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Libman–Sacks endocarditis?- Postmortem studies describe mulberrylike clusters of verrucae on the ventricular surface of the posterior mitral leaflet, often with adherence of the mitral leaflet and chordae to the mural endocardiumLibman–Sacks endocarditis?(often misspelled?Libmann-Sachs) is a form of nonbacterial?endocarditis?that is seen in?systemic lupus erythematosusCaissons disease - This condition, also known as the bends or decompression sickness, is caused by the formation of gas bubbles in the body. Human body tissues contain small amounts of the gases present in the air. At great depths underwater, because of the increased air pressure, larger amounts of gas can be held in solution in the body. However, when a diver or underwater construction worker rises to the surface of the water, the pressure decreases and the gases come out of solution.?Nitrogen bubbles in the respiratory system can cause excessive coughing and difficulty in breathing. Other symptoms include, chest pain, dizziness, paralysis, unconsciousness or blindness. In extreme cases, caisson disease can cause deathCellular dysplasia involves atypical cells that do not invade the basement membrane.AFP is the tumor marker for hepatoma and yolk sac tumors, enolase is the marker for neuroblastomaAchalasia is caused by nerve dysfunction. It is characterized by a decrease in propulsion of food down the esophagus. Hence, there is a decrease in peristalsis.Wiskott-Aldrich syndrome is a combined B- and T-cell pathology which is caused by defective IgM response to bacterial LPS.Job syndrome is a disease characterized by pathological T cells. In this syndrome, T-helper cells are not producing interferon-gamma. Thus, there are increased bacterial infections due to poor PMN chemotaxis. There is also an increase in IgE levels. Staphylococcus aureus is a common infection seen with this disease.antibodies are secreted by either B cells (IgM-monomer, IgD), mast cells, basophils and eosinophils (IgE), or plasma (IgM-pentamer, IgG).Cafu liat spots – tuberous sclerosis, mc cune albright syndrome, fanconi anemia, neurofibromatosis, ataxia telengectasia, maffucci syndrome, wiskot Aldrich syndromeAgonal thrombi are intracardiac and caused by prolonged heart failure.Gaisbock syndrome – polycythemiaIn nephrogenic diabetes insipidus, ADH production and secretion is normal, but there is resistance of ADH receptors.Ketoacidosis is rare in type II diabetes, but a very common concern in type I diabetics.Cyanide poisoning causes malfunction of oxidative phosphorylationMercury poisoning causes renal tubular necrosis as well as pneumonitis, GI ulceration, and gingival lesionsTrichinella spiralis causes trichinosis. It can be transmitted from ingestion of undercooked meat. It causes muscle pain, periorbital edema, fever, and eosinophilia.Cryptosporidium parvum is transmitted via fecal-oral route and causes giardiasis.hepatitis B and hepatitis A have vaccines (hepatitis A → killed vaccine; hepatitis B → immune globulin vaccine/ passive immunity and subunit vaccine/active immunity).Hemoptysis- pneumonia, tuberculosis, bronchitis, idiopathic pulmonary hemosiderosis.Free radicals can cause various forms of cellular injury. These include membrane lipid peroxidation, nucleic acid denaturation, and cross-linking of proteinsMetastatic calcification – normal tissue, Dystrophic calcification is the calcification of degenerate or necrotic tissue. The serum calcium levels remain normal. The pathogenesis is enhanced by collagen and acidic phosphoproteins, and it is commonly seen in hyalinized scars, degenerated leiomyoma foci, caseous nodules, damaged heart valves, and atherosclerotic plaquesStable angina is the most common type of angina. It is seen with coronary artery disease and atherosclerotic narrowing, and it is precipitated by exertion.Prinzmetal angina is seen clinically as intermittent chest pain at rest. It is due to vasospasm.Unstable angina will occur even at rest. It is the most severe coronary artery disease, and could be a sign of oncoming myocardial infarctWerdnig-Hoffman disease is neurodegenerative disease seen with floppy babies (Medulloblastoma is a highly malignant cerebellar tumor that is also of primitive neuroectodermal origin. This type of tumor occurs in childrenAn ependymoma is a tumor which occurs in children. This happens, often, in the 4th ventricle, can cause hydrocephalusFunctional outer aspect (FOA) : Small area of the noncentric cusps --> have functional significance --> located on the inner incline of the non centric cusps near the central fossa --> contact with or close to a small portion of the outer aspect of the opposing centric cusp.The cingulum of the mandibular lateral incisor is slightly distal of center (similar to the maxillary central incisor and mandibular canine).The cingulum of the maxillary lateral incisor is centered (similar to the maxillary canine and mandibular central incisor).The articular eminence is located just anterior and inferior to the articular (glenoid) fossa. The functional portion is on the posterior inferior aspect of articular eminence where the mandibular condyle (and intervening articular disc) rubs against during mandibular movementFour determinants of occlusion: the right and left TMJs, the neuromusculature, and the teeth. As a dentist, the only one that can be directly controlled is the teeth (by restorations, orthodontics, and equilibration).Cervical enamel projections (CEPs) are apical extensions of enamel located at furcation entrances on molar teeth (28% mandibular, 17% maxillary). CEP size can vary greatly from small projections at the CEJ to larger extensions into the furcation proper. They are most commonly found on buccal surfaces. In decreasing order of incidence: Mandibular 2nd molars > Maxillary 2nd molars > Mandibular 1st molars > Maxillary 1st molars.Mandibular 2nd molar, the order from largest to smallest cusps is ML > DL > MB > DB. The same is true for the four major cusps of the mandibular 1st molar; the minor 5th distal cusp is the smallest of all (ML > DL > MB > DB > DA type II canal system has two separate canals leaving the pulp chamber, but later merge together just short of the apical foramenA type I canal system has a single canal from the pulp chamber to the apical foramenA type III canal system has two separate canals leaving the pulp chamber which exit the root at two separate apical foramina.A type IV canal system has a single canal leaving the pulp chamber, but dividing into two separate canals which exit the root at two separate apical foramina.The condyles are in the terminal hinge position during centric relation (CR). This is the most superior and anterior position along the articular eminence of the glenoid fossa, with the articular disc located in betweenThe occlusal table of the mandibular 2nd premolar is the most square shaped.Deficiency of vitamin K produces a clotting disorder characterized by an elevated prothrombin time and easy bleeding, particularly in neonates (hemorrhagic disease of the newborn). The biochemical basis for this hemorrhagic tendency is that glutamate residues on Factors II (Thrombin), VII, IX, and X must be converted to gamma-carboxyglutamate residues (in a vitamin Krequiring reaction) for optimal activityVitamin B12 required forConversion of homocystein to methioneConversion of methylmalanoyl coA to succinyl co AGlucose absorbed in small intestineGastric inhibitory peptide, or GIP stimulates pancreatic insulin secretion at physiologic doses and inhibits gastric acid secretion and gastric motility at pharmacologic dosesVasoactive intestinal polypeptide, or VIP relaxes intestinal smooth muscle and stimulates gut secretion of water and electrolytes.Spermatogonia ----- Primary spermatocyte --- first meiotic division, crossing over occure in prophase of meiosis 1 --- 2 secondary spermatocyte --- 4 spermatids which are haploid due to secondary meiotic division ---- located in lumen of seminiferous tubules ----spermatozoa theough spermiogenesisdecrease in extracellular fluid and the increase in osmolarity act as stimuli for increased thirst and increased secretion of ADH.Neural tube defects most commonly occur in the lumbosacral region, typically resulting in motor and sensory deficits in the lower extremities, and bowel and bladder dysfunction.Ketone bodies are derived from adipose triglyceridesMajor regulator of cerebral blood flow is CO2 which causes vasodilationIn oogenesis, the process of meiosis begins before birth and arrests between birth and puberty in prophase I. In contrast, spermatogenesis does not begin until pubertyPenile erection is mediated by the parasympathetic nervous system. The neurons involved are termed nonadrenergic, noncholinergic (NANC) autonomic neurons, and they release nitric oxide (NO).Antipyrine and tritium are both markers for total body water.Cresyl violet is a histologic dye used to stain Missl substance in neurons. It stains cell bodiesEvans blue and I 131 albumin are markers for plasma compartment Inulin marker for extracellular fluidAlpha-1 adrenergic receptors are coupled to the G protein, Gq. This G protein causes breakdown of the membrane phospholipid phosphatidylinositol bisphosphate (PIP2), forming the products diacylglycerol, which stimulates protein kinase C, and inositol triphosphate (IP3), which releases calcium from the endoplasmic reticulumBeta-1 adrenergic receptors like all beta receptors, are coupled to the Gs G protein, leading to the activation of adenylate cyclase. This increases intracellular concentrations of cAMP by converting ATP to cAMP. cAMP in turn stimulates protein kinase A, also known as cAMP-dependent protein kinaseGamma-aminobutyric acid, type A receptors are not G-protein-coupled receptors, but are instead ligand-gated ion channel receptors. Stimulation of these inhibitory receptors causes a chloride flux, thus stabilizing the membrane potential of the cell.Nicotinic cholinergic receptors are not G-protein-coupled receptors, but are instead ligandgated ion channel receptors. Stimulation of these receptors causes sodium influx, leading to excitation of the cells.Corpus luteum secretes estrogens, progesterone, and relaxin.Eosinophils are involved in late-phase type I hypersensitivity reactions and type II antibody-dependent cell cytotoxicity reactions directed against parasitesIn severe anemia, diminished transport of oxygen in the blood leads to hypoxia in the tissues. The hypoxia causes small arteries and arterioles to dilate, which allows greater than normal amounts of blood to return to the heart.Glycoprotein GPIb on the platelet membrane binds von Willebrand factor, a plasma protein that circulates in a complex with factor VIII.Troponin C is the calcium binding protein that when bound to calcium permits the interaction of actin and myosin. Cross bridges continue as long as calcium is bound to troponin C.Troponin I inhibits the interaction of actin and myosin. Troponin T attaches the troponin complex to tropomyosin.If the substance is reabsorbed by a facilitated mechanism, clearance will eventually increase with increasing plasma concentrations. Approximately 80% of filtered phosphate is reabsorbed in the proximal tubule by a sodium-phosphate cotransporter, which is a facilitated mechanism.Acute magnesium deficiency increases PTH where as chronic magnesium deficiency decreases PTHMagnesium deficiency causes tetanyAngiotensin II increases peripheral vascular resistance directly and stimulates aldosterone secretion, resulting in increased reabsorption of sodium and water in the distal convoluted tubulesThe arcuate arteries are branches of the interlobar arteries of the kidney. The arcuate arteries lie in the corticomedullary junction of the kidney and give rise to interlobular arteries, which enter the cortex of the kidney and supply the glomeruliOf total body weight, approximately 60% is water. One third of this water is extracellular, and two thirds is intracellular. Of the one third that is extracellular, approximately one quarter is plasma volume, and the other three quarters is interstitial volume.Slow waves are oscillating membrane potentials that are generated locally within the gastrointestinal smooth muscle. In each region of the gastrointestinal tract, intrinsic pacemaker cells within the smooth muscle independently generate slow waves. Slow-wave