1. 1st Semester Quick Review Jonathan Abesamis Ross University School of Medicine August 11, 2010

2. Connective Tissue Sheaths of Peripheral Nerves Epineurium – Dense C.T. Perineurium – Flattened Epithelium Blood Nerve Barrier No Basement Membrane Endoneurium – Reticular Fibers

3. Myelin Major Dense Line: Fused Inner Leaflet Intraperiod Line: Fused Outer Leaflet

4. Multiple Sclerosis Episodes of random, multifocal inflammation, edema, and subsequent demyelination of axons in CNS. Each episode may become malignant.

5. Astrocytes Think “End Feet” Scavenges Ions & Metabolic Remnants GlialFibrillar Acidic Protein (GFAP) Unique to Astrocytes

6. Neuron / Nissel Bodies No Nissel Bodies in Axon Transportation Along Axon: Slow  Protein, Actin Intermediate  Mitochondria Fast  Synaptic Vessicles

7. Gastroschisis Newborn Infant with an abdominal wall defect.

8. Neural Tube Defects Think “Failure to Close” Cranial = Anencephaly Cervical/Sacral = Spina Bifida

9. Ectopic Pregnancy Implantation outside uterus. 90% are tubal pregnancies. Eventually hemorrhage results. Implantation in abdominal cavity & ovary are rare.

10. Placenta Previa Implantation in lower segment of uterus. Placenta covers opening. Leads to severe bleeding.

11. Lymphocyte The only leukocyte that can re-enter the bloodstream after entering the connective tissue.

12. Cell Motility / Wound 1st on Site = Neutrophils 2nd on Site = Fibroblasts

13. Integrins Actin Integrins  ECM Heterodimers of α and β subunits. Different combinations of different α and β recognize different ligands.

14. Lamellipodium Actin rearrangements inside the cell to move the cell body. Integrins to attach the cell to the substratum.

15. Epistasis Patient has a certain genotype but the expressed phenotype is partially controlled by another gene. Patient could be AB, but also has hh gene for Fructose Transferase Oh

16. Hemolytic Disease of the Newborn IgG will attack newborn. 2nd Child or Later At Birth of Rh+ Baby At Abortion of Rh+ Fetus By Transfusion By Amniocentesis/ChorionVilli Sampling

17. Amylase Indicative of Acute Pancreatitis

18. γ-Glutamyltransferase (γ-GT) Indicative of Liver Disease

19. AspartateTransaminase (AST) Indicative of Cardiac M.I. Indicative of Liver Trouble

20. AlanineTransaminase (ALT) Indicative of Acute Viral Hepatitis Indicative of Cirrhosis Indicative of Cholestatic Jaundice

21. Lactate Dehydrogenase (LDH) LDH 1 & 2 = Acute M.I. LDH 5 = Acute Hepatitis

22. Therapeutic Plasma Preparations Fresh Frozen Plasma = Liver Cirrhosis Cryoprecipitate = Clotting Disorders Factor VIII Concentrate = Hemophelia A Albumin 5% = Hypovolemic Shock Albumin 25% = Cerebral Edema Immune Serum Globulin = Immune Deficiency Tetanus

23. Electrophoresis: Nephrotic Syndrome Albumin ↑ α2 ↑↑ γ↓

24. Electrophoresis: Liver Cirrhosis Albumin ↑ α2 ↑ γ (IgA) ↑↑ Think “Over Production”

25. Electrophoresis: Immediate Response Albumin ↓ α2 ↑

26. Electrophoresis: Delayed Response Albumin ↓ α2 ↑ γ ↑

27. Blood in Urine Haptoglobin & Hemopexin Prevent loss of hemoglobin & heme groups. Low Plasma Haptoglobin(Hemoglobinuria) Normal Plasma Haptoglobin

28. Acute Phase Proteins Synthesized in Bulk in Response to Infection α1-Antiprotease = Cells Are Dying α2-Antiprotease = Death of Hepatocytes β2-Microglobin = Renal Disease Ceruloplasm = Wilson’s Disease

29. Hyperalbuminemia Dehydration Excessive Stasis During Venepuncture (a.k.a. “Fake Condition”

30. Hypoalbuminemia Think “vasodilation” Albumin↓ α2↑ Proteins in Urine Burns, Renal Disease, G.I. Loss, Hemorrhage

31. Plasma Protein Production With the exception of immunoglobulins (B-lymphocytes) all plasma proteins are synthesized in the liver.

