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Block 4 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Scapula label

A
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2
Q

Where is scapula connected to clavicle?

What does it form with clavicle?

A

Acromion

Shoulder gridle

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3
Q

What is special about clavicle with respect to the development?

What is the orgin?

A

First long bone to ossify wk5-6 and last one to fuse 25 yo

membranous origin

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4
Q

Two joints of clavicle

A

Sternoclavicular joint

Acromioclavicular joint

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5
Q

What is one structure that connects arm to the axial skeleton?

A

Clavicle

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6
Q

Label ligaments

A
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7
Q

Where does the shoulder separation occur?

WHere does the shoulder dislocation occur?

Where does the clavicle break most often?

A

AC joint

glenohumeral joint

Middle/lateral thirds

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8
Q

What is unusal about Strenoclavicular joint

What is the disc made of?

A

Two bursas separated by articular disc

Fibrocartilage

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9
Q

Movements of the Sternoclavicular Joint

Axis? Movement

A

Vertical axis —– protraction/retraction

AP axis —– elevation/depression

Oblique axis —– medial/lateral rotation

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10
Q

How much degree of abduction occurs at glenohumeral joint?

How much occurs at sternoclavicular joint?

What is the name of this movement?

A

120

60

scapulohumeral rhythm

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11
Q

Movements of the Trapezius

Verical axis?

AP axis?

Oblique axis?

A

Retract

(Superior) elevates (Infectior) depresses

Rotate

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12
Q

Trapezius Muscle

Nerve supply

A

Spinal accessory nerve (XI) Supplies motor

Cervical segments C3 & C4 Supply proprioceptive

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13
Q

Latissimus Dorsi

Direction of movement?

Nerve supply?

Connects between?

A

Adduction / Extension

Thoracodorsal nerve (middle subscapular)

Thoracolumbar fascia to humerus

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14
Q

Superficial (extrinsic) Back Muscles

Movement?

Nerve?

A

Medially rotate scapula

Dorsal Scapular nerve

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15
Q

Levator scapula

Movement?

Nerve?

A

Elevates and medially rotates scapula

Dorsal Scapular

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16
Q

Pectoralis Minor

Movememnts?

Nerve?

A

Medial Pectoral Nerve

Depresses, Protracts, Medially Rotates

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17
Q

Serratus Anterior

Movement? Structural importance?

Innervation?

A

Depression, protraction, lateral rotation

Holding medial border of scapula close to ribs

Lorng Thoracic Nerve

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18
Q

What is winging

A

Loss of serratus anterior function e.g. loss of the neve

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19
Q

Muscles of the SC-joint

Protraction

Retraction?

Elevation?

Depression?

Medial rotation?

Lateral rotation?

A
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20
Q

Movements of glenohumeral joint

A

Horizontal transverse axis —– flexion/extension

Horizontal AP axis —– abduction/adduction

Vertical axis —– rotation

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21
Q

Structures protecting muscle around Glenohumeral joint

A

Subdeltoid bursa

Subacromial bursa

Biceps brachii tendon

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22
Q

Pectoralis Major

Nerve?

Movement?

A

Medial and Lateral Pectoral

Flexion, Adduction, medial rotation

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23
Q

Deltoid

Movement?

Innervation?

A

Axillary

Flexion: Anterior

Extension: Posterior

Abduction: Middle

Adduction: Posterior and Anterior

Medial Rotation: Anterior

Lateral Rotation: Posterior

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24
Q

Teres Major

Innervation?

A

Middle Subscapular or thoracodorsal (Latissimus)

Lower Subscapular (Teres)

Extension

Adduction

Medial Rotation

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25
Q

SITS

Function?

A

Supraspinatus

Infraspinatus

Subscapularis

Teres Minor

Stabilization of glenohumeral joint

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26
Q

How medial vs. lateral rotation affects abduction?

A

External rotation of the humerus during flexion or abduction prevents the greater tubercle from hitting the acromion.

