Blood supply to various organs ml/min

Blood supply to various organs ml/min
L-liver                   1500
K-kidney               1250
M- muscle            1000
B- brain                 750
S- skin                   500
C- coronary heart  250

Blood

• Total circulating blood is 8% of total body weight
• Active bone marrow forming the blood cells is called red marrow and inactive marrow is called yellow marrow. Inactive marrow is filled with fats.
• 75% bone marrow belongs to white blood cells producing myloid series
• Neutrophils and monocytes are produced from single precursor. There are se[arate pools for proginators of megakaryocytes, lymphocytes, erythrocytes, eosinophils, and basophils
• Mast cells, kupffer cells, dendritic cells, osteoclasts and langerhans cells also originate from bone marrow
• Best source of hematopoitic stem cells is umbilical cord blood
• Average half life of nutrophils in circulation is 6 hours
• Nutrophils, eosinophols and basophills are collectively called granulocytes/polymorphonuclear cells
• Eosinophils are abundant in GIT and respiratory mucosa
• Mast cells are abundant in areas rich in connective tissue eg beneath epithelium
• Monocyte leave the circulation and become macrophages in tissues. They donot reenter the circulation.
• Pluripotent uncommitted stem cells become committed by the action of IL1, IL6 followed by IL3(I,3,6 commits the stem cells, kind of love guru )
• Cytokines are hormone like molecules that act generally in paracrine fashion
• IL1 increases slow wave sleep and reduces apetite
• Platelets don’t have nuclei.They have half life of 4 days and life span of 8 to 10 days..
Remember the above difference between life span n half life of platelets
• Splenectomy causes increase in circulation platelets.
• Cytoplasm of platelets contains actin, myosin, glycogen, lysosomes, and two types of granules
a. Dense granules: they have nonprotein substances. They contain serotoninand ADP
b. Alpha granules: contain clotting factors, PDGF
• Platelet production is controlled by colony stimulating factor and thrombopoitin. Thrombopoitin controls the maturation of megakaryocytes and is produced by kidney and liver.
• Osmotic fragility of RBC starts at 0.5% saline. Almost half the RBCs are lysed at 0.40 to 0.42% saline. Complete lysis occurs at 0.35% saline.
• 2.5 % hb in adults is HbA2
• Hb F has the ability to decrease the polymerization of deoxygenated HbS. Hydroxyurea causes HbF production and is used in treatment of HbS
• Blood group antigens are called aglutinogens
• Blood group antibodies are called agglutinins
• Blood group antigens are also present in salivery gland, saliva, kidney, pancrease, liver, lungs, testes, semen, and amniotic fluid
• A and B antigens are actually oligosaccharides that differ in their terminal suger. In RBCs they are mostly OLIGOSPHINGOLIPIDS and in other tissues they are glycoprotiens.(past MCQ)
• An antigen called H antigen is present in all RBCs in all individuals. In blood group A the A antigen is attached to H antigen, in blood group B the B antigen is attached to H antigen where as in blood group O no antign is attached to H antigen i.e terminal part of blood group O is H antigen(past MCQ). Blood group AB has both antigens at the terminal.
• Bilirubin rarely penetrates Blood brain barrier in adults. But in neonates and fetus the BBB is permeable to it an in erythroblastosis feotalis it causes KERNICTERUS
• If whole blood is allowed to clot and clot is removed, remaining is called serum. (plasma minus factor 2,5,8,fibrinogen is called serum)(past MCQ)
• Serum has high serotonin level due to breakdown of platelets.
• Thrombomodulin is produced by all endothelial cells except that of microcicculation of brain
• Thombin is procoagulant in circulation blood. It becomes anticoagulant when it binds to thrombomodulin
• Lymph has lower protein content than plasma..