32. Serum vs. Plasma Plasma contains Fibrinogen Allowed to Coagulate

33. PyruvateKinase Deficiency Hemolytic Anemia Enlarged Spleen Abnormal RBS Shape 2,3-BPG ↑ ATP ↓

34. Wrist: Radiocarpal Joint Radius *No Ulna Carpals Scaphoid (RE: Pollex) Lunate Triquetrum *No Pisiform

35. Posterior Dislocation of Elbow May tear Ulnar Collateral Ligament Anterior (Think “diagonal”) Posterior Oblique May damage Ulnar Nerve

36. Glenoid Labrum Fibrocartilage Inferior Aspect of Shoulder Cuff

37. Acromioclavicular Joint Acromioclavicular Coracoacromial Coracoclavicular Ligament Trapezoid Conoid

38. Joints of the Hand Thumb = Saddle Trapezium Metacarpal Phalangeal = Condyloid Palm = Planar Fingers = Hinge

39. Sternoclavicular Joint Interclavicular Anterior Sternoclavicular Costoclavicular

40. Cartilagenous Joints Hyaline = Neck of Femur Fibrocartilage = Intervertebral Discs

41. Hilton’s Law Nerves that supply a joint also supply the muscles moving that joint and the skin overlying their distal attachments.

42. Clara Cells Only in Bronchioles 3 Functions CCSP (Surfactant) & GAGs (Reduce Adhesion) Decrease Inflammatory Response Cytochrome P450 Differentiate into Epithelial Tissue

43. Thymoma Can compress the Right Cephalic Vein

44. Bronichal Veins Venous Drainage of Lungs Bronical Veins Azygous Vein Superior Vena Cava AccesoryHemiazygous/Left Superior Intercostal Vein Pulmonary Veins

45. Bronichial Arteries Blood Supply for Lungs Root of Lung Supporting Tissues Visceral Pleura

46. Thoracocenthesis Remove fluid/pus/blood Location: 9thIntercostal Space Superior to Rib Think “VAN” Midaxillary Line

47. Lymph Drainage of Thorax Superior to Clavical Inferior jugular Lymph Nodes Inferior to Clavical Axillary Lymph Nodes

48. Layers of Thorax Skin Superficial Fascia External Intercostal Muscles Internal Intercostal Muscles Innermost Intercostal Muscles Endothoracic Fascia Parietal Pleura

49. Embryology: Umbilical Veins Left: Persists; Brings 02 From Mother Right: Obliterated 2nd Month of Development

50. Embryology: Vitelline Veins Left: Regresses Right: Forms Hepatic Portion of IVC

51. Embryology: 6 Aortic Arches 1st: Maxillary 2nd: Stapedial 3rd: Common/Internal Right & Left Carotid 4th: Aortic Arch & Right Subclavian 6th: Pulmonary Arteries DuctusArteriosus Think “Head, Head, Neck, Heart, Lungs”

52. Fragile X Syndrome Female: Premutation, 20% Risk for Premature Ovarian Failure Male: Premutation, Unmethylated Risk for FXTAS

53. X-linked Diseases Fragile X Hemophelia Duchenne Muscular Dystrophy Becker’s Muscular Dystrophy (15%) Hypophosphatemia Think “PHEX”

54. DMD Testing CK Levels Stain for Dystrophin Protein PCR & Linkage Analysis

55. OsteogenesisImperfecta Glycine Substitution Collagen Packs Tightly C Terminus worse than N Terminus In Type I: α1 worse than α2 More α1 expressed

56. Embryology: DuctusArteriosus DuctusArteriosus LigamentumArteriosum Think “Left Recurrent Laryngeal N.”

57. AnkylosingSpondylitis Chronic Inflammatory Disease Axial Skeleton Presents as Back Pain Treatment: Supportive/Preventative

