Adam Shared "Latest to do" - 21 Picmonics

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Latest to do

Cranial Nuclei Placement 450
Alar plate (dorsal): sensory
Basal plate (ventral): motor
Lateral nuclei = sensory (aLar plate)
—Sulcus limitans—
Medial nuclei = Motor (basal plate)
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Sleep Physiology 457
Sleep cycle is regulated by the circadian rhythm, which is driven by suprachiasmatic nucleus (SCN) of hypothalamus
Circadian rhythm controls nocturnal release of ACTH, prolactin, melatonin, norepinephrine
SCN causes norepinephrine release causing pineal gland release of melatonin
SCN is regulated by environment (eg, light).
Alcohol, benzodiazepines, barbiturates and norepinephrine are associated with decreased REM sleep and delta wave sleep
Awake (eyes open)
Alert, active mental concentration
Beta (highest frequency, lowest amplitude)
Awake (eyes closed)
Alpha
Non-REM sleep N1 (5%)
Light sleep
Theta
Non-REM sleep N2 (45%)
Deeper sleep; when bruxism (teeth grinding) occurs
Sleep spindles and K complexes
Non-REM N3 (25%)
Deepest non-REM sleep (slow-wave sleep); when sleepwalking, night terrors, and bedwetting occur
Delta (lowest frequency, highest amplitude)
REM sleep (25%)
Loss of motor tone, increased brain O2 use, increased and variable pulse and blood pressure increased ACh
When dreaming, nightmares, and penile/ clitoral tumescence occur; may serve memory processing function
Depression increases total REM sleep but decreases REM latency
Extraocular movements due to activity of PPRF (paramedian pontine reticular formation/ conjugate gaze center)
Occurs every 90 minutes, and duration increases through the night
Beta
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Congenital Cardiac Defect Associations 284
Down syndrome
AV septal defect (endocardial cushion defect), VSD, ASD
Infant of diabetic mother
Transposition of great vessels
Marfan syndrome
MVP, thoracic aortic aneurysm and dissection, aortic regurgitation
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Lymphadenopathy
Enlarged lymph nodes
Lymph node enlargement is due to hyperplasia of particular regions of the lymph node
Follicular hyperplasia (B-cell region) is seen with rheumatoid arthritis and early stages of HIV infection
Paracortex hyperplasia (T-cell region) is seen with viral infections (e.g. infectious mononucleosis)
Hyperplasia of sinus histiocytes is seen in lymph nodes that are draining a tissue with cancer
Painful lymphadenopathy
Draining a region of acute infection (acute lymphadenitis)
Painless lymphadenopathy
Can be seen with chronic inflammation (chronic lymphadenitis); metastatic carcinoma or lymphoma
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Common Causes of Death (US) by Age 45
Listed in order from most likely to third most likely
< 1 Y
Congenital malformations
Preterm birth
SIDS
1–14 Y
Unintentional injury
Cancer
Congenital malformations
15–34 Y
Unintentional injury
Suicide
Homicide
35–44 Y
Unintentional injury
Cancer
Heart disease
45–64 Y
Cancer
Heart disease
Unintentional injury
65+ Y
Heart disease
Cancer
Chronic respiratory disease
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Hospitalized Conditions With Frequent Readmissions 45
Listed in order from most common to third most common
MEDICARE
Congestive HF
Septicemia
Pneumonia
MEDICAID
Mood disorders
Schizophrenia/ psychotic disorders
Diabetes mellitus with complications
PRIVATE INSURANCE
Maintenance of chemotherapy or radiotherapy
Mood disorders
Complications of surgical procedures or medical care
UNINSURED
Mood disorders
Alcohol-related disorders
Diabetes mellitus with complications
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Panic Disorder 517
Defined by recurrent panic attacks (periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following)
Palpitations, Paresthesias, dePersonalization or derealization, Abdominal distress or Nausea, Intense fear of dying
Intense fear of losing control or “going crazy,” lIght-headedness, Chest pain, Chills, Choking, Sweating, Shaking, Shortness of breath
Strong genetic component
Treatment: CBT, SSRIs, and venlafaxine are first line. Benzodiazepines occasionally used in acute setting