REM Sleep

REM Sleep

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REM sleep is characterized by three things: (a) Muscle atonia (b) Rapid eye movement and (c) Desynchronized mixed frequency waves are seen
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Saw tooth appearance of waves are seen in REM sleep- REM sleep is commonly not seen in regular EEG readings (takes about 20 minutes, normal REM latency is 90 minutes or so)
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Appearance of REM sleep in regular recordings or much earlier than expected is called as SOREM period (Sleep Onset REM period). Very suggestive of Narcolepsy, but can also be seen in significantly sleep deprived individuals
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Various types of haemoglobin

Various types of haemoglobin :-

Adult haemoglobin :-

Hb A - two alpha and two beta chains

Hb A2- two alpha and two delta chains 

Fetal haemoglobin :-

Hb F- two alpha and two gamma chains 

Embryonic haemoglobin :-

Gower 1- two zeta and two epsilon chains 

Gower 2- two alpha and two epsilon chains 

Portland - 1 - two zeta and two gamma chains 

Portland 2- two zeta and two beta chains 

In alpha thalessemia :-

Hb Bart - tetramer consisting of four gamma chains 

HbH - tetramer consisting of four beta chains

Miscellaneous :-

Haemoglobin S - glutamic acid is replaced by valine at 6 th position of beta chain 

Haemoglobin C - glutamic acid is replaced by lysine at 6 th position of beta chain 

Haemoglobin E - glutamic acid is replaced by lysine at 26 th position of beta chain

Haemoglobin M. Iwata - histidine is replaced by tyrosine at 87th position at alpha chain; associated with methhaemoglobinemia

HEMOGLOBIN M (Milwaukee) is a rare dominant hereditary disorder where glutamate replaces valine in position 67 on the beta chain of the hemoglobin molecule

