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depolarization
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Primary adrenal insufficiency = problem at level of adrenal glands Causes? Addison’s disease Pathophys? Autoimmune destruction of the adrenal glands Associated with hyperpigmentation POMC is precursor to both ACTH and MSH PAI → lack of negative feedback → high ACTH Lab findings? ACTH high Aldosterone low Destruction of zona glomerulosa Renin high Hypotension → RAAS activation Electrolytes Na+ low, K+ high CBC Eosinophils high Pathophys? Glucocorticoids → eosinophil apoptosis. Lack of glucocorticoids cause eosinophilia. Dx? Cosyntropin testing → no rise in cortisol Adrenal glands aren’t working, so no response to ACTH. Tx? prednisone/hydrocortisone/dexamethasone + fludrocortisone (mineralocorticoid) Stress-dose steroids for surgery, serious illness, etc. Secondary adrenal insufficiency = problem at level of pituitary, reduced ACTH release Causes? MC is prolonged steroid use → ACTH suppression Sheehan’s syndrome (infarction of pituitary) pregnancy Pituitary tumors (ACTH-producing tumor) Lab findings? ACTH low Anterior pituitary is being inhibited Aldosterone normal Zona glomerulosa under control of RAAS system Renin normal Electrolytes Na+ & K+ unaffected (Aldosterone levels are normal) CBC Neutrophilia due to demargination (if pt was recently taking steroids) Dx? Cosyntropin testing → rise in cortisol Adrenal gland is functional Tx? Glucocorticoids Do not need to replace mineralocorticoids since adrenals are functional and aldosterone is under RAAS control Stress-dose steroids for surgery, serious illness, etc. AI with a history of nuchal rigidity and purpuric skin lesions → Waterhouse-Friedrichson syndrome Pathophys? AI 2/2 hemorrhagic infarction of the adrenal glands in the context of Neisseria meningitidis infection Adrenal synthesis enzymes If the enzyme starts with 1 → HTN (high mineralocorticoids) and hypokalemia If the second # is 1 → virilization (high androgens) E.g. 11-beta hydroxylase deficiency → HTN & virilization E.g. 21 hydroxylase deficiency → virilization only E.g. 17-alpha hydroxylase deficiency → HTN only B12 deficiency Where does B12 come from? Animal products VS folic from plants Physiology R factor in saliva binds to B12 and protects it from acidity in the stomach. R factor protector -B12 travels to the duodenum. Parietal cells produce intrinsic factor, which travels to the duodenum. Pancreatic enzymes cleave B12 from R factor and B12 then binds IF. B12-IF complex is reabsorbed in the terminal ileum Reabsorption where? Terminal ileum Causes of B12 deficiency Extreme vegan Pernicious anemia Pancreatic enzyme deficiency Cystic Fibrosis Can’t cleave B12 from R factor Crohn’s Affects terminal ileum Lab markers Homocysteine HIGH MethlyManoicAcid HIGH Presentation? Megaloblastic anemia Subacute combined degeneration (of dorsal columns + lateral corticospinal tract) Peripheral neuropathy Dx of pernicious anemia? anti-IF Ab Folate deficiency Where does folate come from? Leafy things Causes of folate deficiency Poor diet (e.g. alcoholics, elderly) Phenytoin Lab markers Homocysteine HIGH MMA normal Presentation? Megaloblastic anemia Prophylaxis in HIV+ patients CD4 < 200 → PCP TMP-SMX, inhaled pentamidine, dapsone, atovaquone CD4 < 100 → Toxoplasm Treat: TMP-SMX CD4 < 50 → MAC Treat: Azithromycin If live in endemic area, CD4 < 250 → Coccidioides Immitis E.g. Arizona, Nevada, Texas, California Treat: Itraconazole If live in endemic area, CD4 < 150 → Histoplasma Capsulatum E.g. Kentucky, Ohio, Missouri Treat: Itraconazole Diabetes insipidus Dx? Water deprivation test Measure serum osmolality & urine osmolality Deprive pt of water Remeasure serum osmolality & urine osmolality If urine osmolality doesn’t go up → suspect DI Central DI → deficiency of ADH Pathophys? Supraoptic nucleus not making enough ADH Dx? Give desmopressin → urine osmolality increases significantly Nephrogenic DI → kidneys are not responding to ADH Dx? Give desmopressin → urine osmolality doesn’t change much Tx? Hydrochlorothiazide Unless 2/2 lithium, use amiloride or triametere Causes? Lithium SSRIs Carbamazepine Demeclocycline Tx of normovolemic hypernatremia? D5W to correct free water deficit Divine says NS, but most other resources I found said correct free water deficit Tx of hypovolemic hypernatremia? Give NS first until normal volume, then give D5W Consequence of correcting hypernatremia too rapidly? Cerebral edema Osteoarthritis Presentation? Old person with joint pain that gets worse throughout the day Risk Factr? Obesity vs decreases osteoporosis Imaging findings? Joint space narrowing Subchondral sclerosis Subchondral cysts Osteophytes Arthrocentesis findings? <2000 cells Tx? 1st line acetaminophen 2nd line NSAID (e.g. naproxen) 3rd line joint replacement surgery Returned from a business conference 1 week ago + Fever + Nonproductive cough + Abdominal pain + Hyponatremia → Legionella Dx? Urine antigen Tx? FQ or macrolide MaCroLide mnemonic = Mycoplasma, Chlamydia, Legionella What are the common causes of atypical PNA? Mycoplasma, Legionella, Chlamydia MC cause? Mycoplasma CXR findings? Interstitial infiltrates HY associations C. Psittaci → birds C. Burnetii → cows, goats, sheet Mycoplasma → college student w/ walking pneumonia Midsystolic click heard best at the apex. → mitral valve prolapse “Stenosnap & Proclick” Risk Factor? Connective tissue disease Marfarn Ehlers-Danlos ADPKD bilateral renal masses Classic demographic? Young woman psychiatric Pathophys? Myxomatous degeneration MVP vs aortic dissection: cystic medial necrosis Exam maneuvers Anything that increase amount of blood in LV → murmur softer Increase preload Increase afterload Anything that decreases amount of blood in LV → murmur louder Dx? Echo Scaly, itchy skin with yellowish crusting in the winter. → seborrheic dermatitis Tx? Topical antifungals e.g. ketoconazole or selenium sulfide shampoo Classic disease distribution? Hair → e.g. cradle cap Eyebrows Episodic/intermittent HTN + HA → pheochromocytoma Genetic disease associations MEN2A MEN2B VHL in brain (hemangioma) NF-1 growth in skin Pathophys? Catecholamine-secreting tumor Location? Adrenal medulla Posterior mediastinum Organ of Zuckerkandl (chromaffin cells along the aorta) Dx? 1st step: urine metanephrines If elevated → CT abdomen If nothing found on CT → MIBG scan Tx? Alpha blocker (e.g. phenoxybenzamine, phenotaline) THEN beta blocker Most common cause of a Lower GI Bleed in the elderly → diverticulosis Dx? Colonoscopy or barium enema Recall that you acutely do a CT scan for diverticulitis, then 6 weeks later colonoscopy to r/o cancer Ppx? Eat fiber Megaloblastic anemias Blood smear findings? Hypersegmented neutrophils MCV > 100 Classic patient demographic with folate deficiency? Alcoholics Elderly person with poor nutrition Folate synthesis inhibitors Pt with molar pregnancy → methotrexate Pulmonary issue? Pulmonary fibrosis HIV+ pt with ring-enhancing lesions → pyrimethamine-sulfadiazine Pyrimethamine inhibits DHFR AIDS pt on ppx for toxo → TMP-SMX TMP inhibits DHFR Use of leucovorin? Rescue bone marrow in setting of methotrexate toxicity Mechanism? Folinic acid analog CMV presentations Esophagitis → linear ulcers Colitis → post-transplant pt Retinitis → HIV pt with CD4 < 50 Congenital CMV → periventricular calcifications + hearing loss calcifications elsewhere → toxo Histology? Owl’s eye intranuclear inclusions Tx? Gancicyclovir Resistance? UL97 kinase mutation Tx for resistance? foscarnet CD4 < 200 + severe peripheral edema + frothy urine. → FSGS in HIV pt Variant classic in HIV+ pts? Collapsing variant Tx? Steroids + cyclophosphamide + ACE-I Indinavir AE? Kidney stones triad of fever, rash, and eosinophiluria → acute interstitial nephritis Drugs cause? Penicillins Tx? Stop the drug! Can add steroids if severe Vitamin D metabolism Liver converts Vit D to calcidiol (25OH-Vit D). Calcidiol goes to kidney. Alpha-1 hydroxylase converts calcidiol to calcitriol (1,25-OH Vit D). Common causes of Vitamin D deficiency CKD → 1-alpha hydroxyalse deficiency Liver disease → can’t make calcidiol CF → malabsorption Crohn’s → malabsorption Osteomalacia vs Rickets Osteomalacia in adults Rickets in kids Tx? Calcium + vit D Lab findings? Ca++ low Phos low Low in liver disease High in kidney disease (kidneys can’t get rid of phos) PTH high (2ary hyperpara) vs liver dx PTH low Alk phos Aspiration pneumonia Risk Factor? Alcoholism Dementia Neuromuscular problems (e.g. MG, ALS) Bugs? Anaerobes foul smelling Bacteroides FUsobacterium Peptostreptococcus Klebsiella → currant jelly sputum alcoholic Tx? Clindamycin CURB-65 criteria Purpose? Who to admit Cutoff? 