Diagnosis requires attack followed by 1 month (or more) of 1 (or more) of the following:
Persistent concern of additional attacks
ƒ Worrying about consequences of attack
Behavioral change related to attacks
Symptoms are the systemic manifestations of fear
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Rate-Determining Enzymes of Metabolic Processes 84
Glycolysis
Phosphofructokinase-1 (PFK-1)
AMP ⊕, fructose-2,6-bisphosphate ⊕ ATP ⊝, citrate ⊝
Gluconeogenesis
Fructose-1,6-bisphosphatase
AMP ⊝, fructose-2,6-bisphosphate ⊝
TCA cycle
Isocitrate dehydrogenase
ADP ⊕ ATP ⊝, NADH ⊝
Glycogenesis
Glycogen synthase
Glucose-6-phosphate ⊕, insulin ⊕, cortisol ⊕ Epinephrine ⊝, glucagon ⊝
Glycogenolysis
Glycogen phosphorylase
Epinephrine ⊕, glucagon ⊕, AMP ⊕ Glucose-6-phosphate ⊝, insulin ⊝, ATP ⊝
HMP shunt
Glucose-6-phosphate dehydrogenase (G6PD)
NADP+ ⊕ NADPH ⊝
De novo pyrimidine synthesis
Carbamoyl phosphate synthetase II
ATP ⊕, PRPP ⊕ UTP ⊝
De novo purine synthesis
Glutamine-phosphoribosylpyrophosphate (PRPP) amidotransferase
AMP ⊝, inosine monophosphate (IMP) ⊝, GMP ⊝
Urea cycle
Carbamoyl phosphate synthetase I
N-acetylglutamate ⊕
Fatty acid synthesis
Acetyl-CoA carboxylase (ACC)
Insulin ⊕, citrate ⊕ Glucagon ⊝, palmitoyl-CoA ⊝
Fatty acid oxidation
Carnitine acyltransferase I
Malonyl-CoA ⊝
Ketogenesis
HMG-CoA synthase
No regulators
Cholesterol synthesis
HMG-CoA reductase
Insulin ⊕, thyroxine ⊕ Glucagon ⊝, cholesterol ⊝
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Disruptive Mood Dysregulation Disorder 527 FA17
Onset before age 10
Severe and recurrent temper outbursts out of proportion to situation
Child is constantly angry and irritable between outbursts
Treatment: psychostimulants, antipsychotics, CBT
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Epithelial Cell Junctions
Tight junction (zonula occludens)
Prevents paracellular movement of solutes; composed of claudins and occludins
Adherens junction (belt desmosome, zonula adherens)
Below tight junction, forms “belt” connecting actin cytoskeletons of adjacent cells with CADherins (Ca2+-dependent adhesion)
Loss of E-cadherin promotes metastasis
Desmosome (spot desmosome, macula adherens)
Structural support via intermediate filament interactions
Autoantibodies causes pemphigus vulgaris
Gap junction
Channel proteins called connexons permit electrical and chemical communication between cells
Hemidesmosome
connects keratin in basal cells to underlying basement membrane
Autoantibodies causes bullous pemphigoid
Integrins—membrane proteins that maintain integrity of basolateral membrane by binding to collagen and laminin in basement membrane
U. and fibronectin
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Global Cerebral Ischemia
Low perfusion (ex- atherosclerosis)
Acute decrease in blood flow (ex - cardiogenic shock)
Chronic hypoxia (ex- anemia)
Repeated episodes of hypoglycemia (ex- insulinoma)
Mild
Transient confusion With prompt recovery
Moderate
Infraction on watershed area (area between anterior and middle cerebral artery)
Damage to vulnerable areas
Pyramidal neruons ( aver 3, 5, 6 of cerebral cortex)
Pyramidal neurons Of hippocampus
Purkinje layer of cerebellum
Severe
Diffuse necrosis; if pt survives, leads to 'vegetative state'
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Disorders of Primary and Secondary Hemostasis
Primary hemostasis
Mucosal bleeding
Epistaxis (most common)
hemoptysis
GI bleeding
Hematuria
Menorrhagia
Intracranial bleeding occurs in severe cases of thrombocytopenia
Skin bleeding
Petechia (1-2mm), usually only seen in quantitative disroders (thrombocytopenia)
Purpura (>3mm)
Ecchymoses (>1cm)
Easy bruising
Secondary hemostasis
Deep tissue bleeding into muscles and joints (hemarthrosis)
Rebleeding after surgical procedures
E.g. circumcision and wisdom teeth extraction
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Prothrombin 20210A and ATIII Deficiency
Prothrombin 20210A
Point mutation in prothrombin gene
Increased prothrombin production
Increased risk of thrombus formation
ATIII Deficiency
Decreases the protective effects of heparin-like molecules produced by endothelium
Increased risk of thrombus formation
