ANS, Cranial Nerves, dorsal root ganglion, Celiac Ganglia, Schwann Cells, Pia, Arachnoid, Bones of the skull, Anterior chamber of eye structures, Chromaffin cels of adrenal medulla,

thyroid and laryngeal cartilage, parafollicular cells, odontoblasts, bones of the inner ear, aorticopulmonary septum,

enteric nervous system, entrochromaffin cells, melanocytes

Serine

Threonine

Asparagine

"Momma Golgi is Serious with her Threat, eat your Asparagus"

I cell disease is a lysosomal storage disorder: failure of addition of a monnose-6-phosphate to lysosome enzymes: enzymes secreted out of the cell instead of being used in lysosome to breakdown stuff:

results in accumulation of stuff in lysosomes (inclusion bodies) clinically: enlarged liver, spleen, coarse faces, mental retardation, motor retardation due to skeletal abnormalities and joint restriction: death before 10 yo.[image]

zygote-->morula-->blastocyst-->inner cell mass & trophoblast

[image]

A3,C3,

D,

F2,

G,L,P,S,

T2,

V,W

ACE inhibitors: renal damge

Alkylating agents: absence of digits, mulitple anomalies

Aminoglycosides: CN 8 toxicity

Carbamazepine: neural tube defect, craniofacial, fingernail hypoplasia, developmental delay, IUGR

Clarithromycin

Chloramphenicol

Diethylstilbestrol: DES: vaginal clear cell adenocarcinoma: mullerian anomalies

Flourouquinolones

Folate Antagonists (methotrexate and pyrimethamine): neural tube defects

Griseofulvin

Lithium: Ebstein's anomaly (atrialized tight ventricle)

Phenytoin: many problems

Sulfonamides

Tetracycline: discolored teeth

Thalidomide: limb defects

Valproate:inhibition of folate absorption: neural tube defects

Warfarin: bone deformities, fetal hemorrhage, abortion, opthalmologic abnorm.

Cyclin D-CDK4

&

Cyclin E-CDK2

Cyclin A-CDK2

&

Cyclin B-CDK1

Hepatocytes

&

 Hormone producing cells of the adrenal cortex

Mebendazole/Thiabendazole (helminth)

Griseofulvin (fungal)

Vincristine/Vinblastine (cancer)

Paclitaxel(breast cancer)

Colchicine (gout)

CT: Vimentin

Muscle: Desmin

Epethilium:Cytokeratin

Axon: Neural filaments

*can be used as tumor marker to determine the origin of the tumor*

Proline

Arginine

Lysine

Remember: you have to be "PAL" to get into the nucleus

dyenein arm defect:

immotile cilia

bronchiectasis

infertility

situs inversus[image]

Corticosteroids: PLA2 inhibitor

Zileuton: LOX inhibitor

Aspirin, NSAIDs, acetaminophen, COX2 inhibitors: COX inhibitor

Zafirluklast, Monteklast: LTC4 and LTD4 receptors

A cardiac glycoside: which directly inhibits the Na-K ATPase causing an increase in intracellular CALCIUM and an increase in cardiact CONTRACTILITY

used to treat A-fib and CHF

hydroxylated and glycosylated proline and lysine

(proline and lysine are found in elastin too, but not modified)

Type I:Strong (bone, wound repair) Osteogenisis imperfecta

Type II:Slippery (cartilage, nucleus pulposis,vitreous body)

Type III:Bloody (BVs, skin, granulation tissue, uterus, fetal tissue) Ehler's Danlos

Type IV:BM (basement membrane) Alports syndrome

Rolling : selectins

Tight binding: integrins

Diapedisis: PECAM-1

Migration: IL-8, LTB4, Kallikrein,C5a

a TNF-alpha blocker which breaks down granulomas. used for chronic inflammation like RA or Crohn's

*must do PPD before treatment bc if used on someone with latent TB, it can reactivate TB by breaking down the granulomas*

Hyperelastic skin

Hypermobile joints

easy bruising

easy bleeding

berry aneurysms

(Type 3 collagen defect)

cousin nadia: 3 SISTERS

rare autosomal recessive disorder caused by a mutation of a lysosomal trafficking regulator protein

-decrease in phagocytosis. 

