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Secret

Secret

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Published by Travis Jiang
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Published by: Travis Jiang on Jun 24, 2012
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10/09/2013

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Histology:-
 
Phosphorylation of nuclear lamina (by
lamin kinase
) during mitotic prophase
nuclear disassembly into small vesicles.-
 
The outer nuclear membrane is continuous with the ER. -
 
“Diplotene stage” is the part of prophase in which the chromatids appear to repel one another.-
 
Within a Graafian follicle, ovum is surrounded by glycogen rich
ZONA PELLUCIDA
, which triggers the acrosomal reaction.Around the
ZP
is the
corona radiata;
around the
CR
is a hill of follicular cells around ovum,
cumulus oomphorus.
 -
 
Ovary: cuboidal;Fallopian tube: columnar;Uterus: Pst columnar;ECTOcervix: st squamous;ENDOcervix: columnar;  Vagina: St squamous non-keratinized -
 
Early Follicular: nontortuous glands, no vacuoles; Late follicular: coiled glands, stromal edema. No vacuoles.Early Luteal: tortuous glands and basal vacuoles; Late luteal: apical vacuoles and secretions into gland lumen.-
 
“Abundant extracellular space indicates PNS
 
, thus Schwann cell.”Myelin is made of LCFA metabolism and would be facilitated by peroxisomes. -
 
Airway down to RESPIRATORY BRONCHIOLES is PsCC; down to TERMINAL BRONCHIOLES has goblet cells-
 
CONDUCTING ZONE: NOSE to TERMINAL BRONCHIOLE;RESPIRATORY ZONE: Respiratory bronchiole, alveoli  -
 
Type 1 pneumocytes: Squamous-
 
Type 2 pneumocytes: CUBOIDAL w/ round nuclei and washed out foamy cytoplasm.-
 
Clara cells: Columnar -
 
Mesothelium: Stratified squamous-
 
True vocal cords: Stratified squamous -
 
Osteoblasts have PTH receptors;
OBs
arise from mesenchymal stem cells in
periosteum
.-
 
Osteocytes are OBs in matrix; responsible for bone maintenance-
 
Osteoclasts resorb bone in Howship’s lacunae
 
; differentiate by
RANKL and M-CSF
 OCs naturally have tartrate resistant acid phosphatase.-
 
Osteocalcin
is ALSO a marker for increased bone turnover/growth. -
 
Odontoblasts
dentin (inner side); Ameloblasts
enamel (outer side)-
 
BONE:
“within a single Haversian system, the central canal is encircled by multiple concentric lamellae of bony matrix thatcontains lacunae with osteocytes and extracellular bone fluid”Osteocytescommunicate via GAP JUNCTIONS-
 
Erythrocytes: 90% anaerobic metabolism; 10% HMP shunt.-
 
Platelets: ½ of platelet pool is stored in spleen; life span 8-10 days
Dense granules
: ADP, Ca
2+
, histamine, 5HT, epinephrine
α
-granules:
Fibrinogen, fibronectin, Factor V, vWF, PF4, PDGF -
 
Basophil: granules contain
heparin, histamine, leukotrienes
.-
 
Eosinophil ALSO produces
histaminases
and
arylsulfatase
; chemotactic by
eotaxin
.“NAACP:”
N
eoplasms,
A
sthma,
A
llergy,
C
ollagen vascular disease,
P
arasites (invasive) -
 
Neutrophils: “spends 6-10 hours circulation before extravasation;”PRIMARY AZUROPHILIC GRANULES (lysosomes): lysozyme
(β1
-4 linkages), myeloperoxidase (responsible for green color of pus/sputum in bacterial infections), lactoferrin, PLA2, acid hydrolases, elastase, defensins.SECONDARY SPECIFIC GRANULES: PLA2, lysozyme, AP, collagenase, lactoferrin, B12 binding proteins.-
 
IFNγ turns macrophage to
epitheliod cell 
(enlarged with pink nuclei) that FUSES to become:1) Langhan’s giant cell:
 peripheral nuclei 
OR 2) Foreign body giant cell:
haphazard nuclei 
.-
 
Dendritic cells are “the main inducers of the primary antibody response. -
 
Esophagus: St.Sq-
 
Intestinal villi/microvilli: Duodenum > jejunum > ileum-
 
Jejunum has the
largest number of goblet cells in the SI
.-
 
Only jejunum and proximal ileum have plicae circulares.-
 
Paneth granular cells in SI release defensins & lysozyme.-
 
Hepatocytes:
Apical: faces bile canaliculi; Basolateral: faces sinusoids; -
 
ATROPHY:
Micro: “small, shrunken cells with lipofuscin granules.”EM: “decreased intracellular components and autophagosomes”
 
-
 
Endothelium of CV + lymph vessels: Simple Squamous -
 
The DERMIS contains skin appendages (hair follicles, sweat glands) that contain EPITHELIAL STEM CELLS.Anatomy:-
 
