U need to memorize some of the important values…like:
• Serum ca,k,cl,na,hco3,phosphorus,magnesium…anion gap,ph.
• ABGs(arterial blood gases):Po2,Pco2,O2 saturation.
• Gh,serum osmolarity,urine osmolarity.
• BUN,Uric acid,creatinine,albumin,bilirubin(direct,idirect).
• Protein in urine.
• Alt,Ast,amylase.cholestrol,glucose.
• Esr,pt,apt,fibrinogen,platelet count.
• Mch,mchc,mcv.
• Hb,retic count,hct and erythrocyte count.
• CSF R/E
…………………………………….
Important topics:
-Opening in diaphragm.
-Respiratory capacities.
-celiac truk and branches
-type of hyaline cartilage
-cns recepters
-epithelium
-pharyngeal pouches,clefts
-epithelium derivatives
-skull foramina
-cytochrome inducers and inhibitors.
-heart blood supply
-page 600 azim shaikh
-dna and rna viruses
-bones of hand
-purines and pyrimidines
-ulcerative colitis and crohn’s
-tumor markers
-type of errors—biostat
-reflexes values
-age related type of meningitis
-cardiac enzymes
-carotid sheath content
-chemorecepter and baroreceptor
-hormones second messengers
-T and B cells’ CD numbers
-Amino acids derivatives
-Glycogen storage diseases
-joint classifications.
-cartilage types(hyaline,fibrocartilage,elastic
—examples)
-bones classifications
-thirst is stimulated by:
- increased ECF osmolarity.
- decreaded volume of ECF.
- Angiotensin III
-Median nerve:
>Descends on Lateral side of axillary and brachial arteries.
>Enters palm Behind the flexor retinaculum.
>supplies most of the flexors of the forearm(arm flexors supplied by musculocutaneous nerve)
>supracondylar fracture cause median nerve injury---------apelike hand deformity
-Ulnar nerve:
>Descends on Medial side of axillary artery and brachial artery.
>passes behind Medial epicondyle of humerous.
> enters palm anterior to the flexor retinaculum.
>injury leads to claw deformity.
Radial nerve:
-Descends Infront of lateral epicondyle.
-supplies extensors of arm and forearm.
-lesion causes wrisr drop.
Axillary nerve:
-passes through Quadrangular space.
-lies against surgical neck of humerus.
-lesion wil cause paralyzed deltoid and loss of cutaneous sensation over lower 1/3 of deltoid region.
-chlorpromazine can cause parkinsonism
-parkinsonism is aggrevated by Haloperidol
-Digoxin toxicity can increase by chlorothiazide
-centraly acting antihypertensive is methyldopa
-Serotonin is secreted from carcinoid tumor which is responsible for sign and symptoms.
FOOT everters and inverters:
Inverters:
-tibialis anterior
-tibialis posterior
Everters:
-peroneus longus,brevis and tertius
-Granulation tissue in MI appears within 9-10 days and becomes prominent within 2-3 weeks.
Conducting system blood supply:
-SA node__RCA(sometimes LCA,but mainly RCA)
-AV node__RCA
-AV bundle__RCA
-RBB__LCA
-LBB__RCA+LCA
ECG diagnosis of MI:
A.Anterior wall(LAD):v1-v4
1.anteroseptal__LAD (v1-v2)
2.anteriolateral__LAD or LCX(v4-v6)
B.Lateral wall(LCX)__I,aVL
C.Inferior wall(RCA)__II,III,aVF
-posterior interventricular artery accompanies middle cardiac vein
-Anterior interventricular artery is accompanied by great cardiac vein.
_heparin____monitor aptt
_warfarin___monitor pt
-on contraction of diaphragm the intrathoracic pressure decreases.
_Lateral horn is present in T1-L2
_Dorsal colums present only above T5
_Large ventral horn is present in
(C5-T1+L2-S2)
-Eosinophilia present in:
hodgkin lymphoma and polyarteritis nodosa.
