Adam Shared "Latest to do" - 21 Picmonics
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Cranial Nuclei Placement 450
- Alar plate (dorsal): sensory
- Basal plate (ventral): motor
- Lateral nuclei = sensory (aLar plate)
- —Sulcus limitans—
- Medial nuclei = Motor (basal plate)
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
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
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
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
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
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
- Worrying about consequences of attack
- Behavioral change related to attacks
- Symptoms are the systemic manifestations of fear
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 ⊝
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
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
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'
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
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
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
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
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
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)
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
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)
Structures of the Deep and Superficial Perineal Space; Inguinal Cana Contents
