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Block 4 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What are the pharmakinetics of aspirin?

A
  • pKa of 3.5
    • low pH favors absorption rapidly in the stomach
  • unmetabolized salicylates are excreted by kidney
  • under low to moderate [aspirin] it is 1st order kinetics but if its high then its zero order kinetics
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1
Q

When does fibrosis occur?

A
  • usually forms because of chronic inflammation
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2
Q

What are the basic steps of scar formation

A
  • tisue injury
  • inflammation
  • formation of granulation tissue
    • angiogenesis with VEGF
  • scar formation
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3
Q

What is the innervation of the pectoralis minor?

A
  • Medial Pectoral Nerve
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3
Q

What is hyperplasia?

A
  • increased number of cells from persistent stress/stimulus
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4
Q

What is the function of COX-2 and what is it associated with?

A
  • makes prostaglandins from arachiodonic acid
  • response is inducible, inflammatory response
  • associated with
    • inflammation
    • Pain
    • fever
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5
Q

What are the four types of adhesion molecules?

A
  • Selectins
  • Vascular addressins
  • Intregrins
  • Immuoglobulin superfamily
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6
Q

What are the clinical symptoms of infammation?

A
  • Redness - vasodilation
  • Heat - vasodilation
  • Pain - hyperalgesia, sensitization of nociceptors
  • Swelling - increased vascular permeability
  • Loss of function

arthritic disroders have the same symptoms but as have subsequent tissue damage. Cant usually cure but manage the symptoms

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7
Q

What are the arachidonic acid metabolites?

A

phospholipids > (phospholipase A2) > Arachidonic Acids

  • LOX will produce leukotrienes that will cause phagocyte mobilization and changes in vascular permeability > inflammation
  • COX will produce prostaglandins > inflmmation
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8
Q

What are the treatment issues of the acute stage?

A
  • symptoms often resolve on their own
  • psychotherpay for depression, anxiety, anger, grief, pain
  • pharmacotherpay for sleep, depression, anxiety, pain
  • social support is important
  • premorbid physchopathology should be treated
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8
Q

How are cell and tissue injuries recognized by the body?

A
  • Damaged tissues express Damage associated molecular patterns (DAMPs)
  • Leukocytes have DAMP receptors
  • binding initiates intracellular signaling pathway active > mediator production > inflammation
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8
Q

Use of oxicams?

A
  • inhibit COX-1 and COX-2
    • used for long term treatment of RA or osteoarthritis
    • long half life
  • bleeding and ulceration
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8
Q

What is first intention wound healing?

A
  • surgically bringing the two skin edges together to allow the wound to heal more uniformly
  • more of a comestic fix
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9
Q

What is the function of COX-1 and what is it associated with?

A
  • Produces prostaglandins from phospholipids
  • constitutive, physiological regulation
  • Associated wth
    • platelet function
    • GI mucosal integrity
    • Renal function
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10
Q

What are the borders of the axilla?

A

Located below the should joint

  • pectoralis major anteriorly
  • latissimus doris posteriorly
  • serratus anterior medially
  • humerus laterally
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11
Q

What is a keloid?

A
  • hypertrophy of collagen cells
  • looks like a large growing mass
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12
Q

What are the movements of the levator scpaulae?

A
  • elevates and medially rotates scapula
  • pulls glenoid cavity inferiorly
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12
Q

What is the blood and nerve supply of supra and infraspinatus?

A
  • suprascapular nerve and artery
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12
Q

What is the blood and nerve supply of subscapularis muscle?

A
  • upper and lower subscapulars and circumflex scapular artery
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13
Q

What is the blood and nerve supply of teres minor?

A
  • axillary nerve
  • posterior humeral circumflex artery
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13
Q

What is lipid peroxidation?

A
  • oxidative degradation of lipids
  • oxygen molecules steal the electrons in the plasma membrane that results in cell damage
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13
Q

Naproxen (Aleve)

A
  • commonly used for reduction of
    • pain
    • fever
    • inflammation (osteoarthritis, gout, RA, kidney stones, tendinitis, bursitis)
    • stiffness
  • may have antiviral activity against the flu
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14
Q

What is the innervation of the serratus anterior?

A
  • long thoracic nerve

serratus anterior keeps the medial border of the scapula tight against the ribs, if there is damage to the long thoracic, you get winging of the scapula

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14
Q

What are the 3 posterior forearm musles to the thumb?

