Term
| What is Polycystic Kidney Disease and mutation of what gene is involved? |
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Definition
The disease involves the inability of Ca+2 to move from outside the cell to inside the cell. Thus, this disrupts calcium entrance, leading to increased cellular proliferation (Ca+2 functions in inhibiting B-Raf, and without Ca+2, B-Raf would activate MEK, then ERK, leading to basal cell proliferation) and fluid secretion.
It involves the mutation of Polycystin-1 or 2. |
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Term
| What is the effect of rattlesnake poisoning? |
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Definition
| in the rattlesnake/cobra poisoning, their venom contains a phospholipase which hydrolyzes glyerophospholipids. A byproduct of this reaction is "Lysolecithin," which acts as a detergent and dissolves the membranes of RBCs. |
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Term
| What are some integral membrane proteins? |
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Definition
Glycophorin: dictates ABO and MN blood type.
Histamine H1 Receptor
ATP Synthase
Polycystin-1 |
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Term
| What is X-linked Hemophilia? What are the two types? What genes does it involved? Treatments? |
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Definition
Patients who have X-linked hemophilia cannot properly form blood clots.
The two kinds of hemophilia is 1)Bradenburg (-26)and 2) Hemophilia B (Leyden at -20).
Bradenburg is more severe because the mutation is at -26, which overlaps both the Androgen Receptor Gene and HNF4 genes.
Treatment of Hemophilia B (Leyden) is possible because by the time of puberty, the body will begin to produce androgen, and thus increasing the androgen receptor promotion. The genes for Androgen receptor will also promote the making of HNF4 gene and thus factor IX would be made (factor IX is involved with blood clotting cascade). |
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Term
| What does Fluoroquinolone do? What are some medical drugs that does this? |
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Definition
Fluoroquinolonoe antibiotic targets DNA gyrase in many gram-negative bacteria, preventing the transcription of bacterial genes from being made thus stopping the bacteria.
some drugs include: ciprofloxacin and levofloxacin. |
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Term
What is:
1) Xeroderma Pigmentosum
2) Ataxia telangiectasia
3) Fanconi anemia
4) Bloom syndrome
5) Cockayne syndrome
6) Werner's syndrome
-and how is it repaired? |
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Definition
1) caused by mutations in genes involved in nucleotide excision repair. Results in skin cancer such as melanoma
2)caused by a mutation in the gene that detects DNA damage. Associated with increased breast cancer in carriers.
3) Caused by mutation of gene involved with DNA repair. increased risk of X-ray and sensitivity to sunlight.
5)caused by defect in transcription-linked DNA repair
6) caused by mutation in DNA helicase gene. results in premature aging. |
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Term
What are these types of mutation and what is the result?
1) frameshift
2) missense
3) nonsense |
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Definition
1) there are two types of frameshift mutations, they are deletion and insertion. As a result, they often lead to a change in every AA downstream of the mRNA and major result would be truncated proteins.
2)missense mutation is a result of an error that leads to the addition of a different codon/AA.
3) nonsense mutation is a mutation of a nucleotide that leads to formation of an early stop codon. |
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Term
What color do these stains make? What does it specifically stain?
1)Hematoxylin
2) Eosin
3) Masson's Trichrome
4) Mallory's Trichrome
5) PAS
6) Osmium Tetroxide |
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Definition
1) BLUE; stains RER and ribosomes; specifically stains nucleic acids blue
2) PINK; intense pink when around mitochondria; specfically stains elastic fibers - pink, and Reticular fibers - pink.
3) BLACK; cartilage-blue/green, and muscle fibers - red
4) Keratin - orange, cartilage - blue, bone matrix - deep blue, muscle fibers - red
5) basement membrane - blue, glycogen and other carbohydrates - magenta
6) stains membrane lipids; myelin - dark black, and golgi - black |
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Term
What is Epidermolysis?
List the diseases associated with each type and on what gene it is found:
1) Epidermolysis Bullosa Simplex (EBS)
2) Epidermolytic Hyperkeratosis (EH)
3) Epidermolytic Plantopalmar keratoderma (EPPK) |
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Definition
-weakened keratin that breaks. when the skin is stressed, it will tear along the basal lamina.
1) mutation of keratin 5 & 14 - results in blisters soon after birth due to pressure or rubbing. (most severe)
2) excessive kertinization causes breakdown of the epidermis
3) disorder is restricted to palms and sole of feet. |
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Term
What are the different filament types,structures, and what are some subunit examples?
1) microfilaments
2) intermediate filaments
3) microtubules |
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Definition
1) diameter is 6nm; structure is double helix; subunit example: actin.
2) diameter is 10nm; structure is two antiparallel/dimers, forming tetramers; vimentin (mesenchyme), glial fibrillary acidic protein (glia), Neurofilament (neurons), keratins (epithelia), nuclear lamins and desmins (muscle)
3) diameter is 23nm; structure is 13 protofilaments; subunit is alpha and beta-tubulin. |
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Term
What is pemphigus? The two types listed below are different, how?
1) Pemphigus Vulgaris
2) Pemphigus foliaceus |
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Definition
Pemphigus is a skin blistering disease, unlike epidermolysis, it is a disease that is an autoimmune disease.
1) vulgaris - involves autoimmune attack of desmoglein (protein) 3 - affects desmosomes (on lateral side of cell)
2) foliaceus - involves desmoglein 1 - attacks the Hemidesmosomes. |
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Term
| What is Tau proteins? What are they involved with? Mutation of these Tau proteins will lead to what type of neurological disease? |
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Definition
Tau proteins allow microtubules to be packed into tighter bundles and prevent microtubules from being tangled. They are found in the axons of neurons.
In diseases such as Alzheimers, the tau proteins are hyperphosphorylated and thus lead to a formation of Tau filament. This formation does not allow Tau to bind to the microtubules, but instead with each other Tau. |
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Term
| What is X-Linked Adrenoleukodystrophy (X-ALD)? What are the treatments? What other disorder can it often be misdiagnosed for? |
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Definition
X-linked ALD occur due to a mutation in the ABCD1 gene; this gene is involved with ATP dependent transporter of Fatty Acids into the peroxisome. As a result, there's an increased level of Very Long Chain Fatty Acids in the blood.
Treatment: Diet (restrict VLCFA inputs) plus Lorenzo's Oil (olive oil and rapeseed oil; competitive inhibition of VLCFA metabolism) - lorenzo's oil is used to inhibit the formation of VLCFA; if adrenals affected, then treat with adrenal hormone replacement therapy.
It is often misdiagnosed for ADHD |
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Term
| What is the difference between COPI, COPII, and Clathrin? |
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Definition
Clathrin - brings cargo from the outside of cell into early endosome and towards golgi through endosomal process.
COPI - mainly used for Golgi in movement of cargo between golgi pancakes and retrograde towards ER.
COPII - mainly used for ER to Golgi
but remember, movement of cargo and membrane proteins can move in both direction. |
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Term
| How does Salmonella typhimurium cause diarrhea? |
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Definition
| The bacteria gets into the epithelium of intestinal cells and causes a break down of cellular junction (tight, gap, desmosomes). This allows water and other nutrients to go through those junctions, thus leading to diarrhea. |
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Term
Where are the functions of these cells and where are they found?
1) simple squamous
2) simple cuboidal
3) simple columnar
4) Stratified Squamous
5) Stratified Cuboidal
6) Stratified Columnar
7) Pseudostratified epithelium
8) Transitional Epithelium |
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Definition
1) involved in selective diffusion - capillaries, alveoli, kidney glomerulus
2) functions in secretion - kidney tubules, ducts of exocrine glands, germinal epithelium,
3) Absorption - GI tract, Large kidney tubules
4)Protective function - skin
5) ie. salivary gland duct, sweat duct in thin skin
6) ie. largest gland ducts (mammary, oviduct, or salivary)
7)found in much of respiratory system and male reproductive system. it appears to have several layers, but in fact it only has 1, the nuclei are simply located in different positions. examples are trachea, and epididymis
8) these are true stratified. they are a transition between strat cuboidal and strat squamous. has 4-5 layers. functions in protection against toxicity and stretch. forms umbrella cells. ie are bladder and ureter.
7) |
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Term
| Mutation of Swi/Snf family of proteins can lead to what? |
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Definition
Swi/Snf family of proteins are involved with generation of superhelical torsion. It can also reposition histone octamers. This repositioning can change the profile of DNA that is available for transcription!
mutation or lost of function in Swi/Snf subunits can lead to Cancer Initiation! |
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Term
What is Euchromatin vs Heterochromatin?