2+ → hospitalize C = confusion U = uremia (BUN > 20) R = RR > 30 B = BP < 90/60 Age > 65 Drugs commonly used in PNA treatment Ceftriaxone Levofloxacin fluoroquinolone Macrolides - great for atypical PNA Pharmacological management of pulmonary arterial HTN Endothelin antagonists Bosentan ambrisentan PDE-5 inhibitors Sildenafil Tadalafil Prostacyclin analogs Iloprost Epoprostenol Treprostinil Causes? Young female → idiopathic PAH Mutation? BMPR2 55 yo F presents with a 5 week history of a rash on her forehead. PE reveals scaly macules with a sandpaper texture. → actinic keratosis Risk Factor? Sun exposure Tx? Topical 5-FU Possible dangerous sequelae? Squamous cell carcinoma Most likely disease sequelae? Resolution 1ary hyperparathyroidism 2ary hyperparathyroidism 3ary hyperparathyroidism Autonomous PTH production Causes? Adenoma Parathyroid hyperplasia PTH high Ca++ high Phos low Low Ca++ → PTH production Causes? CKD PTH high Ca++ low Phos high PTH production despite normalized of Ca++ levels Causes? CKD s/p transplant PTH high Ca++ high Phos low Tx? Parathyroidectomy (remove 3.5 glands) Cinacalcet (CSR modulator) Hypercalcemia Presentation? bones, stones, groans, psychic overtones Tx? 1st step: Normal Saline Hypercalcemia of malignancy → bisphosphonates EKG finding? Shortened QT Periumbilical pain that migrates to the right lower quadrant. → appendicitis PE findings? McBurney’s point tenderness Psoas sign (flex hip pain) Obturator sign (pain with internal rotation of hip) Rovsing’s sign (palpation of LLQ → pain in RLQ) Dx? CT scan Pregnant → US Kid → US Tx? Surgery Classic drug and viral causes of aplastic anemia. Drugs? Carbamazepine Chloramphenicol Viral? Parvovirus B19 (single stranded DNA virus) Fanconi anemia Pathophys? Problems with DNA repair Fanconi anemia vs Fanconi syndrome Fanconi anemia → cytopenias + thumb anomalies + short stature + cafe-au-lait spots Fanconi syndrome → type 2 RTA (proximal) CD4 count of 94 + MRI revealing ring enhancing lesions in the cortex → toxoplasmosis Tx? Pyrimethamine-sulfadiazine Rescue agent for pt who becomes leukopenic with treatment? leucovorin Who should get steroids? Increased ICP For PCP pneumonia: O2 sat < 92 PaO2 < 70 A-a gradient > 35 Ppx? TMP-SMX for CD4 < 100 Congenital toxo Hydrocephalus Chorioretinitis Intracranial calcifications Classic methods of transmission? handling cat litter Lupus nephritis Associated autoantibody? anti-dsDNA Classic “immunologic” description? “Full house” pattern Tx? Steroids + cyclophosphamide Osteoporosis Screening population? women > 65 Screening modality? DEXA scan Dx? T-score < -2.5 Risk Factor? Postmenopauseal Low BMI Smoking Alcohol Preventive strategies? Weight bearing exercise Smoking cessation Reduce alcohol consumption Tx? 1st line: bisphosphonates + Ca/Vit D supplementation Raloxifene (SERM) Agonist in bone Blocker Antagonist in breast Classic locations of osteoporotic fractures Vertebral compression fracture Hip fracture Name the PNA Red currant jelly sputum. → Klebsiella Rust colored sputum. → Strep pneumo PNA in an alcoholic. → Klebsiella Post viral PNA with a cavitary CXR lesion. → Staph aureus PNA in a patient that has chronically been on a ventilator. → Pseudomonas MC cause of Community Acquired Pneumonia. → Strep pneumo Pharmacological management of MRSA. Vancomycin Clindamycin Linezolid Ceftaroline (5th gen cephalosporin) Tigecycline, tertracycline Pharmacological management of Pseudomonas. Ceftazidime (only 3rd gen cephalosporin) Cefepime (4th gen cephalosporin) Pip-tazo Fluoroquinolones Carbapenems Aztreonam Aminoglycosides JVD and exercise intolerance in a patient with a recent history of an URI. → dilated cardiomyopathy 2/2 viral myocarditis MC cause? Coxsackie B VS Coxsackie A: Hand foot mouth dx Drug causes myocarditis Clozapine Anthracyclines Prevention? Dexrazoxane (iron chelator) Trastuzumab reversible tx for breast cancer Classic cause in a patient with recent history of travel to S. America? Chagas T. Cruzi Potential sequelae? Achalasia Dilated cardiomyopathy Megacolon (2/2 degeneration of myenteric plexus) Massive skin sloughing (45% BSA) in a patient that was recently started on a gout medication? TEN Dx? <10% BSA → SJS >30% BSA → TEN Tx? STOP the drug IVF Topical abx to prevention infection Tetany and a prolonged QT interval in a patient with recent surgical treatment of follicular thyroid carcinoma. → hypocalcemia due to removal of parathyroids Recurrent viral infections + QT prolongation + tetany → DiGeorge syndrome Pathophys? Failure of development of 3rd/4th pharyngeal pouches Trousseau and Chvostek signs. Trousseau → inflation of BP cuff causes carpopedal spasm Chvostek → taping on cheek causes facial muscle spasm Hypocalcemia that is refractory to repletion → consider hypomagnesemia Electrolyte/drug causes of prolonged QT intervals Electrolytes? Hypocalcemia Hypomagnesemia Hypokalemia Drugs? Macrolides FloroQunlones Haloperidol Ondensatron Methadone Hypoalbuminemia and Ca balance Hypoalbumenia → decrease in total body Ca++, no change in ionized Ca++ Drop of 1 in albumin → add 0.8 to Ca++ Abdominal pain radiating to the back → acute pancreatitis Causes? #1 = Gallstones #2 = Alcohol Hypertriglyceridemia Hypercalcemia Scorpion sting Handlebar injuries Lab markers? Lipase - most sensitive Amylase Physical exam signs in pancreatitis. Cullen’s sign = periumbilical ecchymosis Grey Turner sign = flank ecchymosis Tx? NPO + IVF + pain control Meperidine is a good agent because it doesn’t cause sphincter of Oddi spasms Management of gallstone pancreatitis Dx? US then ERCP Tx? DELAYED cholecystectomy What if the patient becomes severely hypoxic with a CXR revealing a “white out” lung? ARDS noncardiogenic pulm edema PCWP? <18 mmHg NORMAL 20 yo M with red urine in the morning + hepatic vein thrombosis + CBC findings of hemolytic anemia. → paroxysmal nocturnal hemoglobinuria Pathophys? Defect in GPI anchors, which attach CD55 and CD59 to cell (they prevent complement from destroying RBC) Sleep → hypoventilation → mild respiratory acidosis → activation of complement cascade Gene mutation? PIGA Dx? Flow cytometry Tx? Eculizumab (terminal complement inhibitor) Vaccine required? pnemococal Neisseria meningitidis Chronic diarrhea and malabsorption in a HIV+ patient + detection of acid fast oocysts in stool. → cryptosporidium parvum Acid-fast organisms Cryptosporidium TB MAC Nocardia Dx? Stool O&P Tx? Nitazoxanide Route of transmission? Contaminated water Muddy