth produce shiga toxin 3/13Ente
roacteriaceae3
Where would you find fecal leukocytes? "Inflammatory enteric infections<div><im
g src=""types enteri.jpeg"" /></div>" 3/13Enteroacteriaceae3
What ugs can trigger post-infective Re? What are 4 symptoms? "<div>CSSY siss
y</div>Campyloacter, shigella, salmonella, yersinia.<div><r /></div><div>Can
t see, cant pee, cant clim a tree</div><div><r /><div>Conjunctivitis, uret
hritis, arthritis, erythema nodosum (red umps on legs)</div><div><img src=""ery
thema nodosum.jpeg"" /></div><div><img src=""Re.jpeg"" /></div></div>" 3/13Ente
roacteriaceae3
Who are the people at highest risk for <i>salmonella</i>?
Young, elderly,
HIV positive
3/13Enteroacteriaceae3
What are the 3 routes of <i>salmonella</i> intestinal invasion? "1. Through micr
ofold (M) cells<div>2. Bacterial-mediated endocytosis (through memrane ruffles)
</div><div>3. Disruption of tight junctions</div><div><img src=""pathogenesis.jp
eg"" /></div>" 3/13Enteroacteriaceae3
Should you give ax for <i>Salmonella </i>gastroenteritis?
No, self-limitin
g illness. x <u>prolong duration of acterial shedding</u>, <>ONLY given to h
igher-risk persons</> 3/13Enteroacteriaceae3
Why dont aminoglycocides work for typhoid fever? What do you use?
"Salmone
lla typhi are<u> facultative&nsp;intracellular</u>, aminoglycocides dont penet
rate cell. Use quinolones or 3rd generations cephalosporins<div><r /></div><div
><img src=""intracellular.jpeg"" /></div>"
3/13Enteroacteriaceae3
What does&nsp;<i>Y. enterocolitica </i>mimic&nsp;clinically? appendicitis
3/13Enteroacteriaceae3
Descrie the roles of rats &amp; fleas in <i>Y. pestis</i>
"Fleas ite rats
and then fleas ite &amp; vomit on people<div><img src=""plague cycle.jpeg"" />
</div>" 3/13Enteroacteriaceae3
Differences etween <i>Salmonella</i> &amp; <i>Shigella&nsp;</i><div>Flagella</
div><div>H2S production</div><div>Lactose fermenter</div><div>Infective dose</di
v>
"Flagella: yes vs. no (gorilla chained)<div>H2S production: yes vs. no (
salmon on lack plate)</div><div>Lactose fermenter: no vs. no (CKEES: citroacte
r, kle, ecoli, enteroater, serratia)</div><div>Infective dose: 200-1 million v
s&nsp;&lt;10 (gorilla is acid stale)</div><div><r /></div><div><r /></div><d
iv>Below: Lactose agar, lack means H2S production</div><div><img src=""shigella
vs.jpeg"" /></div><div>Lactose Positive &nsp; &nsp; &nsp; &nsp; &nsp; &ns
p; &nsp; &nsp;Negative &nsp; &nsp; &nsp; &nsp; &nsp; &nsp; &nsp; &nsp;
&nsp;Negative</div><div><r /></div><div><r /></div>"
3/13Enteroacter
iaceae3
Which species of Yersinia generally have siderophores and which ones dont?
"<i>Y. pestis</i> have them, <i>Y. enterocolitica</i> dont<div><img src=""iron
pestis.jpeg"" /></div>" 3/13Enteroacteriaceae3

Whats the first thing you do when you get a postive culture from a non-infected
site of a patient?
Determine if they are just colonized or actually infecte
d.<div><r /></div><div>*make a clinical determination of the significance of th
e culture - dont just treat</div>
3/14PseudomonasandFriends
Multi-drug resistant hospital outreak strain of&nsp;cinetoacter
. auma
nnii. 3/14PseudomonasandFriends
Have to have very reduced normal microiota flora (following road-spectrum anti
microials) for this organism to proliferate. (not C diff.)
"cinetoacter<d
iv><img src="". path.jpeg"" /></div>" 3/14PseudomonasandFriends
Positive lood cultures for B. cepacia then triggers what?
"Its an infecti
on that triggers another <u>work-up for CF or CGD</u> for example; no one should
just ""get"" B. cepacia"
3/14PseudomonasandFriends
B. cepacia causes UTI in CF patients? Noooo causes <i>pneumonia </i>dont get
tricked 3/14PseudomonasandFriends
Unexplained leukocytosis and diarrhea? C. diff 3/14naeroes Dickey
What is the therapy for otulism? Whats the catch?
<div>Give heptavalent (i
f availale) or trivalent antitoxin. cts y inding free systemic toxin - <u>wo
nt reverse the toxin thats already ound</u> ut will prevent more progression
of the disease</div><div><r /></div><div>weeks to months for motor axons to gr
ow ack</div> 3/14naeroes Dickey
What are the four forms of tetanus?
"1. Localized<div>2. Facial</div><div>3.
Neonatal - follows infection of umilical cord</div><div>4. Generalized</div><d
iv><img src=""localized.jpeg"" /><img src=""facial.jpeg"" /><img src=""neonatal.
jpeg"" /><img src=""tetanus.jpeg"" /></div><div><img src=""paste-391434729423174
.jpg"" /></div>"
3/14naeroes Dickey
Why do you have to give people whove had tetany a tetanus vaccine afterward?
Because the toxins causing the disease actually <u>isnt enough to elicit a <>m
emory</> immune response</u> 3/14naeroes Dickey
What is a common cause of gingivitis?&nsp;<div><r /></div><div>Gram positive/n
egative? Shape?</div><div>Treatment</div>
"Porphyromonas gingivalis<div><
r /></div><div>Gram negative rods - anaeroic</div><div><r /></div><div>treat w
ith doxycycline<r /><div><img src=""gingivitis.jpeg"" /></div></div>" 3/14nae
roes Dickey
What are the three major aspiration syndromes? "1. Chemical penuomonitis second
ary to gastric acid urns<div>2. Bronchial ostruction secondary to particulate
matter</div><div>3. Bacterial aspiration</div><div><r /></div><div><img src=""p
aste-394445501497508.jpg"" /></div>"
3/14naeroes Dickey
What part of klesiella inhiits phagocytosis? <u>Mucoid</u> capsule ID
What is FoodNet and PulseNet? "FoodNet- survey for la confirmed cases of infe
ction caused y enteroacteriaceae. Connects infections with outreaks, and trac
ks sporadic disease y:<div>PulseNet- strains are fingerprinted y pulsed field
gel electrophoresis and compared with strains occuring elsewhere</div><div><img
src=""foodnet.jpeg"" /></div>" ID
What tests can e used to identify enteroacteriaceae "<div>Enteroacteriaceae
are oxidase (-) (lack cytochrome c), and reduce nitrate to nitrite</div><img sr
c=""test entero.jpeg"" />"
ID
What are the major surface antigens of enteroacteriaceae?
Protein antigens
- H antigen (flagella), fimriae (pili)<div>Polysaccharide antigens- K antigen (
capsules), O antigen</div><div>LPS</div><div><r /></div><div>Leads to O:K:H ser
otyping</div> ID
<>ll</> gram (-) acteria contain what that can lead to sepsis?
Endotoxi
n: LPS, (lipid )
ID
Differentiate plasmid transfer y conjugation, transformation and transduction
Conjugation- direct contact<div>Transformation- direct uptake</div><div>Transduc
tion- viral transfer</div>
ID
For the adhesins factor of virulence of enteroacteriaceae, what does P-pili of
E. coli lead to?
P-pili of E. Coli adheres to kidney cells, resulting in
<u>p</u>yelonephritis ID
What can complement do to gram negative acteria unlike gram positive acteria?
ntiodies and <u>complement can lyse gram (-) acteria</u>, ut antiody and co

mplement cannot lyse gram positive acteria ecause of the <u>thickness of pepti
doglycan layer</u>
ID
Descrie pathogenesis of typhoid fever and enterocolitis
Typhoid: acteri
a pass through mucosa--&gt; enter <u>peyers patches</u>. <u>Invade macrophages<
/u> and <u>disseminate</u><div><r /></div><div>Enterocolitis: Intestinal invasi
on and <u>neutrophil recruitment</u> trigger <u>inflammation</u></div> ID
Descrie the chronic carrier state for salmonella
"Persistence of organism
in stool for &gt; 1 year. Some people haror it in their gallladders and const
antly secrete it (1-4% of patients ecome chronic carriers). Typhoid mary (fat
, forty, female). May need cholecystectomy to cure.&nsp;<div><img src=""carrier
.jpeg"" /></div>"
ID
Yersinia enterocolitica produces what sustance related to an E. Coli strain?
Heat-stale toxin similar to ST of ETEC<div><r /></div><div>yerSinia</div>
ID
What are the two kinds of pain? Nociceptive, neuropathic
Neuro
What is nociceptive pain vs. neuropathic pain? <div>Nociceptive: daptive, nece
ssary (fire hot, roken one ad).&nsp;</div><div>Neuropathic: anormal stimula
tion, <u>ypassing nociceptor</u>. Damage to peripheral nerve, can occur anywher
e</div> Neuro
cute pain tends to e what type of pain? How is chronic different?
<div>cu
te- nociceptive, acute injury. Chronic is different in nature and different in m
anagement, alternative therapy can e etter</div>
Neuro
What is hyperalgesia? Nociceptive pain that is out of proportion to the stimul
us. (usually G-protein dependent phosphorylation of nociceptive channels)
Neuro
What is sustance P role in hyperalgesia?
It inds to <u>mast cell recepto
rs</u> release algesic sustances (prostaglandins, radykinin) stimulate nocicepto
rs.
Neuro
Descrie process of skin injury and mast cells causing pain
Injury stimulatio
n of nociceptors sustance P released from nociceptive endmast-cell degranulation
(radykinin/prost.) further stimulation of nociceptors Neuro
What are the difficulties of treating a spider ite?
"Inflamed, so local anes
thetics wont work. (inflammation causes local pH to drop, vasodilation, local pai
n relief small chance of working)<div><img src=""spider.jpeg"" /></div>"
Neuro
What happens to referred pain as it ecomes more evolved clinically?
The pain
ecomes more localized (McBurneys point, crushing susternal chest pain)
Neuro
What does flank pain, radiating to groin signify?
Kidney stone
Neuro
ppendicitis
What does dull umilicus pain localizing to RLQ signify?
Neuro
What does sharp ack pain radiating upwards signify?
ortic dissection
Neuro
What does R shoulder pain signify?&nsp;
Diaphragmatic irritation (laparo
scopy) Neuro
What is guarding?&nsp;What is splinting?
Guarding: painful contraction of
muscles due to nociception that is deeper. Pain feels like its coming from musc
les. (sign, not action)<div><r /></div><div>Splinting: a more conscious action
to protect pain (limping). Or, shallow reathing following thoracic, adominal s
urgical. (action, not sign)</div>
Neuro
Descrie the plasticity-dependence of chronic pain?
Chronic pain may produce
long-term changes elsewhere in the nociceptive system, intractale chronic pain
.
Neuro
Chronic pain relies on activation of which specific receptors? (not axons)
Glutamate NMD receptors, and increase in reception of 2nd order nociceptive neu
rons
Neuro
What is allodynia? Contrast with hyperalgesia.&nsp;
<u>Innocuous</u> stimulu
s perceived as <u>noxious</u>. Hyperalgesia is a <u>painful</u> stimulus that is
<u>extremely painful</u>.&nsp;
Neuro
Descrie the capsaicin allodynia model Destroy C nociceptors alpha, delta fill

vacancies stimulation on these large fiers also cause nociception

Neuro
<div>The CNS parenchyma has no has no nociception, ut what does in the rain?</
div>
Large cereral lood vessels, sense distension and traction, as well as
algesic sustances (radykinin) Neuro
Nosocomial pathogen, immunocompromised host, neutropenic fever Pseudomonas
ID
"<img src=""9d100278c4152ac78f563c55406f9a962cf5e_Q_0.svg"" />"
"<img sr
c=""9d100278c4152ac78f563c55406f9a962cf5e__0.svg"" />"
"<img src=""9d10
0278c4152ac78f563c55406f9a962cf5e_source_svg.svg"" />"
"<img src=""9d10
0278c4152ac78f563c55406f9a962cf5e_EG.jpeg"" />"
ID
What nosocomial pathogen associated with ventilator associated pneumonia, cathet
er associated acteremia, and having received road-spectrum ax?
Stenotro
phomonas
ID
When you think of legionella, what two things should you think aout? 1) Outr
eaks<div>2) Harored in water</div>
3/17LegionellaMycoplasmaChlamydia
Hyponatremia with pneumonia should raise your suspicion of what ug?
Legionel
la
3/17LegionellaMycoplasmaChlamydia
Often seen with altered mental status and pneumonia.
Legionella
3/17Legi
onellaMycoplasmaChlamydia
How is legionella tested for in real world?
Order a urinary legionella antig
en (check sample of urine); a 4x rise in titer levels indicates infection
3/17LegionellaMycoplasmaChlamydia
What are the est agents for treating legionella?
Newer macrolides (azithr
omycin)&nsp;<div>Levofloxacin</div><div><r /></div><div>macrolides: crows</div
><div>levofloxacin (fluoroquinolone)-flower</div>
3/17LegionellaMycoplasma
Chlamydia
How is mycoplasma pneumonia transmitted? What age range is it typically seen in?
Infected respiratory droplets; 5-20 years old (FC: 18-24)
3/17LegionellaMy
coplasmaChlamydia
Name some extrapulmonary manifestations of M. pneumonia (5)
"1. Hemolsysis v
ia cold agglutinin disease<div>2. Erythema multiforme</div><div>3. Stevens-Johns
on syndrome</div><div>4. Encephalitis</div><div>5. ullous myringtis of TM</div>
<div><img src=""stevens johnson.jpeg"" /></div>"
3/17LegionellaMycoplasma
Chlamydia
Why wont eta-lactams work with mycoplasma?
No cell wall
3/17LegionellaMy
coplasmaChlamydia
What are the three main species of chlamy<i>dophila?</i>
C. pneuomonia<di
v>C. psittaci</div><div>C. pecorum/trachomatis</div>
3/17LegionellaMycoplasma
Chlamydia
What is unique aout the reproductive cycle of Chlamydia?
"<div>EBs infect
epithelial cells, convert to RBs, RBs proliferate and form inclusion odies whi
ch then fuse to form one large inclusion ody -&gt; the RBs switch ack to EBs a
nd and then the inclusion ody reaks and releases all the EBs<r /><img src=""c
hla replication.jpeg"" /></div><img src=""image1.png"" />"
3/17LegionellaMy
coplasmaChlamydia
Whats the triad for reactive arthritis?
"<div>""Cant see, cant pee, ca
nt clim a tree""</div><div><r /></div>Uvitis<div>Urethitis</div><div>rthriti
s</div>"
3/17LegionellaMycoplasmaChlamydia
What is lymphogranuloma venereum?
"<div><u>Ulcerative genital infection</u
> caused y <u>C. trachomatis</u> (serovars L1-L3 -&gt; different from usual ser
ovars causing genitourinary disease)</div><div>Predominantly a disease of the ly
mphatic system</div><div>Late stage --&gt;&nsp;<>groove sign</></div><div><img
src=""lV.jpeg"" /></div>"
3/17LegionellaMycoplasmaChlamydia
What are the stages of LGV?
<div>Primary: <u>Genital ulcer</u> at site of in
noculation</div><div>Secondary: 2-6 weeks later -&gt; significant inflammatory r
eaction in the inguinal lymph nodes -&gt; <u>groove sign</u></div><div><r /></div
>
3/17LegionellaMycoplasmaChlamydia
Do you culture C. psittaci?
NO - its so infectious that everyone in the la
will get it
3/17LegionellaMycoplasmaChlamydia
Cat scratch fever is caused y? Bartonella spp. 3/17Zoonotic

What 4 patient populations are particularly susceptile to lower inoculum sizes

of pathogens that cause diarrhea?
Immunocompromised<div>Elderly</div><div>
Infants</div><div>Those on PPIs</div> 3/17Diarrhea
Which E. Coli Strand causes higher incidence of dysentery? (give serotype #)
E. Coli O157&nsp;
3/17Diarrhea
What does E. coli cause that can lead to dysentery and hemolytic uremic syndrome
?
"Hemorrhagic colitis&nsp;<div><img src=""hemorrhagic.jpeg"" /></div>"
3/17Diarrhea
Who is more prone to ischemic colitis from E.coli? &nsp;To Hemolyitic uremic sy
ndrome? Elderly= think ischemic colitis<div>Young= hemolytic uremic syndrome</di
v>
3/17Diarrhea
Do you give ax to patients with salmonella?
No, only given to the elderly c
they are at an increased risk to get acteremia&nsp; 3/17Diarrhea
Who is at the greatest risk for contracting non-typhoid salmonella?<div><r /></
div><div>Why?</div>
Infants--they are susceptile to the lower incoulum size
s and can pick up the organism via cross contamination&nsp;
3/17Diarrhea
What type of diarrhea is ciprofloxacin resistant?
"Campyloacter jejuni di
arrhea&nsp;<div><img src=""resist.jpeg"" /></div>"
3/17Diarrhea
What are three possile complications of campyloacter jejuni? 3 risk facters?
"<div>Guillain-Barres syndrome</div><div>IBS</div><div>Reactive arthritis&nsp;
</div><div><r /></div><div>Risks: chicken, ax, and international travel</div><
div><img src=""campy jejuni risks.jpeg"" /></div>"
3/17Diarrhea
What must e done for patients with recurring outs of C. Difficle infections
Intestinal colonization resistance is lost and must e restored in those with CD
I through Fecal <u>Microiota</u> Transplant&nsp;
3/17Diarrhea
What do aneroes require for growth?&nsp;<div><r /></div><div>Can pathogenic a
naeroes survive in presence of oxygenated atmosphere?</div>
Reduced O<su>2<
/su>. Survive aout up to <u>72 hours</u> in oxygenated atmosphere
Dickey I
D
What is colonization resistance?
Concept that <u>anaeroic acteria</u> o
ccupy ecological niches that would otherwise e filled with pathogenic organisms
.&nsp;<div><r /></div><div>How protect? deplete oxygen and other nutrients, an
d produce various enzymes and toxic products</div>
Dickey ID
<div><u>How are aneroic acteria eneficial?</u></div>naeroic acteria produc
e what vitamin?&nsp;<div>How do anaeoic acteria help fat asorption?</div>
Vitamin K<div><r /><div><u>Deconjugate ile acids</u> to regulate fat asorptio
n and cholesterol metaolism</div></div>
Dickey ID
What is the therapy of clostridial gangrene/myonecrosis? What to avoid? "Surgica
l deridement<div>Hyperaric O2 may help</div><div>Drugs that interefere with <u
>protein synthesis</u></div><div><u><>No role</></u> for clostridial antitoxin
</div><div><img src=""myonecrosis.jpeg"" /></div>"
Dickey ID
C. difficile contain what toxins? (3) "ll have <u>Toxin B </u>(TcdB)<div><div
>Many have <u>Toxin </u> (Tcd)</div><div><r /></div><div><u>Binary toxin</u><
>-</>-&gt; irreversile adenosine diphosphate-riosylation of actin</div></div
><div><img src=""paste-386254998864115.jpg"" /></div>" Dickey ID
Why should infants never eat honey?
"Infants <u>ingest spores</u> from C<u>.
otulinum</u> contained in honey--&gt; guts are <u>permissive</u>, unlike adult
s<div><r /></div><div>Spores can germinate in aies</div><div><img src=""paste
-390446886945100.jpg"" /></div>"
Dickey ID
Drug addicts that skin pop lack tar heroin are at risk for what?
"wound B
otulism<div>Can occur in any traumatic wound</div><div><img src=""otulism.jpeg"
" /></div>"
Dickey ID
Other than clinical impression, how can otulism e diagnosed? "Mouse ioassay
(CDC and a few states including TX)<div><img src=""mouse.jpeg"" /></div>"
Dickey ID
What are the two immunizations given for tetanus?
"Passive and active immu
nization<div><r /></div><div>Passive- 500 U human tetanus Ig (<u>antitoxin</u>)
IM, <u>locks unound toxin</u></div><div>ctive- toxin causing disease is insu
fficient to induce immunity</div><div><r /></div><div><img src=""paste-39302386
7322496.jpg"" /></div>" Dickey ID

Mixed anaeroic pleuropulmonary infections can include what l4 progressing lung

prolems
"<div>1) pneumonitis</div><div>2) aspiration pneumonia</div><div
>3) necrotizing pneumonia</div><div>4) lung ascess</div><div><r /></div><div><
img src=""paste-394690314633708.jpg"" /></div>" Dickey ID
What is diagnostic procedure of choice for anaeroic pleuropulmonary infections?
Why cant you do culture?
"Sputum gram-stain--&gt; variety of acterial mo
rphologies<div>NO culture of expectorated sputum ecause of oral contamination (
unreliale)<r /><div><img src=""paste-396558625407222.jpg"" /><r /><div><r />
<div><img src=""paste-396391121682623.jpg"" /></div></div></div></div>" Dickey I
D
T/F intraperitoneal injection of acteria alone cause peritonitis or ascess for
mation "No, need at least 3 other factors:<div>1) inflammatory mediators</div><
div>2) environment favorale to anaeroic proliveration (dead dissue, dec. O2)</
div><div>3) acterial synergism from oth aeroic and anaeroic</div><div><r />
</div><div><img src=""paste-398882202714271.jpg"" /></div>"
Dickey ID
Contrast primary vs. secondary peritonitis
Primary- usually 1 species, with
out evident source<div><r /><div>Secondary- polymicroial, loss of integrity of
arrier (perforation due to appendicitis, diverticulitis, trauma)&nsp;</div></
div>
Dickey ID
Descrie hepatic and pancreatic ascesses, type of acteria?
"Hepatic- compli
cations of <>cholecystitis/appy/diverticulitis, peritonitis.</> <u>Polymicroi
al</u>&nsp;<div><r /><div>Pancreatic- from pancreatitis, <u>facultative anaero
es (E. coli, enterococcus)</u></div><div><u><r /></u></div><div><img src=""pas
te-400583009763486.jpg"" /></div></div><div><r /></div><div><img src=""paste-40
0677499044062.jpg"" /></div><div><img src=""paste-400780578259210.jpg"" /></div>
"
Dickey ID
Descrie pathogenesis of diverticulitis "Herniation of owel mucosa and sumucos
a through circular muscular layer of gut --&gt; <u>diverticulosis</u>--&gt; infl
ammation of diverticula, <u>diverticulitis</u>--&gt;similar to appy, ostruction
, inflammation, ischemia and <>rupture</><div><u><r /></u></div><div>Located
in sigmoid and descending colon</div><div><r /></div><div><img src=""diverticul
osis.jpeg"" /></div>" Dickey ID
Ostructed common ile duct is from what? Leads to what?
"Multiple stones
--&gt; <u>cholangitis</u>--&gt; results in <>acteremia/sepsis, hepatic ascess
es</><div><img src=""cholangitis.jpeg"" /></div><div><r /></div><div><img src=
""paste-401639571718216.jpg"" /></div>" Dickey ID
What causes emphysematous cholecystitis? <>More common in what patient populati
ons</> "Gas-forming organisms (anaeroes or facultative anaeroes), more common
in diaetics<div><img src=""emphyII.jpeg"" /></div><div><img src=""emphy.jpeg""
/></div>"
Dickey ID
What are the components of informed consent? (4)
greement with physician
recommendations, right to refuse recommended interventions, choice among altern
atives, shared decision-making Ethics
What are the 4 requirements of informed consent?
<div>1. Disclosure</div>
<div>2. understanding</div><div>3. uthorization</div><div>4. Voluntary choice</
div><div><r /></div> Ethics
What are requirements of disclosure? (6)
Diagnosis, nature and purpose of
intervention, enefits, risks, likely consequences, alternatives
Ethics
What are 2 prolems with informed consent?
<div>1. Lack of patient <u>under
standing</u> of information</div><div>2. Patients <u>do not want</u> to make dec
isions</div><div><r /></div> Ethics
What are 4 exceptions to informed consent?&nsp;
<div>1. Lack of decision
making capacity</div><div>2. Emergencies</div><div>3. Therapeutic privilege (wi
thold information ie HIV man suicide)</div><div>4. Waiver</div><div><r /></div>
Ethics
Name the pathogens with high rate, moderate rate and low rate spread
"<div>Hi
gh rate of spread</div><div><>Shigella, norovirus&nsp;</></div><div><r /></d
iv><div>Moderate spread</div><div>Giardia, cryptosporidium, STEC, Salmonella</di
v><div><r /></div><div>Low rate of spread</div><div><>Campyloacter, EIEC, ETE
C, V. cholerae</></div><div><r /></div><div><img src=""spread.jpeg"" /></div>"

ID
What important pathogen for diarrhea produces &gt;100,000 cases per year?
Shiga toxin-producing E. Coli (STEC), aka EHEC ID
What is pathogenesis of clostridium difficile infection?
Susceptile pers
on (age, co-morid, lack of a to c diff. toxins) + receipt of drugs that alter
intestinal microiomeexposure to C diff
ID
Therapy for CDI- 1st, 2nd, and 3+ recurrences? <div>1st, 2nd out inhiition of
growth C. Diff, re-estalish gut flora, immune response toxins</div><div>More th
an 2 recurrences fecal microiota transplant&nsp;</div>
ID
What happened in 2011 Germany with emergence of super-pathogen? What plant?
"<u>EEC</u> that picked up <u>Stx 2 producing phage</u>, douly pathogenic. In
sprouts (dont let elderly eat them)<div><img src=""super (1).jpeg"" /></div>"
ID
In preveral kids, what is a surrogate marker for pain? Fussiness (consolale-ne
ss), high p, tachy
Neuro
Most common NSID in hospital? Toradol IV (ketorolac) Neuro
What is mechanism of toxicity of NSIDs?
Nephrotoxicity-renal lood flow
depends on <u>prostaglandins</u>, locking PG impairs flow.&nsp;
Neuro
<div>What is mechanism of toxicity of acetaminophen?</div>
<div>Hepatotoxic
depletes hepatic antioxidants (glutathione)</div>
Neuro
Prototypical narcotic and what receptors? Give receptor function
Morphine
:<div><r /></div><div>mu agonist (analgesia, respiratory depression, pruritus,
nausea, constipation)</div><div><><r /></></div><div><>k </>agonist (<>mio
sis</>)</div><div><r /></div><div>&nsp;<>d</>elta agonist: analgesia and so
me role in depression</div>
Neuro
Why do narcotics cause respiratory depression? Increases the threshold of CO2,
so stop reathing and also high CO2 makes you tired.&nsp;
Neuro
What is PC? What are modes
<div>Patient-controlled analgesia (most commonly
morphine, ut others too).&nsp;</div><div>Interval dosing, continuous infusion
. Can have lockout dose</div> Neuro
What is naloxone used for, and what is the danger?
Central mu opioid antago
nist, competitive inhiition. Causes horrile withdrawal symptoms, makes pain re
turn. If OD with opioid, reath for them rather than use this.&nsp;
Neuro
What is naluphine, what is it used for?&nsp; Mu, kappa agonist/antagonist, fo
r pruritus.  drug with some antagonist properties to fight off side effects
Neuro
Ondansetron is what type of drug?&nsp; 5-HT3 antagonist, good side effect profi
le, easy to dose.&nsp; Neuro
How to treatment opiate overdosage?
O2, support ventilation, stop opiate, ti
trate naloxone <i>slowly</i>.&nsp;
Neuro
What is CRPS and what is cause? Two types of CRPS?
<div>Complex regional pa
in syndrome, trauma causes anormal discharges in <u>sympathetic efferents</u></
div><div>CRPS I- (RSD) no nerve damage</div><div>CRPS II- (causalgia), nerve dam
aged</div><div><r /></div>
Neuro
<div>How to treat CRPS?&nsp;</div>
1) Block sympathetic innervation to regi
on (local first),<div><r /></div><div>2) Then try neurolytic lockade.&nsp;</d
iv><div><r /></div><div>3) Some use for anti-epileptic drugs.&nsp;</div>
Neuro
Patient has urning pain, swelling, redness, allodynia, loss of function?
"CRPS (complex regional pain syndrome)<div><img src=""CRPS.jpeg"" /></div>"
Neuro
Why use NSIDS as a first line drug for analgesia?
Well-tolerated therapeut
ic window, good side fx profile, adjunct for procedures, allows lower dose of ot
her drugs, anti-inflammation
Neuro
In the primary, pre-emptive treatment of pain, what type of pain should not e o
verlooked?
Neurocognitive&nsp;
Neuro
On what does legionella grow? Doesnt grow on routine acteriological media, nee
d <u>charcoal yeast culture with iron and cysteine</u> ID
If pneumonia with no clear-cut organisms apparent on Gram stain, what to think?
Pneumonia with legionella (technically gram neg. ut stains poorly with gram sta

in)
ID
What is most common strain of legionella? nother strain name? L. pneumophila (
90%). lso L. longeachae is a strain ID
What will rucella grow in? eroic/anaeroic? What will it not grow in. Descri
e morphology
<div>eroic growth on chocolate agar, and sheep lood agar.&ns
p;</div><div><>No growth</> on MacConkey or Eosin methylene lue (EMB) agar&n
sp;</div><div><u>Gram (-) rod</u></div> ID
Pathogenesis of rucellosis
"<div>dapt to intracellular condititions of mac
rophage infect <u>reticuloendothelial</u> system&nsp;</div><div><img src=""retic
llo.jpeg"" /></div>"
ID
Tx for plague? "Gentamicin, may comine tetracycline<div><r /></div><div>amino
glycoside with tetracycline</div><div><r /></div><div><img src=""paste-15252287
8615944.jpg"" /></div>" ID
Two main human ehrlichial diseases?
<div><>Human monocytotropic ehrlichiosi
s (HME)</></div><div>-This acteria is an oligate intracellular pathogen affec
ting <u>monocytes</u> and <u>macrophages</u>.</div><div><><r /></></div><div>
<>Human granulocytotropic anaplasmosis (HG)</></div><div>-The acteria infect
white lood cells called <u>neutrophils</u>, causing changes in gene expression
that prolong the life of these otherwise short-lived cells.</div>
ID
<div>What is diagnostic for ehrlichia? Treatment for this and rickettsiae?</div>
<div>&gt;4x IgG, IgM presence</div><div>Doxycycline</div>
ID
What is mechanism for plasmid transfer y conjugation? Plasmid in donor male ce
ll <u>encodes sex pili</u>transfer replication creates single copy given to femal
e single stranded plasmid converted to circular duplex<div><r /></div><div>1. Sm
all DN circle or plasmid called the F factor is required</div><div>2. F+ cell p
roduces pilus to contact another cell</div><div>3. Single copy is transfered to
cell</div><div>4. Copy is duplicated to ecome a circular duplex</div> ID
What happens with chromosomal gene transfer y conjugation?
"<div>1.Conjugal
plasmid is integrated in the host cell chromosome</div><div>2. Sex pilus rings
to acterial cells together</div><div>3. Donor chromosome is transferred as a s
s DN (&nsp;transfer replication initiated within plasmid sequence, ut flankin
g DN also conjugated)</div><div>4. transferred DN ecomes doule stranded</div
><div>5. donor DN integrated into recipients DN y homologous recomination</d
iv><div><r /></div><div><img src=""paste-258814729257516.jpg"" /></div><div><r
/></div>"
ID
What is mechanism of transformation (4) "<div>1. Trnasfer of naked DN into a re
cipient cell</div><div>2. Doule stranded donor DN inds to specific receptors<
/div><div>3. Single stranded donor DN pairs with homologous region on recipietn
DN and integrated y homologous recomination</div><div>4. Mismatch repair eit
her comes to replace the donor or original DN&nsp;</div><div>5. Cells are plat
ed on media to select for the cells with the desired DN</div><div><r /></div><
div><r /></div><div><r /></div><div><img src=""paste-259252815921652.jpg"" /><
/div><div><r /></div>Development of <u>competence</u>DN <u>inds</u> to cell su
rface DN <u>enters</u> cell DN<u> integrates</u> into chromosome y homologous r
ecomination"
What did Griffith demonstrate? What did very, MacLeod, McCarty do?
G: Smoot
h, rough SPN. <u>Transformation</u> of dead virulent strain into avirulent strai
n<div><r /></div><div>: Transforming principle is <u>DN</u>, ecause transfor
mation is DNse-sensitive</div> ID
What ethical implications are at stake of granting/denying DMC? <div>t stake: d
ecisional rights, autonomy</div><div>lso: consequences/patient est interest</d
iv><div><r /></div>
Ethics
What is difference etween competency vs. capacity&nsp;
"<div><u>Compete
nce</u> is a <u>legal</u> determination, all adults are assumed to e competent
unless court declared incompetent. Binary yes-no</div><div>In clinical practice, d
octors can make decisions if patient lacks <u>decision-making capacity</u>. Degr
ees of capacity.&nsp;</div><div><img src=""Capacity.jpeg"" /></div>" Ethics
What are 4 components of DMC? <div>1. Patient makes and <u>communicates a choi
ce</u> (stroke)</div><div>2. Patient <u>understands</u> relevant information (in
tellectual disaility)</div><div>3. Patient <u>appreciates</u> relevance of info

rmation to own situation (denial, mental disaility)</div><div>4. Patient uses <

u>reasoning</u> in light of their values and goals.&nsp;</div> Ethics
What are questions to ask for clinical assessment of DMC? (understanding, apprec
iation, reasoning)
<div>Understanding: What is X likely to do for you?</div
><div>ppreciation: If enefits or risks occurred, how would your daily life e
affected?</div><div>Reasoning: Tell me how you reached your decision.</div><div>
<r /></div>
Ethics
What are additional tools for assessment of DMC?
<div>Standardized Mental
Status Testing, Macrthur Competence Tool for Treatment,&nsp;</div><div><r />
</div><div>Clinician judgment + sliding scale (higher stakes, more demonstration
of DMC)</div> Ethics
If patients lack DMC, what 2 principles guide care?
<u>Sustituted judgment s
tandard</u>, guided y previously <u>stated wishes</u>. If not known, <u>est inte
rest</u> standard. Or turn to surrogate decision-maker Ethics
Who can e surrogate decision maker?
"<div>1. &nsp;gent under medical power
of tty, legal guardian</div><div>2. &nsp;Spouse</div><div>3. &nsp;dult Chil
d With Waiver and Consent of Other dult Children</div><div>4. &nsp;Majority of
Reasonaly vailale dult Children</div><div>5. &nsp;Parents</div><div>6. &n
sp;Nearest (kinship not geography) Living Relative</div><div>or Memer of Clergy
</div><div>or Individual Clearly Identified to Do So Before Incapacitation</div>
<div><img src=""priority.jpeg"" /></div>"
Ethics
What can a surrogate decision maker not consent to?
<div>1. Voluntary inpati
ent mental health services</div><div>2. Electro-convulsive treatment</div><div>3
. ppointment of another surrogate decision maker</div> Ethics
What are the three colony morphologies oserved with diphtheria?
Gravis,
mitis and intermedius 3/21DiptheriaListeria
How is diphtheria transmitted? (2 modes)
Respiratory and cutaneously - hu
mans are the only natural host 3/21DiptheriaListeria
Does diptheria invade deep tissues?
"No, grows mainly on tonsils or pharynx
- no acteremia<div><img src=""paste-607248246112259.jpg"" /></div>"
3/21Dipt
heriaListeria
Is the cutaneous form of diphtheria lethal?
No, its relatively mild ut is a
way for the disease to spread 3/21DiptheriaListeria
How do you diagnose diphtheria? (clinically, acteriological, toxigenicity)
"<>Clinically</> - pseudomemrane<div><>Bacteriological</> - Cultivate on <u
>Loeffler</u> slant; <u>tellurite</u> agar (<u>catalase positive</u>)&nsp;</div
><div><>Toxigenicity</> - <u>Elek</u> immunodiffusion, PCR for <i><u>tox </u><
/i>gene</div><div><r /></div><div>Elek:</div><div><img src=""elek.jpeg"" /></di
v><div> filter paper strip impregnated with diphtheria antitoxin</div>"
3/21DiptheriaListeria
What is the treatment of Diphtheria?
<div>Treatment (MUST BE PROMPT!)</div><d
iv>a. <>ntitoxin</> (DT = Diphtheria ntitoxin) anti-toxin horse serum (equi
ne antitoxin given IV).&nsp;</div><div>. <>ntiiotics</> administered to su
ppress the toxin-producing acteria: penicillin, erythromycin</div><div>c. <>Cu
taneous Diphtheria</>: Thorough <u>cleansing</u> of lesion with soap and water
and antiiotics</div><div>d. Contact and Droplet Precautions, <>Isolation</></
div><div>e. <>Vaccination</>: <i>must vaccinate, respiratory disease is not im
munizing</i>. DTaP, Tdap, Td contain diphtheria toxoid (inactivated diphtheria t
oxin), which is immunogenic.</div>
3/21DiptheriaListeria
Which populations are especially susceptile to listeria infection?
"Immunoc
ompromised: elderly and IDS<div><u>Pregnant women and their fetuses</u></div><d
iv><r /></div><div><>Perinatal listeriosis</> can have a high mortality rate.
</div><div><img src=""peri.jpeg"" /></div>"
3/21DiptheriaListeria
Do the mothers who contract listeria usually do OK?
Yes, ut their aies us
ually die
3/21DiptheriaListeria
Descrie the gram stain and characteristics of Listeria "Gram (+), acillus, eas
ily over colorized and <>motile</><div>lso weakly hemolytic, resistant to hig
h salt and grows at 4 degree C (survives in your fridge)</div><div><img src=""li
st (1).jpeg"" /><img src=""list 1.jpeg"" /></div>"
3/21DiptheriaListeria
Descrie the pathogeneisis of Listeria (Invades through, name 3 molecules it use

s to get into what cell)&nsp; "Invades through M cells -&gt; gets in the lood
-&gt; uses proteins <>invasin and internalin</>&nsp;to get into <u>macrophag
es</u>.<div><r /></div><div>voids phagosome with <>listeriolysin O</></div><
div><><img src=""paste-631785394274307.jpg"" /></></div><div><><img src=""inv
asion.jpeg"" /></></div>"
3/21DiptheriaListeria
What mediates immunity to Listeria? (which immunity arm)
<div>Need <u>cyt
okine-activated Macrophages</u> and <u>Cytotoxic T cells</u> to clear (<u>MHC cl
ass I gs</u>)</div><div>Key point: <>facultative intracellular</></div>
3/21DiptheriaListeria
How does antrax infect you?
"Inhaled spores<div><img src=""spore.jpeg"" /></
div>" 3/21DiptheriaListeria
What is the treatment for anthrax?
<u>6 week</u> course of <u>ciprofloxacin
</u> or <u>doxycycline</u> to kill all spores<div>susceptile to <>penicillin</
3/21DiptheriaListeria
> ut is usually too late</div>
Cough and cough and have to try to quickly suck in a reath.
"The ""whoop"" i
n whooping cough, caused y ordetella<div><img src=""whoop.jpeg"" /></div>"
3/21BordetellaNeisseria
Hemorrhages elow the eyes and in the conjunctiva of children and aies?
"B. pertussis<div><img src=""eyes (1).jpeg"" /></div>" 3/21BordetellaNeisseria
Whats the main way pertussis is diagnosed today?
"PCR<div><img src=""diag
nosis pert.jpeg"" /></div>"
3/21BordetellaNeisseria
What is the catalase and oxidase status of pertussis? Postive for oth<div>(re
memer purple test)</div>
3/21BordetellaNeisseria
What are two endotoxins that ordetella produces?
"<u>Tracheal cytotoxin</
u> - peptidoglycan fragment which <>kills epithelial cells</><div><r /></div>
<div>Lipo-oligosacchride (<u>LOS</u>) - causes <>inflammation</></div><div><r
/></div><div><img src=""ord endo.jpeg"" /></div>"
3/21BordetellaNeisseria
Broncial plugging is seen in? "Pertussis ronchiopneumonia in aies<div><img
src=""plugging.jpeg"" /></div>" 3/21BordetellaNeisseria
How is pertussis treated?
Early on antiodies may not have an effect ecau
se its toxin-mediated so mainly <>supportive care</><div><><r /></></div><
div><>Macrolides</> may limit severity and transmission</div> 3/21BordetellaNe
isseria
What virulence factors does neisseria have? (3) "<u>Pili</u> for <>adherence</
><div><u>Opacity proteins</u>- outer memrane, <>adherence</></div><div><u>Pol
ysaccharide capsule</u> containg LOS, allows it to <i><>invade</></i> cells an
d get into the loodstream</div><div><img src=""virulence fac.jpeg"" /></div>"
3/21BordetellaNeisseria
How is N. meningitidis treated? Close contacts? <div>Most are <u>penicillin</u>
susceptile, ut should test. 3rd gen cephalosporins can treat.&nsp;</div><div>
<r /></div>Close contacts: rifampin, ceftriaxone, cipro<div><r /></div><div>Va
ccines dont protect against type B</div>
3/21BordetellaNeisseria
What are 3&nsp; hemolytic bacteria? "S. Gallolyticus, enterococcus, milleri
roup strep<div><im src=""amma (1).jpe"" /></div>" ID
What are the 3 common species and reservoir of brucella?
B. abortus- cows
<div>B. melitensis- oats/sheep</div><div>B. suis- pis</div><div><br /></div><d
iv>also B. Canis- dos</div>
ID
What are the 3 types of advance directives established by the Texas Advanced dir
ectives act?
Directives to physicians, Medical Power of Attorney, Out of hosp
ital DNR order Ethics
What is the order of the standards for EoL surroate decision makin? What is on
e restriction? First, <u>substituted judment</u>, then <u>best interest</u>.&n
bsp;<div>Surroates <u>cannot refuse pain meds.</u></div>
Ethics
What is the priority list of surroate decision makers for EoL DM (life-sustaini
n tx, not routine tx)? "<div>1. Aent under MPOA or uardian, attendin physici
an + 1 of the below</div><div>Spouse, adult children, parents, nearest livin re
lative, attendin with concurrence of 2nd physician not involved in care or memb
er of ethics committee</div><div><im src=""hierarchy.jpe"" /></div>" Ethics
What are 3 types of commonly invoked ethical distinctions?
"<div>Withdrawin
 vs. withholdin LST</div><div>Cessation of artificial nutrition/hydration vs.

cessation of other types of LST</div><div>Type of treatment at stake (shouldnt ma

tter)</div><div><img src=""withdraw.jpeg"" /></div>"
Ethics
An advanced directive to physicians is only applicable in what situations?
"<u>Terminal or irreversible condition</u> and <u>unable to ma
e decisions&nbsp;
</u><div><u><img src=""terminal.jpeg"" /></u></div>"
Ethics
When is MPOA operable? After a patient loses capacity to ma
e decisions (termin
al/irreversible condition <b><u>NOT</u></b> required) Ethics
When is Out-of-Hospital DNR operable? Directs healthcare professionals in outof-hospital setting to NOT initiate CPR. (Out-of-Hospital includes Emergency Dep
arment)&nbsp; Ethics
What are the 4 broad categories of motor unit disease? (right title?) Neuropat
hy, myopathy, NMJ disorder, motor neuron disease
Neuro
What are some examples of categories of neuropathies? Motor neuropathy, sensor
y neuropathy, sensorimotor combination Neuro
What is the name for process of single nerve damage, multiple nerves damaged, an
d individual nerves pic
ed off one after the other?
Mononeuropathy, polyneur
opathy, mononeuropathy multiplex
Neuro
<div>What are two examples each of axonal and demyelinating neuropathies?</div>
"<div>Axonal- toxic, metabolic&nbsp;</div><div>Demyelinating- Guillian Barre Syn
drome, Charcot Marie Tooth disease&nbsp;</div><div><img src=""2.jpeg"" /></div>"
Neuro
What are the two examples of electrical testing in PNS and what can they disting
uish? (give each test and what they are distinguishing) "<div><b>Nerve conductio
n velocity</b>- speed of conduction assessed, depends on integrity of myelinated
fibers, whereas amplitude of signal depends on number of axons carrying signal.
<u>Allows distinction between <b>axonal</b> vs. <b>demyelinating</b> neuropathy
</u></div><div><br /></div><div><b>Electromyography (EMG)</b>- stic
ing needle i
nto muscle and observing activity at rest and when volitionally activated. <u>Al
lows distinction between <b>neuropathic</b> process vs. <b>myopathic</b> process
.</u></div><div><br /></div><div><img src=""PNS graph.jpeg"" /></div>" Neuro
On a graph of conduction time vs. amplitude, what will an axonal and demyelinati
ng neuropathy show, respectively?
"<div>Axonal- <u>Normal velocities, but
reduced amplitude</u>. Reduced number of axons in nerve fiberslower amplitude</di
v><div><br /></div><div>Demyelinating- <u>Velocity is reduced, but amplitude is
normal or only slightly diminished.</u> Axons are preserved, just slower.&nbsp;<
/div><div><img src=""PNS graph.jpeg"" /></div>" Neuro
What nerve can be biopsied for PNS studies?
"Sural nerve, but significant mo
rbidity and processing. Not done very much.&nbsp;<div><img src=""sural.jpeg"" />
</div>" Neuro
Describe onion-bulbing deformity. What else is it called?
"Repeated demyelination
and remyelination due to <b>dysfunctional Schwann cell</b>. Schwann cell half-as
s wraps, then stops. Can also be called <u>hypertrophic neuropathy.</u><div><img
src=""onion.jpeg"" /></div>" Neuro
Hypertrophic nerves can occur in what disease? "Charcot marie tooth disease<div
><img src=""hyper.jpeg"" /></div>"
Neuro
What is myasthenia gravis associated with?
"<div>Thymic abnormalities (thym
oma 25%, thymic hyperplasia in 50%, hyperthyroidism 5%)</div><div>Also lymphorrh
ages (scattered lymphocytes)</div><div><img src=""ma.jpeg"" /></div>" Neuro
What are diisopropyl flurorophosphates? Nerve gas. Resemble transition state in
action of esterase.&nbsp;
Neuro
What does it mean to distinguish neuropathy from radiculopathy? Sensory abnormal
ities of <u>dermatome</u> (root) or in <u>territory of peripheral nerve</u>.&nbs
p;
Neuro
What happens with acute denervation? What does a biopsy loo
li
e?
"<div>An
gular atrophic fiber with esterase spread</div><div><u>Fiber type grouping</u> o
n biopsy (indicates denervation with reinnervation) Reflects sprouting</div><div
><img src=""angular.jpeg"" /></div><div><img src=""grouping.jpeg"" /></div>"
Neuro
What determines if a muscle fiber is type I or type II? "By the <u>innervating n
euron.&nbsp;</u><div><br /></div><div><b>Type I</b>- aerobic, lots of mitochondr

ia, red</div><div><b>Type II</b>- anaerobic, glycolytic, white</div><div><br /><

/div><div><br /></div><div>RED, WHITE, blue&nbsp;</div><div><img src=""type.jpeg
"" /></div><div><br /></div>" Neuro
What does an atrophic fiber do to signal reinnervation? "Coats itself with choli
nesterase<div><img src=""angular.jpeg"" /></div>"
Neuro
<div>What are two types of myopathies? Give one example of each</div> "<div>De
generative (dystrophy), inflammatory (myositis)</div><div><br /></div><div>&nbsp
;<img src=""myotonic.jpeg"" />&nbsp;&nbsp;<img src=""inflammatory myo.jpeg"" />&
nbsp;</div><div><br /></div><div><br /></div>" Neuro
"<div><img src=""40591351ae74e8b5fd1c5c4765e742dfad4bb28a_Q_0.svg"" /></div><div
>Name process and what type of disease it indicates</div>"
"<img src=""4059
1351ae74e8b5fd1c5c4765e742dfad4bb28a_A_0.svg"" /><div>(vs. myopathic)</div>"
"<img src=""40591351ae74e8b5fd1c5c4765e742dfad4bb28a_source_svg.svg"" />"
"<div><img src=""40591351ae74e8b5fd1c5c4765e742dfad4bb28a_group atrophy.jpeg"" /
></div>"
Neuro
"<div>What disease is occuring here? Describe 4 morphologic processes</div><img
src=""duchenne.jpeg"" />"
"Duchenne muscular dystrophy<div>Myopathic: Macr
ophages eating, basophilia, central nuclei, fiber size variability&nbsp;</div><d
iv><img src=""biopysy finding.jpeg"" /></div><div><br /></div>" Neuro
What is the distrubtion of dystrophin?&nbsp;
"<div>Subsarcolemmal&nbsp;</div>
<img src=""subsa.jpeg"" /><div><br /></div><div><img src=""subsarcolemmal.jpeg""
/></div>"
Neuro
What causes myotonic dystrophy? Inheritance? What gene, and what type of genetic
mechanism?
"Autosomal dominant (gene is <u>myotonin</u>), <u>trinucleotide
repeat amplification</u>. Long mRNA strands gum up other mRNA. Affects other org
ans, not just muscle.&nbsp;<div><img src=""myot.jpeg"" /></div><div><br /></div>
<div>Get cramping</div>"
Neuro
What are clinical features of Myotonic Dystrophy? Proximal or distal? <div>Myo
tonia- <u>impaired muscle relaxation</u></div><div>EXCEPTION: <u>distal</u> musc
le wasting (most myopathies are proximal wasting)</div><div>Frontal balding, end
ocrine abnormalities</div>
Neuro
Describe EMG of myotonic dystrophy vs. normal.&nbsp;
"Busy muscle. Motorcycle/d
ive bomber EMG. Chloride channel is oscillating and not holding steady.&nbsp;<di
v><img src=""EMG myotonic.jpeg"" /></div>"
Neuro
In myotonic dystrophy, what morphology will you see?
"<u>Internal nuclei</u>
(will see the most internalized nuclei in this disease), abnormal arrangement of
contractile elements&nbsp;<div><img src=""internal.jpeg"" /></div>"
Neuro
What are two types of inflammatory myopathies? "Polymyositis, inclusion body my
ositis. Will see lymphocytic infiltration.&nbsp;<div><img src=""in my.jpeg"" /><
br /><div><img src=""inflammatory.jpeg"" /></div></div>"
Neuro
Other than dystrophic and inflammatory myopathy, what others are there?&nbsp;
Congenital, metabolic, mitochondrial
Neuro
"What results from brown-sequard syndrome?<div><img src=""cord syndromes.jpeg""
/></div>"
"Hemisection cord, CONTRA STT loss and IPSI DC, IPSI UMN wea
nes
s<div>IPSI loss of all sensation at the level of lesion<br /><div><img src=""bro
wn seq.jpeg"" /></div></div>" Neuro
"What is the cause and result from anterior spinal cord syndrome?<div><img src="
"cord syndromes.jpeg"" /><div><br /></div></div>"
Anterior spinal cord syn
drome- cross clamp for abdominal/thoracic aorta. DC still intact, but loss of ot
hers.&nbsp;
Neuro
"What is cause and result for a central cord syndrome<div><img src=""cord syndro
mes.jpeg"" /></div>"
Loss of STT at that level (pain, temp, crude touch)<div>
Syringomyelia</div>
Neuro
What are two categories of myelopathy? Segmental (complete or partial) (level),
tract degeneration.&nbsp;
Neuro
If complete segmental myelopathy, describe result of thoracic vs. cervical?
<div>Thoracic- paraplegia</div><div>Cervical- quadriplegia&nbsp;</div><div><br /
></div> Neuro
What is tabes dorsalis? "Tract degeneration of <u>dorsal columns</u>--&gt;<u>Los
s of proprioception, vibration, fine touch</u>. Do not
now where their feet are

(high stepping). When it gets dar

, cannot see feet anymore. Positive Romberg.
Complication of syphillus<div><img src=""tabes.jpeg"" /></div>" Neuro
What does vitamin B12 deficiency lead to in spinal cord? Give clinical name and
explain.
"<u>Combined system degeneration</u>. Tract degeneration. Demyel
ination of <b>DC</b> and lateral <b>CST</b>. Loss of vibration, tactile discrimi
nation, proprioception and time wea
ness, spasticity, hyperreflexia.&nbsp;<div><
img src=""combined.jpeg"" /></div>"
Neuro
"Describe this gross pathology&nbsp;<div><br /></div><div><img src=""ALS.jpeg""
/></div>"
<div>Thic
white roots are dorsal roots (sensory). Still white b
ecause axons will in tact.</div><div>Thinner roots are ventral roots (motor). Ax
ons have degenerated.</div><div><br /></div>
What is an autosomal recessive disease that results in selective degeneration of
anterior horn neurons? "Spinal muscular atrophy<div><img src=""floppy baby.jpeg
"" /></div><div><img src=""ventral.jpeg"" /></div>"
What are clinical manifestations of spinal epidural mass? Give <u>sequence</u><d
iv><u><b>Name 3 common causes</b></u></div>
"<u>Local</u> pain (bone is pain
sensitive, periostium)&nbsp;<div>Radicular pain (compression of nerve root)</di
v><div>Myelopathy (presses on spinal cord)</div><div><br /></div><div>Neoplasms,
abscess, herniated disc are 3 common causes</div><div><br /></div><div><img src
=""spinal spaces.jpeg"" /></div>"
Emergency_6
What are the 3 spaces of the spinal cord
"Extradural space, intradural ex
tramedullary, intramedullary<div><img src=""extrad.jpeg"" /></div>"
Intradural extramedullary masses arise from what structures? Also give cancer na
mes.&nbsp;
Nerve roots (Schwann cells) and meninges (schwannoma, neurofibro
ma, meningioma)&nbsp; Emergency_6
Intradural extramedullary masses lead to what clinical symptoms?
"Radicul
ar pain, myelopathy.&nbsp;<div><br /></div><div>(unli
e epidural masses, not muc
h local pain in the dura)&nbsp;</div><div><img src=""intradrual extra.jpeg"" /><
/div>" Emergency_6
Intramedullary masses (neoplasms) arise from what cells of CNS (give name of the
cancer)?
Astrocytoma, ependymoma, oligodendroglioma. Not really ever from
the nerve cell itself.&nbsp; Emergency_6
What is the clinical symptom of intramedullary masses? "Myelopathy<div>(unli
e
outer locations, no local pain and no radiculopathy from nerve roots, its in the
spine)</div><div><img src=""intra (2).jpeg"" /></div>" Emergency_6
What did the Harlow experiments show? Mon
eys raised w/ <b>mothers alone</b> (
peer deprivation) showed <b>abnormal social patterns</b>. Mon
eys raised w/ <b>p
eers alone</b> (mother deprivation) were <b>clingy and distressed over minor thi
ngs</b>. <b>Both maternal &amp; peer exposure important to development.&nbsp;</b
>
3/26FamilialInfluences Behavioralscience
What is the definition of clinical futility?
Continued treatment is not relia
bly expected to produce its usually <u>intended</u> physiologic outcome.
Ethics
"The AMA defines ""due process"" in defining futility as doing what 2 things?&nb
sp;"
<div>Negotiate disagreements- identify sources of conflict&nbsp;</div>Th
e hospital policy on futility if this doesnt wor

Ethics
What are the 2 justifications for refusing to comply with patient/family request
for inappropriate treatment under TADA 166.046 <div>A belief by clinicians that
continued treatment would be <b>medical inappropriate and violate integrity</b>
</div><div>OR</div><div>A belief on part of clinicians that <b>continued treatme
nt is both appropriate and necessary and cessation would violate professional in
tegrity&nbsp;</b></div><div><br /></div>
Ethics
What is TADA section 166.046? What is the mechanism?
<u>Decision of physician
not to honor</u> a directive or treatment decision must be reviewed by ethics c
ommittee<div><u>48 hour notice</u> to patient/surrogate and right to attend meeti
ng</div><div><u>written explanation</u> of decision reached to patient/surrogate
and in record</div><div><u>reasonable effort to transfer</u> patient if not agree
with decision of committee</div><div>if attending refuses to carry out request f
or life-sustaining treatment and committee supports refusal, <u>treatment can be
discontinued on 10th day after written decision</u> is given to surrogate</div><

div>extension granted only if <u>judge</u> determines reasonable <u>li

elihood o
f finding willing provider&nbsp;</u></div>
Ethics
What are the 2 definitions of death?
<div><u>Cardiac/cardiopulmonary death</u
>- irreversible cessation of spontaneous respiratory and circulatory functions</
div><div><u>Neurological criteria/ brain death</u>- <b><u>all</u></b> spontaneou
s brain function cessation. If artificial means preclude determination of cardio
pulmonary death.&nbsp;</div>
Ethics
Good choice of words? &nbsp;The tests indicate that Mr. so- and-so has died. Im so
sorry for your loss. Please have your family come to say their goodbyes and see
if theyd li
e to be present when we ta
e off the machines. Yes
Ethics
Blood agar grows nearly all bacteria, but a few important bacteria do not grow o
n blood agar. <u>They do grow on chocolate.</u> Name 2 H. influenza, N. Meningi
tidis&nbsp;
What does CNA plate contain and what does it grow?
"It is blood agar that c
ontains <b>c</b>olistin and <b>n</b>alidixix <b>a</b>cid inhibits gram negatives,
<u>grows only gram positives&nbsp;</u><div><u><img src=""CNA agar.jpeg"" /></u>
</div><div><u><br /></u></div><div><u><b>Mnemonic: Acid = (+)</b></u></div>"
<div>Blood culture bottles in incubator have sensor for CO2 and are scanned cons
tantly. If a bottle is positive for CO2 generation (nearly all bacteria do this)
, what happens?</div> Alarm is sounded and healthcare provider is contacted by
law.&nbsp;
<div>T/F Chlamydia can be diagnosed via antibody test.</div><div><br /></div><di
v>Lyme disease can only be diagnosed by what?</div><div><br /></div>
<div>Fal
se, ab is unreliable for chlamydia</div><div><br /></div><div><div>Sending out t
o CDC.&nbsp;</div></div>
Name the symptoms of specific neuronal population lost: cortical neurons, basal
ganglia neurons, cerebellar neurons, motor neurons
<div>cortical neurons: d
ementia</div><div>basal ganglia neurons: movement disorder</div><div>cerebellar
neurons: ataxia</div><div>motor neurons: wea
ness</div> Neuro
"<img src=""e3d3374ad545922fd267f1b03203208599ad31f2_Q_0.svg"" />"
"<img sr
c=""e3d3374ad545922fd267f1b03203208599ad31f2_A_0.svg"" />"
"<img src=""e3d3
374ad545922fd267f1b03203208599ad31f2_source_svg.svg"" />"
"<img src=""e3d3
374ad545922fd267f1b03203208599ad31f2_substantia nigra.jpeg"" />"
Neuro
Describe the overall design of basal ganglia system
System is loo
ing among
available programs for motor output. If something wrong with the system, will ge
t poorly selected movements movement disorders Neuro
Within movement disorders, what gradient can we have? Give an exemplar disease&n
bsp;
<div>Too much= hyper
inetichuntingtons disease</div><div>Too little= brady

inetic par
insons</div>
Neuro
What is exemplar brady
inetic disease? Give big 4 symptoms
Par
insons diseas
e. Tremor, postural instability, brady
inesis, rigidity. (rigidity, tremor @rest
, postural instability, difficulty initiating or stopping movement)
neuro
Hyper
inetic expresses what 4 symptoms? <b>Chorea</b> (Putamen/GP, decreased MSN
(GABA)= huntingtons disease), <b>athetosis</b> (writhing, more subdued), <b>dyst
onia</b> (involuntary contraction), <b>hemibalismus</b> (damage to STH nucleus (
vascular stro
e) rapid ballistic movement of limb)
Neuro
What are 3 common final pathways of neuronal death?
1. Excitotoxicity (NMDA
receptors/calcium)<div>2. Free radical injury</div><div>3. Fibrillogenesis (prot
ein accumulation)<div><br /></div><div>Leads to necrosis and apoptosis</div></di
v>
Neuro
Name characteristics of huntingtons disease, inheritance, chromosome, <b>gene</b>
, <u>anatomical defect</u>, <u>neuronal loss</u>, symptoms
"<div>Autosomal
dominant, chromosome 4, CAG trinucleotide repeat in huntingtin gene (protein reall
y), <u>caudate atrophy</u>, <u>loss of GABA neurons</u></div><div><br /></div><d
iv>S/Sx: chorea, dementia/psychosis, rigid variant in young.&nbsp;</div><div><im
g src=""caudate atrophy.jpeg"" /></div><div><br /></div>"
Emergency_6 Neur
o
What does anticipation refer to in huntingtons disease?
successive generations<u>
amplification</u> of severity and <u>decreased age</u> of onset Neuro

Abnormal eosinophilic intracellular inclusions are

nown as? What <b>protein</b>
does it consist of? What disease?
"<div>Lewy bodies, alpha-synuclein, Par

insons disease</div><div><br /></div><div><img src=""lewy.jpeg"" /></div>"

Neuro
Describe MPTP connection to par
insonism, and what is enzyme and <u>drug</u> for
prevention.
<div>MPTP (contaminant in the street drug MPPP) is converted to
toxic MPP+ by <u>monoamine oxidase B</u></div><div>Prevented by <b>MAO-B inhibit
or</b>: <u>Selegiline</u> may slow progression of idiopathic Par
insons disease (M
AO also degrades dopamine, bloc
ing also reduces free radical production)</div>
Neuro
"<img src=""6d4e78bbfbbdbab30d95489fa0d7335f629d7f4b_Q_0.svg"" />"
"<img sr
c=""6d4e78bbfbbdbab30d95489fa0d7335f629d7f4b_A_0.svg"" />"
"<img src=""6d4e
78bbfbbdbab30d95489fa0d7335f629d7f4b_source_svg.svg"" />"
"<img src=""6d4e
78bbfbbdbab30d95489fa0d7335f629d7f4b_occlude 1.jpeg"" />"
Neuro
What is the mechanism of Par
insons Disease
"Atrophy of <u>substantia nigra<
/u>, loss of <u>dopaminergic neurons projecting to striatum</u>; <u>lewy bodies<
/u>&nbsp;<div><img src=""substantia nigra.jpeg"" /></div>"
Neuro
Name enzymes of dopamine metabolism, synthesis and degradation "Tyrosine (Tyros
ine hydroxylase) DOPA (DOPA decarboxylase)Dopamine (COMT, MAO)HVA (homovanillic aci
d)<div><img src=""dopamine metabolsim.jpeg"" /></div>" neuro
L-Dopa given for Par
insons disease should act on striatonigral dopamine receptor
s for therapeutic effect. Name 2 other receptors that can cause side effects (1
CNS, 1 PNS)
<div><u>Mesolimbic dopamine receptors</u>: hallucinations, confu
sion</div><div><u>Peripheral dopamine receptors</u>: nausea, vomiting, cardiac a
rrhythmia</div> Neuro
What is the effect of L-Dopa prolonged use on therapeutic window? Solution?
"<div>Decreases therapeutic window. Leads to swinging from dys
inesis, on, off.
Use smaller, more frequent doses to <u>minimize fluctuations</u>. Or, continuous
infusion.</div><div><img src=""dys
inesis.jpeg"" /></div>"
Neuro
What are 5 strategies in increasing Par
insons/L-Dopa therapy Protect L-Dopa f
rom peripheral degradation (carbidopa)<div>Dopamine receptor agonist&nbsp;</div>
<div>Inhibit free radicals (MAO inhibitors)</div><div>Anticholinergics can be us
ed in mild Par
insons disease&nbsp;</div><div>Surgical modification of basal gang
lia circuitry</div>
Neuro
Carbidopa is often used in conjuction with L-dopa. What is the mechanism
<div><b>Aromatic amino acid decarboxylase</b> in GI and blood transforms 95% of
L-dopa to dopa peripherally.&nbsp;</div><div>Carbidopa is an <u>inhibitor of per
ipheral aromatic amino acid decarboxylase</u>increases bioavailability</div><div>
<br /></div><div>AKA carbidopa inhibits DOPA Decarboxylase&nbsp;</div> Neuro
Other than carbidopa, what else can be used to protect dopamine? Name the <u>cla
ss</u> and <u>2 drugs</u>.&nbsp;
<div><u>COMT inhibitors</u>. COMT degrad
es L-dopa peripherally, and dopamine centrally.&nbsp;</div><div><u>Tolcapone</u>
and <u>Eptacapone</u> (fewer side effects)</div>
Neuro
What are side effects of using dopamine receptor agonist in Par
insons?
Valvular
heart disease<div>And&nbsp;<div>Increased gambling, shopping, sex (Vegas)</div>
</div> Neuro
What is the rationale for anticholinergics in mild Par
insons disease? Is this us
ed often?
<div>ACh and dopamine are <u>antagonists</u> in basal ganglia. D
ecreased dopamine leads to excess ACh activityanticholinergic drugs may <u>restor
e balance</u>.</div><div>Rarely used.&nbsp;</div><div><br /></div>
Neuro
What surgical modification may be used in Par
insons disease? (Historical, modern
)&nbsp; "<div>Pallidotomy (globus pallidus), subthalamic nucleus stimulation (De
ep Brain Stimulation)</div><div><img src=""surgeries par
inson.jpeg"" /></div>"
Neuro
Treatment of hyper
inetic movement disorders is limited, but name 2 treatments.&
nbsp; <div><u>Dopamine antagonists</u> (but causes Par
insons, to some this is
preferable)</div><div><u>Botulinum toxin</u>stops local movements</div><div><br /
></div> Neuro
<div>What is Wilsons disease (<b>inheritance</b>, mechanism)? What is the treatme

nt</div>
<div>Autosomal recessive</div><div>Defect in copper transporter
leading to <u>increased copper deposition in tissues</u>liver and brain are prima
ry targets therefore called: <u>hepatolenticular degeneration</u></div><div><br
/></div><div>Treatment is: <u>copper chelation</u> Easy to treat, will die witho
ut it. DO NOT MISS.</div>
Neuro
Hemolytic uremic syndrome (HUS) is a triad of what?
"a triad of thrombocytop
enia, hemolytic anemia, and nephropathy<div><img src=""HUS.jpeg"" /></div>"
"23<div><img src=""mamillary.jpeg"" /></div>" Mamillary body
Whats the most reliable way to diagnose primary syphilis?
Detection of tre
ponemas in chancre (painless lesion) exudate by <b>dar
field exam</b> 3/28Spir
ochetes
"What is the status of RPR (antibody to cardiolipin) or ""nontreponemal"" antibo
dy in primary and secondary syphilis?" <b>Positive in 80%</b> of persons with p
rimary syphilis usually &lt;1:16<div><br /></div><div><b>Always positive</b> in
secondary syphilis usually &gt;1:32 (high), declining slowly but remaining posit
ive if treatment is withheld</div>
3/28Spirochetes
What does the biologic false positive refer to for syphilis? What other disease
may cause this false positive? (4)
"It means reactivity in absence of evide
nce for syphilis. &nbsp;Titer is usually low-ish (&lt;1:8). &nbsp;<div><br /></d
iv><div>Seen in aging, some infections such as infectious mononucleosis, chic
en
pox, malaria,
ala-azar and connective tissue diseases such as lupus erythemato
sus (antiphospholipid ab)</div><div><br /></div><div>Mono</div><div>RF</div><div
>SLE</div><div>Lep</div><div><br /></div><div><img src=""paste-45780056408456.jp
g"" /></div>" 3/28Spirochetes
What is the treatment for syphilis?
<u>Long-acting penicillin</u> because of
slow dividing time of treponemas
3/28Spirochetes
What is the morphology of Borreliae? How is it visualized
"Spirochete. Sim
ilar to treponemas except: can be seen with light micropscope (if visualized usi
ng aniline dyes (Wright or Giemsa stain); 7-20 flagella<div><br /></div><div>Can
be cultivated in vitro or in mouse</div><div><img src=""borrelia light.jpeg"" /
><img src=""borrelia.jpeg"" /></div>" 3/28Spirochetes
What does Borrelia recurrentis cause? From what, and what reservoir?
Human&nb
sp;<b>Louse-borne</b>&nbsp;relapsing fever, human reservoir
3/28Spirochetes
What does Borrelia hermsii and related Borreliae cause? What is the reservoir an
d what is the vector? <b>Tic
-borne relapsing fever</b><div><br /></div><div>c
arried by soft tic
s of genus Ornithodoros, which naturally infest <b>rodents</b
> and small <b>mammals</b> [<u>reservoir</u>] in southwestern states -- AZ, NM,
CO, UT. &nbsp;</div><div><br /></div><div><b>Tic
</b> is the <u>vector</u>, feed
ing on animal and spreading disease to humans. &nbsp;Humans infected incidentall
y</div><div><br /></div><div>*Boy scout troup grand canyon/leaders under tent go
t bug</div>
3/28Spirochetes
What are some clinical manifestations of relapsing fever?
<b>Nonspecific</
b> / <b>generalized</b> symptoms li
e fever (milder each time), headache, muscle
pains<div><br /></div><div><br /></div><div>milder each time and reoccuring bec
ause organism is though to have ability to change outer membrane protein, escapi
ng humoral response</div>
3/28Spirochetes
Why does Borrelia cause <i>relapsing</i>&nbsp;fever (whats the mechanism?)
"<div>1)<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Persist
4-10 days; thereafter brought <span class=""Apple-tab-span"" style=""white-spac
e:pre""> </span>under control by humoral response</div><div><br /></div><div>2)
Recurrence(s) of symptoms, milder each time, <span class=""Apple-tab-span"" styl
e=""white-space:pre""> </span>thought due to ability of organism to <u>change ou
ter membrane protein</u>, thereby escaping host humoral immunity; &nbsp;this is
why it is called relapsing fever &nbsp;</div><div><br /></div>" 3/28Spirochetes
How are the relapsing fever Borreliae diagnosed?
"<b>Dar
field</b> exam o
f <b><font color=""#ff0000"">blood</font></b>" 3/28Spirochetes
What is the reservoir and vector of Borrelia burgdorferi? Where is it endemic?
Reservoir is <b>white-footed mouse</b>. Vector is the <b>hard tic
, genus Ixodes
</b> which feed on white footed mouse, deer and other mammals. &nbsp;Transmitted
by tic
from animal to animal or animal to human. Tic
s may also pass the organ

ism transovarially, so no new bite of an animal is absolutely necessary<div><br

/></div><div>Endemic in New England, Wisconsin&nbsp;</div>
3/28Spirochetes
Do you get infected with lyme disease from a tic
right away? Feeding is prolo
nged. &nbsp;The disease is not transmitted until after 1<u>8-24 hr when tic
reg
urgitates onto s
in surface</u>. &nbsp;This is why you can inspect yourself for
tic
s after hi
ing, etc. and still remove them, being thereafter largely free of
ris
of Lyme disease. &nbsp; 3/28Spirochetes
What is stage 1, 2, 3 of Lyme disease? "First stage: nonspecific/generalized sy
mptoms + <b>erythema migrans</b><div>Second stage: <b>disseminated</b> infection
-<b> arthritis</b>, <b>carditis</b>, <b>bells palsy</b><div>Third stage: <b>&nb
sp;migratory&nbsp;destructive arthritis</b>, <b>cardiac disease, encephalitis</b
></div></div><div><br /></div><div><br /></div><div><img src=""paste-44272522887
559.jpg"" /></div><div>Without erythema migrans, dx problematic in these later s
tages</div>"
3/28Spirochetes
What species causes leptospirosis?
Leptospira
3/28Spirochetes
Associated with wor
in or around bayous, contact with sewage or farm animals, s
wimming in streams, presence on property and/or ownership of dogs.
Leptospi
ra
3/28Spirochetes
What is the port of entry and pathogenesis of leptospira?
<div>Portal of e
ntry: mucosa or brea
in s
in&nbsp;</div><div>Pathogenesis: disseminate widely v
ia bloodstream <b>hematogenously!!</b></div><div><br /></div> 3/28Spirochetes
What are some manifestations of leptospirosis? (4)
"<div>1. Fever (flu li
e
symptoms)</div><div>2. Renal Failure</div><div>3. Liver Disease and Jaundice</d
iv><div>4. Conjunctival Suffusion</div><div><br /></div><div><br /></div>May ran
ge from<b> nonspecific febrile illness</b> to <b>fatal jaundice, renal failure a
nd hemorrhage.</b> &nbsp;Fever and headache (95%), chills, muscle aches (&gt;85%
), conjunctival redness and pain (30%), other symptoms in smaller numbers includ
ing jaundice (20%). &nbsp; &nbsp;<div><br /></div><div>Signs: stiff nec
(20%),
abnormal liver function tests (50%), falling platelet count (50%), hemorrhagic p
neumonia, renal failure.&nbsp;</div><div><br /></div><div>In Malaysia, undiagnos
ed fever, especially if associated with abnormal liver enzymes, is regularly att
ributed to leptospirosis. &nbsp;</div><div><br /></div><div><img src=""paste-444
05666873735.jpg"" /></div>"
3/28Spirochetes
What is Weils disease? "Combined renal and liver failure with leptospirosis<div
><br /></div><div><img src=""paste-44500156154247.jpg"" /></div>"
3/28Spir
ochetes
Diphtheria toxin is secreted as what toxin?
"A-B (activity and binding) toxi
n. A and B subunits on single polypeptide chain, chain is nic
ed yielding separa
te A and B subunits&nbsp;<div><img src=""ab.jpeg"" /></div>"
ID
Among Diphtheria, Listeria, B. Anthracis, B. Cereus, which are motile? Which ma

e spores?&nbsp; Motile: Listeria, B. Cereus<div>Spores: Anthracis, Cereus</div>

ID
How does listeria survive in the gut? <b>Resistant</b> to high <u>salt</u> and
<u>bile</u> concentrations.&nbsp;
ID
What are the 3 means of inoculation of B. anthracis?
<b>Cutaneous</b>- brea
s
in s
in, eschar (80% resolve, 20% progress)<div><b>Intestinal</b>- (near 100% m
ortality)&nbsp;</div><div><b>Pulmonary</b>- Biphasic disease, flu li
e, progress
es to acute (pulm. edema, hemorrhagic pneumonitis, septicemia) (100% mortality)<
/div> ID
B. cereus is resistant to what antibiotic?
-lactam antiiotics. (Penicillin)
<div>Use tetracycline</div>
ID
B. Cereus secretes what that destroys ocular memrane? Lecithinase: cleaves lip
ids
ID
What are the two enterotoxins of B. Cereus? Give heat laile or stale <>Emeti
c</> (<u>heat stale</u>) mimics staph, rapid onset vomiting (1-6 hrs)<div><>G
astrointestinal</> (<u>heat laile</u>), diarrhea delayed onset 8-24 hrs</div>
ID
Has long douling time and to culture has to e done so in mouse footpads.
"M. leprae<div><img src=""rat foot.jpeg"" /></div>"
3/31MycoacteriaTuercul
osis Dickey

"""The one chart you need to know aout leprosy""<div><img src=""paste-683415196

13955.jpg"" /></div>"
3/31MycoacteriaTuerculosis Dickey
Peripheral neuropathy, charcot foot, ut <>not diaetic?</> "Have to suspect
leprosy<div><img src=""paste-83880711291365.jpg"" /></div>"
3/31Mycoacteria
Tuerculosis Dickey
What are the treatments for leprosy? (for each type)
"Tuerculoid form: <u>da
psone</u> or <u>rifampin</u>&nsp;6 months<div>Lepromatous form <u>dapsone</u>,
<u>rifampin</u>, and <u>clofazimine</u> for 25 years&nsp;</div><div><r /></div>
<div><img src=""paste-83880711291365.jpg"" /></div>"
3/31MycoacteriaTuercul
osis Dickey
What is the reversal reaction? "results from the development of a <u>more appro
priate Th1 cellular immune response</u> -&gt;&nsp;<div><r /></div><div>you get
increased</div><div>1) &nsp;<u>erythema of skin plaques</u>&nsp;</div><div>2)
&nsp;<u>swelling of peripheral nerves</u><div><img src=""reversal.jpeg"" /></di
v><div><img src=""chart lepro.jpeg"" /></div></div>"
3/31MycoacteriaTuercul
osis Dickey
"Other skin effect from leprosy?<div><img src=""effect.jpeg"" /></div>" "Erythem
a nodosum leprosum<div><img src=""nodosum.jpeg"" /></div><div><r /></div><div><
img src=""paste-93196495356322.jpg"" /></div>" 3/31MycoacteriaTuerculosis Dic
key
What kind of people get M. kansasii? Is it a pulic health risk?
"ffects
older men who smoke and have underlying lung disease<div><img src=""kansasii.jp
eg"" /></div>" 3/31MycoacteriaTuerculosis Dickey
What is gram stain and morphology of neisseria? Intra/extracellular? eroic/ana
eroic? Grows on what?<div>What test can e used to diagnose GC (gonococcus) on
a colony?</div> "Gram negative diplococci, intracellular. eroic. Chocolate aga
r.&nsp;<div><u>Oxidase reaction test</u>--&gt;can use tetramethyl-p-phenylene d
iamine hydrochloride--&gt; turns <><font color=""#800080"">purple</font></> in
10 seconds<r /><div><img src=""gram neis.jpeg"" /><img src=""oxidase rxn.jpeg"
" /></div></div>"
ID
Implicated in outreak of soft tissues from unclean nail salon eds
"Mycoac
terium chelonae<div><img src=""chelonae.jpeg"" /></div>"
3/31Mycoacteria
Tuerculosis Dickey
Vaccine MPSV4 is indicated for what, compared to MCV4? "MPSV4- persons at risk
(asplenia, complement deficiency)<div>MCV4- &gt;9 mo old.&nsp;</div><div><img s
rc=""vaccine m.jpeg"" /></div>" ID
What are some things you need to make a diagnosis fo non-tuerculoid mycoacteri
a?
"<div>Pulmonary disease--&gt; organisms can e environmental contaminant
s&nsp;</div><div><r /></div><div>1) Radiographic evidence of disease;</div><di
v>2) Multiple sputa/BL specimens that are smear or culture (+);</div><div>3) Hi
stopathologic evidence of granulomas/acteria.&nsp;</div><div>4) Biopsy &amp;/o
r culture of skin/tissue, lood, etc. for other manifestations:</div><div><img s
rc=""al.jpeg"" /></div>"
3/31MycoacteriaTuerculosis Dickey
Which type of nocardia causes soft tissue injuries?
"N. rasiliensis<div><im
g src=""rasiliensis.jpeg"" /></div>" 3/31MycoacteriaTuerculosis Dickey
Descrie pathogenic mechanism of N. gonorrhoeae "Colonize <u>non-ciliated column
ar epithelium</u> of urethra y type IV pili<div>LOS and/or opacity factor cause
s <u>sloughing</u> of cilia from adjacent cells</div><div>dhere more tightly an
d <u>penetrate</u> through epithelium (mediated endocytosis)</div><div>LOS infla
mmation y upregulating neutrophil response</div><div><r /></div><div><img src=
""gono pics.jpeg"" /></div>"
ID
"Just to make you look at it<div><img src=""paste-90769838833667.jpg"" /></div>"
"Mycetoma from stepping on a stick<div><img src=""mycetoma.jpeg"" /></div>"
3/31MycoacteriaTuerculosis Dickey
Have to inform the laoratory that you suspect nocardia ecause they grow &nsp;
slowly and can e overrun y other flora.
"<div>Yes</div><div><img src=""d
iagnosis.jpeg"" /></div>"
3/31MycoacteriaTuerculosis Dickey
Treatments for nocardia?
"<u>Sulfonamides</u>, third gen cephs, others, f
or months at a time<div><img src=""therapy.jpeg"" /></div><div><r /></div><div>
<img src=""paste-93076236272030.jpg"" /></div>" 3/31MycoacteriaTuerculosis Dic

key
Descrie pathogenesis of Bordatella.<div><r /></div><div>1. Where does ordatel
lc colonize?</div><div>2. What memrane proteins act as adhesins (4)</div>
"Bacteria inhaled, colonize <u>ciliated</u> cells of lower respiratory tract (gl
ycolipid receptors on human cells)<div>Memrane proteins <u>FH</u>, FIM, PRN an
d toxin PT act as <u>adhesins</u> on human glycolipids</div><div><img src=""pert
ussis path.jpeg"" /></div>"
ID
What is pathogenesis of N. meningitidis- how is it acquired? Descrie 3 effects
of endotoxin.&nsp;
<>Respiratory acquisition</>--&gt; colonize nasopharyn
x via <u>pili</u><div><u>Invade epithelium</u> and disseminate in lood</div><di
v>Taken up y <u>choroid plexus</u> and then meninges</div><div><u>Meningitis</u
> with or without <u>meningococcemia</u></div><div>Endotoxin (<u>lipid </u> por
tion of LOS) causes:</div><div><r /></div><div>1. DIC</div><div>2. Shock</div><
div>3. Hemorrhage in major organs</div> ID
Where do M. tuerculosis organisms sit in the alveoli? (cell type)
"In nonimmune alveolar macrophages -&gt; replicated unimpeded within phagosomes of alve
olar macrophages<div><r /></div><div><img src=""paste-93793495810318.jpg"" /></
div>" 3/31MycoacteriaTuerculosis Dickey
T/F TB can spread to other areas of the ody like rain via lymphagentous spread
.
True - can lay dormant and then reactivate years later 3/31Mycoacteria
Tuerculosis Dickey
What is a simon focus? "Old primary TB nodule that could reactivate later<div>a
pical firotic scarring<r /><div><r /></div><div><img src=""paste-114632677131
68.jpg"" /><r /><div><img src=""paste-103581726277635.jpg"" /></div></div></div
>"
3/31MycoacteriaTuerculosis Dickey
Why do they CXR people efore they put them on chemotherapy or immunosuppresants
?
"To look for <u>simon focuses</u> which could e evidence of old TB and
you dont want to suppress the immune system (TNF-a) ecause it could reactivate
the disease<div><r /></div><div>Have to treat for the TB first</div><div><r /
></div><div><img src=""simon.jpeg"" /></div><div><r /></div><div><img src=""pas
te-8005819040146.jpg"" /></div>"
3/31MycoacteriaTuerculosis Dickey
+ PPD means you were exposed or infected with TB?
Infected, exposed isnt
the right word to use per Dr. Hamil
3/31MycoacteriaTuerculosis Dickey
Calcification of the pericardium/ restrictive. "TB pericarditis<div><img src=""
pericard.jpeg"" /></div>"
3/31MycoacteriaTuerculosis Dickey
T/F you measure the erythema not the induraton of the PPD test and thus can just
look at it to tell.
FLSE - measure the induration and must feel<div><r /><
/div> 3/31MycoacteriaTuerculosis Dickey
What is the quantiferon gold assay?
"<div>MESURE IFN-y production y sensit
ived T cells</div><img src=""paste-11841224835200.jpg"" /><r /><div><div><img s
rc=""paste-120993523695617.jpg"" /></div></div>"
3/31MycoacteriaTuercul
osis Dickey
What is BCG?
"Live, attenuated vaccine derived from an M. ovis strain<div><
r /></div><div><img src=""paste-11940009082977.jpg"" /><r /><div><img src=""BCG
.jpeg"" /></div></div>" 3/31MycoacteriaTuerculosis Dickey
Should you ignore a BCG status for a PPD?
ctually yes, if their PPD is po
sitive than it still means it came from <i>infection</i>&nsp; 3/31Mycoacteria
Tuerculosis Dickey
What is the MTB/RIF assay?
"<img src=""paste-125215476547587.jpg"" /><div><
r /></div><div><img src=""paste-14736032792750.jpg"" /></div>" 3/31Mycoacteria
Tuerculosis Dickey
What is the treatment for TB? "<><font color=""#ff0000"">RIPE</font></> ther
apy&nsp;<div><r /></div><div><font color=""#ff0000""><>R</></font>ifampin</d
iv><div><><font color=""#ff0000"">I</font></>zoniazid<div>< style=""color: rg
(255, 0, 0); "">P</>yrazinamide</div><div><font color=""#ff0000""><>E</></fo
nt>thamutol</div><div><r /></div><div>Under <u>Directly Oserved Therapy</u></
div><div><img src=""paste-12137577578946.jpg"" /></div></div><div><r /></div><d
iv><img src=""paste-12210592022790.jpg"" /></div>"
3/31MycoacteriaTuercul
osis Dickey
What are the cutoffs for the PPD?
HIV - 5mm<div>Healtcare workers - 10mm</

div><div>Normal, healthy people - 15mm</div>

3/31MycoacteriaTuerculosis Dic
key
"Primary progressive or reactivation TB?<div><img src=""paste-135312944660483.jp
g"" /></div>" "Primary progressive, more diffuse than reactivation<div><r /><
/div><div><img src=""paste-14912126451979.jpg"" /></div>"
3/31Mycoacteria
Tuerculosis Dickey
What does the striatum consist of?
"Caudate, putamen. lso called neostriat
um.<div><img src=""striatum 3d.jpeg"" /></div><div><img src=""glous section.jpe
g"" /></div>" Neuro
What does the lenticular nucleus consist of?&nsp;
"Putamen, glous pallidu
s<div><img src=""glous section.jpeg"" /></div><div><img src=""striatum 3d.jpeg"
" /></div>"
Neuro
"Descrie the pathway of the direct circuit of the asal ganglia system<span cla
ss=""pple-ta-span"" style=""white-space:pre""> </span>"
"Cortex B 6 (Gl
ut) striatum (putamen MSN GB) GPI (MSN GB) VL nucleus (Glut)Promotes movement
B 4<div><img src=""asal gang direct.jpeg"" /><img src=""F BG.jpeg"" /></div><
div><img src=""direct (1).jpeg"" /></div>"
Emergency_6 Neuro
What are the specific GBergic interneurons connecting etween excitatory input
from cortex and inhiitory output to thalamus? What are differences etween pat
hways-- What do they secrete, and what are their receptors? (1, and 2 respective
ly)
"<div>Medium Spiny Neurons.</div><div>Direct: Secrete GB/sustance P a
nd have <u>D1</u> receptors. Exist to disinhiit VL nucleus, permitting movement
.&nsp;</div><div>Indirect: GB/enkephalin and have <u>D2</u> receptors and <u>
Ch</u> receptors</div><div><img src=""asal gand indirect.jpeg"" /></div>"
Emergency_6 Neuro
Descrie pathway of the indirect circuit of asal ganglia system.
"Cortex
B6striatum (putamen GB)GPE (GB) Suthalamic nucleus (Glut)GPI (GB)VL nucleus (
Glut) suppresses movement B4<div><img src=""indirect (1).jpeg"" /><img src=""as
al gand indirect.jpeg"" /><img src=""F BG.jpeg"" /></div>"
Neuro
Descrie the function of sustantia nigra in asal ganglia system? What does it
synapse on?
"Promotes movement, dopaminergic pathway from sustantia nigra t
o putamen/caudate. Synapse with <u>GBergic interneurons</u> (MSN) dopamine acts
on D1 (direct) or D2 (indirect) family<div><img src=""asal gang direct.jpeg""
/><img src=""asal gand indirect.jpeg"" /></div>"
Neuro
What is the <>clinical</>&nsp;<>name</> of an effect of older antipsychotic
(haloperolol) medications? Descrie mechanism <u>Block D receptors</u>hypokine
siaD receptors <u>upregulated</u><>hypersensitivity to D</><div><r /></div><d
iv><>Tardive Dyskinesia</>. Involuntary <u>choreic</u> or <u>athetoid</u> move
ments of mouth/tongue or extremities. May not resolve even when drug stopped.&n
sp;</div>
Neuro
What is the mechanism of huntingtons chorea? Signs and symptoms?
"<div><u>Loss of
MSN (D2) in putamen/caudate in alternate circuit.&nsp;</u></div><div>Signs/sym
ptoms: chorea-athetosis; caudate- dementia, depression</div><div><img src=""asa
l gand indirect.jpeg"" /></div>"
Neuro
What can cause hemiallismus? If infarct on left, where is movement?
"Lesion
in suthalamic nucleus. Lesion <u>removes excitatory drive on the inhiitory out
put</u> of the asal ganglia (from internal segment of the glous pallidus) Cont
ra to infarct right side.&nsp;<div><img src=""asal gand indirect.jpeg"" /></div
><div><r /></div>"
Neuro
Though lesion of suthalamic nucleus can cause contra hemiallismus, what is one
therapeutic effect?
Electrical stimulation of suthalamic nucleus can mimic
lesionrelief of parkinsonian signs.
Neuro
What is the effect of Ch in the BG circuit? What is one therapeutic consequence
?
"Ch interneurons within caudate/putamen have <u>excitatory</u> (muscari
nic) synapses with <u>MSN</u>. These are same <u>MSN that receive inhiitory dop
amine input via D2</u>&nsp;in the indirect circuit. Ch therefore has opposite
effect of dopamine in this circuit.&nsp;<div>nticholinergics used to treat par
kinsons efore dopamine oosting drugs.&nsp;</div><div><img src=""asal gand ind
irect.jpeg"" /></div>" Neuro
What is the effect of L-DOP or nticholinergic overdose? Clinical effect name?

<div>Excess excitation of D1 MSN</div><div>Excess inhiition of D2 MSN</div><div

><r /></div><div><><u>Hyperkinesia</u></>.&nsp;</div><div><r /></div>
Neuro
Name 6 signs of parkinsons
<div>Bradykinesia</div><div>Pill rolling tremor<
/div><div>Rigidity (cogwheel/lead pipe)</div><div>Masked fascies</div><div>Postu
ral instaility</div><div>En loc turning</div><div>Festinating/shuffling gait</
div><div><r /></div> Neuro
Which dopamine receptor is inhiitory, which is excitatory? What is mechanism?
<div>D1- excitatory- Gs closes K channel</div><div>D2- inhiitory- Gi opens K ch
annel</div><div><r /></div>
Neuro
<div>What is function of Ch on movement in asal ganglia? Receptor? Mechanism?<
/div> "<div>Decreases movement. Muscarinic receptor. G protein, closes 2 diffe
rent K channels.&nsp;</div><div><img src=""asal gand indirect.jpeg"" /></div>"
Neuro
What is the function of GB on movement in asal ganglia? Receptor they act on?
Mechanism?
Decreases. GBa. Directly (no G protein) opens Cl- channel
Neuro
What is the overall function and output of glous pallidus internus/externus?
"<u>Inhiitory</u> output (constant/<u>tonic</u>)<div><img src=""direct (1).jpeg
"" /><img src=""indirect (1).jpeg"" /></div>" Neuro
What are the decision-making standards for children?
<div>Best interests of t
he Child =&gt; include DURTION and QULITY of life</div><div>Best interests of
Parents and Family Memers (must alance oth) =&gt; parents are not expected to
devote LL resouces/energy to one child, ut are expected to make some sacrific
es&nsp;</div><div><r /></div><div>*sustituted judgment does not apply</div>
Ethics
<div>What are 5 exceptions to decision-making standards for children?</div>
<div>1. Emergencies</div><div>2. Parent is estranged, lacks DMC, unwilling</div>
<div>3. Parents decisions put child at clear and sustantial risk (including reli
gious)</div><div>4. Child is mature or emancipated minor</div><div>5. Treatment
of specified conditions (drug treatment, suicide prevention, STD, preganancy)</d
iv><div><r /></div>
Ethics
What constitutes an emancipated minor? (4)
1.Married<div>2. in military</di
v><div>3. emancipated y court ruling &gt;16</div><div>4. living apart from pare
nts &gt;16</div>
Ethics
What are the specified conditions that minors may consent for themselves? (4)
Suicide prevention counseling<div>Drug or alcohol dependency testing/tx&nsp;</d
iv><div>STD treatment</div><div>Pregnancy tx for child (except aortion)</div>
Ethics
What is assent, compare to consent? What four parts make it up? <div>ssent</div
><div>1.help minor achieve <u>awareness</u></div><div>2. tell <u>what to expect<
/u></div><div>3. assess <u>understanding</u>/<u>factors</u> influencing his/her
response</div><div>4. solicit an expression of <u>willingness</u> are you ready</d
iv><div><>Minors cannot consent.</></div><div><r /></div>
Ethics
When can confidentiality with pediatric patient e maintained? (2)
<div>-<u
>Title X</u> and <u>Medicaid family planning</u> services are confidential as a
matter of federal law.&nsp;</div><div>-<u>Emancipated</u> and <u>married</u> mi
nors have status of adults.&nsp;</div><div><r /></div>
Ethics
What was the only disease penicillin wasnt effective against at first? TB
What is the asic strucuture of penicillin?
"Four-sided ring attached to fiv
e-sided ring<div><r /></div><div><>Side chain attached to 4 ring <u>determines
other properties</u></></div><div><><u><img src=""structure (1).jpeg"" /></u>
</></div>"
Whats the major mechanism of resistance to penicillin? "Beta-lactamase reaks t
he <u>four memer ring</u><div><img src=""lactamase.jpeg"" /></div>"
What are the enzymes that penicillins interact with? What do these enzymes do?
"Transpeptidases and caroxypeptidases<div><r /></div><div>They control the fol
lowing reaction:</div><div><r /></div><div><div>1.<span class=""pple-ta-span"
" style=""white-space:pre""> </span>The muramic acid of peptidoglycan has side c
hains of 4  (ala-glu-lys-ala). &nsp;Chains of 5 glycines ""ridge"" these cha

ins, specifically inding penultimate lysine to terminal alanine</div><div>2.<sp

an class=""pple-ta-span"" style=""white-space:pre""> </span>This cross-linking
gives integrity to peptidoglycan</div></div><div><r /></div><div><img src=""pa
ste-21895743275009.jpg"" /></div>"
Whats another name for transpeptidases and caroxypeptidases affected y penici
llins? Penicillin-inding proteins
What is the&nsp;MIC(90)?
The concentration of an antiiotic that inhiits
90% of clinical isolates
Whats the general distinction etween actericidal drugs and acteriostatic dru
gs? What disease(s) do you need a acteriocidal "Those that kill acteria - thos
e that simply inhiit<div><r /></div><div>*Important to have actericidal ax i
n things like<> endocarditis or if you are <font color=""#0000ff"">immunosuppre
sed</font>&nsp;</>which will just grow ack if using acteriostatic drugs</div
><div><r /></div><div>Possily <>meningitis</> or <>osteomyelitis</>, neutr
openia</div>"
T/F penicillin is generally considered a actericidal drug.
True - ut doesn
t kill all organisms (E. faecalis)
Why does the distinction etween acteriostatic and -cidal usually not matter?
if organisms are inhiited, the <u>host response clears the infection</u>; linez
olid or vancomycin treat soft tissue S. aureus infections equally&nsp;<div><r
/></div><div>linezolid (acteriostatic)</div><div>vancomycin (acteriocidal)</di
v>
What is phenoxypenicillin (penicillin V)? Function?
" penicillin with a <u>
phenoxy group added to side chain</u> -&gt; <u>resists gastric acids</u> and can
e given <>orally</><div><img src=""structure (1).jpeg"" /></div><div><img sr
c=""V.jpeg"" /></div><div><r /></div>"
Name some penicillins that are long lasting. What drug can e given to make them
last even longer?
Procaine penicillin -&gt; lasts for days<div>Benzathine
penicillin -&gt; weeks</div><div><r /></div><div>Can increase levels y giving
<>proenecid</> to delay excretion from renal tuules (usually not necessary h
owever)</div>
Descrie the distriution of penicillins in the ody. "<div>1.<span class=""p
ple-ta-span"" style=""white-space:pre""> </span>Penicillin, like many antiioti
cs, distriutes to extracellular fluid (ECF); cell memranes exclude it (that is
why levels follow physiological principles)</div><div><r /></div><div>2.<span
class=""pple-ta-span"" style=""white-space:pre""> </span>ECF = &nsp;aout 22%
of lean ody weight; here is how to rememer it:</div><div>a.<span class=""ppl
e-ta-span"" style=""white-space:pre""> </span>two-thirds of ody weight is wate
r of which</div><div>.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>most (two-thirds) is intracellular and</div><div>c.<span class=""pple-t
a-span"" style=""white-space:pre""> </span>the rest (one-third) is extracellula
r</div><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span>B
eta-lactams distriute to 2/3 x 1/3 of <u>lean ody weight*</u> = 2/9 = <>22%.<
/></div><div><r /></div><div>Not fat*</div>"
Do penicillins distriute into fatty tissue?
No
Name some (3) conditions that will greatly <u>increase ECF</u> and thus warrant
dosage adjustment of ax.
Heart failure, cirrohsis with ascites, renal fai
lure (except right after dialysis)
"What are the ""units"" for penicillin?"
1 unit = 0.6mcg<div><r /></div>
<div>400,000units = 250mg (<>milli</>grams)</div>
Calculate the theoretical peak level (ug/ml) after an IV infusion of 25mg/kg/dos
e to a 75kg person.
1.875grams = 3 million units given every 4 hours = 18 mi
llion units daily<div><r /></div><div>ssuming instant distriution, distriute
s to ~20% ody weight = 15 liters</div><div><r /></div><div>Theoretical peak le
vel &nsp;= 1,857,000ug/ 15,000ml = <>125ug/ml</></div>
Why is the calculated theoretical peak level of penicillin not accurate?
PCN has a half life of aout 20 minutes - <u>infusion</u> itself takes <u>20-30
minutes</u><div><r /></div><div>ctual peak value for 1.875 gm (previous proel
m) is closer to 50-60 mcg/ml (calculated at 125ug/ml)</div><div><r /></div><div
>*With initial infusion into lood, <u>kidney sees an especially high concentrat

ion and excretes it very rapidly</u></div>

How do you increase levels of penicillin infusion? Do you doule the dose?
No - you give it in closer intervals<div><r /></div><div>If you were to doule
the dose, you would only get 20 extra minutes of coverage (1 half life)</div>
Whats unique aout nafcillin excretion?
Significant portion excreted in
the <u>liver</u> (other pcns are y kidney and must e adjusted in renal failure
--&gt; creatinine clearance)
Do you adjust PCN dosage in renal failure? What do you use as a guide? Yes - us
e creatinine clearance as a guide
How does the half life of amoxicillin compare to PCN? "T(1/2) = 45 minutes, ca
n e asored from GI tract (nearly 100%), asoprtion occurs over 90-120 minutes
<div><r /></div><div><img src=""paste-32688996089857.jpg"" /></div>"
What was the first eta-lactam effective against gram negative rods like E. coli
?
mpicillin (add amine group) - called amoxicillin (orally)
Simply have to memorize these slow-asoprtion drugs. Give peak and lood levels
after certain time (peak, 24 hrs, or 2, 3-4 weeks)
"<div>1.<span class=""p
ple-ta-span"" style=""white-space:pre""> </span>fter 1.2 million units procain
e penicillin, peak = 1-2 mcg/ml; given once daily</div><div>2.<span class=""ppl
e-ta-span"" style=""white-space:pre""> </span>Blood level still = 0.2 mcg/ml af
ter 24 hours</div><div><r /></div><div>3.<span class=""pple-ta-span"" style="
"white-space:pre""> </span>Benzathine penicillin maintains a level &gt;0.1 mcg/m
l for 2 wk and &gt;0.02 mcg/ml for 3-4 wks. &nsp;Used once a week to treat syph
ilis and once each month for prophylaxis to prevent reinfections y Strep. pyoge
nes with relapses of rheumatic fever</div><div><r /></div>"
What three principles are associated with the general efficacy of antiiotics?
"1. Time that tissue levels exceed MIC (eta lactams)<div>2. Peak level (aminogl
ycosides)</div><div>3. ""rea under the curve"" of MIC (fluoroquinolones)</div><
div><img src=""paste-895844278600544.png"" /></div>"
How long should eta-lactam treatment exceed MIC to e effective?
&gt;60%
of treatment period, no advantage once levels exceed MIC y 2-4 fold
What are the two general ways antiiotic resistance arises? (genetic mechanisms)
<u>Point mutation</u> or acquisition of genetic material (<u>plasmid</u>)
Name 5 mechanisms of acterial resistance to antiiotics.
1. Make enzyme t
hat <u>disrupts ax active site (eta lactamase)</u><div>2. <u>lter site</u> at
which ax acts (mosaic PBPs)</div><div>3. Generate <u>new pathway</u> that ypa
sses the one locked y ax (new PBP2 y mec gene in MRS)</div><div>4. <u>lter
entrance</u> of ax (porin mutation)</div><div>5. Increase rate at which ax is
<u>pumped out</u> of acterium</div>
What percent of S. aureus now makes penicillinases?
&gt;90% thanks to widesp
read use of PCNs
Can increasing dose overcome enzyme-mediated ax resistance?
No, generally is
the case for enzyme-mediated resistance
Resistance of pneumococci to eta-lactams is of concern in which of MOPS?
Meningitis, not the others
What happens when you slightly alter the enzyl side chain of PCNs?
Renders
molecules<u> more resistant to eta-lactamases</u>, ut has some slightly <u>dec
reased efficacy</u> comparted to regular PCN
T/F&nsp;MRS have acquired genetic material that gives them capacity to synthes
ize an enzyme that cross links peptidoglycan and does not react with any of the
known penicillins, cephalosporins (except the newest one ceftaroline), or carap
enems. &nsp;Called PBP2.
True
What NTs does the sustantia nigra contain?
Dopamine, L-dopa
"<div>Whats this called? Indicates pathology in what? What symptoms will patien
t have</div><img src=""ftg.jpeg"" /> &nsp;"
Fier type grouping<div>Motor ne
uron, LMN</div><div>trophy, fasciculation</div>
"19<div><img src=""19.jpeg"" /></div>" Median aperture of magendie
"In the following picture - what is the MIC and the MBC?<div><img src=""paste-73
662984093697.jpg"" /></div>"
MIC = 1mg<div>MBC = 2mg</div><div><r /></div><d
iv>Notice that nothing is growing &nsp;when the 2mg roth is then streaked on a
plate</div>

Descrie (from outside to in) the structure of gram + and - acteria. "G+: Thi
ck peptidoglycan layer and then plasma memrane<div>G-: Outermemrane, thin pept
idoglycan layer, plasma memrane</div><div><img src=""paste-73942156967937.jpg""
/></div>"
"lso known as the ""muralyn sacculus"""
Peptidoglycan
What peptides does Penicillin resemle? "D-la D-la, resemlance allows pcn to
move into the active site of the transpeptidase enzyme and shut down the enzyme<
div><r /></div><div>Ring structure of eta-lactams is a <u>covalent inhiitor o
f transpeptidases</u></div><div><img src=""paste-74264279515140.jpg"" /></div>"
What do high molecular weight PBPs do? Low weight?
<>high</>: synthesize
sugar polymer and other half of enzyme <u>does cross-linking reaction</u> - if i
nhiited is <u>lethal for acteria</u><div><>low: </>only are caroxypeptidase
s - inhiiting them with eta lactams <u>isnt lethal for acteria</u></div>
What is autolysis vs. tolerance for acteria eing exposed to a eta-lactam?
<div>utolysis- <u>Cell wall synthesis is locked and turnover is not</u>. Pepti
doglycan degradation continues and lysis occurs giving a<>&nsp;-cidal</> effe
ct.</div><div><r /></div><div>Tolerance- <u>Some acteria do not continue turno
ver after synthesis is locked</u>. Examples- enterococci, streptococci, staph;
in these cases ax ecomes -<>static</> instead of -cidal</div><div><r /></di
v>
What are the 5 major classes of eta-lactams? "Penicillins<div>Cephalosporins<
/div><div>Cephamycins</div><div>Carapenems</div><div>Monoactams</div><div><img
src=""paste-75393855913988.jpg"" /></div>"
What are the 4 mechanisms of ax resistance? *Note: Musher said there were 5*
"<img src=""paste-75479755259908.jpg"" /><div><r /></div><div>1. eta lactamase
</div><div>2. alter PBP</div><div>3. new PBP (PBP2 y Mec gene in MRS)</div><di
v>4. alter porin</div><div>5. increase pump efflux rate</div>"
Name some gram negative acteria that are intrinsically resistant to ax y havi
ng low permeaility memranes. (2)
Pseudomonas, cinetoacter
Beta lactamase enzymes are thought to have evolved from?
"Transpeptidases
<div><img src=""paste-75715978461185.jpg"" /></div>"
, C, D
Which eta-lactamases have an active site serine?
Which eta-lactamase requires 1-2 zinc ions in the active site? Class B
What is augmentin made of?
moxicillin + clavulanic acid<div><r /></div>
What are Sulactam and Tazoactam?
"Beta-lactamase inhiitors<div><r /><di
v><img src=""inhiitors.jpeg"" /></div></div>"
What is the most common plasmid-encoded lactamase in gram- acteria? (name 2)
"TEM -lactamase and SHV<div><r /></div><div>Bacteria have evolved however to res
ist the new cephalosporin against TEMs and even their como with eta-lactamase
inhiitors</div><div><img src=""TEM.jpeg"" /></div>"
"Which ax are held as ""last resort"" ecause eta-lactamases cant hydrolyze t
hem easily"
Carapenems<div><r /></div><div>Over the last few years resista
nce has evolved though - new eta lactamases emerge&nsp;</div><div><r /></div>
<div>KPC and metallo-B-lactamases are examples</div>
How does S. pneumo exert resistance to B-lactams?
"Extensive alteration of
PBPs<div><img src=""mosaic.jpeg"" /></div>"
"What do ""mosaic enzymes"" refer to?" Trans/caroxypeptidases made up of DN a
cquired from the enviornment that can still perform the cross-linking functions
ut are wont ind eta-lactams
Whats the gene MRS acquires for resistance? Encodes? "mec -&gt; encodes PBP2
a, which eta-lactams dont ind<div><img src=""ypass.jpeg"" /></div>"
"Whats the ""ig"" glycopeptide antimicroial?"
"Vancomycin<div><img src
=""ig.jpeg"" /></div>"
How do glycopeptide ax work? "Bind to terminal D-ala D-ala group on peptide i
n peptidoglycan and sterically get in the way<div><img src=""ig.jpeg"" /></div>
"
Why doesnt vancomycin work against gram negatives?
"Its too ig and cant g
et through the outer memrane<div><img src=""ig.jpeg"" /></div>"
What one step, high resistance mechanism is found on conjugative plasmids in Ent
erococci?
"D-ala D-lactate is incorporated instead of D-ala D-ala which do

esnt allow vancyomcyin to ind<div><r /></div><div>Cause of vancomycin resista

nce<r /><div><img src=""vanc res.jpeg"" /></div></div>"
What does the VanX enzyme do for vancomycin resistance? It allows the acteria t
o make an enzyme which reaks down D-ala D-ala onds so they wont compete with
the new D-lactate onds
How do vancomycin-resistant acteria avoid the fitness cost of manufacturing inf
erior D-lactate onds? "The vanS gene makes a protein that goes out into media
and ""senses"" whether or not vancomycin is present - telling the acteria wheth
er or not to initiate the various vancomycin-resistance cascades<div><r /></div
><div><img src=""transposon.jpeg"" /></div><div>Uses transposons*</div>"
How does cycloserine work? How is it different than a eta lactam?
"Structu
ral analog of D-ala; locks D-ala precursor iosynthesis<div><r /></div><div>*a
cts in the cytoplasm*</div><div><img src=""cycloserine.jpeg"" /></div>"
What is the sensitivity of acid fast test, and auramine, rhodamine test in terms
of # of organisms sensitive? "10⁵-^&nsp;acid fast<div>1
0³- auramine, rhodaine (more sensitive, can e less in ody and still
see)</div><div><r /></div><div><img src=""paste-15023795601893.jpg"" /></div>"
Dickey
When starting patients prophylactically on INH, what else should e given?
"Pyridoxine for peripheral neuropathy&nsp;<div><r /></div><div><img src=""past
e-12811887444285.jpg"" /></div>"
Dickey
Patient has COPD, 100+ pack years, failure to thrive. Chronic cough and low grad
e fever. What ug? How diagnose?
"M. vium<div>Diagnose with sputum, <>B
actec</> culture</div><div><img src=""avium (1).jpeg"" /></div>"
Dickey
What CD4 count shows HIV? What disease does it suggest? CD4 &lt;50, disseminated
M. vium<div><r /></div><div>Normal count is 500 cells/mm3 to 1,000 cells/mm3.
</div> Dickey
Infections of tendon sheaths, ones, ursae, joints, rice odies in tissues
"ll species, typically M. avium-intracellulare<div><img src=""rice ody.jpeg""
/></div>"
Dickey ID
How does VIS strain S. aureus work? (vancomycin-intermediate S. aureus)
"Thickening of cell wall--&gt; more D-ala-D-ala in outer layer of peptidoglycan
which can trap vancomycin<div><r /></div><div><img src=""VIS (2).jpeg"" /></di
v>"
ID
"<img src=""a8fc437853100e38463a801f0f74a36087f997_Q_0.svg"" />"
"<img sr
c=""a8fc437853100e38463a801f0f74a36087f997__0.svg"" />"
"<img src=""a8fc
437853100e38463a801f0f74a36087f997_source_svg.svg"" />"
"<img src=""a8fc
437853100e38463a801f0f74a36087f997_K16.jpeg"" />"
Neuro
"<img src=""a8fc437853100e38463a801f0f74a36087f997_Q_1.svg"" />"
"<img sr
c=""a8fc437853100e38463a801f0f74a36087f997__1.svg"" />"
"<img src=""a8fc
437853100e38463a801f0f74a36087f997_source_svg.svg"" />"
"<img src=""a8fc
437853100e38463a801f0f74a36087f997_K16.jpeg"" />"
Neuro
"<img src=""a8fc437853100e38463a801f0f74a36087f997_Q_2.svg"" />"
"<img sr
c=""a8fc437853100e38463a801f0f74a36087f997__2.svg"" />"
"<img src=""a8fc
437853100e38463a801f0f74a36087f997_source_svg.svg"" />"
"<img src=""a8fc
437853100e38463a801f0f74a36087f997_K16.jpeg"" />"
Neuro
"<img src=""954c74d26314aac57ee70824965977ae153503f_Q_0.svg"" />"
"<img sr
c=""954c74d26314aac57ee70824965977ae153503f__0.svg"" />"
"<img src=""954c
74d26314aac57ee70824965977ae153503f_source_svg.svg"" />"
"<img src=""954c
74d26314aac57ee70824965977ae153503f_K17.jpeg"" />"
Neuro
"<img src=""954c74d26314aac57ee70824965977ae153503f_Q_1.svg"" />"
"<img sr
c=""954c74d26314aac57ee70824965977ae153503f__1.svg"" />"
"<img src=""954c
74d26314aac57ee70824965977ae153503f_source_svg.svg"" />"
"<img src=""954c
74d26314aac57ee70824965977ae153503f_K17.jpeg"" />"
Neuro
What are 3 ethical principles for human sujects research as discussed in Belmon
t report?&nsp; Respect (informed consent)&nsp;<div>Beneficence (assessment ris
k-enefit ratio)</div><div>Justice (fair selection of sujects)&nsp;</div><div>
<r /></div><div>Red BJ</div> Ethics
Define human sujects and research according to the common rule
<div>Human suje
ct- <u>living</u> individual aout whom an investigator conducting research ota

ins:&nsp;</div><div>1. Data through intervention or interaction with individual

or&nsp;</div><div>2. Identifiale private information</div><div><r /></div><d
iv>Research- systematic investigation, testing and evaluation designed to develo
p <u>generalizale knowledge </u>(not individual efore me)</div><div><r /></di
v>
Ethics
What are the elements of IRB review according to the Common Rule? (5) <div>Min
imize risk</div><div>Favorale risk-enefit</div><div>Equity in selection of su
jects</div><div>Protection of confidentiality</div><div>Provisions for informed
consent&nsp;</div><div><r /></div>
Ethics
What are 3 ethical challenges in pediatric research?&nsp;
<div>What is <u>
minimal risk</u>? (sujective vs. ojective standard)</div><div>Soliciting pedia
tric <u>assent</u> (most use age cutoff)</div><div><u>Re-consent </u>for ongoing
research: pediatric ioanking</div> Ethics
<div>What are major challenges in genetics research in human sujects? (2)</div>
<!--anki--><div>ioanking and genetic research:</div><div><r /></div><div><div
>1.Complexity of consent (unspecified future use)</div><div>2. Biological specim
ens/DN is NOT considered a human suject&nsp;</div></div><div><r /></div>
Ethics
Where does the riosome assemle in acterial mRN?
"In a place just upstrea
m of the UG start codon called the Shine-Delgarno sequence<div><r /></div><div
>First  is a Met -&gt; can e replaced later with a different </div><div><im
g src=""initiation.jpeg"" /></div>"
minoglycosides
What type of ax are gentamicin, amikacin?
How do aminoglycosides work?
"Bind to the 30S suunit of riosome and prevent
formation of the initiation complex - cause mis-reading of the inding site: th
e wrong  will come in and form incorrect proteins<div><img src=""aminogly.jpeg
"" /><r /><div><img src=""initiation.jpeg"" /></div><div><r /><div><r /></div
></div></div>"
How does resistance to aminoglycosides come aout?
"Due to enzymatic inacti
vation of the ax<div><r /></div><div>There is a large set of <u>plasmids</u> a
nd resistance enzymes that do things like <>adenylate</>, <>phosphorylate</>
or <>acetylate</> the aminoglycoside - makes it too ulky to ind to riosome
</div><div><r /></div><div><img src=""paste-6472515715073.jpg"" /></div>"
How does tetracycline work?
"ttach to 30S suunit to <>prevent</> <>ind
ing</> of incoming aminoacyl-tRN (<u>lock the  site</u>)<div><r /><div><img
src=""tetracycline mech.jpeg"" /></div></div>"
How does resistance to tetracycline come aout? (2)
"ctive <u>efflux</u> pu
mp<div><r /></div><div>lso y a plasma-encoded <>tetracycline inding protein
</>&nsp;which will ind and sequester the ax from the acterial riosome</div
><div><r /></div><div><img src=""efflux.jpeg"" /></div>"
What is Tigecycline? What is it similar to, what is the advantage?&nsp;
" glycylcycline antiiotic which is similiar to <u>tetracyclines</u><div><r />
</div><div>dvantages: works against <u>MRS</u>, and a <u>road range of oth G
+ and G-</u>, including gram- rods like&nsp;cinetoacter&nsp;</div><div><r /
></div><div>lso works y inding to the 30S suunit preventing incoming aminoac
yl-tRN</div><div><r /></div><div><img src=""tige.jpeg"" /></div>"
Whats the most common macrolide?
"Erythromycin (+ azithromycin and clarit
hromycin)<div><img src=""macrolide lincos.jpeg"" /></div>"
How do macrolides work? "Bind the <u>50S suunit</u> and lock translocation<div
><img src=""macrolide mech.jpeg"" /><r /><div><img src=""paste-8340826488833.jp
g"" /></div></div>"
Whats a famous lincosamide?
"Clindamycin<div><img src=""macrolide lincos.jpe
g"" /></div>"
Macrolides mechanism of action is similiar to what other ax category? "Lincosa
mides, oth ind 50S suunit and lock translocation<div><img src=""macrolide li
ncos.jpeg"" /></div>"
What is the resistance mechanism for macrolides and lincosamides?
"ltered
target:&nsp;<div><u>Methylation of riosomal RN</u> (adenine methylase acts o
n 2 adenines in <>23S rRN</>)- this locks the inding site of erythromycin a
nd clindamycin (which is 50S riosome suunit)</div><div><r /></div><div><img s

rc=""70s.jpeg"" /></div><div><img src=""macrolide lincos.jpeg"" /></div>"

How does chloramphenicol work? How is resistance acquired?
"Binds to the <u
>50S suunit</u> and locks the <>peptidyl transferase reaction</>&nsp;- does
nt allow <u>peptide ond formation</u><div><r /></div><div>Resistance y <u>pl
asmid-encoded acetylase enzyme</u> which acytelates the ax and makes it too ig
to ind</div><div><img src=""chloramphenicol structure.jpeg"" /></div><div><img
src=""protein synth.jpeg"" /></div>"
Does resistance to single ax come on single plasmids? Usually not - resistance
to up to 10 different ax present on these resistance plasmids
What is fusidic acid? What causes resistance? "<u>Steroid</u> like ax that i
nds to <u>EF G</u>&nsp;(elongation factor G)&nsp;--&gt; prevents movement of p
eptide chain from  site to P site<div><div><r /></div><div><>Resistance emerg
es <font color=""#ff0000"">quickly</font> due to mutations in EF-G gene</></div
><div><><r /></><div><img src=""paste-8697308774401.jpg"" /></div></div><div>
<img src=""F.jpeg"" /></div></div>"
What type of ax is Linezolid? "Oxazolidinones<div><r /><div><div><img src=""o
xazolidin.jpeg"" /></div></div></div>"
How does linezolid work? Resistance?
"Binds 50S and <u>prevents association</
u> with 30S suunit<div><r /></div><div>Resistance (although still rare) occurs
through <>mutations</> in the <>23S </>rRN of the 50S suunit</div><div><
r /></div><div>(To get effective resistance would need <i>multiple </i>mutations
y the acteria on the various 23S genes)</div><div><r /></div><div><img src="
"protein synth.jpeg"" /></div><div><img src=""rifampin.jpeg"" /></div>"
Sulfonamides and trimethoprim inhiit the sysnthesis of what? "Precursors to p
urines and pyrimidines<div><img src=""paste-10196252360708.jpg"" /></div>"
What enzyme do sulfonamides inhiit? Trimethoprim?
"Dihydropteroate synthet
ase; dihydrofolate reductase<div><r /></div><div>These ax are <>synergistic</
>&nsp;ecause they are working in the same pathway</div><div><r /></div><div>
<img src=""target sulfo.jpeg"" /></div>"
Resistance to sulfonamides and trimethoprim?
"Plasmid encoded new synthetase
and new reductase (<>BYPSS)</><div><><img src=""ypass (1).jpeg"" /></></di
v>"
Ciprofloxacin, norfloxacin are what kind of ax?
Fluroquinolones - est k
nown type of quinolones
How do quinolones work? "Block DN gyrase, Topoisomoerase IV<div><img src=""past
e-11905649344515.jpg"" /></div>"
How does resistance to quinolones come aout? Most common means is <u>mutation
s</u> in gyrase and topo IV genes<div><r /></div><div><u>Efflux</u> also import
ant</div><div><r /></div><div>Recently discovered plasmid-encoded protein calle
d <>Qnr that protects gyrase</></div>
Why are quinolones considered -cidal? "Cause without gyrase or topo IV <u>chro
msome reaks</u> and <u>kills</u> acteria<div><img src=""quin mech.jpeg"" /></d
iv>"
How does Rifampicin work? Resistance? "<div>Blocks <u>eta-suunit</u> of the
<u>acterial RN polymerase</u> enzyme</div><div><r /></div><div>Resistance due
to <u>chromosomal mutations</u> in the gene for the <u>eta-suunit of RNP</u>
</div><div><img src=""rifa.jpeg"" /></div><div><img src=""rifampin.jpeg"" /></di
v><div><r /></div>"
What are polymixins? Does resistance develop easily against them?
"Cyclic
polypeptides that act like a <u>detergent</u> and disrupt the cytoplasmic memra
ne - <>very toxic so</> <>usually used topically</><div><><r /></></div><
div>dvantage that <u>resistance to them is rare</u></div><div><r /></div><div>
Used against <>multi-drug resistant gram negatives</></div><div><r /></div><d
iv><img src=""polymixin.jpeg"" /></div>"
Cholistin is what kind of ax? "Polymixin<div><img src=""cholistin.jpeg"" /></d
iv>"
How does daptomycin work? What does it work against?
"Similiar to vancomycin
- inserts into cell memrane, creates holes that leak ions--&gt; depolarizes ac
teria resulting in acterial death from release of intracellular ions<div><r />
</div><div>Works against <u>MRS</u> and other troulesome <u>G+s like Vanc-res

istance entercocci&nsp;</u></div><div><r /></div><div><img src=""paste-1378684

5020163.jpg"" /></div>"
What is synergism for ax? (name 2 for purine/pyrimidine synth) " greater than
additive effect when the two or more ax are used together<div><r /></div><div>
ie</div><div><img src=""target sulfo.jpeg"" /></div>"
What is antagonism with ax? Give example
" less than additive effect<div
><img src=""paste-15066745274369.jpg"" /></div><div><r /></div><div><div><>tet
racyclin</> and <>eta lactam</>- are antagonists.&nsp;</div><div><r /></di
v><div>If use tetracyclin, eta lactam will not work ecause tetracyclin has sto
pped growth. Beta lactam only has -cidal effect if it is a growing acteria&nsp
;</div></div><div><r /></div>"
What is indifference when using multiple ax? Each drug works no etter and no
worse alone or in como
minoglycosides are comined with what for synergistic effect? Penicillins&nsp
;ecause PCNs allow increased passage of aminoglycosides<div><r /></div><div>Ex
amples of aminoglycosides: gentamicin, amikacin, toramycin, streptomycin, neomy
cin (used in owel prep)</div>
Beta-lactams are synergistic with?
Beta-lactamse inhiitor
ntagonistic - 
Use of tetracycline and a eta-lactam will have what effect?
eta lactams only work on growing acteria; tetracyclines are <u>acteriostatic</
u> and will stop the acteria from growing
Pontomedullary junction contains what? "Emergence of CN VI, VII, VIII<div><img
src=""678.jpeg"" /></div>"
Neuro
In Texas, statues for confidentiality for pediatric patients are silent. Give an
ethical justification for maintaining confidentiality with your pediatric patie
nts. (4 appeals)
<div>1. ppeal to <u>consequences</u> and <u>fiduciary o
ligations</u>: dolescents are <i>less likely to seek care</i> if they perceive
health care services are not confidential</div><div><r /></div><div>2. ppeal
to <u>developing decisional rights</u></div><div><r /></div><div>3. ppeal to <
u>non-decisional right</u> to <>confidentiality</></div><div>-exception: imman
ent threat of serious harm to patient or others</div><div><r /></div><div>4. p
peal to <u>non-decisional rights</u> of <>honesty</> and <>respect</></div>
Ethics
What is mnemonic for protein synthesis inhiitors?
"<div>Buy <>T 30</>,
<>CELLS</>&nsp;at <>50&nsp;</></div><div><><r /></></div><div>- <>C</
>hloramphenicol/<>C</>lindamycinacteriostatic</div><div><div>- <>E</>rythrom
ycin and other macrolidesacteriostatic</div><div>- <>L</>incosamidesacteriosta
tic</div><div>- <>L</>inezolidacteriostatic against most susceptile acteria,
actericidal against certain strains of S. pneumoniae, B. fragilis, and C. perf
ringens</div><div>- <>S</>treptograminsacteriostatic against E. faecium, acte
ricidal against certain strains of MSS (methicillin-sensitive S. aureus) and MR
S (methicillin-resistant S. aureus)</div></div><img src=""protein synth.jpeg""
/>"
What type of nerves via LVST (lower) and MVST (upper) stalize the ody like on
a oat or earthquake
lpha/gamma motor neuron
What area of the rain causes vertigo toward the side of depolarization?
Broadmanns rea 3a (postcentral gyrus)
t rest potential the transduction channel is open aout how much of the time?
20%
Descrie endolymph (electrolyte, secretion)
<u>K+ rich</u>, secreted y <u>d
ark cells</u> at ase of each cristae and y cells of <u>striae vascularis</u>
"Whats the name of the ""ig"" hair cell?"
"Kinocilium<div><img src=""vesti
ular system pic.jpeg"" /></div>"
What things can cause increased opening of hair cell transduction channels?
High pressure in endolymph<div>Inflammation</div><div>Increased temperature</div
><div>minoglycosides (gentamycin)</div><div>&nsp; &nsp;- wedge in the door</d
iv>
What direction does the saccule detect change? "Up - down<div>&nsp; &nsp; &n
sp; &nsp; __</div><div>&nsp; &nsp; |</div><div>&nsp; &nsp; |</div><div>&ns
p; &nsp; |</div><div>&nsp; &nsp; &nsp; &nsp; &nsp; &nsp; &nsp; __| &nsp

; &nsp;accule<r /><div><r /><div><img src=""saccule.jpeg"" /></div></div></di

v>"
What direction does the utricle sense motion? "Horizontal&nsp;<div>""|______|
tricle""<div><img src=""paste-67744519159809.jpg"" /></div></div>"
The anterior and posterior canals sense change in what directions?
"-P axi
s and around left-right axis<div><img src=""P canals.jpeg"" /></div><div><img s
rc=""P (1).jpeg"" /></div>"
What direction (axis) does the horizontal canal sense movement in?
"round
superior-inferior axis<div><img src=""paste-67954972557313.jpg"" /></div><div><i
mg src=""P (1).jpeg"" /></div><div>Horizontal=Lateral</div><div><r /></div><di
v><r /></div>"
Moving anteriorly causes (de/hyper) polarization? Posteriorly? "nterior: depol
arize<div>Posterior: hyperpolarize</div><div><r /></div><div><img src=""paste-6
8362994450433.jpg"" /></div>"
 single spin to the right will depolarize which side? The same side (right sid
e)<div><r /></div><div>MOOS</div><div>Multiple opposite, Once Same</div>
What is the vestiulo-occular reflex (dolls eye)? What nerves are tested? Norma
l/anormal?
"Test for intact cranial nerves 3,4,6 (midrain function)<div>No
rmal: eyes should stay ""focused"" on stationary oject</div><div>normal: eyes
move with head (like doll with painted-on eyes)</div><div><img src=""horizontal
vesti eye.jpeg"" /></div>"
In what 2 conditions can one use dolls eye maneuver? Pinealoma<div>Comatose p
atient</div>
How is Penicillin V different from PCN G?
Unlike pen G, <u>not destroyed 
y gastric acid</u>, can e given orally
dding an amine group to pcn does what to its efficacy against gram negative org
mpicillin, 10x efficacy against gram ne
anisms? What is this drug called?
gative
In what form is penicillin normally administered today? What properties make thi
s so?
moxicillin, similiar to ampicillin ut is <u>more completely asored f
rom the GI tract</u> (less diarrhea) and has a half life of <u>45-60 minutes</u>
<div><r /></div><div>Dosage of 500mg every 8 hours</div>
This pcn is effective against pseudomonas and used widely in TMC in conjunction
with a eta-lactamase inhiitor (tazoactam). Piperacillin<div><r /></div><di
v>Piperacillin/tazoactam = (<u>Zosyn</u>)</div>
Whats a common side effect of clavulanic acid? Diarrhea
Is clavulanic acid effective against MRS?
No
What are some common infections augmentin (amoxicillin + clav. acid) is used to
treat? Penicillinase <i>Haemophilus</i> or <i>Moraxella </i>(therefore most ac
terial pneumonia, all otitis or sinusitis),&nsp;<div>mixed anaeroic mouth flor
a--&gt;<i>Pasturella</i>,</div><div><i>Penicillin-resistant S. aureas</i>, skin
infections due to <i>strep. pyogenes</i><div><r /></div><div><>NOT MRS Though
</></div></div>
What is Unasyn? Equivalent to? Whats it widely used for?
<div>ampicillin/
sulactam</div><i>IV equivalent of augmentin&nsp;</i><div><r /></div><div>Used
for <u>pneumonia</u>, <u>intra-adominal infection</u></div>
What drug como is recommended for treating intraadominal infections that egan
in the community?
Ticarcillin/clavulanic acid (Timentin)<div><r /></div><
div>Effective against gram(-) rods that are likely to e resistant to piperacill
in y producing a -lactamase</div><div><r /></div><div>vs. piperacillin/tazo w
hich is intraadominal in hospital</div>
What are some acteria that piperacillin and timentin should e used? Klesiel
la, Enteroacter and Pseudomonas (intraadominal infections)
Effective against many hospital-associated gram(-) rods that are resistant to ti
carcillin/clavulanic acid.
Piperacillin/tazoactam (Zosyn)
What are the allergy stats for penicillins?
Some allergy in 1-2% of people<d
iv>naphylaxis in &lt;0.01% of people</div><div><r /></div><div>Mechanism for a
naphylaxis- penicillin acts as <>hapten</>, comining with human proteins, sti
mulating IgE on mast cells or asophils.&nsp;</div>
The risk of giving someone pcn depends on?
"What <u>kind of reaction</u> an

d how <u>remote</u> the previous reaction was<div><r /></div><div><div>a.<span

class=""pple-ta-span"" style=""white-space:pre""> </span><u><>Remote</></u> s
kin rash (very low risk) vs <u><>recent</></u> skin rash (higher risk ut not r
isk of life-threatening reaction) &nsp;vs <><font color=""#ff0000"">type 1 rea
ction</font></> such as hives, swelling, anaphylaxis (major risk)</div><div><r
/></div><div>.<span class=""pple-ta-span"" style=""white-space:pre""> </span
>Might consider readminstration to someone with remote history of enign ""skin
rash,"" ut never would give to someone with history suggesting <><font color="
"#ff0000"">type 1 hypersensitivity&nsp;</font></></div></div><div><r /></div>
"
"Should you just write ""allergic to PCN"" in the chart?"
No, need to desc
rie the nature of the reaction
Musher doesnt like these words: coverage and road spectrum antiiotic Broad sp
ectrum implies that youre giving unnecessary drugs<div><r /></div><div>Kid wit
h menningioccocal meninigitis : only need pcn dont also give vancomycin and taz
oactam</div>
What was the first generation cephalosporin? What is it effective against?
"Cefazolin - effective against<> S. aureus</> and <>S. pyogenes</>, ut not
MRS<div><img src=""cepha 1.jpeg"" /></div><div><r /></div><div>Cephalexin (Kef
lex) also 1st generation (oral version)</div>"
What is a general property of all cephalosporins on enterococcus?
That the
y have no effect :(
Does cefazolin have favorale pharmokinetics? Yes <u>high serum</u> and tissue
levels plus <u>long half-life</u> (90 minutes)
This drug was used extensively in surgical prophylaxis to prevent infection eca
use of efficacy against staph and strep.
Cefazolin - efficacy decreased 
ecause of MRS outreak
What is the oral version of cefazolin (1st generation) cephalosporin? Cephalex
in (Keflex)
Used to e a mainstay treatment for usual infections of skin and soft tissues un
til MRS epidemic.(ceph)
Cephalexin
Whats the idea with ax prophylaxis in surgery?
"When you cut someone op
en you create alot of ""dead spaces"" were lood doesnt flow. so you give the p
t ax--&gt;&nsp;single dose just prior to surgery is proper prophylaxis"
Name two 2nd-generation cephalosporins. What is target? Use?
"Cefoxitin (Mefo
xin) and Cefotetan (Cefotan)<div><r /></div><div>Cefuroxime (Ceftin) $$</div><d
iv><r /></div><div>Broader range of gram (-) (lso HEN PEcKS)</div><div><r /><
/div><div><>have largely een replaced y third generation cephalosporins</></
div><div><><r /></></div><div><>Mnemonic: The FMily is gathered, some weari
ng <font color=""#ff0000"">FUR</font> coats, my <font color=""#ff0000"">FOX</fon
t>Y cousin is drinking fo<font color=""#ff0000"">TE</font> in a toast to my ac
hievement.&nsp;</></div>"
Name two third-gen cephalosporins.
Cefotaxime (Claforan), Ceftriaxone (Roce
phin) - Widely used<div><r /></div><div><r /></div><div>3rd=Tri, T</div><div><
r /></div><div>Cef<>TRI</>axone</div><div>Cefo<>T</>axime</div>
Third gens are good against? Bad against?
"<div>a.<span class=""pple-taspan"" style=""white-space:pre""> </span>Effective against <u>streptococci</u>,
<u>pneumococcus</u>, <u><i>Haemophilus</i></u>, <u><i>Moraxella</i></u>, <u>gono
cocci</u>, gram negative rods (ut not Pseudomonas), <u>Borrelia</u> (lyme disea
se), <u>Haemophilus ducreyi</u> (chancroid)</div><div><r /></div><div>.<span c
lass=""pple-ta-span"" style=""white-space:pre""> </span>Reduced efficacy again
st Staph aureus (vs cefazolin), ut still good</div><div><r /></div><div>c.<spa
n class=""pple-ta-span"" style=""white-space:pre""> </span>Ineffective against
<i>Bacteroides</i> or <i>enterococci</i></div><div><r /></div><div><><u>Penet
rate BBB</u></></div><div><r /></div>"
What is the half life of ceftriaxone? 6-8 hours! - can e given q 24 hours
Does cefotaxime and Ceftriaxone relialy penetrate the BBB and are therefore goo
d at treating acterial meningitis?
Yes
What 3rd gen ceph is good against pseudomonas? Ceftazidime
Your attending: lets give more ceftriaxone against this G(-) more is etter.

You: no the MIC for most G(-)s is only 0.2, the patient wont reach that level
for days due to long half-life of ceftriaxone<div><r /></div><div>ttending: sa
y goodye to honors</div>
What two components keep penicllin from crossing the BBB very much?
Tight ju
nctions and a pump that actively pumps out the PCN
Inflammation to the BBB (meningitis) affects the concentration of penicillin how
?
Inflammation shuts down the pumps in choroid plexus that pump pcn out penicillin concentrations never reach more than a couple of percent of what they
are in the lood - its just that with infammation pcn will stay in the rain fo
r a looong time
Name an oral-third gen ceph that can e given orally. Cefpodoxime (Vantin)<div
><r /></div><div>Like cefotaxime, ut can e given orally.&nsp;</div><div><r
/></div><div>PO= orally</div>
Whats a fourth gen ceph? Use? Cefepime - good against <u>pseudomonas</u>
5th gen ceph? Difference from 4th gen? Ceftaroline - recently released; has pro
perities of cefepime <>ut also inds PBP 2a and is therefore <u>active against
MRS</u></>
Cephalosporins enter gram negative acteria via porins. Can you guess how resist
lterted porins = resistance
ance arises?
What kind of enzymes reakdown cephalosporins? Cephalosporinase, acteria that
have extended-spectrum eta lactamases (ESBLs) are resistant to all pcns and all
cephs
Can nystagmus result from a single head spin? No results form <u>prolonged act
ivation</u> - named for <>fast phase (i.e. which way the eye snaps ack to)</>
Where does the slow phase of nystagmus arise from? The fast phase? (like what pa
rt of the rain)
Slow: Vestiular nucleus (all midrain)<div>Fast: Cortex
</div>
How do warm, cold calorics induce nystagmus?
Warm water <u>increases rownian
mothion</u> which increases transductor channel opening<div><r /></div><div>Co
ldwater <u>decreases rownian motion</u> and makes the other side seem more acti
ve (due to the tonicity at all times of the apparati)</div>
How do multiple spins induce nystagmus? Multiple spins overcome endolymph inerti
a
"Whats the MOo COWS mnemonic? Named for which side of the ""spin"" is depolariz
ed."
Multiple spins - opposite<div>Cold calorics - opposite</div><div>Warm ca
lorics - Same</div>
Increased, prolonged depolarization of hair cells causes? give mechanism
Excitotoxicity - increased <u>Ca+ influx</u> triggers pathologic <u>apoptosis</u
> or activation of <u>Ca-inding proteases</u> which destroy the cells
What is Menieres disease?
"Increased slow uild-up of endolymph in one la
ryinth. Episodic.&nsp;<div>Illustrates that there is very little inhiition of
vestiular system (unlike auditory)</div><div><r /></div><div><r /></div><div>
<img src=""paste-25301652341097.jpg"" /></div><div><r /></div>"
Name some symptoms of Menieres disease.
Episodic - nausea, tinnitus (rin
ging), vertigo, horizontal nystagmus, vomiting, fall to contralateral side
What causes IPSI extensor rigidity in Menieres disease?
"IPSI LVST/MVST
pathway activated, causing ipsi rigidity<div><img src=""archi.jpeg"" /></div>"
T/F eventually you go deaf in the ear with Menieres disease. True - people op
t to have laryinthectomy. But, disease can develop spontaneously in other layr
inth.<div>lso, get relative depolarization of intact side compared to asent la
yrinth ~ 1 week</div><div><r /></div><div><u>Disease illustrates very little i
nhiition of vestiular system</u>&nsp;(unlike auditory)</div>
What happens when you take out the laryinth? "Relative depolarization ecause
your rain now reads the removed side as ""zero"" whereas it used to e slightl
y tonic even at rest -&gt; for a week you get a Menieres attack <>on the other
side</>"
What does inflammation from laryinthitis cause? What can it occur after?
"Increased transductor channel opening and depolarization<div><r /></div><div>M
ay occur <u>post-URI</u></div><div><r /></div><div>Often self-limiting</div><di
v><img src=""depolarization hair cell.jpeg"" /></div>"

Gentamycin causes the transductor channel to? Open

What organisms are not covered y cephalosporins?
"<font color=""#ff0000""
><>LME</></font><div><font color=""#ff0000""><><r /></></font></div><div><
font color=""#ff0000""><>L</></font>isteria</div><div><font color=""#ff0000"">
<></></font>typicals (Chlamydia, Mycoplasma)</div><div><font color=""#ff0000"
"><>M</></font>RS</div><div><><font color=""#ff0000"">E</font></>nterococci
</div><div><r /></div><div>Exception: ceftaroline covers MRS</div>"
Who are the providers of the health care system?
<div><>Private</></div
><div>-physicians (individual, group and private practice entities)</div><div>-h
ealthcare organizations&nsp;</div><div><r /></div><div><>Pulic&nsp;</></di
v><div>-physicians (employed or contracted y government entities)</div><div>-he
althcare organizations (federal, state, local government)</div><div><r /></div>
<div><r /></div>
Ethics
Who are the payers of the health care system? <div><>Private</>-&nsp;</div>
<div>**Employers (sectarian/non; for-profit/not-for-profit)</div><div>**Individu
als (out of pocket, medical savings accnt)</div><div><>Pulic</>- (Federal, st
ate, local government) including medicare, medicaid, TRICRE.&nsp;</div><div><
r /></div>
Ethics
What are the 3 categories of regulators of the health care system?
<div><>
Non-governmental</>&nsp;</div><div><>Governmental</>&nsp;</div><div><>Prof
essional&nsp;</></div><div><r /></div>
Ethics
What is the definition of socialism?
Social ownership of the means of product
ion
Ethics
Do we have socialized medicine in the US? Give 2 examples
<div>Yes!!</div>
<div>Private: cooperative private ownership (Mayo, Cleveland clinic, give a port
ion of income to pool for education/research)&nsp;</div><div>Pulic: pulic own
ership Veteran Health ffairs, Harris Health</div><div><r /></div>
Ethics
Technically speaking, a system is an organized, integrated, and consistent organ
ization of a production or service industry. Descrie the health care system in
the US. We do not have a healthcare system, <u>we have a healthcare gemish</u>!!
!!!!!<div>-<>Disorganized</></div><div>-Not integrated</div><div>-Inconsistent
</div><div>-<>No one is in charge</></div><div>-No one is accountale</div>
Ethics
What are 3 ethical challenges facing our healthcare system?
<div>1)&nsp;<u>
Increasing access</u> (y providing reliale and sustainale sources of payment
for all who need healthcare)</div><div>2)&nsp;<u>Controlling costs</u> (reduce
rate of inflation for healthcare)</div><div>3)&nsp;<u>Improving quality&nsp;</
u></div><div><r /></div>
Ethics
What was the main goal of the C?
Increase numer of <>citizens</> with
source of payment and end cost curve downward Ethics
<div>The current organization and delivery of healthcare in the US reflects the
fundamental merican value of?</div>
<div>Suspicion aout concentrations of p
ower</div><div><r /></div>
Ethics
Descrie Dr. Thomas Percivals account of professionally responsile resource mana
gement. (3)
<div>1) Healthcare resources should e managed on the asis of t
he physicians professional <u>clinical judgment</u>.&nsp;</div><div>2)&nsp;<u>C
ost-enefit argument</u>, ut limited to only the gravest cases. (ie, limit reso
urces for patients not gravely sick)&nsp;</div><div>3) rgument from <u>purest 
eneficence</u> when cost-enefit argument fails.&nsp;</div> Ethics
<div>ccording to Demings concepts, what is the definition of quality?</div>
<div>Progressively and responsily <>minimize variation</> in a production or
service process, which should reduce variation in outcomes and therefore manage
costs.&nsp;</div><div><r /></div><div><r /></div>
Ethics
What is the means to responsily manage costs? Improving quality!
Ethics
What are 3 components of quality improvement? <div>1. Provide physicians with
<u>information aout variation</u> in the <u>processes</u> and <u>outcomes</u> o
f patient care</div><div>2. Provide physicians and other healthcare professional
s with <u>tools</u> to responsily reduce variation</div><div>3.&nsp;<u>Tie pay
to quality </u>(Pay for Performance P4P)</div> Ethics
ppeal to the pr
The concept of quality is supported y which ethical appeal?

ofessional virtue of integrity&nsp;

Ethics
How should we appraise organizational culture? (4)
<div>1) void cultures f
ocused on <u>ottom line</u></div><div>2) Commitment to <u>delierative practice o
f medicine</u></div><div>3) High <u>transparency and accountaility</u></div><di
v>4)&nsp;<u>Rhetoric</u> vs. <u>actual practices</u></div>
Ethics
What are ESBLs? Extended spectrum eta lactamases- <>resistance to cephalospori
ns</>. Especially an increasing prolem in hospitals in the developed world.
ID
What is the most common drug reaction from penicillin? Skin rash. Drug fever is
next most common.&nsp;
ID
What is the pulished rate of cross-reactivity etween penicillin and cephalospo
rins? What is Mushers opinion?&nsp; 10-25%; however, Dr. Musher elieves it
to e 1-5%, if not lower.&nsp; ID
What is the mechanism of action of carapenems? Binds to all known PBPs <u>excep
t PBP2</u> (the MRS one)
ID
What is the resistance to carapenems mediated y? What ug in particular has le
d to this?
<u>Carapenemases</u>, often produced y <i>klesiella</i>. Exce
ssive hospital use has selected this ecoming major prolem. ID
What is the spectrum of activity of carapenems?
<>Very road</>, <u>Gr
am positive</u> (including enterococcus, ut <>NOT MRS</>), <u>gram negative<
/u> rods including <>pseudomonas</>. ID
How does cilastatin help imipenem? What is this comination trade name.&nsp;
"<div>It <u>prevents inactivation</u> y dehydropeptidase I in renal tuular cel
ls, decreasing excretion. <u>Primaxin</u>= imipenem + cilastatin.&nsp;</div><di
v>Mnemonic: <i>The killin is a lastin with cilastatin. </i>(First id 2014)</div>
<div><><font color=""#ff0000"">(Will e on the exam per Musher)</font></></div
>"
ID
Which carapenem is not effective against pseudomonas?&nsp;
Ertapenem
ID
What is the only monoactam that is used? Effective against? Not effective again
st?
"ztreonam. Truly, should e used extensively, ut it just never got tha
t popular. Effective only against <u>gram negative rods</u> including pseudomona
s, ut <>NOT ENTEROBCTER.&nsp;</><div><><img src=""negative alg.jpeg"" /></
ID
></div>"
How do aminoglycosides get transported into the cell? <u>ctive transport</u>
across <u>porins</u> (protein channels), <u>requires oxyge</u>n. Implication: in
effective against <>anaeroes</>&nsp;
ID
What is the mnemonic for aminoglycosides?
"""<><font color=""#ff0000"">Me
an</font></> (a<font color=""#ff0000""><>min</></font>oglycoside) <><font col
or=""#ff0000"">GNTS</font></> ca<><font color=""#ff0000"">NNOT</font></> kil
l <>anaeroes</>. (<i>First id 2014</i>)<div><r /></div><div><><font color=
""#ff0000"">G</font></>entamicin, <font color=""#ff0000""><>N</></font>eomyci
n, <font color=""#ff0000""><></></font>mikacin, <font color=""#ff0000""><>T<
/></font>oramycin, <><font color=""#ff0000"">S</font></>treptomycin</div><di
v><r /></div><div><><font color=""#ff0000"">N</font></>ephrotoxicity (especia
lly when used with cephalosporins)</div><div><font color=""#ff0000""><>N</></f
ont>euromuscular lockade</div><div><font color=""#ff0000""><>O</></font>totox
icity (especially when used with loop diuretics)</div><div><><font color=""#ff0
000"">T</font></>eratogen</div>"
ID
Under what conditions are aminoglycosides actericidal for gram +, and gram -?
<div><u>Gram (-):</u>&nsp;usually achievale concentrations</div><div><u>Gram (
+)</u>: only at very <u>high</u> concentrations or if with <u>synergism</u> with
penicillins (alters wall, can accumulate now)</div>
ID
What is the usual cause of resistance against aminoglycosides? "<u>Enzymatic de
activation</u> of M molecule (acetylation, phosphorylation, adenylation) y <>
aminoglycoside modifying enzymes</>. (Later Ms like gentamicin and amikacin ha
ve fewer sites where deactivation can occur)<div><img src=""modifying.jpeg"" /><
/div>" ID
What is streptomycin used for? What class is it useful against? nti TB. ctive
against gram () rods.&nsp;<div><r /></div><div><i>This was the first M. s suc

h, has the greatest adverse effects of all M</i></div> ID

What are the adverse effects of all aminoglycosides, most prominently&nsp;strep
tomycin?
<div><>Nephrotoxicity</> (inds <u>memrane lipids</u> on prox
imal tuular cells. Taken in y pinocytosis and concentrated 2-5 fold, <u>accumu
lating in lysosomes</u> and endocytic vesicleslipid deris causing swelling of tu
ular cells. Long half life within cells.)</div><div><>CNVIII damage</></div>
ID
We know that streptomycin is toxic, ut what historical mistake was made that re
ally led to this toxicity?
<u>Failure to understand that dosage has to e r
educed in renal insufficiency</u>. In a vicious cycle, administration causes dec
reased clearance, leading to high levelseven more toxicity.&nsp;
ID
Overall, efficacy and adverse effects of aminoglycosides are determined y what?
<div>Efficacy is determined y <u>peak</u> level, adverse effects determined y
<u>trough</u> level.&nsp;</div><div><i>This was a fatal mistake in earlier days
, doctors assumed that peak caused toxicity.&nsp;</i></div>
ID
<div>The medical profession realized aout M that it was cleared y kidney, acc
umulates and is toxic in kidney, and needs to e reduced in persons with decreas
ed renal function with what drug used in 1960s?</div> Kanamycin
ID
In normal renal function, what is half-life of gentamicin?
2.5 hours
ID
What is the use of gentamicin? Fewer inactivation sites (more resistance) than
other M, works nearly all gram () rods <>including pseudomonas</><div><r /></
div>
ID
mikacin
What M has fewest deactivation sites and is really effective? Use?
<div>Effective for nosocomial/community gram (-) infection</div>
ID
Where does vancomycin act and what is the mechanism?
"<div>Binds to <u>D-ala<
/u>, the terminal  on NM pentapeptide.</div><div>Binding <u>sterically inhii
ts pentaglycine ridging</u>, preventing cell wall synthesis.&nsp;</div><div><
><font color=""#ff0000"">(Will e on the exam per Musher)</font></></div><div><
><font color=""#ff0000""><r /></font></></div><div><><font color=""#ff0000""
><img src=""vanc mechanism.jpeg"" /></font></></div>" ID
<div>What can e added for synergy with vancomycin? ntagonism?&nsp;</div>
<div>Synergy: Gentamicin (M)</div><div>ntagonism: Rifampin.&nsp;</div><div><
r /></div><div>(in vitro)</div> ID
What is MIC creep?
In reference to <>vancomycin</> use, MICs are moving u
p ecause of wide use ID
With MSS, how to treat? With MRS, how to treat?
<div>MSS- eta lactam.
MRS- vancomycin, daptomycin</div><div><i>Dont use vancomycin on MSS.</i></div><
div><r /></div><div>MSS= Methicillin Susceptile Staph ureus</div> ID
re polymyxins (colistin) used frequently? What is the consequence?
Not used
frequentlyalmost <u>no resistance</u> in community or hospital.
ID
What are side effects of polymyxins?
Nephro and neurotoxicity, <>not asore
d from GI tract.&nsp;</>
ID
What is a unique use of polymyxins?
Given y <u>inhalation</u> to treat pneu
monia in intuated patients.&nsp;
ID
Do Macrolides have anti-inflammatory effect? Use of this?
Yes, unrelated t
o antiacterial effect. Good for treating exacerations of <u>chronic ronchitis
</u>. Literature also suggests etter outcome of <u>pneumococcal pneumonia</u> w
hen macrolide is used due to this.&nsp;
ID
Macrolides are acteriostatic for what? Bactericidal against what?
<div>Sta
tic for S. aureus&nsp;</div><div>Cidal for Haemophilis&nsp;</div><div><r /></
div>
ID
Why are macrolides used in cystic firosis?
Block <u>alginate</u>, and there
fore iofilm production of pseudomonas in vitro and in vivo. (recall pseudomonas
make slimy iofilm and kill CF patients)
ID
What is the general use of macrolides? <u>typical pneumonias</u> (<i>Mycoplasm
a, Chlamydia, Legionella</i>)<div><u><r /></u></div><div><u>STDs</u> (for <i>Ch
lamydia</i>)</div><div><r /></div><div>and <u>gram-positive cocci</u> (streptoc
occal infections in patients allergic to penicillin). (First id)</div> ID
Resistance to macrolides is encoded y mef and erm gene. What do these genes do?

<div>Mef- efflux pump</div><div>Erm- erythromycin riosome methylation&nsp;</di

v><div><r /></div>
ID
What is clindamycin (lincosamide) effective against?
"<>Gram positive acter
ia</>, S. aureus, most MRS. Most <>anaeroic</> acteria.&nsp;<div><r /></
div><div><><font color=""#ff0000"">polymicroial aove diaphragm</font></></di
v>"
ID
What is the clinical usefulness (situations which anaeroic acteria are importa
nt) of clindamycin<div><r /></div><div>How to treat streptococcal gangrene?</di
v>
<div>1. <u>Intra-adominal infection</u></div><div>2. <u>spiration pneu
monia</u></div><div>3. Mouth ites (Musher prefers augmentin)</div><div>4. Toget
her with <>penicillin</> in <u>streptococcal gangrene.&nsp;</u></div><div><r
/></div>
ID
What 3 factors have led to decreased usage of clindamycin?
<div>1. anaeroe
s (acteroides) ecoming <u>resistant</u></div><div>2. major <u>cause of C. Diff
.</u></div><div>3. vailaility of <u>eta lactam</u> + <u>eta-lactamase inhii
tor</u> cominations</div><div><r /></div>
ID
What antiiotic is used as a topical treatment for acne?
Clindamycin. <i>
Propioniacterium acnes</i>, anaeroic acteria. Clindamycin inhaits hair folli
cles and metaolizes natural oils (seum) as well.&nsp;
ID
"What is ""litchrally"" the only oxazolidinone?"
Linezolid
ID
Linezolid is active against what? Whats the catch?
<div>ctive against <>S
. aureus (including MRS), CONs, pneumococci, enterococcus</>.&nsp;</div><div>
This drug costs $120 day for treatment. Cellulitis treatment would total to $840
. There are other cheaper options!&nsp;</div><div><r /></div><div><i>The jedi
is to practice with the skill of <u>Charles Fraser</u> and wisdom of <u>Stephen
Whitney</u></i></div> ID
What did Wennerg and Gittelsohn show?&nsp;
-Documented area variation in us
e of tonsillectomy (66% in some places, 16-22% others)<div><r /></div><div>-The
y showed that rates of tonsillectomy in Vermont <u>decreased when physicians wer
e provided information</u> aout area variation in the procedure.&nsp;</div>
Ethics
Overall, give the summary of use of M (target, and any synergy)
<u>Gram
(-) rod infections + pseudomonas</u>, ut generally only if not susceptile to o
ther drugs ecause of fear regarding toxicity of M (especially in frail, hospit
alized patients).&nsp;<div><r /></div><div>lso used <u>synergistically</u> wi
th <>eta lactam</>, or <>vancomycin</> vs. gram (+) acteria such as entero
coccus or S. aureus.</div>
When giving vancomycin, what must e done in terms of pharmacokinetics? High hal
f life of 2 hours. Need to measure levels in lood. Thus renal clearance is impo
rtant, reduce dosage if C<su>cr</su> is decreased&nsp;
ID
What is an example in the medical center of doctors using empiric therapy agains
t literature? Vancomycin empric usage for patient who is neutropenic after can
cer chemotherapy.<div>Literature states that it does not enhance outcome unless
patients have indwelling IV lines.&nsp;</div> ID
Rifampin is used in what clinical scenarios? What drug for synergy? (3) "<div>-<
>TB</>, M. vium</div><div>-Prophylaxis/treatment of <>nasal carriage meningo
cocci</></div><div>-gainst acteria adhering to foreign odies as <>iofilm</
>, only <><font color=""#ff0000"">rifampin</font></> and <><font color=""#ff00
00"">quinolones</font></> can kill <>iofilm</>, especially good when togethe
r (<>synergy</>)&nsp;</div><div>prosthesis, osteomyelitis. &nsp;</div>"
ID
What is mechanism of action of rifampin?
Inhiiting DN-dependent RN pol
ymerase.&nsp; ID
What is adverse effect of rifampin?
"Turns urine and tears <><font color=""
#ff761e"">orange</font></>"
ID
What are side effects/reactions of doxycycline? (4)
Rash with sun exposure (
cause unknown)<div>Vaginal thrush</div><div>Diarrhea</div><div>Discolors teeth</
div>
ID
What is used for eradicating meningococcal carriage?
Minocycline (Tetracyclin
e- the original road-spectrum ax)
ID

What is tetracycline first line therapy for?

"<div><>1.<span class=""pple-t
a-span"" style=""white-space:pre""> </span>Rickettsial diseases: Rocky mountain
spotted fever, murine typhus</></div><div><>2.<span class=""pple-ta-span""
style=""white-space:pre""> </span>Q fever</></div><div><>3.<span class=""pple
-ta-span"" style=""white-space:pre""> </span>Psittacosis</></div><div><>4.<sp
an class=""pple-ta-span"" style=""white-space:pre""> </span>Lymphogranuloma ve
nereum</></div><div>5.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>Brucellosis (not alone, though)</div><div><r /></div>" ID
Tell me aout the efficacy of&nsp;Sulfamethoxazole and trimethoprim (Bactrim)&n
"Group  strep are susceptile in vitro, ut dru
sp;&nsp;on Group  strep?
g is poor in vivo ecause they <u>produce enzymes that reak down mammalian tiss
ue releasing thymidine</u>, thus the acteria dont need to synthesize.<div><><im
g src=""ypass (1).jpeg"" /></></div><div><><r /></></div><div><>lso works
on&nsp;</></div><div><>1. Staph</></div><div><>2. Strep  (in viro)</></d
iv><div><>3. HI</></div><div><>4. Nesseria</></div><div><>5. Nocardia</></
div>" ID
What is the clinical use of sulfonamide?
"1. Gram-positive (including <fo
nt color=""#ff0000"" style=""font-weight: old; "">MRS</font>),<div><r /></div
><div><font color=""#ff0000""><>2. simple UTI</>&nsp;</font>(recommended in u
ncomplicated UTI).<r /><div><r /></div><div><r /></div><div>&nsp;gram-negati
ve, Nocardia, Chlamydia.&nsp;</div></div>"
ID
What are 2 adverse effects of sulfonamides? Comment on idiosyncratic/dose-relate
d
<div><u>Stevens Johnson syndrome</u> (idiosyncratic, ie. no one knows wh
y)</div><div><u>Renal insufficiency</u> (dose-related, ie. predictale, will war
n the patient)</div>
ID
Whats the use of ciprofloxacin, and the questionale claim y the scientific comm
unity? "Ciprofloxacin is <>said to e less effective against pneumococcus</>
and <u>no longer recommended for respiratory infections</u>.&nsp;<div><r /></d
iv><div>More effective against <><font color=""#0000ff"">pseudomonas</font></>
, therefore <><font color=""#0000ff"">standardly recommended for UTI</font></>
</div>" ID
What is the clinical use of quinolones?&nsp; (2)
<>pseudomonas</>, <>U
TI</> and intraadominal infection (like gen surg) &nsp;<div>Biofilm</div><div
><r /></div><div>(originally effective against all gram (-) rods, and extreted
in urine)</div> ID
What are adverse effects of quinolones (4)
<>1. Prolong QT interval</> (c
aution with Ca+ channel lockers),&nsp;<div>2. Tendonitis and <>chilles tendo
n rupture</></div><div>3. Drug-drug interaction: increases risk of <>leeding<
/> on <>patients on warfarin </>(y action on vit K and gut)</div><div><>4.
C Diff Colitis&nsp;</></div> ID
What is quinolone used as prophylaxis for?
Immunocompromised patients with
prolonged <>neutropenia</> or those with <>cirrhosis</>, ascites, and prior
spontaneous acterial peritonitis.&nsp;
ID
What is the only lipopeptide? Daptomycin
ID
What is the only lipoglycopeptide? Mechanism of action? Televancin. Blocks pepti
doglycan synthesis y same mechanism of <>vancomycin</>, alters memrane in sa
me way as <>daptomycin</>. Should e a great drug.&nsp;
ID
What was metronidazole introduced for? Now what is it used for? Trichomonas vagi
nalis. Efficacy against <>anaeroic</> acteria, used for <u>intraadominal in
fections</u>. Nontoxic.&nsp;<div>infection elow diaphragm</div>
ID
What are two topical antiiotics
Bacitracin, mupurocin.&nsp;
ID
<div>Nitrofurantoins (fradantin, macrodantin) Cranerry juice, Fosfomycin, Methe
namine mandelate are active only where?</div> <div>Only in urinary tract.&nsp
;</div> ID
Descrie the mechanism of depolarization in vestiular system (start with endin
g hair undle) "Bend hair undle toward kinocilium tension and nonspecific chann
el open time K+ influx Depolarization occurs, voltage gated Ca+ channels open, Ca+
influxsynaptic vesicles fuse with the memrane glutamate release into synapse, act
ion potentials in the 2nd order neuron. &nsp;<div><img src=""depolarization hai
r cell.jpeg"" /></div>"

Descrie the mechanism of hyperpolarization in the vestiular system

Bend hai
r undle away from kinocilium tension and channel open timehyperpolarization
Descrie mechanism of ototoxicity of aminoglycosides (gentamycin)
This dru
g <u>holds the nonspecific transduction channels open</u>&nsp;(like a wedge) ca
using prolonged depolarization and excitotoxicity to first order neurons. Increa
sed Ca+ influx destroys the cell.&nsp;
Descrie the normal horizontal vestiulo-ocular reflex (left) "<div>Depolarize
LEFT layrinth Left (ipsi) vestiular nucleus right (contra) NPHRight (contra) CN
VI (to right lateral rectus) Left MLFLEFT CN III (to left medial rectus) eyes move
right&nsp;</div><div><r /></div><div><r /></div><div><img src=""horiz vest oc
ular hand (1).jpeg"" /></div><div>(mirror image)</div>"
Descrie normal vertical vestiule-ocular reflex (left) "Depolarize LEFT layrin
thLEFT (ipsi) vestiular nucleus ilateral MLFs to CNs III and IV to move eyes up
and down&nsp;<div><img src=""vert vest oc hand.jpeg"" /></div>"
Descrie the mechanism of vertigo (world spinning)? Pathway
"VN sends projec
tions to <u>thalamus</u> and to <u>B3 in cortex</u> which gives one the sense
of dizziness toward the <u>depolarized</u> side<div><img src=""verstiular sys.j
peg"" /></div>"
Descrie the mechanism of falling (vestiular system) "VN sends projection to
<u>IPSI lateral vestiulospinal tract</u> causing <u>rigidity</u> of extensors o
n the <u>depolarized</u> side and the person will <u>fall</u> to the <u>hyperpol
arized</u> side<div><img src=""verstiular sys.jpeg"" /></div>"
Descrie the mechanism of nausea
"Neurons traveling to the <u>VN</u> send
projections to the <u>dorsal efferent nucleus of CN X</u> to cause low-grade na
usea<div><img src=""verstiular sys.jpeg"" /></div>"
Descrie mechanism of vomiting (vestiular system)
"<u>VN</u> sends project
ions to the reticular formation impacting <u>nucleus amiguous</u> and the <u>ph
renic nucleus</u> to cause diaphragmatic <>vomiting</>, <>salivation</>, and
<>cold sweats</><div><><r /></></div><div><>VN--&gt;RF</></div><div><>1
) Nucleus miguous: Regurgitation</></div><div><>2) Phrenic Nucelus: Diaphrag
matic vomiting</></div><div><>3) Salivatory nucleus: Salivation</></div><div>
<>4) IML cell column--&gt;symp ganglion: Pallor and cold sweats</></div><div><
><r /></></div><div><><img src=""paste-26542897889641.jpg"" /><r /></><div
><><img src=""verstiular sys.jpeg"" /></></div></div>"
Descrie what happens with multiple spins to the right, include endolymph, nysta
gmus, world spinning, and falling
<div>When spinning stops, endolymph cont
inues to spin, depolarizing the left</div><div>Nystagmus to LEFT</div><div>World
spins to LEFT</div><div>Fall to RIGHT (hyperpolarized)</div><div><r /></div>
What does the vertical Dolls head maneuver allow you to assess? In what specific
disease is it helpful?&nsp;
"<div>CN VIII in upper medulla to CN III in mid
rain.&nsp;</div><div>Helpful in <u>Parinaud syndrome</u> (pinealoma), y doing
<u>vertical Dolls head</u>, can ypass pretectal area and use vestiular system t
o show that <u>CN III</u> and <u>CN IV</u> are <u>intact</u>.&nsp;</div><div><i
mg src=""vert vest oc hand.jpeg"" /></div><div><img src=""rainstem CN.jpeg"" />
</div>" Emergency_6
Descrie 3 piss poor vestiular inhiition
"Reticular formation &nsp;VN<div
>FN loe&nsp; VN</div><div>VN&nsp; vestiular end organ</div><div><r /></div><d
iv><img src=""paste-26538602922345.jpg"" /></div><div><img src=""verstiular sys
.jpeg"" /></div>"
Descrie what happens with cold calorics in right ear "<div> Brownian motion in
the channels, so relatively hyperpolarized.&nsp;</div><div>Nystagmus to LEFT</
div><div>World spins LEFT</div><div>Fall RIGHT</div><div><img src=""cold caloric
s.jpeg"" /></div>"
Descrie what happens with warm calorics in right ear "<div> Brownian motion in
channels, do relatively depolarized</div><div>Nystagmus RIGHT</div><div>World s
pins RIGHT</div><div>Fall LEFT</div><div><img src=""warm calorics.jpeg"" /></div
>"
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c=""efe10da3f5882e4967f9de9a7a3ff528d90214__0.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"

"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_1.svg"" />"
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__1.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_2.svg"" />"
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__2.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_3.svg"" />"
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__3.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_4.svg"" />"
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__4.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_5.svg"" />"
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__5.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
"<img
0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_6.svg"" />"
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__6.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
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c=""efe10da3f5882e4967f9de9a7a3ff528d90214__7.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
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c=""efe10da3f5882e4967f9de9a7a3ff528d90214__8.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_K1 Sacral Spinal Cord.png"" />"
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c=""efe10da3f5882e4967f9de9a7a3ff528d90214__15.svg"" />"
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0da3f5882e4967f9de9a7a3ff528d90214_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_source_svg.svg"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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657993e325d04ec09df0727dade7dd62679_K2 Lumar Spinal Cord.png"" />"
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1919c8529ca10a6cd0d61790736df662d8_K16 Mid-rain. Level of nuclei of emergence
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1919c8529ca10a6cd0d61790736df662d8_K16 Mid-rain. Level of nuclei of emergence
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1919c8529ca10a6cd0d61790736df662d8_K16 Mid-rain. Level of nuclei of emergence
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1919c8529ca10a6cd0d61790736df662d8_K16 Mid-rain. Level of nuclei of emergence
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1919c8529ca10a6cd0d61790736df662d8_K16 Mid-rain. Level of nuclei of emergence
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_0.svg"" />"
"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_2.svg"" />"
"<img sr
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"<img src=""d761
1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_3.svg"" />"
"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_4.svg"" />"
"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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"<img src=""d761
1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_6.svg"" />"
"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_7.svg"" />"
"<img sr
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"<img src=""d761
1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d7611d87f394d07a93131351cf93aed301f_Q_8.svg"" />"
"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img src=""d761

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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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1d87f394d07a93131351cf93aed301f_K17 Mid-rain. Diecephalon. Level of genicu
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"<img sr
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0da3f5882e4967f9de9a7a3ff528d90214_K21 Hippocampus. thalamus. Brain stem at le
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0da3f5882e4967f9de9a7a3ff528d90214_K21 Hippocampus. thalamus. Brain stem at le
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0da3f5882e4967f9de9a7a3ff528d90214_K21 Hippocampus. thalamus. Brain stem at le
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0da3f5882e4967f9de9a7a3ff528d90214_K21 Hippocampus. thalamus. Brain stem at le
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0da3f5882e4967f9de9a7a3ff528d90214_K21 Hippocampus. thalamus. Brain stem at le
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78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_13.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__13.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_14.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__14.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_15.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__15.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_16.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__16.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_17.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__17.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_18.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__18.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_19.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__19.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_20.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__20.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_21.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__21.svg"" />"
"<img src=""030

78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_22.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__22.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_23.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__23.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_24.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__24.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_25.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__25.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_26.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__26.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_27.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__27.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_28.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__28.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_29.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__29.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""03078fc8dad72a68fc370a383c54d3e7237a3_Q_30.svg"" />"
"<img sr
c=""03078fc8dad72a68fc370a383c54d3e7237a3__30.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_source_svg.svg"" />"
"<img src=""030
78fc8dad72a68fc370a383c54d3e7237a3_K23 Diencephalon. Corpus Striatum at level
of tueral region of hypothalamus..png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_0.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__0.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_1.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__1.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_2.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__2.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"

"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_3.svg"" />"

"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__3.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_4.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__4.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_5.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__5.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_6.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__6.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""34d7155defffe522428e33cf89ea9fc4a36df95_Q_7.svg"" />"
"<img sr
c=""34d7155defffe522428e33cf89ea9fc4a36df95__7.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_source_svg.svg"" />"
"<img src=""34d
7155defffe522428e33cf89ea9fc4a36df95_K24 Striatum and septum.png"" />"
"<img src=""26c2c81ca9629df595f140c1a172247637515_Q_0.svg"" />"
"<img sr
c=""26c2c81ca9629df595f140c1a172247637515__0.svg"" />"
"<img src=""26c2
c81ca9629df595f140c1a172247637515_source_svg.svg"" />"
"<img src=""26c2
c81ca9629df595f140c1a172247637515_K25 Cereral cortex - cytoarchitecture.png"
" />" What types of neurons are these? Where are they located?
"<img src=""3aa63cd4374996c983657a65c9a467ec54e62508_Q_0.svg"" />"
"<img sr
c=""3aa63cd4374996c983657a65c9a467ec54e62508__0.svg"" />"
"<img src=""3aa6
3cd4374996c983657a65c9a467ec54e62508_source_svg.svg"" />"
"<img src=""3aa6
3cd4374996c983657a65c9a467ec54e62508_K26 alpha motor neuron cell ody.png"" />"
What kind of neuron is this?
"<img src=""30df92901d7c205de57368deff32006467a575_Q_0.svg"" />"
"<img sr
c=""30df92901d7c205de57368deff32006467a575__0.svg"" />"
"<img src=""30d
f92901d7c205de57368deff32006467a575_source_svg.svg"" />"
"<img src=""30d
f92901d7c205de57368deff32006467a575_MSN in striatum (caudate + putamen).png"" /
>"
What kind of neuron is this?
"<img src=""30df92901d7c205de57368deff32006467a575_Q_1.svg"" />"
"<img sr
c=""30df92901d7c205de57368deff32006467a575__1.svg"" />"
"<img src=""30d
f92901d7c205de57368deff32006467a575_source_svg.svg"" />"
"<img src=""30d
f92901d7c205de57368deff32006467a575_MSN in striatum (caudate + putamen).png"" /
>"
What kind of neuron is this?
"<img src=""4f7f9e18737e8144d10885f47ad0d7f90966c0_Q_0.svg"" />"
"<img sr
c=""4f7f9e18737e8144d10885f47ad0d7f90966c0__0.svg"" />"
"<img src=""4f7
f9e18737e8144d10885f47ad0d7f90966c0_source_svg.svg"" />"
"<img src=""4f7
f9e18737e8144d10885f47ad0d7f90966c0_K27 Motor end plates. Gold chlorine stain..
png"" />"
What is this?
"<img src=""ed0fe8636272e7268a23f9df85fd645aac85d2_Q_0.svg"" />"
"<img sr
c=""ed0fe8636272e7268a23f9df85fd645aac85d2__0.svg"" />"
"<img src=""ed0f
e8636272e7268a23f9df85fd645aac85d2_source_svg.svg"" />"
"<img src=""ed0f
e8636272e7268a23f9df85fd645aac85d2_K28 nnulo-spiral ending of muscle spindle.
png"" />"
What is this?
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_0.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__0.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_1.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__1.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_2.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__2.svg"" />"
"<img src=""40a

f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_3.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__3.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_4.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__4.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_5.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__5.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_6.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__6.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_7.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__7.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_8.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__8.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_9.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__9.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_10.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__10.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_11.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__11.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_12.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__12.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_13.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__13.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_14.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__14.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_15.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__15.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_16.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__16.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""40af95d54fe4f3090944dcfd5a5caa89dedfc44_Q_17.svg"" />"
"<img sr
c=""40af95d54fe4f3090944dcfd5a5caa89dedfc44__17.svg"" />"
"<img src=""40a

f95d54fe4f3090944dcfd5a5caa89dedfc44_source_svg.svg"" />"
"<img src=""40a
f95d54fe4f3090944dcfd5a5caa89dedfc44_K29 Rostral hypothalamus.png"" />"
"<img src=""820922f785f1276daeec998a50416655f93992_Q_0.svg"" />"
"<img sr
c=""820922f785f1276daeec998a50416655f93992__0.svg"" />"
"<img src=""8209
22f785f1276daeec998a50416655f93992_source_svg.svg"" />"
"<img src=""8209
22f785f1276daeec998a50416655f93992_K30 Cereellar cotex - cytoarchitecture.png
"" />" What is this?
"<img src=""820922f785f1276daeec998a50416655f93992_Q_1.svg"" />"
"<img sr
c=""820922f785f1276daeec998a50416655f93992__1.svg"" />"
"<img src=""8209
22f785f1276daeec998a50416655f93992_source_svg.svg"" />"
"<img src=""8209
22f785f1276daeec998a50416655f93992_K30 Cereellar cotex - cytoarchitecture.png
"" />" What is this?
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_0.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__0.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_1.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__1.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_2.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__2.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_3.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__3.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_4.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__4.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_5.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__5.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_6.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__6.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_7.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__7.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""c0179fcce2a8fd7ec09ced086676e999e6e386_Q_8.svg"" />"
"<img sr
c=""c0179fcce2a8fd7ec09ced086676e999e6e386__8.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_source_svg.svg"" />"
"<img src=""c017
9fcce2a8fd7ec09ced086676e999e6e386_K31 Cereellum. Medulla olongata.png"" />"
"<img src=""1e0d136e4f5e5c756a2d42daf0e62367cfe1a_Q_0.svg"" />"
"<img sr
c=""1e0d136e4f5e5c756a2d42daf0e62367cfe1a__0.svg"" />"
"<img src=""1e0d
136e4f5e5c756a2d42daf0e62367cfe1a_source_svg.svg"" />"
"<img src=""1e0d
136e4f5e5c756a2d42daf0e62367cfe1a_K32 Corpuscle of Meissner.png"" />"
What is this?
"<img src=""9979ed0139ca2d294289079371374470f1a603_Q_0.svg"" />"
"<img sr
c=""9979ed0139ca2d294289079371374470f1a603__0.svg"" />"
"<img src=""9979
ed0139ca2d294289079371374470f1a603_source_svg.svg"" />"
"<img src=""9979
ed0139ca2d294289079371374470f1a603_K33 Sensory Ganglion cells.png"" />"
What is this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_0.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__0.svg"" />"
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3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_1.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__1.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_2.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__2.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_3.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__3.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_4.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__4.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_5.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__5.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_6.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__6.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_7.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__7.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_8.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__8.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_9.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__9.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_10.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__10.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_11.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__11.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_12.svg"" />"
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__12.svg"" />"
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src=""3887
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"<img sr
src=""3887

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"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_13.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__13.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_14.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__14.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_15.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__15.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_16.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__16.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_17.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__17.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""38873a3a9c49c9ae11e63f9546632fe5feec95f_Q_18.svg"" />"
"<img sr
c=""38873a3a9c49c9ae11e63f9546632fe5feec95f__18.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_source_svg.svg"" />"
"<img src=""3887
3a3a9c49c9ae11e63f9546632fe5feec95f_K34 Organ of Corti.png"" />"
What is
this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_0.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__0.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_1.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__1.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_2.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__2.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_3.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__3.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_4.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__4.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_5.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__5.svg"" />"
"<img src=""9324

e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""9324e652865aea0d07f5f60d9f4fd52943a16_Q_6.svg"" />"
"<img sr
c=""9324e652865aea0d07f5f60d9f4fd52943a16__6.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_source_svg.svg"" />"
"<img src=""9324
e652865aea0d07f5f60d9f4fd52943a16_K35 Semicircular canals and crista ampullar
is.png"" />"
What is this?
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_0 (3).svg"" />" "<img sr
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__0 (3).svg"" />" "<img src=""efe1
0da3f5882e4967f9de9a7a3ff528d90214_source_svg (3).svg"" />" "<img src=""efe1
0da3f5882e4967f9de9a7a3ff528d90214_KQ 1.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_1 (3).svg"" />" "<img sr
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__1 (3).svg"" />" "<img src=""efe1
0da3f5882e4967f9de9a7a3ff528d90214_source_svg (3).svg"" />" "<img src=""efe1
0da3f5882e4967f9de9a7a3ff528d90214_KQ 1.png"" />"
"<img src=""efe10da3f5882e4967f9de9a7a3ff528d90214_Q_2 (3).svg"" />" "<img sr
c=""efe10da3f5882e4967f9de9a7a3ff528d90214__2 (3).svg"" />" "<img src=""efe1
0da3f5882e4967f9de9a7a3ff528d90214_source_svg (3).svg"" />" "<img src=""efe1
0da3f5882e4967f9de9a7a3ff528d90214_KQ 1.png"" />"
"<img src=""ac0c9dca4fe159a9159454387780e4f7_Q_0.svg"" />"
"<img sr
c=""ac0c9dca4fe159a9159454387780e4f7__0.svg"" />"
"<img src=""ac
0c9dca4fe159a9159454387780e4f7_source_svg.svg"" />"
"<img src=""ac
0c9dca4fe159a9159454387780e4f7_KQ 2.png"" />"
"<img src=""ac0c9dca4fe159a9159454387780e4f7_Q_1.svg"" />"
"<img sr
c=""ac0c9dca4fe159a9159454387780e4f7__1.svg"" />"
"<img src=""ac
0c9dca4fe159a9159454387780e4f7_source_svg.svg"" />"
"<img src=""ac
0c9dca4fe159a9159454387780e4f7_KQ 2.png"" />"
"<img src=""ac0c9dca4fe159a9159454387780e4f7_Q_2.svg"" />"
"<img sr
c=""ac0c9dca4fe159a9159454387780e4f7__2.svg"" />"
"<img src=""ac
0c9dca4fe159a9159454387780e4f7_source_svg.svg"" />"
"<img src=""ac
0c9dca4fe159a9159454387780e4f7_KQ 2.png"" />"
"<img src=""ac0c9dca4fe159a9159454387780e4f7_Q_3.svg"" />"
"<img sr
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Solicitation of organs- legal? Ethical? "It is legal, ut unethical<div><img src
=""solicit.jpeg"" /></div>"
Ethics
llocating to prisoners, illegal? Unethical?
Its fine. Ones status as prisoner
does not preclude from consideration of transplant. However, may evoke other leg
itimate concerns (noncompliance, ID, psych)
Ethics
What is DCD?
Donation after cardiac death- is a means of organ procurement fo
r patients that are <u>not dead y neurological criteria.&nsp;</u>
Ethics
Why is DCD so controversial?
Some elieve DCD violates <u>dead donor rule</u>
Ethics
What is dead donor rule?
Person cannot e killed <>y or for</> organ p
rocurement.
Ethics
What is the process of donation after cardiac death?
Take to ORremove ventilat
or heart stopsdeclare deathprocure organs
Ethics
DCD hinges upon the definition of irreversile. What are the 2 claims, and which i
s the majority opinion? "<div>Resuscitationnot irreversile not dead violating dead
donor rule</div><div>Resuscitation irreversile dead no violation of DDR.&nsp;</d
iv><div><r /></div><div>Claim 1. Cardiac arrest is only ""irreversile"" when c
irculatory function <><u>cannot</u></> e restored, even if resuscitation effo
rts are undertaken</div><div><r /></div><div>Claim 2- cardiac arrest is ""irrev
ersile"" if circulation could e restored ut no resuscitation efforts are goin
g to occur (<>majority opinion</>)</div>"
Ethics
What is the Pittsurgh protocol? (4)
<div>-Decisions concerning tx must e ma
de <u>long efore</u> decision aout donation</div><div>-Candidates must e on v
entilator and die with <u>1 hr of removal</u></div><div>-Physician who withdraws
LST cannot have any participation of <u>transplant service</u>.&nsp;</div><div
>-Death criteria must e present <u>2-5 minutes prior to procurement</u></div>
Ethics
What is research, what is innovation? What is implication of regulation?
<div><>Research</>- purpose of producing <u>generalizale knowledge for enefi
t of future patients</u></div><div><>Innovation</>- clinical experiment for pu
rpose of <u>enefiting an individual patient</u> (does not come under IRB, goes
to fetal therapy oard, under professional self-regulation)</div><div><r /></di
v>
Ethics
If oligations to fetal patient are not rights ased, what are oligations ased
on?
Oligations to fetal patient are <u>eneficence</u>-ased
Ethics
Under what 2 conditions is a fetus a patient? <div>Fetus is <u>presented</u> t
o the physician</div><div><r /></div><div>There are <u>medical interventions</u
> that are relialy expected to result in a greater alance of <u>clinical goods

over clinical harms for the child</u> that the fetus is relialy expected to e
come in the future.&nsp;</div><div><r /></div>
Ethics
 pre-viale fetus is a patient as a function of what? Pregnant womans autonomou
s decision to confer this moral status on her fetus
Ethics
Viale fetus (24 weeks) is a patient when?
Pregnant patient presents for me
dical care.&nsp;
Ethics
<div>T/F The pregnant woman is ethically oligated to take reasonale health- re
lated risks to herself in order to fulfill her eneficence-ased oligations to
the previale or viale fetal patient</div>
T
Ethics
80% of all nosocomial UTI are a result of what? What aout the rest?
"Indwell
ing urinary catheters. 20% a result of transient urologic instrumentation<div><
r /></div><div><img src=""paste-2800318677346.jpg"" /></div>" Dickey ID
Risk factors for UTI during catheterization are attriuted to alterale and unal
terale factors.&nsp;<div>- Factors that can e changed for catheters<r /></di
v><div>- Factors that cannot e changed for catheters</div>
"<div>lteraleindications, duration, care techniques, type of drainage.&nsp;</div><div><r /
></div><div>Unalterale- female, older, meatus colonization, underlying illness,
drainage ag colonization. Elevated serum creatinine.&nsp;</div><div><r /></d
iv><div><img src=""paste-5854040424751.jpg"" /></div>" Dickey ID
What is one way prevent nosocomial UTI? Intermittent catheterization. lso condo
m catheter<div><r /></div><div>VOID CTHERS</div>
Dickey ID
When sampling urine from catheter, where should it e taken from?&nsp;<div><r
/></div><div>What numerical amount is associated with symptoms and pyuria?&nsp;
</div> "From <u>sampling</u> port, not drainage port. 10² cfu/ml<div
><r /></div><div><img src=""paste-3178275799404.jpg"" /></div>"
Dickey I
D
Nosocomial lower respiratory tract infections are clinically diagnosed with what
? (4) <div>1) New or progressive radiographic infiltrates</div><div>2) Fever</
div><div>3) Leukocytosis</div><div>4) Purulent secretions</div><div><r /></div>
Dickey ID
<div>What are 4 most common pathogens causing nosocomial lower respiratory tract
infections?</div>
"<div>1) S. aureus</div><div>2) Pseudomonas</div><div>3)
Enteroacte</div><div>4) Klesiella.&nsp;</div><div><r /></div><div><>SPEK</
Dickey ID
></div><div><img src=""pathogens.jpeg"" /></div>"
1) The 4 clinical criteria correctly predicts pneumonia how accurately in ventil
ated patients?<div><r /></div><div>2) What method is more specific?</div><div><
r /><div><div>1) New or progressive radiographic infiltrates</div><div>2) Fever
</div><div>3) Leukocytosis</div><div>4) Purulent secretions</div></div><div><r
/></div></div> 60% of the time.<div><r /></div><div>- rochoscope with BL or
protected specimen rush catheters is more specific - rarely done for practical
reasons</div> Dickey ID
What type of intravascular device has the highest rate of infection?
Hemodial
ysis central venous catheter
Dickey ID
What are 3 most common pathogens causing primary loodstream infections?
"1) coagulase-negative staphlococci<div>2) staph. aureus</div><div>3) enterococc
us<r /><div><div><img src=""primary lood.jpeg"" /></div></div></div>" Dickey I
D
What is the minimum cutoff for a significant numer of colonies on a plate for s
emi-quantitative culture?
"15<div><img src=""15.jpeg"" /></div>" Dickey I
D
Descrie the technique to determine if infection is due to catheter or lood cul
ture
"If catheter is site, cultures should e positive &gt;2 hours faster fro
m catheter than peripheral lood culture.&nsp;<div><img src=""cath.jpeg"" /></d
iv>"
Dickey ID
What are 5 evidenced ased interventions from CDC, NEJM to reduce infection from
central lines?<div><r /></div><div>- Use what as antisepsis?</div><div>- void
what catheter sites?</div>
<div>1. Hand washing</div><div>2. Full arrier p
recautions during catheter placement</div><div>3. Clorhexidine skin antisepsis</
div><div>4. voiding femoral catheter sites</div><div>5. Removing catheter SP
when not required.&nsp;</div><div><r /></div><div>Gawande~</div>
Dickey I

D
Gram + or - adhere much etter at adhereing to cardiac endothelum?
gram +
Name some other species of viridans strep? What are they susceptile to?
Mitis, mutans, sanguins, salivanins<div><r /></div><div>PCN</div>
S. epidermidis endocarditis most likely to e seen in who? (3) ddicts, people
with mitral valve prolapse, prosthetic valve
What kind of people are likely to get endocarditis from E. faecalis?
Older me
n after GU procedure, younger women after OB procedure, injecting drug users
Bacteremia due to gonorrhea what do you look at?
Terminal compmlement (M
C) components ecause they may e deficient
Name some oropharyngeal organisms that can cause endocarditis. <>HCEK</><div
><>H</>aemophilus</div><div><></>ggregatiacter actinomycetemcomitans</div>
<div><>C</>ardioacterium hominis</div><div><>E</>ikenlla corrodens</div><di
v><>K</>ingella kingii</div><div><r /></div><div>*<>Fastidious</> organisms
that take longer to grow*</div><div>Tend to e susceptile to <>eta lactam</
> ax&nsp;</div><div><r /></div><div>Skin poppers</div>
Where are 2 fungal endocarditis and where are they likely to e seen? <>sper
gillus</>- prosthetic valves and&nsp;IV drug addicts<div><div><>Candida</>prosthetic valves, indwelling central venous catheters</div></div>
Whats are two symptoms/physical exam clues to tell you that they might have end
ocarditis?
"Fever, heart murmur<div>lso skin manifestations<r /><div><img
src=""signs.jpeg"" /></div></div>"
Systolic murmur that increases with inspiration.
Tricuspid vegetation ec
ause theyre a drug user
3 people you consult when you make a dx of endocarditis?
ID<div>Surgeons<
/div><div>Cardiologist</div>
"""dirty"" urine sediment?"
"Immune complex glomerulonephritis<div><r /></d
iv><div>hematuria, proteinuria, etc.</div><div><img src=""IC.jpeg"" /></div>"
"""gold standard for endocarditis""?" Positive lood cultures - the more (up t
o 3) the etter, ut really 2 is fine
moxicil
What drugs are generally given as prophylaxis for dental procedures?
lin, ampicillin<div><r /></div><div>Dont have to give prophylaxis for GU/GI pr
ocedures anymore</div>
Complete heart lock in someone with heart valve replacement? "ortic valve an
nular ascess - undle of His wraps tightly around aortic annulus<div><r /></di
v><div><img src=""paste-232396385419265.jpg"" /></div>"
Immune complex deposition seen in kidneys in people with infective endocarditis?
Yes
Do people with mitral valve prolapse undergoing oral surgery required prophylaxi
s?
No
Chronic tricuspid insufficiency from endocarditis from an IVD causes what in th
e liver?
Cardiac cirrhosis due to destruction of Triscupid valve and ack
up into the liver
ortic Decrescendo diastolic murmur at ase of the heart is what valve?
little CCR last from the past
Three reasons why hematogenous osteomyelitis tend to happen in the metaphysis of
the one?
"<div>Metaphyseal capillary loops have<>&nsp;inefficient phago
cyte cells</></div><div><r /></div><div>Flow is <>sluggish </>in sinusoidal
venous connections</div><div><r /></div><div>Traumatic thromosis and infarctio
n provides an <>avascular </>environment <span class=""pple-ta-span"" style=
""white-space:pre""> </span>well-suited for acterial growth</div><div><r /></d
iv>"
What special vessels messes with neworns?
"Transphyseal vessels (disappear
at like 7 months) and connect metaphyseal plate with epiphyseal cartilage - <u>
assume infection in long one means its spread to cartilage</u><div><img src=""p
aste-328053897035780.jpg"" /></div>"
T/F, children-&gt;adolescents have more developed epiphsyseal plates that make o
stemyellitis infection harder to spread<div><r /></div>
"True<div><img s
rc=""paste-330772611334148.jpg"" /></div>"
Whats the common one involvement for osteomyelitis in adults? Verteral<div><

r /></div><div>Unlike children which is long ones</div>

What ones does osteomyelitis due to vascular insufficiency almost exclusively i
nvolve? Vascular insufficiency - small ones of hands and feet
re aspirations superiosteum or one marrow or needle aspiration of a joint mor
e sensitive than lood cultures for dx of osteomyelitis?
"Yes<div><img sr
c=""sensitive.jpeg"" /></div>"
Whats a drawack of plain films for dxing osteomyelitis
Requires ~50% re
asorption of one efore it will ecome evident - may take weeks
What is the drug of choice for acute osteomyelitis?
IV vancomycin
Whats some oral therapy for osteomyelitis?
Clinda, or switch from vanc to a
eta-lactam if its MSS
What are some characteristics of septic arthritis in a neonate? Monoarticular knee very common<div>Often seen with osteomyelitis</div><div><r /></div><div><
>* in kids &gt;1 year, <u>not</u>&nsp;associated with osteomyelitis</></div>
"<div><span class=""pple-ta-span"" style=""white-space:pre""> </span> 4-yearold sustained this wound after an encounter with the familys dog. &nsp;What ther
apy will you initiate?</div><div><r /></div><div>&nsp; &nsp; . &nsp;Vancomy
cin</div><div>&nsp; &nsp; B. &nsp;Vancomycin, ceftazidime</div><div>&nsp; &n
sp; C. &nsp;mpicillin-sulactam&nsp;</div><div>&nsp; &nsp; D. &nsp;mpici
llin-sulactam,</div><div><span class=""pple-ta-span"" style=""white-space:pre
""> </span>vancomycin <span class=""pple-ta-span"" style=""white-space:pre"">
</span> <span class=""pple-ta-span"" style=""white-space:pre""> </span>&nsp;<
/div><div><r /></div>" C if not so ad of a ite<div>D if a ad ite (want MRS
coverage)</div><div><r /></div><div><>*WE WNT BROOOD BROOD, WIIDE SPECTRUM
COVERGE*</></div><div>-Musher</div>
Whats the rule if there is purulent collection in the superiosteal space or pr
escence of nonviale (dead) one?
They need to go to OR to have it drained
/ removed
What are 3 routes of acquisition of osteomyelitis?
1) Hematogenous: Beginin
g in metaphysis<div><r /></div><div>2) contiguous focus: post operative, extens
ion from soft tissue infection, direct innoculation</div><div><r /></div><div>3
) vascular insufficiency: poorly controlled diaetes</div>
ID
Why does hematogenous osteomyelitis occur in the metaphysis?
<div>Metaphyseal
capillary loops have <>inefficient phagocyte cells</></div><div>Flow is <>sl
uggish</> in sinusoidal venous connections</div><div>Traumatic thromosis and i
nfarction provides an <>avascular</> environment</div><div>well-suited for ac
terial growth</div><div><r /></div>
ID
In adults, where is osteomyelitis common?
"Verteral ody<div><img src=""v
ert (1).jpeg"" /></div>"
ID
In neonates, how does osteomyelitis typically occur? (location) "Poorly localize
d, multiple one involvement common.<div><img src=""neonate.jpeg"" /></div>"
ID
Osteomyelitis in older infant and child occurs where relative to neworn?
"<div>Cortex is thicker and periosteum tightersoft tissue rupture rare.</div><div
><>Localized</> symptoms</div><div><img src=""one kids.jpeg"" /></div>"
ID
Where is most common location of hematogenous osteomyelitis in children?
"Femur&gt;tiia&gt; humerus (long, weight earing ones)&nsp;<div><img src=""ki
ds perc.jpeg"" /></div>"
ID
How to manage congenital heart surgery patient with fluid drainage from incision
to determine superficial or deep infection?
Sternal staility y physical ex
am (crunch crunch)
ID
What are 3 routes of osteomyelitis due to contiguous focus of infection?
"Postoperative, extension from soft tissues, direct inoculation (puncture wound)
<div><img src=""contiguous.jpeg"" /></div>"
ID
What is the typical patient with osteomyelitis due to vascular insufficiency? Wh
at ones are involved? "<>&gt;50 yrs old</>, often poorly controlled <>diae
tes</>. Small ones of hands and feet almost exclusively.&nsp;<div><img src=""
osteo vascular.jpeg"" /></div>" ID
What is most common acteria of osteomyelitis?&nsp;
S. aureus
ID

What is est way to diagnose osteomyelitis?

"spiration of superiosteum or
one marrow, or needle aspiration of joint. Followed y lood culture.<div><img
src=""sensitive.jpeg"" /></div>"
ID
What is the length of therapy (weeks) for hematogenous osteomyelitis for small,
flat, tuular, and joint ones? "<div>Small 3-4</div><div>Flat- 4</div><div>Tuu
lar 4-6</div><div>Joint- 3-4&nsp;</div><div><img src=""length.jpeg"" /></div>"
ID
What is pathogenesis of septic arthritis? I thought synovial memrane was closed
?
"<i>It is not a closed sac</i>. Intimal surface has an aundant lood su
pplyagent crosses capillary wall and synovium to the joint<div><img src=""joint.j
peg"" /></div>" ID
What does normal synovial fluid contain? (# cells)
~60 mononuclear cells
ID
What does infected synovial fluid contain? (4) <div>Inflammation, &gt;50,000 WB
C</div><div>Joint effusion</div><div>Release of <u>enzymes</u> into fluid</div><
div>Increased <u>protein</u> in joint</div><div><r /></div>
ID
What 3 things modulate joint damage in septic arthritis?&nsp; "<>Firin clot<
/> (impair transport of nutrients and products of metaolism), <>firin</> (a
ttracts leukocytes), <>degranulation of leukocytes</> (release enzymes)<div><i
mg src=""mods.jpeg"" /></div>" ID
What are 3 routes of acquisition of septic arthritis? Hematogenous, contiguous
focus, direct implantation
ID
What are predisposing factors in adults for septic arthritis? (4)
Steroids
, pre-existing arthritis, intraarticular injection, underlying disease ID
Dog ite and PIP involvement. What to give?
"<div><>Vancomycin</> + <>amp
icillin-sulactam </>(Unasyn)</div><div>Vancomycin- MRS, ampicillin-sulactamanaeroe&nsp;</div><div><img src=""ite.jpeg"" /></div>"
ID
For outcomes of one and joint infections:<div>recovery is optimized y what len
gth of therapy? Chronic osteomyelitis occurs in what % of children? Who has high
est risk of sequelae for one/joint infections?</div> &gt;3 weeks<div>&lt;5%</
div><div>neonates</div> ID
Septic arthritis in a child typically occurs in what? "Monoarticular involveme
nt of weight-earing joints (knee&gt;hip&gt;ankle)<div><img src=""septic child.j
peg"" /></div>" ID
How many cases of severe sepsis are there in the US annually? &gt;750,000, 35%
crude mortality&nsp;
What is multi organ dysfunction syndrome (MODS)?
<div>ltered organ funct
ion in an acutely ill patient</div><div>Homeostasis cannot e maintained without
intervention</div><div><r /></div><div><>Can occur in other things esides se
psis</></div>
What is the temperature criteria for SIRS?
Temp 38C&nsp; or 36C&nsp;
Whats the HR criteria for SIRS?
90 eats/min
Whats the respiration rate criterion for SIRS? 20/min
Whats the WBC count for SIRS? <div>12,000/mL or 4,000/mL or &gt;10% immature neu
trophils (ands)</div>
"Pretty chart<div><img src=""paste-49246095015939_1347476461661.jpg"" /></div>"
Risk factors for getting sepsis?
Immunocompromised states (including dia
etes<div>Modern medical care (IV, caths, ventilators, chemo/radioation, ax)</di
v>
"What cell in the ody is most ""exquisite"" at sensing the ""ad news"" of endo
toxin?" "Macrophage/ monocyte<div><img src=""phago.jpeg"" /></div>"
"What ""acute-phase reactant"" does the liver shift to making when the presence
of LPS is sensed?"
"LPS-inding protein (LBP)<div><img src=""today.jpeg"" /
></div>"
What complex do macrophages have that links them to LPS-LBP? What does activatio
n of this complex cause?
"<>TLR4 (with MD2)</>&nsp;-&gt; winds up maki
ng <>TNFalpha, IL-1, tissue factor -&gt; NO -&gt; shock<r /><img src=""paste-6
3578400882689.jpg"" /></>"
Name 4 pathogen associated molecular proteins (PMPS) LPS<div>Unmethylated CpG
DN</div><div>Mannan</div><div>Peptidoglycan</div>

"What are ""damage associated molecular patterns?"""

"Traumatized tissues can
release DMPs which are like PMPs and ind to TLRs and initiate that whole cas
cade thing<div><img src=""paste-75582834475009.jpg"" /></div>"
Can you see altered conciousness in sepsis and acute organ dysfunction? "Yes<div
><img src=""paste-89936615178243.jpg"" /></div>"
What is aiotrophia?
"Nutritionally deficient streptococci<div><img src=""ai
o.jpeg"" /></div>"
ID
Heart murmur patient has cold legs
"Emolus in left peripheral vasculature<
div><img src=""peripheral.jpeg"" /></div>"
ID
What causes heart failure in patients with infective endocarditis?
"Rupture
of aortic valve, mitral valve, or cordae tendinae<div><img src=""failure.jpeg""
/></div>"
ID
What does cluing of the fingers suggest?
"<u>Suacute</u> endocarditis<di
v><img src=""clu.jpeg"" /></div>"
ID
What are emolic extracardiac lesions called? "Janeway lesions<div><r /></div
><div>Hands or feet</div><div><img src=""janeway.jpeg"" /></div>"
ID
What is an extracardiac ocular sign of infective endocarditis? "<div>Roth spots
in fundus</div><div><img src=""roth.jpeg"" /></div><div><r /></div><div><img s
rc=""paste-271910084543016.jpg"" /></div>"
ID
Three asics steps of standard care of sepsis? Make dx<div>Source control</div>
<div>Give ax</div>
T/F NE is preferred over D for sepsis hemodynamic support.
True
What is the mortality rate of sepsis even with appropriate antiiotic coverage a
nd source control?
28-50%!! daaaang
T/F&nsp;Steroid supplementation in patients with refractory septic shock may e
eneficial&nsp;<div><r /></div><div>(2C recommendation y Surviving Sepsis Ca
mpaign 2013; CTH testing to identify patients who may enefit NOT recommended).
&nsp;<div><r /></div></div> True
Whats the term for presence of acteria in the urinary tract wihtout symptoms?
symptomatic acteruria (colonization)
Lower tract signs/symptoms: frequency, urgency, dysuria, suprapuic pain&nsp;
Cystitis
Upper tract signs/symptoms: fever, flank pain, costoverteral angle tenderness&n
pyelonephritis
sp;
What is an uncomplicated UTI? What is a complicated one?
<div>Symptomatic
infection in a<> non-pregnant woman</> with a normal urinary tract and no cat
heter or calculi.</div><div><r /></div><div>Complicated: everything else</div><
div><r /></div>
Re-infection vs. relapse?
Infection with new isolate vs. infection with sa
me isolate&nsp;
T/F Pseudomonas is not a typical cause of <i>uncomplicated</i>&nsp;UTI.
True
S. aureus in a urine culture is very worrisome for?
Hematogenous seeding / 
acteremia<div><r /></div><div>(Staph ascending UTI is rare)</div>
Name some structural host factors that can predispose one to UTIs
<div>Os
truction to flow (prostatic hypertrophy, stones, prolapse)</div><div>Reflux</div
><div>Catheters</div><div>Surgical alteration of the urinary tract</div><div><r
/></div>
T/F&nsp;gents whose effects are primarily limited to the urinary tract (<>nit
rofurantoin)</> are to e preferred to agents which impact the gut flora as wel
l.<div><r /></div>
True
Name three options for treatment of uncomplicated pyelonephritis? What can e gi
ven initially? <div>7 days of a fluoroquinolone</div><div>10-14 days of a etalactam</div><div>14 days of TMP-SMX</div><div> single dose of ceftriaxone or an
aminoglycoside initially is optional</div><div><r /></div>
Why is prostatitis more diffucult to treat?
Many drugs dont achieve therape
utic levels in the prostate
Why are UTIs more common in young oys? Higher prevalence of urinary tract anor
malities
re fungal UTIs typical of colonization and not true UTIs?
Yes

What kind of people are likely to get viral cystitis like adenovirus, BK virus?
<>Severely</>&nsp;immunocompromised (more than just HIV)
"Is ""chronic UTI"" a good term?"
No, doesnt differentiate etween <u>rec
urrent UTIs</u> or <u>interstitial cystitis</u>
Whats the iggest driver of recurrent uncomplicated UTIs in premenopausal women
?
Sexual activity<div><r /></div><div>Ceasing of using spermicide, post-c
oidal voiding, post-coital ax and prophylatic ax may help</div>
Cause of reccurent UTIs in postmenopausal women?
Loss of structural integ
rity, change in flora
What microiology is diagnostic of catheter-associated UTI (for people that have
een cathd in the past 2 days)
<div>Urine culture with &gt;10<sup>5</su
p> cfu/mL&nsp;</div><div>Urine culture with &gt;10³ cfu/mL with pyur
ia</div><div><r /></div>
<div>T/F symptomatic acteruria is a strong risk factor for susequent UTI ut
most episodes of SB do not lead to infection.</div><div><r /></div> True
Should asymptomatic pregnant women e treated for asymptomatic colonization? Why
?
Yes, high risk for progression to pyelonephritis
T/F&nsp;symptomatic acteruria should e treated efore urologic procedures wh
ich violate the mucosa.<div><r /></div>
True
<div> 23 year old sexually active female without comoridities presents to clin
ic with two days of dysuria. &nsp;She otherwise feels well.</div><div>Dx and ca
use</div>
Uncomplicated cystitis/lower urinary tract infection<div><r /><
/div><div>E. coli MCC</div>
What are some treatment options for uncomplicated UTIs <div>TMP-SMX x 3 days</d
iv><div>Nitrofurantoin x 5 days</div><div>Fosfomycin (single dose)</div><div><r
/></div>
Treatment for uncomplicated pyelonephritis?
7 days of fluoroquinolones
<div><div> man is in the hospital after surgery, with a urinary catheter as par
t of the routine post-operative protocol. &nsp;He develops altered mental statu
s after receiving pain medication, which improves two hours later after the pain
medication wears off. &nsp;While he was altered, a urine culture was sent to w
ork up his mental status, which shows over 100,000 cfu of Pseudomonas. &nsp;He
is asymptomatic when re-evaluated the next day.</div><div><r /></div><div>What
is the diagnosis here?</div></div><div><r /></div><div><r /></div>
symptom
atic acteruria associated with catheterization<div><r /></div><div>No treatmen
t necessary</div>
<div> 65 year old man with BPH presented with 5 days of fever to 102 F and flan
k pain. &nsp;His urine grew gram negative organisms, susceptile to ciprofloxac
in. &nsp;fter six days of oral ciprofloxacin, the patient felt etter, ut con
tinued to have daily fevers to 101.</div><div><r /></div><div><div>What conditi
ons might the patient have developed to explain the failure?</div></div><div><r
/></div><div><r /></div>
<div>Prostatitis, ostruction or renal ascess.<
/div><div><r /></div><div>-how do you check for these-</div><div><div>Prostatit
is: physical exam</div><div>Renal ascess: imaging (ultrasound or CT scan)</div>
</div><div>Post-void residual US</div><div><r /></div><div>-treatment-</div><di
v><div>Prolonged antiiotics; may need drainage procedure in severe cases.</div>
</div><div><r /></div><div><r /></div>
<div> 30 year old woman is referred for management of a chronic UTI which has per
sisted for two years despite at least 15 courses of antiiotics. &nsp;Once, her
cultures grew E. coli, ut all of her other cultures were sterile.</div><div><
r /></div>
<div>Interstitial cystitis</div><div><r /></div>
<div> 25 year old female presents with urning and dysuria for the fifth time t
his year. &nsp;Each previous episode was associated with urine cultures growing
E. Coli, and promptly responded to antimicroial therapy.</div><div><r /></div
><div>What factors may e driving the recurrent UTIs?&nsp;</div><div><r /></di
v><div>What could you recommend?</div> <div>Spermicide use, sexual history</div
><div><r /></div><div><div>Ceasing spermicide use, post-coital voiding, post-co
ital prophylaxis, continuous prophylaxis</div></div><div><r /></div><div><r />
</div>
What 3 things are seen with disseminated intravascular coagulation?
Thromoc

ytopenia, decreased firinogen, increased firin degradation products&nsp;

ID
What determines if a patient has recurrent UTIs in terms of #s? 2+ UTIs within 6
months<div>3+ in 1 year</div><div><r /></div>
Catheter-associated UTIs, complicated or uncomplicated? Complicated y definitio
n
What are symptoms of lower tract UTI? Frequency, urgency, dysuria, suprapuic
pain (cystitis)
What are symptoms of upper tract UTI? Fever, flank pain, CV tenderness (pyelo
nephritis)
"The term ""urethritis"" is reserved for who?" <u>Men</u> with history and symp
toms suggestive of a <u>STD</u>
In canada, what was association was noted among quinolone use? Direct associati
on etween numer of prescriptions and resistance of pneumococci to ciprofloxaci
n
What is the drug of choice for treating pneumocystis jiroveci? Sulfonamide
ID
Fidaxomycin is only highly effective against what?
C. diff, and other clost
ridia (doesnt disrupt normal flora). Even etter than vancomycin<div><r /></di
v><div>$2800 for 10 days</div>
re tetracyclines acteriostatic or acteriocidal?
Static, ut do kill gram
(-) rods<div><r /></div><div>*this is why antagonistic with eta-lactams</div>
re macrolides acteriostatic, or acteriocidal? or oth?
Bacteriostatic (
s. aureus), ut cidal for pneumococcus, haemophilus&nsp;
re lincosamides (clindamycin) acteriostatic or acteriocidal? Bacteriostatic
Gram positive rod, squash racket appearance
Tetanus ID
Gram neg diplococci
Neisseria, moraxella
ID
What pigment color is actinomyces?
Blue-red
ID
Is conjugation:<div>cell-cell contact</div><div>DNse sensitive</div><div>DN re
plication</div> + - + ID
<div>Is transformation:</div><div>cell-cell contact</div><div>DNse sensitive</d
iv><div>DN replication</div> - + - ID
Is transduction<div><div>cell-cell contact</div><div>DNse sensitive</div><div>D
N replication</div></div>
- - - ID
Transformation led to what example?
pneumo capsule ID
Conjugation led to what example?
ax resistance ID
Transduction led to what example?
Toxins BCDE
ID
How does virio cholera toxin work?
Turns the on on. permanently activates
Gs, pumps out Cl-/H2O.<div>DP riosylation&nsp;</div>
ID
How does pertussis toxin work? turns the off off<div>permanently disales Gi,
DP riosylation</div> ID
What is E. coli toxin? What is similar, how does it work
heat laile (LT)
toxin. DP riosylation, like cholera toxin, less severe
ID
How does anthrax toxin work?
Edema factor, it <>carries its own adenylate cy
clase</> to increase cMP
ID
Diptheriae toxin works y what? What else works like this?
DP riosylation
, inhiit elongation factor EF2. Exotoxin  of pseudomonas<div><r /></div>
ID
,,, and toxins of staph o what? Disrupt cell membranes ID
Exofoliatin toxin works at what level in ki s? "Stratum granulosum< iv><img src
=""exofoliatin.jpeg"" /></ iv>" ID
What oes agr gene o? <b>Makes</b>&nbsp;<b>extracellular protein</b>s (exoprot
eins ma e uring stationary phase) while <b>suppressing surface</b> <b>proteins<
/b> (ma e uring exponential growth). ID
What staph toxin allows colonization of host? MSCRAMMS
ID
What staph toxin causes clumping
coagulase
ID
What staph toxin causes microcapsule, capsule, slime
glycocalyx
ID
< iv>Clostri ium perfringens ______ causes gas gangrene</ iv> Alpha toxin
ID
What toxin causes HUS. Mechanism?
Shiga toxin (EHEC, Shigella). Cleaves ho

st cell rRNA
ID
What toxin causes scarlet fever rash
erythrogenic toxin
ID
This strep toxin is antiphagocytic, ab is protective against it, but may cause r
heumatic fever M protein
ID
< iv>ab iagnostic for rheumatic fever, not neutralize by cholesterol in skin</
iv>< iv><br /></ iv> DNAse ID
< iv>hemolysin, neutralize by cholesterol in skin; use for rheumatic fever x
if pharyngeal infxn suspecte </ iv>
< iv>Streptolysin O</ iv>< iv><br /></ i
v>
ID
What toxin cleaves host cell rRNA
Shiga toxin
ID
What causes en ocar itis after GU proce ure?
enterococcus
< iv>CF necrotizing pneumonia, CGD pts</ iv>< iv><br /></ iv> Burkhol eria
Plumonary with GI symptoms
Legionella
Pneumonia in farmer with animal poop on shoes Coxiella (Q fever)
Purulent penile ischarge?< iv>Serous penile ischarge?</ iv> Gonococcus< iv>C
hlamy ia</ iv>
foreign born ki , sitting in be , leaning forwar , rooling, resp istress Next st
ep?
< iv>intubate imme iately. haemophilus</ iv>
< iv>3r MC cause of otitis me ia an sinusitis, pre-existing chronic bronchitis
?</ iv>< iv><br /></ iv>
Moraxella
< iv>infects WBC, ticks, NE an MW</ iv>< iv><br /></ iv>
Erlichia
2n MCC UTI in repro age women Staph saprophyticus
< iv>watery early, bloo y late; invasive an secretes toxin</ iv>< iv><br /></ i
v>
Shigella
< iv>Fourniers gangrene on perineum of diabetics. Ludwigs angina from dental proce
ss</div>
Polymicrobial
<div>Cat / dog bite; tx</div> <div>Cat = pasturella, dog = capnocytophagia;&nb
sp;</div><div>tx = combination penicillin+penicillinase inhib</div>
Human bite
<div>Human bites are worse than animal bites --&gt; mouth and s

in things are possible; polymicrobial but also mouth flora li

e ei
enella, pepto
treptococcus, fusobacterium, etc</div><div><br /></div>
RPR/VDRL titer level for primary syphillus
1:16 or less
RPR/VDRL titer level for secondary syphillus
1:32 or more
MHA-TP, TPHA primary and secondary sensitivities
90%, 100%
Vector, reservoir of B. recurrentis
Human louse vector, Human reservoir. Rec
urring fever
Vector, reservoir of B. hermsii and borreliae Tic
vector, rodent small mammal
reservoir in southwestern states.<div>Humans infected incidentally when tic
s f
eed painlessly at night.</div><div><br /></div><div>Boy scout troup and dude in
cabin</div>
Vector, reservoir of B. burgdorferi
Ixodes vector, mouse reservoir. Lyme dis
ease
<div>MCC acute, often have abscess, Rt sided in IVDA</div><div><br /></div>
Staph aureus
<div>Alcoholic w/ meningitis and aortic regurg;</div> pneumococcus
<div>MCC early prosthetic valve endocarditis (x 2)</div>
Staph epidermidi
s or aureus. Late = GAS
Culture negative (x2) endocarditis
HACEK, or fungal
hepatic abscess, what type of bug
anaerobe, pyrogenic usually polymicrobia
l
Pancreatic abscess, what bug
facultative anaerobe li
e e. coli, enterococcus
Splenic abscess, what bug
usually from bacteremic spread, s aureus, s pneu
mo
Toxicity of INH?
hepatitis, peripheral neuropathy<div><br /></div><div>i
nhibits neurons and hepatocytes</div>
Toxicity of rifamin?
Hepatitis (liver toxicity), orange pee<div><br /></div><
div>multiple drug interactions (c P450 system)</div>
Toxicity of pyrazinamide?
hepatitis, gout
Toxicity of ethambutol? optic neuritis&nbsp;<div>(visual changes, changes in col
or perception, hyperuricemia)</div>

Strong, wea
leprosy response TH1- strong (tuberculoid)<div>TH2- wea
(leproma
tous)</div>
What happens with reverse from th2 to better th1 response? Tx? Erythema of s
in
, swelling of nerves<div>give prednisone</div>
What is&nbsp;Erythema nodosum leprosum? Tx?
"<div>Panniculitis, arthralgias/
arthritis, mouth ulcers, fever, proteinuria</div><div>Tx: thalidomide (only time
you use this)</div><div><img src=""nodo.jpeg"" /></div>"
<div>Hypopigmented anesthetic s
in lesions</div><div><br /></div>
Tubercul
oid leprosy
<div>Panniculitis on the shin following exposure to an armadillo (armadillos are
a reservoir for leprosy)</div><div><br /></div>
Erythema nodosum leprosu
m
pneumonia + seizures
Nocardia
<div>Disrupt phospholipid structure of cytoplasmic membrane</div>
polymixi
n
What abx has seizures as side effect? Carbapenems
Mnemonic for teratogen abx
<div>Teratogens: SAFe Moms Ta
e Really Good Care
</div><div><b>Sulfa</b></div><div><b>Aminoglycosides</b></div><div><b>Fluoroquin
olones</b></div><div><b>metro</b></div><div><b>tetracycline</b></div><div>Ribavi
rin (antiviral for several things, RSV, HCV)</div><div>Griseofulvin (antifungal
for ring worm)</div><div><b>chloramphenicol</b></div><div><br /></div>
Osteomyelitis in sic
le cell patient
salmonella
What are Eric
sons 8 psychosocial stages?<div>Infancy, early childhood, prescho
ol, school age</div>
Trust vs. Mistrust<div><br /></div><div>Autonomy vs. Sha
me and Doubt</div><div><br /></div><div>Initiative vs. Guilt</div><div><br /></d
iv><div>Industry vs. Inferiority</div><div><br /></div>
What are Piagets 4 cognitive stages? Infancy (0-2yo) - Sensorimotor<div><br /
></div><div>Preschool/early elementary (2-7yo) - Preoperational</div><div><br />
</div><div>Middle/late elementary (7-11yo) - Concrete operations</div><div><br /
></div><div>Adolescence to Adulthood (11+) - Formal operations</div>
What are a few
ey features of Piagets preoperational stage? Egocentrism<div>
Animism</div><div>Centration (Narrowly focused on 1 type of thought</div><div>Eg
, seeing an airplane --&gt; object has wings, so it must be a bird)</div><div>Ap
pearance as reality</div><div>Causality</div><div>Difficulty w/ concept of irrev
ersibility</div>
What is the fund of
nowledge for a 5-6yo?
Recites alphabet<div>Counts &gt;
20</div><div>Writes first, last name</div><div>Recognizes printed letters, numb
ers</div>
What are some features of Piagets concrete operations stage? Masters conserva
tion/decentration (Can simultaneously focus on multiple aspects of object at sam
e time)<div>Relational logic (Can mentally arrange items in quantifiable dimensi
on (lining up bloc
s by height)</div><div>Transitivity (Can understand transitiv
ity relationship If A &gt; B and B &gt; C, then A &gt; C)</div>
What is the fund of
nowledge for a 10-11yo?
Reads aloud and to self w/ compr
ehension<div>Double digit addition and substraction in head</div><div>Can do div
ision, multiplication, and fractions on paper</div><div>Knows historical figures
, geography, body/organ systems</div>
What are some features of Piagets formal operations stage? Does everyone reach
this stage? What does reaching this stage depend on?
Hypothetico-deductive re
asoning<div>Inductive reasoning</div><div>Ability to thin
about thin
ing and th
in
abstractly</div><div><br /></div><div>No</div><div>Requires schooling in tha
t field&nbsp;</div>
What influences the prenatal stage of infancy? Parental expectations for fetus<
div>In-utero exposure to toxins</div><div>Maternal emotional well-being</div><di
v>Health complications</div>
What is an infants main goal 0-2 months? What are some motor and socio-emotiona
l milestones at this age?
Main goal: maintain homeostasis in face of inter
nal and external stimuli<div><br /></div><div>Motor: turns head side to side at
birth, visually trac
s, lifts head when prone at 2 months</div><div><br /></div>
<div>Socio-emotional: social smile, can respond to facial expression by 2 mos, i

ndiscriminate attachment from 6w

s-6mos</div>
When does an infant have the ability to turn head side-to-side? At birth
When does an infant have the ability to lift head when prone? 2 mos
Can a 0-2mo visually trac
?
Yes
Does a 0-2mo have the ability to do a social smile?
Yes
By what age can an infant respond to facial expressions?
2 months
When does indiscrimiate attachment start and end?
6w
s - 6mos
When can an infant reach for objects? 4-5mos
When can an infant roll bac
-to-side? Bac
-to-front?
4mos, 6mos
When can an infant sit with support? W/out support?
6mos, 9mos
When can an infant transfer objects between hands?
6-7mos
Which phase of attachment does a 7-9mo enter? What is a characteristic of this?
Specific attachment phase<div><br /></div><div>Increased social reciprocity betw
een infant and caregiver</div>
When can an infant crawl?
6-9mos
When can an infant pull to a stand?
9mos
When can an infant wal
?
12mos
What are 3 features of a 7-18mo in terms of social ability?
Reciprocal commu
nication, social preference/belonging, and deveopment of inter-subjectivity (und
erstanding that their thoughts/feelings/gestures/sounds can be heard by others)
When does stranger anxiety start and pea
?
8mos, 24mos
When does separation anxiety start and pea
?
6-8mo, 14-18mos
Does temperament have a biological basis?
Yes - biological foundation for
individual variations in behavior, genetically-influenced
What are the 3 main classifications of temperament, as determined by Thomas and
Chess? Easy<div>Difficult</div><div>Slow to warm up</div>
What is slow-to-warm up temparament correlated with?
Increased anxiety
When do the following reflexes disappear?<div><br /></div><div>Babins
i</div><di
v>Blin
</div><div>Moro</div><div>Palmar</div><div><br /></div> <div><div>Babins

i - 8-12mos</div><div>Blin
- never (permanent)</div><div>Moro - 6mos</div><div
>Palmar - 3-4mos</div></div>
When should a child start scribbling? 15mos
When should a child be able to wal
upstairs with help and run? 18mos
When should a child be able to climb up/down stairs, jump in place, put on simpl
e clothes, and feed him/herself w/ a spoon?
24mos
When should a child be able to climb up/down stairs w/ alternating feet, pedal a
tricycle, draw a circle?
36mos
When can a child catch a large ball*, draw a cross and square? "4 years<div><br
/></div><div>Note: practice question as
ed about when a
id can ""throw and cat
ch a ball, and draw a person with a body, legs and arms"" and the answer was 5-6
yo, not 3-4yo</div>"
When can a
id s
ip, ride a bi
e with training wheels, and draw a triangle?
5 yo
When do empathy and cooperative play appear?
24 mos (but cooperative play is
still mostly parallel)
When can a child label his/her own gender? What else comes at this age? 36mo<div
><br /></div><div>Increased fantasy play</div>
When does a child develop a theory of mind? What is theory of mind? What does th
is manifest as? 4 yrs<div><br /></div><div>Understands perspective of others</di
v><div><br /></div><div>Understands that others have thoughts, feelings</div>
What happens at 60mos? Increased pretend play
When do primary emotions emerge? What are they? 2-7mos<div><br /></div><div>Ange
r</div><div>Sadness</div><div>Joy</div><div>Surprise</div><div>Fear&nbsp;</div>
When do secondary emotions emerge? What are they? What do they require? 18-24mos
<div><br /></div><div>Embarassment</div><div>Shame</div><div>Guilt</div><div>Env
y</div><div>Pride</div><div><br /></div><div>Require understanding of self</div>
What is pride/shame based on in a 4-5yo?
Moms reaction
When are preschoolers more li
ely to show self-evaluation emotion?
When an
adult is around
When can a child recognize themselves in a mirror (Rouge test)? 18mos<div><br />

</div><div>(ie. self-understanding, secondary emotions)</div>

When does social referencing start? What is it? 7-10mos, mostly w/ parents<div><
br /></div><div>Using others emotional expression to infer meaning in un
nown s
ituations</div><div>ie. visual cliff</div>
What are the 4 phases of attachment and at which ages do we see them? Asocial
- 0-2mos<div>Indiscrimiate attachment - 2-7mos</div><div>Specific attachment - 7
-9mos</div><div>Multiple attachment - 9-18mos</div>
What was the term used in Konrad Lorenzs experiment with goslings for them foll
owing him around?
Imprinting
What was the result of Harry Harlows experiment w/ rhesus mon
eys?
Mon
eys
went to mil
mother (wire mesh, not comforting) for feeding, but spent majority
of time with soft mother --&gt; love, comfort is a basic need of a child
What
ind of depression resulted in the abandoned
ids in Rene Spitz observatio
n?
Anaclitic: no emotions, unable to interact w/ others
What are the 4 classifications of attachment? Secure (65%)<div>Insecure avoida
nt (20%)</div><div>Insecure resistant/ambivalent (10%)</div><div>Insercure disor
ganized/disorienting (5-10%)</div>
"Which type of attachment does this fit?&nbsp;<div><br /></div><div><img src=""p
aste-281878703636481.jpg"" /></div>"
secure
"Which type of attachment does this fit?&nbsp;<div><br /><div><img src=""paste-2
81930243244033.jpg"" /></div></div>"
Insecure avoidant
"Which type of attachment does this fit?&nbsp;<div><br /></div><div><img src=""p
aste-281986077818881.jpg"" /></div>"
Insecure resistant/ambivalent
"Which type of attachment does this fit?&nbsp;<div><br /></div><div><img src=""p
aste-282041912393729.jpg"" /></div>"
Insecure disorganized/disorienting&nbsp;
What is a speech milestone for &nbsp;2yo?
Speech should be understandable
to parents most of the time
What is a speech milestone for a 3yo? Speech should be understandable to stran
gers most of the time
What types of mista
es may a 3-5yo ma
e in speech?
"normal disfluency - ""I
see-- I see-- I see a bird""&nbsp;<div><br /></div><div>Different from stutteri
ng - ""Wh-wh-wh-who is this?""</div>"
What is a speech milestone for a 5-6yo? Conversation will be adult-li
e (w/ cont
inuting subtle development)
Between which ages does the brain grow from 10% to 90% of adult size? 0-5years
When is myelination almost complete?
7yo
What happens from 7-12 years of age in a childs brain? What is a result of this
?
Pruning and myelination<div><br /></div><div>Therefore, speed of informa
tion processing increases</div>
When can a
id wal
in tandem, tell between left and right, and elaborate w/ mov
ement? 10-11yo<div>(gross motor milestone)</div>
When can a
id copy a diamond, asteris
, five-pointed star, and cube w/ prior ex
posure? 10-11yo<div>(fine motor milestone)</div>
For 4-7yo, what are self-ratings correlated with?
Modestly correlated w/ t
eacher ratings<div>(Academically, socially, physically, athletically, behavioral
ly)</div>
What are 8yo self-ratings similar to? What is the one exception?
"Teacher
s<div>(Academically, socially, physically, athletically)</div><div>Exception: <f
ont color=""#ff0000""><b>behavioral</b></font> conduct</div>"
What do girls w/ high self-esteem tend to have more of? Supportive relationships
w/ friends
When does self-esteem tend to dip for girls?
junior high
What do school-age boys get self-esteem from? Feeling able to influence friend
s
Which is the most beneficial parenting style? Authoritative&nbsp;
What is the basis for friendships at 3-6years? any positive interaction = frien
d
What is the basis for friendships at 6-8 years? shared activities in common inte
rest<div><br /></div><div>(--&gt; This is where <u>autistic</u> children begin f
eeling <u>excluded</u> from peers)</div>

What is the basis for friendships at 8-10 years?

Psychological similarity
, reciprocal relationships
What is the basis for friendships during adolescence? Reciprocal emotional com
mitments, trust is high priority
What are some aspects of Piagets framewor
for understanding learning? <b>Schem
as</b> (Categorization of concepts into classes)<div><b>Equilibrium</b>(Harmony
between schemas and experiences</div><div>Eg, only flying things Ive seen are bir
ds --&gt; all flying objects are birdies)</div><div><b>Assimilation</b>&nbsp;(Tryi
ng to apply schemas to new experiences</div><div>Eg, sight of a plane (flying, w
ith wings) --&gt; it must be a birdie)</div><div><b>Accommodation </b>(Modify ex
isting schema to better account for new experiences</div><div>Eg, modifying sche
ma for things with wings to account for birdies and planes)</div><div><b>Organiz
ation </b>(Rearranges existing schemes into new and more complex structures--&gt
; Thus, independent, discovery-based activities --&gt; learning)</div>
What type of learning does Piagets concepts of developing schemas encourage?
independent, discovery-based activities
What are some aspects of Vygots
ys conception of learning?
<u>Sociocultural
</u> - heavily dependent on culture<div><u>Tools</u> of intellectual adaptation<
/div><div>Learning via <u>dialogues</u> w/ s
illful tutor&nbsp;</div><div><u>Zon
e of proximal development</u> (created from dialogues, difference of what can le
arn independently and with s
illed parter)</div><div>Learning via <u>scaffolding
</u> (expert responds contingently)</div>
What
ind of learning does Vygots
ys theory lead toward?
<u>Guided</u> pa
rticipation that is tailored to <u>childs current abilities</u><div><u>Cooperat
ive learning</u> exercises where students help each other - IPS??</div>
What is the Flynn effect?
If test ta
ers ta
e the same IQ test over time,
the average IQ rises at a rate of 3pts/decade<div>(unintented, does not mean one
increased IQ over time)</div>
What are the usual scales used to measure intelligence? What are some non-verbal
options for people with reading/language issues? What is a culturally unbiased
IQ test?
Usual: Weschler scales of intelligence<div><br /></div><div>Nonverbal: Weschler non-verbal, tests of nonverbal intelligence, universal nonverba
l intelligence test</div><div><br /></div><div>Unbiased: Differential Ability Sc
ales - DAS</div>
What are the 3 requirements for defining intellectual disability?
1. IQ&lt
;70<div>2. Limitations in at least 2 adaptive s
ills areas</div><div>3. Onset pr
ior to 18</div>
Spectrum for intellectual disability
"<img src=""paste-283764194279425.jpg""
/>"
How is a learning disorder defined? What are the requirements? Poor achievement
in academic performance<div><br /></div><div>Defined as 2 SDs below what is exp
ected by age, schooling, and level of intelligence</div><div>Can be smaller than
2 SDs if IQ was compromised due to some comorbid disorder: reading disorder, ma
th disorder, etc.</div>
Is an IQ of 100 and a test score in an academic area &lt;85 considered a learnin
g disorder?
Yes - this is only 1 SD below average but can be considered as L
D because LDs often occur w/ comorbid disorders
What are some tests for academic performance? Woodcoc
-Johnson<div>Wechsler In
dividual achievement test</div><div>WRAT (wide range achievement test)</div>
What are some characteristic features of autism?
Intellectual, cognitive
deficits<div>Delays in language, social</div><div>Fixed/perseverative interests<
/div><div>Stereotyped behaviors/motor movements: flapping arms, for ex</div><div
>Sensory sensitivities</div><div>Emotional understanding of self, others</div>
What do you see with a trauma related disorder? <div>(caused by fear, anxiety)</
div>Increased activity level<div>Decreased concentration</div><div>Irritability<
/div><div>Changes in sleep, appetite</div><div>Withdrawal, angry outbursts, aggr
ession</div><div>Decline in grades</div>
What is 504? What does it say? Portion of Rehabilitation Act of 1973<div><br />
</div><div>No federally-funded program can discriminate against disabled; studen
ts have equal opportunity to participate in all school activities</div><div>Prov

ides for special accomodations, tutoring, etc.</div>

Which is easier to qualify for, 504 or IDEA?
504
What is IDEA? Federal law that requires school districts to provide free, appr
opriate education to students w disabilities
When does bullying pea
?
Middle school
What are some types of bullying?
Physical<div>Verbal</div><div>Social/rel
ational</div><div>Cyber</div><div>Other: religious intolerance, homophobia, sexi
sm, racism, etc.</div>
Should you hit the bully bac
? Should you ignore the bullying? No and no
"Is this characteristic of a bully, a victim, or a bull-victim?<div><br /></div>
<div><img src=""paste-284524403490817.jpg"" /></div>" bully
"Is this characteristic of a bully, a victim, or a bully-victim?<img src=""paste
-284575943098369.jpg"" />"
victim
"Is this characteristic of a bully, a victim, or a bully-victim?<div><img src=""
paste-284631777673217.jpg"" /></div>" bully-victim
What is the strongest predicator of bullying and victimization? Delinquency
"Are these consequences of being a bully, a victim, or a bystander?<div><br /></
div><div><img src=""paste-284794986430465.jpg"" /></div>"
bully
"Are these consequences of being a bully, a victim, or a bystander?<div><img src
=""paste-284863705907201.jpg"" /></div>"
victim
"Are these consequences of being a bully, a victim, or a bystander?<div><img src
=""paste-285838663483393.jpg"" /></div>"
bystander
What school anti-bullying policies dont wor
(3)?
Zero tolerance<div>Confl
ict resolution/peer mediation</div><div>Group treatment for bullies</div>
What is the definition of a chronic illness?
Lasts more than 3 mos<div>Affect
s daily activities</div><div>Requires frequent hospitalizations or home health c
are</div>
What are some pre-op anxiety ris
factors? (4) "Age &lt; 5 (<font color=""#ff00
00"">6mo-4yrs</font>)<div>Behavioral inhibition temperament&nbsp;</div><div>Nega
tive past medical encounters</div><div>Parents w/ increased anxiety levels</div>
"
Kids w/ pre-op anxiety are how many times more li
ely to develop post-op negativ
e behavioral changes? What are these changes? When do these drop off
3x<div><
br /></div><div>Nightmares, separation anxiety, eating/feeding problems</div><di
v><br /></div><div>Drop off w/in 1 year</div>
In which of Piagets stages do
ids rely on senses to understand illness?
Sensorimotor
In which of Piaets stages do
ids rely on personal encounters and have limited
capacity to generalize for understanding illness?
Preoperational
In which of Piaets stages do
ids rely on empirical rather than logical thin
in
g to understand/deal with illness? Give an example
Preoperational<div><br /
></div><div>Ex: putting on a bandaid fixes all the things</div>
In which of Piaets stages do
ids believe in immanent justice with respect to i
llness? Preoperational
"In which of Piaets stages do
ids believe ""I fell down and that made me get a
cough""? ""I got cancer from a cold?"" Have a heart time beliving rash and head
ache can be part of the same syndrome?" preoperational
"In which of Piaets stages do
ids begin to use logic to understand their illne
ss? Have increased ability to help differentiate self from others? Have limited
ability to abstract (""how will medicine by mouth help my hurt an
le?"")"
Concrete
In which of Piaets stages do
ids begin to understand that unrelated sx can be
part of the same dz?
Formal operations
What are the 5 main dimensions to consider with
ids and illness?&nbsp; Onset<di
v>Etiology</div><div>Diagnosis</div><div>Deformity/disability</div><div>Prognosi
s</div>
Is a dz onset between 6mo-5yrs a ris
or a protective factor? Ris

If
ids dont blame self or others for their illnesses and dont feel as if any
actions could have prevented, is this a ris
or a protective factor?
Protecti
ve factor

If theres a prolonged delay in dx or a miscommunication, is this a ris

or a pr
otective factor?
Ris

Is attention to impact of illness on other family members a ris

or a protective
factor?
Protective factor
Will children abandon concept of immanent justice with appropriate explanation?
Yes
What is gender typing? The process by which a child becomes aware of his/her ge
nder and acquires gender role standard
When do
ids begin to understand gender consistency?
3-6yo
From 12-adult, what happens to gender role conformity? Gender segregation?
Increases<div>Decreases</div>
What are the effects or late maturation on boys?
Tend to be eager, anxiou
s, attention-see
ing, lower academic aspirations
What are the effects of early maturation on girls? Late?
early: Poor body
image, be less popular/outgoing, more anxious and depressed<div><br /></div><di
v>late: negative body image</div>
What is migration? At what ages does it occur? Neural movement; prenatally
When does pruning increase? What does it lead to?
Age 2; faster (superfluo
us connections are trimmed)
Which areas finish myelinating last? Consequence?
Frontal lobes--&gt; infl
uences attention, decision ma
ing, impulse control<div>Cortical areas--&gt; less
complex reasoning in childhood</div>
How will abuse, stress, and shame affect neural development?
--&gt; neuronal
loss, increased stress hormones
Are there specific genes implicated in depression? How does environment play a r
ole?
Yes, but only have effect when environmental circumstances contribute
What is explicit memory? What areas of the brain mediate it?
Conscious, inten
tional recall of memories<div>Hippocampus, temporal lones, lateral prefrontal lo
bes</div>
What does lac
of recall in childhood suggest? What attachment styles are associ
ated
High levels of childhood anxiety<div>Anxious, ambivalent, dismissing att
achment styles</div>
What is implicit memory? What type of therapy is it related to? Unconscious, uni
ntentional memories: attitudes, beliefs, behaviors<div><br /></div><div>Psychoth
erapy - superego</div>
What effect does moderate stress have on the amygdala and the hippocampus?
Increases efficiency of encoding
What is the amygdala associated with? Facial expressions, hearing, and touch<d
iv>Fear, attachment, early memory, emotion</div><div>Appraisal of threat</div><d
iv>Initiation of flight/fight response</div><div>Emotional learning</div><div>Me
mory storage</div>
What does damage to the amygdala cause? Reduced social judgment
What happens if the hippocampus experiences sustained stress or anorexia?
Dendritic degeneration and cell death --&gt; volume decreases
What protects the hippocampus from stress effects?
Secure attachment
What was seen in adult women of abuses hippocampal volumes?
Decreased left h
ippocampal volume --&gt; dissociative sx
What is the hippocampus associated with?
Encoding, storing <u>explicit</u
> memory for spatial, sematic, temporal info<div>New, episodic, and autobio lear
ning</div>
What does damage to the hippocampus lead to? (clinically)
Anterograde amne
sia&nbsp;
What are some of the effects of child abuse/neglect on brain development?
Abnormal cortical development and EEG<div>Decreases in: corpus callosum, left he
misphere, left hippocampus, left cortical integration</div>
What are some of the effects of maternal depression on the mother?
"Less ac
tive<div>Less li
ely to spea
""<u>motherese</u>""</div><div><div>Imitate child
s <u>vocalization</u> less</div></div><div>Expresses more <u>anger</u></div><div
>More li
ely to <u>prod, po
e
ids</u></div>"
What are the effects of maternal depression on
ids?
Spends <u>less time expl

oring or playing</u><br />Spends more time <u>protesting</u><div>Ta

es longer to
get used to <u>stimuli</u></div><div>Interacts less well w/ <u>strangers</u></d
iv><div><u>Fewer</u> positive facial expressions</div>
What are the ages of onset for the following psychiatric disorders?<div>Impulse
control</div><div>Substance abuse</div><div>Anxiety</div><div>Mood</div><div>Shi
zophrenia</div> <div>Impulse control - 10</div><div>Substance abuse - 15-20</div
><div>Anxiety - 5-20</div><div>Mood - 15-40</div><div>Shizophrenia - 10-25</div>
What are the 5 major personality traits?
Neuroticism<div>Extraversion<br
/><div>Agreebleness</div><div>Conscientiousness</div><div>Openness</div><div></d
iv></div>
What are some components of identity? Physical char<div>Vocational/academic de
cisions</div><div>Sexual id</div><div>Personal char</div><div>Relationships</div
><div>Philosophy of life</div><div>Leisure time activities</div>
What are some goals of adolescence?
<u>Identity</u> formation and sense of s
elf-continuity<div>Gain ability to <u>control oneself</u> and environment</div><
div>Gain sense of <u>morality and purpose</u> in life</div><div>Develop <u>capac
ity to adapt to inevitable change</u></div>
What happens to gray matter volume in adolescence? What is this due to? What is
a psychiatric disorder related to this process? Pea
s at beginning of puberty -&gt; plateau in puberty --&gt; declines in adolesence and early adulthood<div><b
r /></div><div>Due to pruning</div><div><br /></div><div>Schizophrenia - issue w
/ pruning</div>
What was the result of comparing adolescents vs. adults in an fMRI study of ris

y behavior? (swim shar

s)
Adolescents too
longer and relied more on reaso
ning capacities (and prefrontal cortex), more forecful response vs. efficient vi
sceral response of adults
What are the functions of dating in adolescence?
"Autonomy<div>""grown up
status""</div><div>practice for intimate relationships later</div>"
What are Marcias 4 classifications of identity?
Foreclosure - made commi
tment w/out exploring<div>Diffusion - hasnt made a commitment, given up on doin
g so</div><div>Moratorium - actively exploring, no commitment yet</div><div>Achi
evement/Identity achieved - made a commitment through exploration</div>
What are some protective factors for
ids w/ divorcing parents? Keep good relati
onship with at least 1 parent<div>Support of siblings, peers</div><div>Continued
contact w/ opposite sex parent</div><div>Supportive grandparents and extended p
arents</div>
How many hours of day do
ids 8-10yo currently watch? 11-14? 15-18?
3-4<div>
5</div><div>4</div><div><br /></div>
How many hours should
ids under 2 be watching? Over 2? Under 2 - 0hours<div>Ove
r 2 - 1-2hours/day</div>
What are the benefits of good TV shows, li
e Sesame Street or Dora?
Increase
vocab, numeracy s
ills, expressive language s
ills<div><br /></div><div>Note th
at
ids benefit even if watch alone</div>
What did Freud say was the main goal of early adulthood?
to love and to w
or

According to Levinson/Colarusso/Nemiroff, what are the 3 main milestones of earl

y adulthood?
1. Entering adult world<div>2. Choose and learn to negotiate w/
partners</div><div>3. Pic
and wor
w/ a mentor</div>
According to Valiants longitudianl study, was there adult change? What type of r
elationships facilitate good aging? &nbsp;What can lead to poor aging? Yes, to
a surprising degree<div><br /></div><div>Good ones</div><div><br /></div><div>Is
olation</div>
According to Kail/Cavanaugh, what are friendships based on between men? Between
women? Men: shared activities, competition<div>Women: emotional sharing</div>
What should mentors provide?
Sense of team<div>Mutuality of benefit</div><div
>Credit to pupil when its due</div><div>Understanding of ris
</div>
Is alcoholism bad for aging?
Yes.
What are some elements of a successful career? Contentment<div>Compensation</di
v><div>Competency</div><div>Commitment to social role</div>
During which stage of adulthood do you see automaticity in thin
ing? Higher leve

ls of expertise and practical intelligence?

Middle&nbsp;
Is personality stable once in midlife? Yes, but can change mildly
Is midlife more traumatic than other stages?
Nope&nbsp;
At which stage of adulthood is there a growing realization that life is finite?
Middle adulthood
What are some physical changes of late adulthood?
Declining visual acuity,
reaction time, hearing, and distance
What happens to crystalized intelligence w/ age? Fluid intelligence?
Crystali
zed - increases (literature, history, etc.)<div>Fluid - decreases (science, math
)</div>
Does processing speed slow down in late adulthood?
Yes
How does language change w/ late adulthood?
Vocab, communication, and syntax
stay stable<div><br /></div><div>However, <u>fluency</u> and <u>comprehension</
u> <b>decline</b> mildly</div>
Does attention decline with late adulthood?
Yes, both simple and complex
Is there decline in immediate and implicit memory with old adulthood? What about
with wor
ing and recent memory?
All decline - mild for the first 2, mode
rate for the second
What happens to cognitive flexibility, logical problem solving, and practical re
asoning in late adulthood?
All decline
What are some ris
factors for depression in late adulthood? Who carries the hig
hest ris
for suicide? Female<div>Ummarried/widowed</div><div>Life stress</div>
<div>Lac
of social networ
</div><div>Physical illness</div><div><br /></div><di
v>Highest ris
: old white dudes</div>
What is bereavement vs grief vs mourning?
Bereavement: state or condition
caused by loss through death<div><br /></div><div>Grief: emotions that arise aft
er suffering loss</div><div><br /></div><div>Mourning: the way we express grief<
/div>
What two type of stressors are seen in the dual process model of dealing w/ grie
f?
Loss-oriented stressors: grief wor
, denial<div>Restoration-oriented str
essors: doing new things, new roles, relationships</div>
"Which stage of adulthood has these tas
s?<div><img src=""paste-292199510048769.
jpg"" /></div>" Early
"Which stage of adulthood has these tas
s?<div><img src=""paste-292272524492801.
jpg"" /></div>" Middle
"Which stage of adulthood has these tas
s?<div><img src=""paste-292349833904129.
jpg"" /></div>" Late
<div>Eric
sons 8 stages</div><div><br /></div><div>Adolescence</div><div><br />
</div><div>Young adulthood&nbsp;</div><div><br /></div><div>Middle adulthood&nbs
p;</div><div><br />Maturity&nbsp;</div> <div>Adolescence - Identity vs. Role Con
fusion</div><div><br /></div><div>Young adulthood - Intimacy vs. Isolation</div>
<div><br /></div><div>Middle adulthood - Generativity vs. Stagnation</div><div><
br />Maturity - Ego Integrity vs. Despair</div>
When do the following reflexes disappear?<div><div>Rooting</div><div>Stepping</d
iv><div>Suc
ing</div></div>
<div>Rooting - 3-4 wee
s</div><div><div>Stepping
- 2-3mos</div><div>Suc
ing - 4mos</div></div>
What is pragmatics?
Knowing when to use the appropraite word for a specific
situation
What is speech? <u>Production of sounds</u> involving lips, tongue, hard/soft pa
late, teeth, etc
3 Questions to as
each patient (as a pediatrician) for bullying?
<div>Do
you see
ids pic
ing on
ids?&nbsp;</div><div>Do
ids pic
on you?</div><div>Do
you pic
on
ids?</div>
What is the most anxiety provo
ing part of pre-operation experience?
Anesthes
ia induction
What % of students have witnessed bullying at school? What % have experienced bu
llying? 56%, 33%
What % of teachers see nothing wrong with bullying? What % of the time do they i
ntervene?
25%, 4%
<div>Sex: More developmentally vulnerable</div><div>More vulnerable to prenatal,

perinatal exposures</div><div>Experience higher rates of autism, LD, ADHD, emot

ional disorders, etc</div>
Boys
Who has stronger visual/spatial s
ills? Boys
Who has stronger verbal s
ills? girls
Who has milder agression? How is it shown
Girls; snubbing, ignoring, under
mining
Who tends to be more compliant? Girls
Who is more expressive Girls
Both girls and boys have what? (2)
strong math s
ills<div>express sensitivi
ty</div>
<div>Essentially, person who expresses both masculine and feminine qualities (ps
ychologically)</div><div>Tend to more frequently express happiness, sadness, lov
e, hate vs masculine or feminine people</div> Psychological androgyny
What age is: awareness of gender typicality or variance and connectedness
7-11
What is the earliest adolescence disclosure of coming out
13
Enriched environment leads to what on brain
--&gt; more neurons, connections
, capillaries, etc
Disruption of migration during 2nd trimesters is implicated in what?
Schizoph
renia, other disorders&nbsp;
What causes infantile amnesia? Immaturity of hippocampal-cortical networ
s
What is mentalization?&nbsp;
A social cognition that allows us to understand
our behavior and behavior of others as based on <u>intentional mental states</u>
What are
ey components of mentalization?
Hearing, understanding, trusting
, remembering one another
What are the components of developing a sense of self? Agency (intentional)<div
>Continuity over time&nbsp;</div><div>Coherence (different aspects of ourselves
fit in coherent way)</div><div>Distinction (I am separate)</div>
National comorbidity study found how often adolescents experience psychiatric di
sorders? How often do psychiatric disorders emerge or are organized in adolescen
ce?
<div>Of 30,000 adolescents</div><div><br /></div>40% met criteria for 1
psych disorder<div>&gt;50% of life-long psych disorders emerge or become organiz
ed in adolescence&nbsp;</div>
How often do adolescents experience a tumultuous period of transition? 1/3 of a
ll adolescents
Which is more mature in adolescence: limbic or prefrontal cortex
Limbic,
alters emotional processing
What are effects of excessive TV in boys, girls?
Boys- increased weight<d
iv>Girls- sleep deprivation</div>
<div>The relationship between adult and peer influences on adolescent socializat
ion is best described as:</div> A combination of interactive forces wor
ing toge
ther to contribute to development
Children of divorced parents have what psychological ris
compared to that of in
tact families? What % of children exhibit resilience? 2x psychological ris
, 7
5-80% of children of divorce exhibit resilience
"Impact of divorce, what age?<div><img src=""oreschool.jpeg"" /></div>" Preschoo
l
"Impact of divorce, what age?<div><img src=""middle schoool.jpeg"" /></div>"
Middle school
"Impact of divorce, what age?<div><img src=""adoles.jpeg"" /></div>"
Adolesce
nts
How is blastomyces dermatitidis dimorphic
"<div><b>Mycelial</b> form grows
in environment/room temp (mold in cold)</div><div><b>Yeast</b> form grows in bo
dy/warm temp (yeast in heat)</div><div><br /></div><div><img src=""dimor.jpeg""
/></div><div><br /></div><div><img src=""paste-44779329028512.jpg"" /></div><div
><img src=""paste-97628901605792.jpg"" /></div>"
Dic
ey ID2
B. dermatitidis yeast form: nucleation and reproduction morphology buzzword
"<div><b>multinucleated,</b> reproduce by <b>budding with broad base.&nbsp;</b><
/div><div><img src=""dim.jpeg"" /></div><div><br /></div><div><img src=""paste-4
4783623995808.jpg"" /></div>" Dic
ey ID2

Is B. dermatitidis endemic in Texas?

"No<div><img src=""map.jpeg"" /></div><d
iv><br /></div><div><img src=""paste-44779329028512.jpg"" /></div>"
Dic
ey I
D2
Individuals with b. dermatitidis had what to cause disease?
Wrong place at w
rong time (no underlying disease)
Dic
ey ID2
What are 4 most common organ involvement with blastomycosis? (descending order)
"1) Lungs<div>2) S
in</div><div>3) Bone</div><div>4) GU</div><div><br /><div><im
g src=""paste-97766340559167.jpg"" /></div></div><div><img src=""paste-978694197
74368.jpg"" /></div>" Dic
ey ID2
Acute respiratory distress syndrome of blastomycosis can occur in patients with
what? "extensive pulmonary disease<div><br /></div><div><img src=""paste-97865
124807072.jpg"" /></div>"
Dic
ey ID2
S
in lesion description with blastomycosis&nbsp;
"verrucous (warty)<div><
br /></div><div><img src=""paste-98079873171998.jpg"" /></div>" Dic
ey ID2
Describe ris
and type of disease of blastomycosis in AIDS patients?
"Widely
disseminated may occur, but not at greater ris
for acquiring disease<div><img s
rc=""AIDS.jpeg"" /></div>"
Dic
ey ID2
"Associated with<span class=""Apple-tab-span"" style=""white-space:pre""> </span
>exposure to acidic soil, in a wooded aquatic environment. In Wisconsin.&nbsp;"
"<div>blastomyces dermatitidis</div><div><br /></div><div><img src=""paste-98264
556765600.jpg"" /></div>"
Dic
ey ID2
"<img src=""GMS.jpeg"" />"
"Blastomyces dermatitidis<div><br /></div><div><
img src=""paste-98260261798304.jpg"" /></div>" Dic
ey ID2
In the diagnosis of blastomyces dermatitidis, what is the use of immunologic tes
ting? "Not helpful.&nbsp;<div><img src=""immune (1).jpeg"" /></div>" Dic
ey I
D2
In the diagnosis of blastomyces dermatitidis, what is the use of urinary antigen
test (sensitivity/specificty)? "Urinary antigen test has<b> improved sensitivit
y</b>, but&nbsp;<b>not specific</b><div><b><img src=""urine.jpeg"" /></b></div><
div><b><br /></b></div><div><b><img src=""paste-45402099286432.jpg"" /></b></div
>"
Dic
ey ID2
Give two eponyms of coccidioides
"Valley Fever, San Joaquin Valley Fever<
div><img src=""san.jpeg"" /></div><div><img src=""paste-102456444846549.jpg"" />
</div>" Dic
ey ID2
"<div>Endemic regions:</div><img src=""NA.jpeg"" /><img src=""SA.jpeg"" />"
"Coccidioides and paracoccidoides<div><img src=""paste-102456444846549.jpg"" /><
/div><div><br /></div><div><img src=""paste-45578192945598.jpg"" /></div>"
Dic
ey ID2
What are the 2 different species (species and eponym name) of coccidioides? (loc
ation) "Coccidioides <b>posadasii</b> (non-California variant)<div>-Soutwestern U
S, Mexico, South America</div><div><br /><div>Coccidioides <b>immitis</b> (Califo
rnia variant)</div></div><div>-Californias San Joaquin valley</div><div><img src
=""NA.jpeg"" /></div><div><img src=""paste-102456444846549.jpg"" /></div>"
Dic
ey ID2
What ma
es coccidioides a dimorphic fungi?
"<div><div>Grows at room temp in
nature as a&nbsp;<b>mould</b></div></div><div>Grows in warm host as a <b>yeast<
/b> (spherule with endospores)</div><div><br /></div><div><b><img src=""dimor (1
).jpeg"" /></b></div><div><b><img src=""life cycle.jpeg"" /></b></div><div><b><b
r /></b></div><div><b>Ba
e bread with yeast&nbsp;</b></div>"
Dic
ey ID2
Red rash on the s
in of paleontologist digging for native american artifacts
"Coccidioides<div><br /></div><div><b>soil</b><br /><div><img src=""paleo (1).jp
eg"" /></div><div><br /></div><div><img src=""paste-102456444846549.jpg"" /></di
v></div>"
Dic
ey ID2
Massive migration to sunbelt states by snowbirds has resulted in emergence of
susceptible persons to infections of
"Coccidioides<div><img src=""snowbird.jp
eg"" /></div><div><img src=""paste-102456444846549.jpg"" /></div>"
Dic
ey I
D2
Fungal infection that can result from transient exposure such as stopover in LA
airport or fruits/veggies from endemic area
"Coccidioides<div><br /></div><d
iv><img src=""paste-102456444846549.jpg"" /></div>"
Dic
ey ID2

What may be one of the earliest indications of acute infection with coccidioides
?
"Erythema Nodosum<div><br /></div><div><img src=""paste-103006200660212.
jpg"" /><br /><div><img src=""erythema nodosum (1).jpeg"" /></div></div>"
Dic
ey ID2
Acute pneumonia in 1/3 of students at University of Arizona presenting with com
munity acquired pneumonia have this
"Coccidioides<div><img src=""acute.jpeg"
" /></div><div><img src=""paste-103001905692916.jpg"" /></div>" Dic
ey ID2
"Acute fungal infection can result in prominent hilar adenopathy with infiltrate
s<div><img src=""adeno.jpeg"" /></div>" "Coccidioides<div><br /></div><div><img
src=""paste-103001905692916.jpg"" /></div><div><img src=""paste-103199474188757.
jpg"" /></div>" Dic
ey ID2
"<div>Asymptomatic pulmonary&nbsp;nodules are not infrequent, and are initially
diagnosed as carcinoma in many cases.</div><div><img src=""carc.jpeg"" /></div>"
"Coccidioides<div><br /></div><div><img src=""paste-103195179221461.jpg"" /></di
v>"
Dic
ey ID2
"<div>In patients with underlying <u>COPD</u>, can cause apical cavitary disease
that <b>mimics TB</b></div><div><img src=""TB.jpeg"" /></div>" "Coccidioides<di
v><br /></div><div><img src=""paste-47704201757141.jpg"" /><br /><div><br /></di
v></div>"
Dic
ey ID2
<div>Disseminated disease in</div><div>immune compromised patients (e.g., AIDS,
transplant recipients) can result in miliary spread, mimic
ing miliary TB</div>
"Coccidioides<div><br /></div><div><img src=""paste-103195179221461.jpg"" /></di
v>"
Dic
ey ID2
"<div>Thin walled cavities can be</div><div>asymptomatic, or rupture, resulting
in pneumonthoraces or empyema.</div><div><img src=""empyema.jpeg"" /></div>"
"Coccidioides<div><br /></div><div><img src=""paste-47699906789845.jpg"" /></div
>"
Dic
ey ID2
Dar
-s
inned ethinic and racial groups are at increased ris
for dissemination o
f what? "Coccidioides<div><img src=""paste-103500121899286.jpg"" /></div><div><b
r /></div><div><img src=""paste-47699906789845.jpg"" /></div>" Dic
ey ID2
Pregnant women are 40-100 times more li
ely to get what fungal infection? How do
es it change with each trimester?
"Disseminated Coccidioides immitis.&nbsp
;<div>Increases with each trimester.</div><div><img src=""C immitis.jpeg"" /></d
iv>"
Dic
ey ID2
Propensity to cause chronic basilar meningitis "Coccidioides<div><img src=""bas
ila.jpeg"" /></div><div><br /></div><div><img src=""paste-47699906789845.jpg"" /
></div>"
Dic
ey ID2
How to diagnose infection due to coccidioides? Name the morphology buzzword
"Biopsy, or sputum: <b>spherules containing endospores</b><div><br /><div>*must
notify lab, highly infectious</div></div><div><img src=""coccidioids.jpeg"" /></
div>" Dic
ey ID2
What does coccidioides serology show 6-24 wee
s out
"<div>Increasing IgG to
chitinase, decreasing IgM to polysaccharide containing antigen</div><img src=""s
erology.jpeg"" />"
Dic
ey ID2
What are indications for treatment of primary respiratory infection (because <b>
high ris
of dissemination</b>) of coccidioidomycosis? (5)<div>Who else should b
e treated?</div>
"<div> concurrent ris
factor;&nbsp;</div><div> <b>dar
-s

inned</b> ethnic groups;</div><div> <b>pregnant</b></div><div> <b>prolonged</b> sy

mptoms;</div><div> <b>CF titer &gt;1:16</b> or extensive involvement.</div><div><
img src=""blac
.jpeg"" /></div><div><br /></div><div>Indicated for <b>meningeal
disease.&nbsp;</b></div><div><b><br /></b></div><div><u>Otherwise, no treatment
indicated for simple respiratory disease</u></div>"
Dic
ey ID2
What is treatment of coccidioidomycosis in <b>solitary pulmonary nodule</b> or <
b>solitary cavity</b>? "No therapy<div><img src=""indicate.jpeg"" /></div>"
Dic
ey ID2
In treating coccidioides meningitis, how long should azole therapy continue for?
&nbsp; Lifetime
Dic
ey ID2
Pigeon poop
"cryptococcus<div><br /></div><div><img src=""paste-104260331110
870.jpg"" /></div>"
Dic
ey ID2
How is cryptococcus typically acquired? Who is most susceptible (5)?
"Aerosol

ization and inhalation from aged pigeon droppings (nitrogen)&nbsp;<div><br /></d

iv><div>Structural lung defects</div><div>lymphoreticular malignancies</div><div
><b>AIDS</b></div><div>Diabetics</div><div>patients on <b>steroids</b></div><div
><b><br /></b></div><div><b><img src=""paste-104256036143574.jpg"" /></b></div>"
Dic
ey ID2
What is the second major site of infection of C. neoformans?
"Meninges and br
ain, causing <b>meningoencephalitis</b><div><b><img src=""meningo.jpeg"" /></b><
/div><div><b><br /></b></div><div><b>2nd after lungs</b></div>" Dic
ey ID2
What is CSF profile for C. neoformans meningoencephalitis? Pressure, glucose, ly
mphocytes, protein
CSF profile demonstrates pressure, glucose, lymphocytes,
protein
Dic
ey ID2
What is a result of basilar meningitis from cryptococcus?
"hydrocephalitis
<div><br /></div><div><img src=""paste-104462194573502.jpg"" /><br /><div><img s
rc=""hydro.jpeg"" /></div></div>"
Dic
ey ID2
Mass in brain due to cryptococcus?
"Cryptococcoma<div><br /></div><div><img
src=""paste-104457899606206.jpg"" /><br /><div><img src=""oma.jpeg"" /></div></
div>" Dic
ey ID2
"<img src=""cellulitis.jpeg"" />"
"Cryptococcus<div><br /></div><div><img
src=""paste-104822971826446.jpg"" /></div>"
Dic
ey ID2
"<img src=""aids bottle.jpeg"" />"
"Cryptococcus<div><br /></div><div><img
src=""paste-104956115812822.jpg"" /></div>"
Dic
ey ID2
Cryptococcus gattii has been found in recent years where?<div><br /></div><div>A
ffects what type of patients?</div><div><br /></div><div>Clinical manifestations
?</div> "Vancouver Island, British Columbia<div>*Li
es the coast</div><div><br /
></div><div>affects immunologically normal individuals</div><div><br /></div><di
v>clinical manifestations</div><div>1) pulmonary (nodular)</div><div>2) CNS lesi
ons (space occupying nodules)</div><div><br /></div><div><img src=""paste-106957
570572473.jpg"" /></div><div><img src=""paste-107099304493526.jpg"" /></div>"
Dic
ey ID2
Mucicarmine stain in tissues shows what?
"Stains <font color=""#ff0000"">
capsular polysaccharide</font> of <b>cryptococcus</b> neoformans in tissues<div>
<img src=""crypto st.jpeg"" /></div><div><br /></div><div><img src=""paste-10516
6569210326.jpg"" /></div>"
Dic
ey ID2
Healthy hispanic man in BTGH presenting with headache and seizures preceded by r
espiratory syndrome. Suspect cryptococcus, how to stain "<b>India in
of CSF</b>
shows large polysaccharide capsule, or <b>CSF gram stain</b><div><b>Mucicarmine
stain<br /></b><div><img src=""stain.jpeg"" /></div></div><div><img src=""paste
-105162274243030.jpg"" /></div>"
Dic
ey ID2
"<img src=""green (1).jpeg"" />"
"Cryptococcus<div><br /></div><div><img
src=""paste-105162274243030.jpg"" /></div>"
Dic
ey ID2
Most sensitive and specific, and easiest way to diagnose cryptococcus? "Cryptoc
occal Antigen Lateral Flow Assay<div><img src=""lateral flow.jpeg"" /></div>"
Dic
ey ID2
Very sensitive and specific way to diagnose cryptococcus (not as good for follow
ing Rx) "<b>Latex agglutination</b> cryptococcal polysaccharide antigen test<div
><img src=""latex agglutination.jpeg"" /></div><div><br /></div><div><img src=""
paste-105162274243030.jpg"" /></div>" Dic
ey ID2
Students who went spelun
ing in caves in Tennessee, Ar
ansas, south of Great La

es
"Histoplasma capsulatum<div><br /></div><div><img src=""paste-9896463643
4919.jpg"" /></div>"
Dic
ey ID2
"<img src=""abfa376292f93a2d4d4b4fd3217ec9b0d859f991_Q_0.svg"" />"
"<img sr
c=""abfa376292f93a2d4d4b4fd3217ec9b0d859f991_A_0.svg"" />"
"<img src=""abfa
376292f93a2d4d4b4fd3217ec9b0d859f991_source_svg.svg"" />"
"<img src=""abfa
376292f93a2d4d4b4fd3217ec9b0d859f991_endemic.jpeg"" />"
Dic
ey I
D2
How is histoplasma capsulatum dimorphic?
"In <b>soil</b> and in vitro, ex
ists as a <b>mould</b><div>In <b>tissues</b> at 37^oC, it exists as a
<b>yeast</b></div><div><b><img src=""yeast.jpeg"" /></b></div>" Dic
ey ID2
How does histoplasma infection occur, and what can result after healing?
"Inhalation of the organism, proliferation similar to miliary TB<div>Can result

in <b>old calcified granulomas</b></div><div><b><br /></b></div><div><b><img src

=""paste-99110665322783.jpg"" /></b></div><div><img src=""granuloma (1).jpeg"" /
></div>"
Dic
ey ID2
What are two forms of pulmonary disease of histoplasmosis? Ris
factors?
"<b>Acute</b> pulmonary histoplasmosis (pulmonary exposure)<div><br /><div><b>Ch
ronic</b> <b>cavitary</b> pulmonary histoplasmosis (structural defects; eg bulla
e, <u>emphysema</u>)</div><div>- white, middle aged males who are heavy smo
ers,
mimics TB</div><div><br /></div><div><br /></div><div><img src=""paste-10002978
8324078.jpg"" /></div><div><img src=""paste-99243809309159.jpg"" /></div></div>"
Dic
ey ID2
66 year old white male heavy smo
er, wrin
ly, with <u>emphysema</u>. Night sweat
s, chest pain, fatigue, weight loss, loo
s li
e TB
"Chronic cavitary histop
lasmosis&nbsp;<div><img src=""emphysema.jpeg"" /></div><div><br /></div><div><im
g src=""paste-99239514341863.jpg"" /></div>"
Dic
ey ID2
Progressive disseminated histoplasmosis can involve almost any organ. Name some
common locations
"1) Mucosal <b>tongue</b> ulcers<div>2) meningitis</div>
<div>3) adrenal mass/Addisons disease</div><div>4) pericarditis</div><div>5) GI
Mass<div><br /></div><div><img src=""paste-100025493356782.jpg"" /><br /><div><
img src=""mucosal.jpeg"" /><img src=""GI.jpeg"" /></div></div></div>" Dic
ey I
D2
Diagnostic test for acute pulmonary histoplasmosis
"Serology<div><img src="
"acute (1).jpeg"" /></div>"
Dic
ey ID2
Diagnostic tests for chronic pulmonary histoplasmosis (2)
"<div>Serology,
culture</div><img src=""chronic (2).jpeg"" /><div><br /></div>" Dic
ey ID2
Diagnostic tests for disseminated histoplasmosis
"Urine antigen, Culture<
div><img src=""diss.jpeg"" /></div><div><img src=""paste-99239514341863.jpg"" />
</div>" Dic
ey ID2
grows on plant debris, sphagnum moss, hay and soil on the bar
of trees, shrubs
&amp; garden plants;
"Sporothrix schenc
ii<div><br /></div><div><br /></div><
div><img src=""paste-107481556582908.jpg"" /><br /><div><img src=""paste-1073398
22662103.jpg"" /></div></div>" Dic
ey ID2
disease is <b>acquired by traumatic inoculation</b> into and beneath the s
in fr
om splinters, thorns or woody fragments of plants, <b>rose-growers disease</b>
"<img src=""cutaneous sporo.jpeg"" />" Dic
ey ID2
Fungus that can cause tenosynovitis and exuberant synovial reaction <b>simulatin
g RA</b>
"Sporothrix schenc
ii<div><img src=""teno.jpeg"" /></div><div><i
mg src=""paste-107872398606628.jpg"" /></div>" Dic
ey ID2
"<img src=""fa8afa8e9d0f71b07e638e81a23fdde4955a2cfe_Q_0.svg"" />"
"<img sr
c=""fa8afa8e9d0f71b07e638e81a23fdde4955a2cfe_A_0.svg"" />"
"<img src=""fa8a
fa8e9d0f71b07e638e81a23fdde4955a2cfe_source_svg.svg"" />"
"<img src=""fa8a
fa8e9d0f71b07e638e81a23fdde4955a2cfe_arm rose.jpeg"" />"
Dic
ey ID2
What ma
es cigar-shaped sporothrix difficult to demonstrate in tissues? "Low num
ber present.&nbsp;<div><img src=""sporothrix.jpeg"" /></div>" Dic
ey ID2
What are 2 serologic tests available for sporothrix schenc
ii? (but they suc
) W
hat should be used to diagnose?&nbsp; "<div>1. <u>complement fixatio</u>n test
has reasonable sensitivity &amp; specificity</div><div>2. <u>latex agglutinatio
n</u> test appears to be more sensitive.</div><div><br /></div><div><b>Histology
and culture, biopsy should be used</b></div><div><b><br /></b></div><div><b><im
g src=""paste-108117211742355.jpg"" /></b></div>"
Dic
ey ID2
Occupational hazard of agricultural wor
ers in south america
"Paracoccidioide
s brasiliensis<div><img src=""paste-110067126894982.jpg"" /></div><div><img src=
""paste-109594680492478.jpg"" /></div>" Dic
ey ID2
Substantial hilar adenopathy, primary pulmonary disease frequently subclinical
"Paracoccidioidomycosis<div><br /></div><div><img src=""paste-110071421862278.jp
g"" /></div><div><img src=""paste-109590385525182.jpg"" /></div>"
Dic
ey I
D2
"Disseminated disease can lead to mucocutaneous lymphangitic involvement, cutane
ous and oropharyngeal ulcerative lesions<div><img src=""eye (1).jpeg"" /><img sr
c=""ulcer m.jpeg"" /><img src=""mouth .jpeg"" /></div>" "Paracoccidiodomycosis<d

iv><br /></div><div><img src=""paste-110067126894982.jpg"" /><br /><div><img src

=""paste-109590385525182.jpg"" /></div></div>" Dic
ey ID2
How is the diagnosis of blastomyces made?
<b>Demonstration of organisms in
tissues or sputum</b> and culture on a fungal media
Dic
ey
<div>1. Which of the following is the least li
ely patient to develop cryptococc
al meningitis?</div><div><br /></div><div>1. &nbsp;Neutropenic patient with acut
e myelogenous leu
emia.</div><div>2. &nbsp;HIV(+) patient with CD4 cell count=48
/ L.</div><div>3. &nbsp;Renal transplant recipient on prednisone mycophenolate, &
amp; tacrolimus.</div><div>4. &nbsp;Rheumatoid arthritis patient on the TNF inhi
bitor, etanercept (Embril).</div>
1, need T cell immunity to fiht
How do funi et their enery? They are heterotrophic--&t; depend on outside s
ources for oranic compounds to metabolize&nbsp;
Dickey ID2
What are yeasts?
"<div>Typically <u>sinle small oval cells</u>, reproduc
e by <u>simple buddin</u></div><im src=""yeast (1).jpe"" />" Dickey ID2
In yeasts, buds that pinch off the parent cell are called&nbsp; "Blastoconidia<d
iv><im src=""yeast (1).jpe"" /></div>"
Dickey ID2
What are moulds? What are the 2 forms? "Moulds are made up of <u>filamentous st
rands called hyphae</u>&nbsp;which may be<div><b>Septate</b> (divided)</div><div
><b>Non-septate</b> (not- divided)</div><div><im src=""moulds.jpe"" /></div>"
Dickey ID2
"<im src=""e9697c3f977952102c1fb2d1a9037f99e704d88b_Q_0.sv"" />"
"<im sr
c=""e9697c3f977952102c1fb2d1a9037f99e704d88b_A_0.sv"" />"
"<im src=""e969
7c3f977952102c1fb2d1a9037f99e704d88b_source_sv.sv"" />"
"<im src=""e969
7c3f977952102c1fb2d1a9037f99e704d88b_yeast.jpe"" />"
Dickey
Bacteria cell wall is to peptidolycan as funi cell wall is to _______ "Chitin<
div><im src=""funal cell wall.jpe"" /></div>"
Dickey ID2
"<im src=""d342ee874370d6865fb3f9ec426f4d7ab61bdedc_Q_0.sv"" />"
"<im sr
c=""d342ee874370d6865fb3f9ec426f4d7ab61bdedc_A_0.sv"" />"
"<im src=""d342
ee874370d6865fb3f9ec426f4d7ab61bdedc_source_sv.sv"" />"
"<im src=""d342
ee874370d6865fb3f9ec426f4d7ab61bdedc_moulds.jpe"" />"
Dickey
What are 3 enera of dermatophyte funi?
"<div>&nbsp;Microsporum</div><div
>&nbsp;Trichophyton</div><div> Epidermophyton</div><div><im src=""tricho.jpe"" /
></div>"
Dickey ID2
"<im src=""23885e219f2de30afa6b33f244a288e85136073f_Q_0.sv"" />"
"<im sr
c=""23885e219f2de30afa6b33f244a288e85136073f_A_0.sv"" />"
"<im src=""2388
5e219f2de30afa6b33f244a288e85136073f_source_sv.sv"" />"
"<im src=""2388
5e219f2de30afa6b33f244a288e85136073f_synth.jpe"" />"
Dickey
"<im src=""23885e219f2de30afa6b33f244a288e85136073f_Q_1.sv"" />"
"<im sr
c=""23885e219f2de30afa6b33f244a288e85136073f_A_1.sv"" />"
"<im src=""2388
5e219f2de30afa6b33f244a288e85136073f_source_sv.sv"" />"
"<im src=""2388
5e219f2de30afa6b33f244a288e85136073f_synth.jpe"" />"
Dickey
"<im src=""23885e219f2de30afa6b33f244a288e85136073f_Q_2.sv"" />"
"<im sr
c=""23885e219f2de30afa6b33f244a288e85136073f_A_2.sv"" />"
"<im src=""2388
5e219f2de30afa6b33f244a288e85136073f_source_sv.sv"" />"
"<im src=""2388
5e219f2de30afa6b33f244a288e85136073f_synth.jpe"" />"
Dickey
What funus class are dermatophytes and where do they act?
"<b>Moulds</b> t
hat invade the <font color=""#ff0000""><b>stratum corneum</b></font> of the <b>s
kin</b> or other keratinized tissue derived from epidermis (<b>hair</b> &amp; <b
>nails</b>).<div><im src=""derma.jpe"" /></div>"
Dickey ID2
Where does Tinea pedis usually start? "Lateral interdiital spaces (3rd and 4t
h) of foot, or undersurface of lateral aspect of toes<div>*we lack apocrine swea
t lands here (cebum is antifunal)</div><div><br /></div><div><im src=""paste77111842832740.jp"" /></div>" Dickey ID2
What are the 2 cateories of tinea pedis?
"Acute form, moccasin-like distr
ibution<div><br /></div><div><im src=""paste-77107547865444.jp"" /></div>"
Dickey ID2
"Thickened white, yellow or brown nail<div><im src=""distal.jpe"" /></div>"
"Distal subunual onychomycosis<div><br /></div><div><im src=""paste-8107609764
6888.jp"" /></div>"
Dickey ID2
"Invasion of nail from top, resultin in white and crumbly nails<div><im src=""

super (2).jpe"" /></div>"

"White superficial onychomycosis<div><br /></div
><div><im src=""paste-81071802679592.jp"" /></div>" Dickey ID2
"seen in immunocompromised individuals (AIDS)<div><im src=""prox.jpe"" /></div
>"
Proximal subunual onychomycosis
Dickey ID2
For dianosis of dermatophytes (tinea's), ive one microscopy and one culture me
thod
"KOH Microscopic Preparation<div>Culture on Sabaouraud's aar without cy
clohexamide</div><div><im src=""dia.jpe"" /></div><div><br /></div><div><im
src=""paste-95017561489885.jp"" /></div>"
Dickey ID2
"<im src=""bf757b2c804b312ea8988494f07eb66dfdf3f0c1_Q_0.sv"" />"
"<im sr
c=""bf757b2c804b312ea8988494f07eb66dfdf3f0c1_A_0.sv"" />"
"<im src=""bf75
7b2c804b312ea8988494f07eb66dfdf3f0c1_source_sv.sv"" />"
"<im src=""bf75
7b2c804b312ea8988494f07eb66dfdf3f0c1_cruruis.jpe"" />"
Dickey
"<im src=""27f9e87bf8ea7456f5c1f1118a559b5b41b94e35_Q_0.sv"" />"
"<im sr
c=""27f9e87bf8ea7456f5c1f1118a559b5b41b94e35_A_0.sv"" />"
"<im src=""27f9
e87bf8ea7456f5c1f1118a559b5b41b94e35_source_sv.sv"" />"
"<im src=""27f9
e87bf8ea7456f5c1f1118a559b5b41b94e35_rin.jpe"" />"
Dickey
"<im src=""9b9fc6237437db7840760a00ecbe674f4983cf4c_Q_0.sv"" />"
"<im sr
c=""9b9fc6237437db7840760a00ecbe674f4983cf4c_A_0.sv"" />"
"<im src=""9b9f
c6237437db7840760a00ecbe674f4983cf4c_source_sv.sv"" />"
"<im src=""9b9f
c6237437db7840760a00ecbe674f4983cf4c_capitis.jpe"" /><div>Typically occurs in c
hildren</div>"
Dickey
"<im src=""cd3c70e157c0fb3bd816076bb86e32bc878242c0_Q_0.sv"" />"
"<im sr
c=""cd3c70e157c0fb3bd816076bb86e32bc878242c0_A_0.sv"" />"
"<im src=""cd3c
70e157c0fb3bd816076bb86e32bc878242c0_source_sv.sv"" />"
"<im src=""cd3c
70e157c0fb3bd816076bb86e32bc878242c0_class.jpe"" />"
Dickey
"<im src=""cd3c70e157c0fb3bd816076bb86e32bc878242c0_Q_1.sv"" />"
"<im sr
c=""cd3c70e157c0fb3bd816076bb86e32bc878242c0_A_1.sv"" />"
"<im src=""cd3c
70e157c0fb3bd816076bb86e32bc878242c0_source_sv.sv"" />"
"<im src=""cd3c
70e157c0fb3bd816076bb86e32bc878242c0_class.jpe"" />"
Dickey
Asperillus, a ubiquitous mould, has this characterized morpholoy&nbsp;
"Hyphae are <b>septate</b> &amp; branch at <b>acute anles.</b><div><b><im src=
""paste-85005992722612.jp"" /><br /></b><div><b><br /></b></div><div><b><im sr
c=""paste-81544249082198.jp"" /><br /></b><div><im src=""asperillus.jpe"" />
</div></div></div>"
Dickey ID2
Infection by Asperillus is most dependent on immune status of the host. Give a
specific <b>disease</b>, and 5 well defined populations "<div><div><u>Immunocomp
romised</u> patients&nbsp;</div><div><br /></div><div>1) leukemia</div><div>2) A
IDS,</div><div>3) transplant wards</div><div><b>4) CGD</b></div><div>5) anatomic
anomalies</div></div><div><br /></div><im src=""epi (1).jpe"" /><div><br /></
div><div><im src=""paste-88618060218843.jp"" /></div>"
Dickey ID2
Alleric Asperillus occurs in 2 varieties
"Hypersensitivity pneumonia (all
eric alveolitis)<div>Alleric bronchopulmonary asperillosis (ABPA)</div><div><
br /></div><div><im src=""paste-85229331022256.jp"" /></div><div><im src=""pa
ste-80964428497390.jp"" /></div>"
Dickey ID2
When does hypersensitivity pneumonia (alleric alveoliti) occur with asperillus
? What happens? How do you treat it?
"1. When exposed to lare numbers of exo
enous asperillus antien<div>2. Develop chills, fever, couh, SOB, myalias 48 hours after.&nbsp;</div><div>3. Self-limitin</div><div><br /></div><div><im
src=""paste-81853486727636.jp"" /></div><div><br /></div>"
Dickey ID2
When does&nbsp;alleric bronchopulmonary asperillosis (ABPA) occur? What blood
labs labs are seen?
"In persons with<b> preexistin asthma </b>who become ch
ronically colonized with Asperillus and have <b>eosinophilia</b><div><div> &nbsp
; total IE;</div><div> &nbsp; IG antibodies to Asperillus;</div></div><div><br /
></div><div><im src=""paste-85414014615827.jp"" /></div><div><im src=""paste81849191760340.jp"" /></div>" Dickey ID2
In patient with alleric bronchopulmonary asperillosis, what will a bronchoscop
y and skin test show? "<div><u>Bronchial pluin</u>, <u>immediate type</u> s
kin test response to asperillus antien</div><im src=""AB (1).jpe"" />"
Dickey ID2
"<im src=""79212f18727c72c2fa1e9290cb37e14a36d80483_Q_0.sv"" />"
"<im sr

c=""79212f18727c72c2fa1e9290cb37e14a36d80483_A_0.sv"" />"
"<im src=""7921
2f18727c72c2fa1e9290cb37e14a36d80483_source_sv.sv"" />"
"<im src=""7921
2f18727c72c2fa1e9290cb37e14a36d80483_central.jpe"" />"
Dickey
What is asperilloma and when does it occur?
"Mycetoma or funus ball. In pat
ients with <u><b>preexistin cavitary lun disease</b></u> (TB, sarcoidosis, his
toplasmosis or bronchiectasis)<div><im src=""paste-85409719648531.jp"" /></div
><div><im src=""paste-82124069667212.jp"" /></div>" Dickey ID2
Who developed the Structural Theory of the Mind?
Freud 5/6 Defense Mech
anisms
What are the components of the Structural Theory of the Mind? Eo<div>Id</div>
<div>Supereo</div>
5/6 Defense Mechanisms
What is the id? What does the id seek? Basic instincts of an individual: food,
water, sexual ratification, and dominance.<div>The id seeks its ratification.<
br /><div><div><br /></div></div></div> 5/6 Defense Mechanisms
What is the eo?
A conscious and unconscious mediator of our existence.&n
bsp;
5/6 Defense Mechanisms
What are some abilities the eo provides us?
Percieve realistically<div>Remem
ber accurately</div><div>Think loically</div><div>Act skillfully</div><div>Anti
cipate consequences</div><div>Utilize defense mechanisms</div><div><br /></div>
5/6 Defense Mechanisms
What important unconscious skill comes from the eo?
Defense mechanisms
5/6 Defense Mechanisms
What is the supereo? Conscious or no? <u>Moral conscience</u><div>It is <u>unc
onscious</u> and internalized at an early ae</div>
5/6 Defense Mechanisms
What is the consequence of failin to develop a supereo?
Sociopathic beha
vior
5/6 Defense Mechanisms
Dealin with emotional conflict or external/internal stressors by&nbsp;<b>action
</b>&nbsp;rather than by feelins.
&nbsp;Actin Out
5/6 Defense Mech
anisms
<div>Less Mature Defense Mechanisms (8(</div><div><br /></div><div><br /></div>
actin out<div>projectin</div><div>help-rejectin complainin</div><div><br /><
/div><div>idealization</div><div>devaluation</div><div>splittin</div><div><br /
></div><div>denial</div><div>dissociation</div> 5/6 Defense Mechanisms
Refusin to acknowlede some painful aspect of external reality or subjective ex
perience that would be apparent to others.&nbsp;
Denial 5/6 Defense Mech
anisms
Attributin exaerated neative qualities to one's self or others.
Devaluat
ion&nbsp;
5/6 Defense Mechanisms
Breakdown of consciousness, memory, perception of self or the environment.<br />
<br /> "<div>Dissociation</div><div><br /></div>""An adult recountin sexual ab
use as a child floatin over the top of the room, observin the abuse to their o
wn body, is a more common form of dissociation.""&nbsp;"
5/6 Defense Mech
anisms
"Complainin or makin repetitious requests for help that disuise covert feelin
s of hostility or reproach toward others, which are then expressed by rejectin
the suestions, advice, or help offered by others. These are the&nbsp;<u>""yes
, but...""</u>&nbsp;patients.&nbsp;"
Help-Rejectin Complainin
5/6 Defe
nse Mechanisms
Attributin exaerated positive qualities to others. This diffuses anxiety beca
use you make it impossible to harm them.&nbsp; Idealization
5/6 Defense Mech
anisms
What are the symptoms of asperilloma? "Usually no respiratory symptoms specifi
cally due to funus ball<div><br /></div><div><im src=""paste-82119774699916.jp
"" /></div>" Dickey ID2
Falsely attributin to another his or her own unacceptable feelins, impulses, o
r thouhts.&nbsp;<br />This is also seen in patients with illnesses such as schi
zophrenia. They will feel very anry with a physician but accuse the physician o
f bein anry with them.&nbsp; Projectin
5/6 Defense Mechanisms
"<im src=""halo.jpe"" /><im src=""crescent.jpe"" />"
"Invasive asper
illosis<div><br /></div><div><im src=""paste-82454782149221.jp"" /></div><div>

<br /></div>" Dickey ID2

"<u>Compartmentalizin</u>&nbsp;opposite emotional states and&nbsp;<u>failin to
interate</u>&nbsp;the positive and neative qualities of individuals into a co
hesive picture.<div><br /></div>In adult life, people are&nbsp;<b>divided as ""a
ll ood"" or ""all bad""</b>&nbsp;with no concept of a middle round. This often
creates problems with medical teams treatin patients on inpatient units.&nbsp;
"
<u>Splittin</u>
5/6 Defense Mechanisms
When does invasive pulmonary asperillosis occur?
"Almost exclusively in <
u>immuno-compromised individuals</u><div>-profound ranulocytopenia predisposed
to acute, rapidly proressive asperillus pneumonia</div><div><br /></div><div><
im src=""paste-85409719648531.jp"" /></div><div><im src=""paste-8245048718192
5.jp"" /></div>"
Dickey ID2
"<div>Neurotic Level or ""Moderately Mature"" Defense Mechanisms (10)</div><div>
<br /></div><br />"
Displacement<div>Identification</div><div>Intellectualiz
ation</div><div>Introjection</div><div>Isolation of affect</div><div>Passive a
ression</div><div>Rationalization</div><div>Reaction formation</div><div>Repress
ion</div>Undoin
5/6 Defense Mechanisms
<u>Transferrin</u>&nbsp;a feelin about, or response to, an object onto another
(usually less threatenin)&nbsp;<u>substitute object</u>.&nbsp;<div><br /></div
><i>Mad at boss, kick the do</i>
<u>Displacement</u>
5/6 Defense Mech
anisms
"Why does this occur<div><im src=""wede.jpe"" /></div>"
"Wede shaped in
farct<div><b>Invasive pulmonary asperillosis</b> has <u>predisposition to invad
e blood </u>vessels producin <font color=""#ff0000"">infarction</font> with nec
rosis.&nbsp;</div><div><br /></div><div><im src=""paste-82450487181925.jp"" />
</div><div><br /></div><div><im src=""paste-89511413416411.jp"" /></div>"
Dickey ID2
In the absence of &nbsp;_______ recovery, Invasive Pulmonary Asperillosis pror
esses relentlessly and disseminates throuhout the body (skin, brain, other visc
era). "Neutrophil<div><im src=""diss (1).jpe"" /></div><div><br /></div><div
><im src=""paste-89515708383707.jp"" /></div>"
Dickey ID2
The individual deals with conflict or stress accompanyin separation from or los
s of an object (real or threatened) by identifyin with the loved object.&nbsp;<
div><br /></div>Children will often dress up like their parents and pretend to 
o to work each day.&nbsp;
Identification 5/6 Defense Mechanisms
The excessive use of&nbsp;<u>abstract thinkin</u>&nbsp;or the makin of&nbsp;<u
>eneralizations</u>&nbsp;to control or minimize disturbin feelins.&nbsp;
Intellectualization
5/6 Defense Mechanisms
"<im src=""82cb06aa8d536af58759e297c02cfc6f1bc8229b_Q_0.sv"" />"
"<im sr
c=""82cb06aa8d536af58759e297c02cfc6f1bc8229b_A_0.sv"" />"
"<im src=""82cb
06aa8d536af58759e297c02cfc6f1bc8229b_source_sv.sv"" />"
"<im src=""82cb
06aa8d536af58759e297c02cfc6f1bc8229b_chronic.jpe"" />"
Dickey N
euro2
Internalizain qualities of an object or person, often obliteratin the distinct
ion between the individual and the object.<div><br /></div>This is the essence o
f the&nbsp;<b>Stockholm syndrome</b>--where prisoners bein to identify with the
ir captors and may become loyal to them. This is also seen with children/parents
, children/doctors, and dieties.&nbsp; Introjection
5/6 Defense Mechanisms
"<im src=""d86cf63115004ee3d9d881d1c736013e393dfee4_Q_0.sv"" />"
"<im sr
c=""d86cf63115004ee3d9d881d1c736013e393dfee4_A_0.sv"" />"
"<im src=""d86c
f63115004ee3d9d881d1c736013e393dfee4_source_sv.sv"" />"
"<im src=""d86c
f63115004ee3d9d881d1c736013e393dfee4_nose.jpe"" />"
Dickey N
euro2
Separatin ideas from the feelins oriinally associated with them. The invididu
al&nbsp;<u>loses touch with the feelins</u>&nbsp;associated with a iven idea w
hile reaminin&nbsp;<u>aware of the conitive</u>&nbsp;elements of it.&nbsp;
Isolation of affect
5/6 Defense Mechanisms
How to confirm dianosis of asperillus? Treatment?
"1. GMS Stain<div>2. Dem
onstration of asperillus invadin into tissue (biopsy) 3. culture&nbsp;</div><d
iv>4. Galactomannan&nbsp;<br /><div>Surical excision</div><div><im src=""asp d

i.jpe"" /></div></div>"
Dickey ID2
Indirectly and unassertively expressin aression toward others. There is a&nbs
p;<u>faade of overt compliance</u>&nbsp;maskin<u>&nbsp;covert resistance</u>, re
sentment, or hostility. It can be a means of dealin with bein in a subordinate
position.&nbsp;
Passive aression
5/6 Defense Mechanisms
Recently, serum ELISA determinations of <b>alactomannan</b> (BioRad Platelia en
zyme immunoassay) or <b> (13) - D-glucan</> have shown improved &nsp;sensitivity
&amp; specificity for diagnosis of invasive disease of what? "spergillus<r
/><div><img src=""recent.jpeg"" /></div>"
Dickey ID2
Name 5 memers of the mucormycetes
"<div><> Rhizopus</></div><div><> Muco<
/>r</div><div> Rhizomucor</div><div> Lichtheimia (formerly sidia)</div><div> po
physomyces</div><div><r /></div><div>ll are uiquitous, common of decaying mat
ter</div><div><img src=""paste-95940979458522.jpg"" /></div><div><r /></div><di
v><img src=""paste-82858509075042.jpg"" /></div>"
Dickey ID2
<u>Concealing</u>&nsp;the true motivations for thoughts, actions, or feelings t
hrough the elaoration of reassuring or&nsp;<u>self-serving</u>, ut&nsp;<u>in
correct</u>, explanations<div><r /></div>I dont want that sandwich. &nsp;It has
mayonnaise and cheese on it. &nsp;That would make me gain weight. &nsp;It also
lacks lettuce or tomatoes and that would deprive me of vegetales so crucial to
a healthy diet. &nsp;&nsp; <u>&nsp;Rationalization</u>
5/6 Defense Mech
anisms
<>Sustituting</>&nsp;ehavior, thoughts, or feelings&nsp;<>diametrically o
pposed</>&nsp;to his or her own unacceptale thoughts or feelings.&nsp;<div><
r /></div>You would look at your neighor with a sudden dislike ecause they ha
ve food and you are hungry. &nsp;But, you would turn to your neighor, smile, a
nd congratulate them for their outstanding performance last lock&nsp; <>React
ion Formation</>
5/6 Defense Mechanisms
Expelling disturing wishes, thoughts, or experiences from&nsp;<u>conscious awa
reness.&nsp;</u>
Repression<r /><div><r /></div><div>This is a&nsp;<i>
<>step-up from denial</></i>. Repression occurs in extreme traumatic events, m
ost often ause. Memories with emotions far eyond the aility of the individual
to address them are repressed. They are not consciously memered. If you ask a
out the memories, they will initially e denied. &nsp;However, on close oserva
tion of the individuals interaction with others, sutle clues to repression can 
e oserved.&nsp;</div> 5/6 Defense Mechanisms
Pathogenesis/entry of mucormycosis
"Through respiratory tract<div><r /></d
iv><div><img src=""paste-86075439579610.jpg"" /><r /><div><r /></div><div><img
src=""paste-82854214107746.jpg"" /></div></div>"
Dickey ID2
The individual deals with emotional conflict or internal/external stressors y w
ords or ehavior designed to negate or&nsp;<>make amends symolically</>&nsp
;for unacceptale thoughts, feelings, or actions. &nsp;
"Undoing<r /><d
iv><r /></div><div>This is often used when someone discusses a negative aspect
of his/her spouse, and then ""undoes"" it y touting positive qualities of the s
pouse to others</div>" 5/6 Defense Mechanisms
Name 3 well-defined patient populations at risk for the low virulence mucormycet
es
"<div>1) Poorly controlled <u>diaetics with ketoacidosis</u></div><div>
2) Renal failure patients who are receiving&nsp;<u>desferrioxamine chelation</u
> therapy</div><div>3) Leukemic patients or one marrow transplant recipients wi
th <u>prolonged granulocytopenia</u>.</div><div><r /></div><div><img src=""past
e-86071144612314.jpg"" /></div>"
Dickey ID2
Mature defense mechanisms (5) ltruism<div>nticipation</div><div>Humor</div><
div>Sulimation</div><div>Suppression</div><div><r /></div><div>HSS</div><div
>SSH</div>
5/6 Defense Mechanisms
"<img src=""d m.jpeg"" /><div><r /></div><div><r /></div>" "Rhinocereral m
ucormycosis<div><r /></div><div><img src=""paste-90348932039130.jpg"" /></div>"
ID2
Dealing with conflict/stress y dedication to meeting the needs of others.&nsp;
5/6 Defense Mechanisms
ltruism
Experiencing emotional reactions in advance of, or anticipating consequences of
possile future events and considering realistic, alternative responses.&nsp;

nticipation
5/6 Defense Mechanisms
What is the only reliale diagnosis of mucormycosis?
"<u>Tissue iopsy</u> an
d microscopic examination with culture<div><div><div><img src=""diagnosis (1).jp
eg"" /></div></div></div><div><r /></div><div><img src=""paste-83219286327565.j
pg"" /></div>" Dickey ID2
"<img src=""50ea1f28e491f07ac400988d2c5fecf11f95387_Q_0.svg"" />"
"<img sr
c=""50ea1f28e491f07ac400988d2c5fecf11f95387__0.svg"" />"
"<img src=""50ea
1f28e491f07ac400988d2c5fecf11f95387_source_svg.svg"" /><div><img src=""paste-83
223581294861.jpg"" /></div>"
"<img src=""50ea1f28e491f07ac400988d2c5fecf11f9
5387_drug.jpeg"" />"
Dickey ID2
Emphasizing the amusing or ironic aspects of the conflict or stressor. Humor is
frequently used to deal with uncomfortale situations. lthough the humor is not
always in the est of taste, it can diffuse the anxiety of the situation. Humor
is often used to deal with difficult patient care situations&nsp;
Humor
5/6 Defense Mechanisms
"<img src=""14931ca4e799307d9610e8caad088e11781ac45_Q_0.svg"" />"
"<img sr
c=""14931ca4e799307d9610e8caad088e11781ac45__0.svg"" />"
"<img src=""1493
1ca4e799307d9610e8caad088e11781ac45_source_svg.svg"" />"
"<img src=""1493
1ca4e799307d9610e8caad088e11781ac45_pulm.jpeg"" />"
Dickey I
D2
"<img src=""f005a33dd46355e49a4161cac853d786e3a1_Q_0.svg"" />"
"<img sr
c=""f005a33dd46355e49a4161cac853d786e3a1__0.svg"" /><div>Fungus</div>"
"<img src=""f005a33dd46355e49a4161cac853d786e3a1_source_svg.svg"" />"
"<img src=""f005a33dd46355e49a4161cac853d786e3a1_renal.jpeg"" />"
Dickey ID2
"<img src=""5f74a0c4387287e917cec092380e6a7a5518a6_Q_0.svg"" />"
"<img sr
c=""5f74a0c4387287e917cec092380e6a7a5518a6__0.svg"" />"
"<img src=""5f74
a0c4387287e917cec092380e6a7a5518a6_source_svg.svg"" />"
"<img src=""5f74
a0c4387287e917cec092380e6a7a5518a6_cutaneous.jpeg"" />"
Dickey ID2
<u>Channeling</u>&nsp;potentially maladaptive feelings or impulses into sociall
y acceptale ehaviors.&nsp; <u>Sulimation</u>
5/6 Defense Mechanisms
<>INTENTIONLLY</>&nsp;avoiding thoughts related to the stress. The idea of i
ntent is of greatest importance.<i>&nsp;Every other defense mechanism just happ
ens</i>. This is the&nsp;<u>only</u>&nsp;defense mechanism a person has contro
l over. <>Supression</>
5/6 Defense Mechanisms
What is the appearance of mucormycosis microscopically "<div>Irregular, non-sep
tate, road hyphae ranching at <>right angles</></div><div><><r /></></div
><div><><img src=""paste-86406152061255.jpg"" /></></div><img src=""diagnosis
(1).jpeg"" />" Dickey ID2
Therapy for mucormycetes? (3) "<>-ggressive, repeated <u>surgical excision</
u></><div><>-IV <u>amphotericin</u> B</></div><div>-recently approved <u>posa
conazole</u></div><div><u><r /></u></div><div><u><img src=""paste-8652641114559
5.jpg"" /></u></div>" Dickey ID2
"IDS patient from Thailand with fever, anemia, weight loss, skin lesions<div><i
mg src=""thai.jpeg"" /></div>" Penicillium marneffei Dickey ID2
Freuds three levels of the mind
Conscious<div>Unconscious</div><div>Prec
onscious</div>
The conscious mind
The conscious was always availale to the individual; on
e could readily access the conscious mind.
5/6 Defense Mechanism
The unconscious mind. The unconscious mind could not e accessed y individual
s ut manifested itself in ehaviors. 5/6 Defense Mechanism
The preconscious mind. <div>The preconscious was a ridge etween the conscious
and unconscious.</div><div>The ridge was made of dreams and fantasies.</div><d
iv><r /></div> 5/6 Defense Mechanism
"<img src=""a02feff78c5c0f160a0f5f736c3917df723e_Q_0.svg"" />"
"<img sr
c=""a02feff78c5c0f160a0f5f736c3917df723e__0.svg"" />"
"<img src=""a02f
eff78c5c0f160a0f5f736c3917df723e_source_svg.svg"" />"
"<img src=""a02f
eff78c5c0f160a0f5f736c3917df723e_red.jpeg"" />"
Dickey I
D2

&nsp; 67-year-old man has prostate cancer. In order to take advantage of hormo
nal manipulation, he had an orchiectomy. To suppress the adrenals, he was placed
on high dose what?
"<div>Ketoconazole</div><div><img src=""keto.jpeg"" /></
div>"
"<img src=""15 (1).jpeg"" />" 1<div>Dermatophyte= KOH staining</div> Dickey
Herpes 3 modes of transmission to neonates
<>1) Intrapartum</> (86%)<div>
2) Postnatal (10%)</div><div>3) Intrauterine/congenital &nsp;(4-5%)</div>
Dickey
"Scarring - What congenital infection is this?<div><img src=""scar.jpeg"" /></di
v>"
Herpes Dickey
Clinical spectrum of intrauterine herpes (3) in infants "<div>1) Cutaneous</div>
<div>2) CNS</div><div>3) Ophthalmologic</div><div><r /></div><img src=""3 (3).j
peg"" />"
Dickey
Transmission of congenital varicella
Transplacental Dickey
"ssociated with&nsp;<div>- hypoplastic lims<div>- scars</div><div>- spontaneo
us aortion</div><div>- cataracts<r /><div><img src=""lims.jpeg"" /></div></di
v></div>"
Congenital varicella
Dickey
"Symptoms include snuffles, stillirth, prematurity, hydrops fetalis<div><img sr
c=""snuffles.jpeg"" /></div>" Congenital syphilis&nsp;
Dickey
What is the hutchinson triad? (of syphillis)&nsp;
"1) Interstitial keratit
is<div>2) Sensorineual deafness</div><div>3) Hutchinson teeth<div><div><img src=
""interst.jpeg"" /></div><div><img src=""deaf.jpeg"" /></div><div><div><img src=
""hutch teeth.jpeg"" /></div></div><div>eyes, ears, teeth</div></div></div>"
Dickey
What % of infants are asymptomatic at irth for toxoplasmosis 70-90% Dickey
"<img src=""3eccf18350a257001837df1d6f3ecd16ce905c8_Q_0.svg"" />"
"<img sr
c=""3eccf18350a257001837df1d6f3ecd16ce905c8__0.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_source_svg.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_matchiing.jpeg"" />"
Dickey
"<img src=""3eccf18350a257001837df1d6f3ecd16ce905c8_Q_1.svg"" />"
"<img sr
c=""3eccf18350a257001837df1d6f3ecd16ce905c8__1.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_source_svg.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_matchiing.jpeg"" />"
Dickey
"<img src=""3eccf18350a257001837df1d6f3ecd16ce905c8_Q_2.svg"" />"
"<img sr
c=""3eccf18350a257001837df1d6f3ecd16ce905c8__2.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_source_svg.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_matchiing.jpeg"" />"
Dickey
"<img src=""3eccf18350a257001837df1d6f3ecd16ce905c8_Q_3.svg"" />"
"<img sr
c=""3eccf18350a257001837df1d6f3ecd16ce905c8__3.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_source_svg.svg"" />"
"<img src=""3ec
cf18350a257001837df1d6f3ecd16ce905c8_matchiing.jpeg"" />"
Dickey
"<img src=""3eccf18350a257001837df1d6f3ecd16ce905c8_Q_4.svg"" />"
"<img sr
c=""3eccf18350a257001837df1d6f3ecd16ce905c8__4.svg"" /><div>Classic triad: Cal
cifications, chorioretinitis, hydrocephalus</div>"
"<img src=""3eccf18350a
257001837df1d6f3ecd16ce905c8_source_svg.svg"" />"
"<img src=""3eccf18350a
257001837df1d6f3ecd16ce905c8_matchiing.jpeg"" />"
Dickey
Name the TORCH infections
<div>- Toxoplasmosis</div><div>- Other: syphilis
</div><div>- Ruella</div><div>- CMV</div><div>- Herpes</div><div>-HIV</div><div
>-VZV/Parvo</div><div><r /></div><div>Congenital Infections</div>
Dickey
What divides the hypothalamus into medial and lateral portions? "Fornix<div><img
src=""pic hypo.jpeg"" /></div>"
"What runs through the lateral hypothalamus?<div><img src=""medial.jpeg"" /></di
v>"
"xonal highway called the Medial Forerain Bundle<div><div><div><img sr
c=""photo 2-1 (1).JPG"" /></div></div></div>"
Mammillary nuclei involved in? "Memory<div><img src=""netter hypo (1).jpeg"" />
</div>"

Function of suprachiasmatic nuclei?

