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76 Cards in this Set
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Cardiac glycosides (digoxin): properties, mechanism, clinical use, toxicity, antidote
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P: 75% bioavailability, 20-40% protein bound, t1/2 = 40hrs, urinary excretion
M: direct inhibition of Na/K ATPase pump --> indirect inhibition of Na/Ca exchanger/antiport --> increase calcium --> positive inotropy; stimulates vagus nerve U: CHF (increases contractility), atrial fibrillation (decreases conduction at AV node + depression at SA node) T: increased parasympathetic activity (nausea, vomiting, diarrhea, blurry yellow vision), arrhythmia Antidote: slowly normalize K, lidocaine, cardiac pacer, anti-dig Fab fragments, Mg |
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apolipoproteins
1. A1 2. B48 3. B100 4. ApoE 5. ApoCII |
1. HDL
2. chylomicrons- used to combine w/ TG, PL, CE during chylomicron formation 3. VLDL, IDL: structural role 4. found on LP to bind cell surface R 5. VLDL, turns on LPL |
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Sickle Cell:
HbS |
E6V (glutamate to valine)
1. decreased electrical charge, so decreased movement speed 2. inc. chance of surviving P. falciparum acute illness |
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Aqueduct of Sylvius
-obstruction? |
-connects third and 4th ventricles
-obstruction: hydrocephalus affecting both lateral ventricles and third ventricle |
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Foramina of Monroe
Foramen of Luschka Foramen of Magendie |
Monroe: lateral ventricle⟿third ventricle
Luschka/Magendie: drain fourth ventricle |
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In utero infection of MUMPS
heart defects |
endocardial fibroelastosis:
-inc. fibrous and elastic tissue -thickened endocardium -mural thrombi -flattened trabeculae -a'nl (stenosed) valves |
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CMV fetal infection
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-incomplete organogenesis of CNS:
1. mental retardation 2. microcephaly, seizures 3. deafness (you can "C", but you can't hear) |
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Herpes neonatal infection
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-keratoconjunctivitis
-pneumonitis -hepatitis -DIC -exanthem -encephalitis |
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Rubella intrauterine infection
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-patent ductus arteriosus (or pulm. aa hypoplasia)
-cataracts -deafness +/- blueberry muffin rash |
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Syphilis intrauterine infection
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-affects mucocutaneous tissues/bones:
1. snuffles 2. maculopapular desquamative rash 3. hepatosplenomegaly 4. neurosyphilis 5. teeth, bone, eye involvement |
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Cardiovascular:
"sharp, knife life pains" "stabbing pain..." |
Dissection Aortic Aneurysm or Pericarditis
-pericarditis relieved by leaning fwd -pericarditis pain related to breathing |
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Ovarian tumors that produce steroid hormones
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1. Sertoli-Leydig cell tumors:
male H⟶masculinization 2. Fibroma-Thecoma: endocrinologic manifestations rare 3. Granulosa cell tumors: secrete E (precocious puberty or endometrial hyperplasia/fibrocystic change in breast in adult women) |
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secrete placental alkaline phosphatase (PLAP)
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1. dysgerminomas (ovary)
2. seminomas (testes) |
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Sydenham chorea
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-hyperextended joints
-hypotonia -diminished DTR -tongue fasciculations -"milk sign": relapsing grip -if no family hx of huntington⟶dx acute rheumatic fever |
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Murmurs:
Aortic Regurge vs. Aortic Stenosis |
Regurge:
Diastolic decrescendo Stenosis: systolic ejection murmur in aorta area, accompanied by thrill, harsh in quality, radiates to carotids |
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Murmurs:
Mitral Regurge vs. Mitral Stenosis |
Regurge: systolic murmur
Stenosis: diastolic murmur, loud S1 and an opening snap that follows S2 |
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Murmurs:
Tricupsid regurgitation |
-high pitched pansystolic murmur:
loudest in 4th intercostal space -incr. during inspiration -reduced in intensity and duration when px is standing and during valsalva maneuver |
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oligodendroglioma
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-"fried egg cells": tumor cells with round nuclei and cleared cytoplams