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27
Q

Name the rotator cuff

A
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28
Q

Glenohumeral joins all movements and muscles

A
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29
Q

Blood supply and nerves for

Supra/infraspinatus?

Teres minor?

Subscapularis?

A

Supra and infraspinatus- suprascapular nerve + artery

Teres minor –axillary nerve and post humeral circumflex artery

Subscapularis – upper and lower subscapulars + circumflex scapular art

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30
Q

Collateral Flow of glenohumeral

A

Dorsal scapular

Suprascapular artery

Posterior circumflex humeral artery

Circumflex scapular from subscapular artery

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31
Q

Bones

A
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32
Q

Bones

A
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33
Q

Axillary arteries

A

superior thoracic
thoracoacromial trunk
lateral thoracic
subscapular
circumflex scapular
- thoracodorsal
- posterior humeral circumflex
anterior humeral circumflex

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34
Q

What is axilla?

A

The space below the shoulder joint, bounded by the pectoralis major anteriorly, the latissimus dorsi posteriorly, the serratus anterior medially, and the humerus laterally.

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35
Q

Posteior wall of Axilla

Members?

A

Subscapularis

Teres major

Latissimus dorsi

Thoracodorsal artery + nerve (to latissimus dorsi)

Quadrangular space with axillary nerve and posterior circumflex humeral artery

Anterior circumflex humeral artery

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36
Q

Medial Wall of Axilla

what muscle is it?

A

Serratus anterior

Long thoracic nerve

Lateral thoracic artery

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37
Q

What part of brachial plexus passes through axilla?

A

Medial cord

Lateral cord

Posterior cord

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38
Q

Brachial plexus

A

Roots: C5-T1

Turnks: Upper, Medial Pattern

Divisions: Anteior Posterio

Cord: Lateral Medial Posterior

Branches: Ulnar, Radial, Musculocutaneous, Median, Axllary

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39
Q

General patters of innervations to hand

A
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40
Q

Innervations of anteior compartment of arm?

Innervation of posterior compartment of arm?

A

Anterior compartment
anterior arm-musculocutaneous
anterior forearm-all median except FCU+2 heads of FDP (ulnar)
anterior hand-all ulnar except thenar comp muscles + lumbricals to the functional midline on radial side (median)

Posterior compartment
shoulder-axillary (deltoid and teres minor)
posterior arm & forearm-radial

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41
Q

What are the branches from each cord?

A

Lateral=lat pec,

Post=upper, middle and lower subscapulars,

Medial=M. pectoral, M. brachial, M. antebrachial cutaneous

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42
Q

Two compartments of arm and their components

A
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43
Q

Components for compartment of arm

A

Biceps brachii

Long head

Short head

Coracobrachialis

Brachialis

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44
Q

Triceps 3 heads

A
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45
Q

Damage of Terminal Branches affecting the Arm

Axillary nerve?

Musculocutaneous nerve?

Radial nerve?

A

Axillary nerve-severely weakened abduction, weakened lateral rotation

Musculocutaneous nerve- almost no forearm flexion, weakened arm flexion

Radial nerve-no forearm extension, arm may be slightly flexed

(note also has major effect on forearm and hand, see later)

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46
Q

Three joints on hand

A 
metacarpophalangeal (MP)
proximal interphalangeal (PIP)
distal interphalangeal (DIP)
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47
Q

What flexor acts on

distal interphalangeal joint?

proximal interphalangeal joint?

A

Flexor digitorum profundus - distal

Flexor digitorum superficialis - proximal

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48
Q

Structure that surrounds all ligments of the hand?

A

Retinaculum

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49
Q

Where does most of posterior muscles originate from?

Exceptions?