brown casts on urinalysis in a patient with recent CT contrast administration (or Gentamicin administration for a life threatening gram -ve infection) → Acute Tubular Necrosis Woman with morning joint stiffness > 1 hr → Rhematoid Arthritis. Antibodies? Rheum Factor (IgM against IgG) anti-CCP - more specific HLA? DR4 Pathophys? IgM constant region activates complement → inflammation → formation of pannus (hypertrophied synovium) → damage to cartilage and bone Caplan syndrome = RA + pneumoconiosis Felty syndrome = RA + neutropenia + splenomegaly (“RANS”) Classic hand/finger findings/distribution? MCP & PIP joints of hands (DIP joints spared) Imaging findings? Symmetric joint space narrowing Tx? Methotrexate (DMARDs) If no response → TNF alpha inhibitor (e.g. infliximab) Required testing prior to starting methotrexate? PFTs Required testing prior to starting infliximab? TB Hep B/Hep C Differentiating Strep pharyngitis from Infectious Mononucleosis LND distribution Anterior cervical → Strep Posterior cervical → Mono Disease onset Acute → Strep Over weeks → Mono Organ involvement Splenomegaly → Mono Pt with sore throat takes amoxicillin and gets rash → mono NOT allergic rxn! CENTOR criteria C = absence of Cough E = tonsillar Exudates N = nodes/anterior cervical lymphadenopathy T = temp (fever) OR <15 → +1 >=45 → -1 Using CENTOR score 0/1 → don’t test, don’t treat 2/3 → rapid antigen test Positive → treat Negative → throat culture 4/5 → treat empirically Tx of Strep pharyngitis? Amoxillcin If PCN allergic → azithromycin Potential sequelae of Strep pharyngitis RF - preventable with abx PSGN Endocarditis MC cause of endocarditis? IVDU Bug? Staph aureus Valve? tricuspid Prosthetic valve endocarditis Bug? Staph epidermidis Endocarditis after dental procedure? Viridans group streptococci Strep viridans, Strep mitis, Strep mutans, Strep sanguineous Patient with malar rash and echo showing vegetations on both sides of the mitral valve → Libman-Sacks endocarditis Presentation? Fever + night sweats + new murmur Splinter hemorrhages Roth spots (retinal hemorrhages) Painless Janeway lesions + painful Osler nodes (immune phenomenon) Dx? 1st step: blood cultures TEE Tx? Abx that include Staph aureus coverage (e.g. vancomycin) for WEEKS Bugs implicated in culture negative endocarditis HACEK H = haemophilus A = actinobacillus C = cardiobacterium E = eikenella K = kingella Coxiella burnetii Blood cultures in a patient with endocarditis reveal S. Bovis (or S. Gallolyticus bacteremia). NBS? Colonoscopy Who needs antibiotic prophylaxis? Hx endocarditis Prosthetic valve Unrepaired cyanotic congenital dz Heart transplant with valve dysfunction Erythematous salmon colored patch with silvery scale on the elbows and knees. → psoriasis Tx? Topical steroids If this patient presents with joint pain (especially in the fingers)? Psoriatic arthritis Imaging? Pencil-and-cup deformity Tx? NSAIDs T of 104 + tachycardia + new onset Afib in a patient with a history of Graves disease. → thyroid storm Lab findings? TSH low T3/T4 high Tx? 1st step: propranolol 2nd step: PTU Then: Prednisone Potassium iodide (Lugul’s solution) Wolff-Chaikoff effect → large amounts of iodine inhibit thyroid hormone synthesis Biopsy revealing tennis racket shaped structures in cells of immune origin. → Langerhans cell histiocytosis Electron microscopy? Birbeck granules (tennis rackets) Marker? S100 Small bowel obstruction in a HIV patient with purple macules on the face, arms, and lower extremities. → Kaposi’s sarcoma Bug? HHV8 Tx? HAART Pathophys of vascular lesions? Overexpression of VEGF Fever + rash + eosinophiluria 10 days after a patient started an antistaphylococcal penicillin. → acute interstitial nephritis Tx? STOP drug + steroids SLE SOAP BRAIN MD S = serositis O = oral ulcers A = arthritis P = photosensitivity B = blood disorders (cytopenias) R = renal A = ANA/anti-dsDNA I = immunologic N = neurologic findings M = malar rash D = discoid rash Type 2 vs 3 HSRs in lupus Type 2 → cytopenias Type 3 → all other manifestations Lupus Ab? ANA anti-dsDNA anti-Smith Lupus nephritis → full house pattern on IF Antiphospholipid antibody syndrome → recurrent pregnancy losses Pathophys? Thrombosis of the uteroplacental arteries. MC cause of death in lupus patients? What I’ve read recently: CV disease Per Divine: Treated → infection Untreated → renal dz Also 40x risk MI Endocarditis in lupus pt? Libman-Sacks endocarditis Neonatal 3rd degree heart block → neonatal lupus Maternal autoimmune dz? Sjogren’s SLE Ab? anti-SSA/anti-Ro anti-SSB/anti-La Tx? Steroids Cyclophosphamide Hydroxychloroquine → good for skin lesions Pulmonary abscesses Bugs? Staph Anaerobes Klebsiella RF? Alcoholism Elderly Post-viral pneumonia MC location of aspiration pneumonia? Superior segment of RLL Chest pain worsened by deep inspiration and relieved by sitting up in a patient with a recent MI or elevated creatinine or URI or RA/SLE. → pericarditis EKG findings? Diffuse ST elevations + PR depression PE finding? Friction rub (“scratchy sound on auscultation”) A few days after MI → fibrinous pericarditis Weeks after MI → Dressler’s Tx? NSAIDS Consider adding on colchicine Cardiac tamponade Beck’s triad = hypotension + JVD + muffled heart sounds EKG findings? Electrical alternans Type of shock? Obstructive cardiogenic (Amboss) CO low SVR high PCWP high Tx? Pericardiocentesis or pericardial Pearly lesion with telangiectasias on the ear in a farmer. → Basal Cell Carcinoma MC type skin cancer Location? Upper lip Dx? Biopsy Tx? Mohs surgery Cold intolerance in a 35 yo white F → hypothyroidism MC cause? Hashimoto’s Histology? lymphoid follicles w/ active germinal centers Lab findings? TSH high T3/T4 low Ab? anti-TPO Anti-thyroglobulin HLA? DR3/DR5 Tx? Levothyroxine Future complication? thyroid lymphoma Massive hematemesis in a patient with a history of chronic liver disease. → ruptured varices Pathophys? L gastric vein has anastomosis with azygos veins. Increased portal pressure → backward flow from L gastric veins to azygous vein (which empties into SVC). Acute tx? IVF + octreotide + ceftriaxone/cipro + EGD w/ ligation/banding Do NOT give a beta blocker for acute tx Prophalaxsis? Beta blocker + spironolactone Other manifestations of elevated portal pressures Caput medusa Internal hemorrhoids Tx for cirrhotic coagulopathies? FFP If uremia → give desmopressin Note: Desmopressin = ADH analog → so, it can cause AE of hyponatremia 2/2 SIADH Hemophilia A Pathophys? deficiency of factor 8 Inheritance? XLR Coag labs? Bleeding time normal PTT HIGH b/c clotting problem PT normal Hemophilia B Pathophys? deficiency of factor 9 Inheritance? XLR Coag labs? Bleeding time normal PTT HIGH PT normal Hemophilia C Pathophys? deficiency of factor 11 Inheritance? AR Coag labs? Bleeding time normal PTT HIGH PT normal Bernard Soulier Syndrome Pathophys? Deficiency of GpIb Coag labs? Bleeding time HIGH PTT normal PT normal Glanzmann Thrombasthenia Pathophys? Deficiency of GpIIbIIIa Coag labs? Bleeding time HIGH PTT normal PT normal Von Willebrand’s disease Pathophys? Deficiency of vWF Inheritance? AD Coag labs? Bleeding time HIGH PTT HIGH vWF is a protecting group for factor 8 PT normal ITP Pathophys? Ab against GpIIbIIIa Classic pt? Pt with SLE Tx? Observation Steroids IVIG Splenectomy TTP Pathophys? Deficiency in ADAMTS13 enzyme → cannot cleave vWF multimers → activation of platelets → thrombosis → thrombocytopenia Presentation? microangiopathic hemolytic anemia + thrombocytopenia + renal failure + fever + neurologic problems Tx? Plasma exchange transfusion****** HUS Bugs? Shigella or