Thorax

Sternum. 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 bronchi at carina. The inf border of sup mediastinum is demaecated. Xiphoid process. At le!el of T"#$th . Sternum is common site for bone bipsy. Ribs. %ncreases the anteroposterior and trans!erse diameter of the thorax by their mo!ement. Tipycal ribs. Are & ' has head,nec(,tubercle,and body. True ribs. #"). False ribs. *"#2 Floating ribs. ##"#2 Thoracic outlet syndrome. %s compression of neuro!ascular bundle in the thoracic outlet +space b,- cla!icle and #st rib., pressure on the lo-er trun( by cer!ical rib and also compress subcla!ian artery result ischemic muscle pain in upper limb. Rib fractures. 1st rib injure the brachial plexus and subcla!ian !essels. /iddle ribs commonly fractures. 0ro(en end causes pneumothorax and lung,spleen injury. o-er rib tear diaphragm" diaphragmatic hernia. st 1 rib. 0roadest and shoartest. Scalene tubercle insertion of ant scalene muscle, 2 groo!e for subcla!ian artery and !ein Mediastinum Ant"sternum and trans!erse thoracic muscle , lat" pleural ca!ities, post" !ertebral column. Superior Mediastinum. Sup" obli1ue plane of #st rib. %nf" line from sternal angle to b,T 2"3. Superior !ena ca!a, brachiocepahlic !ein, arch of aorta, thoracic duct, trachea, !agus ner!e, left recurrent laryngeal ner!e, phrenic ner!e. thymus. Anterior Mediastinum. Ant" pericardium. 4ost" sternum and trans!erse thoracic muscle. Thymus ,lymph node, fat and connecti!e tissue. Middle Mediastinum. b,- and R pleural ca!ities. 5eart, pericardium, phrenic ner!e, roots of great !essels +aorta, pulmonary arteries and Posterior Mediastinum. 4ost to pericardium b,- mediastinal pleura.

6sophagus, thoracis aorta, a7ygos, hemi7ygous, thoracic duct, !agus, sympathetic trun(, splanchnic ner!e Trachea 0egin inf border of cricoid cartilage 89.0ifurcation at sternal angle b,- T2"3. #2 cm long. #9"2$ incomplete rings. /ay be compressed by aortic arch aneurysm, goiter, thyroid tumor causing dysnea. 8arina last tracheal ring separating the opening of Rand main bronchi. /ost sensiti!e area of tracheobronchial tree" cough reflex. Right main bronchus. Shorter,-ider,more !ertical" inf lober bronchus may lodged f body. Run under the arch of a7ygos !ein and di!ed into & lobes sup,mid,inf and finally into #$ segmental. The R sup is eparterial abo!e the le!el of pulmonary a. Left main bronchus. Run inferior to the arch of aorta, cross ant to esophagus and thoracic aorta di!ided into 2 lobes. Pleura 4arietal pleura.%nner!ated by intercostals ner!es and phrenic !ery sensiti!e to pain. 4ulmonary ligament.2 layered !ertical fold of mediastinal pleura. %t support the lung in pleural sac. :isceral pleura. Respiratory reflexes. Pleural cavity. 8ostodiaphragmatic recesses. 8ostomediastinal recess. Rt lung. arger, hea!ier, shorter, -ider. obli1ue and hori7ontal fissure. ;roo!es for !arious structures. +S:8,6sophagus,arch of a7ygos.. Lt Lung. 8ardiac impression, cardiac notch, groo!e for aortic arch, descending aorta, t subcla!ian artery. Pericardium Fibrous pericardium"blends -ith roots of great !essels and central tendon of diaphragm. Serous pericardium" parietal and !isceral. Pericardial sinuses. #"Trans!erse sinus. 4ost" ascending aorta and pulmonary trun(, ant" S:8, sup" left atrium and pulmonary !ein. 2" <bli1ue sinus. 0ehind the heart around the right and left pulmonary !ein and %:8. oronary Arteries. Rt coronary a" ant aortic sinus, run b,- root of pulmonary trun( and Rt auricle, descend in the Rt coronary a. #" SA nodal a" supply SA node and Rt atrium. 2" /arginal a supply inf margin of Rt !entricle. &" 4osterior %: a larger terminal a and supply %: septum. t !entricle and A: node. 2" A: nodal a" supply A: node. Lt oronary a! t aortic sinus of ascending aorta just abo!e the aortic semilunar !al!e. #" Ant %: a"ant aspect of Rt and t !entricle" %: septum and apex. 2" 8ircumflex a"suppply the t atrium and t !entricle.

ardiac veins and coronary sinus. #" 8oronary sinus" largest !ein lies in the coronary sulcus -hich separates the atria from !entricle. <pen into Rt atrium b,- the opening of %:8 and A: opening. # cusp !al!e. Recei!e great, middle, small cardiac !eins. 2"