"Master circadian clock<div><img src=""p
hoto 1-1.JPG"" /></div>"
What is the internal capsule of the hypothalamus?
"Medial forerain undle
<div><img src=""photo 2-1 (1).JPG"" /></div>"
What are the three highways of the hypothalamus?
"Medial forerain undle
<div>Fornix</div><div>Stria terminalis</div><div><img src=""pic hypo.jpeg"" /></
div>"
What connects the midrain and the nucleus accumens in the frontal loe?
"Medial forerain undle<div><img src=""accc.jpeg"" /></div>"
What connects the hypothalamus/rain stem and the hippocampal region of the temp
oral loe?
"Fornix<div><img src=""pic hypo.jpeg"" /></div>"
What connects the hypothalamus-rain stem and the region of the amygdala in the
temporal loe? "Stria terminalis<div><img src=""pic hypo.jpeg"" /><r /><div><i
mg src=""photo 5 (1).JPG"" /></div></div>"
What does the median forrain undle connect? "Hypothalamic/rain stem with th
e orital frontal loe and cingulate gyrus<div><img src=""pic hypo.jpeg"" /></di
v>"
Where does the fornix carry pathways? "Between hypothalamus and hippocampus<di
v><img src=""pic hypo.jpeg"" /></div>"
What connects the medial frontal (N), cingulate, and medial temporal areas (amy
gala)? "Cingulum fasiciulus<div><img src=""cingulum.jpeg"" /></div>"
What connects the medial temporal and medial prefrontal areas? "Uncinate fascic
ulus<div><img src=""uncinate.jpeg"" /></div>"
What connects the left and right anterior temporal loe (amygdala and uncal cort
ex)?
nterior commissure
What connects the hippocampi? Fornix commisure
What interconnects the hippocampus with the hypothalamus and rain stem?
"Fornix<div><img src=""pic hypo.jpeg"" /></div>"
What is the highway for the amygdala and uncus to the hypothalamus and rain ste
m?
"Stria terminalis<div><img src=""pic hypo.jpeg"" /></div>"
What connects the medial prefrontal area and the nucleus accumens with the hypo
thalamus?
Medial forerain undle
What travels from the Ventral Tegmental area to nucleus accumens and amygdala?
"Mesolimic Dopamine pathway<div><img src=""mesol.jpeg"" /></div>"
What travels from the VT (Ventral Tegmental rea) to the medial prefrontal cort
ex?
"Mesocortical dopamine pathway<div><img src=""mesoc.jpeg"" /></div>"
What can directly input into the amygdala?
Olfactory ul
Only sensory system to project directly into the cereral cortex without a synpa
tic station in the thalamus?
Olfactory
ura of horrile smells signals?
"Medial temporal loe epileptic seizure<
div><img src=""medial temp.jpeg"" /></div>"
What is responsile for the autonomic phenomena during fear?
"mygdala to hyp
othalamus via stria terminalis<div><img src=""pic hypo.jpeg"" /></div>"
Do fearful facial expressions depend on CBT?
No
Which areas are involved in conscience? "Ventromedial and orital prefrontal are
a<div><r /></div><div><img src=""paste-168908178851142.jpg"" /><r /><div><img
src=""photo 2 (1).JPG"" /></div></div>"
Doule onds result in light sensitivity
"<img src=""ampho.jpeg"" />"
ID2
mphotericin is insolule at neutral pH. When mixed at acid pH with Na deoxychol
ate, what happens? What aout adding electrolytes? Therefore what is done?
mphotericin B mixed with acid- small micelles formed<div>ddition of electrolyt
es- causes colloid to aggregate</div><div>Mixed with <>D5W (5% dextrose in wate
r)</></div>
ID2
mphotericin inds to plasma proteins and LDL. lso inds to tissues (liver, spl
een, kidneys, lung). What is the resultant half life?&nsp;
Reservoirs leach
ack into lood--&gt; Half life is <>15 days</>. <>Serum and urine levels fo
r 6 weeks</> ID2
Because amphotericin B can cause thromophleitis, how must it e delivered?
Central vein
ID2

Fluconazole is associated with what side effects&nsp; "Stevens Johnson syndrom

e, alopecia, nausea &amp; vomiting<div><img src=""SJ.jpeg"" /><img src=""alopeci
a.jpeg"" /></div>"
ID2
What electrolytes are low when taking amphotericin B? K+, Mg++ &amp; icarona
te
ID2
"This 56-year-old man underwent lung transplant 12 months ago, complicated y in
vasive aspergillosis for which he is on chronic suppressive therapy. He has diff
use one pain. What is the prolem?<div><img src=""56.jpeg"" /></div>" "Periost
itis from fluoride intoxication due to voriconazole<div><img src=""vori shape.jp
eg"" /></div>" ID2
What is anidulafungin used for? pproved FD 2006 for&nsp;<div><u>Candidemia</u
>, deep candida infections and candida esophagitis.&nsp;</div> ID2
What are 3 side effects of&nsp;itraconazole adrenal excess syndrome?
drenal
excess syndrome:<div><>Hypertension, edema, hypokalemia</></div>
ID2
Name 3 CMV symptoms in addition to microcephaly, lueerry muffin rash, &amp; he
aring loss
1) jaundice<div>2) hepatosplenomegaly</div><div>3) CNS calcifica
tions</div>
Dickey
Infants with CMV can lose hearing late-onset?<div>What proportion?</div>
Yes, 1/3-1/2 of hearing loss is late-onset
Dickey
Toxoplasmosis classic triad
"1) CNS calcifications<div>2) hydrocephalus</div
><div>3) chorioretinitis<div><r /><div><img src=""toxo.jpeg"" /><img src=""scar
s.jpeg"" /></div></div></div>" Dickey
While you write, the pt pretends to write
"<span class=""pple-ta-span"" s
tyle=""white-space:pre""> </span>Echopraxia pathological imitation of movements
of one person y another<div><r /></div><div><i>praxis=action</i></div>"
Pt maintains unnatural posture for a long time; ex: arm up in the air or fist cl
enched "<span class=""pple-ta-span"" style=""white-space:pre""> </span>Catalep
sy general term for an immoile position that is constantly maintained<div><r /
></div><div>(lepsis = seizure)</div>"
markedly <>slowed motor activity</>, often to a <>point of immoility and see
ming unawareness of surroundings</>
"<span class=""pple-ta-span"" style=""w
hite-space:pre""> </span>Catatonic stupor&nsp;"
Rather than eing a fixed pose, pt may e in a position ut can move their arm,
for ex; they will then ecome fixed in the position that you moved them to
"<span class=""pple-ta-span"" style=""white-space:pre""> </span>Waxy flexiilit
y condition of a person who can e molded into a position that is then maintaine
d; when the examiner moves the persons lim, the lim feels that it is made of wa
x"
lack of physical movement, as in the extreme immoility of catatonic schizophren
ia
akinesia
<div>If laugh or get surprised, will lose all ody tone</div><div>nimal model w
/ type of dog: dog comes in, show dog treat, and dog collapses /c its so excited
&nsp;</div><div><r /></div> "<span class=""pple-ta-span"" style=""white-spa
ce:pre""> </span>Cataplexy temporary loss of muscle tone and weakness precipitat
ed y a variety of emotional states<div><r /></div><div><i>cata=down;&nsp;plex
is=low or stroke</i></div>"
"Pt sits in community meetings and does sign-language-like movements; in her min
d, she is translating what is happening into ""sign language""&nsp;" "<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Stereotypy repetitive f
ixed pattern of physical action or speech<div><r /></div><div><i>stereo</i>=sol
id; <i>typos</i>=type</div>"
pt is very excited and arms are moving all over the place while he/she speaks
"<span class=""pple-ta-span"" style=""white-space:pre""> </span>Psychomotor agi
tation excessive motor and cognitive over activity, usually nonproductive and in
response to internal tension"
pt has a profoundly dropped head, not really moving when speaking
"<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Psychomotor retardation
decreased motor and cognitive activity, visile slowing of thought, speech, and
movement"
<div>Pts will often have an unsuppressale feeling that they need to walk; inter

nal state of feeling agitated, cant sit still</div><div>if have them sit down, th
eyll start shuffling their feet</div><div><r /></div> "<span class=""pple-taspan"" style=""white-space:pre""> </span>kathisia sujective feeling of muscula
r tension secondary to antipsychotic or other medication, which can cause restle
ssness, pacing, repeated sitting and standing; can e mistaken for agitation<div
><r /></div><div><i>kathisis- sitting</i></div>"
failure of muscle coordination; irregularity of muscle action "<span class=""p
ple-ta-span"" style=""white-space:pre""> </span>taxia"
difficulty in performing voluntary movements, as in extrapyramidal disorders
dyskinesia
slowness of motor activity with a decrease in normal spontaneous movement
radykinesia
random and involuntary quick, jerky, purposeless movements
chorea
slow, sustained contractions of the trunk or lims
dystonia
pt can truly e laughing one second and in tears the next second; or&nsp;fluctu
ate etween elevated, euphoric, happy mood, and then can ecome profoundly irrit
ale w/in a short amount of time
"<span class=""pple-ta-span"" style=""w
hite-space:pre""> </span>Laile mood (mood swings) oscillations etween euphoria
, depression, or anxiety"
<div>pathological feeling of sadness</div><div>the most severe sad mood</div><di
v><r /></div> depression
Lost aility to experience pleasure
"<span class=""pple-ta-span"" style=""w
hite-space:pre""> </span>nhedonia loss of interest and withdrawal from all regu
lar and pleasurale activities, often associated with depression"
"<div>o<span class=""pple-ta-span"" style=""white-space:pre""> </span>Individu
al who does not have the aility to e aware of their emotions/mood and thus cant
descrie it</div><div>o<span class=""pple-ta-span"" style=""white-space:pre""
> </span>Dr. Spock type individual</div><div><r /></div>"
"<span class=""p
ple-ta-span"" style=""white-space:pre""> </span>lexithymia a persons difficulty
in descriing or eing aware of emotions or mood<div><r /></div><div><i>&nsp;
lexis- word; thymia- feelings, passion</i></div>"
condition in which the emotional tone is in harmony with the accompanying idea,
thought, or speech; also further descried as road or full affect in which a fu
ll range of emotions is appropriately expressed appropriate affect
disharmony etween the emotional feeling tone and the idea, thought, or speech a
ccompanying it inappropriate affect
"<div>disturance in affect manifested y a severe reduction in the intensity or
externalized feeling tone</div><div>o<span class=""pple-ta-span"" style=""whi
te-space:pre""> </span>Severely depressed, very little range in affect</div><div
><r /></div>" lunted affect
"<div>reduction in the intensity of externalized feeling tone&nsp;</div><div>o<
span class=""pple-ta-span"" style=""white-space:pre""> </span>Mildly to modera
tely depressed</div><div>o<span class=""pple-ta-span"" style=""white-space:pre
""> </span>Not as much animation&nsp;</div><div><r /></div>" restricted/const
ricted affect
pt has no aility to convey emotions regardless of what he/she is talking aout&
nsp; "<span class=""pple-ta-span"" style=""white-space:pre""> </span>Flat af
fect asence or near asence of any signs of affective expression; voice monoton
ous, face immoile"
"<div>rapid speech that is <>increased in amount and difficult to interrupt</>
</div><div>o<span class=""pple-ta-span"" style=""white-space:pre""> </span>Ver
y pathologic finding</div><div>o<span class=""pple-ta-span"" style=""white-spa
ce:pre""> </span>Seen in manias</div><div><r /></div>" pressured speech
false sensory perception not associated with real external stimuli; there may or
may not e a delusional interpretation of the experience
hallucination
really depressed pt hearing voice that tells him/her he/she is ad, evil, doomed
, have done something wrong
"<span class=""pple-ta-span"" style=""white-spa
ce:pre""> </span>Mood congruent hallucination hallucination in which the content
is consistent with either a manic or depressed mood; e.g. the manic patient wou
ld hear voices saying the patient is of inflated worth, power, and knowledge"

manic pt w/ persecutory hallucination, telling him/her he/she is ad

"<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Mood incongruent halluc
ination hallucination in which the content is not consistent with either a depre
ssed or manic mood"
False perception of orders that a person may feel oliged to oey or unale to r
esist (often dangerous) "<span class=""pple-ta-span"" style=""white-space:pre""
> </span>Command hallucination<div>Pt hears voice that tells him/her to hurt sel
f or others</div>"
Its sort of dark and pt sees a chair ut thinks its a dog
"<div>Illusion mispercep
tion or misinterpretation of real external sensory stimuli</div><div>i.<span cla
ss=""pple-ta-span"" style=""white-space:pre""> </span>Some sort of sensory sti
mulus is there instead of just coming out of the lue</div><div><r /></div>"
"Pt has experienced much trauma; mind ""shuts down"" and pt feels as if he/she i
s outside his/her ody watching the trauma happen; can lead to multiple personal
ities" "<span class=""pple-ta-span"" style=""white-space:pre""> </span>Dissoci
ation defense mechanism involving the segregation of any group of mental or eha
vioral processes from the rest of the persons psychic activity"
indirect speech that is delayed in reaching the point ut eventually gets from t
he original point to the desired goal; characterized y an over inclusion of det
ails and parenthetical remarks circumstantiality&nsp;
"<div>o<span class=""pple-ta-span"" style=""white-space:pre""> </span>Start to
give answer, ut then trail off on another idea&nsp;</div><div>o<span class=""
pple-ta-span"" style=""white-space:pre""> </span>When ask them what you first
asked them, they dont recall</div><div><r /></div><div>inaility to have goal di
rected associations of thought; speaker never gets from desired point to desired
goal</div>"
"<span class=""pple-ta-span"" style=""white-space:pre""> </span
>Tangentiality"
Pt doesnt have cognitive aility to rememer enough detail so get stuck on some
thing and keep talking aout it "<span class=""pple-ta-span"" style=""white-spa
ce:pre""> </span>Perseveration persisting response to a previous stimulus after
a new stimulus has een presented; often associated with cognitive disorders"
"o<span class=""pple-ta-span"" style=""white-space:pre""> </span>sk pt a ques
tion: get a statement that doesnt really pertain, then the next one isnt really co
nnected to the first statement, and on and on" "<span class=""pple-ta-span"" s
tyle=""white-space:pre""> </span>Loosening of associations flow of thought in wh
ich ideas shift from one suject to another in a completely unrelated way; when
severe, speech may e incoherent"
Pts speech is very fast; were you ale to slow him/her down enough, you would f
ind logical connections "<span class=""pple-ta-span"" style=""white-space:pre""
> </span>Flight of ideas rapid, continuous veralizations or plays on words prod
uce constant shifting from one idea to another; ideas tend to e connected ut t
oo fast for the listener to comprehend"
fixed false elief, ased on incorrect inference aout external reality, not con
sistent with the patients intelligence and cultural ackground, cannot e correct
ed y reasoning.
delusion
pathological persistence of an irresistile thought or feeling that cannot e el
iminated from consciousness y logical effort, associated with anxiety osessio
n
pathological need to act on an impulse that, if resisted, produces anxiety; repe
titive ehavior in response to an osession or performed according to certain ru
le
compulsion
partial or total inaility to recall past experiences; may e medical or emotion
al in origin
amnesia
amnesia for events occurring after a point in time
anterograde
amnesia for events occurring efore a point in time
retrograde
literal thinking; limited use of metaphor without understanding of nuances of me
aning, one dimensional thought concrete thinking
What level of intellectual disaility?&nsp;<div>IQ of 50 to 55 up to 70</div><d
iv>18yo functions like a 9yo, for ex</div>
mild
What level of intellectual disaility?&nsp;<div>IQ 35-40 up to 50-55</div>

moderate
What level of intellectual disaility?&nsp;<div>IQ 20-25 to 35-40</div><div>19y
o w/ mental aility of a 6yo</div>
severe
What level of intellectual disaility?&nsp;<div>IQ elow 20-25</div> severe
What is the est indirect test for diagnosis of pneumocystis pneumonia?&nsp;
"<>Oximetry</> (exercise). Patients desaturate very rapidly. High sensitivity/
specificity<div><img src=""oximetry.jpeg"" /></div><div><img src=""oximetry pic.
jpeg"" /></div>"
ID2
What high sensitivity serology test can e done for pneumocystis?
"Beta 13 glucan serum test<div><img src=""assay.jpeg"" /></div>"
ID2
What is the est overall way to diagnose PCP? "Direct visualization--&gt; indu
ced sputum with hypertonic saline or ronchoalveolar lavage (<>BL</>)<div><im
g src=""BL (1).jpeg"" /></div>"
ID2
What particular stain is the est for seeing P. jirovecii?
"<div>Immunofluo
rescent antiody stain</div><img src=""fluo.jpeg"" />" ID2
Caused y road spectrum antiiotics, corticosteroids and chemotherapy, surgical
procedures, prosthetic devices Candida<div><r /></div><div><>Broad spectrum a
ntiiotics</> (eliminate normal flora)</div><div><>Corticosteroids and chemoth
erapy</> (interfere with PMN, macrophage, lymphocyte #)&nsp;</div><div><>Surg
ical procedures</> (disrupt arriers) <>Prosthetic devices</></div> ID2
"Patient complains of urning in mouth, food tastes funny<div><img src=""acute (
2).jpeg"" /></div>"
<>cute atrophic candidiasis</> (erythematous)<div><r
/></div><div>NOTE: no plaques, ut do not miss</div> ID2
"Cutaneous mucocutaneous candidiases is caused y what? (not the fungus)<div><im
g src=""chronic (3).jpeg"" /></div>"
Lack of T cell immunity<div><r /></div>
<div>Present in infancy</div> ID2
How is cutaneous candida demarcated from dermatophyte (jock itch)?
"Candida
has <u>satellite lesions</u><div>Dermatophytes have a sharp order&nsp;</div><
div><img src=""satelline.jpeg"" /></div>"
ID2
In addition to PCP, what else are HIV patients susceptile to with low CD4 count
s?
"Candida<div><img src=""low.jpeg"" /></div><div>3</div>"
ID2
Most candida is susceptile to amphotericin B, and fluconazole is therapeuticall
y equivalent. But, what aout for C. krusei and C. glarata? What to use?
C. krusei is <u>resistant</u> to azoles &amp; C. glarata is <u>relatively resis
tant</u>. &nsp;(<>must use amphotercin B)</><div><r /></div><div>The <>echi
nocandins</> have very good activity</div>
ID2
If Candida is suspected, what additional interventions are recommended? "Check e
yes (if in eye, therapy must e longer)<div>Take out catheter</div><div><img src
=""eye (2).jpeg"" /></div><div><img src=""cath (1).jpeg"" /></div>"
ID2
Give the range of reduced affect in descending order&nsp;
CONSTRICTED &gt;
BLUNTED &gt; FLT
BS
Depression can e thought of as a final common pathway of psychological, iologi
cal, sociocultural factors. Name the 5 psychological factors&nsp;
Psychody
namic&nsp;<div>Cognitive&nsp;</div><div>Interpersonal stressors</div><div>Lear
ned Helplessness</div><div>Trauma</div>
Depression in adults can e predicted y what in childhood?
"Childhood traum
a<div><img src=""trauma.jpeg"" /><r /><div><r /></div></div>"
Descrie the diathesis-stress model in developmental psychopathology
"Diathes
is--&gt;individual has <>vulneraility</> or due to heredity, developmental mi
llieu, adverse event.&nsp;<div><>dult stressful life</> <>event</> leads t
o illness.&nsp;<div><img src=""diathesis.jpeg"" /></div></div>"
How many suicides per year? Homocides? 30,000<div>20,000</div><div><r /></div>
<div><>depression is the major risk factor for suicide</></div>
Much greater mortaility for depressed than nondepressed patients after what?
"Myocardial infarction<div><img src=""MI risk.jpeg"" /></div>"
In the treatment of depressed HIV patients, which is etter, Imipramine (TC), P
aroxetine (SSRI)?&nsp; "Imipramine<div><img src=""paroxetine.jpeg"" /></div>"
Depression is sadness plus (5) <div> generalized self hatred and criticism&nsp;
</div><div> self preoccupation</div><div> helplessness, hopelessness</div><div> iso
lation, clinging dependency</div><div> worthlessness</div>

What is premenstrual dysphoric disorder? Epidemiology? <div>1 week efore mense

s, improved after onset</div><div><r /></div><div>1 of:&nsp;ffective laility
,&nsp;Interpersonal Irritaility, nger,&nsp;Depressed Mood, Hopelessness, Sel
f Depreciation,&nsp;nxiety/Tension</div><div><r /></div><div><>2-6%</> of m
enstruating women</div><div><r /></div>
"<img src=""9490e157d907874585ad08677a2d6f1433f1f_Q_0.svg"" />"
"<img sr
c=""9490e157d907874585ad08677a2d6f1433f1f__0.svg"" /><div><img src=""virus.j
peg"" /></div>" "<img src=""9490e157d907874585ad08677a2d6f1433f1f_source_svg.
svg"" />"
"<img src=""9490e157d907874585ad08677a2d6f1433f1f_eola.jpeg"
" />"
Dickey
"<img src=""afd73f916181f85e2ad4d94267d35542084_Q_0.svg"" />"
"<img sr
c=""afd73f916181f85e2ad4d94267d35542084__0.svg"" /><div><img src=""virus.j
peg"" /></div>" "<img src=""afd73f916181f85e2ad4d94267d35542084_source_svg.
svg"" />"
"<img src=""afd73f916181f85e2ad4d94267d35542084_hep.jpeg""
/>"
Dickey
"<img src=""3c49df409705ace27249e51d3ec6602870c8a_Q_0.svg"" />"
"<img sr
c=""3c49df409705ace27249e51d3ec6602870c8a__0.svg"" /><div><img src=""virus.j
peg"" /></div>" "<img src=""3c49df409705ace27249e51d3ec6602870c8a_source_svg.
svg"" />"
"<img src=""3c49df409705ace27249e51d3ec6602870c8a_polio.jpeg"
" />"
Dickey
What type of immunity is required to fight cryptococcal meningitis?&nsp;
"T cell<div><img src=""t cell.jpeg"" /></div><div>1</div>"
Dickey
"When is the ""respiratory season""?" Fall through winter
5/13Paramyxoviru
s
How far do large droplets generally travel?
3-6 feet&nsp; 5/13Paramyxoviru
s
What people are more likely to get paramyxoviruses?
Early childhood and olde
r people
5/13Paramyxovirus
"What is the most common cause of hospitilization for children in the US? (give
<font color=""#ff0000"">symptom</font> and cause)"
<>Bronchiolitis</> - m
ostly caused y viruses and MCC of that is <>RSV</> 5/13Paramyxovirus
Bronchiolitis can appear very similiar to? How to tell? sthma<div><r /></div><
div>Therell e wheezing, contractions etc. ut <>steroids wont work and neith
er will ronchodilators</></div>
5/13Paramyxovirus
What is medical name for croup? Give anatomical association with stridors?
<div>Croup is <u>acute laryngotracheoronchitis</u></div><div><r /></div>Croup
is characterized y a loud cough that resemles the arking of a seal and diffic
ulty reathing. Usually mild<div><r /></div><div>Can give you oth <u>inspirato
ry</u>&nsp;(aove cords) and <u>expiratory stridor</u>&nsp;(elow cords)&nsp;
</div> 5/13Paramyxovirus
Croup is most commonly caused y which viruses? Parainfluenza type 1 and 2
5/13Paramyxovirus
Is co-infection common with kids with ronchiolitis? If so how much?
"Yes ao
ut 30% have co-infection, doesnt alter outcomes ut results in longer hospital
stays<div><img src=""coinf.jpeg"" /></div>"
5/13Paramyxovirus
What causes atelectasis in ronchiolitis?
"Shedding of airway epithelium w
ill clog up airways downstream - causing lung collapse<div><img src=""paste-7525
64169605123.jpg"" /></div>"
5/13Paramyxovirus
"What is this called?<div><img src=""paste-753156875091971.jpg"" /></div>"
"""Thum sign"" - caused y epiglotitis<div><r /></div><div>Super dangerous</di
v>"
5/13Paramyxovirus
Most causes of otitis media are acterial, ut what sets you up for a acterial
OM infection? Viral infection, ecause it clogs up the Eustachian tue
5/13Paramyxovirus
What strategy to prevent infant infection from influenza/RSV? Vaccinate the mo
ther when shes pregnant -&gt; will increase her titers for a couple of months w
hich shell transfer to the child
5/13Paramyxovirus
Greatest risk of RSV moridity vs greatest numers?
Risk: kids with comorid
ities<div>Numers: healthy kids</div> 5/13Paramyxovirus
What part of immunity is responsile for viral clearance and therefore ilness re

covery from RSV?

"Cellular immunity -&gt; kids lacking it will usually di
e<div><img src=""prog.jpeg"" /></div>" 5/13Paramyxovirus
What is given to high risk neonates to reduce hospitilizaiton from RSV? "Paliviz
uma (Synagis)<div><r /></div><div>ntiody against F protein<r /><div><img sr
c=""synagis.jpeg"" /></div></div>"
5/13Paramyxovirus
Do you need 10x the amount of antiodies in general to prevent infection in URI
or LRI? "URI - some vaccines may not elicit a good enough response to protect UR
I<div><img src=""10x.jpeg"" /></div><div><r /></div>" 5/13Paramyxovirus
T/F RSV and parainfluenza are mucosally restricted? What systems? What aout muc
osally restriced is important? True - will cause infection in <u>airway</u> or
<u>GI</u>, not systemic<div><r /></div><div><>Mucosally restricted do not prod
uce lifelong immunity</></div> 5/13Paramyxovirus
MERS (Middle east respiratory syndrome) caused y?
Coronavirus
5/13Para
myxovirus
Major transmission animal of raies in the US? Major reservoir? Bats!<div>Raccoo
ns most commonly raid.&nsp;</div>
5/13Paramyxovirus
What is the main difference etween a manic episode and hypomanic episode?
Similar in symptoms.&nsp;<div><r /></div><div>Manic: The mood disturance is<
> sufficiently severe to cause marked</> <>impairment</>, including <>psycho
tic symptoms</></div><div><r /></div> 5/13cyclingmood
Non-therapeutic use of exogenous testosterones can result in&nsp;
manic ty
pe symptoms&nsp;
5/13cyclingmood
What happens to serum RPR over time?
susides over 1-2 years, <>ecomes nega
tive</>. Small percent are serofast (remain &lt;1:4)<div><r /></div><div><r /
></div><div>primary: &lt;1:16</div><div>secondary: &gt;1:32</div><div>False +: &
lt;1:8, and MH/TPH negative</div><div>Resolved: RPR is negative</div> ID2
How to diagnose herpes? 1. rapid nucleic acid detection<div>2. Culture to differ
entiate etween type 1 and type 2</div> ID2
What history is remarkale for pelvic inflammatory disease?
Unprotected sex<
div>Lower adominal pain</div><div>Dyspareunia</div>
ID2
What is mimimal examination criteria for PID? (CDC)
Tenderness in: lower ad
omen, when cervix is moved, adnexal mass
ID2
out how long should you have had the cold efore you start suspecting <>acte
rial sinusitis?</>
"10 days, if not usually its viral<div><r /></div><div>
<img src=""paste-720218770899218.jpg"" /></div>"
5/14URIs URIDickey
Name some complications of acterial sinusitis. (4)
"Orital cellulitis<div>
Potts puffy tumor</div><div>Intracranial extension</div><div>Septic cavernous s
inus thromosis</div><div><><r /></></div><div><><img src=""orital.jpeg"" /
></></div><div><><r /></></div><div><img src=""paste-1027330407399427.jpg""
/></div><div>Potts</div>"
5/14URIs URIDickey
What is Potts puffy tumor? Cause?
"Osteomyelitis of the frontal one with
superiosteal ascess<div><r /></div><div>Due to acterial sinusitis<r /><div>
<img src=""potts (1).jpeg"" /></div></div>"
5/14URIs URIDickey
What is the etiology of herpangina and what does it represent? Location?
"Etiology: enterovirus<div>Represents viral replicaton at secondary site <>afte
r viremia</></div><div>Location: Posterior throat: soft palate, tonsils, uvula,
post pharynx</div><div><><img src=""herpangina (1).jpeg"" /></></div>"
5/14URIs URIDickey
What is the progression of sinuses as aies age?
"Maxillary and Ethmoid (
M.E.) are present at irth<div><r /></div><div>Spehnoids in first 2 years, then
frontal in 6-8</div><div><img src=""sinus (1).jpeg"" /></div><div><r /></div><
div><i>dult anatomy reached y 12 years</i></div>"
5/14URIs URIDickey
Whats the difference with nasal discharge and cough in viral vs. acterial sinu
sitis? "Lasts 3-6 days with viral, persistent with acterial<div><r /></div><d
iv><img src=""paste-720214475931922.jpg"" /></div>"
5/14URIs URIDickey
What percentage of URIs are complicated y acterial sinusitis? 5%
5/14URIs
URIDickey
"What is this? What is the etiology?<div><img src=""paste-1040533136867331.jpg""
/></div>"
Herpes gingivostomatitis<div>(Herpes simplex)</div><div><r /></
div><div><i>stoma = mouth</i></div>
5/14URIs URIDickey

What are the centor criteria for determining strep vs viral pharyngitis? (4)
"<>T</>onsillar exudates<div>Tender anterior cervical <>a</>denopathy</div><
div><>F</>ever</div><div><></>scence of cough</div><div><r /></div><div><
>TF&nsp;</></div><div><img src=""strep (1).jpeg"" /></div>"
5/14URIs
URIDickey
T/F Fever &gt;101 distinguishes viral croup from acterial tracheitis? False
5/14URIs URIDickey
What lymph nodes disappear y puerty? 2 chains in retropharyngeal space<div><
r /></div><div><r /></div><div>Retropharyngeal infections (2-4 yrs of age) thou
ght to occur as a result of suppurative adenitis of the nodes</div>
5/14URIs
URIDickey
Whats another name for peritonsillar ascess? "Quinsy (teens)<div><img src=""p
eri (1).jpeg"" /></div>"
5/14URIs URIDickey
What does the pt have: limitation of neck movement, torticollis, dysphagia, odny
nophagia, drooling, stridor.
Retropharngeal ascess (toddlers)
5/14URIs
URIDickey
What is risk of sertraline (zoloft)
Half life 24 hrs, risk of <u>discontinua
tion symptoms</u>
5/14TreatmentDepression1
<div>Synonym:</div>Pandemic Infleunza<div>Interpandemic Influenza</div> ntigeni
c shift<div>ntigenic drift</div>
What are normal oropharyngeal secretions? What is always anormal?
naeroe
s (10⁸), facultative anaeroes (10⁷)<div><r /></div><div>
<>Never</> gram (-) normally!</div>
"Good or ad sputum sample?<div><img src=""ad.jpeg"" /></div>" Bad. Epithelial
cells, cannot use
&nsp; 39-year-old alcoholic man presents to the ER at BTGH with fever &amp; pr
oductive cough. s you examine him, you note the particularly foul odor of his 
reath. The est diagnostic test in this case is Sputum gram stain<div><r /></di
v><div>(NEVER anaeroic sputum culture; contamination from mouth)</div>
Port score &gt;130. Class and mortality Class V; 29% mortality&nsp;
Compare: PNS vs. CNS with respect to myelination cell and numer of axons invest
ed&nsp;
Cental: oligodendroglia, multiple axons!<div>Peripheral: Schwann
cell, single axon!</div>
DemyelinatingDiseases
Mutiple sclerosis and post-infectious encephalomyelitis are disorders of what my
elin? Central myelin! DemyelinatingDiseases
GBS and CMT are _____ myelin disorders Peripheral
DemyelinatingDiseases
Give an example of a genetic disease of oth central and peripheral myelin?
Leukodystrophies
DemyelinatingDiseases
Imaging technique that allows radiological detection of white matter pathways
"Diffusion Tensor Imaging (DTI)<div><img src=""DTI.jpeg"" /></div>"
Demyelin
atingDiseases
What is characteristic/slogan of MS lesions? &nsp;Where can plaque occur and wh
at is the color of acute plaque?
Disseminated in space and time; plaques
may occur anywhere there is myelin; acute plaque may e pink! DemyelinatingDis
eases
"Disease? &nsp;What is the arrow pointing to?<div><img src=""paste-700509165981
48.jpg"" /></div>"
MS; arrow is pointing to demyelinating periventricular p
laque; note the grey appearance (loss of lipid) of the plaque (normally should 
e white in color)<div><r /></div><div><>periventricular, grey white junction,
supial</></div>
DemyelinatingDiseases
"Disease? &nsp;What oservations are noted?<div><img src=""paste-70171175682430
.jpg"" /></div>"
MS, loss of texture and color of the periventricular are
as<div><r /></div><div><>MS plaques occur: periventricular, grey white junctio
n, supial</></div>
DemyelinatingDiseases
"MRI analysis of plaques in MS disease can demonstrate what important characteri
stic of disease?<div><img src=""paste-70214125355298.jpg"" /></div>"
"Dissemi
nation in space and time! &nsp;It can show flares of demyelinating / plaque act
ivity. &nsp;Note: this means you should treat the disease etween ""attacks"" -&gt; can prescrie medicine constantly!!"
DemyelinatingDiseases
"Normal myelin stains lack or lue; what is seen in this image?<div><img src=""

paste-70334384439519.jpg"" /></div>"
Plaque in pons - will not stain; likely
MS
DemyelinatingDiseases
"What is seen here?<div><img src=""paste-70471823393152.jpg"" /></div>" Demyelin
ation of the spinal cord in MS; note that a Brown-sequard lesion can also result
in a partial demyelination of the spinal cord DemyelinatingDiseases
"What pathology is evidenced here? &nsp;What clinical symptoms will the lesions
likely produce?<div><img src=""paste-70514773066031.jpg"" /></div>"
MS withi
n the optic chiasm.<div><r /></div><div>Lesion in the chiasm will likely produc
e i-temporal hemianopsia; lesion in the optic nerve (ex. optic neuritis) can le
ad to total anopsia</div>
DemyelinatingDiseases
"What ""zone"" is the arrow pointing to in this image of CNV? &nsp;Descrie the
significance of this area.<div><img src=""paste-70557722739093.jpg"" /></div>"
Nerve root entry zone (<u><>Redlich-Oersteiners zone</></u>) - transition e
tween CNS and PNS myelin; note that a majority of cranial nerves are myelinated
y Schwann cells (PNS) until just efore entering the rainstem (CNS) where they
will e myelinated y the oligodendroglia
DemyelinatingDiseases
PT presents with trigeminal neuralgia, hemifacial spasm, and radicular pain. &n
sp;What should you consider in a young patient vs. older patient?
"Young:
MS<div>Old: vascular / neoplasm</div><div><r /></div><div><img src=""redlich.jp
eg"" /></div>" DemyelinatingDiseases
Therapeutics for MS are directed primarily at modifying what function? Cellular
immunity
DemyelinatingDiseases
What structures are spared in MS infiltration with lymphocytes and macrophages (
xons DemyelinatingDiseases
leading to myelin sheath stripping)
"What disease process is shown here?<div><img src=""paste-71116068487509.jpg"" /
></div>"
MS; perivascular lymphocytes are attacking oligodendrocytes
DemyelinatingDiseases
"What process is occuring here?<div><img src=""paste-71150428225916.jpg"" /></di
v>"
MS: spinal cord demyelination (showing macrophages and denuded axons); t
he green arrow points to axons which are usually spared<div><r /></div><div>1.
lymphocytes first infiltrate perivascularly and kill oligos</div><div>2. Macroph
ages then start to strip myelin away</div>
DemyelinatingDiseases
What are some notale risk factors for MS?
Specific HL types<div>Twin stud
ies...</div><div>Theories of viral infection (?)</div><div><u>Higher lattitudes<
/u> (possily related to vitamin D) - Minnesota</div> DemyelinatingDiseases
How are acute flares of MS treated? &nsp;What aout chronic treatment? &nsp;r
e there any concerns regarding these options? cute: corticosteroids (high dos
e)<div>Chronic: immune modulators (/B interferon)</div><div><r /></div><div>Co
ncerns: cost, immuno-suppresion! (opportunistic infection)</div>
Demyelin
atingDiseases
<div>What disease:</div>1. Monophasic T-cell mediated HS<div>2. Perivenular lymp
hocytes (cell-mediated, like MS)</div><div>3. Swelling</div><div>4. Scattered he
morrhage</div> "<div>Chief symptoms of cute disseminated encephalomyelitis (D
E)</div><div><r /></div><div><img src=""paste-96374771155256.jpg"" /></div>"
DemyelinatingDiseases
Disease with symptoms of hyperacute DE (acute disseminated encephalomyelitis) +
multiple hemorrhages + firinoid necrosis of vessels "cute hemorrhagic leuko
encephalopathy<div><r /></div><div><img src=""paste-96379066122552.jpg"" /><r
/><div><img src=""paste-71944997175637.jpg"" /></div><div><img src=""paste-71979
356914041.jpg"" /></div></div>" DemyelinatingDiseases
Clinical presentation of inflammatory polyradiculoneuritis. &nsp;TX? <>Rapid
</> progression, <>respiratory</> <>failure</>, usually good outcome, possi
ly resulting from infection/vaccination; related to <u>humoral</u> response!<di
v><r /></div><div>TX: <u>plasma exchange</u> or <u>corticosteroids</u></div>
DemyelinatingDiseases
What are some (3) genetic disorders of myelin and their deficiencies (Leukodystr
ophies)?
<u>Metachromatic leukodystrophy</u>- deficiency of <>arylsulfat
ase</><div><u>Krae</u>- deficiency of&nsp;<><u>Galactocerroside&nsp;-galac
tosidase</u>&nsp;</></div><div><u>drenoleukodystrophy (LD/MLD)</u>-&nsp;de
fect in peroxisomal memrane&nsp;<u>protein that i<>mports acyl-co synthetase

into peroxisome.</></u></div> DemyelinatingDiseases

utosomal recessive ryl-sulfatase  deficiency resulting in the accumulation of
galactosyl-3-sulfatide in macrophages and matrix. &nsp;Causes myelin destructi
on. &nsp;
"Metachromatic leukodystrophy.<div><r /></div><div>Note that no
rmally normal myelin will stain lue with toluidine or cresyl violet; however wi
th MLD will stain rown!</div><div><img src=""meta.jpeg"" /></div>"
Demyelin
atingDiseases
Stain technique for identifying MLD?
"<><font color=""#800080"">Cresyl viole
t</font></> or <><font color=""#0000ff"">toluidine lue</font></> --&gt; will
produce <><font color=""#996633"">rown</font></> product (metachromatic)<div
><r /></div><div>Orthochromatic: will e lue</div><div><r /></div><div><img s
rc=""paste-72301479461311.jpg"" /></div><div><img src=""paste-72786810765656.jpg
"" /></div>"
DemyelinatingDiseases
Infant presents with auto-recessive disorder and is lacking<> aryl sulfatase</
> in urine/firolasts. &nsp;Is diagnosed with mental retardation, weakness, l
indness, and spasticity. &nsp;What is the disease and prognosis?
Metachro
matic Leukodystrophy; no TX availale, likely will die in 24 months
Demyelin
atingDiseases
Kraes: autosomal recessive deficiency of what? ccumulation of what? What is s
een
"<u>Galactocerroside&nsp;-galactosidase</u>--&gt; &nsp;Defiency of thi
s enzyme causes accumulation of <u>galactocerroside</u> in macrophages<div><r
/></div><div><><u><i>demyelination with multinucleated glooid cells</i></u></
></div><div><img src=""paste-72945724555703.jpg"" /></div>"
DemyelinatingDis
eases
"Demyelination with <u>multinucleated glooid cell</u>; Disease?<div><img src=""
paste-72945724555703.jpg"" /></div>"
Kraes DemyelinatingDiseases
X-linked recessive disease with parieto-occipital demyelination; treatment?
drenoleukodystrophy; Lorenzos Oil
DemyelinatingDiseases
Involves the spinal cord and peripheral nerves of adults; causes parieto-occipit
al demyelination. &nsp;Peroxisomal disorder.
Demyelin
drenoleukodystrophy
atingDiseases
drenoleukodystrophy genetics and cause "<div><>X-linked recessive</> defect i
n peroxisomal memrane <u>protein that i<>mports acyl-co synthetase into perox
isome.</></u></div><div><u><r /></u></div><div><u><img src=""adreno.jpeg"" /><
/u></div>"
DemyelinatingDiseases
"What is shown here. &nsp;What is the likely disease?<div><img src=""paste-7325
9257168257.jpg"" /></div><div><img src=""paste-73658689126819.jpg"" /></div>"
<u>Demyelination of the parieto-occiptal area</u>; likely adrenoleukodystrophy
DemyelinatingDiseases
What is the envelope and strand charactersitics of parvo?
"Nonenveloped, s
sDN<div><r /></div><div><img src=""paste-506011571978719.jpg"" /><r /><div><i
mg src=""paste-340831424741917.png"" /></div></div>"
5/16DickeyCantnki 5/16P
oxandFriends Dickey
What genus of parvo replicates in RBCs? Erythrovirus
5/16DickeyCantnki 5/16P
oxandFriends Dickey
When do outreaks of parvo B19 infections peak? "Spring<div>""to B19 in spring m
aking love""<r /><div><img src=""spring.jpeg"" /></div></div>" 5/16DickeyCantn
ki 5/16PoxandFriends Dickey
What is hydrops fetalis?<div><r /></div>
Heart failure in the fetus<div><
5/16DickeyCantnki 5/16PoxandFri
r /></div><div>occurs in Parvovirus</div>
ends Dickey
What is the most common characteristic of B19 infection in children is? "Erythem
a infectiosum (Fifth Disease)<div><img src=""erythema.jpeg"" /></div><div><img s
rc=""paste-515138377482719.jpg"" /></div>"
5/16DickeyCantnki 5/16PoxandFri
ends Dickey
What family causes monkeypox? "Orthopoxvirus, resemles smallpox<div><img src=
""orthopox.jpeg"" /></div>"
5/16DickeyCantnki 5/16PoxandFriends Dickey
Where is monkeypox endemic and what are its reservoirs? Endemic in Central and W
est frica<div><r /></div><div>Rodent reservoirs (prairie dog in US outreak)</
div><div><r /></div><div>Smallpox vaccine protects</div>
5/16DickeyCantn

ki 5/16PoxandFriends Dickey
Viral infection that resemles smallpox from exotic animals shipped from Ghana a
nd West frica. "Monkeypox<div><img src=""monkey (1).jpeg"" /></div>" 5/16Dick
eyCantnki 5/16PoxandFriends Dickey
T/F, there can e complications with Smallpox vaccination. If so, name "Yes&ns
p;<div>1)&nsp;<u>myopericarditis</u></div><div>2) p<u>ostvaccinial encephalitis
</u></div><div>3)&nsp;<u>eczema</u></div><div>4) spread to <u>eyes</u> and stuf
f</div><div><r /><div><img src=""complic.jpeg"" /></div></div>"
5/16Dick
eyCantnki 5/16PoxandFriends Dickey
"""Scay mouth"" virus with painful pruritic lesions at sites of contacts."
"Parapoxvirus (ORF)<div><img src=""ORF (1).jpeg"" /></div>"
5/16DickeyCantn
ki 5/16PoxandFriends Dickey
What are 2 medications for poxvirus infections? Cidofovir<div>Vaccinia immune gl
oulin (VIG)</div><div><r /></div>
5/16DickeyCantnki 5/16PoxandFriends Dic
key
Can you use electron microscopy to dx poxvirus? Yes
5/16DickeyCantnki 5/16P
oxandFriends Dickey
 person gets a poxvirus infection and develops postinfectious (post vaccination
) encephalitis - should VIG e given? No, <u>dont give VIG if pt has postinfe
ctious encephalitis</u> 5/16DickeyCantnki 5/16PoxandFriends Dickey
What are some treatments (surgical and medical) and prevention for HPV? Surgery,
caustic agents, local hyperthermia<div><r /></div><div>Interferons, <>Imiquim
od</></div><div><><r /></></div><div>Prevention:&nsp;<>HPV Vaccine</></di
v>
5/16DickeyCantnki 5/16PoxandFriends Dickey
What are some common S/Sx of progessive multifocal leukoencephalopathy (PML)?
Mono or hemiparesis, <u>gait</u> anormalities<div><u>Speech</u> impairment</div
><div><u>Visual</u> impairment</div><div><u>Cognition</u> changes</div> 5/16Dick
eyCantnki 5/16PoxandFriends Dickey
When is uproprion contraindicated?
Eating disorders, metaolic disturances
<div>History of seizures</div><div><r /></div><div><>Wellutrin</>&nsp;is th
e only antidepressant that increases D &amp; NE without changing 5HT (so you can
live&nsp;<>well</>&nsp;&amp; have a&nsp;<>great sex life</>). Buproprion
reminds me of&nsp;<>prion</>&nsp;=&gt; rain =&gt; seizure, so the one majo
r contraindication of Buproprion is seizure)</div>
Who is ideal for mirtazapine? Cancer, transplant, HIV... patients who have poo
r appetite and sleep
MOIs types and use
MOI-, MOI-B<div><r /><div>MOI- is <u>rarely</u> us
ed&nsp;</div></div>
MOI action
Inhiits monoamine oxidase--&gt; enzyme that metaolizes NE, ser
, dop, tyramine
When is ECT not indicated (3) <div>Somatization Disorders</div><div>Personalit
y Disorder (OCD)</div><div>Other nxiety Disorders</div>
75% of patients report this with ECT
Memory impairment, returns to aseline w
ithin 6 months
What type of language does Brocas phasia impair?
ll language.... written
, deaf sign language
5/16CorticalEagleman
<div>Superficial appearance of normality</div><div>-&nsp;Inaility to coordinat
e mental functions taking unseen goals</div><div>into account</div><div>- Disinh
iition and lack of ehavioral control (impulsive, quick to anger, rude comments
)</div><div>-&nsp;Stimulus-ound</div><div>-&nsp;Emotional impairments (reduce
d aility to recognize others emotional states; irritale, aggressive, alteration
of patients moods and emotions)</div><div>-&nsp;Difficulty planning and organiz
ing their lives</div><div>-&nsp;Impaired working memory (delayed response task<
/div><div>impairments)</div>
Frontal loe damage
5/16CorticalEagleman
"<img src=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60_Q_0.svg"" />"
"<img sr
c=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60__0.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_source_svg.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_summary.jpeg"" />"
5/16Cort
icalEagleman
"<img src=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60_Q_1.svg"" />"
"<img sr

c=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60__1.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_source_svg.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_summary.jpeg"" />"
5/16Cort
icalEagleman
"<img src=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60_Q_2.svg"" />"
"<img sr
c=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60__2.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_source_svg.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_summary.jpeg"" />"
5/16Cort
icalEagleman
"<img src=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60_Q_3.svg"" />"
"<img sr
c=""f0f9e0278c6a2d00af5730a1dea913df92c6ec60__3.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_source_svg.svg"" />"
"<img src=""f0f9
e0278c6a2d00af5730a1dea913df92c6ec60_summary.jpeg"" />"
5/16Cort
icalEagleman
Relative suicide risk with depression? 10x
BS
Chronic, persistent irritaility y age 10, efore 18. Temper outursts.&nsp;<
r />&gt;1 year.&nsp; What is disruptive mood dysregulation disorder BS
What are patients with disruptive mood dysregulation disorder at risk for?
dult depression, anxiety disorder
BS
What class of drugs are associated with development of manic symptoms? Dopamine
agonists
BS
What causes <>perivenous encephalomyelitis</>? What are two types?
Typicall
y <u>post-infectious demyelination</u>--&gt; antigen and myelin are similar<div>
<r /></div><div><u>cute disseminated encephalomyelitis</u> (DE)</div><div><u>
cute hemorrhagic leukoencephalopathy</u> (HL- hyperacute DE+hemorrhages)</div
>
What causes metachromatic leukodystrophy? <>genetics</>? What accumulates?
utosomal recessive deficiency of <u>arylsulfatase </u>--&gt; accumulation of <
u>galactosyl-3-sulfatide (cereroside sulfate)</u>
How is definitive diagnosis of metachromatic leukodystrophy made?
lack of
<u>aryl sulfatase </u> in <>urine</> or in <>cultured firolasts</>
What are the 2 ventral stream lesion consequences?
Prosopagnosia (visual o
ject agnosias)&nsp;<div>chromatopsia (loss color vision)</div>
<div>Name lesion consequence</div><div>Primary visual cortex--&gt;</div><div>Sec
ondary--&gt;</div><div>Tertiary--&gt;</div>
"<div>Primary visual cortex--&gt
;<u>scotomas</u></div><div>Secondary--&gt;<u>visual agnosias</u> (e.g. difficult
y recognizing ojects)</div><div>Tertiary--&gt;<u>very specific deficits</u> (e.
g. face lindness)</div><div><u><img src=""visual.jpeg"" /></u></div>"
Coronavirus:<div>DN, RN</div><div>Icosahedral, helical</div><div>Single, doul
e (+/-)</div><div>Enveloped, non-enveloped</div>
"RN, helical, +RN, env
eloped<div><r /></div><div><img src=""paste-621760940605911.jpg"" /><r /><div>
<r /></div><div><img src=""paste-465595929723421.png"" /></div></div>" ID2
How long does MMR vaccine last? ppears to wane aout 10 years after second dose
ID2
"<img src=""rash.jpeg"" /><div>This patient comes to ER. What is your first move
</div>" Isolate the patient. Measles is extremely infectious y respiratory drop
lets
ID2
RSV patients can go home and still e sick. What are most common symptoms?
"Hypoxemia, cough, altered airways<div><img src=""pattern.jpeg"" /></div>"
What are the genera of picornaviruses Enterovirus (now includes <u>rhinovirus<
/u>)<div>Hepatovirus</div><div>Parechovirus</div><div>Kouvirus (aiche)</div>
cid stale genera of picornavirus
Enterovirus (rhinovirus acid laile, ut
considered enterovirus)
What functions does the preoptic/anterior hypothalamic regulate? (4)
"Materna
l/paternal ehavior<div>Temp regulation</div><div><u>Fluid Balance</u></div><div
><u>sexual ehavior</u></div><div><img src=""photo 1-1.JPG"" /></div>"
What functions does the magnocellular part of the supraoptic nucleus control?
"Oxytocin + <>vasopressin release </>(female onding)<div><img src=""photo 1-1
.JPG"" /></div><div><r /></div><div>Magnum condoms for female onding</div>"
Suprachiasmatic nucleus controls?
"Circadian rythms<div><img src=""paste-4

372276707331.jpg"" /></div>"
Mammillary ody function?
"Memory<div><img src=""arcuate.jpg"" /></div><di
v><img src=""7 (3).jpeg"" /></div><div><img src=""7 1.jpeg"" /></div><div>7</div
>"
The lateral hypothalamus mostly contains axons from?
"Medial forerain undle
<div><r /></div><div><r /></div><div><r /></div><div><img src=""paste-2214914
6345473.jpg"" /></div><div><img src=""medial.jpeg"" /></div>"
How does the hypothalamus communicate with amygdala?
"Via stria terminalis<di
v><r /></div><div><img src=""paste-24094766530561.jpg"" /></div>"
How does the hypothalamus communicate with the frontal loe and cingulate gyrus?
"Via the medial forerain undle<div><img src=""pleasure-center.jpg"" /></div>"
How does the hypothalamus communicate with the hippocampus?
"Via the fornix<
div><img src=""pic hypo.jpeg"" /><r /><div><img src=""amy.jpg"" /></div></div>"
How does the hypothalamus communicate with the rainstem and thery control auto
nomic and arousal functions?
"Via the MFB<div><img src=""paste-20796231647233
.jpg"" /></div><div><div><r /></div></div>"
How does the hypothalamus communicate with the pituitary (nuclei)?
"Via the
supraoptic, paraventricular and arcuate<div><r /></div><div><>Hormonal contro
l</></div><div><><img src=""rostral hypo.jpeg"" /></></div><div><><r /></>
</div><div><><img src=""arcuate.jpg"" /></></div><div><></><><img src=""net
ter hypo (1).jpeg"" /></></div>"
Fear is mainly orchestrated in the?
"mygdala<div><r /></div><div><r /></d
iv><div><r /><div><img src=""paste-20791936679937 (1).jpg"" /></div></div>"
Limic system part responsile for pain?
"Cingulate<div><r /></div><div>
<r /></div><div><img src=""paste-22149146345473.jpg"" /></div>"
What loes does the cingulum fasciculus/ undle connect?
"Interconnects m
edial frontal loe and medial temporal loe<div><img src=""uncinate.jpeg"" /></d
iv>"
What does the uncinate fasiculus connect?
"Interconnects medial temporal a
nd medial prefrontal<div><r /></div><div><r /></div><div><img src=""paste-2465
3112279041.jpg"" /></div>"
Name three commisural connections and what they connect "<div>Corpus callosum co
nnects L and R neocortex</div><div>nterior commissure L and R anterior temporal
loe (amygdala/uncal cortex)</div><div>Fornix commissure L and R hippocampi</di
v><div><r /></div><div><img src=""corpus.jpeg"" /></div><div>Corpus</div><div><
img src=""corp.jpeg"" /></div><div><r /></div><div><img src=""ant (2).jpeg"" />
</div><div><img src=""comm forn.jpeg"" /></div>"
What pathway explains why with intense emotion there is autonomic stress?
"<div>The connection etween the amygdala and hypothalamus via the stria termina
lis</div><div><img src=""paste-25271587569665.jpg"" /></div>"
What sense directly connects to the amygdala? Olfactory
What is Urach-weithe disease? (add reverse)<div><r /></div><div>Symptoms?</div
>
Rare genetic disease that causes calcification of medial temporal loes
as well as dermatological symptoms&nsp;<div><r /></div><div>Cannot recgonize f
earful expressions or make fearful expressions</div>
Is fearful expression dependent on corticoular?
No<div><r /></div><div>
(i.e.) a CBT lesion wont affect making a scared face in response to fearful sti
mulus</div>
Whats the difference etween cued and contextual fear? (which regions?)
Cued = kid that got conditioned to e afraid of mouse, goes to the <>amygdala</
><div><><r /></></div><div>Contextual = eing scared of dark allys cuz you g
ot mugged there once = <>hippocampus</></div>
Descrie the pathway of autonomic activation for a medial temporal loe seizure.
"<div>medial temporal loe -&gt; &nsp;fornix/stria terminalis -&gt; hypothalamu
s -&gt; MFB -&gt; NS</div><div><img src=""pic hypo.jpeg"" /></div>"
What explains the foul smell at the eginning of a seizure?
"Direct olfactor
y connection to amygdala<div><img src=""olfactor.jpeg"" /></div>"
Can you experience deja vu and memory loss with a medial temporal loe seizure?
Yes
"<img src=""da0858d6eeead5078f2791779075fcd7ced3_Q_0 (3).svg"" />" "<img sr

c=""da0858d6eeead5078f2791779075fcd7ced3__0 (3).svg"" />" "<img src=""da0

858d6eeead5078f2791779075fcd7ced3_source_svg (3).svg"" />" "<img src=""da0
858d6eeead5078f2791779075fcd7ced3_tmpjewtyc.png"" />"
"<img src=""da0858d6eeead5078f2791779075fcd7ced3_Q_1 (3).svg"" />" "<img sr
c=""da0858d6eeead5078f2791779075fcd7ced3__1 (3).svg"" />" "<img src=""da0
858d6eeead5078f2791779075fcd7ced3_source_svg (3).svg"" />" "<img src=""da0
858d6eeead5078f2791779075fcd7ced3_tmpjewtyc.png"" />"
"<img src=""80c87cd154de92e74875d8262c9d564807c964d7_Q_0.svg"" />"
"<img sr
c=""80c87cd154de92e74875d8262c9d564807c964d7__0.svg"" />"
"<img src=""80c8
7cd154de92e74875d8262c9d564807c964d7_source_svg.svg"" />"
"<img src=""80c8
7cd154de92e74875d8262c9d564807c964d7_tmpoetza.png"" />"
"<img src=""80c87cd154de92e74875d8262c9d564807c964d7_Q_1.svg"" />"
"<img sr
c=""80c87cd154de92e74875d8262c9d564807c964d7__1.svg"" />"
"<img src=""80c8
7cd154de92e74875d8262c9d564807c964d7_source_svg.svg"" />"
"<img src=""80c8
7cd154de92e74875d8262c9d564807c964d7_tmpoetza.png"" />"
"<img src=""80c87cd154de92e74875d8262c9d564807c964d7_Q_2.svg"" />"
"<img sr
c=""80c87cd154de92e74875d8262c9d564807c964d7__2.svg"" />"
"<img src=""80c8
7cd154de92e74875d8262c9d564807c964d7_source_svg.svg"" />"
"<img src=""80c8
7cd154de92e74875d8262c9d564807c964d7_tmpoetza.png"" />"
"<img src=""8947046817ae6da4e831253950dfc4fe_Q_0.svg"" />"
"<img sr
c=""8947046817ae6da4e831253950dfc4fe__0.svg"" />"
"<img src=""894
7046817ae6da4e831253950dfc4fe_source_svg.svg"" />"
"<img src=""894
7046817ae6da4e831253950dfc4fe_tmpjyy2lv.png"" />"
"<img src=""65e2603ea08fd55c35249d69463dfd0f402330c_Q_0.svg"" />"
"<img sr
c=""65e2603ea08fd55c35249d69463dfd0f402330c__0.svg"" /><div><img src=""amy.jpg
"" /></div>"
"<img src=""65e2603ea08fd55c35249d69463dfd0f402330c_source_svg.
svg"" />"
"<img src=""65e2603ea08fd55c35249d69463dfd0f402330c_tmptg3n8t.p
ng"" />"
"<img src=""65e2603ea08fd55c35249d69463dfd0f402330c_Q_1.svg"" />"
"<img sr
c=""65e2603ea08fd55c35249d69463dfd0f402330c__1.svg"" />"
"<img src=""65e2
603ea08fd55c35249d69463dfd0f402330c_source_svg.svg"" />"
"<img src=""65e2
603ea08fd55c35249d69463dfd0f402330c_tmptg3n8t.png"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_Q_0.svg"" />"
"<img sr
c=""21664214eae72ca31103f677a53e93c62ed4f23__0.svg"" /><div><img src=""amy.jpg
"" /></div>"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_source_svg.
svg"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_tmp_qfv1c.p
ng"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_Q_1.svg"" />"
"<img sr
c=""21664214eae72ca31103f677a53e93c62ed4f23__1.svg"" /><div><img src=""pic hyp
o.jpeg"" /></div>"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_sou
rce_svg.svg"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_tmp
_qfv1c.png"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_Q_2.svg"" />"
"<img sr
c=""21664214eae72ca31103f677a53e93c62ed4f23__2.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_source_svg.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_tmp_qfv1c.png"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_Q_3.svg"" />"
"<img sr
c=""21664214eae72ca31103f677a53e93c62ed4f23__3.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_source_svg.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_tmp_qfv1c.png"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_Q_4.svg"" />"
"<img sr
c=""21664214eae72ca31103f677a53e93c62ed4f23__4.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_source_svg.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_tmp_qfv1c.png"" />"
"<img src=""21664214eae72ca31103f677a53e93c62ed4f23_Q_5.svg"" />"
"<img sr
c=""21664214eae72ca31103f677a53e93c62ed4f23__5.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_source_svg.svg"" />"
"<img src=""2166
4214eae72ca31103f677a53e93c62ed4f23_tmp_qfv1c.png"" />"
"<img src=""46ead649951f437d6cf846cc62cf9f6d92540a0_Q_0.svg"" />"
"<img sr
c=""46ead649951f437d6cf846cc62cf9f6d92540a0__0.svg"" />"
"<img src=""46ea

d649951f437d6cf846cc62cf9f6d92540a0_source_svg.svg"" />"
"<img src=""46ea
d649951f437d6cf846cc62cf9f6d92540a0_tmp_apcwx.png"" />"
"<img src=""46ead649951f437d6cf846cc62cf9f6d92540a0_Q_1.svg"" />"
"<img sr
c=""46ead649951f437d6cf846cc62cf9f6d92540a0__1.svg"" />"
"<img src=""46ea
d649951f437d6cf846cc62cf9f6d92540a0_source_svg.svg"" />"
"<img src=""46ea
d649951f437d6cf846cc62cf9f6d92540a0_tmp_apcwx.png"" />"
"<img src=""46ead649951f437d6cf846cc62cf9f6d92540a0_Q_2.svg"" />"
"<img sr
c=""46ead649951f437d6cf846cc62cf9f6d92540a0__2.svg"" />"
"<img src=""46ea
d649951f437d6cf846cc62cf9f6d92540a0_source_svg.svg"" />"
"<img src=""46ea
d649951f437d6cf846cc62cf9f6d92540a0_tmp_apcwx.png"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_Q_1.svg"" />"
"<img sr
c=""72fcd62c06535f1fff429968c61326738aa3e__1.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_source_svg.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_tmpj6ojd2.png"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_Q_2.svg"" />"
"<img sr
c=""72fcd62c06535f1fff429968c61326738aa3e__2.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_source_svg.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_tmpj6ojd2.png"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_Q_3.svg"" />"
"<img sr
c=""72fcd62c06535f1fff429968c61326738aa3e__3.svg"" /><div><img src=""amy.jpg
"" /></div>"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_source_svg.
svg"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_tmpj6ojd2.p
ng"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_Q_4.svg"" />"
"<img sr
c=""72fcd62c06535f1fff429968c61326738aa3e__4.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_source_svg.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_tmpj6ojd2.png"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_Q_5.svg"" />"
"<img sr
c=""72fcd62c06535f1fff429968c61326738aa3e__5.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_source_svg.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_tmpj6ojd2.png"" />"
"<img src=""72fcd62c06535f1fff429968c61326738aa3e_Q_6.svg"" />"
"<img sr
c=""72fcd62c06535f1fff429968c61326738aa3e__6.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_source_svg.svg"" />"
"<img src=""72
fcd62c06535f1fff429968c61326738aa3e_tmpj6ojd2.png"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_0.svg"" />"
"<img sr
c=""4d547189a43ac6a8efd85c5cee50cae0357__0.svg"" /><div><img src=""amy.jpg
"" /></div>"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_source_svg.
svg"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.p
ng"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_1.svg"" />"
"<img sr
c=""4d547189a43ac6a8efd85c5cee50cae0357__1.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_source_svg.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.png"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_2.svg"" />"
"<img sr
c=""4d547189a43ac6a8efd85c5cee50cae0357__2.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_source_svg.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.png"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_3.svg"" />"
"<img sr
c=""4d547189a43ac6a8efd85c5cee50cae0357__3.svg"" /><div><img src=""amy.jpg
"" /></div>"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_source_svg.
svg"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.p
ng"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_4.svg"" />"
"<img sr
c=""4d547189a43ac6a8efd85c5cee50cae0357__4.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_source_svg.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.png"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_5.svg"" />"
"<img sr
c=""4d547189a43ac6a8efd85c5cee50cae0357__5.svg"" />"
"<img src=""4d5
47189a43ac6a8efd85c5cee50cae0357_source_svg.svg"" />"
"<img src=""4d5

47189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.png"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_6.svg""
c=""4d547189a43ac6a8efd85c5cee50cae0357__6.svg"" />"
47189a43ac6a8efd85c5cee50cae0357_source_svg.svg"" />"
47189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.png"" />"
"<img src=""4d547189a43ac6a8efd85c5cee50cae0357_Q_7.svg""
c=""4d547189a43ac6a8efd85c5cee50cae0357__7.svg"" />"
47189a43ac6a8efd85c5cee50cae0357_source_svg.svg"" />"
47189a43ac6a8efd85c5cee50cae0357_tmpxtuxuk.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_0.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__0.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_1.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__1.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_2.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__2.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_3.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__3.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_4.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__4.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_5.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__5.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_6.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__6.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""8289a505f699790aafaa64f43487076e65ff1_Q_7.svg""
c=""8289a505f699790aafaa64f43487076e65ff1__7.svg"" />"
9a505f699790aafaa64f43487076e65ff1_source_svg.svg"" />"
9a505f699790aafaa64f43487076e65ff1_tmpqtdc05.png"" />"
"<img src=""51ca856835d4589f7e724e064915956f008eff5_Q_0.svg""
c=""51ca856835d4589f7e724e064915956f008eff5__0.svg"" />"
856835d4589f7e724e064915956f008eff5_source_svg.svg"" />"
856835d4589f7e724e064915956f008eff5_tmphjx1x.png"" />"
"<img src=""51ca856835d4589f7e724e064915956f008eff5_Q_1.svg""
c=""51ca856835d4589f7e724e064915956f008eff5__1.svg"" />"
856835d4589f7e724e064915956f008eff5_source_svg.svg"" />"
856835d4589f7e724e064915956f008eff5_tmphjx1x.png"" />"
"<img src=""51ca856835d4589f7e724e064915956f008eff5_Q_2.svg""
c=""51ca856835d4589f7e724e064915956f008eff5__2.svg"" />"
856835d4589f7e724e064915956f008eff5_source_svg.svg"" />"
856835d4589f7e724e064915956f008eff5_tmphjx1x.png"" />"
"<img src=""51ca856835d4589f7e724e064915956f008eff5_Q_3.svg""
c=""51ca856835d4589f7e724e064915956f008eff5__3.svg"" />"
856835d4589f7e724e064915956f008eff5_source_svg.svg"" />"
856835d4589f7e724e064915956f008eff5_tmphjx1x.png"" />"
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What are the types of poliovirus vaccines? Which is used in the US?
<u>Live
attenuated</u>- &nsp;monovalent, ivalent, trivalent<div><u>Inactivated</u>- tr
ivalent (US)</div>
Picornavirus virology<div>DN, RN</div><div>Icosahedral, helical</div><div>Sing
le doule, (+/-)</div><div>Enveloped</div>
"RN<div>Icosahedral</div><div>s
sRN (+)</div><div>non-enveloped</div><div><img src=""paste-309744451453469.png"
" /></div>"
nterograde and Retrograde amnesia
nterograde- unale to form new memories
<div>Retrograde- unale to rememer past</div> 5/19Neuroplasticity1
Explicit vs Implicit memories:<div><r /></div><div>What type of memory are thes
e (long term/short term)?</div> "<div>Long term memories</div><div><r /></div>E
xplicit- conscious memories<div>Implicit- unconscious memories</div><div><img sr
c=""memory chart.jpeg"" /></div>"
5/19Neuroplasticity1
Name the general principle of how memory works <u>ssociative neural network</u
><div> memory is an associated network of distinct regions of cortex</div><div>
<r /></div><div>Its a constellation</div>
5/19Neuroplasticity1
Concussions disrupt _____ of recent memories
"Consolidation&nsp;<div><img sr
c=""conso.jpeg"" /></div>"
<div>Not discussed:</div><div><r /></div>side from Ch depletion in lzheimer
s, what else causes neuron loss? What is a therapy?
Excitotoxicity from exce
ss glutamate.<div><r /><div><u>Memantine</u>- limits neurons sensitivitiy to g
lutamate</div></div>
What are the species of family picornavirus genus enterovirus? (5)
Poliovir
us, Coxsackie /B, Echovirus, Enterovirus, Rhinovirus<div><r /></div><div>Polio
virus, Echovirus, Rhinovirus, Coxsackievirus, HV</div><div>PERCH on a peak (p
ico)</div>
"Mucosal ulcers, meningitis, adrenal mass/ddisons disease, pericarditis, GI Ma
ss<div><img src=""mucosal.jpeg"" /><img src=""GI.jpeg"" /></div>"
Progress
ive disseminated histoplasmosis Dickey
Patient comes in with lithium toxicity. What drug are they likely taking?
Iuprofen (NSIDS contraindicated)
5/19Moodstailizer
<div>Topiramate Zonisamide Gaapentin Pregaalin</div><div>Can we use these anti
convulsants as mood stailizers?</div><div>
</div>
No, they lack evidence. Gaapent
in manufacturers got in troule for marketing this.&nsp;
5/19Moodstailiz
er
What are causes of exudates of pleural surface?&nsp; <div><>ID</>- TB, act
erial/viral/funal/parasitic infections</div><div><>Neoplastic</>- mesothelioma
, tumors<r /><div><>Gastrointestinal diseases</></div></div><div><>Rheumatic
disorders</>- SLE, rheumatoid pleuritis</div><div><>Trauma</></div><div><>M

isc</>.&nsp;</div>
5-FC and amptotericin B are used together for what?
Candida and cryptococcal
meningitis
90% of people who die y suicide have what?
1 or more psychiatric disorders
BS
What psychiatric illness/risks are associated with suicide?
<>B</>orderlin
e personality disorder<div><></>lcohol and drug ause<r /><div><>B</>ipola
r and major depression</div><div><r /></div></div><div><r /></div><div>BB</di
v>
BS
In reference to demographic and historical risk factors, who is at risk for <u>c
ompletion</u>&nsp;of suicide attempts? Older males<div>In the contrary, younger
females have unsuccessful attempts&nsp;</div> BS
What popular merican component leads to suicide in older adults?
Disillus
ionment with retirement, too high of expectations (Prudential) BS
Does asking a patient aout a plan for suicide increase their risk for completin
g that plan?
No
BS
What are acute risk factors for suicide? (4)
<>H</>opelessness<div><>O</>
ver 60 and suddenly alone<r /><div><>P</>anic attacks</div><div>Blow to self<
>-esteem</></div><div><><r /></></div><div><r /></div><div>HOPE</div></div
>
BS
How do you assess a patient for suicide risk? (important, will use) (3) sk aou
t <u>suicidal ideation</u>&nsp;&amp;&nsp;<u>suicide plan</u><div>sk aout pla
ns for <u>future</u> whether patient is <u>hopeless</u></div><div>sk aout patt
ern of <u>giving away possessions</u> in recent weeks</div>
BS
If a patient has a firearm in their house, what is their relative suicide risk?
3-4 times more likely BS
How do you treat suicidal intent? (3) Psychotherapy and medication together. (
synergy)<div>ECT (can go from imminent danger to etter in 3 days)</div><div>Lit
hium</div>
BS
Suicide rate is higher in physicians than general population. But what is partic
ularly true?
Female physicians have relative risk 3-6x higher than general po
pulation, making them as high as male physicians.&nsp; BS
Who am I descriing?<div>Male or female physician, middle aged, white, <>divorc
ed, separated, single, or currently having marital disruption</></div> Profile
of a physician at high risk for suicide BS
What are risk factors for suicide in physicians? (5)
<div><u><>W</>orkaholi
c</u></div><div><u></u><u><>E</>xcessive risk taking</u></div><div><u></u><u>S
ustance&nsp;<>a</>use</u></div><div><u><>P</>erfectionism</u></div><div><
><u></u></><>M</>ood&nsp;disorder</div><div><u><r /></u></div><div><u>WEP
eM</u></div>
BS
What professional changes in physicians can increase suicide risk?
<div>Inc
reased <u><>w</>ork demands</u></div><div><u><></>ccess</u> to means (guns,
medications)</div><div>Changes in&nsp;<u><>s</>tatus</u>&nsp;(autonomy, sec
urity, finances)</div><div><r /></div><div>WS</div> BS
What % of medicated depressed patients are adequately treated with antidepressan
ts?
Only 20%
BS
What % of patients communicate their intent of suicide in the following settings
?<div>Primary care</div><div>Mental health&nsp;</div><div>Hospitalized&nsp;</d
iv>
58% (~60%)<div>36% (~40%)</div><div>23% (~20%)</div><div><i>Understand t
hat many people deny inent</i></div>
BS
Suicide is what relative leading cause of death those:<div>25-34&nsp;</div><div
>15-34</div>
<div><u>2nd</u> leading cause of death for people 25-34</div><di
v><u>3rd</u> leading cause of death for those 15-24</div><div><r /></div><div>m
ore common in mid 20s</div>
BS
What type of immunity helps to defend lungs from LRI? ll of it: cell mediated
, humoral, neutrophils ID2
Colonization y the ug is correlated with increased salivary proteolytic activi
ty and decreased levels of cell-surface fironectin
Pseudomonas aeruginosa
ID2
Colonization of this ug follows aspiration of organisms that have colonized the

nasopharynx
Strep. pneumo ID2
Inhalation of this ug in aerosolized acterial particles in hospital patients r
eceiving humidified neulizer air
Legionella, gram (-) acilli
ID2
What ugs can spread hematogenously from extrapulmonary source&nsp;
anaeroi
c pelvic infections, rt sided S. aureus endocarditis&nsp;
ID2
"<img src=""4 (4).jpeg"" />"
4<div>Given cefepime, not acterial. Immunocompr
omised= aspergillus</div>
ID2
"<img src=""2 (1).jpeg"" />"
2
ID2
"<img src=""1.jpeg"" />"
1<div>Gram neg</div><div><r /></div><div>2, can
dida. 3, pneumococcus (community typically)&nsp;</div> ID2
"Whats going on here?<div><img src=""cerv.jpeg"" /></div>"
Cervical adeniti
s. Pus <i>in</i>&nsp;lymph node. Infection of the lymph node itself&nsp;
What are the 4 suppurative neck infections?
" Peritonsillar&nsp;<div> Retroph
aryngeal&nsp;</div><div> Parapharyngeal&nsp;</div><div> Cervical lymphadenitis</
div><div><img src=""oeri.jpeg"" /></div><div><img src=""peri (1).jpeg"" /></div>
<div><img src=""cerv.jpeg"" /></div>"
"<div>Whats this?</div><img src=""retro (1).jpeg"" />" Retropharyngeal infectio
n<div><r /><div>(Widening of pre-verteral space=P diameter of contiguous vert
eral odies)</div></div>
Diagnose and contrast these suppurative neck infections:<div><r /></div><div>La
te adolescence, <u>muffled voice</u>, can visualize on physical</div><div>Toddle
rs, <u>Limited ROM</u>, not visualized&nsp;</div>
"<div>Peritonsilar asce
ss</div><div>Retropharyngeal ascess</div><div><r /></div><img src=""peritonsil
ar.jpeg"" /><div><img src=""retroi.jpeg"" /></div>"
<div>Sore throat, dysphagia</div><div>Trismus</div><div>Muffled or hot potato vo
ice</div><div>Drooling</div><div><r /></div><div>Early 20s</div>
"Periton
sillar ascess<div><r /></div><div><img src=""paste-722314714939752.jpg"" /></d
iv>"
"Diagnose<div><img src=""acterial tra.jpeg"" /></div>" Bacterial tracheitis
Patient has a sore throat. Is the sufficient for diagnosis of pharyngitis? If no
t, what is (3)? <div><>Erythema, exudate, ulceration</></div><div><r /></div>
Requires ojective evidence of pharyngeal inflammation<div><r /></div><div><u>E
EU to Exactly diagnose</u></div>
Patient comes in with sore throat and conjunctivitis. What are you thinking?&ns
p;
"<u>denovirus</u>, causes oth. Do not think 2 separate ugs<div><img s
rc=""conj (1).jpeg"" /></div>"
Viral or acterial? Sore throat +<div><div> Conjunctivitis&nsp;</div><div> Coryza
(acute rhinitis)</div><div> Cough&nsp;</div><div> Hoarseness&nsp;</div><div> nt
erior stomatitis&nsp;</div><div> Ulcers</div></div><div><r /></div> Viral ph
aryngitis
dolescent with fever, pharyngitis, lymphadenopathy<div><u>transaminitis</u>, <u
>splenomegaly</u></div> "Mononucleosis<div><r /></div><div>lways on differenti
al for liver (hep) illness</div><div><r /></div><div><img src=""paste-714609543
610654.jpg"" /></div><div><img src=""paste-714708327858462.jpg"" /></div>"
For the centor criteria, if 3 or 4, what is PPV for strep over virus? If &lt;3,
what is NPV?
<div>PPV if 3 or 4: 40-60%</div><div>NPV if &lt;3: 80%</div><div
><r /></div><div><r /></div><div><div>Centor criteria</div><div>-Tonsillar exu
dates</div><div>-Tender anterior cervical adenopathy</div><div>-Fever</div><div>
-sence of cough</div></div><div><r /></div>
"How did this happen?<div><img src=""rash (1).jpeg"" /></div>" EBV + amoxicilli
n causes this morilliform rash
Can you catch a cold from saliva?
"Not really. Must e from droplets/sneez
ing, or hand self-inoculation<div><r /><div><img src=""trans (3).jpeg"" /></div
></div>"
What is a ad superinfection following influenza?
S. aureus
dult with cold like illness + FEVER
Influenza
What is this<div><div> &nsp;Disorganized Thoughts</div><div> &nsp;Hallucinations
or Delusions</div><div> &nsp;Loss of the self, physical and mental oundaries,
i.e. not sure where I stop and you egin</div><div> &nsp;Gross impairment of rea
lity testing</div></div>
Thought disorder
5/21ThoughtDisorders

Schizophrenia not meeting criteria of paranoid, disorganized, catatonic type

Undifferentiated type schizophrenia
5/21ThoughtDisorders
<u>sence</u> of prominent delusions, hallucinations, disorganized speech, and
grossly disorganized or catatonic ehavior<div><r /></div><div>There is <u>cont
inuing disturance</u> as indicated y negative symptoms or two of the criterion
Residual type schizophrenia&nsp;
 symptoms in attenuated form</div>
5/21ThoughtDisorders
What are causes of sustance induced thought disorders? (3)
Steroids<div>Int
erferons</div><div>nticholinergics</div>
5/21ThoughtDisorders
<div>Patient is diagnosed with schizophrenia and is also ausing one of these: </di
v><div><r /></div><div>lcohol</div><div>mphetamines</div><div>Cannais</div><
div>Cocaine</div><div>Hallucinogens</div><div>Inhalants</div><div>Opiates</div><
div>PCP</div><div>Sedatives</div><div>Hypnotics</div><div>nxiolytics</div><div>
<r /></div><div>What is the prolem with this?</div><div>
intoxication</u>!<div><r /></div><div><i>Do not e MS2 in BTGH on psych calling
drug addicts psychotic/schizophrenic</i></div> 5/21ThoughtDisorders
There are 4 dopamine pathways. Which 2 are significant in thought disorders?
<div><u>Mesolimic</u>&nsp;(+ symptoms)</div><div><u>Mesocortical</u>&nsp;(- s
ymptoms)</div><div>Nigrstriatal</div><div>Tueroinfundiular</div>
5/21Thou
ghtDisorders
Who is genetically at risk for schizophrenia?&nsp;
First degree relatives h
ave high risk<div>Monozygotic twins 45% chance, dizygotic 12%</div><div><r /></
div><div><i>Proaly not a single gene</i></div>
5/21ThoughtDisorders
What is the neurodevelopmental hypothesis for schizophrenia?
<div>Schizophren
ia arises from <u>anormal rain development</u> and manifests itself clinically
during late adolescence and early adulthood due to <u>post-natal rain maturati
on</u></div>
5/21ThoughtDisorders
What is the evidence for neurodevelopmental hypothesis for schizophrenia? (in pr
egnancy)
Increased risk with:<div><r /><div>Ostetrical complications (h
ypoxia)</div><div>Viral in utero exposure</div><div>Utero famine</div></div>
5/21ThoughtDisorders
What is the pathophysiology associated with neurodevelopmental hypothesis? (2)
<u>Increased</u> numers of cells in <u>deep cortical layers</u>&nsp;<div><u>de
creased</u> in <u>outer layers</u><div><u><r /></u></div><div>Cortical atrophy
and ventricular enlargement&nsp;</div></div> 5/21ThoughtDisorders
When would you need to hospitalize for a psychotic disorder?
Medical <u>evalu
ation</u><div><u>Safety</u> of patient, others</div><div>Inaility <u>to care</u
> for self</div>
5/21ThoughtDisorders
Descrie the possile final common pathway for schizophrenia
Genetic anormai
lities--&gt; more sensitive to perinatal anoxia, infections, toxins--&gt; perina
tal events result in anormal neural migration--&gt; anormalities of dopamine,
glutamate
5/21ThoughtDisorders
Synonymous for psychosis
thought disorder
What sustances cause psychotic disorders during withdrawal?
<div>lcohol</di
v><div>Sedatives</div><div>Hypnotics</div><div>nxiolytics</div>
The following are sutypes of what<div>Erotomanic Grandiose Jealous&nsp;Persecu
tory Somatic&nsp;Mixed</div> Delusional disorder
Of the other 2 dopamine pathways (nigrostriatal, tueroinfundiular), what are t
heir relationship to tx of psychosis? Nigrostriatal- altered y antipsychotic
drugs causing <u>movement</u> side effects<div><r /><div><div>Tueroinfudiular
- &nsp;affected y antipsychotic drugs causing <u>prolactin related</u> side ef
fects</div></div></div>
<div>DEMOGRPHIC &amp; HISTORICL RISK FCTORS for what?</div><div><r /></div><
div>Male gender (2:1)</div><div>Increasing age</div><div>Living alone</div><div>
Marital status other than living with spouse</div><div>History of early parental
loss</div><div>Recent interpersonal loss</div><div>Family history of suicide</d
iv>
Suicide
Protein accumulation extracullar is called<div>Protein accumulation intracellula
r is called</div>
"Extracellular- <font color=""#ff0000"">Plaque</font>&n
sp;&nsp;(think eta-amyloid)<div>Intracellular- <font color=""#ff0000"">Inclusi

on</font> (think tau, alpha synuclein, SOD)&nsp;</div>"

What are the possile fates of misfolded protein? (3) "<div>1. utophagy (lyso
somes)</div><div>2. Firils (nm) and inclusions (um)</div><div>3. Proteosome--&g
t; degraded or refolded</div><img src=""fate.jpeg"" />"
What is prion-like templating in neurodegeneration?
"Misfolding of a protein
--&gt; templating (modifies native protein, especially into eta pleated sheets)
--&gt; aggregation<div><img src=""prion like.jpeg"" /></div><div><r /></div>"
What are possile intracellular inclusion proteins? What types of cells affected
? What diseases are associated? "<u>Tau synuclein</u> (<font color=""#0000ff"">m
icrotuule related</font>; <>Progressive supranuclear palsy parkinsonism; lzhe
imers)</><div><><r /></><div><u>lpha synuclein</u> (<font color=""#ff0000"
">neuronal/oligodendrocytes</font>; <>Lewy Bodies; Parkinsons)</></div><div><
><r /></></div><div><u>Superoxide dismutase</u> (<font color=""#ff0000"">neur
onal</font>; <>Familial LS)</></div></div>"
Which are more toxic, firils (nanometers) or inclusions (microns)
"Firils
. There is thought that inclusions may have a protective mechanism<div><img src=
""firill.jpeg"" /></div>"
What is the story with LS and the mutation of superoxide dismutase?
It was t
hought that the accumulation of free radicals from this enzyme mutation caused d
isease. In reality, the <u>enzyme worked fine</u>, ut had a <u><>higher propen
sity to polymerize into firils</></u> and form toxic products and this caused
disease
Parkinsons disease is an <>alpha synuclein</> pathology. What is the patholog
y of progressive supranuclear palsy (<>PSP</>), another cause of parkinsonism?
Tauopathy
What are 2 other causes of Parkinsonism?
<>Post-encephalitic parkinsonis
m</> (DeNiro)<div><>Progressive supranuclear palsy</> (tauopahy)</div><div><
r /></div><div><r /></div><div><r /></div><div><u>Postencephalitic parkinsonis
m</u>: viral etiology influenza pandemic</div><div><r /></div><div><u>Progressi
ve supranuclear palsy (Mickey mouse Midrain)</u>&nsp;usually presents as an is
olated vertical gaze palsy, followed y paresis of other ocular movements, and s
igns and symptoms of Parkinsonism (ie, tremor, radykinesia, rigidity, and postu
ral instaility).</div>
"What causes ""mickey mouse"" midrain? Name the structural protein defect<div><
img src=""mickey.jpeg"" /></div>"
Progressive supranuclear palsy (PSP)<div
>Tauopathy</div>
"<div>What is this? Disease?</div><img src=""gloose.jpeg"" />" Gloose neuronal
tangle in PSP (progressive supranuclear palsy)<div><r /></div><div>Tau immunor
eactive</div>
 patient presents with the following 3 diseases:<div><r /><div><div> Striatonig
ral degeneration= parkinsonism</div><div> Olivopontocereellar degeneration= atax
ia</div><div> Shy Drager dysautonomia= autonomic dysfunction</div></div><div><r
/></div><div>Based on your understanding of molecular neuropathology, what is yo
ur diagnosis? What is the <>molecular asis</>? (once thought to e 3 separate
disease)</div></div> "Multiple system atrophy, a ""synucleinopathy""<div><r
/></div><div><div><span class=""pple-ta-span"" style=""white-space:pre""> </sp
an> Recently, intracytoplasmic a-synuclein inclusions in oligodendrocytes found,
termed glial cytoplasmic inclusions (GCI)</div></div><div><r /></div>"
What is diagnostic of MS, gross and microscopic (2)
"<div>Gross: trophy of
pons</div><div>Microscopic: alpha-synuclein positive inclusions</div><img src=""
MS.jpeg"" /><div><r /></div>"
Patient presents with ataxia, clumsiness, dysarthria, loss of tendon reflexes, a
nd impaired sensation. lso accompanied y interstitial myocarditis,&nsp;diaet
es mellitus
Friedreichs ataxia
What is the inheritance pattern of Friedreichs ataxia? What is the genetic caus
e? What is the gene name?
"<u>utosomal recessive</u><div><u>G triplet r
epeat expansion on chromosome 9</u> (amplification of oth alleles of frataxin,
or amplification of one allele with point mutation of the other)&nsp;</div><div
><u>Frataxin</u></div><div><u><r /></u></div><div><div>Friedreichs taxia: Chr
omosome 9. G is the 7th letter in the alphaet,  is 1st, G++ = 9</div><div st

yle=""text-decoration: underline; ""><r /></div></div>"

"<div>Diagnose:</div><img src=""cere atro.jpeg"" />"
Cereellar atrophy: Frie
dreichs ataxia
What spinal cord tracts degenerate in Friedreichs ataxia?&nsp;
"Posteri
or columns, CST, spinocereellar tracts<div><img src=""friedreichs.jpeg"" /></di
v>"
What protein mutations caus familial LS?
"SOD mutations (firils, not fre
e radical accumulation)<div><img src=""SOD1.jpeg"" /></div><div><r /></div><div
><img src=""SOD.jpeg"" /></div>"
What is the cytoplasmic inclusion called in Parkinsons disease? What is its str
uctural protein?
"<div>Lewy ody (accumulates in sustantia nigra)</div><
div>alpha synuclein</div><img src=""lewy (1).jpeg"" />"
For influenza vaccine, what type are nasal spray and injection? Nasal- live atte
nuated<div>Injection- killed</div>
What is the major complication (<>non</>-neurologic) in <u>kids</u> and <u>adu
lts</u> following influenza?
Otitis media (kids)<div>Sinusitis (adults)</div>
Which type of influenza has sutypes (H<su>x</su>N<su>x</su>)?
Type  o
nly (H1N1, H2N2)
HHV- give viral properties
"dsDN, enveloped<div><img src=""paste-372317829
988893.png"" /></div>" 6/20HHVDickey
How does HHV 1-3 grow and where is it latent? "Rapid growth, latent in <>DRG<
/><div><><img src=""HSV gangl.jpeg"" /></></div>"
6/20HHVDickey
How does HHV 5, 6, 7 (eta sufamily) grow and where does it persist? "Slow gr
owth, persist in <>CD4+, monocytes/macrophages</><div><><img src=""class.jpeg
"" /></></div><div><><r /></></div><div><><r /></></div><div><><img src=
""paste-184851097453174.jpg"" /></></div>"
6/20HHVDickey
How does HHV 4, 8 (gamma sufamily) grow and where is it latent?
Poor gro
wth, latent in <>lymphocytes</>
6/20HHVDickey
What immunity controls herpes viruses? Cell-mediated immune response<div>-IDS
and CMV, old people and shingles</div> 6/20HHVDickey
What does latent HSV make that allows it to remain so? anti-apoptotic mRN
6/20HHVDickey
Where specifically does varicella zoster remain latent? "<>Dorsal root</> or <
6/20HHVD
>trigeminal ganglia</><div><img src=""HSV gangl.jpeg"" /></div>"
ickey
How is varicella zoster (chicken pox) spread from person to person?
"Respira
tory is major, also contact. Patients require droplet and contact isolation.&ns
p;<div><img src=""pox (1).jpeg"" /></div>"
6/20HHVDickey
Though antivirals are not recommended for EBV, what can e given for severe infe
ction? Steroids
6/20HHVDickey
"<img src=""intra (3).jpeg"" />"
<u>HSV</u> histopathology
6/20HHVD
ickey
"<img src=""ecz.jpeg"" />"
Eczema herpeticum, HSV<div><r /></div><div><i>M
ay develop in people who have underlying skin disorders such as eczema</i></div>
6/20HHVDickey
"<div>Diagnosis? Bug?</div><img src=""herp stom.jpeg"" /><div>Who is at risk</di
v>"
Herpetic stomatitis: recurrent<div>HSV</div><div><r /></div><div><div>P
atients who are immunocompromised</div></div> 6/20HHVDickey
What does the Tzanck prep demonstrate histopathologically?
"Multinucleated
giant cells- HSV<div><img src=""tz.jpeg"" /></div>"
6/20HHVDickey
Who develops varicella pneumonia
"Immunocompromised adults and adolescent
s<div><img src=""vari.jpeg"" /></div><div><r /></div><div><img src=""paste-1861
78242347638.jpg"" /></div>"
6/20HHVDickey
"<div>What do you see here? What are some possiilities this could e?</div><img
src=""ex va.jpeg"" />" <div>Cortical atrophy, hydrocephalus ex vacuo.</div><div
>Could e lzheimers, Picks disease or lewy ody dementia</div>
Human challenge studies with Norwalk virus showed what?&nsp; "n identical in
oculum can produce widely divergent clinical manifestations.<div><img src=""norw
alk challenge.jpeg"" /></div>" 5/23GIvirusRD
dvantages of qeutiapine (seroquel)
No EPS, no prolactin elevation,&nsp;sto

nger antidepressant activity (enhanced NE activity)

5/23ntipsychoticsRD
Parvovirus B19 inds what in the ody? Blood group P antigen receptor<div>(Pres
ent on&nsp;RBC precursors, megakaryocytes,</div><div>and endothelial cells)</di
v>
Dickey
Descrie the iphasic course of disease for parvovirus (19)
"Biphasic<div>Ph
ase 1= <u>viremia</u></div><div><u><r /></u></div><div>Phase 2= immune-mediated
,&nsp;<u>immune complex</u> disease (arthritis)&nsp;</div><div><img src=""19.
jpeg"" /></div>"
Dickey
What is protective (a specifically to what) to parvovirus B19 infection?
Neutralizing antiodies to <>VP1</> Dickey
What adenovirus serotypes is an oral live virus vaccine approved for in 2011?
Types 4 and 7 Dickey
ssociated with reactivation in immunosuppressed kidney transplant patients
"BK virus<div><r /></div><div><img src=""paste-515902881661415.jpg"" /></div>"
Dickey
What is used in the treatment PML caused y JC virus? (ie, what is it indicitave
of)
HRT therapy- control of HIV Dickey
HPV vaccine protects against which serotypes? "6,11<div>16,18 (iggest cause o
f cancer)</div><div><r /></div><div><img src=""paste-516027435712977.jpg"" /></
div>" Dickey
<div>Transmission via roken skin--&gt; incuation 1-3 mo--&gt;lytic infx of epi
thelium of skin and mucous memranes</div>
HPV
Dickey
Where in the differentiated state of epithelium are HPV viral proteins/particles
<>assemled</>?
"<div>Stratum corneum</div><img src=""hpv .jpeg"" /><div
><r /></div>" Dickey
What common test is not useful in the diagnosis of papillomavirus
"Serolog
y<div><img src=""serology (1).jpeg"" /></div>" Dickey
Compare smallpox vs. chicken pox:<div>Description</div><div>Timing</div><div>Dep
th</div><div>Scar</div><div>Spread</div><div>Location</div>
"<div><img src="
"timing.jpeg"" /></div><div><img src=""paste-311711546474749.png"" /></div>"
Dickey
How to diagnose Parvovirus B19 infection?
"B19 IgM antiody<div>B19 DN (P
CR)</div><div><img src=""diag (1).jpeg"" /></div>"
Dickey
<div>Vesiculopustular rash with residual scarring</div> "Smallpox<div><img src="
"residual.jpeg"" /></div>"
Dickey
Which poxvirus cannot e diagnosed y culture? Molluscipoxvirus
Dickey
In HHV infection, what controls primary and recurrent infection? What prevents a
nd modifies the severity of infection?&nsp;
<u>Cell-mediated immunity</u> is
critical for control of primary and recurrent infections (CD8+ T cells)<div><r
/></div><div><u>Serum antiodies</u> play a role in preventing and modifying th
e severity of infection (Neut, CF, IF, ELIS)</div>
6/20HHVDickey
HSV reactivation- is it always symptomatic?
No, reactivation may e asymptom
atic
6/20HHVDickey
What is associated (causes) superinfection y CMV?
"<>Evasion of CD8 T cel
ls</> (downregulation of MHC I y viral protein)<div><r /></div><div><r /></d
iv><div>FC ""MHC I-viral peptide complex is unstale in CMV-infected cells CMV e
ffectively thwarts cytotoxic T-cell mediated
illing by bloc
ing MHC I expressio
n of viral antigens on the surface of CMV-infected white blood cells.""</div>"
6/20HHVDic
ey
"Caused by CMV, name them and who is at ris
<div><img src=""colitis.jpeg"" /></d
iv>"
"CMV pneumonia and colitis: immunocompromised patient (chemo/transplant/
HIV)<div><br /></div><div><img src=""paste-188222646780534.jpg"" /></div>"
6/20HHVDic
ey
Closely related to HHV 6. Fever, seizures, URI, Gastroenteritis in viremic patie
nts. Common in childhood.&nbsp; "HHV 7 (less common cause of roseola)<div><img s
rc=""paste-352509440819830.jpg"" /></div>"
6/20HHVDic
ey
How to diagnose EBV from CMV? (+) Monospot test = heterophile antibodies<div>C
MV will have a (-) monospot test</div> 6/20HHVDic
ey
Where does EBV persist? B cells--&gt; passed down to progeny<div><br /></div><di
v>(though the T cell response it what is atypical lymphocyte)</div>
6/20HHVD

ic
ey
What is Hebb's rule?
"""Neurons that fire together wire together""<div><img s
rc=""hebb.jpeg"" /></div>"
Is neuroplasticity in development limited to the young brain?&nbsp;
No, mech
anisms are maintained in the adult brain
What main principle underpins storage of experience dependent changes? Give an e
xample "<b>Competition for space</b>. Synapses that get good feedbac
stay stro
ng, those that don't go away.&nbsp;<div><br /></div><div>Ex. at NMJ in youth, ea
ch fiber has several axons. In adulthood just 1<br /><div><img src=""competition
.jpeg"" /></div></div>"
Neurons are competing with one another for what?&nbsp; <u>Neurotropins</u>- pro
mote growth and survival, guide axons. (NGF is an example)
What is one therapy for stro
e victims with one wea
upper limb?
"Constra
in the strong arm: competitive environment to foster recovery<div><img src=""str
ong.jpeg"" /></div>"
What explains the greater plasticity of the young brain?
<u>Overproductio
n of synapses</u> (prune bac
synapses based on use)<div><u>Cell death</u> (50%
more neurons are made than are needed)&nbsp;</div>
What happens to unused cortex in the case of say an amputee or congenitally blin
d?
"Unused cortex is ta
en over by competing neighborhoods&nbsp;<div><img s
rc=""amputee.jpeg"" /></div><div><img src=""blind (1).jpeg"" /></div><div><br />
</div>"
How is cortical ta
eover so rapid? Giveshort term and long term reasons "<div>Sh
ort term: unmas
ing of already-existing connections</div><div>Long term: growth
of new axons</div><div><img src=""new friend.jpeg"" /></div>"
Multiple system atrophy is characterized by what 3 degenerations?
<div>Par

insonism, cerebellar ataxia, autonomic dysfunction</div><div><br /></div><div><

u>Striatonigral degeneration</u> - par
insonism</div><div><u>Olivopontocerebella
r degeneration</u> - ataxia</div><div><u>Shy Drager dysautonomia</u> autonomic d
ysfunction</div>
Hemi-neglect is more common with lesions of which hemisphere? Right
Agnosia = defect of ___<div>Apraxia = defect of ____</div><div>Aphasia = defect
of ____</div> Knowing<div>Doing</div><div>Language</div>
What function does the Stroop Test test?
"Tas
shifting<div><img src=""st
oop test.jpeg"" /></div>"
What are the 3 main cortical degeneration diseases?
Alzheimer's&nbsp;<div>Pi
c
's</div><div>Lewy body dementia</div>
In classical AD, where does the dz start? What do you see clinically at first an
d as the dz progresses? -starts in region of hippocampus and adjacent cortex (en
torhinal cortex)<div>-early sx: loss of <u>recent memories</u></div><div>-as pro
gresses, problem becomes more pervasive</div>
In the variant form of AD, where does the dz start? What do you see clinically a
t first and as the dz progresses?
-can start in <b>Broca's</b> or <b>Werni
c
e's</b><div>-<u>aphasia</u> that progresses over period of months to years</di
v><div>-then morphs into <u>AD w/ memory disturbances&nbsp;</u></div>
What are the 2 main molecules involved with AD? What do each form when they poly
merize? "Beta-amyloid - plaues<div>Tau - neurofibrillary tangles</div><div><br
/></div><div><img src=""paste-39079907426736.jpg"" /></div>"
Which region of the brain is affected in Pic
's Dz? What is the clinical deficit
? Is memry affected? What is the molecule involved and what are the polymerized
forms called? "Frontotemporal&nbsp;<div>Disinhibition, loss of planning&nbsp;<
/div><div>Memory is intact</div><div>Tau - Pic
bodies (neurofibrillary tangles)
</div><div><img src=""Pic
.jpeg"" /></div><div><img src=""pic
bod.jpeg"" /></di
v>"
What molecule is involved in Lewy Body Dementia? What is the polymerized form ca
lled? What is the clinical presentation and <b>2 clinical features </b>of LBD?
"Alpha synuclein --&gt; Lewy bodies<div>Cognitive function that tends to <u>fluc
tuate</u> and is often accompanied by <u>well formed visual hallucinations</u></
div><div><img src=""lew bod.jpeg"" /></div>"
In AD, where does atrophy usually start (specific structures)? What NT is lost?

Amygdala, hippocampus, an temporal lobe<div>Ach</div>

What is hydrocephalus ex vacuo? What dz do we see it in?
When the ventric
les are big becaues they're compensating for volume loss from atrophy<div>AD</di
v>
"Name the dz:&nbsp;<img src=""paste-7352984010753.jpg"" />"
AD
What's the difference between plaues and tangles?
Plaue = extracellular<d
iv>Tangle = intracellular</div>
Which is the initiating event in AD, plaues or tangles?
Plaues --&gt; h
ence AD is a beta-amyloidopathy&nbsp;
T/F: amyloid deposits in mature neuritic plaues and in the walls of cortical an
d leptomeningeal blood vessels in AD
T
"What are the 2 circled things?<img src=""paste-7559142440961.jpg"" />" blue = B
-amyloid plaue<div>green = tau tangle</div>
"What is shown?<img src=""paste-7649336754177.jpg"" />" CERAD <u>plaue estimati
on</u> in AD<div>(<u>How many/How much</u> and disease severity correlation)</di
v>
"What is this?<div><img src=""paste-7705171329025_978336055.jpg"" /></div>"
Neurofibrillary tangle in AD
Which has good correlation with dementia: plaue staging/counting or tangle stag
ing/counting? Tangle
Does B-amyloid deposition affect tau polymerization?
Yes - current theory is
that B amyloid somehow sets into motion tau tangle deposition
What are the 3 progression stages of AD?
<u>Pre-symptomatic</u>- no impai
rment, but beta-amyloid is accumulating and tangles forming.<div><u>Mild cogniti
ve impairment</u> (MCI)- mild memory and cognitive loss, not interfering with da
ily living</div><div><u>AD</u>- demented, impaired</div>
Which stage of progression to AD does this describe?<div><br /></div><div>The pt
has no cognitive impairment. There is growing evidence that B-amyloid is accumu
lating and tangles are beginnign to form, esp in the hippocampus and adjacent te
mporal cortex.</div>
Pre-symptomatic
Which stage of progression to AD does this describe?<div><br /></div><div>The pt
has mild deterioration of memory and cognitive function that worries the pt but
which does not interefere w/ daily living/</div>
Mild Cognitive Impairmen
t
Which stage of progression to AD does this describe?<div><br /></div><div>Pts ar
e fran
ly demented on clinical exam,neuropsych eval, and there is impairment of
ADLs</div>
AD
Research shows about how long does it ta
e for plaues to ta
e form? How long un
til macros/microglia react? How long until neuritic processes form?
"1 day<d
iv>a couple of days</div><div>a couple more days</div><div><br /></div><div><img
src=""plaue.jpeg"" /></div>"
"What is this?<div><img src=""paste-9096740732929.jpg"" /></div>"
Amyloid
deposition in blood vessels in AD
What is the major clinical feature of Pic
s' Dz?
Frontal disinhibition
Where do you see atrophy in Pic
's Dz? What is spared "<u>Temporal and frontal
</u><div>Sparing of posterior 2/3 of superior temporal gyrus, parietal lobes, an
d precentral gyrus</div><div><img src=""pic
(1).jpeg"" /></div>"
Do you see neuronal loss and gliosis in Pic
's Dz?
Yes
"What is this?<div><img src=""paste-10075993276417.jpg"" /></div>"
Frontote
mporal atrophy in Pic
's Dz
In which dz does disinhibition lead to emergence of new artistic or musical abil
ities? "Pic
's<div><img src=""pic
talent.jpeg"" /></div>"
How do the neurons loo
in Pic
's Dz? """ballooned""<div><img src=""pic
bal.j
peg"" /></div>"
T/F: We see plaues, tangles, granulovacuolar degeneration, and faintly basophil
ic intraneuronal cytoplasmic inclusionsof tau in Pic
's Dz&nbsp;
"F: only
see the&nbsp;faintly basophilic intraneuronal cytoplasmic inclusionsof tau (Pic

bodies)<div><img src=""pic
bod.jpeg"" /></div>"
"What is this?<div><img src=""paste-10376640987137.jpg"" /></div>"
Pic
bod
ies

"What do these images show (name each)?<div><img src=""paste-10432475561985.jpg"

" /></div>"
Left: globose tangles in PSP<div>Right: Pic
bodies&nbsp;</div>
"What is this?<div><img src=""paste-10488310136833_978336055.jpg"" /></div>"
Neuronal loss, gliosis, and rarefaction in Pic
's dz
What do we see microscopically in LBD? Are they easy to identify on H&amp;E? How
do we usually visualize them? "subtle <font color=""#ff0000"">eosinophilic</fo
nt> cytoplasmic inclusions in <u>cortical neurons</u> (Lewy bodies)<div>No</div>
<div>Immunohistochemistry</div><div><img src=""subtle.jpeg"" /></div><div><img s
rc=""lew bod.jpeg"" /></div>"
What is the second most common cause of dementia after AD?
LBD
What does this describe?<div><br /></div><div>Fluctuating cognitive features, vi
sual hallucinations, extrapyramidal features</div>
LBD
"What's this? What protein?<div><img src=""paste-10827612553217_978336055.jpg""
/>&nbsp;</div>" Cortical Lewy Bodies (alpha-synuclein)
What is the mechanism of Donepezil (Aricept)? What dz do we use it in? Side effe
cts?
Central cholinesterase inhibitor<div>AD</div><div>Peripheral <u>choliner
gic hyperactivity</u> (vomiting, diarrhea, sweating)</div>
What are the mechanisms of Riluzole and Memantine? What dz do we use them in?
Inhibit glutamate excitotoxicity (Memantine by non-competitive NMDA receptor ant
agonism)<div>Riluzole - ALS</div><div>Memantine - AD - marginally helpful</div>
T/F: evidence suggests neurodegenerative disorders may at least in part be due t
o chronic oxidative and excitotoxic injury
T
What are many intracytoplasmic neuronal inclusions composed of? What does this i
ndicate?
Stress protein conjugated w/ a structural protein --&gt; indicat
es chronic cellular stress may have been present
Women - 2-3x more
Who's more li
ely to get AD: men or women?
What do almost all pts w/ Down's Syndrome develop if they live past 30? AD
At what ages is AD usually clinically noticed? After dx, how many years until pt
dies? 50-65yo (although onset in 30s or 40s may occur)<div>3-12 years</div>
T/F: if you get to the MCI (mild cognitive impairment) stage of AD progression,
you always progress to AD
False - most do, but not all
Which basal forebrain nucleus is depleted of cells in AD? What does it do?
"Basal nucleus of Meynert - responsible for the majority of cortical cholinergic
projections<div><img src=""meynert.jpeg"" /></div>"
What are tacrine hydrochloride, rivastigmine, and galantamine? What dz are they
used in? Which one has hepatic toxicity?
Central cholinesterase inhibitor
s<div>AD</div><div>Tacrine&nbsp;</div>
What are the 2 main drugs (by name) used in AD (the drugs you should
now)? <u>M
echanism</u>
<b>Donepezil</b> - Ach esterase inhibitor<div><b>Memantine</b> NMDA non-competitive antagonist - decr glutamate</div>
"Which dz is ""
nife-edge"" cortical atrophy characteristic of?"
"Pic
's<
div><img src=""Pic
.jpeg"" /></div>"
Huntington's overview: Onset age? Death in how many years? Atrophy of what brain
structures? Do we see compensatory hydrocephalus? Which NT is diminished?
"20s-40s<div>10-15</div><div>caudate and (to a lesser degree) putamen</div><div>
yes</div><div>GABA</div><div><img src=""hunt (1).jpeg"" /></div>"
What may be the mechanism of valproic acid?
Inhibiting voltage <b>Na+</b> ch
annels<div>Increasing <b>GABA</b></div><div>Regulating downstream signal cascade
s</div>
What would the ideal mood stabilizer do?
<div>Treat manic phase</div><div
>Treat depressive phase</div><div>Prevent manic and depressive episodes</div><di
v><br /></div><div><i>None of the currently available agents treat all phases of
illness in an ideal manner</i></div><div><i>
</i></div>
What is the conseuence of low sodium diet on lithium levels? <u>Increases lit
hium levels</u>, lithium is excreted along with sodium
Who should avoid lithium?
Patients with <u>impaired renal function</u>
What leads to the compliance issue with valproic acid? Weight gain
What are side effects of valproic acid in women?
Polycystic ovarian syndr
ome (PCOS), insulin resistance&nbsp;
Which TCA is often used in lower doses for pain management?
Amitriptyline

Which TCA was very serotinergic and used for OCD?

Clomipramine
Which TCA is used for enuresis? Imipramine
Which TCA has useful therapeutic levels?
Nortriptyline
Which class anti-depressants can cause hypertensive crisis?
MAOIs
What is the prevalence of MDD among perinatal women?
10-15%
What are some ris
s of depression in pregnancy? <div><u>MDD relapse</u></div><di
v>Increased suicidality</div><div>Poor motivation for prenatal care</div><div><u
>Disruption of maternal infant bonding</u></div><div><u>Low birth weight and dev
elopmental delay</u></div><div>Self harm</div><div>Harm to infant</div>
What are ris
s of antidepressants in pregnancy? <div><u>Congenital cardiac</u> a
bnormalities (1st TM, paroxetine)</div><div>Newborn persistent <u>pulmonary hype
rtension</u> (variable data, 3rd TM, SSRIs)</div><div>Neonatal <u>withdrawal syn
drome</u> (3rd TM, SSRIs)</div><div><u>Prematurity</u>, low birth weight (some s
tudies)</div>
How many times is ECT given per wee
? How long is a course? When is maximal impr
ovement 2-3 times per wee
<div>6-20 treatments.</div><div>Maximum improvement is
no additional improvement after <u>2 successful treatments</u></div>
Transmission of HIV reuires contact of infected fluid with what?
<div> Con
tact of infected fluid with <u>mucosa</u> or <u>non-intact s
in</u> or</div><div
> Inoculation of infected fluid <u>directly into bloodstream</u> (transfusion, in
travenous drug use)</div>
5/27HIVRetroRD
What is the single highest ris
parenteral and sexual exposure for HIV? "Blood t
ransfusion<div>Receptive anal intercourse</div><div><img src=""estimated per act
.jpeg"" /></div>"
5/27HIVRetroRD
In addition to viral load, what is another factor associated with increased ris

of acuisition HIV?
<u>Ulcerative</u> or <u>inflammatory STD</u> in either i
nfected or un-infected partner 5/27HIVRetroRD
Predicted ris
of AIDS according to age depends on what two factors?
"CD4 cou
nt and viral load<div><img src=""predict.jpeg"" /></div><div>Bottom left, we can
not wait to treat</div><div>Top right, we can wait</div>"
5/27HIVRetroRD
What is the earliest way to diagnose HIV? Then what (2nd)? Then what (3rd)?
"Earliest- Viral load (RT PCR)<div>P24</div><div>Antibody&nbsp;</div><div><img s
rc=""stages.jpeg"" /></div>"
5/27HIVRetroRD
What is FDA approved for home testing of HIV by patient?&nbsp; "HIV saliva rapi
d test<div><img src=""home.jpeg"" /></div>"
5/27HIVRetroRD
Who should be tested for HIV? All persons 13-64<div>Yearly if ongoing ris
fac
tors</div>
5/27HIVRetroRD
What class of HIV drugs are most well tolerated Integrase inhibitors
5/27HIVT
reatmentRD
What are the 4 broad goals of HIV treatment?
Suppress HIV viral load<div>Rest
ore immunologic function (CD4 count)</div><div>Reduce HIV morbididty, prolong li
fe</div><div>Prevent transmission</div> 5/27HIVTreatmentRD
What is considered undetectable viral load in HIV patients?
"&lt;20 RNA copi
es/mL<div><img src=""goal .jpeg"" /></div>"
5/27HIVTreatmentRD
"<div>What does this chart show?</div><img src=""reduction non.jpeg"" />"
HIV has an impact on end-organ damage distinct from opportunistic infections. <u
>Immune suppression impacts other organs</u> (heart, liver etc.)&nbsp; 5/27HIVT
reatmentRD
In treatment for HIV, when is the magnitude of CD4+ cell count increased the gre
atest? When is there highest li
elihood of CD4+ cell count normalization?
"Low CD4 counts<div>Earlier therapy</div><div><img src=""immune (2).jpeg"" /></d
iv>"
5/27HIVTreatmentRD
What body habitus changes occur with PI, NNRTI? "<b>Fat deposition</b> (intrabdo
minal, dorsocervical, breasts)<div><img src=""lipo.jpeg"" /></div><div><br /></d
iv><div>NN= nom noms, PI= <b>p</b>retty<b> i</b>nconvenient fat for an elite gay
</div>" 5/27HIVTreatmentRD
What body habitus change occurs with NRTI?
"<b>Fat atrophy</b> (Extremity w
asting, Facial lipoatrophy&nbsp;Mostly D4T, ddI and AZT)<div><img src=""lipo.jpe
g"" /></div>" 5/27HIVTreatmentRD
What is the main cause of virologic failure (incomplete suppression)?&nbsp;

Inadeuate adherence&nbsp;<div><br /></div><div>(also, pre-existing resistance,

inadeuate potency/drug levels)</div> 5/27HIVTreatmentRD
Aerosolized rat urine in 4 corner states
"Hantavirus<div><br /></div><div
><img src=""paste-210479167308406.jpg"" /></div>"
Is hantavirus an arbovirus?
"No, spread by rat urine aerosol&nbsp;<div><br /
></div><div><img src=""paste-210474872341110.jpg"" /></div>"
What is the tx for arenavirus lassa fever?
Ribavirin
What are 3 mechanisms of rotavirus induces diarrhea?
<b>Enterocyte</b> destru
ction--&gt; malabsorption<div><b>NSP4</b>--&gt;Cl-</div><div>Activation of <b>en
teric nervous system</b></div>
Pathogenesis of rotavirus (give spread, replication and shed timing)
<b>Fecal
-oral</b> spread, fomites--&gt; short <b>&lt;48 hr</b> incubation--&gt;replicate
s in <b>epithelial cells</b> of small intestines, <b>shed 10 days</b>
Resistance to rotavirus infection correlates best with what?
Serum and intest
inal mucosal antibody
Does norovirus cause bloody diarrhea? No
"Lesion here results in what (3)<div><img src=""orbito.jpeg"" /></div>" Orbitofr
ontal lobe: disinhibition, impulsive, environmental dependency syndrome
"<div>Lesion here results in what?</div><img src=""dlp.jpeg"" />"
Dorsolat
eral PFC: no wor
ing memory, can't learn from mista
es&nbsp;
"<div>What is this area associated with?</div><div><img src=""ventro (2).jpeg""
/></div>"
Lowered activity- depression<div>Higher activity- mania</div>
"In relation to eyes, lesion here results in what? Seizure here?<div><img src=""
FEF.jpeg"" /></div>"
"FEF<div>Lesion- eyes loo
toward lesion (left)<div>Seiz
ure- eyes loo
away from lesion (right)</div></div><div><img src=""FEF (1).jpeg"
" /></div>"
"<div>Lesion in <b>SS2</b>^&nbsp;and^&nbsp;3^oresu
lts in what?</div><img src=""SI.jpeg"" />"
Astereognosia, asomatognosia
"<img src=""hip.jpeg"" /><div>Lesion here results in what?</div>"
Hippocam
pus: Anterograde amnesia
What is the definition of TBI? External force--&gt;immediate structural or phys
iological damage (seen in AMS)--&gt; at least <u>transient functional disability
</u>
5/23TBI
T/F Perinatal trauma, intracranial surgery, inflammatory disorder of CNS, s
ull
fracture without cerebral involvement are all important causes of TBI "F, thes
e are all exclusions, among others<div><img src=""excl.jpeg"" /></div>" 5/23TBI
What do you need in a history (4, at least one) to determine if TBI occured, as
stated by american congress of rehabilitation medicine <div> &nbsp;any period of
loss of consciousness (<b>LOC</b>)</div><div> &nbsp;any loss of memory for event
s immediately before or after the</div><div>accident (posttraumatic amnesia, <b>
PTA</b>)</div><div> &nbsp;any <b>alteration in mental state</b> at the time of th
e accident (e.g., feeling dazed, disoriented, or confused)</div><div> &nbsp;<b>fo
cal neurologic deficit</b>(s) that may or may not be transient</div>
5/23TBI
Concussion=
Mild TBI
5/23TBI
Patient has LOC for 45 min and cannot remember the last 30 hours. Is this a mild
TBI? "No<div><img src=""mild.jpeg"" /></div>"
5/23TBI
What is the function of glasgow coma scale?
"Reliable, objective and practic
al scale for assessing coma and imparied consciousness behaviorally&nbsp;<div><i
mg src=""glas.jpeg"" /></div>" 5/23TBI
What is the classification for a patient with LOC PTA AOC and GCS below mild thr
esholds, but abnormal CT or MRI?
"Complicatied mild TBI<div><img src=""TB
I.jpeg"" /></div>"
5/23TBI
What is the distribution (and age) of TBI across the lifespan? "Trimodal<div>Ve
ry young (0-4), young adults (15-24), elderly (&gt;70)</div><div><img src=""epi
(3).jpeg"" /></div>"
5/23TBI
In the trimodal distribution of TBI, what is the cause of TBI? "Fall, MVC, Fall
<div><img src=""epi fal.jpeg"" /></div>"
5/23TBI
What is the leading cause of death and disability around the world?
TBI<div>
<br /></div><div>Also leading cause of coma</div>
5/23TBI
Patients with TBI are how much more li
ely to die than population? Average life

reduction?
2-5x li
ely to die<div>4-7 years life reduction</div> 5/23TBI
What is the cost of persons with moderate/severe TBI who develop neuropsychiatri
c disorder?
~4x healthcare costs compared to persons with TBI alone 5/23TBI
What are the 3 injury factors affecting TBI?
"<b>Inertial forces</b><div><b>C
ontact Forces</b></div><div>both leading to--&gt; <b>Cytotoxic cascade</b></div>
<div><img src=""factors.jpeg"" /></div>"
5/23TBI
What particular force leads to LOC?
"Rotational force, especially on upper b
rain stem (reticular activating system)<div><img src=""rotation.jpeg"" /></div>"
5/23TBI
Does baseline intellectual function matter in TBI outcome?
Of course. If hi
gh functioning, can be considered normal post TBI but really impaired compared t
o baseline
5/23TBI
What % of mod/severe TBI will develop chronic neuropsychiatric symptoms related
to TBI 35-60% 5/23TBI
What pre-injury factors ma
e you more li
ely to get a TBI?
"Major depressio
n, substance use disorder<div><img src=""substance.jpeg"" /></div>"
5/23TBI
Long term psych outcomes are particularly high for what following a TBI?
"Suicide attempt<div><img src=""suicid.jpeg"" /></div>" 5/23TBI
What probably acounts for the weight gain in atypical antipsychotics? Does weigh
t gain alone account for the insulin resistance and dyslipidemia during treatmen
t?
Histamine bloc
ade, and through actions of serotonin systems.<div>No.</d
iv>
5/23AntipsychoticsRD
There are additional side affects from typical antipsychotics mediated by other
neurotransmitters. Name 3
<b>Anticholinergic</b>- dry mouth, blurred visio
n, constipation<div><b>Anti-histamine</b>- weight gain, drowsiness</div><div><b>1 drenergic blck de</b>- r
hs

ic hyer
ensin</div>
5/23An
isych
i
csRD
Wh
4 br d f c
rs rel
e

he u
cme f
er TBI? "Cgni
in, em
in, beh
vir, sensrim
r func
in<div><img src=""f c
rs (1).jeg"" /></div>"
5/23TBI
Is TBI
shis
ic
ed nd nu nced cl ssific
in f di gnsis?
N, in f
c

here is much wi
hin-di gnsis he
ergenei
y, including:<div><div><br /></di
v><div> &nbs;nn-ene
r
ing vs. ene
r
ing TBI</div><div> &nbs;diffuse vs. fc
l vs. diffuse+fc l injuries</div><div> &nbs;mild TBI wi
h r wi
hu
neurim g
ing bnrm li
ies&nbs;</div><div> &nbs;mild TBI invlving func
in l, n
s
ruc

ur l, disru
in</div></div> 5/23TBI
C n ele wi
h GCS scre f 15 s
ill h ve CT bnrm li
ies n
he d y f injury
?
Yes, 5-10% d
5/23TBI
Wh h s mre TBIs, men r wmen?
"Men by f c
r f 1.4x<div><img src=""
men.jeg"" /></div>"
5/23TBI
Wh
% f new HIV di gnsis 
ien
s h ve CD4 &l
;200? 30%- g l is

es
eve
ryne befre
his h ens
P
ien
s wi
h CD4 &l
;200 re
risk fr wh
? &l
;100?
"&l
;200 = PCP
nd
hrush<div>&l
;100 Every
hing else</div><div><img src="".jeg"" /></div>"
Nrm l CD4 cun
is bve?
&g
;500
Wh
is
he ms
cmmn infec
in nd where in n HIV 
ien
? Lungs re
he m
s
infec
ed rg n, <u>b c
eri l neumni </u> is
he ms
cmmn illness
P
ien
resen
s wi
h HIV nd ring enh ncing lesin "CNS lymhm <div><img s
rc=""lymh (1).jeg"" /></div>"
Wh
re
he m jr dv n
ges (4) nd dis dv n
ges f CT im ging (2)? "<b>Adv
n
ges:&nbs;</b><div>-less exensive
h n MRI</div><div>-F s
</div><div>-Mre "
"en""
h n MRI</div><div>-N bslu
e cn
r indic
ins</div><div><br /></div>
<div><b>Dis dv n
ges:</b></div><div>-Im ge qu li
y is inferir
 MRI</div><div
>-<u>Ps
erir fss n
well visu lized</u> due
 bny r
if c
</div><div><img
src=""fss .jeg"" /></div>" R dilgic lIm ging
Wh
re
he rim ry uses fr CT neurlgic l im ging (3)?
"<b>CVA- quickly
rule u
hemrrh ge s c use wi
hin
he
ime windw
 use TPA</b><div><b><br /
></b></div><div>Tr um - rule u
in
r cr ni l bleed nd ""m ss effec
""</div><di
v><br /></div><div>When MRI is cn
r indic
ed</div>" R dilgic lIm ging
Wh
cn
r s
is used in CT im ging? Hw des i
hel shw CNS 
hlgy?

Idine<div><br /></div><div>I
will incre se in
ensi
y in
he br in  renchym w

here
he BBB is cmrmised (ie due
 
hlgy)</div> R dilgic lIm ging
Wh
re
he 2
yes f MRI? Wh
is
he difference in
he sign l me sured?
T1 me sures rel x
in f m gne
iz
in
h
is  r llel
 m gne
ic field<div><
br /></div><div>T2 me sures rel x
in f m gne
iz
in
h
is erendicul r

m gne
ic field</div> R dilgic lIm ging
Wh
re
he dv n
ges (2) nd dis dv n
ges (4)
 MRI vs CT? <b>Adv n
ges:</
b><div>Suerir im ge qu li
y</div><div>Av il ble im ges in 3 l nes</div><div><
br /></div><div><b>Dis dv n
ges:</b></div><div>Exensive</div><div>Slw</div><d
iv>C n c use cl us
rhbi </div><div>Cn
r indic
ed fr iml n
ed devices sens
i
ive
 m gne
ic fields</div> R dilgic lIm ging
Wh
re
he uses f MRI fr neurlgic l im ging (2)? Preferred me
hd
 de
e
c
<u>in
r cr ni l bleeds</u> (<b>exce
</b> in cu
e c ses where
ime is m jr
f c
r)<div><br /></div><div>Nninv sive s
udy f <u>cerebr l vessels</u></div>
R dilgic lIm ging
Wh
cn
r s
gen
is used fr MRI? Hw des i
wrk? G dlinum<div><br /></di
v><div>Wrks
he s me s idine des fr CT</div>
R dilgic lIm ging
Wh
is nrm l ressure hydrceh lus? Wh
re
he resen
ing sym
ms? Tre
me
n
?
Hydrceh us
h
ccurs due
 slw incre se in CSF ressure frm dr in
ge dysfunc
in- br in d 
s
 r dr in ge by incre sing ven
ricle size<div>
<br /></div><div>G i
bnrm li
ies, urin ry incn
inence, memry lss -
hese h
ve chrnic, insidius nse
</div><div><br /></div><div>Tx: seri l LPs</div>
R dilgic lIm ging
Wh
is
he ms
cmmn
ye f br in
umr? Be very secific. Me
s
sis<div><
br /></div><div>Frm- lung, bre s
, skin, kidney, GI</div><div>(L
s f B d S
uf
f Kills Gli )</div>
R dilgic lIm ging
Wh
is DWI
echnique fr neurlgic l im ging? Diffusin weigh
ed im ging<div><
br /></div><div>Mdified MRI
h

r cks <u>w
er diffusin</u> nd is helful i
n lc lizing where d m ge frm <u>ischemic s
rke ccurs</u></div>
R dilg
ic lIm ging
Wh
is
he flwch r
fr figuring u
wh

ye f im ge md li
y
s
udy is?
"<img src="" s
e-80530636800538.jg"" /><div>An
mic- being whi
e inside, grey
u
side</div>" R dilgic lIm ging
Why is T1&nbs;MRI cnsidered n
mic? Bec use gr y m

er is gr y nd whi
e m


er is whi
e<div><br /></div><div>(T₂&nbs;h s whi
e m

er s d rke
r
h n gr y m

er)</div>
R dilgic lIm ging
Wh
is
he difference be
ween T₂&nbs; nd T₂+FLAIR? Wh

is i
used fr? T₂+FLAIR m kes CSF d rk (regul r T₂&nbs;h
s CSF brigh
)<div><br /></div><div>Used
 visu lize <u>eriven
ricul r l ques
in MS</u></div>
R dilgic lIm ging
"<img src="" s
e-81166291960180.jg"" /><div>Wh
is
he 
hlgy?</div>"
Sub r chnid hemrrh ge<div><br /></div><div>*n
e
he highligh
ing f sulci nd
gyri</div>
R dilgic lIm ging
Wh

hree cndi
ins re berry neurysms ssci
ed wi
h?
ADPKD, bifid r
R dilgic lIm ging

ic v lve, m rf ns syndrme
"<img src="" s
e-81462644703623.jg"" /><div>Wh
is
he im ging md li
y nd 
CT<div><br /></div><div>In
r  renchym l hemrrh ge (in

hlgy?</div>"
R dilgic lIm ging
r ne r b s l g ngli )</div>
"<img src="" s
e-81608673591685.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" CT<div><br /></div><div>Emblic s
rke f righ
MCA&nbs
;</div><div><br /></div><div>*n
e-
he d rk regin is edem (w
er is d rk n C
T)</div>
R dilgic lIm ging
"<img src="" s
e-81767587381631.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" CT<div><br /></div><div>Eidur l hem
m (lens e r n
ce resec
ing su
ure lines)</div>
R dilgic lIm ging
"<img src="" s
e-82025285419429.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Subdur l hem
m (cnc ve
e r nce desn
resec
su
ure lines)</div> R dilgic lIm ging
"<img src="" s
e-82484846920105.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI (wi
h cn
r s
)<div><br /></div><div>Txl smsi

s enceh li
is (mul
ile ring-enh ncing lesins)</div> R dilgic lIm ging

"<img src="" s
e-82669530513749.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Prim ry CNS lymhm (SINGLE
ring-enh ncing lesin)</div> R dilgic lIm ging
"<img src="" s
e-82824149336474.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" CT<div><br /></div><div>Nrm l ressure hydrceh lus</d
iv>
R dilgic lIm ging
"<img src="" s
e-83859236454746.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Alzheimers dise se (n
e dif
fuse cr
ic l
rhy nd hydrceh lus ex v cu)</div> R dilgic lIm ging
"<img src="" s
e-84009560310079.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Frn

emr l demen
i (sel
ec
ive
rhy f frn
l nd
emr l lbes)</div>
R dilgic lIm ging
"<img src="" s
e-84129819394448.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T 2 re T2+FLAIR MRI<div>B

m 2 re T1 MRI</div><div
><br /></div><div>Mul
ile sclersis (mul
ile dissemin
ed lesins, ch r c
eris
R dilgic lIm ging

ic eriven
ricul r lesins</div>
"<img src="" s
e-84262963380532.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Pi
ui
ry denm (n
e m ss
in sell
urcic )</div>
R dilgic lIm ging
"<img src="" s
e-84383222464830.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T2 MRI<div><br /></div><div>Meningim (n
e hw m ss is
cmressing r
her
h n inv ding br in  renchym )</div>
R dilgic lIm g
ing
"<img src="" s
e-84512071483818.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Glibl s
m mul
ifrme (cl
ssic bu

erfly lesin s i
inv des b
h hemisheres vi crus c llsum)</div>
R dilgic lIm ging
"<img src="" s
e-84653805404469.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Medullbl s
m (n
e m ss i
n s
erir fss nd dil
in f l
er l ven
ricles)</div>
R dilgic lIm g
ing
"<img src="" s
e-84735409783168.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Bil
er l cus
ic schw nnm
s (m sses in n
medull ry junc
in)</div>
R dilgic lIm ging
"<img src="" s
e-84868553769315.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T2 MRI<div><br /></div><div>Here
ic enceh li
is (hyer
in
ensi
y f
emr l lbes)</div>
R dilgic lIm ging
"<img src="" s
e-84945863180702.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" CT<div><br /></div><div>Neurcys
ercersis (mul
ile cys
R dilgic lIm ging

ic lesins
hrughu
br in)</div>
"<img src="" s
e-85023172591945.jg"" /><br /><div>Wh
is
he im ging md li
y
nd 
hlgy?</div>" T1 MRI<div><br /></div><div>Br in me
s
ses (m sses ms
R dilgic lIm ging

cmmn

he gr y/whi
e m

er junc
in)</div>
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Demen
i ,
g i
rblems, urin ry incn
inence</div>
Nrm l ressure hydrceh lus
R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Periven
ri
cul r whi
e m

er lesins</div>
MS
R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Mul
ile r
ing-enh ncing lesins</div><div>vs</div><div>Single ring-enh ncing lesin</div>
Txl smsis<div>vs</div><div>Prim ry CNS lymhm </div><div><br /></div><div>B
R dilgic lIm ging

h seen rim rily in HIV+ 
ien
s</div>
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Wrs
he d
che f life, gyri nd sulci highligh
ed</div> Sub r chnid hemrrh ge R dilg
ic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Cnvex, d
es n
crss su
ure lines</div> Eidur l hem
m
R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Mul
ile c
ys
ic lesins</div>
Neurcys
ercecsis
R dilgic lIm ging

Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Mul
ile l

esins
gr y/whi
e m

er junc
in</div>
Me
s
ses<div>(L
s f B d S
uf
f Kills Gli )</div>
R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Cnc ve, d
Subdur l hem
m
R dilgic lIm g
es n
resec
su
ure lines</div>
ing
Wh
5 cndi
ins re differen
i l di gnses fr ring-enh ncing lesins n neur
im ging l bs? Txl smsis<div>Tumrs</div><div>Lymhm </div><div>Cerebr l
bscess</div><div>Tuberculm s</div><div><br /></div><div>They ll disru

he BB
B lng
he erihery f
he m ss - c use cn
r s

 le k in
 br in  renchym
nd enh nce</div>
R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Cr
ic l
Alzheimers
R dilgic lIm ging

rhy, hydrceh lus ex v cu</div>
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Blun
ing 
f
he gr y/whi
e junc
in</div> E rly ischemic s
rke R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Bu

erfly
lesin</div>
Glibl s
m mul
ifrme R dilgic lIm ging
Wh
is ssci
ed wi
h
he fllwing buzzwrds?<div><br /></div><div>Hyerin
en
si
y (im ging) in
emr l lbe</div> HSV enceh li
is
R dilgic lIm g
ing
Hw des
he fMRI nd PET sc n me sure neur l c
ivi
y? fMRI- me sures m gne
ic
rer
ies f <b>xyhemglbin</b> vs <b>dexyhemglbin</b>
 de
ermine <u>bl
d flw</u> -&g
; c
ivi
y<div><br /></div><div>PET- me sures <b>cnsum
in f
fludexyglucse</b>
 de
ermine <u>me
blic r
e</u> -&g
; c
ivi
y</div>
R dilgic lIm ging
Wh
is
he ms
cmmn si
e in
he br in fr hemrrh gic hyer
ensive s
rke?
B s l g ngli
R dilgic lIm ging
Wh
is n ischemic s
rke?
Decre se bld flw secnd ry


hrmbus (lc
l frm
in) r emblus (frm he r
r c r
id)
R dilgic lIm ging
Wh
re
he (3) risk f c
rs fr ischemic s
rkes?
-Any
hing
h
incre ses
risk f <b>
hersclersis</b> (h
n, DM, smking)<div><br /></div><div>-<b>V s
s sm</b> (subs
nce buse)</div><div><br /></div><div>-<b>Hyerc gul ble</b> s
R dilgic lIm ging


e</div>
Wh
im ging shuld yu d n susec
ed ischemic s
rke 
ien
?
<b>CT fi
rs

 rule u
bleeding</b>&nbs;(s yu c n give TPA s )<div><br /></div><di
v>DWI</div><div><br /></div><div>MRI l
er</div>
R dilgic lIm ging
Wh
is
he
re
men
fr ischemic s
rkes? (3) <b>Asirin</b><div><br /></div><
div><b>TPA</b>- mus
be given wi
h 4.5 hurs (IV) r 6 hurs (IA) f s
rke in 
rder
 wrk</div><div><br /></div><div><b>Permissive h
n</b></div>
R dilg
ic lIm ging
Which
ye f s
rke is mre cmmn, ischemic r hemrrh gic? Ischemic
R dilgic lIm ging
Incre sed ge<div><br /></div><div>Alchl buse</div><div><br /></div><div>Lw
TGs/LDL</div><div><br /></div><div>Afric n meric n</div><div><br /></div><div>A
n
ic gul
in drugs</div><div><br /></div>Reerfusin f ischemic re <div><br
/></div>
The (7) risk f c
rs fr hemrrh gic s
rke
R dilgic lIm g
ing
Wh
im ging shuld be dne n 
ien
wi
h ssible hemrrh gic s
rke?
CT w/ cn
r s
- de
ermine if
here is bleeding!
R dilgic lIm ging
Wh
re
he 3
re
men
s fr hemrrh gic s
rke?
Reverse n
ic gul
in<
div>-w rf rin: FFP+vi
K</div><div>-he rin: r
mine sulf
e</div><div><br /><
/div><div>Serius BP regul
in (CPP shuld be be
ween 61-80 mmHg)</div><div><br
/></div><div>Surgic l ev cu
in if hem
m is l rge</div>
R dilgic lIm g
ing
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_0.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_0.svg"" />"
"<img src=""6c01
d bd63c70950905c8 71 5592136017408f3_surce_svg.svg"" />"
"<img src=""6c01
d bd63c70950905c8 71 5592136017408f3_
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_1.svg"" />"
"<img sr

c=""6c01d bd63c70950905c8 71 5592136017408f3_A_1.svg"" />"

"<img src=""6c01
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"<img src=""6c01
d bd63c70950905c8 71 5592136017408f3_
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_2.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_2.svg"" />"
"<img src=""6c01
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"<img src=""6c01
d bd63c70950905c8 71 5592136017408f3_
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_3.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_3.svg"" />"
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"<img src=""6c01
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_4.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_4.svg"" />"
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"<img src=""6c01
d bd63c70950905c8 71 5592136017408f3_
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_5.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_5.svg"" />"
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d bd63c70950905c8 71 5592136017408f3_surce_svg.svg"" />"
"<img src=""6c01
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_6.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_6.svg"" />"
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"<img src=""6c01
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_7.svg"" />"
"<img sr
c=""6c01d bd63c70950905c8 71 5592136017408f3_A_7.svg"" />"
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R dilgic lIm ging
"<img src=""6c01d bd63c70950905c8 71 5592136017408f3_Q_8.svg"" />"
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"<img src=""6c01
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R dilgic lIm ging
 rxysm l, bnrm l, excessive&nbs;<u>hyersynchrnus</u>&nbs;disch rge f c
r
ic l neurns, resul
ing in &nbs;<i>ch nge in beh vir</i>&nbs;r in n&nbs
;<i>EEG disch rge</i> "Seizure<br /><div><br /></div><div>c n be rvked r u
nrvked</div><div><br /></div><div><img src="" s
e-38289633444397.jg"" /></d
iv>"
Dickey
recurren
unrvked seizures<div><br /></div><div>OR ne unrvked seizure + h
igh likelihd f mre</div><div><br /></div><div>OR rvked by sme
hing
h

shuldn
rvke seizures</div>
eilesy<br /><div><br /></div><div>2 r
mre se r
ed by mre
h
24 hurs</div>
Dickey
"<div>MS2 resen
s
 yu 
ien
h ving ""seizure"". Culd i
ins
e d be n
e f
he fllwing?</div><div><br /></div><div> &nbs;G s
resh ge l reflux</di
v><div> &nbs;Bre
h-hlding sells</div><div> &nbs;Slee myclnus</div><div> &nb
s;Nigh

errrs</div><div> &nbs;Mvemen
disrders</div><div> &nbs;Migr ines</d
iv><div> &nbs;Tr nsien
ischemic

cks</div><div> &nbs;Ver
ebrb sil r insuffi
ciency</div><div> &nbs;Hyglycemi </div><div> &nbs;Hyxi </div><div> &nbs;Psyc
hgenic seizures</div>" Yes,
hese re ll differen
i l di gnses
Dickey
A 
ien
is suddenly sh king. Is he/she defini
ely h ving
seizure? N
Dickey
Which seizure differen
i l di gnsis is  r
icul rly h rd

re

Psychge
nic seizures, <u>cnversin disrder</u> wi
h n EEG disch rge
Wh
is
he life
ime rev lence f single seizure?
9-10% Dickey

Wh
is
he life
ime rev lence f eilesy?

"0.5-1.0% (3% by ge 75)<div><im
g src="" ge rel
ed.jeg"" /></div>"
Dickey
Seizures c n be divided in

w
yes b sed n wh
?<div><br /></div><div>Wh

re
he
w
yes</div> "<b><div></div></b><b>B sed n nse
</b><div><b><br /></
b></div>Fc l nse
- ini
i l c
iv
in f sys
em f neurns limi
ed
 <u>ne
cerebr l hemishere</u>.<div><br /><div><b>Gener lized nse
</b>-&nbs;firs
cl
inic l ch nges indic
e invlvemen
f <u>b
h hemisheres</u>.</div></div><div>
<br /></div><div><img src="" s
e-38585986187804.jg"" /></div>"
Dickey
Fc l seizures c n be subdivided b sed n
he level f cnsciusness.&nbs;<div>
Wh
re
he
w
yes?</div><div><br /></div><div>Wh
c n b
h
yes evlve in
"<div>1) n l
er
in f cnsciusness ( ur s = fc l m
r sei

?</div>
zures, simle  r
i l seizures)</div><div><br /></div><div>2) im ired r l
ere
d, bu
NOT lss f cnsciusness (dyscgni
ive, cmlex  r
i l seizures)</div><
div><br /></div><div><br /></div><div>b
h
yes c n evlve in
 secnd rily gen
er lized seizures</div><div><img src="" s
e-38607461024053.jg"" /></div>"
Dickey
Brief s
ere
yic rdrme
h
recedes
he mre bvius clinic l even
by sec
nds
 minu
es Aur
Dickey
Des n ur im ir cgni
in? N. (C n be&nbs;
s
e, smell, fe r, dissci
i
n,&nbs;dej vu)
Dickey
An ur is
he c use f wh
cl ss f <b>seizure</b>? Fc l seizure Dickey
(l
in
 s
rike):
he seizure i
self
Ic
us Dickey
Semiurseful r nn-urseful u
m
ic beh virs during
he seizure.
<b>Au
m

isms</b> (Fr ex mle: icking
cl
hes, lism cking, sw llwing &nbs;C n 
ccur in b
h  r
i l nd gener lized eilesies)<div><br /></div><div>-c n ccur
in b
h  r
i l (
end
 be unil
er l) nd gener lized eilesies</div>
Dickey
<div>Cnfusin, smnlence & m; f
igue (cmlex  r
i l nd</div><div>sme gen
er lized seizures)</div><div>Ah si ( r
i l seizures ffec
ing l ngu ge re s)
</div><div>Fc l we kness</div><div>Tdds  r lysis ( r
i l seizures)</div>
Ps
ic
l s

e Dickey
<div>Lc lize
he seizure:</div><div> &nbs;Clnic mvemen
s,
nic s
uring, r

ni </div><div> &nbs;Cn
r l
er l
nic s
uring r biz rre bil
er l hyer
kine
ic mvemen
s</div> Frn
l lbe
Dickey
Where is
he seizure:<div><div> &nbs; ur f smell,
s
e, em
in</div><div> &nb
s;fllwed by cnfusin nd s
ring</div></div>
Temr l lbe Dickey
Where is
he seizure:&nbs;<div>Sm
sensry ch nges</div>
P rie
l lbe
Dickey
Where is
he seizure:<div>fl shing ligh
s, visu l dis
r
ins, eye mvemen
s</di
v>
Occii
l lbe Dickey
D gener lized seizures lw ys le d
 LOC?
Yes
Dickey
<div>P
ien
is s
iff nd
hen becmes jerky</div>
Tnic-clnic seizure
Dickey
Ree
ed, rhy
hmic jerking
Clnic seizure Dickey
Suddenly becmes s
iff Tnic Seizure Dickey
Gener lized, AOC, bu
bsence f muscle c
ivi
y. Tyic lly in children, bl nk s

re.<div><br /></div><div>Burs
ing medi
ed by wh

ye f ch nnels?</div><div
>Blcked by wh
drug?</div>
Childhd bsence seizure<div><br /></div><div>b
urs
ing medi
ed by T-
ye c lcium ch nnels</div><div><br /></div><div>blcked b
y E
hsuximide</div>
Dickey
Simil r
 bsence seizure bu
&nbs;mild m
r c
ivi
y ( ny clnic c
ivi
y u

side f ce)
A
yic l bsence seizure
Dickey
Whle bdy jerks, ree
i
ive
Myclnic seizure
Dickey
Lss f muscle
ne, ls knwn s dr

cks (kids, he d suddenly drs)
A
nic seizure Dickey
In inf n
s, flexr s
uring. Sudden jerk fllwed by s
iffening
Inf n
il
e s sms
Dickey
Wh
is defini
in f severe PCP?
O₂&nbs;&l
;70<div>Give  B
c
rim</div>
Hw d yu ev lu
e immunlgic resnse
 HIV? Tre
men
resnse?
Immunl

gic resnse- CD4<div>Tre
men
resnse- vir l l d&nbs;</div>

Wh
is
he re-exsure rhyl xis f HIV?
Em
rici
bine/
enfvir
Wh
is
he s
-exsure rhyl xis f HIV? Trile
her y wi
hin 72 hurs
Hw
 reven
HIV
hrugh drug use?
D n
use:<div><br /><div>IVDU</div><di
v>O
her subs
nces ( lchl)</div><div>-incre sed
r nsmissin vi incre sed ris
ky beh vir</div></div>
Wh
is
he r
e f erin
l
r nsmissin f HIV in un
re
ed regn ncy nd del
ivery? U
 40%
In AIDS, wh
is w s
ing syndrme ch r c
erized by?
Weigh
lss, di rrhe , f
ever
Wh
is
he me
blism nd
xici
y f CCR5 n
gnis
s?
Me
blized in l
iver P450 sys
em<div><u>He

xici
y</u></div>
Wh
is
he me
blism nd
xici
y f fusin inhibi
r?
Me
blized
hr
ugh hydrlysis<div><u>Injec
in si
e re c
in</u></div>
Wh
is
he elimin
in nd
xici
y f NRTIs? Excre
ed
hrugh
he kidneys--Dr
ugs require dse djus
men
fr ren l func
in (exce
fr <u> b c vir</u>, whic
h is liver)<div><br /></div><div><u>Mi
chn
ri l
xici
y</u>- inhibi
mi
chn
dri l DNA syn
hesis, le ding
 neur
hy,  ncre
i
is, he
i
is, nd <u>l c

ic cidsis</u></div>
Wh
is
he me
blism nd
xici
y f in
egr se inhibi
r?
Me
blized
hr
ugh liver<div>Well
ler
ed, bu
c n d <u>hyerchles
erlemi </u>, <u>rh bdm
ylysis</u></div>
Wh
is
he me
blism nd
xici
y f r
e se inhibi
rs? Seci l rer
y?
Me
blized in liver P450 ( re inhibi
rs f
he sys
em), <u>incre se serum leve
ls f 
her drugs</u> me
blized
hrugh
he sys
em<div><br /></div><div>GI, me

blic
xici
y</div><div><br /></div><div><b>Pr
</b>e se inhibi
r <b>r
</b
>ec
s 
her drugs nd r ises serum level</div>
Hw
 ev lu
e
re
men
resnse fr HIV?
Af
er s
r
ing, 2-4 weeks l
er

ke vir l l d. Then every 4-8 weeks un
il nn-de
ec ble. Then 3-4 mn
hs f

er .
"wh
4 even
s wuld be
""disru
in"" n br in func
in/s
ruc
ure in
TBI?"
ny lss f <b>cnsiusness</b><div> ny lss f <b>memry</b> (befre nd f
er)
</div><div> ny l
er
in in <b>men
l s

e</b></div><div><b>fc l neurlgic d
efeci
</b></div>
17TBI
Gl sgw cm sc le in
s fr mild, mder
e, severe TBI?
severe: 3-8 (yu
ge
3 fr simly cming in live)<div>mder
e: 9-12</div><div>mild: 13-15</div
>
17TBI
wh
2 lbes re ms
sensi
ive
 r

in l frces? frn
l nd
emr l
17TBI
where d we find s
r in/she ring frces n br in
lng <u>gr y-whi
e m


er junc
ins</u> (es frn
l,
em lbes); nd <u>crus c llsum</u> 17TBI
wh
fe
ures f
he skull resul
in cn
usins reg rdless f in
f cn
c

n skull?
cris
g lli nd shenid ridge 17TBI

he cy

xic c sc se fllwing TBI c uses d m ge bec use f cu
e excesses f
wh
neur
r nsmi

ers? f
er hw lng will
hey level u
nd re
urn
 nrm l
?
DA<div>NE</div><div>5HT</div><div>Ach</div><div><br /></div><div>level 
u
in d ys-weeks</div> 17TBI
wh
% f 
s fully recver frm TBI 1 mn
h f
er?
50%
17TBI
n
yic l recvery frm TBI c n be bec use f (3)
cmlic
ed mild TBI<div
>rir TBI</div><div> dverse neurgene
ic f c
rs</div> 17TBI
Tre
men
fr mucs l c ndidi sis?
Flucn zle
Ubiqui
us l
en
EBV c n le d
 wh
in HIV 
ien
s? Prim ry CNS lymhm , sy
s
emic lymhm
Ms
cmmn <u>dissemin
ed</u> dise ses in HIV<div>Fung l</div><div>Mycb c
eri
l</div><div>B c
eri l</div>
<div>Fung l: His
l smsis</div><div>Mycb c
er
i l: TB, MAC</div><div>B c
eri l: B r
nell </div>
Hw re sm
frm disrders dis
inguished frm 
her disrders?
The dis
rders in
his gru re dis
inguished by
he <u>sym
ms</u> f
he disrder nd

he <u>m
iv
in</u>.
Are sm
frm disrders lw ys cnscius?
N, m y ls be uncnscius (cn

versin disrder)
<div>Defini
in: The resen

in f sychlgic l dis
ress by me ns f sym
ms
Sm
iz
in

h
resemble hysic l dise se</div><div> </div>
Wh
re ssible m
iv
ins fr sm
frm disrder?&nbs;
<b>M niul
in<
/b> f in
erersn l rel
inshis<div><b>Privileges </b>f
he sick rle includ
ing&nbs;<i>s nc
ined deendency</i>&nbs;(cul
ur l s nc
in f
he sick rle)<
/div><div><b>Fin nci l</b>&nbs;g in</div><div><div><b>Cmmunic
in </b>f ide
s r feelings
h
re smehw <i>blcked</i> frm verb l exressin</div><div><
b>Influence </b>f in
r sychic defenses </div></div><div><b><br /></b></div>
D hysic l nd sychlgic l dis
resses c rry
he s me rivileges?
<div>Phy
chlgic l dis
ress des n
c rry
he s me rivilege s hysic l dis
ress</div>
In develmen
, wh
 ren
l influences c n le d
 sm
izing beh vir? (2)
1. P ren
l figues
h
h ve been dem nding nd unrew rding <b>exce
during
im
es f illness</b><div><b><br /></b><div>2. P ren
l figure wi
h <b>signific n

illness</b></div></div>
Children exerience unle s n
ffec
ive s

es befre
hey h ve
he bs
r c
v
c bul ry
 exress
hem. Wh
c n
his le d
?
F ilure
 g in
he <b>v
erb l skills</b>
 exress ffec
ive s

es m y be cmnen
f sm
izing be
h vir
Wh
is
he neurbilgic l
hery f sm
iz
in disrder?
<div>Righ
hemis
here (nn-dmin n
) l ngu ge ssci
ed bnrm li
ies&nbs;</div>
Hw des cul
ure l y in
 sm
iz
in?
Wes
ern cul
ures h ve mre wrds

 cnvey em
in l dis
ress.<div>In m ny <u>nn-Wes
ern cul
ures</u>, sm
ic
r hysic l b sed
erms re used
 cnvey em
in l dis
ress</div>
Wh
is ne c u
in when ev lu
ing
sm
ic 
ien
? <div>M ny 
ien
s wi
h
sm
iz
in disrders f
en h ve sme <b>re l</b> medic l cndi
in s well</div>
<div><br /></div>
Wh
re sme difficul
ies fr
he men
l he l
h rfessin l in
king c re f
sm
izing 
ien
? Sm
izing 
ien
s will c
ively <u>resis
being
sych
men
l he l
h rfessin l f
er <u

ien
</u><div>They re usu lly sen


>medic l r surgic l hysici n h s given u</u></div>
Wh
re 4 cmrbid disrders in sm
frm disrders? <div>Md Disrders</div
><div>Anxie
y Disrders</div><div>Persn li
y Disrders</div><div><div><b>Subs

nce Abuse</b> (Of
en i
rgenic)</div></div>
Wh
re
w nevers in
re
ing sm
izing 
ien
? Hw m ny rim ry c re MD
s d
hey need? "Never frge

h

here m y be
<u>re l</u> medic l cndi
in
resen
<div><br /><div>Never s y ""I
s ll in yur he d""</div><div><div><br />
</div><div>H ve nly ONE rim ry c re MD.</div></div></div>"
Inv sive di gns
ic rcedures shuld be b sed n {{c1::bjec
ive cri
eri }} nd
n
n
he 
ien
s subjec
ive cml in
s
"<div><br /></div><i><fn
clr
=""#0000ff"">Rec ll Dr. D sc nd
he&nbs;Mnch usen syndrme 
ien
: d n
be
n en bler&nbs;</fn
></i>"
Acu
e nse
r ex cerb
in f hysic l sym
ms is usu lly ssci
ed wi
h __
___?
S
ressr
Wh
re
he cri
eri fr sm
iz
in disrder? (4) <div>-<b>P in</b> sym

ms in&nbs;<b>4</b>&nbs;<b>differen
</b> bdy si
es</div><div>-A
le s
<b>2 GI
</b> sym
ms</div><div>-A
le s
<b>ne sexu l</b> r rerduc
ive rblem 
he
r
h n  in</div><div>-A
le s
<b>ne seudneurlgic</b> sym
m (we kness, l
ss f sensry, bu
c nn
rerduce)</div><div><br /></div><div>4 limbs</div>
<div>2 in
es
ines</div><div>1 geni
li &nbs;</div><div>1 br in</div>
Wh

her y h s been shwn
 reduce
he frequency nd severi
y f sym
ms f
sm
iz
in disrder? S
iul
in?
<div>Cgni
ive beh vir l
her y (CBT)<
/div><div><br /></div><div><i>(rim ry MD mus
sur

he use f
her y)</i></
div>
Wh
h s ls been shwn
 imrve sci liz
in nd cing skills in 
ien
s
wi
h sm
iz
in disrder?
Gru
her y
Di gnse:<div><br /><div><div><div>1) A sensry r m
r sym
m</div><div>2) Th
e sym
m is receded by
cnflic
</div><div>3) N
in
en
in l (uncnscius)</
div><div>4) N findings in medic l wrk u</div></div></div></div>
Cnversi
n disrder

Wh
re
w educ
in l r ches in
he m n gemen
f cnversin disrder?

<b>Psycheduc
in l r ch</b> wi
h emh sis n <b>mind-bdy</b> cnnec
in<d
iv><b>F mily educ
in</b> is ls imr
n
s
he f mily envirnmen
reinfrce
s
he cnversin sym
m</div>
Wh
re
w
echniques in m n ging cnversin disrders?
<u>Hynsis</u>

 rel x defenses<div><br /><div><u>Amb rbi
l</u> in
erviews</div></div>
Wh
re 3
her eu
ic beh vir l r ches
 cnversin disrder
<b>Pr is
e nd rew rd</b> d 
ive beh vir<div><b>Ignre</b> sick rle beh vir</div><di
v><b>Cmbined beh vir l
her y</b> (hysic l, ccu
in l, nd seech
her y
)</div>
Wh
re sme Seed (1996) recmmend
ins fr beh vir l r ch
 cnversin
disrder?
1. Cmle
e di gns
ic
es
s befre beh vir l in
erven
ins s

r
ed<div><b>2. Dn
men
in</b> cnversin disrder
 
ien
(be mre v gue)<
/div><div>3. One ersn crdin
ing c re</div><div>4. Shw rgress
hrugh <b>
vide
ing</b></div><div><br /></div><div>Physic l
her y&nbs;</div><div>Occu

in l
her y</div>
<div>Di gnse:&nbs;</div><div>-Preccu
in wi
h h ving serius dise se due

 misin
erre

in f bdily sens
ins</div><div>-C nn
be re ssured</div><d
iv>-N
delusin l</div>
Hychndri sis
Wh
re
he 3 fund men
l ch nges in neur l func
in
h
c use 
ien
s
 sei
ze?
"<u><div>1. Lss f inhibi
in</div><div></div></u><div>gener lized eil
esy + febrile r febrile seizures</div><br /><u>2. In
rinsic exci
bili
y</u><
div>benign f mili l nen
l cnvulsins</div><div><u><br /></u></div><div><u>3.
Excessive synchrniz
in</u></div><div>childhd bsence eilesy</div><div><u
><br /></u></div><div><u><img src="" s
e-39466454483235.jg"" /></u></div>"
Dickey Seizures
Hw des lchl wi
hdr w l c use seizures?
"Lss f chrnic GABA s
imul
i
n le ds
 disinhibi
in (exci

ry:inhibi
ry r
i
hrwn ff)<div><img src="
" s
e-6923487281558.jg"" /></div>"
Dickey Seizures
Hw des hyn
remi c use seizures? Neurns swell -&g
; less in
ercellul r s
 ce -&g
; eh 
ic
r nsmissin is much mre effec
ive -&g
; incre sed synchrn
y
Seizures
Hw des hyxic-ischemic injury c use seizures?
Le ds
 ex
r cellul r <
u> ccumul
in f glu
m
e</u> (exci

ry:inhibi
ry inu
r
i
hrwn ff)
Dickey Seizures
Sequence f even
s
h
cnver
s nrm l neur l ne
wrk in
 n bnrm lly&nbs
;<u>hyerexci
ble</u>&nbs; nd&nbs;<u>hyersynchrnus</u>&nbs;ne<br /><div>
<br /></div><div>Describe l
en
erid</div> <div>Eile
genesis</div><div><
br /></div><div>There is usu lly <u>l
en
erid</u> frm
he insul

h
c u
ses <b>eile
genesis</b> nd
he develmen
f <b>clinic l eilesy</b></div>
Dickey Seizures
"<img src="" s
e-1778116460894.jg"" /><div>Hw des
his circui
wrk in
he b
r in? Hw c n i
g wrng, nd wh
h ens?</div>"
Ac
ivi
y f
he yr mid
l neurns c
iv
es feedb ck inhibi
in- reven
s verexci

in<div><br /></div
><div>These inhibi
ry in
erneurns re vulner ble
 cell de
h -&g
; lss f i
nhibi
in le ds
 hyerexci
bili
y</div>
Dickey Seizures
<u>Gener lized eilesy wi
h febrile seizures lus (GEFS+)</u><div><u><br /></u>
</div><div>Mu

in in wh
rece
r?</div><div><br /></div><div>Le ds
 wh
?<
/div><div><br /></div><div>Onse
?</div><div><br /></div><div>Clinic l resen

i
Mu

in in <b>GABA_A&nbs;rece
r</b>,&nbs;<div><br
n?</div>
/></div><div>le ds
 dysfunc
in l inhibi
in -&g
; incre sed exci
bili
y</di
v><div>(DISINHIBITION)<br /><div><br /></div><div>nse
: wi
hin firs
dec de</di
v><div>febrile seizures
h
ersis
beynd 5 ye rs +/- febrile gener lized sei
zures</div><div><br /></div><div><b>G</b>EFS <b>G</b>ABA</div></div>
Dickey S
eizures
<u>Benign F mili l Nen
l Cnvulsins.</u><div><br /></div><div>Resul
s frm w
h
?</div>
Lss f func
in mu

in in <b>K<su>+</su>&nbs;ch nnels</b>
-&g
;&nbs;<div>decre sed hyerl rizing curren
-&g
;&nbs;</div><div>incre se
d b seline exci
bili
y</div> Dickey Seizures
Hw des glisis ffec
rensi
y fr seizures?
Glisis fllwing neurn

l lss le ds
 incre sed synchrniz
in f rem ining neurns -&g
; <u>incre s
ed ch nce f seizure</u>
Dickey Seizures
"<img src="" s
e-2040109465934.jg"" /><div>Gener lized seizure, fc l seizure,
In
eric
l disch rge
Dickey Seizures
r in
eric
l disch rge?</div>"
"<img src="" s
e-2091649073497.jg"" /><br /><div>Gener lized seizure, fc l se
izure, r in
eric
l disch rge?</div>" Gener lized seizure
Dickey Seizures
"<img src="" s
e-2126008811893.jg"" /><br /><div>Gener lized seizure, fc l se
izure, r in
eric
l disch rge?</div>" Fc l seizure Dickey Seizures
Wh
re
he ms
imr
n
di gns
ic
ls fr seizures?
Medic l nd f mi
ly his
ry<div>DETAILED descri
in f even
</div><div>Neur ex m</div><div>L b/
im ging s
udies</div> Dickey Seizures
Wh
is
he c use f ch nnel
hies eilesy r childhd bsence eilesy?
Gene
ic Dickey Seizures
A 
ien
h s n unrvked seizure nd is rushed

he hsi
l. His EEG, MRI,
nd neur ex m re ll nrm l.&nbs;<div><br /></div><div>Wh
is his ch nce f
h ving n
her seizure?&nbs;<div><br /></div><div>Shuld he be
re
ed?</div><
/div> 30%, likely
his w s c
u lly rvked seizure, bu
rvc
in is unk
nwn<div><br /></div><div>yes,
re
firs
unrvked seizure wi
h n
i-eile
i
c drugs</div><div>(new AAN guidelines)</div>
Dickey Seizures
A 
ien
h s n unrvked seizure nd is rushed

he hsi
l. His EEG, MRI,
nd neur ex m re ll <b> bnrm l</b>.&nbs;<div><br /></div><div>Wh
is his
ch nce f h ving n
her seizure?&nbs;</div><div><br /></div><div>Shuld he be

re
ed?</div> 90%<div><br /></div><div>Prb bly gd ide
 s
r

hinking
meds</div>
Dickey Seizures
A 
ien
h s n unrvked seizure nd is
ken

he hsi
l where she h s 3
mre seizures in
he fllwing 10 hurs.&nbs;<div><br /></div><div>Des she h
ve eilesy?</div>
N- mul
ile seizures in
he s me 24 hur erid nly c
un
s 1<div><br /></div><div>Need 2 indenden
seizure eisdes fr eilesy di
gnsis</div> Dickey Seizures
Des
re
men
l
er
he risk f recurrence f
er
he firs
unrvked seizure?
N
Dickey Seizures
Hw re
re
men
s chsen fr eilesy? (2)
1) syndrme cl ssific
in (ex.
childhd bsence eilesy use e
hsuximide)<div><br /></div><div>2)
ye f sei
zure</div><div>- fc l-nse
= n rrw sec
rum gen
s</div><div>- gener lized-n
se
= br d sec
rum gen
s</div><div><br /></div>
Dickey Seizures
Nrm lly n single n
i-eile
ic drug is mre effec
ive
h n n
her (cnsideri
ng
hey re b
h rri
e fr
he secific eilesy),
he m jr difference is
in side effec
s.&nbs;<div><br /></div><div>Wh
is
he exce
in?</div>
E
hsuximide fr childhd bsence seizures is bes

Dickey Seizures
Wh
re
he 7 mech nisms fr n
i-eile
ics? <div><u>1. Blck</u> vl
ge g

ed <u>sdium</u> ch nnels- decre se del riz
in</div><div><u>2. Blck</u> vl

ge g
ed <u>c lcium</u> ch nnels- decre se del riz
in</div><div><u>3. Incr
e se 
ssium</u> ch nnel en
ime- incre se hyerl riz
in</div><div><br /
></div><div><u>4. Incre se GABA_A</u>&nbs;rece
r c
ivi
y -&g
; inc
re se&nbs;Cl<su>-</su>&nbs;influx -&g
; incre se hyerl riz
in</div><div
><u>5. Decre se GABA u
ke/me
blism</u> -&g
; incre se GABA_A&nbs;
rece
r&nbs; c
ivi
y -&g
; incre se&nbs;Cl<su>-</su>&nbs;influx -&g
; incr
e se hyerl riz
in</div><div><br /></div><div><u>6. Blck NMDA</u> rece
r
-&g
; decre se del riz
in frm glu
m
e</div><div><u>7. Blck AMPA</u> rece

r -&g
; decre se del riz
in frm glu
m
e</div> Dickey Seizures
Differen
i
e be
ween br d sec
rum nd n rrw sec
rum n
i-eile
ics.&nbs;<
div><br /></div><div>When shuld e ch be given?</div> Br d sec
rum- h ve mul

ile mech nisms f c
in nd wrk fr <u>mul
ile seizure
yes</u> (use fr g
ener lized seizures r if
ye is uncle r)<div><br /></div><div>N rrw sec
rumselec
ive mech nism
h
wrks fr <u>secific seizure
yes</u> (use fr cle r
ly di gnsed seizure
ye, ei
her gener l r fc l)</div>
Dickey Seizures
Wh
n
ieile
ics re n
me
blized by
he liver? Where re
hey me
blized
?
G b en
in, reg b lin, levi
ir ce
m<div><br /></div><div>Kidney</div>
Seizures
M
ch
he n
ieile
ic wi
h i
s fun f c
<div><br /></div><div>DRUG</div><div>C

rb m zeine&nbs;</div><div>G b en
in</div><div>Pheny
in</div><div>Phenb rbi

l</div><div><br /></div><div>FACT</div><div>Nn-line r elimin
in kine
ics</di
v><div>Lnges
h lf-life</div><div>Shr
es
h lf-life</div><div>Au
-induces i
s
wn me
blism</div> <div>Nn-line r elimin
in kine
ics--Pheny
in</div><di
v>Lnges
h lf-life--Phenb rbi
l (100 hrs)</div><div>Shr
es
h lf-life--G b 
en
in (5 hrs)</div><div>Au
-induces i
s wn me
blism--C rb m zeine</div>
Seizures
Wh
re
he dverse effec
s (3 +
xici
y) f ll n
ieile
ic drugs? <div>Diz
ziness</div>Drwsiness<div>R sh</div><div><div><br /></div><div>Uns fe in regn
ncy (defini
ely fr lder drugs, uncle r fr newer nes)</div></div>
Dickey S
eizures
Wh
re
he&nbs;<b>
xici
ies</b> ssci
ed wi
h n
i-eile
ic drugs?
Txici
y
 <b>bne m rrw</b> nd <b>liver</b><div><b><br /></b></div><div>Sh k
e
h
f

y liver nd f

y bne m rrw!</div> Dickey Seizures
N me
he fllwing drugs s br d r n rrw sec
rum<div><br /></div><div>V lr

e</div><div>Znis mide</div><div>Pheny
in</div><div>E
hsuximide</div>
V lr
e- br d<div>Znis mide- br d</div><div>Pheny
in- secific fr <u>fc
l</u>&nbs;(<b>Ph</b>eny
in = <b>f</b>c l)</div><div>E
hsuximide- secific f
r <u> bscence</u> seizures (b
h french sunding)</div> Seizures
A 
ien
h s gener lized eilesy, nd
he hsi
l nly h s drugs fr fc l
nse
. D yu give
hem
h
? NO<div><br /></div><div>I
wn
hel nd i
mig
h
m ke
hem wrse</div>
Dickey Seizures
Wh
n
i-eile
ic cl ss ( nd n me) is
he firs
line
re
men
fr fc l eile
sies?&nbs;<div><br /></div><div>Secnd line? (give drug n me + cl ss)</div>
Sdium ch nnel blckers (Oxc rb zeine)<div> ls leve
ir ce
m, c rb m zeine, 
heny
in<br /><div><br /></div><div>Secnd line: l cs mide, l m
rigine,
ir
m
e, znis mide</div></div>
Dickey Seizures
Hw successful re n
i-eile
ic regimens?<div>(fr c
ins)</div>
"2/3 re
seizure free f
er
heir 1s
, 2nd, r 3rd drugs<div><br /></div><div>1/3 cn
in
ue
 h ve seizures desi
e
re
men
</div><div><img src=""AED.jeg"" /></div>"
Dickey Seizures
Wh
re sme nn-h rm clgic l
re
men
s fr medic lly refr c
ry 
ien
s w
i
h eilesy? (4)
<u>Ke
genic</u> die
(ex
reme
kins)<div>high f
, lw
c rb induces ke
sis =&g
; n
icnvuls n
effec
s<br /><div><br /></div><div>E
ilesy <u>surgery</u> (lesinec
my, lbec
my, hemisherec
my, crus c lls

my)</div><div><br /></div><div><u>V gus nerve</u> s
imul
r</div><div><br /></
div><div>Resnsive <u>fc l cr
ic l s
imul
in</u></div></div>
Dickey S
eizures
Wh
re sme
echniques
 use in
he m n gemen
f hychndri sis? 1. Exl
re when
he sym
m beg n<div>2. Use c re when
r nsl
ing sm
ic in
 sychl
gic l</div><div>3. Encur ge indeendence & m; discur ge regressin</div><div>
<b>4. Dn
sk dn

ell wi
h reg rd
 ny reviusly men
ined sym
m</b></
div>
<div>Rel
ed
 OCD</div><div>Preccu
in wi
h n im gined defec
in&nbs; e
r nce</div>
Bdy Dysmrhic Disrder
Wh
is
he
re
men
(2) f bdy dysmrhic disrder? <b>SSRI</b> (simil r

OCD
re
men
, remember we use&nbs;fluvx mine SSRI fr OCD)<div><b>Beh vir l

her y</b></div>
<div>Sym
ms re in
en
in lly cre
ed fr
he urse f ssuming
he sick rle
nd
he

en
in nd reduc
in f resnsibili
y
h
ccm nies i
.</div>
F c
i
ius Disrder
Of
en ccurs by rxy, usu lly in children under
w, wi
h cml in
s f ne 
r seizures
F c
i
ius disrder
Is
here ny h rm c
her y
h
wrks fr f c
i
ius disrder?
Nne r
ven
Wh
is
he m n gemen
f f c
i
ius disrder? <div>Sur
ive, nn ccus
ry,
nd em
hic <b>cnfrn

in</b></div><div>Lng-
erm <b>sych
her y</b></div>
<div>Di gnsis:</div><div>Individu ls feign illness fr <i>re sns 
her
h n
h
e sick rle</i></div><div>Secnd ry g in, f
en fin nci l is invlved</div>
M lingering

M n gemen
f m lingering?
<div>Medic l nd sychi
ric <b>ev lu
in</b></
div><div>Allw 
ien

 <b>give u sym
ms</b> wi
h digni
y.</div>
Is nrexi nervs included in bdy dysmrhic disrder?
N
sym
ms/signs f cu
e he
i
is
sym
ms ms
ly nnsecific - m l ise, f
ever, nrexi , n use /vmi
ing, RUQ  in<div><br /></div><div>signs - j undice
+ he
meg ly, elev
ed l bs fr liver
es
s (<b>ALT&g
;&g
;AST</b>, <b>bilirub
in, LDH, lk hs</b>)</div>
hw m ny ser
yes f heA re
here? wh
re
he imlic
ins f
h
?
jus
ne ser
ye; ne infec
in r ne v ccine = univers l heA r
ec
in
IgM n
i-HAV (-), IgG n
i-HAV (+)...wh
des
his indic
e? "reslved heA i
nfec
in<div><img src="" s
e-20955145437185.jg"" /></div>"
is heA
re
ed?
<b>r rely</b>, wuld nly give immune serum glbulin (<b
>ISG</b>) if very severe r immuncmrmised (very yung r ld)
bes
w y
 reven
heA? (give secific
ye) "<u>in c
iv
ed</u> HAV v ccine
- c n hel even when given f
er exsure<div><br /></div><div><img src="" s
e65296387801718.jg"" /></div>"
heA is ms
cmmnly fund where?
"<div>develing cun
ries</div><div><im
g src=""develing.jeg"" /></div>"
Which
w cmlic
ins f chrnic he
i
is c n le d
 de
h? "cirrhsis nd/
r he
cellul r c rcinm <div><img src="" s
e-25503515803649.jg"" /></div>"
Describe
he relic
in s
r
egy f heB
"heB is dsDNA virus<div>uses
liver cell m chinery fr ei
her</div><div><br /></div><div>(1) DNA
r nscri
in

 RNA --&g
; reverse
r nscri
in
 DNA --&g
; incrr
in in
 cell DNA</
div><div><br /></div><div>r</div><div><br /></div><div>(2) DNA
r nscri
in

mRNA --&g
; heB r
ein syn
hesis</div><div><br /></div><div><img src=""relic

in B.jeg"" /></div>"
where des heB h ve highes
rev lence?
"subs h r n fric , si <div><im
g src=""m  B.jeg"" /></div>"
bigges
risk f c
rs (3) fr heB cquisi
in? "he
ersexu l
r nsmissin, injec

ing drug use, nd ""unknwn"" (erh s due
 sh ring f husehld i
ems like r
zrs/u
ensils/e
c.)<div><br /></div><div><img src="" s
e-25915832664065.jg""
/></div>"
cu
e heB infec
in
yunger r lder ge le ds
 higher likelihd f chrn
ic infec
in? wh
bu
risk f sym
m
ic infec
in? "yunger ge --&g
; gre

er risk f <b>ersis
en
</b> infec
in<div>lder ge --&g
; gre
er risk f <b>
sym
m
ic</b> infec
in</div><div><img src=""u
cme.jeg"" /></div>"
b
h heB S n
igen nd n
ibdy re neg
ive...des
his me n 
ien
h s never
been infec
ed?&nbs; "n,
here is
sm ll windw where b
h heB surf ce n

igen nd n
ibdy will be bsen
;
es
fr <u>HBcAb</u><div><br /></div><div><im
g src="" s
e-26787711025153.jg"" /></div>"
Which gen
ye f heC is ms
cmmn? gen
ye 1 nd 1b
highes
re s f rev lence fr heC? "EGYPT, si <div><img src=""c m .jeg""
/></div><div><br /></div><div><img src="" s
e-247437360890486.jg"" /></div>"
n
ibdy
 heC rem ins high reg rdless f infec
in is cu
e r chrnic...hw
d yu
ell
he difference?
"lk
heC RNA - will n
be resen
if heC
is cn
rlled<div><br /></div><div><img src="" s
e-28776280883201.jg"" /></div
><div><img src=""chrnic C.jeg"" /></div>"
Tw f c
rs
h
slw dwn rgressin f heC? Tw f c
rs
h
seed u rgre
ssin rgressin f heC
slwing dwn f c
rs - fem le, yung ge
infe
c
in<div>seeding u f c
rs - lchl use, cinfec
in (like w/ 
her he
i
i
s, HIV)</div>
"<img src="" s
e-28965259444225.jg"" />"
<div>ex
r he
ic m nifes

ins
f heC</div>
is
here v ccine fr heC?
NO - reven
by viding risky exsures
"<img src="" s
e-29175712841729 (1).jg"" />"
nswer - B

w key sym
ms f creu
zfeld
-j kb dz?
resenile demen
i nd myclnus
Hw
 kill rin cn
min
in <div>S
e m u
cl ving 1 hur
132<su></su>
C</div><div><br /></div><div>Immersin in N OH fr 1 hur
rm
emer
ure</d
iv>
<div>_____ ssci
ed wi
h ri
u l c nnib lism</div><div><br /></div><div>_____

ssci
ed wi
h i
rgenic sre d:</div><div><br /></div><div>-Surgic l equimen

; Hum n grw
h hrmne; Crne l nd dur m
er gr f
s</div>
Kuru&nbs;<div>C
JD</div>
P
ien
frm new Guine rrives wi
h cerebell r <b>
xi </b>, shivering <b>
rem
r</b> nd <b>chre </b>. His u
sy shws neurn l lss, mylid l ques, nd
n infl mm
in Kuru
P
ien
resen
s wi
h demen
i , clnus, EEG ch nges. Sngifrm ch nges nd s
r
CJD
glisis re n
ed.
Linked
 BSE (m d cw dise se), iden
ified in Gre
Bri
in in 1996.&nbs;
V ri n
CJD
<div>P
ien
frm Lndn wi
h rehensin, rched b ck, bnl. he d</div><div>
s
ure, s
r igh
bduc
ed hind limbs, nd s
ring eyes.&nbs;</div>
Bvine S
ngifrm Enceh l
hy (BSE)&nbs;
Acu
e he
i
is l bs? Elev
ed l nine min
r nsfer se (<b>ALT&g
;&g
;AST</b>
)<div> s r

e min
r nsfer se (<b>AST</b>)</div><div>l c

e dehydrgen se <b
>(LDH</b>)</div><div> lk line hsh
se (<b> lk hs</b>)</div><div>bilirubin
(<b>bili</b>)</div>
"<img src=""6 (2).jeg"" />"
B
Wh
re
he 3 endin
s f
re
men
f chrnic HBV infec
in? HBeAg sercnver
sin (frm Ag
 Ab)<div><br /></div><div>elmini
in f de
ec
ble virus</div><
div><br /></div><div>ALT&l
;0.5 ULN</div>
ID blck6
re
men
6/4
re
men

s
Wh
is
he difference be
ween fe r nd nxie
y?
<div><b>Fe r</b> is
re
snse

<u>knwn
hre
</u> while <b> nxie
y</b> is <u>v gue, in
ern l r c
nflic
u l</u></div>
_______ c n be ch r c
erized by sychlgic l dis
ress, hysic l dis
ress r
c
Anxie
y
mbin
in f
he
w
T/F Anxie
y is
yic lly <u>univers l</u> nd uses simil r cing mech nisms
F lse, nxie
y is <u>individu lly</u> deenden
n <b>defenses</b> nd <b>cing
mech nisms</b>
Wh
is
he SES ssci
in wi
h nxie
y disrders?
<u>Higher sciecnmic
s

us</u> is ssci
ed wi
h higher rev lence f nxie
y disrders
Wh
is n
in l rev lence f nxie
y disrder?
1 in 4
Wh
is
he 12 mn
h in
rev lence fr nxie
y disrder?&nbs;
~18%
Wh h s mre nxie
y, men r wmen?
Wmen (30.5) vs. Men (19.5)
Wh
did Freud believe c used nxie
y?&nbs;
<div>Freud believed nxie
y w s
c used by <u>cnflic
be
ween uncnscius <b>sexu l</b> r <b> ggressive</b> urg
es
dds wi
h
he <b>suereg</b></u>. Defense mech nisms were c
iv
ed. Sym

m
ic nxie
y ccurred wi
h
he <u>f ilure f defense mech nisms.</u></div>
Wh
ccurs bilgic lly in nxie
y?
<div><u>Incre sed sym
he
ic
ne</u> (
 r
icul rly in  nic</div><div>disrder) in resnse
 mder
e s
imuli</div><
div><br /></div><div>Neur
r nsmi

er unders
nding is derived frm
he
rge
n
eur
r nsmi

ers in
re
men
- <u>GABA, nreinehrine nd ser
nin</u></div>
Wh
is
he rle f NE in nxie
y disrders? Wh
des i
c use, wh
is wrng,
nd wh
is 
en
i l
re
men
?
<u>Insmni </u>, <u>s
r
le</u> nd <u>
u
nmic hyer rus l</u> re ch r c
eris
ic f incre sed nreinehrine func
i
n<div><br /></div><div><div>Individu ls wi
h nxie
y disrders m y h ve <u>rl
y regul
ed nreinehrine func
in</u></div><div><br /></div><div><u>Nreineh
rine n
gnis
s</u> reduce nxie
y sym
ms</div></div>
Wh
is
he rle f ser
nin in nxie
y disrders? P
en
i l
re
men
?
<div>Acu
e s
ress is ssci
ed wi
h <u>incre sed
urnver f 5HT</u> in
he <b>
PFC</b>, <b>nucleus ccumbens</b>, <b> mygd l </b> nd <b>l
er l hy
h l mus</
b></div><div><br /></div><div>The ser
inergic n
ideress n
s s well s <u>5HT
1A gnis
s</u> re effec
ive in
he
re
men
f nxie
y</div>
Wh
is
he rle f GABA in nxie
y disrder/
re
men
? <div><u>An
gnis
s f G
ABA-A</u> c n induce  nic

cks</div><div><br /></div>S
rngly sur
ed by

he <u>effic cy f medic
ins (benzdi zeines)
h
enh nce
he c
ivi
y f GAB
A- A</u>
<div>Di gnse:</div><div><b>4</b> r mre wi
h bru
nse
nd e king wi
hin 1
0 minu
es</div><div>P li

ins</div><div>Swe
ing</div><div>Trembling r sh ki

ng</div><div>Feeling f chking</div><div>Ches
 in</div><div>N use </div><div>

Dizziness r f in
ness</div><div>Dere liz
in</div><div>Feeling f lsing cn
r
l r ging cr zy</div><div>Fe r f dying</div><div>P res
hesi s</div><div>Chill
s r h
fl shes</div> P nic A

ck
<div>Anxie
y bu
being in l ces where esc e migh
be difficul
r hel migh

n
be v il ble in
he even
f  nic

ck</div><div><br /></div><div>Si
u

ins re vided r endured wi
h gre
dis
ress</div> Agr hbi <div><br /></
div><div><i> gr =m rke
l ce + hbs=fe r</i></div>
A

cks l s

le s
nce mn
h nd re ccm nied by <b>fe r f h ving n

her

ck</b>, w<b>rry bu

he imlic
ins f n

ck</b> r <b>signifi
c n
beh vir l ch nge</b>
P nic Disrder
Wh
ercen
f  nic disrder 
ien
s seek mbul
ry medic l service rir

di gnsis? Imlic
in?
90%. Shuld be n differen
i l fr ER r rim ry
c re dcs wrking u
seemingly nrm l sys
ems f cml in
(ie ches
 in, ch
king)
Wh
d ele wi
h  nic disrders ls h ve? 30% h ve cmrbid <u>deressin<
/u>, 15% cmrbid <u> lchl buse</u><div><u><br /></u></div><div><i>The lch
l use is
her eu
ic in GABA 
en
i
in bu
is bused</i></div>
A
wh
ge r nge des  nic disrder
yic lly ccur? Men r wmen?&nbs;
Yung dul
hd. Wmen 2.5x mre likely
h n men
Wh
is ne f
he ms
cmmn sychi
ric drders.&nbs;M rked fe r f nd bje
c
r si
u
in Secific hbi <div><br /></div><div><div>Ms
cmmn include</d
iv><div> &nbs; nim ls</div><div> &nbs;birds</div><div> &nbs;insec
s&nbs;</div><
div> &nbs;heigh
s</div><div> &nbs;
hunder</div><div> &nbs;flying</div><div> &nbs
;sm ll enclsed s ces</div><div> &nbs;bld</div><div> &nbs;injury</div><div> &n
bs;injec
ins</div><div> &nbs;den
is
s</div><div> &nbs;hsi
ls</div></div>
M rked fe r f sci l si
u
ins, exsure
 unf mili r ele r scru
iny by 

hers, fe r f humili
in r emb rr ssmen
<div><br /></div><div>The ersn rec
gnizes
he excess fe r, si
u
ins re vided r endured wi
h in
ense nxie
y 
r dis
ress</div>
Sci l hbi
Wh
ccurs when:<div><div>The ersn is exsed


r um
ic even
in which b

h re resen
:</div><div>-Ac
u l r erceived
hre
f de
h r serius injur
y</div><div>(DSM 5 is mre secific bu
wh
culd ly s recii

ing ev
en
including sexu l ss ul
r exsure s
firs
resnder)</div></div>
PTSD
Wh
re PTSD cri
eri (3 + bnus)
<div><b>Re-exeriencing</b></div><div>Re
cllec
ins, dre ms, c
ing/feeling even
were reccurring, dis
ress
in
ern l
/ex
ern l cues f</div><div>even
, sychlgic l re c
ivi
y
cues</div><div><b
r /></div><div><b>Avid nce</b></div><div>Effr
s
 vid
hugh
s/feelings/cn
vers
ins, viding ele/l ces/ c
ivi
ies, mnesi fr
r um
ic even
s, dim
inished  r
ici
in in c
ivi
ies, de
ched/es
r nged frm 
hers, res
ric
ed
r nge f ffec
, sense f freshr
ened fu
ure</div><div><b><br /></b></div><div
><b>Arus l</b></div><div>Difficul
y f lling/s
ying slee, irri
bili
y r u

burs
s f nger, difficul
y cncen
r
ing,</div><div>hyervigil nce, ex gger
ed
s
r
le resnse</div><div><br /></div><div>DSM 5 dds <b>Neg
ive
hugh
s nd
md r feelings</b></div><div>Feelings m y v ry frm ersis
en
nd dis
r
e
d sense f self r 
hers
 es
r ngemen
frm 
hers r m rkedly diminished in

eres
in c
ivi
ies,
 n in bili
y
 remember key sec
s f
he eve
</div>
Wh
re sub
yes f PTSD? (2) <div><b>Preschl Sub
ye</b> - includes cri
eri

 di gnsed children <u>yunger
h n 6 ye rs</u></div><div><br /></div><div><
b>Dissci
ive Sub
ye</b> - fr individu ls where PTSD is seen wi
h rminen
d
issci
ive sym
ms including&nbs;<u>feeling de
ched frm nes wn mind</u> r
bdy, r exeriences in which
he wrld seemes unre l, dre mlike r dis
r
ed</
div>
Di gnse:<div><div>Excessive nxie
y r wrry fr <b>mre d ys
h n n
</b> fr

le s
6 mn
hs</div><div><br /></div><div>Assci
ed sym
ms:</div><div>Res

lessness</div><div>E sily f
igued</div><div>Difficul
y cncen
r
ing</div><div>
Irri
bili
y</div><div>Muscle
ensin</div><div>Slee dis
urb nce</div></div>
Gener lized nxie
y disrder (GAD)
In wh

ien
s nd wh
se

ing is GAD mre cmmn? Wmen nd urb n re s

GAD is cmrbid wi
h wh
?

90% cmrbid wi
h 
her <u>sychi
ric disrders
</u>
Hw is OCD defined? (3) -Ei
her <u>bsessins</u> r <u>cmulsins</u><div><div
><div>-<u>Persn recgnizes</u>
hey re unre sn ble</div><div>-<u>M rked dis
r
ess</u> nd
ime cnsum
in</div></div></div>
Wh is mre ffec
ed in OCD, men r wmen?
Ac
u lly, OCD is
he nly nxie

y disrder where <u>equ lly ffec
ed</u>
When is
he nse
f OCD sefic lly?
<b>&l
;25</b>, f
en dlescence r chil
dhd
Wh
re 4 
her bsessive cmulsive disrders included wi
hin
he sec
in in D
SM 5? <div><b>Tric
illm ni </b> (h ir icking nd bsessin, n
leci be
c use c n see h ir cming b ck)</div><div><b>H rding</b>&nbs;</div><div><b>Exc
ri
in</b> (skin icking) disrder</div><div><b>Bdy Dysmrhic Disrder&nbs;
</b></div>
Bb is 29 y medic l s
uden
wh h d sever l 5-10 min eisdes f swe
ing, ch
es
nd bdmin l  in,
ingling in his rms, dizziness wi
h feeling
h
sme

hing re lly b d w s h ening. &nbs;Yu re his new PCP nd yu fund n
hing u

f
he rdin ry nd
ld him

ke i
e sy. &nbs;Bb n
iced
h

hese sell
s h ened when his m
her sked him
 g wi
h her

he G lleri , s he s

ed ging wi
h her shing. &nbs;When
he rblem f iled
 reslve, he s
r
ed

 vid le ving his cnd l
ge
her. &nbs;Als, he f
en is h ving few bee
rs
nigh

 g
 slee.
P nic

ck
Amy is 21 ye r ld Rice cllege s
uden
. &nbs;Al
hugh she lves
 si
u
d
rs, she h s been un ble
 jin her cl ssm
es wh h ng u
n
he green gr ss
re s n Rice remises. &nbs;Amy h s signific n
fe rs bu
siders. &nbs;Thu
s, she h s been viding ny u
drs c
ivi
ies. &nbs;She is very fr id f run
ning in

sider. &nbs;Even
he
hugh
f
h
m kes her nxius. &nbs;She e
ven is un ble
 lk
sider nd rec lls
ing
ge
her
he  ges wi
h ic
u
res f siders in her 7
h gr de Bilgy bk. Secific hbi (siders)
<div>Tim is yung execu
ive
Ale. &nbs;He frequen
ly

ends cm ny-sn
sred, sci l even
s, bu
finds himself fe rful nd  r lyzed
 cnverse/in
er
c
during
hese func
ins. &nbs;He feels k when mee
ing 1-n-1 r
lking n

he hne. &nbs;The w y
 succeed
Ale is
 be seen

hese g
herings n
d Tim is very cncerned
h
he will be  ssed ver fr rm
in. &nbs;He cme
s
 seek yur hel.</div>
Sci l hbi &nbs;(Sci l Anxie
y Disrder)
Bre

wns n AC re ir cm ny. &nbs;He is &nbs;unsuccessful. &nbs;He h s s

r
ed
 d mre nd mre ri
u ls
h
cs
him l
s f
ime. &nbs;He wnders if
hes n
cr zy bec use he c n
seem
 s
 ding
hese
hings even
hugh he wuld l
ike
. &nbs;Sme
imes, he mws his y rd fur r five
imes un
il
he 

ern i
s jus
righ
, nd he w shes his h nds n wful l
. &nbs;Bre

s wife m de him c
me in
 see yu.
OCD
Six mn
hs g, Kelly w s ss ul
ed by m n in cllege. &nbs;Thugh she esc e
d, she fel


he
ime
h
her life w s in je rdy. &nbs;She h s frequen
ni
gh
m res bu

he even
, vids schls, never le ves
he huse f
er d rk, nd
h s
ruble being lne wi
h m n. &nbs;She is ls e sily s
r
led, very nx
ius, nd h s very h rd
ime sleeing.
PTSD
<div>Tw weeks g, M ri w s severely injured. &nbs;She w s w lking in
he med
ic l cen
er nd w s hi
, ne rly killed by drunk driver. &nbs;Her lef
leg h d

 be mu

ed. &nbs;She des n
rec ll hw she w s
ken

he hsi
l. &
nbs;She kind f wke u in bed like in d ze n yur service
BTGH. &nbs;She
h s insmni , l
s f nxie
y, nd s ys, i
feels unre lbeing here in bed wi
h n
lef
leg.</div>
Acu
e s
ress disrder*<div><br /></div><div>N
cvered in cl ss
(bu
vigne

e in syll bus)</div>
Tin is 37 y l wyer, lives by herself wi
h her dg, nd describes herself s
nervus ersn. She cmes
 see yu frequen
ly fr v rius cncerns including m
uscle
ensin, f
igue, nd insmni . &nbs;Physic lly, ll is fine wi
h her bu

she rem ins wrried nging bu
her v rius sym
ms desi
e f yur frequen

re ssur nce. GAD (gener lized nxie
y disrder)
L
ish is 40 y den
l ssis
n
wh cmes
 see yu
yur rim ry c re ce
n
er bec use f signific n
new nse
nxie
y. &nbs;Her nxie
y is s b d
h

she feels like juming u
f her skin. She ls c/ f signific n
insmni nd l

ely her he r
feels like severely r cing ll
he
ime. &nbs;She ls rer
s
signific n
incre se in e
i
e, e
ing fr
w, nd weigh
lss. Yu feel her u
lse nd i
is 127. Her U
x nd U regn ncy re neg
ive.&nbs; Anxie
y Disrder
Due T GMC (gener l medic l cndi
in)
Yu re n c ll in
he BTGH EC nd yu re seeing Rich rd wh c me in fr s much
nxie
y, I need X n x, A
iv n. He is  cing, res
less, nd ree
edly sking fr
X n x 2 mg. He s ys, I
wrks like
ch rm, dc, jus

rus
me. Yu li
ely
ld
him
h
dinner is being served nd
h
X n x is n
n frmul ry. He lks di
sheveled. Yu re very busy running sever l cdes
h
nigh
. Hurs l
er, nur
se c lls yu nd sk yu
 cme s Rich rds VS re cncerning nd he h s nw mr
e nxie
y. VS re: HR 129, BP 182/159, RR 24. He is ls swe
y nd
remulus.&n
bs;
Subs
nce induced nxie
y disrder<div><br /></div><div>(c n be in
xic

in r wi
hdr w l)</div>
<div>-Recurren

hugh
s r imulses
h
re in
rusive/in rri
e nd c use
m rked nxie
y/dis
ress</div><div>-Thugh
s re <b>NOT simly excess wrries b
u
life rblems</b></div><div>-Persn

em
s
 ignre/suress
he
hugh
s<
/div><div>-Persn recgnizes
h

he
hugh
s re
<b>rduc
f his/wn mind<
/b></div>
Obessins (OCD)
<div>-Ree
i
ive beh virs/men
l c
s
h
ersns feels driven
 erfrm in
resnse

he bsessins</div><div>-Beh virs
h
re imed
reducing dis

ress r reven
ing sme dre ded even
</div>
Cmulsins (OCD)
Wh
re
he
w cmnen
s f nes
hesi ?
Hynsis- l
ered cnsciusness<
div>An lgesi -  in relief</div>
Wh
is S
ge I c lled? Wh
is i
defined s? "An lgesi ; ""cnscius sed
in
"""
Wh
is defined s
he end f s
ge I? "LOC, nd in bili
y
 fllw cmm nds<d
iv><br /></div><div><img src=""s
ge 1.jeg"" /></div>"
Describe nes
he
ic MCA flw
"There is
diffusin gr dien
frm
he r
ery r
s
r lly
w rd
he f
hmunulus. Therefre, he d nd
ngue re nes
he
ized
firs
.<div><img src=""MCA flw.jeg"" /></div>"
Wh
is
yic lly
he firs
sign f lc l nes
hesi
xici
y, n hyl xis?
"""Funny
s
e in mu
h, funny feeling in
ngue""<div><img src=""MCA flw.jeg"
" /></div>"
Wh
is
he rder f lss f sens
in? <div>Or l numbness</div><div>H nds,
hen
fee
</div><div>Lss f clr erce
in</div><div>Viscer l n lgesi </div><div>
Lss f cnsciusness</div>
Wh
is
he n me f S
ge II? Wh
is i
defined by? (3)
Delerium; LOC,

w l nes (decr
ic
e, decerebr
e), dys u
nmi (vi
ls g cr zy)
When is
he highes
risk f de
h frm nes
hesi ?
S
ge 2: delirium&nbs;
Wh
re
he sym
ms f s
ge II nes
hesi ? "C
echl rele se (EKG dysrhy
hm
i )<div>Lss f r
ec
ive irw y reflexes ( sir
in risk)</div><div>Ocul r we
irdness (discnjug
e, r id mvm
)</div><div>Irregul r resir
in</div><div><br
/></div><div><img src=""s
ge 2.jeg"" /></div>"
D yu lw ys  ss
hrugh s
ge II n
he w y
 s
ge III?
Yes, nd in b
h
direc
ins. Ging
 s
ge III, s well s cming b ck
 s
ge I.&nbs;
Wh
is s
ge III defined by? (2)
"4 l nes, begins wi
h <u>rhy
hmic resi
r
in</u> nd re
urn f
he <u>eyes

midline si
in wi
h sm ll uils</u>
<div><img src=""s
ge 3.jeg"" /></div><div><br /></div><div>in
ercs
l  r lys
is nd di hr gm
ic bre
hing le ds
 ""<b>see-s wing</b>"" f ches
nd bdm
en</div>"
When is
he end f s
ge III nes
hesi ?&nbs; V sm
r nd resir
ry cll 
se (de
h s
ge IV)
Wh
is linked
 s
er
ive cgni
ive dysfunc
in,  r
icul rly in lder 

ien
s nd c n be linked

lng
ime? Very dee nes
hesi
Wh
is
he HBV v ccine b sed ff f? Wh
will
v ccin
ed 
ien
s serlgy
shw? V ccine is b sed n <b>HBsAg</b>. The 
ien
will shw n
i-HBsAg n
ib
dy, wi
h <u>n cre</u> n
ibdy
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60e29 3 d66f32c280d31cdd8 c2f7738ee5_surce_svg.svg"" />"
"<img src=""7195
60e29 3 d66f32c280d31cdd8 c2f7738ee5_E gr h.jeg"" />"
"<img src=""719560e29 3 d66f32c280d31cdd8 c2f7738ee5_Q_2.svg"" />"
"<img sr
c=""719560e29 3 d66f32c280d31cdd8 c2f7738ee5_A_2.svg"" />"
"<img src=""7195
60e29 3 d66f32c280d31cdd8 c2f7738ee5_surce_svg.svg"" />"
"<img src=""7195
60e29 3 d66f32c280d31cdd8 c2f7738ee5_E gr h.jeg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Q_0.svg"" />"
"<img sr
c=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_A_0.svg"" />"
"<img src=""e5e1
0b9d559f6c2e5d3e96b623b7c7 b36 8311d_surce_svg.svg"" />"
"<img src=""e5e1
0b9d559f6c2e5d3e96b623b7c7 b36 8311d_Gr h B.jeg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Q_1.svg"" />"
"<img sr
c=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_A_1.svg"" /><div>indic
es infec
i
n wi
h HBV AT SOME TIME; si
ive during windw erid; <b>C</b>u
e r <b>C</b>
hrnic infx</div>"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_su
rce_svg.svg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Gr
h B.jeg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Q_2.svg"" />"
"<img sr
c=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_A_2.svg"" /><div>indic
es RECENT H
BV infec
in (dis e rs f
er cu
e infx); si
ive in Cu
e infx</div>"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_surce_svg.svg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Gr h B.jeg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Q_3.svg"" />"
"<img sr
c=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_A_3.svg"" /><div>indic
es IMMUNITY

 HBV ( s resul
f infec
in r v ccin
in); her lds reslu
in f infx (i
mmune, cure, NO c
ive dise se!)</div>" "<img src=""e5e10b9d559f6c2e5d3e96b623b7
c7 b36 8311d_surce_svg.svg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7
c7 b36 8311d_Gr h B.jeg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Q_4.svg"" />"
"<img sr
c=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_A_4.svg"" /><div>resence in c rrie
r = LOWER
i
er f HBV; indic
es dring level f viremi (lw
r nsmissibili

y)</div>"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_surce_svg.
svg"" />"
"<img src=""e5e10b9d559f6c2e5d3e96b623b7c7 b36 8311d_Gr h B.je
g"" />"
"<img src=""81d4fe5 920519848f0320eed29d4f59e46e925d_Q_0.svg"" />"
"<img sr
c=""81d4fe5 920519848f0320eed29d4f59e46e925d_A_0.svg"" /><div>sever l sub
yes;
rduced in excess during infx (cn
inued resence = c rrier s

e/chrnic HBV);
S= Sick (live virus, cu
e, chrnic, r c rrier)</div>"
"<img src=""81d4
fe5 920519848f0320eed29d4f59e46e925d_surce_svg.svg"" />"
"<img src=""81d4
fe5 920519848f0320eed29d4f59e46e925d_HBV gr h.jeg"" />"
"<img src=""81d4fe5 920519848f0320eed29d4f59e46e925d_Q_1.svg"" />"
"<img sr
c=""81d4fe5 920519848f0320eed29d4f59e46e925d_A_1.svg"" /><div>indic
es infec
i
n wi
h HBV AT SOME TIME; si
ive during windw erid; Cu
e r Chrnic infx</d
iv>"
"<img src=""81d4fe5 920519848f0320eed29d4f59e46e925d_surce_svg.svg"" />
"
"<img src=""81d4fe5 920519848f0320eed29d4f59e46e925d_HBV gr h.jeg"" />

"
"<img src=""81d4fe5 920519848f0320eed29d4f59e46e925d_Q_2.svg"" />"
"<img sr
c=""81d4fe5 920519848f0320eed29d4f59e46e925d_A_2.svg"" />"
"<img src=""81d4
fe5 920519848f0320eed29d4f59e46e925d_surce_svg.svg"" />"
"<img src=""81d4
fe5 920519848f0320eed29d4f59e46e925d_HBV gr h.jeg"" />"
"<img src=""39e01c05472 5e1f92652346e3b 02bee 9199b0_Q_0.svg"" />"
"<img sr
c=""39e01c05472 5e1f92652346e3b 02bee 9199b0_A_0.svg"" />"
"<img src=""39e0
1c05472 5e1f92652346e3b 02bee 9199b0_surce_svg.svg"" />"
"<img src=""39e0
1c05472 5e1f92652346e3b 02bee 9199b0_ cu
e C.jeg"" />"
"<img src=""39e01c05472 5e1f92652346e3b 02bee 9199b0_Q_1.svg"" />"
"<img sr
c=""39e01c05472 5e1f92652346e3b 02bee 9199b0_A_1.svg"" />"
"<img src=""39e0
1c05472 5e1f92652346e3b 02bee 9199b0_surce_svg.svg"" />"
"<img src=""39e0
1c05472 5e1f92652346e3b 02bee 9199b0_ cu
e C.jeg"" />"
"<img src=""39e01c05472 5e1f92652346e3b 02bee 9199b0_Q_2.svg"" />"
"<img sr
c=""39e01c05472 5e1f92652346e3b 02bee 9199b0_A_2.svg"" />"
"<img src=""39e0
1c05472 5e1f92652346e3b 02bee 9199b0_surce_svg.svg"" />"
"<img src=""39e0
1c05472 5e1f92652346e3b 02bee 9199b0_ cu
e C.jeg"" />"
"<img src=""7c88f7dcc 4f29be256 66c 299ec4315b2795e2_Q_0.svg"" />"
"<img sr
c=""7c88f7dcc 4f29be256 66c 299ec4315b2795e2_A_0.svg"" />"
"<img src=""7c88
f7dcc 4f29be256 66c 299ec4315b2795e2_surce_svg.svg"" />"
"<img src=""7c88
f7dcc 4f29be256 66c 299ec4315b2795e2_Chrnic C.jeg"" />"
"<img src=""7c88f7dcc 4f29be256 66c 299ec4315b2795e2_Q_1.svg"" />"
"<img sr
c=""7c88f7dcc 4f29be256 66c 299ec4315b2795e2_A_1.svg"" />"
"<img src=""7c88
f7dcc 4f29be256 66c 299ec4315b2795e2_surce_svg.svg"" />"
"<img src=""7c88
f7dcc 4f29be256 66c 299ec4315b2795e2_Chrnic C.jeg"" />"
"<img src=""7c88f7dcc 4f29be256 66c 299ec4315b2795e2_Q_2.svg"" />"
"<img sr
c=""7c88f7dcc 4f29be256 66c 299ec4315b2795e2_A_2.svg"" />"
"<img src=""7c88
f7dcc 4f29be256 66c 299ec4315b2795e2_surce_svg.svg"" />"
"<img src=""7c88
f7dcc 4f29be256 66c 299ec4315b2795e2_Chrnic C.jeg"" />"
Wh
is
he mech nism f m n
dine? Wh
is
he resis
nce mech nism? "In
erfe
res wi
h unc
ing<div>Mu

ins in M2 r
ein</div><div><img src=""
rge
s.jeg
"" /></div>"
Wh
is
he effic cy f m n
dine vs. rim n
dine in
erms f sym
ms, c
ivi

y, nd shedding?
"Am n
dine h s mre imrvemen
, c
ivi
y, nd decre se
d shedding cm red
 rim n
dine nd l ceb.<div><img src=""l ceb.jeg"" />
</div>"
Hw des m n
dine cm re
 rim n
dine in flu A rhyl xis in
erms f Infl
uenz like illness, Adverse even
?
"Am n
dine h s signific n
r
ec
in
g ins
ILI nd infec
in, bu
higher AE. (influenz like illness nd dverse eff
ec
s)<div><img src=""rh.jeg"" /></div>"
Wh
re 2 rhyl xis 
ins fr influenz A? Wh
re 2 rhyl xis 
ins f
r influenz A nd B? A: Am n
dine nd Rim n
dine<div>A + B: Osel
mivir nd
Z n mivir</div><div><br /></div><div><i>V ccines re recmmended fr ru
ine r
even
in
hugh, n
drugs</i></div>
Wh
is
he mech nism f
el revir, bcerevir? Wh
re
he uses f
hem?
Serine r
e se inhibi
r; <b>HCV</b> infec
in in cmb wi
h <u>IFN </u> nd <u>
rib virin</u>
Wh
d nxily
ics d? Wh
d sed
ive-hyn
ics d? Decre se nxie
y; induce
drwsiness, rm
e slee
Wh
is
he Gld s
nd rd
re
men
f nxie
y disrders?
SSRI, SNRI, TCA
In ddi
in
 gld s
nd rd
x fr nxie
y disrders, wh
is 
in l djunc
i
ve nd <u>
ime-limi
ed </u>
re
men
? Benzdi zeine (klnin)
Are b rbi
ur
es indic
ed fr nxie
y disrders?
N lnger
Wh
re
he 3 firs
line SSRI fr nxie
y
re
men
? Ci
lr m, Esci
lr m
, P rxe
ine<div><br /></div><div>Anxius ci
sh esc ed frm
he  r
</div>
D we use burrin (wellbu
rin) fr nxie
y
re
men
?
N
Wh
is
he c
in f b rbi
ur
es

he ch nnel level?
Incre se
he <u>
dur
in</u>&nbs;f ening f <u>GABA</u> Cl- in--&g
; hyerl rizing cell
T/F b rbi
ur
es requre
he resence f GABA in rder
 flux ClF lse, i
ncre se Cl- in ch nel indeenden
ly f GABA<br><br>(m king
hem mre d ngerus)

B rbi
ur
es d wh
s resul
f i
s me
blism?

Induce he
ic CP450 enz
ymes
Wh
3 drugs in
er c
wi
h b rbi
ur
es?
heny
in,&nbs;v lric cid, w
rf rin&nbs;
Wh
cndi
in is cn
r indic
ed fr b rbi
ur
e
re
men
?
Prhyri
Wh
re
he 3 cl sses f c
ing fr b rbi
ur
es? When re
hey used? "Lng- c

ing (
her eu
ic lly), shr
nd in
ermedi
e c
ing, ul
r shr
c
ing (ECT
h
er y)<div><img src=""b rb.jeg"" /></div>"
Wh
is
he 
en
i l f
l verdse 
en
i l f b rbi
ur
es? CNS deressin
nd resir
ry deressin
Wh
unique side-effec
c n ccur in children nd lder dul
s n b rbi
ur
es?
P r dxic l exci

in
Wh
is
he mech nism f benzdi zeine?
GABA incre ses
he <u>frequency<
/u> f ening f <u>GABA rece
r Cl- ch nnel</u>--&g
; hyerl rizing
Wh
m kes benzdi zeines s fer
h n b rbi
ur
es? (2) "GABA v il bili
y is r

e-limi
ing s
e (binds rece
r
 incre se GABA 
en
i
in f ch nnel)<div>D
es n
induce he
ic enzymes</div><div><img src=""bzd rece
r.jeg"" /></div>
"
Wh
is
 lw ys be vided while
king benzdi zeine?
Alchl! And 
h
er CNS deress n
s
Describe
he memry im irmen
f benzdi zeines?
C n be
side effec
, n
d even erm nen
in sme 
ien
s. We
es

his.
Wh

ien
shuld n
receive benzdi zeines due
 resir
ry deressin?
P
ien
s wi
h <u>COPD</u>
Wh
re
he 3 benzdi zeine rece
rs, func
in, nd lc
in (CNS, eriher l
)?
"<b><fn
clr=""#408000"">BZD₁</fn
></b> (CNS) - Slee<div
><fn
clr=""#408000""><b>BZD₂</b></fn
> (CNS) - Cnfusin, cgni

in</div><div>M
r cn
rl</div><div><br /></div><div><fn
clr=""#0000ff""><
b>BZD₃</b></fn
> (Periher l) - Muscle rel x
in</div>"
Benzdi zeines, b rbi
ur
es: which incre ses dur
in nd which incre ses
he
frequency f GABA Cl- ch nnels? Benzdi zeine- frequency<div>B rbi
ur
es- dur

in</div>
Wh
re
he 3 benzs
h
d n
require xid
in fr elimin
in?
"LOTs<di
v><br /></div><div><b><fn
clr=""#00ff00"">L</fn
></b>r ze m (1s
)</div><d
iv><b><fn
clr=""#00ff00"">O</fn
></b>x ze m</div><div><b><fn
clr=""#00
ff00"">T</fn
></b>em ze m</div><div><br /></div><div>C n be used in 
ien
s w
i
h <u>liver im irmen
</u>, r <u> lchl wi
hdr w l</u></div>"
"<img src=""4b170e08bcf96f 737f093b6fb8056f7f38fcb55_Q_0.svg"" />"
"<img sr
c=""4b170e08bcf96f 737f093b6fb8056f7f38fcb55_A_0.svg"" />"
"<img src=""4b17
0e08bcf96f 737f093b6fb8056f7f38fcb55_surce_svg.svg"" />"
"<img src=""4b17
0e08bcf96f 737f093b6fb8056f7f38fcb55_gr h.jeg"" />"
"<img src=""4b170e08bcf96f 737f093b6fb8056f7f38fcb55_Q_1.svg"" />"
"<img sr
c=""4b170e08bcf96f 737f093b6fb8056f7f38fcb55_A_1.svg"" />"
"<img src=""4b17
0e08bcf96f 737f093b6fb8056f7f38fcb55_surce_svg.svg"" />"
"<img src=""4b17
0e08bcf96f 737f093b6fb8056f7f38fcb55_gr h.jeg"" />"
"<img src=""4b170e08bcf96f 737f093b6fb8056f7f38fcb55_Q_2.svg"" />"
"<img sr
c=""4b170e08bcf96f 737f093b6fb8056f7f38fcb55_A_2.svg"" />"
"<img src=""4b17
0e08bcf96f 737f093b6fb8056f7f38fcb55_surce_svg.svg"" />"
"<img src=""4b17
0e08bcf96f 737f093b6fb8056f7f38fcb55_gr h.jeg"" />"
Gre
use fr X n x?
"Airl ne fligh
nxie
y. f s
c
ing, f s
ff<div><img
src=""gr h (1).jeg"" /></div>"
P
ien
cmes in
 BTGH ER wi
h verdse f benzdi zeine. Tre
men
? Flum zen
il<div><br /></div><div>Use wi
h c u
in bec use i
is c n c use wi
hdr w l sym

ms</div><div><br /></div>
Wh
is selec
ive BZD gnis
fr BZD1 (slee) nd is me
blized less in wme
n
h n men?
Zlidem (Ambien)
Wh
is nn-BZD, nn-b rbi
ur
e nxily
ic? Ac
in? Busirne,  r
i l 5HT-1
A rece
r gnis
. *Migh
n
c
u lly wrk
Wh
is firs
line fr s
ge frigh

Be
-blcker (r nll)
Des BIS (bisec
r l index) wrk? Frm
he mvie w ke? Hw des i
wrk?

N
rven, re lly $$$. Usu lly rcessed EEG le ds.&nbs;

Wh
is
he bre d nd bu

er f gener l nes
hesi ?
<u>Vl
ile nes
hesi </
u>. Adminis
ered vi lungs<div>(isflur ne, desflur ne (
en
), sevflur ne, ni

rus xide) dn
memrize</div>
Wh
s
ruc
ures cmse
he  r medi n zne f regin l circul
in?
"<div>Py
r mid l
r c
s</div><div>CN III, VI, XII</div><div>
issue drs l

his</div><i
mg src=""ne

er willis.jeg"" /><div><img src=""Screen Sh
2014-06-06
10.26.
45 AM.jg"" /></div>"
Wh
is
he r
eri l suly

he  r medi n zne?
"Shr
br nches f <b> n

erir sin l</b>, <b>ver
ebr l</b>, <b>b sil r r
eries</b><div><b><img src=""S
creen Sh
2014-06-06
10.26.45 AM.jg"" /><br /></b><div><b><img src=""FA wil
lis.jeg"" /></b></div></div>"
Wh
is
he r
eri l suly

he l
er l zne f regin l circul
in?&nbs;
"Ver
ebr l r
ery (PICA)<div>B sil r r
ery (An
erir inferir cerebell r, suer
ir cerebell r)</div><div><img src=""FA willis.jeg"" /></div><div><img src=""Sc
reen Sh
2014-06-06
10.26.45 AM.jg"" /></div>"
If ne f
he
w znes ( r medi n, l
er l) is cmrmised, is
he 
her zne
ffec
ed?
N,
he
w znes re indeenden

The medull in
he  r medi n zne is served m inly by? "<b>ASA</b><div><b><img
src=""Screen Sh
2014-06-06
10.26.45 AM.jg"" /><br /></b><div><b><img src="
"FA willis.jeg"" /></b></div></div>"
The medull in
he l
er l zne is served by wh
3 r
eries? "<b>Ver
ebr l</b
><div>PICA</div><div>An
erir inferir cerebell r</div><div><img src=""Screen Sh

2014-06-06
10.26.45 AM.jg"" /></div><div><img src=""FA willis.jeg"" /></
div>"
The ns in
he  r medi n zne is served m inly by?
"Shr
br nches f
he b
sil r<div><img src=""Screen Sh
2014-06-06
10.26.45 AM.jg"" /><br /><div><
img src=""FA willis.jeg"" /></div></div>"
The l
er l zne f
he ns is served m inly by?
"Lnger br nches f
he
b sil r<div><div>Suerir cerebell r (rs
r l ns)</div><div>An
erir inferir
cerebell r (c ud l ns)</div><div><img src=""Screen Sh
2014-06-06
10.26.45
AM.jg"" /></div><div><img src=""FA willis.jeg"" /></div></div>"
Wh
r
ery is
br nch f
he AICA (r f
he b sil r) nd sulies
he l byrin
"<div><b>In
ern l udi
ry</b> (r <b>l byrin
hine</b>) <b> r
ery</b></d

h?
iv><div><b><img src=""Screen Sh
2014-06-06
10.26.45 AM.jg"" /></b></div><i
mg src=""ne

er willis.jeg"" /><div><br /></div>"
Bil
er l znes f ischemi in
he ns c n be rduced by?
"B sil r insuffi
ciency<div><img src=""FA willis.jeg"" /></div>"
The midbr in f
he  r medi n zne is served by?
"Br nches f b sil r r

ery<div><b>Medi l br nches</b> f
he s
erir cerebr l r
ery</div><div><img s
rc=""Screen Sh
2014-06-06
10.26.45 AM.jg"" /></div><div><img src=""ne

er
willis.jeg"" /></div><div><img src=""FA willis.jeg"" /></div>"
The dienceh ln is m inly served by wh
r
in f circul
in
"Ps
eri
r circul
in<div><img src=""FA willis.jeg"" /></div>"
The medi l dienceh ln (
h l mus, hy
h l mus) is served by wh
?
"<u>Ps

ermedi l r
eries</u> ff
he s
erir cerebr ls nd s
erir  r
f s
eri
r cmmunic
ing r
ery<div><img src=""Screen Sh
2014-06-06
10.26.45 AM.jg
"" /></div><div><br /></div><div><img src="" s
e-406179352150556.jg"" /><br />
<div><img src=""FA willis.jeg"" /></div></div>"
"The l
er l dienceh ln (ven
r l nd l
er l
h l mus) is served by?<div><img
src=""
h l mus.jeg"" /></div>" "PCA--&g
;<u>Th l mgenicul
es</u><div><img src
="" n
s
cr n.jeg"" /></div><div><img src=""Screen Sh
2014-06-06
10.26.
45 AM.jg"" /></div>"
Occlusin f
he
h l mgenicul
es resul
s in wh
? Wh
des
his cndi
in r
duce? Hemi nes
hesi ,
h l mic  in
The in
ern l c sule- n
erir limb is served by wh
? Wh
re
hey br nches f?
"<b>Medi l s
ri
e</b> r
eries, br nching ff
he <b>ACAs</b> nd n
erir  r

f s
erir cmm. r
ery<div><br /></div><div><br /></div><div><img src="" s

e-405294588887580.jg"" /><br /><div><img src=""len
icul s
ri
e.jeg"" /></div
><div><img src=""c sule.jeg"" /></div><div><br /></div><div><img src=""c suel

.jeg"" /></div><div><img src=""FA willis.jeg"" /></div><div><br /></div></div>

"
Occlusin f
he medi l s
ri
e r
eries c n resul
in wh
?
"Frn
l
xi ,
vi cmrmise f frn
-n
ine 
hw y<div><img src=""len
icul s
ri
e.jeg"
" /></div><div><img src=""c sule.jeg"" /></div><div><br /></div><div><div>Cr

ex<b>Frn
n
ine</b> 
hw y (vi ALIC) r P rie
-Occi
-Temr (POT) n
in
e 
hw y (vi PLIC) cerebr l crus (FPT med POT l
)n
ine nuclei (<b>syn se</b>
)n
-cerebell r
r c
(<b>decuss
in</b>)&nbs;<u>MCP</u>&nbs;(inu
) cerebellu
m</div><img src=""necerebellum (1).jeg"" /></div>"
The in
ern l c sule-genu nd s
erir limb re (m inly) sulied by wh
? Br n
ches f?
"<b>L
er l s
ri
es</b> rising frm
he <b>MCA</b><div><img sr
c=""len
icul s
ri
e.jeg"" /></div><div><img src=""c sule.jeg"" /></div><div
><img src=""c suel.jeg"" /></div>"
Occlusin f
he l
er l s
ri
es resul
s in wh
?
"Hemi resis/ r lysis 
f rm, f ce, nd leg<div><img src=""len
icul s
ri
e.jeg"" /></div><div><img
src=""c sule.jeg"" /></div><div>PLIC is u
</div>"
In ddi
in

he len
icul-s
ri
es, wh
else c n suly
he s
erir limb 
f
he in
ern l c sule? "<u>Th l mgenicul
es</u> nd <u> n
erir chrid l</u>
r
eries<div><br /></div><div><img src="" n
(3).jeg"" /></div><div><img src="
"FA willis.jeg"" /><br /><div><img src="" n
s
cr n.jeg"" /></div></div><di
v><br /></div>"
Wh
c n serve
he ven
r l nd inferir regin f
he in
ern l c sule
hrugh w
hich
he 
ic r di
ins curse? (Give br nch) "PCA--&g
; Th l mgenicul
es<di
v><img src="" n
s
cr n.jeg"" /></div><div><img src=""
ic r d.jeg"" /></d
iv>"
Where des
he n
erir chrid l r
ery rise frm?
"Direc
ly frm
he <u>in

ern l c r
id</u>, jus
l
er l

he s
erir cmmunic
ing<div><br /><div><
img src="" n
(3).jeg"" /></div><div><img src=""FA willis.jeg"" /><br /><div><
br /></div></div></div>"
Wh
des
he n
erir chrid l r
ery suly? Wh
is cnsequence f cclusi
"Inferir sec
f
he s
erir limb<div><br /></div><div>Occl
n f
his?
usin c n c use <u>cn
r l
er l hemilegi wi
h s s
ici
y</u> [<b>n sensry
invlvemen
</b> since
hese
h l mcr
ic l 
hw ys en
er
he in
ern l c sule
bi
mre suerirly], s well s <u>cn
r l
er l hmnymus hemi nsi </u
> [since
he inf rc
c n cmrmise
he very inferir nd s
erir zne f
he
s
erir limb where
he 
ic r di
ins run].&nbs;</div><div><br /></div><div
><br /></div><div><img src=""c sule.jeg"" /></div><div><img src=""c suel.jeg
"" /></div><div><br /></div><div><img src=""
ic r d.jeg"" /></div><div><img s
rc=""cr
icsin l.jeg"" /></div><div><img src="" n
(3).jeg"" /></div>"
Wh
r
eries serve
he b s l g ngli ? "L
er l (MCA) nd medi l (ACA) s
ri
e
r
eries&nbs;<div><br /></div><div><img src=""len
icul s
ri
e.jeg"" /></div>
<div><img src="" n
s
cr n.jeg"" /></div>"
In chrnic hyer
ensin, wh
r
eries re  r
icul rly vulner ble
 hemrrh ge
?
"L
er l nd medi l s
ri
e--&g
; sulying
he b s l g ngli <div><img s
rc=""len
icul s
ri
e.jeg"" /></div>"
Describe
he curse f
he h
h lmic r
ery
"Origin
es frm
he in
ern l c
r
id, nd emerges frm
he c vernus sinus<div><img src=""c v (1).jeg"" /></di
v><div><img src=""h.jeg"" /></div>"
Wh
des
he s
erir cerebr l r
ery ls suly, in ddi
in f
he ccii

l lbe? "Ven
r l r
ins f
he
emr l lbe<div><img src=""cr
.jeg"" /></di
v>"
"<img src=""58d 25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_Q_0.svg"" />"
"<img sr
c=""58d 25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_A_0.svg"" />"
"<img src=""58d
25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_surce_svg.svg"" />"
"<img src=""58d
25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_cr
.jeg"" />"
"<img src=""58d 25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_Q_1.svg"" />"
"<img sr
c=""58d 25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_A_1.svg"" />"
"<img src=""58d
25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_surce_svg.svg"" />"
"<img src=""58d
25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_cr
.jeg"" />"
"<img src=""58d 25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_Q_2.svg"" />"
"<img sr

c=""58d 25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_A_2.svg"" />"

"<img src=""58d
25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_surce_svg.svg"" />"
"<img src=""58d
25ef3cc4b0c1d4ccd3029ec25f1c fd812cd_cr
.jeg"" />"
Wh
is cnsequence f n inf rc
in f
he s
erir cerebr l r
ery in rel

in
 visin? "<u>Prs gnsi </u> nd <u>ure lexi wi
hu
gr hi </u> du
e
 inf rc
in f
he ven
r l ""wh
"" s
re ms f 
ic r di
ins<div><br /><d
iv><img src=""cr
.jeg"" /></div><div><img src=""s
re m.jeg"" /></div></div>"
Wh
r
ery serves
he mygd l nd hic mus?
"PCA<div><img src=""cr

.jeg"" /></div>"
Wh
ul
in h s  r
icul rly high rev lence f hychndri sis? 2nd ye r
medic l s
uden
s<div><br /></div><div>Anxie
y ver de
h + feelings f insignif
ic nce&nbs;</div>
Wh
is
he l byrin
hine (in
ern l udi
ry) r
ery br nch f?
"AICA, 
r f
he b sil r<div><img src=""ne

er willis.jeg"" /></div><div><img src=""FA
willis.jeg"" /></div><div><img src=""Screen Sh
2014-06-06
10.26.45 AM.jg"
" /></div>"
Wh
re
he rim ry n s
mises?
"Be
ween
he r
eries f
he circle f w
illis.<div>(Wi
h n cclusin f in
ern l c r
ied in
he neck, bld c n flw
crss
he cmmunic
ings)&nbs;<br /><div><img src=""FA willis.jeg"" /></div></
div>"
Wh
re secnd ry n s
mses? M y n
be resen
nrm lly, r nly in rudimen

ry frm. They devel in resnse
 <u>lw ressure n ne side</u> f
he 

en
i l n s
msis.&nbs;
Wh
re ex mles f secnd ry n s
mses?
"<u>Oh
h lmic</u> nd br nches
f ex
ern l c r
id (<u>f ci l</u>)<div>Muscul r br nches f <u>ver
ebr l</u> n
d muscul r br nches f <u>ex
ern l c r
id</u></div><div><u>Sickle-sh ed zne</
u> where MCA
erri
ry brders ACA nd PCA
erri
ry</div><div><img src=""cr
.j
eg"" /></div>"
Wh
is
he w
ershed zne in
he cerebr l circul
in? When c n
his h en? Wh
"The sickle-sh ed zne (brder f MCA wi
h ACA nd PCA)

is
he resul

h s lw s fe
y f c
r fr erfusin.&nbs;<div><br /></div><div>An <u> cu
e</
u>&nbs;dr in ressure in
he in
ern l c r
id c uses
his, becu se
he n s

mses re n
well develed r bsen
, nd will resnd nly

<u>chrnic</u
> ressure gr dien
.&nbs;</div><div><br /></div><div>The resul
is <u>selec
ive
we kness in shulder/hi muscles</u>&nbs;</div><div>""m n in
b rrel""</div><
div><img src=""cr
.jeg"" />&nbs;</div>"
Arre
here ny r
eries wi
hin
he br in?
N
Hw is i

h
brui
c n be de
ec
ed rund
he rbi
?
"In c r
id insu
fficiency, n s
msis be
ween
he f ci l r
ery (high ressure) nd h
h lmic
r
ery (lw ressure) le ds
 re
rgr de flw in
he h
h lmic<div><img src=""
f ci l (1).jeg"" /></div><div> </div>"
Wh
fr c
in f bld des
he br in require? 20% (1 li
er/min)<div>The br in
is nly 2% f bdy weigh
.&nbs;</div>
T/F
he CNS
issue is cns
n
ly n
he edge f hyxi True, fllwing
cmle

e lss f bld suly, ch nges in neur l func
in ccur in secnds wi
h irreve
rsible d m ge in minu
es
Regul
in f
he cerebr l circul
in c n ccur lc lly nd vi neur l regul
i
n. Describe lc l regul
in. Au
regul
in (<u>mygenic reflex:</u>&nbs;dec
re sed ressure dil
es, incre sed ressure cns
ric
s <i>see Bernullis rinci
le</i>)<div>Ac
ive neurns incre se flw (fMRI rincile)</div>
Is ANS neur l regul
in f cerebr l bld flw imr
n
? Wh
is
he exce
in
?
N, exce
in is during <b>chrnic hyer
ensin</b>.&nbs;<div>Mygenic
reflex in resnse
 incre sed sys
emic ressure ges u

in
,
hen is v
ercme-- frcing vessel
 dil
e. BUT in
he se

ing f chrnic hyer
ensin, B
P c n rise
 higher levels befre mygenic reflex is vercme.&nbs;</div>
Hw much c n
he nrm l ANS regul
e
he bld ressure

he br in? Only
f
ew ercen
. (10% +/- 5%)
Which md li
y h s brigh
CSF? "T2&nbs;<div><img src="" s
e-84868553769315.j
g"" /></div>"
Hw is v r nes
hesi dminis
ered? Selec
hw much O2 %
 bre
h (21% is n

rm l.) Selec
hw much drug s ercen
f insired ir. &nbs;
Wh
is MAC?
Minim l Alvel r Cncen
r
in= ED 50<div><br /></div><div><i>C
ncen
r
in f v r</i>&nbs;
1
m in
he lungs
h
is needed
 reven
m
vemen
in 50% f subjec
s in resnse
 surgic l  in.&nbs;</div>
Wh
mul
ile f MAC llws fr 95% f 
ien
s
 be dequ
ely nes
he
ized?
1.3MAC
High MAC = lw r high 
ency? Lw 
ency, me ns we need
l
f g s %
 ne
s
he
ize&nbs;
Wh
is
he rel
inshi be
ween MAC nd liid slubili
y?
MAC f
vl
il
e gen
is inversely rr
in l
 i
s liid slubili
y<div><br /></div><div>L
w MAC (high 
ency) = very liid sluble</div>
Wh
is
he rim ry c use f ischemic s
rkes? Wh
re 2 w ys
his rcess c n
c use s
rke? "<b><fn
clr=""#ff0000"">A
hersclersis</fn
></b> s wning
<u>embli</u> r <u>
hrmbi</u><div><br /></div><div>C n ffec
c r
id/he r
-&
g
;
hrmbus -&g
;
hrws <b>embli</b>
 cerebr l vessels</div><div><br /></di
v><div>C n ffec
in
r cr ni l vessels -&g
; gr du lly enl rging l que ccludes
vessel -&g
; erdes
hrugh end
helium c using <b>
hrmbi</b> frm
in</div>"
S
rke
Mech nis
ic lly hw des
hersclersis c use embli r
hrmbi frm
in?
"I
<b>erdes</b> in

he <b>end
helium</b> which c uses <b><fn
clr=""#ff0
000"">infl mm
ry resnse</fn
></b>" S
rke
"Wh
is ""rim ry reven
in"" fr ischemic s
rkes? Hw effec
ive is i
?"
Decre sing BP<div>Decre sing liids</div><div>Smking cess
in</div><div>Exerci
se</div><div>Cn
rlling DM</div><div><br /></div><div>Hugely reduces
he risk 
f s
rke</div> S
rke
Once signific n

hersclersis h s ccured nd i
is
hrwing embli, hw d w
e
re
i
?
"End r
erec
my- surgic lly remve
he l que<div><img src=""en
r
.jeg"" /></div>"
S
rke
Describe
he v ccine fr HIB. <b>Pr
ein-lys cch ride cnjug
e</b> f
he C
PS f HIB cnjug
ed
 ne f sever l r
eins: OMP, CRM r TT
Besides
hersclersis, wh
is n
her m jr c use f s
rke? "C r
id dissec

in secnd ry
 neck
r um <div><br /></div><div><img src="" s
e-5530629387084
5.jg"" /></div>"
S
rke
Describe
he secific we kness c used by w
ershed inf rc
s (Gdm n) m n in
b rrel we kness<div><br /></div><div>legs nd f ce re fine, un ble
 lif
rm
s</div> S
rke
Wh
gives r
ec
in
 HIB? Medi
ed by n
ibdy
 CPS
Wh
s
he immuniz
ins schedule fr HIB?
3-4 dses ver 18 mn
hs
Wh

ye f li h s been er dic
ed? Tye 2<div><br /></div><div>(
herefre r
isk f giving v ccine cn
ining
ye 2 s
r in becu se 1 b ck mu

in c n le d

 W
li)</div>
Re c
in
 which drugs re cn
r indic
ins fr
he li v ccine?
An hyl
c
ic re c
ins
 <b>s
re
mycin</b>, <b>nemycine</b> r <b>lymixin B</b>
Wh
nn-cerebr l re c n ls h ve w
ershed inf rc
s?
"Rims f
he cer
ebell r hemisheres<div><img src="" s
e-55482387529900.jg"" /></div>" S
rke
Wh
re
he s
ruc
ur l ch nges seen in severe glb l hyerfusin?
"L min r
necrsis (cr
ic l cll se)<div><br /></div><div>B s l g ngli shrink ge</div>
<div><br /></div><div>Hydrceh lus ex v cu (cmens
ry)</div><div><br /></di
v><div><img src="" s
e-55602646614411.jg"" /></div>" S
rke
Hw lng nd when shuld ersns wi
h susec
ed nd cnfirmed mums be isl
ed?
Fr 5 d ys f
er nse
f  r
i
is
"<img src="" s
e-55637006352774.jg"" /><div>Describe
he 
hlgy seen here.
Wh
c uses
his resen

in?</div>" Inf rc
in f w
ershed zne be
ween ACA
nd MCA<div><br /></div><div> r
i l hyerfusin (fllwing MI)</div>
S
rke
Wh

ye f v ccine is
he MMR v ccine?
Live

enu
ed viruses
Is i
k
 give MMR v ccine
 smene wi
h HIV?
Yes, s lng s
heyre
n
severely immuncmrimised<div><br /></div><div>(CD4 % &g
;15% r cun
&g
;
200, c n give
 HIV ele)</div>
"<img src="" s
e-55679956025738.jg"" /><div>Wh
des
his sulc l de
h discl

Bec use
he sulci re less well

r
in sugges
? Why is
his seen?</div>"
erfused
h n
he gyri (vessels run lng surf ce),
hey re rel
ive w
ershe
d zne<div><br /></div><div>Hy
ensive even
will c use d m ge/disclr
in f
sulci firs
</div>
S
rke
Describe
he v ricell v ccine Live

enu
ed <b>lyhilized </b>virus (Ok s

r in)<div><br /></div><div>lyhilized=freeze dried</div>
Wh
neurns re eseci lly vulner ble
 ischemic d m ge? (3) Why?
"<b><fn

clr=""#ff0000"">Purkinje cells</fn
></b> f <b><fn
clr=""#ff0000"">cere
bellum</fn
></b><div><br /><div><b><fn
clr=""#ff0000"">Pyr mind l cells</f
n
></b> f <b><fn
clr=""#ff0000"">hic mus</fn
></b> (<u>Smmers sec
r
</u> f hic mus)</div><div><br /></div></div><div><b>Middle</b> (l min r) l
yers f <b>cerebr l cr
ex</b></div><div><br /></div><div>These neurns receive
l
s f exci

ry <b>glu
m
ergic</b> inu
, wi
hu
xygen neurns <b> ren

ble
 crrec
in levels</b> -&g
; <b>exci

xici
y</b></div><div><b><br /></
b></div><div><b><img src="" s
e-55881819488621.jg"" /></b></div>"
S
rke
In ele 12m - 12yr ld, wh

her v ccine c n
he v ricell v ccine be cmbi
ned wi
h? Wh
is
he ssci
ed risk? "C n be cmbined wi
h
he MMR v ccine (m
king i

he MMRV)<div><br /></div><div>Incre sed risk f <fn
clr=""#ff0000"
"><b>febrile seizures</b></fn
> f
er firs
dse</div>"
C n yu h ve 2 eisdes f v ricell ? Yes, bu
i
s very uncmmn<div><br /></d
iv><div>Tyic lly yu c n h ve
cule lesins s n inf n
(which usu lly ges
unrecgnized) nd
hen re c
iv
in in childhd if yu ge
immuncmrmised</
div>
"<img src="" s
e-55881819488621.jg"" /><div>Wh
is seen here? Why?</div>"
Selec
ive lesin f hic mus (Smmers sec
r) fllwing <b>hyerfusin</b>
even
-
hese neurns re mre vulner ble&nbs;<div><br /></div><div>(These neur
ns receive l
s f exci

ry&nbs;<b>glu
m
ergic</b>&nbs;inu
, wi
hu
xy
gen neurns&nbs;<b> ren
ble
 crrec
in levels</b>&nbs;-&g
;&nbs;<b>exc
i

xici
y</b>)</div> S
rke
Why re
he firs
72 hurs f
er cerebr l inf rc
d ngerus? "Bec use cr
ic
l <b>swelling</b> c n le d
 <b><fn
clr=""#ff0000"">herni
ins</fn
></b><
div><img src=""hern.jeg"" /></div>"
S
rke
Wh
effec
h s
he in
rduc
in f
he v ricell v ccine (in 1995) h d n
he 
ccurence f HZ? Incidence in v ccin
ed children w s 79% lwer
h n unv ccin
ed
"<img src="" s
e-55937654063495.jg"" /><div>Wh
h ened here?</div>"
PCA inf rc
(ei
her frm cl
r cmressin due
 incre sed ICP)--&g
; medi l
S
rke
ccii
l/
emr l inf c
in
T/F everyne shuld be immunized wi
h VZV? If s hw m ny
True, 2 dses r
e indic
ed fr nn-immune ele (unless cn
r indic
ed)
Describe
he
imeline f his

hlgy f inf rc
in (D y 1, D y 2-2weeks, 2 we
eks-mn
hs)
"D y 1: <b><fn
clr=""#ff0000"">red neurn</fn
></b> (esin
hilic nd ykn
ic) nd neuril r ref c
in<div><br /></div><div>D y 2-weeks:
<b>Neu
rhil infil
r
e,</b>&nbs;<b>neurn l lss</b>, <b>neuril r ref c
in
</b>,&nbs; s
rglisis, v scul r rlifer
in</div><div><br /></div><div>2 wee
ks-mn
hs: <b>cys
ic c vi
y</b> f CSF nd <b>m crh ges</b>, surrunded by w l
l f<b> <fn
clr=""#ff0000"">re c
ive glisis</fn
> ( s
rcy
es)</b>. Grssl
y see<b><fn
clr=""#ff0000""> liquef c
ive necrsis</fn
></b></div><div><img
src=""red.jeg"" /></div><div><img src=""w ll.jeg"" /></div>" S
rke
T/F V ricell v ccine c n be given
 susce
ible ersns f
er exsure.
True
Wh

ye f v ccine is r
virus?
Live,

enu
ed<div><br /></div><div>Sh
uld be given
 ll inf n
s</div>
Why shuld yu
es
eles frm 
her cun
ries (eseci lly
ric l clim
es)
fr V ricell n
ibdies?
In
he US ms
ele will h ve n
ibdies, ms

ele h ve been exsed<div><br /></div><div>In 
her cun
ries ele re les
s likely
 h ve been exsed nd m y be susce
ible</div>
Wh
s
he difference be
ween
he shingles v ccine nd
he regul r v ricell ne
?
I
cn
ins 10-50x mre virus
Ch r c
erize
he v scul r rlifer
in seen f
er cerebr l inf rc

Abnrm l
vessels<div><br /></div><div>They h ve minim l s
rcy
e invlvemen
-&g
; few


igh
junc
ins -&g
; <u>le ky vessels</u> -&g
; will shw cn
r s
enh cemen
(
lk like
umr</div> S
rke
"<img src="" s
e-56212531970455.jg"" /><div>Wh
is wrng wi
h
hese neurns?
Wh
is
he c use?</div>"
"""red neurns""<div><br /></div><div>This is wi

hin <u>1 d y</u> f
er ischemic s
rke</div><div><br /></div><div>*n
e
h
en
d
heli l cells re n
d m ged</div>" S
rke
Why is in
ususce
in
cn
r indic
in
 r
virus v ccine? Wh
else is
c
n
r indic
in? Bec use firs
dse is ssci
ed wi
h i
<div><br /></div><div>Al
s dn
give if hx f SCID</div>
"<img src="" s
e-56367150793099.jg"" /><div><img src="" s
e-56839597195656.j
g"" /><br /><div>Wh
is
he 
hlgy here? Describe
he micrscic findings</
div></div>"
Rem
e middle cerebr l r
ery inf rc
<div><br /></div><div>D m g
ed neuril h s been cle red, cmens
ry hydrceh lus</div><div><br /></div><
div>C n see c vi
y wi
h r refied neuril nd m crh ges, c n see w ll f <u>re
c
ive s
rcy
es</u> surrunding c vi
y</div> S
rke
"<img src="" s
e-56886841835876.jg"" /><div>Exl in why
hese findings re see
n fllwing MCA inf rc
?</div>" A
rhy f cerebr l crus nd medull ry yr mid<d
iv><br /></div><div>The xns
h
m de u
hese regins h ve degener
ed fllw
ing
he de
h f
heir <u>sm s in
he cr
ex</u></div> S
rke
"<img src="" s
e-57028575756656.jg"" /><div>Wh
is
he 
hlgy here? Wh
i
s
he c use?</div>"
Mul
ile hemrrh gic emblic inf rc
s<div><br /></div><
div>The f c

here re mul
ile sugges
s embli being
hrwn frm he r
</div>
S
rke
A
ri l fibrill
in, v lvul r dise se, nd lef
ven
ricul r
hrmbi re ll c us
es f ______
h
c n c use CNS dise se c rdigenic embli
S
rke
Is
here n n
ibdy ssci
ed wi
h er
ussis n
igens?
N<div><br /></d
iv><div>(Im n
sure wh

h
me ns)</div>
Hw des v sculi
is c use mul
ifc l s
rkes? "Infl mm
ry <b>infil
r
e
hic
kens vessel w ll</b> -&g
; <u>n rrw lumen</u> -&g
; decre sed bld flw<div><b
r /></div><div><b>Infl mm
in disru
s end
helium</b> -&g
; <u>
hrmbgenesis<
/u></div><div><img src=""inf rc
(1).jeg"" /></div>" S
rke
Wh
neumcccus v ccine is recmmended fr ersns
le s
65y r 
hers

high risk fr dise se? Pneumccc l lys cch ride 23&nbs;
Wh
re l cun r inf rc
s? Where d
hey ccur? D
hey usu lly c use much d m g
e? Wh
h ens when
here re
ns f
hem?
"Inf rc
s f <u>sm ll vessels</u
> c using
iny regins f ischemic d m ge<div><b>BG, Pns, IC<br /></b><div><br
/></div><div>Bec use
hey re s sm ll
hey c n be <u> sym
m
ic</u>, r c use
<u>huge d m ge</u> if
hey re in in
ern l c sule</div><div><br /></div><div>I
f yu ccumul
e enugh f
hem,
hey c n c use dissci
in f br in re s nd

hus <b>mvemen
disrders nd cgni
ive decline</b></div><div><br /></div><div>
<img src="" s
e-57638461112701.jg"" /></div></div>" S
rke
"Where is
he ""meningi
is bel
"" = hyerendemic re ?" "<img src="" s
e-227882
374791171.jg"" />"
Wh
is
he referred meningiccc l v ccine? MnCnjug
eV ccine (MnCV)<div><b
r /></div><div>MnPS is n cce
ble l
ern
ive</div>
The cmbined Hib-MenCY-TT v ccine desn
cver which meningiccc l ser
yes?
"Men A r W, me ns cllege ged kids nd dlescen
s s
ill h ve
 ge

he regul
r ne<div><img src="" w.jeg"" /></div>"
Hw d yu reven
l cun r s
rkes?
Tre
high bld ressure
S
rke
Describe
he 
hgenesis f l cun r s
rkes
"<b>Chrnic hyer
ensin</b> c u
ses sm ll vessels f  renchym
 <u>
hicken nd becme
r
uus</u><div><br />
</div><div>These 
hlgic l vessels re mre likely
 cclude nd
 hemrrh
ge</div><div><br /></div><div><img src="" s
e-57685705753017.jg"" /></div>"
S
rke
Wh
crrel
es wi
h
he effic cy f He B v ccine? serum n
i-HBs
Wh
is given
 susce
ible ersns s
exsure fr He B?
He B immune gl
bulin (HBIG)
Wh
re
he
re
men
s fr
hrmb
ic ischemic s
rke? (3)
TPA if wi
hin 4.
5 hurs f sym
ms nd n hemrrh ge (checked vi CT)<div><br /></div><div>Su
r
ive c re (d NOT llw hy
ensin, ermi
hyer
ensin)</div><div><br /></di

v><div>An
i-l
ele
drugs (86 mg sirin)</div>

S
rke
Wh
re
he
re
men
s fr emblic ischemic s
rke?
Remve surce<div><br />
</div><div>Cnsider n
i-c gul
in (w rf rin/he rin)</div><div><br /></div><d
iv>Direc

hrmbin inhibi
r (d big
r n)</div> S
rke
Cm re d big
r n (direc

hrmbin inhibi
r) effic cy wi
h cl ssic n
i-c gul
n
s like w rf rin
D big
r n h s fewer eisdes f hemrrrh ge, <b>be

er
reven
in</b> f s
rke, nd <b>n need
 mni
r INR</b><div><br /></div><div
>Hwever i
is <u><i>n
reversible</i></u> like w rf rin is</div><div><br /></d
iv><div>Als $$$</div> S
rke
Hw des hyer
ensin c use hemrrh gic s
rkes?
"Incre sed <b>ressure c
uses micr neurysms</b>
 frm<div><br /></div><div>These c n slwly<b> ze</
b> bld r burs
(in
  renchym )</div><div><img src="" mylid.jeg"" /></div>
"
S
rke
Where d  renchym l (hyer
ensive) hemrrh gic s
rkes nrm lly ccur? "B s l g
ngli nd
h l mus (65%)<div>Pns (10%)</div><div>Cerebellum ( rund dee nucle
i) (10%)</div><div><img src=""micr.jeg"" /></div><div><img src=""ns.jeg"" /
></div><div><img src=""cere.jeg"" /></div>"
S
rke
Are hemrrh gic r ischemic s
rkes mre ssci
ed wi
h he d che? Which ne h s
f s
er clinic l curse?
Hemrrh gic fr b
h
S
rke
"<img src="" s
e-58750857642415.jg"" /><div>Wh
is
he 
hlgy? Wh
likely
c used i
? Wh
wuld
he sym
ms be?</div>" In
r cerebr l hemrrh ge f b s
l g ngli <div><br /><div>Hyer
ensin</div><div><br /></div></div><div>Dense hem
i resis</div><div>Only mildly decre sed level f cnsciusness if
ll</div>
S
rke
"<div><img src="" s
e-58785217380746.jg"" /></div>Hw c n 1 micr neurysm ru

ure rduce
his c
s
rhic hemrrh ge?"
The hemrrh ge frm
he firs
mi
cr neurysm <u>c uses dj cen
nes
 ru
ure</u>
S
rke
"<img src="" s
e-58815282151796.jg"" /><div>Wh
is
he 
hlgy here? Wh
s
ym
ms re likely resen
ing?</div>" Cerebell r hemrrh ge<div><br /></div><d
iv>Isil
er l
xi </div><div>He d che in
he b ck f
he he d nd neck</div>
S
rke
"Wh
re ssible cmlic
ins f cerebell r hemrrh ge? Wh
is ssible
"Incre sed ressure c n

re
men
?<div><img src=""c hemm.jeg"" /></div>"
c use
he <b>medull

wis
</b>- <b><fn
clr=""#ff0000"">sudden deressin
f bre
hing</fn
></b><div><br /></div><div>Surgic l ev cu
in f
he hemrrh
ge- <b>
his is
he <fn
clr=""#ff0000"">nly in
r cerebr l hemrrh ge
h
c
n be
re
ed by surgery</fn
></b></div>"
S
rke
"<img src="" s
e-58901181497765.jg"" /><div>Wh
is wrng? Ch nce f recvery?
</div>" Pn
ine ICH<div><br /></div><div>Very r-
he RAS is kncked u
nd

hey re likely cm
se</div> S
rke
Where d micr neurysms f Ch rc
-Buch rd
yic lly devel? "B s l g ngli
nd
h l mus<div>Pns</div><div>Cerebellum</div><div><br /></div><div>All
he l
ces hyer
ensive hemrrh ges ccur-
hey re
he c use</div><div><img src=""micr
S
rke
.jeg"" /></div>"
Besides hyer
ensive hemrrh ges (wi
h micr neurysms), wh
re
he 2 c uses f
"<b><fn
clr=
 renchym l hemrrh ge? Hw re
hey quickly iden
ified?
""#ff0000"">Amylid ngi
hy&nbs;</fn
></b><div><b><fn
clr=""#ff0000"">M
e
s

ic
umrs</fn
></b></div><div><br /></div><div>They re iden
ified bec u
se
hey re hemrrh ges in
nn-cl ssic hyer
ensive hemrrh ge lc
in (ie, n


h l mus, BG, ns, medull )</div><div><img src="" mylid (1).jeg"" /></div>
<div><img src=""
umr bleed.jeg"" /></div>"
S
rke
"<img src="" s
e-59433757442360.jg"" /><div>Lb r hemrrh ge in eldery 
ien

</div><div><br /></div><div>Wh
is
he likely e
ilgy?</div>" "<b><fn
clr=
""#ff0000"">Amylid ngi
hy</fn
></b><div><br /></div><div>Be
- mylid buil
ds u in vessel w ll nd m kes i
we k- incre sed risk f hemrrh ge</div><div><
img src="" ngi.jeg"" /></div>"
S
rke
"<img src="" s
e-59996398158120.jg"" /><div>Mul
ile hemrrh ges in nn-cl ssi
c hyer
ensive hemrrh ge lc
in</div><div><br /></div><div>C use?</div>"
Me
s

ic
umrs
S
rke
Wh
re
he 4
re
men
md li
ies f in
r cerebr l hemrrh ge?
<u>Su

r
ive c re</u><div><br /></div><div><u>Surgic l ev cu
in</u> (f <b><i>cerebel

l r</i></b> hemrrh ge nly)</div><div><br /></div><div><u>Ven
ricul r dr in ge<
/u> if i
cn
ins bld</div><div><br /></div><div><u>Ac
iv
ed f c
r VII</u>

 incre se c gul
in n slw ex nsin (m y n
imrve u
cme)</div>
S
rke
Wh
is
he rim ry c use f nn-
r um
ic <u>sub r chnid</u> hemrrh ges?
"Berry neurysms<div><img src=""berry.jeg"" /></div>" S
rke
Where d berry neurysms
yic lly devel?
"An
erir circul
in f circle
f willis<div>A

he <u>bifurc
ins</u></div><div>Prxim l</div><div><br /></di
v><div><img src="" s
e-60636348285253.jg"" /></div><div><img src=""berry.jeg"
" /></div>"
S
rke
Where d myc
ic neurysms
yic lly devel? Hw d
hey frm? "<u>Dis
l r
i
ns f n
erir circul
in</u><div><br /></div><div>Sm ll se
ic embli
hrwn
frm <b>infec
ed v lves</b>-
hey infec
nd d m ge vessel w ll</div><div><img s
rc=""myc
ic.jeg"" /></div>" S
rke
In wh
% f 
ien
s re
here mul
ile berry neurysms?
"15-20%<div><br
/></div><div>This 
ien
h s 1 gi n
nd 1 sm ll neurysm</div><div><img src=""
S
rke
 s
e-61280593379693.jg"" /></div>"
Describe wh
h ens when
berry neurysm ru
ures. Where is
he bld? Wh

bu
ne rby vessels?
"Bld flws in
 <u>sub r chnid s ce</u>- rduces ""
wrs
he d che f life""<div><br /></div><div><u>Ne rby vessels c n g in
 s s
ms</u>, c using fc l ischemi in 
her  r
s f
he br in</div>"
S
rke
Hw re size f neurysm nd rb bili
y f ru
ure rel
ed?
Incre sed size &g
; incre sed rb bili
y f ru
ure S
rke
Wh
re
he 2
re
men
s fr neurysms?
<div>Injec
in f
hrmb
ic ci
ls in
 neurysm (nw 1s
line, IR)</div><div><br /></div>Pl
inum cli crss

he neck f
he neurysm (m inly fr 
ien
s cn
r indic
ed fr ciling, surgic
l)
S
rke
Wh
c uses
c vernus sinus neurysm? "<u>C r
id r
ery</u> ru
ures wi
hin

he sinus<div><img src=""c v (2).jeg"" /></div><div><img src=""c v crss.jeg""
/></div>"
S
rke
Wh
re
he 4
yes f v scul r m lfrm
ins? Wh
2 re clinic lly releven
?
"<b>Ar
erivenus m lfrm
in</b><div><br /></div><div><b>C vernus ngim </b>
</div><div><br /></div><div>Venus ngim </div><div><br /></div><div>C ill ry

el ngec
si </div><div><br /></div><div><img src=""MAL (1).jeg"" /></div><div>
<br /></div><div>AVM</div><div><img src=""AVM.jeg"" /></div><div><br /></div><d
iv>""Pcrn"" c vernus ngim </div><div><img src=""crn.jeg"" /></div>"
S
rke
Describe
he s
ruc
ure f n r
erivenus m lfrm
in. Describe
he surrundin
g neuril.
"An s
msed bnrm l <b> r
eries</b> nd <b>veins</b> (n c il
l ry bed)<div><br /></div><div>There is in
ervening neuril
h
is <u><b>gli

ic</b></u></div><div><br /></div><div><img src="" s
e-61576946122852.jg"" /></
div><div><img src=""AVM.jeg"" /></div><div><img src="" vm cgi.jeg"" /></div>"
S
rke
Wh
cndi
ins des n r
erivenus m lfrm
in c use?
"Slw bleeding i
n
  renchym -&g
; irri

in c n c use <u>fc l seizures</u><div><br /></div>
<div>Shun
s bld w y frm dj cen

issue -&g
; <u>fc l ischemi </u></div><di
v><br /></div><div><img src=""AVM.jeg"" /></div>"
S
rke
"<div><img src="" s
e-61916248539588.jg"" /></div>Wh
re key grss nd his

lgic l iden
ifiers f r
erivenus m lfrm
ins seen here?? (4)"
<div><u>
Hemsiderin desi
in</u> nd <u>gr nul r bdies</u> rund vessels</div><div><
br /></div><u>Psi
ive el s
ic s
in</u> ( r
eri l cmnen
h s in
ern l el s
i
c l min )<div><br /></div><div>1. differen
sized vessels</div><div>2. gli
ic

issue</div><div>3. hemsiderin</div><div>4. el s
ic l min </div>
S
rke
Wh
is
he nnu l risk f signific n
hemrrh ge frm r
erivenus m lfrm
i
ns?
2-4%
S
rke
Describe
he s
ruc
ure f
c vernus ngim . Describe
he surrunding neuril
(2)
"1. Clus
er f differen
sized hy linized vessels (NO r
eri l cmnen

)<div>2.&nbs;There is NO in
ervening neuril<div><img src=""crn.jeg"" /><
/div><div><img src=""MAL (1).jeg"" /></div></div>"
S
rke

"<img src="" s
e-62564788601289.jg"" /><div>N
e
he mul
ile c vernus ngim

s (in ns nd
emr l lbe). Wh
is
he likely mu

in
h
c n c use f mil
i l dise se?</div><div><br /></div><div>Wh
is
he 
hgnmnic e r nce f
c vernus hem ngim s seen here?</div>" <b>CCM1: kri
mu

in </b>(cerebr l c v
ernus m lfrm
in)<div><br /></div><div>Pcrn e r nce</div>
S
rke
Wh
rblems d c vernus ngim s c use?
They c n ze bld which c uses
<b>fc l defici
s</b> r <b>seizures</b><div><br /></div><div>Als c n cn
in
<b>fibrin
hrmbi</b></div>
S
rke
Hw re v scul r m lfrm
ins
re
ed? Remved (surgic l) r glued shu
(IR)
S
rke
When d v ss sms fllwing
SAH ccur? Hw re
hey
re
ed? <b>2-14</b> d ys
f
er hemrrh ge<div><br /></div><div>If neurysm is re ired,
re
ed by <u>in
cre sing BP</u></div><div><u>C + ch nnel blckers</u></div>
S
rke
If v scul r m lfrm
in hemrrh ges, where des
he bld g?
Ei
her i
n

he sub r chnid s ce r in
 br in  renchym
S
rke
Wh
is
he cn
r indic
in fr OPV? <div>Immunsuressed & m; HIV-infec
ed
ersns nd
heir cn
c
s</div>
Wh
is
he cn
r indic
in f MMR?
Immundeficien

ien
s
Wh
is
he cn
r indic
in fr r
virus?
P
ien
s wi
h <b>SCID</b> r his

ry f <b>in
ussusce
in</b>
Are CNS
umrs s
ged? Why?
N, bu

hey re gr ded.&nbs;<div><br /><div>Th
is is bec use fr TMN, in
he CNS
here re n ndes, me
s
sis is very r re,
nd
he size lne is n
relev n
wi
hu
infrm
in f i
s lc
in.&nbs;</di
v></div>
Wh
cells re n
differen
i
ed in
 cell lines bu
c n devel in
 ny f
h
e CNS cells?
"Primi
ive Neurec
derm<div><img src=""h
.JPG"" /></div>"
Wh
wuld yu c ll
umr f rimi
ive neurec
derm? Primi
ive Neurec
derm
l Tumr (PNET)<div>(Medullbl s
m )&nbs;</div>
Wh
wuld yu c ll
umr f
he glibl s
line?
"Glibl s
m mul
ifrme
(GBM)<div><img src=""h
.JPG"" /></div><div><br /></div>"
Wh
wuld yu c ll
umr f imm
ure s
rcy
e, ligdendrcye, nd eendymc
y
e?
"An l s
ic s
rcy
m , n l s
ic ligdendrglim , n l s
ic eendy
mm <div><img src=""h
.JPG"" /></div>"
Wh
wuld yu c ll
umr f ei
her
he s
rcy
e, ligdendrcy
e, r eendym
As
rcy
m , ligdendrglim , eendymm
cy
e line?
Wh
wuld yu c ll
umr f
he neurbl s
line? Neurn line?
"Neurbl
s
m <div>Neurcy
m , r g nglicy
m </div><div><img src=""h
.JPG"" /></di
v>"
Which CNS
umrs ge
which gr de?
"Gr de IV- rimi
ive neurec
erm l
um
rs, Glibl s
m mul
ifrme<div>Gr de III- n l s
ic
umrs</div><div>Gr de IIs
rcy
m ... (AOE)</div><div><br /></div><div><img src=""h
.JPG"" /></div>
<div><br /></div>"
Wh
CNS
umr ge
s gr de I?
Seci l circums
nce: circumscribed ilcy
ic s

rcy
m
"<div>Nrm l r bnrm l?</div><img src=""v ri ble.jeg"" />" V ri ble mrhl
gy f nrm l neurns
"<div>Wh
s
he s
in, nd wh
is i
s
ining</div><img src=""syn ses.jeg""
/>"
Syn 
hysin. Used
 shw syn ses
"<div>Wh
is
he m rker here?</div><img src=""neu.jeg"" />" neu-N. Shws neu
rns wi
hu

he surf ce s
in. <b>s
ins nucleus</b>
"Wh
is h ening wi
h
hese s
rcy
es?<div><img src=""re c
.jeg"" /></div>"
Re c
ive s
rcy
es- if
hey re c

 injury, infec
in, r s
rke,
hey m y bec
me ne s
ic r re c
ive.&nbs;<div><br /></div><div>Tyic lly h s esinhilic
blwn u cy
l sm</div>
"<img src=""4c5c2c6d722e5ffb07462b8297 c76ec1600d1 _Q_0.svg"" />"
"<img sr
c=""4c5c2c6d722e5ffb07462b8297 c76ec1600d1 _A_0.svg"" />"
"<img src=""4c5c
2c6d722e5ffb07462b8297 c76ec1600d1 _surce_svg.svg"" />"
"<img src=""4c5c
2c6d722e5ffb07462b8297 c76ec1600d1 _lig.jeg"" />"
"<img src=""4c5c2c6d722e5ffb07462b8297 c76ec1600d1 _Q_1.svg"" />"
"<img sr
c=""4c5c2c6d722e5ffb07462b8297 c76ec1600d1 _A_1.svg"" />"
"<img src=""4c5c

2c6d722e5ffb07462b8297 c76ec1600d1 _surce_svg.svg"" />"

"<img src=""4c5c
2c6d722e5ffb07462b8297 c76ec1600d1 _lig.jeg"" />"
"Wh
is
his? Wh
s
in is
his?<div><img src=""gli l.jeg"" /></div>"
Gli l immunm rker: Gli l Fibrill ry cidic r
ein (GFAP) This is
he wrkhrse
. Bes
used fr <b> s
rcy
es</b>
Wh
d we use fr s
ining ligdendrcy
es? "There re n gd immunm rkers
<div><img src=""lig n.jeg"" /></div>"
"<img src=""c039d400808d461685349f31 f0d3723 fe8 74f_Q_0.svg"" /><div>Wh
s
he
difference be
ween
hese?</div>"
"<img src=""c039d400808d461685349f31 f0d
3723 fe8 74f_A_0.svg"" /><div>The ligdendrglim h s higher densi
y,
h
s
ll. Nrm l is fried egg e r nce&nbs;</div>" "<img src=""c039d400808d46168534
9f31 f0d3723 fe8 74f_surce_svg.svg"" />"
"<img src=""c039d400808d46168534
9f31 f0d3723 fe8 74f_nrm l bnrm l.jeg"" />"
Fr s
ining Eendym ,
here re n gd immun s
ins, bu
wh
des EM shw?
"Micrvilli nd cili <div><img src=""eendym .jeg"" /></div>"
Hw c n we s
in mening
heli l cells r desmsmes?
"EMA- ei
heli l membr n
e n
igen<div><img src=""EMA.jeg"" /></div>"
Where d childhd
umrs ccur ms
f
en?
Br ins
em nd s
erir fss . (
Pedi
ric br in
umrs re 2nd ms
cmmn f
er leukemi s)&nbs;
Wh
re
he ru
es f cquisi
in f meningi
is?
Hem
genus r direc
e
x
ensin
Wh
ul
ins re
risk fr neisseri meningi
idis?
Yung dul
s liv
ing in clse qu r
ers (<b>mili
ry recrui
s</b>, <b>cllege s
uden
s</b>)&nbs;
Why is hemhilus influenz e
ye B meningi
is success s
ry?&nbs; Incidenc
e dec 98%, very r re nw. 3-10% mr
li
y
Wh
is
he emiric
her y fr dul
s wi
h meningi
is? Elderly?&nbs; Adul
s:
V ncmycin, 3rd gener
in ceh lsrin (cef
xime/cef
ri xne)<div>Elderly:
bve + micillin fr lis
eri </div>
Wh
is
he 
hgenesis f meningi
is? "A

ch
 n sh rynge l ei
helium--&g

;  ss
hrugh mucs in
 bld--&g
;crss BBB--&g
; mul
ily in sub r chnid
s ce<div><img src=""
h (1).jeg"" /></div><div><img src=""bbb.jeg"" /></div>
"
"Kid cmes in wi
h recurren
sinusi
is. Then ge
s AMS
his is MRI<div><img src="
"sinu (1).jeg"" /></div>"
Br in bscess frm sinusi
is, cn
iguus&nbs;
Wh
2 even
s ul
im
ely resul
frm 
hhysilgy f meningi
is
"Incre s
e in ICP, decre se in CBF (cerebr l bld flw)<div><img src=""
h.jeg"" /></
div>"
Wh
is
he resul
f infl mm
ry r v scul r invlvemen
f cr ini l nerves fr
m meningi
is? --&g
; cul r  lsies, de fness. Eseci lly in children, c n del
y seech develmen

Wh
is glucse nd WBC fr vir l nd b c
eri l meningi
is?
"<div><div>Gluc
se:</div><div>B c
eri l &l
;40</div><div>Vir l nrm l</div></div><div><br /></di
v>WBC:<div>B c
eri l &g
;1000</div><div>Vir l &l
; 300</div><div><img src=""wbc.
jeg"" /></div>"
"<img src=""711fb1460b64456d7e02 c1e042c14d316f21 27_Q_0.svg"" />"
"<img sr
c=""711fb1460b64456d7e02 c1e042c14d316f21 27_A_0.svg"" />"
"<img src=""711f
b1460b64456d7e02 c1e042c14d316f21 27_surce_svg.svg"" />"
"<img src=""711f
b1460b64456d7e02 c1e042c14d316f21 27_cm 2.jeg"" /><div>N me
hese 3 cmlic

ins frm meningi
is</div>"
Wh
is

yic l c use f Ase
ic meningi
is Vir l meningi
is
Wh
is
he dis
inguishing f c
r f br in bscess?
"<b>Fc l neurlgic def
ici
s</b><div><br /></div><div><div>Fever</div><div>He d che</div><div>N use , v
mi
ing</div><div>Al
ered Men
l S

us</div><div>Seizures</div></div><div><img
src=""c se 2.jeg"" /></div>"
Wh
is
he
ime sc le fr br in bscess? (vs meningi
is)
"<div>~1 week. M
uch lnger
h n meningi
is</div><div><img src="" bscess (2).jeg"" /></div>"
Where re eendym in
he br in?
"<img src=""eendym l.jeg"" />"
Tumr cell rlifer
in, differen
i
in, nd rgr mmed cell de
h re ll due
Gene
ic cn
rl

 wh
?
Wh
de
ermines
he n ming f CNS
umrs ( nd
umrs elsewhere)?
Tumrs

re n med ccrding

he <u>simil ri
y</u> f
umr cells
 rchi
ec
ure f n

rm l
issue during develmen

Wh
re
he sym
ms
h
ccur frm CNS
umrs nd hw d
hese h en?
Cmressing r <u>inv ding dj cen
neur l
issue</u>--&g
; fc l signs<div><br
/></div><div><u>Incre sed ICP</u>, wi
h i
s signs nd sym
ms</div>
In ddi
in
 cl ssific
in lng his
lgic l lines, hw shuld we
hink bu
Org nize by grss lc
in

rg nizing
umrs?
Hw des
he hum n hkwrk v ccine wrk?
"induces n
i-enzyme n
ibdies
(s
ing bld feeding)<div><img src=""v ccine (1).jeg"" /></div>"
Lives in cecum nd endix, eggs m
ure f
er 4-6 hurs f xygen exsure
Pinwrm (En
erbius vermicul ris)
Wh
is
he rel
ive vulner bili
y f gli , neurns, end
helium

s
rke?
Neurns &g
;&g
; Gli &g
; End
helium
Fur cmmn childrens
umrs ( ccrding
 Dr. Gdm n)
"1. Medullbl s

m <div>2. Pn
ine glim </div><div>3. Pilcy
ic s
rcy
m *</div><div>4. Eend
ymm *</div><div><br /></div><div>Be

er rgnsis</div><div><br /></div><div><i
mg src="" s
e-712646743556288.ng"" /></div>"
well circumscribed, gr de I s
rcy
m
h
c n be
gd c ndid
e fr surgic
l resec
in?
Juvenile ilcy
ic s
rcy
m
"Child resen
s wi
h severe he d che nd bnrm l swelling f
heir he d. &nbs;
Im gine disl yed midline m ss in
he s
erir fss nd bs
ruc
ed CSF flw
c using incre se ICP. &nbs;Wh
is 
hlgy nd rgnsis? Sfx f
x?<div><img
src="" s
e-68251325300901.jg"" /></div>"
"Medullbl s
m ; 2-3 mn
hs if
n

re
ed; 5-7 ye rs ssible wi
h ggressive chem
her y (will likely see 20
-25 
reduc
in in IQ)<div><img src="" s
e-68715181768950.jg"" /></div>"
"N
e
he fllwing ch nges in
he his
lgic l im ge: hyercellul ri
y, lemr
hism, nd irregul r mi
sis. &nbs;Wh
is
he likely 
hlgy? &nbs;Wh
s
r
uc
ure is
he rrw in
ing
?<div><img src="" s
e-68723771703555.jg"" /></d
iv>"
"Medullbl s
m ; rrw in
s

""<b><u>rse

e</u></b>"" r ""<b><u
>Hmer Wrigh
Rse

e</u></b>"" which is c used by rien

in f cells during 
rimi
ive neurn l differen
i
in.&nbs;<div><br /><div>N
e
h
xn l, neurn
l, nd syn 
ic cmnen
s c n be seen in
his s
ruc
ure.</div></div>"
"<img src="" s
e-68852620722440.jg"" /><div><b>Describe</b>
his im ge nd di
gnse? Presen
in hw m ny? Wh
else is i
c lled?</div>"
Medullbl s
m
dissemin
in in CSF (PAP sme r); rese
in bu
15% f 
ien
s

ime f DX
- n
e
he <u>high nucleus
 cy
l smic r
i</u><div><u><br /></u></div><div>
Als c lled <b>dr me
s
ses</b>, 
ien
s c n resen
wi
h sin l r
rble
ms</div>
"Child resen
s wi
h f s
grwing infil
r
ing
umr
h
e rs
 crss
he
midline (
hrugh
he crus c llsum) n im ging. &nbs;The friendly neighbrh
d r dilgis
describes
he im ge s ""bu

erfly"". &nbs;Give
he 
hlgy
nd likely grss e r nce.<div><br /></div><div><img src="" s
e-6947539098039
1.jg"" /></div>"
"Glibl s
m mul
ifrm, will be mul
iclred n grss e
x min
in nd will l ck dis
inc
brder (b/c f infil
r
ing ch r c
er). &nbs
;Inv sin in
 crus c llsum is cmmn...m y e r s ""<u>bu

erfly</u>""

ye lesin<div><br /></div><div><img src="" s
e-69011534512416.jg"" /></div>
"
"Describe
his im ge<div><img src="" s
e-69488275882229.jg"" /></div>"
Likely <u>n
ine glim </u>&nbs;which is cmmn childhd
umr. &nbs;N

e
h
glim in
his lc
in will likely ffec
n
ine
r c
s,
he MLF, nd

he re
icul r c
iv
ing sys
em...very r rgnsis
Yu susec
glibl s
m mul
ifrme ( Gr de IV Nel sm) in 
ien
. &nbs;Wh

secific fe
ures will yu lk
 iden
ify in his
lgic ex min
in
 cnf
irm yur susicins?
"Hyercellul r field wi
h <b>hyercellul ri
y, lemrh
ism, mi

ic evidence</b> nd ms
imr
n
ly: <b>v scul r rlifer
in nd ne
crsis</b><div><b><br /></b></div><div><b>N
e:</b></div><div><b>1.
 rrw =
v scul r rlifer
in</b></div><div><b>2. b

m rrw = necrsis wi
h seud
llis ding</b>&nbs;(Gdm n n lgy: c r wreck (whi
e s
uff) surrunded by sec


rs)</div><div><b><img src="" s
e-69608534966543.jg"" /></b></div>"
"<div>P
hlgy bserves
hese his
lgic l im ges, describe nd wh
is
he lik

ely <b><fn
clr=""#ff0000"">rgnsis</fn
></b>?</div><div><br /></div><img

src="" s
e-69745973919964.jg"" /><div><img src="" s
e-70398808948979.jg"" />
<br /><div><img src="" s
e-680550452953286.ng"" /></div><div><br /></div></div
>"
"Sugges
ive f Glibl s
m mul
ifrme wi
h evidence f hyercellul ri
y
, lemrhism, nd necrsis wi
h <b><fn
clr=""#ff0000"">seud llis ding</
fn
></b>, <b><fn
clr=""#ff0000"">v scul r rlifer
i</fn
><fn
clr=""
#ff0000"">n</fn
></b> ( rrw). &nbs;<b>Me n surviv l is 9-12 mn
hs</b>&nbs;h
wever yunger individu ls m y live lnger wi
h ggressive
re
men
"
"Describe
he secific s
ining
echnique f
his im ge nd
he likely 
hlgy
<div><img src="" s
e-69879117906134.jg"" /></div>"
<b>GFAP immunsi
ive (
fr differen
i
in)</b><div><b><br /></b><div><b>Glibl s
m mul
ifrm</b></di
v></div>
"Describe
he gr de nd likely 
hlgy f
his 
ien
?<div><img src="" s
e-7
0480413327608.jg"" /></div>" "An l s
ic s
rcy
m , gr de III<div><br /><di
v>N
e: indis
inc
brder f lesin, <u>cingul
e herni
in</u>, nd <u>cmres
sed ven
ricle</u>...highly infil
r
ing!!</div></div><div><br /></div><div><img
src=""AA.jeg"" /></div>"
Cm re
he his
lgic l im ging f n l s
ic s
rcy
m nd glibl s
m mul

ifrme? "An l s
ic s
rcy
m will h ve <u><b>hyercellul ri
y</b></u> nd <u>
<b>lemrhism</b></u>, nd <b><u>mi

ic lly c
ive&nbs;</u></b>bu

here wil
l <b>ms
likely NOT be ny necrsis r v scul r rlifer
in</b><div><br /></d
iv><div>Hwever: b
h re highly infil
r
ing nel sms
h
c n crss
he midli
ne f
he br in
hrugh
he crus c llsum</div><div><img src="" s
e-706006724
11940.jg"" /></div>"
Fllw u wi
h 
ien
di gnsed wi
h n An l s
ic s
rcy
m reve ls evidence
"Prgressin
 glibl s
m mul
f v scul r rlifer
in nd necrsis?