What are the two types of Heterochromatin? and give examples |
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Definition
Euchromatin is light staining. It is the gene-rich areas. It is where chromatin is "loose." It facilitates access of transcription machinery.
Heterochromatin is dark staining. It has few or no genes. It has lots of repeated elements. It is often found at the centromeres or telomeres (end of DNA). It has HIGHLY compact chromatin.
2 types of heterochromatin are:
Facultative: example would be X-chromosome Barr Body. Sometimes the genes needed can be activated, otherwise, it is very highly packed or unactive X chromosome.
Constitutive: examples would include telomeres and centromeres. |
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Term
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Definition
| The heritable changes that we obtain without changes in DNA. There is chromatin remodeling according to the external environment and experiences that we have gone through. It has potential to favorably modify gene expression. |
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Term
| How are nerve gases an example of enzyme inhibitor? What is it's mechanism of action? Give a specific example of an enzyme affected? What is the course of treatment and antidote? |
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Definition
Following an attack of serine on the nerve gas, the nerve gas intermediate is very stable (becoming an irreversible inhibitor) and holds up the active site from being used by other molecules.
An example is the Acetylcholinesterase that breaks down acetylcholine. By filling up the active site of Acetylcholinesterase, the enzyme is therefore unable to cleave acetylcholine, so that it can undergo reuptake of the cell. By preventing cleavage of acetylcholine, the cell is undergoing a "constitutive" activation of the nervous system! results in muscle spasm and death
Treatment is atropine, which is a competitive inhibitor of acetylcholine receptor.
antidote is 2-PAM, which removes the organophosphate(stabled nerve gas) and therefore restores acetylcholinesterase activity. |
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Term
The collagen Associated diseases listed below have what type of defects?
1) Osteogenesis Imperfecta
2) Alports Syndrome
3) Goodpasture's Syndrome |
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Definition
1) like the name has it, it cannot make bones very well. Collagen that is affected is type I/III. note that type I is most abundant and type III is in the lamina reticularis.
2) In Alports syndrome, the Basement Membrane deteriorates, allowing proteins and RBCs to enter the urine. It collagen IV that has gone bad. Remember, collagen type IV is found in Lamina densa.
3)Also called anti-glomerular basement antibody disease, it is an autoimmune disease attacking the lungs and the kidneys, directed toward alpha-3(IV) NCI domain. |
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Term
What are some phenotypes of Diabetic Glomerular Basement Membrane (GBM) as compared to normal?
What are the results of Diabetic TBM? |
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Definition
In normal GBM, the membrane is much smaller.
A phenotype that can readily be observed under microscopy is a thickening of the basement membrane in patients with Diabetic GBM. This is especially evident in the kidney, leading to diabetic nephropathy.
Diabetic TBM has a phenotype that shows thickening of diabetic tubular basement membranes. You can observe this by staining it with PAS. Dark colors will appear. |
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Term
| What are the dangers associated with Diabetic Hyperglycemia? |
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Definition
- when the levels of glucose rises (hyperglycemia) in blood, patients with diabetic hyperglycemia are unable to bring the glucose into the cell. as a result, there is an increase in amino acid degradation/metabolism, which results in reactive oxygen intermediates.
As a result, you get this Advanced Glycated End-product (AGE) which results in endothelial leakage, thicker BM, generation of immunogenicity.
Also the AGE Receptor (RAGE) will create a decreased cell potential, lower conduction speeds, and generate ROS (reactive oxygen species), which will ultimately lead to Apoptosis. |
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Term
| How are collagen Fibers formed? |
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Definition
Inside cell:
-3 nonlinear peptides come together to form 1 collagen molecule.
-Collagen molecule is synthesized as individual chains called "procollagen" that contain registration peptides.
-procollagen gets transported outside the cell/leaves the cell
Outside cell: matrix
-Procollagen gets cleaved at non-helical registration peptides and becomes an insoluble "tropocollagen"
-tropocollagen aggregate to form "collagen fibrils" (cross-linking of tropocollagen reinforce fribillar structure)
-these collagen fribrils then associate to form "collagen FIBERS" |
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Term
| What is the pathology of Marfan Syndrome? What are the phenotypes within the human body of patients with this disorder? What are the extrabodily phenotype? |
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Definition
Patients with Marfan Syndrome have issues with their collagen and elastic fibers. Marfan syndrome is an autosomal dominant disorder.
within the body: the absence of fibrillin leads to loss of elastic fibers in the body. Also they show mitral valve prolapse where the valve cannot close normally. Additionally, scans may show up with an aortic dissection, where the inside wall separates from the muscle and blood flow through this space.
External features of pt are tall with long arms, legs, fingers, and toes.
The disease is a result of a deficiency in the protein fibrillin 1, which is responsible for this syndrome. |
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Term
| How does the cholera Toxin affect the CFTR channel? |
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Definition
Cholera toxin goes in and messes up the CFTR channel so that it doesn't close. People with cholera are not able to close the CFTR channel. Therefore, chloride is constantly being pump out, Na will also leave pericellularly and as a result, water will go along with it. Ultimately you have diarrhea and dehydration. It untreated, this may lead to death.
Cholera will alter an AA on the alpha S subunit... Eventually it will lead to the phenotype of Massive Diarrhea.
Cholera toxin will "ribosylate"(meaning it adds an ADP-ribose sugar onto something. In this case to Arg201) the Galpha S subunit and prevent hydrolyzing GTP, thus the subunit is unable to be deactivated. This will lead to constant activation of signal transduction pathway and eventually leading to diarrhea and dehydration. Specifically cAMP that is always being activated.
Activated cAMP cannot be stopped and there will be a constant increased in PKA, which will bind to the CFTR channel and promote Cl- secretion, pericellular secretion of Na and water. Thus, eventually leading to diarrhea and dehydration. |
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Term
| What is cystic fibrosis and how is it affected in patients with mutant copies of CFTR gene? |
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Definition
CFTR is a transmembrane Channel that allows for Chloride to leave the cell.
CFTR in airways is a result of the CFTR gene where the outcome is a bad fold and the protein gets hung up in the ER. As a result, the cell is unable to properly secrete choloride into the lumen of the airway epithelia. Ultimately, the mucous on the outside begins to build up, which encourages bacterial growth, leading to, a secondary infection. Patients will also experience this "drowning in their lungs" feeling. |
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Term
| What is the mechanism of cyanide poisoning and what is the outcome? |
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Definition
Cyanide binds to Cytochrome a3 and prevents hydrogen from leaving the matrix and entering the inner membrane space.
You can't generate energy when you have cyanide poisoning because it binds to cyt a3, which will prevent electron from being sent to O2 in complex IV. Therefore you will die. |
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Term
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Definition
In a fed state, we will increase F2,6bP which will act on PFK-1 and increase glycolysis. At the same time F2,6bP will act on Gluconeogenesis and inhibit it from generating glucose molecules. In the fed state, Kinase will be activated.
When you are starving, you will have less F2,6bp and you will have more F6P. If this is the case, since you have less F2,6BP, PFK1 will be acted upon less, and gluconeogenesis will be less inhibited.
The same reaction is likewise. When you are full, you will have less F6P and more F2,6bP. Therefore you will have more PFK1 and less Gluconeogenesis (due to inhibition).
Glucagon will convert the kinase from the active form to the inactive form (in this example, phosphorylation of the kinase will inhibit the kinase). |
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Term
| What is the master regulatory step of glycolysis? |
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Definition
Glycolysis step 3: phosphorylation of F6P to become F1,6bP. This step utilizes ATP.
This step is the point of no return; irreversible = commitment step. This is also the rate limiting step. |
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Term
| What steps yield ATP and NADH in Glycolysis? |
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Definition
Step 6: Glyceraldehyde-3-Phosphate to 1,3bPG yields 1 NADH that can be used for oxidative phosphorylation.
Conversion of 1,3bPG to 3Phosphoglycerate yields 1 ATP (but remember that each glucose is broken down into eventually 2 G3P, and thus 2 ATP is made, which recovered the 2 ATPs expended in the first step of glycolysis).
Step 10: PEP to pyruvate generates 1 ATP (but remember 2 ATP b/c of 2 G3P).
The net yield of ATP in glycolysis is 2 ATP per glucose molecule, and 1 NADH. |
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Term
| To form Citrate in the TCA cycle, what molecule is needed and what are the negative regulators of this step? |
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Definition
| Step 1: Acetyl CoA + oxaloacetate + H20 is required to make Citrate. Negative regulates of this step include succinyl-CoA, NADH, and well-fed state. |
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Term
| The formation of a-ketoglutarate and NADH, from isocitrate and NAD+, is regulated by what? |
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Definition
Negatively regulated by ATP and NADH.
