ThoraxSternum. Flat bone – manubrium, body, xiphoid process.Manubrium. Superior margin jugular notch.Sternal angle.2nd ribs articulate here.Aortic arch begins and end.Trachea bifurcates into R and L bronchi at carina.The inf border of sup mediastinum is demaecated.Xiphoid process.At level of T-10th .Sternum is common site for bone bipsy.Ribs. Increases the anteroposterior and transverse diameter of the thorax by their movement.Tipycal ribs. Are 3 – 9 has head,neck,tubercle,and body.True ribs. 1-7.False ribs. 8-12Floating ribs. 11-12

Thoracic outlet syndrome.Is compression of neurovascular bundle in the thoracic outlet (space b/w clavicle and 1st rib), pressure on the lower trunk by cervical rib and also compress subclavian artery result ischemic muscle pain in upper limb.Rib fractures.1st rib injure the brachial plexus and subclavian vessels.Middle ribs commonly fractures. Broken end causes pneumothorax and lung/spleen injury.Lower rib tear diaphragm- diaphragmatic hernia.1 st rib. Broadest and shoartest. Scalene tubercle –insertion of ant scalene muscle, 2 groove for subclavian artery and veinMediastinumAnt-sternum and transverse thoracic muscle , lat- pleural cavities, post- vertebral column.Superior Mediastinum. Sup- oblique plane of 1st rib. Inf- line from sternal angle to b/w T 4-5.Superior vena cava, brachiocepahlic vein, arch of aorta, thoracic duct, trachea, vagus nerve, left recurrent laryngeal nerve, phrenic nerve. thymus.Anterior Mediastinum.Ant- pericardium. Post- sternum and transverse thoracic muscle.Thymus ,lymph node, fat and connective tissue.Middle Mediastinum.b/w L and R pleural cavities. Heart, pericardium, phrenic nerve, roots of great vessels (aorta, pulmonary arteries and Posterior Mediastinum.Post to pericardium b/w mediastinal pleura.

Esophagus, thoracis aorta, azygos, hemizygous, thoracic duct, vagus, sympathetic trunk, splanchnic nerveTrachea Begin inf border of cricoid cartilage C6.Bifurcation at sternal angle b/w T4-5.12 cm long. 16-20 incomplete rings. May be compressed by aortic arch aneurysm, goiter, thyroid tumor causing dysnea.Carina last tracheal ring separating the opening of Rand L main bronchi. Most sensitive area of tracheobronchial tree- cough reflex.Right main bronchus.Shorter,wider,more vertical- inf lober bronchus may lodged f body.Run under the arch of azygos vein and dived into 3 lobes sup,mid,inf and finally into 10 segmental. The R sup is eparterial – above the level of pulmonary a.Left main bronchus.Run inferior to the arch of aorta, cross ant to esophagus and thoracic aorta divided into 2 lobes.Pleura Parietal pleura.Innervated by intercostals nerves and phrenic – very sensitive to pain.Pulmonary ligament.2 layered vertical fold of mediastinal pleura. It support the lung in pleural sac.Visceral pleura. Respiratory reflexes.Pleural cavity.Costodiaphragmatic recesses. Costomediastinal recess. Rt lung.Larger, heavier, shorter, wider. oblique and horizontal fissure.Grooves for various structures. (SVC,Esophagus,arch of azygos).Lt Lung.Cardiac impression, cardiac notch, groove for aortic arch, descending aorta, Lt subclavian artery.PericardiumFibrous pericardium-blends with roots of great vessels and central tendon of diaphragm.Serous pericardium- parietal and visceral.Pericardial sinuses.1-Transverse sinus. Post- ascending aorta and pulmonary trunk, ant- SVC, sup- left atrium and pulmonary vein.2- Oblique sinus. Behind the heart around the right and left pulmonary vein and IVC.Coronary Arteries.Rt coronary a- ant aortic sinus, run b/w root of pulmonary trunk and Rt auricle, descend in the Rt coronary a.

1- SA nodal a- supply SA node and Rt atrium.2- Marginal a – supply inf margin of Rt ventricle.3- Posterior IV a –larger terminal a and supply IV septum. Lt ventricle and AV node.4- AV nodal a- supply AV node.

Lt Coronary a- Lt aortic sinus of ascending aorta just above the aortic semilunar valve.1- Ant IV a-ant aspect of Rt and Lt ventricle- IV septum and apex.2- Circumflex a-suppply the Lt atrium and Lt ventricle.

Cardiac veins and coronary sinus.1- Coronary sinus- largest vein lies in the coronary sulcus which separates the atria

from ventricle. Open into Rt atrium b/w the opening of IVC and AV opening. 1 cusp valve. Receive great, middle, small cardiac veins.

