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  1. indications for muscle biopsy
    • clnically sick muscle
    • neuromuscular disease
    • autoimmune
    • treatment related
  2. contraindications for biopsy
    • genetic testing available
    • myasthenia gravis
    • periodic paralyses
    • endocrine myopathies
  3. HE
    used for muscle fiber pathology nnuclei
  4. endomysium
    surrounds each fasicle
  5. muscle cell
    multicucleated at the periphery
  6. angular atrophy
    neuogenic dysfunction
  7. morular formations
    dennervation as nuclear clumps
  8. ALS
    • large axonal neuropathy
    • angular atrophy
  9. Hydrolytic enzymes NSE stain
  10. non- specific esterase
    brown stain that measures integiry oof motor end plates
  11. Myofibilar atpase
    myosin loss PH stain
  12. mosiac pattern
    • normal muscle differentiation
    • type I fibers slow twitch
    • type II fibers fast twitch, glycogen rich
  13. loss of mosaic fiber
    a fiber type atrophy
  14. duchenne muscular dystrophy
    • dystrophin deficiency
    • chromosome Xp21. weakness proximal to distal. failure to walk eventually
  15. dermatopyostis
    • clnical rash
    • progressive pelvic/femoral weakmess
    • chronic inflammation
  16. myopathic changes
    • myofiber size
    • round atrophy
    • inflamation/myositis
    • degenerating regenerating fibers
  17. trichrome
    fibrosis, ragged red fibers
  18. ragged red
  19. oxidative enzymes
    • NADH, SDH, COX 2
    • NADH, succinate dehydrogenase reaction in ragged red myopathy
  20. hydrolytic enzymes
    • alkaine phosphatase
    • acid
    • regeneration microvascular, lysosomes
  21. alkaline phosphatase activity
    low in dermatomysosis, connective tissue pathology
  22. acid ohisphatase
    lysosomal activity, macrophages
  23. analgesia
    muscle relaxation
    inhalation anesthetics flurane, diethy; ether
  24. MAC- minimul alveolar concentration
    concentration at which 50% of patients are unresponsive
  25. meyer-overton rule
    anestheesia commences when a chemical substabce reaches a certain concnetration. Anesthetics disorder membrane lipids and increase membrane volume.
  26. mesencephalic reticular formation
    • major center of consciousness. When activity is depressed, ascending influences on limbic system are reduced.
    • ALL agents block neuronal responses to sensory input
  27. area implicated in primary action of anesthetics
    dorsal lamina of spinal cord
  28. stage 3
    surgical anesthesia
  29. stage 4
    medullary paraysis= death
  30. daltons law
    alveoli>bld>brain. Parital pressure of each componenet gas is related to its concentration
  31. brain concentration closely follows arterial concentration
    anything that increases delivery of anesthesia will hasten
  32. genrealization
    anything that enhances overall systemic uptake and removal of anesthetic from lungs will lower alveolar partial pressure and delay anesthesia.
  33. concnetration efect
    higher concentration of nitrous oxide is taken up more rapidly
  34. second gas effect
    potent agents are delivered with nitrous oxide so increased amounts get to alveoli as NO get to pulmonary bld
  35. ideal inhlanation agent
    low bld, tissue solubility, no biostransformation, no toxicity, nonirritating, highly potent can be given ample O2
  36. halothane
    no longer used because of CV depression, hypotension
  37. dexmedetomidine
    not a true anesthetic
  38. opiod
    sedation, euphoria, nausea, chest wall, rep depresion
  39. anesthesia for inhalation
  40. TIA
    propofol with opiod
  41. uncoop patients
  42. CV compromised
  43. hypothesis of depression
    functional depression in amine-dependent synaptic transmission
  44. antidepressants
    enhance monoamines and their metabolites(NE, dopa, serotinin)
  45. antidepressants classes
    • amine reuptake
    • MOI inhibitors
    • SSRIs
    • tricyclics(non selective)
  46. tricyclic antidepressants
    mixed NE and 5HT uptake inhibitors, dangerous in CV hen overdoes, low margin of safety
  47. TCA
    anticholergics, alcohol, CNS depressant, local anesthetics and vasoconstritors, use epinephrine carefully avoid levonoedefrin
  48. MAOIs
    used for atypical depression/panic disorder, clinical effect persists after drug discontinued, depressed REM sleep, correction of sleep disorder
  49. MAOI adverse
    • dry mouth
    • headache
    • CNS stim and depress
  50. MAOI drug interactions
    • hypertensice crisis
    • alsohol CNS depressants
    • opiods/meperidine
  51. SSRIs
    wider margin of safety, OCD and depression, anxiety
  52. SSRI adverse
    GI symptoms, contrandicated with MAOIs,
  53. serotinin syndrome
    SSRI and MAOI fever agittaion can lead to seizure coma and death
  54. 2nd gen nonselective reuptake blockers
    non-lethal, but sedation, hypotension, dry mouth
  55. 2nd generation
    Buproprion-ADHD smoking cessation
  56. Bipolar disorder
    lithium salts decreases suicide risk and mood swings
  57. lithium salt
    overdose more common due to accmulation. Nausea trmor, diarreha, convulsions
  58. most common psychiatric disorder
    anxiety, avoid dentist
  59. anxiety medication
    • therapy
    • SSRIs
    • benzodiazepienes
    • buspirone
    • antihistamines
    • beta blockers
  60. benzo anti anxiety
  61. mechanism of action
    binding to benzodiazepine receptor on the GABA complex
  62. benzoGABA complex
    antianxiety, CNS depression, anterograde amnesia, inhibition stage 4 sleep, respiratory depression, drowsiness
  63. flumazenil
    benzodiapeine antagonist used to treat ODs
  64. BZ agonist
  65. barbituates
    • IV anesthtics that bind to receptors on the GABA to increase effects.
    • Lower margin of safety than BZs
    • Inhibite glutamate receptors
  66. barbituate adverse
    CNS depression, CV depression, anticonvulsant action