A
  • Abductor pollicis longus
  • extensor pollicis brevis
  • extensor pollicis longus
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14
Q

What are the cardinal signs of inflammation?

A
  • Rubor – redness
  • Tumor – swelling
  • Calor – heat
  • Dolor – pain
  • Function laesa – loss of function
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15
Q

What is the segmental innervation of the Shoulder? Elbow? Wrist?

A
  • Shoulder C5,6
  • Elbow C6,7
  • Wrist C7,8
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17
Q

What are the movements of the rhomboids?

A
  • elevates scapula
  • adducts scapula
  • medially rotates scapula
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17
Q

Disease Modifying Antiarthritic Drugs (DMARDs)

A
  • Azathioprine - purine synthesis inhibitor
  • Ciclosproin - calcineurin inhibitor
  • Methotrexate (MTX) - purine metabolism inhibitor
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19
Q

What are the actions of the pectoralis major at the glenohumeral (GH) joint?

A
  • Flexion
  • Adduction
  • Medial rotation
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20
Q

What movements occur at the sternoclavicular joint?

A
  • vertical axis
    • protraction/retraction
  • AP axis
    • elevation/depression
  • Oblique axis
    • medial/lateral rotation
    • movement of the scapula up and down
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21
Q

What is purulent inflammation?

A
  • Characterized by the production of pus, an exudate consisting of neutrophils, liquefied debris of nercrotic cells and edema fluid (abscesses)
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21
Q

What is the inflammation process?

A
  • Microbes or necrotic tissue
  • Stimuli recognized by sentinel cells
    • produce mediators
  • leukocytes and plasma proteins are recruited from circulation
    • elminate microbes and dead tissue
  • Remove tissue damage and repair
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23
Q

What is the innervation of the deltoid?

A
  • Axillary nerve
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23
Q

What is salcicylism and what are the symptoms? How do you treat?

A
  • overdose of aspirin
  • adults
    • tinnitus
    • hearing loss
    • vertigo
  • children
    • acidosis
    • hyperventilation
    • lethargy
  • treatment
    • bicarbonate
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24
Q

Name the branches off the axillary artery

A
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26
Q

What is the innervation of the Teres Major?

A
  • lower subscapular
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27
Q
A
29
Q

What are the psychosocial issues in the resuscitative or critical stage

A
  • stressors of ICD
  • cognitive: drowsiness, confusion
  • delirium and brief psychotic reactions
  • intubation
  • pain
  • sleep disturbance
  • family is anxious and distressed
30
Q

What are the two joints of the clavicle?

A
  • sternoclavicular joint (sc)
    • connects clavicle to manubrium
  • Acromioclavicular joint (ac)
    • acromial end of clavicle (flat end) to the acromian of scapula
31
Q

What is the nerve supply of the levator scapulae?

A
  • Dorsal scapular
31
Q

How does wound healing occur?

A
  • Occurs during inflammatory process but doesn’t finish until the original stimulus is eliminated
  • Injured tissue is replaced by
    • Regeneration of native parenchymal cells
    • Filling with fibrous tissue (scarring)
    • Combination of both
33
Q

What is contained within the quadrangular space?

A
  • located underneath the deltoid
  • quadangular space borders
    • superior - teres minor
    • medially - long head of the triceps
    • inferior - teres major
    • laterally - lateral head of the tricpes
  • contents
    • axillary nerve
    • posterior circumflex huemral artery
35
Q

What ligaments make up the sternoclavicular (SC) joint?

A
  • sternoclavicular ligament
  • articular disc
    • between clavicle and manibrium
    • made up fibrocartilage
  • costoclavicular ligament
36
Q

What is mitochondrial permeability transition?

A
  • large increase in intracellular [Ca2+] will go to mito and mess with oxidative phosphoyrlation = mito permeability transition
  • leads to necrosis
37
Q

What is the nerve supply to the rhomboids?

A
  • dorsal scapular nerve
37
Q

What is helaing by second intention?

A
  • extensive tissue damange and loss
  • edges can not be brought together
  • scarring is much more typical
39
Q

What are the movements of the latissimus dorsi?