-may contain areas of calcification, hemorrhage, or cysts -middle aged px, both sexes -cerebral hemispheres -better prognosis than astrocytomas |
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antibodies:
anticentromere vs. antitopoisomerase |
Scleroderma
anticentromere: limited systemic sclerosis (no visceral involvement) antitopoisomerase: diffuse systemic sclerosis |
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UTI/Bacterial prostatis
Etiologic Agents |
E. Coli (most common)
Klebsiella Proteus Psuedomonas Enterobacter Serratia Enterococcus Staphylococcus |
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Aschoff Bodies
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Myocardial involvement in Rheumatic Fever:
collections of fibrinoid necrosis, lymphocytes, plasma cells, and histiocytes resoultion: aschoff bodies replaced by discrete fibrous scars |
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I-cell disease
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-inherited lysosomal storage d/o
-failure of addition of mannose-6-phosphate to lysosome proteins--> EZ secreted outside cell Clinical Presentation: -coarse facial features -restricted joint movement -skeletal a'nl: dislocation of hip -psychomotor retardation -high plasma levels of lysosomal EZ -fatal in childhood |
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Organ of Corti
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houses the hair cells from the cochlear branch of CN VIII
-rest on the basilar membrane |
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Neurofibromatosis 1
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-Cafe au lait spots
-Lisch Nodules: small, pigmented nodular lesions of hamartomatous nature found in IRIS of px |
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Neurofibromatosis 2
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-cafe au lait spots
-schwannomas of CN VIII (bilateral) |
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Coarctation of Aorta
Preductal vs. Postductal |
Preductal (infantile):
-narrowing of aorta PROXIMAL to opening of ductus arteriosus -causes reversal of flow in intercostal aa-->rib notching Postductal (adult): -narrowing of aorta DISTAL to opening of ductus arteriosus -disparity in pressure between upper and lower extremities -most common type; allows survival into adulthood |
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Products made in hypothalamus:
1. Supraoptic and paraventricular nuclei 2. arcuate nucleus 3. anterior and medial hypothalamus |
1. Oxytocin, TRH (mainly PVN)
2. Dopamine, GHRH 3. GnRH |
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adenovirus
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-naked ICOSAHEDRAL DNA viruses
-affects children and sometimes adults in same household; swimming pools can be a source symptoms: 1. pharyngoconjunctivitis 2. watery, non-bloody diarrhea 3. URI |
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carcinoma of pancreas:
clinical presenting sx |
sx usually vague: ab pain
cancer of head of pancreas: 1. jaundice 2. enlarged palpable gallbladder (courvoisier's sign) > no sig. tenderness though 3. Migratory thrombophlebitis (trousseau's syndrome) > redness and tenderness on palpating extremities |
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pancreatic adenocarcinoma:
risk factors markers |
Risk Factors:
1. inc. in Jewish and African American males 2. CIGARETTES (but not ETOH!) Markers: CEA and CA 19-9 |
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C1V1=C2V2
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use to calculate osmolarity of added solution...
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Testosterone
Functions? |
1. Differentiation of epididymis, vas deferens, seminal vesicles
2. growth spurt: penis, seminal vesicles, sperm, muscle, RBCs 3. deepening of voice 4. closing of epiphyseal plates (via E converted from T) 5. Libido |
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DHT
Functions |
Early:
differentiation of penis, scrotum, prostate Late: prostate growth, balding, sebaceous gland activity |
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Inhibin
Source? Function? |
Source:
Sertoli Cells of the seminiferous tubules Function: selective inhibition of FSH release from anterior pituitary |
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facial nucleus location
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lower pons
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medulla:
nuclei contained |
1. Cr. IX
2. Cr. X 3. Cr. XI 4. Cr. XII |
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oculomotor nucleus location
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Midbrain
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Klebsiella granulomatis
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causes granuloma inguinale (rare STD in USA)
-lesions may mimic those of syphilis |
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Why is EPI used to treat anaphylaxis?