"one #round substance Proteloglycans. ;lycoaminoglycane +8hondroitin sulfate, (eratin sulfate.. Glycoprotein. <steonectin, osteocalcin +calcium binding protein.. Mineral inorganic component. 5ydroxyapatite crystals, citrate ions and carbonate. )3= of the bone mass" hardness,rigidity of bone. >ater +tissue fluid.. )= $ibers Type % collagen tensile strength of bone. ells Osteoprogenrator cells?<steoblast?osteogenesis and bone repair mitosis. 1!%steoblast -!!!!!! secrete osteoid is unmineri7ed bone matrix consisting of proteoglycans, glycoprotein, type % collagen. For minerali7ation occurs <steoblast secrete osteocalcin and Al( 4"""" release 8a and 4<2. <steoblast possess 4T5 and #,23 +<52. !it @ receptors. Clinical marker for osteogenesis and bone repair""" osteocalcin and Al( 4. &!%steocytes '!%steoclast @eri!ed from granulocyte"monocyte progenitor cells -ithin the bone marro-. /ultinucleated cells resides in shallo- depression called ho-ship lacunae. 0one resorption secrete lysosomal en7ymes to digest the proteoglycan of bone matrix. Secrete collagenase to digest type % collagen. 5a!e ruffled border closest to the bone that contain 5 AT4ase and carbonic anhydrase produced 5 ions that create acidic en!ironment to digest the mineral component of the bone. 8linical mar(er for bone resorption urine hydroxyproline and urine pyridinoline cross" lin(. 4ossess calcitonin receptors. %steogenesis Intramembraneous Ossification. Flat bones of s(ull. Endochondral ossification. 5umerus, femur, tibia and other long bones. 5ormonal influence. ;5 stimulate hepatocytes in li!er to produce somatomedin 8 +insulin li(e gro-th factor. -hich promote s(eletal gro-th and bone remodeling. 4T5 acts on <steoblast"increase bone resorption, ele!ate blood 8a le!els.

arbohydrates /onosaccharides" aldoses and (etoses. /onosaccharides can be lin(ed by glycosidic bonds. @isaccharides" 2 /onosaccharides, lactose +galactose A glucose., maltose+glucose A glucose. , sucrose +glucose A fructose.. <ligosaccharides" &"#2 /onosaccharides. 4olysaccharides" more than #2 /onosaccharides. Starch +amylase A amylopectin.. Lipids Fatty acids Triacyglycerol 4hospholipids Sphingolipids Steroid ;lycolipids !it A,B,@,6 6ssential fatty acids inoleic acid" prostaglandins inolenic acid Plasma lipoproteins 8hylomicrons '$= T; : lo- density lipoprotein" 9$= T; o- density lipoprotein" *= T; " 3$= 8 5igh density lipoprotein"3 = T; (itamins )ater soluble B comple *nergy releasing! thiamine +0#., ribofla!in +02., Ciacin +0&., 0iotin, 4antothenic acid. +ematopoietic , $olic acid- "1& %thers pyridoxine, pyridoxal, pyridoxamine. /orphology 8occus 0acillus ;ram A Steptococcus Staphylococcus 8lostridium 0acillus isteria 8orynebacteria /ycobacterium ;ram " Ceisseria

Spiral

Spirochetes Treponema

4leomorphic

eptospira 0orrelia 8hlamydia Ric(ettsia

ip cleft ;erm cells deri!ed fromD 8ornybacteria diphtheria 8lostridium Shigella @rug inducer p23$ 6ndotoxic shoc( Sepsis amellar bodies are found in 8oncentration the urine" 88@ Somites de!eloped mesoderm 6xcretion of drug increased due to increased !olume of distribution. Acute respiratory syndrome" surfactant deficiency 2 testes produced #3$ millions sperms. 0o-en diseasesD 8ommon cause of 4%@" 8hlamydia 4olycystic <!arian diseases" %nc .5 Rupture of perineal membrane" urine in scrotum @6S clear cell carcinoma of !agina 5,< recurrent abortion progesterone Co fetus and sno- storm 29EE 4renatal chromosomal abnormality " #2"#* -ee(s Thyroglossal duct cyst abo!e hyoid bone Con disjunction occur anaphase Renal blood flo- measure 4A5A 4artial mole 9'EE human menopausal raised 5, FS5, dec estrogen 5alf time of dopamine" 2 min & smooth muscle layers" stomach Ceurulation is the process primiti!e strea( 8hronic !illous sampling " trisomy of E chromosome 4 R bleeding " superior rectal Spermatogenesis FS5 A testosterone Cec( of fibula common peroneal 8A cer!ix metastasi7ed to labia majora" round lig of uterus >hich hormone increases 8 4 store" insulin 4rimordial germ cells" yol( sac >hich supporting ligament of uterus palpable in 4R exam" uterosacral lig

