OMSI- FAMM Exam 2

parts of the vertebra labled- top down

Parts of the vertebra- side view (thoracic)

How many vertebra in each section

• Cervical: 7

• Throacic: 12

• Lumbar: 5

• Sacral: 5, fused

• Coccygeal: 4, fused

A total of 33, 24 mobile and 9 immobile

Spinal curves

Primary curves- before birth

• Thoracic

• Sacral

Secondary curves- with mile stones, aka lordoses

• Cervical- when baby lifts head

• Lumbar- when toddler stands

Hyperkophosis

hunchback, exagerated rounding of upper back

Hyperlordosis

swayback, exagerated inward curve of lumbar spine

Lumbar kyphosis

flattening of the lumbar spine

Denis Spinal Columns

A way of looking at a spinal cords section as 3 columns: Anterior, middle, and posterior

What is the precursor to the vertebra

scerotomes, on the medical sides of the somite during development

Klippel-Feil syndrome

partial or full fusion of the cervical vertebra, causes a shorted neck with little movement

Lumbar region x-ray characteristic

The scottie dog formed by the body and posterior formations.

Lumbar spinal stenosis

narrowing of the spinal canal in the lumbar region, puts pressure on the nerves below it.

What are the anterial sacral foramen used for

sites for nerves for the glutear and lower limbs to pass through.

Sacral Canal

houses spinal nerve roots

*articular process of sacrum articulates with pelvis

lumbosacral angle

angle between L5 and S1

• Too big: pain on lumbar back

• Too small: stiffness of lower back

supernumerary ribs

rare extra rib- like protrusions on lumbar or cervical spine

Spinal movements

herniated discs

When the soft center of the disk is pushed outward through the cord outer layer, causes radiating arm and leg pain

Motor neuron

• Efferent, info from CNS to limbs

• Cell body is in brain, spinal cord, or ganglion

Sensory neurons

• Afferent, info goes from limbs to CNS

• Cell body is located in brain or ganglion

ganglia

collection of cell bodies in the PNS

Nucleus

collection of cell bodies in CNS. Also called:

• Cortical layer

• body

• center

tract

bundles of axons in CNS. Also called:

• fasiculus

• funiculus

• lemiscus

• peduncle

Epidural space

in the spine, a small cavity between the spinal sac and the dura mater. Contains fat, veins, and nerve roots. In all sections except sacrum, but epidurals are delivered between lumbar vertebra

connective tissue layers of a nerve

• surrounding axon: endoneurium

• surrounding fasicle: perineurium

• Surrounding nerve: Epineurium

All nerves are

spinal or cranial, or derivatives of them

Spinal nerves

31 pairs

• 8 cervical

• 12 thoracic

• 5 lumbar

• 5 sacral

• 1 coccygeal

end of spinal cord

tapers off between L1 and L2, the end is called the conus medullaris. It is achored to the coccyx through the filum terminale. At this point, it turns into several branching nerves called the cauda equina

Spinal nerve structure

• ventral root are motor neurons, somas in ventral horn of spinal cord

• dorsal root are sensory neurons, somas in a ganglion close to the spine while fibers enter dorsal horn.

They will come together to form spinal nerve, then split into Rami

• Dorsal Ramus: supplies mortor and sensory innervation to the skin/muscles of the back

• ventral ramus: supplies motor and sensory innervation of the ventral and lateral skin and muscles of the trunk and limbs

How many cranial nerves are there?

12, all arise from brain accept CN XI, that originates from superior spinal cord

Which glucose form is more common

97% of glucose is cyclic, since that’s the more stable conformation. When linearized, it has a highly reactive aldehyde group.

Where is most glucose metabolized in the body?

60% in the liver

• uses GLUT-2 transporters that have low affinity, a way of making sure only excess glucose is taken in

• once in the liver, glucose will be phosphorylated (glucokinase) so it can’t escape the cell.