A
  • powerful adductor
  • extensor
  • if the the glenohumeral joint is stabilized
    • latissimus dorsi will help to retract adn depress the shoulder girdle at the SC joint
40
Q

What is the innervation of the latissimus dorsi?

A
  • throacodorsal nerve
42
Q

What are the ligaments of the acrmioclavicular (AC) joint?

A
  • coracoclavicular ligament
  • coracoacromial liagment

shoulder seperation occurs at AC joint if you tear these ligaments

43
Q

What is hypertropy?

A
  • Enlargement of the cell
    • results in an overall increase in volume in the organ or tissue
43
Q

What is fibrinous inflammation?

A
  • Develops when vascular leaks are large or there is a local procagulant stimulus
45
Q

What is the mechanism of action of aspirin?

A
  • Asprin covalently and ireversibly modifies both COX-1 and COX-2 by actylating serine 530
    • blocks arachidonic acid from binding
  • also inhibits thromboxane A2 it supresses platelet adhesion and aggregation
46
Q

What is metaplasia

A
  • when one cell type swtiches to another cell type

usually reversible if noxious stimulant is removed

48
Q

Name the cutaneous innervation

A
49
Q

Allopurinol?

A
  • inhibits synthesis of uric acid by inhibiting xanthine oxidase
  • used with caution in patients with liver disease or bone marrow depression
51
Q

What are the movements around the glenohumeral joint?

A
  • Horizontal transverse axis
    • flexion/extension
  • Horizontal AP axis
    • abduction/adduction
  • Vertical Axis
    • lateral medial rotation
53
Q

What muscles make up the rotator cuff muscles? What action does each muscle have?

A
  • supraspinatus
    • abduction
  • Subscapularis
    • medial rotation
  • Infraspinatus
    • lateral rotation
  • Teres minor
    • lateral rotation
54
Q

What are the movements of the trapezius?

A

Divided in three parts

  • superior
    • contraction causes the scapula towards the skull
    • laterally rotates the scapula upward
  • middle
    • abduct the scapula medially
  • inferior
    • depress the scapula inferiorly
    • laterally rotate the scapula upward
55
Q

Ibuprofen

A
  • stronger antipyretic, analgesic and anti-inflammatory
  • vasoconstriction, vision damage
57
Q

What are the contents of the axilla?

A
59
Q

What is the neural innervation of the trapezius?

A
  • CN XI
    • supplies motor
  • cervical segments C3 adn C4
    • supply proprioceptive
60
Q

What is compartment syndrome?

A
  • trauma to the forearm that causes swelling that is rescrited by the fascial compartments
  • elevated pressure in compartment can cause further damage to all structures due to blood flow impairment
61
Q

What is necrosis?

A
  • premature cell death by autolysis

can be the result of blood flow loss (isschemic/coagulative necrosis), trauma, infection,

liquefactive necrosis - cells liquify

62
Q

What are the actions of the deltoid muscle at the glenohumeral joint?

A
  • Anterior
    • flexion
    • adduction
    • medial rotation
  • Middle
    • abduction
  • Posterior
    • extension
    • adduction
    • lateral rotation
63
Q

What is serous inflammation?

A
  • Exudation of cell-poor fluid into spaces created by cell injury or into body cavities lined by peritoneum, pleura, or pericardium
64
Q

What does VEGF do?

A
  • Vascular Endothelial growth factor
  • stimulates angiogenesis
65
Q

What does TGF and EGF do?

A
  • Transforming Growth Factor
    • stimulates fibroblasts to help develop the ECM
  • Epidermal Growth Factor
67
Q

What is the scapulohumeral rhythm?

A
  • of the 180° abduction of the arm
    • 120° takes place at glenohumeral joint
    • 60° happens sternoclavicular joint
  • 2:1 ratio of combination of movements
68
Q

What are the actions of the serratus anterior at the Sternoclavicular (SC) joint?

A
  • Depresses on AP axis
  • Protracts on vertical axis
  • Laterally rotates on oblique axis
69
Q

What defines the movement in the oblique axis of the sternoclavicular (SC) joint?

A
  • movement of the inferior angle in either a lateral or medial direction = lateral and medial rotation
70
Q

Indomethacin

A
  • ankylosing spondylitis
  • Reiter syndrome: reactive arthritis due to a bacterial infection
  • acute gouty arthritis
  • Speed the closure of patent ductus arteriosus in premature infants

DONT USE AS SIMPLE ANALGESIC OR ANTIPYRETIC or long term use

  • ulcers, life-threatening shock, severe or lethal hepatitis
72
Q

What is the action of the teres major at the glenohumeral joint?