2-

Bone

Ground substanceProteloglycans. Glycoaminoglycane (Chondroitin sulfate, keratin sulfate). Glycoprotein. Osteonectin, osteocalcin (calcium binding protein).Mineral inorganic component. Hydroxyapatite crystals, citrate ions and carbonate. 75% of the bone mass- hardness/rigidity of bone.Water (tissue fluid). 7%Fibers Type I collagen –tensile strength of bone. Cells Osteoprogenrator cells—Osteoblast—osteogenesis and bone repair – mitosis.1-Osteoblast ------- secrete osteoid is unminerized bone matrix consisting of proteoglycans, glycoprotein, type I collagen.For mineralization occurs Osteoblast secrete osteocalcin and Alk P---- release Ca and PO4.Osteoblast possess PTH and 1,25 (OH2) vit D receptors.Clinical marker for osteogenesis and bone repair--- osteocalcin and Alk P.2-Osteocytes3-Osteoclast Derived from granulocyte-monocyte progenitor cells within the bone marrow.Multinucleated cells resides in shallow depression called howship lacunae.Bone resorption – secrete lysosomal enzymes to digest the proteoglycan of bone matrix.Secrete collagenase to digest type I collagen. Have ruffled border closest to the bone that contain H ATPase and carbonic anhydrase – produced H ions that create acidic environment to digest the mineral component of the bone.Clinical marker for bone resorption – urine hydroxyproline and urine pyridinoline cross- link. Possess calcitonin receptors.Osteogenesis Intramembraneous Ossification. Flat bones of skull.Endochondral ossification. Humerus, femur, tibia and other long bones.Hormonal influence.GH stimulate hepatocytes in liver to produce somatomedin C (insulin – like growth factor) which promote skeletal growth and bone remodeling.PTH acts on Osteoblast-increase bone resorption, elevate blood Ca levels.

CarbohydratesMonosaccharides- aldoses and ketoses.Monosaccharides can be linked by glycosidic bonds.Disaccharides- 2 Monosaccharides, lactose (galactose + glucose), maltose(glucose + glucose) , sucrose (glucose + fructose).Oligosaccharides- 3-12 Monosaccharides.Polysaccharides- more than 12 Monosaccharides.Starch (amylase + amylopectin).

LipidsFatty acidsTriacyglycerolPhospholipids Sphingolipids Steroid Glycolipids vit A,K,D,EEssential fatty acidsLinoleic acid- prostaglandins Linolenic acid

Plasma lipoproteinsChylomicrons – 90% TGV low density lipoprotein- 60% TGLow density lipoprotein- 8% TG - 50% CHigh density lipoprotein-5 % TG

Vitamins

Water soluble

B complex

Energy releasing- thiamine (B1), riboflavin (B2), Niacin (B3), Biotin, Pantothenic acid.Hematopoietic – Folic acid, B12Others – pyridoxine, pyridoxal, pyridoxamine.

Morphology Gram + Gram -Coccus Steptococcus

StaphylococcusNeisseria

Bacillus ClostridiumBacillus Listeria Corynebacteria Mycobacterium

Spiral SpirochetesTreponema

Leptospira Borrelia

Pleomorphic Chlamydia Rickettsia

Lip cleft Germ cells derived from?Cornybacteria diphtheriaClostridiumShigellaDrug inducer p450Endotoxic shockSepsisLamellar bodies are found in Concentration the urine- CCDSomites developed – mesoderm Excretion of drug increased due to increased volume of distribution.Acute respiratory syndrome- surfactant deficiency2 testes produced – 150 millions sperms.Bowen diseases?Common cause of PID- ChlamydiaPolycystic Ovarian diseases- Inc L.HRupture of perineal membrane- urine in scrotumDES – clear cell carcinoma of vaginaH/O recurrent abortion – progesteroneNo fetus and snow storm – 46XXPrenatal chromosomal abnormality - 14-18 weeksThyroglossal duct cyst – above hyoid boneNon disjunction occur – anaphaseRenal blood flow measure – PAHAPartial mole – 69XXhuman menopausal – raised LH, FSH, dec estrogenHalf time of dopamine- 2 min3 smooth muscle layers- stomachNeurulation is the process –primitive streakChronic villous sampling - trisomy of X chromosomeP R bleeding - superior rectal Spermatogenesis – FSH + testosteroneNeck of fibula – common peronealCA cervix metastasized to labia majora- round lig of uterusWhich hormone increases C P L store- insulinPrimordial germ cells- yolk sacWhich supporting ligament of uterus palpable in PR exam- uterosacral lig

Urachal cyst is remnant of- allantois

Different types of transport

Simple diffusion- Facilitated diffusion- carrier mediated.Primary active transportNa/K ATPase.Ca ATPase (Ca pump).H/K ATPase (proton pump).Secondary active transportIf same direction cotransport or symportNa-glucose cotransport in small intestine.Na-K-Cl cotransport in thick ascending limb.If direction are different counter transport or antiportNa-Ca exchangeNa-H exchangeExcitatory neurotransmitterAch, NE, E, dopamine, glutamate, serotonin.Inhibitory neurotransmitterGABA,GlycineThick filament. Myosin – A (mota) 2 haeds and single tail.Thin filamentActin, Tropomyosin, Troponin.Troponin. Complex f 3 globular proteins.Troponin T – for Tropomyosin.Troponin I– for inhibition. Inhibit the interaction of actin and myosin.Troponin C – for Ca. Ca binding protein, when bound to Ca permit acton of actin and myosin.In skeletal muscle Ca bind to troponin C. and in smooth muscles Ca binds to calmodulin.