Haemoglobin lepore :-

Two alpha and two ( delta - beta fusion ) chains

Haemoglobin produced by yolk sac- Gower 1 Gower 2 and Portland

By liver- HB F

By bone marrow- HB A

At term 70% is HB F

Physiology

100 important points of physiology
1. Potassium is mainly regulated by - Aldosterone.
2. Tip of scapula at level – T7.
3. Oblique fissure of the lung at level - T3 to T6 Costochondral.
4. Decussating of medial lemniscuses - Internal Arcuate Fibers.
5. Superficial temporal artery relation with which nerve - Auriculotemporal nerve.
6. Correct about Thyroid gland - lymph drainage to deep cervical lymph nodes.
7. Anemic hypoxia occur in – Methemoglobulenemia.
8. In cerebral circulation brain arteries - Do not anastomose once entered in the brain (controvertial).
9. Phase 1 of transformation of drug metabolism – Oxidation.
10. Standard deviation shows - Variability of individual observation.
11. Counseling in patients is - To help themselves.
12. A young girl who is going to die and asks you “Am I going to die?” Doctor response should be – “What your parents have told you?”
13. In whole wheat – Thiamine.
14. Cholesterol enriched diet – Egg.
15. Origin of peroxisomes – SER.
16. Organelle where protein combines with carbohydrates, packed and released - Golgi complex.
17. Correct about DNA – Euchromatin is transcriptionally active.
18. ADPKD associated with – Renal failure (vs) Cerebral haemorrhage (controversial) here most probable Renal failure.
19. Cause of delay in healing – Infections.
20. PaO2 decreased, PCO2 increased, hydrogen ion increased; manifestation (looked like kind of COPD) – Hypoventilation.
21. PCO2 31, HCO3 19, pH increased (Metabolic alkalosis scenario) - Hyperventilation
22. Person with tachycardia, and heat intolerance with low level of TSH, on giving TRH; level of TSH and thyroid hormones increases. Diagnosis – Hyperthyroidism with thyroid problem.
23. Origin of oxytocin and ADH – Hypothalamus.
24. Difference between systemic and pulmonary circulation - Low resistance in pulmonary circulation.
25. Mean systemic filling pressure is regulated by - Venous return.
26. Systolic pressure is directly related to which one of the following – Renin.
27. ADH responds to – Osmolarity.
28. Osmoreceptors – ADH.
29. Right border of heart on X-ray also visible a part of – SVC.
30. In MI sensitive cardio marker – Tropinin T.
31. Diabetic nephropathy investigation - Urine albumin.
32. Young boy with generalized edema and proteinuria - Lesion of basement membrane.
33. Lesion of parasympathetic system affects mostly - GI muscles.
34. Stress hormone of our body - ACTH.
35. S2 sound heard on - Closure of aortic and pulmonary valve.
36. A patient with history hemorrhage (trauma) receives a bag stored for 2 weeks mainly contains – RBCs.
37. Due to inspiration – Decreased negative intrapleural pressure.
38. Important buffer of blood - HCO3-.
39. Max increase in ECF due to infusion of - Hypertonic NaCl.
40. Auscultation of tricuspid valve best heard at – Right lower end of the body of sternum.
41. GVE vagus nerve for preganglionic fiber arises from – Dorsal nucleus.
42. Thorn prick in left lower limb caused abscess - Staph aureus.
43. Diabetic female after abdominal surgery; dyspnea and cough - Pulmonary embolism.
44. MCC of pulmonary embolism – DVT.
45. Typhoid fever 1st week test – Blood culture
46. Typhoid fever 2nd week test – Blood culture and Widal test.
47. Typical feature of falciparum - Black water fever.
48. Alcoholic patient with deranged LFTs; on biopsy – Mallory bodies.
49. Councilman bodies seen in – Apoptosis.
50. Natural self-defense against tumors – Apoptosis.
51. P53 gene absent results in - cell survival.
52. Pain mediator - Bradykinins.
53. Metaplasia – Functional change in cells.
54. Female with infection of HPV, comes after 2 years, Pap smear shows prominent nucleoli and increased nucleus size – Dysplasia.
55. Gas exchange occur - Simple squamous epithelial layer.
56. Patient with granulomatous disease, biopsy done. Microscopic finding that suggests TB – Epitheloid cells.
57. The spindle fibers will decrease in discharge of impulses when - Muscle contracts (vs) When efferent gamma discharge occurs. (controversial) here most probable “muscle contracts”
58. Diagnosis for leprosy, initial investigation - Nasal scrapping.
59. Benign neoplasm – Adenoma.
60. 3 germ layers tumor – Teratoma.
61. When adrenalin release from medulla, causes vasodilation by acting on - Beta 2 adrenergic receptors.
62. Increased GFR and increased plasma flow occur due to - Dilation of afferent arteriole.
63. Charateristic of cerebellar lesion - Dymetria
64. Emax of a drug depends on – Efficacy
65. Study in which every person of a population has equal chances of being selected – Random sampling.
66. Amniocenthesis is done - After 14th weeks.
67. 1st response against acute inflammation in tissue – Macrophages.
68. In dark granules containing cells; IgE attaches to – Basophils.
69. Opsonization - C3b.
70. Exudate - more than 3g of proteins.
71. About active transport of drug all are true except - All drugs pass via active transport.
72. Pulmonary artery supply to – Alveoli.
73. Muscles of back innervated by - Dorsal rami.
74. In young boy dyspnea produced on lying - Retrosternal goiter.
75. Most important cause of bronchogenic cancer – Smoking.
76. Edema caused by - Increased hydrostatic pressure.
77. Edema caused by - Lymphatic blockage.
78. BP 210/180mmHg and creatinine 8% damaged part – Juxtaglomerular apparatus.
79. Female with blood group A, have 2 children; one with O and other with AB, blood group of father is – B.
80. Genetically true hermaphrodite – XX/XY.
81. DNA replication occur in – Interphase.
82. Glycogenolysis caused by deficiency of which hormone - Insulin
83. Investigation for liver amoebic abscess – Serology.
84. Surgery of submandibular gland; nerve damaged - marginal mandibular branch of facial.
85. On posterior surface of oblique and transversalis fascia - Arcuate line.
86. Aspirin overdose causes – Coma.
87. Cardiac output measurement via thermodilution – Temperature change downstream with CO.
88. Father with defective gene on one autosomal chromosome, develops disease later in his life; chances of getting disease in children – Half of the children will be affected.
89. If left circumflex artery occluded - Infarction of left atrium and left ventricle.
90. MCC of multiple fractures in adult – Osteoporosis.
91. Patient with fracture of many bones and low BP immediate treatment - Volume replacement.
92. Most common fracture of long bone - Tibia.
93. Collagen fibers – Eosin stain
94. Gamma efferent supply to – Intrafusal muscle spindles.
95. Micturition – Self generating.
96. Hallmark of HIV – Proliferation of virus in T-Cells.
97. 1g protein gives energy – 4 kcalories.
98. Isotonic and isometric contraction difference is that isotonic contraction – consumes more phosphate bond.
99. Autonomic nervous system – parasympathetic increase salivary secretion.
100. Protrusion of mandible – Lateral pterygoid.