-recurrent pyogenic infections,

-partial albinism

-peripheral neuropathy.[image]

Wear and tear pigment: sign of aging: yelow-brown pigment containing residues of lysosomal digestions. found in the liver, kidney, heart muscle, retina, adrenals, nerve cells, and ganglion cells

[image]

Cerebral hemispheres, basal ganglia, hippocampus and amygdala

[image]

Thalamus, hypothalamus and the optic nerves and tracts

[image]

Failure of the neuropores to fuse in the 4th week resulting in a persistent connection between amniotic cavity and spinal canal

associated with Low Folic acid intake before conception and during pregnancy

elevated alpha-fetoprotein in amniotic fluid and maternal serum along with increase AChesterase

[image]

elevation of AFP in maternal serum AND amniotic fluid

and elevation of Acetylcholinesterase

If you see a tuft of hair/dimple upon newborn exam in the lumbo-sacral region what should you be concerned about?

[image]

spina bifida occulta: failure of bony spinal canal to close, but no structural herniation

[image]

A meningocele is herniation of the meninges only through a spinal canal defect.

A myelomeningocele is herniation of the meninges and the spinal cord through a spinal canal defect.

Sonic hedgehog protein defect

failure of L and R hemispheres to septate

moderate: cleft lip/palate

severe:cyclopia

also associated with Patau syndrome (trisomy 13) and Fetal Alcohol Syndrome

[image]

What is anencephaly and its characterististic?

anterior neural tube defect:

no forebrain, open calvarium

elevated AFP, polyhydramnios (no fetal swalling center)

associated with maternal type I diabetes and low folic acid[image]

Posterior fossa malformations

-cerebellar tonsillar and vermian herniation through foramen magnum with acqueductal stenosis and hydrocephalus

I:mild, subclinical

II-IV:clinical symptoms: thoacolumbar myelomeningocele and

Syringomelia

[image]

A posterior fossa malformation like Arnold-Chiari

-agenisis of cerebellar vermis with cystic enlargement of 4th ventricle

associated with spina bifida and hydrocephalus

[image]

A cystic enlargement of the central canal of the spinal cord: crossing fibers of the spinothalamic tract are typically damaged first.

assoc with chiari malformation I

cape like bilateral loss of pain and temperature sensation in upper extremeties

(fine touch is preserved)

usually C8-T11

[image][image]

RER staining in the cell bodies and dendrites

(NO RER IN AXONS)[image]

Astrocytes:physical support, repair K metabolism, removal of excess NT, maintains BBB, reactive gliosis in injury,  marker is GFAP for astrocyte tumors

Microglia:Phagocytes, make multinucleated giant cells in response to HIV

Oligodendroglia:destroyed in MS, look like fried eggs on H&E

Ependymal cells: arises from neuroectoderm, line ventricles and make CSF
Schwann cells:myelinates one axon in PNS, promotes axonal regeneration, destroyed in Guilan Barre Syndrome, associated with acoustic neuroma (schwannoma) NFtype II

[image]

ENDOTHELUM

(nonfenestrated capillary endothelial cells)

BASEMENT MEMBRANE

ASTROCYTE FOOT PROCESSES

What is excessive Norepinephrine associated with?

low levels?

excessive: anxiety and mania

low: depression

Locus ceruleus

reticular formation

solitary tract

MesoCor-MesoLim-NigroStri-TuberoIn

Mesocortical Pathway: ventral tegmental of midbrain to cortex

blocking: increase in negative symptoms of psychosis

Mesolimbic Pathway: ventral tegmental of midbrain to limbic system. primary target for anti-schizo drugs

blocking: relief of psychosis

Nigrostriatal Pathway: substantia nigra(pars compacta) to the striatum (caudate and putamen)

blocking: parkinsonian symptoms

Tuberoinfundibular pathway: arcuate nucleus of hypothalamus to pituitary

blocking: increase in release of prolactin from pituitary

gynecomastia, galactorrhea and ameonrhhea 

[image]

Chlamydia species

(sketchy)

(serotonin)

depression, anxiety and decreased alertness

originates in the Raphe nucleus

"You are missing Sera so you will be sad, anxious and just wanna sleep until she comes back"

Alzheimer's and Huntington's disease

(increased in parkinsons)

What amino acid is GABA synthesized from?

what cofactor does it require?