What two enzymes primarily phosphorylate glucose

• Glucokinase: low affinity (high km) but high capacity (high Vmax), good for storeing excess of glucose

• hexokinase: high affinity (low km) but low capacity (low Vmax), keeps cells that don’t store glucose from taking in too much

phosphofructokinase-1

• catalyzes fuctose 6-P to fructose 1,6 bis

• irriversable

• promoted allosterically by AMP and Fructose 2,6 bisphosphate (most potent)

• inhibited allosterically by ATP and citrate

Fructose 2,6 bisphosphate affect on PFK-1

• F 2,6 -BP is stimulated by insulin

• in turn, stimulates glycolysis and ATP formation

PEP to Pyruvate

• irreversable step

• stimulated by fructose 1,6 BP

• pyruvate kinase

• produces ATP

glycolysis energy yeild

• 2 ATP

• 2 NADH

• 2 pyruvate

*anerobic glycolysis also produces lactate by reducing pyruvate- regenerating the NAD+ needed for glycolysis

how is glucose stored for multi-day fasting

through gluconeogenesis- the formation of glucose molecules through building up hydrocarbons

critical steps of gluconeogenesis

• Pyruvate to oxaloacetate (pyruvate carboxylase)

• Oxaloacetate to PEP (PEP Carboxykinase)

• F 1,6 B-P to F 6-P (Fructose 1-6 Bisphosphatase)

• Glucose 6-P to Glucose (Glucose 6 phosphatase)

pyruvate carboxylase

converts pyruvate to oxaloacetate, kicking off gluconeogenesis

PEP Carboxykinase

Turns OAA to PEP

• OAA is in mitochondria, must leave through malate (reduced OAA) -aspartate shuttle

• removes a carbon, making a 3 carbon molecule

Fructose 1-6 Bisphosphatase

• F 1,6 B-P to F 6-P

• regulated by insulin(inhibits)/glucagon(promotes)

• AMP inhibits

Glucose 6 phosphatase

• Glucose 6-P to Glucose

• needed to release glucose into blood

Glycogen in composed of

• alpha 1,4 glucose linkages

• branch points at alpha 1,6-glycosidic bonds (roughly every 18-12 glucose)

forms a spherical shape around progenetory protein- glycogenin (a glycosyltransferase)

Where is glycogen mainly found

• liver

• skeletal muscles (the most by weight)

  • however, unlike hepatocytes, glucose cannot be released into the bloodstream since skeletal muscle does not have glucose-6-phosphatase

• at low levels: kidney, heart, brain

Glycogenesis

addition of glucose onto glycogen molecule

• primarily controlled by insulin

glycogenlysis

breaks glycogen down into glucose (liver) or glucose-1-phosphate (skeletal muscle)

• rapidly releases glucose into body

glycogen phosporylase

removes 1 glucose from glycogen through phosphorylytic cleavage (PLP coenzyme)

debranching enzyme

removes branched glucose (alpha 1,6 bonds), then transfers most of the branch to the main chain. Then hydralizes the remaining alpha 1,6 glucose to create free glucose

phosphoglucomutase

converts released glucose-1-phosphates from glycogenlysis to glucose-6-phosphates for glycolysis and reverse

glycogen storage disease

insufficent or excessive glycogen is produced, can affect various organs.

pentose phosphate pathway

• occures in cytosol

• oxidative phase: generates nucleotide intermediates and NADPH

• non oxidative: generates intermediates for glycolysis

what cells have a lot of PPP activity

• cells that rapidly devide- nucleotide synthesis and NADPH to turn RNA to DNA

• cells that have a lot of oxidative phosphorylation- NADPH as a antioxidant and cofactor to several antioxidant enzymes.

Glutathione (GSH)

a major cellular antioxidant. It’s oxidized (GSSG) form is reduced by NADPH to restore GSH afterwards.

glucose-6-phosphate dehydrogenase

fist and rate limiting reaction in the Pentose phosphate pathway, it converts glucose-6-phosphate into 6-phosphogluconolactone (a short lived intermediate to ribulose) while producing NADPH.