A

lateral epicondyle or the supracondylar ridge

The exceptions are the three thumb muscles, the extensor indices and the supinator

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50
Q

Posterior Forearm (Thumb Muscles)

A

Abductor pollicis longus (APL)

Extensor pollicis brevis (APB)

Extensor pollicis longus (EPL)

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51
Q

Anatomical Snuffbox

Contents

A

Radial artery

Base of 1st metacarpal

Styloid process of radius

Crossed by dorsal digital branches of radial nerve

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52
Q

Posterior Forearm Muscles

A
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53
Q

Posterior Forearm Muscles

A
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54
Q

Posterior forearm muscles that don’t cross the wrist

A
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55
Q

Pronators and Supinators of forearm

A

Pronator Quadratus

Pronator Teres

Supinator

Biceps

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56
Q

What is innervated by deep Radial Nerve?

A

Posterior forearm muscles except brachioradialis and the externsor carpi radialis longus ECRL

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57
Q

Which radius branch is motor?

Which radius branch is sensory?

A

Deep

Sensory

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58
Q

Hand innervations

A
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59
Q

Compartment Syndrome

A
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60
Q

Arteries of the arm

A

Brachial artery

Profunda brachii artery

Radial recurrent artery

Ulnar recurrent artery

Interosseous arteries

Radial

Ulnar

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61
Q

Where does the blood supply come from to thumb/index?

Where does the blood supply the rest finers?

A

Deep palmar arch

Superficial palmar arch

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62
Q

Connective tissue between radius and ulna

A

Intraosseus membrane

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63
Q

Arteries of the forearm

A
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64
Q

List five muscles in superficial layer of the anterior forearm

A
  1. Pronator teres
  2. Flexor carpi radialis
  3. Palmaris longus
  4. Flexor digitorum superficialis (hidden – intermediate layer)
  5. Flexor carpi ulnaris
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65
Q

What attaches anterior foream superficial muscles?

A

Common flexor tendon

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66
Q

Deep muscle the the anterior forearm

A
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67
Q

What supplies deep anteiror forearm muscle group?

* Except two heads of Flexor digitroum profundus (FDP)

A

Anterior interosseus branche of the median nerve

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68
Q

Wrist flexors

A

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

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69
Q

Finger flexors

A

Flexor digitorum superficialis

Flexor pollicis longus

70
Q

Finger Flexors

A
71
Q

Musculocutaneous Nerve

A

Motor branches (to ant arm muscles)

Cutaneous branch (lateral cutaneous nerve of forearm)

72
Q

Median Nerve

Innervation?

A

forearm anterior compartment muscles except flexor carpi ulnaris and the medial two heads of FDP (unlar)

Muscular branches to thenar compartment and lumbricals to the 2nd and 3rd digits

Cutaneous innervation of hand (3 ½ digits in hand including dorsal distal phalanges )

73
Q

Ulnar Nerve

Innervations?

A

Muscular branches to forearm and hand

Cutaneous branches to hand

Forearm:

it innervates 1 ½ muscles:

flexor carpi ulnaris &

half of flexor digitorum profundus

Hand:

it innervates all muscles except…

thenar compartment

half the lumbricals (first two on radial side)

Cutaneous innervation

1 ½ digits- note that the dorsal branch of the ulnar leaves much higher in the forearm and can be used in analysis of lesions

74
Q

Radial Nerve in Arm

A

Radial nerve to posterior arm muscles

Posterior cutaneous nerve of forearm

Motor innervation

Arm & Forearm:

it innervates all muscles in the posterior compartment (note innervation of posterior interosseus branch)

Cutaneous innervation

2 brachial cutaneous nerves in arm

Posterior antebrachial to forearm

Superficial radial to hand 3 ½ digits on the posterior surface

75
Q

What is rubor?

What is tumor?

What is calor?

What is dolor?

What is functio laesa?

A

Redness, swelling, heat, pain, loss of function

76
Q

What cells mediate inflammation?

A

Macrophages, mast cells, dendritic cells (myeloid lineage)

77
Q

What recognizes necrosis?

What to these cells produce?

A

Mast cells or macrophages (sentinel cells)

Release

78
Q

Stimuli for inflammation

A

Infections (bacterial, viral, fungal, parasitic) and microbial toxins

Tissue necrosis : ischemia (MI), chemical thermal irradation injury, foregin bodies, hypoxia

Hypersensitivity or immunopathology chronic autoimmune, allergies

79
Q

What triggers inflmmation in case of microoorganisms?