What happens if there is a deficiency?

Where is it synthesized?

Glutamate-->GABA

needs Vitamin B6 (PYRIDOXINE)

main inhibitory NT of CNS

deficiency of B6 can result in convulsions bc less inhibition

decreased in HD: chorea

synthesized in nucleus accumbens

[image]

Mediates consciousness, attentiveness, and alertness Consists of the reticular formation, locus ceruleus, and raphe nuclei

lesions cause coma

[image]

Connective Tissue Disease

Sicca complex: Dry eyes, dry mouth

Rheumatoid Arthritis

Antibodies to SS-A(Ro) or Anti-SS-B(La), increased IgG, leukopenia, thrombocytopenia

[image]

RA:inflammatory

erosions

onset 35-45

begins over months

symmetric

systemic

MCP,PIP

OA:noninflammatory

spur formation

onset after 40

begins over years

asymmetric

involves ONLY joints

DIP, PIP, LS spine

[image]

a connective-tissue disease related to polymyositis that is characterized by inflammation of the muscles and the skin. characterized by symmetrical proximal muscle weakness,  plaque like lesions over MCP, DIP, and PIP: Gottron's papules and heliptrope rash over eyelids (young children can get calcinotic lesions in BVs of legs)

must measure muscle enzymes (CPK, Aldolase, LDH, Neopterin and vWF antigen) along with RF, ANA

[image][image]

symptom of various connective tissue diseases like scleroderma, dermatomyositis, polymyositis, Sjorgrens, SLE, and others..

caused by vasospasms resulting in excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas.

[image]

An autoimmune connective tissue disease characterized by hardening of the skin. previously called CREST syndrome for the symptoms: Calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, and telangiectasia

check for Ant-centromere (limited) and Ant-SCL70(diffuse)

localized can cause morphea: hardened lesions

[image]

28 year old woman: notice skin tightening around lips

[image]

Polyarteritis Nodosa

Kawasaki's Disease

A medium vessel vasculitis that causing multisystem necrotizing vasculitis of small and medium vessels occuring at the bifurcations of arteries resulting in intmal proliferation, wall degeneration, and fibrinoid necrosis leading to occlusion and ischemia to end organs.

splinter hemorrhages, painful nodules, livedo and purpura, testicular pain, mononeuritis multiplex

sausage link look from dilatation and narrowing

associated with Hep B (10-30%)

NO PULMONARY INVOLVEMENT

[image]

[image]

sausage link

[image]

[image]

Acute systemic vasculitis, leading cause of acquired heart disease in children in developed countries

-self limited usually involving primarily the coronary arteries

child under 5 yo.

sx: high fever>5days

bilateral nonexudative conjunctivitis

strawberry tongue

cracked lips

oropharyngeal erythema

rash , edema

cervical LAD

very high platelet count and size increase

increase liver enzymes

Tx: important to prevent CAD: high dose aspirin and IVIG

[image][image]

What are two large vessel vasculitis?

Giant cell arteritis

Takayasu's arteritis

aka cranial or temporal arteritis

inflammation of the medium and large arteries branching from the carotid, particulary the temporal. with headache, scalp pain, tender artery, fever malaise, fatigue, anorexia, weight loss, sweats, jaw caludication EMERGENCY: BECAUSE CAN LEAD TO OPTIC NEUROPATHY

Tx: high dose steroids

>50yo, more in women, rare in blacks

segmental involvement: with giant cells

assoc. with polymyalgia rheumatica (stiffness, aching and pain in the neck, shoulders, low back, hips and thighs

elevated ESR

[image][image]

[image]

large and medium vessel arteritis usually inolving te aortic arch and its branches

mostly affects girls and Asian women

histology is the same as Giant cell arteritis

check pulses and perform angiography

Tx prednisone perhaps comb with methotrexate/mycophenolate

[image]