Glucose-6-phosphate dehydrogenase deficiency

restricts the Pentose phosphate pathway, especially seen in red blood cells since their only way of replenishing NADPH is PPP. Causing hemolytic anemia (RBC are destroyed faster than made.

• X-linked recessive, especially in middle Easters, tropical African, Mediterranean, and asian population.

• Is exacerbated if diet is high in foods or drugs that create reactive oxygen species, such as fava beans

Lattisimus dorsi

• A: Adduction, extension, Internal rotation, horizontal abduction of humerus. turnkey support, scapula depression, respiration aid.

• O: posterior iliac crest to T7 spinous process

• I: Intertubercular grove of humerus

• N: thoracodorsal (C6-8)

Trapezius

• A: covers upper back, shoulders, neck

  • Elevation of scapula, extension/rotation of head and neck to opposite side

  • elevation, upward rotation and adduction of scapula

  • depression, adduction, and upward rotation of scapula

• O: External occipital protuberance, superior nuchal line, nuchal ligament, and spinal process C7-T12

• I: lateral 1.3 clavicle, acromion and spine of scapula

• N: CNXI and C 2/3-4 ventral rami

What muscles move the shoulder girdle

• pectoralis minor: abduction, downward rotation, depression

• Serratus anterior: Abduction, upward rotation, depression, stabilize

• Trapezius: elevation, adduction, upward rotation, depression

• Levator Scapulae: elevation, downward rotation

• Rhomboids: adduction, downward rotation

Levator Scapulae

• A:

  • elevate and downward rotate scapula

  • laterally flex head and neck to same side

  • extend head and neck

• O: Tansverse process’ of C1-C4

• I: medial border of scapula below superior angle

• N: dorsal scapular nerve and C3-C4 nerve

Rhomboids (major + minor)

• A: elevate, adduct, and downward rotate scapula

• O:

  • Minor: spinal process of C7-T1

  • Major: spinal process of T2-T5

• I: medial boarder of scapula

• N: dorsal scapular nerve

Serratus posterior superior

• A: elevates ribs 2-5

• O: C7-T3 spinal process

• I: Ribs 2-5

• N: anterior Rami T2-T5

Serratus posterior inferior

• A: depresses ribs 9-12

• O: T11-L3

• I: Ribs 9-12

• N: anterior rami T9-T12

Errector Spinae family

Deep to serratus posterior, flexes spine to same side and extends vertebral column. Innervated by dorsal rami.

• spinalis- connects to spinous processes to spinous processes

• longissimus- connects common tendon (deep portion of thoracocolumbar fascia) and transverse processes to ribs, then transverse processes and mastoid

• Illiocostalis- connects common tendon and ribs to transverse processes and ribs

Transversospinalis family

Rotates spine to opposite side, extends vertebral column. Innervated by dorsal rami

• Rotatores- transverse process to spinal processes, creates a V shape

• Multifidi- Sacrum and transverse processes connect to spinous processes 2-4 vertebra below

• Semispinalis- transverse process’ of C4 to T12 to spinal processes 4/6 segments inferior.

  • semispinalis capitis: transverse processes to between superior and inferior nuchal lines

Minor deep layer

stabilize vertebra, aid in movement and respiration. innervated by dorsal rami (intertransversarii also innervated by anterior Rami.