ifrme<div><br /></div><div><br /></div><div><img src="" s
e-699053172064451.
ng"" /></div><div><br /></div><div>
</div><div><br /></div><div><img src="" s

e-700826993557702.ng"" /></div>"
"<div>P
ien
demns
r
es
he fllwing im ges indic
ive f gr de III nel
sm ( n n l s
ic s
rcy
m ). &nbs;Wh
is
he rgnsis?</div><img src="" s

e-70828305678584.jg"" /><div><img src="" s
e-70841190580329.jg"" /></div>"
18-24 mn
hs wi
h r di
in
her y nd chem
"Describe
his im ge. &nbs;Wh
is
he likely gr de f
his nel sm?<div><img
src="" s
e-70965744632065.jg"" /></div>"
"Gr de II As
rcy
m ; will see
<u>hyercellul ri
y</u> nd <u>lemrhism</u>, bu


<i>lesser degree</i>

h n n l s
ic s
rcy
m . &nbs;<div><br /></div><div>N
e: If
here re mi


ic figures
hink: n l s
ic s
rcy
m </div><div><img src=""AA.jeg"" /></div>
"
"Me n surviv l
ime: n l s
ic s
rcy
m vs. s
rcy
m <div><br /></div><div
>( n l s
ic s
rcy
m )<br /><div><img src="" s
e-71103183585451.jg"" /></di
v><div><br /></div><div>( s
rcy
m )</div><div><img src="" s
e-71116068487259.
jg"" /></div><div><br /></div></div>" "18-24 mn
hs (AA)<div>36 mn
hs ( s
rc
y
m )</div><div><img src=""AA.jeg"" /></div>"
"Ms
cmmn lc
ins fr ilcy
ic s
rcy
m ? (3)<div><br /></div><div><im
g src="" s
e-71416716198071.jg"" /></div>"
<b>O
ic nerve</b> (shwn) - n

e c n be surgic lly remved; 
ien
is blind lre dy<div><br /><div><b>Hy
h l
mus (sur
en
ri l)-de dly</b></div><div><b><br /></b></div><div><b><br /></b>
</div><div><b>Cerebellum (s
erir fss )&nbs;</b></div></div>
"<img src="" s
e-71468255805712.jg"" />&nbs;<div>Describe
he 
hlgy, gr d
e, nd
re
men
</div>" Bil
er l <b>
ic nerve glim </b>; gr de I, c n likely
be
re
ed wi
h surgic l resec
in. &nbs;N
e
h

he 
ien
will be m de bl
ind by
his cndi
in nd
h
surgery des n
fur
her ffec
bili
y
 see...
"Describe
hs his
lgic l im ges belw. Wh

umr? &nbs;Wh
des
he rrw 
Hyercellul ri
y
in

?<div><img src="" s
e-71588514890006.jg"" /></div>"
, v scul r rlifer
in s seen in <b>ilcy
ic s
rcy
m (gr de I)</b>. &nbs
<b>Rsen
h l Fiber</b>&nbs;which is n <u>esinhilic cll
;Arrw in
s

ec
in f cells</u>, demns
r
es <u>slw grwing
umr</u>
"P
ien
resen
s cml ining f seizures. &nbs;On his
lgic ex min
in yu f
ind hyercellul ri
y nd lemhism wi
h ""fried egg"" cells; di gnse nd gr d

e<div><br /></div><div><img src="" s
e-71640054497442.jg"" /></div><div><img s

rc="" s
e-71652939399415.jg"" /></div>"
Oligdendrglim (gr de II)<div
> N
e
h

ien
c n resen
wi
h fc l r secnd rily gener lized seizures</d
iv>
Wh
his
lgic l evidence is needed
 recl ssify gr de II ligdendrglim
gr de III n l s
ic ligdendrglim ?
V scul r rlifer
in + necrsi


s; ligdendrglim will lre dy resen
wi
h hyercellul ri
y nd lecy
sis
Wh
is
he rgns
ic difference wi
h lss f he
erzygci
y (19q / 1 dele
i
n) in
re
men
f ligdendrglim ? Lss f 1 / 19q = 124 mn
h surviv l (1
0 yrs)<div>1 / 19q reserved = 12 mn
h surviv l (1 yr)</div>
Resnse
 chem
her y is be

er in 
ien
s wi
h ligdendrglim wh l ck w
h
gene?
19q / 1 (dele
in = lss f he
erzygsi
y)
Gr de II nel sm
h
is cmmnly seen in
he ven
ricles nd h s 
en
i l
 s
re d in
he CSF. &nbs;Ven
ricul r
ubercle s
ruc
ures seen during his
lgic e
x min
in f n iden
ifying fe
ure? "Eendymm <div><br /></div><div><img sr
c="" s
e-72176925409527.jg"" /></div><div>(eendymm in 4
h ven
ricle)</div>"
"Describe
he grss 
hlgy nd imr
n
his
lgic l im ging seen belw. Di
gnse nd gr de<div><img src="" s
e-72297184493832.jg"" /></div><div><img src=
"" s
e-72310069395650.jg"" /></div>" "Grss: eendymm (gr de II) dissemin

ed in
he ven
ricul r sys
em<div>His
: <b>ven
ricul r
ubercles</b> (indic
ive
f
his nel sm)</div><div> Will see cle r zne wi
h reduced cellul ri
y (<u><b
><fn
clr=""#ff0000"">eriv scul r rse

ing</fn
></b></u>)</div>"
"Iden
ify
hese im ges nd n
e
he bnrm l s
ruc
ure. Wh
gr de?&nbs; Exl i
n hw sudden de
h c n ccur<div><div><img src="" s
e-72456098283771.jg"" /></
div><div><img src="" s
e-72503342923982.jg"" /></div></div>" "<b><u>Cllid c
y
s</u> </b>( rising frm <b>eendym </b> <u>gr de 1</u>) - c n c use <fn
cl
r=""#ff0000""><b>si
in l</b></fn
> <b>hydrceh lus</b>&nbs;( nd s
i
in
l he d ches)-  r
icul r rien

in m y c use <u>bs
ruc
in f ven
ricul r f
lw (<b>3rd ven
ricles</b>)</u>&nbs;<div><b><br /></b></div><div><b><br /></b><
/div>"
"<img src="" s
e-72615012073600.jg"" /><div>Describe
his im ge? &nbs;Wh
wi
ll be seen n his
lgic ex min
in?</div>"
"<b>Cen
r l neurcy
m </b>; in

r ven
ricul r m
er l neurn l
umr. &nbs;<div>His
lgic l ex min
in will s
hw <u>cle r h l cells</u> (resembling fried egg lig cells)</div><div><img sr
c="" s
e-72627896975485.jg"" /></div>"
Wh
is
he le s
cmmn childhd
umr? Wh
m kes i
rel
ively cur ble?
"Eendymm - re smewh
circumscribed&nbs;<div><img src=""circ.jeg"" /></div
>"
"Wh
des
his shw?<div><img src=""rg (1).jeg"" /></div>" Prgressive mu

mre severe frm ver
ime. In
his c se, ll glibl s


ins mve c ncer

m s m y begin s n s
rcy
e/ s
rcy
m <div><br /></div>
N me 3 hum n fil ri ses (
ric l  r si
ic dise ses - infec
in wi
h <u>fil ri
l nem
des</u>)
<div> Lymh
ic fil ri sis (LF)</div><div> Onchcerci sis
(River Blindness)</div><div> Li sis (Afric n eye wrm dise se)</div>
Wh
medicine 
her
h n DEC c n be used fr LF by wuchereri b ncrf
i? Als us
ed fr s
rngylides
Ivermec
in
C n use ul
r sund f lymh dr in ge- fr wh
? Wh
will yu see?
LF,
he
dul
wrm nes
s nd see Fil ri D nce Sign (FDS)
"<img src=""l .jeg"" />"
L L
Wh
is
he di gnsis f L L (l b nd clinic l)? Wh
is
re
men
? "L b: Mi
crfil ri e in bld, clinic l: in
he eye<div>DEC r ivermec
in</div><div><br /
></div><div><img src=""l life.jeg"" /></div>"
"<img src=""nch.jeg"" />"
Onchcerc vlvulus
Wh
c ncers re cmmn, bu
d n
g

he br in very much? U
erine, cervic
l, nd rs

e c rcinm s
"P
ien
resen
s cml ining f eisdic seizures nd &nbs;hemi resis. &nbs;
Im ging reve ls well circumscribed lesin in
he ex
r - xi l cm r
men
. &nbs
;Wh
is
he ms
likely lesin? Frm wh
cell?<div><img src="" s
e-515653773
55908.jg"" /></div>" "Meningim (frm mening
heli l cell); n
e
h

hese

end
 be rim rily ex
r - xi l nd b sed in
he dur ...<div><img src="" s
e-5

1595442126989.jg"" /></div>"
Describe
he rel
ively uncmmn e r nce f n in
r -ven
ricul r meningim wh
des i
rise frm?
Mening
heli l cells
h
rem in in
he <u>chr
id lexus</u> c n give rise
 <u>in
r -ven
ricul r meningim s</u>. &nbs;Hwev
er, n
e
h
ms
f
he
ime meningim s rise frm
he dur i
self.
"Grss sec
in + his
lgic l im ge. &nbs;Wh
is
he likely nel sm<div><img
src="" s
e-51831665328254.jg"" /></div><div><img src="" s
e-51844550230144.j
g"" /></div>" Mening
heli l cell (meningim ) rlifer
in in dur nd r ch
nid c s
"Describe
his nel sm nd give ex mles f clinic l sym
ms yu migh
see wi

h
his 
ien
?<div><img src="" s
e-51964809314575.jg"" /></div>"
Ex
r - x
i l
umr, hmgenus nd firm; <u>meningim </u>&nbs;f
he l
er l cmlexi

y nd will likely resen
wi
h <u>fc l nuerlgic l defici
s nd seizures</u>
"Dx?<div>Wh
sym
ms will likely ccm ny
meningim in
his lc
in?<div>
<img src="" s
e-52085068398853.jg"" /></div></div>" Dx: <u>F lcine meningim
</u>, well circumscribed<div> N
e
he <b>disru
in in nrm l sulci s
ruc
ure</
b> which will likely le d
 cmressin f
he m
r hmnculus ffec
ing <u>l
wer ex
remi
y m
r func
in</u>. &nbs;</div><div><br /></div><div>Addi
in l s
ym
ms culd include bwel/bl dder dysfunc
in nd jerking f ex
remi
ies, e
c.
</div>
"<div>Tw 
ien
s resen
wi
h blindness nd
he grss 
hlgies belw, diffe
ren
i
e nd describe
he likely c uses f
he nel sms. &nbs;Hw will yu r
ceed wi
h
re
men
.</div><img src="" s
e-52299816763504.jg"" /><div><img src=
"" s
e-52312701665383.jg"" /></div>" T im ge: likely <b>meningim </b> f

he 
ic nerve; n
e hw
he
umr rises in
he <u>dur l she
h</u>&nbs; nd <u
>cmresses
he 
ic nerve</u>&nbs;le ding
 blindness<div><br /></div><div>B


m im ge: likely <b>ilcy
ic s
rcy
m </b>&nbs;
he nel sm rises wi
hin

he nerve s
ruc
ure nd <u>enl rges i
</u></div><div><u><br /></u></div><div>De
si
e differen
c us li
ies,
he
re men
fr b
h nel sms is surgic l resec
i
n f
er llwing 
ien

 rgress
 blindness.</div>
Hw des
he sych
her is
incre se func
in l bili
y nd decre se sym
ms?
incre se <u>insigh
</u> nd
he <u>r nge</u> f beh vir l resnses
Define: Occurs when
he 
ien
s uncnscius feelings frm
he  s
bu
his  r
en
s (r 
her imr
n
ersns) re exerienced in
he resen
rel
inshi wi

h
he
her is
nd re n lyzed&nbs; <div>Tr nsference</div><div><br /></div>
We re ll
he sum f f ll
he rel
inshis we h ve ever h d
"<img src="" s
e-52493090291841.jg"" /><div>His
lgy sec
in reve ls cle ring
f nucleus nd disl ced chrm
in, wh
is
he likely 
hlgy?</div>"
"Meningim ...cells wi
h disl ced chrm
in re ls knwn s ""<b>Li

le Orh
n Annie</b>"" cells. k in
r nucle r cy
l sic cle rings"
Hw is
r nsference used in sych
her y?
T unders
nd  s
rel
inshis
in
he cn
ex
f resen
nes
Define:&nbs;Occurs when
he
her is
uncnsciusly re-exeriences feelings b
u
his  ren
s (r 
her imr
n
ersns) wi
h
he 
ien

Cun
er
r nsfere
nce<div><br /></div><div>Feelings c n be f ny
ye; lving, ngry, grief, i
y
, nxius...</div>
Wh
re
he g ls f sych n lysis? <b>Recvery</b> f <u>childhd exerien
ces</u> nd <u>cnflic
s</u> s
hey re recre
ed in
he rel
inshi wi
h
he
n lys
.<div><br /></div><div>Sym
m reslu
in, <u>rewrking f ersn li
y</u
></div>
Wh

yes f 
ien
s d we w n
fr sych n lysis? Rel
ively s
ble, high
func
ining 
ien
s. Mus
h ve insigh
, high eg s
reng
h, n
sych
ic
"Cn
r s
nd describe
he fllwing his

hlgic l sec
ins; wh
re
he re
lev n
s
ruc
ures nd likely 
hlgic surce?<div><img src="" s
e-52639119180
064.jg"" /></div>"
"2: Fibrbl s
ic rchi
ec
ure f <b><u>meningim </u></b
><div>3. Whrls (cmmnly seen in <u s
yle=""fn
-weigh
: bld; "">meningim </u
>)</div>"
Hw lng shuld 
ien
s underg sych n lysis? Hw m ny
imes er week shuld

hey cme in? 3-6 ye rs dur
in<div>4-5x er week!&nbs;</div>
"<div>Describe wh
yu see here. Wh
is di gnsis, gr de? Wh
des i
rise f

rm?&nbs;</div><div><div><img src="" s
e-53017076301941.jg"" /></div><div><im

g src="" s
e-53047141073137.jg"" />&nbs;</div></div>"
"Meningim , gr
de I<div>Frm <b>mening
heli l cells</b> ( r chnid cells) in dur <br /><div><f
n
clr=""#ff0000""><b>Ps mmm bdies</b>, <b>whrled 

ern</b></fn
><div>
<fn
clr=""#ff0000""><b><br /></b></fn
></div><div><br /></div></div></div><
div><br /></div><div><img src="" s
e-729148007907496.ng"" /></div>"
Wi
h such high frequency f sych
her y visi
s, n
much h s ch nged
e ch
visi
. Wed like
 ge


heir uncnscius
hugh. Wh
re sme
echniques 
f chieving
his?
<div>Use f f n
sy nd dre ms&nbs;</div><div>Free ss
ci
in</div><div>Cuch ( n lys
u
f view)&nbs;</div><div>Neu
r l n lys
</d
iv>
"Cell rcesses secured by
igh
junc
ins f
en bscure cell brders in his
l
gic l im ging f
his
umr
ye. &nbs;Wh
<b>
echnique</b> is u
ilized in
he
fllwing im ge
 imrve visu liz
in f
his <b>
umr</b>?<div><img src=""
s
e-53167400157319.jg"" /></div>"
Ei
heli l Membr ne An
igen (s
ins junc

in l cmlexes, desmsmes)<div><br /></div><div>Meningim </div>
Wh
is

he he r
f sych n lysis? Use f
r nsference
Wh
is sychdyn mic sych
her y? &nbs;Difference wi
h sych n lysis?
"Simil r
 sych n lysis, bu
use f ""<u>here nd nw</u>"""
Meningim s re usu lly slw grwing, well cirumcsribed nd surgic lly r ch
ble. &nbs;Wh
is cmmn gene
ic bnrm li
y fund in
hese <b>gr de I </b>
u
mrs? "Chrmsme 22 ""Merlin"" dele
in (lss f n
i-ncgene)"
Wh

ye f 
ien
s shuld be used fr sychdyn mic sych
her y? Simil r

 sych n lysis, c n include <u>less s
ble ersn li
y disrders</u><div><u><
br /></u></div><div> ngry girl in
he vide</div>
"P
ien
resen
s cml ining f unil
er l
inni
us nd rgressive he ring ls
s. &nbs;When ev lu
ing
hem fr surgic l remv l yu cnsul

he fllwing im
ging resul
. &nbs;Wh
is
he likely di gnsis? Wh
d yu c ll
his im ge sig
n? Tre
men
?<div><img src="" s
e-53395033424057.jg"" /></div>"
"<u>Cere
belln
ine ngle Schw nnm </u>; resen
s s ""<b>snw cne sign</b>""&nbs;
<div><br /></div><div>N
e: inv sin in
 udi
ry c n l; ls knwn s <u> cus

ic neurm </u></div><div><u><br /></u></div><div>Tre
men

ins include: <u>
surgic l resec
in</u> r <u>r di- bl
in</u> (s
ere
c
ic r disurgery)</div
>"
Fr sychdyn mic sych
her y, hw lng shuld 
ien
s be
re
ed? Hw m ny

imes er week? Mn
hs
 ye rs in dur
in<div>Sever l
imes
week</div>
<div>Describe
he
echnique:</div><div>F ce
 f ce, si

ing u</div><div>In
er
re

in nd cl rific
in</div><div>Sme sur
ive in
erven
in</div> Psychdy
n mic sych
her y<div><br /></div><div>(vide)</div>
Schw nn cell
umrs resul
in <b>
w</b> cmmn nel sms. &nbs;<b>N me</b>
he
m nd
he likely ssci
ed <b>chrmsm l</b> <b> brnm li
y</b> nd <b>NF
y</
b>e.
"<b>Schw nnm </b>; chrmsme <b>2</b>2 (""Merlin"") (NF<b>2</b>)<div><
b>Neurfibrm </b>; chrmsme <b>1</b>7 (NF<b>1</b>)</div>"
Describe
he gene rel
ed 
hgensis f Neurfibrm
sis
ye 2. Give inheri

nce.&nbs;
"NF2 is n u
sm l dmin n
cndi
in. &nbs;Every cell is l c
king ne cy f Chrmsme 22 (""Merlin"") which redisses
 m lign n
cell
cycles. &nbs;<div><br /></div><div><b>Susec
NF2 wi
h bil
er l cus
ic neur
m s</b></div><div><b><img src=""NF2.jeg"" /></b></div><div><b><br /></b></div><
div><b><div>Rule f 2s:</div><div>NF2, ch22, 2 cus
ic neurm s, 2
yes f ben
ign
umrs</div></b></div>"
A deficiency in chrmsme 22 ( n n
i-ncgene) redisses
 wh

w
yes 
f nel sms?
"<b>Schw nnm s</b> nd <b>meningim </b>. &nbs;P
ien
s re

risk fr Schw nnm s (+ NF2) nd mul
ile meningim s<div><img src=""ch r
(4).
jeg"" /></div>"
Wh
kind f 
ien
s re c ndi

es fr brief
her y? Mus
be ble
 <u>iden

ify discre
e issues</u>, quickly frm <u>gd wrking rel
inshi wi
h
her is

</u>,&nbs;simil r
 sych n lysis
"M
ch
he rri
e
erm fr
he his
lgic l im ge:<div>An
ni A, An
ni B,
Verc y Bdy. &nbs;</div><div><br /></div><div>Wh
dise se re
hese
yic lly
seen in?</div><div><br /></div><div><img src="" s
e-53888954663002.jg"" /></d

iv><div><img src="" s
e-53901839564901.jg"" /></div>" "<img src="" s
e-539147

24466997.jg"" />"
Cn
r s

he lc
in f grw
h nd
x 
ins be
ween Schw nnm nd Neurfib
rm ? "Schw nnm s
end
 ccur

he erihery f
he nerve nd re f
en c
ndid
es fr remv l. &nbs;Hwever, neurfibrm s
end
 infil
r
e
he nerve
wi
h li

le r
uni
y
 s lv ge<div><img src=""sch vs neur.jeg"" /></div>"
<div>Describe
he
her y:</div><div>F ce
 f ce</div><div>Dur
in f
her y
se

beginning</div><div>Fcus f cn
en
</div>
Brief
her y
Wh
re
he g ls f cgni
ive
her y?
"<div>Views cnscius
hugh
s
s&nbs;rducing nd ere
u
ing sym
ms.</div><div><br /></div><div><div>Rem
v l f sym
ms
hrugh <u>iden
ifying nd l
ering cgni
ive dis
r
ins</u></d
iv><div>
</div></div><div>""Thugh
s cre
e yur feelings which cre
e yur c
ins""
</div>"
"<div>Chrmsme 17 bnrm li
y wi
h his
lgic l evidence f nerve infil
r
in
. &nbs;Wh
is
he likely nel sm nd 
en
i l 
hlgic l rgressin?</div
><img src="" s
e-54107997995240.jg"" /><div><br /></div>"
"<b>Neurfibrm
</b> (
ye I); n
e
h

here is risk fr rgressin

<b>neurfibrs rc
m </b>which is frm f
""eriher l nerve she
h
umr"" (PNST)"
Prim ry CNS lymhm s se risks
 wh
secific grus f 
ien
s? (2)
"<b>Elderly 
ien
s</b> (ddx: nrm l senescence f immune sys
em)<div><b>Immun
cmrmised 
ien
s</b>: eseci lly wi
h
r nsl n
s nd AIDS</div><div><br /><
/div><div><img src="" s
e-54713588383995.jg"" /></div><div><img src=""PCNSL (1
).jeg"" /></div>"
Wh

ien
s re c ndid
es fr cgni
ive
her y? Wh
mus

hey h ve?
"<div>Deressin, nxie
y, hbi s, sm
iz
in</div><div>Mus
h ve sme <u>m

iv
in
 wrk u
side f
her y</u></div><div><b><br /></b></div><div><b>N
<
/b> used fr severe <u>ersn li
y 
hlgy</u>, subs
nce buse disrders</div
><div><img src=""n
e.jeg"" /></div>"
"In
r - xi l nel sm
h
cmmnly frms rund nd infil
r
es bld vessels.
&nbs;Ms
cmmnly ffec
s B-cells<div><img src="" s
e-54709293416699.jg"" />
</div>" Prim ry CNS lymhm (l rge cell lymhm )<div><br /></div><div>big nucl
ei, less m
ure
h n re l lymhcy
es, &nbs;<b> ngicen
ric ccumul
in f cel
ls</b></div>
"Describe
he
her y:<div>Beh vir l ssignmen
s<br /><div>Re ding<br /><div>Le
rning
 recgnize u
m
ic
hugh
s""</div></div></div>"
Cgni
ive
her 
y
Wh
is
he dur
in nd frequency f cgni
ive
her y?
Limi
ed: 15-25 s
essins in dur
in<div>Weekly frequency</div>
"P
ien
resen
s
 AIDs clinic wi
h n r
unisi
c EBV infec
in. &nbs;Yu
susec
 rim ry CNS lymhm b sed n
he his
lgic l im ges belw. &nbs;Ex
l in
he 
hgenesis f his cndi
in nd
echniques yu culd use
 immun-

ye nd cnfirm yur di gnsis?<div><img src="" s
e-54855322304756.jg"" /></di
v>"
"EBV infec
in in AIDs 
ien
s c n drive lymhrlifer
ive disrders
by<u> infec
ing cell recursrs nd driving
hem in

he cell cycle.</u> &nbs;
<b>B-cells usu lly infec
ed</b><div><br /></div><div>Immun-hen
ying c n cnf
irm infec
ed cells:</div><div><br /></div><div><b><u>CD20 = B-cells</u> (<fn
c
lr=""#ff0000"">
his ic</fn
>)</b></div><div><b><u>CD3 = T-cells</u></b></div
>"
Wh
is
he use f
r nsference nd defenses in cgni
ive
her y?
Since
h
e g l is sym
m reduc
in
hrugh ch nging nes <u>subjec
ive exerience</u>, c
gre
ex
en
. In
erre

in f
r
nflic
s frm childhd re n
exlred

nsference nd defenses <b>n
used s much</b>
Wh
is
he g l f beh vir l
her y? Mdify m l d 
ive beh virs by <u>reinf
rcing&nbs; rri
e beh virs</u>
Wh
ini
i l
her y migh
be cnsidered in rim ry CNS lymhm
 c
iv
e
Cr
ics
erids! &nbs;N
e hwever
h
even
u lly
he

sis f B-cells?

umr will becme <b>resis
n
</b>...
Wh
cndi
ins re gd fr beh vir l
her y?
P
ien
s wi
h <b>hbi s
</b>, <b>sychhysilgic l</b> cndi
ins, 
her
rge
ed beh virs
<div>Describe
his
her y:</div><div><br /></div><div>Sys
emic desensi
iz
in

(www.vir
u llybe

er.cm</div><div>see cm ny -&g
; envirnmen
s)</div><div>Imlsi

n
her y nd flding</div><div>Aversin
her y</div><div>Bifeedb ck </div>
Beh vir l
her y
Wh
is
he g l f sur
ive sych
her y? <u>M in
ining</u> r recvering

he <u>bes
level f func
in</u> fr n individu l
Wh
is gd
her y fr high func
ining 
ien
s in crisis, 
ien
s wi
h se
rius nd ersis
en
men
l illnesses (e.g. Schizhreni , Bil r I), severe e
rsn li
y disrders, r medic lly ill 
ien
s? Sur
ive sych
her y
"<div>Mul
ile, discre
e, well-circumscribed lesins wi
h edem n
ed n im ging
nd grss insec
in. &nbs;Wh
is
he likely (gener l) c use?</div><img src="
" s
e-55091545506032.jg"" /><div><img src="" s
e-55104430407903.jg"" /></div
><div><br /></div>"
Me
s

ic
umrs
Wh

her y is being described?<div><br /><div>Av il ble, redic
ble
her is

</div><div>Ther is
m y c
s guide r men
r</div><div>Sugges
in, reinfrcem
en
,
e ching, re li
y
es
ing, re ssur nce</div><div>Mre c
ive
her is
</div
></div> Sur
ive sych
her y
Wh
is
he use f
r nsference nd defenses in sur
ive sych
her y?
N in
erre

in f
r nsference<div>Ad 
ive <u>defenses reinfrced</u></div>
Wh
re g ls f gru sych
her y? <div>Of
en fcus n<u> in
erersn l rel

inshis</u></div>
"Tumr me
s
sis
 midbr in c us

ive f P rkinsns; where re
he ms
likel
y surces fr
his me
s
sis?<div><img src="" s
e-55224689492231.jg"" /></div
>"
Lung, Bre s
, Skin, Kidney, GI; n
e hwever
h
ms
sys
emic
umrs c
n even
u lly m ke
heir w y

he br in...
<div>Sme grus require very high func
ining individu ls wi
h gd self bserv

in skills</div><div><br /></div><div>Sme grus re mre sur
ive, fcusin
g n si
ive reinfrcemen
f d 
ive beh vir, re li
y
es
ing, re ssur nce,
nd s n.</div>
Gru sych
her y
Yu susec
br in me
s
sis frm
sys
emic si
e. &nbs;Wh
rcedures /
re

men
s shuld be cnsidered?
<b>P n C
/MRI </b>f
hr x nd bdmen
 sc n
fr rim ry
umr si
e<div>Fllw wi
h <b>cr
ics
erid</b> Tx
 reduce bud n

edem nd <b>exlre chem/r di
in</b>
her y 
ins...</div>
These
w sys
emic si
es re
he surce rxim
ely 80% f me
s

ic
umrs

h
h ve sre d

he br in
<b>Lung</b> nd <b>Bre s
</b>; n
e
h
mel nm
(skin) is cm r
ively r re, bu
will lms
lw y be seen in br in if P
die
s frm mel nm
"Iden
ify
his im ge nd give
he likely sys
emic surce f me
s
sis?<div><img
src="" s
e-55585466745125.jg"" /></div>"
Meninge l c rcinm
sis; likely
frm lung, bre s
, skin, kidney, GI
Ms
likely surce f bne me
s
sis? PBKTL: rs

e, bre s
, kidney,
hyrid
, lungs<div><br /></div><div>le d ke

le</div>
"Well circumscribed lesin in
he cerebellum is n
ed n im ging. &nbs;His
lg
y reve ls f my / bldy cy
l sm.<div><br /></div><div><img src="" s
e-557400
85567709.jg"" /></div><div><img src="" s
e-810322889801938.ng"" /></div>"
Hem ngibl s
m ; n
e
h
b sed jus
n im ging yu culd cnsider: ilcy
ic
s
rcy
m ,
xl sm , me
s
sis, e
c.
Hem ngibl s
m s frmed frm bne m rrw derived recursrs
h
re invlved i
n v scul r re ir (hem ngibl s
) re ssci
ed wi
h wh
u
sm l dmin n
di
srder? Wh
else is
his disrder ssci
ed wi
h?
<b>vn Hiel Lind u</b>
(VHL); n
e
h

ien
will h ve nly ne cy f n n
i-ncgene nd be

incre sed risk fr <u>ren l cell c rcinm </u> s well<div><u><br /></u></div><d
iv> There is 15-20% ch nce
h n n individu l wi
h hem ngibl s
m is  r

f VHL f mily (high risk fr mul
ile lesins!!)</div>
Wh
cndi
in des b sil r r
ery cclusin le d
? lcked in syndrme
Wh
is
he use f
r nsference nd defenses in brief
her y? B
h re in
err
e
ed s i
rel
es

her y
Wh
is
he dur
in nd frequency f brief
her y?
12-20 sessins, weekly
Wh
re
he g ls f brief
her y?
Cl rifies nd <u>reslves n re f cn
flic
</u>
h
in
erferes wi
h <u>curren
func
in</u>
In sych n lysis, is
here in
erre

in f
r nsference r defenses? Yes.<div

><div>Tr nsference is in
erre
ed since
his reresen
s  s
cnflic
s</div><div

>M l d 
ive defenses re in
erre
ed</div></div>
Wh
is
he 
hhysilgy f neurcys
icercsis?
"M ss effec
<div>Infl mm

ry resnse</div><div>Obs
ruc
in f
he fr min nd ven
ricul r sys
em f b
r in</div><div><img src=""neur (2).jeg"" /></div>"
DickeyPr

"Wh
re
he s
ges f neurcys
ercsis?<div><img src=""neurcy.jeg"" /></div>
"
<div>A. Vi ble cys
(T1 + cn
r s
)</div><div>B. Ini
i l infl mm
in</d
iv><div>C. Degener
ing cys
</div><div>D. C lcified  r si
e (CT)</div> DickeyPr


Clinic l sec
rum f gi rdi in children (3)
"Asym
m
ic gi rdi sis (60%)<d
iv>Acu
e gi rdi sis (lse, ful-smelling, s
e
rrhe , n bld, fever)</div><d
iv>Chrnic gi rdi sis (s
e
rrhe , <b>grw
h re
rd
in</b>)</div><div><br /><
/div><div><img src="" s
e-85920820757110.jg"" /></div>"
DickeyPr

Wh
is
he firs
nd secnd c use f s
e
rrhe ?
"Cys
ic fibrsis, chrni
c gi rdi sis<div><br /></div><div><img src="" s
e-85916525789814.jg"" /></div>
"
DickeyPr

Wh
is n en
er-
es
?&nbs; Used fr gi rdi l mbli <div>P
ien
sw llws c
sule n end f s
ring--&g
; in jejunum, where
rhzi
es

ch--&g
; 4-24 hr
s l
er, s
ring wi
hdr wn</div> DickeyPr

Wh
is
he #2 di rrhe l dise se in children in develing cu
ries f
er r
vi
rus?
"Cry
sridium<div><img src=""2 (2).jeg"" /></div>" DickeyPr

Wh
is ni
zx nide used fr? "Pedi
ric 
ien
s wi
h <u>gi rdi </u> nd <u>c
ry
sridium</u><div><u><img src=""A264_gi rdi .ng"" /></u></div><div><u></u>
<u><img src=""A314_cry
.ng"" /></u><br /><div><div><div><div><div><u><br /></
u></div><div><u><img src="" s
e-85993835201142.jg"" /></u></div><div><u><br />
</u></div><div><u><br /></u></div><div><u><br /></u></div><div></div></div></div
></div></div></div>"
DickeyPr

"Wh
is ""big cry
sridium""? Tx?" "Cyclsri sis; TMP-SMX effec
ive<div><
img src=""big (1).jeg"" /></div>"
DickeyPr

Wh
is di gnsis f mebi sis? (3)
1. Trhzi
e wi
h endcy
sed RBC n S

l O& m;P&nbs;<div>2. Elis </div><div>3. Serlgy</div><div><br /></div>
DickeyPr

Tre
men
f mebi sis (inv sive, sym
m
ic)?
"Inv sive: Me
rnid zle
+ lumin l gen
<div>Asym
m
ic: Lumin l gen
lne (idquinl,  rmmycin)
</div><div><br /></div><div><img src="" s
e-86135569121910.jg"" /></div>"
DickeyPr

Wh
s
he ms
cmmn s
erir fss
umr in children?
Pilcy
ic s
rc
y
m
Wh
s
he ms
cmmn s
erir fss
umr in dul
s? Hem ngibl s
m
Wh
is
he resen

in f neurcys
icercsis in
he US? Endemic re s?
US- single ring-enh ncing lesin n CT<div>Endemic- mul
ile lesins wi
h incre
sed ICP</div> DickeyPr

Wh
is
x fr single-ring enh ncing lesin f neurcys
icercsis? Mul
ile cys

s?
"Single: sn
neusly<div>Mul
ile: lbend zle, r ziqu n
el</div><div
><br /></div><div><img src="" s
e-86169928860278.jg"" /></div>"
DickeyPr


Hw d di gnse hyd
id cys
? Im ging DickeyPr

Wh
is kluver-bucy syndrme? Wh
re sym
ms?&nbs; <b>Bil
er l
emr l l
be d m ge&nbs;</b><div><b><br /></b><div>Diminished fe r resnse (frm mygd l
d m ge)</div><div>Hyersexu li
y</div><div>Visu l gnsi (bjec
s, ele)</d
iv></div>
Three m jr dise ses
h
we re cncerned bu
wi
h leishm ni sis (jus
lis
)
-Viscer l leishm ni sis<div>-Cu
nus leishm ni sis</div><div>-Muccu
neus Lei
shm ni sis</div><div><br /></div><div>2 millin new c ses er ye r</div>
Wh
is
he
yic l ge fr schis
sme infec
in?
"~15, rund mid
 l
e
dlescence&nbs;<div><img src=""qge.jeg"" /></div>"
Hw d yu di gnse FUS/FGS?
Iden
ific
in f v in cervic l sme r r bis
y
Wh
is 
hhysilgy f FUS? Lc
in?
"<div>Migr
ing eggs c use <u>gr
nulm s</u>--&g
;mucs l ersins nd <u>ulcer
ins</u>, <u>cn
c
bleeding</

u></div><div><br /></div><div>Ms
cmmnly ffec
s <u>cervix</u> nd <u>v gin <

/u></div><div><u><img src=""schis.jeg"" /></u></div>"
Wh
is
he 
hgenesis f S. m nsni infec
in? Wh
c n
his le d
?
"In
es
in l nd liver gr nulm s nd fibrsis<div><img src=""
h (1).jeg"" />
</div><div><br /></div><div>He
slenmeg ly, liver fibrsis (like n lchli
c). Bldy s
ls nd grw
h s
un

</div><div><img src=""schis kid.jeg"" /><
/div>"
Wh
c n c use chl ngic rcinm ?
"Clnrchi sis<div><img src=""clnr lif
e.jeg"" /></div>"
Des schis
sme h ve n in
ermedi
e hs
?
"N, l rv s
ge c n le ve
he s
n ils nd g direc
ly in

he skin.<div><img src=""schis
 life.jeg"" /></div>
"
Exis
s in bdy s mdified egg "Micrfil ri - wuchereri b ncrf
i<div><img sr
c=""mf.jeg"" /></div>"
N me fluke in lung, bld, liver, in
es
ine gruing.&nbs;
Lung-  r gnism
us<div>Bld- schis
smes</div><div>Liver- F scil he
ic , clnrchis</div><
div>In
es
in l- f scil s.&nbs;</div>
Leishm ni sis 
hgenesis (shr
, describe 2 frms)
"<div>Leishm ni s (c
nine reservir) --&g
; S ndfly --&g
; BITE/vmi
--&g
; Hum n --&g
; Leishm ni s
is</div><div><br /></div><div>Mnemnic: un<i>le sh</i>
he <i>s ndfly</i>&nbs;<
/div><div><br /></div><div>-
nigh
in <u>rm s
ig
e</u> frm</div><div>-<u>
rm s
ig
e</u>&nbs;(m
ile, fl gell
ed) ge
s h gcy
ized by m crh ges, bu

c n esc e lyssme, lw H m kes
r nsfrm
in<div>-bugs relic
e inside m c
rh ge s <u> m s
ig
es</u> (wi
hu
fl gell e, nn m
ile)</div><div><br /></
div><div><br /></div><div><br /></div><div><img src="" s
e-104183021699073 (1).
jg"" /></div></div>"
Viscer l leishm ni sis, wh
s n
her n me
k l - z r dise se
Viscer l leishm ni sis eidemilgy
"<img src="" s
e-13782550052865 (1).jg
"" /><div><br /></div><div>Indi (S

e f Bih r), Ne l, B ngl desh</div><div><
br /></div><div>Sud n</div><div><br /></div><div>Br zil (n
shwn bve)</div>"
Viscer l leishm ni sis, clinic l fe
ures. Include ms
susce
ible
"<div>-<
u>""bl ck fever""</u> -&g
; hyerigmen

in</div>-fever nd <u>he
</u><b><u
>slenmeg ly</u>&nbs;(sleen is h rd like rck)</b><div>-<u>neu
reni , hy
erg mm glbulinemi </u></div><div>-<u>children &l
; 5</u> ms
susce
ible</div>
<div><br /></div><div><img src="" s
e-104402065031169.jg"" /></div>"
"<img src="" s
e-104470784507905.jg"" />"
leishm ni
di gnsis f viscer l leishm ni
"<b>-<u>fine needle sir
in f sleen
</u> (&g
;90% sens) -&g
; </b>lk fr<b> m s
ig
es in m crh ges</b><div>-b
ne m rrw sir
in</div><div>-in
r derm l leishm ni skin
es
(simil r
 TB
skin
es
). n
suer helful sme
imes bec use i
ll be si
ive even f
er
re

men
/cure</div><div>-ELISA n
gre
</div><div><br /></div><div><img src="" s

e-105823699206145.jg"" /></div>"
Pen
v len
n
imny (<b>Sdium s
ibglu

re
men
f viscer l leishm ni sis
cn
e</b>)<div>-side effec
include n use vmi
ing,  ncre
i
is</div><div><br
/></div><div>Amh
ericin B</div><div>-mre used bec use f resis
nce
w rds
SbV</div><div>-bu
exensive</div><div><br /></div><div>Mil
efsine</div><div>n
ic ncer drug rigin lly</div><div>-nly r l leishm ni sis
x</div><div>-
er

genic</div>

lk bu
ch r c
eris
ic f fevers in viscer l leishm ni sis "-siking, bu
c
ns
n
ly high fever<div>-
he e k f fever ex
remely high -&g
; 103/104 F due

 cns
n
rele se f  r si
e incre sing cy
kines</div><div>-le ds
 c
bli
c s

e (r id decline + m l bsr
in)</div><div><br /></div><div><img src=""
s
e-106038447570945.jg"" /></div>"
Mil
efsine (rigin lly
chem) m y be used s drug

re
wh
?<div>Wh

re sme side effec
s?</div>
Viscer l leishm ni sis<div><br /></div><div>Side
effec
s</div><div>-<b>
er
genici
y</b> in nim ls</div>
"<img src="" s
e-107391362269185.jg"" /><div><br /></div>"
"Cu
neus leish
m ni s ""cheese izz lesin"""
Cu
neus leishm ni sis eidemilgy
<u>New wrld</u><div>-
ex s, kl hm (L
. mexic n )</div><div>-su
h meric (L. m znensis; L. br zilienesis)</div><di

v><u><br /></u></div><div><u>Old wrld</u></div><div>-russi (L. m jr)</div><di

v>-middle e s
(L. m jr; L.
ric )</div><div>-indi (L.
ric )</div><div>si (L.
ric )</div>
Cu
neus leishm ni sis clinic l m nifes

ins "Devels
si
e where  r si
e
re incul
ed ( inless)<div>-we
lesin -&g
; <b>izz </b>&nbs;like wi
h r i
sed brders nd verlying <u>urulen
exud n
</u></div><div>-dry lesin -&g
; sm
ller nd cvered wi
h <u>crus
</u> (s.. izz vs
r
ill ?)&nbs;</div><div><i
mg src="" s
e-7614977015809_1376941536207.jg"" /></div>"
cu
neus leishm ni sis m y devel in
 wh
in HIV 
ien
s <b>diffuse cu
n
eus leishm ni sis</b><div>-cu
neus ndules nd l ques</div><div>-immuncmr
mised 
ien
</div><div><br /></div>
cu
neus leishm ni sis vs diffuse cu
neus leishm ni sis, wh
re
he resul
s
frm leishm ni skin
es
?
Cu
neus<div>-<b>si
ive</b> (in
c
cell-medi

ed resnse)</div><div><br /></div><div><br /></div><div>Diffuse</div><div>-<b
>neg
ive</b> (f
en in immuncmrmised, s defec
ive cell-medi
ed immuni
y)<
/div>
"<img src="" s
e-110848810942465.jg"" />"
Muccu
neus leishm ni <div><br
/></div><div>-ini
i l lesins simil r
 cu
neus leishm ni sis</div><div>-ms

ele wi
h
his ls h ve cu
neus sc r
h
h s he led. infec
ins rem in
drm n
fr weeks/ye rs.</div>
 r si
e infec
in
h
le ds
 n s l se
um des
ruc
in, r l mucs , bu
s r
es
ngue
"-muccu
neus leishm ni sis<div><img src="" s
e-1108488109424
65.jg"" /></div>"
<b>-Pen
v len


re
men
f muccu
neus/cu
neus (DCL) leishm ni sis
n
imny (SbV)</b><div>-ke
cn zle nd i
r cn zle</div><div>-
ric l  rm
mycin</div><div>-immun
her y wi
h BCG</div><div>-Sbv + IFN g mm fr <b>diffus
ed cu
neus leishm ni s</b></div>
Leishmni sis v ccine
-s
ill under develmen
<div>-blck vec
r frm h ving s
exu l frm f leishm ni sis&nbs;</div><div>-r r ise immuni
y
 hel figh
inf
ec
ins</div>
Americ n ch g s dise se c used by wh
-Try nsm Cruzi
Ch g s dise se, 
hgenesis (including
r nsmissin) "<div>Try nsm cruzi-&g
;Kissing bug (Reduviid gu
)--&g
;BITE/ scr
ch--&g
;Hum n--&g
;Americ n Try
nsmi sis</div><div><br /></div>Tr nsmissin<div>-<b>kissing bug</b> bi
es r
feces</div><div>-r
hrugh <b>bld
r nsfusn </b>(screening b nks in SA w s s
uccessful)</div><div>-zn
ic dise se where hum n is inciden
l hs
, rden
re
servir</div><div><br /></div><div>P
hgenesis</div><div>-
ry nsm s <b>ene

r
e</b> v rius cells

he wund si
e nd divide</div><div>-even
u lly burs

u
f cells</div><div><br /></div><div><br /></div><div><br /></div><div><br />
</div><div><img src="" s
e-116427973459969.jg"" /></div>"
Try nsm cruzi eidemilgy "Cen
r l nd su
h meric <div><br /></div><div>
<img src="" s
e-116513872805889.jg"" /></div>"
Lis

he differen
s
ges f ch g s dise se
Acu
e<div>Chrnic (30% f cu
e
becme chrnic)</div><div>Recurren
</div>
Acu
e ch g s dise se clinic l m nifes

ins "-<b>ch gm </b> -&g
; indur
ed
lesins  inless
si
e f infec
in<div>-m l ise, fever, edem </div><div>-hig
h  r si
emi s</div><div>-<b>severe&nbs;myc rdi
is</b></div><div><b>-Rm n s
sign</b>&nbs;-&g
; if cnjunc
iv is r
f en
ry</div><div><img src="" s
e-1
16672786595841.jg"" /></div>"
chrnic ch g s dise se clinic l m nifes

in "<b>C rdimy
hy (ch mber enl
rgemen
)</b><div>-cnduc
in defec
in</div><div>-lef
ven
ricul r neurysm</div
><div><img src="" s
e-116840290320385.jg"" /></div><div><br /></div><div><div>
<b>Meg cln</b>&nbs; nd meg esh gus</div></div><div><img src=""meg cln.je
g"" /></div>"
Di gnsis f cu
e ch g s dise se
"Micrscy f bld sme r: <b>fl gell

ed
rym s
g
e</b><div><b><br /></b></div><div>r n bisy: nn fl gell
ed
m s
g
e wi
hin cells<br /><div><img src="" s
e-116900419862529.jg"" /></div
><div><br /></div><div><br /></div><div>Relev n
clinic l fe
ures</div><div>-my
c rdi
is</div><div>- r si
e de
ec
in</div><div>-T.cruzi igM</div></div>"
Chrnic ch g s dise se di gnsis
"<img src="" s
e-11025181048833_1376941

536207.jg"" />"
"<img src="" s
e-117093693390849.jg"" />"
Ch g s dise se ( cu
e) n micrs
cy
"
ien
cmes in wi
h enl rged cln nd c rdimy
hy, yu
ke s mle f he
r
nd ge
s
his<div><br /></div><div><img src="" s
e-117145232998401.jg"" /><
/div><div><br /></div><div>wh
s
he c use?</div>"
Chrnic Try nsme (ch
g s)<div>-c n see <u> m s
ig
es</u> in he r

issue</div><div><br /></div>
Acu
e/Chrnic ch g s
re
men
"Acu
e<div>-<u>Nifur
imx</u> (nly cures 50%)</
div><div>-<u>Benznid zle</u></div><div><br /></div><div>- ce m ker,
r nsl n

fr c rdimy
hy</div><div><br /></div><div>Chrnic</div><div>-drugs h ve lim
i
ed effic cy</div><div><br /></div><div><img src=""benz.jeg"" /></div>"
su
hern cne in
i
ives nd s
r
egies
 reduce ch g s dise se,
lk bu
s
r

egies
 reduce b
h vec
r
r nsmissin nd
r nsfusin
r nsmissin "<b><fn

clr=""#ff0000"">Vec
r
r nsmissin reduc
in</fn
></b><div>-sr y wi
h ins
ec
icides</div><div>-educ
in</div><div>-husing imrvemen
</div><div><br /></
div><div>Tr nsfusin
r nsmissin reduc
in</div><div>-100% dnr screening</div
><div><img src=""s
r
egies.jeg"" /></div>"
Mnemnic fr ch g s dise se
"Tm Cruise <b>(T.cruize)</b> is n <b> meric n<
/b>&nbs; c
r, f
er recieving
b d <b>kiss </b>frm cr zy f n, fel
s d nd
h d <b>dil
ed he r
</b> (enl rged he r
in chrnic), swllen eyes frm crying
<b>(Rm n in cu
e</b>), nd develed <b>big clns</b><div><br /><div><br /><
/div><div><img src="" s
e-117544664956929.jg"" /></div></div>"
Hum n Afric n
ry nsmi sis is c used by wh

w subsecies--&g
; seed --&g

; lc
in
"<u>Try nsm Brusei.</u> <b>G mbiense</b> -&g
; slwer nse

-&g
; wes
fric <div><u>Try nsm Brusei</u>. <b>Rhdesiense</b> -&g
; mre r
id nse
(<b>R</b> fr <b>R</b> id) -&g
; e s
fric </div><div><br /></div><
div><img src=""lc
in.jeg"" /></div>"
Wh
H is ssci
ed wi
h emyem ? Crrel
es wi
h
he need fr wh
? &l
;7.3.
Crrel
es wi
h need fr ches

ube fr reslu
in
Sleeing sickness is c used by Try nsm Brusei (ei
her g mbiensi r rhdesie
nsis)
Eidemilgy f sleeing sickness
"Sub-s h r n Afric <div>-e s
-&g
; T.Br
usei rhdesiensis</div><div>-wes
-&g
; T.brusei g mbiensi</div><div><br /></div
><div><img src=""lc
in.jeg"" /></div>"
Hum n Afric Try nsm sis (HAT) 
hgenesis "<div>Try nsm brucei/g mbiens
is/rhdesienseTseTse FlyBITEHum nAfric n Try nsmi sis</div><div><br /></div>-
r n
smi

ed vi Tse
se fly bi
es (<b>
</b>ry nsm brusei fr <b>T</b>se
se)<div>
he  r si
e divides nd lives in v rius bdily fluids (CSF, bld, lymh)<br /
><div>-v ri ble surf ce glycr
ein c uses recurren
fever</div><div>-inv des C
NS
 c use sleeing sickness</div></div><div><br /></div><div><img src="" s
e119228292136961.jg"" /></div>"
Clinic l m nifes

in f HAT (give bld, CNS) "-skin incul
in -&g
;  inles
s ch ncre<div>-nce  r si
e in <u>bld</u> -&g
; <b>chrnic eridic fever </b
> nd <b>he
slenmeg ly</b> wi
h <b>swllen cervic l lymh ndes </b>(<b>Win

erb

ms</b> sign)</div><div><img src="" s
e-119382910959617.jg"" /></div><d
iv><br /></div><div>-nce  r si
e in <u>CNS</u> -&g
; <b>sleeing sickess</b> &g
; <b>he d che</b>, cnfusin, slee w lking, de
h</div><div><br /></div><div
><br /></div>"
chrnic nd recurren
fever wi
h lymh den
hy nd he
slenmeg ly, +
r ve
l his
ry: wh
shuld be n yur differen
i l? hum n fric n
ry nsm sis
di gnsis f HAT
"-
rym s
g
e n micrscy f <b>bld sme r</b><div
>-lumb r unc
ure if susec
ing CNS inv sin:</div><div>-Nnsecific l bs: high
igM, ESR, hyerg mm glbinemi </div><div><img src=""sme r.jeg"" /></div>"
Tre
men
f HAT (e rly nd l
e s
ge) E rly s
ge Nn-CNS<div>-<b>sur min</b>
fr Rhdesi n</div><div>-r <b>en
midine</b> fr G mbien ( inful injec
in)</
div><div><br /></div><div>L
e s
ge CNS frm</div><div>-<b>mel rsrl</b> (hig
hly
xic)</div><div>-Eflrni
hine fr G mbien</div><div><br /></div>
Preven
in f HAT
Rhdesi n HAT<div>-c

le zn
ic (cws igs) <b>reserv
ir m n gemen
</b> nd vec
r cn
rl</div><div><br /></div><div>G mbien HAT</di
v><div>-n zn
ic reservir</div><div>-deend n c se de
ec
in nd m n gemen

</div>
Wh
clus
er f ersn li
y disrders crrel
e wi
h sych
ic disrders?
Clus
er A (10x ch nce f sychsis)
Clus
er B ersn li
y disrders sh re cmmn defici
f wh
? Wh
is
heir
e
ndency? Defici
s in <u>em
hic bili
y</u>,
endency
 <u>ex
ern lize ersn l
difficul
ies</u> (decre ses
heir ersn l resnsibili
y)
Wh
is
he  r dx f clus
er C disrders?
Rew rded sci lly, bu
diminishe
d c  ci
y fr in
im cy, h ve m jr inhibi
ins in ursui
f life g ls
Bec use ersn li
y disrders d n
inheren
ly c use dis
ress, when d
hese 

ien
s seek
re
men
? A
urging f 
hers, r when cnfused by f ilures. Or du
e
 secnd ry cnsequences
Wh
re
he 4
emer men
s described by Clninger
<div> &nbs;Nvel
y seeki
ng (imulsive)</div><div> &nbs;H rm vid nce</div><div> &nbs;Rew rd deendence
(

en
in
 le sing 
hers)</div><div> &nbs;Persis
ence (erservering nd mb
i
ius)</div>
Wh
is
he rel
inshi f heri
ble f c
rs nd envirnmen
in Ch r c
er?
We kly rel
ed
 heri
ble f c
rs<div>Devels frm <u>cul
ure</u>, <u>unique
life even
s&nbs;</u></div>
There re 3 cmnen
s f ch r c
er described by Clninger, <b>self direc
edness
, cer
iveness, self
r nscendence</b>. Hw d
hese ch nge in ging?
Self-direc
edness nd cer
iveness incre se frm 20s-40s<div>Self-
r nscenden
ce <u>decre ses</u>
hrugh 40s, m y incre se g in in 50s</div>
Wh
re
he 3 ms
cmmn ersn li
y disrders?
Avid n
(C), brderline
(B), OCD (C)
Wh
re
he 2 le s
cmmn ersn li
y disrders?
Schizid,  r nid<div><
br /></div><div>We vid
he ids</div>
Wh
is
he rim ry defense mech nism f clus
er A?
Prjec
in<div><br /></d
iv><div>(schiz)</div>
During 
ien
in
erview, 
ien
is described s:<div><div>Indifference Cns
ri
c
ed (desn

lk much) Sli
ry Asexu l</div></div> Schizid ersn li
y dis
rder (rjec
inis
yung m n, sci l, cn
en
wi
h sli
ude)
<div><b>High h rm vid nce, lw nvel
y seeking </b>(desn
like subs
nces, d
esn
w n
new jb)&nbs; nd <b>lw&nbs;rew rd deendence</b>. Wh
PD?</div>
Schizid disrder&nbs;<div><br /></div><div>I
s disrder bec use limi
ed d 

ibili
y, nd 10x risk f sych
ic disrder</div>
<div>Rel
in l defici
s secnd ry
 ersn l ddi
ies&nbs;</div><div> &nbs;In

erersn l</div><div> &nbs;Ide
in</div><div> &nbs;Beh vir</div><div> &nbs;A
e r nce</div><div><br /></div><div>Key fe
ures:&nbs;</div><div><div> &nbs;A
y
ic l
hugh
s, beh virs</div><div> &nbs;Cnnec
ins des
bilize nd disrg niz
e</div><div> &nbs;Res
ric
ed d 
ive c  ci
y</div></div><div><br /></div><div>
M gic l
hinking, dd beliefs</div>
Schiz
y l ersn li
y disrder&nbs;
<div> &nbs;P

ern f verin
erre
ing
he envirnmen
&nbs;</div><div> &nbs;Per
v sive, unw rr n
ed susiciusness</div><div> &nbs;Unremi

ing hyervigil nce</d
iv><div> &nbs;Self referen
i l (egcen
ric)</div><div><br /></div><div><div>Sus
icius Mis
rus
ful Unfrgiving*</div><div>Isl
ed* Hyersensi
ive Egcen
ric</d
iv></div>
P r nid ersn li
y disrder
Wh
is Tern ry Aw reness?
Knwledge f hysic l, men
l, siri
u l cmne
n
s
A 
ien
resen
s wi
h referen
i l nd m gic l
hinking, sci l nxie
y nd ye
rnings, dd beh vir nd e r nce
Schiz
y l ersn li
y disrder
Describe
he rcess f rim ry nd secnd ry injury? Tr um c uses <u>rim ry
injury</u> which c uses energy
r nsfer

issue nd
disru
in
 nrm l ce
llul r rcesses. &nbs;<div><u><br /></u></div><div><u>Secnd ry Injury</u>&nbs
;resul
s in:<div><br /><div> hyxi </div><div> ischemi </div><div> incre sed ICP
--&g
; risk f herni
in</div><div> cidsis --&g
; b/c f nerbic glyclysis</
div><div> free r dic l injury</div><div> exci

xici
y</div></div></div><div><br
/></div><div><b>Tr um is rcess, n
n even
</b></div><div><br /></div><div
>N
e Tr um is le ding c use f de
h belw ge 40</div>
Clinic l sym
ms f sc l l cer
in? M jr bleeding - sc l is highly well v
scul rized... ly ressure
 reslve, bu
usu lly n

m jr risk f de
h.<d

iv><br /></div><div><i>D n
be dis
r c
ed by sc l bleeding 
ien
nd miss

mre serius bleed n n
her 
ien
</i></div>
"P
ien
resen
s wi
h blun
frce he d
r um resul
ing in
fr c
ured skull in

he
emr l regin. &nbs;Friends rer

h
he w s lucid fr shr

ime, b
u
beg n
 de
erir
e in
 his curren
uncncius s

e. &nbs;Di gnsis + lik
ely v scul r cmrmise?<div><img src="" s
e-9960029159561.jg"" /></div>"
"Eidur l Hem
m ; middle meninge l r
ery<div><br /></div><div>N
e: disl cem
en
f skull in
 br in is ssible</div><div> <b><u>Herni
in</u></b>: cingul

e --&g
; unc l --&g
;
nsil r c n resul
frm incre sed ICP /
r um </div><div>
<br /></div><div> Rec ll: bld resec
s su
ure bund ries (be
ween dur /bne)</d
iv><div><br /></div><div><img src="" s
e-9972914061512.jg"" /></div>"
"P
hlgy rvides
his s mle. &nbs;Describe
he likely 
hlgy nd n
ure
f
he bleeding? Cm re fresh nd ld bld.<div><br /><div><img src="" s
e-10
093173145887.jg"" /></div></div>"
Subdur l hem
m (n
e hw i
is cnfin
ed wi
hin
he hemishere)<div><br /></div><div>Fresh bld frm re c
ive gr nul

in
issues (ligh
er brwn/red re s)</div><div><br /></div><div>Old bld in d
rker brwn re s ( re f <u>ini
i l hemrrh ge</u>)</div>
Ex nds gr du lly ver erid f d ys
 weeks b/c f rebleeding frm gr nul

in
issues.
"Subdur l Hem
m ; ccurs in
he dur (we k inner brder cell l
yer)<div><br /></div><div><img src="" s
e-10222022164661.jg"" /></div><div><b
r /></div><div>""Gr nul
in
issue is <b>highly v scul r
issue</b> m de u f
<b>sm ll bld vessels, fibrbl s
s, nd myfibrbl s
s</b> nd is
he firs
h
se f wund re ir.""</div>"
"Describe
he likely 
hlgy nd n
e grss 
hlgic l fe
ures.<div><img src
="" s
e-10342281249034.jg"" /></div>" Chrnic subdur l hem
m ; brwn gr nul

in
issue is rne
 rebleeding...
ien
m y resen
wi
h herni
in.<div><b
r /></div><div>Cl ssic scen ri: &nbs;he d che fr lng erid f
ime; mre ur
gen
signs - blwn uil, e
c.</div>
Cres
s f gyri re cmmnly invlved in _______ (
hlgy)<div>while
he de
hs
gre
er ex
en
by ________ (
hlgy)</div>
f sulci re ffec
ed

Cres
s f gyri = cn
usin (br in im c
n in
erir f skull)<div>De
hs f sul
ci = Ischemic lesin</div>
Are s ms
cmmnly invlved in br in cn
usin? Wh
re
hese cn
usins ls
knwn s?
"<u>Inferir sec
s f frn
l</u> nd <u>
emr l lbes</u>,
ls knwn s <b>gliding cn
usins</b><div><b><br /></b></div><div>Rec ll: Cres

s f gyri re ms
vulner ble</div><div>Rec ll: C lv rium is rel
ively sm
h b
u
n
erir nd inferir fss /regins h ve s
ruc
ur l nd rchi
ec
ur l ""h z r
ds"" - ex. shenid ridge, cris
g lli, e
c.</div><div><img src=""gliding.jeg"
" /></div>"
"Cm re nd cn
r s

he fllwing secimens - iden
ify relev n
clinic l sym

ms yu wuld likely find<div><img src="" s
e-10591389352175.jg"" /></div>"
<b>Lef
</b>: cu
e cn
usin resul
ing in <u>frn
l lbe hemrrh ge</u>&nbs; n
d bld rele se in
 <u>sub r chnid s ce</u>. P
en
i l fr <u>v ss sm</u>.<
div><u><br /></u></div><div><b>Righ
</b>: ld/chrnic cn
usin, rbi
frn
l c
n
usin.&nbs;<u>brwn disclr
in = hemsiderin nd m crh ge r
if c
s</u>
, n
e
he evidence (divi
s) f cle red necr
ic
issue - evidence in frn
l l
be sugges
s <u>likely ersn li
y l
er
in, disinhibi
in, r fc l frn
l de
fec
s / seizures</u></div><div> <b>Ansmi </b>&nbs;- d m ge
 lf c
ry bulbs
nd lss f smell</div>
Cn
usin in
his re ses high risk f memry dis
urb nce nd seizures
Temr l regin
P
ien
suffers
blw

he he d while s

in ry, fllwing im ging, where w
uld yu exec

he cn
usin
 be?
The cn
usin will be l rges


he si

e f im c
(<b>Cu</b>)<div> <b>Cu</b>&nbs;is ssci
ed wi
h s

in ry he
d
r um ; m y ls see sme evidence f cn
r cu (180 w y frm si
e f im c

)&nbs;</div>
P
ien
f lls r h s MVC...wuld yu exec

 bserve cu r cn
r cu c
"B
h! &nbs;Cu n
he side f im c
, bu
ls
cn

n
usin n im ging?
r cu cn
usin n
he si
e side.<div><br /></div><div>N
e: cn
r cu ssci
ed wi
h mving he d im c
; cu - ssci
ed wi
h s

in ry he d im c

</div><div><br /></div><div><img src="" s
e-11012296147260.jg"" /></div>"

Exl in
he cnce
f skull beveling fllwing rjec
ile injury.
"A bulle
regin f residu l wi


hrugh
he skull cre
es sm ll en
ry hle, bu
ls
de-di me
er d m ge. &nbs;A bulle
c n simil rly le ve n exi
wund in
he s me
f sin (sm ll exi
hle wi
h l rger wide-di me
er residu l d m ge)<div><br /></
div><div><img src="" s
e-11149735100534.jg"" /></div><div><img src=""bevel.je
g"" /></div>"
The ms
de dly frms f mm h ve wh
qu li
ies?
"L rge di me
er nd see
d; KE is ms
imr
n
...mre le
h l
 h ve sm ll rund ging f s

h n l rge
rund ging slw...<div><img src=""KE.jeg"" /></div>"
An

em

 reresen
Dr. Gdm ns gun knwledge in single ques
in:&nbs;<
div><br /></div><div>A d ngerus 
ien
is sh
by by feder l ir m rsh ll wi

h s
nd rd issue side rm nd res
r ined un
il l nding. &nbs;Prir
 surger
y, yu m ke be
wi
h yur fellw residen
s
h

re
ing
he 
ien
will inv
lve remv l f wh
kind f rjec
ile?</div> Likely .40 c liber Bee S fe bu
lle
; n
e
h
feder l ersnnel f
en c rry 0.4 side rms nd use n l ne w
uld necessi

e bee s fe mmuni
in which slin
ers un im c
nd wn
neces
s ry  ss
hrugh
he
rge
(r
he w ll f
he l ne). &nbs;Surgery will like
ly invlve iden
ifying m ny fr gmen
s r
her
h n ex
r c
in f single bulle
.
"Imr
n
di gns
ic r c
ice fllwing rjec
ile injury?<div><img src="" s
e
-11536282157322.jg"" /></div>" "T ke
w views!!<div><img src="" s
e-115491670
59241.jg"" /></div>"
"Injury
 whi
e m

er nd <b> xn l sherids</b>&nbs; re iden
ified wi
h imm
unhis
chemis
ry nd H& m;E in 
ien
sever l weeks s

r um
ic insul
.<
div><img src="" s
e-11626476470533.jg"" /></div>"
"<u>Diffuse xn l injur
y</u>; rgressive in n
ure: ch nges c n be iden
ified in s li

le s 3 hurs
s
injury, nd ccumul
e ver d ys
 weeks. &nbs;<div><br /></div><div>Arr
ws in

 xn l sherids</div><div><br /></div><div><img src="" s
e-1163936
1372336.jg"" /></div>"
"Diffuse e
echi l hemrrh ges re n
ed un ex min
in f 
ien
wh suffe
red rjec
ile wund
hrugh
heir femur. &nbs;Likely c use?<div><img src=""
s
e-11759620456655.jg"" /></div>"
F
emblism - secnd ry
 bne injury
(
yic lly lng bnes). &nbs;Bne m rrw c n be rele sed due

r um nd circ
ul
e, eve
u lly re ching
he br in!
"P
hlgy receives
s mle f
he fllwing br in desribed s ""fle bi

en""
wi
h mul
ile e
echi e. &nbs;Wh
d yu susec
?<div><img src="" s
e-1187987
9541002.jg"" /></div>" "F
emblism - 2/2
r um
ic injury
 lng bnes nd r
ele se f bne m rrw.<div><img src="" s
e-11892764442833.jg"" /></div>"
"Describe
he likely 
hlgy f
his grss sec
in<div><img src="" s
e-120216
13461761.jg"" /></div>"
<b>Swiss-cheese br in</b> is <u>s
-mr
em r

if c
</u>&nbs;due
 g s rduced frm b c
eri fllwing de
h. &nbs;I
is n
r
if c
rel
ed

r um r insul
, bu
r
her ne rel
ed


necess rily
s
-mr
em ch nge. &nbs;
"Sin l crd sec
ins ms
rne
 injury?<div><img src="" s
e-12073153069358.
jg"" /></div>" <b>Cervic l</b> nd <b>lumb r</b> regins...fr c
ure dislc
in
wi
h
r nsec
in f crd is likely
 resul
in <u>cmle
e  r lysis nd sens
ry defici
belw
he level</u>
"Prcedur l c u
in fr 
ien
s wi
h f ci l nd neck
r um include inser
in 
f wh
devices?<div><img src="" s
e-12193412153567.jg"" /></div>"
NG nd E
T
ubes; ic
ure deic
s n NG
ube
h
w s errneusly inser
ed in 
ien
w
i
h m ssive f ce
r um nd skull fr c
ure
Where n
mic lly des
subdur l hem
m ccur?
"Ac
u lly ccurs in
he
dur in
he we k <u>inner brder cell l yer</u><div><u><img src=""brder cell.j
eg"" /></u></div>"
Clus
er A disrders h ve decre se in wh

emer men
? Incre sed vulner blili

y f wh
?
Decre sed <u>rew rd deendence</u>.&nbs;Incre sed vulner bili
y
f sychsis.<div><br /></div><div>Weird (<b>A</b>ccus
ry,&nbs;<b>A</b>lf,<b
>&nbs;A</b>wkw rd). Prjec
inis
guy didn
w n

 le ve</div>
Wh
re
he clus
er B disrders?
u
<b>B hn</b><div><br /></div><div>Br
derline</div><div>An
isci l</div><div>His
rinic</div><div>N rcissis
ic</div>

Wh

emer men
(high nd lw) ch r c
erize clus
er B disrders?

High <u>
nvel
y seeking</u>, lw <u>h rm vid nce</u><div><u><br /></u></div><div>1. An

isci l&nbs;<div>2. Brderline&nbs;</div><div>3. His
rinic (
he
ric l)&nbs
;</div><div>4. N rcissis
ic</div><br /><br />Be dr m queen</div><div>Odd</div
><div>Wild (B d

he Bne).</div>
Wh
ch r c
er defines clus
er B disrders?
Em
hic defici
s, Imm
ure Men

l Mech nisms
Wh
re clus
er B disrders susce
ible
?
<u>Md disrders</u>, <b>e rly<
/b> nse
<u> lchlism</u><div><u><br /></u></div><div>Oddb ll, high nvel
y se
eking lw h rm vid nce</div>
Wh
des
his define?<div><br /></div><div><div> &nbs;Perv sive 

ern f gr n
disi
y</div><div> &nbs;L ck f em
hy clrs lve rel
inshis&nbs;</div><di
v> &nbs;Unquench ble needs fr dmir
in</div><div> &nbs;70% re m le</div></di
v>
N rcissis
ic ersn li
y disrder
<div>Wh
des
his describe?</div><div><br /></div><div>En
i
lemen
Gr ndisi
y
Cme
i
ive</div><div>Exli

ive Exce
in l Unem
hic</div><div>N rcissis
i
c</div><div>Envius*</div><div><br /></div><div><div> &nbs;Gr ndisi
y</div><div
> &nbs;Ex
ern lizing defenses&nbs;</div><div> &nbs;L ck f em
hy</div></div>
N rcissis
ic ersn li
y disrder&nbs;
<div>Wh
des
his describe?</div><div><br /></div><div> &nbs;Beh vir l vil

in f 
hers righ
s&nbs;</div><div> &nbs;Irresnsible
wrk, hme</div><div
> &nbs;L ck f enduring

chmen
s</div><div> &nbs;Ree
i
ive irri
bili
y nd
ggressin&nbs;</div><div> &nbs;Predmin n
ly m le</div>
An
isci l ers
n li
y disrder
<div>Wh
des
his describe:</div><div><br /></div><div>Irresnsible Aggressiv
e Dishnes
</div><div>Unsci lized Imulsive</div><div>Remrseless</div>
An
isci l ersn li
y disrder
Wh
is
he
ri l fibrill
in f sychi
ry? "Brderline ersn li
y disrder
. ""Predic
bly unredic
ble"""
Which gender is mre susce
ible
 Brderline PD?
Fem le
Which PD is&nbs;<div> &nbs;Ex
r rdin ry Ins
bili
y, V cill
in&nbs;</div><d
iv> &nbs;As if<div>-Deficien
rel
in l memry</div><div>-Fr gile view f self,
Brderline PD

hers</div></div>
Wh
des
his describe?<div><br /></div><div>R geful/Adul
in<div>Aggressive/S
elf Des
ruc
ive Ide liz
in/Dev lu
in</div><div>Discnnec
f effr
nd exe
c

ins</div></div>
<div>Brderline ersn li
y disrder</div>
Clus
er C disrders?
C-DOPA<div><br /></div><div><b>D</b>eenden
&nbs;</div>
<div><b>O</b>bsessive Cmulsive&nbs;</div><div><b>P</b> ssive Aggressive*&nbs
;</div><div><b>A</b>vid n
</div><div><br /></div><div>Wrried (Cw rdly, Cmulsi
ve, Clingy).</div>
Wh

emer men
ch r c
erizes clus
er C disrders?
<u>High H rm vid nce</
u>, rew rd deendence<div><div><br /></div><div>1. Avid n
</div><div>2. Deende
n
</div><div>3. Obsessive-Cmulsive</div><br /><br />
he C m de
he l nd-brne
nxius</div>
Wh
ch r c
er
r i
describes clus
er C disrders?&nbs;
<u>Excess</u> f
m
ure men
l mech nisms<div><br /></div><div>They re
 m
ure! (OCD, vid
n
, deenden
)</div>
Wh
re clus
er C 
ien
s susce
ible
?
<u>Deressin</u>, <b>l
e</b> 
nse
<u> lchlism</u>
Wh
PD des
his describe?<div>Isl
ed bu
lnging fr

chmen
s&nbs;</div>
<div>E sily emb rr ssed bu
n
egcen
ric&nbs;</div><div>Pl in nd dr b bu
n
Avid n


eccen
ric</div>
Wh
PD des
his describe?<div><br /></div><div>Deferen
i l Obsequius Cncili

ry Clinging<div><div>Tr des self c
u liz
in fr rxim
in</div></div></
div>
<div>Deenden
&nbs;(clus
er C)</div><div><br /></div><div>Wrried (Cw r
dly, Cmulsive, Clingy).</div>
<div>Wh
PD des
his describe?</div><div><br /></div><div> &nbs;Perv sive 


ern f erfec
inism nd inflexibili
y&nbs;</div><div> &nbs;Res
ric
ed ccess

 em
ins f self, 
hers</div><div> &nbs;<b>Misses fres
, knws minu
i e f

rees</b></div><div> &nbs;Direc
/indirec
effr
s
 cn
rl 
hers</div><div> &nb

s;Defici
s in l y, jy, sn
nei
y</div>

Obsessive cmulsive PD
<div>Wh
des
his describe?</div><div><br /></div><div>Perfec
inis
ic Tedius
Indecisiveness Scruulsi
y</div><div>Cn
rlling Rule Bund Shy&nbs;S
ingy</d
iv>
Obsessive cmulsive ersn li
y disrder
wh
is
he defini
ive hs
nd reservir f
xl sm -c

-inges
in f cy
es frm fd

xl smsis is
r nsmi

ed
 hum n hw
cn
min
ed wi
h <b>c
feces</b><div>-undercked infec
ed <b>me
s wi
h
x
cys
s</b><br /><div>-
r nsl cen
l/cngeni
l (TORCHES)</div><div>-
r nsfusins
</div></div>
Txl sm , wh

hree differen
frms des i
exis
by "<b>Trhzi
e</b><div>
-inv des
issues</div><div>-
ered n
erir end, blun
s
erir end, l rge nuc
leus</div><div><img src="" s
e-183064391057409.jg"" /></div><div><br /></div><
div><br /></div><div><b>Tissue cys
</b></div><div>-cn
ining drm n
br dyzi
e
</div><div>-skele
l muscle, he r

issue, br in</div><div>-sheric l in br in,
elng
ed in c rdi c</div><div><img src="" s
e-183042916220929.jg"" /></div><d
iv><br /></div><div><br /></div><div><b>Ocys
</b></div><div>-excre
ed by c
s</
div><div><br /></div><div><img src=""s
ges (2).jeg"" /></div>"
-seen in<b> nrm

xl sm cu
e dise se m nifes

in, which ul
in?
l hs
s</b><div>-usu lly sym
m
ic</div><div>-10-20% wi
h cervic l lymh den

hy r mn-like illness</div><div>-usu lly self reslving</div>
Cngeni
l
xl smsis, ch nce f infec
in deends n wh
f
he m
her?
-infec
in ch nce higher wi
h <u> dv ncing ges

in l ge</u><div><u><br /></u>
</div><div><u>Severi
y is ssci
ed wi
h e rlier ges

in l ge</u></div>
cngeni
l
xl sm , clinic l m nifes

ins "-resul
frm cu
e rim ry infe
c
in cquired by m
her during regn ncy<div>-in fe
us: CNS nd sys
emic m nife
s

ins</div><div><br /></div><div><u>CNS sym
ms</u></div><div>-enceh li
is<
/div><div><b>-chrire
ini
is</b></div><div>-hydrceh lus</div><div>-in
r cr ni
l c lcific
in (le ding
 men
l re
rd
in)</div><div><br /></div><div><u>S
ys
emic</u></div><div>-neumni
is</div><div><b>-he
slenmeg ly</b></div><di
v><br /></div><div><img src=""cng.jeg"" /></div>"
hw is
iming f infec
in during regn ncy rel
ed
 cngei
l
xl smsis
<u>E rly</u> infec
in in regn ncy<div>-mre <u>severe</u> enceh li
is in fe
u
s</div><div>-s
illbir
h mre likely</div><div><br /></div><div>Infec
in in <u>l

er</u> regn ncy</div><div>-c use less severe dise se</div><div>-bu
<b><u>hig
her ch nce</u> f h ving infec
in</b>&nbs;in fe
us</div>
Re c
ive
xl smsis, wh
re
he clinic l m nifes

ins, in wh
ul
in
?
-immuncmrmised (AIDS, Tr nsl n
)<div>-re c
iv
in f chrnic infec

in<br /><div>-<u>enceh li
is/m ss lesin</u>, chrire
ini
is r re</div></div
>
"<img src="" s
e-183665686478849.jg"" /><div>N me. When des
his devel?</di
v>"
re
inchridi
is<div><br /></div><div>-f
en seen in
x infec
in</di
v><div>-
ien
f
en sym
m
ic frm cngeni
l infec
in un
il <u>secnd r

hird dec de f life</u></div>
Txl sm di gnsis
-<u>Serlgy</u> fr nrm l hs
<div><br /></div><div>L
w yield<br /><div>-bserv
in f  r si
e in 
ien
bld/
issue<br /><div>-Im
ging (CT, MRI) wi
h cn
r s
in AIDS 
ien
s</div><div><br /></div><div><br />
</div></div></div>
Txl sm
re
men
fr newbrn
<div>yrime
h mine/sulfn mide fr 1 ye
r</div>
Sir mycin sfx, used fr wh

-r lly dminis
ered<div>-GI sfx, rlnged QT</
div><div>-used fr
x in reg wmen firs

rimes
er</div>
-lng c
ing <u>dihydrf
yrime
h mine mech nism, wh
is i
m inly used fr
l
e reduc
se inhibi
r</u> (flic cid n
gnis
)<div>-cmbined wi
h sulf di
zine(synergis
) is
re
men
f chice fr
x</div><div><br /></div>
wh
is
he m in limi

in f yrime
h mine/sulf di zine
re
men

&nbs;-

xici
y
wh
is n l
ern
ive
 yrime
h mine/sulf di zine fr
x infec
in Pyrime
h
mine/clind mycin<div>- ls limi
ed by
xici
y</div>
ms
cmmn c use f  r si
ic hum n de
h
M l ri
M in eidemilgy f m l ri
-ms
ly yung children in sub-s h r n fric

-er dic
ed fr 50 ye rs<div>-s
ill h ve

lk bu
s

us f m l ri in US
c ses rer
ed (1337, 8 died), ll m inly imr
ed&nbs;</div>
P. F lci rum le ds
 ________<div><br /></div><div>P. Viv x is ms
________</
div><div><br /></div><div>P. v le is endemic
 _______</div><div><br /></div><
div>P. M l ri e c uses ________ syndrme</div> <b>Pl smdium.F lci rum</b><div
>-ms
f
l</div><div>-le ds
 cerebr l m l ri </div><div><br /></div><div><b>
Pl smdium viv x</b></div><div>-ms
rev len
</div><div>-nly cc ssin lly c u
se de
h, bu
debili

ing</div><div><br /></div><div>Pl smdium v le</div><div
>-endemic
 wes
fric </div><div><br /></div><div>Pl smdium m l ri e</div><di
v>-chrnic infec
in</div><div>-c n c use <u>nehr
ic syndrme</u></div>
Fem le nheles msqui
<div><br /></di
l smdium vec
r nd defini
ive hs

v><div>hum n serves s reservir/in
ermedi
e hs
</div>
Life cycle/
hgenesis f l smdium (KNOW THIS)
"Ex-ery
hr
ic cycle (h
e
ic)<div>-injec
ed by <b>fem le nheles msqui
</b></div><div>-inv des liv
er s srzi
es, m
ure in
 schizn
s</div><div><br /></div><div>Ery
hrcy
ic
cycle (dise se c using s
ge)</div><div>-ru
ures frm liver s merzi
es</div
><div>-inv des RBC</div><div>-
w frms -&g
; sme ges
hrugh sexu l rerduc

in (ery
hrcy
ic schizgny) nd sme ges
hrugh sexu l (g me
cy
ic s
ge)<
/div><div><br /></div><div>In msqui
</div><div>-msqui
 inges
s g me
cy
es</
div><div>-sexu l relic
in ccurs in ms
qui
</div><div><br /></div><div><img
src="" s
e-185869004701697.jg"" /></div><div><br /></div><div><br /></div>"
which secies f l smdium h ve drm n
s
ge/hynzi
es
h
ersis
s in li
ver nd c use rel ses by inv ding bld s
re m weeks/ye rs l
er?
P.viv x<
div>P.v le</div><div><br /></div><div>Therefre use rim quine s well</div>
l smdium infec
in, wh
des
er
i n/qu r
n fevers refer
? (give secies)
"Ter
i n<div>-P.f lci rum</div><div>-P.viv x</div><div>-P.v le</div><div>-<b>f
ever every secnd d y</b></div><div><b><br /></b></div><div>Qu r
n</div><div>-P
.m l ri e</div><div>-<b>fever every
hird d y</b></div><div><b><br /></b></div><
div><img src="" s
e-186109522870273.jg"" /></div>"
Tyic l/cmmn findings/m nifes

in f l smdium
-eridic fever, chills,
swe
ing, he d che, n us e<div>&nbs; &nbs; &nbs; &nbs; &nbs; -due
 <b>r
infl mm
ry cy
kines during ru
ure f infec
ed RBC</b><br /><div>-enl rged s
leen</div><div><br /></div></div>
clinic l m nifes

in f severe m l ri , which secie secific lly?
-Pl smd
ium f lci rum<div><br /></div><div>Fe
ures</div><div>-severe hemly
ic nemi /
j undice</div><div>-Org n f ilures due
 s
icky RBC lugging u bld flw (hy
xi )</div><div>&nbs; &nbs; &nbs; &nbs; &nbs;-CNS -&g
; cerebr l m l ri -&
g
; seizure, cm , l
ered men
l s

us</div><div>&nbs; &nbs; &nbs; &nbs; &
nbs;-Kidney f ilure</div><div>&nbs; &nbs; &nbs; &nbs; &nbs;-Lung -&g
; ul
mn ry edem </div><div>&nbs; &nbs; &nbs; &nbs; &nbs;-c rdiv scul r -&g
; s
hck</div><div>-Hyglycemi </div><div>&nbs; &nbs; &nbs; &nbs; &nbs; -child
ren nd regn n
wmen</div><div>&nbs; &nbs; &nbs; &nbs; &nbs; - cu
e nse

CNS-like sym
m nd rem
ure delivery</div><div><br /></div><div><br /></div>
wh is susce
ible
 severe m l ri
-immuncmrmised<div>-children</div><d
iv>-regn n
wmen</div>
Di gnsis f l smdium, wh
s
he m in me
hd <b>Micrscy f
hin/Thick bl
d sme rs</b><div>-s
ined wi
h <u>rm nwsky</u> s
in</div><div><br /></div><di
v><br /></div>
Di gnsis f l smdium, wh
d
hey lk like under micrsce?
"<div>-P
.f lci rum: Ring frms in RBC wi
h <u>mul
ile</u> rg nism er RBC, <b>mn/b
n n -sh ed</b></div><div><img src="" s
e-186581969272833.jg"" /></div><div><b
r /></div><div>-P.viv x/v le/m l ri e: nly <u>1</u> rg nism er RBC in ring f
rm. enl rging mebid
rhzi
e nd dividng ery
hrcy
ic schizn
. <b>Sun-sh
ed</b></div><div><b><img src="" s
e-186667868618753.jg"" /></b></div>"
"<img src="" s
e-193385197469697.jg"" /><div><br /></div><div>which secies</d
iv>"
-P.viv x/v le/m l ri e
"<img src=""d578 fc5132b96 b47241826c9ec9b153858d7db_Q_0 (12).svg"" />" "<img sr
c=""d578 fc5132b96 b47241826c9ec9b153858d7db_A_0 (12).svg"" />" "<img src=""d578
fc5132b96 b47241826c9ec9b153858d7db_surce_svg (13).svg"" />" "<img src=""d578
fc5132b96 b47241826c9ec9b153858d7db_
mc jbkm.ng"" />"

"<img src=""d578 fc5132b96 b47241826c9ec9b153858d7db_Q_1 (11).svg"" />" "<img sr

c=""d578 fc5132b96 b47241826c9ec9b153858d7db_A_1 (11).svg"" />" "<img src=""d578
fc5132b96 b47241826c9ec9b153858d7db_surce_svg (13).svg"" />" "<img src=""d578
fc5132b96 b47241826c9ec9b153858d7db_
mc jbkm.ng"" />"
"<img src=""d578 fc5132b96 b47241826c9ec9b153858d7db_Q_2 (10).svg"" />" "<img sr
c=""d578 fc5132b96 b47241826c9ec9b153858d7db_A_2 (10).svg"" /><div><b><img src="
" s
e-186667868618753.jg"" /></b></div>"
"<img src=""d578 fc5132b96 b4724
1826c9ec9b153858d7db_surce_svg (13).svg"" />" "<img src=""d578 fc5132b96 b4724
1826c9ec9b153858d7db_
mc jbkm.ng"" />"
"<img src=""d578 fc5132b96 b47241826c9ec9b153858d7db_Q_3 (9).svg"" />" "<img sr
c=""d578 fc5132b96 b47241826c9ec9b153858d7db_A_3 (9).svg"" />" "<img src=""d578
fc5132b96 b47241826c9ec9b153858d7db_surce_svg (13).svg"" />" "<img src=""d578
fc5132b96 b47241826c9ec9b153858d7db_
mc jbkm.ng"" />"
"<img src="" s
e-193441032044545.jg"" /><div><br /></div><div>which secie</di
v>"
P.f lci rum
-secies<div>-lc
in nd i
s

re
men
s
r
egy f l smdium deends n
ssci
ed drug-resis
nce</div><div>-clinic l s

us f 
ien
&nbs;</div><div>
-regn ncy</div><div>-drug llergies</div>
ms
drugs fr l smdium re c
ive g ins
wh
frm f
he  r si
e -
he bl
d frm
ssuming n drug resis
nce
ll, wh
is
he drug f chice fr l smdium
<div>chlrquine</div><div><br /></div>

re men
f P.f lci rum infec
in in cen
r l meric wes
f  n m c n l
<u>-
hese re gener lly dn
h ve chlrquine-resis
nce s
r ins</u><div>-s us
e <b>chlrquine</b></div>

re
men
f uncmlic
ed chlrquine resis
nce P.f lci rum Or l<div><b>-qui
nine +&nbs;dxycycline</b></div><div><b>-m l rne</b></div><div><br /></div><di
v>-meflquine (3rd line), sych effec
s</div>
"<b><fn
clr=

re
men
f cmlic
ed chlrquine resis
nce P.f lci rum
""#ff0000"">IV drugs</fn
></b><div><b><fn
clr=""#ff0000""><br /></fn
></b>
</div><div><b><u><fn
clr=""#ff0000"">Ar
esun
e</fn
></u></b></div><div><b>
<br /></b><div>-<b>Quinidine</b></div><div>+</div><div>-dxycycline</div></div>"
Which regins re resis
n

 chlrquine?
P u New Guine , Indnesi (90%
f wrld??)<div><br /></div><div>S, use quinine + dxycycline</div>

re
men
fr Pl smdium viv x/P.v le. nrm l, resis
nce, nd wh
else
"If n chlrquine resis
nce (u
side f  u new guine /indnesi )<div>-<b>C
hlrquine</b></div><div><br /></div><div>If wi
h chlrquine resi
nce ( u /i
ndnesi )</div><div>-<b>quinine lus dxycycline</b>,
e
r cycline r meflquine
</div><div><br /></div><div><b>since
hey c n rel se</b></div><div>- dd <b><fn

clr=""#ff0000"">Prim quine</fn
></b></div>"
Prim quine cn
r indic
ied in wh
2 cndi
ins?
-regn ncy<div>-G6PD def
iciency</div>
drug f chice fr severe m l ri 
ien
requiring  ren
er l
her y Ar
emisi
nins<div>-shuld be <u> ccm nied</u> by r l drugs ASAP (dxy, clind , meflqu
ine)</div>
Uncmlic
ed/n

re men
in regn n
wmen fr m l ri (nrm l, resis
n
)
chlrquine resis
nce<div>-<b>chlrquine</b></div><div><br /></div><div>Chl
rquine resis
nce P.f lci rum</div><div>-<b>quinine + clind mycin</b></div><div
>-m y use <b> r
esun
e</b></div><div><br /></div><div><br /></div><div><b>dn

use: dxy,
e
r , rim quine,
v qune</b></div>
M l ri reven
in: viding msqui

Avid ms
qui
:&nbs;<div>-insec
reel
len
s (DEET)<br /><div>-insec
icide
re
ed bed ne
s<br /><div><br /></div></div
></div>
M l ri reven
in: rhyl xis fr
r velers <div><div><div>Prhyl xis drugs
in
r velers</div><div>-
v qune-rgu nil</div></div></div><div>-meflquine<
/div><div>-dxy</div><div><br /></div><div><br /></div>
M l ri reven
in: regn n
wmen
<div>in
ermi

en reven

ive
her y</d
iv><div>-F nsid r (<b>sulf dxine-yrime
h mine)</b></div><div>-mn
hly IPT fr
HIV+ regn n
wmen</div><div>-r else jus

w dse
hrughu
regn ncy</div>
<div>Fever</div><div>Chills</div><div>Swe
s</div><div>He d ches</div><div>N use

/vmi
ing</div><div>Bdy ches</div><div>Gener l m l ise</div><div>+</div><div>

<b>Mild j undice&nbs;</b></div><div><b>Enl rgemen
f
he liver&nbs;</b></div>
Severe m l ri P. f lci rum
Where re 90% f viscer l leishm ni sis?
"&nbs;B ngledesh,&nbs;Indi , S
ud n<div><img src=""90%.jeg"" /></div>"
B ghd d bil, Delhi bil, Chiclers ulcer, U
, Ale Evil:
hese re ll n mes
fr wh
?
"Cu
neus leishm ni sis<div><img src="" s
e-107391362269185.j
g"" /></div>"
Secies (2) f lesichm ni
h
c uses cu
neus leishm ni sis? "L. mexic n (ne
w wrld)<div>L.
ric (ld wrld)</div><div><img src=""mexic .jeg"" /></div>"
Wh
c uses recurren
Ch g s dise se?&nbs;
Re c
iv
in f cu
e dise se c
curs bec use f <u>s
er
ive immunsuressin</u>
Describe
he s
ges f Hum n Afric n Try nsmi sis (HAT)
E rly S
ge: Asy
m
m
ic&nbs;<div>L
e S
ge: CNS invlvemen
</div>
Describe
he sym
ms f CNS invlvemen
f HAT Diurn l smnlence, nc
urn l in
smni (slee d y, u
nigh
)<div>Cns
n
He d che</div><div>Beh vir ch nge<
/div>
Describe
he
imefr me f G mbi n vs Rhdesi n HAT
G mbi n- sym
m
ic f
r mn
hs r ye rs<div>Rhdesi n- weeks&nbs;</div>
Wh
re cmmn cmlic
ins f m l ri in regn ncy? <div>They ge
mre sever
e dise se ver ll (due
 reduced immune resnse)</div><div>Misc rri ge/rem
u
re</div><b>Hyglycmei </b><div><b>Anemi </b>&nbs;</div>
P
ien
resen
s wi
h:<div>Severe hemly
ic nemi </div><div>AMS, seizures</div>
<div>Acu
e kidney f ilure (sludging)</div><div>Pulmn ry edem </div><div>Hygly
cemi </div><div>CV cll se, shck</div>
M nifes

ins f <u>severe m l
ri &nbs;</u>
Generic n me f f nsid r
sulf dxine-yrime
h mine
Defini
in:<div>-s
ble,&nbs;<u>heri
ble ch nge</u>&nbs;in cell grw
h cn
r
l<br />- ssci
ed ch nges in grw
h 

erns, membr ne s
ruc
ure nd func
in,
bichemic l c
ivi
y, nd
umr frm
in</div> Cellul r
r nsfrm
in
rle f viruses in c ncer frm
in (3) - ffec
s
ruc
ure r func
in f <u>cell
ul r ncgenes</u> nd in
erru
in f <u>
umr suressrs</u><div>-in
rduce v
ir l ncgenes</div><div>- l
er hs
immune resnse</div>
wh

w
umr suressrs re invlved in ging frm G1 s
ge
 S h se f cel
l cycle "53 nd RB<div><br /></div><div><img src="" s
e-265828410851329.jg""
/></div>"
RNA
umr viruses, wh
re
he mech nisms f
r nsfrm
in
-virus <u>c rrie
s</u>&nbs;cellul r derived ncgenes<div>-<u>r
-ncgenes</u> in infec
ed ce
lls is <u> c
iv
ed/deregul
ed</u> due
 virus in
egr
in (rm
rs)</div><d
iv>-Virus-encded regul
ry r
ein <u>dysregul
es
r nscri
in f cellul r r
egul
ry genes</u>&nbs;</div>
DNA
umr viruses mech nism f
r nsfrm
in -<b>in
erru
in</b> f cellul r
<u>
umr suressr</u><div>-<b> c
iv
in</b> f cellul r <u>
yrsine kin se</
u></div><div>-<b>inhibi
in</b> f <u> 
sis</u></div>
Ms
cmmn c uses f cu
e he
i
is HAV, HBV
Wh
s
he difference be
ween RNA nd DNA viruses in
erms f
r nsfrming genes
?
RNA<div>-
r nsfrming genes re <u>n
</u> essen
i l</div><div><br /></d
iv><div>DNA</div><div>-
r nsfrming genes <u> re</u> essen
i l fr relic
in (
<b>exce
HHV8</b>)</div>
T/F, DNA Tumr virus ncgenes h ve cellul r hmlgs -f lse,&nbs;<b>exce
H
HV8</b>
EBV ssci
ed burki

s lymhm is ssci
ed wi
h incre se
r nscri
in f w
h

"c-MYC<div><br /></div><div>MYC gene being dis l ced frm chrmsme 8

 14 le ding
 incre sed MYC r
ein<div><br /></div><div><img src="" s
e-199
600015147395.jg"" /></div></div>"
EBV m lign ncies (burki

nd n sh rynge l c rcinm ), wh
is
he eidemilg
y ( ge lc
in f b
h)
Burki

<div>- fric </div><div>-childhd</div><d
iv><br /></div><div>NPC</div><div>-<b> si </b> nd l sk </div><div>- ge 50-70s<
/div>
f lse

rue r f lse, burki

s lymhm is lw ys c used by EBV

EBV nd ___ re c-f c
rs fr develmen
fr burki

lymhm develmen

m l ri
k si s rcm ssci
ed wi
h HHV8, wh
s
he his
lgic l fe
ures nd <b>cell
line rigin</b>?
"-<b>sindle cells</b> f <b>end
heli l rigin</b> wi
h
sli
like v scul r s ces, ex
r v s
ed RBCs, nd infl mm
ry cells<div><br />
</div><div><img src="" s
e-274800597532673.jg"" /></div>"
"<img src="" s
e-274976691191809.jg"" /><div><br /></div><div>Wh

echnique w
s used? wh
is
he likely 
hlgy</div>"
VIA, r visu l insec
in f <u>
ce
ic cid</u> s
in. C ncerus
issue
urns whi
e. HPV- ssci
ed cervic l c r
cinm
"merkel cell c rcinm ssci
ed wi
h wh
virus<div><img src=""merkel.jeg"" /
></div>"
-lym viruses (BK virus, JC virus, SV40)
__________ c use
umrs in 
her nim ls bu
h ve n
been ssci
ed wi
h hum n
Adenviruses

umrs.
The 
hgenesis f HCV- ssci
ed HCC is due
 wh
? "<u>Chrnic infl mm
in
</u> (cirrhsis)<div><img src=""HCC.jeg"" /></div>"
Wh
re
he ssci
ed m lign ncies f EBV?
<b>Afric n Burki

s Lymhm </b
><div><b>N sh rynge l c rcinm </b></div><div><b>Hdgkins Lymhm </b></div><
div>B cell lymhm </div><div>T cell lymhm &nbs;</div>
Wh
ver ll rcesses c n c
iv
e ncgenes? S
ruc
ur l ch nge, l
ered exre
ssin (micrRNA)
Wh
is
he mech nism f HCV--&g
; slenic lymhm wi
h villus lymhcy
es
<div>Direc
immuns
imul
in f B cells by virus.&nbs;</div>
HPV c ncer mech nism f disru
in f 53 nd Rb is by wh
?
Gene rduc
s<b>
E6</b> --&g
; disru
(53) nd <b>E7</b> --&g
; disru
(Rb)
P
hgenesis is mul
if c
ri l. Assci
ed wi
h mncln l in
egr
in f virus
in
 CD4-si
ive leukemic T cells (si
e v ries fr e ch 
ien
); li

le vir l
n
igen exressed.
HTLV-1
<div>P
hgenesis: rb bly mul
if c
ri l.&nbs;R ndm in
egr
in f vir l&nbs
;sequences is de
ec
ed in&nbs;ms

umrs.&nbs;Tr ns- c
iv
ing gene&nbs;r
duc
s (X gene; PreS2)&nbs; nd chrnic infl mm
in&nbs;m y l y rle.</div>
HBV
Hw
 screen fr HBV ssci
ed HCC? <div>-liver ul
r sund</div><div>-serum
<b> lh -fe
r
ein</b></div>
When des HCV ssci
ed HCC dise se
yic lly ccur? Wh
in
he serum is
yic
lly high?
"2 r mre dec des f infec
in. <b>Serum AFP</b> levels re ver
y high.&nbs;<div><img src=""dec des.jeg"" /></div>"
P
hgenesis: Encdes <u>hmlgues</u> f cellul r genes (Bcl-2, G r
ein- cu
led rece
r, IL6 nd MIP1) whse exressin m y enh nce
umr frm
in
HHV-8
Wh

w drugs re le
h l in wi
hdr w l? Describe sym
ms&nbs;
<div><b>
Alchl</b> delirium
remens</div><div><b>Benzdi zeines</b> seizures / rel
ed
cmlic
ins</div>
All drugs f buse ini
i lly ffec

he br in by influencing
he mun
f
{{c
1::neur
r nsmi

er}} resen


he syn se r by in
er c
ing wi
h secific {{c
1::neur
r nsmi

er}} rece
rs.
<div> gnis

nic
inic ce
ylchline rece
r</div> Nic
ine
gnis

CB1 nd CB2 rece
rs
C nn binids
n
gnis

NMDA glu
m
e rece
rs Phencyclidine (PCP)
&nbs; r
i l gnis

5-HT2A rece
rs
H llucingens
Wh
is
he d mine
hery nd
he fin l cmmn 
hw y?
DA rele se in NA
cc: fin l cmmn 
hw y in
he cu
e reinfrcing effec
s f m ny bused drugs!
25-66% f lchlics devel wh
?
Deressin
Wh
is
he cmrbidi
y wi
h lchl in men nd wmen Men: 
her subs
nces, <
u>cnduc
</u> disrder, <u> n
isci l</u> d<div>Wmen: nxie
y nd md disrde
rs</div>
Wh
re sme gene
ic vulner bili
y
 lchl buse
"<div>4x incre sed risk
in <u>clse rel
ives</u> f n lchlic 
</div><div><br /></div><div><u>Iden

ic l
wins</u> &g
; fr
ern l
wins</div><div><br /></div><div>incre sed r
es i
n <u> d
ed- w y sns nd d ugh
ers</u> f lchlic 
ien
s</div><div><img sr

c=""gene vuln.jeg"" /></div>"

Wh
is CAGE fr IDing lchlics
<div>Cu
dwn</div><div>Annyed</div><di
v>Guil
y</div><div>Eye ener</div><div><br /></div><div><div>H ve yu ever fel

yu needed
 <b>C</b>u
dwn n yur drinking?</div><div>H ve ele <b>A</b>n
nyed yu by cri
icizing yur drinking?</div><div>H ve yu ever fel
<b>G</b>uil

y bu
drinking?</div><div>H ve yu ever fel
yu needed drink firs

hing i
n
he mrning (<b>E</b>ye-ener)
 s
e dy yur nerves r
 ge
rid f h ng
ver?</div></div>
Wh
l bs shw he vy drinking? <div>GGT&g
;35, MCV&g
;91</div><div>Elev
ed LFT
s wi
h AST&g
;ALT</div>
Alchl use c n le d
 wh
induced me
blic disrders? Hw

re
? Wh
if
yu d n

re
?
"Thi mine deficiency--&g
; Wernickes enceh l
hy.&nb
s;<div>Tre
wi
h <u>IV
hi mine</u> <b><fn
clr=""#ff0000"">PRIOR</fn
></b
>
 <u>glucse</u></div><div><u><br /></u></div><div>If un
re
ed, c n le d

Krs kffs sychsis (chrnic). Defined by cnf bul
in, severe n
ergr de m
nesi </div>"
<div>Wh
is being described?</div><div>2 r mre f
he fllwing&nbs;</div><d
iv>Au
nmic hyer c
ivi
y (HR, BP, RR, T, swe
)&nbs;</div><div>Anxie
y</div><
div>Insmni </div><div>Psychm
r gi

in</div><div>N use / vmi
ing</div><d
iv>Tremr</div><div>R rely: udi
ry, visu l,
c
ile h llcn/illsn</div><div>R r
ely: gr nd m l seizures</div><div>Pe k
3 d ys, l s
s 7-10 d ys</div> Alchl
wi
hdr w l
<div>Wh
is
his. Hw m ny 
ien
s ge

his?</div><div><br /></div><div>Cnfus
in</div><div>Disrien

in</div><div>Fluc
u
ing/cluded cnsciusness</div><d
iv>Perce
u l dis
urb nces</div><div>Mr
li
y</div><div>-Infxn, embli, c rdi c
rrhy
hmi s, me
blic dis
urb nces, hyerk lemi , hyeryrexi , dehydr
in</d
iv>
Delirium
remens<div><br /></div><div>1/3 f 
ien
s wi
h seizures g 
n
 devel DTs</div>
Wh
hr se describes lchl deendence?
"<b>Ph rm cgene
ic dise se</b>-&g
; dise se c using gen
( lchl) in
er c
s wi
h
he gene
ic b ckgrund f
h
e hs
rg nism (hum n)
 rduce
he m nifes

ins f
he dise se.<div><img src
=""de (1).jeg"" /></div>"
Wh
3 meds re FDA rved fr lchl deendence
<div>n l
rexne (firs
l
ine)</div><div> c mrs
e (GABA gnis
/NMDA n
gnis
)</div><div>disulfir m</
div>
Benzs h ve crss
ler nce wi
h wh
? Alchl nd b rbi
ur
es<div><br /></div
><div><div>Alchl-like effec
s</div><div>Tre
wi
hdr w l sym
ms</div></div>
"<img src=""11649246e027d06ff2bc18ef b e8c0596864f51_Q_0.svg"" />"
"<img sr
c=""11649246e027d06ff2bc18ef b e8c0596864f51_A_0.svg"" />"
"<img src=""1164
9246e027d06ff2bc18ef b e8c0596864f51_surce_svg.svg"" />"
"<img src=""1164
9246e027d06ff2bc18ef b e8c0596864f51_dis.jeg"" />"
"<img src=""3808935340 d22b3e9dc82939c0ff32020 c8b31_Q_0.svg"" />"
"<img sr
c=""3808935340 d22b3e9dc82939c0ff32020 c8b31_A_0.svg"" />"
"<img src=""3808
935340 d22b3e9dc82939c0ff32020 c8b31_surce_svg.svg"" />"
"<img src=""3808
935340 d22b3e9dc82939c0ff32020 c8b31_n l
.jeg"" />"
"<img src=""cc76c0c4cb3020bcde26005e 0062519e0d50d7 _Q_0.svg"" />"
"<img sr
c=""cc76c0c4cb3020bcde26005e 0062519e0d50d7 _A_0.svg"" />"
"<img src=""cc76
c0c4cb3020bcde26005e 0062519e0d50d7 _surce_svg.svg"" />"
"<img src=""cc76
c0c4cb3020bcde26005e 0062519e0d50d7 _ c m.jeg"" />"
Are benzdi zeines le
h l in verdse? N.&nbs;Lw le
h li
y in verdse, <u>u
nless cmbined wi
h 
her sed
ives</u>,
hen le
h l !!!
<div>Define nd cn
r s
:</div><div><br /></div><div>-ium nd n
ur lly ccurr
ing derived drugs, (mrhine nd cdeine)</div><div><div><br /></div><div>-cl ss
f subs
nces
h
c
s n&nbs;iid rece
rs, includes syn
he
ic drugs
h

be r li

le resembl nce
 ium</div></div> Oi
es<div><br /></div><div>Oi
ids</div>
<div>Tx fr iid wi
hdr w l:</div><div>Alh 2 drenergic gnis
& m; n
ihy
er
ensive</div><div>Suresses <u> u
nmic</u> sx f i
e wd</div> Clnidin
e
Elderly 
ien
wh lives lne resen
s wi
h eriher l neur
hy, m crcy
ic

nemi , nd hyer-segmen
ed PMNs. &nbs;Yu susec
he m y be m lnurished nd d

eficien
in wh
?<div><br /></div>
"Vi
min B12, c usi
ive f Cmbined Sys

em Degener
in;
re
men
wi
h B12 shuld hel
his 
ien
!<div><br /></div><d
iv>N
e hw
he s
erir nd l
er l
r c
s f
he sin l crd re degener
ing
(CST + DC)<br /><div><img src="" s
e-28604482191629.jg"" /></div></div>"
"<img src=""2176238908 5 0dceb3de28e026e6f660f5c958_Q_0.svg"" />"
"<img sr
c=""2176238908 5 0dceb3de28e026e6f660f5c958_A_0.svg"" />"
"<img src=""2176
238908 5 0dceb3de28e026e6f660f5c958_surce_svg.svg"" />"
"<img src=""2176
238908 5 0dceb3de28e026e6f660f5c958_wi
h.jeg"" />"
"<img src=""2176238908 5 0dceb3de28e026e6f660f5c958_Q_1.svg"" />"
"<img sr
c=""2176238908 5 0dceb3de28e026e6f660f5c958_A_1.svg"" />"
"<img src=""2176
238908 5 0dceb3de28e026e6f660f5c958_surce_svg.svg"" />"
"<img src=""2176
238908 5 0dceb3de28e026e6f660f5c958_wi
h.jeg"" />"
"P
ien
fllwing b ri
ric surgery w s n
given ny sulemen
s fr s
- c
re. &nbs;She resen
s wi
h cl ssic sym
ms f Wernickes enceh l
hy (<b>n
me</b>
hem) nd
<b>deficiency</b> f ______? <b>Wh
</b> is shwn belw?<div
><img src="" s
e-29197187678467.jg"" /></div>"
Wernickes enceh l
h
y = Thi mine deficiency<div><div><b><br /></b></div><div><b>M</b>en
l ch nge</d
iv><div><b>O</b>h
h lmlegi </div><div><b>A</b>
xi </div><div><b>N</b>ys
gmu
s</div></div><div><br /></div><div>N
e
h
grss sec
in reve ls <u>m mill ry
bdy hemrrh ge</u>, v scul r rlifer
in, nd
rhy le ding

he bve sy
m
ms.</div><div><br /></div><div>Rec ll: lchlics, lw SES, regn ncy (b/c 
f N/V) nd GI surgery re ll risk f c
rs.</div>
Tx fr iid wi
hdr w l:<div>Mu rece
r gnis
<div>Cmmnly used drug

re
Me
h dne

wi
hdr w l sx</div></div>
<div>Tx fr iid wi
hdr w l:</div><div>P r
i l gnis

mu rece
rs, becmi
ng mre widely used fr de
x</div><div><br /></div><div>Seed?</div> Burenr
hine<div><br /></div><div>Ul
r r id de
xific
in</div>
Tw cl sses nd meds f
re
men
f iid deendence <div><b>Agnis
rel cem
en
</b></div><div>-me
h dne ( gnis
) m in
en nce</div><div>-burenrhine ( r

i l) m in
en nce</div><div><br /></div><div><b>Oiid n
gnis
s</b></div><div
>-n l
rexne (lng l s
ing) nly n
gnis
curren
ly used</div>
<div>N me
he drug:</div><div>High dses llevi
e cr ving, induce crss
ler n
ce,</div><div><u>blcks herin induced euhri </u></div><div><br /></div><div>T
hery: n need fr herin r ssci
ed m l d 
ive beh virs wi
h b
ining
he
drug</div><div><br /></div><div>Prven effic cy in reducing:</div><div>Herin u
se, 
her drug use, he l
h rblems, crime</div><div><br /></div><div>Cn
rvers
y:</div><div>Prim ry urse crime reduc
in? Tr ding ne ddic
in fr n
her?
</div> Me
h dne<div><br /></div><div>H ve reduced h rm, bu

echnic lly s
ill
ddic
ed

his drug.&nbs;</div>
"Alchlic 
ien
resen
s

he medic l s
uden
run clinic wi
h
xi , ccul
r m
r bnrm li
ies, nys
gmus, nd memry
ruble. &nbs;Using yur wesme
beh vir science
erminlgy, yu ls describe ""cnf bul
in"" in yur n
es.
&nbs;<b>Wh
is
his</b>? Wh
is
he ms
likely <b>
re
men
</b> nd <b>risk
</b> if
re
men
is n
received?"
P
ien
likely h s <b>Wernickes Enceh
l
hy</b> (Thi mine deficiency) - rri
e
re
men
wuld be
 rel ce <b
>
hi mine</b>. &nbs;If
re
men
is n
dminis
ered
he 
ien
is
risk f
develing chrnic cndi
in knwn s <b>Krs kffs sychsis</b><div><b><br
/></b></div><div>N
e: Thi mine shuld be dminis
ered befre glucse becu se
h
i mine (vi
min B1) is invlved in glucse me
blism</div>
"__________ disrder
h
sme
imes c uses mvemen
disrders (chri
he
sis,
sychsis) - m jr clinic l sym
m is n excess f cer (due
 in dequ
e me

blism nd secre
in). &nbs;Physic l ex m f
he 
ien
reve ls ________ rin
gs:<div><img src="" s
e-29562259898565.jg"" /></div><div><br /></div><div>Give

he likely <b>dise se</b> nd cmmn re s f sym
m m nifes

in.&nbs;</div
>"
Au
sm l recessive; K yser-Fleischer; Wilsns Dise se<div><br /></div>
<div>N
e: cer is nrm lly exc
e
ed in bile fllwing rele se frm
he liver
nd circul
in
hrughu

he bdy. &nbs;Wilsns dise se h s <u>defec
in c
er excre
in nd
r sr
r
eins</u>&nbs;which llw nrm l dis
ribu
in.<
/div><div><br /></div><div>Cer will build u in:</div><div>1. <b>Liver</b> -

excess cer c uses free-r dic l d m ge (liver cirrhsis)</div><div>2. <b>Br in

</b> - d m ges b s l g ngli (len
ifrm nucleus degener
in)</div><div>3. <b>Ey
e</b> - desi
s rund Iris</div>
Difference be
ween n lxne, n l
rexne?
Oiid n
gnis
s<div>N lxneshr

erm cu
e verdse</div><div>N l
rexne- chrnic deendence</div><div><b
r /></div><div>N l
rexne is lnger wrd</div>
Wilsns Dise se c n c use cirrhsis f
he liver nd 
her 
hlgies due
 f
ree-r dic l d m ge (liver nd b s l g ngli ) nd me
blic bnrm li
ies secnd
ry
 r cer excre
in nd
r nsr
. Wh
re sme
re
men

ins f
h
is cndi
in? Tre
wi
h cmunds
h
<b>chel
e cer (Penicill mine)</b>&
nbs; nd llw excre
in in urine.<div><br /></div><div><b>Zinc</b>&nbs;is ls
gd 
in bec use i
will cme
e wi
h cer fr bsr
in</div><div><br
/></div><div><b>Liver
r nsl n
</b></div><div><br /></div><div>N
e: Think bu

Wilsns when yu see liver nd br in dysfunc
in, eseci lly in
he cn
ex

f mvemen
disrder!</div>
"His
lgic l sec
in reve ls <b>Alzheimer
ye II s
rcy
sis</b> ( le nuclei
wi
h eriher l nucle r chrm
in), cmmnly seen in wh
c
egry f dise ses?
<div><img src="" s
e-29858612641999.jg"" /></div>"
<b>He
ic enceh l
h
y</b> (frm circul
ing mmni ); n
e
h
grss 
h m y demns
r
e cerebr l
edem s well!<div><br /></div><div>Als n
e
he
he mun
f s
rcy
ssis c
rrel
es wi
h
he mun
f enceh l
hy</div>
"The fllwing secimen w s b
ined frm chrnic lchlic wh died f liver
cirrhsis. &nbs;Describe
he bnrm li
y nd likely clinic l defici
s f
he 
"<b><fn
clr=

ien
?<div><img src="" s
e-29978871726343.jg"" /></div>"
""#ff0000"">Verm l
rhy</fn
></b> frm lchl - likely ssci
ed wi
h nnreversible wide-b sed <b><fn
clr=""#ff0000"">g i

xi </fn
></b>"
Wh
s
imul n
wi
hdr w l syndrme is sychi
ric emergency? <b>Wi
hdr w l dy
shri </b><div><br /></div><div><div>Dyshric md + 2 r mre:&nbs;</div><di
v>F
igue</div><div>Vivid, unle s n
dre ms</div><div>Insmni r hyersmni </
div><div>Incre sed e
i
e</div><div>Psychm
r re
rd
in r gi

in</div>
</div>
"N
e
he fllwing lesin in
he crus c llsum (knwn s <b>M rchiv v -Bign m
i syndrme</b>). &nbs;This cndi
in w s likely c used by wh
?<div><img src=""
R id crrec
in r
re
men
f hyn

 s
e-30227979829464.jg"" /></div>"
remi ; (firs
seen in lchlics)
R id crrec
in f hyn
remi c n resul
in 
hlgic ch nges
 wh

w re
gins f
he CNS?
"<b>Crus C llsum</b> (M rchiv v -Bign mi syndrme) -demyelin
in & m; necrsis f crus c llsum. Seen wi
h r id crrec
in f
hyn
remi ; firs
described in lchlics<div><img src="" s
e-30288109371609.
jg"" /></div><div><br /><div><b>Cen
r l Pn
ine Myelinlysis</b> (n
e
h

hi
s c n resul
in <b>LOCKED IN SYNDROME</b>&nbs; s well bec use f
he ffec
n
n
ine
r c
s - c n be n <u>i
rgenic dise se</u></div></div><div><img src=""
 s
e-30300994273487.jg"" /></div><div><img src=""cm.jeg"" /></div>"
"Abuse / In
xic
in f
his subs
nce resul
s in necrsis f
he u
men bec u
se f

xic me
blic frm (<u>frmic cid</u>). &nbs;Wh
is
he subs
nce
nd ms
cmmn frm f <b>
re
men
</b>?<div><img src="" s
e-30438433226981.jg
"" /></div>"
Me
h nl! &nbs;Tre
wi
h n e
h nl dri (
 cre
e cme
i

ive si
u
in)
P
ien
resen
s wi
h bil
er l glbus  llidum necrsis fllwing xygen deriv

in nd likely inh l
in f wh
subs
nce? "C rbn Mnxide; i
will bind

 hem glbin nd reduce
he xygen c rrying c  ci
y f
he bld<div><br /></di
v><div>Cmmn wi
h exsure
 g sline, u
 exh us
, nd in dequ
e ven
il
i
n</div><div><img src=""CO.jeg"" /></div>"
"Cm re
he
w sec
ins, n
e
he relev n
brnm li
ies, nd give
he likely
c use f e ch?<div><img src="" s
e-30734785970303.jg"" /></div>"
Lef
: <u
>Me
h nl</u> isning wi
h bil
er l necrsis f <u>u
men</u><div>Righ
: <u>
CO</u> isning wi
h bil
er l necrsis f
he <u>GP</u></div><div><br /></div>
<div>Mnemnic:&nbs;</div><div>ne wrd;
w wrds</div>
"He ve me
l (fr ex mle le d) in
xic
in c uses
he fllwing e r nce his

lgic lly. &nbs;Describe
he im ge nd likely grss findings, cnsequences?<d

iv><img src="" s
e-30863634989305.jg"" /></div>"

"His
lgy reve ls <u>v
scul r necrsis</u>&nbs;--&g
; bre kdwn f
he <b>BBB</b> nd <b>edem </b><div
><img src="" s
e-30876519891187.jg"" /></div>"
Wh
is
he me
blism
ime nd effec

ime f mhe
mine?
Slw me
blism,
effec
s l s
sever l hurs <u>lnger
h n cc ine</u>
Wh
drug is being described:<div><div>Ex
reme euhri in ure frm&nbs;</div>
<div>Hyer ler
ness</div><div>Gr ndisi
y</div><div>Hyersexu li
y</div><div>Hy
er
lk
iveness</div><div>R id nse
f c
in</div><div>R id ex
inc
in f eu
hri </div><div>R id
ler nce</div></div><div><br /></div><div>Wh
frms re

here?</div> "Cc ine<div><img src=""cc ine (1).jeg"" /></div>"
<div>Wh
is being described:</div><div>Im ired crdin
in, euhri , nxie
y
, sens
in f slwed
ime, im ired judgmen
, sci l wi
hdr w l</div><div><br /
></div><div>Cnjunc
iv l injec
in</div><div>Incre sed e
i
e</div><div>Dry m
u
h</div><div>T chyc rdi </div> C nn bis in
xic
in
Wh
c n c use c nn bis wi
hdr w l? Wh
re sym
ms Cess
in r reduc
in i
n he vy nd rlnged use (d ily/fr few mn
hs)<div><br /></div><div>Sym
ms
re mild, flu like:</div><div><div>-<b>irri
bili
y</b>, nger, r ggressin&n
bs;</div><div>-<b>res
lessness</b></div><div>-nervusness / nxie
y&nbs;</div>
<div>-<b>deressed</b> md&nbs;</div><div>-slee difficul
y&nbs;</div><div>-d
ecre sed e
i
e / w
lss&nbs;</div><div>-<b> bdmin l  in</b>,
remrs, swe

s, fever, chills, he d che</div></div>
Wh
re chrnic dverse effec
s f c nn bis? Cgni
ive difficul
ies<div>Im i
red m
r func
in</div><div>Deressin</div><div><b>P r ni </b></div><div>Psyc
hsis</div><div><b>Am
iv
in l syndrme</b></div>
Wh
is
he s
ree
n me fr hencyclidine? Wh
cl ss? "PCP. ""Angel dus
""<div
><br /></div><div>H llucingen</div>"
<div>Wh
cl ss re
he fllwing?</div><div><br /></div>Erg
<div><div>LSD</div
><div>Mesc line</div><div>Psilcybin</div><div>MDMA (Ecs
sy)</div></div>
"<img src=""
her.jeg"" />"
Wh
is ve
erin ry nes
he
ic
h
induces PCP-like h rm clgy?
"Ke
min
e<div><img src=""ke
mine.jeg"" /></div>"
Wh
drug is being described:<div><div><br /></div><div>- belligerence, imulsiv
eness, hmicid l
endencies</div><div><br /></div><div>- ver
ic l nd hrizn
l
nys
gmus,
chyc rdi ,
xi , fever</div><div><br /></div><div>- sychm
r
gi

in, sychsis, delirium</div></div>
PCP in
xic
in
Wh
c n ccur fllwing cess
in f use wi
h h llucingen? Wh
is i
?
<div><u>H llucingen Persis
ing Perce
in Disrder</u></div><div>(Fl shb cks)</
div><div><br /></div><div><div>Fllwing cess
in f use:<b> reexeriencing</b>
f erce
u l sym
ms exerienced while in
xic
ed wi
h
he h llucingen</div
><div><br /></div><div>(geme
ric h llucin
ins, f lse erce
ins f mvm
in 
eriher l visin, fl shes f clr, in
ensified clrs,
r ils f im ges f mvi
ng bjec
s, si
ive f
erim ges, h ls rund bjec
s, m crsi , micrsi )</d
iv><div>
</div></div>
<div>The fllwing c n be used s wh
?</div><div><br /></div><div>Alih
ic nd
rm
ic hydrc rbns</div><div>G sline, glue,  in

hinner, sr y  in
</div
><div>H lgen
ed hydrc rbns</div><div>Cle ners,
yewri
er crrec
in fluid,
sr y c n</div><div>rell n
s</div><div>Tluene, benzene, ce
ne, me
h nl, 

hers</div><div>Huffing nd B gging</div> Inh l n
s
Wh
re b
h s l
s?
"Syn
he
ic c
hinnes- frm Kh
l n
(bl ck h wk dwn)
<div>Mehedrne = C
hinne + Amhe
mine</div><div><img src=""b
h.jeg"" /></d
iv>"
Are syn
he
ic c nn binids simil r
 c nn bis? Wh
c n
hey c use
"N, ver
y li

le s
ruc
ur l simil ri
y<div>Link
 sychsis</div><div><img src=""syn
h.
jeg"" /></div>"
Wh
re firs
nd secnd line meds
 be given fr <b> lchl wi
hdr w l?</b>
1s
: BZDs (crss
ler n
wi
h E
h)<div>2nd: n
i-cnvuls n
s</div>
Wh
re
he
w r ches
 Ph rm clgic l In
erven
ins fr Alchl Deende
nce
<div>1. Tre
men
f <u>cmrbid sychi
ric</u> sym
ms
 reduce</div
><div>
endency
 self-medic
e</div><div><br /></div><div>2. Direc
effr
s
 <u
>rduce dverse effec
s</u> wi
h inges
in r
 mdify neur
r nsmi

er sys
em

s medi
ing lchl reinfrcemen
</div>

Oiid in
xic
in cri
eri includes wh

<div><b>Puill ry cns
ric
in</
b> + 1 r mre:</div><div>Drwsiness / cm </div><div>Slurred seech</div><div>I
m ired

en
in / memry</div>
In rel
in
 rel
ives f lchlics, describe b sline endgenus iid level
s nd effec
f n l
rexne
<div><div>Rel
ives f lchlics h ve<b> <u>dec
re sed b seline</u> levels f endgenus iids (be
endrhins)</b></div><div
>N l
rexne
x will <u>incre se</u> levels f endgenus iids, es in lchl
ics nd rel
ives f lchlics</div></div>
Wh
is
he m n gemen
f lchl in
xic
in? There re n n
gnis
s
 reve
rse effec
<div><br /></div><div>Nu
ri
in</div><div>Fluids</div><div>IV
hi mine
</div><div>Prm
e s fe
y</div>
Wh
is
he m jr defense mech nism f in
erven
in fr lchl deendence? Hw
Deni l<div>F mily in
erven
in/m
iv
in l in
erviewing</div>

 vercme?
The rcess f
re
ing wi
hdr w l is c lled
De
xific
in
Wh
is
he effec
f cmbining n l
rexne + c mrs
e
ge
her fr lchl wi
"N mre effec
ive
h n ei
her lne<div><img src=""cmb

hdr w l
her y?
ine.jeg"" /></div><div><br /></div>"
"<div>Describe wh
is ccuring:</div><div><br /></div><div>M l d 
ive beh vir
l r sychlgic l ch nges</div><div>1 r mre:</div><div>-slurred seech<s n
cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-nys
gmus</div><div>
-incrdin
in<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>
-im ired

n/memry</div><div>-uns
e dy g i
<s n cl ss=""Ale-
b-s n"" s

yle=""whi
e-s ce:re""> </s n>-s
ur/cm </div>"
Sed
ive, hyn
ic, r
nxily
ic in
xic
in
N me 3 Sed
ives, Hyn
ics, r Anxily
ics
"<div><img src=""sh .jeg"" /></
div>"
"Wh
des
his define?<div><div>2 r mre, develing w/in hurs

few d ys:
</div><div>- u
nmic hyer c
ivi
y (di hresis, HR&g
;100)</div><div>-h nd
re
mr<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-insmni </d
iv><div>-n use /vmi
ing <s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re"
"> </s n>-h llucin
ins (A/V,
c
ile)</div><div>- nxie
y<s n cl ss=""Ale-

b-s n"" s
yle=""whi
e-s ce:re""> </s n>-sychm
r gi

in</div><div><s
n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-gr nd m l seizure
s</div></div><div><br /></div>" Sed
ive, Hyn
ic, r Anxily
ic Wi
hdr w l
Wh
re
w risks f benzdi zeines? <div>Tler nce --&g
; dse esc l
in</d
iv><div>Abru
discn
inu
in --&g
; wi
hdr w l</div><div><br /></div><div>Ther
efre, mus

er dse</div>
"Wh
is being described:<div><div>3 r mre:</div><div><s n cl ss=""Ale-
bs n"" s
yle=""whi
e-s ce:re""> </s n>-dyshric md<s n cl ss=""Ale-
bs n"" s
yle=""whi
e-s ce:re""> </s n>-y wning</div><div><s n cl ss=""Ale
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-n use /vmi
ing<s n cl ss=""Ale
-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-fever</div><div><s n cl ss=""A
le-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-muscle ches<s n cl ss=""Ale
-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-insmni </div><div><s n cl ss=""
Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-l crim
in/rhinrrhe </div>
<div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-di rrhe <
/div><div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>-ui
ll ry dil
in/ilerec
in/di hresis</div></div><div><br /></div>" Oiid w
i
hdr w l
Wh
is
he func
in f subxne (SL burenrhine/n lxne)? SL burenrhine
( r
i l gnis
) rescri
in h s led
 injec
in f
he drug
 incre se bi
v il bili
y. N lxne h s n n
gnis
effec
r lly.&nbs;<div><br /></div><d
iv><br /><div>Therefre,
his cmbin
in exis
s
 reven
injec
in f SL cmb
in
in.&nbs;</div></div><div><br /></div><div>Pele
ry
 ge
higher by inje
c
ing burenrhine IV.. S when yu give  r
i l gnis
nd n n
gnis


ge
her n
gnis
blcks
he rece
r s  r
i l gnis
wn
wrk.. S
hey g



ke
he drug r lly if
hey w n
i

 wrk</div>
Hw

ell
he difference if HDV cinfec
in r suerinfec
in wi
h HBV by ser
lgy? "HDV-HBC <u>Cinfec
in</u>:&nbs;<b>IgM An
i-HBc</b><div>HDV Suerinfec


in: rising IgG An
i-HDV</div><div><img src=""HDV.jeg"" /></div>"

Which HSV virus is ssci
ed wi
h lwer SE grus? Which is mre rev len
f
e
r uber
y?
<div><b>HSV1</b> mre rev len
in <u>lwer SE gru</u>s; rim
ry infec
ins ccur e rly in life</div><div><b>HSV2</b> mre rev len
f
er <u>
6/20HHVDickey
uber
y</u></div>
Hw nd when shuld yu
es
fr l l ?
"Bld in
he d y. Exhibi
s diur
n l eridici
y<div><img src=""L (1).jeg"" /></div>"
"Wh
is
his?<div><img src=""br dy.jeg"" /><div><br /></div></div>" Cys
cn

ining br dyzi
es f Txl smss
"<img src=""bld (1).jeg"" /><br /><div>Wh
is
his?</div>" Afric n Try ns
imi sis (HAT)
<div>A 23 y s
uden
wi
h
recen
vir l infec
in resen
s wi
h 3 d ys f rgr
essively</div><div>wrsening we kness nd
ingling in his fee
. Yes
erd y he w s
dr gging his fee
bu
</div><div>
d y he s
r
ed
 h ve we kness in his h nds
s well. Yu n
ice
h
he seems
</div><div>be bre
hing f s
er
h n nrm l.
On ex m, yu n
e reduced DTRs bil
er lly in</div><div>lwer ex
remi
ies.</div>
<div>A. Wh
is
he ms
likely di gnsis?</div><div>B. Wh
is
he 
hhysil
gy (mech nism)?</div><div>C. Wh
wuld yu exec
nerve cnduc
in velci
y

es

 reve l? Wh
bu
</div><div>nerve bisy?</div><div><br /></div>
<div>A. Guill in-B rr Syndrme</div><div>B. Acquired u
immune

ck f erihe
r l myelin fllwing infec
in (ms
f
en</div><div>C mylb c
er jejuni) due

 mlecul r mimicry. C n be
riggered by flu r flu v ccine.</div><div>C. Decre
sed cnduc
in velci
y, disersed mli
ude. Bisy wuld shw mnnucle r</div
><div>infil
r
in f ffec
ed eriher l nerves.</div> Q1
"<div>A 30 y wm n resen
s wi
h we kness nd
ingling in her rms nd legs whi
ch</div><div>h s rgressively wrsened ver
he  s
six mn
hs. A nerve bisy
is erfrmed:</div><div><img src="" s
e-39762807226369.jg"" /></div><div>A. W
h
is
he ms
likely disgnsis?</div><div>B. Wh
is
he 
hhysilgy (mech
nism)?</div><div>C. Lis

w 
her hysic l ex m findings
h
wuld sur

h
is di gnsis.</div>"
<div>A. Ch rc
-M rie-T
h Dise se</div><div>B. Defec
i
ve rduc
in f r
eins invlved in s
ruc
ure/func
in f myelin she
h -&g
;<
/div><div>ree
ed demyelin
in nd remyelin
in -&g
; nin bulbing/hyer
rhi
c neur
hy.</div><div>Ms
cmmn mu

in is dulic
in f chrmsme 17 (PM
P22 gene).</div><div>C. Perne l
rhy, es c vus, enl rged nerves visible n
neck.</div>
Q2
"<div>An 8 y by resen
s wi
h rxim l lwer limb we kness. He h s difficul
y
rising</div><div>frm se
ed si
in (mus
ush himself u using his rms). A
muscle bisy is</div><div>erfrmed:</div><div><img src="" s
e-39874476376065
.jg"" /></div><div>A. Describe
w bnrm l findings in
his bisy.</div><div>
B. Wh
is
he ms
likely di gnsis?</div><div>C. Wh
is
he 
hhysilgy (
mech nism)?</div><div><br /></div>"
<div>A. Fibrf

y rel cemen
, <b>v ri
ble muscle fiber size</b>, necr
ic nd regener
ing muscle fibers.</div><div>B.
Duchenne r Beckers muscul r dys
rhy</div><div>C. X-linked mu

in (m les nl
y) in DMD gene =&g
; dysfunc
in l dys
rhin r
ein (rvides</div><div>muscle
s
bili
y) =&g
; muscle we kness & m; he r
rblems. Duchenne h s NO func
in
l</div><div>dys
rhin where s Becker h s SOME func
in l dys
rhin (less seve
re).</div>
Q3
"<div>A 50 y m le resen
s wi
h dis
l muscle we kness. His m
her exerienced
</div><div>simil r syndrme beginning
ge 60. A muscle bisy is erfrmed:<
/div><div><img src="" s
e-39999030427649.jg"" /></div><div>A. Wh
&nbs;h llm
rk 
hlgic l&nbs;finding is reve led by
he bisy?</div><div>B. Wh
is
he
ms
likely di gnsis?</div><div>C. Wh

her hysic l ex m findings m y h ve

ied yu ff

he di gnsis?</div>" "<div>A.<s n cl ss=""Ale-
b-s n"" s

yle=""whi
e-s ce:re""> </s n>In
ern l nuclei in muscle fibers</div><div>B.<s
 n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>My
nic Dys
rh
y</div><div>C.<s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>F
rn
l b lding, h
che
f cies, c
r c
s, 
sis, mu
h dr, gri nd ercussi
n my
ni , rrhy
hmi s</div>" Q4
Cn
r s

eni slium in
es
in l infec
in wi
h
issue infec
in (cys
icercsis
) in
erms f cquisi
in
"<div><b>In
es
in l infec
in</b>: <b><fn
cl

r=""#ff0000"">l rv e</fn
></b> re inges
ed in <u>undercked rk</u></div><di

v> In sm ll in
es
ine, l rv e m
ure in
 dul
s (c n grw u
 5 me
ers in 3 m
n
hs!)</div><div>- Adul
s

ch

he in
es
in l w ll nd cnsume fd, c usin
g m lnu
ri
in</div><div>- Gr vid rgl

ids cn
ining eggs re shed in feces<
/div><div><br /></div><div><div><b>Tissue infec
in</b> (cys
icercsis): <b><fn

clr=""#ff0000"">eggs</fn
></b> re inges
ed in fd r w
er cn
min
ed w
i
h <u>hum n feces</u></div><div> In sm ll in
es
ine, eggs h
ch in
 ncsheres
, which inv de nd sre d
 
her
issues</div><div> Cys
icerci (T eni s l rv l
frmfluid-filled cys
s, e ch wi
h
single inv gin
ed sclex) devel in <b>br
in, muscles, eyes</b></div><div> Cys
icerci grw
 becme s ce-ccuying lesin
s seizures, neurlgic defec
s, blindness</div></div><div><br /></div><div><img
src="" s
e-86165633892982.jg"" /></div>"
"<div>A 50 y m le resen
s wi
h dis
l muscle we kness. His m
her exerienced
</div><div>simil r syndrme beginning
ge 60. A muscle bisy is erfrmed:<
/div><div><img src="" s
e-39999030427649.jg"" /></div><div>A. Wh
&nbs;h llm
rk 
hlgic l&nbs;finding is reve led by
he bisy?</div><div>B. Wh
is
he
ms
likely di gnsis?</div><div>C. Wh

her hysic l ex m findings m y h ve

ied yu ff

he di gnsis?</div>" <div>A. In
ern l nuclei in muscle fibers
</div><div>B. My
nic Dys
rhy</div><div>C. Frn
l b lding, h
che
f cies, c

r c
s, 
sis, mu
h dr, gri nd ercussin</div><div>my
ni , rrhy
hmi
s</div> Q4
"<img src="" s
e-40102109642753.jg"" /><div><div>A. Wh
re s f
he sin l c
rd re lesined?</div><div>B. Give ne ssible e
ilgy.</div><div>C. Lis

hr
ee hysic l ex m findings.</div></div>" <div>A. Sub cu
e cmbined degener
in:
Drs l clumns nd cr
icsin l
r c
s</div><div>bil
er lly.</div><div>B. B12
deficiency, Vi
min E deficiency, NO
xici
y, HIV myel
hy.</div><div>C. We k
ness, hyerreflexi , clnus, +B binski, im ired si
in/vibr
in sense,</div>
<div>+Rmberg</div>
Q5
"<img src="" s
e-40248138530817.jg"" /><div><div>A. Wh
re s f
he sin l c
rd re lesined?</div><div>B. Give ne ssible e
ilgy.</div><div>C. Wh
eye
finding is ssci
ed wi
h
his dise se?</div></div>" <div>A. Bil
er l drs l
clumns nd DRGs.</div><div>B. Ter
i ry syhilis (neursyhilis)</div><div>C. A
rgyll Rber
sn uils cns
ric
in resnse
 ccmmd
in bu
n
ligh
.</di
v>
Q5
"<div>A 55 y m le resen
s wi
h 3 mn
h his
ry f he d ches, n use nd im
ired</div><div>cgni
ive func
in, which h s g

en rgressively wrse. He rece
n
ly h d seizure</div><div>which fin lly ersu ded him
 seek medic l c re. A

umr w s de
ec
ed n im ging</div><div> nd bisy erfrmed:</div><div><img
src="" s
e-45475113730049.jg"" /></div><div>A. Lis

w 
hlgic l findings
in
his bisy.</div><div>B. Wh
is
he ms
likely di gnsis?</div><div>C. Wh
<div>A. Pseud-

is
he ver ge surviv l fr
his
ye f
umr?</div>"
llis ding necrsis nd v scul r rlifer
in.</div><div>B. Glibl s
m mul
if
Q7
rme.</div><div>C. 9 mn
hs.</div>
"<div>A 55 y m le resen
s wi
h 3 mn
h his
ry f he d ches, n use nd im
ired</div><div>cgni
ive func
in, which h s g

en rgressively wrse. He rece
n
ly h d seizure</div><div>which fin lly ersu ded him
 seek medic l c re. A

umr w s de
ec
ed n im ging</div><div> nd bisy erfrmed:</div><div><img
src="" s
e-45552423141377.jg"" /></div><div>A. Lis

w&nbs;
hlgic l find
ings in
his bisy.</div><div>B. Wh
is
he ms
likely di gnsis?</div><div>C
. Wh
is
he ver ge surviv l fr
his
ye f
umr?</div><div><br /></div>"
<div>A. Hyercellul ri
y, lemrhism, berr n
mi
sis, bsence f necrsis r
</div><div>v scul r rlifer
in.</div><div>B. An l s
ic s
rcy
m .</div><di
v>C. 18 mn
hs.</div> Q8
"<img src="" s
e-45603962748929.jg"" /><div><div>A. Lis

w&nbs;
hlgic l
findings in
his
umr bisy.</div><div>B. Wh
is
he ms
likely di gnsis?<
/div><div>C. Wh
is
he rgnsis fr
his
ye f
umr?</div></div>" <div>A.
Ps mmm bdies (cl cific
in), whrled 

ern.</div><div>B. Meningim .</div>
<div>C. Excellen
rgnsis benign, rese c
ble.</div>
Q9
"<img src="" s
e-45917495361537.jg"" /><div><div>A. Describe ne 
hlgic l
finding in
his
umr bisy.</div><div>B. Wh
is
he ms
likely di gnsis?</d

iv></div>"
<div>A. Fried egg cells, chicken wire 

ern.</div><div>B. Olig
Q10
dendrglim .</div>
"<div>A 5 y by resen
s wi
h hydrceh lus. A
umr bisy is erfrmed:</div>
<div><img src="" s
e-46102178955265.jg"" /></div><div>A. Describe
w 
hlg
ic findings.</div><div>B. Wh
is
he ms
likely di gnsis?</div>"
<div>A.
Hmer-Wrigh
rse

es, sm ll blue cells.</div><div>B. Medullbl s
m .</div>
Q11
"<div>A 5 y by resen
s wi
h lef
-sided
xi . A
umr bisy is erfrmed:</
div><div><img src="" s
e-46179488366593.jg"" /></div><div>A. Describe
w 
h
lgic findings.</div><div>B. Wh
is
he ms
likely di gnsis?</div><div>C. Wh
<div>A. Cle r f my cell

syndrme is
his
umr ssci
ed wi
h?</div>"
s, v scul r rlifer
in.</div><div>B. Hem ngibl s
m .</div><div>C. Vn Hie
l-Lind u syndrme hem ngibl s
m , bil
er l ren l cell c rcinm </div><div> nd
Q12
lycy
hemi .</div>
"<div>13. A 45 ye r ld f mer resen
s wi
h myclnic jerks, seizures nd rgre
ssive</div><div>demen
i . A br in bisy is erfrmed:</div><div><img src="" s

e-46278272614401.jg"" /></div><div>A. Describe
w 
hlgic findings.</div><d
iv>B. Wh
is
he ms
likely di gnsis?</div><div>C. Wh
is
he 
hhysilg
y (mech nism)?</div>" <div>A. Sngifrm ch nges, ex
r cellul r rin r
ein
(requires seci l s
in), fibrill ry r</div><div>flrid l ques.</div><div>B. Cre
u
zfeld
-J kb dise se.</div><div>C. PrPc =&g
; PrPsc (be
-le
ed shee
)</div>
Q13
"<div>A chrnic lchlic m n resen
s

he ER wi
h dehydr
in, nys
gmus,

xi ,</div><div> nd men
l cnfusin. He w s u
n NS wi
h 5% dex
rse nd deve
led</div><div>wrsening cnfusin nd memry lss in
he subsequen
d ys. If
u
sy were</div><div>erfrmed, fllwing wuld be n
iced:</div><div><img src=
"" s
e-47317654700033.jg"" /></div><div>A. Wh
is
he ms
likely di gnsis?<
/div><div>B. Why did
he sym
ms wrsen f
er beginning
re
men
, nd re
hey
likely
</div><div>imrve in
he fu
ure?</div><div>C. Wh
shuld h ve been d
<div>A. Thi mine (B1) de
ne firs

 vid wrsening f sym
ms?</div>"
ficiency.</div><div>B. Excessive glucse fur
her dele
es ATP. P
ien
c me in w
i
h reversible Wenickes</div><div>enceh l
hy (MOAN: Men
l ch nge, Oh
h lm
legi , A
xi , Nys
gmus) nd</div><div>nw h s irreversible Krs kffs sychsis
( n
ergr de mnesi nd</div><div>cnf bul
in).</div><div>C. Alw ys give
hi
mine ( .k. . b n n b g) befre glucse in n lchlic!</div>
Q14
"<div>22 y well-nurished m n w s brugh

 clinic by his  ren
s fr recen

nse
</div><div>f res
ing
remr, muscle rigidi
y, clumsy g i
, slurred seech
nd drling. On ex m</div><div>he
meg ly w s resen
bu
he h d n cirrh
ic
s
igm
. He ls h d n</div><div>in
eres
ing eye finding (see belw). L b s
ud
ies reve led bnrm l LFT nd</div><div>neg
ive he
i
is  nel.</div><div><img
src="" s
e-47399259078657.jg"" /></div><div>A. N me
he</div><div>in
eres
ing
eye finding.</div><div>B. Wh
is
he ms
likely di gnsis?</div><div>C. Wh

is
he
re
men
?</div>"
<div>A. K yser-Fleischer ring.</div><div>B. Wils
ns dise se.</div><div>C. Penicill mine.</div> Q15
"<div>55 y m n wi
h h/ liver cirrhsis w s brugh


he ER wi
h fl ing

remr,</div><div>cnfusin, slee cycle revers l. During
he hsi
l curse he
died f m ssive GI</div><div>bleeding. On u
sy
he fllwing w s fund:</div>
<div><img src="" s
e-47450798686209.jg"" /></div><div>A. Wh

hlgic fe
u
re is
he red rrw in
ing
?</div><div>B. Wh
w s
he ms
likely di gnsis
?</div>"
<div>A. Alzheimer
ye II s
rcy
e.</div><div>B. He
ic enceh
l
hy.</div> Q16
"<img src="" s
e-47592532606977.jg"" />"
"<img src="" s
e-47699906789377
.jg"" /><div><img src=""K9.jeg"" /></div><div><img src=""dec (1).jeg"" /></di
v>"
Q17
"<img src="" s
e-47764331298817.jg"" /><div><img src="" s
e-47785806135297.j
g"" /><br /><div><br /></div></div>"
"<img src="" s
e-47798691037185.jg"" /
>"
Q18
"<div><div><img src="" s
e-47867410513921.jg"" /></div></div>"
"<img sr
c="" s
e-47888885350401.jg"" />"
Q19
"<div><div><img src="" s
e-48009144434689.jg"" /><img src="" s
e-479833746309

13.jg"" /></div></div>"
"<img src="" s
e-47996259532801.jg"" />"
Q20
"<img src="" s
e-48077863911425.jg"" />"
"<img src="" s
e-48095043780609
.jg"" /><div><img src=""K11.jeg"" /></div>" Q21
"<img src="" s
e-48150878355457.jg"" />"
"<img src="" s
e-48163763257345
.jg"" />"
Q22
"<img src="" s
e-48245367635969.jg"" /><div>Iden
ify
he inned cr ni l nerves
</div>" "<img src="" s
e-48318382080001_1375136067430.jg"" />"
Q22
Describe
he <b>findings</b>&nbs;(4) f medi l
emr l lbe seizure nd illu
s
r
e hw
hey m ke sense wi
h
he n
my
"<div>ANS c
iv
in, smell, mem
ry lss, dej vu</div><img src="" s
e-48395691491329.jg"" /><div><br /></div>
"
Q24
"<div><img src="" s
e-48468705935361.jg"" /></div>Iden
ify
he ins. Wh
runs
in
he s
ruc
ure indic
ed by
he ins (wi
h
he crrec
rien

in)?"
"<img src="" s
e-48490180771841.jg"" /><div><img src=""c sule.jeg"" /></div>
"
Q25
"<img src="" s
e-48584670052353.jg"" />"
"<img src="" s
e-48601849921537
.jg"" />"
Q26
"<img src="" s
e-48722109005825.jg"" /><img src="" s
e-48743583842305.jg"" /
>"
"<img src="" s
e-48765058678785.jg"" /><div><div>Wh
re
he secific
GABAergic in
erneurns cnnec
ing be
ween exci

ry inu
frm cr
ex nd inhi
bi
ry u
u


h l mus? Wh
re differences be
ween 
hw ys-- Wh
d
hey
secre
e, nd wh
re
heir rece
rs? (1, nd 2 resec
ively)</div><div><br /><
/div><div>Medium Siny Neurns.</div><div>Direc
: Secre
e GABA/subs
nce P nd h
ve&nbs;<u>D1</u>&nbs;rece
rs. Exis

 disinhibi
VL nucleus, ermi

ing m
vemen
.&nbs;</div><div>Indirec
: GABA/enkeh lin nd h ve&nbs;<u>D2</u>&nbs;r
ece
rs nd&nbs;<u>ACh</u>&nbs;rece
rs</div><div><img src=""b s l g nd indi
rec
.jeg"" /></div></div>"
Q27
"<img src="" s
e-48872432861185.jg"" />"
"<img src="" s
e-48936857370625
.jg"" />"
Q28
"<img src="" s
e-49014166781953.jg"" />"
"<img src="" s
e-49027051683841
.jg"" />"
Q29
"<img src="" s
e-49112951029761.jg"" /><img src="" s
e-49121540964353.jg"" /
>"
A Red in: PICA<div>B Blue in: PCA</div><div>C Green in: B sil r</div>
Q30
"<img src="" s
e-49224620179457.jg"" /><img src="" s
e-49250389983233.jg"" /
>"
"<img src="" s
e-49263274885121.jg"" />"
Q31
"<img src="" s
e-49452253446145.jg"" />"
"<img src="" s
e-49465138348033
.jg"" />"
Q32
"<img src="" s
e-49525267890177.jg"" /><img src="" s
e-49559627628545.jg"" /
>"
"<img src="" s
e-49615462203393.jg"" />"
Q33
"<img src="" s
e-49727131353089.jg"" />"
"<img src="" s
e-49740016254977
.jg"" /><div><div>CN VIII in uer medull
 CN III in midbr in.&nbs;</div><d
iv>Helful in&nbs;<u>P rin ud syndrme</u>&nbs;(ine lm ), by ding&nbs;<u>v
er
ic l Dlls he d</u>, c n by ss re
ec
l re nd use ves
ibul r sys
em
 sh
w
h
&nbs;<u>CN III</u>&nbs; nd&nbs;<u>CN IV</u>&nbs; re&nbs;<u>in
c
</u
>.&nbs;</div><div><img src=""ver
ves
c h nd.jeg"" /></div><div><img src=""b
r ins
em CN.jeg"" /></div></div>"
Q34
"<img src="" s
e-49804440764417.jg"" />"
"<img src="" s
e-49825915600897
.jg"" /><div><img src=""k8.jeg"" /></div>"
Q34
"<img src="" s
e-49894635077633.jg"" /><div>Iden
ify e ch in. A lesin

he
leg re f
he blue in wuld c use wh
sym
ms in yur 
ien
?</div>"
"<img src="" s
e-49916109914113.jg"" />"
Q36
"Iden
ify
he inned vessels<img src="" s
e-50109383442433.jg"" />" "<img sr
c="" s
e-50083613638657.jg"" />"
Q37
"<img src="" s
e-50173807951873.jg"" />"
"<img src="" s
e-50208167690241
.jg"" /><div><img src=""s
rng (1).jeg"" /></div>"
Q38
"<img src="" s
e-50298362003457.jg"" />"
"<img src="" s
e-50311246905345
.jg"" /><div><img src="" s
e-121912646696961.jg"" /></div>" Q39
"<img src="" s
e-50384261349377.jg"" /><img src="" s
e-50397146251265.jg"" /

>"
"<img src="" s
e-50418621087745.jg"" />"
Q40
"Iden
ify<div><img src="" s
e-50491635531777.jg"" /></div>" Red: O
ic Nerve
<div>Bl ck: M mmill ry bdies</div><div>Yellw: M ss In
ermedi </div><div>Green
: Pine l Gl nd</div><div>Whi
e: Suerir Clliculus</div>
Q41
Cmlic
ed v ricell c n le d
 wh
serius secnd ry infec
in?
"Secnd
ry infec
in wi
h <u>gru A s
re</u><div><img src=""cmlic
ed .jeg"" /></di
v><div><br /></div><div>I believe
he legs re necr
ic nd will be mu

ed</d
iv>"
6/20HHVDickey
"Iden
ify<div><img src="" s
e-50680614092801.jg"" /></div>" "Yellw: O
ic C
hi sm<div>Blue: L min Termin lis</div><div>Whi
e: Hy
h l mic sulcus</div><div
>Green: Crus C llssum</div><div><br /></div><div><img src=""5 (2).jeg"" /></
div><div>5= l min
ermin lis&nbs;</div>"
Q41b
"<img src="" s
e-50861002719233.jg"" />"
"<img src="" s
e-50882477555713
.jg"" />"
Q42
"<img src="" s
e-50955491999745.jg"" /><div><img src="" s
e-50968376901633.j
g"" /></div>" "<img src="" s
e-50981261803521.jg"" />"
Q43
"<img src="" s
e-51054276247553.jg"" />"
"<img src="" s
e-51067161149441
.jg"" />"
Q44
"<img src="" s
e-51200305135617.jg"" /><img src="" s
e-51213190037505.jg"" /
>"
"<img src="" s
e-51226074939393.jg"" />"
Q45
Describe b
es
s
 de
ermine EBV fr:<div>Acu
e infec
in</div><div>Prir infe
c
in</div><div>Af
er sever l mn
hs</div>
"<div><b> n
i-VCA</b> (<b>v</b>i
r l <b>c</b> sid <b> </b>n
igen) <b>IgM</b> indic
es cu
e infec
in</div><div
><b> n
i-VCA</b> <b>IgG</b> indic
es rir infec
in</div><div><b>EBNA</b> f
e
r sever l mn
hs&nbs;</div><div><img src=""ebn .jeg"" /></div>"
6/20HHVD
ickey
"<img src="" s
e-51299089383425.jg"" />"
"<img src="" s
e-51311974285313
.jg"" />"
Q46
"<img src="" s
e-51393578663937.jg"" />"
"<img src="" s
e-51415053500417
.jg"" />"
Q47
"<img src="" s
e-51488067944449.jg"" />"
"<img src="" s
e-51616916963329
.jg"" /><div><div>Cerebellum<u>SCP</u>&nbs;(u
u
) Den

-rubr-
h l mic
r c

(DRTT,&nbs;<b>decuss
in</b>) Red nucleus (<b>n syn se</b>) VL
h l mus (<b>s
yn se</b>) ALIC frn
l cr
ex (BA 4 nd 6)</div><div><br /></div><img src=""nec
erebellum (1).jeg"" /><img src=""ne l b.jeg"" /></div><div><img src=""midbr i
n.jeg"" /></div>"
Q48
"<img src="" s
e-51694226374657.jg"" />"
"<img src="" s
e-51707111276545
.jg"" /><div><br /></div><div><img src="" rchi cerebellum.jeg"" /></div><div><
img src="" lecerebellum.jeg"" /></div><div><br /></div><div><br /></div><div>
<br /></div><div><b>Dendri
es</b>&nbs;f&nbs;<u>urkinje cells</u>, inu
sign
ls frm&nbs;<b> r llel fibers</b>&nbs;frm&nbs;<u>gr nule cells</u>&nbs; n
d&nbs;<b>climbing fibers</b>&nbs;frm&nbs;<u>inferir lives</u><div><img src
=""n
ure cr
ex.jeg"" /><img src=""cr
ex cl ss.jeg"" /></div></div><div><br
/></div>"
Q49
"<img src="" s
e-51780125720577.jg"" />"
"<img src="" s
e-51793010622465
.jg"" />"
Q50
"<img src="" s
e-51904679772161.jg"" />"
"<img src="" s
e-51917564674049
.jg"" />"
Q51
"<img src="" s
e-51990579118081.jg"" />"
"<img src="" s
e-52003464019969
.jg"" />"
Q52
"<img src="" s
e-52059298594817.jg"" /><img src="" s
e-52072183496705.jg"" /
>"
"<img src="" s
e-52085068398593.jg"" />"
Q52
"<img src="" s
e-52162377809921.jg"" /><img src="" s
e-52175262711809.jg"" /
>"
"<img src="" s
e-52196737548289.jg"" />"
Q54
"<img src="" s
e-52265457025025.jg"" />"
"<img src="" s
e-52278341926913
.jg"" />"
Q55
"<img src="" s
e-52355651338241.jg"" />"
"<img src="" s
e-52368536240129
.jg"" />"
Q56
"<img src="" s
e-52432960749569.jg"" />Iden
ify. Wh

hw ys
ermin
e here?
"
"<img src="" s
e-52467320487937.jg"" /><div><br /></div><div><div>1 Per

iher l lymd l ncice
r C fibers syn ses IPSI Rexed I nd II</div><div><br /

></div><div>2 Rexed I nd II crsses midline in n
erir whi
e cmmissure (s me le
vel) u sin l crd in CONTRA STT syn se VPL nd ne rby nuclei (<u>in
r l min r
nucleus f
h l mus</u>)</div><div><br /></div><div>3 VPL nd ne rby nuclei f
h
l mus &nbs;</div><div>PLIC Ps
cen
r l gyrus SSI, SSII nd insul r cr
ex</div
><div>ALIC cingul
e gyrus</div><div><br /></div><div><img src=""slw bdy.jeg""
/></div></div>"
Q57
Cn
r
s
which secific nervus
issue HSV1 nd HSV2 re l
en

HSV1-
r
igemin l g ngli ( bve w is
, res. secre
ins/s liv )<div>HSV2- s cr l g ngli
(belw w is
, sexu l cn
c
)</div>
6/20HHVDickey
"<img src="" s
e-54558969561089.jg"" /><img src="" s
e-54571854462977.jg"" /
>"
"<img src="" s
e-54584739364865.jg"" />"
"<img src="" s
e-56234006806529.jg"" /><img src="" s
e-56246891708417.jg"" /
>"
"<img src="" s
e-56259776610305.jg"" />"
"<img src="" s
e-56319906152449.jg"" /><img src="" s
e-56388625629185.jg"" /
>"
"<img src="" s
e-56401510531073.jg"" />"
"<img src="" s
e-56478819942401.jg"" />Iden
ify"
"<img src="" s
e-564917
04844289.jg"" />"
"<img src="" s
e-56569014255617.jg"" />Iden
ify"
O
ic r di
ins
"<img src="" s
e-71481140707329.jg"" /><img src="" s
e-71506910511105.jg"" /
>"
"<img src="" s
e-71515500445697.jg"" />"
"<img src=""52234f15768ce 4c8 f8d08c51524cc8 cc59c69_Q_0.svg"" />"
"<img sr
c=""52234f15768ce 4c8 f8d08c51524cc8 cc59c69_A_0.svg"" />"
"<img src=""5223
4f15768ce 4c8 f8d08c51524cc8 cc59c69_surce_svg.svg"" />"
"<img src=""5223
4f15768ce 4c8 f8d08c51524cc8 cc59c69_
mr83g
n.ng"" />"
"<img src=""333b747727d685 e1 05f97e be1cbbb 5519 ec_Q_0.svg"" />"
"<img sr
c=""333b747727d685 e1 05f97e be1cbbb 5519 ec_A_0.svg"" />"
"<img src=""333b
747727d685 e1 05f97e be1cbbb 5519 ec_surce_svg.svg"" />"
"<img src=""333b
747727d685 e1 05f97e be1cbbb 5519 ec_
mc4hl .ng"" />"
"<img src=""333b747727d685 e1 05f97e be1cbbb 5519 ec_Q_1.svg"" />"
"<img sr
c=""333b747727d685 e1 05f97e be1cbbb 5519 ec_A_0.svg"" />"
"<img src=""333b
747727d685 e1 05f97e be1cbbb 5519 ec_surce_svg.svg"" />"
"<img src=""333b
747727d685 e1 05f97e be1cbbb 5519 ec_
mc4hl .ng"" />"
"<img src="" s
e-71721658875905.jg"" /><img src="" s
e-71824738091009.jg"" /
>"
"<img src="" s
e-71837622992897.jg"" />"
Prvide
he rcesses
h
fi
s
he fllwing
imeline f develmen
:<div><br /
></div><div>Cmle
e
4 weeks</div><div>Cmle
e by 8 weeks</div><div>Cn
inue
s frm 8 weeks
 dul
hd</div>
"Neurul
in (cmle
e by 4 weeks)<div>S
egmen

in nd cle v ge (cmle
e by 8 weeks)</div><div>Prlifer
in nd migr

in (8 weeks - dul
hd)</div><div><img src=""10005880_10152260797548577_84007
93461014597871_.jg"" /></div>"
"<img src="" s
e-72022306586625.jg"" />Which vessels sulies
he re f
he
in?" Red= SCA<div>Blue= B sil r</div><div>Whi
e= AICA</div><div>Bl ck= Pic </
div><div>Yellw = ASA</div><div>Green= SCA, AICA, PICA</div>
M jr even
s
h
ccur during neurul
in?
"1. <b>Differen

in</b> - <u>n
eurec
derm</u> / <u>neur l cres
</u><div>&nbs; &nbs; &nbs; &nbs; G s
rul

in - frm
in f
he
hree germ l yers</div><div><br /><div>2. Es
blish <b> x
is f symme
ry</b> (ceh lic
 c ud l; ven
r l
 drs l (m
r
 sensry))</d
iv></div><div><br /></div><div>3. Sign l <b>mlecule gr dien
s&nbs;</b></div><d
iv><b><img src=""neur .jeg"" /></b></div><div><br /></div><div><img src=""A29F
CC88-4A96-4638-A709-BE7DC8EBBCAA.jg"" /></div><div><img src=""10386908_10152260
797553577_1916435788819194410_.jg"" /></div>"
"<img src="" s
e-72206990180353.jg"" /><img src="" s
e-72219875082241.jg"" /
>"
"<img src="" s
e-72241349918721.jg"" />"
Exl in
he in
er c
in f mesderm nd neur-ec
derm during
he differen
i
i
n h se f neurul
in? "Mesderm <b>sends sign ls</b>

he neur-ec
derm fr
differen
i
in; fr ex mle <u>NOGGIN</u>&nbs;hels rm
es develmen
f

he c ud l regin in

he br in<div><img src=""10386908_10152260797553577_191643
5788819194410_.jg"" /></div><div><img src=""A29FCC88-4A96-4638-A709-BE7DC8EBBC
AA.jg"" /></div>"

"<img src="" s
e-72752451026945.jg"" />"

"<img src="" s
e-72825465470977
.jg"" />"
Exl in
he imr
nce f ensuring dequ
e levels f <b>flic cid</b>&nbs;in
wmen f childbe ring ge?
"The <u>clsure f
he neur l
ube</u> nd frm

in f
he <u>drs l ven
r l xis </u>( s shwn belw) is rm
ed by sign l m
lecules essen
i l fr m in
en nce nd develmen
. &nbs;One such mlecule is <b
>flic cid</b>&nbs;- deficiency in flic cid culd rduce incmle
e clsu
re f
he crd / neur l
ube defec
s) Ex. Sin Bifid <div><br /></div><div><img
src="" s
e-75720273428590.jg"" /><img src="" s
e-75733158330477.jg"" /><img
src="" s
e-75746043232358.jg"" /></div>"
"<img src="" s
e-72907069849601.jg"" />"
"<img src="" s
e-72975789326337
.jg"" />"
Seci lized regin f mesderm
h
even
u lly frms s
ruc
ures in
he sine; &n
bs;in n dul
i
will ersis
s
he <u>nucleus ulsus.</u><div><u><br /></u
></div><div>This s
ruc
ure ls sends sign l _______

he <u>BASAL PLATE</u>&n
bs;
 rm
e develmen
f
he m
r regins f
he sin l crd.</div>
"<div>N
crd; n
e
h
sign ling
 B s l Pl
e invlves mlecule: <fn
cl
r=""#ff0000"">SONIC HEDGEHOG!</fn
></div><div><fn
clr=""#ff0000""><img src=
"" s
e-76020921139434.jg"" /></fn
></div><img src=""1024x-Cervic l_ver
ebr _
english.ng"" />"
"<img src="" s
e-73044508803073.jg"" />"
"<img src="" s
e-73117523247105
.jg"" />"
"<img src="" s
e-73186242723841.jg"" />"
"<img src="" s
e-73212012527617
.jg"" />"
"<img src="" s
e-73272142069761.jg"" />"
"<img src="" s
e-73285026971649
.jg"" />"
"<img src="" s
e-73340861546497.jg"" />"
"<img src="" s
e-73353746448385
.jg"" />"
"<img src="" s
e-73431055859713.jg"" />"
"<img src="" s
e-73443940761601
.jg"" />"
"<img src="" s
e-73499775336449.jg"" />"
"<img src="" s
e-73512660238337
.jg"" />"
"<img src="" s
e-73581379715073.jg"" />"
"<img src="" s
e-73602854551553
.jg"" />"
The l r l
e (drs l regin) nd B s l Pl
e (ven
r l regin) f
he develin
g sin l crd devel wi
h
he hel f sign ling mlecules. &nbs;<b>Iden
ify</b
>
hree imr
n
ex mles nd exl in
he <b>n
ure</b> f
heir c
in?
"<b>Wn
s nd BMPs</b> (vi ec
derm) c
ing n
he l r l
e rm
e develmen

f
he <u>drs l / sensry regin.</u><div><br /></div><div><b>Snic Hedgehg<
/b> (vi
he N
crd) rm
e develmen
f
he <u>ven
r l / m
r regin</u><
/div><div><br /></div><div>N
e
h

hese mlecules func
in s <u>gr dien
</
u>;
h
is gre
er cncen
r
in f SHH will m ke m
r develmen
mre like
ly
 ccur!</div><div><br /></div><div><img src="" s
e-76398878261378.jg"" />
</div><div><br /></div><div><img src="" s
e-76278619177200.jg"" /></div><div><
img src=""10386908_10152260797553577_1916435788819194410_.jg"" /></div>"
"<img src="" s
e-73671574028289.jg"" />"
"<img src="" s
e-73684458930177
.jg"" />"
"<img src="" s
e-73761768341505.jg"" />"
"<img src="" s
e-73783243177985
.jg"" />"
"<img src="" s
e-73899207294977.jg"" />"
"<img src="" s
e-73869142523905
.jg"" />"
Exl in
he imr
nce f <b>re
inic cid</b> in
he cn
ex
f develmen
nd
regn ncy risk f c
rs? Wh
drug is risk? Re
inic cid is invlved wi
h <
u>neur l
ube clsure</u> s well s <u>m
r/sensry develmen
</u> (rec ll: f
unc
ins s gr dien
!)<div><br /></div><div><b>Acu
ne</b>&nbs;( cne
x) is
deriv
ive f re
inic cid nd ses subs
n
i l risk
 embrylgic develme
n
(influences gr dien
s). &nbs;<u>C nn
rescribe cu
ne
 wm n f rerdu
c
ive ge unless she is n
w frms f bir
h cn
rl!!</u></div>
"<img src="" s
e-73967926771713.jg"" />"
"<img src="" s
e-73989401608193
.jg"" />"

"<img src="" s
e-74062416052225.jg"" />"

"<img src="" s
e-74075300954113
.jg"" />"
Segmen

in is rcess cmle
e by rund 8 weeks nd invlves
he develmen

f
he rsenceh ln in
 ________ (
w s
ruc
ures) nd
he Rhmbenceh ln i
n
 _________ (
w s
ruc
ures)? "<div>Telenceh ln (cerebr l hemisheres)</div>
<div>Dienceh ln (
h l mus)</div><div>Mesenceh ln (midbr in)</div><div>Me
enc
eh ln (ns)</div><div>Myelenceh ln (medull )</div><img src="" s
e-7656638
1986017.jg"" /><div><img src=""10463685_10152260797543577_4434658882886257462_
.jg"" /><br /><div><img src=""

erning.jeg"" /></div></div>"
"<img src="" s
e-74144020430849.jg"" />"
"<img src="" s
e-74156905332737
.jg"" />"
"<img src="" s
e-74212739907585.jg"" />"
"<img src="" s
e-74225624809473
.jg"" />"
"<img src="" s
e-74431783239681.jg"" />"
"<img src="" s
e-74496207749121
.jg"" />"
Describe hw
he rsenceh ln ch nges
hrughu
segmen

in. Wh
f c
r le
ds

his?
"The rsenceh ln <b>enl rges</b> e rly in <b>segmen

in</b>
nd frms
he s
ruc
ures f
he <u>Telenceh ln</u>&nbs; nd <u>Dienceh ln</
u><div><u><br /></u></div><div>L
er, under
he influence f f c
rs such s <b>
Snic Hedge Hg</b>&nbs;
he rsenceh ln fur
her ex nds nd <b>underges cle
v ge</b> (Telenceh ln regins; rec ll: frm cerebr l hemisheres)</div><div><
br /></div><div>Wrdy di gr m:</div><div><img src="" s
e-76725295776139.jg"" /
></div><div><img src=""10463685_10152260797543577_4434658882886257462_.jg"" />
</div><div><br /></div><div><br /></div><div><img src=""

erning.jeg"" /></di
v><div><br /></div>"
Prlifer
in f rimi
ive leuri
en
i l cells in develing <b>sin l crd</b
> ccurs rim rily rund
he _________ which resul
s in gr du l enl rgemen
f
" . cen
r l c n l<div>b. gr y m

er</div><div><br /></div><div>

he ________
N
e
h

he whi
e nd gr y m

er will devel incre sing ne
wrks / in
egr
i
n during
his
ime.</div><div><br /></div><div>Occurs during rlifer
in nd
migr
in h se f develmen
.</div><div><img src=""10463685_10152260797543577_
4434658882886257462_.jg"" /></div>"
"<img src="" s
e-74564927225857.jg"" />"
"<img src="" s
e-74577812127745
.jg"" />"
"<img src="" s
e-74689481277441.jg"" />"
"<img src="" s
e-74668006440961
.jg"" />"
Iden
ify
hree imr
n
even
s
h
ccur during
he rlifer
in nd migr
i
n h se f embrylgic l develmen
? 1. Evlu
in f <u>cmu

in c  ci
y<
/u> - cr
ic l grw
h cn
inues in
 dul
hd!<div><br /><div>2. Prlifer
in
f <u>neurec
derm l recursrs</u></div><div><br /></div><div>3. Migr
in</di
v></div>
"<img src="" s
e-74758200754177.jg"" />"
"<img src="" s
e-74771085656065
.jg"" />"
"<img src="" s
e-74826920230913.jg"" />"
"<img src="" s
e-74839805132801
.jg"" />"
"<img src="" s
e-74895639707649.jg"" />"
"<img src="" s
e-74908524609537
.jg"" />"
"<img src="" s
e-74977244086273.jg"" />"
"<img src="" s
e-76647986364417
.jg"" />"
"<img src="" s
e-76686641070081.jg"" />"
"<img src="" s
e-76699525971969
.jg"" />"
"<img src="" s
e-77090367995905.jg"" />"
"<img src="" s
e-77103252897793
.jg"" />"
"<img src="" s
e-77167677407233.jg"" />"
"<img src="" s
e-77180562309121
.jg"" />"
"<img src="" s
e-77232101916673.jg"" />"
"<img src="" s
e-77244986818561
.jg"" />"
"<img src="" s
e-77313706295297.jg"" />"
"<img src="" s
e-77330886164481
.jg"" />"
"<img src="" s
e-77382425772033.jg"" />"
"<img src="" s
e-77403900608513

.jg"" />"
"<img src="" s
e-77481210019841.jg"" />"
"<img src="" s
e-77494094921729
.jg"" />"
"<img src="" s
e-77549929496577.jg"" />"
"<img src="" s
e-77567109365761
.jg"" />"
"<img src="" s
e-77622943940609.jg"" />"
"<img src="" s
e-77635828842497
.jg"" />"
"<img src="" s
e-77695958384641.jg"" />"
"<img src="" s
e-77717433221121
.jg"" />"
"<img src="" s
e-77786152697857.jg"" />"
"<img src="" s
e-77803332567041
.jg"" />"
"<img src="" s
e-77854872174593.jg"" />"
"<img src="" s
e-77867757076481
.jg"" />"
"<img src="" s
e-77966541324289.jg"" />"
1. PCA<div>&nbs; . He d che, F
ilure
 see bjec
s n
heir righ
side</div><div>&nbs; b. Righ
hmnymus H
emi nsi wi
h M cul r s ring</div>
"<img src="" s
e-78151224918017.jg"" />"
"<img src="" s
e-78164109819905
.jg"" />"
"<img src="" s
e-78241419231233.jg"" />"
"<img src="" s
e-78254304133121
.jg"" />"
"<img src="" s
e-78310138707969.jg"" />"
"<img src="" s
e-78323023609857
.jg"" />"
"<img src="" s
e-78464757530625.jg"" />"
"<img src="" s
e-78481937399809
.jg"" />"
"<img src="" s
e-78533477007361.jg"" />"
"<img src="" s
e-78546361909249
.jg"" />"
"<img src="" s
e-78623671320577.jg"" />"
"<img src="" s
e-78636556222465
.jg"" />"
"<img src="" s
e-78692390797313.jg"" />"
"<img src="" s
e-78713865633793
.jg"" />"
"<img src="" s
e-78786880077825.jg"" />"
"<img src="" s
e-78799764979713
.jg"" />"
"<img src="" s
e-78855599554561.jg"" />"
"<img src="" s
e-78868484456449
.jg"" />"
"<img src="" s
e-78924319031297.jg"" />"
"<img src="" s
e-78937203933185
.jg"" />"
"<img src="" s
e-78993038508033.jg"" />"
"<img src="" s
e-79005923409921
.jg"" />"
"<img src="" s
e-79066052952065.jg"" />"
"<img src="" s
e-79078937853953
.jg"" />"
"<img src="" s
e-79194901970945.jg"" />"
"<img src="" s
e-79164837199873
.jg"" />"
"<img src="" s
e-79263621447681 (1).jg"" />" "<img src="" s
e-79276506349569
.jg"" />"
"Exl in
he imr
nce nd func
in f
he __________ (
ends
 be in
he eriv
en
ricul r re ) in cr
ic l develmen
? Describe i
? Wh
bu
in grwing by
s?<div><div><img src=""84229671-E767-4813-8E93-0F931118C163.jg"" /></div></div>
"
"The <u>germin l m
rix</u> hels
 <b>s wn gli l / neurn l recursr
s</b> r s
em cells. &nbs;<b>Neurns nd gli l
r vel
 frm
he l yers f cr

ex. &nbs;</b><div><br /></div><div>N
e
h
cr
ic l l yers devel <b>frm

he inside</b> (l yer 1 is u
side, l yer 6 ms
in
erir)&nbs;</div><div><br />
</div><div>Fin lly: In
he im ge belw (11 y m le) n
e
h
blue regins re

hicker mre develed re s f cr
ex (fllwing germin l m
rix migr
in nd m

ur
in), while yellw/re d re s re s
ill develing. <b>PFC is l s

hing

 becme dul

hickness</b></div><div><br /></div><div><img src="" s
e-7867950
5895555.jg"" /></div>"
Exl in
he func
in f B-C
enin in neur l develmen
nd redic

he effec

f ver c
iv
in.
"B-C
enin cn
rls
he <u>en
r nce f cells in

he ce
ll cycle</u> nd ffec
s<u> migr
in</u> 

erns. &nbs;Over-exressin drives
mre cells
 cen
er
he cell cycle nd c n rduce enl rged (
hlgic l) br

ins! Bu
, m y be useful fr regener
in fllwing d m ge.&nbs;<div><br /></div

><div><img src="" s
e-78808354914524.jg"" /></div>"
Wh
re
he
w ms
cmmn cndi
ins
h n m nifes
s
resul
f neur l
ube
defec
in
he n
erir neurre?
"Anenceh ly (f ilure
 frm br in)<div
><div>Enceh lcele (f ilure
 cmle
ely enclse
he br in)</div></div><div><b
r /></div><div><img src="" s
e-78932908966022.jg"" /></div><div><img src="" s

e-78954383802607.jg"" /></div>"
Sin bifid ccul
is nrm lly sym
m
ic, bu
hw c n i
be di gnsed?&nbs
;
<div>C n be visu lized n <u>x-r y</u>.&nbs;</div><div><br /></div><div
>Sin bifid is usu lly <b>NOT</b> de
ec
ble in u
er by me suremen
f <u>m

ern l serum lh fe
r
ein</u>&nbs;(unlike
he 
her neur l
ube defec
s)</d
iv>
N me
hree subs
nce / drug rel
ed risk f c
rs fr neur l
ube defec
s?
1. <b>Fl
e</b> deficiency - hels in sign ling neur l
ube clsure<div><br /><
div>2. <b>Re
inic cid</b> dminis
r
in ( cu
ne) - &nbs; ls invlved in ne
ur l
ube clsure nd m
r/sensry develmen
</div><div><br /></div><div>3. <b
>V lr
e</b> (fr seizures)</div></div>
Mlecul r f c
rs, such s Snic Hedge Hg h ve differen
effec
s deending n

he s
ge f rgressin, lc
in, r ex
en
f gr dien
. &nbs;Wh
is
he effe
c
f SHH in rcesses f <b>neurul
in</b> nd <b>grw
h/differen
i
in</b>?
"Neurul
in - SHH hels
 rm
e <b><fn
clr=""#ff0000"">ven
r l (m
r) d
evelmen
</fn
></b> &nbs;
hrugh in
er c
in wi
h n
crd nd b s l l
e<di
v><br /></div><div>Grw
h nd regul
in - SHH rm
e <fn
clr=""#ff0000""><
b>cle v ge f</b>&nbs;<b>Prsenceh lic</b></fn
> regin (Telenceh ln)</div>
<div><img src=""10005880_10152260797548577_8400793461014597871_.jg"" /></div><
div><img src=""snic.jeg"" /></div><div><br /></div><div><img src=""

erning.
jeg"" /></div>"
"Iden
ify
his f
l cndi
in. Describe
he defec
, nd where<div><img src=""
s
e-79413945303173.jg"" /></div>"
Anenceh ly - defec
f <u> n
erir neur
re</u>; r high cr
ic l develmen
, wh
ersis
s is mix
ure f <u>
iss
ues nd bld vessels</u>; highly rne
 infec
in bec use f exsure<div><br
/></div><div>Incidence: 1/3000</div>
"Iden
ify nd describe
he <b>
w</b> cndi
ins seen belw<div><img src="" s
e
-79594333929666.jg"" /></div>" Lef
: A likely <b>Meningcele</b>, frm <u>s

erir neurre</u> defec
. ( ssuming i
is filled wi
h CSF nd desn
cn
in
neur l
issue)&nbs;<div><br /></div><div>Righ
: <b>Enceh lcele</b> - cn
in
s br in
issue; redisses
 seizures nd in
ellec
u l defici
. Frm <u> n
eri
r neurre</u> defec
. Severi
y deends n m
f cerebr l
issue which herni

es</div><div><br /></div><div>Surgic l remv l fr b
h is likely indic
ed</di
v>
"Cm re nd cn
r s

he fllwing s
erir neru l re (neur l
ube) defici
s
nd Iden
ify
he 
hlgy; which is likely
 cn
in neur l
issue?<div><img
src="" s
e-79826262163682.jg"" /></div>"
Lef
: <b>Meningcele</b> - cn

ins <u>nly sin l fluid nd dur </u>;
here will be less neurlgic l defici
s
, hwever <u>skin ersin n s c c n redisse
 infec
in (meningi
is)</u><di
v><u><br /></u></div><div>Righ
: <b>Meningmyelcele</b>&nbs;- sin l crd is
in
he s c (indic
ed by red rrw) -
he grw
h <u>cn
ins neur l
issue</u>;

his 
ien
will likely suffer frm m
r/sensry m lfunc
in wi
h lss f bwe
l / bl dder cn
rl; n ex mle f <u>sym
m
ic sin bifid </u></div>
Im ging reve ls misfrmed nd rly segmen
ed br in s
em, c ud lly ex
ended c
erebell r
issue, nd elng ded ns. &nbs;Yu ls bserve signific n
hydrdc
eh lus. &nbs;Wh
is
he likely cndi
in?
"Arnld Chi ri M lfrm
in (def
ec
in b
h n
erir nd s
erir neurre); n
e
h

he <u>cerebr l queduc

m y be m lfrmed r bnrm l le ding
 hydrceh lus</u><div><br /></div><div
>Arrws in

: ex
ended cerebell r
issue, bsence f cerebr l queduc
, eln
g
ed ns, nd <b><fn
clr=""#ff0000"">""Midbr in be king""</fn
></b><br />
<div><img src="" s
e-80268643795245.jg"" /></div><div><img src="" s
e-8036742
8043012.jg"" /></div><div><br /></div></div>"
Sec
rum f defec
s resul
ing in r divisin f
he
elenceh lic hemisheres
frm
he rsenceh ln. &nbs;Assci
ed wi
h <u>
rismy 13 nd 18</u>, l
hug

h <b>ms
c ses re sr dic</b>. &nbs;Iden
ify
he cndi
in nd rvide
he b

es
nd wrse c se scen ris f clinic l m nifes

in. "<b>Hlrsenceh ly</b
><div><br /><div>Minim l lesin: <u> rrhinenceh ly</u> - bsence f lf c
ry b
ulbs nd
r c
s</div><div><img src="" s
e-80427557585089.jg"" /></div><div><br
/></div><div>Severe: <u> lb r hlrsenceh ly</u> - cycli nd midf ci l d
efec
s</div></div><div><img src=""
el.jeg"" /></div>"
"Newbrn wi
h
rismy 13 resen
s wi
h hy
elrism (eyes re clse
ge
her); g
rss u
sy f
he br in reve ls
he fllwing lb r findings:<div><img src=""

el.jeg"" /><br /><div><img src="" s
e-80564996538589.jg"" /></div></div>"
"<b>Hlrsenceh ly</b>; n
e
h
<u s
yle=""fn
-weigh
: bld; "">cycli </
u>&nbs;(single eye) c n ls resen
(ins
e d f hy
elrism); if
he lesin i
s minr i
is ssible fr nly
he lf c
ry
r c
s
 be ffec
ed (= rrhinenc
eh ly)<div><br /></div><div>Rec ll: Trismy 18 is ls n iden
ified gene
ic ri
sk, l
hugh ms
c ses re sn
neus</div>"
"Grss insec
in f
he br in reve ls ""b
winged ven
ricles"". &nbs;Yu sus
ec
rblem wi
h <u> xn l migr
in</u> ffec
ing
he frm
in f wh
br in
s
ruc
ure? &nbs;Describe
he in
elligence nd clinic l sym
ms f 
ien
w
i
h
his cndi
in?<div><img src="" s
e-80698140524711.jg"" /></div>" <u>Agene
sis f
he Crus C llsum</u> (due
 bnrm l xn l migr
in); 
ien
c n b
e <b>in
ellec
u lly nrm l</b>, bu
mre likely
 h ve sme<b> dis bili
y</b>
nd/r <b>eilesy</b>
"Grss insec
in f
he br in reve ls
he fllwing bnrm li
y; iden
ify
he c
ndi
in nd
he likely disrder
h
ccured? <b>Wh
is
he c use</b>? &nbs;W
h
re
he sym
ms f
his 
ien
?<div><img src="" s
e-80844169412846.jg""
/></div>"
<b>Lissenceh ly</b> (sm
h br in); due
 <u>neurn l migr
i
n disrder</u>; N
e
he <u> bsence f sulci nd gyri</u>; 
ien
will likely h
ve severe <b>seizures nd in
ellec
u l dis bili
y</b> - ls susec

<u>gene

ic defici
</u>
Ven
ricles re resen
, bu
sulci nd gyri re bsen
due
 neurn l migr
in
disrder
"Lissenceh ly (sm
h br in)<div><img src="" s
e-8083987444555
0.jg"" /></div>"
"Micrscic bnrm li
ies f
he gyri (sekled e r nce) re n
ed un grss
ex min
in. &nbs;Iden
ify
he cndi
in, nd
he <b>c use</b><div><img src=""
 s
e-80990198300802.jg"" /><img src="" s
e-1397706912170224.ng"" /></div>"
<b>Plymicrgyri </b> (m ny sm ll gyri); bnrm l&nbs;<u>gyr l 

ern frm
i
n</u>. <u>Of
en nly
w l yers re resen
: mlecul r nd neurn l</u>&nbs;cr
ex is m lfrmed nd severe <b>in
ellc
u l dis bili
ies</b> nd <b>seizures</
b> resul

"Describe
he gene
ic infleunces nd ch r c
eris
ics f B nd He
er
i (Duble
Cr
ex). &nbs;Hw des
he dise se differ be
ween m les nd fem les?<div><img
src="" s
e-81119047319799.jg"" /></div>"
<b>Dublecr
in</b>. Defec
ive g
ene is resen
n
he X-chrmsme (x linked <u>dmin n
</u>); m les wi
h
his c
ndi
in usu lly die in u
er.<div><br /></div><div>Fem les will h ve ne defec

ive nd ne gd cy; X-in c
iv
in (lyniz
in) c uses neurns wi
h
he gd
cy
 migr
e nrm lly, while neurns wi
h
he defec
ive cy will h ve r
migr
in nd frm
he inner cr
ic l l yer...</div>
"The fllwing MRI im ge is b
ined; wh
is
he likely cndi
in? &nbs;Descri
be 
ien
wi
h such 
hlgy.<div><img src="" s
e-81114752352503.jg"" />
</div>" <b>B nd He
er
i </b> (duble cr
ex); 
ien
c n m ke i


een ge
ye rs nd dul
hd bu
will
hen devel severe, <b>un
re
ble seizures</b> (
erh s due
 <u>hyersynchrnici
y</u>)<div><br /></div><div>Rec ll: gene
ic in
fluence f
his dise se (n X chrmsme) - m les die in u
er; fem les exress
ne gd nd ne b d defec
ive cy le ding
 v rying degress f neurn l migr

in
 frm
w cr
ic l l yers</div>
"Iden
ify
he cndi
in in
he fllwing im ge if
he c use is due
:<div> ) f
c l lss f reviusly frmed cr
ex</div><div>b) fc l lss f germin l m
rix<
/div><div><br /></div><div><img src="" s
e-81368155422902.jg"" /></div>"
" ) Prenceh ly - fc l lss f reviusly frmed m
rix<div>b) Schizenceh ly
- fc l lss f germin l m
rix</div><div><br /></div><div>Rec ll
h
<b><u>se
cific regins f germin l m
rix re designed
 ""ul
e"" secific regins 

f cr
ex</u></b>; lss f germin l m
rix resul
s in bsence f cr
ic l migr
i

n nd develmen
.</div>"
N me
he cndi
in<div> ) fc l lss f germin l m
rix</div><div>b) fc l lss
f reviusly frmed cr
ex</div><div>c) glb l lss f reviusly frmed cr
ex
</div> ) Schizenceh ly<div>b) Prenceh ly</div><div>c) Hydr nenceh ly</div>
"Describe
he cndi
in shwn in
he fllwing im ges?<div><img src="" s
e-8162
5853460735.jg"" /></div>"
Hydr nenceh ly - glb l lss f reviusly frm
ed cr
ex; yu c n c
u lly shine ligh

hrugh
he he d! &nbs;B by c n survi
ve bu
will h ve severe in
ellc
u l dysfunc
in
Exl in
he risk f rem
ure delivery wi
h resec

 germin l m
rix c
ivi
y?
&nbs;Wh
c
s
rhic cndi
in c n be seen? "Germin l m
rix is highly c
iv
e during develmen
(c uses rlifer
in nd develmen
f cr
ic l l yers).
&nbs;Therefre rem
ure delivery c uses <u>bld ressure fluc
u
ins, hyxi
</u>&nbs;
h
c n resul
in <u>germin l m
rix hemrrh ge (<b>in
r ven
ricul r
hemrrh ge</b>)</u>. &nbs;Cnversely nrm l
erm b bies h ve
less c
ive ger
min l m
rix
h
is n
s rne
 hemrrh ge)<div><br /></div><div><img src="
" s
e-81746112544976.jg"" /></div>"
Ms
cmmn in
r cr ni l hemrrh ge in nen
es ( r
icul rly <u>re-
erm</u>)
"<b><fn
clr=""#ff0000"">In
r ven
ricul r hemrrh ge</fn
></b>; resul
s frm
ru
ure f germin l m
rix hemrrh ge in

he ven
ricle...rec ll
h

he germ
in l m
rix is <u>eseci lly fr gile nd rne
 ru
ure</u> due
 high c
ivi

y nd r ressure regul
in in <u>rem
ure inf n
s</u><div><u><img src=""
s
e-81741817577680.jg"" /></u></div>"
Describe mul
icys
ic Enceh l
hy? Lc
in? Se r
ed by wh
?
"<u>Mul

ile l rge cys
ic c vi
ies</u>
h
ccuy ms
f <u>b
h cerebr l hemisheres<
/u>; se r
ed by <u>
hin w lls f gli
ic neuril</u><div><u><img src=""mul
i.
jeg"" /></u></div>"
"<img src="" s
e-81445464834049.jg"" />Wh

hlgy des
his im ge shw?"
Tye Gruing (Neur
hy)
"<img src="" s
e-81552839016449.jg"" />Wh

hlgy des
his im ge shw?"
Gru A
rhy (Neur
hy)
"<img src="" s
e-81625853460481.jg"" />Wh

hlgy des
his im ge shw?"
Ch rc
-M rie T
h (Hyer
rhic neur
hy)
"<img src="" s
e-81776177315841.jg"" />Wh

hlgy des
his im ge shw?"
Duchenes Muscul r Dys
rhy (Arrw
 fibrf

y rel cemen
, Als v ri ble fib
er size nd necr
ic fibers)
"<img src="" s
e-81926501171201.jg"" />Wh

hlgy des
his im ge shw?"
My
nic Dys
rhy (In
ern l nuclei)
"<img src="" s
e-82059645157377.jg"" />Wh

hlgy des
his im ge shw?"
"My
nic Dys
rhy (Frn
l b lding, ""my
nic f cies"")"
"<img src="" s
e-82149839470593.jg"" />Wh

hlgy des
his im ge shw?"
Infl mm
ry mysi
is (M ny CD8+ T-cells)
"<img src="" s
e-82227148881921.jg"" />Wh

hlgy des
his im ge shw?"
Brwn-Sequ rd Injury
"<img src="" s
e-82308753260545.jg"" />Wh

hlgy des
his im ge shw?"
ASA Occlusin
"<img src="" s
e-82368882802689.jg"" />Wh

hlgy des
his im ge shw?"
Syringmeli
"<img src="" s
e-82429012344833.jg"" />Wh

hlgy des
his im ge shw?"
Sub cu
e Cmbined Sys
em Degener
in (B12 r Vi
E deficiency, NO
xici
y, HI
V myel
hy)
"<img src="" s
e-82566451298305.jg"" />Wh

hlgy des
his im ge shw?"
Friedreichs A
xi (DC, DSCT, nd CST lesined)
"<img src="" s
e-82652350644225.jg"" />Wh

hlgy des
his im ge shw?"
Ter
i ry Syhilis (T bes Drs lis)
"<img src="" s
e-82712480186369.jg"" /><img src="" s
e-82725365088257.jg"" /
>Wh

hlgy des
his im ge shw?" Amy
rhic L
er l Sclersis (UMN & m;
LMN)
"<img src="" s
e-82806969466881.jg"" />(Assci
ed wi
h fly b by)&nbs;Wh
Sin l Muscul r A
rhy r Plimyeli
is


hlgy des
his im ge shw?"

(Ven
r l hrns d m ged)

"<img src="" s
e-82995948027905.jg"" />&nbs;Wh

hlgy des
his im ge sh
Me
s
isis
 ver
ebr l bdy (PB KTL)
w?"
"<img src="" s
e-83129092014081.jg"" />Wh

hlgy des
his im ge shw?"
In
r dur l, Ex
r medull ry m ss (Schw nnm , Neurfibrm , Meningim )
"<img src="" s
e-83184926588929.jg"" />Wh

hlgy des
his im ge shw?"
In
r medull ry
umr (As
rcy
m , Eendymm , Oligdendrglim )
"<img src="" s
e-83262236000257.jg"" />Wh

hlgy des
his im ge shw?"
Glibl s
m mul
ifrme (Gr de IV, Necrsis wi
h Pseud- llis ding, V scul r r
lifer
in)
"<img src="" s
e-83438329659393.jg"" />Wh

hlgy des
his im ge shw?"
An l s
ic As
rcy
m (Gr de III, Absence f necrsis r v scul r rlifer
in
)
"<img src="" s
e-84254373445633.jg"" />Wh

hlgy des
his im ge shw?"
Meningim (Gr de I, Ps mmm bdies, Whrled 

ern)
"<img src="" s
e-84396107366401.jg"" />Wh

hlgy des
his im ge shw?"
Schw nnm (Gr de I, Sindle cells, An
ni A nd B, Verc y Bdy)
"<img src="" s
e-84572201025537.jg"" />Wh

hlgy des
his im ge shw?"
Neurfibrm (Gr de I, Frm Schw nn cells, N An
ni r Verc y)
"<img src="" s
e-84675280240641.jg"" />Wh

hlgy des
his im ge shw?"
Oligdendrglim (Gr de III r I, Fried egg cells, chicken-wire 

ern)
"<img src="" s
e-84842783965185.jg"" />Wh

hlgy des
his im ge shw?"
Bi
emr l (he
ernymus) hemi nsi (Pi
ui
ry denm , Prl c
inm , Hyer/Hy
-i
ui
rism)
"<img src="" s
e-85023172591617.jg"" />Wh

hlgy des
his im ge shw?"
Pilcy
ic s
rcy
m &nbs;
"<img src="" s
e-85100482002945.jg"" />Wh

hlgy des
his im ge shw?"
Meningim (Dur )
"<img src="" s
e-85156316577793.jg"" />Wh

hlgy des
his im ge shw?"
Medullbl s
m (Gr de IV, Hmer-Wrigh
Rse

es, Sm ll Blue cells)
"<img src="" s
e-85289460563969.jg"" />Wh

hlgy des
his im ge shw?"
Eendymm (Gr de II r III, Periv scul r seud-rse

e)
"<img src="" s
e-85345295138817.jg"" />Wh

hlgy des
his im ge shw?"
Cllid cys
(Gr de I, Psi
in l Hydrceh lus)
"<img src="" s
e-85474144157697.jg"" />Wh

hlgy des
his im ge shw?"
Hem ngibl s
m (Gr de I, Cle r f my cells, High v scul r rlifer
in)
"<img src="" s
e-85602993176577.jg"" />Wh

hlgy des
his im ge shw?"
Bi
emr l (he
ernymus) Hemi nsi (Cr nih ryngim )
"<img src="" s
e-85783381803009.jg"" />Wh

hlgy des
his im ge shw?"
Me
s
sis (Lung, Bre s
, Mel nm , Gr y-whi
e junc
in, Mul
ile)
"<img src="" s
e-85869281148929.jg"" />Wh

hlgy des
his im ge shw?"
Alzheimers Dise se (Cr
ic l (es. Temr l)
rhy, Hydrceh lus Ex-V cu)
"<img src="" s
e-85959475462145.jg"" />Wh

hlgy des
his im ge shw?"
Alzheimers Dise se (Neurfibrill ry T ngles, Be
-Amylid l ques, Be
-Amylid
Angi
hy)
"<img src="" s
e-86118389252097.jg"" />Wh

hlgy des
his im ge shw?"
Picks Dise se (Frn

emr l A
rhy w/ Knife-Edge Gyri)
"<img src="" s
e-86178518794241.jg"" />Wh

hlgy des
his im ge shw?"
Picks Dise se (Pick Bdy (T u), B llned Neurn)
"<img src="" s
e-86264418140161.jg"" />Wh

hlgy des
his im ge shw?"
Cr
ic l Lewy Bdy (Lewy Bdy Demen
i , Alh -Synuclein)
"<img src="" s
e-86427626897409.jg"" />Wh

hlgy des
his im ge shw?"
Hun
ing
ns Dise se (C ud
e A
rhy, Medium Siny Neurn des
ruc
in)
"<img src="" s
e-86483461472257 (1).jg"" />Wh

hlgy des
his im ge shw
?"
P rkinsns Dise se (Deigmen

in f Subs
n
i Nigr )
"<img src="" s
e-86577950752769.jg"" />Wh

hlgy des
his im ge shw?"
P rkinsns Dise se (Lewy Bdy, Alh -Synuclein)
"<img src="" s
e-86633785327617.jg"" />Wh

hlgy des
his im ge shw?"
Prgressive Sur nucle r P lsy (Mickey Muse Midbr in)
"<img src="" s
e-86762634346497.jg"" />Wh

hlgy des
his im ge shw?"

Prgressive Sur nucle r P lsy (Glbse T ngles (T u), NO Lewy Bdies)

"<img src="" s
e-86891483365377.jg"" />Wh

hlgy des
his im ge shw?"
Mul
ile Sys
em A
rhy (A
rhy f Pns, Gli l cy
l smic inclusin f Alh -s
ynuclein)
"<img src="" s
e-87621627805697.jg"" />Wh

hlgy des
his im ge shw?"
Mul
ile Sclersis ( Periven
ricul r Pl ques, Mul
ile Lesins)
"<img src="" s
e-87690347282433.jg"" />Wh

hlgy des
his im ge shw?"
Mul
ile Sclersis (Periv scul r Lymhcy
es, Mul
ile Pl ques in Pns nd O
ic
Chi sm)
"<img src="" s
e-87759066759169.jg"" />Wh

hlgy des
his im ge shw?"
Subf lcine (Cingul
e) Herni
in (Isi ACA inf rc
, Cn
r leg we kness, Urin r
y Incn
inence)
"<img src="" s
e-87844966105089.jg"" />Wh

hlgy des
his im ge shw?"
Unc l (Tr ns
en
ri l) Herni
in (Kernh ns N
ch, Blwn Puil, Isi PCA cmr
essin, Cn
r l
er l hemi nsi )
"<img src="" s
e-88072599371777.jg"" />Wh

hlgy des
his im ge shw?"
unc l (Tr ns
en
ri l) herni
in (Kernh ns N
ch, Isi Blwn Puil (Dwn nd
Ou
), Isi PCA cmressin, Cn
r l
er l hemi nsi )
"<img src="" s
e-88128433946625.jg"" />Wh

hlgy des
his im ge shw?"
Dure
Hemrrh ge (Due
 Unc l Herni
in, Te ring f vessels in br ins
em)
"<img src="" s
e-88205743357953.jg"" />Wh

hlgy des
his im ge shw?"
Tnsill r (Cerebell r) Herni
in (Lss f resir
ry cen
er)
"<img src="" s
e-88334592376833.jg"" />Wh

hlgy des
his im ge shw?"
An
erir Cerebr l Ar
ery Inf rc
(Cn
r leg we kness)
"<img src="" s
e-88472031330305.jg"" />Wh

hlgy des
his im ge shw?"
Middle Cerebr l Ar
ery Inf rc
(Cn
r hemi resis, Ah si if dmin n
side, He
mineglec
if nn-dmin n
)
"<img src="" s
e-88527865905153.jg"" />Wh

hlgy des
his im ge shw?"
Ps
erir Cerebr l Ar
ery Inf rc
(Cn
r hmnymus hemi nsi w/ m cul r s rr
ing, Cmressin vi Unc l herni
in)
"<img src="" s
e-88691074662401.jg"" />Wh

hlgy des
his im ge shw?"
Mul
ile Inf rc
s (Likely Emblic)
"<img src="" s
e-89408334200833.jg"" />Wh

hlgy des
his im ge shw?"
L cun r Inf rc
(Chrnic Hyer
ensin)
"<img src="" s
e-89464168775681.jg"" />Wh

hlgy des
his im ge shw?"
Red Neurns (Ischemi , 12 hurs r less)
"<img src="" s
e-89515708383233.jg"" />Wh

hlgy des
his im ge shw?"
Re c
ive glisis (Ischemi , 2 weeks s
inf rc
)
"<img src="" s
e-89588722827265.jg"" />Wh

hlgy des
his im ge shw?"
Cys
ic s ce (Ischemi , A
le s
2 mn
hs s
inf rc
, Gli l sc rring surrundi
ng)
"<img src="" s
e-89666032238593.jg"" />Wh

hlgy des
his im ge shw?"
Inf rc
f Pyr mid l cells f Hic mus (Vulner ble
 Ischemi , Smmers Sec

r CA1, CCR1 Kri
1 mu

in)
"<img src="" s
e-89760521519105.jg"" />Wh

hlgy des
his im ge shw?"
W
ershed Inf rc
be
ween ACA nd MCA (M n in b rrell we kness)
"<img src="" s
e-89837830930433.jg"" />Wh

hlgy des
his im ge shw?"
Ru
ured Ch rc
-Buch rd seud neurysms in B s l g ngli , Pns, nd Cerebellum
(Chrnic Hyer
ensin)
"<img src=""84229671-E767-4813-8E93-0F931118C163.jg"" /><div>Describe
he cell
cycle 

ern f
he germin l m
rix</div>"
"There is
unique migr
ry / c
ell cycle 

ern: cells migr
e&nbs;<b>frm
he ven
ricul r surf ce u

w rd
s
he cr
ex&nbs; nd en
er&nbs;<u>S-h se</u></b>. &nbs;They
hen descend b c
k

he&nbs;<b>ven
ricul r surf ce fr</b>&nbs;<b s
yle=""
ex
-decr
in: un
derline; "">mi
sis</b>.&nbs;"
"<img src="" s
e-90009629622273.jg"" />Wh

hlgy des
his im ge shw?"
Hemrrh gic S
rke (Lb r s
rkes, Amylid Angi
hy, Ale-green birefringence
)
"<img src="" s
e-90086939033601.jg"" />Wh

hlgy des
his im ge shw?"
Berry Aneurysms (Sub r chnid Hemrrh ge, Adul
Plycys
ic Kidney Dise ses, M r

f ns, Ehlers-D nls Syndrme)

"<img src="" s
e-90232967921665.jg"" />Wh

hlgy des
his im ge shw?"
C vernus Sinus Aneurysm (In
ern l C r
id ru
ure, NO Sub r chnid hemrrh ge,
Cr ni l nerve III, IV, V1, V2, 6  lsy)
"<img src="" s
e-90361816940545.jg"" />Wh

hlgy des
his im ge shw?"
Eidur l Hem
m (fresh bld ( r
eri l, middle meninge l), resec
s su
ures, d
irec
blw
 he d)
"<img src="" s
e-90542205566977.jg"" />Wh

hlgy des
his im ge shw?"
Subdur l Hem
m (Mix
ure f fresh nd ld bld (Venus, she red bridging vein
s), Crsses su
ures, Crescen
mn n CT, F lls)
"<img src="" s
e-90709709291521.jg"" />Wh

hlgy des
his im ge shw?"
Acu
e cn
usin (Inferir frn
l nd
emr l lbes, Fresh bld n cres
s)
"<img src="" s
e-90838558310401.jg"" />Wh

hlgy des
his im ge shw?"
Chrnic Cn
usin (Inferir frn
l nd
emr l lbes, Hemsiderin-l dden disc
lr
in)
"<img src="" s
e-90898687852545.jg"" />Wh

hlgy des
his im ge shw?"
F
Emblism (Lng bne fr c
ures, Diffuse e
echi e, Sudden nse
dysne , Fle
-bi

en e rence)
"<img src="" s
e-91027536871425.jg"" />Wh

hlgy des
his im ge shw?"
Ps
-Mr
em g s Ar
if c
(Swiss-Cheese br in, due
 b c
eri )
"<img src="" s
e-91104846282753.jg"" />Wh

ye f im ging md li
y?"
CT (Thick whi
e skull)<div>T1 MRI (Thin Skull, n
mic gr y nd whi
e)</div><di
v>T2 MRI (Thin Skull, reversed gr y nd whi
e)</div>
"<img src="" s
e-92247307583489.jg"" />Wh

hlgy des
his im ge shw?"
Cnvexi
y Meningi
is (Sub r chnid us, b c
eri l)
"<img src="" s
e-92457760980993.jg"" />Wh

hlgy des
his im ge shw?"
B sil r meningi
is (Sub r chnid us, TB r Fung l)
"<img src="" s
e-92663919411201.jg"" />Wh

hlgy des
his im ge shw?"
Emyem (Eidur l r subdur l surf ce us, B c
eri l)
"<img src="" s
e-92943092285441.jg"" />Wh

hlgy des
his im ge shw?"
Absesses (In  renchym , An erbes)
"<img src="" s
e-93157840650241.jg"" />Wh

hlgy des
his im ge shw?"
TB meningi
is (Mul
inucle
ed gi n
cells, cr ni l neur
hy, b sil r meningi
i
s)
"<img src="" s
e-93368294047745.jg"" />Wh

hlgy des
his im ge shw?"
Cry
cccus Meningi
is (S  bubble micr bscesses, Te r dr ye s
)
"<img src="" s
e-93711891431425.jg"" />Wh

hlgy des
his im ge shw?"
Cry
cccus Meningi
is (Te r dr ye s
, Indi ink s
in, L
ex gglu
in
in f
r lys cch ride c sul r n
igen, AIDS 
ien
s)
"<img src="" s
e-94098438488065.jg"" />Wh

hlgy des
his im ge shw?"
His
l smsis (Mul
ile bsesses, ye s
s wi
hin m crh ges, Urine n
igen
es

)
"<img src="" s
e-94394791231489.jg"" />Wh

hlgy des
his im ge shw?"
Mucrmycsis (DKA, Leukemic 
ien
s, Inv des l rge vessels, Nn-se

ed, Righ

ngle br nching, Bisy fr Dx)
"<img src="" s
e-94725503713281.jg"" />Wh

hlgy des
his im ge shw?"
Asergillsis (Sm ll vessels, Se

ed, Acu
e ngle br nching)
"<img src="" s
e-95021856456705.jg"" />Wh

hlgy des
his im ge shw?"
Vir l Enceh li
is c using hemrrh gic necrsis f
emr l lbe (HSV, Cwdry A
inclusins, L
en
in
rigemin l g ngli )
"<img src="" s
e-95309619265537.jg"" />Wh

hlgy des
his im ge shw?"
HSV Enceh li
is (Cwdry A In
r nucle r inclusins, HSV Enceh li
is, Hemrrh ge
f
emr l lbe, L
en
in
rigemin l g nglin)
"<img src="" s
e-95627446845441.jg"" />Wh

hlgy des
his im ge shw?"
R bies (Negri bdy esinhilic cy
l smic inclusin in Purkinje cells f cereb
ellum)
"<img src="" s
e-95842195210241.jg"" />Wh

hlgy des
his im ge shw?"
R bies (Bulle
sh ed c sid, Agi

in,  r lysis, de
h, Negri bdy esinhil
ic cy
l smic inclusins in Purkinje cells r cerebellum)
"<img src="" s
e-96224447299585.jg"" />Wh

hlgy des
his im ge shw?"

Prim ry CNS Lymhm (B-cells, AIDS 
ien
s)

"<img src="" s
e-96520800043009.jg"" />Wh

hlgy des
his im ge shw?"
Prgressive Mul
ifc l Leukenceh l
hy (JC virus, Grund-gl ss in
r nucle r
inclusins f ligdendrcy
es, AIDS 
ien
s, De
ec
wi
h PCR)
"<img src="" s
e-96868692393985.jg"" />Wh

hlgy des
his im ge shw?"
Txl smsis (Mul
ile ring-enh ncing lesins, Br dyzi
es in cys
s, AIDS 
ie
n
, Re c
iv
in r hem
genus sre d)
"<img src="" s
e-97242354548737.jg"" />&nbs;Cm re
hese CNS 
hlgies"
HSV Enceh li
is: Cwdry A In
r nucle r inclusins f As
rcy
es<div>PML: JC vir
us, Grund-gl ss in
r nucle r inclusins f Oligdendrcy
es</div><div>R bies: N
egri Bdy cy
l smic inclusins f Purkinje cells f cerebellum</div>
"<img src="" s
e-97744865722369.jg"" />Wh

hlgy des
his im ge shw?"
Neurcys
icercsis (T.slium, Cys
s becme l rv which migr
e
 br in, mul
il
e ring enh ncing lesins)
"<img src="" s
e-97976793956353.jg"" />Wh

hlgy des
his im ge shw?"
Prin dise se (Sngifrm ch nges, PrPc
 PrPsc be
-shee
s, N infl mm
ry ch
nges, Elev
ed 14-3-3 r
eins, Myclnic jerks, Peridic disch rge 

ern n
EEG, R idly rgressive demen
i
"<img src="" s
e-98453535326209.jg"" />Wh

hlgy des
his im ge shw?"
Wernickes Enceh l
hy (Thi mine B1 deficiency, M mmil ry bdy hemrrh ge, Du
e
 ATP dele
in (B n n b g befre glucse!), Men
l Ch nges Oh
h lmlegi
A
xi Nys
gmus MOAN, Krs kffs sychsis if un
re
ed)
"<img src="" s
e-98792837742593.jg"" />Wh

hlgy des
his im ge shw?"
Wilsns Dise se (Au
sm l recessive, Lw serum cerull smin, Cirrhsis, Len
i
frm mucleus degner
in (P rkinsns like disrder), K yser-Fleischer rings, Tr
e
w/ Penicill mine chel
in)
"<img src="" s
e-98973226369025.jg"" /><div>Wh

hlgy des
his im ge sh
w?</div>"
He
ic Enceh l
hy (Amni build-u, Alzheimer Tye II As
r
cy
es)
"<img src="" s
e-119464515338241.jg"" />Wh

hlgy des
his im ge shw?"
Verm l A
rhy f Chrnic Alchlism (An
erir lbe le ding
 g i

xi )
"<img src="" s
e-119533234814977.jg"" />Wh

hlgy des
his im ge shw?"
Cen
r l Pn
ine Myelinlysis (Due
 r id crrec
in f hyn
remi , c n be s
sci
ed wi
h chrnic lchlism)
"<img src="" s
e-119610544226305.jg"" />Wh

hlgy des
his im ge shw?"
Me
h nl isining (Hemrrh gic necrsis f Pu
men, Blindness, Anin-G  Me
b
lic Acidsis,
re
wi
h e
h nl r Fmeizle)
"<img src="" s
e-119773752983553.jg"" />Wh

hlgy des
his im ge shw?"
C rbn Mnxide isining (Liquef c
ive necrsis f Glbus P llidus, He d che
nd Cherry Red skin,
re
wi
h 100% Oxygen)
"<img src="" s
e-119902602002433.jg"" />Wh

hlgy des
his im ge shw?"
Le d isining (Edem due
 v scul r des
ruc
in f BBB, Wris
nd f
dr,

re
wi
h Dimerc rl nd EDTA chel
in)
"<img src="" s
e-120087285596161.jg"" />Wh

hlgy des
his im ge shw?"
Anenceh ly (An
erir neurre defec
, Lw flic cid, Elev
ed AFP nd AChE)
"<img src="" s
e-120164595007489.jg"" />Wh

hlgy des
his im ge shw?"
Enceh lcele (An
erir neurre defec
Lw flic cid, Elev
ed AFP nd AChE)
"<img src="" s
e-120306328928257.jg"" />Wh

hlgy des
his im ge shw?"
Sin Bifid Occul
(Ps
erir neurre defec
, Lw flic cid)
"<img src="" s
e-120469537685505.jg"" />Wh

hlgy des
his im ge shw?"
Meningcele (Ps
erir Neurre defec
, Less sym
m
ic
h n meningmyelcele)
"<img src="" s
e-120529667227649.jg"" />Wh

hlgy des
his im ge shw?"
Meningmyelcele (Ps
erir neurre defec
, mre sym
m
ic)
"<img src="" s
e-120581206835201.jg"" />Wh

hlgy des
his im ge shw?"
Arnld-Chi ri M lfrm
in (Assci
ed wi
h Syringmyeli , meningmyelcele, Cer
ebell r herni
in, Suerir nd inferir cllicili fusin, Aqueduc
l s
ensis,
Hydrceh lus)
"<img src="" s
e-120757300494337.jg"" />Wh

hlgy des
his im ge shw?"
Hlrsenceh ly (defec
in cle v ge (4
h
 8
h week), Assci
ed wi
h Cycli
, Sn
nues br
in, Severe MR)

"<img src="" s
e-120933394153473.jg"" />Wh

hlgy des
his im ge shw?"

Cycli (Assci
ed wi
h Hlrsenceh ly, Defec
in cle v ge (4
h
 8
h week
), Sn
nues br
in, Severe MR)
"<img src="" s
e-121109487812609.jg"" />Wh

hlgy des
his im ge shw?"
Hy
elrism (Assci
ed wi
h Lb r r Alb r Hlrsenceh ly, Defec
in cle v
ge (4
h
 8
h week))
"<img src="" s
e-121165322387457.jg"" />Wh

hlgy des
his im ge shw?"
Arrhinenceh ly (Defec
in cle v ge (4
h
 8
h weeks), Le s
severe frm, Ans
mi , Sme in
ellecu l dis bili
y)
"<img src="" s
e-121328531144705.jg"" />Wh

hlgy des
his im ge shw?"
Agenesis f Crus C llsum (Defec
in rlifer
in nd migr
in, Assci
ed w
i
h seizures nd in
ellec
u l dis bili
y
"<img src="" s
e-121384365719553.jg"" />Wh

hlgy des
his im ge shw?"
Lissenceh ly (Defec
in rlifer
in nd migr
in, Assci
ed wi
h seizures
nd in
ellec
u l dis bili
y)
"<img src="" s
e-121440200294401.jg"" />Wh

hlgy des
his im ge shw?"
Plymicrgyri (Defec
in rlifer
in nd migr
in, Assic
ed wi
h seizure
nd MR)
"<img src="" s
e-121611998986241.jg"" />Wh

hlgy des
his im ge shw?"
B nd He
er
i (Cr
ic l rg niz
in defec
)
"<img src="" s
e-121667833561089.jg"" />Wh

hlgy des
his im ge shw?"
Fc l He
er
i r Schizenceh ly
"<img src="" s
e-121723668135937.jg"" />Wh

hlgy des
his im ge shw?"
Righ
Cr ni l Nerve 6 P lsy
"<img src="" s
e-121779502710785.jg"" />Wh

hlgy des
his im ge shw?"
Lef
Cr ni l Nerve 3 P lsy (Dwn nd Ou
, P
sis)
"<img src="" s
e-121989956108289.jg"" />Wh

hlgy des
his im ge shw?"
Age-Rel
ed M cul r Degner
in?
"<img src="" s
e-122148869898241.jg"" />Wh

hlgy des
his im ge shw?"
Re
ini
is Pigmen
s (Periher l visin ls
)
"<img src="" s
e-122204704473089.jg"" />Wh

hlgy des
his im ge shw?"
Di be
ic Re
in
hy
"<img src="" s
e-122260539047937.jg"" />Wh

hlgy des
his im ge shw?"
Re
in l De
chmen
(Fl
ers, Fl shes, F lling cur
in)
"<img src="" s
e-122316373622785.jg"" />Wh

hlgy des
his im ge shw?"
Cen
r l Re
in l Ar
ery Occlusin (Cherry Red Fve , Kee ressure n eye, 97 min
u
es befre re
in l cell de
h, Check fr surce f cl
befre 
her eye ls
)
"<img src="" s
e-122479582380033.jg"" />Wh

hlgy des
his im ge shw?"
O
ic Neuri
is (P le swllen disc, Mul
ile Sclersis)
"<div>Di gnse, describe wh
yu see (5 findings), nd give
he ssci
ed m lf
rm
in</div><img src="" rnld 1.jeg"" /><img src="" rnld.jeg"" />" "Arnld
Chi ri M lfrm
in. Defec
in <b>b
h</b> n
erir nd s
erir neurre.<div
><br /><div><b><fn
clr=""#ff0000"">Midbr in be king</fn
></b></div><div>cer
ebell r
nsils disl ced dwnw rd</div><div>elng
ed br ins
em</div><div> qued
uc
l s
ensis</div><div>hydrceh lus.&nbs;</div><div><br /></div><div>Assci

ed wi
h<b> lumbs cr l meningmyelcele</b></div></div>"
All neur l
ube defec
s, including sin bifid ccul
re de
ec
ble in u
er
by me suring m
ern l serum lh fe
r
ein (AFP)
F lse, ll bu
sin bif
id ccul

re de
ec
ble
Gener l GI Virus Ch r c
eris
ics<div>Incub
in erid</div><div><u>Ru
e f sr
e d</u>?</div><div>Cul
iv
in e se?</div><div># in s
l?</div>
<div><b>
Brief</b> incub
in erid</div><div><u>Fec l - r l sre d</u></div><div><b>Di
fficul
</b>
 cul
iv
e</div><div><b>Abund n
</b> excre
in f virus in s
l</
div><div><br /></div>
Cl ssic finding&nbs;s
uricul r nd subccii
l lymh den
hy
"Rubell
&nbs;<div><img src=""rub.jeg"" /></div><div><br /></div><div><img src="" s
e210728275411574.jg"" /></div>"
When des fl vivirus ccur? Wh
ges? "Summer/e rly f ll<div>Bimd l ge dis
r
ibu
in (children nd elderly)</div><div><br /></div><div><img src="" s
e-21085
2829463158.jg"" /></div>"

Describe HIV life cycle <div>1) &nbs;<u>g120</u>  ches
 <u>CD4 +</u> crec
e
r (<u>CCR5</u> r CXCR4)</div><div>- &nbs;Hmzyg
es fr CCR5 dele
in = c
mle
e r
ec
in frm HIV</div><div>- &nbs;He
erzyg
es: rel
ive r
ec
in
(slw rgressin)</div><div>2) <u>g41</u> fuses
 <u>hs
cell membr ne</u><
/div><div>3) Reverse
r nscri
in (ssRNA--&g
; dsDNA)</div><div>4) In
egr se: i
n
egr
es vir l DNA in
 hs
DNA</div><div>5) Hs

r nscribes/
r nsl
es vir l
DNA</div><div>6) Pr
e se: cle ves li-r
eins</div><div>7) Vir l ssembly/bu
dding</div>
Wh
is used
 di gnse cu
e re
rvirus syndrme?
24 n
igen
Mnemnic fr dimrhic fungi
<b>B</b>dy <b>H</b>e
<b>C</b>h nges <b>S</b>h
e<div><div><br /></div><div><b>B</b>l s
</div><div><b>H</b>is
</div><div><b>
C</b>cci nd <b>C</b> ndid </div><div><b>S</b>r
hrix</div></div>
Dickey
Where des bl s
mycsis like
 infec
in
he bdy (Mnemnic)?<div><br /></div>
<div>Wh
bu
regin?</div> "<b>BLAS</b>
<div><br /><div><b>B</b>ne</div><
div><b>L</b>ung</div><div><b>A</b>nd <b>S</b>kin</div></div><div>GU</div><div><b
r /></div><div>Ohi nd gre
l kes regins</div><div><br /></div><div><img src=
"" s
e-98260261798304.jg"" /></div>" Dickey
Why d echinc ndins l ck c
ivi
y g ins
cry
cccus?
Cry
cccus h s
<b>be
1,6 gluc n</b> link ge, n
1,3&nbs;
N me ll f
he T u
hies (2) "PSP<div><img src="" s
e-391331650207935.ng""
/><br /><div>Picks dise se</div></div><div><img src="" s
e-392985212617119.ng
"" /></div>"
N me ll f
he lh -synuclein 
hlgies (3) "P rkinsns<div>Lewy Bdy demen

i </div><div>Mul
ile sys
em
rhy</div><div><br /></div><div><br /></div><di
v><br /></div><div><br /></div><div><br /></div><div><img src="" s
e-1019930178
748742.ng"" /></div><div><img src="" s
e-1017477752422674.ng"" /></div>"
In

en
in is
dise se r sym
m? I
s sym
m, like
cugh
<div><div>M kes c reless mis
kes, h s r

en
in
 de
il</div><div>H s di
fficul
y sus
ining

en
in</div><div>Des n
seem
 lis
en</div><div>Des n

fllw
hrugh r finish
sks</div><div>Avids c
ivi
ies
h
require sus

ined men
l effr
</div><div>Lses
hings e sily</div><div>Is e sily dis
r c
ed<
/div><div>Is frge
ful</div></div>
In

en
ive sym
ms
<div>Fidge
s, squirms</div><div>H s difficul
y rem ining se
ed</div><div>Runs 
r climbs excessively (children), exeriences subjec
ive res
lessness ( dul
s)</d
iv><div>H s difficul
y wi
h quie
c
ivi
ies</div><div>Is n
he g r driven by
m
r</div><div>T lks excessively</div>
Hyer c
ivi
y
Wh
re 4 neursychlgic l
es
s fr

en
in?
"Prcessing seed<div>


en
in
es
s (cn
inuus erfrm nce)</div><div>wrking memry
es
s</div><div>
execu
ive func
ining (wiscnsin c rd sr
ing)</div><div><br /></div><div><img
src="" s
e-923417969013.jg"" /></div><div><br /></div>"
<div>Wh
w s Hinsh ws cnclusin bu
ADHD dis ri
y be
ween C lifrni nd N
C. Why re
here mre ADHD di gnsis in NC?</div>
<u>Educ
in l licy</u
> w s
he re sn why. NC w s ne f
he firs
s

es
 imlemen
n child lef

behind, CA w s ne f
he l s
.<div><br /></div><div>--&g
; mre ADHD wi
h n ch
ild lef
behind
 imrve schl numbers</div>
"<div>Ae
i
e suressin (uncle r im c
n grw
h)</div><div>Slee dis
urb nc
es</div><div>Md dis
urb nces</div><div>Dull feeling</div><div>Irri
bili
y&nbs;
</div><div>Anxie
y</div><div>Psychsis</div><div>M ni </div><div>Res
lessness</d
iv><div>Aw reness f e ks</div><div><br /></div><div><div>He d ches</div><div>T
ic disrders</div><div>GI rblems</div><div>Incre sed ulse nd bld ressure<
/div><div>Le
h rgy nd f
igue</div><div>P
en
i l fr buse (n cle r evidence)
</div><div><b><u><fn
clr=""#ff0000"">SUDDEN CARDIAC DEATH</fn
></u></b>, 
r
icul rly if
here is n underlying he r
defec
r dise se</div></div><div><br
/></div>"
Side effec
s f s
imul n
s
Give n SNRI, lh
drenergic gnis
, nd mre selec
ive lh n
gnis
fr
A
mxe
ine (imrved erfrm nce n neursychlgic l


en
in disrders.
me sures)<div><br /></div><div>Clnidine</div><div><br /></div><div>G unf cine (
hyer c
ivi
y nd imulsivi
y)</div>
Wh
is
he dv n
ge f
mxe
ine? Wh
is dr wb ck?
"N
bus ble; m
us
be
ken d ily<div><br /></div><div><img src="" m.jeg"" /></div>"

Wh
else shuld be used in ddi
in
 meds fr
x f

en
in disrders?

"Beh vir l
re
men
s<div>Ac demic wrkl ce mdific
ins&nbs;</div><div><img
src="" dd.jeg"" /></div>"
Wh
ge/gender h s
he highes
r
e f TBI?
"M les 0-4 yrs<div><img src=""e
i (4).jeg"" /></div>"
Wh
re
he gender differences f TBI mng ele 15-24 nd &g
;70 yrs?
15-24= m les re 2x s likely
h n fem les<div>&g
;70= n gender differneces</di
v>
"<img src=""MSA (1).jeg"" /><div>Describe wh
is h ening nd di gnse</div>"
Mul
ile Sys
em A
rhy<div>A
rhy f
he ns, lh synuclein</div>
"<img src=""4 9ee40c44e6f16e3d9670 bb02407f569634936_Q_0.svg"" />"
"<img sr
c=""4 9ee40c44e6f16e3d9670 bb02407f569634936_A_0.svg"" />"
"<img src=""4 9e
e40c44e6f16e3d9670 bb02407f569634936_surce_svg.svg"" />"
"<img src=""4 9e
e40c44e6f16e3d9670 bb02407f569634936_me
h.jeg"" />"
"<img src=""fe 4b9022740f4f 447d9e415e 006fe789c9 3b_Q_0.svg"" />"
"<img sr
c=""fe 4b9022740f4f 447d9e415e 006fe789c9 3b_A_0.svg"" />"
"<img src=""fe 4
b9022740f4f 447d9e415e 006fe789c9 3b_surce_svg.svg"" />"
"<img src=""fe 4
b9022740f4f 447d9e415e 006fe789c9 3b_micr.jeg"" />"
3 defici
s frm drs l s
re m? Ar xi , simul
gnsi , kine
si
Q:&nbs;Where re m nd
ry s
s in udi
ry 
hw y? "<div>IPSI&nbs;<b>C</b>
chle r nucleus</div><div><b>I</b>nferir clliculus</div><div><b>M</b>edi l gen
icul
e nucleus</div><div><b>B</b>r dm nn&nbs;<b>A</b>re 41 (suerir gyrus 
f
emr l lbe)</div><div><br /></div><div><div>CIMBA</div></div><div><img src=
""rcessing.jeg"" /></div><div><br /></div><div><img src="" scending udi
ry.
jeg"" /></div>"
Segmen
ed Viruses:
BOAR<div>Buny , Or
hmyxvirid e, Arenvirus, Revirid e
&nbs;</div>
buzzwrds
+ RNA viruses Crn , Picrn virid e, C licivirid e, enveled RNA
buzzwrd
s
dsRNA Revirid e&nbs;
buzzwrds
RNA virus
h
relic
es in
he nucleus
Influenz viruses
buzzwrd
s
DNA viruses
HHAPPPy<div><br /><div>HHVs</div><div>He dnviruses</div><div>A
denviruses</div><div>P rv</div><div>Px</div></div><div>P illm (Plym nd
P v )</div> buzzwrds
Negri Bdies
Rh bdvirus
buzzwrds
Gu rineri bdy&nbs;
Px Viruses&nbs;<div>(esinhilic in
r cy
l smic inc
lusin bdies)&nbs;</div>
buzzwrds
Tsz nck Sme r HSV 1 & m; 2; VZV
buzzwrds
Owls Eyes Inclusin Bdies
CMV
buzzwrds
Reyes Syndrme Influenz nd VZV
buzzwrds
Acid l bile
Rhinvirus<div>( ll 
her Picrn viruses re cid s
ble)</div>
buzzwrds
Indi Ink (c sule)
Cry
 buzzwrds
Se

e hyh e
cu
e ngles Asergillus
buzzwrds
Nn-se

e hyh e
righ
ngles
Mucrmyce
es&nbs;
buzzwrds
Di gnsis: Bl s
myces Tissue r su
um
buzzwrds
B rrel-sh ed hyh e
Cccidiides
buzzwrds
Br d-b sed buds
Bl s
, Ccci buzzwrds
Thin-b sed buds Cry
 buzzwrds
Di gnsis: Periher l bld sme r/bne bisy His
l smsis buzzwrds
Cig r Sh ed
Sr
hrix
buzzwrds
Huge LDH
His
l smsis buzzwrds
Di gnsis: Cmlemen
fix
in
es

cccidiides<div><br /></div><div>Cmle
men
fixing IgG
i
er</div>
buzzwrds
Di gnsis: Cry
cccus Cry
ccc l An
igen
buzzwrds
Di gnsis: Cmlemen
fix
in nd gglu
in
in
Sr
hrix&nbs;
buzzwrds
Germ
ubes
37 C
C. lbic ns (n

he 
her C ndid )&nbs;
buzzwrd
s

Lw CD4, r id des
ur
in n exercise, lw LDH

PCP
buzzwrds
Pigens Cry
cccus
buzzwrds
B
s nd Birds His
l smsis buzzwrds
F my red lvel r exud
es
PCP
buzzwrds
Di gnsis: C liciviruses
PCR!<div>C n
use cul
ures</div>
buzzwrd
s
Resis
nce
 Azles: C. krusei
buzzwrds
Dis
inguishing r
ein n influenz A, B, C
Nucler
ein (NP)
buzzwrd
s
Pr
eins n influenz
HA nd NA
buzzwrds
Pr
ein
h
dis
inguishes HSV1 nd HSV2
gG
buzzwrds
Pr
eins n  r myxviruses
HN nd Fusin buzzwrds
Pr
ein n gru A r
viruses VP6
buzzwrds
Pr
ein n EBV VCA
buzzwrds
VSG
Pr
ein n Try n misis Afric ns&nbs; buzzwrds
2 le ding c uses f childhd di rrhe : Gru A r
virus<div>En
eric denvirus
es (40, 41)</div>
buzzwrds
Adul
di rrhe c use: Nrvirus&nbs; buzzwrds
Virus
h
c uses PML JC Plym viurs buzzwrds
T c uses f cld:
Rhin nd Crn viruses&nbs; buzzwrds
Le ding C use f Ase
ic Meningi
is
Picrn virus En
ervirus 68-71 ( nd ech
virus)&nbs;
buzzwrds
Le ding Vir l C use f P r ly
ic Dise se:
En
ervirus 71 buzzwrds
Le ding vir l c use f men
l re
rd
in:
CMV
buzzwrds
Le ding c use f meningi
is in AIDS 
ien
s
Cry
cccus&nbs;
buzzwrd
s
Le ding c use f neumni in AIDS 
ien
s
buzzwrd
neumcys
is&nbs;
s
Cli
is nd re
ini
is in immuncmrmised (AIDS)
CMV&nbs;
buzzwrd
s
An
imicrbi l given fr PCP
Pen
midine&nbs;
buzzwrds
Pul
in ms
susce
ible
 Inv sive Pulmn ry Asergillus L
e s
ge AIDS<
div>Leukemic wi
h gr nulcy
eni </div><div>CGD</div><div>Tr nsl n
s</div>
buzzwrds
Pul
in ms
susce
ible
 Mucr
Di be
ic Ke
 cidsis - Rhincerebr l<di
v>Leukemic r BMT - Pulmn ry</div><div>P ren
er l Drug Addic
s - C ud
e, Pu
m
en</div>
buzzwrds
AIDS 
ien
s in SE Asi
Penicullium m rneffi&nbs;
buzzwrds
D rk skinned m les r regn n
wmen
Cccidiides
buzzwrds
Adul
s in Chin Gru B r
virus
buzzwrds
NANA
Influenz nd  r influenz
buzzwrds
SLAM
Me sles (wild
ye)
buzzwrds
CD 46 Me sles V ccine&nbs; buzzwrds
He rin-like GAGs
RSV
buzzwrds
LA, Ohi/Miss R V lley, S
. L wrence v lley, C rlin s Bl s
myces
buzzwrd
s
Wes
Tex s, AZ, NM, CA, Mexic Cccidides
buzzwrds
Ri Gr nde v lley, Hus
n, Miss R v lley
His
l sm
buzzwrds
Nr
h Wes
ern Nr
h Americ , Clr d&nbs;
Cl
i Fever&nbs;<div>(Clr d
Tick Fever - R
virus)&nbs;</div>
buzzwrds
Equ
ri l Bel
(C ribbe n), SW J  n HTLV-1 buzzwrds
IV Drug users in
he US nd Eure
HTLV-2 buzzwrds
An
igens: gB & m; gD Infec
ivi
y fr HSV
buzzwrds
Se sn: Influenz
Win
er buzzwrds
Se sn: RSV
F ll/Win
er, every ye r buzzwrds
Se sn: P r influenz 3 <b>Sring</b>/L
e Win
er&nbs; buzzwrds
Se sn: P r influenz 1, 2
<b>F ll,</b> every 
her ye r buzzwrds
Se sn: Crnvirus
Win
er buzzwrds
Se sn: Mums Win
er/Sring buzzwrds
Se sn: Me sles Schl ye r wi
h sring bre k buzzwrds

Se sn: R
virus

Cler mn
hs in
emer
e,
ric l ye r-rund sm ll e
k summer&nbs; buzzwrds
Allergic Alveli
is nd Hyersensi
y Pneumni Asergillus - nrm l hs

buzzwrds
Reservir: Penicillium m rneffei
b mb r

buzzwrds
Reservir: R bies
B
s
buzzwrds
Things
h
lk like TB:
Ccci<div>His
</div><div>Asergillus</div><div>
<br /><div>MAC</div><div><br /></div><div>Sr
hrix</div></div>
buzzwrd
s
Risk f c
r fr llergic brnchulmn ry sergillsis:
As
hm
ics/CF
buzzwrds
Risk f c
r fr sergillm : Pre-exis
ing c vi
ry lung dz buzzwrds
Risk f c
r fr chrnic necr
izing sergillsis
Di be
es, cd, s
erids
buzzwrds
Risk f c
r fr ulmn ry mucrmycsis: Leukemic/m rrw
r nsl n

buzzwrd
s
Risk f c
r fr ren l mucrmycsis
Ren l f ilure&nbs;
buzzwrds
Risk f c
r fr Rhincerebr l mucrmycsis:
DKA
buzzwrds
Risk f c
r fr c ud
e mucrmycsis: IV drug ddic
s buzzwrds
Risk f c
rs fr cry
 nuemni
COPD, Hdgkins, AIDS, di be
es, s
erids
buzzwrds
Risk f c
rs fr chrnic c vi
ry ulmn ry his
l smsis:&nbs;
Lung s
r
uc
ur l defec
s buzzwrds
He
i
is ms
d ngerus
 regn n
wmen
HEV
buzzwrds
10% risk f fe
l hydrs, s
ill bir
h B19 in regn n
wmen buzzwrds
Selunking&nbs;
His

buzzwrds
Burn 
ien
under dressings
Mucrmycsis
buzzwrds
Ou
dr ccu
in - rch elgy, gricul
ure Ccci buzzwrds
Be ver d ms
Bl s
 buzzwrds
Whi
e, middle- ged, smker
chrnic c vi
ry ulmn ry his

buzzwrd
s
B ske
we ving, hr
icul
ure, dbe brick m king, berry icking Sr
hrix&nbs;
buzzwrds
Club sh ed
Crn virus
buzzwrds
Bulle
sh ed Rh bdvirus&nbs;
buzzwrds
E
ing shellfish
HAV
buzzwrds
Un s
eurized milk
Tick brne enceh li
is buzzwrds
4 crner, r
ci
ies, r
urine
H n
virus, Buny virus buzzwrds
Unchlrin
ed l, mili
ry recrui
s&nbs;
Adenvirus 4, 7 buzzwrds
Ure
er l bs
ruc
in
BK virus
buzzwrds
Red Pigmen

Penicillium m rneffi&nbs;
buzzwrds
Universi
y f Arizn s
uden
s Cccidides
buzzwrds
C. immi
us
regn ncy&nbs; buzzwrds
AIDS in b

le
Cry
cccus
buzzwrds
Agricul
ur l Wrker
P. Br siliensis&nbs; buzzwrds
H l sign, crescen
sign
Inv sive ulmn ry Asergillus&nbs;
buzzwrd
s
G l c
m nn n & m; 1-3 B-D gluc n
Asergillus
buzzwrds
KOH di gnsis Derm
hy
es&nbs;
buzzwrds
Limb hyl si &nbs; Cngeni
l V ricell
buzzwrds
Cngeni
l: C
r c
s Rubell buzzwrds
Cngeni
l: Pneumni Alb , snuffles
Syhilis
buzzwrds
Cngeni
l: Cu
neus Sc rs
Heres buzzwrds
Cngeni
l: CNS c lcific
ins Txl smsis buzzwrds
D rkfield Ex m Syhilis
buzzwrds
S
eele Sign, B rking Se l
Cru
buzzwrds
Muffled/h


 vice
Peri
nsil r Infec
in&nbs;
buzzwrds
Cirrhsis & m; HCC
HCV
buzzwrds
Adul
T Cell Lymhm
HTLV-1 buzzwrds
Prim ry He
cellul r C rcinm &nbs; HCV, HBV
buzzwrds

Afric n Burki

s Lymhm

EBV
buzzwrds
N sh rynge l C rcinm
EBV
buzzwrds
K sis S rcmm
HHV-8 buzzwrds
C s
lem ns Dise se
HHV-8 buzzwrds
Merkel Cell C rcinm
Plym virus
buzzwrds
Wh
des Acyclvir
re
?
HSV 1,2; VZV
buzzwrds
Wh
des Rib virin
re
? (4) 1) RSV<div>2) L ss </div><div>3) Hun
viruses</d
iv><div>4) HCV</div>
buzzwrds
Wh
des Osel
mivir
re
?
Influenz A, B buzzwrds
Wh
des Am n
idine
re
?
Influenz A (nne circul
ing nw)
buzzwrd
s
Wh
d G ngciclvir nd V lg nciclvir
re
? CMV
buzzwrds
Tre
men
fr CMV re
ini
is:
Fsc rne
, Cidfvir&nbs;
buzzwrds
Imiquimd
Geni
l W r
s buzzwrds
Kliks S
s Me sles buzzwrds
S liv ry Gl nds Mums buzzwrds
Fl ccid P r lysis
Plivirus
buzzwrds
HHV6
Six
h dise se/Rsel &nbs;
buzzwrds
Sl ed Cheeks Fif
h dise se - P rvvirus B19 buzzwrds
Sc bby Mu
h
ORF
buzzwrds
Ixdes Tick&nbs;
Tick-brne enceh li
is buzzwrds
Rec
l Prl se Trichuri sis
buzzwrds
Micrfil ri e
nigh
: LF
buzzwrds
Micrfil ri e during
he d y: L L buzzwrds
Bl ck Fly
Hum n Onchcerci sis&nbs;
buzzwrds
Gr nulm rund eggs Schis
smi sis&nbs; buzzwrds
Anim l:<div>T eni S gin
</div><div>T eni Slium</div>
S gin
: Cws<di
v>Slium: Pigs</div>
buzzwrds
Lefflers Syndrme, Bili ry Tr c
Obs
ruc
in Asc ris buzzwrds
Three le ding sil-
r nsmi

ed helmin
hs:
1) Asc ri sis &nbs;<div>2) Tric
huri sis&nbs;</div><div>3) Hkwrm&nbs;</div>
buzzwrds
Sc
ch
e
Pinwrm&nbs; buzzwrds
Hydrbiid Sn ils, Uncked Fish Orien
l Liver Flukes&nbs;
buzzwrds
S
e
rrhe
G. L mbli
buzzwrds
Swimming ls in
he f ll
Cry
sridium P rvum&nbs;
buzzwrds
Anchvy P s
e Liver Abscess c used by Hum n Amebi sis&nbs; buzzwrds
S ndfly, dgs Leishm ni sis&nbs;
buzzwrds
Bl ck fever
K l -Az r
buzzwrds
Pizz -like lesin
Cu
neus Leishm ni sis&nbs; buzzwrds
Tse
se fly&nbs;
HAT
buzzwrds
Win
erb

ms Cervic l Aden
hy&nbs;
G mbi n HAT&nbs;
buzzwrd
s
Rm n s Sign Acu
e Ch g s
buzzwrds
Dishw sher&nbs;
C ndid P rnychi &nbs;
buzzwrds
Jck I
ch w/s
elli
e lesins&nbs;
C ndid buzzwrds
Jck I
ch w/u
s
elli
e lesins
Tine Cruris&nbs;
buzzwrds
Sh ke n B ke Amh
ericin B buzzwrds
Adren l Suressin&nbs;
Ke
cn zle&nbs;
buzzwrds
Adren l Excess I
r cn zle
buzzwrds
Hu
chinsns Tri d
Cngeni
l Syhilis:<div>In
ers
i
i l Ker
i
is, Hu
chin
sn Tee
h, Sensrineur l De fness&nbs;</div> buzzwrds
Sinuses resen

bir
h:
M xill ry, E
hmid
buzzwrds
Ms
cmmn c use f her ngin :
En
ervirus
buzzwrds
C use f H nd, F
, nd Mu
h Dise se: Cx A16, En
71 buzzwrds
Gd gr m s
in 20 PMN: 1 Ei
heli l Cell
buzzwrds
Su
um w/ful
s
e
An erbic Pleurulmn ry Infec
in
buzzwrds
Incre sed c-MYC
r nscri
in EBV c using Burki

s Lymhm
buzzwrds
Ambisense ssRNA Aren virus
buzzwrds
Re
rviruses
HTLV 1, 2<div>HIV 1, 2</div><div>SIV</div>
buzzwrds
Cn
r indic
in
 R
virus v ccine: SCID
buzzwrds

Cn
r indic
in
 DT P:

Enceh l
hy wi
hin 7 d ys f l s
dse
buzzwrds
Cn
r indic
in
 Pli V ccine
Immune Deficiency
buzzwrds
Cn
r indic
in
 MMR V ccine Immune Deficiency&nbs; buzzwrds
DNA He
i
is HBV
buzzwrds
Enveled He
i
is&nbs;
HBV, HCV ( ll 
hers re n
enveled) buzzwrd
s
He
i
is wi
h fec l/r l sre d
HAV, HEV
buzzwrds
He
i
is wi
h n chrnic infec
in
HAV
buzzwrds
Fluc
u
ing ALT "HCV<div><br /></div><div><img src="" s
e-372287765217910.jg""
/></div>"
buzzwrds
Ms
cmmn infec
ius di rrhe in AIDS:
C. difficile&nbs;
buzzwrd
s
HIV med cn
r indic
ed in regn ncy
Ef virenz
buzzwrds
Pr
eins fr en
ry f HIV in
 cells: g41, g120
buzzwrds
Vir l c sid r
ein used fr di gnsis f HIV 24
buzzwrds
C-rece
rs fr en
ry f HIV in
 cells
CCR5, CXCR4
buzzwrds
Vir l c use f myc rdi
is, eric rdi
is
Cx B buzzwrds
Reservir: Aren viruses Rden
s buzzwrds
Reservir: Filviride Frui
B
s
buzzwrds
Heres virus wi
h n re c
iv
in
CMV
buzzwrds
C use f r l h iry leukl ki EBV
buzzwrds
Fec l Ex m: Bl ck & m; Gld
S
rngylides&nbs;
buzzwrds
Sclersing Ker
i
is&nbs;
"Onchcerci sis - ""River Blindness""&nbs;"
buzzwrds
C l b r Swelling
L L buzzwrds
C use: Unilcul r Hyd
id
Echincccus gr nulsus&nbs; buzzwrds
C rdimy
hy, Meg cln, Meg esh gus
Chrnic Ch g s buzzwrds
Lc
in: P. Viv x
Asi , L
in Americ
buzzwrds
Lc
in: P. Ov le
Wes
Afric , P cific Isl nds
buzzwrds
M l ri wi
h drm n
s
ge in
he liver
P. viv x, P. v le
buzzwrd
s
I
r cn zle shuld be
ken wi
h:
cke
buzzwrds
Cr bs P r gnimus wes
erm ni buzzwrds
Wh
cl ss is
mxe
ine? Wh
is i
helful fr?
SNRI. Imrved <u>erfr
m nce</u> n neursychlgic l me sures
Wh
re
he side effec
s f
mxe
ine (s
r
err ) (4)
"<div> e
i
e d
ecre se</div><div>GI sym
ms</div><div>mild incre se in bld ressure nd uls
e</div><div>r re nd serius <b><fn
clr=""#ff0000"">he

xici
y</fn
></b
></div><div><b><fn
clr=""#ff0000""><br /></fn
></b></div><div><b><fn
cl
r=""#ff0000""><img src="" s
e-2186138354031.jg"" /></fn
></b></div>"
Hw mus

mxe
ine be delivered? Hw f
en mus
i
be
ken? Requires <u>
i
r

in</u>

rge
des<div>T ken d ily</div>
Wh
is
he m in dv n
ge f
mxe
ine (s
r
err ) ver 
her

en
in disr
der drugs?
N
bus ble
Wh
re
he dv n
ges f busirne? Del yed nse
f c
in<div>N
bus ble
</div><div>N drug in
er c
ins</div>
Wh
re side effec
s f busirne?
Dizziness, he d che, n use
Mech nism + difference be
ween me
hylhenid
e nd dex
r mhe
mine? "<b>B
h
</b> incre se c
echl mines

he syn 
ic clef
by <u>inhibi
ing reu
ke</u>
f NE nd D.<div><br /></div><div><b><fn
clr=""#ff0000"">Dex
r mhe
min
e</fn
></b> ls <u>incre ses resyn 
ic rele se</u> f c
echl mines</div>"
Where is L4 lc
ed?

 f ili c cres

Where des C8 exi
?
inferir
 C7
The sin l crd segmen
is
yic lly lc
ed sme dis
nce _______

he crres
nding ver
ebr l level suerir
A lesin
h
ccurs in
he sin l crd r ne r
he sin l crd will m nifes
i

self in 

ern simil r

he 

ern f
he ________
derm
nes
E ch derm
ne segmen
sles ______ s i
rgresses frm ______
 ______
dwnw rd; s
erir
 n
erir

Wh
re
he fur
yes f neurns yu c n see in
he erihery? Where d
hey 
rgini
e nd g
?
1. sm
ic: sin l crd--&g
;neurmusc. jxn<div>2. resy
n 
ic viscer l m
r: sin l crd--&g
;neurn lc
ed wi
hin g nglin in
he e
rihery</div><div>3. s
syn 
ic viscer l: g nglin in erihery--&g
; sm
h
muscle r gl nd</div><div>4. sensry: rece
r in erihery--&g
; sin l crd&nb
s;</div>
Wh
is
he nerve suly f
he erec
r sin e? Wh
is i
s rien

in? Func
i
n?
segmen
l drs l r mi<div>Ver
ic l</div><div>Ps
ur l</div>
Wh
re
he suerfici l muscles f
he b ck? Dee muscles?
1. Erec
r Sin
e<div>2. Tr nsverssin lis-semisin lis</div>
Wh
is
he innerv
in f
he
r nsverssin lis? Wh
is i
s rien

in? Func

in? segmen
l drs l r mi<div><br /></div><div>Di gn l</div><div><br /></di
v><div>R

in l</div>
Thr cic ver
ebr e h ve f ce
s n
he ___________ fr r
icul
in wi
h _______

r nsverse rceses; ribs f
he s me number
S cr l ver
ebr e h ve ________ fr
he  ss ge f _______ nd _______ f sin l
nerves fr min ; drs l nd ven
r l r mi
Wh
is kyhsis? Wh
des i
resul
frm? where is i
lc
ed in
he dul
?
nrm l rim ry curv
ure; cnc ve n
erirly<div><br /></div><div>sh e f ver
e
br e</div><div><br /></div><div>
hr cic regin</div>
Wh
is Lrdsis? Wh
des i
resul
frm? where is i
lc
ed in
he dul
?
Secnd ry curv
ure; cnc ve s
erirly<div><br /></div><div><br /></div><div>s
h e f
he in
erver
ebr l discs</div><div><br /></div><div>cervic l regin</div
>
Wh
is l
er l curv
ure in
he ver
ebr l clumn ?
sclisis
Wh
re
he cmnen
s f

yic l ver
ebr ? 1. bdy<div>2. edicle</div><div
>3. l min </div><div>4. sinus rcess</div><div>5.
r nsverse rcess</div><di
v>6. r
icul r rcess</div><div>7. cs
l f ce
s</div>
Wh
re
he cs
l f ce
s fr? Ar
icul r rcesses?
r
icul
in wi
h ribs<d
iv><br /></div><div>synvi l jin
r
icul
ins be
ween dj cen
ver
ebr e</div
>
Wh
re
he synvi l jin
s be
ween dj cen
r
icul r f ce
s? zyg hyse l j
in
s
In
erver
ebr l jin
s re cmsed f _________ frming __________ r symhysis
jin
s in
erver
ebr l discs; fibrc r
il ginus jin
s
Wh
is
he in
erver
ebr l fr men?
s ce be
ween dj cen
ver
ebr l edicle
s. They llw fr  ss ge f sin l nerves ssci
ed wi
h e ch ver
ebrl level
Wh
unique fe
ure des C2 h ve?
dn
id rcess
Wh
is resen
in ll cervic l ver
ebr e? Wh
ges
hru i
? fr men
r nsver
s rium.<div>hle in
r nsverse rcess fr ver
ebr l r
ery</div>
Wh
re
he 5 ver
ebr l lig mne
s?
1. sur sin us lig men
<div>2. in
ers
inus lig men
</div><div>3. lig men
um fl vum</div><div>4. s
erir lngi
udin
l lig men
</div><div>5. n
erir lngi
udin l lig men
</div>
Wh
is
he ligmen
um fl v ?
nncn
inuus series f lig men
s which s nds

he g  be
ween
he dj cen
ver
ebr l l min .&nbs;
Wh
is
he l s
lig men

 be ierced during eidur l nes
hesi r sin l

?
lig men
um fl vum
Where d
he sin l crd nd meninges lie?
s ce be
ween
he ligmen
um fl v
nd
he s
erir lngi
udin l lig men

Wh
is
he lig men
um nuch e? ex nded r
in f sur sinus lig men
which
fills g  cre
ed by cervic l curv
ure f
he ver
ebr l clumn
Wh
is
he imr
nce f
he s
erir lngi
udin l lig men
? 1. rvides s

erir reinfrcemen

 in
erver
ebr l disc<div>2. reven
s s
erir herni
in<
/div><div><br /></div>
Wh
h ens in disc hern
in?
he nnulus fibrsis
e rs nd llws nucleus u
lsus
 herni
e nd ssibly ress n nerve fibers.&nbs;
Which direc
in d ms
herni
ins ccur? why? s
erir l
er l herni
in bec
use f
he ddi
in l sur
rvided by
he s
erir lngi
udin l lig men

herni
ed disc ms
f
en ffec
s
he ________
nex
sin l nerve
Where is
he i -m
er? Wh
re den
icul
e lig men
s? Wh
is
he filum
ermin

le
 in
ed n
he surf ce f
he sin l crd<div><br /></div><div>ex
ensin
s f i
h
nchrs sin l crd
 dur m

er nd divides ven
r l frm drs l
r
s</div><div><br /></div><div>mdifc
in f i
h
ex
ends frm cnus med
ull ris

he cccyx</div>
Wh
is
he sub r chnid s ce? Wh
is i
filled wi
h? be
ween
he i nd
he
r chnid<div><br /></div><div>filled wi
h CSF</div>
Wh
re dur l s cs? Where d
hey end? L
er l ex
ensins f dur rund e ch s
in l nerve<div><br /></div><div>S2</div>
Wh
des
he eidur l s ce cn
in? f
s nd vessels
Where is cerebr l sin l fluid remved frm ? sub r chnid s ce
level infer
ir
 end f sin l crd (
yic lly rund L4)
Wh
m rks
he end f
he sin l crd? L1/L2
Where is nes
hesi in
rduced fr childbir
h? eidur l s ce
Wh
is direc
ly n
erir

he lig men
um fl vum? Wh
is n
erir

h
?
eidur l s ce. dur m

er
The sin l crd nd sin l nerve re r
ec
ed by _______ __________ _________
nd CSF, which is lc
ed ____________ i m

er, r chnid m

er, dur l m


er<div><br /></div><div>be
ween i m

er nd
he r chnid m

er in sub r chn
id s ce</div>
The sin l nerve while r
ec
ed by ________ will exhibi
n enl rgemen
c lled

he ________

he dur l s c; drs l r
g nglin
Sm s f sensry neurns re lc
ed__________ nd
r nsmi
sign ls ________. Th
eir sh e is __________ u
side
he CNS; in

he CNS<div><br /></div><div>seud
unil r</div>
Sm s f m
r neurns re lc
ed ________ nd
r nsmi

heir sign l_________ v
i _______. Their sh e is ______
inside
he CNS; u
f
he CNS vi c
i
n 
en
i l<div><br /></div><div>mul
il r</div>
In viscer l m
r neurns,
he resyn 
ic neurn is derived frm __________ nd
neur l
ube; neur l cres

he s
syn 
ic neurn is derived frm _______


The viscer l sign ls begins in sm ___________ is
r nsmi

ed u
wi
hin ____
_____,
r nsferred ver

new neurn wi
h in ________ nd
hen
r nsmi

ed

_______
wi
hin CNS, sin l nerve, g nglin, even
u l
rge

Wh
is
he difference be
ween sensry g ngli nd u
nmic g ngli in
erms f
sensry: n syn se, seudunil r neurns<div>

heir syn ses nd sh e?
<br /></div><div> u
nmic: syn se; mul
il r neurns</div>
Where re whi
e r mus cmmunic
ins fund? &nbs;Wh
is
heir urse?
T1-L2<div>c rry resyn
ic sym
he
ic fibers frm
he l
er l hrn f
he sin
l crd

he sym
he
ic ch in</div>
Where is
he sym
he
ic ch in? Wh
des i
d?
All ver
eb l levels<div>
<br /></div><div> c
s like n elev
r llwing sym
he
ic fibers
 ex
end su
erir
 T1 nd inferir
 L2. Smewhere in
he sym
he
ic ch in, resyn 
ic
sym
he
ic fibers syn se n
 s
syn 
ic sym
he
ic fibers</div>
Drs l r mus is _______
h
innerv
es _________
h
_________
mixed s
in l nerve; muscles f
he b ck (erec
r sin e/
r nsverssin lis)
h
mve
h
e ver
ebr l clumn
Where des
he sym
he
ic ch in lie rel
ive

he ver
ebr ? i
lies beside

he ver
ebr l bdy
Whi
e r mus c rry resyn 
ic sym
he
ic fibers frm _________
 ______. They
exis
be
ween ______________<div><br /></div><div>Gr y r mus c rries s
syn

ic sym
he
ic nerve fibers frm __________
 ________</div> l
er l hrn f
sin l crd
 sym
he
ic ch in. T1 nd L2<div><br /></div><div>sym
he
ic
ru
nk
 ll nerve fibers<br /><div><br /></div><div><br /></div></div>
Presyn
ic Sym
he
ic fibers re fund in _______ sin l crd segmen
s nd in
______ ver
ebr l levels 14; ll
Ps
syn 
ic sym
he
ic fibers re needed
 suly____________
v scul

ure in ALL derm
mes
Why is
he sin l crd shr
er
h n
he sym
he
ic ch in?&nbs;
1. diffe
ren
i l grw
h<div>2. ver
ebr l clumn grws mre
h n
he cell &nbs;cycle s
l
led nervus
issue</div><div>3. C ud equin e r nce f
he drs l nd ven
r

l r
s f
he lumb r nd s cr l sin l nerves</div>

Wh
des
he sin l crd use
 dis
ribu
e
he sign ls beynd
he
hr clumb r
regin?
sym
he
ic ch in
All 31  irs f sin l nerves c rry _________frm
he .........
 suly ______
__ nd ________ s
syn 
ic sym
he
ic fibers frm
he sym
he
ic ch in
 s
uly swe
gl nds in skin nd sm
h muscles in v scul
ure
Wh
d
he &nbs;seci lized cells in
he T1-L2 regin cn
rl?

hermre
gul
ry mech nisms
sym
he
ic xn m y  ss
hrugh _________ befre i
c
u lly _______
g ngli ; syn ses
All sm
h muscle rg ns receive ________ innerv
in. Sme
imes
he sym
he
ic
is s
imul
ry nd 
her
imes i
is inhibi
ry.
du l n
gnis
ic&nbs;
Are
here  r sym
he
ic fibers in
he uer nd lwer limbs? n
The cells frmed by neur l
ube lie in __________ nd ______ nd will be ______(
sh e) m
r neurns
br in nd sin l crd<div><br /></div><div>mul
il r</d
iv>
The cells frmed by
he neur l cres
s lie ________ nd re _______(sh e) sensr
y neurns nd __________
u
side
eh br in nd sin l crd<div>seuduni
l r sensry &nbs;neurns</div><div>s
syn
ic u
nmic neurns</div>
mul
il r sm
ic m
r neurns re derived frm _______
neur l
ube
suedunil r sensry neurns re derived frm _______ neur l cres

viscer l u
nmic m
r neurns re derived frm&nbs; neur l
ube (re syn) n
d neur l cres
(s
syn.)
The ven
r l hrn is
he lc
in f sm s fr mul
il r m
r neurns
The drs l hrn is
he lc
in f sm s fr
sensry in
erneurns
The l
er l hrn is resen
in _______ nd is
he lc
in f sm s fr......
T1-L2; resyn
ic sym
he
ic m
r neurns
The Lef
crn ry r
ery divides in
 _______ nd _______
lef
n
erir de
scending<div><br /></div><div>lef
circumflex r
ery</div>
Wh
des
he righ
crn ry r
ery br nch in
?
1. sin
ri l br nch<div
>2. righ
m rgin l r
ery</div><div>3. righ
s
erir descending</div>
<b>*The lef
n
erir descending r
ery fllws _________</b><div><b>The righ
m
rgin l r
ery fllws________</b></div><div><b>Righ
Ps
erir descending r
er
y fllws____________*</b></div>
1. gre
vein<div>2. sm ll c rdi c vein<
/div><div>3. middle c rdi c vein</div><div>A <u>Gre
</u> <u>LAD</u></div><div>R
n <u>Mid Ps
</u> fr</div><div> <u>Sm ll M rgin</u></div>
Pin: in
erven
ricul r se
um<div>CC?</div>
Ven
ricul r se
l defec

Pec
in
e muscles/ uricles re frm wh
embrylgic l rigin? rimi
ive
ri
Wh
re
he 3 br nches cming ff f
he RCA? 1. sin
ri l r
ery<div>2. righ

m rgin l r
ery</div><div>3. righ
s
erir descending</div>
Wh
re
he
hree cm r
men
s f
he Thr cic c vi
y? 1. R ulm c vi
y<div>2.
L ulm c vi
y</div><div>3. medi s
inum</div>
Thr cic is en

he

hrugh _________. Clsed
b

m wi
h ________
suer
hr cic er
ure<div><br /></div><div>di hr gm</div>
Wh
re 3 func
ins f
he
hr cic c ge?
1. rvides

chmen
s fr ue
r limb<div>2. r
ec
s
hr cic nd bdmin l rg ns</div><div>3. resis
s neg
i
ve ressures gener
ed by lungs during bre
hing</div>
True ribs (Ribs _______)<div>F lse Ribs (Ribs ________)</div><div>Fl
ing Ribs
Ribs _______</div>
1-7<div><br /></div><div>8-10</div><div><br /></div><div
>11-12</div>
A muscul
endinus  r
i
in ________,

ches
 ________ nd __________
inferir m rgin f
hr cic c ge<div><br /></div><div>suerir lumb r ver
ebr e<
/div>
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Where n
he di h gm des
he eric rdium lie? cen
r l r
in
Wh
is
he bld suly

he di hgr m?
Br nches f
he in
ern l
hr c
ic r
ery nd
hr cic r

Wh
is innerv
in
 di hr gm?
m
r: hrenic nerves<div>sensry: hren
ic/in
ercs
l/subcs
l nerves</div>
During frced exeri
in
he di hr gm curves suerirly in
 _________
righ
nd lef
dmes (4
h in
ercs
l s ce nd 5
h rib)
Wh
6 muscles id in Insir
in?
Pec
r lis m jr/minr<div>Serr
us An
e
rir</div><div>Sc lne</div><div>S
erncleidm s
id</div><div>Ex
ern l In
ercs

l</div>
Wh
3 muscles id in exir
in?
IN
ern l in
ercs
l<div>Innerms
in
er
cs
l</div><div> bdmin l muscles</div>
Thr cic mvemen
s re due

cmbin
in f ________, ________, ________
1. Di hr gm<div>2. Accessry muscles</div><div>3. Mvemen
f
he jin
s</div>
During insir
in, d muscles cn
r c
r rel x?
Cn
r c

 incre se n

erir, s
erir nd
r nsverse di me
er f
hr x
During exir
in, d muscles cn
r c
r rel x?
rel x decre sing in
r
h
r cic vlume
Why is R hemidi hr gm f
en higher
h n L?
Liver
Wh
is dysne ?
Difficul
bre
hing
Wh
ccessry muscles re f
en used
 ssis
in bre
hing during dysne ?
1. Suer s
ern l re
r c
ins bve cl vicle nd s
ernum<div>2. in
ercs
l re
r
c
ins be
ween ribs</div><div>3. Subcs
l belw cs
l m rgin f rib c ge</div>
<div>4. subs
ern l re
r c
ins belw xihid rcess</div><div><br /></div>
Wh
cmens
ry resir
ry mech nisms re used during dysne ?
n s l fl
ring<div>grun
ing during exir
in</div><div> ccessry muscles in neck nd sh
ulders</div>

Why d individu ls wi
h dysne refer
 si
u ins
e d f lying dwn? Di hr g
m wrks be

er wi
h gr vi
y
Wh
lines
he inside f
he
hr cic c vi
y? Wh
lines
he lungs?
1.  rie

l Pleur <div>2. Viscer l leur </div>
Wh
is
he
r chebrnchi l
ree m de u f? 1. Tr che <div>2. M in Brnchi</
div><div>3. Lb r Brnchi</div><div>4. segmen
l brnchi</div>
Wh
is hydr
hr x? Hem
hr x?
leur l effusin in which serus fluid
ccumul
es in
eh leur l c vi
y<div><br /></div><div>bld ccumul
es in
he 
leur l c vi
y</div>
Cm red

he Lef
Lung,
he righ
lung is _________ (2)
L rger nd he vi
er<div>Shr
er nd wider</div>
Where des
he ex f
he lung lie? Where des
he b se lie?
bve
he 1s
ri
b; res
s n
he di hr gm
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Hw m ny lbes des
he Lef
Lung h ve? Wh
is
he n me f i
s fissure?
2 (Suerir nd inferir)<div><br /></div><div>Oblique Fissure</div>
The
r che is cnsidered s  r
f
he ________
medi s
inum
Cm red

he lef
,
he righ
m in brnchi runs _______
wider, shr
er,
nd mre ver
ic l
Hw m ny lb r brnchi re n
he Lef
lung? Righ
Lung?
2 n lef
(2 lb
es)<div>3 n righ
(3 lbes)</div>
E ch lung h s _______ sulying bld

he lung<div>E ch lung h s _______ dr i
ning bld frm
he lung</div> n ulmn ry r
ery&nbs;<div><br /></div><div>

w ulmn ry veins</div>
Wh
re
he sh es f
he brnchulmn ry segmen
s? Hw m ny re in ech lung?
Pyr mid l<div><br /></div><div>10 in Righ
Lung</div><div>8-10 in Lef
Lung</div
>
Wh
is
he sm lles
surgic lly resec
ble re ?
Brnchulmn ry segmen

Pulmn ry, lb r, nd segmen
l r
eries run wi
h ______<div><br /></div><div>Pu
lmn ry veins run ________</div>
m in, lb r, segmen
l brnchi<div><br /
></div><div>indeenden
f
he r
eries nd brnchi</div>
Wh
is
he brnchulmn ry segmen
sulies by?
"Segmen
l brnchus<div>
segmen
l br nch f ulmn ry r
ery</div><div><br /></div><div><img src="" s
e

-64046552318445.jg"" /></div>"
Wh
is
he brnchulmnry segmen
dr ined by? "In
ersegmen
l veins
h
lie i
n
he cnnec
ive
issue be
ween dj cen
segmen
s<div><br /></div><div><img src=
"" s
e-64050847285741.jg"" /></div>"
Wh
is ulmn ry emblism? wh
is i
c used by?
bs
ruc
in f ulmn ry
r
ery<div><br /></div><div>Bld cl
r ir bubble</div>
Pulmn ry emblism resul
s in __________f
he righ
side f
he he r
. cu
e di
l
in
Wh
is ulmn ry inf rc
?
medium sized emblus
h
blcks
brnchulmn
ry segmen
resul
in in necr
ic lung
issue
Wh
is
he lung hilum? &nbs;Wh
des i
cn
in?
medi s
in l surf ce f l
ung
h
cn
ins<div>1. Pleur l sleeve</div><div>2. ulmn ry lig men
</div><di
v>3. ulmn ry r
ery</div><div>4. ulmn ry veins</div><div>5. brnchus</div>
"<img src="" s
e-65133179044343.jg"" /><div><br /></div><div>Wh
is 1?</div>"
Pleur l Sleeve
"<img src="" s
e-65128884077047.jg"" /><div><br /></div><div>Wh
is 2?</div>"
ulmn ry lig men

"<img src="" s
e-65128884077047.jg"" /><div><br /></div><div>Wh
is
he Red 
u
line?</div>" Pulmn ry r
eries (2)
"<img src="" s
e-65128884077047.jg"" /><div><br /></div><div>Wh
is
he blue
u
line?</div>" ulmn ry veins
"<img src="" s
e-65128884077047.jg"" /><div><br /></div><div>Wh
is
he green
M in brnchus
u
line?</div>"
"<img src="" s
e-65356517343747.jg"" /><div><br /></div><div>Is
his lef
r r
igh
Lung?&nbs;</div>" Lef

"<img src="" s
e-65352222376451.jg"" /><div><br /></div><div>Wh
is
he blue?
</div><div><br /></div><div>Wh
is
he red?</div><div><br /></div><div>Wh
is
Pulmn ry Veins<div>Pulmn ry r
eries</div><div>M in Br

he green?</div>"
nchus</div>
Hw c n yu differen
i
e ulmn ry r
ery f hilum? Thicker w lled<div>Usu l
ly ms
suerir s
ruc
ure</div><div>Usu lly 1</div>
Hw c n yu differen
i
e ulmn ry veins f hilum?
Thin w lled<div>Usu lly
ms
n
erir nd inferir s
ruc
ures</div><div>Usu lly 2</div>
Hw c n yu differen
i
e M in brnchus?
Thickes
w lled<div>Hy line C r

il ge</div><div>Presen
in cen
er</div><div>Brnchi l r
eries re resen
surr
uding i
</div>
Wh
re 4 medi s
in l l ndm rks in
he lef
lung?
1. Ar
ic imressin<div
>2. c rdi c imressin</div><div>3. c rdi c n
ch</div><div>4. Lingul </div>
"<img src="" s
e-79615808766444.jg"" /><div><br /></div><div>Wh
is 1, 2, 3,
4</div>"
1. Ar
ic Imressin<div>2. C rdi c Imressin</div><div>3. c rd
i c n
ch</div><div>4. lingul </div>
Wh
is
he c rdi c n
ch? Where is i
resen
? inden

in in n
erir brder 
f lef
lung resul
ing frm devi
in f he r


he lef
<div><br /></div><div>s
uerir lbe</div>
Wh
is
he lingul ?
resul
s frm c rdi c n
ch nd sh es n
erir/inferir
suerir lbe in

hin
ngue like rcess
Wh
is
he c rdi c imressin? Imressin
h
is l rger n
he lef
, n
erir

 lung hilum
Wh
is
he r
ic imressin? Prminen
grve fr
he rch f
he r
nd d
escending r

Wh
d brnchi l r
eries suly? Hw m ny g
 Lef
brnchi l nd hw m ny g
es
 righ
brnchi l? s
ruc
ures in
he hilum,
issue f lung, brnchi ls<div>
<br /></div><div>Tw

he Lef
Brnchi l</div><div><br /></div><div>One

he
righ
brnchi l</div><div><br /></div>
Wh
innerv
es
he  rie
l leur ?
An
erir r mi f in
ercs
l nerves<div>
Phrenic Nerves</div>
Lungs nd viscer l leur re innerv
ed by ____________
n
erir nd s

erir ulmn ry lexus
Lung nd Viscer l Pleur Efferen
Nerves: P r sym
he
ic:&nbs;<div>Tw c
ins
?</div><div>Cr ni l Nerve?</div>
Brnchicns
ric
r<div>Secre
m
r</di

v><div>CNX</div>
Lungs nd viscer l leur :Efferen
Nerves: sym
he
ic<div>Tw c
ins?</div>
Brnchdil
r<div>Inhibi
Secre
in</div>
Lungs nd Viscer l leur fferen
nerves<div>Wh

w sensry sign ls?</div>
Reflexive: Subcnscius sens
in<div>Ncice
ive: P in resnses</div>
The suerfici l lexus r
he _______ lies _______ . I
dr ins ........... nd c
n
ins subleur l lexus<div> dee
 viscer l leur . i
dr ins lung
issue n
d viscer l leur </div><div><br /></div><div>Brnchulmn ry ndes</div>
The Dee lexus lies in __________ nd cn
ins ________ nd _______ ndes.
submucs f brnchi nd cnnec
ive
issue be
ween brnchi<div><br /></div><div>
ulmn ry ndes nd brnchulmn ry ndes</div>
The
r chebrnchi l ndes ex
end &nbs;____________. They surrund ____, ______
, ________
"frm wi
hin lung,
hrugh hilum, in
 medi s
inum<div><br /></d
iv><div>Lb r Brnchi</div><div>M in Brnchi</div><div>Sides f
r che </div><di
v><br /></div><div><img src="" s
e-82424717377992.jg"" /></div>"
The brnchmedi s
in l
runks dr in in
 ______ nd cn
in__________ "veins i
n neck<div>cn
in lymh
ic vessels</div><div><br /></div><div><img src="" s
e
-82420422410696.jg"" /></div>"
"<img src="" s
e-82502026789237.jg"" /><div><br /></div><div>Wh
is 5, 4, 3</
div>" 5. P r ver
ebr l line<div><div>4. Sc ul r Line</div></div><div>3. Axill
ry line</div>
"<img src="" s
e-82544976462163.jg"" /><div><br /></div><div>Wh
is 1, 2, 3</
div>" 1. P r s
ern l Line<div>2. Midcl vicul r Line</div><div>3. Axill ry line
</div>
<b>*Wh
is
he level f
he blique fissure?*</b>
T2 ver
ebr e s
erir<d
iv>6
h cs
l c r
il ge n
erirly</div>
Where des hrizn
l fissure ex
end? frm blique fissure lng 4
h rib n
er
irly
Wh
re
he surf ce m rkings f
he Righ
lung?
2nd rib/6
h rib<div><br
/></div><div>6
h, 8
h, 10, 10</div>
Wh
re
he surf ce m rkings f
he lef
lung? 2/4
h/6
h ( r s
ern l)<div><br
/></div><div>6
h ,8
h, 10
h, 10
h</div>
Wh
re
he righ
lines f leur l refelec
in 2nd/6
h<div><br /></div><div>8
h
, 10
h, 12, 12</div>
Wh
re
he Lef
lines f leur l reflec
in 2nd/ 6
h ( r s
ern l)<div><br /
></div><div>8
h, 10
h, 12, 12</div>
"Bec use
he lungs d n
fully cculy
he ulmn ry c v
y
exir
in, wh

re
he
w recesses?<div><br /></div><div><img src="" s
e-83099027243352.jg""
/></div>"
1. Cs
di hr gm
ic recess<div>2. Cs
medi s
in l recess</div
>
Where d
he
w lexuses f
he lung dr in?
Tr chebrnchi l ndes nd
hen
brnchmedi s
in l lymh
runks
Where is
he lung wi
h resec


he leur l s c?
Ou
side, bu

he lung is
surrunded by i

Where d
he viscer l nd  rie
l l yers becme cn
inuus
 frm
s c?
hilum
Wh
is
he  rie
l s c filled wi
h? Wh
is i
s func
in?
leur l fluid<di
v><br /></div><div>lubric
es</div><div>surf ce
ensin</div>
Wh
is
he 
hlgy reresen
ed by
he green rbe? Prbe  ssing
hrugh ri
gh

rium w ll inferirly

en
fr men v le (r ASD)
Wh
re
he 3 cmnen
s f
he
hr ic c vi
y?
R/L ulmn ry c vi
ies<d
iv>medi s
inum</div>
An
my:Medi s
inum C vi
y Thr cic nd
Wh
is
he medi s
inum cvered by n b
h sides?
medi s
in l leur
An
my:Medi s
inum C vi
y Thr cic nd
Why is
he medi s
inum highly mbile? Accmd
es mvemen
f
he he r
<div>de
ls wi
h vlume nd ressure ch nges in
he
hr cic c vi
y</div>
An
my:
Medi s
inum C vi
y Thr cic nd
Wh
is
he
r nsverse
hr cic l ne? Wh
des i
include? Wh
junc
in des
i
 ss
hrugh?
hrizn
l l ne
h
is ging
 include s
ern l ngle&
nbs;<div> sses
hrugh junc
in f T4/T5</div>
An
my:Medi s
inum C vi


y Thr cic nd
Wh
re
he sec
ins f
he medi s
inum?
"<img src="" s
e-2168958484979.
jg"" />"
An
my:Medi s
inum C vi
y Thr cic nd
"Wh
re
he veins in
he suerir medi s
inum?<div><img src="" s
e-2203318223
264.jg"" /></div>"
1. Suerir Ven C v <div>2. R/L br chiceh lic</div><d
iv>3. Righ
/Lef
in
rn l jugul r</div><div>4. Righ
/lef
subcl vi n</div>
An
my:Medi s
inum C vi
y Thr cic nd
"Wh
re
he r
eries in
he suerir medi s
inum?<div><img src="" s
e-2246267
896326.jg"" /></div>" 1. Ar
<div>2. Br chiceh lic</div><div>3. R/L cmmn
c r
id</div><div>4. R/L subcl vi n</div><div>5. R/L
hr cic (m mm ry)</div>
An
my:Medi s
inum C vi
y Thr cic nd
Wh
is signific n
bu

he R/L in
ern l
hr cic r
ery?
T by ss
blc
ked LAD, we c n use
he in
ern l
hr cic nd s
i
ch i
n

he &nbs;he r
in
CABG An
my:Medi s
inum C vi
y Thr cic nd
Wh
is n r
ic ngigr hy? Where is c
he
er  ssed? Hw is visu liz
in

ken l ce?
r digr hic visu liz
in f
he rch f
he r
.<div>C
he
e
r is  ssed in
 scending r
vi femr l r br chi l r
ery</div><div>vi in
jec
in f r di que cn
r s
m
eri l</div> An
my:Medi s
inum C vi
y Thr
cic nd
Wh
re
he m jr nerves f
he suerir medi s
inum?&nbs;<div>CN? Sin l nerv
es?</div>
"1. R/L V gus (CNX)<div>2. R/L Phrenic (C3-C5)</div><div>3. R/L
sym
he
ic ch in</div><div><img src="" s
e-2555505541503.jg"" /></div>"
An
my:Medi s
inum C vi
y Thr cic nd
Wh
des
he lef
l rynge l br nch f
he v gus nerve wr  rund?
lig men

um r
erisum An
my:Medi s
inum C vi
y Thr cic nd
{{c1::lef
recurren
l rynge l br nch f
he v gus nerve}} wr s rund&nbs;{{c
2::lig men
um r
erisum}}
An
my:Medi s
inum C vi
y Thr cic nd
{{c1::suerir medi s
inum}} cn
ins
he {{c2::
r che nd esh gus}} "<img sr
c="" s
e-2731599200610.jg"" />"
An
my:Medi s
inum C vi
y Thr cic nd
Describe
he
r che n
mic lly (3) Inclines

he righ
<div>Ends
s
ern
l ngle</div><div>Divides

he c rin in

he righ
nd lef
m in brnhus</di
v>
An
my:Medi s
inum C vi
y Thr cic nd
Wh
is
he
r che m de u f? Hy line c r
il ge nd muscle
An
my:Medi s
i
num C vi
y Thr cic nd
Where des
he esh gus lie? be
ween
r che
nd ver
ebr l bdies
An
my:
Medi s
inum C vi
y Thr cic nd
The esh gus is &nbs;{{c1::fibrmuscul r
ube}}
h
inclines

he&nbs;{{c2
::lef
}}
An
my:Medi s
inum C vi
y Thr cic nd
Wh
is
he sm lles
subdivisin f
he inferir medi s
inum? " n
erir medi s
An
my:Medi s
i

inum<div><img src="" s
e-3663607103987.jg"" /></div>"
num C vi
y Thr cic nd
Wh
re
he cn
en
s f
he n
erir medi s
inum?
1. lse cnnec
ive
iss
ue<div>2. F
</div><div>3. lymh
ic vessels</div><div>4. br nches f in
ern l

hr cic (m mm ry) r
ery- n
erir in
ercs
l r
eries</div>
An
my:Medi s
i
num C vi
y Thr cic nd
Wh
des
he middle medi s
inum cn
in?
he r

An
my:Medi s
inum C vi

y Thr cic nd
Where des
he esh gus lie in
he s
erir medi s
inum?
Ps
erir

he
he r
, medi l
 r
An
my:Medi s
inum C vi
y Thr cic nd
where des
he
hr cic descending r
lie? "<img src="" s
e-3912715206998.
jg"" /><div>Ps
erir
 r
f lef
lung</div>"
An
my:Medi s
inum C vi

y Thr cic nd
Wh
br nches cme ff f
he
hr cic descending r
? Which re  ired nd wh
ich re un ired?
"<img src="" s
e-3955664879958.jg"" /><div>1.
hr cic
descending r
</div><div>2. esh gen l r
eries (un ired)</div><div>3. brn
chi l r
eries</div><div>4. s
erir in
ercs
l r
eries</div>"
An
my:
Medi s
inum C vi
y Thr cic nd
{{c1:: n
erir in
ercs
l r
eries}} re br nches ff f
he&nbs;{{c2::in
ern
l
hr cic m mm ry r
ery}}
An
my:Medi s
inum C vi
y Thr cic nd
{{c1::s
erir in
ercs
l r
eries}} re  ired br nches ff f
he&nbs;{{c2:

:
hr cic descending r
}}

An
my:Medi s
inum C vi
y Thr cic nd
{{c1::
hr cic r
ic neurysm }} is &nbs;{{c2::dil
in f segmen
f
he

hr cic r
}}
An
my:Medi s
inum C vi
y Thr cic nd
{{c1::
hr cic r
ic neurysm}} is risk fr&nbs;{{c2:: ru
ure/disssec
in 
f
he r
}}
An
my:Medi s
inum C vi
y Thr cic nd
Wh
re sme f
he c uses fr
hr cic r
ic neurism?

hersclersis<
div>cys
ic medi l necrsis</div><div>b c
eri l infec
ins</div><div>
r um </div>
<div> r
eri
is syndrmes</div><div>cngeni
l</div>
An
my:Medi s
inum C vi

y Thr cic nd
Where des
he zygus vein sys
em lie? s
erir medi s
inum An
my:Medi s
i
num C vi
y Thr cic nd
Wh
m kes u
he zygs sys
em?
zygs, hemi zygs, ccessry hemi zygs
An
my:Medi s
inum C vi
y Thr cic nd
{{c1::s
erir in
ercs
l veins}} dr in in
 &nbs;{{c2:: zygus sys
em}}
An
my:Medi s
inum C vi
y Thr cic nd
Wh
is lymh? cle r fluid frm bdy
issues
h
sulies m
ure immune cells
An
my:Medi s
inum C vi
y Thr

 bld,
r nsr
s f
, remves 
hgens
cic nd
Wh
is
he l rges
lymh ch nnel in
he bdy?
hr cic duc

An
my:Medi s
i
num C vi
y Thr cic nd
Where des
he
hr cic duc
rgin
e nd scend
hrugh?
bdmen, di hr
gm
An
my:Medi s
inum C vi
y Thr cic nd
{{c1::
hr cic duc
}} cnveys ms
f
he lymh fluid in
he bdy in
&nbs;{{c2
::
he venus sys
em}}
An
my:Medi s
inum C vi
y Thr cic nd
Where des
he
hr cic duc
em
y in
?
lef
subcl vi n

he junc
in
An
my:Medi s
i
f
he in
ern l jugul r vein in
he suerir medi s
inum
num C vi
y Thr cic nd
Wh
re
he
w m jr u
nmic nerves in
he s
erir medi s
inum? 1.
hr
cic sym
he
ic
runk<div>2. esh ge l lexus</div>
An
my:Medi s
inum C vi

y Thr cic nd
"<img src="" s
e-5600637354365.jg"" />"
1.
hr cic sym
he
ic
runk<di
v> .
hr cic sl nchnic nerves</div><div>2. esh ge l lexus</div>
An
my:
Medi s
inum C vi
y Thr cic nd
Wh
is
he esh ge l lexus? v gus nerve rviding  r sym
he
ic innerv
i
n

he esh gus
An
my:Medi s
inum C vi
y Thr cic nd
&nbs;{{c1::viscer l nervus sys
em}} is n
her n me fr&nbs;{{c2:: u
nmic n
ervus sys
em}}
An
my:Medi s
inum C vi
y Thr cic nd
{{c1:: u
nmic nerves }} re ccm nied by &nbs;{{c2::viscer l fferen
fiber
s (sensry)}}
An
my:Medi s
inum C vi
y Thr cic nd
Where d
he reg nglinic cell bdies fr sym
he
ics lie?
"In
ermedil
er
l cell clumns (IML) f T1-L3<div><img src="" s
e-6060198854896.jg"" /></div>
"
An
my:Medi s
inum C vi
y Thr cic nd
Where d s
g nglinic sym
he
ic cell bdies lie? "1.  r ver
ebr l g ngli
n (sym
he
ic
runk)<div>2. rever
ebr l g nglin (in lexus)</div><div><img s
rc="" s
e-6158983102671.jg"" /></div>"
An
my:Medi s
inum C vi
y Thr
cic nd
"Exl in
his ic
ure in
erms f sym
he
ic
r nsmissin<div><img src="" s
e6296422056246.jg"" /></div>" 1. Preg nglinic nerve exi
s n
erir r
le
fr
m IML<div>2. P sses vi whi
e r mi cmmunic
es</div><div>3. T sym
he
ic
ru
nk where i
scends, descends, syn ses, r  sses righ

hrugh</div><div>4. s
l nchnic nerves
 re ch rever
ebr l g nglin</div><div>5.
hse
h
syn se
wi
hin sym
he
ic ch in rejin ven
r l r mi vi grey cmmunic n
es</div>
An
my:Medi s
inum C vi
y Thr cic nd
Where d reg nglinic cell bdies fr  r sym
he
ic lies?
CN III, VII, IX,
X<div>S cr l u
flw (2-4)</div>
An
my:Medi s
inum C vi
y Thr cic nd
Where d s
g nglinic cell bdies fr  r sym
he
ics lie? w ll f rg n/
i
ssue
An
my:Medi s
inum C vi
y Thr cic nd
Wh
sin l r
s frm in
ercs
l nerves?
T1-T11 An
my:Medi s
inum C vi

y Thr cic nd
Wh
sin l r
es frm subcs
l nerve?
T12
An
my:Medi s
inum C vi


y Thr cic nd
Wh
d
he drs l r mi f
he
hr cis sin l nerves innerv
e?&nbs; jin
s,
skin f b ck
An
my:Medi s
inum C vi
y Thr cic nd
Wh
re
he derm
mes f
he nile? Umbilicus?
"T4/T5<div>T10</div><div
><img src="" s
e-6914897346847.jg"" /></div>" An
my:Medi s
inum C vi
y Thr
cic nd
Wh
is Shingles?
Heres Zs
er infec
in: migr
in f v ricell zs
er v
irus

he nervus sys
em<div><br /></div><div>Re c
iv
in resul
s in migr
i
n dwn
he sensry neurns

he skin</div>
An
my:Medi s
inum C vi
y Thr
cic nd
Wh
is heres zs
er
re
ed wi
h?
n
ivir ls nd s
erids An
my:Medi s
i
num C vi
y Thr cic nd
Wh
is Zs
v x?
Shingles medic
in fr
hse ver 60 An
my:Medi s
i
num C vi
y Thr cic nd
Wh
is
hr cen
esis? inser
in f hydermic needles
hrugh n in
ercs
l
s ce in

he leur l c vi
y An
my:Medi s
inum C vi
y Thr cic nd
Wh
is

hr cen
esis used fr? Where is
he needle usu lly inser
ed. Why?
"remve s mle f fluid r remve bld/us<div>suerir

he rib
 vid d m
ge

he in
ercs
l nerve nd vessels</div><div><br /></div><div><img src=""
s
e-7228429959513.jg"" /></div>"
An
my:Medi s
inum C vi
y Thr cic nd
When 
ien
is urigh
, where des fluid ccumul
e? cs
di hgr m
ic reces
s
An
my:Medi s
inum C vi
y Thr cic nd
Where is needle inser
ed during exir
in? Why
in

he 9
h ICS in mid
xill ry line, vid inferir brder f lung
An
my:Medi s
inum C vi
y Thr
cic nd
Wh
is
he bld suly fr
he di hr gm?
br nches f
he in
ern l
hr ci
c nd
hr cic r