frequencies are relatively constant and are characteristic of each region of the gut.ADH also controls the reabsorption of urea in the papillary collecting duct. High urine flow rates indicate low ADH, which increases urea clearance. In contrast, low urine flow rates indicate high ADH, which results in a greater reabsorption of urea and a lower urea clearanceNADPH oxidase that seems to be defective in the phagocytes of patients with Chronic granulomatous disease which also shows lack of phagocytesProgesterone prepares the uterus for implantation and prepares mammary glands for secreting functions. Progesterone is stimulated by leutinizing hormone from the anterior pituitary.Under normal conditions one third of the cardiac cycle is spent in systole and two thirds is spent in diastole. As pulse increases dramatically, the time spent in diastole decreases more but the time spent in systole decreases only slightlyThe first event that occurs in the pre-B cell (progenitor) is gene rearrangement of the heavy chain. The D gene and J gene recombination event occurs first, followed by V recombination with the D-J region.Hypoventilation is the underlying mechanism for developing hypoxemia in the COPD patient.Decreased oxygen-carrying capacity is the underlying cause for hypoxemia in anemia Hypoxemia in fibrosis is due to a V/Q mismatch. The mechanism for hypoxemia in right-to-left cardiac shunt is a venous admixtureThe best markers for identification of B cells are CD19, CD20, and CD21. TheCD21 marker is a receptor for EBV (Epstein-Barr virus)The CD3 marker is used for signal transduction in the different T cellsCD56 marker is used to identify NK (natural killer) cells and CD 16 marker for nk cells in ADCC Von Willebrand factor (vWF) is a self-polymerizing clotting protein present in the serum and the subendothelial basal lamina, which has binding sites for collagen, platelets, and fibrin. At a site of injury, vWF forms the bridge between the exposed collagen fibers and platelets in circulation, stimulating platelet degranulation and initiating the cellular component of the clotting cascade. An equally important role for vWF is binding platelets to the newly formed fibrin strands in a blood clot.Hypoxia in the tissues. Causes small arteries and arterioles to dilate (so ' blood return to the heart [preload]). Hypoxia in the pulmonary circulation results in vasoconstriction of those vesselsAspirin inhibits the cyclooxygenase pathway without affecting the lipoxygenase pathway, leading to a decreased ratio of prostaglandins (bronchodilators) to leukotrienes (bronchoconstrictors).Fibrinogen is cleaved by thrombin twice as it is activated to form fibrin. The initial cleavage causes it to polymerize, and the second causes it to branchTheca cells begin to express LH receptors and side-chain cleavage enzyme before formation of corpus luteumFor aldosterone - angiotensin II and potassium are the main longterm regulatorsDuring the contraction cycle, ATP binds to myosin, causing the dissociation of myosin from actin.Golgi tendon – detects changes in muscle tensionMuscle spindle – detects the changes in muscle lengthSerotonin is the primary neurotransmitter of the raphe nucleiCell bodies that contain acetylcholine are found in the basal nucleus of Meynert (which degenerates in Alzheimer disease), in the medial septum and diagonal band complex, and in the striatumDopamine- containing cell bodies are found in the midbrain (in the substantia nigra pars compacta and in the ventral tegmental area). The cell bodies in the hypothalamus contribute to then tuberoinfundibular pathwayNorepinephrine- containing neurons are found predominantly in the locus ceruleus of the pons and midbrainVascular endothelial growth factor (VEGF) is a heparin-binding glycoprotein that increases endothelial cell proliferation in vitro and increases capillary growth (i.e., angiogenesis) in vivo. Unlike most other growth factors, VEGF has unique target cell specificity for vascular endothelial cells. VEGF is overexpressed in solid tumors and in ischemic areas of the heart and retinaThrombospondin is a multifunctional glycoprotein that interferes with tumor growth, angiogenesis, and metastasisThe most common form of atrial septal defect is located near the foramen ovale (not to be confused with a patent foramen ovale, which is of little or no hemodynamic significance). They result from incomplete adhesion between the septum primum and the septum secundum during developmentAlpha2-receptor agonists directly inhibit pancreatic insulin secretion. Beta2- adrenergic agonists stimulate insulin secretion.A patient that has a large difference in blood pressure between his legs and arms suggests disease of the aorta distal to the arch, where the vessels supplying the arms arise. In younger individuals, coarctation of the aorta is the most probable diagnosis. In older individuals, severe atherosclerosis of the abdominal aorta, iliac system, or femoral system is the most probable diagnosis.Phenylephrine acts on the alpha-1 receptor to increase intracellular Ca+ through formation of inositol 1,4,5-triphosphateAtrial natriuretic factor is released from the atria when blood volume increases. It acts on the kidneys to increase the excretion of sodium and water. ANF, however, does not play an important role in regulating plasma sodium concentration because any tendency for sodium concentration (and osmolarity) to change is immediately compensated for by changes in ADH levels,The major mechanism for controlling extracellular sodium concentration (and extracellular osmolarity) therefore is the ADH-thirst mechanismBlood ketones (acetoacetic acid and beta-hydroxybutyric acid) are synthesized from free fatty acids in response to severe insulin deficiencyJust before menstruation, sex steroid levels are low, but gonadotropin levels (especially FSH) begin rising slightly. Basal body temperature remains high during the luteal phase of the menstrual cycle, but falls precipitously a few days before the onset of pensation for high altitude includes an increase in the renal excretion of bicarbonate. The diminished barometric pressure found at high altitude causes arterial hypoxia, which is sensed by peripheral chemoreceptors. The ventilation rate increases, thereby causing a respiratory alkalosis. The kidney then compensates by increasing the excretion of HCO3Gastric inhibitory peptide (GIP) is produced in the duodenal and jejuna mucosa by K cells and is released in response to intraluminal glucose and fatty acids. GIP is sometimes called glucose-dependent insulinotropic peptide because it stimulates pancreatic insulin secretion in the presence of hyperglycemiaHemoglobin doesn’t affect the oxygen saturation and arterial pO2The fibrous pericardium, which surrounds the heart, does not simply separate the heart from other chest structures, but has the important physiologic role of limiting the distension of the heart during diastole. This helps keep the (normal) heart functioning in a useful part of Starling's curve.GABA-A action by increasing the duration of chloride channel opening, thus decreasing neuron firing. GABA-B receptor increases K+ conductanceAt the beginning of aerobic (isotonic) exercise, increased stroke volume is the most important adjustment for maintaining adequate cardiac outputIncreased heart rate becomes more important later in isotonic exercise (beyond 50% of maximal work capacityFolate is involved in the transfer of carbons 2 and 8 of the purine nucleus (affecting adenosine and guanosine) and the 5-methyl group of thymidine. This means that folate is required for synthesis of 3 of the 4 nucleic acid bases of DNA and 2 of the 4 nucleic acid bases in RNAHormone-sensitive lipase is found in and degrades stored triacylglcerols in adipocytes.Lead inhibits ALA dehydrase and ferrochelatase, the enzymes of the heme synthesis pathwayThe principal route of metabolism of ethanol is via alcohol dehydrogenase, which uses hydrogen from ethanol to form NADH from NAD+, markedly increasing the ratio of NADH to NAD+. The relative excess of NADH has a number of effects, including inhibiting, rather than stimulating fatty acid oxidation; inhibiting gluconeogenesis rather than stimulating it; inhibiting, rather than stimulating (choice C) glycerophosphate dehydrogenase; and favoring the formation of lactate rather than pyruvate from glycolysis (thereby increasing, rather than decreasing the lactate/pyruvate ratioTryptophan – precursor of niacinHistidine has the highest buffering capacityVitamin B1, or thiamine, is the coenzyme required (as the pyrophosphate) for the decarboxylation of alpha-ketoacidsA triple helix, such as the one found in collagen, is composed of thre polypeptide chains wound together to form one structure. The chains are highly enriched with the hydrophilic goooutacids glycine and proline.A signal sequence contains a stretch of 30 hydrophobic amino acids.The start transfer sequence and stop transfer sequence are each composed of n25-30 hydrophobic amino acids.Transmembrane domains contain 25-30 hydrophobic amino acids. This is enough to form an alpha helix that will span a lipid bilayer.The key to this question is understanding how and when the body utilizes fuel stores. The stores of ATP will be used up in less than 1 second once the race has started. Creatine phosphate will be the primary source of energy for the next 3 or 4 seconds. After the creatine phosphate stores are depleted, the majority of ATP needed to complete the race will be derived from glycolysis (anaerobic respiration). If the race were to last for an extended period of time, then the processes of gluconeogenesis and lipolysis might be utilized.Folic acid is a pteridine vitamin that exists as tetrahydrofolate (TH4) in its most reduced form. TH4 can accept methyl, methylene, or formyl carbons and transfer them as methyl groups. This function is vital in nucleotide and amino acid synthesis.Pantothenic acid is a key vitamin in acyl transfer reactionsvitamins in carboxylation reactions) include biotin and vitamin K. Biotin carries the carboxyl group in the pyruvate carboxylase and acetyl-CoA carboxylase reactions. Vitamin K is used in post-translational carboxylation of amino acid residues in blood clotting factors.Vitamin C in hydroxylation Decarboxyltion by thiamineProcesses that occur exclusively in the cytoplasm include cholesterol synthesis in cytosol or in ER) and fatty acid synthesisThe immediate precursor of cysteine is serine. Serine is also the precursor of the nonessential amino acid glycine.Albinism – due to deficiency of aromatic amino acids Maple syrup disease due to deficiency of branched chain amino acidsPyruvate cannot be directly converted to phosphoenolpyruvate in gluconeogenesis. Therefore, pyruvate carboxylase (a mitochondrial enzyme;converts pyruvate to oxaloacetate, which can be converted to phosphoenolpyruvate by phosphoenolpyruvate carboxykinaseCirculating insulin binds to a receptor on the plasma membrane of target cellsSelective IgA deficiency (<5 mg/dL) is the most common of all the primary immunodeficiency diseasesGTP, rather than ATP, is used as the energy source in protein synthesis, specifically in theformation of the activated elongation factor to which tRNA binds, and in the transfer of the elongating chain from the P to the A site in the ribosomeThe first step in killing bacteria is the production of superoxide ion, O2- , by the action of NADPH oxidase on NADPH and O2. The superoxide is then converted to hydrogen peroxide, either spontaneously or through the action of superoxide dismutase. The hydrogen peroxide can also be converted to the toxic HOCl. radical by the action of myeloperoxidaseThe primer molecule required by DNA polymerase is a short strand of RNA (4-10 bases) complementary to the template strand of the DNA molecule. The primer is synthesized by a specific RNA polymerase known as primase. The growing end of the RNA primer is a free 3'-OH group. The primer RNA is excised at a later stage of replication. The primase does not itself require a primer for initiation of nucleotide synthesis.Peroxisomes are cell organelles that are present in only small numbers in most mammalian cells. In the liver, however, these single membrane-bound organelles are present in large numbers and are import in detoxification and long chain fatty acid metabolism. The clinically important degradation of