Frachal cyst is remnant of" allantois @ifferent types of transport Simple diffusion" Facilitated diffusion" carrier mediated. 4rimary acti!e transport Ca,B AT4ase. 8a AT4ase +8a pump.. 5,B AT4ase +proton pump.. Secondary acti!e transport %f same direction cotransport or symport Ca"glucose cotransport in small intestine. Ca"B"8l cotransport in thic( ascending limb. %f direction are different counter transport or antiport Ca"8a exchange Ca"5 exchange 6xcitatory neurotransmitter Ach, C6, 6, dopamine, glutamate, serotonin. %nhibitory neurotransmitter ;A0A,;lycine Thic. filament. /yosin A +mota. 2 haeds and single tail. Thin filament Actin, Tropomyosin, Troponin. Troponin. 8omplex f & globular proteins. Troponin T for Tropomyosin. Troponin % for inhibition. %nhibit the interaction of actin and myosin. Troponin 8 for 8a. 8a binding protein, -hen bound to 8a permit acton of actin and myosin. %n s(eletal muscle 8a bind to troponin 8. and in smooth muscles 8a binds to calmodulin. A/S 4reganglionic SCS T#" &. 4reganglionic 4SCS S2"S2. Adrenal medulla" synapse directly on chromaffin cells 6 "*$= and C6" 2$=. Adrenergic receptors. Alpha "# excitation. Alpha "2 inhibition.. 0eta # excitation. 0eta "2 inhibition.. 8holinergic receptors. Cicotinic receptors. C excitation. /uscarinic receptors. / inhibition in heart /2. and excitatory in smooth muscle and glands /&.

Autonomic centers. Medulla :asomotor center Respiratory center S-allo-ing,coughing,!omiting center. Pons 4neumotaxic center Midbrain /icturition center 5ypothalamus Temperature regulation center Thirst and food inta(e regulation center Sensory system. Types of sensory transducer Mechanoreceptors 4acinian corpuscles Goint receptors Stretch receptors in muscles 5air cells in auditory and !estibular systems. 0aroreceptors in carotid sinus Photoreceptors Rods and cones of the retina. hemoreceptors <lfactory receptors Taste receptors <smoreceptors 8arotid body o2 receptors Somatosensory system Touch, mo!ement ,temperature, pain Path0ays @orsal column system" fine touch, pressure, t-o point discrimination, !ibration, proprioception. +group t-o fibers. Anterolateral system. Temperature, pain light touch. +group %%% and %: fibers. Somatosensory corte1" sensory homunculus" major areas are S% S %%. Pain" nociceptors" free ner!e ending" p substances. %lfaction" receptor cells" they are only to replace themsel!es. Fnmyelinated 8 fibers, smallest and slo-est. Also inner!ated by : ner!e detect noxious and painful stimuli. Are true neurons. 4repiriform cortex.

Taste Ant 2,& fungiform papillae salty,s-eet,umami. 8C :%%" chorda tympani. 4ost #,& circum!allate and foliate papillae sour and bitter.8C %E 0ac( of throat and epiglottis 8C E. )A'A#$ enter medulla solitary tract solitary nucleus posteromedial nucleus of thalamus taste cortex. Motor system /otor unit. Fine control +muscles of eye. a single motorneuron inner!ate only a fe- muscle fibers. arger mo!ement +postural muscles. a single motorneuron may inner!ate thousands of muscle fibers. /otorneuron pool group of motorneurons that inner!ate fibers -ithin the same muscles. /uscle sensors. Types of muscle sensors. a. /uscle spindles +groups %a and %% afferents. are arranged in parallel -ith extrafusl fibers. @etect both static and dynamic changes in muscle length. b. ;olgi tendon organs. +groups %b afferents. are arranged in series -ith extrafusl fibers. @etect muscle tension. c. 4acinian corpuscles +groups %% afferents. are distributed throughout the muscles. @ectec !ibration. d. Free ner!e ending . +groups %%% and %: afferents. Types of muscle fibers. a. 6xtrafusal fibers. /a(e up a bul( of muscles. inner!ated alpha motorneurons pro!ide force for muscle contraction. b. %ntrafusal fibers. Smaler than extrafusl inner!ated gamma motorneurons encapsulated in sheaths to form muscles spindles.

;eneral type fiber A" alpha large alpha motor neuron

Sensory type fiber %a" muscle spindle afferents. %b" golgi tendon organs

@iameter argest argest

8onducting !elocity Fastest Fastest

A beta touch, pressure

%%" 2ndary afferent of muscle spindles, touch and pressure.

/edium

/edium

A gamma motorneuron to muscle spindle infrafusal fiber A delta touch, %%%" touch, pressure, pressure,temperature fast pain, temperature 0 preganglionic autonomic fibers 8 " postganglionic 4ain, temperature autonomic fibers

