Case 1 Unveil Independent Learning

Question 1

What do NSAIDs do

Answer 1

Inhibit PGHS-2 dervied prostaglandins (e.g. PGE2) which reduces the extend and duration of local inflammation caused by vasodilation and increased vascular permeability

Question 2

What two effects do NSAIDs have

Answer 2

Analgesic and anti-pyretic

Question 3

What does analgesic mean

Answer 3

Decrease in pain and swelling

Question 4

What does anti-pyretic mean

Answer 4

Decrease in temperature

Question 5

How do NSAIDs exert their anti-pyretic property

Answer 5

NSAIDs inhibit hypothalamic PGHS-2 which normally generates PGE2 in response to circulating pyrogens. So by blocking PGE2 you stop pyrexia

Question 6

How do NSAIDs decrease pain and swelling

Answer 6

Largely due to PGH2. PGH2 supercharged the pain response

Question 7

What is the full name form aspirin

Answer 7

Acetyl salicylic acid

Question 8

What is the only irreversible inhibitor of PGHS-1 and PGHS-2

Answer 8

Aspirin

Question 9

Describe the mechanism of action of aspirin

Answer 9

Acetylation of serine reside in the COX domain active site

Question 10

What is the origin of aspirin

Answer 10

Willow tree bark containing salcin

Question 11

Describe ibuprofen

Answer 11

It is produced as a racemate, the S-enantiomer is the active NSAID

Question 12

Describe the mechanism of action of ibuprofen

Answer 12

It competes with AA for the COX domain site of PGHS-1 and PGHS-2. It is a reversible, competitive inhibitor

Question 13

Describe the origin of ibuprofen

Answer 13

Derived from propanoic acid

Question 14

Why may paracetamol be chosen over NSAIDs

Answer 14

It can have better analgesic and anti-pyretic effects

Question 15

What is one thing paracetamol doesn’t do that NSAIDs do

Answer 15

Little anti-inflammatory activity

Question 16

What is the mechanism of action of paracetamol

Answer 16

May affect peroxidase domain activity in PGHS-2 or PGHS-3 in the CNS or its metabolites may be having affects in the CNS>

Question 17

Describe the WHO pain ladder

Answer 17

Mild pain- paracetamol. Moderate pain- paracetamol/ weak opiods (codine). Strong pain- strong opiods (morphine/ heroine)

Question 18

What converts phospholipids to AA

Answer 18

Phospholipase A2

Question 19

Describe stage 1 of a bruise

Answer 19

Red bruise- fresh blood from capillaries, well oxygenated

Question 20

Describe stage 2 of a bruise

Answer 20

Blue bruise (around 24 hours later), oxygen is used up

Question 21

Describe stage 3 of a bruise

Answer 21

Purple bruise (2-4 days later) RBCs break down and release Hb

Question 22

Describe stage 4 of a bruise

Answer 22

Green bruise (5-7 days later) Hb broken down into verdin

Question 23

Describe stage 5 of a bruise

Answer 23

Yellow bruise (1-2 weeks later) verdin is converted to bilirubin

Question 24

Describe stage 6 of a bruise

Answer 24

(2-4 weeks later) pale discoloration of bruise

Question 25

Describe the timescale of a wound healing

Answer 25

1. Haemostasis. 2. Inflammatory phase. 3. Proliferation and migration. 4. Maturation

Question 26

Describe proliferation and migration

Answer 26

Granulation (in granulation tissue fibroblasts produce collagen and ECM, neutrophils and capillaries needed for angiogenesis). Contraction- wound can feel itchy (myofibroblasts) and epithelialisation

Question 27

Why will the timescale on healing be shorter due to having stitches

Answer 27

1st intention rather than 2nd intention

Question 28

Describe maturation

Answer 28

When the collagen is remodelled from type 3 to type 1, and small blood vessels decrease

Question 29

Describe serous exudate

Answer 29

Exudate during inflammatory wound healing stages (excessive is a sign of high bioburden)

Question 30

Describe sanguinous exudate

Answer 30

Fresh blood- indicator wound bed has undergone trauma such as dressing change, small amount is usual during inflammation

Question 31

Describe purulent discharge

Answer 31

Milky/ green/ yellow colour and thick, indication of infection

Question 32

What does discharge aid

Answer 32

Cells t migrate into the affected area e.g. WBCs

Question 33

Describe a fibroclot

Answer 33

A scab which contains neutrophils and macrophages which secrete growth factor

Question 34

What are neutrophils replaced by in the wound

Answer 34

After 48-96 hours neutrophils are replaced by macrophages as the predominant cells in the wound

Question 35

What type of cut requires a suture

Answer 35

Secondary intention, wound 6.5mm deep or 20mm long