-PGI2__by endothelial cells
-TXA2__by platelets
Blood transfusion induced electrolye embalance is as follows:
-hypocalcemia
-hyperkalemia
-hypothermia
-metabolic acidosis
-left shift of oxy-hem curve
*common peroneal nerve injury__loss of everion and dorsiflexion
*Tibial nerve injury__loss of inversion and planteflexion.
-pelvic parietal peritoneum is supplied mainly by Obturater nerve.
Lymph drainage:
*labia majora and glans penis—superior inguinal L.N
*cervix—internal and external iliac L.N
*prostate__internal iliac L.N
*Urinary bladder__internal and external iliac L.N
-allantois__Urachus__median umblical ligament
-Somatotropic (acidophilic) adenoma__gigantisim
-corticotropic (basophilic) adenoma__cushing disease
-prolactinoma—acidophil(30%)
-GH adenoma—acidophil
-ACTH adenoma—basophil
-TSH adenoma—basophil(chromophobe)
*in axila—cords of brachial plexus
*base of neck----roots
*posterior triangle of neck—trunk and division
*detoxification of drugs—ESR
-Boat shaped cyst—pneumocystis carnii
-Epidural __middle meningeal artery
-Subdural__superior cerebral vein
TYPHOID fever investigations:
-1st week____blood culture
-2nd week___antibody/widal
-3rd week___stool
-4th week___urine culture
-vit b12 absorbed from terminal ileum
-middle rectal artery remains in true pelvis
-renal medullary rays—collecting ducts
-Anxiolytic effect by GABA
-lipid which does not contain glycerol is sphingomyelin
-taste fibers from anterior 2/3 tongue passes thru internal capsule
-for controlling tachycardia;;
Amiodarone>lidocaine>procainamide
-glucose transported mainly by facilitated diffusion
-amino acids—Na cotransport
-sarcoma—hematogenous
-carcinoma—thru lympatic
-night terrors happens in NON-REM
-nightmares happens in REM
-glutamate for fast pain fibers
-substance p for slow fibres
-glutamate released by rods and cons
-blood brain barriers made by astrocytes
-fungiform—salty and sweet
-foliate—sour taste
-circumvillate—bitter taste
Stretch reflex:
-monosynaptic
-Ia fibers affected
- alpha motorneurons
Inverse muscle stretch reflex:
-Disynaptic
-Ib fibres
-gamma motorneurons
-Golgi tendon organs
-Horner’s syndrome happens if lesion above T1
-in the cerebellum…granule cells is the only excitatory neurons while all others are inhibitory
-trouble going downstairs==Trochlearnerve damage
-trigeminal neuralgia—v2+v3
-Glossopharyngeal nerve supplies carotid body and parotid gland
-loss of accommodation causd by damage to midbrain
-lesion to pretectum leads to loss of reaction to liht but intact accommodation
-liquid dysphagia is due to neuromuscular incordination
-study brain stem lesions very well…for example medial medullary syndrome…etc
-nuclei which lies beneath the fourth ventricular floor:
Vestibular,vagal,abducent,hypoglossal.
-spinal cord ends:
*in infants:L3
*in adults:lower border of L1
-Subarachinoid space ends at (S2-S3)
-internal capsule—projection fibres
-at the level of superior colliculus—occulomotor nerve nucleus-midbrain—red nucleus
-genu+anterior 2/3 of posterior limb-----------------àmotor
-increased plasma osmolarity stimulates osmorecepters in anterior hypothalamaus.
-intestinal cells of kajal are the pacemakers of GI smooth muscles.
-vommiting and swallowing centres is in the medulla
-most colonic water absorption occur in proximal colon
-in multiple myeloma,the alkaline phosphatase is not increases.