ethanol to (potentially toxic) acetaldehyde occurs in humans in both peroxisomes and the smooth endoplasmic reticulum (P450 system). Acetaldehyde is then oxidized to (non-toxic) acetate. This reaction, catalyzed by aldehyde dehydrogenase, occurs in the mitochondria.Diverticulitis is a disease of the elderly and usually involves the distal colon. In severe cases, however, the diverticula may extend throughout the colon and up to the cecum. Inflammation of a cecal diverticulum can closely mimic acute appendicitis. The essentials of diagnosis for diverticulitis are acute abdominal pain and fever, left lower abdominal tenderness, and mass. Leukocytosis is commonly present together with nausea and vomitingPreeclampsia- hypertension, edema of ankle and proteinuriaDisseminated intravascular coagulopathy - hypofibrinogenemia, thrombocytopenia, fibrin degradation products, and prolonged prothrombin time.Chronic antral (type B) gastritis is associated with Helicobacter pylori.Chronic fundal (type A) gastritis is associated with pernicious anemia.It is due to subacute granulomatous (de Quervain) thyroiditis, which frequently develops after a viral infectionConn's syndrome results from hypersecretion of aldosterone. It is characterized by hypertension, hypernatremia, and hypokalemia.Microorganisms that can trigger Reiter's syndrome include Shigella spp., Salmonella spp., Yersinia spp., Campylobacter jejuni, and Chlamydia trachomatis. Most patients are younger males.Reiters syndrome – reactive arthrtitis, urethritis, conjunctivitisBechets syndrome – ulceration which are herpetiform oral ulcers, skin lesions, genital ulcers, ocular lesionsRheumatoid arthritis- The metacarpo phalangeal and proximal interphalangeal joints of the hands are characteristically involvedSeptic arthritis – neisseria and staphPlummer-Vinson syndrome predisposes for squamous cell carcinoma of the esophagusSteatorrhea – celiac sprueSuperior vena cava (SVC) syndrome is characterized by obstruction of venous return from the head, neck, and upper extremities. More than 85% of cases of SVC syndrome are related to malignancy. Bronchogenic carcinomas (most commonly small cell cancer and squamous cell cancer) account for more than 80% of these cases. Among bronchogenic carcinomas, the most common causes of SVC syndrome (in order of frequency) are small cell carcinoma, epidermoid carcinoma, adenocarcinoma , and large cell carcinomaHashimoto' disease may be associated with thymic disorders, including thymic hyperplasia, benign thymomas, and malignant thymomaAchalasia (from the Greek "unrelaxed") is a disease of ganglion cells in the esophageal myenteric plexus causing a failure of relaxation in the lower esophageal (cardiac) sphincter. The cause of achalasia is usually not determined. The peristaltic waves in the esophagus stop before the sphincter, and the food collects in the esophagus, which becomes dilated andnelongated.The most probable etiology of bacterial endocarditis involving the tricuspid valve is illicit intravenous drug. Staphylococcus aureus accounts for 60-90% of cases of endocarditis in intravenous drug usersAn hourglass-shaped stomach within the thoracic cavity is a feature of a sliding hiatal hernia. A massively dilated esophagus (mega esophagus) can be caused by Chagas' disease, a trypanosomal disease that can also cause massive dilation of the colonSeveral gastrointestinal diseases are associated with rheumatologic complaints. The most frequent of these are the chronic inflammatory bowel diseases, ulcerative colitis, and Crohn's disease, which can be associated with sacroiliitis or lower limb arthritis. Other gastrointestinal diseases associated with arthropathy include bypass surgery, Whipple's disease, Behcet's syndrome, and celiac disease.The glycogen accumulation in von Gierke's disease occurs primarily in the liver and kidneys, accounting for the enlargement of these organs.Mallory-Weiss lesions are actual tears of the epithelia of the proximal stomach or distal esophagus as a result of retching, nausea, and vomiting (seen in patients with anorexia and alcoholismGranular complement and IgG deposition at the dermal/epidermal junction is a characteristic of systemic lupus erythematosus.Microscopic blisters are a characteristic of dermatitis herpetiformis.Munro abscesses are a characteristic of psoriasis.Solar elastosis is found in actinic keratoses.Urticaria (hives) are pruritic wheals that form after mast cells degranulate and trigger localized dermal edema with dilated superficial lymphatic channels with an allergic response (commonly to certain types of shellfish).In decreasing order of frequency in regards to risk of oral cancer, the following can be stated: (1)lateral border of tongue (2) floor of the mouth; (3) tip of the tongue, (4) hard palate; (5) ventral tongue surface, and (6) buccal mucosaThis is a description of Zenker's diverticulum, which is a false diverticulum formed by herniation of the mucosa at a point of weakness at the junction of the pharynx and esophagus in the posterior hypopharyngeal wall. The cause is believed to be loss of elasticity of the upper esophageal sphincter. Zenker's diverticulum is also associated with halitosis, and if the diverticulum fills completely with food, it can cause dysphagia or obstruction of the esophagus.Bullous pemphigoid – eosinophils in bullaeIn the process of apoptosis, cells shrink and cytoplasmic organelles become more densely packed. Cytoplasmic blebs may form, and apoptotic bodies (membrane-bound cellular fragments) can be produced. The most characteristic feature of apoptosis is a distinctive peripheral aggregation of chromatin, sometimes accompanied by breaking up of the nucleus into several fragments.Bleeding not seen in barrets esophagusPassing fecal material in urine strongly suggests the possibility of a fistula between the bowel and bladder. Of the diseases listed, only Crohn disease (a type of inflammatory bowel disease) commonly produces fistulas. Fistulas are produced in Crohn disease because the disease affects the entire thickness of the bowel wall rather than being restricted to the mucosa (e.g., ulcerative colitisMorning stiffness – rheumatoid arthritisHashimoto's disease (autoimmune thyroiditis) confers a 60-80-fold increased risk for developing thyroid lymphomaKaposi's sarcoma is a spindle cell neoplasm that is highly associated with AIDS and with the Herpes simplex virus type 8. The tumor has an appearance similar to that of angiosarcoma-proliferating stromal cells and endothelium, creating vascular channels that contain blood cells.A third heart sound (S3) is a low-pitched sound occurring at the termination of rapid filling. In patients over 40 years of age, the appearance of a third heart sound strongly suggests congestive heart failureMutation in the collagen gene and lysine hydroxylase gene results in hyperextensible, fragile skin, hypermobile joints, dislocations, varicose veins, ecchymoses, and arterial intestinal ruptures. Inheritance varies – ehler danlos syndromeWith Riedel's thyroiditis, an uncommon form of chronic (possibly autoimmune) thyroiditis that is characterized by dense fibrosis that destroys the thyroid gland and also extends into the adjacent muscle and connective tissue of the neck. The condition is clinically important because it may mimic malignancy. A key to the diagnosis is the woody hardness of fibrosis.Crigler-Najjar (choice A) syndrome is a rare, mild to severe form of inherited unconjugated hyperbilirubinemia.Dubin-Johnson syndrome is an inherited conjugated hyperbilirubinemia associated with a darkly pigmented liver.Gilbert's syndrome is a common, benign form of inherited unconjugated hyperbilirubinemia.Rotor's syndrome resembles Dubin-Johnson syndrome, but is associated with a normal colored liver.A decrease in acid secretion leads to increased secretion of gastrin by antral G cellsC-reactive protein is one of the most commonly measured acute-phase reactants, which are a group of serum proteins showing a rapid increase in concentration in response to any inflammatory process. This finding is entirely nonspecific. It only indicates a recent inflammatory process. C-reactive protein would be expected to be elevated following a dental procedure and in cases of pharyngitis (viral and bacterial).Erythema nodosum is a form of panniculitis, which is chronic inflammation in the subcutaneous fat lobules. Erythema nodosum presents as painful erythematous nodules, often with fever and malaiseThe pupillary light reflex pathway has an afferent limb (CN II) and efferent limb (CN III). The ganglion cells of the retina project bilaterally to the?pretectal nucleiMolluscum contagiosum virus is a poxvirus that causes small tumor-like papules of the skinGenetic reassortments seen in – influenza virus and rota virus which have segmented genomesAcute epididymitis and orchitis with prominent neutrophils in a sexually active male are most likely caused by infection with Neisseria gonorrhoeae or Chlamydia trachomatis.Viral causes of neonatal encephalitis include three members of the herpes family of viruses: herpes simplex I, herpes simplex II, and cytomegalovirus.the fact that patients with sickle cell anemia are more susceptible to osteomyelitis caused by Salmonella.It is convenient to classify meningitis based on the cerebrospinal fluid (CSF findings: (1) acute pyogenic meningitis if neutrophils are markedly increased, (2) acute lymphocytic meningitis if lymphocytes (alone) are markedly increased, and (3) chronic meningitis if lymphocytes, plasma cells, macrophages, and fibroblasts are increased.Herpes and mumps – acute lymphocytic meningitisAnticentromere antibodies – CREST syndromeChlamydia, Mycoplasma, and Ureaplasma are not effectively treated by penicillins and cephalosporins, and are important causes of post-gonococcal urethritis.Shigella species causes epidemics of dysentery in military camps and other close quarter areasThis patient has osteomyelitis due to a cat bite that penetrated the periosteum. Whenever you see dog or cat bites in a question stem, consider Pasteurella multocida as a primary cause of wound infection.Orbivirus is the cause of Colorado tick fever, which is the only tick-borne viral disease in the United States.Chlamydia exhibit distinct infectious and reproductive forms. The extracellular infectious form is known as the elementarly body (EB), which cannot reproduce. It attaches to the host cell and enters through endocytosis. Once inside the cell, the EB is transformed into the reticulate body (RB) within the endosome. The RB is capable of binary fission and divides within the endosome; fusion with other endosomes occurs to form a single large inclusion. Eventually, the RBs undergo DNA condensation and disulfide bond bridgings of the major outer membrane protein, forming EBs. The EBs are then released.Vibrio cholerae produces a secretory diarrhea caused by increases in cAMP in the intestinal cells.Salmonella spp. are carried in nature by animal reservoirs such as poultry, turtles, cattle, pigs, and sheepChemiclave or heat/chemical sterilizer. Its conditions are formaldehyde and alcohol at a temperature of 132 C for periods of 20-30 minutes at 20-40 psi (pounds per square inch).The most common bacterium implicated in community-acquired pneumonia is the pneumococcus Streptococcus pneumoniae. When community-acquired pneumonia occurs in elderly patients or patients with comorbidity, aerobic gram-negative bacilli and Staphylococcus aureus are added to the list.The concomitant administration of bacteriostatic and bactericidal antibiotics would result in antagonism of the antibacterial effects of both agents. The reason for the antagonism between the two is that each agent interferes with the mechanism of action of the other agent.Impetigo is highly infectious, and mini-epidemics can occur in daycare settingsNeonatal herpes meningitis - A distinguishing feature is the propensity to involve the temporal lobe, with mass effect on imaging studies and temporal lobe seizure foci on EEGsNeisseria gonorrhoeae, which is a sexually transmitted gram-negative coccus that can live in phagocytic vacuoles in neutrophils and macrophages. The organism is the most common cause of septic arthritis in otherwise healthy, sexually active adults.Staph. aureus is the most likely cause of bacterial pneumonia complicated by abscess formationCandida tends to colonize