A

Pathogen-associated molecular pattenrs (PAMSs) binds to pattern recognition receptors (PRR)

80
Q

Two types of PRR

A

Toll-Like Receptors

Other receptors (dectin)

81
Q

What triggers inflmmation in case of damaged tissue?

A

damage-associated molecular patterns (DAMPs) aka alarmis (HMGB1-1, S100A8/A9, ATP)

82
Q

Side effect of inflammatory response (general name)?

A

Collateral damage

83
Q

What is scarring?

A

Filling of the defect tissue with firbous tissue

84
Q

Acute vs. Chronic inflammation

A

ACUTE: Rapid onset (minutes) and short duration

CHRONIC: follow acute inflammation or insidious (slow) onset

85
Q

What is half life of neutrophil?

A

Short

86
Q

What releses TNF-a tumor necrosis factor?

What is the target for TNF

A

Macrophage

Endothelium (dilatation)

87
Q

What are the initial effect of actute inflammation on endothelium?

A

Vasodilation

Increase vascular permeability

Recruitment, adhesion, transmigration

Chemotaxis

Phagocytosis

88
Q

What is immediate effect on blood vessels during injury? What follows after?

What is mediators of vasodilatation?

Result of dilatation of blood flow?

A

Vasoconstriction, vasodilation

Histamine and nitric oxide

Greater but slower blood flow (stasis)

89
Q

What causes vascular leakage?

How long does it last?

What can cause damage to endothelium?

A

Histamine and leukotrienes

15-30 min

Severe injuries, microbes, neutrophils migrating

90
Q

What is transudate?

What is exudate

A

Fluid with no cells (low protein content)

Fluid with cells (high protein concentrations)

91
Q

Inflammation of lymphatics?

Inflammation of lymph nodes?

A

Lymphangitis

Lymphadenitis

92
Q

What is the red streaks near a sking would is a clinical sing of?

A

Infection in the wound (streak follows lymphatic channels)

93
Q

What produces chemokines? Example? What are they?

A

Molecules that recurit cells to site of injury, Macrophages, CXCL8

94
Q

Extravasation steps

A

Margination, rolling, and adhesion

95
Q

Four groups of adhesion molecules?

Where are they expressed?

A

selectins, vascular addressins, integrins, and immunoglobulin superfamily

Activated on endothelium

96
Q

What blood vessels allow migration of white blood cells?

What is the name of the molecule that initially grabs WBCs?

Where are adhesion molecules present? Function?

What do leukocytes secrete to enter extravascular tissue?

A

Veins

Selectins

Migration of leukocytes (CD31/PECAM-1)

Collagenases

97
Q

Examples of chemoattractants

A

Chemokines CXCL8

Complement system C5a

Leukotrienes LTB4

Bacterial origin N-formylmethionine terminal amino acid and some lipids

98
Q

Steps of phagocytosis

A

Recognition and attachement

Engulfment of the particle into a phagosome

Fusion of the phagosome with th lysosome to from phagolysosome

99
Q

NADPH oxidase

A

complex of proteins that assembles at the phagolysosome membrane and generates a hostile microenvironment that leads to killing and degradation of ingested materials

100
Q

Pattern of actue inflammation:

Serous inflammation

Fibrinous inflammation

Purulent inflamation

A

Seruous: Exudation of cell-poor fluid into spaces created by cell injury (peritoneum, pleura, or pericardium)

Fibrinous: inflammation develops when vascular leaks are large or there is a local procoagulant stimulus

Purulent inflammation is characterized by the production of pus, an exudate consisting of neutrophils, the liquefied debris of necrotic cells, and edema fluid (abscesses)

101
Q

Outcomes of acute inflamation

A

Resolution

Fibrosis

Chronic inflammation

102
Q

Histopathology

Characteristic of acute inflammation

Chracterstics of chronic inflammation

A

Neutrophilic

Monocytic

103
Q

What occurs when connective tissue replaces the old tissue?