• interspinales: between spinal processes, extension and rotation

• intertransversarii: between transverse presses, flexion

• Levatores costarum: C7 to T11 transverse presses to the ribs 1-2 vertebra below. Elevates ribs and lateral flexion

posteiror neck muscles

splenius capitis

• A: bilateral (both sides of body) and unilateral (one side of body) extension of head and neck

• O: SP C7-T4 and ligamentum nuchae

• I: mastoid process and superial nucchal line

• N: Posterior Rami C2-3

Splenius cervicis (aka colli)

• A : bilateral and unilateral extension of neck, lateral flexion and rotation on the same side

• O: SP of T3-T6

• I: TVPs C1-C2 or C3

• N: C4-6

semispinalis capitis

most superior portion of the semispinalis that connects to occipital protrusion

• A: extension of the head and neck

• O: anterior protrusion of C4-7 and the transverse processes of C7 to T6

• I: between nuchal lines (four curved ridges of bone on the back of the skull's occipital bone)

• N: posterior Rami

suboccipital region muscles- rectus capitis posterior minor and major

• A: extend head and ipsilateral (turns head to same side as agonist muscle) rotation

• O: spinal process of C2 (major) and posterior tubercle of C1 (minor)

• I: Inferiror nuchal lines

• N: suboccipital nerve

suboccipital region muscles- obliques capitis superior and inferior

• A: extend head (superior) and ipsilateral rotation (inferior)

• O: spinal process of C2 (inferior) and Transverse process of C1 (superior)

• I: between nuchal lines laterally (superior) and transverse process of C1 (inferior)

• N: suboccipital nerve

suboccipital triangle

Composed of rectus capitis posterior major, obliquus capitis superior, and obliquus capitis inferior that protect:

• vertebral artery

• suboccipital nerve

• suboccipital vernous plexus

Triangle of auscultation

Where vitals are taken in the back. Framed by trapezius and latrissumus dorsi on two sides

joints of the vertebral column

• atlanto-occipital: between Atlas and occipital bone

• atlantoaxial: between Atlas and axis, where most cervical rotation occured.

• Intervertebral: cartilage joints between disks and vertebra

• zygapophysial: facet joints between vertebra protrusions not connected by disk

• costovertebral: joins connecting ribs and spine

IV disk structure

• outer, fiberious layer for abosrbing shock and support

• pulpy inner nucleus, houses spinal cord

Glycolysis steps that produce energetic molecules

For anerobic respiration, lactate dehydrogenase will reduce pyruvate into lactic acid- oxidizing NADH to NAD+ to replinish stores.

when is pyruvate converted to acetyl coa

when cell’s every level is low- Pyruvate Dehydrogenase complex (PDHC) is driven by mass action ratio

how does PDHC work

will ultimately transfer the pyruvate acetyl group to coenzyme A, forming a CO2 and a NADH.

• Located in the mitochondria, so pyruvate must be trafficked inside

• E1 complex has TPP as a cofactor

• E2 complex has lipoic acid and coA as cofactors

• E3 complex has FAD and NAD+ as cofactors to facilitate high energy electron movement

How does arsenic kill?

It binds to the thiol group in the lipoic acid (that allows it to oxidize) of PDHC, hauling conversion of pyruvate to acetyl coa

wernicke-korsakoff syndrome

a thymine deficiency, which is needed for TPP. This means pyruvate would not be converted, and if a patient with this is given glucose their cells would instead undergo anerobic respiration (which would produce acid in the brain)

therefore, any patient with extremely low blood sugar in the ER is given a dose of thymine just in case

PDHC regulator enzymes

• PDH kinase inactivates E1 (Adds phosphate)

  • promoted by high energy molecules like ATP, Aceytl Coa, and NADH

• PDH phosphatase activates E1 (removes phosphate)

  • promoted by high pyruvate levels

  • promoted by high calcium levels, since in skeletal muscle high intercellular calcium means the cross bridge cycle is activated

Citric Acid Cycle

remeber what steps produce high energy molecules. Key steps are the oxidations:

• isocitrate dehydrogenase - produces a-ketoglutartate, produces NADH and CO2. stimulated by ADP and Ca, inhibited by high energy molecules

• a-ketoglutartate dehydrogenase complex- produces succinyl coA, NADH and CO2. same inhibitors/promoters. Has the same cofactors as PDHC

• Succinate dehydrogenase: produces Fumarate and FADH.

