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By J. Grobock. Covenant College.

The medial elbow is supported by the ulnar collateral ligament and the radial collateral ligament supports the lateral side purchase pletal 100mg fast delivery muscle relaxant otc usa. The proximal radioulnar joint is a pivot joint that allows for rotation of the radius during pronation/supination of the forearm buy discount pletal 50 mg online muscle relaxant robaxin. The hip joint is a ball-and-socket joint whose motions are more restricted than at the shoulder to provide greater stability during weight bearing. The iliofemoral, pubofemoral, and ischiofemoral ligaments strongly support the hip joint in the upright, standing position. The ligament of the head of the femur provides little support but carries an important artery that supplies the femur. The patella, a sesamoid bone incorporated into the tendon of the quadriceps femoris muscle of the anterior thigh, serves to protect this tendon from rubbing against the distal femur during knee movements. The medial and lateral tibiofemoral joints, between the condyles of the femur and condyles of the tibia, are modified hinge joints that allow for knee extension and flexion. As the knee comes into full extension, a slight medial rotation of the femur serves to “lock” the knee into its most stable, weight-bearing position. Two extrinsic ligaments, the tibial collateral ligament on the medial side and the fibular collateral ligament on the lateral side, serve to resist hyperextension or rotation of the extended knee joint. Two intracapsular ligaments, the anterior cruciate ligament and posterior cruciate ligament, span between the tibia and the inner aspects of the femoral condyles. The anterior cruciate ligament resists hyperextension of the knee, while the posterior cruciate ligament prevents anterior sliding of the femur, thus supporting the knee when it is flexed and weight bearing. The medial and lateral menisci, located between the femoral and tibial condyles, are articular discs that provide padding and improve the fit between the bones. It consists of the articulation between the talus bone and the medial malleolus of the tibia, the distal end of the tibia, and the lateral malleolus of the fibula. Gliding motions at the subtalar and intertarsal joints of the foot allow for inversion/eversion of the foot. The ankle joint is supported on the medial side by the deltoid ligament, which prevents side- to-side motions of the talus at the talocrural joint and resists excessive eversion of the foot. The lateral ankle is supported by the anterior and posterior talofibular ligaments and the calcaneofibular ligament. An inversion ankle sprain, a common injury, will result in injury to one or more of these lateral ankle ligaments. In the skull, the bones develop either directly from mesenchyme through the process of intramembranous ossification, or indirectly through endochondral ossification, which initially forms a hyaline cartilage model of the future bone, which is later converted into bone. In both cases, the mesenchyme between the developing bones differentiates into fibrous connective tissue that will unite the skull bones at suture joints. In the limbs, mesenchyme accumulations within the growing limb bud will become a hyaline cartilage model for each of the limb bones. Mesenchyme cells at the margins of the interzone will give rise to the articular capsule, while cell death at the center forms the space that will become the joint cavity of the future synovial joint. The hyaline cartilage model of each limb bone will eventually be converted into bone via the process of endochondral ossification. However, hyaline cartilage will remain, covering the ends of the adult bone as the articular cartilage. The growing bones of child have an Synovial joints are places where bones articulate with each epiphyseal plate that forms a synchondrosis between the other inside of a joint cavity. Being less dense than bone, joints are the ball-and-socket joint (shoulder joint), hinge the area of epiphyseal cartilage is seen on this radiograph as joint (knee), pivot joint (atlantoaxial joint, between C1 and the dark epiphyseal gaps located near the ends of the long C2 vertebrae of the neck), condyloid joint (radiocarpal joint bones, including the radius, ulna, metacarpal, and phalanx of the wrist), saddle joint (first carpometacarpal joint, bones. Which of the bones in this image do not show an between the trapezium carpal bone and the first metacarpal epiphyseal plate (epiphyseal gap)? Which system of the body to maintain stable contact between the bones in all knee malfunctions in rheumatoid arthritis and what does this positions. What ligament supports the knee when flexed and the anterior motions involve increasing or decreasing the angle of the cruciate ligament becomes tight when the knee comes into foot at the ankle?