ANS Preganglionic SNS T1-L3.Preganglionic PSNS S2-S4.Adrenal medulla- synapse directly on chromaffin cells – E -80% and NE- 20%.Adrenergic receptors. Alpha -1 excitation.Alpha -2 inhibition..Beta – 1 excitation.Beta -2 inhibition..Cholinergic receptors.Nicotinic receptors. N – excitation.Muscarinic receptors. M – inhibition in heart M2. and excitatory in smooth muscle and glands M3.

Autonomic centers.MedullaVasomotor center Respiratory center Swallowing,coughing,vomiting center.PonsPneumotaxic centerMidbrainMicturition centerHypothalamusTemperature regulation centerThirst and food intake regulation centerSensory system.

Types of sensory transducerMechanoreceptors Pacinian corpusclesJoint receptorsStretch receptors in musclesHair cells in auditory and vestibular systems. Baroreceptors in carotid sinus

PhotoreceptorsRods and cones of the retina.

ChemoreceptorsOlfactory receptorsTaste receptorsOsmoreceptorsCarotid body o2 receptors

Somatosensory systemTouch, movement ,temperature, painPathways Dorsal column system- fine touch, pressure, two point discrimination, vibration, proprioception. (group two fibers)Anterolateral system. Temperature, pain light touch. (group III and IV fibers)

Somatosensory cortex- sensory homunculus- major areas are SI S II.Pain- nociceptors- free nerve ending- p substances.

Olfaction- receptor cells- they are only to replace themselves.Unmyelinated C fibers, smallest and slowest.Also innervated by V nerve – detect noxious and painful stimuli.Are true neurons. Prepiriform cortex.

Taste Ant 2/3 – fungiform papillae – salty,sweet,umami. CN VII- chorda tympani.Post 1/3 – circumvallate and foliate papillae – sour and bitter.CN IX – Back of throat and epiglottis – CN X.7+9+10 – enter medulla –solitary tract –solitary nucleus– posteromedial nucleus of thalamus– taste cortex.

Motor system

Motor unit. Fine control (muscles of eye) a single motorneuron innervate only a few muscle fibers.Larger movement (postural muscles) a single motorneuron may innervate thousands of muscle fibers.Motorneuron pool – group of motorneurons that innervate fibers within the same muscles.

Muscle sensors.Types of muscle sensors.a. Muscle spindles (groups Ia and II afferents) are arranged in parallel with extrafusl fibers. Detect both static and dynamic changes in muscle length.b. Golgi tendon organs. (groups Ib afferents) are arranged in series with extrafusl fibers. Detect muscle tension.c. Pacinian corpuscles (groups II afferents) are distributed throughout the muscles. Dectec vibration.d. Free nerve ending . (groups III and IV afferents)

Types of muscle fibers.a. Extrafusal fibers. Make up a bulk of muscles.– innervated alpha motorneurons – provide force for muscle contraction.b. Intrafusal fibers. Smaler than extrafusl– innervated gamma motorneurons –encapsulated in sheaths to form muscles spindles.

General type fiber Sensory type fiber Diameter Conducting velocityA- alpha large alpha motor neuron

Ia- muscle spindle afferents.Ib- golgi tendon organs

Largest

Largest

Fastest

Fastest

A – beta touch, pressure

II- 2ndary afferent of muscle spindles, touch and pressure.

Medium Medium

A – gamma motorneuron to muscle spindle infrafusal fiber A – delta touch, pressure,temperature

III- touch, pressure, fast pain, temperature

Medium Medium

B – preganglionic autonomic fibers

Small Medium

C - postganglionic autonomic fibers

Pain, temperature Smallest Slowest

Muscle spindlesDistributed throughout the muscle.Types of intrafusal fibers in muscle spindles1- Nuclear bag fibers - dectect the rate of change in muscle length (fast dynamic change). Innervated by group Ia afferents. Nucleus collected in central bag region. 2- Nuclear chain fibers - dectect static changes in muscle length. Innervated by group II afferents. Nucleus arrange in rows..

Muscles reflexes.

Stretch reflex (myotatic) – knee jerk. Monosynaptic.Muscle stretch –– stimulate group Ia afferent –– synapse on alpha motoneurons in spinalcord – innervate homonymous muscle–– causes contraction in the muscle that wsa stretched. At the same time synergistic muscle are activated and antagonistic muscles are inhibited.Golgi tendon reflex – disynaptic. Opposite and in reverse of stretch reflex.Active muscle contraction stimulate G T O and group II afferent . the group Ib stimulate inhibitory interneuron in spinal cord , these neurons inhibits alpha neurons and relaxed contracted muscle.Flexor withdrawal reflex – polysynaptic. Flexion on ipsilateral and extension on contralateral. Brainstem control of posture.