Positively regulated by ADP and NAD+ |
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Term
| Conversion of a-ketoglutarate and NAD+, to succinyl CoA and NADH requires what molecule and what is it regulated by? |
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Definition
It requires CoA-SH and NAD+.
It is negatively regulated by succinyl-CoA and NADH |
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Term
What steps generate NADH/FADH2?
What steps generate GTP? |
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Definition
Steps 3,4,8 yields NADH.
Step 3: isocitrate to a-ketoglutarate
Step 4: a-ketoglutarate to succinyl-CoA
Step 8: malate to Oxaloacetate
Step 6: Succinate to Fumarate (yield FADH2)
Step 5: generates GTP (which will later be converted to ATP in the process of GTP+ADP = GDP + ATP_
Conversion of succinylCoA to succinate yields GTP |
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Term
| What enzyme of the TCA is also involved in oxidative phosphorylation? |
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Definition
| Succinate dehydrogenase. It converts succinate to fumarate |
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Term
| What is significant about Complex III and Complex IV? |
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Definition
The electrons that CoQ gained from complex I and II will be deposited at Complex III. Eventually complex III will undergo a series of redox reactions and ultimately lead to the reduction of Cytochrome C.
You need to have oxygen to receive electron from glucose. The final recipient of electron is oxygen and it will be converted to water. |
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Term
| What is Anencephaly and Spina Bifida and failure at what day results in these disorders? |
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Definition
Anencephaly is failure of anterior neurpore closure. Failure occurs at 25 days.
Spina bifida is failure of posterior neuropore closure at about 27th day. |
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Term
| What are the steps of the development of the Neural Tube? |
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Definition
-Neurulation starts with induction of the neural form.
-Notocord releases SHH and Noggin.
Noggin and Chordin inhibits BMP and induce neural form.
-Neural tube "zips" closed cranially and caudally.
-Cranial Neuropore closes at 25 days.
-Caudal Neuropore closes at 27 days
-Somites are mesoderm that will become dermis, muscle, and vertebrae
-Notochord becomes part of the intervertebral discs. |
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Term
| What disease is Multiple Sclerosis? |
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Definition
-It is a chronic disease of the CNS, predominately affects young adults.
-It is an autoimmune and/or viral disease, but genetic and environmental factors may contribute (women>men).
-Characterized by areas of demyelination and T-cell predominant perivascular inflammation in the brain white matter.
-Symptoms include numbness, paresthesia, double vision, optic neuritis, ataxia, and bladder control problems.
It is primarily due to oligodendrocyte damage. |
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Term
| How does a neural transmission - action potential occur? |
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Definition
1) Dendrites receive stimulus signal from another neuron
2) Some Na channels begin to open
3) Once the cell reaches threshold, the other Na channels also open (depolarization)
4) After the cell reaches about +30mV, the K (delayed) channel opens, and at the same time Na channels get inactivated
5) The efflux of K will repolarize the cell and bring the cell past normal (-90mV)
6) Once it goes past the resting cell (-70mV) this is called hyperpolarization
7) The hyperpolarization ensure that the cell does not depolarize again and prevents messages from going in the opposite direction (or at least make sure it goes in one direction). |
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Term
| How does Herpes Zoster (Shingles)arise? |
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Definition
-Shingles is a disease caused by the same virus that causes chickenpox (varicella zoster). After chickenpox, the virus remains dormant in DRG neurons for life.
-Virus can become active again and cause shingles (unsual skin sensation, itching or a burning, tingling or shooting pain).
-The skin reddens/swells, and a rash of fluid-filled blisters develops. blisters usually crust over within a week and eventually heal.
-Symptoms appear on only one side of the body, usually the face or torso.
-When the virus is activated, it can send it's action down the axon (since it was dormant in the DRG). it can affect the face or sides of the back. |
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Term
| What are the clinical effects of beta blockers? |
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Definition
| Beta blocker therapy lowers blood pressure and has a calming effect. Ultimately, it decreases the oxygen demand placed on the heart. |
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Term
| When Gprotein reassociates to the 7TM-R, how do we know that it won't just get activated again?This is a problem!!! How can we make sure that the 7TM-R gets deactivated? Otherwise, GTP will just exchange for GDP and the cycle continues. |
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Definition
1)PKA and PKC will phosphorylate the Ligand-bound 7TM-R and this will desensitize it (heterologous desensitization)
2) phosphorylated GPCR can’t interact with the heterotrimer (thus, the Gprotein activation cycle is broken).
3) Phosphorylation of the 7TM-R doesnt affect the affinity for the ligand; instead, it simply prevents the reforming of the Gprotein with 7TM-R.
4) the phosphorylation reduces the affinity of receptor for ligand only b/c it facilitates uncoupling of the receptor from its Gprotein.
5) free beta-gamma subunit recruit GPCR kinase (GRKs).
6) GRKs phosphorylate only ligand-bound occupied GPCRs (so… more phosphorylation occur??)
7) phosphorylated GPCRs recruit and bind arrestins (Arr)
8) Arr-bound GPCR is internalized and degraded. OR Arr-bound GPCR is dephosphorylated and recycled to the cell surface (resensitization) |
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Term
| What is Jansen's Metaphysical Chondrodysplasia (Ligand-independent)? |
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Definition
| In this disease, Jansen's metaphysical chondrodysplasia - the mutation is at the Parathyroid Hormone Receptor (PTHr). The receptor is mutated so that it THINKS/BELIEVE it is responding to PTH (even though PTH isn't even bound to it). This mutation is a LIGAND-INDEPENDENT Gprotein activation. Result is hyperglycemia (increase breaking down of calcium in bones, thus increasing amount of Ca++ floating in blood), from resorption of bones. |
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Term
| What is Bordetella pertussis? Where does it target? What is the patient's phenotype after being infected by this bacteria? |
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Definition
| In this example, Bordetella pertussis targets the Galpha I subunit and adds an ADP-ribosylation at a C-terminal cys residue. This ribosylation (modification) prevents the Galpha I subunit for carrying out it's function. Since alpha I cannot inhibit certain things, the action is carried out constantly and you end up with this "whooping cough." |
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Term
| Defect in what will lead to precociuos puberty? |
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Definition
When luteinizing hormone that are activated early will lead to premature testosterone production. Example as early as 3yrs old.
Luteinizing hormone receptor MUTATION in Leydig cells is a LIGAND-INDEPENDENT event in which the receptor BELIEVES that it is receiving signals from lutenizing hormone and thus promotes the premature production of testosterone which will lead to precocious puberty. |
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Term
| What compound is used for treatment of angina or hypertensive emergencies or to induce controlled hypotension? |
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Definition
Nitroglycerin.
Nitroglycerin can bypass the NOS enzyme and is converted directly to NO. NO activates Guanylate Cyclase (GC), leading to increased levels of cGMP and subsequent vasodilation and smooth muscle relaxation. |
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Term
| What is Duchenne's Muscular Dystrophy? |
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Definition
It is X-linked, recessive disorder caused by a mutation in the dystrophin gene. Females can only be carriers.
Patients with DMD often has defective dystrophin. Dystrophin is associated with F-actin and it functions to reinforce and stabilize the sarcolemma during the stress of muscle contraction by maintaining a link between the cytoskeleton and the extracellular matrix.
Most DMD patients die between teens to early 20s.
Since males don't reach reproductive age, it is hard to pass on his affected DMD gene onto the daughter. therefore, it is rare to see a female with both DMD gene. |
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Term
| Sarcopenia is a condition of what? |
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Definition
-A condition of decreased lean body mass during aging due to loss of skeletal muscle mass.
-overall leads to decreased muscle strength placing patients at risk for falls. |
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Term
| What is Atherosclerosis? What are the symptoms? What is the mechanism? |
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Definition
Disease:
1. Atherosclerosis is a disease in which lesions are caused by the chronic inflammatory, fibroproliferative response to injury of the endothelium.