-tight junction in colon
-leaky junction in small intestine and gall bladder
-cryptàsecretion
-villiàabsorption
-ABO incompatability in infants:
*O motheràA orB baby
*A motheràB or AB baby
*B motheràA or AB baby
-progesteron is reason behind increased temperature during ovulation
-Fibroadenomaànot precursor of CAàbelow 25 yr
-Fibrocystic changesàprecursor fro CAà20-50 yr
-Granulosa cell tumoràcall exner bodies
-Dysgerminomaàshriler duval bodies
–in renal failure:
*early stage—dilute urine
*late stage____concentrate urine
-fat absorption occur primarily in jejunum
-oblique fissure extends from T3—6th costal cartilage on both lungs
-groove for subclavian artery is at first rib.
-azygos vein enters thorax inlet
-right middle lobe has 2 bronchopulmonary segment
-diaghragm is not attached to T 10
-Tendon of popletial muscle is intracapsular
-DIFFICULTY in:
*flexing knee and thighàsartorius
*flexing knee and extending hipàsemitendinous
*flexing hip and extending kneeàrectus femoris
-Conus medullaris is pial extension to the coccyx
-revise muscles of laryns…narroeing,widening,tensing vocal cord…etc
-absorption of short chain FFA happens in colon
-osteosarcoma in metaphysis
-occulocardiac reflex mediated by trigeminal
-thyroid derived from endoderm
-albumin has low molecular weight and high concentration
-amoebic abcess occur in
Cecum>ascending colon>sigmoid >rectum
-somites are present in paraxial mesoderm
-strongest layer in small bowel in circular layer
-embryonic primary vesicle is mesencephalon
Lymph drainage of
-lateral handàinfraclavicular
-medial handàepitrochlear
-lateral ventricle roof formed by body of corpus callosum
-dermatome of perineal region is S3S4
-CVAàheart sounds in JVP
C wave first sound
V wave 2nd
A wave 4th
-in cell cycle:
Replicationàinterphase
Divideàprohase
Align 2 chromosomesàmetaphase
-noradrenaline and serotonin metabolized by MAO
-adrenaline by COMT
-liver makesàfactors 1,2,7,9,10 but not 4(calcium)
-connections of cerebulum
*cerebellum to midbrain through superior cerebellar peduncle<SCP>
*cerebellum to pons through MCP<middle>
*cerebellum to medulla through ICP<inferior>
-narcolepsyàdefect in hypothalamus
-U wave in papillary repplarization
Pt had ankle sprain:
-if pt can stand on toeàrupture of plantaris tendon
-if cannot stand on toeàrupture of achiles tendon
HEARTSOUNDS
■S1:
●Short pitch///frequency.
●Long duration ====0.14 seconds.
●Formed by===AV VALVES CLOSURE
>>>Mitral valve=== Best heard at apex///5th
Left ics////9cm left Lateral to
Sternum.
>>>Tricuspid valve===== 4th left ICS near to
Sternum. (Some references say right
4th ics).
●Splitting ===mostly pathologic due to early MV valve closure due to inspiration which delays tricuspid valve closure.
■S2:
● High frequency ////pitch
●Short duration (o.11–.14 second )
●Sharp sound
●Intensity///sharpness due to
Tautness of A & P valves
●Splitting===mostly physiological
Due to early Aortic valve closure.
●Aortic valve===Best heard at right 2nd ics.
●pulmonary valve===Best heard at left 2nd ics.
■S3:
●Formed by PASSIVE VENTRICULAR FILLING
●Normal in children, Adolescent, pregnancy
●Abnormal in adults= IHD (MR,TR=== pansystolic murmur ))))
■S4:
●Formed by ACTIVE VENTRICULAR FILLING.
●By atrial contraction against hypertrophic left ventricle in HCM.
● Coincides with A wave of jvp///P wave of Ecg.
●Abnormal mostly
●can’t be heart in AF.
“Storage of different blood products”!
Whole blood is stored at 4° C for 3 weeks.
Packed cells (RBCs) are stored at 1-6° C for 35 days.
FFP (fresh frozen plasma) and cryoprecipitate can be stored at -40° C for 2 years.
Platelets are stored at 22° C for 5 days.