Neurotransmitters

BRIEF REVIEW OF NEUROTRANSMITTERS

Acetylcholine (ACh)
1. Neurotransmitter at nerve-muscle connections for all voluntary muscles of the body
2. Also many of the involuntary (autonomic) nervous system synapses
3. Despite long history, the exact role of ACh in the brain unclear
4. Cholinergic neurons concentrated in the RAS and basal forebrain
5. Significant role in Alzheimer disease
6. Dementia in general associated with decreased ACh concentrations in amygdala, hippocampus, and temporal neocortex
7. Associated with erections in males
8. Muscarinic and nicotinic receptors
9. In the corpus striatum, ACh circuits are in equilibrium with dopamine neurons.

Norepinephrine (NE)
1. One of the catecholamine neurotransmitters
2. Transmitter of the sympathetic nerves of the autonomic nervous system, which mediate emergency respons
a. Acceleration of the heart
b. Dilatation of the bronchi
c. Elevation of blood pressure
3. Implicated in altering attention, perception, and mood
4. Key pathway: locus ceruleus in upper pons
5. Implicated in monoamine hypothesis of affective disorders:
a. Depletion of NE leads to depression
b. Excess of NE (and serotonin) leads to mania
c. Based on two observations:
1. Reserpine depletes NE and causes depression.
11. Antidepressant drugs block NE re-uptake, thus increasing the amount of NE available postsynaptically.
6. Receptors:
a. Alpha-I: sympathetic ( vasoconstriction)
b. Alpha-2: on cell bodies of presynaptic neurons, inhibit NE release
c. Beta-1: excitatory for heart, lungs, brain
d. Beta-2: excitatory for vasodilatation and bronchodilatation

Dopamine
1. The other catecholamine neurotransmitter
2. Synthesized from the amino acid tyrosine
3. D2 receptors most important
4. D1 and D5 stimulate G-protein and increase cAMP and excitation
5. D2, D3, and D 4 inhibit G-protein and decrease cAMP and excitation
6. Three pathways of known psychiatric importance:
a. Nigrostriatal pathway • Blockade leads to tremors, muscle rigidity, bradykinesia b. Meso-limbic-cortico pathway • Blockade leads to reduction of psychotic symptoms
c. Tuberoinfundibular system • Blockade leads to increases in prolactin (Dop = PIF)

Serotonin (5-hydroxytryptamine, 5-HT)
1. The transmitter of a discrete group of neurons that all have cell bodies located in the raphe nuclei of the brain stem
2. Changes in the activity of serotonin neurons are related to the actions of psychedelic drugs.
3. Involved in the therapeutic mechanism of action of antidepressant treatments (most are 5-HT re-uptake inhibitors; a few new ones are 5-HT agonists)
4. Has inhibitory influence; linked to impulse control
5. Low 5-HT =low impulse control
6. Has role in regulation of mood, sleep, sexual activity, aggression, anxiety, motor activity, cognitive function, appetite, circadian rhythms, neuroendocrine function, and body temperature