Symptoms:
1. Vascular disease downstream of endothelial injury (endothelial cell injury is the first step in atherosclerosis)
2. "hardening" of the arteries (sklerosis = hard) due to fibrofatty intimal plaques
3. Blood vessel lumens decrease, and are susceptible to occlusion; resulting in ischemia
4. Risk factors: LDL levels, diabetes mellitus, hyerptension, smoking
Mechanism:
1. Injury to the endothelium
2. Lipids taken up by the macrophages in tunica intima and fibroblasts of subendothelial space proliferate
3. Macrophages release lipid and cytokines which stimulate collagen production and proliferation of smooth muscle cells (atheroma is formed)
a. Atheroma - lesions due to the deposition of fatty material in the wall of the vessel; usually in large (elastic) arteries
b. Lesions are responsible for:
i. Myocardial infarction (heart)
ii. Cerebral infarction and stroke (brain)
iii. Gangrene and loss of function (peripheral vasculature) |
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Term
| What are the steps in the formation of an Atheroma? |
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Definition
1. Damage of the endothelium of an artery - caused by hypercholesterolemia - followed by infiltration of LDL in tunica intima
2. Lipids are taken up by macropahges and fibroblasts of the subendothelial space proliferate
3. Macrophages release lipids into the subendothelial space and macrophage-derived cytokines stimulate the production of collagen
4. The ulceration of the atheroma provides a surface for thrombosis (formation of a fibrin-platelet containing thrombus). Catastrophic consequences such as luminal obstruction, leading to infarction or sudden cardiac death. |
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Term
| What are the characteristics of Blood Vessels? |
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Definition
Large (Elastic) Arteries
1. Conducting Arteries - because they conduct blood from the heart to the medium sized distributing arteries
2. Receive blood from heart under high pressure. Wall distends during systole (heart contraction) and recoil during diastole (relaxation) - thereby sustaining a continuous blood flow despite intermittent pumping of heart.
Medium-sized, Muscular Arteries
1. Distributing arteries - allow selective distribution of blood to different organs relative to functional needs.
2. Different from elastic arteries, Muscular arteries have:
a. Prominent internal elastic membranes
b. Fewer elastic sheaths, more prevalent smooth muscle fibers in tunica media
c. Thick tunica adventitia and recognizable external elastic membrane
Arterioles
1. Resistance vessels - regulate the distribution of blood to different cappilary beds by vasoconstriction and vasodilation.
2. Major determinants of systemic blood pressure
3. 1-2 concentric layers of vascular smooth muscle in t. media
Capillaries: Exchange Vessels
1. Thin tubes consisting only of endothelial cells and basal laminae
2. Small diameter (4-10um), permit passage of one RBCs at a time.
3. 3 types of capillaries: continuous (great number of transport vesicles), fenestrated (have pores and holes), and discontinuous (have gaps between cells and an incomplete basal lamina, found in: liver, spleen, and bone marrow)
Venous system: Capacitance or Reservoir Vessels
1. Postcapillary venule: receives blood from capillaries
2. Resembles continuous capillary but with wider lumen
3. Muscular venule - distal to postcapillary venules in venous network; presence of tunica media and thin tunica adventitia
Postcapillary venules
1. Preferred site of leukocyte egress from blood across vessel walls (via diapedesis - disruption of endothelial junctional complexes and migration through subendothelial basement membrane.)
Veins
1. Veins (like arteries) have three tunics
2. Distinction between tunics often unclear and the internal elastic lamina is thin or absent
3. Tunica media is thinner than that found in arteries of same diameter
4. Veins have thinner walls and larger lumens than arteries
5. Tunica adventitia is thicker than t. media in same vein
6. Veins have valves to prevent reflux of blood |
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Term
| What are the 3 layers/Tunics of Arteries and Veins? |
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Definition
Tunica Intima (inner)
1. Single layer of endothelial cells
2. Basal lamina of endothelial cells
3. Sub-endothelial layer-loose connective tissue
a. (in arteries: also a layer of fenestrated Elastin)(also have Internal Elastic Membrane)
Tunica Media (middle)
1. Concentric layer of smooth muscle
2. Sheets of fenestrated elastin
3. Collagen fibers (Extends from IEM to the External Elastic Membrane)
Tunica Adventitia (outer)
1. Longitudinally arranged connective tissue (large vessels have vasa vasorum, & autonomic neural tissue/nervi vascularis).
Note: large vessels need vasa vasorum (blood supply) and autonomic neural tissue (nerve impulse) |
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Term
| What is tumor angiogenesis? can it be stopped? |
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Definition
Tumors require/relies upon pro-angiogenic signals. Tumors need vessels for nutrients required for growth. Angiogenic recruitment depends on the secretion by tumors of endothelial cell growth factors (angiogenic peptides) similar to those produced during physiologic angiogenesis.
2 antiangiogenic peptides: angiostatin and endostatin.
The can stop or slow cancer growth in mice by preventing the development of new blood vessels needed to nourish growing tumors. |
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Term
| What Cyclins are involved with which stages of the cell cycle? |
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Definition
Cyclin E pushes cells into S phase.
By the time E gets degraded, you get production of cyclin A, which will drive the cell into G2.
As A is going away, you get cyclin B, which will drive cells into the Mphase.
As midway through Mphase, cyclin B will get degraded.
Cyclin D allows passage through G1 phase, Cyclin D also inhibits Rb(check point for G1 and Sphase), which allows for cell to enter into S phase. |
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Term
| What complex is responsible for regulating M Phase of the cell cycle? |
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Definition
If Cdk1 is still activated, you will still have spindles and those spindles won't be degraded. Therefore, in order for the cycle to proceed you have to shut these guys off. One mechanism is through the degradation of Cyclin through APC/C ligases function.
Anaphase Promoting Complex - APC will lead to the degradation of Cdk1 by adding ubiquitination onto Cyclin. ubiquitination will eventually cause cyclin to be released from Cdk and cyclin to be recycled. Cdk without cyclin is inactive. |
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Term
| What is abdominal Pregnancy? |
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Definition
-typically located in the rectouterine pouch, attached to peritoneum.
-midline section of bladder, uterus, and rectum to show an abdominal pregnancy in the rectouterine (Douglas) pouch. |
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Term
| What is the fertilization process? |
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Definition
Fertilization: Process by which male and female gametes (spermatozoa and oocyte) fuse
1. Oocyte (plus corona radiata cells) is ovulated from the ovary and swept into the uterine tube
2. Spermatozoa (sperm) must first undergo: REQUIREMENTS
a. Capacitation: "Conditioning" in female repro tract (approx 7 hrs) that allows sperm to pass through the corona cells and undergo acrosome reacion
i. Conditioning is established by interaction b/t sperm and mucosa of uterine tube
ii. Removal of glycoprotein coat and seminal plasma proteins from sperm plasma membrane overlying acrosome region
b. Acrosome reaction: leads to release of enzymes (eg acrosin- and trypsin-like substances)
i. Requires capacitated sperm
ii. Sperm bind to zona pellucida; mediated by ZP3
iii. Above binding induces enzyme release; mediated by ZP3
iv. Sperm penetrates zona pellucida and contacts plasma membrane of oocyte
3. Sperm can be viable in female repro tract for several days; sperm movement is aided by
a. uterine cilia
b. Fluid movement
c. Flagella
4. Fertilization occurs 12-24hrs following ovulation
5. Fertilization likely occurs in ampulla of uterine tube |
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Term
| What are the phases of fertilization? What happens after fertilization? |
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Definition
Phases of Fertilization: Sperm Perspective
1. Capacitated Sperm bind to and penetrate corona radiata
2. 1 or more sperm (spermatozoa) penetrates the zona pellucida
3. 1 sperm (spermatozoon) penetrates oocyte membrane while losing its own plasma membrane; leading to fusion of sperm and oocyte cell membranes.
Following Fertilization:
1. When the sperm head contacts oocyte surface
a. Contact leads to release of lysosomal enzymes from cortical granules lining oocyte plasma membrane (cortical reaction)
b. Oocyte membrane becomes impenetrable to other sperm
c. Zona pellucida properties are altered to prevent further binding and penetration by sperm (zona reaction) |
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Term
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Definition
-95% of ectopic pregnancies occur in uterine tube, and most of these occur in ampulla.
-embryo is approximately 2 months old and is about to escape through a rupture in the tubal wall. |
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Term
| What genes are involved with forming Anterior/Posterior Axis? |
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Definition
Axes Patterning Genes: Ant-Posterior Axis (before gastrulation)
1. AVE (Anterior Visceral Endoderm) - acts with node as second signaling region in head. Expresses genes essential for head formation. Thus, the cranial end of the embryo is established before gastrulation |
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Term
| What genes are responsible for forming the Dorsal/Ventral Axis? |
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Definition
Axes Patterning Genes: Dorsal-Ventral Axis (during gastrulation)
1. The primitive streak is initiated and maintained by Nodal (TGF-beta family)
2. Bone Morphogenetic Protein 4 (BMP4) - secreted throughout the bilaminar disc, acts with FGF to ventralizes mesoderm into intermediate and lateral plate structures.