DORSUM of HAND
sensory innervation: 1)
Median nerve
gets 2, 3, lateral 4
th
fingerbed;2)
Radial nerve
gets thumb and dorsum proximal to 2 and lateral 3
rd
fingerbed;3)
Ulnar nerve
gets lateral 4
th
and 5
th
fingerbeds and dorsum proximal to lateral 3
rd
, 4
th
, and 5
th
fingerbed.-
 
MEDIAN NERVE:
“OAF” (brevis); anterior forearms muscles (except FCU), ½ of FDP, and 1
st
and 2
nd
lumbricals.*Proximal to wrist, median nerve PASSES B/T the TWO HEADS OF THE PRONATOR TERES*
RADIAL NERVE:
Abductor pollicis longus, extensor pollicis brevis. -
 
Lumbricals
extend 
@ IP joints and
spread 
@ MCP.Extensor digitorum
helps
extend @ IP joints by ASSISTING lumbricals.EDM extends @MP joints (NOT IP joints)-
 
Palmaris longus in forearm by MEDIAN NERVE.-
 
“Making a TIGHT fist” requires stabilization by the wrist extensors. -
 
Deep laceration of RADIAL side of wrist: Radial A, Median N, Palmaris longus, FCR.-
 
Deep laceration of ULNAR side of wrist: Ulnar A, ulnar N, FCU.-
 
BRACHIAL PLEXUS:
Median nerve from “LATERAL & MEDIAL CORDS.”Nerve to subclavius & suprascapular nerve from “UPPER TRUNK.”-
 
MC nerve injured with clavicular fractures
ULNAR NERVE.-
 
Median nerve cutaneous sensation can be BLOCKED @ “distal forearm before the carpal tunnel, in a superficial positionbetween the tendons of the Palmaris longus and the FCR.”RADIAL N and DEEP BRACHIAL A. go through spiral groove. -
 
RADIAL A and MEDIAN N run together. -
 
MEDIAN N courses between FDS and FDP muscles before wrist.-
 
Wrist Flexion:
C6
, C7, C8, T1; Elbow flexion:
C6
, C7, C8; Deltoid + Sensation: C5,
C6
; Sensation 1
st
3 digits:
C6
, C7, C8 -
 
The superficial arch (of ulnar artery) and the deep arch (of radial artery ensure collateral to hand.-
 
Colles fracture
lunate dislocation into carpal tunnel
MEDIAN NERVE lesion.-
 
The PHRENIC NERVE lies on the anterior surface of the anterior scalene DEEP to the prevertebral fascia.-
 
Postganglionic sympathetic to visceral organs uses
catecholamines
.-
 
Irritation of the phrenic nerve (think mass effect) can cause
dyspnea
and
hiccups
.-
 
Suboccipital triangle:
obliquus capitis superior, obliquus capitis inferior, rectus capitis posterior major.
 -
 
Supracondylar surface of femur forms the floor of the popliteal fossa (hence popliteal artery)-
 
Coarctation
: DECREASED BLOOD FLOW THRU DESCENDING AORTA, off of which most intercostals arteries arise. BUT, the1
st
intercostals originate directly off the subclavian artery @ the costocervical trunk. Flow remains anterograde.-
 
TRAP: Sternoclavicular joint dislocations can impingeTRACHEA; ****
 Aorta and SVC are BELOW this level 
.**** -
 
INTERCOSTAL SPACES:
 
 Anterior drainage
to internal thoracic (parasternal) nodes
 
;
 posterior drainage
is to para-aortic nodes.PO2 in the left atrium is LOWER than those in the pulmonary veins because deoxygenated blood from the bronchial arteries(no typo) to the left heart. The bronchial veins return blood to the right heart via the
azygous, hemiazygous, or intercostal v.
 -
 
Intercostal nerves:
12 pairs of thoracic nerves; 11 intercostal pairs; 1 subcostal pair.
the VENTRAL PRIMARY RAMI of theTHORACIC SPINAL NERVES
supply
musculature, parietal pleura, and parietal peritoneum
.TRAP: These are found
LATERAL
to the ANGLE OF THE RIB. -
 
Intercostal arteries:
12 posterior/anterior, 11 intercostal pairs, and 1 subcostal pair.ANTERIOR:
Pairs 1-6
are from INTERNAL THORACIC ARTERIES;
Pairs 7-9
are from MUSCULOPHRENIC ARTERIES*There are no
anterior intercostals arteries
in the
LAST TWO spaces
; branches of 
 posterior intercostals arteries
supply these.POSTERIOR: Pairs
1-2
are from
superior intercostals arteries
, a branch of costocervical trunk of subclavian artery.
9 pairs
of intercostals and
1 pair
of subcostal arteries from the thoracic aorta.-
 
INTERCOSTAL VEINS
 Anterior branches drain to the
internal thoracic
and
musculophrenic veins
 Posterior branches drains to the azygos.
 