Glutamic Acid
1. One of the major amino acids in general metabolism and protein synthesis, also a neurotransmitter
2. Stimulates neurons to fire; principal excitatory neurotransmitter in the brain 3. The neurotransmitter of the major neuronal pathway that connects the cerebral cortex and the corpus striatum
4. Also the transmitter of the granule cells, which are the most numerous neurons in the cerebellum
5. Evidence that glutamic acid is the principal neurotransmitter of the vi-sual pathway
6. May have a role in producing schizophrenic symptoms
7. Reason for PCP symptoms (antagonist ofNMDA glutamate receptors)
8. Glutamate agonists produce seizures in animal studies

Enkephalins
1. Composed of two peptides, each containing five amino acids
2. Normally occurring substances that act on opiate receptors, mimicking the effects of opiates
3. Neurons are localized to areas of the brain that regulate functions influenced by opiate drugs.

Substance P
1. Peptide containing 11 amino acids
2. A major transmitter of sensory neurons that convey pain sensation from the periphery, especially the skin, into the spinal cord
3. Also found in numerous brain regions
4. Opiates relieve pain in part by blocking the release of substance P.
5. New class of antidepressant medications being tested to work on substance P

Gamma Amino-butyric Acid (GABA)
1. One of the amino-acid transmitters in the brain
2. Occurs almost exclusively in the brain
3. Reduces the firing of neurons; principle inhibitory neurotransmitter in the brain 4. The transmitter present at 25 to 40% of all synapses in the brain
5. Quantitatively, the predominant transmitter in the brain
6. Associated with anxiety, cannabis, benzodiazepines

Broadman Areas

Brodmann areas for human

Areas 3, 1 & 2 - Primary Somatosensory Cortex (frequently referred to as Areas 3, 1, 2 by convention)
Area 4 - Primary Motor Cortex
Area 5 - Somatosensory Association Cortex
Area 6 - Premotor cortex and Supplementary Motor Cortex (Secondary Motor Cortex)(Supplementary motor area)
Area 7 - Somatosensory Association Cortex
Area 8 - Includes Frontal eye fields
Area 9 - Dorsolateral prefrontal cortex
Area 10 - Anterior prefrontal cortex (most rostral part of superior and middle frontal gyri)
Area 11 - Orbitofrontal area (orbital and rectus gyri, plus part of the rostral part of the superior frontal gyrus)
Area 12 - Orbitofrontal area (used to be part of BA11, refers to the area between the superior frontal gyrus and the inferior rostral sulcus)
Area 13 and Area 14* - Insular cortex
Area 15* - Anterior Temporal Lobe
Area 17 - Primary visual cortex (V1)
Area 18 - Secondary visual cortex (V2)
Area 19 - Associative visual cortex (V3,V4,V5)
Area 20 - Inferior temporal gyrus
Area 21 - Middle temporal gyrus
Area 22 - Superior temporal gyrus, of which the caudal part is usually considered to contain the Wernicke's area
Area 23 - Ventral Posterior cingulate cortex
Area 24 - Ventral Anterior cingulate cortex.
Area 25 - Subgenual cortex (part of the Ventromedial prefrontal cortex)
Area 26 - Ectosplenial portion of the retrosplenial region of the cerebral cortex
Area 27 - Piriform cortex
Area 28 - Posterior Entorhinal Cortex
Area 29 - Retrosplenial cingulate cortex
Area 30 - Part of cingulate cortex
Area 31 - Dorsal Posterior cingulate cortex
Area 32 - Dorsal anterior cingulate cortex
Area 33 - Part of anterior cingulate cortex
Area 34 - Anterior Entorhinal Cortex (on the Parahippocampal gyrus)
Area 35 - Perirhinal cortex (on the Parahippocampal gyrus)
Area 36 - Parahippocampal cortex (on the Parahippocampal gyrus)
Area 37 - Fusiform gyrus
Area 38 - Temporopolar area (most rostral part of the superior and middle temporal gyri)
Area 39 - Angular gyrus, considered by some to be part of Wernicke's area
Area 40 - Supramarginal gyrus considered by some to be part of Wernicke's area
Areas 41 & 42 - Primary and Auditory Association Cortex
Area 43 - Primary gustatory cortex
Area 44 - pars opercularis, part of Broca's area
Area 45 - pars triangularis Broca's area
Area 46 - Dorsolateral prefrontal cortex
Area 47 - Inferior prefontal gyrus
Area 48 - Retrosubicular area (a small part of the medial surface of the temporal lobe)
Area 49 - Parasubiculum area in a rodent
Area 52 - Parainsular area (at the junction of the temporal lobe and the insula)