3. Chordin, Goosecoid, noggin & follistatin - antagonize activity of BMP4 and dorsalize mesoderm in head to form notochord and paraxial mesoderm.
4. Later, Brachyury (T) gene - antagonizes BMP4 to dorsalize mesoderm in caudal embryo |
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Term
| What genes are responsible for forming the Left/Right Axis? |
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Definition
Axes Patterning Genes: Left-Right Axis - Gene cascade, initiated by Fibroblast Growth Factor (FGF8) on left side, establishes expression of Nodal on the left side
1. FGF8 secreted by node and primitive streak, establishes expression of Nodal on the left side near the node.
2. Later, as the neural plate is induced, FGF8 induces expression of Nodal and Lefty-2 in the lateral plate mesoderm; whereas, Lefty-1 is expressed on the left side of the ventral aspect of the neural tube.
3. Brachyury (T) gene, expressed in the notochord, also participate in induction of these three genes.
4. In turn, expression of Nodal and Lefty-2 regulates expression of the TF PITX2, which establishes left sidedness.
5. Sonic Hedgehog (SHH), expressed in the notochord, may serve as a midline barrier and repress expression of left- side genes on the right.
Expression of Snail may regulate downstream genes important for establishing right sidedness |
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Term
| What is Caudal Dysgenesis? |
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Definition
Malformation: Caudal dysgenesis (sirenomelia)
Bradyury (T) gene - induces caudal dorsal mesoderm formation.
Condition: absence of brachyury (T) gene - leads to shortening of embryonic axis (caudal dysgenesis) and may result in fusion of the limb buds. |
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Term
| What are the results of malformation in ciliated cells and L/R Axis formation? |
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Definition
Nodes contain ciliated cells.
Abnormalities in cilia proteins lead to laterality defects in mice. |
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Term
| What is the malformation of Conjoined twins? What elements are involved? |
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Definition
Malformation: Conjoined Twins
Goosecoid (dorsalizes head mesoderm) helps regulate head development.
Condition: Over or Under - expression of Goosecoid results in head malformations similar to conjoined twin phenotype. |
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Term
| What is a malformation that result in tumors associated with gastrulation? what is the phenotype and cause? |
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Definition
Tumors associated with Gastrulation: Sacrococcygeal Teratoma (usually not malignant)
this is a result of remnants of the primitive streak.
the baby shows a huge tumor beneath it in the sacrococcygeal region. Most common in female fetuses. |
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Term
| What are some other teratogenesis Associated with Gastrulation? |
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Definition
Holoprosencephaly - high doses of alcohol - lead to craniofacial malformations
Caudal dysgenesis (sirenomelia) - insufficient mesoderm formation leads to abnormal lower limbs, Urogenital system, and lumbosacral vertebrae
Situs inversus - cilia defects - lead to transposition of viscera in thorax and abdomen |
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Term
| What organs/features are derived from the Ectoderm Germ Layer? |
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Definition
Derivative of Ectodermal Germ Layer:
- Central Nervous System and Periperal Nervous System
- Sensory epithelium of ear, nose and eye
- Epidermis,
- Mammary glands, pituitary gland
- Enamal of teeth
- Neural crest cells |
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Term
| What are some derivatives of the Endodermal Germ Layer? |
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Definition
Derivatives of the endodermal germ layer:
- Epithelial lining of: GI tract, respiratory tract, urinary bladder, and auditory tube
- Parenchyma of: thyroid, parathyroids, liver and pancreas |
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Term
| What are some derivatives of the Mesodermal Germ Layer? |
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Definition
Derivatives of the mesodermal Germ layer:
- paraxial mesoderm: somites (axial skeleton), and skeletal muscle
- Intermediate mesoderm: urogenital structures
- Lateral plate mesoderm: heart and blood vessels body wall
- Smooth muscle (splanchnic/visceral)
- Cardiac muscle (splanchnic/visceral)
- Cardiovascular system (splanchnic/visceral) mesoderm
- Respiratory system (cartilaginous, muscular, connective tissue of trachea and lungs)
-Digestive system (muscle, connective tissue and peritoneal component of gut wall)
Both Paraxial and lateral Plate:
- Skeletal system (derive from mesoderm and neural crest)
- Urogenital system (derived mainly from intermediate mesoderm) |
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Term
| What are some Neural Crest Derivatives? It is part Ectoderm formation. |
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Definition
-Connective Tissue and Bones of the face and skull
-cranial nerve ganglia
-cells of the thyroid gland
-conotruncal septum of the heart
-odontoblasts
-dermis in face and neck
-spinal (dorsal root) ganglia
-sympathetic chain and preaortic ganglia
-parasympathetic ganglia of the GI tract
-adrenal medulla
-schwann cells
-glial cells
-Meninges (forebrain)
-Melanocytes
-Smooth muscle cells to blood vessels of the face and forebrain |
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Term
| What are some Neural crest related Cranio-facial defects? |
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Definition
Treacher Collins Syndrome - Small mandible, malformed ears
DiGeorge Anomaly - craniofacial defects; eg low-set ears and widely-spaced eyes
Robin Sequence - small mandible
Hemifacial microsomia - lower half of one side of the face is underdeveloped. |
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Term
| What is the significance of segmentation? |
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Definition
The significance of segmentation is that each somites form different things.
Sclerotome: ribs, vertebrae, cartilage
Myotome: muscles of back, body wall (intercostals) and some limb muscles
Dermatome: dermis of the back
Other: most of musculature for body wall (obliques, transverse abdominus) and limbs form from a ventrolateral group of cells |
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Term
| What do myocardial infarcted cells look like? |
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Definition
In myocardial ischemia caused by occlusion of the coronary artery results within the first 24 hours in the necrosis of cardiocytes.
3 days later, the necrotic cardiocytes are surrounded by neutrophils.
after 3 weeks, capillaries, fibroblasts, macrophages, and lymphocytes are observed in the necrotic area.
After 3 months, the infarcted region is replaced by scar tissue. |
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Term
| What are the dermatomes of the body? |
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Definition
A dermatome is the area innervated by the sensory root from a single level of the spinal cord.
C5 clavicle
C6 thumb
C7 index finger
C8 pinky finger
T4 nipple (teat=t4)
T7 xiphoid process
T10 umbilicus
L1 inguinal ligament
S2,3,4 external genitalia |
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Term
| What is arterial thoracic outlet syndrome? |
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Definition
| It is when the bulge of the subclavian artery is "downstream" of the constriction and causes (over time) a secondary bulge lateral to the rib due to the blood flow turbulence caused by the constricture. |
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Term
| What are breast Adenocarcinoma? |
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Definition
most breast adenocarinomas are lactiferous duct carcinomas that begin as painless masses in the upper lateral quadrant. late stages of cancer can cause contraction of suspensory ligaments, thus dimpling of the skin. more advance cancers can invade the retromammary space or bursa thus fixing the breast to the underlying perimysium.
Phenotypes include:
-skin dimpling (it goes inside the body and looks like facial dimples.
-Edema of the skin (excess fluid causes swelling)
-Nipple retraction inward and deviation from normal.
-Abnormal contours |
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Term
| About 75% of the breast is drained by what node? |
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Definition
Axillary lymph nodes (mainly pectoral nodes).
Medial quadrants drain into parasternal nodes. |
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Term
| What is gynecomastia? (gyneco, women + mastos, breast) |
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Definition
| Excessive development of the male mammary gland, mainly due to ductal proliferation and periductal edema. Frequently occurs at puberty and obese males due to increased estrogen levels. |
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Term
| What is Neurogenic (or neurological) thoracic outlet syndrome? |
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Definition
The inferior trunk of brachial plexus is elevated by cervical rib.
the syndrome is an ulnar nerve paresthesia; compression of C8 and T1 nerve roots as they pass over 1st rib. |
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Term
| What is the difference between polythelia and polymastia? |
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Definition
Polythelia (polys, many + thele, nipple) is a supernumerary nipple(s) which may appear similar to a mole, and is/are more common than polymastia. the nipples usually would align the milkline.
polymastia is supernumerary breast. |
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Term
1) Where is the Sternal Angle?