/edium Small Smallest

/edium /edium Slo-est

Muscle spindles @istributed throughout the muscle. !ypes of intrafusal fibers in muscle spindles #" Cuclear bag fibers " dectect the rate of change in muscle length +fast dynamic change.. %nner!ated by group %a afferents. Cucleus collected in central bag region. 2" Cuclear chain fibers " dectect static changes in muscle length. %nner!ated by group %% afferents. Cucleus arrange in ro-s.. Muscles refle1es. "tretch refle #myotatic. (nee jer(. /onosynaptic. /uscle stretch stimulate group %a afferent synapse on alpha motoneurons in spinalcord inner!ate homonymous muscle causes contraction in the muscle that -sa stretched. At the same time synergistic muscle are acti!ated and antagonistic muscles are inhibited. Golgi tendon refle disynaptic. <pposite and in re!erse of stretch reflex. Acti!e muscle contraction stimulate ; T < and group %% afferent . the group %b stimulate inhibitory interneuron in spinal cord , these neurons inhibits alpha neurons and relaxed contracted muscle. $le or %ithdra%al refle polysynaptic. Flexion on ipsilateral and extension on contralateral. "rainstem control of posture. Motor centers and path%ays. 4yramidal tracts corticospinal and cotricobulbar pass through medullary pyramids. E trapyramidal tract originate in follo%ingRubrospinal 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 !entromedial spinal cord. Stimulatory effects on both extensors and flexors. 4redominant 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. 4redominant on extensors. Lateral vestibulospinal tract originates in @eiters nucleus to the ipsilateral motoneurons and interneurons. stimulation of extensors and inhibition of flexors. Tectospinal tract originate in sup colliculus to cer!ical spinal cord. 8ontrol of nec( muscles. erebellum , central control of mo!ements. Functions of cerebellum :estibulocerebellum control of balance and eye mo!ements. 4ontocerebellum planning and initiation of mo!ements. Spinocerebellum synergy control of rate,force,range,and direction of mo!ements. ayers of cerebellar cortex. ;ranular layer innermost layers. 4ur(inje cell layer middle layer /olecular layer outermost layer. onnection in the cerebellar corte1. Input to the cerebellar corte . 8limbing fibers motor learning. /ossy fibers :estibulocerebellum 4ontocerebellum Spinocerebellum. <utput to the cerebellar cortex. Purkin&e cells are the only output." al-ays inhibitory ;A0A. "asal ganglia! striatum, globus pallidus, subthalamic nuclei and substantia nigra. Thalamic outflo- to motor cortex plan and execute smooth mo!ements. Language Rt hemisphere" facial expression, intonation, body language, spatial tas(. t hemisphere language aphasia. >ernic(e area sensory aphasia difficulty understanding -ritten and spo(en language. 0roca area motor aphasia speech and -ritten are affected. Short term memory synaptic changes. ong term memory structural changes. 8SF composition. 8SF e1ual blood Ca,8l,58<&,osmolarity. 8SF greater than blood /g cretinine Temperature regulation. 5eat generating mechanisms respone to cold. a"Thyroid hormone increase metabolic rate and heat production by Ca"B"AT4ase.

b"8old acti!ate sympathetic !ia acti!ation of beta receptors in bro-n fat, increase metabolic rate and heat production. c. shi!ering most potent mechanism for increasing heat production. cold acti!ate the shi!ering respone posterior hypothalamus alpha and gamma neurons are acti!ated" contraction of s(eletal muscle and heat production. 5eat loss mechanisms respone to heat. a"5eat loss by radiation and con!ection -hen temp incrs. Ant hypothalamus incrs temp causes decrs in sympathetic tone to cutenous blood !essels, incrs artero!enous shunt of blood to !enous plexus near the surface of s(in.shunting of -arm blood to s(in incrs heat loss. b" haet losss by e!aporation acti!ity of s-eat galnds under sym control. Fe!er 4yrogens incre production of % " #in phagocytic cells. % " # act on ant hypothalamus to incrs the production of prostaglandin. 4rostaglandin increase the set point temp. 5eat exhaustion excessi!e s-eating. 5eat stro(e incrs temp. Arteries thic( -alled extensi!e elastic tissue and smooth muscles. Fnder high pressure. 0lood in arteries are stressed !olume. Arterioles high resistance in 8:S. Smooth muscle -all inner!ated by ACS. Alpha"# receptors are found on arterioles of s(in, splanchnic, renal circulation. 0eta "2 founds on arterioles of s(eletal muscles. 8apillaries largest total cross sectional area. Thin -alled, lo- pressure, highest proportion of blood, unstressed blood. Alpha"# receptors. :elocity of blood flo-" : H,A H blood flo-. A" cross"sectional area. H 42"4# , R

8apacitance " distensibility of blood !essels. :,4. 8hronotropic produce changes in heart rate. @romotropic produce changes in condution !elocity in A: node. SA nod, atria, A: node ha!e 4S !agal inner!ation but !entricles donot. 8ontractility is intrinsic ability of cardiac muscles to de!elop force at a gi!en muscle length called inotropism. Related to intracellular 8a concentration. 8an be estimated by ejection fraction I 33= Stro(e !olume " !olume ejected by !entricle on each beat. S: I end" diastolic !olume end systolic !olume. 8ardiac output I S: x 5R 6jection fraction is fraction of end diastolic !olume ejected in each S:. 6FI S:, end" diastolic !olume Special circulation Autoregulation blood flo- to an organ remain constant o!er a -ide range of perfusion pressure. 5eart, brain, (idney. :asodilation occure. Acti!e hyperemia blood flo- to an organ is proportional to its metabolic acti!ity. 4assi!e hyperemia" blood flo- inc to an organ that occurs after period of occlusion. Myogenic hypothesis :ascular smooth muscle contract -hen it is stretched !asoconstriction -ill maintain a constant flo-. Metabolic hypothesis. Tissue supply of o2 is matched to the tissue demand for o2. !asodilator matebolates, 8<2, 5, B, lactate, adenosine arteriolar !asodilation inc blood flo- , inc <2 demand. +ormonal control. Sympathetic inner!ation of !ascular smooth muscles. %nc tone !asoconstriction. @ec tone !asodilation. Skin has greatest innervation and coronary, pulmonary and cerebral vessel have little. (asoactive hormones 5istamine arteriolar dilation and !aso constriction local edema. 0rady(inin arteriolar dilation and !aso constriction local edema. Serotonin arteriolar constriction migraine headaches. 4rostaglandins 4rostacyclin !asodilator. 6 series !asodilators. F series and thromboxane A2 !asoconstrictor. Respiratory physiology Lung volumes Tidal !olume !olume of inspired and expired. %nspiratory reser!e !olume !olume inspired abo!e tidal !olume. 6xpiratory reser!e !olume !olume exspired abo!e tidal !olume.