E. coli O157:H7 Presentation? Fever+ microangiopathic hemolytic anemia + thrombocytopenia + renal failure + neurologic Platelet deficiency vs coagulation factor bleeds Platelet deficiency → mucosal bleeds, petechiae, heavy menses Coag factor deficiency bleeds → hemarthrosis Why do patients with CKD develop coagulopathy? Uremia → platelet dysfunction Tx? Desmopressin Note: Desmopressin = ADH analog → so, it can cause AE of hyponatremia 2/2 SIADH Exercising caution with transfusion in patients with Bernard Soulier syndrome Do NOT give transfusion that includes platelets They can have an anaphylactic rxn to GpIb (since they don’t have GpIb) Oropharyngeal candidiasis. RF? HIV Chronic ICS use TNF inhibitor Micro finding? Germ tubes at 37 C Tx oral candidiasis? Nystatin swish-and-swallow Tx invasive candidiasis? Amphotericin B Prevention of Amphotericin B toxicity? Liposomal formulation Pleural effusions Light’s criteria (must meet all 3 to be considered transudative!) LDH < 2/3 ULN LOW Pleural LDH/serum LDH < 0.6 LOW Pleural protein/serum protein < 0.5 LOW Causes of transudative effusion CHF Cirrhosis Nephrotic syndrome Note: Per UW 2021: Mechanism of transudate effusion? Decreased pulmonary artery oncotic pressure, e.g. hypoalbuminemia in nephrotic syndrome Increased pulmonary capillary hydrostatic pressure, e.g. volume overload in heart failure Causes of exudative effusion Malignancy Cancer Parapneumonic effusion Tb Note: Per UW 2021: Mechanism of exudate effusion? Inflammatory increased in vascular permeability of membrane (increased flow of interstitial edema into pleural space) Unique cause of both transudative & exudative effusions? PE Classic Pleural Effusion findings? Decreased breath sounds Dullness to percussion Decreased tactile fremitus Tx? Chest tube Chylothorax = lymph in the pleural space Pathophys? Obstruction of thoracic duct or injury to the thoracic duct Pleural fluid findings? High Triglycerides Holosystolic murmur heard best at the apex with radiation to the axilla in a patient with a recent MI. → mitral regurg 2/2 papillary muscle rupture Dx? Echo Why widely split S2? Aortic valve is closing earlier (LV is emptying into both aorta & LA) Maneuvers that increase intensity Increase preload (putting more blood in that can be regurgitated) Increase afterload Decubitus ulcers RF? Elderly Paraplegic Fecal/urinary incontinence Poor nutrition Staging Stage 1 = non-blanchable erythema Tx? Repositioning q2hrs Stage 2 = loss of epidermis + partial loss of dermis Tx? Occlusive dressing superficial Stage 3 = involves entire dermis, extending to subQ fat Does NOT extend past fascia Tx? Surgical debridement Stage 4 = muscle/tendon/bose exposed Tx? Surgical debridement General tx strategies? Repositioning + good nutritional support Marjolin’s ulcer = non-healing wound that is actually squamous cell carcinoma T1DM Pathophys? Autoimmune destruction of pancreas Ab? anti-GAD 65 (glutamic acid decarboxylase) anti-IA2 (islet tyrosine phosphatase 2) Islet cell autoantibodies Insulin autoantibodies Dx? A1c > 6.5% (twice) Fasting BG >= 126 (twice) Oral glucose tolerance test >= 200 (twice) Sxs of DM + random glucose > 200 Tx? Long-acting insulin + mealtime insulin Long-acting Glargine Detemir Rapid-acting Lispro Aspart Glulisine 3 HY complications Nephropathy Retinopathy & cataracts Neuropathy Chronic DM care A1c q3 months Foot exam annually Eye exam annually Microalbumin:Cr ratio annually Nephroprotection in DM? ACE-I GI bleed algorithm 1st step: ABCs + 2 large-bore IVs + IVFs 2nd step: NG lavage Clear fluid → go deeper Blood → UGIB → upper endoscopy Bilious fluid → have ruled out UGIB → proceed to colonoscopy See source → intervene as needed See nothing → CT angiography for large bleed Tagged RBC scan for smaller bleed Antiplatelet Pharmacology Aspirin Mechanism? Irreversibly inhibits COX-1 and COX-2 Clopidogrel/ticlopidine = P2Y12 (ADP receptor) blockers Mechanism? Inhibit platelet activation Abciximab/eptifibatide/tirofiban = GpIIbIIIa receptor blockers Mechanism? Inhibit platelet aggregation Ristocetin cofactor assay Issues with adhesion step → abnormal result Abnormal ristocetin cofactor assays: Von Willebrand disease Bernard Soulier disease Normal ristocetin cofactor assay: Glanzmann Thrombasthenia Von Willebrand disease effects on PTT? Increased Pathophys? vWF is a protecting group for Factor 8. Treatment of VWD? Desmopressin Mechanism? Increases release of vWF from Weibel-Palade bodies of endothelial cells Note: Desmopressin = ADH analog → so, it can cause AE of hyponatremia 2/2 SIADH HSV1 vs HSV2. Oral herpes → HSV1 Genital herpes → HSV2 Dx? PCR (most up-to-date) Tzanck smear (outdated, not very sensitive, nonspecific) → intranuclear inclusions Brain area affected by HSV encephalitis? Temporal lobes CSF findings in HSV encephalitis? RBCs******* Tx herpes encephalitis? Acyclovir AE? Crystal nephropathy Can’t see, can’t pee, can’t climb a tree. → reactive arthritis HLA? B27 Classic bug? Chlamydia Tx? steroids Need abx? Only if ongoing infection Can’t see, can’t pee, can’t hear a bee → Alport syndrome Inheritance? X-linked dominant Tx of NG & CT NG → treat empirically for both → ceftriaxone + azithro/doxy CT → azithro/doxy Hypovolemic Septic Neurogenic Cardiogenic CO low PCWP low SVR high*** CO high PCWP normal SVR low Tx? norepi CO low SVR low CO low PCWP high*** SVR high*** Tx anaphylactic shock? epinephrine Melanomas ABCDE A = asymmetry B = irregular borders C = color variation D = diameter > 6 mm E = evolving Dx? Full-thickness biopsy Excisional for small lesions Punch for larger lesions Most important prognostic factor → Breslow depth DM pharmacology Lactic acidosis → metformin Decreases hepatic gluconeogenesis → metformin Hold before CT w/ contrast → metformin Weight gain → sulfonylureas & TZDs (-glitizones) Diarrhea → acarbose & migliton Inhibits disaccharidases (can’t reabsorb disaccharides) Recurrent UTIs → SGLT-2 inhibitors Weight loss → GLP-1 agonists (e.g. liraglutide, exenatide) & DPP4 inhibitors (-gliptins) Contraindicated in pt with HF → TZDs PPAR-gamma receptor found in kidney → water retention Contraindication in pt with MTC → GLP-1 agonists Biggest risk of hypoglycemia? Sulfonylureas RF esophageal adenocarcinoma Barrett’s esophagus RF esophageal squamous cell carcinoma Smoking Drinking Achalasia Location esophageal adenocarcinoma? Lower 1/3 Location esophageal squamous cell carcinoma? Upper 2/3 MC US? Adenocarcinoma MC worldwide? Squamous cell carcinoma Presentation? Dysphagia to solids → dysphagia to liquids Dx? EGD Staging? CT scan or esophageal US Factor V Leiden Pathophys? Resistance to protein C Dx? Activated Protein C resistance assay Patient needs super large doses of heparin to record any changes in PTT → AT-III deficiency Recall that heparin is a AT-III activator 35 yo with a hypercoagulable disorder that does not correct with mixing studies. → antiphospholipid antibody disorder Anaphylaxis in a patient with a long history of Hemophilia A → Ab against factor 8 that cause type 1 HSR with transfusion Hx of hemophilia, diagnosed 5 years ago. Before you would give them factor 8 concentrate and PTT would normalize. Now they’re requirizing larger doses of factor 8 to normalize PTT. → inhibitor formation (antibodies against clotting factors) Skin necrosis with Warfarin → protein C/S deficiency Prothrombin G20210 mutation → overproduction of factor II Rash in dermatomal distribution → VZV infection Contraindications to VZV vaccination? Pregnant woman Kid < 1 year Severe immunosuppression (e.g. HIV with CD4 < 200) Tx? Acyclovir If resistant, foscarnet Tzanck smear findings? Intranuclear inclusions Shingles vaccination guidelines? Adults over 60 #1 cause of ESRD in the US → DM nephropathy Histology? Kimmelsteil-Wilson nodules #2 cause of ESRD in the US → hypertensive nephropathy Pt with BP 240/150. How fast should you lower BP? 25% in first 24 hrs Drugs for hypertensive emergencies? Nicardipine Clevidipine Nitroprusside AE? Cyanide poisoning Tx? Amyl nitrate + thiosulfate OR hydroxocobalamin Labelol Renal protective medications in patients with DKD or hypertensive nephropathy? ACE-I Anemia + Cranial Nerve deficits + Thick bones + Carbonic Anhydrase 2 deficiency + Increased TRAP + Increased Alkaline Phosphatase. → osteopetrosis Pathophys? Carbonic anhydrase is defective → osteoclasts cannot produce acid to resorb bone Tx? IFN-gamma Osteoclasts are a specialized macrophage IFN-gamma is an activator of macrophages Clinical diagnostic criteria for Chronic Bronchitis Diagnostic criteria? 