What are these Sternal Anomalies:
2) pectus excavatum
3) pectus carinatum
4) premature sternal fusion
5) sternal fistula |
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Definition
1) the angle will run between T4 and T5
2)sunken sternum. looks like a golf hole in person... Destiny has this.
3)looks like the keel of a boat (pigeon chest). The ridge projects anteriorly (more rare of a condition).. Cuong has this.
4)Associated with increased incidents of heart defects
5) holes in sternum |
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Term
| What is emphysema? What are the results/phenotype? |
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Definition
-Emphysema is one of several Chronic Obstructive Pulmonary Diseases COPD.
-Most frequently caused by smoking cigarettes, emphysema is the destruction of the respiratory and/or terminal bronchioles by fibrosis
-this leads to the need to increase the amount of air drawn into the lungs in order for adequate gas exchange.
-As a result, chronic emphysema leads to a "barrel chest" - an increase in the anteroposterior dimension of the chest, the ribs becoming more horizontal and the diaphragm flattened. (one of the true skeletons in the gross lab suffered from emphysema)
-these are all reminders of the muscle actions involved in heavy inspiration. |
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Term
What is Tracheoesophageal fistula (TEF)?
What is esophageal atresia? |
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Definition
-defects in the proper development of the esophaus and trachea occur in approximately 1/3000 births with 90% of the time a blind esophagus and a developed trachea, but with a tracheoesophageal fistula attaching from just below the bifurcation to the distal portion of the esophagus. The superior part of the esophagus is blind and just hangs there.
-4% infants have just isolated esophageal atresia (an interruption)
-4% of the time a common communication between trachea and esophagus occurs at the level of the bifurcation of the bronchi. The esophagus binds to the trachea.
-infants with TEF are at increased risk for defects in vertebral anomalies, anal atresia (absence), cardiac defects, renal anomalies and limb defects.
2) esophageal atresia occurs in about 4% of tracheoesophageal fistula. It is the condition where the trachea is developed normally; however, the esophagus have both ends blinded. |
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Term
1) What is hemothorax?
2) what is hydrothorax? |
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Definition
1) Hemothorax is the accumulation of blood in the pleural space, typically caused by injury to an intercostal vessel rather than laceration of the lung itself.
2) Hydrothorax is the excessive accumulation of fluid, other than blood, within the pleural space (bodily fluid = pleural effusion). A hydrothorax is often caused by congestive heart failure or infection of the lung. The term pleural effusion is used much more frequently than hydrothorax; but they mean the same. |
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Term
| What are Hiccups and what is the cause? |
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Definition
Hiccups are involuntary, spasmodic contractions of the diaphragm, which are interrupted by spasmodic closure of the glottis (the aperture of the larynx (voice box) which causes the characteristic sound.
Hiccups can be caused by diaphragmatic irritation, consumption of certain food and drink can be exhausting if they go on for long periods of time.
even infants in utero can have hiccups. |
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Term
| About 30% of extrapulmonary malignant tumors metastases to the lungs, why? |
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Definition
The reason why these malignant tumors will settle in the lung is because after leaving most of the veins, the next capillary bed that these tumors will find is in the lungs. Thus, the lung is usually where u would find about 30% of extrapulmonary malignant tumors.
common tumors that metastasize to the lung include: salivary gland, thyroid, breast, kidney, colon, uterine, bladder, ovarian, and prostate. |
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Term
|
Definition
Pleurisy = pleuritis.
Pleuritis is an inflammation of the pleural membrane, often due to either viral or bacterial causes.
Inflammation can lead to pleural friction (a pleural rub) and adhesions (a pleural adhesion) of the visceral and parietal layers to each other.
this condition can lead to a sharp stabbing pain upon deep inhalation, and an increased rate of respiration because there are nerve fibers in the parietal pleura. the rubbing of the pleural membranes due to pleuritis can often be heard with a steth (sounnds like palm of hands moving back and forth). |
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Term
| What is Pneumothorax? Can it be spontaneous? |
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Definition
Pneumothorax is typically the result of traumatic injury to the wall of the lung, or an infection causing a hole in the lung which allows air to be pulled into the pleural space. In both cases, air (or gas) is in the pleural cavity. The inheren elasticity of the lung causes the lungs to collapse on itself toward the hilum at the mediastinum.
Common symptoms are chest pain, respiratory distress, and tachycardia.
Yes it can be spontaneous. Spontaneous (primary) pneumothorax affects about 9k persons each year in the US who have no history of lung disease. this type of pneumothorax is most common in men between the ages of 20 and 40, particularly in tall, thin men. Spontaneous Pneumothorax (secondary) occurs in those individuals with known lung disease. (as a result of smoking).
-diagnosis would reveal absent breath sounds over the affected lungs. |
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Term
|
Definition
The lungs serve as a natural filter for venous clots because of their capillaries.
Approximately 95% of the time the thromboemboli originate in the deep leg veins, caused by stasis (bed rest), trauma, or coagulation disorders.
Patients often present with sudden dyspnea, lightheadedness, and tachycardia. |
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Term
|
Definition
The lungs serve as a natural filter for venous clots because of their capillaries.
Approximately 95% of the time the thromboemboli originate in the deep leg veins, caused by stasis (bed rest), trauma, or coagulation disorders.
Patients often present with sudden dyspnea, lightheadedness, and tachycardia. |
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Term
| Where are the Veins, Arteries, and Nerves located in the Hilum region of the Right and Left Lungs? |
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Definition
Right Lung Has grooves for:
-the superior vena cava,
-arch of the Azygos vein,
-groove for the esophagus
Right Hilum:
-bronchus: Superior and Posterior
-pulmonary arteries: middle
-Pumonary veins: anterior and inferior
Left Lung has groove for:
-cardiac impression
-arch of the aorta
-groove for subclavian artery
Left Hilum:
-bronchus: posterior
-pulmonary artery: superior
-pulmonary vein: anterior and inferior |
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Term
| What is Thoracentesis and Thoracotomy? |
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Definition
Thoracentesis is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes.
A cannula (large hollow needle) is carefully introduced through the space between the ribs into the pleural space, generally after the administration of local anesthesia. Some sources reccomend the mid-axillary line, the middle of the intercostal space, avoiding the intercostal nerve and vessels that run just inferior to each rib. |
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Term
What is cardiac tamponade?
What is pericardiocentesis? |
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Definition
Cardiac tamponade is the compression of the heart due to the rapid accumulation of fluid in the pericardial sac which prevents the chambers from expanding fully (diastolic filling), thus limiting the ability of the heart to pump blood (stroke volume). this can be a life threatening medical emergency, corrected by removal of the fluid(pericardiocentesis).
Periocardiocentesis is
-the removal of excess fluid from the pericardial sac.
-It is used to treat cardiac tamponade.
-Most frequently performed with the aid of ultrasound guidance. Place the needle just to the left of the xiphoid process, angled at about 40degrees pointing towards medial edge of left scapula. |
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Term
| What locations would you most likely find blockage in the arteries of the heart? |
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Definition
1. 40-50% Anterior Interventricular Branch/ Left Anterior Descending Artery
2. 30-40% Right Coronary Artery
3. 15-20% Circumflex branch. |
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Term
| What is Coronary Artery Bypass Surgery? What artery and veins would they use? |
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Definition
When coronary atherosclerosis becomes significant (>80%) and leads to pain or reduced life style, surgery to bypass the blockage is often performed (over 300k times per year in the US).
Generally the distal end of the internal thoracic "mammary" artery is attached to the existing coronary artery distal to the blockage (it maintains its native proximal attachment), thereby providing an alternative route for blood to reach the heart muscles.
However, this can only be used for one graft, and the artery is usually only long enough to bypass the anterior interventricular descending arery. Hence, additional arteries (ie radial artery from arm) or veins (usually the great saphenous vein in the leg) are harvested for additional grafts - one end is attached to the ascending aorta and the other end distal to the blockage.
Veins are losing favor to arteries as they dont last as long and have valves necessitating their place in only one direction. |
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Term
| What is the direction of heart sounds? |
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Definition
| Aortic, Pulmonary, Tricuspid, Mitral |
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Term
| What is Left Ventricular Hypertrophy? What is the phenotype? |
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Definition
Chronic hypertension and aortic stenosis (pressure overloads due to narrowing of the aorta) tend to produce left ventricular hypertrophy (wall thickening) without ventricular dilation (enlargement of the chamber size). So it basically gets thicker inwards.