Motor centers and pathways.Pyramidal tracts corticospinal and cotricobulbar pass through medullary pyramids.Extrapyramidal tract originate in following-Rubrospinal tract– originate in red nucleus and to lateral spinal cord. Stimulation of red nucleus produce stimulation of flexors and inhibition of extensors.

Pontine reticulospinal tract– originates in the nucleus of pons and projects to the ventromedial spinal cord. Stimulatory effects on both extensors and flexors. Predominant on extensors.Medullary reticulospinal tract– originates in medullary reticular formation to the interneuron in the intermediate gray matter. Stimulatory effects on both extensors and flexors. Predominant on extensors.Lateral vestibulospinal tract – originates in Deiters nucleus to the ipsilateral motoneurons and interneurons. stimulation of extensors and inhibition of flexors.Tectospinal tract – originate in sup colliculus to cervical spinal cord. Control of neck muscles.

Cerebellum – central control of movements.Functions of cerebellumVestibulocerebellum – control of balance and eye movements.Pontocerebellum – planning and initiation of movements.Spinocerebellum– synergy control of rate,force,range,and direction of movements.

Layers of cerebellar cortex.Granular layer innermost layers.Purkinje cell layer middle layerMolecular layer – outermost layer.

Connection in the cerebellar cortex.Input to the cerebellar cortex.Climbing fibers– motor learning.Mossy fibers– Vestibulocerebellum Pontocerebellum Spinocerebellum.Output to the cerebellar cortex.Purkinje cells are the only output.- always inhibitory –GABA.

Basal ganglia- striatum, globus pallidus, subthalamic nuclei and substantia nigra. Thalamic outflow to motor cortex – plan and execute smooth movements.

Language – Rt hemisphere- facial expression, intonation, body language, spatial task.Lt hemisphere– language – aphasia.Wernicke area –sensory aphasia– difficulty understanding written and spoken language.Broca area– motor aphasia– speech and written are affected.

Short term memory – synaptic changes.Long term memory– structural changes.

CSF composition. CSF equal blood – Na,Cl,HCO3,osmolarity. CSF greater than blood– Mg cretinine

Temperature regulation. Heat generating mechanisms– respone to cold. a-Thyroid hormone increase metabolic rate and heat production by Na-K-ATPase.

b-Cold activate sympathetic via activation of beta receptors in brown fat, increase metabolic rate and heat production. c. shivering most potent mechanism for increasing heat production. cold activate the shivering respone – posterior hypothalamus– alpha and gamma neurons are activated- contraction of skeletal muscle and heat production.

Heat loss mechanisms– respone to heat.

a-Heat loss by radiation and convection when temp incrs. Ant hypothalamus – incrs temp causes decrs in sympathetic tone to cutenous blood vessels, incrs arterovenous shunt of blood to venous plexus near the surface of skin.shunting of warm blood to skin incrs heat loss. b- haet losss by evaporation – activity of sweat galnds under sym control.

Fever

Pyrogens – incre production of IL- 1in phagocytic cells. IL- 1 act on ant hypothalamus to incrs the production of prostaglandin. Prostaglandin increase the set point temp.

Heat exhaustion – excessive sweating.

Heat stroke – incrs temp.

Arteries – thick walled – extensive elastic tissue and smooth muscles. Under high pressure. Blood in arteries are stressed volume.

Arterioles – high resistance in CVS. Smooth muscle wall innervated by ANS. Alpha-1 receptors are found on arterioles of skin, splanchnic, renal circulation. Beta -2 founds on arterioles of skeletal muscles.

Capillaries – largest total cross sectional area. Thin walled, low pressure, highest proportion of blood, unstressed blood. Alpha-1 receptors.

Velocity of blood flow- V Q/A

Q – blood flow. A- cross-sectional area.

Q P2-P1 / R

Capacitance - distensibility of blood vessels. V/P.Chronotropic – produce changes in heart rate. Dromotropic – produce changes in condution velocity in AV node.SA nod, atria, AV node have PS vagal innervation but ventricles donot. Contractility – is intrinsic ability of cardiac muscles to develop force at a given muscle length called inotropism. Related to intracellular Ca concentration. Can be estimated by ejection fraction = 55%Stroke volume - volume ejected by ventricle on each beat.SV = end- diastolic volume – end systolic volume.Cardiac output = SV x HREjection fraction is fraction of end diastolic volume ejected in each SV.EF= SV/ end- diastolic volume

Special circulation

Autoregulation – blood flow to an organ remain constant over a wide range of perfusion pressure. Heart, brain, kidney. Vasodilation occure.Active hyperemia – blood flow to an organ is proportional to its metabolic activity.Passive hyperemia- blood flow inc to an organ that occurs after period of occlusion.

Myogenic hypothesisVascular smooth muscle contract when it is stretched – vasoconstriction will maintain a constant flow.

Metabolic hypothesis.Tissue supply of o2 is matched to the tissue demand for o2. vasodilator matebolates, CO2, H, K, lactate, adenosine – arteriolar vasodilation inc blood flow , inc O2 demand.