An
my:Medi s
inum C vi
y Thr cic nd
Wh
is
he innerv
in f
he di hr gm?
M
r: Phrenic<div>Sensry: Phrn
ic, in
ercs
l, subcs
l nerves</div> An
my:Medi s
inum C vi
y Thr cic nd
Wh
re
he 3 l rge hles in
he di hgr m? Wh
re
heir ver
ebr l levels?
C v l (T8)<div>Esh ge l (T10)</div><div>Ar
ic hi
us (T12)</div>
An
my:
Medi s
inum C vi
y Thr cic nd
Wh
 sses
hrugh
he c v l ening? Wh
is
he ver
ebr l level?
IVC, lym
An
my:Medi s
inum C vi
y Thr cic nd
h
ics<div>T8</div>
Wh
 sses
hrugh
he esh ge l hi
us ? Wh
is
he ver
ebr l level?
Esh gus, v g l
runks, bld nd lymh
ic vessels<div>T10</div>
An
my:
Medi s
inum C vi
y Thr cic nd
Wh
 sses
hrugh
he r
ic hi
us? Wh
is
he ver
ebr l level?
r
,

hr cic duc
, zygus/hemi zygus veins<div>T12</div> An
my:Medi s
inum C vi

y Thr cic nd
Wh
re
he muscles invlved in insir
in? ec m jr/minr<div>serr
us n

erir</div><div>sc lene</div><div>s
erncleidm s
id</div><div>ex
ern l in
erc
s
l</div>
An
my:Medi s
inum C vi
y Thr cic nd
Wh
re
he muscles invlved in exir
in?
in
ern l in
ercs
l<div>innerm
s
in
ercs
l</div><div> bdmin l muscles</div>
An
my:Medi s
inum C vi

y Thr cic nd
"Wh
ges
hrugh
he ""sm ll"" enings f
he di hr gm?"
sym
he
ic
run
ks, sl nchnic nerves, bld nd lymh
ic vessels
An
my:Medi s
inum C vi

y Thr cic nd
T/F The lungs re inside
he leur l c vi
y?
F lse
hey re u
side
he leur
l c vi
y bu
inside
he
hr cic c vi
y
Wh
is
he eri
neum? The lining rund
he bdmin l rg ns
Wh
is
he erineum
u
le
f
he elvis
Wh
re
he bund ries f
he bdminelic c vi
y r
ec
ed by?
"1. Ribs
<div>2. Lumb r ver
ebr e</div><div>3. Pelvis</div><div><br /></div><div><img src
="" s
e-816043786791.jg"" /></div>"
Wh
re
he muscul r bund ries f
he bdminelvic c vi
y? "1. Abdmin l mu
scles<div>2. resir
ry di hr gm</div><div>3. elvic di hr gm</div><div>4. ur
geni
l di hr gm</div><div><br /></div><div><img src="" s
e-820338754087.jg"
" /></div>"

Wh
is
he bdminelvic c vi
y lined by?

eri
neum (viscer l nd  rie

l)
Where des
he
es
icle begin frming? high wi
hin
he bdmin l c vi
y ne r
h
e kidneys
Where is
he develing
es
icle ini
i lly si
ined? be
ween
he s
erir mu
scul r w ll nd eri
ne l c vi
y
{{c1::
he gubern culum}} ulls
he
es
icle in

he&nbs;{{c2::develing scr

l fld}}
{{c1::
he rcessus v gin lis}} is {{c2:: n u
cke
ing f
he eri
ne l c vi

y}}
h
ex
ends in

he develing scr
l fld
{{c1:: s
he
esis is ulled
hrugh
he scr
um}} i
mus
 ss
hrugh &nbs;{{
c2::l yers f
he bdmin l w ll}}
As
he
es
is {{c1:: sses
hrugh l yers f
he n
erir bdmin l w ll,}} i
&n
bs;{{c2::icks u
l yer f
issue frm e ch f
he l yers f
he bdmin l w
ll }}
Wh
h ens nce
he descen
f
he
es
es is cmle
e? Wh
rem ins? Prcessu
s v gin lis shuld clse ff nd bli
er
e bu
i
will le ve
remn n
c lled

he
unic v gin lis, which wr s rund
he u
side f
he
es
icle
The
unic v gin lis is
remn n
f _________ rcessus v gin lis
"<img src="" s
e-2134598746410.jg"" /><div><img src="" s
e-2216203125040.jg"
" /></div>"
1. Tes
icle<div>2. Gubern culum</div><div>3. Duc
us Deferens</di
v><div>4. Prcessus V gin lis</div><div>5. Tunic v gin lis</div>
Wh
re
he cn
en
s f
he serm
ic crd?
"1. Tes
icle<div>2. Duc
us Defer
ens</div><div>3. Tes
icul r r
ery</div><div>4. P minifrm lexus f veins</div
><div>5. lymh
ics</div><div>6. nerve fibers frm T10</div><div>7. Prcessus v
gin lis</div><div>8. Tunic v gin lis</div><div><img src="" s
e-3362959393218.j
g"" /></div>"
Nerve fibers in serm
ic crd re frm wh
sin l crd?
T10
Wh
is
he remn n
f
he gubern culum c lled in fem les?
"rund lig men

f
he u
erus<div><img src="" s
e-2821793513828.jg"" /></div>"
In fem les,
he v ry is ulled frm si
in wi
h in _______
 si
in wi
h
in _______
bdmen, elvis
Where des
he rund lig men
f
he u
erus g? Where des i
ccuy? Wh
des
i
rem in cnnnec
ed
?
"1.  sses
hrugh l yers f bdmin l w ll<div>
2. ccuies s me 
hw y s develing serm
ic crd</div><div>3. Rem ins cnne
c
ed

he develing l bi l fld</div><div><img src="" s
e-2826088481124.jg"
" /></div>"
"Wh
re
he dee l yers f
he bdmin l w ll?<img src="" s
e-3380139262523.j
1.  rie
l eri
neum<div>2. ex
r eri
ne l f
</div><div>3.

g"" />"
r nsvers lis f sci </div>
"Wh
re
he muscul r l yers f
he bdmin l w ll?<div><img src="" s
e-352187
3183279.jg"" /></div>" 1. Rec
us bdminus<div>2.
r nsversus bdminus</div><d
iv>3. in
ern l blique</div><div>4. ex
ern l blique</div>
Wh
vein ges

he serm
ic crd? Wh
r
ery?
P minifrm lexus f ve
ins<div>Tes
icul r r
ery</div>
Tes
icles re cn
rled mre by _________
h n _______ hrmn l cn
rl; sym

he
ic/ r sym
he
ic cn
rl
T/F All muscle is surrunded by f sci . Why&nbs;
True. IF ll l yers f m
uscle need
 mve, Lse CT need
 be l id dwn s
h
muscle c n mve nd c
n
r c
rel
ive
 e ch 
her
"L bel
he suerfici l l yers f
he bdmin l w ll<div><img src="" s
e-3758096
384514.jg"" /></div>" 1. Sc r s f sci <div>2. C mers f sci </div><div>3. S
kin</div>
Are bdmin l muscle l yers cmle
e? N,
hey re incmle
e nd end in ne
ursis
Where d bdmin l muscle fibers s
? "semilun r line (l
er l brder f
he r
ec
us she
h)<div><img src="" s
e-3942779978217.jg"" /></div>"
The neur
ic fibers f
he rec
us she
h  ss _______________&nbs;
n
erir
nd s
erir

he rec
us bdminus muscle
{{c1::
he neursis fibers}} fuse in
he midline s&nbs;{{c2::line lb }}

"<img src="" s
e-3938485010921.jg"" /><div>Exl in e ch f
he numbers</div>"

"<img src="" s
e-4191888081314.jg"" />"
The neursis fibers f
he bdmin l muscle fuse in
he midlien knwn s
he
line lb
In wh
direc
in d muscle fibers run in rec
us bdminis?<div>Are
hey cn
inu
"ver
ic lly<div>N,
hey re in
erru
ed by
endinus in
ersec
i
us?</div>
ns</div><div><img src="" s
e-4264902525409.jg"" /></div>"
The rec
us bdminis is surrunded by ________ " neurses f 
her bdmin l
muscles, such s
he rec
us she
h<div><img src="" s
e-4260607558113.jg"" /></
div>"
"<img src="" s
e-4260607558113.jg"" /><div>Wh
is number 4? Wh
is i
s signi
fic nce?</div>" Arcu
e line: in
f
r nsi
in where<div><br /></div><div>1.
Suerir: h lf f
he neur
ic fibers  ss n
erir
 rec
us bdminus nd 

her h lf  ss s
erir</div><div>2. Inferir: All neur
ic fibers  ss n
e
rir
 rec
us bdminus</div>
"<img src="" s
e-4767413699027.jg"" /><div><br /></div><div>Wh
s ging n

e ch number?</div>"
"<img src="" s
e-4780298600931.jg"" />"
Tr nsversus bdminis muscle fibers run in wh
direc
in?
hrizn
lly
Where d
r nsversus bdminis muscle fibers s
?
A
semilun r lines
Lwer muscle fibers f
he
r nsversus bdminus rise frm ____________. Wh

re
hey rel ced by in
he regin f
he inguin l c n l?
L
er l h lf f
inguin l lig men
<div><br /></div><div>
r nsvers lis f sci </div>
Wh
des
he
r nsvers lis f sci cn
inue n
 in serm
ic crd?
in
ern l
serm
ic f sci
"<img src="" s
e-5093831213542.jg"" />"
"<img src="" s
e-5106716115405.
jg"" />"
In wh
direc
in
 In
ern l blique muscle fibers run?
Inw rd nd uw r
d
In
ern l blique muscle fibers rise frm ________
inguin l lig men

Where d muscle fibers f inguin l bilque s
?
Semilun r line
Muscle fibers frm in
ern l blique cn
inue n
 serm
ic crd s _________
"crem s
er muscle<div><img src="" s
e-6240587481575.jg"" /></div>"
"<img src="" s
e-5450313499111.jg"" />"
"<img src="" s
e-5463198401051.
jg"" />"
In wh
direc
in d ex
ern l blique muscle fibers run?
inw rd nd dwnw
rd
Where d ex
ern l blique muscle s
? semilun r line
Wh
is
he lwer free edge f
he neursis f ex
ern l blique c lled?
inguin l lig men

Where des
he inguin l lig men


ch?
"ASIS nd ubic
ubercle<div><im
g src="" s
e-7056631267792.jg"" /></div>"
Wh
des
he inguin l lig men
llw fr?
s
ruc
ures f
he femr l
ri ng
le
  ss s
erir

he inguin l lig men

Wh
is
he ex
ern l inguin l ring?
"se r
in in neur
ic fibers nd
h
e exi
f
he inguin l c n l<div><img src="" s
e-5733781340640.jg"" /></div>"
Wh
des
he f sci frm ex
ern l blique cn
inue n
 serm
ic crd s
ex
ern l serm
ic f sci
"<img src="" s
e-6618544603616.jg"" />"
"<img src="" s
e-6631429505487.
jg"" />"
"<img src="" s
e-7082401071602.jg"" />"
1. Sc r s f sci <div>2. C mer
s f sci </div><div>3. Skin</div>
Sc r s f sci is ________ l yer. C mer f sci is _________ l yer membr n
us; f

y
Which suerfici l l yer f
he bdmin l w ll dis e rs in
he m le? c mers
f sci
Clles f sci is cn
inu
in f _________
sc r s f sci
Wh
3
hings des clles f sci
"1. Ps
erir edge f urgeni
l


ch
?
di hr gm<div>2. ischiublic r mi</div><div>3. f sci l
</div><div><br /></d
iv><div><img src="" s
e-7318624272928.jg"" /></div>"
Wh
is
he d r
s muscle?
invisibly
hin l yer f sm
h muscle

ches

 inner surf ce f scr
l skin

Wh
re
he
hree l yers f
he scr
l s c? Scr
l skin<div>D r
s muscle</
div><div>clles F sci </div>
Abve
he rcu
e line ___________
"h lf f
he enur
ic fibers  ss s

erir
 rec
us bdminus nd h lf  ss n
erir
 rec
us bdminus<div><br />
</div><div><img src="" s
e-7503307866297.jg"" /></div>"
Belw
he rcu
e line_________ " ll neur
ic fibers  ss n
erir
 rec
us
bdminis muscle<div><br /></div><div><img src="" s
e-7550552506634.jg"" /></d
iv>"
Belw
he rcu
e line wh
re
he nly
w
hings
h
re fund s
erir


he muscle?

r nsvers lis f sci <div> rie
l eri
neum</div>
"<img src="" s
e-7709466296589.jg"" />"
1. urgeni
l di hr gm<div>2. 
elvic di hr gm</div>
The clles f sci cre
es uch ________
surrunding ex
ern l geni
li <d
iv><br /></div>
Wh
re
he l yers f
he serm
ic crd?
"1. Tunic v gin lis<div>2. in
e
rn l serm
ic f sci </div><div>3. crem s
eric muscle</div><div>4. ex
ern l ser
m
ic f sci </div><div>5. clles f sci </div><div>6. d r
s muscle</div><div>7.
skin</div><div><br /></div><div><img src="" s
e-7907034792497.jg"" /></div>"
Tunic v gin lis is frm __________
rcesses v gin lis frm eri
neum
The in
ern l serm
ic f sci is frm&nbs;

rnsvers lis f sci
The crem s
eric muscle is frm&nbs;
in
ern l blique
The ex
ern l serm
ic f sci is frm&nbs;
ex
ern l blique
The clles f sci is frm
sc r s f sci
Wh
h ens if
he m le ure
hr ru
ures?
1. Urine cllec
s in s ce defin
ed by clles f sci <div>2. urine will cllec
in n
erir bdmin l w ll bu
n

flw in

high r n l regin</div>
In femr l herni s, rg ns  ss in
 ________
hrugh
he ________
"
high;
femr l c n l<div><img src="" s
e-8744553415216.jg"" /></div>"
Inguin l herni s  ss
hrugh
he ___________ ex
ern l inguin l ring
In bu
5% f dul
s,
hey h ve 
en
__________
rcess v gin lis
P
en
rcess v gin lis fllws _________
cmle
e 
h f inguin l c n l
Wh
is n indirec
inguin l herni ?
bdmin cn
en
s  ss
hrugh 
en
r
cesses v gin lis nd mus  ss
hrugh dee inguin l ring
Where is
he dee inguin l ring?
l
er l

he inferir eig s
ric r
er
y
Direc
inguin l herni s  ss
hrugh&nbs;
"Hesselb chs
ri ngle<div><img
src="" s
e-8740258447920.jg"" /></div>"
Wh
is
he Hesselb chs
ri ngle bunded by? "<img src="" s
e-9216999817636.
jg"" /><div>1. Inferir eig s
ric r
ery</div><div>2. rec
us bdminus</div><d
iv>3. inguin l lig men
</div>"

he dee inguin l ring is
he _________ nd
he ex
ern l inguin l ring is
he __
________
en
r nce f
he inguin l c n l; exi
f
he inguin l c n l
Direc
inguin l herni s re _________ nd _________ l yers f bdmin l w ll
cquired; ush
hrugh
Indirec
inguin l herni s re _________ nd fllw ________
cngeni
l<div>n

ur l 
h f inguin l c n l (mus
 ss
hrugh dee inguin l ring -en
r nce f
inguin l c n l)</div>
"<img src="" s
e-9672266351055.jg"" /><div>Wh
is 1?</div>" ASIS
"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 2?</div>" Pubic Tubercle
"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 3?</div>" Inguin l lig men


"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 4?</div>" L cun r lig men

"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 5?</div>" Pec
ine l lig me
n

"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 6?</div>" Femr l c n l
"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 7?</div>" Ex
ern l inguin
l ring
"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 8?</div>" Medi l Crus
"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 9</div>" L
er l crus

"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 10?</div>" In
ercru l fiber

s
"<img src="" s
e-9667971383759.jg"" /><div>Wh
is 11?</div>" dee inguin l ri
ng
"<img src="" s
e-10441065496811.jg"" />"
1. In
ern l blique<div>2. crem
s
eric muscle</div><div>3. ilihyg s
ric nerve</div><div>4. iliinguin l nerve
</div>
The ingin l regin is innerv
ed by _____
L1
The umbilicus is innerv
ed by&nbs;
T10
If yu re kicked in
he gn ds, where will yu feel  in
T 10 derm
ne:
umbilicus
Wh
is
he derm
ne fr
he xihid

he 6
h in
ercs
l s ce?
T6
Umbilicus is lc
ed
Wh
ver
ebr l level? L3/L4
If bdmin l  in is dull, v gue, rly lc lized, nd midline i
is viscer l (
Referred  in)
If bdmin l  in is severe, recise, lc lized, nd l
er lized
i
is s
m
ic
Wh
is
he lc
in f
he kidney hilums?
"Lef
: L1<div>Righ
: L2</div><di
v><img src="" s
e-13430362734989.jg"" /></div>"
Why re
he kidneys
differen
levels?
"Liver s
 righ
kidney scen
i
n such
h
i
is 1"" lwer
h n lef
<div><img src="" s
e-13426067767693.jg""
/></div>"
The righ
kidney inferir edge is ____________ bve
he ili c cres

"1 finge
r bre d
h&nbs;<div><img src="" s
e-13426067767693.jg"" /></div>"
Where des
he ure
er lie?
"ver
ic l l ne lng
is f lumb r
r nsverse
rcesses<div><img src="" s
e-13426067767693.jg"" /></div>"
Wh
ercen
f bld vlume flws
hrugh kidneys<div><br /></div>
20%
Wh
cvers
he suerir le f
he kidney?
leur l c vi
y
Where des ren l bisy ccur? "inferir

he
i f
he 12
h rib
 vid hi


ing
he leur l s c<div><img src="" s
e-13563506721187.jg"" /></div>"
Where is
he
r nsylric l ne?

r nsverse l ne midw y be
ween suerir
brders f ublic symhysis nd m nubrium
Wh
re
he 6 func
ins f
he kidney? 1. regul
es fluid in bdy<div>2. m in

in sml ri
y</div><div>3. in b l nce</div><div>4. H b l nce</div><div>5. excr
e
in f w s
es</div><div>6. rduce hrmnes (ery
hrie
in nd renin)</div>
Wh
rcess h ens in ure
er? Peris
lsis;
r nsr

in f urine
Where des mic
ur
in urin
in rcess ccur? ure
hr
They kidney nd sur ren l gl nd re &nbs;enc sed wi
h&nbs; f sci l l ne
"<img src=""84c59 e15d 065f127f4c9ced12281894cf0fd12_Q 0.svg"" />"
"<img sr
c=""84c59 e15d 065f127f4c9ced12281894cf0fd12_A 0.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_surce_svg.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_
mnYfCq.ng"" />"
"<img src=""84c59 e15d 065f127f4c9ced12281894cf0fd12_Q 1.svg"" />"
"<img sr
c=""84c59 e15d 065f127f4c9ced12281894cf0fd12_A 1.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_surce_svg.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_
mnYfCq.ng"" />"
"<img src=""84c59 e15d 065f127f4c9ced12281894cf0fd12_Q 2.svg"" />"
"<img sr
c=""84c59 e15d 065f127f4c9ced12281894cf0fd12_A 2.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_surce_svg.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_
mnYfCq.ng"" />"
"<img src=""84c59 e15d 065f127f4c9ced12281894cf0fd12_Q 3.svg"" />"
"<img sr
c=""84c59 e15d 065f127f4c9ced12281894cf0fd12_A 3.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_surce_svg.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_
mnYfCq.ng"" />"
"<img src=""84c59 e15d 065f127f4c9ced12281894cf0fd12_Q 4.svg"" />"
"<img sr
c=""84c59 e15d 065f127f4c9ced12281894cf0fd12_A 4.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_surce_svg.svg"" />"
"<img src=""84c5
9 e15d 065f127f4c9ced12281894cf0fd12_
mnYfCq.ng"" />"
The eriren l f sci __________. Wi
hin
his f sci is __________
h
surrunds
nd r
ec
s susends e ch kidney<div>eriren l f

h
surrunds nd r
ec


s gl nds</div>
Ger
s f sci is n
her n me fr
he _________, which susends kidneys frm _
________ nd _________ eriren l f sci <div><br /></div><div>di hr gm,
r nsve
rs lis f sci </div>
Periren l f
 d is __________ nd i
__________. P r ren l f
is ___________
in
ern l
 eriren l f sci ; r
ec
s kidneys nd sur ren l gl nds<div><br /><
/div><div>ex
ern l
 eriren l f sci </div>
Which ribs re in cn
c
wi
h Righ
Kidney? Lef
kidney?
1. Righ
: 12
h r
ib<div>2. Lef
: 11
h rib wi
h suerir le. 12
h rib crsses ver hilum</div>
On r digr hs which sh dws shuld be  r llel?
s s m jr nd kidney s
h dws
Kidneys lie n
erir
 _________ nd l
er l
 _______
"qu dr
us lumb
rum nd l
er l
 s s m jr<div><br /></div><div><img src="" s
e-31718333481
307.jg"" /></div>"
Of
he hil r s
ruc
ures which is ms
n
erir? "Ren l Vein<div><img src="" s
e
-31808527794424.jg"" /></div>"
Wh
fills
he sinus rund
he hil r s
ruc
ures?
Periren l f

Wh
is rder f flw in kidney?
ren l  ill --&g
;minr c lyces--&g
;m
jr c lyces--&g
;ren l elvis--&g
;ure
er
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 0.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 0.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 1.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 1.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 2.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 2.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 3.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 3.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 4.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 4.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 5.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 5.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 6.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 6.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 7.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 7.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 8.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 8.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 9.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 9.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 10.svg"" />"
"<img sr

c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 10.svg"" />"

"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
"<img src=""9e98750579235d582023f7 69edb8e9ff75e6fc6_Q 11.svg"" />"
"<img sr
c=""9e98750579235d582023f7 69edb8e9ff75e6fc6_A 11.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_surce_svg.svg"" />"
"<img src=""9e98
750579235d582023f7 69edb8e9ff75e6fc6_
mF9RxCG.ng"" />"
Hw m ny minr c lyces re
here er yr mid? Hw m ny m jr c lyces re
here 
er  ill ?
1 minr c lyx er yr mid<div>2. 2/3 m jr c lces rund  ill
</div>
Wh
re whi
e circles wi
hin cr
ex r medull ?
fluid filled cys
s which
re re s f 
hlgy where glmeruli nd nehrns h ve been des
ryed frm c
cumul
in f
xins
Wh
is
he rgressin f v scul
ure in ren l circul
in?
"<img src="" s

e-56208237003178.jg"" />"
RA is in __________<div>segmen
l r
eries re in ________</div><div>in
erlb r
r
eries re &nbs;_________</div><div> rcu
e r
eries re ________</div><div>i
n
erlbul r r
eries re ________&nbs;</div><div> fferen
r
eriles re_______
_</div> hilum<div>sinus</div><div>be
ween medull r yr mids</div><div>
brder
be
ween medull nd cr
ex</div><div>br nches ff f
he rcu
e</div><div>br nc
hes ff f in
erlbul r r
eries</div>
"<img src="" s
e-71807558222338.jg"" /><div>These re _____ r
eries</div>"
segmen
l
"<img src=""4433000b3741ef2558bd 8f763d209cc93332407_Q 0.svg"" />"
"<img sr
c=""4433000b3741ef2558bd 8f763d209cc93332407_A 0.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_surce_svg.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_
mgNS6IF.ng"" />"
"<img src=""4433000b3741ef2558bd 8f763d209cc93332407_Q 1.svg"" />"
"<img sr
c=""4433000b3741ef2558bd 8f763d209cc93332407_A 1.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_surce_svg.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_
mgNS6IF.ng"" />"
"<img src=""4433000b3741ef2558bd 8f763d209cc93332407_Q 2.svg"" />"
"<img sr
c=""4433000b3741ef2558bd 8f763d209cc93332407_A 2.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_surce_svg.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_
mgNS6IF.ng"" />"
"<img src=""4433000b3741ef2558bd 8f763d209cc93332407_Q 3.svg"" />"
"<img sr
c=""4433000b3741ef2558bd 8f763d209cc93332407_A 3.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_surce_svg.svg"" />"
"<img src=""4433
000b3741ef2558bd 8f763d209cc93332407_
mgNS6IF.ng"" />"
Wh
m kes u
he ren l cruscle?
glmerulus<div>glmerul r c sule: visce
r l,  rie
l, c sul r s ce</div>
Wh
re
he s ce be
ween dcy
e f
rcesses?
fil
r
in sli
s
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 0.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 0.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 1.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 1.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 2.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 2.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 3.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 3.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 4.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 4.svg"" />"
"<img src=""4e 0

c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"

"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 5.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 5.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 6.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 6.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
"<img src=""4e 0c566470e6c786390288ef402659dfdeb e15_Q 7.svg"" />"
"<img sr
c=""4e 0c566470e6c786390288ef402659dfdeb e15_A 7.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_surce_svg.svg"" />"
"<img src=""4e 0
c566470e6c786390288ef402659dfdeb e15_
meLzLh_.ng"" />"
The fil
r
in b rrier is m de u f&nbs;<div>______end
helium</div><div>_____
__ b semen
membr ne</div><div>________ be
ween dcy
e edicles</div> fenes
r

ed<div>ch rged</div><div>fil
r
in sli
s</div>
Wh

ye f ei
helium is rxim l
ubule m de u f?&nbs;
Cubid l
 clu
mn r ei
helium wi
h micrvilli (Brush brder)
Wh
re
he m cul dens ?
seci l cells inside
he dis
l cnvlu
ed
ubul
e
h
re nex


he jux
glmerul r  r
us cells which re lc
ed be
ween

he fferen
nd efferen
r
eriles
Hw m ny nehrns re
here er kidney? 1 millin
Where is
he ren l cruscle lc
ed? 1. Cr
ex- suerfici l nehrns<div>2. c
r
ic l-medull ry regin- jux
medull ry nehrns</div>
Ren l cruscle is m de u f ______ nd _____ glmerulus nd bwm ns c sule
Wh
 r
s f
he nehrn re in
he cr
ex?
1. glmeruli<div>2. rxim l nd
dis
l cnvlu
ed
ubules</div><div>3. fferen
nd efferen
r
eriles</div><d
iv>4. eri
ubul r ne
wrk</div>
Wh
 r
s f
he nehrn re in
he medull ? Ls f Henle<div>Prxim l s
r
igh

ubule</div><div>Cllec
ing Tubules</div><div>Cllec
ing Duc
</div><div>V s
Rec
i</div>
E ch nehrn h s
w r
eriles nd
w se
s f c ill ries ssci
ed wi
h i
:
_______ 1. fferen
nd eferen
r
erile<div>2. glmerul r nd eri
ubul r c i
ll ries</div>
V s rec
i nd eri
ubul r c ill ries re ex
ensins f ________. They in
er c

nd exch nge wi
h _________
efferen
r
erile<div><br /></div><div>cnvlu

ed
ubules nd ls f henle</div>
Even
u ll
he v s rec
i

in lw ________ nd becme _________ which uni
e

frm ________ xygen s

us; venules; in
erlbul r veins
eri
ubul r c ill ries surrund _________<div><br /></div><div>v s rec
surr
und _________</div>
cnvlu
ed
ubules<div><br /></div><div>ls f henle</
div>
Wh
is fil
r
e? Wh
is fil
r
in fr c
in? Wh
is nrm l fil
r
e rduc
i
n r
e?
he l sm vlume
h
 sses frm glmerulus in
 bwmn s c sule<div>
<br /></div><div>fil
r
in vlume/Pl sm vlume</div><div><br /></div><div>200
L/d y</div>
Wh
is n imr
n
cliniic l rel
inshi rel
ed

he lc
in f
he lef

ren l vein?
"
he lef
ren l vein is crssed by
he suerir mesen
eric r
er
y.<div><img src="" s
e-96529389977989.jg"" /><br /><div><br /></div><div>If
h
ere is r
erisclersis r n r
ic neurysm,
he lef
ren l vein c n becmem c
mressed--&g
;resul
ing in ren l hyer
ensin</div></div>"
Wh
is
he nly sym
m
h
reve ls venus hyer
ensin?
"""b g f wrms
sym
m""<div>Cmressin f lef
ren l vein m y le d
 v riscci
ies f lef


es
icul r veins ( minifrm lexus) which re  l ble when  l
ing lef
gn
d</div>"
The urin ry bl dder h s wh
muscle nd wh

ye f ei
helium?
1. de
ru
sr muscle<div>2. ur
helium</div>
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 0.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 0.svg"" />"
"<img src=""962b

75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"

"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 1.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 1.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 2.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 2.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 3.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 3.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 4.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 4.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 6.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 6.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 7.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 7.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 8.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 8.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
"<img src=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_Q 9.svg"" />"
"<img sr
c=""962b75c3e ce19f66e7e1841e55c385d7 46c35e_A 9.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_surce_svg.svg"" />"
"<img src=""962b
75c3e ce19f66e7e1841e55c385d7 46c35e_
msGx9vl.ng"" />"
Wh
is
he rel
in f
he bl dder nd u
erus? u
erus is s
erir
 bl dder
Kidney s
nes re _______ nd c n be brken u by wh
rcedure?
uric ci
d crys
ls nd c lcium c rbn
e crys
ls<div><br /></div><div>Li
h
risy (shc
k w ves
 bre k u h rd kidney s
nes)</div>
An s
mses ccur ll lng e ch ure
er by wh
4 r
eries?
1. ren l r
ery<
div>2.
es
icul r/v ri n</div><div>3. r
ic/ cmmn ili c br nches</div><div>4
. suerir vesicul r r
ery</div>
Cnce
u l B sic Bdy Pl n<br /><div><br /></div><div><div>The mesen
ery llws
fr
he  ss ge f s
ruc
ures
 nd frm
he viscus wi
hu
en
ering
he {{c1::
eri
ne l c vi
y}}</div><div>Ar
eries</div><div>Veins</div><div>Nerves</div><di
v>Lymh
ics</div><div><br /></div><div>In rder
 ccess {{c1::eri
ne l}} s

ruc
ure yu will need
 cu

hrugh
le s
ne f
hese l yers f eri
neum<
/div></div><div><br /></div>
"<img src="" s
e-72636486910461.jg"" />"
8-20 n
my
"<img src=""33 1 d8fd056b55d93d635766b79c5518270843c_Q_0.svg"" />"
"<img sr
c=""33 1 d8fd056b55d93d635766b79c5518270843c_A_0.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_surce_svg.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_
m4UgKw4.ng"" />"
10-20 An
my
"<img src=""33 1 d8fd056b55d93d635766b79c5518270843c_Q_1.svg"" />"
"<img sr
c=""33 1 d8fd056b55d93d635766b79c5518270843c_A_1.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_surce_svg.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_
m4UgKw4.ng"" />"
10-20 An
my
"<img src=""33 1 d8fd056b55d93d635766b79c5518270843c_Q_2.svg"" />"
"<img sr
c=""33 1 d8fd056b55d93d635766b79c5518270843c_A_2.svg"" />"
"<img src=""33 1

d8fd056b55d93d635766b79c5518270843c_surce_svg.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_
m4UgKw4.ng"" />"
10-20 An
my
"<img src=""33 1 d8fd056b55d93d635766b79c5518270843c_Q_3.svg"" />"
"<img sr
c=""33 1 d8fd056b55d93d635766b79c5518270843c_A_3.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_surce_svg.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_
m4UgKw4.ng"" />"
10-20 An
my
"<img src=""33 1 d8fd056b55d93d635766b79c5518270843c_Q_4.svg"" />"
"<img sr
c=""33 1 d8fd056b55d93d635766b79c5518270843c_A_4.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_surce_svg.svg"" />"
"<img src=""33 1
d8fd056b55d93d635766b79c5518270843c_
m4UgKw4.ng"" />"
10-20 An
my
"<img src="" 50d6e253855190808 4 3d7b85e8cc 5b856e40_Q_0.svg"" />"
"<img sr
c="" 50d6e253855190808 4 3d7b85e8cc 5b856e40_A_0.svg"" />"
"<img src="" 50d
6e253855190808 4 3d7b85e8cc 5b856e40_surce_svg.svg"" />"
"<img src="" 50d
6e253855190808 4 3d7b85e8cc 5b856e40_
mXW9crb.ng"" />"
10-20 An
my
"<img src="" 50d6e253855190808 4 3d7b85e8cc 5b856e40_Q_1.svg"" />"
"<img sr
c="" 50d6e253855190808 4 3d7b85e8cc 5b856e40_A_1.svg"" />"
"<img src="" 50d
6e253855190808 4 3d7b85e8cc 5b856e40_surce_svg.svg"" />"
"<img src="" 50d
6e253855190808 4 3d7b85e8cc 5b856e40_
mXW9crb.ng"" />"
10-20 An
my
"<img src="" 50d6e253855190808 4 3d7b85e8cc 5b856e40_Q_2.svg"" />"
"<img sr
c="" 50d6e253855190808 4 3d7b85e8cc 5b856e40_A_2.svg"" />"
"<img src="" 50d
6e253855190808 4 3d7b85e8cc 5b856e40_surce_svg.svg"" />"
"<img src="" 50d
6e253855190808 4 3d7b85e8cc 5b856e40_
mXW9crb.ng"" />"
10-20 An
my
"<img src=""8972532dc333b7c386464e413c63b319bd2806 b_Q_0.svg"" />"
"<img sr
c=""8972532dc333b7c386464e413c63b319bd2806 b_A_0.svg"" />"
"<img src=""8972
532dc333b7c386464e413c63b319bd2806 b_surce_svg.svg"" />"
"<img src=""8972
532dc333b7c386464e413c63b319bd2806 b_
mJqg_Gv.ng"" />"
10-20 An
my
"<img src=""8972532dc333b7c386464e413c63b319bd2806 b_Q_1.svg"" />"
"<img sr
c=""8972532dc333b7c386464e413c63b319bd2806 b_A_1.svg"" />"
"<img src=""8972
532dc333b7c386464e413c63b319bd2806 b_surce_svg.svg"" />"
"<img src=""8972
532dc333b7c386464e413c63b319bd2806 b_
mJqg_Gv.ng"" />"
10-20 An
my
"<img src=""2174 4d8d71db8484915f7cbb65 1265cf89c18 _Q_0.svg"" />"
"<img sr
c=""2174 4d8d71db8484915f7cbb65 1265cf89c18 _A_0.svg"" />"
"<img src=""2174
4d8d71db8484915f7cbb65 1265cf89c18 _surce_svg.svg"" />"
"<img src=""2174
4d8d71db8484915f7cbb65 1265cf89c18 _
mm_C
E9.ng"" />"
10-20 An
my
"<img src=""2174 4d8d71db8484915f7cbb65 1265cf89c18 _Q_1.svg"" />"
"<img sr
c=""2174 4d8d71db8484915f7cbb65 1265cf89c18 _A_1.svg"" />"
"<img src=""2174
4d8d71db8484915f7cbb65 1265cf89c18 _surce_svg.svg"" />"
"<img src=""2174
4d8d71db8484915f7cbb65 1265cf89c18 _
mm_C
E9.ng"" />"
10-20 An
my
"<img src=""2174 4d8d71db8484915f7cbb65 1265cf89c18 _Q_2.svg"" />"
"<img sr
c=""2174 4d8d71db8484915f7cbb65 1265cf89c18 _A_2.svg"" />"
"<img src=""2174
4d8d71db8484915f7cbb65 1265cf89c18 _surce_svg.svg"" />"
"<img src=""2174
4d8d71db8484915f7cbb65 1265cf89c18 _
mm_C
E9.ng"" />"
10-20 An
my
"<img src="" fb674cf6f736390459d2d671 01796edd12f3cc_Q_0.svg"" />"
"<img sr
c="" fb674cf6f736390459d2d671 01796edd12f3cc_A_0.svg"" />"
"<img src="" fb6
74cf6f736390459d2d671 01796edd12f3cc_surce_svg.svg"" />"
"<img src="" fb6
74cf6f736390459d2d671 01796edd12f3cc_
m
Y B_.ng"" />"
10-20 An
my
<div>N
ice
h

he {{c1::ven
r l mesen
ery}} is nly fund in
he suerir r

ins f
he in
es
in l
r c
. Therefre nly
he regins ne r
he s
m ch nd l

iver will be se r
ed in
 righ
nd lef
h lves f
he eri
ne l c vi
y. Infe
rir

his level
here is n se r
in. The inferir free edge f
he {{c1::v
en
r l mesen
ery}} is fund

he inferir edge f
he {{c1::lesser men
um}} i
.e.
he he
duden l lig men
.</div><div><br /></div> "<img src="" s
e-110694
192120346.jg"" />"
8-20 An
my
"<img src=""5 8c 799efec315f6d89057d6bdd09c8bc6148d9_Q_0.svg"" />"
"<img sr
c=""5 8c 799efec315f6d89057d6bdd09c8bc6148d9_A_0.svg"" />"
"<img src=""5 8c
799efec315f6d89057d6bdd09c8bc6148d9_surce_svg.svg"" />"
"<img src=""5 8c
799efec315f6d89057d6bdd09c8bc6148d9_
mJUNHFS.ng"" />"
10-20 An
my
"<img src=""5 8c 799efec315f6d89057d6bdd09c8bc6148d9_Q_1.svg"" />"
"<img sr
c=""5 8c 799efec315f6d89057d6bdd09c8bc6148d9_A_1.svg"" />"
"<img src=""5 8c
799efec315f6d89057d6bdd09c8bc6148d9_surce_svg.svg"" />"
"<img src=""5 8c
799efec315f6d89057d6bdd09c8bc6148d9_
mJUNHFS.ng"" />"
10-20 An
my
"<img src=""556f2645cdcf3df92bcef85cc df35 f3b896258_Q_0.svg"" />"
"<img sr
c=""556f2645cdcf3df92bcef85cc df35 f3b896258_A_0.svg"" />"
"<img src=""556f
2645cdcf3df92bcef85cc df35 f3b896258_surce_svg.svg"" />"
"<img src=""556f
2645cdcf3df92bcef85cc df35 f3b896258_
mR23IA.ng"" />"
10-20 An
my
"<img src=""556f2645cdcf3df92bcef85cc df35 f3b896258_Q_1.svg"" />"
"<img sr
c=""556f2645cdcf3df92bcef85cc df35 f3b896258_A_1.svg"" />"
"<img src=""556f
2645cdcf3df92bcef85cc df35 f3b896258_surce_svg.svg"" />"
"<img src=""556f
2645cdcf3df92bcef85cc df35 f3b896258_
mR23IA.ng"" />"
10-20 An
my
"<img src=""556f2645cdcf3df92bcef85cc df35 f3b896258_Q_2.svg"" />"
"<img sr
c=""556f2645cdcf3df92bcef85cc df35 f3b896258_A_2.svg"" />"
"<img src=""556f
2645cdcf3df92bcef85cc df35 f3b896258_surce_svg.svg"" />"
"<img src=""556f
2645cdcf3df92bcef85cc df35 f3b896258_
mR23IA.ng"" />"
10-20 An
my
"<img src=""310 08bb312993e7e28983743dc3dfb35e3218f6_Q_0.svg"" />"
"<img sr
c=""310 08bb312993e7e28983743dc3dfb35e3218f6_A_0.svg"" />"
"<img src=""310
08bb312993e7e28983743dc3dfb35e3218f6_surce_svg.svg"" />"
"<img src=""310
08bb312993e7e28983743dc3dfb35e3218f6_
mn c4jb.ng"" />"
10-20 An
my
"<img src="" s
e-126555506344287.jg"" /><div><br /></div><div><div>During deve
lmen
:</div><div>The {{c1::liver}} gre
ly incre ses in size nd migr
es ver


he righ
side f
he bdmin l c vi
y, bu
i
m in
ins i
s {{c1::drs l}}
nd {{c1::ven
r l mesen
eries}}</div><div><br /></div><div>The ven
r l mesen
ery
f
he liver will becme knwn s
he {{c1::f lcifrm lig men
}}</div><div><br
/></div><div>The inferir edge f
he f lcifrm lig men
cn
ins
he {{c1::umbi
lic l vein}}.</div><div><br /></div><div>The mesen
ery be
ween
he liver nd
he
s
m ch will becme knwn s
he {{c1::lesser men
um}}. I

 is derived frm

he rimi
ive ven
r l mesen
ery&nbs;</div><div><br /></div><div>The gu

ube r


es

he righ
: s
h

he n
erir surf ce (lesser men
um) shif
s
w rd

he righ
, nd
he drs l mesen
ery winds u n
he lef
side f
he s
m ch.</di
v></div><div><br /></div>"
8-20 An
my
"<img src=""069d533cfc2f8125404c8300ce094b77 6b0 f58_Q_0.svg"" />"
"<img sr
c=""069d533cfc2f8125404c8300ce094b77 6b0 f58_A_0.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_surce_svg.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_
mWrjqQM.ng"" />"
10-20 An
my
"<img src=""069d533cfc2f8125404c8300ce094b77 6b0 f58_Q_1.svg"" />"
"<img sr
c=""069d533cfc2f8125404c8300ce094b77 6b0 f58_A_1.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_surce_svg.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_
mWrjqQM.ng"" />"
10-20 An
my
"<img src=""069d533cfc2f8125404c8300ce094b77 6b0 f58_Q_2.svg"" />"
"<img sr
c=""069d533cfc2f8125404c8300ce094b77 6b0 f58_A_2.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_surce_svg.svg"" />"
"<img src=""069d

533cfc2f8125404c8300ce094b77 6b0 f58_
mWrjqQM.ng"" />"

10-20 An
my
"<img src=""069d533cfc2f8125404c8300ce094b77 6b0 f58_Q_3.svg"" />"
"<img sr
c=""069d533cfc2f8125404c8300ce094b77 6b0 f58_A_3.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_surce_svg.svg"" />"
"<img src=""069d
533cfc2f8125404c8300ce094b77 6b0 f58_
mWrjqQM.ng"" />"
10-20 An
my
<div>n
ice
h

he  ncre s (green s
ruc
ure) begins i
s develmen
in
he {{
c1::drs l mesen
ery (drs l mesg s
rium)}} f
he s
m ch &nbs;bu
winds u 
n
he s
erir w ll nd lses i
s {{c1::mesen
ery}}. I
winds u h ving
surf
ce
h
is n
cvered wi
h eri
neum nd
herefre becmes secnd rily {{c1::r
e
reri
ne l}}.</div><div><br /></div>
"<img src="" s
e-14131730894064
2.jg"" />"
8-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_0.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_0.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_1.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_1.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_2.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_2.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_3.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_3.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_4.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_4.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_5.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_5.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_6.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_6.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_7.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_7.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_8.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_8.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
"<img src=""8b42 bd2198dde90f7253017209d430e3cb0f17d_Q_9.svg"" />"
"<img sr
c=""8b42 bd2198dde90f7253017209d430e3cb0f17d_A_9.svg"" />"
"<img src=""8b42

bd2198dde90f7253017209d430e3cb0f17d_surce_svg.svg"" />"
"<img src=""8b42
bd2198dde90f7253017209d430e3cb0f17d_
mvRXQ0m.ng"" />"
10-20 An
my
<div>As
he s
m ch r

es nd bends, nd
he liver grws,
he uer righ
side
f
he eri
ne l c vi
y cmes
 lie {{c1::s
erir}}

he s
m ch nd bec
mes isl
ed nd is knwn s
he {{c1::lesser s c (men
l burs ).}}</div><div><
br /></div>
"<img src="" s
e-141364553581048.jg"" />"
8-20 An
my
<div>During develmen
:</div><div>The gu

ube bends

he belly s
h
ven
r
l surf ce winds u n
he {{c1::suerir}} side f
he s
m ch nd
he drs l su
rf ce winds u n
he {{c1::inferir}} side f
he s
m ch.&nbs;</div><div>The
gre
ly incre sed r
e f differen
i l grw
h f
he drs l surf ce f
he s
m
ch rduces
he gre
er curv
ure f
he s
m ch.</div><div>The cmbin
in f

hese c
ins resul
s in
he dis
l r
in f
he s
m ch,
he {{c1::ylrus}},
winding u n
he righ
side f
he bdy.</div><div><br /></div>
"<img sr
c="" s
e-141437568024750.jg"" />"
8-20 An
my
<div>F lcifrm lig men
&nbs;</div><div>Derived frm {{c1::rimi
ive ven
r l mes
en
ery}} (2 l yers f eri
neum)</div><div>cnnec
s
he liver

he {{c1:: n
e
rir bdmin l w ll}}</div><div><br /></div><div>Rund lig men
f liver</div><d
iv> .k. . lig men
um {{c1::
eres he
is}}</div><div>{{c1::
hick inferir}} edge
f f lcifrm lig men
</div><div>Cn
ins bli
er
ed {{c1::umbilic l vein}}</di
v><div><br /></div>
"<img src="" s
e-155361851998748.jg"" />"
8-20 An

my
"<img src=""66b90ec95b0 8dd88c80793d0234 93251b95eb_Q_0.svg"" />"
"<img sr
c=""66b90ec95b0 8dd88c80793d0234 93251b95eb_A_0.svg"" />"
"<img src=""66b9
0ec95b0 8dd88c80793d0234 93251b95eb_surce_svg.svg"" />"
"<img src=""66b9
0ec95b0 8dd88c80793d0234 93251b95eb_
mKxOLO4.ng"" />"
10-20 An
my
"<img src=""66b90ec95b0 8dd88c80793d0234 93251b95eb_Q_1.svg"" />"
"<img sr
c=""66b90ec95b0 8dd88c80793d0234 93251b95eb_A_1.svg"" />"
"<img src=""66b9
0ec95b0 8dd88c80793d0234 93251b95eb_surce_svg.svg"" />"
"<img src=""66b9
0ec95b0 8dd88c80793d0234 93251b95eb_
mKxOLO4.ng"" />"
10-20 An
my
<div>Over
ime,
he fur &nbs;l yers f
he drs l mesen
ery f
he &nbs;s
m
ch ( .k. .
he {{c1::gre
er men
um}}) fuse

hemselves, fuse

he {{c1::
r
nsverse cln}}, nd fuse

he {{c1::mesen
ery f
he
r nsverse cln}}</div
><div><br /></div>
"<img src="" s
e-201150498341323.jg"" />"
8-20 An

my
"<img src=""e1 8d50 98970f9 3859e217f9377 dd730d 110_Q_0.svg"" />"
"<img sr
c=""e1 8d50 98970f9 3859e217f9377 dd730d 110_A_0.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_surce_svg.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_
mRcXSfu.ng"" />"
10-20 An
my
"<img src=""e1 8d50 98970f9 3859e217f9377 dd730d 110_Q_1.svg"" />"
"<img sr
c=""e1 8d50 98970f9 3859e217f9377 dd730d 110_A_1.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_surce_svg.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_
mRcXSfu.ng"" />"
10-20 An
my
"<img src=""e1 8d50 98970f9 3859e217f9377 dd730d 110_Q_2.svg"" />"
"<img sr
c=""e1 8d50 98970f9 3859e217f9377 dd730d 110_A_2.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_surce_svg.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_
mRcXSfu.ng"" />"
10-20 An
my
"<img src=""e1 8d50 98970f9 3859e217f9377 dd730d 110_Q_3.svg"" />"
"<img sr
c=""e1 8d50 98970f9 3859e217f9377 dd730d 110_A_3.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_surce_svg.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_
mRcXSfu.ng"" />"
10-20 An
my
"<img src=""e1 8d50 98970f9 3859e217f9377 dd730d 110_Q_4.svg"" />"
"<img sr
c=""e1 8d50 98970f9 3859e217f9377 dd730d 110_A_4.svg"" />"
"<img src=""e1 8
d50 98970f9 3859e217f9377 dd730d 110_surce_svg.svg"" />"
"<img src=""e1 8

d50 98970f9 3859e217f9377 dd730d 110_
mRcXSfu.ng"" />"

10-20 An
my
"<img src=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_Q_0.svg"" />"
"<img sr
c=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_A_0.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_surce_svg.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_
m91w4Qs.ng"" />"
10-20 An
my
"<img src=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_Q_1.svg"" />"
"<img sr
c=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_A_1.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_surce_svg.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_
m91w4Qs.ng"" />"
10-20 An
my
"<img src=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_Q_2.svg"" />"
"<img sr
c=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_A_2.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_surce_svg.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_
m91w4Qs.ng"" />"
10-20 An
my
"<img src=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_Q_3.svg"" />"
"<img sr
c=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_A_3.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_surce_svg.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_
m91w4Qs.ng"" />"
10-20 An
my
"<img src=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_Q_4.svg"" />"
"<img sr
c=""b226b57bb c9 96b2 277762e4c8b5 9bdf93678_A_4.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_surce_svg.svg"" />"
"<img src=""b226
b57bb c9 96b2 277762e4c8b5 9bdf93678_
m91w4Qs.ng"" />"
10-20 An
my
Eilic Fr men<div><br /></div><div><div>fr men f {{c1::Winslw}}</div><div>E
n
ryw y
 men
l burs </div><div>Cnnec
s lesser s c nd gre
er s c&nbs;</di
v><div><br /></div><div>Bund ries f eilic fr men:</div><div>Suerir: {{c1
::liver}}</div><div>Inferir: {{c1::dudenum}}</div><div>Ps
erir: {{c1::IVC}}<
/div><div>An
erir: {{c1::he
duden l lig men
cn
ining r
l
ri d}}</div
><div>{{c1::<div><div>He
ic r
l vein</div><div>He
ic r
ery rer</div><
div>Cmmn bile duc
</div></div><div></div>}}</div></div>
"<img src="" s

e-236768662127030.jg"" />"
8-20 An
my
"<img src="" fc5 37 3f0d718f88f4 9d64d918bfcb9d7c3d5_Q_0.svg"" />"
"<img sr
c="" fc5 37 3f0d718f88f4 9d64d918bfcb9d7c3d5_A_0.svg"" />"
"<img src="" fc5
37 3f0d718f88f4 9d64d918bfcb9d7c3d5_surce_svg.svg"" />"
"<img src="" fc5
37 3f0d718f88f4 9d64d918bfcb9d7c3d5_
mAbnPz7.ng"" />"
10-20 An
my
"<img src="" fc5 37 3f0d718f88f4 9d64d918bfcb9d7c3d5_Q_1.svg"" />"
"<img sr
c="" fc5 37 3f0d718f88f4 9d64d918bfcb9d7c3d5_A_1.svg"" />"
"<img src="" fc5
37 3f0d718f88f4 9d64d918bfcb9d7c3d5_surce_svg.svg"" />"
"<img src="" fc5
37 3f0d718f88f4 9d64d918bfcb9d7c3d5_
mAbnPz7.ng"" />"
10-20 An
my
"<img src=""7d100fb24103041478e67d85fd797d25873e8 93_Q_0.svg"" />"
"<img sr
c=""7d100fb24103041478e67d85fd797d25873e8 93_A_0.svg"" />"
"<img src=""7d10
0fb24103041478e67d85fd797d25873e8 93_surce_svg.svg"" />"
"<img src=""7d10
0fb24103041478e67d85fd797d25873e8 93_
mDCNiN9.ng"" />"
10-20 An
my
"<img src=""d2e63d11260fcfbe98d6c7cfbf6fecfe16d7698e_Q_0.svg"" />"
"<img sr
c=""d2e63d11260fcfbe98d6c7cfbf6fecfe16d7698e_A_0.svg"" />"
"<img src=""d2e6
3d11260fcfbe98d6c7cfbf6fecfe16d7698e_surce_svg.svg"" />"
"<img src=""d2e6
3d11260fcfbe98d6c7cfbf6fecfe16d7698e_
m6nICNd.ng"" />"
10-20 An
my
Omen
l burs <div><br /></div><div><div>E rly in develmen
i
w s
he uer ri
gh
side f
he eri
ne l c vi
y</div><div><br /></div><div>As
he s
m ch r


es nd bends, nd
he liver grws,
he uer righ
side cmes
 lie {{c1::s

erir}}

he s
m ch</div><div><br /></div><div>The men
l burs is mre cmm
nly c lled
he {{c1::lesser s c}}</div><div><br /></div><div>I
is cn
inuus w

i
h
he gre
er s c
hrugh
he {{c1::eilic fr men}}</div></div><div><br /><
/div> "<img src="" s
e-252986458636828.jg"" />"
8-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_0.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_0.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_1.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_1.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_2.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_2.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_3.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_3.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_4.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_4.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_5.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_5.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_6.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_6.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_7.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_7.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
"<img src=""7e052ce7fd50313ed12ff0ff416116 68f28939d_Q_8.svg"" />"
"<img sr
c=""7e052ce7fd50313ed12ff0ff416116 68f28939d_A_8.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_surce_svg.svg"" />"
"<img src=""7e05
2ce7fd50313ed12ff0ff416116 68f28939d_
m70zM_.ng"" />"
10-20 An
my
L rge In
es
ine<div><br /></div><div><div>Fe
ures</div><div>S ccul
ins (h us

r )</div><div>{{c1::Aendices eilic }}-blbs f f
</div><div>{{c1::Teni c
li}} lngi
udin l ribbns f muscle</div><div><br /></div><div>{{c1::In
r eri

ne l}}  r
s</div><div>Tr nsverse cln</div><div>Sigmid cln</div><div><br />
</div><div>{{c1::Re
reri
ne l}}  r
s</div><div>Ascending cln</div><div>Des
cending cln</div><div>Rec
um</div></div><div><br /></div>
"<img src="" s

e-345255241056661.jg"" />"
8-20 An
my
"<img src=""2 1cc3 ff1c8d0228cf0f6 9298 3b2de42c 078_Q_0.svg"" />"
"<img sr
c=""2 1cc3 ff1c8d0228cf0f6 9298 3b2de42c 078_A_0.svg"" />"
"<img src=""2 1c
c3 ff1c8d0228cf0f6 9298 3b2de42c 078_surce_svg.svg"" />"
"<img src=""2 1c
c3 ff1c8d0228cf0f6 9298 3b2de42c 078_
mZw
c z.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_0.svg"" />"
"<img sr

c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_0.svg"" />"

55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_1.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_1.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_2.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_2.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_3.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_3.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_4.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_4.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_5.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_5.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_6.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_6.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_7.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_7.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""fef155e14717f34 e4cb752276ee2811f11c 52e_Q_8.svg""
c=""fef155e14717f34 e4cb752276ee2811f11c 52e_A_8.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_surce_svg.svg"" />"
55e14717f34 e4cb752276ee2811f11c 52e_
meOMAlf.ng"" />"
10-20 An
my
"<img src=""22 384cb2b615231d036f299e26b1087 0 5386_Q_0.svg""
c=""22 384cb2b615231d036f299e26b1087 0 5386_A_0.svg"" />"
84cb2b615231d036f299e26b1087 0 5386_surce_svg.svg"" />"
84cb2b615231d036f299e26b1087 0 5386_
mxX7qB4.ng"" />"
10-20 An
my
"<img src=""22 384cb2b615231d036f299e26b1087 0 5386_Q_1.svg""
c=""22 384cb2b615231d036f299e26b1087 0 5386_A_1.svg"" />"
84cb2b615231d036f299e26b1087 0 5386_surce_svg.svg"" />"
84cb2b615231d036f299e26b1087 0 5386_
mxX7qB4.ng"" />"
10-20 An
my
"<img src=""c61b7d8f7967 f13e17cf321473429bf873e10 6_Q_0.svg""
c=""c61b7d8f7967 f13e17cf321473429bf873e10 6_A_0.svg"" />"
7d8f7967 f13e17cf321473429bf873e10 6_surce_svg.svg"" />"
7d8f7967 f13e17cf321473429bf873e10 6_
mZHBsu2.ng"" />"
10-20 An
my
"<img src=""4e793e844353e2b3 f4f5946b1231ebf97 d9 3c_Q_0.svg""

"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""fef1
"<img src=""fef1
/>"
"<img sr
"<img src=""22 3
"<img src=""22 3
/>"
"<img sr
"<img src=""22 3
"<img src=""22 3
/>"
"<img sr
"<img src=""c61b
"<img src=""c61b
/>"

"<img sr

c=""4e793e844353e2b3 f4f5946b1231ebf97 d9 3c_A_0.svg"" />"

"<img
3e844353e2b3 f4f5946b1231ebf97 d9 3c_surce_svg.svg"" />"
"<img
3e844353e2b3 f4f5946b1231ebf97 d9 3c_
m1XgFh.ng"" />"
10-20 An
my
"<img src=""4e793e844353e2b3 f4f5946b1231ebf97 d9 3c_Q_1.svg"" />"
c=""4e793e844353e2b3 f4f5946b1231ebf97 d9 3c_A_1.svg"" />"
"<img
3e844353e2b3 f4f5946b1231ebf97 d9 3c_surce_svg.svg"" />"
"<img
3e844353e2b3 f4f5946b1231ebf97 d9 3c_
m1XgFh.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_0.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_0.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_1.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_1.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_2.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_2.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_3.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_3.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_4.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_4.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_5.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_5.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_6.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_6.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_7.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_7.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_8.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_8.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_9.svg"" />"
c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_9.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
"<img src=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_Q_10.svg"" />"

src=""4e79
src=""4e79
"<img sr
src=""4e79
src=""4e79
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr
src=""2b91
src=""2b91
"<img sr

c=""2b918 c dcdd 459729f8b475d4d5cb5 6 7 e48_A_10.svg"" />"

"<img src=""2b91
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_surce_svg.svg"" />"
"<img src=""2b91
8 c dcdd 459729f8b475d4d5cb5 6 7 e48_
m20mRq.ng"" />"
10-20 An
my
<div>O
her fe
ures</div><div><br /></div><div>{{c1::Tr nsylric}} l ne</div><
div>Level f &nbs;L1</div><div>Midw y be
ween jugul r n
ch nd ubic symhysis
</div><div><br /></div><div>S
ruc
ures n {{c1::
r nsylric}} l ne</div><div>G
llbl dder</div><div>Pylric shinc
er</div><div>( nd 
hers
 be discussed l

er)</div><div><br /></div><div>{{c1::Umbilicus}} ver
ebr l level L3-L4</div><div
><br /></div><div>{{c1::In
ersinus}} l ne- ssing
hrugh ASIS</div><div><br
/></div><div>{{c1::McBurneys in
}}</div><div>Incisin in
fr endix</div
><div>Si
e fr rebund
enderness</div><div><br /></div>
"<img src="" s

e-422272594608620.jg"" />"
8-20 An
my
"<img src=""469b b 8 261ff1488c6f68 26eb 8290fc57f1e_Q_0.svg"" />"
"<img sr
c=""469b b 8 261ff1488c6f68 26eb 8290fc57f1e_A_0.svg"" />"
"<img src=""469b
b 8 261ff1488c6f68 26eb 8290fc57f1e_surce_svg.svg"" />"
"<img src=""469b
b 8 261ff1488c6f68 26eb 8290fc57f1e_
mlXwPKO.ng"" />"
10-20 An
my
"<img src=""469b b 8 261ff1488c6f68 26eb 8290fc57f1e_Q_1.svg"" />"
"<img sr
c=""469b b 8 261ff1488c6f68 26eb 8290fc57f1e_A_1.svg"" />"
"<img src=""469b
b 8 261ff1488c6f68 26eb 8290fc57f1e_surce_svg.svg"" />"
"<img src=""469b
b 8 261ff1488c6f68 26eb 8290fc57f1e_
mlXwPKO.ng"" />"
10-20 An
my
"<img src=""2926 c2630393234498b738ded31268fb37df04c_Q_0.svg"" />"
"<img sr
c=""2926 c2630393234498b738ded31268fb37df04c_A_0.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_surce_svg.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_
msg3Q5u.ng"" />"
10-20 An
my
"<img src=""2926 c2630393234498b738ded31268fb37df04c_Q_1.svg"" />"
"<img sr
c=""2926 c2630393234498b738ded31268fb37df04c_A_1.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_surce_svg.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_
msg3Q5u.ng"" />"
10-20 An
my
"<img src=""2926 c2630393234498b738ded31268fb37df04c_Q_2.svg"" />"
"<img sr
c=""2926 c2630393234498b738ded31268fb37df04c_A_2.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_surce_svg.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_
msg3Q5u.ng"" />"
10-20 An
my
"<img src=""2926 c2630393234498b738ded31268fb37df04c_Q_3.svg"" />"
"<img sr
c=""2926 c2630393234498b738ded31268fb37df04c_A_3.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_surce_svg.svg"" />"
"<img src=""2926
c2630393234498b738ded31268fb37df04c_
msg3Q5u.ng"" />"
10-20 An
my
"<img src=""64b0b8f3f802 e53673c9 332337c0ec2c548093_Q_0.svg"" />"
"<img sr
c=""64b0b8f3f802 e53673c9 332337c0ec2c548093_A_0.svg"" />"
"<img src=""64b0
b8f3f802 e53673c9 332337c0ec2c548093_surce_svg.svg"" />"
"<img src=""64b0
b8f3f802 e53673c9 332337c0ec2c548093_
mW6QUL.ng"" />"
10-20 An
my
"<img src=""64b0b8f3f802 e53673c9 332337c0ec2c548093_Q_1.svg"" />"
"<img sr
c=""64b0b8f3f802 e53673c9 332337c0ec2c548093_A_1.svg"" />"
"<img src=""64b0
b8f3f802 e53673c9 332337c0ec2c548093_surce_svg.svg"" />"
"<img src=""64b0
b8f3f802 e53673c9 332337c0ec2c548093_
mW6QUL.ng"" />"
10-20 An
my
"<img src=""64b0b8f3f802 e53673c9 332337c0ec2c548093_Q_2.svg"" />"
"<img sr
c=""64b0b8f3f802 e53673c9 332337c0ec2c548093_A_2.svg"" />"
"<img src=""64b0
b8f3f802 e53673c9 332337c0ec2c548093_surce_svg.svg"" />"
"<img src=""64b0
b8f3f802 e53673c9 332337c0ec2c548093_
mW6QUL.ng"" />"
10-20 An
my
"<img src=""64b0b8f3f802 e53673c9 332337c0ec2c548093_Q_3.svg"" />"
"<img sr
c=""64b0b8f3f802 e53673c9 332337c0ec2c548093_A_3.svg"" />"
"<img src=""64b0

b8f3f802 e53673c9 332337c0ec2c548093_surce_svg.svg"" />"

b8f3f802 e53673c9 332337c0ec2c548093_
mW6QUL.ng"" />"
10-20 An
my
"<img src=""64b0b8f3f802 e53673c9 332337c0ec2c548093_Q_4.svg""
c=""64b0b8f3f802 e53673c9 332337c0ec2c548093_A_4.svg"" />"
b8f3f802 e53673c9 332337c0ec2c548093_surce_svg.svg"" />"
b8f3f802 e53673c9 332337c0ec2c548093_
mW6QUL.ng"" />"
10-20 An
my
"<img src=""64b0b8f3f802 e53673c9 332337c0ec2c548093_Q_5.svg""
c=""64b0b8f3f802 e53673c9 332337c0ec2c548093_A_5.svg"" />"
b8f3f802 e53673c9 332337c0ec2c548093_surce_svg.svg"" />"
b8f3f802 e53673c9 332337c0ec2c548093_
mW6QUL.ng"" />"
10-20 An
my
"<img src=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_Q_0.svg""
c=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_A_0.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_surce_svg.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_
mMSgWRN.ng"" />"
10-20 An
my
"<img src=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_Q_1.svg""
c=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_A_1.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_surce_svg.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_
mMSgWRN.ng"" />"
10-20 An
my
"<img src=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_Q_2.svg""
c=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_A_2.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_surce_svg.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_
mMSgWRN.ng"" />"
10-20 An
my
"<img src=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_Q_3.svg""
c=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_A_3.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_surce_svg.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_
mMSgWRN.ng"" />"
10-20 An
my
"<img src=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_Q_4.svg""
c=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_A_4.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_surce_svg.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_
mMSgWRN.ng"" />"
10-20 An
my
"<img src=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_Q_5.svg""
c=""1124e30fb6d5c01cb396d9f0e0e c7c3be333656_A_5.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_surce_svg.svg"" />"
e30fb6d5c01cb396d9f0e0e c7c3be333656_
mMSgWRN.ng"" />"
10-20 An
my
"<img src=""91d9eebd6746896d530725f6 1eff1 776094cb5_Q_0.svg""
c=""91d9eebd6746896d530725f6 1eff1 776094cb5_A_0.svg"" />"
eebd6746896d530725f6 1eff1 776094cb5_surce_svg.svg"" />"
eebd6746896d530725f6 1eff1 776094cb5_
mJj6IE
.ng"" />"
10-20 An
my
"<img src=""91d9eebd6746896d530725f6 1eff1 776094cb5_Q_1.svg""
c=""91d9eebd6746896d530725f6 1eff1 776094cb5_A_1.svg"" />"
eebd6746896d530725f6 1eff1 776094cb5_surce_svg.svg"" />"
eebd6746896d530725f6 1eff1 776094cb5_
mJj6IE
.ng"" />"
10-20 An
my
"<img src=""91d9eebd6746896d530725f6 1eff1 776094cb5_Q_2.svg""
c=""91d9eebd6746896d530725f6 1eff1 776094cb5_A_2.svg"" />"
eebd6746896d530725f6 1eff1 776094cb5_surce_svg.svg"" />"
eebd6746896d530725f6 1eff1 776094cb5_
mJj6IE
.ng"" />"
10-20 An
my
"<img src=""91d9eebd6746896d530725f6 1eff1 776094cb5_Q_3.svg""
c=""91d9eebd6746896d530725f6 1eff1 776094cb5_A_3.svg"" />"

"<img src=""64b0
/>"
"<img sr
"<img src=""64b0
"<img src=""64b0
/>"
"<img sr
"<img src=""64b0
"<img src=""64b0
/>"
"<img sr
"<img src=""1124
"<img src=""1124
/>"
"<img sr
"<img src=""1124
"<img src=""1124
/>"
"<img sr
"<img src=""1124
"<img src=""1124
/>"
"<img sr
"<img src=""1124
"<img src=""1124
/>"
"<img sr
"<img src=""1124
"<img src=""1124
/>"
"<img sr
"<img src=""1124
"<img src=""1124
/>"
"<img sr
"<img src=""91d9
"<img src=""91d9
/>"
"<img sr
"<img src=""91d9
"<img src=""91d9
/>"
"<img sr
"<img src=""91d9
"<img src=""91d9
/>"
"<img sr
"<img src=""91d9

eebd6746896d530725f6 1eff1 776094cb5_surce_svg.svg"" />"

"<img src=""91d9
eebd6746896d530725f6 1eff1 776094cb5_
mJj6IE
.ng"" />"
10-20 An
my
"<img src=""91d9eebd6746896d530725f6 1eff1 776094cb5_Q_4.svg"" />"
"<img sr
c=""91d9eebd6746896d530725f6 1eff1 776094cb5_A_4.svg"" />"
"<img src=""91d9
eebd6746896d530725f6 1eff1 776094cb5_surce_svg.svg"" />"
"<img src=""91d9
eebd6746896d530725f6 1eff1 776094cb5_
mJj6IE
.ng"" />"
10-20 An
my
<div>
his is
he gener l scheme f nerves s
hey suly
he bdy w ll in
he
h
r x nd bdmen. N
ice
h

he nerves will run be
ween
he {{c1::secnd}} nd

he {{c1::
hird}} l yers f muscul
ure. Als n
ice
h


he mid xill ry l
ine
hey will give rise

{{c1::l
er l cu
neus br nch}}
h
rises

he
surf ce f
he skin
 suly i
. Addi
in lly ne r
he midline
here will be n
{{c1:: n
erir cu
neus br nch}}
h
m kes i
s w y

he surf ce
 suly

he skin. Re lize
h
e ch f
hese nerves d NOT run in hrizn
l l ne. The
ribs ( nd cnsequen
ly
he my
mes nd derm
mes) will sl n
dwnw rd s
hey
m ke
heir w y frm s
erir si
in ne r
he ver
ebr e
 n n
erir si

in ne r
he s
ernum.</div><div><br /></div> "<img src="" s
e-42242291846402
8.jg"" />"
8-20 An
my
<div>: n
ice
h
m ny (if n
ll) f
he in
ercs
l nerves ( nd T12, nd L1
nd s well) will give rise

{{c1::secnd ry cll
er l br nch}}
h
suli
es
he s me in
ercs
l s ce.</div><div><br /></div><div>&nbs;The rim ry br n
ch will hug
he {{c1::under}}surf ce f
he rib, nd
he cll
er l br nch will
be fund lng
he {{c1::suerir}} edge f
he rib belw.&nbs;</div><div><br /
></div><div>Therefre e ch my
me nd derm
me will be sulied by
w br nche
s rising frm
he s me sin l nerve (redund ncy is gd). The m in br nch f
h
e in
erc s
l nerves
ends
 be li

le bi
l rger.&nbs;</div><div><br /></d
iv>
"<img src="" s
e-422556062450204.jg"" />"
8-20 An
my
<div>n
ice
h

he in
ercs
l nerves T2 T11 ( nd T12) re rel
ively bring.
Beginning
L1 we will &nbs;begin
 see frm
in f
he lumb r lexus. N
ic
e hw
he L1 fiber will sli
nd give ff cll
er l br nch. These
w br nch
es re
he iliinguin l nd ilihyg s
ric nerves. The iliinguin l nd ilihy
g s
ric nerves suly
he {{c1::L1}} derm
me f
he n
erir bdmin l w ll.
The iliinguin l nerve c n be fund in
he inguin l c n l. I

yic lly m kes i

s w y
w rd
he surf ce f
he skin by  ssing
hrugh
he {{c1::suerfici l in
guin l ring}}. &nbs;The {{c1::iliinguin l}} nerve sulies
he skin f
he su
erir sec
f
he scr
um nd l bi m jr . The nerve suly

he 
her r

ins f
he scr
um nd l bi m jr cme frm
he {{c1::udend l}} nerve (S2, S
3, S4) nd will be discussed l
er.&nbs;</div><div><br /></div>
"<img sr
c="" s
e-422611897025052.jg"" />"
8-20 An
my
"<div>: N
ice in
his view f
he n
erir bdmin l w ll we see
he
w br nch
es f L1 s
hey m ke
heir w y
w rd
he midline s
hey c n rise

he surf
ce f
he skin
 becme n
erir cu
neus br nches. The ne
h
is mre infer
ir is
he {{c1::iliinguin l}} nerve. N
ice
he gener l dwnw rd sle f
he
nerves s
hey
r verse frm s
erir
 n
erir. The iliinguin l c n frequen

ly be fund  ssing
hrugh
he {{c1::suerfici l inguin l ring}}. The iliingu
in l nerve will suly sens
in

he suerir sec
s f
he scr
um nd
he
l bi m jr .</div><div><img src="" s
e-422783695716892.jg"" /></div>"
8-20 An
my
"<img src=""547 8748d929 295631fe 54d95f6e048d3dd648_Q_0.svg"" />"
"<img sr
c=""547 8748d929 295631fe 54d95f6e048d3dd648_A_0.svg"" />"
"<img src=""547
8748d929 295631fe 54d95f6e048d3dd648_surce_svg.svg"" />"
"<img src=""547
8748d929 295631fe 54d95f6e048d3dd648_
mf3ziry.ng"" />"
"<img src=""547 8748d929 295631fe 54d95f6e048d3dd648_Q_1.svg"" />"
"<img sr
c=""547 8748d929 295631fe 54d95f6e048d3dd648_A_1.svg"" />"
"<img src=""547
8748d929 295631fe 54d95f6e048d3dd648_surce_svg.svg"" />"
"<img src=""547
8748d929 295631fe 54d95f6e048d3dd648_
mf3ziry.ng"" />"
"<img src=""547 8748d929 295631fe 54d95f6e048d3dd648_Q_2.svg"" />"
"<img sr
c=""547 8748d929 295631fe 54d95f6e048d3dd648_A_2.svg"" />"
"<img src=""547
8748d929 295631fe 54d95f6e048d3dd648_surce_svg.svg"" />"
"<img src=""547

8748d929 295631fe 54d95f6e048d3dd648_
mf3ziry.ng"" />"

"<img src=""547 8748d929 295631fe 54d95f6e048d3dd648_Q_3.svg"" />"
c=""547 8748d929 295631fe 54d95f6e048d3dd648_A_3.svg"" />"
"<img
8748d929 295631fe 54d95f6e048d3dd648_surce_svg.svg"" />"
"<img
8748d929 295631fe 54d95f6e048d3dd648_
mf3ziry.ng"" />"
"<img src=""547 8748d929 295631fe 54d95f6e048d3dd648_Q_4.svg"" />"
c=""547 8748d929 295631fe 54d95f6e048d3dd648_A_4.svg"" />"
"<img
8748d929 295631fe 54d95f6e048d3dd648_surce_svg.svg"" />"
"<img
8748d929 295631fe 54d95f6e048d3dd648_
mf3ziry.ng"" />"
"<img src=""547 8748d929 295631fe 54d95f6e048d3dd648_Q_5.svg"" />"
c=""547 8748d929 295631fe 54d95f6e048d3dd648_A_5.svg"" />"
"<img
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"<img
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"<img

"<img sr
src=""547
src=""547
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src=""547
src=""547
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src=""547
src=""547
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src=""14e6
src=""14e6
"<img sr
src=""14e6
src=""14e6
"<img sr
src=""14e6
src=""14e6
"<img sr
src=""14e6
src=""14e6
"<img sr
src=""14e6
src=""14e6
"<img sr
src=""14e6
src=""14e6
"<img sr
src=""14e6
src=""14e6
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src=""14e6
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"<img src=""14e68c76fb9373163d270 4828cc48631e65d3f1_Q_12.svg"" />"
"<img sr
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"<img src=""14e6
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"<img src=""14e6
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The fregu
will include {{c1::
he s
m ch,
he firs
nd secnd s
ges f
he d
udenum,
he sleen,  ncre s, nd liver.&nbs;}}
The midgu
will include
he {{c1::secnd,
hird nd fur
h s
ges f
he dudenu
m,
he jujuneum, ileum, scending cln nd
he firs
2/3 f
he
r nsverse cl
n.}}&nbs;
The secnd s
ge f
he dudenum is
r nsi
in in
be
ween {{c1::fregu
nd
midgu
}}. As

r nsi
in in
, i
will
yic lly receive bld suly frm b

h
he {{c1::celi c
runk nd
he suerir mesen
eric r
eries.}}
The hindgu
will include {{c1::
he dis
l 1/3 f
he
r nsverse cln,
he desce
nding cln, sigmid cln, rec
um nd n l c n l.&nbs;}}
Bec use f i
s size, lc
in, nd embrylgic l rigin,
here is cer
in re
f
he liver
h
is n
cvered by eri
neum. This re is knwn s
he {{c1:
:b re re f
he liver.&nbs;}}
"<img src=""192b41346e5eb0bd4175b4e0f465 927dc1 1f64_Q_0.svg"" />"
"<img sr
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b41346e5eb0bd4175b4e0f465 927dc1 1f64_Q_1.svg"" />"
"<img sr
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b41346e5eb0bd4175b4e0f465 927dc1 1f64_Q_3.svg"" />"
"<img sr
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b41346e5eb0bd4175b4e0f465 927dc1 1f64_Q_4.svg"" />"
"<img sr
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"<img src=""192b
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"<img src=""192b
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"<img sr
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b41346e5eb0bd4175b4e0f465 927dc1 1f64_Q_6.svg"" />"
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"<img src=""192b
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"<img src=""192b
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"<img src=""192b
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"<img
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"<img
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"<img
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"<img
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"<img
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"<img src=""835297625b99593 f 371b66839c1474c252d2 6_Q_0.svg"" />"
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"<img
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"<img src=""53c093b89022de2d444785043f3cee7873bb7db2_Q_6.svg"" />"
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"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_1.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_1.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_2.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_2.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_3.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_3.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_4.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_4.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_5.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_5.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_6.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_6.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_7.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_7.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_8.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_8.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_9.svg""
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_9.svg"" />"

"<img src=""53c0
/>"
"<img sr
"<img src=""53c0
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"<img src=""53c0
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"<img src=""fe1f
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"<img src=""fe1f
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"<img src=""4 4
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"<img src=""4 4
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"<img src=""4 4
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"<img sr
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"<img src=""4 4
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"<img sr
"<img src=""4 4

dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"

"<img src=""4 4
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_Q_10.svg"" />"
"<img sr
c=""4 4 dbb6294b4f1 5e06f4e30c5871400b802797_A_10.svg"" />"
"<img src=""4 4
dbb6294b4f1 5e06f4e30c5871400b802797_surce_svg.svg"" />"
"<img src=""4 4
dbb6294b4f1 5e06f4e30c5871400b802797_
meyrsly.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_0.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_0.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_1.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_1.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_2.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_2.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_3.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_3.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_4.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_4.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_5.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_5.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
"<img src=""cc5960 c7 565542db29 c6b9cec c380b6d0664_Q_6.svg"" />"
"<img sr
c=""cc5960 c7 565542db29 c6b9cec c380b6d0664_A_6.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_surce_svg.svg"" />"
"<img src=""cc59
60 c7 565542db29 c6b9cec c380b6d0664_
m8zsb2b.ng"" />"
The lines f eri
ne l reflec
in re se r
ed by s ce nd re n
ne r e ch

her. As cnsequence, sme f
he lig men
s f
he liver re single l yer f
eri
neum r
her
h n
he
yic l duble l yer. These single l yer lig men
s en
circle
he
 f
he liver much like
crwn nd re n med {{c1::crn ry lig m
en
s}}.&nbs;<div><br /></div><div>Where
he single l yered crn ry lig men
s
r ch e ch 
her nd es
blish duble l yer f eri
neum-
his we will c ll

he {{c1::righ
nd lef

ri ngul r lig men
s}}.</div>
<div>The slenic r
ery is ms
e sily iden
ified by i
s
r
uus sh e, nd i
s
si
in lng
he {{c1::suerir}} brder f
he bdy f
he  ncre s.&nbs;</
div><div><br /></div>
"<img src=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_Q_0.svg"" />"
"<img sr
c=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_A_0.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_surce_svg.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_
mh
lfc.ng"" />"
"<img src=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_Q_1.svg"" />"
"<img sr
c=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_A_1.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_surce_svg.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_
mh
lfc.ng"" />"
"<img src=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_Q_2.svg"" />"
"<img sr
c=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_A_2.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_surce_svg.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_
mh
lfc.ng"" />"
"<img src=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_Q_3.svg"" />"
"<img sr
c=""24f5ebdc7d99c7c7f84b6ff 2 05465b5840211_A_3.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_surce_svg.svg"" />"
"<img src=""24f5
ebdc7d99c7c7f84b6ff 2 05465b5840211_
mh
lfc.ng"" />"

"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_0.svg"" />"

"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_0.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_1.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_1.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_2.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_2.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_3.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_3.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_4.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_4.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_5.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_5.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_6.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_6.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_7.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_7.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_8.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_8.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_9.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_9.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
"<img src=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_Q_10.svg"" />"
"<img sr
c=""d871bc1588f5948ee16e6d2 91b900 7b8b59dfb_A_10.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_surce_svg.svg"" />"
"<img src=""d871
bc1588f5948ee16e6d2 91b900 7b8b59dfb_
myu2rvx.ng"" />"
N me
he
r
eries
<div>The l rge g s
rduden l r
ery will  ss s
erir

he {{c1::ylric s
hin
er/1s
s
ge f dudenum}}.</div><div><br /></div>
<div>Like
he 2nd s
ge f
he dudenum,
he  ncre s will ge
bld suly frm
b
h
he {{c1::celi c
runk}} nd
he {{c1::suerir mesen
eric r
ery}}.</div>
<div><br /></div>

"<img src=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_Q_0.svg"" />"

"<img sr
c=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_A_0.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_surce_svg.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_
mlmx41m.ng"" />"
N me
he
r
eries
"<img src=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_Q_1.svg"" />"
"<img sr
c=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_A_1.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_surce_svg.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_
mlmx41m.ng"" />"
N me
he
r
eries
"<img src=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_Q_2.svg"" />"
"<img sr
c=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_A_2.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_surce_svg.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_
mlmx41m.ng"" />"
N me
he
r
eries
"<img src=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_Q_3.svg"" />"
"<img sr
c=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_A_3.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_surce_svg.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_
mlmx41m.ng"" />"
N me
he
r
eries
"<img src=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_Q_4.svg"" />"
"<img sr
c=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_A_4.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_surce_svg.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_
mlmx41m.ng"" />"
N me
he
r
eries
"<img src=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_Q_5.svg"" />"
"<img sr
c=""e5b72cf30357e11ff74e5c6e100193c5881 9bf3_A_5.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_surce_svg.svg"" />"
"<img src=""e5b7
2cf30357e11ff74e5c6e100193c5881 9bf3_
mlmx41m.ng"" />"
N me
he
r
eries
"The suerir mesen
eric r
ery will be si
ined be
ween
he {{c1::neck f
he
 ncre s}} nd
he {{c1::uncin
e rcess f
he  ncre s}}.&nbs;<div><img src
="" s
e-150998165225473.jg"" /></div>"
"<img src=""f e02cb023779995b 117ce81eb4158649257fb_Q_0.svg"" />"
"<img sr
c=""f e02cb023779995b 117ce81eb4158649257fb_A_0.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_surce_svg.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_
mfjrvh.ng"" />"
N me
he
r
eries
"<img src=""f e02cb023779995b 117ce81eb4158649257fb_Q_1.svg"" />"
"<img sr
c=""f e02cb023779995b 117ce81eb4158649257fb_A_1.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_surce_svg.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_
mfjrvh.ng"" />"
N me
he
r
eries
"<img src=""f e02cb023779995b 117ce81eb4158649257fb_Q_2.svg"" />"
"<img sr
c=""f e02cb023779995b 117ce81eb4158649257fb_A_2.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_surce_svg.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_
mfjrvh.ng"" />"
N me
he
r
eries
"<img src=""f e02cb023779995b 117ce81eb4158649257fb_Q_3.svg"" />"
"<img sr
c=""f e02cb023779995b 117ce81eb4158649257fb_A_3.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_surce_svg.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_
mfjrvh.ng"" />"
N me
he
r
eries
"<img src=""f e02cb023779995b 117ce81eb4158649257fb_Q_4.svg"" />"
"<img sr
c=""f e02cb023779995b 117ce81eb4158649257fb_A_4.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_surce_svg.svg"" />"
"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_
mfjrvh.ng"" />"
N me
he
r
eries
"<img src=""f e02cb023779995b 117ce81eb4158649257fb_Q_5.svg"" />"
"<img sr
c=""f e02cb023779995b 117ce81eb4158649257fb_A_5.svg"" />"
"<img src=""f e

02cb023779995b 117ce81eb4158649257fb_surce_svg.svg"" />"

"<img src=""f e
02cb023779995b 117ce81eb4158649257fb_
mfjrvh.ng"" />"
N me
he
r
eries
<div>The u
nmic nerves in
he fregu

ke n
he n me f
he vessel which
h
ey surrund (i.e. he
ic lexus). Plexus fibers will be cnsidered
 be {{c1::
s
syn 
ic sym
he
ic}} (h ving syn sed in
he rever
ebr l g ngli ), {{c1::
resyn 
ic  r sym
he
ic}} (h ving ye

 h ve syn sed in
he in
r mur l g n
gli ), nd {{c1::viscer l fferen
}} (c rrying sensry infrm
in b ck

he c
rresnding ver
ebr l levels).</div><div><br /></div>
"<img src=""7f090f9e1 f639151596bb5300910003e5822218_Q_0.svg"" />"
"<img sr
c=""7f090f9e1 f639151596bb5300910003e5822218_A_0.svg"" />"
"<img src=""7f09
0f9e1 f639151596bb5300910003e5822218_surce_svg.svg"" />"
"<img src=""7f09
0f9e1 f639151596bb5300910003e5822218_
mv7cu1r.ng"" />"
N me
he
r
eries
"<img src=""7f090f9e1 f639151596bb5300910003e5822218_Q_1.svg"" />"
"<img sr
c=""7f090f9e1 f639151596bb5300910003e5822218_A_1.svg"" />"
"<img src=""7f09
0f9e1 f639151596bb5300910003e5822218_surce_svg.svg"" />"
"<img src=""7f09
0f9e1 f639151596bb5300910003e5822218_
mv7cu1r.ng"" />"
N me
he
r
eries
The n
ches which re
yic lly fund n
he suerir/ n
erir brder f
he sl
een re remn n
s f
he {{c1::mul
ilbul r embrynic frm
in}} f
he sleen.&
nbs;
"<img src=""7b582c1b34 0d5f3731c6d0b2c47b2b0580d009c_Q_0.svg"" />"
"<img sr
c=""7b582c1b34 0d5f3731c6d0b2c47b2b0580d009c_A_0.svg"" />"
"<img src=""7b58
2c1b34 0d5f3731c6d0b2c47b2b0580d009c_surce_svg.svg"" />"
"<img src=""7b58
2c1b34 0d5f3731c6d0b2c47b2b0580d009c_
mg kfi.ng"" />"
N me
he
r
eries
"<img src=""7b582c1b34 0d5f3731c6d0b2c47b2b0580d009c_Q_1.svg"" />"
"<img sr
c=""7b582c1b34 0d5f3731c6d0b2c47b2b0580d009c_A_1.svg"" />"
"<img src=""7b58
2c1b34 0d5f3731c6d0b2c47b2b0580d009c_surce_svg.svg"" />"
"<img src=""7b58
2c1b34 0d5f3731c6d0b2c47b2b0580d009c_
mg kfi.ng"" />"
N me
he
r
eries
"The deressin n
he viscer l surf ce f
he sleen which is clses


he n

ches will be fr
he rel
inshi wi
h
he {{c1::s
m ch}}. The deressin n

he viscer l surf ce which is fur
hes
w y frm
he n
ches is fr
he rel
ins
hi wi
h
he {{c1::kidney}}. The slenic flexure f
he {{c1::cln}} will rel

e

he sleen n
he 
her viscer l deressin.&nbs;<div><img src="" s
e-169
827301851137.jg"" /></div>"
The slenic vein  sses {{c1::suerir/ n
erir}}

he suerir mesen
eric r

ery, while
he lef
ren l vein will  ss {{c1::s
erir}}

he SMA
"<img src=""110c41d9bc042f8b0259f9dd13 3839 fed2ec4 _Q_0.svg"" />"
"<img sr
c=""110c41d9bc042f8b0259f9dd13 3839 fed2ec4 _A_0.svg"" />"
"<img src=""110c
41d9bc042f8b0259f9dd13 3839 fed2ec4 _surce_svg.svg"" />"
"<img src=""110c
41d9bc042f8b0259f9dd13 3839 fed2ec4 _
mhehr
b.ng"" />"
N me
he
r
eries
"<img src=""110c41d9bc042f8b0259f9dd13 3839 fed2ec4 _Q_1.svg"" />"
"<img sr
c=""110c41d9bc042f8b0259f9dd13 3839 fed2ec4 _A_1.svg"" />"
"<img src=""110c
41d9bc042f8b0259f9dd13 3839 fed2ec4 _surce_svg.svg"" />"
"<img src=""110c
41d9bc042f8b0259f9dd13 3839 fed2ec4 _
mhehr
b.ng"" />"
N me
he
r
eries
"<img src=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_Q_0.svg"" />"
"<img sr
c=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_A_0.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_surce_svg.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_
m5gfkhm.ng"" />"
N me
he
r
eries
"<img src=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_Q_1.svg"" />"
"<img sr
c=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_A_1.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_surce_svg.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_
m5gfkhm.ng"" />"
N me
he
r
eries

"<img src=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_Q_2.svg"" />"

"<img sr
c=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_A_2.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_surce_svg.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_
m5gfkhm.ng"" />"
N me
he
r
eries
"<img src=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_Q_3.svg"" />"
"<img sr
c=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_A_3.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_surce_svg.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_
m5gfkhm.ng"" />"
N me
he
r
eries
"<img src=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_Q_4.svg"" />"
"<img sr
c=""6 bc587f1d42568f5 3164590ff0959d6c7b4fec_A_4.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_surce_svg.svg"" />"
"<img src=""6 bc
587f1d42568f5 3164590ff0959d6c7b4fec_
m5gfkhm.ng"" />"
N me
he
r
eries
Wh
lbe exis
s be
ween
he g llbl dder nd f lcifrm lig men
?
qu dr
e
lb
Wh
runs be
ween
he c ud
e lbe nd lef
lb?
lig men
um vensum
Qu dr
e nd c ud
e lbes re func
in lly  r
f
he _________ lbe f
he li
ver
Lef
. They re sulied by
he lef
r
in f
he bili ry
ree nd
hus
re func
in lly  r
f
he lef
lbe
N me
he brders f
he b re re f
he liver Suerir crn ry lig men
, infe
rir crn ry lig men
, lef

ri ngul r lig men
, righ

ri ngul r lig men

Wh
vessels dr in
he liver nd where d
hese vessels dr in in
?
he
ic
veins which dr in in
 IVC
The sleen is cnnec
ed

he s
erir w ll vi
he ________. Wh
des
his l
ig men
cn
in?
lienren l lig men
<div>slenic vessels nd
il f  nc
re s</div>
Wh
cnnec
s
he sleen

he s
m ch? Wh
des
his lig men
cn
in?
g s
rslenic lig men
<div>shr
g s
rics, lef
g s
reilic r
ery</div>
Wh
is
he sm lles
br nch f
he celi c
runk?
lef
g s
ric r
ery
Shr
g s
ric r
er
ies rise frm __________ slenic r
ery
The cmmn he
ic r
ery gives rise
 wh
3 r
eries?
he
ic rer<d
iv>righ
g s
ric r
ery</div><div>g s
rduden l r
ery</div>
The g s
rduden l r
ery gives rise
 wh
2 br nches?
righ
g s
rei
lic r
ery<div>suerir  ncre
icduden l r
ery</div>
Wh
is r
l sys
em?
when c ill ry bed dr ins in
 n
her c ill
ry bed
hrugh veins wi
hu
firs
 ssing
hrugh
he he r

The he
ic r
l sys
em receives i
s venus dr in ge frm _________ diges
iv
e
r c

Wh
vessels dr in in

he he
ic r
l vein?
"1. suerir mesen
eric
vein<div>2. inferir mesen
eric vein</div><div>3. slenic vein</div><div><br /><
/div><div><img src="" s
e-7915624726913.jg"" /></div>"
Pr
l hyer
ensin c n cmrmise bld flw nd c use bld
 be reru
ed


he IVC
hrugh which enl rged veins? 1. esh ge l<div>2.  r umbilic l veins
</div><div>3. veins in bdy w ll</div><div>4. rec
l veins</div>
<div>Ile l Diver
iculum (Meckels diver
iculum)</div><div><br /></div><div><div>Re
mn n
f {{c1::vi
elline duc
}}</div><div>Fund in {{c1::2}}% f ul
in</div
><div>Lc
ed wi
hin 2 fee
f ilecec l junc
in (n n
imesen
eric surf ce f
ileum)</div><div>2 inches lng</div><div>M y cn
in 2 ec
ic
issue
yes  nc
re
ic r g s
ric
issues</div><div><br /></div><div>If resen
,
hen 25% m y be


ched

he {{c1::umbilicus}} nd m y serve s surce fr
wis
ing r s
r
ngul
ins f
he ls f
he sm ll in
es
ine.</div></div><div><br /></div>
"<img src="" s
e-264930762686858.jg"" /><div><img src="" s
e-264952237523484.
jg"" /></div>" 10-30 An
my
"<img src="" 31595f39724d461e 88 1718c898fc9f902b818_Q_0.svg"" />"
"<img sr
c="" 31595f39724d461e 88 1718c898fc9f902b818_A_0.svg"" />"
"<img src="" 315
95f39724d461e 88 1718c898fc9f902b818_surce_svg.svg"" />"
"<img src="" 315
95f39724d461e 88 1718c898fc9f902b818_
mwQhCme.ng"" />"
Iden
ify + Bld
Suly nd Sec
ins
10-30 An
my

"<img src="" 31595f39724d461e 88 1718c898fc9f902b818_Q_1.svg"" />"

"<img sr
c="" 31595f39724d461e 88 1718c898fc9f902b818_A_1.svg"" />"
"<img src="" 315
95f39724d461e 88 1718c898fc9f902b818_surce_svg.svg"" />"
"<img src="" 315
95f39724d461e 88 1718c898fc9f902b818_
mwQhCme.ng"" />"
Iden
ify + Bld
Suly nd Sec
ins
10-30 An
my
"<img src="" 31595f39724d461e 88 1718c898fc9f902b818_Q_2.svg"" />"
"<img sr
c="" 31595f39724d461e 88 1718c898fc9f902b818_A_2.svg"" />"
"<img src="" 315
95f39724d461e 88 1718c898fc9f902b818_surce_svg.svg"" />"
"<img src="" 315
95f39724d461e 88 1718c898fc9f902b818_
mwQhCme.ng"" />"
Iden
ify + Bld
Suly nd Sec
ins
10-30 An
my
<div>If yu lk clsely

he
w edges f
he scending nd descending cln,
yu c n see
h

he {{c1::medi l}} (rigin lly mesen
eric) edge cn
ins
cn
sider ble number f r
eries nd veins. In cn
r s
,
he {{c1::l
er l}} (rigin
lly n
imesen
eric) edge is devid f v scul
ure.&nbs;</div><div><br /></div>
<div>Surgens c n
ke dv n
ge f
his si
u
in nd m ke
surgic l incisin
in
he {{c1:: r clic gu

er}}, lng
he {{c1::whi
e line f Tld
}}, nd h ve
rel
ively bldless l ne f incisin. They c n
hen reflec

he l rge in
es

ine ( nd i
s ssci
ed v scul
ure)

he si
e side nd h ve rel
ively f
ree ccess

he re
reri
ne l s
ruc
ures (ure
ers, IVC, r
, e
c)&nbs;</d
iv><div><br /></div>
"<img src="" s
e-296928269042150.jg"" />"
10-30 An

my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_0.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_0.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_1.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_1.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_2.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_2.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_3.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_3.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_4.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_4.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_5.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_5.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""073290d534662b1eec7860e 85f10943412fdcd7_Q_6.svg"" />"
"<img sr
c=""073290d534662b1eec7860e 85f10943412fdcd7_A_6.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_surce_svg.svg"" />"
"<img src=""0732
90d534662b1eec7860e 85f10943412fdcd7_
mhLU2SP.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_0.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_0.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"

10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_1.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_1.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_2.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_2.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_3.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_3.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_4.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_4.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_5.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_5.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_6.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_6.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
"<img src=""e 215 d018d37c 36f9db119766bd7c7 803e2c_Q_7.svg"" />"
"<img sr
c=""e 215 d018d37c 36f9db119766bd7c7 803e2c_A_7.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_surce_svg.svg"" />"
"<img src=""e 21
5 d018d37c 36f9db119766bd7c7 803e2c_
mBVWl3Q.ng"" />"
10-30 An
my
The hindgu
is sulied by br nches f
he {{c1::inferir mesen
eric r
ery}}. W
hile
he suerir mesen
eric r
ery rises frm
he r
ne r
he celi c
runk
( rx. {{c1::L1}}). The inferir mesen
eric rises frm
he r
much lwer (
"<img src="" s
e-329415401669093.jg"" />"
10-30 An
rx. {{c1::L3}})

my
"<img src=""0d be881eee34fe3bee33b4e203de192c3873435_Q_0.svg"" />"
"<img sr
c=""0d be881eee34fe3bee33b4e203de192c3873435_A_0.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_surce_svg.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_
mQw73Ue.ng"" />"
10-30 An
my
"<img src=""0d be881eee34fe3bee33b4e203de192c3873435_Q_1.svg"" />"
"<img sr
c=""0d be881eee34fe3bee33b4e203de192c3873435_A_1.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_surce_svg.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_
mQw73Ue.ng"" />"
10-30 An
my
"<img src=""0d be881eee34fe3bee33b4e203de192c3873435_Q_2.svg"" />"
"<img sr
c=""0d be881eee34fe3bee33b4e203de192c3873435_A_2.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_surce_svg.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_
mQw73Ue.ng"" />"
10-30 An
my
"<img src=""0d be881eee34fe3bee33b4e203de192c3873435_Q_3.svg"" />"
"<img sr
c=""0d be881eee34fe3bee33b4e203de192c3873435_A_3.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_surce_svg.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_
mQw73Ue.ng"" />"

10-30 An
my
"<img src=""0d be881eee34fe3bee33b4e203de192c3873435_Q_4.svg"" />"
"<img sr
c=""0d be881eee34fe3bee33b4e203de192c3873435_A_4.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_surce_svg.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_
mQw73Ue.ng"" />"
10-30 An
my
"<img src=""0d be881eee34fe3bee33b4e203de192c3873435_Q_5.svg"" />"
"<img sr
c=""0d be881eee34fe3bee33b4e203de192c3873435_A_5.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_surce_svg.svg"" />"
"<img src=""0d b
e881eee34fe3bee33b4e203de192c3873435_
mQw73Ue.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_0.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_0.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_1.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_1.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_2.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_2.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_3.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_3.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_4.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_4.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_5.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_5.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
"<img src=""73e874ef7b38df 34 14234fccd44756cf620bd _Q_6.svg"" />"
"<img sr
c=""73e874ef7b38df 34 14234fccd44756cf620bd _A_6.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _surce_svg.svg"" />"
"<img src=""73e8
74ef7b38df 34 14234fccd44756cf620bd _
mMK
W07.ng"" />"
10-30 An
my
<div>The sm ll in
es
ine underges
r
her gr du l
r nsi
in s i
rgresses
frm
he fregu


he hindgu
. One f
he visu l clues
h
c n hel dis
ingui
sh
he jejunum frm
he ileum is
he br nching 

ern f
he r
eri l suly. T
his clue m y be  r
icul rly helful when n ev lu
ing n r
erigr m.</div><di
v><br /></div><div>The bes
clue is
 lk

he levels (number) f v scul r
rc des. While
he r
eri l suly

he jejunum will
yic lly h ve ne level 
f rel
ively {{c1::l rge rching rc de}},
he ileum will
yic lly h ve {{c1:
:sever l l yers f sm ller rc des}}.&nbs;</div><div><br /></div><div>In my i
nin,
he leng
h f
he {{c1::v s rec
}} r
eries re
 simil r
 reli bly
use s de
ermining f c
r.&nbs;</div>
"<img src="" s
e-41428395543805
2.jg"" />"
10-30 An
my
"<img src=""fb67f413223 8fb742f2ff001bc9e94e99547 bb_Q_0.svg"" />"
"<img sr
c=""fb67f413223 8fb742f2ff001bc9e94e99547 bb_A_0.svg"" />"
"<img src=""fb67
f413223 8fb742f2ff001bc9e94e99547 bb_surce_svg.svg"" />"
"<img src=""fb67

f413223 8fb742f2ff001bc9e94e99547 bb_
mmUreBb.ng"" />"

10-30 An
my
"<img src=""fb67f413223 8fb742f2ff001bc9e94e99547 bb_Q_1.svg""
c=""fb67f413223 8fb742f2ff001bc9e94e99547 bb_A_1.svg"" />"
f413223 8fb742f2ff001bc9e94e99547 bb_surce_svg.svg"" />"
f413223 8fb742f2ff001bc9e94e99547 bb_
mmUreBb.ng"" />"
10-30 An
my
"<img src=""fb67f413223 8fb742f2ff001bc9e94e99547 bb_Q_2.svg""
c=""fb67f413223 8fb742f2ff001bc9e94e99547 bb_A_2.svg"" />"
f413223 8fb742f2ff001bc9e94e99547 bb_surce_svg.svg"" />"
f413223 8fb742f2ff001bc9e94e99547 bb_
mmUreBb.ng"" />"
10-30 An
my
"<img src=""41c27c22bb775cf2bc30 4bbde3235e18e00d55d_Q_0.svg""
c=""41c27c22bb775cf2bc30 4bbde3235e18e00d55d_A_0.svg"" />"
7c22bb775cf2bc30 4bbde3235e18e00d55d_surce_svg.svg"" />"
7c22bb775cf2bc30 4bbde3235e18e00d55d_
mfNLF.ng"" />"
10-30 An
my
"<img src=""561fb0c2c ce108545cdb21f8 d3237d07340e21_Q_0.svg""
c=""561fb0c2c ce108545cdb21f8 d3237d07340e21_A_0.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_surce_svg.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_
mvR dkF.ng"" />"
10-30 An
my
"<img src=""561fb0c2c ce108545cdb21f8 d3237d07340e21_Q_1.svg""
c=""561fb0c2c ce108545cdb21f8 d3237d07340e21_A_1.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_surce_svg.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_
mvR dkF.ng"" />"
10-30 An
my
"<img src=""561fb0c2c ce108545cdb21f8 d3237d07340e21_Q_2.svg""
c=""561fb0c2c ce108545cdb21f8 d3237d07340e21_A_2.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_surce_svg.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_
mvR dkF.ng"" />"
10-30 An
my
"<img src=""561fb0c2c ce108545cdb21f8 d3237d07340e21_Q_3.svg""
c=""561fb0c2c ce108545cdb21f8 d3237d07340e21_A_3.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_surce_svg.svg"" />"
b0c2c ce108545cdb21f8 d3237d07340e21_
mvR dkF.ng"" />"
10-30 An
my
"<img src=""c79cd66d397e316 9900bfb 947299342888572b_Q_0.svg""
c=""c79cd66d397e316 9900bfb 947299342888572b_A_0.svg"" />"
d66d397e316 9900bfb 947299342888572b_surce_svg.svg"" />"
d66d397e316 9900bfb 947299342888572b_
mlssedq.ng"" />"
10-30 An
my
"<img src=""c79cd66d397e316 9900bfb 947299342888572b_Q_1.svg""
c=""c79cd66d397e316 9900bfb 947299342888572b_A_1.svg"" />"
d66d397e316 9900bfb 947299342888572b_surce_svg.svg"" />"
d66d397e316 9900bfb 947299342888572b_
mlssedq.ng"" />"
10-30 An
my
"<img src=""c79cd66d397e316 9900bfb 947299342888572b_Q_2.svg""
c=""c79cd66d397e316 9900bfb 947299342888572b_A_2.svg"" />"
d66d397e316 9900bfb 947299342888572b_surce_svg.svg"" />"
d66d397e316 9900bfb 947299342888572b_
mlssedq.ng"" />"
10-30 An
my
"<img src=""c79cd66d397e316 9900bfb 947299342888572b_Q_3.svg""
c=""c79cd66d397e316 9900bfb 947299342888572b_A_3.svg"" />"
d66d397e316 9900bfb 947299342888572b_surce_svg.svg"" />"
d66d397e316 9900bfb 947299342888572b_
mlssedq.ng"" />"
10-30 An
my
"<img src=""c294f9 00bb1b8 5e907202659 d32fe446386b4_Q_0.svg""
c=""c294f9 00bb1b8 5e907202659 d32fe446386b4_A_0.svg"" />"
f9 00bb1b8 5e907202659 d32fe446386b4_surce_svg.svg"" />"

/>"
"<img sr
"<img src=""fb67
"<img src=""fb67
/>"
"<img sr
"<img src=""fb67
"<img src=""fb67
/>"
"<img sr
"<img src=""41c2
"<img src=""41c2
/>"
"<img sr
"<img src=""561f
"<img src=""561f
/>"
"<img sr
"<img src=""561f
"<img src=""561f
/>"
"<img sr
"<img src=""561f
"<img src=""561f
/>"
"<img sr
"<img src=""561f
"<img src=""561f
/>"
"<img sr
"<img src=""c79c
"<img src=""c79c
/>"
"<img sr
"<img src=""c79c
"<img src=""c79c
/>"
"<img sr
"<img src=""c79c
"<img src=""c79c
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"<img sr
"<img src=""c79c
"<img src=""c79c
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"<img sr
"<img src=""c294
"<img src=""c294

f9 00bb1b8 5e907202659 d32fe446386b4_
m
NBixH.ng"" />"

10-30 An
my
"<img src=""c294f9 00bb1b8 5e907202659 d32fe446386b4_Q_1.svg"" />"
"<img sr
c=""c294f9 00bb1b8 5e907202659 d32fe446386b4_A_1.svg"" />"
"<img src=""c294
f9 00bb1b8 5e907202659 d32fe446386b4_surce_svg.svg"" />"
"<img src=""c294
f9 00bb1b8 5e907202659 d32fe446386b4_
m
NBixH.ng"" />"
10-30 An
my
"<img src=""c294f9 00bb1b8 5e907202659 d32fe446386b4_Q_2.svg"" />"
"<img sr
c=""c294f9 00bb1b8 5e907202659 d32fe446386b4_A_2.svg"" />"
"<img src=""c294
f9 00bb1b8 5e907202659 d32fe446386b4_surce_svg.svg"" />"
"<img src=""c294
f9 00bb1b8 5e907202659 d32fe446386b4_
m
NBixH.ng"" />"
10-30 An
my
"<img src=""c294f9 00bb1b8 5e907202659 d32fe446386b4_Q_3.svg"" />"
"<img sr
c=""c294f9 00bb1b8 5e907202659 d32fe446386b4_A_3.svg"" />"
"<img src=""c294
f9 00bb1b8 5e907202659 d32fe446386b4_surce_svg.svg"" />"
"<img src=""c294
f9 00bb1b8 5e907202659 d32fe446386b4_
m
NBixH.ng"" />"
10-30 An
my
The Aendix<div><br /></div><div><div>Lc
ed
junc
in f {{c1::
eni cli&n
bs;}}</div><div>V ri ble in i
s lc
in. Sme
imes lc
ed re
reri
ne lly b
ehind
he cecum</div><div>Lumin l ening in

he {{c1::cecum}} c n becme bs

ruc
ed.</div><div>E rly endici
is-- Dull, ching {{c1::viscer l}}  in in mid
line ne r {{c1::umbilicus}}</div><div>L
e endici
is irri

es surrunding 
rie
l eri
neum f bdmin l w ll. Becmes &nbs;sh r, lc lized {{c1::sm
i
c}}  in.</div></div><div><br /></div> "<img src="" s
e-428835304636861.jg""
/>"
10-30 An
my
"<img src="" 4857e462de63827e2814fb99ee325615f6cbfd4_Q_0.svg"" />"
"<img sr
c="" 4857e462de63827e2814fb99ee325615f6cbfd4_A_0.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_surce_svg.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_
m3gRsj.ng"" />"
10-30 An
my
"<img src="" 4857e462de63827e2814fb99ee325615f6cbfd4_Q_1.svg"" />"
"<img sr
c="" 4857e462de63827e2814fb99ee325615f6cbfd4_A_1.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_surce_svg.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_
m3gRsj.ng"" />"
10-30 An
my
"<img src="" 4857e462de63827e2814fb99ee325615f6cbfd4_Q_2.svg"" />"
"<img sr
c="" 4857e462de63827e2814fb99ee325615f6cbfd4_A_2.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_surce_svg.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_
m3gRsj.ng"" />"
10-30 An
my
"<img src="" 4857e462de63827e2814fb99ee325615f6cbfd4_Q_3.svg"" />"
"<img sr
c="" 4857e462de63827e2814fb99ee325615f6cbfd4_A_3.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_surce_svg.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_
m3gRsj.ng"" />"
10-30 An
my
"<img src="" 4857e462de63827e2814fb99ee325615f6cbfd4_Q_4.svg"" />"
"<img sr
c="" 4857e462de63827e2814fb99ee325615f6cbfd4_A_4.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_surce_svg.svg"" />"
"<img src="" 485
7e462de63827e2814fb99ee325615f6cbfd4_
m3gRsj.ng"" />"
10-30 An
my
<div>Viscer l P in:&nbs;</div><div>V gue, {{c1::rly}} lc lized</div><div>Gu

nly senses dis
en
in nd ischemi </div><div>P in fibers ( fferen
s)
r vel w
i
h {{c1::sym
he
ics}}</div><div>Fregu
deriv
ives refer  in
 {{c1::eig
s
ric}} regin {{c1::T8}}</div><div>Midgu
deriv
ives refer  in
 {{c1::eriu
mbilic l}} regin -{{c1::T10}}</div><div>Hindgu
deriv
ives refer  in
 {{c1:
:hyg s
ric}} regin {{c1::L1}}</div><div><br /></div><div>Sm
ic  in:</div><
div>Assci
ed wi
h {{c1::eri
ni
is}}</div><div>Irri

in f  rie
l eri
n
eum nd i
s ssci
ed sm
ic nerve fibers</div><div>{{c1::Well}} lc lized&nbs
"<img src="" s
e-456168476508652.jg"" />"
;</div><div><br /></div>
10-30 An
my

"<img src=""e87 5bebbd28c1040cf08997de00bc d8e7c8997_Q_0.svg"" />"

"<img sr
c=""e87 5bebbd28c1040cf08997de00bc d8e7c8997_A_0.svg"" />"
"<img src=""e87
5bebbd28c1040cf08997de00bc d8e7c8997_surce_svg.svg"" />"
"<img src=""e87
5bebbd28c1040cf08997de00bc d8e7c8997_
mxqlB8Q.ng"" />"
10-30 An
my
"<img src=""e87 5bebbd28c1040cf08997de00bc d8e7c8997_Q_1.svg"" />"
"<img sr
c=""e87 5bebbd28c1040cf08997de00bc d8e7c8997_A_1.svg"" />"
"<img src=""e87
5bebbd28c1040cf08997de00bc d8e7c8997_surce_svg.svg"" />"
"<img src=""e87
5bebbd28c1040cf08997de00bc d8e7c8997_
mxqlB8Q.ng"" />"
10-30 An
my
"<img src=""e87 5bebbd28c1040cf08997de00bc d8e7c8997_Q_2.svg"" />"
"<img sr
c=""e87 5bebbd28c1040cf08997de00bc d8e7c8997_A_2.svg"" />"
"<img src=""e87
5bebbd28c1040cf08997de00bc d8e7c8997_surce_svg.svg"" />"
"<img src=""e87
5bebbd28c1040cf08997de00bc d8e7c8997_
mxqlB8Q.ng"" />"
10-30 An
my
"<img src=""c087d778e42f459fb fc683015e4d69965f8eee0_Q_0.svg"" />"
"<img sr
c=""c087d778e42f459fb fc683015e4d69965f8eee0_A_0.svg"" />"
"<img src=""c087
d778e42f459fb fc683015e4d69965f8eee0_surce_svg.svg"" />"
"<img src=""c087
d778e42f459fb fc683015e4d69965f8eee0_
mXm9Eu.ng"" />"
10-30 An
my
"<img src=""c087d778e42f459fb fc683015e4d69965f8eee0_Q_1.svg"" />"
"<img sr
c=""c087d778e42f459fb fc683015e4d69965f8eee0_A_1.svg"" />"
"<img src=""c087
d778e42f459fb fc683015e4d69965f8eee0_surce_svg.svg"" />"
"<img src=""c087
d778e42f459fb fc683015e4d69965f8eee0_
mXm9Eu.ng"" />"
10-30 An
my
"<img src=""559108bfd065c62812b12d00d468fe9 9fdbf3c8_Q_0.svg"" />"
"<img sr
c=""559108bfd065c62812b12d00d468fe9 9fdbf3c8_A_0.svg"" />"
"<img src=""5591
08bfd065c62812b12d00d468fe9 9fdbf3c8_surce_svg.svg"" />"
"<img src=""5591
08bfd065c62812b12d00d468fe9 9fdbf3c8_
mHQf4r.ng"" />"
10-30 An
my
"<img src=""559108bfd065c62812b12d00d468fe9 9fdbf3c8_Q_1.svg"" />"
"<img sr
c=""559108bfd065c62812b12d00d468fe9 9fdbf3c8_A_1.svg"" />"
"<img src=""5591
08bfd065c62812b12d00d468fe9 9fdbf3c8_surce_svg.svg"" />"
"<img src=""5591
08bfd065c62812b12d00d468fe9 9fdbf3c8_
mHQf4r.ng"" />"
10-30 An
my
<div>{{c1::Lumb r}} r
eries c n l y vi
lly imr
n
rle in sulying
he

ermin l  r
f
he sin l crd. The m jr suly

he sin l crd nrm lly c
mes frm
he ver
ebr l r
eries inside
he {{c1::skull}}. The lumb r regin f

he sin l crd m y be qui
e deenden
n suly cming frm {{c1::lumb r}} r
e
ries. This suly m y becme cmrmised during surgeries

re
bdmin l r

ic neurysms</div><div><br /></div>
"<img src=""03c0269feb 098d1064251cbc43c62c 15 2381_Q_0.svg"" />"
"<img sr
c=""03c0269feb 098d1064251cbc43c62c 15 2381_A_0.svg"" />"
"<img src=""03c0
269feb 098d1064251cbc43c62c 15 2381_surce_svg.svg"" />"
"<img src=""03c0
269feb 098d1064251cbc43c62c 15 2381_
mCNnb0D.ng"" />"
11-6 Gi
"<img src=""9175047b c 22d7c403d8776 b37b43c13f9d6f_Q_0.svg"" />"
"<img sr
c=""9175047b c 22d7c403d8776 b37b43c13f9d6f_A_0.svg"" />"
"<img src=""9175
047b c 22d7c403d8776 b37b43c13f9d6f_surce_svg.svg"" />"
"<img src=""9175
047b c 22d7c403d8776 b37b43c13f9d6f_
mzDkWVE.ng"" />"
11-6 Gi
"<img src=""9175047b c 22d7c403d8776 b37b43c13f9d6f_Q_1.svg"" />"
"<img sr
c=""9175047b c 22d7c403d8776 b37b43c13f9d6f_A_1.svg"" />"
"<img src=""9175
047b c 22d7c403d8776 b37b43c13f9d6f_surce_svg.svg"" />"
"<img src=""9175
047b c 22d7c403d8776 b37b43c13f9d6f_
mzDkWVE.ng"" />"
11-6 Gi
"<img src=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_Q_0.svg"" />"
"<img sr
c=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_A_0.svg"" />"
"<img src=""e8ec
f f663e4d 41c696 e29fe59821 328 1dcc_surce_svg.svg"" />"
"<img src=""e8ec
f f663e4d 41c696 e29fe59821 328 1dcc_
mg3MLS.ng"" />"

11-6 Gi
"<img src=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_Q_1.svg""
c=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_A_1.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_surce_svg.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_
mg3MLS.ng"" />"
11-6 Gi
"<img src=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_Q_2.svg""
c=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_A_2.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_surce_svg.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_
mg3MLS.ng"" />"
11-6 Gi
"<img src=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_Q_3.svg""
c=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_A_3.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_surce_svg.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_
mg3MLS.ng"" />"
11-6 Gi
"<img src=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_Q_4.svg""
c=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_A_4.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_surce_svg.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_
mg3MLS.ng"" />"
11-6 Gi
"<img src=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_Q_5.svg""
c=""e8ecf f663e4d 41c696 e29fe59821 328 1dcc_A_5.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_surce_svg.svg"" />"
f f663e4d 41c696 e29fe59821 328 1dcc_
mg3MLS.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_0.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_0.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_1.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_1.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_2.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_2.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_3.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_3.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_4.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_4.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_5.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_5.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_6.svg""
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_6.svg"" />"
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"

/>"
"<img sr
"<img src=""e8ec
"<img src=""e8ec
/>"
"<img sr
"<img src=""e8ec
"<img src=""e8ec
/>"
"<img sr
"<img src=""e8ec
"<img src=""e8ec
/>"
"<img sr
"<img src=""e8ec
"<img src=""e8ec
/>"
"<img sr
"<img src=""e8ec
"<img src=""e8ec
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e
/>"
"<img sr
"<img src=""d3 e
"<img src=""d3 e

11-6 Gi
"<img src=""d3 e bbfb493e968989 97b26448762279e1cd19_Q_7.svg"" />"
"<img sr
c=""d3 e bbfb493e968989 97b26448762279e1cd19_A_7.svg"" />"
"<img src=""d3 e
bbfb493e968989 97b26448762279e1cd19_surce_svg.svg"" />"
"<img src=""d3 e
bbfb493e968989 97b26448762279e1cd19_
mbUSvs.ng"" />"
11-6 Gi
Lumb r Veins<div><br /></div><div><div>Like in
ercs
l veins,
here re segmen

l veins dr ining
he bdy w ll in
he lumb r regin,
hese re c lled {{c1::lum
b r}} veins</div><div>Like
he zygus nd hemi zygus veins,
here re {{c1::ve
r
ic l}} cnnec
ins be
ween
he {{c1::lumb r}} veins,
hese re c lled {{c1:: s
cending lumb r}} veins.</div><div>There re cnnec
ins be
ween {{c1::lumb r}} v
eins nd zygus veins</div></div><div><br /></div><div>The re
reri
ne l r

ins f
he gu

ube ( scending cln, descending cln) will f
en h ve ddi
i
n l dr in ge vi
he lumb r veins f
he s
erir bdmin l w ll. These m y bec
me enl rged during {{c1::r
l hyer
ensin}}. The lumb r veins will be cnnec
ver
ic lly running {{c1:: scending lumb r}} vein. The {{c1::

ed
ge
her vi
scending lumb r}} veins re cnnec
ed

he zygus nd
he hemi zygus veins.
Therefre
hrugh
hese cnnec
ins m y be n l
ern
ive 
hw y fr venus re

urn

he suerir ven c v in c ses f {{c1::r
l hyer
ensin}}</div>
"<img src="" s
e-258625750696452.jg"" />"
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_0.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_0.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_1.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_1.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_2.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_2.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_3.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_3.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_4.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_4.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_5.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_5.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_6.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_6.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi
"<img src=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_Q_7.svg"" />"
"<img sr
c=""c5 e1c88389707f226f49b3ce1367 0 3b6f8e02_A_7.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_surce_svg.svg"" />"
"<img src=""c5 e
1c88389707f226f49b3ce1367 0 3b6f8e02_
mX0dz3.ng"" />"
11-6 Gi

<div>As yu re dissec
ing
he s
erir bdmin l w ll nd remving
he f
, y

u m y find se r
e l yer (r membr ne)
h
reminds yu f secnd l yer f
eri
neum. This is {{c1::Ger
s (ren l) f sci }}. Dee
 {{c1::Ger
s f sci
}} yu will find secnd l yer f f
. This is
he {{c1::erinehric f
}}. {{c
1::Ger
s f sci }} nd {{c1::erinehric f
}} serve
 s
bilize nd r
ec

h
e kidney. This f sci nd ssci
ed f
c n be qui
e imressive in size.&nbs;<
/div><div><br /></div><div>The ren l r
ery, vein nd ure
er c n be fund wi
hin

he f
filled s ce knwn s
he {{c1::ren l sinus}}</div><div><br /></div>
"<img src="" s
e-300411487519037.jg"" />"
11-6 An
my
"<img src=""74ee151ccf679f 8eb3 70d41d0f03 8257147_Q_0.svg"" />"
"<img sr
c=""74ee151ccf679f 8eb3 70d41d0f03 8257147_A_0.svg"" />"
"<img src=""74ee
151ccf679f 8eb3 70d41d0f03 8257147_surce_svg.svg"" />"
"<img src=""74ee
151ccf679f 8eb3 70d41d0f03 8257147_
mX8N0fW.ng"" />"
11-6 Gi
"<img src=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_Q_0.svg"" />"
"<img sr
c=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_A_0.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_surce_svg.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_
m3RFOlb.ng"" />"
11-6 Gi
"<img src=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_Q_1.svg"" />"
"<img sr
c=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_A_1.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_surce_svg.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_
m3RFOlb.ng"" />"
11-6 Gi
"<img src=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_Q_2.svg"" />"
"<img sr
c=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_A_2.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_surce_svg.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_
m3RFOlb.ng"" />"
11-6 Gi
"<img src=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_Q_3.svg"" />"
"<img sr
c=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_A_3.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_surce_svg.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_
m3RFOlb.ng"" />"
11-6 Gi
"<img src=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_Q_4.svg"" />"
"<img sr
c=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_A_4.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_surce_svg.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_
m3RFOlb.ng"" />"
11-6 Gi
"<img src=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_Q_5.svg"" />"
"<img sr
c=""52e4281fd02d7dc3ccb2129166ec2d f8d2331c0_A_5.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_surce_svg.svg"" />"
"<img src=""52e4
281fd02d7dc3ccb2129166ec2d f8d2331c0_
m3RFOlb.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_0.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_0.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_1.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_1.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_2.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_2.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_3.svg"" />"
"<img sr

c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_3.svg"" />"

"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_4.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_4.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_5.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_5.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_6.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_6.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
"<img src=""569fcd80771c124ecdcdb7f 9ed488 663868504_Q_7.svg"" />"
"<img sr
c=""569fcd80771c124ecdcdb7f 9ed488 663868504_A_7.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_surce_svg.svg"" />"
"<img src=""569f
cd80771c124ecdcdb7f 9ed488 663868504_
mBl c
C.ng"" />"
11-6 Gi
Ren l V scul
ure<div><br /></div><div><div>Ren l veins re ms
n
erir</div><
div><br /></div><div>{{c1::Lef
ren l}} vein  sses be
ween r
nd SMA</div><
div>This rel
inshi m y le d
 blck ge nd ssci
ed hyer
ensin f
he {{
c1::lef
ren l}} vein (Imr
n
n
e:
his is qui
e differen
frm ren l hyer
e
nsin). Bec use
he lef

es
icul r vein dr ins in

he {{c1::lef
ren l}} vein,
c se f venus hyer
ensin f
he lef
ren l vein m y resul
in v ricsi
ies
f
he {{c1::lef
 minifrm lexus}} f veins in
he lef
serm
ic crd. V r
icsi
ies f
he {{c1:: minifrm lexus}} f veins is c lled {{c1::v riccel
e}}.&nbs;</div><div><br /></div><div><br /></div><div>{{c1::Lef
ren l}} vein r
eceives dr in ge frm lef
gn d l vein nd lef
dren l vein</div><div><br /></
div><div>{{c1::Ure
er nd ren l elvis}} re ms
s
erir</div></div><div><br
/></div>
"<img src="" s
e-355193795379677.jg"" />"
11-6 An
my
"<img src=""5e26 9053 b2b729f6e6c686dbebb74401c62516_Q_0.svg"" />"
"<img sr
c=""5e26 9053 b2b729f6e6c686dbebb74401c62516_A_0.svg"" />"
"<img src=""5e26
9053 b2b729f6e6c686dbebb74401c62516_surce_svg.svg"" />"
"<img src=""5e26
9053 b2b729f6e6c686dbebb74401c62516_
mh z_3M.ng"" />"
11-6 Gi
"<img src=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_Q_0.svg"" />"
"<img sr
c=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_A_0.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_surce_svg.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_
mfwlYA1.ng"" />"
11-6 Gi
"<img src=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_Q_1.svg"" />"
"<img sr
c=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_A_1.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_surce_svg.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_
mfwlYA1.ng"" />"
11-6 Gi
"<img src=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_Q_2.svg"" />"
"<img sr
c=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_A_2.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_surce_svg.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_
mfwlYA1.ng"" />"
11-6 Gi
"<img src=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_Q_3.svg"" />"
"<img sr
c=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_A_3.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_surce_svg.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_
mfwlYA1.ng"" />"

11-6 Gi
"<img src=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_Q_4.svg"" />"
"<img sr
c=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_A_4.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_surce_svg.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_
mfwlYA1.ng"" />"
11-6 Gi
"<img src=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_Q_5.svg"" />"
"<img sr
c=""ce 184053d3 315d39bd5c4f795f9f 575 8898d_A_5.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_surce_svg.svg"" />"
"<img src=""ce 1
84053d3 315d39bd5c4f795f9f 575 8898d_
mfwlYA1.ng"" />"
11-6 Gi
"<img src=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_Q_0.svg"" />"
"<img sr
c=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_A_0.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_surce_svg.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_
mkTwElU.ng"" />"
11-6 Gi
"<img src=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_Q_1.svg"" />"
"<img sr
c=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_A_1.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_surce_svg.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_
mkTwElU.ng"" />"
11-6 Gi
"<img src=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_Q_2.svg"" />"
"<img sr
c=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_A_2.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_surce_svg.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_
mkTwElU.ng"" />"
11-6 Gi
"<img src=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_Q_3.svg"" />"
"<img sr
c=""1df2b99cc5c3164d703e7f2 b62ffb80 f b0973_A_3.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_surce_svg.svg"" />"
"<img src=""1df2
b99cc5c3164d703e7f2 b62ffb80 f b0973_
mkTwElU.ng"" />"
11-6 Gi
Ure
ers<div><br /></div><div><div>Rel
inshis:</div><div>Ps
erir
 {{c1::re
n l r
ery nd veins}}</div><div>An
erir
 {{c1::s s muscle}}</div><div>Ps

erir
 {{c1::gn d l vessels}}</div><div>Crsses elvic brim
bifurc
in f
{{c1::cmmn ili cs}}</div><div><br /></div><div>Bld suly</div><div>Ren l</
div><div>Gn d l</div><div>Cmmn ili cs</div><div>In
ern l ili cs</div><div><br
/></div><div>Cns
ric
in in
s</div><div>A
junc
in wi
h {{c1::ren l elvis}
}</div><div>A
bifurc
in f {{c1::cmmn ili cs (
elvic brim}})</div><div>A
"<img sr

en
ry in
 {{c1::urin ry bl dder}}</div></div><div><br /></div>
c="" s
e-355438608515612.jg"" />"
11-6 An
my
"Adren ls<div><br /></div><div><div>Als c lled {{c1::sur ren l gl nds}}</div><
div><br /></div><div>Bld suly frm:</div><div>{{c1::Ar
}} direc
ly</div><d
iv>{{c1::Ren l}} r
eries</div><div>{{c1::Inferir hrenic}} r
eries</div></div
><div><img src="" s
e-401244434727452.jg"" /></div>"
11-6 An
my
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_0.svg"" />"
"<img sr
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_0.svg"" />"
"<img src=""5c0
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
"<img src=""5c0
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_1.svg"" />"
"<img sr
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_1.svg"" />"
"<img src=""5c0
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
"<img src=""5c0
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_2.svg"" />"
"<img sr
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_2.svg"" />"
"<img src=""5c0
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
"<img src=""5c0
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_3.svg"" />"
"<img sr

c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_3.svg"" />"

bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_4.svg""
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_4.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_5.svg""
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_5.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_6.svg""
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_6.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_7.svg""
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_7.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_Q_8.svg""
c=""5c0 bd3949b0fcff6ccbfe8224db 9b185cc46f5_A_8.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_surce_svg.svg"" />"
bd3949b0fcff6ccbfe8224db 9b185cc46f5_
mVMUC
0.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_0.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_0.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_1.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_1.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_2.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_2.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_3.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_3.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_4.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_4.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_5.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_5.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_6.svg""

"<img src=""5c0
"<img src=""5c0
/>"
"<img sr
"<img src=""5c0
"<img src=""5c0
/>"
"<img sr
"<img src=""5c0
"<img src=""5c0
/>"
"<img sr
"<img src=""5c0
"<img src=""5c0
/>"
"<img sr
"<img src=""5c0
"<img src=""5c0
/>"
"<img sr
"<img src=""5c0
"<img src=""5c0
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"

"<img sr

c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_6.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_7.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_7.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""2b4e0694749e586dcd2b8ee995361d324625fedc_Q_8.svg""
c=""2b4e0694749e586dcd2b8ee995361d324625fedc_A_8.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_surce_svg.svg"" />"
0694749e586dcd2b8ee995361d324625fedc_
m_j
QH.ng"" />"
11-6 Gi
"<img src=""0fe0b1136bbb627f9614e02 d c9d7477544de71_Q_0.svg""
c=""0fe0b1136bbb627f9614e02 d c9d7477544de71_A_0.svg"" />"
b1136bbb627f9614e02 d c9d7477544de71_surce_svg.svg"" />"
b1136bbb627f9614e02 d c9d7477544de71_
mv9647j.ng"" />"
11-6 Gi
"<img src=""93c94e f4c29591f43 b3c81503ccececf8189d8_Q_0.svg""
c=""93c94e f4c29591f43 b3c81503ccececf8189d8_A_0.svg"" />"
4e f4c29591f43 b3c81503ccececf8189d8_surce_svg.svg"" />"
4e f4c29591f43 b3c81503ccececf8189d8_
mZZP_Jl.ng"" />"
11-6 Gi
"<img src=""93c94e f4c29591f43 b3c81503ccececf8189d8_Q_1.svg""
c=""93c94e f4c29591f43 b3c81503ccececf8189d8_A_1.svg"" />"
4e f4c29591f43 b3c81503ccececf8189d8_surce_svg.svg"" />"
4e f4c29591f43 b3c81503ccececf8189d8_
mZZP_Jl.ng"" />"
11-6 Gi
"<img src=""93c94e f4c29591f43 b3c81503ccececf8189d8_Q_2.svg""
c=""93c94e f4c29591f43 b3c81503ccececf8189d8_A_2.svg"" />"
4e f4c29591f43 b3c81503ccececf8189d8_surce_svg.svg"" />"
4e f4c29591f43 b3c81503ccececf8189d8_
mZZP_Jl.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_0.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_0.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_1.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_1.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_2.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_2.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_3.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_3.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_4.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_4.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_5.svg""

"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""2b4e
"<img src=""2b4e
/>"
"<img sr
"<img src=""0fe0
"<img src=""0fe0
/>"
"<img sr
"<img src=""93c9
"<img src=""93c9
/>"
"<img sr
"<img src=""93c9
"<img src=""93c9
/>"
"<img sr
"<img src=""93c9
"<img src=""93c9
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"

"<img sr

c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_5.svg"" />"

e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_6.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_6.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_7.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_7.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src="" 36be2b9671bf3 e9d 49919814d1b62805565db_Q_8.svg""
c="" 36be2b9671bf3 e9d 49919814d1b62805565db_A_8.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_surce_svg.svg"" />"
e2b9671bf3 e9d 49919814d1b62805565db_
m78sgDF.ng"" />"
11-6 Gi
"<img src=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_Q_0.svg""
c=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_A_0.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_surce_svg.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_
mv6xScG.ng"" />"
11-6 Gi
"<img src=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_Q_1.svg""
c=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_A_1.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_surce_svg.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_
mv6xScG.ng"" />"
11-6 Gi
"<img src=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_Q_2.svg""
c=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_A_2.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_surce_svg.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_
mv6xScG.ng"" />"
11-6 Gi
"<img src=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_Q_3.svg""
c=""ff5045c34cbe1c51f390bb88d8d18b71829 4486_A_3.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_surce_svg.svg"" />"
45c34cbe1c51f390bb88d8d18b71829 4486_
mv6xScG.ng"" />"
11-6 Gi
"<img src=""8ddd3347 228b 0259ffbbf1034 3f1ded1cf633_Q_0.svg""
c=""8ddd3347 228b 0259ffbbf1034 3f1ded1cf633_A_0.svg"" />"
3347 228b 0259ffbbf1034 3f1ded1cf633_surce_svg.svg"" />"
3347 228b 0259ffbbf1034 3f1ded1cf633_
m9J1 i.ng"" />"
11-6 Gi
"<img src=""8ddd3347 228b 0259ffbbf1034 3f1ded1cf633_Q_1.svg""
c=""8ddd3347 228b 0259ffbbf1034 3f1ded1cf633_A_1.svg"" />"
3347 228b 0259ffbbf1034 3f1ded1cf633_surce_svg.svg"" />"
3347 228b 0259ffbbf1034 3f1ded1cf633_
m9J1 i.ng"" />"
11-6 Gi
"<img src=""8ddd3347 228b 0259ffbbf1034 3f1ded1cf633_Q_2.svg""
c=""8ddd3347 228b 0259ffbbf1034 3f1ded1cf633_A_2.svg"" />"
3347 228b 0259ffbbf1034 3f1ded1cf633_surce_svg.svg"" />"
3347 228b 0259ffbbf1034 3f1ded1cf633_
m9J1 i.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_0.svg""
c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_0.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_1.svg""

"<img src="" 36b

"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src="" 36b
"<img src="" 36b
/>"
"<img sr
"<img src=""ff50
"<img src=""ff50
/>"
"<img sr
"<img src=""ff50
"<img src=""ff50
/>"
"<img sr
"<img src=""ff50
"<img src=""ff50
/>"
"<img sr
"<img src=""ff50
"<img src=""ff50
/>"
"<img sr
"<img src=""8ddd
"<img src=""8ddd
/>"
"<img sr
"<img src=""8ddd
"<img src=""8ddd
/>"
"<img sr
"<img src=""8ddd
"<img src=""8ddd
/>"
"<img sr
"<img src=""b5ee
"<img src=""b5ee
/>"

"<img sr

c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_1.svg"" />"

c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_2.svg""
c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_2.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_3.svg""
c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_3.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_4.svg""
c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_4.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_5.svg""
c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_5.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""b5eec69667deee7306 e9 3 65b065fd8235042_Q_6.svg""
c=""b5eec69667deee7306 e9 3 65b065fd8235042_A_6.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_surce_svg.svg"" />"
c69667deee7306 e9 3 65b065fd8235042_
mY45JA.ng"" />"
11-6 Gi
"<img src=""732d1fc3cdb0f177d2237cb89727bb275599ed73_Q_0.svg""
c=""732d1fc3cdb0f177d2237cb89727bb275599ed73_A_0.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_surce_svg.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_
mPHHy3L.ng"" />"
11-6 Gi
"<img src=""732d1fc3cdb0f177d2237cb89727bb275599ed73_Q_1.svg""
c=""732d1fc3cdb0f177d2237cb89727bb275599ed73_A_1.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_surce_svg.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_
mPHHy3L.ng"" />"
11-6 Gi
"<img src=""732d1fc3cdb0f177d2237cb89727bb275599ed73_Q_2.svg""
c=""732d1fc3cdb0f177d2237cb89727bb275599ed73_A_2.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_surce_svg.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_
mPHHy3L.ng"" />"
11-6 Gi
"<img src=""732d1fc3cdb0f177d2237cb89727bb275599ed73_Q_3.svg""
c=""732d1fc3cdb0f177d2237cb89727bb275599ed73_A_3.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_surce_svg.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_
mPHHy3L.ng"" />"
11-6 Gi
"<img src=""732d1fc3cdb0f177d2237cb89727bb275599ed73_Q_4.svg""
c=""732d1fc3cdb0f177d2237cb89727bb275599ed73_A_4.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_surce_svg.svg"" />"
1fc3cdb0f177d2237cb89727bb275599ed73_
mPHHy3L.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_0.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_0.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_1.svg""

"<img src=""b5ee
"<img src=""b5ee
/>"
"<img sr
"<img src=""b5ee
"<img src=""b5ee
/>"
"<img sr
"<img src=""b5ee
"<img src=""b5ee
/>"
"<img sr
"<img src=""b5ee
"<img src=""b5ee
/>"
"<img sr
"<img src=""b5ee
"<img src=""b5ee
/>"
"<img sr
"<img src=""b5ee
"<img src=""b5ee
/>"
"<img sr
"<img src=""732d
"<img src=""732d
/>"
"<img sr
"<img src=""732d
"<img src=""732d
/>"
"<img sr
"<img src=""732d
"<img src=""732d
/>"
"<img sr
"<img src=""732d
"<img src=""732d
/>"
"<img sr
"<img src=""732d
"<img src=""732d
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"

"<img sr

c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_1.svg"" />"

421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_2.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_2.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_3.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_3.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_4.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_4.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_5.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_5.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_6.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_6.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src=""7859421ddbcc3 ecf2c952 07 5972778015001 _Q_7.svg""
c=""7859421ddbcc3 ecf2c952 07 5972778015001 _A_7.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _surce_svg.svg"" />"
421ddbcc3 ecf2c952 07 5972778015001 _
mTK9m
m.ng"" />"
11-6 Gi
"<img src="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _Q_0.svg""
c="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _A_0.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _surce_svg.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _
mMecsiS.ng"" />"
11-6 Gi
"<img src="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _Q_1.svg""
c="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _A_1.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _surce_svg.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _
mMecsiS.ng"" />"
11-6 Gi
"<img src="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _Q_2.svg""
c="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _A_2.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _surce_svg.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _
mMecsiS.ng"" />"
11-6 Gi
"<img src="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _Q_3.svg""
c="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _A_3.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _surce_svg.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _
mMecsiS.ng"" />"
11-6 Gi
"<img src="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _Q_4.svg""
c="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _A_4.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _surce_svg.svg"" />"
f184bbdd0f6d 5db795d52830e673c259 4 _
mMecsiS.ng"" />"
11-6 Gi
"<img src="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _Q_5.svg""

"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src=""7859
"<img src=""7859
/>"
"<img sr
"<img src="" fe9
"<img src="" fe9
/>"
"<img sr
"<img src="" fe9
"<img src="" fe9
/>"
"<img sr
"<img src="" fe9
"<img src="" fe9
/>"
"<img sr
"<img src="" fe9
"<img src="" fe9
/>"
"<img sr
"<img src="" fe9
"<img src="" fe9
/>"

"<img sr

c="" fe9f184bbdd0f6d 5db795d52830e673c259 4 _A_5.svg"" />"

"<img src="" fe9
f184bbdd0f6d 5db795d52830e673c259 4 _surce_svg.svg"" />"
"<img src="" fe9
f184bbdd0f6d 5db795d52830e673c259 4 _
mMecsiS.ng"" />"
11-6 Gi
Defini
ins<div><br /></div><div><div>{{c1::Pelvic girdle}}: &nbs;ring f bnes
&nbs;(ilium, ischium, ubis, s crum)</div><div><br /></div><div>{{c1::Pelvic c
vi
y}}: &nbs;inferir r
in f bdmenelvic c vi
y; divided in
 gre
er
nd lesser elvis</div><div><br /></div><div>{{c1::Perineum}}: &nbs; re be
ween

highs nd bu

cks; cccyx
 ubis; includes nus, nd ex
ern l geni
li </di
v><div><br /></div><div>{{c1::Pelvic nd urgeni
l di hr gms}}: &nbs;se r
e
s elvic c vi
y nd erineum</div></div><div><br /></div>
11-13 n

my
Bund ries Of The Pelvis<div><br /></div><div><div>Gre
er (F lse) Pelvis</div><
div>Suerir
 {{c1::elvic inle
}}</div><div>Occuied by {{c1:: bdmin l visce
r }}</div><div><br /></div><div>Lesser (True) Pelvis</div><div>Be
ween {{c1::el
vic inle
}} nd {{c1::u
le
}}</div><div>Occuied by elvic viscer nd dee er
ineum</div><div>Flr: &nbs;{{c1::elvic di hr gm}}</div><div><br /></div><div
>Perineum</div></div><div><br /></div> "<img src="" s
e-243997092086282.jg""
/>"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_0.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_0.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_1.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_1.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_2.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_2.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_3.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_3.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_4.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_4.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_5.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_5.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_6.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_6.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src=""b74f13d 62c08b93b9 f348cf0c2 120589d219_Q_7.svg"" />"
"<img sr
c=""b74f13d 62c08b93b9 f348cf0c2 120589d219_A_7.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_surce_svg.svg"" />"
"<img src=""b74f
13d 62c08b93b9 f348cf0c2 120589d219_
mL4VTkF.ng"" />"
11-13 An
my
"<img src="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_Q_0.svg"" />"
"<img sr

c="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_A_0.svg"" />"

5f1f812 e0100fb340b965 0e043dedc3ef8_surce_svg.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_
mZEPUSN.ng"" />"
11-13 An
my
"<img src="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_Q_1.svg""
c="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_A_1.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_surce_svg.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_
mZEPUSN.ng"" />"
11-13 An
my
"<img src="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_Q_2.svg""
c="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_A_2.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_surce_svg.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_
mZEPUSN.ng"" />"
11-13 An
my
"<img src="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_Q_3.svg""
c="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_A_3.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_surce_svg.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_
mZEPUSN.ng"" />"
11-13 An
my
"<img src="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_Q_4.svg""
c="" 27f5f1f812 e0100fb340b965 0e043dedc3ef8_A_4.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_surce_svg.svg"" />"
5f1f812 e0100fb340b965 0e043dedc3ef8_
mZEPUSN.ng"" />"
11-13 An
my
"<img src=""63675b8b957b93b d40 3b 3208d17c3f1fbe84_Q_0.svg""
c=""63675b8b957b93b d40 3b 3208d17c3f1fbe84_A_0.svg"" />"
5b8b957b93b d40 3b 3208d17c3f1fbe84_surce_svg.svg"" />"
5b8b957b93b d40 3b 3208d17c3f1fbe84_
mneC5N.ng"" />"
11-13 An
my
"<img src=""63675b8b957b93b d40 3b 3208d17c3f1fbe84_Q_1.svg""
c=""63675b8b957b93b d40 3b 3208d17c3f1fbe84_A_1.svg"" />"
5b8b957b93b d40 3b 3208d17c3f1fbe84_surce_svg.svg"" />"
5b8b957b93b d40 3b 3208d17c3f1fbe84_
mneC5N.ng"" />"
11-13 An
my
"<img src=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_Q_0.svg""
c=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_A_0.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_surce_svg.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_
mX9m_zC.ng"" />"
11-13 An
my
"<img src=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_Q_1.svg""
c=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_A_1.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_surce_svg.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_
mX9m_zC.ng"" />"
11-13 An
my
"<img src=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_Q_2.svg""
c=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_A_2.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_surce_svg.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_
mX9m_zC.ng"" />"
11-13 An
my
"<img src=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_Q_3.svg""
c=""dd21ef 2cd017c0b2b803cedfde932100b83ec92_A_3.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_surce_svg.svg"" />"
ef 2cd017c0b2b803cedfde932100b83ec92_
mX9m_zC.ng"" />"
11-13 An
my
"<img src="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_Q_0.svg""
c="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_A_0.svg"" />"
8927e78e0d172bfd4 fee5de8d b8ce72e39_surce_svg.svg"" />"
8927e78e0d172bfd4 fee5de8d b8ce72e39_
mmOSgTM.ng"" />"
11-13 An
my
"<img src="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_Q_1.svg""

"<img src="" 27f

"<img src="" 27f
/>"
"<img sr
"<img src="" 27f
"<img src="" 27f
/>"
"<img sr
"<img src="" 27f
"<img src="" 27f
/>"
"<img sr
"<img src="" 27f
"<img src="" 27f
/>"
"<img sr
"<img src="" 27f
"<img src="" 27f
/>"
"<img sr
"<img src=""6367
"<img src=""6367
/>"
"<img sr
"<img src=""6367
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/>"
"<img sr
"<img src=""dd21
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/>"
"<img sr
"<img src=""dd21
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/>"
"<img sr
"<img src=""dd21
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/>"
"<img sr
"<img src=""dd21
"<img src=""dd21
/>"
"<img sr
"<img src="" 601
"<img src="" 601
/>"

"<img sr

c="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_A_1.svg"" />"

"<img src="" 601
8927e78e0d172bfd4 fee5de8d b8ce72e39_surce_svg.svg"" />"
"<img src="" 601
8927e78e0d172bfd4 fee5de8d b8ce72e39_
mmOSgTM.ng"" />"
11-13 An
my
"<img src="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_Q_2.svg"" />"
"<img sr
c="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_A_2.svg"" />"
"<img src="" 601
8927e78e0d172bfd4 fee5de8d b8ce72e39_surce_svg.svg"" />"
"<img src="" 601
8927e78e0d172bfd4 fee5de8d b8ce72e39_
mmOSgTM.ng"" />"
11-13 An
my
"<img src="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_Q_3.svg"" />"
"<img sr
c="" 6018927e78e0d172bfd4 fee5de8d b8ce72e39_A_3.svg"" />"
"<img src="" 601
8927e78e0d172bfd4 fee5de8d b8ce72e39_surce_svg.svg"" />"
"<img src="" 601
8927e78e0d172bfd4 fee5de8d b8ce72e39_
mmOSgTM.ng"" />"
11-13 An
my
"Pelvic Flr: &nbs;Pelvic Di hr gm<div><br /></div><div><div>Tn lly {{c1::c
n
r c
ed}} fr sur
func
in</div><div><br /></div><div>Assis
s in m in
en nc
e f {{c1::fec l nd urin ry cn
inence}}</div><div><br /></div><div>Ac
ively {{
c1::cn
r c
s}} during frced exir
in, cughing, sneezing, vmi
ing</div></di
v><div><img src="" s
e-278356830454068.jg"" /></div>"
11-13 An
my
"<img src=""27 832460c6098411303833e110e632f 55 6918_Q_0.svg"" />"
"<img sr
c=""27 832460c6098411303833e110e632f 55 6918_A_0.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_surce_svg.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_
mAL
LPI.ng"" />"
11-13 An
my
"<img src=""27 832460c6098411303833e110e632f 55 6918_Q_1.svg"" />"
"<img sr
c=""27 832460c6098411303833e110e632f 55 6918_A_1.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_surce_svg.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_
mAL
LPI.ng"" />"
11-13 An
my
"<img src=""27 832460c6098411303833e110e632f 55 6918_Q_2.svg"" />"
"<img sr
c=""27 832460c6098411303833e110e632f 55 6918_A_2.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_surce_svg.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_
mAL
LPI.ng"" />"
11-13 An
my
"<img src=""27 832460c6098411303833e110e632f 55 6918_Q_3.svg"" />"
"<img sr
c=""27 832460c6098411303833e110e632f 55 6918_A_3.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_surce_svg.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_
mAL
LPI.ng"" />"
11-13 An
my
"<img src=""27 832460c6098411303833e110e632f 55 6918_Q_4.svg"" />"
"<img sr
c=""27 832460c6098411303833e110e632f 55 6918_A_4.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_surce_svg.svg"" />"
"<img src=""27 8
32460c6098411303833e110e632f 55 6918_
mAL
LPI.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_0.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_0.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_1.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_1.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_2.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_2.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_3.svg"" />"
"<img sr

c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_3.svg"" />"

"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_4.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_4.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_5.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_5.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_6.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_6.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_7.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_7.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"<img src=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _Q_8.svg"" />"
"<img sr
c=""1e041f67664bcb72fd7f69634f64cc53 b6c254 _A_8.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _surce_svg.svg"" />"
"<img src=""1e04
1f67664bcb72fd7f69634f64cc53 b6c254 _
mDumr6r.ng"" />"
11-13 An
my
"Perineum<div><br /></div><div><div>Abduc
ed
high/li
h
my si
in: &nbs;{{c
1::di mnd}} sh e</div><div><br /></div><div>Suerirly bunded by {{c1::elvic
u
le
}}</div><div><br /></div><div>An
erirly bunded by {{c1::ubic symhysis
}}</div><div><br /></div><div>L
er lly bunded by
he {{c1::ischiubic r mi}}
nd {{c1::ischi l
ubersi
ies}}</div><div><br /></div><div>Ps
erirly bunded
by {{c1::s cr
uberus lig men
s}}, {{c1::s crum}}, nd {{c1::cccyx}}</div></di
v><div><img src="" s
e-292590352073106.jg"" /></div>"
11-13 An
my
"<img src=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_Q_0.svg"" />"
"<img sr
c=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_A_0.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_surce_svg.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_
m3B6HE.ng"" />"
11-13 An
my
"<img src=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_Q_1.svg"" />"
"<img sr
c=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_A_1.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_surce_svg.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_
m3B6HE.ng"" />"
11-13 An
my
"<img src=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_Q_2.svg"" />"
"<img sr
c=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_A_2.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_surce_svg.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_
m3B6HE.ng"" />"
11-13 An
my
"<img src=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_Q_3.svg"" />"
"<img sr
c=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_A_3.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_surce_svg.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_
m3B6HE.ng"" />"
11-13 An
my
"<img src=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_Q_4.svg"" />"
"<img sr
c=""7fe0 f4ddffbbb565 079c38d1ed6688de77629d_A_4.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_surce_svg.svg"" />"
"<img src=""7fe0
f4ddffbbb565 079c38d1ed6688de77629d_
m3B6HE.ng"" />"

11-13 An
my
Clinic l Crrel
in: &nbs;{{c1::Eisi
my}}<div><br /></div><div><div>Surgic
l incisin f erineum</div><div><br /></div><div>Decre se excessive
e ring f
erineum during childbir
h</div><div><br /></div><div>Ru
ine use is widely deb

ed</div><div>descen
f
he b by is rres
ed r r
r c
ed</div><div>when ins
r
umen

in such s frces re necess ry</div><div>exedi
e delivery in
he c se
f fe
l dis
ress</div></div><div><br /></div> "<img src="" s
e-32210536733125
8.jg"" />"
11-13 An
my
"<img src=""2b06eb7e141 1672120ce7 f2663fbefdd95c9 7_Q_0.svg"" />"
"<img sr
c=""2b06eb7e141 1672120ce7 f2663fbefdd95c9 7_A_0.svg"" />"
"<img src=""2b06
eb7e141 1672120ce7 f2663fbefdd95c9 7_surce_svg.svg"" />"
"<img src=""2b06
eb7e141 1672120ce7 f2663fbefdd95c9 7_
m2BNxr3.ng"" />"
11-13 An
my
"<img src=""2b06eb7e141 1672120ce7 f2663fbefdd95c9 7_Q_1.svg"" />"
"<img sr
c=""2b06eb7e141 1672120ce7 f2663fbefdd95c9 7_A_1.svg"" />"
"<img src=""2b06
eb7e141 1672120ce7 f2663fbefdd95c9 7_surce_svg.svg"" />"
"<img src=""2b06
eb7e141 1672120ce7 f2663fbefdd95c9 7_
m2BNxr3.ng"" />"
11-13 An
my
"<img src=""2b06eb7e141 1672120ce7 f2663fbefdd95c9 7_Q_2.svg"" />"
"<img sr
c=""2b06eb7e141 1672120ce7 f2663fbefdd95c9 7_A_2.svg"" />"
"<img src=""2b06
eb7e141 1672120ce7 f2663fbefdd95c9 7_surce_svg.svg"" />"
"<img src=""2b06
eb7e141 1672120ce7 f2663fbefdd95c9 7_
m2BNxr3.ng"" />"
11-13 An
my
"<img src=""75d5 66908b0e334825d0e41647 66e173293bc9_Q_0.svg"" />"
"<img sr
c=""75d5 66908b0e334825d0e41647 66e173293bc9_A_0.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_surce_svg.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_
m yy0lB.ng"" />"
11-13 An
my
"<img src=""75d5 66908b0e334825d0e41647 66e173293bc9_Q_1.svg"" />"
"<img sr
c=""75d5 66908b0e334825d0e41647 66e173293bc9_A_1.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_surce_svg.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_
m yy0lB.ng"" />"
11-13 An
my
"<img src=""75d5 66908b0e334825d0e41647 66e173293bc9_Q_2.svg"" />"
"<img sr
c=""75d5 66908b0e334825d0e41647 66e173293bc9_A_2.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_surce_svg.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_
m yy0lB.ng"" />"
11-13 An
my
"<img src=""75d5 66908b0e334825d0e41647 66e173293bc9_Q_3.svg"" />"
"<img sr
c=""75d5 66908b0e334825d0e41647 66e173293bc9_A_3.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_surce_svg.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_
m yy0lB.ng"" />"
11-13 An
my
"<img src=""75d5 66908b0e334825d0e41647 66e173293bc9_Q_4.svg"" />"
"<img sr
c=""75d5 66908b0e334825d0e41647 66e173293bc9_A_4.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_surce_svg.svg"" />"
"<img src=""75d5
66908b0e334825d0e41647 66e173293bc9_
m yy0lB.ng"" />"
11-13 An
my
"An l Tri ngle: &nbs;{{c1::Ischi n l Fss }}<div><br /></div><div><div>L rge f
sci -lined wedge sh ed s ce&nbs;</div><div><br /></div><div>Lc
ed be
ween
skin nd n l regin/elvic di hr gm</div><div><br /></div><div>Filled wi
h f

nd lse cnnec
ive
issue</div><div>Func
in
 sur
{{c1:: n l c n l}} bu

flexible
 ermi
descen
f {{c1::feces}}</div><div><img src="" s
e-3224747
34518729.jg"" /></div></div>"
11-13 An
my
Ischi n l fss : &nbs;Pudend l Nerve<div><br /></div><div><div>Arises frm {{c
1::s cr l lexus (S2-S4)}}</div><div><br /></div><div>M in nerve f
he erineum
; chief sensry nerve f
he {{c1::ex
ern l geni
li }}</div><div><br /></div><d
iv>Ex
ern l ure
hr l nd
he n l shinc
ers</div><div><br /></div><div>Exi
s e
lvis
hrugh {{c1::gre
er sci
ic fr men}}</div><div><br /></div><div>Br nches
</div><div>{{c1::Inferir rec
l}} nerve ( n l shinc
er, eri n l skin)</div><d

iv>{{c1::Perine l}} nerve (suerfici l uch)</div><div>--Suerfici l br nch</di

v><div>--Dee br nch</div><div>{{c1::Drs l}} nerve f
he cli
ris/enis (dee
"<img src="" s
e-322633648308630.jg""
uch)</div></div><div><br /></div>
/>"
11-13 An
my
Ischi n l fss : In
ern l Pudend l Ar
ery<div><br /></div><div><div>Arises frm
{{c1::in
ern l ili c}} r
ery nd  sses medi lly
hrugh {{c1::ischi n l fss
}}</div><div><br /></div><div>M in r
ery f erineum including muscles nd ski
n f n l/urgeni
l
ri ngles, erec
ible bdies</div><div><br /></div><div>Br n
ches</div><div>Inferir rec
l r
ery</div><div>Perine l r
ery</div><div>Drs l
r
eries f
he enis/cli
ris</div></div><div><br /></div>
"<img src="" s

e-322762497327423.jg"" />"
11-13 An
my
"<img src=""d21052 842db13b7cb7f4c751242be157 cc55c6_Q_0.svg"" />"
"<img sr
c=""d21052 842db13b7cb7f4c751242be157 cc55c6_A_0.svg"" />"
"<img src=""d210
52 842db13b7cb7f4c751242be157 cc55c6_surce_svg.svg"" />"
"<img src=""d210
52 842db13b7cb7f4c751242be157 cc55c6_
mjUERQW.ng"" />"
11-13 An
my
"<img src=""d21052 842db13b7cb7f4c751242be157 cc55c6_Q_1.svg"" />"
"<img sr
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11-13 An
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c=""0df86 e 689187d77cd4fe7 677bc49d075859e8_A_0.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_surce_svg.svg"" />"
"<img src=""0df8

6 e 689187d77cd4fe7 677bc49d075859e8_
mgx0R2d.ng"" />"

11-13 An
my
"<img src=""0df86 e 689187d77cd4fe7 677bc49d075859e8_Q_1.svg"" />"
"<img sr
c=""0df86 e 689187d77cd4fe7 677bc49d075859e8_A_1.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_surce_svg.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_
mgx0R2d.ng"" />"
11-13 An
my
"<img src=""0df86 e 689187d77cd4fe7 677bc49d075859e8_Q_2.svg"" />"
"<img sr
c=""0df86 e 689187d77cd4fe7 677bc49d075859e8_A_2.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_surce_svg.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_
mgx0R2d.ng"" />"
11-13 An
my
"<img src=""0df86 e 689187d77cd4fe7 677bc49d075859e8_Q_3.svg"" />"
"<img sr
c=""0df86 e 689187d77cd4fe7 677bc49d075859e8_A_3.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_surce_svg.svg"" />"
"<img src=""0df8
6 e 689187d77cd4fe7 677bc49d075859e8_
mgx0R2d.ng"" />"
11-13 An
my
"<img src=""5eb44963ed7284e6185 dee56b fc6c3657024f3_Q_0.svg"" />"
"<img sr
c=""5eb44963ed7284e6185 dee56b fc6c3657024f3_A_0.svg"" />"
"<img src=""5eb4
4963ed7284e6185 dee56b fc6c3657024f3_surce_svg.svg"" />"
"<img src=""5eb4
4963ed7284e6185 dee56b fc6c3657024f3_
m8Dq29.ng"" />"
11-13 An
my
"<img src=""5eb44963ed7284e6185 dee56b fc6c3657024f3_Q_1.svg"" />"
"<img sr
c=""5eb44963ed7284e6185 dee56b fc6c3657024f3_A_1.svg"" />"
"<img src=""5eb4
4963ed7284e6185 dee56b fc6c3657024f3_surce_svg.svg"" />"
"<img src=""5eb4
4963ed7284e6185 dee56b fc6c3657024f3_
m8Dq29.ng"" />"
11-13 An
my
"<img src=""6053f0686e7c8d83617d226c324 f821e14e5fb4_Q_0.svg"" />"
"<img sr
c=""6053f0686e7c8d83617d226c324 f821e14e5fb4_A_0.svg"" />"
"<img src=""6053
f0686e7c8d83617d226c324 f821e14e5fb4_surce_svg.svg"" />"
"<img src=""6053
f0686e7c8d83617d226c324 f821e14e5fb4_
mBGbXYM.ng"" />"
11-13 An
my
"<img src=""6053f0686e7c8d83617d226c324 f821e14e5fb4_Q_1.svg"" />"
"<img sr
c=""6053f0686e7c8d83617d226c324 f821e14e5fb4_A_1.svg"" />"
"<img src=""6053
f0686e7c8d83617d226c324 f821e14e5fb4_surce_svg.svg"" />"
"<img src=""6053
f0686e7c8d83617d226c324 f821e14e5fb4_
mBGbXYM.ng"" />"
11-13 An
my
Clinic l Crrel
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11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_0.svg"" />"
"<img sr
c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_0.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_1.svg"" />"
"<img sr
c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_1.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_2.svg"" />"
"<img sr
c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_2.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_3.svg"" />"
"<img sr

c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_3.svg"" />"

"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_4.svg"" />"
"<img sr
c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_4.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_5.svg"" />"
"<img sr
c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_5.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_Q_6.svg"" />"
"<img sr
c=""7d25df6 4f7517e5d0 0c804869874b42c2bbe10_A_6.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_surce_svg.svg"" />"
"<img src=""7d25
df6 4f7517e5d0 0c804869874b42c2bbe10_
mFTyNXK.ng"" />"
11-13 An
my
"<img src=""1c3 20 1243b983245ec03b71180074884f6 ff6_Q_0.svg"" />"
"<img sr
c=""1c3 20 1243b983245ec03b71180074884f6 ff6_A_0.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_surce_svg.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_
mxGCeTX.ng"" />"
11-13 An
my
"<img src=""1c3 20 1243b983245ec03b71180074884f6 ff6_Q_1.svg"" />"
"<img sr
c=""1c3 20 1243b983245ec03b71180074884f6 ff6_A_1.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_surce_svg.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_
mxGCeTX.ng"" />"
11-13 An
my
"<img src=""1c3 20 1243b983245ec03b71180074884f6 ff6_Q_2.svg"" />"
"<img sr
c=""1c3 20 1243b983245ec03b71180074884f6 ff6_A_2.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_surce_svg.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_
mxGCeTX.ng"" />"
11-13 An
my
"<img src=""1c3 20 1243b983245ec03b71180074884f6 ff6_Q_3.svg"" />"
"<img sr
c=""1c3 20 1243b983245ec03b71180074884f6 ff6_A_3.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_surce_svg.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_
mxGCeTX.ng"" />"
11-13 An
my
"<img src=""1c3 20 1243b983245ec03b71180074884f6 ff6_Q_4.svg"" />"
"<img sr
c=""1c3 20 1243b983245ec03b71180074884f6 ff6_A_4.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_surce_svg.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_
mxGCeTX.ng"" />"
11-13 An
my
"<img src=""1c3 20 1243b983245ec03b71180074884f6 ff6_Q_5.svg"" />"
"<img sr
c=""1c3 20 1243b983245ec03b71180074884f6 ff6_A_5.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_surce_svg.svg"" />"
"<img src=""1c3
20 1243b983245ec03b71180074884f6 ff6_
mxGCeTX.ng"" />"
11-13 An
my
"Clinic l Crrel
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11-13 An
my
"<img src=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_Q_0.svg"" />"
"<img sr
c=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_A_0.svg"" />"
"<img src=""b8e0
70dcb89c3705c747fdfdc85c 80099 6bfff_surce_svg.svg"" />"
"<img src=""b8e0
70dcb89c3705c747fdfdc85c 80099 6bfff_
m2B7F9k.ng"" />"
11-13 An
my
"<img src=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_Q_1.svg"" />"
"<img sr

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70dcb89c3705c747fdfdc85c 80099 6bfff_surce_svg.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_
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11-13 An
my
"<img src=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_Q_2.svg""
c=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_A_2.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_surce_svg.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_
m2B7F9k.ng"" />"
11-13 An
my
"<img src=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_Q_3.svg""
c=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_A_3.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_surce_svg.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_
m2B7F9k.ng"" />"
11-13 An
my
"<img src=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_Q_4.svg""
c=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_A_4.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_surce_svg.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_
m2B7F9k.ng"" />"
11-13 An
my
"<img src=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_Q_5.svg""
c=""b8e070dcb89c3705c747fdfdc85c 80099 6bfff_A_5.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_surce_svg.svg"" />"
70dcb89c3705c747fdfdc85c 80099 6bfff_
m2B7F9k.ng"" />"
11-13 An
my
"<img src=""b738c5 118039466599c39e 4 df38f82316fd6e_Q_0.svg""
c=""b738c5 118039466599c39e 4 df38f82316fd6e_A_0.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_surce_svg.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_
mAuN7iL.ng"" />"
11-13 An
my
"<img src=""b738c5 118039466599c39e 4 df38f82316fd6e_Q_1.svg""
c=""b738c5 118039466599c39e 4 df38f82316fd6e_A_1.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_surce_svg.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_
mAuN7iL.ng"" />"
11-13 An
my
"<img src=""b738c5 118039466599c39e 4 df38f82316fd6e_Q_2.svg""
c=""b738c5 118039466599c39e 4 df38f82316fd6e_A_2.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_surce_svg.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_
mAuN7iL.ng"" />"
11-13 An
my
"<img src=""b738c5 118039466599c39e 4 df38f82316fd6e_Q_3.svg""
c=""b738c5 118039466599c39e 4 df38f82316fd6e_A_3.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_surce_svg.svg"" />"
c5 118039466599c39e 4 df38f82316fd6e_
mAuN7iL.ng"" />"
11-13 An
my
"<img src=""b 9fcb0484374d8031c034 84b5c2e50148117bc_Q_0.svg""
c=""b 9fcb0484374d8031c034 84b5c2e50148117bc_A_0.svg"" />"
cb0484374d8031c034 84b5c2e50148117bc_surce_svg.svg"" />"
cb0484374d8031c034 84b5c2e50148117bc_
m8C6mC.ng"" />"
11-13 An
my
"<img src=""b 9fcb0484374d8031c034 84b5c2e50148117bc_Q_1.svg""
c=""b 9fcb0484374d8031c034 84b5c2e50148117bc_A_1.svg"" />"
cb0484374d8031c034 84b5c2e50148117bc_surce_svg.svg"" />"
cb0484374d8031c034 84b5c2e50148117bc_
m8C6mC.ng"" />"
11-13 An
my
"<img src=""b 9fcb0484374d8031c034 84b5c2e50148117bc_Q_2.svg""
c=""b 9fcb0484374d8031c034 84b5c2e50148117bc_A_2.svg"" />"
cb0484374d8031c034 84b5c2e50148117bc_surce_svg.svg"" />"
cb0484374d8031c034 84b5c2e50148117bc_
m8C6mC.ng"" />"
11-13 An
my
"<img src=""b 9fcb0484374d8031c034 84b5c2e50148117bc_Q_3.svg""

"<img src=""b8e0
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/>"
"<img sr
"<img src=""b8e0
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/>"
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"<img sr

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"<img src=""b 9f
cb0484374d8031c034 84b5c2e50148117bc_surce_svg.svg"" />"
"<img src=""b 9f
cb0484374d8031c034 84b5c2e50148117bc_
m8C6mC.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_0.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_0.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_1.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_1.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_2.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_2.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_3.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_3.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_4.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_4.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_5.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_5.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_6.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_6.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_7.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_7.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"<img src=""13fe58d860 32 f45e19dd4935757978bdb500 _Q_8.svg"" />"
"<img sr
c=""13fe58d860 32 f45e19dd4935757978bdb500 _A_8.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _surce_svg.svg"" />"
"<img src=""13fe
58d860 32 f45e19dd4935757978bdb500 _
m4vJW18.ng"" />"
11-13 An
my
"Clinic l Crrel
in: &nbs;Ru
ure f Ure
hr in M les<div><br /></div><div><d
iv>D m ge
 enile ure
hr /vessels resul
s in urine/bld  ss ge in

he {{c1
::suerfici l erine l}} s ce</div><div><br /></div><div>Cnfined s
erirly b
y

chmen
f {{c1::erine l f sci (Clles)}}
 {{c1::urgeni
l di hr gm}}<
/div><div><br /></div><div>Cnfined l
er lly by

chmen
f {{c1::erine l f
sci }}
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frw rd</div><div>Scr
um</div><div>Penis</div><div>Inferir bdmin l w ll</div
></div><div><img src="" s
e-663649756643718.jg"" /></div>"
11-13 An

my
Hw i
wrks: &nbs;Erec
in, Emissin, Ej cul
in, Remissin<div><br /></div><
div><div><b>Erec
in-
urgid erec
ile bdies</b></div><div>Ar
erirvenus n s
m

ses in crr c verns clsed</div><div>P r sym
he
ic innerv
in frm {{c1
::elvic sl nchnics (S2-S4)}} c uses rel x
in f
he sm
h muscle nd s
r ig
h
ening/dil
in f
he {{c1::helicine}} r
eries</div><div>{{c1::Bulbsngisu
s nd ischic vernsus}} muscles cmress veins</div><div><br /></div><div><b>Em
issin-delivery f semen in

he ure
hr </b></div><div>Sym
he
ic resnse fr
m {{c1::lumb r sl nchnics(L1-L2)}}</div><div><br /></div><div><b>Ej cul
in-se
men exelled
hrugh ex
ern l ure
hr l rifice</b></div><div>Sym
he
ic frm {{
c1::lumb r sl nchnics (L1-L2)}}</div><div>Clsure f {{c1::in
ern l ure
her l}}
shinc
er</div><div>P r sym
he
ic frm {{c1::elvic sl nchnics(S2-S4)}}</div
><div>Cn
r c
in f
he {{c1::ure
her l}} muscle</div><div>M
r frm
he {{c1:
:Pudend l nerve (S2-S4)}}</div><div>Cn
r c
in f {{c1::bulbsngisus}} muscl
e</div><div><br /></div><div><b>Remissin</b></div><div>Sym
he
ic s
imul
in
c uses cns
ric
in f {{c1::helicine}} r
eries</div><div>Rel x
in f {{c1::b
ulbsngisus}} nd {{c1::ischic vernsus}} muscles</div></div><div><br /></di
v>
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_0.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_0.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_1.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_1.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_2.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_2.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_3.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_3.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_4.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_4.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_5.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_5.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"<img src="" d0653ef41 31b1641bc4507bd36e2121c36cef9_Q_6.svg"" />"
"<img sr
c="" d0653ef41 31b1641bc4507bd36e2121c36cef9_A_6.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_surce_svg.svg"" />"
"<img src="" d06
53ef41 31b1641bc4507bd36e2121c36cef9_
mYbkBDj.ng"" />"
11-13 An
my
"Fem le Suerfici l Puch: &nbs;Erec
ile
issue<div><br /></div><div><div>Cli

ris</div><div>R
</div><div>Tw {{c1::crur }}</div><div>Bdy</div><div>Tw {{c1
::crr c verns }}</div><div>Gl ns f
he cli
ris</div><div><br /></div><div
>Bulbs f
he Ves
ibule</div><div>M sses f elng
ed erec
ile
issue</div><div>
Gre
er ves
ibul r gl nds (B r
hlin)</div><div>Overl ed by bulbs</div><div>Se
cre
e {{c1::mucus}} in

he {{c1::ves
ibule}} during sexu l rus l</div></div
><div><img src="" s
e-738781619552640.jg"" /></div>"
11-13 An
my
"<img src=""3dbf402b2be819f 913353871039717152f639c8_Q_0.svg"" />"
"<img sr
c=""3dbf402b2be819f 913353871039717152f639c8_A_0.svg"" />"
"<img src=""3dbf
402b2be819f 913353871039717152f639c8_surce_svg.svg"" />"
"<img src=""3dbf

402b2be819f 913353871039717152f639c8_
m FxSSU.ng"" />"

11-13 An
my
"<img src=""f12efd8d5df7 47 fcf9e00df84cf18d0f53c8fb_Q_0.svg""
c=""f12efd8d5df7 47 fcf9e00df84cf18d0f53c8fb_A_0.svg"" />"
fd8d5df7 47 fcf9e00df84cf18d0f53c8fb_surce_svg.svg"" />"
fd8d5df7 47 fcf9e00df84cf18d0f53c8fb_
mfmwAD.ng"" />"
11-13 An
my
"<img src=""f12efd8d5df7 47 fcf9e00df84cf18d0f53c8fb_Q_1.svg""
c=""f12efd8d5df7 47 fcf9e00df84cf18d0f53c8fb_A_1.svg"" />"
fd8d5df7 47 fcf9e00df84cf18d0f53c8fb_surce_svg.svg"" />"
fd8d5df7 47 fcf9e00df84cf18d0f53c8fb_
mfmwAD.ng"" />"
11-13 An
my
"<img src=""f12efd8d5df7 47 fcf9e00df84cf18d0f53c8fb_Q_2.svg""
c=""f12efd8d5df7 47 fcf9e00df84cf18d0f53c8fb_A_2.svg"" />"
fd8d5df7 47 fcf9e00df84cf18d0f53c8fb_surce_svg.svg"" />"
fd8d5df7 47 fcf9e00df84cf18d0f53c8fb_
mfmwAD.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_0.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_0.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_1.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_1.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_2.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_2.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_3.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_3.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_4.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_4.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_5.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_5.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_6.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_6.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_7.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_7.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_8.svg""
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_8.svg"" />"
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"

/>"
"<img sr
"<img src=""f12e
"<img src=""f12e
/>"
"<img sr
"<img src=""f12e
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/>"
"<img sr
"<img src=""f12e
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/>"
"<img sr
"<img src=""c3 8
"<img src=""c3 8
/>"
"<img sr
"<img src=""c3 8
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/>"
"<img sr
"<img src=""c3 8
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/>"
"<img sr
"<img src=""c3 8
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/>"
"<img sr
"<img src=""c3 8
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/>"
"<img sr
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"<img sr
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"<img src=""c3 8
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"<img sr
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11-13 An
my
"<img src=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_Q_9.svg"" />"
"<img sr
c=""c3 8570328e29b93 08fd 0ec574c8 d839 2eb0_A_9.svg"" />"
"<img src=""c3 8
570328e29b93 08fd 0ec574c8 d839 2eb0_surce_svg.svg"" />"
"<img src=""c3 8
570328e29b93 08fd 0ec574c8 d839 2eb0_
mmLlJ08.ng"" />"
11-13 An
my
"<img src=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_Q_0.svg"" />"
"<img sr
c=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_A_0.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_surce_svg.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_
mFPYRw7.ng"" />"
11-13 An
my
"<img src=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_Q_1.svg"" />"
"<img sr
c=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_A_1.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_surce_svg.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_
mFPYRw7.ng"" />"
11-13 An
my
"<img src=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_Q_2.svg"" />"
"<img sr
c=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_A_2.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_surce_svg.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_
mFPYRw7.ng"" />"
11-13 An
my
"<img src=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_Q_3.svg"" />"
"<img sr
c=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_A_3.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_surce_svg.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_
mFPYRw7.ng"" />"
11-13 An
my
"<img src=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_Q_4.svg"" />"
"<img sr
c=""bd2128f3cbf44fcc3 99549c4150dccb621 25c5_A_4.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_surce_svg.svg"" />"
"<img src=""bd21
28f3cbf44fcc3 99549c4150dccb621 25c5_
mFPYRw7.ng"" />"
11-13 An
my
Clinic l Crrel
in: &nbs;Kegel Exercises<div><br /></div><div><div>Suerfici
l
r nsverse erine l, bulbsngisus muscle, ex
ern l n l shinc
er sur

erine l bdy</div><div><br /></div><div>N func
in l dem nds rel
ed
 urin
i
n r erec
in-
end
 be underdeveled in fem les</div><div><br /></div><div>K
egel exercises: &nbs;vlun
ry cn
r c
in nd rel x
in f {{c1::erine l}} m
uscles</div><div><br /></div><div>S
reng
hen nd devel muscles
 hel reven

urin ry s
ress incn
inence nd s
 r
um rl se f elvic vicser </div><div
><br /></div><div>1 in 9 wmen will h ve
surgic l rcedure
 ddress urin ry
s
ress incn
inence/rl se; surgic l cs
s es
im
ed
ver $1 billin nnu
lly</div></div><div><br /></div>
11-13 An
my
"<img src=""c32 9735512e 1139317e569 41685be3481 8d1_Q_0.svg"" />"
"<img sr
c=""c32 9735512e 1139317e569 41685be3481 8d1_A_0.svg"" />"
"<img src=""c32
9735512e 1139317e569 41685be3481 8d1_surce_svg.svg"" />"
"<img src=""c32
9735512e 1139317e569 41685be3481 8d1_
mNkYzgV.ng"" />"
11-13 An
my
"<img src=""c32 9735512e 1139317e569 41685be3481 8d1_Q_1.svg"" />"
"<img sr
c=""c32 9735512e 1139317e569 41685be3481 8d1_A_1.svg"" />"
"<img src=""c32
9735512e 1139317e569 41685be3481 8d1_surce_svg.svg"" />"
"<img src=""c32
9735512e 1139317e569 41685be3481 8d1_
mNkYzgV.ng"" />"
11-13 An
my
"<img src=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_Q_0.svg"" />"
"<img sr
c=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_A_0.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_surce_svg.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_
mL8zL5b.ng"" />"
11-13 An
my
"<img src=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_Q_1.svg"" />"
"<img sr
c=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_A_1.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_surce_svg.svg"" />"
"<img src=""2e 7

ec6e62c8be f2fc1915f5e1cd85b2b80911d_
mL8zL5b.ng"" />"

11-13 An
my
"<img src=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_Q_2.svg"" />"
"<img sr
c=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_A_2.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_surce_svg.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_
mL8zL5b.ng"" />"
11-13 An
my
"<img src=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_Q_3.svg"" />"
"<img sr
c=""2e 7ec6e62c8be f2fc1915f5e1cd85b2b80911d_A_3.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_surce_svg.svg"" />"
"<img src=""2e 7
ec6e62c8be f2fc1915f5e1cd85b2b80911d_
mL8zL5b.ng"" />"
11-13 An
my
"<img src=""5f1c4de7db08e2255f1630f92119d81bdb f4c7f_Q_0.svg"" />"
"<img sr
c=""5f1c4de7db08e2255f1630f92119d81bdb f4c7f_A_0.svg"" />"
"<img src=""5f1c
4de7db08e2255f1630f92119d81bdb f4c7f_surce_svg.svg"" />"
"<img src=""5f1c
4de7db08e2255f1630f92119d81bdb f4c7f_
mYBhGrO.ng"" />"
Muscle nd A

c
hmen
nd Func
in
11-13 An
my
"<img src=""5f1c4de7db08e2255f1630f92119d81bdb f4c7f_Q_1.svg"" />"
"<img sr
c=""5f1c4de7db08e2255f1630f92119d81bdb f4c7f_A_1.svg"" />"
"<img src=""5f1c
4de7db08e2255f1630f92119d81bdb f4c7f_surce_svg.svg"" />"
"<img src=""5f1c
4de7db08e2255f1630f92119d81bdb f4c7f_
mYBhGrO.ng"" />"
Muscle nd A

c
hmen
nd Func
in
11-13 An
my
"<img src=""5f1c4de7db08e2255f1630f92119d81bdb f4c7f_Q_2.svg"" />"
"<img sr
c=""5f1c4de7db08e2255f1630f92119d81bdb f4c7f_A_2.svg"" />"
"<img src=""5f1c
4de7db08e2255f1630f92119d81bdb f4c7f_surce_svg.svg"" />"
"<img src=""5f1c
4de7db08e2255f1630f92119d81bdb f4c7f_
mYBhGrO.ng"" />"
Muscle nd A

c
hmen
nd Func
in
11-13 An
my
<div>Uer limi
f bl dder filling</div><div>&nbs;is
he {{c1::umbilicus}}</di
v><div><br /></div><div><div>Obli
er
ed umbilic l r
eries frm {{c1::medi l um
bilic l lig men
s func
in?}}</div></div><div><br /></div><div><div>Af
er bl dde
r is s
re
ched inferirly, l
er lly, nd suerirly, i
mus
ex nd g ins

he
{{c1::sm ll in
es
ines}} whse eris
lsis hi
s
he bl dder w ll c using reflex
cn
r c
ins
he
hinner
he bl dder w ll
he s
rnger
he reflex cn
r c
in &
nbs; nd
he gre
er
he urge
 mic
ur
e</div></div><div><br /></div> "<img sr
c="" s
e-140578574565761.jg"" />"
11-17 An
my
"<img src=""42dc11363e2922fc2692c81e8754598e13738 7_Q_0.svg"" />"
"<img sr
c=""42dc11363e2922fc2692c81e8754598e13738 7_A_0.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_surce_svg.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_
mjykHkP.ng"" />"
11-17 An
my
"<img src=""42dc11363e2922fc2692c81e8754598e13738 7_Q_1.svg"" />"
"<img sr
c=""42dc11363e2922fc2692c81e8754598e13738 7_A_1.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_surce_svg.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_
mjykHkP.ng"" />"
11-17 An
my
"<img src=""42dc11363e2922fc2692c81e8754598e13738 7_Q_2.svg"" />"
"<img sr
c=""42dc11363e2922fc2692c81e8754598e13738 7_A_2.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_surce_svg.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_
mjykHkP.ng"" />"
11-17 An
my
"<img src=""42dc11363e2922fc2692c81e8754598e13738 7_Q_3.svg"" />"
"<img sr
c=""42dc11363e2922fc2692c81e8754598e13738 7_A_3.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_surce_svg.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_
mjykHkP.ng"" />"
11-17 An
my
"<img src=""42dc11363e2922fc2692c81e8754598e13738 7_Q_4.svg"" />"
"<img sr
c=""42dc11363e2922fc2692c81e8754598e13738 7_A_4.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_surce_svg.svg"" />"
"<img src=""42dc
11363e2922fc2692c81e8754598e13738 7_
mjykHkP.ng"" />"
11-17 An
my

"<img src=""d21824dce77cb26211244206c8161cd176064854_Q_0.svg""
c=""d21824dce77cb26211244206c8161cd176064854_A_0.svg"" />"
24dce77cb26211244206c8161cd176064854_surce_svg.svg"" />"
24dce77cb26211244206c8161cd176064854_
m0gukJ7.ng"" />"
11-17 An
my
"<img src=""d21824dce77cb26211244206c8161cd176064854_Q_1.svg""
c=""d21824dce77cb26211244206c8161cd176064854_A_1.svg"" />"
24dce77cb26211244206c8161cd176064854_surce_svg.svg"" />"
24dce77cb26211244206c8161cd176064854_
m0gukJ7.ng"" />"
11-17 An
my
"<img src=""d21824dce77cb26211244206c8161cd176064854_Q_2.svg""
c=""d21824dce77cb26211244206c8161cd176064854_A_2.svg"" />"
24dce77cb26211244206c8161cd176064854_surce_svg.svg"" />"
24dce77cb26211244206c8161cd176064854_
m0gukJ7.ng"" />"
11-17 An
my
"<img src=""d21824dce77cb26211244206c8161cd176064854_Q_3.svg""
c=""d21824dce77cb26211244206c8161cd176064854_A_3.svg"" />"
24dce77cb26211244206c8161cd176064854_surce_svg.svg"" />"
24dce77cb26211244206c8161cd176064854_
m0gukJ7.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_0.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_0.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_1.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_1.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_2.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_2.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_3.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_3.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_4.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_4.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_5.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_5.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_6.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_6.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_7.svg""
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_7.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my

/>"
"<img sr
"<img src=""d218
"<img src=""d218
/>"
"<img sr
"<img src=""d218
"<img src=""d218
/>"
"<img sr
"<img src=""d218
"<img src=""d218
/>"
"<img sr
"<img src=""d218
"<img src=""d218
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c
/>"
"<img sr
"<img src=""b63c
"<img src=""b63c

"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_8.svg"" />"

c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_8.svg"" />"
"<img
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
"<img
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_9.svg"" />"
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_9.svg"" />"
"<img
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
"<img
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_Q_10.svg"" />"
c=""b63c6b3429e05 75c50dec d467dc80fb5d1d5f_A_10.svg"" />"
"<img
6b3429e05 75c50dec d467dc80fb5d1d5f_surce_svg.svg"" />"
"<img
6b3429e05 75c50dec d467dc80fb5d1d5f_
mRE8KX0.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_0.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_0.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_1.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_1.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_2.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_2.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_3.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_3.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_4.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_4.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_5.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_5.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_6.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_6.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_7.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_7.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_8.svg"" />"
c=""59b 9182f210e45 949883b130902 f50e394061_A_8.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my

"<img sr
src=""b63c
src=""b63c
"<img sr
src=""b63c
src=""b63c
"<img sr
src=""b63c
src=""b63c
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b
"<img sr
src=""59b
src=""59b

"<img src=""59b 9182f210e45 949883b130902 f50e394061_Q_9.svg"" />"

c=""59b 9182f210e45 949883b130902 f50e394061_A_9.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_surce_svg.svg"" />"
"<img
9182f210e45 949883b130902 f50e394061_
mR4OwQ_.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_0.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_0.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_1.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_1.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_2.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_2.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_3.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_3.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_4.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_4.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_5.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_5.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_6.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_6.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_7.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_7.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_8.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_8.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_9.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_9.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_10.svg"" />"
c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_10.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my

"<img sr
src=""59b
src=""59b
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb
"<img sr
src=""ccb
src=""ccb

"<img src=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_Q_11.svg"" />"

c=""ccb f5cd33ecd4b0f317c55b6ed50c94f256cf3_A_11.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_surce_svg.svg"" />"
"<img
f5cd33ecd4b0f317c55b6ed50c94f256cf3_
mim89I.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_0.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_0.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_1.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_1.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_2.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_2.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_3.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_3.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_4.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_4.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_5.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_5.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_6.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_6.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_7.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_7.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_8.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_8.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_9.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_9.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my
"<img src=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_Q_10.svg"" />"
c=""4c41d62f7b8ddcedb82e021059fc2bb53c3 0278_A_10.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_surce_svg.svg"" />"
"<img
d62f7b8ddcedb82e021059fc2bb53c3 0278_
mLN895S.ng"" />"
11-17 An
my

"<img sr
src=""ccb
src=""ccb
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41
"<img sr
src=""4c41
src=""4c41

"<img src=""4526b 62ef417de 7825ff756ef 415984 c05 5_Q_0.svg""

c=""4526b 62ef417de 7825ff756ef 415984 c05 5_A_0.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_surce_svg.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_
mUZnVJD.ng"" />"
11-17 An
my
"<img src=""4526b 62ef417de 7825ff756ef 415984 c05 5_Q_1.svg""
c=""4526b 62ef417de 7825ff756ef 415984 c05 5_A_1.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_surce_svg.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_
mUZnVJD.ng"" />"
11-17 An
my
"<img src=""4526b 62ef417de 7825ff756ef 415984 c05 5_Q_2.svg""
c=""4526b 62ef417de 7825ff756ef 415984 c05 5_A_2.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_surce_svg.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_
mUZnVJD.ng"" />"
11-17 An
my
"<img src=""4526b 62ef417de 7825ff756ef 415984 c05 5_Q_3.svg""
c=""4526b 62ef417de 7825ff756ef 415984 c05 5_A_3.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_surce_svg.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_
mUZnVJD.ng"" />"
11-17 An
my
"<img src=""4526b 62ef417de 7825ff756ef 415984 c05 5_Q_4.svg""
c=""4526b 62ef417de 7825ff756ef 415984 c05 5_A_4.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_surce_svg.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_
mUZnVJD.ng"" />"
11-17 An
my
"<img src=""4526b 62ef417de 7825ff756ef 415984 c05 5_Q_5.svg""
c=""4526b 62ef417de 7825ff756ef 415984 c05 5_A_5.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_surce_svg.svg"" />"
b 62ef417de 7825ff756ef 415984 c05 5_
mUZnVJD.ng"" />"
11-17 An
my
"<img src="" 18690e43c9f178d3c579e386dc68b7fee 4384_Q_0.svg""
c="" 18690e43c9f178d3c579e386dc68b7fee 4384_A_0.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_surce_svg.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_
m3uMY k.ng"" />"
11-17 An
my
"<img src="" 18690e43c9f178d3c579e386dc68b7fee 4384_Q_1.svg""
c="" 18690e43c9f178d3c579e386dc68b7fee 4384_A_1.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_surce_svg.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_
m3uMY k.ng"" />"
11-17 An
my
"<img src="" 18690e43c9f178d3c579e386dc68b7fee 4384_Q_2.svg""
c="" 18690e43c9f178d3c579e386dc68b7fee 4384_A_2.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_surce_svg.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_
m3uMY k.ng"" />"
11-17 An
my
"<img src="" 18690e43c9f178d3c579e386dc68b7fee 4384_Q_3.svg""
c="" 18690e43c9f178d3c579e386dc68b7fee 4384_A_3.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_surce_svg.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_
m3uMY k.ng"" />"
11-17 An
my
"<img src="" 18690e43c9f178d3c579e386dc68b7fee 4384_Q_4.svg""
c="" 18690e43c9f178d3c579e386dc68b7fee 4384_A_4.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_surce_svg.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_
m3uMY k.ng"" />"
11-17 An
my
"<img src="" 18690e43c9f178d3c579e386dc68b7fee 4384_Q_5.svg""
c="" 18690e43c9f178d3c579e386dc68b7fee 4384_A_5.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_surce_svg.svg"" />"
90e43c9f178d3c579e386dc68b7fee 4384_
m3uMY k.ng"" />"
11-17 An
my

/>"
"<img sr
"<img src=""4526
"<img src=""4526
/>"
"<img sr
"<img src=""4526
"<img src=""4526
/>"
"<img sr
"<img src=""4526
"<img src=""4526
/>"
"<img sr
"<img src=""4526
"<img src=""4526
/>"
"<img sr
"<img src=""4526
"<img src=""4526
/>"
"<img sr
"<img src=""4526
"<img src=""4526
/>"
"<img sr
"<img src="" 186
"<img src="" 186
/>"
"<img sr
"<img src="" 186
"<img src="" 186
/>"
"<img sr
"<img src="" 186
"<img src="" 186
/>"
"<img sr
"<img src="" 186
"<img src="" 186
/>"
"<img sr
"<img src="" 186
"<img src="" 186
/>"
"<img sr
"<img src="" 186
"<img src="" 186

<div>{{c1::Medi l umbilic l lig}} fuses
he
r nsvers lis f sci

he s
eri
r rec
us she
h nd limi
s l
er l nd suerir filling f
he bl dder. Once
he
bl dder h s filled
he {{c1::PVF}} nd
he {{c1::SVF}} u

he umbilicus
he
bl dder c n nly fill by ex nding s
erirly g ins

he sm ll in
es
ine. As

he bl dder w ll s
re
ches s i
fills ,
he eris
lsis f
he {{c1::sm ll in
es

ine}} hi

ing
he bl dder c uses incre singly s
rnger reflexive cn
r c
ins w
hich resul
s in
gre
er desire
 mic
ur
e.&nbs;</div><div><br /></div>
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_0.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_0.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_1.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_1.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_2.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_2.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_3.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_3.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_4.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_4.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_5.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_5.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_6.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_6.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
"<img src=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_Q_7.svg"" />"
"<img sr
c=""b8e2775ec0b640789c64cbf94eb 5e36b062887f_A_7.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_surce_svg.svg"" />"
"<img src=""b8e2
775ec0b640789c64cbf94eb 5e36b062887f_
mKHXB9D.ng"" />"
11-17 An
my
<div>Mbiliz
in f
he serm frm re
e
es
is

he bulb &nbs;f
he ure
hr
is by cn
r c
in f
he sm
h muscle under
he cn
rl f
he {{c1::lumb r s
l nchnics sym
he
ics}} l d
he gun. Ej cul
in e rs
 be
sin l crd r
eflex - sh

he gun ff vilen
s sm f
he bulbsngisus muscle g ins

h
e {{c1::UG di hr gm}} &nbs;squeezes
he {{c1::ure
hr l mull }} nd rels

he semen frm
he m le &nbs;bdy. &nbs;</div><div><br /></div>
11-17 An
my
"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_0.svg"" />"
"<img sr
c=""01111586b825c31017c84be384e0f678103 8f0c_A_0.svg"" />"
"<img src=""0111
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
"<img src=""0111
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my

"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_1.svg""

c=""01111586b825c31017c84be384e0f678103 8f0c_A_1.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my
"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_2.svg""
c=""01111586b825c31017c84be384e0f678103 8f0c_A_2.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my
"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_3.svg""
c=""01111586b825c31017c84be384e0f678103 8f0c_A_3.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my
"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_4.svg""
c=""01111586b825c31017c84be384e0f678103 8f0c_A_4.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my
"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_5.svg""
c=""01111586b825c31017c84be384e0f678103 8f0c_A_5.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my
"<img src=""01111586b825c31017c84be384e0f678103 8f0c_Q_6.svg""
c=""01111586b825c31017c84be384e0f678103 8f0c_A_6.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_surce_svg.svg"" />"
1586b825c31017c84be384e0f678103 8f0c_
m0ZPQs .ng"" />"
11-17 An
my
"<img src=""8056789326b28 fbc55b757d91d183e48 45c52_Q_0.svg""
c=""8056789326b28 fbc55b757d91d183e48 45c52_A_0.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_surce_svg.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_
mIksm2m.ng"" />"
11-17 An
my
"<img src=""8056789326b28 fbc55b757d91d183e48 45c52_Q_1.svg""
c=""8056789326b28 fbc55b757d91d183e48 45c52_A_1.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_surce_svg.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_
mIksm2m.ng"" />"
11-17 An
my
"<img src=""8056789326b28 fbc55b757d91d183e48 45c52_Q_2.svg""
c=""8056789326b28 fbc55b757d91d183e48 45c52_A_2.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_surce_svg.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_
mIksm2m.ng"" />"
11-17 An
my
"<img src=""8056789326b28 fbc55b757d91d183e48 45c52_Q_3.svg""
c=""8056789326b28 fbc55b757d91d183e48 45c52_A_3.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_surce_svg.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_
mIksm2m.ng"" />"
11-17 An
my
"<img src=""8056789326b28 fbc55b757d91d183e48 45c52_Q_4.svg""
c=""8056789326b28 fbc55b757d91d183e48 45c52_A_4.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_surce_svg.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_
mIksm2m.ng"" />"
11-17 An
my
"<img src=""8056789326b28 fbc55b757d91d183e48 45c52_Q_5.svg""
c=""8056789326b28 fbc55b757d91d183e48 45c52_A_5.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_surce_svg.svg"" />"
789326b28 fbc55b757d91d183e48 45c52_
mIksm2m.ng"" />"
11-17 An
my

/>"
"<img sr
"<img src=""0111
"<img src=""0111
/>"
"<img sr
"<img src=""0111
"<img src=""0111
/>"
"<img sr
"<img src=""0111
"<img src=""0111
/>"
"<img sr
"<img src=""0111
"<img src=""0111
/>"
"<img sr
"<img src=""0111
"<img src=""0111
/>"
"<img sr
"<img src=""0111
"<img src=""0111
/>"
"<img sr
"<img src=""8056
"<img src=""8056
/>"
"<img sr
"<img src=""8056
"<img src=""8056
/>"
"<img sr
"<img src=""8056
"<img src=""8056
/>"
"<img sr
"<img src=""8056
"<img src=""8056
/>"
"<img sr
"<img src=""8056
"<img src=""8056
/>"
"<img sr
"<img src=""8056
"<img src=""8056

<div>Circul r fibers rund
he beginning f
he ure
hr wi
hin
he {{c1::
rign
e}} c
like shinc
er rund
he rigin f
he ure
hr nd cns
i
u
e
he {{c
1::invlun
ry shinc
er}} f
he bl dder. During semen mbiliz
in nd ej cul

in
his shinc
er reven
s {{c1::semen}} frm being frced in

he bl dder. M
les wi
h TURP surgery (
r nsure
hr l resec
in f
he rs

e) &nbs;will like
ly be s
erile s {{c1::semen}} will mix wi
h urine nd
he serm re ins
n
ly k
illed. &nbs;Em
y bl dder h s flds c lled rug e
he llw fr ex nsin.&nbs;
</div><div><br /></div>
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_0.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_0.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_1.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_1.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_2.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_2.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_3.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_3.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_4.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_4.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_5.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_5.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""74c b8c80e9241247db094268 f1c1ce0fee cce_Q_6.svg"" />"
"<img sr
c=""74c b8c80e9241247db094268 f1c1ce0fee cce_A_6.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_surce_svg.svg"" />"
"<img src=""74c
b8c80e9241247db094268 f1c1ce0fee cce_
m5FGzui.ng"" />"
11-17 An
my
"<img src=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_Q_0.svg"" />"
"<img sr
c=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_A_0.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_surce_svg.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_
mkrO783.ng"" />"
11-17 An
my
"<img src=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_Q_1.svg"" />"
"<img sr
c=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_A_1.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_surce_svg.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_
mkrO783.ng"" />"
11-17 An
my
"<img src=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_Q_2.svg"" />"
"<img sr
c=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_A_2.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_surce_svg.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_
mkrO783.ng"" />"
11-17 An
my
"<img src=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_Q_3.svg"" />"
"<img sr
c=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_A_3.svg"" />"
"<img src=""04fc

fc392e847 308f06bcf0 23e08ee8236b1bb_surce_svg.svg"" />"

"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_
mkrO783.ng"" />"
11-17 An
my
"<img src=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_Q_4.svg"" />"
"<img sr
c=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_A_4.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_surce_svg.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_
mkrO783.ng"" />"
11-17 An
my
"<img src=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_Q_5.svg"" />"
"<img sr
c=""04fcfc392e847 308f06bcf0 23e08ee8236b1bb_A_5.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_surce_svg.svg"" />"
"<img src=""04fc
fc392e847 308f06bcf0 23e08ee8236b1bb_
mkrO783.ng"" />"
11-17 An
my
"<img src=""2280ed76fd002232d7899d7971829802ede5371c_Q_0.svg"" />"
"<img sr
c=""2280ed76fd002232d7899d7971829802ede5371c_A_0.svg"" />"
"<img src=""2280
ed76fd002232d7899d7971829802ede5371c_surce_svg.svg"" />"
"<img src=""2280
ed76fd002232d7899d7971829802ede5371c_
m_k0KO.ng"" />"
11-17 An
my
"<img src=""2280ed76fd002232d7899d7971829802ede5371c_Q_1.svg"" />"
"<img sr
c=""2280ed76fd002232d7899d7971829802ede5371c_A_1.svg"" />"
"<img src=""2280
ed76fd002232d7899d7971829802ede5371c_surce_svg.svg"" />"
"<img src=""2280
ed76fd002232d7899d7971829802ede5371c_
m_k0KO.ng"" />"
11-17 An
my
"<img src=""2280ed76fd002232d7899d7971829802ede5371c_Q_2.svg"" />"
"<img sr
c=""2280ed76fd002232d7899d7971829802ede5371c_A_2.svg"" />"
"<img src=""2280
ed76fd002232d7899d7971829802ede5371c_surce_svg.svg"" />"
"<img src=""2280
ed76fd002232d7899d7971829802ede5371c_
m_k0KO.ng"" />"
11-17 An
my
"<img src=""1c1d6396b02eff53132f8d0 06215dec7992f3f6_Q_0.svg"" />"
"<img sr
c=""1c1d6396b02eff53132f8d0 06215dec7992f3f6_A_0.svg"" />"
"<img src=""1c1d
6396b02eff53132f8d0 06215dec7992f3f6_surce_svg.svg"" />"
"<img src=""1c1d
6396b02eff53132f8d0 06215dec7992f3f6_
mROFKVs.ng"" />"
11-17 An
my
"<img src=""1c1d6396b02eff53132f8d0 06215dec7992f3f6_Q_1.svg"" />"
"<img sr
c=""1c1d6396b02eff53132f8d0 06215dec7992f3f6_A_1.svg"" />"
"<img src=""1c1d
6396b02eff53132f8d0 06215dec7992f3f6_surce_svg.svg"" />"
"<img src=""1c1d
6396b02eff53132f8d0 06215dec7992f3f6_
mROFKVs.ng"" />"
11-17 An
my
"<img src=""d1 ef845 1e7d476 596b125b6482b054f14843c_Q_0.svg"" />"
"<img sr
c=""d1 ef845 1e7d476 596b125b6482b054f14843c_A_0.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_surce_svg.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_
mfEuT9.ng"" />"
11-17 An
my
"<img src=""d1 ef845 1e7d476 596b125b6482b054f14843c_Q_1.svg"" />"
"<img sr
c=""d1 ef845 1e7d476 596b125b6482b054f14843c_A_1.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_surce_svg.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_
mfEuT9.ng"" />"
11-17 An
my
"<img src=""d1 ef845 1e7d476 596b125b6482b054f14843c_Q_2.svg"" />"
"<img sr
c=""d1 ef845 1e7d476 596b125b6482b054f14843c_A_2.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_surce_svg.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_
mfEuT9.ng"" />"
11-17 An
my
"<img src=""d1 ef845 1e7d476 596b125b6482b054f14843c_Q_3.svg"" />"
"<img sr
c=""d1 ef845 1e7d476 596b125b6482b054f14843c_A_3.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_surce_svg.svg"" />"
"<img src=""d1 e
f845 1e7d476 596b125b6482b054f14843c_
mfEuT9.ng"" />"
11-17 An
my
<div>Three dis
inc
feels f rs

e </div><div>Sf
nd sngy {{c1::rs

i
i
s}}</div><div>Firm {{c1::nrm l}}</div><div>Firm nd bumy - {{c1::c ncer}}</div

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e serum n
igen}}; high levels s

sci
ed wi
h rs

e c ncer; red
es  l ble c ncer by 2
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he slwes
grwing c ncers usu lly in rs


e 10 ye rs befre me
s
sizing</div></div><div><br /></div><div>Men
ke&nbs
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;{{c1::S w P lme

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grwing rs

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e-303246165934436.jg"" />"
11-17 An
my
"<img src=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_Q_0.svg"" />"
"<img sr
c=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_A_0.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_surce_svg.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_
mNnisNd.ng"" />"
11-17 An
my
"<img src=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_Q_1.svg"" />"
"<img sr
c=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_A_1.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_surce_svg.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_
mNnisNd.ng"" />"
11-17 An
my
"<img src=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_Q_2.svg"" />"
"<img sr
c=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_A_2.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_surce_svg.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_
mNnisNd.ng"" />"
11-17 An
my
"<img src=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_Q_3.svg"" />"
"<img sr
c=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_A_3.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_surce_svg.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_
mNnisNd.ng"" />"
11-17 An
my
"<img src=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_Q_4.svg"" />"
"<img sr
c=""37b1b0 1 8b693972be867f7e0b7d9db75e0ec2_A_4.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_surce_svg.svg"" />"
"<img src=""37b1
b0 1 8b693972be867f7e0b7d9db75e0ec2_
mNnisNd.ng"" />"
11-17 An
my
"<img src=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_Q_0.svg"" />"
"<img sr
c=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_A_0.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_surce_svg.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_
mcGhHe0.ng"" />"
11-17 An
my
"<img src=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_Q_1.svg"" />"
"<img sr
c=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_A_1.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_surce_svg.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_
mcGhHe0.ng"" />"
11-17 An
my
"<img src=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_Q_2.svg"" />"
"<img sr
c=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_A_2.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_surce_svg.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_
mcGhHe0.ng"" />"
11-17 An
my
"<img src=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_Q_3.svg"" />"
"<img sr
c=""c92f008f070fb10e399b09bcd70f1 9c81e375d7_A_3.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_surce_svg.svg"" />"
"<img src=""c92f
008f070fb10e399b09bcd70f1 9c81e375d7_
mcGhHe0.ng"" />"
11-17 An
my
<div>{{c1::Rund lig f u
erus}}

ches u
erine hrn

he l bi m jr , ull
s u
erus ver bl dder eseci lly in nulli rus wmen.</div><div><br /></div><di
v>{{c1::Susensry lig}}. - fld f eri
neum cn
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in eri
neum.&nbs;</div><div><br /></div>
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_0.svg"" />"
"<img sr
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_0.svg"" />"
"<img src=""6e1e
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
"<img src=""6e1e

d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"

11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_1.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_1.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_2.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_2.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 n
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_3.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_3.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_4.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_4.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_5.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_5.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_6.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_6.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_7.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_7.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_8.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_8.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_Q_9.svg""
c=""6e1ed44991e0e926f5265765e4b8bf7f b451dd7_A_9.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_surce_svg.svg"" />"
d44991e0e926f5265765e4b8bf7f b451dd7_
mVw_1 A.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_0.svg""
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_0.svg"" />"
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_1.svg""
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_1.svg"" />"
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_2.svg""
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_2.svg"" />"
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"

/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
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"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""6e1e
"<img src=""6e1e
/>"
"<img sr
"<img src=""5ef6
"<img src=""5ef6
/>"
"<img sr
"<img src=""5ef6
"<img src=""5ef6
/>"
"<img sr
"<img src=""5ef6
"<img src=""5ef6

1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"

11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_3.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_3.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_4.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_4.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_5.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_5.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_6.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_6.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_7.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_7.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_8.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_8.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_9.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_9.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_10.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_10.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
"<img src=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_Q_11.svg"" />"
"<img sr
c=""5ef61244e42b80b17c44109b1 f8b934d6155ecc_A_11.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_surce_svg.svg"" />"
"<img src=""5ef6
1244e42b80b17c44109b1 f8b934d6155ecc_
mBO111.ng"" />"
11-17 An
my
<div><div> {{c1::Lev
r ni}} nd {{c1::erine l bdy}} hel sur

he rec
um,
v gin , &nbs; nd bl dder in
he fem le elvis. {{c1::Perine l bdy}} &nbs;s

bilizes
he UG di hr gm nd sur
s
he bl dder s well. &nbs;{{c1::Nulli r
us}} n bir
h; {{c1::mul
i rus}} ne r mre bir
hs
hrugh

he bir
h c n l.<
/div></div><div><br /></div><div>&nbs;</div><div><br /></div>
11-17 An

my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_0.svg"" />"
"<img sr
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_0.svg"" />"
"<img src=""0675
d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"
"<img src=""0675
d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_1.svg"" />"
"<img sr
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_1.svg"" />"
"<img src=""0675

d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"

d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_2.svg""
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_2.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_3.svg""
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_3.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_4.svg""
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_4.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_5.svg""
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_5.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_Q_6.svg""
c=""0675d8efb5f3f e8ce30e257e680b5d93b2c8b70_A_6.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_surce_svg.svg"" />"
d8efb5f3f e8ce30e257e680b5d93b2c8b70_
mXCH9UG.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_0.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_0.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_1.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_1.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_2.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_2.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_3.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_3.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_4.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_4.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_5.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_5.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
"<img src=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_Q_6.svg""
c=""89bd65c4 4bc7be 5170cfbbb975dbde4ec40b5e_A_6.svg"" />"

"<img src=""0675
/>"
"<img sr
"<img src=""0675
"<img src=""0675
/>"
"<img sr
"<img src=""0675
"<img src=""0675
/>"
"<img sr
"<img src=""0675
"<img src=""0675
/>"
"<img sr
"<img src=""0675
"<img src=""0675
/>"
"<img sr
"<img src=""0675
"<img src=""0675
/>"
"<img sr
"<img src=""89bd
"<img src=""89bd
/>"
"<img sr
"<img src=""89bd
"<img src=""89bd
/>"
"<img sr
"<img src=""89bd
"<img src=""89bd
/>"
"<img sr
"<img src=""89bd
"<img src=""89bd
/>"
"<img sr
"<img src=""89bd
"<img src=""89bd
/>"
"<img sr
"<img src=""89bd
"<img src=""89bd
/>"
"<img sr
"<img src=""89bd

65c4 4bc7be 5170cfbbb975dbde4ec40b5e_surce_svg.svg"" />"

"<img src=""89bd
65c4 4bc7be 5170cfbbb975dbde4ec40b5e_
mNFkzZH.ng"" />"
11-17 An
my
<div>In nulli rus wmen
he u
erus is 3 inches in leng
h nd
he u
erus bdy

 cervix r
i is {{c1::2:1}} while in
he mul
i rus wmen
he u
erus bdy is
lnger such
h

he r
i is {{c1::3:1}}. In s
men us l wmen
he r
i dr
s
 {{c1::1:1}}.&nbs;</div><div><br /></div><div>In regn ncy
he {{c1::is
hm
us}} sf
ens nd is  l ble s
he cervix mves se r
ely frm
he bdy f
he
u
erus. &nbs;</div><div><br /></div>
11-17 An
my
"<img src=""22c70714495ec4e1f73f7fcd33de1886618867d _Q_0.svg"" />"
"<img sr
c=""22c70714495ec4e1f73f7fcd33de1886618867d _A_0.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _surce_svg.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _
mJ5EAww.ng"" />"
11-17 An
my
"<img src=""22c70714495ec4e1f73f7fcd33de1886618867d _Q_1.svg"" />"
"<img sr
c=""22c70714495ec4e1f73f7fcd33de1886618867d _A_1.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _surce_svg.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _
mJ5EAww.ng"" />"
11-17 An
my
"<img src=""22c70714495ec4e1f73f7fcd33de1886618867d _Q_2.svg"" />"
"<img sr
c=""22c70714495ec4e1f73f7fcd33de1886618867d _A_2.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _surce_svg.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _
mJ5EAww.ng"" />"
11-17 An
my
"<img src=""22c70714495ec4e1f73f7fcd33de1886618867d _Q_3.svg"" />"
"<img sr
c=""22c70714495ec4e1f73f7fcd33de1886618867d _A_3.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _surce_svg.svg"" />"
"<img src=""22c7
0714495ec4e1f73f7fcd33de1886618867d _
mJ5EAww.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_0.svg"" />"
"<img sr
c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_0.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_1.svg"" />"
"<img sr
c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_1.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_2.svg"" />"
"<img sr
c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_2.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_3.svg"" />"
"<img sr
c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_3.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_4.svg"" />"
"<img sr
c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_4.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_5.svg"" />"
"<img sr
c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_5.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""79b f964 7fd4d5941bf284e4725 c336b6c034_Q_6.svg"" />"
"<img sr

c=""79b f964 7fd4d5941bf284e4725 c336b6c034_A_6.svg"" />"

"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_surce_svg.svg"" />"
"<img src=""79b
f964 7fd4d5941bf284e4725 c336b6c034_
mmcg0X8.ng"" />"
11-17 An
my
"<img src=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_Q_0.svg"" />"
"<img sr
c=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_A_0.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_surce_svg.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_
mU
JM6l.ng"" />"
11-17 An
my
"<img src=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_Q_1.svg"" />"
"<img sr
c=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_A_1.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_surce_svg.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_
mU
JM6l.ng"" />"
11-17 An
my
"<img src=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_Q_2.svg"" />"
"<img sr
c=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_A_2.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_surce_svg.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_
mU
JM6l.ng"" />"
11-17 An
my
"<img src=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_Q_3.svg"" />"
"<img sr
c=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_A_3.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_surce_svg.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_
mU
JM6l.ng"" />"
11-17 An
my
"<img src=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_Q_4.svg"" />"
"<img sr
c=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_A_4.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_surce_svg.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_
mU
JM6l.ng"" />"
11-17 An
my
"<img src=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_Q_5.svg"" />"
"<img sr
c=""1226fcde86dfc83cfdf2dd4fb6448e29c6149ff3_A_5.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_surce_svg.svg"" />"
"<img src=""1226
fcde86dfc83cfdf2dd4fb6448e29c6149ff3_
mU
JM6l.ng"" />"
11-17 An
my
"<div>{{c1::Ec
ic}} bnrm l l ce f iml n

in f
he fer
ilized vum. C u
ses c n be endme
risis r sc rred nd s
en
ic FT due
 STDs. O
her 
en
i l
si
e is
he {{c1::eri
ne l c vi
y}} if vum f lls frm
he fimbri e. {{c1::Ce
rvic l}} iml n

in is usu lly sn
neusly br
ed.</div><div><img src="" s
11-17 An
my

e-533164355223918.jg"" /></div>"
"<img src=""36789dfe5190bf506fc8b7f 22842bd35e3d1065_Q_0.svg"" />"
"<img sr
c=""36789dfe5190bf506fc8b7f 22842bd35e3d1065_A_0.svg"" />"
"<img src=""3678
9dfe5190bf506fc8b7f 22842bd35e3d1065_surce_svg.svg"" />"
"<img src=""3678
9dfe5190bf506fc8b7f 22842bd35e3d1065_
m
ON
9U.ng"" />"
11-17 An
my
"<img src=""36789dfe5190bf506fc8b7f 22842bd35e3d1065_Q_1.svg"" />"
"<img sr
c=""36789dfe5190bf506fc8b7f 22842bd35e3d1065_A_1.svg"" />"
"<img src=""3678
9dfe5190bf506fc8b7f 22842bd35e3d1065_surce_svg.svg"" />"
"<img src=""3678
9dfe5190bf506fc8b7f 22842bd35e3d1065_
m
ON
9U.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_0.svg"" />"
"<img sr
c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_0.svg"" />"
"<img src=""d45b
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
"<img src=""d45b
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_1.svg"" />"
"<img sr
c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_1.svg"" />"
"<img src=""d45b
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
"<img src=""d45b
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_2.svg"" />"
"<img sr

c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_2.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_3.svg""
c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_3.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_4.svg""
c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_4.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_5.svg""
c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_5.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_Q_6.svg""
c=""d45bd8e908e6902d6f3595f9cc04d04ceb1b50ff_A_6.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_surce_svg.svg"" />"
d8e908e6902d6f3595f9cc04d04ceb1b50ff_
m8rwLr1.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_0.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_0.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_1.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_1.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_2.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_2.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_3.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_3.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_4.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_4.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_5.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_5.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_6.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_6.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_7.svg""

"<img src=""d45b
"<img src=""d45b
/>"
"<img sr
"<img src=""d45b
"<img src=""d45b
/>"
"<img sr
"<img src=""d45b
"<img src=""d45b
/>"
"<img sr
"<img src=""d45b
"<img src=""d45b
/>"
"<img sr
"<img src=""d45b
"<img src=""d45b
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"

"<img sr

c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_7.svg"" />"

1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""44 71367547493 109f517b1f4c61e8c42cb0128_Q_8.svg""
c=""44 71367547493 109f517b1f4c61e8c42cb0128_A_8.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_surce_svg.svg"" />"
1367547493 109f517b1f4c61e8c42cb0128_
m_qd1ES.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_0.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_0.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_1.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_1.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_2.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_2.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_3.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_3.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_4.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_4.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_5.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_5.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_6.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_6.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_7.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_7.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""0 25 5e 209073ee 20910df31f5df2086135015_Q_8.svg""
c=""0 25 5e 209073ee 20910df31f5df2086135015_A_8.svg"" />"
5e 209073ee 20910df31f5df2086135015_surce_svg.svg"" />"
5e 209073ee 20910df31f5df2086135015_
mIde0Ls.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_0.svg""
c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_0.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_1.svg""

"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""44 7
"<img src=""44 7
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""0 25
"<img src=""0 25
/>"
"<img sr
"<img src=""d39d
"<img src=""d39d
/>"

"<img sr

c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_1.svg"" />"

25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_2.svg""
c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_2.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_3.svg""
c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_3.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_4.svg""
c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_4.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_5.svg""
c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_5.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""d39d25b0432320d051766b7032d35f99ec0 cfb2_Q_6.svg""
c=""d39d25b0432320d051766b7032d35f99ec0 cfb2_A_6.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_surce_svg.svg"" />"
25b0432320d051766b7032d35f99ec0 cfb2_
mrE5H5Z.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_0.svg""
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_0.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_1.svg""
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_1.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_2.svg""
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_2.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_3.svg""
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_3.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_4.svg""
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_4.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_5.svg""
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_5.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_6.svg""

"<img src=""d39d
"<img src=""d39d
/>"
"<img sr
"<img src=""d39d
"<img src=""d39d
/>"
"<img sr
"<img src=""d39d
"<img src=""d39d
/>"
"<img sr
"<img src=""d39d
"<img src=""d39d
/>"
"<img sr
"<img src=""d39d
"<img src=""d39d
/>"
"<img sr
"<img src=""d39d
"<img src=""d39d
/>"
"<img sr
"<img src=""bd76
"<img src=""bd76
/>"
"<img sr
"<img src=""bd76
"<img src=""bd76
/>"
"<img sr
"<img src=""bd76
"<img src=""bd76
/>"
"<img sr
"<img src=""bd76
"<img src=""bd76
/>"
"<img sr
"<img src=""bd76
"<img src=""bd76
/>"
"<img sr
"<img src=""bd76
"<img src=""bd76
/>"

"<img sr

c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_6.svg"" />"

"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_7.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_7.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_8.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_8.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_9.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_9.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_10.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_10.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_11.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_11.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_12.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_12.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_13.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_13.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_14.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_14.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_15.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_15.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_16.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_16.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_17.svg"" />"
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_17.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_18.svg"" />"

src=""bd76
src=""bd76
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src=""bd76
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src=""bd76
src=""bd76
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src=""bd76
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src=""bd76
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src=""bd76
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src=""bd76
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src=""bd76
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src=""bd76
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c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_18.svg"" />"

"<img src=""bd76
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img src=""bd76
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
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11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_19.svg"" />"
"<img sr
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_19.svg"" />"
"<img src=""bd76
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img src=""bd76
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
"<img src=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_Q_20.svg"" />"
"<img sr
c=""bd76ed5f669d1db ce9874 cd26f9f766bb6df65_A_20.svg"" />"
"<img src=""bd76
ed5f669d1db ce9874 cd26f9f766bb6df65_surce_svg.svg"" />"
"<img src=""bd76
ed5f669d1db ce9874 cd26f9f766bb6df65_
mPKh
WI.ng"" />"
11-17 An
my
<div>Assci
ed wi
h infer
ili
y issues re when
he {{c1::u
erus}} si
ining
is si
e
 e ch 
her; i.e. re
rflexed nd n
iver
ed u
s sh r bend in u

erus which cmresses
he {{c1::u
erine}} lumen nd res
ric

he  ss ge f ser
m.&nbs;</div><div><br /></div><div>Ps
- r
ui
in nd s
men us l u
erus
e
nd
 be in {{c1::ver
ic l}} si
in which m kes
hem rne
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><div><br /></div>
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e-608927578325532.jg"" />"
11-17 An

my
"<img src=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_Q_0.svg"" />"
"<img sr
c=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_A_0.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_surce_svg.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_
mF4Lufi.ng"" />"
11-17 An
my
"<img src=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_Q_1.svg"" />"
"<img sr
c=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_A_1.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_surce_svg.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_
mF4Lufi.ng"" />"
11-17 An
my
"<img src=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_Q_2.svg"" />"
"<img sr
c=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_A_2.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_surce_svg.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_
mF4Lufi.ng"" />"
11-17 An
my
"<img src=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_Q_3.svg"" />"
"<img sr
c=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_A_3.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_surce_svg.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_
mF4Lufi.ng"" />"
11-17 An
my
"<img src=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_Q_4.svg"" />"
"<img sr
c=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_A_4.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_surce_svg.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_
mF4Lufi.ng"" />"
11-17 An
my
"<img src=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_Q_5.svg"" />"
"<img sr
c=""b9c 1174b 6dc101c2eb4b5299 716 c190 6c60_A_5.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_surce_svg.svg"" />"
"<img src=""b9c
1174b 6dc101c2eb4b5299 716 c190 6c60_
mF4Lufi.ng"" />"
11-17 An
my
"<img src=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_Q_0.svg"" />"
"<img sr
c=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_A_0.svg"" />"
"<img src=""9f94
ce6efc8004d21 14d5d0f1b0d11ff3746478_surce_svg.svg"" />"
"<img src=""9f94
ce6efc8004d21 14d5d0f1b0d11ff3746478_
m7zVT7K.ng"" />"
11-17 An
my
"<img src=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_Q_1.svg"" />"
"<img sr
c=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_A_1.svg"" />"
"<img src=""9f94
ce6efc8004d21 14d5d0f1b0d11ff3746478_surce_svg.svg"" />"
"<img src=""9f94
ce6efc8004d21 14d5d0f1b0d11ff3746478_
m7zVT7K.ng"" />"

11-17 An
my
"<img src=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_Q_2.svg""
c=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_A_2.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_surce_svg.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_
m7zVT7K.ng"" />"
11-17 An
my
"<img src=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_Q_3.svg""
c=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_A_3.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_surce_svg.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_
m7zVT7K.ng"" />"
11-17 An
my
"<img src=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_Q_4.svg""
c=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_A_4.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_surce_svg.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_
m7zVT7K.ng"" />"
11-17 An
my
"<img src=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_Q_5.svg""
c=""9f94ce6efc8004d21 14d5d0f1b0d11ff3746478_A_5.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_surce_svg.svg"" />"
ce6efc8004d21 14d5d0f1b0d11ff3746478_
m7zVT7K.ng"" />"
11-17 An
my
"<img src=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_Q_0.svg""
c=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_A_0.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_surce_svg.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_
mAs0Ryg.ng"" />"
11-17 An
my
"<img src=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_Q_1.svg""
c=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_A_1.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_surce_svg.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_
mAs0Ryg.ng"" />"
11-17 An
my
"<img src=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_Q_2.svg""
c=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_A_2.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_surce_svg.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_
mAs0Ryg.ng"" />"
11-17 An
my
"<img src=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_Q_3.svg""
c=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_A_3.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_surce_svg.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_
mAs0Ryg.ng"" />"
11-17 An
my
"<img src=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_Q_4.svg""
c=""c76d832c3ec9f4f23f 48 1bb0c46252eb12d581_A_4.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_surce_svg.svg"" />"
832c3ec9f4f23f 48 1bb0c46252eb12d581_
mAs0Ryg.ng"" />"
11-17 An
my
"<img src=""3e76e97e66718d4bed90dce2c36f2512fb 9072c_Q_0.svg""
c=""3e76e97e66718d4bed90dce2c36f2512fb 9072c_A_0.svg"" />"
e97e66718d4bed90dce2c36f2512fb 9072c_surce_svg.svg"" />"
e97e66718d4bed90dce2c36f2512fb 9072c_
mHgFqUU.ng"" />"
11-17 An
my
"<img src=""0c195843 3c30db957 8c052407d28 1907cedd5_Q_0.svg""
c=""0c195843 3c30db957 8c052407d28 1907cedd5_A_0.svg"" />"
5843 3c30db957 8c052407d28 1907cedd5_surce_svg.svg"" />"
5843 3c30db957 8c052407d28 1907cedd5_
m78uA2
.ng"" />"
11-17 An
my
"<img src=""0c195843 3c30db957 8c052407d28 1907cedd5_Q_1.svg""
c=""0c195843 3c30db957 8c052407d28 1907cedd5_A_1.svg"" />"
5843 3c30db957 8c052407d28 1907cedd5_surce_svg.svg"" />"
5843 3c30db957 8c052407d28 1907cedd5_
m78uA2
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/>"
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"<img src=""9f94
"<img src=""9f94
/>"
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/>"
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/>"
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11-17 An
my
"<img src=""0c195843 3c30db957 8c052407d28 1907cedd5_Q_2.svg"" />"
"<img sr
c=""0c195843 3c30db957 8c052407d28 1907cedd5_A_2.svg"" />"
"<img src=""0c19
5843 3c30db957 8c052407d28 1907cedd5_surce_svg.svg"" />"
"<img src=""0c19
5843 3c30db957 8c052407d28 1907cedd5_
m78uA2
.ng"" />"
11-17 An
my
"<img src=""0c195843 3c30db957 8c052407d28 1907cedd5_Q_3.svg"" />"
"<img sr
c=""0c195843 3c30db957 8c052407d28 1907cedd5_A_3.svg"" />"
"<img src=""0c19
5843 3c30db957 8c052407d28 1907cedd5_surce_svg.svg"" />"
"<img src=""0c19
5843 3c30db957 8c052407d28 1907cedd5_
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11-17 An
my
<div>U
erine  in r di
es lng
he {{c1::lumb r sl nchnics}};  in is referre
d {{c1::T12, L1, L2}} levels f
he b ck.&nbs;</div><div><br /></div><div>Cervi
c l nd v gin l  in re sensed in ll elvic rg ns vi
he {{c1::elvic sl nc
hnics}}.&nbs;</div><div><br /></div><div>Sm
ic sens
in is sensed lc lly in
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he lwer v gin , ves
ibule, nd nus&nbs;</div><div><br /></div>
c="" s
e-638189190513180.jg"" />"
11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_0.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_0.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
mPQhevf.ng"" />"
11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_1.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_1.svg"" />"
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6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
mPQhevf.ng"" />"
11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_2.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_2.svg"" />"
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6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
mPQhevf.ng"" />"
11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_3.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_3.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
mPQhevf.ng"" />"
11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_4.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_4.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
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11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_5.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_5.svg"" />"
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6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
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11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_6.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_6.svg"" />"
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6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
mPQhevf.ng"" />"
11-17 An
my
"<img src=""e07c6d556e269c28f87dd59debd f3873 645bc _Q_7.svg"" />"
"<img sr
c=""e07c6d556e269c28f87dd59debd f3873 645bc _A_7.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _surce_svg.svg"" />"
"<img src=""e07c
6d556e269c28f87dd59debd f3873 645bc _
mPQhevf.ng"" />"
11-17 An
my
"<img src=""8 6fc6eb43d7cdef8c433b 737226b7fffe 94b6_Q_0.svg"" />"
"<img sr
c=""8 6fc6eb43d7cdef8c433b 737226b7fffe 94b6_A_0.svg"" />"
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c6eb43d7cdef8c433b 737226b7fffe 94b6_surce_svg.svg"" />"
"<img src=""8 6f

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mv2gL0.ng"" />"

11-17 An
my
Wh
is lc
ed

he junc
in f
he cccygeus muscle nd
endinus rch?
"sine f
he ischium<div><img src="" s
e-1322849927685.jg"" /></div>"
Wh
 sses
hrugh
he b
ur
ry fr men?
"Ob
ur
ry r
ery, nerve ,veins
<div><br /></div><div><img src="" s
e-1318554960389.jg"" /></div>"
Wh
br nches cme ff f
he s
erir divisin f
he in
ern l ili c r
ery?
"Ililumb r<div>L
er l S cr l</div><div>Suerir glu
e l</div><div><br /></div>
<div><img src="" s
e-1486058684890.jg"" /></div>"
Where des
he ililumb r r
ery g?
"s
erirly

he s crili c jin
<div
><br /></div><div><img src="" s
e-1481763717594.jg"" /></div>"
Where des
he suerir glu
e l r
ery  ss?&nbs;
"Be
ween lumbs cr l
ru
nk (L4/L5) nd S1<div><br /></div><div>Abve irifrmis</div><div><br /></div><d
iv><img src="" s
e-1481763717594.jg"" /></div>"
Describe
he curse f
he v s deferens frm
he dee inguin l ring
"Alng

he l
er l w ll, crssing ver
he ure
er (w
er under
he bridge), ex nds in

mu ll which lies medi l

he semin l gl nd, suerir

he rs

e<div><
br /></div><div><img src="" s
e-1623497638398.jg"" /></div><div><br /></div><d
iv><img src="" s
e-1644972474923.jg"" /></div>"
Wh
br nches des
he umbilic l r
ery give ff befere i
bli
er
es? Wh
d
es i
cn
inue u
he n
erir w ll s? "suerir vesicul r br nches<div><br /><
/div><div>medi l umbilic l lig men
s

he umbilicus</div><div><br /></div><div
><img src="" s
e-1709396984325.jg"" /></div>"
Where des
he inferir vesicul r r
ery g
? "Ps
erir side nd b se f bl d
der. I
sulies semin l gl nds, rs

e, nd lwer rec
um<div><br /></div><div
><img src="" s
e-1705102017029.jg"" /></div>"
Wh
is
he l s
in
r elvic br nch
he in
ern l udend l &nbs; r
ery gives ff
?
"middle rec
l<div><br /></div><div><img src="" s
e-1915555414552.jg""
/></div>"
Af
er
he in
ern l udend l r
ery gives ff
he middle rec
l br nch, where de
s i
cn
inue
?
"Ps
erir

he ischi l sine nd cccygeus s i
exi

s
he elvis
hrugh
he gre
er sci
ic fr men<div><br /></div><div><img src="
" s
e-1911260447256.jg"" /></div>"
Where des
he inferir glu
l r
ery  ss?
"Ps
erir
 cccygeus muscle,
inferir
 irifrmis, exis

he gre
er sci
ic fr men<div><br /></div><div><
img src="" s
e-1911260447256.jg"" /></div>"
Hw re in
ern l udend l nd inferir glu
e l si
ined rel
ive
 e ch 
her
?
The inferir glu
e l is mre medi l
h n
he in
ern l udend l
Hw d yu iden
ify
he b
ur
r
"Lk fr i
 ssing
hrugh
he b
ur

r c n l by
he b
ur
r in
ernus muscle<div><br /></div><div><img src="" s
e1911260447256.jg"" /></div>"
Where des
he suerir rec
l cme frm?&nbs;<div><br /></div><div>Where des

he middle rec
l cme frm?</div><div><br /></div><div>Where des
he inferir
rec l cme frm?</div> "IMA<div><br /></div><div>Br nches ff f in
ern l uden
d l (in
r elvic)</div><div><br /></div><div>Br ches ff f in
ern l udend l (
u
side f elvic befre in
ern l udend l ges
hru lccks c n l)</div><div><br
/></div><div><img src="" s
e-2293512536531.jg"" /></div>"
D fem les h ve inferir vesicul r r
eries?
N,
hey re rel ced by u
erine
r
eries
Where is
he u
erine r
ery nd vein lc
ed? C rdin l lig men
s
Where des
he ure
er  ss in
he fem le?
"Belw u
erine r
ery, bve v g
in l r
ery<div><br /></div><div><br /></div><div><img src="" s
e-2383706849789
.jg"" /></div>"
Where is
he v ri n r
ery lc
ed?<div><br /></div><div><br /></div><div>Where
is
he u
erine r
ery lc
ed?</div> "Susensry lig men
<div><br /></div><di
v><br /></div><div>C rdin l lig men
</div><div><br /></div><div><br /></div><div
><img src="" s
e-2461016261088.jg"" /></div>"
Wh
d v gin l r
eries n s
 mse wi
h?
"dee nd erine l r
eries f

he udend l r
ery<div><br /></div><div><img src="" s
e-2456721293792.jg"" /><
/div>"

Where des
he udend l nerve rigin
e? where des i
run s
erir
? Where d
es i
exi
? Wh
des i
give ff befre en
ering
he udend l c n l? "S2-S4<d
iv>Ps
erir
 cccygeus muscle nd ichi l sine</div><div>Exis
gre
er sci
i
c fr men</div><div>Gives ff inferir re
l</div><div><br /></div><div><img src
="" s
e-2619930051086.jg"" /></div>"
inferir eig s
rics cme ff f wh
? "ex
ern l ili c r
ery<div><br /></div><
div><img src="" s
e-2615635083790.jg"" /></div>"
Are
he r mi cnnec
ed

he s cr l sym
he
ic ch in grey r whi
e? Grey: Th
ey re s
syn ic sym
he
ic nd
hus re unmyelin
ed<div><br /></div><div>R
emember n
hing hs in
 sym
he
ic ch in 
her
h n in T1-L2</div>
Wh
is
he lymh
ic dr in ge f
he fundus f
he u
erus?
Suerfici l ingu
in l ndes lng rund lig men

Wh
is
he lymh
ic dr in ge f
he Perineum? suerfici l inguin l nde
U
erus  in runs lng ________ fferen
s
 wh
sin l levels?
Sym
he

ic fferen
s
 T12, L1, L2
If viscer is in cn
c
wi
h eri
neum, hw is  in c rried by nd where is i

referred?
sym
he
ics; uer lumb r re
If viscer is belw
he eri
neum, hw is  in c rried nd where is i
referred

?
 r sym
he
ics; s crum nd lwer elvis
Wh
ver
ebr l level des Rec
um begin? Osi
e S3
Wh
is
he func
in f rec
l v lves f Hus
n?
"They hld nd segmen
f
eces in
he rec
l v ul
bve
he ubrec
lis muscle<div><br /></div><div><img
src="" s
e-3221225472531.jg"" /></div>"
Wh
re n l clumns? Wh
re
hey jined by? "lngi
udin l flds f mucs n
d submucs <div><br /></div><div>An l V lves</div><div><br /></div><div><img src
="" s
e-3216930505235.jg"" /></div>"
Wh
is
he s ce be
ween n l clumns? " n l sinus<div><br /></div><div><img sr
c="" s
e-3216930505235.jg"" /></div>"
Wh
is
he func
in f
he ubrec
lis muscle?
"Pulls
he recum frw rd
se r
ing uer recum frm lwer. The feces ccumul
es in
he v ul
.&nbs;<di
v><br /></div><div><img src="" s
e-3569117823516.jg"" /></div>"
Where des
he nus begin?
" n l clumns<div><br /></div><div><img src=""
s
e-4887672783352.jg"" /></div>"
Wh
is
he junc
in be
ween endderm nd ec
derm?
ec
in
e line
Wh
is cmmn si
e f rec
l c ncer? "Pec
in
e line<div><br /></div><div><im
g src="" s
e-4883377816056.jg"" /></div>"
Describe
he sens
in bve nd belw
he ec
in
e line
"Abve: viscer l
fferen
s<div>belw: sm
ic f
he inferir rec
l nerve</div><div><br /></div
><div><img src="" s
e-4883377816056.jg"" /></div>"
Describe r
eri l suly bve nd belw ec
in
e line "<div><br /></div>Abve:
suerir rec
l r
ery frm inferir mesen
eric, middle rec
l r
ery frm in
e
rn l udend l r
ery<div><br /></div><div>Belw: Inferir rec
l r
ery frm in

ern l udend l r
ery (in
ern l ili c r
ery)</div><div><br /></div><div><img sr
c="" s
e-4883377816056.jg"" /></div>"
Describe venus dr in ge bve nd belw ec
in
e line "Abve: Suerir nd mid
dle rec
l vein (
 r
l venus sys
em)<div><br /></div><div>Belw: Inferir r
ec
l vein (
 sys
emic sys
em)</div><div><br /></div><div><img src="" s
e-4883
377816056.jg"" /></div>"
Describe lymh
ic dr in ge bve nd belw ec
in
e line
" bve: inferir
mesen
eric r in
ern l ili c ndes<div><br /></div><div>belw: suerfici l ingu
in l lymh ndes</div><div><br /></div><div><img src="" s
e-4883377816056.jg""
/></div>"
Wh
c n h en if n l v lves
e r during defec
in? feces c n ene
r
e in

submucs nd b c
eri c n
unnel in

he ischi n l fss
Why re in
ern l hemrrhids  inless?
hey re bve
he ec
in
e line nd r
e c rried by viscer l fferen
s. Ex
ern l hemrrids re belw
he ec
in
e lin
e nd re  inful
Wh
is
he  in sc le used wi
h edi
ric 
ien
s?
"FACES r Wng-B ker<div
><br /></div><div><img src=""Screen Sh
2014-11-25
9.33.41 PM.ng"" /></div>
"

A 
ien
wi
h BMI f 28 wuld be cl ssified s:<div>1. nrm l</div><div>2. v

erweigh
</div><div>3. bese</div>
verweigh
&nbs;<div><br /></div><div>
BMI &l
;25 is nrm l, while &g
;30 is bese</div>
A 
ien
wi
h BMI f 43 wuld be cl ssified s:<div>1. cl ss 1&nbs;besi
y&n
bs;</div><div>2. cl ss 2&nbs;besi
y&nbs;</div><div>3. cl ss 3&nbs;besi
y&n
bs;</div>
Cl ss 3 besi
y r mrbidly bese.<div><br /></div><div><div>1.
cl ss 1&nbs;besi
y = BMI be
ween 30 - 35</div><div>2. cl ss 2&nbs;besi
y = B
MI be
ween 35 - 40</div><div>3. cl ss 3&nbs;besi
y = BMI &g
; 40</div><div><br
/></div><div><br /></div></div>
A BMI f 19 wuld be cnsidered:<div>1. nrm l</div><div>2. verweigh
</div><div
>3. bese</div> nrm l
P in
h
is linked

issue d m ge, such s
he  in ssci
ed wi
h r
hri
is
, is referred
 s?
ncice
ive r sm
ic  in
Wh
is br dyc rdi ?
lw he r
r
e (&l
;60 bm)
Wh

emer
ures wuld be cl ssified s hy
hermi ? Any
emer
ure less
h
n 95 F.
A 75 y/ 
ien
wi
h bld ressure f 135/89 wuld be cnsidered<div><br /><
/div><div>1. nrm l</div><div>2. rehyer
ensive</div><div>3. hyer
ensive</div>
Prehyer
ensive, which en
ils sys
lic be
ween 120 - 139 mmHg nd
di s
lic
be
ween 80 - 89 mmHg.
Wh
re
he lw i
ched sunds uscul

ed when me suring bld ressure nd be
s
he rd wi
h
he bell f
he s
e
hsce?
Kr
kff Sunds
Wuld 2 d y ld 
ien
wi
h he r
r
e f 120 bm be cnsidered<div><br /><
/div><div>1. br dyc rdic</div><div>2. nrm l</div><div>3.
chyc rdic</div>
"Nrm l<div><br /></div><div><img src=""Screen Sh
2014-11-25
9.50.01 PM.ng
"" /></div>"
Which
w he r
v lves re uscul

ed wi
h b
h
he bell nd di hr gm f
he s

e
hsce, er BCM s
nd rds? The
ricusid nd mi
r l
Wh
is
he ngle
which we re sused
 r ise
he he d f
he ex m
ble w
hen ev lu
ing 
ien
fr jugul r venus dis
en
in? 30 degrees
Wh
c uses
hrills nd brui
s? Hw re
he
w differen
?
Thrills nd brui

s re c used by
urbulen
bld flw.<div><br /></div><div>Yu <u>feel
hrills
when  l
ing</u> ulse nd <u>he r brui
s when uscul

ing</u> ulse.</di
v>
Wh
is
he ulse  l
ed n
he drsum f
he f
? drs lis edis
Wh
is
he  r
f
he c rdi c cycle ccuring be
ween S1 (lub) nd S2 (dub)?
sys
le
Wh
is
he le ding reven
ble c use f de
h?
b cc/smking
Wh
re vesicul r bre
h sunds?
Tye f bre
h sunds ch r c
erized by

heir lc
in ver ms
f
he lungs in
nrm l ex m nd
he lnger dur
in f
insir
ry cm red
 exir
ry sunds.
Which lbe f
he lungs is bes
ssessed n
erirly r l
er lly nd n
s
eri
rly? Righ
middle lbe
Which dven
i
ius bre
h sunds re music l nd high-i
ched wi
h
hissing r
shrill qu li
y? Wheezes
Wh
is eghny?
An E-
-A ch nge in
r nsmi

ed bre
h sunds in 
ie
n
wi
h fever, cugh, nd brnchi l bre
h sunds. This mre
h n
riles
he li
kelihd f neumni .
Yur 
ien
resen
s wi
h chief cml in
f  in in
he RUQ f
he bdmen.
In wh
rder wuld yu erfrm  l
in, uscul

in, ercussin, nd insec

in? In which qu dr n
wuld yu begin nd in which qu dr n
wuld yu end?
1. Insec
in<div>2. Auscul

in</div><div>3. P l
in</div><div>4. Percussin
</div><div><br /></div><div>S
r
in LLQ (di gn l
 qu dr n
in  in) nd end
in RUQ (qu dr n
in  in).</div>
N me n n
mic l s
ruc
ure (if ny)
h
c n be  l
ed in e ch f
he fur
bdmin l qu dr n
s fr n individu l wi
h
nrm l ex m.
RUQ - liver<div>
LUQ - sleen (bu
n
nrm lly in ms
ele)</div><div>RLQ - n
hing</div><div
>LLQ - sigmid cln</div>
Wh
is
he nrm l liver s n

he midcl vicul r line?
6 - 12 cm (7 cm
is ide l)

Where in yur ercussin f
he bdmen d yu exec

 he r
ym nic sunds? D
ull sunds?
Tym nic sunds in
he regin belw
he liver<div><br /></div><d
iv>Dull sunds

he liver</div>
Wh
is dysh gi ?
difficul
y sw llwing
Wh
is dynh gi ?
P inful sw llwing
Wh
is melen ? Bl ck,
rry feces ssci
ed wi
h uer GI bleeding
Wh
is hem
chezi ? The e r nce f red bld in
he feces, which is indic

ive f lwer GI bleeding
Wh
re sme ssible c uses why fem le m y resen
wi
h  in in
he RLQ?
- endici
is<div>-ec
ic regn ncy</div><div>-v ri n m lign ncy</div>
Wh
re
he 5 ercussin n
es f
he lungs? Which ne indic
es he l
hy
issue
?
1. Fl
<div>2. Dull</div><div>3. Resn n
(nrm l)</div><div>4. Hyerres
n n
</div><div>5. Tym nic</div>
N me sever l cndi
ins ssci
ed wi
h dullness
 lung ercussin.
1. A
ele
c
sis (lb r bs
ruc
in)<div>2. Pleur l effusin</div><div>3. Cnslid
in (
lveli fill wi
h fluid r bld)</div>
N me sever l cndi
ins ssci
ed wi
h hyerresn nce when ercussing
he lungs
.
1. COPD<div>2. As
hm </div><div>3. Pneum
hr x</div>
"Yu re  l
ing 
s ches
s
erirly nd sk him
 s y ""99."" Wh
re
yu checking fr nd wuld i
be incre sed, nrm l, r decre sed if he des h ve
COPD?" Yu re checking fremi
us (vibr
in l resn nce) f
he lungs. This wil
l be decre sed wi
h COPD.
Wh
re 2 imr
n
neck ex m findings imr
n
in ssessing
he 
ien
s <u>
resir
ry sys
em</u>, er B
es?
1. Use f sscessry muscles during ins
ir
in (use is bnrm l, n
needing
 use
hem is nrm l)<div><br /></div><di
v>2. Tr che l devi
in frm
he midline</div>
Wh
re
he 3 kinds f bre
h sunds yu lis
en fr? Which ne is nrm lly he r
d ver ms
f b
h lungs nd l s
s lnger in insir
in
h n exir
in?
1. <b>Vesicul r</b> -- he rd ver b
h lungs, wi
h insir
in l s
ing lnger
h
n exir
in<div><br /></div><div>2. <b>Brnchvesicul r</b> -- insir
in nd
exir
in re simil r in leng
h</div><div><br /></div><div>3. <b>Brnchi l</b>
-- exir
ry is lnger
h n insir
ry, he rd ver
he m nubrium</div>
Wh
re
he 3
yes f dven
i
ius lung sunds? Which f
he 3 sugges
s
he r
esence f secre
ins in
he lungs?
1. Cr ckles<div>2. Wheezes</div><div>3.
Rhnchi (sugges
s secre
ins)</div>
"Yur 
is cml ining f fever nd cugh. On uscul

in yu n
ice decre sed
bre
h sunds in
he lwer lef
lbe. Yu sk
he 
ien

 s y ""ee"" while
uscul

ing ver
he s me re .&nbs;<div><br /></div><div>Wh
sund d yu ex
ec

 he r
hrugh
he s
e
hsce if
he 
ien
des h ve lef
lwer lb r
neumni ? Wh
is
h
clinic l finding c lled?</div>" There is n E
 A ch ng
e c lled egh ny. I
shuld be lc lized nd
he A h s n s l ble
ing qu li
y

 i
.
Fr wh
ge gru is n nnu l influenz v ccine NOT reccmended?
&l
;6 m
n
hs
When yu ex mine 
in
he suine si
in, yu re un ble
 feel
he PMI. De
scribe
m neuver yu c n erfrm
  l
e i
mre e sily.
Yu shuld
urn

he 
n
 his/her lef
side.
Wh
re sys
le nd di s
le nd where d
hey nrm lly ccur in rel
in

h
e he r
sunds SI (lub) nd S2 (dub)? Sys
le is ven
ricul r cn
r c
in, ccu
rs be
ween S1 - S2.<div><br /></div><div>Di s
le is ven
ricul r rel x
in, cc
urs be
ween S2 - S1.</div>
Yu re seeing 76 y/ fem le 
wi
h HTN nd
f mily his
ry f CVA wi
h yur
rece
r. On ex mining her c r
id r
eries, yu de
ec
b
h
hrills nd bru
i
ver her righ
c r
id r
ery. Wh
2
es
s wuld yu sugges
shuld be erfr
med?
1. C r
id ul
r sund<div>2. L b
 check TSH levels</div>
Why d yu use
he bell f
he s
e
hesce in ddi
in

he di hr gm when us
cul

ing
he
ricusid nd mi
r l v lves?
T lis
en fr murmurs s well s
S3 nd S4, which re lwer i
ched nd c n be missed wi
h
he di hr gm.
In  l
ing
he eriher l ulses f 66 y/ m le wi
h cnges
ive he r
f ilur
e, hw wuld yu gr de brisk r nrm l li
e l ulses vs. bsen
ed l ulses,

nd wh
wuld
his hysic l ex m sugges
?