2 years 3 months/year of chronic cough PFT findings FEV1 low FEV1/FVC ratio low RV high TLC high Which PFT market can differentiate CB from emphysema? DLCO DLCO normal → CB DLCO low → emphysema ****** Tx acute exacerbation? Abx + bronchodilators + corticosteroids (“ABCs”) Prevention? Stop smoking! Afib #1 RF? Mitral stenosis #1 RF MS? Rheumatic fever #1 RF CAD and AAA: smoking #1 RF stroke and aortic dissection: HTN MC arrhythmia in hyperthyroidism → Afib MC site of ectopic foci in Afib → pulmonary veins EKG findings? “Irregularly irregular” + no P waves Location of emboli formation? LA appendage Who should be cardioverted back to sinus rhythm? New onset (<48 hrs) Afib Anticoagulated for 3 weeks + TEE negative for clot Afib that’s refractory to medical therapy Afib & HDUS Q on T phenomenon? Depolarization during T wave (repolarization) can cause QT prolongation → Torsades → death Prevention? SYNCHRONIZED cardioversion Tx? Rate control Beta blockers ND-CCB (e.g. verapamil, diltiazem) Rhythmic control Amiodarone Reducing stroke risk in Afib? Anticoagulation for CHA2DS2VASc score >= 2 Anticoagulation options Valvular cause (e.g. MS) → warfarin Any other cause → warfarin or NOAC (apixiban) Reversal of AC Warfarin → Vit K, four-factor PCC Heparin → protamine sulfate Dabigatran → idarucizumab Crusty, scaly, ulcerating lesion with heaped up borders → squamous cell carcinoma Classic location? Below Lower lip Precursor lesion? Actinic keratosis What if it arises in a scar or chronic wound? Marjolin ulcer Hypothermia + hypercapnia + non pitting edema + hyponatremia + HR of 35 + hypotension in a patient with a history of papillary thyroid cancer → myxedema coma Tx? Levothyroxine + steroids Lab findings? TSH high T3/T4 low LDL high Acute onset “dermatologic” breakout in a patient with a recent history of weight loss and epigastric pain. → Leser–Trélat sign associated with visceral malignancy pancreatic cancer Lymph node associations Supraclavicular → Virchow’s node Periumbilical → Sister Mary Joseph What are mets to the ovaries called? Kruckenberg tumor Classic bug associated with gastric cancer? H. pylori (MALToma) Classic histological finding in the diffuse type of gastric cancer? Signet ring cells RBCs without central pallor + elevated MCHC + anemia. → hereditary spherocytosis Inheritance? AD Pathophys? Deficiency of spectrin, ankyrin, or band 3.2 Intravascular or extravascular hemolysis? Extravascular (RBCs bound by IgG, attacked by splenic macrophages) Dx? Osmotic fragility test Eosin-5-maleimide Acidified glycerol lysis test Tx? Splenectomy Post-splenectomy preventative care? Strep pneumo Hinflue vaccine Neisseria Septic shock Hemodynamic parameters CO high SVR low PCWP normal MvO2 high Tx? IVF + norepi + broad-spectrum abx (cover MRSA + Pseudomonas) E.g. vanc + pip-tazo E.g
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Depolarization
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Central - brain and spinal cord Peripheral - everything else soma - body dendrites - the fingers that extend from the soma or cell body afferent - from the body to the central nervous system (sensory information) Sensory info - coming into the CNS (from the body) Afferent neuron Interneuron - in between CNS and PNS Motor info - coming out of the CNS (to the body) Efferent neuron Neurons: nerve cells Receive information in dendrites Information flows through the axon Eventually reaches an effector Synapse: gap between two neurons Synaptic terminals Glial cells Support the neurons Schwann cells & Oligodendrocytes Myelin sheath On the axon Function: prevents cross-talk and accelerates the speed of action potential Schwann cell - produces myelin sheath in PNS Oligodendrocytes - produces myelin sheath in CNS Like an octopus: many arms wrapping around different / same neurons unlike Schwann cell Node of Ranvier - space in between schwann cells Saltatory conduction Presence of node of Ranvier allows jumping of signals → much faster nerve impulse jumps from node to node Grey matter - cell body, dendrites, synapses White matter - myelinated axons (white color comes from lipid) Dorsal root ganglion Large collection of afferent neurons near the spinal cord Cell body Location is different in Sensory vs. peripheral neurons Sensory neurons - cell body in dorsal root ganglion Peripheral neurons - cell body in gray matter (make sure to know how to identify which microscope took what kind of pictures) SEM vs. TEM SEM - outer surface TEM - inner matter, more detail? Interneurons Help with more complicated types of signals such as reflex Non-decremental action potential: does not die out over space Energy at first same as energy at the end Nerve impulse Resting membrane potential: Inside of axon is -70 mV due to negatively charged proteins inside Inside: potassium outside: sodium Ions cannot diffuse in and out of membrane: requires proteins to allow exchange Depolarization (sodium influx) Threshold hit: open voltage gated sodium channel → facilitated diffusion of sodium ions (NA+) into the cells → inner charge becomes more positive Repolarization (potassium efflux) Voltage gated potassium channels open a little later → facilitated diffusion of potassium ions (K+) to out of the cells → inner charge becomes more negative hillock Refractory period Absolute: absolutely will not get an action potential during this period Relative: membrane potential lower than -70mV → can get an action potential depending on the size of the stimulus because it requires a bigger stimulus to reach the threshold Sodium-potassium pump Active transport (against concentration gradient) resets the sodium and potassium to allow the nerve impulse to happen again pumps 3 sodium out, pumps 2 potassium in Intensity is indicated by the frequency of action potentials Ex. very hot - thousands of action potentials Ex. nice and warm - some action potentials
