Injuries and Disorders - Anatomy

The ankle jerk (Achilles) reflex tests the nerve root S1, S2. Biceps reflex tests roots C5, C6. Brachioradialis reflex tests C5, C6, C7. Triceps reflex tests C6, C7, C8 nerve roots. Patellar (knee jerk) reflex tests the L2, L3, L4 nerve roots.

Mast cell functions in allergic responses by release histamine and other chemicals that promote inflammation. Macrophages are part of the innate immune system and function to engulf and remove debris. Neutrophils are also part of the innate immune system and have macrophagic properties, especially when fighting bacterial infection. Natural killer cells bind to and destroy pathogens without the use of antigens.

Calor—or redness—is associated with increased blood flow, which can result from inflammation. During an inflammation response, histamine release results in vasodilation and increased bloodflow, which can cause the infalmmed area to appear red.

A prolonged P-R interval, that does not get progressively longer is typical of a type I A-V block.

Troponin is a complex of proteins that play an important role in skeletal and cardiac muscle contraction. Troponin is released into the bloodstream when there is damage to the heart. This is a common diagnostic laboratory test for patients with heart problems or chest pain.

Amenorrhea: no appearance or cessation of menstruation

Polymenorrhea: menstruation less then 21 day interval

Metrorrhagia: intercyclic or irregular menstruation

Dysmenorrhea: intermittent, cramping pain accompanying menstruation

Blood is around 55% plasma, 45% erythrocytes (red blood cells), and less than 1% of leukocytes and platelets.

This man is suffering from acute inflammatory demyelinating polyradiculoneuropathy (AIDP), also known as Guillain-Barre Syndrome. As suggested by the name, the pathology is due to demyelination.

AIDP is a symmetric ascending paralysis that begins in the feet and ascends to the trunk and upper extremities. The paralysis will often impair breathing and frequently affects the facial nerve as well. This disease commonly follows an illness, especially infectious diarrhea caused by Campylobacter jejuni. The immune response to foreign antigens mistakenly targets host nerve tissues, specifically the myelin sheaths.

Inhibition of ACh release into synaptic cleft can also result in weakness, but describes the effects of botulinum toxin in botulism. The toxin is made by the bacteria Clostridium botulinum as a foodborne illness. Patients experience weakness, trouble seeing, fatigue, and possible speech difficulties. Muscular weakness may follow. Diagnosis is made by identifying the toxin in food or feces.

Blockade of action potentials is seen in conduction blockages as a result of nerve injury, such as neuropraxia, axonotmesis, or neurotmesis.

Blockade of presynaptic voltage-gated calcium channels describes Lambert-Eaton Syndrome, a presynaptic neuromuscular junction disorder characterized by muscular weakness of the limbs. It is an autoimmune condition that attacks presynaptic voltage-gated calcium channels. Proximal muscles are affected first, so patients have difficulty climbing stairs or standing up from sitting. They also may have difficulty reaching over their head or combing their hair. Diagnosis is made by EMG, which shows normal latency and conduction velocities, but small amplitudes. Rapid bursts of stimuli or exercising the muscle will lead to greatly increased amplitudes due to an influx of calcium.

Blockade of postsynaptic ACh receptors is seen in myasthenia gravis, a postsynaptic neuromuscular junction disorder very similar to Lambert-Eaton Syndrome. It is an autoimmune disorder directed against postsynaptic acetylcholine receptors and is characterized by easy fatigue. Muscles become progressively weaker with activity, so patients tend to have symptoms at the end of the day. Earliest signs include difficulty keeping the eyes open, or difficulty with chewing, speaking, or swallowing. EMG studies will show progressively decreasing amplitudes with repeated stimuli.

"Sawtooth" P waves are characteristic of atrial flutter.

Benign prostatic hypertrophy is usually seen in the transitional zone. Most carcinomas originating in the peripheral zone. The posterior zone does not exist.

Celiac disease is an autoimmune response in which the body attacks the brush border of the small intestine and therefore prevents proper nutrient absorption. The small intestine's brush border is made of many small protrusions called villi and microvilli, which increase surface area in order to increase absorption area. Without these areas of absorption, the body cannot absorb a sufficient amount of necessary nutrients from the diet.