Brisk r nrm l ulses wuld be
gr ded 2+.<div><br /></div><div>Absen
ulses wuld be gr ded 0.</div><div><br /
></div><div>N
e: Diminished ulses wuld be gre ded 1+.</div>
Wh
is
he Sch mr
h Sign used
 check?
I
is used
 check fr digi
l
clubbing.
Wh
is
he hysilgic sli

ing f S2?
Yu c n he r
his in sme 
s be
c use
he r
ic nd ulmnic clsures re n
ex c
ly in sync (eseci lly in in
sir
in).
Which side f
he s
e
hesce re bld flw sunds bes
he rd wi
h?

he bell
Wh
is
he ide l cuff bl dder wid
h size? If
he cuff bl dder wid
h is
 l rg
e, will yu veres
im
e r es
im
e BP?&nbs; Cuff bl dder wid
h shuld be 40%
f
he uer rm circumference.<div><br /></div><div>If
he wid
h is
 l rge,
yu c n unders
im
e
he BP.</div>
R
e
he fllwing
emer
ures in rder f ccur cy: xill ry, r l, rec
l,
y
m nic. 1. Rec
l<div>2. Tym nic</div><div>3. Or l</div><div>4. Axill ry</div>
Wh
re
he 4 m jr
yes f  in?
1. <b>Ncice
ive / Sm
ic</b><div><br
/></div><div>2. <b>Neur
hic</b> -- resul
s frm direc
injury

he PNS r C
NS</div><div><br /></div><div>3. <b>Psychgenic</b></div><div><br /></div><div>4
. <b>Idi
hic</b> -- l cks n iden
ifi ble e
ilgy</div>
"Wh
re
he ""4 As"" f  in m n gemen
?"
1. An lgesi <div><br /></div><di
v>2. Ac
ivi
ies f d ily living</div><div><br /></div><div>3. Adverse effec
s</d
iv><div><br /></div><div>4. Aberr n
drug-rel
ed beh virs</div>
Wh
is
he nrm l BP fr dul
s?
120/80 mmHg
Wh
is
he nrm l he r
r
e r nge fr dul
s? 50 - 90 bm
Wh
is
he nrm l resir
ry r
e fr dul
s? 12 - 20 bre
hs er minu
e
Wh
is
he nrm l
emer
ure fr dul
s?
98.6 F&nbs;
Wh
is
he 80/40 rule fr bld ressure cuff size?
In rder
 b
in ccur

e BP me suremen
s,
he cuff bl dder leng
h shuld be ~80% nd
he wid
h shuld
be ~40% f
he circumference f
he uer rm.
Wh
re sme f c
rs
h
c n c use BP me suremen

 be in ccur
e? 1. Smki
ng r drinking c ffeine &l
;30 minu
es rir
 me suremen
<div><br /></div><div
>2. Mving rund rir
 me suremen
(
he 
shuld si
wi
h
heir fee
n
he
flr fr
le s
5 minu
es befre
king BP)</div><div><br /></div><div>3. T
king BP ver cl
hing</div><div><br /></div><div>4. N
si
ining
he rm s

h

he br chi l r
ery is
he r
level</div>
Wh
is n uscul

ry g ?
"C n be he rd during BP me suremen
s resul

f r
eri l s
iffness r
hersclersis.<div><br /></div><div><img src=""Screen
Sh
2014-11-25
11.23.41 PM.ng"" /></div>"
Gener lly, will ersns
emer
ure be lwer in
he mrning r in
he f
ern
Temer
ure is gener lly lwer in
he mrning.
n/evening?
D xill ry
emer
ures
end
 be high r lw? Wh
bu
rec
l
emer
ures?
Axill ry
emer
ures
end
 be sligh
ly lw.<div><br /></div><div>Rec
l
eme
r
ures
end
 be sligh
ly high.</div>
Wh
is
he ide l di me
er f
he PMI, ccrding
 B
es?
1 - 2.5 cm. Any

hing l rger will indic
e lef
ven
ricul r hy
erhy.
Clsure f
he mi
r l v lve rduces which he r
sund? S1
Clsure f
he r
ic v lve rduces which he r
sund? S2
"Wh
wuld c use yu
 he r n ""ening sn "" during uscul

in f
he mi

r l v lve?"
mi
r l s
ensis
Is n S3 he r
sund nrm l?
"In children i
is nrm l, bu
in dul
s i
is
bnrm l nd indic
es ch nge in ven
ricul r cmli nce (""S3 g ll"")."
Is n S4 he r
sund nrm l?
The S4 he r
sund indic
es s
iffened ven
ric
le requireming mre wrk by
he
rium
 fill. I
is bnrm l.
S2 c n be sli
in
 n A2 + P2 sund during insir
in. Which f
hese
w su
nds is luder? "A2 is luder bec use r
ic ressure &g
; ulmnic ressure.<di
v><br /></div><div><img src=""Screen Sh
2014-11-25
11.35.17 PM.ng"" /></di
v>"
The S1 he r
sund c n sli
in
 n e rlier mi
r l cmnen
nd l
er
ricusi
d cmnen
. Which f
he
w will be luder? The e rlier mi
r l cmnen
&nbs
;<div><br /></div><div>N
e: The e rlier cmnen
is luder fr S2 sli

ing

s well.</div>
Are ll he r
murmurs bnrm l? N, he l
hy children c n h ve he r
murmurs.
Wh
is
he <u>ulse ressure</u>? Wh
f c
rs c n c use
his v lue
 fluc
u

e?
The difference be
ween sys
lic ressure nd di s
lic ressure. I
c n
fluc
u
e widely
hrughu

he d y wi
h hysic l c
ivi
y, em
ins,  in, c ff
eine in
ke, e
c.
Lb r neumni will h ve wh
ercussin n
e? dull ercussin n
e
Simle chrnic brnchi
is will h ve which ercussin n
e?
resn nce (which
is
he nrm l sund f he l
hy lungs)
A l rge leur l effusin will h ve which lung ercussin n
e? fl
ercussin
n
e
A l rge neum
hr x will h ve which lung ercussin n
e?

ym ny
COPD r regul r neum
hr x will h ve which lung ercussin n
e?
hyerres
n n
ercussin n
e
Wh
re sme
echniques fr elici
ing mre secific infrm
in frm 
ien
s w
i
hu
sking direc
yes/n ques
ins? -mul
ile chice ques
ins<div>-gr ded r
esnse ques
ins</div>
Wh
is
he CAGE Ques
inn ire used fr?
"Alchlism ssessmen
<div><br /
></div><div><div>H ve yu ever fel

he need
 <fn
clr=""#E70038""><u>C</u>
</fn
>u
dwn n drinking?</div><div>H ve yu ever fel
<fn
clr=""#E70038""
><u>A</u></fn
>nnyed by cri
icism f yur drinking?</div><div>H ve yu ever fe
l
<fn
clr=""#E70038""><u>G</u></fn
>uil
y bu
drinking?</div><div>H ve y
u ever
ken drink firs

hing in
he mrning (<fn
clr=""#E70038""><u>E</
u></fn
>ye-ener)
 s
e dy yur nerves r ge
rid f h ngver?</div></div>"
Wh
re sever l c uses f dysesi ? Dyesi (chrnic uer GI  in) c n be
c used by GERD r he r
burn.
Wh
culd be
he c use be
ween  in in
he LLQ f
he bdmen? diver
iculi
is
Ding wh

hings u
 20 minu
es befre n r l
em is
ken c n ffec
yur
re ding?
e
ing, drinking, nd smking
Wh
is
he cce
ed
emer
ure fr fever?
101 F fr rec
l
em<div><br />
</div><div>100.4 F fr r l
em</div><div><br /></div><div>99 F fr xill ry
e
m</div>
Will sinus rrhy
hmi s slw dwn r seed u during insir
in?
They se
ed u during insir
in nd slw dwn during exh l
in
Wh
is ne ? A  use in bre
hing. Slee ne is
cmmn cndi
in
h
inv
lves erids f s
ed/diminished bre
hing during slee.
Wh
re
he BP r nges fr s
ge 1 nd s
ge 2 hyer
ensin?
S
ge 1 hyer
en
sin = 140-159 / 90-99<div><br /></div><div>S
ge 2 hyer
ensin = &g
;160 / 100
</div>
Wh
is yrexi ?
fever
Wh
is
he ms
bused rescri
in drug in
he Hus
n re ( nd n
inwide)?
vicdin
Wh
re
he
w ms
cmmn subs
nces bused by 
s wi
h chrnic  in?
Alchl nd ids
Is lwer ex
remi
y edem rel
ed

he CVS r PVS?
b
h
Wh
is hem
ysis?
Si

ing u f bld r bld-
inged su
um frm
he res
ir
ry
r c
.
Are cr ckles cn
inuus r discn
inuus? Wh
bu
rhnchi nd wheezing?
Cr ckles re discn
inuus, while rhnchi nd wheezing re cn
inuus.
C n yu he r s
ridr during exir
in? N, nly during insir
in
Hw d yu c lcul
e BMI in weigh
nd inches? (Weigh
*700/heigh
)/ heigh

Why d yu es
im
e
he sys
lic ressure by  l
in? Wh
d yu dd
 i
?
1. vid discmfr
<div>2. vid errr c used by missed uscul
ry g </div><d
iv><br /></div><div> dd 30 mmHg
 i
</div>
Wh
c n n uscul
ry g  be due
?
r
eri l s
iffness r
hersclersis
Wh
is
he ejec
in sund? is i

hlgic? 
hlgic cndi
in in which n
Ejec
in sund ccm nies
he ening f
he r
ic v lve<div><br /></div><div
>S1, Ej, S2</div>
Which v lve clses firs
in S2 sli

ing?
r
ic bec use filling
ime f

he righ
side is incre sed del ying
he ulmnic v lve clsure

Why is A2 luder
h n P2?&nbs; Ar
ic ressure is gre
er
h n ulmnic ressur

e
T/F sys
le ccm nies c r
id us
rke
True
Wh
side f
he s
e
hesce d yu use fr higher i
ched sunds? Hw bu
lw
er i
ched sunds?
Di hr gm<div><br /></div><div>Bell</div>
Wh
is music l bre
hing sund
h

ien
s nd 
hers c n he r?
wheezing
Where d yu he r brnchvesicul r sunds?
ver
he 1s
nd 2nd in
ers ces
n
erirly nd be
ween
he sc ul
When d yu he r rhnchi?
exir
ins
Wh
is mnemnic fr 
ien
s ersec
ive n
he illness?
FIFE<div>Feeling
s, ide s, func
in, exec

ins</div>
P in frm s
m ch, dudenum, r  ncre s will be fel
in wh
regin? eig s
r
ic regin
P in frm sm ll in
es
ine, endix nd rxim l cln will be fel
in wh
regi
n?
 r umbilic l regin
P in frm cln, bl dder, r u
erus will be fel
in wh
regin?
Hyg s

ric regin
P in frm rec
um will be in wh
regin?
sur ubic r s cr l regin
P in frm
he liver r bili ry
ree will be fel
in wh
regin?
righ
u
er qu dr n
r eig s
ric regin
Wh
ch nges d yu he r ging u frm umbilicus
 liver?

ym ny
 dulln
ess
Wh
ch nges d yu he r ging dwn frm lung
 liver? resn nce
 dullness
Wh
shuld
he liver s n be in mids
ern l line?
4-8 cm
Hw will
he sunds ch nge in slenmeg ly?
They will ch nge frm
ym nic

 dull ins
e d f rem ining
ym nic
Wh
re
he cmnen
s f
he 
ien
his
ry? ini
i l infrm
in<div>chief c
ml in
</div><div>resen
illness</div><div> s
medic l his
ry</div><div>medic

ins</div><div> llergies</div><div>f mily his
ry</div><div>sci l his
ry&nbs
;</div><div>review f sym
ms</div>
Wh
is included in
he resen
illness?
sym
m

ribu
es, relev n
ROS
, 
ien
ersec
ive
Wh
is included in
he  s
medic l his
ry? medic l, surgic l, sychi
ric,
gyn, reven

ive he l
h
<div>Q6. Which f
he fllwing findings wuld be cnsidered  r
f
he review
f sys
ems f 
ien
wi
h ches
 in? Ple se describe which cmnen
f
he
cmle
e his
ry
he 
her nswers wuld f ll in
.</div><div><br /></div><div>P

ien
denies vmi
ing r di rrhe </div><div>&nbs; &nbs;</div><div>P
ien
h s
his
ry f rir he r


ck.</div><div>&nbs; &nbs;</div><div>P
ien
re
r
s
he ches
 in l s
s fr 1 minu
e.</div><div>&nbs; &nbs;</div><div>P
ie
n
h s fl
ffec
nd e rs deressed.</div><div><br /></div>
ROS: den
ies vmi
ing r di rrhe <div><br /></div><div><div>P
ien
denies vmi
ing r di
rrhe -ROS</div><div>&nbs; &nbs;</div><div>P
ien
h s his
ry f rir he
r


ck.-PMH</div><div>&nbs; &nbs;</div><div>P
ien
rer
s
he ches
 in
l s
s fr 1 minu
e.-HPI</div><div>&nbs; &nbs;</div><div>P
ien
h s fl
f
fec
nd e rs deressed.-Physic l ex m finding</div></div><div><br /></div>
Where is
he hysilgic l sli

ing f S2 bes
he rd?
ulmnic v vle during
insir
in
Wh
re  ck ye rs?
 cks d y x ye rs smked
Wh
re sme Gener l ROS quse
ins?
fever, chills, swe
s, f
igue, weigh
l
ss
Wh
c n be  l
ed in
he RUQ??
Liver, ssibly lwer le f righ
kidn
ey
Hw d yu me sure
he jugul r venus ressure? Dis
nce in cm frm
he highes

in
f uls
in f
he in
ern l jugul r

he s
ern l ngle. Bes
dne
60
degrees
T/F r
e f ddi
in
 rescri
in durgs, lchl, nd illici
drugs re simil
r
 r
es f ddic
in in gene rl ul
in wi
hu
chrnic  in
True
Wh
re sme C rdi c ROS?
Ches
 in<div>SOB</div><div>P li

ins</div><
div>Lwer ex
remi
y edem </div><div>exercise limi

ins</div><div>ligh
he dedn

ess</div><div>dysne n exer
in</div>
Wh
re eriher l ROS?
Cld ex
remi
ies<div>clubbing</div><div>cy nsis
</div><div>edem </div><div>c ill ry refill</div><div>h irless n legs</div>
Wh
re sme nn infec
ius c uses f fever?

r um <div>bld disrders</div>
<div>drugs re c
ins</div><div>immune disrders</div>
Wh
re sme resir
ry ROS? ches
 in<div>shr
ness f bre
h (
res
? exe
rcise?)</div><div>wheezing?</div><div>cughing?</div><div>bld in su
um?&nbs;
</div>
Which dven
i
l sunds re he rd n exir
in?
wheeze nd rhnchi
which dven
i
i l sunds re he rd n insir
in?
s
ridr
Hw d yu r
e wm ns gr vid TPAL s

us? Gr vid : # f regn ncies<div>T:
full
erm</div><div>P: Pre
erm</div><div>A: Abr
ins/misc rri ge</div><div>L:
Living</div><div><br /></div><div>
wins: cun
s ne regn ncy bu

w living 
ele</div>
Wh
dysuri ? burning while urin
ing
Wh
h ens when m crh ge firs
engulfs b c
eri in h gsme "<img sr
c="" s
e-12459700126223.jg"" />"
M crh ges ls c
s &nbs;_____ nd re ______
h
h ve migr
ed

he
is
sue
"<img src="" s
e-12545599472122.jg"" />"
Self renewing s
em cells c n differen
i
e in

bi
en
i l cell becming ei
h
er _______ r ________ "lymhcy
e r mncy
e<div><br /></div><div><img src=""
 s
e-12665858556435.jg"" /></div>"
"<img src="" s
e-12700218294632.jg"" />"
m crh ge
Wh
4
hings d m crh ges c use
 h en when
hey inges
b c
eri ? "rele se
chemic ls
h
incre se bld flw<div> llw fr e sier end
heli l cell cn
r
c
in</div><div>s
imul
e nerves fr  in</div><div>rele se cy
kines</div><div>
<br /></div><div><img src="" s
e-12820477378913.jg"" /></div>"
Wh
is
he F b regin? "
w iden
ic l ""h nds""
h
gr b n
 n
igens<div><br
/></div><div><img src="" s
e-12949326397965.jg"" /></div>"
Wh
is
he Fc regin?<div><br /></div><div>Wh
des i
de
ermine?</div>
"cns
n
regin:
il
h
binds
 rece
rs n surf ce f m crh ges<div><br
/></div><div> n
ibdy cl ss</div><div><br /></div><div><img src="" s
e-1304811
0645615.jg"" /></div><div><br /></div>"
Wh
exl ins n
ibdy diversi
y?
DNA
h
m kes u
he n
ibdy genes mig
h
ch nge nd
hese ch nges re enugh
 genre
e
he 100 millin differen
n

ibdies<div><br /></div><div>Mdul r design nd junc
in l diveris
y &nbs; llw
s fr sm ll m
f gene
ic inf
 cre
e incredible n
ibdy diversi
y</div>
Exl in cln l selec
in
"<img src="" s
e-13361643258279.jg"" /><div><b
r /></div><div><img src="" s
e-13374528160125.jg"" /></div>"
Wh
is sniz
in
Prcess by which n
ibdies
g inv ders fr des
ruc
in
Hw d n
ibdies f cili

e n
igen des
ruc
in
"<img src="" s
e-134561
32538852.jg"" />"
When re n
ibdies effec
ive in defending g ins
viruses?
When
hey re u

side f
he cells. They kee viruses frm en
ering nd re knwn s neu
r lizin
g n
ibdies
Wh
re neu
r lizing n
ibdies?
"<img src="" s
e-13615046328462.jg"" /
>"
T cells re his
lgic lly iden
ic l
 _________.&nbs;<div><br /></div><div>Wh
ere re
hey rduced nd wh
d
hey h ve?</div>
B Cells<div><br /></div>
<div>Bne m rrw; surf ce T cell rece
rs (TCR)</div>
Where d B cells nd T cells m
ure?
B- bne m rrw<div>T -Thymus</div>
Wh
resen
s n
igens
 T cells?
MHC
Hw des MHC 1 infrm
he killer cell f wh
is ging n?
"<img src="" s

e-13945758810445.jg"" />"
MHC II disl y fr gmen
s f r
eins bu
re in
ended fr _______ cells heler T
cells
Wh
kinds f cells m ke MHC II APC (like m crh ges)
Cl ss I MHC des wh
?<div><br /></div><div>Cl ss II MHC des wh
?</div>
I- ler
CTL
h
sme
hing is n
righ
in
he cell<div><br /></div><div>II- le
r
s heler T
h
sme
hing is n
righ
</div>

Wh
is
he s
ruc
ur l difference be
ween MHC I nd II? "I: ne lng ch in lus
shr
be
ch in<div><br /></div><div>II:
w lng ch ins: Alh nd be
</div><
div><br /></div><div><img src="" s
e-14130442404077.jg"" /></div><div><br /></
div><div><br /></div>"
Hw c n yu differen
i
e cl ss I vs II MHC
"<img src="" s
e-14173392077300
.jg"" /><div><br /></div><div><img src="" s
e-14186276979215.jg"" /></div>"
Fr heler T cell
 be c
iv
ed wh
2
hings mus
h en? "1. T cells mus

recgnize cgn
e n
igen n cl ss II MHC<div>2. Need c s
imul
in by B7 n s
urf ce f APC</div><div><br /></div><div><img src="" s
e-14315125998107.jg"" /
></div>"
Subccii
l  r
f ver
ebr l r
ery ierces wh
s
ruc
ure? s
erir
l n

 ccii
l membr ne
Ver
ebr l r
ery en
ers cr ni l c vi
y
hrugh wh
?
fr men m gnum
Wh
re
he 2 func
ins f hyid bne? 1. nchr fr neck muscles<div>2. ssis

s in keeing irw y en</div>
The suerfici l f sci f
he neck cn
ins wh
muscle?
l
ysm
Pl
ysm rises frm wh

w muscles? Wh
des i
blend in wi
h?
del
id
nd ec
r lis m jr f sci <div><br /></div><div>blends wi
h f ci l muscles ver

he m ndibul r edge</div>
Wh
is
he func
in f
he dee f sci f
he neck?
llws s
ruc
ures in
he
neck
 glide sm
hly
Wh
des
he inves
ing l yer f dee f sci d?
sli
s nd inves
s T nd
SCM
Where des
he re
r che l l yer f dee f sci

ch? hyid
 fibrus eric r
dium
The viscer l cm r
men
wi
hin
he re
r che l l yer f
he dee f sci cn
in
s wh
?
hyrid gl nd<div>l rynx/
r che </div><div>h rynx/esh gus</div><div>i
nfr hyid muscles</div>
Wh
is
he clinic l signific nce f
he re
rh rynge l s ce? "cn
inues in


hr x nd is cndui
fr sre d f infec
in<div><br /></div><div><img src=""
 s
e-25769803776515.jg"" /></div>"
Wh
innerv
es ex
rinsic b ck muscles? Wh
re
hey? (3)
An
erir r mi&nb
s;<div><br /></div><div>
r ezius, lev
r sc ul e, rhmbids</div>
Wh
re in
rinsic muscles innerv
ed by?
Ps
erir r mi
Where des
he subccii
l
ri ngle lie?
"Bene
h
he Tr ezius, in
rinsi
c b ck muscles nd SCM<div><br /></div><div><img src="" s
e-26053271618047.jg"
" /></div>"
Wh
re
he cn
en
s f
he subcci
l
ri ngle?
ver
ebr l r
ery nd sub
ccii
l nerve C1
Wh
re
he sin l r
s f lesser ccii
l nerve?
C2-C3
Wh
re
he sin l r
s f
he subccii
l nerve nd gre
er ccii
l nerve
resec
ively? C1, C2
Wh
5 nerves lie in
he l
er l cervic l regin?
M
r: CN XI<div>Sensry
:</div><div>lesser ccii
l nerve( C2-C3)</div><div>gre
er uricul r nerve C2C3</div><div>Tr severse Cervic l nerve C2-C3</div><div>Sur cl vicul r nerve C3C4</div>
Wh
des
he ex
ern l jugul r vein ierce nd where? inves
ing f sci

s

erir brder f SCM
Wh
c n be  l
ed

he mcl vicul r
ri ngle?
uls
in f subcl vi n
r
ery
Wh
re
he br nches f
he subcl vi n r
ery? 1. cmmn c r
id<div>2. ver
ebr
l r
ery</div><div>3. in
ern l
hr cic r
ery</div><div>4.
hyrcervic l
runk
</div><div> . sur sc ul r</div><div>b.
r nsverse cervic l</div><div>c. inferi
r
hyrid</div>
Wh
is
he sensry innerv
in f SCM? C2-C3
Wh
re
he cmnen
s f
he inn
e immune sys
em?
cmle
men
<div>h gcy

es (m crh ges nd neu
rhils)</div><div>NK cells</div>
When d cmlemen
r
eins begin
 be m de? during firs

rimes
er
Where re r
eins f cmlemen
sys
em m de? liver
Wh
is
he ms
bund n
cmlemen
r
ein? C3

C3 r
eins re cn
inu lly brken dwn in
 2 cmenen
s: Wh
des e ch  r

d?
"C3b: very re c
ive nd binds
 min r hydrxyl grus<div><br /></di
v><div>C3 :

r ch m crh ges nd neu
rhils nd c
iv
e
hem
 becme 
e
n
killers.&nbs;</div><div><br /></div><div>C3 nd C5
re n hyl
xins</div
><div><br /></div><div><img src="" s
e-30073361007120.jg"" /></div>"
Wh
h ens if C3b desn
find chemic l gru wi
hin 60 micrsecnds? "<img sr
c="" s
e-30112015712763.jg"" />"
Wh
h ens nce C3 is clied?
"1. h s
 be clse
 surf ce f b c
er
i r virus&nbs;<div>2. binds
 B&nbs;</div><div>3. D cmes lng nd clis 
ff  r
f B
 yield C3bBb</div><div><br /></div><div><img src="" s
e-30154965
385774.jg"" /></div>"
Wh
is
he func
in f C3bBb? Wh
is ls c lled?
"cle ves 
her C3 r
ei
ns nd frms C3b<div><br /></div><div>cnver
se</div><div><br /></div><div><img
src="" s
e-30180735189493.jg"" /></div>"
When
he C3bBb c
s like ch in s w, wh
des i
d? "<img src="" s
e-302580
44600827.jg"" />"
Wh
cmlemen
r
eins m ke
MAC (membr ne

ck cmlex) "C5b, C6, C7, C8
, C9<div><br /></div><div><img src="" s
e-30253749633531.jg"" /></div>"
Wh
cmlemen
r
eins m ke
he s
lk f
he MAC?
"<img src="" s
e-302537
49633531.jg"" />"
Wh
des C9 d in MAC?
"<img src="" s
e-30253749633531.jg"" />"
Hw d hum n cells defend
hemselves frm being

cked by MACs?
"MCP: cl
is C3b
 n in c
ive frm<div>DAF: cceler
es des
ruc
in f C3bBb</div><div>
CD59: kicks lms
finished MACs ff befre
hey c n m ke
hle in ur cells</d
iv><div><br /></div><div><img src="" s
e-30455613096462.jg"" /></div>"
Wh
is
he cen
r l l yer in
he lec
in c
iv
in 
hw y?
"MBL (m nnse bi
nding lec
in)<div><br /></div><div><img src="" s
e-30928059498983.jg"" /></div
>"
Wh
is
he signific nce f MBL? Wh
des i
n
bind
?
"M nnse binding
lec
in c n bind c rb (secific lly m nnse) which is fund n
he surf ce f m
ny cmmn 
hgens.<div><br /></div><div>Des n
bind
 c rbhydr
es n he l

hy hum n cells</div><div><br /></div><div><img src="" s
e-30923764531687.jg""
/></div>"
Describe
he lec
in c
iv
in 
hw y "<img src="" s
e-31005368910352.jg"" /
><div><br /></div><div>MLB binds
 MASP</div><div>MLB binds

rge
(m nnse)
</div><div>MASP c
s like cnver
se
 cli C3</div><div>Then
he whle C3bBb

hing s
r
s g in</div>"
Wh
re
he 3 func
ins f
he cmlemen
sys
em?
1. des
ry inv ders vi
MACs<div>2. enh nce func
in f h gcy
ic cells by
gging inv ders wi
h iC3b</
div><div>3. ler

her cells vi chem

r c
n
s (C3
nd C5 )</div>
Wh
is iC3b? Wh
is i
s rle? "i
is
he clied, in c
ive frm f C3b (in c
i
ve fr m king MACs)<div><br /></div><div>I
serves s
m rker n inv ders fr m
crh ges
 cme e
i
.</div><div><br /></div><div><img src="" s
e-312759518
49994.jg"" /></div><div><br /></div><div><br /></div>"
Wh
re
he rles f C3 nd C5 ?
They re fr gmen
s f cmlemen
r
ein
s
h
serve s chem

r c
n
s


r c
mre m crh ge nd neu
rhils.<div
><br /></div><div>They c
s n hl
xins</div>
Wh
is
he m in s
udied cy
kine
h
rimes res
ing m crh ge? This cy
kin
e is rduced m inly by ________
"<img src="" s
e-31787052958205.jg"" /
><div><br /></div><div>IFN g mm </div><div>heler T nd NK cells</div>"
When m crh ges becme c
iv
ed wh
h ens? "They uregul
e cl ss II MHC m
lecules<div>They begin
 c
s APCs nd disl y fr gmen
s f
he inv ders</div
><div><br /></div><div><img src="" s
e-31782757990909.jg"" /></div>"
Hw d m crh ges becme hyer c
iv
ed?
"<img src="" s
e-31782757990909
.jg"" /><div><br /></div><div><img src="" s
e-31950261715428.jg"" /></div><di
v><br /></div><div>LPS binds
 rece
rs n rimed m crh ges</div><div><br />
</div><div>M nnse c n bind
 rece
rs n m crh ges</div><div><br /></div><d
iv><br /></div><div><br /><div><br /></div></div>"
Once m crh ges re hyer c
ive, wh
h ens? "1. grw l rger nd incre se r

e f h gcy
sis<div>2. rduce TNF</div><div><br /></div><div><br /></div><div

><img src="" s
e-31945966748132.jg"" /></div><div><br /></div><div><img src=""

 s
e-32006096290301.jg"" /></div>"
Cell fe
ures f hyer c
ive m crh ges?
"1. Incre sed number lyssmes<d
iv>2. Incre sed rduc
in f re c
ive xygen mlecules like H2O2</div><div>3. m
crh ges c n ls dum cn
en
s f lyssmes n
 mul
icellul r  r si
es en b
ling i
des
ry inv ders
h
re
 l rge
 e
</div><div><br /></div><div><i
mg src="" s
e-32169305047553.jg"" /></div>"
T/F neu
rhils re APC F lse;
hey live shr

ime nd le ve
he bld s
re m
re d
 die
"<img src="" s
e-32293859098963.jg"" />"
Neu
rhils:
rilbed nucelus, c
le r cy
l sm
Describe h gcy
ic c
ivi
y f neu
rhils
"1. rduce b

le cy
kines lik
e TNF<div>2. give ff des
ruc
ive chemic l s
red inside</div><div><br /></div><
div><img src="" s
e-33088428048824.jg"" /></div>"
Wh
cy
kines d m crh ges give ff when c
iv
ed? TNF nd IL-1
Wh
mlecules re exressed n
he surf ce f end
heli l cells? When re
hey
exressed?
"ICAM (in
r cellul r dhesin mlecule)<div>SEL (selec
in)</div>
<div><br /></div><div><img src="" s
e-33084133081528.jg"" /></div><div><br /><
/div><div>ICAM is lw ys resen
</div><div>SEL is exressed when vessels receive
l rm sign ls (TNF n IL-1)</div>"
Wh
des neu
rhil sense fr
 g frm rll

s
? Wh
des i

hen be
gin
 exress? Why?
"C5 nd LPS.<div><br /></div><div>In
egrin</div><div><b
r /></div><div><br /></div><div>In
egrin c n
hen bind
 ICAM</div><div><img sr
c="" s
e-33689723469951.jg"" /></div>"
Wh
sign ls end
heli l cell
 exress SEL? Hw lng des
his
ke? "TNF nd
IL-1<div><br /></div><div><img src="" s
e-33728378175618.jg"" /></div><div><b
r /></div><div>6 hurs fr
his r
ein
 be m de nd
r nsr
ed
 surf ce f
end
heli l cell. Yu w n

 m ke sure

ck is serius.&nbs;</div>"
Wh
c uses neu
rhil
 le ve bld vessel nce i
h s s
ed?
"When
h
e neu
rhil senses chem

r c
n
s like C5 nd fMET<div><br /></div><div><img
src="" s
e-33754147979399.jg"" /></div>"
Neu
rhils fllw
he
r il f ________ e
ides

he si
e f infl mm
in
f-me
e
ides<div><br /></div><div>m crh ges inges
b c
eri nd rele se f-me

e
ides which

r c
s neu
rhils</div>
Wh
des
he neu
rhil lgic refer
?
The w y
he neu
rhil rlls, s

s, nd exi
s is f irly cmlic
ed bu
his is necess ry
 ensure
h

he inf
lux f neu
rhils in
 surrunding
issues is c
u lly necess ry nd n
c usin
g unnecess ry d m ge
Wh
re
he 3 w ys NK cells kills cells?
"1. frce
hem
 cmmi
suicide
by using n injec
in sys
em where
hey use erfrin r
eins
 deliver suicid
e enzyme (gr nzyme B) in


rge
cell<div><br /></div><div>2. NK cells in
er
c
wi
h r
ein c lled F s n
he surf ce f i
s
rge
, sign ling i

 selfdes
ruc
</div><div><br /></div><div>3. A me
hd simil r
 T Cells. They h ve c

iv
ing nd inhibi
ry rece
rs</div><div><br /></div><div><img src="" s
e-34
389803139222.jg"" /></div><div><br /></div><div><br /></div>"
NK cells in
rduce _____ in

he
rge
cell vi n injec
in sys
em gr nzyme
B
"The ""dn
kill"" sign l is cnveyed by rece
rs
h
recgnize _______<div><
br /></div><div>The Kill sign l invlved NK rece
rs being c
iv
ed by _______
___</div>"
"cl ss 1 MHC mlecules<div>unusu l c rbhydr
e r r
ein n

rge
cell</div><div><br /></div><div><img src="" s
e-34643206210032.jg"" /></d
iv>"
Wh
is
he benefi
f NK cells killing cells
h
d NOT recgnize MHC1
"Sme viruses m y
urn ff MHC mlecule exressin. Killer T cells wuldn
be b
le
 recgnize
hese vir lly infec
ed cells.<div><br /></div><div>NK c
s s
b ck u
 &nbs;
 kill
hese vir lly infec
ed cells
h
jus
dn
disl y MHC
mlecules</div><div><br /></div><div><img src="" s
e-34638911242736.jg"" /></
div>"
Wh
mlecules c
iv
e NK cells?
LPS<div>IFN lh </div><div>IFN be
</di
v>

Describe
he immune sys
em cer
in be
ween m crh ges nd NK cells "1. LPS
c
iv
es NK cells<div>2. NK cell rele ses IFN g m </div><div>3. IFN g mm c use
s m crh ges
 m ke l
f TNF</div><div>4. TNF s
imul
es i
self
 secre
e
IL-12</div><div>5. IL-12 nd TNF influence NK
 incre se
he mun
f IFN g m
m
hey rduce</div><div>6. mre IFN g mm , mre m crh ges c n be rimed</div
><div><br /></div><div><br /></div><div><img src="" s
e-35399120454197.jg"" />
</div>"
Wh
c uses
he uregul
in f IL-2 rece
rs n
he surf ce f NK cells? Wh

is IL-2? Wh
des i
c use
TNF.<div>IL-2 is
grwh
f c
r</div><div><br /
></div><div>MORE NK cells</div>
Hw d &nbs;h gcy
es nd
he cmlemen
sys
em wrk
ge
her?
1. iC3B

gs inv ders fr inges
in. Cmlemen

hen snizes inv ders<div><br /></div>
<div>2. m crh ges c
u lly m ke cmlemen
r
eins</div><div>C3, f c
r B, n
d f c
r D.</div><div><br /></div><div>3. M crh ges secre
e chemic ls
h
inc
re se v scul r erme bili
y s
h
mre cmlemen
ge
s in

he
issues</div>
Hw des incre sed cy
slic c lcium injure
he cell
"1. f ilure f ATP gener

in<div>2. Ac
iv
in f Phshli se (membr ne d m ge)</div><div>3. Pr
e se
(membr ne nd cy
skele
l d m ge)</div><div>4. endnucle se (DNA d m ge)</div>
<div>5. ATP se (less ATP)</div><div><img src="" s
e-42906723287532.jg"" /></di
v>"
Cellul rInjury
Wh
is
he in
rinsic 
hw y resul
f?
"incre sed mi
chndri l erme b
il
y nd
he rele se f r- 

ic mlecules (cy
c) in

he cy
l sm<div><
br /></div><div><img src="" s
e-43611097924243.jg"" /></div>" Cellul rInjury
Where re FAS nd FASL lc
ed? "F s is
de
h rece
r exressed n m ny cell

yes<div><br /></div><div>FASL is
he lig nd exressed n T cells&nbs;</div><d
iv><br /></div><div><img src="" s
e-43843026158212.jg"" /></div>"
Cellul r
Injury
Cm re in
risic nd ex
rinsic 
hw y f 
sis
"In
rinsic: sign l c
iv

es r
eins
h
rele se cy
chrme c frm mi
chndri <div><br /></div><div><
img src="" s
e-44066364457619.jg"" /><br /><div><br /></div><div>ex
rinsic: si
gn l c
iv
es r
eins
h
direc
ly c
iv
e c s ses</div></div><div><br /></
div><div><img src="" s
e-44079249359492.jg"" /></div>"
Cellul rInjury
K rylysis vs yknsis vs k ryrrhexis "<img src="" s
e-45015552229857.jg"" /
>"
Cellul rInjury
"<img src="" s
e-46866683134152.jg"" /><div>which r
in is firs
rder nd z
er rder?</div>"
"<img src="" s
e-46888157970974.jg"" />"
"<img src="" s
e-46926812676572.jg"" />"
B; C
Hw d yu c lcul
e

l mun
f drug in
he bdy? "<img src="" s
e-469697
62349135.jg"" />"
Wh
re
he 3 imr
n
ch r c
eris
ics f firs
rder kine
ics?
"1. R
e
f drug elimin
in is direcl
y rr
in l
 drug cncen
r
in<div><br /></
div><div><img src="" s
e-47012712022266.jg"" /><br /><div><br /></div><div>2.h
lf life is cns
n
.</div><div>3. Cns
n
ercen
ge f
he drug is elimin
ed
er uni

ime</div></div><div><br /></div><div><img src="" s
e-47025596924247.
jg"" /></div>"

1/2 = 0.7/ Ke
"<img src="" s
e-47416438948190.jg"" />"
T: zer rder<div>B

m: firs

rder</div>
Wh
2 ch r c
eris
ics re secific
 zer rder kine
ics
"1. cns
n
m
un
f drug ls
er uni

ime<div>2. h lf life is n
cns
n
, deends n cnc
en
r
in (
he higher
he cncen
r
in,
he lnger
he h lf life)</div><div><br
/></div><div><img src="" s
e-47553877901717.jg"" /></div>"
"<img src="" s
e-47605417509377.jg"" />"
"<img src="" s
e-47691316855201.jg"" />"
B
"<img src="" s
e-47717086658703.jg"" />"
"<img src="" s
e-47729971560566
.jg"" />"
"<img src="" s
e-47764331299297.jg"" />"
A
Wh
is
he difference be
ween ne cm r
men
nd 2 cm r
men
en mdel
"<img src="" s
e-47807280972286.jg"" />"
"<img src="" s
e-47841640710523.jg"" />"
<div>A: 3 cm r
men
mdel</div

><div>B: 2 cm r
men
mdel</div><div>C: firs
rder</div><div>D: zer rder</d

iv>
"<img src="" s
e-47876000448956.jg"" />"
<div>D</div><div><br /></div><di
v>inverse gnis
decre eses c
ivi
y</div><div><br /></div><div> n
gnis
; jus

blcks c
ivi
y</div><div><br /></div><div> gnis
: incre ses c
ivi
</div>
"<img src="" s
e-47910360187388.jg"" />"
D
"<img src="" s
e-47936129991183.jg"" />"
A
Wh
vein is used fr cen
r l line l cemen
? "subcl vi n vein unc
ure<div><b
r /></div><div><img src="" s
e-5235565134301.jg"" /></div>"
Wh
lymh
ics lie in
he l
er l cervic l regin. Wh
vessel d
hey run ln
g?
"<img src="" s
e-5269924872743.jg"" />"
Wh
2 lymhndes m ke u
he dee cervic l lymhndes? "<img src="" s
e-526562
9905447.jg"" />"
Wh
is s
e dy s

e? "<img src="" s
e-9341553869325.jg"" />"
Hw c n yu incre se Css wi
hin
her eu
ic windw?
"Incre se r
e f infusi
n<div><br /></div><div><img src="" s
e-9461812953574.jg"" /></div>"
Wh
drugs d yu need
 be c reful bu
simly r ising
he r
e f infusin?
"Quinine<div>Li
hium</div><div>Digi
lis</div><div><br /></div><div><img src=""
s
e-9457517986278.jg"" /></div>"
Time needed
 re ch s
e dy s

e deends nly n ________
"h lf life f dr
ug<div><br /></div><div><img src="" s
e-9633611645438.jg"" /></div><div><br />
</div><div><img src="" s
e-9646496547319.jg"" /></div>"
Hw lng wil i

ke
 re ch s
e dy s

e cncen
r
in? (fr ur urses)
"4-5 h lf lives<div><br /></div><div><img src="" s
e-9680856285691.jg"" /></di
v>"
Wh
is
he L ding Blus dse? "The mun
f drug needed
 immedi
ely chi
eve &nbs; s
e dy s

e cncen
r
in f drug<div><br /></div><div><img src=""
s
e-9826885173756.jg"" /></div><div><br /></div><div><img src="" s
e-10436770
529792.jg"" /></div>"
T/F A f s
er r
e f infusin ch nges
he
ime needed
 chieve s
e dy s

e
"F<div><br /></div><div><img src="" s
e-9947144258054.jg"" /><br /><div><br />
</div><div><br /></div></div>"
"<img src="" s
e-10492605104518.jg"" />"
<div>Kee l ding dse s me, nd
reduce m in
en nce dse</div><div><br /></div><div>Bec use
heir kidneys dn
w
rk very well,
hey m in
in
he cncen
r
in lnger s yu dn
need
 kee
dding mre drug</div>
"<img src="" s
e-10608569221467.jg"" />"
A
"<img src="" s
e-10668698763707.jg"" />"
T/F When ds ges re dubled, h lved, r s
ed during s
e dy s

e dminis
r

in,
he
ime required
 chieve
new s
e dy-s

e level is indeenden
f
he
ru
e f dminis
r
in
"<img src="" s
e-10874857193946.jg"" />"
Hw d yu c lcul
e
he e k nd
rugh levels
s
e dy s

e?
"<img sr
c="" s
e-10977936409079.jg"" />"
"<img src="" s
e-11046655885805.jg"" />"
4-5 &nbs;h lf lives (8-10)<div>
<br /></div><div>blus: 1 gr m&nbs;</div><div><br /></div><div>l ding dse =vd
*Css</div>
"<img src="" s
e-11166914970075.jg"" />"
2 d ys
"<img src="" s
e-11201274708439.jg"" />"
400 &nbs;mg
"<img src="" s
e-11338713661664.jg"" />"
"<img src="" s
e-11437497909477
.jg"" />"
T/F
he mrhlgic fe
ures f irreversible d m ge
ke lnger
h n
hse f re
versible d m ge True
Incre sed w
er in
he cell, de
chmen
f ribsmes, nucle r chrm
ic cluming
, nd cy
skele
l ch nge re ll indic
ins f ________
hydric ch nge
Incre sed f
in cell nd in
erference wi
h r
ein/ f
me
blism is indic
iv
e f _______
f

y ch nge (s
e
sis)
Hw d yu
ell
he difference be
ween hydric ch nge nd liid build u?
<div>hydric ch nge: nucleus s
ill s
ys in
he cen
er. w
er desn
mve nucle
us. usu lly bund ry</div><div><br /></div><div>liid build u: nucleus will m
ve

he side.&nbs;sc

ered drs
hrughu
</div>

"<img src="" s
e-18150531793238.jg"" />"

hydric ch nge
"<img src="" s
e-18176301597022.jg"" />"
f

y ch nge
T/F f

y ch nge nd hydric ch nge re irreversible F lse:
hey re reversib
le
T/F necrsis is lw ys 
hlgic

rue
Wh
is
he resul
f den
ur
in f in
r celul r r
eins nd enzym
ic diges

in f
he le
h lly injured cell?
necrsis
Wh
re 2 ch r c
eris
ics f
he cy
l sm nd nucleus
h
re indici
ive f
necrsis?
"<img src="" s
e-18300855648733.jg"" />"
Wh
d yu
hink f when yu he r c gul
ive necrsis?
ischemic injury

 ms

issues
Wh
d yu
hink f when yu he r liquef c
ive necrsis
br in nd bsces
s
Wh
d yu
hink f when yu he r &nbs;c seus necrsis
TB r fungi
Wh
d yu
hink f when yu he r f
necrsis injury
 f

y
issues ( ncre
s nd bre s
) nd rele se f enzymes (ie  ncre
ic li ses)<div><br /></div>
Wh
rg n underges b
h hyer
hy nd hyerl si ? u
erus during regn ncy
Hyer
rhy is
he resul
f incre sed ________<div><br /></div><div>Wh
c n i

be induced by? (3)</div>
cellul r r
eins<div><br /></div><div>mech nic
l sensrs</div><div>grw
h f c
rs&nbs;</div><div>v sc c
ive gen
s (Alh dr
energic)</div>
Wh
re hysilgic nd 
hlgic ex mles f hyerl si ?
"<div>Physilgi
c: rlifer
in f gl ndul r ei
helium f fem le during uber
y</div><div><br
/></div><div>P
h lgic</div><div>1. <b>incre se in liver
issue m ss</b> f
er
d m ge</div><div>2. <b>Endme
ri l hyerl si </b>due
 unsed es
rgen sec
re
in</div><div>3. grw
h f c
rs frm <b>vir l</b> genes s
imul
e cellul r r
lifer
in</div><div><br /></div><img src="" s
e-18726057410938.jg"" /><div><
br /></div><div><img src="" s
e-18738942312928.jg"" /></div>"
Wh
is c chexi ?
m rked muscle lss
Describe
he mech nism f
rhy
"<img src="" s
e-19099719565757.jg"" /
><div><br /></div><div><img src="" s
e-19112604467680.jg"" /></div>"
Wh
re russell bdies?
"in
ensely esinhilic s
ining n
ibdies buil
d u in
he l sm cell<div><br /></div><div><img src="" s
e-19207093748115.jg
"" /></div>"
Wh
is lifuscin?
we r nd
e r igmen
frm membr ne d m ge
Wh
is
he difference be
ween dys
rhic nd me
s

ic c lcific
in "<img sr
c="" s
e-19469086753245.jg"" />"
Hw des c lcific
in e r grssly nd micrscic lly?
"grss: h rd gri


y ndules<div><br /></div><div>micr: mrhus gr nul r blue m
eri l, l min

ed c lcium ndules (s mmm bdies)</div><div><br /></div><div><img src="" s

e-19503446491579.jg"" /></div>"
Oil red O nd Sud n s
ins wh
?
F
s/liids
Prussi n blue s
ins wh
?
irn
Fn
n M ssn s
ins wh
?
Mel nin
PAS s
ins wh
?
c rbhydr
es
irreversible cell injury is ssci
ed wi
h ________
lss f membr ne in
egri

y
Why is res
r
in f bld flw n
lw ys helful? Wh
level incre ses in my
c rdi l cell necrsis? gener
in f xygen derived free r dic ls
 rduce
reerfusin injury<div><br /></div><div>cre
ine kin se</div>
Chles
erl is cmmnly desi
ed ________<div><br /></div><div>Glycgen is seen
m inly in _________</div><div><br /></div><div>Lifuscin is fund m inly in __
________</div><div><br /></div><div><br /></div><div>Hemsiderin e rs where__
______</div><div><br /></div><div>Immunglbins re fund _________</div>

herm s in r
eri l w lls (yellw)<div><br /></div><div>liver nd musle</div><
div><br /></div><div>c rdi c mycy
es, he
cy
es (brwn)</div><div><br /></div
><div>mnnucle r h gcy
e sys
em (m rrw, liver, sleen, kufer cells) s
r g
e f irn</div><div><br /></div><div>l sm cells (russell bdies)</div>
Wh

ye f necrsis is ssci
ed wi
h cu
e  ncre
i
is
f
necrsis
Wh

ye f cells h ve
he highes

elmer se c
ivi
y?
germ cells: ll

ws
hem
 re
in
he bili
y
 divide

Where is gr nzyme B fund?
NK r Cy

xic T cells
S
e
sis usu lly ccurs wi
h inges
in f __________
lchl
Wh
is BPH?
benign rs

ic hyerl si
Wh
d lifuscin gr nules reresen
? undiges
ed cellul r rg nelles in u
h
gic v cules.<div><br /></div><div>A
rhy is f
en ssci
ed wi
h incre sed d
es
ruc
in f subcelllul r cmnen
s by u
h gy</div>
Hyerc lcemi , hyer r
hyridism, bne des
ruc
in, nd Vi
min D in
xic
in
re ll recurssrs
 wh

ye f c lcific
in?
me
s

ic: high c lcium
serum levels
F
necrsis is f
en fund in wh

yes f
issues? bre s
nd  ncre s
Where is n
hr c
ic igmen

in cmmnly fund?
lung nd hil r lymh nd
es
Wh
des
he rever
ebr l f sci blend in wi
h? Wh
is i
s l
er l ex
ensin c
lled? Blends in wi
h
he <b>end
hr cic f sci </b>;&nbs;<div>ex
ends l
er l
ly s
he <b> xill ry she
h</b></div>
Des
he cervic l r
in f
he sym
he
ic ch in h ve whi
e r grey r mi cmmu
nic n
es?
Jus
grey. Remember cr nis cr l = P r sym
he
ic, cervic l = s
ym
he
ic&nbs;<div><br /></div><div><br /></div>
Wh
re
he 4 ch r c
eris
ics f Hrners syndrme?
"1. cn
r c
in f
he 
uil (misis)<div>2. dring f
he eyelid (
sis)</div><div>3. sinking f
he
eye (en
h lms)</div><div>4. v sdil
in nd bsence f swe
ing n f ce nd
neck ( nhydrsis)</div><div><br /></div><div><img src="" s
e-205269371977924.j
g"" /></div>"
The
hyrid gl nd lies dee
 wh

w muscles?
"<img src="" s
e-578446
19543050.jg"" /><div><br /></div><div>S
ern
hyrid nd s
ernhyid C5-T1</div>
"
Wh
des
he
hyrglss l duc
cnnec
?<div><br /></div><div>Wh
c n remn n
s
"<b>I


ches
he
hyrid gl nd

he
ngue,
f
his duc
frm?</div>
</b> during
he relc
in f
he
hyrid gl nd frm
he fr men cecum (b ck f

ngue)

he
r che .&nbs;<div><br /></div><div><br /></div><div><b>Rem n n
s
: Thyrglss l duc
cys
s.</b></div><div><br /></div><div><img src="" s
e-58059
367907837.jg"" /></div><div><br /></div>"
Where des
he yr mid l lbe f
hyrid gl nd ex
end nd hw des i
devel?
"1. Ex
ends suerirly lng is
hmus<div>2. Devels frm remn n
s f ei
helium
nd cnnec
ive
issue f
hyrglss l duc
s</div><div><br /></div><div><img src
="" s
e-58179626992084.jg"" /></div><div><br /></div>"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 0.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 0.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
Sensry innerv

in f he d&nbs;
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 1.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 1.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 2.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 2.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 3.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 3.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 4.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 4.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 5.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 5.svg"" />"
"<img src=""8d13

bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"

"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 6.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 6.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
"<img src=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_Q 7.svg"" />"
"<img sr
c=""8d13bdb01e d345d768889b9fd640dfe5 48 bb4_A 7.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_surce_svg.svg"" />"
"<img src=""8d13
bdb01e d345d768889b9fd640dfe5 48 bb4_
mWmnFd.ng"" />"
The suerir r
f ns cervic lis jins nd descends frm wh
cr ni l nerve?
CNXII
Describe
he curse f
he v gus nerve in
he neck n
he righ
nd lef
side.
"Righ
:  sses be
ween br chiceh lic vein ( n
erir
 v gus) nd subcl vi n
r
ery (s
erir
 v gus)<div><br /></div><div>Lef
:  sses be
ween cmmn c r

id nd subcl vi n r
ery&nbs;</div><div><br /></div><div><img src="" s
e-8644
0511799833.jg"" /></div>"
"N me
he l beled br nches f
he v gus nerve.<div><img src="" s
e-864920514072
97.jg"" /><div><br /></div></div>"
1. h rynge l nerve<div>2. suerir l ry
nge l nerve (A. in
ern l nd &nbs;B. ex
ern l br nch)</div><div>C. inferir l r
ynge l nerve</div><div>3. recurren
l rynge l nerve</div><div>4. c rdi c br nche
s</div>
Describe
he curse f
he hrenic nerve in
he neck.<div><br /></div><div>Where
is i
frmed nd where des i
g?</div>
"<img src="" s
e-86646670229994
.jg"" /><div><br /></div><div><br /></div>"
"<img src="" s
e-90452011254252.jg"" />"
Pink: <b>Hyglss l (CN XII)</b
><div>Red: Suerir r
<b> ns cervic lis</b></div><div>Blue: inferir r
<b>
ns cervic lis</b></div><div>Green: <b>Sin l Acccesry Nerve (CN X1)</b></div
><div>S
r: <b>Phrenic (C3, C4, C5)</b></div>
Innerv
in f dig s
ric muscle?&nbs; VII nd V₃
Innerv
in f mhyid muscle? Ans cervic lis-suerir r

Innerv
in f
hyrhyid muscle?
"C1 sin l nerve.<div><br /></div><div><
img src="" s
e-90666759618942.jg"" /></div>"
Innerv
in f s
ylhyid muscle?
CN VII
Innerv
in f SCM?
CN XI (sin l ccessry nerve)
Innerv
in f mylhyid muscle?
V₃
Innerv
in f genihyid muscle?
C1
Innerv
in f s
ernhyid muscle?
<b>Ans cervic lis</b> -- suerir r
&
nbs;
Innerv
in f s
ern
hyrid muscle?
Ans cervic lis -- suerir r

Hw re B cell Rec
rs m de? 1. Gene segmen
s
h
re chsen
 m ke u
he
fin l Hc re lc
ed n chrmsme 14<div>2. One chrmsme 14 is silenced</div>
<div>3. D nd J segmen
s re jined by dele
ing in
ervening DNA</div><div>4. V s
egmen
s re jined
 D nd J</div><div>5. Cns
n
regins fr IgM nd IgD re
chsen&nbs;</div><div>6. re rr nged gene segmen
s re
es
ed-if r
ein
r nsl

in fr b
h chrmsmes is
ermin
ed, cell underges 
sis</div><div>7. I
f full leng
h r
ein is rduced, i
is
r nsr
ed
 cell surf ce nd sign
ls 
her gene
 s
 rducing r
ein</div><div>8. Then ligh
ch in rduc
in
begins in
simil r m nner</div><div>9. If he vy nd ligh
ch in dn
m
ch u

hen
he cell underges 
sis</div><div><br /></div><div><br /></div>
An
igens
h
m
ch
he BCR re c lled
he _________<div><br /></div><div>Wh
i
s
he ei
e?</div>
"Cgn
e;&nbs;<div><br /></div><div>regin f
he cgn

e
h
binds

he BCR</div><div><br /></div><div><img src="" s
e-12557625380
0969.jg"" /></div>"
When
he ei
e is m
ched

he cgn
e,
he nucleus is sign led. Hw is
his
dne? "Ig lh nd Ig be
re
w ccessry r
eins
h
sign l
he nucleus.
<div><br /></div><div>Fr
hese Ig lh nd be
r
eins
 send
he ""BCR &nbs
;eng ged"" sign l, clus
ering f BCRs mus
ccur
 bring enugh Ig lh nd I
g be
mlecules
ge
her</div><div><br /></div><div><img src="" s
e-1257136927
54455.jg"" /></div>"

Hw re BCRs clus
ered? 1. when BCRs bind
 n ei
e
h
is ree
ed m ny
i

mes n single n
igen<div>2. BCRs bind
 ei
es n individu l n
igens
h

re clse
ge
her</div><div>3. BCRS bind
 ei
es n n
igens
h
re clum
ed
geher</div>
The cmle
e BCR h s 2  r
s. Wh
re
hey?
1. Hc/Lc  r

h
recgnizes
h
e n
igen bu
c n
sign l<div>2. Ig lh nd Igbe
r
eins c n sign l bu
re
blind
 wh
s ging n u
side
he cell</div>
"Wh
is
he cmlemen
rece
r nd wh
is i
s urse n B cells?&nbs;<div><
br /></div><div>Why is
he cmlemen
rece
r c lled
""c-rece
r""<br /></d
iv>"
"A rece
r
h
c n bind
 cmlemen
fr gmen
s which re decr
ing
n inv der<div><br /></div><div>An snized n
igen (decr
ed by cmlemen
fr
gmen
s) c
s s
cl m
h
brings
he BCR nd cmlemen
rece
rs
ge
her n

he surf ce f
he B cell</div><div><br /></div><div>When
he BCR nd cmlemen

rece
r re brugh

ge
her by n snized n
igen,
he sign l
h

he BCR
sends is mlified gre
ly</div><div><br /></div><div>i.e.
he number f BCRS c
lus
ered necess ry
 send
he sign l

he nucleus is decre sed 100 fld</div>
<div><br /></div><div><img src="" s
e-126005750530325.jg"" /></div>"
Wh
re
he 2 w ys B cells re c
iv
ed
1. T cell deenden
c
iv
in<d
iv>2. T cell indeenden
c
iv
in</div>
Describe T cell deenden
c
iv
in f B cells "1. requires crss linking f BC
R<div>2. A c-s
imul
ry sign l invlving direc
cn
c
be
ween B cell nd Th
cell vi CD40 L &nbs;(Th cell) nd CD40 rece
r n B cell</div><div><br /></di
v><div><img src="" s
e-126250563666200.jg"" /></div>"
Describe
he 2 requiremen
s fr T cell indeende
B cell c
iv
in
1. L rge
number f BCR crss linking<div>2. T cell d nger sign ls&nbs;</div><div><br />
</div><div>The re sn
h
yur immmune sys
em is n
eng ged wi
h yur wn DNA
(even
h i
h s ree
ed ei
es
h
wuld f cili

e BCR clus
ering) is
h


here re n d nger sign ls cming frm
he immune sys
em eng ging in b

le wi

h DNA</div>
Wh
re
he dv n
ges f T cell indeenden
c
iv
in (2)
1. n need
 w
i
fr Th cell c
iv
in<div>2. Th cells nly recgnize r
ein n
igens resen

ed by cl ss MHC-s figh
wuld be limi
ed</div>
Wh
is mi
gen nd hw des i
c
iv
e B cells? Hw is
his
ye f c
iv
i
Mi
gens
n differen

h n T cell nd T cell indeenden
c
iv
in?&nbs;
bind
 mlecules n
he surf ce f B cells
h
re NOT BCRs<div><br /></div><
div>BCRs re ssci
ed wi
h
hese mlecules nd clus
er when mi
gens bind.&nbs
;</div><div><br /></div><div>This
ye f c
iv
in des n
deend n
he cg
n
e n
igen</div>
Hw is lycln l c
iv
in (mi
gen) n ex me f
he immune sys
em gne wrng
??
A  r si
ic

ck c
iv
es B cells whse BCRs d n
even recgnize
h
e  r si
e!<div><br /></div><div>This is r
ec
ive w y
h

he  r si
e is
ble
 dis
r c

he immune sys
em frm fcusing n
he secific inv sin</div>
Wh
re
he 3 s
es f B cell m
ur
in?
Cl ss swi
ching<div>Sm
ic Hye
rmu

in</div><div>C reer Decisin</div>
When virgin B cells is firs
c
iv
ed, wh
n
ibdy des i
m inly rduce?
IgM,
he def ul
n
ibdy cl ss<div><br /></div><div>I
ls rduces <b>IgD bu

jus

iny fr c
in</b></div>
Wh
n
ibdy exis
s s en
mer?
"IgM<div><br /></div><div><img src="" s

e-126654290592299.jg"" /></div>"
Wh
is IgM very gd
? Why re
hey s
ruc
ur lly m de
 d
his?
Ac
iv
i
ng cmlemen
c sc de<div><br /></div><div>Fr
he cmlemen
c sc de
 ccur,

w r mre C1 cmlexes mus
firs
be brugh
clse
ge
her.&nbs;</div><div><
br /></div><div>IgM h ve Fc regins very clse
ge
her, which bind
he C1 nd c
nsequen
ly bring
he C1s very clse
ge
her,
riggering
he cmlemen
ch in re
c
in n
he inv ders surf ce</div>
Why is
he IgM medi
ed cmlemen
c sc de helful fr clever b c
eri
h
h ve
evlved c
s which resis

he

chmen
f cmlemen
r
eins?
B cells
c n m ke n
ibdies which will bind
 essen
i lly ny c
bc
erium migh
u

n, which c n
hen c
iv
e
he cmlemen
c sc de
Wh
is
he func
in f IgG1? Very gd
snizing inv ders fr inges
in b

ec use Fc regin binds
 neu
rhils nd m crh ges

Wh
is
he func
in f IgG3? Wh
rcess des i
c rry u
? "I
frms brid
ge be
ween NK cells nd v
he
rge
cell.&nbs;<div><br /></div><div>An
ibdy de
enden
cellul r cy

xici
y (ADCC)</div><div><br /></div><div><img src="" s
e
-127058017518035.jg"" /></div>"
Wh
n
ibdy is
he lnges
living?
IgG<div><br /></div><div>Als  sses cr
ss
he l cen


he fe
us</div>
Wh
is g mm glbulin sh
? A sh

h
cn
ins n
ibdies frm l rge num
ber f ele, sme f whm h ve been exsed
 He A
Wh
n
ibdy is ms
bund n
in
he bdy? bld?
Bdy: A<div>bld: G</di
v>
Wh
n
ibdy exis
s s dimer?
"IgA<div><br /></div><div><img src="" s

e-127251291046418.jg"" /></div>"
Why is
he clied
ge
her s
ruc
ure f IgA n
ibdies imr
n
?
1. I
l
lws fr
he
r nsr
crss
he in
es
in l w ll nd u
in

he in
es
ine<div
>2. m kes
hem resis
n

 cids nd enzymes fund in
he diges
ive
r c
</div>
Why re IgA n
ibdies gd
cllec
ing 
hgens in
 clums?
I
h s 4
F b regins
h
cllec

hgens in
 clums
h
c n be swe
&nbs;u
f

he bdy wi
h mucus r feces
Wh
n
ibdy is secre
ed in

he milk f nursing m
hers?
IgA
C n IgA c
iv
e
he cmlemen
?
N, 
herwise ur mucs l surf ces wuld
be in cns
n
s

e f infl mm
in
Wh
is n hyl c
ic shck c used by? M s
cell degr nul
in f his
mine
Wh
h ens f
er firs
nd secnd exsure
 llergen?
"<img src="" s

e-127513284051423.jg"" /><div><br /></div><div><img src="" s
e-128097399603691
.jg"" /></div>"
If IL 4 nd 5 re resen
IgM swi
ches
 ________
IgE- gd fr  r si
es<
div>IgA-gd fr b c
eri which inv de diges
ive
r c
</div>
If
here is l
f IFN g m , B cells swi
ch
 rduce ______ IgG3<div><br /><
/div><div>m kes sense bec use IFN g mm is rduced by NK cells nd IgG3 c
s s
bridge be
ween NK nd
rge
cell</div>
If
here is l
f TGF be
, B cells ch nge frm IgM
 _________ n
ibdy r
duc
in IgA (gd fr viruses -cmmn cld /b c
eri n mucs l surf ces)
"<img src=""f5 78f2636603c21d4b4655587c289eed 3 8807_Q 0.svg"" />"
"<img sr
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c=""f5 78f2636603c21d4b4655587c289eed 3 8807_A 1.svg"" />"
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Cl ss swi
ching nd sm
ic hyermu

in re cn
rlled by ___________ T heler
cell cy
kine secre
in
T/F T cell indeenden
B cell c
iv
in usu lly underg cl ss swi
ching r sm
F lse

ic hyermu
in
If B cell becmes l sm cell, i

r vels b ck
 ________ r ________
 m
ke wh
?
sleen r bne m rrw<div><br /></div><div>secre
ed frm f
he
BCR- n
ibdy mlecule</div>
Cl ss swi
ching nd sm
ic hyermu

in f B cells require lig
in f ______
______ CD40 n B cels by CD40 Lig nd (n T cells)
T cell deenden
c
iv
in f B cells resul
s in ___________ n
ibdies
IgG, IgA, r IgE

Describe
he s
ruc
ur l ch r c
eris
ics f MHC 1 mlecules

1. H ve binding
grve clsed
b
h ends<div>2. nly llw sm ll r
eins in
he grve</div><
div>3. Mlecule is m de u f HLA r
ein wi
h be
2 micrglbulin</div>
Wh
genes cde fr cl ss I MHC r
eins? where re
hey lc
ed
3 genes
c lled HLA-A, HLA-B, HLAC lc
ed n Chrmsme 6
Hw
he cl ss II MHC mlecule s
ruc
ur lly differ frm cl ss I The binding gr
ve f Cl ss II MHC mlecules is en
b
h ends s
h
e
ide c n h ng u
.
Hw re r
eins rcessed
 be resen
ed n MHC I n
he cell surf ce?
"1. Pr
e smes ch u misflded r d m ged r
eins<div>2. Pe
ides re c rrie
d by TAP 1 nd TAP2 crss ER</div><div>3. Sme e
ides re ""chsen"" (nes
h

fi
cl ss I MHC mlecule)</div><div><br /></div><div><img src="" s
e-1725803
75888147.jg"" /></div>"
Hw re APC seci lized fr n
igen resen

in by cl ss I MHC?
"1. <b>I
n
erfern g mm </b> uregul
es 3 seci lized r
eins<div>2. These r
eins re
l ce s
ck r
eins f
he r
e sme</div><div>3. This ""cus
mized r
e sme"
" nw referen
i ll cu
s e
ides
h
h ve ei
her <b>hydrhbic r b sic c
er
mini</b><br /></div><div>4. In ddi
in, TAP
r nsr
er screens r
eins fr r

e smes s
h
nly r
eins
h
re f crrec
leng
h</div><div><b><br /></
b></div><div>Nw
hese cus
m m de e
ides re
he righ
size fr
he cl ss 1 m
lecule</div><div><br /></div><div>This seci liz
in is differen
frm
he r n
dm h cking
he r
e smes d in ll 
her cells.</div>"
Hw re MHC II mlecules m de? Tw r
eins ( lh nd be
) re injec
ed in


he ER where
hey bind
 <b>inv ri n
ch in</b>
Wh
is
he func
in f
he inv ri n
ch in (2) "1. Fills
he grve f
he MHC
II mlecule nd kees i
frm icking u 
her e
ides in
he ER<div>2. <b>Guid
es MHC mlcule u

hrugh glgi s
ck
 endsmes</b></div><div><br /></div><d
iv><img src="" s
e-172863843729735.jg"" /></div><div><br /></div>"
Hw re MHC II mlecules l ded wi
h e
ides? "1. A h gsme wi
h h gcy
se
d r
ein merges wi
h endsme<div>2. enzymes in endsme ch u r
ein in
 
e
ides</div><div>3. cy
l smic <b>HLA-DM</b>
r vels

he endsme nd c
l
yzes
he rele se f
he inv ri n
ch in (<b>CLIP)</b>&nbs;s
h
e
ide c n b
ind
 grve</div><div>4. MHC II wi
h e
ide is disl yed n surf ce</div><div
><br /></div><div><img src="" s
e-172859548762439.jg"" /></div>"
Wh
re
he 2 requiremen
s fr T cells
 be c
iv
ed?
"1. T cell mus

recgnize cgn
e n
igen n MHC mlecule<div>2. Mus
receive c-s
imul
ry sig
n l (B7-CD28 in
er c
in)</div><div><br /></div><div><img src="" s
e-1731215417
67469.jg"" /></div>"
Wh
re
he 3
yes f n
igen resen
ingn cells?
dendri
ic cells<div>m cr
h ges</div><div>B cells</div>
Wh
APC h s s
r-fish like sh e nd c n ini

e
he immune resnse by c
iv
Dendri
ic cells

ing virgin T cells
Wh
re
he 3 s
ges f dendri
ic cells?
1. Res
ing<div>2. Tr veling</div
><div>3. Presen
er</div>
Wh
2 sign ls re necess ry
 c
iv
e dendri
ic cells frm
he res
ing h se


he
r veling h se? 1. Exsure
 cy
kines frm 
her immune cells (TNF fr
m m crh ges nd neu
rhils)<div>2. Ac
iv
in f TLRs (cellul r rece
rs wh
ich recgnize mlecul r 

erns ch r c
eris
ic f <b>br d cl sses f inv ders)
</b></div><div><b><br /></b></div><div>*n
e TLRs recgnize gener l ch r c
eris

ics NOT single inv der</div>
<div>TLR3 is used
 sense</div>TLR 4 is used
 sense _________<div>TLR 7 is us
ed
 sense __________</div><div>TLR 9 is used
 sense ________</div><div><br /
></div> <div>Duble s
r nded RNA f Viruses</div>LPS: cmnen
s f b c
eri l ce
ll w lls<div>single s
r nded RNA f viruses</div><div>duble s
r nded DNA f b c

eri </div><div><br /></div><div>TLR 7 nd 9 re wi
hin w lls f h glyssme.&
nbs;</div>
Why is wh
TLRs recgnize imr
n
? They recgnize s
ruc
ur l fe
ures which
re s imr
n


he 
hgen
h

hey c nn
be e sily l
ered by mu

in
&nbs;
Af
er dendri
ic cell is c
iv
ed, wh
builds u wi
hin
he cell?<div><br /></d
iv><div>Wh
incre ses n
he surf ce s i

r vels?</div>
1. MHC II mlecu

les wi
h n
igens h gcy
sed nd fused wi
h endsmes<div>2. MHC I nd MHCII r

ece
rs nd B7 c-s
imul
ry r
eins<br /><div><br /></div></div>
Af
er dendri
ic cells re c
iv
ed, where d
hey
r vel
? Wh
d
hey d?
Tr vel
 lymhnde
 c
iv
e virgin T cells
T/F dendri
ic cells Kill
F lse,
hey nly
r vel
 resen
n
igens
 T
cells in lymhnde
T/F M crh ges
r vel
 lymh nde
F lse. They resen
n
igen nd h gcy

se n
igens
Hw re T cells cn
inu lly s
imul
ed? " c
iv
ed m crh ges c
s ""refuelin
g s

ins"" which kee exerienced T cells
urned n s
h

hey c n cn
inue

  r
ici
e in
he b

le"
D B cells c
s APCs e rly n in
he inefec
in?
N,
hey h ven
been c

iv
ed ye
!<div><br /></div><div><br /></div><div>Usu lly during
secnd

ck
, memry B cells lef
ver frm firs


ch re
he ms
imr
n
APCs bec use

hey c n quickly cncen
r
e sm ll mun
s f n
igen fr resen

in</div>
Wh
dv n
ge d B cells h ve ver 
her APC s in
erms f n
igen resen

in
?
"They h ve

n f BCRs
h
bind
 n
igens. The whle cmlex is dr
gged in

he cell nd fused wi
h n endsme. The n
igen is
hen l ded n
 M
HC II rece
r nd disl yed n
he cell surf ce<div><br /></div><div>Bec use
h
ere re s m ny BCRs, n
igens c n be cncen
r
ed.</div><div><br /></div><div>T
his imr
n
bec use heler T cell c
iv
in requires TCRs
 be crsslinked (
simil r
 hw BCRs h d
 be crsslinked by ree
ed ei
es
 be c
iv
ed)<
/div><div><br /></div><div>S cncen
r
in le ds
 c
iv
in!!</div><div><br
/></div><div><img src="" s
e-173774376796500.jg"" /></div>"
In wh
rder re APCs usu lly u
ilized in resnse
 
hgen
"<img sr
c="" s
e-173860276142283.jg"" />"
wh
re CD1 mlecules? nn-cl ssic l mlecules
h
resemble MHC I mlecules<di
v><br /></div><div>They s mle <b>liids frm cells </b> nd resen

hem n
he
surf ce f APCs</div>
Wh
is
he lgic f cl ss I resen

in (2) 1. Need
 fcus

en
in f ki
ller T cells n infec
ed cells (
hgen inside f cells)<div>2. Need cn
rlled
resen

in s
h
r ndm debris n cell surf ce desn
se
ff immune resn
se</div><div><br /></div>
Wh
is
he lgic f MHC II resen

in? (2) 1. Adver
ise

l envirnmen

u
side cells<div>2. 2 cell mech nism r
her
h n jus
Th sign ling immue resns
e. Th nd APC mus
gree
ge
her
h n
here h s been n infec
in befre Th c n
be c
iv
ed&nbs;</div>
All reg nglinic neurns rele se ______ n
 ________rece
rs n s
g nglin
ic neurns
Ach; Nic
inic
Which l ces nly h ve sym
he
ic innerv
in Bld vessels nd skin
Ps
syn ic  r sym
he
ic neurns rele se _________ n
 wh

ye f rece
r
s?
Ach n musc rinic
Ps
syn 
ic sym
he
ic neurns rele se _______
 wh

e f rece
rs? Wh

re
he exce
ins
"NE n drenergic rece
rs&nbs;<div><br /></div><div>S
we
gl nds: Ach n
 musc rinic rece
rs</div><div>Kidney sm
h muscle v scul

ure: D mine n
 D1</div><div>Adren l medull rele ses Einehrine</div><div
><br /></div><div><br /></div><div><img src="" s
e-192762427211996.jg"" /></di
v><div><br /></div><div><br /></div><div><br /></div>"
Wh

ye f nic
inic rece
r exis
s

he neurmuscul r junc
in? N1
Wh

ye f nic
inic rece
r exis
s n ll s
g nglinic neurns? N2
Wh
re
he 6 s
es invlved in Ach nerve
ermin l
"<img src="" s
e-193007
240348082.jg"" />"
Wh
rece
r des  ncre s h ve
 reduce
he rele se f insulin during sym
h
e
ic innerv
in?
lh 2, decre se cAMP, en K+ ch nnels (hyerl rize
cell)
Wh
is
he r
e limi
ing s
e f
he frm
in f NE/Ei?
L Tyrsine--&g
;
L d vi
yrsine hydrxyl se
NE/Ei c n be me
blized in
 ___________ nd ______. I
is
hen excre
ed in ur
ine s ______.<div><br /></div><div>Wh
is d mine excre
ed s?</div> COMT nd
MAO<div><br /></div><div>VMA</div><div><br /></div><div>HVA</div>

Wh
is hechrmcy
m ?

umr f dren l medull -rele ses
n f eine
hrine
Mic
ur
in is cn
rlledin wh
 r
f
he br in s
em?
Midbr in
Where re
he neum
xic nd neus
ic cen
er lc
ed?<div><br /></div><div>Whe
re is
he insr
ry cen
er lc
ed</div>
Pneum
xic: Uer ns<div>Ane
us
ic: lwer ns</div><div><br /></div><div>Insir
ry cen
er: Medull </div>
Where is
he c rdiv scul r cen
er lc
ed?
Medull
Why re bld vessels lw ys smewh
cns
ric
ed?
Sym
he
ic
ermin ls r
e lw ys rele sing sme mun
f nreinehrine
During high bld ressure, firing f b rrece
rs incre ses r decre ses? Wh

bu
during lw bld ressure?
Firing incre ses during high bld ress
ure--&g
; sign ls PS sys
em<div><br /></div><div>Firing s
s during lw bld 
ressure--&g
;sign ls sym
he
ic sys
em</div>
Wh
kinds f neurns re rel ying ressure nd chemic l infrm
in

he br i
n s
em?<div><br /></div><div>Wh
is
he embrylgic l rigin f
hese neurns?<
/div> sensry, seudunil r neurns frm bld vessels

he CNS<div><br />
</div><div>neur l cres
</div>
Wh

ye f rece
rs exis
n cns
ric
r sm
h muscle f
he eye?<div><br />
</div><div>Wh
is clinic l crrel
in fr dil
ing
he eye?</div> "M3-s
im
ul
in c uses cn
r c
in f shinc
er muscle= misis<div><br /></div><div>Use
M3 blckers like
rine
 c use uil dil
in</div><div><br /></div><div><im
g src="" s
e-211883621613868.jg"" /></div>"
Wh
rece
r exis
s n r di l muscle f eye?<div><br /></div><div>Ac
iv
in f
" lh 1-NE/Ei<div><br /></div><div>dil

his rece
r c uses wh
?</div>

in (mydri sis)</div><div><br /></div><div><img src="" s
e-211887916581164.j
g"" /></div>"
Wh
re
he PS nd S rece
rs n lung?<div>Ac
iv
in f e ch resul
s in wh
?
</div> "M3: Brchcns
ric
in (Gq--&g
;C 2+)<div>be
2: brnchdil
in (Gs-&g
;cAMP/PKA---&g
; MLK hsh
se)</div><div><br /></div><div><img src="" s
e
-213300960821568.jg"" /></div>"
Wh
re c
ive dil
rs f
he brnchi Be
2 gnis
s (**
erl), NO, PED inhib
i
rs<div><br /></div><div>M3 blckers, s
erids, leuk
riene blckers</div>
Wh
PS nd S rece
rs exis
s

he SA nde?<div><br /></div><div>Wh
des c
"M2: lwer he r
r
e<div>Be
1

iv
in f
hese rece
rs c use?</div>
: incre se he r
r
e</div><div><br /></div><div><img src="" s
e-21263094592343
2.jg"" /></div>"
PS r S innerv
in is redmin n
ly fund in ven
ricles?
"Sym
he
ic (mi
nim l  r sym
he
ic)<div><br /></div><div><img src="" s
e-213361090363752.jg
"" /></div>"
Sym
he
ic innerv
in
 he r
incre sese wh
?
"chrn
ry (HR)<div>dr
m
ry (cnduc
in velci
y)</div><div>cn
r c
ili
y (in
ry</div><div>c lci
um reu
ke in SER (lusi
ry)</div><div><br /></div><div><img src="" s
e-21335
6795396456.jg"" /><br /><div><br /></div></div>"
Ac
iv
in f wh
rece
rs will c use v scns
ric
in nd v sdil
in n cr
n ry r
eries? lh 1 : cns
ric
in<div>be
2: v sdil
in</div>
Hw des Ach c
ing n M2 lwer he r
r
e?
"<img src="" s
e-21404399016366
9.jg"" />"
Hw des Ne/Ei c
ing n be
1 incre se he r
r
e? "<img src="" s
e-214039
695196373.jg"" />"
N me ll
he rece
rs
h
when c
iv
ed cns
ric
bld vessels (5) "Eineh
rine: lh 1--&g
;MLC kin se<div> ngi
ensin II: AT1</div><div>v sressin : V1<
/div><div>His
mine: H1--&g
; cns
ric
SMC cre
ing hles be
ween
hem</div><di
v>End
helin: ET1</div><div><br /></div><div><img src="" s
e-214194314019082.j
g"" /></div>"
N me ll
he rece
rs n bld vessels
h
c use dil
in
"Ei-Be
2-MLC
hsh
se<div>His
mine-H2</div><div>Br dykinin-K2</div><div>NO-cGMP rel xes s
mc</div><div><br /></div><div><img src="" s
e-214190019051786.jg"" /></div>"
Wh
kinds f drugs c n be given
 v sdil
e r
eriles nd
hus lwer bld 
ressure?
C 2+ blckers (nifediine)<div> lh 1 blckers (* zsin)</div><
div>ACE inhibi
r</div><div>K+ ch nnel ener (NO)</div><div><br /></div>

H1 rece
rs n sm
h muscle le ds
 _________<div>H2 rece
rs n sm
h musc

le le ds
 _______</div>
"cns
ric
in f venules<div>dil
in f r
eri
les</div><div><br /></div><div><img src="" s
e-214795609440457.jg"" /></div><d
iv><br /></div><div><br /></div>"
Wh
dil
es fferen
r
eriles in
he kidney
 incre se ren l bld flw? Wh
"DA (D1--&g
;Gs)

rece
rs re
hey wrking n r wh
mech nism is used?
<div>Prs
gl ndins (Gs)</div><div>ANP (cGMP)</div><div><br /></div><div><img sr
c="" s
e-214967408132302.jg"" /></div>"
Wh
cns
ric
s r
eriles
 decre se ren l bld flw?
"NE/Ei cns
ric

s b
h fferen
nd efferen
r
eriles<div><br /></div><div>Renin</div><div><b
r /></div><div>Angi
ensin II: cns
ric
s efferen
r
erile</div><div><br /></d
iv><div><img src="" s
e-214963113165006.jg"" /></div>"
Ac
iv
in f be
1 rece
rs in kidney resul
s in wh
?
"rduc
n f re
nin<div><br /></div><div><img src="" s
e-215031832641806.jg"" /></div>"
Why wuld yu use lh 1 blckers nd be
1 blckrs fr hyer
ensin? " lh 1
blckers (dil
e r
eriles)<div>be
1 :decre se HR (CO), decre se renin rduc

in</div><div><br /></div><div><img src="" s
e-215027537674510.jg"" /></div>"
Wh
PS nd S rece
rs exis
in de
russr muscle. Wh
h ens when
hese rece
M3: Gq--&g
;C 2+--&g
;cn
r c
in<div>be
2: Gs--&g
;ML

rs re c
iv
ed
C hsh
se-&g
;rel x
in</div>
Wh
PS nd S rece
rs exis
n sinch
er muscle in bl dder? Wh
h ens when

hese rece
rs re c
iv
ed? NANC--&g
;m kes NO<div>M2--&g
;Gi, rel x
in</d
iv><div> lh 1---&g
;Gq, cn
r c
in</div>
Hw d yu
re
BPH
T msulsin (flm x) = lh 1 blcker
Hw d yu
re

nic bl dder?
Tre
wi
h musc rinic gnis
(M3 gnis

=be
h nechl)
Hw d yu
re
n ver c
ive bl dder? M3 blcker (xybu
ynin)
&nbs;Wh
rece
rs re c
iv
ed in liver
 rduce/rele se glucse?&nbs;
Be
2, gluc gn rece
rs, cr
isl rece
rs
Wh
rece
rs re resen
in dise
 c
iv
e HSL nd rele se f

y cids?
Be
1/Be
3 (NE)<div>Gluc gn rece
rs</div>
Wh
rece
rs re lc
ed in  ncre s
 m ke mre gluc gn? Be
2 rece
rs
Wh
rece
rs re lc
ed in  ncre s
 reduce insulin rduc
in?
lh 2
rece
rs&nbs;<div>IPSP,Gi decre se cAMP, ens K+ ch nnels</div><div><br /></d
iv><div>remember
h
insulin rduc
in is incre sed by blckign K+ ch nnels (s
ulfnylure s)</div>
Where re ms
f
he be
1 rce
rs lc
ed in ur bdy?
he r
. Bu
ls
resen
in CNS, kidneys, i
ui
ry, dise
ADrenergic nervus sys
em is gener lly medi
ed by EPi nd NE, wh
is n exce

in?
Temer
ure cn
rl by Ach nd Swe
gl nds by Ach
Wh
is
he effec
f lbu
erl n bld glucse?
be
2 gnis
, incre se
gluc gn--&g
;incre se glucse
Clnidine ( lh 2 gnis
) is
cmmnly used n
ihyer
ensive during emergenci
es. Wh
is
he effec
n insulin nd glucse levels?
lh 2 in  ncre s, dec
re se insulin, incre se glucse bld levels
If yu give sin l nes
ehsi C1-C7
 
ien
wh
h ens

he he r
lungs
nd bld ressure
CN re fine, bu
sym
he
ic u
u
is in
erru
ed<div>h
e r
:fine since under v g l
ne</div><div>lungs: fine since under v g l
ne</d
iv><div>bld vessels: n
regul
ed well bec use
yic lly under sym
he
ic c
n
rl</div>
Wh
h ens if
here is lesin lng
he sym
he
ic ch in sulying
he eye?
Wh
wuld be
re
men
?
unsed PS c
in n
he eye (Hrners)<div>1.
misis</div><div>2. 
sis</div><div>3. en
h lmsis</div><div>4. nhydrsis (s
we
ing medi
ed by Sym
he
ic)</div><div><br /></div><div>Add einehrine. Tyr
mine wuld h ve n effec
since sym
he
ic nerve
ermin ls re ls
. Tyr mine
is c
echl mine rele sing gen
</div>
Wh
is gd medic
in

re

umr f dren l medull
henxybenz mine
:
re
es high bld ressure nd swe
ing c used by high einehrine levels<div
><br /></div><div>I
is n lh
n
gnis
</div>
Wh
sys
em is resnsible fr bdy
emr
ur cn
rl vi swe
? Which NT is rel

e sed nd wh
rece
r is ffec
ed

sym
he
ic<div>Ach</div><div>M3</div>
"<img src="" s
e-216281668125144.jg"" />"
<div>Secnd rder neurns f sym

he
ic rele se
he fllwing.</div><div><br /></div><div>2 . Ms
rg ns Nre
inehrine</div><div>2b. Kidneys d mine wrking n D1 rece
rs, r ise cAMP, di
l
e bld vessels nd incre se ren l bld flw</div><div>2c. Swe
gl nds ce

ylchline is rele sed, ev r
in f swe
cls
he skin (regul
es bdy
eme
r
ure)</div><div>2c. Adren l medull rele ses ms
ly einehrine</div><div><br
/></div>
"<img src="" s
e-216328912765380.jg"" />"
<div>All u
nmic g ngli .</div
><div>Firs
rder Neurns rele se ce
ylchine; i
wrks n nic
inic ch nnels (
nn-secific c
in ch nnels) n s
-g nglinic neurns.&nbs;</div><div><br /
></div>
"<img src="" s
e-216389042307567.jg"" />"
Insulin
"<img src="" s
e-216423402045778.jg"" />"
B
"<img src="" s
e-216457761784198.jg"" />"
E
Wh
is be
h nechl used

re
? Hw des i
wrk?
Urin ry re
ensin<div>Xe
rs
mi (dry mu
h due
 s livery gl nd m lfunc
in)</div><div><br /></div><di
v><br /></div><div>Musc rinic gnis

h
cn
r c
s de
rusr muscle nd rel xes
shinc
er</div>
Wh
re 4 s
imuli fr ccu
e infl mm
in?
<div>1. Infec
ins (b c
eri l, v
ir l, fung l,  r si
ic -TLRs re imr
n
fr de
ec
ing
hese)&nbs;</div><div
>2. Tissue necrsis (necr
ic cells rele se
l
f chemkines)&nbs;</div><div
>3. Freign bdies (usu lly frm
r um ; f
en c rry micrbes)&nbs;</div><div>4
.Immune re c
ins ( u
immuni
y)</div>
Hw des swelling ccur in cu
e infl mm
in? <div>Nrm lly:&nbs;</div><div>F
luid flw in
he bld vessels is such
h

here is ne
exi
in r
eriles nd
ne
re bsr
in in venules&nbs;</div><div><br /></div><div>In cu
e infl mm
i
n:&nbs;</div><div>Fluid flw in BOTH r
eriles nd venules incre ses nd resu
l
s in ne
exi
f fluid in

he in
ers
i
ium (resul
s in swelling)</div>
V scul r le k ge is
h llm rk f _______ infl mm
in nd le ds
 _________
cu
e infl mm
in;edem
Describe
he 3 mech nisms by whicih v scul r le k ge c n ccur 1. Cn
r c
in 
f end
heli l cells vi his
mines, br dykinin, leuk
rines, subs
nce P<div>2.
End
heli l cell injury due
 injuries r burns</div><div>3. Incre sed
r nsr

f fluids (
r nscy
sis-VEGF c n incre se
his)</div>
In nrm l vessels, wh
cells frm
he cen
r l clumn nd which cells re n
he
Red in cen
r l clumn, whi
e cells in erihery
erihery?
P-selec
in rele se frm ________ bdies re medi
ed by _______ "Weibel-P l de b
dies, His
mine nd
hrmbin<div><br /></div><div><img src="" s
e-258754599715
321.jg"" /></div>"
TNF nd IL-1 le d
 end
heli l exressin f Wh
?&nbs;
selec
in
Wh
is di edesis? Where des
his ms
ly ccur?
Prcess by which leukcy

es ge

hrugh end
helium<div><br /></div><div><br /></div><div>s
c ill ry
venules</div>
Af
er
r versing end
helium, hw d
he neu
r hils ene
r
e
he b semen
mebr
ne?
secre
e cll gen se
 bre k dwn cell m
rix
Once leukcy
es ierce b semen
memebr ne,
hey migr
e lng
chem
c
ic gr d
ien
. Hw d
hey bind

he ex
r cellul r m
rix?
wi
h in
egrins nd CD44
Wh
is leukcy
e dhesin deficiency
ye 1? There is defec
in
he bisyn

hesis f be
2 ch in n in
egrins
Wh
is leukcy
e dhesin deficiency
ye 2? defec
s in E nd P selec
ins
Wh
re
he 3 h ses f cu
e infl mm
in
"<img src="" s
e-25917980147759
1.jg"" />"
Wh
d TLRs recgnize? LPS
G r
ein-culed rece
rs c n recgnize _________
N-fMe
residues frm b c

eri
Wh
is
he ms
cmmn rece
r fr snins? IgG rece
r r cmlemen
rece

r
Wh
3 rece
rs ll bind micrbes fr h gcy
sis? Wh
d e ch recgnize?
m nnse rece
rs-sug rs fund in micrbi l cell w lls<div>sc venger rece
rs-

ce
yl
ed lw-densi
y lir
eins</div><div>snin rece
rs</div>

Describe engulfmen
rcess f h gcy
sis
M crh ge enclses
he  r
icle
s in h gsme nd fuses i
wi
h lyssm l gr nule
Describe
he killing rcess f h gcy
sis
O2 cnver
ed
 O2- vi NADPH x
id se<div>O2- cnver
ed
 H2O2 vi suerxide dismu
se (SOD)</div><div>H2O2 c
nver
ed
 HOCL (ble ch) vi melerxid se</div>
Wh
enzyme d neu
rhils use
 cnver
H2O2 in
 HOCL?
myelerxid se
Wh
re
he 4 neu
rhil

r c
n
s? C5 <div>LPS (b c
eri l rduc
s)</div><d
iv>IL-8</div><div>LTB4</div>
Wh

w
hings rm
e  in? PGE2 nd br dykinin
PGE2 rm
es Feeeeever nd  in
PGI2, D2, nd E2 ll rm
e ______ nd ______ v sdil
in nd v scul r erme
bili
y
Wh
d LTC4, D4, nd E4 rm
e?
V scns
ric
in, brnchcns
rc
in, v
scul r erme bili
y (cn
r c
in f end
heli l cells
 m ke
hem le ky)
Wh
des br dykinin f cili

e?
v sdil
in, incre sed v scul r erme b
ili
y,  in
Wh
killer
hings d neu
rhils ls cn
in in ddi
in
 ROS?
Enzymes:
el s
se nd lyszyme<div>Defensins</div>
Wh
re defensins?
(c
ininc rginine-rich gr nule) e
ides
h
kill mic
rbes
Wh
is chedi k-hig shi syndrme? Wh
re sme sym
ms? (6)
u
sm l recess
ive syndrme in which
here is defec
ive fusin f h gsmes n dlyssmes du
e

r
ein
r fficking defec
.&nbs;<div><br /></div><div>1. incre sed risk
f infec
ins</div><div>2. neu
reni (de
h f neu
rhils)</div><div>3. gi n

gr nules rising due
 fusin f gr nules</div><div>4. defec
ive rim ry hems

si ( bnrm lly dense gr nules in l
ele
s)</div><div>5. lbinism</div><div>6
. eriher l neur
hy (c n
mve r
eins rund nerve)</div>
Wh
is chrnic gr nulm
us dise se? Wh
is
he gene
ic inheri
nce? Wh
de
s i
resul
in? Defec
in
he gene
h
cdes cmnen
s f h gcy
e xid se<di
v><br /></div><div>Resul
s in n
being ble
 rduce suerxide frm O2</div>
<div><br /></div><div>X linked</div><div><br /></div><div>defec
s in b c
eri l k
illing nd recurren
infec
ins</div>
Where d his
mine nd ser
nin c
? bld vessels-v sdil
in nd incre ses
erme bili
y&nbs;
Where re his
mine nd ser
nin s
red s refrmed mlecules?
m s
cel
ls<div><br /></div><div>*ser
nin is resen
in l
ele
s nd neurendcrine ce
lls nd is imr
n
in c gul
in</div>
Wh
re
he 3 r chidnic cid me
bli
es?
rs
gl ndins<div>leuk
rienes<
/div><div>lixins</div>
Where is r chidnic cid derived frm? Hw des i
nrm lly exis
s? f

y c
id derived frm die
ry surces<div>N
free in
he cell. Nrm lly es
erified in
membr ne hshliids</div>
Wh
d lixins d?
Inhibi
neu
rhil dhesin nd chem
xis
Wh
des
hrmbx ne A2 d?
v scns
ric
in, rm
es l
ele
ggreg
in
"<img src="" s
e-264161963540983.jg"" />"
Asrin nd NSAIDs inhibi
________
"Cx 1 nd 2
 inhibi
rs
gl ndin sy
n
hesis<div><img src="" s
e-264157668573687.jg"" /></div>"
Wh
re lixygen se inhibi
rs? Wh
c n
hey be useful fr
re
men
in?
"<img src="" s
e-264157668573687.jg"" /><div><br /></div><div>Inhibi
leuk
ri
ene rduc
in</div><div>brnchcns
ric
in</div>"
Hw d TNF/IL-1 medi
e infl mm
in? 1. induce end
heli l dhesin mlecules
<div>2. rduc
in f cy
kines</div><div>3. rm
e fever ( c
iv
e COX c
ivi

y
 m ke PGE2)</div>
Wh
re Zileu
n nd Mn
eluk s
&nbs; Leuk
riene inhibi
rs. USeful in
re
i
ng s
hm
Wh
des NO d in
erms f infl mm
in
"Prm
e v sdil
in nd inhibi

s infl mm
ry resnse<div><br /></div><div><img src="" s
e-264454021317139.j
g"" /></div>"
Hw is
he cmlemen
sys
em medi
r f infl mm
in?
C3 nd C5
rig

ger m s
cell deggr nul
in resul
ing in his
mine medi
ed v sdil
in nd v
scul r erme bili
y
Hw des F c
r 12 h ve
rle in medi
ing infl mm
in?
1. Prm
es Cm
lemen
<div>2. Prm
es cl

ing</div><div>3. Prm
es Kinin sys
em (Kinin cle ve
s HMWK in
 br dykinin, which medi
es v sdil
in, v scul r erme bili
y, nd
 in)</div>
"<img src="" s
e-264724604256761.jg"" />"
neu
rhils
Wh
is Dneezil?
Reversible ce
ylchline es
er se inhibi
r secific

CNS<div><br /></div><div>used

re
Allzheimers (memry lss)</div>
Wh
re nes
igmine nd yrids
igmine used fr?
my s
heni gr vis, en
ngle gl ucm , revers l f nn del rizing neurmuscul r blck de fllwing su
rgery
Where is PAM nd
rine ms
useful? Hw d
hey e ch wrk

re
rg nhs
h
e isning&nbs; PAM effec
s re ms
n
icible wi
h <b>nic
inic </b>si

es. Regener
es Aches
er se<div><br /></div><div>A
rine wrks be

er erihe
r l <b>musc rinic </b>si
es. Blcks M3 si
es</div>
Wh
inhibi
r is f
en fund in g rdening insec
icides nd nerve g ses?
ce
ylchlines
er se inhibi
rs
"<img src="" s
e-292401373512029.jg"" />"
Simv s

in
"<img src="" s
e-292435733250326.jg"" />"
<div>Answer: Nes
igmine, Pyrid
s
igmine re reversible eriher l c
ing ce
ylchline es
er se inhhibi
rs</di
v><div><br /></div><div>Me
h chline. <b>Chlinergic gnis
used

es
fr s

hm </b> me
h chline ch llenge
es
dne under c reful medic l suervisin</div
><div><br /></div><div>Ech
hih
e irreversible Ach se inhibi
r used in lw d
ses

re
gl ucm ( s eye drs)</div><div><br /></div><div>Dneezil CNS
c
ing reversible Ach se inhibi
r fr
re
ing Alzheimers</div><div><br /></div><
div><b>Edrhnium shr
c
ing Ach se inhibi
r fr
es
ing Tensiln
es
fr M
y s
heni gr vis &nbs;</b></div><div><br /></div>
Wh
re
he 2
yes f TCRs? " lh be
<div>g mm del
</div><div><br /></di
v><div><img src="" s
e-308511795839524.jg"" /></div>"
lh be
rece
rs f

r di
in l T cell recgnize _______ nd ________
"b
h
heh e
ide nd MHC mlecule!<div><br /></div><div><br /></div><div><img
src="" s
e-308563335446924.jg"" /></div><div><img src="" s
e-308584810283229.
jg"" /></div><div><br /></div>"
Once TCR h s recgnized i
s cgn
e n
igen, hw des i

r nsmi

his sig l

"A CD3 cmlex is used
 hel
r nsmi
sign l f

he nucleus f
he T cell?
rm lh be
(u
side cell)
 nucelus<div><br /></div><div>CD3 m de u f g m
m , del
, esiln, nd ze
</div><div><br /></div><div>Clus
ering f TCR ( lh
be
uni
wi
h CD3) le ds
 c
iv
in f kin se enzymes
h
c
iv
e
he nuc
leus</div><div><br /></div><div><img src="" s
e-308722249237153.jg"" /></div><
div><br /></div>"
Hw is
he TCR vers
ile?
1. when T cells recgnize self in
hymus= 
s
is<div>2. when TCR m
ched wi
h cgn
e nd cs
imul
ry sign ls re c
i v
ed
=T cell is c
iv
ed</div>
CTLs
yic lly exress wh
c rece
r?<div>Th
yic lly exress wh
c rece

"CD8<div><br /></div><div>CD4</div><div><br /></div><div><img sr
r?</div>
c="" s
e-308915522765011.jg"" /></div><div><br /></div>"
Wh
is
he urse f
he CD4 nd CD8 c rece
r? (3) 1. Fcus

en
in f
h
e Th cells nd CTLs n
he rer MHC mlecule<div><br /></div><div>2. S
bilize
TCR/MHC in
er c
in</div><div><br /></div><div>3. S
reng
hen
he TCR sign l


he nucelus (b
h CD4 nd 8 h ve
ils
h
edx
end in

he cy
l sm nd re l
sely ssci
ed wi
h TCR/CD3 cmlex)</div>
Wh
c-s
imul
in rcess ccurs in TCRs befre
hey re c
iv
ed? "T m ke

he sign l re ch
he nucleus, clus
ering f TCRs is necess ry. Bu

his require
s
n f TCR eng ging
he cgn
e n
igen.<div><br /></div><div>Hwever, cs
i
mul
in c n enh nce
he sign l s
h
n
s much clus
ering mus
ccur (we w
n

 lwer
he clus
ering requiremen
)</div><div><br /></div><div>S B7 r
ein
s c
s cs
imul
ry r
eins
h
lug in
 CD28 T cell rece
rs</div><div><
br /></div><div><img src="" s
e-309100206358816.jg"" /></div><div><br /></div>
"

Fr T cells
 be c
iv
ed, wh

w
hings mus
h en firs
? "TCR mus
be lig

ed wi
h MHC-e
ide<div>C s
imul
ry sign l (B7 inser
ign in
 CD28 rece
r
)</div><div><br /></div><div><img src="" s
e-309095911391520.jg"" /></div>"
Eng gemen
f TCR mlecules wi
h MHCII-e
ide uni
s resul
s in uregul
in f
wh
? 1. Adhesin mlecules: s
reng
hening
he glue
h
hlds APC nd T cell

ge
her-
his is necses ry bec use
hey need
 s
y
ge
her lng enugh fr

hreshld level f TCR eng gemen
nd clus
ering
 be me
<div><br /></div><div>2
. CD40L r
eins n
he T cell:
his is imr
n
bec use
his <b> ) </b>incre s
es exressin f B7 c s
imul
ry mlecules n APC nd <b>b) </b>rlngs
he l
ife f dendri
ic cell <b>c)</b>T cell c n use
his CD40L
 c
iv
e B cells</di
v>
Wh
h ens f
er heler T cell c
iv
in?
1. Prlifer
es driven by grw
h
f c
rs like IL-2 (which
hey rduce)<div><br /></div><div>**They re simul
i
ng
heir wn rlifer
in!</div>
Exl in cln l selec
in s i
refers
 Th cells?
There is
culing f
c
iv
in

he uregul
in f grw
h f c
rs.<div><br /></div><div>When Th ce
lls re c
iv
ed,
hey rduce l rge mun
s f IL-2 nd rece
rs n
heir sur
f ce.</div><div><br /></div><div>Th which re selec
ed fr c
iv
in (bec use T
CR recgnize nd inv der) uregul
e
heir grw
h f c
r rece
rs nd rlifer

e
 frm clne</div>
Wh
is Il-2? grw
h f c
r&nbs;
Wh
is
he rle f Th cell in CTLs resse
 
hgen? (3) 1. Hel CTL effi
cien
ly c
iv
ely killer T (ins
e d f rlifer
ing widely nd n
living very
lng)<div>2. Hel CTL gener
e memry CTL</div><div>3. C n suly IL-2 required
fr CTL
 rlifer
e</div>
Exl in why mlific
in f TCR sign l is n
s imr
n
in exerienced T cel
ls s i
is in virgin T cells. In 
her wrds, exeriened T cells h ve reduced r
equirmen
fr c-s
imul
in
1. virgin: when TCR eng ge cgn
e, liid r f
s
re rushed

he surf ce<div>2. re c
iv
in: TCR nd liid r f
s re n
ss
ci
ed</div><div>3. c
iv
in: TCRs cme very clse

he r f
s, bringing
hem
in clse cn
c
wi
h dwns
re m sign lig mlecules
 c
iv
e
he nucleus</di
v><div><br /></div><div>Cs
imul
in recrui
s liid r f
s

he surf ce f
he
cell.&nbs;</div><div><br /></div><div>Exerienced T cells h ve m ny mre r f

s
h n n ive cells. This exl ins why re c
iv
in f exerienced T cells des n

require s s
rng cs
imul
in, bec use
he r f
s in exerienced T cells re
lre dy n
he surf ce, jus
w i
ing
 c rry
he sign l</div>
Wh
re
he cmen
s f
he u
er l yer f
he glbe? "<img src="" s
e-310749
473800765.jg"" />"
Wh
re
he cmnen
s f
he middle l yer f
he glbe
"Chrid<div>Cil
i ry bdy wi
h cili ry rcess</div><div>iris s
rm </div><div><br /></div><div>
<img src="" s
e-310843963081022.jg"" /></div>"
Mel ncy
es re f wh
rigin? neur l cres

Wh
m kes u
he inner l yer f
he eye?
"Re
in l igmen
ed ei
helium<d
iv>r serr
</div><div> n
erir rjec
ins f cili ry rcess</div><div>s
e
rir iris</div><div>neur l re
in l n s
erir surf ce f iris</div><div><br />
</div><div><img src="" s
e-310839668113726.jg"" /></div>"
"<img src="" s
e-311020056740352.jg"" />"
Wh
ch mbers cn
in queus humr
n
erir ch mber nd s
erir ch mber
Wh
bunds
he n
erir ch mber?
"s
erir surf ce f crne
 n
erir
c sule f lens<div><br /></div><div><img src="" s
e-311114546020769.jg"" /><
/div>"
Wh
bunds
he s
erir ch mber?
"s
erir iris
 n
erir hy lid f ce
<div><br /></div><div><img src="" s
e-311110251053473.jg"" /></div>"
Wh
bunds
he vi
reus bdy? " n
erir hy lid f ce
 inner re
in l surf ce<
div><br /></div><div><img src="" s
e-311110251053473.jg"" /></div>"
Wh
des vi
reus bdy ms
ly cn
in? "w
er wi
h cll gen
ye II nd hy lur
nic cid<div><br /></div><div><img src="" s
e-311110251053473.jg"" /></div>"
"<img src="" s
e-311226215170389.jg"" />"
hyium: ggreg
e f whi
e cel
ls nd infl mm
ry debris
"<img src="" s
e-311269164843360.jg"" />"
hyhem : bld cllec
s behind

he crne nd in frn
f
he iris ( n
erir bdy)

Wh
is n en glbe? full
hickeness l cer
in r erfrm
in f
he cre n
, limbus, r scler
Wh
re 3 signs f en glbe? "1. lw in
r cul r ressure<div>2. e ked uil<
/div><div>3. seidel si
ive
es
ing</div><div><br /></div><div><img src="" s
e
-311410898764219.jg"" /></div>"
Wh
re
he 3 sm
h muscles in
he eye
1. cns
ric
r muscle (iris s
r
m rund uil)<div>2. dil
r (r di l muscles in iris s
rm )</div><div>3. cir
cumferen
i l muscle in cili ry bdy</div>
Misis is under
he cn
rl f wh
CN? CN III (cns
ric
r muscle)
Wh
h ens

he lens when circumferen
i l muscles f
he cili ry bdy re re
l xed? "The znule fibers re ulled nd
he lens is
hinner<div><br /></div><d
iv><img src="" s
e-311548337717557.jg"" /></div>"
Wh
h ens

he lens when
he circumferen
i l muscle in
he cili ry bdy re
cn
r c
ed?
"
ensin is rele sed n znule fibers nd lens ge
s f

er<div><
br /></div><div><img src="" s
e-311544042750261.jg"" /></div>"
T ge
incre sed wer ( ccmid
in) wh
sh e d yu w n

he lens
 be? Are

he circumfere
n il muslces f
he cili ry bdy cn
r c
ed r rel xed? "<img sr
c="" s
e-311544042750261.jg"" /><div><br /></div><div>
hicker</div><div>muscle
s
 be cn
r c
ed</div>"
Wh
is resbyi
"Lens lses el s
ici
y nd desi
e s me cn
r c
in f s
m
h circumferen
i l muscle in cili ry bdy, lens des n
ge
f

er (resby
i )<div><br /></div><div>v<img src="" s
e-311544042750261.jg"" /></div>"
Accmd
in is cn
rlled by wh
cr ni l nerve?
CN III
Cnvergence is cn
rlled by wh
cr ni l nerve n wh
muscles?
CN III 
n medi l rec
i muscles
Misis is cn
rlled by wh
CN?
III
Wh
3 rcesses ccur in
he ne r synkinesis reflex? Accmd
in (lens incre
ses curv
ure
 incre se wer- cili ry muscles)<div>Cnvergence (demns
r
e
inw rd mvemen
f b
h eyes
w rds e ch 
her. Eyes dduc
)</div><div>Misis-
uil shrinks
 blck ligh
sc

ered by erihery f crne )</div>
Wh
is M rcus Gunn J w winking "Aberr n
cnnec
in be
ween
he m
r br nches
f <b>CN V3</b> innerv
ing
he <b>ex
ern l 
erygid muscle</b> nd fibers f

he suerir divisin f <b>CN III</b>
h
innerv
e
he <b>lev
r sueriris m
uscle</b><div><b><br /></b></div><div><b><img src="" s
e-312201172746634.jg""
/></b></div>"
Wh
5 l ces is mel nin fund in
he eye?
Chrid<div>Cili ry Bdy</div><d
iv>Iris</div><div>Re
in l igmen
ei
helium</div><div>single l yer f undiffere
n
i
ed neur l re
in ver
he s
erir iris</div>
Why d ele wi
h cngen
i l hrners syndrm h ve he
erchrmi ?
"Sym
h
e
ic sys
em is resnsible fr
he migr
in f mel ncy
es

he iris s
rm i
n
he beginning f life<div><br /></div><div><img src="" s
e-312403036209508.j
g"" /></div>"
Wh
cul r effec
s d
hse wi
h lbinism h ve? (5)
1. h
hbi : iris h s
n igmen

in<div>2. blnde fundus: unigmen
ed re
in </div><div>3. fve l hy
l si : fve des n
devel</div><div>4. Nys
gmus: eyes sh ke b ck nd fr

h</div><div>5. S
r bismus (crssing f
he eye)</div><div><br /></div>
"<img src="" s
e-312570539934153.jg"" /><div><br /></div><div>Cnvergence f
ll
he lines is ________</div>" 
ic nerve (CN II)
Where re
he 3 ms
likely l ce fr mel nm in
he eye?
1. Chrid (ms

cmmn)<div>2. Iris</div><div>3. Cili ry Bdy (le s
cmmn)</div>
Why is chrid 
en
i l l ce fr me
s
sis f chrid l mel nm ? I
is hi
ghly v scul rized
Hw is chrid l mel nm
re
ed?
"Pl que r di
in<div><br /></div><div><
img src="" s
e-312699388953039.jg"" /></div>"
Wh
is
he bld suly f
he re
in ? Inner 2/3 f re
in : cen
r l re
in l r

ery<div><br /></div><div>Ou
er 1/3 f re
in : chrid l v scul
ure<br /><div><b
r /></div><div><br /></div></div>
"<img src="" s
e-312866892677583.jg"" /><div>Wh
is
his indic
ive f?</div>
"
cen
r l re
in l r
ery cclusin (inner 2/3 f re
in is ligh
er)&nbs;<

div><br /></div><div>Als
end
 see

cherry red s
</div>
Hw re cili ry muscle nd znul r fibers rel
ed?
"When cili ry muscles r
e rel xed, znul r fibers re under
ensin (un ccmd
ed<div><br /></div><div>
<br /></div><div>When cili ry muscles re
ensed, znul r fibers re rel xed ( c
cmd
ed)</div><div><br /></div><div><img src="" s
e-340629561278820.jg"" /><
/div>"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 0.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 0.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 1.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 1.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 2.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 2.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 3.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 3.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 4.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 4.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 5.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 5.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 6.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 6.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 7.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 7.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 8.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 8.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 9.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 9.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 10.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 10.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src=""7fde7994847c60857b29334d85b4be114379bfb5_Q 11.svg"" />"
"<img sr
c=""7fde7994847c60857b29334d85b4be114379bfb5_A 11.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_surce_svg.svg"" />"
"<img src=""7fde
7994847c60857b29334d85b4be114379bfb5_
mCMFJzr.ng"" />"
"<img src="" s
e-340767000232390.jg"" />"
Nerve Fibers l yer ( xns f g n
glin cells)<div>g nglin cell l yer</div><div>Inner lexifrm l yer</div><div>I
nner nucle r l yer</div><div>Ou
er Plexifrm l yer</div><div>Ou
er Nucle r L yer
</div><div><b>Ou
er limi
ing membr ne</b></div><div>Inner nd u
er segmen
s f
rds nd cnes</div><div>Pigmen
ed ei
helium</div>
"<img src="" s
e-1052266987874.jg"" />"
ulcer
in: lss f surf ce ei

helium
"<img src="" s
e-1078036791785.jg"" />"
celluli
is: diffuse infl mm
in
f sf

issues
Wh
re sys
emic effec
s f infl mm
in (2) "<img src="" s
e-1120986464745.
jg"" />"
Wh
re 4 w ys he ling c n c use mre injury? "<img src="" s
e-1163936137706.
jg"" />"
"<img src="" s
e-1189705941521.jg"" />"
Gr nnul
in Tissue: lse edem
us
issue wi
h sm ll bld vessels, few chrnic infl mm
ry cells, nd fibrbl
s
s
Wh
re 3 cl sses f chlinergic n
gnis
s? Musc rinic blckers (PNS)<div>G
nglinic blckrs (nic
inic)</div><div>Neurmuscul r junc
in blckers (nic
ini
c)</div>
A
rine, scl mine r glycyrll
e c n be used reer
ively fr wh
re s
reduce secre
ins (inhibi
M3)
n?
Org nhsh
e isning c n be
re
ed wi
h wh
?
P m r
rine
Hw d yu
ermin
e
he effec
s f succinylchline f
er surgery?
I
h s
h lf life f &l
;1 minu
e s jus
sur

ien
nd w i

Wh
is
he nly clinic lly useful del rizing nmj blcker?
succinylchline
Wh

re
men
is given fr m lign n
hyer
hermi ?
d n
rlene: blcks rele
se f c lcium fr SR nd reduces muscle
ne nd he
rduc
in<div><br /></div
><div>Agressive cling wi
h ice  cks</div>
Wh
des b
x d? Wh
3
hings is i
clinic lly used fr?
reven
s rele se
f ce
ylchline<div>1.fc l dys
ni </div><div>2. s
r bismus</div><div>3. cerv
ic l dys
ni </div>
Wh
re yu given
eye dc
rs ffice s
h
he c n me sure refr c
ive errr
?

rine-cyclegic eye dr<div><br /></div><div>Temr rily  r lyzes
cili ry muscle
 inhibi
ccmd
in. Lens c n n lnger ch nge i
s sh e. N
bili
y
 u
fcus-
hen yu c n me sure refr c
ive errr</div>
"<img src="" s
e-6962141987305.jg"" />"
This slide is frm liver wi
h
s
e
sis. The slide is
mix
ure f <b>ink cells wi
h rund nuclei </b> nd cle
r s ces (v cules). Sm ll red nucle
e cells re seen be
ween m ny f
he cel
ls. These re red bld cells in
he sinusids. I
is n
cle r whe
her
he cle
r s ces re in cells r ex
r cellul r, bu
in sme re s
he cle r s ce is dj
cen


nucleus.
"<img src="" s
e-7022271529733.jg"" />"
This slide is frm
he skin in

ien
wi
h GVHD. &nbs;Abu
h lf
he slide is l vender nd h lf is ink. The in
k m
eri l m y h ve sme fibers (line r rr ngemen
). There re sc

ered d rk d

s (cell nuclei). The l vender re is cmsed f cells in n rderly rr ngem
en
. They h ve ink (n
s ink s
he 
her re ) cy
l sm nd rund
 v l
nuclei. Sme cells in
he l vender re h ve h ls r s ces rund
hem, nd s
me cells h ve sm ll nucleli. In
he cen
er f
he slide
here re
w very ink
, shrunken (sm ller
h n
he surrunding cells) cells wi
h very d rk nuclei.
"<img src="" s
e-7185480286976.jg"" />"
<div>This slide is frm liver wi

h hydric ch nge (cludy swelling). H lf f
he slide cn
ins cells (lygn
l) wi
h <b> bund n
gr nul r ink cy
l sm nd sm ll rund nuclei, gener lly in

he cen
er f
he cell. </b>This is
he  r
f
he slide m rked wi
h n N. In
h
e  r
wi
h n H
he cells re l rger, swllen, cle r (wi
hu

he gr nul r ink q
u li
y) wi
h simil r bu
m ybe sligh
ly sm ller nuclei.</div><div><br /></div>
"<img src="" s
e-7224134992185.jg"" /><img src="" s
e-7237019894073.jg"" />"
"<img src="" s
e-7271379632896.jg"" />"
<div>This is
crss sec
in f
lung wi
h l rge c se
ing gr nulm . &nbs;The nrm l
issue is d rk nd sng
y in e r nce. There is l rge, rund,  le re resen
. The cen
r l r
in
f
his  le re h s cheesy e r nce i
is n
liquid r slid, bu
cn
ins
crumbling m
eri l.</div><div><br /></div>
"<img src="" s
e-7310034338560.jg"" />"
This is
crss sec
in f he r

shwing righ
nd lef
ven
ricles nd in
erven
ricul r se
um. There is n re
f cu
e inf rc
(c gul
ive necrsis) in
he n
erir-se
l regin. &nbs;Th
e u
er erime
er f
he he r
is cvered by
rim f yellw
issue (eic rdi l
f
). The muscle w ll is red,
he w ll f
he lef
ven
ricle is
hicker
h n
he

righ
. In
he w ll f
he lef
ven
ricle, ex
ending in

he se
um
here is n
re f yellw-gr y-
n
issue.
"<img src="" s
e-7340099109632.jg"" />"
<div>This is
br in crss sec
i
n frm 
ien
wh h d rem
e s
rke wi
h reslved liquef c
ive necrsis (j
us
cys
ic s ce lef
). &nbs;One side e rs
 h ve nrm l grey nd whi
e m


er. The 
her side is dis
r
ed,
here is lss f br in subs
nce nd s ce
rem ins. Sme grey lbul r m
eri l is resen
n
he surf ce ver
he cys
, n
d sme brwn m
eri l (?hemrrh ge) is seen in
he c vi
y.</div><div><br /></div
>
"<img src="" s
e-7378753815296.jg"" />"
This slide shws
w crss sec
i
ns f kidney wi
h eriher l necr
ic re (inf rc
) n e ch iece. &nbs;B

h sec
ins f kidney re simil r shwing gd dem rc
in f
he cr
ex nd medu
ll . In
he cr
ex
ne end, n b
h sec
ins,
here is well circumscribed
re
h
is sligh
ly  ler
h n
he nrm l cr
ex. This re is surrunded by
d rk brder.<div><br /></div><div><div><br /></div><div>Bld vessels bleed u

in
 surrunding re . In lms
ll inf rc
s yu ge
d rk rim rund
he necrs
ed re </div></div><div><br /></div>
"<img src="" s
e-7421703488145.jg"" />"
This is
crss sec
in f lung
wi
h n inf rc
(c gul
ive necrsis). In
his l b we re emh sizing
he necr

ic re r
her
h n
he hemdyn mic rblem f ulmn ry emblus). &nbs;Yu
c n see
he hil r vessels nd brnchi in
he cen
er. There is

ri ngul r r we
dge sh ed d rk red-brwn re in ne  r
f
he lung. The res
f
he lung sur
f ce is
n-brwn-reddish in clr nd lks sngier
h n
he d rk
ri ngul r re
.
"<img src="" s
e-7460358193860.jg"" />"
<div>This slide shws fllicul r
cell hyerl si f
he
hyrid. There re irregul r cle r s ces lined by cell
s
h
re re

y simil r in e r nce (squ re ink cells wi
h rund urle nuc
lei). Finger-like rjec
ins f
hese cells r
rude in

he s ces in sme r
e s. The s ces re fllicles f
he
hyrid, sme gr nul r ink m
eri l is see
n in sme f
he fllicles (cllid). Nrm lly
he fllicles re rund lined wi

h single l yer f cubid l cells.</div><div><br /></div>
"<img src="" s
e-7499012899196.jg"" /><div><img src="" s
e-7511897801083.jg"
" /></div><div><img src="" s
e-7524782702956.jg"" /></div><div><br /></div><di
v>Wh
is differen
bu

he bnrm l sec
in f liver?</div><div><br /></div><
div>Wh
is
his rcess c lled?</div><div><br /></div><div>Is
his rcess reve
rsible r irreversible</div><div><br /></div><div>Wh
s
in is used?</div>"
bnrm l liver is  ler in clr, mre yellw<div>F

y ch nge</div><div>reversi
ble</div><div>Oil Red O</div>
"<div>60 ye r ld fem le
ER wi
h subs
ern l  in</div><div>T chyc rdi , nxius<
/div><div>C rdi c enzymes elev
ed</div><div>EKG cnsis
en
wi
h cu
e MI</div><
div><img src="" s
e-7606387081591.jg"" /></div><div><img src="" s
e-761927198
3463.jg"" /></div><div><br /></div><div><img src="" s
e-7675106558335.jg"" />
</div><div><br /></div><div>Why re c rdi c enzymes elev
ed?</div><div><br /></
div><div>Is
his d m ge reversible r n
?</div>"
injury
 myc rdi l cel
ls<div><br /></div><div>irreversbile: d m ge
 membr ne in
egri
y</div>
"<div>48 ye r ld m n wi
h lng-s
nding his
ry f rly cn
rlled hyer
ensi
n</div><div>BP = 210/160</div><div>EKG lef
ven
ricul r enl rgemen
</div><div><
img src="" s
e-7713761263991.jg"" /></div><div><br /></div><div><img src="" s

e-7726646165888.jg"" /></div><div><br /></div><div>Wh
is
his rcess c lled
?</div><div><br /></div><div>Wh
c uses
his d 
ive rcess?</div>" Hyer
r
hy<div><br /></div><div><div>Incre sed bld ressure LV wrk h rder; when musc
le wrks g ins
resis
nce i
ge
s l rger (s me ccurs wi
h skele
l muscles n
d weigh
lif
ing)</div></div><div><br /></div><div><br /></div>
"<img src="" s
e-7825430413694.jg"" /><div>EM liver cell</div><div><br /></div
><div>Lef
: Mi
chndri </div><div>Middle: SER</div><div><br /></div><div>34 y/
n henb rbi
l</div><div><br /></div><div>Wh
is
he rcess</div>" Hyer
r
hy
"<div>35 ye r ld fem le fever, cugh, bld-
inged su
um</div><div>Fever</div>
<div>CXR mul
ile lung ndules, hil r den
hy</div><div><img src="" s
e-7881
264988550.jg"" /></div><div><br /></div><div>Wh
is
he rcess</div><div>Wh

is ssible e
ilgy?</div>" C seus necrsis<div><br /></div><div>TB f fung

l infec
in</div>
"<div>36 ye r ld fem le wi
h his
ry f lchl buse</div><div>ER severe midli
ne bdmin l  in</div><div>Abdmin l
enderness & m; gu rding</div><div>Elev

ed myl se & m; li se</div><div><img src="" s
e-7971459301751.jg"" /></div><
div><img src="" s
e-7984344203627.jg"" /></div><div><br /></div><div>Is
his 
rcess reversible r irreversible?</div><div>Where des
he myl se nd li se c
<div>Ques
in 2 : Is
his rcess reversible r irrevers
me frm?</div>"
ible?</div><div>Irreversible necrsis is irreversible</div><div><br /></div><div
>Ques
in 3 : Where des
he myl se & m; li se cme frm?</div><div>D m ged 
ncre
ic cin r cells cn
in
hese enzymes nd wi
h cell de
h
hey re rele s
ed in

he bld</div><div><br /></div>
"<img src="" s
e-8022998909170.jg"" />"
Grss c lcific
in f r
ic v
lve
"<img src="" s
e-8057358647566.jg"" />"
micrscic c lcific
in f kid
ney
ubules
"<div>80 ye r ld fem le hsi
lized wi
h righ
hi fr c
ure</div><div>Swelling
& m;
enderness in righ
c lf</div><div>2 d ys l
er cu
ely shr
f bre
h</
div><div><img src="" s
e-8087423418712.jg"" /></div>" C gul
ive necrsis
"<div>38 ye r ld m n wi
h rgressive  in n w lking, fr 3 mn
hs</div><div>P
in relieved by res
</div><div>His
ry f di be
es melli
us, cig re

e smking</
div><div>Presen
s
 ER wi
h  in in righ
f
nd skin ch nges</div><div><br /
></div><div><img src="" s
e-8211977470326.jg"" /></div><div><br /></div><div>W
h
is
his rcess c lled</div><div>Wh
is
he micrscic er nce</div><div
>Wh
c used
his 
ien
s leg  in</div><div>Wh
f c
rs m y h ve influced
he
bld suly
 his legs?</div><div><br /></div>"
<div>Ques
in 2 : Wh
i
s
his rcess c lled?</div><div>G ngrene</div><div>Ques
in 3 : Wh
is
he mic
rscic e r nce f
his lesin?</div><div>C gul
ive necrsis</div><div>Que
s
in 4 : Wh
c used
his 
ien
s leg  in (relieved by res
)</div><div>Ischemi
c used
he  in, when he s
ed w lking
he muscles h d
 erfrm less wrk
s
he degree f ischemi w s minimized</div><div><div>Ques
in 5 : Wh
f c
rs
m y h ve influenced
he bld suly
 his legs?</div><div><br /></div><div>Di
be
es melli
us ssci
ed
hersclersis
bld suly</div><div>Cig re

e smk
ing v scns
ric
in in sme 
ien
s</div></div><div><br /></div>
"<div>65 ye r ld fem le h d s
rke 6 mn
hs g</div><div>She died f resir

ry f ilure</div><div>Au
sy erfrmed</div><div><img src="" s
e-877032321881
2.jg"" /></div><div><div>Ques
in 2 : Wh
w s
he ini
i l 
hlgic rcess?<
/div></div><div><br /></div>" <div>Ques
in 2 : Wh
w s
he ini
i l 
hlgi
c rcess?</div><div><br /></div><div>Liquef c
ive necrsis wi
h
ime
he necr

ic m
eri l h s been remved, le ving
cys
ic c vi
y</div><div><br /></div>
"<div>9 ye r ld by wi
h cu
e myelgenus leukemi </div><div>Tre
ed wi
h bne
m rrw
r nsl n

in</div><div>Develed di rrhe nd skin r sh</div><div><im
g src="" s
e-8817567859072.jg"" />Ques
in 2 : Wh
is
he rcess in
he rev
ius slide?</div><div><br /></div>"

sis
Hw des DNA bre kdwn differ in 
sis nd necrsis " 
sis: in
ernucles
m l cle v ge ""l dder 

ern""<div><br /></div><div>necrsis: r ndm nucle r b
re kdwn ""sme r 

nern""</div><div><br /></div><div><img src="" s
e-88476326
30300.jg"" /></div><div>A: cn
rl</div><div>B: 
sis</div><div>C: necrsis
</div>"
"<div>28 ye r ld m le wi
h igmen
ed lesin n fre rm (resen
fr ye rs)</div
><div>Lesin remved by derm
lgis
(bec use f fe r f skin c ncer)</div><div
><img src="" s
e-8886287335792.jg"" /></div><div><img src="" s
e-889917223768
3.jg"" /></div><div><br /></div><div>Wh

ye f igmen
is seen in
hese cell
s?</div><div>Hw d yu iden
ify
his igmen
</div>"
mel nin<div><br /></div>
<div>fn
n m ssn</div>
"<img src="" s
e-9028021256538.jg"" />"
squ mus me
l si <div><br /></
div><div>chrnic cervici
is: cervix ges frm clumn r
 squ mus</div>
"<img src="" s
e-9148280340850.jg"" />"
c gul
ive necrsis f kidney
"<img src="" s
e-9191230013796.jg"" />"

sis ccuring in endme
riu
m.<div><br /></div><div>rlifer
ive h se, bu
n
en
ering secre
ry h se</d

iv>
"<img src="" s
e-9234179686763.jg"" />"
Liver, irn s
in, hem chrm
s
is
"<img src="" s
e-9268539425109.jg"" />"
fibrinid necrsis
"<div>72 ye r ld m n ches
 in</div><div>Hsi
lized</div><div>C rdi c rres

n 3rd hsi
l d y</div><div>Au
sy</div><div><img src="" s
e-10561324581235
.jg"" /></div><div><img src="" s
e-10574209483136.jg"" /></div><div><br /></d
iv><div><div>Describe
he s
es
h
neu
rhils
ke
 ge
frm bld (Im ge 1
)

he injured myc rdium (Im ge 2)</div></div><div><br /></div>"
"<img sr
c="" s
e-10591389352339.jg"" />"
"<div>55 ye r ld wm n
ER c/ fever, chills, cugh, shr
ness f bre
h</div><d
iv>Fever - 102F,
chyne , r les, dullness
 ercussin RLL & m; LUL</div><div
>L b leukcy
sis wi
h lef
shif
nd gr m si
ive ccci su
um</div><div>CXR i
nfil
r
es in RLL & m; LUL</div><div><img src="" s
e-10630044057858.jg"" /></
div><div><img src="" s
e-10642928959870.jg"" /></div><div><img src="" s
e-106
55813861760.jg"" /></div><div><img src="" s
e-10711648436653.jg"" /></div><di
v>Wh
is
he c use f
he eriher l bld leukcy
sis nd lef
shif
?</div><d
iv><br /></div><div>Rel
e
he clinic l signs nd sym
ms

he infl mm 
yr 
rcess nd infl mm
ry medi
rs resnsible</div><div><br /></div><div>Wh
is

his rcess c lled?</div><div><br /></div><div>Wh
re
he ssible u
cmes
fr n cu
e infl mm
ry rcess?</div>"
Il1-TNF incre se rele se f leuk
cy
es frm bne m rrw in cu
e infl mm
in<div><br /></div><div>Fever nd Chi
lls: IL-1, IL-6, TNF</div><div><br /></div><div>Prs
gl ndins (PGE2): rm
e f
ever</div><div><br /></div><div>Cugh nd SOB: due
 fluid in irw ys/ lveli</
div><div><br /></div><div>Acu
e infl mm
in f
he lung: neumni </div><div><b
r /></div><div><div>Cmle
e reslu
in</div><div>Abscess frm
in</div><div>He
ling by fibrsis (sc rring)</div><div>Prgressin
 chrnic infl mm
in</div>
</div><div><br /></div>
"<div>45 ye r ld fem le lng his
ry f RUQ  in r di
ed
 R sc ul ; severe,
ching, ressure-like, s
e dy</div><div>P in l s
ed sever l hurs, +/- n use </
div><div>Accm nied f

y me ls</div><div>N sym
ms be
ween eisdes</div><di
v>US mul
ile g ll s
nes,
hick GB w ll</div><div><br /></div><div><br /></div>
<div><img src="" s
e-10866267259279.jg"" /></div><div><br /></div><div><img sr
c="" s
e-10896332030403.jg"" /></div><div><img src="" s
e-10909216932128.jg"
" /></div><div><img src="" s
e-10922101833969.jg"" /></div><div><img src="" s

e-10934986736043.jg"" /></div><div><br /></div><div><div>Ques
in 1</div><div>
B sed n
his 
ien
s his
ry nd US ex m, des she h ve cu
e r chrnic chlec
ys
i
is? Why?</div></div><div><br /></div><div><div>Ques
in 2</div><div>Describ
e
he grss e r nce (cm re wi
h nrm l g ll bl dder - Im ge 10) f
his 

ien
s g ll bl dder (Im ge 12) Wh
fe
ures sur
yur di gnsis f cu
e r ch
rnic chlecys
i
is?</div><div><br /></div></div><div><br /></div><div><div>Ques

in 3</div><div>Describe
he micrscic fe
ures f
his g ll bl dder. (Im ges
14-17)</div></div><div><br /></div><div><br /></div>" <div>Sym
ms fr
lng
erid f
ime</div><div>Thick GB w ll (fibrsis)</div><div>Sugges
s chrnic in
fl mm
in</div><div><br /></div><div><br /></div><div><div><br /></div><div>G l
l bl dder w ll is much
hicker (fibrsis),
here e r
 be l rge s
nes in
h
e lumen.</div></div><div><br /></div><div><div>The w ll is
hicker,
here is m
rked infl mm
ry infil
r
e f chrnic infl mm
ry cells bene
h
he ei
heli
um. Belw
he infl mm
in is dense fibrsis.</div></div><div><br /></div><div>C
hrnic infl mm
in ch r c
erized by:</div><div>1) m crh ges, l sm cells, ly
mhcy
es</div><div>2) fibrsis</div><div>3) m s
cells nd esinhils</div><di
v><br /></div>
Hw d yu differen
i
e l sm cell? "<img src="" s
e-11003706212607.jg"" /
>"
"<img src="" s
e-11038065951208.jg"" />"
"<img src="" s
e-11072425689307.jg"" />"
green: neu
rhil<div>blue: m cr
h ge (mncy
e)</div><div>red: esinhil</div><div>yellw:b shil</div><div>
bl ck: lymhcy
e</div>
"<div>8 ye r ld by fever, shr
ness f bre
h</div><div>PH recurren
b c
eri l
infec
ins neumni , 
i
is medi </div><div>PE fever 102F, r les in RLL</div><d

iv>CXR RLL infil
r
e</div><div>L b WBC wi
h lef
shif
; bld & m; su
um cu
l
ures = S. ureus</div><div>Tre
ed infil
r
e slw
 cle r lung bisy</div><
div>Referred fr leukcy
e func
in
es
s</div><div><img src="" s
e-11162620002
735.jg"" /></div><div><br /></div><div><br /></div><div><img src="" s
e-111755
04904642.jg"" /></div><div><br /></div><div><div>Ques
in 1</div><div>Describe

he micrscic fe
ures f
he lung bisy (Im ges 25 & m; 26)</div><div><br /
></div><div><div>Ques
in 2</div><div>Hw des
his resnse differ frm
h
se
en in nrm l hs
wi
h
his rg nism?</div><div><br /></div></div><div><div>Qu
es
in 3</div><div>Wh

ye f leukcy
e func
in defec
migh
be resnsible f
r
he 
hlgic findings seen in
his 
ien
? (
hink why yu ge
gr nulm
u
s infl mm
in)</div><div><br /></div><div><br /></div></div><div><br /></div><d
iv><br /></div></div><div><br /></div>" <!-- nki-->There e rs
 be gr nul
m
us
ye f infl mm
in in
he lung<div><br /></div><div><br /></div><div>In
nrm l individu l yu wuld exec
n cu
e infl mm
ry resnse
 S. ureu
s</div><div><br /></div><div>Yu ge
gr nulm
us infl mm
in when yu h ve
r
uble killing n rg nism rdin rily S. ureus is e sy
 kill s yu migh
sus
ec
killing defec
; 
her leukcy
e func
in defec
s invlve migr
in r chem

c
ic defec
s.</div><div><br /></div><div><div>chrnic gr nulm
us disrder: d
n
h ve NADPH xid se: dn
h ve xid
ive burs
.</div><div><br /></div><div>s

hey c n
kill very well</div></div><div><div><br /></div><div>chrnic s

e: e
riher l cuff f lymhcy
es</div><div><br /></div><div>seci l frm f infl mm

in: gr nulm </div><div><br /></div><div>
ye f chrnic infl mm
in</div><di
v>ei
heliid his
icy
es (h ve inker cy
l sm): c
iv
ed m crh ges</div>
<div>gi n
cells</div><div>cuff f lymhcy
es</div><div><br /></div><div>Is i

c se
ing r n
?</div><div><br /></div><div><br /></div><div>
his is lung
issu
e nd lveli</div><div><br /></div><div>d rker re (lymhcy
es)</div><div>ins
ide is  le re (ei
hleid his
cy
es)</div><div>3 gi n
cells</div></div><div
><br /></div><div><br /></div>
"<div>As  r
f
he wrk-u f
his 
ien
, Ni
rblue Te
r zlium (NBT)
es

w s erfrmed (Im ges 27 & m; 28)</div><div><img src="" s
e-11265699217696.j
g"" /></div><div><img src="" s
e-11278584119542.jg"" /></div><div><br /></div>
<div><div>Bld frm 
ien
+ yellw dye &nbs;- dye
ken u by neu
rhils</d
iv><div>In nrm l ersn
he dye is reduced

blue 
(frm z n) (Im ge 28)<
/div><div>If xygen r dic ls re n
rduced ( s in CGD)
here is n clr ch n
ge (Im ge 27)</div><div>Defec
in CGD = mu

ins in genes fr NADPH xid se whi
ch gener
es suerxide</div></div><div><br /></div>"
"<div>81 ye r ld m le he d che, fever, cnfusin</div><div>PE fever (102F), s
if
f neck</div><div>LP elev
ed ressure wi
h cludy fluid; &nbs; WBCs, r
ein,
g
lucse; gr m + ccci seen n Gr m s
in</div><div>Desi
e IV n
ibi
ic
her y,

he 
ien
died n
he secnd hsi
l d y</div><div><br /></div><div><br /></
div><div><img src="" s
e-11321533792631.jg"" /></div><div><br /></div><div><im
g src="" s
e-11334418694523.jg"" /></div><div><div>Ques
in 1 Describe
he gr
ss e r nce f
he br in
u
sy (Im ge 29)</div><div><br /></div></div><di
v><div>Ques
in 2 Describe
he infl mm
ry infil
r
e seen in Im ge 30.</div><d
iv><br /></div><div><br /></div><div><br /></div><div>Ques
in 3 Hw wuld yu c
h r c
erize
his infil
r
e wi
h l rge numbers f neu
rhils nd
high r
ein
cn
en
?</div><div><br /></div></div><div><br /></div><div><br /></div>"
<br /><div>Answer
he meninges re cludy wi
h cre my, yellw-
n m
eri l vis
ible in
he sub r chnid s ce</div><div><br /></div><div>Answer
he cells rese
n
re m inly neu
rhils</div><div><br /></div><div>Answer i
is n exud
e</di
v>
"<img src="" s
e-11398843203992.jg"" /><div><br /></div><div>In
his c se, why
is
he resence f neu
rhils indic
ive f chrnic infl mm
in?</div>"

ien
h s h d &nbs;UC fr lng
ime.<div><br /></div><div>Injury
 cln l
ks like new injury e ch
ime, s neu
rhils ( cu
e infl mm
in) ccurs firs

</div>
"<img src="" s
e-11527692222852.jg"" /><div><br /></div><div><img src="" s
e11540577124736.jg"" /></div><div>Lymhc
es in liver</div>"
Chrnic infl mm

in: he
i
is
"<div>25 ye r ld fem le wi
h SOB, cugh, bnrm l ches
x-r y, fever, & m; r

hri
is</div><div><img src="" s
e-11579231830408.jg"" /></div>"

S rcid
sis
"<img src="" s
e-11574936863112.jg"" /><div><br /></div><div>In s rcidsis, d
 yu see eriher l cuff f lymhcy
es?</div><div><br /></div><div>Wh
sym
S rcidsis:
ye f gr nulm frm
in

ms d yu
yic lly see?</div>"

h
is nn c se
ing<div><br /></div><div>N</div><div><br /></div><div><b>SOB
, r
hri
is</b> : bc yu
yic lly see s rcidsis in lung nd synvi l jin
s</
div>
"<img src="" s
e-11733850653008.jg"" /><div> bnrm l lyssme</div>" Chedi k
Hig shi Syndrme
Wh
re
he differen
cmnen
s f
he lens? Wh
is e ch l yer m de u f/wh
"An
erir nd s
erir c sule (
ye IV cll gen nd
h

ges n
here?
ick BM)<div>An
erir ei
helium<br /><div>An
erir nd s
eirr cr
ex</div><di
v>Equ
r: ei
heli l cells differen
i
e
equ
r in
 lens fbiers</div><div>
Nucleus</div><div><br /></div><div><img src="" s
e-12962211299648.jg"" /></div
></div>"
Lens ccun
s fr _____ f eyes 
ic l wer 1/3 (+20D)
Wh
re lens fibers? highly differen
i
ed ei
heli l cells wi
h n nuclei, 
rg nelles, nd cy
l sm is filled wi
h crys
llins
Crne ccun
s fr ________ f 
ic l wer 2/3
"<img src="" s
e-13052405612905.jg"" />"
"<img src="" s
e-13065290514796
.jg"" />"
Wh
m kes lens cle r? "<img src="" s
e-13108240187684.jg"" />"
"<img src="" s
e-13142599926053.jg"" />"
C
r c
: n

cle r lens
Wh
de n
erir ei
heli l cells d? cn
inu lly rduce BM m
eri l which mi
gr
es s
erirly during lens fiber differen
i
in<div><br /></div><div>Thrug
hu
life, n
erir c sule cn
inues

hicken while s
erir c sule rem ins
very
hin</div>
Where re
he reservir f ei
heli l cells lc
ed?
equ
r. They re lw ys
in
he rcess f differen
i
ing frm ei
heli l cells
 lens fibers
Hw is
he lens susended?
"by Znule fibers
h


ch frm
he lens equ

r c sule

he inner nn igmen
ed cells ver
he cili ry rcess<div><br />
</div><div><img src="" s
e-14001593385433.jg"" /></div>"
Wh
re
he 2 func
ins f
he cili ry bdy? m kes humr<div>cn
r c
s
 cc
md
e lens</div>
"<img src="" s
e-14048838025611.jg"" />"
znule fibers c me lse nd lens
fell u
l ce
"Wh
gene
ic disrder is
his cmmn in?<img src="" s
e-14044543058315.jg"" /
>"
M rf ns
Wh
is c
r c

"<img src="" s
e-14177687044517.jg"" />"
"<img src="" s
e-14203456848240.jg"" /><div><br /></div><div>Wh
gene
ic dis
rder is
his c
r c
cmmnly seen in?</div>" Snwfl ke c
r c
<div><br /></d
iv><div>Dwnsyndrme</div>
"<img src="" s
e-14254996455784.jg"" /><div>Wh

ien
s h ve
his
ye f c

r c
?</div>" chris
m s
ree: my
nic dys
rhy
"Wh

ie
ns h ve
his
ye f c
rc
?<div><img src="" s
e-14289356194168.j
g"" /></div>" sunflwer: wilsns dise se: c n
me
blize cer
Why d c
r c

ien
s ge
myic shif
?
They h ve
 much wer. C
r
c
incre ses di
eric wer f
he lens (
 much si
ive)
Hw des secnd ry c
r c
frm?<div><br /></div><div>Hw is i

re
ed?</div>
"<img src="" s
e-14602888806896.jg"" />"
Bec use re
in is n ex
ensin f CNS, wh
des i
h ve?
1. bld -re
in
l b rrier<div>2. Muller cells (GFAP +) nd n lgus
 s
rcy
e</div>
Where des re
in end? Or serr

Wh
re
he 5 w ys by which neur l re
in

ches

he ic l surf ce f
he
RPE? "<img src="" s
e-14783277433086.jg"" /><div><br /></div><div><img src=
"" s
e-14796162335169.jg"" /></div>"
Where re w
er ums lc
ed in
he eye?
RPE nd end
helium f crne
Hw des re
in l de
chmen
ccur?
" s we ge, vi
reus degern
es nd begi
ns
 eel w y frm
he re
in l surf ce,
his
r c
in c n c use re
in l
e r

nd subsequen
ly re
in l de
chmen
<div><br /></div><div><br /></div><div><im

g src="" s
e-14980845928880.jg"" /></div><div><br /></div>"
Wh
re sym
ms f re
in l de
chmen
?
fl hses<div>fl
ers</div><div>c
ur
in henmenn</div><div>blurry visin</div>
"<img src="" s
e-15036680503710.jg"" />"
<div>hrseshe
e r</div><div><b
r /></div><div>vi
reus ried
bi
nd ulled
he re
in w y frm RPE</div>
"<img src="" s
e-15113989915120.jg"" />"
<div>cur
in: even
h i
s n
h
e
  r
f
he eye</div><div><br /></div><div>
he cur
in is n
he b

m 
r
f his eye</div><div>due
 re
in l
e r</div>
Wh
re 3 w ys
 view s
erir glbe "<img src="" s
e-15148349653399.jg"" /
>"
Wh
re
he 3 l ndm rks fund in direc

h lmscy "<img src="" s
e-152342
48999286.jg"" />"
Wh
re
he CN III cn
rlled cul r muscles? suerir rec
us<div>medi l rec
u
s</div><div>inferir rec
us</div><div>inferir blique</div><div>lev
r  lebr
e sueriris</div><div>circumferen
i l cili r bdy muscle</div><div>iris cns
i
c
r</div>
Is
he crne v scul r r v scul r? Where des i
receive i
s nu
ri
in frm? (
3)
Te r film<div>L
er l diffusin frm limbus v scul
ure</div><div> queu
s humr frm n
erir ch mber</div><div><br /></div><div><br /></div>
Wh
re
he 5 l yers f
he crne
ei
helium<div>bwm ns l yer</div><div>s

rm </div><div>desceme
s l yer</div><div>end
helium</div>
Wh

ye f ei
heli l cells exis
in crne ?<div>Wh
 in fibers innerv
e e
i
helium?</div> s
r
ified squ mus nn ker
inized<div>CN V1</div>
Wh
m kes u bwm ns l yer? Wh
is i
s func
in l urse? Tye 1 Cll gen,
m in
in sh e f crne
Wh
is unique bu

he rg niz
in f
he s
rm in
he crne ?
<b>Tye
1 fibers </b>secre
ed by ker
cy
es re rg nized wi
h recise fiber s cing

llw fr bslu
e
r ns rency f
he crne
Why is
he scler  que?
Fibers v ry in di me
er, s cing, direc
in li
y
, rr ngemen

Wh
m kes u Desceme
s l yer? Cll gen
ye IV
Wh
secre
es desceme
s l yer? End
helium
Wh
unique
hing des end
helium f crne h ve?
ATP drive ums
h
rem
ve H20 u
f s
rm l m
rix
 reserve erfec
s cing
h
m in
ins cren l

ic cl ri
y<div><br /></div><div>*RPE h s
hese s me ums
h
dr ws w
er
nd kees re
in

ched</div>
"<img src="" s
e-15801184682415.jg"" />"
Wh
else besides en glbe c n siedel
es
shw?
"Ei
heli l bsence r c
rne l br sin<div><br /></div><div><img src="" s
e-15835544420590.jg"" /></d
iv>"
"<img src="" s
e-15869904159020.jg"" /><div>This is
crne l ulcer: Wh
l ye
rs re ffec
ed</div>" Infec
in f crne l s
rm c uses dis rr ngeme
f fibe
rs nd ls
cl ri
y<div><br /></div><div><br /></div><div>Ei
heli l
 s
rm </
div><div><br /></div>
"<img src="" s
e-16058882720031.jg"" /><div><br /></div><div>Wh
l yers re
ffec
ed?</div>" Ei
helium: Flurcine s
ins where
here is n ei
heli l defec

<div><br /></div><div>This is n ei
heli li
is</div>
"<img src="" s
e-16093242458416.jg"" /><div>Wh
l yers re ffec
ed</div>"
<div>iece f me
l
h
wen
in
 his eye</div><div><br /></div><div>crne s

ed i
</div><div><br /></div><div>flung nd s
ed in crne </div><div><br /><
/div><div>rus
ring in crne c n be c used by freign bdy
h
si
s in crne
fr while</div><div><br /></div><div>ei
helium nd bwm ns, s
rm , invlved<
/div><div><br /></div><div>if i
 sses
hrugh decime
s (in
r cul r lesin)</d
iv>
"<img src="" s
e-16136192131314.jg"" /><div>Wh
l yers re invlved?</div>"
Bwm ns: cnic l sh e f crne <div>Decime
s: end
helium cmrmised nd ums
n lnger wrks le ding
 w
er flw nd s
rm disrg niz
in=cludy crne <
/div>
Wh
is ker
cnus? Wh
l yer is ffec
ed?
"Degener
ive dise se f crne


h
le ds
 r
rusin f crne in
 cne sh e<div><br /></div><div>Bwm ns

l yer lses in
egri
y</div><div><br /></div><div><img src="" s
e-16213501542893
.jg"" /></div>"
Wh
sign c n be used
 lk fr ker
cnus? "<img src="" s
e-16265041150428
.jg"" /><div><br /></div><div>when
hey lk dwn,
he whle eyelid r
rudes b
ec use
he crne is s cnic l in sh e</div>"
"<img src="" s
e-16299400888746.jg"" /><div>There is edem nd cludy s
rm
</div>" Fuchs end
heli l dys
rhy:<div>Lss f end
heli l cells, which cn
i
n
he ums
h
reven
s w
er frm le king u
in
 s
rm </div><div><br /></d
iv><div>If
here re n ums, w
er flws u
in
 s
rm c using cludy crne
nd edem </div>
"<img src="" s
e-17811229376972.jg"" />"
Tr chm <div><br /></div><div><d
iv>c uses bums
 grw</div><div><br /></div><div>h s fibr
ic effec
</div><d
iv><br /></div><div>eye lid cn
r c
s inw rds</div><div><br /></div><div>eyel sh
es ll rubbing u in yur eye</div><div><br /></div><div>c uses re lly b d irri


in. essen
i llly ge
sc rring
 ei
helium</div></div>
Wh
re
he s
es f crne l
r nsl n

"<img src="" s
e-18017387807210
.jg"" />"
"<img src="" s
e-18051747545463.jg"" /><div><br /></div><div>Hw is
his indic
<div>limbus is
he very

ive f rblem s
crne l
r nsl n
</div>"
edge f
he crne . nd i
des h ve vessels.&nbs;</div><div><br /></div><div>
vessels h ve grwn
w rds
he gr f
nd m de i
ll cludy</div><div><br /></di
v>
"<img src="" s
e-18094697218403.jg"" /><div><br /></div><div>Wh
is
his?</di
v>"
dwngrw
h f ei
elium f
er r di l ker
my
Wh
re
he s
es f LASIK
"<img src="" s
e-18146236826066.jg"" />"
"<img src="" s
e-18197776433482.jg"" />"
cnjunc
ivi
is
"<img src="" s
e-18592913424810.jg"" />"
subcnjunc
iv l hemrrh ge&nbs;
Wh
innerv
es
he suerir nd inferir r
ins f
he rbicul ris cculi?
The
emr l br nch f
he f ci l nerve will innerv
e
he suerir r
ins f
rbicul ris culi (uer eye lid) while
he zygm
ic br nch f
he f ci l nerve
will innerv
e
he inferir r
ins f rbicul ris culi (lwer eyelid). &nbs
;
Where is  lebr l r
in f rbicul ris culi fund? Wh
is i
resnsible f
r?
Suerifici l
 f
fund rund rbi
<div><br /></div><div>resnsible
fr ligh
blinking f eye</div>
Where is rbi
l r
in f rbicul ris culi fund? Wh
is i
s func
in?
Suerfici l

he bnes f rbi l rim<div><br /></div><div>rduces ex gger
ed
clsure f eyes</div>
Wh
des
he
rs l l
e serve s?
in
f

chmen
fr lev
r  lebr
e sueriris nd suerir
rs l muscle
Which  r
s f lev
r  lebr e sueriris re sm
h nd s
r i
ed
<div>Lev

r  lebr e sueriris ( lng wi
h i
s sm
h muscle fibers (suerir
rs l
muscle)) &nbs;

ch in
, nd re
r c
,
he suerir
rs l l
e
 en
he e
yes.</div><div><br /></div>
Wh
is
he nerve suly
 lev
r  lebr e sueriris?
Therefre, yu c
n s y
h
lev
r  lebr e h s du l nerve suly - sm
ic fibers frm III (s

r i
ed r
in) nd sym
he
ic fibers frm
he suerir cervic l g nglin (su
erir
rs l muscles)
Wh
re
he
w  r
s f
he cnjunc
iv ? Where d
hey mee
? bulb r nd  le
br l<div><br /></div><div>cnjunc
iv l frnix</div>
Exl in hw Hrners syndrme c uses 
sis nd misis <div>This si
u
in wul
d resul
frm lss f sym
he
ic nerve suly

he sm
h muscle fibers f

he suerir
rs l muscle. Als n
ice
he sligh
cns
ric
in f
he righ
u
il (misis). These re
w sym
ms ssci
ed wi
h Hrners syndrme which is r
esul
f lss f sym
he
ic nerve suly

he he d.</div><div><br /></div><di
v><br /></div><div>sym
he
ic
 sm
h suerir
rs l muscle (
sis)</div><d
iv><br /></div><div>sym
he
ic
 r di l muscles (misis)</div>
Wh
wuld h en if yu h ve
lss f sm
ic nerve suly (CN III)

he s
r
i
ed r
in f lev
r  lebr e sueriris? In ddi
in
 lss f  r sym

he
ics
 eye Cmle
e clsure f eye<div>Mydri sis (lss f PS innerv
in f

cns
ric
r muscle)</div>
Where d ms
f
he ex
r cul r muscles rise frm?
"cmmn
endinus ring<d
iv><br /></div><div><br /></div><div><img src="" s
e-61714385076668.jg"" /></d
iv>"
Wh
re
he func
ins f
he lng cili ry nerve?
"1. Gener l sensry fibe
rs frm V1<div>2. C rry s
syn 
ic sym
he
ic fibers frm suerir cervic l
g nglin
 dil
ing r di l muscle</div><div><br /></div><div><img src="" s
e-6
1843234095404.jg"" /><img src="" s
e-61856118997193.jg"" /></div>"
Wh
re
he func
ins f
he shr
cili ry nerve?
1. C rry s
syn 
ic 
r sym
he
ic nerves frm cili ry g nlgin
 cns
ric
r muscle (cns
ric
in)
nd cili ry muscle ( ccmd
in)<div>2. Gener l sensry fibers frm V1</div><di
v>3. C rry s
syn 
ic sym
he
ic fibers frm c r
id lexus (suerir cervic
l g nlgin</div>
Where d resyn 
ic  r sym
he
ic fibers
h
g
 cili ry g nlgin rise fr
CN III
m?
Wh
sinus is lc
ed n ei
her side f
he i
ui
ry fss
c vernus
Wh
nerves hi
chhike n
he u
side f
he in
ern l c r
id r
ery? where re

hey cming frm nd where re
hey ging?
"s
syn 
ic sym
he
ic fibers
frm
he suerir cervic l g nglin.&nbs;<div><br /></div><div>They jum ff

he in
ern l c r
id r
ery nd hi
chhike wi
h nerve fibers (lng nd shr
cili
ry)&nbs;
 g
 <b>glbe f
he eye </b>&nbs; nd
 <b>lev
r  lebr e sue
riris </b>(sm
h muscle: suerir
rs l muscle)</div><div><br /></div><div><i
mg src="" s
e-62161061675428.jg"" /></div>"
Wh
is
he c r
id sihn?
"The u
urn f
he in
ern l c r
id r
ery<div><
br /></div><div><img src="" s
e-62204011348388.jg"" /></div><div><br /></div><
div><img src="" s
e-62216896249997.jg"" /></div>"
Wh
nerves re lc
ed medi l

he 
ic nerve? l
er l?
N
ice hw
he l
ng cili ry nerves (br nches f
he n scili ry) re lc
ed n
he medi l side
f
he 
ic nerve while
he shr
cili ry nerves (cming frm
he cili ry g ngl
in) re lc
ed n
he l
er l side f
he 
ic nerve.&nbs;
A lesin f cr ni l nerve VI le ds
 wh
?
"<div>A lesin f cr ni l nerve
VI ( bducen
nerve) will resul
in we kness f
he l
er l rec
us muscle. As r
esul
,
he unsed c
in f
he medi l rec
us will ull
he ffec
ed eye in

n dduc
ed si
in. This im ge reresen
s lesin f
he righ
bducen
nerv
e.&nbs;</div><div><br /></div><div><img src="" s
e-62272730824818.jg"" /></di
v><div><br /></div>"
A lesin f cr ni l nerve III le ds
 wh
? (3)
<div>A lesin f cr ni l
nerve III (cculm
r nerve) will resul
in we kness f ms
f
he ex
r cul
r muscles (including lev
r  lebr e sueriris). As
resul
,
he unsed
c
in f
he rbicul ris culi &nbs;will <b>ull
he ffec
ed eye clsed </b> n
d i
m y be necess ry
 hysic lly lif

he uer eyelid
 en
he eye. &nbs
;Addi
in lly lss f
he  r sym
he
ic fibers frm III will resul
in
he un
sed c
in f
he sym
he
ic fibers nd will rduce dil
in f
he uil (
<b>mydri sis</b>). &nbs;Fin lly, since VI is s
ill c
ive,
he ffec
ed eye wil
l be ulled in
 n <b> bduc
ed si
in. </b>This im ge reresen
s lesin f

he righ
cculm
r nerve.&nbs;</div><div><br /></div>
Lesin f cr ni l nerve IV le ds
 wh
? Wh
key m rker den
es
his
rchle r
nerve lesin? "<div>A lesin f cr ni l nerve IV (
rchle r nerve) will resul

in we kness f
he suerir blique muscle. As resul
f
he unsed c
in
f inferir blique (which

ches n

he s
erir nd l
er l sec
f
h
e glbe)
he eye will be ulled in

<b>sligh
ly elev
ed nd ex
r
ed &nbs;
si
in. </b>&nbs;As resul

he im ge
h
f lls n

he re
in n
he b ck
f
he eye will be r

ed sligh
ly. As resul

he 
ien
will <b>
il

heir
he d</b> ( c
iv
ing
he ves
ibul r  r
us nd
heir cnnec
ins

he eye)
nd use
he c
ive in
rsin muscles f
he un ffec
ed eye
 cmens
e nd bri
ng b
h im ges in
 lignmen
. This im ge reresen
s lesin f
he lef

rchl
e r nerve.&nbs;</div><div><br /></div><div><img src="" s
e-62474594287725.jg"
" /></div><div><br /></div><div><img src="" s
e-31082678321815.jg"" /></div><d
iv><br /></div>"

Hw d dendri
ic cells receive imu
frm
he inv der? 1. 

ern recgni
in r
ece
rs (TLRs)<div>2. Sense cy
kine envirnmen
(cells in differen
re s f b
dy rduce ch r c
eris
ic mix
ures f cy
kines in resnse
 inv ders)</div>
Wh
re
he 2 w ys
he dendri
ic cells direc

he T cells nce
hey h ve receiv
ed imu
frm
he inv der?
1. C s
imul
ry mlecules lug in
 rece
r m
lecules n surf ce f Th (i.e. B7 in
 CD28)<div><br /></div><div>2. DCs rduc
e cy
kines which deend n
he iden
i
y f
he inv der&nbs;</div>
If
here is b c
eri l infec
in r
here is
virus, wh
cy
kines d dendri

ic cells
 ler
virgin Th cells? Wh
d
he virgin Th cells
hen rduce?
"IL-12<div><br /></div><div>TNF, IFN g mm , IL-2</div><div><br /></div><div><img
src="" s
e-114808770789620.jg"" /></div>"
Wh
re
he 3 Th1 cy
kines? Wh
d
hey e ch d?
"TNF: Ac
iv
es m crh
ges, NK cells<div><img src="" s
e-114860310397203.jg"" /></div><div>IFN g mm :
c
iv
es m crh ges, influces B cell during cl ss swi
ching
 m ke IgG3</div
><div><br /></div><div>IL-2: s
imul
es NK cells
 rlifer
e, ls serves s
grw
h f c
r fr CTL, Th1 cells</div><div><br /></div>"
Wh

ye f heler Cells will be s
imul
ed if yu encun
er  r si
e r b c

eri in yur in
es
ine? Th2 Heler cells
If yu re infec
ed by r si
e r e
fd
h
is cn
min
ed by b c
eri , w
h
cy
kine des yur dendri
ic cell rduce
 s
imul
e virgin heler T cells
?
"<img src="" s
e-115010634252537.jg"" /><div>IL-4</div>"
Wh
des IL-4 d? (2) Grw
h f c
r fr Th2 cells<div>Grw
h f c
r fr B cell
s: cl ss swi
ch
 rduce IgE</div>
Wh
re
he 3 Th2 cy
kines? Wh
re
hey e ch imr
n
fr? 1. IL-4: grw
h
f c
r, swi
ch
 m ke IgE<div>2. IL-5: encur ge B cells
 rduce IgA</div><d
iv>3. IL-13: s
imul
es rduc
in f mucus in
he GI sys
em</div>
Wh
des IL-13 d?
S
imul
es rduc
in f mucus in
he in
es
ines, reven

s mre in
es
in l b c
eri r  r si
es frm bre ching in
es
in l w ll
Wh
des IL-5 d?
Encur ge B cells
 rduce IgA
Wh
heler T cells re c
iv
ed in
he c se f fung l infec
ins?
Th17 cel
ls
Wh
cy
kines d dendri
ic cells secre
e in resnse
 fung l infec
ins?
"<img src="" s
e-115264037323017.jg"" /><div><br /></div><div>TGFbe
nd IL-6
</div>"
Wh
cy
kines d Th17 cells rduce? Wh
re e ch f
hese imr
n
fr?
IL-17: recrui
m ssive number f neu
rhiles<div>IL-21: grw
h f c
r fr Th17
cells</div>
If 
ien
s h ve
gene
ic defec
in IL-17 secre
ins, wh
d
hey suffer frm?
fung l infec
ins (IL-17 is imr
n
fr recrui
men
f neu
rhils
 defend
g ins
fungi nd ex
r cellul r b c
eri )
Wh
re Th0 cells?
subse
f Th cells
h
rem in uncmmi

ed. They knw wh
ere
 g bu
w i

 survey
he cy
kine envirnmen
f
he b

le befre diffe
ren
i
ing in
 secific heler T cells
h
rduce secific
yes f cy
kines
If Th0 cells sense
l
f IL-12 wh
d
hey differen
i
e in
?<div><br /></d
iv><div><br /><div><br /></div><div>IL4?</div><div><br /></div><div><br /></div>
<div>IL6, TGFbe
?</div></div><div><br /></div> "<br /><div><div><img src="" s

e-115491670589684.jg"" /><br /><div>Th1 cells
h
re lre dy
here figh
ing b
c
eri rduce IFN g mm which rm
es m crh ges
 rduce TNF which induce
s i
self
 rduce IL-12. IL-12 rm
es NK nd TH1
 m ke mre IFN g mm s w
ell s
ell Th0
 becme Th1 cell</div><div><br /></div><div>IL4?</div><div><
img src="" s
e-115504555491577.jg"" /></div><div><br /></div><div>IL6, TGFbe

?</div></div><div><img src="" s
e-115517440393481.jg"" /></div></div>"
DEscribe si
ive feedb ck in
erms f lcking
he heler T cell rfile
Once heler T cells cmmi


 r
icul r rfile,
hey begin
 secre
e grw
h
c
rs
h
re secific fr
heir cell
ye&nbs;<div><br /></div><div>1. IL-2
, IFN-g mm </div><div>2. IL-4</div><div>3. IL-21</div>
Hw d Th1 cells decre se rflifer
in f Th2 cells? IFN g mm m de by Th1 in
bhi
s Th2 cells
Hw des Th2 cells inhibi
Th1 cells? IL-10 rduced by Th2 reduces Th1 cell 
rlifer
in

T/F cy
kines h ve very limi
ed r nge T:
hey c n
r vel nly shr
dis
nces
Exl in hw si
ive TB skin
es
ccurs
1. if yu h ve c
ive TB r h ve
been infec
ed in
he  s
, immune sys
em includes memry, Th1
ye heler T cel
ls<div>2. Th cells recgnize TB fr gmen
s nd secre
e <b>IFN g mm nd TNF</b></
div><div>2. IFN g mm c
iv
es m crh ges</div><div>3. TNF recrui
s neu
rhil
es nd c
iv
es m crh ges nd NK cells</div><div>4. Resul
n
redness nd swe
lling ensues</div>
Wh

w mleclues re cruci l fr CTL killing c
in? erfrin nd gr nzyme B
Wh
re
he 2 w ys CTL c n kill
rge
cell Perfrin delivers Gr nzyme B, wh
ich
riggers 
sis<div><br /></div><div>CTL F sL binds
 F s r
ein n
r
ge
surf ce nd
riggers 
sis</div>
Wh
re lymhid fllicles m de &nbs;u f? "lse ne
wrks f fllicul r de
ndri
ic cells embedded in B cells<div><img src="" s
e-117304146788606.jg"" /><
/div>"
Hw re fllicul r dendri
ic cells differen

h n dendri
ic cells?
Dendri
i
c cells re
sen
inel cell<div>FDCs
ke
heir l ce in lymhid rg ns</div><d
iv><br /></div><div>dendri
ic cells resen

 heler T</div><div>FDC resen


B cells</div>
Hw d FDCs resen

 B cells? "1. They bind <b>cmlemen
fr gmen
s</b>
h

re bund
 n
igen nd in w y becme ""Decr
ed"" wi
h n
igen<div><br /></d
iv><div>2.
hey h ve <b>Fc rece
rs</b>
h
llw snized inv ders (by n
ib
dies)


ch n
he surf ce f FDC cells</div>"
Wh
ccurs in germin l cen
er?
B cells whse rece
rs re crss linked
by
heir cg n
e n
igen (resen
ed by FDCs) nd re c
iv
ed by Th begin
 
rlifer
e c using
he fllicle
 begin
 grw
Wh
des i
me n
h
B cells rlifer
ing in germin l cen
ers re very fr gil
e?
"They mus
receive rer ""rescue sign ls"" 
her wise
hey will cmmi

suicide<div><br /></div><div>Th migr
e
 lymhid mlecule exressing CD40L

 lug in
 CD40 rece
r n B cell nd llw i

 cn
inue
 rlifer
e (c
s
imul
in)</div>"
Wh
h ens f
er B cells in germin l cen
ers re rescued by cs
imul
in by h
eler T cells? They rlifer
e, underg sm
ic hyermu
in, nd cl ss swi
ch
ing
Wh
MALT des n
h ve HEV?
sleen<div><br /></div><div><br /></div><div>MAL
T: Peyers 
ch, Sleen, Lymhnde</div>
Hw d n
igen en
er
he lymhnde? Where re
hese n
igens resen
ed
?
1) APCs-dendri
ic cells
h
en
er wi
h lymh: resen
ed
 Th<div>2) snized
ei
her by cmlemen
r n
ibdies en
er wi
h lymh: c 
ured by FDC
 disl y

 B cells</div>
Wh
re
he w lls f
he m rgin l sinus lined wi
h in
he lymh nde? Wh
is

he urse f
hese
hings?
M crh ges: reduce # f inv ders
h

he d 

ive immune sys
em will need
 de l wi
h
Where re high end
heli l venules fund wi
hin
he lymhndes?  r cr
ex
Wh
cells re lc
ed wi
hin
he  r cr
ex f
he lymhnde? T cells nd dend
ri
ic cells
Wh
h ens
 B cells nce
hey encun
er
heir cgn
e n
igen disl yed n F
DCs?
They migr
e

he brder f
he lymhid fllicle where
hey mee
c
i
v
ed T cells
h
h ve migr
ed
here frm
he  r cr
ex
Hw d APCs nd lymhcy
es knw where
 g wi
hin lymhnde nd when
 g

here? FDCs rduce chemkine CXCL13<div>N ive B cells en
er
he nde wi
h CXCL
13 rece
rs</div><div><br /></div><div>Once B cell finds cgn
e n
igen, i
d
wnregul
es CXCL13 rece
r nd uregul
es CCR7 rece
r</div><div><br /></div>
<div>CCR7 is rduced

he brder f
he lymhid fllicle. Thus B cell c n
h
en migr
e
 be c
iv
ed by Th cell (CD40 L)</div>
Which cells exress CCR7 rece
r
c
iv
ed Theler<div><br /></div><div>A
c
iv
ed B cell</div><div><br /></div><div>They migr
e

he lymhid fllicle
brder s
h

hey c n m ke cn
c
fr cs
imul
in f B cell</div>
Wh
is s
ruc
ur lly signific n
bu

he M cell
h
verlies eyers 
ches?
"N
e sily c
ed wi
h mucus, s
hey re e sily ccessible
 micrrg nisms

h
inh bi

he in
es
ine.&nbs;<div><br /></div><div>M cells enclse in
es
in l

n
igens in vesicles nd vi endsmes er
r nsr
ed in
 eyers 
ch belw<

/div><div><br /></div><div><img src="" s
e-117961276784943.jg"" /></div>"
Hw re M cells selec
ive bu

he n
igens
hey
r nsr
?
They nly
r ns
r
n
igens
h
c n bind
 mlecules n
he surf ce f
he M cell
Wh
re f
he sleen cn
ins ms
ly T cells?
"PALS<div><br /></div><d
iv><img src="" s
e-118128780509495.jg"" /></div>"
Where re n iive B cells lc
ed in
he sleen? "Regin be
ween PALs nd m rgin
l sinus<div><br /></div><div><img src="" s
e-118124485542199.jg"" /></div>"
Des
he sleen h ve lymh
ics en
ering r dr ining i
?
"N.<div><br /><
/div><div><img src="" s
e-118124485542199.jg"" /></div>"
Wh
is lc
ed in
he m rgin l sinus f
he sleen?
Residen
dendri
ic cells

h

ke u freign n
igens nd resen

hem n MHCII mlecules<div><br /></d
iv><div>r infec
ed dendri
ic cells disl y freign n
igens n MHC I mlecules<
/div>
Wh
h ens nce dendri
ic cells in
he sleen re c
iv
ed? "They migr
e


he PALS where T cells re g
hered<div><img src="" s
e-118124485542199.jg""
/></div>"
Once heler T cells in
he sleen &nbs;h ve been c
iv
ed by dendri
ic cells i
n
he m rgin l sinus, where d
hey g? "Mve
 lymhid fllicles
 c
iv
e
B cells<div><br /></div><div><img src="" s
e-118124485542199.jg"" /></div>"
Why re B cells nd T cells ke
se r
ely wi
hin lymhid rg ns?
"<img sr
c="" s
e-119129507889484.jg"" />"
Hw d Th m in
in
cns
n
level f CD40L r
eins n i
s surf ce? "Th nd
B cells eng ge in ""d nce wi
hin lymhid fllicle.<div><br /></div><div>Th
cell rvides cs
imul
in (CD40L)required
 c
iv
e B cell nd B cell rvid
es resen
ed n
igen c-s
imul
in required
 rech rge
he T cell</div><div><b
><br /></b></div><div><b>When B cells bind cgn
e n
igen,
he whle cmlex f
BCR nd n
igen is dr gged in
 cell nd cu
in
 fr gmen
s nd resen
ed by MH
C II (serving s APC). When c
iv
ed, B cells ls exress B7 n surf ce
 res

imul
e Th cells s
h
mre CD40L c n be rduced nd
r nsr
ed

he surf
ce.</b></div>"
"D n ive T cell h ve "" ssr
s""
 ge

 si
es f infl mm
in?" N.<div>
<br /></div><div>Only  ssr
s
 secnd ry lymhid rg ns,</div>
Wh
d virgin T cells h ve n
heir surf ce
h
llw
hem
 en
er
hrugh HE
Vs?
L-selec
in which binds
 GLYCAM-1 n HEVs in lymh ndes
Wh
 ssr
s
 c
iv
ed T cells h ve?
1. res
ric
ed  ssr
s
h
enc
ur ge
hem
 re
urn
 s me
ye f secnd ry lymhid rg ns s
he ne in wh
ich
hey g ined
heir exerience<div><br /></div><div>2.  ssr
s
h
llw
h
em
 exi

he bld
si
es f infec
in</div>
Once B cells re c
iv
ed nd rlifer
e in
he germin l cen
er, wh
h ens?
(3)
1. Ms
becme l sm cells nd
r vel
 sleen r bne m rrw where
h
ey rduce n
ibdies<div>2. recircul
e
 secnd ry lymhid rg ns nd mlif
y rense by being res
imul
ed nd rlifer
ing</div><div>3. g b ck
 res
in
g s

e in sleen r bne m rrw
 func
in s memry cells</div>
Under nrm l cndi
ins, wh
immune cells c
wi
h res
r in

 de l wi
h cmme
ns l b c
eri which cc sin lly en
er
he
issues frm
he in
es
ines? 1. M cr
h ges &nbs;
h
underlie
he in
es
in l w ll
h
dn
re lly give ff cy
ki
nes
 sign l full blwn

ck<div><br /></div><div>2. B cells
h
give ff
IgA n
ibdies
h
bind
 inv ding b c
eri , clum
hem, nd usher
hem b ck 
u
in

he in
es
ine</div>
Wh
cy
kine s
imul
es Th
 becme iTreg? &nbs;Where des
his cme frm?
"Ei
heli l cells
h
line
he in
es
ine rduce TGFbe
<div><br /></div><div><
img src="" s
e-130970732724445.jg"" /></div>"
Wh
d iTregs rduce? Wh
is
heir func
in l urse?
"TGF be
: binds

 T cells nd reduces
heir rlifer
in r
e<div><br /></div><div>IL-10: bin
ds
 T cells nd blcks cs
imul
ins sign ls (CD28)</div><div><br /></div><di
v><img src="" s
e-130966437757149.jg"" /></div>"
Hw des immune sys
em decide whe
her Th shuld becme Th 17 r iTreg? "If
her
e is n inv sin f b c
eri , dendri
ic cells rduce IL-6 nd TGFbe
<div><br /
></div><div><img src="" s
e-131133941481737.jg"" /></div><div><br /></div><div

>If
here is n re l d nger, dendri
ic cells dn
rduce IL-6 nd Th cells re

simly under
he influence f TGF be
frm ei
heli l
issue</div><div><br /><
/div><div><img src="" s
e-131155416318173.jg"" /></div>"
Wh
is
he firs
s
e in de c
iv
ing
he immune sys
em?
As freign n
ig
en is elimin
ed
he level f c
iv
in f
he inn
e nd d 
ive sys
em decre
ses
Wh
rece
r d APCs bind
 n virgin T cells
 reduce c
iv
in? "CTLA-4<
div><br /></div><div><img src="" s
e-131305740173621.jg"" /></div>"
Where re CD28 rece
rs lc
ed n T cells? CTLA-4?
"CD28 is disl yed n
h
e surf ce f T cells<div><br /></div><div>CTLA-4 is s
red inside T cellss. Once
T cells h ve been c
iv
ed, mre CTLA-4 is mved

he surf ce where i
u
c
me
es CD28 fr B7 binding</div><div><br /></div><div><img src="" s
e-131301445
206325.jg"" /></div>"
Hw re exerienced, lre dy c
iv
ed, n
re lly useful T cells dissed? Wh

is
his rcess c lled?
"When T cells re c
iv
ed,
hey becme incre s
ingly sensi
ive
 lig
in f
heir F s r
ein, ei
her by
heir wn F s lig nd
r
eins r by F s lig nd r
eins n 
her T cells<div><br /></div><div>Then,
""exh us
ed"" T cells becme
rge
s fr F s medi
ed killing.&nbs;</div><div><
br /></div><div>Ac
iv
in-induced cell de
h (AICD)</div>"
"<img src="" s
e-157728378978789.jg"" />"
Aqueus humr is syn
hesized by wh
? "
w l yers f ei
heli l cells n
he c
ili ry rcesses<div><br /></div><div><img src="" s
e-158205120348645.jg"" /><
/div>"
Cili ry rcesses re c ill ryr-rich nd m inly sulied by _________ m jr r

eri l circle f
he iris
Wh
jins
he <b>inner nn igmen
ed</b> nd <b>u
er igmen
ed l yers</b> f

he ei
heli l cells n
he cili ry rcess?
"<img src="" s
e-15841557374608
5.jg"" /><div><br /></div><div><img src="" s
e-158428458648048.jg"" /></div><
div><br /></div><div><br /></div><div>jined by
igh
junc
ins which frm <b>
bld queus l yer</b></div><div><br /></div>"
"<img src="" s
e-158643207012555.jg"" />"
Aqueus humr frmul
in nd secre
in in
 s
erir ch mber resul
s frm wh

3 rcesses? Ac
ive secre
in<div>Ul
r fil
r
in</div><div>Simle Diffusin<
/div>
Wh
re
he 3 urses f queus humr?
1. rvides imr
n
nurishmen

fr crne <div>2. cre
es IOP
 give glbe i
s sh e</div><div>3. Rel ce flu
id in
he vi
reus c vi
y</div>
Describe
he 
h f inflw f queus humr
"1. Angle (cili r rcess)<div>2
. s
erir ch mber</div><div>3. Thrugh Puil</div><div>4. An
erir ch mber</di
v><div><br /></div><div><img src="" s
e-158806415770085.jg"" /></div>"
Wh
re
he 2 m jr ru
es f u
flw? Which ne is ressure deenden
nd whic
h is ressure indeenden
?
Tr becul r u
flw: ressure deeden
&nbs;<div>
*ms
cmmn*<br /><div><br /></div><div>Uvescle rl u
flw: ressure indeende
n
</div><div><br /></div><div><br /></div></div>
Describe
he 
hw y f
he
r becul r u
flw "Trbecul r meshwrk<div>Schlemm
s c n l</div><div>venus sys
em</div><div><br /></div><div><img src="" s
e-1590
51228905826.jg"" /></div>"
Describe
he 
hw y f
he uvescler l u
flw "1. n
erir ch mber<div>2. cili
ry muscle</div><div>3. suercili ry nd sur chrid l s ces</div><div>4. scler
&nbs;</div><div><br /></div><div><img src="" s
e-159128538317282.jg"" /></di
v>"
Wh
venus 
hw y des queus humr
ke when exi
ing vi
r becul r u
flw?
eiscler l veins, <b> n
erir cili ry</b> nd suerir 
h lmic veins, c verns
sinus
Wh
re
he 3 l yers f
he
r becul r meshwrk?
jux
c n licul r, crne
scler l, uve l
L min l r
in f 
ic nerve is cn
inuus wi
h wh
? Wh
is i
cmsed f?
Scler : cmsed f l min cribs <div><br /></div><div>L min cribs is fenes

r
ed cnnec
ive
issue l mell e
h
rvides
he m in sur
fr
he 
ic ne
rve s i
exi
s
he eye</div>

Wh
rvides
he m in sur
fr
he 
ic nerve s i
exi
s
he eye? l min c
ribrs
Wh
h ens in en ngle gl ucm ?
Tr becul r meshwrk becmes dysfunc
in
l le ding
 incre sed u
flw resis
nce, incre sed IOP which is
r nsmi

ed

l min cribrs , nd ul
im
e de
h f nerves
h
frm CN II
"<img src="" s
e-159527970275570.jg"" />"
Lef
: nrm l cu
 disc r
i<d
iv>Righ
: Huge cu
 disc r
i (0.9) =gl ucm </div>
Wh
3 bserv
ins re yu lking fr when lking

ic nerve
clr, c
n
ur, cuing
"<img src="" s
e-159583804850528.jg"" />"
cngeni
l gl ucm . IOP is s h
igh, crne l end
heli l ums c n
kee u. W
er is frced in
 crne , c usin
g i

 lse cl ri
y
Wh
re 5 w ys
 lwer IOP
1. Mdify ANS
 slw dwn bld flw s
h
le
ss queus humr is rduced <b>( lh 1 gnis
s)</b><div>2. Slw dwn rduc
i
n f queus by ei
heli l cells ver cili ry rcess (<b>be
1 blcker, lh
2 gnis
s, c rbnic nhydr se inhibi
rs)</b></div><div>3. Induce PS misis n
d ccmd
in
 ull uve l
r c
nd en u
r becul r meshwrk <b>(M3 gnis

s/Aches
er se inhibi
rs)</b></div><div>4. Mech nic lly en
r becul r meshwr
k</div><div>5. Cre
e r
ifici l cndui

h
c rries queus humr frm n
eri
r ch mber direc
ly
 venus sys
em</div>
Wh
rece
rs re lc
ed n
he cili ry bdy? "be
1 rece
r (incre se que
us humr)<div> lh 2 rece
r (decre se queus humr)</div><div><br /></div><d
iv><img src="" s
e-160468568113639.jg"" /></div>"
Wh
d CAIs d?
"C rbnic nhydr se inhibi
rs decre se queus humr r
duc
in<div><br /></div><div><img src="" s
e-160464273146343.jg"" /></div>"
Hw c n uvescler l u
flw be incre sed?
rs
gl ndin gnis
s
Wh
is clsed ngle gl ucm ? Iris
uches lens nd blcks flw f queus hum
r frm s
erir ch mber
 n
erir ch mber
Des queus humr cn
in r
ein?
N, r
ein free ul
r fil
r
e f bld
l sm
Wh
is nrm l ressure in n
erir ch mber?
~20 mm Hg
Hw des
r becul r mesh becme d m ged?
de d cells, c gul
ed r
eins,
debris clgs exi

hrugh
r becul r mesh nd c n l f schlemm
Wh
re 7 w ys

re
en ngle gl ucm
1. Be
1 blcker<div>2. lh 2
gnis
</div><div>3. lh 1 gnis
(cns
ric
bld vessels)</div><div>4. c r
bnic nhydr se inhibi
r</div><div>5. M3 gnis
s (ilc rine)</div><div>6.Ach
es
er se inhib
rs (nes
igmine, yrids
igmine)</div><div>7. Prs
gl ndins PGF
2 lh wrk
 cns
ric
muscle nd imrve uvescler l u
flw</div>
"<img src="" s
e-161151467913675.jg"" />"
Alh 2 n
gnis

"<img src="" s
e-161177237717480.jg"" />"
A
rine
Wh
is
he difference be
ween rim ry nd secnd ry in
en
in? "Prim ry: wund
edges clsely sed, less cl

ing, less debris, less infl mm
in, less gr nu
l
in
issue, sm ller sc r <b>n wund cn
r c
in vi myfibrbl s
s</b><div><
b><br /></b></div><div>secnd ry: l rger wund, mre bld nd necr
ic debris,
l rger mun
s f gr nul
in
issue, <b>cn
r c
in by myfibrbl s
s</b></div>
<div><b><br /></b></div><div><b><img src="" s
e-21487721382180.jg"" /></b></di
v><div><b><br /></b></div><div><b><img src="" s
e-21522081120538.jg"" /></b></
div><div><b><img src="" s
e-21543555956988.jg"" /></b></div><div><b><br /></b>
</div><div><b><br /></b></div><div><b>vs secnd:</b></div><div><b><img src="" s

e-21556440858894.jg"" /></b></div><div><b><img src="" s
e-21569325760773.jg"
" /></b></div><div><b><img src="" s
e-21590800597247.jg"" /></b></div><div><b>
<br /></b></div><div><b><br /></b></div>"
Describe in de
il
he sequence f wund he ling by rim ry in
en
in 1. Incis
in<div>2. Bld/fibrin fill
he g  (ink cellul r m
eri l n surf ce)</div><
div>3. hems
sis nd sc b frm
in</div><div>4. Neu
rhils infil
r
e
 dige
s
fibrin</div><div>5. Eiderm l cells rlifer
e
 bridge
he g  (b s l l ye
r)</div><div>6. M crh ges rel ce neu
rhils</div><div>7. Gr nul
in
issue
fills
he injured re (lse edemus
issue wi
h sm ll vessel nd l
s f fibr
bl s
s)</div><div>8. Cll gen is l id dwn vi fibrbl s
s</div><div>9. Ei
heli
um is nrm lized</div><div>10. Weeks l
er: cn
inued cll gen nd fibrbl s
ic

rlifer
in</div><div>11. Mn
hs l
er: eidermis is nrm l bu
<b>derm l e

nd ges dn
regener
e</b></div><div>12. sc rring</div>
Wh
is
he difference be
ween fibrinus
issue nd fibrus
isssue?
fibrinu
s: ink, v scul r, cellul r<div>fibrus: desi
in f cll gen usu lly ssci

ed wi
h l
s f fibrbl s
s</div>
Wh
is
he micrscic e r nce f kelids? I
h s
he s me micrscic e
r nce s ny 
her sc r frm
in<div><br /></div><div>1. usu lly n derm l 
end ges</div><div>2. dense cll gen</div><div>3. verlying eidermis in
c
</div
>
Wh
re 3 medi
rs f cll gen syn
hesis?
PDGF, TGF be
, TNF
Ndul r regner
in is
yic l fr wh

ye f
issue injury? he
cy
e injur
y
Why des vir l he
i
is resul
in regner
in where s b c
eri l infec
in f

he liver le ds
 sc rring? vir l he
i
is desn

yic lly le d
 d m ge


he sur
ing cnnec
ive
issue fr mewrk.<div><br /></div><div><br /></div>
T/F gluccr
icids inhibi
wuld he ling by inhibi
ing cll gen syn
hesis
True
In
erms f wund he ling, wh

ye f cells wuld yu see rim rily n d y 1<d
iv>d y 2-3?</div><div>4-5?</div><div>secnd week?</div><div>mn
hs l
er?</div>
d y 1: fibrin, bld<div>D y 2-3: ne
ruhils, m crh ges gr nul
in
issue, e
iderm l cells rlifer
ing</div><div>D y 4-5: nev scul riz
in, cll gen l i
d dwn</div><div>secnd week: cll gen rminen
, fibrbl s
s rminen
(infl mm

in, edem , nev scul ri
y (gr nul
in) reduced)</div><div>Mn
hs: cll gen i
ncre ses, fibrbl s
s decre se, eidermis is nrm l, n derm l end ges (Sc rr
ing)</div><div><div><br /></div></div>
Wh


ches

he m s
id rcess? SCM nd s
erir belly f dig s
ric
N me in rder frm s
erir
 n
erir:<div><br /></div><div> r
icul r
ubercl
e,
ym nic l
e, m ndibulu r fss </div>
"
ym nic l
e, m ndibul r fss
, r
icul r&nbs;
ubercle<div><br /></div><div><img src="" s
e-46639049867688.
jg"" /></div>"
Wh
se r
es
he ex
ern l udi
ry me
us frm
he m ndibul r fss ? "
ym ni
c l
e (i
is mre ver
ic l)<div><br /></div><div><img src="" s
e-466390498676
88.jg"" /></div>"
Wh
exi
s

he s
ylm s
id fr men? m jr br nch f VII&nbs;
___________is deressin wi
hin
he e
rus r
in f
he
emr l bne
h

when r
icul
ed wi
h
he ccii
l bne will frm__________
"jugul r fss ;
jugul r fr men<div><br /></div><div><img src="" s
e-46763603919370.jg"" /></d
iv>"
Wh
exi
s
he e
r
ym nic fissure? Describe where
his is? "chrd
ym ni<
div><br /></div><div>medi l

he m ndibul r fss nd lies very ne r where
he
squ mus r
in f
he
emr l bne r
icul
es wi
h
he gre
er wing f
he
shenid</div><div><br /></div><div><img src="" s
e-46759308952074.jg"" /></di
v>"
Wh
CN is chrd
ym ni frm? VII
in wh
m nner des
he in
ern l c r
id r
ery crss
he fr men l cerum?
Hrizn
lly
Wh
des jugul r fr men receive dr in ge frm nd wh
CNs g
hrugh
here?
"Venus dr in ge frm sigmid sinus nd inferir e
rs l sinus<div><br /></div>
<div>CN IX, X, XI</div><div><br /></div><div><img src="" s
e-47017006989828.jg
"" /></div>"
Describe
he rigin nd 
h f gre
er e
rs l nerve. S
r
wi
h
he f ci l ne
rve
"1. F ci l nerve exi
s in
ern l udi
ry me
us<div>2. F ci l nerve
r v
els wi
hin e
rus r
in f
emr l bne</div><div>3. F ci l nerve gives rise

 <b>gre
er e
rs l nerve</b></div><div>4. gre
er e
rs l nerve will le ve
e
rus bne nd rene
er
he middle cr ni l fss

he hi
us f
he f ci l c
n l</div><div>5. Gre
er e
rs l nerve slides lng grve n
he surf ce f

he e
rus r
in
w rds
he fr men l cerum</div><div>6. gre
er e
rs l n
erve crsses fr men l cerum hrizn
lly
w rds
he 
erygid c n l</div><div>
7. gives PS innerv
in
 l crim l gl nd</div><div><br /></div><div><img src=""
 s
e-47175920779784.jg"" /></div>"

"<img src="" s
e-47214575485392.jg"" />"

Red: hi
us f f ci l c n l<div>
Yellw: Grve he ded
w rds fr men l cerum<br /><div><br /></div></div>
Middle e r c vi
y is cnnec
ed

he b ck f
he
hr
vi _______. Wh

her
s
ruc
ures is
he middle e r cn
inuus wi
h? h ryng
ym nic
ube<div><br />
</div><div>m s
id n
rum</div><div>m s
id ir cells</div>
The in
ern l e r is wi
hin &nbs;__________ nd is filled wi
h __________
"e
rus r
in f
emr l bne; fluid<div><br /></div><div><img src="" s
e-4
7382079209975.jg"" /></div>"
Which r
ins f
he ves
ibulcchle r nerve
r vel n
erirly nd s
erirly?
"An
erirly: cchle r r
in<div><br /></div><div>s
erirly: ves
ibul r r
i
n</div><div><br /></div><div><img src="" s
e-47510928228808.jg"" /></div>"
Wh
rvides sensry innerv
in

he inner e r?
Ves
iubul r nd cchle r
r
ins f VIII
Wh
3 br nches des CN VII give ff? "<img src="" s
e-47626892345800.jg"" /
><div><br /></div><div>1. gre
er e
rs l nerve</div><div>2. chrd
ym ni</di
v><div>3.
iny br nch
 s
edius musclle</div>"
Describe
he 
h f
he chrd
ym ni "I
br nches ff f CN VII nd crsses

he neck f
he m lleus<div><br /></div><div><img src="" s
e-47854525612443.jg"
" /></div>"
A

chmen
s f
ensr
ym ni? An
erir w ll f
ym nic c vi
y nd neck f m l
leus
Wh
is
he umb?
cen
r l in
f
he cnc ve
ym nic membr ne
A

chmen
s f s
edius muscle?
"s
erir w ll f
ym nic c vi
y
 s

es<div><br /></div><div><img src="" s
e-48086453846427.jg"" /></div>"
Middle e r c vi
y is cn
inuus wi
h m s
id ir cells s
erirly vi ________
di
us d n
rum
M s
idi
is m y end nger wh
nerve?
"CN VII<div><br /></div><div><img src=""
 s
e-48296907243962.jg"" /></div>"
Ov l windw nd rmn
ry re n wh
w ll f
he
ym nici c vi
y?
"medi l<
div><br /></div><div><img src="" s
e-48352741818779.jg"" /></div>"
Wh
rvides sensry innerv
in

he mucus membr ne f
he middle e r?
Tym nic lexus f CN IX
P in frm 
i
is medi is c rried by wh
cr ni l nerve?
IX
____________ is &nbs;cn
inu
in f
he
ym nic lexus f IX nd rvides w
h
innerv
in?
Lesser e
rs l nerve;&nbs;<div>PS innerv
in
 secre

m
r fibers

he  r
id gl nd</div><div><br /></div>
Gre
er e
rs l nerve gives wh
innerv
in? PS innerv
in
 l crim l gl nd
s<div><br /></div>
Wh
is fund n
he rmn
ry?
"
ym nic lexus f IX
h
rvides gen
er l sensry fibers
 mucs f middle e r<div><img src="" s
e-49177375539642.
jg"" /></div>"
Hw des
he chrd
ym ni exi
middle e r?
"An
erirly wi
h
he
ensr
ym
ni nd  sses
hrugh
he e
r
ym nic fissure<div><br /></div><div><img src="
" s
e-49310519525762.jg"" /></div>"
Wh
3
hings run n
erirly frm
he middle e r?
1. h ryng
ym nic
ube
<div>2.
ensr
ym ni</div><div>3. chrd
ym ni</div>
Lesser e
rs l nerve f IX is PS
 ________<div><br /></div><div>Gre
er e
r
s l nerve f VII is PS
 ________</div>
 r
id<div>l crim l</div>
Genicul
e g nglin f VII is ________ g nglin
sensry
S
edius is innerv
ed by ________
VII
Tensr
ym ni is innerv
ed by _____ CN V3
Chrd
ym ni gives wh

ye f innerv
in? (2)
PS
 subm ndibul r gl n
d nd sublingu l gl nds<div><br /></div><div>Sensry
 n
erir 2/3 f
ngue</
div>
Wh
nerves run n
he in
ern l c r
id &nbs; r
ery in
he regin f
he fr me
n l cerum? Wh
re
hese nerves c lled when
hey jum ff?
"s
sy 
ic sym

he
ic fibers f
he c r
ix lexus<div><br /></div><div>dee e
rs l nerve</
div><div><br /></div><div><img src="" s
e-51887499903273.jg"" /></div>"
Wh

w nerves jin u he ding
w rds 
eryg l
ine g nglin?
"dee e

rs l nerve (sym
he
ics)<div>gre
er e
r l nerve ( r sym
he
ics frm VII

)</div><div><br /></div><div>frm nerve f
he 
erygid c n l</div><div><br /><

/div><div><img src="" s
e-51883204935977.jg"" /></div>"
Ps
syn 
ic  r sym
he
ic fibers f 
eryg l
ine g nglin jum n
 wh
n
erve
 g
 wh

w l ce? "V2<div><br /></div><div>g
 l crim l gl nd n
d mucus gl nds</div><div><br /></div><div><img src="" s
e-51883204935977.jg""
/></div>"
Describe cmle
e 
h f gre
er e
rs l nerve beginning
suerir s lv
ry
nucleus
"1. Begins
suerir s lv
ry nucleus<div>2. Tr vels wi
hin V
II</div><div>3. Br nches ff
genicul
e g nglin n
erirly</div><div>4.Exi
s


he hi
us f
he f ci l c n l nd runs wi
hin grve n e
rus r
in f

emr l bne</div><div>5. Jins wi
h s
syn 
ic sym
he
ic nerves frm in
er
n l c r
id (dee e
r l nerve)</div><div>6. Tr vels s nerve f 
erygid c n
l</div><div>7. Syn ses

eryg l
ine g nglin</div><div>8. Ps
syn 
ic PS
fibers hi
chhike n V2
 l crim l nd mucss l gl nds</div><div><br /></div><di
v><img src="" s
e-51883204935977.jg"" /></div>"
Wh
is
he nerve f rigin fr
he cili ry g nglin? CN III
Wh
is
he nerve f rigin fr
he 
ic g nglin?
IX
Wh
is
he nerve f rigin fr
he 
eryg l
ine?
VII
Wh
is
he nerve f rigin fr
he subm ndibul r g nglin
VII
Af
er giving ff
he gre
er e
rs l nerve, wh
re
he 
her
w br nches f c
i l nerve gives befre exi
ing __________?
"1. gives ff nerve
 s
edius
muscle<div>2. gives ff chrd
ym ni</div><div><br /></div><div>exi
s s
ylm
s
id fr men</div><div><br /></div><div><img src="" s
e-52325586567449.jg"" /
></div>"
Gre
er e
rs l nerve hi
ch hikes n wh
br nch f
rigemin l?<div><br /></div
><div>Chrd
ym ni hi
chhikes n wh
br nch f
rigemin l</div>
"V2<div>
<br /></div><div>V3</div><div><br /></div><div><img src="" s
e-52445845651749.j
g"" /></div>"
Chrd
ym ni exi
s skulll ___________
hrugh e
r
ym nic fissure&nbs;
Wh
is
he lingu l nerve? Wh
nerve hi
ch hikes n
his
"Br nch f V3
h

chrd
ym ni hi
chhikes n<div><br /></div><div><img src="" s
e-5244155068
4453.jg"" /></div>"
Where d
he  r sym
he
ic fibers f chrd
ym ni syn se? "Subm ndibul r g
nglin<div><br /></div><div><img src="" s
e-52441550684453.jg"" /></div>"
Wh
gl nds d chrd
ym ni suly? subm ndibul r nd sublingu l gl nds
Wh
sensry innerv
in des chrd
ym ni give?
"Seci l sensry
 n
e
rir 2/3 f
nuge<div><br /></div><div><img src="" s
e-52441550684453.jg"" />
</div>"
Wh
gives <b>gener l sensry</b> fibers
 n
erir 2/3 f
ngue?
Lingu l
br nch f V3
Wh
re
he 5 skele
l s
ruc
ures rund
he  r
id gl nd?
r mus f m ndibl
e<div>m s
id rcess</div><div>s
ylid rcess</div><div>s
ylm s
id fr men</
div><div>
ym nic r
in f
emr l bne</div>
Wh
is
he  r
id gl nd surrunded by? (f sci )
inves
ing f sci f neck
Wh
divides  r
id gl nd in
 dee nd suerfici l r
in?  ss ge f f ci
l nerve
Where is
he dee r
in f
he  r
id gl nd lc
ed? "be
ween m ndible nd m
s
id rcess<div><br /></div><div><img src="" s
e-53244709568749.jg"" /></div
>"
Wh

w vessels  ss
hrugh  r
id gl nd?
"ex
ern l c r
id r
ery<div>re

rm ndibul r vein</div><div><br /></div><div><img src="" s
e-53270479372722.jg
"" /></div>"
Wh
3 nerves  ss
hrugh  r
id gl nd?
"Br nches f f ci l<div> uricul

emr l (V3)</div><div>PS fibers frm 
ic g nglin hi
chhiking n uricul
em
r l&nbs;</div><div><br /></div><div><img src="" s
e-53266184405426.jg"" /></
div>"
Wh
is s
ensens duc
? Wh
des i
ierce nd where des i
em
y
" r
id
duc
nd buccin
r<div><br /></div><div>in

he mu
h si
e
he secnd ml
r</div><div><br /></div><div><img src="" s
e-53266184405426.jg"" /></div>"
 r sym
he
ic fibers frm
he 
ic g nglin f IX hi
chike n wh
nerve?

" uricul
emr l&nbs;<div><br /></div><div><img src="" s
e-53266184405426.jg

"" /></div>"
Wh

ye f innerv
in d br nches f f ci l nerve
h
exi
s
ylm s
id fr
men give? Wh
re
hey innerv
ing (3) "sm
ic m
r fibers
 s
r i
ed muscle
<div><br /></div><div>1. s
ylhyid</div><div>2. s
erir belly f dig s
ric</d
iv><div>3. 6 br nches

he f ce</div><div><br /></div><div><img src="" s
e-53
566832116126.jg"" /></div>"
Wh
re
he 6 br nches f
he f ci l nerve?
"
emr l (suerir rbicul rici
s cculi)<div>zygm
ic (inferir rbicul ris cculi)</div><div>bucc l</div><div
>m ndibul r</div><div>cervic l</div><div>s
erir uricul r</div><div><br /></d
iv><div><img src="" s
e-53596896887293.jg"" /></div>"
T/F
hymus h s HEVs
F lse<div><br /></div><div>B
h Thymus nd sleen d n

h ve HEV</div><div>We dn
knw hw T cells en
er
he
hymus frm
he bld ex
c
ly</div>
Wh
des i
me n
h

he T cells en
er
he
hymus s nude
They d n
exr
ess CD4, CD8, r TCRs
Why re virgin T cells resis
n

 
sis? They re n ked nd
hus h ve n
FAS n
igen nd ls
hey h ve high levels f BCL-2
T cells in
he
hymic cr
ex exress high levels f wh
? Why is
his imr
n
?
F s nd lw levels f Bcl-2,
hus
hey re highly sensi
ive
 sign ls
h

rig
ger 
sis.<div><br /></div><div>T cells re
es
ed fr
ler nce f self nd
MHC res
ric
in when
hey re in highly vulner ble cndi
in</div>
Wh
cells resen
self MHC mlecules l ded wi
h e
ides

he T cells in
he
cr
ex? Wh
ex c
ly re
hey resen
ing?
Thymic ei
heli l cells<div><br
/></div><div>A s mling f r
eins m de by
he
hymic ei
heli l cells by MHC1<
/div><div><br /></div><div>S mling f r
eins icked u frm
he envirnmen
b
y MHC 2</div>
When d T cells becme SP (single si
ive)?
During r sligh
ly f
er si
iv
e selec
in
kes l ce in
he cr
ex f
he
hymus
Where des neg
ive selec
in f T cells
ke l ce?
Thymic MEdull
Wh

w cells medi
e
he
ler nce f self in
hymus? 1. Thymic dendri
ic cell
(self n
igens vi MHC1 nd (sme MHCII))<div>2. medull ry
hymic ei
heli l ce
ll (self n
igens nd
issue secific r
eins vi MHC II)</div>
Wh
is
he signific nce f
hymic dendri
ic cells nly l s
ing week "They n
ly resen
""curren
self- n
igens""<div><br /></div><div>Any m
uring T cells

h
recgnized n inv der wuld be dele
ed s lng s
hymic dendri
ic cells cn

inued
 resen

hese freign inv ders, which wuld be BAD</div>"
Hw re T cells reven
ed frm

cking
issue secific r
eins
h
re n
f
Medu lly
hymic ei
heli l cells exress sever l
hus n
und in
he
hymus?
d
issue -secific r
eins n MHCII<div><br /></div><div>Hw
hey d s is uncl
e r</div>
Wh

w
hings
 medull ry
hymic ei
heli l cells d?
1. exress sever
l
hus nd
issue secific r
eins
 T cells-MHCII<div>2. Exress self n
ige
ns n MHCII mlecules vi u
h gy-MHCII</div>
Hw d medu lly
hymic ei
heli l cells exress self n
igens n MHC II Vi u

h gy: When cells re s
rving,
hey c n enclse r
ins f
heir cy
l sm in
membr ne which
hen fuses wi
h lyssme. Then r
in f
hese degr ded r

eins c n be rcessed fr disl y n MHC II<div><br /></div><div>Au
h gy c n

hen rvide
he diverse surce f self n
igens required
 elimin
e ms
sel
f-re c
ive heler T cells during neg
ive selec
in</div>
Hw des
he s me TCR when i
eng ges MHC-e
ide cmlexes sign l 3 differen

u
cmes: si
ive selec
in, neg
ive selec
in, r c
iv
in? "<img src="" s

e-59231893979660.jg"" /><div>Three differen
in
er c
ins:</div><div>Cr
ic l

hymic ei
heli l cell</div><div>dendri
ic cell/medu lly
hymic ei
heli l cell</
div><div>An
igen resen
ing cell</div><div><br /></div><div>Differ in Cellul r
dhesin mlecules, number r
ye f MHC-e
ide cmlexes
hey exress, differe
n
mix
ures f cs
imul
ry mlecules, differen
T cells?</div>"
Wh
re 5 l yers f r
ec
in
h
reven

he T cell frm

cking self?
1.&nbs;&nbs;Virgin T cells re n
llwed u
in

he
issues<div>2. Even if
T cells recgnize r re self n
igen in
he
hymus,
his r re self n
igen is

in such lw cncen
r
in in
he lymhid rg n
h

hey re n
usu lly c
iv

ed</div><div>3. nTregs re resen

 hel reven
u
immuni
y if self n
igen
s re rele sed in
 bld nd lymh
ic sys
ems (wrk by <b>dwnregul
ing
he c
s
imul
ry mlecules n APCs</b>)</div><div>4. If self-re c
ive T cell ges in


issues,
hey will die r becme nergized due

he l ck f crss-linking s

imul
in nd cs
imul
in (rdin ry cells dn
h ve c s
imul
ry mlecules
r high levels f MHC II,
hus virgin T cell c n g u clse

hese cells nd
n
be c
iv
ed by
hem)</div><div>5. Even if i
des receive c-s
imul
in,

hey will die due
 chrnic s
imul
in by self n
igens vi ACID</div>
Hw re nTregs frmed? Subse
f
hymic Th cells re selec
ed
 becme n
ur l
regul
ry T cells
Wh
gene is essen
i l fr giving nTregs
heir regul
ry rer
ies
Fx3
Where re nTregs fund? lymhndes nd 
her secnd ry lymhid rg ns.<div><br
/></div><div>Af
er
hey re gener
ed in
he
hymus,
hey exress dhesin mlec
ules which llw
hem
 en
er lymhndes nd 
her secnd ry lymh rg ns</div>
Wh
d nTregs d? Are
hey n
igen secific? They seem
 be ble
 suress

he c
iv
in f r
en
i lly self-re c
ive T cells by dwnregul
ing
he c-s

imul
ry mlecules n n
igen resen
ing cells
Hum ns wi
h mu

in in Fx3 suffer frm wh
? ggressive u
immune dise se si
nce nTregs dn
wrk rerly
Wh
is
he difference be
ween iTregs nd n
regs?
inducible: res
r in immu
ne sys
em
 kee i
frm verre c
ing by secre
ing n
iinfl mm
ry cy
kines (
TGF be

nd IL-10)<div><br /></div><div>nTregs: rvide r
ec
in g ins
T ce
lls which h ve 
en
i l
 re c
g ins
self- n
igens</div>
Wh
re nergized T cells?
When
T cell recgnizes i
s cgn
e n
igen re
sen
ed n cell bu
des n
receive
he required c-s
imul
in
he T cell is
neu
ered nd dies by 
sis
"<img src="" s
e-59910498812268.jg"" />"
Where re B cells
lerized fr self n
igen? bne m rrw
If
B cell recgnizes self n
igen in
he bne m rrw wh
h ens?
"They r
e given secnd ch nce
gene rr ngemen
c lled"" rece
r edi
ing"""
Wh
if f
er sm
ic hyermu

in, B cells c
u lly recgnize self n
igens? (
2)
This desn
re lly h en bec use B cells in germin l cells re fr gile
nd die by 
sis if
hey d n
recevie cs
imul
in by T cells (CD40) nd
recgni
in f cgn
e resen
ed by FDCs<div><br /></div><div>BUT</div><div><br
/></div><div>1. FDCs nly disl y n
igens
h
h ve been snized ei
her by n

ibdies r cmlemen
. Self n
igens re n
usu lly snized</div><div><br />
</div><div>Als remember
he d nce be
ween B cells nd T cells:</div><div><br />
</div><div>T cells c
iv
es B (CD40)</div><div>B cells rech rge T (resen
fr g
men
s f cgn
e n
igen vi MHC II)</div><div><br /></div><div>Bu
if B nd T c
ells re n
lking
s me  r
s f n
igen,
he d nce desn
re lly wrk.&nbs
;</div><div><br /></div><div>In 
herwrds, if B cell recgnizes self- n
igen
s, i
is unlikely
h
i
will find T cell
h
des nd will die<br /><div><b
r /></div><div><br /></div></div>
Why is self
ler nce reserved during B cell hyermu

in? (2 re sns)
L ck f snized self n
igen<div>l ck f germin l cen
er Th cells which c n r
vide hel fr B cells
h
recgnize self n
igen</div>
Wh
is
he difference be
ween edem
nd effusin?
Edem : excess fluid in i
n
ers
i
ium<div>Effusin: excess fluid in bdy c vi
y</div><div><br /></div><div
>(hydr
hr x, hydreri
neum, hydreric rdium)</div>
Hw des edem ccur? Wh
re sme usu l c uses? Wh
is
he ne
resul

<div>Incre sed hydrs

ic ressure&nbs;</div><div>Decre sed nc
ic ressure (
i.e. lw lbumin frm liver f ilure)&nbs;</div><div><br /></div><div>Lymh
ic
bs
ruc
in (f
en s
surgic l)&nbs;</div><div>N /w
er re
en
in (frm ren l
nd c rdi c rblems)&nbs;</div><div>Infl mm
in</div><div>&nbs;</div><div>N
e
resul
: fluid ge
s fil
ered u
f
he c ill ry bed nd n
very much ge
s r
e bsrbed b ck in
he venules&nbs;</div>
Hyermi vs Cnges
in. Which is c
ive vs  ssive
<div>Hyeremi = c
ive
rcess; incre sed r
eri l bld flw
 n re &nbs;</div><div>Cnges
in = 
ssive rcess; decre sed venus flw frm re &nbs;</div><div>Since hyeremi

nd cnges
in b
h incre se hydrs

ic ressure,
hey c n be seen wi
h edem &n
bs;</div>
"<img src="" s
e-61370787692918.jg"" />"
"Ex mle f Pi

ing edem - nrm
lly when yu ush dwn n
his
issue, i
shuld ""bunce b ck"" quickly. In i


ing edem , i
desn
"
"<img src="" s
e-61409442398587.jg"" />"
Lung
issue - lks shiny bec us
e i
s filled wi
h fluid nd reflec
ing ligh

"<img src="" s
e-61443802136962.jg"" />"
Lung
issue frm
he lef
im ge
- r
eins re cidic/esinhilic. E ch lvel r s ce is filled wi
h r
ein
nd fluid (exud
e). The whi
e s ce is bec use sme fluid is remved while rce
ssing. This envirnmen
f cili

es b c
eri l grw
h unfr
un
ely. N
ice hw
lvel r w ll is  cked wi
h RBCs. This resul
s in l
f ressure u
in

he
ulmn ry v scul
ure
"<img src="" s
e-61478161875346.jg"" />"
Lymhedem - f
en
imes s
-su
rgic l, bu
c n ls ccur frm bs
ruc
in f lymh
ics by  r si
ic infec
in
; if
here is
 much fluid build-u,
he skin c n
e r nd ulcer
e
"<img src="" s
e-61512521613686.jg"" />"
full bdy edem : n s rc
"<img src="" s
e-61546881352028.jg"" />"
"<b>Chrnic cnges
in</b> in lu
ngs - red bld cells will le k u
in

he lvel r s ces nd rele se hemgl
bin. M crh ges will e

hese. These m crh ges
h
ick u
he bre kdwn r
duc
s f RBCs re c lled ""He r
F ilure Cells"""
"<img src="" s
e-61581241090427.jg"" />"
Nu
meg liver: Ex mle f <b>chr
nic,  ssive cnges
in</b> (buildu n venus side). N
ice hw
here re l
er
n
ing re s f ligh
nd d rk. This is usu lly c used by: c rdi c dysfunc
in (
i.e. righ
he r
f ilure, cnges
ive he r
f ilure)
"<img src="" s
e-61615600828765.jg"" />"
"<img src="" s
e-61628485730670
.jg"" /><div><br /></div><div>Nu
meg liver - micrscic view: - RBCs le k u

nd m ke zn l 

ern. The RBCs die nd m ke
brwner s
in icked u by Ku
ffer cells. The whi
e re s re c
u lly nrm l
issue nd
he brwner
issue is

he d m ged
issue.</div>"
Wh
re
he 4 s
es in which end
helium resnds
 injury? <div>1. Injury

 end
helium&nbs;</div><div>2. Pl
ele
s dhere
 end
helium, ggreg
e
 f
rm l
ele
lug&nbs;</div><div>3. C gul
in c sc de is c
iv
ed --&g
; fib
rin cl
&nbs;</div><div>4. Fibrinlysis is l
er c
iv
ed
 bre kdwn cl
n
d res
re bld flw&nbs;</div>
Wh
re 3 end
heli l f c
rs
h
rm
e cl

ing? <div>vWF, k vn Willeb
r nd f c
r, - (l
ele
dhesin)&nbs;</div><div>Tissue F c
r k F.III (
rig
gers c gul
in c sc de)&nbs;</div><div>Inhibi
rs f l smingen c
iv
r (i
nhibi
fibrinlysis)</div>
Wh
re 7 f c
rs
h
inhibi
cl

ing?
<div>PGI2 nd NO (reven
l
el
e
dhesin/ ggreg
in)&nbs;</div><div>ADP se (inhibi
s l
ele
ggreg
in)&
nbs;</div><div>He rin-like mlecule (cf c
rs
h
c
iv
e n
i-
hrmbin)&nb
s;</div><div>Thrmbmdulin (binds
hrmbin)&nbs;</div><div>Pr
eins C nd S (
cle ve f c
r V
nd VIII cmlex)&nbs;</div><div>
PA (incre ses fibrinlysis)
</div><div><br /></div><div>1. NO</div><div>2. ADP se</div><div>3. PGI2</div><di
v>4. He rin&nbs;</div><div>5. Thrmbmdulin</div><div>6. TFPI</div><div>7.
P
A</div>
"<img src="" s
e-65712999629223.jg"" />"
F vr
hrmbsis:<div><div>1.&nb
s;l
ele
s bind vWF</div><div>2. Tissue f c
r se
s ff ex
rinsic 
hw y</div
><div><br /></div><div>Inhibi

hrmbsis</div><div>1. NO, PGI2, ADP se inhibi
s
l
ele
ggreg
in</div><div>2. He rin binds wi
h n
i
hrmbin
 inhibi
<b
>
hrmbin nd X nd IX </b></div><div>3. Tissue f c
r 
hw y inhibi
r inhibi

s <b>VII </b></div><div>4. Thrmbin-
hrmbmdulin cmlex c
iv
es Pr
ein C
, which wi
h Pr
ein S in c
iv
es <b>V nd VIII </b></div><div><br /></div></d
iv>
"<img src="" s
e-65871913419129.jg"" />"
Wh
re
he n
i
hrmb
ic rer
ies f v scul r end
helium? (3)
"An
il

ele
: PGI2, NO, ADP se<div>An
i C gulen
: He rin, Thrmbmdulin, Tissue f c

r 
hw y inhibi
r</div><div>Fibrinly
ic effe
s:
PA</div><div><br /></div><d
iv><img src="" s
e-66026532241831.jg"" /></div>"

Hw d he rin like mlecules wrk?

Tge
her w
h n
i
hrmbin i
inhibi
s
h
rmbin nd f c
r X nd IX
Hw des
hrmbmdulin wrk? "I
frms cmlex wi
h
hrmbin
 c
iv
e r

ein C, which wi
h r
ein S inhibi
s F c
r V nd VIII <div><br /></div><div><i
mg src="" s
e-66022237274535.jg"" /></div>"
Wh
des
PA d?
Tissue l smingen c
iv
r. I
s cle ves l smingen

l smin, which degr des fibrin cl
s
Wh
r
he 3 r
hrmb
ic rer
ies f v scul r end
helium? "1. Pl
le
effe
c
s (l
le
s binds <b>vWF</b> nd underlying cll gen)<div>2. End
heli l cells
syn
hesize <b>
issue f c
r </b>which se
s ff ex
rincisc cl

ing c sc de</div
><div>3. An
ifibrinly
ic effec
s: secre
es <b>inhibi
rs f l smingen c
iv

r</b></div><div><br /></div><div><img src="" s
e-66271345377703.jg"" /></div>
"
"<img src="" s
e-66310000083147.jg"" />"
4 y wi
h fever, m l ise, r sh;
Hx f uer resir
ry infec
ins. Child h d dise se
h
llwed recurren
i
nfec
ins. Ended u h ving sesis nd c used gener lized v scul r injury --&g
;
resul
ed in bleeding nd cl

ing simul
neusly&nbs;<div><br /></div><div>e
e
chi e</div>
"<img src="" s
e-66344359821711.jg"" />"
V sculi
is - eidermis is
he d
rk s
ining brder. Pink re is cll gen in dermis. All f
he d rker s
ining
regins in
he dermis re c
u lly des
ryed bld vessels bec use end
xins fr
m sesis re

ching
 bld vessels --&g
; neu
rhils will des
ry
he ves
sels.&nbs;
Wh
is e
echi e, urur , ecchymsis? bld in skin: sm ll, medium, l rge
Wh

yes f gr nules d l
ele
s h ve?
Alh
nd del

Where re l
le
s m de frm nd where? meg k rycy
es in bne m rrw
Wh
d lh gr nules cn
in? P selec
in CAM, fibringen, fibrnec
in, f c
r
V, VIII
Wh
d del
gr nules h ve?
ADP, ATP, C 2+, his
mine, ser
nin, EPI
Wh
re
he 4 s
es l
ele
s underg f
er v scul r injury? 1. dhesin<div>
2. sh e ch nge</div><div>3. secre
in</div><div>4. ggreg
in</div>
Wh
end ges d l
le
s give ff
 bind fibringen nd vWF f
er
hey h ve
been c
iv
ed? GP IIb, III
Hw des
he l
le
surf ce ch nge
 enh nce c gul
in?
Incre ses neg
i
vely ch rged hshliids which bind c lcium&nbs;
Hw des
he l
ele
sh e ch nge?
Frm sm
h disks
 siky frms which g
re
ly incre ses surf ce re
Wh
h ens f
er l
ele
s bind
 vWF/underlying cll gen nd underg sh e c
h nge? Rele se Tye A nd D gr nules
Why is rele se f D gr nules very imr
n
?
C 2+ is imr
n
fr c gul
i
n c sc de<div>ADP is r
en
c
iv
r f l
le
ggreg
in</div>
Wh

w mlecules mlify l
ele
ggreg
in?
ADP nd TXA2 hels frm
rim ry hems

ic lug
Hw des
hrmbin hel wi
h
he s
biliz
in f l
ele
lug?
Cnver
s
fibringen
 nn crss linked fibrin
Wh
is Gl nzm nn Thrmb s
heni ?
"Deficiency in GPIIB nd GPIII (
he 
end ges
h
hel bind fibringen)<div><br /></div><div><img src="" s
e-6714751
8706192.jg"" /></div>"
Wh
is Bern rd-Sulier syndrme?
"Defec
s in GPIb le ding
 in bili
y

bind vWF<div><br /></div><div><br /></div><div><img src="" s
e-67289252626960.
jg"" /></div>"
C gul
in 
hw y deends n ______ nd is n
gnized by______
C 2+<div
>cum din</div>
C gul
in cmnen
s re ssembed n ____________ in c
iv
ed l
ele
s
"neg
ively ch rged hshliids in c
iv
ed l
ele
s<div><br /></div><div><i
mg src="" s
e-67461051318728.jg"" /></div>"
Wh
c
lyzes
he cnversin f r
hrmbin

hrmbin?
F c
r X nd V
wi
h c lcium cnver
r
hrmbin

hrmbin
Wh
re
he 6 rles f
hrmbin in
he c gul
in 
hw y?
"<img src="" s

e-67937792688658.jg"" /><div><div>1. Cnver
s fibringen in
 fibrin (n
ye
c

rss linked)&nbs;</div><div>2. Induces l
ele
c
iv
in (rele se TXA2)</div>

<div>3. Triggers l
ele
c
iv
ing rece
rs n 
her infl mm
ry cells
 me
di
e rinfl mm
ry effec
s --&g
;
issue re ir nd ngigenesis&nbs;</div><
div>4. Induces PDGF rele se --&g
; sm
h muscle cell grw
h&nbs;</div><div>5.
Ac
iv
es mncy
es nd lymhcy
es&nbs;</div><div>6.Als h s n
ic gul n
eff
ec
s (when i
encun
ers nrm l end
helium,
hrmbmdulin cnver
s
hrmbin in

 n n
ic gul n
enzyme
 reven
cl

ing ex
ending  s
si
e f injury!)&n
bs;</div><div><br /></div></div>"
Wh
re 3 f c
rs
h
limi
c gul
in?
<div>1. Dilu
in (bld flw rem
ves c
iv
ed c gul
in f c
rs
h
re remved in
he liver)</div><div>&nbs
;</div><div>2. Need fr neg
ively ch rged hshliids ( s l
ele
s re used
in cl

ing, less surf ce is v il ble
 kee c gul
in c sc de ging)&nbs;
</div><div><br /></div><div>3.End
heli l secre
in f n
ic gul
in f c
rs</
div>
Pl smin is gener
ed by wh
2 
hw ys?
1. F c
r XII-deenden

hw y<
div>2.
P </div>
F c
r XII deficiecy le ds
 rblems wi
h_________
vercl

ing

PA is syn
hesized by ______ nd is ms
c
ive when bund
 ________ end
hel
ium<div><br /></div><div>fibrin</div>
"<img src="" s
e-68298569941358.jg"" />"
Tissue F c
r 
hw y inhibi
r in c
iv
es wh
?
X se nd VII
Hw re medu lly
hymic ei
heli l cells ble
 resen

issue secific r
ein
s s well s every r
ein ssible frm ur genme?
"<div><b>Tissue Secific
:</b></div><div><b>&nbs;</b>Prim rily resen
s n MHC-II (c n resen

issue-s
ecific n
igens)</div><div><br /></div><div><b>All ssible self n
igens m de i
n bdy:</b></div><div>Exress AIRE which llws
hem
 shw every r
ein ssi
ble frm ur genme. These self- n
igens (remember,
hese m y be ""ex
r cellul r
"" self- n
igens) m y r m y n
be resen
ed n
he Thymic dendri
ic Cells</div
><div><br /></div><div>The m in ide is
h

hey will disl y
hese necess ry
n
igens n MHC-II by diges
ing i
i
self ( u
h gy). Nrm lly, MHC-II nly dis
l ys ex
ern l n
igen, bu

he u
h gy f i
s wn r
eins resul
s in u
h g
smes
h
fuse wi
h endsmes
h
l d
he MHC-II!&nbs;<br /><div><br /></di
v><div><br /></div></div>"
Wh
is
he difference be
ween
hemrrh ge nd hem
m ?
<div>Hemrrh ge
= bld u
side bld vessels&nbs;</div><div>Hem
m = m ss-like cllec
in f
bld</div>
Wh
re 3 m ssive hemrrh gic disrders?
<div>1. M rf n syndrme (ru
ure
f r
)&nbs;</div><div>2. Ar
ic bdmin l neurysm (ru
ure in
 bdmen)&n
bs;</div><div>3. Myc rdi l inf rc
in (ru
ure f he r
f r
s cmlic
i
n)&nbs;</div>
Defec
s f rim ry hems
sis
ke
he frm f:&nbs; e
echi e<div>uur </di
v><div>skin bleeds</div><div>eis
xis</div><div>GI bleeding</div><div>excessive
mens
ru
in</div>
Bleedign in
 jin
s (hem r
hrsis) is ch r c
eris
ic f
hemhili
"<img src="" s
e-123634928583064.jg"" />"
Segmen
f cln - sm ll d
s r
e e
echi e- ex mle f bleeding disrder
"<img src="" s
e-123677878256022.jg"" />"
Br in wi
h hemrrh gic buildu
Wh
re
he 4 f
es f
<div>Pr g
in - grws&nbs;</div><div

hrmbus?
>Embliz
in - bre ks ff nd ges elsewhere&nbs;</div><div>Disslu
in - diss
lved by fibrinlysis&nbs;</div><div>Org niz
in & m; rec n liz
in - infl m
m
in & m; re ir, new lumen is cre
ed&nbs;</div>
Wh
re
he 3 f c
rs
h
le d

hrmbsis? 1. end
heli l injury<div>2. bn
rm l bld flw</div><div>3. hyerc gul bili
y</div>
Chrnic recurren
bld lss le ds
 _______ nd _______ nemi
irn ls
s; irn deficiency
Hw des infl mm
in cn
ribu
e

hrmbsis? Wh
is
his rcessed
ermed?
Infl mm
in nd 
her s
imuli c n resul
in r
hrmb
ic gene exressin in en
d
helium<div><br /></div><div>end
heli l c
iv
in</div>
Turbulence c uses _________ r ________<div>S
sis is
m jr cn
ribu
r f ___
______</div>
end
hleli l injury r dysfunc
in<div><br /></div><div>venus

hrmbi</div>
Describe nrm l l min r bld flw
Pl
ele
s nd 
her bld cells re cen

r l, se r
ed frm
he end
helium by slwer mving l yer f l sm
Hw d s
sis nd
urbulence l
er bld flw (3)
1. Prm
e end
heli l
c
iv
in nd enh nce r gul n
c
ivi
y nd leukcy
e dhesin<div>2. Disru

l min r flw nd bring l
ele
s in
 cn
c
wi
h end
helium</div><div>3. re
ven
w shu
nd dilu
in f c
iv
ed cl

ing f c
rs</div>
Describe hw e ch f
hese clinic l rblems le d
 l
er
ins in bld flw<d
iv><br /></div><div> cu
e myc rdi l inf rc
in:&nbs;</div><div><br /></div><di
v><div>rhem
ic mi
r l v lve s
ensis</div><div><br /></div><div>hyerviscci
y<
/div><div><br /></div><div>sickle cell dise se</div></div>
cu
e myc rdi l
inf rc
in: nn cn
r c
ile he r
muscle-bld dens
mve<div><br /></div><div
>rhem
ic mi
r l v lve s
ensis: Dil
in f
rium rm
es
urbulence</div><di
v><br /></div><div>hyerviscci
y: lycy
hemi ver is excess RBC which c uses
sm ll vessel s
sis</div><div><br /></div><div>sickle cell dise se: sh e f RBC
imedes bld flw in sm ll vessels</div>
Define hyerc gul bili
y
ny l
er
in f
he c gul
in 
hw ys
h

redisses ne

hrmbsis
Prim ry vs secnd ry hyerc gul bili
y rim ry: gene
ic<div>secnd ry: cquired
</div>
Wh
is
he ms
cmmn &nbs;mu

in
h
le ds
 hyerc gul bili
y? Wh
is

his mu

in c lled? Wh
des i
le d
?
in
mu

in in
he f c
r V g
ene<div><br /></div><div>Leiden Mu

in</div><div><br /></div><div>In c
iv
in
f Pr
ein C (which wi
h S usu lly in c
iv
es F c
r V nd VIII)</div>
Wh
is
he leiden mu

in?
in
mu

in in f c
r V gene
h
le ds
 in
civ
in f r
ein C
Wh
is
he cnsequence f defec
in
he r
hrmbin gene?
elev
ed r
hr
mbind levels nd 3x risk f venus
hrmbsis
Wh
d eleve
ed levels f hmcy
eine cn
ribu
e
? Hw?
r
eri l nd ven
us
hrmbsis due
 inheri
ed deficiency f cys

hine be
-syn
he
se
Wh
re 3 w ys secnd ry hyerc gul
ibili
y c n ccur?
1. C rdi c f ilu
re r
r um c n le d
 s
sis<div>2. Or l cn
r ceive le ds
 frm
in f c
 gul
ive f c
rs</div><div>3. Tumrs- c gul
ive f c
rs</div>
Wh
is He rin induced
hrmbcy
eni syndrme?
Fllwing dminis
r
in
f he rin, n
ibdies c n be induced
 e r
h
recgnize clexes f he
rin nd f c
r 4.<div><br /></div><div>This binding resul
s in l
ele
c
iv
i
n, ggreg
in, nd cnsum
in (hence
hrmbcy
eni )</div><div><br /></div>
<div><br /></div>
Wh
re
he clinic l cnequences f n
ihshliid n
ibdy syndrme?
Recurren

hrmbses, ree
ed misc rri ges, c rdi c v lve vege

ins,
hrmbc
y
eni <div><br /></div><div>ulmn ry emblism, ulmn ry hyer
ensin, s
rke
, bwel inf rc
in, renv scul r hyer
ensin</div>
n
ibdies in n
ihshliid n
ibdy syndrme gives f lse si
ive fr wh


es

serlgic
es
fr syhillis
"<img src="" s
e-125000728183194.jg"" />"
"Ex mle f
hrmbus in si
u - s
ilver s
in.<div>D rker cells re WBCs nd surrunded by fibrin nd RBCs.<br /><
div><br /></div><div>Lines f Z hn: l
ern
ing l yers f l
ele
s nd fibrin
nd RBC</div><div><img src="" s
e-34630321308086.jg"" /></div><div><br /></div>
<div>&nbs;</div></div>"
"<img src="" s
e-125043677856118.jg"" />"
"Mur l
hrmbus: mur l me ns ""


he side""; ic
ure in he r
s lef
ven
ricle. The fibrus regin is frm cl


h
c used s
sis. Tiny  r
s f
he cl
frm
his lef
ven
ricle re likel
y
 g in

he c r
ids nd c use s
rke."
"<img src="" s
e-125120987267429.jg"" />"
Rec n lized vessel - ll f
he
ink
issue is fibrcll genized
issue. The lumens re new in rder
 es
blis
h bld flw
The ex
ern l n s l is

ermin l br nch f __________ n scili ry&nbs;
The zygm
icf ci l nd zygm
ic
emr l re br nches f _______
h
c rry h
i
chhiking fibers f ______
 ________ V2, VII

he l crim l gl nd
The men
l nerve is
ermin l br nch f ________
inferir lvel r nerve

Wh
nerves ene
r
e
he  r
id gl nd Br nches f f ci l<div> uricul
emr l

(V3)</div><div>PS fibers frm 
ic g nglin hi
chhiking n uricul
emr l&nbs
;</div>
"Wh
nerve sulies uer e r regin?<div><br /></div><div>Wh
nerve sulies
skin f lwer e r regin nd ver
he m ndible?</div><div><br /></div><div><img
src="" s
e-140801912865308.jg"" /></div>"
Auricul
emr l (V3)<div><br />
</div><div>Gre
er ruicul r (C2-C3)</div>
Where des ex
ern l n s l br nch f V1 slide u
be
ween?
"N s l bne nd
n s l c r
il ge<div><br /></div><div><img src="" s
e-140883517243932.jg"" /></
div>"
where c n
he zygm
ic f ci l nerve be seen cming
hrugh? "Sm ll hle n

he n
erir surf ce f
eh zygm
ic bne<div><br /></div><div><img src="" s
e140879222276636.jg"" /></div>"
Where des
he bucc l br nch f V3 rise frm? "Infr
emr l fss <div><br /><
/div><div><img src="" s
e-141141215281496.jg"" /></div><div><br /></div><div><
img src="" s
e-141205639791132.jg"" /></div>"
Wh
des uricul
emr l br nch f V3 run wi
h?
"Suerfici l
emr l r

ery<div><br /></div><div><img src="" s
e-141201344823836.jg"" /></div>"
L yers f sc l "<img src="" s
e-141471927763183.jg"" /><div><img src="" s
e141484812665189.jg"" /></div>"
Wh
jins
he frn
lis nd ccii
lis muscles
 m ke single uni
which slid
es
he sc l b ckw rds nd frw rds?
g le neur
ic <div><br /></div><div>
This m
in is ssible bec use f
he deeer lying lse l yer f
he sc l which
is used
 se r
e
he sc l frm
he deeer lying eris
eum.</div>
Buccin
r lies dee
 wh
?&nbs;
bucc l f
 d
Where is
he zygm
icus muscle rel
ive
 lev
r nguli ris?
"Mre su
erfici l nd l
er lly<div><br /></div><div><img src="" s
e-141815525147164.j
g"" /></div>"
Describe
he curse f
he
r nsverse cervic l nerve? "<div>midin
f
he 
s
erir edge f SCM

he skin f
he n
erir
ri ngle f
he neck</div><div><
br /></div><div><br /></div><div><img src="" s
e-141884244623541.jg"" /></div>
<div><br /></div><div><br /></div>"
Wh
h ens if buccin
r muscle lses i
s nerve suly?
<div>fd m y
e
nd
 ccumul
e in
he s ce be
ween
he cheeks nd
he gums.</div><div><br /><
/div>
Wh
is
he bucch rynge l f sci ? Where des i
exe
nd?
F sci n
he u

side f
he buccin
r.&nbs;<div><br /></div><div><div>s
erirly  s

he 

erygm ndibul r r he
 surrund
he u
er surf ce f
he suerir h rynge l c
ns
ric
r nd
he r l h rynx (mre de
ils will cme l
er when we inves
ig

e
he h rynx).&nbs;</div></div><div><br /></div>
Wh
re
he

chmen
s f
he buccin
r?
"
erygm ndibul r r he
 rbi
cul ris ris<div><br /></div><div><img src="" s
e-142107582923033.jg"" /></div
>"
Describe
he curse f
he f ci l r
ery<div><br /></div><div>Wh
br nches des
i
give ff?</div>
"Pierce subm ndibul r gl nd<div>Crss m ndible n
erir

 m sse
er muscle</div><div><br /></div><div>Submen
l, inferir l bi l, sueri
r l bi l</div><div><img src="" s
e-142141942661642.jg"" /></div>"
Dis
l

he suerir l bi l br nch wh
des
he f ci l r
ery becme?
" ngu r<div><br /></div><div><img src="" s
e-142137647694346.jg"" /></div>"
Suerfici l
emr l r
ery rises dee wi
hin _________ s ex
ern l c r
id giv
es ff m xill ry
 r
id gl nd
M xill ry r
ery runs
hrugh nd sulies ______
infr
emr l fss
Ps
erir uricul r nd ccii
l r
eries rise dee wi
hin _______
 r
id
gl nd
Sur rbi
l nd infr rbi
l r
eries re br nches f ________
"
h lm
ic r
ery, which rises frm
he in
ern l c r
id<div><br /></div><div><img src=
"" s
e-142137647694346.jg"" /></div>"
Wh

w vein lexuses dr in in

he c vernus sinus? "O
h lmic veins nd emi
ss ry veins f 
erygid lexus<div><br /></div><div><img src="" s
e-1423953457
31899.jg"" /></div>"

Wh
is
he re
rm ndibul r vein frmed by?

"Suerfici l
emr l vein nd m
xill ry vein<div><br /></div><div><img src="" s
e-142532784685393.jg"" /></di
v>"
Wh
frms
he cmmn f ci l vein?
" n
erir br nch f Re
rm ndibul r vein
nd f ci l vein<div><br /></div><div><img src="" s
e-142653043769681.jg"" /><
/div>"
Wh
r
in f re
rm ndibul r vein dr ins in
 in
ern l jugul r? Ex
ern l jugu
l r?
"An
erir re
rm ndibul r wi
h f ci l --&g
;cmmn f ci l--&g
;in
ern l
jugul r<div><br /></div><div>Ps
erir re
rm ndibul r wi
h s
erir uricul r
vein--&g
;ex
ern l jugul r</div><div><br /></div><div><img src="" s
e-142648748
802385.jg"" /></div>"
Describe
he lc
in f
he re
rm ndibul r vein
"Ps
erir
 m ndible,
wi
hin  r
id gl nd<div><br /></div><div><img src="" s
e-142648748802385.jg""
/></div>"
Wh
is n emblus?
De
ched in
r v scul r m ss (s, l, g)
h
is c rried

si
e dis
n
frm rigin
Wh
is ulmn ry
hrmbemblism? Where des i
usu lly cme frm? emblism

h

r vels
 ulmn ry r
ery: usu lly frm DVT
Wh
is s ddle emblus?
An emblus
h
s
r ddles
he bifurc
in f
he
ulmn ry r
ery
"<img src="" s
e-26955214750077.jg"" />"
"<img src="" s
e-26968099652014
.jg"" />"
Wh
is  r dxic l emblus? A cl
frm venus circul
in
h
ends u in
r
eri l circul
in
hrugh shun
in
he he r
: like 
en
fr men v le
Wh
is f
emblus? Wh
is usu lly frm? Wh
re cmmn clinic l resen

i
When f
glbule ges
 lungs&nbs;<div><br /></div><div>Bne fr c
ur
ns?
es nd sf

issue
r um </div><div><br /></div><div>Dysne (ulmn ry vessels)
nd e
echi e n skin verlying ches
</div>
Wh
is n ir emblus? When is i
cl ssic lly seen?
g s bubble
h
bs
ruc

s vessel; decrmressin sickness
Wh
is n mni
ic fluid emblus? Wh
des i
f
en le d
? When mni
ic fl
uid en
eres m
ern l circul
in due


e r in l cen
l membr ne nd u
erine
veins<div><br /></div><div>DIC: Dissemin
ed in
r v scul r c gul
in due


he
hrmb
ic n
ure f mni
ic fluid</div>
Wh
is DIC? Dissemin
ed in
r v scul r c gul
in: sys
emic c
iv
in f c
l

ing r
eins
Wh
is n inf rc
in? Are f c gul
ive necrsis due
 ischemi frm decre
sed bld flw
Wh
is
he difference be
ween red nd whi
e inf rc

Red: hemmrh gic nd due

 cclusin f veins r ccurs in r gns wi
h duble bld flw<div><br /></di
v><div>Whi
e: Due
 r
eri l cclusin</div>
Wh
rg ns d yu usu lly see red inf rc
?
lse
issues wi
h duble bld
suly<div>1) lung</div><div>2) v ries</div><div>3)
es
es</div><div>4) sm ll i
n
es
ine</div>
Wh
rg ns d yu usu lly see whi
e inf rc
? sleen, he r
, kidneys<div><br /
></div><div>Slidi
y f
he
issue subs
n
i lly limi
s
he mun
f nu
rien
s
(bld/xygen/glucse/fuel)
h
c n flw in

he re f ischemic necrsis.&nb
s;</div>
"<img src="" s
e-27376121545056.jg"" /><div>Red r whi
e inf rc
?</div>"
Red
"<img src="" s
e-27410481283453.jg"" /><div><br /></div><div>Red r whi
e inf
rc
?</div>"
<br /><div><br /></div><div>kidney:
his inf rc
is whi
e. Hwev
er,
here is red rim rund i
. There is bleeding rund
he whi
e inf rc
. &n
bs;</div>
"<img src="" s
e-27444841021803.jg"" /><div>red r whi
e inf rc
</div>"
Inf rc
- he r
: ex mle f n
her whi
e inf rc

"<img src="" s
e-27479200760062.jg"" />"
Micrscic view f c gul
ive
necrsis
Wh
is shck? Wh
re
he 3 mech nisms
h
le d

his?
in dequ
e erfus
in

issues<div><br /></div><div>1. decre sed c rdi c u
u
(c rdi c f ilure

)</div><div>2. decre sed vlume (bld lss--&g
;hyvlemi )</div><div>3. V sd

il
in (sesis induced v sdil
in)</div><div><br /></div><div>b c
eri l
xin
s--&g
;infl mm
ry medi
rs--&g
;v sdil
in nd cl

ing</div>
Wh
re
he 3 clinic l s
ges f shck?
<div>Prim ry, nn-rgressive cmens
ed</div><div>Prgressive - l c
ic cidsis, ren l f ilure</div><div>Irr
eversible - severe rg n d m ge</div><div><br /></div>
Wh
mrhlgy is ssci
ed wi
h shck
 he r

issue?
"cn
r c
in b n
d necrsis<div>-esinhilic</div><div>-w vy b nds crss fibres</div><div>-fl

nuclei</div><div>-cn
r c
ed cells</div><div><br /></div><div><img src="" s
e27766963569007.jg"" /></div>"
Wh
mrhlgy is ssci
ed wi
h shck
 kidney?
" cu
e
ubul r necrsis<
div>-esinhilic PCT</div><div>-cell u
line bu
n nuclei</div><div>-bli
er

ed lumen</div><div><br /></div><div><img src="" s
e-27818503176552.jg"" /></di
v>"
Wh
mrhlgy is ssci
ed wi
h shck
 lung?
"diffuse lvel r d m ge
<div>-fibrin binds
 lveli--&g
;hy line membr ne</div><div><br /></div><div><
img src="" s
e-27852862914916.jg"" /></div>"
Wh
mrhlgy is ssci
ed wi
h shck
 dren l gl nds?
cr
ic l cell li
id dele
in
Wh
mrhlgy is ssci
ed wi
h shck
 GI
r c
? mucs l hemrrh ge
Wh
mrhlgy is sci
ed wi
h shck
 liver?
f

y ch nge nd necrsi
s
MI wi
h reerfusin le ds
 wh
&nbs;mrhlgy in he r
?
cn
r c
in b nd
necrsis
Resir
ry dis
ress syndrme le ds
 frm
in f wh
in lungs?
hy line
membr ne:<div><br /></div><div>Red inf rc
le ds
 le k ge f fibrin frm bld
vessels which binds
 lveli</div>
"<img src="" s
e-28054726377839.jg"" />"
cn
r c
in b nd necrsis
"<img src="" s
e-28089086116200.jg"" />"
cu
e
ubul r necrsis (PCT)
"<img src="" s
e-28114855919972.jg"" />"
"Diffuse lvel r d m ge<div><br
/></div><div><img src="" s
e-28127740821935.jg"" /></div>"
Wh
re Lines f Z hn? Is
his ch r c
eris
ic f n
e r s
mr
em cl
s?
Ch r c
eris
ic l
ern
ing l yers f l
ele
/fibrin desi
s nd RBC l yers<div
><br /></div><div> n
emr
em cl
s</div>
Wh
d s
mr
em cl
s lk like?
"Ps
mr
em cl
s re n


ched
 v
essel w lls, resemble in vi
r bld cl
s nd m y shw se r
in f <b>red cel
ls nd l sm </b> s
h

he cl

ed l sm resembles ""chicken f
"" l yered 
n
 f rubber gel
inus d rk red m ss f ery
hrcy
es resembling ""curren

jelly""<div><br /></div><div><img src="" s
e-35476429865342.jg"" /></div>"
Wh
is hleb
hrmbsis? Wh
re sme ch r c
eris
ics nd wh
re
hey ls
c lled?
"venus
hrmbsis
h
is lms
lw ys cclusive nd cn
in m
re red cells nd re c lled ""red/s
sis
hrmbi"""
Mur l
hrmbi re fund where? he r
ch mbers r r
ic lumen
Wh
re Vege

ins?

hrmbi n he r
v lves
Wh
re
he 2 b sic cmnen
s f
1. Nel s
ic cells
h
cns
i


umr?
u
e
he  renchym <div>2. Re c
ive s
rm cn
ining cnnec
ive
issue, bld ve
ssels, immune cells</div>
Cl ssific
in f
umrs is b sed n ________, bu

heir grw
h nd sre d re c
ri
ic lly deenden
n
heir _________  renchym l cmnen
<div><br /></div><d
iv>s
rm </div>
Define
he fllwing:<div><br /></div><div>Fibrm </div><div>Adenm </div><div>P
illm </div><div>Cys
denm </div><div>Ply</div><div>rh bdmym </div><div><
br /></div>
<div>Fibrm : benign
umr in fibrus
issue</div><div>Adenm :
benign
umr in gl ndul r
issue</div><div>P illm : benign
umr wi
h finger l
ike rjec
ins</div><div>Cys
denm : benign
umrs frming cys
s</div><div>Pl
y: benign
umr
h
rjec
s in
 lumen</div><div>rh bdmym : benign
umr f
skele
l muscle</div><div><br /></div>
"<img src="" s
e-39573828665727.jg"" />"
ly
"<br /><div><img src="" s
e-39599598469342.jg"" /></div>"
Ply
S rcm s re ______ in rigin<div>C rcinm s re _______ in rigin</div>

mesenchym l<div>ei
heli l</div>

Wh
re 4 exce
ins

he m lign ncy n ming rule?
lymhm <div>he
m </d
iv><div>neurbl s
m </div><div>mel nm </div>
Wh
is Ewing S rcm ? Wh
is i
s embrylgic l rigin?
M lign n
bne

umr<div><br /></div><div>Neur l cres
</div>
Wh
is wilms
umr? m lig n
ren l
umr
Wh
kind f
umr is lemrhic denm ?<div><br /></div><div>Wh
des i
u
su lly cn
in?</div><div><br /></div><div>Where is i
cmmnly fund?</div><div
><br /></div> "Tye f Mixed
umr in which
umr underges <b>divergen
diffe
ren
i
in</b>&nbs;<div><br /></div><div>Cn
in ei
heli l cmnen
s sc

ered
in myxid s
rm wi
h isl nds f c r
il ge r bne</div><div><br /></div><div
>S liv ry r P r
id gl nd</div><div><br /></div><div><img src="" s
e-401708291
20029.jg"" /></div>"
Where re cmmn l ces fr
er
m s
 e r?
v ry nd n
erir medi
s
inum
Wh
is cmmn
er
m ?
"Ov ri n dermid cys
r cys
ic
er
m <div><
br /></div><div><img src="" s
e-40278203302164.jg"" /></div>"
Wh
is cmmn h m r
m ?
"Pulmn ry chndrid h m r
m <div><br /></div><
div><div>A disrg nized by benign- e ring m sses cmsed f cells indigenus


he  r
icul r si
e</div><div>A ulmn ry chndrid h m r
m cn
ins isl nd
s f disrg nized bu
his
lgic lly nrm l c r
il ge, brnchi, nd vessels</div
></div><div><br /></div><div><img src="" s
e-40316858007961.jg"" /></div><div>
<br /></div>"
Wh
is cmmn chris
m ?
"Sm ll ndule f well develed  ncre
ic
issu
e fund in submucs , s
m ch, r dudenum<div><br /></div><div><img src="" s
e
-40437117092380.jg"" /></div><div><br /></div><div>Chris
m -
issue rlifer

ing in n re differen
frm
he indigenus
issues. In
he submucs , yu c
n see  ncre
ic isle
.</div>"
"<img src="" s
e-40480066765340.jg"" />"
Chris
m -
issue rlifer
in
g in n re differen
frm
he indigenus
issues. In
he submucs , yu c n se
e  ncre
ic isle
.
Wh
m lign ncy ch r c
eris
ic is cri
ic lly imr
n
when n lyzing   sme rs
?
High nucle r: cy
l smic r
i
Why d we use
he dB HL sc le? We dn
he r ll frequencies equ lly
"<img src="" s
e-46145128628626.jg"" /><div>Wh
des
his gr h shw?</div>"
The gr h belw shws
h
if yu w n

 he r sme
hing, we need higher mli
u
de fr lwer frequencies. We he r sund be

er
4 kHz
h n
100 Hz&nbs;
Wh
re
he 2 cmnen
s f he ring? cnduc
ive= ge

ing vibr
in frm u
si
de
 inside<div>sensrineur l=
urning vibr
in in
 elec
ric l sign l fr
he
br in</div>
Sunds
resn n
frequency re _____ mlified
Wh
is imed nce mism
ch?
sund desn
swi
ch well be
ween medium f dissi
mil r ccus
ic imed nce
The res n
frequency f
he E r c n l is due
 i
s leng
h r sh e? leng
h
Why d b bies like higher i
ched sunds?
B bies h ve shr
er e r c n ls s

heir resn n
frequencies re 10Hz (higher)
In
er ur l in
nsi
y difference r
he he d sh dw wrks well fr _________, bu

is n
s discrimin
ry fr _________ high frequency sunds; lw frequency su
nds
Wh
re
he 3 l yers f
he
ym nic membr ne? Wh
is
he his
lgic l s
ruc
u
re f e ch
cu
neus: s
r
ified squ mus<div>fibrus: u
er r di l, inner
circumferen
i l</div><div>mucs l: simle cubid l (nn cili
ed)</div>
Wh
is mnl min r l yer?
"If e r drum is ru
ured nd hle is big enugh,
mucs l l yer will fuse wi
h
he cu
neus l yer<div><img src="" s
e-467721938
53853.jg"" /></div>"
Wh

he
w surces f mlific
in
 m ke u fr
he 30dB lss in in
ensi
y
f sund when ging frm ir
 w
er? <div>1. Be
ween
he
ym nic membr ne n
d
he v l windw (+25 dB)&nbs;</div><div>2. Ossicles s mlifier (1.3x mlif
ic
in, s +27.5 dB bu
f vrs high frequencies &g
; 1 kHz)&nbs;</div>
Wh
is
he firs
bne
 ge
messed u in middle e r? dis
l end f incus: ver

y lusy bld suly

Wh
reflex reduces
he mli
ude f lw frequency sunds?
Accus
ic s
ed
i l reflex
A
i
s ening frm middle e r, ei
helium f eus
ci n
ube ch nges frm ______
__
 __________
simle cubid l
 seuds
r
ified cili
ed clumn r e
i
helium
If
here is us in
he middle e r, where else will i
be fund? m s
id cells! (
n
necess rily
sign f m s
idi
is)
Wh
is
he func
in f
he eus
chi n
ube
Le
s mre ir in

he middle e
r
 suly mucs l l yer f
ym nic membr ne nd reven

he frm
in f re

r c
in cke

Wh
wuld h en if yu h ve CN VII  r lysis befre middle e r?
Hyer cu
sis due
 lss f ASR (s
edi l muscle)<div><br /></div><div>Lw frequency vw
el sunds verwer high frequency cnsn n
sunds</div>
Wh
is chles
e
m ?
des
ruc
ive, ex nding grwh
f ker
inizing sq
u mus ei
helium in
he middle e r due
 re
r c
in cke
nd in bili
y fr e
x
ern l l yer f squ mus ei
helium
 rerly desqu m
e
Why d ele wi
h muscul r dys
rhy h ve
higher risk fr e r infec
ins?
Muscles f h rynx c n
llw eus
chi n
ube

r nsmi
ir s well
Wh
ch r c
eris
ics f eus
chi n
ube le ds
 mre e r infec
ins? (3)
shr
er<div>hri
zn
l</div><div>denser c r
il ge (n rrwer)</div>
Wh
is myringsclersis vs
ym nsclersis? Myringsclersis is C desi
i
n n TM<div>Tym nsclersis is C desi
in n ssicles&nbs;</div>
Wh
3
hings ccur
 TM if
here re recurren
e r infec
ins?<div><br /></div
><div>Wh
bu
res
f middle e r? (3)</div> C lcium desi
in (myringscler
sis)<div>Eiderm l egs</div><div>Fibrus
issue disrg niz
in</div><div><br
/></div><div>Ossicul r ersin</div><div>Jin
ersin</div><div>C lcium desi

in n ssicles (
ym nsclersis)</div>
Wh
is effec
f lchl n br in? Wh
bu
wi
hdr w l?&nbs;
"Binds

 NMDA rece
rs
 blck C 2+ influx<div>Binds
 GABA rece
rs
 incre se Cl
-influx</div><div><br /></div><div>Wi
hdr w l:&nbs;</div><div>Incre se C 2+ inf
lux due
 incre se f glu
m
e rece
rs f
er chrnic use f lchl</div><di
v><br /></div><div><img src="" s
e-51303384351216.jg"" /></div><div><br /></di
v><div><br /></div>"
Hw des chrnic use f lchl ch nge number f ch nnels?
"I
decre ses
h
e number f chlride ch nnels (GABA)<div><br /></div><div><img src="" s
e-51354
923958774.jg"" /></div><div><br /></div><div>Incre ses number f c lcium ch nne
ls (NMDA glu
m
e ch nnels)</div><div><br /></div><div><img src="" s
e-5136780
8860512.jg"" /></div>"
"<img src="" s
e-51896089837983.jg"" />"
D
"<img src="" s
e-51939039510778.jg"" />"
"<img src="" s
e-51951924412615
.jg"" />"
"<img src="" s
e-51977694216561.jg"" />"
D
"<img src="" s
e-52012053954953.jg"" />"
5
Where re h ir cells lc
ed in u
ricle, s ccule, semicircul r duc
, nd cchle
r duc
? m ccul e f u
ricle nd s ccule<div><br /></div><div>cris
e mull ris
f semicircul r duc
</div><div><br /></div><div>sir l rg n f cr
i in cchle
r duc
</div>
erilymh is in simil r inic cmsi
in
 _______ nd cn
ins li

le _______
__.<div><br /></div><div>Where des i
emerge frm?</div><div><br /></div><div>w
here des i
dr in
 nd by wh
?</div>
cerebrsin l fluid<div>li

le 
r
ein</div><div><br /></div><div>eris
eum</div><div><br /></div><div>by eril
ymh
ic duc

 sub r chnid s ce</div>
endlymh is ch r c
erized by wh
inic cn
en
?<div><br /></div><div>Wh
is i

gener
ed by?</div><div><br /></div><div>Where is i
dr ined
 nd by wh
?</
div>
high 
ssium, lw sdium<div><br /><div>1. s
ri v scul ris (sc l med
i ) f cchle </div><div>2. d rk cells f mull in semicircul r c n l</div><di
v><br /></div><div>Dr ined frm <b>ves
ibule</b> in
 <b>venus sinus f dur m

er</b> by sm ll <b>endlymh
ic duc
</b></div></div><div><b><br /></b></div><d
iv><b><br /></b></div>

s ccule nd u
ricle re cmsed f very
hin cnnec
ive
issue she
h lined wi

h __________ ei
helium<div><br /></div><div><br /></div><div>Tw m cul e re li
ned wi
h _______ cells, innerv
ed by ________</div>
"&nbs;simle squ mus<d
iv><br /></div><div>clumn r neurei
heli l cells</div><div><br /></div><div>ve
s
ibul r nerve<br /><div><br /></div><div><img src="" s
e-117673513976292.jg""
/></div><div><br /></div></div>"
Aic l end f e ch h ir cell h s _________
"kincilium wi
h bundle f s
e
rcili <div><br /></div><div><img src="" s
e-117707873714586.jg"" /></div><div
><img src="" s
e-117729348551066.jg"" /></div>"
Tis f s
ercili nd kincilium in m cul e f u
ricle nd s ccule re embedded
in wh
?
"
hick, gel
inus l yer f r
eglyc ns c lled ""
li
hic mem
br ne"" which h s c lcified 
li
hs in
hem<div><br /></div><div><img src="" s

e-117780888158692.jg"" /></div>"
E ch semicircul r duc
ex
ends frm nd re
urns

he w ll f
he ________
"u
ricle<div><br /></div><div><img src="" s
e-117896852275722.jg"" /></div>"
Hw des
he r
glyc n l yer ver

is f h ir cells &nbs;differ in u
ric
le/s ccule vs semicircul r duc
"m cul e f u
ricle nd s ccule h ve 
li
hic m
embr ne<div><br /></div><div><img src="" s
e-117944096915940.jg"" /></div><div
>cris
e mull ris f semicircul r duc
h s cul , which is
hicker nd desn

h ve 
li
hs</div><div><br /></div><div><img src="" s
e-117922622079498.jg""
/></div>"
Hw d mvemen
s f
he he d c
iv
e sensry h ir cell bundles?
mvemen

s f
he he d c use mvemen
f
he endlymh which mves
he 
li
h membr ne 
f m cul nd cuul ver cris
mull ris<div><br /></div><div>Sensry cell h i
r bundles in
hese r
eglyc n l yers bend, ch nging
he res
ing 
en
i l nd
r
e f n
m rele se
 fferen
nerves</div>
Wh
h ens when h ir bundle is deflec
ed
w rd
he kincilium?
"Ti lin
ks
h
cnnec
s
erecili re uled nd c
in ch nnels en
 llw influx 
f K+ resul
ing in del riz
in, C 2+ en
ry nnd rele se f n
m<div><br /></div
><div><img src="" s
e-118008521425418.jg"" /></div>"
H ir cells f cris
e mull res de
ec
________
r

in l r ngul r m
vemen
s f
he he d
Hw des cris
e mull res de
ec
r

in l mvemen
? On e ch side f
he he d
, h ir cells re rien
ed wi
h si
e l ri
y, s
h

urning
e he d c uses
h ir cell del riz
in n ne side nd hyerl riz
in n
he 
her<div><br
/></div><div>Neurns receive imu
frm se
s f semicircul r duc
s n
he b sis
f rel
ive
r nsmi

er disch rge r
es f
he 2 sides</div>
Hw des
he endlymh dr in in

he endlymh
ic duc
?
vi h gcy
sis
,
r nscy
sis, nd endcy
sis
U
ricle de
ec
s ________ mvemen
<div>S ccule de
ec
s _______ mvemen
s</div>
hrizn
l<div>ver
ic l</div>
Prblems f
he ves
ibul r sys
em c n resul
in&nbs; Ver
ig, r diziness,
sense f
he bdy r

ing nd
l ck f equilibrium
Cchle r duc
/sc l medi is cn
inuus wi
h wh
?
"s ccule<div><br /></div
><div><img src="" s
e-118128780509706.jg"" /></div>"
Wh
re
he 3  r llel cm r
men
s f
he cchle ? Wh
des e ch cm r
men

cn
in?
"<div>Sc l ves
ibuli: erilymh</div>cchle r duc
(sc l medi
): endlymh<div>sc l
ym ni: erilymh filled</div><div><br /></div><div><img
src="" s
e-118167435215370.jg"" /></div>"
Cchle r duc
is in re li
y, ne lng
ube beginning
_____ nd ending
____
___
"v l windw, rund windw<div><br /></div><div><img src="" s
e-1181631
40248074.jg"" /></div>"
Wh
se r
es
he sc l ves
ibuli frm
he sc l medi ?
"<img src="" s

e-113966957199882.jg"" /><div>Reisnners membr ne (simle squ mus ei
helium</
div>"
Wh
seer
es sc l
ym ni frm
he sc l medi ?
"B sil r membr ne m de 
f cll ge
ye 1<div><br /></div><div><img src="" s
e-113962662232586.jg"" /><
/div>"
Wh
is
he func
in f
he s
ri v scul ris? Where is
his fund?
"rduc

in nd m in
en nce f
he endlymh<div><br /></div><div>Fund in sc l medi </

div><div><br /></div><div><br /></div><div><br /></div><div><img src="" s
e-113

962662232586.jg"" /></div>"
Where is
he rg n f cr
i fund?
"in
he w ll
h
se r
es
he sc l me
di frm
he sc l
ym ni (b sil r membr ne regin)<div><br /></div><div><img s
rc="" s
e-113962662232586.jg"" /></div>"
Wh
re
he 2 m jr
yes f h ir cells resen
wi
hin
he sir l rg n (rg n
f cr
i)<div><br /></div><div>Hw d
hey differ in rg niz
in, sh e, nd l
c
in</div>
"1. u
er h ir cells: 3 rws ne r v l windw, curved rw f ln
ger s
erecili , embedded in
ec
ri l membr ne<div>2. inner h ir cells: ne rw
, line r rr y f shr
s
erecili ,&nbs;</div><div><br /></div><div><img src="
" s
e-118309169136138.jg"" /></div>"
Where re
he cell bdies f
he fferen
bil r neurns
h

r nsmi
sunds

"Bny cre f
he mdilus nd cns
i
u
e
he sir l g nglin<di

he br in?
v><br /></div><div><img src="" s
e-114503828111882.jg"" /></div>"
Wh
re ill r cells? "Cells
h
u
line
ri nglu r,
unnel like s ce be
w
een in
he inner nd u
er h ir cells<div><br /></div><div><img src="" s
e-1146
32677130762.jg"" /></div>"
Wh
re h l nge l cells?
"In
im
ely surrund nd direc
ly sur
b
h i
nner nd u
er h ir cells, lms
cmle
ely enclsing e ch IHC bu
nly
he b s
l ends f
he OHC<div><br /></div><div><img src="" s
e-114628382163466.jg"" /
></div>"
Wh
is
he 
h f sund w ves
hrugh
he e r?
"1. sund w ves en
er e
r nd c use
ym nic membr ne
 vibr
e<div>2.
ym nic membr ne vibr
in mve
s ssicles llwing w ves
 be mlified</div><div>3. s
es
v l windw gen
er
es<b> ressure w ves in erilymh wi
hin sc l ves
ibuli</b></div><div><b>4.
</b>&nbs;ressure w ves c use <b>reissners membr ne
 mve</b>, resul
ing in w
ve frm
in f <b>endlymh in
he sc l medi </b> nd
hen disl cemen
f <
b> secific regin f
he b sil r membr ne</b></div><div><br /></div><div>5. H i
r cells in
he rg n f cr
i re dis
r
ed nd ini

e nerve sign l

he c
chle r br nch f VIII</div><div>(IHC re mre he vily innerv
ed nd c
u lly se
nd
he sign ls
 CNS. OHC mlify
he sign l IHC send)</div><div>6. Rem ining 
ressure w ves re
r nsferred
 sc l
ym ni
 exi
inner e r
hrugh rund w
indw</div><div><br /></div><div><img src="" s
e-114898965103114.jg"" /></div>
"
"<img src="" s
e-114894670135818.jg"" />"
High frequency sunds rduce m xim l mvemen
f b sil r membr ne _________<div
><br /></div><div>Lwes
frequency sunds c n be de
ec
ed
 rduce mvemen
f
b sil r membr ne
_________</div>
"ne res
v l windw (l
s f
ye I cl
l gen, n rrw)<div><br /></div><div> ex f cchle (n
much
ye I cll gen, w
ider)</div><div><br /></div><div><img src="" s
e-115044993991178.jg"" /></div>
"
Wh
is
he func
in f sur
ing cells (h l nge l cells)
recircul
ing K+

 m in
in high K+ in endlymh
Wh
is BAHA? Hw des i
wrk?
bne nchred he ring id<div><br /></di
v><div>On
he b sis
h
vibr
ins f
he bne c n s
ill resul
in sensrineur
l he ring.</div><div><br /></div><div>Pele wi
h
hese h ve cnduc
ive he ring
lss</div>
Wh
is resby cusis? Why des
his ccur?
Lss f high frequency he ring b
efre lw frrequency he ring<div><br /></div><div>Likely ccurs bec use lw f s
unds h ve

r vel
hrugh
he high f r nge, s erh s
here is
rhy</div>
Cnnexin 26 is imr
n
in __________ (4 medi
rs?)
u
sm l recessive he r
ing lss<div><br /></div><div>K+ me
blism, cchle r develmen
disrder, h ir
cell lss, sir l g nglin neurn degener
in</div>
Wh
is benign  rxysm l si
in l ver
ig c used by? Disl ced 
cni
h

mull ris regin f semicircul r duc
s nd

r vel frm m cul e in

he cris

c use br in

hink he d is sinning
Wh
is suerir c n l dehisence syndrme?
Enh nced in
r cr ni l sund erc
e
in nd dizziness wi
h lud sunds nd ressure ch nges
Wh
is ves
ibul r neuri
is? Wh
is sym
m? In
ern l e r infl mm
in resum
bly due
 virus<div><br /></div><div>Acu
e unil
er l ves
ibul r defici
</div>

Wh
is menieres dise se? Wh
re c use nd sym
ms? C used by incre se ress

ure wi
hin membr nus l bryn
h. Ru
ures nd le ks endlymh in
 erilymh<div>
<br /></div><div>Sym
ms include ver
ig, ressure,
inni
us, he ring lss</div
>
Wh
re cchle r iml n
s?
sm ll device wrn behind
he e r, which cn
ins
micrhne, cnver
er, nd
r nsmi

er
h
sends elec
ric l imulses

re
ceiver
h
is
hre ded in
 in
ern l e r
h
s
imul
e
he nerve direc
ly
Wh
re sme drugs
h
c use 

xici
y?
ce
minhen<div> minglycside
</div><div> n
im l ri ls</div>
Wh
is
he webber
es
The Weber
es
is execu
ed by hi

ing
he
uning frk n
d
hen hlding i
in
he middle f
he 
ien
s frehe d.<div><br /></div><div>A
nrm l resul
is when
he sund is
he s me in b
h e rs. If
he sund is luder
in ne e r, i
is indic
ive f cnduc
ive he ring lss (CHL) in
h
e r r se
nsrineur l he ring lss (SNHL) in
he si
e e r. The reverse is ls
rue. I
f
he sund is quie
er in ne e r, i
is indic
ive f SNHL in
h
e r r CHL i
n
he si
e e r.</div>
Imir mine nd mi
ri
yline re ______ TCAs
Wh
effec

 be
3 rece
rs h ve in<div> dise</div><div>skele
l muscle</d
iv><div>urin ry bl dder</div> lilysis<div><br /></div><div>
hermgenesis</di
v><div><br /></div><div>rel x
in f bl dder</div>
As gru n mine ge
s l rger in c
ech lmines, hw des ffini
y fr be

nd
lh rece
rs ch nge? be
incre ses<div> lh decre ses</div>
"<img src="" s
e-121045063303375.jg"" />"
A
Wh
is
he effec
f Einehrine n&nbs;<div><br /></div><div>He r
R
e, CV,
Cn
r c
il
y, Lusi
ry</div><div><br /></div><div>Puil cns
ric
in/Dil
in</
div><div><br /></div><div>Brnchi l sm
h muscle</div><div><br /></div><div>Bl
d vessels
 skin</div><div><br /></div><div>Bld vessels
 skele
l muscle</
div><div><br /></div><div>Bl dder
ne</div><div><br /></div><div>Bl dder Shinc
<div>Einehrine

er</div><div><br /></div><div>Bld glucse level</div>
effec
s lh 1, 2, nd be
1, 2, 3</div><div><br /></div><div>He r
R
e, CV,
Cn
r c
il
y, Lusi
ry- incre se vi Be
1, Be
2</div><div><br /></div><div>P
uil cns
ric
in/Dil
in: dil
e vi lh 1</div><div><br /></div><div>Brnch
i l sm
h muscle: dil
e vi be
2</div><div><br /></div><div>Bld vessels

skin: cns
ric
vi lh 1 (ms
bld vessels h ve lh 1)</div><div><br /><
/div><div>Bld vessels
 skele
l muscle: cns
ric
vi lh 1 nd dil
e vi
be
2</div><div><br /></div><div>Bl dder
ne: decre se vi lh 2 nd be
2
</div><div><br /></div><div>Bl dder Shinc
er: cn
r c
vi lh 1</div><div><b
r /></div><div>Bld glucse level: incre se vi be
2</div>
A
hysilgic l cncen
r
ins (lwer cncen
r
ins) f einehrine des dil

in r cns
ric
in f bld vessels
 skele
l muscle redmin
e?
dil
in
(be
2)<div><br /></div><div>Be
2 rec
rs re mre sensi
ive
 EPI
h n l
h 1</div>
Why des NE h ve li

le effe
n brnchi l sm
h muscle nd bld glucse level
s
They dn
c
n be
2 rece
rs
Why des Isr
ernl h ve li

le effec
n bld vessels
 skin, cns
ric
in
f bld vessels
 skele
l muscle, nd li

le effec
n bl dder
ne nd bl dd
er shinc
ers? Desn
h ve effec
n lh rece
rs!
Effec
s f drenergic gnis
s deend n wh
3
hings? " 1/b2 rec
r r
i<div
>which drenergic rece
rs
he gnis
s wrk n</div><div>cncen
r
in</div><d
iv><br /></div><div><img src="" s
e-121508919771690.jg"" /><br /><div><br /></
div></div>"
Veins nd skin vesslels cn
in ms
ly wh

ye f rece
rs?
lh 1
"<img src="" s
e-121556164411717.jg"" />"
<div># 1 : ne shuld recgnize

he drug nd wh
cl ss i
belngs
.&nbs;</div><div>&nbs; &nbs; &nbs; &nbs
; Me
clr mide is d mine (D2) blcker.</div><div><br /></div><div>Nrm lly,
D mine decre ses rl c
in rele se frm i
ui
ry.</div><div>A d mine blck
er, will incre se rl c
in rele se frm i
ui
ry.</div><div><br /></div>
If einehrine is given
 smene wi
h hrners, which eye will dil
e mre?
The ffec
ed ey bec use rece
rs re uregul
ed in bsence f nrm l sym
he

ic innerv
in

<div> 2 gnis
s nd b blckers re useful

re
chrnic gl ucm .</div><div>

Which drug wuld yu chse if
he 
ien
h s ls high BP? Why?</div><div><br
/></div>
be
blckers: decre se c rdi c u
u
nd decre se rele se f r
enin<div><br /></div><div> lh 2 gnis
s ls hel reduce nreinehrine rele
se
hugh.</div>
Clnidine reduces rele se f ________ frm drenergic nerve
ermin ls nreine
hrine
Why is
yr mine cn
r indic
ed in MAOI T much c
echl mine in syn 
ic clef

.&nbs;<div><br /></div><div>inhibi
rs f MAO incre se c
echl mine cncen
r

in</div><div><br /></div><div>Tyr mine is n indirec
gnis

h
c uses
he r
ele se f NE</div>
Wh
is
he nly muscle f m s
ic
in
h
c n re
r c

he m ndible?

emr l
is
Infr
emr l fss cmmunic
es medi lly wi
h ________
hrugh _________

eryg l
ine fss <div><br /></div><div>
hru 
erygm xill ry fissure</div>
Wh
is
he rien

in f
he l
er l 
erygid muscle? Wh
re i
s l
er l

"<div>: The l
er l 
erygid muscle h s rel
ively hrizn
l

chmen
s
rien

in wi
h i
s l
er l

chmen
in

he he d f
he m ndible nd
he
r
icul r disc f
he
emrm ndibul r jin
TMJ</div><div><br /></div><div><img
src="" s
e-166825119711640.jg"" /></div><div><br /></div>"
Hw d we chieve l
er l grinding f
ee
h?
When
he 
erygid muscles n
h
e lef
side f
he f ce cn
r c
,
hey will shr
en nd ull
he lef
side f
h
e m ndible
w rd
he 
erygid rcess ( nd midline). As resul

he m ndible
s whle will mve w y frm
he midline (since in n
mic l si
in IT IS I
N
he midline)
w rd
he righ
side. In rder
 re
urn
he m ndible b ck

midline neu
r l si
in,
he 
erygid muscle n
he righ
side will cn
r c

nd shr
en. By l
ern
ing be
ween righ
side nd lef
side cn
r c
in f
he 

erygid muscles we re ble
 chieve l
er l grinding m
in f
he m ndibl
e.&nbs;
{{c1::bucc l f V3}} sulies&nbs;{{c2::gener l sensry
 b
h skin n u
side
f cheek nd mucs n inside f cheek}}
{{c1::Lingu l f V3}} sulies {{c2::gener l sensry
 n
erir 2/3 f
ngue}}
{{c1::hi
chhiking fibers f chrd
ym ni n lingu l f V3}} suly&nbs;{{c2::

s
e sensry
 n
erir 2/3 f
ngue}}
{{c1::inferir lvel r nerve}} sulies&nbs;{{c2::gener l sensry
 fibers f

ee
h nd m ndible}}
{{c1::
ermin l end f inferir lvel r}} exi
s
hrugh men
l fr men giving&nb
s;{{c2::gener l sensry
 skin f chin (men
l br nch)}}
{{c1:: uricul
emr l nerve}} c rries hi
chhiking PS fibers frm&nbs;{{c2::
i
c g nglin }}
&nbs;{{c3:: r
id gl nd}}
{{c1::dee
emr l nerve}} sulies {{c2::m
r innerv
in

emr is muscle
}}
Where des dee
emr l nerve lie? Is i
m
r r sensry?
dee

emr l
is muscle in
emr l fss (M
r)
Wh

w br nches f V3 c rry PS fibers?
Lingu l (
 subm ndibul r/sublin
gu l gl nds: PS f VII)<div>Auricul
emr l (
  r
id: PS f IX)</div>
Wh
innnerv
es uer
ee
h? Wh
br nch f V is
his frm?
s
erir sueri
r lvel r V2
Wh
innerv
es mylhyd nd n
erir belly f dig s
ric
"br nch cming 
ff inferir lvel r nerve<div><br /></div><div><img src="" s
e-168087840096796
.jg"" /></div>"
uricul
emr l nerve gener lly frms l rund&nbs;
middle meninge l
r
ery
Wh

w br nches des m xill ry r
ery give ff befre  ssing
hrug 
eryg
l
ine fss ? middle meninge l nd inferir lvel r
When des uricul
emr l nerve becme urely sensry g in?

he resyn 
ic
 r sym
he
ic fibers frm IX syn se in
he 
ic g nglin (lc
ed very ne r V
3
fr men v le). The s
syn 
ic fibers frm
he 
ic g nglin hi
ch hike 
n
he uricul
emr l nerve (f V3 gener l sensry
 skin)
 m ke
heir w y 
ver

he  r
id gl nd. The s
syn 
ic fibers f
he 
ic g nglin re secre


m
r

he gl nd. <b>Once
he uricul
emr l nerve  sses
hrugh
he gl n
d nd m kes i
s w y u

he skin, i
h s given ff ll i
s  r sym
he
ic fib
ers nd nce g in is urely gener l sensry nerve</b>
Wh

w bld
hinner medic
ins wrk synnergis
ic lly?
Asrin (inhibi
s
c
iv
in f l
el
s)<div>W rf rin: inhibi
s fibrin frm
in</div> A
Wh
is
he n
id
e
 n verdse f he rin? r
mine sulf
e
Wh
is clidgrel?
Pl vix: inhibi
s ADP rece
rs n l
le
es reven
ing

heir c
iv
in. irreversible
<div>Asirin nd He rin were dminis
ered

his 
ien

</div><div>reven

fur
her cl
frm
in.</div><div><br /></div><div>Asirin, Indme
h cin, Ibur
fen, N rxen re ll</div><div>NSAIDs (NnS
erid l An
i-infl mm
ry drugs.&nb
s;</div><div><br /></div><div>Why lw dse sirin is suerir
 
her NSAIDs
in reven
ing</div><div>fur
her cl
frm
in?&nbs;</div><div><br /></div><div
><div>Lw cs
- Asirin is che </div><div>Lng-
erm s fe
y recrd f ver 150
ye rs</div><div>Inhibi
s nly COX-1 nd n
COX-2</div><div>Inhibi
s COX enzyme
reversibly</div><div>Inhibi
s COX enzyme irreversibly</div></div><div><br /></di
v>
Inhibi
s Cx 1/2 irreversibly
Wh
f c
rs des He rin in c
iv
e? 2, 9, 10, 11, 12
Wh
is
he generic n me fr
PA
l
el se
"<img src="" s
e-174414326923629.jg"" /><div><br /></div><div>Wh
is
he n
i
d
e
 he rin verdse?</div>"
r
mine sulf
e<div><br /></div><div><
div>He rin is neg
ively ch rged lys cch ride sulf
e.</div><div>Pr
mine is
si
ively ch rged r
ein fund in serm (simil r
 his
nes bund
 DNA i
n chrmsmes).&nbs;</div></div><div><br /></div>
<div>If He rin is n
wrking nd&nbs;</div><div>W rf rin
kes d ys

ke e
ffec
,</div><div>wh

ins re v il ble mng n
ic gul n
s
h
wrks</div
><div>immedi
ely n c gul
in f c
rs.</div><div><br /></div><div>Remember
h

cl
is l
ele
s + Fibrin.</div><div><br /></div><div>Clidgrel</div><div>
Asirin</div><div>D big
r n</div><div>Mncln l n
ibdies g ins
l
ele
gl
ycr
ein II /IIIb</div><div>Cum din</div><div>Hirudin r Leirudin</div><div>
<br /></div>
<div>When he rin is n
wrking, direc

hrmbin inhibi
rs re
useful.</div><div>&nbs;D big
r n</div>
<div>Wh
is c 
ril?</div><div>Hw is c 
ril heling
his 
ien
?</div><d
iv><br /></div><div>&nbs;In
re</div><div>&nbs;ACE inhibi
r</div><div>&nbs
;ARB</div><div>&nbs;Diure
ic</div><div>&nbs;Cl
bus
er&nbs;</div><div><br />
</div><div>See n
es  ge</div><div><br /></div>
Ace inhibi
r
<div>Tre
men
wi
h ACE inhibi
rs resul
s in :</div><div><br /></div><div>Less
Angi
ensin II</div><div>Less Angi
ensin 1 nd Angi
ensin II</div><div>Less An
gi
ensin II nd mre Br dykinin</div><div>Less urine rduc
in</div><div>Mre
bld vlume</div><div><br /></div>
Less ngi
ensin nd mre br dykinin<div
><br /></div><div><div>ACE inhibi
s &nbs;Angi
ensin 1
Angi
ensin II</div><div
>ACE inhibi
rs ls inhibi
s degr d
in f br dykinin</div><div><br /></div><d
iv>Angi
ensin II nd br dykinin re n
gnis
ic in
heir c
ins.</div></div><d
iv><br /></div>
Hw des c 
ril hel 
ien
s wi
h he r
f ilure? (2)<div><br /></div><div><d
iv>&nbs;Incre sing bld vlume</div><div>&nbs;Decre sing bld vlume</div><d
iv>&nbs;Lwering bld ressure</div><div>&nbs;Incre sing C rdi c u
u
/ sys
"<div>He r
f il

emic BP</div><div>&nbs;Dil
ing bld vessels</div></div>
ure 
ien
s h ve high venus ressure le ding
 high end di s
lic vlume, ul
mn ry cnges
in, nd lw BP</div><div><br /></div><div><br /></div><div><div>A
CE inhibi
rs decre se bld vlume (by decre sing sdium nd w
er re bsr
in
).</div><div>Less bld vlume n venus side le ds
 less end di s
lic vlume
nd mre efficien
c rdi c uming</div><div><br /></div><div><img src="" s
e175264730448257.jg"" /></div><div><br /></div><div><br /></div><div><br /></div
><div><br /></div></div>"
"<img src="" s
e-27964532064259.jg"" /><div><br /></div><div>Hw is
he m lign
ncy sre ding here?</div>"
Cln c ncer inv ding in
 eri
neum. <b>Seedin
g in
 bdy c vi
y.</b>
"<img src="" s
e-28222230102019.jg"" /><div><br /></div><div>Wh
is seen here
? In wh

ye f m lign ncy (c rcinm /s rcm ) is
his mre cmmn?</div>"

Hem
genus sre d - m inly seen in <b>s rcm s</b> bu
ls seen in c rcinm s
.<div><br /></div><div>Sever l mini
umrs resul
.</div>
"<img src="" s
e-28415503630339.jg"" /><div><br /></div><div>Hw is
his m lig
n ncy sre ding?</div>" Bre s
c rcinm ---+ lymh
ics
The 3 ms
cmmn c ncers in m les in rder re {{c1::rs

e (25%), lung (15%)
, cln nd rec
um (10%)}}; in fem les i
is {{c1::bre s
c ncer (26%), lung (14
%), nd cln nd rec
um (10%)}}. Knw
he incidence. "<img src="" s
e-287075
61406467.jg"" />"
The 3 ms
cmmn c uses f c ncer de
h in m les in rder re {{c1::lung (31%),
rs

e (10%), nd cln nd rec
um (8%)}}; in fem les
hey re {{c1::lung (26
%) nd bre s
(15%)}}. "<img src="" s
e-30021821399043.jg"" />"
<div>The l s
h lf cen
ury h s seen sh r decline in
he number f de
hs by {
{c1::cervic l c ncer}} l rgely due
 P  nicl u (P ) sme r
es
.&nbs;Als
dwnw rd
rend in {{c1::s
m ch c ncer}}, l rgely due

reduc
in in die
ry
c rcingens</div><div><br /></div>
Ms
c rcinm s ccur l
er
h n {{c1::55}} ye rs f ge. C ncer is
he m in c u
se f de
h in wmen ged {{c1::40-79}} nd men {{c1::60-79}}.&nbs;This rising
incidence wi
h ge m y be exl ined by
he ccumul
in f {{c1::sm
ic mu

i
ns}}.
<div>Ms
benign nel sms DO/ DO NOT becme c ncerus?</div><div><br /></div>
DO NOT;
hugh
hey m y
<div>Abu
{{c1::15%}} f ll c ncers wrldwide re believed
 be c used direc

ly r indirec
ly by infec
ius gen
s.&nbs;{{c1::HPV}} is resnsible fr l r
ge m jri
y f cervic l c ncer c ses</div><div><br /></div>
Wh
is
he single ms
cn
ribu
ing envirnmen
l f c
r cn
ribu
ing
 rem

ure de
h in
he US? I
is linked
 incre sed incidence in sever l
ye f c nc
ers.
Smking
Hw des lchl ffec
c ncer incidence? Which c ncers?
<div>Incre ses

he risk f c ncers f
he rh rynx, l rynx, esh gus, nd liver.</div>
Die
, besi
y, dverse sexu l h bi
s, smking, ccu
in l exsure, lifelng e
xsure
 es
rgen ( r
icul rly in
he bsence f rges
erne) ll incre se

he incidence f cer
in c ncers. Wh

yes f c ncer is es
rgen linked
?
bre s
nd endme
ri l c ncers
J  n h s n incre sed risk f wh

ye f c ncer? Wh
bu
Aus
r li nd New
Ze l nd?
s
m ch<div><br /></div><div>skin c ncer</div>
Arsenic nd rsenic cmunds le d
 wh
? Wh

ye f cmnen
s cn
in rse
nic?
<div>squ mus cell c rcim f skin, lung c ncer, ngis rcm f liver<
/div><div><br /></div><div>By-rduc
f me
l smel
ing; cmnen
f llys, el
ec
ric l nd semicnduc
r devices, medic
ins nd herbicides, fungicides, nd
nim l dis</div><div><br /></div>
<div>Asbes
s</div>
<div>Lung, esh ge l, g s
ric, cln c rcinm , mes
he
lim </div><div><br /></div><div>Frmerly used fr m ny lic
ins bec use f
fire, he
, nd fric
in resis
nce; s
ill fund in exis
ing cns
ruc
in s wel
l s fire-resis
n

ex
iles, fric
in m
eri ls (i.e., br ke linings), underl y
men
nd rfing  ers, nd flr
iles</div><div><br /></div>
Benzene <div><b>Acu
e myelid leukemi </b> - frm
in f mylbl s
s
em cells -+ WBCs --+ neu
rhils</div><div><br /></div><div>Princi l cmnen
f ligh

il; desi
e knwn risk, m ny lic
ins exis
in rin
ing nd li
hgr hy, 
in
, rubber, dry cle ning, dhesives nd c
ings, nd de
ergen
s; frmerly wide
ly used s slven
nd fumig n
.</div><div><br /></div>
<div>Beryllium nd beryllium cmunds</div><div><br /></div> <div>Lung c rcin
m </div><div><br /></div><div>Missile fuel nd s ce vehicles; h rdener fr lig
h
weigh
me
l llys,  r
icul rly in ers ce lic
ins nd nucle r re c

rs</div><div><br /></div>
<div>C dmium nd c dmium cmunds</div><div><br /></div>
<div>Prs

e c
rcinm </div><div><br /></div><div>Uses include yellw igmen
s nd hshrs; f
und in slders; used in b

eries nd s lly nd in me
l l
ings nd c
in
gs</div><div><br /></div>
<div>Chrmium cmunds</div> <div>Lung c rcinm </div><div><br /></div><div>C
mnen
f me
l llys,  in
s, igmen
s, nd reserv
ives</div><div><br /></

div>
<div>Nickel cmunds</div><div><br /></div>
<div>Lung nd rh rynge l c rc
inm </div><div><br /></div><div>Nickel l
ing; cmnen
f ferrus llys, ce
r mics, nd b

eries; by-rduc
f s
inless-s
eel rc welding</div><div><br /
></div>
<div>R dn nd i
s dec y rduc
s</div> <div>Lung c rcinm </div><div><br /></di
v><div>Frm dec y f miner ls cn
ining ur nium; 
en
i lly serius h z rd in
qu rries nd undergrund mines</div><div><br /></div>
<div>Vinyl chlride</div>
<div><b>He
ic ngis rcm </b></div><div><br /
></div><div><b>Refriger n
</b>; mnmer fr vinyl lymers; dhesive fr l s
ic
s; frmerly<b> iner
ersl rell n
in ressurized cn
iners</b></div><div>
<br /></div>
<div>Acquired cndi
ins
h
redisse
 c ncer c n be divided in
 3 c
egr
ies: {{c1::chrnic infl mm
in, recursr lesins, nd immundeficiency s

es}
}</div><div><br /></div><div>Precursr lesins c n be defined s {{c2::lc lized
mrhlgic ch nges
h
re ssci
ed wi
h high risk f c ncer}}</div><div>
<br /></div>
Fr 
ien
s wi
h chrnic infl mm
in,
here is incre sed risk f c ncer in 

ien
s wi
h&nbs;chrnic infl mm
ry cndi
ins f
he GI
r c
. Sme f
hese c
hrnic infl mm
in disrders include (4):<div><br /></div><div><div>{{c1::Ulcer

ive cli
is, H ylri g s
ri
is, vir l he
i
is, nd chrnic  ncre
i
is}}</
div></div><div><br /></div><div><div>Mech nism is uncle r, s {{c1::COX-2}} inhi
bi
rs reduce infl mm
in -i
is n re f rese rch fr c ncer
re
men
</div>
</div><div><br /></div>
<div>P
ien
s wh re immundeficien
, nd  r
icul rly
hse wh h ve defici
s
in {{c1::T-cell immuni
y}}, re
incre sed risk fr c ncers.&nbs;M inly {{c1:
:lymhm s}} bu
ls {{c1::c rcinm s}} nd even sme {{c1::s rcm s}}.</div><d
iv><br /></div>
"<img src="" s
e-37705517891587.jg"" /><div><br /></div><div>Mes
helim </div
><div>Wh

hlgic l cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</di
v>"
<div><b>Asbes
sis nd silicsis redissing
 mes
helim (shwn b
ve) nd lung c rcinm </b> (ins
ig
ed by
he sbes
s fibers nd silic  r
icl
es). m ge f mes
helim : &nbs;Mes
helim frms cvering ver
he en
ire l
ung
h
c n be e sily remved bu
i
s difficul

 reven
grw
h&nbs;</div><
div><br /></div>
"<img src="" s
e-38079180046339.jg"" /><div>IBD</div><div>Wh

hlgic l c
ndi
in nd ssci
ed nel sm?</div>" <div><b>Infl mm
ry bwel dise se redi
ssing
 clrec
l denc rcinm </b>. This is mder
ely differen
i
ed
u
mr&nbs;</div><div>&nbs;</div>
"<img src="" s
e-38152194490371.jg"" /><div>Lichen Sclersis</div><div>Wh

<div><b>Lichen sclersis

hlgic l cndi
in nd ssci
ed nel sm?</div>"
redissing
 vulv r squ mus cell c rcinm . The lef
side is nrml wi
h ri
dges. As yu g

he righ
, i
is fl

ened (n ridges) nd incre se in cll g
en in
he dermis (hence sclersis). If un
re
ed, n
he righ

here re blue d

s in
he dermis (infl mm
ry cells)&nbs;</b></div><div><b><br /></b></div><di
v><div>Lichen sclersus (LIE-kun skluh-ROW-sus) is n uncmmn cndi
in
h
cr
e
es 
chy, whi
e skin
h
s
hinner
h n nrm l. Lichen sclersus m y ffec

skin n ny  r
f yur bdy, bu
ms
f
en invlves skin f
he vulv , fres
kin f
he enis r skin rund
he nus.</div><div><br /></div><div>Anyne c n
ge
lichen sclersus, bu
s
men us l wmen re
highes
risk. Lef
un
re

ed, lichen sclersus m y le d
 
her cmlic
ins.</div></div>
"<img src="" s
e-38371237822467.jg"" /><div>P ncre
i
is</div><div>Wh

hl
<div><b>
gic l cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div>"
P ncre
i
is redissing
  ncre
ic c rcinm -</b>
here is n s
rm be
we
en gl nds. C n be ins
ig
ed by lchlism nd germline mu

ins&nbs;</div><di
v><br /></div><div>The gl nds h ve li

le surrunding s
rm - very
igh
gl nds
.</div>
"<img src="" s
e-38452842201091.jg"" /><div>Chrnic chlecys
i
is</div><div>Wh

is
he 
hlgic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div>"
<b>Chrnic chlecys
i
is redissing
 g llbl dder c ncer </b>(c n be ins
ig

ed by bile cids, b c
eri , g lls
nes). These re r re nd lms
lw ys well d

ifferen
i
in.
"<img src="" s
e-38560216383491.jg"" /><div>Esh ge l C rcinm </div><div>Wh

is
he 
hlgic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div>"
Reflux esh gi
is - B rre

esh gus redissing
 esh ge l c rcinm (ins

ig
ed by g s
ric cid)&nbs;
"<img src="" s
e-38659000631299.jg"" /><div>MALT lymhm </div><div>Wh
is
h
e 
hlgic cndi
in, ssci
ed nel sm?</div>"
<b>Sjgren syndrme, H s
him

hyridi
is</b> (chrnic infl mm
in f
hyrid) redissing
 MALT ly
mhm s (MALT lymhm s ls ccur in<b> H. ylri</b> infec
ins nd c n g w
y if H. ylri is remved)&nbs;
"<img src="" s
e-38873748996099.jg"" /><div>Chl ngis rcm </div><div>Wh
is

he 
hlgic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div>"
<div>Ois
hrchis nd <b>chl ngi
is</b> (infl mm
in f liver bile duc
) redi
ssing
 <b>chl ngic rcinm , he
cellul r c rcinm , nd cln c rcinm <
/b>. C n be ins
ig
ed by<b> Liver flukes</b> (is
hrchis viverrini).&nbs;</d
iv>
"<img src="" s
e-38951058407427_1407034041372.jg"" /><div>G s
ri
is</div><div>
Wh
is
he 
hlgic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div
>"
<div>G s
ri
is nd ulcers redissing
 <b>g s
ric denc rcinm nd
MALT lymhm </b> (c n be ins
ig
ed by H. ylri) N
ice
he huge incre se in i
nfl mm
in n
he lef
(
here re n gl nds).&nbs;</div><div><br /></div>
"<img src="" s
e-39049842655235.jg"" /><div>He
cellul r c rcinm </div><div
>Wh
is
he 
hlgic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</di
v>"
<div><b>He
i
is redissing he
cellul r c rcinm (c n be ins
ig

ed by HeB/C virus). There is n irregul ri
y in gl nds nd
here is gi n
cel
l wi
h huge nucleus n
he righ
</b></div>
"<img src="" s
e-47691316854787.jg"" /><div><img src="" s
e-47704201756675.j
g"" /></div><div>Os
emyeli
is</div><div>Wh
is
he 
hlgic cndi
in, ssc
i
ed nel sm, nd e
ilgic gen
?</div>"
Os
emyeli
is redissing
 c
rcinm in dr ining sinuses (c n be ins
ig
ed by b c
eri l infec
in) They
end

 redisse
 ggressive squ mus cell c rcinm s.&nbs;
"<img src="" s
e-47815870906371.jg"" /><div>Cervic l C rcinm </div><div>Wh

is
he 
hlgic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div>"
Chrnic cervi
is redissing
 cervic l c rcinm (ins
ig
ed by HPV)&nbs;
"<img src="" s
e-48030619271171.jg"" /><div><br /></div><div><img src="" s
e48043504173059.jg"" /></div><div>Chrnic cys
i
is</div><div>Wh
is
he 
hl
gic cndi
in, ssci
ed nel sm, nd e
ilgic gen
?</div>" Chrnic cys
i
is
redissing
 bl dder c rcinm s (c n be ins
ig
ed by Schis
smi sis). On l
ef

he  r si
es h ve died nd c lcified nd c using chrnic irri

in (ex ml
e f Ps mmm bdies)&nbs;
"<img src="" s
e-190361540493733.jg"" /><div><br /><div><img src="" s
e-19037
4425395607.jg"" /></div><div><br /></div><div><img src="" s
e-190421670035864.
jg"" /></div><div><br /></div><div><img src="" s
e-190391605264792.jg"" /></d
iv></div>"
Mild<div><br /></div><div>Mder
e</div><div><br /></div><div>CI
S</div><div><br /></div><div>CIS</div>
"<img src="" s
e-190520454283618.jg"" /><div><img src="" s
e-190533339185554.
jg"" /></div>" fibrdenm
"<img src="" s
e-190571993891198.jg"" /><div><img src="" s
e-190584878793087.
jg"" /></div>"
hyrid denm
"<img src="" s
e-190632123433374.jg"" /><div><img src="" s
e-190645008335260.
jg"" /></div>" bre s
c rcinm <div><br /></div><div>c n see l
s f infl mm

ry cells, disrg nized gl nds</div>
Hw de benign vs m lign n

umrs differ in
heir grss e r nce
<div>Gr
ss e r nce</div><div><br /></div><div>Benign lc lized, ushing brder, enc 
sul
ed, hmgeneus cu
surf ce, sf
</div><div><br /></div><div>M lign n
infi
l
r
ive, he
ergeneus surf ce, <b>hemrrh ge & m; necrsis</b>, firm</div><di
v><br /></div>
Hw d benign vs m lig n n

umrs differ in
heir micrscic e r nce
<div>Micrscic e r nce</div><div>Benign well differen
i
ed, surrunded by

c sule</div><div>M lign n
v ri ble differen
i
in, mi
ses, lemrhism, hy

erchrm
ic, high N:C</div><div><br /></div>
Me
s
isis m rks
umr s m lign n
exce
fr wh

w c ncers?
glim s
f CNS<div>b s l cell c rcinm s f skin</div>
Wh

ye f c ncers
yic lly sre d vi lymh
ics?&nbs;<div><br /></div><div
>hem
genus sre d?</div>
lymh
ic: c rcinm s<div>hem
genus sre d: s
rcm s</div>
Fd ges
hrugh r l fissure &nbs;<div>{{c1::r l ves
ibule}} </div><div>r l c
vi
y </div><div>rh rynx &nbs;</div><div>l ryngh rynx &nbs;</div><div>esh
gus</div><div><br /></div><div>Air ges
hrugh nse </div><div>N sh rynx </div>
<div>rh rynx </div><div>l ryngh rynx </div><div>l rynx </div><div>lungs</div>
"<div>{{c1::Or l ves
ibule}} - s ce be
ween lis/cheeks nd den
l rch</div><d
iv><br /></div><div>{{c1::Or l  l
glss l rch}} - divisin be
ween r l c vi

y (h rd  l
e) nd rh rynx (sf
 l
e)</div><div><br /></div><div><img sr
c="" s
e-22539988369409.jg"" /></div>"
"<img src=""9144e92c309f5 fb6661e58846cd303f0f89b9e5_Q_0 (10).svg"" />" "<img sr
c=""9144e92c309f5 fb6661e58846cd303f0f89b9e5_A_0 (10).svg"" />" "<img src=""9144
e92c309f5 fb6661e58846cd303f0f89b9e5_surce_svg (10).svg"" />" "<img src=""9144
e92c309f5 fb6661e58846cd303f0f89b9e5_
muuizr.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_0.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_0.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_1.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_1.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_2.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_2.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_3.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_3.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_4.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_4.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_5.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_5.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_6.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_6.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_7.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_7.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_8.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_8.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_9.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_9.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_10.svg"" />"
"<img sr

c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_10.svg"" />"

"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
"<img src=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_Q_11.svg"" />"
"<img sr
c=""503c6705c46d 566d0 73bd1b7e42890ef ee24d_A_11.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_surce_svg.svg"" />"
"<img src=""503c
6705c46d 566d0 73bd1b7e42890ef ee24d_
mx
yeq.ng"" />"
<div><div>If frenulum is
 lng, {{c1::g -

hed}}</div><div>If frenulum is

 shr
, {{c1::seech 
hlgy}}</div></div>
<div>All
he
ngue muscles (ending in -glssus) re innerv
ed by
he hyglss
l nerve (CN XII) EXCEPT fr
he {{c1:: l
glssus}}.</div>
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_0.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_1.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_2.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_3.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_4.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_5.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_6.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_7.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
"<img src="" 2cffb2445b46c3c27db05146 f0842d36e780f3_Q_8.svg"" />"
"<img sr
c="" 2cffb2445b46c3c27db05146 f0842d36e780f3_A_0.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_surce_svg.svg"" />"
"<img src="" 2cf
fb2445b46c3c27db05146 f0842d36e780f3_
m ymkv9.ng"" />"
<div>The inferir lvel r nerve (V3)&nbs;en
ers
he {{c1::m ndibul r fr men}}
nd exi
s
he {{c1::men
l fr men}}</div><div>Becmes
he men
l nerve</div><d
iv>Sensry frm
he chin nd lwer li</div>
"<img src=""8b35bc58bb517 e38402 301e0b0 b 06 fef 6_Q_0.svg"" />"
"<img sr
c=""8b35bc58bb517 e38402 301e0b0 b 06 fef 6_A_0.svg"" />"
"<img src=""8b35
bc58bb517 e38402 301e0b0 b 06 fef 6_surce_svg.svg"" />"
"<img src=""8b35
bc58bb517 e38402 301e0b0 b 06 fef 6_
m3bm5 z.ng"" />"
"<img src=""8b35bc58bb517 e38402 301e0b0 b 06 fef 6_Q_1.svg"" />"
"<img sr
c=""8b35bc58bb517 e38402 301e0b0 b 06 fef 6_A_1.svg"" />"
"<img src=""8b35
bc58bb517 e38402 301e0b0 b 06 fef 6_surce_svg.svg"" />"
"<img src=""8b35
bc58bb517 e38402 301e0b0 b 06 fef 6_
m3bm5 z.ng"" />"
{{c1::Geniglssus}}

ches
 suerir men
l sine<div>{{c1::Genihyid}}


ches
 inferir men
l sine</div>

"<img src=""4e69d326 0fc9e9570 5c b e003fd0e67456056_Q_0.svg"" />"

"<img sr
c=""4e69d326 0fc9e9570 5c b e003fd0e67456056_A_0.svg"" />"
"<img src=""4e69
d326 0fc9e9570 5c b e003fd0e67456056_surce_svg.svg"" />"
"<img src=""4e69
d326 0fc9e9570 5c b e003fd0e67456056_
mkgsu.ng"" />"
"<img src=""4e69d326 0fc9e9570 5c b e003fd0e67456056_Q_1.svg"" />"
"<img sr
c=""4e69d326 0fc9e9570 5c b e003fd0e67456056_A_1.svg"" />"
"<img src=""4e69
d326 0fc9e9570 5c b e003fd0e67456056_surce_svg.svg"" />"
"<img src=""4e69
d326 0fc9e9570 5c b e003fd0e67456056_
mkgsu.ng"" />"
"<img src=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _Q_0.svg"" />"
"<img sr
c=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _A_0.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _surce_svg.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _
mvsbsw.ng"" />"
"<img src=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _Q_2.svg"" />"
"<img sr
c=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _A_0.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _surce_svg.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _
mvsbsw.ng"" />"
"<img src=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _Q_3.svg"" />"
"<img sr
c=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _A_0.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _surce_svg.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _
mvsbsw.ng"" />"
"<img src=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _Q_4.svg"" />"
"<img sr
c=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _A_0.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _surce_svg.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _
mvsbsw.ng"" />"
"<img src=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _Q_5.svg"" />"
"<img sr
c=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _A_0.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _surce_svg.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _
mvsbsw.ng"" />"
"<img src=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _Q_6.svg"" />"
"<img sr
c=""4f33f684c91c19bf 0f70e304c6f3c15e6 9b0f _A_0.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _surce_svg.svg"" />"
"<img src=""4f33
f684c91c19bf 0f70e304c6f3c15e6 9b0f _
mvsbsw.ng"" />"
A

ching

he lingul is
he {{c1::shenm ndibul r lig men
}} which susends

he m ndible. shenm ndibul r lig men
: sine f shenid
 lingul
<div>Tendn in
ersec
in be
ween bellies f dig s
ric slides
hrugh {{c1::s
yl
hyid}} nd sling frm {{c1::lesser hrn f hyid}}</div>
"<img src=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_Q_0.svg"" />"
"<img sr
c=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_A_0.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_surce_svg.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_
mmfmhg.ng"" />"
"<img src=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_Q_1.svg"" />"
"<img sr
c=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_A_1.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_surce_svg.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_
mmfmhg.ng"" />"
"<img src=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_Q_2.svg"" />"
"<img sr
c=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_A_2.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_surce_svg.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_
mmfmhg.ng"" />"
"<img src=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_Q_3.svg"" />"
"<img sr
c=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_A_3.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_surce_svg.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_
mmfmhg.ng"" />"
"<img src=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_Q_4.svg"" />"
"<img sr
c=""641732424cb c0e7d2c7b507 6f24d6057 49f 6_A_4.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_surce_svg.svg"" />"
"<img src=""6417
32424cb c0e7d2c7b507 6f24d6057 49f 6_
mmfmhg.ng"" />"
"<img src=""40fd505473 e571624f6f e1b 685d7800f27958_Q_0.svg"" />"
"<img sr
c=""40fd505473 e571624f6f e1b 685d7800f27958_A_0.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_surce_svg.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_
m36m19.ng"" />"

"<img src=""40fd505473 e571624f6f e1b 685d7800f27958_Q_1.svg"" />"

"<img sr
c=""40fd505473 e571624f6f e1b 685d7800f27958_A_0.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_surce_svg.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_
m36m19.ng"" />"
"<img src=""40fd505473 e571624f6f e1b 685d7800f27958_Q_2.svg"" />"
"<img sr
c=""40fd505473 e571624f6f e1b 685d7800f27958_A_0.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_surce_svg.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_
m36m19.ng"" />"
"<img src=""40fd505473 e571624f6f e1b 685d7800f27958_Q_3.svg"" />"
"<img sr
c=""40fd505473 e571624f6f e1b 685d7800f27958_A_0.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_surce_svg.svg"" />"
"<img src=""40fd
505473 e571624f6f e1b 685d7800f27958_
m36m19.ng"" />"
<div>The {{c1::sublingu l}} gl nd lies suerir

he mylhyid while
he {{c1:
:subm ndibul r}} gl nd lies ms
ly inferir
 i
.</div><div>Tngue ls

che
s

he geni l/men
l sine, suerir

he mylhyid nd h s
he {{c2::lingu
l r he}} dwn
he middle (if i
desn
fuse, ge
frked
ngue)</div>
<div>{{c1::Lingu l}} nerve  sses lng m ndible under
he r l mucs , clse


he r
s f wisdm

h, nd c n be d m ged during n ex
r c
in.&nbs;</div>
"<img src=""f7b3470f 471d426672628 ff4e5c591b317224f_Q_0.svg"" />"
"<img sr
c=""f7b3470f 471d426672628 ff4e5c591b317224f_A_0.svg"" />"
"<img src=""f7b3
470f 471d426672628 ff4e5c591b317224f_surce_svg.svg"" />"
"<img src=""f7b3
470f 471d426672628 ff4e5c591b317224f_
mmskymi.ng"" />"
"<img src=""f7b3470f 471d426672628 ff4e5c591b317224f_Q_1.svg"" />"
"<img sr
c=""f7b3470f 471d426672628 ff4e5c591b317224f_A_0.svg"" />"
"<img src=""f7b3
470f 471d426672628 ff4e5c591b317224f_surce_svg.svg"" />"
"<img src=""f7b3
470f 471d426672628 ff4e5c591b317224f_
mmskymi.ng"" />"
"<img src=""f7b3470f 471d426672628 ff4e5c591b317224f_Q_2.svg"" />"
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"<img src=""f7b3
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"<img src=""f7b3
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d166463b2 4ed76f0683ccdf11e2cfdb722_
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"<img src=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_Q_2.svg""
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"<img src=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_Q_3.svg""
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d166463b2 4ed76f0683ccdf11e2cfdb722_
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"<img src=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_Q_4.svg""
c=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_A_4.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_surce_svg.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_
mi6fls2.ng"" />"
"<img src=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_Q_5.svg""
c=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_A_5.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_surce_svg.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_
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"<img src=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_Q_6.svg""
c=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_A_6.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_surce_svg.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_
mi6fls2.ng"" />"
"<img src=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_Q_7.svg""
c=""78dd d166463b2 4ed76f0683ccdf11e2cfdb722_A_7.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_surce_svg.svg"" />"
d166463b2 4ed76f0683ccdf11e2cfdb722_
mi6fls2.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_0.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_1.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
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"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_2.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_4.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
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"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_5.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_6.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_7.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_8.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
.ng"" />"
"<img src="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_Q_9.svg""
c="" f3b1 50 62f27ed50646062498bd3f04 4ecd 1_A_0.svg"" />"

"<img src=""78dd
/>"
"<img sr
"<img src=""78dd
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"<img sr
"<img src=""78dd
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"<img sr
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"<img sr
"<img src=""78dd
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"<img sr
"<img src=""78dd
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"<img sr
"<img src="" f3b
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"<img sr
"<img src="" f3b
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"<img sr
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"<img sr
"<img src="" f3b
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"<img sr
"<img src="" f3b
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"<img sr
"<img src="" f3b
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"<img sr
"<img src="" f3b
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"<img sr
"<img src="" f3b
"<img src="" f3b
/>"
"<img sr
"<img src="" f3b

1 50 62f27ed50646062498bd3f04 4ecd 1_surce_svg.svg"" />"

"<img src="" f3b
1 50 62f27ed50646062498bd3f04 4ecd 1_
mhzii
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"<img src=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_Q_0.svg"" />"
"<img sr
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"<img src=""0268
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"<img src=""0268
2c8d59fecc305 7203f9b0 e14e2cfb78b8d_
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"<img src=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_Q_1.svg"" />"
"<img sr
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"<img src=""0268
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"<img src=""0268
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"<img src=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_Q_2.svg"" />"
"<img sr
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"<img src=""0268
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"<img src=""0268
2c8d59fecc305 7203f9b0 e14e2cfb78b8d_
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"<img src=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_Q_3.svg"" />"
"<img sr
c=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_A_3.svg"" />"
"<img src=""0268
2c8d59fecc305 7203f9b0 e14e2cfb78b8d_surce_svg.svg"" />"
"<img src=""0268
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"<img src=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_Q_4.svg"" />"
"<img sr
c=""02682c8d59fecc305 7203f9b0 e14e2cfb78b8d_A_4.svg"" />"
"<img src=""0268
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"<img src=""0268
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"<img src=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_Q_0.svg"" />"
"<img sr
c=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_A_0.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_surce_svg.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_
m76_c2e.ng"" />"
"<img src=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_Q_1.svg"" />"
"<img sr
c=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_A_1.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_surce_svg.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_
m76_c2e.ng"" />"
"<img src=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_Q_2.svg"" />"
"<img sr
c=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_A_2.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_surce_svg.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_
m76_c2e.ng"" />"
"<img src=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_Q_3.svg"" />"
"<img sr
c=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_A_3.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_surce_svg.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_
m76_c2e.ng"" />"
"<img src=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_Q_4.svg"" />"
"<img sr
c=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_A_4.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_surce_svg.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_
m76_c2e.ng"" />"
"<img src=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_Q_5.svg"" />"
"<img sr
c=""c 6064c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_A_5.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_surce_svg.svg"" />"
"<img src=""c 60
64c6 dce7f2 c2f29dcf7b 716bf5 5ebfe_
m76_c2e.ng"" />"
<div>The
ngue is sulied by
he lingu l r
ery (frm
he ex
ern l c r
id r

ery), which divides in
 i
s
ermin l br nches,
he {{c1::dee lingu l r
ery}}
nd
he {{c1::sublingu l r
ery}}.</div>
"<img src="" s
e-10724962834887
5.jg"" />"
"<img src=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_Q_0.svg"" />"
"<img sr
c=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_A_0.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_surce_svg.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_
m rcsiy.ng"" />"
"<img src=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_Q_1.svg"" />"
"<img sr
c=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_A_1.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_surce_svg.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_
m rcsiy.ng"" />"
"<img src=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_Q_2.svg"" />"
"<img sr
c=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_A_2.svg"" />"
"<img src=""7993

fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_surce_svg.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_
m rcsiy.ng"" />"
"<img src=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_Q_3.svg"" />"
"<img sr
c=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_A_3.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_surce_svg.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_
m rcsiy.ng"" />"
"<img src=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_Q_4.svg"" />"
"<img sr
c=""7993fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_A_4.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_surce_svg.svg"" />"
"<img src=""7993
fe3c9d1d168042d1ccdb6d3be5c9c0b3c8bb_
m rcsiy.ng"" />"
"<img src=""cd1 82bc1c2976d9374 7157 57ff5113d80045f_Q_0.svg"" />"
"<img sr
c=""cd1 82bc1c2976d9374 7157 57ff5113d80045f_A_0.svg"" />"
"<img src=""cd1
82bc1c2976d9374 7157 57ff5113d80045f_surce_svg.svg"" />"
"<img src=""cd1
82bc1c2976d9374 7157 57ff5113d80045f_
mfu2xf.ng"" />"
"<img src=""337e5e 99d875ece2e90725c4bd3992937397d14_Q_0.svg"" />"
"<img sr
c=""337e5e 99d875ece2e90725c4bd3992937397d14_A_0.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_surce_svg.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_
m9h6nz.ng"" />"
"<img src=""337e5e 99d875ece2e90725c4bd3992937397d14_Q_1.svg"" />"
"<img sr
c=""337e5e 99d875ece2e90725c4bd3992937397d14_A_1.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_surce_svg.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_
m9h6nz.ng"" />"
"<img src=""337e5e 99d875ece2e90725c4bd3992937397d14_Q_2.svg"" />"
"<img sr
c=""337e5e 99d875ece2e90725c4bd3992937397d14_A_2.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_surce_svg.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_
m9h6nz.ng"" />"
"<img src=""337e5e 99d875ece2e90725c4bd3992937397d14_Q_3.svg"" />"
"<img sr
c=""337e5e 99d875ece2e90725c4bd3992937397d14_A_3.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_surce_svg.svg"" />"
"<img src=""337e
5e 99d875ece2e90725c4bd3992937397d14_
m9h6nz.ng"" />"
"<div>Wh r
ns duc
(subm ndibul r duc
) ends
{{c1::sublingu l  ill }} n ei

her side f lingu l frenulum.&nbs;</div><div>Gleeking (glicking) is ejec
in 
f s liv frm
he duc
s  ill e.&nbs;</div><div><br /></div><div><img src="" s

e-133478993625089.jg"" /></div>"
"<img src=""ec14eb5b 395109bc3b60436f d2 e8019 39ccd_Q_0.svg"" />"
"<img sr
c=""ec14eb5b 395109bc3b60436f d2 e8019 39ccd_A_0.svg"" />"
"<img src=""ec14
eb5b 395109bc3b60436f d2 e8019 39ccd_surce_svg.svg"" />"
"<img src=""ec14
eb5b 395109bc3b60436f d2 e8019 39ccd_
mlqw
b.ng"" />"
"<img src=""2 7bc35e487f21f51 5d163d17938 2df3d 2036_Q_0.svg"" />"
"<img sr
c=""2 7bc35e487f21f51 5d163d17938 2df3d 2036_A_0.svg"" />"
"<img src=""2 7b
c35e487f21f51 5d163d17938 2df3d 2036_surce_svg.svg"" /><div><br /></div><div><i
mg src="" s
e-43649752629797.jg"" /></div><div><br /></div><div>dee r
in 
f subm ndibul r gl nd is be
ween myhyid muscle nd s
ylglssus muscle</div>"
"<img src=""2 7bc35e487f21f51 5d163d17938 2df3d 2036_
mcyqg .ng"" />"
"<img src=""2 7bc35e487f21f51 5d163d17938 2df3d 2036_Q_1.svg"" />"
"<img sr
c=""2 7bc35e487f21f51 5d163d17938 2df3d 2036_A_0.svg"" />"
"<img src=""2 7b
c35e487f21f51 5d163d17938 2df3d 2036_surce_svg.svg"" />"
"<img src=""2 7b
c35e487f21f51 5d163d17938 2df3d 2036_
mcyqg .ng"" />"
"<div>The sublingu l mucs h s micrscic s liv ry gl nds which re innerv
ed
by
he {{c1:: r sym
he
ics frm VII}} (secre
m
r fibers).</div><div><br /
></div><div><img src="" s
e-140514150055937.jg"" /></div>"
"<img src=""359b1002f2354d689b87051f860dfcf43 12d0 1_Q_0.svg"" />"
"<img sr
c=""359b1002f2354d689b87051f860dfcf43 12d0 1_A_0.svg"" />"
"<img src=""359b
1002f2354d689b87051f860dfcf43 12d0 1_surce_svg.svg"" />"
"<img src=""359b
1002f2354d689b87051f860dfcf43 12d0 1_
mndw_lq.ng"" />"
<div>{{c1::V ll
e  ill }} - l rge
s
e buds (ushing n
hem c uses g gging)
</div><div><br /></div><div>{{c2::Lingu l sulcus}} divides&nbs;</div><div>&nbs
; &nbs;- An
erir 2/3 f
ngue&nbs;</div><div>&nbs; &nbs;- Ps
erir 1/3 f

ngue (in rh rynx)</div><div><br /></div><div>H l
sis usu lly em n
es fr
"<img src="" s
e-151195
m b c
eri in
he {{c3::v llecul e}}.&nbs;</div>

733721089 (1).jg"" />"

"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_0.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_0.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_1.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_1.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_2.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_2.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_3.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_3.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_4.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_4.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_5.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_5.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_6.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_6.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_7.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_7.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<img src=""75852049ff1106b6105d15d1e74 be2c009 7f_Q_8.svg"" />"
"<img sr
c=""75852049ff1106b6105d15d1e74 be2c009 7f_A_8.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_surce_svg.svg"" />"
"<img src=""7585
2049ff1106b6105d15d1e74 be2c009 7f_
m73qwzd.ng"" />"
"<div>{{c1::Fr men cecum}} is embrylgic l remn n
f
he
hyrglss l duc
.&n
bs;</div><div><br /></div><div><img src="" s
e-152926605541379.jg"" /></div>"
<div>Jugul r lymh
ic
runk dr ins
he {{c1::righ
}} side f
he he d nd neck<
/div>
"<img src=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_Q_0.svg"" />"
"<img sr
c=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_A_0.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_surce_svg.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_
mwyg9s.ng"" />"
"<img src=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_Q_1.svg"" />"
"<img sr
c=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_A_0.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_surce_svg.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_
mwyg9s.ng"" />"
"<img src=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_Q_2.svg"" />"
"<img sr
c=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_A_0.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_surce_svg.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_
mwyg9s.ng"" />"
"<img src=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_Q_3.svg"" />"
"<img sr
c=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_A_0.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_surce_svg.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_
mwyg9s.ng"" />"
"<img src=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_Q_4.svg"" />"
"<img sr
c=""618fc8b801bcb367 354c9dc7fe8 ef 5b774 40_A_0.svg"" />"
"<img src=""618f
c8b801bcb367 354c9dc7fe8 ef 5b774 40_surce_svg.svg"" />"
"<img src=""618f

c8b801bcb367 354c9dc7fe8 ef 5b774 40_
mwyg9s.ng"" />"

"<img src=""c91e8fc5c764d18e36d4eb19f6bffc04e9 58089_Q_0.svg"" />"
"<img sr
c=""c91e8fc5c764d18e36d4eb19f6bffc04e9 58089_A_0.svg"" />"
"<img src=""c91e
8fc5c764d18e36d4eb19f6bffc04e9 58089_surce_svg.svg"" />"
"<img src=""c91e
8fc5c764d18e36d4eb19f6bffc04e9 58089_
my2bqc.ng"" />"
"<img src=""c91e8fc5c764d18e36d4eb19f6bffc04e9 58089_Q_1.svg"" />"
"<img sr
c=""c91e8fc5c764d18e36d4eb19f6bffc04e9 58089_A_1.svg"" />"
"<img src=""c91e
8fc5c764d18e36d4eb19f6bffc04e9 58089_surce_svg.svg"" />"
"<img src=""c91e
8fc5c764d18e36d4eb19f6bffc04e9 58089_
my2bqc.ng"" />"
"<img src=""c91e8fc5c764d18e36d4eb19f6bffc04e9 58089_Q_2.svg"" />"
"<img sr
c=""c91e8fc5c764d18e36d4eb19f6bffc04e9 58089_A_2.svg"" />"
"<img src=""c91e
8fc5c764d18e36d4eb19f6bffc04e9 58089_surce_svg.svg"" />"
"<img src=""c91e
8fc5c764d18e36d4eb19f6bffc04e9 58089_
my2bqc.ng"" />"
"<img src=""b117cf8f97ce ee636ffd36e65f32e2fbd6c30f_Q_0.svg"" />"
"<img sr
c=""b117cf8f97ce ee636ffd36e65f32e2fbd6c30f_A_0.svg"" />"
"<img src=""b117
cf8f97ce ee636ffd36e65f32e2fbd6c30f_surce_svg.svg"" />"
"<img src=""b117
cf8f97ce ee636ffd36e65f32e2fbd6c30f_
mcihqfs.ng"" />"
"<img src=""c97eec e1f480bf3e753 fd33bd1224b17e92254_Q_0.svg"" />"
"<img sr
c=""c97eec e1f480bf3e753 fd33bd1224b17e92254_A_0.svg"" />"
"<img src=""c97e
ec e1f480bf3e753 fd33bd1224b17e92254_surce_svg.svg"" />"
"<img src=""c97e
ec e1f480bf3e753 fd33bd1224b17e92254_
mqsreyc.ng"" />"
"<img src=""279ec33cb1 4d1288e6c52 0372df511150dc43_Q_0.svg"" />"
"<img sr
c=""279ec33cb1 4d1288e6c52 0372df511150dc43_A_0.svg"" />"
"<img src=""279e
c33cb1 4d1288e6c52 0372df511150dc43_surce_svg.svg"" />"
"<img src=""279e
c33cb1 4d1288e6c52 0372df511150dc43_
msu03hq.ng"" />"
"<div>H rd  l
e cmrised f 2  irs f cr ni l bnes ({{c1::m xill ry}} nd {
{c1:: l
ine}})
h
fuse in
he midline s&nbs;{{c1::in
erm xill ry}} nd {{c
1::in
er l
ine}} su
ures.&nbs;</div><div>F ilure
 fuse - {{c2::clef
 l
e
}}</div><div><br /></div><div><img src="" s
e-189279208734723.jg"" /></div>"
"<img src="" 40d7094e821e408d93ec3 9f44b c7c696e206d_Q_0.svg"" />"
"<img sr
c="" 40d7094e821e408d93ec3 9f44b c7c696e206d_A_0.svg"" />"
"<img src="" 40d
7094e821e408d93ec3 9f44b c7c696e206d_surce_svg.svg"" />"
"<img src="" 40d
7094e821e408d93ec3 9f44b c7c696e206d_
mi3lk.ng"" />"
"<img src="" 40d7094e821e408d93ec3 9f44b c7c696e206d_Q_1.svg"" />"
"<img sr
c="" 40d7094e821e408d93ec3 9f44b c7c696e206d_A_0.svg"" />"
"<img src="" 40d
7094e821e408d93ec3 9f44b c7c696e206d_surce_svg.svg"" />"
"<img src="" 40d
7094e821e408d93ec3 9f44b c7c696e206d_
mi3lk.ng"" />"
Wh
re u
sm l dmin n
inheri
ed c ncer syndrmes? Wh
re 3 ex mles?
Syndrmes
h
invlve n inhei
ed mu

in usu lly in
mu

in ccuring in
single llele f
umr suressr gene<div><br /></div><div>Childhd re
in
bl s
m (Rb)</div><div>F mili l denm
us lysis (APC)</div><div>Li Fr um
eni Syndrme (53)</div>
Wh
is re
inbl s
m c ncer syndrme? inheri
ed in
mu

in in single llel
e fr RB
umr suressr
Wh
is f mili l denm
us lysis? mu

in in llele f APC gene
Wh
is Li Fr umeni Sydrme?
mu

in f 53 gene
T/F
umr is frmed by
he cln l ex nsin f single recursr cell
h
h
s incured gene
ic d m ge
T
Wh
re 4 cl sses f nrm l regul
ry genes
h
re
rge
s f gene
ic d m ge
?
1. grw
h rm
ing r
 ncgenes<div>2. grw
h inhibi
ing
umr sure
ssr genes</div><div>3. genes
h
regul
e 
sis</div><div>4. genes invlve
d in DAN re ir</div>
Mu

ins
h
cn
ribu
e

he develmen
f
he m lign n
hen
ye re refe
rred
 s ________ mu

ins driver
Wh
re  ssenger mu

ins? Mu

ins
h
le d
 genmic ins
bili
y nd i
ncre se
he frequency f mu

ins
Hw d eigene
ic bber
ins cn
ribu
e

he m lign n
rer
ies f c ncer c
ells? Aberr n
DNA me
hyl
in c n be resnsible fr silencing f
umr sure
ssr genes
Wh
re
he 8 key ch nges in m lig ncy?
Self sufficiency in grw
h sign

ls<div>insensi
ivi
y
 grw
h inhibi
ry sign ls</div><div>ev sin f 
sis

</div><div>limiless relic
ive 
en
i l</div><div>sus
ined ngigenesis</div>
<div> bili
y
 inv de r me
s
isize</div><div>defec
s in DNA re ir</div><div>
l
ered cellul r me
blism</div>
Wh
re ncgenes? Wh
re
heir unmu

ed cellul r cun
er r
s
Genes
h

rm
e u
nmus cell grw
h in c ncer cell<div><br /></div><div>r
-nc
genes: nrm l genes
h
rm
e cell grw
h nd rlifer
in. Hwever,
heir 
r
-nc genes re subjec

 regul
ry elemen
s nd ex
ern l sign ls</div>
Overexressin f r
-ncgenes le ds
 ______
nel si
Prduc
s f ncgenes, ncr
eins, c n c
s wh
5
hings?<div><br /></div><
div>Wh
is differen
bu

hese ncr
eins s sed
 r
-ncr
eins<
/div> 1. grw
h f c
rs<div>2. grw
h f c
r rece
rs</div><div>3. sign l
r
nsducing r
eins</div><div>4. nucle r
r nscri
in r
eins</div><div>5. cycli
ns/CDKs</div><div><br /></div><div>Their rduc
in desn
deend n grw
h f c

rs r ex
ern l sign ls</div>
Hw d ncr
eins c
s grw
h f c
rs?
1. c ncer cells cquire
he bil
i
y
 syn
hesize GF
 which
hey re rensive cre
ing u
crine l<div>2.
ncr
eins c n ls be sign l
r nsducers like RAS which llws fr incre sed
exressin f grw
h f c
r genes</div>
Hw d ncr
eins c
s grw
h f c
r rece
rs
1. Oncgenic versins f
grw
h f c
r rece
rs re ssci
ed wi
h cns
i
ui
ive c
iv
in wi
hu
bi
nding
 grw
h f c
r r
her
h n nrm l GF rece
rs which re nly
r nsien
l
y c
ive<div><br /></div><div>2. simly ver exressin f grw
h f c
r rece

rs (nrm l nes)</div><div><br /></div>
Wh
re 4 ex mles f hw ncr
ieins mimic
he func
in f nrm l cy
l smi
c sign l
r nsducing r
eins? mu

ed RAS ncgene<div>mu

ed BRAF</div><div>
mu

ed PI3K</div><div>mu

ed nn rece
r
yrsine kin ses</div>
"<img src="" s
e-199282187567608.jg"" />"
In mu
n
RAS, wh
is blcked? "in c
iv
in by hydrlysis f GTP c using fr
cn
inu lly c
ive R s, MAP-Kin se 
hw y<div><br /></div><div><img src="" s

e-199277892600312.jg"" /></div>"
Wh
is BRAF? Kin se
h
is us
re m f MAPK nd dwns
re m f RAS
Wh
des ncgenic PI3K d?
c
iv
es AKT which is resnsible fr in c
iv

ing BAD (which is r 

ic)&nbs;
Wh
gene mu

in ch r c
erizes CML (chrnic myelgenus leukemi )
"<div>In
CML
he <b>ABL gene is
r nslc
ed frm chrmsme 9</b>
 <b>chrmsme 22</
b> where i
fuses wi
h
he BCR gene, which le ds

cns
i
uively c
ive
yrs
ine kin se</div><div><br /></div><div><img src="" s
e-199419626520961.jg"" /><
/div><div><br /></div><div>The resul
is BCR-ABL
yrsine kin se</div><div><br
/></div><div>Tre
men
f CML h s been revlu
inized by im
inib mesyl
e
h

inhibi
s
he BCR-ABL
yrsine kin se</div><div><br /></div>"
Wh
is
he
re
men
fr CML? im
inib mesyl
e, which inhibi
s BCR-ABL
yrsi
ne kin se
Wh
re
w w ys cell grw
h is c
iv
ed vi mu

ins in nnrece
r
yrsine
kin ses
1. chrmsm l
r nslc
ins (CML)<div>2. in
mu

ins in ge
nes
h
exress neg
ive regul
ry dem ins
h
kee enzymes in check &nbs;(
JAK-2 mu

in c
iv
es STAT f mily)</div>
Hw d ncr
eins c
s mu
n

r nscri
in f c
rs?
ersis
n
mli
fied exressin f MYC r
ein
Wh
is
he gene
ic ch r c
eris
ic f Burki

lymhm ? "MYC gene being dis l c
ed frm chrmsme 8
 14 le ding
 incre sed MYC r
ein<div><br /></div><div
><img src="" s
e-199600015147395.jg"" /></div>"
Wh
re sme rles f MYC
1. uregul
es exressin f
elmer se<div>2. r
ergr m sm
ic cells in
 luri
en
cells</div>
"<img src="" s
e-199668734624292.jg"" />"
Which cyclin/CDK cmlex is verexressed in m ny c ncers
CycD/CDK4
T/F
 ge
c ncer, yu need
 lse b
h cies f
umr suressr genes
T
Wh
re 3 ex mles f
umr suresssr genes we
lked bu
? Rb<div>53</div>
<div>APC</div>

