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M3

Stimulation of bronchiolar smoothmuscle M3 receptors causes bronchoconstriction Stimulation of non-innervated vascular M3 receptors results in vasodilation and a drop in blood pressure As a result of the baroreceptor reflex, heart rate is increased
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M3

In lungs, stimulation of M3 receptors produces bronchoconstriction and increases mucus secretion Stimulation of B2 receptors produces bronchodilation But, when a blood vessel is directly stimulated it will generate a baroreceptor reflex that counteracts the direct effect (e.g. a drug)
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M3 and B2 stimulation decrase blood

Changes in airway resistance Q=P/R, where R=8nl/3.14r^4 Bronchial smooth muscle:

Parasympathetic nervous system bronchoconstriction via M3 (increase R) Sympathetic nervous system bronchodilation via B2 receptors (decrease R)

Lung volume:
Increased lung volume decreased resistance (greater radial traction on airways) 6/6/12

Chemoreceptors

Peripheral

Carotid and aortic bodies respond to decrease PO2, increased PCO2, and decreased blood pH Less sensitive, but respond more quickly because they can directly monitor arterial blood

Central
Respond to increased PCO2, decreased pH of brain interstitial fluid, 6/6/12

Macrophages with hemosiderin in alveolar cavities indicates prior hemorrhage

Macrophages with hemosiderin: Heart Failure Cells

See in CHF (along with heavy, edematous lungs, dyspnea, edema, orthopnea from backward failure) See in Goodpasture snydrome Microhemorrhages in alveolar cavities develop due to extravasation 6/6/12 secondary to congestion

Histo findings in lung dz

Asbestosis: ferruginous bodies (asbestos fibers with protein coat) Asthma: intra-alveolar Charcot Leyden crystals from eosinophil enzymes; Curschmann spirals (corkscrew casts from mucus plugs) Bronchogenic carcinoma: neoplastic cells
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COPD: increased Reid index

Hilar lymph nodes

TB granuloma (Ghon complex + lobar and perihilar lymph node involvement Sarcoidosisbilateral Silicosis

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Calcium oxalate urinary crystal

Vegan diet, ethylene glycol poisoning, calcium oxalate stone Looks like back of envelope Stupurous, metabolic acidosis with increased anion gap, calcium oxalate crystals: pt drank ethylene glycol MC stone we pass: calcium oxalate stone

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Uric acid urinary crystal

Urine pH must be acidic Pts with gout have acidic urine To stop uric acid crystals from forming, alkalinze urine with acetazolamide (carbonic anhydrase inhibitor) Acetazolamide blocks bicarb reclamation/reformation

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Triple phosphate urinary crystal with amorphous phosphates

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Cystine urinary crystal

Hexagonal Cystinuria

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Autosomal recessive polycystic kidney disease (ARPKD, infantile)

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A. Kidney of a 2-year-old ARPKD-affected child. Macroscopically , the organ displays multiple small cysts on its surface and is

Anterior spinal artery ASA

Medial medullary syndrome (rostral medulla)

Corticospinal tract (medullary pyramid) contralateral spastic hemiparesis Medial lemniscus contralateral loss of tactile and vibration sensation from trunk and extremities Hypoglossal nc ipsilateral flaccid hemiparalysis of tongue (pt to side of 6/6/12 lesion)

Lateral medullary syndrome (rostral medulla); Posterior Wallenberg artery inferior cerebellar
PICA Vestibular nc nystagmus, nausea, vomiting, vertigo Inferior cerebellar peduncle ipsilateral cerebellar signs (dystaxia, dysmetria, dysdiadochokinesia) Nucleus ambiguus of CN 9, 10, 11 ipsilateral loss of gag reflex 6/6/12 (efferent), dysarthria, dysphagia,

Medial inferior pontine syndrome (caudal pons)

Basilar artery Corticospinal tract contralateral hemiparesis Medial lemniscus contralateral loss of tactile sensation from trunk and extremities Abducens nerve roots (CN 6) ipsilateral lateral rectus paralysis
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Lateral inferior pontine syndrome (caudal pons)

Anterior inferior cerebellar artery AICA Facial nc (CN 7) ipsilateral facial nerve paralysis, ipsilateral loss of taste from anterior 2/3 tongue, ipsilateral loss of lacrimation and salivation, loss of corneal and stapedial reflexes Cochlear nc (CN 8) unilateral 6/6/12 central deafness

Lateral superior pontine syndrome (rostral pons)

Anterior inferior cerebellar artery AICA Spinal trigeminal nc and tract (CN 5) ipsilateral loss of pain and temperature sensation from face (more than lateral inferior pontine syndrome) No facial, cochlear, or vestibular (CN 7+8)
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Seen in multiple sclerosis