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-causes an inc. in cAMP :
1. decreases mast cell degranulation 2. smooth muscle dilation in airways |
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infant botulism
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<1 yr old
eyelid drooping difficulty feeding neurotoxin: flacid paralysis (inhibits release of Ach) |
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LYSOGENY
what is it? examples? |
-stable association between bacterium and temperate phage-->how bacterium can get some of its toxins
examples: ABCDE: shigA-like toxin Botulinum toxin Cholera toxin Diptheria toxin erythrogenic toxin of strep pyogenes |
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Budd Chiari syndrome
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thrombosis obstructs venous outflow of the liver
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chloroquine
contraindications/SFX |
psoriasis
chloroquine-retinopathy |
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digoxin toxicity
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(used for CHF, atrial fib, atrial flutter)
-n/v -anorexia -yellow-green halos in visual field -cardiac arrhythmias |
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flecainide SFX
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(class IC to treat ventricular arrhythmia)
-paresthesia -ataxia -flushing -vertigo -tinnitus -depression -worsening of cardiac arrhythmias |
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drugs that can induce lupus
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procainamide
hydralazine chlorpromazine isoniazid methlydopa quinidine |
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ataxia telangiectasia
1. clinical presentation 2. etiology |
clinical:
-telangiectasias of the skin and eyes -variable immunodef. -progressive ataxia-->wheelchair bound by adolescence -high incidence of malignancy, esp. lymphoreticular (hodgkin, NHL, leukemia) etiology: -11q22-23 mutation: codes for a tumor suppression gene -mutation causes inc. sn to ionizing radiation, defective DNA repair, frequent c-somal a'nl |
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Abdominal Layers
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Sometimes Extra Innings TAke Too long. END PLEASE!
Superficial fascia (camper, scarpa) External Oblique Internal Oblique Transversus abdominalis Traversalis fascia Extraperitoneal tissue peritoneum |
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Thiazides vs. Loop Diuretics
Effect on Calcium |
Thiazides: Increase Calcium reabsoprtion
Loops: block Ca reabsorption |
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Venous drainage of Gonads
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Left Ovary/Testis-->left gonadal vein-->left renal vein-->IVC (varicocele more common on LEFT)
Right ovary/testis-->right gonadal vein-->IVC |
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lymphatic drainage of Gonads
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Ovaries/testes-->para-aortic LN
distal 1/3 of vagina, vulva, scrotum--> superficial inguinal nodes proximal 2/3 of vagina/uterus--> obturator, external iliac, hypogastric nodules |
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what stains TRAP positive (tartrate-resistant acid phosphatase) and talk about that condition
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Hairy cell leukemia
-rare chronic B cell leukemia of middle aged men -pancytopenia, splenomegaly, cells w/ cytoplasmic villi (hairs) in BM, spleen, and peripheral blood |
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S-100 marker
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1. Melanoma
2. neural tumors 3. astrocytomas |
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CA-125 Marker
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serous cystadenocarcinoma of the ovary
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Reiter Syndrome
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"can't see, can't pee, can't climb a tree"
triad of: conjunctivitis, urethritis, arthritis autoimmune rxn to previous infxn w/: shigella, salmonella, yersinia, campylobacter, chlamydia |
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Lymphatic drainage of the body
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Right lymphatic duct-->right subclavian vein
right arm, right of the chest, right side of head Thoracic duct-->left subclavian vein: drains rest of body |
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Inclusion bodies:
Cowdry Type A Koilocytes Negri Bodies Owl-eye inclusions Guarnieri bodies |
Cowdry Type A: HSV
Koilocytes: HPV (enlarged nucleus, perinuclear vacoulization) Negri bodies: Rabies (eosinophilic, intraCYTOplasmic) Owl Eye Inclusions: CMV (basophilic, intraNUCLEAR) Guarnieri bodies: poxviruses (intraCYTOplasmic) |
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clue cells; condition associated w/ it?