Nerve fibres

NERVE FIBRES

✔ Nerve fibers within peripheral nerves are divided into 3
types A, B and C according to their diameters,
conduction velocities, and physiologic characteristics.

✔A fibers are large, myelinated, conduct rapidly, and carry
various motor or sensory impulses.

✔B fibers are smaller myelinated axons that conduct less
rapidly than A fibers. These fibers serve autonomic
functions.

✔C fibers are the smallest and are non myelinated. They
conduct impulses the slowest and serve pain conduction
and autonomic functions.

✔A delta fibers carries pain and temperature.

✔A alpha fibers are related to motor function and reflex
activity.

✔A beta fibers innervate muscle and transmit touch and
pressure sensations.

✔A gamma fibers control muscle spindle tone.

✔B fibers are thinly myelinated preganglionic autonomic
axons that ultimately control vascular smooth muscle.

✔ A alpha and A beta fibers have maximum conduction
velocity of 30-70m/s.

✔ Conduction velocity of A gamma
fiber is 15 -30m/s and that of A delta fiber is 12-30m/s.

✔Type C fiber has a velocity of 0.5-2 m/s.

✔Type A fiber have the largest diameter, type B fibers
are smaller and type C is the smallest.

Kidney values

renal plasma flow - 625 ml / min

glomerular capillary pressure - 45 mmhg

peri tubular capillary pressure - 8 mmhg

pressure in renal vein - 4 mmhg

cortical blood flow - 5 ml per gm of kidney tissue per minute

medullary blood flow- outer 2.5 ml

Inner 0.6 ml

AV oxygen difference - 14 ml / l blood

po2 cortex - 50 mmhg

po2 medulla - 15 mmhg

Insulin

Mineral Stored With Insulin In Beta Cell Granules :- Zinc

Mineral Which Increases Insulin Sensitivity And Alleviates Insulin Resistance :- Chromium

One Gram Of Insulin Neutralizes 2.5 Grams Of Glucose

Insulin Works By
Tyrosine Kinase Receptor Pathway

Fetal Hyperinsulinemia Due To Maternal Hyperglycemia Is Called -" Pederson Hypothesis"

Discovered By Banting And Best

Chemical Structure Given By -" Sanger"

Only Insulin Sensitive Area Of Brain Is -" Satietary Centre / Venteromedial Nucleus Of Hypothalamus

Insulin Secretion Begins At 11-12 Weeks Of Intrauterine Life

Transport or binding proteins in plasma

Transport or binding proteins in plasma

Ceruloplasmin: Binds & transport copper ion in plasma

Transferrin: Transports iron

Ferritin: Storage form of iron in tissues

Transthyretin (Prealbumin): Binds transports thyroxine (TBG) & retinol

Transcortin: Binds cortisol (cortisol binding globulin, CBG)

Haptoglobin: Binds extracorpuscular Hb (levels are in low in hemolytic anemias)

Hemopexin: Binds heme

Important facts about vascular system

Important facts about vascular system

Maximum diameter - Vena cava
Maximum wall thickness - Aorta
Minimum diameter & minimum wall thickness - Capillaries
Maximum total cross sectional area - Capillaries
Minimum total cross sectional area - Aorta
Maximum blood volume in - Veins (55-60%)
Minimum blood volume in - Arterioles
Maximum vascular resistance  - Arterioles
2nd max vascular resistance (after arterioles) - Capillaries
Site of gas exchange - Capillaries
Maximum blood flow velocity - Aorta
Minimum blood flow velocity - Capillaries
Maximum flow rate - Aorta & Vena cava
Minimum flow rate - Capillaries
Maximum blood pressure - Aorta
Minimum blood pressure - Vena cava