However, in Volume overloading, as a consequence of aortic or mitral valve regurgitation tend to cause both ventricular hypertrophy AND chamber dilation (enlargement). |
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Term
| What happens in Mitral Valve Prolapse? |
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Definition
In mitral valve prolapse, the mitral valve everts into the left atrium when the left ventricle contracts during systole. Although relatively common and often benign, it may produce chest pain, shortness of breath, and cardiac arrhythmia.
Endocarditis may be associated with mitral valve prolapse.
Mitral valve (systemic) prolapse is more common than tricuspid valve (pulmonary) prolapse since the left ventricle contracts at higher pressure to pump blood through out the body than the right ventricle needs to pump blood to the lungs. |
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Term
| What is Pericardial (Friction) Rub? |
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Definition
-If the serous layer of the pericardium becomes rough, typically secondarily due to viral infections, then friction and vibrations (sounds) may occur with each cardiac cycle.
-a pericardial friction rub is highly specific for acute pericarditis.
-pericardial rub may sound like squeaky leather and may be widespread, but usually best heart between the apex and sternum, often louder with deep inspiration (elongates the pericardial sac as the diaphragm is pulled inferiorly). |
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Term
| What is Pericarditis? How is it different from a heart attack? |
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Definition
-Pericarditis [pericaradia + G. -itis inflammation] is an inflammation of the pericardial sac lining typically due to viral or bacterial infections.
-Noninfectious causes include malignancy (35%).
-Acute pericarditis can be classified as being fibrinous (usually viral), purulent (usually bacterial), or hemorrhagic (blood).
*Pain from acute pericarditis tends to remain substernal with some referred to back and shoulders, but rarely radiates down the left arm.
*Pain often worsens upon lying down (opposite of typical heart attach pain.)
Pericarditis is present in about 5% of ED non-acute myocardial infarction chest pain admissions. |
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Term
| What is Aortic Valvular Stenosis? |
|
Definition
-Aortic valvular stenosis is a condition in which the leaves of the aortic valves fuse together, leaving only a small opening for blood.
-Rheumatic disease may cause adult onset of aortic valvular stenosis
-in adults, aortic valvular stenosis can lead to a jetting of blood which cause enlargement of the aortic arch |
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Term
| What happens when Atrial Septation fails? |
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Definition
-if Atrial septation fails, then an Atrial Septal Defect will be present.
-Atrial septal defects allow a left-to-right shunting of blood (opposite direction vs normal)
-most children have few symptoms other than shortness of breath, easy fatigability, or poor growth if the defect is large.
-most ASD are detected when murmur is heard. because more blood is pass through the right side of the heart, the closure of the pulmonary valve is delayed and so you have a split 2nd heart sound.
-ASD can be treated without open heart surgery by placing an amplatzer septal occluder - transcather device into the defect. |
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Term
| What is Atrioventricular Septal (Canal) Defects? |
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Definition
-this is thought to happen due to failure of the endocardial cushions to form properly.
-improper endocardial cushion formation may lead to lack of separation of the mitral and tricuspid valves (thus a canal)
-Neural crest cells are thought to help form the endocardial cushions |
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Term
| What is Coarctation of the Aorta? What is the hallmark diagnosis of this disorder? |
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Definition
Coarctation of the aorta is a constriction in the aorta 95% of the time just above or below the attachment of the ductus arteriosus.
-pre-ductal coarctation of the aorta is a blockage above the ductus arteriosus which then usually remains open.
-post-ductal coarctation of the aorta is a blockage below the ductus arteriosum which in this instance generally closes to become the ligamentum arteriosum.
-the hallmark diagnosis is hypertension in the upper extremities and hypotension in the lower limbs and left ventricular hypertrophy. |
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Term
| In the development of the Aortic arches, which arch would be found in adults? |
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Definition
Arch III - adult artery formed is common carotid artery and internal carotid artery (in neck)
Arch IV - Adult artery formed is the arch of the aorta
Arch VI - adult artery formed is the pulmonary arteries. |
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Term
| Define Dextrocardia and Situs Inversus. What is the difference between the two? |
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Definition
In Dextrocardia, the base of the heart is directed to the right side of the body as opposed to the left (normal) side. Individuals with dextrocardia have an increased risk of having heart defects.
In Situs Inversus, the individual have a completely reversed abdominal organs in relationship to the side of the body they are normally found. These individuals have only a slight increased risk of having heart defects. |
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Term
What is significant about endocardial cushions?
Abnormalities in endocardial cushion formation can lead to what? |
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Definition
-improper endocardial cushion formation may lead to lack of separation of the mitral and tricuspid valves (thus you get a canal instead of valves).
-
Abnormalities in endocardial cushion formation can lead to:
-Atrial and Ventricular Septal Defects
-Atrioventricular (canal) defects
-Transposition of the greater vessels, and other defects.
Note: neural crest cells contribute to the cells that form the endocardial cushions. |
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Term
| What is the result of ventricular septal defects? |
|
Definition
VSD is the most common heart defect with incidence as high as 12-25/10k live births.
VSD results in 1.2-1.7times more blood passing into the pulmonary trunk than the aorta because of increased pressure of the left ventricle forcing blood to flow from the left ventricle to the right ventricle.
-infants with larger VSD presents with rapid breathing, grunting respiration with feeding, and slow weight gain. |
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Term
| What are the two shunts that allow right to left blood flow? (thus bypassing blood flowing to the fetal lungs, which are at that time not functional) |
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Definition
1) the foramen ovale and ostium secundum allows right to left atrial flow.
2) the ductus arteriosus allows blood to bypass the lung and enter the systemic system (right to left blood flow). |
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Term
| What are the embryonic structures of the heart and what are their structures in adults? |
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Definition
1) Sinus venous becomes coronary sinus and right atrium
2) atrium becomes auricles/pectinate muscles of atria (R&L)
3)Ventricle becomes trabecular walls of ventricles (R&L)
4) bulbus cordis becomes Aortic vestibule of L. ventricle; conus arteriosus of R. ventricle
5)Truncus arteriosus becomes ascending aorta and pulmonary trunk. |
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Term
| Immediately after birth, what happens? |
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Definition
1) with the first few breaths at birth, bradykinin is released from the lungs decreasing vascular resistance within the lungs significantly. bradykinin also stimulates the smooth muscle in the wall of the ductus arteriosus to contract, causing an increase in blood flowing to the lungs.
2) rise in blood flowing to the lungs. blood from lungs gets pushed back to the left atrium, which significantly increases pressure within the L atrium.
3) blood flow within the right atrium tends to drop as the umbilical vein is lost, thus reducing the pressure within the R atrium.
4)because Latrium pressure is much greater than the R atrium, the septum primum (more flexible) is pushed against the more rigid septum secundum, thus closing the fossa ovale, thereby closing the atrial shunt. |
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Term
| What is Patent foramen ovale and how is it related to Paradoxical Embolism and Stroke? |
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Definition
A patent foramen ovale (PFO) is not considered ASD because no septal tissue is missing. As a result, interatrial shunting cannot occur as long as left atrial pressure exceeds right atrial pressure and the flap valve remnant of septum primum of the foramen ovale is competent.
The clinical importance of a PFO lies in its association with paradoxical embolism and stroke.
Paradoxical embolization occurs when an embolus arising in the systemic venous system or the right atrium crosses the PFO during right-to-left shunting and enters the systemic arterial circulation. |
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Term
| What is Persistent truncus arteriosus? |
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Definition
Persistent truncus arteriosus is the congenital cardiac malformation in which the outflow of the heart is through a single vessel rather than a pulmonary trunk and aorta.
-persistent truncus arteriosus is due to the failure of the conotruncal ridges to fuse with one another. |
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Term
| What is pulmonary stenosis? |
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Definition
-Pulmonary stenosis includes a vide variety of congenital conditions that may not be diagnosed until adulthood, depending on the severity.
-Pulmonary stenosis including pulmonary valvular stenosis in which the pulmonary valves are abnormally small and the ductus arteriosus remains open.
-At other times the pulmonary trunk may be small or narrow. If only moderate stenosis is present, infants and children are asymptomatic unless under going exertion.
-A systolic trill in the suprasternal notch and at the left upper sternal border is common with significant stenosis. |
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Term
| Where are the recurrent Laryngeal nerves located? |
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Definition
the Right Reccurent laryngeal nerve is found under the right subclavian artery.
The Left reccurent laryngeal nerve is located under the arch of the aorta next to the ligamentum arteriosum. |
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Term
| What is Transposition of the Great Vessels? |
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Definition
-Transposition of the great vessels is the congenital condition in which the right ventricle pumps blood into the aorta and the left ventricle pumps blood into the pulmonary trunk.
