Mammalian Anatomy Exam 1

Hic locus ubi mor est gaudet succurrere vitae

This is the place where rejoices in helping life

How many years have humans been studying anatomy

2000 years

Recent discoveries in human anatomy

1. Cornoid layer of the masseter

2. Sub-arachnoidal lymphatic membrane

3. Nasopharynx tuborial salivary gland

SLIM

Subarachnoidal lymphatic membrane; Divides the arachnoid space

Why is anatomy important in understanding

Pathogens, genetics, environment

Gwo Pye

Lymphatic filariasis; elephantitis

What causes lymphatic philariasis

obstruction of lymphatic drainage caused by Washeteria bancrotti (nematode spread by mosquitos)

Most common deaths in America

1. Heart disease

2. Cancer

3. Unintentional injuries

4. Stroke

5. COPD and other chronic lower respiratory disease

What causes the most deaths worldwide

tuberculosis

How many people died of TB in 2020

25 million

What is the leading cause of death for people with AIDS

Tuberculosis

Nematode spread by mosquitoes

W. barcrofti

Causes of pneumonia

Strep. pneumonia, COVID, influenza, measles

How many people has the measles vaccination saved

17.5 million people

When was the measles vaccine licensed

1963; second dose in 1989

Oldest surgical procedure

Trepanation

putting holes in the skull; thought to relieve headaches; used for hysteria and seizures

Trepanation

Why did self-trepanation resurface in the 60s

Thought it could improve brain function and that fontanelles caused more sensitivity

Greek physician from 460 BC

Hippocrates

In the time of Hippocrates, it was thought that ____ and _____ caused disease

gods and demons

Hippocratic corpus

diagnosis, prognosis, humoral theory, ethics, epidemics

What terms did Hippocrates introduce

Kyposis, Scoliosis, diabetes, gastritis, hysteria

Scoliosis

lateral curvature of the spine

Kyposis

Hunch of the upper spine

What disease did Hippocrates figure out how to treat

Empyema

Empyema

Pus filled fluid in the lung (pleural space)

How did Hippocrates treat Empyemas

Used a lead pipe to drain

What were some beliefs of Hippocrates

thought leading a good moral life could keep people healthy; believed in patient confidentiality; used early chiropractic techniques

Earliest expression of medical ethics; two versions (classical and modern)

Hippocratic oath

Who is the surgeon general

Dr. Denise Hinton

Secretary of health

RFK

Mistaken as the symbol of medicine; used by US medical corps

Caudices; staff of Hermes

Great anatomist; dissected over 600 bodies; unethical practices; distinguished nerves and tendons

Herophilus

Beliefs of Herophilus

sperm produced in the testes; thought there were 6 pairs of cranial nerves

Herophilus controversies

Vivisection; made it so dissection was banned for 1700; dissected animals in the meantime

Doctor of Marcus Aurelius

Claudius Galen

What did Claudius Galen discover

The voice in the larynx and the pulse from the heart; identified that urine is made in the kidneys and sent through the uterus

What incorrect things did Claudius Galen believe?

Thought the liver made blood from food; thought the spleen balanced the liver

What book did Claudius Glen write

One uses and parts of the body

Galenical

Early pharmaceutical

Roles in early dissection

Anatomist, Ostenor, Barber surgeon

Sits above during the dissection and teaching

Anatomist

Points at what the anatomist says

Ostenor

Makes cuts, split in specialty

Barber surgeon

Did his dissections, even though he was an anatomist; did dissections in winter

Andreas Vesalius

What artist did Andreus Vesalius work with

Jan van Calcar

What did Jan van Calcar and Andreas Vesalius do

Made the first accurate text book

Physician to kings, did vivisection in animals, wrote about hearts in animals

William Harvey

What did William Harvey Discover

The heart pumps blood into arteries and back out into veins in a circuit; wasn’t well received at first; discovered that veins prevent backflow

Commissioned to paint anatomy lesson of famous surgeon Dr. Nicolas Tulp

Rembrandt Harmesonzoon van Rijn

Trial that prosecuted Nazis

Nuremberg Trials

Smaller trials to prosecute doctors for human experimentation

Doctors’ trial

Studied twins

Dr. Mengle

What type of experiments did Dr. Mengle do

Wanted to see if twins could accept blood transfusions, infected them with malaria, amputations without anesthesia and tried to switch body parts; give prisoners hyperthermia, mustard gas, pathogens and tried to find treatments

A twin in Auszwitz; measured naked every day, given many injections and became very ill

Eva Kar

Ethics made from Nuremberg trials, 10 elements

Nuremberg Code

Doctors took her cervical cancer cells to make cell lines (HELA cells); one of the most used cells in all of biomedical research; hospital began to profit and no family was told; did not remain anonymous

Henrietta Lax

1. Must be able to do chemical reactions

2. No heritable traits

3. Not able to reproduce

4. Doesn’t respond to stimuli

5. Homeostasis

6. Made of cells

Definition of Life

Irreversible cessation of heart and lung function; with modern advances in life support, a person can be cardiopulmonary alive, but considered dead

Definition death

Brain Death

Death of the brain stem

Extracorporeal membrane oxygenation; takes blood out and acts as the lungs (does respiration); takes out CO₂ and adds O₂

ECMO

Medical interventions that replace or support essential organ function

Dialysis, ostomies, insulin, CPR, artificial nutrition and hydration, ventilators, ECMO