Hormonal control.

Sympathetic innervation of vascular smooth muscles. Inc tone – vasoconstriction. Dec tone – vasodilation.Skin has greatest innervation and coronary, pulmonary and cerebral vessel have little.Vasoactive hormonesHistamine – arteriolar dilation and vaso constriction – local edema. Bradykinin – arteriolar dilation and vaso constriction – local edema.Serotonin – arteriolar constriction – migraine headaches.Prostaglandins Prostacyclin – vasodilator. E series – vasodilators. F series and thromboxane A2– vasoconstrictor.

Respiratory physiologyLung volumes Tidal volume – volume of inspired and expired. Inspiratory reserve volume – volume inspired above tidal volume.Expiratory reserve volume – volume exspired above tidal volume.

Residual volume – volume remain after maximal expiration. Not measured by spirometry.Dead space. Anatomical dead space – volume of conducting airways. 150 ml.Physiologic dead space – functional measurement – does not participate in gas exchange.Ventilation rates Minute ventilation = TV x breath/min.Alveolar ventilation = [TV – dead space] x breath/min.Lung capacities

Inspiratory capacity = TD + IRV.Functional residual capacity = ERV + RV. Volume remaining after tidal volume expired and not measure by spirometry.Vital capacity or forced vital capacity.TV + IRV +ERV Total lung capacity = all four lung volumes. Forced expiratory volumes FEV1 is normally 80% of FVC.COPD FEV1 is dec. while in restrictive lung disease FEV1 is normal or inc.

Muscle of inspiration. Diaphragm is most important muscle. External intercostals and accessory muscles.Muscle of expiration – abdominal muscle and internal intercostals muscles.

Surface tension and surfactantP = 2T/rIn the absence of surfactant small alveoli have tendency to collapse atelectasis.Surfactant – lines alveoli – reduce surface tension – inn compliance – type 2 alveoli. In fetus 35 weeks gestation. Oxygen transport O2 carried in blood in two forms, dissolved and bound to hb.Methemoglobin fe+++ – does not bind o2.Shift to the right When affinity of hb for oxygen is dec.Inc Pco2 or dec pH. Inc temperature.Inc 2,3 DPG concentration.Shift to the leftWhen affinity of hb for oxygen is inc.Dec Pco2 or inc pH. Dec temperature.Dec 2,3 DPG concentration.Causes of hypoxemia and hypoxia.Hypoxemia Dec in arterial Po2.A-a gradient = PAo2 – Pao2

Normal A-a gradient < 10 mm Hg.Hypoxia Dec oxygen delivery to tissues. O2 delivery = CO x O2 content of blood.CO2 transport Form of CO2 in bloodCO2 is produced in tissue and carried to the lungs in venous blood in 3 forms.1- Dissolved CO2 which is free in solution.2- Carbaminohemoglobin bound to Hb.3- HCO3 90%.V/Q Defects V/Q ratio.Ratio of alveolar ventilation to pulmonary blood flow. If frequency, TV, CO are normal the V/Q ratio is 0.8 – resultsPo2 100 mmHg and CO2 40 mm Hg.Control of breathingSensory information (Pco2,lungs stretch, irritants,muscle spindles,tendons and joints) is coordinated in the brain stem.The output of the brainstem controls the respiratory muscles and the breathing cycles.Central control of breathing1-Medullary respiratory center – is located in the reticular formation.a- Dorsal respiratory group – responsible for inspiration and basic rhythm.Input – from vagus and glossopharyngeal nerves. Vagus from peripheral chemoreceptors and mechanoreceptors in the lung. Glossopharyngeal nerves from peripheral chemoreceptors.Output – from dorsal group to via phrenic nerve to the diaphragm.b-Ventral respiratory group – for expiration, only in active process.2- Apneustic center – located in lower pons- stimulates inspiration producing deep and prolonged Inspiratory gasp.3- Pneumotaxic center- located in lower pons – inhibits inspiration regulates Inspiratory volume and respiratory rate.Chemoreceptors for Co2,H and o21- Central chemoreceptors in the medulla – sensitive to the pH of CSF. Dec pH of CSF inc in breathing rate.H does not cross the BBB as well as co2 do.2- Peripheral chemoreceptors in the carotid and aortic bodiesa- Dec in arterial Po2- stimulate the peripheral chemoreceptors and inc breathing rate. Po2 must dec to low level < 60 mm Hg.b- inc arterial Pco2 – response is greater in central chemoreceptors.c- inc in arterial H – In metabolic acidosis H is inc and hyperventilation occurs.

1- Lung stretch receptors- located in smooth muscles of the airways. When these receptors are stimulated by distention of the lungs, they produced reflex dec in breathing frequency. Hering – Breuer reflex.2- Irritant receptors 3- J juxtacapillary receptors – are located in alveolar walls close to the capillaries. Engorgement of the pulmonary capillaries LHF , stimulates the J receptor , rapid shallow breathing.4- joint and muscle receptors – activated during exercise.