Residual !olume !olume remain after maximal expiration. Cot measured by spirometry. 2ead space. Anatomical dead space !olume of conducting air-ays. #3$ ml. 4hysiologic dead space functional measurement does not participate in gas exchange. (entilation rates /inute !entilation I T: x breath,min. Al!eolar !entilation I JT: dead spaceK x breath,min. Lung capacities %nspiratory capacity I T@ A %R:. Functional residual capacity I 6R: A R:. :olume remaining after tidal !olume expired and not measure by spirometry. :ital capacity or forced !ital capacity. T: A %R: A6R: Total lung capacity I all four lung !olumes. Forced expiratory !olumes F6:# is normally *$= of F:8. 8<4@ F6:# is dec. -hile in restricti!e lung disease F6:# is normal or inc. Muscle of inspiration. @iaphragm is most important muscle. 6xternal intercostals and accessory muscles. /uscle of expiration abdominal muscle and internal intercostals muscles. Surface tension and surfactant 4 I 2T,r %n the absence of surfactant small al!eoli ha!e tendency to collapse atelectasis. Surfactant lines al!eoli reduce surface tension inn compliance type 2 al!eoli. %n fetus &3 -ee(s gestation. %1ygen transport <2 carried in blood in t-o forms, dissol!ed and bound to hb. /ethemoglobin feAAA does not bind o2. Shift to the right >hen affinity of hb for oxygen is dec.

%nc 4co2 or dec p5. %nc temperature. %nc 2,& @4; concentration.
Shift to the left >hen affinity of hb for oxygen is inc.

@ec 4co2 or inc p5. @ec temperature. @ec 2,& @4; concentration. auses of hypo1emia and hypo1ia. +ypo1emia @ec in arterial 4o2. A"a gradient I 4Ao2 4ao2

Cormal A"a gradient L #$ mm 5g. +ypo1ia @ec oxygen deli!ery to tissues. <2 deli!ery I 8< x <2 content of blood. %& transport Form of 8<2 in blood 8<2 is produced in tissue and carried to the lungs in !enous blood in & forms. #" @issol!ed 8<2 -hich is free in solution. 2" 8arbaminohemoglobin bound to 5b. &" 58<& '$=. (34 2efects (34 ratio. Ratio of al!eolar !entilation to pulmonary blood flo-. %f fre1uency, T:, 8< are normal the :,H ratio is $.* results4o2 #$$ mm5g and 8<2 2$ mm 5g. ontrol of breathing Sensory information +4co2,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. 8entral control of breathing #"/edullary respiratory center is located in the reticular formation. a" @orsal respiratory group responsible for inspiration and basic rhythm. %nput from !agus and glossopharyngeal ner!es. :agus from peripheral chemoreceptors and mechanoreceptors in the lung. ;lossopharyngeal ner!es from peripheral chemoreceptors. <utput from dorsal group to !ia phrenic ner!e to the diaphragm. b":entral respiratory group for expiration, only in acti!e process. 2" Apneustic center located in lo-er pons" stimulates inspiration producing deep and prolonged %nspiratory gasp. &" 4neumotaxic center" located in lo-er pons inhibits inspiration regulates %nspiratory !olume and respiratory rate. hemoreceptors for o&-+ and o& #" 8entral chemoreceptors in the medulla sensiti!e to the p5 of 8SF. @ec p5 of 8SF inc in breathing rate. 5 does not cross the 000 as -ell as co2 do. 2" 4eripheral chemoreceptors in the carotid and aortic bodies a" @ec in arterial 4o2" stimulate the peripheral chemoreceptors and inc breathing rate. 4o2 must dec to lo- le!el L 9$ mm 5g. b" inc arterial 4co2 response is greater in central chemoreceptors. c" inc in arterial 5 %n metabolic acidosis 5 is inc and hyper!entilation occurs.