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All of the depres- sant effects of morphine are potentiated by concurrent use of sedatives order pletal 100 mg with amex muscle relaxer 93, volatile anesthetics generic pletal 100mg line spasms rectal area, nitrous oxide and alcohol. Traditionally used for Respiratory postoperative pain but currently its use is restricted (in Respiratory depression which at the extreme leads to ap- many hospitals) to the treatment of postoperative shiver- nea. May cause sei- zures if used in large doses or over an extended time frame due to the accumulation of its excitatory metabo- lite, normeperidine. In this case, close monitoring Mechanism of Action is indicated and supplemental doses may be necessary. Muscle relaxants are the most common cause of anaphylactoid reactions under general Duration anesthesia. Competitive inhibitor at the acetylcholine receptors of Enhanced neuromuscular blockade is seen in patients the post-synaptic cleft of the neuromuscular junction. Muscle relaxants are the most common cause of anaphy- Duration lactoid reactions under general anesthesia. Increased risk of arrhythmias in patients receiving tricyclic antidepres- sants and volatile anesthetics. Mechanism of Action Histamine release may occur with rapid administration Competitive inhibitor at the acetylcholine receptors of or higher dosages. Muscle relaxants are the most com- Dose mon cause of anaphylactoid reactions under general an- Intubation : 0. Depolarizing muscle relaxant; ultra short-acting; Used Bradycardia, junctional rhythm and sinus arrest can oc- for rapid sequence induction. Succinylcholine (Sch) attaches to nicotinic cholinergic Respiratory receptors at the neuromuscular junction. There, it mim- Occasionally leads to bronchospasm and excessive sali- ics the action of acetylcholine thus depolarizing the vation due to muscarinic effects. Neuromuscular blockade increased thereby theoretically increasing the risk of re- (paralysis) develops because a depolarized post- gurgitation. Most of the other effects are secondary to the depolari- Dose zation and subsequent contraction of skeletal muscle. Deficiency can re- sult as a genetic defect, as a consequence of various medications or a result of liver disease. The latter two causes are usually relative while the genetic de- fect can produce a complete lack of pseudocholines- terase activity in homozygous individuals. The use of succinylcholine in a patient with pseudocholin- estersase deficiency leads to prolonged paralysis. In anesthesia practice, neostigmine ropine or more commonly glycopyrrolate) in order to is used for the reversal of neuromuscular blockade. Neostigmine Dose does not antagonize succinylcholine and may prolong For reversal of neuromuscular blockade: 0. Therefore, Has additive anticholinergic effects with antihistamines, atropine has an anti-parasympathetic effect. Contraindications Onset Contraindicated in patients with narrow-angle glau- Immediate coma, gastrointestinal or genitourinary obstruction. Duration 1-2 hours Elimination Hepatic, renal Effects Most effects result from the anticholinergic action of at- ropine. Can also be used for creases cerebral metabolic rate and intracranial pres- maintenance of anesthesia or for sedation, in each case sure. Maintenance of anesthesia:100-200 ug/kg/minute Respiratory Sedation: 40-100 ug/kg/minute Depression of respiratory centre leads to brief apnea. Propofol effectively blunts the airway’s response to ma- Onset nipulation thus hiccoughing and bronchospasm are Within one arm-brain circulation time (approximately rarely seen. Patients often experience pleasant dreams Offset of effect is more prolonged when administered under anesthesia followed by a smooth, clear-headed as a continuous infusion. Strict aseptic technique must be used when Elimination handling propofol as the vehicle is capable of support- Rapid redistribution away from central nervous system ing rapid growth of micro-organisms. May con- Decreases the rate of dissociation of the inhibitory neu- tribute to post-operative confusion and delirium. Onset Respiratory Within one arm-brain circulation time (approximately Depresses the rate and depth of breathing leading to 20 seconds). Does not blunt the airway’s re- sponse to manipulation therefore coughing, hiccough- Duration ing, laryngospasm and bronchospasm may be seen at Approximately 5-10 minutes after single induction light planes of anesthesia.