58. Tetrology of Fallot VSD Overriding Aorta Pulmonary Stenosis Hypertrophy of RV

59. Hypophosphatemia X-linked ↓PHEX = ↑PTN  ↓NPT2 = ↓Phosphate Autosomal Dominant ↑FGF3  ↓NPT2 = ↓Phosphate Autosomal Recessive ↓NPT2 = ↓Phosphate

60. Hamartomas Altering Tumor Supressors No stimulation; only lack of inhibitor. TSC1 vs. TSC2 TSC2 is more common. Think “HemarTWOmas”

61. Polycystic Kidney Disease Kidney Failure PKD1 vs. PKD2 PKD1 is more common.

62. Autosomal Recessive Diseases Hereditary Hemachromatosis EDS VI & VII Hypophosphatemia (Think “NPT2”) Recessive Dystrophic EB Carcinomas

63. Lung Branching 23 Branch Generations 1-16: Anatomical Dead Space 17-23: Respiratory Zone

64. Familial Hypertrophic Cardiomyopathy MYH7 = β Myosin Heavy Chain TNNT2 = cTnT ??? = Myosin Binding Protein

65. Partitioning of Outflow Tract Aortico Pulmonary Septum Divides; TruncusArteriosus & ConusCordis Into; Aorta & Pulmonary Trunk

66. Differentiation of Heart Tube Think “ABC” TruncusArteriosus BulbusCordis ConusCordis Primitive Ventricle Primitive Atrium Sinus Venosus

67. Primitive Inflow to Heart Vitteline Veins Deoxy from Yolk Sac Cardinal Veins Deoxy from Fetus Umbilical Veins Oxy from Placenta (a.k.a. “mom”)

68. 5 Nerves of Skin Free Nerve Endings (Epidermis) Pain Merkel (Stratum Basale) Touch Meissner’s (Dermal Papilae) Touch Pacinian Pressure Ruffini’s Strech

69. Effect of NO in Smooth Muscle NO  Relax  Increase Blood Flow Arterioles & Metarterioles

70. Marfan Syndrome / Endocarditis Effects Fibrous Skeleton Causes; Mitral/Aortic Valve Prolapse Which leads to; Regurgitation

71. Valve Heart Sounds Think “All Physicians Take Money”

72. Internal Right Atrium Sinus Venarum Smooth CristaTerminalis Ridge Inbetween Pectinate Muscles Rough

73. Typical Intercostal Nerves 3rd – 6th Endothoracic Fascia Near the Angle of the Rib; Between Internal/Innermost Muscles At the Angle of the Rib; Collateral Branches

74. Thoracic Splanchnic Nerves Supply Viscera Inferior to Diaphragm Greater = T5-T9 Think “Heart” Lesser = T10-T11 Least = T12

75. 5 Layers of Skin Stratum Corneum Stratum Lucidum Only in Thick Skin Stratum Granulosum Water Proof Contains Lamellar Granules Stratum Spinosum Last Layer with Mitotic Activity Stratum Basale

76. Selectins in Diapedesis Endothelial Cells P-selectins E-selectins Lymphocytes L-selectins

77. Blood Flow Control Arterioles Smooth Muscle Capillaries Pericytes

78. Fenestrated Capillaries Rapid Exchange Kidney, Intestine, and Endocrine Glands No Diaphragm in Renal Glomerulus

79. Metarterioles Discontinuous Smooth Muscle If any smooth muscle  Metarteriole; not capillary

80. Asthma Constriction of Bronchioles Dyspnea β2 Agonist  Relax

81. BALT Bronchus Associated Lymphoid Tissue Protects Against Infection

82. Steps of Smell Odorant & Receptors Mitral Cells/Glomeruli If Enough; Signal Sent

83. Olfactory Epithelium Pseudostratified Columnar Epithelium Olfactory Receptor Cells Sustentacular Cells Supporting Cells Basal Cells

84. Brody Jenner Syndrome Cilia & Flagella Affected Males Infertile Lack of Dynein

85. Respiratory Epithelium Ciliated Columnar Goblet Cells Brush Cells Sensory Receptors Basal Cells Granular Cells Secrete Bombasin & Seratonin