    • decreased REM sleep
    • liver
    • teratogensis
  67. SSRI
    first line agents in anti-axiety drugs
  68. alcohol
    chloral hydrate
  69. ethanol
    sedative GABA ergic, NMDA antagonism, low margin of safety. Acetaminophen interaction
  70. Acetominophen toxicity
    linked to toxic metabolite, need to detox NAPQI y glutathione. NAPQI non-detoxed causes liver damamge. NAPQI productiion induced by ethanol
  71. ethanol metabolizes to
  72. Psychosis-Schizo
    • deerly disordered thought
    • organic-memory loss
    • idiopathic-memory and orientation are in tact(Scitzo)
  73. Scitzo
    • Positive-hallucination, delusions
    • negative symptoms- blunted affect, anhedonia, social withdrawl, aolition, alogia
  74. antipsychitic drugs
    block dopamine recceptors to reduce positive symtoms

    block serotinin receptors
  75. antipsychotics
    • phenothiazines
    • thioxanthenes
    • buterophenones
  76. dopamine bloackade
    decrase emotional display, antiemitic effect, hypothalmic loss of thermoregu, increase appitite weight gain

    EPS, dystonia, tremors
  77. adrengic blockage
    cholergic block
    • postural hypotension
    • reflex tachy

    blurred vision, dry mouth, constipation, dyskinesia suppresion
  78. incidence of tardive dyskinesia a function of
    neuroleptic exposure, risperidone
  79. 2nd gene atypical antipsychotuucs
    • improved negative symptoms
    • reduced risk of TD, EPS
  80. 2nd gene antipsychotic
    clozapine...no prolactin increase but seizure, tachy, constipation, agranulocutosis
  81. adverse effects antipsychotic
    anti-serotinin, antidopamine, antiNE, aticholergic, antihitsmin....LOSE libido, erection
  82. agjuncts anticonvulsants
    • baribituates
    • phenytonin
    • used in bipolar disorder-carbamasepine
  83. nicotinic vs muscarinic
    ligand gated vs G-protein linked
  84. somatic nervous system
    one receptor rule, nicotinic striated muscle
  85. tubocaruarine
    nicotinic antagonist, paralysis and flaccid muscles
  86. 70/90
    • 70% before any effect
    • 90% for full efcect
  87. receptor reserve
    greatest in muscle od respiration, least in muscles face and eyes
  88. tubocaruraine problems
    • release histamine
    • afffects muscarinic
    • short duration
  89. nondepolarizer
    competitive antagonist for nicotinic, slow in onset
  90. depolarizing blocking agents
    prolong depolarization to sustain the inactivation. These are AGONIST drugs...succinylcholine
  91. succ
    rapid onset, short duration...needs continuous duration patients with congential deficiency of cholinesterases.
  92. malignant hyperthermia
    genetic diseasse after triggering agents,, alternered ryanoodine receptor magnifies Ca release
  93. diazepam-valium
    GABA activaton
  94. gangionic blockers
    old drugs...site dependent
  95. hyaline cartiladge
    most common at synovial joint, chrondyctes reside in launae in basophillic matrix, proteoglycans then collagen II further out
  96. perichondrim
    fibroblasts and chondroblasts. ABSENT at articular surfaces
  97. cartilage growth
    • appositional- incorporation at perichondrium
    • instersitial growth0 divison of chdrocytes within cartilage itseld

