true vocal cords covered by stratified squamous epithelium
nose paranasal sinuses nasopharynx most of larynx and tracheobronchial tree are lined with pseudostratified columnar mucus secreting epithelium
stratified epithelium is only found in oropharynx laryngopharynx anterior epiglottis upper half of posterior epiglottis and vocal folds
corynebacterium diphtheria colonizes oropharynx of non immunized children and can cause pharyngitis and the pseudomembrane which is tightly adherent will cause bleeding if avulsed or scraped
immunization with the diphtheria toxoid induces production of circulating IgG against the exotoxin B subunit effectively preventing the dz.
C. diphtheria releases its exotoxin which when released into the bloodstream causes deactivation of elongation factor-2 a protein that facilitates the movement of forming peptide chain on human ribosome.
Insulin DOC for gestational diabetes
smooth muscle cells of the afferent arteriole would most likely undergo hyperplasia and hypertrophy if clip applied to the right renal artery significantly reduces kidney perfusion
renal hypo perfusion is characteristic of renal artery stenosis which activates RAAS. Hypertrophies smooth muscle cells of the afferent and efferent arterioles synthesize renin which increases A-II mediated vasoconstriction and aldosterone mediated sodium and water retention
remember if mentions difficulty rising from chair think inferior gluteal nerve and polymyositis but with polymyositis its more concerned with overall muscle weakness esp. In hips and shoulders
polymyalgia rheumatica includes bilateral stiffness of should and pelvic girdle muscles fever weight loss and increased ESR and a/w temporal arteritis
myasthenia gravis causes muscle weakness that worsens with activity
eaton lambert is para neoplastic syndrome a/w small cell lung cancer that causes muscle weakness that improves with activity
any time you see fibrotic destruction of any transplanted organ immediately think chronic rejection especially in lung transplants because acute reject can mostly be treated with immunosuppressants
remember CREST and know that since E in CREST causes esophageal dysmobility therefore anytime you see heartburn that cant be treated with OTC antacids think CREST
nitroprusside is a short acting balanced venous and arterial vasodilator that decreases both preload and afterload and since these changes are balanced stroke volume is maintained
tampon in vagina there's activation of macrophages and T lymphocytes which then produced symptoms of toxic shock syndrome (fever vomiting diarrhea and muscle pain)
fluid filtered by glomerulus is primary reabsorbed by proximal tubule portion of nephron
descending loop of henle is water permeable
ascending loop of henle is impermeable to water
ADH promotes aquaporin (water channel) insertion into the apical membranes of principal cells lining the late distal tubules and collecting ducts increasing water reabsorption
lecithinase in the main toxin of c perfringens its concentration correlates with its lethal and necrotic effects
lecithinase is known as phospholipase C or alpha toxin which catalyzes the splitting of phospholipid molecules.
Primary pulmonary defence mechanism that clears the respiratory tract of deposited particles less than 2micronmetres in size is via phagocytosis
coughing and sneezing are way of clearing the largest particles
palpable but non tender GB (Courvoisier sign) weight loss and obstructive jaundice a/w pruritis dark urine and pale stools are indicative of adenocarcinoma at the head of the pancreas compressing the common bile duct
cancers of body and tail do not obstruct the bile duct and thus they usually do not produce symptoms until they invade splanchnic plexus and cause mid epigastric abdominal pain
smoking mcc of pancreatic cancer
sickle cell anemia – valine substituted for glutamic acid known for HbS aggregates in deoxygenated state therefore when oxygen unloading (hypoxic states requires more oxygen to tissues therefore oxygen unloads)
sickling occurs under all conditions a/w anoxia including low pH and high 2,3DPG
Ach and adenosine both reduce the rate of spontaneous depolarization in cardiac pacemaker cells
NE facilitates opening of L-type calcium channels and sodium channels in phase 4 of the nodal action potntial and this leads to increased calcium and sodium influx and more rapid depolarization
anterior displacement of tibia with respect to her femur means Anterior cruciate ligament injured
fibular aka lateral collateral ligament is strong and rarely injured therefore injury to this ligament would require a forceful blow to the medial knee while the leg is extended
patellar ligament is the inferior projection of quadriceps femoris tendon and injury to this causes difficulty with leg extension
posterior cruciate ligament extends from medial epicondyle of the femur to posterior head head of the tibia. It function to prevent posterior movement of the tibia with respect to the femur.