foreign bodies, such as intravenous and Foley catheters, prosthetic valves, and ventricular shuntsNatural transformation occurs in Haemophilus species, Streptococcus species, Neisseria gonorrhoeae, and Helicobacter pylori.Fungal arthritis can be caused by coccidioidomycosis, blastomycosis, sporotrichosis, and candidiasisThe vagina of prepubertal girls and postmenopausal women is colonized by colonic and skin bacteria, including Staphylococcus epidermidis, which is normally found on the skin. The vagina of women of childbearing age tends to be colonized by Lactobacillus species, yeasts such as Candida , and Streptococcus speciesThe three major causes of neonatal meningitis are group B streptococci (Streptococcus agalactiae, Escherichia coli gm –ve rods, and Listeria monocytogenes – gm +ve rodsRespiratory syncytial virus is the most common cause of bronchiolitis, tracheobronchitis, and pneumonia in children younger than 1 year of age.The agent specifically associated with contact lens use is Acanthamoeba, which can infect lens solution. This amoeba is dangerous because it causes an intractable ulcerative keratitis that may progress to uveitisEnteroviruses, arboviruses, and type 2 herpes simplex virus are the most common causes of viral meningitisNuchal rigidity and elevated lymphocytes – herpes virusNuchal rigidity and elevated PMNs – e coliPrimary mandibular 1st molar – largest is MB, longest and sharpest is MLa maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTSextra root in mandibular 1st molar is second distal rootpermanent maxillary molar cusps largest to smallest – ML>MB>DBThe general rule for mandibular lingual cusps is that they occlude in the lingual embrasures between their maxillary counterparts and the teeth mesial to their counterparts, EXCEPT for the distolingual cusps of the mandibular molars, which occlude in the lingual grooves of their maxillary counterpartsOne of the distinctions between the mandibular first-molar mesial and distal roots is the deep root concavity seen running the length of the mesial surface of the mesial root.Haversian systems, with concentric rings of bone with osteocytes and canaliculi, which surround a canal with artery, vein, and nerve, are found only in compact (lamellar) bone. These systems do not exist within the inner spongy layers of bone, whether we are looking at alveolar bone or any other bone in the body.Reducing sugars contain a free anomeric carbon (oxygen on Cl atom is available for redox reaction) that can be oxidized. If the oxygen on the anomeric carbon (the carbonyl group) of a sugar is not attached to any other structure, that sugar is a reducing sugar. The carbonyl group of the monosaccharides has reducing properties. The reducing properties are lost when the carbonyl carbon forms a glycosidic bond. Examples- glucose, lactose, galactose, fructoseThe carboxyls of uronic acids and the sulfate groups contribute to the highly charged nature of GAGs. Their electrical charge and their macromolecular structure are important in the their role as lubricants and support elements in connective t issue. If oxygen is involved, this bond is classified as 0-glycosidic (found in polysaccharides); if nitrogen is involved, this bond is classified as N-glycosidic found in glycoproteins and nucleotidesMolecule ComponentsCharacteristic RoleProteoglycan Protein + GAGslong & straightlubrication, ECM, Molecular "sieve''Glycoprotein Protein + CarbohydrateShort & branchedEnzymes, honnones, antibodies,structu ral prote insGlycolipids lipid + CarbohydrateNIACell membrane receptorsDextran is a "sticky" polymer of glucose molecules linked together in a.- (1 ,6) linkages with some a- 1, 3 branchesDisulphide bonds more abundant in Insulin and ImmunoglobulinsPyruvate derivatives – Mnemonic is ALIVa- alanine, leucine, isoleucine, valineOxaloacetate – aspartate – AlyMeT- Aspartate, lysine, methionine, threonine3 phosphoglycerate – serine – cysteine, glycineAlpha ketoglutarate- glutamate – AGP – arginine, glutamate, prolineChronic anemia – lysine replaces glutamateSicke cell anemia – valine replaces glutamateMethemoglobin – tyrosine replaces histidineHistones package and order the DNA into structural units called nudeosomes. Nucleosomes are repeating subunits of chromatin, consisting of a DNA chain coiled around a core of histones.Phosphorylation of serine and threonine residues on histones is part of the process for replication, while acetylation of lysine residues in the histones is used for transcriptional activation.hydrophilic amino acids are – basic amino acids, acidic amino acids, thiol amino acids, serine and threoninebasic are positively charged and acidic are negatively chargedglobulins – alpha , beta n gammaalpha – PEAL – prothrombin, erythropoietin, angiotensinogen, lipoproteins HDLbeta globulins – lipoptroteins LDL, transferringpeptide bond formation is a CONDENSATION type of reactionelectrophoresis - Used to separate various proteins based on protein size and charge, Procedure that depends primarily on electrostatic net charge alpha keto acids – pyruvate, oxaloacetate, and alpha ketogluterateCysteine is derived from methionineBoth ketogenic and glucogenic – PITT- phenylanine, tyrosine, tryptophan, isoleucinePhosphoenolpyruvate and erythrose 4 phosphate produces shikimate ------ Chorismate-------tryptophan, tyrosine and phenylalanine Intracellular events in collagen formation – translation, hydroxylation, glycosylation and peptide formationCollagen has 35%glycine, 21% proline, 11% alanineMitochondria not involved in collagen synthesisAdult hemoglobin (HbA) has two alpha chains and two beta chains and feta l hemoglobin (HbF) has two alpha chains and two gamma chains.The enzyme methemoglobin reductase reduces methemoglobin back to normal hemoglobin, using the coenzyme NADH as a reductantThreonine is precursor of isoleucineThe amorphous elastin is surrounded by microfibrils. The most important microfibril protein, fibrillin-1, is defective in Marfan syndromeAs a result, patients with vitamin C deficiency (scurvy} form a collagen with insufficient hydroxyproline that denatures spontaneously at room temperature.Collagen and reticular fibers make up the stroma of all lymphoid tissues except the thymus.Choline deficiency causes abnormal fat metabolism and can lead to fatty liver disease and hepatic cirrhosis.Choline is essential for the secretion of lipoproteins from hepatocytes, especially very low density lipoproteins (VLDL).Almost exclusively absorbed in the ileum and returned to the liver via the enterohepatic (portal) circulationArachidonic acid can be synthesized from dietary linoleic acid.Phospholipids – 1 glycerol+2 fatty acids+phosphateThe sphingomyelins: are a group of phospholipids that are found especially I nerve t issue and yield sphingosine, choline, a fatty acid and phosphoric acid upon hydrolysisVLDL,LDL,HDL - These lipoproteins are transported into the cells by way of receptor mediated endocytosisExtrahepatic ti ssues convert ketone bodies back to acetyl CoA by using succinyl CoA as a CoA donor and the enzyme thiophorase. The liver itself lacks t hiophorase and thus cannot use ketone bodies for its own energy needs.First formed ketone body is acetoacetate --- either beta hydroxyl butyrate or directely to acetoneCitrate is transported out of the mitochondria to the cytoplasm (where fatty acid synthesis occurs) via the citrate-malate-pyruvate shuttlephospholipids phosphatidylcholine (lecithin) and sphingomyelin, which are important for membrane function, intracellular signaling and hepatic export of very-low-density lipoproteinsCholine can be synthesized de novo (from phosphatidylserine in membranes) and is abundant in food, choline deficiency is very rare. However, a deficiency of choline in the diet can cause abnormalities in the metabolism of fats and can lead to fatty liver disease and eventually hepatic cirrhosis.Fovea - This is the center of the retina that receives the focus of the object of regard. Nerve cells are more densely packed in this area, especially cones, so images that are focused on the fovea can be seen in greater detail.Vestibule (saccule and utricle) - associated with sense of balance Semicircular canals - concerned with equilibriumThe only protease of the extrinsic pathway is factor VIla, which is formed from the inactive factor VII by thrombin on factor XHemoglobin is the oxygen-bearing protein of red blood cells and exists in two conformational states - tense (T) or relaxed (R). The T conformation has a weaker affinity for oxygen (e.g., in the capillaries), while the R conformation has a stronger affinity for oxygen (e.g., in the lungs (150-300 fold increase over the T state)).Hemoglobin combines reversibly with carbon dioxide at the protein portion of the hemoglobin molecule.? Early Embryo - yolk Sac ? Mid Gestation - mostly liver, but also spleen and lymph nodes? Final Month of Gestation to about 20 yea rs old - exclusively in the bone marrow? 20 years old and older- marrow of membranous bones, such as the vertebrae, sternum. ribs, and iliaAn oxyntic gland is composed of three main types of cells: (1) mucous neck cells, which secrete mainly mucus;(2) peptic (or chief) cells, which secrete large quantities of pepsinogen; and (3) parietal (or oxyntic) cells, which secrete hydrochloric acid and intrinsic factor.Pyloric glands secrete mostly mucous, have G cells which are enteremdocrineOxyntic glands also contain enterochromaffin-like (ECL) cells which secrete histamine, and D cells, which secrete somatostatin Chyme in duodenum slows down gastric emptyingAbsorption of dipeptide and amino acids across the brush border occurs by multiple secondary active transporters utilizing either sodium-dependent cotransport (amino acids) or hydrogen-dependent cotransport (di- and tri-peptidesIn the contractile cycle, the dissociation of the actin-myosin complex results from ATP binding to the myosin head (actin-myosin + ATP __. actin+ myosin-ATPThe three sources of high-energy phosphate to keep the ATP"pool"filled are creatine phosphate, glycogen and cellular respiration in the mitochondria of the muscle fibers."Fast" muscles are for rapid, powerful actions (jumping, short distance running) while "slow" muscles are for prolonged activity (body posture, running a marathon).the finer the movement required, the greater the number of muscle spindles in a muscle.Oxidative capacity of muscle fibers is related to ! Number of capillaries, ! Myoglobin content ! Number of mitochondriaThe annulospiral endings (sensory terminals) are wrapped around specialized muscle fibers that belong to the muscle spindle (intrafusal fibers) and are quite separate from the fibers that make up the bulk of the muscle (extrafusal fibers)Stretch reflex - it is initiated at receptors called muscle spindles that are sensitive to muscle length and tension. This reflex stimulates the stretched muscle to contract. An example is the patellar reflex (knee jerk reflex), in which the striking of the patellar tendon at the knee causes the quadriceps muscles to contract and swing the lower leg forward.Basal ganglia -like the cerebellum, constitutes another accessory motor system that functions usually not by itself but in close association with the cerebral cortex and corticospinal motor system.FrontalContains the primary motor (movement) area and influencespersonality, judgment, abstract reasoning, social behavior andlanguage expressionTemporalControls hearing, language comprehension, storage and recallof memoriesParietalInterprets and integrates sensations of: pain, temperature and touch - particularly in regards to size, shape, distance andtexture;Important for awareness of body shapeOccipitalFunctions mainly to interpret visual stimuliLocal blood flow is regulated by tissue metabolism.Pulmonary circuit supplies to alveoliCompliance decreases at high pressureZidovidune – thymidine analogThe 70s ribosomes are the sites of protein synthesis (translation) in bacterial cells and chloroplasts and are composed of two rRNA subunits (30s & 50s) and 55 proteins.The 80s ribosomes are the sites of protein synthesis (translation) in the cytoplasm of eukaryotic cells and are composed of two rRNA subunits (40s & 60s) and 84 proteins.Nucleases that cleave internal phosphodiester bonds are called endonucleases, and those that cleave bonds at the 5' end or 3' end are called exonucleases.Ultraviolet light produces