Wh
is
he rle f Rb? When is i
c
iv
ed? Wh
ccurs when i
is c
iv
ed v
s in c
iv
ed "I
is key neg
ive regul
r f
he G1/S cell cycle
r nsi
i
n<div><br /></div><div> c
iv
ed (dehshryl
ed)=NO
r nscri
in f genes ne
eded fr S h se</div><div><br /></div><div>de c
iv
ed (Phshryl
ed)=
r nsc
ri
in f genes fr S h se</div><div><br /></div><div>Ac
iv
ed: Cycle h l
ed<
/div><div>de c
v
ed: cycle cn
inues</div><div><br /></div><div><img src="" s

e-199862008152514.jg"" /></div>"
Hw c n RB be cmrmised? (2) Lss f func
in mu

ins (b
h RB lleles)<div
><br /></div><div>shif
frm c
ive hyhshryl
ed
 in c
ive hshryl
e
d s

e by</div><div><b> ) incre sed CDK/Cyc c
ivi
y</b></div><div><b>b) decre
sed CDK inhibi
rs</b></div>
"<img src="" s
e-199943612531226.jg"" />"
<div>P3
53 &nbs;
hw r
s nel s
ic
r nsfrm
in by wh
3 mec hnisms

hw r
s nel s
ic
r nsfrm
in by
hree in
erlcking mech nisms</div><div><br
/></div><div><br /></div><div>Ac
iv
in f
emr ry cycle rres
(quiescence)
</div><div>Induc
in f erm nen
cell cycle rres
(senescence)</div><div>Trigg
ering f rgr mmed cell de
h ( 
sis)</div><div><br /></div>
Wh

w w ys c n 53 be degr ded?
<div><b>MDM2 </b> nd i
s f milies f r

eins s
imul
e
he degr d
in f 53</div><div><br /></div><div>MDM2 gene is
mlified in 1/3 f s rcm s</div><div><br /></div><div>The
r nsfrming r
eins
f sever l DNA viruses bind 53 nd rm
e i
s degr d
in</div><div><b>HPV </
b>des
his in cervic l c ncer nd in sme c ncers f
he he d nd neck</div><di
v><br /></div>
Wh
re
he key ini

rs f 53
h
sense DNA d m ge nd hyxi ?
<div>Key
ini
i
rs f 53 c
iv
in re
w rel
ed r
ein kin ses</div><div>A
xi

el ngiec
si mu

ed nd
xi -
el ngiec
si nd R d3</div><div><br /></div><
div><br /></div><div><b>ATM/ATR nd RAD3</b></div>
Hw des 53 induce quiesecnce <div>1. ATM/ATR c
iv
es 53</div><div>2. 53
c
iv
es
r nscri
in f 21</div><div>3. 21 inhibi
s cyclin/CDK cmlex nd i
nhibi
s hsh
ryl
in f RB</div><div>4. h l
f cell cycle</div><div><br /><
/div>
Hw des 53 induce 
sis? direc
s 

ic genes like BAX nd um
Wh
re APCs? Wh
des i
secific lly d?
"cl ss f
umr suressrs whs
e m in func
in is
 dwn regul
e grw
h rm
ing sign ls<div><br /></div><di
v>regul
des
ruc
in f be
c
enin</div><div><br /></div><div><img src="" s

e-36301063586271.jg"" /></div>"
Wh

hw y is APC
cmnen
f?
<div>APC is cmnen
f
he WNT sign
ling 
hw y which h s m jr rle in cn
rlling <b>cell f
e, dhesin, nd c
ell l ri
y during embrylgy</b></div><div><br /></div>
Wh

hree
hings re fund l
er l

he hyglssus? "lingu l nerve<div>hyg
lss l nerve</div><div>wh r
ns duc
: subm ndibul rduc
</div><div><br /></div><d
iv><img src="" s
e-46037754446203.jg"" /></div>"
Wh
2
hings re medi l

he hylglssus?
"glssh rynge l nerve<div>lingu
l r
ery</div><div><br /></div><div><img src="" s
e-46033459478907.jg"" /></d
iv>"
Lingu l vein dr ins in
 _______
In
ern l jugul r vein
Wh
re
he

chmen
s f
he shenm ndibul r lig men

sine f
he sh
enid

he lingul
"<img src="" s
e-46553150521922.jg"" />"
"<img src="" s
e-46596100194879.jg"" />"
"<img src="" s
e-46621869998639.jg"" />"
"<img src="" s
e-46656229737002.jg"" />"
"<img src="" s
e-46681999540773.jg"" />"
"<img src="" s
e-46707769344563.jg"" />"
"<img src="" s
e-46759308952103.jg"" />"
s
ylglssus
"<img src="" s
e-46862388167200.jg"" />"
hyglssus
"<img src="" s
e-46888157970990.jg"" />"
Wh
is
he si
in f
he dee r
in f
he subm ndibul r gl nd?
"L
er l


he s
ylglssus nd medi l
 myelhyid<div><br /></div><div><img src=""
s
e-46961172414848.jg"" /></div><div><img src="" s
e-47059956662821.jg"" /></

div><div><br /></div><div><img src="" s
e-151676770058487.jg"" /></div>"

The h rd  l
e receives sensry innerv
in rim rily frm___________
ermin l
br nches f m xi lly divisin f
rigemin l V2
Ar
eries f h rd  l
e rise frm _________
m xill ry r
ery
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 1.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 1.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 2.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 2.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 3.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 3.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 4.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 4.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 5.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 5.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 6.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 6.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
"<img src=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_Q 7.svg"" />"
"<img sr
c=""c95259d e4 6253cecc5fc6b8e81dc99cc33432d_A 7.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_surce_svg.svg"" />"
"<img src=""c952
59d e4 6253cecc5fc6b8e81dc99cc33432d_
mfuIKXf.ng"" />"
Wh
re
he 4 cn
r indic
ins
 MRI?
P ce m kers<div>Aneurysm clis</
div><div>bulle
fr gmen
s :eye nd sin l c n l</div><div>cchle r iml n
s</div
>
"<div>Wh
is resen


he yellw rrw? Where is i
nrm lly fund? Be secif
ic.</div><img src="" s
e-639950127359.jg"" />"
sc l hem
m : usu lly
underne
h g le neur
ic
"<div>Describe
he fr c
ure indic
ed

he rrw nd i
s e
ilgy.</div><img s
rc="" s
e-700079669489.jg"" />"
<b>Cmminu
ed</b> fr c
ure c used by <b>
sc l hem
m </b>
"<div>Describe
he fr c
ures frm lef

 righ
.</div><img src="" s
e-820338753
739.jg"" /><img src="" s
e-833223655636.jg"" /><div><br /></div>"
Cmminu

ed, line r, deressed fr c
ure
"<div>Sinuses:</div><img src="" s
e-867583394059.jg"" />"
"<div>P
hlgy? C n
hese hem
m s sre d  s
su
ures? C n i
remve
he dur
frm
he skull?</div><img src="" s
e-893353197808.jg"" />" <b>Eidur l hem

m </b>-
hese hem
m s <b>c n
crss su
ures</b> bu
subdur l hem
m s c n
. The <b>dur c n be s
ried ff f
he skull in eidur l hem
m s.</b>
"<div>P
hlgy?</div><img src="" s
e-927712936160.jg"" />" Eidur l hem
m
(lens sh ed)
"<div>Wh

ye f hem
m s re ic
ured here? Hw c n yu
ell, nd wh
is
h
eir e
ilgy?</div><img src="" s
e-936302870745.jg"" />"
<b>Subdur l</b>
hem
m : n
ice
h

hese <b>c n crss su
ures. </b>Of
en <b>c used by ru
u
red bridging vein</b>. N
ice hw cu
ely i
is dense nd whi
e (lef
),
hen chr
nic is much d rker (righ
). &nbs;
"<div>Which br in is nrm l? Hw c n yu
ell? Wh
is
he secific issue wi
h

he 
her br in?</div><img src="" s
e-1009317314798.jg"" />" Nrm l n <b>lef

</b>. There is <b>bld in
he sinuses f
he br in n
he righ
</b>. <b>Sub r
chnid hemrrh ge</b> is
hrughu

he en
ire br in nd diffuse. This w s likel

y c used by
r um ; ms
cmmn c use f nn-
r um
ic sub r chnid hemrrh ge i

s n neurysm. &nbs;
Wh
is
he ms
cmmn c use fr sub r chnid hemmrh ge?
Tr um .
Wh
is
he ms
cmmn c use f nn-
r um
ic sub r chnid hemrrh ge? ru
ured
neurysm
Wh
sh e re eidur l hem
m s? Why re
hey
his sh e?
<b>lens-sh ed,
</b>due
 <b>crssing
he midline bu
n
crssing su
ures</b> bec use dur is

 firmly

ched
su
ure in
s.
Wh
sh e re subdur l hem
m s? Why? <b>Crescen
sh ed, </b>bec use
hey c n
<b>crss su
ure in
s bu
n
midline</b> bec use f
he reflec
in f
he men
inge l l yer f dur w y frm eris
eum cre
ing <b>f lx</b>.
"<div>Wh
re
he brigh
s
s sc

ered in
he br in  renchym ?</div><img src
="" s
e-1267015352610.jg"" />"
Axn l injuries (hem
m s) in whi
e m


er.
"<div>P
hlgy?</div><img src="" s
e-1352914698522.jg"" />" Br in cn
usins
wi
hin gr y m

er (infr cr ni l hem
m s)
Why is einehrine gd drug fr
re
ing gl ucm ? inhibi
s queus humr 
rduc
in vi lh 1 (inhibi
bld flw) nd lh 2 (decre se qeus humr r
duc
in)
T/F clnidine nd lh me
hyld reduces sym
he
ic u
flw frm CNS nd decr
e ses NE rele se
True
"<img src="" s
e-41089952121361.jg"" />"
B (nly c
s n&nbs;D1 which in
cre ses v sdil
in in erihery)
Wh
is
he difference be
ween lbu
erl nd s lme
erl?
"<img src="" s

e-41132901793881.jg"" />"
Hw des high levels f henylehrine effec
he r
?
high cncen
r
ins f 
henylehrine will cns
ric
crn ry r
eries nd decre se bld flw
 myc rd
ium
If yu see ri rism is i
mre likely due
 vi gr r sickel cell dise se?
sickle cell dise se
Hw des henylehrine c
s n s l decnges
n
?
cns
ric
s bld vessels
vi lh 1 rece
rs such
h
Gq--&g
;IP3--&g
;C 2+<div><br /></div><div>Redu
ces bld flw
 nse nd relieves cnges
in</div>
Wh
re 2 side effec
s f henylehrine?
High bld ressure, urin ry re

en
in
Wh
kinds f side effec
s d be
2 selec
ive gnis
h ve? ( lbu
erl, s lme
e
rl?) be
1 side effec
s:
chyc rdi nd high bld ressure
Wh
is rebund hyer
ensin? S
ing f wh
drug c uses
his?
high bl
d ressure f
er individu l is
ken ff f clnidine (emergency hyer
ensive)<
div><br /></div><div>&nbs;</div>
"<img src="" s
e-41742787150226.jg"" />"
A
In m ny hsi
ls, wh
re
he 2 firs
line drugs
 r ise BP? NEi ( lh , be

1)<div> ngi
ensin II</div>
"<img src="" s
e-41910290874811.jg"" />"
C: be
3 gnis
s c use incre s
ed bre kdwn f TG which c n le d
 n incre se f FA which c n isn
he he r


Where re be
3 rece
rs ms
ly fund?
dise nd skele
l<div><br /><
/div><div>be
3: bre kdwn f
riglyceride</div><div>Be
1/3 rm
e
hermgen
esis in skele
l</div>
Wh
re 4 ex mles f indirec
gnis
s?
ehedrine<div> mhe
mine</div><
div>me
hylhenid
e</div><div>
yr mine</div>
Wh
is ehedrine useful fr? Wh
des i
d? 1. n s l decnges
n
<div>2. r i
se b during surgery</div><div><br /></div><div>Ac
iv
es lh nd be
rece

rs</div>
Adder ll is __________<div>Ri
lin is ________</div>
mhe
mine<div><br /></
div><div>me
hylhenid
e</div>
Hw d
hees drugs incre se DA nd NE levels?<div><br /></div><div>ME
hylhenid

e</div><div><br /></div><div>Amhe
mine</div> "decre se reu
ke<div><br /></d
iv><div>disl ce DA/NE</div><div><br /></div><div><img src="" s
e-4240421211392
8.jg"" /></div>"

"<img src="" s
e-42438571852225.jg"" />"

D: lh 1 gnis

"<img src="" s
e-42468636623298.jg"" />"
brnchdil
r: D<div> n
ihyer

ensive in regn n
wmen: lh me
hyld ( lh 2 gnis
)</div><div>R ises BP
: henylehrine</div>
Hw d yu
re
lzheimers?

 li

le Ach<div><br /></div><div>ACHes
er se
inhibi
rs</div>
Hw d yu
re
deressin?
T li

le Ser
nin<div><br /></div><div>SSRI
nd TCA</div>
Hw d yu
re
Schizhreni ?
 much DA<div><br /></div><div>D2 blckers</di
v>
Hw d yu
re
ADD

 li

le NE nd DA in RAS<div><br /></div><div>Ri
lin
nd Adder ll</div>
"<div>40 ye r ld F</div>firm nn-
ender ndule in neck n righ
side<div>n sym

ms</div><div>surgic l resec
in</div><div><img src="" s
e-33436320399748.jg
"" /></div>"
bulging u
, ex nding in

issue wi
hin fibrus c sule wi
h w
ell circumscribed brders: f vr benign ver m lign n
<div><br /></div><div>n i
nfil
r
ive brders</div>
"<img src="" s
e-33432025432452.jg"" /><div>Wh
gener l rcess d fe
ures 
f secimen sugges
?</div>"
well circumscribed ndule, fc l-nel s
ic rc
ess<div><br /></div><div>circumscribed, ushign brder, hmgenus surf ce=benig
n</div>
"<img src="" s
e-33779917783407.jg"" /><div><br /></div><div><br /></div>"
W n


ke sec
in frm erihery<div><br /></div><div>Sec
in includes
he e
rihery.</div><div><br /></div><div>Nrm l
hyrid wi
h
hin fibrus c sule</di
v><div><br /></div><div>Lesin n lef
side:&nbs;</div><div> ) fllicles re m
re crwded</div><div>b) micrfllicles re resen
wi
h li

le cllid</div><div
>c) They lk simil r

he cllid n
he u
side</div><div>d) ressure
rh
y jus
u
side
he c sule le ding

bi
f infl mm
in</div><div><br /></di
v><div><br /></div><div><br /></div>
"<img src="" s
e-33943126540668.jg"" /><div>Wh
cnfirms
h

his is benign?
</div>" lk simil r

hyrid fllicles in nrm l
hyrid bu
jus
mre crwde
d<div><br /></div><div>Pink s
uff is cllid</div>
"<img src="" s
e-34011846017404.jg"" /><div>Wh
n me wuld yu give
his?</di
v>"

hyrid fllicul r denm
"60 ye r ld fem le, &nbs;neck  in nd h rseness<div>H rd, irregul r ndule-L
lbe f
hyrid</div><div><img src="" s
e-34132105101648.jg"" /></div><div><b
r /></div><div>Wh
gener l rcess d grss fe
ures sugges
?</div>" 1. Lesi
n seems
 blend in

he
hyrid<div>2. nn circumscribed</div><div>3. infil
r

ive brders</div><div>4.  in nd h rseness me ns
h

umr is infil
r
ing i
n
 nerves nd l rynx.<br /><div>5. Desml s
ic re c
in</div><div>6. e rs h
rd nd ndul r</div></div><div><br /></div><div>M lign n
lesin</div>
"<img src="" s
e-34321083662713.jg"" />"
1. Nrm l residu l
hyrid flli
cles filled wi
h cllid n
he righ
<div>2. On
he lef
, n lnger h ve fllicl
es
h
resemble nrm l fllicles</div><div>3. lemrhism</div><div>4. mi

ic
c
ivi
y</div><div>5. Prly differen
i
ed c rcinm </div>
"<img src="" s
e-34518652158329.jg"" /><div><br /></div><div>Wh
micrscic
fe
ures des
his im ge sugges
</div>" Hyerchrm
ism: d rker nuclei, chrm
i
n c rse<div>lemrhism: differen
size nd sh e</div><div>rminen
nucleli
</div><div><br /></div><div><br /></div><div><b> denc rcinm </b>: even if
hey
re n
frming gl nds bec use nrm lly
hey wuld frm gl nds</div>
"Why des 
ien
h ve h rseness?<div><img src="" s
e-34668976013648.jg"" /><
/div><div><img src="" s
e-34681860915577.jg"" /><br /><div><img src="" s
e-34
656091111801.jg"" /></div></div>"
Lc l Inv sin f nerves in
he regin
Cm re sym
ms,
ex
ure f m ss, nd ge f nse
fr 
ien
s wi
h
hyrid f
llicul r dnm vs
hyrid denc rcinm ?
Age: yung vs ld<div><br /></di
v><div>Tex
ure f m ss: firm circumscribed vs h rd irreg. brder</div><div><br /
></div><div>O
her sym
ms: nne vs h rseness nd  in</div>
Wh

ye f dise se is luus (sys
emic r lc l)?
<b>Sys
emic</b> - Luus
Ery
hem
sus is
<u>syndrme</u>&nbs;
h
&nbs; ffec
s <u>m ny</u> rg ns sys

ems<div><br /></div><div><br /></div>

<br /><div><br /></div><div>29 yr ld fem le, n cml in
s</div><div>lef
UOQ b

re s
3 cm, sli
ry, discre
e, freely mv ble ndule</div><div>resen
fr sme
mn
hs, w xes nd w nes wi
h mens
ur l cycle</div>
1. Mre likely
 be ben
ign, &nbs;bec use i
is hrmn lly regul
ed<div><br /></div><div>2. f vrs ben
ign bec use</div><div> ) yung</div><div>b) m ss is descre
e nd freely mve ble
</div>
<br /><div>If wm n h s s
rng f mily his
ry f bre s
c ncer, wh
wuld yu
sugges
?</div> fine needle sri
in (FNA) bisy<div><br /></div><div>di gns

ic rcedure: suerfici l lesin, ull u
m
eri l, s
in, lk under micrsc
e, ge
cy
lgy</div><div><br /></div><div> dv n
ge: u

ien
rcedure, f
s
er resul
s, lw risk f infec
in nd hemrrh ge, n nes
hesi , lw cs
, f s

resul
s</div>
"<img src="" s
e-34836479738237.jg"" /><div><br /><div><img src="" s
e-360175
95744625.jg"" /></div></div><div><br /></div><div>Wh
is
his?</div>" Nrm l b
re s
: lbul r duc
, gd secre
ry cells
"<img src="" s
e-36051955482978.jg"" /><div><br /></div><div><img src="" s
e36064840384873.jg"" /></div><div><br /></div><div>Bre s
Tissue</div>" Cy
lgy
: lk
cellul ri
y<div><br /></div><div>The f c

h
yu h ve
n f cells
me ns yu re wi
hin lesin</div><div><br /></div><div><div>The cnfigur
in i
s sugges
ive f
he duc
- gl ndul r s
ruc
ure f
he bre s
</div><div>Cells re
rderly, unifrm, lw N:C</div><div>Sugges
s benign rcess</div></div><div><b
r /></div><div>Ge
s
ghrned sh e clus
ered f cells, which re
he gl ndul r
uni
s</div><div><br /></div><div>mucid m
eri l is
he s
rm .</div><div><br />
</div><div><b> le urle line is
duc

rying
 frm: sugges
ive f duc
-gl n
dul r s
ruc
ure</b></div><div><br /></div><div>Im ge 2:</div><div>cells ll lk
simil r
 e ch 
her, nrm l N:C r
i</div><div><br /></div><div>Indic
es be
nign
umr</div><div><br /></div>
"<img src="" s
e-36197984371074.jg"" /><div>Wh
rcedure is used
 excise

he
umr? Wh
is
he urse f inking
he
umr</div>"
Lumec
my: ink

he u
side
 m ke sure yu see cle r &nbs;m rgin f
he
umr nd yu h ve g


en ll f i
u
<div><br /></div><div><br /></div><div><br /></div>
"<img src="" s
e-36339718291826.jg"" /><div><br /></div><div>Bre s
Tissue</di
v><div><br /></div>"
Prlifer
in f b
h s
rm
nd gl nds: Fibr denm <di
v><br /></div><div>mild incre se in cellul ri
y f s
rm </div><div>B
h s
rm
nd gl nds re resen
</div><div>Seemingly nrm l gl ndul r-duc
s
ruc
ure
h

indic
es benign&nbs;</div><div>n hemmrh ge r necrsis</div>
"<img src="" s
e-36593121362290.jg"" /><div><br /></div><div>Wh
d grss fe

ures sugges
?</div>" 1. N
re lly circumscribed<div>2. He
ergenei
y wi
hin

he
umr</div><div>3. see sme deressed re s wi
h &nbs;hemrrh ge nd necr

ic re s</div><div>4. seems bi
infil
r
ive s
umr is ushing in
 muscle
nd f
</div><div>5. firm nd gri

y, he vily c lcified</div><div><br /></div><di
v>indic
ins f m lign ncy</div><div><br /></div>
"<img src="" s
e-36846524432766.jg"" /><div><br /><div><img src="" s
e-368594
09334648.jg"" /></div></div>"
) Infil
r
ing f
!<div>b) very irregul r gl nd
s</div><div>c) re c
ive s
rm =gives i
h rd, s
ne like feel
 i
</div><div>d)
lks mder
ely differen
i
ed:
rying
 frm gl nds</div><div><br /></div>
"<img src="" s
e-37009733190012.jg"" /><div><br /></div><div>Wh
micrscic
fe
ures des
his sugges
in
he bre s
?</div>"
"<img src="" s
e-37035502993768.jg"" /><div><br /></div><div><img src="" s
e37048387895678.jg"" /></div>" nrm l vs m lign n
bre s

issue
"<img src="" s
e-37082747634040.jg"" /><div><br /></div><div><img src="" s
e37095632535932.jg"" /></div><div><br /></div><div><br /></div><div><img src=""
s
e-37108517437808.jg"" /></div>"
"<img src="" s
e-37151467110767.jg"" /><div><br /></div><div>Wh
s
in?</div>
"
Es
rgen Rece
r S
in<div><br /></div><div><br /></div>
"<img src="" s
e-37198711751023.jg"" /><div>es
rgen si
ive</div><div><img s
rc="" s
e-37211596652925.jg"" /></div><div>rges
erne neg
ive</div><div><br
/></div><div>Wh
d
hese resul
s me n nd hw d
hey ffec

ien
s
re
me
n
r rgnsis?</div>" <div>P
ien
w s ER+, PR-</div><div>Es
rgen is rm

er f bre s
c ncer</div><div>ER si
ivi
y is indic
ive f resnse
 n
ies

rgen Rx (T mxifen, hrec
my)</div><div>Tre
men
effic cy incre ses wi
h E

R+, PR+</div><div>Limi
ed u
ili
y s rgns
ic indic
r</div><div><br /></div>
Wh
re
he clinic l differences be
ween
hse wi
h fibr denm vs duc
l den
"<img src="" s
e-37280316129659.jg"" />"
c rcinm
"<div><s n cl ss=""Ale-
b-s n"" s
yle=""whi
e-s ce:re""> </s n>Wh
is
sen
inel lymh nde nd wh
is i
s signific nce?</div><div><br /></div>"
<div>A sen
inel lymh nde is
he firs
nde in
he regin l lymh
ic re
h

receives flw frm
he rim ry
umr. If
his firs
s
 nde is neg
ive fr
um
r,
hen 
her lymh ndes in
he regin d n
h ve
 be excised. This gre
ly
decre ses
he mrbidi
y f
he rcedure. In
he c se f xill ry lymh nde di
ssec
in, disru
in f
he lymh
ic dr in ge frm
he rm m y le d
 lymhede
m .</div><div><br /></div>
"<img src="" s
e-37366215475605.jg"" /><div><div>lymh
ic vessels s
uffed wi

h bre s

issue</div></div><div><br /></div><div><img src="" s
e-37447819854216
.jg"" /></div><div><br /></div><div>desml s
ic resnse
 inv ding bre s

i
ssue in
 lymhndes</div>"
<div>Hw successful is screening fr bre s
c ncer?</div><div><br /></div>
<div>M mmgr hy is
very successful screening me
hd fr bre s
c ncer. Mr
l
i
y in wmen &g
;50 is decre sed by 20-39%; smewh
less, bu
s
ill signific n

in wmen &l
;49. P r
f ru
ine he l
h c re. Ul
r sund nd CT sc ns m y be us
ed
 ev lu
e ques
in ble m mmgr ms.</div><div><br /></div>
<div>66 ye r ld m n urin ry frequency, difficul
y viding; 
herwise gd he l

h</div><div>PE: nrm l; rec
l ex m firm enl rgemen
f L lbe f rs

e</div>
<div>L b: H/H, ly
es, UA WNL</div><div>PSA = 13 (N=&l
;4)</div><div>Alk Phs = 1
75 (N=38-126)</div><div><br /></div><div><div>Wh
is
he differen
i l di gnsis
f firm ndule in
he rs

e?</div></div><div><br /></div> <div>1. Benign h
yerl si cen
r l (urin ry re
en
in/dysuri ) (lder men)</div><div>2. C ncer 
s
erir/l
er l (lder men)</div><div>3. Acu
e rs

i
is yung men,
ender, b
ggy</div><div>4. Chrnic rs

i
is nrm l
 ex m, sym
m
ic</div><div><br
/></div>
<div>Wh
is
he signific nce f n elev
ed PSA?</div><div><br /></div>
<div>PSA is secific fr <b>rs

e duc
& m; cin r cells</b>, nrm l r m li
gn n
</div><div>N
seen in 
her
issues</div><div>Levels u
 10 ng/ml re se
en in benign&nbs;</div><div>&g
;10 c ncer ( nd inf rc
s)</div><div>Useful fr s
creening nd de
ec
in f remissin r rel se. S
ill cn
rversi l m ny men wi

h c ncer re sym
m
ic, signific n
number f men wi
h c ncer h ve nrm l PSA
.</div><div><br /></div>
"<img src="" s
e-38689065402760.jg"" />"
D rker re n lef
is
umr in
rs

e<div>M lign n
re s re bluer
h n nrm l due
 incre sed cellul ri
y<
/div>
"<img src="" s
e-38732015075693.jg"" /><div><br /></div><div><img src="" s
e38839389258105.jg"" /></div>" nrm l rs

e<div>nrm l rs

ic gl nds nd
s
rm in be
ween</div><div>d rk l yer by gl nds re myfibrbl s
s fr exulsi
n f secre
ry m
eri l</div><div><br /></div><div><br /></div><div>rs

e c n
cer:</div><div>Lss f myei
heli l cells</div><div>rminen
nucleli</div><di
v>crwded gl nds</div><div><br /></div><div><br /></div>
"<img src="" s
e-38985418146170.jg"" />"
rs

e
umr h s inv ded nerve
s u

 me
s
isize<div>erineur l inv sin</div>
Hw des rs

e c ncer
end
 dissemin
e? hem
genusly
Prs

e c ncer
yic lly rduces _______ me
s
sis? s
ebl s
ic
"<img src="" s
e-39462159516031.jg"" />"
Lks like gl ndul r
issue frm
ing wi
hin bne: me
s
sis f rs

e c ncer
 bne
<div>Wh
ru
e f me
s
sis did
hese rs

e c ncer cells
ke
 sre d


he bne m rrw?</div><div><br /></div><div>A. &nbs;Hem
genus</div><div>B. &
nbs;Lymh
ic</div><div>C. Celmic</div><div>D. &nbs;Direc
ex
ensin</div><d
iv><br /></div> Hem
genus<div><br /></div><div>lymh
ics dn
c
u lly g in

 bne</div>
"<div>8 m. ld by wi
h bdmin l m ss</div><div>CT 6 cm m ss in regin f L d
ren l, wi
h c lcific
ins</div><div>Elev
ed urin ry c
echl mines</div><div>M
ss resec
ed, lymh ndes bisied, bne m rrw bisies erfrmed</div><div>Sm

ll rund blue cell
umr - + NSE, NB84</div><div>FISH N-Myc mlific
in duble
minu
es</div><div><br /></div><div><img src="" s
e-39595303502207.jg"" /></di
v><div><br /></div>"
"<img src="" s
e-39651138077041.jg"" /><div><br /></div><div><br /></div>"
1.lks fleshy, very cellul r<div>2. he
ergenus er nce</div><div>3. ch lky
whi
e re s indic
e necrsis</div>
"<img src="" s
e-39741332390227.jg"" /><div><img src="" s
e-39754217291959.j
g"" /></div>" sm ll rund blue cell
umr
yic lly fund in <b>m lign n
dre
n l
umrs</b>
Wh
is neurbl s
? rimi
ive cell
h
gives rise
 g nglin cells
Where re neurbl s
m s usu lly fund? <div>Usu l si
e <b> dren l medull </b>,
c n be seen in <b>medi s
inum</b>, 
her bdmin l si
es <b>g ngli , Org n f Zu
ckerk ndl</b></div><div><br /></div>
N me sme 
her m lign ncies
h
re cmmn in children.
<div>Acu
e leuke
mi & m; lymhm </div><div>Br in
umrs</div><div>Wilms
umr</div><div>he

bl s
m </div><div>rh bdmys rcm </div><div>s
es rcm </div><div>Ewing s rc
m </div><div><br /></div>
sm ll rund blue cell
umrs re ch r c
eris
ic f wh
kinds f
umrs?
seen mre f
en in children<div>rersen
undifferen
i
ed cells</div><div><br />
</div><div>neurbl s
m </div><div>ewing</div><div>rh bdmys rcm </div><div>wi
lms
umr</div><div>he
bl s
m </div><div>e
c</div>
"<div>Im ge #25 shws me
s

ic denc rcinm in
he bne. Wh
n
ibdy s
in
culd yu erfrm
 rve rs

ic rigin?</div><div><br /></div><div><img sr
c="" s
e-40398462386559.jg"" /></div><div><br /></div>"
PSA
Wh
is
he difference be
ween RA nd OA?
"<img src="" s
e-42949672960357
.jg"" />"
N me
he eleven ACR di gns
ic cri
eri fr sys
emic luus ery
hem
sus:
"<div><u>Ou
line + Brief Descri
in</u></div><div><br /></div>1) M l r R sh (fi
xed ery
hem fl
r r ised - ver m l r eminences [f ce]; nn-sc rring)<div>2)
Discid R sh (ery
hem
us r ised 
ches - sc rring)</div><div>3) Ph
sensi
iv
i
y (resul
ing in skin r sh)</div><div>4) Or l Ulcers&nbs;</div><div>5) <b>Nne
rsive</b> Ar
hri
is (differen
frm Rheum
id Ar
hri
is)</div><div>6) Pleuri
i
s r Peric rdi
is&nbs;</div><div>7) Ren l Disrder (r
einuri OR cellul r c s

s)</div><div>8) Neurlgic Disrder &nbs;(seizures OR sychsis)</div><div>9)
Hem
lgic Disrder (hemly
ic nemi , leukeni , lymheni ,
hrmbcy
eni
)</div><div>10) Immunlgic Disrder ( n
i-DNA n
ibdies; n
-Sm n
ibdy; n

i-hshliid n
ibdy)</div><div>11) Psi
ive An
inucle r An
ibdy (gre
er
h
e
i
er
he mre likely i
is luus)</div><div><br /></div><div><img src="" s
e
-50783693308166.jg"" /></div>"
Hw m ny f
he 11 ACR di gns
ic cri
eri mus
be resen
fr
di gnsis f lu
us
 be m de? A
le s
4
Discuss
he eidemilgy f luus. In wh
e
hnici
ies is
he rev lence incre s
ed (4)? <div>Asi ns</div><div>Afr-Americ ns</div><div>Afr-C ribbe ns</div><div
>His nic Americ ns</div>
Discuss
he eidemilgy f luus. Wh
is
he
yic l ge f nse
?
<div><u>
B

m Line:</u> ms
re di gnsed e rly in life (16-36 yrs f ge)</div><div><
br /></div><div>65% ges f 16-55 y</div><div>15% f
er 55 y</div><div>20% &l

;16 y</div>
Is es
rgen rel cemen

her y ssci
ed wi
h n incre sed risk in Luus? Why
Yes. Es
rgen incre ses immune c
ivi
y:<div><br /></div><div>Es
r why n
?

rgen s
imul
es
hymcy
es, CD8+ nd CD4+ T cells, B cells, m crh ges, rele
se f cy
kines (IL-1) nd exressin f VCAM nd ICAM.</div><div><br /></div><d
iv>Es
r dil reduces 
sis in self-re c
ive B-cells rm
ing selec
ive m
u
r
in f B-cells wi
h high ffini
y fr n
i-DNA.</div>
Is r l cn
r ce
in ssci
ed wi
h n incre sed risk f luus?
N
Hw d
he sym
ms f luus rise? Wh
rg ns
 n
ibdies
rge
? Wh

yes
f cells d
hey ls
rge
? <div>1) Au
immuni
y resul
s in n
ibdy cmlex
es desi
ing n rg ns nd binding
 cell surf ce n
igens, c using <u> n
ibd
y-medi
ed d m ge</u> g ins
DNA/RNA cmlexes.</div><div><br /></div><div>&nbs
;2) Org ns f n
e: kidney, skin, chrid lexus in br in, lung, synvium, eri

c rdium, nd leur </div><div><br /></div><div>&nbs;3)Als n
ibdies

ch


: l
ele
s, ery
hrcy
es, leukcy
es (
hus
hrmbcy
eni , hemly
ic nemi ,
leukeni ...)</div><div><br /></div>
"<img src="" s
e-14925011353601.jg"" /><div><br /></div><div>Wh
sign f luu
s is
his?</div>"
<b>M l r R sh</b>: Fixed ery
hem , fl
r r ised, ver

he m l r eminences. S res
he n sl bi l flds.
"<img src="" s
e-15148349652993.jg"" /><div><br /></div><div>Wh
sign f luu
s is
his?</div>"
<b>Discid Luus:</b> &nbs;ery
hem
us r ised 
ches
wi
h dheren
ker

ic sc ling nd fllicul r lugging;
rhic <b>sc rring</b
> in lder lesins
Wh
is
he #1 c use f de
h in 
ien
s w
h RA?
C rdiv scul r dise se<d
iv><br /></div><div>O
her cmlic
ins: In
ers
i
i l lung dise se nd s
er
sis</div>
"<img src="" s
e-15290083573761.jg"" /><div><br /></div><div>Wh
sign f luu
s is
his, if
he 
ien
h d jus
been in
he sun?</div>"
<b>Ph
sensi
iv
i
y: </b>skin r sh
Wh
re
he gene
ic f c
rs
h
incre se risk f RA? (2)
"1. MHC II rbl
em: HLA lleles c rry sh red ei
e n
he DR be
ch in wi
hin binding grv
e f MHC mlecule
h
resul
s in r- r
hri
ic effec
s<div>2. SNP rblem sc


ered crss genme
h
incre se risk f u
immune dise ses</div><div><br /></d
iv><div><img src="" s
e-43220255900014.jg"" /></div><div><br /></div><div><br
/></div>"
"<img src="" s
e-15380277886977 (1).jg"" /><div><br /></div><div>Hw c n yu d
ifferen
i
e
his sign f Luus frm Rheum
id Ar
hri
is?</div><div>Hw m ny j
in
s re ffec
ed by luus, nd wh
will yu find un  l
in?</div>"
1) Nn-ersive Ar
hri
is<div>2) The DIP jin
s re ffec
ed in
he ic
ure n
h
e lef
(RA
yic lly ffec
s MP nd PIP)</div><div><br /></div><div>Luus invlv
es 2 r mre eriher l jin
s. The jin
s re swllen,
ender, nd effused - mu
ch like RA.</div>
Hw migh
luus ffec

he lungs r leur (6)? <div><b>1. Pleuri
is</b></div><d
iv><b>2. Pleur l effusins</b> re very cmmn.</div><div>3. Pulmn ry infil
r

es, which mus
be dis
inguished frm neumni </div><div>4. Alvel r hemrrh ge<
/div><div>5. In
ers
i
i l fibrsis</div><div>6. Pulmn ry hyer
ensin</div><div
><br /></div><div>These m y le d
 hyxi in
he 
ien
.</div>
Smking is huge risk f c
r fr which
ye f r
hri
is?
Rheum
id r
hr
i
is
Hw d jin
s feel clinic lly in RA vs OA?<div><br /></div><div>Wh
jin
s re
effec
d in
he h nd in RA vs OA</div> RA: jin
s feel sf
nd sngy, MCP nd
PIP<div>OA: jin
s feel h rd nd bny, MCP, PIP nd DIP</div>
"<img src="" s
e-43787191583120.jg"" /><div><br /></div><div><img src="" s
e43800076485063.jg"" /></div><div><br /></div><div><img src="" s
e-438129613869
46.jg"" /></div>"
<div>E rly RA - h nds f
he PIP c n swell - x-r ys lk
rel
ively benign. C n see li

le s
eeni sme
imes.&nbs;</div><div><br /
></div><div>L
er RA - infl mm
in c uses uln r devi
in, sublux
in f MCPs&
nbs;</div><div><br /></div><div>Severe RA - r
hri
is mu
il ns (cmle
e jin

des
ruc
in)&nbs;</div>
Wh
re rheum
id ndules?
"<img src="" s
e-43993350013144.jg"" /><div><i
mg src="" s
e-44006234915027.jg"" /></div><div><br /></div><div>
hey re like
gr nulm s - shw u
ex
ensr si
es f
he rm (elbw).&nbs;</div>"
Hw is
he he r
invlved in luus (5)? <b>1. Peric rdi
is</b><div>2. Myc rdi
i
s</div><div>3. Fibrinus endc rdi
is</div><div><b>4. V lvul r dise se/insuffici
ency</b> ( n
ibdies

ck v lves)</div><div>5. Crn ry r
ery dise se / Myc
rdi l inf rc
in</div>
Describe
he 3 s
es in
he 
hgeneis f RA <div>1. In
he RA jin
,
he syn
vium ge
s infl med nd ge
s filled wi
h immune cells. Infl mm
in des
rys
he
synvium nd c r
il ge, nd ls
he bne if i
rgresses f r enugh&nbs;</di
v><div><br /></div><div>2.In synvi l lining,
here is hyerl si frm
he infl
mm
in nd i
becmes
he  nnus&nbs;</div><div><br /></div><div>3. P nnus wi
ll des
ry c r
il ge nd
urn n s
ecl s
s
 d m ge bne&nbs;</div>
"<img src="" s
e-44092134261054.jg"" /><div><img src="" s
e-44105019162910.j

g"" /></div>" N
e difference be
ween nrm l nd RA synvi l membr ne

Hw migh
luus ffec

he CNS (2)? Wh
ercen
ge f 
ien
s exhibi
sme sr
Seizures nd sychsis<div><br /></div><div>50%<

f neurlgic l issue?
/div>
"<img src="" s
e-44139378901297.jg"" /><div><br /></div><div>Describe wh

hi
s is</div>"
Nrm l jin
wi
h few infl mm
ry cells resen

"<img src="" s
e-44272522887382.jg"" /><div>Describe wh
is ccuring &nbs;in
E rly RA (3 m jr s
es)</div><div><br /></div><div>When des P nnus frm?</div
>"
1. Infil
r
in by
v rie
y f immune cells: neu
rhils-rducing ri
nfl mm
ry cy
kines<div>2. T cells becme c
iv
ed when n
igen is resen
ed
by dendri
ic cells</div><div>3. T cells c
iv
e B cells which rduce n
ibdie
s,&nbs;</div><div>4. P nnus frms when synvi l
issue begins
 inv de nd deg
r de
he c r
il ge</div>
A 
ien
exhibi
s s
rke nd h s luus. Is
he c use due

cl
? Neurlg
ic disrder - ex mle f c
ive cerebr l v sculi
is. If yu h ve s
rke in lu
us, i
s n
frm bld cl
- i
s frm
he <b>infl mm
in f
he bld vess
els c using hemrrh ging (hemrrh gic s
rke) r ischemi (ischemic s
rke)&nbs
;</b>
"<img src="" s
e-18090402250753.jg"" /><div><br /></div><div>Yu lk nd see

his under
he micrsce f 
ien
wi
h luus. Wh
is
his? Wh
signs f l
uus ccur in urine?</div>"
A cellul r c s
f RBCs. In
he nehrns, RBCs c
n en
er due
 u
immune kidney d m ge nd clum
ge
her.<div><br /></div><di
v>1) &nbs;Persis
en
r
einuri (&g
;0.5 gr ms er d y)</div><div>2) &nbs;Cel
lu r C s
s (RBCs, Hb, gr nul r,
ubul r, r mixed)</div>
"<img src="" s
e-44268227920086.jg"" /><div>Describe wh
is ging in es
blis
hed RA (4 m jr even
s)</div>" 1. Addi
in l recrui
men
nd infil
r
in f im
mune cells<div>2. P nnus becmes highly develed infl mm
ry
isssue</div><div
>3. TNF lh , IL-1, nd IL-6 re rele sed</div><div>4. Enzymes
h
degr de bn
e nd c r
il ge re rele sed&nbs;</div>
Wh
is rhem
id f c
r?
n n
ibdy g ins

he Fc r
in f IgG
Wh
is n
i-cyclic ci
rullin
ed e
ide? ( CCP)
secific m rker fr RA
(if 
ien
h s
his, he/she cer
inly h s RA)
Wh
3 n
ibdies c n be fund in 
ien
s wi
h RA?
1. Rhem
id F c
r<div>
2. An
i cyclic ci
rullin
ed e
ide</div><div>3. n
i nucle r n
ibdies</div>
"<img src="" s
e-18335215386627.jg"" /><div><br /></div><div>Yu lk

kid
ney slide f 
ien
wi
h Luus nd see
his. Wh
is ccuring?</div>"
Infl mm
in f
he glmerulus - lymhcy
es h ve inv ded.
Wh
kinds f
re
men
s re given fr
hse wi
h RA? secific inhibi
rs f i
mmune sys
em r drugs
h

rge
secific r
ins f
he immune sys
em<div><br
/></div><div><br /></div><div>I dn
l n n memrizing ll
hese? Ide is
h

yu w n


rge
differen

hw ys nd cs
imul
ry mlecules since RA is
immune regul
ed</div><div><br /></div><div><div>1. Me
h
rex
e ( c
u lly used
fr
he densine 
hw y
 ch nge i
s effec
n infl mm
in)&nbs;</div><div>
2. <b>E
nerce
</b> (
ke TNF rece
r nd fused i

 Fc f IgG)&nbs;</div><d
iv>3. I<b>nflixim b</b> (chimeric)&nbs;</div><div>4. <b>Ad limum b</b> (hum n r
ecmbin n
)&nbs;</div><div>Side effec
s: infec
in g ins
TB, celluli
is, vir
l syndrmes, he
i
is&nbs;</div><div>5. IL1 rece
r n
gnis
: wrks very we
ll in edi
ric RA&nbs;</div><div>6. Ri
uxim b: dele
es B-cell ul
ins ( n

i-CD20)&nbs;</div><div>7. CTLA-4 Ig:
rge
s
he T-cell ul
ins by n
gn
izing
he CD28-B7 cs
imul
in&nbs;</div><div>8. An
i-IL6 Rece
r: &nbs;</di
v><div>9. Tf ci
inib - JAK inhibi
r, s
hese c n blck
l rge number f cy

kines bec use i
s

he
 f c sc de&nbs;</div><div>10. NSAIDs&nbs;</div
><div>11. Cr
ics
erids&nbs;</div></div>
Wh
is
he difference be
ween cl ss ne nd cl ss
w nehri
is due
 Luus?
"<div><img src="" s
e-18545668784129.jg"" /></div><div><br /></div>Cl ss 1 - M
inim l Mes ngi l: &nbs; n
ibdies bind n
igen in
he subend
heli l s ce nd

he resen
mes ngi l cells re ble
 cle n
he debris- n
ibdies effec
ively.
<div><div><br /></div><div>Cl ss 2 - Mes ngi l Prlifer
in: &nbs;mes ngi l ce
lls mus
rlifer
e
 de l wi
h bund nce f n
igen- n
ibdy cmlexes. These
cmlexes re lc
ed in
he sub-mes ngi l s ce.</div><div><br /></div></div>"

Wh
re sme risk f c
rs fr OA?

<div>1. Age&nbs;</div><div>2. Obesi
y (
imr
n
fr knee nd h nd OA bu
n

he hi)&nbs;</div><div>3. Fem le&nbs;<
/div><div>4. Occu
in l bending r lif
ing&nbs;</div><div>5. An
mic bnrm
li
ies (v rum/bw-legged nd v lgus/knck-knee)&nbs;</div><div>6. Prir knee in
jury nd surgery&nbs;</div><div>7. Secnd ry OA Dise se Assci
ins (i.e. cr
meg ly, hemchrm
sis)&nbs;</div>
Wh
re clinic l m nifes

ins f OA? (2)
"1. invlves (DIP unlike in RA)<
div>2. Jin
s feel h rd nd bny due
 s
ehy
e frm
in</div><div><br /></d
iv><div><img src="" s
e-45483703664884.jg"" /></div>"
Which
ye f r
hri
is, RA r OA, is mre ffec
ed by bimech nic l f c
rs?
OA (sme
hing is d m ging
he c r
il ge nd
he chndrcy
es re c
)
Wh
re
he 
hgenic even
s
h
le d
 OA? (5)
1. Injury
 c r
il ge<d
iv>2. Chndrcy
es re c
by rlifer
ing, frming clus
ers, nd rele sing m
ri
x degr ding enzymes</div><div>3. Gr du l lss f r
icul r c r
il ge</div><div>4
. Thickening f subchndr l bne</div><div>5. Bny u
grw
hs frm c lled s
e
hy
es&nbs;</div>
Why wuld yu n

re
OA wi
h immune suresin?
There re NO u
 n
ibd
ies! OA is mre f mech nic l rblem due
 injury f
he c r
il ge, re c
in
f chndrcy
es
 c r
il ge nd subsequen
c
iv
in, &nbs; nd fin lly f ilu
re f jin

Wh
re
he fur hem
lgic l m nifes

ins f Luus?
Hemly
ic nemi
<div>Leukeni </div><div>Lymheni </div><div>Thrmbcy
eni </div>
Hw migh
yu
re
OA? <div>1. Nnh rm clgic r ch: 
ien
educ
in, we
igh
lss, hysic l
her y&nbs;</div><div>2. Ph rm clgic: indic
in is  in
relief, s
re
wi
h <b> ce
minhen nd NSAIDs</b>; <b>s
erid sh
s&nbs;</
b></div><div>3. Surgic l: if
he  in isn
cn
rlled by medicine nd
her y,

hen

l jin
r
hl s
y is n 
in&nbs;</div>
Wh
l b
echnique migh
yu use
 de
ermine if yur 
ien
h s n
i-nucle r
n
ibdies
 hel wi
h di gnsis f luus?
"<div><b>Indirec
Immunfluresc
ence</b></div><div><br /></div><div><u>FYI</u></div><div><div>1) P
ien
s serum d
ilu
ed nd l yered n
slide which h ve cells r
issue (He2)</div><div>2) Unb
und n
ibdies re w shed ff</div><div>3) Flurescein
gged secnd ry re gen

direc
ed
 Hum n Ig is dded</div><div>4) Bund n
ibdies will fluresce</div
></div><div><img src="" s
e-21646635171841.jg"" /></div>"
Yu ge

he
es
resul
s b ck frm
he ANA ( n
i-nucle r n
ibdy)
es
nd yur
Yur 


ien
s resul
s re si
ive. Wh
des
his me n clinic lly?
ien
m y r m y n
h ve luus. Pr c
ic lly ll 
ien
s (96%) re s
i
ive fr
ANA, bu
nly fr c
in (11%) f 
ien
s wh re ANA si
ive h ve Luus.
If yur 
ien
is si
ive fr ANA n
ibdies, wh
secnd
es
migh
yu run

 becme mre si
ive
h
yur 
ien
h s SLE nd n
sme 
her u
immune d
ise se? D n n
i-DNA n
ibdy
es
.<div><br /></div><div>Thugh i
is nly s
i
ive in 50-60% f 
ien
s wi
h c
ive SLE, si
ive
es
r rely ccurs wi
h
ny 
her dise se. Thus if
hey re si
ive wi
h b
h
he ANA (highly sensi
ive
) nd An
iDNA An
ibdy (highly secific)
es
s,
here is gre
liklihd
hey
h ve SLE.</div>
Wh
re
he
hree immunlgic ( n
ibdy) signs f Luus?
1) n
i-DNA<div>
2) n
i-Sm (resence f n
ibdy
 Sm nucle r n
igen)</div><div>3) n
i-hsh
liid</div>
Wh
re
he clinic l fe
ures f 
ien
wi
h n
i-hshliid n
ibdies (
PL Ab)? D 
her dise ses c use
he e r nce f PL Ab s well?
<div>An

ibdies crss-re c
wi
h l sm membr ne cmnen
s nd c use <b> r
eri l nd ve
nus
hrmbses, sn
neus misc rri ges, nd lw l
ele
s.</b> These 
ien
s
re rne
 g ngrene nd 
her eriher l v scul r issues.</div><div><br /></d
iv><div>O
her dise ses c n c use
he e r nce f PL Ab</div><div><br /></div>
Hw d yu
re
smene wi
h n
i hshliid syndrme?
An
ic gul n
s even
hugh PT nd PTT will be elev
ed lre dy.
Hw d yu
es

 see if smene h s n
i-hshliid syndrme (3)? <div>1)
n bnrm l serum level f IgG r IgM n
ic rdiliin n
ibdies</div><div><br /
></div><div>2) si
ive
es
resul
fr luus n
ic gul n
(LAC)</div><div><b
r /></div><div>3) f lse-si
ive
es
resul
fr
le s
6 mn
hs cnfirmed b

y Trenem  llidum immbiliz
in r flurescen

renem l n
ibdy bsr
i

n
es
</div><div><br /></div><div> n
i be
2 glycr
ein</div><div><br /></div
>
Au
 n
ibdies in SLE re m inly direc
ed g ins
wh
? DNA nd RNA cmlexes
Wh
drugs c n induce luus, nd wh
re
he sym
ms f
his? <div>Chrnic use
f hydr l zine, rc in mide</div><div><br /></div><div><div>Ar
hri
is, r sh, f
ever nd leurisy</div></div><div><br /></div><div>Reslves when drug is wi
hdr
wn</div>
Wh
c uses nen
l luus? Wh
re sme f
he sym
ms? When m y sme f
he
sym
ms cle r u in
he inf n
?
<div>m
ern l u
- n
ibdies crss l c
en
, c use <b>r sh, hem
lgic dise se, he
i
is, nd irreversible he r
blc
k.</b></div><div><br /></div><div><div>By six mn
hs f life, m
hers n
ibdies
re n lnger
here, s dise se cle rs u.&nbs;</div></div>
Hw d yu
re
SLE h rm clgic lly (11 drugs)? Wh
is
he m in in
frm 
ur lec
urer bu

he drugs used

re
Luus?
<u>Ms
f
hese drugs
re n
FDA rved!!</u><div><br /></div><div>Cr
ics
erids &nbs;- &nbs; n

i infl mm
ry</div><div>Hydrxychlrquine -&nbs; n
i rlifer
ive</div><!-nki--><div>Me
h
rex
e&nbs;-&nbs; n
i rlifer
ive</div><div>Az
hirine&nb
s;-&nbs; n
i rlifer
ive</div><div>Mychenl
e&nbs;-&nbs; n
i rlifer

ive</div><div>Cyclhsh mide&nbs;-&nbs; n
i rlifer
ive ( lkyl
ing)</div>
<div>Ri
uxim b - n
i CD20 (dele
es B-cells!!)</div><div>Belimum b - BAFF inhib
i
r (recen
ly FDA rved)</div><div>T crlimus - c lcineurin inhibi
r</div><
div>IVIg - immunmdul
r</div><div>Asirin - n
ic gul n
, n
i-infl mm
ry<
/div>
T be di gnsed wi
h n
ihshliid syndrme wh
cri
eri mus
be me
?
<div>Fr n
i-hshliid syndrme, 1 clinic l nd 1 l br
ry cri
eri mus
b
e me
:&nbs;</div><div><br /></div><div><br /></div><div><b>Clinic l cri
eri :&n
bs;</b></div><div>V scul r
hrmbsis&nbs;</div><div>Pregn ncy mrbidi
y</div>
<div>&nbs;&nbs;</div><div><b>L br
ry cri
eri &nbs;</b></div><div>1. Luus
n
ic gul n
si
ive (
hese c
u lly elev
e PT/PTT)&nbs;</div><div>2. An
ic
rdiliin Abs&nbs;</div><div>3. An
i-b2-glycr
ein Abs&nbs;</div>
<div>Hw re n
i-nucle r n
ibdies (ANA) de
ec
ed?&nbs;</div><div><br /></div
><div><br /></div><div><br /></div>
Serum frm 
ien
is dded
 slides
c
ed wi
h rlifer
ing He-2 cells nd flurescen
ly l beled n
i-hum n n
ib
dies re
hen dded; nucle r 

ern f s
ining reresen
s si
ive
es
&n
bs;
Which mech nism f u
immune injury is
hugh

 cn
ribu
e
 luus nehri
is
?&nbs; Immune cmlexes ccumul
e in
he glmeruli f
he kidney nd resul
in
cellul r rlifer
in nd infl mm
ry infil
r
in&nbs;
"<div>31 ye r ld G1P1 n cml in
s</div><div>P  sme r mild
yi (Im ge #2)
(Nrm l Im ge #1) -&g
; re
urn in 6 mn
hs</div><div>Seen 1 ye r l
er P  sme r
= high gr de squ mus in
r ei
heli l lesin-&g
;bisy</div><div>Nrm l bisy (
Im ge #3) P
ien
s bisy (Im ge #4 & m; 5)</div><div><br /></div><div><img src=
"" s
e-26980984553820.jg"" /></div><div><br /></div><div><img src="" s
e-2699
3869455748.jg"" /></div>"
nuclei l rger, cy
l sm less<div>infl mm
ry c
ells (neu
rhils
h
re infil
r
ing</div><div>
mder
e
 severe dysl si
</div><div><br /></div><div>1.&nbs;Im ge 1 - nrm l   sme r. Yu shuld see
m
ure squ mus cells wi
h sm ll rund cen
r l nuclei. Or nge is
he ker
in nd
green re in
ermedi
e. There is n bsence f infl mm
in.</div><div><br /></
div><div>2.&nbs;Im ge 2 - bnrm l   s
in. The N:C r
i is l rger. There r
e infl mm
ry cells in
he erihery. Remember
h
severe dysl si invlves

he surf ce f
he cells,
hen
his   sme r shws severe dysl s
ic cells.&nbs
;</div>
"<div>31 ye r ld G1P1 n cml in
s</div><div><br /></div><div>P  sme r mild

yi (Im ge #2) (Nrm l Im ge #1) re
urn in 6 mn
hs</div><div><br /></div><div
>Seen 1 ye r l
er P  sme r = high gr de squ mus in
r ei
heli l lesin --&g
; b
isy</div><div><br /></div><div>Nrm l bisy (Im ge #3) P
ien
s bisy (Im ge
#4 & m; 5)</div><div><br /></div><div><img src="" s
e-27135603376500.jg"" /><
/div><div><br /></div><div><img src="" s
e-27148488278400.jg"" /></div><div><b
r /></div><div><img src="" s
e-27161373180277.jg"" /></div><div><br /></div>"

1.lw gr de dysl si limi
ed
 lwer 1/3<div>2. Bu
nw yu h ve dysl si mv
ing
w rd
he surf ce (n
full
hickness dysl si )</div><div>3. S we wuld s
y mder
e dysl si </div><div>4. nuclei irregul r, r isinid nuclei, binuclei,
erinucle r h ls, ll fe
ures f HPV ch nge</div><div><br /></div><div>Im ge
4 - bnrm l cervic l mucs . In
he middle
here re l rger cells wi
hu
much
m
ur
in. This lks like mder
e dysl si . &nbs;</div><div><br /></div><di
v>Im ge 5 -
he nuclei re irregul r, l rger, nd r isinid. There re binuclei
d cells. This is indic
ive f HPV.&nbs;</div><div><br /></div>
"<div>1. &nbs;Im ge #5 shws l
er
ins in cervic l ei
heli l cells irregul r
hyerchrm
ic nuclei wi
h h les. Wh
is resnsible fr
hese ch nges? Wh
is
i
s rle in cervic l c ncer?</div><div><br /></div><div><img src="" s
e-273116
97035637.jg"" /></div>"
<div>1. Ch nges due
 HPV</div><div>2. M ny ser

yes (v ri
ins f HPV virus) (16,18,31,33 & m; 35) --&g
; c ncer</div><div>
3. Ms
infec
ins will reslve; 10-15 ye rs
 devel c ncer</div><div><br /><
/div>
<div>Wh
re
he risk f c
rs fr cervic l c ncer?</div><div><br /></div>
<div>E rly ge
firs
in
ercurse;&nbs;</div><div>mul
ile sex  r
ners;</div
><div>&nbs;hx f geni
l HPV/STDs;&nbs;</div><div>geni
l
r c
nel si ;&nbs
;</div><div>smking;&nbs;</div><div>sex  r
ner wi
h risk f c
rs fr STDs; im
mundeficiency;&nbs;</div><div>r nu
ri
in</div><div><br /></div>
<div>Wh
is
he difference be
ween in si
u nd inv sive squ mus c ncer?</div><
div><br /></div>
"<div>In si
u c ncer invlves
he ei
helium nly, inv s
ive c ncer ene
r
es
he b semen
membr ne in

he deeer
issue (see bnus im
ge)</div><div><br /></div><div><img src="" s
e-27414776250748.jg"" /></div><d
iv><br /></div><div>micrinv sive: de
h less
h n 3mm</div><div>N risk f me

s
sis: usu lly jus
h ve surgery
 ge

he lesin u
.&nbs;</div><div><br /><
/div><div>Bnus Im ge - nce
he bre ch h s ccurred,
hen i
is cnsidered inv
sive c ncer. If
his de
h is 3 mm in cervix,
hen i
s cnsidered ""micrinv si
ve c ncer""&nbs;</div><div><br /></div>"
<div>Cmmen
n
he effec
iveness f
he P  sme r s c ncer screening me sure
.</div><div><br /></div>
<div>While
he P  sme r is n
erfec
& m; m
y be subjec

 s mling errrs, i
h s succeeded in reducing
he cervic l c nce
r mr
li
y by 60%. Cervic l c ncer is nw &l
;10
h c use f de
h in wmen (w s
#1). New HPV
es
ing shuld imrve resul
s fur
her.</div><div><br /></div>
<div>54 ye r ld m n, hx rheum
id r
hri
is n Celebrex & m; b by sirin</di
v><div>C/ eisdes f eig s
ric  in, n use , he r
burn imrve wi
h H2 blcke
rs</div><div>Sligh
imrvemen
wi
h smking cess
in</div><div>Mild eig s
ric

enderness</div><div><br /></div><div><div>Wh
re yur di gns
ic cnsider
i
ns? Wh
ev lu
in wuld yu rder?</div></div><div><br /></div><div><br /></d
iv>
<div>1. Sugges
ive f GE reflux, g s
ri
is, ulcer, g s
ric c ncer r lym
hm </div><div>2. Uer endscy wuld be gd firs
s
e wi
h bisy if les
in is seen</div><div>3. R dilgic s
udies m y be v lu ble</div><div><br /></di
v>
"<img src="" s
e-27659589386642.jg"" /><div> bnrm l<br /><div><br /></div><di
v><br /></div><div><img src="" s
e-27672474288503.jg"" /></div></div><div>nrm
l</div>"
Im ge 6 - bnrm l. Sused
 be sm
h. Sme
hing

he b se
f
he esh gus is m king l
f bumy ndules&nbs;
"<img src="" s
e-27762668601730.jg"" />"
Bisy--&g
; chrnic c
ive g s

ri
is wi
h sir l rg nisms c/w H. ylri&nbs;
"<img src="" s
e-27805618274701.jg"" /><div><img src="" s
e-27822798143858.j
g"" /></div>" lymhl sm cy
ic infil
r
e des
rying gl nds&nbs;<div>Infil
r

e= cln l B lymhcy
es</div><div><br /></div><div>Im ge 9 -
here is huge
mun
f infil
r
e inv ding
he s
m ch ei
helium/gl nds bec use f
he H. yl
ri. This is MALT lymhm f B-cells. If yu
re

he H. ylri,
hen
he MA
LT lymhm ges w y</div><div><br /></div><div>Im ge 10 - nrm l gl nd n
he
lef
. All f
he urle d
s re lymhcy
es. These re infil
r
ing nd des
ry
ing
he gl nds</div>
"<div>Wh
is yur di gnsis? Wh
des
cln l ul
in me n?</div><div><br />
</div><div><img src="" s
e-28479928140178.jg"" /></div><div><br /></div><div><
img src="" s
e-28492813042020.jg"" /></div><div><br /></div><div><img src=""

s
e-28505697943951.jg"" /></div><div><br /></div><div><img src="" s
e-28527172

780386.jg"" /></div>" <div>1.G s
ri
is wi
h H. ylri nd
(MALT) lymhm </d
iv><div><br /></div><div>2. Cln l ul
in = ll cells exress
he s me m rke
rs ll derived frm s me mu
n
cell; wi
h B cells = m ke ei
her k  r l mbd
ligh
ch in</div><div><br /></div>
<div>Unusu l fr b c
eri r 
her infec
ius gen
nel sm? O
her ex mles?</d
iv><div><br /></div>
<div>M ny b c
eri , viruses,  r si
es induce infl mm
i
n,
h
lef
un
re
ed rgress
 nel si (H. ylri, IBD --&g
; GI nel si
)</div><div><br /></div><div>He
i
is B & m; C (liver c ncer); HPV (cervic l
c ncer); EBV (lymhm , NPC); HHV8 (K si s rcm ); Schis
sm m nsnii (bl dd
er c ncer); Liver flukes (liver c ncer), HTLV-1 (ATLL)</div><div><br /></div>
<div>In gener l, hw d infec
ius gen
s induce nel si ?</div><div><br /></di
v>
"<img src="" s
e-28595892257070.jg"" />"
<div>63 ye r ld m n - &nbs;incre sing f
igue & m; weigh
lss, decre sed 
e
i
e, bl ck s
ls</div><div>PE gu i c + s
ls</div><div>Irn deficiency nemi
</div><div>CEA = 9ng/ml (N&l
;3)</div><div><br /></div><div><br /></div><div><d
iv>Exl in
he 
ien
s sym
ms nd
heir signific nce.</div></div><div><br /></
div>
"<img src="" s
e-28647431864629.jg"" />"
<div>Wh
is CEA nd wh
des n elev
ed level me n? N me 2 
her
umrs wi
h
elev
ed CEA.</div><div><br /></div>
<div>CEA = gru f glycr
eins c
s

umr m rker</div><div><br /></div><div>Clrec
l CA, lung CA, bre s
CA, S
m
ch CA,  ncre
ic CA, v ri n CA</div><div><br /></div><div>Ren l dise se, cirr
hsis, he vy smkers</div><div><br /></div><div>Bes
used
 fllw
re
men
&
m; dise se rgressin</div><div><br /></div>
"<img src="" s
e-28814935589188.jg"" /><div><div>Wh
is frzen sec
in nd
why re m rgins sked fr?</div></div><div><br /></div>"
"<img src="" s

e-28832115458372.jg"" /><div>M rgins re sked
 m ke sure
hey dn
h ve
 g
 b ck in
 cllec
mre
issue</div>"
"<img src="" s
e-28909424869762.jg"" /><div><br /></div><div><img src="" s
e29016799052156.jg"" /></div>" irregul r ulcer wi
h r ised edges<div><br /></di
v><div><br /></div><div>Im ge 11 - yu c n see n irregul r ulcer wi
h r ised ed
ges (m lign n
). Clse
 i
re lys.&nbs;</div><div><br /></div><div>Im ge
12 - c n see
he ulcer diing dwn nd infil
r
ing
he sers n
he b

m. T
his exl ins
he bleeding since
he submucs h s
he l rger vessels. &nbs;</di
v>
"<div>4. &nbs;Describe
he grss fe
ures f
he secimen (Im ges #11& m;12).
D yu f vr benign r m lign n
rcess, nd why?</div><div><br /></div><div>
<img src="" s
e-29098403430786.jg"" /></div><div><br /></div><div><img src=""
s
e-29111288332668.jg"" /></div>"
"<img src="" s
e-29180007809348.jg"" /
>"
"<img src="" s
e-29214367547766.jg"" /><div><br /><div><img src="" s
e-292272
52449652.jg"" /></div><div><br /></div><div><img src="" s
e-29240137351542.jg
"" /></div></div><div><br /></div><div><div>5. &nbs;Im ges #13-15 shw micrsc
ic fe
ures f
he cln c ncer. Wh

ye f c ncer is i
? Wh
gr de wuld y
u give i
?</div></div><div><br /></div>"
<div>Adenc rcinm </div><div><b
r /></div><div>Mder
ely differen
i
ed (in 
her re s f
he
umr
here were
rly differen
i
ed cells seen. Adequ
e s mling f

umr is necess ry

ev lu
e i
s cy
lgic nd rgns
ic fe
ures)</div><div><br /></div><div>Im ge
13 - The lef
is nrm l. C n see
he cry
s nd nrm l submucs . On
he righ
,

his lks like i
s ushing u
. This ex mle h s inv sive c ncer
h
is ene

r
ing
he b semen
membr ne.</div><div><br /></div><div>Im ge 14 - nce i
ge

s

he f
,
hen
here is likelihd
h
i
will seed in

he eri
neum&n
bs;</div><div><br /></div><div>Im ge 15 &nbs;- i
s frming gl nds ( denc rci
nm ) - bu

he gl nds lk li

le dd (mder
ely differen
i
ed)&nbs;</div>
<div><br /></div>
"<img src="" s
e-29351806501223.jg"" />"
lymh
ic inv sin f
umr<div>
<br /></div><div>Im ge 16 -
he
umr cells re lugging
he lymh
ic (yu c n
n
ice
he r
erile n
he righ
nd vein nd
he b

m righ
). This ch nges

he gr de (n

he s
ge) f
he
umr.&nbs;</div>
"<img src="" s
e-29446295781735.jg"" /><div><img src="" s
e-29459180683635.j

g"" /></div><div><img src="" s
e-29472065585500.jg"" /></div>"

<div>Im
ges #16-18 shw
umr cells in lymh
ic s ces (16) nd in regin l lymh ndes
(17 & m; 18).&nbs;</div><div><br /></div><div>Im ge 18 - Ker
in immuns
in
hels ick u

he clus
ers f me
s

ic c ncer in
he nde. This s
in highlig
h
s ei
heli l cells, n
lymhcy
es, s i
c n hel us differen
i
e be
ween c
ells</div><div><br /></div>
<div>Sme clrec
l c ncers rise in 
ien
s wi
h n inheri
ed c ncer syndrme
such s F mili l Adenm
us Plysis (FAP) Syndrme. As resul
f mu

ins
in
he APC gene
hese 
ien
s devel hundreds f lys
hrughu

he GIT, s
me f which becme m lign n
.</div><div><br /></div><div><div>In gener l, wh

clinic l fe
ures sugges
n inheri
ed c ncer syndrme?</div></div><div><br /></
div><div><br /></div> <div>Fe
ures f inheri
ed c ncer syndrmes include:</di
v><div>1. E rly nse
f c ncer</div><div>2. C ncer in 2 r mre clse rel
ives
</div><div>3. Mul
ile r bil
er l c ncers</div><div><br /></div>
<div>Wh
re
he recmmended c ncer screening me sures fr clrec
l c ncer?</
div><div><br /></div> "<img src="" s
e-29549374996804.jg"" />"
"<img src="" s
e-29583734735172.jg"" /><img src="" s
e-29635274342735.jg"" /
>"
Im ge 20 -   s
in. The r nge cy
l sm imlies ker
in rduc
in. T
he nucleus is very l rge nd h s high N:C r
i. Lks like squ mus cell c rc
inm . This h s been cughed u
which is mre cncerning, cnsidering hw e sy
i
w s fr
he
umr cells
 n
-s
ick.
"<img src="" s
e-29695403884927.jg"" />"
ker
in fern-rducing ker
in l
ike nrm l sq mus cells
<div>Wh
envirnmen
l/chemic l f c
rs h ve been imlic
ed in
he develmen

f c ncer (
his 
ien
& m; 
hers) (Rbbins  322-323)</div><div><br /></div
>
"<img src="" s
e-29777008263511.jg"" /><div><img src="" s
e-297941881
32715.jg"" /></div>"
<div>D yu
hink
h

he liver ndules re rim ry liver nel sms r me
s


ic c ncer frm
he lung? Hw culd yu
ell? Describe
he s
es c ncer cell g
es
hrugh
 me
s
size. (Rbbins  311)</div><div><br /></div>
The res
ence f single lung m ss wi
h mul
ile liver m sses sugges
s
h

he lung is

he rim ry si
e
<div>The liver is cmmn si
e f me
s
sis f lung c ncer, s re br in nd b
ne. Ms
liver c ncers re sli
ry m sses, s
he resence f mul
ile ndules
sugges
s me
s

ic
umr. Bisy f ne f
he ndules migh
hel well differe
n
i
ed squ mus c ncer wuld be cnsis
en
wi
h lung rim ry. Wi
h rly dif
feren
i
ed
umrs
his dis
inc
in m y n
be e sy.</div><div><br /></div>
"<img src="" s
e-29884382445892.jg"" />"
"<img src="" s
e-29918742184278.jg"" />"
<div>Liver me
s
sis frm lung
c ncer</div><div><br /></div>
"<img src="" s
e-29974576759108.jg"" /><div><img src="" s
e-30073361006962.j
g"" /></div><div><br /></div><div><img src="" s
e-30086245908845.jg"" /></div>
"
1. clus
er f cells wi
h very l rge nuclei nd li

le cy
l sm. M lign
ncy, RBC is
h
li

le
iny red d
<div><br /></div><div>2. n nrm l lung
iss
ue. Very li

le cy
l sm, n gl nds, n ker
in, sm ll cell c rcinm </div><div
>lk like lymhcy
es.&nbs;</div><div><br /></div><div>Im ge 22 - P  s
in. T
he cells h ve VERY li

le cy
l sm (
he d rk blue is c
u lly
he nucleus).&nbs
;</div><div><br /></div><div>Im ge 23 -
his is bisy f
he lung, nd cle r
ly lks bnrm l. There is n nrm l lung
issue. They ren
frming gl nds r
m king ker
in (s
his is n
squ mus r denc rcinm ). This is c lled <b>s
m ll cell c rcinm .</b></div>
<div>Wh
is yur exl n
in f
he elev
ed glucse nd ACTH, hyk lemi , nd
lk lsis?</div><div><br /></div>
<div>The 
ien
h s  r nel s
ic sy
ndrme invlving ec
ic rduc
in f ACTH</div><div><br /></div>
<div>Wh

her syndrmes f
his kind ( r nel s
ic syndrmes) culd yu see
wi
h sm ll cell c rcinm f
he lung?</div><div><br /></div> <div>SIADH, Hye
rc lcemi , E
n-L mber
syndrme (seud-my s
heni ), nd Cr
ic-cerebell r de
gener
in</div><div><br /></div>
<div>Wh
re
he m jr risk f c
rs fr
his
ye f sm ll cell c rcinm c nce
r?</div><div><br /></div>
<div>Smking, smking, smking</div><div>Sme
y

es f ccu
in l exsures nd r dn ccun
fr sm ll number f 
ien
s</

div><div><br /></div>
"<img src="" s
e-30210799960471.jg"" />"
A
"<div>53 ye r ld s
men us l wm n wi
h 3 mn
h his
ry f v gin l bleeding<
/div><div><br /></div><div><img src="" s
e-30249454666255.jg"" /></div><div><b
r /></div><div><img src="" s
e-30262339568156.jg"" /></div><div><br /></div><d
iv><img src="" s
e-30275224470042.jg"" /></div>"
1. very blue
umr: n

frming ny gl nds<div>2. mi
ses c n be seen, c r
il ge frming</div><div>ei
h
eli l nd mesenchym l fe
ures: mixed m lign n
mulleri n
umr</div><div><br />
</div><div>Di gnsis: c rcins rcm </div><div><br /></div><div>Im ge 27 - endm
e
rium is filled wi
h
umr cells. The
umr c
u lly bulged u
.&nbs;</div><di
v><br /></div><div>Im ge 28 - very blue
umr . On
he lef
is jus
shee
s f bl
ue cells.</div><div><br /></div><div>Im ge 29-The cells n
he righ
is chesive
nd n
he lef
is dischesive. The isl nds f ligh
blue re c r
il ge. The gl
nds re d rk blue n
he righ
. This is c rcins rcm (mixed m lign n
Mulle
ri n
umr =
rile MTs).</div>
"<div>54 ye r ld wm n wi
h r idly enl rging skull m ss</div><div><br /></div>
<div><img src="" s
e-30313879175417.jg"" /></div><div><br /></div><div><img sr
c="" s
e-30326764077303.jg"" /></div>"
"<img src="" s
e-30361123815798.jg"" />"
"<img src="" s
e-30374008717424
.jg"" /><div><br /></div><div>In
he br in, yu c n see
he gl nds in
he righ

side
h
re m lign n
; sme re s h d squ mus ei
helium
h
is benign. End
me
riid denc rcinm
ends
 give gl nds wi
h squ mus me
l si .&nbs;</d
iv>"
"<img src="" s
e-30399778521501.jg"" /><div>ER immuns
in</div>"
"<img src="" s
e-30425548325275.jg"" /><div><br /></div><div>PAX8 s
in</div>"
"<img src="" s
e-30459908063576.jg"" />"
Endme
ri l bisy subsequen
ly
shws
he ex c
s me
issue s
ruc
ure s
he br in grw
h.
"<img src="" s
e-36992553320977.jg"" />"
P21: CDK inhibi
r<div>GADD45: F
cili

es DNA re ir</div><div>BAX: ini
i
es 
sis</div><div>MYC/CDK4: gr
w
h rm
ing genes</div><div>BCL-2: inhibi
s 
sis</div>
When des 53 medi
ed cell cycle rres
ccur? l
e in G1: blcks rgressin 
f cells frm G1
 S
Tumrs wi
h ________ 53 lleles r mre likely
 be killed
h n
umrs wi
h __
______ 53
wild
ye; mu

ed
Tes
icul r
umrs nd childhd cu
e lymhbl s
ic leukemi s h ve _______ 53
lleles wild
ye: e sy
 kill
Lung nd clrec
l c ncers c rry ______ 53 lleles
mu

ed; resis
n

 r
di
in nd chem
her y
Wh

hw y is APC
cmnen
f? Wh
des i
medi
e
he degr d
in f?
"WNT sign ling<div>be
c
enin</div><div><br /></div><div><img src="" s
e-3732
3265802510.jg"" /></div>"
B l ncing c
be
ween wh

w genes regul
e 
sis?
"<img src="" s

e-37379100377495.jg"" />"
N
e v rius lc
ins f grw
h f c
rs
"<img src="" s
e-37529424232934
.jg"" /><div><b><br /></b></div><div><b>Nucleus:&nbs;</b></div><div>
r nscri

in f c
rs: MYC</div><div>Cell Cycle cmnen
s: Cyclin D/CDK4, CDK inhibi
rs<
/div><div>Tumr Suressr: 53, Rb</div><div>A

ic inhbi
rs: BCL2</div><di
v>DNA re ir: BRCA1/2, hMSH2</div><div><br /></div><div><b>Membr ne:</b> GF, GFR
</div><div><br /></div><div><b>Cy
l sm:&nbs;</b></div><div><br /></div><div>S
ign l Tr nsducer: RAS, BRAF, PI3K</div><div>APC</div>"
T/f c rcingenesis is mul
is
e rcess
"<img src="" s
e-37679748088181
.jg"" />"
Wh
re
he 7 s
es invlved in
he bilgy f
he
umr grw
h
1. m lig
n n

r nsfrm
in in 1 cell<div>2. grw
h f bnrm l cell</div><div>3. lc l
inv sin</div><div>4. me
s
sis</div><div>5. Angigenesis medi
ed by VEGF nd
bFGF</div><div>6. Prgressin nd new mu

ins</div><div>7. he
ergenei
y: sub
ul
ins devel wi
h new mu

ins</div>
Wh
is required fr
i
mus


umr
 enl rge beynd 1-2 mm in di me
er?
h ve
he c  ci
y
 induce ngigenesis

Wh
is
he du l effec
f ngigenesis n
umr grw
h?

1. ngigenesis
delivers nu
rien
s nd xygen<div>2. Newly frmed end
heli l cells s
imul
e
h
e grw
h f dj cen

umr cells by secre
ing grw
h f c
rs</div>
Wh
re
he 2 m jr h ses f
he me
s

ic c sc de? "1. inv sin f
he ex
r
cellul r m
rix<div>2. v scul r dissemin
in, hming f
umr cells, nd cln
iz
in</div><div><br /></div><div><img src="" s
e-37924561224197.jg"" /></div
>"
"<img src="" s
e-37920266256901.jg"" />"
Wh
re
he 4 s
es by which
umr cells inv de
he ex
r cellul r m
rix?
"1. Cells De
ch (dwn regul
e E c dherin)<div>2. A

chmen

 m
rix cmnen

s vi l minin nd fibrnec
in rece
rs</div><div>3. Degred
in f ECM vi r

ely
ic enzymes (Tye 4 cll gen se)</div><div>4. Migr
in f cells vi m
ili

y f c
rs</div><div><br /></div><div><img src="" s
e-38169374359915.jg"" /></
div><div><br /></div><div><img src="" s
e-38182259261826.jg"" /></div><div><br
/></div><div><img src="" s
e-38195144163675.jg"" /></div><div><br /></div><di
v><img src="" s
e-38208029065573.jg"" /></div>"
Hw d
umr cells imrve
heir surviv l while
r veling
hrugh bld vessels?
l
ele
s nd
umr cells clus
er in
 n ggreg
e
Hw d
umr cells exi
frm bld vessels?
dhesin mlecules CD44
Dwnregul
in r uregul
in f E c dherins decre se me
s
sis
Uregul

in f E c dherins
Wh
re 3 w ys &nbs;by which
umrs ev de T cell recgni
in nd c
iv
in?
"<img src="" s
e-38732015075845.jg"" />"
Wh

umr n
igens re recgnized by immune sys
em?

umr n
igen rduced b
y ncgenic viruses
Wh
re ncfe
l n
igens?
r
eins
h
re exressed
high levels n c
ncer cells nd nrm l develing fe
l
issues<div><br /></div><div>Oncfe
l r

eins re sufficien
ly secfic
h

hey c n serve s m rkers
h
id in
umr
di gnsis nd clinic l m n gemen
</div>
Wh
re
he 2 ms

hrughly s
udied ncfe
l n
igens?
CEA: c rcinembr
ynic n
igen<div><br /></div><div>AFP: lh fe
r
ein</div>
Wh
is
he difference be
ween gr de nd s
ge f
umr "<img src="" s
e-389338
78538682.jg"" />"
N me
he nel se ssci
ed wi
h e ch b c
eri r infec
ius gen
<div><br /><
/div><div>1. H ylri/IPD</div><div>2. He
i
is</div><div>3. HPV</div><div>4. E
BV</div><div>5. HHV8</div><div>6. Schis
sm M nsnii</div><div>7. Liver Flukes
</div><div>8. HTVL-1 (hum n T lymh
ric virus 1)<br /><div><br /></div></div>
<div>1. H ylri/IPD: M l
Lymhm , g s
ric denc rcinm , r clrec
l c nce
r</div><div>2. Liver C ncer</div><div>3. HPV: cervic l c ncer</div><div>4. EBV:
lymhm , NPC</div><div>5. HHV8: K si S rcm </div><div>6. Schis
sm M nsni
i: Bl dder C ncer</div><div>7. Liver Flukes: chl ngis rcm , liver c ncer, cl
n c ncer</div><div>8. HTVL-1 (hum n T lymh
ric virus 1): ATLL ( dul
T cell
leukemi /lymhm )<br /></div><div><br /></div>
Righ
sided cln c ncer resen
s wi
h wh
sym
m?<div><br /></div><div>Lef
s
ided cln c ncer resen
s wi
h wh
?</div>
Bld lsss<div><br /></div><div
>cns
i
in r di rrhe </div>
Wh
re 3 fe
ures f inheri
ed c ncer syndrmes?
1. e rly nse
f c ncer
<div>2. c ncer in 2 r mre clse rel
ives</div><div>3. mul
ile r bil
er l c
ncers</div>
Schis
smi sis c uses ________ nd
hen ______ chrnic cys
i
is&nbs;<div><br /
></div><div>bl dder, liver, rec
l c rcinm </div>
Gnrrhe , Chl mydi , HPV c uses ________
hen ______ chrnic cervici
is<div><
br /></div><div>cervic l c rcinm </div>
B c
eri l infec
in in bne c n c use _______
hen ______
s
emyeli
is<di
v><br /></div><div>c rcinm in dr ining sinuses</div>
HHV8 c n c use _________
K si S rcm
He
i
is B/C virus c n c use _________
hen _______
he
i
is<div><br /></di
v><div>he
cellul r c rcinm </div>
EBV c n c use _________ nd
hen _______
mnnuclesis; lymhm
H Pylri c n c use ________ nd
hen _______
g s
ri
is; g s
ric denc rcinm

r MALT lymhm
Liver flukes c n c use _______ nd
hen _________
chl ngi
is;&nbs;<div><
br /></div><div>chl ngis rcm , he
cellul r c rcinm , cln c rcinm </div
>
G s
ric Acids c n c use ______ nd
hen ______ reflux esh gi
is; B rre

s<div
><br /></div><div>Esh ge l c rcinm </div>
Mu

in in
rysingen gene c n c use _______ nd
hen _______<div><br /></div>
<div>Alchlism c n c use _______
hen ______</div>
heredi
ry  ncre
i
is;
 ncre
ic c rcinm <div><br /></div><div>chrnic  ncre
i
is;  ncre
ic c rc
inm </div>
Infl mm
ry bwel dise se c n c use _______
clrec
l c rcinm
Lichen sclersis c n c use _______
vulv r squ mus cell c rcinm
Abes
s c n c use ________
lung c ncer, esh ge l, g s
ric, cln c ncer,
mes
helim
Sjgren syndrme r H shim
s c n c use ______ MALT lymhm
"L: rxim l  r
f r
ic rch
ill cmmn c r
r
ic s c becmes&nbs;

id<div>Righ
: br chiceh lic
runk</div><div><br /></div><div><img src="" s

e-43954695307540.jg"" /></div>"
3rd r
ic rch becmes "righ
nd lef
cmmn c r
id nd rxim l in
ern l c r

id<div><br /></div><div><img src="" s
e-43950400340244.jg"" /></div>"
4
h r
ic rch becmes "L: r
be
ween cmmn c r
id nd duc
us r
erisus<d
iv><br /></div><div>Righ
: rxim l  r
f subcl vi n</div><div><br /></div><di
v><img src="" s
e-43950400340244.jg"" /></div>"
6
h r
ic rch becmes "L: rxim l lef
ulmn ry r
ery nd duc
us r
erisus
<div><br /></div><div>R: rxim l righ
ulmn ry r
ery</div><div><br /></div><
div><img src="" s
e-43950400340244.jg"" /></div>"
Wh
bnes d 1s
h rynge l rch give rise? (6)
"m xill <div>zygm
ic</
div><div> r
f
emr l</div><div>m ndible</div><div>m lleus&nbs;</div><div>i
ncus</div><div><br /></div><div><img src="" s
e-44165148705266.jg"" /></div>"
Wh
bnes d 2nd h rynge l rch give rise?(3) "s
es<div>s
ylid rcess</div
><div>lesser hrn f hyid nd uer hyid bne</div><div><br /></div><div><img
src="" s
e-44160853737970.jg"" /></div>"
Wh
bnes d 3rd h rynge l rch give rise? (1)
lwer hyid bne
Wh
c r
il ge d 4/6 h rynge l rch give rise
? (2)
hyrid c r
il ge<div>cr
icid c r
il ge<br /><div><br /></div><div><br /></div></div>
"<img src="" s
e-44276817854892.jg"" />"
Wh
&nbs;muscles d 1s
h rynge l rch give rise
? (5)
m s
ic
in<div>
n
erir belly f dig s
ric</div><div>mylhyid&nbs;</div><div>
ensr
ym ni</
div><div>
ensr  l
ini</div>
Wh
muscles d 2nd h rynge l rch give rise
? (4) s
edius<div>s
ylhyid
</div><div>s
erir belly f dig s
rc</div><div>f ci l exressin</div>
Wh
muscles d 3rd h rynge l rch give rise
?
s
ylh ryngeus muscle
Wh
muscles d 4
h/6
h h rynge l rch give rise
? cric
hyrid&nbs;<div>l
ev
r  l
ini</div><div>cns
ric
rs f h rynx</div>
Wh
nerves d 1, 2, 3, 4
h nd 6
h h ryng el rch give rise
?
1-
rige
min l<div>2- f ci l</div><div>3- glssh rynge l</div><div>4-suerir l ryge l<
/div><div>6-recurren
l rynge l br nch</div>
Wh
is
he rim ry cri
eri fr v sculi
is 
hlgy? 1. vessel well necrsis
wi
h nucle r fr gmen

in<div>2. inv sin f vessel w lls wi
h neu
rhils</div
><div>3. Fibrinid desi
s in r dj cen

 vessel w ll</div>
Wh
is
he secnd ry cri
eri fr v sculi
is 
hlgy?
1. eriv scul r
hemrrh ge<div>2. chrnic gr nulm
us infl mm
in</div><div>3. eriv scul r f
ibrsis</div><div>4.
hrmbsis f vessel</div>
Wh
re
he 2
yes f v sculi
is&nbs;
humr l medi
ed nd cell medi

ed
Wh

ye f v scuil
is invlves gr nul m
us re c
in nd
del yed
ye hye
rsensi
ivi
y re c
in? cell medi
d v sculi
is: invlving lymhcy
es nd m cr
h ges
Hw des humr l medi
ed v sculi
is ccur? (6) u
 n
ibdies (ANCA r n
i-end

heli l cell bs) rm
e
hese even
s<div><br /></div><div>1. incre sed erme

bili
y f vessel in
im
</div><div>2. immune cmlex desi
in</div><div>3. c

mlemen
c
iv
in</div><div>4. recrui
men
nd inv sin f neu
rhils</div><d
iv>5. rduc
in f rinfl mm
ry cy
kines</div><div>6. end
heli l cell inju
ry le ds

hrmbsis (virchws
ri d)</div>
Wh
n
igen des P-ANCA bind?<div>C-ANCA?</div>
" n
imyelerxid se<div
><br /></div><div> n
ir
ein se</div><div><br /></div><div><br /></div><div><im
g src="" s
e-50654844289446.jg"" /></div>"
Wh
is rim ry v sculi
is?<div><br /></div><div>Wh
is secnd ry v sculi
is?</
div><div><br /></div><div>Wh
re gene
ic rediss
ins
h
le d
 v sculi
i
s?</div>
idi
hic lss f
ler nce
 self<div><br /></div><div>resn
se
 infec
in,
umrs, drugs,
umrs</div><div><br /></div><div>dysregul
in
f dhesin mlecule exressin</div><div>unb l nced infl mm
in</div>
Hw des v sculi
is m nifes
in skin? r sh, urur , ulcer
in, g ngrene
hw des v sculi
is m nifes
in nervus sys
em? he d che, s
rke, eriher l ner
ve d m ge
Hw des v sculi
is m nifes
in irw ys?
nsebleeds, ulmn ry infil
r
e
s, ulmn ry hemrrh ge
Hw des v sculi
is m nifes
in
he c rdiv scul r sys
em?
CAD, MI, eric r
di
is, r
ic insufficiency, cl udic
in
Hw des v sculi
is m nifes
in GI?
 in, bldy s
ls
Hw des v sculi
is m nifes
in kidney? hem
uri , r
einuri , glmerulnehri

is, hyer
ensin, AKI
Hw des v sculi
is m nifes
in MSK?
r
hr lgi s, my lgi s, mysi
is
Hw des v sculi
is c use clinic l sym
ms?
Infl mm
in le ds
 end
heli
l injury,
hrmbsis, vessel cclusin, nd dwns
re m ischemi
Wh
<b>l rge vessel</b> dise se is ssci
ed wi
h <b>hyer
ensin, decre sed b
r chi l r
ery ulse</b>, BP differen
i l gre
er
h n 10 mmHg, subcl vi n 
r r
ic brui
, nd n ngigr m bnrm li
y? "T k y sus dise se<div><br /></d
iv><div><img src="" s
e-51135880626703.jg"" /></div>"
Wh
<b>l rge vessel </b>dise se is ssci
ed wi
h he d che, j w in,
emr l
r
ery
enderness, reduced r
ery uls
in, nd blindness
"<img src="" s

e-51174535332367.jg"" />"
Wh
<b>medium vessel</b> dise se is ssci
ed wi
h rlnged fevers frm unkn
wn rigin, reddening f
he lis, desqu m
in f fingers nd
es?
"<img sr
c="" s
e-51281909514750.jg"" />"
Wh
is
he lng
erm sequel e fr K w s kis dise se? Why is
his imr
n

Crn ry r
ery neurysms<div><br /></div><div>Crn ry r
ery neurysms re
y
ic lly sym
m
ic un
il yu ge
he r
f ilure</div>
Wh
d gr nulm
sis wi
h ly ngi
is, micrscic ly ngi
is, nd esinhil
ic gr nulm
sis &nbs;wi
h lyg ngi
is (<b>sm ll vessel)</b> ll h ve in cmm
"They ll c use necr
izing glmerulnehri
is<div><br /></div><div><img
n?
src="" s
e-51535312585255.jg"" /></div>"
Gr nulm
sis wi
h ly ngi
is is ssci
ed wi
h h ving wh

ye f ANCA?
C-ANCA ( n
ibdy
h

rge
s PR3 n
igen in cy
l sm f neu
rhil)
Micrscic ly ngi
is is ssci
d wi
h wh
ANCA?
P-ANCA ( n
ibdy
h


rge
s n
igen in cy
l sm f neu
rhil: meylerxid se)
Gr nulm s in
he uer irw y nd
s ddle nse defrmi
y is ch r c
eris
ic f
wh

ye f sm ll vessel v sculi
is? "gr nul m
sis wi
h ly ngi
is<div><br
/></div><div><img src="" s
e-51707111277105.jg"" /></div>"
Wh
re 3 gener l
re
men
s
r
egies fr v sculi
is? 1. ngigr hy<div>2. n

ic gul
in</div><div>3. immunsuressive
her y</div>
Sh e f mesenchym l cells nd
yic l s rcm cells: sindle
"<u>The m in in
s frm
his lec
ure:</u><div><br /></div><div><img src="" s
e
-13898514169857.jg"" /></div><div><br /></div><div><b>When cnsidering
umrs..
.</b></div><div>If
he cells lk like sindles,
hen
hey re mesenchym l in r
igin = s rcm </div><div>If
he cell lk sheric l,
hen
hey re ei
heli l in
rigin = c rcinm </div><div>Exce
ins: sme
imes
he cells re sindles bu
s
hws signs
hey h ve n ei
heli l rigin, such s
he resence f
igh
junc
i
ns r rim rily
he resence f ker
in rduc
in. Thus
hese re ms
likely 
rly differen
i
ed c rcinm s.</div><div><br /></div><div>P
hlgis
s use gr

ding sc les
 de
ermine hw differen
i
ed
he m lign n

umr is. There re
h
ree ses
s f gr ding sc les:</div><div><br /></div><div><div>1) Squ mus cell &n
bs;1, 2, r 3; where 1 is well differen
i
ed (lks kind f nrm l) nd 3 is 
rly differen
i
ed (lks like sme
hing else)</div><div>2) Adenc rcinm uni
que gr ding sc les fr
he differen

yes f denc rcinm s: (N

ingh m-Bre s

nd Gle sn-Prs

e.</div><div>3) Ur
heli l (
r nsi
in l) cell c rcinm l
w gr de r high gr de (lw gr de lks like nrm l; high gr de sme
hing else)</
div></div><div><br /></div><div>4) &nbs;Then yu h ve s rcm
id c rcinm s. T
hese re lw ys rly differen
i
ed, hence
hey h ve ch r c
eris
ics f b
h s
rcm s nd c rcinm s nd 
hlgis
s c nn

ell which
hey re bec use
hey
h ve

ribu
es f b
h (cy
ker
in + nd vimen
in +)</div>"
"<img src="" s
e-14104672600065_1407034041372.jg"" /><div><br /></div><div>Des
cribe e ch f
hese
hree:</div>"
<div>All re nrm l...</div><div><br /><
/div>1) ei
helium<div>2) gl ndul r</div><div>3)
r nsi
in l ei
helium</div>
"<img src="" s
e-14375255539713.jg"" /><div><br /></div><div>Wh
level f dif
feren
i
in f skin Squ mus Cell C rcinm ?</div>"
Well differen
i
ed Skin
SCC -
he cells re ms
ly rund. The sindle sh ed cells re
he cnnec
ive

issue hlding u
he nel sm. N
ice ker
in rduc
in.
"<img src="" s
e-14452564951041.jg"" /><div><br /></div><div>Wh
level f dif
feren

in f SCC (squ mus cell c rcinm )?</div>"
Mder
ely differen
i
e
d squ mus cell c rcinm frm lung. Ms
ly rund cells. N
ice
he high m g vie
w shws
igh
-junc
ins nd rund cells.
"<img src="" s
e-14529874362369_1407034041372.jg"" /><div><br /></div><div>Wh

level f differen
i
in f SCC? Why?</div>" <div>Prly Differen
i
ed Squ m
us Cell C rcinm Wi
h S rc m
id Fe
ures</div><div><br /></div><div>The righ

side lks mesenchym l in rigin (due
 sindle sh es), s yu wuld
hink s
rcm , bu

he ker
in rduc
in n
he lef
gives w y
his is ei
heli l in
rigin. Thus, rly differen
i
ed SCC.</div><div><br /></div>
"<img src="" s
e-14817637171201_1407034041372.jg"" /><div><br /></div><div>Wh
ere re
he nrm l gl nds where re
he bnrm l gl nds? Wh
kind f c ncer? Wh
Nrm l lef
h lf<div>Abnrm l righ
h lf

level f differen

in?</div>"
</div><div><br /></div><div>Gl nds = Adenc rcinm </div><div>Well differen
i
e
d bec use
umr cells s
ill m ke gl nds.</div>
Pre

y sure we dn
need
 memrize
he N

ingh m His
lgic Scre, bu
wh

is
he n me f
he c ncer yu use
his in rder fr gr ding urses? Is gr de 3
wrse r be

er
h n gr de 1? "Bre s
C ncer<div><br /></div><div>Gr de 3 is w
rse<br /><div><br /></div><div><img src="" s
e-15113989914625_1407034041372.j
g"" /></div><div><br /></div></div>"
"<img src="" s
e-15212774162435.jg"" /><div><br /></div><div><img src="" s
e15320148344835.jg"" /></div><div><br /></div><div>Which is
gr de 3 bre s
de
nc rcinm ? Why</div>" <div><u>Pic
ure 1:</u></div><div><br /></div>Mre mi

i
c figures<div>L
s f lemrhism</div><div>Less c
u l gl ndul r frm
in</di
v>
Wh
is
he firs
line f
re
men
fr P rkinsns?
L-d is
he immedi
e
recursr f d mine.&nbs;
Wh
re
he differen
s
ins 
hlgis
s use fr bre s
c ncer? Why is
his he
lful? <div><u>S
ins fr:</u></div>ER - fr es
rgen rece
r<div>PR - fr r
ges
erne rece
r</div><div>Her2/neu - fr hum n eiderm l grw
h f c
r rece

r 2</div><div>Ki67</div><div><br /></div><div>Imr
n
fr deciding
re
men

regime</div>
"<img src="" s
e-5905580032327.jg"" />"
Fluxe
ine, Ser
r line, nd Eci
lr m re ll wh
? SSRI
Wh
re sme drenergic side effec
s? (7)
1.
chyc rdi <div>2. high BP</d
iv><div>3. hyerglycemi </div><div>4. cns
i
in (D2)</div><div>5. Urin ry re

en
in</div><div>6. C rdi c rrhy
hmi s</div><div>7. Hemrrh ge&nbs;</div>
Wh
is
he mech nism by which Be
1 blckers h ve
heir effec
?
1. Reduc
e HR nd cn
r c
il
y<div>2. Reduce CO</div><div>3. Reduce O2 dem nd</div><div>4
. Reduce Renin rduc
in</div><div>5. Reduce bld ressure</div>
"<img src="" s
e-15917148798977.jg"" /><div><br /></div><div>Hw d yu knw w
hich s mle is c ncerus (ei
helium)?</div>" <div>B

m s mle = c ncer</div

><div><br /></div><div>A l
f blue ll
hrughu
ei
heli l l yer (nrm l ne

r s
r
um b s le) = l
f nuclei = l
f rlifer
in = incre sed ver ll&
nbs;N:C r
i = ms
likely c ncerus.</div><div><br /></div><div>R id grw
h
--+ due
 HPV; 16 u
s
he bre ks n
he cell cycle, bu

his des desn
m

e
r when HPV resen
.</div><div><br /></div>
Wh

ye f rece
rs re lc
ed n end
heli l cells?<div><br /></div><div>Sm
M3 n end
heli l cells<div><br /></div><div> 1

h muscle cells?</div>
n sm
h muscle cells surrunding vessels</div>
Wh
re
he c rdisecific B1 n
gnis
s?
cebu
ll<div>be
xll</div><d
iv>esmll</div><div>
enll</div><div>me
rll</div>
Wh
re
he B1  r
i l gnis
s?
PA (indll nd cebu
ll)
Wh
8
hings re be
blckers used

re
? Hw d
hey hel?
1. hyer

ensin- be
1<div>2. CHF- reduce C rdi c wrk l d<div>3. myc rdi l inf rc
i
n-ree
MI, inf rc
size, sudden rrh
hmi s</div><div>4. Angin  in-reduce O2
dem nd</div><div>5. Gl ucm -reduce queus humr rduc
in</div><div>6. Migr i
ne-reduce bld suly
 br in v sc</div><div>7. Hyer
hyridism- reven
c rdi
c rrhy
hmi s</div><div>8. Perfrm nce nxie
y</div></div>
"<img src="" s
e-16149077032963.jg"" /><div><br /></div><div>S
in fr 16. Wh
y is
his imr
n
?</div>"
HPV resul
s in 16 verexressin. P
ien
is HP
V+.
Why shuld yu n
s
 be
blckers bru
ly? # f rece
rs incre ses, bru

s
ing c n c use rrhy
hmi s
Wh
re 5 dverse effec
s f be
blckers?
1. br dyc rdi <div>2. brnchcn
s
ric
in</div><div>3. decre sed RAAAs c
ivi
y--&g
; decre sed bld ressure</
div><div>4. hyglycemi </div><div>5. sexu l im irmen
</div>
If be
blcker is n
enugh
 reduce bld ressur wh
else c n yu use
h

will wrk synnergis
ic lly wi
h i
? diure
ic
"<img src="" s
e-16363825397761 (1).jg"" /><div><br /></div><div>Which is nrm
l ei
helium?</div>" Lef
is nrm l.<div>Righ
is c rcinm in si
u.</div>
Wh
re
he dv n
ges f using  r
i l be
gnis
? Wh
re
hese  r
i l
gnis
s?
indll, cebu
ll<div><br /></div><div>1. Minimize dis
urb nc
es in glucse nd liid me
blsm</div><div>2. Br dyc rdi is minimized</div><di
v>3. brnchcns
ric
in is minimized</div>
Wh
sc le is used
 gr de bre s
c ncer? Wh
bu
rs

e c ncer? "Bre s

- N

ingh m<div><div>Prs

e - Gle sn (b sed n rim ry + secnd ry 

ern 
f gl nds r
her
h n ercen
ges like N

ingh m)</div><div><br /></div><div><im
g src="" s
e-16638703304705.jg"" /></div></div>"
Acebu
ll, be
xll, esmll,
enll, me
rll re ll mre secific
 wh

rece
rs? B1
Wh
re MSA blckers? membr ne s
bilzing c
ivi
y: sme b blckers reduce r
 g
in f c
in 
en
i ls
Wh
unique c
ivi
y d sme be
blckers like indll nd cebu
ll h ve?
in
rinsic sym
hmime
ic c
ivi
y:
hey c
iv
e be
rece
rs in
he bsence
f c
echl mines<div><br /></div><div>These re c
u lly  r
i l gnis
s&nbs;
</div>
"<img src="" s
e-16741782519809.jg"" /><div><br /></div><div>This is rs

e.
Where is
he
umr?</div>"
"Tumr =
he sm ll  le blue ""mini gl nds""; (

he l rger d rk blue rimmed gl nds re nrm l)<div>The s
rm is very cellul r s
well. Shuld be mre like
he s
rm in
he righ

hird f
he ic
ure belw (

he middle
hird f
his ic
ure s
he
umr).</div><div><br /></div><div><img s
rc="" s
e-16995185590275.jg"" /></div>"
"<img src="" s
e-6820408066528.jg"" />"
"<img src="" s
e-6859062772086.jg"" />"
"<img src="" s
e-6871947673809.
jg"" />"
By wh
mech nism d lh 1 blckers h ve
heir effec
s?
1. decre se v sc
ul r
ne<div>2. decre se venus re
urn</div><div>3. decre se rel d</div><div>
4. decre se c rdi c u
u
</div><div>5. decre se bld ressure</div>
Hw re
he w ys by which be
1 blckers h ve
heir effec
differen

h n
he w
y lh 1 blckers h ve
heir effec
? be
1:<div>1. Reduce HR nd cn
r c
il

y<div>2. Reduce CO</div><div>3. Reduce O2 dem nd</div><div>4. Reduce Renin rdu

c
in</div><div>5. Reduce bld ressure</div></div><div><br /></div><div> lh

1:</div><div>1. decre se v scul r
ne<div>2. decre se venus re
urn</div><div>3
. decre se rel d</div><div>4. decre se c rdi c u
u
</div><div>5. decre se bl
d ressure</div></div>
Wh
re 2 dverse effec
s f lh 1 blckers? 1. reflex
chyc rdi (such
dr
 in BP
h
he r
s
r
s uming f s
er)<div>2. r
hs

ic hyer
ensin</div>
<div><br /></div><div><br /></div>
"<img src="" s
e-7645041787132.jg"" /><div><br /></div><div>Wh
n
m is c
iv
<div>V scul r
ne is m in
ined by sym
he
ic

ing
hese rece
rs?</div>"
nervus sys
em c
ing n lh -1 / Gq / C 2+ rece
rs.</div><div><br /></div><d
iv><br /></div><div>NE</div>
Hw is BP in vessels m in
ined high enugh
 erfuse rg ns? "<img src="" s

e-7730941132873.jg"" />"
Hw des flm x wrk? "There re lh 1 rece
rs resen
b
h in sm
h mus
cle f rs

e nd invlun
ry shinc
er f bl dder.<div><br /></div><div><img
src="" s
e-7786775707960.jg"" /></div>"
"<img src="" s
e-18421114732545.jg"" /><div><br /></div><div><img src="" s
e18442589569025.jg"" /></div><div><br /></div><div>Why is
his slide f c ncer

issue differen
nd unique? Wh
is i
?</div>" S rcm
id C rcinm - cexres
sin f vimen
in nd cy
ker
in.
Wh
is henxybenz mine? Wh
is i
used

re
?
irreversible 1 blcker
used hechrmcy
m : remember
his is

umr f dren l medull secre
ing


n f NE
Wh
is
he m in use f clnidine?
emergency n
ihyer
ensive: 2 gnis
(
reduce rele se f NE)
Wh

ye f blcker is yhimbine? Wh
w s i
used fr?
lh 2 secific
blcker<div><br /></div><div>Used
 be used fr
hse wi
h erec
ile dysfunc
i
n. lh 2 blckers inrved bld flw
 geni
ls</div>
Wh
wuld yu
re
frs
bi
e wi
h?
lh 1 blcker (imrve bld flw)
"<img src="" s
e-18558553686019.jg"" /><div><br /></div><div>Wh

ye f c nc
er is
his?</div>"
Ur
heli l (
r nsi
in l) cell c rcinm , lw gr de. The
re is lss f l ri
y bu

here is s
ill sme rgressin
w rds
he surf ce
s i
m
ures.&nbs;
Wh

her dverse effec
s besides reflex
chyc rdi nd r
hs

ic hy
ensi
n c n resul
frm lh 1 blckers?
n s l cnjes
in<div>ej cul
in inhibi

ed (i
is lh 1 medi
ed)</div>
Why is flm x cn
r indic
ed in il
s,
hse er
ing he vy m chinery?
I
is n lh 1 /d blcker
h
c n le d
 s
ru l hy
ensin s ne f i
s
side effec
s
Wh
is l be
ll nd c rvedill used fr? (hin
:
hese re mixed lh / be
b
lckers)
lh 1 blcker (dil
e bld vessels, bu
resul
s in reflex
c
hyc rdi )<div><br /></div><div>be
1 blcker: reven
s incre se in he r
r
e</
div><div><br /></div><div>Essen
i lly,
hese drugs decre se PVR nd bld ressu
re wi
hu
ch nging HR nd CO</div>
Wh
d l be
ll, c rvidill, nd clnidine ll h ve in cmmn?
"They r
e ll chice emergy n
i- hyer
ensive medic
ins<div><br /></div><div><img src
="" s
e-8259222110597.jg"" /></div>"
"<img src="" s
e-8297876816242.jg"" />"
<div>Ter zsin is
lh -1 blc
ker, decre ses BP, le ds
 reflex
chyc rdi .</div><div><br /></div>
"<img src="" s
e-8336531521963.jg"" />"
"<img src="" s
e-8349416423760.
jg"" />"
"<img src="" s
e-8383776162241.jg"" />"
"T msulsin: lh 1 blcker<div
><img src="" s
e-8413840933192.jg"" /></div><div><br /></div><div><div>M3 blc
kers re used

re
OverAc
ive Bl dder.</div><div>Oxybu
ynin (M3 blcker) h s
# 1 m rke
sh re.</div></div><div><br /></div>"
Wh
effec
des D mine h ve if i
binds
 D1 vs D1 nd be
"<img src="" s

e-8465380540865.jg"" />"
Wh
effec
des D min h ve in
he GI
r c
n D1 nd D2 rece
rs
"<img sr
c="" s
e-8461085573569.jg"" />"
Wh
effec
des D mnie h ve in
he vmi
ing cen
er? "<img src="" s
e-846108

5573569.jg"" />"
Wh
re PDE-3 inhibi
rs used fr?
"incre se c rdi c u
u
nd dil
e vess
els<div><br /></div><div><img src="" s
e-8555574853996.jg"" /></div>"
Amirne nd Mirinne re _______
PDE3 inhibi
rs
Wh
rheum
ic dise se rim rily effec
s muscle?
lymysi
is
Wh
rheum
ic dise se rim rily
rge
s muscle nd skin?
derm
mysi
is
Wh
rheum
ic dise se rim rily
rg
s skin nd bld vessels? sclerderm
Wh
rheum
ic dise se rim rily
rge
s s liv ry nd l crim l gl nds? sjgrens
syndrme
{{c1::sclerderm }} is mul
isys
ic dise se ch r c
erized by {{c2::fibrsis f
skin nd in
ern l rg ns}}
"<img src="" s
e-11235634446693.jg"" />"
"<img src="" s
e-11278584119696.jg"" /><div><br /></div><div>Wh
dise se is

his?</div>"
sys
emic sclersis
Wh
re
he 2 subse
s f sclerderm ? "Sys
emic sclersis nd lc lized scler
derm <div><br /></div><div><img src="" s
e-11450382811493.jg"" /></div>"
Wh
re
he 4 subse
s f sys
emic sclersis? "Diffuse cu
neus<div>limi
ed c
u
neus: CREST (c lcinsis, r yun uds, esh ge l dysm
ili
y, sclerderm l l
yd c
yly,
el ngec
si s)</div><div>sys
emic sclersis sine sclerderm </div><di
v>verl  syndrmes</div><div><img src="" s
e-11446087844197.jg"" /></div>"
Wh
ulmn ry dise se is ssci
ed wi
h <b>diffuse cu
neus</b> sys
emic scle
rsis? in
ers
i
i l lung dise se
Wh
ulmn ry dise se is ssci
ed wi
h <b>limi
ed cu
neus </b>sys
emic scle
rsis? ulmn ry hyer
ensin
Wh
r
he 4 h ses
h
re indic
ive f sys
emic sclersis "1. R yn uds h
enmenn<div><img src="" s
e-11562051961136.jg"" /><br /><div>2. Edem
us Ph
se</div><div><img src="" s
e-11574936863008.jg"" /></div><div>3. Fibr
ic h s
e</div></div><div><img src="" s
e-11587821764896.jg"" /></div><div>4. A
rhic
Ph se</div><div><img src="" s
e-11600706666784.jg"" /></div><div><br /></div>
"
"<img src="" s
e-11643656339806.jg"" />"
N ilfld c ill ries
h
re r
esen
in b
h <b>sys
emic sclersis nd derm
mysi
is</b>
Wh
3 lung dise ses re ssci
d wi
h sys
emic sclersis?
"1. sir
in 
neumni
is/neumni <div><br /></div><div>2. in
ers
i
i l lung dise se (diffuse
cu
neus)</div><div><br /></div><div><img src="" s
e-11712375816453.jg"" /></
div><div><br /></div><div>3. ulmn ry hyer
ensin (limi
ed cu
neus)</div>"
Why des ulmn ry hyer
ensin ccur in sys
emic sclersis?
Prlifer
ive v
scul
hy le ds
 in
im l hyerl si nd fibrsis<div><br /></div><div>*S, s
ys
emic sclersis
rge
s m inly skin (sclerderm ) lng wi
h v scul
hy. Inf
l mm
in f bld vessls le ds
 hyerl si nd fibrsis, which n rrws vesse
l lumen nd le ds
 ulmn ry hyer
ensin in lung</div>
Wh
ren l crisis c n ccur in sys
emic sclersis?<div><br /></div><div>Wh
is

he cri
ic l
re
men
?</div> Sclerderm ren l crisis c n ccur due
 cceler

ed hyer
ensin such
h

here is r idly rgressive ren l f ilure<div><br /
></div><div>ACE inhibi
rs: nly
ime ACE inhibi
rs re indic
ed when
here is
ren l f ilure</div>
CREST sym
ms re ssci
ed wi
h wh

ye f sys
emic sclersis?
"limi
ed
cu
neus sys
emic sclersis<div><br /></div><div><img src="" s
e-119786637889
02.jg"" /></div>"
"<img src="" s
e-12013023527314.jg"" />"
Tel ngec
si s-sym
m f limi
e
d cu
neus sys
emic sclersis (CREST)
"<img src="" s
e-12038793330948.jg"" />"
C lcinsis (sym
m f limi
ed c
u
neus sys
emic sclersis)-CREST
{{c1::lymysi
is nd derm
mysi
is}} re ch r c
erized by {{c2::syme
ric r
xim l we kness nd nn symme
ric rxim l muscle we kness}} s due
 infl m
i
n f &nbs;{{c3:: skele
l muscle}}
"<img src="" s
e-12124692676953.jg"" /
>"
Hw des lymysi
is gener lly resen
clinic lly?
<b>nse
f rxim l mus
cle we kness in shulder nd elvic girdles</b><div><br /></div><div>N
e:<div>we kness in neck flexrs</div><div>-dysh gi due
 esh ge l dysfunc
in</div
><div>-dyshni - due
 h ryge l we kness</div><div>-r yn uds henmenn</div

></div>
Hw des derm
mysi
is differ frm lymysi
is?
In ddi
in
 rxim l
we kness,
hese 
ien
s ls exhibi
<b>skin r shes</b><div><br /></div><div>G


ns  ules</div><div>Heli
re r sh</div><div>Sh wl/V sign</div><div>Periun
g l
ele ngec
si s</div><div>n ilfld c ill ry dili

in nd dr u
</div>
"<img src="" s
e-12468290060625.jg"" />"
G

rns  ules-derm
mysi
i
s<div><br /></div>
"<img src="" s
e-12502649799052.jg"" />"
Heli
re R sh-derm
mysi
is
"<img src="" s
e-12528419602703.jg"" />"
R sh-Derm
mysi
is
Wh
 r
f
he immune sys
em is invlved in lymysi
is?
Cell-medi
ed cy


xici
y: CD8+ T cells
Wh
 r
f
he immune sys
em is invlved in derm
mysi
is? Humr l Immune R
esnse:<div><br /></div><div>CD4+heler CElls</div><div>Cmlemen
</div><div>Im
munglbin desi
in</div>
{{c1::sjgrens syndrme}} is n u
immune disrder ch r c
erized by lymhcy
e
infil
r
in f&nbs;{{c2::s liv ry nd l crim l gl nds le ding
 dysfunc
in}
}
"<img src="" s
e-13499082211687.jg"" />"
Wh
u
immune dise se is ch r c
erized by xers
mi nd ker
cnjun
ivi
is?
Sjgrens sydrme
Wh
u
immune dise se h s 44 fld incre sed risk f <b>B cell lymhm s</b>
(Nnhdgkins lymhm ) Sjgrens syndrme
s rcm s

echnic lly, hem
lgic m lign ncies re _______
"<img src="" s
e-1000727380508.jg"" /><div><br /></div><div>Wh
2nd ry lymh
id rg n is
his?</div><div><br /></div><div>Wh
re sym
ms ssci
ed?</div>
<div><br /></div><div>On
uch re f &nbs;lymhm wh

ye f 

ern d
yu see?</div>" big lymh nde excised frm 
ien
<div><br /></div><div>Sym
m
s: lw gr de fever, n sue vming, ls
weigh
</div><div><br /></div><div>On
u
ch re: Dischesive: single cells n


ched
 e ch 
her. R rely see clus
e
rs f cells</div><div><br /></div><div><br /></div>
"<img src="" s
e-1215475745309.jg"" /><div><br /></div><div><img src="" s
e-1
228360647196.jg"" /></div><div><br /></div><div>1. H& m;E s
in f lymh nde:
Describe wh
yu see</div><div>2. Tuch re slide f lymh nde: Describe wh
1. Cmle
ely rel ced lymh nde by sm ll li

le cells<

yu see</div>"
div>2. Single cell dischesive cells indic
ing lymhm </div><div><br /></div>
"<img src="" s
e-1301375091228.jg"" /><div><br /></div><div>H& m;E sec
in f
lymhm </div><div><br /></div>"
C (1-10) re _____ cell m rkers<div>C (10 nd bve) re _____ cell m rkers</div
>
T;<div><br /></div><div>B</div>
"<img src="" s
e-1361504633184.jg"" /><div><br /></div><div>Is
his &nbs;T r
B cell nel sm?</div>"
T cell: yu see CD3 s
ins mre
h n CD8
"<img src="" s
e-1541893259804.jg"" /><div><br /></div><div>Gru r dischesi
ve?</div>"
Dischesive (sme sm ll clus
ers, bu
ms
ly single cells)<div><
br /></div><div><br /></div>
"<img src="" s
e-1576252997995.jg"" /><div><br /></div><div>Which s
in is mr
e rminen
? Wh

ye f nel sm?</div>"
CD20; B cell nel sm
"<img src="" s
e-1666447311388.jg"" /><div><br /></div><div><img src="" s
e-1
679332213099.jg"" /></div>"
L rge B cell nel sm<div><br /></div><div><br /
></div>
Ri
uxim b is
________ cell inihibi
r CD20&nbs;
"<img src="" s
e-1851130905116.jg"" /><div><br /></div><div>Wh
rg n?</div><
div><br /></div><div>Is
his bnrm l in 95 y.?</div>" Bne (ink)<div>c r
il g
e (ligh
ink)</div><div><br /></div><div>Abnrm l</div>
"<div><img src="" s
e-2070174237212.jg"" /></div><div><br /></div><div><br /><
/div><img src="" s
e-1962800054812.jg"" /><div><br /></div><div>S
in f bne
m rrw: Describe wh
yu see (n mely ch r c
eris
ics f cells)</div><div><br />
</div><div>Wh
s
ins shuld yu d nex
?</div>"
lemrhism<div>Sme s
indle sh e nd rund?</div><div><br /></div><div>3 s
ins:</div><div>Vimen
in:
Is i
s rcm ?</div><div>Cy
ker
in: Is i
c rcinm ?</div><div>CD45: s
ins l
l whi
e cells. Is i
lymhm r leukemi ?</div>
"<img src="" s
e-2113123910172.jg"" /><div><br /></div><div>Tuch re f bne

m rrw: Wh
d yu see? Wh
des
his sugges
?</div>"

On
uch re f
bne yu see dischesive cells which re sugges
ive f lymhm r leukemi .&nb
s;<div><br /></div><div>S
hen yu d differen
s
ins
 see whe
her i
is
T cell/ B cell lymhm r leukemi </div>
"<img src="" s
e-2138893713765.jg"" /><div><br /></div><div>Wh
s
in is ms

rminen
? Wh
des
his sugges
?</div><div><br /></div><div>If
here is hem

lgic m lign ncy in
he lymhid wh
is i
c ll? If i
is in
he bne m rrw
wh
is i
c lled?</div><div><br /></div>"
CD45: Leukemi (f myelid rigi
n)<div><br /></div><div>Leukemi : Hem
lgic m lign ncy f bne m rrw</div><di
v>Lymhm : Hem
lgic m lign ncy f lymh nde&nbs;</div><div><br /></div>
Wh
sh e re:<div><br /></div><div>Ei
heli l nel sms</div><div><br /></div>
<div>Mesenchym l nel sms</div><div><br /></div><div>Hem
lgic m lign ncies</
div>
Rund<div>Sindle</div><div>Rund nd dischesive</div>
Tumr gr ding deends n wh
______
nucle r ch r c
eris
ics nd
umr mrh
lgy<div><br /></div><div>(N/C r
i, lemrhism, mi
sis, necrsis e
c e
c)</
div>
The Ne r Synkinesis reflex is cn
rlled by wh
CN?
"<img src="" s
e-172872
43366718.jg"" />"
Wh
re
he 7 CN III cn
rlled cul r muscles?
suerir rec
us<div>medi
l rec
us</div><div>inferir rec
us</div><div>inferir blique</div><div>lev
r
 lebr l sueriris (skele
l  r
)</div><div>circum cili ry bdy&nbs;</div><
div>iris cns
ric
r</div>
In re
in l
e r, wh

w l yers se r
e?
u
er segen
s f rds nd cnes<
div><br /></div><div>Re
in l igmen
ed ei
helium</div>
Why des
he ngle ge
n rrwer s we ge?
The lens cn
inues
 grw slwl
y
hrughu
life
The lens is derived frm wh

ye f cells?
ei
heli l
Why is
he lens cle r in e rly life?
1. sh e nd rr ngemen
f lens fibrs<d
iv>2. regul r in
ercellul r in
erdigi

ins</div><div>3. sm ll mun
f in
ers

i
i l fluid</div><div>4. crys
llin r
ein dis
ribu
in</div><div>5. bsence 
f ll r gnelles</div><div>6. sm
h surf ce f lens c sule</div><div>7. unifr
mi
y f
he single l yer f n
erir ei
heli l cells</div>
Wh
m kes u
he znule fibers? Wh
d
he znule fibers

ch?
fibrilli
n<div><br /></div><div>Lens equ
r c sule

he inner nn igmen
ed cells ve
r cili ry rcess</div>
When severe,
c
r c
c n resen
s ________ leukcri (whi
e uil)
Nucle r c
r c
s re cl sic lly rel
ed
 _______<div><br /></div><div>Ps
eri
r subc sul r c
r c
s re
yic lly rel
ed
 __________</div><div><br /></d
iv><div>Pl r c
r c
s re ________</div>
ge nd smking<div><br /></div>
<div>s
erids</div><div><br /></div><div>resen

bir
h</div>
Wh
re
he 5 sym
ms f c
r c
?
"1. decre sed visin<div>2. gl re frm l
igh
s</div><div>3. decre sed clr s
ur
in</div><div>4. decre sed brigh
ness<
/div><div>5. myic shif
</div><div><br /></div><div><img src="" s
e-1890215107
0008.jg"" /></div>"
Wh
is
echnique by which c
r c
is
re
ed? "h cemulsific
in<div><br /><
/div><div><br /></div><div><img src="" s
e-19039590023618.jg"" /></div><div><b
r /></div>"
Wh
is
he his
lgy f
he ei
helium in
he crne <div><br /></div> s
r
ifi
ed squ mus, nn ker
inized
Wh
secre
es
he
ye 1 fibers f
he crne l s
rm ? ker
cy
es
Wh
re
he 4 sym
ms f crne l br sin?<div><br /></div><div>Wh
s
in c
n be used
 de
ec

his?</div>
 in<div>
e ring</div><div>h
hbi </
div><div>redness</div><div><br /></div><div>Sidel
es
</div>
P
ien
s wi
h ker
cnus
yic lly resen
wi
h (4)
1. decre sed visin<div>
2. lyi </div><div>3. n  in (unless
hey ls h ve hydrs)</div><div>4. Mu
nsns sign</div>
If 
ien
resen
s wi
h blurry visin in
he mrning
h
imrves ver
he d
y, wh
migh
he/she h ve?
Fuchs End
heli l dys
rhy:<div><br /></div><di
v>Crne dries u
ver
he d y, remving sme f
he fluid.</div>
T/F crne l
r nsl n
requires HLA nd bld
ye m
ching
FALSE

Wh
is ene
r
ing ker
l sy

full
hickness crne l
r nsl n

Wh
is DSEK? Decime
s s
riing end
heli l ker
l sy<div><br /></div><div
>Remves end
helium, deceme
s, s
erir s
rm </div>
Wh
is DALK? Dee n
erir l mell r ker
l s
y<div><br /></div><div>Only
r
nsl n
s ei
helium, bwm ns, s
rm </div>
Wh
is DMEK? Desceme
s membr ne end
heli l ker
l s
y<div><br /></div><div
>nly
r nsl n
s desceme
s nd end
helium</div>
Wh

ye f crne l
r nsl n
wuld be gd fr fuchs end
heli l dys
rhy? K
er
cnus?
1. DSEK<div>2. DALK</div>
Wh
re s

r nsl n
signs nd sym
ms f infec
in/rejec
in? (6)  in<div
>blurred visin</div><div>scler l redness</div><div>nev scul riz
in
limbus
</div><div>crne l h ze</div><div>h ls</div>
Wh
is r di l ker

my?
crne l curv
ure crrec
ed by r di l incisins
ene
r
ing dee s
rm
Wh
re sme cmlic
ins f LASIK? (5)
1. dry eyes<div>2. ei
heli l d
wngrw
h</div><div>3. infec
in</div><div>4. h ls/gl re</div><div>5. fl  disl
dgemen
</div>
Wh
is queus humr syn
hesized by? 2 l yers f ei
heli l cells n
he cili
ry rcesses
T/F u
flw f queus humr invlves incy
sis, h gcy
sis,
r nscy
sis, n
d excy
sis
F lse: Bulk flw (simil r
 erilymh)
Wh
l yer f
r becul r meshwrk ffers ms
resis
nce?
jux
c n licul r
Describe rim ry en ngle gl ucm nse
.
 inless, slw, rgressive lss
f eriher l nd
hen cen
r l r
in f visin.
NSAIDs sh re wh

ye f c
ivi
y?<div><br /></div><div><br /></div> "<img sr
c="" s
e-25301652341080.jg"" />"
Why will 
hlgic l dise se in Rhem
id dise se rgress even while clinic l
m nifes

ins re suressed? NSAIDs used fr rheum
ic dise ses re used fr
sym
ms bu
re n
cur
ive
Wh
re
he rheum
id dise ses in which NSAIDS re rescribed?
"<img sr
c="" s
e-25456271163682.jg"" />"
Wh
re
he mech nisms f NSAIDs?
"<img src="" s
e-25490630902116.jg"" /
>"
Wh
re
he
rge
s f nnselec
ive NSAIDs?
"<img src="" s
e-25486335934820
.jg"" />"
Wh
is
he
rge
f selec
ive NSAID like cxib?
"<img src="" s
e-254863
35934820.jg"" />"
"<img src="" s
e-25606595019307.jg"" />"
Why d NSAIDS le d
 GI ulcer
ins nd bleeds?
PGE2 mdul
es g s
ric m
ucs l cid secre
in, mucus levels nd bld flw<div><br /></div><div>PGI2 cn
fer v sdil
ive cy
r
ec
ive rer
ies</div>
Hw d NSAIDs reduce
he rinfl mm
ry resnse?
"<img src="" s
e-262121
85407825.jg"" />"
Wh
is
he difference be
ween COX 1 nd COX2? "<img src="" s
e-26280904884548
.jg"" />"
Inhibi
in f Cx1 r Cx2 resul
s in ms
f
he unw n
ed side effec
s?
"<img src="" s
e-26276609917252.jg"" />"
Inhibi
in f Cx 1 r 2 is
hugh

 medi
es
he n
iyre
ic, n lgesic, nd
n
iinfl mm
ry c
ins f NSAIDS?
"<img src="" s
e-26276609917252.jg"" /
>"
Inhibi
in f wh
rs
gl ndins le ds
 GI side effec
s f NSAIDs? PGI2 nd
PGE2
Inhibi
in f wh
mlecule vi NSAIDS le ds
 dis
urb nces in l
ele
func
i
n?
TxA2
Wh
is S
evens-Jhnsn Syndrme?
Diffuse, sever, muccu
neus eru
in i
nvlving 2 r mre mucs l surf ces wi
h r wi
hu
viscer l invlvemen

Wh
re
he 4 grus f nn selec
ive NSAIDS? Acidic NSAIDS ( srin, sdium s
licyl
e)<div>Ace
minhen</div><div>Prinic Acid deriv
ives &nbs;(Iburhe
n nd n rxen)</div><div>Ace
ic cid deriv
ives (indme
h cin, diclfen c, ke

rl c)</div>

Wh
is
he ms
cmmn use f srin? he r
dise se

&nbs;Wh
NSAID d we use fr inhibi
in f &nbs;l
ele
ggreg
in?
Asrin nly
Hw des srin wrk? Hw des s licyclic cid differ? Asrin: cv len
ly mdif
ied hmlgus serin residues in b
h cx1 nd cx by ce
yl
in<div><br /></di
v><div>Irreversible</div><div><br /></div><div><br /></div><div>S licylic cid:
reversible inhibi
r f b
h Cx1 nd Cx2</div><div><br /></div><div><br /></di
v>
_______ frm f s licyll
es ccun
s fr ms
f
he n
i-infl mm
ry c
ivi
y
nd is well bsrbed &nbs; nin frm
Wh
drug in
er c
in d s licyl
es h ve?
C uses w rf rin levels
 incre
se bec use i
disl ces w rf rin frm l sm r
ein binding si
es
Wh
re
he effec
s f high dse
xici
y f s licyl
es
 CNS?
s
imul

in high fllwed by deressin lws
Wh
effec
s d s licyl
e h ve n resir
in? induc
in: resir 
ry lk lsis
<div><br /></div><div>deress n
: resir
ry cidsis</div>
Hw d yu
re
s licyl
e
xici
y? 1. CVD nd resir
ry sur
<div>2. Bi
c rb
 crrec
cid-b se bnrm li
ies</div>
Wh
syndrme is ssci
ed wi
h sirin use in children?
Reyes Syndrme:
invlves swelling f liver nd br in edem .<div><br /></div><div>Usu lly given f
r
re
men
f febrile vir l illnesses</div>
Wh
is ce
minhen used fr? i.e wh
effec
s des i
h ve? Wh
effec
s des
i
l ck?
n
iyre
ic nd n lgesic effec
s (l cks n
i-infl mm
ry nd 
l
ele
effec
s)&nbs;
Is ce
minhen ssci
ed wih
Reyes syndrme?
NO!
When is ce
minhen
xic? F
l?
10x
her eu
ic dse<div><br /></div><di
v>20x
her eu
ic dse</div>
Wh
is n n
id
e fr ce
minhen isning?
N- ce
yl-cys
eine (Mucm
ys
)
Wh
is
he secnd le ding c use f liver
r nsl n

in?
ce
minhen-in
duced he
ic f ilure
When will yu s
r

 feel sym
ms frm
xic mun
f ce
minhen?
Yu m y rem in sym
m free fr u
 24 hurs f
er
king
xic dse<div><br
/></div><div>*n use , vmi
ing, n
feeling well, r e
i
e, bdmin l  in
</div>
Wh
re
he s
ges f ce
minhen isning? "<img src="" s
e-29356101468480
.jg"" />"
Wh
re
w NSAIDS
h
re rrinic cid deriv
ives?
iburfen, n r
xen
Wh
re iburfen nd n rxn indic
ed fr?
cu
e nd chrnic rheum
id r

hri
is nd s
e r
hri
is
Unlike ce
minhen, iburfen disl ys wh
3 rer
ies?
n
iyre
ic<div>
n lgesic</div><div> n
i-infl mm
ry</div>
Hw des n rxen cm re
 srin?
I
is 20x mre 
en

h n srin nd h
s less severe GI effec
s
h n srin
Wh
3 NSAIDS f ll under
he c
egry f ce
ic cid deriv
ives?
indme
h
cin<div>diclfen c</div><div>ke
rl c</div>
Wh
drug rm
es
he clsure f 
en
duc
us r
erisus?
indme
h cin
Which h s lwer dverse effec
rfile: Indme
h cin r Iburfen
Iburfe
n
Wh
drug is used rim rily s n n
iinfl mm
ry in
he
re
men
f cu
e gu

y r
hri
is nd nylsing sndyli
is?&nbs; indme
h cin
Wh
drug is useful fr s
er
ive  in when 
ien
c nn
sw llw nd yu
dn
w n

 us n rc
ic (ne f
he few NSAIDs rved fr  ren
l dminis

r
in Ke
rl c
Wh
des diclfen c d?
decre se r chidnic cid levels
Use f N rxen wi
h PPI is le ding
 demise f ______ Cxibs (cx2 blckers)
Why d Cx 2 inhibi
rs like Celebrex le d
 c rdiv scul r cl

ing rblems?
"Prs
gl ndins (PGI2-rs
gl ndin m de by end
heli l cells
 reven
cl

ing
) re m de 50% by cx 1 nd 50% cx 2<div><br /></div><div>Thrmbx ne (rm
es

cl

ing) is m de by Cx 1 nly.</div><div><br /></div><div>S if yu blck Cx

2, yu h ve mre
hrmbx ne
h n rs
gl ndins. And yu h ve c rdiv scul r c
l

ing rblems</div><div><br /></div><div><img src="" s
e-29978871726540.jg"
" /></div>"
Wh
is
he m in use f celecxib?
"Relieve signs nd sym
ms f rheum
i
d r
hri
is<div><br /></div><div><img src="" s
e-30833570218296.jg"" /></div>"
Wh
re
he drug in
er c
ins ssci
ed wi
h celecxib?
1. Flucn zle i
ncre ses celecxib levels<div>2. Celecxib incre ses li
hium levels</div><div>3.
w rf rin 
ien
s need
 check PT mre f
en</div>
N me 7 drugs we h ve
lked bu

h
re irreversible srin<div>ech
hih
e/
isflurh
e</div><div>henxybenz mine</div><div>s rin</div><div>mer zle</d
iv><div>l vix</div>
me
h chline is fr wh

es
?<div><br /></div><div>Edrhnium is fr wh

es

?</div> s
hm <div><br /></div><div>my s
heni gr vis</div>
"<img src="" s
e-36726265348385.jg"" />"
NE: Only drug
h
will exhibi
:
<div>1. N be
2, s PR ges w y u</div><div>2. be
1 c uses incre se in sys

lic</div><div>3. incre se in PR c uses incre se in Di s
lic</div><div>4. Reflex
br dyc rdi </div>
"<img src="" s
e-36846524432660.jg"" />"
Einehrine:<div>1. Be
2 llw
s fr dil
in (decre se in PR)</div><div>2. Be
1 incre ses Sys
lic</div><div
>3. Be
2 decre ses di s
lic</div><div>4. Incre se HR (unlike DA-yu h ve
ve
ry sligh
incre se in HR)</div>
"<img src="" s
e-37087042601237.jg"" />"
Isr
ernl<div><br /></div><d
iv>1. n lh 1 (s dr s
ic decre se in PR)</div><div>2. In resnse (reflex

chyc rdi )</div>
"<img src="" s
e-37121402339608.jg"" />"
D mine<div><br /></div><div>1.
D1: lwers eriher l resis
nce</div><div>2. Di s
lic ressure desn
decre s
e whle l
bec use D1 nly ens vessels f cri
ic l rg ns</div><div>3. HR d
esn
g u
h
much bec use cn
r c
ili
y is incre sed n
HR i
self, decre si
ng dem nd n he r
</div>
Wh
f c
r is mi
genic fr v rie
y f ei
heli l cells?
EGF
Wh
f c
r is mi
genic fr he
cy
es, bili ry ei
helium, lung, kidney nd m
m ry cells?
HGF
Wh
f c
r c uses migr
in nd rlifer
in f fibrbl s
s, sm
h muscle cel
ls, nd m ny
umr cells?
PDGF<div><br /></div><div>*s
red in l
ele
s &
nbs; nd rele sed when l
ele
s re c
iv
ed</div>
Wh
f c
r rm
es ngigenesis in chrnic infl mm
in, he ling f wunds nd
in
umrs?
VEGF
Wh
f c
r cn
ribu
es
 wund he ling, hem
iesis, ngigenesis, develme
n
nd 
her rcesses FGF
Wh
f c
r is
grw
h inhibi
r fr ei
heli l cells, 
en
fibrgenic gen
TGF-be


, nd h s s
rng n
i-infl mm
ry effec
s?
"<img src="" s
e-59034325483962.jg"" />"
frn
 n s l duc
:  ss ge by wh
ich frn
l sinus dr ins in
 e
hmid l infundibulum
"<img src="" s
e-59064390255041.jg"" />"
eh
mid l infundibulum: frn
l
sinus nd n
erir e
hmid l dr ins in

his
"<img src="" s
e-59090160058813.jg"" />"
shenid s
ium: These re highe
r
h n
he flr f
he shenid sinuses s dr in ge in
he erec
si
in is di
fficul

"<img src="" s
e-59128814764484.jg"" />"
m xill ry s
ium: m xi lly sinus
dr ins
hrugh m xill ry s
ium in
 hi
us semilun ris
"<img src="" s
e-59176059404738.jg"" />"
e
hmid ir cells
"<img src="" s
e-59210419143109.jg"" /><div><img src="" s
e-59223304044994.j
g"" /></div>" ening f e
hmid ir cells in
 n s l c vi
y
"<img src="" s
e-59270548685243.jg"" /><div><br /></div><div><img src="" s
e59300613456280.jg"" /></div><div><img src="" s
e-59657095741893.jg"" /></div>
"
n sl crim l duc
em
ies in

he inferir me
us f n s l c vi
y:&nbs
;
"<img src="" s
e-60099477373390.jg"" /><div><br /></div><div><img src="" s
e60112362275262.jg"" /></div>" 
erygm xill ry fissure<div>
erygl
ine fss

</div><div>shen l
ine fr men</div>

"<img src="" s
e-60443074757055.jg"" />"
"<img src="" s
e-60468844560840.jg"" />"
"<img src="" s
e-60511794233778.jg"" />"
"<img src="" s
e-60550448939460.jg"" /><div><br /></div><div><img src="" s
e238198886236860.jg"" /></div>" eus
ci n
ube is medi l
 sinsum
"<img src="" s
e-60584808677838.jg"" />"
"<img src="" s
e-60619168416178.jg"" />"
middle cnch
"<img src="" s
e-60675002991045.jg"" />"
suerir chnch
"<img src="" s
e-60709362729398.jg"" /><div><img src="" s
e-60722247631297.j
g"" /></div><div><br /></div><div><img src="" s
e-60743722467785.jg"" /></div>
"
suerir, middle nd inferir me
us
"<img src="" s
e-61104499720647.jg"" />"
e
hmid ir cells
Wh

w sinuses dr in in
 infundibulum?
"Frn
l (vi frn
l n s l duc

) nd n
erir e
hmid l<div><br /></div><div><img src="" s
e-61229053772298.j
g"" /></div><div><br /></div><div><img src="" s
e-61241938674106.jg"" /></div>
"
"<img src="" s
e-61327838020106.jg"" />"
enings fr n sl crim l duc

{{c1::
i f
ngue/frn
lwer
ee
h}}
 {{c2::submen
l ndes}}
{{c1::bdy f
ngue/uer
ee
h/lwerside
ee
h}}
&nbs;{{c2::subm ndibul r n
des}}
{{c1::s
erir
nuge}}
&nbs;{{c2::jugul-dig s
ric ndes/lingu l nd  l
i
ne
nsils}}
{{c1::middle e r c vi
y }}
 {{c2::
ub l
nsil}}
{{c1::n s l c vi
y/h rynx}}
&nbs;{{c2::
nsils nd
hen
 cervic l ndes}}
{{c1::l rynx nd
hyrid gl nd }}
&nbs;{{c2::re nd  r
r che l ndes}}
{{c1::sen
inel nde fr he d}}=&nbs;{{c2::juguldig s
ric nde}}
{{c1::sen
inel nde fr neck}} =&nbs;{{c2::jugul-mhyid nde}}
The&nbs;{{c1::
nsils }} dr in

he&nbs;{{c2::dee cervic l ndes}} nd
hen


h
&nbs;{{c3::juguldig s
ric}}
{{c1::dee cervic l ndes}} re ssci
ed wi
h  in when sw llwing
"<img src="" s
e-72915659784760.jg"" />"
"<img src="" s
e-72915659784760.jg"" />"
"<img src="" s
e-73065983640012.jg"" />"
ening f n s l l crim l duc

"<img src="" s
e-73186242724304.jg"" />"
"<img src="" s
e-73212012528076.jg"" />"
ening f n s l l crim l duc

"<img src="" s
e-73246372266451.jg"" />"
semilun r hi
us le ds in
 ch m
ber c lled infundibulum
"<img src="" s
e-73280732004815.jg"" />"
s
erir ir cells en belw s
uerir cnch (suerir me
us)
"<img src="" s
e-73358041416126.jg"" />"
ening
 frn
l n s l duc

"<img src="" s
e-73495480369615.jg"" />"
rnunced inw rd fld c lled

rus
ub rius
"<img src="" s
e-73529840107992.jg"" />"
behind
rus
ub rius is dee re
cess: h rynge l b sil r f sci nd bucch rynge l f sci
"<img src="" s
e-73564199846362.jg"" />"
f
er yu remve mucs cvering
eus
ci n
ube, yu see
w muscles:
he ne belw eus
ci n
ube nd medi l is
lev
r  l
i<div><br /></div><div>innerv
ed vi h rynge l br nch f v gus</
div>
Where des lev
r  l
i

ch?
frm b ck f eus
ci n
ube
 sf
 l

e. ulls
he  l
e uw rds when sw llwing ( lng wi
h
ensr  l
i)
"<img src="" s
e-73671574028757.jg"" />"
remve lev
r  l
i nd yu c
n see
ensr  l
i which is l
er l&nbs;
Wh
re
he

chmen
s f
he
ensr  l
i "rf f medi l 
erygid l
e<
div>runs frw rds nd dwnw rds
w rds h mulus</div><div>M kes 90 degree
urn</
div><div><br /></div><div><img src="" s
e-73705933767125.jg"" /></div><div><br
/></div><div>Then inser
s n  l
ine neursis n sf
 l
e</div>"
"<img src="" s
e-73757473374692.jg"" />"
"<img src="" s
e-73860552589804.jg"" />"
"<img src="" s
e-73894912328173.jg"" />"

"<img src="" s
e-73920682131951.jg"" />"

"<img src="" s
e-73955041870305.jg"" />"
"<img src="" s
e-73980811674103.jg"" />"
"<img src="" s
e-74006581477859.jg"" />"
Wh
is
he func
in f
he cns
ric
rs f
he h rynx?
m ss ges fd d
wn in esh gus
Wh
is
he innerv
in f
he cns
ric
rs?
h ryge l br nch f v gus
Wh
is s lingh ryngeus innerv
ed by?
CNX (muscles f h rynx re 10)
All muscles in glssus re innerv
ed by ____ exce

XII,  l
glssus which
is innerv
ed by X (Bec use  l
ine nd h rynx muscles re by X)
All muscles f h rynx re innerv
e by _____ exce
______
X (h rynge l br
nch), s
ylh ryngeus (IX) which is nly m
r br nch f IX
All muscles f l rynx re innerv
ed by ______<div><br /></div><div>EXCEPT fr _
_______, which is _____</div> recurren
l rynge l<div><br /></div><div>cric
h
yrid (ex
ern l br nch f suerir l rynge l)</div>
"<img src="" s
e-74410308403754.jg"" />"
Wh
re
he V2 br nches? (7) infr rbi
l<div>zygm
ic
emr l</div><div>z
ygm
ic f ci l</div><div>lesser  l
ine</div><div>gre
er  l
ine</div><div>
n s l
ine</div><div>suerir lvel r (s
erir, middle, n
erir)</div>
{{c1::shen l
ine fr men}} ens frm&nbs;{{c2::
eryg l
ine fss }} in

Tr nsmi
s r
eries nd nerves
 n s l c vi
y
&nbs;{{c3::n s l c vi
y}}
On
he shenid bne, wh

w whles en in
 
eryg l
ine fss ? "<img sr
c="" s
e-74710956114327.jg"" />"
Wh
re
he 3 r
eries
h
m ke u
he kiesselb chs re ?
"e
hmid l (n s
cili ry br nch frm 
h lmic r
ery<div><br /></div><div>shen l
ine (
ermin
l  r
f m xill ry)&nbs;</div><div><br /></div><div>suerir l bi l frm (f c
i l r
ery)</div><div><br /></div><div><img src="" s
e-74942884348463.jg"" /><
/div>"
"<img src="" s
e-2821793513696.jg"" /><div><br /></div><div>Bl ck re s re l
w

enu
in. G s in s
m ch is indic
ed by bl ck n
he righ

di hr gm. T
his 
ien
is bu

 die, wh
is wrng?</div>"
This is c
u lly nrm
l ches
x-r y. As
hm is n

dise se f
he lung  renchym , bu
f
he irw y
s. Thus ches
x-r y is n

he bes
di gns
ic
echnique.
Wh
is
he cu
e ch nge in sirme
ry seen wi
h s
hm ex cerb
in? "Severe
decre se in e k flw! B
h exh l
in nd inh l
in ffec
ed.<div><br /></div>
<div><img src="" s
e-3500398346241.jg"" /></div>"
As
hm is <i>cyclic&nbs;</i>&nbs;dise se
h
is ll bu

he irw ys nd N
OT
he lung  renchym . Thus hw shuld ne di gnse s
hm ?
sirme
ry<div>m
e
h chline
es
</div>
Hw d yu
es
fr s
hm h rm clgic lly? "<img src="" s
e-4286377361409.
jg"" /><div><br /></div><div>FEV1 % Decre se (<b>Lef
w rd Shif
)</b> s cm re
d
 nrm l&nbs; f
er<b> Me
h chline Tes
. </b>The shif
is lg ri
hmic, shwi
ng hyersensi
ivi
y f s
hm
ic lungs!</div><div><br /></div><div>Airw ys cns

ric
due
  r sym
he
ic s
imul
in frm v gus nerve n muscurinic chlinerg
ic rece
rs.</div>"
"<img src="" s
e-5308579577859.jg"" /><div><br /></div><div>Wh
is ging n h
ere? Hw d yu survive
his?</div> wh
re
he 4 his
lgic l fe
ures"
"Fibrin cl
-
ermed l s
ic brnchi
is - ne f
he wrs
cmlic
ins f s

hm . The bdy mus
vercme
his i
self, bu

he 
ien
will need
 be n ven

il
r.<div><br /></div><div><img src="" s
e-5201205395457.jg"" /><br /><div><
br /></div></div>"
Describe s
hm (5 key in
s): <div>A dise se ch r c
erized by: &nbs;</div><di
v><br /></div><div>1) In
ermi

en
irw y bs
ruc
in due
:&nbs;</div><div>irw y hyerresnsiveness</div><div>- mucus hyersecre
in</div><div>- Pl s
ic
brnchi
is.</div><div><br /></div><div>2) Esinhilic eri-brnchv scul r infl
mm
in.</div><div><br /></div><div>3) High serum IgE levels</div><div><br /></
div><div>4) Presence in
he lung f Th2 nd Th17 cells</div><div><br /></div><di
v>5) L ck f lung des
ruc
in nd hyxemi </div><div><br /></div>
Review: wh
re
he differen

yes f T-heler cells,
he cy
kines c using
h
eir cln l ex nsin,
he cy
kines
hey rduce,
he n
ibdy resnse, nd bi

lgic rle?
"<img src="" s
e-5793910882305.jg"" /><div><br /></div><div>Th
1 cells rduce cy
kines which
ge
her rm
e c
iv
e cellul r nd humr def
ense mech nisms
h
r
ec
us frm in
r cellul r 
hgens such s Lis
eri s
., Mycb cium s., Leishm ni s., e
c.<div><br /></div><div>Th2 cells, n
h
e 
her h nd, rduce cy
kines
h
r
ec
us frm l rge, ex
r cellul r 
hg
ens such s in
es
in l wrms.</div><div><br /></div><div><b>B
h cell
yes ls
h ve d rk side: Th1 cells re ssci
ed wi
h u
immuni
y where s Th2 cells
re ssci
ed wi
h llergy nd s
hm . &nbs;</b></div></div>"
There re
sec
rum f llergic irw y dise ses
h
mimic s
hm . N me sme mi
ld, mder
e, nd severe ex mles:
"<img src="" s
e-6249177415681.jg"" />
"
As
hm f
en ffec
s
he lwer irw y. Wh
ffec
s
he uer irw y
h
is sim
il r? "Chrnic rhinsinusi
is; llergic fung l rhinsinusi
is<div><br /></div>
<div><img src="" s
e-6249177415681.jg"" /></div>"
Wh
is n indic
r
h
yu h ve Churg S
r uss syndrme? (3) <div>Severe lwe
r irw y dise se</div>L rge incre se in esinhils<div>H d s
hm in  s
</div>
<div><br /></div>
"M in in
f
his:<div><img src="" s
e-6609954668545.jg"" /></div>" m ny dis
e ses re simil r
 s
hm nd h ve s me immunlgic l b sis.
Describe gr hic lly
ye 1 nd
ye 4 hyersensi
ivi
y.<div><br /></div><div>M
in in
s
 knw:</div><div>- wh
cells re invlved in e ch</div><div>- which
is mre ssci
ed wi
h s
hm ?</div> "<img src="" s
e-42013370089473_1407034
041372.jg"" /><div><br /></div><div>Tye I invlves B-cells, Th2 cells, M s
ce
lls, esinhils due
 &nbs;(IL4, 5, 6, 9)</div><div>Tye IV invlves nly Th2
cells due
 (IL-4, 13)</div><div><br /></div><div>As
hm :<b> Tye IV Hyersens
i
ivi
y ms
likely</b></div><div><br /></div>"
Describe curren
s
hm
her y: (4)
"<img src="" s
e-6807523164161_14070340
41372.jg"" />"
Key Pin
: As
hm is driven by wh

ye f cell?
Th2 cells
Wh
is
he ms
imr
n
in
erleukin medi
r in develing
he s
hm hen
y
IL-13
e?
"<img src="" s
e-7842610282497.jg"" /><div>IL4 nd IL13 b
h wrk n wh
rece

r?</div><div><br /></div><div>Wh
re
heir differeing effec
s?</div><div><b
r /></div><div>Tge
her wh
d
hey cn
rl?</div>"
<div>IL-13 nd IL-4 wrk
n s me rece
r. IL-13 wrks ms
ly n
he <b>
issues</b>
hugh. IL-4 wrks 
n <b>lymhcy
es</b> l rgely.</div><div><br /></div><div>IL-4 nd IL-13 func
in
cer
ively, bu
se r
ely,
 cn
rl ll sec
s
he immune resnse
h

underlies s
hm nd 
her llergic- like re c
ins including <b>exulsin f in

es
in l  r si
es nd gr nulm
us dise se</b> f
he liver induced by eggs f
cer
in  r si
es. &nbs;IL-4 func
ins e rly, during fferen
immuni
y,
 c

iv
e Th2 cells. &nbs;Al
hugh IL-4 nd IL-13 re b
h m de by Th2 cells, IL-13
is f r mre imr
n

h n IL-4 in inducing effec
r immune resnses such s
irw y hyerresnsiveness. &nbs;Desi
e
hese differences, b
h func
in
hrug
h
he s me rece
r sign ling mie
y, IL-4R . &nbs;</div><div><br /></div>
"<img src="" s
e-7958574399491.jg"" />"
<div>&nbs;This slide summ rizes
wh
we knw bu

he mech nisms underlying s
hm like dise se in
he muse.
&nbs;Al
hugh n
required fr ll sec
s f
he s
hm hen
ye,
ye I hye
rsensi
ivi
y mech nisms undub
edly cn
ribu
e
 dise se, s shwn n
he lef
.
&nbs;Hwever,
he surrise finding is
h
IL-4 nd IL-13 ls direc
ly elici


he 
hgnmnic fe
ures f s
hm by c
ing direc
ly n
he
rge

issues 
f
he lung. &nbs;</div><div><br /></div>
In s
hm ,
he irw ys re hyerre c
ive. They cns
ric
when even sligh
ly b
h
ered. Of
en disl ys hw in
he firs
s
ges?
s simle cugh
Review:<div><br /></div><div><b>IL-4</b></div><div><br /></div><div>Cell
h
r
<div>Th2 cells</div><div><br /></div>Gr
duces i
nd i
s effec
s: (2)</div>
w
h f c
r fr Th2 cells nd s
imul
es IgE rduc
in frm B cells
Review:<div><br /></div><div><b>IL-5</b></div><div><br /></div><div>Cell
h
r
Th2 cells<div><br /></div><div>F vrs de
duces i
nd i
s effec
s: (2)</div>
velmen
fr esinhils, ls s
imul
es IgA rduc
in</div>
Review:<div><br /></div><div><b>IL-6</b></div><div><br /></div><div>Cell
h
r

Dendri
ic cells<div><br /></div><div>Al

duces i
nd i
s effec
s:</div>
ng wi
h TGF-be
influence Th17 cells
 secre
e IL-17 nd IL-21</div>
Review:<div><br /></div><div><b>IL-9</b></div><div><br /></div><div>Cell
h
r
Th2 cells<br /><div><br /></div><div>Cn
duces i
nd i
s effec
s: (2)</div>

ribu
es
 gble
cell me
l si nd m s
cell develmen
</div>
Review:<div><br /></div><div><b>IL-10</b></div><div><br /></div><div>Cell
h

rduces i
nd i
s effec
s:</div>
<div>T-regs nd TH2</div><div><br /></di
v>Inhibi
r f llergic infl mm
in lng wi
h TGFB which is ls rduced by T
-regs<div><br /></div><div>Blcks cs
imul
ry mlecules n T cells</div><div><
br /></div><div>IL-10 rele sed by TH2 is ging
 inhibi
TH0 frm becming Th1<
/div>
Review:<div><br /></div><div><b>IL-13</b></div><div><br /></div><div>Cell
h

rduces i
nd i
s effec
s:</div>
<b><div></div></b><b>Th2 cells</b><div><
b><br /></b></div>THE MOST IMPORTANT medi
r f s
hm fe
ures<div>* irw y hy
erresnsivness</div><div>*gble
cell me
l si /mucus ver rduc
in</div><di
v>*mucs l edem </div>
Wh
re
he in
rinsic nd ex
rinsic c uses f s
hm ? <div><u>In
rinsic:</u></
div><div>Ad 
ive immune resnse invlving Th2 cells nd secre
ed cy
kines, <b
>eseci lly IL-13.</b></div><div><br /></div><div><u>Ex
rinsic:&nbs;</u></div><
div>Wh
drives
he lung Th2 resnse:
he nly
hing
h
h s been cle rly iden

ified is r
ein se c
ivi
y (n
ur l surces f r
ein se frm llen nd fun
gi re linked
 s
hm )&nbs;</div>
<u><b>M jr Pin
s</b></u><br /><div><br /></div><div><div>{{c1::Fung l irw y}}
infec
in is cmmn in severe llergic irw y dise se&nbs;</div><div><br /></d
iv><div>Allergic infl mm
in nd llergic dise ses re
resnse
 unregul
e
d {{c1::r
ein se}} c
ivi
y.</div><div><br /></div><div>Pr
ein ses induce b

h <b>{{c1::Th2 nd Th17::</b>2
yes f
cells<b>}}&nbs;</b>resnses
h
re
required fr dise se exressin (mech nism unknwn).</div><div><br /></div><div
>And, r
ein ses c
iv
e immune cells such
h

hey c n resnse
 Th2 nd T
h17 cells.</div><div><br /></div><div>Fibringen is cle ved nd
hese cle ved 
r
icles sign l
hrugh TLR{{c1::4}}, which
hen uregul
es
he IL-13 rece
r</
div><div><br /></div><div>Allergic resnses re PROTECTIVE g ins
fungi nd 

her
hings en
ering
he resir
ry
r c
!!</div></div>
TLR4 sign l ls uregul
es which rece
r?
IL-13
Wh
re
he rsed
her ies fr s
hm
<div><b>Brnchdil
in</b>: vi
2 agonists&nsp;</div><div><>Immunosuppression:</> using nti-IL-13 and nti-I
L-13-receptor, STT6 antagonists&nsp;</div><div><>Restoring airway patency:</
> anticoagulants, firinolytics (for firin filled clots in airways)</div><div><
r /></div><div><>nti-fungal antiiotics: </>for patients with severe asthma
that can tolerate this, it is a miracle drug</div>
Ruchit ?s<div><r /></div><div><div>Physiologically, asthma is characterized y
the following (select the est answer):</div><div><r /></div><div>Fixed airway
ostruction&nsp;</div><div>Hyperresponsiveness to methacholine challenge&nsp;<
/div><div>Th2 and Th17 cell-driven allergic airway inflammation&nsp;</div><div>
Chronic hypoxemia&nsp;</div><div>B and C&nsp;</div></div>
 and c
Ruchit ?s<div><r /></div><div><div><div>Proale underlying causes of asthma in
clude which of the following?</div><div><r /></div><div>T helper type 2 cells (
Th2 cells)&nsp;</div><div>Environmental proteinases&nsp;</div><div>Fungi&nsp;
</div><div>Cigarette smoke&nsp;</div><div>, B, and C</div></div></div>
, B, and C
<div>What is the main difference etween emphysema and asthma? (Fundamental caus
e, physiological findings, immune profile)</div><div><r /></div><div>What is th
e difference etween emphysema and ronchitis (two chronic ostructive diseases)
<r /><div><r /></div><div><r /></div></div> "COPD = Emphysema (physiological
finding) + Bronchitis (clinical diagnosis defined where patient has productive
cough most days for &gt;3 months)<r /><div><r /></div><div><img src=""paste-12
575664242689.jpg"" /></div>"
What are some causes of COPD? <>1) smoking</><div><><r /></></div><div><
><u>lso</u><r /></><div>use of iofuels inside home (Central merica)</div><d
iv>inhaling smoke from disel (truck drivers)</div><div>coal miners</div></div>

Emphysema is a chronic disease and is <>progressive despite smoking cessation</

>. It is associated with an <>inflammatory process</>. There is little a clin
ician can do to treat this disease pharmacologically.<div><r /></div><div>Howev
er, a few drugs may e used to treat the symptoms: (3)</div>
<div><u>Bronchod
ilation:&nsp;</u></div><div>2-R agonists (aluterol)</div><div>Muscarinic Ch
receptor antagonists (like ipratropium romide)</div><div><r /></div><div><u>I
mmunosuppression:</u>&nsp;</div><div>Corticosteroids (used rarely)</div><div><
r /></div><div><u>Supplemental O2</u></div><div><r /></div>
What is the only way to cure emphysema? lung transplantation
"What are the radiological signs of emphysema?<div><r /></div><div><img src=""p
aste-14177687044097.jpg"" /></div>"
<div>Bottom picture = emphysema</div>1)
1-2 cm wider retrosternal air space (see the top portion of ri cage ulges)<div
>2) Flatter diaphragm</div>
With emphysema, what is more difficult and <>why</> - exhalation or inspiratio
n?
"Exhalation ecause the lower airways collapse, causing air to remain in
lungs.<div><r /></div><div>The upper conductive zone is held open y the trach
eal cartilagenous rings. The &nsp; respiratory zone is held open y surfactant.
But the <>lower conductive zone is held open y ""tethering."" </>These tethe
rs are made of elastin. The elastin is destroyed in an anti-elastin, autoimmune
response stimulated y the Th1 and Th17 cells (asthma is <>Th2 and Th17</>). W
hen these tethers are cut, there is no repair and they collapse.</div>"
If you take the T-cells from emphysema patients, they will dramatically respond
to elastin peptide and generate what cytokines? Which is the most important?
"IFN-gamma&nsp;and IL-10<div><r /></div><div><r /></div><div><img src=""paste
-18966575579137.jpg"" /></div>"
What are the potential treatments for COPD? (3) <div>Bronchodilation: 2 agonists
and M3 lockers</div><div><r /></div><div>PPR- aonists (Rosilitazone) - may a
ctually help lun rerowth</div><div><br /></div><div>Osteopontin antaonists</d
iv>
Describe the autoimmune component of emphysema: "Carbon black is thouht to be a
key trier in creatin the autoimmune response. It can activate macrophaes an
d neutrophils to destroy lun parenchyma (via elastase and matrix metalloprotein
ases). Your luns cannot et rid of carbon black (found in any type of black smo
ke).<div><br /></div><div>Elastin peptides are presented on APCs to Th1 cells. T
h1 keeps the macrophaes stimulated (think IFN-amma) and the neutrophils stimul
ated (think IL-2). The macrophaes and neutrophils are rechared to destroy more
elastin.</div><div><br /></div><div><im src=""paste-19443316948995.jp"" /></d
iv>"
Fundamental cause of asthma vs. emphysema:
"<im src=""paste-19524921327617
.jp"" />"
Physioloical findins of asthma vs. emphysema: Asthma: reversible airway obstru
ction (parenchyma not affected)<div><br /></div><div>Emphysema: irreversible air
way obstruction (parenchyma affected)</div>
Immune profile of asthma vs emphysema: Asthma: Th2, Th17, IE, and <b>no </b>au
toimmunity<div><br /></div><div>Emphysema: Th1, Th17, and stron autoimmune comp
onent</div>
Ruchit's Questions<div><br /></div><div><div>Physioloically, emphysema is chara
cterized by which of the followin?</div><div><br /></div><div>Fixed airway obst
ruction&nbsp;</div><div>Preserved lun architecture despite marked hypoxemia&nbs
p;</div><div>Predominant Th2 cells in the lun&nbsp;</div><div>Loss of lun volu
me&nbsp;</div><div>Weiht ain&nbsp;</div></div>
A
Ruchit's Questions<div><br /></div><div><div><div>Potential future therapies for
emphysema miht include which of the followin?</div><div>&nbsp;</div><div>Beta
-2 adreneric receptor aonists&nbsp;</div><div>Glucocorticosteroids&nbsp;</div>
<div>Peroxisome proliferator activated receptor amma (PPAR-) aonists (e.., r
osilitazone)&nbsp;</div><div>Insulin&nbsp;</div><div>Smokin cessation interven
tion&nbsp;</div></div></div>
Peroxisome proliferator activated receptor amma
(PPAR-) aonists (e.., rosilitazone)&nbsp;
Ruchit's Questions<div><br /></div><div><div><div>Which of the followin contrib
ute to the pathoenesis of emphysema?</div><div>&nbsp;</div><div><div>Th2 cells&

nbsp;</div><div>Immunolobulin E (IE) and mast cells&nbsp;</div><div>Elastases&

nbsp;</div><div>Tree pollens&nbsp;</div><div>Obesity&nbsp;</div></div></div></di
v>
Elastases&nbsp;
"<im src=""paste-48743583842305_1420570953745.jp"" /><div>How would you test t
he functionin of this muscle?</div>" First ask the patient to adduct the eye,
then ask the patient to look downward
"<im src=""paste-51264729645057.jp"" /><div>Identify the structure indicated b
y the red arrow<tr><br /></tr><tr>Notice the location of the lacrimal land to d
etermine if this is a riht or left eye</tr></div>"
Frontal N. &nbsp;branch
of V1<div>Riht eye since Lacrimal land is always Lateral</div>
Orbit
"<div>Identify the foramen indicated by the red arrows</div><im src=""paste-516
98521341953.jp"" />" Supraorbital notch/foramen&nbsp;
Orbit
"Identify the bone indicated by the red arrows<div><im src=""paste-520163489218
57.jp"" /></div>"
Zyomatic
Orbit
"<div><div>Identify the structure indicated by the red arrow</div><div><br /></d
iv><div>Notice the location of the lacrimal land to determine if this is a rih
t or left eye</div></div><im src=""paste-52544629899265.jp"" />"
Trochlea
r n. (CN IV)<div>Left eye</div> Orbit
"How would you test the functionin of this nerve?<div><im src=""paste-52944061
857793.jp"" /></div>" <div>First ask the patient to adduct the eye, then ask t
he patient to look downward</div><div><br /></div>
Orbit
"Identify the foramen indicated by the red arrows<div><im src=""paste-533735585
87393.jp"" /></div>" Optic canal
Orbit
"How would you test the functionin of this nerve?<div><im src=""paste-53803055
316993.jp"" /></div>" Ask the patient to abduct the eye<div><br /></div><div>(
lateral rectus - pointin to abducens n.)</div> Orbit
"Identify structure indicated by arrow<div><im src=""paste-54099408060417.jp""
/></div>"
Frontal n. - branch of V1<div><br /></div><div>(NFL mneumonic medial to lateral)</div>
Orbit
"How would you test the functionin of this nerve?<div><im src=""paste-54546084
659201.jp"" /></div>" Superior oblique.<div>First ask the patient to adduct th
e eye, then ask the patient to look downward</div><div><br /></div><div>&nbsp;(t
his question has popped up in many different anles)</div>
Orbit
"<div>Identify</div><im src=""paste-54936926683137.jp"" />" Infraorbital for
amen<div><br /></div><div>(note: optic canal on medial side (round hole); superi
or and inferior orbital fissure)</div> Orbit
"How would you test the functionin of this muscle?<div><im src=""paste-5539219
3216513.jp"" /></div>" First ask the patient to abduct the eye, then ask the pa
tient to look upward<div>(that is superior rectus)</div>
Orbit
"Identify<div><im src=""paste-55946243997697.jp"" /></div>" lacrimal land
Orbit
"<div>What bone is this?</div><im src=""paste-56238301773825.jp"" />" Lacrimal
bone!&nbsp;<div>(ethmoid is posterior to it and maxilla piece is anterior; also
notice the nasolacrimal fossa)</div> Orbit
"Identify the bone<div><im src=""paste-56865366999041.jp"" /></div>" Maxilla
Orbit
"Identify<div><im src=""paste-57415122812929.jp"" /></div>" Foramen for Zyo
maticofacial nerve
Orbit
"Identify the structure<div><im src=""paste-57831734640641.jp"" /></div>"
Abducent nerve (VI)
Orbit
"Identify the structure<div><im src=""paste-58149562220545.jp"" /></div>"
<div>frontal &nbsp;- branch of V1</div> Orbit
"Identify the bone<div><im src=""paste-58720792870913.jp"" /></div>" Zyomati
c
Orbit
"Identify the muscle indicated by the red arrows<div><im src=""paste-5924477888
1025.jp"" /></div>"
Lateral rectus<div><br /></div><div>(Know how to test it
and what nerve innervates it)</div>
Orbit
"Identify the hole<div><im src=""paste-59571196395521.jp"" /></div>" Inferior
orbital fissure<div><br /></div><div>(thins that o throuh it: zyomatic nerv
e, infraorbital vessels/nerve...not covered but found online)</div>
Orbit

"Name the specific nerve that innervate these muscle fibers<div><im src=""paste
-60172491816961.jp"" /></div>" Mandibular branch of VII
Face
"Identify the muscle indicated by the red arrow<div><im src=""paste-60700772794
369.jp"" /></div>"
orbicularis oculi - orbital portion
Face
"Identify the muscle<div><im src=""paste-60997125537793.jp"" /></div>"
PLATYSMA<div><br /></div><div>Innervation? VII (cervical branch)</div> Face
"Name the specific nerve that would supply sensation from this reion of the ski
n<div><im src=""paste-61383672594433.jp"" /></div>" <div><br /></div><div><b
r /></div><div>Zyomaticofacial of V2</div><div><br /></div>
Face
"Identify this nerve<div><im src=""paste-61735859912705.jp"" /></div>"
Auriculotemporal n.<div><br /></div><div>(branch of V3)</div> Face
"Identify the nerve<div><im src=""paste-62049392525313.jp"" /></div>" Mandibul
ar branch of VII
Face
"Identify<div><im src=""paste-62727997358081.jp"" /></div>" Orbicularis ocul
i - orbital portion
Face
"Name the specific nerve that would supply sensation from this reion of the ski
n<div><im src=""paste-63020055134209.jp"" /></div>" Transverse cervical of C
2,C3
Face
"Name the specific nerve that innervates these muscle fibers<div><im src=""past
e-63436666961921.jp"" /></div>"
Temporal branch of VII<div>(superior por
tion of orbicularis oculi)</div>
Face
"Identify the muscle<div><im src=""paste-63758789509121.jp"" /></div>"
Occipitalis
Face
"Name the specific nerve that would supply sensation from this reion of the ski
n<div><im src=""paste-64119566761985.jp"" /></div>" <div><br /></div><div><b
r /></div><div>Mental of V3</div><div><br /></div>
Face
"Identify the muscle indicated by the red arrow<div><im src=""paste-64424509440
001.jp"" /></div>"
orbicularis oculi - orbital portion
Face
"Identify<div><im src=""paste-65631395250177.jp"" /></div>" Frontalis
Face
"Name the specific nerve that innervates these muscle fibers<div><im src=""past
e-66052302045185.jp"" /></div>"
Buccal branch of VII<div><br /></div><di
v>(pointin to zyomaticus)</div>
Face
"Name the specific nerve that would supply sensation from this reion of the ski
n<div><im src=""paste-66370129625089.jp"" /></div>" Supraorbital of V1
Face
"Identify this nerve<div><im src=""paste-67070209294337.jp"" /></div>"
<div><br /></div><div><br /></div><div>Temporal branch of VII</div><div><br /></
div>
Face
"Identify nerve<div><im src=""paste-67611375173633.jp"" /></div>"
<div><br
/></div><div><br /></div><div>Zyomatic branch of VII</div><div><br /></div>
Face
"Identify the muscle indicated by the red arrow<div><im src=""paste-68049461837
825.jp"" /></div>"
Orbicularis Oris
Face
"Name the specific nerve that innervates these muscle fibers<div><im src=""past
e-68341519613953.jp"" /></div>"
Cervical branch of VII Face
"Name the specific nerve that would supply sensation from this reion of the ski
n<div><im src=""paste-68637872357377.jp"" /></div>" Infraorbital of V2
Face
"Identify the muscle<div><im src=""paste-69050189217793.jp"" /></div>"
Depressor anuli oris Face
"Identify the nerve<div><im src=""paste-69827578298369.jp"" /></div>" <div><br
/></div><div><br /></div><div>Buccal branch of VII</div><div><br /></div>
Face
What information is athered durin pre clinical testin?
1. Toxicity info
(acute, subchronic, chronic, rep fxn, carcinoenicity, mutaenicity, investiat
ive toxicity)<div><br /></div><div>2. NED (no effect dose)</div><div><br /></div
><div>3. LD1/LD50</div>
What is the purpose of phase 1, 2, 3, 4 ?
I- determine safety and dosae<d
iv>II- determine efficacy, dosae rane, side effects</div><div>III-verify effic

acy, detect adverse effect in larer pool</div><div>IV-find rare adverse effects

</div>
When can dru be used by physician if deemed appropriate?
Phase IV
Why are women underrepresentated in clinical trials
1. effects of dru on me
nstrual cycle<div>2. effect of exoenous hormone therapy on dru</div><div>3. ef
fect of dru on oral contraceptives</div>
What are the 5 major roups of adults at hih risk for developin aids <div>1.
Homosexual or bisexual men ~ 50% of cases in the US&nbsp;</div><div>2. IV dru u
sers&nbsp;</div><div>3. Recipients of HIV infected blood&nbsp;</div><div>4. Hete
rosexual contacts of members of the other hih risk roups (mainly IV dru users
)&nbsp;</div><div>5. HIV infection of newborn &nbsp;</div>
What are the 3 routes of transmission of AIDS? 1. sexual<div>2. parenteral</div
><div>3. placenta</div>
How is sexual transmission of HIV enhanced?
By coexistin sexually transmitt
ed diseases especially those associated with enital ulceration (i.e. schistosom
iasis reatly enhances HIV transmission, so removin it can decrease HIV infecti
on)&nbsp;
What are the ways by which viral transmission occurs? (eneral) 1. Direct inocul
ation into blood vessels<div>2. infection of dendritic cells or CD4+ in mucosa</
div>
What is the viral core of HIV made up of?
<div>1. Major capsid protein p24
&nbsp;</div><div>2. Nucleocapsid protein p7/p9&nbsp;</div><div>3. 2 copies of vi
ral enome = RNA&nbsp;</div><div>4. 3 viral enzymes: HIV protease, RT, and inte
rase&nbsp;</div>
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 0.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 0.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 1.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 1.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 2.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 2.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 3.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 3.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 4.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 4.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 5.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 5.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 6.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 6.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 7.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 7.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"
"<im src=""4a465dd1aabf39dd228684b5daf2956ca80f4002_Q 8.sv"" />"
"<im sr
c=""4a465dd1aabf39dd228684b5daf2956ca80f4002_A 8.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_source_sv.sv"" />"
"<im src=""4a46
5dd1aabf39dd228684b5daf2956ca80f4002_tmpiThUar.pn"" />"

What is the most common HIV1 subroup world wide?<div><br /></div><div>Where is

Subtype B most prevelant?</div><div>Where is subtpe E most prevelant?</div>
<div>M (major) - most common worldwide and subdivided even more&nbsp;</div><div>
&nbsp; &nbsp; &nbsp;Subtype B is most common in western &nbsp; &nbsp; &nbsp; Eur
ope and US&nbsp;</div><div>&nbsp; &nbsp; &nbsp; Subtype E is most common in Thai
land&nbsp;</div><div>Clade C is fastest spreadin worldwide&nbsp;</div><div>O (o
utlier) &nbsp;</div><div>N (neither m nor o)&nbsp;</div>
What are 2 main tarets of HIV? immune system and CNS
What are the 3 important enomic structures we need to know about HIV enome?
LTR: control reions that bind TF<div>VIF: inhibits <b>APBEC3</b> to promote <b
>viral replication</b></div><div>VPU: promotes <b>CD4 deradation</b> to increas
e <b>virion release</b></div>
How does HIV infect cells? (4) "1) GP120 binds CD4<div>2) conformation chane l
eads to GP 120 havin site that binds to CCR5 and CXCR4</div><div>3) GP41 membra
ne penetration</div><div>4) Membrane fusion</div><div><br /></div><div><im src=
""paste-138108968370716.jp"" /></div>"
What therapeutic implications does the requirement co-receptors have for HIV res
istance?
1. homozyotes with defective copies of CCR5 conveys resistance
to HIV<div>2. heterozyotes delay onset of disease</div>
Why is HIV inefficient at infectin naiive T cells?
T-cells contain the enzy
me APOBEC3G that actively mutates HIV enome by chanin cytosine to uracil
What 4 ways are T cell populations depleted by HIV?
"<div>1. Direct killin
of infected cells&nbsp;</div><div>2. Chronic activation of uninfected cells lead
s to apoptosis by activation induced cell death (AICD)&nbsp;</div><div>3. Killin
 by CD8+ Tc cells &nbsp;</div><div>4. HIV infects cells in lymphoid orans and
may cause proressive destruction of the architecture and cellular composition o
f lymphoid tissues&nbsp;</div><div><br /></div><div><im src=""paste-13833230667
0042.jp"" /></div>"
How are macrophaes involved in HIV infection? (2)
1. in brain and lun, 10
-50% of macrophaes can be infected<div>2. Infected macrophaes release a ton of
IL-6 which stimulate B cells to proliferate</div>
How are dendritic cells involved in HIV infection? (3) 1.&nbsp;<b>Mucosal dendr
itic cells</b> are infected and can transport it to reional lymph nodes --&t;
transmission to TH cells&nbsp;<div><br /></div><div>2.&nbsp;<b>Dendritic cells</
b> express lectin-like receptor that binds HIV and displays it as an intact, inf
ectious form to T-cells&nbsp;</div><div><br /></div><div>3.&nbsp;<b>Follicular d
endritic cells </b>can be reservoirs for HIV&nbsp;</div>
How are B cells affected in HIV infections? (2) 1. B cells undero paradoxical a
ctivation leadin to lare erminal centers<div>2. HIV infected macrophaes prod
uce Il-6 which stimulates proflieration of B cells</div>
Despite the proliferation of B cells in HIV infections, why are patients still p
rey to infections of pneumonia and influenza? 1. B cells are activated but the
massively decreased Th cells results in suppressed activity of antibody<div><br
/></div><div>2.&nbsp;This impaired humoral immunity renders these patients prey
to disseminated infections of S. pneumonia and H. influenza, both of which requ
ire antibodies for effect opsonization and clearance&nbsp;</div>
what are the 3 phases of HIV infection? 1. acute retroviral syndrome<div>2. midd
le chronic phase</div><div>3. clinical AIDS</div>
What happens in the acute retroviral syndrome phase? (3)
1. infection of
<b>memory Th</b> cells in mucosal tissue<div>2. <b>dendritic cells</b> take viru
s to lymph nodes, infects other cells</div><div>3. HIV specific CD8+ Tc cells ca
n be seen and attempt to contain the infection</div>
What happens in middle chornic phase? Are there any symptoms? Clinically laten
t state where disease is present in lymph nodes and spleen (sites of continuous
HIV replication) but NO SYMPTOMS
What are the 3 hallmarks of clinical AIDs?
1. extremely low Th cell count a
nd hih viral load<div>2. Increased infection&nbsp;</div><div>3. increased tumor
development</div>
What opportunistic diseases are HIV patients at risk from?<div><br /></div><div>
1) Most common reason for death</div><div>2) most common infection</div><div>3)

another emerin infection</div>

1. Pneumocystic jiroveci funus<div>2. C
andidiasis</div><div>3. dru resistant TB</div>
What cancers are HIV patients susceptible to?<div><br /></div><div>What is a com
mon feature of these tumors?</div>
<div>Hiher incidence of:&nbsp;</div><di
v>1. Kaposi's sarcoma (from its herpesvirus HHV8)&nbsp;</div><div>2. B-cell lymp
homa (from Eppstein Barr virus)&nbsp;</div><div>3. Cervical carcinoma in women a
nd anal carcinoma in men (from HPV)&nbsp;</div><div><br /></div><div>Caused by o
ncoenic DNA viruses</div>
"<im src=""paste-140587164500499.jp"" />"
Pathoenesis of HIV-1 infection.
The initial infection starts in mucosal tissues, involvin mainly memory CD4+ T
cells and dendritic cells, and spreads to lymph nodes. Viral replication leads
to viremia and widespread seedin of lymphoid tissue. The viremia is controlled
by the host immune response, and the patient then enters a phase of clinical lat
ency. Durin this phase, viral replication in both T cells and macrophaes conti
nues unabated, but there is some immune containment of virus (not illustrated).
There continues a radual erosion of CD4+ cells and ultimately, CD4+ T-cell numb
ers decline, and the patient develops clinical symptoms of full-blown AIDS.&nbsp
;
"<im src=""paste-140612934304032.jp"" />"
The early period after primary i
nfection is characterized by dissemination of virus, development of an immune re
sponse to HIV, and often an acute viral syndrome. Durin the period of clinical
latency, viral replication continues, and the CD4+ T cell count radually decrea
ses until it reaches a critical level below which there is a substantial risk of
AIDS-associated diseases.&nbsp;
What part of the brain defines if a condition is intra-axial or extra-axial?
pia mater&nbsp; 2-10
The otic placode is from what erm layer?
ectoderm
<div>The upper lip is formed by:</div> <div>Medial nasal prominences (philtrum)
</div><div>Maxillary prominence</div>
What is the benefit of a partial aonist?
Stimulation of receptors without
the bad side-effects that occur with full aonists.
Instead of usin diazepam (full aonist) for eneral anxiety, use what dru? Wha
t receptor does it work on? Why?
Buspirone (Buspar) --+ 5-HT (seratonin)
receptors (partial aonist!)<div><br /></div><div>Diazepam can lead to addiction
or withdrawal.</div>
What is buprenorphine used for? "Used to treat opiod addiction (partial aonist)
.<div><br /></div><div><im src=""paste-133955734994945.jp"" /><br /><div><br /
></div></div>"
Narcotics are (full/partial) aonists? Full
Use of methadone:
"Lon actin full aonist, used to treat narcotic addict
ion.<div><br /></div><div><im src=""paste-133783936303105.jp"" /></div>"
Heroin can kill (full aonist, potent). What do you ive to someone who overdose
d on this? What type of dru is this (aonist, antaonist, inverse aonist)?
Naloxone (Narcan) - and a lare amount (10-20 vials of 0.4 mL<div><br /></div><d
iv>Antaonist to opoid receptors</div>
Pindolol and Acebutolol are what type of dru (partial/full aonist, antaonist,
inverse aonist)?
Partial aonists - beta blockers
What is important to know about how to ive Naloxone? It has a shorter duratio
n of action (half-life) than most narcotics. Must ive continuous infusion (also
inhalation form).
Name four inverse aonists we know and what receptor they work on:
1) Teraz
osin (alpha1 - inverse aonist)<div>2) Carvedilol (beta blocker, but also some a
lpha - inverse aonist)</div><div>3) Respiridone 5-HT receptors for psych patien
ts (schizophrenia, the mixed and manic states of bipolar disorder) - inverse ao
nist</div><div>4) Diphenhydramine (H1 receptor - inverse aonist)</div>
What is a dru we know that you should not drink milk with or have anythin that
is basic in your stomach?
"Tetracycline<div><br /></div><div>Bioavailabili
ty decreases in certain cases:</div><div><im src=""paste-124274878709761.jp""
/></div>"
"What order of kinetics?<div><br /></div><div><im src=""paste-120065810759681.j

p"" /></div><div><br /></div><div>Percentae of drus&nbsp;eliminated this way?

</div>" 1st order<div>About 95% of drus eliminated this way.</div>
"What order of kinetics?<div><im src=""paste-120125940301825.jp"" /></div><div
><br /></div><div>When does this occur?</div>" <div>Zero</div><div>Overdose - e
x) too much alcohol</div>
What is Levetiracetam used for? anti-seizure medication (wide Therapeutic Index)
<div>Keppra</div>
Why not ive phenytoin directly? What do you ive?
Give Fosphenytoin - the
prodru.<div><br /></div><div>Phenytoin directly iven will cause arrhythmias&nb
sp;</div>
"<im src=""paste-128376572477441.jp"" />"
Green - epi and methadone<div>Bl
ue - pinolol</div><div>Purple - carvidelol</div><div><br /></div><div>Red - nala
xone</div>
"<im src=""paste-128539781234689.jp"" />"
B
"<im src=""paste-128698695024641.jp"" />"
B
"<im src=""paste-128754529599489.jp"" />"
C<div><br /></div><div>About 20x
's more expensive to do IV than PO</div>
"<im src=""paste-128883378618369.jp"" />"
Prodru
Tylenol + Codeine &nbsp;= ?
Tylenol 3
Difference between therapeutic window and therapeutic index?
Let's say a the
ED50 = 50 m and the LD50 = 125 m, the ratio of LD50 to ED50 is the TI and the
TW is the absolute difference (75 m).
What shows up as hih density on CT?
hemolobin
RadioloyOrbit
What are the seven bones that form the orbit? "frontal<div>sphenoid</div><div>
zyomatic</div><div>maxilla</div><div>lacrimal</div><div>ethmoid</div><div>palat
ine</div><div><im src=""paste-45719926866251.jp"" /></div>" RadioloyOrbit
"What are these imaes showin?<div><im src=""paste-45788646343015.jp"" /></di
v>"
blowout fractures<div><br /></div><div>fracture in orbital floor and the
fat herniates downwards alon with the inferior rectus</div><div><br /></div><d
iv>herniation leads to double vision,</div><div>also numbness if hit infraoribta
l foramen</div> RadioloyOrbit
"What is this imae showin?<div><im src=""paste-45908905427259.jp"" /></div>"
left eye lens dislocated<div><br /></div><div>hematoma near nasal crest</div>
RadioloyOrbit
"What is this imae showin?<div><im src=""paste-45943265165612.jp"" /></div>"
retinal detachment
RadioloyOrbit
"What is this imae showin?<div><im src=""paste-45990509805820.jp"" /></div>"
childhood retinoblastoma - mass = calcium
RadioloyOrbit
"What is this imae showin?<div><im src=""paste-46140833661187.jp"" /></div>"
adult melanoma RadioloyOrbit
"What space is the injury located in?<div><im src=""paste-46183783334223.jp""
/></div>"
hemanioma inside the muscle cone = intraconal RadioloyOrbit
"What space is the injury located in?<div><im src=""paste-46218143072589.jp""
/></div>"
extraconal mass<div>displacin the medial rectus muscle</div>
RadioloyOrbit
If you have a slow loss of vision? Where is the patholoy located?<div>lobe</di
v><div>optic nerve</div><div>muscles</div><div><br /></div>
optic nerve
RadioloyOrbit
"<div>What is wron here?</div><div><im src=""paste-46411416600839.jp"" /></di
v>"
"HUGE extraocular muscles<div><br /></div><div>thyroidorbitomoa and Grav
e's diease</div><div><br /></div><div>proression of disease is usually ""I'M SL
OW""</div><div>inferior rectus, medial rectus, superior, lateral</div>" Radiolo
yOrbit
<div>Which CN is actually inside the cavernous sinus?</div>
"<im src=""past
e-46531675685203.jp"" /><div>CN VI</div>"
RadioloyOrbit
"Is this normal?<div><im src=""paste-46608985096601.jp"" /></div>"
"NO, abn
ormal cavernous sinus<div><im src=""paste-46621869998483.jp"" /></div><div>nor
mal</div>"
RadioloyOrbit
"<im src=""paste-46647639802245.jp"" /><br />What fractures is this showin?"
ZMC = zyomatico-maxillary complex fracture<div><br /></div><div>bone held in pl

ace by 4 sutures, fractures can make it move around in the tissue</div> Radiolo
yOrbit
"What is this a fracture of? Complications?<div><im src=""paste-46681999540617.
jp"" /></div>" fracture of zyomatic arch<div><br /></div><div>TRISMUS = lockja
w (clinical inability to open the the mouth because of reduced muscle of mastica
tion function)</div>
RadioloyOrbit
"<im src=""paste-46802258624914.jp"" /><div>Pteryopalatine fossa?&nbsp;</div>
"
DOWN: exit into palatine foramen<div>UP: orbital fissure</div><div>POSTE
RIOR: Vidian's canal</div><div>SUPERIORLATERALLY: foramen rotundum - cavernous s
inus</div><div>LATERALLY: pteryomaxillary fossa</div><div><br /></div><div>impo
rtant because tumor can invade from palate and head to the pteryopalatine fossa
</div> RadioloyOrbit
What are sinuses lined by?
ciliated respiratory epithelium RadioloyOrbit
"Which is normal? What patholoy?<div><im src=""paste-46986942218630.jp"" /></
div>" normal left<div><br /></div><div>sinusitis riht</div> RadioloyOrbit
"What is this showin?<div><im src=""paste-47034186858829.jp"" /></div><div><i
m src=""paste-47047071760703.jp"" /></div>" mandibular fractures, involves m
ultiple fractures
RadioloyOrbit
What three distinct prominences can be seen at 42 days in the face reion?
"<div>1) Mandibular (1st pharyneal arch) caudal to the stomodeaum</div><div>2)
Maxillary (dorsal 1st pharyneal arch) - lateral to the stomodeum</div><div>3) F
rontonasal cranial to the stomodeum</div><div><br /></div><div><im src=""paste6614249635843.jp"" /></div>"
"<im src=""5cac40e490a4b80d0da096537c14c486791be359_Q_0.sv"" />"
"<im sr
c=""5cac40e490a4b80d0da096537c14c486791be359_A_0.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_source_sv.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_tmpl1ucxu.pn"" />"
"<im src=""5cac40e490a4b80d0da096537c14c486791be359_Q_1.sv"" />"
"<im sr
c=""5cac40e490a4b80d0da096537c14c486791be359_A_1.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_source_sv.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_tmpl1ucxu.pn"" />"
"<im src=""5cac40e490a4b80d0da096537c14c486791be359_Q_2.sv"" />"
"<im sr
c=""5cac40e490a4b80d0da096537c14c486791be359_A_2.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_source_sv.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_tmpl1ucxu.pn"" />"
"<im src=""5cac40e490a4b80d0da096537c14c486791be359_Q_3.sv"" />"
"<im sr
c=""5cac40e490a4b80d0da096537c14c486791be359_A_3.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_source_sv.sv"" />"
"<im src=""5cac
40e490a4b80d0da096537c14c486791be359_tmpl1ucxu.pn"" />"
Placodes are paired _____ ( erm layer) thickenins. What do the otic placodes a
nd lens placodes become?
Ectoderm.<div><br /></div><div>The otic placode
will become the otic vesicles (ear and vestibular structures)</div><div>The lens
placode will become the lens of the eye</div>
What are the three placodes?
"<div>Otic placodes <span class=""Apple-tab-span
"" style=""white-space:pre""> </span></div><div>Olfactory placodes</div><div>Opt
ic placodes</div>"
<div>Failure of the forebrain to induce the optic placode properly can lead to w
hat?&nbsp;</div>
"lack of lateral miration of the optic plate = cyclops<
div><br /></div><div><im src=""paste-13782550052865.jp"" /></div>"
The optic placode invainates to form what? What happens next? Optic vesicle (s
ensory epithelium) is formed from the invaination. It attaches to the forebrain
by the optic stalk, which then will become the optic nerve. Then the optic vesi
cle induces overlyin ectoderm to becom the lens. Then the cornea forms.
What is the oriin of the retina?
"<im src=""paste-14181982011393.jp"" /
><div><br /></div><div>Anterior Neuroepithelium</div>"
What is the oriin of the RPE? "<im src=""paste-14181982011393.jp"" /><div><b
r /></div><div>Posterior Neuroepithelium</div>"
What is the erm layer the cornea comes from? "<im src=""paste-15801184681985
(1).jp"" /><br /><div><br /></div><div>Surface Ectoderm</div>"
The anterior chamber of the eye forms as a space develops between the {{c1::lens

}} and its closely associated {{c1::iridopupillary membrane}} and the {{c1::corn

ea}}.
"<im src=""paste-35948876267523.jp"" />"
Where does the external ear come from? 1st Pharyneal Cleft<div><br /></div><di
v><br /></div><div>Ectoderm</div>
What does the middle ear oriinate from?<div><br /></div><div>Tympanic cavity, m
alleus, incus, stapes</div>
<div>Tympanic cavity: from 1st pharyneal pouch
(endoderm)&nbsp;</div><div>Malleus, incus: from 1st pharyneal arch</div><div>St
apes: from 2nd pharyneal arch</div>
From what does the tympanic membrane oriinate? (3 layers)&nbsp;
<div>3 l
ayers</div><div><br /></div><div>1st branchial cleft (ectoderm)&nbsp;</div><div>
Fibrous stratum in middle (mesoderm)</div><div>1st branchial pouch (endoderm)&nb
sp;</div><div><br /></div>
What does the inner ear oriinate from?&nbsp; "<div>Otic placode (ectoderm) in
vainates to form ""otocyst"" (otic vesicle)&nbsp;</div><div><br /></div><div>Bi
furcates to form:&nbsp;</div><div>Ventral (auditory): saccule and cochlear duct&
nbsp;</div><div>Dorsal (vestibular): utricle, semicircular canals, endolymphatic
duct&nbsp;</div><div><br /></div><div><im src=""paste-47218870452225.jp"" /><
/div>"
Nasal placodes develop (induced by underlyin ventral forebrain) and is where th
e specialized olfactory epithelium comes from. In week 5, these invainate to fo
rm what?
"nasal pits/prominences<div><br /><div><im src=""paste-47489453
391875.jp"" /></div></div>"
Where is the nasolacrimal roove located?
Between lateral nasal prominence
and the maxillary prominence.<div><br /></div><div><div>Becomes the nasolacrima
l duct with fusion of the prominences</div></div>
"<im src=""paste-47579647705089.jp"" /><div><br /></div><div>What is this?</di
v>"
"<u><b>Oblique fascial cleft</b></u><div><br /></div><div>No fusion of t
he nasolacrimal roove from lateral nasal prominence to maxillary prominence.</d
iv><div><br /></div><div><im src=""paste-47871705481217.jp"" /></div>"
What forms the upper lip?
Formed by medial nasal prominences (philtrum) an
d maxillary prominence
"<im src=""paste-65163243814913.jp"" /><div><br /></div><div><div>6.5 weeks {{c1::palatine shelves}} form on each side of the tonue, primary palate still n
ot fused with secondary palate</div><div><br /></div><div>7 weeks - palatine she
lves become {{c1::horizontal}} but are still not fused in the midline; +/- fusio
n with primary palate</div><div><br /></div><div>10 weeks - palatine shelves hav
e {{c1::fused in the midline}}; fusion complete with primary palate and nasal se
ptum&nbsp;</div></div>"
When fusion of the palate does not occur, you et:
"<im src=""paste-669284
75373569.jp"" /><div><br /></div><div>CLEFT PALATE/LIP</div>"
The anterior 2/3 of the tonue comes from where?
1st pharyneal arch, iv
es off V3
What is the copula and where does it come from? "Midline swellin - 2nd arch<div
><br /></div><div><im src=""paste-67121748901889.jp"" /></div>"
Posterior 1/3 of tonue comes from where?
"<div>Copula is ""overtaken"" by
midline swellins from 3rd and 4th arches called hypopharyneal eminence</div><
div><br /></div><div>Gives CN IX reion (3rd arch) and CN X reion (4th arch)&nb
sp;</div>"
"KNOW<div><br /></div><div><im src=""paste-67280662691841.jp"" /></div>"
Motor innervation of tonue:
CNXII
Name the normal (2) and abnormal (2) remnants of the thyrolossal duct and some
clinical correlations: Normal: pyramidal lobes, foramen cecum (seen in 2/3 of p
eople)<div><br /></div><div>Abnormal: thyrolossal duct cyst, ectopic thyroid</d
iv>
The skull larely oriinates from the ____?
Neural Crest
<div>Thyroid oriinates as an {{c1::endodermal diverticulum}} at the {{c1::foram
en cecum}}.</div><div><br /></div><div>Thyroid descends from the base of the ton
ue to its normal location via the {{c1::thyrolossal duct (which normally oblit
erates)}}.</div>

Growth of the skull is not complete at birth because the brain must row. How is
this possible? How many are present and where are they?
Fontanelles - 6
are present at birth (anterior, posterior, 2 sphenoid, 2 mastoid)
When do the posterior and anterior fontanelles close? <div>Posterior closes by
3 months</div><div>Anterior closes by 18 months</div>
What is it called when the bones of the skull fuse too early? craniosynostosis
What is Leukocyte adhesion deficiency type 1? Issue with beta 2 chain in inte
rins
What is leukocyte adhesion deficiency type 2? absence of selectin liand on ne
utrophil (sialyl-lewis x) which binds to E/P selectin
What is chediak-hiashi syndrome? What are some symptoms? (6) autosomal recess
ive syndrome in which there is a defective fusion of phaosomes and lysosomes du
e to a protein traffickin defect.&nbsp;<div><br /></div><div>1. increased risk
of infections</div><div>2. neutropenia (death of neutrophils)</div><div>3. iant
ranules arisin due to fusion of ranules</div><div>4. defective primary hemos
tasia (abnormally dense ranules in platelets)</div><div>5. albinism</div><div>6
. peripheral neuropathy (can't move proteins around nerve)</div>
What ene is involved in chediak hiashi syndrome?
LYST (cytosolic protein
involved in lysosomal traffickin)
What is chronic ranulomatous disease? What is the enetic inheritance? Problem
with NADH oxidase so that there is no super oxide formation?<div><br /></div><di
v>x linked (membrane bound)</div><div>AR (cytoplasmic component)</div>
What complement deficiency is involved in bacterial and viral infections but in
some patients may not show many clinical manifestions C2: because alternative
complement pathway is still intact (C3)
What complement deficiency is involved in serious and recurrent pyoenic infecti
ons and leads to increased immune complex-mediated lomerulonephritis? C3 defic
iency
What does C5-C9 defects lead to? (2)
1. MAC issues&nbsp;<div><br /></div><div
>2. increased susceptibility to onococcal and meninococcal infections&nbsp;</d
iv>
What are 3 immunodeficiency syndroms that affect T cell lineae?
ADA defi
ency<div><br /></div><div>X linked SCID</div><div><br /></div><div>Di Geore syn
drome</div>
If a patient presents with oral candidiasis, extensive diaper rash, and failure
to thrive, what miht he/she have?
SCID
Describe X linked SCID "Mutation of cytokine amma chain in receptors for cytok
ines lead to iniability for Pro T to mature to immature T cells<div><br /></div>
<div><im src=""paste-8997956485657.jp"" /></div>"
Describe ADA? SCID (severe combined immune deficiency)<div><br /></div><div>AD
A deficiency</div><div><br /></div><div>hih adenosine levels leads to hih dATP
levels which inhibits ribonucelotide reductase.</div><div><br /></div><div>Ribo
nucleotide reductase is a key enzyme in synthesis of dexoyribonucleotides needed
for DNA synthesis.</div><div><br /></div><div>Rapidly dividin cells (immune ce
lls) are most affected</div>
What 2 treatment methods are used for SCID?
1. bone marrow transplant<div>2.
ene therapy</div>
What are the immuno consequences of Di Geore Syndrome? "3/4th pharyneal pouche
s do not form and thus thymus does not develop, preventin the maturation of T c
ells<div><br /></div><div><im src=""paste-9448928051737.jp"" /></div>"
What 2 immunodeficiency syndroms affect B-cell lineae? 1. x linked aammalobul
inemia: Bruton Disease<div>2. Hyper-IM syndrome</div>
What happens in X linked Aammalobulinemia?
"B cell maturation stops after i
nitial heavy chain ene rearranement due to a mutation in BTK ene on x chromos
ome.<div><br /></div><div>The result of this mutation is that downstream sinali
n to the nucleus does not occur for the pre-B cells to mature onto an immature
B cell</div><div><br /></div><div><im src=""paste-9444633084441.jp"" /></div>"
What are the 7 characteristics of x-linked Aammalobulinemia? 1. decreased B c
ells in circulation<div>2. decreased I</div><div>3. Decreased erminal centers&
nbsp;</div><div>4. decreased&nbsp;plama cells</div><div>5. increased bacteria an

d viruses that are usually opsonized or neutralized by antibodies</div><div>6. a

utoimmune disease</div><div>7. INTACT T cell response!&nbsp;</div>
What is Hyper IM syndrome?
B cells lack inability to class switch from IM
(remember that class switchin is T cell activation dependent)<div><br /></div><
div>SO, this is due to a CD40L mutatation that prevents CD40 receptor on B cell
from bein activated by CD40L on T cell--&t; thus, no class switchin</div>
What is common variable immunodeficiency? How is it dianosed? Special immunode
ficiency dianosed by exclusion<div><br /></div><div>Similar to XLA, except that
there is the normal number of mature B cells but lack of plasma cells</div>
What are the two pathways by which host T cells reconize donor antiens
Direct: donor APCs present forein antien to host T cell<div><br /></div><div>I
ndierct: host APC present forein antie to host T cells</div>
What APCs are reconized by host T cells in transplant rejection?
donor de
ndritic cells are major initiatiors for anti raft responses because they expres
s hih levels of MHC1/II and have costimulatory molecules
What 2 ways do host T cells encounter donor dendritic cells?
1. within the r
afted oran<div>2. after the dendritic cells travel to the drainin lymph nodes<
/div>
What are the 2 T cell mediated reactions aainst tissue transplants?<div><br /><
/div><div>How do these 2 reactions differ in their timin and the types of cells
involved</div> Acute cellular rejection: Initial; CD4--&t;cytokines--&t;infla
mmation--<div>&t;vascular permeability--&t;activated macrophes--&t;raft dam
mae</div><div><br /></div><div>Chronic rejection: lymphocytes--&t;cytokines--&
t;proliferation of vascular endothelial and smooth &nbsp;muscle cells</div>
What are the 3 antibody mediated reactions?
Hyperacute<div>Acute antibody me
diated rejection</div><div>Chronic antibody-mediated rejection</div>
What is the hyperacute rejection of rafts?
An antibody mediated reaction th
at occurs when pre-formed antidoner antibodies are present in the circulation of
the recipient
Why miht multiparous women reject rafts taken from her children, husband, or e
ven from unrelated individuals who share HLA alleles with the husband ?<div><br
/></div><div>What type of reaction is this?</div>
Due to a hyperacute reac
tion:&nbsp;Multiparous women may develop antibodies aainst paternal HLA antien
s shed from the fetus and may have preformed antibodies that will react with ra
fts taken from their husbands or children or even from unrelated individuals who
share HLA alleles with the husband<div><br /></div><div>Hyperacute rejection</d
iv>
What is the acute antibody mediated rejection? Rejection of the translplant cau
sed by anti-donor antibodies produced after transplant<div><br /></div><div><br
/></div><div><div>*In recipients not previously sensitized to transplantation an
tiens, exposure to MHC-I/II of the donor raft may evoke antibodies&nbsp;</div>
<div><br /></div><div>*The antibodies formed by the recipient may cause injury b
y several mechanisms includin complement-dependent cytotoxicity, inflammation,
and antibody-dependent cell-mediated cytotoxicity&nbsp;</div></div><div><br /></
div>
What are the inital tarets of antibodies usually?
raft vasculature
What 3 drus can be iven to increase raft survival? 1. steroids<div>2. mycph
enolate (inhibits lymphocyte proliferation)</div><div><b>3. Tacrolimus</b></div>
What is Tacrolimus?
Inhibitor of calcineurin which is required for activatio
n of a TF (NFAT) which stimulates transcription of cytokine enes that encode IL
-2 (rowth factor)
What are the side effects of immunosuppresion? What are some examples? Opportun
istic infection and increased risk of cancer<div><br /></div><div>1. Polyoma vir
us&nbsp;</div><div>2. EBV---&t;lymphoma</div><div>3. HPV--&t;Cervical cancer</
div><div>4. HHV8--&t; Kaposi Sarcoma</div>
What is the polyoma virus?
Most frequent viral infection in those who are i
mmunosuppresed for rafts.<div><br /></div><div>Latent infection of epithelial c
ells in GU tract that infects renal tubules and cause raft failures</div>
"<im src=""paste-10677288698291.jp"" /><div><br /></div><div>Read throuh this
carefully: Explains difference between Direct and indirect pathway as well as a

cute cellular reaction. Remember acute cellular reaction: CD4--&t;cytokines--&

t;inflammation--&t;vascular permeablity--&t;activated macrophaes--&t;raft a
nd vascular damae</div>"
Frontal plaiocephaly (coronal)<div>Frontal brachycephaly</div><div><br /></div>
<div>Occipital plaiocephaly (lambdoidal)</div><div>Occipital brachycephaly</div
><div><br /></div><div>Scaphocephaly (saital)</div><div><br /></div><div>Trio
nocephally (metopic: frontal)</div><div><br /></div><div>Clover Leaf &nbsp;(meto
pic, coronal, labdoid)</div>
"<im src=""paste-122127395062265.jp"" />&nbsp;"
&nbsp;Formed by the epi
lottic cartilae, aryepilottic cold, and arytenoid cartilaes
"<im src=""paste-122161754800649.jp"" />"
"<im src=""paste-122196114538994.jp"" />"
"<im src=""paste-122230474277356.jp"" />"
"<im src=""paste-122264834015718.jp"" />"
space between tonue and epilot
tis
"<im src=""paste-122299193754118.jp"" />"
cricoid cartilae: posterior is
more prominent
"<im src=""paste-122367913230828.jp"" />"
vestibular fold above and vocal
fold below
"<im src=""paste-122402272969227.jp"" />"
vocal folds below
"<im src=""paste-122445222642157.jp"" />"
vestibular fold above, vocal fol
d below
"<im src=""paste-122488172315118.jp"" />"
"<im src=""paste-122548301857286.jp"" />"
epilottic cartilae
"<im src=""paste-122591251530243.jp"" />"
"<im src=""paste-122728690483719.jp"" />"
arytnoid cartilae
"<im src=""paste-122848949567981.jp"" /><div><br /></div><div><im src=""paste
-122861834469878.jp"" /></div>"
vocal process in line with vocal fold
"<im src=""paste-122887604273639.jp"" />"
"<im src=""paste-122913374077431.jp"" />"
"<im src=""paste-122947733815815.jp"" />"
vocal processes of arytnoid cart
ilae
"<im src=""paste-123016453292531.jp"" />"
Tension of vocal cords is controlled by what? "tilt of the cricoid cartilae<d
iv><br /></div><div><im src=""paste-123050813030914.jp"" /></div>"
Gap of vocal liaments is controlled by what? "tilt of arytnoid cartilae<div>
<br /></div><div><im src=""paste-123085172769288.jp"" /></div>"
"<im src=""paste-123119532507629.jp"" />"
vocal liament is upper border o
f conus elasticus (membranous sheet)<div><br /></div><div>conus elasticus extend
s all the way to border of cricoid cartilae</div>
"<im src=""paste-123171072115199.jp"" />"
conus elasticus
"<im src=""paste-123265561395739.jp"" />"
Runs forwards and downwards: pul
ls arch of cricothyroid cartilae upwards, pulls arytenoid cartilae backwards,
makin vocal folds loner and tihter
"<im src=""paste-123385820480001.jp"" />"
Remove thyroid cartilae to see
the inner laryneal muscles
"<im src=""paste-123420180218349.jp"" />"
"lateral crico-arytenoid muscle:
pulls arytnods forwards and laterally producin a widenin of the posterior voc
al openin <b>adduct</b><div><br /></div><div>posterior crico-arytenoid muscle b
ehind: pulls arytnoid cartilae backwards, laterally rotatin arytnoid cartilae
, widenin the vocal openin <b>abduct</b></div><div><br /></div><div>Both conve
re on muscular process of arytenoid cartilae</div><div><br /></div><div><im s
rc=""paste-143288698929556.jp"" /></div>"
"<im src=""paste-123471719825898.jp"" />"
shortens vocal liaments and sla
ckens the vocal liament tension (<b>relaxation)</b>
"<im src=""paste-123557619171858.jp"" />"
transverse arytenoid muscle
"<im src=""paste-123634928583162.jp"" />"
brins two arytenoid cartilaes
toether
labial branch comes from what nerve?
V2
Nasopalatine nerve runs throuh the sphenopalatine foramen, and innervates septu

m, then runs throuh incissive fossa to supply anterior palate "<im src=""past
e-124322123350546.jp"" />"
o to masseter, temporalis, pter
"<im src=""paste-124365073023526.jp"" />"
yoids
"<im src=""paste-124399432761853.jp"" />"
linual nerve
IX runs lateral to what 2 thins?
<!--anki-->internal carotid artery, late
ral to stylopharyneus
"<im src=""paste-124712965374493.jp"" />"
Hypolossal runs between hyolos
suss medially and myelohyoid laterally
"<im src=""paste-124850404327963.jp"" />"
phrnic nerve runs anterior to sc
alene
"<im src=""paste-142644453835010.jp"" />"
shape varies based on arytenoid
cartilaes
Very enerally, how are vaccines connected to memory B and T cells?
Vaccines
trick the immune system into thinkin it is bein attacked, and therefore the i
mmune system produces central memory B and T cells as well as lon-lived antibod
y secretin plasma B cells in the bone marrow. Therefore, when an actual attack
comes, the immune system is prepared, as they are more numerous and more easily
activated than the virin B and T cells.
What is required for the production of memory helper T cells? 1) Dendritic cel
ls collect debris from distant tisues<div>2) Dendritic cells present these pepti
des to Th cells on MHCII in lymph nodes</div><div>3) Th cells that reconize the
peptide proliferate</div><div>4) Some of these Th cells become memory cells</di
v>
What is required for the production of memory B cells? 1) B cell reconizes an
attacker or frament in lymph node<div>2) B cell receives co-stimulation from Th
cells and proliferates</div><div>3) Some will become memory cells</div>
Do you need cells to become infected to create memory helper T cells and B cells
?
No - since MHCII presents viral particles that are outside of cells not
inside.
To enerate a memory killer T cell do you need an infection?
Yes, infection o
f an APC must occur - MHCI presents viral particles that are from the inside of
the cell to activate CD8+ T cells<div><br /></div><div>Also need help from Th ce
lls to produce memory killer T cells.</div>
In the effort to create a cure for AIDS, what type of memory cells seem to be im
portant and what are not so important? <div>Important: creatin memory killer T
cells</div><div><br /></div>Not as important: memory B cells cannot protect aa
inst HIV-1
Was Salk's vaccine infectious? What about Sabins?
No. Salk would treat the
polio virus with formaldehyde to kill it, and then inoculate his patients.<div>
<br /></div><div>Yes. Sabin's was an attenuated (weakened form) of polio</div>
"How does formaldehyde work in order to ""kill"" viruses - or make them non-infe
lues the viral proteins toether
ctious?"
"What four vaccines mentioned are ""killed"" virus vaccines?" common flu vacci
ne<div>Salk's polio vaccine</div><div>typhoid</div><div>old pertussis</div>
How can vaccines be used to treat bacterial infections that produce toxins?
Bacteria produce toxins causin nasty symptoms. We create vaccines by purifyin
the toxins, treatin them with aluminum salts to weaken the toxin (now it is cal
led a toxinoid), and then injectin the toxinoid into a patient. B cells are mob
ilized and produce antibodies that bind to the real toxin once infected.
Vaccines aainst what two bacteria have been made and were mentioned in class?
diphtheria and tetanus&nbsp;
What is an antitoxin? Antibodies aainst toxins
Antitoxin to diptheria was made how? When would you use an antitoxin vs. a vacci
ne?
"<div><im src=""paste-35386235551745.jp"" /></div><div><br /></div>Vac
cines cause the immune system to produce antibodies aainst toxins (antitoxins)
and is iven for prevention.<div><br /><div>Antitoxins can be iven directly onc
e someone is infected.</div></div>"
"What is an ""acellular vaccine""? What is the example?"
A vaccine made f
rom only <b>important proteins of the bacteria that the immune system needs to s

ee to create memory cells - not the entire cell nor killed cell.</b><div><br /><
/div><div>The new pertussis vaccine is made this way (the old one was made from
the whole killed pertussis bacteria and half of all inoculated had an adverse ef
fect).</div>
Benefit of an acellular vaccine as compared to a killed bacteria vaccine?
less side effects
"What are ""subunit vaccines""? What is the benefit of this type? What is an exa
mple?" Viral proteins produced by enetic enineerin.<div><br /></div><div>Bec
ause only one or a few synthetic viral proteins are used to make a subunit vaccine
, there is no possibility of infection with the microbe itself.</div><div><br />
</div><div>hepatitis B virus vaccine and HPV</div>
What is the major drawback of non-infectious vaccines? Is this a problem for mos
t pathoens?
Memory killer T cells will not be made because antien presentin
 cells will not be infected.<div><br /></div><div>This is not a problem for vac
cinatin aainst many diseases (extracellular bacteria), and is not even a probl
em for some infectious diseases, as memory B cells can produce antibodies that p
rotect aainst many infectious pathoens.</div>
"What is an ""attenuated vaccine""? What is an example?"
Weakened form of
the microbe<div><br /></div><div><div>Viroloists noticed that when a virus is
rown in the laboratory in a cell type which is not its normal host, the virus s
ometimes accumulates mutations which weaken it.&nbsp;</div><div><br /></div><div
>The Sabin polio vaccine, for example, was made by rowin poliovirus, which nor
mally reproduces in human nerve cells, in monkey kidney cells. This stratey res
ulted in polioviruses which were still infectious, but which were so weak that t
hey could not cause the disease in healthy individuals.&nbsp;</div></div><div><b
r /></div>
What are four examples of attenuated vaccines? measles<div>rubella</div><div>mu
mps</div><div>Sabin's polio</div>
What are the pros and cons of attenuated vaccines?
Pros:<div>1) they produc
e memory killer T cells as they are mildly infectious</div><div><br /></div><div
>Cons:</div><div>1) patient receivin the vaccine may produce enouh virus to in
fect someone else</div><div>2) very unlikely but the attenuated virus may be abl
e to mutate and reain its normal strenth - some people who were inoculated wit
h Sabin's vaccine contracted polio this way</div>
"What is a ""carrier vaccine""?"
The most interestin vaccine of them all
!!<div><br /></div><div>Scientists use enetic enineerin to introduce a sinle
ene from a pathoenic virus into another virus (the carrier) that does not cau
se disease. Once the carrier virus infects the APC's of the patient, the APC wil
l produce the proteins of the carrier virus as well as the protein from the sin
le ene of the pathoenic virus. Thus, this type of virus can enerate memory ki
ller T cells.</div><div><br /></div><div>Think of it as a Trojan Horse.</div>
What type of vaccine shows promise for a vaccine aainst AIDS? <b>Carrier Vacci
ne</b><div><br /></div><div>Extra:</div><div><div>A vaccine trial in Thailand us
ed a canarypox virus (a cousin of Jenners cowpox virus) as a Trojan horse to carr
y in several genes for HIV-1 proteins.&nbsp;</div><div><br /></div><div>This car
rier virus vaccination was then boosted by vaccinating the same individuals with a
subunit vaccine containing a synthetic version of one of the same HIV-1 protein
s produced by the carrier virus.&nbsp;</div><div><br /></div><div>The people rec
eiving these vaccinations, and a roughly equal number of individuals who receive
d a placebo vaccination, were followed for a period of three years to determine
how many in each group subsequently became infected with the AIDS virus as a res
ult of ris
y sexual behavior. Although the authors claimed that the trial showed
a significant, though modest, reduction in the rate of HIV-1 infection, the data
is not very convincing.</div></div>
<div>Of the two types of vaccines that create memory
iller T cells ({{c1::atten
uated, carrier vaccines}}) which is the one that&nbsp;will <b><u>never</u></b> b
e used in attempting to creat an AIDS vaccine and why?</div>
<b>Attenuated Va
ccine:</b>&nbsp;because the AIDS virus has an extremely high mutation rate, ther
e is great concern that an attenuated form of HIV-1 might mutate to become letha
l again.

"What is the drawbac

to the ""
illed virus""?" Chemicals used to
ill these mic
robes is not guaranteed to be 100% effective.<div><br /></div><div>If a vaccine
is intended to protect against a virus li
e influenza, which otherwise will infe
ct a large fraction of the population, a few live viruses in the vaccine prepara
tion is not a major concern because without vaccination, many more people would
contract the disease.&nbsp;<div><br /></div><div>A vaccine that has even a small
probability of causing the disease could not be used to vaccinate the general p
ublic.</div></div>
What is responsible for opening eustacian tube while yawning? levator palati<d
iv>tensor palati</div><div>salpingo pharyngeus&nbsp;</div><div>maybe tensor tymp
ani</div>
What is the motor innervation of uvula? CN X-pharyngeal branch
What is the sensory innervation to the uvula? lesser palatine from V2 and IX
What are the attachments of the temporalis muscle?
temporal fossa to corono
id process of mandible
What are the attachments of masseter? zygomatic arch to angle of mandible
What are the attachments of Lateral pterygoid? lateral pterygoid to articular d
isc and head of mandible
What are attachments of medial pterygoid?
medial aspect of lateral pterygo
id, medial surface of angle of mandible
What is the innervation of the epiglottis?
taste: internal branch of superi
or laryngeal<div>sensation: internal branch of superior laryngeal</div>
<div>What does our body produce in an emergency?</div><div>(plasma levels go up)
</div><div><br /></div><div>A. Insulin</div><div>B. Growth hormone</div><div>C.
Epinephrine</div><div>D. Cortisol</div><div>E. Epinephrine &amp; Cortisol</div><
E
Dic
ey Immunopha
div>F. IL-6 (Interleu
in-6)</div><div><br /></div>
rmacology pharmacology_bloc
4
<div>What are the four main mediators of inflammation? Where can they be found?<
/div> "1) histamine - use anti-histamines<div>2) prostaglandins - use COX inhi
bitors</div><div>3) leu
otrienes - use LOX inhibitors, or LT bloc
ers</div><div>
4) cyto
ines - use steroids to decrease IL-1, IL-2, IL-12, TNF-alpha, INF-gamma)
</div><div><br /></div><div>FOUND IN MAST CELLS: in response to allergens, mast
cells enter tissue and release contents</div><div><img src=""paste-4469772464989
1.jpg"" /></div>"
Dic
ey Immunopharmacology pharmacology_bloc
4
<div>What is the difference between the immediate and late phase reactions in te
rms of mast cell release? &nbsp;</div><div><br /></div><div>What are the implica
tions for treatment?</div>
"early phase (immediately): release preformed gr
anule contents (ex. histamine)<div>histamine will move fluid OUT of vascular sys
tem</div><div><u>EARLY PHASE: ANTI-HISTAMINES</u></div><div><br /></div><div>lat
e phase (3-16 hours): leu
otriends, prostaglandins, and cyto
ines released</div>
<div><u>LATE PHASE: STEROIDS</u></div><div><u><br /></u></div><div><u><img src="
"paste-45015552229866.jpg"" /></u></div><div><u><br /></u></div>"
Dic
ey I
mmunopharmacology pharmacology_bloc
4
How do antihistamines inhibit histamine levels? Do they interact with the mast c
ells? act on histamine receptors to control the effects of released antihistam
ines, but DO NOT bloc
its release from mast cells<div><br /></div><div>no effec
t on the cyto
ines produced by mast cells</div> Dic
ey Immunopharmacology pharma
cology_bloc
4
What receptors do mast cells have? (2) What is the effect of epinephrine on mast
cell degranulation?
"beta-2, H2<div><br /></div><div>epinephrine will be inh
ibitory to mast cell degranulation (beta-2)</div><div><br /></div><div>histamine
released from the mast cell can negatively feedbac
on the mast cell and preven
t more histamine release</div><div><img src=""paste-45732811768331.jpg"" /></div
>"
Dic
ey Immunopharmacology pharmacology_bloc
4
REVIEW: Where are the histamine receptors located? (H2/H1)
H2 on smooth mus
cle cell arteriole: DILATE<div><br /></div><div>H1 in endothelial cells + venule
s: CONSTRICT</div>
Dic
ey Immunopharmacology pharmacology_bloc
4
What are H2 receptor bloc
ers used for? Name some.
decrease gastric acid&nb
sp;<div><br /></div><div>(****tidine)</div><div>Cimetidine, Ranitidine, Fomatidi
ne</div>
Dic
ey Immunopharmacology pharmacology_bloc
4

What is the mechanism of action of anti-histamines.

prevent histamine from w
or
ing at H1 receptors<div>inverse agonists, stabilize inactive receptor conform
ation</div>
Dic
ey Immunopharmacology pharmacology_bloc
4
What are the side effects of anti-histamines? anti-cholinergic effects
Dic
ey Immunopharmacology pharmacology_bloc
4
What is Promethazine (Phenergan) more often used for? 1st generation antihista
mine - enter CNS, cause sedation<div><br /></div><div>used more as an anti-emeti
c</div> Dic
ey Immunopharmacology pharmacology_bloc
4
How do anti-histamines cause sedation? histamine is released in the cortex, bra
instem, and spinal cord --&gt; acts on the wa
e-active brainstem, controls alert
ness and
eeps us awa
e Dic
ey Immunopharmacology pharmacology_bloc
4
What is the effect of lipocortin on lipid mediators?
"decreased phospholipase
A2 activity<div>decreased arachidonic acid levels --&gt; no lipid mediators mad
e</div><div><img src=""paste-48842368090612.jpg"" /></div>"
Dic
ey Immunopha
rmacology pharmacology_bloc
4
How do the following drugs wor
?<div><br /></div><div>Zileuton</div><div><br /><
/div><div>Motelu
ast</div>
"Zilueton: lipoxygenase inhibitor<div><br /></di
v><div>Montelu
ast: cyst-leu
otriene bloc
ers</div><div><br /></div><div>Both af
fect leu
otriene pathway (allergies)</div><div><br /></div><div><img src=""paste
-49276159787458.jpg"" /></div>" Dic
ey Immunopharmacology pharmacology_bloc
4
What is the action of chloroquine? What is it used to treat?
anti-malarial dr
ug<div><br /></div><div>inhibits lysosomes from pic
ing up proteins, degrading a
nd presenting them to the immune system</div><div><br /></div><div>used to treat
Rheumatoid Arthritis and Lupus</div> Dic
ey Immunopharmacology pharmacology_b
loc
4
What is the antidote for an overdose of heparin?
protamine sulfate
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""paste-50049253900629.jpg"" />"
B
Dic
ey Immunopharmacolog
y pharmacology_bloc
4
"<img src=""paste-50075023704400.jpg"" />"
A, F
Dic
ey Immunopharmacolog
y pharmacology_bloc
4
What is the difference between ***sone and ***solone for steroids? What are the
implicatons of these differences?
***sone = inactive
etone group at posit
ion 11 at ring C<div>(cortisol = hydrocortisone)</div><div><br /></div><div>***s
olone = active OH group at position 11 at ring C</div><div>(topical/inhaled ster
oids are the OH-ated active form for rapid use)</div><div><br /></div><div>patie
nts with significant liver function should be treated with methyl prednisolone (
already posses ACTIVATED group)</div> Dic
ey Immunopharmacology pharmacology_b
loc
4
What is multiple sclerosis? What do you treat it with? multiple sclerosis = aut
oimmune disease (IgG against central myeline made by oligodendrocytes)<div><br /
></div><div>treatment: steroids, interferon-gamma</div><div><br /></div><div>int
erferon = host-encoded proteins, interfere with the ability of viruses to infect
and replicate</div>
Dic
ey Immunopharmacology pharmacology_bloc
4
What is Guillian-Barre Syndrome? Treatment?
autoimmune disease (IgG against
peripheral myeline made by Schwann cells)<div><br /></div><div>treatment: respir
atory support, IVIG (= pooled IgG from healthy people)</div>
Dic
ey Immunopha
rmacology pharmacology_bloc
4
What is the effect of Campylobactor jejuni on Guillain-Barre Syndrome (GBS)?
after infection with the bacteria, antibodies made against bacterial epitpes cro
ss-react with peripheral myelin --&gt; cause disease
Dic
ey Immunopharmacolog
y pharmacology_bloc
4
"<img src=""paste-59051505353225.jpg"" />"
A
Dic
ey Immunopharmacolog
y pharmacology_bloc
4
"<img src=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_Q_0.svg"" />"
"<img sr
c=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_A_0.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_source_svg.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_tmp7GKcTD.png"" />"
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_Q_1.svg"" />"
"<img sr

c=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_A_1.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_source_svg.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_tmp7GKcTD.png"" />"
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_Q_2.svg"" />"
"<img sr
c=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_A_2.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_source_svg.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_tmp7GKcTD.png"" />"
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_Q_3.svg"" />"
"<img sr
c=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_A_3.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_source_svg.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_tmp7GKcTD.png"" />"
Dic
ey Immunopharmacology pharmacology_bloc
4
"<img src=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_Q_4.svg"" />"
"<img sr
c=""3ff4199f4798a4063a5ac696bba69fe785e4cd15_A_4.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_source_svg.svg"" />"
"<img src=""3ff4
199f4798a4063a5ac696bba69fe785e4cd15_tmp7GKcTD.png"" />"
Dic
ey Immunopharmacology pharmacology_bloc
4
What are the side effects of anti-metabolites?<div><br /></div><div>What do anti
-metabolites inhibit?</div>
GI epithelium - inflammation of stomach lining<d
iv>hair follicles - loss of hair</div><div>other blood cells - myelosuppression<
/div><div><br /></div><div>inhibit prolfieration of lymphocytes by bloc
ing synt
hesis of and depleting nucleotides needed for DNA synthesis</div><div><br /></di
v><div>METHOTREXATE<br />AZATHIPRINE<br />MYCOPHENOLATE<br />LEFLUNOMIDE</div>
Dic
ey Immunopharmacology pharmacology_bloc
4
"How does the ""early"" activation pathway of T cell activation wor
? &nbsp;What
is released?" "1) Increased intracellular Ca2+<div>2) Activation of calcinueri
n (phosphatase)</div><div>3) NFAT dephosphorylated (active) --&gt; goes to nucle
us to help IL-2 production/transcription</div><div><br /></div><div>IL-2 release
</div><div><img src=""paste-60700772794847.jpg"" /></div>"
Dic
ey Immunopha
rmacology pharmacology_bloc
4
"What is the purpose of ""late"" T-cell activation? What does it depend on?"
"CALCIUM INDEPENDENT --&gt; move activated T cells into the G1 phase of the cell
cycle<div><br /></div><div>1) IL-2 bind IL-2 receptor</div><div>2) mTOR promote
s G1 --&gt; S</div><div><br /></div><div><img src=""paste-60855391617499.jpg"" /
></div>"
Dic
ey Immunopharmacology pharmacology_bloc
4
Anti-inflammatory steroids increase what? What does this result in?
"increas
e I
B --&gt; results in fewer inflammatory cyto
ines<div><img src=""paste-616413
70632652.jpg"" /></div>"
Dic
ey Immunopharmacology pharmacology_bloc
4
How does TNF-alpha increase cyto
ine production?<div><br /></div><div>What are s
ome potential approaches for an anti-inflammatory drug?</div> when TNF binds,
I
B degreades so more NF
B active --&gt; more cyto
ine production<div><br /></di
v><div>potential approaches</div><div>1) neutralizing antibodies</div><div>2) mu
tated soluble receptors</div><div>3) receptor bloc
eres</div> Dic
ey Immunopha
rmacology pharmacology_bloc
4
What is Rituximab (Rituxan) used for? B-cell specific anti CD20 monoclonal ant
ibodies<div><br /></div><div>approved to treat vasculitis, B cell lymphoma</div>
Dic
ey Immunopharmacology pharmacology_bloc
4
Where are CD19 and CD20 mostly found in?
mostly found in B cells Dic
ey I
mmunopharmacology pharmacology_bloc
4
What is the idea behind engineered T cells?<div>What are the side effects?</div>
"use chimeric TCRs so that they can specifically bind to targets li
e cancer cel
ls<div><br /></div><div>CD19, CD20: B cell malignancies</div><div>CEA: colorecta
l cancer</div><div>Erb-B2: breast cancer</div><div>GD2: neuroblastoma</div><div>
<br /></div><div>SIDE EFFECTS</div><div>1) cross reactivity with other proteins<
/div><div>2) low level expression of hte target protein in normal tissues<br /><
div><img src=""paste-62251255988613.jpg"" /></div></div>"
Dic
ey Immunopha
rmacology pharmacology_bloc
4
"<img src=""paste-63578400882943.jpg"" />"
E

"<img src=""paste-63690070032670.jpg"" />"

C
"<img src=""paste-192126772052507.jpg"" />"
running down cribriform plate
"<img src=""paste-192302865711621.jpg"" />"
3, 4, 6 entering dura
"<img src=""paste-192337225450008.jpg"" />"
"<img src=""paste-192371585188358.jpg"" />&nbsp;"
"<img src=""paste-192405944926730.jpg"" />"
"<img src=""paste-192448894599707.jpg"" />"
"<img src=""paste-192560563749393.jpg"" />"
Branch of V1
"<img src=""paste-192594923487768.jpg"" />"
Branch of V1<div><br /></div><di
v>V1 splits into: frontal, nasociliary, lacrimal</div>
"<img src=""paste-192629283226131.jpg"" />"
<div>Frontal gives off: supraorb
ital, supratrochlear</div><div><br /></div>Nasociliary gives off ethmoidal nerve
s as well as cutaneous infratrochlear nerve<div><br /></div><div>Ethmoidal nerve
s give off external and internal nasal</div><div><br /></div>
"<img src=""paste-193578470998522.jpg"" />"
Frontal nerve of V1 exits via in
fraorbital margin and gives off supra orbital and supratrochlear
"What innervates this area?<div><br /></div><div><img src=""paste-19367296027901
9.jpg"" /></div>"
Ethmoid branches of nasociliary nerve (internal nasal?)
"<img src=""paste-193720204919291.jpg"" />"
To see roots of V2 and V3 what do you have to remove? "lateral pterygoid muscl
e<img src=""paste-193763154592262.jpg"" />"
"<img src=""paste-193801809297899.jpg"" /><div><br /></div><div>Insertions?</div
>"
Insertion points are medial aspect of lateral pterygoid and medial aspec
t of mandibular angle
"<img src=""paste-193849053938171.jpg"" />"
Foramen rotundum is located unde
r supraorbital fissure
"<img src=""paste-193883413676530.jpg"" /><div><br /></div><div>Root of maxillar
y nerve exiting foramen rotundum, across pterygomaxillary fissure and divides in
to two branches ______ and &nbsp;_______&nbsp;</div>" "<img src=""paste-193922
068382209.jpg"" /><div><br /></div><div><img src=""paste-193943543218683.jpg"" /
></div>"
"<img src=""paste-193990787858939.jpg"" />"
"maxillary &nbsp;nerve entering
pterygopalatine fossa gives off two branches laterally (infraorbital and posteri
or superior alveolar)<div><br /></div><div>Medially gives off palatine nerves th
at splits into greater and lesser</div><div><img src=""paste-194076687204855.jpg
"" /><br /><div><br /></div><div>Medially also gives off nasopalatine nerve that
innervates nasal septum</div></div>"
"<img src=""paste-194132521779710.jpg"" />"
maxially nerve also gives off zy
gomatic branches, which are the branches that PS nerve fibers from greater petro
sal hitchhi
e on to go to mucosal and lacrimal glands
"<img src=""paste-195665825104361.jpg"" />"
Foramen ovale emerges behind roo
f of lateral pterygoid plate
"&nbsp;<img src=""paste-195743134515666.jpg"" />"
runs deep to head of man
dible and then runs upwards to supply lateral side of head anterior to ear
"<img src=""paste-195811853992396.jpg"" />"
"&nbsp;&nbsp;<img src=""paste-195854803665351.jpg"" />" Just before entering man
dibular foramen, inferior alveolar gives off mylohyoid branch
"<img src=""paste-195897753338325.jpg"" />"
lingual nerve runs downwards tow
ards the corner of the medial pterygoid muscle
What innervation does lingual nerve give?
1. General sensory to anterior 2
/3 of tonuge<div>2. carries special sensory from chorda tympany to anterior 2/3
of tongue</div><div>3. PS from chorda tympani to submandibular and sublingual gl
and</div>
"<img src=""paste-196619307844056.jpg"" /><div><br /></div><div>Name the nerves
L-R</div>"
XI<div><br /></div><div>X</div><div><br /></div><div>XII</div><d
iv><br /></div><div>IX<br /><div><br /></div><div><br /></div></div>
"<img src=""paste-196615012876760.jpg"" />"
notice how the hypoglossal nerve
swoops<div><br /></div><div><br /></div>
"<img src=""paste-196705207189997.jpg"" />"
IX runs lateral to internal caro
tid and stylopharyngeus muscle

What does the pharyngeal branch of vagus supply?&nbsp; pharyneal constrictors<d

iv>all muscles of palate except tensor palati</div><div>&nbsp;(palatoglossus, pa
latopharyngeus, levator palati)</div><div><br /></div><div><div>Pharyngeal const
rictors</div><div>salpingopharyngeus</div><div>levator palati</div><div>palatogl
ossus</div><div>palatopharyngeus</div><div>uvula</div><div>Sensory to mucosa in
laryngopharynx</div></div>
"<img src=""paste-196975790129619.jpg"" />"
external branch of superior lary
ngeal
"<img src=""paste-197018739802585.jpg"" />"
internal branch of superior lary
ngeal enters through foramen within thyrohyoid membrane
What does the internal branch of superior laryngeal innvervate? 1. Larynx above
vocal cords<div>2. Epiglottis</div><div>3. Valleculae (taste and general sensati
on)</div>
"<img src=""paste-197860553392674.jpg"" />"
Recurrent laryngeal runs between
trachea adn pole of thyroid gland
"<img src=""paste-200407468999214.jpg"" />"
recurrent laryngeal runs with br
anch of inferior thyroid artery (inferior laryngeal artery)
"<img src=""paste-200532023050811.jpg"" />"
To see hypoglossal nerve, you mu
st remove stylohyoid and posterior digastric
"<img src=""paste-201017354355259.jpg"" />"
Hypoglossal nerve runs below sty
loglossus and between hyoglossus medially and mylohyoid laterally
"<img src=""paste-201051714093619.jpg"" />"
Lingual nerve and hypoglossal ne
rve run through same gap between hyoglossus and myelohyoid.<div><br /></div><div
>Lingual nerve runs alongside the styloglossus though a little bit higher</div>
"<img src=""paste-201094663766585.jpg"" />"
cervical plexus arises anterior
to middle scalene
Why are we better at dealing with subsequent attac
s by pathogens? (3) "1. More
B/ T cells to respond<div>2. B/ T cells are easier to reactivate (sole requirem
ent of cognate antigen?)</div><div>3. Memory B cells are upgraded Naiive B Cells
(Have undergone class switching and somatic hypermutation!)&nbsp;</div><div><br
/></div><div><br /></div><div><div>1. There are more B and T cells to respond t
o attac
ers &nbsp;</div><div>First invasion has only 1 in a million B/T cells th
at recognize invader&nbsp;</div><div>But second invasion results in about 1 in a
thousand B/T cells</div><div><br /></div><div>&nbsp;</div><div>2. B and T cells
are easier to activate&nbsp;</div><div>Its possible that re-activation require
s only the cognate antigen, and not necessarily the co-stimulation&nbsp;</div><d
iv><br /></div><div><br /></div><div>3. Memory B cells are ""upgraded"" nave B ce
lls&nbsp;</div><div><br /></div><div>During an attac
, the B-cell will class-swi
tch to a more appropriate antibody class. This class switch is imprinted on the
memory B cell, so it ma
es the perfect antibody for future attac
s&nbsp;</div><d
iv><br /></div><div>Somatic hypermutation will fine tune the BCRs and antibodies
too --&gt; the central memory B cells will be activated quic
ly and efficiently
, and the long-lived plasma cells will ma
e antibodies that tag invaders better&
nbsp;</div><div>&nbsp;</div></div>"
When B cells are activated what
inds of B cells are produced? Where are they pr
oduced and where do they migrate?
"1. Short lived plasma cells produced in
lymphoid follicles (after being actived by FDC) and migrate to bone marrow and
spleen to ma
e antibodies<div><br /></div><div>2. Long lived memory plasma cells
produced in lymphoid follicles (after being activated by FDC) and migrate to bo
ne marrow <b>continually produce antibodies, specifically IgG</b></div><div><b><
br /></b></div><div>3. Central memory B cells produced in lymphoid organs but <b
>stay in secondary lymphoid organs</b>&nbsp;and <b>act as memory stem cells</b><
/div><div><b><br /></b></div><div>a. They act to re supply long lived plasma cel
ls and can regenerate to maintain pool of central memory B cells. They also can
quic
ly be activated to a B cell to ma
e short lived plasma B cells if another a
ttac
occurs</div><div><br /></div><div><img src=""paste-292998373966104.jpg"" /
></div>"
What are the 3 roles of central memory B cells? "<img src=""paste-29299407899880
8.jpg"" /><div><br /></div><div>1. Maintain pool of central memory B cells</div>
<div>2. Resupply long lived plasma B cells</div><div>3. If body attac
ed again,

can be activated to become short lived plasma B cells</div>"

What are the 3 T cells made when T cell is activated? "<img src=""paste-293122
928017755.jpg"" /><div><br /></div><div>1. Effector T cells</div><div>2. Memory
effect T cells (what is left of effector T cells)</div><div>3. Central memory T
cells that remain in bone marrow and secondary lymphoid organs</div><div><br /><
/div><div>Central memory T cells maintain pool of themselves and can be reactiva
ted under second attac
to become effector and memory effector T cells</div>"
What are the 2 roles of central memory T cells? "1. Maintain a supply of themsel
ves<div>2. Can be reactivated under second attac
to become effector and memory
effector T cells</div><div><br /></div><div><img src=""paste-293118633050459.jpg
"" /></div>"
Once B cells become short and long lived plasma cells where do they migrate? How
is this different than central memory B cells? "short and long lived plasma cel
ls migrate to spleen and bone marrow to ma
e antibodies<div><br /></div><div>cen
tral memory B cells stay in lymphoid organ to act as memory ""stem cells""</div>
"
"What are the ""
illed"" vaccinations?" flu, polio, old pertusis, typhoid
What are the vaccines against bacteria? diptheria, tetanus
What are the acellular vaccinations?
"new pertussis&nbsp;<div><br /></div><di
v><img src=""paste-294617576636773.jpg"" /></div><div><br /></div><div><img src=
""paste-294630461538661.jpg"" /></div>"
What are the subunit vaccines? "<img src=""paste-294733540753765.jpg"" /><div><
br /></div><div>HEPB and HPV</div>"
What are the attenuated vaccines? In what patients are attenuated vaccines contr
aindicated?
measles, mumps, rubella, sabins polio&nbsp;<div><br /></div><div
>Immunosuppressed patients because the virus is just wea
ened</div><div><br /></
div>
What is an example of a carrier vaccine?
HIV-1 in canarypox virus
How are the requirements for generating memory &nbsp;B/Th cells differen than ge
nerating memory
iller T cells B/Th (just need presentation of debris from batt
le scene (viral coat, proteins, part of bacteria cell wall)<div><br /></div><div
>Killer T (infection of APC as well as help from Th)</div>
"<img src=""paste-345534413930809.jpg"" />"
E
______ is overexpressed in synovial tissue in RA
IL-6
"<img src=""paste-345590248505730.jpg"" />"
"<img src=""paste-34567185288431
0.jpg"" />"
CEA is commonly found in what type of cancer? colorectal
Erb-B2 is found in what type of cancer? Breast Cancer
GD2 is found in what type of cancer?
Neuroblastoma
Name the receptor that the drug acts on.<div><br /></div><div>EPI</div><div><br
/></div><div>NE</div><div><br /></div><div>Dobutamine</div>
"<div><div>EPI all adrenergics (low doses beta dominates, high doses alpha dominates)</div><di
v><br /></div><div>NE - all except beta2</div><div><br /></div><div>Dobutamine beta 1 only</div></div><div><img src=""paste-248115965723034.jpg"" /></div>"
"<img src=""1962815b71095b9dfa67028021a714fbd352f50d_Q_0.svg"" />"
"<img sr
c=""1962815b71095b9dfa67028021a714fbd352f50d_A_0.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_source_svg.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_tmp89MBhB.png"" />"
"<img src=""1962815b71095b9dfa67028021a714fbd352f50d_Q_1.svg"" />"
"<img sr
c=""1962815b71095b9dfa67028021a714fbd352f50d_A_1.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_source_svg.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_tmp89MBhB.png"" />"
"<img src=""1962815b71095b9dfa67028021a714fbd352f50d_Q_2.svg"" />"
"<img sr
c=""1962815b71095b9dfa67028021a714fbd352f50d_A_2.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_source_svg.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_tmp89MBhB.png"" />"
"<img src=""1962815b71095b9dfa67028021a714fbd352f50d_Q_3.svg"" />"
"<img sr
c=""1962815b71095b9dfa67028021a714fbd352f50d_A_3.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_source_svg.svg"" />"
"<img src=""1962
815b71095b9dfa67028021a714fbd352f50d_tmp89MBhB.png"" />"

Name the receptor that the drug acts on.<div><br /></div><div>Isoproterenol</div

><div><br /></div><div>Phenylephrine</div><div><br /></div><div>Dopamine</div>
"<div>Isoproterenol - beta1/beta2 only</div><div><br /></div><div>Phenylephrine
- alpha1 (some alpha2)</div><div><br /></div><div>Dopamine - alpha1 at high dose
s, alpha2 a little, beta1 at medium doses</div><div><div><img src=""paste-248150
325461177.jpg"" /></div></div>"
"<div>35<span class=""Apple-tab-span"" style=""white-space:pre""> </span>y/o<spa
n class=""Apple-tab-span"" style=""white-space:pre""> </span>F<span class=""Appl
e-tab-span"" style=""white-space:pre""> </span>presents<span class=""Apple-tab-s
pan"" style=""white-space:pre""> </span>after<span class=""Apple-tab-span"" styl
e=""white-space:pre""> </span>being<span class=""Apple-tab-span"" style=""whitespace:pre""> </span>stung<span class=""Apple-tab-span"" style=""white-space:pre"
"> </span>by<span class=""Apple-tab-span"" style=""white-space:pre""> </span>a<s
pan class=""Apple-tab-span"" style=""white-space:pre""> </span>bee<span class=""
Apple-tab-span"" style=""white-space:pre""> </span></div><div>Her<span class=""A
pple-tab-span"" style=""white-space:pre""> </span>face<span class=""Apple-tab-sp
an"" style=""white-space:pre""> </span>is<span class=""Apple-tab-span"" style=""
white-space:pre""> </span>swollen,<span class=""Apple-tab-span"" style=""white-s
pace:pre""> </span>she<span class=""Apple-tab-span"" style=""white-space:pre"">
</span>is<span class=""Apple-tab-span"" style=""white-space:pre""> </span>wheezi
ng,<span class=""Apple-tab-span"" style=""white-space:pre""> </span>and<span cla
ss=""Apple-tab-span"" style=""white-space:pre""> </span>has<span class=""Apple-t
ab-span"" style=""white-space:pre""> </span>an<span class=""Apple-tab-span"" sty
le=""white-space:pre""> </span>erythematous<span class=""Apple-tab-span"" style=
""white-space:pre""> </span>rash<span class=""Apple-tab-span"" style=""white-spa
ce:pre""> </span>throughout<span class=""Apple-tab-span"" style=""white-space:pr
e""> </span>her<span class=""Apple-tab-span"" style=""white-space:pre""> </span>
body<span class=""Apple-tab-span"" style=""white-space:pre""> </span></div><div>
Vital<span class=""Apple-tab-span"" style=""white-space:pre""> </span>signs<span
class=""Apple-tab-span"" style=""white-space:pre""> </span>BP<span class=""Appl
e-tab-span"" style=""white-space:pre""> </span>90/60,<span class=""Apple-tab-spa
n"" style=""white-space:pre""> </span>P<span class=""Apple-tab-span"" style=""wh
ite-space:pre""> </span>120,<span class=""Apple-tab-span"" style=""white-space:p
re""> </span>RR<span class=""Apple-tab-span"" style=""white-space:pre""> </span>
26<span class=""Apple-tab-span"" style=""white-space:pre""> </span></div><div><b
r /></div><div>Diagnosis?</div><div><br /></div><div>Pathophysiology?</div><div>
<br /></div><div>Treatment?</div>"
"<img src=""paste-248270584545473.jpg""
/>"
<div>What are the effects of epinephrine in treating anaphylactic shoc
? (recept
ors)</div>
"<img src=""paste-248313534218616.jpg"" />"
"<img src=""paste-248468153041445.jpg"" /><div>Diagnosis?</div><div><br /></div>
<div>Pathophysiology?</div><div><br /></div><div>Treatment?</div>"
"<img sr
c=""paste-248489627877469.jpg"" />"
"<img src=""paste-248528282583371.jpg"" /><br /><div>Diagnosis?</div><div><br />
</div><div>Pathophysiology?</div><div><br /></div><div>Treatment?</div>"
"<img src=""paste-248541167484991.jpg"" />"
"<img src=""paste-248579822191020.jpg"" />"
"<img src=""paste-24861418192934
3.jpg"" />"
"<img src=""paste-248670016504393.jpg"" />"
"<img src=""paste-24868290140577
6.jpg"" />"
"<img src=""paste-248773095719262.jpg"" /><div>Diagnosis?</div><div>Pathophysiol
ogy?<br />Treatment?</div>"
"<img src=""paste-248828930293857.jpg"" />"
"<img src=""paste-248863290032539.jpg"" /><br /><div>Diagnosis?</div><div>Pathop
hysiology?<br />Treatment?</div>"
"<img src=""paste-248876174934264.jpg""
/>"
What type of receptors are present in smooth muscle of prostate and involuntary
sphincter of the bladder?
alpha-1, used for benign prostate hypertrophy
"<img src=""paste-248940599443885.jpg"" />"
"<img src=""paste-24895348434562
6.jpg"" />"
"<img src=""paste-248996434018594.jpg"" />"
"<img src=""paste-24900931892063

1.jpg"" />"
"<img src=""paste-249035088724342.jpg"" />"
"<img src=""paste-24905656356075
1.jpg"" />"
"<img src=""paste-249082333364567.jpg"" />"
"<img src=""paste-24909521826651
0.jpg"" />"
"<img src=""paste-249125283037505.jpg"" />"
"<img src=""paste-24913816793934
5.jpg"" />"
Children do not transmit tuberculosis, true or false? true
Why do adults get apical TB?
The upper parts of the upper lobes are very succ
eptible. This is because there is high O2 levels and lymph drainage occurs here
which is how the TB travels there. The TB does not go there originally but after
spreading via lymph.
When treating TB it is all about balance. What is one example of this? Corticos
teroids vs. Antibiotics<div><br /></div><div>Need to decrease inflammatory respo
nse (immune system) that contributes to tissue damage or dysfunction (corticoste
roids), but also need antibiotics to help immune system fight off the mycobacter
ia.</div><div><br /></div><div>prednisone or dexamethasone are used</div>
What 2 ways can you diagnose TB infection? Which way is best? <div>Tuberculin
s
in Test</div><div><b>Interferon-gamma Release Assays - the best way (not cross
-react with BGC vaccine or other mycobacteria)</b></div><div><br /></div>
What are 5 therapies for TB?
<div><b>Corticosteroids</b> decrease Th1 respons
es; used when the inflammatory response is harmful, causing excess tissue damage
[meningitis]</div><div>Thalidomide &nbsp;decreases TNF-alpha levels</div><div>P
entoxifylline decreases TNF-alpha levels</div><div>Nitrous oxide - increases
il
ling of Mtb</div><div>Specific cyto
ines INF-g, IL-12</div><div><br /></div>
Describe the structure of corticosteroids
21 carbon steroid compound synth
esized from cholesterol in the adrenal cortex Pharm24.Corticosteroids
What are the two types of corticosteroids? What does each regulate physiological
ly?
Glucocorticoids: regulate carbohydrate, lipid and protein metabolism (co
rtisol)<div><br /></div><div>Mineralcorticoids: regulate electrolyte and water b
alance through effects on ion transport in epithelial cells (aldosterone)&nbsp;<
/div> Pharm24.Corticosteroids
What stimulates the physiological release of corticosteroids? Corticotropin a

a ACTH release Pharm24.Corticosteroids

Glucocorticoids exert their physiologic actions by binding to the {{c1::cytosoli
c glucocoritcoid receptor}}
Pharm24.Corticosteroids
Describe the mechanism of glucocorticoid receptors
glucocorticoids bind to
receptors intracellularly --&gt; go to the cell nucleus --&gt; bind to hormone r
esponsive elements (HREs) --&gt; regulate gene promoters&nbsp; Pharm24.Corticos
teroids
How to glucocoticoids affect lipocortins? What other molecules are affected as a
result?
"Glucocorticoids induce the synthesis of lipocortins which supre
ss phospholipase A2.<div><br /></div><div>Arachidonic acid and production of pro
-inflammatory molecules are decreased</div><div><br /></div><div><br /></div><di
v><img src=""paste-21260088116250.jpg"" /></div>"
Pharm24.Corticosteroids
What is the effect of glucocorticoids on postaglandin H synthase-2&nbsp;&nbsp;(P
GHS-2)? <div>Supression</div><div><br /></div><div>PGHS-2 is induced by pro-infl
ammatory stimuli li
e PGE2 according to the slide, but I couldnt find anything
about this online ... not exactly sure what this is&nbsp;</div> Pharm24.Corticos
teroids
Glucocorticoids reduce prostaglandin levels. What effects result in a pt?
PUBS- perforations, ulcers, bleeds&nbsp;<div><br /></div><div>Reduction in pro-i
nflammatory response (PGD, PGE, PGI2)</div><div><br /></div><div>-similar to NSA
IDs</div>
Pharm24.Corticosteroids
Physiologic effects + mechanism of action of corticosteroids on vasculature
"Effects: Reduce hyperemia and edema<div><br /></div><div>Mechanism: Through eff
ects upon histamine,
inins, prostaglandins, leu
otrienes, and lympho
ines&nbsp;
</div><div><br /></div><div><img src=""paste-26066156519932.jpg"" /></div>"
Pharm24.Corticosteroids
Physiologic effects + mechanism of action of corticosteroids on cells "Effects

: Inhibition of leu
ocyte infiltration and function<div><br /></div><div>Mechani
sm: Inhibition of chemotactic factors&nbsp;</div><div><br /></div><div><img src=
""paste-26061861552636.jpg"" /></div>" Pharm24.Corticosteroids
Physiologic effects + mechanism of action of corticosteroids on connective tissu
e
"Effects: promote tissue repair&nbsp;<div><br /></div><div>Mechanism: th
rough synthesis of new tissue and repair of damaged tissue&nbsp;</div><div><br /
></div><div><img src=""paste-26061861552636.jpg"" /></div>"
Pharm24.Corticos
teroids
Order in terms of potency:<div><br /></div><div>Prednisone, Triamcinolone, Corti
sol, Betamethasone&nbsp;</div> "Cortisol --&gt; Prenisone/Prednisolone --&gt; T
riamcinolone --&gt; Betamethasone&nbsp;<div><br /></div><div><img src=""paste-22
552873271984.jpg"" /><br /><div><br /></div><div><br /></div></div>"
Pharm24.
Corticosteroids
What factors affect the duration of action of glucocorticoids (4)?
<b>1. Pr
otein binding: </b>more bound, longer duration&nbsp;<div><b>2. 11 beta-HSD II bi
nding affinity:</b> lower affinity, longer duration (HSD can inactivate cortisol
)</div><div><b>3. Lipophilicity-</b>greater lipophilicy promotes adipose storage
and extends duration&nbsp;</div><div><b>4. Glucocorticoid Receptor affinity: </
b>Stronger binding, longer duration&nbsp;</div> Pharm24.Corticosteroids
Therapeutic uses of corticosteroids (4) 1. Hormone replacement for adrenal insuf
ficiency&nbsp;<div>2. Suppression of inflammation + immune response</div><div>3.
Leu
emia</div><div>4. Prevention of organ transplantation</div>
Pharm24.
Corticosteroids
What is the appropriate treatment for patients w/ Addisons disease (primary ad
renal insufficiency?
Hydrocortisone w/ mineralcorticoid suppplement (fludroco
rtisone)&nbsp; Pharm24.Corticosteroids
What is the treatment for secondary adrenal insufficiency?
Hydrocortisone A
LONE<div><br /></div><div>*RAAAS provides enough mineralcorticoid&nbsp;</div>
Pharm24.Corticosteroids
Name some diseases that steroids are used for in order to supress inflammation a
nd the immune response (7)?
1. Rheumatoid arthritis<div>2. Asthma</div><div>
3. Collagen diseases (SLE)</div><div>4. Vasculitis</div><div>5. Neuromuscular di
sorders (Bells Palsy)</div><div>6. Infections (meningitis)</div><div>7. HIV rel
ated disorders (penumocystis carinii pneumonia)&nbsp;</div>
Pharm24.Corticos
teroids
T/F: Steroids cure the underlying pathological progress of a disease&nbsp;
F:&nbsp;Because the corticosteroids are not curative, the pathologic process wil
l progress while clinical manifestations are suppressed.
Pharm24.Corticos
teroids
T/F:<div><br /></div><div>Adverse effects of glucocorticoid therapy are mainly s
een in long-term usage</div>
T:&nbsp;When more powerful glucocorticoids are a
dministered over longer periods of time<div>(&gt; 2 wee
s) at higher doses, seri
ous adverse effects occur.</div><div><br /></div><div>The adverse effects associ
ated with short term glucocorticoid therapy (~1 wee
) are few</div>
Pharm24.
Corticosteroids
What are the side effects of steroids? <div><b>CUSHINGOID (</b>mnemonic<b>)&nbs
p;</b></div><div><br /></div><div>Cataracts</div><div>Ulcers</div><div>S
in: str
iae, thinning, bruising</div><div>Hypertension/ Hirsutism/ Hyperglycemia</div><d
iv>Infections</div><div>Necrosis, avascular necrosis of the femoral head</div><d
iv>Glycosuria</div><div>Osteoporosis, obesity</div><div>Immunosuppression</div><
div>Diabetes</div><div><br /></div><div>*Generally pts will have Cushing-li
e sy
mptoms.&nbsp;</div>
Pharm24.Corticosteroids
What is Cushings syndrome?&nbsp;
ACTH excess &nbsp;caused by pituitary ov
erproduction, tumors, or exogenous glucocorticoid&nbsp;<div><br /></div><div>Sym
ptoms:</div><div><div>1. muscle wea
ness - (due</div><div>to decreased muscle ma
ss)</div><div>2. central fat deposition</div><div>3. moon face</div><div>4. purp
le abdominal striae</div><div>5. glucose intolerance</div><div>6. neuropsychiatr
ic disorders</div></div><div><br /></div><div>**Pts on chronic steroid therapy w
ill gradually have these symptoms&nbsp;</div><div><br /></div> Pharm24.Corticos
teroids

How might you manage the adverse effects of steroids in a pt? 1. Give intermit
tent doses --&gt; good for allergies&nbsp;<div>2. Use topical (psoriasis) and lo
cal administration (asthma inhalers)</div>
Pharm24.Corticosteroids
Why do you want to ta
e a pt off steroids slowly?
1. Most frequent problem
: Disease can flare up<div>2. Most serious problem: acute adrenal insufficiency
(adrenal doesnt start ma
ing its own corticoids immediately after withdrawal)</
div><div><br /></div> Pharm24.Corticosteroids
4 important glucocorticoids you HAVE TO KNOW
Prednisone<div>Prednisolone</div
><div>Dexamathasone</div><div>Triamcinolone&nbsp;</div><div><br /></div><div>*Pr
ednisone/prednisolone are wea
er than the others and used first.&nbsp;</div>
Pharm24.Corticosteroids
TB is an obligate ______ and usually found in what part of the lung?
aerobe;
apex<div>&nbsp;*highest O2 concentration</div>
What is injected in a TB s
in test?
Injection of PPD (purified protein deriv
ative) which is actually a mixture of hundreds of different TB antigens I
What can cause a decreased response to tuberculin?
Immunosupressive states:
basically the sic
er you are, the less li
ely you are to have a positive s
in t
est because memory cell responses are less present.&nbsp;<div><br /></div><div>I
.e HIV, malignancy, CVD, corticosteroids, TNF alpha inhibitors, stress, old age<
/div> I
How does TB disseminate? Where does it disseminate to? lymphohematogenously: be
gins in regional lymphnodes of the lung and move to meninges, apices of lung, ly
mph nodes, and other organs
What are the 5 fates of MTB in the body?
<div>1. Host response
ills all
organisms&nbsp;</div><div>2. Organisms multiply immediately causing primary TB&nbs
p;</div><div>3. Bacilli become dormant [latent] and never cause disease&nbsp;</d
iv><div>4. Latent organisms begin to grow, causing reactivation TB&nbsp;</div><div
>5.Re-infection occurs, but is rare in low prevalence conditions</div>
How is MTB ta
en to lymphnodes? Ingested by macrophages and ta
en to lymphnodes
What 4 ways are MTB
illed inside cells?
1. phagosome/lysosome fusion<div
>2. ROS/RNS</div><div>3. Tc cells
ill infected macrophages</div><div>4. Apoptos
is</div>
How does HIV affect progression of TB? accelerates and amplifies TB
What interleu
in is essential for granuloma formation? IL-17
Balance of what two helper T cell responses determines how TB manifests in human
s?
TH1 and TH2<div><br /></div><div><div>Th1: IFN, TNF, and IL-2 are release
d. IL-10 suppresses this response&nbsp;</div><div>Th2: IL-4, IL-5, IL-13 and IL10 are released. This is inhibited by IFN&nbsp;</div></div><div><br /></div>
Why do ranulomas form in TB infection? Why would Infliximab, adalimumab, and et
anercept be contraindicated in TB?
MTB stimulates the release of TNF alpha
from macrophaes<div><br /></div><div>They are all anti TNF alpha drus!&nbsp;</
div><div><br /></div>
IFN amma is involved with macrophae ______, while TGF beta and IL-10 are macro
phae ________. This balance seems to overn disease manifestation of Tb
activation; inactivation
What is the role of IL-12 in respondin to TB? It stimulates TH0 cells into TH1
cells, which help restore IFN amma production in advanced TB
Spectrum of clinical TB depends on what two helper T cell responses?
TH1 and
TH2
What type of TB infection is characterized by mycobacterial rowth that is arres
ted and a systemic TH1 response predominantes? latent TB infection
What type of TB infection is characterized by the followin cytokine profile:<di
v><br /></div><div>Hih levels of INF- and IL-12 locally, low levels of IL-4 an
d &nbsp;IL-5, containment of infection with few systemic sins or symptoms&nbsp;
</div> Lymph node TB (local)
What type of TB infection is characterized by a resistant immune response with f
ew bacilli, neative TST in only 5-10% of cases, and tends to be mild? pleural
TB
What aressive form of TB is characterized by hematoenosu dissemination, a ne
ative TST in 50%, and a lack of T cell proliferation? Miliary TB

What type of TB is characterized by a predominant TH2 response (decreased IFN a

mma and IL-12 and increased levels of IL-4)
Pulmonary TB
What is Immune reconstitution inflammatory syndrome?
From Wiki:<div>Immune re
constitution inflammatory syndrome (IRIS) (also known as immune recovery syndrom
e) is a condition seen in some cases of AIDS or immunosuppression, in which the
immune system beins to recover, but then responds to a previously acquired oppo
rtunistic infection with an overwhelmin inflammatory response that paradoxicall
y makes the symptoms of infection worse.</div><div><br /></div><div>If the CD4 c
ount rapidly increases (due to effective treatment of HIV, or removal of other c
auses of immunosuppression), a sudden increase in the inflammatory response prod
uces nonspecific symptoms such as fever, and in some cases a worsenin of damae
to the infected tissue.</div><div><br /></div><div>It is enerally advised that
when patients have low initial CD4 T cell count and opportunistic infection at
the time of their HIV dianosis, they receive treatment to control the opportuni
stic infections before HAART is initiated approximately two weeks later</div>
What are two tests to detect TB? Do these tests have the ability to distinuish
between TB infection and TB disease?
TST and IFN amma release assay<div><br
/></div><div>no</div>
"<im src=""paste-27977416966145.jp"" /><div>Identify 2. What is its sinficanc
e and what is the clinical correlationa ssociated with it?&nbsp;</div>" Scutum place where the tympanic membrane inserts.<div><br /></div><div>Usually it is p
ointy but if you have a cholesteatomas then it will be eroded and dull.&nbsp;</d
iv>
2-19
"<im src=""paste-28256589840385 (1).jp"" /><div>identify&nbsp;</div>" 1. Head
of malleus and body of incus&nbsp;<div>2. Aditus&nbsp;</div><div>3. Mastoid air
cells&nbsp;</div>
2-19
"<im src=""paste-28385438859265 (2).jp"" /><div>identify</div>"
vestibul
e &nbsp;&amp; semicircular canals&nbsp; 2-19
"<im src=""paste-28509992910849.jp"" /><div>What happened?&nbsp;</div>"
Transverse Fracture - Notice the left white arrow is not filled with air anymore
(mastoid air cells and middle ear cavity). The second arrow on the riht points
to a fracture oin throuh the cochlea. &nbsp;
2-19
"<im src=""paste-28686086569985.jp"" /><div>What happened?</div>"
"Transve
rse Fracture - different anle. You can ""see"" the tympanic membrane because of
the blood in the middle ear cavity. The fracture (pointed out by the white arro
w) is oin throuh the cochlea"
2-19
"<im src=""paste-32633161515009.jp"" /><div>What is happenein?&nbsp;</div>"
Facial paralysis -&nbsp;<div><br /></div><div>if you see this dianosis, must as
k if it affects the forehead or not. This is a case of Bell's palsy, which is an
example of peripheral palsy. Central facial palsy is characterized by contralat
eral paralysis of the lower half of one side of the face (excludes the forehead)
</div> 2-19
"<im src=""paste-32710470926337.jp"" /><div>What is happenin?&nbsp;</div>"
Vestibular Schwannoma - you aren't necessarily concerned about CN VIII since peo
ple can be fine without hearin, but CN VII damae can have pretty bad quality o
f livin issues 2-19
You use contrast ... for CT and ... for MRI&nbsp;
iodine&nbsp;<div>Gadolin
ium&nbsp;</div> 2-19
T or F. contrast crosses the BBB
False<div><br /></div><div><div>so vesse
ls in the brain will show up well but it won't permeate the brain tissue. The pi
tuitary and pineal land, as well as the venous sinuses, would be filled with co
ntrast because they are not covered by a tiht BBB.&nbsp;</div><div><br /></div>
</div> 2-19
"<im src=""paste-33071248179201.jp"" />"
Glioblastoma&nbsp;
2-19
"<im src=""paste-33131377721345.jp"" /><div>which ons is extraaxial v intraaxi
al?&nbsp;</div>"
Upper = intra - lymphoma&nbsp;<div>lower = extraaxial meninioma&nbsp;</div> 2-19
"<im src=""paste-33406255628289 (1).jp"" /><div>Which is suprahyoid and which
is infrahyoid?</div>" top: suprahyoid<div>bottom: infrahyoid</div>
2-19
"<im src=""paste-33500744908801.jp"" /><div>identify</div>" parotid mass - p

leomorphic adenomas
2-19
"<im src=""paste-33565169418241.jp"" /><div>whats the problem?&nbsp;</div>"
tonsilitis - blocks off the airway
2-19
"<im src=""paste-33625298960385.jp"" /><div>identify</div>" linual thyroid
2-19
"<im src=""paste-33706903339009.jp"" /><div>identify the problem in the riht
imae</div>"
thyroid mass
2-19
"<im src=""paste-33771327848449 (1).jp"" /><div>identify the problem in the ri
ht imae</div>"
parathyroid adenoma
2-19
"<im src=""paste-33835752357889.jp"" /><div>whats wron?</div>"
"paralyz
ed vocal cords<div><im src=""paste-33848637259777 (1).jp"" /></div>" 2-19
To prevent infection, the GI tract has several defenses (6):
1) acid secretio
n<div>2) viscous layer of mucus over epithelium</div><div>3) pancreatic enzymes
and bile deterents (especially viruses with envelope structure)</div><div>4) I
A</div><div>5) peristalsis</div><div>6) normal ut flora discouraes colonizatio
n of pathoenic bacteria.=</div>
Many GI pathoens are resistant to local defenses. What is an example of an enve
loped virus that is resistant to inactivation by acid, bile, and pancreatic enzy
mes?
Norovirus - scoure of cruise ship industry!
How do many helminths and protozoa escape destruction in the GI?
Many hav
e acid-resistant outer coats.<div><br /></div><div><div>Shiella is resistant to
acid and as few as 100 oranisms can cause illness.</div></div>
<div><u>Adhesion and Local Proliferation</u></div><div><br /></div><div>____ and
____ bind to the intestinal epithelium and multiply in the overlyin mucous lay
er.</div><div><br /></div>
V. cholerae; enterotoxienic E. coli&nbsp;
"<div><u>Adhesion and Mucosal Invasion</u></div><div><br /></div><div>Pathoens
such as {{c1::Shiella}}, {{c1::Salmonella enterica}},<span class=""Apple-tab-sp
an"" style=""white-space:pre""> </span>{{c1::Campylobacter jejuni}}, and {{c1::e
ntamoeba histolytica}} invade the intestinal mucosa and<span class=""Apple-tab-s
pan"" style=""white-space:pre""> </span>lamina propria and cause ulceration,&nbs
p;inflammation, and hemorrhae that manifest&nbsp;clinically as dysentery</div><
div><br /></div>"
"<im src=""paste-6854767804417.jp"" />"
What are three examples of when the mucociliary defense is not workin properly?
smokers<div>cystic fibrosis</div><div>acute - mechanical ventilation</div>
<div>How are the followin removed from the respiratory tract:</div><div><br /><
/div><div>1) lare particles and&nbsp;microoranims trapped in mucosa</div><div>
2) particles smaller than 5 microns</div>
<div>1) trapped in the mucocilia
ry blanket and swept to throat by ciliary action to be swallowed</div>2) carried
to the alveoli where they are phaocytosed by alveolar macrophaes
How does the influenza virus establish itself in the respiratory tract? What can
easily follow an influenza infectino "<div>Influenza viruses have envelope pr
oteins called hemalutinins that bind to sialic acid on the surface of&nbsp;epi
thelial cellsin the lower respiratory track and pharynx.&nbsp;Attachment induces
the host cell to endocytose the virus, leadin to viral entry and replication.<
/div><div><br /></div><div><div>The resultin damae to the respiratory<span cla
ss=""Apple-tab-span"" style=""white-space:pre""> </span>epithelium sets the sta
e for superinfection by S penumoniae and S aureus, often leadin<span class=""Ap
ple-tab-span"" style=""white-space:pre""> </span>to serious pneumonias.</div></d
iv>"
What do H influenzae, M pneumoniae, and B pertussis each do to increase their ab
ility to establish infection? Release toxins that impair ciliary activity
What does charcoal not absorb? iron, cyanide, stron acids and bases, alcohol,
hydrocarbons
What metal toxicity leads to muscle weakness, loss of sensation, anemia and derm
atitis? arsenic
What metal poisonin leads to blue line on ums, constipation, attacks of intens
e pain, and wrist drop? lead<div>lead colic and raidal nerve damae</div>
What type of poisonin leads to retinal damae and metabolic acidosis? methanol
How do oranochlorides work?
They slow the repolarization of neurons
"<div>It is estimated that the normal human body harbors&nbsp;10x more microbial

cells than human cells with most of these bein symbiotic. When the host immune
system is attenuated, what may occur even with the ""healthy"" oranisms?</div>
<div><br /></div>"
They can cause infections
<div>Microbes can enter the host by breachin {{c1::epithelial surfaces}}, {{c1:
:inhalation}}, {{c1::inestion}}, or {{c1::sexual transmission}}.</div>
For defense, what does the skin/epidermis produce?<div><br /></div><div>What are
three pathoens that are resistant to these peptides?</div>
1. antimicrobial
fatty acids&nbsp;<div>2. cationic peptides like defensins<div>3. cathelicidins
are produced by leukocytes and epithelial cells that are toxic to microbes</div>
<div><br /></div><div><div>Shiella ssp, S aureus, and Candida</div></div></div>
Most skin infections occur when what happens? What is an exception with funi? W
hat about an example of an oranism penetratin the skin to infect?&nbsp;
"Mechanical injury is usually necessary.<div><br /></div><div>Dermatophytes (fun
i) doesn't need this and can infect intact skin.</div><div><br /></div><div>Sch
istosoma (parasitic flatworm) pierces skin throuh enzymatic deradation of adhe
sive proteins that hold the keratinocytes toether.<div><br /></div><div>Dermato
phyte Infection</div><div><im src=""paste-15281493639169.jp"" /></div></div>"
To be infected with cholerae you need how many oranisms?<div><br /></div><div>C
ompare this to TB?</div>
Vibrio cholerae --+ 10^11 oranisms<div><br /></
div><div>TB --+ &lt;10 oranisms</div>
In order for a urinary tract infection to occur, pathoens must be able to ...
adhere to urothelium to avoid bein washed away. (women have a 5 cm distance bet
ween urinary bladder and skin vs 20 cm in men)
Why miht antibiotics cause vainal infection in women? <div>Vaina is protected
from pathoens by lactobacilli, which ferment lucose to lactic acid, producin
a low pH environment that suppresses the rowth of pathoens.</div><div><br /><
/div><div><div>Antibiotics can kill the lactobacilli and allow overrowth of yea
st, causin vainal candidiasis</div></div>
Name an example of each:<div><br /></div><div>1) Placental - Fetal transmission<
/div><div>2) Transmission durin birth</div><div>3) Transmission via maternal mi
lk</div>
"1) Rubella -&nbsp;durin the first trimester can lead to heart
malformations, mental retardation, cataracts, or deafness while rubella infectio
n durin the third trimester has little effect.<div><br /></div><div>2)&nbsp;Exa
mples include onococcal and chlamydial conjunctivitis</div><div><br /></div><di
v>3)&nbsp;Examples include cytomealovirus, HIV, and Hepatitis<span class=""Appl
e-tab-span"" style=""white-space:pre""> </span>B<span class=""Apple-tab-span"" s
tyle=""white-space:pre""> </span></div>"
The most common and efficient mode of microbial dissemination is throuh ____.
The bloodstream
"<im src=""paste-26804890894337.jp"" /><div><br /></div><div>You see these in
a slide of CNS tissue. What is the dianosis?</div>"
Rabies
How does S aureus travel to infect other cells in the body?
Secretes hyaluro
nidase that derades the EC matrix.
How do rabies and poliovirus spread in a host? Infects peripheral nerves and th
en travels alon the axons to the CNS!
Where does mumps infect?
"Salivary lands<div><br /></div><div><im src="
"paste-27062588932097.jp"" /></div>"
"<div>{{c1::Bacterial spores}}, {{c1::protozoan cysts}}, and&nbsp;{{c1::helminth
es}} can remain viable in a<span class=""Apple-tab-span"" style=""white-space
:pre""> </span>cool and dry environment for months to&nbsp;years.</div>"
Most pathoens are transmitted from person to person by {{c1::respiratory}}, {{c
1::fecal-oral}}, or {{c1::sexual routes}}
Most enteric pathoens are spread by the {{c1::fecal-oral route}}.<div><br /></d
iv><div>Examples of viral and bacterial enteric pathoens:</div>
<div>Vir
al epidemics carried this way include&nbsp;hepatitis A and E, poliovirus, and&nb
sp;rotavirus</div><div><br /></div><div>V cholerae, Shiella, C jejuni and Salmo
nella are also transmitted this way</div><div><br /></div>
How do spirochetes and trypanosomes evade host defense? they switch their major
surface proteins periodically
How does influenza escape host defense? complex RNA enome allows for antienic

shifts via frequent recombination events

How does&nbsp;S pneumoniae escape host defense? In addition to blockin phaocyt
osis, there are a ton of enetic variants of this oranism due to mutation - ove
r 90 different serotypes exist of S pneumoniae
The carbohydrate capsule on the surface of many bacteria that cause pneumonia or
miniitis can evade host destruction by:
<div>blockin phaocytosis by ne
utrophils</div><div><br /></div><div>ex) S. pneumoniae, N. meninitides, H. infl
uenzae</div>
What do some strains of E. Coli cause in newborns that can be life threatenin?
How does it evade destruction? Meninitis<div><br /></div><div>Has a special ca
psule containin sialic&nbsp;acid that will not bind C3b</div>
<div>S. Aureus can escape destruction in an interestin way - what is this?</div
>
"Expresses protein A, which binds<span class=""Apple-tab-span"" style=""
white-space: pre""> </span>the Fc portion of antibodies and so inhibits<span cla
ss=""Apple-tab-span"" style=""white-space: pre; ""> </span>phaocytosis"
"<div>Some viruses produce soluble homoloues of&nbsp;{{c1::IFN alpha/beta}}&nbs
p;or {{c1::IFN amma receptors}} that function<span class=""Apple-tab-span"" sty
le=""white-space:pre""> </span>as decoys and take up and inhibit the actions of<
span class=""Apple-tab-span"" style=""white-space:pre""> </span>secreted {{c1::i
nterferons}}.</div>"
Here are four examples of when the host response is the major cause of tissue in
jury and not the infectious pathoen: "<div>The <u>ranulomatous inflammatory
reaction to <span class=""Apple-tab-span"" style=""white-space:pre""> </span>M t
uberculosis</u> sequesters the bacilli and prevents their spread, but it can als
o <u>produce<span class=""Apple-tab-span"" style=""white-space:pre""> </span>tis
sue damae and fibrosis</u></div><div><br /></div><div>Damae to hepatocytes fol
lowin <u>hepatitis B <span class=""Apple-tab-span"" style=""white-space:pre"">
</span>and C infection</u> is mainly due to the effects of <span class=""Apple-t
ab-span"" style=""white-space:pre""> </span>the immune response on infected live
r cells rather than cytopathic effects of the virus</div><div><br /></div><div><
div><u>Antibodies produced aainst the streptococcal M protein of S pyoenes can
cross-react with cardiac proteins and damae the heart leadin to rheumatic hea
rt disease</u></div><div><br /></div><div><u>Poststreptococcal lomerulonephriti
s</u> is <span class=""Apple-tab-span"" style=""white-space:pre""> </span>caused
by immune complexes formed <span class=""Apple-tab-span"" style=""white-space:p
re""> </span>between antistreptococcal antibodies and <span class=""Apple-tab-sp
an"" style=""white-space:pre""> </span>circulatin streptococcal antiens; <u>th
ese <span class=""Apple-tab-span"" style=""white-space:pre""> </span>complexes d
eposit in the renal lomeruli, <span class=""Apple-tab-span"" style=""white-spac
e:pre""> </span>producin inflammation in the kidney</u></div></div><div><br /><
/div>"
"<im src=""paste-35480724832257.jp"" />"
"<im src=""paste-2847563317249.jp"" />"
"<im src=""paste-2933462663169.
jp"" />"
2-20
"<im src=""paste-3032246910977_2997561.jp"" />"
"<im src=""paste-304513
1812865.jp"" />"
2-20
"<im src=""paste-3113851289601.jp"" />"
"<im src=""paste-3131031158785.
jp"" />"
2-20
"<im src=""paste-3204045602817.jp"" /><div>identify the vein</div>" Juular
vein&nbsp;
2-20
"<im src=""paste-3715146711041.jp"" /><div>identify the problem</div>"
Condylar fracture&nbsp; 2-20
"<im src=""paste-3852585664513.jp"" /><div>Identify the problem</div>"
"Jefferson Fracture -&nbsp;&nbsp;typical C1 fracture. Can present in multiple wa
ys. Fractures in both anterior and posterior rins of the atlas&nbsp;<div><br />
</div><div><im src=""paste-3955664879617.jp"" /></div>"
2-20
"<im src=""paste-4123168604161.jp"" /><div>What is the problem?&nbsp;</div>"
"Odontoid fracture&nbsp;<div><br /></div><div><im src=""paste-4183298146305_299
7561.jp"" /></div>"
2-20
"<im src=""paste-4252017623041.jp"" /><div>What type of fracture is this?&nbsp

;</div>"
"Hanman fracture (Traumatic Spondylolisthesis) of C2 - Fracture
is between the articulation of the vertebrae&nbsp;<div><br /></div><div><im sr
c=""paste-4342211936257.jp"" /></div>" 2-20
"<im src=""paste-4419521347585.jp"" /><div>What are the arrows pointin to? Wh
at is the space inbetween called?&nbsp;</div>" "blue - inferior articulatin pr
ocess&nbsp;<div>red - superior articulatin process&nbsp;</div><div>facet joint
is in between&nbsp;</div><div><br /></div><div><im src=""paste-4539780431873 (1
).jp"" /></div>"
2-20
"<im src=""paste-4617089843201.jp"" /><div>What is the problem?&nbsp;</div>"
Jumped Facet - dame to spinal cord&nbsp;
2-20
"<im src=""paste-4672924418049_2997561.jp"" /><div>What are the arrows pointin
 at? What type of vertebrae are these?&nbsp;</div>"
Pedicles&nbsp;<div>Thora
cic vertebrae (note the ribs)&nbsp;</div>
2-20
The spinal cord ends at ...., while the cauda equina oes on<div>The dura ends a
t ....</div><div>Pia mater ends at....&nbsp;</div><div><br /></div>
L1/L2&nb
sp;<div>S2&nbsp;</div><div>filum terminale connectin to coccyx&nbsp;</div>
2-20
"<im src=""paste-5102421147649 (2).jp"" /><div>What type of vertebrae are thes
e?</div>"
lumbar 2-20
"<im src=""paste-5312874545153 (1).jp"" /><div>What is the problem here?&nbsp;
</div>" "Disc herniation&nbsp;<div><br /></div><div><im src=""paste-53515292508
17 (1).jp"" /></div>" 2-20
"<im src=""paste-5420248727553.jp"" /><div>identify the problem&nbsp;</div>"
Disc herniation&nbsp; 2-20
"<im src=""paste-5514738008065.jp"" /><div>What is occurin at the red dotted
line</div>"
"Listhesis - foward displacement of the vertebral body aainst a
nother&nbsp;<div><im src=""paste-5570572582913.jp"" /></div>" 2-20
What invasive technique would you use to visualize the vessels?&nbsp; DSA (di
ital subtraction anioraphy)&nbsp;
2-20
How many paired aortic arches are there?&nbsp; Five - I, II, III, IV &amp; VI (
V never completely forms)&nbsp;
What does the 1st aortic arch become?&nbsp;
Maxillary Artery&nbsp;
What does the 2nd Aortic Arch become?&nbsp;
Hyoid &amp; Stapedial Arteries<d
iv><br /></div>
What does the 3rd Aortic Arch become?&nbsp;
Common &amp; Proximal Internal C
arotid Arteries
What will become the otic vesicles and the oriin of the ear and vestibular stru
ctures? What is their embyroloical oriin?
otic Placodes - Ectoderm
What will become the lens of the eye? What is its embryoloical oriin? Lens Pla
codes - Ectoderm
What does the Paraxial Mesoderm become in the Head &amp; Neck?&nbsp;
&nbsp;Floor of brain case<div>&nbsp;- Small part of occipital reion</div><div>&nbsp;All voluntary craniofacial muscles</div><div>&nbsp;- Dermis + CT of dorsal head
</div><div>&nbsp;- Menines caudal to prosencephalon</div>
What does the Lateral Plate Mesoderm become in the Head &amp; Neck reion?&nbsp;
&nbsp;- Laryneal cartilaes (arytenoid &amp; cricoid)<div>&nbsp;- CT in the re
ion of the laryneal cartilaes</div>
What does the 1st Pharyneal Arch form?&nbsp; <b>the JAW</b><div><b><br /></b>
</div><div>- Maxilla, Mandible, Muscles with CN V3 innervation</div><div>- Malle
us &amp; Incus</div><div>- Trieminal Nerve (CN V3)</div>
What does the 2nd Pharyneal Arch become?&nbsp; <b>the FACE</b><div><b><br /></b
></div><div>&nbsp;- Stapes, Styloid process, lesser horn &amp; upper body of Hyo
id</div><div>&nbsp;- Muscles innervated by CN VII</div><div>&nbsp;- Facial Nerve
(CN VII)&nbsp;</div>
What does the 3rd Pharyneal Arch become?&nbsp; <b>the TONGUE</b><div><b><br /><
/b></div><div>&nbsp;- Lower hyoid</div><div>&nbsp;- Stylopharyneus</div><div>&n
bsp;- Glossopharyneal Nerve (CN IX)&nbsp;</div>
What do the 4th &amp; 6th Pharyneal Arches become?&nbsp;
&nbsp;<b>the LAR
YNX</b><div><br /></div><div>- All of the cartilaes of the larynx<div>- Cricoth
yroid, Levator palatini, Constricters of pharynx</div></div><div>- 4th: Superior