Types of chemoreceptors Location Stimuli inc the breathing rCentral Medulla Dec pH inc Pco2Peripheral Carotid & aortic bodies Dec Po2, inc Pco2, dec

pH

Body fluids TBW – 60% of body weight. Highest in newborn and adults. ICF – 2/3 of TBW. Major cations are K & Mg. Major anion are proteins & organic phosphate.ECF – 1/3 of TBW. Composed of interstitial fluid and plasma. Major cations are Na. Major anion are Cl & HCO3.a- plasma is ¼ of ECF.1/12 of TWB. Major plasma protein are albumin & globulin.b- interstitial fluid is ¾ of ECF.1/4 of TBW.60%-40%-20% rule- TBW-ICF-ECF.TWB – Tritiated water.ECF – Mannitol, inulin.Plasma – Evans blue.Interstitial and ICF – indirectly.RBF – 25% cardiac output. Vasoconstriction of the renal arterioles – dec in RBF- produced by activation of SNS and angiotension II. Vasodilatation of renal arterioles – inc in RBF, produced by prostaglandin E2 and I2,bradykinins,nitric oxide, dopamine.Autoregulation – 80-200 mmHg. Measurement of RBF – PAH.GFR – inulinEstimate of GFR with blood urea nitrogen and serum creatinine.. Both BUN and creatinine inc when GFR dec.Filtration fraction– GFR/RPF = 0.20. 20% of the RPF is filtered.Na transport Proximal tubules – reabsorb 2/3 or 70% of Na & H2O. Site of glomerulotubular balance. Cotransport - with HCO3, glucose, amino acid, phosphate and lactate. Countertransport – Na-H exchange.Carbonic anhydrase inhibitors – inhibit the reabsorption of HCO3.

Thick ascending limb of loop of Henle- 25% of Na. Na-K-Cl cotransporter. Site of action of loop diuretics which inhibits Na-K-Cl cotransporter. Impermeable to H2O. diluting segment.Distal tubules and collecting duct – reabsorb 8% of Na.Early distal tubule – reabsorb NaCl by Na-Cl cotransporter– thiazide diuretics.Impermeable to H2O – cortical diluting segment.Late distal tubules and collecting duct Two cell types – Principal cells- reabsorbs Na & H2O and secrete K. Aldosterone inc Na reabsorption and inc K secretion.ADH inc H2O permeability.Spironolactone – antagonist of aldosterone.Alpha intercalated – secrete H and reabsorbe K.Phosphate. 85 % is reabsorbe in PT Na-phosphate Cotransport. PTH inhibits phosphate reabsorption-phosphouria. Is a urinary buffer for H excretion.Calcium – PT & Thick Ascending Limb. Furosemide – treatment for hypercalcemia. PTH – inc reabsorption – thiazides treatment of idiopathic hypercalciuriaMagnesium - PT & Thick Ascending Limb. In TAL – Mg & Ca compete for reabsorption.Acid base balance Acid production- volatile acid and nonvolatile acid.Volatile acid – CO2 – produced by aerobic metabolism of cells. CO2 + H2O = H2CO3 = H + HCO3Carbonic anhydrase present in all cells.Non volatile acid – fixed acid – sulfuric acid (product of protein catabolism), phosphoric acid (phospholipids catabolism). Others are ketoacid, lacticacid, salicylic acid.Buffer – prevent a change in pH when H ion are added or removed from a solution. Extracellular buffers – major extracellular buffer – HCO3. phosphate minor extracellular buffer is a most important urinary buffer.Intracellular buffer – organic phosphate, proteins, Hb is major intracellular buffer.Excretion of fixed H – in 2 forms – excretion of titratable acid & as NH4.Hyperkalimia inhibits the NH3 synthesis.Metabolic acidosis – overproduction of fixed acid & loss of bases – a-inc arterial H (acidemia). b-HCO3 is used to buffer the extra fixed acid- arterial HCO3 dec. primary disturbance. c- academia – hyperventilation – respiratory compensation. d. correction of metabolic acidosis – inc excretion of fixed H. e- serum anion gap – [Na]-[Cl]+[HCO3] – unmeasured anion – phosphate, citrate, sulfate, protein. 12 mEq/L.

In metabolic acidosis HCO3 replaced by unmeasured anion- Cl. 1- Anion gap in inc – if concentration of unmeasured anion is inc to replace HCO3.2- Anion gap is normal – if concentration of Cl is inc to replace HCO3. hyperchoremic metabolic acidosis.Metabolic alkalosis Loss of fixed acid or gain of base – dec in arterial H (alkalemia). Arterial HCO3 inc. alkalemia cause hypoventilation – respiratory compensation for metabolic alkalosis.Correction of metabolic alkalosis – inc excretion of HCO3 because filter load is inc.Respiratory acidosis – dec in respiratory rate & retention of CO2. inc arterial PCO2 – inc H & HCO3.