pyrimidine dimers in DNA, which interfere with replication and transcription. These lesions are removed via the action of an endonuclease, an enzyme that excises a 12 bp (base pair) fragment surrounding the dimer. Then DNA polymerase I fills in the gap and DNA ligase seals the seams.Only tryptophan, methionine, and selenocysteine are coded by just one codon.Aldolase is plenty in skeletal and heart muscleCreatinine Kinase level is elevated in dermatomyositis, polymyositis and muscular dystrophies. Elevated LDH with more or less normal AST and CK levels is typical for pulmonary infarction Glutamyl transferase (GGT) is used as a sensitive indicator of biliary obstruction.Acid phosphatase (ACP) and prostate-specific antigen (PSA) are tumor markers used for the diagnosis and follow-up of patients with prostatic cancer.Serine and Threonine are not transaminated. They are oxidatively deaminated (release NH3) by a dehydratase enzyme to form pyruvate and propionyl coA respectivelyEnzymes involved in deamination reactions include glutamate dehydrogenase (for glutamate), histidase (for histidine) and serine dehydratase (for serine and threonine)Oxidative deamination occurs primarily on glutamic acid because glutamic acid is the end product of many transamination reactionsSerine is converted to pyruvate and threonine to a-ketobutyrate (which is decarboxylated oxidatively to form propionyl CoA); ammonium ion is released.Carbonic anhydrase also functions in the kidney with the reabsorption of bicarbonate ionThrombin lyses the arginyl and glycine residuesLimit dextrins" are various branched polysaccha ride fragments that remain following the hydrolysis of starch.Isomaltase cleaves a glucose linked 1,6 to another glucose as is found at the branch points in starch and glycogenCovalent modification (the reversible covalent modification of an enzyme): enzyme phosphorylation is the most common form of covalent modification. Phosphorylation occurs on either Ser-OH, Thr-OH or Tyr-OH groups.Both enzymes (glycogen synthase and phosphorylase) are phosphorylated at specific serine residuesNon competitive inhibitor = allosteric inhibitorclassic example is the irreversible inhibition of cyclooxygenase (COX) by aspirin (acetylsali cylate), which acetylates the active site serine residuecompetitive inhibition – Km increased, Vm remains samenon competitive inhibition – Km remains same, Vm decreasedMixed inhibition – Km increased, Vm decreasedUncompetitive inhibition – Km and Vm decreasedAt Vmax all of the active sites are saturated with substrateTrypsin cleaves peptide bonds in which the carboxyl group is contributed by lysine and arginine (basic amino acidsPlasma cholinesterase – organophosphorous poisoning Action of the ScapulaWhat the Action Looks Like (Move Your Body!)Primary MusclesElevation of the scapulaLifting your shoulders to your earsUpper trapezius, levator scapulaeDepression of the scapulaPressing your shoulders downLower trapeziusRetraction (adduction) of the scapulaPinching your shoulder blades togetherRhomboids?middle trapeziusProtraction (abduction) of the scapulaForward rounding shouldersSerratus anteriorUpward rotation of the scapulaLifting arms above head, scapulae rotate upUpper and middle trapeziusDownward rotation of the scapulaOccurs only when you lower your armsRhomboidsA major target of GH is the liver, where it causes the liver to form several small proteins called somatomedins that have the potent effect of increasing all aspects of bone growthGH enhances body protein, uses up fat stores and conserves carbohydratesInositol triphosphate (JP,) and diacylglycerol (OAG calcium--calmodulin Angiotensin II (vascular smooth muscle), Catecholamines (alpha receptors), ) Gonadotropin releasing honnone, Growth hormone, releasing honnone., Oxytocin, and/or Thyroid releasing honnone, Vasopressin (V 1 receptor, vascular smooth muscle)Toxic goiter, thyrotoxicosis, graves disease – Less TSH levels, have long acting thyroid stimulatorInsulin lowers blood sugar by binding to tyrosine-kinase receptors on striated muscle (skeletal and cardiac) and adipose cell membranes, resulting in a cascade that translocates GLUT-4 glucose transporters to the cell membrane. GLUT-4 transporters allow facilitated diffusion of glucose into the muscle and fat cells.Glucagon and insulin increases – arginine and alanineSomatostatin – depress insulin and glucagonCholecytokinin – duodenum and jejunumSecretin – duodenumThe enterogastric reflex also reduces motility and forcefully closes the pyloric sphincter.Enterogastrones are released by the small intestine in response to the acidity of the duodenal chyme, the presence of amino acids and the presence of free fatty acids in the chyme.Pheochromocytome – excess release of 3 methoxy 4 hydroxymandelic acidEpinephrine Dilates bronchioles in the lungs, dilates blood vessels in skeletal muscle and relaxes bronchiolar smooth muscleNorepinephrine - Constricts blood vessels in almost all areas of the body,GIP is also thought to have significant affects on fatty acid metabolism through stimulation of lipoprotein lipase activity in adipocytes.GIP receptors are seven-transmembrane proteins found on beta cells in the pancreas.It has been found that type 2 diabetics are not responsive to GIP. Cortisol (glucocorticoid} influences carbohydrate, lipid and protein catabolism. Glucocorticoids promote gluconeogenesis by inducing synthesis of the enzyme phosphoenolpyruvate carboxykinase (PEPCK}.Testosterone is a precursor oftwo other hormones, DHT and estradiol.ACTH – indicator for pituitary functionSteroid receptors – act through intracellular receptorsThyroid hormones increase glycogenolysis, gluconeogenesis, lipolysis, protein synthesis and degradation. The hormones overall effects are catabolic. Thyroid hormones stimulate bone maturation as a result of ossification and fusion of the growth plates. Thyroid hormones are lipophilic hormones that exert their effects via transcriptional processes.Nucleic acid hormones/ amine hormones – catecholamines, thyroid hormonesCatecholamine act through cell membrane receptors, thyroid hormones act through the nuclear receptorsnerve fibers of the CNS (brain and spinal cord) are not enclosed by a neurilemma. ‘Right-sided lesions of the spinal cord result in loss of motor activity on the same (ipsilateral) side and pain and temperature sensations on the opposite (contralateral) side.Nerve block produced by local anesthetics is called a nondepolarizing nerve block.The hyperpolarized state is achieved either by increasing Cl flow into the cell (GABAA receptors) or increasing K? flow out of the cell (GABA8 receptors).Striatum – caudate + putamenLentiform nucleus = putamen + globus pallidusThe output of the cerebellum is excitatory, while the basal ganglia are inhibitoryNicotinic Receptors ? Stimulated by ACh and nicotine, not stimulated by muscarine ? Found at all ganglionic synapses ? Also found at neuromuscular junctions and the adrenal medulla ? Produce excitation ? The fast EPSP (excitatory postsynaptic potentials) results from activation of nicotinic receptors, which cause ion channels to openMuscarinic Receptors ? Stimulated by ACh and muscarine, not stimulated by nicotine ? Found at target organs when ACh is released by postganglionic neurons (all of parasympathetic and some sympathetic) including heart, smooth muscle and glands ? The slow EPSP is mediated by muscarinic receptors that inhibit the M current, a current produce by conductance of potassiumThe cholinergic effects of preganglionic autonomic neurons (both sympathetic and parasympathetic) are excitatory. The cholinergic effects of postganglionic parasympathetic fibers can be either excitatory or inhibitoryThe fibers of the pyramidal tract that synapse with cranial nerves located in the brain stem form the corticobulbar tractThe fibers of the pyramidal tract that synapse with spinal nerves sending information about voluntary movement to the skeletal muscles form the corticospinal tract.Lateral corticospinal – cross, anterior corticospinal - doesn’t crossDescending pathways can be subdivided into (1) a lateral system, which ends on motor neurons to limb muscles and on the lateral group of interneurons, and (2) a medial system, which ends on the medial group of interneurons.The lateral system includes the lateral corticospinal tract and part of the corticobulbar tract. These pathways influence the contralateral motor neurons that supply the musculature of the limbs, especially the digits and the muscles of the lower part of the face and the tongue. The medial system includes the ventral corticospinal, lateral and medial vestibulospinal, reticulospinal and tectospinal tracts. These pathways mainly affect posture and provide the motor background for movement of the limbs and digits.Sympathetic preganglionic neurons are located in the thoracolumbar region of the spinal cord and sympathetic postganglionic neurons are located in paravertebral and prevertebral ganglia.Autonomic effectors - cardiac muscle, smooth muscle and glandsSomatic effectors – skeletal muscleElectrical synapses are rare in the CNS (common in cardiac and smooth muscle). They are connected by gap junctions, which allow local electrical currents resulting from action potentials in the presynaptic neuron to pass directly to the postsynaptic neuron. Norepinephrine stimulates mainly alpha -receptors. 2. Epinephrine stimulates both alpha and beta –receptorsGap junctions have connexonsActive transport - The source of this energy is ATP (primary active transport} or another molecule with a favorable concentration gradient (secondary active transport; e.g., cotransporters and antiporters}CAAT is the binding site for RNA transcription factorsThe intercellular matrix also contains a calcium-binding protein called osteocalcin as well as a calcium and collagen-binding protein called osteonectin.Exergonic delta G – negative, Endergonic delta G – positiveIsotopes have same atomic number but different mass numberThe cell cycle consists of the following: ? G1 = growth and preparation of the chromosomes for replication ? S = synthesis of DNA (and centrosomes) ? G2 = preparation for mitosis ? M = mitosisDoubling of DNA occurs in S phaseAmmonia is formed in the tubular cells by the deamination of certain amino acids, particularly glutamic acid. Phosphate and ammonium excretion measurements provide good information on how much acid is being eliminated by the kidneys.The Bainbridge Reflex is a positive feedback mechanism in which there is a compensatory increase in heart rate, due to a rise in right atrial pressure. It is commonly referred to as an Atrial Reflex.Blood flow to the coronary arteries would be greatest during ventricular relaxation in a resting individual. Ventricular volume is greatest following atrial systole.Ventricular pressure is greatest during ventricular ejectionAfterload for the left ventricle is determined by aortic pressure; afterload for the right ventricle is determined by pulmonary artery pressureHistamine and bradykinin - venous constriction and arteriolar dilationSerotonin – arteriolar constrictionIncrease intrathorasic pressure causes decreases in venous returnDecrease in venous compliance and increase in venous return – sympathetic stimulationAn anxious dental patient may have a higher systolic blood pressure than previously noted; this is most likely due to decreased arterial compliance.Velocity of conduction is highest in Purkinje fibers The ventricular conducting system is capable of intrinsic pacemaker activity at a rate of 30-40 impulses per minute. If the SA and AV nodes are injured, the ventricular conducting system can take over control of heart rate and rhythmProteins also participate in pH buffering, mainly through their histidine side chainsThe most important laboratory test for the distinction between metabolic and respiratory acidosis is the determination of the total plasma carbon dioxide (C02 + H2C03 + HC03. In respiratory acidosis, the total carbon dioxide is elevated because C02 retention is by definition, the cause of the acidosis; in metabolic acidosis, it is reduced because the patient hyperventilates in an attempt to eliminate excess carbonic acidIntegral proteins - The nonpolar side chains of these amino acids interact with the membrane lipidsGases such as oxygen and carbon dioxide diffuse freely across membranes, but most nutrients, metabolic intermediates