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fdjksl afdjs klejfsieofwjnervous system the body's speedy, electrochemical communication network, consisting of all the nerve cells of the peripheral and central nervous systems three critical features of the nervous system They receive input from the surrounding world. They process the info from the surroundings. They initiate responses to the internal and external environments, when necessary. neuron a nerve cell; the basic building block of the nervous system dendrites Branchlike parts of a neuron that are specialized to receive information. cell body Largest part of a typical neuron; contains the nucleus and much of the cytoplasm axon the extension of a neuron, ending in branching terminal fibers, through which messages pass to other neurons or to muscles or glands glial cell cells in the nervous system that support, nourish, and protect neurons nerves bundled axons that form neural "cables" connecting the central nervous system with muscles, glands, and sense organs how many neurons die everyday? 9,000 When neurons die can they be replaced? no what can kill neurons? alcohol intake, inhaling gas fumes neurons are what kind of cell eukaryotic what does the cell body contain nucleus, mitochondria, endoplasmic reticulum, and so on What does a dendrite do? receives information what does the axon do? carries impulses away from the cell body what does the cell body do? process information sciatic nerve nerve extending from the base of the spine down the thigh, lower leg, and foot How many more glial cells are there than neurons? 9x Do glial cells divide? yes glial cells act as a barrier for harmful things entering the brain blood brain barrier Blood vessels (capillaries) that selectively let certain substances enter the brain tissue and keep other substances out how is the blood brain barrier broken down hypertension, radiation, some infectious organisms sensory neurons neurons that carry incoming information from the sensory receptors to the brain and spinal cord. stimulations like temp, touch, taste, smell, light or sound motor neurons neurons that carry outgoing information from the brain and spinal cord to the muscles and glands Interneurons neurons within the brain and spinal cord that communicate internally and intervene between the sensory inputs and motor outputs. peripheral nervous system network of sensory cells modified to receive info from the environment and motor pathways that transmit signals to effectors, the muscles and glands capable of responding to that stimulus sensory pathway nerves coming from the sensory organs to the CNS consisting of afferent neurons motor pathways In the peripheral nervous system, common routes by which motor nerve impulses are transmitted. somatic nervous system the division of the peripheral nervous system that controls the body's skeletal muscles (voluntary) autonomic nervous system the part of the peripheral nervous system that controls the glands and the muscles of the internal organs (such as the heart). Its sympathetic division arouses; its parasympathetic division calms. (involuntary) sensory neurons alert the brain of a stimulus motor neurons help the brain to execute a response reflex signal that skips the brain, and goes to stimulate the motor neuron. direct sensory response autonomic nervous system helps us with homeostasis sympathetic nervous system the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations parasympathetic nervous system the division of the autonomic nervous system that calms the body, conserving its energy dendrites recieve signals from external stimuli two ways dendrites receive stimuli through motor neurons and interneurons connecting with other neurons or directly from external stimulus resting potential of neuron its stable, negative charge when the cell is inactive action potential of neuron a very brief shift in a neuron's electrical charge that travels along an axon resting potential is produced as proteins within the neurons plasma membrane pump sodium ions out of the cell and potassium ions into the cell what ion goes into the cell potassium what ion goes out of the cell sodium how does the pumping of ions affect the charge of the cell? more positive on the outside more negative on the inside greater positive charge out of the cell makes the cell polarized when stimulated dendrites briefly open ion channels made of proteins which allow charged ions down the concentration gradient concentration gradient A difference in the concentration of a substance across a distance. when ion channels open the negative charge inside the cell is temporarily changed either decreasing or increasing changes in the cells electrical charge converge from the dendrites to the cell body when charges converge that is called action potential terminal buttons Small knobs at the end of axons that secrete chemicals called neurotransmitters axon terminals (terminal buttons) doe what i response to action potential release contents of vesicles, small sacks of chemicals inside the axon terminal into the space between cells which can influence nearby cells myelin sheath A layer of fatty tissue segmentally encasing the fibers of many neurons; enables vastly greater transmission speed of neural impulses as the impulse hops from one node to the next. as the action potential moves down the axon ion channels allow positively charged ions to rush in changing the charge to positive. other ion channels allow positively charged ions to rush out what restores the action potential ion channels letting the influx of positively charged ions to rush put Where are ion channels concentrated in the gaps in the myelin sheath fatty myelin is what color white fatty myelin shows up as white when tightly packed together regions of the brain with many cell bodies and dendrites appear what color gray multiple sclerosis myelin sheath destruction. disruptions in nerve impulse conduction little myelin causes the neurons to lose its ability to conduct electrical impulses which makes it harder for the brain to send signals to muscles synapse the junction between the axon tip of the sending neuron and the dendrite or cell body of the receiving neuron at a synapse and neurons interacts with another cell What happens at a synapse? When a nerve impulse reaches the synapse at the end of a neuron, it cannot pass directly to the next one. Instead, it triggers the neuron to release a chemical neurotransmitter. The neurotransmitter drifts across the gap between the two neurons. sacs called vesicles release neurotransmitters into the synaptic cleft synaptic cleft The narrow gap that separates the presynaptic neuron from the postsynaptic cell. what happens when the action al potential reaches the axon terminal? little sacks called vesicles merge with axon cell membrane axon cell membrane presynaptic membrane the vesicles open and release chemicals called neurotransmitters neurotransmitters send a signal to the cell receiving the signal after sending a signal to a cell the neurotransmitters diffuse away and binds to nearby receptor sites after neurotransmitters diffuse the gates open in the post synaptic cell membrane and the signal enters the post synaptic cell after the signal enters a new neurotransmitter is released from the post synaptic cell receptors and is recycled or broken down what are neurotransmitters broken down by enzymes found in the synaptic cleft when a postsynaptic cell is a muscle cell it contracts when a postsynaptic cell is a gland it secretes how do neurotransmitters affect the neuron by causing it to fire on its own action potential or receives the likelihood of it firing on its own action potential what a neurotransmitter does to a neuron is decided by receptor the ability for neurons to not fire helps with filtering overwhelming sensory info such as a concert Acetylcholine A neurotransmitter that enables learning and memory and also triggers muscle contraction Acetylcholine is released by motor neurons at the point where they synapse with muscle cells Botulinum toxin an acetylcholine antagonist; prevents release by terminal buttons. most toxic substance known what does botox do blocks release of acetylcholine so less contractions in muscles =less wrinkles glutamine involved with learning and memory, more sensitive