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seen in bacterial vaginosis
-caused by Gardnerella vaginalis -malodorous thin & gray discharge |
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patent foramen ovale vs. atrial septal defect
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PFO: residual slit like opening between atria; patent to a probe but not hemodynamic significance
ASD: much larger opening; can result in inc. O2 saturation on right side(would not result in systolic murmur) |
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glutamate receptors
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NMDA receptors: permeable to Ca and Na
ligand gated: activates channel voltage gated: dep. necessary to expel the Mg ion that plugs the channel other Receptors: ligand gated cation channels: AMPA, kainate |
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lymphoid stem cells give rise to
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NK cells
B cells T cells (helper and cytotoxic) |
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meyloid stem cells give rise to
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neutrophils
monocytes-->macrophages dendritic cells eosinophils basophils mast cells platelets RBCs |
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Leigh Disease
(subacute necrotizing encephalomyopathy) |
-a'nl mitochondrial DNA: defective cytochrome oxidase
-mm and brain particularly affected -intellectual deterioration, weakness, ataxia, seizures -usu. infants 3mos-2yrs, but can also affect teens and adults |
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Inheritance mode, accumulation of?
Adrenoleukodystrophy Krabbe Disease Metachromatic leukodystrophy |
Adreno: XL; a'nl lipid metabolism (demyelination)
Krabbe: AR; cerebroside accum. in histiocytes of CNS metachro: AR; sphingolipids in CNS and elsewhere |
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Cushing Triad
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1. htn
2. bradycardia 3. respiratory depression d/t inc. ICP which constricts the arterioles; cerebral ischemia stim. sym response-->htn and reflex bradycardia |
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spinocerebella degenerative dz
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Friedrich ataxia
olivopontocerebellar atrophy -->ataxia is the prominent symptom |
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involvement of soles and palms by rash
-dz process? |
Secondary syphilis
-caused by treponema pallidum -spirillar prokaryote w/ internal flagellum Rocky Mountain spotted fever -caused by rickettsia rickettsii -tick born dz! (think parks, mountains) |
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Trinucleotide Repeat Disorders
1. Name 2 2. Mode of inheritance 3. Etiology |
1. Huntington's
-AD -polyglutamate exitoxicity 2. Friedrich ataxia: -AR -impaired mitochondrial function |
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Skewed Distributions
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Positive Skew: Mean > Median > mode
Negative Skew: Median > Mean > mode -median is a better representation of central tendency than the mean -mode is least affected by outliers in the sample |
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von Hippel-Landau disease
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-Autosomal dominant
-mutated tumor suppressor VHL on c3 Presentation: 1. cavernous hemangiomas in skin, mucosa, organs 2. bilateral renal cell carcinoma 3. hemangioblastoma in retina, brain stem, cerebellum 4. pheochromocytomas |
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APGAR scoring
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Appearance
Pulse Grimace Activity Respiration -taken at 1 and 5 minutes -max score 10 (2 for each parameter) |
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oxytocin, vasopressin produced where?
released by? |
made by hypothalamus, released by posterior pituitary (derived from diencephalic neuroectoderm)
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adenocarcinomas w/ the worst prognosis
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pancreatic adenocarcinoma
esophageal adenocarcinoma |
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ways to reduce bias
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1. blind studies (double blind better)
2. placebo responses 3. crossover studies (each subject acts as own control) 4. randomization |
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hypertension, bradycardia, respiratory depression indicates what?
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incr. intracranial pressure
what is the pathway that causes this? |
incr. intracranial pressure (from whatever mechanism) --> constriction of the arterioles -->causes cerebral ischemia (inc. CO2 levels)--> stimulates reflex sympathetic response to vasoconstrict (brain trying to increase blood flow to brain) --> HYPERTENSION --> results in reflex bradycardia
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pH, Bicarb, pCO2 profiles:
(w/o compensation) metabolic acidosis metabolic alkalosis respiratory alkalosis respiratory acidosis |
Metabolic acidosis: all LOW
metabolic alkalosis: all HI respiratory alkalosis: pH= hi, bicarb= low, pCO2= low respiratory acidosis: pH= low, bicarb= hi, pCO2= hi |
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