Disorders CO2+H2O H HCO3 Res comp Renal compMetabolic acidosis Dec Inc Dec Hyperventilation Metabolic alkalosis Inc Dec Inc HypoventilationRespiratory acidosis Inc Inc Inc None Inc H

excretion , inc HCO3 reabsorption

Respiratory alkalosis dec Dec Dec dec H excretion , dec HCO3 reabsorption

GIT physiologyEpithelial cells Muscularis mucosa Cicular muscleLongitudinal muscle Submucosal plexus. It is formed by branches that have perforated the circular muscular fibers.Myenteric plexus (Auerbach's plexus) of nerves and ganglia situated between the circular muscular fibers and the longitudinal muscle fibers of the muscularis externa.The vagus innervates E ,S,P,upper large intestine. And pelvic nerve innervate lower large intestine,rectum,anus.Extrinsic – SNS & PSNS.Intrinsic – (enteric nervous system).Myenteric plexus – primary control the motility of GI smooth muscles.Submucosal plexus- primary control secretion and blood flow.GI hormones – 4 official GI hormones.Gastrin, CCK, secretin, GIP.GI secretions

Salivary secretions. Function of saliva- initial starch digestion by amylase & initial triglyceride digestion.High volume, high K & HCO3, low Na & Cl, hypotonicity, presence of amylase, lingual lipase, kallikreinGastric secretion-Parietal Chief G cells. .

Info: Cranial Nerves (CN) 1. Shortest CN - Olfactory 2.Longest CN - Vagus3.Largest CN - Trigeminal4.Thickest CN - Optic5.Longest Intracranial Course - Trochlear6.Longest Intradural Course - Abducent7.Longest Intraosseous Course - Facial8.Thinnest CN – Trochlear

Main features of cerebellum3 lobes – anterior, posterior, floculonodular.2 hemisphere – vermis, intermediate, lateral zones. 3 functional regions – vestibule cerebellum, spino cerebellum (vermis + intermediate zone), cerebro cerebellum (lateral zone).3 pairs of peduncles – inferior, medial, superior.Superficial grey matter (cerebellar cortex), internal white matter, 3 pairs of deep nuclei (fastigial, interposed, dentate).Major Afferents – climbing fibers from inf olive, and mossy fibers from many brainstem and spinal cord nuclei.Inf cerebellar peduncle – post spino cerebellar tractBasement membrane – consist of IV type collagen, glycoprotein, Proteloglycans & reticular lamina.Cell junctions allow cells to adhere. There are 3 types of cell junctions:

Anchoring junctions (Adherens junctions, Desmosomes and Hemidesmosomes), which transmit stress through tethering to cytoskeleton are cell–cell or cell–matrix

Occluding Junctions (Tight junctions), which seal gaps between cells, making an impermeable barrier

Channel forming junctions (Gap junctions and plasmodesmata), which links cytoplasm of adjacent cells.

Microvilli – core of actin microfilament & function to increase absorptive surface area of epithelial cell. Columnar epithelium of small & large intestine, PTC of kidneys, columnar epithelium of respiratory tract.

Stereocilia - long, branched microvilli- epididymis.

Cilia – 9 peripheral pairs of microtubules & 2 central microtubules- ATPase dynein- pseudostratified ciliated columnar respiratory cell& tail of sperm.

Epithelium Simple Squamous epithelium – blood vessels, mesothelium & inside renal glomerular capsule. Stratified Squamous epithelium – oral cavity, pharynx, esophagus (non keratinized) & in skin (keratinized). Simple columnar epithelium – small & large intestine. Pseudostratified columnar epithelium – nasal cavity, trachea, bronchi, epididymis. Simple cuboidal epithelium – renal tubules, secretory cells of salivary glands acini. Stratified cuboidal epithelium – ducts of salivary glands. Transitional epithelium – ureter & bladder.

Glands have 8 types – 1- Endocrine

2- Exocrine has 3 groups Apocrine portion of secreting cell body is lost during secretion- sweat gland. Holocrine - the entire cell disintegrates to secrete its substances (e.g., sebaceous glands). Merocrine - cells secrete their substances by exocytosis (e.g., mucous and serous glands). Also called "eccrine". Serous - secrete a watery, often protein-rich product. Mucous – secrete a viscous product, rich in carbohydrates (e.g., glycoproteins). Sebaceous glands — secrete a lipid product. Unicellular glands- goblet cells in respiratory & GI epithelium. Multicellular –may be endocrine or exocrine. Connective tissue – 4 special CT- adipose tissue, bone, cartilage, bone marrow. Support cells, guest cells, ground substance (ECM). Support cells – fibroblast – produce collagen – resistance to injury.

Myofibroblast – actin & myosin – ability to contract. Chondroblast & chondrocytes – produce type II collagen. Osteoblast & Osteocytes – produce type I collagen. Adipocytes.

Permanent guest cells – macrophage & mast cell. Transient cells – migrate into CT from blood. ECM – fibrillar protein – collagen, elastin, fibrillin, fibronectin.

Type I collagen – skin, bone, ligament, tendon, cornea. Type II – cartilage, intervertebral disc & vitreous body of eye.

Type III – blood vessels, Type IV- basal lamina.