    intersitial- chondrocytes within the cartilagde
  98. elastic cartiladge
    less abindant matrix, elastic fibers,with type II
  99. fibrocartilage
    intervertbral discs, articular spaces, attach to bones. Perichrondrom absent, type I, aciophillic, collagen arrange din direction of tensile forces.
  100. intramembranous ossification
    • flat bones-mesnechymal cells differentiate into osteoblsts
    • produces islands of womven bone
    • womven bone remodeled in to compact bone
  101. fontanelle
    periostem and primitive connective tissue
  102. endchonrdal ossi
    • long bone begin with template from cartiladge
    • osteoblasts invade from perichondrom and secrete osteoid around catilage
  103. primaru center of ossification
  104. seocndary center of ossification
    b/t metaphysis and epiphysis...cartiladge replaced with bone marrow except at articular
  105. epiphyseal plate
    resting zone, proliferatin hypertrophic-degenrative, calcification.

    this is where chondrocytes are replaced by bone!
  106. growth hormone
    drives chondrocyte prolif...Laron;s syndrome prevens GH binding dwarfism
  107. acromegaly vs gigantism
    GH overprodcution post/ppre epuusyseal plate closure
  108. FGFR3
    • chondrocytes ar epiphyseal plate inhibited
    • common drawrfism- achondroplasia
  109. fracture healing
    • granulation tissue...soft callus
    • then ossification to form woven bone"hard callus".
    • Resolution woven bone reabsorbed
  110. osteogenesis imperfecta
    x-ray, collagen test, genetic test type I collagen mutation. too little and fragile bone, blue sclera
  111. osteopetrosis
    • dense bone architecturall unsound, bone marrow transplant
    • compression of cranial nerve, reduced hematapoesis
  112. osteoporosis
    • too much reansorption, porous bone
    • aging has reduced osteoblast fnction
  113. pagets disease
    • increased bone remodeling, gain in bone massjigsaw, cotton wool
    • increased circumference
    • alkaline phosphatiase anf hydroxyproline
  114. calcium disease of bone
    • PTH-hyper
    • rickets
  115. PTH hyper
    when serum Ca2+ is low
  116. PTH receptors
    osteoblasts do not have them
  117. primary hyper PTH
  118. seondary PTH
    kidney failure low Ca2+
  119. vitamin d deficiency
    poorly mineralized bone matrix-ostepmalcia and rickets in children
  120. bone fractiure
    closed, open, compression veterbra
  121. healing bone
  122. ostomyelitis
    inflammation of bone, staph aureaus
  123. osteonecrois
    • BRONJ, compromised bld supply
    • inhibit bone remodeling via osetoclasts
  124. osteoma
    benign lesion of membranous bone (head and neck) radioopaque
  125. osteosarcoma
    • malignant (knee area)
    • RB genes mutated
    • osteoblast malignant
    • Codeman triange, indisticnt border
  126. osteochondroma
    • common beningn tumor
    • near metaphysis growth plate
  127. fibrous dysplasia
    developmental tuor like condition where bone is replaced by fibrous stoma
  128. giant cell
  129. osteoarthritis
    affect weight bearing joint, degeenration of articular cartillage
  130. rheumatorid arthtitis
    TNF-alpha inflammatory cells, immune complex, small joints
  131. gout
    • hyperuricemia
    • cytokine, inflammation chemotaxis tissue desctruction, uric acid depsotion in joint space,
    • renal failure
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