• Malate dehydrogenase: produces oxaloacetate, generated NADH. Not significantly allosterically regulated.

• Succinyl Coa to succinate produces a GTP as the thoester bond in CoA is broken

Total citric acid cycle yeilds

• 3 NADH

• 1 FADH2

• 1 GTP

Electron Transport Chain inhibitors

inhibit electron flow at complex 4

• cyanide

• carbon monoxide

inhibits ATP synthase

• oligomycin (from streptomyces)

Thermoginin (UCP1 protein)

Found in brown fat of newborns, this uncoupling protein acts as a more favorable rout for protons to enter the mictochondrial matrix. As protons pass through, heat is generated.

General cell signaling steps

• signaling cell

• signal molecule

• signal receptor

• intracellular signal transcution with second messengers

• cellular response

Neuroendocrine signaling

for long distance targets and cells with neuronal input. Triggers hormone release into blood

paracine signaling

short distance, works on neighboring cells

Juxtracrine signaling

cells must be in physical contact, ligand and recepotor are on cell membrane (no signal molecule)

Autocrine

cells produce a signal that affects themselves

nuclear vs membrane receptors

• nuclear- steroidal signaling molecule comes into cell and find nuclear/cytosolic receptor. This will go to nucleus and effect gene transcription, slow response

• cell surface receptor: ligand is hydrophlic and cannot enter cell, receptor is on outside of membrane and uses second messengers. Fast reponse

second messengers

Hydrophilic

• cAMP- kinase activation (glycogen breakdown, HCL secretion, smell)

• cGMP- kinase activation (smooth muscle relaxation, phototransduction)

• Ca2+ - exocytosis, apoptosis, muscle contraction

• IP3- Ca2+ release

Hydrophobic (membrane associated)

• PIP2

• PIP3

• DAG- kinase activation (cell growth/metabolism, HCL, smooth muscle contraction)

Gases (diffuse across membranes)

• NO

• CO

Botulinum toxin

neurotoxin produced by botulism, interfears with neuromuscular junction communication, no neurotransmitter is released

• loss of skeletal muscle function

• blurred vision

• drooping eyelids

• difficulty speaking

• muscle weakness

• respiratory failure

GPCR

activates trimeric G protein by releasing GDP and allowing GTP to associate. Will inactivate once GTP is hydralized

• Beta andrenergic receptor

• muscarinic acetycholine receptor

• glucagon receptor

G proteins

a type of gtpase, are on/off switches for a signal transduction.

• monomeric: activated by other signaling proteins like Ras, Rab, Rho, Ran

• Heterotrimeric: activated by GPCRs, membrane bound. when activated (associated to GTP) Alpha (binds GTP) and beta/gamma subuts will dissasociate and signal other molecules

Major trimeric g protein pathways

• Gs- alpha subunit stimulates cAMP

• Gi- inhibits cAMP

• Gq- stimulates phospholipase C pathway

Protein Kinase A (PKA)

cAMP dependent protein Kinase, is regulated with a bound regulator protein.

• cAMP present: regulator protein dissasociate, PKA is activated

pseudohypoparathyroidism (PHP)

a parathyroid hormone resistance, cannot regulate blood calcium and phosphorus levels. An example of a Gs and GPCR disfunction

• Gs loss of function

• elevated phosphorus, low calcium

• short stature

• short limbs (especially 4th metacarpal)

• obesity

• delayed development

phospholipase C pathway

Gq protein activates phospholipase C, which triggers IP3 and DAG to dissasociate and signal the release of calcium, which activates protein Kinase C. Used in:

• smooth muscle contraction

• hormone secretion

• glycogen breakdown

thoracocolumbar ligament

fascia covering the latissimus dorsi

ligamentum nuchae

a thick, triangular band of connective tissue at the back of the neck