and coenzymes are water soluble and can-not cross the lipid bilayer. Also because inorganic ions cannot cross, the electrical conductivity of lipid bilayers is very low.Amelogenins: are hydrophobic proteins rich in proline, histidine and glutamine. Represent the main protein present in forming enamel; expression stops when enamel reaches full thickness. Loss of function: A thin hypoplastic enamel layer is formed that lacks enamel rods. Ameloblast.in: this protein is present in much smaller amounts compared with amelogenin; it is found mostly in newly formed (secretory stage) enamel and more so at the outer surface than in deeper areas closest to the DEJ. Loss of function: terminal d ifferent iating ameloblasts detach from the dentin and enamel formation aborts.Enamelin: this protein is the largest and the least abundant of the enamel matrix proteins; ispresent only at the growing enamel surface. Loss of function: not knownThe end of the glycolysis process yields two pyruvic acid molecules with a net gain of 2 ATP and two NADH per glucoseEmbden-Meyerhof pathway ends with the formation of a pyruvate and a glyceraldehyde-3-phosphate (which is converted by enzymes outside the pathway to pyruvate). Note: These bacteria lack either of the key enzymes 6-phosphofructokinase or aldolase of the Embden-Meyerhof pathway.HMP pathway - Oxidative portion irreversible which produces ribuloase 5 phosphate This porion generates NADPH, which is needed for biosynthetic pathways such as fatty acid and cholesterol synthesisNon oxidative portion – produces products which can enter glycolysis,,, enzymes are transaldolase and transketolaseHMP pathway – corneaLysergic acid diethylamide interferes with the action of serotonin in the brain.Antithrombin Ill contains an arginine residue that combines with the active site serine of factors Xa and IXa; thus the inhibition is stoichiometric.Heparin prevents the activation of factor IX (Christmas factor) and interferes with thrombin action. Heparin can also enhance t he removal of lipoproteins from the blood by binding apolipoprotein E (protein found on some liposomes) and by activating lipoprotein lipaseProstaglandins are 20-carbon fatty acids that contain a five carbon ring.Glucokinase is inhibited by the CoA-thioesters of long-chain fatty acids. These products are most abundant during fasting, when the liver metabolizes large amounts of fatty acids from adipose tissue.Vit C – phagocytic action and antibody synthesisNiacin – used to treat hyperlipidemiaOnly two reactions are known to require cobalamin coenzymes in human tissues. The cytoplasmic methylation of homocysteine to methionine requires methylcobalamin and the mitochondrial methylmalonyi-CoA mutase reaction requires deoxyadenosylcobalaminVitamin B6 deficiency is most common in alcoholics, in whom it contributes to sideroblastic anemia, peripheral neuropathy and seizuresFolic acid – required for synthesis of purines and thymidinePantothenic acid – component of Fatty acid synthase, Co ABiotin is a prosthetic group of pyruvate carboxylase, acetyi-CoA carboxylase, propionyi- CoA carboxylase and other ATP-dependent carboxylases. These multiunit enzymes contain biotin covalently bound to thee-amino group of a lysine residueAlcoholics – riboflavin deficiency – dermatitis of scrotum and noseSmall bronchioles have non-ciliated bronchiolar epithelial cells (Clara cells) that secrete a surface-active lipoproteinThe oviducts capture the ovulated cumulus-oocyte complex and transport it medially into the oviduct and toward the uterus. Important: Estrogen promotes ciliation and transport; progesterone inhibits transport.Only Sertoli cells express the androgen receptor and the FSH receptor, so these hormones regulate spermatogenesis indirectly through their actions on Sertoli cellsThe oculomotor nerve emerges from the interpeduncular fossa of the midbrain and then passes between the superior cerebellar artery and the posterior cerebral artery immediately lateral to the basilar artery.The superior rectus muscle can elevate and adduct the eye from the neutral position. From the abducted position, it is the only muscle that can elevate the eyeThe inferior rectus muscle can depress and adduct the eye from the neutral position. From the abducted position, it is the only muscle that can depress the eyeThe lateral rectus muscle can abduct the eye.The superior oblique muscle can depress and abduct the eye from the neutral position. From the adducted position, it is the only muscle that can depress the eye.The inferior oblique muscle can elevate and abduct the eye from the neutral position. From the adducted position, it is the only muscle that can elevate the eye.Focal spots for migration of cells for wound repair Desmosomes – cathedrins, tight junctions – occludins, claudins, intermediate junctions – cathedrins, actins, hemidesmosomes – integrins, gap junctions - connexinsOne of the oncogenes frequently found with colon CA is mutated version of a protein that usually interacts with catenins. Loss of functioning adherens may ??tumor metastasis. serous acini - contain only serous cells and are generally sphericalmucous acini - contain only mucous cells and are generally tubularserous demilunes – sublingual glandcomponents of basal lamina - From epithelium ! connective tissue Lamina lucida: Electron-clear layer Lamina densa (basal lamina): Product of epithelium Type IV collagen! Proteoglycans! Laminin Fibronectin! Anchoring fi brils (type VII collagen)! Reticular lamina: Product of CT Reticular fibers (type III collagen)Merocrine Secretory product released from secretory granulesMajor salivary glands, pancreatic acinar cellsApocrineSecretory product is released with cytoplasmMammary glands, apocrinesweat glandsHolocrineSecretory product is released with portion of cellSebaceous glandsserous glands – well developed striated and intercalated ductsmucous – less developed striated and intercalated ductsSimple squamous Lining, diffusion, filtrationEndothelium of blood vessels, mesothelium, thin descending and ascending loop of henle, teritiary brochioles Simple cuboidal Intercalated ducts of salivary glands, CT, PCT, DCT, thick descending and ascending loop of henle, respiratory bronchiolesSimple columnarSecretion/ absorptionGI lining, uterine epithelium, striated ducts of salivary glands, terminal bronchiolesStratified squamous Abrasion and protection,Deep – cuboidalSurface – squamousskin, linings of mouth, oropharynx, laryngopharynx, esophagus (usually not keratinized), anus, and vagina Stratified columnarLarge ducts of salivary glandsMale urethraStratified cuboidal Ducts of sweat glandsTransisitional epitheliumurinary bladder, ureter, and upper part of the urethra papillary layer – finely constructed, loose CT, more elastic fibers and provide skin tonereticular layer of dermis – thick, dense irregular CTMalpighian layer denotes the stratum basale and stratum spinosum together Tonofibrils & desmosomes are especially well developed in keratinocytes Firmness of cartilage depends on: ? Electrostatic bonds between collagen fibers & GAG side chains of matrix glycoproteins ? Binding of water to the (-) charged proteoglycan complexes The only blood supply is provided by BVs entering cartilage through the perichondrium Perichondrium covers all cartilage except: Fibrocartilage, Articular cartilage of joints, Nasal/costal cartilageFibrocartilage - intervertebral discs (vertebra), knee joint, TMJ, & symphysis pubis Perichodrium – chondroblastsEpiblast – ectoderm and mesodermHypoblast – primary yolk sac, endodermNotochord – nucleus pulposusTumor characterized by amine precursor uptake and decarboxylation (converts precursors to amines) (APUD). Resultant production of hormonelike substances.caused by neural crest cells,Septum transversum – contributes for formation of diaphragm3 to 8 weeks – fetus most susceptible for teratogensNeurectoderm - ? Posterior pituitary gland, CNS neurons, Oligodendrocytes & astrocytes, Pineal gland Maxillary teeth are developed from Arch I and a globular process Cleft palate – failure of fusion of the lateral palatine processes, nasal septum &/or median palatine process Lymphatic system depends on: Skeletal muscle contraction, presence of valves in lymphatic vessels, breathing & gravity to move fluid Lymphatic supply of tongue – Tip – submental lymph nodesLateral borders – submandibularMid dorsum – inferior cervicalPosterior 3rd – superior deep cervicalLymph nodes – cortex have germinal centers, outer cortex – B cells, inner cortex – T cells, medulla-arranged in medullary chords, plasma cells Carcinoma of the larynx would most likely affect? ? Deep cervical lymph nodes Outpouching of midgut – formation of liver, lungs, gall bladder, pancreasParasympapthetic of Foregut – T5 to T9Midgut – T10 – T 12Hind gut – S2 – S4Calcium – active absorption in dudodenum, passive in duodenum and ileumSpleen - White pulp One card says: Contains lymphatic nodules & lymphocytes, like a lymph node Another card: Contains compact masses of lymphocytes surrounding branches of the splenic artery Red pulp Consists of a network of blood-filled sinusoids, along w/ lymphocytes, macrophages, plasma cells, monocytes & RBCs Contains: splenic cords, numerous erythrocytes and blood vascular sinusoids PALS is the center zone of the spleen, surrounding the Central arteriole USMLE says: “T cells are found in the PALS & the red pulp. B cells are found in follicles w/in the white pulp.” The B cells in the white pulp are analogous with the B cell outer cortical germinal centers in the lymph node Pharyngeal tonsils – no crypts, sinuses, pseudostratified ciliated epitheliumPalatine – stratified squamous, many crypts and lymphoid folliclesLingual – each lymphoid follicles with single cryptLacrimal gland - Lacrimal puncta collects tears and drains into the Lacrimal canals (superior and inferior), which join the Lacrimal sac, which drains down the Nasolacrimal duct to empty underneath the inferior nasal concha in the Inferior meatusOccipital + mastoid ---- retropharyngeal+ parotid+ sunmandibular ----- jugulodigastric+ sublingual ---- juguloomohyoidEmbryonic mesentery Adult mesentery Dorsal mesogastrium Greater omentumOmental bursaDorsal mesoduodenum Disappears (duodenum lies retroperitonealPleuropericardial membrane PericardiumContribution to diaphragmVentral mesentery Falciform ligamentLigamentum teresLesser omentum (hepatogastric,hepatoduodenal ligaments)Portal triad – located anterior to the epiploic foramenPeyers patches - Germinal center-?IgA positive B cells, CD4 T cells & APCs Reversal lines – cibriform plate of alveolar processROS – rotundum, ovale, spinosum – greater wing of sphenoidOptic canal – lesser wing of sphenoidLamina papyreca – ethmoid boneSuperior orbital fissure –b/n greater and lesser wing of sphenoidInternal auditory meatus – posterior cranial fossaPosterior and middle cranial fossa are separated by petrous part of temporal boneInguinal ligament connects the pubic tubercle to anterior superior iliac spine Interneurons form a communicating network between sensory and motor neurons.Unipolar – sensory neurons, bipolar – retina and 8th nerve, multipolar – motor and mixed neuronJugular foramen - Passage between the petrous potion of the temporal bone and the jugular process of the occipital Pterygoid canal – deep & greater petrosal nerves (these form the nerve of the pterygoid canal)Pterygomaxillary fissure – PSA artery/vein/nerve & maxillary artery Pterygopalatine canal – greater & lesser palatine artery/vein/nerve Right recurrent laryngeal nerve – hooks around the subclavian arteryLeft recurrent laryngeal nerve – hooks around the ligamentum ateriosumHypoglossal – loops around the occipital artery, between hyoglossus and mylohyoidErythrocyte - Energy source is glucose o 90% from anaerobic metabolism – degraded to lactate o 10% from HMP shunt RBC MB contains chloride-bicarbonate antiport – allows transport of CO2 to lungs for elimination RBC - Shrink and crenate in hypertonic solution, Become ghost cells in hypotonic solution Neutrophils - Large, spherical azuriphilic 1° granules (lysosomes) Plasma cells – well developed ER, golgi apparatusFluid movement = k[(Pc + 0i) – (Pi + 0c)].Globin – taut – less effinity for O2, relax – high effinity for O2Hb is important due to its ability to combine reversibly with O2 at the ferrous heme prosthetic group Sickle cell anemia - causes Hb to