[image]

Granulomatosis with polyangiitis

Churg Strauss Syndrome

Microscopic polyangiitis

aka Wegener's

small vessel granulomatous vasculitis of:

upper and lower respiratory tracts

glomerulonephritis

can involve any organ system

more commly in middle aged whites

eye involvement

skin lesions

nasal septal perforation->saddle nose

eustachian tube blockage->otits media

tracheal stenosis-->airway obstruction

cardiac involvement

CNS

pulmonary:cough, hemoptysis, dyspnea, chest discomfort

Renal:high mortality if untreated

C-ANCA

ANCA- PR3

Tx: glucocorticoid, prednisone, cyclophosphamide, rituximab

[image][image]

Churg Strauss

aka allergic granulomatosis and angiitis

often see nasal polyps

p-ANCA

small vessel vasculitis that tends to involve the kidneys more than the lungs

histologically similar to PAN

75% ANCA: anti-myeloperoxidase

[image]

Henoch-Schonlein Purpura

IgA

usually see peak in the spring

Hep C

These disease are also linked to Hep C:

Multiple myeloma, lymphoproliferative disorders, connective tissue disease, liver disease

What is Bechet's Syndrome?

leukocytoclastic venulitis with fibrinoid necrosis

most commin in mediterranean, middle east and far east ppl

recurrent apthous ulcers, painful, shallow or deep with necrosis (can involve genitals)

bilateral eye involvment

may have GI ulcerations

[image]

dry, thickened, scaly or flaky skin

commonly genetic

[image]

rare AR disease of thick ridged cracked skin. Usually fatal

[image]

thick taut membran

e that cracks with respiration and may shed leaving normal or abnormal skin[image]

What is this ?

[image]

What is this?

[image]

Arthrogryposis Multiplex Congenita

widespread joint contractures  due to failure of muscle development, decreased fetal movement

What is this baby's condition called?

[image]

Amelia: complete absence of limb. suppression of limb bud development in week 4

Merolemila: partial absence of limb. arrest/disturbance od diferentiation/growth in week 5

(a form is ectrodactyly)

What condition does this family have?

[image]

Ectrodactyly: a form of meromelia resulting in hand/foot, lobster claw deformity. absent central digit, with developmental failure of one or more digital ray.

What form of meromelia is characterized by the absence of a thumb specifically?

[image]

congenital absence of radius: failure of radial mesenchyme primordium formation in wk 5

What disorder does he have?

[image]

Achondroplasia: mutation in FGFR3causing failure of long bone growth

Autosomal dominant: homozygous can be fatal

Thanatrophoric Dysplasia

FGFR3 defect

femurs are refered to as french telephone receiver

most die in newborn period

[image]

AR lysosomal storage disease caused by deficiency in Glucocerebrosidase causing glucocerebroside to accumulate in macrophages

Gaucher cells: crumpled paper cytoplasm

Type I:nonneuropathic, milder

Sx:hepatosplenomegaly, bone erosion, fracture, pain

Tx:enzyme replacement

[image][image]

What is happening in this bone?

[image]

Osteomyelitis

Tx: antibiotics, surgical drainage

Primariy caused by pyogenous bacteria-S.aureus (80%)

metaphysis usually affected in children

epiphysis and subchondral areas in adults

Who is most at risk for osteomyelitis caused by salmonella?

Sickle cell patients

more prone to infections by encapsulated bacteria [image]

Sequestrum and Involucrum

Sequestrum: necrotic bone in acute inflammation

Involucrum: new bone forms a sleeve around dead infected bone [image]

This is a picture of? And what gene is it associated with?

[image]

Osteochondroma

• inactivation of EXT1 gene in sporadic tumors
• encodes proteins for proteoglycan biosynthesis and reduced expression causes ineffective endochondral ossification

What bone dysfunction is most often in young male, causing nocturnal pain and relieved by aspirin/NSAIDs ususally in the proximal femur?

What is causing the pain?