Questions on bladder

Shape of empty bladder👉 tetrahedral,
Shape of distended bladder👉 ovoid,
Average capacity of bladder👉 120-320 ml,
Mean capacity of bladder👉 220ml,
Sense of filling of bladder first starts at👉 100-150ml,
First desire of micturition👉 150-200ml,
Painful sensations starts wen amount reached above👉 450ml,
Micturition beyond voluntary control wen collection reaches about👉 800ml,
Most fixed part of bladder👉 neck,
Superior surface of Bladder is 👉 covered with peritoneum,
Inferolateral surfaces are👉 devoid of peritoneum..

Pressures

Some important pressures
ICP:: 2-12 mm Hg (50-180 mm Water)
IOP:: 10-20 mm Hg
Pulmonary capillary wedge pressure:: 6-12 mm Hg (Swan Ganz)
Mean pulmonary artery pressure (PAP) :: 15 mmHg
Portal venous pressure:: 5-10 mm Hg
Intrauterine pressure in L1:: 40-50 mm Hg
Intrauterine pressure in L2 & L3:: 100-120 mm Hg
Intrathoracic pressure:: -3.8 to -6 mm Hg (- 5 to - 8 cm water)
Intrapulmonary pressure:: -1 to +1 cm water
Interstitial pressure:: -5 to 0 mm Hg
Calf pressure during walking:: 200 mm Hg
Venous pressure at the ankle during quiet standing :: 85-90 mm Hg
Cerebral perfusion pressure:: 50-70 mmhg
First breath inflation pressure:: 25 - 40 cm H20
Synovial fluid pressure:: -4 to -6 mm Hg
Epidural negative pressure: -4 to -6 mm Hg

Effects on gravity

Effects of gravity on blood pressure-
Positive g
-occurs while ascending up
-CO decreases
-blood rushed towards lower limb
-black out of vision occurs

Negative G
-occurs while diving
-blood s rushed towards head
-CO increases
-red out occurs

Magnitude of gravitational effect - 0.77mmHg of vertical distance above/below the heart

Clotting Pathways

Pacemakers in body

Pacemaker of CVS : SA node
Pacemaker of RS   : Pre-botzinger complex
Pacemaker of GIT : Interstitial cells of cajal
Pacemaker of uterine contractions located in tubal ostia

Receptors

Info
1)Slowly adapting deep receptor--Ruffini's end organ
2)Rapidly adapting deep receptor--Paccinian corpuscles
3)slowly adapting superficial receptor is--Merkels disc
4)Rapidly adapting superficial receptor is --Meissners corpuscles

Lung sounds

💨Lung Sounds: Differential Diagnosis

☑Rales(crackles)
🔺Simulated by rolling hair near ear between two fingers.
🔺Best heard on inspiration in lower bases.
🔺Unrelieved by coughing.
🔺Associated with bronchitis, CHE and pneumonia.

☑Wheezes
🔺High—pitched, squeaky sound.
🔺Best heard on expiration over all lung fields.
🔺Unrelieved by coughing.
🔺Associated with asthma, bronchitis, CHF, and emphysema.

☑Rhonchi
🔺Coarse, harsh, loud gurgling.
🔺Best heard on expiration over bronchi and trachea.
🔺Often relieved by coughing.
🔺Associated with bronchitis and pneumonia.

☑Stridor
🔺Harsh, high—pitched, audible sound.
🔺Easily heard without stethoscope during inspiration and expiration

Intestine malabsorption tests

Best test for intestinal malabsorption? D Xylose test

Best test for generalised malabsorption? Fecal fat estimation

Gold std for fat maabsorption? Fecal fat estimation

Test to diagnose pancreatic exocrine def?NBT PABA test

Test to detect B12 malabsorption? SCHILLING test