become less soluble under low O2 tension & to polymerize into crystals that distort the RBCs into a sickle shape and increases isoelectric pHSickle cell anemia – missense mutationCarbonic anhydrase in kidney tubular cells is associated with reabsorption of bicarbonate ion Thrombin acts upon the arginyl-glycine linkages in fibrinogen to produce a fibrin monomer Venous thrombi – not seen in COPDDeep vein thrombosis – virchows triad – hypercoagulability, stasis, endothelial damageStroke following MI – arterial thrombiArterial thrombi – lines of ZahnSplenic infarcts – mostly due to emboli from left side of heartDIC - Amniotic embolism – causes the post partum, splenic embolismParadoxical emboli Begin in the venous system. End up in the systemic arterial system rather than the pulmonary artery. Most often allowed by an atrial septal defect.Deficiency of platelet adhesion – von willebrand diseae, Bernard soulier syndrome Deficiency of primary aggregation – glanzmann thrombasthenaDeficiency of secondary aggregation – aspirin usePlatelet aggregation – ADP and thrombaxane ITP – acute – self limiting and in children, chronic – adults, normal PT and PTTTTP – pentad – fever, purpura, renal failure, hemolytic anemia, neurologic changes, helmet cells Hemolytic uremic syndrome – children after gastroenteritis, E. coliCross linking of platelets – require Gp11a/111a receptorVit K dependent factors – 2,7,9,10, protein C n SPT- extrinsic, PTT – intrinsic, TT- fibrinogen levelsLaminar flow – platelets away from blood vesselsLiver disease – 2,5,7,9,10,11,12Aspirin – normal CT, platelet count, decreased BTVon wille- Increased PTT, BTHemophilia – normal PT, BT n prolonged PTTDIC – increases PT,PTT, fibrin split productsRosenthal syndrome – hemophilia C Autopsy findings of essential finding of HTN – nephrosclerosisPreeclampsia – HTN, proteinuria, edema in pregnant, if seizures are present – eclampsiaSickle cell trait – resistant to malaria, heterozygous Sickle cell anemia – salmonella osteomyelitisAlpha thalassemia – gene deletion, beta thalassemia – defect in mRNA processingNormochromic, normocyticMacrocytic, hyperchromicMicrocytic, hypochromicAcute hemorrhage, hereditary spherocytosis, aplastic anemia, sickle cell disease, thalassemia, G6PH defeiciencyIron deficiency anemiaMegalosblastic and pernicious anemiaPassive congestion of liver – nutmeg liverIncreased neutrophils – bacterial infection, increased mononuclear cells – viral and occasionally fungal infections, increased eosinophils – parasitic infectionsDecreased in leukocytosis – typhoid fever, brucellosisAtherosclerosis – abdominal aorta>coronary arteries>popliteal arteries>carotid arteriesLymphocytosis with hacking cough – Bordetella pertussis ALL Enlarged lymphnodes, Children, CALLA, null cells, associated with downs syndrome, AMLAdults – most common, most malignant type, sterna tenderness, splenomegaly, hepatomegalyCMLYoung n middle aged adults, Philadelphia chromosome (t 9:22), splenomagaly, elevated vit b12, high uric acid levelsCLLOlder adults, increased CD5 B cells, least malignant, similar to small lymphocytic lymphomaProtein casts in urine – Multiple myelomaRubbery supraclavicular lymphnodes – mycosis fungodoisesOsteomyelitis – druggies – pseudomonasProsthetic replacements – S. aureus, S. epididermidisVertebrae – M. tuberculosisSexually active – N. gonorrheaDelayed eruption, malocclusion – ricketsAchondroplasia – deficiency of Fibroblast growth factor Pagets disease – cotton wool appearance, mosaic pattern of reversal lines, predisposition to pagets diseaseMost common benign bone tumor – osteochondromaSuppurative arthritis – Staphylococci, Streptococci, gonococciReiters syndrome – Chlamydia, arthritis, uveitis, conjunctivitisMorning stiffness, pannus, symmetric involvement –Rheumatoid arthritisOverproduction of uric acid – Leesch nyhan syndrome, G6 p deficiency Pseudogout – calcium pyrophosphate, rhomboid crystal, negative bifringenceInfectious arthritis Overall – S. aureus – coagulase15 – 40 yrs – N. gonorrhea – pilliProsthetic joint –coagulase –ve staphylococcusViral – rubells, hepatitis B, parvovirus – Type III hypersensitivityWeight bearing areas – M. tuberculosisLesser omentum – connects stomach to liver, has two ligaments – heptoduodenal, hepatogastricGreater omentum – connects stomact to transverse colonRectal columns of Morgagni = vertical folds, produced by the infolding of the mucous MB around the submucosa Urea cycle - Ornithine + Carbamoyl phosphate ??Citrulline + Aspartate ??Argininosuccinate??(Fumarate), Arginine ??Urea Intemediate of cholesterol synthesis - HMG CoA, mevaolonic acid, isopentyl pyrophosphate, and squalene Glucose transport from the lumen of the nephron depends on Na+ transport Secondary active transport occurs in proximal tubule and is saturable Phosphate excreted through Cl, ammonium excreted through NaThe most important secretory mechanism for conservation of Na+ by the kidney is: H+ secretion for the reabsorption of both Na+ & HCO3 Begin at the future cusp and spread down the cusp slope Tomes fibers – serve as pain receptorsCrown height is less than MD diameter - primary maxillary canineAll posterior teeth have rectangular occlusal tables, EXCEPT PM1s, which have trapezoidal occlusal tables The transverse groove of the oblique ridge connects central & distal pits All Mx roots are inclined distally & lingually EXCEPT the DB root of Mx M1 (inclined bucally) Orifice location in maxillary molar - MB: under the mesial slope of the MB cusp DB: under the B groove P: slightly distobuccal to the ML cusp tip Mesial root of max 1st molar- Flattened MD and has root depressions on both its M & D surfaces Furcations of max 1st molar - Distance from cervical line (from farthest - closest): D > F > M As the mouth is opened widely, the articular disc moves anteriorly in relation to the articular eminence, but distally in relation to the condyle Intrinsic muscles of tongue – Longitudinal – shortens the tongueSuperior longitudinal – tongue in concaveInferior longitudinal – tongue convexTranverse – narrows the tongueVertical – flattens and broadensExtrinsic muscles of tongue – Genioglossus – protrudes the tongueStyloglossus – elevates and retractsHyoglossus – depresses the lateral border of tongue Gingival ligament- Includes the dentogingival, alveologingival, and circumferential fibers At the time enamel matrix is first formed in a tooth, the nuclei of ameloblasts move to the non-secreting end of the cell The SUBGLOTTIS receives sensory innervation from the Superior Laryngeal Nerve Ventilation is high = apex of lungs Perfusion is high = base of lungsIn a pulmonary AV shunt, the O2 partial pressure in arterial blood is low First rib:Two tubercle – transverse tubercle, scalene tubercleMuscular attachments – serratus anterior, anterior scalene, middle scalene, intercoastal muscles Relations – superiorly – brachial plexus, subclavian vesselsInferiorly – intercostals vessels Anteriorly – T1 nerve root, sympathetic trunkDeep Facial Vein communicates between Facial Vein and the Pterygoid Plexus (which also becomes Max Vein) Superior Ophthalmic Vein is a communication between the Facial Vein & Cavernous Sinus Superior and Middle Constrictors are split by CN IX (glossopharyngeal) and the Stylopharyngeus muscleCholine acetyltransferase catalyzes formation of Ach from acetyl CoA & Choline in the presynaptic terminal Post translational modifications- detected by mass spectrometry, western n eastern blottingAddition of disuplhideAddition of functional groupRemoval of methionineProteosome autolytic cleavageCreation of calcium binding sitesEnzymes for forming cDNA librariesReverse transcriptaseRNAsesDNA polymeraseDNA ligaseRestriction endonucleasesPyruvate – CORT Carboxylation – oxaloaceteteOxidation – acetyl coAReduction – lactateTransamination – alaninePhages that replicate only via the lytic cycle are known as virulent phages while phages that replicate using both lytic and lysogenic cycles are known astemperate?phagesAmino acyl tRNA – binds to A site, peptidyl site binds to P siteCharacteristic Slow Twitch (type I) Think O2 Fast twitch (type II) Myosin-ATPase activity Low High Contraction Low High Resisitance to fatigueHigh LowOxidative capacityHigh LowAnerobic glycoslysisLowHighMitochondriaHighLowSarcoplasmic reticulumLow HighMyoglobinHigh Low CapillariesHighLowGlycogen Low High Foam cellsArtherosclerosisHelmet cellsTTPHeinz bodies G6PD deficiencyReed Sternberg cell (CD 30+, CD 15+)Hogdkin lymphomaStarry sky appearanceBurkitts lymphomaSezary cells (T cells - cerebriform nuclei)Mycosis fungoides, Sezary syndromeAuer rodsAMLNull cells ALLMyeloma cells with russel bodies (plasma)Multiple myelomaRouleaux formationMultiple myelomaMonoclonal Ig spike , M protein MULTIPLE MYELOMAFirst metatarsal of great toe affected Gout Pain at nights Acute gout Tophus of external ear/ Achilles tendonAcute gout Paneth cellsBase of lieberkuhn glands – secrete lysosymesAmpulla of vater 2nd part of duodenumPlica circularis Mucosal folding of jejunumTenia coli- smooth muscle layerColon Brunner glands Submucosal glands of duodenumCrypts of lieberkuhnLamina propria, colonFalciform ligament Liver to peritoneumLiverFalciform ligament, ligament teres, ligamentum venosum, IVCRokitansky-Aschoff sinuses: Deep diverticula of the mucosa of gall bladderSubmucosal plexus, meissners plexus Controls secretionsMyeteric/ auerbach plexus Controls motilityCardiac glands Mainly produce mucusPyloricMucous and gastrinOxyntic glands Histamine, pepsinogen, HCLGIP Insulin increasesFe DuodenumFolateJejunumVit B12IleumVIPSecretion of bicarbonate, decrease of HCLDay care microbial infections Rotavirus, Giardia, Campylobacter jejuniAppendicitis Rebound pain, mc burney point, leucocytosisPigmentation -buccal mucosa, polyps in jejunumPetz jeger syndrome, Addison diseaseWhipple diseaeSkin pigmentation, PAS +ve macrophagesAdenocarcinomasRectosigmoid colonGreen pigmentation of cornea, hepatolenticular degeneration Wilson diseaseCharcot laden crystals Asthma Crohns diseaseM. paratuberculosis, proteus, listeriaHirschprung diseaseLack of myenteric n meissner plexus, lack of neural crest migrationMeckels diverticulumTrue, omphalomeseteric vitilline ductRoot canal growth media Thioglycollate mediaCounter current multiplierLoop of henleCountercurrent exchangerMedullary BV of vasa rectaDecreased GFRIncreased hydrostatic pressure in bowmans capsule, afferent arteriole constriction, efferent arteriole dilatation, ureteral blockage, increases plasma proteinsCostovertebral angle tendernessPyelonephritisMacula densa ? Na+ sensor ? Part of distal convoluted tubule Juxtaglomerular cellsModified smooth muscle of afferent arteriole ? Secrete renin in response to low renal BP, low Na+, & high sympathetic tone Diluting segment Thick ascending loop of henleStruvite stone (magnesium ammonium phosphate stone)Stagharn pattern, ProteusAlport syndrome X linked collagen disorder, hematuria, proteinuria, ocular lesions. Deafness- type 4 collagen deficientRenal cell carcinomaStarts in renal tubule cell, associated with von hipple syndrome, spreads through hematogenouslyBergers disease Ig A nephropathyAlcoholic hepatitisMallory bodiesBudd chiari syndromeOcclusion of IVC, hepatic veinVitmian D excessPremature closure of suturesRubellaDeafness, cataracts, micropthalmiaASA, valium, dilantinCleft lip n palateCMV, toxoplasmaMicrocephaly, hydrocephaly and micropthalmiax- ray radiationMicrocephalyEthyl alcoholMidface deficiencyCrown root ratio of primary is smaller than permanentRoots are longer than permanent teethDevelopemental groove on distal surface of root, smaller FL dimensionPrimary mandibular central incisorPrimary maxillary 1st molarTrapezoidal – peripheral, rectangular – occlusal tableH shaped occlusal grooveZuckercandl tubercle Mesial surface of primary mandibular 1st molarMesial root of mandibular 1st molar Concavities on both sides of mesial rootsGreatest axial inclination28 max CINo mesial root depression Mand 2nd premolarMax 1stmolar ML>MB>DB>DLMaxillary 1st molarThe ML cusp tip is located D to the MB cusp tip The DB cusp tip is located L to the MB cusp tip Opening of jawLateral ptetygoid, digastrics and omohyoidClara cellsEpithelial cells of small bronchioles and secrete GAGSV/Q = 0Means airway obstructionV/Q= infinityBlood flow obstructionSpirometry can’t measure RV, FRC, n Total lung capacity J receptorsCauses shallow, rapid breathingCuneiform