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Viral gastroenteritis Pathogenesis: ¾ Rota virus causes osmotic diarrhea due to nutrient malabsorption buy cheap pletal 50mg muscle spasms 7 little words. Caliciviruses such as the Norwalk virus also produce diarrhea in a similar but slightly different mechanism that culminates in nutrient malabsorption buy pletal 50 mg on line stomach spasms 6 weeks pregnant. Clinical Features: ¾ Rota virus infection causes sudden onset of vomiting followed by mild to very severe diarrhea mixed with mucus and fever. Clostridium perfringens Pathogenesis The spores are able to survive cooking, and if the cooked food (meat and poultry) is not cooled enough, they will germinate. When massive dose of these organisms are ingested with food, toxins are elaborated in the intestinal tract which cause increased fluid and electrolyte secretion. Escherichia Coli 0157:H7 Pathogenesis: Its somatic 0 and flagellar H antigens designate E-coli 0157:H7. All enter hemorrhagic strains produce shiga toxin 1 and/ or shiga toxin 2, also referred to as Vera toxin 1 and Vera toxin 2. The ability to produce shiga toxin was acquired from a bacteriophage, presumably directly or indirectly from shigella (7). This bacterium attaches itself to the walls of intestine, producing a toxin that attacks the intestinal lining (7). Clinical Features: ¾ Incubation period: The initial symptoms of hemorrhagic colitis generally occur 1 to 2 days after eating contaminated food, although periods of 3 to 5 days have been reported. Bacillus Cereus Pathogenesis: The pathogenic agent of Bacillus cereus food poisoning appears to be an entero toxin. This spore forming bacterium produces a cell–associated endo toxin that is released when cells die upon entering the digestive tract (4). Clinical features ¾ Incubation period: From 1 to 16 hours in cases where vomiting is the predominant symptom; from 6 to 24 hours where diarrhea is predominate (10,7). Clinical Features Typical symptoms include severe abdominal pain, cramps, diarrhea, vomiting, and nausea. The onset of symptoms is rapid (usually 1 to 8 hours) and of short duration (usually less than 24 hours). Pathogenesis It is primarily caused by botulinum toxin, which is a neurotoxin that binds to the synapses of motor neurons preventing neurotransmission. Clinical Features Symptoms of botulism occur within 18 to 24 hours of toxin ingestion and include blurred vision, difficulty in swallowing and speaking, muscle weakness, nausea, and vomiting. Without adequate treatment, 1/3 of the patients may die within a few days of either respiratory or cardiac failure. Lead poisoning Possible sources of contamination include residues migrating into foods from soldered cans, leaching from utensils, contaminated water, glazed pottery, painted glassware and paints. Toxicity occurs due to its affinity for cell membranes and mitochondria, as a result of which it interferes with mitochondrial oxidative phosphorylation and sodium, potassium, and calcium transport. Clinical Features Lead poisoning is characterized by abdominal pain and irritability followed by lethargy, anorexia, pallor, ataxia, and slurred speech, joint pain, peripheral motor neuropathy and deficits in short-term memory and the ability to concentrate. Convulsions, coma and death due to generalized cerebral edema and renal failure occur in most severe cases. Pathogenesis It is well absorbed by lungs and gastrointestinal tract, and excreted in small amounts in urine and/or feces. Clinical features Inhalation of mercury vapor manifests with cough, dyspnea, and tightness or burning pain in the chest. Acute high dose ingestion of mercury can cause nausea, vomiting, hematemesis abdominal pain, diarrhea and tenesmus. Major complications of mercury poisoning include: ¾ Respiratory distress, pulmonary edema, lobar pneumonia and fibrosis. Clinical Features: Major clinical features of arsenic poisoning include nausea, vomiting, diarrhea, abdominal pain, and delirium. Diagnosis of Food-borne Diseases A variety of infectious and non-infectious agents should be considered in patients suspected of having a food borne illness. However, establishing a diagnosis can be difficult, particularly in patients with persistent or chronic diarrhea, those with severe abdominal pain and when there is an underlying disease process.