#" ung stretch receptors" located in smooth muscles of the air-ays. >hen these receptors are stimulated by distention of the lungs, they produced reflex dec in breathing fre1uency. +ering , "reuer refle1. 2" %rritant receptors &" G juxtacapillary receptors are located in al!eolar -alls close to the capillaries. 6ngorgement of the pulmonary capillaries 5F , stimulates the G receptor , rapid shallo- breathing. 2" joint and muscle receptors acti!ated during exercise. Types of chemoreceptors 8entral 4eripheral ocation /edulla 8arotid M aortic bodies Stimuli inc the breathing r @ec p5 inc 4co2 @ec 4o2, inc 4co2, dec p5

0ody fluids T0> 9$= of body -eight. 5ighest in ne-born and adults. %8F 2,& of T0>. /ajor cations are B M /g. /ajor anion are proteins M organic phosphate. 68F #,& of T0>. 8omposed of interstitial fluid and plasma. /ajor cations are Ca. /ajor anion are 8l M 58<&. a" plasma is N of 68F.#,#2 of T>0. /ajor plasma protein are albumin M globulin. b" interstitial fluid is O of 68F.#,2 of T0>. 9$="2$="2$= rule" T0>"%8F"68F. T>0 Tritiated -ater. 68F /annitol, inulin. 4lasma 6!ans blue. %nterstitial and %8F indirectly. R0F 23= cardiac output. :asoconstriction of the renal arterioles dec in R0F" produced by acti!ation of SCS and angiotension %%. :asodilatation of renal arterioles inc in R0F, produced by prostaglandin 62 and %2,brady(inins,nitric oxide, dopamine. Autoregulation *$"2$$ mm5g. /easurement of R0F 4A5. ;FR inulin 6stimate of ;FR -ith blood urea nitrogen and serum creatinine.. 0oth 0FC and creatinine inc -hen ;FR dec. Filtration fraction ;FR,R4F I $.2$. 2$= of the R4F is filtered. /a transport Pro imal tubules reabsorb 2,& or )$= of Ca M 52<. Site of glomerulotubular balance. 8otransport " -ith 58<&, glucose, amino acid, phosphate and lactate. 8ountertransport Ca"5 exchange. 8arbonic anhydrase inhibitors inhibit the reabsorption of 58<&.

!hick ascending limb of loop of 'enle" 23= of Ca. Ca"B"8l cotransporter. Site of action of loop diuretics -hich inhibits Ca"B"8l cotransporter. %mpermeable to 52<. diluting segment. (istal tubules and collecting duct reabsorb *= of Ca. 6arly distal tubule reabsorb Ca8l by Ca"8l cotransporter thia7ide diuretics. %mpermeable to 52< cortical diluting segment. ate distal tubules and collecting duct T-o cell types Principal cells" reabsorbs Ca M 52< and secrete B. Aldosterone inc Ca reabsorption and inc B secretion. A@5 inc 52< permeability. Spironolactone antagonist of aldosterone. Alpha intercalated secrete 5 and reabsorbe B. 4hosphate. *3 = is reabsorbe in 4T Ca"phosphate 8otransport. 4T5 inhibits phosphate reabsorption"phosphouria. %s a urinary buffer for 5 excretion. 8alcium 4T M Thic( Ascending imb. Furosemide treatment for hypercalcemia. 4T5 inc reabsorption thia7ides treatment of idiopathic hypercalciuria /agnesium " 4T M Thic( Ascending imb. %n TA /g M 8a compete for reabsorption. Acid base balance Acid production" !olatile acid and non!olatile acid. :olatile acid 8<2 produced by aerobic metabolism of cells. 8<2 A 52< I 528<& I 5 A 58<& 8arbonic anhydrase present in all cells. Con !olatile acid fixed acid sulfuric acid +product of protein catabolism., phosphoric acid +phospholipids catabolism.. <thers are (etoacid, lacticacid, salicylic acid. 0uffer pre!ent a change in p5 -hen 5 ion are added or remo!ed from a solution. 6xtracellular buffers major extracellular buffer 58<&. phosphate minor extracellular buffer is a most important urinary buffer. %ntracellular buffer organic phosphate, proteins, 5b is major intracellular buffer. 6xcretion of fixed 5 in 2 forms excretion of titratable acid M as C52. 5yper(alimia inhibits the C5& synthesis. /etabolic acidosis o!erproduction of fixed acid M loss of bases a"inc arterial 5 +acidemia.. b"58<& is used to buffer the extra fixed acid" arterial 58<& dec. primary disturbance. c" academia hyper!entilation respiratory compensation. d. correction of metabolic acidosis inc excretion of fixed 5. e" serum anion gap JCaK"J8lKAJ58<&K unmeasured anion phosphate, citrate, sulfate, protein. #2 m61, .

%n metabolic acidosis 58<& replaced by unmeasured anion" 8l. #" Anion gap in inc if concentration of unmeasured anion is inc to replace 58<&. 2" Anion gap is normal if concentration of 8l is inc to replace 58<&. hyperchoremic metabolic acidosis. /etabolic al(alosis oss of fixed acid or gain of base dec in arterial 5 +al(alemia.. Arterial 58<& inc. al(alemia cause hypo!entilation respiratory compensation for metabolic al(alosis. 8orrection of metabolic al(alosis inc excretion of 58<& because filter load is inc. Respiratory acidosis dec in respiratory rate M retention of 8<2. inc arterial 48<2 inc 5 M 58<&. @isorders /etabolic acidosis /etabolic al(alosis Respiratory acidosis 8<2A52< @ec %nc %nc 5 %nc @ec %nc 58<& @ec %nc %nc Res comp 5yper!entilation 5ypo!entilation Cone Renal comp %nc 5 excretion , inc 58<& reabsorption dec 5 excretion , dec 58<& reabsorption