Normally heperin-like molecules activate ATIII which inactivates thrombin and coagulation factors
PTT does not rise with standard heparin dosing
Use high dose heparin to activate the limited ATIII and follow up with coumadin
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Monoclonal Gammopathy of Undertermined Significance (MGUS)
Increased serum protein with M spike on SPEP
Other features of multiple myeloma are absent
No Bence Jones proteinuria
Common in elderly (seen in in 5% of 70-year-old individuals)
1% of patients with MGUS develop multiple myeloma each year
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Vocal Cord Nodule (Singer's Nodule), Laryngeal Papilloma, Laryngeal Carcinoma
Vocal Cord Nodule (Singer's Nodule)
Nodule that arises on the true vocal cord
Due to excessive use of vocal cords
Usually bilateral
Composed of degenerative (myxoid) connective tissue
Laryngeal Papilloma
Benign papillary tumor of the vocal cord
Due to HPV 6 and 11
Usually single in adults and multiple in children
Presents with hoarseness
Laryngeal Carcinoma
Squamous cell carcinoma usually arising from the epithelial lining of the vocal cord
Risk facts: alcohol and tobacco, rarely arise from a laryngeal papilloma
Presents with horseness, cough and stridor
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Squamous Cell Carcinoma of the Oral Cavity
malignant neoplasm of squamous cells lining the oral mucosa
Risk factors: tobacco and alcohol
Floor of outh is the most common location
Oral leukoplakia and erythroplakia are precursor lesions
Usually bopsied to rule out carcinoma
Leukoplakia is a white plaque that cannot be scraped away; often represents squamous cell dysplasia
Hairy leukoplakia is a white, rough ('hairy') patch that arises on the lateral tongue
It is usually seen in immunocompromised individuals (e.g. AIDS) and is due to EBV-induced squamous cell hyperplasia
Not pre-malignant
Erythroplakia (red plaque) represents vascularized leukoplakia and is highly suggestive of squamous cell dysplasia
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Vulvar Carcinoma
Carcinoma arising from squamous epithelium lining the vulva
Relatively rare, accounting for only a small percentage of female genital cancers
Presents as leukoplakia; biopsy may be required to distinguish carrcinoma from other causes of leukoplakia
Etiology may be HPV related or non-HPV related
HPv -realted vulvar carcinoma is due to high-risk HPV types 16, 18, 31 and 33
Risk factors are related to HPV exposure
Multiple partners, early first age of intercourse, generally occurs in women of reproductive age
Arises from vulvar intraepithelial neoplasia (VIN), a dysplastic precursor lesion characterized by koilocytic change
Disordered cellular maturation, nuclear atypia and increased mitotic activity
Non-HPV related vulvar carcinoma arises, most often, from long-standing lichen sclerosis
Chronic inflammation and irritation eventually lead to carcinoma
Generally seen in elderly women (average age is > 70 years)
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Lipoma, Liposarcoma, Rhabdomyoma; Rhabomyosarcoma
Lipoma
Benign tumor of adipose tissue
Most common benign soft tissue tumor in adults
Liposarcoma
Malignant tumor of adipose tissue
Most common malignant soft tissue tumor in adults
Lipoblast is the characteristic cell
Rhabdomyoma
Benign tumor of skeletal muscle
Cardiac rhabdomyoma is associated with tuberous sclerosis
Rhabomyosarcoma
Malignant tumor of skeletal muscle
Most common malignant soft tissue tumor in children
Rhabdomyoblast is the characteristic cell; desmin positive
Most common site is the head and neck; vagina is the classic site in young girls
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Myocardial Infarction ECG Changes
ST elevation (STEMI, transmural infarct)
ST depression (NSTEMI, subendocardial infarct)
Hyperacute (peaked) T waves
T-wave inversion
New left bundle branch block
Pathologic Q waves
Poor R wave progression (evolving or old transmural infarct)
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Structures of the Deep and Superficial Perineal Space; Inguinal Cana Contents
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