Blood collecting in the left upper quadrant would suggest a splenic laceration.

The spleen is one of the most commonly injured organs with blunt abdominal trauma. It can and will bleed enough to make a patient hemodynamically unstable. Ultrasound performed in the trauma bay looks at four potential spaces of fluid collection: Morrison's pouch (right upper quadrant/liver), splenorenal recess (left upper quadrant/spleen), subxiphoid (heart), and the pouch of Douglas (suprapubic/pelvis). The liver is located in the right upper quadrant of the abdomen and the spleen in the left upper quadrant

This patient's ultrasound showed fluid collection in the perisplenic space as well as extensive bleeding, which would suggest a splenic laceration as the cause of the patient's condition.

The liver is in the right upper quadrant. The right and left iliac arteries are in the right and left lower quadrants, respectively. Bladder laceration would result in fluid collection in the pelvis.

Giardiasis is the disease caused by the Giardia parasite. The parasite is passed through feces and can live up to several weeks outside of a host. Common symptoms of giardiasis is diarrhea, gas, stomach cramps, and dehydration. It is treated via prescription medication. Gastritis is characterized by inflammation of the stomach. In giardiasis, the intestines are affected. Gout is a rheumatoid disease and is not caused by an infectious agent. Geranium is a type of flower.

Salmonella is an illness caused by a bacterium. Salmonella is often found in raw egg or poultry. It typically presents with gastrointestinal discomfort, diarrhea, and fever. It can be treated with antibiotics, but rarely becomes serious unless it is present in the old, the young, or the immunocompromised.

The correct answer is the lower esophageal sphincter. In "heartburn," a patient's lower esophageal sphincter, which separates the distal esophagus from the proximal stomach, transiently relaxes its tone, inappropriately allowing food/digestive contents that have been acidified for digestion in the stomach to travel backwards into the distal esophagus. In patients with normal lower esophageal sphincter tone, i.e. without GERD, digestive contents that have passed to the stomach remain in the stomach without traveling backwards and causing an acidic, burning sensation in the esophagus.

The other answers are incorrect for the following reasons:

The epiglottis prevents food from being swallowed into the airway by closing off the airway temporarily during swallowing. It does not separate the esophagus from the stomach.

The upper esophageal sphincter is located proximally in the esophagus and opens to allow food to enter the esophagus from the pharynx. It does not separate the esophagus from the stomach.

The ileocecal valve is located distally in the small intestine, separating the ileum from the cecum of the colon. It functions to prevent colo-ileal reflux, but not gastro-esophageal reflux.

The left mainstem bronchus does not play any role in digestion of food or acid reflux, as it is part of the more distal respiratory tract.

Thiamine is a vitamin required for the metabolism of carbohydrates and amino acids. Deficiency of this vitamin results in beriberi, a disease typically of the malnourished. Symptoms of this disease manifest in many different ways such as heart failure, neuropathy, and leg swelling.

Acute diverticulitis: left lower quadrant

Acute pancreatitis: epigastric, can radiate to back, poorly localized, leaning forward may help alleviate pain, laying supine aggravates. May have positive Grey Turner's sign and Cullen's sign.

Acute cholecystitis: Right Upper Quadrant, Positive Murphy Sign, may radiate into right shoulder and scapula

Peptic ulcer: epigastric, may radiate to back, wakens patient at night, possible relief with certain foods, gnawing/aching pain, heartburn

Gout is a rheumatic disease that features monosodium urate crystals in tissue as the result of excess levels of uric acid in the blood stream. This can be caused by over or under excretion of uric acid. Gout can be both acute or chronic. Obesity, alcohol consumption, meat-rich diets, and poor kidney function are all risk factors. Ebola is an infectious virus that causes hemorrhagic fever. Asthma is a form of COPD (the other is chronic bronchitis), and is characterized by bronchoconstriction, causing difficulty breathing, especially when exhaling.

Hypernatremia. A pathological heart, is a heart that is not functioning properly. The kidneys rely heavily upon the heart for their perfusion and alteration to their perfusion will cause the activation of the renin-angiotensin-aldosterone system (RAAS). Thus, a pathological heart, which cannot adequately perfuse the kidneys with blood, will lead to the activation of the RAAS, causing hypernatremia (from increased aldosterone levels).