Respiratory al(alosis

dec

@ec

@ec

#5T physiology 6pithelial cells /uscularis mucosa 8icular muscle ongitudinal muscle
Submucosal plexus. %t is formed by branches that ha!e perforated the circular muscular fibers. /yenteric plexus +AuerbachPs plexus. of ner!es and ganglia situated bet-een the circular muscular fibers and the longitudinal muscle fibers of the muscularis externa. The !agus inner!ates 6 ,S,4,upper large intestine. And pel!ic ner!e inner!ate lo-er large intestine,rectum,anus. 6xtrinsic SCS M 4SCS. %ntrinsic +enteric ner!ous system.. /yenteric plexus primary control the motility of ;% smooth muscles. Submucosal plexus" primary control secretion and blood flo-. ;% hormones 2 official ;% hormones.;astrin, 88B, secretin, ;%4.

;% secretions

Sali!ary secretions. Function of sali!a" initial starch digestion by amylase M initial triglyceride digestion. 5igh !olume, high B M 58<&, lo- Ca M 8l, hypotonicity, presence of amylase, lingual lipase, (alli(rein ;astric secretion"4arietal 8hief ; cells. .
%nfoQ 8ranial Cer!es +8C. #. Shortest 8C " <lfactory 2. ongest 8C " :agus &. argest 8C " Trigeminal 2.Thic(est 8C " <ptic 3. ongest %ntracranial 8ourse " Trochlear 9. ongest %ntradural 8ourse " Abducent ). ongest %ntraosseous 8ourse " Facial *.Thinnest 8C Trochlear /ain features of cerebellum & lobes anterior, posterior, floculonodular. 2 hemisphere !ermis, intermediate, lateral 7ones. & functional regions !estibule cerebellum, spino cerebellum +!ermis A intermediate 7one., cerebro cerebellum +lateral 7one.. & pairs of peduncles inferior, medial, superior. Superficial grey matter +cerebellar cortex., internal -hite matter, & pairs of deep nuclei +fastigial, interposed, dentate.. /ajor Afferents climbing fibers from inf oli!e, and mossy fibers from many brainstem and spinal cord nuclei. %nf cerebellar peduncle post spino cerebellar tract

0asement membrane consist of %: type collagen, glycoprotein, 4roteloglycans M reticular lamina.

8ell junctions allo- cells to adhere. There are & types of cell junctionsQ Anchoring junctions +Adherens junctions, @esmosomes and 5emidesmosomes., -hich transmit stress through tethering to cytos(eleton are cellcell or cellmatrix <ccluding Gunctions +Tight junctions., -hich seal gaps bet-een cells, ma(ing an impermeable barrier 8hannel forming junctions +;ap junctions and plasmodesmata., -hich lin(s cytoplasm of adjacent cells. Microvilli core of actin microfilament M function to increase absorpti!e surface area of epithelial cell. 8olumnar epithelium of small M large intestine, 4T8 of (idneys, columnar epithelium of respiratory tract.

Stereocilia " long, branched micro!illi" epididymis. ilia ' peripheral pairs of microtubules M 2 central microtubules" AT4ase dynein" pseudostratified ciliated columnar respiratory cellM tail of sperm. *pithelium Simple S1uamous epithelium blood !essels, mesothelium M inside renal glomerular capsule. Stratified S1uamous epithelium oral ca!ity, pharynx, esophagus +non (eratini7ed. M in s(in +(eratini7ed.. Simple columnar epithelium small M large intestine. 4seudostratified columnar epithelium nasal ca!ity, trachea, bronchi, epididymis. Simple cuboidal epithelium renal tubules, secretory cells of sali!ary glands acini. Stratified cuboidal epithelium ducts of sali!ary glands. Transitional epithelium ureter M bladder. #lands ha!e * types #" 6ndocrine 2" 6xocrine has & groups Apocrine portion of secreting cell body is lost during secretion" s-eat gland. 5olocrine " the entire cell disintegrates to secrete its substances +e.g., sebaceous glands.. /erocrine " cells secrete their substances by exocytosis +e.g., mucous and serous glands.. Also called ReccrineR. Serous " secrete a -atery, often protein"rich product. /ucous secrete a !iscous product, rich in carbohydrates +e.g., glycoproteins.. Sebaceous glands ? secrete a lipid product. Fnicellular glands" goblet cells in respiratory M ;% epithelium. /ulticellular may be endocrine or exocrine. onnective tissue 2 special 8T" adipose tissue, bone, cartilage, bone marro-. Support cells, guest cells, ground substance +68/.. Support cells fibroblast produce collagen resistance to injury. /yofibroblast actin M myosin ability to contract. 8hondroblast M chondrocytes produce type %% collagen. <steoblast M <steocytes produce type % collagen. Adipocytes. 4ermanent guest cells macrophage M mast cell. Transient cells migrate into 8T from blood. 68/ fibrillar protein collagen, elastin, fibrillin, fibronectin. Type % collagen s(in, bone, ligament, tendon, cornea. Type %% cartilage, inter!ertebral disc M !itreous body of eye. Type %%% blood !essels, Type %:" basal lamina. ;lycoaminoglycans 5yaluronic acid, 8hondroitin sulfate, dermatan sulfate, (eratin sulfate, heparin sulfate. ;lycoprotein aminin, 6ntactin, Tenascin.