A

Fibrosis and angiogenesis

104
Q

What can cause chronic inflammation?

A

Pathogens such as mycobacteria (hard to eradicate)

Delayed-type hypersensitivity

Autoimmune diseases (rheumatoid arthiritis and multiple sclerosis), Allergic disease (asthma)

Exposure to toxic exogenous (particulate silica and silicosis) or endogenous (plasma lipids and atherosclerosis)

105
Q

Tuberculous Granuloma

histopathology

A

Epitheloid cells and multi-nucleated giant cells

106
Q

What is the most potent macrophage activator?

A

INFg

107
Q

What stiumlates differentiation of macrophage

A

INFg and microbes to classical activation M1 inflammatory

IL13 and IL4 to alternative acitvation M2 anti-inflammatory (repair)

= balance

108
Q

What is stimulated by cytokines TNFa and IL1 in hypothalamus?

What are cytokines?

A

Prostaglandins

Stimulate production of leukocytes from precurosrs in bone marrow

109
Q

Examples of mediators intracellular granules?

Examples of signalling synthesized de novo?

A

Histamine

Prostaglandins, cytokines

110
Q

What causes mast cell degranulation

A

Physical injurt (trauma, thermal)

Antibodies binding to mast cells (allergic reactions)

Complement anaphylatoxins (C3a C5a)

Cytokines (IL-1, CXCL8)

111
Q

What molecules can be released from membrane to initiate inflamation? Enzyme?

Derivatives synthesized by? What molecules are synthesized?

A

Arachidonic acid (AA), phospholipase A2

Cycloocygenases (prostaglandins and thromboxanes) and lipoxygenases (leukotrienes and lipoxins)

112
Q

Platelet activating factor

Importance?

Source?

A

Vasodilator with potency from 100 to 10000 times greater of histamine

Many cells: platelets, basophils, basophils, mast cell, neutrophils, macrophages, and endothelial cells

113
Q

Derivative of NO

Enzymes in macrophages that produces NO

A

Peroxynitrite

Nitric oxide synthetase (iNOS)

114
Q

What are examples of proinflammatory cytokines? Maily produced by?

A

TNF-a, IL-1, and IL-3

115
Q

What synthesizes Arachidonic Acid?

Enzymes that catalyze Arachidonic acids?

A

Phospholipase A

Cytochrome p450 - epoxyeiocosatrienoic acids (vary)

Lipoxygenases - Leukotrienes, Lipoxins (phagocytosis, permiability)

Cyclooxygenases - Prostaglandins, Prostacyclins, Thromboxane (inflammation)

116
Q

COX-1 functions

COX-2 functions

A

COX-1 functions (physiological)

Platelet function

GI Mucosal Integrity

Renal function

COX-2 functions (inflammation)

Inflammation

Pain

Fever

117
Q

What are the effects of prostaglandins on pain?

Side effect of subudral injections of PGE1 with bradykinin/histamine?

A

They sensitize (hyperagesia)

Headache and pain

118
Q

Examples of pyrogens secreted by neutrophils

A

cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6), interferons, and tumor necrosis factor-α (TNF-α)

119
Q

What is the initial thermoregulatory response mediated by?

What regulates late response?

What suppresses PGE2 synthesis?

A

Prostaglandins and ceramide release in preoptic area in anterior hypothalamus = elevation of set point = fever

Coordinate induction of COX-2 and microsomal PGE synthase-1 (mPGES-1). Formation of PGE2. PGE2 corsses BBB acts on EP3 & EP1 receptors on thermosensitive neuros => hypothalamus elvates temperature and decrease heat loss.

NSAIDs

120
Q

What molecules inhibit

A
121
Q

What molecules inhibits inflammatory mediators?

A

5-LOX inhibitors and leukotriene receptor antagonists (Zafirlukast, zileuton)

Corticosteroid (Predinisone, Dexamethasone)

NSAIDs

122
Q

Mechanism of Aspirin

Type of inhibition? Mechanism?