Medial longitudinal fasciculus syndrome (pons)

Interrupts fibers from contralateral abducens nc that project thru MLF to ipsilateral medial rectus nc (CN 3) Medial rectus palsy on attempted lateral conjugate gaze Nystagmus in abducting eye
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Facial colliculus syndrome (pons)

Pontine glioma or CVA Internal genu of facial nerve ipsilateral facial paralysis, ipsilateral loss of corneal reflex Abducens nc lateral rectus paralysis, medial (convergent strabismus), horizontal diplopia

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Parinauds syndrome (dorsal midbrain)

Pinealoma or germinoma of pineal gland Superior colliculus and pretectal area paralysis of upward and downward gaze, pupillary disturbances, absence of convergence Cerebral aqueduct noncommunicating hydrocephalus
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Benedikt syndrome (paramedian midbrain)

Oculomotor nerve roots ipsilateral oculomotor paralysis, eye abduction and depression caused by intact lateral rectus (CN 6) and superior oblique (CN 4), ptosis, fixation, dilation of ipsilateral pupil Dentaothalamic fibers contralateral cerebellar dystaxia with intention tremor Medial lemniscus contralateral loss

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Weber syndrome (medial midbrain)

Posterior cerebral artery PCA Oculomotor nerve roots ipsilateral oculomotor paralysis, eye abduction and depression caused by intact lateral rectus (CN 6) and superior oblique (CN 4) (down and out), ptosis, fixation, dilation of ipsilateral pupil Corticospinal tracts contralateral 6/6/12 spastic hemiparesis

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Cranial fossae

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Basal ganglia

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Diabetes Mellitus

Type 1

Absolute insulin deficiency Antibodies against B-islet cells DKA HLA relationship Insulin always used FHx DM Obesity

Type 2

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Diabetic Neuropathy

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DM Neuropathy

Osmotic damage

Glucose aldose reductase sorbitol Lens

Sorbitol draws water into the lens Retinal vessels in lens become weak Microabscesses form and rupture blind

Schwann cells

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Osmotic damage casues demyelination of peripheral nerves

Brachial Plexus

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Growth factors

A 45yo man who has been sedentary for the past year participates in an exercise study. The quadriceps are excercised at 75% of max workload for 30 minutes. Muscle Bx is taken 30 minutes before exercise during resting conditions. Another Bx is taken 60 minutes after the exercise is terminated. Which of the following sets of changes is expected in the 6/6/12 muscle Bx following exercise,

Rickets (Osteomalacia in adults)

Bowed legs, chest deformity, fractures Defective mineralization/calcification of osteoid soft bones. Low vit D low Ca2+ increased PTH decreased PO4

Low vit D due to chronic renal insufficiency, intestinal malabsorption, dietary deficiency, lack of sunlight

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Widened osteoid seams due to

Psoriatic arthritis

Sausage-shaped DIP joints (finger/toe) Pencil-in-cup deformity of DIP joint Nail pitting Psoriasis on extensor surfaces of elbows and knees

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Seronegative spondyloarthropathies

-RF; +HLA-B27; male; sacroiliitis; spondylitis (involve axial skeleton)

Ankylosing spondylitis

Bilateral sacroiliitis with morning stiffness Fused vertebrae kyphosis nonpulmonary restrictive lung dz (blood gas abnormalities) Aortitis with aortic regurgitation Uveitis with potential for blindess

Reiter 6/6/12

syndrome

Acid-Base

In a healthy person, serum pH is regulated by HCO3- reabsorption (proximal tubule of kidneys) and blood Pco2 (respiratory activity) In a healthy person:

pH = 7.40 Pco2 = 40 mm Hg Po2 = 100 mm Hg Hco3- = 24 mEq/L

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Differentiation of acidbase disturbances and Causes of high related causes anion-gap

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Acid-base disturbances

Anion gap

Difference between serum Na+ and Cland HCO3- ion concentrations Anion gap = [Na+] - [Cl-] - [HCO3-]

(normal = 812)

Normal anion gap acidosis: HCO3- loss Increased anion gap acidosis: H+ excess

Mixed disorder
Combination of multiple acid-base 6/6/12 disturbances

Acid-Base Disturbances and Compensatory Mechanisms

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Toxoid + polyribitol phosphate

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IL-2

Produced by Th1 cells Activates and clones cells of cellmediated immunity (CD8, macrophage) IL-2 used for cancer treatment:

Increased NKC and CD8 following in vitro Cx with IL-2 may benefit in battle against malignant cells

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