Osteoid Osteoma

most common site is proximal femur

pain caused by prostaglandin E2 made by tumor

tumor nidus is radiolucent, well defined and circumscribed zone surrounded by sclerotic bone

[image] [image]

dont confuse with osteoblastoma which is mostly in spine and long bones with dull achy pain

fibrous dysplasia

70%:monostic

polyostic can involve the carniofacial, pelvic, shoulder girdle regions and be more severe

[image] [image] [image]

What is this? What gene is associated?

[image]

Aneurysmal Bone Cysts

benign, but rapidly growing

translocation 17p13 upregulating

USP6 gene which encodes a protease that upregulates NFkB which increases metalloproteases

Malignant osteoblasts making bone matrix

most common primary malignant bone tumor

bones of the knee most commonly

young patients

Tx:chemo followed by surgery

poor prognosis if metastasis to lungs

Rb gene mutation

p53 mutations

INK4a mutations and p14

[image]

Ewing sarcoma and Primitive neuralectoderm tumor

EWS and PNET

small blue cell tumors

affects adolescents and rarely AA

present w/ tender masses, fever, leukocytosis mimicking acute osteomyelitis

What does this child have? What other sx would you observe?

[image]

Hand-Schuller Chrisitan Disease

a type of Langerhans Cell Histiocytosis[image]

rare: lytic skull lesions, diabetes insipidus, exopthalmus

Langerhans Cell Histiocytosis

[image]

osteoclast dysfunction: gain in bone mass

common in caucasians

Can be polyostotic or monostotic

increased risk of osteosarcoma

[image]

aka avascular necrosis: ischemia from vessel damage, obstruction, embolism, injury caused by trauma, steroids, infection, XRT, connective tissue disease, alcohol, SS, idiopathic

usually causes damage to femoral head [image]

hands: increased risk for osteosarcoma

overgrowth of cartilage, benign adult bone tumor

[image]

Chondrosarcoma:painful enlarging mass, buly tumor, most de novo but can arise in endochondroma or osteosarcoma

adult bone tumor

common in axial skeleton,

rare in distal extremities

dedifferentiated: worse prognosis

Adult bone tumor: osteoclastoma

benign, locally aggressive, cystic degeneration

collection of mononuclear tumot cells expressing RANKL which promotes proliferation of osteoclasts

knee is common site

[image]

Ankylosing Spondylitis

(remember assoc. with HLAB27)

Acute gout

(remember parallel :yellow)

[image]

decreased GABA

increased NE

Limbic system

[image]

the suprachiasmatic nucleus of the hypothalamus

"You need sleep to be charismatic"

MELATONIN

[image]

the Anterior hypothalamus (also called preoptic:GnRH release)

Anterior/Cooling: A/C Please

Coolin and Parasympathetic

 also releases GnRH

[image]

Posterior Hypothalamus

responsible for heating and sympathetic

[image]

Supraoptic nucleus of the hypothalamus

produces ADH and thus regulates water balance

[image]

Ventromedial nucleus of the hypothalamus stimulates satiety

stimulated by leptin

"If you injure your VM, you grow ventrally and medially"

[image]

Lateral nucleus of the hypothalamus stimulates hunger and is thus inhibted by leptin

[image]

The paraventricular and supraoptic nuclei of the hypothalamus

[image]

The area postrema which is not protected by the blood brain barrier

[image]

releases many hormones (CRT, GHRH, TRH, somatostatin, dopamine) to the anterior pituutary and regulates hunger and satiety

[image]

neuroectoderm

recieves projections from supraoptic (ADH/vasopressin) and paraventricular(oxytocin) nuclei

List the stages of Sleep and the associated EEG waveforms for each:

Awake(eyes open)

Awake(eyes closed)

Stage 1

Stage 2

Stage 3

REM

Awake (open):Beta

Awake (closed): Alpha

Stage 1 (light sleep): Theta

Stage 2 (45% of sleep here:deeper/bruxism): Sleep spindles and K complexes:

Stage 3 and 4(deepest nonREM-slow wave: sleep walking, night terrors, and bedwetting): Delta

REM: Beta (brain uses a lot of oxygen here;looks like u are awake)

"at nights, BATS Drink Blood

Acetylcholine

Think about REST and DIGEST

[image]

decreases slow wave sleep (stage 3 and 4)

Decreases REM latency (increases total REM)

increases REM early in sleep cycle

repreated nighttime awakenings

early morning awakening (screeening question)

Stage 2

they have a hard time getting to REM sleep

every 90 minutes

duration of REM increases through night

time to get to REM sleep decreases during the night

What neurotransmitter is essential for initiating sleep?