Downstream results?

Used for what condition?

Contraindicated to what patients?

A

Covalent modification (irreverisble inhibition) both COX-1 and COX-2 at serine-530 = acetylation

Results in steric block preventing arachidonic acid binding

* COX-2 retains activity but ptorudces different products

Suppressing platelet adhesion and aggregation

Antiplatelet agent for acute ischemic stroke and prevention of stroke

Platelates disorder, pregnancy (postpartum hemmorage, closing fetal ductus arteriosus)

123
Q

Action of aspirin with varying concentrations

A
124
Q

Uses of aspirin

A
  • *1.Fever**
  • *2.Pain** (mild-to-moderate, such as headache, muscle pain, joint pain, postoperative pain, migraine, etc.)
  • *3.Rheumatic fever**
  • *4.Inflammatory diseases**, such as rheumatoid arthritis, pericarditis, and Kawasaki disease.
  • *5**.Lower doses of aspirin have also shown to reduce the risk of death from a heart attack, or the risk of stroke in some circumstances.
125
Q

pKa of Aspirin

Effect of low pH?

Effect of high pH?

A

3.5

low pH = favors absorption

high pH = favors excretion

126
Q

What metabolizes and what are the metabolites of Aspirin?

A

urine as free salicylic acid (10%), salicyluric acid (75%), salicylic phenolic (10%) and acyl (5%) glucuronides and gentisic acid (<1%)

127
Q

Drug interactions

Heparin

Antiacids

Probenecid, Sulfinpyrazone

Bilirubin, Phenytoin, Naproxen, Thyroxine

A

Hemmorage

Reduced rate of absorption

Decreased urate excretion

Increased plasma concentration

128
Q

Adverse effects of Aspirin

A

Gastrointestinal symptoms (inhibition of COX-1), most common

Gastric mucosal lesions, nausea, and vomiting. Possibly hemorrhage, peptic ulcers, perfoations

Allergic reactions (Hypersnesitivity)

Bronchospasms, rhinitism, conjunctivits

Hematologic effects (Antiplatelet)

Increased blood fibrinolytic activity, thrombocytopenia

Metabolic acidosis

Respiratory alkalosis

CNS

Tinnitus via arachidonic acid and NMDA cascade

Renal damge

Reduction on GFR (inhibition of prostaglandins)

Reye’s sydrome - severe heptic damage (fatty liver) and encephalopathy

129
Q

What is Salicylism?

Dose?

Symptoms adults? Children?

Treatment?

A

Overdose of aspirin / Poisoning

5g/day of aspirin or salicylate

Adults: tinnitus, children: acidosis and hyperventillation

NaHCO3 (prevent uptake) IV, correction of acid-base disturbance, electrolyte replacement, cooling, forced diuresis

130
Q

Contraindication of aspirin

Gastrointestinal?

Circulatory?

Immune?

Respiratory?

Children?

A

Stomach bleeding, peptid ulcers, gastritis

Hemophilia, bleeding

Allergic

Asthma or NSAID bronchospasm

Kidney disease, hyperuricemia, or gout

Reye’s syndrome (cold or influenza symptoms)

131
Q

5 COX-2 selective inhibitors

A

Celecoxib

Valdecoxib

Rofecoxib

Etoricoxib

Lumiracoxib

132
Q

Families of NSAIDs

A
133
Q

Ibuprofen

Examples?

Type? Function?

Application?

A

Advil, Motrin, Motrin IB, Nuprin

Strong antipyretic, analgestic, and anti-inflammatory

Mild antiplatelet

Vasoconstriction (hypertension)

Fever, inflammation, headach, menstul, pain, toothache, pack pain, arthitis, minor injuries

134
Q

Naproxen

Example?

Clinical application?

Other effects?

A

Aleve

Pain, fever, inflammation, stiffness

Anti-virial effects

135
Q

Indomethacin

Example?

Applications?

Long term use?