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Rectum and anal canal: The descending colon of large intestine opens into last part buy 100mg pletal overnight delivery spasms rectal area, the rectum and anal canal discount pletal 100mg without prescription muscle relaxant quiz. The narrow portion of the distal part of the large intestine is called the anal canal, which leads to the outside through an opening called the anus. Absorption of Food: Absorption is the process by which water, minerals, vitamins and end products of digestion are absorbed through the mucosa of alimentary canal (especially the small intestines) into blood stream either directly or via lymphatic vessels. The main absorption occurs in small intestines especially in the lower (ileum) part, the upper part of the small intestine is mainly associated with the process of digestion. Both monosaccharide and amino acids are absorbed by a positive pressure gradient between the intestinal content and the blood as well as by an active process involving enzymatic reactions and transported in the blood stream to the liver via the hepatic portal system. The excess amount of glucose is converted into glycogen and stored in the liver, when need arises glycogen is converted into glucose and is utilized by the body. Large quantities of water are however absorbed from the large intestine and the fluid content of the small intestine are converted into the pasty consistency and ejected through the opening called the anus. Movements of the gastro intestinal tract: Deglutition is the process by which the masticated food is transported across the pharynx and reaches the stomach. After being in the stomach for 3 or 4 hours the pyloric sphincter opens pushing the food into the duodenum. They are; 1) Pendular Movement: these movements are induced by contractions of the circular and longitudinal muscles of the intestine. In the higher animals, and man the gaseous exchange between the tissues and environment is termed as Internal or tissue respiration. The exchange of gases between the body and the environment­taking place in the lungs is termed as external respiration. Inspiration is an active muscular contraction while expiration is merely a passive act of the relaxation of respiratory muscles. Structure of respiratory system: The respiratory system is responsible for taking in oxygen and giving off carbon­di­oxide and water. The two lungs, which are the principal organs of the respiratory system, are situated in the upper part of the thoracic cage. The pharynx is a tube approximately 12cm in length, which is a common opening for both diges­ tive and respiratory system. It connects the oral cavity to the oesophagus (food tube) and the nasal cavity to the larynx and wind pipe. The epiglottis folds down over the opening like a trap door while food or liquid is being swal­ lowed, it prevents the entry of foreign substances into the respiratory passage ways. The closure of epiglottis, when we swallow, is a reflex action and can be interfered with, if one attempts to talk and swallow at the same time. It is the vocal cords inside the box, which by its coming together and going away from one another produces different sounds. The trachea branches at its lower end into the right and left bronchi which enters the lungs, within the lungs those passage ways repeatedly divide, forming microscopic tubes called bronchioles. Each bronchiole ends with several clusters of microscopic elastic air sacs called alveoli, which are the functional units of lungs. The right lungs have three lobes­upper, middle and lower, and the left lung has two lobes­ upper and lower. Respiration may be defined as the mechanical process of breathing in and out, a function which involves both the respiratory system and muscles of the respiration. Exhalation – which refers to the expulsion of air from the alveoli Inhalation The diaphragm when relaxed is a flattened dome shape structure pointing upwards to the lungs. It flattens, pulls down the thorax, increases the volume of the thorax, and thus decreases the atmospheric pressure in the lungs. Exhalation During the processes of exhalation, the diaphragm relaxes, the thorax is pushed up, the volume decreases and the atmospheric pressure increases and air rushes out of the lungs. The inspired air, which contains oxygen, passes down into the billions of minute air chambers or air cells known as alveoli, which have very thin walls. It is at this point that the fresh air gives off its oxygen to the blood and takes carbon di oxide from the blood by diffusion, which is then expelled with the expired air. Physiology of Respiration: The respiratory center of the brain is located in the medulla, immediately above the spinal cord. From the neck part of the cord, these nerve fibers continue through the phrenic nerve to the diaphragm. If there is an increase in Co2 in the blood, the cells of the respiratory center are stimulated and they in term send impulses down the phrenic nerve to the diaphragm.

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