-
 
**N.A.V. from
inferior
superior;
“Going
up
from the
NAVel.”
 -
 
CAMPER’S FASCIA
contains the fat. “You get
fat
while eating smores at
camp
.”**Camper fascia
Scarpa fascia
external oblique…** -
 
Great saphenous vein passes ANTERIOR to MEDIAL MALLEOLUS, POSTERIOR TO MEDIAL KNEE, and thru saphenous hiatusto fascia lata (fossa ovalis) to empty into femoral vein.-
 
Short saphenous vein drains LATERAL DORSUM OF FOOT and runs on posterior leg; drains into popliteal fossa nodes.-
 
Varus for medial; Va
l
gus for
lateral
.-
 
ACL prevents anterior subluxation of knee (hyperextension)Attaches to 1) Anterior intercondylar tibia & 2) Posteromedial side of lateral femoral condyle -
 
MCL attaches to medial epicondyle of femur with shaft of tibia
 
;
resists
valgus and external rotation forces of proximal tibia.-
 
LCL attaches to lateral epicondyle of femur with head of fibula
 
;
resists
varus forces and rotation forces of proximal fibula.-
 
PCL attaches to 1) posterior part of intercondylar area of tibia 2) anterolateral surface of medial epicondyle of femur -
 
S/S of meniscus injury: “1) pain; 2) knee catches, locks, or fives way when walking; 3) swelling/popping of knee.”-
 
FEMORAL N (L2-L4) involved in PELVIC FRACTURES.Lesion: weakened hip flexion, loss of extension @ knee, sensory loss @ anterior thigh, medial leg, and foot.-
 
MC site of lateral femoral nerve entrapment: inguinal ligament
“meralgia paresthetica”
numbness or burningsensation over the lateral part of the thigh when walking or prolonged standing; OBESE PATIENTS.-
 
L5-S1 => QUADRICEPS FEMORIS => LATERAL ROTATIONS1-S2 => PIRIFORMIS => LATERAL ROTATION when leg is EXTENDED; ABDUCTION when thigh is FLEXED.-
 
OBTURATOR N (L2-L4) injured in ANTERIOR HIP DISLOCATIONLesion: weakened thigh adduction & medial rotation of thigh.-
 
SUPERIOR
GLUTEAL N can be damaged by POSTERIOR HIP DISLOCATION or POLIO;It travels through
greater sciatic foramen
 
ABOVE
piriformis & against
UPPER BORDER
of foramen.-
 
INFERIOR
GLUTEAL N can be damaged by POSTERIOR HIP DISLOCATION
“Can’t jump, climb stairs, or rise from sitting.”It travels through
greater sciatic foramen
 
BELOW
piriformis & against
LOWER BORDER
of foramen.-
 
PUDENDAL
N passes through GSF
BELOW
piriformis & against
LOWER BORDER
of foramen and exits LSF to enter perineum.-
 
SCIATIC N lesion
weak thigh extension, loss of knee flexion, loss of function below knee. Exits GSF BELOW piriformis. Sciatica
Compression of lumbar spine affecting sciatic nerve roots (L4-S3 tibial; L4-S2 peroneal)
“weakened leg extension, loss of knee flexion, loss of function below the knee, pain/sensory loss on posterior thigh,lateral leg, and foot” -
 
BUTTOCKS:
 superior medial aspect: superior gluteal nerve (L4-S1); inferior medial aspect: sciatic nerveSuperior lateral aspect: SAFE; Inferior lateral aspect: tendinous insertions.PSOAS inserts on lesser trochanter
 
; G.MAX inserts on gluteal tuberosity;G.MED,MIN,PIRIFORMIS inserts on greater trochanter-
 
GENITOFEMORAL N & ILIOINGUINAL N (L1-L2) -
 
TRAP: Common peroneal injured at fibular head
 
; even though the question only specifies failure of dorsiflexion,
do not choose anterior compartment of leg
, as small pressure (such as wearing a cast) would not damage the nerve there.-
 
MC foot fracture from fall from height:
calcaneus
.-
 
Superficial inguinal lymph nodes drain cutaneous lymph from umbilicus to feet, including external genitalia & anus (butexcluding the posterior calf, which drains to popliteal lymph nodes)BOUNDED by 1) inguinal ligament, 2) sartorius, and 3) adductor longus muscle, and overlie the femoral NAV. -
 
Tumors
from penis, vagina, and anal canal drain to
MEDIAL SIDE
of 
HORIZONTAL CHAIN
of 
SUPERIFICIAL INGUINAL NODES
. -
 
Prostate lymph drains to INTERNAL ILIAC NODES (and a minor bit to external iliac + sacral nodes)-
 
Superior bladder drains to EXTERNAL ILIAC nodes; inferior bladder drains to INTERNAL ILIAC nodes -
 
Ureters pass OVER the external iliac arteries and UNDER the gonadal vessels
 
;As they enter the true pelvis: pass LATERAL to internal iliacs and MEDIAL to gonadal vessels.-
 
TESTICULAR TORSION:
MEDICAL EMERGENCY + SEVERE PAIN;
absent cremasteric reflex (negative Prehn’s)
 
VARICOCOELE
: WORSE w/ EXERCISE; gets LARGER WITH VALSALVA; more common on LEFT b/c of renal vein
thrombosis
(think anti-coagulation causes) or
malignancy
;NO ASSOCIATION WITH STARLING’S FORCES. -
 
SPERMATOCOELE:
dilated efferent duct in the epididymis. -
 
Sperm flagella derived from CENTRIOLE.

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