Oblique popliteal ligament is a wide fibrous band that connects the posterior distal femur to the posterior proximal tibia
l. pneumophila cultured on media supplemented with l cysteine and agar used is buffered charcoal yeast extract agar (water colonization)
spaghetti and meatball appx on KOH stain = malassezia furfur
deficiency of mitochondrial enzymes and common subunit containing lipoic acid is abnormal in these enzymes and lipoic acid is a cofactor for PDH and deficiency results in lactic acidosis
lipoic acid is a cofactor of alpha ketoglutarate dehydrogenase and branch chain ketoacid DH and deficiency of that results in maple syrup urine dz.
Citrullinemia results from deficiency of arginosuccinate synthetase which requires ATP as a cofactor
methylmalonic aciduria or acidemia results in acidemia d/t increased circulating levels of methylmalonic acid which generally results from a deficiency of VB12 dependent enzyme methylmalonate mutase.
Homocystinuria results from deficiency of cystathionine synthase and is characterized by premature atherosclerosis. Homocysteine is disposed of by the body by two ways 1-conversion to cysteine by the combined actions 2 VB6 requiring enzymes (cystathionine synthase and cystathionase) 2- conversion to methionine by a folate and VB12 dependent process
orotic aciduria d/t defective pyrimidine synthesis resulting from a deficiency of orotate phosphoribosyl transferase which require glutathione asa coenzyme
radial nerve receive fibers from C5-C8 and T1. It is the largest branch of brachial plexus and supplies posterior arm and forearm extensors of the upper limb. Tracks within the radial groove on the humerus it's vulnerable to injury should the humerus fracture which therefore results in wrist drop and unable to extend the hand upon injury
median nerve damage limits hand flexion
recurrent branch of median nerve or deep branch of the ulnar nerve would both limit finger abduction
damage to the deep branch of the ulnar nerve would also limit thumb adduction
damage to the median nerve affects opposition of the thumb
polyethylene glycol is a laxative which is poorly absorbable and therefore attracts water into the intestinal lumen. It is also known as an osmotic laxative which therefore distends the intestinal wall and increases peristalsis.
Lactase deficiency also characterized by osmotic diarrhea is a deficiency of intestinal brush border enzyme lactase (disaccharidase) and causes inability to break down lactose into glucose and galactose and undigested lactose is non absorbable osmotic substance and its accumulation in small intestine leads to increase in secretion of water and electrolytes into the lumen.
Diarrhea alternating with constipation= irritable bowel syndrome
Crohn's diarrhea is secretory characterized by high electrolyte content d/t poor absorption and increased losses from inflamed intestinal mucosa
rectal prolapse is protrusion of rectal mucosa through the anus a/w pregnancy and constipation and is also seen importantly in children in CYSTIC FIBROSIS
digoxin toxicity can lead to changes in vision as a characteristic side effect and nausea and decreased appetite as common side effects especially if medically history states CHF. Arrythmias are the most serious and potentially fatal effects of digoxin toxicity and need to be txt w/ management of hyperkalemia and possibly w/ anti digoxin antibody
angioedema is a severe s/e clinically seen as edema of lips and larynx. a/w ACE-I
bronchoconstriction is a s/e of nonspecific beta adrenergic blockers in patients with COPD and asthma
long term control of HTN in a chronic ischemic myocardial failure patient- ACE-I because inhibits myocardial remodelling (like beta blockers) and also deterioration of ventricular contractile function, in addition to reducing BP
thiazide diuretic is one of initial treatments for essential HTN in pt. w/o CHF or diabetes (pts with CHF or diabetes ACE-I should be used)
terazosin for pts w/ HTN and BPH
vaccine with bacterial capsular polysaccharide conjugated with diphtheria toxoid- h influenza type B
acellular pertussis vaccine contains purified components of bordetella pertussis and detoxified pertussis toxin
hep B vaccine contains purified inactivated HbsAg particles obtained from yeast through recombinant technology
varicella vaccine contains love attenuate varicella virions
BCG vaccine is also live attenuated vaccine obtained from a strain of mycobacterium bovis (used to immunize against TB)
Sabin oral polio vaccine contains live attenuated virions and the Salk inactivated polio vaccine contains inactivated virions