A

Indocin

Ankylosing spondylitis

**Reiter syndrome **(reactive arthritis due to bacterial infection in intestine, genitals, or urinary tracts)

Acute gouty arthritis

Closure ductous arteriosus

NO LONG TERM USE - SEVERE ADVERSE EFFECTS

Bleeding, ulcerations (need low doses + anti ulcer drug)

Life-threatening shock

Severe or lethal hepatitis and severe bone marrow damage

136
Q

Piroxicam

Example?

Half-life?

Side effects?

A

Feldene, Fexicam

t1/2 = 45h = long acting anti-inflammatory and analgestic

Bleeding and ulceration

137
Q

Meloxicam

Example?

Specificity?

A

Mobic

Low dose: COX-2>COX-1

138
Q

Acetaminophen

Examples?

Lack of what?

Asthma, Reye?

Side effects?

Treatment of toxicity?

A

(Tylenol, APAP)

Anti-inflammatory effects

OK with those diseases

Liver toxicity (4g/day)

N-acetyl cysteine to replenish gluathione

139
Q

Mechanisms of action of NSAIDs

Anti-inflmmatory effect

Analgesic effect

Antipyretic effect

A

Aspirin irreversible inactivation of COX1/2. Other NSAID reverisble.

Inhibition of prostaglandin production.

Inhibition of prostaglandins incuded by IL1/IL2, resetting thermoregulatory system (vasodilation

140
Q

Therapeutic effects of NSAIDs

A
141
Q

How long does it take for anti-inflammatory effects to develop?

A

Even after several weeks

142
Q

NSAIDs vs. glucocorditoicds (anti-inflammation)

Effect?

Clinical usage

Side effects?

A
143
Q

NSAIDs vs. glucocorditoicds (Analgesia)

What do they alleviate? More effective with?

Effects?

Clinical use?

Side effects?

A

Headache, Myalgia, Neuralgia, Postoperative pain, Dysmenorrhea.

Integumental structures

144
Q

NSAIDs vs. glucocorditoicds (Anti-pyresis)

Use?

Effects

Clinical usage

Side effects

A

Elevated body temperature

Viral infection (influenza and chickenpox) in children and adolescents Reye’s syndome

145
Q

Adverse effects of NSAIDs and tretments

A

Gastrointestinal (ulceration, gastric bleeding, anemia, shock) treatment with antiacids. Prostaglandin introduction PGE2 to reduce damage (cyctoprotective effect of PGE2). Time-release, nonacetylated use, with food.

Hypersensitivity anaphylactic reaction with hock, cross-hypersensitivity

Analgestic Abuse Nepropaht regulation renal blood flow

146
Q

COX-2 Selective Drugs

What drug?

Stomach?

A

Celecoxib (only selective COX-2 inhibitor)

Specifically inhibition of COX-2 would reduce the inflammatory response and pain but not inhibit the cytoprotective action of prostaglandins in the stomach, which is largely mediated by COX-1.

147
Q

What COX-2 have been removed from the market?

A

Rofecoxib (Vioxx) and valdecoxib

Increase heart attack and stroke

148
Q

Drugs to treat gout

A

Relieve inflammation pain (nonsalicylate NSAIDs, colchicine, glucocorticoids)

To prevent inflammatory responses to crystals (colchicine and NSAIDs)

To inhibit urate formation (allopurinol) or to augment urate excretion (probenecid)

149
Q

Colchicine

Use?

Mechanism?

Adverse affects?

Liver damage?

A

Inflammation and pain relief in acute gouty arthritis

Prevent polymerization of tubulin into microtubules (prevents leukcyte migration and phagocytosis), inhibit cell mitosis

Diarrhea

Rare at higher doses

150
Q

Probenecid (Benemid) and Sulfinpyrazone (Anturane)

Mechanism?

When used?

Side effects?

A

prevent reabsorption of uric acid.

used for chronic gout, often in combination with colchicine.

Urolithiasis (formation of urate stomes), GI distrubances, dermatitis,

151
Q

Allopurinol (Zyloprim)

Mechanism?

Side effects?

Liver damage?