Does not require stopping treatment, comfort care (massage, pain management, spiritual counseling)

Palliative care

No longer seeking care, pain management, actively dying, around 6 months left of life

Hospice

How is ventilator priority decided

Uses the SOFA system, rates the short-term health of the organ systems, then adds the score for a long-term prognosis

Pediatric cancer drug in short supply

Methotrexate

Diagnosis must be _____ to make good ethical decisions

correct

Eyes closed, cannot be roused, typically lasts days to weeks, might be on a ventilator or not, could come out or progress to a vegetative state

Coma

Higher brain function gone, brain stem still intact, heart and lung function fine, some reflexes but no purposeful reactions

Vegetative state

Beyond one month

persistent vegetative state

Beyond one year

Permanent vegetative state

Ending life supports/medical intervention; usually ending extraordinary measures

Passive euthanasia

Prescription drugs that patient choses if/when to take; First legal in Oregon

Physician assisted suicide/death

Reasons people chose physician assisted death

Loss of autonomy, life is less enjoyable, feeling burdensome, inadequate pain control, loss of dignity

Went into a coma, put on a ventilator, courts allowed the ventilator to be removed if there was no chance of survival, live another 10 years in a comatose state; first case to question removing a ventilator; decided that someone could make decisions for another

Karen Ann Quinlan (1975)

Parents did not want his ventilator taken off, UK hospital said no and wouldn’t allow for experimental treatments

Charlie Gard

Questioned if quality of life is subjective, fell from a tree and broke his neck; put on a ventilator and sedated; probably would have been paralyzed and require a ventilator forever; took him out of sedation to ask

Tim Bowers

Had an iron lung; went to college and law school; went on to advocate for disables

Paul Alexander

First doctor to do physician assisted suicides, used KCl to stop their heart; first patient died in his van

Jack Kavorkian

Husband died of Huntington’s and sons were sick, shot both of her sons and claims they wanted to her

Carol Carr

Nancy Cruzan; paramedics got her heart beating but had no oxygenation to her brain for 15 minutes; in a coma and transferred to a persistent vegetative state; took the word of a friend

1983 Right to die case

Went into cardiac arrest, electrolyte disturbances caused by bulimia, permanent vegetative state; had sleep/wake cycle; thought wanted to pull the feeding tube; got taken in and out off the ventilator for five years; died by loss of hydration for 13 days

Terri Shivo

Visited the hospital complaining of a headache but sent home; after CT scan, doctors discovered blood clots; 9 weeks pregnant, many news articles claimed it was because of abortion laws

Adriana Smith

Why did dehydration cause death

Extracellular fluids become concentration, hypothalamus causes thirst, decreased dieresus, can’t get rid of metabolic waste, altered pH, decreased blood volume and pressure, heart pumping harder to compensate, organ damage

The law that said pregnant patients could not have certain life-saving procedures withdrawn

Advanced healthcare act

Criteria for brain death

1. Irreversible loss of the capacity for consciousness

2. Neuroimaging evidence or intercranial hypertension

3. Person has a minimum core temperature of 36 degrees C

4. Systolic blood pressure of at least 100 mm Hg, or mean arterial

5. Elimination of other factors

6. An adequate time period takes place

Evidence of hypertension needed

Intercranial pressure measurements that equal or exceed mean arterial pressure

How to raise someone’s core body temperature

Warm blankets, warm fluids, automated temperature regulation, thermal mattress, warm oxygen

What period of time must take place before brain death is declared

24 hours

Confounders to eliminate before brain death

1. Use tox screen to rule out tox exposure

2. Serially measure drug levels to not exceed therapeutic drug range OR allow for five elimination half-lives

3. Perform ancillary testing in addition to the complete clinical examination must be corrected

How to test for a brain death

1. Coma

2. Pupillary reflex

3. Oculocephalic and oculovestibular reflexes

4. Corneal reflex

5. Motor response of the face and limbs

6. Gag and cough reflexes

Shining a bright light into the eyes and looking for constriction; there should be absence of ipsilateral and contralateral pupillary response, with pupils fixed in a midsize or dilated position

Pupillary refleces

Rotate the head briskly horizontally to both sides. There should be no movement of the eyes relative to the head; there should be absence of extraocular movements

Oculocephalic response

Examine the auditory canal for patency and an intact tympanic membrane. Elevate the head 30 degrees to place the horizontal semicircular canals in the correct vertical position. Irrigate with at least 30 mL of ice water for at least 60 seconds using a syringe. Test both sides separately with a 5 minute interval in between

Oculovestibular reflex

Touch the cornea of both eyes with a cotton swab on a stick at the external border of the iris, applying light pressure and observing for eyelid movement; no eyelid movement seen is consistent with brain death

Corneal reflex

Apply deep pressure to limbs; noxious stimuli should not produce grimacing, facial muscle movement, or a motor response of the limbs other than spinally mediated reflexes

Motor response of the face and limbs test

1. Condyles at the level of the temporomandibular joint

2. The supraorbital notch bilaterally

3. The sternal notch

4. all four extremities, both proximally and distally

5. insert a cotton swab into each nostril to perform a “nasal tickle”

Limbs tested in the motor response of face and limbs test

Stimulate the posterior pharyngeal wall bilaterally with a tongue depressor or suction catheter

Gag reflex

Stimulate the tracheobronchial wall to the level of the carina with deep endotracheal placement of a suction catheter

Cough reflex