Laryneal Branch of Vaus</div><div>- 6th: Recurrent Laryneal Branch of Vaus<

/div>
What does the 1st Pharyneal Pouch become?
<b>the EAR</b><div><b><br /></b>
</div><div>Middle ear + Eustachian tube</div>
What does the 2nd Pharyneal Pouch become?
<b>the TONSILS</b><div><b><br />
</b></div><div>&nbsp;- Forms fossa of tonsils, not lymphatic tissue</div><div>&n
bsp;- Palatine tonsil primordium&nbsp;</div>
What does the 3rd Pharyneal Pouch become?&nbsp;
<b>the INFERIOR PARATHYR
OID &amp; THYMUS</b><div><b><br /></b></div><div>&nbsp;- Dorsal win: inferior p
arathyroid</div><div>&nbsp;- Ventral win: thymus</div>
What does the 4th Pharyneal Pouch become?&nbsp;
<b>the SUPERIOR PARATHYR
OID &amp; CALCITONIN</b><div><b><br /></b></div><div>- Dorsal win: superior par
athyroid</div><div>- Ventral win: ultimobranchial body = infiltrates the thyroi
d land as the <u>parafollicular C cells</u>, which secrete calcitonin</div>
Which pharyneal cleft actually becomes somethin? What does it become?&nbsp;
1st Pharyneal Cleft: Ear - auditory canal&nbsp;
What forms the center of the face embryoloically?&nbsp;
Stomodeum (= fut
ure mouth)
How does the eye form embryoloically?&nbsp;
&nbsp;- <b>Optic placodes</b> in
vainate to form <b>optic vesicle</b><div>&nbsp;- <b>Optic vesicle</b> is attach
ed to forebrain by <b>optic stalk</b>, which will become the <b>optic nerve</b>&
nbsp;</div><div>&nbsp;- Also induces overlyin ectoderm to form <b>lens vesicle<
/b></div><div>&nbsp;- <b>Lens</b> induces ectoderm to differentiate into the <b>
cornea</b>&nbsp;</div>
What embryoloically forms the external ear?&nbsp;
1st branchial cleft --&
t; External auditory canal&nbsp;
What embryoloically forms the middle ear?&nbsp;
&nbsp;- 1st pharyneal p
ouch --&t; tympanic cavity<div>&nbsp;- 1st pharyneal arch --&t; malleus, incu
s</div><div>&nbsp;- 2nd pharyneal arch --&t; stapes</div>
What embryoloically forms the 3 layers of the tympanic membrane?
&nbsp;1st branchial cleft = ectoderm - outer layer<div>&nbsp;- 1st branchial pouch = e
ndoderm - inner layer</div><div>&nbsp;- Fibrous stratum in middle = mesoderm&nbs
p;</div>
How does the inner ear form embryoloically?&nbsp;
"- Otic placode invaina
tes to form ""otocyst"" (otic vesicle)<div>- Otic vesicle bifurcates to form:</d
iv><div>--&t; Ventrally (auditory) - saccule &amp; cocchlear duct</div><div>--&
t; Dorsally (vestibular/balance) - utricle, &nbsp; &nbsp; &nbsp; semicircular c
anals, endolyphatic duct</div>"
What are otoliths?
"Weihts on hair cells that are responsible for you know
in which way is ""up"""
How does the nose form embryoloically? - Nasal placodes develop and invainate
to make nasal pits/prominences<div>- Nasolacrimal roove becomes nasolacrimal du
ct</div><div>(Lateral nasal prominence and maxillary prominence fuse to make nas
olacrimal duct)</div><div>- Medial rowth of maxillary prominence = protrustion
of the nose</div>
What is the upper lip formed by embryoloically?
Formed by medial nasal p
rominences (philtrum) and maxillary prominence
Embryoloy explains why the tonue has five cranial nerves -&nbsp;<div><br /><di
v>- What forms the Anterior 2/3 of the tonue? What is its innervation?&nbsp;</d
iv><div><br /></div><div>- What forms the midline swellin (copula)? What is its
innervation?</div><div><br /></div><div>- What forms the Posterior 1/3 of the t
onue? What is its innervation?</div></div>
"<b>Anterior 2/3</b>: 1st arch f
orms median tonue bud then lateral linual swellin; CN V3<div><br /></div><div
><b>Midline Swellin (copula)</b>: from 2nd arch;&nbsp;</div><div>CN VII</div><d
iv><br /></div><div><b>Posterior 1/3</b>: Copula is ""overtaken"" by midline swe
llins from 3rd &amp; 4th arches; CN IX (3rd arch) &amp; CN X (4th arch)&nbsp;</
div><div><br /></div><div><b>- Motor innervation is purely by CN XII</b></div><d
iv><b><br /></b></div><div><b><br /></b></div><div><b><im src=""paste-167937516
241129.jp"" /></b></div>"
What is the embryoloical formation of the thyroid land?&nbsp; - Thyroid oriin

ates as endodermal diverticulum at the <u>foramen cecum</u><div>- Descends from

the base of the tonue to its normal location at the end of a slender <u>thyrol
ossal duct</u> (which normally obliterates)&nbsp;</div>
What is the Sistrunk procedure?&nbsp; "Procedure to remove a thyrolossal cyst
- must remove the middle part of the hyoid when removin the cyst<div><br /></d
iv><div><im src=""paste-168027710554333.jp"" /></div>"
<div>How many baby teeth are there?&nbsp;</div><div>How many adult teeth?&nbsp;<
/div> Baby Teeth: 20<div>Adult Teeth: 32</div>
What is the embryoloy of the skull?&nbsp;
- Almost all of it is <u>neural
crest</u>
What are Fontanelles?&nbsp;<div>How many are present at birth?&nbsp;</div><div><
br /></div>
- Membrane covered spaces between flat bones<div>- 6 fontanelles
are present at birth&nbsp;</div>
<div>When does the posterior fontanelle close?&nbsp;</div><div>When does the ant
erior fontanelle close?</div><div>What is it called if the bones fuse too early?
&nbsp;</div>
- Posterior closes by 3 months<div>- Anterior closes by 18 month
s</div><div>- Craniosynostosis&nbsp;</div>
What is the most common head shape abnormality?&nbsp; "- Scaphocephaly, which
affects the Saittal Suture (Top Picture)&nbsp;<div><br /></div><div><im src=""
paste-168276818657678.jp"" /></div>"
What is the dominant inflammatory reaction in the followin infectious aents?<d
iv><br /></div><div>prion</div><div>virus</div><div>bacteria</div><div>mycobacte
ria</div><div>funi</div><div>protozoan</div><div>multicellular parasites</div>
"<im src=""paste-4127463571457.jp"" />"
Equilibrium of the microbiome is shifted in two scenarios:
1) host immunode
ficiency - can cause symbiotic bacteria to become pathoenic<div>2) chanes in c
omposition of microbiome due to pathoens or antibiotics</div>
What is virulence?
<div>Property of infectious aent that reflects disease
producin potential</div><div><br /></div>
<div><div>Introduction of pathoens into immunoloically nave populations can be
catastrophic: think of smallpox comin to the Americas and what this did to Nati
ve Americans.</div></div><div><br /></div>What is defined by:&nbsp;movement of o
ranisms from one usually isolated ecosystem to a new ecosystem.
Emerin
Infections
Infectious aents are always evolvin, and so is our ____ immune system. It is a
continous ame between the two.
adaptive
How miht one et a systemic infection? Injection (medical, recreational, insect
vectors) - blood stream infection
What is the proper terminoloy for an infection/inflammation of the followin or
ans?<div><br /></div><div><div>Respiratory:&nbsp;</div><div>GI:</div><div>Liver
:</div><div>Gallbladder:</div><div>Kidney:</div><div>Bladder:&nbsp;</div><div>Br
ain:</div><div>Bloodstream:&nbsp;</div><div>Localized:</div></div><div><br /></d
iv>
<div>Respiratory: Sinusitis/Pharynitis/Bronchitis/Pneumonia</div><div>G
I: Gastroenteritis</div><div>Liver: Hepatitis</div><div>Gallbladder: Cholecystit
is</div><div>Kidney: Pyelonephritis</div><div>Bladder: Cystitis</div><div>Brain:
Encephalitis/Cerebritis</div><div>Bloodstream: Septicemia --+ (can be broken do
wn further by oranism: Viremia/Funemia/Bacteremia)</div><div>Localized: Absces
s / Granuloma</div>
Most GI infections are from what mode of infection?
Fecal/oral - inestion
How does a prion replicate?
<div>No nucleic acids in prions. They contact no
rmal host proteins and turn&nbsp;alpha helix rich proteins into beta-pleated she
et (virulent) proteins.</div>
T/F: Viruses only contain DNA or RNA but not both?
T
What is viral trophism? <div>Viruses can only infect cells with the particular r
eceptors that they can bind to. Example - rabies infects neurons.</div>
What component of viruses are most often the tarets for pharmaceuticals?
the viral enzymes - polymerases and proteases(for cuttin up translated viral pr
otein)
Which is hypermutatable? DNA or RNA virus?
RNA -&nbsp;rapid antien drift a
llows evasion of host humoral response and vaccines<div><br /></div><div>Think o

f Influenza!</div>
Where do we see DNA and RNA viruses replicatin?
"Nuclear inclusions - DN
A viruses<div>Cytoplasmic inclusion - RNA viruses</div><div><br /></div><div>Mak
es sense</div><div><br /></div><div><im src=""paste-8950711844865 (1).jp"" /><
/div>"
How do viruses produce disease (3)?
1) Direct cytopathic effects (cells fill
ed with virus, host protein synthesis is shut off, and apoptosis may be activate
d)<div>2) Anti-viral immune reactions (virus released durin host mediated dama
e by Tc cells destroyin infected cells)</div><div>3) Transformation of host cel
l to neoplasm (stimulate cell rowth/division, possibly inactivate tumor suppres
sors/mitotic check points, or insertional mutaenesis)</div>
What class of virus causes the common cold?
Rhinovirus - Inhaled (upper resp
. infection)
Norovirus vs. Rotavirus:
<div>Both = viral astroenteritis</div><div><br
/></div>Norovirus - cruise ship<div>Rotavirus - transmitted enerally by youn k
ids</div>
What does Epstein Barr virus cause?
infectious mononucleosis; transformation
of B cells to lymphoma
Describe arbovirus:
Infection via injection. Arthropod borne. West Nile ence
phalitis.
HPV causes what?
enital warts --+ some will et squamous carcinoma in ce
rvix
With RNA viruses, which strand is translated, positive or neative?<div><br /></
div><div>Remember, the polymerase is not accurate --&t; mutation prone.</div>
Positive Strand
<div><u>Let's play, is this a DNA or RNA virus?</u></div><div><br /></div><div>A
ctivate interferon system to some deree</div><div><br /></div><div><div>Invade
fast, replicate fast (thus error prone), kill cell (sometimes with assistance of
host) - leadin to more rapid cell lysis.</div></div><div><br /></div><div><div
>Totally dependent on host for translation and often bias host to produce viral
proteins instead of host proteins</div></div> RNA
T/F: Mycobacteria are bacteria T
What are three differences between prokaryotes and eukaryotes that pharmaceutica
ls play on to kill these parasites?
Cell wall<div>DNA replication with cytop
lasmic polymerases</div><div>Transcription and Translation occurin in cytoplasm
(30S/50S ribosome)</div>
Gram stainin of ram positive/ram neative bacteria - what are the respective
colors? <div>Gram positive - dark blue</div><div>Gram neative - red</div><div><
br /></div>
What is a cork-screw bacteria called? Spirochetes
What does is an extremily elonated bacteria called and look like?
<div>Fil
amentous bacteria (may be mistaken for funi)</div>
What are the five ways to describe a prokaryotic pathoen?
1) color (ram s
tain)<div>2) metabolic (anaerobic vs aerobic)</div><div>3) shape</div><div>4) lo
cation (intracellular vs extracellular)</div><div>5) host response (pyroenic most bacteria / ranulomatous - mycobacteria)</div>
What ets stained in a ram positive bacteria? "cell wall (peptidolycan)<div><
br /></div><div>Dark Blue vs. Red</div><div><im src=""paste-13138304958465.jp"
" /></div>"
What is a biofilm and where do they form?
Layer of areated bacteria.<di
v><br /></div><div>Artificial joints / cardiac valve</div>
What is the difference between an endotoxin and exotoxin? What is the main examp
le of an endotoxin? What causes toxic shock - endoxins or exotoxins? What is a s
uperantien?
<div>1) endoxin - part of bacteria; exotoxin - released from bac
teria</div><div>2) LPS (ram neative)</div><div>3) exotoxin</div><div>4) a majo
r exotoxin that can cause a hue immune response --&t; toxic shock</div><div><b
r /></div><div><u><br /></u></div><div><u>Endotoxins</u></div><div>Toxins that a
re a part of the bacteria: LPS (ram neative) leads to septic shock (cytokine s
torm, deranulation..).</div><div><br /></div><div><u>Exotoxins</u></div><div>To
xins released by bacteria that may activate or inhibit host sinalin pathways</

div><div>- Superantiens are major exotoxins (mostly from ram positive) that ma
y lead to cytokine overactivity, capillary leak, toxic shock (especially in vai
nal infections from contaminated tampons).</div><div>- (example is cholera relea
sin toxins that cause the secretion of water in GI)</div><div><br /></div>
<div>Immune response to bacterial antiens may result in antibodies that cross-r
eact with host tissues:</div><div><br /></div><div>What are some examples?</div>
<div>Myocarditis and valvular heart disease (Streptococcal)&nbsp;</div><div>Glom
erulonephritis (Streptococcal)</div><div><br /></div><div>Rheumatic disease!</di
v>
What are two examples of mobile enetic elements that allow the transfer of ene
tic material betwen bacteria? Plasmids and bacteriophaes
What are two examples of enetic information that plasmids carry to bacteria?
antibiotic resistance<div>virulence factors</div>
What miht evolutionary/enetic advantae miht bacteriophaes ive to certain b
acteria?
<div>ABCD</div><div><br /></div>Ability to produce toxins in:<di
v><div>Botulism</div><div>Cholera</div><div>Diptheria</div><div><br /></div><div
>Disease production requires bacteria plus phae in these cases</div></div><div>
<br /></div>
What are examples of how a bacteria miht invade an individual cell and what is
the advantae in doin this?
<div>Bind surface receptors</div><div>Some bore
holes in cells</div><div><br /></div><div>Once inside intracellular bacteria are
less apparent to the immune system</div><div>- Growth and lysis (cytotoxic infe
ction)</div><div>- May inhibit lysosomes/autophay and replicate more slowly in
host cell</div><div><br /></div>
Bacterial infections may be acute and localized or chronic or systemic (sepsis).
Chronic inflammation ives rise to an increase in what immune cells? Lymphocy
tes and plasma cells
Describe the prototypic mycobacteria TB:<div><br /></div><div>extracellular/intr
acellular?</div><div>what cell does it infect?</div><div>stainin and shape?</di
v><div>type of immune reaction?</div> Intracellular<div><br /><div>Non-cytolyt
ic infection of macrophaes</div><div><br /></div><div>Weakly ram + rod</div><d
iv>AFB (acid fast - red stainin resistant to acid treatment do to cell wall)</d
iv><div><br /></div><div>GRANULOMATOUS</div><div>TB may be latent or activated b
ased on host immune status</div></div>
What does sinle strand positive vs. sinle strand neative vs. retrovirus mean?
<div>Keep in mind that it is the positive strand that is translated:</div><div><
br /></div>RNA virus with one positive RNA strand - can produce viral protein di
rectly&nbsp;but to produce more RNA, cRNA must serve as template for RNA product
ion by viral polymerase<div><div><br /></div><div>RNA virus with one neative RN
A strand -&nbsp;cRNA must be produced for translation but the neative strand ca
n serve as template for polymerase</div></div><div><br /></div><div><div>Retrovi
ruses - has reverse transcriptase which produces DNA which may be inserted into
host enome</div></div><div><br /></div>
Which has a larer payload (in terms of enes and proteins injected) - RNA or DN
A virus?
DNA
Which viruses cause viral exanthemas? <div>Measles (Rubeola) - RNA virus</div>
<div>Mumps - RNA virus</div>
What are some &nbsp;RNA virus (13)?
Influenza viruses<div><br /><div>Viruses
causin Viral exanthema (viral rash + other systemic symptoms): measles and mum
ps</div><div><br /></div><div>Gastroenteritis:&nbsp;&nbsp;norovirus and rotaviru
s</div><div><br /></div><div>Viral Hemorrhaic Fevers (20 total): ebola, yellow
fever, marbur, SARS</div><div><br /></div><div>Rabies</div><div>Polio</div><div
><br /></div><div>HIV</div><div>HEPC</div></div>
Name the DNA viruses we should know (6):
<div>SEAHHH</div><div><br /></di
v><div>Smallpox</div><div>Ebstein Barr</div>Adenovirus (can cause bronchitis, co
njunctivitis, or astroenteritis)<div>Herpes Simplex (enital and oral)</div><di
v>Herpes Zoster (chickenpox and shinles - reactivation of latent HZV)</div><div
>HPV</div>
Three measures public health has used to reduce viral infections:
Vaccinat
ion<div>Control of vectors (like mosquito control)</div><div>Quarantine (ebola p

atients)</div>
"Identify the muscle of the infratemporal reion<div><im src=""paste-8263517077
505.jp"" /></div>"
Lateral Pteryoid muscle<div><br /></div><div>buccal bra
nch of V3 exits between heads of lateral pteryoids</div>
Infratemporal Po
stLab
"<div>Identify this nerve near the infratemporal reion</div><div><im src=""pas
te-8774618185729_1424358109408.jp"" /></div>" Linual Nerve Infratemporal Po
stLab
"Identify the artery in the infratemporal reion<div><im src=""paste-9418863280
129 (1).jp"" /></div>" Maxillary artery
Infratemporal PostLab
"Identify the nerve in the infratemporal reion<div><im src=""paste-98784247808
01.jp"" /></div>"
Buccal Branch of V3 (different than buccal of VII)
Infratemporal PostLab
"Identify the nerve in the infratemporal reion<div><im src=""paste-10569914515
457.jp"" /></div>"
Nerve to mylohyoid
Infratemporal PostLab
"Identify this artery of the infratemporal reion<div><im src=""paste-110466558
85313.jp"" /></div>" Middle menineal artery Infratemporal PostLab
"Identify this nerve near the infratemporal reion<div><im src=""paste-11540577
124353_1424358109408.jp"" /></div>"
"Buccal branch of VII (see it over the s
urface of buccinator and question also says ""near"" infratemporal fossa)"
Infratemporal PostLab
"Identify the artery of the infratemporal reion<div><im src=""paste-1213757757
8497 (1).jp"" /></div>"
Maxillary artery&nbsp; Infratemporal PostLab
"Identify this muscle of the infratemporal reion<div><im src=""paste-127131031
96161_1424358109408.jp"" /></div>"
Medial Pteryoid muscle (attachment to m
edial side of anle of mandible with mandible removed) Infratemporal PostLab
"Identify the nerve near the infratemporal reion<div><im src=""paste-132929237
81121.jp"" /></div>" Auriculotemporal nerve&nbsp;<div><br /></div><div>(you s
ee the middle menineal to the left of the arrow comin up and the nerve wrappin
/passin next to it; nerve travelin straiht back towards parotid land)</div>
Infratemporal PostLab
"Identify the muscle of the infratemporal reion<div><im src=""paste-1404024809
0625.jp"" /></div>"
Medial Pteryoid
Infratemporal PostLab
"Identify the nerve of the infratemporal reion<div><im src=""paste-14499809591
297.jp"" /></div>"
Inferior alveolar n (you see n. to mylohyoid comin off
beneath the lowest red arrow as the main portion of the nerve heads towards the
(removed) mandibular foramen) Infratemporal PostLab
"Identify this muscle found in the deep neck<div><im src=""paste-24288040058881
.jp"" /></div>"
"Middle scalene m (you see omohyoid swoopin across and
it said ""deep muscle"")"
Neck PostLab
"Identify the structure<div><im src=""paste-24893630447617.jp"" /></div>"
Lesser Occipital nerve&nbsp;<div>(comin out of Erb's point at the posterior ed
e of SCM and towards the reion immediatelly posterior to the ear)</div><div><br
/></div><div>Other ones: reat auricular (comin from same point and oin supe
riorly/vertically to reion near the earlobe) and transverse cervical (oin hor
izontally from the same point over the TOP of SCM towards platysma to supply sen
sory) and some supraclaviular branches (shootin down to area above clavicle)</d
iv><div><br /></div><div>These are all branches of the cervical plexus.</div>
Neck PostLab
"Identify the muscle indicated by the red arrow<div><im src=""paste-27509265530
881.jp"" /></div>"
Mylohyoid&nbsp;<div>(other: anterior belly of diastric
to the sides)</div>
Neck PostLab
"Identify this muscle<div><im src=""paste-28200755265537.jp"" /></div>"
Stylohyoid&nbsp;<div><br /></div><div>(you see some of it split in order to allo
w the diastric muscle to o in between; but essentially it is thin and small an
d comin from styloid process)<div><br /></div></div> Neck PostLab
"Identify this structure<div><im src=""paste-28918014803969.jp"" /></div>"
External juular vein (over the top of SCM)<div><br /></div><div>(IJV will be de
ep to SCM)</div>
Neck PostLab
"Identify this muscle<div><im src=""paste-85564338470913.jp"" /></div>"

Posterior Diastric
Neck PostLab
"Identify this structure<div><im src=""paste-86157043957761.jp"" /></div>"
Supraclavicular nerve Neck PostLab
"Identify this nerve found in the deep neck<div><im src=""paste-86612310491137.
jp"" /></div>" "C5 of brachial plexus<div><br /></div><div>(hard to see but it
is the top nerve that comes toether to form the bi bunch of the brachial plexu
s below - comes out between the anterior and middle scalenes)</div><div><br /></
div><div>Note: Phrenic nerve will be on top of the anterior scalene</div><div><i
m src=""anterior_scalene_-_structures_anterior_and_posterior_to_it1315963485163
.jp"" /></div>"
Neck PostLab
"Identify the muscle indicated by the red arrow<div><im src=""paste-87492778786
817.jp"" /></div>"
Trapezius (alon the back)<div><br /></div><div>You can
also see spinal accessory nerve (XI) comin straiht down into the muscle. Above
the left arrow.</div> Neck PostLab
"Identify this muscle<div><im src=""paste-88205743357953_1424358109408.jp"" />
</div>" Thyrohyoid - you see it alon the side the of the thyroid cartilae - o
in upward to hyoid<div><br /></div><div>(the one to the riht of the arrow is o
mohyoid)</div> Neck PostLab
"Identify this structure<div><br /></div><div><im src=""paste-88819923681281.jp
"" /></div>" PLATYSMA muscle<div><br /></div><div>(outer muscle coverin of t
he anterior neck)</div> Neck PostLab
"Identify the nerve found in the deep neck<div><im src=""paste-89378269429761.j
p"" /></div>" Ansa Cervicalis<div><br /></div><div>-see it formin the loop.&n
bsp;</div><div>Can you find: vaus n (Dives riht down), phrenic n. (on anterior
scalene)?</div>
Neck PostLab
"Identify this artery found in the deep neck<div><im src=""paste-90228672954369
.jp"" /></div>"
Suprascapular artery<div><br /></div><div>- comin off t
hyrocervical trunk and lateral and seems to be turnin in towards the suprascaul
ar notch)</div> Neck PostLab
"Identify the muscle<div><im src=""paste-90963112361985.jp"" /></div>"
Sternothyroid - oin straiht up and down between sternal area and thyroid<div>
<br /></div><div>(NOT cricothyroid which is a bit deeper and medial to the arrow
)</div><div>Also see: omohyoid, thyrohyoid (above sternothyroid), sternohyoid (c
enter line)</div>
Neck PostLab
"Identify this muscle<div><im src=""paste-93445603459073.jp"" /></div>"
Omohyoid
Neck PostLab
How does Enfuvirtide work?
Blocks CD4 bindin of HIV GP 120/41
DNA or Viral Genomes are more stable? Which is easier to develop vaccine?<div><b
r /></div><div><br /></div>
DNA viruses is more stable and thus easier to de
velop vaccine aainst.<div>&nbsp;</div>
What are 2 retroviruses we should know? HIV/HTLV (Human T lymphotropic virus)
In addition to our SEAHHH DNA viruses what other DNA viruses should we know?
SEAHH: Small pox, EBV, adenovirus, herpes simplex, herpes zoster, HPV<div><br />
</div><div>Hep B and Polyoma (remember polyoma is a common disease in people who
receive rafts and are immunosuppressed)&nbsp;</div><div><br /></div>
Is Hep C a RNA or DNA virus?
RNA virus<div><br /></div><div><br /></div><div>
Hep B is a DNA virus</div>
Is polio a DNA or RNA virus?
RNA virus<div><br /></div><div>Between Reddy and
Goodman, the RNA viruses we have seen are:</div><div><br /></div><div>Influenza
viruses</div><div>Viruses causin Viral exanthema (viral rash + other systemic
symptoms): measles and mumps</div><div>Gastroenteritis:&nbsp;&nbsp;norovirus and
rotavirus</div><div>Viral Hemorrhaic Fevers (20 total): ebola, yellow fever, m
arbur</div><div>Rabies</div><div>HIV</div><div><b>Polio</b></div><div><b>Hep C<
/b></div><div><b>SARS</b></div><div><br /></div><div><br /></div><div><br /></di
v>
What is the idea of tropism?
Viruses have a clear, preferred taret based on
the hosts cell surface markers (i.e. hep C entry into hepatocytes is uided by v
iral surface proteins bindin to liver cell surface proteins)
What is the structural difference between naked and enveloped virus? Which one i
s more effective?
"Naked virus<div><br /></div><div><im src=""paste-58448

9214410978.jp"" /></div><div><br /></div>"

What does virustatic refer to? What does Virucidal refer to?
Virustatic= prev
entin viral replication (keep it static)<div><br /></div><div>virucidal = elimi
nate (kill) kill the virus (sounds like suicide)</div>
What are interferons? What are their approved uses ?
Host-encoded antiviral p
roteins<div><br /></div><div>Hep B/C, Hairy cell leukemia, Kaposi</div><div><br
/></div><div>Helpful? : If you remember MS causes formation of antibodies aains
t myelin basic protein due to infection by <b>EBV and Herpes </b>which are virus
es and treatment is steroids and <b>interferon amma</b></div><div><b><br /></b>
</div><div>so you ive interferon to help fiht viruses</div><div><br /></div>
{{c1::amantadine}} is an {{c2::anti-influenza}} dru that works by&nbsp;{{c3::in
hibitin viral uncoatin in endosomes}} works by inhibitin PP/acidification of
endosome
What are 2 NRTIs we should know (nucleotide reverse transcriptase inhibitors) an
d what do they treat? AZT for HIV<div><br /></div><div>Acyclovir for Herpes</d
iv>
How do NRTIs work?
They bind the active site of the polymerase (mimic nucle
otides) and et incorporated into the RNA/DNA chain and prevent elonation
What is an NNRTI we should know and what does it do?
Efavirenz aainst HIV
What is the difference between NRTI and NNRTI? <div>Helpful description I found
online:</div><div><br /></div>HIV uses a compound called reverse transcriptase
to convert its RNA to DNA. Think of it like a zip openin to make sinle-strande
d RNA and closin to make double-stranded DNA. In this case, reverse transcripta
se is like the bit at the bottom of a jacket where you insert one part of a zip
to meet the other part of the zip to allow the zip to close.<div><br /></div><di
v><div>The difference between NNRTIs and NRTIs is how they stop reverse transcri
ptase from workin. Think aain of the zip. NRTIs work in different ways but one
of the main ways is to compete with reverse transcriptase for their interaction
site with HIV enetic material. This is like tryin to zip up a jacket with mor
e than one sets of zips. So NRTIs are like another zip ivin the zipper another
track to follow.</div><div><br /></div><div>NNRTIs work by sittin in a bindin
site in the virus structure and this is a bit like havin an object that blocks
the teeth of the zipper, so the zipper cannot et past the block.</div></div>
{{c1::ralteravir}} is an {{c2:: &nbsp;Interase Inhibitor }} used to treat&nbsp
;{{c3::HIV}}
{{c1::AZT}} is a&nbsp;{{c2::NRTI used to treat HIV}}
{{c1::Acyclovir}} is a&nbsp;{{c2::NRTI used to treat Herpes}}
{{c1::Efavirenz}} is a&nbsp;{{c2::NNRTI used to treat HIV}}
{{c1::Indinavir}} is a&nbsp;{{c2::protease inhibitor used to treat HIV}}
What is Oseltamivir?
Neuraminidase inhibitor aainst Flu (aka tamiflu)
What are 2 prophylactic treatements for the flu?
Oseltamivir (oral) and Z
anamivir (inhaled or intranasal)
Name 3 influenza drus. "<div>Amantadine (inhibits viral uncoatin in endosomes)
&nbsp;</div><div>Oseltamivir (inhibits buddin and release - oral)&nbsp;</div><d
iv>Zanamivir (inhibits buddin and release - inhaled/intranasal)&nbsp;</div><div
><br /></div><div><im src=""paste-587950958051826.jp"" /></div>"
What are 5 anti-HIV drus?
"<div>1. Entry / Fusion Inhibitors (Enfuviritide
)&nbsp;</div><div>2.&nbsp;Nucleosides-RTI (AZT)&nbsp;</div><div>3. Nonnucleoside
s-RTI (Efavirenz)&nbsp;</div><div>4. Interase inhibitors (***ravir/ Ralteravi
r)&nbsp;</div><div>5. Protease inhibitors (****navir / Indinavir)&nbsp;</div><di
v><br /></div><div><im src=""paste-588079807070729.jp"" /></div>"
What is the role of proteases in viral maturation?
"As the viron buds from
the surface, viral protease is activated and cleaves polyproteins into component
proteins, which them assemble into the mature virion<div><br /></div><div><b>pr
otease inhibitors prevent this essential step in virus maturation</b></div><div>
<b><br /></b></div><div><b><im src=""paste-588075512103433.jp"" /></b></div>"
What combnation of drus is preferential in HIV therapy?
2 NRTI with&nbsp
;<div><br /></div><div>either&nbsp;</div><div><br /></div><div>protease inhibito
r</div><div>NNRTI&nbsp;</div><div>Interase Inhibitor</div>
What is recommended for PEP (post exposure prophylaxis) 28 days of Prophylactic

therapy&nbsp;
<div>Which of the followin is a DNA virus?&nbsp;</div><div><br /></div><div>Hep
atitis B&nbsp;</div><div>Hepatitis C&nbsp;</div><div>Influenza&nbsp;</div><div>S
ARS&nbsp;</div><div>Ebola&nbsp;</div><div>Papilloma (HPV)&nbsp;</div><div>Rabies
&nbsp;</div><div>Polio</div>
Hep B and HPV
<div>Which of the followin is an RNA Virus?&nbsp;</div><div>Hepatitis B&nbsp;</
div><div>Hepatitis C&nbsp;</div><div>Papilloma - HPV&nbsp;</div><div>Herpes&nbsp
;</div><div>Pox&nbsp;</div><div>Polyoma&nbsp;</div>
Hep C<div><br /></div>
<div>All viruses have their favorite host cells, termed tropism. What is the basis
for viral tropism? &nbsp;Human hepatitis virus infects only humans and that too
only infects hepatocytes and not other human cells?&nbsp;</div><div>A. Viral ge
nome having complementarity with liver DNA&nbsp;</div><div>B. Capsid proteins bi
nding to hepatocyte cell surface&nbsp;</div><div>C.Viral envelope proteins bindi
ng to hepatocyte cell surface proteins&nbsp;</div><div>D. Viral cell membrane fu
sing with hepatocyte cell surface&nbsp;</div><div>E. Viruses prefer liver becaus
e it gets blood from portal vein &nbsp;</div> C.Viral envelope proteins bindin
g to hepatocyte cell surface proteins&nbsp;
<div>There are several approved prophylactic treatments for influenza. How does
<b>amantadine </b>wor
as a prophylactic anti-Flu drug?&nbsp;</div><div>A. By in
hibiting viral RNA polymerase&nbsp;</div><div>B. Inhibits acidification of endos
ome / uncoating of the virus&nbsp;</div><div>C. Inhibits neuraminidase / budding
and release of virus&nbsp;</div><div>D. Prevents entry into host cells; inhibit
s infection of new cells&nbsp;</div><div>E. Induces synthesis of interferons and
also boosts host immune system&nbsp;</div>
B. Inhibits acidification of end
osome / uncoating of the virus&nbsp;<div><br /></div><div>Inhbiting Neuraminidas
e would be <b>oseltamavir/Zanamivir</b></div><div><br /></div><div>Preventing en
try into new cells would be &nbsp;<b>enfuvirtide</b></div>
<div>Accidental infection by HIV and other viruses does occur. Many cases have b
een documented. Post-Exposure Prophylactic (PEP) treatment is recommended. What
is the CDC recommended duration for PEP?&nbsp;</div><div>A. One wee
&nbsp;</div>
<div>B. Two wee
s&nbsp;</div><div>C. Four wee
s&nbsp;</div><div>D. One year&nbsp
;</div><div>E. For the remainder of ones life&nbsp;</div>
C: 4 wee
s (28 d
ays)
Name all the RNA viruses we
now (13) Influenza<div><br /><div>Measles</div><d
iv>Mumps</div><div><br /></div><div>Norovirus</div><div>Rotavirus</div><div><br
/></div><div>Ebola</div><div>Yellow Fever</div><div>Marburg</div><div>SARS</div>
<div>Rabies</div></div><div><br /></div><div>HIV</div><div>Hep C</div><div><br /
></div><div>Polio</div>
Name all the DNA viruses we
now (8)
small pox<div>EBV<br /><div>adenovirus</
div></div><div>Herpes Simplex</div><div>Herpes Zoster</div><div>HPV</div><div>He
p B</div><div>polyoma</div>
What is the MAIN difference between human cells and bacterial cells?<div><br /><
/div><div><br /></div> bacterial cells have cell walls - eu
aryotic cells dont
In addition to the difference in cell wall, what are some other differences betw
een eu
aryotes and pro
aryotes? &nbsp;What receptors can recognize these differe
nces? peptidoglycans<div>LPS (endotoxin)</div><div>bacterial flagella proteins
</div><div>f-methionine</div><div>double-stranded RNA</div><div><br /></div><div
>TLRs can recognize these general differences</div>
What is <u>isoniazid<i>&nbsp;</i>(INH)</u>&nbsp;used for and what is its action
?
anti-TB drug<div><br /></div><div>action: inhibits the synthesis of myco
lic acid, which is in mycobacteria cell membranes</div>
Can Isoniazid (INH) be used prophylactically?<div><br /></div><div>What is a sid
e effect of Isoniazid?</div>
Yes! healthcare wor
ers are often on INH-alpha-T
B prophylactic therapy<div><br /></div><div>SIDE EFFECT: neuropathy (Vitamin B6
supplementation can prevent it)</div>
What drugs are part of the anti-TB coc
tail (NOT RESPONSIBLE FOR)?
PIERS<di
v><br />Pyrazinamide</div><div>Isoniazid (INH)</div><div>Ethambutol</div><div>Ri
fampin</div><div>Streptomycin</div>
What class of drugs are Sulfonamide and Trimethoprim? anti-metabolites against
bacteria --&gt; bacteria cannot ma
e nucleotides<div><br /></div><div>both impa

ct folate metabolism</div>
What is Bactrim or Cotrimoxazole a combination of?
Sulfonamide + Trimethopr
im --&gt; anti-metabolites against bacteria, no folate!
What are three drugs that act as inhibitors of cell wall synthesis?
Penicill
ins (***cillin)<div>Cefazolin (Cef***)</div><div>Vancomycin (only for MRSA)</div
>
Gram positive cells have what two distinguishing characteristics?
1) Pepti
doglycans (&gt;90% of dry weight)<div>Penicillin and cephalosporins target pepti
doglycan synthesis</div><div>made of D-amino acids + modified carbohydrates</div
><div><br /></div><div>2) Lipoteichoic acids&nbsp;</div><div>lipids + teichoic a
cid</div>
Gram negative cells tend to have what two distinguishing characteristics?
LPS (endotoxin)<div>low amounts of peptidoglycans (10% of dry weight)</div>
Peptidoglycan is composed of what?
D-amino acids and modified carbohydrates
What are transpeptidases required for? What drug binds to them? transpeptidases
are required for bacterial cell wall synthesis<div><br /></div><div>Penicillin b
inds to transpeptidases COVALENTLY/IRREVERSIBLY and inactivates the enzyme --&gt
; SUICIDE SUBSTRATES</div><div><br /></div><div>Cephalosporins also bind to tran
speptidases</div>
What does Penicillinase (a
a beta-lactamase) do?
beta-lactam ring in Peni
cillins is unstable<div><br /></div><div>degrades penicillin by opening beta-lac
tam right in penicillin</div><div>--&gt; drugs that inhibit penicillinase can pr
olong hte effects of penicillin</div>
Is the beta-lactam ring stable? What are the implications of this?
NO!<div>
<br /></div><div>low pH in stomach opens ring structure</div><div>penicillinase
(a
a beta-lactamase) can degrade penicillin</div>
What is the first orally available penicillin? AmOxicillin (amoxicillin)<div><b
r /></div><div>O for ORAL!</div>
What is Augmentin?
Amoxicillin + Clavulanic acid (to inhibit penicillinase)
What is Zosyn and where is it used?
Piperacillin + Tazobactam<div>covers bot
h Gram +/- organisms</div><div><br /></div><div>used mostly in intensive care se
ttings</div><div><br /></div><div>Taxobactam - inhibitor of penicillinase</div>
How can bacteria develop resistance to Penicillin?
ma
e beta-lactamase enzy
me
Name six Gram + bacteria.
<ul><li>Staphylococcus</li><li>Streptococcus</li
><li>Pneumococcus</li><li>Enterococcus</li><li>Listeria</li><li>Clostridium</li>
</ul>
Name six Gram negative bacteria.
<div><div><ul><li>Proteus</li><li>E.coli
</li><li>Klebsiella</li><li>Haemophilus</li><li>Enterobactor</li><li>Neisseria</
li></ul><div>PEK HEN</div></div></div>
What types of drugs are more effective against Gram positive bacteria? Why?
Penicillins - because Gram positive bacteria have thic
cell walls<div>Cephalosp
orins</div>
What are some advantages of Cephalosporin over Penicillin?
<ol><li>more res
istant to beta-lactamase</li><li>less hypersensitivity reactions</li><li>more gr
am negative coverage</li></ol>
What is the difference between the older generations of Cephalosporin and the ne
wer generations?
Older generations
illed gram positive<div>- Cefazolin</
div><div>- Cefoxitin<br /><div><br /></div><div>New generations
ill more gram n
egative coverage</div></div><div>- Ceftriaxone</div><div>- Cefepime</div>
What are some drugs that inhibit protein synthesis in bacteria? (7)
Tetracyc
line (***cycline)&nbsp;<div>Streptomycin (***mycin)&nbsp;</div><div>Azithromycin
(Z-pa
)&nbsp;</div><div>Clindamycin, Erythromycin - inhibit translocation&nbsp;
</div><div>Linezolid - inhibits formation of ribosome&nbsp;</div><div>Chloramphe
nicol - inhibits peptidyl transferase</div>
How does Linezolid wor
?
inhibits formation of ribosome complex - bloc
s
protein synthesis
How do Tetracycline and Doxycycline wor
?
prevents binding of tRNA to 30S
ribosome - bloc
s protein synthesis
How do ***floxacins wor
?
"inhibit DNA gyrase (topoisomerase)<div><br /><d

iv><img src=""paste-66778151518334.jpg"" /></div></div>"

What is the general trend with newer generation drugs with regard to gram +/- co
verage? newer generation drugs have less Gram + coverage, more Gram - drug<div><
br /></div><div>(ex. ***floxacins, Cephalosporins)</div>
How does Rifampin/Rifamycin wor
?
inhibits RNA polymerase - only RNA synth
esis inhibitor in clincal use, used in treating RB
What drugs are bacteriostatic? (5)
"<div>tetracyclines-protein</div><div>er
ythomycine-protein</div><div>chloramphenicol-protein</div><div>sulfonamides-fola
te</div><div>vancomycin</div><div><img src=""paste-66941360275750.jpg"" /></div>
"
What drugs are bactericidal? (6)
"Penicillins<div>Cephalosporins</div><di
v>Vancomycin</div><div>Aminoglycosides</div><div>Ciprofloxacin-DNA<br />Rifampin
-RNA</div><div><br /><div><img src=""paste-66937065308454.jpg"" /></div></div>"
What type of drug do you give pateints who are immunocompromised or on immunosup
ressant drugs? (bactericidal vs. bacteriostatic)
"bactericidal!<div><br /
></div><div>because in normal people either one is o
ay, our immune system will
clear the remaining bacteria</div><div><br /></div><div><img src=""paste-6693706
5308454.jpg"" /></div>"
<div>Which one of the following drugs inhibit Gyrase / DNA synthesis?</div><div>
<br /></div><div>Streptomycin</div><div>Tetracycline</div><div>Azithromycin</div
><div>Moxifloxacin</div><div>Erythromycin</div><div>Linezolid</div><div>Clindamy
cin</div><div><br /></div>
Moxifloxacin
<div>Which one of the following drugs wor
by inhibiting&nbsp;</div><div>cell wa
ll synthesis?</div><div><br /></div><div>Vancomycin</div><div>Streptomycin</div>
<div>Cipro</div><div>Clindamycin</div><div>Trimethoprim</div><div>Penicillins</d
iv><div>Cephalosporins</div><div><br /></div> Vancomycin<div><div>Penicillins<
/div><div>Cephalosporins</div></div><div><br /></div>
<div>Which one of the following drugs wor
s by inhibiting&nbsp;</div><div>Bacter
ial protein synthesis?</div><div><br /></div><div>Vancomycin</div><div>Streptomy
cin</div><div>Ciprofloxacin</div><div>Penicillins</div><div>Cephalosporins</div>
<div>Tetracycline</div><div>Azithromycin</div><div><br /></div> <div>Streptomyci
n</div><div><div>Tetracycline</div></div><div>Azithromycin</div>
What is the difference between narrow spectrum and broad spectrum antibiotics? G
ive an example of each. NARROW: Isoniazid (INH) - covers just one bug<div><br />
</div><div>BROAD: Tetracycline - covers lots of bugs, inhibitor of protein synth
esis</div><div>active against gram + and negative</div>
"<img src=""paste-67422396612953.jpg"" />"
1. C: penicillin, cefalosporine,
vancomycin<div>2. A, B Tetracycline, azithromycin</div><div>3. G Ciprofloxin</d
iv><div>4. D Rifampin</div><div>5. F Sulfonamides, trimethoprim</div><div>6. C</
div><div>7. E Vancomycin</div>
Vancomycin: What of bugs is it used for (gram +/-)? What is its mechanism?
Gram positive MRSA bugs<div><br /></div><div>Mechanism Binds D-alanine and preve
nts transpeptidase enzyme for cross-lin
ing&nbsp;</div>
Which of the following inhibit bacterial protein synthesis?<div><br /></div><div
><div>A. &nbsp;Tetracycline, Streptomycin</div><div>B. Penicillin, Cephalosporin
, Vancomycin&nbsp;</div><div>C. Sulfamethoxizole, Trimethoprim</div><div>D. Cipr
ofloxacin E. Rifampin</div></div>
A&nbsp;
Where would aerobic bugs be found? Anaerobic? Airway/Lungs<div><br /></div><di
v>GI tract, urinary tract&nbsp;</div>
What is the drug of choice to treat syphilis? Penicillin G
Anaerobes in the GI, Vagina, Urethra are treated with what drug? What about the
rest of the body?
Metronidazole&nbsp;<div><br /></div><div>Clindamycin&nbs
p;</div>
Name some mechanisms for developing drug resistance
<div><br /></div><div>1.
Degrade the drug. Example: Penicillinase (beta-lactamase)&nbsp;</div><div>2. Ch
ange (mutate) targets altered penicillin binding proteins</div><div>3a. Efflux p
umps - pump drug out of the cells</div><div>3b. Alter membrane / Decrease permea
bility into cells</div><div>4. Transfer resistance genes from other cells (via p
lasmids)</div>
What organisms cause community acquired penumonia? What is the treatment?&nbsp;

<div>Strep. Pneumoniae</div><div>or Staph. Aureus (MSSA)</div><div><br /></div><

div><div>Cephalosporins (3rd generation) + Azithromycin</div><div>or Moxifloxaci
n (covers both gram ve and +ve)</div></div>
What is augmentin?
Amoxicillin 250 milligrams + Clavulanic acid 125 milligr
ams&nbsp;<div><br /></div><div>*Better than amoxicillin alone because&nbsp;Clavu
lanic acid inhibits penicillinase (a beta lactamase). The bacteria that acquired
drug resistance by degrading Amoxicillin are now susceptible to the combination
drug</div>
Clavulanic acid is an inhibitor of penicillinase {{c1::(-lactamase)}}
Why give antiiotics to patients w/ viral infections? <div>1. Pressure from pa
tients for medication</div><div><r /></div><div>2. May help in preventing oppor
tunistic infections from taking over since patiens immune system</div><div>is 
usy fighting the virus</div><div>(especially in elderly &amp; immunocompromised
patients)</div><div><r /></div><div><r /></div><div>**Downside = Development o
f drug resistance.</div>
"What are some ways acteria ""take over"" the ody?&nsp;"
<div><>Coagulas
e</> converts firinogen --&gt; firin, coats acteria, prevents phagocytosis&n
sp;</div><div><r /></div><div><>Catalase</> converts toxic H2O2--&gt;H20, a
cteria can multiply happily</div><div><r /></div><div><>Hemolysis</> Lyses l
ood &amp; immune cells &gt; more difficult to clear infection&nsp;</div><div><r
/></div><div><>Collagenase, Hyaluronidase </> spread y digesting extracellula
r matrix&nsp;</div><div><><r /></></div><div><>Toxins </> to get more nutri
ents, water, electrolytes, etc. from host cells</div>
How do acteria ecome resistant to drugs?<div><r /></div><div><div>1. &nsp;De
grade the drug (like eta-lactamases)</div><div>2. &nsp;lter drug-inding site
s y mutations</div><div>3. &nsp;Exchange drug resistance genes (via plasmids)&
nsp;</div><div>4. &nsp;Pump out the drug (increased efflux)</div><div>5. &nsp
;lter cell memrane to decrease entry of drugs&nsp;</div><div>6. &nsp;ll of
the aove</div></div>
ll of the aove
Name some drugs used to treat TB
<div>PIERS</div><div><r /></div><div>Py
razinamide <>Isoniazid</> (INH) Ethamutol Rifampin Streptomycin</div><div><r
/></div><div>Only resonsile for isoniazid right now</div>
<div> 40 year-old patient is diagnosed with duodenal ulcer.The patient has a hi
story of smoking, claims to consume alcohol in moderation and is in the middle o
f a second divorce.</div><div><r /></div><div>What treatments would you use?</d
iv><div><r /></div><div><div>. &nsp;Penicillin G</div><div>B. &nsp;PPI + Met
ronidazole + moxicillin&nsp;</div><div>C. &nsp;Bismuth susalicylate</div><di
v>D. &nsp;PPI</div><div>E. &nsp;Clarithromycin (expensive)</div></div>
B
What is Z-Pak? How does it work?
<div>zithromycin - Effective against ma
ny different acteria (Broad spectrum).</div><div><r /></div><div>Inhiits prot
ein synthesis</div>
<div>Match the following:</div><div>1. &nsp;Penicillins</div><div>2. &nsp;Quin
upristin / Dalphopristin</div><div>3. &nsp;minoglycosides (example: Streptomyc
in)&nsp;</div><div>4. &nsp;Tetracycline</div><div>5. &nsp;Vancomycin</div><di
v><r /></div><div>. Teeth discoloration, Phototoxicity (avoid in children)&ns
p;</div><div>B.  glycopeptide antiiotic used to treat MRS ugs&nsp;</div><di
v>C. Can cause anaphylaxis (life-threatening)</div><div>D. ntiiotics of last r
esort / expensive</div> 1 --&gt; C<div>2 --&gt; D</div><div>3 --&gt; </div><div
>4--&gt; </div><div>5--&gt;B</div>
What drug do you use to treat MRS? MSS?
MRS: vacomycin<div>MSS: Nafcil
lin&nsp;</div>
What drug do you used to treat VRE (vancomycin-resistant enterococci)?&nsp;
Daptomycin, Linozelid, tygrecyclin&nsp;<div><r /></div><div>Quinupristin / Dal
phopristin is the last resort</div>
One of your paitents has sulfa drug allergies. What drugs would you also avoid?&
nsp; Thiazide diuretics, Loop diuretic furosemide, Sulfonylureas, Sulfasalazi
ne, any sulfa-related drug.
Descrie the drug progression (antiiotic ladder) for gram positive acteria?&n
sp;
"<img src=""paste-3122441224774.jpg"" />"

Descrie the drug progression (antiiotic ladder) for gram negative acteria?&n
sp;
"<img src=""paste-3156800963130.jpg"" />"
What are the drug targets in fungi?&nsp;
Ergosterol, glucan, chitan&nsp;
What drugs inhiit ergosterol synthesis?
*azole drugs (ex. Ketoconazole)&
nsp;
What drug inhiits glucan synthesis?
Caspofungin
mphoter
What drug inds to ergosterol and causes cell memranes to leak ions?
cin
What drug is used against protozoa? Mechanism? Metronidazole--inds ETC protein
s, results in cell dealth.&nsp;
What drugs are anti-malarials? Chloroquine: inds to heme&nsp;<div><r /></div
><div>rtemisinin: for drug resistant strains&nsp;</div>
What drug is used against worm parasites? Mechanism?
Meendazole: inhiits mi
crotuule formation and paralyzes worms
What drug can cause life-threatening anaphylaxis?
Penicillin
"Identify the nerve found in the deep neck<div><img src=""paste-36537286787073.j
pg"" /></div>" "C3 of cervical plexus<div><r /></div><div>Compare to this imag
e:</div><div><img src=""cervical_plexus1315878250226.jpg"" /></div><div>(Trace p
hrenic &nsp;descending on the right and supraclavicular on the left --&gt; up t
o C3)</div><div>C2,3 - transverse cervical. C3,4 supraclavicular nerves, C1,2 superior root; C2,3 - inferior root. C3,4,5 - phrenic nerve</div>"
Neck Pos
tLa
"Identify this structure<div><img src=""paste-37636798414849.jpg"" /></div>"
transverse cervical nerve
Neck PostLa
"Identify this muscle<div><img src=""paste-38225208934401.jpg"" /></div>"
Sternothyroid Neck PostLa
"Identify this structure<div><img src=""paste-38942468472833.jpg"" /></div>"
<div>great auricular nerve</div>
Neck PostLa
"Identify the muscle indicated y the red arrow<div><img src=""paste-39638253174
785.jpg"" /></div>"
Trapezius
Neck PostLa
"Identify this nerve found in the deep neck<div><img src=""paste-44182328573953.
jpg"" /></div>" Hypoglossal nerve<div><r /></div><div>-swooping across aout a
fingers width aove the common carotid ifurcation</div><div>-lateral to hyoglo
ssus</div><div>-near/slightly elow the posterior elly of digastric</div>
Neck PostLa
"Identify the foramen indicated y the red arrow<div><img src=""paste-9713498036
6337.jpg"" /></div>"
Foramen Spinosum<div><r /></div><div>(middle meningeal
artery)</div> PostLa
"Identify the foramen<div><img src=""paste-97963909054465.jpg"" /></div>"
Carotid canal PostLa
"Identify the cranial nerce as it pierces through the dura<div><img src=""paste98578089377793.jpg"" /></div>" Trochlear nerve (CN IV) PostLa
"Identify these cranial nerves as they pierce through the dura within the crania
l cavity<div><img src=""paste-99200859635713.jpg"" /></div>"
glossopharyngeal
and vagus nerves&nsp;<div><r /></div><div>(not spinal accesory - that is nerv
e almost diving into foramen magnum under the left red arrow)</div>
PostLa
"Identify the cranial nerve as it pierces the dura<div><img src=""paste-99866579
566593.jpg"" /></div>" Spinal accessory nerve PostLa
"Identify the venous structure<div><img src=""paste-106446469464065.jpg"" /></di
v>"
Venous confluence
PostLa
"Identify the venous structure<div><img src=""paste-106523778875393.jpg"" /></di
v><div><img src=""paste-106536663777281.jpg"" /></div>" Superior sagittal sinus
PostLa
"Identify the venous structure<div><img src=""paste-106588203384833.jpg"" /></di
v>"
Great Cereral vein (of Galen) PostLa
"Identify the foramen<div><img src=""paste-106725642338305.jpg"" /></div>"
Jugular foramen PostLa
"Identify the foramen indicated<div><img src=""paste-106871671226369.jpg"" /></d
iv>"
Foramen lacerum PostLa
"Identify the cranial nerve which would pierce through the dura at this location

<div><img src=""paste-107043469918209.jpg"" /></div>" Olfactory nerve (CN I)

PostLa
"Identify the venous structure found within the cranial cavity<div><img src=""pa
ste-107133664231425.jpg"" /></div>"
Inferior sagittal sinus PostLa
"Identify this dural fold<div><img src=""paste-107296872988673.jpg"" /></div>"
Tentorium cereelli
PostLa
"Identify the nerve as it pierces the dura<div><img src=""paste-107374182400001.
jpg"" /></div>" Hypoglossal nerve (CN XII)
PostLa
"Identify the venous structure<div><img src=""paste-107464376713217.jpg"" /></di
v>"
superior petrosal sinus PostLa
"Identify the cranial nerve as it pierces dura<div><img src=""paste-107554571026
433.jpg"" /></div>"
Trigeminal nerve (CN V) PostLa
"Identify the foramen<div><img src=""paste-107610405601281.jpg"" /></div>"
Foramen ovale PostLa
"Identify the cranial nerve as it pierces dura<div><img src=""paste-107666240176
ducent nerve (CN VI) PostLa
129.jpg"" /></div>"
"Identify the venous structure<div><img src=""paste-107846628802561.jpg"" /></di
v>"
Superior petrosal sinus PostLa
"Identify the foramen<div><img src=""paste-107915348279297.jpg"" /></div>"
Stylomastoid foramen<div><r /></div><div>(posterior to the root of the styloid
process)</div> PostLa
"Identify the cranial nerve as it pierces the dura<div><img src=""paste-10816016
1415169.jpg"" /></div>" Optic nerve (CN II)
PostLa
"Identify the foramen<div><img src=""paste-108246060761089.jpg"" /></div>"
Lesser palatine foramen PostLa
"Identify the venous structure<div><img src=""paste-108301895335937.jpg"" /></di
v>"
"Straight sinus<div><img src=""paste-108396384616451.jpg"" /></div>"
PostLa
What are two types of unicellular eukaryotes? what are is the immune reponse to
each? Fungi-granulomas<div>protozoans-lymphocytic</div>
Compare and Contrast Yeast vs Hyphal in shape, area of infection, and temperatur
e
"<img src=""paste-859934057038014.jpg"" />"
What stain is used to detect fungi?
GMS stain: stains fungi lack and ackgr
ound is pale green
Superficial infections typically involve _______ or __________ of __________<div
><r /></div><div>Deep infections typically involve________</div>
skin or
mucosa of GI/GU systems<div><r /></div><div>viscera</div>
What are two deep fungal infections that are hyphae in form?
mucormycosis and
aspergillosis
What is dermatomycosis? Skin fungal infection (athletes foot)
What are two superficial fungal infections that infect GI and GU system Thrush f
rom candida infection-GI<div>Fungal vaginitis-GU</div>
Cryptococcus is an indicator of ______ IDS
Coccidioidmycosis infects what organ first?&nsp;
Lungs and then may sprea
d.&nsp;
Why are protozoans very diffiult to treat?
They are eukaryotes, and host is
also eukaryote
Name 3 examples of protozoan disease
Toxoplasmosis<div>frican sleeping disea
se</div><div>Chagas</div>
Parasitic worms and surface parasites are ______
metazoans
What infection is characterized y adominal distention, pain, nutritional compe
tition etween worms and host? scariasis
What is the most common cause of epilepsy in central/south america and india?
Neurocysticerosis- Pig tape worm that infects rain
Cryptococcus, coccidiodmycosis, histoplasmosis, and astomycosis are all _______
_.
yeast fungal forms
what is sensation in the ventricle of the larynx?
internal ranch of super
ior laryngeal
nterior: Frontal and anterior ethmoidal
What opens into hiatus semilunaris?
<div>Posterior: Maxillary</div>

What are the piriform recsses? Gutters where food and liquid flow when swallowi
ng
Where will you find tectorial memrane? continuing from posterior longitudinal l
igament over axis and covering the odontoid process
What are some landmarks for palatoglossus?
"anterior to palatine tonsil and
at the same plane as vallante papilla<div><r /></div><div><img src=""paste-335
13629811284.jpg"" /></div>"
"<img src=""paste-33547989549652.jpg"" /><div><r /></div><div>yellow pin?</div>
"
arytenoid cartilage
"<img src=""paste-33582349288020.jpg"" /><div><r /></div><div>What is this spac
e and what lies in it?</div>" retropharyngeal: sympathetic chain
What are landmarks for each portion of the sympathetic chain? "superior C1-C4:
deep to posterior digastric<div>middle C5-C6: deep to inferior thyroid artery</
div><div>Inferior C7-C8: deep to verteral artery origin</div><div><r /></div><
div><img src=""paste-33668248633821.jpg"" /></div>"
What is the first rach off of CN VII greater petrosal
What innervates hard palate?
nasopalatine and greater palatine
What are the attachment points of tensor tympani?
eustacian tue to malleu
s
"<img src=""paste-33775622816340.jpg"" /><div><r /></div><div>green</div>"
olfactory nerves&nsp;<r /><div><r /></div>
What sensory innervations does IX have? (8)
Oropharynx<div>Nasopharynx</div>
<div>Middle Ear Cavity</div><div>Eustacian tue</div><div>Posterior 1/3 of tongu
e (Sensory and taste)</div><div>palatine tonsil</div><div>carotid ody/carotid s
inus</div><div>Back of uvula</div>
What is the innervation of palatine tonsil?
V2 (lesser palatine) and IX
What exits via Foramen Ovale? V3 ND lesser petrosal nerve (otic ganglion is l
ocated right outside foramen ovale)
What muscles are innervated y CN XII genioglossus<div>hyoglossus</div><div>st
yloglossus</div>
If you have trochlear nerve damage, what happens?
IO takes over so eye is
adducted, elevated, and slightly extorted.<div><r /></div><div>You tilt head aw
ay from eye with trochlear nerve damage</div>
What is the Cervical plexus made up of? ventral primary rami of C1-C4<div><r />
</div><div>Phrenic Nerve</div><div>nsa</div><div>Lesser occipital (C2-C3)</div>
<div>greater auricular (C2-C3)</div><div>transverse cervical (C2-C3)</div><div>s
upraclavicular (C3-C4)</div><div><r /></div><div><r /></div>
What is located in omoclavicular triangle?
suclavian artery and external j
ugular vein
What part of thyroid does superior thyroid artery supply? What nerve runs with t
his?
superior poles of thyroid<div>External ranch of superior laryngeal</div
>
What part of thyroid does inferior thyroid artery supply?
4 parathyroid gl
ands<div>lower thyroid poles</div>
What muscles open the jaw?
gravity, lateral pterygoid, myelohyoid, anterior
digastric, geniohyoid
What muscles close the jaw?
masseter, medial pterygoid, temporalis
What arch is hyoid one derived from
2nd and 3rd<div><r /></div>
what attaches to coronoid
temporalis
What is path of verteral artery?
Enters verteral foramen of C6, enters s
kull through posterior atlanto occipital memrane into foramen magnum
Which muscle of mastication opens the jaw
lateral pterygoid
Which layer in the scalp causes profuse leeding?
loose connective tissue
What nerve sweeps past the sumandiular gland and can e easily injured or cut?
mandiular ranch of facial nerve
Where do the cutaneous ranches of cervical plexus appear?
"<img src=""past
e-37439229919533.jpg"" /><div><div>Cutaneous ranches appear at the posterior o
rder of the SCM, just aove midpoint.</div><div>Clinically, pain in the diaphrag
m or pericardium via the phrenic nerve (C3,4,5) refer pain to the area supplied
y the supraclavicular n.</div><div><r /></div><div>&nsp;Great auricular (C2-3

): To skin over lower half of pinna and angle of jaw, skin over Parotid Gland</d
iv><div>&nsp;Lesser occipital (C2-3): To scalp aove and ehind ear</div><div>&
nsp;Transverse cervical (C2-3): To skin of front, side of neck</div><div>&nsp;
Supraclavicular (C3-4): To skin over clavicle, lateral neck, anterior upper thor
acic wall</div><div><r /></div></div>"
What does the internal carotid ecome? opthalmic artery
What triangle is CN XI in?
"<img src=""paste-38066295144885.jpg"" /><div><
r /></div><div>posterior triangle</div>"
"<img src=""paste-38208029065812.jpg"" />"
isthmus of thyroid gland
Where does pain in diaphragm and pericardium via phrenic nerve refer pain to?
cutaneous region innervated y supraclaviacular nerve (C3-C4)
What are the autoantiodies for diffuse cutaneous systemic sclerosis
anti-top
oisomerase I
What are the antiodies for limited scleroderma?
nti-centromere
Streptococcus pneumonia is a major acterial cause of what?
MOPS: Meningits,
Otitis Media, Pneumonia, Sinusitis
why do antiodies not typically kill gram positive acteria?
ecause of the t
hickness of the cell wall
Incidents of pneumococcal pneumonia occurs far greater in what population? What
are the clinical manifestations like? Incidence of pneumococcal pneumonia far
greater in elderly than in younger adults (usually more serious, too, ut not in
this case).<div><r /></div><div>Clinical manifestations often more sutle in e
lderly. Hinojosa et al, Clin Infect Dis 49:546, 2009</div><div><r /></div>
Descrie the morphology of Streptococcus pneumonia y microscopic exam <div>Pai
rs or chains of elongated cocci</div><div>Gram* positive&nsp;</div><div><r /><
/div>
ll pneu
Descrie how Strep Pneumonia can e identified via alpha hemolysis
mococci produce toxin called alpha- hemolysin. &nsp;When grown on agar that con
tains RBCs, &nsp;reaks hemogloin to a greenish pigment. Colonies on lood aga
r surrounded y greenish zone. The hemolytic pattern gives a good head start in
acterial identification.
Pneumococci are catalase ________ (positive or negative)
negative
What are pneumococci susceptile to inhiition y?
Optochin susceptiility:
nearly all pneumococci are susceptile to inhiition y optochin and do not gro
w around disk that contains this sustance (optochin diffuses into the agar).
What is a definitive identification of Strep Pneumo in the la? Colonies dissolv
e in ile salts -- &nsp;definitive identification
What is the est defense against strep pneumonia infection?
"<div>1.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Capsule is not recogniz
ed y receptors on PMN, and therefore, <>in asence of antiody to specific cap
sular polysaccharide</>, organisms not readily ingested y PMN&nsp;</div><div>
2.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Best defense
against infection is antiody to capsule, whether acquired naturally or vaccineinduced&nsp;</div><div><r /></div>"
Why is the strep pneumonia polysaccharaide capsule not sucesptile y PMNs?
".<span class=""pple-ta-span"" style=""white-space:pre""> </span>ll humans h
ave IgG to pneumococcal cell wall. Ig and complement diffuse through capsule, <
>ut capsule prevents PMN receptors from interacting with Fc of IgG.</>"
How is Lipotechoic acid in Strep Pneumonia involved in the disease process? (3)<
div><r /></div><div>What does Lipotechoic cid contain? What is important aout
this structure? (2)</div>
"<div>1.<span class=""pple-ta-span"" style=""w
hite-space:pre""> </span>Lipoteichoic acid&nsp;Protrudes into capsule; <>media
tes attachment, interacts with &nsp;(TLR 2 &gt;&gt;4), stimulates inflammatory
responses&nsp;</></div><div><r /></div><div>2. Lipotechoic acid<span class=""
pple-ta-span"" style=""white-space:pre""> </span>contains the unique, cholinerich C-polysaccharide of S. pneumoniae;</div><div><span class=""pple-ta-span""
style=""white-space:pre""> </span>a. &nsp; C reactive protein produced y live
r in inflammatory&nsp;diseases and infections reacts with this choline rich C-p
olysacchride--&gt;activates complement</div><div><span class=""pple-ta-span""
style=""white-space:pre""> </span>. &nsp;Important proteins that render pneumo

coccus virulent attach&nsp;to this choline &nsp; &nsp; &nsp; &nsp;</div><di

v><r /></div><div><img src=""paste-8555574854748.jpg"" /></div><div><r /></div
>"
What type of proteins render Strep pneumococcus highly virulent? What are some e
xamples? Why? "Choline Binding proteins: Psp and PspC<div><r /></div><div><i
mg src=""paste-8551279887452.jpg"" /></div><div><r /></div><div>These proteins
ind to the unique choline-rich C polysaccharaide part of lipotecohic acid.</div
><div><r /></div><div>These inding proteins are highly conserved and <>may ha
ve antiphgocytic function</></div>"
What is the molecular make up of peptidoglycan? glucosamine and muramic acid in
long chains
What is pneumolysin? What 3 things does it do? " major virulence factor:<div><
r /></div><div><div>1.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>ctivates complement, stimulating inflammation</div><div>2.<span class="
"pple-ta-span"" style=""white-space:pre""> </span>Damages ciliated cells and P
MN</div><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span>
Reproduces changes of pneumonia in animals</div></div><div><r /></div><div><r
/></div>"
utolysin: allows for self destr
What cell wall hydrolase lyses pneumococci?
uction of pneumococci in vitro.&nsp;<div><r /></div><div>In vivo, releases su
stances such as <>pneumolysin</> that cause inflammation and/or damages tissue
s</div>
In order to cause disease, acteria must adhere to what? How does this occur in
the case of pneumoccoci? How aout in gram negative rods?
In order to caus
e disease, must first adhere to epithelial cells. &nsp;Bacterial surface consti
tuents (molecules or actual structures) interact with surface molecules on mamma
lian cells causing adherence.&nsp;<div><r /></div><div>&nsp;In the case of pn
eumococci, <>lipoteichoic acid </>protrudes through capsule to surface of act
erium, interacts with epithelial cell surface. &nsp;</div><div><r /></div><div
><r /><div>Gram negative rods have <>fimriae</> which serve the same functio
n. &nsp;</div></div>
If acteria are sufficient in numer that you can find them in cultuer ND they
cause no signs or symptoms what is it called? colonization
What is suclinical or latent disease? If organisms are invading tissues and pr
oliferating and ut not causing symptoms, it is called suclinical or latent dis
ease. &nsp;
Strep pneumonia occurs y what 2 general ways? Which is more common for <>strep
pneumonia?</> Which is more common for <>meningococcus</> "<div>1.<span cl
ass=""pple-ta-span"" style=""white-space:pre""> </span>Carried y secretions t
o space from which clearance is poor ecause of damage to clearance mechanisms o
r ostruction (the usual mechanism for pneumococci)--&gt;strep pneumonia</div><d
iv><r /></div><div>2.<span class=""pple-ta-span"" style=""white-space:pre"">
</span>Local invasion through respiratory epithelial cell layers with organisms
going directly to lood stream or lymphatics --&gt; meningococcus</div><div><r
/></div><div><r /></div><div><r /></div>"
What 4 things diminish expulsion of inhaled or aspired strep pneumonia and lead
to acteria reaching distal ronchioles or alveoli?
1. Smoking- increases mu
cus production and causes inflammation, diminishing clearance<div>2. Inflammatio
n from viral infection or pollution</div><div>3. Viral infection damages ciliary
clearance ND increases expression of receptors to which pneumococci adhere</di
v><div>4. lcohol, codeine, and morphine supress cough</div>
"What is the ""pneumonia""&nsp;"
alveoli infiltrate made up of WBC, plasm
a constituents, RBCs that have exited capillaries due to inflammatory cytokines
that have attracted leukocytes and increased capillary permeaility
How does pneumococci cause intense activation of the inflammatory response? (3 m
ajor ways)
1. peptidglycan and pneumolysin--&gt;alt. complement--&gt;C5a<di
v><r /></div><div>2. antiody--&gt;classical complement pathway--&gt;C5a</div><
div><r /></div><div>3. Taken up y dendritic cells and macrophages--&gt;TNFalph
a, IL1, IL6</div>
How does asence of a spleen influence progression and incidence of strep pneumo

nia?
1. Does not predispose to pneumococcal pneumonia<div>2. DOES predispose
to overwhelming sepsis and shock in pneumococcal pneumonia&nsp;</div><div><r /
></div><div>Spleen is NOT ale to clear acteria in asence of opsonizing antio
dy.</div>
What immune defenses do we have against pneumococcal infection esdies antiodie
s to the capsule itself?
1. Patency of Eustacian tues and sinus (good cl
earance)<div>2. Good health</div><div>3. Innate immunity</div><div>4. Humoral: a
ntiody to surface protein and pneumolysin</div>
Is conjugate vaccine etter than polysacchride vaccine? No, suggested that start
primary immunization with protein conjugate and then ooster with polysacchride
vaccine
4 cell types involved in nervous system Sensory cells<div>Neurons</div><div>Glia
</div><div>Effector cells (final targets)</div>
2 parts, and functions of a polarized neuron? Somatodendritic portion - protei
n synthesis and receive signal inputs<div>xonal portion - transmit signals</div
>
gray matter would e the somatodendritic portion or axonal portion of a neuron?
"<img src=""paste-2817498546598.jpg"" />"
Neuronal sudomain that receives excitatory signals? Inhiitory signals?
"Dendritic spine - excitatory<div>Dendritic shaft - inhiitory</div><div><img sr
c=""paste-2877628088740.jpg"" /></div>"
t what location in the neuron are neurotransmitter vesicles concentrated?
Synaptic Bouton (the end of the axon)
What structural feature of neurons can you use to identify the neuron type?
Dendritic ranching patterns<div><r /></div>
What is the most important factor that determines electrical signaling in neuron
s
regulated ion movement across cell memrane<div><r /></div>
how do you measure the electrical field across a memrane?
"use a test elec
trode (that you put in the cell) and compare to a reference electrode (outside o
f the cell)<div><r /></div><div>voltage difference is LWYS INSIDE THE CELL OUTSIDE THE CELL</div><div><r /></div><div><img src=""paste-4157528342992.jpg""
/></div>"
2 key determinants of memrane potential
charge displacement<div>memrane
thickness</div>
T/F - you need a lot of charge separation across the memrane in order to create
a signficant memrane potential
False<div><r /></div><div>you only need
60 unalanced charges to create 1mV memrane potential across a 1um^2 surface o
f normal memrane</div><div><r /></div><div><r /></div>
What is the advantage of myelinated axons over unmyelinated axons in terms of co
nducting action potentials?
myelinated axons have thicker memranes - since
charge displacement and memrane thickness are what determine memrane potential
- you dont need as much of a charge difference to get the same potential diffe
rence -- allows rapid conduction&nsp;
rapid transient change in memrane potential? action potential
What is the purpose of Waters of Hydration around an ion?
"Waters of hydra
tion - surround an ion - use dipoles to dissipate the charge over greater surfac
e area - lower the energy of solvation<div><r /></div><div><img src=""paste-568
6536700214.jpg"" /></div><div><r /></div><div>Note - waters are poppin on and o
ff all the time - not stuck!</div>"
Why cant ions cross the lipid ilayer? e specific
energetic cost of losing
waters of hydrations is too high - thermodynamically unfavorale<div><r /></di
v>
What are the 2 types of ion channels
P(ore) loop channels&nsp;<div>Cys- loop
receptors</div>
Major differences etween P(ore) channels and Cys loop receptors
P(ore)<d
iv>- tetrameric (smaller)</div><div>- highly selective cation channels</div><div
>- Selectivity filter - replaces oxygens for lost waters of hydration</div><div>
<r /></div><div>Cys Loop receptors</div><div>- Broadly selective for cations vs
anions</div><div>- pentameric structure (much igger)</div><div>- Fixed rings o
f charge - select for charge of permeating ions</div>

Explain the structural features of P-loop channel

"<img src=""paste-633507
6762102.jpg"" /><div><r /></div><div>1st part - selectivity filter with oxygens
replacing lost waters</div><div>2nd part - water filled portion&nsp;</div><div
>3rd part - gate</div>"
Decrie relationship etween numer of inding sites in channel and rate of perm
eaility
"<img src=""paste-6468220748222.jpg"" /><div><r /></div><div>mo
re inding sites - faster rate of ion movement</div>"
Why is it important to maintain high levels of calcium for calcium ion channels?
low levels of calcium - very stale when single ion inds to ion inding site will never leave!<div>low concentrations of calcium - acts as a channel locker<
/div>
GB receptors, Nicotinic ch receptors, Glycine recetors, and 5-HT receptors ar
e examples of what type of receptor&nsp;
Cys- Loop receptor
How do Cys- loop receptors select for cations or anions?
Ring of charge if positive, it allows anions to pass through and vice versa
Ring of charge in Cys-loop receptor is filled with Glutamate residues -- is it m
ore likely to e a nicotinic ch receptor or glycine receptor? "Nicotinic ch R
eceptor - selects for cations<div><r /></div><div>glutamate (glutamic acid) - n
egatively charged at ody pH - selects for cations</div><div><img src=""paste-74
25998455240.jpg"" /></div>"
T/F Cys loop receptors can select etween monovalent and divalent cations
"Partially true<div><r /></div><div><img src=""paste-7503307866354.jpg"" /></di
v>"
For a positive charge, if in a positive potential -- would it have high potentia
l energy or low potential energy?
High<div><r /></div><div>PE = charge *
potential</div><div><r /></div><div>so negative charge in a negative potential
= high potential energy</div><div><r /></div><div>negative charge in positive p
otential = low potential energy = charge is happy!</div>
Na ions moving into cell - positive current or negative current?
"negativ
e current&nsp;<div><r /></div><div><img src=""paste-8796093022306.jpg"" /></di
v><div>think aout what the charge is outside</div><div><r /></div><div>so nega
tive charges moving out - negative current.. etc</div>"
Function of Na/K pump electrogenic pumping (+1 charge outside when it pumps 3
Na out and 2 K in) MINTINS ion concentration gradients
T/F Na/K pump activity depends on the memrane potential
False - Na/K pum
p activity is independent of memrane potential
"Explain this graph<div><img src=""paste-9139690406240.jpg"" /></div>" <div>I =
flow</div><div>Em = memrane potential</div><div><r /></div>Each ion has its o
wn unique memrane potential at which the net flow = 0<div><r /></div><div>in o
ther words - each ion has its own memrane potential at which it is happy -- onc
e the memrane reaches that potential there is no more NET movement of THT PRT
ICULR ION - this is called the equilirium potential of the ion</div>
What factors determine what the equilirium potential is going to e? Factors
given in the Nernst Potential (used to calculate equilirium potential)<div>- co
ncentration gradient</div><div>- charge of the ion</div>
Charge separation will continue until energy in concentration gradient is alanc
ed y what?
energy in electrical gradient
What is the nernst potential
Memrane potential that alances an ions concen
tration gradient&nsp;
What is the nernst equation at normal ody temperature "<img src=""paste-992996
4388532.jpg"" />"
"<img src=""paste-10007273800028.jpg"" /><div>explain each term</div>" I = flow
across the memrane<div>Gx - permeaility &nsp;</div><div>Vm - Ex = driving fo
rce -- difference etween what the memrane potential actually is and what the p
ermeale ion wants it to e</div>
What factor in ohms law determines the current that flows for any given conduct
ance
"Driving force<div><img src=""paste-10660108829108.jpg"" /></div>"
Define conductance, resistance and current
"conductance - slope of line of
current vs driving force<div>resistance - reciprocal of conductance&nsp;<r /><
div>Current - charges per second crossing the memrane</div><div><r /></div><di

v><img src=""paste-11420318040200.jpg"" /></div><div><r /></div></div>"

Currents are directed to move the memrane potential towards a certain target po
tential - what is this new target potential called?
"<div>ttractor point&n
sp;</div><div>Note - in this example, the attractor point is the same as the equ
ilirium potential ut that is not always the case!</div><div><img src=""paste-1
1626476470702.jpg"" /></div><div><r /></div>"
Equilirium potential of K is around -90mV. If memrane potential is -65mV, and
you open only K channels, what will potassium do? (leave the cell or enter the c
ell)
K wants the memrane potential to e -90, so it wants to make the cell m
ore negative. So it will leave the cell to make it more negative.
What is the equilirium potential of Na? Cl? K? Ca?
"Ena = +62mV<div>Ecl = 71mV</div><div>Ek = -91mV</div><div>Eca = +124 mV</div><div>Note - this is for a
standard cell with expected concentration gradients shown elow - if the concen
trations were different, the equilirium potentials would also e different</div
><div><img src=""paste-11888469475704.jpg"" /></div>"
Why is the resting memrane potential closest to potassiums equilirium potentia
l?
"K has the greatest conductance, ut there is little conductance from Na
and Cl as well<div><img src=""paste-12519829668238.jpg"" /></div><div><r /></d
iv><div>Can also refer to this equation elow - note that since Gk will e the h
ighest at rest, Er (resting potential) will e determined mostly y potassium</d
iv><div><img src=""paste-12532714569868.jpg"" /></div>"
What role does the Na/K pump play in determining the resting memrane potential?
"Little to no role in GENERTING memrane potential<div><r /></div><div><img sr
c=""paste-12683038425478.jpg"" /><r /><div><r /></div></div>"
"When do you use the GHK equation?<div><img src=""paste-14834817040470.jpg"" /><
/div>" To calculate the steady state potential when multiple ions are permeale
across the memrane<div><r /></div><div>Note - THIS IS NOT N EQUILIBRIUM POTE
NTIL! (even though it looks like the nernst equation)</div><div><r /></div>
<div>What part of a neuron initiates action potential? Why?</div>
<div>xo
n hillock</div><div>- Due to its large concentration of VG-Na channels</div>
<div>What type of ion channel produces action potential firing?</div> Voltagegated ion channels
<div><div>How is excitaility defined in the context of neurons?</div></div>
Excitaility measures how easy it is to fire an action potential.
<div>The minimum current needed to reach the threshold for an action potential i
s called []</div>
Rheoase
<div>The time to fire at a current that is 2x Rheoase is called []</div>
Chronaxie<div><r /></div><div>^{Note: Rheoase = minimum current to reach th
reshold for action potential}</div>
Current clamp experiments: how do they work, what do they help you determine
"<div>Experimenter ""clamps"" the current to e a specific (constant) amount, re
cords the neuronal response.</div><div>- Experiment helps determine minimum syna
ptic currents needed to fire an P (aka rheoase)</div><div><img src=""paste-216
50930139512.jpg"" /></div>"
Give equation for neuronal conductance, G (hint: it has 3 properties) <div>G =
*N*P_open</div><div><br /></div><div><br /></div><div>Written out...</
div><div>Conductance_overall = conductance_{sinle channel} *
# of channels * probability that they are open&nbsp;</div>
Voltae-clamp experiments: how do they work, what do they show: "<div>E<sub>m</s
ub> is ""clamped"" (i.e. held constant) so the drivin force is constant. THUS,
all chanes in current are due to chane in the probability that a channel is op
en&nbsp;</div><div><br /></div><div><im src=""paste-58909771432777.jp"" /></di
v>"
T/F: Chanes in voltae chane the probability that certain channels are open, n
ot the properties of the open channel itself. True<div><br /></div><div>^{I
dea initially proposed by Hodkin &amp; Huxley, and patch clamp experiments conf
irmed.}</div>
Patch clamp: what is it Voltae clamp that records a sinle channel
Compare VG Na and VG K channels in terms of activatin/inactivatin switches.
<div>VG Na has multiple activatin switches, and an inactivatin switch&nbsp;</d

iv><div>VG K has multiple activation switches, but no inactivation switch</div>

VG channel function in eneral is determined by (5):
<div>1. Number of Gatin
Chares&nbsp;</div><div>2. Intrinsic Stability of Closed and Open in the absenc
e of membrane potential (when Em = 0 mV)&nbsp;</div><div>3. Kinetics that determ
ine how rapidly the transitions between these states occur (i.e. the AP we see i
s because VG-Na channels open/close faster than VG-K channels)&nbsp;</div><div>4
. Selectivity properties that determine which ions that can pass throuh the ope
n channel&nbsp;</div><div>5. Inactivation will occur in many channels durin sus
tained depolarization</div>
<div>What is the effect of membrane depolarization on a voltae-ated Na channel
? Talk about relative stability of the conformations of the channel.</div>
"Positive potential destabilizes closed channel conformation, shiftin channel t
o open conformation, allowin Na into the cell.<div><br /></div><div><im src=""
paste-24623047508570.jp"" /></div>"
<div>Describe the steps of an action potential:</div> <div><div>1. Depolarizat
ions open Voltae-ated Na channels</div><div>2. These channels pass inward + cu
rrents, further depolarizin the cell</div><div>3. At Threshold, a positive feed
back cycle is initiated - more Na+ channels open more depolarization.</div><div>4.
After a short delay, K+ channels open and Na+ channels Inactivate,
cell repolar
izes (i.e. returns to neative membrane potential)</div><div>5. Refractory perio
d exists: Neuron cant fire another action potential until Na+ channels recover fr
om Inactivation.</div><div><br /></div></div>
VG-K+ channel shows positively charged Arg/Lys in 4th transmembrane segment (S4)
. Explain how these S4 switches move in the following cases and their effect on
channel conformation:<div><br /></div><div>At 0 mV Em</div><div>At positive/depo
larized Em</div><div>At negative/hyperpolarized Em</div>
"<div><b>At a 0
mv Em:&nbsp;</b></div><div>No ""preferred"" position for the charge&nbsp;</div><
div>Channel opening and closing depends on conformational, intrinsic properties
of the channel&nbsp;</div><div><img src=""paste-26826365731106.jpg"" /></div><di
v><b><br /></b></div><div><b>At a positive/depolarized Em:</b>&nbsp;</div><div>P
ositive charge at switch moves up during channel activation/open</div><div>It wi
ll repel the positive charge in the cytoplasm&nbsp;</div><div><br /></div><div><
img src=""paste-26152055865634.jpg"" /></div><div><b><br /></b></div><div><b>At
a negative/hyperpolarized Em:&nbsp;</b></div><div>Positive charge at switch move
s down during channel inactivation/closing&nbsp;</div><div>It will be attracted
to the negative charge in the cytoplasm</div><div><img src=""paste-2613917096375
2.jpg"" /></div><div><br /></div><div><br /></div><div>This movement shifts gati
ng charges up and down across the lipid bilayer, producing what we see as ""volt
age dependence""</div>"
Surface charge effects: explain effect on voltage-gated channels
"<div>Me
mbrane has some ""fixed charges"" on lipids, proteins, and glycosylations&nbsp;<
/div><div>If an ion binds to a channel, the channel ""feels"" a different voltag
e than what we consider on the macro-scale.&nbsp;</div><div>Tends to be channel
type specific</div>"
Effect of hypercalcemia vs. hypocalcemia (i.e. extracelleular Ca2+ levels) on Na
channel
Hypercalcemia<div>- Higher Ca binding than normal --&gt; more po
sitive charges than normal --&gt;destabilizes Na channels gating charges in ope
n state, moving it to closed state --&gt; harder to fire AP</div><div>Result: De
creased excitability of neurons --&gt; fatigue, depression, confusion, cardiac a
rrythmias, coma/death</div><div><br /></div><div>Hypocalcemia</div><div>- Lower
Ca binding than normal --&gt; more negative charges than normal --&gt; stabilize
s Na channel gating charges in open state --&gt; easier to fire AP</div><div>Res
ult:&nbsp;increased excitability of neurons --&gt; cramps, tingling in extremiti
es, spasms, seizures, cardiac arrhythmias</div>
What are features of bacteria that distinguish them from eu
aryotes? (5)
-Cell Wa
ll<div>-Lac
organelles (nucleus/mitochondria)</div><div>-DNA not pac
aged in hi
stones</div><div>-Can initiate multiple cell cycle events in a single cell</div>
<div>-Divide by binary fission&nbsp;</div>
<div>In terms of propagation of neuronal signal, define:</div>-Sin
s<div>-Source
s</div> <div>Sin
s = locations where + charges entering the cell drive the depol

arization&nbsp;</div><div>Sources = peripheral locations that are depolarized du

e to the + charges flowing in at the sin
</div>
What is a local circuit current?
Current loop between nearby parts of the
same cell that are at different potentials<div>Used to describe AP propagation<
/div>
Effect of decreased&nbsp;axon diameter on internal resistance, membrane resistan
ce, and conduction velocity:
Internal resistance: goes up (slowing conduction
speed)<div>Membrane resistance: goes up (accelerating conduction speed)</div><d
iv>Conduction velocity: decreases as sqrt(diameter)</div><div><br /></div><div><
sub>Note: increasing membrane resistance reduces lea
age of AP out of axon, mean
ing the AP propagates faster</sub></div>
Effect of myelination on axons membrane conductance, capacitance, and conduction
velocity
<div>Myelination reduces the amount of current needed to depolar
ize the membrane by reducing the membrane conductance (Increasing Resistance) an
d reducing capacitance (greater charge separation). Result: increased conduction
velocity</div><div><br /></div><div>Myelination -thic
er--&gt;increased resista
nce--&gt;decreased membrane conductance</div><div>Thic
er--&gt;greater charge se
pearation--&gt;greater potential (V)--&gt;reduced capacitance</div><div><br /></
div><div>C= q/V</div>
How does myelin thic
ness change with increasing axon diameter Myelin thic
ness
increases with increased axon diameter
How does the immune system detect/sense bacteria?
Identifies PAMPS/MAMPS (
pathogen/microbial associated molecular patterns) through TLRs or NOD receptors<
div><br /></div><div>Ex. LPS identified by TLR 4; Peptidoglycan/flagellin identi
fied by TLR 5&nbsp;</div>
In what
ind of axons does saltatory conduction occur? What is the benefit?
Myelinated axons<div><br /></div><div>Benefit: increased conduction velocity of
AP because depolarization only has to occur at nodes of Ranvier</div>
What is the difference between a Gram+ bacteria and a Gram- bacteria? <div>Gra
m-negative bacteria contain an inner membrane surrounded by a<b> thin cell wall
</b>that is encompassed by an outer membrane.</div><div><br /></div><div>Gram-po
sitive bacteria have a single membrane that is surrounded by a <b>thic
cell wal
l</b>.</div>
How do you perform a gram stain?
VIAS<div><br /></div><div>1. Crystal <b>
V</b>iolet (ma
es gram + blue)</div><div>2. Application of <b>I</b>odine</div><d
iv>3. <b>A</b>lcohol wash</div><div>4. Application of <b>S</b>afranin (ma
es gra
m - red)&nbsp;</div><div><br /></div><div>Cells that absorb cristal violet and h
old onto it will appear blue. Cells that absorb safranin will appear red.&nbsp;<
/div>
What is the composition of peptidoglycan? (3) What type of bacteria is it abunda
nt in? "NAG (N-acetylglucosamine)<div>NAM (N-acetylmuramic acid)</div><div>Mura
myl peptide (pentapeptide attached to NAM)</div><div><br /></div><div>*Peptides
cross-lin
to ma
e a mesh-li
e structure; cell wall helps preserve cell shape an
d integrity&nbsp;</div><div><br /></div><div>*Abundant in <b>gram +</b> bacteria
</div><div><img src=""paste-19679540150896.jpg"" /></div><div><br /></div>"
What important antibiotic binds to late peptidoglycan precursors at the pentapep
tide portion and prevents cell wall synthesis? "Vancomycin: binds D-Ala residue
s and prevents cross lin
ing by transpeptidase<div><br /></div><div>*Vancomycin
resistant bacteria change the terminal amino acids so that vancomycin is rendere
d useless<br /><div><br /></div><div><img src=""paste-19907173417636.jpg"" /></d
iv></div>"
"<div>Lipolysaccharide (LPS)</div><div><br /></div><div>Abundant in {{c1::Gram (
-)}} bacteria&nbsp;</div><div>Protects cell from {{c1::environmental stresses li

e antibiotics}}&nbsp;</div><div>{{c1::Lipid A moiety}} can be modified to resis

t cationic peptide antibiotics that would otherwise disrupt LPS&nbsp;</div><div>
Lin
ed with {{c1::human metabolic disorders&nbsp;}}</div><div>Endotoxin activity
- contributes to {{c1::severe immune responses --&gt; sepsis&nbsp;}}</div><div>
Binds to {{c1::TLR4}}</div><div><br /></div><div><img src=""paste-22204980920996
.jpg"" /></div>"
Flagellin:<div><br /></div><div><div>Protein that ma
es up the {{c1::filament po

rtion of the flagellum}}.</div><div><br /></div><div>Ligand for the {{c1::TLR5}}

receptor.</div><div><br /></div><div>Flagella allow bacteria to {{c1::move towa
rds food sources and away from environmental stress.}}</div></div>
What are common molecular targets of antibiotics in bacteria? (5)
Ribosome
s, RNA synthesis, DNA gyrase, Cell wall, Folate metabolism&nbsp;
Why do antibiotics have toxicity problems? (2) 1. Antibiotics can target mitoch
ondrial function, especially mitochondrial ribosomes.<div><br /></div><div>*Mito
chondria were once pro
aryotes (endosymbiotic theory)</div><div><br /></div><div
>2. We have microbiota that controls a lot of normal physiology; these would als
o be
illed by antibiotics</div>
Our favorite critter, clostridium difficile, causes diarrhea that is treated wit
h what?&nbsp; Poop microbiota transplantation&nbsp;<div><br /></div><div>Poop
Poop Poop&nbsp;</div>
What gene is used to study evolutionary relationships between bacteria? 16S
How do you distinguish streptococcus pneumoniae from viridians streptococci (alp
ha-hemolytic strep)?
1) Optochin susceptibility: &nbsp;viridian resistant, pn
eumococcus susceptible<div><br /></div><div>2) Bile salts (2% sodium deoxycholat
e): pneumococcus<b> lyse</b>; all other alpha-hemolytic streps&nbsp;<b>NOT lysed
</b></div>
How do you differentiate between gamma-hemolytic streptococci and other streptoc
occi? "<div>Bile Esculin Test</div><div><br /></div>Gamma-hemolytic strep (Str
eptococcus gallolyticus [bovis] and Enterococci) grow in augur composed of 40% b
ile + Esculin. The augur turns blac
where the gamma-hemolytic strep are, since
they hydrolyze the esculin.<div><br /></div><div><img src=""paste-48679159332865
.jpg"" /></div>"
What is the importance (structural, virulence, toxicity) of muramyl dipeptide?
<div>Cross-lin
s with peptidoglycan</div><div><br /></div>Phage receptor &nbsp;--&gt; &nbsp;increased virulence ---&gt; scarlet fever, toxic strep syndrome<div
><br /></div><div>Exhibits endotoxin-li
e activity</div>
Pyrogenic exotoxins are named SPEA, SPEB, SPEC...<div><br /></div><div>They are
responsible for what symptom? How does the streptococcus gain the ability to ma

e them?</div><div><br /></div> Scarlet fever rash<div><br /></div><div>Bacterio

phages</div>
Whats different about superantigen presentation on MHC II?
"Dont require i
ntracellular processing. Bind outside conventional binding groove on MHCII, and
bind only to the Vbeta variable element of T-cell receptor.<div><br /></div><div
><img src=""paste-66692252172289.jpg"" /></div>"
There are four main acute suppurative diseases caused by S. Pyrogenes: "Pharyng
itis/tonsillitis (the ""strep throat"")<div><img src=""paste-71687299137537.jpg"
" /><br /><div>Pyoderma (impetigo)</div><div><img src=""paste-71700184039425.jpg
"" /></div><div>Cellulitis (lymphangitis)</div><div><img src=""paste-71713068941
313.jpg"" /></div><div>Erysipelas</div><div><img src=""paste-71725953843201.jpg"
" /></div><div><br /></div><div>Rarely: pneumonia, otitis media, bacteremia, pur
peral sepsis&nbsp;</div></div>"
<div>A 65-year-old man is admitted to the hospital with an acute myocardial infa
rction. &nbsp;Emergency angiography demonstrates 95% acute occlusion of the left
anterior descending coronary artery. Which of the following streptococcal compo
nents could be used therapeutically in this man?</div><div><br /></div><div><div
>DNAse B</div><div>Strepto
inase</div><div>Streptolysin O</div><div>Hyalunonidas
e</div></div> <div>Strepto
inase</div>
<div>A 20-year-old boy is admitted to LDS Hospital in Salt La
e City with fever,
a new heart murmur and joint swelling. &nbsp;His pediatrician suspects acute rh
eumatic fever. &nbsp;Which test is appropriate?</div><div><br /></div><div><div>
&nbsp;Anti-streptolysin O titers (ASO)</div><div>&nbsp;Blood cultures</div><div>
&nbsp;Joint fluid PCR for Streptococcus pyogenes</div><div>&nbsp;Optochin suscep
tibility test</div></div><div><br /></div>
<div>ASO</div>
<div>What streptococcal components is the Lancefield grouping system based on?</
div><div><br /></div><div><div>&nbsp;Capsular polysaccharide</div><div>&nbsp;Pyr
ogenic exotoxins</div><div>&nbsp;C-carbohydrates</div><div>&nbsp;Teichoic acids<
/div></div><div><br /></div>
<div>C-carbohydrates</div>

<div>A 56-year-old man is admitted with necrotizing cellulitis of the left leg.
&nbsp;He has a BP=86/65 mmHg, diffuse redness of the s
in, abnormal liver enzyme
s, elevated creatinine and thrombocytopenia. &nbsp;You suspect the toxic strep s
yndrome. &nbsp;The pathogenesis of this syndrome is suspected to be a result of
superantigen production, which includes which one of the following?</div><div><b
r /></div><div><div>Strepto
inase</div><div>Streptolysin O</div><div>Pyrogenic e
xotoxin A</div><div>DNAse</div></div><div><br /></div> <div>Pyrogenic exotoxin
A</div>
<div>A 48-year-old man with COPD is admitted to the MEDVAMC with LLL pneumonia.
&nbsp;His sputum grows an alpha-hemolytic streptococcus on the blood agar plates
. Which of the following laboratory tests will be used to identify this particul
ar organism?</div><div><br /></div><div><div>Bacitracin susceptibility</div><div
>Bile esculin</div><div>Lactose fermentation</div><div>Optochin susceptibility</
div></div><div><br /></div>
Optochin susceptibility
All of the following components of Streptococcus pyogenes are associated with an
antigenic response except:<div><br /><div><div>Hyaluronic acid</div><div>Strept
olysin O</div><div>DNAse</div><div>M-protein</div></div><div><br /></div></div>
Hyaluronic acid
You saw a 13-year-old boy in the Medicine/Pediatrics Clinic yesterday with a sor
e throat, fever, cervical adenopathy, and tonsillar exudates on examination. &nb
sp;The laboratory called this morning to tell you that there is a beta-hemolytic
organism growing on the blood agar plates from the throat swab. &nbsp;The diagn
ostic test that they will run to differentiate the different beta-hemolytic orga
nisms is:<div><br /><div><div>Optochin susceptibility</div><div>Bile solubility<
/div><div>Bacitracin susceptibility</div><div>Penicillin susceptibility</div></d
iv><div><br /></div></div>
<div>Bacitracin Susceptibility</div><div><br /><
/div><div>BRAS</div><div>Group B resistance to Bacitracin</div><div>Group A susc
eptible to Bacitracin (S. Pyogenes)</div>
Two siblings came to the HMO this morning with sore throats accompanied by tonsi
llar exudates and a diffuse rash that had the characteristic of fine sandpaper.
&nbsp;Their problem was caused by:<div><br /></div><div><div>Streptococcus agala
ctiae</div><div>Streptococcus salivarius</div><div>Streptococcus pneumoniae</div
><div>Streptococcus pyogenes</div></div><div><br /></div>
<div>Streptococc
us pyogenes</div>
The drug of choice for treatment of 2 siblings with S. Pyrogenes in the absence
of allergy would be:<div><br /></div><div><div>Determined by antimicrobial susce
ptibility testing of an organism grown from a throat swab.</div><div>Amoxicillin
.</div><div>Azithromycin.</div><div>No antibiotics are required for this disorde
r; it heals by itself without sequelae.</div></div><div><br /></div>
Amoxicil
lin (beta-lactam antibiotics)<div><br /></div><div><div>Penicillins and cephalos
porins (both are beta lactams) are used to treat infection</div><div><br /></div
><div>Long-term penicillin prophylaxis is used for rheumatic fever pts (at ris

for recurrences)&nbsp;</div><div>Macrolides are alternative agents in pts. with

penicillin allergy (though macrolide resistance is fairly prevalent)</div></div>
You are volunteering on a medical mission trip in Jamaica. &nbsp;Several childre
n have been seen with cellulitis in the last month. &nbsp;Today, a child comes i
n with diffuse anasarca. &nbsp;He has a BP = 145/98 mm Hg and his urine is foamy
. &nbsp;When you do a urine dipstic
, there is 4+ protein and 2+ blood. &nbsp;Th
e pathophysiological mechanism responsible for his disease is:<div><br /></div><
div><div>Cross reacting Abs to renal tubular antigens;</div><div>Immune complex
deposition in renal glomeruli;</div><div>Activated T-cells attac
ing renal glome
rular cells;</div><div>Emboli to renal arteries.</div></div><div><br /></div>
Immune complex deposition in renal glomeruli;
What is the pathway of a signal through a neuron?
"<img src=""paste-884247
86690521.jpg"" /><div><br /></div><div>spine--&gt;shaft--&gt;soma--&gt;hilloc
-&gt;axon</div>"
What are the excitatory cation channels at the CNS and PNS?<div><br /></div><div
>What are the inhibitory anion channels at the CNS?</div>
<div>CNS: Glutam
ate (excitatory NT) &nbsp;</div><div>PNS: ACh - NMJ&nbsp;</div><div>PNS: ACh - a
utonomic ganglia&nbsp;</div><div><br /></div><div><br /></div><div><div>CNS: GAB

A (inhibitory NT)&nbsp;</div><div>Spinal cord: 1/2 use glycine/GABA&nbsp;</div><

/div><div><br /></div>
Name the steps facilitating synaptic release of NT
<div>Synaptic release of
NTs:&nbsp;</div><div>1. AP propagates to presynaptic bouton area&nbsp;</div><di
v>2. Depolarization opens VG gated Ca channels&nbsp;</div><div>3. Ca rushes into
cell&nbsp;</div><div>4. Specialized proteins (li
e SNARE and SNAP25) initiate t
he Ca-dependent release of NTs by fusing vesicle to membrane&nbsp;</div><div>5.
This fusion machinery is a target for bacterial toxins&nbsp;</div><div>6. Ca tri
ggers vesicle release&nbsp;</div><div>7. Vesicles are recycled and reused (helpe
d by clathrin and dynamin)&nbsp;</div>
What proteins initiate the Ca-dependent release of NT by fusing the vesicle to t
he membrane? What is the significance of these proteins with respect to bacteria
l toxins?
"SNARE and SNAP25<div><br /></div><div>These are targets for bac
terial toxins (botox)</div><div><br /></div><div>Quic
description (probably too
detailed):</div><div><br /></div><div>1. SNARE proteins on the vesicle and pres
ynaptic membrane form complexes</div><div>2.SNARE protein complexes pull the ves
icle closer to the membrane<br /><div>3. Ca2+ enter via VG calcium channels and
bind to synaptotagmin and promotes fusion of vesicle to presynaptic plasma membr
ane&nbsp;</div><div><br /></div><div><br /></div><div><br /></div><div><img src=
""paste-88776974008677.jpg"" /><br /><div><br /></div></div></div>"
Where are NTs released wtihin CNS pre-synaptic boutons? What is positioned dire
ctly below this location?
"active zones<div><br /><div>Ca channels</div></
div><div><br /></div><div><img src=""paste-88897233092932.jpg"" /></div>"
Usually,&nbsp;EM changes occur with very small changes in ion concentration. Wha
t is a major exception? "Intracellular Ca2+.<div><br /></div><div><div>When Ca c
hannels are active, there is a significant concentration change for intracellula
r Ca which is at 100 nM in a cell&nbsp;</div><div><br /></div><div>Since Ca is a
second messenger, this is the way that electrical signaling transforms into bio
chemical signaling&nbsp;</div></div><div><br /></div><div><img src=""paste-88931
592831430.jpg"" /></div>"
What two proteins help facilitate vesicle recycling?
"<img src=""paste-889831
32438885.jpg"" /><div><br /></div><div>1. Clathrin coats the remnants of the ves
icle</div><div>2. Dynamin pinches off teh coated vesicular membrane</div>"
What is the main receptor found at excitatory receptors? What are the two subtyp
es? How do they differ? Ionotrophic glutamate receptors that open in response to
released glutamate to allow cations to pass through the channels.<div><br /></d
iv><div><br /></div><div>Note: glutamate receptor channels do NOT pass glutamate
thorugh them. Glutamate binds to these receptors and causes these channels to o
pen.</div><div><br /></div><div>AMPA receptors: monovalent cations (Na/K)</div><
div>NMDA: general cations (Na/K/ Ca2+) <b>this receptor is involved in plasticit
y and biochemical signaling</b></div>
Why does opening of the glutamate receptor channel drive the membrane potential
to depolarize? "The zero current potential of the Glutamate receptor channels i
s near 0mV<div><br /></div><div><img src=""paste-89090506621750.jpg"" /></div><d
iv><br /></div><div>Negative current flows to reach attractor.&nbsp;</div>"
Why are glutamate receptors closed at rest?
"Opening requires a torqued conf
ormation which is energetically unfavorable.<div><br /></div><div><img src=""pas
te-89253715378602.jpg"" /></div>"
"<img src=""paste-89296665051606.jpg"" />"
Glutamate binding stabilizes the
originally unfavorable torqued conformation --&gt; opens pore --&gt; lets catio
ns pass through&nbsp;<div><br /></div><div>Note that antagonists stabilize the r
elaxed, closed state</div>
For sustained current injections, signals decay exponentially with distance with
a characteristic <b>space constant. </b>What influences this space constant?
"Higher membrane resistance and lower axial resistance increase the space consta
nt&nbsp;<div><br /></div><div>Thin
: thic
er myelin, increased membrane resistan
ce, longer distance signal can travel.</div><div><br /></div><div>Thin
: if diam
eter is larger, there is lower axial resistance and the signal can travel farthe
r</div><div><br /></div><div><img src=""paste-89477053677920.jpg"" /></div>"
Voltage gated channels tend to reshape basic synaptic responses.&nbsp;<div><br /

></div><div>Explain how the following influence synaptic response:</div><div><br

/></div><div>H- Channels</div><div>A-type potassium channels</div><div>Ca2+/Na2
+ channels</div>
"<img src=""paste-89562953023845.jpg"" />"
If two EPSP synaptic events occur together with an electrically overlapping comp
artment, how do they summate?<div><br /></div><div>If two EPSPs are generated in
an electrically distance compartment, how do they summate?</div>
"Subline
arly<div><br /></div><div>Linearly</div><div><br /></div><div>Explanation:</div>
<div><div>BIG PICTURE: currents have a mass and space associated with them. If E
PSPs are too close together, then they are ""fighting"" for the same spot to dep
olarize (so 1+1 &lt; 2). If they are far away, then they have their own receptor
s to wor
with (so 1+1 = 2) &nbsp;</div><div><br /></div><div>If two EPSPs occur
at the same time but are distant electrically, then they summate linearly (sinc
e both are independent)&nbsp;</div><div><br /></div><div>If two EPSPs occur toge
ther and overlap electrrically, then they summate sub-linearly&nbsp;</div><div>1
) Due to decreased driving force as membrane becomes more depolarized&nbsp;</div
><div>2) Overlapping receptors populations result in competition between NTs for
the same receptor --&gt; sub-linear summation&nbsp;</div></div><div><br /></div
>"
Ability of potential to summate <b>temporally </b>depends on what?
rate lim
iting step for response termination i.e the elimination of transmitters within t
he synaptic cleft via reupta
e, upta
e into astrocytes, brea
down of ntm (achest
erase)
Reptitive stimulation of same synapses results in what type of summation?
temporal: <b>sublinear</b>
Why do transient current injections decay faster with distance as compared to su
stained current injections??
Due to charging of membrane capacitance<div><br
/></div><div>Remember, capacitance is bad for propagation of signal down axon. T
hats why we have myelin to reduce capacitance</div>
"Know what is going on here since this is the major excitatory synapse in the br
ain<div><br /></div><div><img src=""paste-93325344375249.jpg"" /></div>"
1. <b>VGluT</b> pac
s ntm into the vesicle&nbsp;<div>2. Glutamate is released</d
iv><div>3. Glutamate is upta
en by <b>EAA</b> which are located on glial cell as
trocytes</div><div>4. Glutamate is converted bac
into glutamine, transported ba
c
into neuron</div><div>5. Glutamine is converted to Glutamate via <b>PAG</b></
div>
"Know the steps involved here since this is the major inhibitory synapse in the
brain<div><br /></div><div><img src=""paste-93544387707359.jpg"" /></div>"
1. <b>GAD </b>converts Glutamate to GABA<div>2. <b>VIAAT</b> pac
s vesicle full
of GABA</div><div>3. GABA is reupta
en by GABA transporters</div><div>4. GABA is
converted bac
into glutamate by <b>GABA-T</b></div><div>5. Glutamate converted
bac
into glutamine</div><div>6. Glutamine ta
en bac
into neuron</div>
What are the 3 types of coordinated activity of synapses? Describe each Feedbac

: Circuit stabilizes firing even if inputs increase in strength<div><br /></div>

<div>Feed-forward: circuit rapidly adapts to sustained input</div><div><br /></d
iv><div>Lateral Inhibition: circuit sharpens S:N ratio by supressing off target
neuron firing</div>
What is the appeal to special obligations?
As fiduciaries of patient, physi
cian can be trusted to
now what he or she is doing, to protect and promote pati
ents health related interests
What are the 3 components of the ethical concept of medicine as a profession?
1. commit to becoming and remaining <b>scientifically and clinically competent</
b><div>2. commit to using <b>
nowledge and s
ills to primarily protect and protm
ote health</b> related interest of patients</div><div>3. physicians should maint
ain and pass on medicine to future physicians and patients as a <b>public trust<
/b> that exists primarily to benefit present and future presents</div>
"<img src=""paste-98075578204528.jpg"" />"
C
"<img src=""paste-98109937942849.jpg"" />"
E
A 76-year-old woman is admitted to Baylor St. Lu
es Medical Center with a hip fra
cture and undergoes internal fixation. &nbsp;She had a Foley urinary catheter pl
aced on admission. &nbsp;Five days after surgery, she develops delirium, fever a

nd cloudy urine. &nbsp;The urine culture is most li

ely to grow which of the fol
lowing organisms?
<div>Enterococcus faecalis</div>
A 68-year-old woman has a history of mitral stenosis. &nbsp;She presented to her
PCP with a 2-month history of fatigue, intermittent low-grade fevers and mild s
ymptoms of congestive heart failure, which are new. &nbsp;Three sets of blood cu
ltures are positive in both the aerobic and anaerobic bottles for alpha-hemolyti
c, Gram-positive cocci. &nbsp;The organism is most li
ely?
<div>Streptococc
us sanguis</div>
A 56-year-old man was admitted with fevers and chills. &nbsp;Two sets of blood c
ultures are growing Streptococcus constellatus. &nbsp;Which of the following tes
ts is most li
ely to be helpful?<div><br /></div><div><div>A) Transthoracic echo
cardiogram</div><div>B) Transesophageal echocardiogram</div><div>C) Computerized
tomographic scan of the chest &amp; abdomen</div><div>D) Ultrasound of the
idn
eys</div><div>E) Urine culture</div></div><div><br /></div>
C)&nbsp;Computer
ized tomographic scan of the chest &amp; abdomen (loo
ing for abscesses)
&nbsp;A 78-year-old man has been on the rehabilitation ward with an indwelling F
oley catheter for months. &nbsp;A urine culture done for surveillance purposes i
s growing a vancomycin-resistant Enterococcus faecium, but there is no pyuria on
urinalysis. &nbsp;The most appropriate approach to this man is:<div><br /></div
><div><div>A) Place him in contact isolation.</div><div>B) Treat him with PO lin
ezolid, to which the organism is susceptible.</div><div>C) Treat him with IV dap
tomycin, to which the organism is susceptible.</div><div>D) Change the Foley to
a suprapubic catheter.</div><div><br /></div><div><br /></div></div>
A) place
him in contact isolation<div><br /></div><div>he has no pyuria (WBC or pus in u
rine), hes colonized but no infected</div><div>colonized because he had a Foley
catheter and he had antibiotics earlier that wiped out other competing bacteria
</div>
<div><div>This 75-year-old man with benign prostatic hypertrophy is admitted wit
h fevers and chills. &nbsp;Three sets of blood cultures are growing Enterococcus
faecalis. &nbsp;Echocardiogram shows &nbsp;a bicuspid aortic valve with vegetat
ions. &nbsp;You diagnose infective endocarditis. &nbsp;What is the most appropri
ate antimicrobial therapy?</div></div> IV ampicillin + IV gentamicin
<div><div>Streptococcus agalactiae normally inhabits where? (2)</div></div>
bowel<div>vagina</div>
<div><div>Streptococcus agalactiae most commonly infects what populations?</div>
</div> "post partum women<div>newborns (early or late-onset)</div><div><br /></
div><div>older people CAN get group B strep, but they usually have an underlying
medical condition (diabetes, cirrhosis, cancer, genitounrinary disorders)</div>
<div><br /></div><div><img src=""paste-79306571121100.jpg"" /></div>"
<div><div>What is the difference between early-onset and late-onset neonatal Gro
up B Strep (GBS) infection?</div></div> <u>early-onset: &lt; 7 days of birth</u>
<div>- primary bacteremia (no identifiable focus)</div><div>- pneumonia</div><di
v>- meningitis</div><div>- preceding maternal obstetric complications (e.g., ear
ly rupture of membrans and prolonged labor)</div><div><br /></div><div><u>late-o
nset: 7 days - 3 months</u></div><div>- bacteremia + meningitis</div>
<div><div>What is the pathogenesis of GBS infection? (from mother to neonate)</d
iv></div>
In absence of antibody to type-specific carbohydrate, mothers an
d neonates may become infected during labor and birth
<div><div>Maternal Group B strep infection presents as what?</div></div>
pregnancy complications<div>- endometritis</div><div>- chorioamnionitis</div><di
v>- bacteremia</div><div>- C-section wound infections</div>
<div><div>What are some ris
factors for Strep. agalactiae infection during labo
r/birth?</div></div>
absence of antibody to type-specific carbohydrate<div>yo
ung age of mother</div><div>premature rupture of membranes</div><div>prolonged l
abor</div>
<div><div>What are the more common infections of Streptococcus agalactiae? (6)</
div></div>
- OB/GYN<div>- s
in and soft tissue</div><div>- bacteremia</div>
<div>- urinary tract</div><div>- pneumonia</div><div>- septic arthritis</div>
<div><div>Prevention of GBS?</div></div>
"pregnant women are screened for
Group B Strep.<div><br /></div><div>if POSITIVE, then treated before or at time

of delivery with penicillin + cephalosporins</div><div><img src=""paste-7930227

6153804.jpg"" /></div>"
<div><div>Examples of gamma-hemolysis streptococci?</div></div> "streptococcus g
allolyticus<div>enterococcus</div><div>some ""milleri"" group streptococci</div>
"
<div><div>Is Streptococcus gallolyticus sensitive to penicillin?</div></div>
YES
<div><div>Patients who have what must undergo colonoscopy to screen for colon ad
enocarcinoma?</div></div>
S. gallolyticus bacteremia or endocarditis
<div><div>Which grows well in 6.5% NaCl solution?</div></div><div>enterococcus o
r S. gallolyticus</div> "enterococcus<div><br /></div><div><img src=""paste-7943
5420139987.jpg"" /></div>"
<div><div>Which type of enterococcus is more common?</div></div>
"enteroc
occus faecalis (80-90%)<div><br /></div><div>vs. enterococcus faecium (5-10%)</d
iv><div><br /></div><div><img src=""paste-79431125172691.jpg"" /></div>"
<div><div>Where does enterococcus usually reside?</div></div> substantial port
ion of normal bowel flora<div><br /></div><div>entero = intestinal</div>
Which is resistant to penicillin?<div><br /></div><div>Strep. gallolyticus or en
terococcus</div>
enterococcus
Not as intrinsically virulent as other streptococci<div>Infections occur in hosp
italized patients</div><div>- can be transfered on the hands of healthcare perso
nnel</div>
Enterococcus
Which bacteria is not as intrinsically virulent as the other streptococci? Where
does it usually cause infections?
Enterococcus, usually cause infections i
n areas that have been previously damaged
What are the main types of enterococcal infections?
"<b>endocarditis</b><div
><b>UTI</b></div><div>intra-abdominal, pelvic, wound infections</div><div>sponta
neous peritonitis</div><div>nosocomial bacteremia</div><div>CNS infections, pneu
monia (very rare)</div><div><br /></div><div><img src=""paste-80032420594048.jpg
"" /></div>"
What can predispose enterococcus to colonize? &nbsp;Where can it survive for pro
longed periods? predispose: prior antibiotic therapy, surgery, invasive procedur
es<div><br /></div><div>survive: inanimate environment</div>
How are enterococci resistant to antibiotics? (4 ways) <u>1) high-level aminogl
ycoside resistance</u><div>- plasmid-mediated acquisition of aminoglycoside modi
fying enzymes</div><div><br /></div><div><u>2) alter penicillin-binding proteins
</u></div><div>- beta-lactam cannot bind</div><div><br /></div><div><u>3) beta-l
actamase production</u></div><div>- inactivate penicillin + ampicillin</div><div
><br /></div><div><u>4) vancomycin resistance</u></div><div>- altered terminal D
-alanyl~D-alanine on the peptidoglycan side chain so vancomycin cannot bind</div
>
How do you treat Enterococci?<div><br /></div><div>inhibition</div><div>
illing<
/div> inhibition: ampicillin + vancomycin --&gt; tolerance (NOT KILLED!!)<br /
><br /><div>
illing: combination of ampicillin + aminoglycoside (gentamycin or s
treptomycin) for SYNERGY!</div>
Group G Streptococci (S. canis, S. anginosis) are normally found where?<div><br
/></div><div>What underlying diseases are common?</div> normal flora of pharynx,
s
in, intestinal tract and vagina<div><br /></div><div>underlying diseases:</di
v><div>- malignancy</div><div>- alcohol abuse</div><div>- diabetes mellitus</div
>
The most common infectious disease worldwide? Caused by what? dental caries<di
v><br /></div><div>Viridans Streptococci</div>
The most common cause of infective endocarditis?
Viridans streptocci
"Microaerophilic Streptococci or ""Milleri"" group includes what species? (3)&nb
sp;"
S. anginosus<div>S. constellatus</div><div>S. intermedius</div>
Where are microaerophilic streptococci usually found? How do they cause disease?
&nbsp;What do they cause?
found: normal constituents of <b>human bowel</b>
<div><br /></div><div>cause disease when they spread directly or via the blood s
tream to normally sterile areas</div><div><br /></div><div>cause:&nbsp;</div><di
v>- <b>abscess </b>(brain, liver/splenic abscesses)</div><div>- <b>empyema</b> (

pus in pleural cavity)</div><div>- infective endocarditis (VERY RARE!)</div><div

><br /></div>
What types of infections are caused by anaerobic streptococci? (peptococcus/pept
ostreptococcus) <div>normal constituents of GI and female GU tract: cause proble
ms when they end up in normally sterile locations because of altered anatomy</di
v><div><br /></div>- septic abortion<div><div>- endometritis, tubo-ovarian absce
ss (female pelvic tract infection)</div><div>- pulmonary/pleural infections</div
><div>- diabetic food ulcers</div><div>- primary bacteremia&nbsp;</div></div>
Describe the process of sensory detection
"<img src=""paste-3719441678600.
jpg"" /><div><br /></div><div>Sensory stimuli are transduced into graded changes
in Em --&gt; changes neuronal firing rate.&nbsp;</div>"
What is a receptor potential? What are they converted to?
<b>graded</b> re
sponse to a stimulus that may be DEPOLARIZING or HYPERPOLARIZING (li
e post-syna
ptic potentisl)<div><br /></div><div>converted to RATE CODES for transmission to
CNS<br /><div><br /></div><div>Receptor potentials have a threshold in stimulus
amplitude that must be reached before a response is generated, and their amplit
ude saturates in response to intense stimuli.</div></div>
"What is a ""rate code""?"
<div><b>&nbsp;neuronal firing rate pattern that
is specific to the characteristics of the stimuli</b></div><div><br /></div>Spec
ific characteristics, such as intensity and duration, that are converted into sp
ecific patterns of action potentials for transmission to the CNS<div><br /></div
><div>Ex. Increase in the intensity of the stimulus elicits an increase in the m
agnitude of the receptor potential, which produces an increased rate and number
of action potentials.</div><div><br /></div><div>-From text&nbsp;</div>
What receptors are used for the vertebrate visual system? For chemicals and temp
erature?
vertebrate visual system: CNG<div><br /></div><div>chemicals/tem
perature: Trp&nbsp;</div>
What is adaptation in the context of sensory stimulation? What is it regulated b
y?
"<div>Partial desensitization of a response&nbsp;when the stimulus is co
ntinuous for an extended period of time.&nbsp;</div><div><br /></div><div><b><u>
*Ca regulated</u></b></div><div><br /><div><div>Example: &nbsp;</div><div>Your s

in feels when you put a shirt on initially (in presence of wea

stimuli, recept
or is in sensitive state)&nbsp;</div><div>Soon after, you wont constantly get i
nput that the shirt is touching your s
in (in presence of ""stronger"" stimuli,
receptor is adapted to only respond to BIGGER stimulus)</div></div><div><br /></
div></div>"
What is a receptive field?&nbsp;
"The space or set of stimuli in which th
e sensory receptor is located and where it produces the transduction of the stim
uli<div><br /></div><div>set of stimuli that affect the firing of a sensory neur
on</div><div>organization: center vs. the surround - antagonistic field organiza
tion helps sharpen information going into CNS (provides contrast)</div><div><br
/></div><div><img src=""paste-83910776062173.jpg"" /></div>"
Give an example of somewhere in your body with small receptive fields?&nbsp;<div
><br /></div><div>What is the relationship between field size and how critical t
he information is?</div>
One example would be your finger. You need to be
able to distinguish between two stimuli that are a close distance. This is less
important for the leg, forearm, etc.&nbsp;<div><br /></div><div><u>size of the
receptive field is inversly related to how critical the information is</u><div><
br /></div><div>Other example: visual receptive fields are large in periphery, b
ut small in fovea.&nbsp;</div><div><br /></div></div>
T/F Receptive fields have positive and negative stimuli&nbsp; T<div><div><br /
></div></div>
T/F Sensory information is segregated, with each neuron passing a small, well de
fined picture of the overall stimuli. "T<div><br /></div><div>Info comes in on
""labeled lines"", each of which contains a limited representation of the stimu
lus. Ensures the CNS
nows what type of information it is receiving</div>"
T/F All sensory informations enters the cortex via the same region&nbsp;
"F<div><br /></div><div><img src=""paste-5291399709436.jpg"" /></div>"
What primarily determines the area of the cortex devoted to a certain type of se
nsory information?
1. Complexity of the information<div>2. Importance for c

onscious decision ma
ing&nbsp;</div><div><br /></div><div>Ex. Vision, speech hav
e large areas devoted to them&nbsp;</div>
T/F We sense distinct information in our CNS because our receptors can induce di
fferent types of potentials.
"F<div><br /></div><div>The same receptor potent
ial generating channel is used for all stimuli, it is the differential expressio
n of receptors that leads to distinct information to our CNS.&nbsp;</div><div><b
r /></div><div><img src=""paste-6116033430262.jpg"" /></div>"
Describe the organization of a receptor field. What is the functional purpose of
this
ind of organization?
"<div><div>The ""center"" vs. the ""surround"" (
opposing responses in each)&nbsp;</div><div>Antagonistic field organization help
s sharpen information going into CNS (provides contrast)</div></div><div><br /><
/div><div><br /></div><div><img src=""paste-4952097292748.jpg"" /></div>"
There are four types of neurotransmitters involved in neuromodulation of the ner
vous system. What are they?
1) Cholinergic (Ach in CNS)<div>2) Catecholamine
s (Dopamine)</div><div>3) Indoleamines (Serotonin)</div><div>4) Neuropeptides</d
iv>
Sensory Systems<div><br /></div><div>Sensory stimuli are transduced into what?</
div><div><br /></div><div>These are then converted into what?</div>
Sensory
stimuli transduced into <i>graded changes in Em</i>&nbsp;--&gt; then converted i
nto a change in neuronal firing rate (for info. to be transmitted to the CNS)
Information comes into the CNS on what? labeled lines - each contains a very lim
ited representation of the physical stimulus<div><br /></div><div>information in
labeled lines is combined and further processed in the CNS in order to generate
appropriate output responses</div>
T/F: Neuromodulatory systems are targets for drugs of abuse?
T
<div>What are the two mechanisms the CNS uses for neuromodulation?</div>
G-protein coupled receptors (positioned far from center of synapse and ONLY resp
ond to strong stimuli)<div><br /></div><div>Receptors that allow Ca+ to enter th
e neuron (thin
NMDA glutamate receptors). Once calcium enters the cell, enzymes
are activated/deactivated (li
e calmodulin) that lead to neural modulation.</di
v><div><br /></div><div><br /></div><div>Usually a single synapse will have both
&nbsp;<u>classical transmission receptors</u>&nbsp;as well as specific&nbsp;<u>n
euromodulatory receptors.</u><div><u><br /></u></div><div><div>Neurotransmitters
released at the synapse affect both&nbsp;<u>ionotropic receptors that produced
excitatory</u>&nbsp;and inhibitory currents&nbsp;<b>AND</b>&nbsp;<u>G-protein co
upled receptors that are neuromodulatory</u></div></div><div><u><br /></u></div>
<div><div>Keep in mind that specific&nbsp;<u>neuromodulatory systems</u>&nbsp;ex
ist in the CNS that release transmitters that&nbsp;<u>primarily function as neur
omodulators</u>.</div></div></div>
Capsaicin activates what channels?
activates heat sensitive channel TrpV1 (
normally responds to high, noxious temps)<div><br /></div><div>APs reaching the
CNS from the axons are interpreted as a burning sensation even though no heat ha
s been applied</div>
Do most sensory pathways cross over in the CNS? Examples of systems?
"YES!<di
v><br /></div><div>somatosensory</div><div>auditory</div><div>visual</div><div><
br /></div><div><img src=""paste-7932804596310.jpg"" /></div>"
Describe the process of motor responses.
"<img src=""paste-84666690306371
.jpg"" />"
Are cortical motor centers organized in a manner related to body plan importance
?
"yes, motor homunculus<div>areas of cortex devoted to motor control in d
ifferent body areas are related to the complexity of movements produced by that
body region</div><div><br /><div><img src=""paste-85744727097719.jpg"" /></div><
/div>"
What center 1) regulates motor center outputs and 2) monitors sensory feedbac
i
nformation?
intermediary centers
"Sensory information is fed into the motor system at what levels?<div><br />Diff
erence about sensors in ""series"" vs. ""parallel"" in regards to muscles.</div>
"
"AT ALL LEVELS! feed into the motor system to help trigger responses nad
provide feedbac
<div><br /></div><div>FEEDBACK IS CRITICAL FOR PROPER EXECUTION
OF MOTOR RESPONSES!</div><div>series - information about muscle forces</div><di

v>parallel - information about muscle length</div><div><img src=""paste-85688892

522808.jpg"" /></div>"
What are simple motor programs triggered by sensory inputs?
"reflexes<div><b
r /></div><div><img src=""paste-85714662326583.jpg"" /></div>"
What is a motor unit? "motor neuron + subset of muscle fibers<div><br /></div>
<div>motor neurons connect to a subset of muscle fibers in a single muscle</div>
<div>fibers controlled as a UNIT by the motor neuron</div><div><br /></div><div>
<img src=""paste-85491324027216.jpg"" /></div>"
Neuromodulation is typically produced by activating {{c1::cellular enzyme system
s}} that produce covalent modifications of {{c1::channels and receptors}}.<div><
br /></div><div>Describe how this happens for calcium:</div>
"Glutamate is re
leased at a synaptic terminal. Glutamate binds to NMDA receptor. Calcium enters
the cell via NMDA receptors that are 1) bound to glutamate and 2) not bloc
ed by
Mg+2 (meaning the cell must already be <u>depolarized</u>).<div><br /></div><di
v>Intracellular calcium concentrations can also increase via 1) voltage gated ca
lcium channels and 2) by activated Gq-proteins that send a second messenger (IP3
) to ER to open up calcium channels (
ind of li
e in muscle).<div><br /></div><d
iv><img src=""paste-10243497000961.jpg"" /></div></div><div><br /></div><div>Int
racellular calcium then activates one of several cellular enzyme pathways that c
an covalently modify channels and receptors, effect gene expression, and even ef
fect learning and memory.</div><div><br /></div><div><img src=""paste-1036805105
2545 (1).jpg"" /></div>"
Each muscle fiber receives input from many motor neurons. T/F "FALSE, receives
input from a SINGLE motor neuron<div><br /></div><div><img src=""paste-85487029
059920.jpg"" /></div>"
Muscles with finer control have larger/smaller motor units.
smaller
What are coordinated motor plans produced by? &nbsp;Where are these located?
"produced by specific circuits called <u>central pattern generators: </u>located
in specific regions of the CNS<div><br /></div><div><img src=""paste-8552138879
8225.jpg"" /></div><div><img src=""paste-85534273700086.jpg"" /></div>"
What two atypical synaptic connections are made by neuromodulatory systems?
"1) En Passant &nbsp;(""in passing"", neuromodulatory axon sends off little modu
latory offshoots at synapses)&nbsp;<div><img src=""paste-12717398163457.jpg"" />
</div><div><br /></div><div><div>2) Synapsing onto other synapses</div></div><di
v><br /></div><div><br /></div>"
Where are peptide transmitters synthesized?
In the ER (at the soma) and plac
ed into vesicles as inactive precursurs (one long peptide not yet cut up into in
dividual peptide transmitters)
Describe the closure of the Neural Tube "Neural groove ""pulled down"" into meso
derm and lateral ends brought together to close neural tube. Closure complete by
Wee
6.<div><br /></div><div>Becomes encapsulated in mesoderm with overlying, B
MP-secreting ectoderm and underlying Shh secreting Notochord.</div>"
T or F: Li
e the derivative of th rest of the neural tube, the &nbsp;derivatives
of the Prosencephalon have inner grey matter surrounded by outer white matter.
F- Prosencephalon derived cortex (grey matter outside white matter) is unique in
this aspect of <u>proliferation + migration</u>
Describe the Dandy Wal
er malformation. "Occlusion of the 4th ventricle in devel
opment leads to ""blowout"" or rupture of cerebellum.<div><br /></div><div><img
src=""paste-89713276879328.jpg"" /></div>"
Describe the process of release for a neuromodulatory neuropeptide (5): <div>1)
Synthesized into vesicles in ER as inactive precoursers</div><div>2) Proteolytic
cleavage in vesicle produces active peptides</div><div>3) Transported to synaps
e by axonal transport</div><div>- Often found in neurons that also contain a cla
ssical neurotransmitter</div><div>4) Released in response to <b>strong repetitiv
e action potentials</b></div><div>5) Often act on <b>G-protein coupled receptors
</b></div><div><br /></div>
"Which is a glutamate terminal, a peptidergic terminal?<div><img src=""paste-164
79789514753_1408681277100.jpg"" /></div>"
Left - glutamate (non-dense vesi
cles)<div>Right - peptidergic (dense vesicles)</div>
Compare learning and memory with plasticity in the following:<div><br /></div><d

iv>Level of action and how its revealed:</div> <div><u>Learning and Memory</u>:

Organism level changes in Nervous System function</div><div>-&nbsp;changes in b
ehavior to the same stimulus</div><div><br /></div><div><u>Plasticity</u>:&nbsp;
Cellular and Circuitry level changes in Nervous System function</div><div>-&nbsp
;changes in neuronal firing in response to the same stimulus</div><div><br /></d
iv>
What drives learning and memory, and plasticity?
<u><b>Experience</b></u>
T/F: Plasticity underlies changes in learning and memory.
T
Where do you draw the line between neuromodulation and plasticity?
There is
none - neuromodulation is <u>short term/immediate term</u> plasticity (i.e. cel
lular and circuitry level changes in the nervous system)<div><br /></div><div><b
>FYI</b></div><div><div><u>Short term</u> (ms-sec): <b>dynamic changes in gating
states or Ca levels</b>, rapidly reverts&nbsp;</div><div><u>Intermediate term <
/u>(s-hours): <b>changes in covalent bonds</b>, reverts if enzymes clear them&nb
sp;</div><div><u>Long term</u> (hours to days): <b>involves gene expression chan
ges and/or cytos
eletal changes</b>, reverts if there is an opposing long term p
lasticity also happening&nbsp;</div></div>
Describe short term plasticity and its time frame?
(ms-sec): dynamic change
s in gating states or Ca levels,<u> <b>rapidly reverts</b></u>
Describe intermediate term plasticity and its time frame:
(s-hours): chang
es in covalent bonds, <b>reverts if enzymes clear them</b>&nbsp;
Describe long term plasticity and its time frame:
(hours to days): involve
s gene expression changes and/or cytos
eletal changes, <b>reverts if there is an
<u>opposing long term</u> <u>plasticity</u> also happening</b>
Plasticity occurs in two ways: <div><b>Excitability</b>- Changes in Li
elihood
of firing Action Potentials in response to the same stimuli</div><div><b>Synapti
c</b>- Changes in the strengths of connections between neurons</div><div><br /><
/div><div>Neuronal connectivity cannot change - genetically regulated!</div>
What receptor is a good example of <u>associative plasticity</u>, when changes a
re produced in response to &nbsp;multiple factors present at the same time.
NMDA receptor:&nbsp;&nbsp;associates post-synaptic cell firing a spi
e potential
+ glutamate binds to ma
e the receptor active.
Under what circumstances are NMDA channels open?
When the <u>cell is depo
larized</u>&nbsp;(i.e. no Mg+2 is bloc
ing the channel)
Why does Mg+2 bloc
the NMDA channel? "<div>Mg+2 has an affinity for fitting i
n the middle of the NMDA channel. It can only do this when K+ is not shooting ou
t and
noc
ing it out of the way, which happens during an action potential/depol
arization.</div><div><br /></div><div><img src=""paste-20946555502593.jpg"" /></
div><div><br /></div>Also, Mg+2 is fat - carries a lot of water with it."
When the NMDA is not bloc
ed, what is going through it? What is the net current?
"<div>Na and <b><u>Ca+2</u></b> are going into the cell</div><div>K+ is leaving
the cell</div><div><br /></div>Net current is positive (because so much K+ is le
aving the cell, even though Ca+ is entering)<div><br /></div><div><img src=""pas
te-21242908246017.jpg"" /></div>"
At what potentials (+/-) do AMPA receptors pass current? NMDA receptors?
AMPA: at both + and - potentials<div><br /></div><div>NMDA: at + potentials (bec
ause Mg+2 bloc
s at negative potentials)</div>
Why are NMDA receptors part of the neuroplasticity lecture?
Ca2+ ions enteri
ng through NMDA receptors play an important role in regulating synaptic plastici
ty.
When Satan tries to tell you about your past...what do you do? "You tell him ab
out his future.<div><br /></div><div><img src=""paste-22733261897729.jpg"" /></d
iv>"
In synaptic plasticity, what are the Hebbian plasticity rules? "<div>1) If syna
ptic input from A contributes to firing of post-synaptic B --&gt; connection fro
m A to B strengthens</div><div><br /></div><div>2) If synaptic input from A are
not associated with firing of post-synaptic B --&gt; connection from A to B wea

en</div><div><br /></div><div>Graphically:</div><div><img src=""paste-2391437790

4129.jpg"" /></div>"
How do you produce both synaptic neuron action potentials and Long Term Potentia

tion (LTP)
"high frequency stimulation<div><br /></div><div>Graphically:<br
/><div><br /></div><div><img src=""paste-25361781882881.jpg"" /></div></div>"
T/F: Pairing Synaptic activity with Post-synaptic Depolarization Strengthens Syn
apses&nbsp;
T
How does long term potentiation (LTP) affect AMPA receptors?
Upregulated - in
crease in sensitivity to ion movements
How does long term depression (LTD) affect AMPA receptors?
AMPA receptors a
re internalized or removed (decreases ability to depolarize)
How does long term potentiation (LTP) affect the number of Glu receptors and neu
ronal morphology?
"Glu receptors are inserted; neuronal spines grow<div><b
r /></div><div><img src=""paste-26946624815105.jpg"" /></div>"
<div>How might calcium levels in postsynaptic neuron be regulated by glutamate?<
/div><div><br /></div>How is AMPA regulated by these intracellular calcium level
s?
<div>More glutamate --&gt; NMDA receptor is activated and opens (during
depolarization) --&gt; calcium influx</div><div><br /></div>More calcium --&gt;
upregulation of AMPA (neuron is more sensitive to glutamate)<div>Less calcium -&gt; downregulation, removal of AMPA (neuron is less sensitive glutamate)</div>
What happens to the synaptic strength during repetitive synaptic stimulation wit
hout action potential firing? wea
ens synaptic strength
Hippocampal and cerebellar LTD are produced by the activation of different enzym
e systems, and the end result is the same...
internalization of AMPA receptor
s
Hippocampal LTD is produced by activation of what enzyme?<div><br /></div><div>W
hat about cerebellar LTD?</div> "hippocampus: Ca-dependent phosphatases (calcine
urin)<div><br /></div><div>cerebellum: Ca-dependent
inases (Protein
inase C)</
div><div><br /></div><div><img src=""paste-229827994976768.jpg"" /></div><div><b
r /></div><div><img src=""paste-230051333276148.jpg"" /></div>"
Pur
inje output inhibits or promotes movement? inhibits
What are the role of granule cells in their interaction with Pur
inje neurons?
Granule cells synapse with pur
inje neurons in the cerebellum. Important sensory
feedbac
information important for motor coordination is given through this syn
apse.
In the hippocampus, how does NMDA facilitated influx of Ca2+ promote plasticity
changes?
calcium--&gt;CAM--&gt;CAMKII<div><br /></div><div>1. CAMKII phos
phorylates AMPA and NMDA to increase conductance of channels</div><div>2. CAMKII
--&gt;cAMP--&gt;PKA--&gt;CREB--&gt;increase more AMPA receptors&nbsp;</div><div>
3. CAMKII facilitates increase in NO which stimulates the release more ntm.</div
>
"What cell type is depicted below<div><img src=""paste-105780749533805.jpg"" /><
/div>" Pur
inje neurons
What are the 2 major classes of cells in the nervous system?
Neurons and Glia
3 main functions of myelin:
"1. Speeds the action potential<div>2. Decreases
metabolic demands</div><div>3. Reduces space requirements needed for rapid sign
al communication.</div><div><br /></div><div>(He stated this in lecture when on
this slide, but it was not on the PPT.)</div><div><img src=""paste-1065151889414
13.jpg"" /></div>"
What are 3 major morphological classes of neurons?
"<div>Bipolar, Pseudouni
polar,&nbsp;Multipolar</div><div><img src=""paste-106558138614126.jpg"" /></div>
"
Describe the morphology of a bipolar neuron. What is an example?
"Have si
ngle axon and single dendrite that emerge from opposite ends of a cell.<div><br
/></div><div>Example: retinal ganglion cells.</div><div><br /></div><div><img sr
c=""paste-106798656782693.jpg"" /></div>"
Describe the morphology of a pseudo unipolar neuron. What is an example?
"<div>Dendrite and axon emerging from the same process;</div><div><img src=""pas
te-106833016521080.jpg"" /></div><div>Example--Dorsal root ganglion:</div><div><
img src=""paste-106854491357875.jpg"" /></div>"
Describe the morphology of a multipolar neuron. What is the difference between G
olgi I and Golgi II neurons
"<div>Have <b>more than two dendrites that can b
e extensively branched</b>.</div><div>Golgi I = neurons with <b>long axons</b></

div><div>Golgi II (granule neurons)= neurons with <b>short, locally projecting a

xons</b></div><div><img src=""paste-106906030965056.jpg"" /></div><div><br /></d
iv>"
What 4 functional components do most neurons have?
"1-Input (somatodendriti
c)<div>2-Integrative (hilloc
)</div><div>3-Conduction (axon)</div><div>4-Output
(synaptic bouton)</div><div><img src=""paste-107610405601993.jpg"" /></div>"
"The colors on the following image correspond to what structural/functional comp
onents of a neuron?<div><img src=""paste-107670535144142.jpg"" /></div>"
Blue-Dendrites<div>Red-Synapse</div><div>Green-Axon</div>
T or F: Each dendritic spine recieves no more than 1 input.
"F: they recieve
many inputs. The image below depicts 1 spine recieving 10 inputs<div><img src="
"paste-107825153966793.jpg"" /></div>"
"As depicted below, what transmembrane protein is abundant at the axon hilloc
?<
div><img src=""paste-107906758345307.jpg"" /></div>"
Voltage gated Na channel
s
There are many {{c1::dendrites}} per cell, but usually only one {{c1::axon}}.
<br /><div><br /></div>
Which appears first durng neuronal differentiation, axons or dendrites?<div><br
/></div>
Axons.
{{c1::Axons}} are cylindrical, whereas {{c1::dendrites}} have a significant tape
r and spines.
T or F: Both dendrites and axons can be myelinated
T: although, dendrites a
re RARELY myelinated
Ribosomes are found in {{c1::dendrites}}, but are not found in {{c1::axons}}
{{c1::Axon}} branches are far from cell body; {{c1::dendrites}} branch extensive
ly near cell body
Action potentials are generated at the {{c1::axon hilloc
}} and conducted {{c1::
away}} from the cell body, whereas dendrites modulate the excitability of the {{
c1::cell soma and the axon initial segment}}
{{c1::MAP2}} is expressed exclusively in dendrites
T or F: Glia outnumber neurons in the Nervous system
"T....but, I have heard
from other professors this is actually incorrect.<div><img src=""paste-109139413
958979.jpg"" /></div>"
Oligodendrocytes myelinate {{c1::CNS}} neurons; Schwann cells myelinate {{c1::PN
S}} neurons
Describe the function of astrocytes (5) "<div>Astrocytes participate in the form
ation and maintenance of the</div><div><b>1) blood-brain barrier&nbsp;</b></div>
<div>2) Buffer K+ concentrations in CNS</div><div>3) affect reupta
e of NT</div>
<div>4) Tiled/segmented (do not overlap in domains)</div><div>5) control blood f
low to different regions of the brain</div><div><img src=""paste-109349867356760
.jpg"" /></div>"
Describe the function and origin of microglia <div>1. Microglia are scavengers
and remove debris after injury, disease,&nbsp;or neuronal death</div><div>2. Mo
nocyte Derivatives (Not derived from neuroectoderm)</div>
{{c1::Radial glia}} guide migrating neurons and direct outgrowth of axons
T or F: Glia do <b>not</b> fire action potential
T, but do have Ca2+ spi

es
"What function of astrocytes is being depicted below<div><img src=""paste-109654
810034873.jpg"" /></div>"
Astrocytes receiving signal and increasing local
blood flow
Describe the 4 types of microglia
<div>1. Amoeboid: mainly present during
development,</div><div>phagocytose debris but are <b>not antigen presenting</b><
/div><div><br /></div><div>2. Ramified: common morphology of resting microglia</
div><div><br /></div><div>3. Activated: phagocytic and antigen presenting</div><
div><br /></div><div>4. Gitter cells: microglia full of debris unable to</div><d
iv>phagocytose any more material</div>
What are the functions of microglia? (8)
<div>-<b>Scavenging</b> and phag
ocytosis</div><div>-<b>Cytotoxicity</b>: release of cytotoxic substances,</div><
div>proteases, cyto
ines, glutamate</div><div>-<b>Antigen presenting</b> (after
activation)</div><div><div>- <b>inflammation</b> in aging</div><div>-response to

<b>viruses and bacteria</b></div></div><div><br /></div><div>-refinement of cor

tical circuits (development)</div><div><br /></div><div>-Synaptic stripping (dis
ease)</div><div>- neuropathic pain (through the release of</div><div>prostagland
ins and activation of P2X receptors)</div>
T or F: Oligodendrocytes only myelinate 1 neuron
"F: they are mutlipolar
and myelinate many neurons in CNS<div><br /></div><div><img src=""paste-23443649
4885777.jpg"" /></div>"
What are the 2 classes of schwann cells, and describe their function and the num
ber of axons they myelinate
"Myelinating-they myelinate PNS neurons (one axo
n)<div><br /></div><div>Non-myelinating-involved in <b>nociception </b>(multiple
axons)<b>,</b> damaged in chemotherapy induced neuropathy</div><div><br /></div
><div><img src=""paste-234711372792408.jpg"" /></div><div><br /></div><div><img
src=""paste-109989817483980.jpg"" /></div>"
What are 2 tests to differentiate strep and staph?
"1. strep: strip of butt
on candy; staph: cluster of ""staff""<div><br /></div><div>2. staph is catalase
postive, strep is catalyse negative</div>"
What is the major virulence factor for Strep Pyogenes? What about for pneumococc
us
Group A pyogenes: M protein (antiphagocytic)<div><br /></div><div>Pneumo
coccus: pneumolysin</div>
When enzyme in Group A strep is responsible for beta hemolytic ability? streptol
ysin O: destroys RBC and WBC
pyoderma impetigo can be caused by what two bacterial infections?
Strep py
ogenes and/or staph aureus
What is the difference between erysipelas and cellulitis
Erysipelas: infe
ction of superfiical s
in only, bright red rash with sharp border<div>Cellulitis
: infection of dermis, not a clear border</div>
Necrotizing fascitis and Fourniers gangrene is often caused by what ______
strep. pyogenes&nbsp;<div><br /></div><div>M proteins bloc
phagocytosis allowin
g bacteria to move rapidly through tissue and follow path along the fascia</div>
Group A strep is senstive to ________ penicillin G
How do you treat severe strep pyogenes infections?
high dose penicillin and
<b>clindamycin</b><div><b><br /></b></div><div>clindamycin inhibits bacterial r
ibosome and shuts down protein synthesis of pyrogenic toxin and M protein</div>
Rheumatic fever follows what type of streptococcal infection?<div><br /></div><d
iv>Acute glomerulonephritis follows what type of streptococcal infection</div>
group A streptococcal pharyngitis (NOT SKIN)<div><br /></div><div>Group A strept
ococca pharyngitis or s
in infection</div>
What are the 5 manifestations of rheumatic fever?
SPECC<div><br /></div><d
iv>Subcutaneous nodules</div><div>Polyarthritis</div><div>Erythema marginatum</d
iv><div>Chorea</div><div>Carditis</div>
How do you treat patients who are susceptible to recurrent bouts of rheumatic fe
ver?
prophylactic penicillin therapy: prevents future group A strep infection
s
What are the 3 bacteria most often responsible for meningitis immediately after
birth? E coli<div>Listeria</div><div>Group B strep</div>
subacute bacterial endocarditis is usually caused by what?<div><br /></div><div>
How about acute infective endocarditis?</div> Strep. sanguis (viridens group)<
div><br /></div><div>Staph aureus</div>
How do the streptococci wor
together to establish subaccute bacterial endocardi
tis?
Pyogenes causes rheumatic fever which damages heart valves.<div><br /></
div><div>Viridens or group D can more easily adhere to therat valves and cause S
BE</div>
IF strep. intermedius grows in the blood, what should you suspect?
abcess h
iding in an organ you should investigate with a CAT scan with contrast
If you hear about hospitalization, infected catheters, UTIs, or endocarditis, an
tibiotic therapy what bacteria should you thin
about? enterococcus&nbsp;
How do you usually treat enteroccocus? ampicillin plus aminoglycoside (genta/st
reptomycin)
If you see Strep Bovis (gallolyticus) what should you be aware of?
Cancer i
n the bowel!

Does pneumococcus have lancefield antigens?

NO!
otitis media is caused by what 3 main bacteria? strep pneumo<div><br /></div><di
v>haemophilius influenza</div><div><br /></div><div>Moraxella Catarrhalis</div>
What diseases are caused by HITB?
MBECS<div><br /></div><div>Meningitis</d
iv><div>Bactermia</div><div>Epiglottitis</div><div>Cellulitis</div><div>Septic a
rthritis</div>
What causes respiratory disease especially in adults wea
ened by preexisting lun
g disease such as COPD from smo
ing or a recent viral influenza infection?
NTHI
What 2 bacteria cause meningitis later in life (6 months to 3 years)
Haemophi
lius Influenza&nbsp;<div>Neisseria Meningitides</div>
Child develops severe upper airway wheezing (Stridor), unable to swallow, excess
iv droooling, cherry red at base of tonuge
epiglottitis due to HIB
What treatment is used for HIB? Ampillicin/amoxicillin for less serious&nbsp;<d
iv><br /></div><div>Cefotaxime/ ceftriaxone for more serious</div>
How do you differentiate the cause of a veneral chancer between syphilis and H.
ducreyi?
Syphilis is painless and non suppurative
H Influenza needs _______ and grows only on _______
Factor V and X and grows
on chocolate agar<div>V-NAD</div><div>X-hemin</div>
H parainfluenza needs _________ and grows on ____
factor V (NAD) blood aga
r
How do you define virulence?
frequency of severe disease/ frequency of all di
sease or freqency of which bacteria is present
What is acute purulent tracheobronchitis?<div><br /></div><div>What are two caus
es?</div>
"most identified cause of increased cough, sputum, fever, high W
BC count in COPD<div><br /></div><div>""exacerbation of COPD""<br /></div><div><
br /></div><div>1) NTHI</div><div>2) Moraxarella</div>"
What 2 diseases are most commonly caused by H parainfluenza?
Sinusitis<div>Br
onchitis</div>
What are 2 vaccine options for HITB?
PRP capsule (&gt;2 yrs old)<div><br /></
div><div>Protein conjugated vaccine (diptheria toxin or Neisseria outer membrane
protein)</div>
What is the Bile Esculin test used for? <div>Bile-esculin test is widely used to
differentiate <b>enterococci and group D streptococci</b>, which are bile toler
ant and can hydrolyze esculin to esculetin, from <b>non-group D viridans group s
treptococci</b>, which grow poorly on bile.&nbsp;</div><div><br /></div><div><br
/></div>Bile-esculin test is based on the ability of certain bacteria, notably
the <b>group D streptococci</b> and <b>Enterococcus species</b>, to hydrolyze es
culin in the presence of bile (4% bile salts or 40% bile).<div><br /></div><div>
<br /></div>
Describe the steps of transduction
"1. bacteriophage infects host cell by b
inding to cell surface and injecting their DNA into cytoplasm<div>2. bacteriopha
ge DNA replicated and phage proteins made</div><div>3. New phages made by assemb
ly of phage DNA and phage proteins</div><div>4. occasionally a piece of host cel
l DNA may be pac
aged into phage coat (transducing phage)</div><div><img src=""p
aste-259772506964415.jpg"" /></div><div>5. Transducing bacteriophage then infect
s another cell, injecting his+ gene into recipient cell</div><div>6. homologous
recombination transfers trait to recipient cell</div>"
How does HITB cause meningitis? &nbsp;Is it still a big problem?
"directl
y invade superficial layers of pharynx<div>circulates in blood</div><div>settler
s in choroid plexus --&gt; MENINGITIS<br /><br /></div><div>used to be major cau
se of meningitis in young children but now have protein-conjugate capsular polys
acc (HIB)</div><div><br /></div><div><img src=""paste-173920405684759.jpg"" /></
div>"
How do you determine virulence of organisms? (equation) Virulence = frequency of
severe disease / frequency normally colonizing humans
For bacterial invasions, pathogenesis results when what happens?
when the
bacteria grows faster than humans can ma
e antibodies to it
What is the difference between gram negative and gram positive bacteria in regar
ds to complement
illing?
gram negative: Fab of IgG or IgM able to covalen

tly bind to antigen<div>fix complement and activate complement cascade</div><div

>can generate MAC (C5-C9)</div><div><br /></div><div>gram positive cannot be
il
led this way because of thic
peptidoglycan layer</div>
Are antibody of PRP capsule and antibodies of LOS/outer membrane proteins bacter
icidal? YES because can do complement (as opposed to gram positive bacteria)
Does NTHI spread by local infection? How does it spread? Pathogenesis? NO, unli

e HITB<div><br /></div><div>spread by proliferating in already damaged/inflamed

tissues - lower respiratory tract of smo
ers, patients with respiratory virus,
middle ear/sinuses that are bloc
ed (thus, pathogenesis is similar to pneumococc
us!)</div><div><br /></div><div>most people who are colonized dont develop dise
ae, but if they do they li
ely have otitis media or sinusitis</div>
What are the identifying chacteristics of Moraxella catarrhalis?<div><br /></div
><div>&nbsp;Is it usually cultured from blood of infected patient?<div><br /></d
iv><div>What diseases does it cause?</div></div>
gram negative,&nbsp;dipl
ococci<div><br /></div><div>NO, almost never cultured<br /></div><div><br /></di
v><div>2nd major cause of exacerbated COPD (behind NTHI)</div><div>3rd major cau
se of Otitis Media and Pneumonia</div><div><br /></div>
If you have no spleen, what organsims are you at ris
of infection? Why?
spleen required to remove encapsulated organisms<div><br /></div><div>Strep. pne
umo (polysaccharide) and Haemophilus (HITB, polyribosyl ribitol phosphate [PRP])
</div><div><br /></div><div><br /></div><div>SNHKS</div><div><br /></div><div>St
rep Pneumo</div><div>Nesseria</div><div>HI</div><div>Klebsiella</div><div>Salmon
ella</div>
What do you treat Haemophilus Influenzae meningitis with?
"ceftriaxone<div
><img src=""paste-178266912588065.jpg"" /></div>"
What do you treat mucosal infections (otitis media, conjunctivits, bronchitis) o
f Haemophilus influenzae with? amoxicillin +/- clavulanate
What can be used for prophylaxis for Haemophilus influenzae meningitis? "Rifampi
n<div><img src=""paste-176475911225594.jpg"" /></div>"
What is the vaccine for Haemophilus influenzae for? &nbsp;What is it conjugated
to? When should it be given?
"for type B capsular polysaccharide (polyribosyl
ribitol phosphate)<div><br /></div><div>conjugated to <b>diphtheria toxoid</b></
div><div><br /></div><div>given between 2-18 months of age</div><div><br /></div
><div><img src=""paste-176583285407994.jpg"" /></div>"
What does Haemophilus influenzae cause? "<img src=""paste-176999897235535.jpg""
/><div>E = epiglottitis</div><div>M = meningitis (capsulated only)</div><div>O =
otitis media</div><div>P = pneumonia</div><div><br /></div><div>MBECS</div><div
><br /></div><div>Meningitis</div><div>Bacteremia</div><div>Epiglottitis</div><d
iv>Cellulits</div><div>Septic Arthritis</div>"
Haemophilus parainfluenza needs what factors? What does it grow on?
"needs j
ust V factor (NAD), grows on blood agar<div><br /></div><div><img src=""paste-17
8997057028197.jpg"" /></div>"
What are the major advantages (4) and disadvantages of CT imaging (2)? "<b>Adva
ntages:&nbsp;</b><div>-less expensive than MRI</div><div>-Fast</div><div>-More "
"open"" than MRI</div><div>-No absolute contraindications</div><div><br /></div>
<div><b>Disadvantages:</b></div><div>-Image quality is inferior to MRI</div><div
>-<u>Posterior fossa not well visualized</u>&nbsp;due to bony artifact</div>"
What are the primary uses for CT neurological imaging (3)?
"<b>CVA- quic
ly
rule out hemorrhage as cause within the time window to use TPA</b><div><b><br /
></b></div><div>Trauma- rule out intracranial bleed and ""mass effect""</div><di
v><br /></div><div>When MRI is contraindicated</div>"
What contrast is used in CT imaging? How does it help show CNS pathology?
Iodine<div><br /></div><div>It will increase intensity in the brain parenchyma w
here the BBB is compromised (ie due to pathology)</div>
What are the 2 types of MRI? What is the difference in the signal measured?
T1 measures relaxation of magnetization that is <b>parallel</b> to magnetic fiel
d<div><br /></div><div>T2 measures relaxation of magnetization that is <b>perpen
dicular</b> to magnetic field</div>
What are the advantages (2) and disadvantages (4) to MRI vs CT? <b>Advantages:</
b><div>Superior image quality</div><div>Available images in 3 planes</div><div><

br /></div><div><b>Disadvantages:</b></div><div>Expensive</div><div>Slow</div><d
iv>Can cause claustrophobia</div><div>Contraindicated for implanted devices sens
itive to magnetic fields</div>
What are the uses of MRI for neurological imaging (2)? Preferred method to dete
ct&nbsp;<u>intracranial bleeds</u>&nbsp;(<b>except</b>&nbsp;in acute cases where
time is major factor)<div><br /></div><div>Noninvasive study of&nbsp;<u>cerebra
l vessels</u></div>
What contrast agent is used for MRI? How does it wor
? Gadolinum<div><br /></di
v><div>Wor
s the same as iodine does for CT</div>
What is DWI technique for neurological imaging? Diffusion weighted imaging<div><
br /></div><div>Modified MRI that trac
s&nbsp;<u>water diffusion</u>&nbsp;and is
helpful in localizing where damage from&nbsp;<u>ischemic stro
e occurs (irrever
sible damage to Na/K+ pump)</u></div>
What is associated with the following buzzwords?<div><br /></div><div>Periventri
cular white matter lesions</div>
MS
What is associated with the following buzzwords?<div><br /></div><div>Worst head
ache of life, gyri and sulci highlighted</div> Subarachnoid hemorrhage
What is associated with the following buzzwords?<div><br /></div><div>Convex, do
es not cross suture lines</div> Epidural hematoma
What is associated with the following buzzwords?<div><br /></div><div>Concave, d
oes not respect suture lines</div>
Subdural hematoma
In T1 MRI, how does CSF and fat appear? "Fat (myelin) is bright<div><br /></div>
<div>CSF is dar
</div><div><br /></div><div><img src=""paste-270454090629377.jpg
"" /></div>"
In T2 MRI, how does fat and CSF appear? "CSF is bright<div><br /></div><div>Fat
(myelin is dar
)</div><div><br /></div><div><img src=""paste-270449795662081.jpg
"" /></div>"
Why are CT scans of posterior fossa structures angled? To avoid radiation to ey
es
"<img src=""paste-270570054746310.jpg"" /><div>L: normal</div><div>R: Abnormal</
div><div><br /></div><div>What is this?</div>" MS: progressive demylinating dis
ease. Loo
at how dar
the <b>white matter</b> became in MS comapred to normal a
nd how the <b>Sulci </b>are less pronounced due to atrophy
"<img src=""paste-270673133961404.jpg"" /><div><br /></div><div>What type of art
erial infarcts are these?</div><div><br /></div><div>What causes this decrease i
n density in specific regions?</div>" From left to right:<div><br /></div><div
>ACA, PCA, MCA</div><div><br /></div><div>When the Na/K &nbsp;pump fails, Na flo
ws bac
into the cell, bringing water with it.</div><div><br /></div><div>Water
decreases the density on CT&nbsp;</div>
"<img src=""paste-270810572914885.jpg"" /><div><br /></div><div>This is a DWI- w
hat is it showing?</div>"
Acute MCA infarct in which there is irreversible
damage to Na/K pumps leading to restricted water movement<div><br /></div><div>
This is indicated by BRIGHT BRIGHT white on DWI</div>
Teichoic acid is found in gram+ or gram gram positive
What is teh only gram + bacteria with an endotoxin?
Listeria
What ma
es up LPS?
"<div>1. O antigen</div><div>2. Core sugars</div><div>3.
Lipid A moity</div><div><br /></div><div><br /></div><img src=""paste-222049809
20996.jpg"" />"
What structure do abx enter through? What happens if these structures are mutate
d?
Porin proteins<div><br /></div><div>Abx Resistance</div>
"<img src=""paste-275174259687828.jpg"" />"
gram positive: peptidoglycan and
techoic acid<div>Gram negative: LPS and Porins, 2 membrane layers</div>
What organisms have capsules (mnemonic)?
<div>Capsule mnemonic</div><div>
&nbsp;<b>S</b>ome <b>N</b>asties <b>H</b>ave <b>K</b>apsule<b>S</b>:&nbsp;</div>
<div>Strep pneumo</div><div>Neisseria meningitidis</div><div>Haemophilus</div><d
iv>Klebsiella</div><div>Salmonella</div><div><br /></div>
What is the QUellung reaction? when pneumococci on slide smear are mixed with a
small amount of anti serum (serum with antibodies to capsular antigens) and met
hylene blue, capsule will appear to swell.&nbsp;<div><br /></div><div>Detect org
anisms with capsule</div>

"<img src=""paste-275389008052610.jpg"" />"

vancomycin binds here!
Mnemonic for obligate aerobes? <div>Mnemonic: Nagging Pests Must Breathe</div><
div><br /></div><div>Nocardia, Pseudomonas, Mycobacteria, Bacillus</div><div><br
/></div>
Menomonic for anaerobes <div>Clostridium, Bacteroides, Actinomyces</div><div><br
/></div><div><br /></div><div>Cant breathe air</div>
What is a mnemonic for obligate intracellular (meaning it cant ma
e its own ATP
)
<div>Mnemonic: Stay inside when its Really Cold</div><div>Ric
ettsia, Chl
amydia</div><div><br /></div>
What is a mnemonic for facultative intracellular
<div>Mnemonic: Some Nast
y Bugs May Live FacultativeLY.</div><div><br /></div><div>Salmonella, Neisseria,
Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia</div><div>
<br /></div>
Endospores<div><br /></div><div>How are they formed?</div><div>What do they cont
ain?</div><div>How do you
ill them?</div>
<div>formed by some Gram + rods,
especially Bacillus and Clostridium</div><div><br /></div><div>contain <b>dipic
olinic acid</b></div><div><br /></div><div>must autoclave to
ill (120 oC for 15
min)</div><div><br /></div>
What are the various parts of the bacterial growth curve?
"<img src=""past
e-275702540665265.jpg"" /><div><br /></div><div><div>Lag metabolic activity w/o
division</div><div>Log rapid cell division</div><div>Stationary nutrient depleti
on slows growth</div><div>Death prolonged nutrient depletion and buildup of wast
e leads to death</div><div>Bacterial toxins are released from mid-log phase to s
tationary phase</div></div><div><br /></div>"
What is the eagle effect?
paradoxically reduced antibacterial effect of pe
nicillin at high doses though recent usage generally refers to the relative lac

of efficacy of beta lactam antibacterial drugs on infections having large numbe

rs of bacteria.The former effect is paradoxical because the effectiveness of an
antibiotic generally rises with increasing drug concentration.
What other disease is Strawberry tongue seen in other than Scarlet Fever?
Kawasa
i Vasculitis
What is the usual oral form of penicillin?<div><br /></div><div>Which 2 &nbsp;pe
nicillin variants wor
well on gram &nbsp;negative?&nbsp;</div> am<b>o</b>xacill
in<div><br /></div><div>ampicillin</div><div>piperacillin</div>
Augmentin
amoxicillin and clavulanic acid
Zosyn Piperacillin<div>Tazobactam</div>
Unasyn ampicillin + sulbactam
Timentin
ticarcillin+clavulanic acid
Name the Long Tracts of the nervous system (3): Corticospinal Tract (upper motor
neurons)<div>Dorsal Column System (proprioception/fine touch)</div><div>Spinoth
alamic System (pain/thermal sensation)</div>
Definition: signs/symptoms on the <u>same side</u> as the involved CNS structure
Ipsilateral
Definition: signs/symptoms on the <u>opposite side</u> as the involved CNS struc
ture
contralateral
An extrachromosomal, autonomously replicating circular DNA
Plasmid
A bacteria has a circular DNA, separate from chromosomal DNA, that does not have
a replication origin. Is it a plasmid? No-must replicate autonomously
First bacteria in which plasmids recognized
Shigella
3 ways plasmids can be transferred
conjugation, transformation, transductio
n
Definition of transposon
Small genetic elements capable of mediating thei
r own movement from one DNA strand to another. Do not have replication origins (
she said the last sentence, but didnt put it in ppt)
Spinothalamic tract:<div>- Fn: {{c1::Pain/thermal sensation}}</div><div>- # neur
ons involved: {{c1::3}}</div><div>- Synapses at: {{c1::spinal cord + VPL nucleus
}}</div><div>- Decussates at: {{c1::spinal cord (at level of entry)}}</div>
"<font color=""#0000ff""><img src=""paste-44744969291026.jpg"" /></font>"
Definition of compound transposon
Transposon that carries accessory genes
li
e Abx resistance

Describe the 2 methods of transposition "Copy/paste or Cut/paste<div><img src=""

paste-140243567116636.jpg"" /></div>"
Class II transposition is the same as {{c1::Cut and Paste}} transposition
{{c1::Conjugation}} is the only DNA transfer mechanism that requires cell-cell c
ontact
What are the 2 requirements of conjugation
<div>Cell-to-cell (intra- and in
ter-species) contact long&nbsp;</div><div>&nbsp; &nbsp; &nbsp;enough for a conju
gation bridge to be built via&nbsp;</div><div>&nbsp; &nbsp; &nbsp;a sex pilus</d
iv><div><br /></div><div>Presence of a conjugal plasmid capable of transfer&nbsp
;</div><div>&nbsp; &nbsp; &nbsp;replication (plasmids can be lost if not useful
for&nbsp;</div><div>&nbsp; &nbsp; &nbsp;survival)</div><div><br /></div>
Describe sequence of events of bacterial conjugation
"1-Male sends out sex pi
lli to establish cell-cell contact with female. Establishing a stable conjugatio
n bridge is the rate limiting step for this entire process.<div><br /></div><div
>2-Male initiates transfer replication which creates a ssDNA copy of the plasmid
for transfer. This process is the driving fore for transfer and is a REQUIRED s
tep.</div><div><br /></div><div>3-Female converts ssDNA to dsDNA and becomes mal
e.</div><div><br /></div><div><img src=""paste-154167851090280.jpg"" /></div>"
What is the rate limiting step for conjugation Establishment of cell-cell conju
gation bridge.
What is the driving force of genetic transfer in conjugation
Transfer replica
tion
Describe how chromosomal DNA can be transferred by conjugation "Plasmid DNA int
egrated into male bacterias genome, yet still retains ability to undergo transf
er replication. When undergoing transfer replication, will drag along some adjac
ent host DNA. Upon entry into female bacteria, ssDNA must be integrated into hos
t genome as male chromosomal DNA renders it unable to exist as plasmid<div><img
src=""paste-154416959193410.jpg"" /></div>"
Define: Decussate
to cross<div>)</div>
<div>Disease in which spinal segmet (cervical, thoracic, lumbar, sacral) would b
e most severe? Least severe?</div>
<div>Most severe = cervical (more stuff
gets
noc
ed out downstream)</div><div>Least severe = &nbsp;sacral (already furt
her down the spinal cord --&gt; less stuff gets
noc
ed out)</div>
<div>Symptoms of complete transection of spinal cord (segmental lesion) at a giv
en spinal level (2):</div>
<u>Wea
ness</u> below lesion [due to
noc
out of
corticospinal tract motor function]<div><u>Loss of sensation</u> below lesion [
due to
noc
out of dorsal column system + spinothalamic system sensory functions
]</div>
Selective tract disease: define a disease that <u>preferentially affects certain
long tracts</u> of nervous system&nbsp;<div><br /><div>_{(Ex: a disease that
affects corticospinal tract but not the spinothalamic tract or the dorsal colum
n system would be a selective tract disease)}</div></div>
Describe the Griffith experiment
"<div>Griffith: avirulent pneumococcus c
an be transformed into a virulent bacterium using a heat-
illed extract of the v
irulent donor strain.</div><div><br /></div><div><img src=""paste-15486793075953
7.jpg"" /></div><div><br /></div>"
Describe the&nbsp;Avery, MacLeod and McCarty experiment "<div>Avery, MacLeod and
McCarty: transforming principle is DNA, because transformation is DNAse-sensitive
. Transformation does not require cell-to-cell contact.&nbsp;</div><div><br /></
div><div><img src=""paste-154906585465195.jpg"" /></div>"
Describe the sequence of events for transformation
<div>1-Development of co
mpetence; not all bacteria can be transformed</div><div>2-DNA binds to the cell
surface</div><div>3-DNA enters the recipient cell</div><div>4-DNA integrates int
o host chromosome by homologous recombination. Plasmid molecules can replicate e
xtrachromosomally</div><div><br /></div>
What role do pilli play in bacterial transformation
Reach extracellularly to
grab DNA
Signs and symptoms (3) that localize to <u>Cerebral hemisphere</u> upon neurolog
ical differential Dx: Contralateral long tract findings<div>Defects of higher
function (aphasia, apraxia, agnosia)</div><div>Visual field defects</div>

<u>collection of language disorders</u>&nbsp;caused by damage to cerebral hemisp

here&nbsp;
<u>Aphasia</u>
<u>inability to execute complex motor tas
s</u>; can be caused by damage to cere
bral hemisphere&nbsp; <u>Apraxia</u>
<u>inability to interpret complex sensory information</u>&nbsp;(e.g. facial reco
gnition); can be caused by damage to cerebral hemisphere&nbsp; <u>Agnosia</u>
Transformation (natural variety) uses {{c1::ss}}DNA
RecA (bacterial protein) plays what role in transformation
Searches for hom
ologous DNA sequences for integration of exogenous DNA.
What epigenetic modification must be made to DNA during transformation if it is
to be saved from deletion
Methylation
Capsule exchange occurs by what process of DNA acquisition
"Transformation.
...sorry I really dont understand capsule exchange<div><img src=""paste-15557660
0363564.jpg"" /></div>"
Describe&nbsp;Zinder and Lederberg
Zinder and Lederberg described a DNase-r
esistant filterable agent, which could transduce an auxotroph of Salmonella to pro
totrophy. Cell-cell contact was not required. Particle was smaller than a bacter
ium (bacteriophage = bacterial virus).&nbsp;
Definition of transduction
<div>Transduction: Bacteriophage-mediated transf
er of genetic material from one bacterial cell to another.</div><div><br /></div
>
Describe the Hershey Chase experiment "Blender experiment:<div><br /></div><di
v>1. Alternatively label Phage protein or DNA with sulfur and allow it to infect
bacteria.</div><div><br /></div><div>2. Blend to remove Phage from bacteria.</d
iv><div><br /></div><div>3. Image bacteria, see that DNA is present within bacte
ria and not protein</div><div><img src=""paste-155963147420196.jpg"" /></div><di
v><img src=""paste-155976032322078.jpg"" /></div>"
Basal ganglia:<div><br /></div><div>Contralateral/Ipsilateral findings: {{c1::Co
ntralateral}}</div><div>Prime manifestations = {{c1::Movement disorders (Par
ins
ons Huntingtons)}}</div>
Cerebellum:<div><div><br /></div><div>Contralateral/Ipsilateral findings:&nbsp;{
{c1::<u>Ipsilateral action tremor</u> when cerebellum itself is involved}}</div>
<div>Prime manifestations = {{c1::ataxia, dysdiadocho
inesia (inability to do ra
pid alternating movements))}}</div></div>
<div><br /></div>
Brainstem:<div><br /></div><div><div>Contralateral/Ipsilateral findings: {{c1::I
psilateral CN, Contralateral long tract}}</div><div>Prime manifestation = {{c1::
Disturbances of conjugate gaze and/or puipls, disturbances of balance)}}</div></
div>
Describe lytic and lysogenic cycles of bacteriophage replication
<div>Lyt
ic: phage nucleic acid is replicated, structural components are synthesized and
phage particles assemble in cytoplasm. Bacterium is lysed and mature phage are r
eleased</div><div><br /></div><div>Lysogenic: integration of the phage DNA into
the chromosome; phage DNA is passively replicated with the chromosome</div><div>
<br /></div>
Give potential causes of neurological disorders correlating to the time course o
f the condition:<div><br /></div><div><div>Seconds to minutes {{c1::(trauma, str
o
e)&nbsp;}}</div><div>Minutes to hours {{c1::(acute infection, intoxications, d
emyelination)&nbsp;}}</div><div>Days to wee
s {{c1::(chronic infections, demyeli
nation , neoplasm)&nbsp;}}</div><div>Months to years {{c1::(neurodegeneration)}}
</div></div>
List potential Etiologies of neurological disorders (8):
Vascular<div>Inf
ectious&nbsp;</div><div>Inflammatory/demyelinating</div><div>Neoplasm</div><div>
Neurodegenerative</div><div>Toxic/metabolic</div><div>Trauma</div><div>Developme
ntal</div>
In brainstem, why are CN findings ipsilateral but long tract findings contralate
ral?
Long tract findings are contralateral because <u>decussation has already
occurred</u>;&nbsp;
Neuro exam: Questions to as
that relate to time course of disease
Single e
pisode or multiple?<div>Same location or several?</div><div>Getting better, wors
e, or staying same?</div><div>Associated systemic diseases/signs/symptoms?</div>

<div>Family history?</div>
Why would a lesion above the VPL (ventral posterior lateral) nucleus produce the
following symptoms:&nbsp;Loss of pain, thermal, proprioception, fine touch sens
ations&nbsp;
<u>long tract neurons come together above the VPL</u>; lesion of
nucleus causes loss of fn to dorsal column pathway (propriocption/fine touch) a
nd spinothalamic system (pain/thermal)
How do bacteriophages bind to bacterial surface "Use normal cell surface protein
s as ""receptors""<div><br /></div><div>Ex:O-antigens, porins, flagella, or pili
</div><div><br /></div>"
T or F: Bacteriophages can only transfer Phage DNA to bacteria "F: 1% of phages
undergo ""mispac
ing"" in which they pac
some host genomic DNA into virus."
Describe the clincial relevance of transduction <div>Premise: result of occasion
al pac
aging of host DNA during lytic infection and subsequent transfer to a rec
ipient via phage injection&nbsp;</div><div><br /></div><div><div>Shig<b>A-</b>li

e toxin&nbsp;</div><div><b>B</b>otulinum toxin (Clostridium botulinum)&nbsp;</d

iv><div><b>C</b>holera toxin (Vibrio cholerae)&nbsp;</div><div><b>D</b>iphtheria
toxin (Corynebacterium diphtheriae)&nbsp;</div><div><b>E</b>rythrogenic toxin (
Streptococcus pyogenes)&nbsp;</div></div><div><br /></div><div><br /></div>
<div>Which of the following are DNA donors for gene transfer?&nbsp;</div><div><b
r /></div><div>A. Bacterial chromosomes&nbsp;</div><div>B. Plasmids&nbsp;</div><
div>C. Transposons&nbsp;</div><div>D. Phages&nbsp;</div><div>E. All of the above
&nbsp;</div>
E
<div>Which of the following gene transfer processes requires cell-cell contact?&
nbsp;</div><div><br /></div><div>Transformation&nbsp;</div><div>Transduction&nbs
p;</div><div>Conjugation&nbsp;</div><div>All of the above&nbsp;</div><div>None o
f the above&nbsp;</div> Conjugation
<div>Gene transfer can include :</div><div><br /></div><div>Genes encoding toxin
s&nbsp;</div><div>Genes encoding antibiotic resistance&nbsp;</div><div>Genes enc
oding selective advantage&nbsp;</div><div>Any genes&nbsp;</div><div>None of the
above&nbsp;</div>
Any genes
<div>Using bacteriocidal antibiotics to treat infections may lead to the followi
ng&nbsp;</div><div><br /></div><div>Transformation&nbsp;</div><div>Selection for
bacteria encoding resistance to the antibiotic&nbsp;</div><div>Dysbiosis&nbsp;<
/div><div>All of the above&nbsp;</div><div>None of the above&nbsp;</div>
D
<div>With all the ways bacteria evade antibiotics, what can you do?&nbsp;</div><
div><br /></div><div>A Thin
for yourself&nbsp;</div><div>B Keep up with the fie
ld of antibiotic resistance&nbsp;</div><div>C Be sure of your diagnosis before p
rescribing antibiotics&nbsp;</div><div>D All of the above&nbsp;</div><div>E None
of the above&nbsp;</div>
D
What is the main function of the meninges?
Protection
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c=""d8a49eb53cc0f042fa5b4dafbe612573968460cb_A_4.svg"" />"
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"What layer of dura forms these structures/sinuses:<div><br /></div><div><img sr
c=""paste-35708358098945.jpg"" /></div>"
Meningeal layer
Arachnoid is the foam padding for the brain and is filled with what substance?
CSF
How does CSF enter the venous system from the subarachnoid space?
"Through
the arachnoid villi into the venous sinuses:<div><br /></div><div><img src=""pa
ste-36013300776961.jpg"" /></div>"
Describe the pia
"Pia mater consists of small plexuses of blood vessels t
hat are embedded in connective tissue and is externally covered with mesothelial
cells (a single layer of flattened cells).<div><br /></div><div><img src=""past
e-36009005809665.jpg"" /></div>"
Periosteal layer of the dura ends where? What about the meningeal layer of dura?
"Periosteal layer - foramen magnum<div>Meningeal layer - goes down past foramen
magnum and covers spinal cord</div><div><img src=""paste-41927470743553.jpg"" />
</div>"
"Where is the best place to access the CSF?<div><br /></div><div><img src=""past
e-41966125449217.jpg"" /></div>"
<div>Lumbar cistern ma
es a good point f
or CSF access.</div><div>Between vertebrae L3/L4 or L4/L5</div>
"<img src=""paste-42077794598915.jpg"" />"
What are the four functions of CSF:
"<div>1) Provides buoyancy to brain (les
s traction on nerves and vessels because the brain ""floats"")</div><div><br /><
/div><div>2) Dampens effects of trauma</div><div><br /></div><div>3) Provides sta
ble ionic environment</div><div>-&nbsp;Brain substance has neurons and EC fluid
(200 mL); the 150 mL of CSF acts as ionic buffer.</div><div><br /></div><div>4)
Removes metabolites from brain extracellular fluid</div><div>-&nbsp;Because of t
he equilibrium with the EC fluid of the brain, CSF provides a purge for the extr
acellular fluid to get rid of its unwanted metabolites</div><div><br /></div>"
How much CSF do you have at any one time during the day?<div><br /></div><div>Ho
w much is made per day?</div> <div>150cc present, 500cc/day made</div><div><br
/></div>
Describe the actual CSF fluid: <div>Clear, low viscosity</div><div><br /></div>
<div>Very little protein</div><div><br /></div><div>Less glucose than serum</div
><div><br /></div><div>Acellular</div><div><br /></div>
What ma
es the CSF?
<b>Class</b>: Choroid Plexus<div><br /></div><div><b>Tex
t</b>:&nbsp;About 70% of the CSF present in the brain and spinal cord is produce
d by the choroid plexuses. The remaining 30% of CSF, which is secreted by the pa
renchyma of the brain, crosses the ependyma (a single layer of ciliated columnar
epithelial cells lining the ventricular system) and enters the ventricles. The
formation of CSF is an active process involving the enzyme carbonic anhydrase an

d specific transport mechanisms.</div>

What is aseptic meningitis?
non-bacterial,&nbsp;non-neutrophilic meningitis
"<img src=""paste-42975442763777.jpg"" /><div><br /></div><div>What is this and
where is it located?</div><div>What causes this?</div>" <div>Epidural hematoma</
div><div><br /></div><div>Between s
ull and the periosteal layer of dura.</div><
br /><div>Middle Meningeal Artery rupture - often at Pterion</div>
"<img src=""paste-43160126357505.jpg"" /><div><br /></div><div><div>What is this
and where is it located?</div><div>What causes this?</div></div>"
Subdural
hematoma (acute or chronic - the others are only acute)<br /><div><br /></div><
div>Between dura and arachnoid</div><div><br /></div><div>Trauma - venous</div>
"<img src=""paste-45655502356481.jpg"" /><div><br /></div><div>What is this, whe
re is it located.</div><div><br /></div><div>What causes this?</div>" "<div>Su
barachnoid bleed</div><div><br /></div><div>Between the arachnoid and pia mater<
/div><div><img src=""paste-45818711113729.jpg"" /></div><div><br /></div>Aneurys
mal rupture of cerebral arteries (typically)<div>Often trauma</div><div>(THUNDER
CLAP HEADACHE)</div>"
A patient comes in with meningitis. The patient has increased pressure in the 3r
d ventricle but not the 4th ventricle. What is this called? Where is the problem
?
"Meningitis closing off narrow cerebral aqueduct.<div><br /></div><div>C
alled non communicating ""Hydrocephalus"" when there is bloc
ed CSF flow.</div>"
What is the Area Postrema and what is its significance? "Not covered by BBB<div>
Senses toxins in order to
now when to vomit</div><div><br /></div><div><img src
=""paste-120525372260353.jpg"" /></div>"
What is the OVLT (organum vasculosum lamina terminalis) and what is unique about
it?
"<div>Lac
s BBB</div><div>Senses osmolar changes, ma
es ADH decisions</d
iv><div><br /></div><div><img src=""paste-126113124712449.jpg"" /></div>"
What are the exceptions to restriction of use of Protected Health Information wi
thout patient authorization?
Treatment, Payment, HEalth Care Operations (TPO)
Generally, communications between doctor-patient are confidential unless you hav
e some exception that permits disclosure, such as: (5) 1. Medical records are 1
00 yrs or older<div>2. Prob of iminent physical injury to self or others</div><d
iv>3. Dislosure of medical info to person legally authorized to consent to treat
ment</div><div>4. Health provides involved in care</div><div>5. Legal proceeding
s (mal practice, collection for medical services, civil commitment proceedings)<
/div><div><br /></div>
What are the 3 required disclosures to government agencies?
<div>Abuse (chil
d, elderly)&nbsp;</div><div>Injuries (bullet or gunshot)&nbsp;</div><div>Reporta
ble communicable diseases (HIV)&nbsp;</div>
Thapar v. Zezul
a (Tex. 1998): No statutory exception to confidentiality for wa
rning identified individuals in Texas. &nbsp;Affirmed that physicians are permit
ted, but have no legal duty, to warn law enforcement and other medical personnel
.&nbsp;
<div>You are wor
ing at the des
in your hospital when another employee of the h
ospital as
s for information about a patient who was admitted last night with a
pulmonary embolus secondary to cancer. You
now the details of the case. The per
son requesting the information states that he is a close friend and co-wor
er of
your patient. He shows you proper identification proving he really is a co-wor

er of your patient who also wor

s in the hospital. Which of the following is the
most appropriate response to this request?&nbsp;</div><div><br /></div><div>A.
Give him the information on the patient.&nbsp;</div><div>B. Give him the informa
tion only if he is a relative of the patient.&nbsp;</div><div>C. Inform him that
you are not at liberty to give details regarding the patient without the patien
ts permission.&nbsp;</div><div>D. Have him sign a release or consent form before
revealing the information.&nbsp;</div> C
<div>You are seeing patients in clinic when two men in dar
suits and dar
glass
es come in and show you badges mar
ing them as members of a federal law enforcem
ent agency. The identification is legitimate. These men in blac
inform you that t
hey are ma
ing a minor investigation of one of your patients. They as
to loo
at
the patients chart for a few minutes, saying, You wouldnt want to interfere with a
federal investigation, would you? What should you do?&nbsp;</div><div><br /></div

><div>A Give them the chart.&nbsp;</div><div>B Give them the chart but watch wha
t they do with it.&nbsp;</div><div>C As
them to sign a release for the chart so
you are absolved of responsibility.&nbsp;</div><div>D Tell them you cannot show
them the chart unless there is a signed release from the patient.&nbsp;</div><d
iv>E Tell them you can give copies but not the original record.&nbsp;</div><div>
F Dont give them the chart but read the relevant information to them.</div>
D
What are the 2 main goals of HIPPA?
(1) protect privacy/confidentiality&nbsp
;<div>&nbsp;(2) permit the the flow of medical information&nbsp;</div>
Confidentiality is important because: (5)
<div>1. Its a negative right (r
ight not to have something happen)&nbsp;</div><div>2. Respects patient autonomy&
nbsp;</div><div>3. Its concordant with physicians fiduciary duties&nbsp;</div>
<div>4. Personal trust is essential to good medical care&nbsp;</div><div>5. Publ
ic trust is necessary for success of medical profession&nbsp;</div>
T/F the ethical guidelines of HIPPA are the following:&nbsp;<div><br /></div><di
v><br /></div><div><div>1. The communication should be necessary and effective f
or good patient care&nbsp;</div><div>2. The ris
s of breaching confidentiality a
re proportional to the li
ely benefits&nbsp;</div><div>3. The alternatives for c
ommunication are impractical&nbsp;</div><div>4. The communication practice shoul
d be transparent (
nown to patients, publicly discussed, absence of patient obje
ction)&nbsp;</div></div>
T
What establishes the legal right of patients to access and amend PHI and receive
accounting of disclosures?
HIPAA
The _____ dural layer is vascular and innervated. The _____ dural layer is smoot
h, avascular, and covered by mesothelium.
Periosteal, Meningeal
What forms a tent-li
e roof over the posterior cranial fossa? tentorium cerebe
lli
The anterior dura is supplied by what arteries? What about the lateral dura? The
posterior dura?
<div>1) Anterior aspect is supplied by the anterior meni
ngeal arteries (which arise from the anterior ethmoidal branches of the ophthalm
ic arteries)</div><div><br /></div><div>2) Lateral aspect is supplied by the mid
dle meningeal artery&nbsp;</div><div><br /></div><div>2) Posterior aspect is sup
plied by branches of the vertebral and occipital arteries</div>
T/F: the arachnoid mater is vascular
False - avascular
Large aggregations of arachnoid villi are called ...
"arachnoid granulations<
div><br /></div><div><img src=""paste-51715701211137.jpg"" /></div>"
"<img src=""paste-107803679129601.jpg"" />"
"What is a ""spinal cord tract""?"
Bundles of fibers that have the same ori
gin, course, and termination; can be motor or sensory&nbsp;
At several places in the cranial cavity, the subarachnoid space is enlarged; the
se enlargements are called {{c1::subarachnoid cisterns}}.<div><br /></div><div>T
he largest of these is called what?</div>
"the cisterna magna<div><br /></
div><div><img src=""paste-135630772240385.jpg"" /></div>"
T/F Ascending tracts transmit sensory information to the brain T
What two tracts (fasciculus) ma
e up the Dorsal Columns/medial lemniscus pathway
?&nbsp; Fasciculus Gracilis<div>Fasciculus Cuneatus</div>
Where does the spinal cord end? Where does the dural sac end? What is the signif
icance of this? "Spinal cord: L1/L2<div>Dural Sac: S2 (carries the cauda equina)
</div><div><br /></div><div>The lumbar cistern (between the conus medullaris and
the end of the dural sac) ma
es for a good point of access for CSF. ""Because o
f the large size of the subarachnoid space and relative absence of neural struct
ures, this space is most suitable for the withdrawal of CSF by lumbar puncture""
</div>"
What does the lumbar cistern contain? Filum terminale
What type of information do the dorsal column tracts transmit? Mechanosensory&n
bsp;
Gracile fasciculus vs Cuneate fasciculus<div><br />Which is located more mediall
y? Laterally?</div>
<div>Medial: Gracile fasciculus</div><div><br /></div><d
iv>Lateral: Cuneate fasciculus</div>
Mechanosensory information from the lower body comes from what tract? What about

the upper body?

Lower body: Gracile fasciculus<div><br /></div><div>*Gra
ceful, li
e a ballerinas legs</div><div><br /><div>Upper body: Cuneate fascicul
us&nbsp;</div></div><div><br /></div><div>*Cunning, closer to the brain&nbsp;</d
iv>
Where do the dorsal columns (gracile/cuneate fasciculus) decussate?
Medial L
emniscus&nbsp;
From the periphery to the cortex, describe the pathway of the <b>dorsal column t
racts</b>. Specifically,<div><br /></div><div>1. How many axons are involved? Is
the input ipsilateral or contralateral?</div><div>2. Where do the periphery neu
rons synapse?</div><div>3. Where does the tract decussate?&nbsp;</div><div>4. Wh
at nucleus does it reach when it gets to the brain?</div>
"1. 3 axon syste
m: Results in contral lateral input due to crossing<div>2. Periphery to ipsilate
ral spinal cord, ascends until it hits either the <b>gracile or cuneate fascicul
us</b> where it synapses.&nbsp;</div><div>3. 2nd order neuron d<b>ecussates at m
edial leminiscus</b> (medulla) and ascends to VPL nucleus, where it synapses aga
in</div><div>4. 3rd order neuron ascends from <b>VPL (ventral posterolateral nuc
leus)</b> to cortex</div><div><br /></div><div><img src=""paste-65717294597184.j
pg"" /></div>"
"Memorize<div><br /></div><div><img src=""paste-118339233906689.jpg"" /></div><d
iv><br /></div>"
Spinocerebellar tracts (both dorsal and ventral) convey what type of information
?
Nonconscious proprioception about ipsilateral <i>lower</i> limbs --&gt;
cerebellum<div><div><br /></div><div>**FYI: Specifically, the dorsal provides th
e cerebellum with information about <i>muscle spindles</i> and <i>tendon afferen
ts</i>, and therefore the status of individual muscles as well as groups of musc
les (e.g., how long each muscle is, how fast each muscle is moving, and how much
tension is on each muscle). The individual is not aware of this information goi
ng to the cerebellum (nonconscious proprioception). With this information, the c
erebellum is enabled to coordinate and&nbsp;integrate neural signals controlling
movement of individual lower limb muscles and posture. Damage to the dorsal spi
nocerebellar tract results in the loss of nonconscious pro- prioception and coor
dination ipsilateral to the lesion.</div></div><div><br /></div><div><div>This v
entral conveys information about whole limb movements and postural adjustments t
o the cerebellum. Damage to this tract results in loss of nonconscious proprioce
ption and coordination in the lower limb.</div></div><div><br /></div>
There are four cavities in the brain
nown as ventricles. What are they?
"2 Lateral Ventricles<div>3rd Ventricle</div><div>4th Ventricle</div><div><br />
</div><div><img src=""paste-118334938939393.jpg"" /></div>"
The lateral horns are composed of different parts. What are the parts? "The ant
erior (frontal) horn located in the frontal lobe, the body located in the pariet
al lobe, the posterior (occipital) horn located in the posterior lobe, and an in
ferior horn located more ventrally in the temporal lobe.<br /><div><br /></div><
div><img src=""paste-118334938939393.jpg"" /></div>"
How are the two lateral ventricles connected? "Interventricular Foramina of Mo
nro<div><br /><div><img src=""paste-118803090374657.jpg"" /></div><div><br /></d
iv></div>"
Describe the pathways of the dorsal/ventral spinocerebellar tracts. Specifically
,<div><br /></div><div>1. Where do periphery (1st order) neurons synapse?</div><
div>2. What structure does it travel through when it reaches the brain?</div>
"Dorsal:&nbsp;<div><br /></div><div>1. Periphery to ipsilateral spinal cord, syn
apses at <b>Clar
es</b> nucleus</div><div>2. Ascends until it hits the inferior
cerebellar peduncle (in medulla of brainstem) and goes to cerebellum</div><div>
<br /></div><div><img src=""paste-72743861093118.jpg"" /></div><div>Ventral:</di
v><div>1. Periphery to ipsilateral spinal cord and synapses.</div><div>2.Decussa
tes at that level, then ascends until it hits the <b>superior cerebellar peduncl
e*</b> (in pons of brain stem) and decussates again to go to cerebellum</div><di
v><br /></div><div><img src=""paste-72842645341144.jpg"" /></div><div>Some
ey p
oints: Both synapse immediately once they enter the spinal cord. Both stay ipsil
ateral (ventral tract crosses, but then crosses bac
).&nbsp;</div><div><br /></d
iv><div>*Peduncles connect the brain stem to the cerebellum&nbsp;</div>"

How are the 3rd and 4th ventricle connected?

"Cerebral Aqueduct of Sylvius<di
v><br /></div><div><img src=""paste-126607045951489.jpg"" /></div>"
The cuneate spinocerebellar tract conveys what
ind of information?
Unconsci
ous proprioceptive information from the <i>upper</i>&nbsp;limbs
The fourth ventricle communicates with the subarachnoid space (specifically cist
erna magna) via two lateral apertures called:<div><br /></div><div>and one midli
ne aperture called:</div><div><br /></div><div>At the caudal end of the fourth v
entricle, a small central canal extends throughout the spinal cord but is patent
only in the upper cervical segments.</div>
"foramina of Lusch
a<div><br /><
/div><div>foramen of Magendie</div><div><br /></div><div><img src=""paste-126731
600003073.jpg"" /></div>"
Describe the pathway of the cuneocerebellar tract. Specifically,<div><br /></div
><div>1. Does the periphery neuron stay ipsilateral or contralateral?</div><div>
2. Where does it synapse when it reaches the brain?</div>
"<div>Stays ipsi
lateral</div><div><br /></div>1. Periphery to ipsilateral spinal cord<div>2. Asc
ends until it hits the<b> acessory cuneate nucleus </b>(near the inferior cerebe
llar peduncle) and synapses, then goes to cerebellum&nbsp;</div><div><br /></div
><div><img src=""paste-41712722379384.jpg"" /></div>"
Where is the choroid plexus located? (3)
"In each of the ventricles. <b>L
ateral ventricles were emphasized in class</b>.<div>1) lateral ventricles</div><
div>2) Roof of 3rd ventricle</div><div>3) T shaped structure near medulla of 4th
ventricle</div><div><img src=""paste-126933463465985.jpg"" /></div><div><br /><
/div><div><b>Text</b>: In each lateral ventricle, the choroid plexus is located
in the medial wall and extends from the tip of the inferior horn to the interven
tricular foramina. In the third and fourth ventricles, the choroid plexus is loc
ated in the roof</div>"
Describe the flow of CSF starting with the choroid plexus:
"1) <b>Lateral v
entricle through foramina of Monro to 3rd ventricle</b><div>2) Through the <b>ce
rebral aqueduct of Sylvius to 4th ventricle</b></div><div>3) Through&nbsp;the <b
>foramina of Lusch
a and Magendie</b> and enters the c<b>erebellomedullary ciste
rn (cisterna magna)</b></div><div>4)&nbsp;The CSF in the <b>cisterna magna</b> t
hen travels <b>rostrally over the cerebral hemisphere</b></div><div>5) CSF trave
ls along <b>nerve sleeves</b>&nbsp;(li
e optic nerve) and enters the <b>arachnoi
d villi/granulations</b>.<br /><div>6) Arachnoid villi allow flow of CSF into th
e <b>dural venous sinuses</b> but do not allow flow in the opposite direction be
cause the pressure in the subarachnoid space is higher compared with the dural v
enous sinuses.</div><div>7) <b>Jugular vein</b></div><div><br /></div><div>CSF i
n the cisterna magna also flows downward into the spinal subarachnoid space and
then ascends along the ventral surface of the spinal cord into the basal part of
the brain where it courses dorsally to empty into the dural sinuses</div></div>
<div><br /></div><div><img src=""paste-127246996078593.jpg"" /></div>"
What are the 4 spinocerebellar tracts? Dorsal, Ventral, Cuneo, Rostral (similar
to ventral tract except that it contains afferents from the tendons of the uppe
r limb, not discussed in class but in the text).&nbsp;
Describe the choroid plexus and how ma
es CSF: "<div>Thin
: fronds of vasculari
zed connective tissue in ventricles</div><div><br /></div><div>Three layers:</di
v><div><br /></div><div>1) pial membrane</div><div>2) &nbsp;fenestrated endothel
ial layer</div><div>3) choroidal epithelial cells (lots of mitochondria and basa
l infoldings) with tight junctions that filter proteins (blood-CSF barrier).</di
v><div><br /></div><div>Use carbonic anhydrase for production</div><div><img src
=""paste-50757923504640.jpg"" /></div><div><br /></div>"
Do you puncture the dural sac when doing an epidural? "You better not! Only en
ters the epidural space.<div><br /></div><div><img src=""paste-131181186121729.j
pg"" /></div>"
What layers do you travel through with your Lumbar Puncture needle in order to o
btain CSF?
"<div>1) S
in</div><div>2) Subcutaneous Tissue</div><div>3) Supr
aspinous ligament</div><div>4) Ligamentum flavum</div><div>5) Dura+arachnoid</di
v><div><br /></div><div>Now you are in the dural sac.</div><div><br /></div><div
>Remember, go between L3/L4 (adult) or L4/L5 (child)</div><div><img src=""paste131318625075201.jpg"" /></div>"

Symptoms of meningitis:<div><br /></div><div>Lab signs of meningitis</div>

<div><b>Headache, fever</b>, nec
stiffness, photophobia, encephalopathy</div><d
iv><br /></div><div><div>High <b>WBC count</b> and<b> protein in CSF</b></div></
div><div><br /></div>
The spinothalamic tracts conveys what
ind of information?
Crude touch, Pai
n/Temperature&nbsp;<div><br /></div><div>*Specifically, the lateral spinothalmic
tract does the pain/temperature. The anterior lateral spinothalmic tract does c
rude touch.&nbsp;</div>
"Describe meningiomas (3):<div><img src=""paste-131490423767041.jpg"" /></div>"
<div>Benign</div><div>Slow-growing</div><div>Asymptomatic</div>
"Whats happening to the patient on the right?<div><br /></div><div><img src=""p
aste-131576323112961.jpg"" /></div>"
Papilledema: due to increased cranial pr
essure around the optic nerve<div><br /></div><div>Boarders become smudged aroun
d optic disc</div>
Patient comes in with elevated protein and white blood cells in their CSF, after
you do a lumbar puncture. What does this mean? "Infection or inflammation<div><
br /></div><div><img src=""paste-139169825292289.jpg"" /></div>"
"If your patients CSF loo
s li
e the tube on the right:<div><br /></div><div><i
mg src=""paste-131868380889089.jpg"" /></div><div>What is this called, and what
has happened to your patient:</div>"
Xanthochromia - from heme being degraded
to bilirubin<div><br /></div><div>Subarachnoid hemorrhage</div>
Spinothalamic fibers arising from the lowest part of the body (the sacral and lu
mbar levels of spinal cord) ascend __________, whereas those arising from the up
per extremities and nec
(the cervical cord) ascend __________. What concept is
this an example of?
Somatotopic organization&nbsp;<div><br /></div><div>dors
olaterally; ventromedially</div>
Describe the pathway of the spinothalamic tract. Specifically,<div><br /></div><
div>1. Where do the first order neurons enter the spinal cord?</div><div>2. What
is the specific name of the tract that the first neuron travels within the spin
al cord?</div><div>3. Does the primary afferent synapse ipsilaterally or contral
aterally with the 2nd order neurons?</div><div>4. What area of the spinal cord d
oes the 2nd order travel in? Where does it cross?</div><div>5. Where do the seco
nd order neurons terminate?</div>
"<div>*Both result in contralateral inpu
t&nbsp;</div><div><br /></div><div>Direct pathway:</div><div>1. Primary afferent
s enter the dorsal horn</div><div>2. Send collaterals up and down the spinal cor
d (<b>Lissauers tract</b>) usually one or two vetebral levels above or below.&nbs
p;</div><div>3. It synapses ipsilaterally with second order neurons (close to sp
inal level where it enters).&nbsp;</div><div>3.&nbsp;Axons from 2nd order neuron
s in the dorsal horn cross midline (<b>anterior white commisure)&nbsp;</b>and as
cend the spinal cord in the<b> lateral funiculus&nbsp;</b></div><div>4. Axons fr
om 2nd order neurons terminate in VPL nucleus</div><div><br /></div><div><img sr
c=""paste-30648886625190.jpg"" /></div>"
RBCs in CSF mean:
<div><u>Xanthochromia</u></div>1) subarachnoid hemorrhag
e&nbsp;<div>2) also possibly, but more rarely hemorrhagic meningitis</div>
Things need to be hydrophobic to cross the BBB. Or they need carrier-mediated tr
ansport (diphenhydramine).<div><br /></div><div><u>Which cross, which dont?</u><
/div><div><div>Morphine vs heroin</div><div>Atenolol vs metoprolol</div><div>Cef
azolin vs nafcillin</div><div>Dopamine vs L-dopa</div></div>
All the ones on
the right cross, the left ones do not.
Intracranial pressure is high in your patient. What symptoms/signs will they hav
e? (5) headache<div>vomiting</div><div>hypertension</div><div>bradycardia (refl
ex from carotid sinus due HTN from heart trying to pump blood to brain against i
ncreased pressure)</div><div>papilledema</div>
What cells function to move the CSF and line the pathways where CSF travels?
Ependymal cells use their cilia
What are the two types of hydrocephalus? Describe them:<div><br /></div><div>Whe
re is the most common obstruction?</div>
<div>In <b>non-communicating</b>
<b>hydrocephalus</b>, the CSF in the ventricles can not reach the subarachnoid
space. This results from obstruction of interventricular foramina, cerebral aque
duct, or the outflow foramens of the fourth ventricle (median and lateral apertu

res). <u>The most common obstruction is in the cerebral aqueduct</u>. A bloc

at
any of these sites leads rapidly to dilatation of one or more ventricles. If th
e s
ull is still pliable, as it is in children younger than 2 years, the head ma
y enlarge.</div><div><br /></div><div>In <b>communicating hydrocephalus</b>, the
obstruction of CSF flow is in the subarachnoid space from prior bleeding or men
ingitis. This causes thic
ening of the arachnoid leading to bloc
age of the retu
rn-flow channels.</div>
What two diseases have Igs in their CSF?
Guillain Barre Syndrome<div>Mult
iple Sclerosis</div>
<div>A 10 year old with a history of sic
le cell anemia presents w/ sepsis. What
is the most li
ely offending organism?</div><div><br /></div> "<img src=""past
e-1271310319991.jpg"" />"
"<img src=""paste-1305670058421.jpg"" /><div>gram +/-</div>"
positive&nbsp;
<div>Aminoglycoside anbitiotic require oxygen to
ill bacteria. Which class of b
acteria are aminoglycosides ineffective in treating?&nbsp;</div><div><br /></div
>
"<img src=""paste-1344324764008.jpg"" />"
"<img src=""paste-1378684502377.jpg"" />"
"<img src=""paste-1391569404265.
jpg"" />"
"<img src=""paste-1425929142512.jpg"" /><div><br /></div><div><img src=""paste-1
438814044459.jpg"" /></div>"
B&nbsp;<div><br /></div><div>Associate Strep Pyo
gnes with chains of gram positive cocci and <b>lymphangitis&nbsp;</b></div><div>
<b><br /></b></div><div><b>erysipelas (CABG and axillary lymph node dissection f
or breast cancer)</b></div>
T/F Descending tracts transmit info to periphery
T
Motor neurons descend from the {{c1::cerebral cortex and brain stem}} and termin
ate in the ventral horn of the {{c1::spinal cord}}.
<div><br /></div><div><b
r /></div>These are specifically referring to UPPER motor neurons. These synapse
with your LOWER motor neurons, which go from your spinal cord to your muscles.
This is equivalent terminology to 1st order, 2nd order neurons etc that we use f
or sensory neurons&nbsp;
What are the seven descending (motor) tracts discussed in lecture? Which ones ar
e located laterally in the spinal cord, which ones are medial in the spinal cord
?&nbsp; "Lateral: Corticospinal<div>Rubrospinal</div><div><br /></div><div>Media
l:</div><div>Tectospinal</div><div>Pontine (medial) Reticulospinal</div><div>Med
ullary (lateral) Reticulospinal</div><div>Medial Vestibulospinal</div><div>Later
al Vestibulospinal&nbsp;</div><div><br /></div><div>May be helpful to visualize
where these tracts are in the spinal cord, well eventually have to
now this:&n
bsp;</div><div><br /></div><div><img src=""paste-3277060047188.jpg"" /></div>"
Describe the pathway of the corticospinal tract. Specifically,<div><br /></div><
div>1. Where do the fibers originate in the brain?</div><div><div>3. As they des
cend do they stay ipsilateral or contralateral to their origin?</div></div><div>
2. What tracts do they become a part of when it reaches the midbrain? The medull
a?&nbsp;</div><div>3. Where do they decussate?</div>
"1. Cerebral cortex (pre
central gyrus)<div>2. Ipsilateral</div><div>3.&nbsp;<b>Cerebral peduncles </b>o
f the midrain; <b>pyramids</b> of the medulla</div><div>4. Junction between medu
lla and spinal cord (pretty much in the <b>medullary pyramids</b>) --&gt; finall
y forms the lateral corticospinal tracts</div><div><br /></div><div><img src=""p
aste-32220844655662.jpg"" /></div>"
What does the corticospinal tract innervate?
Motor innervation to FLEXORS&nbs
p;<div><br /></div><div>*Thin
of the corticospinal tract as your main source of
voluntary movement</div>
What does the rubrospinal tract innervate?
Motor innervation to the SHOULDE
RS (upper body)<div><br /></div><div>*Minor source of voluntary movement, but ca
n ta
e over for the corticospinal tract if it is damaged&nbsp;</div>
Describe the pathway of the rubrospinal tract. Specifically,<div><br /></div><di
v>1. Where does it originate?</div><div>2. Where does it decussate?</div><div>3.
Where does it run in the spinal cord?</div><div>4. Where does it terminate?</di
v>
"1. Red nucleus (located in midbrain)<div>2. Midbrain&nbsp;</div><div>3.
Lateral funiculus</div><div>4. Cervical cord&nbsp;</div><div><br /></div><div><
img src=""paste-32263794328588.jpg"" /></div><div><br /></div><div><img src=""pa

ste-108503758799175.jpg"" /></div>"
What are the two divisions of the <b>reticulospinal</b> tract? What is the funct
ion of each?
Medial (pontine): Excitatory --&gt;Postural control of muscles,
startle reflex<div><br /></div><div>Lateral (medullary): Inhibitory --&gt; &nbsp
;inhibit interneurons to prevent constant motor firing&nbsp;</div>
The lateral medullary reticulospinal tract is driven by cerebral cortical input
from where?
The medullary reticular formation (MRF) Neurons in the MRF send
axons to both sides of the spinal cord and temrinate at all levels of the cord
Decerebrate rigidity can result from damage to the {{c1::cortical descending sys
tems}} because the inhibitory influence of the {{c1::medullary reticular formati
on}} is removed "<img src=""paste-8332236554378.jpg"" /><div>Head is arched bac

, the arms are extended by the sides, and the legs are extended. Elbow extension
is the hallmar
of decerebrate rigidity</div><div><br /></div><div><img src=""p
aste-108503758799175.jpg"" /></div>"
Tectospinal Tract:<div><br /></div><div>Origin: {{c1::Superior colliculus}}</div
><div>Termination: {{c1::Upper cervical cord only}}</div><div>Function: {{c1::Re
flexive movements of head and nec
in response to visual, auditory, and somatose
nsory input}}</div>
The vestibulospinal tract arises from the {{c1::medial and lateral nuclei&nbsp;}
}
Axons from the lateral vestibulospinal tract&nbsp;<div><br /></div><div>Travel {
{c1::ipsilateral}}</div><div>Descend in the {{c1::ventral funiculus}}</div><div>
Exert {{c1::excitatory influence}} on {{c1::spinal reflex and extensor muscle to
ne&nbsp;}}</div>
"Extends full length of the spinal cord<div><img src=""p
aste-32349693674568.jpg"" /></div>"
The medial vestibulospinal tract&nbsp;<div><br /></div><div>Flan
s the {{c1::ant
erior median fissure}}.</div><div>Axons descend only to {{c1::cervical levels}}<
/div><div>Provides vesitbular input to {{c1::motor neurons innervating the nec

and forelimb}}</div>
"<img src=""paste-32345398707272.jpg"" />"
Summary of all the descending tracts:&nbsp;
"<img src=""paste-9831180141404.
jpg"" />"
What is proprioception? The ability to sense stimuli arising within the body reg
arding position, motion, and equilibrium.&nbsp;
Receptors embedded within intrafusal muscle fibers that encode limb dynamics (ch
anges in muscle length) are called what?
Muscle spindles&nbsp;
What is the difference between Group Ia afferents and Group II afferents?&nbsp;
Group 1a afferents: respond to changes in muscle length<div><br /></div><div>Gro
up II afferents: slower, adaptive response to constant (sustained) muscle length
)</div>
What is fusimotor control?
Adjustment of the sensitivity/dyanmic range of m
uscle spindles by gamma motor neurons (type of lower motor neuron)&nbsp;
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_0.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_0.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_1.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_1.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_2.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_2.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_3.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_3.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_4.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_4.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc

708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_5.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_5.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_6.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_6.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_7.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_7.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_8.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_8.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
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"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_9.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_9.svg"" />"
"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_source_svg.svg"" />"
"<img src=""bebc
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"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_10.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_10.svg"" />"
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708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
"<img src=""bebc708f07f727b5daf465c4952477a7a28133eb_Q_11.svg"" />"
"<img sr
c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_11.svg"" />"
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"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
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c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_12.svg"" />"
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c=""bebc708f07f727b5daf465c4952477a7a28133eb_A_13.svg"" />"
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"<img src=""bebc
708f07f727b5daf465c4952477a7a28133eb_tmpIyqVWR.png"" />"
What mechanisms do enterobacteriaceae use to gain carbapenem resistance? (2)
<div>Carbapenem-resistance in Enterobacteriaceae can occur by many mechanisms, i
ncluding the production of a metallo-beta-lactamase (such as NDM, VIM, and IMP)
or a carbapenemase (such as Klebsiella pneumoniae carbapenemase, KPC).&nbsp;</di
v><div><br /></div>
What plate do you culture on to test for lactose fermentation MacCon
ey Agar p
late
does E. coli test positive or negative on a lactose fermentation test? What abou
t pseudomonas aeruginosa?
E. coli - lactose fermentation positive - turns
pin
<div>P. aeruginosa - lactose fermentation negative&nbsp;</div>
What are common diseases associated with E.coli? (3)
"<div>UTI (#1 Cause), Pn
eumonia, bacteremia</div><div><br /></div><div><br /></div><img src=""paste-3247
4247725692.jpg"" />"
Patients placed on ________ have an increased ris
of getting nocosomial pneumon
ia from E. coli ventilators
What vessels are located in subarachnoid space? "cerebral arteries and bridging
veins<div><br /></div><div><img src=""paste-16222091477433.jpg"" /></div>"
Subdural bridging veins leave their position on the surface of the pia to penetr
ate ________ and traverse the ________ and _________ to empty in to what?
"arachnoid and traverse the meningeal dura and subdural space&nbsp;to empty into
venous sinus<div><br /></div><div><img src=""paste-16222091477433.jpg"" /></div
>"
Describe the flow of CSF&nbsp; "<img src=""paste-16411070038395.jpg"" /><div><b

r /></div><div>Choroid Plexus in Lateral ventricles 2 Interventricular Foramen of

Monro Third ventricle Cerebral Aqueduct of Sylvius Fourth ventricle 2 Lateral For
amina of Lusch
a and 1 Medial Foramen of Magendie Cisterna Magna--&gt; Subarachno
id space around brain, &nbsp;spinal canal, nerve sleeves Arachnoid granulations-&gt;superior saginal sinus/radicular veins --&gt;jugular vein</div>"
What are common nocosomial infections caused by Klebsiella
"<div>Pneumonia,
UTI, biliary infection, peritonitis, wound infection</div><div><br /></div><div
>note -
lebsiella can cause UTIs and pneumonia in healthy people as well</div>
<div><br /></div><div><img src=""paste-32903744455294.jpg"" /></div>"
Where is the choroid plexus found?
"<div>Found on the floor of the two late
ral ventricles</div><div><br /></div><div>&nbsp;on the roof of the third ventric
le</div><div><br /></div><div>and a T shaped structure adjacent to the medulla o
f the 4th ventricle&nbsp;</div><div><br /></div><div><img src=""paste-1652273918
8091.jpg"" /></div><div><br /></div>"
What are the 4 functions of the CSF?
<div>Buoyancy to brain: less traction on
nerves and vessels</div><div>Dampens effects of trauma</div><div>Provides stabl
e ionic environment</div><div>Removes metabolites from brain extracellular fluid
&nbsp;</div>
What features of Klebsiella provide protection against our immune system? (2)
Mucoid capsule - antiphagocytosis - no antigenic response<div>Beta-lactamase pro
duction - resistance to ampicillin</div><div><br /></div><div>Note - some
lebsi
ella are carbapen resistant because of&nbsp;carbapenemase (such as Klebsiella pn
eumoniae carbapenemase, KPC).&nbsp;</div><div><br /><div><br /></div></div>
Papilledema is a sign of what? increased CSF pressure causing optic nerve bulgi
ng<div><br /></div><div>Remember: CSF continues along the spinal nerves in the s
leeve of the subarachnoid space</div>
CSF that exits the 4th ventricle is continuous with what?
central canal of
the spinal cord
Why do things li
e clavulinic acid need to be added to the medication in order t
o treat Klebsiella infections? clavulinic acid is a beta lactamase inhibitor Klebsiella produces beta lactamase so need to overcome that
T/F there is no feedbac
regulation of choroid plexus production of CSF True
What is the difference between non-communicating and communicating hydrocephalus
?
"<img src=""paste-17562121273742.jpg"" />"
Currant jelly sputum is normally associated which bacteria? These are commonly s
een in which patients? "<div>Currant-jelly sputum associated with Klebsiella pneu
moniae pneumonia.</div><div>Seen in compromised hosts: alcoholics, COPD, intubat
ed. &nbsp;</div><div><br /></div><div><img src=""paste-34170759807466.jpg"" /></
div><div><br /></div><div><img src=""paste-34183644709502.jpg"" /></div>"
What are two examples of non communicating hydrocephalus?
Stenosis of left
intraventricular foramen of monroe--&gt;left lateral ventricle will swell<div><
br /></div><div>stenosis of cerebral aqueduct--&gt;both lateral ventricles and 3
rd ventricle will swell</div>
What are 2 examples of communicating hydrocephalus?
scarring of arachnoid gr
anulations from meningitis<div><br /></div><div>Venous hypertension in saggital
sinus from depressed s
ull fracture</div>
What is normal pressure hydrocephalus? What is the clinical triad associated wit
h this? <div>increased subarachnoid space volume, but there is no increase in in
tracranial pressure</div><div>Clinical triad: Wac
y, Wobbly, and Wet = Dementia, a
taxia, and urinary incontinence</div><div><br /></div>
Describe the clinical features of Friedlanders disease? This is commonly associa
ted with which bacteria?
"<div>Friedlanders disease: propensity for upper
lobes, abscess formation, hemoptysis, severe, bulging fissure sign on CXR caused
by edematous lobar consolidationfrequently in alcoholics</div><div><br /></div><
div><img src=""paste-36086315221740.jpg"" /></div><div><br /></div><div>normally
associated with Klebsiella pneumoniae yet often hard to distinguish clinically
from other bacterial pneumonias</div><div><br /></div>"
What is the blood supply to the spinal cord?
anterior 2/3= anterior spinal ar
tery<div>posterior 1/3= 2 posterior spinal arteries</div>
Which bug is associated with UTIs, produces urease, forms crystals, is highly mo

tile, and forms biofilms?

Proteus mirabilis
Close cousins of Proteus - seen in individuals with long term catheter use&nbsp;
Morganella, Providencia
Where do the anterior and posterior spinal arteries arise from? directly from ve
rtebral arteries at level of medulla (or sometimes posterior inferior cerebellar
artery)
What bacteria has an inducible expression of Beta- lactamase, and is commonly as
sociated with high antibiotic resistance?
Enterobacter
What is the vaso corona?
Small anastomosing arteries between anterior and
posterior spinal arteries
Where do the primary neurons of the CST originate?<div><br /></div><div>Where do
es CST decussate?</div><div><br /></div><div>Within the lateral CST, legs are re
presented _________</div><div><br /></div><div>Where does the primary neuron of
the CST eventually synapse?</div>
"Pre central gyrus<div><br /></div><div>
medullary pyramids</div><div><br /></div><div>Laterally</div><div><br /></div><d
iv>Ventral Horn</div><div><br /></div><div><img src=""paste-17991618003410.jpg""
/></div><div><br /></div><div><img src=""paste-18004502905371.jpg"" /></div>"
Interruption of CST leads to ________ and _______
upper motor neuron wea
n
ess and hyper-reflexia
What test allows you to calculate antibiotic resistance for enterobacter?
"Dis
approximation test<div><br /></div><div><img src=""paste-34531537060494.jp
g"" /></div><div>treatment with cefoxitin can induce beta lactamse production in
enterobacter</div><div><br /></div><div>&nbsp; Place cefoxitin and 2nd antibiot
ic dis
on the plate, incubate overnight. &nbsp;Compare radius red to blue. &nbs
p;If red smaller than blue, than antagonism has occurred (inducible resistance).
&nbsp;</div>"
Interruption of lower motor neuron leads to what? (3) Wea
ness, muscle atrophy
, hyporeflexia
Dorsal Column System can be clinically tested by what 4 tests? "<img src=""past
e-18279380812155.jpg"" />"
Sensation from leg travels through ______ to synapse on _________<div><br /></di
v><div>Sensation from arm travels through _______ to synapse on to ________</div
>
Fasciculus gracilis--&gt;nucelus gracilis<div><br /></div><div>fasciulus
cuneatus --&gt; nucleus cuneatus</div>
Serratia marcescens produces a red pigment
nown as ? prodigiosin
In the dorsal column system, secondary axons cross the midline via _______ and a
scends in the ________ to synapse in the ________
"internal arcuate fibers
; medial lemniscus; VPL nucelus of the thalamus<div><br /></div><div><img src=""
paste-18455474471453.jpg"" /></div>"
Afferent neurons receiving signals from pain or thermal receptors enter the spin
al cord and immediately synapse on ________ and _______ ipsilateral marginal nuc
elus<div>substantia gelatinosa</div>
What bacteria normally loves water, causes nosocomial infections (necrotizing br
onchopneumonia with abscess formation), and infections in IV drug users (endocar
ditis, osteomyelitis)? Serratia marcescens
Within the STT system, the secondary neuron decussates in __________ and ascends
________ to synapse on __________
anterior white commissure<div><br /></di
v><div>STT</div><div><br /></div><div>VPL of thalamus</div>
T/F Serratia marcescens ferments lactose
True - although it does it slowl
y<div><br /></div><div>Tests for it may show up to be negative because it fermen
ts it slowly</div>
What bacteria is associated with catheter associated UTIs and brain abcesses in
neonates
"Citrobacter diversus<div><img src=""paste-35467839930834.jpg""
/></div>"
How does the body arrangment differ in the STT, DC, CST STT/ CST (legs lateral,
arms medial)<div><br /></div><div>DC (legs medial-gracilis; arms lateral-cuneate
)</div>
"<img src=""paste-18811956756593.jpg"" />"
cervical
"<img src=""paste-18846316494970.jpg"" />"
Thoracic
"<img src=""paste-18880676233344.jpg"" />"
lumbar

"<img src=""paste-18906446037110.jpg"" />"

sacral
gram (-) bacteria that infects prosthesis
Proteus mirabilis
Describe the features of proteus when plated on agar? "gray blue uniform film<
div>non lactose fermenter</div><div>swarming colonies observed</div><div><br /><
/div><div><img src=""paste-36906653975094.jpg"" /></div>"
"<img src=""paste-21410411971003.jpg"" />"
CT
What clinical problems are associated with Proteus mirabilis infections?
UTI with catheters usually<div>complicated pyelonephritis&nbsp;</div><div><br />
</div><div>Note - Klebsiella pneumoniae can cause uncomplicated and complicated
pyelonephritis&nbsp;</div>
<div>Indirect pathway of the spinothalamic tract:</div><div><br /></div>Ascend {
{c1::bilaterally}}<div>Exhibit poor {{c1::somatotopy}};&nbsp;</div><div>Ma
e mul
tiple synapses in the {{c1::reticular formation, hypothalamus, and limbic system
&nbsp;}}</div>
"<img src=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_Q 0.svg"" />"
"<img sr
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"<img src=""d2a1
f821ef81809b22aa0932fae2aa6a0761244c_tmp0AyayJ.png"" />"
"<img src=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_Q 1.svg"" />"
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c=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_A 1.svg"" />"
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"<img src=""d2a1
f821ef81809b22aa0932fae2aa6a0761244c_tmp0AyayJ.png"" />"
"<img src=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_Q 2.svg"" />"
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c=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_A 2.svg"" />"
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"<img src=""d2a1
f821ef81809b22aa0932fae2aa6a0761244c_tmp0AyayJ.png"" />"
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c=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_A 3.svg"" />"
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"<img src=""d2a1
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"<img src=""d2a1
f821ef81809b22aa0932fae2aa6a0761244c_tmp0AyayJ.png"" />"
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c=""d2a1f821ef81809b22aa0932fae2aa6a0761244c_A 5.svg"" />"
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"<img src=""d2a1
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"<img src=""d2a1
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"<img src=""d2a1
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"<img src=""paste-21444771709353.jpg"" />"
MRI
"<img src=""paste-21470541512866.jpg"" /><div><br /></div><div>What view?</div>"

Axial: Pt lying on bac

, loo
ing up at pt from feet
Leading cause of watery diarrhea among people traveling to developing countries,
and leading cause of mortality amoung young children in developing countries
Enterotoxigenic E. coli (ETEC)<div><br /></div><div><br /></div>
"<img src=""paste-21504901251546.jpg"" /><div><br /></div><div>Imaging modality?
</div>" T1 MRI:&nbsp;Gray matter is grey, white is white, with amazing detail. B
asal ganglia seen very well.<div><br /></div>
"<img src=""paste-21552145891769.jpg"" /><div><br /></div><div>What imaging moda
lity?</div>"
<div>T2 MRI. Note reversed color of gray/white matter and white
CSF</div><div><br /></div>
"<img src=""paste-21590800597435.jpg"" /><div>What imaging modality?</div>"
<br /><div>T2 with flair: Non-anatomical, CSF is dar
</div>
What is T2 with Flair particularly helpful for? . This is useful for things li
e
MS that have periventricular demylinating plaques that would be obscured with n
ormal T2
"<img src=""paste-21702469747120.jpg"" />"
MRA (special use of MRI to speci
fically loo
at blood vessels)<div><br /></div><div><div>Here the patients R MCA
is completely occluded.</div></div><div><br /></div>
"<img src=""paste-21749714387220.jpg"" />"
Buzz words: Adult polycystic
id
ney disease, worst headache of life, AVM, Aneurysm,&nbsp;<div><br /></div><div>S
ubarachnoid hemorrhage</div>
Describe how the Heat stable (ST) and Heat labile enterotoxins of ETEC cause wat
ery diarrhea? <div>Heat stable (ST) increases cGMP</div><div>Heat labile (LT)
increases cAMP</div><div><div>Both act on the CFTR to cause secretion of chlorid
e into the lumen</div></div><div><br /></div>
"<img src=""paste-21784074125588.jpg"" />"
Buzzword: Hypertension, hempares
is--&gt; intraparenchymal hemorrhage in or near basal ganglia
"<img src=""paste-21878563406136.jpg"" /><div><br /></div><div><img src=""paste21891448308150.jpg"" /></div>" Right MCA infarct:<div><br /></div><div><div>Not
e the hypodensity of the R MCA distribution. This is most li
ely some time (24-4
8 hours) after the stro
e has occurred, and <b>signifies edema forming in the ar
ea</b> (remember: water is dar
on CT). Acutely, you might see blunting of the g
ray-white junction on CT as the first sign of stro
e.</div></div><div><br /></di
v>
"<img src=""paste-21955872817464.jpg"" /><div><br /></div><div><img src=""paste21973052686770.jpg"" /></div>" <div>CT of Epidural hematoma. Note biconvex appe
arance and respect for suture lines.</div><div><br /></div>
"<img src=""paste-22007412425016.jpg"" />"
"<img src=""paste-22020297327072
.jpg"" /><div><br /></div><div><div>T1 MRI of Subdural hematoma. Note concave ap
pearance, and no respect of suture lines. Associated with deceleration injuries
(li
e in this pt).</div></div><div><br /></div>"
What type of hemorrhage is associated with coup contra coup, elderly, alcoholics
?
Subdural
Immunity against what feature of Enterotoxigenic E. coli is protective against w
atery diarrhea? "Fimbriae (pili) that attach to intestinal mucosa -&nbsp;<div><b
r /></div><div><img src=""paste-37757057499704.jpg"" /></div>"
Subarachnoid hemorrhage is caused by what two things? 1. rupture of aneurysm<d
iv>2. arterial venous malformation</div>
"<img src=""paste-22110491640120.jpg"" />"
"<img src=""paste-22123376542180
.jpg"" /><div><br /></div><div>Normal pressure Hydrocephalus</div>"
"<img src=""paste-22157736280376.jpg"" /><div><br /></div><div><img src=""paste22170621182331.jpg"" /></div>" <div>Dx: T1 MRI showing selective atrophy of the
frontal and temporal lobes, consistent with frontotemporal dementia (FTD)</div>
<div><br /></div>
"<img src=""paste-22209275887968.jpg"" /><div><br /></div><div><img src=""paste22222160789914.jpg"" /></div>" <div>Dx: T1 MRI Alzheimers disease. Note the diff
use cortical atrophy that is characteristic. Not shown here is hydrocephalus ex
vacuo, or <b>enlargement of the ventricles because of atrophy, </b>not increased
CSF pressure. CSF increases to fill empty space left by atrophied cortex. &nbsp
;This is also a/w Huntingtons</div><div><br /></div>

What is the treatment choice for Enterotoxigenic E. coli?

Bismuth Subsalic
ylate - prophylaxic and treatment<div>antibiotics are effective but not necessar
y</div>
"<img src=""paste-22260815495639.jpg"" /><div><br /></div><div><img src=""paste22273700397368.jpg"" /></div>" <div>Dx: Top 2 images are T2 with FLAIR, bottom
2 are T1 of Multiple sclerosis. Periventricular white matter lesions are charact
eristic.</div><div><br /></div>
E. coli strains that causes bloody diarrhea?
Enterohemorrhagic E.coli (EHEC)<
div>Shiga toxin producing E. coli (STEC)</div><div>&nbsp;</div>
"<img src=""paste-22312355103032.jpg"" /><div><br /></div><div><img src=""paste22325240004968.jpg"" /></div>" <div>Dx: T1 MRI with pituitary mass in sella tur
cica. &nbsp;Given the patients presentation, this is li
ely a prolactin-secreting
pituitary adenoma</div><div><br /></div>
What product of hypothalamus inhibits prolactin release?
Dopamin inhibits
prolactin
Common causes of getting bloody diarrhea from&nbsp;Enterohemorrhagic E. coli (EH
EC) or Shiga Toxin-producing E. coli (STEC)
raw hamburger meat<div>taco bell
</div><div>bagged spinach (bad?)</div>
mechanism of action of shiga li
e toxin produced by Shiga Toxin- producing E. co
li&nbsp;
destroys ribosomal protein synthesis (binds 60S unit)
"<img src=""paste-23119808954680.jpg"" /><div><img src=""paste-23132693856628.jp
g"" /></div>" <div>Dx: T2 MRI with extracranial mass growing compressing (but
NOT invading) adjacent brain parenchyma, consistent with meningioma (benign)</di
v><div><br /></div>
"<img src=""paste-23179938496824.jpg"" /><div><img src=""paste-23192823398903.jp
g"" /></div>" <div>Dx: T1 MRI of Butterfly glioma, most li
ely glioblastoma mu
ltiforme, the most common and malignant glial tumor. GBM classically produces a b
utterfly lesion because of its tendency to spread to both hemispheres across the
corpus callosum.</div><div><br /></div>
Why are the virulence factors of E0157:H7 (the most important clone of EHEC)?
- produces shiga li
e toxin via STX genes given by bacteriophage&nbsp;<div>- LEE
pathogenicity island - binds and removes the microvilli on enterocytes</div><di
v><br /></div><div>EHEC serotype o157:H7 is the most important source of outbrea

s of E.coli</div><div><br /><div><br /></div><div><br /></div></div>

"<img src=""paste-23222888169784.jpg"" /><div><br /></div><div><img src=""paste23235773071726.jpg"" /></div>" <div>Dx: T1 MRI on left and CT scan on right sho
wing mass lesion in posterior fossa (within cerebellum), consistent with <b>medu
lloblastoma</b>. &nbsp;Note also the non-communicating hydrocephalus with dilati
on of the lateral ventricles.</div><div><br /></div>
"<img src=""paste-23274427777336.jpg"" /><div><img src=""paste-23287312679368.jp
g"" /></div>" <div>Dx: T1 MRI with bilateral masses in the pontomedullary junc
tion, consistent with bilateral <b>acoustic/vestibular schwannomas </b>(common i
n NF2)</div><div><br /></div>
"<img src=""paste-23325967384888.jpg"" /><div><br /></div><div><img src=""paste23338852286890.jpg"" /></div>" <div>Dx: T2 MRI of <b>Herpes encephalitis.</b> C
lassically in young people with altered mental status and fever with T2 MRI show
ing hyperintensity in the temporal lobes.</div><div><br /></div>
"<img src=""paste-23386096927032.jpg"" /><div><img src=""paste-23398981829106.jp
g"" /></div>" <div>Dx: <b>Neurocystercercosis</b> on CT. Multiple cystic lesio
ns throughout brain. Associated with ingestion of the eggs of Taenia solium in f
ood or water.</div><div><br /></div>
"<img src=""paste-23446226469176.jpg"" /><div><img src=""paste-23454816403846.jp
g"" /></div>" <div>Dx: T1 MRI showing brain metastases. These are the most com
mon tumors of the brain, and usually occur at the gray/white matter junction.</d
iv><div><br /></div>
What are the most common cancers going to the brain?
<div>Lung, Breast, S
in,
Kidney, GI. (Lots of Bad Stuff Kills Glia)</div><div><br /></div>
Describe the similarities and differneces between EHEC, STEC, AEEC, atypical EPE
C, and typical EPEC
"<img src=""paste-39191576576398.jpg"" /><div>EPEC - has
lee pathogenicity island</div><div>EHEC = lee pathogenicity island + shiga toxi

n producer</div><div>AEEC - Both the EPEC and the enterohemorrhagic E. coli (EHE

C) subsets of STEC strains with lee pathogenicity island</div>"
"<img src=""b454339baca533b36f7df1e5a04582151737b3fa_Q_0.svg"" />"
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"<img src=""b454
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"<img src=""b454339baca533b36f7df1e5a04582151737b3fa_Q_1.svg"" />"
"<img sr
c=""b454339baca533b36f7df1e5a04582151737b3fa_A_1.svg"" />"
"<img src=""b454
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"<img src=""b454
339baca533b36f7df1e5a04582151737b3fa_tmplLUdLr.png"" />"
"<img src=""b454339baca533b36f7df1e5a04582151737b3fa_Q_2.svg"" />"
"<img sr
c=""b454339baca533b36f7df1e5a04582151737b3fa_A_2.svg"" />"
"<img src=""b454
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"<img src=""b454
339baca533b36f7df1e5a04582151737b3fa_tmplLUdLr.png"" />"
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c=""b454339baca533b36f7df1e5a04582151737b3fa_A_3.svg"" />"
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"<img sr
c=""b454339baca533b36f7df1e5a04582151737b3fa_A_4.svg"" />"
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"<img src=""b454
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"<img src=""b454339baca533b36f7df1e5a04582151737b3fa_Q_5.svg"" />"
"<img sr
c=""b454339baca533b36f7df1e5a04582151737b3fa_A_5.svg"" />"
"<img src=""b454
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"<img src=""b454
339baca533b36f7df1e5a04582151737b3fa_tmplLUdLr.png"" />"
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"<img sr
c=""b454339baca533b36f7df1e5a04582151737b3fa_A_6.svg"" />"
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"<img src=""b454
339baca533b36f7df1e5a04582151737b3fa_tmplLUdLr.png"" />"
"<img src=""b454339baca533b36f7df1e5a04582151737b3fa_Q_7.svg"" />"
"<img sr
c=""b454339baca533b36f7df1e5a04582151737b3fa_A_7.svg"" />"
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"<img src=""b454339baca533b36f7df1e5a04582151737b3fa_Q_8.svg"" />"
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c=""b454339baca533b36f7df1e5a04582151737b3fa_A_8.svg"" />"
"<img src=""b454
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c=""b454339baca533b36f7df1e5a04582151737b3fa_A_9.svg"" />"
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c=""b454339baca533b36f7df1e5a04582151737b3fa_A_10.svg"" />"
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c=""b454339baca533b36f7df1e5a04582151737b3fa_A_11.svg"" />"
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c=""b454339baca533b36f7df1e5a04582151737b3fa_A_12.svg"" />"
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"<img src=""b454
339baca533b36f7df1e5a04582151737b3fa_tmplLUdLr.png"" />"
What are the 3 main divisions of white matter in the spinal cord?
Dorsal,
lateral, and ventral funiculus
What are the divisions of the grey matter called?&nbsp; Laminae
Laminae I-IV
Exteroceptive -- pain and temperature
Laminae V-VI
Proprioception
Laminae VII
Clar
s nucleus, autonomic ganglia

Laminae VIII, IX, X

Motor&nbsp;
1. End of spinal cord veterbral level<div>2. End of dura mater</div><div>3. End
of pia mater&nbsp;</div>
L1/2<div>S1</div><div>Coccyx (filum terminale)</
div>
How many pairs of spinal nerves are there?
31 (8C, 12T, 5L, 5S + 1 coccyx)
As you ascend the spinal cord, how does the size of the cord change?
Increase
s, cause as you go up you have more information to carry bac
to the brain!<div>
<br /></div>
Above T1, spinal nerves exit (above/below) vertebrae. Below T1, the spinal nerve
s exit (above/below) the vertebrae
Above (Exception: C7 has a nerve going u
nder it called C8)<div><br /></div><div>Below</div>
What is the clinical presentation of EHEC? (4) <div>1. Abdominal cramping</div>
<div>2. watery and bloody diarrhea</div><div>3. High fever frequently absent</di
v><div>4. Hemolytic uremic syndrome (HUS)</div><div><br /></div>
What are the ascending tracts?&nbsp;
Dorsal column, Spinothalmic, Spinocerebe
llar (Dorsal/Ventral and Cuneocerebellar)
What are the features of hemolytic uremic sydrome (3)? Describe the pathogenesis
?
"Renal failure,&nbsp;<div>hemolytic anemia,&nbsp;</div><div>thrombocytop
enia (due to excess platelet aggregation and clot formation) - can lead to organ
ischemia eventually</div><div>Schistocytes! - see arrows below</div><div><br />
</div><div><img src=""paste-39479339385106.jpg"" /></div><div><br /></div><div>P
athogenesis -</div><div>&nbsp;Toxin produced attac
s 28S ribosomal RNA (destroyi
ng ribosomes), and damages endothelial cells&nbsp;</div><div><br /></div><div>da
mage of endothelial cells leads to platelet aggregatiation, which then cleaves t
he RBCs flowing by into helmet shaped shistocytes</div>"
What should you never give to treat patients with EHEC <div>Antibiotics! increa
sed ris
of Hemolytic uremic syndrome!</div><div><br /></div><br />
T/F EHEC 0157H7 can ferment sorbitol
False<br /><div><br /></div><div>Note most non-0157H7 EHEC strains can ferment sorbitol!</div>
T/F Enterpathogenic E.coli (EPEC) causes severe diarrhea by attaching and effaci
ng microvilli on intestinal epithelial cells
True - they have LEE pathogenici
ty island
What protects babies (&lt;6 months) against the effects of EPEC (watery diarrhea
)?
Breastfeeding<div>- inhibits adherence</div><div>- protective antibodies
</div>
Describe the mechanism by which Enteropathogenic E.coli adhere to intestinal epi
thelial cells cytos
eletal proteins
<div>EPEC carries its own receptor, inje
cts it into the host cells, binds to it, and then activates host actin and filam
ent formation machinery</div><div><br /></div><div>The attaching and effacing hi
stopathology results in pedestal-li
e structures, which rise up from the epithel
ial cell on which the bacteria perch</div>
2nd most common bacterial cause of travelers diarrhea, which normally has a stac

ed bric
adherence pattern
"Enteroaggregative E. coli (EAEC)<div><br /></di
v><div><img src=""paste-40570261078446.jpg"" /></div>"
What enterobactericiae is very similar to Shigella in pathogenesis and clinical
presentation? Enteroinvasic E. coli (EIEC)<div><br /></div><div><div><b>Invade
</b> epithelial cells</div><div>Microbial proteins ta
e over the host actin-fila
ment assembly</div><div>Ma
e cells rearrange their cytos
eletons and put <b>adhe
rent pedestals</b> on cell surface</div><div><b>Spread directly from cell to cel
l</b></div></div><div><br /></div>
<div>T/F: Enterobacteriaceae can cause infections outside the intestine.</div>
True
E.coli strains that adhere individually at random to tissue culture cells
Diffuse Adhering E. coli (DAEC)
What two E.coli strians&nbsp;usurps cytos
eleton to form adherent pedestals<div>
<br /></div>
EIEC and EPEC
Describe the pathogenesis of ETEC with gut epithelial cells&nbsp;
"&nbsp;A
.ETEC bind loosely via fimbriae, secrete toxins (li
e Cholera toxins) into the g
ut that then gain entry into the cell without disruption of cytos
eleton.<div><b
r /></div><div><img src=""paste-40900973560078.jpg"" /></div>"

{{c2::LOS::LPS vs. LOS}} organisms are sensitive to {{c1::bile salts}} and canno
t live in the gut
LPS resists Abx, bile salts, complement
Describe the interaction of EPEC with gut epithelial cells
"<img src=""past
e-41416369635606.jpg"" /><div>EPEC destroys the brush border microvilli,(<b>via
LEE pathogenicity)</b>&nbsp;and becomes firmly attached through a pedestal consi
sting of actin and actin binding proteins.</div>"
H antigens are from {{c1::flagella}}
Describe the pathogenesis of EIEC
"<img src=""paste-41455024341246.jpg"" /
><div>C. EIEC, gains entry into the cell, escaping from the immune system by dig
esting the phagolyosome. &nbsp;EIEC can grow and divide in the cell cytoplasm an
d gain entry to neighbouring cells by bursting through and digesting membranes (
<b>similar to shigella infection)</b></div>"
Describe the pathogenesis of EHEC
"<img src=""paste-41493679046894.jpg"" /
><div><div>D. EHEC (has both LEE pathogenicity and Shiga Toxin), operates li
e E
PEC, but in addition <b>Shiga toxins</b> are liberated that the epithelial cells
ta
e up in coated pits and ta
en to the Golgi. &nbsp;The toxins then travel fro
m Golgi to the E.R. where they destroy ribosomes by the removal of a single aden
ine residue from the <b>28SrRNA</b>. &nbsp;This results in the death of the cell
.&nbsp;</div></div><div><br /></div>"
24 yo female medical student&nbsp;Elective rotation in Guadalajara, Mexico<div>7
days after arrival develops watery diarrhea, nausea, abdominal cramps</div><div
>No fever</div><div>No blood or mucus in the stool</div><div>Had eaten undercoo

ed chic
en 3 hours prior to onset</div><div>Stool without fecal leu
ocytes</div>
<div><br /></div><div>most li
ely diagnosis?</div>
ETEC &nbsp;<div><br /></
div><div><div>Most common cause of travelers diarrhea</div><div>No fecal leu
ocyt
osis</div><div>No fever</div></div><div><br /></div>
What is unique about E.coli 0104:H4?
<div>Enteroaggregative E. coli genetic b
ac
ground</div><div>Plus Shiga toxin producing genes (prophage)</div><div>Plus e
xtended-spectrum beta-lactamase plasmid</div><div><br /></div>
What transcription factor regulates virulence genes of EAEC&nbsp;, including pla
smid genes encoding the aggregative adherence fimbriae (AAF)?<div><br /></div>
AggR&nbsp;
K antigens are from {{c1::capsule}}
O antigens are from {{c1::oligosaccharides associated with LPS}}
antigen that confers motility to enterobactericeae
H antigen
Enterobactericieae virulence factors (8):
Exotoxins<div>LPS (endotoxin)</d
iv><div>LOS (endotoxin)</div><div>H antigen (flagella), O antigen</div><div>K an
tigen (capsule)</div><div>Adhesins</div><div>Iron upta
e</div><div>Plasmids</div
>
H, O, and K antigens are virulence factors of {{c1::enterobacteriaceae::type of
bacteria}}
Enterobactericieae natural habitat
lower GI tract
Why Enterobacteriaceae K antigens are poor immunogens mimic human oligosacchar
ides (e.g. Klebsiella)<div>_{- thus, immune system recognizes them as self an
d doesnt react}</div>
K antigen function
shield, camouflage, resist drying, ma
e <b>biofilms</b>
adhesins are {{c1::fimbriae (pili)}}
adhesin is an enterobacteriaceae virulen
ce factor (at least we learned it in this lecture)
<div>H antigen (flagella) and O antigen: why are patients only&nbsp;protected fr
om re-infection of same serotype, not other serotypes?</div>
<u>antigenic var
iability</u> of H and O antigens
Bacteria use {{c1::siderophores}} to capture iron from host
siderophores: fn
capture iron from host for bacteria
most common extra-intestinal (and nosocomial) infection caused by E. coli
UTI
2nd most common extra-intestinal infection by E. coli abdominal/pelvic infecti
on
Gram (-) rods, facultative anaerobes that dont sporulate
Enterobacteriace
ae
Most {{c1::enterobacteriaceae}} are motile except {{c2::Shigella and Klebsiella:

:2 exceptions}}
agar that inhibits Gram(+) growth, contains lactose, pH indicator, and bile salt
s
MacCon
ey agar
On MacCon
ey agar, bacteria that is Lactose (+) is {{c1::pin
::color}} and Lacto
se (-) {{c1::tan/grey::color}} "<img src=""paste-50238232461914.jpg"" />"
Lactose (-) Enterobacteriaceae Pseudomonas<br />Proteus<div>Providencia</div><d
iv>Yersinia</div><div>Salmonella</div><div>Shigella</div><div>Serratia (+/-)</di
v>
MacCon
ey agar inhibits Gram {{c1::(+):: (+) vs. (-)}} growth also has lactose
, pH indicator, and bile salts
Enterobacteriaceae is oxidase {{c1::(-):: (+) or (-)}}
Antibodies to these two Enterobacteriaceae antigens are protective (help opsoniz
e/lyse) H antigen (flagella)<div>O antigen</div>
Examples of lactose-(+) Enterobacteriaceae&nbsp;
"<div>Citrobacter</div><
div>Klebsiella</div><div>E. Coli</div><div>Enterobacter</div><div>Serratia</div>
<img src=""paste-74208444940388.jpg"" /><div><img src=""paste-74238509711546.jpg
"" /><br /><div><br /></div></div>"
Highly motile and swarms on blood agar plates. Produces a rapid-acting urease.
"Proteus<div><img src=""proteus.jpeg"" /></div>"
H antigen is&nbsp;<b>Not</b>&nbsp;found in what 2 species?
<div>(not found
in
lebsiella and shigella)</div><div><br /></div><div>_{H antigen = flagella}</div>
<b>All</b>&nbsp;gram (-) bacteria contain what that can lead to sepsis? Endotoxi
n: LPS, (lipid A)
What tests can be used to identify enterobacteriaceae "<div>Enterobacteriaceae
are oxidase (-) (lac
cytochrome c), and reduce nitrate to nitrite</div><img sr
c=""test entero.jpeg"" />"
Iron overload states, such as hemochromocytosis and thalassemias, increase susce
ptibility to infection with {{c1::Yersinia}}
How are they connected: iron overload and yersinia
Iron overloaded states,
such as&nbsp;<u>hemochromatosis</u>&nbsp;and&nbsp;<u>thalassemias</u>&nbsp;incre
ase susceptibility to infection with Yersinia because&nbsp;<u>yersinia doesnt m
a
e siderophores</u>
"Which pathogens are considered ""lower inoculum""?"
Shigella, Norovirus&nbsp
;
Which pathogens show a moderate rate of spread? Giardia, Cryptosporidium, Shiga
toxin producing E. Coli, Salmonella
Which pathogens exhibit a low rate of spread? Campylobacter, enteroinvasive an
d enterotoxigenic E Coli (EIEC, ETEC) and VIbrio Cholerae
Expected Inoculum Size:<div><br /></div><div>High:</div><div>Moderate:</div><div
>Low:</div>
<br /><div><div>High: 10-100 organisms</div><div>Moderate: 80 to
100,000 organisms&nbsp;</div><div>Low: 500 to &gt; 1,000,000 organisms</div></d
iv>
Which populations are more susceptible to lower inoculum sizes? Immunocompromise
d, elderly, infants, and pts on PPI inhibitors&nbsp;
High dose pathogens must first multiply in {{c1::food}} before they can produce
disease
Low Dose Pathogens Commonly Cause Diarrhea Outbrea
s in Day Care Centers: Which
of the following doesnt fit?<div><br /></div><div>A. Shigella</div><div>B. Cyro
tosporidium</div><div>C. Giardia</div><div>D. Campylobacer jejuni</div><div>E. N
orovirus</div> D
Most important foodborne vehicle for diarhhea Leafy greens (22%)
Reason for the upta
e of foodborne diahrrea
Globalization of food supply
How would you test for shiga toxin producing E. Coli? E. Coli 0157: Negative f
or sorbitol, test for O157, MacCon
ey&nbsp;<div><br /></div><div>E. Coli non-O15
7: Positive for sorbitol, test stools for <b>shiga toxin 1 and 2 by EIA&nbsp;</b
></div>
How does shiga toxin E. Coli
ill people?&nbsp; Hemolytic Uremic Syndrome:&nbsp;
<div><br /></div><div>Endothelial damage --&gt; platelet aggregation --&gt; dest
ruction of RBCs = schistocytes&nbsp;</div>

Where is shiga toxin E. Coli found?&nbsp;

Primarily surface of raw meat, b
ut also surfaces of produce, unpasteurized apple juice, toddler pools, petting z
oos
88 yo man with blood diarrhea and subsequent renal failure.&nbsp;<div><br /></di
v><div>Negative for sorbitol negative E. Coli</div><div>Stool positive for Shiga
toxin by EIA</div><div><br /></div><div>What caused this?</div> HUS due to non O
157 shigatoxin productin E Coli (STEC)
What is the forebrain composed of? (2)<div><br />Function?</div>
"cerebra
l cortex + collection of deep nuclei derived from telencephalon and diencephalon
<div><br /></div><div>function: wor
together with the cortex to generate cognit
ive and emotional life<br /><div><br /></div><div><img src=""paste-3265420685478
44.jpg"" /></div></div>"
Non typhoid Salmonella is primarily associated with what source?
"Poultry
, chic
ens!!<div><br /></div><div><img src=""paste-8559869821486.jpg"" /></div>"
What are the deep nuclei located in the forebrain? (4) What are they derived fro
m?
"1) thalamus<div>2) hypothalamus</div><div>3) basal ganglia</div><div>4)
nuclei of the limbic system</div><div><br /></div><div>derived from telencephal
on and diencephalon</div><div><br /></div><div><img src=""paste-326722457174468.
jpg"" /></div>"
What group of people have the highest rates of salmonella infection in the U.S?
Why?
Infants<div><br /></div><div>1. Susceptible to low inoculum sizes</div><
div>2. High rates of cross-contamination</div><div><br /></div>
<div>80-year old woman develops fever after heart surgery, is given antibiotics
for sternal osteomyelitis.</div><div>She develops fever and profuse diarrhea&nbs
p;</div><div>Her white count is 30,000 (normal 5,000 to 10,000)</div><div>Stool
sample collected and contains both blood and WBCs</div><div><br /></div><div>Dia
gnosis this lady.</div> Clostridium difficile&nbsp;
Most susceptible individuals of C. difficile? Advanced age, individuals on ant
ibiotics, chemo, or PPIs.&nbsp;
What is the treatment for initial C Difficile infections? What about recurring i
nfections?
<div>1st or 2nd bout: goals are to inhibit of growth of C. diffi
cile (vegetative forms), preserve/re-establish gut flora, and develop immune res
ponse to toxins (C. difficile produces toxins A&nbsp;and B --&gt; IV monoclonal
antibodies prevent recurrence)&nbsp;</div><div><br /></div><div>&gt; 2 recurrenc
es of CDI: gut microbiota resistance lost --&gt; restore via fecal transplant</d
iv>
Most common causes of death from diarrhea in the U.S
1. C difficile<div>2. No
rovirus</div><div>3. Salmonella&nbsp;</div><div><br /></div><div>Mainly in elder
ly!</div>
3 post enteric infection disorders and their associated bugs. 1. Reactive arth
iritis (C jejuni, salmonella, shigella, yersinia <b>CSSY</b>)<div>2. Post-infect
ious IBS</div><div>3. Guillain-Barre Syndrome (campylobacter)</div>
"<img src=""4a914338bd6450c6cffdfb9e6cdbfd021adeb63f_Q_0.svg"" />"
"<img sr
c=""4a914338bd6450c6cffdfb9e6cdbfd021adeb63f_A_0.svg"" />"
"<img src=""4a91
4338bd6450c6cffdfb9e6cdbfd021adeb63f_source_svg.svg"" />"
"<img src=""4a91
4338bd6450c6cffdfb9e6cdbfd021adeb63f_tmpDaSqm8.png"" />"
Pts family has diahrrea (but she is initially symptom free) and 10 days later de
velops motor wea
ness, decrease reflex, increase in CSF protein.<div><br /></div
><div>What is this?</div><div>Why did pt not present w/ diahrrea?</div> Campylob
acter jejuni (causes Guillian Barr)<div><br /></div><div>Asymptomatic infection
--&gt; antibodies --&gt; can still lead to Guillian Barr&nbsp;</div>
Major ris
factor for campylobacter
Chic
en&nbsp;
Campylobacter is resistant to what antibiotic? Ciprofloxacin&nbsp;
What are the three parts of the basal ganglia? What are their spatial relationsh
ips?
"1) putamen (lateral), 2) globus pallidus (both external to thalamus, se
parate from thalamus by internal capsule)<div><br /></div><div>3) caudate nucleu
s - large, tadpole shaped nucleus that resides in the wall of lateral ventricle<
br /><div><br /></div></div><div><img src=""paste-346655400395111.jpg"" /></div>
<div><img src=""paste-501145374032749.jpg"" /></div>"
What bugs are contraindicated for antibiotics? Shigella toxin E Coli&nbsp;<div>

<br /></div><div>Mild Salmonella</div>

"<img src=""a7252c0844fc21f3b49fbd2bf4ba8f8cf47ef2fd_Q_0.svg"" />"
"<img sr
c=""a7252c0844fc21f3b49fbd2bf4ba8f8cf47ef2fd_A_0.svg"" />"
"<img src=""a725
2c0844fc21f3b49fbd2bf4ba8f8cf47ef2fd_source_svg.svg"" />"
"<img src=""a725
2c0844fc21f3b49fbd2bf4ba8f8cf47ef2fd_tmpcjXQuU.png"" />"
"<img src=""9c5e1b9872f0c342988d567a3880497921148261_Q_0.svg"" />"
"<img sr
c=""9c5e1b9872f0c342988d567a3880497921148261_A_0.svg"" />"
"<img src=""9c5e
1b9872f0c342988d567a3880497921148261_source_svg.svg"" />"
"<img src=""9c5e
1b9872f0c342988d567a3880497921148261_tmp0u2nBG.png"" />"
"<img src=""2ed5eeb59b7d8104f4a07ea5599a43224b7317f2_Q_0.svg"" />"
"<img sr
c=""2ed5eeb59b7d8104f4a07ea5599a43224b7317f2_A_0.svg"" />"
"<img src=""2ed5
eeb59b7d8104f4a07ea5599a43224b7317f2_source_svg.svg"" />"
"<img src=""2ed5
eeb59b7d8104f4a07ea5599a43224b7317f2_tmp7e37xe.png"" />"
"<img src=""2ed5eeb59b7d8104f4a07ea5599a43224b7317f2_Q_1.svg"" />"
"<img sr
c=""2ed5eeb59b7d8104f4a07ea5599a43224b7317f2_A_1.svg"" />"
"<img src=""2ed5
eeb59b7d8104f4a07ea5599a43224b7317f2_source_svg.svg"" />"
"<img src=""2ed5
eeb59b7d8104f4a07ea5599a43224b7317f2_tmp7e37xe.png"" />"
What portion of the thalamus receives input from basal ganglia and the cerebellu
m and has output to the cortex to help with motor control?
"ventrolateral n
ucleus<div><br /></div><div><img src=""paste-481452948980105.jpg"" /></div><div>
<br /></div><div><img src=""paste-362078627954964.jpg"" /></div>"
"<img src=""0a68722cf08794c8452c43d6cd8f339238285d2f_Q_0.svg"" />"
"<img sr
c=""0a68722cf08794c8452c43d6cd8f339238285d2f_A_0.svg"" />"
"<img src=""0a68
722cf08794c8452c43d6cd8f339238285d2f_source_svg.svg"" />"
"<img src=""0a68
722cf08794c8452c43d6cd8f339238285d2f_tmpT7MuHQ.png"" />"
"<img src=""63a3b61128a74536700937641cef1b6c630e8dfe_Q_0.svg"" />"
"<img sr
c=""63a3b61128a74536700937641cef1b6c630e8dfe_A_0.svg"" />"
"<img src=""63a3
b61128a74536700937641cef1b6c630e8dfe_source_svg.svg"" />"
"<img src=""63a3
b61128a74536700937641cef1b6c630e8dfe_tmpT7MuHQ.png"" />"
"<img src=""0d08b9c04aa1113433426a60f1bd9f9b192945a1_Q_0.svg"" />"
"<img sr
c=""0d08b9c04aa1113433426a60f1bd9f9b192945a1_A_0.svg"" />"
"<img src=""0d08
b9c04aa1113433426a60f1bd9f9b192945a1_source_svg.svg"" />"
"<img src=""0d08
b9c04aa1113433426a60f1bd9f9b192945a1_tmpHqblDo.png"" />"
"<img src=""3fa73fd92cdedde74c60afaa7ace4634c10ac171_Q_0.svg"" />"
"<img sr
c=""3fa73fd92cdedde74c60afaa7ace4634c10ac171_A_0.svg"" />"
"<img src=""3fa7
3fd92cdedde74c60afaa7ace4634c10ac171_source_svg.svg"" />"
"<img src=""3fa7
3fd92cdedde74c60afaa7ace4634c10ac171_tmpMWYFf9.png"" />"
"<img src=""824a11176262dbd0ee29aa6b00d1307a69a24184_Q_0.svg"" />"
"<img sr
c=""824a11176262dbd0ee29aa6b00d1307a69a24184_A_0.svg"" />"
"<img src=""824a
11176262dbd0ee29aa6b00d1307a69a24184_source_svg.svg"" />"
"<img src=""824a
11176262dbd0ee29aa6b00d1307a69a24184_tmpV9CxyG.png"" />"
"<img src=""8a99bdf1193f2ef5c252bc3e27cc81abcdb0248a_Q_0.svg"" />"
"<img sr
c=""8a99bdf1193f2ef5c252bc3e27cc81abcdb0248a_A_0.svg"" />"
"<img src=""8a99
bdf1193f2ef5c252bc3e27cc81abcdb0248a_source_svg.svg"" />"
"<img src=""8a99
bdf1193f2ef5c252bc3e27cc81abcdb0248a_tmpr8h70g.png"" />"
"<img src=""8a99bdf1193f2ef5c252bc3e27cc81abcdb0248a_Q_1.svg"" />"
"<img sr
c=""8a99bdf1193f2ef5c252bc3e27cc81abcdb0248a_A_1.svg"" />"
"<img src=""8a99
bdf1193f2ef5c252bc3e27cc81abcdb0248a_source_svg.svg"" />"
"<img src=""8a99
bdf1193f2ef5c252bc3e27cc81abcdb0248a_tmpr8h70g.png"" />"
Ventrolateral Nucleus<div><br /></div><div>part of {{c1::thalamus}}</div><div>in
put: {{c1::basal ganglia and cerebellum}}</div><div>output: {{c1::cortex to help
with motor control}}</div>
"<img src=""paste-481448654012809.jpg"" /><div><
br /></div><div><img src=""paste-362074332987668.jpg"" /></div>"
Ventral posterior lateral (VPL) and ventral posterior medial (VPM)<div><br /></d
iv><div>part of: {{c1::thalamus}}</div><div>input:{{c1::</div><div> somatosensor
y (DC) and spinothalamic tracts (STT)</div><div></div><div>}}- responsible for s
ensation from {{c1::contralateral::contra/ipsi?}}</div><div>output: {{c1::post-c
entral gyrus of the cortex}}</div>
"<img src=""paste-481641927541129.jpg""
/>"
What part of the thalamus receives input from somatosensory + spinothalamic trat

s + outputs to post-central gyrus of the cortex?