to glutamine, better memory and learning dopamine influences movement, learning, attention, and emotion. loss of is responsible for parkinson's. chief of happiness serotonin Affects mood, hunger, sleep, and arousal who makes serotonin more? men cocaine a powerful and addictive stimulant, derived from the coca plant, producing temporarily increased alertness and euphoria. tricks pleasure center in brain and binds with presynaptic membrane where dopamine is usually reabsorbed from the synaptic cleft. blocks reuptake sites dopamine remains in cleft repeatedly stimulating it prozac and zoloft block serotonin from being reabsorbed and recycled by presynaptic cells which prolongs it affect Selective Serotonin Reuptake Inhibitors (SSRIs) a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters morphine and heroin mimic endorphins and bind to receptor sites. in high doses gives endorphins rush which causes euphoria. slows down respiratory rate and can be fatal nicotine mimics acetylcholine by binding to the same receptors and release adrenaline and other stimulating chemicals. rapid surges the rapid depletions of these chemicals make smokers want another cigarette drugs become addictive because the body's think that there is more natural amounts of usual neurotransmitters. reduces sensitivity to drugs, needing more to have the same reaction DRD4 gene that encodes a certain class of dopamine receptor. It can be mutated for those seeking sensation, altering the mesolimbic pathway and the way sensations are rewarded caffeine a mild stimulant found in coffee, tea, and several other plant-based substances cellular waste products takes form of a variety of molecules such as adenosine adenosine when binds with receptor reduces the likelihood of a neuron initiating an action potential as more adenosine binds with more receptors we feel tired when we sleep cellular waste products are reabsorbed and recycled effects of alcohol slowed down reactions slurs speech by blocking receptors for glutamate, provides buzz by blocking dopamine reuptake, blocks pain by stimulating the release of endorphins, increases feeling of happiness by modifying the efficiency of serotonin receptors muscles generate force through contraction skeletal muscle is attached to bones by connective tissue and is controlled by individual neurons attached to each muscle fiber cardiac muscles causes the heart to pump blood blood through the body smooth muscle, involuntary, surrounds blood vessels and many internal organs which help to move blood, move food through digestive system myofibrils cylindrical organelle within muscle cells that can contract; contains repeating units, called sarcomeres in which the contraction takes place Sarcomere the fundamental unit of muscle contraction , made of actin myosin actin protein of muscle tissue; makes up the thin filaments myosin protein of muscle tissue, making up the thick filaments muscle fiber contraction Results from a sliding movement where the actin and myosin filaments merge using ATP. Globular portions of the myosin filaments can form cross-bridges with actin filaments. Reaction between actin and myosin filaments generates the force of contraction. First step of sarcomere contraction detach, link between myosin and a parallel action filament is broken as a molecule of ATP bonds to myosin Second step of sarcomere contraction reach, as the atp breaks down, energy released alters the shape of the myosin into a higher energy shape and myosin now reaches farther down the actin filament Third step of Sarcomere contraction reattach, the myosin reattaches to the actin filament at this new location Fourth step of Sarcomere contraction pull back, the myosin then snaps back to its original shape, pulling the actin filament as it does so and shorting the fiber relaxed sarcomere Actin & Myosin myofilaments lie side by side contracted sarcomere the Z lines are close together duration between contraction and relaxation is called twitch fast twitch muscle fibers that react quickly and fatigue quickly slow twitch type of muscle that contracts slowly and is fatigue resistant Oxytocin peptide hormone, produced in neurons within the hypothalamus and released by the posterior pituitary, influences trust in others, increases the social attachments, directs the ejection of breast milk, and contractions in the uterus during childbirth synthesis site of oxytocin hypothalamus target tissues of oxytocin uterus and mammary glands effect of oxytocin Effects uterus - uterine contractions during labor, direct myometrium, other effects are on limbic system in both men and women increased by touch - reflects on bonding and trust hormones chemical messengers that are manufactured by the endocrine glands, travel through the bloodstream, and affect other tissues two systems for carrying out communication nervous and endocrine endocrine system the body's "slow" chemical communication system; a set of glands that secrete hormones into the bloodstream endocrine cells produce regulatory hormones target cells cells that have receptors for a particular hormone endocrine glands Glands of the endocrine system that release hormones into the bloodstream endocrine gland examples pituitary, thyroid, parathyroid, adrenal, pineal hormones help regulate homeostasis pheromones Chemical signals released by an animal that communicate information and affect the behavior of other animals of the same species. such as sexual reproduction and territory marking step one of how a hormone affect a certain cell signal is sent by a hormone being released from a gland step two of how a hormone affects a certain cell signal is received, although the hormone has no effect on most tissues it comes in contact with, cells with the right receptor in their cytoplasm or on their plasma membrane receives the signal step three of how a hormone affects a certain cell cell responds, hormone binds to receptor, causes response in target cell, can be change in gene expression in nucleus, can cause cell to start or stop producing a certain protein, alter rate of producing protein amines hormones adrenaline, hormones that are synthesized from single amino acids polypeptide hormones insulin and glucagon, chains of amino acids steroid hormones estrogen and testosterone, lipids lipid Energy-rich organic compounds, such as fats, oils, and waxes, that are made of carbon, hydrogen, and oxygen. most amines and polypeptide hormones are — while lipids are not water soluble amines and polypeptide hormones — pass through memebrane cannot lipids —pass through membranes can amines and polypeptide hormones bind to receptors embedded within the cell membrane which can influence inside the cell steroids hormones bind to receptors within the cytoplasm or nucleus of the cell, always passes into nucleus once a steroid is in the nucleus it binds to DNA, influencing gene expression paracrine receptors target cell receptors for a specific hormone can be nearby hormones secreted by glands in one part of the body are able to regulate cell function in another part of the body Prostaglandins Modified fatty acids that are produced by a wide range of cells. dilation or construction of blood vessels and affecting tissue inflammation what does asprin do Inhibits prostaglandins, decreases inflammation, and slows transmission of pain to site of injury Hypothalamus underside of brain, functions as liaison between the nervous and endocrine systems and it receives input from neurons throughout the brain and rest of body. sends out appropriate hormones to regular nearly every