Glycoaminoglycans – Hyaluronic acid, Chondroitin sulfate, dermatan sulfate, keratin sulfate, heparin sulfate.

Glycoprotein – Laminin, Entactin, Tenascin.

Cartilage- 3 types .

Hyaline – template for bone formation – rich in Hyaluronic acid, Chondroitin sulfate, and keratin sulfate- good shock absorber.

Elastic – greater flexibility – external ear, auditory canal, epiglottis of larynx. Fibrocartilage – greater resistance to being stretched (tensile strength) - intervertebral disc, menisci of knee, attachment of ligament& tendons,

Bipolar neurons have two processes extending from the cell body - retinal cells, olfactory epithelium cells. Pseudounipolar cells - dorsal root ganglion cells- Actually, these cells have 2 axons rather than an axon and dendrite. One axon extends centrally toward the spinal cord, the other axon extends toward the skin or muscle. Multipolar neurons have many processes that extend from the cell body. However, each neuron has only one axon - spinal motor neurons, pyramidal neurons, Purkinje cells. Lymphatic vessels are not found- CNS, cartilage, bone, bone marrow, thymus, placenta, cornea, teeth, fingernail.

The lymph node, MALT, spleen act as a filter. Lymph nodes- cortex & medulla- outer cortex – germinal centers –B cells

proliferating. Inner are paracortex - T cells proliferating. Spleen – red pulp – filet & clear damage & aging RBCs. White

pulp – collection of antigens from the blood stream. Pulmonary epithelium – metabolic transformation of lipoprotein &

prostaglandin, conversion of angiotension I to angiotension II.

GIT – 4 layers – mucosa- has 3 components. Epithelium, Lamina propria – GALT- IgA. Muscularis mucosa. Submucosa – house of larger blood vessels & mucus secreting glands. Muscularis externa – 2 layers of muscles – inner circular & outer longitudinal.

Serosa - mesentery – blood & lymphatic vessels. Celiac disease- small intestinal villi- autoimmune disease – gluten

sensitivity. DIC – consumption of both platelets & clotting factors. PT measure –Factor I (fibrinogen), II,V,VII,X. platelet count, fibrinogen level, fibrin degradation products. Normal platelets count – 150,000- 450,000. 15,000-20,000 – bleeding occurs. Carcinoid tumors- secret a variety of bioactive substances- GI peptides (gastrin, insulin,VIP,glucagon) & others peptides ATCH, calcitonin, bioactive amines 5,HT. Urinary 5-HIAA is diagnostic test.

Wolffian ducts to internal organ need – testosterone but differentiation of indifferent organs need dihydrotestosterone.

Most common cause of infection involving catheter & prosthetic devices – stap epidermidis.

Xeroderma pigmentosa – extreme sensitivity to sunlight & inc predisposition to skin cancers. Lysogeny – state of stable association of bacterial & viral DNA.COBEDS (cholera toxin,O antigen of salmonella,botulinum toxin,erythrogenic exotoxin strep pyogen, diphtheria, shiga). Trinucleotide repeat with CAG Huntington disease – CAG

Fragile syndrome- CGG Myotonic dystrophy- CTG Septic shock – serous complication of gram- negative infections-

endotoxin LPS – Lipid A is toxic component of LPS. Stimulate of macrophage to secrete large amount of IL-1,IL-6 & TNF alpha.

Important chemotactic factor- C5a & IL-8

Menopause estrogen – estrone-endometrial hyperplasia- endometrial cancer. VEGF – proangiogenic growth that inc endothelial cell proliferation.

Factors that strength the gastric musocal barrier- mucus,gastrin,prostaglandins. Factors that weaken the gastric mucosa- bile salt,aspirin,NSAID,ethanol,H pylori. Force vital capacity – total lung capacity + residual volume. TBW=ICF+ECF

ECF=plasma +ISF TBW=ICF+(plasma +ISF)

Adding resistance lowers the resistance & removing the resistance inc total resistance. VWF- present in serum & subendothelial basal lamina which has binding site for collagen, platelets, fibrin.

Pain referred from epigastric region – greater splanchnic nerve. In case of gas gangrene cause of death- toxemia. Cushing reflex.

Unconjugated bile is carried by – albumin. Corynebacterium – club shaped.

CD- cluster of differentiation.

Perforation of duodenum- Gastroduodenal a. Calcium stone- loop diuretic.

Cycticercosis – taenia solium. Most radiosensitive tumor- seminoma. Germinal follicle are present in – cortex of thymus.

In resting stage actin is in contact with – tropomyosin. Adult derivates of ventral mesentery – greater omentum & falciform lig.

Synarthrotic joint – have little or no movement.Syn –together. Synostosis –osseous connection b/w bones. Amphiarthrotic joint- slightly movements.Amphi-surrounding. In form of lig-syndesmosis, Fibrocartilage – symphysis. Diarthrotic joint – most mobile. Di – separate.

Pollicis – thumb, pronate – bent forward, teres round. Ancon – elbow. Indicis – pointer finger. Scalene – uneven. Spelinus – bandage.