A

Allopurinol inhibits the synthesis of uric acid by inhibiting xanthine oxidase

GI distrubances, dermatitis

Yes!

152
Q

Treatment of acute gout?

A

Acute gout is treated with Nonsalicylate NSAIDs (indomethacin, naproxen, and sulindac). + no diaraha

Chronic gout is treated with uricosuric agents (probenecid, sulfinpyrazone) or allopurinol

153
Q

DMARDs

What are they?

Examples?

A

Disease-modifying antiarthritic drugs (DMARDs)

A category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression.

Azathioprine (Purine synthesis inhibitor)

Ciclosporin (Cyclosporin A) calcineurin inhibitor

Methotrexate (MTX) Purine metabolism inhibitor

Leflunomide Pyrimidine synthesis inhibitor

Anti-TNF- a Drugs

154
Q

3 stages of recovery

A

.Resuscitative or Critical Stage

Acute Stage

Long Term Rehabilitation Stage

155
Q

Resuscitative or Critical Stage

Psychological characteristics?

Treatment?

A

Stressors (over/understimulation), congitive challenges (drownsiness, confusion, disorientation), delurium, intubation limit communication, pain, sleep disturbance, family anxious

physical survival, coping skills & defense mechanism, manage pain, comfort, educate family

156
Q

Acute Stage

Psychological characteristics?

Treatment?

A

Start to understand impact, guilt, anger, grief, loss of faith, depression, anxiety, sleep dissturbance, premorbid psychopathology, ASD/PTSD

Psychoeducation: symptoms resolve on their own, ASD not always turn into PTSD, psychotherapy, pain management, coping > avoidance, drugs (sleep, depression, anxiety, pain) social support, premorbid psychpathology after discharge

157
Q

ASD vs. PTDS

A

Both cause by trauma

2d-4w vs. More than a month

158
Q

Long Term Rehabilitation

Psychological characteristics?

Treatment?

A

“SCARED” response, adjusting, physical changes, depression, anxiety, grief, PTSD, identitiy, work, finance, family, roles, sexual dysfunction, social withdrawal/support

outpatient psychotherapy, social skills, prepare for community, social support, improve self-esteem, vocational rehabilitation, premorbid psychoapthology

159
Q

Long term effects on burn

A

Pediatric adjust well

–Aggressiveness
–Anxiety
–Disturbed self-esteem
–Depression
PTSD symptoms

Mother effect on child

Greater difficulty with adjustement if exposed surfaces

Younger better than older

Best predictor amount of function, then location of burn

Half have to change work

2 year

160
Q

4 cell adaptations?

What is dysplasia?

A

hypertrophy, atrophy, hyperplasia and metaplasia

epithelial anomaly of growth and differentiation

161
Q

Rotator Cuff Injury

Symptoms?

Causes?

Risk Factors?

A

Tenderness (especailly when reaching), weakness, loss of range of moition, keeping inactive

Tendinitis (overuse and overload), bursitis (irritationm iflammation, attrition of supraspinatus)

40yo+, althele, construction worker, poor posture & weak shoulder muscle

162
Q

Rotator Cuff Impingement Syndrome

A

Tendons become entrapped under the acromion: compression, injury, rotator cuff tendonitis

163
Q

liquefactive necrosis

A

necrosis which results in a transformation of the tissue into a liquid viscous mass

164
Q

What occurs during necrosis?

A

[Na+] up

[Ca++] up

Lactic acid up

Inorganic PO4 up

165
Q

What moves stuff into mitochondria

A

High conductance pores

166
Q

Examples of oxygen reactive species

A

O2*-, H2O2, OH*

167
Q

Functions of macrophages

A
168
Q

Stages of wound healing

A

Injury

Coagulation

Inflammation

Proliferation

Remodeling

169
Q

Granulation tissue

A

New connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process

170
Q

Two types of angiogenesis

A

From pre-existing vessels

From EPCs from the bone marrow

171
Q

primary and secondary intention

A

Block 4 (4 decks)

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