What neurotransmitter is essential for REM sleep?

Serotonin for initiation

Acetylcholine for REM

PPRF

Paramedian Pontine Reticular Formation

they decrease

REM sleep

and Delta sleep (slow wave: stage 3and 4)

so you sleep more like an old person and you lose high quality sleep

melatonin: not very effective, causes vivid dreams, safe for less than 3 months

valerian and chamomile: OTC herbals

Antihistamines:poor sleep quality, not for long term, avoid in elderly

Trazadone: Antidepressent: increases REM sleep, small risk of priapism

TCAs: Antidepressant, small risk of arrhythmias, avoid in elderly

Long acting benzos: addictive, short term (less than 35 days)

Zolpidem: long acting benzo like

Lunesta: may be used long term

Ramelteon: non addictive bc acts on melatonin receptors instead of GABA/benzo receptors, not for hepatic pts

Darkness causes suprachiasmatic nucleus to release NE

which stimulates the pineal gland to release melatonin

What is this picture showing. It is an embryological anomaly that is lateral and does not move with swallowing. Why does it occur?

[image]

Branchial Cleft cyst caused by persistence of the cervical sinuses derived from he second to fourth branchial/pharyngeal clefts that should have been obliterated

[image]

What does the third pharyngeal/branchial pouches become?

the fourth pouch?

Third: inferior parathyroid and the thymus

Fourth: superior parathyroid

DiGeorge Syndrome

CATCH22

Cardiac defects

abnormal facies

thymic aplasia-->low T cells-->recurrent viral/fungal and other infections

Cleft palate

hypoCalcemia-->tetany

immature T cells

22q11 deletion

M and T structures

mandible

meckel's cartilage

malleus

mandibular ligament

muscles of mastication

masseter

medial and lateral pterygoid

myohyoid

temporalis

antertior two thirds of the tongue

tensor tympani

tensor vali palatini

nerve innervation: mandibular and maxiallary branches of Trigeminal

[image]

[image]

 [image]

Treacher-Collins Syndrome (another T word)

facial abnormalities with usually little to no mental dysfunction

[image]

S structures

stapes

styloid process

styloid-hyoid ligament

lesser horn of hyoid

stapedius

innervation: cranial nerve Seven (7)

-muscles of facial expression

Pharyngeal:

stylo-pharyngeus muscle

innervation: glossopharyngeal nerve

congenital abnormality:pharyngo-cutaneous fistula

[image]

CricoThyroid and Larynx

innervation: laryngeal branches of vagus nerve

innervate muscles of the larynx (except cricoid)

superior laryngeal: swallowing

recurrent laryngeal :speaking

Label the 12 cranial nerves

[image]

know this

[image]

Which cranial nerve is responsible for:

eyelid opening:

taste from anterior 2/3 of tongue:

head turning:

tongue movement:

eyelid opeing: CNIII (oculomotor)

taste from anterior 2/3 of tongue: CN VII (facial)

head turning: CN XI (accessory)

tongue movement: CN XII (hypoglossal)

Which cranial nerve is responsible for:

muscles of mastication:

balance:

monitoring the carotid body and sinus chemo and baroreceptors:

muscles of mastication: CN V (Trigeminal)

balance:CN VIII (vestibulocochlear)

monitoring the carotid body and sinus chemo and baroreceptors: CN IX (glossopharyngeal)

What would cause this abnormality?

[image]

lesion of CN VI (Abducens)

Name the lesion.

Eye looks down and out with ptosis, pupilary dilation and loss of accomodation

CN III

(uncal herniation)

Name the lesion.