A
  • Extension
  • Adduction
  • Medial rotation
73
Q

What are the adverse effects of aspirin?

A
  • GI problems
  • allergic reaction: bronchospasm
  • hematologic effects: antiplatelet
  • renal damage
  • Reye’s syndrome (kids) - severe hepatic damage (fatty liver) and encephalopathy
74
Q

What are the treatment issues of te resuscitative or critical stage?

A
  • physical survival is main goal
  • use existing coping skills and defense mechanisms
  • manage pain
  • comfort patient
  • education and support family members
75
Q

What are the movements of the pectoralis minor?

A
  • actions on girdle
    • depressses
    • protracts
    • medially rotates
76
Q

What is the innervation of the pectoralis major muscle?

A
  • medial and lateral pectoral nerve
76
Q

Where do most posterior forearm muscles arise from?

A
  • arise from the common extensor tendon off the
    • lateral epicondyle
    • supracondylar ridge

exceptions: three thumb muscles, extensor indices and supinator

77
Q

What is a common cause of fever?

A
  • produced by production of pyrogens released by neutrophils
  • Released at the hypothalamus to elevate the set point
  • late response
    • COX-2 and microsomal PGE sythase-1 in blood vessels in the hypothalamus forms PGE2
    • PGE2 triggers the hypothalamus to elevate body temp
77
Q

What are the clinical uses of aspirin?

A
  • Fever
  • Pain (mild to moderate)
  • Rheumatic fever
  • inflmmatory diseases
  • Lower doses of aspirin have shown reduced risk of death from a heart attack
79
Q

Drugs for gout?

A
  • probenecid and sulfinpyrazone
    • prevents the reabsorption of uric acid
    • chronic acid with colchicine
  • can cause GI disturbances and dermatitis
80
Q

What are the psychological issues of long term rehabilitation?

A
  • adjusting to physical limitations
  • physical: itching, limited endurance, decrease in function, amputations
  • depression, anxiety, grief, PTSH
  • adjustment
    • physical appearance
    • return to work
    • financial problems
    • family stain
81
Q

What are the treatment issues at the long term rehabilitation stage?

A
  • outpatient psychotherpay for adjustment, grief, depression, anxiety, PTSH
  • social skills training
  • prepare burn victims community
  • encourage social support
  • improving self esteem
  • vocation rehabilitation
  • address premorbid psychopathology
83
Q

Use of Acetaminophen?

A
  • for analgesic and antipyretic effects
    • no lack of anti-inflammatory effects
  • lacks gastric problems, no platelet interference, half life of 2-3 hrs

High levels can cause liver toxicity

84
Q

What are the psychosocial issues of the acute stage?

A
  • patients start to understand impact of injuries
    • guilt and or anger
    • grief
    • loss of faith
  • depression
  • generalized anxiety
  • sleep disturbance
  • PTSD or acute stress disorder
85
Q

How are pathogenic microbes recognized

A
  • many microbes have highly conserved Pattern Associated patterns (PAMPs)
  • Leukocytes have Pattern Recognition Receptors (PRR)
    • Toll-like receptors
    • Usually promotes phagocytosis
  • Binding causes intracellular pathways to be activated > mediators production> inflammation
86
Q

What are the sites of collateral in the shoulder?

A
  • dorsal scapular
  • suprascapular artery
  • posterior circumflex humeral artery
  • circumflex scapular from subscapular artery
87
Q

Use of colchicine?

A
  • alkaloid
  • used for relief of inflammation and pain in acute gouty arthritis
    • drug of choice for acute attacks
  • takes 12-24 hours for pain relief
  • side effect
    • diarrhea

NSAIDS (indomethacin, naproxen and sulindac) are preferred to colchicine

88
Q

What are the reactive oxygen species (ROS)?

A
  • H2O2
  • OH
  • O2-
89
Q

What causes perfusion injury?

A
  • Oxygen Free radicals
  • Ca2+ overload
90
Q

When cells are stressed what they may retain or uptake?

A
  • Iron
  • Fat
91
Q
A

Block 4 (3 decks)

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