-Transposition of the great vessels is thought to be due to a failure of spiraling of the conotruncal ridges.
-Transposition of the great vessels is present in about 4.8 /10,000 live births. For these newborns to survive a communication must exist between the two sides of the heart through either a persistent foramen ovale or patent ductus arteriosus.
-Without treatment 30% die within the first week, 50% by the first month, and 90% by the first year. |
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Term
| What are some Unusual Congenital Venous Abnormalities? |
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Definition
-Double inferior vena cava
-Absence of inferior vena cava
-Left superior vena cava
-Double superior vena cava |
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Term
| What is the Vagus Nerve? Where does it originate and what does it innervate? |
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Definition
-Vagus (the 10th of 12 cranial (from the brain stem) nerves
- The vagus nerve (CN X) is the major parasympathetic nerve supplying to all thoracic organs and upper 2/3 of abdominal organs.
- It originates from the medulla of the brain and descends through the neck to reach the superior mediastinum where it enters the thorax.
- Preganglionic parasympathetic motor neurons are located in the medulla (brain stem) while the postganglionic nerve cell bodes are located in the terminal organs. |
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Term
| What is Pancoast syndrome? |
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Definition
Pancoast Syndrome (tumor; =superior sulcus tumor). Apical bronchogenic carcinoma can impinge on adjacent anatomical structures. Sometimes these causing Horner’s syndrome [an interruption of sympathetic innervation to the head and neck (ptosis (drooping of the upper eye lid), myosis (constriction of the pupil), and anhydrosis (reduce sweating) unilaterall].
The patient also may present with neurovascular compromise for the arm with wasting, pain, or paraesthesia of the arm, most often of the ulnar nerve. (Netter Clinic Anat. 321) |
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Term
| What is Thymoma... Yes, ThyMoma... Where can they grow? |
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Definition
| Tumors (thymoma, 80% benign) of the thymus are rare, but can grow and affect the trachea, superior vena cava and occasionally other mediastinal structures. |
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Term
| What are compression fractures? |
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Definition
Osteoporosis [osteon, bone + poros , pore +osis, condition] - (frequent in post-menopausal elderly women), some cancers, and trauma may lead to collapse (compression fracture) of a vertebral body.
Compression fractures often trap spinal nerves, as they pass out the intervertebral foramen, leading to pain or loss of function as the spinal nerves exit out the intervertebral foramen. |
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Term
| Where would an epidural injection be made? And why? |
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Definition
sacral hiatus, posterior, inferior opening to the sacral canal. The sacral hiatus is due to failure of the posterior arch of S5 (and occasionally S4) to form and fuse in the midline.
The sacral hiatus is often oval or cone shaped.
The sacral hiatus is covered by the posterior sacrococcygeal ligament.
Penetrating into the sacral hiatus allowing access to epidural space filled with fat, veins, and sacral nerve roots.
You could inject an epidural into the sacral hiatus since there is only fat and venous blood.
The epidural will bathe S2,3,4,5 (genitalia area) to prevent/lessen the pain! |
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Term
| During a midline spinal tap, what structures will the needle penetrate? |
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Definition
1) skin
2) subcutaneous tissue
3) supraspinous ligament (toughest)
4) interspinous ligament
5) ligamentum flavum (tough and you may miss this)
6) fatty tissue (& venous blood) within the extra dural space
7) dura mater (tough)
8Arachnoid mater (and into the subarachnoid space) |
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Term
| What is Kyphosis? (hump-back) |
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Definition
kyphosis - an anterior concave curvature of the vertebral column.
In adults, kyphosis is used to describe excessive or pathologic anterior curvature of the spine, most frequently in the thoracic region (kyphosis is an example of excess so-called primary curvature of the spine) in elderly. |
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Term
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Definition
Lordosis [G. lordosis, a bending backward] an anterior convex curvature of the vertebral column.
The normal lordosis (so-called secondary curvature) of the lumbar and cervical regions occurs upon holding ones head up and stands.
Most frequent lordosis in adults is within the lumbar spine (can occur with pregnancy). |
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Term
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Definition
-Many times the pain of disease or pathology in an internal organ is perceived as pain in skin (normally pain within the skin would be called somatic pain). If pain over a given region of skin is actually caused by disease or pathology from an internal organ this is called “referred pain”.
-A classic example is pain from a myocardial infarction (heart attack) is often felt by the individual as occurring in the chest, but also down the ventral surface of the left arm. Nothing is wrong the individuals left arm, just their heart.
-One theory is that pain fibers (afferent nerve) from both internal organ and body wall (somatic region) synapse on the same nerve (second order afferent) within the spinal cord. There is AFFERENT NERVE CONVERGENCE.
-When the second order afferent is activated, the brain has no mechanism of knowing whether the pain is from a visceral or somatic region. Since most pains are from somatic regions, the brain often perceives the pain as somatic pain. |
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Term
| What is a Rhizotomy? What does it do? |
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Definition
Rhizotomy [G. rhiza, root + tome, section or cut]
Rhizotomy is the sectioning of the dorsal (sensory) or ventral (motor) roots of a spinal nerve in order to relief intractable pain (dorsal rhizotomy) or spastic paralysis (ventral rhizotomy). |
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Term
| What is scoliosis? In general, what does it look like? |
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Definition
Scoliosis [G. skoliosis, a crookedness] an abnormal lateral and/or rotational curvature of the vertebral column.
Scoliosis most frequently initiates during adolescence and involves both lumbar and thoracic region.
Screening for scoliosis often involves having the patient bend forwards looking at the height of the left and right shoulder blades (scapulae). if they have scoliosis, one shoulder/side should be higher than the other. |
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Term
| What is a spinal tap? (lumbar puncture) |
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Definition
Spinal Tap is also known as a lumbar puncture.
Some of the reasons your doctor may want to do a spinal tap include the following:
-To look for infection
-To check to see if there is bleeding around the brain (subarachnoid hemorrhage)
-To look for causes of unexplained seizures
-To look for causes of headaches
Cerebral spinal fluid is most commonly taken from the lumbar cisterna by inserting a spinal tap needle between L3/L4 or L4/L5.
A horizontal line across the superior iliac crests generally falls between L3 and L4 or on the L4 spinous process. |
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Term
| What is spondylolysis? What can it lead to? |
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Definition
Spondylolysis [G. spondylos, vertebra + G. lysis, lossening or break] - typically is a defect in the pars interarticularis, that part in between the superior and inferior facets. The bone breaks, most common at L5, inferior facets, can lead to pain and instability of 5th lumbar vertebra as it sits on top of the sacrum. This may be unilateral or bilateral.
It looks like a dog wearing a red collar.
Spondylolysis may worsen and develop into spondylolisthesis. |
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Term
| What is Spondylolisthesis? |
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Definition
Spondylolysis can lead to spondylolisthesis (which is basically breaking off and dislocation or subluxation)
Spondylolisthesis, [G. spondylos, vertebra + G. olisthesis, a slipping and falling]
is a slipping (= subluxation) of vertebra in relation to the adjacent inferior vertebra or sacrum. Often spondylolisthesis is caused by spondylolysis of the L5 vertebra allowing the vertebral column to slide forward on top of the sacrum, resulting in compression of sacral spinal nerves and thus, leg pain. |
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Term
| What is backache and backpain? How do you diagnose it? |
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Definition
It has been estimated that more than 80% of people will suffer with back pain at some point in their life.
Back pain may be due to the spinal cord, spinal nerves, vertebral bodies, intervertebral joints, intervertebral ligaments, muscles and their interactions with each other.
Problems with one set of structures can lead to problems with a second set of structures.
Part of a differential diagnosis for back pain should include: intervertebral disc rupture and herniation; nerve inflammation or compression; degenerative changes in the vertebral facet joints; metabolic bone disease; abdominal aortic aneurysm, metastatic cancer; myofascial disorders; back strain and sprain. |
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Term
| What is the difference between back sprains and back strains? |
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Definition
It is often difficult to distinguish back strain from sprain.
-Back sprain (like a sprained ankle) involves damage to back ligaments which connect vertebrae. This is less common than back strain.
-Back strain is a muscular problem, generally microscopic tears to muscle fibers typically due to over use. This it typical of the weekend warrior.
-Both conditions can cause back pain which in turn tends to cause protective reflex tonic muscle contraction (tight back) to guard and protect the back from excessive movement (and further damage).
-At one point bed rest was recommended for back strain, but recent studied have shown that generally people get better, faster just going about normal (non excessive) activities. |
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