"ventral posterior later
al (VPL)<div>ventral posterior medial (VPM)</div><div><img src=""paste-481706352
050560.jpg"" /></div>"
Collection of nuclei for autonomics, appetite, temperature control, circadian rh
ythms, endocrine
"Hypothalamus<div><img src=""paste-481921100415384.jpg""
/></div>"
The hypothalamus receives information from where?<div><br /></div><div>What is i
t the supreme command of?</div> "receives information from almost everywhere in
the brain + regulates internal homeostasis<div><br /></div><div>supreme command
of endocrine and autonomic systems</div><div><img src=""paste-481955460153732.jp
g"" /></div>"
Collection of nuclei for communicating with the cortex and other deep nuclei - i
nvolved with emotional regulation and memory
"limbic system<div><br /></div><
div><img src=""paste-481989819892104.jpg"" /></div>"
What happens if the hippocampus is damaged?
"if both the hippocampi or forni
ces are damaged, new memories may not be formed<div><br /></div><div><img src=""
paste-496197571707272.jpg"" /></div>"
"<img src=""ca901c06158723c374ec6b67bd8d389c6f986e5a_Q_0.svg"" />"
"<img sr
c=""ca901c06158723c374ec6b67bd8d389c6f986e5a_A_0.svg"" />"
"<img src=""ca90
1c06158723c374ec6b67bd8d389c6f986e5a_source_svg.svg"" />"
"<img src=""ca90
1c06158723c374ec6b67bd8d389c6f986e5a_tmpbN18Ka.png"" />"
Where does the fornix go between?
"the hippocampus and mammillary bodies<d
iv><br /></div><div><img src=""paste-496240521380232.jpg"" /></div>"
What is the function of the amygdala? How might this be important clinically?
"interpretation/experience of fear<div>- may be important in anxiety disorders</
div><div><img src=""paste-496395140202919.jpg"" /></div>"
A patient is infected with Shigella. What might their symptoms be:
frequent
stools, blood + mucous, straining, painful defecation<div><br /></div><div>comm
unicable dysentery!</div>
A patient (2 yr old) has loose stool with bloody mucous. The bacteria does not p
roduce H2S and the MacCon
ey agar comes bac
tan. What are you thin
ing the bact
eria is and what are three possible ways it spreads.
<div>Shigella</div><div>
<br /></div>Fecal-oral, fecal contamination of water, foodborne
T/F: Fever is more common in EHEC and Cholera than with a Shigella infection&nbs
p;
F<div><br /></div><div>Shigella presents more often with fever because i
t invades epithelial cells along the gut; cholera and EHEC do not invade</div>
Define dysentery:
frequent passage of stool containing blood and mucus
What are the four species of Shigella? Which is the foodborne strain? Which infe
cts usually by male-male sex? <div><div>S. sonnei, S. flexneri, S. dysenteriae
, S. boydii</div></div><div><br /></div><div><div>Foodborne strain: S. sonnei</d
iv><div>Sexual transmission during male-male sex: S. flexneri</div></div><div><b
r /></div>
Shigella is one of the most communicable bacterial diarrheas (only need 10-100 o
rganisms).<div><br /></div><div>Which of the following factors is more important
in its pathogenesis: invasiveness or shiga toxin?</div>
Invasiveness
Describe the clinical presentation of Shigellosis:<div>- how long do symptoms la
st?</div><div>- intrafamilial spread?</div><div>- where are the organisms?</div>
<div>Acute diarrhea:</div><div>1) at first fever, abd cramps, voluminous watery
stool <b>(organism invades small bowel)</b></div><div>2) then, increased # of st
ools with small volume + mucus and blood, fecal urgency (<b>organism invades lar
ge intestine mucosa)</b></div><div><br /></div><div>Lasts 48 hours</div><div><br
/></div><div>Intrafamilial spread with 1-3 day interval</div>
Patient has shigellosis but no bacteria in their stool. Why?
Lower bacterial
counts in stool during the later phase of infection (large intestine), than when
the small bowel was infected.
Patients develop diarrhea because the inflamed colon, damaged by Shiga toxin, is
unable to reabsorb fluids and electrolytes. Why is the stool important?
"<div><b><u>Diagnosis<span class=""Apple-tab-span"" style=""white-space:pre""> <
/span>is made this way</u></b></div><div>1) Stool culture</div><div>2) Fecal leu

ocytosis</div><div>3) Stool assay for Shiga toxin</div><div><br /></div>"

Treatment for shigellosis:

<div>1) Antibiotics shorten duration and decreas
e transmission (tx: fluoroquinolones, cephalosporins, azithromycin)</div><div>2)
Replace fluid losses</div><div>3) Avoid antimotility agents</div>
Prevention for Shigellosis
<div>1) Chlorinated water supply</div><div>2) Ha
nd washing</div><div>3) Breast feeding (maternal antibodies)</div><div><br /></d
iv>
What bacteria cause <b>Enteric Fever</b>?<div>What is the mechanism?<br /><div>A
re leu
ocytes present in feces?</div></div>
"<img src=""paste-30743375904769
.jpg"" />"
What bacteria cause <b>Dysentery</b>?<div>What is the mechanism?<br /><div>Are l
eu
ocytes present in feces?</div></div> "<img src=""paste-30739080937473.jpg"" /
>"
What bacteria cause <b>watery diarrhea</b>?<div>What is the mechanism?<br /><div
>Are leu
ocytes present in feces?</div></div> "<img src=""paste-30739080937473
.jpg"" />"
Who is at the highest ris
for developing Salmonella? <div>Young, elderly, HIV
, and vascularly damaged pts. at highest ris
&nbsp;</div>
What are the carriers of Salmonella?
<div>Carried by reptiles, amphibians, ro
dents, raw poultry, peanut butter&nbsp;</div>
What can Salmonella cause (vascular)? <div>Predilection for causing aneurisms
(vascular damage)&nbsp;</div>
Differences between non-typhoid and typhoid Salmonella <div><b><u>Non-typhoid S
almonella:&nbsp;</u></b></div><div>Gastroenteritis &nbsp;</div><div>Bacteremia (
in extremes of age, AIDS, steroids, IBD, sic
le cell)&nbsp;</div><div><br /></di
v><div><b><u>T</u></b><u><b>yphoid fever --&gt; can cause systemic disease&nbsp;
</b></u></div><div>Travelers to Asia, only humans/primates are carriers&nbsp;</d
iv><div>Chronic, asymptomatic carriage in <b><u>gallbladder</u></b> (reservoir f
or bacteria)&nbsp;</div><div>Enteric fever symptoms are nonspecific: leu
openia,
rose spots, relative bradycardia even with high fever</div>
"<img src=""paste-73143293050881.jpg"" /><div><br /></div><div>hard nodules on s
oles of feet - what is this?</div>"
<div>These rashes are called
eratoderma
blennorrhagica. In addition, some people with Reiters syndrome develop mouth u
lcers that come and go. In some cases, these ulcers are painless and go unnotice
d.&nbsp;</div><div><br /></div>
Why will you see a decrease in the prevalence of typhoid fever well before a dec
rease in Shigella-dysentery with a public health intervention? The infectious d
ose is so low with Shigella as compared to Salmonella
<div>Salmonella bacteremia occurred in HIV patients at rates 20-100 times higher
than the general population, with recurrence rates of 40-50%</div><div><br /></
div><div><u><b>Recurrent Salmonella bacteremia is an AIDS defining illness</b></
u></div>
What bacterial infection do you diagnose via a bone marrow biopsy?
Salmonel
la<div><br /></div><div><div><u><b>Diagnosis made through bone marrow biopsy &nb
sp;or blood</b></u></div><div>Stool cultures frequently negative</div><div>Blood
culture: 50-70% positivecentrifuge blood and plate the buffy coat</div><div>Bone
marrow: 90% positive, even after antibiotics started</div></div><div><br /></di
v>
How are the limbic system and memories related? "limbic system may ""tag"" memor
ies with emotional salience<br /><div><img src=""paste-496390845235623.jpg"" /><
/div>"
"How does the forebrain interact with the external world?<div><u>sensory</u>:&nb
sp;{{c1::</div><div>dorsal column, spinothalamic tract</div><div></div>}}<div><u
>motor</u><i style=""text-decoration: underline; "">:</i>{{c1::</div><div>&nbsp;
corticospinal tract (CST)</div><div></div>}}<div><u>special senses</u>: {{c1::vi
sion, hearing, smell taste}}</div>"
How does the forebrain interact with the internal world? (3)
1) limbic system
- emotions, memories<div>2) basal ganglia - train of thought and emotions</div>
<div>3) cortex - plans, aspirations, schemas, plots</div>
The motor cortex gets a lot of help from what two structures? basal ganglia an
d cerebellum

The dorsal column system converges with what?<div><br /></div><div>VPL (ventral

posterior lateral) for?</div><div>VPM (ventral posterior medial) for?</div>
converges with dorsal column system in thalamus<div><br /></div><div>VPL for bod
y</div><div>VPM for face</div>
"<u>How does the forebrain execute action?</u><div><u><br /></u></div><div>Where
are ""plans"" formulated?</div><div>Where does the information flow to? (2)</di
v><div><br /></div>"
"plans formulated in frontal cortex<div><br /></div><div
>information flows in parallel to basal ganglia + cerebellum (for computation an
d smoothing)</div><div><img src=""paste-497511831700000.jpg"" /></div>"
<u>How does the forebrain execute action?</u><div><u><br /></u></div><div>Outflo
w from basal ganglia and cerebellum converge where?</div><div><br /></div><div>W
here does this then project to?</div><div><br /></div> "outflow converges on VE
NTTROLATERAL (VL) nucleus of thalamus<div><br /></div><div>VL projects BACK to f
rontal cortex with ""execution"" plan<br /></div><div><br /></div><div><img src=
""paste-497507536732704.jpg"" /></div>"
<div>Are actions of basal ganglia always a motor act?</div>
NO!, also includ
es train of though, focus of attention, emotional control<div><br /></div><div>(
note. basal ganglia disturbances causes movement disorders)</div>
Caudate nucleus (of basal ganglia)<div><br /></div><div>Shape?</div><div>Positon
of head?</div><div>Position of tail?</div>
"shape: large, tadpole shaped nu
cleus<div><br /></div><div>head: resides in wall of lateral ventricle</div><div>
<br /></div><div>tail: extends in the temporal lobe, but still in wall of ventri
cle</div><div><img src=""paste-499818229137788.jpg"" /></div>"
The amygdala is located near the termination of what two structures? &nbsp;What
is the implication of this?
"near the termination of caudate nucleus and hip
pocampus<div><br /></div><div>THUS: basal ganglia and limbic system can communic
ate</div><div><br /></div><div><img src=""paste-499813934170492.jpg"" /></div>"
What is the function of the internal capsule? "allows communication betweend d
eep nuclei and neocortex (part of white matter) - also the white matter through
several spinal tracts travel through<div><img src=""paste-497979983135226.jpg""
/></div>"
What structure connects the caudate nucleus and putamen?
"nucleus accumbe
ns<div><img src=""paste-497975688167930.jpg"" /></div>"
The forebrain is everything above what structure?
the midbrain, supratento
rial
What does the telencephalon become? Diencephalon? mesencephalon? metencephalon?
myelencephalon? "cerebral hemispheres&nbsp;<div>thalamus + hypothalamus</div><di
v>midbrain</div><div>pons and cerebellum</div><div>medulla</div><div><br /></div
><div><img src=""paste-33736968110550.jpg"" /></div>"
In which fossa is the cerebellum located?
"Posterior Fossa<div><img src=""
paste-240634132693695.jpg"" /></div>"
Five motor functions regarding cerebellum:
1. Motor Coordination<div>2. Mot
or Learning</div><div>3. Balance</div><div>4. Posture</div><div>5. Proprioceptio
n</div>
4 NON-motor functions of cerebellum
1-Blood pressure<div>2-Breathing Rhythm<
/div><div>3-Cognition</div><div>4-Languagex</div>
T or F: Cerebellum has 40% the surface area of the cerebral cortex and less than
half the neurons of the brain F: First part true, but it has MORE than half th
e neurons in brain
"White arrow points to:<div><img src=""paste-262027364794717.jpg"" /></div>"
Floculus
<div>Function?</div><div>Frontal Lobe {{c1::motor and higher cortical function}}
</div><div>Parietal Lobe - {{c1::sensation}}</div><div>Occipital Lobe - {{c1::vi
sion}}</div><div>Temporal Lobe {{c1::memory and hearing}}</div><div>Cerebellum {
{c1::coordination of motor}}</div>
"<img src=""0a2a318f954f4ee6cea6ba0cdd5b660dcc3ef9f5_Q_0.svg"" />"
"<img sr
c=""0a2a318f954f4ee6cea6ba0cdd5b660dcc3ef9f5_A_0.svg"" />"
"<img src=""0a2a
318f954f4ee6cea6ba0cdd5b660dcc3ef9f5_source_svg.svg"" />"
"<img src=""0a2a
318f954f4ee6cea6ba0cdd5b660dcc3ef9f5_tmpAfmLJL.png"" />"
"Arrow points to:<div><img src=""paste-262087494336767.jpg"" /></div>" Vermis

Name the deep cerebellar nuclei from medial to lateral Fastigial, Globose, Embo
liform, Dentate<div><br /></div><div><br /></div><div>Dont eat greasy food</div>
Name the 3 peduncles and their connections
Superior--&gt; connects cerebell
um with midbrain<div>Middle--&gt; connects cerebellum with pons</div><div>Inferi
or--&gt; connects cerebellum with medulla</div>
"<img src=""cd197430150e056627a896caeeb180ddf8c7a427_Q_0.svg"" />"
"<img sr
c=""cd197430150e056627a896caeeb180ddf8c7a427_A_0.svg"" />"
"<img src=""cd19
7430150e056627a896caeeb180ddf8c7a427_source_svg.svg"" />"
"<img src=""cd19
7430150e056627a896caeeb180ddf8c7a427_tmpol929n.png"" />"
cranial nerves f
rom midbrain, pons, and medulla
Name the cell layers of the cerebellar cortext from superficial to deep "Molecul
ar; Pur
inje; Granular; White matter<div><img src=""paste-311260574908736.jpg""
/></div><div><br /></div><div>Miles Per Gallon and you fill from inside out</div
>"
"<img src=""1c06d04272748d9f3bf50d15f9066720b98bc38d_Q_0.svg"" />"
"<img sr
c=""1c06d04272748d9f3bf50d15f9066720b98bc38d_A_0.svg"" />"
"<img src=""1c06
d04272748d9f3bf50d15f9066720b98bc38d_source_svg.svg"" />"
"<img src=""1c06
d04272748d9f3bf50d15f9066720b98bc38d_tmpEU1MvU.png"" />"
putting nerves a
nd vessels together
"<img src=""paste-199484051030522.jpg"" /><div><br /></div><div>what mode of ima
ging - left to right</div>"
T2, CT, T1
<div>Frontal lobe demarcated by {{c1::Central Sulcus}}</div><div>Parietal lobe d
emarcated by {{c1::Central Sulcus}} and {{c1::parietooccipital fissure}}</div><d
iv>Temporal Lobe demarcated by {{c1::lateral fissure}} and {{c1::parietooccipita
l fissure}}</div><div><br /></div>
3 criteria for finding central sulcus <div>Must be continuous along the convex
ity of the brain (outer surface)</div><div>Must dive into the longitudinal fissu
re</div><div>Must NOT connect with the lateral fissure</div><div><br /></div>
<div>The motor pathway actually originates in the motor cortex in the {{c1::prec
entral gyrus}}.&nbsp;</div><div>The sensory pathways both actually send their fi
nal synapse to the sensory cortex in the {{c1::post central gyrus}}.&nbsp;</div>
<div><br /></div>
"<img src=""paste-200029511877068.jpg"" /><div>identify significance of blue box
</div>" precentral gyrus<div>highlighting motor cortex. In this area you will fi
nd neurons that send an axon all the way down to the spinal cord to the *gasp* l
ower motor neurons you learned all about last lab.&nbsp;</div>
"<img src=""paste-200231375339958.jpg"" />"
postcentral gyrus - somatosensor
y - this is where long tracts for spinothalamic and dorsal column eventually wil
l end
Output of the cerebellar cortex is from which neurons? What neurotransmitter do
they release? Pur
inje cells; GABA
Sensory homonculus - order from lateral to medial - &nbsp;are head, arms, and le
gs
"<br /><div><img src=""paste-200373109260832.jpg"" /></div><div><img src
=""paste-200940044943834.jpg"" /></div>"
The 2 main afferents to the cerebellum and their origin.
climbing fibersfrom inferior olive.<div>Mossy fibers- Spinal, vestibular, and pontine inputs (s
ensory).</div><div><br /></div><div><br /></div>
"<img src=""42fa35341374e48e1791b78f22d33b7581e8c10b_Q_0.svg"" />"
"<img sr
c=""42fa35341374e48e1791b78f22d33b7581e8c10b_A_0.svg"" />"
"<img src=""42fa
35341374e48e1791b78f22d33b7581e8c10b_source_svg.svg"" />"
"<img src=""42fa
35341374e48e1791b78f22d33b7581e8c10b_tmpgLu7T3.png"" />"
putting nerves a
nd vessels together
What is the optic nerve called once you go posterior to the optic chiasm
"optic tract<div><br /></div><div><img src=""paste-234324825735698.jpg"" /></div
>"
What nerve is crushed in tentorial herniation "oculomotor<div><br /></div><div
><img src=""paste-234320530768402.jpg"" /></div>"
What nerve originates in between the olive and pyramid in the medulla "CN12<di
v><br /></div><div><img src=""paste-234320530768402.jpg"" /></div><div><br /></d
iv><div><img src=""paste-349352639857186.jpg"" /></div>"

"What region would be affected if you damaged the left anterior cerebral artery?
What would the clincal manifestations be? Which side of the body would be affec
ted?<div><img src=""paste-234582523773188.jpg"" /></div>"
"yellow - fronta
l lobe -&nbsp;<div><br /></div><div>NOTE -&nbsp;That region is the leg region fo
r both postcentral gyrus (sensory) and precentral gyrus (motor) so both systems
would show deficit in the legs.</div><div><br /></div><div>right side would be a
ffected because fibers cross</div><div><br /></div><div><img src=""paste-2346941
92922928.jpg"" /></div><div><br /></div>"
What do each of these cause?<div><br /></div><div>Bartonella Henselae = {{c1::ca
t scratch}}</div><div>Bartonella Quintana= {{c1::trench fever}}</div><div>Barton
ella Bacilliformis= {{c1::oroya fever/verruga peruana}}</div>
Clinical presentation:<div>Cat scratch, Trench Fever, Oroya Fever, Endocarditis,
Osteomylitis={{c1::bartonella}}</div>
Anterior circulation of the brain is from which main artery?
Internal carotid
artery and branches
Posterior circulation is from what main artery? vertebral arteries&nbsp;
What treatment is used for bartonella?<div><br /></div><div>{{c1::doxycycline+/rifampin; chloramphenicol}}</div><div><br /></div>
"<img src=""paste-153231
548219786.jpg"" />"
If the Left internal carotid artery is occluded, how will the left frontal lobe
get its blood? Lateral temporal lobe?<div><br /></div><div>Hint: trace the circu
lation from the right ICA through the circle of willis to the left ACA and MCA</
div>
"<div>Right ICA to &nbsp;Right Anterior Cerebral to anterior communicati
on to Left Anterior Cerebral to left Frontal Lobe</div><div>Right ICA to Right A
nterior Cerebral to anterior communication to Left Anterior Cerebral to Left Mid
dle Cerebral to &nbsp;Left lateral temporal lobe</div><div><br /></div><div>Also
R Posterior Communicating
right posterior cerebral
left posterior cer
Right ICA
ebral left Posterior Communicating Left ICA &nbsp;--- also fine</div><div><br />
</div><div><br /></div><div><img src=""paste-186517544766577.jpg"" /></div>"
T/F Brucella grows on chocolate and blood agar but NOT Mac Con
ey or EMB
True
Fever of un
nown origin, culture gram -, endocarditis, osteomyelitis, epididymoo
rchitis, aseptic meningtis
"<img src=""paste-153570850636169.jpg"" /><div><
br /></div><div>gram - (red barn)</div><div>undulating fever (hills)</div><div>o
steomyelitis (fish)</div>"
What causes parinaud oculoglandular syndrome? Bartonella
What are some ris
factors for Bartonella?
"Immunosuppression/HIV<div><br /
></div><div><img src=""paste-153630980178314.jpg"" /></div>"
What is the clinical presentation for Bartonella in immuno<b>competent </b>patie
nts? immuno<b>compromised?</b> "immunocompetent: cat scratch<div>immunocompromi
sed: Bacillary angiomatosis</div><div><br /></div><div><img src=""paste-15362668
5211018.jpg"" /></div>"
Systemic febrile illness of un
nown cause +/- rash is reason to suspect what?
Zoonotic gram(-) bacteria
"<img src=""cb5c375666323bb26df5986d1b1483d58e73dc72_Q_0.svg"" />"
"<img sr
c=""cb5c375666323bb26df5986d1b1483d58e73dc72_A_0.svg"" />"
"<img src=""cb5c
375666323bb26df5986d1b1483d58e73dc72_source_svg.svg"" />"
"<img src=""cb5c
375666323bb26df5986d1b1483d58e73dc72_tmpFXdwB2.png"" />"
putting nerves a
nd vessels together
"<img src=""2fa1d89c22482f4b3262b1d6674defd4bd0cac60_Q_0.svg"" />"
"<img sr
c=""2fa1d89c22482f4b3262b1d6674defd4bd0cac60_A_0.svg"" />"
"<img src=""2fa1
d89c22482f4b3262b1d6674defd4bd0cac60_source_svg.svg"" />"
"<img src=""2fa1
d89c22482f4b3262b1d6674defd4bd0cac60_tmpqrIyHS.png"" />"
putting nerves a
nd vessels together
Describe baseline activity of Pur
inje cells
Spontaneously active
Mossy fibers synapse onto {{c1::Granule Cells}} which release {{c1::glutamate}}
from their axons. These axons are called {{c1::paralell fibers}} in the molecula
r layer.
What are the 3 inhibitory interneurons in the cerbellar cortex? Bas
et, Stellate
, and Golgi cells.<div><br /></div><div>Stellate: superficial molecular</div><di

v>Bas
et: Molecular (wrap around pur
inje cell bodies li
e a bas
et)</div><div>G
olgi: Granule layer</div>
Which cell types of the cerebellar cortex provide spatial inhibition to Pru
inje
cells? Bas
et and stellate
Which cell types of the cerebellar cortex provide temporal inhibition to mossy f
iber input?
Golgi II cells
So....describe the circuit of the cerbellar cortex.
Pur
inje cells recieve 1
000s of excitatory parallel fiber inputs from granule cells. To be clear, each
parallel fiber only synapses once per pur
inje cell (so each parallel fiber syna
pses at a few hundred adjacent pur
injes).&nbsp;<div><br /></div><div>If many pa
rallel fibers spi
e--&gt;activation of pur
inje cells within close spacial proxi
mity. Leads to inhibition of deep cerebellar nuclei by pur
inje cells. This sequ
ence is for correct movements.</div><div><br /></div><div>If an error is registe
red by the cerebral (not cerebellar) cortex, then inferior olive neurons are act
ivated. Note that each climbing fiber wraps around ONE pur
inje neuron--so when
the climbing fiber releases glutamate it MASSIVELY depolarizes the pur
inje cell
. Activation by the climbing fiber leads to a complex spi
e pattern which WEAKEN
S the synapses of the granule cells (paralell fibers) that spi
ed immediately be
fore the &nbsp;inferior olive (climbing fiber) stimulus. This dissociates the se
nsory input (carried by the mossy fibers via the granule cells) &nbsp;from the e
rroneous motor pattern generated by the pur
inje cells.</div>
What are the 3 functional subdivisions of the cerebellum? To which anatomical di
visions do they map onto
"Spinocerebellum, Cerebrocerebellum (a
a Pontoce
rebellum), and Vestibulo cerebellum.<div><br /></div><div>Spinocerebellum-Vermis
and Paravermis (paravermis is not really an anatomical division, rather a funct
ional one). Comprises majority of anterior lobe.</div><div><br /></div><div>Pont
ocerebellum-Lateral hemispheres</div><div><br /></div><div>Vestibulocerebellum-F
loculo-nodular lobe</div><div><img src=""paste-312570539934443.jpg"" /></div>"
Three main sources of info to cerebellum and their respecive functions "<img sr
c=""paste-312613489607262.jpg"" />"
Describe&nbsp;Multilayered fiber system <div>Consists of the afferent from the h
ypothalamus,</div><div>as well as the serotonergic input from the raphe</div><di
v>nuclei, the noradrenergic input from the locus</div><div>ceruleus, &amp; the d
opaminergic input from the</div><div>VTA</div><div><br /></div><div><br /></div>
<div>Hypothalamus--afferent</div><div>Raphe Nucleus-5HT</div><div>Locus Ceruleus
-NE</div><div>VTA-DA</div>
Describe Climbing fiber system&nbsp;
<div> Consists of the olivocerebellar tra
cts.</div><div> Privileged interaction with Pur
inje cells</div>
Describe Mossy fiber system
<div>Includes all afferents which are not part o
f the</div><div>climbing fiber &amp; the multilayered fiber system</div>
<div>The fastigial nucleus projects, {{c1::bilaterally}}, to</div><div>the {{c1:
:vestibular nucleus}} and the{{c1::</div><div> pontine</div><div>reticular forma
tion</div><div>}}.&nbsp;</div>
<div>The interposed nucleus sends information</div><div>primarily to the descend
ing systems via the</div><div>{{c1::contra}}lateral {{c2::red nucleus}}</div>
<div>The dentate nucleus sends information to</div><div>the {{c1::contra}}latera
l {{c1::motor &amp; premotor}} cortices</div><div>via the {{c1::ventrolateral}}
thalamus.</div>
4 Major functions of pons
"<img src=""paste-313150360519099.jpg"" />"
Name the 2 principle regions of the pons
Basis Pontis and Pontine Tegment
um
Where is Basis Pontis Located and what does it contain? <div>ventral (corticospi
nal and</div><div>corticobulbar tracts, pontine nuclei)</div>
Where is pontine tegmentum located and what does it contain?
<div>dorsal (nuc
lei of</div><div>the cranial nerves, reticular formation,</div><div>respiratory
centers&nbsp;</div>
Which cranial nerves emanate from/synapse in the pons? "5,6,7,8<div><br /></div
><div><img src=""paste-349348344889890.jpg"" /></div>"
In a myelin stain, axons appear Dar

Raphe nucleus secretes what neuromodulator? What are its functions (3)? "Seroton

in.<div><br /></div><div>Responsible for:</div><div>Circadian Rhythms</div><div>

Alertness</div><div>Pain modulation</div><div><img src=""paste-334775520854418.j
pg"" /></div>"
What type of bartonella:<div>Cat scratch disease, enlarged nodes and other organ
involvement</div>
Bartonella henselae
What type of bartonella?<div>Trench fever, single febrile episode lasting 4-5 da
ys, homeless patient</div>
bartonella quintana
Locus Ceruleus secretes what? Describe functions (4)
Norepinephrine<div><br /
></div><div><div>Sleep-wa
e cycles</div><div>Arousal</div><div>Attention</div><d
iv>Memory&nbsp;</div></div>
What type of bartonella?<div>Oroya fever, verruga peruana, wart li
e-reddish nod
ule</div>
Bartonella bacilliformis
Brucella <b>Melitenis</b> is the most common species often found in what type of
cheese?
<b>goat cheese</b>
Fever of un
nown origin accompanied by depression and bac
pain?
Brucella
What are the various clinical manifestations of brucellat at different phases? (
Acute, advanced, chronic)
"Acute (&lt;8 wee
s): non specific flu li
e symp
toms<div>Advanced (&lt;1 yr): undulant fevers, arthritis</div><div>Chornic (&gt;
1 year): mimcs miliary TB with supperative lesions in liver, spleen and bone</di
v><div><br /></div><div><img src=""paste-154550103179657.jpg"" /></div><div>chro
nic: thin
liver, spleen, bone (osteomyelitis)</div><div><br /></div><div><br />
</div>"
What are 3 ways brucella is transmitted?&nbsp;<div><br /></div><div><br /></div>
<div>T/F Brucella can enter intact s
in</div> 1. direct contact with <b>hooved
animals</b><div>2. inhaled aerosols (placentas --thin
abortions in animals)</d
iv><div>3. ingestion of unpasturized animal products (goat cheese)</div><div><br
/></div><div>TRUE</div>
Describe the pathogenesis of brucella and how it travels to reticuoendothelial s
ystem "1. Brucella activates T cells to produce IFN-alpha which activates macr
ophages to phaogcytose brucella<div>2. Brucella bloc
s phagosomal acidification
and incubates intracellularly</div><div>3. Infects reticuloendothelial system (l
iver, spleen, bone marrow)</div><div><br /></div><div><img src=""paste-154545808
212361.jpg"" /><br /><div><br /></div></div>"
How do you treat Brucella?
"doxycycline + rimfampin<div><br /></div><div><i
mg src=""paste-154545808212361.jpg"" /></div>"
Which bacteria is gram - coccobacillus, has many forms (ulceroglandular, glandul
ar, oculoglandular, oropharyngeal, pneumonic etc)?<div><br /></div><div>What is
its virulence factor?</div>
Franciella<div><br /></div><div>Thic
capusle</d
iv>
How does Yerssinia Pestis appear on Wayson Stain?
Bipolar staining (safety
pin)<div><br /></div><div><br /></div>
What is the major virulence factor for Yersinia?
Beta lactamases
Other than the bubonic plague, what other plagues are associated with Yersinia?
Septicemic: DIC--&gt;poor blood perfusion--&gt;necrosis<div><br /></div><div>pne
umonic: rapid hemorrhagic respiratory failure</div>
How can you differentiate Ehrlichia and Ric
ettsia Ric
ettsii? Ric
ettsia has <
b>thrombocytopenia and hyponatremia</b><div><br /></div><div>Ehrlichia has l<b>e
u
openia</b> (it infects WBC rather than endothelium, which is what ric
ettsia d
oes)</div>
necrotizing fascitis following cellulitis from a cat/dog bite "<div><br /></di
v><div>Pasteurella</div><div><br /></div><img src=""paste-156225140425100.jpg""
/><div><br /></div>"
Ric
etssia and Erhlichia are both &nbsp;________ intracellular parasites
obligate
Fever, headache, myalgia + rash that appears on palms and soles of feet "Ric
ets
sia<div><br /></div><div><img src=""paste-156375464280467.jpg"" /></div>"
What do you use to treat the following?<div><br /></div><div>Bartonella: {{c1::D
oxycyclin + rifampin/chloramphenicol}}</div><div>Brucella: {{c1::Doxycyclin+rifa
mpin}}</div><div>Fraceilla: {{c1::Streptomycin}}</div><div>Pasteruella: {{c1::Pe
nicillin + beta lactamase inhibitor}}</div><div>Ric
ettsia: {{c1::Doxycylin}}</d

iv><div>Ehrlichia: {{c1::Doxycyclin}}</div><div>Yersinia: {{c1::Doxycylin+strept

omycin}}</div> "<img src=""paste-156727651598730.jpg"" /><div><br /></div><div>
tire: doxycyclin<br /><div><img src=""paste-156822140879241.jpg"" /></div><div>t
ire: doxycyclin</div><div>Gun: rifampin<br /><div><img src=""paste-1567620113370
92.jpg"" /></div><div>Spear thing: Streptomycin</div><div><br /></div><div><br /
><div><img src=""paste-156740536500620.jpg"" /></div></div></div><div>Pencil: pe
nicillin</div><div><img src=""paste-156869385519507.jpg"" /></div><div>Tire: dox
ycyclin</div><div><br /></div><div><img src=""paste-156895155323272.jpg"" /></di
v><div>Pooper-scooper: Streptomycin+doxycyclin</div><div><br /></div></div>"
&nbsp;common features for&nbsp;Legionella, Mycoplasma, and Chlamydia
atypical
pneumonia<div>intracellular bacteria</div>
2 main diseases from legionella legionnaires disease<div>pontiac fever</div>
Can you use the gram stain for legionella? what type of culture can it grow in?&
nbsp; <div>Aerobic, Gram-negative bacillus</div><div>Does not grow on routine
bacteriological media</div><div>Need charcoal yeast culture with iron and cystei
ne</div><div>Technically Gram-negative but stains poorly with Gram stain</div><d
iv>Key point: consider it in a case of pneumonia with no clear-cut organisms app
arent on Gram stain in the right clinical context.</div><div><br /></div>
Species of legionella that causes most of human diseases
<div>L. pneumoph
ila is the most common species
accounts for ~90% of human disease</div><div><br
/></div>
&nbsp;factors that predispose to Legionella infection (5)
<div><br /></div
><div><div>Cigarette smo
ing</div><div>Chronic lung disease</div><div><b>Increas
ing age</b></div><div>Transplant status</div><div>Some types of <b>immunosuppres
sion</b></div></div><div><b><br /></b></div><div><b>(things in bold emphasized i
n class)</b></div><div><br /></div><div><br /></div>
<div>65-year-old male with moderate COPD goes on a trip to Washington, D.C. for
business.</div><div>One wee
into his trip, he develops fevers, chills, myalgias
, cough, vomiting, and diarrhea. &nbsp;The hospital staff notes that he is quite
disoriented.</div><div>Several others from the hotel have a similar syndrome.</
div><div><br /></div><div><div>features -&nbsp;</div><div><div>Almost always has
<b>high fever</b></div><div>Can have associated thrombocytopenia</div><div><b>H
yponatremia</b> more prominent than in other causes of pneumonia</div><div>Varia
ble CXR</div><div><b>Altered mental status </b>can often be seen.</div></div></d
iv><div><br /></div><div>What disease?</div>
Legionnaires disease<div><br /><
/div><div><br /></div>
<div>Fevers, chills, malaise, headache</div><div>Minimal or no respiratory sympt
oms</div><div>Can also occur as an outbrea
</div><div>Illness usually self-limit
ed. &nbsp;Tends to be milder than Legionnaires disease.</div><div><br /></div>
Pontiac fever
What is the most common test used to diagnose Legionella? What is the disadvanta
ge of using this test?<div><br /></div><div><br /></div>
<div>Urinary Leg
ionella antigen</div><div><div>Disadvantage: specific for L. pneumophila serogro
up 1 only</div></div><div><div>Highly specific, variable sensitivity</div></div>
<div><br /></div><div><div>KEY POINT: Difficult to diagnose on Gram stain and ro
utine bacterial culture!</div><div>Can try to obtain special Legionella culture
medium</div></div><div><br /></div><div>PCR can also be used, but not currently
recommended by CDC</div><div><br /></div>
What method of diagnosing do you not want to use if you suspect Legionella
Serology - ta
es 12 wee
s! Patient gon die by the time you get the results bac
<
div><br /></div><div>Serology only used for epidemiology&nbsp;</div>
Treatment choice for Legionella Macrolides (azithroMYCIN)<div>Respiratory Flouro
quinolones (levofloxacin)</div><div><br /></div><div>7-10 days for treatment</di
v>
<div>Aerobic, Gram-negative bacillus</div><div>Stains poorly on Gram stain</div>
<div>Can cause atypical pneumonia with a variety of extrapulmonary symptoms</div><
div><br /></div><div><br /></div><div>Disease:</div><div><br /></div><div>Diagno
sis method?</div><div><br /></div><div>Treatment?</div> Legionella<div><br /></d
iv><div><div>Thin
of outbrea
s (American Legion Convention) and water as the so
urce of transmission.</div><div>Diagnosis: urinary Legionella antigen most pract

ical, though specialized culture is useful</div><div>Also causes Pontiac fever (

thin
of burning car)</div><div>Treatment: new macrolides or respiratory fluoroq
uinolones</div><div><br /></div><div><br /></div></div>
smallest intracellular bacteria that cannot be detected by Gram stain Mycoplas
ma - NO CELL WALL!
Why cant you treat Mycoplasma with Penicillins or cephalosporins
No cell
wall!&nbsp;
Most common disease causing species of Mycoplasma
M. pneumoniae&nbsp;
Route of transmission of Mycoplasma pneumoniae infected respiratory droplets du
ring close contact<div><br /></div>
T/F Mycoplasma pneumonia always causes pneumonia
False -&nbsp;Many do NOT
develop pneumonia&nbsp;<div><br /></div><div>general features li
e fever, heada
che, malaise, pharygitis, rhinorrhea, cough&nbsp;</div><div><br /></div>
<div>21-year-old college student goes to the student health clinic on campus wit
h 6 days of intermittent fevers, dry cough, malaise, and headache.</div><div><b>
PE unremar
able</b></div><div>(Perhaps some faint crac
les in the right mid-axil
la auscultated by an ambitious first-year medical student with a desire to impre
ss)</div><div>CXR with a strea
y, interstitial patter</div><div><br /></div><div
>You suspect mycoplasma</div><div><br /></div><div>What is the diagnostic test o
f choice?</div> <div>Cold agglutinins
can be done but a bit impractical</div><di
v>Fourfold increase in titers of paired sera</div><div>Single titer not thought
to be diagnostic</div><div><b>PCR of nasopharyngeal sample diagnostic test of ch
oice when available</b></div><div>Not visualized by Gram staining</div><div>Fast
idious and difficult to grow in a laboratory</div><div><br /></div><div><br /></
div><div>Overall theme: DIFFICULT TO MAKE AN OBJECTIVE DIAGNOSIS SOMETIMES</div>
<div><br /></div>
Treatment for Mycoplasma infection
<div>Macrolides
azithromycin most active
</div><div>Doxycycline</div><div>Respiratory fluoroquinolone (levofloxacin, moxi
floxacin)</div><div><br /></div><div>Many times treat empiricially (before you c
onfirm that it is mycoplasma because it is difficult to diagnose definitively)</
div>
<div>Smallest organism in the world</div><div>Intracellular</div><div>No cell wa
ll</div><div>Transmission: infected respiratory droplets</div><div>Thin
younger
patients (children and young adults) rather than older patients.</div><div>Subt
le onset of disease and wide spectrum of severity. &nbsp;Does not always cause p
neumonia.</div><div>Many associations with extrapulmonary manifestations most no
table are cold agglutinin disease and erythema multiforme</div><div>Treatment: a
zithromycin best, respiratory fluoroquinolone also possible</div><div><br /></di
v>
Mycoplasma
3 most important strains of chlamydia <div>C. trachomatis</div><div>C. pneumon
iae</div><div>C. psittaci</div><div><br /></div>
Describe the lifecycle of Chlamydia - SUPER HIGH YIELD "Elementary bodies - E f
or enter - infectious phase<div>Reticulate bodies - R for Replicate - form inclu
sion bodies in cell</div><div><br /></div><div><div>Elementary body phagocytosed
by alveolar macrophage</div><div>EB undergoes morphological changes to become R
B</div><div>RB replicates via binary fission in&nbsp;<b>inclusion bodies&nbsp;</
b></div><div>RBs revert to EBs</div><div>Inclusion bodies burst releasing Ebs</d
iv></div><div><br /></div><div>Chlamydia starts with elementary bodies -infects
the cell - now reticulate body - (IT IS AN OBLIGATE INTRACELLULAR BACTERIA) - st
arts replicating and now you can visualize under the microscope as inclusion bod
ies in the cell- once they burst out they are called elementary bodies again</di
v><div><br /></div><div><br /></div><div><br /></div><div><img src=""paste-26800
1664303814.jpg"" /></div>"
<div>Generally associated with sexually transmitted infections (STIs)</div><div>C
an <b>cause conjunctivitis and pneumonia in neonates </b>(acquired through birth
canal if mothers are infected)</div><div><br /></div><div><div>Spectrum of dise
ases in teenagers/adults:</div><div>Urethritis, epididymitis, prostatitis, cervi
citis, pelvic inflammatory disease, proctitis, complications during pregnancy, r
eactive arthritis (formerly Reiters syndrome)&nbsp;</div></div><div><div>Lymphogr
anuloma venereum (LGV)</div></div><div><br /></div>
Chlamydia Trachomatis

What cranial nerves originate from the meduall? "IX, X (posterior to olive)<div>
<br /></div><div>XII (between pyramid and olive)</div><div><br /></div><div>XI</
div><div><br /></div><div><img src=""paste-6841882903068.jpg"" /></div>"
Which nerves originate from Pons?
"V<div>VI,&nbsp;VII,&nbsp;VIII</div><div
><br /></div><div><img src=""paste-6837587935772.jpg"" /></div><div><br /></div>
<div><img src=""paste-349348344889890.jpg"" /></div>"
Serovars L1-L3 of Chlamydia trachomatis cause which specific disease? In which p
opulations do you generally see them now?
LGV (lymphogranuloma venereum)<d
iv><br /></div><div><div>Ulcerative genital infection caused by C. trachomatis (
serovars L1-L3
different from usual serovars causing genitourinary disease)</div
><div>Predominantly a disease of the lymphatic system</div></div><div><br /></di
v><div><div>Initially endemic in tropical areas amongst heterosexuals (Africa, I
ndia, Caribbean)</div><div>Now outbrea
s in developed countries, often in MSM wh
o are HIV+.</div></div><div><br /></div><div><br /></div>
Which posterior circulation vessels lie over the midbrain?<div><br /></div><div>
Which posterior circulation vessels lie over medulla?</div>
"Posterior cereb
ral<div>Superior cerebellar</div><div><br /></div><div>AICA</div><div>PICA</div>
<div>Vertebral&nbsp;</div><div>ASA</div><div><br /></div><div><img src=""paste-6
975026889244.jpg"" /></div><div><br /></div>"
Stages of disease include<div><div>Primary: Genital ulcer at site of inoculation
</div><div>Secondary: 2-6 wee
s later significant inflammatory reaction in the i
nguinal lymph nodes <b> groove sign</b></div></div><div><b><br /></b></div><div><b>
<br /></b></div><div><b><br /></b></div><div>What bacteria causes this? (be spec
ific) What specific disease is the groove sign associated with?</div><div><br />
</div> "LGV (lymphogranuloma venereum)<div>Chlamydia trachomatis (serovars L1-L
3)</div><div><br /></div><div><b><img src=""paste-268418276131510.jpg"" /></b></
div><div><br /></div>"
What nerves exit at the pontomedullary junction?
"VI, VII, VIII (medial t
o most lateral)<div><br /></div><div><img src=""paste-72430328480168.jpg"" /></d
iv><div><br /></div><div><img src=""paste-349348344889890.jpg"" /></div>"
What is the
ey epidemiological difference between the populations that Chlamydi
a pneumoniae infects and the populations that Mycoplasma infects
Chlamydi
a pneumoniae - ELDERLY<div>mycoplasma - Kids and young adults</div>
"<img src=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_Q 0.svg"" />"
"<img sr
c=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_A 0.svg"" />"
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d52c42dca35ace4584b1b45a237bb16aa0e1_source_svg.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_tmpyIt4f6.png"" />"
"<img src=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_Q 1.svg"" />"
"<img sr
c=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_A 1.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_source_svg.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_tmpyIt4f6.png"" />"
"<img src=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_Q 2.svg"" />"
"<img sr
c=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_A 2.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_source_svg.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_tmpyIt4f6.png"" />"
"<img src=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_Q 3.svg"" />"
"<img sr
c=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_A 3.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_source_svg.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_tmpyIt4f6.png"" />"
"<img src=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_Q 4.svg"" />"
"<img sr
c=""cdd3d52c42dca35ace4584b1b45a237bb16aa0e1_A 4.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_source_svg.svg"" />"
"<img src=""cdd3
d52c42dca35ace4584b1b45a237bb16aa0e1_tmpyIt4f6.png"" />"
T/F Chlamydia pneumonia infections can be readily identified clinically False<di
v><br /></div><div><div>No significant difference in symptoms, physical exam, or
lab tests.</div><div>Can be asymptomatic or very mild
life-threatening</div></d
iv><div><br /></div>
<div>60-year-old female with coronary artery disease and DM presents with a 4-da
y history of dry cough, low-grade fevers, slight fatigue, and slightly sore thro
at.</div><div>PE perhaps some scattered crac
les at the bases</div><div>CXR
some

what increased interstitial mar

ings</div><div><br /></div><div>You suspect C. p
neumoniae. What diagnostic test would you use?</div>
<div>NO DEFINITIVE ANSWE
R FOR DIAGNOSIS!</div><div><br /></div><div>&nbsp;this is the KEY POINT!</div><d
iv>Many times treatment is empirical!</div><div>Most labs unable to culture Chla
mydia</div><div>DFA/PCR on the horizon</div><div>Can use acute and convalescent
titers but not practical for immediate diagnosis</div><div><br /></div><div><br
/></div>
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 0.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 0.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_source_svg.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_tmpWpcB4i.png"" />"
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 1.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 1.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_source_svg.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_tmpWpcB4i.png"" />"
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 3.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 3.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_source_svg.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_tmpWpcB4i.png"" />"
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 4.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 4.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_source_svg.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_tmpWpcB4i.png"" />"
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 5.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 5.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_source_svg.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_tmpWpcB4i.png"" />"
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 6.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 6.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_source_svg.svg"" />"
"<img src=""4307
6ab5530be1e11d3a73f8910122c00bbbc0b9_tmpWpcB4i.png"" />"
"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 7.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 7.svg"" />"
"<img src=""4307
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"<img src=""4307
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"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 8.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 8.svg"" />"
"<img src=""4307
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"<img src=""4307
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"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 9.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 9.svg"" />"
"<img src=""4307
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"<img src=""4307
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"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 10.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 10.svg"" />"
"<img src=""4307
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"<img src=""4307
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"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 11.svg"" />"
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"<img src=""4307
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"<img src=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_Q 12.svg"" />"
"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 12.svg"" />"
"<img src=""4307
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"<img src=""4307
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"<img sr
c=""43076ab5530be1e11d3a73f8910122c00bbbc0b9_A 13.svg"" />"
"<img src=""4307
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"<img src=""4307
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Where does the trochlear nerve exist? "dorsal midbrain<div><br /></div><div><i

mg src=""paste-349348344889890.jpg"" /></div>"
Treatment choice for C. pneumoniae
DOXYCYCLINE<div>however, use macrolides
(azithroMYCIN) for empirical treatment of atypical pneumoniae</div><div>flouroqu
inolones&nbsp;e.g., levofloxacin)</div>
Where is the trigeminal nerve? "lateral mid pons<div><br /></div><div><img src=
""paste-72426033512872.jpg"" /></div><div><br /></div><div><img src=""paste-3493
48344889890.jpg"" /></div>"
clincial features of psittacosis&nbsp; <div>Most common in younger ages but pos
sible for everyone</div><div>Fever, dry cough, myalgias</div><div>Some people
no
respiratory symptomatology</div><div>Headache seen frequently, quite bad</div><
div>Incubation period usually 1-2 wee
s, can be longer</div><div>CXR abnormal in
the vast majority</div><div><br /></div>
Treatment for psittacosis
<div>Treatment of choice: tetracyclines (e.g., d
oxycycline)</div><div>Second-line: macrolides, such as azithromycin</div><div><b
r /></div>
<div>There is a distinction between the genus Chlamydia and the genus Chlamydoph
ila (for my fellow type A people in the audience).</div><div>C. trachomatis, C.
pneumoniae, C. psittaci</div><div>Unique life cycle</div><div>C. trachomatis thi
n
STDs, what you dont want on Saturday night</div><div>C. pneumoniae anything fro
m subtle to riproaring pneumonia, tends to be more in the elderly</div><div>Trea
t with doxycycline, macrolides, or respiratory fluoroquinolones</div><div>C. psi
ttaci thin
BIRDS!</div><div><br /></div><div><br /></div>
"<img src=""past
e-269784075731056.jpg"" />"
<div>Atypical pneumonia</div><div>Remember the limitations of this designation.</d
iv><div>Causative organisms:</div><div>Traditionally designated to be Legionella
, Mycoplasma, and Chlamydia</div><div>Characterized by a more indolent onset, of
ten more extrapulmonary symptoms, and many times a normal WBC count but other la
boratory abnormalities</div><div>Difficult to diagnose</div><div>Gram staining n
ot helpful</div><div>Difficult to grow</div><div>Serial antibody titers can be d
one but often not clinically useful</div><div>Treatment:</div><div>Macrolides, r
espiratory fluoroquinolones, tetracyclines</div><div><br /></div><div><div>Keep
in mind infections other than pneumonia:</div><div>L. pneumophila: Pontiac fever
(in addition to Legionnaires disease)</div><div>C. trachomatis: STIs</div></div><
div><br /></div><div>How do you recognize chlamydia symptoms?</div>
"<img sr
c=""paste-269882859979255.jpg"" /><div><br /></div>"
necessary first event in pathogenesis of Staph infection
adherence
Staph aureus colonization site "nose and throat (30-50% of normal persons)<div>
<br /></div><div><img src=""paste-21101174325586.jpg"" /></div>"
more li
ely to exhibit prolonged carriage of S. aureus persons with <u>brea
s i
n s
in</u><div><br /></div><div>Examples:&nbsp;</div><div><b>atopic dermatitis,
ezcema&nbsp;</b></div><div><b>Needle users</b>: pareneteral drug addicts, diabet
is on insulin, hemodialysis Px, allergy shot recipients</div>
Protein A binds to all human IgG except {{c1::IgG3}}
Staph aureus toxin that causes food poisoning enterotoxin (A, B, C<sub>1-2</su
b>, D, E)
How foreign bodies (e.g. sutures &amp; prosthetic devices) predispose to infecti
on with staphylococci (3):
1.<b> breach in protective anatomic barriers</b>
<div>2. bacteria <b>adhere</b> to devices via serum and matrix proteins (e.g. fi
bronectin, fibrinogen)</div><div>3. organisms become encased in <b>protective gl
ycocalyx</b></div>
furuncles and carbuncles
"<div><br /></div><div>furuncle = infection of 1
follicle; carbuncle = infection of several follicles</div><div><br /></div>""bo
ils"" - deep-seated infection around hair follicles caused by <u>Staph infection
</u>"
Clinical cues (7) suggesting bacteremia is complicated (e.g. caused by endocardi
tis)
(1) community-acquired<div>(2) younger patient without underlying diseas
es</div><div>(3) no recognizable primary infection</div><div>(4) s
in evidence o
f systemic infection</div><div>(5) failure to defervesce by 72 hours on appropri
ate therapy</div><div>(6) + blood cultures at 48-96 hours on therapy</div><div>(
7) abnormal echocardiogram.<div><br /></div><div>probably dont need to
now all

of these?</div></div>
exfoliatin toxin damages {{c1::stratum granulosum}} level of the s
in. "<img sr
c=""paste-25988847108762.jpg"" />"
Where is the midbrain? "<img src=""paste-195494026412417.jpg"" />"
What are the 3 compartments of the Midbrain?
"Tectum, Tegmentum, Crus Cerebri
<div><br /></div><div><img src=""paste-195536976085452.jpg"" /></div><div><img s
rc=""paste-196387379609994.jpg"" /></div>"
What is the cerebral peduncle? "Everything except the tectum<div><br /></div><d
iv><img src=""paste-195532681118156.jpg"" /></div>"
What composes the Tegmentum (3) of midbrain
"1. Cerebral aqueduct and periaq
ueductal grey<div>2. Red nucleus and decussation of superior cerebellar peduncle
s</div><div>3. Substantia Nigra</div><div><br /></div><div><img src=""paste-3745
81277753796.jpg"" /></div><div><img src=""paste-195532681118156.jpg"" /></div>"
T/F the superior and inferior colliculi are considered part of the cerebral pedu
ncles False: cerebral peduncles are everything except the tectum
What contains mostly the corticobulbar and corticospinal pathways?
"Crus Ce
rebri<div><img src=""paste-196383084642698.jpg"" /></div>"
What separates the tegmentum from the crus cerebri?
"substantia nigra<div><b
r /></div><div><img src=""paste-196383084642698.jpg"" /></div>"
"<img src=""paste-196529113530685.jpg"" /><div><br /></div><div>At level of infe
rior colliculus:</div><div><br /></div><div>What is Blue, Green, Yellow, Blac
?<
/div><div><br /></div>" "<img src=""paste-196541998432614.jpg"" />"
"<img src=""558aa54d0ecd88471b1251fc78c867ab05023847_Q 0.svg"" />"
"<img sr
c=""558aa54d0ecd88471b1251fc78c867ab05023847_A 0.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_source_svg.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_tmpH_I6qY.png"" />"
"<img src=""558aa54d0ecd88471b1251fc78c867ab05023847_Q 1.svg"" />"
"<img sr
c=""558aa54d0ecd88471b1251fc78c867ab05023847_A 1.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_source_svg.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_tmpH_I6qY.png"" />"
"<img src=""558aa54d0ecd88471b1251fc78c867ab05023847_Q 2.svg"" />"
"<img sr
c=""558aa54d0ecd88471b1251fc78c867ab05023847_A 2.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_source_svg.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_tmpH_I6qY.png"" />"
"<img src=""558aa54d0ecd88471b1251fc78c867ab05023847_Q 3.svg"" />"
"<img sr
c=""558aa54d0ecd88471b1251fc78c867ab05023847_A 3.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_source_svg.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_tmpH_I6qY.png"" />"
"<img src=""558aa54d0ecd88471b1251fc78c867ab05023847_Q 4.svg"" />"
"<img sr
c=""558aa54d0ecd88471b1251fc78c867ab05023847_A 4.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_source_svg.svg"" />"
"<img src=""558a
a54d0ecd88471b1251fc78c867ab05023847_tmpH_I6qY.png"" />"
Where do CN III and IV arise from the midbrain? "III=ventrally: medial to crus c
erebri<div>IV-dorsally, inferior to inferior colliculus</div><div><br /></div><d
iv><img src=""paste-221981089726850.jpg"" /></div>"
What are the two modulating nuclei of the midbrain and where aer they located?
"Substantia nigra: Inferior Colliculus<div>Red Nuclie: Superior colliculus<br />
<div><br /></div><div><br /></div><div><img src=""paste-222603859984923.jpg"" />
</div></div>"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 0.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 0.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 1.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 1.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 2.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 2.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7

099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 3.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 3.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 4.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 4.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 5.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 5.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 6.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 6.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 7.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 7.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 8.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 8.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 9.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 9.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
"<img src=""73f7099a8a76dec58dd58d89b2c829b1062d500d_Q 10.svg"" />"
"<img sr
c=""73f7099a8a76dec58dd58d89b2c829b1062d500d_A 10.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_source_svg.svg"" />"
"<img src=""73f7
099a8a76dec58dd58d89b2c829b1062d500d_tmpIuiTnV.png"" />"
Where is the periaqueductal grey and what is it rich in?
"<div>Surroundin
g cerebral aqueduct of sylvius and is rich in <b>en
aphalins</b> for modulation
of autonomics and pain</div><div><br /></div><div><br /></div><img src=""paste-2
78936651039151.jpg"" /><div><br /></div>"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 0.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 0.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 1.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 1.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 2.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 2.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 3.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 3.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 4.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 4.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 5.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 5.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad

a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 6.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 6.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 7.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 7.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 8.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 8.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 9.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 9.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 10.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 10.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 11.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 11.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 12.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 12.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
"<img src=""98ada26e456b437239db9ecc7818916cc103d7b5_Q 13.svg"" />"
"<img sr
c=""98ada26e456b437239db9ecc7818916cc103d7b5_A 13.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_source_svg.svg"" />"
"<img src=""98ad
a26e456b437239db9ecc7818916cc103d7b5_tmpHEZPDu.png"" />"
Which CN exits dorsally from the midbrain inferior to inferior colliculus and cr
osses? "CN IV<br /><div><br /></div><div><br /></div><div><br /></div><div><img
src=""paste-278932356071855.jpg"" /></div>"
What is the MLF and where is it located? What does it do?
"Medial Longitud
inal Fasiculus<div>Located Ventral to nucleus of CN IV</div><div>Feeds from vest
ibular nuclei to nucleus of IV (and III, and VI)<br /><div><br /></div><div><br
/></div><div><img src=""paste-278932356071855.jpg"" /></div></div><div><br /></d
iv><div><img src=""paste-279147104436654.jpg"" /></div>"
Where is the Central Tegmental Area?&nbsp;<div><br /></div><div>What does it con
tain? What is it useful for?</div>
"1.Around the superior cerebellar pedunc
le area<div>2. Contains reticular formation</div><div>3. Contains serotonin fibe
rs which regulate wa
efulness<br /><div><br /></div><div><br /></div><div><img s
rc=""paste-279190054109615.jpg"" /></div><div><br /></div><div><img src=""paste279202939011502.jpg"" /></div></div>"
Where is the decussation of the superior cerebellar peduncle?<div>Where are thes
e fibers traveling to?</div>
"<div>1. Anterior to superior cerebellar peduncl
e</div><div>2. Travels to red nucleus and ventrolateral nucelus of thalamus</div
><div><br /></div><img src=""paste-279473521951150.jpg"" />"
Where in the midbrain are there massive amounts of descending fibers? "<div>Cr
us Cerebri</div><div><br /></div><img src=""paste-279469226983854.jpg"" /><div><
br /></div><div><img src=""paste-279606665937327.jpg"" /></div>"
What descending fibers are located in the medial 1/5 of the crus cerebri?
"<div>Frontopontine Fibers</div><div><br /></div><div><br /></div><br /><div><br
/></div><div><img src=""paste-279761284759982.jpg"" /></div>"
What descending fibers are located in the middle 3/5 of the crus cerebri (medial
and lateral) "<div>Medial: corticobulbar</div><div>Lateral: corticospinal</di
v><div><br /></div><div><br /></div><br /><div><br /></div><div><img src=""paste

-279761284759982.jpg"" /></div>"
What descending fibers are located in the lateral 1/5 of the crus cerebri?
"<div>Fibers that run from parietal, occipital, and temporal lobes to the <b>pon
tine nuclei</b></div><div><br /></div><div><br /></div><br /><div><br /></div><d
iv><img src=""paste-279761284759982.jpg"" /></div>"
What are the 2 parts of the substantia nigra? "<div>1. Medially: Pars compacta
</div><div>2. Laterally: Pars Reticulata</div><div><br /></div><div><img src=""p
aste-279976033124783.jpg"" /></div><div><br /></div><br /><div><br /></div><div>
<img src=""paste-279761284759982.jpg"" /></div>"
What is contained in the pars compacta of the substantia nigra? "<div>1. Mediall
y: Pars compacta: dopamine fibers to basal ganglia (important in par
insons)</di
v><div><br /></div><div><br /></div><div><img src=""paste-279976033124783.jpg""
/></div><div><br /></div>"
What fibers are contained in the pars reticulata of the substantia nigra
"<div>1. Laterally: Pars reticulata: GABA fibers to thalamus</div><div><br /></d
iv><div><img src=""paste-279976033124783.jpg"" /></div>"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 0.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 0.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 1.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 1.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 2.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 2.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 3.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 3.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 4.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 4.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 5.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 5.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 6.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 6.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 7.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 7.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 9.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 9.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 10.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 10.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 11.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 11.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"

"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 12.svg"" />"

"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 12.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 13.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 13.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 14.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 14.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 15.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 15.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 16.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 16.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 17.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 17.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 18.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 18.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
"<img src=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_Q 19.svg"" />"
"<img sr
c=""76b4019bc2cbfe18c7b054655ea9b8587d025f5d_A 19.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_source_svg.svg"" />"
"<img src=""76b4
019bc2cbfe18c7b054655ea9b8587d025f5d_tmpUhRiGq.png"" />"
Which CN axons exit ventromedially of midbrain? "<div>III (contain both somatic
GSE and automatic GVE fibrs)</div><div><br /></div><img src=""paste-338280214167
955.jpg"" /><div><img src=""paste-338293099069841.jpg"" /></div>"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 0.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 0.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 1.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 1.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 2.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 2.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 3.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 3.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 4.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 4.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 5.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 5.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 6.svg"" />"
"<img sr

c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 6.svg"" />"

"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 7.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 7.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 8.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 8.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 9.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 9.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 10.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 10.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 11.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 11.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 12.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 12.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 13.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 13.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
"<img src=""eee6002e863944e49580d2d5356dfbe9efe5e254_Q 14.svg"" />"
"<img sr
c=""eee6002e863944e49580d2d5356dfbe9efe5e254_A 14.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_source_svg.svg"" />"
"<img src=""eee6
002e863944e49580d2d5356dfbe9efe5e254_tmp
VUGiE.png"" />"
Where is the ventral tegmental area located and what is it an important source f
or?
"<img src=""paste-339547229520273.jpg"" /><div><br /></div><div>1. adjac
ent to pars compact</div><div>2. important source of <b>dopaminergic fibers to f
orebrain</b><br /><div><br /></div><div><br /></div></div>"
At what level is the Red Nucleus prominent? Where does it receive fibers from? W
here does it project fibers to? "Superior colliculus<div><img src=""paste-339581
589258641.jpg"" /></div><div><br /></div><div>Receive: Superior cerebellar pedun
cle</div><div>Project: 1) flexor musculature 2) inferior olivary nucleus</div>"
What do you see at the extreme rostral end of midbrain?<div><br /></div><div>Wha
t 2 things does this area contain?</div>
Pretectal area that replaces sup
erior colliculus<div><br /></div><div>1. Edinger Westphal Nucleus</div><div>2. P
osterior Commisure</div>
What does the Edinger Westfall Nucleus contain? <div>presynaptic parasympathetic
fibers of III to ciliary ganglion for pupillary constriction of pupillary light
reflex as well as accommodation for near vision.&nbsp;</div><div><br /></div>
{{c1::Webers Syndrome}} results from&nbsp;{{c2::vascular insufficiency in media
l aspect of midbrain at level of superior colliculus}}<div><br /></div><div>What
are the symptoms?</div>
Ipsilateral Ocoulmotor paralysis with contralate
ral upper motor neuron lesion
{{c1::Benedit
ts syndrome}} exhibits&nbsp;{{c2::ipsilateral III paralysis with
contralateral tremor and possible contraleral somatosensoty loss}}<div><br /></d
iv><div>What is the cause? (5)</div>
"Vascular lesion to:<div><br /></div><di
v>III</div><div>Red Nucelus</div><div>Superior Cerebellar Peduncle</div><div>Med
ial Lemniscus (dorsal column)</div><div>Spinothalamic tract</div><div><br /></di
v><div><img src=""paste-106132936851986.jpg"" /></div>"

Those with {{c1::Gaze Palsy or Parinauds syndrome}} exhibit&nbsp;{{c2::upward g

aze paralysis, large pupil, abnormal eleveation of upper eyelid, paralysis of ac
comidation}}<div><br /></div><div>What is the cause?</div>
Pineal tumor whi
ch affects pretectal area and posterior commisure&nbsp;
The level of inferior colliculus is important for&nbsp;{{c1::auditory}} pathways
<div><br /></div><div>What are the inputs and outputs?</div>
Inputs: Lateral
lemniscus originating from <b>superior olivary</b> nucleus of pons and <b>cochle
ar nuclei</b> of medulla<div><br /></div><div>Output: <b>Medial geniculate nucle
us</b> of thalamus</div>
Level of superior colliculus is important for&nbsp;{{c1::visual}} pathways<div><
br /></div><div>What are the inputs and outputs?</div> Inputs: Retina<div>Outpu
ts: <b>cervical muscles via tectospinal tract </b>for coordination and visual tr
ac
ing</div>
"<img src=""paste-313085936009963.jpg"" />"
penicillin resistance in Staph aureus is due to {{c1::beta-lactamase}}
<div>Pseudomonas aeruginosa,&nbsp;Stenotrophomonas maltophilia,&nbsp;Acinetobact
er species,&nbsp;Bur
holderia cepacia complex: do these ferment sugars</div><div
><br /></div> "No<div><img src=""paste-398345331802344.jpg"" /></div>"
Where are NFGNB found? Ubiquitous in environment, not normal colonizers of huma
n GI tract
NFGNBs usually cause what type of infection (Hint: to do with context of infecti
on)
Nosocomial
T or F: NFGNBs are usually found in nutrient poor areas li
e mattresses or plast
ics
T
T or F: NFGNBs rely only on inherent antibacterial resistance and are slow to mu
tate/acquire new resistance
"F:<div><img src=""paste-401755535835397.jpg"" /
></div>"
"Four factors of the ""perfect storm"" in hospitals that leads to NFGNB infectio
n"
"<img src=""paste-401875794920039.jpg"" /><div><img src=""paste-40237830
6093670.jpg"" /></div>"
<div>Which of the following persons is at highest ris
for infection due to a no
n-fermenting Gram-negative bacillus?</div><div>19 year-old college student with
meningitis</div><div>25 year-old man with a sexually transmitted disease</div><d
iv>75 year-old man with nosocomial pneumonia after admission for a stro
e</div><
div>10 year-old boy with an ear infection</div><div>57 year-old man with bronchi
tis</div><div><br /></div>
75 year-old man with nosocomial pneumonia after
admission for a stro
e
<div>Leading NFGNB causing disease in humans</div><div><br /></div>
Pseudomo
nas aeruginosa (PA)
Diseases caused by&nbsp;Pseudomonas aeruginosa (PA):<div><br /></div><div>{{c1::
Ventilator associated}} Pneumonia</div><div>Catheter related {{c1::Bacteremia}}
and {{c1::UTI}}</div><div>Bacteremia in {{c2::neutropenic}} patients (gut source
) and {{c2::burn}} patients (s
in source)</div><div>Chronic lung infection in pt
with {{c3::Cystic Fibrosis}}</div><div>Infection in patients with Diabetes</div
>
<div>Which of the following persons is at highest ris
for infection due to Pseu
domonas?</div><div>30 year-old football player with a boil</div><div>80 year-old
women with community-acquired pneumonia</div><div>3 year-old boy with septic ar
thritis</div><div>23 year-old man with leu
emia and neutropenic fever</div><div>
65 year-old diabetic with otitis media</div><div><br /></div> <div>23 year-old
man with leu
emia and neutropenic fever</div><div><br /></div>
hospital-associated MRSA
SCCmec Type II &amp; III (multiple antibiotic re
sistances)
Community associated MRSA
SCCmec type IV (fewer antibiotic resistances)
<b>Resistance</b>&nbsp;to certain antibiotics expressed by a subset of a microbi
al population that is&nbsp;<b>considered to be susceptible to these antibiotics
for in vitro testing</b>
heteroresistance
Basics of&nbsp;Stenotrophomonas maltophilia (SM)<div><br /><div><div>Much more l
imited data vs. PA</div><div>{{c1::Low}}-virulence organism</div><div>{{c1::More::
more or less}} often colonizer vs. true infection</div><div>Broad environmental

range</div><div>Causes significant problems in {{c2::oncology}} patients</div><d

iv>Inherent {{c3::carbapenem}} resistance</div><div>Increases in prevalence with
increasing {{c3::carbapenem}} use</div></div><div><br /></div></div>
Ris
factors for stenotrophomonas (4) "<div>1. prolonged ICU stay</div><div>2.
catheter/ventilator (plastics)</div><div>3. Cancer</div><div>4. broad spectrum
antibiotics</div><div><br /></div><div><br /></div><div><br /></div><img src=""p
aste-409224483963400.jpg"" />"
<div>Which of the following persons is at highest ris
for infection due to Sten
otrophomonas?</div><div>53 year-old neutropenic women status-post a stem-cell tr
ansplantation recently treated for pneumonia with a broad spectrum antibiotic</d
iv><div>27 year-old man with AIDS and meningitis</div><div>37 year old alcoholic
with pancreatitis and subsequent pancreatic abscess</div><div>23 year-old women
with cystitis</div><div><br /></div> 53 year-old neutropenic women status-pos
t a stem-cell transplantation recently treated for pneumonia with a broad spectr
um antibiotic
<div>100% of {{c1::soil}} samples yield (drug sensitive) Acinetobacter.&nbsp;2570% of {{c1::s
in}} samples have Acinetobacter (drug sensitive)</div><div><br />
</div>
Acinetobacter Baumanii infections (3) "<div>1. catheter/ventilator</div><div>2
. s
in/soft tissue</div><div>3. intra abdominal</div><div><br /></div><img src="
"paste-411410622317019.jpg"" /><div><br /></div>"
When to Thin
of Acinetobacter As A Causative Agent of Infection
"<img sr
c=""paste-411487931728397.jpg"" />"
<div>Which of the following persons is at highest ris
for infection due to Acin
etobacter?</div><div>57 year-old man with community-acquired pneumonia</div><div
>27 year-old man with AIDS and meningitis</div><div>43 year-old man with cathete
r-related bacteremia after 2 wee
stay in an intensive care unit&nbsp;</div><div
>80 year-old nursing home resident with post-influenza pneumonia</div><div><br /
></div> 43 year-old man with catheter-related bacteremia after 2 wee
stay in an
intensive care unit
<div>Which of the following persons is NOT at significant ris
for infection due
to Bur
holderia cepacia complex?</div><div>19 year-old women with cystic fibros
is and pneumonia</div><div>11 year-old boy with chronic granulomatous disease an
d pneumonia</div><div>37 year-old man with leu
emia, neutropenia, and a bloodstr
eam catheter infection</div><div>19 year-old women with cystic fibrosis and a ur
inary tract infection</div><div><br /></div>
<div>19 year-old women with cyst
ic fibrosis and a urinary tract infection</div><div><br /></div>
Species of bur
holderia common in USA B. cepacia
B. Cepacia has what important use
"Agricultural<div><img src=""paste-41260
4623225178.jpg"" /></div><div><img src=""paste-412617508127301.jpg"" /></div>"
Describe cepacia syndrome in CF patients (3)
<div>Necrotizing granulomatous p
neumonia with bacteremia and death</div><div>Can be transmitted patient-to-patie
nt</div><div>Carriers have increased ris
of post- lung transplant complications
</div><div><br /></div>
"Most common cause?<div><br /></div><div><img src=""paste-66443144069121.jpg"" /
></div>"
Bullous Impetigo - S. Aureus
"Most common cause?<div>Tx?</div><div><img src=""paste-66670777335809.jpg"" /></
div>" Folliculitis - S. Aureus<div><br /></div><div>Treatment involves local a
ntiseptic measures.</div>
If a woman has had mastectomies with ipsilateral lymph node dissections, she sho
uld not have what done to the ipsilateral arm? IVs --+ ris
for Streptococcal
Cellulitis/Erysipelas
What is the Eagle Effect?
"<div><b>Poor
illing activity of penicillin aga
inst slow growing (or dormant) organisms when they exist in a high inoculum.</b>
</div><div><br /></div><div>Penicillin only wor
s in the exponential phase - not
beginning plateau or late plateau.</div><div>Thus, add Abx that interfere with
protein synthesis/toxin production in plateau phase (clindamycin).</div><div><br
/></div><div><img src=""paste-95206540050433.jpg"" /></div><div><br /></div><di
v><br /></div>"
Autonomic neuropathy in diabetic causes what? (2)
"<div>1) Lac
of perspir

ation --&gt; drying --&gt; crac

s/fissures in s
in</div><div>&nbsp;</div><div>2)
Decreased vascular regulation &nbsp;--&gt; can result in collapse of arch with
bony protrusions, <b>Charcots foot abnormality (""roc
er bottom"" foot)&nbsp;</
b></div><div><b><img src=""paste-15762529976321_1408681277100.jpg"" /></b></div>
"
<div>The most common pathophysiologic process leading to diabetic foot infection
s is:</div><div><br /></div><div><div>a. &nbsp;Peripheral vascular disease</div>
<div>b. &nbsp;Hyperglycemia</div><div>c. &nbsp;Neuropathy</div><div>d. &nbsp;Dep
ressed neutrophil function</div></div><div><br /></div> c. &nbsp;Neuropathy
<div>Your roommate was celebrating his 21st birthday, injudiciously as it turns
out, and lost all of his inhibitions due to alcohol. &nbsp;He happened to provo

e a fight with a big guy in the bar and punched him in the mouth. &nbsp;28 hours
later, his right hand began to swell at the 2nd &amp; 3rd metacarpal-phalangeal
joints over some lacerations that he suffered. &nbsp;The bacteriology most li
e
ly includes:</div><div><br /></div><div><div>a. Enterococcus faecalis</div><div>
b. &nbsp;Streptococcus iniae</div><div>c. &nbsp;Pseudomonas aeruginosa</div><div
>d. &nbsp;Anaerobic organisms (Veilonella, Peptostreptococcus, Fusobacterium)</d
iv></div><div><br /></div>
d. &nbsp;Anaerobic organisms (Veilonella, Peptos
treptococcus, Fusobacterium)
"The abnormal foot shown is caused by:<div><br /></div><div><img src=""paste-766
99525971969 (1).jpg"" /></div><div><br /></div><div><div>a. Autonomic neuropathy
</div><div>b. Peripheral sensory &nbsp; &nbsp;neuropathy</div><div>c. Vascular i
mpairment of the large vessels of the an
le &amp; foot</div><div>d. &nbsp;An abs
cess in the foot</div></div><div><br /></div>" a. Autonomic neuropathy<div><br
/></div><div>Charcot foot</div>
"The abnormalities of the toes shown are caused by<div><br /></div><div><img src
=""paste-76806900154369.jpg"" /></div><div><br /></div><div><div>Motor neuropath
y</div><div>Sensory neuropathy</div><div>Autonomic neuropathy</div><div>Vascular
occlusion</div></div><div><br /></div>"
<div><br /></div>Motor neuropath
y<div><br /></div><div>Flexors become much stronger than extensors - causes the
hammer-toe appearance.<div><br /></div><div><br /></div></div>
36 hours ago, while trying to pet it, your neighbors cat bit you on the hand. &nb
sp;Your index finger is now swollen &amp; tender. &nbsp;The bacteriology li
ely
includes:<div><br /></div><div><div>a. Streptococcus zooepidemicus</div><div>b.
Enterococcus faecium</div><div>c. Pseudomonas aeruginosa</div><div>d. Pasteurell
a multocida</div></div><div><br /></div>
d. Pasteurella multocida
<div>The hand surgeons consulted you to help with management of an infection in
a 34-year-old man who had amputated his right index finger in a snow blower 5 da
ys ago. &nbsp;They reattached his finger, but it is now red, tender and swollen
and a culture is growing an aerobic, gram-negative rod. &nbsp;You suspect the in
fection was caused by:</div><div><br /></div><div><div>Pseudomonas aeruginosa th
at contaminated the snow blower blades.</div><div>Nosocomial Klebsiella pneumoni
ae infection.</div><div>Aeromonas hydrophila from medicinal leaches used to main
tain blood vessel patency.</div><div>Fusobacterium from his mouth&nbsp;</div></d
iv><div><br /></div>
Aeromonas hydrophila from medicinal leaches used to main
tain blood vessel patency.
"This 28-year-old man returned last night from a 4-day s
i trip in Aspen. &nbsp;
Yesterday, he began to develop this rash confined to his chest &amp; below. &nbs
p;He spent a lot of time drin
ing beer in the hot tub. &nbsp;It is li
ely caused
by:<div><br /></div><div><img src=""paste-77103252897793 (1).jpg"" /></div><div
><br /></div><div><div>a. Streptococcus pyogenes</div><div>b. Staphylococcus epi
dermidis</div><div>c. Streptococcus iniae</div><div>d. Pseudomonas aeruginosa</d
iv></div><div><br /></div>"
d. Pseudomonas aeruginosa
&nbsp;24 hours ago, while trying to unhoo
this fish from his line, a 42-year-ol
d cirrhotic Gulf fisherman stepped on the dorsal fin which penetrated his foot.
&nbsp;Now, he presents with a rapidly progressive necrotizing cellulitis of the
foot and leg. &nbsp;The most li
ely organism causing this is:<div><br /></div><d
iv><div>a. Streptococcus pyogenes</div><div>b. Aeromonas hydrophila</div><div>c.
Vibrio vulnificus</div><div>d. Pseudomonas aeruginosa</div></div><div><br /></d
iv>
c. Vibrio vulnificus

"The hand surgeons biopsied this abnormal bone 2 days ago; the culture is growin
g Ei
enella corrodens. &nbsp;This li
ely resulted from:<div><br /></div><div><im
g src=""paste-77279346556929.jpg"" /></div><div><br /></div><div><div>a. Penetra
tion from a fishing hoo
</div><div>b. dog bite</div><div>c. Human bite/saliva co
ntamination</div><div>d. Bacteremic spread from endocarditis</div></div><div><br
/></div>"
c. Human bite/saliva contamination
"Ten months ago, this happy fellow underwent coronary artery bypass surgery requ
iring harvesting of his left saphenous vein for the graft. &nbsp;He presented ye
sterday with this problem in the leg. &nbsp;The li
ely organism is:<div><br /></
div><div><img src=""paste-77369540870145.jpg"" /></div><div><br /></div><div><di
v>Streptococcus agalactiae</div><div>Streptococcus pyogenes</div><div>Pseudomona
s aeruginosa</div><div>Staphylococcus aureus</div></div><div><br /></div>"
Streptococcus pyogenes
"This 72-year-old man presented with pain in the left arm. On examination, it fe
els to you li
e Rice Krispies. &nbsp;What is the organism?<div><br /></div><div>
<img src=""paste-77468325117953.jpg"" /></div><div><br /><div><div>Streptococcus
anginosus</div><div>Pseudomonas aeruginosa</div><div>Clostridium septicum</div>
<div>Aeromonas hydrophila</div></div><div><br /></div></div><div>What antibiotic
do you treat him with?</div>" <div>Clostridium septicum</div><div><br /></div>
<div>Penicillin</div>
"While feeding this squirrel in Hermann Par
, your girlfriend was bitten on the
finger. &nbsp;Management should include:<div><br /></div><div><img src=""paste-7
7622943940609 (1).jpg"" /></div><div><br /></div><div><div><br /></div></div>"
<div>Tetanus immunization</div><div>Prophylactic azithromycin</div><div><br /></
div><div>(squirrels dont typically have rabies - but if the bite was unprovo
ed
, then you would consider rabies immunization)</div>
"This patient li
ely has underlying:<div><br /></div><div><img src=""paste-77816
217468929.jpg"" /></div><div><br /></div><div><div>Burn</div><div>Diabetes melli
tus</div><div>Zipper trauma</div><div>Hidradenitis suppurativa</div></div><div><
br /></div>"
Fouriers Gangrene in Patients with Diabetes - could also have le
u
emia.
"The microbiology of this disorder includes:<br /><div><br /></div><div><img src
=""paste-77902116814849.jpg"" /></div><div><br /></div><div><div>Aeromonas hydro
phila</div><div>Polymicrobial flora</div><div>Staphylococcus saprophyticus</div>
<div>Streptococcus pneumoniae</div></div><div><br /></div>"
Polymicrobial fl
ora - due to fecal matter bacteria infecting
"This 25-year-old man injured his leg while waters
iing in La
e Conroe. &nbsp;Th
e causative organism is li
ely to be:<div><br /></div><div><img src=""paste-7801
3785964545.jpg"" /></div><div><br /></div><div><div>Aeromonas hydrophila</div><d
iv>Vibrio vulnificus</div><div>Streptococcus pyogenes</div><div>Staphylococcus a
ureus</div></div><div><br /></div>"
<div>Aeromonas hydrophila - fresh water!
</div>
"Which of the following are true about the infection exhibited by this patient?<
div><br /></div><div><img src=""paste-78103980277761.jpg"" /></div><div><br /></
div><div><div>Facultative Gram-negative bacilli are commonly present</div><div>E
nterococcus faecalis is usually present</div><div>Anaerobic mouth microbes are t
he predominant flora</div><div>Staphylococcus aureus is the most common cause</d
iv></div><div><br /></div>"
Anaerobic mouth microbes are the predominant flo
ra;<div>- dental problem; bacteria get into the soft tissues surrounding the nec

</div><div>- thin
Ludwigs angina</div>
"What is the function of the sulcus limitans?<div><img src=""paste-8099449326796
9.jpg"" /></div>"
<div>separates motor from sensory function</div>
What do you do to test XII lesion?
"<div>If lesioned, when stic
out tongue
it points toward the wea
side.</div><div><br /></div><div><img src=""paste-810
93277515777.jpg"" /></div><div><br /></div><div><br /></div>"
<div>What does the alar plate become? {{c1::dorsal horn}}</div>What does the bas
al plate become? {{c1::ventral horn}} "<img src=""paste-83129092014081 (1).jpg
"" />"
How do you test lesion of XI? "<div>Test by as
ing patient to shrug shoulders,
turn head against resistance. Wea
ness can result in torticollis.&nbsp;</div><d

iv><br /></div><div><img src=""paste-83232171229185.jpg"" /></div><div><br /></d

iv><div>Remember: nuclei for this CN are in spinal cord and not medulla</div>"
<div>Do unilateral lesions to corticobulbar fibers produce noticeable effects?</
div>
No, for the most part.<div>Cortical supply to nuclei is bilateral. (exce
pt for lower part of CN VII)</div><div>If you see effects, then the problem is e
lsewhere.</div>
<div>Lesions at nucleus of IX may cause a person to lose what? {{c1::gag reflex}
}.</div>
Lesion of VIII may produce {{c1::nystagmus}}.
What are the 2 major decusssations in the Caudal medulla?
1. Dorsal column
s become medial lemniscus (ascending)<div>2. Pyrmidal tracts (descending)</div>
"<img src=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_Q 0.svg"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 0.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 1.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 3.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 4.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 7.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_source_svg.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 8.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_source_svg.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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"<img sr
c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 9.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_source_svg.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
"<img src=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_Q 10.svg"" />"
"<img sr
c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 10.svg"" />"
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"<img src=""c0f0
f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 11.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 12.svg"" />"

"<img src=""c0f0
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"<img src=""c0f0
f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 13.svg"" />"
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c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 18.svg"" />"
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f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
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"<img sr
c=""c0f0f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_A 19.svg"" />"
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"<img src=""c0f0
f1aedc3f16c5cf9b6e2ea16ab1638733a6c4_tmp9NbmGQ.png"" />"
Why is the caudal meduall described as closed?&nbsp;
"<div>There is the prese
cence of a central canal, as opposed to the presence of the fourth ventricle (op
en).</div><div><br /></div><div><img src=""paste-475074922545507.jpg"" /></div><
div><br /></div><div><img src=""paste-475165116858902.jpg"" /></div>"
Second order neurons from Dorsal Column tract ascend via ______, ________ fasciu
lus and then decussate to form _________
"Gracilis, cuneatus; medial lemn
iscus<div><br /></div><div><img src=""paste-430458802274698.jpg"" /></div><div><
br /></div><div><img src=""paste-430630600966391.jpg"" /></div>"
Primary motor fibers from cortex descend down ________ on the ventral surface of
the meduall and then decussate via _________ and continue down&nbsp;<div><br />
</div><div>1. spinal cord as _______</div><div>2. or stop at CN nuclei as ______
____</div><div><br /></div>
"Pyramids, pyramidal decussation<div><br /></div
><div>Corticospinal pathways</div><div>Corticobulbar pathways</div><div><br /></
div><div><img src=""paste-430759449986176.jpg"" /></div>"
Pyramidal decussation fibers become ________ pathway; Uncrossed fibers continue
as ________ tract.
"1. lateral corticospinal pathway<div>2. Ventral Cortico
spinal tract</div><div><br /></div><div><br /></div><div><img src=""paste-430755
155018880.jpg"" /></div>"
Where are the pyramids and inferior olivary nucelus located?
"Pyramids on ven
tral surface<div>Inferior Olivary nucelus just lateral</div><div><br /></div><di
v><img src=""paste-430879709069652.jpg"" /></div>"
90% of fibers in the pyramidal tract decussate to {{c1::dorsolateral}} position
as the {{c1::lateral cortico spinal tract}}<div><br /></div><div>10% of fibers r
emain uncrossed as&nbsp;{{c1::ventral corticospinal tract}}</div>
Name the pathway of the dorsal column 1. Arise from dorsal column of spinal co
rd<div>2. Continue through fasciulus gracilis/cuneatus</div><div>3. Synapse with
respective nucleus gracilis/cuneatus</div><div>4. Second order neurons decussat
e via <b>internal arcuate fibers</b></div><div>5. Second order neurons ascend vi
a medial lemniscus</div><div>6. Terminates in VPL nucleus of thalamus</div>

What types of fibers are contained in MLF?

"1. Ascending fibers from <b>ves
tibular nuclei: </b>relay info about head in space to CN III, IV, VI to mediate
control over position and movements of eye relative to head position &nbsp;(Head
to eye)<div><br /></div><div><br /></div><div>&nbsp;The main ""direct path"" ne
ural circuit for the horizontal rotational VOR is fairly simple. It starts in th
e <b>vestibular system, where semicircular canals get activated by head rotation
and send their impulses via the vestibular nerve (cranial nerve VIII) through S
carpas ganglion and end in the vestibular nuclei in the brainstem.</b> From the
se nuclei, fibers cross to the <b>contralateral cranial nerve VI nucleus </b>(ab
ducens nucleus). There they synapse with 2 additional pathways. One pathway proj
ects directly to the lateral rectus of eye via the abducens nerve. Another nerve
tract projects from the abducens nucleus by the medial longitudinal fasciculus
to the contralateral oculomotor nucleus, which contains motorneurons that drive
eye muscle activity, specifically activating the medial rectus muscle of the eye
through the oculomotor nerve.<br /><div><b><br /></b></div><div>2. Descneding f
ibers from <b>medial vestibular nucleus: </b>Projects to muscles of nec
to medi
ate control over position and movements of eye relative to head position</div></
div>"
"<img src=""paste-23738284245762.jpg"" />"
C.
Spinal Nucleus of V is located dorsolaterally and extends caudally from the Pons
(level of trigeminal nerve) through medualla to as far as what level? What does
it then become continuous with?
"<img src=""paste-431742997496202.jpg""
/><div><br /></div><div>C2</div><div>Substantia Gelatinosa of Spinal Cord</div>"
"<img src=""paste-24047521891088.jpg"" />"
A
"<img src=""paste-24081881629444.jpg"" />"
B
"<img src=""paste-24219320582872.jpg"" />"
D
"<img src=""paste-24253680321282.jpg"" />"
B. bullous impetigo
"<img src=""paste-24279450125060.jpg"" />"
A
"<img src=""paste-24313809863406.jpg"" />"
D
"<img src=""paste-24373939405600.jpg"" />"
D
"<img src=""paste-24416889078472.jpg"" />"
D. what hes really saying is MS
CRAMMs bind to all of them
"<img src=""paste-24451248816890.jpg"" />"
D
Where do the descending fibers of V (spinal trigeminal tract) lie?
"Lateral
to the spinal nucleus of V<div><br /></div><div>Note: Its weird. There are desc
ending fibers of V (even tho youre conveying sensory information because the ne
urons first go down (spinal trigeminal tract) then synapse onto the spinal nucle
us (medial)</div><div><br /></div><div><img src=""paste-432159609323847.jpg"" />
<br /><div><br /></div><div><img src=""paste-431738702528906.jpg"" /></div></div
>"
"<img src=""paste-24494198489820.jpg"" />"
B
"<img src=""paste-24528558228206.jpg"" />"
E (because hes a young man, you
assume a deep seeded infection with endocarditis)
"<img src=""paste-24571507901140.jpg"" />"
B
Within the pons, what is the spinal nucleus of V replaced by? Chief Sensory nu
celus of V
The anterior and posterior spinocerebellar tracts convey what type of informatio
n to the cerebellum?
Proprioception (remains ipsilateral)&nbsp;<div><br /></d
iv><div>Note: Anterior reaches <b>superior peduncle</b> before going into cerebe
llum. Posterior reaches <b>inferior peduncle</b> before going into cerebellum. B
oth of these tracts relay information of <b>lower half of the body</b></div><div
><b><br /></b></div><div>(as opposed to cuneocerebellar which is upper half)</di
v>
Where does the tectospinal tract begin and continue down to? What does it do?
1. Superior colliculus of midbrain<div>2. Follows Medial Longitudinal Fasciculus
to cervical levels</div><div>3. Synapses with anterior horn moto neurons</div><
div>4. Terminates at nec
muscles to mediate posterual movements</div><div><br /
></div><div>Fxn: coordinate eye and nec
movements</div>
At the level of the pyramidal decussations, what 6 things should you see?
"1. Fasciulus Gracilis<div>2. Fasiculus Cuneatus</div><div>3. Spinocerebellar (r

emember anterior and posterior)</div><div>4. Spinothalamic</div><div>5. Corticos

pinal tract</div><div>6. Spinal Nucleus of V (along with its tract laterally)</d
iv><div><br /></div><div><img src=""paste-432765199712650.jpg"" /></div>"
Describe how the Spinal nucleus of V changes from spinal cord--&gt;medulla--&gt;
Pons
"Spinal cord: Substantia Gelatinosa<div>Medulla: Spinal nucleus of V</di
v><div>Pons: Sensory nucleus of V</div><div><br /></div><div>Spinal nucleus of V
replaces Gelatinosa</div><div>Sensory nucleus of V replaces spinal nucleus of V
</div><div><br /></div><div><img src=""paste-432760904745354.jpg"" /></div>"
What is the pathway of the cuneocerebellar tract? Fxn? FXn: conduct propriocept
ion from upper half of the body<div><br /></div><div>1. Primary neurons enter <b
>fasiculus cuneatus</b> above level of C8</div><div>2. terminate on <b>accesssor
y cuneate nucelus </b>(synapse)</div><div>3. Secondary neurons run as cuneocereb
ellar tract</div><div>4. Passes through<b> inferior cerebellar peduncle</b></div
><div>5. End in cerebellum</div>
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 0.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 0.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 1.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 1.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 2.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 2.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 3.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 3.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 4.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 4.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 5.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 5.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 6.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 6.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 7.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 7.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 8.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 8.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 9.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 9.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
"<img src=""04baca9077d3f36b03a84963a5348e53634c8eef_Q 10.svg"" />"
"<img sr
c=""04baca9077d3f36b03a84963a5348e53634c8eef_A 10.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_source_svg.svg"" />"
"<img src=""04ba
ca9077d3f36b03a84963a5348e53634c8eef_tmpp
FUEF.png"" />"
T/F At the level of the medial lemniscus decussation, you should note the access
ory cuneate nucleus<div><br /></div><div><br /></div> "T<div><br /></div><div>

<img src=""paste-474039835427171.jpg"" /></div>"

"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 0.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 0.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 1.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 1.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 2.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 2.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 3.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 3.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 4.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 4.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 5.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 5.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 6.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 6.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 7.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 7.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_Q 8.svg""
c=""f5fafb07c6c9fc12bd9de50f7cc56d681fa0e535_A 8.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_source_svg.svg"" />"
fb07c6c9fc12bd9de50f7cc56d681fa0e535_tmp50nZr
.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 0.svg""
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 0.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 1.svg""
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 1.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 2.svg""
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 2.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 3.svg""
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 3.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 4.svg""
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 4.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 5.svg""
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 5.svg"" />"
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"

/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""f5fa
"<img src=""f5fa
/>"
"<img sr
"<img src=""61c2
"<img src=""61c2
/>"
"<img sr
"<img src=""61c2
"<img src=""61c2
/>"
"<img sr
"<img src=""61c2
"<img src=""61c2
/>"
"<img sr
"<img src=""61c2
"<img src=""61c2
/>"
"<img sr
"<img src=""61c2
"<img src=""61c2
/>"
"<img sr
"<img src=""61c2
"<img src=""61c2

8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 6.svg"" />"
"<img sr
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 6.svg"" />"
"<img src=""61c2
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
"<img src=""61c2
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 7.svg"" />"
"<img sr
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 7.svg"" />"
"<img src=""61c2
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
"<img src=""61c2
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
"<img src=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_Q 8.svg"" />"
"<img sr
c=""61c28e8eab7ff95e8053ba3e5a0d414281c80952_A 8.svg"" />"
"<img src=""61c2
8e8eab7ff95e8053ba3e5a0d414281c80952_source_svg.svg"" />"
"<img src=""61c2
8e8eab7ff95e8053ba3e5a0d414281c80952_tmpHK7YEL.png"" />"
List the location of Cranial Nerve Nuclei medial to lateral (hint: thin
of vent
ral/dorsal horn layout) "<img src=""paste-594174365663766.jpg"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 0.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 0.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 1.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 1.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 2.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 2.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 3.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 3.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 4.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 4.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 5.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 5.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 6.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 6.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
"<img src=""46d0d22d79fd12a152241f2485fc3859de050658_Q 7.svg"" />"
"<img sr
c=""46d0d22d79fd12a152241f2485fc3859de050658_A 7.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_source_svg.svg"" />"
"<img src=""46d0
d22d79fd12a152241f2485fc3859de050658_tmpFQjKOE.png"" />"
What tracts are present in the midline of the medulla from ventral to dorsal?
"<img src=""paste-613407229215077.jpg"" /><div><img src=""paste-675220398539311.
jpg"" /><br /><div><img src=""paste-613420114116948.jpg"" /></div></div>"
The vagus nerve carries afferent fibers to what nucleus in the medulla?<div><br
/></div><div>The vagus nerve carries efferent fibers from what nuclei in the med
ulla?</div>
"Afferent to <b>Solitary</b> (remember visceral afferent)<div><b
r /></div><div>Efferent from <b>Dorsal Nucleus of X</b> and <b>nucleus Ambiguus&
nbsp;</b></div><div><b><br /></b></div><div><b><img src=""paste-633142603940374.
jpg"" /></b></div><div><b><br /></b></div><div><b><img src=""paste-6331554888420
68.jpg"" /></b></div>"
"<img src=""paste-633344467403292.jpg"" /><div><br /></div><div>The arrows on ea
ch of these pictures point to slightly &nbsp;different areas so its probably bes
t to just stare at each pictures and observe the relationships rather than
eep

an
i-ing everything&nbsp;</div>"
What is medial medullary syndrome? What 3 things does it cause? "Lesion of anter
ior spinal branches of vertebral artries<div><br /></div><div>Thin
of the thing
s that are in the medial midline of the medulla</div><div><img src=""paste-63360
2165440852.jpg"" /></div><div><br /></div><div>1. Loss of sensation from contral
ateral body (b/c medial lemniscus is out)</div><div>2. Contralateral upper motor
neuron paralysis (b/c pyramids are out)</div><div>3. Ipsilateral tongue paralys
is( XII hypoglossal nucleus is out)</div>"
What 3 nuclei are located in the latearl medulla from ventral to dorsal "<img sr
c=""paste-633653705048421.jpg"" /><div><br /></div><div><img src=""paste-6336665
89950292.jpg"" /></div>"
"<img src=""paste-635371691967004.jpg"" />"
"<img src=""paste-635406051705198.jpg"" />"
What is lateral medullary syndrome caused by? What are the symptoms? (4)
"Lesion to PICA (AKA wallenberg)<div><br /></div><div><img src=""paste-635539195
691348.jpg"" /></div><div>1. Loss of contralateral pain and temp (spinothalamtic
is out)</div><div>2. Loss of pain and temprature from ipsilateral face (Spinal
nucleus of V is out)</div><div>3. Loss of gag reflex, difficulty with speech and
swallowing (nucleus ambiguus of IX and X are out)</div><div>4. Possible loss of
sympathetics (Horners syndrome) (long descending pathways from hypothalamus ar
e out)</div>"
What nuclei are located on the far lateral medulla? (5) "<img src=""paste-635659
454775653.jpg"" /><div><img src=""paste-635672339677524.jpg"" /></div>"
What is dorsal medullary syndrome? What are the symptoms? (3) Lesion of medial
branch of PICA (posterior inferior cerebellar artery)<div><br /></div><div>Symp
toms overlap with lateral medullary syndrome</div><div><br /></div><div>1. Nysta
gmus (due to problems with vestiular nuclei connections with MLF)</div><div>2. V
omiting and Vertigo (Vestibular Nuclei)</div><div>3. Ataxia (damage to cerebella
r afferent fibers going through inferior cerebellar peduncle)</div>
Purple/blac
discoloration or myonecrosis/fasciitis in a diabetic foot: Diabetic
fetid foot
Cutaneous bullae or soft-tissue gas in the foot of your diabetic patient?
Diabetic fetid foot
<b>X &nbsp;Vagus Nerve</b><div><b><br /></b></div><div>Nucleus ambiguous:</div>
"<div>motor to pharynx and soft palate and larynx; SVE</div><div><br /></div><di
v><img src=""paste-37233071489025.jpg"" /></div>"
<b>X &nbsp;Vagus Nerve</b><div><b><br /></b></div><div>dorsal motor nucleus:</di
v>
"<div>Presynaptic parasympathetic fibers to smooth muscles of gut tube;
GVE</div><div><br /></div><div><img src=""paste-37228776521729.jpg"" /></div>"
<b>X &nbsp;Vagus Nerve</b><div><b><br /></b></div><div>solitary nucleus:</div>
"<div><div>Baroreceptors in carotid sinus (and aortic arch) to monitor blood pre
ssure and sensations from gut tube; GVA</div></div><div><br /></div><br /><div><
img src=""paste-37572373905409.jpg"" /></div>"
<b>X &nbsp;Vagus Nerve</b><div><b><br /></b></div><div>solitary nucleus to VPM:<
/div> "Taste fibers around epiglottis; SVA<div><br /><div><img src=""paste-376
88338022401.jpg"" /></div></div>"
<b>X &nbsp;Vagus Nerve</b><div><br /></div><div>reticular formation near solitar
y nucleus:</div>
"chemoreceptors in carotid body monitor blood oxygen lev
els; SVA<br /><div><img src=""paste-37903086387201.jpg"" /></div>"
Patient has&nbsp;paralysis of muscles of larynx and pharynx produces hoarseness
or difficulty swallowing. Where is the lesion? "nucleus ambiguus or vagus nerve
itself<div><br /></div><div><img src=""paste-39444979646465 (1).jpg"" /></div>"
<div>I found this helpful from wi
i:</div><div><br /></div><div>The corticobulba
r tract innervates <u>cranial motor nuclei bilaterally</u> with the exception of
&nbsp;<u>{{c1::the </u><u>lower facial nuclei</u> which are innervated only unil
aterally (below the eyes) and <u>cranial nerve XII</u>}}.</div>
<b>CN IX</b><div><b><br /></b></div><div><div>Inferior salvatory nucleus (within
reticular formation):</div></div>
"Secretomotor supply to parotid gland; G
VE<br /><div><br /></div><div><img src=""paste-40046275067905.jpg"" /></div>"
<b>CN IX</b><div><b><br /></b></div><div><div>solitary nucleus (2):</div></div>

"Sensory from taste, chemoreceptors in carotid body; SVA<br /><div>carotid body

reflex; SVA (reticulospinal neurons within reticular formation to phrenic nerve
to increase respiration)</div><div><br /></div><div><img src=""paste-40205188857
857_1407282835056.jpg"" /></div>"
<div>Motor nucleus of VII found {{c1::in tegmentum of pons (I guess the pons has
a tegmentum too?}}</div><div>Fibers exit {{c2::caudal::caudal/rostral}} to pons
to innervate muscles of {{c1::facial expression}} and {{c1::stapedius muscle}}<
/div> "<br /><div><img src=""paste-45526653337601.jpg"" /></div>"
<b>CN VII</b><div><b><br /></b></div><div>superior salvatory nucleus in reticula
r formation of pons:</div>
"<div>supplies parasympathetics to lacrimal and
salivary glands as well as nasal mucosa; GVE</div><div><br /></div><div><img src
=""paste-46037754445825.jpg"" /></div>"
<b>CN VII</b><div><b><br /></b></div><div>solitary nucleus to VPM:</div>
"taste from anterior tongue; SVA<div><br /></div><div><img src=""paste-462138481
04961.jpg"" /></div>"
<b><u>CN VII Lesions</u></b><div><b><br /></b></div><div><div>Upper motor neuron
s corticobulbar fibers are {{c1::bilateral::unilateral/bilateral}} to dorsal hal
f of motor nucleus of VII. The ventral half are from {{c1::contralateral::ipsila
teral/contralateral}} cortex only.</div></div><div><br /></div><div><div>1) Thus
a lesion of nerves to the muscles of the forehead/eyes would cause what?</div><
/div><div><br /></div><div>2) What about a lesion of those to the muscles of the
mouth?</div> 1) Nothing - bilateral supply to dorsal half of motor nucleus<di
v><br /></div><div>2) Paralysis - strictly unilateral, contralateral supply to v
entral half of motor nucleus</div>
enzyme that converts H2O2--&gt; H2O + O2
catalase
interacts with serum fibrinogen D fragment to produce clumping coagulase
Staph enzymes (3)
Catalase<div>Coagulase</div><div>Hyaluronidase</div>
, , , and&nbsp;<b> toxins</b>: Fn isrupt cell membranes (Staph toxin)
Panton-Valentine leukoci in
strong association with invasive soft tissue inf
ections cause by community-acquire MRSA.
Once CNV sensory (GSA) fibers enter pons, the primary neurons may: (2) < iv>1)
Synapse in main sensory nucleus of V (tactile info)</ iv>< iv>2) Or enter tract
of V an synapse in spinal nucleus of V (pain an temperature)</ iv>< iv><br /><
/ iv>
basis for Staph serotyping
microcapsule
Components of Staph glycocalyx (3)
"microcapsule< iv>capsule</ iv>< iv>""sl
ime""</ iv>"
<b>Staphylococci A herence ligan s that bin fibronectin, fibrinogen, collagen,
etc. to colonize host tissue</b>
MSCRAMMs
Well- ocumente infections cause by&nbsp;<u>coagulase negative Staph (4)</u>
UTIs< iv>Osteomyelitis</ iv>< iv>en ocar itis (unusual)</ iv>< iv>bacteremia in
critically ill/immunosuppresse patients</ iv>
How penicillin kills bacteria beta-lactam ring inhibits penicillin bin ing pro
tein (aka&nbsp;<u>transpepti ase)</u>&nbsp;activity, preventing pepti oglycan cr
oss-linkage --&gt; no cell wall is forme < iv><br /></ iv>< iv>MRSA has Penicill
in bin ing protein 2A which has low affinity for beta-lactam Abx</ iv>
Pain an temperature of CNV synapse where?
spinal nucleus of V&nbsp;
Tactile info from CNV synapses where? main sensory nucleus of V&nbsp;
Trace the path of nerves from the main sensory nucleus of V/spinal nucleus of V
to the post central gyrus.
< iv>2n or er neurons ascen to <u>VPM of contr
alateral thalamus</u></ iv>< iv>3r or er neurons from <u>VPM to post central gy
rus</u> of cortex (near lateral fissure).</ iv>
methicillin resistance implies resistance to
all&nbsp;<b>penicillins</b>&nbsp
;an &nbsp;<b>cephalosporins</b>
< iv>relative or er of susceptibility to -lactamase:</div><div>cloxacillin, oxaci
llin, nafcillin, dicloxacillin, penicillin</div>
penicillin&gt;&gt;&gt;di
cloxacillin&gt;cloxacillin&gt;oxacillin&gt;nafcillin
<div>Motor to muscles of mastication (plus 4 others) originates from where?</div
><div><r /></div><div>It has ilateral or unilateral supply from the cortex?&n
sp;</div>
motor nucleus of V<div><r /></div><div>ilateral</div>

What comes from the mesencephalic nucleus of V? "<div>Muscle spindles from V3 (s

imilar to DRG of spinal nerves) ut soma lies inside CNS this is unique exceptio
n.</div><div><r /></div><div><img src=""paste-50517405335553.jpg"" /></div>"
What is unique aout the jaw jerk reflex?
<u>Monosynaptic</u> from afferen
ts directly onto motor nucleus of V (i.e. there are no interneurons like you mig
ht typically see in a spinal cord reflex).
What are the 2 parts of the asal ganglia? &nsp;What makes up each part?
striatum (caudate nucleus and putamen)<div><r /></div><div>lentiform nucleus (p
utamen and glous pallidus)</div>
NeuroLa4
The LIC separates what two structures? caudate from lentiform nucleus NeuroLa
4
The PLIC separates what two structures? lentiform nucelus and thalamus NeuroLa
4
Caudate protrudes into what ventricle? &nsp;Thalamus protrudes into what ventri
cle?
caudate - lateral ventricle<div><r /></div><div>thalamus - third ventri
cle</div>
NeuroLa4
Coronal section: &nsp;which part of the internal capsule is present if you can
see the thalamus?
PLIC
NeuroLa4
Coronal section: &nsp;which part of the internal capsule is present if you can
LIC
NOT see the thalamus?
NeuroLa4
Function of asal ganglia?
"<img src=""paste-34857954574744.jpg"" />"
NeuroLa4
"Coronal: head of caudate<div><img src=""paste-35003983462868.jpg"" /></div>"
putamen NeuroLa4
"coronal: head of caudate<div><img src=""paste-35038343201229.jpg"" /></div>"
caudate nucleus NeuroLa4
"coronal: head of caudate<div><img src=""paste-35107062677980.jpg"" /></div>"
lue- lateral ventricle<div><r /></div><div>light purple- cingulate gyrus</div>
<div><r /></div><div>dark purple - corpus callosum</div>
NeuroLa4
"coronal: head of caudate<div><img src=""paste-35141422416325.jpg"" /></div>"
LIC
NeuroLa4
"coronal, anterior commisssure<div><img src=""paste-35210141893026.jpg"" /></div
>"
purple - lateral sulcus<div><r /></div><div>light lue - lateral ventri
cle</div><div><r /></div><div>red - caudate nucleus</div>
NeuroLa4
"coronal, anterior commissure<div><img src=""paste-35296041238948.jpg"" /></div>
"
red - putamen<div><r /></div><div>light lue- 3rd ventricle</div><div><
r /></div><div>salmon - hypothalamus</div>
NeuroLa4
"coronal, anterior commissure<div><img src=""paste-35416300323225.jpg"" /></div>
"
red - glous pallidus<div><r /></div><div>lue-green - optic chiasm</di
v><div><r /></div><div>salmon - infundiular stalk</div>
NeuroLa4
"coronal, anterior commissure<div><img src=""paste-35502199669143.jpg"" /></div>
"
light purple - cingulate gyrus<div><r /></div><div>dark purple - corpus
callosum</div> NeuroLa4
"coronal, anterior commissure<div><img src=""paste-35553739276699.jpg"" /></div>
"
light purple - fornix<div><r /></div><div>dark purple - LIC</div>
NeuroLa4
"coronal, anterior commissure<div><img src=""paste-35596688949654.jpg"" /></div>
"
insular cortex NeuroLa4
"coronal, mid thalamus<div><img src=""paste-35682588295587.jpg"" /></div>"
red - caudate nucleus<div><r /></div><div>dark purple - PLIC</div><div><r /></
div><div>light lue - lateral ventricle (inferior horn)</div> NeuroLa4
"coronal, mid-thalamus<div><img src=""paste-35742717837739.jpg"" /></div>"
red - putamen<div><r /></div><div>dark purple - thalamus</div><div><r /></div>
<div>salmon - mammillary ody</div>
NeuroLa4
"coronal, mid thalamus<div><img src=""paste-35871566856616.jpg"" /></div>"
red - glous pallidus<div><r /></div><div>purple - fornix</div><div><r /></div
><div>salmon - hypothalamus</div>
NeuroLa4
"coronal, mid thalamus<div><img src=""paste-35914516529578.jpg"" /></div>"
amygdala
NeuroLa4
"coronal, posterior thalamus<div><img src=""paste-35983236006330.jpg"" /></div>"

red - caudate nucleus<div><r /></div><div>dark purple - PLIC</div><div><r /></

div><div>light purple - hippocampal formation</div>
NeuroLa4
"coronal, posterior thalamus<div><img src=""paste-36086315221419.jpg"" /></div>"
dark purple - posterior commissure<div><r /></div><div>green - thalamus (latera
l geniculate)</div>
NeuroLa4
"coronal, posterior thalamus<div><img src=""paste-36172214567341.jpg"" /></div>"
purple - thalamus (medial and lateral nuclei)<div><r /></div><div>salmon - thal
amus (medial geniculate)</div> NeuroLa4
"axial cut<div><img src=""paste-36696200577479.jpg"" /></div>" dark purple - co
rpus callosum<div><r /></div><div>light purple - fornix</div><div><r /></div><
div>red - putamen</div> NeuroLa4
"axial cut<div><img src=""paste-36782099923403.jpg"" /></div>" dark purple - th
alamus<div><r /></div><div>light purple - cingulate gyrus</div><div><r /></div
><div>red - caudate nucelus</div>
NeuroLa4
"axial cut<div><img src=""paste-36846524432836.jpg"" /></div>" glous pallidus
NeuroLa4
Many of the glous palladus structures are innervated y what NT?
dopamine
NeuroLa4
Disorders of asal ganglia: descrie parkinons disease. &nsp;include symptoms
<div>Loss of dopaminergic innervation of the asal ganglia</div><div><r /></div
><div>Resting tremor, postural instaility, cogwheel rigidity, en-loc turning,
akinesia, shuffling gait, masked facies</div> NeuroLa4
Disorders of asal ganglia: descrie Huntingtons disease. &nsp;include symptom
s
<div>Trinucleotide Repeat Disease (CG, Chrom. 4)</div><div><r /></div>
<div>utosomal Dominant</div><div><r /></div><div>Choreiform Movements (twistin
g and writhing), aggression, depression, dementia</div> NeuroLa4
"What disease is depicted here?<div><img src=""paste-37138582208798.jpg"" /></di
v>"
<div>Caudate atrophy in Huntingtons Disease</div>
NeuroLa4
Important thalamus nuclei, give function of each<div><div><r /></div><div>Later
al Geniculate Nucleus (LGN)-&nsp;{{c1::Vision}}</div><div><r /></div><div>Medi
al Geniculate Nucleus (MGN)-&nsp;{{c1::uditory}}</div><div><r /></div><div>Ve
ntral Lateral (VL)-&nsp;{{c1::Motor (from Basal Ganglia and Cereellum to Motor
Cortex)}}</div></div>
NeuroLa4
<div>Important thalamus nuclei, give function</div><div><r /></div><div>Ventral
Posterior Lateral Nucleus (VPL)-&nsp;{{c1::STT and DC from lower ody and post
erior 1/3 of head}}</div><div><r /></div><div>Ventral Posterior Medial Nucleus
(VPM)-&nsp;{{c1::STT and DC from anterior 2/3 of head}}</div>
NeuroLa
4
The PLIC contains which nerve tracts?(3)
DC:&nsp;Travels through PLIC to
Somatosensory Cortex (Postcentral Gyrus)<div><r /></div><div>SST (fast pain):&
nsp;Travels through PLIC to somatosensory cortex (postcentral gyrus)</div><div>
<r /></div><div>SST (slow pain):&nsp;Through PLIC to postcentral gyrus, SSII (
superior part of lateral ventricle), and Insular cortex.</div> NeuroLa4
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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19a349458663c7829ffed3320a5463382_tmpDx46D2.png"" />"
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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19a349458663c7829ffed3320a5463382_tmpDx46D2.png"" />"
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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19a349458663c7829ffed3320a5463382_tmpDx46D2.png"" />"
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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19a349458663c7829ffed3320a5463382_source_svg.svg"" />"
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c=""7784c3ae68510e07441989939ef3f8242aed85e_ 11.svg"" />"
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"<img src=""7784
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Which nerve tract travels through the LIC?
<div>SST (slow pain): Through L
IC to cingulate gyrus</div>
NeuroLa4
SST fast pain pathway travels through PLIC to where?
somatosensory cortex (po
stcentral gyrus)
NeuroLa4
SST slow pain pathway travels through PLIC to where? (3)<div><r /></div><div>Tr
avels through LIC to where? (1)</div> <div>Through PLIC to postcentral gyrus,
SSII (superior part of lateral ventricle), and Insular cortex.</div><div><r /><
/div><div><div>Through LIC to cingulate gyrus</div></div>
NeuroLa4
the intralaminar nucleus is involved in what pathway? slow pain
NeuroLa
4
Where &nsp;do tha asal ganglia tract &amp; dentato-ruro-thalamic tract synaps
e?
VL nucleus of thalamus NeuroLa4
What disease affects the striatum (caudate &amp; putamen)?&nsp;
Huntingt

ons disease<div><r /></div><div>(Hunt Four food, D, TR, anticipation) &lt;--t

his is what it said in the notes on the powerpoint, not sure what it means...</d
iv>
NeuroLa4
<div>What are the neurons in the striatum called?</div> <div>Medium Spiny Neuron
s (MS. N, GB, inhiitory)</div>
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 0.svg"" />"
"<img sr
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"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 1.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 1.svg"" />"
"<img src=""c5e
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"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 2.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 2.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 3.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 3.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 4.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 4.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 5.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 5.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 6.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 6.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 7.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 7.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 8.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 8.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 9.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 9.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4
"<img src=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_Q 10.svg"" />"
"<img sr
c=""c5e9a52f062194c93d1e1c3ea3fd5d7c35872f_ 10.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_source_svg.svg"" />"
"<img src=""c5e
9a52f062194c93d1e1c3ea3fd5d7c35872f_Screen Shot 2015-03-25 at 12.03.16 PM.png""
/>"
NeuroLa4

"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 0.svg"" />"

"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 0.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 1.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 1.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 2.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 2.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 3.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 3.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 4.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 4.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 5.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 5.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 6.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 6.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 7.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 7.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 8.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 8.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 9.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 9.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 10.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 10.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 11.svg"" />"
"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 11.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4

"<img src=""92acc6aa9493e7673d552f13670e1a664c50d_Q 12.svg"" />"

"<img sr
c=""92acc6aa9493e7673d552f13670e1a664c50d_ 12.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_source_svg.svg"" />"
"<img src=""92ac
c6aa9493e7673d552f13670e1a664c50d_Screen Shot 2015-03-25 at 12.03.32 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 0.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 0.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 1.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 1.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 2.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 2.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 3.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 3.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 4.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 4.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 5.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 5.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 6.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 6.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 7.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 7.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 8.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 8.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 9.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 9.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 10.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 10.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4

"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 11.svg"" />"

"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 11.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 12.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 12.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_Q 13.svg"" />"
"<img sr
c=""064ffa3ddca0295a7c6a323d22dc6f36fe6687_ 13.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_source_svg.svg"" />"
"<img src=""064f
fa3ddca0295a7c6a323d22dc6f36fe6687_Screen Shot 2015-03-25 at 12.03.51 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 0.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 0.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 1.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 1.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 2.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 2.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 3.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 3.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 4.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 4.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 5.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 5.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 6.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 6.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 7.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 7.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 8.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 8.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4

"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 9.svg"" />"

"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 9.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 10.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 10.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 11.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 11.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 12.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 12.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 13.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 13.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 14.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 14.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""205ff302811fdd96087a114d52d60c8ae4c8358_Q 15.svg"" />"
"<img sr
c=""205ff302811fdd96087a114d52d60c8ae4c8358_ 15.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_source_svg.svg"" />"
"<img src=""205f
f302811fdd96087a114d52d60c8ae4c8358_Screen Shot 2015-03-25 at 12.04.04 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 0.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 0.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 1.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 1.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 2.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 2.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 3.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 3.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 4.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 4.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4

"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 5.svg"" />"

"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 5.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 6.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 6.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 7.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 7.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 8.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 8.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 9.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 9.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 10.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 10.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 11.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 11.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 12.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 12.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 13.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 13.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 14.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 14.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 15.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 15.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 16.svg"" />"
"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 16.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4

"<img src=""2030cfc95479367e1a168f1332a90d9cea5_Q 17.svg"" />"

"<img sr
c=""2030cfc95479367e1a168f1332a90d9cea5_ 17.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_source_svg.svg"" />"
"<img src=""203
0cfc95479367e1a168f1332a90d9cea5_Screen Shot 2015-03-25 at 12.04.18 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 0.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 0.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 1.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 1.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 2.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 2.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 3.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 3.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 4.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 4.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 5.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 5.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""5e899221a8f72c4538c248cf866045d472c28f5_Q 6.svg"" />"
"<img sr
c=""5e899221a8f72c4538c248cf866045d472c28f5_ 6.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_source_svg.svg"" />"
"<img src=""5e89
9221a8f72c4538c248cf866045d472c28f5_Screen Shot 2015-03-25 at 12.04.35 PM.png""
/>"
NeuroLa4
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 0.svg"" />"
"<img sr
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 0.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 2.svg"" />"
"<img sr
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 2.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 4.svg"" />"
"<img sr
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 4.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 5.svg"" />"
"<img sr
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 5.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 6.svg"" />"
"<img sr
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 6.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img src=""85
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"

"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 7.svg"" />"

c=""85f858914671e450f565d6c8e2ec08c80ee5_ 7.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 8.svg"" />"
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 8.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 9.svg"" />"
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 9.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 10.svg"" />"
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 10.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 11.svg"" />"
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 11.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""85f858914671e450f565d6c8e2ec08c80ee5_Q 12.svg"" />"
c=""85f858914671e450f565d6c8e2ec08c80ee5_ 12.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_source_svg.svg"" />"
"<img
f858914671e450f565d6c8e2ec08c80ee5_tmpWt0W.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 0.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 0.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 1.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 1.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 2.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 2.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 3.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 3.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 4.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 4.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 5.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 5.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 6.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 6.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""c727f830c100c301f28728329ed322983380_Q 7.svg"" />"
c=""c727f830c100c301f28728329ed322983380_ 7.svg"" />"
"<img
f830c100c301f28728329ed322983380_source_svg.svg"" />"
"<img
f830c100c301f28728329ed322983380_tmpcFqNur.png"" />"
"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 0.svg"" />"
c=""650a2a54de90a299084e0f33920c978a51e12c_ 0.svg"" />"
"<img
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"

"<img sr
src=""85
src=""85
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src=""85
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src=""85
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src=""650a
src=""650a

"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 1.svg"" />"

"<img sr
c=""650a2a54de90a299084e0f33920c978a51e12c_ 1.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"
"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 2.svg"" />"
"<img sr
c=""650a2a54de90a299084e0f33920c978a51e12c_ 2.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"
"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 3.svg"" />"
"<img sr
c=""650a2a54de90a299084e0f33920c978a51e12c_ 3.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"
"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 4.svg"" />"
"<img sr
c=""650a2a54de90a299084e0f33920c978a51e12c_ 4.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"
"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 5.svg"" />"
"<img sr
c=""650a2a54de90a299084e0f33920c978a51e12c_ 5.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"
"<img src=""650a2a54de90a299084e0f33920c978a51e12c_Q 6.svg"" />"
"<img sr
c=""650a2a54de90a299084e0f33920c978a51e12c_ 6.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_source_svg.svg"" />"
"<img src=""650a
2a54de90a299084e0f33920c978a51e12c_tmp2Rni2a.png"" />"
"<img src=""paste-247046518866382.jpg"" /><div>Descrie</div>" <div>Silhouette
sign - whole left lower loe is filled with infiltrate (fluid in alveoli + cells
). Doesnt look like pleural effusion since you can see diaphragm&nsp;</div><di
v>Note that viral pneumonia tends to give a patchy infiltrate and give not as hi
gh of a WBC count</div>
"<img src=""paste-247106648408270.jpg"" />"
Pneumococcus
"<img src=""paste-247188252786906.jpg"" />"
Haemophilus
"<img src=""paste-247226907492586.jpg"" />"
Legionella (no cell walls)&nsp;
"<img src=""paste-247252677296372.jpg"" />"
Moraxella
"<img src=""paste-247282742067450.jpg"" />"
Staph ureus
UTI:&nsp;List in decreasing order of likelihood the acteria that might cause t
his disease?
<div>E. coli (85%)&nsp;</div><div>Staphylococcus saprophyticus
(5-10%)&nsp;</div><div>Gram (-) rods --&gt; Proteus is one that causes stones</
div>
"<img src=""paste-247385821282696.jpg"" /><div>Name of this disease, causative o
rganism?</div>" Cellulitis<div>Group  Strep leads the list in causes of this</d
iv><div><r /></div>
Name four gram-negative anaeroes.
"1) Bacteroides (non-spore forming acil
li)<div>2) Porphyromonas, Prevotella (acilli)</div><div>3) Veillonell (cocci)</
div><div>4) Fusoacterium (fusiform shaped)</div><div><r /></div><div><img src=
""paste-383304356331747.jpg"" /></div>"
Name three gram-positive anaeroes.
"1) Peptostreptococcus (anaeroic strep)
<div>2) Clostridium (spore-forming acilli)</div><div>3) ctinomyces (ranching
rods)</div><div><img src=""paste-383300061364451.jpg"" /></div>"
"What is this?<div><img src=""paste-383922831622684.jpg"" /></div>"
"LRGE G
RM POSITIVE RODS&nsp;<div>+ asence of inflammatory cells = histotoxic Clostri
dium</div><div><r /></div><div>C. perfringens, C. histolyticum, C. novyi or C.
septicum</div><div><img src=""paste-384043090706666.jpg"" /></div>"
Clostridium species have what characteristics? 1) gram positive rods<div>2) spo
re forming</div><div>3) oligate aneroic</div>
Symptoms associated with C. difficile? 1) watery diarrhea<div>2) anorexia</div>
<div>3) nausea</div><div>4) adominal pain</div><div>5) leukocytosis with neutro
philic predominance</div>
Method preferred to identify C. difficile?
PCR
What is the virulence factor of C. otulinum? (most common type)
Botulinu
m toxin (most disease is cuased y types , B, E)

Pathogenesis of otulinum toxin?

"toxin cleaves SNRE proteins that attac
h Ch vesciles to pre-synaptic memrane<div>--&gt; FLCCID PRLYSIS</div><div><
r /></div><div><img src=""paste-390068929823018.jpg"" /></div>"
Floppy ay who is costipated, has a weak cry, and hypotonia. &nsp;What does sh
e have? &nsp;What can this progressinto?
C. Botulinum<div><r /></div><di
v>can progress to upper airway ostruction and respiratory failure</div>
What are the three ways C. otulism causes disease?1
"1) ingest spores - infa
nts + honey<div>2) ingest pre-formed toxin - canned food</div><div>3) wound otu
lism - through skin reak (drug addicts skin-popping lack tar heroin)</div><div
><r /></div><div><img src=""paste-390223548645802.jpg"" /></div>"
Ingesting preformed Botulism toxin can lead to what clinical symptoms? (2)
symmetrical voluntary muscle paralysis<div>CN III, IV, VI, VII, IX --&gt; lurre
d vision, diplopia, ptosis</div>
BOTULIS<div><r /></div><div>Fever?</div><div>Neurological manifestations?</div>
<div>Responsive?</div><div>Heart rate?</div><div>Sensory deficits?</div><div><r
/></div>
1) no fever<div>2) symmetical neurological manifestiations</div>
<div>3) patient remains responsive - no upper rain lesions</div><div>4) heart r
ate normal or slow</div><div>5) NO sensory deficits, <>only motor</></div>
Tetanus most often occurs as a result of?<div><r /></div><div>Where does the to
xin enter? How cause disease?</div>
"result of acute injuries - puncture and
lacerations<div><r /></div><div>tetanospasmin toxin enters nervous system via
lower motor neuron presynaptic terminals --&gt; inhiits inhiitory neurotransmi
tters</div><div><r /></div><div><img src=""paste-393457659019520.jpg"" /></div>
"
How does neonatal tetanus usually occur?<div><r /></div><div>How does it presen
t?</div>
usually follows infection of the umilical stump caused y failu
re of aseptic technique/mother inadequately immunized<div><r /></div><div>prese
nts with failure to nurse and weakness, ridigity comes later</div><div>very high
mortality rate</div>
Generalized tetanus starts with what syptoms? Progression of disease?<div><r />
</div><div>What is the frequenct cause of death is tetanus patients?</div>
"1) egins with trismus (lockjaw) + risus sardonicus<div>2) opisthotonic posturi
ng (flexion of arms, extension of legs)</div><div>3) adominal muscles + diaphra
gm contract (respiratory failure)</div><div><r /></div><div>DETH: autonomic dy
sfunction (BP and pulse fluctuations)</div><div><img src=""paste-393973055095011
.jpg"" /></div>"
Treatment of tetanus? (4)
1) respiratory support (tracheostomy)<div>2) en
zodiazepines</div><div>3) metronidazole/penicillin for wound</div><div>4) comin
ed alpha-and eta-lockade for autonomic dysfunction</div>
Pneumonitis most commonly occurs where in the lung? Which lung? 1) posterior seg
ments of upper loes<div>2) apex of lower loes</div><div><r /></div><div>RIGHT
LUNG MORE FREQUENT (ecause right main stem ronchus comes off at less of an ac
ute angle)</div>
What are the 4 immune compromised states that lead to pseudomona?
1. neutr
openic fever<div>2. urn patients</div><div>3. CF</div><div>4. diaetics/IV drug
users</div>
What diseases are caused y pseudomonas? (7)
1. Ventilator associated pneumon
ia<div>2. Catheter associated acteremia/UTI</div><div>3. Respiratory failure in
CF</div><div>4. Infection in Diaetes patients</div><div>5. Otitis Externa</div
><div>6. Hot Tu Folliculitis</div><div>7. Osteomyelitis&nsp;</div>
"<div>What do these images show? What is the progression of disease?</div><img s
rc=""paste-395252955349238.jpg"" /><r /><div><img src=""paste-395265840251150.j
pg"" /></div><div><img src=""paste-395283020120333.jpg"" /></div>"
Mixed an
aeroic, aeroic pleuropulmonary infections<div>1) Pneumonitis</div><div>2) aspi
ration pneumonia</div><div>3) necrotizing pneumonia</div><div>4) lung ascess</d
iv>
Factors that predispose one to aspiration/anaeroic infections? 1) decreased <>
consciousness </>(easier to aspirate, ie. seizures, anasthesia)<div>2) aspirati
on <>secondary to GI dysfunction</> (impaired gastirc emptying, esophageael dy
sfunction)</div><div>3) aspiration after <>disruption of usual mechanical arri

ers</> (endotracheal tue, tracheostomy)</div><div>4) increased <>acterial in

oculum</> (peridontal disease)</div><div>5) <>osturction</> (foreign ody)</
div>
Patient comes in with foul reath and large amounts of sputum. &nsp;He also has
a low-grade fever, malaise, weight loss, and pleuritic chest pain and cough. &n
sp;What does he have? "anaeroic pleuropulmonary infection<div><img src=""past
e-395888610508902.jpg"" /></div>"
What is the pivotal step in pathogenesis of actinomycosis?
disruption of mu
cosal arrier
What does Gardnerella vaginalis cause?<div><r /></div><div>What population does
this usually occur in? &nsp;</div><div><r /></div> "acterial vaginosis - h
omogenous vaginal discharge with ""fishy"" odor<div><r /></div><div>usually occ
urs in sexually active young women</div><div><r /></div>"
<div>How do you identify Gardnerella vaginalis (3)?</div>
"1) homogenous d
ischarge with pH &gt; 4.6<div>2) (+) whiff test with KOH (fishy odor)</div><div>
3) presence of clue cells = epithelial cells of vagina with stippled apperance (
covered with acteria)</div><div><img src=""paste-398607324807357.jpg"" /></div>
"
Intra-adominal infections are often exhiit iphasic illness. What does this me
an?<div><r />What organisms cause?</div>
"1) acute peritonitis (also act
eremia)<div>E. coli from the gut</div><div><r /></div><div>2) intraperitoneal a
scesses&nsp;</div><div>Bacteroides fragilis + anaeroic organisms</div><div><
r /></div><div><img src=""paste-399569397481790.jpg"" /></div>"
Primary peritonitis (spontaneous acterial peritonitis)<div><r /></div><div>adu
lt patient population? What acteria?<div><r /></div><div>children patient popu
lation? What acteria?</div></div>
"DULT: cirrhotics with ascites&nsp;<di
v>E. coli</div><div><r /></div><div>CHILDREN: nephrotic syndrome</div><div>Stre
p. pneumoniae</div><div><r /></div><div><img src=""paste-399968829440267.jpg""
/></div>"
Secondary peritonitis usually results in what type of infection with gut acteri
a? How is this different from primary peritonitis?
results in polymicroial
infection due to gut microorganisms spilled into peritoneum<div><r /></div><di
v>primary is usually caused y single species</div>
What does the acteriology of appendicitis reflect? &nsp;What does it result fr
om?
reflects owel flora<div><r /></div><div>results from persistent ostru
ction of appendiceal lumen</div>
Splenic ascesses usually result form what type of spread? What acteria?<div><
r /></div><div>ssociated with what/? (2)</div> acteremic spread<div>S. aureus,
S. pneumoniae</div><div><r /></div><div>associated with endocarditis + hemoglo
inopathies</div>
What is the most sensitive diagnostic test for intra-adominal infections
"computated tomography<div><r /></div><div><img src=""paste-402335356420177.jpg
"" /></div>"
ntiiotics against gram negative anaeroic?
"Imipenem<div>Meropenem</div><di
v>Metronidazole</div><div>Piperaccilin/Tazoactam</div><div>Chloramphenicol</div
><div>mpicillin/sulactam</div><div><img src=""paste-402769148117254.jpg"" /></
div>"
"<img src=""paste-402897997136259.jpg"" />"
3
"<img src=""paste-402923766939952.jpg"" />"
2
"<img src=""paste-402958126678351.jpg"" />"
C
"<img src=""paste-402983896482120.jpg"" />"
4
"<img src=""paste-403022551187770.jpg"" />"
C
"<img src=""paste-403056910926162.jpg"" />"
C
"<img src=""paste-403082680729927.jpg"" />"
B
"<img src=""paste-403117040468298.jpg"" />"
B
"<img src=""paste-403142810272077.jpg"" />"
"<div><img src=""paste-40315569
5173684.jpg"" /></div>"
"<img src=""paste-403190054912295.jpg"" />"
E
"<img src=""paste-403224414650698.jpg"" />"
D
"<img src=""paste-403258774389042.jpg"" />"
E<div><r /></div><div>wound ot

ulism</div>
What acteria cause each of the following?<div><r /></div><div>primary peritoni
tis</div><div>pancreatic ascess</div><div>emphysematous cholecystitis</div><div
>splenic ascess</div> <div>primary peritonitis - E. coli (adults), S. pneumoni
ae (children)</div><div><r /></div><div>pancreatic ascess - facultative anaero
es (e. coli, enterococcus)</div><div><r /></div><div>emphysematous cholecystit
is - gas forming organisms (E coli)</div><div><r /></div><div>splenic ascess Strep aureus, S. pneumoniae (loodstream pathogens)</div>
Prolems in fourth ventricle can lead to what?<div><r /></div><div>Prolems in
cereellum can lead to what?</div>
fourth ventricle - CSF ostruction<div><
r /></div><div>cereellum - ataxia</div>
Brainstem lesions will lead to what? (2)
ipsilateral cranial nerve findin
gs<div><r /></div><div>contralateral arm/leg motor/sensory findings</div>
What cranial nerves are located in the midrain?&nsp;<div><r /></div><div>What
are they responsile for?</div>
"III, IV<div><r /></div><div>pupillary
control, accommodation, vertical gaze&nsp;</div><div>oculomotor manifestations
may arise</div><div><r /></div><div><img src=""paste-412235256037748.jpg"" /></
div>"
What cranial nerve are located in the pons?
"V, VI, VII<div><r /></div><div
><img src=""paste-412355515122049.jpg"" /></div><div><img src=""paste-4124113496
96829.jpg"" /></div>"
"lesion
 lesion at nucleus of VI can damage what other cranial nerve? How?
at nucleus of VI can also damage VII<div><r />VII sends fiers around VI</div><
div><img src=""paste-412454299369839.jpg"" /></div>"
CN V has multiple nuclei.<div><r /></div><div>Function of each nucleus</div><di
v>motor nucleus: {{c1::mastication&nsp;}}</div><div>main sensory nucleus: {{c1:
:fine touch}}</div><div>spinal nucleus: {{c1::pain/temperature}}</div><div>mesen
chephalic nucleus: {{c1::jaw jerk reflex}}</div>
"<img src=""paste-412690
522571131.jpg"" />"
What CN is located pontomedullary?
VIII
What are some clinical cues to rainstem injuries? (3) "1) disturances in acco
mmodation and pupils<div>2) disturances in auditory and vestiular functions</d
iv><div>3) disturances of gaze</div><div><img src=""paste-426060755763582.jpg""
/></div>"
How does normal gaze work? CNs involved?<div><r /></div><div>How does disconjug
ate gaze occur?</div> "normal gaze - eyes move conjugately (together) to keep
images on homologues portions of the retina<div><r /></div><div>CN 3,4,6 are co
nnected via MLF (medial longitudinal fasciculus)</div><div><r /></div><div>disc
onjugate gaze results in diplopia --&gt; interruption of any of the nuclei/nerve
s involved in ocular motility OR the MLF</div><div><r /></div><div><img src=""p
aste-426692115956090.jpg"" /></div>"
"<img src=""paste-426717885759831.jpg"" /><div>1) What type of tumor is this?</d
iv><div>2) What structure is this tumor growing in?</div><div>3) What CNs would
you expect deficits in?</div><div>4) Prognosis?</div>" 1) rainstem glioma - ne
oplasm arising from astrocytes<div>2) tumor growing on the right side of the pon
s</div><div>3) CN V, VI, VII nuclei</div><div>4) neoplasm will ultimately interf
ere with consciousness y destroying the reticular activating system</div>
"<img src=""paste-426846734778708.jpg"" /><r /><div>1) What type of tumor is th
is?</div><div>2) What structure is this tumor growing in?</div><div>3) What will
result? (on what sides)</div><div>4) What CN might e affected?</div>" "1) sus
tantia nigra metastasis (midrain)<div>2) situated in sustantia nigra, partiall
y compressing crus</div><div>3) contralateral hemiparkinsonism + contralateral U
MN weakness</div><div>4) might lead to ipsilateral CN III signs (diplopia + pupi
llary dilation)</div><div>CN IV wont e affected ecause exits dorsally</div><d
iv><r /></div><div><img src=""paste-426971288830210.jpg"" /></div>"
"<img src=""paste-427104432816451.jpg"" /><r /><div>1) What type of tumor is th
is?</div><div>2) What structure is this tumor growing in?</div><div>3) What will
result?</div>" 1) medullolastoma<div>2) fourth ventricle</div><div>3) ostruct
ive (non-communicating) hydrocephalus --&gt; headache, nausea, and enlarged head
s in children since sutures havet fused</div><div>-&gt; as tumor gets igger, c

an affect cereellum and rainstem as well</div>

"<img src=""paste-427233281835360.jpg"" /><r /><div>1) Where in the rainstem a
re you? What type of section?</div><div>2) What is this?</div><div>3) What will
the patient show initially? Progression?</div>" 1) cereellum --&gt; level of me
dulla, axial section<div>2) metastasis</div><div>3) ipsilateral ataxia + hypoton
ia without CSF ostruction when in the hemisphere</div><div>--&gt; if enlarged,
then rainstem/CSF flow can mess up</div>
"<img src=""paste-427366425821534.jpg"" /><r /><div>What is this image showing?
What would you expect to see in patients?</div>"
left cereellar hemisphe
re mass<div>ipsilateral cereellar findings</div>
Draw level of medulla. "<img src=""paste-427679958434117.jpg"" /><div><img src=
""paste-427710023205243.jpg"" /><r /><div><img src=""paste-427697138303267.jpg"
" /></div></div>"
What will e affected in a lateral medullary syndrome?<div><r /></div><div>What
will e affected in medial medullary syndrome?</div> "<img src=""paste-427791
627583902.jpg"" /><div><img src=""paste-430712205344915.jpg"" /><r /><div><img
src=""paste-427813102420685.jpg"" /></div></div>"
Draw level of pons.
"<img src=""paste-427851757125965.jpg"" /><div><img src=
""paste-427886116864310.jpg"" /></div><div>(this image is flipped)<r /><div><im
g src=""paste-427864642027670.jpg"" /></div></div>"
Emotional control of expression is found with corticoular (UMN) fiers. T/F?<d
iv><r /></div><div>What is it driven y?</div> FLSE, found separate<div>driven
y limic system talking to the CN 5 + 7 motor nuclei</div>
What is the theory of the mind? Mediated y what neurons?
specific cogniti
ve capacity<div>aility to attriute mental states to oneself and others and to
understand that others have eliefs, desires, and intensions that are different
from ones own</div><div><r /></div><div>mediated y MIRROR NEURONS</div><div><
r /></div><div>autism = defects of aility to discvern what others are thinking
/feeling</div>
Draw the level of the midrain. "<img src=""paste-428208239411527.jpg"" /><div><
img src=""paste-428238304182508.jpg"" /></div>"
What happens in Dorsal Midrain parinaud syndrome?
"1) compression of aqued
uct<div>-- ostructuve hydrocephalus<div><r /></div><div>2) compression of 3/4<
/div><div>-- disturances of accommodation</div><div>-- mid-position pupils with
inaility to converge</div><div>-- patient cannot look up or down ecause verti
cal gaze control cenetered in midrain</div><div><r /></div><div><img src=""pas
te-428384333070611.jpg"" /></div><div><r /></div></div>"
"<img src=""paste-428418692809202.jpg"" /><div>What is this image showing? What
structure commonly leads to tumors in this area?</div>" neoplasm dorsal to the m
idrain compressing the midrain<div><r /></div><div>pineal gland</div>
Tumors of CN 8 occur where?<div>Most commonly from what type of cell?</div><div>
What will patient present with?&nsp;</div><div>What happens if tumor enlarges?<
/div> "occur at cereellopontine angle<div>from Schwann cells</div><div><r />
</div><div>patients may lose hearing ipsilaterally, have haring prolems</div><d
iv><r /></div><div>as tumor enlarges, may encroach ont he pons --&gt; long trac
t and cereellar inflow (middle cereellar peduncle) prolems</div><div><img src
=""paste-232392090452355.jpg"" /></div>"
What is affected in lateral inferior syndrome of the pons?<div><r /></div><div>
What is affected in medial inferior syndrome of the pons?</div> "<div>1. Medial:
CST/CBT and ML</div><div>2. V, VI, VII, VIII, MCP</div><div><r /></div><img sr
c=""paste-428676390846829.jpg"" /><div><r /></div><div><r /></div>"
What is affected in paramedian syndrome of the midrain?<div><r /></div><div>Wh
at is affected in median syndrome of the midrain?</div><div><r /></div><div><
r /></div>
"<div>Median: ML and 3/4</div><div>Paramedian: ML, STT, SCP</div
><div><r /></div><div><r /></div><img src=""paste-428925498949958.jpg"" />"
How does the medial lemniscus change in positioning of head, arms, legs througho
ut the rainstem?
1) medulla: HL vertical, man standing up drinking<div>2
) pons: horizontal, man lying down on the ground drinking</div><div>3) &nsp;mid
rain: LH, man lying on ground and police holding up legs</div>
Schloendorff vs Society of New York Hospitals """Every human eing of adult ye

ars and sound mind has a right to e down with his/her own ody""&nsp;"
What are the 2 legal aspects of reasons for informed consent? <div>Battery: Ha
rmful or offensive touching of another person without their consent. E.g., surge
ry w/o consent or eyond scope of consent.&nsp;</div><div><r /></div><div>Negl
igence: Physician failed to disclose a risk that should have een disclosed, pat
ient would not have consented had the risk een discussed, and that risk occurre
d and caused harm. &nsp;</div><div>&nsp;</div>
What 4 standards are considered when deciding on the extend of disclosure?
<div>1. Professional Practice Standard (what do most clinicians deem material/pe
rtinent?)&nsp;</div><div>2. Reasonale Patient Standard (what would a reasonal
e patient deem material pertinent?)&nsp;</div><div>3. Sujective Standard (what
would this individual patient deem material pertinent?)&nsp;</div><div>4.State
Standards (Texas Medical Disclosure Panel)&nsp;</div>
"What is a solution to the proglme of ""lack of patient understanding informati
on""&nsp;"
ask patients to repeat ack information in their own words
What is a solution to the prolem that patients do not want to make decisions?
Use decision aids and present information in a clear alanced manner
T/ F Emergency exception to informed consent should e used if it is known that
the patient would NOT want treatment
False!
Explain what therapeutic privilege is with regards to it eing an exception to i
nformed consent May withhold information when disclosure would severely harm the
patient or undermine informed decision-making
"T/F the waiver aspect of the ""Exceptions to informed consent"" entitles patien
ts to the right to actively participate in health care, ut does not force them
to"
T
What other 3 issues should e kept in mind when considering informed consent?
1. Disclosure of training status<div>2. Disclosure of other information (success
rate, history of malpractice, conflicts of interest, cost etc)</div><div>3. Rev
isiting consent (if there is an increase in risk, decrease in enefits)</div>
"<div>You are discussing the care of an elderly woman with her family. &nsp;lt
hough she is awake and alert, the patient is very ill and physically fragile. &n
sp;You are awaiting the results of a iopsy for what will likely e cancer, whi
ch has already metastasized through the ody. &nsp;The family asks that you inf
orm them first aout the results of the iopsy. &nsp;They are very loving and c
aring and are constantly surrounding the patient. &nsp;They do not want to depr
ess the patient further, and ecause there will e no hope for a cure they see n
o reason to ruin her remaining life with this information. &nsp;What should you
tell them?<span class=""pple-ta-span"" style=""white-space:pre""> </span>&ns
p;</div><div>&nsp;</div><div>You will honor their wishes.&nsp;</div><div>You a
gree with their wishes and you ask them to give you the written request.&nsp;</
div><div>You ask them to involve the hospital ethics committee.&nsp;</div><div>
You tell them you are oligated to inform the patient of the findings. &nsp;</d
iv><div>Explain to them that decision can only e made y the health care proxy&
nsp;</div><div>&nsp;</div>" You tell them you are oligated to inform the pa
tient of the findings.
"<div>In Texas, informed consent requires<span class=""pple-ta-span"" style=""
white-space:pre""> </span>&nsp;</div><div><r /></div><div><r /></div><div> T
hat the health care provider identify what information is important to the patie
nt in front of her/him and disclose that.&nsp;</div><div>B That the health care
provider disclose all remotely possile alternatives.&nsp;</div><div>C That th
e health care provider performing the procedure e the one who otains consent.&
nsp;</div><div>D That the health care provider disclose only the alternatives c
overed y the patients insurance. &nsp;</div>"
C That the health care provider
performing the procedure e the one who otains consent.&nsp;
Distinguish DMC and competence ased on&nsp;<div><r /></div><div>Determined y
:</div><div>Scope of Determination:</div><div>Scale</div><div>Presumptive for ad
ults</div><div>Possile for minors</div>
"<img src=""paste-15790447263764
3.jpg"" />"
T/ F all adult patients are considered competent unless a court has declared the
m incompetent True

{{c1::competence}} is a legal determination that is road and general<div><r />

</div><div>{{c1::capacity}} is a medical, clinical notation specific to a partic
ular situation</div>
What are 2 tools for assessing DMC
standardized mental status testing<div>M
acrthur competence tool for treatment</div>
What is ultimately used to assess DMC? Clinicial judgment and application of sl
iding scale (higher stakes decision need a greater demonstration of DMC)
How can you enhance DMC?
1. Treat underlying medical, physical, psychiatr
ic conditions<div>2. Enhance understanding, appreciation, reasoning</div><div>3.
Wait it out if possile</div>
How do mental illness and religion play a role in DMC MEntal illness is not a
homogenous category and not necessarily a contraindication to DMC<div><r /></di
v><div>Patients may refuse effective medical treatments ecause of religious el
iefs, ut must ensure that the elief is sincere</div>
If a patient is determined to lack DMC, what steps should e taken?
1. Sust
ituted judgment standard<div>2. Best Interest Standard</div><div>3. Surrogate De
cision-maker</div>
What order of surrogates should you turn to?
1. gent under medical power of
atty, or legal guardian<div>2. Spouse</div><div>3. dult Child with waiver and c
onsent of other adult children</div><div>4. majority of reasonaly availale adu
lt children</div><div>5. Parents</div><div>6. Nearest living relative/memer of
clergy/individual clearly identified to do so efore incapacitation</div><div><
r /></div>
What are the 2 standards surrogate must use?
1. sustituted jugement<div>2. 
est interest standard</div>
What can a surrogate decision maker not consent to?
voluntary inpatient ment
al health services<div>electro-convulsive treatment</div><div>appointment of ano
ther surrogate decision maker</div>
What are 2 ways to assess plausiilty? Does surrogate offer an explanation aou
t the patients eliefs and values that would support his or her decision as ei
ng in accordance with 1) the patients wishes or 2) est interest of the patient<
div><r /></div><div>Consider whether the patient, tho incapacitated is clearly
expressing resistance to the surrogates decision</div>
<div>The following are key components of decision making capacity&nsp;</div><di
v>. Understanding, ffect, Judgment, Conclusion &nsp;</div><div>B. Reasoning,
Understanding, Clarity, Insight &nsp;</div><div>C. Understanding, ppreciation,
Reasoning, Communication &nsp;</div><div>D. Reasoning, Understanding, Insight,
Communication&nsp;</div>
C
<div> 58 year old man is out of town on usiness in New York. He has a myocardi
al infarction and deteriorates despite thromolytics and angioplasty. He is intu
ated and is disoriented and unale to understand his condition. He needs a coro
nary ypass. His wife is the health-care proxy ut she is in another city. You w
ould like her consent in order to perform the surgery ecause she is the designa
ted surrogate. Which of the following is true in this case?&nsp;</div><div><r
/></div><div>. She must come to the hospital to sign consent in person.&nsp;</
div><div>B. The wife must designate a local guardian until her arrival.&nsp;</d
iv><div>C. You must repeat the angioplasty instead.&nsp;</div><div>D. Telephone
consent is only valid for minor procedures.&nsp;</div><div>E. Take consent for
the ypass over the phone and have a second person witness the telephone consen
t. &nsp;</div> E
What are social and cultural predispositions to depression? (2) 1. Cohort effect
(Steady increase in depression and suicide among certain cohort groups)<div>2.
Immigration (integration, assimilation, rejection, marginalization)</div>
What 2 diseases have the highest prevelance of depression?
Stroke and Parki
nsons
What is a must ask question of a patint once youve diagnosed him/her with major
depressive disorder and what to start treatment?
must e sure to ask pati
ent aout sustance ause if you egin pharmacological treatment of depression
"<img src=""213c35a61ada94f999df6c186ddefa281458d_Q_0.svg"" />"
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c=""213c35a61ada94f999df6c186ddefa281458d__0.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
Kodachromes La5 NervousSystem
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c=""213c35a61ada94f999df6c186ddefa281458d__1.svg"" />"
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
Kodachromes La5 NervousSystem
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
Kodachromes La5 NervousSystem
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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35a61ada94f999df6c186ddefa281458d_tmpa_ePD3.png"" />"
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35a61ada94f999df6c186ddefa281458d_source_svg.svg"" />"
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"<img src=""28e554c91976972502d517555f60dd02d10dd7_Q_8.svg""
c=""28e554c91976972502d517555f60dd02d10dd7__8.svg"" />"
54c91976972502d517555f60dd02d10dd7_source_svg.svg"" />"
54c91976972502d517555f60dd02d10dd7_tmpKFzkra.png"" />"
Kodachromes La5 NervousSystem
"<img src=""28e554c91976972502d517555f60dd02d10dd7_Q_9.svg""
c=""28e554c91976972502d517555f60dd02d10dd7__9.svg"" />"
54c91976972502d517555f60dd02d10dd7_source_svg.svg"" />"
54c91976972502d517555f60dd02d10dd7_tmpKFzkra.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_0.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__0.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_1.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__1.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_2.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__2.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_3.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__3.svg"" />"

"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""28e5
"<img src=""28e5
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc

e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_4.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__4.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_5.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__5.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_6.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__6.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_7.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__7.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_8.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__8.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""73fce084ed28de0a8d3601565492754c6a82_Q_9.svg""
c=""73fce084ed28de0a8d3601565492754c6a82__9.svg"" />"
e084ed28de0a8d3601565492754c6a82_source_svg.svg"" />"
e084ed28de0a8d3601565492754c6a82_tmpJHcRHn.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_0.svg""
c=""4350f07591c52a343f0185da8e587ea3a8714d8__0.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_1.svg""
c=""4350f07591c52a343f0185da8e587ea3a8714d8__1.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_2.svg""
c=""4350f07591c52a343f0185da8e587ea3a8714d8__2.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_3.svg""
c=""4350f07591c52a343f0185da8e587ea3a8714d8__3.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_4.svg""
c=""4350f07591c52a343f0185da8e587ea3a8714d8__4.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_5.svg""
c=""4350f07591c52a343f0185da8e587ea3a8714d8__5.svg"" />"

"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""73fc
"<img src=""73fc
/>"
"<img sr
"<img src=""4350
"<img src=""4350
/>"
"<img sr
"<img src=""4350
"<img src=""4350
/>"
"<img sr
"<img src=""4350
"<img src=""4350
/>"
"<img sr
"<img src=""4350
"<img src=""4350
/>"
"<img sr
"<img src=""4350
"<img src=""4350
/>"
"<img sr
"<img src=""4350

f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_6.svg"" />"
"<img sr
c=""4350f07591c52a343f0185da8e587ea3a8714d8__6.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_7.svg"" />"
"<img sr
c=""4350f07591c52a343f0185da8e587ea3a8714d8__7.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_8.svg"" />"
"<img sr
c=""4350f07591c52a343f0185da8e587ea3a8714d8__8.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_9.svg"" />"
"<img sr
c=""4350f07591c52a343f0185da8e587ea3a8714d8__9.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4350f07591c52a343f0185da8e587ea3a8714d8_Q_10.svg"" />"
"<img sr
c=""4350f07591c52a343f0185da8e587ea3a8714d8__10.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_source_svg.svg"" />"
"<img src=""4350
f07591c52a343f0185da8e587ea3a8714d8_tmpiusEY.png"" />"
Kodachromes La5 NervousSystem
Cereellar Peduncles: which carry info from the rainstem to/from the cereellum
?
"<img src=""paste-92444876079461.jpg"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_0.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__0.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_1.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__1.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_2.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__2.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_3.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__3.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_4.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__4.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_5.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__5.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem

"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_6.svg"" />"

"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__6.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_7.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__7.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""a76f56707ddcf94d1dad54fee86731e92f941_Q_8.svg"" />"
"<img sr
c=""a76f56707ddcf94d1dad54fee86731e92f941__8.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_source_svg.svg"" />"
"<img src=""a76f
56707ddcf94d1dad54fee86731e92f941_tmp8M9kDg.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_0.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__0.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_1.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__1.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_2.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__2.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_3.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__3.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_4.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__4.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_5.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__5.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_6.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__6.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
"<img src=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3_Q_7.svg"" />"
"<img sr
c=""c0a9fe7fc20d04dcc30a1e784f5eeedd1566aa3__7.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_source_svg.svg"" />"
"<img src=""c0a9
fe7fc20d04dcc30a1e784f5eeedd1566aa3_tmpfgc_mt.png"" />"
La5 NervousSystem
What are the 4 layers of the cereellum?<div><r /></div><div>What is contained
in each layer?</div>
"Molecular: Parallel fiers (Dendrites of Purkinje Cells
)<div>Purkinje: Purkinje nuclei</div><div>Granular: Granular nuclei</div><div>De
ep Nuclei: white matter aove 4th ventricle</div><div><div>-Fastigial (medial, d
eep in the vermis)</div><div>-Dentate (lateral in the hemisphere)</div><div>-Vest

iular (lateral wall of 4th ventricle)</div></div><div><r /></div><div><img src=

""paste-107825153966611.jpg"" /></div>" La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_0.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__0.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_1.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__1.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_2.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__2.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_3.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__3.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_4.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__4.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_5.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__5.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_6.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__6.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
"<img src=""fa6389899758dc7c6935f25e32defcd054c016_Q_7.svg"" />"
"<img sr
c=""fa6389899758dc7c6935f25e32defcd054c016__7.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_source_svg.svg"" />"
"<img src=""fa63
89899758dc7c6935f25e32defcd054c016_tmpjiT9hJ.png"" />"
La5 NervousSystem
How is the medial lemniscus organized? "<img src=""paste-176617645146378.jpg""
/><div><r /></div><div>Homunnccuuuullluuussss</div><div><r /></div><div>Eviden
tly this is Latin for ""little man.""</div><div><r /></div><div>Who knew? Who c
ared? Now you do.&nsp;</div><div><r /></div><div>BM, HONORS.&nsp;</div>"
La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_0.svg"" />"
"<img sr
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__0.svg"" />"
"<img src=""2e3e
"<img src=""2e3e
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_1.svg"" />"
"<img sr
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__1.svg"" />"
"<img src=""2e3e
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
"<img src=""2e3e
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_2.svg"" />"
"<img sr
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__2.svg"" />"
"<img src=""2e3e
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
"<img src=""2e3e

ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_3.svg""
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__3.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_4.svg""
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__4.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_5.svg""
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__5.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_6.svg""
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__6.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""2e3eca589e6ad5a245fd28973aa0799a233c8_Q_7.svg""
c=""2e3eca589e6ad5a245fd28973aa0799a233c8__7.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_source_svg.svg"" />"
ca589e6ad5a245fd28973aa0799a233c8_tmpw2OtZg.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_0.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__0.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_1.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__1.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_2.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__2.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_3.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__3.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_5.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__5.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_6.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__6.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""cf7fc4596f97852e0c6ec60f062668f616ae3_Q_7.svg""
c=""cf7fc4596f97852e0c6ec60f062668f616ae3__7.svg"" />"
c4596f97852e0c6ec60f062668f616ae3_source_svg.svg"" />"

/>"
"<img sr
"<img src=""2e3e
"<img src=""2e3e
/>"
"<img sr
"<img src=""2e3e
"<img src=""2e3e
/>"
"<img sr
"<img src=""2e3e
"<img src=""2e3e
/>"
"<img sr
"<img src=""2e3e
"<img src=""2e3e
/>"
"<img sr
"<img src=""2e3e
"<img src=""2e3e
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f
/>"
"<img sr
"<img src=""cf7f
"<img src=""cf7f

c4596f97852e0c6ec60f062668f616ae3_tmp_y62G.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_0.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__0.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_1.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__1.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_2.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__2.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_3.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__3.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_4.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__4.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_5.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__5.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_6.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__6.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_7.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__7.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_8.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__8.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""29433a06fe2f47de2dedcf90e6a42a09e8699_Q_9.svg""
c=""29433a06fe2f47de2dedcf90e6a42a09e8699__9.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_source_svg.svg"" />"
3a06fe2f47de2dedcf90e6a42a09e8699_tmpT8kp8X.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_0.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__0.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_1.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__1.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"

/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""2943
"<img src=""2943
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49

030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_2.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__2.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_4.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__4.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_5.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__5.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_6.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__6.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_7.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__7.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_8.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__8.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""fe49030606ee4276d740d708719ceffcda7070_Q_9.svg""
c=""fe49030606ee4276d740d708719ceffcda7070__9.svg"" />"
030606ee4276d740d708719ceffcda7070_source_svg.svg"" />"
030606ee4276d740d708719ceffcda7070_tmpOsNDNZ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_0.svg""
c=""f2fc92e67dcd7e0802151df994ea12c05acf__0.svg"" />"
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_1.svg""
c=""f2fc92e67dcd7e0802151df994ea12c05acf__1.svg"" />"
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_2.svg""
c=""f2fc92e67dcd7e0802151df994ea12c05acf__2.svg"" />"
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_3.svg""
c=""f2fc92e67dcd7e0802151df994ea12c05acf__3.svg"" />"
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_4.svg""
c=""f2fc92e67dcd7e0802151df994ea12c05acf__4.svg"" />"
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"

/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""fe49
"<img src=""fe49
/>"
"<img sr
"<img src=""f2fc
"<img src=""f2fc
/>"
"<img sr
"<img src=""f2fc
"<img src=""f2fc
/>"
"<img sr
"<img src=""f2fc
"<img src=""f2fc
/>"
"<img sr
"<img src=""f2fc
"<img src=""f2fc
/>"
"<img sr
"<img src=""f2fc
"<img src=""f2fc

92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_5.svg"" />"
"<img sr
c=""f2fc92e67dcd7e0802151df994ea12c05acf__5.svg"" />"
"<img src=""f2fc
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
"<img src=""f2fc
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_6.svg"" />"
"<img sr
c=""f2fc92e67dcd7e0802151df994ea12c05acf__6.svg"" />"
"<img src=""f2fc
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
"<img src=""f2fc
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""f2fc92e67dcd7e0802151df994ea12c05acf_Q_7.svg"" />"
"<img sr
c=""f2fc92e67dcd7e0802151df994ea12c05acf__7.svg"" />"
"<img src=""f2fc
92e67dcd7e0802151df994ea12c05acf_source_svg.svg"" />"
"<img src=""f2fc
92e67dcd7e0802151df994ea12c05acf_tmpKn4BuH.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_0.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__0.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_1.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__1.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_2.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__2.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_3.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__3.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_4.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__4.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_6.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__6.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_7.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__7.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""87a9dc7461a497670f08952d02dc6004015d1f_Q_8.svg"" />"
"<img sr
c=""87a9dc7461a497670f08952d02dc6004015d1f__8.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_source_svg.svg"" />"
"<img src=""87a
9dc7461a497670f08952d02dc6004015d1f_tmpWkkERQ.png"" />"
Kodachromes La5 NervousSystem
"Identify the location of a medial and lateral medullary syndrome. Which is the
most common?<div><img src=""paste-388222093885695.jpg"" /></div>"
"Lateral
medullary is the most common.<div>Lots get Lateral!<r /><div><img src=""paste-

388209208983851.jpg"" /></div><div><r /></div></div>" La5 NervousSystem

"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_0.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__0.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_1.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__1.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_2.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__2.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_3.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__3.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_4.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__4.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_5.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__5.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_6.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__6.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_7.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__7.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_8.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__8.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""e29e1229a0d676ea4818c9e77213aa4934ac_Q_9.svg"" />"
"<img sr
c=""e29e1229a0d676ea4818c9e77213aa4934ac__9.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_source_svg.svg"" />"
"<img src=""e29e
1229a0d676ea4818c9e77213aa4934ac_tmpg1vsOk.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_0.svg"" />"
"<img sr
c=""32810e7cf6e568657d0c22edc0146fcde30e__0.svg"" />"
"<img src=""3281
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
"<img src=""3281
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_1.svg"" />"
"<img sr
c=""32810e7cf6e568657d0c22edc0146fcde30e__1.svg"" />"
"<img src=""3281
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
"<img src=""3281
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"

Kodachromes La5 NervousSystem

"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_2.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__2.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_3.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__3.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_4.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__4.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_5.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__5.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_6.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__6.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_7.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__7.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_8.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__8.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""32810e7cf6e568657d0c22edc0146fcde30e_Q_9.svg""
c=""32810e7cf6e568657d0c22edc0146fcde30e__9.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_source_svg.svg"" />"
0e7cf6e568657d0c22edc0146fcde30e_tmpRSPi8H.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_0.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__0.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_1.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__1.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_2.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__2.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_3.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__3.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"

/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""3281
"<img src=""3281
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0

Kodachromes La5 NervousSystem

"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_4.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__4.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_5.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__5.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_6.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__6.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4a0c0cc15fc1c5d908d04c22e21096f342fa_Q_7.svg""
c=""4a0c0cc15fc1c5d908d04c22e21096f342fa__7.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_source_svg.svg"" />"
c0cc15fc1c5d908d04c22e21096f342fa_tmpPERUht.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_0.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__0.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_1.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__1.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_2.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__2.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_3.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__3.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_4.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__4.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_5.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__5.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""667d96e44ff7ecc2cd9233f374434ae2963e7e_Q_6.svg""
c=""667d96e44ff7ecc2cd9233f374434ae2963e7e__6.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_source_svg.svg"" />"
96e44ff7ecc2cd9233f374434ae2963e7e_tmpfgE2BI.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_0.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__0.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"

/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""4a0
"<img src=""4a0
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""667d
"<img src=""667d
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2

Kodachromes La5 NervousSystem

"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_1.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__1.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_2.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__2.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_3.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__3.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_4.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__4.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_5.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__5.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_6.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__6.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_7.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__7.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_8.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__8.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""d4d24359f940e812a7e42f3d0493480ac7ee518_Q_9.svg""
c=""d4d24359f940e812a7e42f3d0493480ac7ee518__9.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_source_svg.svg"" />"
4359f940e812a7e42f3d0493480ac7ee518_tmp6fXC9k.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_0.svg""
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__0.svg"" />"
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_1.svg""
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__1.svg"" />"
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_2.svg""
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__2.svg"" />"
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"

/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""d4d2
"<img src=""d4d2
/>"
"<img sr
"<img src=""a281
"<img src=""a281
/>"
"<img sr
"<img src=""a281
"<img src=""a281
/>"
"<img sr
"<img src=""a281
"<img src=""a281

Kodachromes La5 NervousSystem

"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_3.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__3.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_4.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__4.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_5.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__5.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_6.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__6.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_7.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__7.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_8.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__8.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_9.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__9.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_10.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__10.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""a2814f834636a24367f0f4292a6f75e3d888fa69_Q_11.svg"" />"
c=""a2814f834636a24367f0f4292a6f75e3d888fa69__11.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_source_svg.svg"" />"
"<img
4f834636a24367f0f4292a6f75e3d888fa69_tmpZx2rjW.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_0.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__0.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_1.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__1.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_2.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__2.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"

"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""a281
src=""a281
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2

Kodachromes La5 NervousSystem

"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_3.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__3.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_4.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__4.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_5.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__5.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_6.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__6.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_7.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__7.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_8.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__8.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_9.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__9.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_10.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__10.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_11.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__11.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""4ec2413847d7d8d29ec53512633d4e451f7cc0e_Q_12.svg"" />"
c=""4ec2413847d7d8d29ec53512633d4e451f7cc0e__12.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_source_svg.svg"" />"
"<img
413847d7d8d29ec53512633d4e451f7cc0e_tmp2BQyJ.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_0.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__0.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_1.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__1.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"

"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""4ec2
src=""4ec2
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199

Kodachromes La5 NervousSystem

"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_2.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__2.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_3.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__3.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_4.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__4.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_5.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__5.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_6.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__6.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_7.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__7.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_8.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__8.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_9.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__9.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_10.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__10.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_11.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__11.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_12.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__12.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_13.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__13.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"

"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199

Kodachromes La5 NervousSystem

"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_14.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__14.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_15.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__15.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_16.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__16.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""3199651087a302c940c01f2c51cddd0e89758658_Q_17.svg"" />"
c=""3199651087a302c940c01f2c51cddd0e89758658__17.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_source_svg.svg"" />"
"<img
651087a302c940c01f2c51cddd0e89758658_tmpO5sYe.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_0.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__0.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_1.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__1.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_2.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__2.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_3.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__3.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_4.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__4.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_5.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__5.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_6.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__6.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_7.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__7.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"

"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""3199
src=""3199
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d

Kodachromes La5 NervousSystem

"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_8.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__8.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_9.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__9.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_10.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__10.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_11.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__11.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_12.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__12.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_13.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__13.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""245d3049cd5cc67e76c3aa6783c94d10f38ee74_Q_14.svg"" />"
c=""245d3049cd5cc67e76c3aa6783c94d10f38ee74__14.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_source_svg.svg"" />"
"<img
3049cd5cc67e76c3aa6783c94d10f38ee74_tmpmvRKX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_0.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__0.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_1.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__1.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_2.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__2.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_3.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__3.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_4.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__4.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"

"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""245d
src=""245d
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac

Kodachromes La5 NervousSystem

"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_5.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__5.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_6.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__6.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_7.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__7.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_8.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__8.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_9.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__9.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_10.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__10.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_11.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__11.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_12.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__12.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_13.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__13.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_14.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__14.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""6ac682c859197d5ad79f3dc258cf2203d2f0e_Q_15.svg"" />"
c=""6ac682c859197d5ad79f3dc258cf2203d2f0e__15.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_source_svg.svg"" />"
"<img
682c859197d5ad79f3dc258cf2203d2f0e_tmpTadPyY.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_0.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__0.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"

"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""6ac
src=""6ac
"<img sr
src=""125c
src=""125c

Kodachromes La5 NervousSystem

"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_1.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__1.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_2.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__2.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_3.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__3.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_4.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__4.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_5.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__5.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_6.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__6.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_7.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__7.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_8.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__8.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_9.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__9.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_10.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__10.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_11.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__11.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"
Kodachromes La5 NervousSystem
"<img src=""125cd909c2a80955e3d89992f49e8dc56f4_Q_12.svg"" />"
c=""125cd909c2a80955e3d89992f49e8dc56f4__12.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_source_svg.svg"" />"
"<img
d909c2a80955e3d89992f49e8dc56f4_tmpn5KX.png"" />"

"<img sr
src=""125c
src=""125c
"<img sr
src=""125c
src=""125c
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Kodachromes La5 NervousSystem

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Kodachromes La5 NervousSystem
"Identify the location of medial and lateral inferior syndrome in the pons.&nsp
;<div><img src=""paste-388282223427838.jpg"" /></div>" "<img src=""paste-388269
338525959.jpg"" />"
La5 NervousSystem
"Identify the location of median and paramedian syndrome in the midrain.<div><i
mg src=""paste-388376712708348.jpg"" /></div>" "<img src=""paste-38832087813350
0.jpg"" />"
La5 NervousSystem
Descrie classical presentation for Pertussis 1. Catarrhal Stage-URI w/out fev
er<div>2. Paroxysmal cough (staccatoed) followed y whoop (or gasping inhalation
) and post-tussive emesis. Lasts 2-3 weeks.</div><div>3. Convalescent phase-lowe
r frequency of paroxysms with dry cough. Lasts 3 months.</div>
One of the main reasons Pertussis is on the rise
Waning immunity-vaccines
give you 5 or 6 years of protection
charcoal agar supplemented with 10% horse lood and cephalexin <div>&nsp;Regan
Lowe agar</div><r><r>ordatella
lthough acteria die, toxins re
What causes prolonged timeline of pertussis
main
Following infection, antiodies develop to many B. pertussis antigens, including
:
PT, FH, PRN, FIM, Cya, and LOS
T or F: Pertussis stays only in upper airway
"F: can trave to smaller airways
including alveoli<div><img src=""paste-12906376725086.jpg"" /></div>"
Descrie the treatment of Pertussis
"<img src=""paste-12949326397988.jpg"" /
>"
What are the gram negative facultative anaeroes? (9) "Enteroactericiae:<div>
<r /></div><div><font color=""#ff1d1a"">1. E Coli</font></div><div><font color=

""#ff1d1a"">2. Klesiella</font></div><div><font color=""#ff1d1a"">3. Enteroact

er</font></div><div><font color=""#ff1d1a"">4. Serratia</font></div><div><font c
olor=""#ff1d1a"">5. Yersinia&nsp;</font></div><div><font color=""#ff1d1a"">6. S
higella</font></div><div><font color=""#ff1d1a"">7. Proteus, morganella, provide
ncia</font></div><div><font color=""#ff1d1a"">8. Citroacter</font></div><div><f
ont color=""#ff1d1a"">9. Salmonella</font></div>"
<>What are the gram negative cocci ?</>
"<font color=""#a71e1d""><>Ness
eria</></font><div><font color=""#a71e1d""><>Moraxella (diplococci)</></font>
</div>"
What are the gram negative coccoacilli?
"<font color=""#a21ea7""><>Haem
ophilus Influenza</></font><div><font color=""#a21ea7""><>Bordatella</></font
></div><div><font color=""#a21ea7""><>Brucella</></font></div><div><font color
=""#a21ea7""><>Fraciella</></font></div><div><font color=""#a21ea7""><>Pastru
ella</></font></div>"
What are the gram negative curved rods? "<font color=""#480c4a""><>1. C Jejuni<
/></font><div><font color=""#480c4a""><>2. H Pylori</></font></div><div><font
color=""#480c4a""><>3. Virio chloera</></font></div>"
What two actreia do not exhiit gram staining? Mycoplasm<div>Ureplasma</div>
T or F: Neisseria is an intracellular acteria T
"Name pathology and causative agent<div><img src=""paste-14504104558954.jpg"" />
</div>" "<img src=""paste-14559939133911.jpg"" />"
Why do we see more N Meningitidis infections in winter concomitant viral diseas
e increases susceptiility to the acteria. N. meningitidis could have een ther
e (colonization) or can e newly acquired.
2 specific patient populations susceptile to recurrent N. Meningitidis asplenic
or non-complement forming patients
Descrie diagnosis of N. meningitidis "<img src=""paste-16011638079972.jpg"" /
>"
Treatment of N. meningitidis infection: Most are penicillin susceptile (ut sho
uld susceptiility test); use 3rd gen cephalosporins.<div><r /></div><div>Suppo
rtive care.</div>
T or F: N. gonorrea is not invasive
F: is an invasive disease
Male and female presentations of gonorrhea
<div>Males: gonorrhoea (urethrit
is), epididymitis</div><div>Females: Often asymptomatic; vaginitis, urethritis, e
ndocervicitis, artholinitis, salpingitis, PID, perihepatitis (Fitz-Hugh-Curtis
syndrome), arthritis dermatitis syndrome</div><div><div>Both genders: pharyngiti
s, proctitis</div></div><div><r /></div>
Presentation of gonorrhea in neonates. Route of transmission? <div>Neonates: c
onjunctivitis, soft tissue ascess, arthritis, acteremia and sepsis</div><div><
r /></div><div>Vertically: mom to ay</div>
N. gonorrhea:&nsp;Bacteria penetrate through the columnar epithelium of urethra
via {{c1::parasite-mediated endocytosis}}<div><r /></div>
T or F: Gonorrhea does not involve exotoxin release
T
Who is susceptile to more systemic consequences of gonorrhea asplenic and non
-complement forming pt.
Treatment of N gonorrhea
Penicillin resistant-use ceftriaxone. Should e
susceptiility tested. Route/duration of Rx depends on clinical syndrome.
Preventive measures taken to prevent vertical transmission of gonorrhea <div>Neo
natal conjunctivitis is preventale y screening and treatment of mothers. Infan
t eye drops (1% silver nitrate, 1% tetracycline, or 0.5% erythromycin) alone do
not treat estalished infection.</div><div><r /></div>
Disease epidemic in former Soviet Union in 90s and in developing countries
Diphtheria
<div>Clu shaped, nonmotile, noncapsulated acillus; Chinese letters or V and L pa
lisades formed y daughter cells that are attached after cell division</div><div
>. Gram positive, ut may e Gram variale in smears from specimens.</div><div>
c. Metachromatic granules (polymetaphoshate) visile when stained with methylene
Diptheria
lue. NO SPORES.</div><div><r /></div>
Organism is fastidious - &nsp;requires nicotinic acid, pantothenic acid and oth
er vitamins to grow;&nsp;Resistant to and reduces potassium tellurite (cystine-

tellurite lood agar): Black colonies (tellurite inhiits other respiratory flor
a like Strep). No hemolysis.
Diphtheria
Pseudomemranes formed in mouth, pharynx, larynx can lead to death y suffocatio
n, ut toxic effect on heart are usual cause of death Diphtheria
"Bacteria that causes ""Bull Neck"" (adenopathy and edema)"
Diphtheria
Sore throat, low grade fever, pseudomemranes in throat, cardiac, neurologic and
cutaneous symptoms
Diphtheria
Which diphtheria vaccine do you give for each age group (children, adolescents,
and adults)
: DTaP (diphtheria-tetanus-acellular pertussis) contains diphthe
ria toxoid for children, Tdap (contains  of infant dose of diphtheria toxoid) for
adolescents and adults, and Td (tetanus diphtheria toxoids) for wound managemen
t and every 10 years in adults through lifetime talk aout the differnces etwee
n each
Food orne pathogens that shows up in sporadic outreaks in susceptile populati
ons int he US (immunocompromised, elderly)
Listeria mono
"<div>gram positive, clu shaped acillus Is tellurite resistant, catalase posit
ive,&nsp;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> <
/span>Can multiply in cold temperatures at 4C (from 1000 to 108 cfu in 8 weeks),
weakly hemolytic, motile</div><div><r /></div>"
Listeria monocytogenes
T/F Listeria invades epithelial cells and reaches the loodstream causing acter
emia
True
T/F antiodies against Listeria confer protection
False -&nsp;<div>Need T
cell mediated immunity - if compromised Listeria can multiply in macrophages e
cause it is a facultative intracellular pathogen</div>
"Sepsis like syndrome - potentially fatal in neonates - 2 phases<div><div><span c
lass=""pple-ta-span"" style=""white-space:pre""> </span>Early onset (&lt;6 day
s): usually leads to sepsis, acteremia, characteristic rash</div><div><span clas
s=""pple-ta-span"" style=""white-space:pre""> </span>Late onset (&gt;6 days):
usually leads to meningitis</div></div><div><r /></div>"
Perinatal lister
iosis (Listeria monocytogenes)
What are the laoratory diagnosis methods for Listeria? "<div>1.<span class=""p
ple-ta-span"" style=""white-space:pre""> </span><>Isolation of organism from n
ormally sterile lood,</> spinal fluid or skin lesions;</div><div>2.<span class
=""pple-ta-span"" style=""white-space:pre""> </span>Motile at 22 ut not 37C</di
v><div>3.<span class=""pple-ta-span"" style=""white-space:pre""> </span>Cold e
nrichment (incuate 4 weeks to 6 months at 4C)</div><div>4.<span class=""pple-ta
-span"" style=""white-space:pre""> </span><>PCR</> and immunofluorescence met
hods</div><div><r /></div><div><r /></div><div><r /></div><div>&nsp;Gram sta
in: Often dismissed as a contaminant, must track down diphtheroid</div><div><span
class=""pple-ta-span"" style=""white-space:pre""> </span>Serology is unrelial
e</div><div><r /></div>"
What drug can you not give for a Listeria infection?
Cephalosporins - and a f
ew other Beta-lacatams<div>Listeria lacks the Penicillin inding protein target&
nsp;</div>
Methods of preventing listeria infection?
Pasteurize dairy food, and prope
r food handling! - do not give to pregnant women and immunocompromised!<div><r
/></div><div>There is no vaccine - BECUSE NTIBODIES RE USELESS - rememer T c
ell dependent immunity for Listeria</div>
"<div><span class=""pple-ta-span"" style=""white-space:pre""> </span>Spore-for
ming, encapsulated Gram-positive. Staining can e Gram variale;&nsp;Cells grow
in long, end-to-end chains. Unlike most other acilli, this acteria is NON-MOT
ILE - NO HEMOLYSIS and susceptile to penicillin</div><div><r /></div>"
Bacillus anthracis
Descrie the mechanism of action of the tripartite of B. anthracis
"<div>Tr
ipartite Toxin is on pOX1: 2 TOXIC + 1 BINDING SUBUNIT</div><div><span class=""p
ple-ta-span"" style=""white-space:pre""> </span>Lethal Factor (LF):<span class=
""pple-ta-span"" style=""white-space:pre""> </span>metalloprotease that cleave
s MPKK and causes macrophages to release cytokines such as TNF that induce shock
&nsp;</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span
>Edema Factor (EF): CaM-dependent adenyl cyclase cMP; &nsp;edema in cutaneous

tissue</div><div><span class=""pple-ta-span"" style=""white-space:pre""> </span

>Protective ntigen (P): Receptor inding and EF/LF transport&nsp;</div><div><
r /></div><div><>No activity of either EF or LF in the asence of P (Binding
moiety)&nsp;</></div><div><r /></div>"
What sustance is generally used as a vaccine for B. anthracis injected Recepto
r inding protein (P) needed for EF/LF transport<div><r /></div><div>exists as
either the</div><div>- nthrax vaccine adsored form</div><div>- recominant P
</div><div>- ttenuated Live form</div><div><r /></div><div>Treatment for anthr
ax also uses P inhiitors - such as antiodies or small molecule inhiitors aga
inst P</div>
"<div><span class=""pple-ta-span"" style=""white-space:pre""> </span>spore-for
ming, <>non-encapsulated</>, Gram-positive acillus.&nsp;</div><div>Spores ar
e resistant to dry heat, radiation, disinfectants and dessication</div><div>Colo
nies are hemolytic&nsp;</div><div><span class=""pple-ta-span"" style=""whitespace:pre""> </span>Organism is <>motile</></div><div>&nsp;<>resistant to pe
nicillin</></div><div>secretes lecithinase</div>"
Bacillus cereus<div><r
/></div><div>lecithinase: cleaves lipids (destroys ocular memrane)</div><div>he
molysis is from the toxin</div><div><r /></div>
T/F You need to treat B. cereus GI symptoms with cephalosporin antiioitcs
False<div><r /></div><div>GI disease in B. cereus is self limiting</div><div><
r /></div><div><r /></div>
What are the gram positive cocci?
"<font color=""#7227a7"">Staph</font><di
v><font color=""#7227a7"">Strep</font></div>"
What are the 3 gram negative, aeroic acilli? "<font color=""#0000ff"">1. Pseu
domona</font><div><font color=""#0000ff"">2. Legionella</font></div><div><font c
olor=""#0000ff"">3. Bartonella&nsp;</font></div>"
What are the gram positive non spore forming acteria? (aeroic and anaeroic)
Coryneacterium Diptheria<div>Listera Monocytogenes</div><div><r /></div><div>T
ropheryma Whipplei</div><div>Erysipelothrix Rhusiopathiae</div><div><r /></div>
<div>ctinomyces</div><div>propioniacterium</div><div>Lctoacillus</div><div>B
ifidoacterium</div>
What are the spore forming gram positive acilli
1. Bacillus (anthracis a
nd cereus)<div>2. Clostridium (tetani, perfringens, difficile, otulinum)</div>
What are the gram negative cocci?
1. Neisseria<div>2. Moraxella</div>
What are the 2 somatic upper motor neuron pathways?&nsp;
Corticoular from the cortex to cranial nerve nuclei<div>Corticospinal - cortex to ventral ho
rn of spinal cord</div>
The lower motor neuron pathway generally involve what two systems?
Nuclei i
n rainstem<div>Ventral horn of spinal cord</div>
What nuclei in the rainstem are involved in parasympathetic (or other autonomic
)innervation in the ody (5) <div><>Nuclei of rainstem</>&nsp;</div><div>
Edinger-Westphal (midrain) to III</div><div>Superior salivatory (lower pons) to
VII&nsp;</div><div>Inferior salivatory (medulla) to IX</div><div>Nucleus amig
uus of X (medulla) to heart</div><div>Dorsal motor nucleus of X (medulla) to lun
gs and GIT&nsp;</div><div><r /></div>
What are the presynaptic autonomic nuclei for visceral autonomics? In what spina
l levels are they in - think parasympathetics and sympathetics? <div>Intermediol
ateral IML cell column of spinal cord T1- L2 (sympathetics)</div><div><div>Inter
mediolateral IML cell column of S2, S3, S4 (para)</div></div><div><r /></div>
What are the different postsynaptic ganglia for the sympathetic and parasympathe
tic nervous system?<div><r /></div><div>Head and neck?</div><div>spinal cord (2
)</div><div>gland</div> <div>Ciliary, Otic, Pterygopalatine, and Sumandiular g
anglia</div><div>Paraverteral ganglia of sympathetic chain to vasculature and g
lands of periphery</div><div>Preverteral ganglia (celiac, superior mesenteric,
Inferior mesenteric) to gut tue</div><div>drenal medulla</div><div><r /></div
>
What are the receptor types on the ganglia for the parasympathetic nervous sytem
? What receptor types are found on the final target?
<div>Nicotinic at presyn
aptic terminals &nsp;and adrenal medulla</div><div>Muscarinic at postsynaptic t
erminals (effector organs cells)&nsp;</div><div>cardiac-decreases heart rate</d

iv><div>In eye constriction, accommodation</div><div>in exocrine glands - lacrim

al, salivary, gut tue and sweat glands</div><div><r /></div>
Descrie the aroreceptor reflex - how it triggers radycardia "1) Baroreceptor
s excites Nucleus tractus solitarius (NTS)- &nsp;(release glutamate on NTS)<div
>2) NTS projects motor fiers to nucleus amiguus - which send motor fiers to d
ecrease heart rate</div><div><r /></div><div>NTS - also needs to inhiit sympat
hetic outflow</div><div>- NTS sends another fier to the Caudal Ventrolateral Me
dulla (CVLM)&nsp;</div><div>- CVLM sends inhiitory signals (GB) to the RVLM
(Rostral ventrolateral medulla)&nsp;</div><div>&nsp;RVLM normally stimulates t
he IML (for sympathetics) ut now the CVLM fiers will inhiit the RVLM - result
s in decrease vasoconstriction and decreased lood pressure and heart rate</div>
<div><r /></div><div><img src=""paste-31306016621110.jpg"" /></div>"
Injection of capsaicin into the heart causes stimulated of what?
small di
ameter pain fiers in the Vagus nerve
What reflex is triggered when you inject capsaicin into the heart?
"Cardiop
ulmonary Reflex - &nsp;Injection of capsaicin into heart of experimental animal
s causes stimulation of small diameter pain fiers in Vagus. This &nsp;results
in radycardia, hypotension and apnea via pathways identical to &nsp;arorecept
or reflex ( see elow)<div><r /></div><div><img src=""paste-31417685770978.jpg"
" /></div>"
Which nuclei do the afferent signals from the aro and chemoreceptors go to? (e
specific) Where are they located?
Medial and commisural sunuclei of NTS (
nucleus of solitary tract)<div><r /></div><div>Located in the caudal floor of 4
th ventricle</div>
What are the results (3) of the chemoreceptor reflex when you have high CO2, low
O2, or high H+ in the lood? Increase lood pressure&nsp;<div>Bradycardia</d
iv><div>Increased respiration</div>
descrie the mechanism of the chemoreceptor reflex when you have high CO2, low O
2, or high H+ in the lood?
"<div><div><div><>Increase lood pressure</></
div><div>Carotid ody afferents terminate in<> commisural sunucleus</> of NTS
(nucleus of solitary tract)&nsp;</div><div>NTS <>excites</> &nsp;rVLM (rost
ral ventrolateral medullary pressor area)&nsp;</div><div>rVLM excites IML (inte
rmediolateral cell column of spinal cord)</div><div>IML presynaptic sympathetic
neurons increases lood pressure.</div></div></div><div><r /></div><div>NO INVO
LVEMENT OF CVLM HERE!</div><div><r /></div><div><div><>Bradycardia</></div><d
iv>Chemoreceptors stimulate NTS</div><div>NTS excites nucleus amiguus</div><div
>Nucleus amiguus fiers of Vagus slow down heart rate</div><div><r /></div><di
v><r /></div><div><r /></div><div><>Increased respiration:</></div><div>Chem
oreceptors stimulate NTS</div><div>NTS excites of rVRG (rostral ventral respirat
ory group)</div><div>rVRG excites PMN phrenic motor nucleus&nsp;</div><div>PMN
increases activity of the respiratory diaphragm.&nsp;</div><div><r /></div><di
v><img src=""paste-31997506355786.jpg"" /></div><div><r /></div></div><div><r
/></div><div><r /></div>"
Why would the chemical composition of the lood affect heart rate?
Blood ch
emistry is determined, to a large extent, y the concentrations of gases in the
lood. <>High caron dioxide concentrations and low oxygen concentrations</> 
oth indicate that <>gas exchange is occurring at a slower than ideal rate</>.
The low rate of gas exchange could e due to rapid metaolism or to a low concen
tration of oxygen in the external environment. <>By monitoring lood chemistry
the ody is ale to increase the heart rate and the rate of gas exchange to comp
ensate</>. Similarly, if the oxygen concentration is high or the caron dioxide
concentration is low then the heart rate can slow down to conserve energy.
T/F - CVLM inhiits the RVLM in the chemoreceptor reflex
False
What is the function&nsp;of rVLM (rostral ventrolateral medullary pressor area)
&nsp;<div><r /></div> <div>rVLM excites IML (intermediolateral cell column) pr
esynaptic sympathetic neurons - which causes vasoconstriction, and increases lo
od pressure</div><div><r /></div>
What is the role of the Nucleus amiguus in the aroreceptor and chemoreceptor r
eflex? <div>Nucleus amiguus fiers of Vagus slow down heart rate</div><div><r
/></div>

What is the function of the&nsp;rVRG (rostral supart of Ventral Respiratory Gr

oup)<div><r /></div> rVRG stimulates the PMN (phrenic motor nucleus) - increa
ses the activity of respiratory diaphragm
What is the function of the Dorsal respiratory group (DRG)?<div><r /></div>
Sensory! - receives afferent from pulmonary stretch receptors
What are the 3 main respiratory groups? "Dorsal respiratory group (sensory)<div>
Ventral respiratory group (motor) - lots of different sugroups</div><div>Pneumo
taxic center - considered vital for maintaining normal reathing pattern</div><d
iv><r /></div><div><img src=""paste-33638183862760.jpg"" /></div>"
What are the different sugroups (4) of the VRG and what are the functions of ea
ch?
"<div>cVRG caudal part mostly expiratory neurons</div><div><>rVRG rostr
al part mostly inspiratory neurons exhiits a urst pattern of activity (to PMN)
- most important in chemoreceptor and aroreceptor reflexes</></div><div>Botzi
nger complex (rostral to rVRG) mostly expiratory neurons</div><div>Pre-Botzinger
complex implicated as site of respiratory rhythm generation</div><div><r /></d
iv><div><img src=""paste-33642478830056.jpg"" /></div>"
What nucleus is located in the ventral horn of C3,4, and 5?
"Phrenic motor n
ucleus<div><r /></div><div><img src=""paste-33492154974870.jpg"" /></div>"
Where is the pneumotaxic center?
"dorsolateral pontine tegmentum - just c
audal to inferior colliculus in midrain<div><r /></div><div><img src=""paste-3
3496449942166.jpg"" /></div>"
<div>defined as prolematic decrease in lood pressure (decrease in p greater t
han 20 mm Hg and increase in heart rate more than 10 eats /min) as a result of
standing up.</div><div><r /></div>
Orthostatic hypotension<div><r /></div>
<div><div>In order to comat getting dizzy when standing up rapidly, the ody no
rmally increases sympathetic activity (aroreceptor reflex) and lood plasma lev
els of norepinephrine. This should cause vasoconstriction and increasing lood p
ressure.&nsp;</div></div><div><r /></div>
What prolems are associated with orthostatic hypotension as a result of sympath
etic nerve damage? (3) Diaetes<div>Syphilis</div><div>utonomic insufficiency
-&nsp;may also fail to have normal norepinephrine increases in plasma levels as
well as orthostatic hypotension. &nsp;</div><div><r /></div>
What is a side effect of sympatholytic drugs used to treat systemic hypertension
?
Orthostatic hypotension<div><r /></div><div>cessation of meds should ge
t rid of the side effect</div>
Symptoms of Horners syndrome? (4)
<div>Ptosis - (slight) of upper eyelid</
div><div>Miosis- pupillary constriction</div><div>nhidrosis loss of sweating to
at least half of face</div><div>Flushed appearance loss of vasoconstriction</div>
<div><r /></div>
<div>interruption of pathway to IML (intermediolateral cell column of spinal cor
d (lesions of hypothalamus, tegmentum, medulla, and cervical spinal cord), multi
ple sclerosis, or Pancoast tumor of the lung could lead to what condition?</div>
Horners syndrome
What are Pancoast tumors? What condition could it lead to and how?
<div>Pan
coast <>tumors</> are located in the <>apex of the lung</>. They may <>inva
de</> surrounding tissues including the <>stellate ganglion</> of the sympath
etic chain. This would interrupt the sympathic pathways to the head and therefor
e produce <>Horners syndrome.</>&nsp;</div><div><r /></div>
Failure of developing the myenteric plexus in the hindgut can lead to what?&nsp
;
Hirschsprungs Megacolon - lack of peristalsis and consequent distention
Spasmodic vasoconstriction of hands and feet as a response to cold or stress can
lead to what phenomenon?
"Raynauds phenomenon<div><r /></div><div><img
src=""paste-34664681046374.jpg"" /></div>"
Lesion of which nucleus will lead to unopposed pupillary dilation?
"Edinger
westphal nucleus (Parasympathetic nucleus of oculomotor nerve)<div><r /></div>
<div>pathway -&nsp;</div><div><r /></div><div>Edinger westphal - neuron goes a
nd synapses with the ciliary ganglion - short ciliary fiers cause pupil constri
ction normally</div><div><r /></div><div>Opposing actions starts at superior ce
rvical ganglion (sympathetic) - goes to dilate pupil, and raise upper eyelid via
levator palperae superioris</div><div><r /></div><div><img src=""paste-349910

98561150.jpg"" /></div><div><r /></div>"

Lesion of which nucleus will lead to inadequate salivation, and lack of lacrimat
ion?
"Superior salivatory nucleus of CN7 - look at pathway elow<div><r /></
div><div><img src=""paste-35137127449324.jpg"" /></div><div><r /></div>"
Lesion of this nucleus will lead to decreased partoid gland secretions "Inferio
r salivatory nucleus of CN9<div><r /></div><div><img src=""paste-35257386533508
.jpg"" /></div>"
What nuclei (2) are generally associated with the parasympathetic functions of C
N10&nsp;
"<img src=""paste-35394825486898.jpg"" /><div><r /></div><div>D
orsal motor nucleus of vagus&nsp;</div><div>Nucleus amiguus&nsp;</div>"
Fiers from the dorsal motor nucleus synapse on which ganglia in the Intestine?
What are they opposed y?
"Dorsal motor nucleus of vagus synapse on URBC
HS and MEISSNERS PLEXUSES - invovled in forgut and midgut (up to 2/3 of transve
rse mesocolon)<div><r /></div><div>NOTE - hindgut parasympahtetic nuclei come f
rom IML of spinal levels S2-S4 and synapse on aurachs and meissners plexus as
well<r /><div><r /></div><div>Generally opposed y sympathetic fiers coming f
rom IML (sympathetic nuclei) - which synapse on celiac, superior mesenteric and
inferior mesenteric ganglion - &nsp;and oppose the action of parasympathetics o
n the gut</div></div><div><r /></div><div><img src=""paste-35532264440368.jpg""
/></div>"
From what levels of the spinal cord do the sympathetics that innervate the adren
al medulla come from? "IML of T4-T9, and T10, and T11<div><r /></div><div><im
g src=""paste-35669703393704.jpg"" /></div>"
Descrie the sympathetics and parasympathetic (somatic and visceral) innervation
of the ladder?
"Sympathetics - T12 to L2 IML - go to inferior mesenteri
c ganglion - then superior hypogastric plexus - then hypogastric nerve - then in
ferior hypogastric plexus &nsp;- then to trigone of ladder<div><r /></div><di
v>Parasympathetics -</div><div>Somatic fiers to external urethral sphincter - s
tarts at ONUFS NUCLEUS in ventral horn - goes as PUDENDL NERVE&nsp;</div><div
><r /></div><div>Visceral fiers - Parasympathetic preganglion neurons - go as
PELVIC SPLNCHNICS - innervate the ladder and the internal urethral sphincter</
div><div><r /></div><div><img src=""paste-35807142347316.jpg"" /></div>"
Lesion of the Onufs nucleus will result in what prolem?
Urinary incontin
ence - lose the pudendal nerve that innervates the external urethral sphincter
CPC: 16 yo oy, Tennessee, sudden onset fever, chills, fatigue. 3 days prior ra
it hunting, sustained minor scratches to L hand. Red erythematous tender papule
on L thum. L thum with ender ulcerated lesion with rasied edges. Tender epitr
ochlear node, tender axillary node. WBC count slightly elevated. What Dx
Tularemia (Francisella)
<div>CPC:  30 year old professional musician came to the emergency room complai
ning of worsening<u> fever, nausea, vomiting and diarrhea</u>. &nsp;He had een
on a <u>musical tour in India </u>and had returned home 5 days earlier. &nsp;H
is symptoms egan two days after his arrival and progressively worsened. &nsp;H
is<u> diarrhea was descried as watery, frequent (ten times per day) and non-lo
ody</u>. &nsp;The patient denied the presence of headache, adominal pain, or s
kin rash. He has not een coughing. &nsp;There is no history of urinary tract i
nfections. On physical examination, the lood pressure was 121/73, pulse 85, res
piratory rate 20, and oral temperature 105oF. &nsp;He was not jaundiced. &nsp;
His lungs and heart were normal. &nsp;His <u>adomen was mildly distended</u>,
and his <u>spleen tip was palpale</u> 1 cm elow the left costal margin. &nsp;
No enlarged lymph nodes were detected.&nsp;</div><div><r /></div><div>what cli
nical syndrome should this remind you of</div> <div>Clinical syndrome = enteric
fever</div><div><r /></div><div>S. Typhi</div><div>(later confirmed y Positiv
e lood culture)</div>
CPC: 21 yo F, with fever, chills, nausea, loss of appetite, and right lower ack
pain for the preceding 3 weeks. &nsp;Traveled to Mexico for 2 months efore re
turning 1 month ago. &nsp;While in Mexico she traveled in rural areas and ate i
ndigenous foods including vegetales, spices, goat meat and cheese. &nsp;She ha
d een seen in an outlying clinic two days earlier and ciprofloxacin was prescri
ed for her illness. &nsp;The ack pain increased, so she came to the hospital.

She had no suprapuic pain, dysuria, diarrhea, vomiting, cough or hemoptysis. &
nsp;She owns a pet cat and a pet dog. &nsp;She has no known exposure to a pers
on who has tuerculosis.&nsp;<div><r /></div><div>Oral temp= 40.8 C. Her tympa
nic memranes and throat were normal, the neck was not stiff, and she had no enl
arged lymph nodes. She had, however, costo-verteral tenderness.&nsp;</div><div
><r /></div><div>Elevated liver enzymes</div><div>Slightly elevated white lood
cells in urine</div> Brucella melitensis<div><r /></div><div><div><su>Young
healthy woman has fever, flank pain (CV tenderness) and not much else --&gt; p
yelonephritis likely from UTI&nsp;</su></div><div><su>No dysuria or suprapui
c pain&nsp;</su></div><div><su>No stiff neck (so rules out meningitis symptom
s)</su></div></div>
<div> 13 year old girl from New Mexico was admitted to the hospital with <u>two
days of intermittent fever and severe pain in the left axilla</u>. &nsp;Three
days earlier she had een picking pion nuts in the woods (in New Mexico) and that
evening she noticed an area of redness on the left upper arm resemling an <u>i
nsect ite</u>; however, she could not rememer eing itten. &nsp;Over the nex
t 48 hours she developed <u>pain in the ack of her neck</u>, a tender swelling
in the left axilla, fever and chills without headache, conjunctivitis, cough, na
usea, or vomiting. &nsp;She had no history of contacts with rodents and the oth
er memers of her family and her pets (a dog, cat and two raits) were well. &n
sp;</div><div><r /></div><div>T= 102.4 F, pulse 88 and BP 102/70. &nsp;Poster
ior cervical lymphadenopathy associated with some muscular pain was present.  t
ender, 2 1/2 x 3 inch mass thought to represent a lymph node was present in the
left axilla. &nsp;<u>Two small macular areas of redness were noted on the left
upper arm</u>. &nsp;Her lungs were clear, and she had no heart murmurs. &nsp;H
er <u>liver and spleen were palpated to 1 cm elow the costal margins (enlarged)
</u>, and the rest of her physical examination was normal.</div>
Y. Pesti
s<div><r /></div><div>Fagets sign: fever + relative radycardia (should e hig
her than 88 given the fever) --&gt; seen in yellow fever, Typhoid fever, tularem
ia, rucellosis, legionella/mycoplasma pneumonia</div>
Pairing of fever + relative radycardia Fagets sign<div><r /></div><div><su>r
elative radycardia = radycardia given teh circumstances (e.g. Pulse of 88 with
a 105 fever)</su></div><div><su><r /></su></div><div>^{seen in yellow fe
ver, Typhoid fever, tularemia, rucellosis, some legionella/mycoplasma pneumonia
s}</div>
CPC:  16 year old oy from Tennessee was well until 1 day ago &nsp;when he not
ed the <u>sudden onset of fever, chills, headache, malaise and fatigue</u>. &ns
p;Three days earlier he had een <u>rait hunting</u>, and had field-dressed se
veral raits. &nsp;He sustained minor scratches to his left hand. &nsp;On the
day his illness egan, he noted a red erythematous, tender papule on the left t
hum. &nsp;Over the next 24 hours his temperature rose to 105oF, and he develop
ed severe myalgias. &nsp;He had a fever of 102oF and a normal physical examinat
ion except for anormalities in his right upper extremity. &nsp;The <u>left thu
m had a tender ulcerated lesion with raised edges</u>. &nsp;He also had a <u>t
ender, left epitrochlear node (size=1 cm) and a tender axillary node</u> (size=4
cm). &nsp;The remainder of the physical examination was normal. His white lood
count was 13,200/mm3.&nsp;
Francisella tularemia
Most common way humans are infected with tularemia
tick ites
<div>CPC: 49 yo F with <u>chronic Hep C, ascites</u>, presents in late Octoer w
ith fever, <u>altered mental status</u>, and hypotension. &nsp;Her family says
that she had een well ut had eaten at a seafood restaurant 2 days earlier. &n
sp;Her physical exam showed hemorrhages on her lower extremities. &nsp;The next
a.m., she had developed some ullae.&nsp;</div><div><r /></div><div>What Dx +
appearance of Gram stain</div> <div><>Virio vulnificus</> - raw shellfish co
nsumption (chronic liver disease) --&gt; high mortality&nsp;</div><div><>Gram
(-) rod</> looks like a <>comma</></div><div><r /></div><div>Key feature was
that there was a skin/soft tissue manifestation --&gt; go down the differential
</div>
What are the series of Ifs and susequent actions for making EOL decisions?
<div>If patient has DMC, patient makes the decision&nsp;</div><div><r /></div>

<div>If patient lacks DMC, we turn to evidence of patients wishes (advance dire
ctives = written document to show treatment preferences in the event that someon
e lacks DMC)&nsp;</div><div><r /></div><div>If there are no advance directives
(pretty often), we turn to surrogates to make EOL decisions&nsp;</div>
What is a terminal condition? incurale condition caused y injury, disease, o
r illness that according to reasonale medical judgment will produce death withi
n <>6 months</>&nsp;even with life-sustaining treatment
what is an irreversile condition?
1. Can never e cured<div>2. Leaves pers
on unale to care for OR make decision for himself</div><div>3. Fatal without li
fe sustaining treatment</div>
T/F patient must have DMC to complete a directive, ut not revoke it
T
re directives typically applicale to pregnant patients?
No
What things can an MPO NOT consetnt to 1. voluntary inpatient mental health ser
vices<div>2. ECT</div><div>3. PSychosurgery</div><div>4. ortion</div><div>5. O
mission of care primarily intended to relieve comfort</div>
What is considered out-of hospital in an out of hospital DNR
1. community<div
>2. outpatient</div><div>3. ED</div>
When are dvanced directives, MPO, and OOP DNR completed?
"<img src=""past
e-330330229703000.jpg"" />"
T/F surrogates can refuse pain medication
false
What is the heirarchy for consent to medical treatment act heirarchy (routine tr
eatment)
"<img src=""paste-330398949179699.jpg"" />"
What is the heirarchy for the TD (life sustaining treatment) "<img src=""past
e-330394654212403.jpg"" />"
T/F surrogates can request that antiiotics e witheld on asis of patients wish
es.&nsp;<div><r /></div><div>T/F Once antiiotics are initiated they can e wi
thdrawn</div> T<div><r /></div><div>T</div><div><r /></div><div><div>Ex. Ms.
C is a 70-year-old woman who has advanced lung cancer with widespread metastase
s. She is currently dependent on mechanical ventilation and requires artificial
nutrition and hydration. She is unale to participate in decision making. She ha
s developed a life-threatening infection. &nsp;</div><div><r /></div><div>Surr
ogates can request that antiiotics e withheld on the asis of patient wishes;
if antiiotics are initiated, they can e withdrawn. &nsp;</div><div><r /></di
v><div>Explanation: &nsp;</div><div>There is no distinction (legally or ethical
ly) etween withdrawing and withholding LST. Both withdrawing and withholding ar
e legally and ethically permissile. &nsp;</div><div>However: Many physicians 
elieve it is ethically and legally less acceptale to withdraw treatment than to
withhold it ecause it feels different.&nsp;</div><div>Should the treatment ty
pe matter?&nsp;</div><div><r /></div><div>Explanation:&nsp;</div><div>The typ
e of LST should not matter. ny treatment can e withheld or withdrawn. &nsp;</
div><div>However, some physicians are still slow to withdraw feeding tues ecau
se of their personal moral concerns. &nsp;&nsp;</div></div>
<div>Mr. G is a 52-year-old man admitted to the hospital with a severe ilateral
stroke. &nsp;He is unresponsive, unale to communicate, and tests show that he
has severe anoxic rain injury. &nsp;His physician recommends either doing a t
racheotomy or shifting the goals of care to palliation (comfort care only; no ag
gressive therapies). &nsp;Mr. G has no legal guardian and no Medical Power of 
ttorney. &nsp;ccording to Texas law, who is his legal surrogate to make this d
ecision?&nsp;</div><div>His adult daughter who lives out of state.&nsp;</div><
div>His ex-wife who visits daily.&nsp;</div><div>His girlfriend.&nsp;</div><di
v>His clergyman.&nsp;</div>
His dult daughter
For surrogate decision making, surrogates first make decisions in accordance wit
h the patients est interest. True or False&nsp;
False: sustituted judgm
ent
 patient must e in a terminal or irreversile condition and lack decision maki
ng capacity in order for a medical power of attorney (MPO) to e applicale. Tr
ue or False&nsp;
False<div><r /></div><div>False: This is true for livin
g wills ut not for MPOs. For the MPO to e applicale, the patient must lack
decision making capacity ut he/or she does not need to e in a terminal or irre
versile condition&nsp;</div>

Patients can refuse mechanical ventilation ut not artificial nutrition and hydr
ation. True or False&nsp;
False: &nsp;Patients can refuse any and all tre
atment&nsp;
<div>Mr. Z. is a motorcycle enthusiast and daredevil. Nevertheless, he is concer
ned aout advance care planning and always keeps a copy of his Directive to Phys
icians (Living Will) right with him. This document states in no uncertain terms
that he never wants to e intuated. One evening he has an accident and is roug
ht to the closest ED. His living will and his wishes thereof are noted in his me
dical record. Mr. Z. has a possile closed head injury and his LOC and respirato
ry status start to deteriorate. If he is not intuated he will ecome severely c
ompromised or even die. What should happen?&nsp;</div><div>. He should e intu
ated&nsp;</div><div>B. He should not e intuated&nsp;</div>  (dont know if
it is terminal and irreversile)
<div>Mr.  is a 72-year-patient with COPD; he also has severe dementia. Mr. s wi
fe is 68 years old and in good mental and physical health. He has three grown da
ughters. His friend states he is the medical power of attorney. Who makes decisi
ons?&nsp;</div><div>. &nsp;His wife&nsp;</div><div>B. &nsp;His medical powe
r of attorney&nsp;</div><div>C. &nsp;His three daughters&nsp;</div><div>D. &n
sp;He does&nsp;</div> B
<div>Suppose there is no medical power of attorney. Who makes decisions for Mr.
, assuming he lacks capacity?&nsp;</div><div>His wife&nsp;</div><div>His thre
e daughters&nsp;</div><div> friend&nsp;</div>

<div>Mr.  is a 72 year patient with COPD; he also has some degree of dementia t
hat manifests occasionally, usually in the evening. Mr. s wife is 68 years old a
nd in good mental and physical health. He has three grown daughters. He has a fr
iend who is his medical power of attorney. Who makes decisions for him?&nsp;</d
iv><div>His wife&nsp;</div><div>His medical power of attorney&nsp;</div><div>H
is three daughters&nsp;</div><div>He does&nsp;</div> He does
Bite wound infections/clenched fist injuries result from innoculation of skin or
ganism from ____ flora which usually lead to _______ infections mouth; polymicro
ial
What causes a majority of simple cellulitis?
Strep Pyogenes
What causes <>cellulitis</> associated with athletes foot?
strep pyogenes
Patients with underlying dermatitis, diaetics, and IV drug addicts are prone to
skin infections caused y ________
staph aureus
Hw does the pus differ etween staph and strep? Staph: thick purulent exudate<di
v>Strep: thin dishwater pus</div>
Morphologically how does clostridial myonecrosis appear?
Gram + rods with
no inflammatory cells
How does anaeroic cellulitis present on examination? Crepitus on Examination
(cruchy feel due to the presence of air in the sucutaneous tissue)
Virio soft tissue infections occur frequently in_______
pts with cirrhos
is, IDS, malignancy
What are 3 polymicroial infections?
Fouriers Gangrene<div>Meleneys Gangren
e</div><div>Ludwigs angina</div>
Necrotizing perineal infections, mixed owel flora, occurs in <>diaetics with
granulocytopeneia</> <>fouriers gangrene</>
Post surgical mixed infection Melenys gangrene
What are 3 types of neuropathy found in diaetic foot infections? What aer they
manifested y Sensory: temp insensitivity, urning or shooting, hyperestheia,
parasthesis, diminshed ankle reflexes<div><r /></div><div>autonomic: loss of pe
rspiration, drying of skin, cracking and fissuring. loss of autonomic innervatio
n to lood vessels supplying ones of mid foot--&gt;collapse of arch--&gt;charco
t</div><div><r /></div><div><r /></div><div>motor: wasting of intrinsic foot m
uscles--flexors&gt;extensors--&gt;hammer toe deformity</div>
thletes foot in diaetics is due to what acteria and worsened y entry of ____
_____ Candida licans: invade normal skin--&gt;reakdown and maceration in in
terdigital spaces--&gt;ecome portals of entry for <>staph/strep acteria</>
<div>4 CNs in medulla (12, 11, 10, 9)</div>
"<div>12, 11, 10, 9</div><img sr
c=""paste-144469814936055.jpg"" />"

4 CN in pons
"8, 7, 6, 5<div><r /></div><div><img src=""paste-14446551996875
9.jpg"" /></div>"
4 CNs aove pons
"4 &amp; 3 (in midrain)&nsp;<div>2 &amp; 1 (aove mid
rain)</div><div><r /></div><div><img src=""paste-144465519968759.jpg"" /></div>
"
4 motor nuclei in the midline of rainstem
"3, 4, 6, 12<div><r /></div><di
v><img src=""paste-144663088464940.jpg"" /></div>"
Structures in Midline of Brainstem
Motor pathway (CST)<div>Medial lemniscus
(DC)</div><div>Motor nucleus and nerve (CN 3, 4, 6, 12)</div><div>Medial longit
udinal fasciculus</div>
<div>4 structures on Side of Brainstem</div>
<div>Spinothalamic tract</div><d
iv>(chief) Sensory nucleus of CN 5</div><div>Sympathetic pathway</div><div>Spino
cereellar tract&nsp;</div><div><r /></div><div><su>*rememer that this is fo
r the rainstem, not the spinal cord (in spinal cord STT is more medial, CST is
more lateral)</su></div>
<div>CN __ Nucleus located in medial midrain; axons exit ventromedial midrain,
just medial to crus cereri</div>
"<div>CN III&nsp;</div><div>- note loca
tion of CN III nucleus, CN III drippings medial to crus cereri</div><img src=""
paste-146269406233510.jpg"" />"
Parasympathetic nucleus of CN 3 Edinger-Westphal nucleus
<div>CN 3</div><div><r /></div><div>Motor to {{c1::SR, IR, MR, IO}} muscles of
the eye; also {{c1::levator palperae}}</div><div><r /></div><div>Exits etween
{{c2::posterior cereral}} and {{c2::superior cereellar}} artery</div><div><r
/></div><div>Parasympathetic to {{c3::pupillary sphincter}} muscle and {{c3::ci
liary}} muscle</div>
<div>CN 4 Trochlear nerve</div><div>Trace its path from the trochlear nucleus to
where it exits the midrain</div>
Troclear nucleus: located in <>medial m
idrain</>, <>axons cross midline</>, then exit the midrain <>dorsally</>,
just <>inferior to inferior colliculus</>
Only CN whose axons cross midline efore exiting midrain
CN IV<div><r />
</div><div><div>--&gt; damage to CN 4 nucleus will cause contralateral CN 4 defi
cits!</div></div>
<div><div>Eye muscle important in reading and walking down stairs</div></div>
<>Superior Olique</> &nsp;(depresses adducted eye)
<div>Fine touch &amp; proprioception from anterior 2/3 of head: what CN nucleus<
/div> Chief sensory nucleus of CN 5
<div>Pain &amp; temperature from anterior 2/3 of head: what CN nucleus</div>
Spinal nucleus of CN 5
motor to muscles of mastication: what CN nucleus
Motor nucleus of CN 5
<div>muscle spindles from V3; similar to DRG, except soma lies w/in CNS: what CN
nucleus</div> Mesencephalic nucleus of V
motor to lateral rectus muscle aducens nucleus (CN 6)
<div>Fiers exit caudal to pons to innervate muscles of facial expression and st
apedius muscle (inner ear)</div>
Motor nucleus of 7 (tegmentum of pons)
<div>Nucleus for Parasympathetics to lacrimal &amp; salivary glands &amp; nasal
mucosa</div>
Superior salivatory nucleus
<div>Nucleus for Taste from anterior tongue</div>
solitary nucleus (CN 7)<
div><r /></div><div>- solitary nucleus also has sensory taste fiers + sensory
from viscera and vessels (CN 9 and 10)</div>
Two nuclei, 1 for alance, 1 for hearing
vestiular nucleus (alance)<div
>cochlear nucleus (hearing)</div>
<div>Nucleus for Secretomotor to parotid glands (presynaptic parasympathetic)</d
iv>
inferior salivatory nucleus (CN 9)
What nucleus?<div>CN 9 &amp; 10 sensory from viscera and vessels; CN 9, 10, &amp
; 7 sensory from taste fiers of tongue and eppiglottis&nsp;</div>
Solitary
nucleus
What nucleus?<div><r /></div><div><div>motor to smooth muscles and glands (pres
ynaptic parasympathetic) of digestive tract</div></div> <>Dorsal motor nucleus
of X</>
What nucleus?<div><><div><r /></div><div>CN 9 &amp; 10 motor to muscles of pha

rynx and larynx&nsp;</div></></div> Nucleus amiguus

<div>What CN?</div><div><r /></div>1) Motor to SCM + Trapezius<div><r /></div>
<div>2) Motor to somite muscles of tongue</div> 1) CN 11<div><r /></div><div>2)
CN12</div>
<div>What nucleus?</div><div><r /></div><>Motor to somite muscles of tongue</
>
Hypoglossal nucleus
<div>Extraocular muscles: innervation of each</div>
LR<su>6</su>SO<su>4</
su>l<su>3</su><div><su><r /></su></div><div><su>lateral rectus y CN 6</
su></div><div><su>Superior olique y CN 4</su></div><div><su>ll others y
CN 3</su></div>
"What CN is damaged? Name of palsy?<div><img src=""paste-160786395693362.jpg"" /
></div>"
CN6. Lateral rectus palsy
Damage to CN 4 causes what two prolems with eye?
<>Hypertropia</> - aff
ected eye higher than unaffected side (c cant depress eye)<div><>Extorsion</
> - cant intort eye</div>
Damage to what CN causes difficulty seeing when going down stairs or reading? Wh
y?
CN 4&nsp;<div><r /></div><div>Why: Depression y SO is maximal when ey
e is adducted</div>
Only CN nucleus lesion resulting in contralateral defecit. Explain why CN 4<div
><r /></div><div>explanation: CN 4 only CN whose axons cross midline efore exi
ting midrain</div>
Damage to CN 3: What direction will eye point down and out<div>- unopposed SO,
LR</div>
Damge to CN 3: What 3 signs
Ptosis (underactino of levator palperae)<div>Di
lated pupil (loss of P/S to pupil)</div><div>Eye points down and out (unopposed
SO and LR)</div>
<div>n 85-year-old man is admitted to the hospital with a severe ilateral stro
ke. &nsp;He is unresponsive, unale to communicate, and tests show that he has
severe anoxic rain injury. &nsp;He is dependent on endotracheal intuation and
mechanical ventilation. The attending physician elieves that continuing aggres
sive treatment would not enefit the patient and would therefore e medically in
appropriate. He has tried on several occasions to discuss this with the patients
daughter (the patients only family memer), ut she insists that aggressive treat
ment continue. The attending physician has asked the hospital ethics committee t
o review the case in accordance with the Texas dvance Directives ct, Section 1
66.046. &nsp;If the ethics committee agrees that continuing aggressive treatmen
t would e medically inappropriate, what should the attending do?&nsp;</div><di
v>Discontinue the inappropriate interventions immediately.&nsp;</div><div>Seek
a second opinion from another attending physician.&nsp;</div><div>Give the daug
hter 10 days to try to transfer the patient or come to grips with her fathers dea
th with support from the health care team and then discontinue the inappropriate
interventions&nsp;</div><div>Seek legal counsel prior to discontinuing inappro
priate treatments. &nsp;</div><div>Give the daughter 48 hours to try to transfe
r the patient. &nsp;</div>
<div>Give the daughter 10 days to try to transfe
r the patient or come to grips with her fathers death with support from the healt
h care team and then discontinue the inappropriate interventions&nsp;</div><div
><r /></div>
<div>Light Touch &amp; Viration (~DC) from nterior 2/3 of Head</div><div><r /
></div><div>xons of CN 5 (w/ somas in the trigeminal ganglion) enter the rain
stem at the level of {{c1::mid-pons}} and project to and synapse on the ipsilate
ral {{c1::chief sensory nucleus of 5}}</div><div>2 neurons from {{c1::chief senso
ry nucleus}} of 5 project across midline to form the {{c1::trigeminal lemniscus}
}</div><div>{{c2::Trigeminal lemniscus}} projects to and synapses on {{c2::Ventr
al Posterior Medial (VPM)}} nucleus of the thalamnus</div><div>3 neurons travel t
hrough the {{c2::PLIC}} to project to the head area of the {{c2::post-central gy
rus (SSI)}}</div><div><r /></div>
"<img src=""paste-164587441751016.jpg""
/>"
"<img src=""1ff3890ccfcd31365d53eea271e8da7df_Q 0.svg"" />"
"<img sr
c=""1ff3890ccfcd31365d53eea271e8da7df_ 0.svg"" />"
"<img src=""1ff3
890ccfcd31365d53eea271e8da7df_source_svg.svg"" />"
"<img src=""1ff3

890ccfcd31365d53eea271e8da7df_tmp8lrLw.png"" /><div><div><su><r /></su

></div><div><su><r /></su></div><div><su>xons of CN 5 (w/ somas in the tri
geminal ganglion) enter the rain stem at the level of mid-pons and project to a
nd synapse on the ipsilateral&nsp;<>chief sensory nucleus of 5</></su></div>
<div><su>2 neurons from chief sensory nucleus of 5 project across midline to for
m the&nsp;<>trigeminal lemniscus</></su></div><div><su>Trigeminal lemniscus
projects to and synapses on&nsp;<>Ventral Posterior Medial (VPM)</>&nsp;nuc
leus of the thalamnus</su></div><div><su>3 neurons travel through the&nsp;<>P
LIC</>&nsp;to project to the head area of the&nsp;<>post-central gyrus (SSI)
</></su></div></div><div><su><><r /></></su></div>"
DC-like pathway
of CN V to ant. 2/3 of head
"<img src=""1ff3890ccfcd31365d53eea271e8da7df_Q 1.svg"" />"
"<img sr
c=""1ff3890ccfcd31365d53eea271e8da7df_ 0.svg"" />"
"<img src=""1ff3
890ccfcd31365d53eea271e8da7df_source_svg.svg"" />"
"<img src=""1ff3
890ccfcd31365d53eea271e8da7df_tmp8lrLw.png"" />"
DC-like pathway
of CN V to ant. 2/3 of head
"<img src=""27a26f195430575d0e48020ca29100f8c760f_Q 0.svg"" />"
"<img sr
c=""27a26f195430575d0e48020ca29100f8c760f_ 0.svg"" />"
"<img src=""27a2
6f195430575d0e48020ca29100f8c760f_source_svg.svg"" />"
"<img src=""27a2
6f195430575d0e48020ca29100f8c760f_tmp8lrLw.png"" />"
DC-like pathway
of CN V to ant. 2/3 of head
<div><r /></div>
"<img src=""9e8dc04550d295fae1ca3d3272d3a32a3e3f4e_Q 0.svg"" />"
"<img sr
c=""9e8dc04550d295fae1ca3d3272d3a32a3e3f4e_ 0.svg"" />"
"<img src=""9e8d
c04550d295fae1ca3d3272d3a32a3e3f4e_source_svg.svg"" />"
"<img src=""9e8d
c04550d295fae1ca3d3272d3a32a3e3f4e_tmpsmaa07.png"" /><div><div><su><r /></su
></div><div><su>CN 5 enters the rain stem at the level of mid-pons and then d
escends in the <>Spinal Tract of CN 5</> until it reaches the caudal portion o
f the <>Spinal Nucleus of CN 5</>, where it synapses.</su></div><div><su>2 ax
ons decussate (in the medulla) and join the STT to ascend in the <>Trigeminal L
emniscus of the STT</></su></div><div><su>Trigeminal Lemniscus (of STT) proje
cts to and synapses on Ventral Posterior Medial (<>VPM</>) nucleus of the thal
amus</su></div><div><su>3 neurons travel through the <>PLIC</> to project to
the head area of the <>post-central gyrus (SSI)</></su></div></div><div><r /
></div>"
Pain & Temperature (~STT) from nterior 2/3 of Head
"<img src=""9e8dc04550d295fae1ca3d3272d3a32a3e3f4e_Q 1.svg"" />"
"<img sr
c=""9e8dc04550d295fae1ca3d3272d3a32a3e3f4e_ 0.svg"" />"
"<img src=""9e8d
c04550d295fae1ca3d3272d3a32a3e3f4e_source_svg.svg"" />"
"<img src=""9e8d
c04550d295fae1ca3d3272d3a32a3e3f4e_tmpsmaa07.png"" /><div><div><div><su>CN 5
enters the rain stem at the level of mid-pons and then descends in the&nsp;<>
Spinal Tract of CN 5</>&nsp;until it reaches the caudal portion of the&nsp;<
>Spinal Nucleus of CN 5</>, where it synapses.</su></div><div><su>2 axons decu
ssate (in the medulla) and join the STT to ascend in the&nsp;<>Trigeminal Lemn
iscus of the STT</></su></div><div><su>Trigeminal Lemniscus (of STT) projects
to and synapses on Ventral Posterior Medial (<>VPM</>) nucleus of the thalamu
s</su></div><div><su>3 neurons travel through the&nsp;<>PLIC</>&nsp;to proj
ect to the head area of the&nsp;<>post-central gyrus (SSI)</></su></div></di
v><div><div><r /></div></div></div>" Pain & Temperature (~STT) from nterior
2/3 of Head
"<img src=""d552069fc6a14f9a7738911c1fa54c618888f_Q 0.svg"" />"
"<img sr
c=""d552069fc6a14f9a7738911c1fa54c618888f_ 0.svg"" />"
"<img src=""d552
069fc6a14f9a7738911c1fa54c618888f_source_svg.svg"" />"
"<img src=""d552
069fc6a14f9a7738911c1fa54c618888f_tmpsmaa07.png"" /><div><div><div><su>CN 5
enters the rain stem at the level of mid-pons and then descends in the&nsp;<>
Spinal Tract of CN 5</>&nsp;until it reaches the caudal portion of the&nsp;<
>Spinal Nucleus of CN 5</>, where it synapses.</su></div><div><su>2 axons decu
ssate (in the medulla) and join the STT to ascend in the&nsp;<>Trigeminal Lemn
iscus of the STT</></su></div><div><su>Trigeminal Lemniscus (of STT) projects
to and synapses on Ventral Posterior Medial (<>VPM</>) nucleus of the thalamu
s</su></div><div><su>3 neurons travel through the&nsp;<>PLIC</>&nsp;to proj
ect to the head area of the&nsp;<>post-central gyrus (SSI)</></su></div></di

v></div><div><r /></div>"
Pain & Temperature (~STT) from nterior 2/3 of H
ead
<div><su>CN 5 enters the rain stem at the level of <>{{c1::mid-pons}}</> and
then descends in the&nsp;<>{{c1::Spinal Tract of CN 5}}</>&nsp;until it rea
ches the caudal portion of the&nsp;{{c1::<>Spinal Nucleus of CN 5</>,}}&nsp;
where it synapses.</su></div><div><su>2 axons decussate (in the medulla) and jo
in the STT to ascend in the&nsp;<>{{c2::Trigeminal Lemniscus of the STT}}</><
/su></div><div><su>Trigeminal Lemniscus (of STT) projects to and synapses on V
entral Posterior Medial ({{c2::<>VPM</>)}}&nsp;nucleus of the thalamus</su><
/div><div><su>3 neurons travel through the&nsp;<>{{c2::PLIC}}</>&nsp;to proj
ect to the head area of the&nsp;<>{{c2::post-central gyrus (SSI)}}</></su></
div>
"<img src=""d552069fc6a14f9a7738911c1fa54c618888f_tmpsmaa07.png"" />"
"<img src=""paste-310045099164270.jpg"" /><div><div>FYI:</div><div>The spinal tr
act of CN5 is actually synapsing all along the spinal nucleus of 5</div><div>You
cant see TL of STT until mid pons level</div><div>SN of 5 is a continuation of
Marginal nucleus &amp; sustantia gelatinosa&nsp;</div></div>"
<div>Corticoular Tract (CBT) = Pyramidal tract of the head&nsp;</div><div><r
/></div><div>1 pyramidal neurons originate in head portion of {{c1::pre-central gyr
us}}</div><div>Descends through {{c1::the genu of the IC}}</div><div>Synapses on
CNs {{c1::5, 7, 10, 11 &amp; 12}}</div><div><r /></div><div>Has {{c2::i}}late
ral projections to each motor nucleus</div><div>EXCEPTION: lower portion of {{c3
::CN7}} ONLY receives {{c2::contra}}lateral input &nsp;</div><div>Serves muscle
s of the lower face&nsp;</div><div><r /></div>
"<img src=""paste-310740
883865956.jpg"" />"
<div>n 80-year-old is admitted to the hospital with a massive intracranial lee
d. He has een placed on the ventilator ecause of the respiratory failure assoc
iated with intracranial herniation. When you try to remove the ventilator, there
are no respirations. The patient makes no purposeful movements. There is no pup
ilary reaction when you shine a light in his eyes. Corneal reflexes are asent.
The medical team has conducted all appropriate tests and concluded that the pati
ent suffered irreversile cessation of entire rain function. Which of the follo
wing is the most appropriate action regarding this patient?&nsp;</div><div>Remo
ve the ventilator&nsp;</div><div>Make the patient DNR&nsp;</div><div>Get a cou
rt order authorizing you to remove the ventilator &nsp;</div><div>Invoke the fu
tility policy&nsp;</div>
Remove the ventilator&nsp;
CN that does NOT receive ilateral projection from CBT to motor nucleus CN 7 (lo
wer portion serving lower face) only receives contralateral input
Effect of Lesion to motor nucleus of trigeminal nerve: Jaw points toward or away
lesion?
Jaw points <u>towards</u> lesion
Effect of Lesion to Motor nucleus of CN 7:
Bells palsy<div>- weakness of f
acial expression on one side of face</div><div>- hyperacusis</div>
Effect of lesion of nucleus amiguus
Uvula points away from lesion (CN 10 is
affected)
Effect of lesion to Upper Cervical Spinal cord Weakness in shrugging and turnin
g head toward lesion (CN 11 --&gt; Trapezius + SCM)
Hypoglossal (XII) nucleus lesion: tongue points towards or away from lesion?
"Towards lesion (""lick your wound"")"
"<img src=""57d507064a21acd060d94e749ea67197fd849_Q 0.svg"" />"
"<img sr
c=""57d507064a21acd060d94e749ea67197fd849_ 0.svg"" />"
"<img src=""57d5
07064a21acd060d94e749ea67197fd849_source_svg.svg"" />"
"<img src=""57d5
07064a21acd060d94e749ea67197fd849_tmpaLVo35.png"" />"
"<img src=""920a65284511628572935c05ac00d62e5a55_Q 0.svg"" />"
"<img sr
c=""920a65284511628572935c05ac00d62e5a55_ 0.svg"" />"
"<img src=""920a
65284511628572935c05ac00d62e5a55_source_svg.svg"" />"
"<img src=""920a
65284511628572935c05ac00d62e5a55_tmpJ_O5sG.png"" />"
"<img src=""920a65284511628572935c05ac00d62e5a55_Q 1.svg"" />"
"<img sr
c=""920a65284511628572935c05ac00d62e5a55_ 1.svg"" />"
"<img src=""920a
65284511628572935c05ac00d62e5a55_source_svg.svg"" />"
"<img src=""920a
65284511628572935c05ac00d62e5a55_tmpJ_O5sG.png"" />"
"<img src=""920a65284511628572935c05ac00d62e5a55_Q 2.svg"" />"
"<img sr

c=""920a65284511628572935c05ac00d62e5a55_ 2.svg"" />"

65284511628572935c05ac00d62e5a55_source_svg.svg"" />"
65284511628572935c05ac00d62e5a55_tmpJ_O5sG.png"" />"
"<img src=""45428d06fef96130978126704f260270636c4e8_Q 0.svg""
c=""45428d06fef96130978126704f260270636c4e8_ 0.svg"" />"
8d06fef96130978126704f260270636c4e8_source_svg.svg"" />"
8d06fef96130978126704f260270636c4e8_tmpFBMOSE.png"" />"
"<img src=""45428d06fef96130978126704f260270636c4e8_Q 1.svg""
c=""45428d06fef96130978126704f260270636c4e8_ 1.svg"" />"
8d06fef96130978126704f260270636c4e8_source_svg.svg"" />"
8d06fef96130978126704f260270636c4e8_tmpFBMOSE.png"" />"
"<img src=""5d0e1a23386cd49fcc7254637267037924099_Q 0.svg""
c=""5d0e1a23386cd49fcc7254637267037924099_ 0.svg"" />"
e1a23386cd49fcc7254637267037924099_source_svg.svg"" />"
e1a23386cd49fcc7254637267037924099_tmpo1Xnr5.png"" />"
"<img src=""5d0e1a23386cd49fcc7254637267037924099_Q 1.svg""
c=""5d0e1a23386cd49fcc7254637267037924099_ 1.svg"" />"
e1a23386cd49fcc7254637267037924099_source_svg.svg"" />"
e1a23386cd49fcc7254637267037924099_tmpo1Xnr5.png"" />"
"<img src=""c91169c62af92cf09a902c56e20c97240da0a_Q 3.svg""
c=""c91169c62af92cf09a902c56e20c97240da0a_ 3.svg"" />"
69c62af92cf09a902c56e20c97240da0a_source_svg.svg"" />"
69c62af92cf09a902c56e20c97240da0a_tmpV3IMxD.png"" />"
"<img src=""c91169c62af92cf09a902c56e20c97240da0a_Q 4.svg""
c=""c91169c62af92cf09a902c56e20c97240da0a_ 4.svg"" />"
69c62af92cf09a902c56e20c97240da0a_source_svg.svg"" />"
69c62af92cf09a902c56e20c97240da0a_tmpV3IMxD.png"" />"
"<img src=""c91169c62af92cf09a902c56e20c97240da0a_Q 5.svg""
c=""c91169c62af92cf09a902c56e20c97240da0a_ 5.svg"" />"
69c62af92cf09a902c56e20c97240da0a_source_svg.svg"" />"
69c62af92cf09a902c56e20c97240da0a_tmpV3IMxD.png"" />"
"<img src=""d90f4c042407ce5f2c2c6c6aeef84e02988cd8_Q 0.svg""
c=""d90f4c042407ce5f2c2c6c6aeef84e02988cd8_ 0.svg"" />"
f4c042407ce5f2c2c6c6aeef84e02988cd8_source_svg.svg"" />"
f4c042407ce5f2c2c6c6aeef84e02988cd8_tmpS9uGC.png"" />"
"<img src=""d90f4c042407ce5f2c2c6c6aeef84e02988cd8_Q 1.svg""
c=""d90f4c042407ce5f2c2c6c6aeef84e02988cd8_ 1.svg"" />"
f4c042407ce5f2c2c6c6aeef84e02988cd8_source_svg.svg"" />"
f4c042407ce5f2c2c6c6aeef84e02988cd8_tmpS9uGC.png"" />"
"<img src=""0de4fefa1e55515c4ad9341ac9647c531fdf_Q 0.svg""
c=""0de4fefa1e55515c4ad9341ac9647c531fdf_ 0.svg"" />"
fefa1e55515c4ad9341ac9647c531fdf_source_svg.svg"" />"
fefa1e55515c4ad9341ac9647c531fdf_tmpm7X0SM.png"" />"
"<img src=""0de4fefa1e55515c4ad9341ac9647c531fdf_Q 1.svg""
c=""0de4fefa1e55515c4ad9341ac9647c531fdf_ 1.svg"" />"
fefa1e55515c4ad9341ac9647c531fdf_source_svg.svg"" />"
fefa1e55515c4ad9341ac9647c531fdf_tmpm7X0SM.png"" />"
"<img src=""21f81741d3e88ac5c1e8fade9c6783d74d3dddf_Q 0.svg""
c=""21f81741d3e88ac5c1e8fade9c6783d74d3dddf_ 0.svg"" />"
1741d3e88ac5c1e8fade9c6783d74d3dddf_source_svg.svg"" />"
1741d3e88ac5c1e8fade9c6783d74d3dddf_tmpWMLfVE.png"" />"
"<img src=""21f81741d3e88ac5c1e8fade9c6783d74d3dddf_Q 1.svg""
c=""21f81741d3e88ac5c1e8fade9c6783d74d3dddf_ 1.svg"" />"
1741d3e88ac5c1e8fade9c6783d74d3dddf_source_svg.svg"" />"
1741d3e88ac5c1e8fade9c6783d74d3dddf_tmpWMLfVE.png"" />"
"<img src=""21f81741d3e88ac5c1e8fade9c6783d74d3dddf_Q 2.svg""
c=""21f81741d3e88ac5c1e8fade9c6783d74d3dddf_ 2.svg"" />"
1741d3e88ac5c1e8fade9c6783d74d3dddf_source_svg.svg"" />"
1741d3e88ac5c1e8fade9c6783d74d3dddf_tmpWMLfVE.png"" />"
"<img src=""002e35d6d441e034f8077fce6de39f4969c5_Q 0.svg""

"<img src=""920a
"<img src=""920a
/>"
"<img sr
"<img src=""4542
"<img src=""4542
/>"
"<img sr
"<img src=""4542
"<img src=""4542
/>"
"<img sr
"<img src=""5d0
"<img src=""5d0
/>"
"<img sr
"<img src=""5d0
"<img src=""5d0
/>"
"<img sr
"<img src=""c911
"<img src=""c911
/>"
"<img sr
"<img src=""c911
"<img src=""c911
/>"
"<img sr
"<img src=""c911
"<img src=""c911
/>"
"<img sr
"<img src=""d90
"<img src=""d90
/>"
"<img sr
"<img src=""d90
"<img src=""d90
/>"
"<img sr
"<img src=""0de4
"<img src=""0de4
/>"
"<img sr
"<img src=""0de4
"<img src=""0de4
/>"
"<img sr
"<img src=""21f8
"<img src=""21f8
/>"
"<img sr
"<img src=""21f8
"<img src=""21f8
/>"
"<img sr
"<img src=""21f8
"<img src=""21f8
/>"

"<img sr

c=""002e35d6d441e034f8077fce6de39f4969c5_ 0.svg"" />"

"<img src=""002e
35d6d441e034f8077fce6de39f4969c5_source_svg.svg"" />"
"<img src=""002e
35d6d441e034f8077fce6de39f4969c5_tmpTamOl2.png"" />"
"<img src=""002e35d6d441e034f8077fce6de39f4969c5_Q 1.svg"" />"
"<img sr
c=""002e35d6d441e034f8077fce6de39f4969c5_ 1.svg"" />"
"<img src=""002e
35d6d441e034f8077fce6de39f4969c5_source_svg.svg"" />"
"<img src=""002e
35d6d441e034f8077fce6de39f4969c5_tmpTamOl2.png"" />"
"<img src=""71a55ce918fd900eee90794791921407f3f2_Q 0.svg"" />"
"<img sr
c=""71a55ce918fd900eee90794791921407f3f2_ 0.svg"" />"
"<img src=""71a
55ce918fd900eee90794791921407f3f2_source_svg.svg"" />"
"<img src=""71a
55ce918fd900eee90794791921407f3f2_tmpodKzh3.png"" />"
"<img src=""1a9190de7639a377af2c4e76951d7aed85d47_Q 1.svg"" />"
"<img sr
c=""1a9190de7639a377af2c4e76951d7aed85d47_ 1.svg"" />"
"<img src=""1a9
190de7639a377af2c4e76951d7aed85d47_source_svg.svg"" />"
"<img src=""1a9
190de7639a377af2c4e76951d7aed85d47_tmpfNZcD7.png"" />"
"<img src=""224feca7d26981476699ae07ddf76e85224d9e_Q 0.svg"" />"
"<img sr
c=""224feca7d26981476699ae07ddf76e85224d9e_ 0.svg"" />"
"<img src=""224f
eca7d26981476699ae07ddf76e85224d9e_source_svg.svg"" />"
"<img src=""224f
eca7d26981476699ae07ddf76e85224d9e_tmpMFjHDI.png"" />"
"<img src=""7e79f7372e0585ef3f2aaa8685627e7e5fc4_Q 0.svg"" />"
"<img sr
c=""7e79f7372e0585ef3f2aaa8685627e7e5fc4_ 0.svg"" />"
"<img src=""7e7
9f7372e0585ef3f2aaa8685627e7e5fc4_source_svg.svg"" />"
"<img src=""7e7
9f7372e0585ef3f2aaa8685627e7e5fc4_tmpByUOOK.png"" />"
"<img src=""7e79f7372e0585ef3f2aaa8685627e7e5fc4_Q 1.svg"" />"
"<img sr
c=""7e79f7372e0585ef3f2aaa8685627e7e5fc4_ 1.svg"" />"
"<img src=""7e7
9f7372e0585ef3f2aaa8685627e7e5fc4_source_svg.svg"" />"
"<img src=""7e7
9f7372e0585ef3f2aaa8685627e7e5fc4_tmpByUOOK.png"" />"
"<img src=""42f6e7528df5ef7cea19718cca38ac316da04_Q 0.svg"" />"
"<img sr
c=""42f6e7528df5ef7cea19718cca38ac316da04_ 0.svg"" />"
"<img src=""42f
6e7528df5ef7cea19718cca38ac316da04_source_svg.svg"" />"
"<img src=""42f
6e7528df5ef7cea19718cca38ac316da04_tmpee1QIc.png"" />"
"<img src=""42f6e7528df5ef7cea19718cca38ac316da04_Q 1.svg"" />"
"<img sr
c=""42f6e7528df5ef7cea19718cca38ac316da04_ 1.svg"" />"
"<img src=""42f
6e7528df5ef7cea19718cca38ac316da04_source_svg.svg"" />"
"<img src=""42f
6e7528df5ef7cea19718cca38ac316da04_tmpee1QIc.png"" />"
"<img src=""f32fdccd6f1a26c6d7a2d045fd11554a6f8c61_Q 0.svg"" />"
"<img sr
c=""f32fdccd6f1a26c6d7a2d045fd11554a6f8c61_ 0.svg"" />"
"<img src=""f32f
dccd6f1a26c6d7a2d045fd11554a6f8c61_source_svg.svg"" />"
"<img src=""f32f
dccd6f1a26c6d7a2d045fd11554a6f8c61_tmpXry66J.png"" />"
<div>Sympathetic Nervous system</div><div>Emerges from spinal cord (in {{c1::tho
racic}} and {{c1::lumar}} regions)</div><div><r /></div><div>Parasympathetic N
ervous system</div><div>{{c1::Cranio-sacral}} outflow&nsp;</div><div><div>CNs {
{c1::3, 7, 9, &amp; 10::name them}}</div><div>S2-S4</div></div><div><r /></div>
Sympathetic NS<div><r /></div><div><div>Descending fiers (1) from hypothalamus
descend through the {{c1::lateral rainstem}} and synapse on preganglionic neuro
ns in the {{c1::intermediolateral cell column}} of the lateral horn (T1-L2)</div
><div><r /></div><div>Preganglionic fiers (2) exit the spinal cord to innervate
the neary {{c2::paraverteral}} and {{c2::preverteral}} ganglia&nsp;</div><d
iv><r /></div><div>Postganglionic axons (3) innervate lood vessels, pupil, hear
t, lungs, GI tract, &amp; other viscera&nsp;</div></div><div><r /></div>
"<img src=""f91f7a1af724a36959ec6efdee0798110d85d1_Q 0.svg"" />"
"<img sr
c=""f91f7a1af724a36959ec6efdee0798110d85d1_ 0.svg"" />"
"<img src=""f91f
7a1af724a36959ec6efdee0798110d85d1_source_svg.svg"" />"
"<img src=""f91f
7a1af724a36959ec6efdee0798110d85d1_tmpFMSgEg.png"" />"
<div>Descending fiers from the hypothalamus, &amp; pretectal area (CN3 only) pr
oject onto what 5 <u>parasympathetic cranial nerve nuclei</u>:</div><div><div><
r /></div></div>
<div><div><>Edinger-Westphal nucleus</> (CN 3)</div><d
iv>Superior salivatory nucleus (CN 7)</div><div>Inferior salivatory nucleus (CN
9)</div><div><>Nucleus amiguus</> &amp; <>dorsal nucleus</> of the vagus ne
rve (CN 10)</div></div>

Parasympathetic ganglia of head:

3977 COPS<div><r /></div><div>Ciliary</
div><div>Otic</div><div>Pterygopalatine</div><div>Sumandiular</div><div>lso,
P/S ganglion cells in viscera innervated y Vagus (X)</div>
Presence of what anatomical feature suggests Edinger-WEstphal nucleus must also
e present?
"<div>Optic tract</div><img src=""paste-1277997583697440.jpg"" /
>"
Vestiular nucleus (CN 8) exists anywhere we can see what anatomical structure?
"4th ventricle<div><r /></div><div><img src=""paste-1278135022650236.jpg"" /></
div>"
<div>Sympathetic ctivation of Eye</div><div><r /></div><div>From what ganglion
: {{c1::superior cervical ganglion}}</div><div><r /></div><div>3 Functions</div
><div>{{c1::Pupillary dilation&nsp;}}</div><div>{{c1::Sweating of forehead&nsp
;}}</div><div>{{c1::Elevates eyelid (superior tarsal muscle)}}</div><div><r /><
/div>
Parasympathetic ctivation of Eye<div><r /></div><div>What cranial nerve: {{c1:
:CN 3}}</div><div><r /></div><div>Functions:</div><div><div><div>{{c1::Pupillar
y constriction}}</div><div>{{c1::Pupillary light reflex}}</div><div>{{c1::<div><
div><div>Synkinesis (Constriction,&nsp;Convergence,&nsp;ccommodation of lens)
</div></div></div><div></div>}}</div></div></div><div><r /></div>
"<img src=""90a5319fd0669375607e3ea196dd0e284aa785e_Q 2.svg"" />"
"<img sr
c=""90a5319fd0669375607e3ea196dd0e284aa785e_ 2.svg"" />"
"<img src=""90a5
319fd0669375607e3ea196dd0e284aa785e_source_svg.svg"" />"
"<img src=""90a5
319fd0669375607e3ea196dd0e284aa785e_tmpM4QEW.png"" />"
<div>Pupillary light reflex - Parasympathetic</div><div><r /></div><div>{{c1::W
type}} cells respond to diffuse light (still activated if lood, cloudiness, et
c in eye)</div><div>CN {{c1::2::#}} senses light and relays signal to to a nucle
us in the {{c1::pretectal area}}; there is {{c1::ilateral::uni/i lateral}} com
munication etween these nuclei thru the {{c1::posterior commissure}}&nsp;</div
><div><r /></div><div>Secondary axons then project onto the preganglionic cell
odies in the {{c2::Edinger-Westphal nucleus&nsp;}}</div><div>Preganglionics tr
avel to and synapse at {{c2::ciliary ganglion}}</div><div>Postganglionic then in
nervate the {{c2::pupillary sphincter muscle}}</div><div><r /></div> "<img sr
c=""paste-1354576850584388.jpg"" />"
nisocoria results from damage to {{c1::efferent::afferent vs. efferent}} compon
ent of what CN {{c2::3::#}}<div><r /></div><div>Explain why damage to the other
component does NOT result in anisocoria</div> <div>Explanation:&nsp;</div><di
v>fferent damage is protected from symptoms due to <>ilaterality</> of senso
ry input into EW nucleus</div>
"<div>Damage to what CN would produce these findings</div><img src=""paste-13561
53103581558.jpg"" />" CN3<div><r /></div><div>eliminates response <u>only on
damaged side</u> to <u>light shone on either side</u></div>
"<div>Damage to what CN would produce these findings:</div><img src=""paste-1356
251887829364.jpg"" />" CN2 (afferent)<div><r /></div><div><div>eliminates resp
onse of oth pupils to light shone on damaged side</div></div><div><r /></div><
div><div>damage to optic nerve or retina; as light is directed to damaged side,
the pupil is still constricted from the preceding stimulating of the opposite ey
e. But then the reflex circuit sees reduced afferent input due to the damage, an
d thus BOTH pupils will dilate&nsp;</div></div><div><r /></div><div>also calle
d fferent Pupillary Defect (PD) = Marcuss-Gunn pupil</div>
fferent Pupillary Defect (Marcus-Gunn pupil): results from damage to what nerve
?
"CN2<div><r /></div><div><div><su>damage to optic nerve or retina; as
light is directed to damaged side, the pupil is still constricted from the prece
ding stimulating of the opposite eye. But then the reflex circuit sees reduced a
fferent input due to the damage, and thus BOTH pupils will dilate&nsp;</su></d
iv><div><r /></div><div><img src=""paste-1356427981488518.jpg"" /></div></div>"
fferent Pupillary Defec
Both eyes dilate when light shines into lesioned eye
t (PD, Marcus-Gunn Pupil)
Causes of PD (5)
<div><>Optic Neuritis</></div><div>- Lesion of CN II.</d
iv><div>- Think Multiple Sclerosis</div><div>Optic nerve ischemia</div><div>Larg
e retinal detachment</div><div>Central Retinal rtery Occlusion</div><div>Centra

l Retinal Vein Occlusion</div>

T/F: Opacities of lens or cornea can cause PD False
"Uncal herniation: which numer?<div><img src=""paste-1445711761637906.jpg"" /><
/div>" "<div>#1 is uncal herniation</div><div><r /></div><div>From wiki:</div>
<u>The uncus can squeeze the oculomotor nerve</u>, which may affect the parasymp
athetic input to the eye on the side of the affected nerve, causing the pupil of
the affected eye to dilate and fail to constrict in response to light as it sho
uld. <u>Pupillary dilation often precedes the somatic motor effects of cranial n
erve III compression</u>, which present as deviation of the eye to a ""down and
out"" position due to loss of innervation to all ocular motility muscles except
for the lateral rectus (innervated y cranial nerve VI) and the superior olique
(innervated y cranial nerve IV). <u>The symptoms occur in this order ecause t
he P/S fiers surround the motor fiers of CNIII and are hence compressed first<
/u>"
CN damaged in uncal herniation CN 3
Uncal herniation: which is affected first, P/S or motor function?<div><r /></di
v>
"P/S affected first ecause run on outside<div><r /></div><div><img src
=""paste-1445969459675936.jpg"" /></div>"
<div>Sympathetic outflow of Superior Cervical Ganglion:</div><div><r /></div><d
iv>Uncrossed pathway from hypothalamus</div><div>Through {{c1::lateral}} portion
of rain stem&nsp;</div><div>Synapse on preganlionics in the {{c1::intermediol
ateral nucleus}} of spinal cord (<>{{c1::T1}}</>)</div><div>Preganglionics syn
apse at {{c1::superior cervical ganglion}}</div><div>Postganglionics innervate:<
/div><div>-&nsp;Uncrossed pathway from hypothalamus</div><div>Through lateral p
ortion of rain stem&nsp;</div><div>Synapse on preganlionics in the intermediol
ateral nucleus of spinal cord (T1)</div><div><r /></div><div>Postganglionics in
nervate:</div><div>- {{c2::Pupillary dilator muscle}}</div><div>- {{c2::Sweat gl
ands on forehead}}</div><div>- {{c2::Superior tarsal muscle (elevates eyelid)}}<
/div><div><r /></div> "<img src=""paste-1446454790980448.jpg"" />"
"<img src=""paste-1446540690326842.jpg"" /><div>Name for this condition</div><di
v>What are its symptoms</div>" Horners syndrome (loss of sympathetic innervati
on to eye)<div><r /></div><div>Ptosis, Miosis, nhydrosis</div>
Horners Syndrome causes (3)
<div>1. Compression of superior cervical ganglio
n (ie Pancoast Tumor)</div><div>2. Damage to lateral rainstem (where sympatheti
cs descend)</div><div>3. Damage to intermediolateral nucleus at T1</div><div><r
/></div>
Patient with anisocoria. R pupil larger than L pupil.&nsp;<div><r /></div><div
>What are 2 possile lesion locations?</div><div>How could you distinguish the t
wo?</div>
<div><>Locations</></div><div>Left sympathic pathway --&gt; mi
osis on left</div><div>Right parasympathetic CN3 --&gt; mydriasis on right&nsp;
</div><div><r /></div><div><>Distinguish:</></div><div>Shine a light!</div><d
iv>If oth pupils equally responsive to light --&gt; L sympathetic lesion</div><
div>R puil unresponsive to light (in either eye) --&gt; R CN3 lesion</div>
"<div>If you want: name the damage in each</div><img src=""paste-144771751136537
8.jpg"" />"
<div>1 left CN 3 lesion; Down and out</div><div>2 left sympathet
ic lesion; Miosis (constricted pupil) (rememer sympathetic normally dilates pup
il) &amp; Ptosis (droopy eyelid c sympathetic normally innervates superior tars
al)</div><div>3 Right CN 6 lesion; CN 6 innervates LR, so here R LR not working
properly</div><div>4 Left CN 6 lesion</div><div>5 cant see what this is showing,
so I whited it out</div><div>6 (top right) Right CN 4 lesion; CN 4 innervates S
O (normally depresses and intorts eye); here the R eye is aove the L eye= hyper
tropia; hypertropia is exaggerated when eyes are maximally adducted (like while
reading or walking down stairs)</div><div>Dont do 7 or 8 (whited out) c they did
nt learn it this la</div><div>9 Left CN 2 damage; PD; oth eyes constrict in re
sponse to light in Right eye (so oth CN 3s are okay); neither pupil constricts i
n response to light in left eye, so ovi the afferent (CN 2) of L eye is damaged
</div><div><div>1 left CN 3 lesion; Down and out</div><div>2 left sympathetic le
sion; Miosis (constricted pupil) (rememer sympathetic normally dilates pupil) &
amp; Ptosis (droopy eyelid c sympathetic normally innervates superior tarsal)</
div><div>3 Right CN 6 lesion; CN 6 innervates LR, so here R LR not working prope

rly</div><div>4 Left CN 6 lesion</div><div>5 cant see what this is showing, so I

whited it out</div><div>6 (top right) Right CN 4 lesion; CN 4 innervates SO (no
rmally depresses and intorts eye); here the R eye is aove the L eye= hypertropi
a; hypertropia is exaggerated when eyes are maximally adducted (like while readi
ng or walking down stairs)</div><div>Dont do 7 or 8 (whited out) c they didnt lea
rn it this la</div><div>9 Left CN 2 damage; PD; oth eyes constrict in respons
e to light in Right eye (so oth CN 3s are okay); neither pupil constricts in res
ponse to light in left eye, so ovi the afferent (CN 2) of L eye is damaged</div
><div><r /></div><div><r /></div></div><div><r /></div>
"<img src=""paste-7086696038401_1408681277100.jpg"" /><div><r /></div><div>What
infectious acteria could this e?</div>"
Either staph or strep
"<img src=""paste-7155415515137_1408681277100.jpg"" /><div><r /></div><div>What
type of hemolytic?</div>"
Beta hemolytic - clear area around colonies
"<img src=""paste-7206955122689.jpg"" /><div><r /></div><div><img src=""paste-7
219840024577_1408681277100.jpg"" /></div><div><r /></div><div><img src=""paste35184372088833.jpg"" /></div><div><r /></div><div>What acteria?</div>"
gram positive rods/eta hemolytic/necrotizing tissue<div><r /></div><div>Group
 strep</div>
"<img src=""paste-7400228651009 (1).jpg"" /><div><r /></div><div>What clinical
plating diagnostic test depicted?</div><div>What are the implications/what acte
ria is this?</div>"
Bacitracin susceptiility<div>- see the acitracin discs
?</div><div><r /></div><div>Differentiate etween S. pyogenes and other eta he
molytic strep</div><div><r /></div>
What are the four acterial culture plates we should know:
<div>1) <u>Blood
agar</u>: grows aout everything that infects humans</div><div><r /></div><div
>2) <u>Chocolate agar</u>: a few important pathogenic acteria do not grow on l
ood agar, ut grow on chocolate: &nsp;<u>H. influenzae, N. meningitidis</u></di
v><div><r /></div><div>3)<u> McConkeys agar</u>:&nsp;<>suppress</><>&nsp;gr
am positive</>;&nsp;detects falling<> pH </>from <>fermenting lactose</> (
red)</div><div><r /></div><div>4) <u>CN plate</u>:&nsp;<>suppress gram negat
ives;&nsp;</><u>lood agar</u> that contains <u>colistin</u> and <u>nalidixic
acid</u></div><div><r /></div>
"<div>Patient has sinusitis and is also coughing up dark sputum. You plate the s
putum.</div><r /><div><img src=""paste-9990093930497.jpg"" /></div><div><r /><
/div><div><img src=""paste-10002978832385.jpg"" /></div><div><r /></div><div><i
mg src=""paste-10033043603457 (1).jpg"" /></div><div><r /></div><div><img src="
"paste-10067403341825.jpg"" /></div><div><r /></div><div>Name acteria:</div>"
Gram negative coccoaccili<div><div>See how it does not grow well on lood augur
ut does on chocolate augar</div></div><div>Thus, H. influenzae&nsp;</div>
"<img src=""paste-10290741641217.jpg"" /><div><r /></div><div>What type of plat
e?</div>"
McConkeys agar<div>- fermenting lactose (pinkish color)</div>
Rememer, laoratories dont give their answer aout what acteria they culture
until they have a complete answer. Thus, call efore to see what good informatio
n they can give if clinically relevant, especially in finding out aout antiiot
ic susceptiility.
How do you do an antiiotic susceptiility test using tue dilutions? "<div>Tu
e dilutions:</div><div>a. progressively dilute antiiotics in roth yielding a
row of tues with a range of concentrations</div><div>. add acteria to each, p
lace in incuator</div><div>c. examine tues next day to see which concentration
of antiiotics inhiited growth; lowest concentration is called (not surprising
ly) minimal inhiitory concentration (MIC)</div><div>d. culture tues with no gr
owth; lowest concen-tration which kills = min actericidal conc (MBC)</div><div>
<r /></div><div><img src=""paste-10754598109185.jpg"" /></div><div><r /></div>
"
What is&nsp;Kiry Bauer used for?
"<div>ntiiotic susceptiility; measure
s MIC only</div><div><r /></div><div>1) Plate</div><img src=""paste-11020886081
537.jpg"" /><div><r /></div><div>2) &nsp;Less susceptile the acteria - the c
loser it grows to the antiiotic disc. Each disc is a different antiiotic that
diffuses. Las have standards determine susceptililty ased on distance from d
isc.</div><div><r /></div><div><img src=""paste-11033770983425_1408681277100.jp

g"" /></div>"
"What is E-strip?<div><img src=""paste-11192684773377.jpg"" /></div>" "ntiio
tic susceptiility testing - measures MIC. You can see on the strip how suscepti
le the acteria is to the antiiotic on the strip. t lower concentrations of a
x, there is more acteria growth.<r /><div><r /></div><div><img src=""paste-1
1261404250113.jpg"" /><div><r /></div><div><r /></div><div><r /></div></div>"
utomated way of determining susceptiility:<div><r /></div><div>E-strip and Ki
ry/Bauer is what Musher/BTGH use: E strip is etter than Kiry/Bauer, ut is mo
re expensive</div>
Use vitek machine<div><div>- like tue dilution, ut ele
ctronically monitor rate of acterial growth in tue of certain antiiotic conce
ntration</div></div>
4 techniques in determining antiiotic susceptiility: tue dilutions<div>kiry
/auer</div><div>e-strips</div><div>Vitek - automated</div>
How long does it take to grow acterial colonies?<div><r /></div><div>How long
efore la gets ack with you?</div>
8-12 hrs<div><r /></div><div>It takes t
he la 48 hrs to get ack to you though ecause they dont work 24 hrs per day</
div>
Why, When (2), and How (4) do you do a lood culture? "<font color=""#0000ff""
>Why</font>: acteria in lood = greater severity of infection<div><r /></div><
div><font color=""#0000ff"">When</font>: hospitalized patients with fever; outpa
tients with high fever</div><div><r /></div><div><font color=""#0000ff"">How</f
ont>:</div><div>1) sterilize skin well</div><div>2) otain sufficient lood volu
me (20 mL - single needle stick!)&nsp;</div><div>3) inoculate two ottles that
contain roth + essential nutrients + sustances to adsor antiiotics/lock com
plement</div><div>- one ottle is anaeroic (air is replaced with N2 and CO2)</d
iv><div>- one is aeroic&nsp;(air is replaced with O2, N2 and CO2)</div><div>4)
Do this for 2 sites! So 4 ottles total.</div><div><r /></div><div>Note: one 
lood culture = single sample dispensed to two ottles</div>"
"<img src=""paste-12270721564673.jpg"" /><div>Why is there color change in these
<div>Bottles have an <><u>CO2</
roth ottles containing acteria?</div>"
u></>-sensitive indicator on ottom.&nsp;ll growing acteria generate CO2.&n
sp;Placed in incuator, ottoms up; constantly scanned; alarm goes off when posi
tive</div><div><r /></div><div>Gram stain is done</div><div><r /></div><div><i
>By law</i>, a health-care provider must e called if gram stain shows acteria<
/div><div><r /></div>
How many sites do you take lood from? How many ottles for each site are inocul
ated? Two sites, one culture for each, two ottles for each site
Why is volume crucial when drawing lood for culture? <div>s the volume of l
ood eing cultured increases from 5 ml to 20 ml, rate of positivity increases y
aout 0.8-3% for each extra ml.</div><div><><r /></></div><div><>Important
implications when we otain lood cultures: volume is crucial</></div><div><r
/></div>
<div>out {{c1::5%}} all lood cultures have coag neg staph as contaminants. <
><u>That numer may exceed all the true positives!</u></></div>
"<div><div>One time Donald, Jessica, and Erin went to Russia to do some prison m
inistry work. They got sick. They had sputum samples taken and this is what came
ack:</div></div><div><r /></div><div><img src=""paste-10230612099073 (1).jpg"
" /></div><div><r /></div><div>Whats the stain? Whats the acteria? Why do yo
u use this stain and not others?</div>" cid fast stain (red acteria against a
green ackround = positive)<div>Mycoacteria</div><div><div>Have a waxy coat tha
t prevents penetration y other stains</div></div><div><r /></div>
"<div><img src=""paste-14929306320897.jpg"" /></div><div><r /></div><div>What i
s the stain and what is it used for?</div>"
<div>uramine stain - mycoacter
ia</div>
Purpose of PCR in Infectious Disease: "<div>llows for identification of small
amount of microial DN in a clinical sample or in a acterial culture.</div><d
iv><r /></div><div><img src=""paste-23476291239937.jpg"" /></div>"
<div>Mycoacteria:<div><r /></div><div>How long does it take to culture?&nsp;{
{c1::4-8 weeks}}&nsp;</div><div>Why is PCR important in patients with possile
mycoacteria infection? {{c1:: 1) Can tell TB from nontuerculous Mycoacteria 2

) Indentify mutations that render organism susceptile to certain drugs; 3) take

s 2 hrs!!::3}}</div></div>
Who developed the ELIS for pneumococcus?
Dr. Musher is a oss
What is ELIS? Used in ID to detect presence of a toxin (especially to detect i
f C difficile is present and producing toxin)<div><r /></div><div><u>FYI</u></d
iv><div><div>In multi-well plastic plates, coat wells with antitoxin. &nsp;</di
v><div>dd diarrheal fluid, and &nsp;allow to stand for 1 hour. &nsp;</div><di
v>Toxin, if present, is trapped.</div><div>dd antiody to toxin that is chemica
lly linked to a color reagent. &nsp;Wait 1 hour. &nsp;dd developing reagent.
&nsp;Wait 20 minutes and read color change. &nsp;Modestly laor intensive: 3-4
hours. &nsp;</div><div>Compared to cytotoxicity assay, EI 96% sensitive, 97%
specific</div></div>
Main point from V study comparing PCR vs ELIS in diagnosis of C difficile?
PCR is ultra sensitive, more so than ELIS. However, drawack is that it may e
so sensitive as to detect colonization rather than disease.<div><r /></div><div
><u>FYI:</u></div><div><div>12 ELIS positive. &nsp;ll were also positive y P
CR.&nsp;</div><div>BUT 10 additional, ELIS-negative samples were positive y P
CR. &nsp;Diagnosis in all samples with positive PCR was confirmed y culture of
toxin-producing C. difficile.</div></div>
Most common cause for positive lood test:<div><r /></div><div>What can you do
to determine if this is contamination?</div>
coagulase negative staph - conta
mination<div><r /></div><div><>use PCR:&nsp;</>distinguish MRS from MSS fr
om coagulase negative staphylococci</div>
How can you diagnose if staph aureus is colonizing?
nasal swa --+ PCR<div><
r /></div><div><div>Identifies <i>orf</i> (present in all S. aureus) and <i>mec
</i> (methicillin-R)</div></div>
3 enefits of identifying MRS carriers quickly using nasal swa/PCR: "<img sr
c=""paste-30331059044353.jpg"" />"
Most <i>infants</i> hospitalized for pneumonia have what type of infection?
"Viral NOT acterial<div><r /></div><div><img src=""paste-32774895435777.jpg""
/></div>"
Huge enefit of using PCR when trying to diagnose cause of pneumonia: &nsp;De
termine if virus is the cause
"<>Very Important to Know:</><div><r /></div><div><div> West frican mission
ary survives a severe nonspecific ferile illness suggestive of the new XYZ viru
s. &nsp;You saved serum from when he ecame ill (= ""acute"" serum). &nsp;Now
that he is etter, you otain another serum (=""convalescent"" serum). &nsp;You
send these two sera together to e studied for IgG assay to XYZ virus. &nsp;Wh
ich result would provide the est evidence to confirm your clinical impression?<
/div></div><div><r /></div><div><img src=""paste-33621003993089.jpg"" /></div>"
"<img src=""paste-33689723469825.jpg"" /><div><r /></div><div>Read ruchit if yo
u dont understand this concept</div>"
"<img src=""paste-33964601376769.jpg"" /><div><r /></div><div>Previous card wit
h this:</div><div><r /></div><div>This test has high {{c1::specificity::specifi
city/sensitivity}} ut low {{c1::sensitivity::specificity/sensitivity}}</div>"
<div>+ test shows that they definitely have strep</div>
Very Important:<div><r /></div><div>Lyme serology is {{c1::<>unreliale</>::u
nreliale/reliale}}</div>
Patient admitted for 5 days of cough and fever; x ray shows pneumonia. &nsp;Spu
tum gram stain shows inadequate specimen. &nsp;Patient responds slowly to treat
ment with ceftriaxone and azithromycin (recommended road spectrum antiiotics). D
octor is interested to estalish diagnosis. &nsp; Otains a serum from day of d
ischarge. &nsp;ntiody to Mycoplasma is 1:32 &nsp;(la states that normal is
&lt;1:16).&nsp;<div><r /></div><div>So you decide to ring patient ack in two
weeks and otain a convalescent serum. Result is antiody to Mycoplasma at 1:64</
div><div><r /></div><div>What does the antiody dilution ratio need to e to ac
tually e diagnostic in this case?</div>
 fourfold rise to 1:128<div><r
/></div><div>must have 4-fold increase in order to e diagnostic</div>
Main symptom of primary syphilis (T. pallidum) painless lesion called chancre a
t innoculation site

T. pallidum contains what cell memrane lipid that results in a type of autoimmu
nity for the host? How? <div>Cardiolipin (a phosphatidylcholine) is <>incorpora
ted into T. pallidum cell memrane from mammalian host rather than synthesized</
>. &nsp;The acteria then alters the cadiolipin so that host makes antiody to
it --&gt; results in autoimmunity</div>
Symptoms of secondary syphilis (3)
"<div>1. organism has disseminated (incl
uding CNS/CSF)</div><div>2. lesions in skin, rash on trunks and extremities incl
uding soles of feet and palms of hands (likes to replicate in cool areas)</div><
div>3.&nsp;Condoloma lata (flat topped) on mucous memranes</div><div><r /></d
iv><div><r /></div><div>Note: theoretically contagious at theis point ut very
few organisms present, someone who touches the lesions would have to have reaks
in their own skin</div><div><r /></div><div><img src=""paste-44659069944200.jp
g"" /></div>"
Circumstances in which syphilis ecomes latent? in asence of disease, disease 
ecomes latent in everyone who is affected (due to humoral and cell-mediated immu
ne mechanisms)
Treatment of lyme disease (Borrelia urgdorferi)?
"doxycycline or ceftriax
one<div><r /></div><div><img src=""paste-44779329028487.jpg"" /></div>"
Species of Leptospira that infects humans?
Leptospira interrogans
Leptospira interrogans is found mostly in what climates? &nsp;Common in which m
ediums? <div>tropical, warm areas (Malaysia, Central merica, surfers)&nsp;</di
v><div><r /></div><div>Survive well in water and soil (outreaks after flooding
),&nsp;can e associated with sewage, farm animal contact, swimming</div><div><
r /></div><div>Rare in Houston so dont worry</div>
Depressed patients hard-on lasts much longer than he expected, and he didnt ev
en take any of that viagra... Trazodone!!!<div><r /></div><div>- etter get i
t down, the lawsuits will come flying in soon</div>
Depressed patient dies from an aortic dissection. Needless to say, patient is no
t happy aout it...
Should have managed his Hypertension etter after giving
him all that Venlafexine!!!
1. Depressed pregnant womans child comes out with half a heart. What happened..
.<div><r /></div><div>2. GFDI, she gave irth to child and still depressed!!! W
hat to do...</div>
1. Paroxetine!!!<div><r /></div><div>2. Sertraline</div
>
Depressed patient has OCD. Kill two irds with one stone and give him...
Fluvoxamine!!!
Depressed patient ODs on his meds very easily. What did he do...
Took too
many Tricyclics!!!
Your depressed, possily DHD smoker-patients simultaneously start siezing while
having the greatest sex of their life (rather, not the worst)...
Bupropri
on!!!<div><r /></div><div>(they stopped smoking though)</div>
Depressed patient develops Parkinsons. You can kill two irds with one stone and
treat him with...
Selegiline!!!
 piano fell on top of your depressed patient and messed up his ack forever. Tr
eat him with... Duloxetine
Patient takes a lot of his oring SSRI and nothing happens... Fluoxetine!!!
Your depressed patient starts eating a Turducken a day and sleeping 15 hours...
"Mirtazapine!!!<div><r /></div><div><img src=""paste-3616358168265116.jpg"" /><
/div><div>(Nomzzz)</div>"
Treatment for your 90 y/o depressed insomniac...
Mirtazapine!!!
Depressed patient has oatload of medications. Give him...
Citalopram!!!
Depressed patient is popping hydros for the nail sticking through his foot. You
give him paroxetine. What happens... Them hydros stop working!!!<div><r /></
div><div>- 26D inhiition!</div>
Depressed patient is popping hydros for the nail sticking through his foot. You
give him sertraline. What happens... Nothing! Sertraline is so oring!&nsp;<
div><r /></div><div>- consider doing something for that P infection though!&n
sp;</div>
Depressed patient suddenly not so depressed, ut looks red in the face with BP d
ropping like its hot.&nsp;<div><r /></div><div>He dies. Oops.&nsp;</div><div>

<r /></div><div>What happened?&nsp;</div>

Serotonin Syndrome!&nsp;
Depressed patient performing well with Rx of Nefazodone, ut develops 18 other
prolems requiring meds. What to do... Get him off the Nefadozone (33/4 inhii
tion)<div><r /></div><div>- maye switch him to Buproprion and give him some e
nzos for the siezures?&nsp;</div><div><r /></div><div>- or Venlafaxine and a
BP cuff</div>
"<img src=""paste-65270617997770.jpg"" />"
"BLCK: right C<div>WHITE: lef
t C</div><div>RED: MC</div><div>GREEN: PC</div><div><r /></div><div><img sr
c=""paste-65352222376399.jpg"" /></div>"
"<img src=""paste-65451006624284.jpg"" />"
BLUE: SC<div>RED: Basilar</div>
<div>WHITE: IC<r />BLCK: Verteral</div><div>YELLOW: PIC</div>
"<img src=""paste-65493956297090.jpg"" />"
"RED: optic chiasm<div><r /></d
iv><div>BLUE: internal carotid</div><div><r /></div><div><img src=""paste-65515
431133741.jpg"" /></div>"
"<img src=""paste-65661460021743.jpg"" />"
BLCK: occpital loe<div>WHITE:
medulla</div><div>YELLOW: tonsil of cereellum</div>
"<img src=""paste-65773129171286.jpg"" /><div>What does the lack pin secrete?</
div>" "Sustantia Nigra - dopamine<div><r /></div><div><img src=""paste-65786
014073095.jpg"" /></div>"
"<img src=""paste-66460323938782.jpg"" />"
<div>BLUE: C</div><div>RED: th
alamus</div><div>GREEN: hypothalamus</div><div>ORNGE: mammillary ody</div><div
>WHITE: cereral aqueduct</div><div>BLCK: pineal gland</div>
<u>DORSL COLUMNS REVIEW</u><div>IPSILTERL/CONTR?</div><div><r /></div><div>
What level is the medial lemniscus found?</div><div><r /></div><div>lesions el
ow medial lemniscus?</div><div><r /></div><div>lesions aove medial lemniscus</
div>
"medial lemniscus = medulla<div><r /></div><div>lesions elow ML = ipsi
</div><div><r /></div><div>lesions aove = contra</div><div><r /></div><div><i
mg src=""paste-66623532695728.jpg"" /></div><div><r /></div><div><img src=""pas
te-66636417597878.jpg"" /></div>"
<u>DORSL COLUMNS REVIEW</u><div><r /></div><div>Below T6 goes where?</div><div
><r /></div><div>ove T6 goes where?</div>
"elow T6 (from lower ody legs)
--&gt; fasiculus gracilis<div><r /></div><div>aove T6 (from upper ody + post
erior 1/3 head) --&gt; fasciculus cuneatus</div><div><r /></div><div><img src="
"paste-66782446485753.jpg"" /></div>"
<u>DORSL COLUMNS REVIEW</u><div><r /></div><div>Function?</div><div><r /></di
v><div>Travel from DRG to fasciculus gracilis/cuneatus IPSI/CONTR?</div>
1) fine touch<div>2) proprioception</div><div>3) viration</div><div><r /></div
><div>travel: ipsilateral</div>
<u>DORSL COLUMNS REVIEW</u><div><r /></div><div>Where does the anterior 2/3 of
head information input?</div><div><r /></div><div>Where does it synapse? (loca
tion)</div><div><r /></div><div>Where does it decussate?</div> "input: through
trigeminal ganglion<div><r /></div><div>synapse: IPSI-lateral chief sensory nuc
leus of nucleus (PONS)</div><div><r /></div><div>decussate: immediately to form
trigeminal lemniscus in ""golden slide of V""</div><div><r /></div><div><img s
rc=""paste-66932770341276.jpg"" /></div>"
<u>DORSL COLUMNS REVIEW</u><div><r /></div><div>IPSI/CONTR?</div><div><r /><
/div><div>lesion to trigeminal ganglion or chief sensory nucleus of V?</div><div
><r /></div><div>lesion to trigeminal lemiscus?</div> "<div>lesion to trigemin
al ganglion or chief sensory nucleus of V?</div><div>IPSI</div><div><r /></div>
<div>lesion to trigeminal lemiscus?</div><div>CONTR</div><div><r /></div><div>
<img src=""paste-67070209294536.jpg"" /></div>"
<u>SPINOTHLMIC TRCT REVIEW</u><div><r /></div><div>Function (3)</div><div><
r /></div><div>Synapse?</div><div><r /></div><div>Decussate?</div>
1) pain<
div>2) temperature</div><div>3) crude touch</div><div><r /></div><div>Syapse: R
exeds lamina 1 and 2 (marginal nucleus and sustantia gelatinosa)</div><div><r
/></div><div>Decussate: immediately through anterior white commissure</div>
<u>SPINOTHLMIC TRCT REVIEW</u><div><r /></div><div>lesion to Rexed 1 and 2 o
r DRG?</div><div><r /></div><div>lesion to ST tract? (specific)</div> "<div>le
sion to Rexed 1 and 2 or DRG?</div><div>IPSI</div><div><r /></div><div>lesion t
o ST tract? (specific)</div><div>CONTR (starting 2 levels elow lesion)</div><d

iv><r /></div><div><img src=""paste-67237713019116.jpg"" /></div>"

<u>SPINOTHLMIC TRCT REVIEW</u><div><r /></div><div>Pain to the anterior 2/3
of the head enters at what level?</div><div>What direction does it then travel?<
/div><div>Where does it synapse?</div><div>What does it decussate?</div>
"enters at trigeminal ganglion (MID-PONS)<div>1) travels down IPSI spinal tract
of V</div><div>2) synapse in IPSI spinal nucleus of V (MEDULL)</div><div>3) cro
ss at medulla and forms trigeminal lemnisuc of STT in ""golden slide of V""</div
><div><r /></div><div><img src=""paste-67426691580276.jpg"" /></div>"
<u>SPINOTHLMIC TRCT REVIEW</u><div><r />Lesions to STV or SNV?</div><div><r
/></div><div>Lesions to TL of STT?</div>
"<div>Lesions to STV or SNV?</di
v><div>IPSI</div><div><r /></div><div>Lesions to TL of STT?</div><div>CONTR</d
iv><div><r /></div><div><img src=""paste-67469641253236.jpg"" /></div>"
<u>CORTICOSPINL TRCT REVIEW</u><div><r /></div><div>Travels in what?</div><di
v><r /></div><div>Synapse in thalamus?</div><div><r /></div><div>Where does it
decussate?</div><div><r /></div><div>Lesion aove decussation?</div><div>Lesio
n elow decussation?<r /><r /></div> "<div>Travels in PLIC</div>NO synapse in
thalamus<div>decussate: caudal medulla</div><div><r /></div><div>lesion aove
decussation: contra</div><div>lesion elow decussation: ipsilateral</div><div><
r /></div><div><img src=""paste-67641439945210.jpg"" /><r /><div><r /></div></
div>"
<u>CORTICOBULBR TRCT REVIEW</u><div><r /></div><div>Runs through what?</div><
div>Travels with what?</div><div>Where does it synapse?</div><div><r /></div>
"runs through genu of the internal capsule (CST is through PLIC)<div>travels wit
h CST until caudal medulla</div><div>ilaterally synapses on CN V, VII (upper fa
ce), IX, X, XI, XII</div><div><r /></div><div><img src=""paste-67778878898644.j
pg"" /></div>"
<div> 75 year old man with PMH of HTN, DM, CD, and afi suddenly discovers he
cant move his right leg. &nsp;Upon exam, you notice hes lost sensation to his rig
ht leg as well. &nsp;</div><div>&nsp;First imaging test you order?</div><div>&n
"<div>Order a CT w/o contrast.</div><div
sp;What could have happened?</div>
>Possile Left C stroke.</div><div><img src=""paste-68680822030522.jpg"" /></d
iv><div><r /></div>"
<div>32 yo man with multiple minor ruises and head trauma after falling down a
flight of stairs.&nsp;He says he never used to fall ut has recently ecome clu
msy, especially when walking down stairs.&nsp;He also complains of difficulty r
eading the newspaper unless he holds it up high at eye level.&nsp;You notice his
head is cocked slightly up and to one side</div><div><r /></div><div>What lesio
n? Impairs what?</div> "<img src=""paste-68719476736446.jpg"" />"
"<img src=""paste-68753836474779.jpg"" /><div>Diagnosis? CN?</div>"
"<img sr
c=""paste-68771016343827.jpg"" />"
How does an uncal herniation affect CN III?
"<img src=""paste-68934225101318
.jpg"" /><div>parasypathetics affected first ecause they run on the outside</di
v>"
"<img src=""paste-68968584839458.jpg"" /><div><img src=""paste-68981469741404.jp
g"" /></div><div>Diagnosis?</div>"
<div>Diagnosis: fferent pupillary defec
t (PD)</div><div>Likely caused y Optic Neuritis 2/2 Multiple Sclerosis</div><d
iv><r /></div>
"<img src=""paste-69020124447062.jpg"" /><div><img src=""paste-69037304316132.jp
g"" /></div><div>Diagnosis?</div>"
"<img src=""paste-69067369087395.jpg"" /
>"
"<img src=""paste-70330089472369.jpg"" /><div>LESIONS!</div><div><r /></div><di
v>What level are we at?</div><div>What is the circled structure?</div><div>Ipsi/
contra - what tract?</div>"
level: medulla olongata - decussation of the py
ramids<div><r /></div><div>GREEN: fasciculus cuneatus</div><div>DCT - ipsilater
al</div><div><r /></div><div>RED: spinal nucleus of V</div><div>STT anterior 2/
3 head - ipsilateral</div><div><r /></div><div>BLUE: spinothalmic tract</div><d
iv>STT contralateral - starting two levels elow lesion</div>
"<img src=""paste-70501888164164.jpg"" /><r /><div>LESIONS!</div><div><r /></d
iv><div>What level are we at?</div><div>What is the circled structure?</div><div
>Ipsi/contra - what tract?</div>"
level: medulla (higher ecause can see i

nferior olivary nucleus)<div>structure: medial lemniscus</div><div>lesion: DCT contra</div>

"<img src=""paste-70604967379319.jpg"" /><r /><div>LESIONS!</div><div><r /></d
iv><div>What level are we at?</div><div>What is the circled structure?</div><div
>Ipsi/contra - what tract?</div>"
level: PONS (lower)<div><r /></div><div
>GREEN: corticospinal, corticoular tracts</div><div>CST - contra</div><div><r
/></div><div>RED: spinothalamic</div><div>STT - contra, starting 2 levels elow
lesion</div><div><r /></div><div>BLUE: spinal tract of V, spinal nucleus of V<
/div><div>STT anterior 2/3 head - IPSI</div>
"<img src=""paste-70793945940339.jpg"" /><r /><div>LESIONS!</div><div><r /></d
iv><div>What level are we at?</div><div>What is the circled structure?</div><div
>Ipsi/contra - what tract?</div>"
thoracic<div><r /></div><div>corticospi
nal</div><div><r /></div><div>ipsilateral ecause elow decussation in medulla<
/div>
"<img src=""paste-72009421685195.jpg"" />"
Superior cereellar peduncle
"<img src=""paste-72095321031113.jpg"" />"
middle cereellar peduncle
"<img src=""paste-72146860638660.jpg"" /><div>Be specific.</div>"
"fascicu
lus cuneatus (more lateral)<div>fasciculus gracilis (more medial)</div><div><r
/></div><div><img src=""paste-72245644886355.jpg"" /></div>"
"<img src=""paste-72288594559430.jpg"" /><r /><div><r /></div>"
Cereral
peduncle
"<img src=""paste-72322954297833.jpg"" /><r /><div><r /></div>"
Trigemin
al Nerve
"<img src=""paste-72357314036219.jpg"" /><div>What tract?</div><div><div><r /><
/div></div>"
medullary pyramids<div>CST tract</div>
"<img src=""paste-72434623447514.jpg"" />"
CN XII (etween pyramid/olive)
"<img src=""paste-72468983185890.jpg"" />"
CN IX and X
"<img src=""paste-72503342924261.jpg"" />"
CN VIII
"<img src=""paste-72529112728040.jpg"" />"
CN VI
"<img src=""paste-72563472466424.jpg"" /><div>ignore D, E</div>"
a) olfac
tory ul<div>) olfactor tract</div><div>c) mammillary ody</div><div>f) infund
iular stalk - attach to pituitary</div><div>g) middle cereellar peduncle</div>
<div>h) cereellar hemisphere</div><div>i) pyramid of medulla</div>
"<img src=""paste-72683731550695.jpg"" /><r /><div><r /></div>"
a) parie
to-occipital sulcus<div>) calcarine sulcus</div>
"<img src=""paste-72786810765565.jpg"" /><div><r /><div><r /></div></div>"
1) tectum<div>2) red nucleus</div><div>3) sustantia nigra</div><div>4) crus cer
eri</div><div><r /></div><div>MIDBRIN</div>
"<img src=""paste-72907069849865.jpg"" /><r /><div><r /><div><r /></div></div
>"
1) diencephalon (thalamus, hypothalamus)<div>2) midrain</div><div>3) po
ns</div><div>4) medulla olongata</div>
What are the 3 most common causes of Otitis Media
Strep Pneumo<div>HI</div
><div>Moraxella</div>
70 s riosome?<div><r /></div><div>60 s riosome?</div><div><r /></div>
Prokaryotes<div><r /></div><div>eukaryotes</div>
Gram positive or negative: Endotoxin, LPS, Lipid , Periplasmic space?<div><r /
></div><div>Exception</div>
Negatvie<div><r /></div><div>Listera has endoto
xin</div>
What organism have a protein capsule? Bacillus nthracis
What drug requires oxygen to kill acteria? What are these typs of acteria?
aminoglycosides: Nagging Pests must reathe<div><r /></div><div>Nocardia, pseud
omona, mycoacteria, acillus</div>
<div>Gram (+) cocci in pairs</div><div>Gram (+) cocci in fix this to clusters, c
oag (+)</div><div>Gram (+) cocci in chains, coag (-), novoiocin resistant</div>
<div>lpha hemolytic, optochin sensitive</div><div>4 things caused y strep pneu
mo</div><div>MCC otitis externa</div><div>Type of acteria active in CGD</div><d
iv>MCC of meningitis in a ay?</div><div><r /></div> <div>Strep</div><div>sta
ph</div><div>staph saprophyticus (epidermitis is novoiocin susceptile)</div><d
iv>Strep Pneumo</div><div>MOPS</div><div>Pseudomona</div><div>Catalase +</div><d
iv>Group B strep, Listeria, E Coli</div>

<div>What do we use to classify streps?</div><div>Toxin results in scarlet fever

?</div><div>Golden crusted lesions</div><div>Giving antiiotics prevents which o
f the complications of strep?</div><div>Colonoscopy for which strep?</div><div>M
IC v. MBC?</div><div>Currant jelly sputum</div><div>Swarms catheters; urease cry
stals in ladder</div> Lancefield Classification y looking at C car<div><r /
></div><div>Erythrogenic Toxin </div><div><r /></div><div>Strep or Staph impet
igo/pyoderma</div><div><r /></div><div>Rheumatic Heart ut NOT glomerulonephrit
is</div><div><r /></div><div>Group D (gallolyticus)</div><div><r /></div><div>
MIC stops growth, MBC minimum level to kll</div><div><r /></div><div>Klesiella
</div><div><r /></div><div>Proteus</div>
What are the gram positive rods (4) Which ones are spore forming?
Corynea
cterium diptheria (non spore)<div>Listera Monocytes (non spore)</div><div><r />
</div><div>Bacillus (Spore, non motile)</div><div>Clostridium (spore</div><div><
r /></div>
Malignant Eschar via skin contact<div>Intestinal Necrosis</div><div>Mediastinal
acillus anthracis
Hemorrhage, pleural effusion</div>
Bacillus nthracis<div><r /></div><div>pXO1: Tripartite toxin:</div><div><r />
</div><div><div>Which factor increased cMP, causing swelling?</div><div>Which f
actor increases TNFa causing death?</div><div>Which factor helps to ind?</div><
/div><div><r /></div> EF (Edema factor)<div><r /></div><div>LF (lethal factor
)</div><div><r /></div><div>P (protective antigen)</div>
What do you use to treat Bacillus anthracis? What vaccines are used?
Cipro or
tetracycline<div><r /></div><div>Recominant, attenuated, live P</div>
What enzyme does Bacillus Cereus secrete?&nsp;<div><r /></div><div>Spore formi
ng?</div><div>Motile?</div><div>Encapsulated?</div>
lecithinase (cleaves lip
id)<div><r /></div><div>Spore forming</div><div>Motile</div><div>Non-capsulated
</div><div><r /></div><div><div>B. cereus, youre RUNNING around NKED!</div></div>
<div><r /></div>
What toxins in B cereus cause what symptoms?
Heat staile--&gt;vomiting--&gt;
reheated fried rice<div>Heat laile--&gt;late onset diarrhea--&gt;contaminated m
eat</div>
<div>Kid comes in and has this weird gray pseudomemrane in the ack of his thro
at. &nsp;His neck looks a little weird too. &nsp;</div><div><r /></div><div><
r /></div><div><div>What does he have?</div><div>What is the toxin mediated eff
ect here?</div><div>What vaccine did this kid miss out on (most likely)?</div><d
iv>When I want to diagnose this, I do what test?</div><div>What medium do I need
to use?</div><div>How do I treat this?</div></div><div><r /></div>
Diptheri
a toxin<div><r /></div><div>B toxin encoded y lysogenic acteria: inhiit pro
tein synthesis (riosylation of EF2)</div><div>DTaP</div><div>ELEK immunodiffusi
on or PCR</div><div>Tellurite will show lack colonies, so use Loefflers medium</
div><div>Tx: anti-toxin, vaccine</div>
Is diptheria toxin due to circulating toxins or acteremia?
"<img src=""past
e-53029961204056.jpg"" />"
<div>Bay comes in and is ferile and his anterior fontanel seems to e ulging.
&nsp;He is fussy and not feeding well. He was orn 2 days ago. &nsp;Mom remem
ers eating some smoked salmon and trying some milk with a ham and cheese sandwi
ch at the farmers market while pregnant.</div><div><r /></div><div>Whats the majo
r virulence factor?</div><div>Motile/immotile?</div><div>Dx y?</div><div>Treatm
ent?</div><div><r /></div>
Listeria Monocytogenes<div><r /></div><div><>L
isteriolysis O</> (escapte from phagolysosome),&nsp;<r /><div>Motile (actin r
ocket)</div><div>Look for Toxin in lood/ CSF</div><div>mpicillin</div><div><r
/></div><div><r /></div></div>
Because Listeria is _________, it requires what type of cells for defense?
Oligate intracellular (T cells)
Gram postive, tellurite resistant
Listeria Monocytogenes
"<img src=""paste-53395033424234.jpg"" />"
<div>-WTERHOUSE-FRIEDERICHSEN S
YNDROME adrenal insufficiency; look for Endotoxin (LOS) mediated inflammatory DI
C/hemorrhage in lood vessels</div><div><r /></div><div><r /></div><div><div>Endotoxin (<>LOS</>; hemorrhage inducing + sepsis), <>Opacity protein </>(op
a) in outer memerane, Polysaccharide capsule,<> Pili </>for adherence</div></

div><div><r /></div><div><div>Transmitted y respiratory secretions -&gt; colon

ize nasopharynx via pili and invade epithelium + spread in lood</div><div>-If i
nvades choroid/meninges = meningitis</div></div><div><r /></div><div>Penicillin
, Ceftriaxone, Rifampin</div><div><r /></div><div><r /></div><div><r /></div>
<div>What kind of people are highest risk for repeated infection with N. meningi
tides?</div><div><r /></div> "-People with MC (C6-C9) deficiency!!!&nsp;<di
v><img src=""paste-56268366545289.jpg"" /></div>"
"<img src=""paste-56302726283608.jpg"" />"
"<div><div>Give her some IM ceft
riaxone, counseling on safe sex, and DMIT TO THE HOSPITL. &nsp;This is an eme
rgency. &nsp;She has PID with Fitz-Hugh-Curtis Syndrome. &nsp;Her reaction is
the chandelier sign. &nsp;This can compromise her ay, so DMIT HER</div></div
><div><r /></div><div><r /></div><div><div>You need to start treatment of mom
now, and when ay is orn give erythromycin eye drops</div></div><div><r /></d
iv><div><div>Test her for chlamydia ecause she proaly has oth. &nsp;dd<>
azithromycin</> to treatment</div></div><div><r /></div><div><div>Test her y
culture. &nsp;Chocolate agar!!!</div></div><div><r /></div><div><div>The arthr
itis she is experiencing is part of Neisseria gonorrheahappens in teens</div></di
v><div><r /></div><div><r /></div><div><r /></div><img src=""paste-5631561118
5543.jpg"" />"
What is the pathogenesis of Neisseria Gonorrhea "<img src=""paste-56650618634584
.jpg"" />"
"<img src=""paste-56693568307583.jpg"" />"
<div>-BOTH. Toddler Epiglottis.
&nsp;Bay Meningitis. &nsp;The incidence of Haemophilus type B illness has fal
len drastically ecause of the vaccine BUT there are parents who do not vaccinat
e or who have kids who cannot e vaccinated. &nsp;They may still get these thin
gs.</div><div><r /></div><div><>MBECS (</>meningitis, epiglottitis, sepsis, s
eptic arthritis)</div><div><r /></div><div><div>Key part = lack of vaccines. &n
sp;Leads you away from other causes.</div><div><r /></div><div>-Diagnose y: C
hocolate agar with Factor 10, 5, CO2, clinical picture, imaging, CSF</div><div><
r /></div><div>-We RUSH them to get admitted, to stailize airway, etc. &nsp;S
tart empiric treatment.</div></div><div><r /></div><div><r /></div>
"<img src=""paste-56796647522659.jpg"" />"
H Ducreyi<div><r /></div><div>H
Nontypale, Moraxella, or H. Parainfluenza</div><div><r /></div><div>H Influen
za egyptius</div><div><r /></div><div>B has a capsule</div>
"<img src=""paste-56925496541528.jpg"" />"
Moraxella
"<img src=""paste-56959856279936.jpg"" />"
Bordatella Pertussis<div><r /><
/div><div>ttachment: FH</div><div>Exotoxin: <>PT (</>riosylates GI, and dis
ales chemokine receptors)<>, EF (</>increases cMP)</div><div>Endotoxin: <>T
racheal Cytotoxin</> (kills ciliated epithelial cells) and <>LPS</></div><div
><><r /></></div><div>Colonizes respiratory tract, Release toxins--&gt;edema,
lymphocytosis--&gt;cugh</div><div><r /></div><div>Suppportive Respiratory trea
tment, vaccine, macrolides</div>
"<img src=""paste-57140244906328.jpg"" />"
Bordatella Pertussis
"<img src=""paste-57166014710132.jpg"" />"
<div>-Pasturella cat; capnocytop
hagia dog</div><div>-Francisella tularensis; ticks on rait are the culprit</di
v><div>**these are oth gram (-) rods!!!</div><div><r /></div>
"<img src=""paste-57316338565466.jpg"" />"
"Legionella<div><r /></div><div
>Warm, moist environments</div><div><r /></div><div>Pontiac Fever (flu like ill
ness that resolves quickly), Legionnaires Disease (Pneumonia with CNS and liver
mannifestations</div><div><r /></div><div>Urinary ntigen Test</div><div><r />
</div><div>zithromycin, cipro, tetracycline</div><div><r /></div><div><img src
=""paste-57552561766876.jpg"" /></div>"
"<img src=""paste-57707180589400.jpg"" />"
<div>This is mycoplasma pneumoni
a which often occurs in clusters of people. Its an atypical pneumonia prevalent o
n college campuses. &nsp;CXR often looks way worse than clinical story and its u
sually a patchy CXR</div><div><r /></div><div><r /></div><div><div>-Gram stain
shows nothing c cell wall is atypical</div></div><div><r /></div><div><div>-C
ell wall is made of cholesterol.</div></div><div><r /></div><div>Treat with azi
thro, cipro, or tetracycline. Not B-lactams due to cell wall issue.</div>
"<img src=""paste-57853209477464.jpg"" />"
Mycoplasma

<div>Girl comes in with walking pneumonia that she caught from her friend.</div><d
iv><r /></div><div>Bay is orn at home and gets no post-natal care. Two weeks
later, he presents to the doctor and the doctor notes corneal opacity and what s
eems to e lindness.</div><div>What could have prevented this?</div><div>What c
an also e caused y this?</div><div><r /></div><div> dude with IDS touches 
irds in the park all the time. He presents with pneumonia.</div><div><r /></div
>
Chlamydia Pneumonia<div><r /></div><div>Chlamydia Trachomatis: Erythrom
ycin drops; LGV, urethritis, PID</div><div><r /></div><div>C Psitacci: Birds</d
iv><div><r /></div><div><r /></div>
"<img src=""paste-57956288692568.jpg"" />"
Chlamydia<div><r /></div><div><
r /></div><div>Rickettsiae</div>
What is the treatment for C. Psittaci&nsp;
doxycycline (Treat like a zoonot
ic)
"<img src=""paste-58025008169304.jpg"" />"
Need to rule out EHEC: IF have H
US, antiiotics could e a lot worse<div><r /></div><div>Shigella invades intes
tinal epithelial cells and secretes Shiga B toxin that destroys 60 S riosome-&gt;stop protein synthesis</div>
"<img src=""paste-58153857188184.jpg"" />"
This is EHEC exhiiting HUS (O15
7: H7 strain). &nsp;Commonly contaminates spinach, red meat, etc. &nsp;HUS pre
sents with triad colored aove of hemolytic anemia, thromocytopenia, and kidney
failure. &nsp;<>NOTE this has no fever; shigella has fever.</><div><><r />
</></div><div>attach to intestinal cell surface via fimrae and secrete shiga-l
ike toxin (does <>not invade cell--therefore no fever)</><r /><div><r /></di
v></div>
"<img src=""paste-59042915418456.jpg"" />"
Salmonella Enterocolitica<div><
r /></div><div><div>SCD kids have no spleen so encapsulated organisms are a BIG
prolem!!! &nsp;They are at increased risk for <>aortic aneurysm, osteomyeliti
s</></div></div><div><r /></div><div><div>Invade intestinal epithelial cells.
&nsp;Trigger inflammation. &nsp;Do NOT invade loodstream; self-limited.</div>
</div><div><r /></div>
"<img src=""paste-59085865091416.jpg"" />"
<div>-She has Yersinia entercoli
tica</div><div>-COLD (@ 4 C)</div><div>-Domestic and wild animal reservoir, also
undercooked pork, and contaminated camp water</div><div>-Diagnose with cold enr
ichment</div><div><r /></div>
What is the pathogenesis of Yersinia Entercolitica?<div><r /></div><div>What is
the pathogenesis of Salmonella Enterocolitica</div>
Invades epithelial cells
--&gt;disseminate in lood--&gt;acteremia--&gt;secretes ST toxin<div><r /></di
v><div><r /></div><div>Invades epithelial cells, triggers inflammation, does NO
T invade lood stream</div>
Which enteroactericiae invades intestinal epithelial cell and disseminates in 
lood?<div><r /></div><div>Which one invades epithelial cell ut does not dissem
inate in lood</div><div><r /></div><div>Which one does not invade epithelial c
ell at all</div>
Yersinia (ST); C Jejuni (LT)<div><r /></div><div>Salmon
ella enterolitica</div><div><r /></div><div>EHEC (no fever)</div>
"<img src=""paste-59304908423512.jpg"" />"
<div>This is Campyloacter jejun
i</div><div>-Invade epithelial cells, disseminate in lood, and secrete LT enter
otoxin</div><div>-Tx fluid/electrolyte replacement, azithromycin</div><div><r /
></div>
"<img src=""paste-59811714564440.jpg"" />"
<div>-This is virio cholera</di
v><div>-Rehydration</div><div>-10%</div><div><r /></div>
What toxin does virio cholera release? B Choleragen: LT (heat laile)--&gt;cM
P--&gt;increase chloride and water secretion
Does virio invade epithelial cells?
No (similar to EHEC)
"<img src=""paste-60430189855075.jpg"" />"
<div>Carries vancomycin resistance</div><div>Meningitis in a neworn</div><div>I
ntraadominal ascess &nsp;</div><div>Dental cavity</div><div>New onset sepsis
+ history of lood in stool for 6 months</div><div>Cellulitis in a fisherman</di
v><div><r /></div>
Enterococcus<div><r /></div><div>Group B (agalactiae) s
trep</div><div><r /></div><div>Milleri</div><div><r /></div><div>Viridens</div
><div><r /></div><div>Strep Gallolyticus</div><div><r /></div><div>Iniae</div>

Pneumonia + diarrhea&nsp;<div><r /></div><div>Pneumonia + ird</div><div><r /

></div><div>Pneumonia in intuated patient; lue-green colonies &nsp;</div><div>
<r /></div><div>Resp failure in CF pt&nsp;</div><div><r /></div><div>Vent pt
+ imipenem use&nsp;</div><div><r /></div><div>Neonatal pneumonia&nsp;</div><d
iv><r /></div><div>Currant jelly sputum, alcoholic&nsp;</div> legionella<div><
r /></div><div>legionella</div><div><r /></div><div>pseudomona</div><div><r /
></div><div>pseudomona</div><div><r /></div><div>stenotrophomona</div><div><r
/></div><div>e coli, group B, listeria</div><div><r /></div><div>Klesiella</di
v>
"<img src=""paste-61499636711744.jpg"" />"
HiB epiglotitis thum sign
<div>Name a major difference in structure etween Haemophilus influenza type B a
nd the non-groupale Haemophilus influenza?&nsp;</div><div><r /></div><div><r
/></div><div><div>What is the growth requirement for H. flu?</div></div><div><
r /></div><div><r /></div><div><div>2 most common clinical manifestations of H.
flu type B?</div></div><div><r /></div>
1. Type B has capsule<div><r />
</div><div>2. X and V</div><div><r /></div><div>3. Epiglottitis and meningtis</
div>
Toxin forming acteria that cause diarrhea
Staph aureus<div>C perfringens</
div><div>B Cereus</div>
rice water stools, toxin-mediated
cholera
"<img src=""paste-62874026246592.jpg"" />"
Bloody diarrhea followed y ascending paralysis -&nsp; c. jejuni
Diarrhea in IDS pt; stacked rick appearance&nsp;
EEC
Nerve damage in Mycoacteria leprae results as a result of what? (2)&nsp;<div>&
nsp;What is palpale?</div><div>Chronic nerve damage results in?</div> 1) direc
t inding of organisms to Schwann cells<div>2) immunologic damage to infected ne
rve cells</div><div><r /></div><div>palpale nerve are characteristic</div><div
><r /></div><div>chronic nerve damage results in&nsp;</div><div>1) loss of sen
sation</div><div>2) lack of sweating with dry skin</div><div>3) predisposition t
o injuries and infection</div>
What does RMSF infect vs Erlichia?
RMSF: infects endothelial cells--&gt;thr
omocytopenia and hyponatriemia<div><r /></div><div>Erlichia: infects WBC--&gt;
thromocytopenia and leukopenia</div>
What causes human monocytotropic erlichiosis and human granulocytotropic anaplas
mos?
Erlichia
capnocytophagia caused y&nsp; cat and dog ights
Parinaud Oculoglandular syndrome
Bartonella: Folllows from contamination
of eye, often from patients own hand
Tick its with local eschar and surrounding lymphadenopathy
Fracisella
"<img src=""paste-74272869450085.jpg"" />"
Pneumonia, high fever, headache hyponatremia, altered mental status, elevated li
ver function test
Legionnaries&nsp;
ssociated with cold gglutinin disease or Stevens Johnson<div><r /></div><div>
Grows on Eatons gar</div>
Mycoplasma
Chronic Ocular Trachoma in frica
Types BC C. Trachomatis<div><r /></div
><div>frica, lindness, chronic</div>
Lymphogranuloma venereum; serum types? Inguinal LD with ulceration caused y t
ypes L1-L3 of C. Trachomatis
Neonatal conjunctivitis and pneumonia; serum types?
D-K of Chlamydia Trachom
atis
If you suspect chlamydia what should you also treat for? What do you give?
lso cover for gonorrhea<div><r /></div><div>Give zithromycin + ceftriaxone</d
iv>
positive chandelier sign for PID (cervical motion tenderness) Chlamydia
"<img src=""paste-76514842378634.jpg"" />"
pseudomona
What organisms have hyaluronidase?
Strep /pyogenes<div>C Perfringens</div>
<div>Staph</div>
Makes extracellular proteins and not surface proteins in stationary phase&nsp;
gr gene in Staph
Which valvse are damaged in Staph aureus vs Strep
Staph: acute--&gt;normal

right sided valves (tricuspid)<div><r /></div><div>strep: suacute--&gt;alread

y damaged left sided</div>
Treatment for Staph
Treat with Nafcillin if not MRS (Nafcillin is of penici
llin class with eta lactamase resistance)<div><r /></div><div>If MRS (treat w
ith vancomycin)</div>
What is the mechanism ehind the negative D test?
"There is an erythromyci
n specific efflux pump that kicks erythromycin out of the cell ut lets clindamy
cin stay -its ok to use clindamycin<div><r /></div><div><img src=""paste-776014
69104627.jpg"" /></div>"
"<img src=""paste-78198469558466.jpg"" /><div><r /></div><div>What if its &lt; 4
8 h after surgery<tr><span class=""pple-ta-span"" style=""white-space:pre""> <
/span>- what if its &gt; 48 h after surgery</tr><tr><span class=""pple-ta-span"
" style=""white-space:pre""> </span>- What if its a diaetic?</tr><tr><span class
=""pple-ta-span"" style=""white-space:pre""> </span>- What if this person was
just itten y a dog or cat?</tr><tr><span class=""pple-ta-span"" style=""whit
e-space:pre""> </span>- What if you see foul discharge + palpate crepitus</tr><d
iv><r /></div></div>" Strep <div><r /></div><div>Staph</div><div><r /></div
><div>Staph</div><div><r /></div><div>Pasteruella&nsp;</div><div><r /></div><
div>Polymicroial</div>
"<img src=""paste-78237124264296.jpg"" /><div><img src=""paste-78250009165981.jp
g"" /></div>" Clostridium Perfringens<div><r /></div><div>Clostridium septicu
m</div><div><r /></div><div>Treat with hyperaric O2, deridement, clindamycin
(inhiit protein synthesis)</div>
"<img src=""paste-78666620993938.jpg"" />"
Scarlet fever: Strep <div><r /
></div><div>Virio Vulnificus</div><div><r /></div><div>eromona Hydrophilia</d
iv><div><r /></div><div>Polymicroial</div><div><r /></div><div>Deridement an
d ax</div>
Mechanism of Toxin  and B in C diff<div><r /></div> <div>Exotoxin  : inds
to rush order of intestine. &nsp; for apple (chocolate rushed on apples). E
xotoxin  causes diarrhea y inding to rush order =watery diarrhea</div><div>
<r /></div><div><div>Exotoxin B: disrupts cytoskeleton integrity y depolymeriz
ing actin= enterocyte death and necrosos-&gt;pseudomemrane that covers colonic
mucosa (pseudomemranous colitis)</div></div><div><r /></div>
How does paralysis pattern differ in C. Botulinum, C. tetanus, and GBS Botulinu
m: descending flaccid paralysis<div>Tetanus: descending spastic paralysis</div><
div><r /></div><div>GBS: ascending paralysis</div>
strict anaeroe that has squash racket appearance
"<img src=""paste-826824
15415482.jpg"" /><div><r /></div><div>clostridium tetani</div>"
"<img src=""paste-82708185219584.jpg"" />"
<div>Thoracic disease: lung mass that extends to chest wall</div><div>Pelvis: as
sociated w/ IUD</div><div><r /></div><div>Treatment?</div>
Penicillin for a
ctinomyces
"<div>42 yo M with IVDU (heroin) presents with slurred speech, diplopia, and dys
phagia. Physical exam showed ilateral ptosis, sluggish pupillary response to li
ght, ilateral CN VII palsies, and multiple skin ascesses on his arms and legs.
Shortly after admission, the dysphagia progressed, necessitating intuation for
airway protection</div><div><img src=""paste-86320252715227.jpg"" /></div>"
C. Botulism
Mnemonic for Diphtheria "<img src=""paste-86470576570725.jpg"" />"
<div>Pregnant pts: flu-like in mom, granulomatous infantiseptica in fetus</div><
div>Perinatal sepsis &lt; 5 days, meningitis &gt;5 days</div><div>On the ddx for
meningitis in old people, along with pneumococcus and meningococcus</div><div><
r /></div>
Listerua
"<img src=""paste-86547885982053.jpg"" />"
<div>Listeria cause meningitis i
n elderly and neonates (give ampicillin to cover)</div><div>1. GBS 2. E coli 3.
Listeria</div><div>B cereus</div><div>B anthrax</div><div><r /></div>
How is pertussis Toxin antiphagocytic? <div>Pertussis toxin: -B toxin  active
; B inds. Turns the off off--&gt; increased cMP--&gt; Intoxicates macrophages. 
ntiphagocytic &nsp;</div><div><r /></div>
cMP inducers "<img src=""paste-87630217740648.jpg"" />"

DP riosylating -B toxins

"<img src=""paste-88141318848962.jpg"" />"
"<img src=""paste-7589207212822.jpg"" />"
D
"<img src=""paste-7627861918484.jpg"" />"
D
"<img src=""paste-7662221656858.jpg"" />"
C<div><r /></div><div>rememer
that Nocardia rasiliensis = skin infections</div><div>Nocardia asteroides = pul
monary infections</div>
"<img src=""paste-7696581395226.jpg"" />"
B, nonsmokers only
"<img src=""paste-7722351199002.jpg"" />"
C<div><r /></div><div>rememer
Nocardia asteroides = pulmonary</div><div>Nocardia rasieliensis = skin</div>
"<img src=""paste-7756710937364.jpg"" />"
D, lots of orgasnisms, no inflam
mation
"<img src=""paste-7786775708442.jpg"" />"
D, skin only + no lungs&nsp;
"<img src=""paste-7821135446806.jpg"" />"
"C<div><r /></div><div><img src
=""paste-13838384627989.jpg"" /></div>"

"<img src=""paste-7855495185174.jpg"" />"
"<img src=""paste-20770461844252.jpg"" />"
B
"<img src=""paste-6635724472688.jpg"" />"
"C<div><r /></div><div><img src
=""paste-14087492731280.jpg"" /></div>"
"<img src=""paste-6670084211042.jpg"" />"
B - never use exposure
"<img src=""paste-6695854014979.jpg"" />"
" - Simon focus roken down<div
><r /></div><div><img src=""paste-14207751815290.jpg"" /></div>"
"<img src=""paste-6721623818676.jpg"" />"
D

"<img src=""paste-6747393622457.jpg"" />"
"<img src=""paste-6773163426329.jpg"" />"
B!!!
"<img src=""paste-6798933230087.jpg"" />"
"C<div><r /></div><div><img src
=""paste-14439680049553.jpg"" /></div>"
"<img src=""paste-6824703033881.jpg"" />"
B<div>supleural fluid - not as
good</div><div>Quantiferon gold test just tells you if they were infected&nsp;<
/div>
"<img src=""paste-6893422510570.jpg"" />"
D
"<img src=""paste-6919192314304.jpg"" />"
"C<div><r /></div><div><img src
=""paste-14650133446740.jpg"" /></div>"
"<img src=""paste-6944962118178.jpg"" />"
B
"<img src=""paste-6979321856535.jpg"" />"
D
"<img src=""paste-7013681594849.jpg"" />"
"D<div><r /></div><div><img src
=""paste-15543486644494.jpg"" /></div>"
"<img src=""paste-7039451398691.jpg"" />"
D - miliary TB
"<img src=""paste-7073811137048.jpg"" />"
C
How is Bezathine administered to treat syphyllis and prophylactically prevent re
infections y Strep Pyogenes? Used once a week to treat syphilis and once each
month for prophylaxis to prevent reinfections y Strep. pyogenes with relapses
of rheumatic fever
Classes of antioitcs that inhiit cell wall synthesis (4). &nsp;What type of 
ugs do they act on?
Beta-lactams, glycopeptides (e.g. vancomycin), lipoglyco
peptides (e.g. televancin), and cycloserine (antiiotic that enters cytoplasm, n
ot a class)<div><r /></div><div><div>May act directly on <>Grampositive</> ug
s. &nsp;Must penetrate OM of Gramnegative ugs!</div></div> antiioticsDM
Mechanism of eta lactams
<div>Penicillin inhiits synthesis of peptidogly
can y inding covalently to highMW PBPs &amp; rendering the enzymes inactive</di
v><div><r /></div><div>PBP = Penicillin Binding Protein (aka transpeptidase &am
p; DDcaroxypeptidase), crosslinks DalaDala</div> antiioticsDM
Penicillin and ampicillin are eta lactamase {{c1::susceptile::susceptile or r
esistant}}
antiioticsDM
ugmentin is eta-lactamase {{c1::resistant::susceptile or resistant}} augmenti
n = amoxicillin+clavulanic acid antiioticsDM
What make ampicillin and amoxicillin efficacious against gram negative acteria?
amino group added to lactam ring
antiioticsDM
4 methods of resistance to original penicillins and amoxicillin 1. enzyme inacti
vation: lactamase reaks active site on lactam ring&nsp;<div><r /></div><div>2
. altered target: mosaic PBPs (pneumococcus w/macrolides; staph w/methicillin; o

vercome w/inc conc)&nsp;</div><div><r /></div><div>3. target ypass (PBP2a in

MRS/S. epidermidis; PBP5 in enterococci; TMP/sulfa resistance)&nsp;</div><div>
<r /></div><div>4. memrane perm : porin mutation (Gram(-) rods, cephalosporins)
; efflux pumps (pneumococcus w/macrolides); intrinsic (Psuedomonas/ cinetoacte
r)</div>
antiioticsDM
What are the 2 anti-pseudomonal penicillins?
piperacillin (used w/ eta-lacta
mase inhiitor) and ticarcillin antiioticsDM
dverse side effects of penicillins? What can you tuse instead of penicillin?
<div>overall low risk of adverse side effects for&nsp;penicillins:&nsp;</div><
div><r /></div><div>type1 hypersensitivity = IgE mediated anaphylaxis (do not g
ive penicillins);&nsp;</div><div><r /></div><div>type2 HS = macular rash, can
still treat w/penicillins (can sustitute 1st gen cephalosporin [cefazolin] for
these patients)&nsp;</div><div><r /></div><div>clavulanic acid cz diarrhea</di
v>
antiioticsDM
Must use actericidal penicillins to treat what conditions?
endocarditis, me
ningitis, and osteomyelitis<div><r /></div><div>actericidal v. acteristatic: n
ot a good distinction ecause most the time it makes no difference (inhiited a
cteria are cleared y host). Only important in dz where acterial persistence ca
n cause damage&nsp;</div>
antiioticsDM
Classes of eta-lactams (5)
<div>Penicillin</div><div><r /></div><div>Cepha
losporin</div><div><r /></div><div>Monoactam</div><div><r /></div><div>Cepham
ycin lactamase resistant</div><div><r /></div><div>Carapenem lactamase resistant</
div>
antiioticsDM
2 important 3rd gen cephalosporins
ceftriaxone and&nsp;cefpodoxime (oral v
ersion of cefotaxime) antiioticsDM
resistance to methicillin and nafcillin (used to treat S. aureus)
MRS due
to target ypass: S. aureus mec gene encoding PBP2a antiioticsDM
reisistance to cephalosporins overuse has led to high resistance in hospitals;
cephalosporins can induce acterial cephalosporinase production in vivo (exten
ded spectrum lactamases); MRS resistance greatly usage
antiioticsDM
Which antioitics cause <>neutropenia