Eye moves upward, partcularly with contralateral gaze and ipsilateral head tilt. difficulty looking down causing diplopia (problems going down stairs)

CN IV

[image]

Name the lesion.

medially directed eye that can't abduct.

Have patient look UP

(IOU)

KNOW IT!

OTOMAI

Occulomotor, Trochlear, Opthalmic, Maxillary, Abducens, Internal carotid

What structures run through the cavernous sinus?

Internal carotid artery, pituitary gland, extraocular muscle nerves (oculomotor, trochlear and abducens), V1 and V2 of trigeminal nerve (opthalmic and maxillary), postganglionic sympathetic fibers en route to orbit

[image]

To Zanzibar By Motor Car

Temporal

Zygomatic

Buccal

Mandibular

Cervical

[image]

What muscles cause the jaw to close?

And what is their innervation?

Masseter

Temporalis

Medial pterygoid

(all innervated by mandibular division of trigeminal nerve)

[image]

Lateral pterygoid

mandibular division of trigeminal nerve

[image]

 The parotid gland

[image]

glossopharyngeal nerve

CN IX

Having the patient say:

Mi mi mi

la la la

khu khu khu

tests what nerves?

mimimi: facial (muscles of mastication)

lalala: hypoglossal (tongue)

khukhukhu: vagus (elevation of palate)

CN VIII

VESTIBULOCOCHLEAR

Where are the CN nuclei located in brainstem?

CN III & IV: midbrain

CN V, VI, VII, VIII: pons

CN IX, X, XI, XII: medulla

[image]

nucleus SolitArius: taste, baroreceptors, gut distension

Nucleus Ambiguus: motor to pharynx, larynx and upper esophagus

Dorsal Motor nucleus:: misnomer-autonomic information to heart, lungs, upper GI

NASA Motor

Nsolitarius: think about eating alone

Nambiguus: think A for Action

Dorsal motor: think misnomer

[image]

Hoarseness

difficulty swallowing

loss of gag reflex

Preoptic area of hypothalamus

Dorsal Motor nucleus

Vagus Nerve

Posterior and Lateral Hypothalamus

Sympathetic Ganglion T1-L3

injury to the superior cervical ganglion causing ptosis, miosis, anhydrosis

[image]

intercalated cells: aldosterone stimulates acid secretion

prinicipal cells: aldosterone increases Na reabsorption and K secretion

Acetazolamide

respiratory alkalosis from hyperventialtion so acetazolamide is a

carbonic anhydrase inhibitor to help you excrete bicarb and alkalanize the urine

also treats glaucoma

SULFA DRUG

can cause metablic acidosis

Spirinolactone

K sparing, aldosterone antagonist but binds to androgen receptors; therefore, can be used to treat acne and PCOS

LOOP diuretics

(furosemide..etc)

Thiazide diuretic

acts at the Distal tubule

Name the lesion

scapular winging

name the lesion

loss of forearm pronation

name the lesion

cannot abduct or adduct fingers

name the nerve damaged

weak lateral rotation of th arm

name the damaged nerve

unable to abduct arm beyond 10 degrees

acute interstitial nephritis

can be drug induced and treated with corticosteroids

What neoplasm is associated with down's syndrome

cardiac rhabdomyoma

astrocytoma

angiomyolipoma

Legionella

test urine if suspect the cause of pneumonia

Linezolid (oral)

used for MRSA and VRE

Macrolides to doo

Milk (calcium)

magnesium

iron-containing preparations

Nephrotoxic

Ototoxic

Teratogenic

"NOT"

"SAT"

Sulfonamides

Amiodarone

Tetracyclines

grey baby: Chloramphenicol

Grey MAN: Amiodarone

RED MAN: Vancomycin

URIs

Pneumonia

STDs

gram positive infections in Penicillin-allergic pts

Atypical pneumonia

Only DNA virus that is not double stranded

Penicillins

Piperacillin

Cephalosporins

Macrolides

Metronidazole AFTER 1ST trimester

Nitrifurantoin (esp for UTIs)

Foscarnet

Ganciclovir

Zanamivir

Oseltamivir