8artilage" & types . 5yaline template for bone formation rich in 5yaluronic acid, 8hondroitin sulfate, and (eratin sulfate" good shoc( absorber. 6lastic greater flexibility external ear, auditory canal, epiglottis of larynx. Fibrocartilage greater resistance to being stretched +tensile strength. " inter!ertebral disc, menisci of (nee, attachment of ligamentM tendons, "ipolar neurons ha!e t-o processes extending from the cell body " retinal cells, olfactory epithelium cells. Pseudounipolar cells " dorsal root ganglion cells" Actually, these cells ha!e 2 axons rather than an axon and dendrite. <ne axon extends centrally to-ard the spinal cord, the other axon extends to-ard the s(in or muscle. Multipolar neurons ha!e many processes that extend from the cell body. 5o-e!er, each neuron has only one axon " spinal motor neurons, pyramidal neurons, 4ur(inje cells. ymphatic !essels are not found" 8CS, cartilage, bone, bone marro-, thymus, placenta, cornea, teeth, fingernail. The lymph node, /A T, spleen act as a filter. ymph nodes" cortex M medulla" outer cortex germinal centers 0 cells proliferating. %nner are paracortex " T cells proliferating. Spleen red pulp filet M clear damage M aging R08s. >hite pulp collection of antigens from the blood stream. 4ulmonary epithelium metabolic transformation of lipoprotein M prostaglandin, con!ersion of angiotension % to angiotension %%. ;%T 2 layers mucosa" has & components. 6pithelium, amina propria ;A T" %gA. /uscularis mucosa. Submucosa house of larger blood !essels M mucus secreting glands. /uscularis externa 2 layers of muscles inner circular M outer longitudinal. Serosa " mesentery blood M lymphatic !essels. 8eliac disease" small intestinal !illi" autoimmune disease gluten sensiti!ity. @%8 consumption of both platelets M clotting factors. 4T measure Factor % +fibrinogen., %%,:,:%%,E. platelet count, fibrinogen le!el, fibrin degradation products. Cormal platelets count #3$,$$$" 23$,$$$. #3,$$$"2$,$$$ bleeding occurs. 8arcinoid tumors" secret a !ariety of bioacti!e substances" ;% peptides +gastrin, insulin,:%4,glucagon. M others peptides AT85, calcitonin, bioacti!e amines 3,5T. Frinary 3"5%AA is diagnostic test. >olffian ducts to internal organ need testosterone but differentiation of indifferent organs need dihydrotestosterone. /ost common cause of infection in!ol!ing catheter M prosthetic de!ices stap epidermidis. Eeroderma pigmentosa extreme sensiti!ity to sunlight M inc predisposition to s(in cancers. ysogeny state of stable association of bacterial M !iral @CA.8<06@S +cholera toxin,< antigen of salmonella,botulinum toxin,erythrogenic exotoxin strep pyogen, diphtheria, shiga..

Trinucleotide repeat -ith 8A; 5untington disease 8A; Fragile syndrome" 8;; /yotonic dystrophy" 8T; Septic shoc( serous complication of gram" negati!e infections" endotoxin 4S ipid A is toxic component of 4S. Stimulate of macrophage to secrete large amount of % "#,% "9 M TCF alpha. %mportant chemotactic factor" 83a M % "* /enopause estrogen estrone"endometrial hyperplasia" endometrial cancer. :6;F proangiogenic gro-th that inc endothelial cell proliferation. Factors that strength the gastric musocal barrier" mucus,gastrin,prostaglandins. Factors that -ea(en the gastric mucosa" bile salt,aspirin,CSA%@,ethanol,5 pylori. Force !ital capacity total lung capacity A residual !olume. T0>I%8FA68F 68FIplasma A%SF T0>I%8FA+plasma A%SF. Adding resistance lo-ers the resistance M remo!ing the resistance inc total resistance. :>F" present in serum M subendothelial basal lamina -hich has binding site for collagen, platelets, fibrin. 4ain referred from epigastric region greater splanchnic ner!e. %n case of gas gangrene cause of death" toxemia. 8ushing reflex. Fnconjugated bile is carried by albumin. 8orynebacterium club shaped. 8@" cluster of differentiation. 4erforation of duodenum" ;astroduodenal a. 8alcium stone" loop diuretic. 8ycticercosis taenia solium. /ost radiosensiti!e tumor" seminoma. ;erminal follicle are present in cortex of thymus. %n resting stage actin is in contact -ith tropomyosin. Adult deri!ates of !entral mesentery greater omentum M falciform lig. Synarthrotic joint ha!e little or no mo!ement.Syn ,together. Synostosis osseous connection b,- bones. Amphiarthrotic joint" slightly mo!ements.Amphi"surrounding. %n form of lig" syndesmosis, Fibrocartilage symphysis. @iarthrotic joint most mobile. @i separate.

4ollicis thumb, pronate bent for-ard, teres round. Ancon elbo-. %ndicis pointer finger. Scalene une!en. Spelinus bandage.