cartilage Elastic Vocal folds Attaches to arytenoidsAdams appleThyroid cartilageCremaster muscle Arise from inferior obliqueBreastCoopers ligaments, 4th intercoastal nerveExternal intercoastal musclesRibs upward and outwardAccessory muscles Elevates sternum, first two ribsInternal intercostals musclesRibs downward n inwardIncrease complianceEMPYSEMA – due to less elastic recoil and increases FRCDecrease complianceFibrosis, respiratory distress syndromeSore throat Strep. Pyogenes, coxsachkie virus, Epstein bar virus, corynebacteriumBronchitis <5yrs – RSV>5 yrs- mycoplasma, virusesRespiratory distress syndromeAtelectasis, hyaline membrane thickening, ground glass appearanceSarcoidosisSchaumann bosies, asteroid bodies, increased ACE, non caseating granulomasPan acinar emphysema Alpha 1 antitrypsin deficiencyCentriacinar emphysemaSmokingAsthma Goblet cell hyperplasiaDr hacking coughBordetella, viral pneumoniaProductive coughAsthma, Chronic bronchitisChronic bronchitisSmooth muscle hypertrophy, predisposed to brchogenic carcinomaInterstitial/ atypicalRSV, mycoplasma, legionella, adenovirus, ChlamydiaSeen in young childrenLobar pneumoniaPnemucoccus, seen in middle age, rusty sputumBronchopneumonias. pyogenes, s. aureus, klebsiella, H.influenzaseen in infants and children Lung abscessPseudomonas, Klebsiella (in alcoholics), Proteus, AnaerobesNeonate pneumoniaGroup B strep- s. agalacteacie, E.coliFerruginous bodiesAsbestosisBerylloisisMimics sarcoidosisCarcinoma of apex of lundHorners syndromeHeart failure cellsHemosiderin laden alveolar cells, chronic passive congestion of lungsAzygos Rt lumbar + Rt subcostal2,3,4,ribsHemizygosLt lumbar + Lt subcostalLast 4 ribsAccessory hemizygos4 – 8 th ribsMean arterial pressureDiastolic+1/3 pulse pressurePostural hypotension is compensated by constriction of systemic arteriolesIVCGreatest osmolarityRight vagus SA nodeLeft vagus AV nodeSA node and AV node Short fibers, no phase1 and 2Ventricles n atria Long fibers, all phases are presentTeratology of fallot RIPO- righ ventricular hypertrophy, interventricular septal defect, pulmonary stenosis, overriding of aortaTrabeculae carinaeRight ventricleCongenital hear lesions seen in Marfan syndrome – aorta dilation, dissectionDown syndromeTurners syndrome – coarctation of aortaStable angina ExertionPrinzmetal anginaDue to decreased blood flowUnstable anginaOccurring at rest, not due tp exertionEndocarditis Roth spots, osler nodes, splinter hemorrhagesBacterial myocarditisDiphtheria, meningococciViral Rubella, coxsackie, influenzaProtozoalTrypanosome, toxoplasma Reynaud phenomenonScleroderma, SLEOnly myosinH zoneOnly actin I bandCarotid triangleCarotid arteries, internal jugular vein, vagus nerve, CN XII (where the IJV originates from) OccipitalCervical plexus, accessory SubclavianBrachial plexus, subclavian arteryPalatopharyngeus, Salpingopharyngeus, PalatoglossusPharyngeal plexusC1 via XIIThyrohoid, GeniohyoidAMRMU- axillar, musculocutaneous, radial, median, ulnar56 - 567- 5678 - 678T1- 8T1Little finger UlnarThumbRadial, medianMid three fingersMedianGlenohumeral joint movementsFlexion – BPDExtension - DLTAbduction- DSAdduction – PLTLateral rotation – DITMedial rotation - PLSTDPectoralis, deltoid, biceps, latissmus dorsi, teres, supraspinatus, infraspinatus, subclaviusPectoralis major, deltoid, bicepsDeltoid, latissmus dorsi, Teres majorMaffucci syndromeEnchondromas, hemangiomasErythematous rash, sandpaper rash Streptococcus pyogenesPetechaie, purpura Ricketessia, Neisseria Diffuse erythematous, sunburn like S. aureusInt granular layer of cerebral cortexThalamocotical tractsInt pyramidal layerCorticospinal, corticobulbar tractsFrontal Main motor functions, anti social behaviour, lacks self discipline, higher intellectual – broca’s areaParietal Taste, sensory areasTemporalHearing and taste – wernickes areaOccipitalvisualAlzheimers diseasePresenlin gene, apolipoprotein geneDue to Abeta amyloid, senile plaques, neurofibrillary tanglesTreatment 0 AchE inhibitorsPicks diseaseFrontal lobe, temporal lobeAbnormal Tau proteinsAmygdalaHas ADH and oxytocin recpetorsThalamusLateral geniculate, anterior geniculate, VPM, VPL, VA/VLHypothalamusSeptate nucleus, suprachiasmatic nucleus, suproptic nucleus, lateral – obesity, ventromedial – satiety centerAnterior hypothalamicRegulates cold – stimulate PNSPosterior hypothalamicRegulates heat – stimulate SNSSubstantia nigraDopamine as neurotransmitterGray communicating ramiPostganglionic, unmyelinatedWhite communicating ramiPreganglionic, myelinatedSubconsciuous proprioceptionPosterior spinocerebellar- ipsilateralConsciuous proprioceptionGML, CLUUMNPyramidal tractsNeonatal meningitisE.coli, Listeria, S. agalacteciaInfants n children meningitisH.influenza, S. pneumonia, N.miningitisAdolescents meningitisN.meningitisElderly meningitisS.pneumonia, ListeriaViral encephalitisHIV, Rabies, Arthropod borne virus, Herpes simplexPatau syndrome – 13Microcephaly, micropthalmia, cleft lip n palate, polydactylyEdward syndrome – 18Small head, micrognathia, pinched face appearance, mental retardation Autosomal recessive HTN- gauchers, tay sachs, neman pickX linked Fabry, HuntersBilateral schanomasCharacteristic of neurofibromatosisInduction n repressionThis is for controlling transcription/translation of an enzyme.. Irreversible inhibitionirreversible inhibition of cyclooxygenase (COX) by aspirin (acetylsalicylate) which acetylates the active site serine residue G protein gated channels Atrial myocytes, CNS neuronsSpinal trigeminal nucleusOralis- fine tactile of orofacialInterpolaris – tactile + dental painCaudalis – nociception + thermalGreat cerebral veinCorpus callosum+ interior of hemisphereIANBLateral to Medial pterygoid and Pterygomandibular raoheDesminIntermediate filament in musclesVimetin Int filament in mesenchymal cellsGlial fibrillarInt filament in CNSHumerus Muscle attached are = DPTLTDeltoid, pectoralis major, teres major, latissmus dorsi, tricepsE. coliO antigen – lipopolysaccharide, H antigen – flagellin, K antigen – capsule `Free radical injuryLipid peroxidation of cell membraneCrosslinking of proteinsFragmentation of proteinSingle stranded breaks in DNAAldolaseDeficiency – rhabdomyolysis, hemolytic anemiaPyruvate kinaseHemolytic anemiaLead ALA synthase deficiencyG6PDAllosteric activator is NADP, deficiency – hemolytic anemiaVon griek diseaseDef – glucose 6 phosphataseHepatlomegaly, short stature, hypelipidemia, lactic acidosis, hyperuricemiaPompe diseaseDef – lysosomal alpha 1,4 glucosidaseCardiomegaly, muscle weaknessCori diseaseDef – debranching enzymeLiver enlargementAndersen diseaseDef – branchind enzymeCirrhosis, infantile hypotoniaMc Ardle diseaseDef – muscle glycogen phosphorylaseMuscle cramps, weakness, myoglobinuriaHers diseaseDef – hepatic glycogen phosphorylaseHepatomegaly, cirrhosis`Maple syrup diseaseBranched amino acids – Valine, leusine, isoleucineHormone sensitive lipaseActivated by cortisol, epinephrineCell membraneCholesterol increases mechanical stability; also decreases MB fluidity, but prevents freezing Increasing unsaturated FAs increases fluidity Feulgen reaction Differentiates DNA and RNAGolgi apparatus Cis – faces receives material, Trans – transportation functionForms glycoproteins for extracellular use Proteoglycan assembly from proteoglycan core proteinsModifies N-oligosaccharides on asparagine Adds O-oligosaccharides to serine & threonine residues (O-linked glycosylation) PeroxisomesBile acid synthesisAntigen specific cellsB cells, dendritic cells, langerhan cells, macrophagesNon specific antigen cellT lymphocytes, NK cells – NON specific immunityAcid fastMycobacterium, mycoplasma, nocardiaCapsulated bacteriaSome Killer Have Pretty Nice CapsulesStreptococcus, Klebsiella, Hemophilus, Pseudomonas, Neisseria, CryptococcusVolutin granulesPseudomonas, CorynebacteriumTransposonsGenes that often encode proteins necessary for ABX resistance and that can change positions on a chromosome or “jump” from a plasmid to a chromosome IgG2 Immune response for encapsulated bacteriaEndotoxins act viaIL 1 , TNF, activate alternate pathways, hagemans factorLysogeny is shown by OBED – salmonella o toxin, botulin toxin, erythrogenic toxin by strep, diphtheria toxinSepsisStaph. aureus, Klebsiella sp., and E. coliC. diphtheria, PseudomonasProtein inhibitors by inhibiting elongation factor 2Shigella, E.coliInterferes with 60s ribosomesSuper antigensTSST, Erythrogenic – MHC IIIncrease adenylate cyclaseHPAC – heat labile toxin of E.coli, Pertussis, Anthrax,CholeraLecithinClostridium perfringes-*/DesmogleinS. aureusPhosphokinaseBacillus anthracisUrease producing bacteriaPUNCH – proteus, ureaplasma, nocardia, crytococcus, helicobactCatalaseSCAPE – staph. Aureus, Candida, Aspergillus, Pseudomonas, Enterobacteriaciae Cholesterol required n growth mediaMycoplasmaHigh salts Staphylococcus, vibrioCysteineLegionella, brucella, Franciella, PasteurellaBuy AT 30, CCELL at 50 (macrilides):30S: Aminoglycocides (streptomycin, gentamycin), Tetracyclines50S: Clindamycin, Chloramphenicol, Erythromycin, Lincomycin, LinezolidVancomycinInhibits peptidoglycan cross-linking by binding to D-alanyl-D-alanine during cell wall synthesisPencillins, cephalosporinsInhibit peptidoglycan cross-linking by blocking transpeptidase during last stage of cell wall synthesisSulphonamides Inhibit folic acid synthesis by competing with p-aminobenzoic acid (PABA)MetronidazoleInhibit protein synthesis Fluoroquinolones (ciprofloxacin, ofloxacin)Inhibit DNA gyrasesDiphtheriaABCDEFNosocomial infectious agentaPESS – pseudomonas, E.coli, Staph, StrepBorreliaLYMES diseaseHiking through woods, polyarthritis, skin rash, Bulls eye, transmitted by arthropod, ticksRickettesisInsect vector, headache, fever, vasculitis, endothelial cells, maculopapular rash – hands, soles n feetCoxiellaOnly ricketessia transmitted by aerosolStreptoccousImpetigo in preschool chidlremM.scrofulaceumCervical lymphadenitis in childrenViruses n Bacteria transmittd by respiratory dropletsBRAVID- bordetella, rabies, adeno, varicella, influenza, diptheria Segmented RNA virusBOAR – bunya, orthomyxo, arena, reovirusNegative polarityOrthomyxovirus, paramyxo virusGenetic reassortment/ shiftsTwo virus affects one cell n bring major changesGenetic driftGenetic change due to mutation- HIV, Infulenza virus`RNA naked virus CPR – calci, picorna, reo HIV The two important envelope proteins are gp120 (mediates attachment to CD4) and gp41 (mediates fusion to the host cell). The nucleocapsid is composed of p24 and p7.Neither positive/ negative rnaEnterovirus Coxsachkie, HAV, Echo, PolioCommon coldRhinovirus, corona virusMeasles 3Cs – cough, coryza, conjuncitvitsCytopathic effect for paramyxovirusSyncitia formationVirus transmitted by arthropodsToga, bunya, Colti, flaviRubivirusOnly toga virus not transmitted by arthropodsDNA virus HHAPPPY- hepadna, herpes, adeno, pox, papavo, parvoDNA envelopedHPH – herpes, pox, hepadna Vaccinia virusRelated virus to eliminate smallpoxAdeno virusFever, pharyngitis, conjuncitivits, tranmsited by ocular secretionsCongenitally transmitted virusTORCH – toxoplasma, rubella, cytomegalo, herpesTzanck test HSV 1, HSV 2, VZVHerpes Budding from nuclear membraneSexual sporesAsco, zygo, basidioAsexual sporesClamidio, arthro,blasto, spornagipHistoplasmaIntracellular parasites in macrophages, bird n bat droppings, chlamydiosporesBlastomycosisNecrotic Skin n bone lesionsAtrophic glossitisFili n fungi are lostCryptococcusPigeon droppingsAspergillus45 angled septae, fungus ball, mycetoma, aflatoxinsMucormycoisisNon septate, diabetics, hemorrhagic infarctions and necrosis after fungal infections, hyphae in n around blood vesselsEntameoba Flask shaped ulcers, amoebiasis, fine chromatine spokes, Giardia Fatty, foul smelling diarrhea, malabsortion, Entameoba and trichomonasAppear as non pathogenic in oral cavity LeshmaniaSand fly, leshmaniasis, kala azarTrypanosomeChagas disease, resides in cardiac musclesToxoplasmaDivides in the epithelial lining of catsCat scratch disease Bartonella, cat scratchTrichinellaLarvae in muscles, periorbital edemaEnterobiusPerianal itch, most common worm in USTaenia soliumCysticercosis, neurocysticercosisDiphyllobothriumMegaloblastic anemiaEchinococcusHydatid cyst disease, liver n lungsTrichurisBarrel shaped eggsAscaris Bile stained, knobby eggsInterferom gammaInhibits TH2IL 10, IL4Inhibits TH1 cells ................
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