86. Nasal Cavity Vestibule Stratified Squamous / Vibrissae Respiratory Segment Olfactory Segment

87. Sympathetic Trunk Inside of the Mediastinum Outside of the Pleural Cavity

88. Lung Volume / Respiratory Disease Obstructive Emphysema, Chronic Bronchitis ↓TLC, ↑↑RV, ↑RV/TLC% Restrictive Pulmonary Fibrosis ↓TLC, ↓RV, (normal) RV/TLC%

89. Right Vagus Nerve Right Vagus Nerve Anterior to Subclavian Artery; Right Recurrent Laryngeal Nerve Posterior to Hilum Right Pulmonary Plexus & Esophageal Plexus *Left Vagus passes over arch of aorta.

90. Muscle Fascia Epimysium Entire Muscle Perimysium Bundle Endomysium Myofibril Individual Fiber

91. Classification of Skeletal Muscle Red: Type I Slow Repetitive Posture White: Type IIB Fast Twitch Fingers & Eyes Intermediate: Type IIA

92. Hind Brain Voluntary Movement Cerebellum Initiate Pons Regulate Medulla 4th Ventricle

93. Nerve Regeneration Repaired by proliferation of astrocytes. Astrocytic Scar = Gliosis Anterograde Degeneration Only PNS Only if soma is intact.

94. Layers of Cerebral Cortex Molecular Layer Purkinje Layer Granular Cell Layer

95. Blood Brain Barrier Endothelial Cells and Tight Junctions Pass Freely: O2, H2O, CO2 Active Transport: Glucose, aa, vitamins Cannot Pass: Macromolecules

96. SNPs Single Nucleotide Polymorphism Used to create haplotypes to differentiate between maternal/paternal chromosomes.

97. Purines / Pyrimidines Think “GATTACA” Purines Guanine Adenine Pyrimidines Thymine Cytocine

98. Camptothecin Chemotherapeutic Agent Topoisomerase I Inhibitor Used to Treat Cancer

99. Ciprofloxacin Antibiotic Inhibits Gyrase Activity in Bacteria Think “Topoisomerase II”

100. Doxorubicin / Etoposide Chemotherapeutic Agent Inhibits Topoisomerase Type II Used to Treat Cancer

101. Topoisomerase II / Gyrase 2 Cuts Induces Negative Supercoils Opening DNA instills positive supercoils.

102. Exonuclease vs. Endonuclease Exonuclease Removes nucleotides from a 3’ end of DNA strand. Think “Proofread” Endonuclease Cut inside of a DNA strand to produce single stranded nicks. These nicked ends can be used by Exonucleases

103. Replication Eukaryotes replicate their DNA only in S-phase Think “G1, S, G2, M”

104. Bacteria vs. Eukaryotes SSB / RPA Primase / Polα Pol III Polymerase / Polδ and ε β2 Sliding Clamp (subunit of Pol III) / PCNA 3’ Exonuclease of Pol I / RNaseH and/or FEN1 γ subunit of Pol III / RFC

105. Oligomycin Inhibition of ATP Synthase

106. Km The concentration of substrate at which ½ of the active sites are filled.

107. Inhibitors Competitive Inhibitors Noncompetitive Inhibitors Irreversible Inhibition Covalent Bond Most are toxins

108. Werner’s Syndrome Advanced Aging Telomeres Shorter Than Normal

109. RNA vs. DNA Synthesis NTPs Instead of dNTPs No Primers No Proofreading U instead of T RNA pol

110. Rifampicin Inhibits RNA polymerase in bacterial cells by binding to β-subunit of RNA polymerase (the essential polymerase enzyme). Used to treat TB, Leprosy, MRSA, and bacterial meningitis due to lipophic nature and uniqueness. Adverse effects include hepatotoxicity.

111. Promoters Prokaryotic TATAAT -10 bp Eukaryotic TATA Box -25 bp CAT Box -50 to -100

112. Ribosome Structure Prokaryotes (70S) 50S (23S & 5S) 30S Eurakyotes (80S) 60S (28S, 5.8S, & 5S) 40S