aspect of the organisms physiology, including body temp, hunger. thirst, and water balance pituitary gland The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. posterior pituitary gland also known as the neurohypophysis; it is made up of nervous tissue/neurons and stores and secretes 2 hormones made by the hypothalamus (oxytocin and ADH); it is controlled by action potentials from the hypothalamus antidiuretic hormone (ADH) influences the absorption of water by kidney tubules anterior pituitary produced many hormones such as TSH, LH, FSH, prolactin, ACTH Thyroid Stimulating Hormone (TSH) causes thyroid to produce thyroxine, important in cellular respiration Follicle-stimulating hormone (FSH) stimulates development of follicles in ovaries and sperm maturation Lutenizing hormone (LH) triggers ovulation and stimulates testosterone production, works with FSH prolactin stimulates mammary glands to produce milk Adrenocorticotropic hormone (ACTH) Stimulates adrenal glands to produce cortisol and other stress related hormones Corticotropin-releasing hormone (CRH) Promotes secretion of adrenocorticotropic hormone (ACTH) growth hormone several effects, stimulating liver to release chemicals that spur growth of bones, cartilage, and other tissues excessive production of growth hormone during childhood can cause extreme growth called gigantism increased exposure to growth hormone in adulthood results in hands, face, feet growing unusually absence of growth hormone dwarfism how is pituitary dwarfism treated if caught early? shots of human growth hormone pineal gland secretes melatonin regulates sleep cycles thyroid gland releases thyroxine, influences the rate and efficient of cellular metabolism, regulates calcium levels in blood parathyroid glands regulate calcium levels in blood adrenal glands release adrenaline and cortisol (prepares body for action), regulate organisms response to stress. sit right above kidneys. pancreas releases insulin and glucagon, maintains blood glucose levels wishing a narrow range gonads release the sex steroids, including testosterone, estrogen, and progesterone, responsible for numerous physical, behavioral, and emotional features, including much sexual behavior, development, and growth Under active thyroid fatigue and weight gain overactive thyroid jitteriness, rapid heartbeat, weight loss, irritability when iodine intake is low, the thyroid is unable to produce thyroxine which causes thyroid to swell Calcitonin Lowers blood calcium levels insulin A hormone produced by the pancreas or taken as a medication by many diabetics negative feedback A primary mechanism of homeostasis, whereby a change in a physiological variable that is being monitored triggers a response that counteracts the initial fluctuation. positive feedback Feedback that tends to magnify a process or increase its output. endocrine disrupters Chemicals that disrupt normal hormone functions Polychlorinated biphenyls (PCBs) A group of industrial compounds used to manufacture plastics and insulate electrical transformers, and responsible for many environmental problems. Phthalates found in cosmetics, deodorants, and many plastics used for food packaging, children's toys, and medical devices. Cause kidney & liver damage, cancer, and low sperm counts. Bisphenol A (BPA) a substance widely used in plastics and to line food and drink cans, which has raised health concerns because it is an estrogen mimic endocrine disrupters effect on mammals reproductive harm endocrine disrupters effect on fish reproductive functioning endocrine disrupters effect on invertebrates defective shells, masculinization of female genitalia, reducing fertility oxytocin posterior pituitary, uterus, breast, brain, reduce stress, more trusting "love hormone" antidiuretic hormone (ADH) posterior pituitary, kidneys, water retention in kidneys Thyroid Stimulating Hormone (TSH) anterior pituitary, thyroid, stimulates production of thyroxine, important in cellular respiration Follicle-stimulating hormone (FSH) anterior pituitary, ovaries, testes, stimulates ovary development and sperm maturation prolactin anterior pituitary, mammary glands, milk production growth hormone anterior pituitary, liver and other organs, stimulates release of chemicals that spur growth of bones, cartilage, and other tissues cortisol and adrenaline adrenal glands, smooth, cardiac, skeletal muscle, blood vessels, cell throughout body, imitates response to stress, regulates response to long term stress melatonin pineal gland, brain, regulate sleep cycle thyroxine thyroid, cells throughout body, influenced metabolic spew and efficiency calcitonin and parathyroid hormone thyroid, bones, causes bones to pick up excess calcium in blood insulin pancreas, liver, adipose tissue, skeletal muscle, take up glucose in blood which reduces its level glucagon pancreas, liver, adipose tissue, concert stored glycogen into glucose estrogen, testosterone, progesterone gonads, cells uterus, breasts, balls, puberty, pregnancy, sperm production, egg production heritable sensory autonomic neuropathy condition in which afflicted individual cannot feel pain sensory neurons affected by skin and joints affected by syphilis Interneurons are affected by parkinsons motor neurons are affected by polio Oligodendrocytes Type of glial cell in the CNS that wrap axons in a myelin sheath. Microglia Act as phagocytes, eating damaged cells and bacteria, act as the brains immune system astrocyte release gliotransmitters by expcytosis to send signals to neighboring neuron connectomes Map of the network of connections between neurons in the human brain resting potential -70 mV action potential +30 mV (depolarized) Channelopathies diseases and disorders that are the result of ion channel dysfunction Tetrodotoxin -Poisoning can result from ingestion of poorly prepared puffer fish (exotic sushi) -Highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization - blocks action potential without changing resting potential (same mechanism as Lidocaine) -Causes nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes. -Treatment is primarily supportive. epilepsy potassium channel mutations, muscle weakness the synapse excitatory neurotransmitters chemicals released from the terminal buttons of a neuron that excite the next neuron into firing inhibitory neurotransmitters chemicals released from the terminal buttons of a neuron that inhibit the next neuron from firing GABA An inhibitory neurotransmitter in the brain. caffeine — glutamine and — GABA activity increases, decreases Alcohol — GABA activity and — Glutamate activity increases, decreases functions of muscle generate movement, force, heat, homeostasis 2 mutates copies of them upstairs gene causes excess muscle build up muscle is composed of bundles of muscle fibers bundles of muscle fibers are composed of muscle fibers muscle fibers are composed of myofibrils myofibrils are composed of actin and myosin actin and myosin are composed of sarcomere slow fiber muscle is dark mest fast fiber muscle is light meat motor unit A motor neuron and all of the muscle fibers it innervates rigor mortis stiffness after death caused by lack of ATP, muscle remains in a state of contraction acromegaly abnormal enlargement of the extremities during adulthood when exposed to excess growth hormone Addison Disease low levels of cortisol, autoimmune disease, depression, dizziness, low blood glucose, low blood pressure chronic stress excess cortisol, high blood glucose, obesityfdwkqfejifijeoiefowojk
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