Medical Condition and Injury

Exam 2

Anatomy has its own vocabulary for surface regions (anterior)

NOTE- Mammary Gland (all mammals) is NOT the same as breast tissue !! Males? Yes !

• Males can get breast cancer, uncle beat it… 2 grandmothers didn’t

• Adipose tissue around → just primates

Heart disease! #1 in women?

• #1 killer in U.S.

• Issued w/ heart valves & blood vessels that innervate heart → arrhythmias, congenital

• Cardiac muscle… intercalated disc… desmosomes & gap junction

2015

• NM hiking trail… foot got hung up & all quad tendons on left side detached 

• One hip replaced in ‘18, other in ‘19, reconstructed knee 

• Left knee bucked out at Auburn game going down steps 

Anatomy has its own vocabulary surface regions- (posterior) 

• 7, 12, 5, 5, & 4 = #’s; MRI?? Yes!

  • CPL = Aub!

• Remember- “cervi” or “cervical” is neck in G/L; cervical vertebrae are in the neck

• Reminder: know vertebrae types and numbers

• Cervix is a neck-like structure in female reproductive tract

Question on Exam 

Left knee (reconstructed) buckles on the way to sing spirit of Aggieland… appears to be under heading of entropy going up 

• ATP helps w/ growth and repair, knee appears to be deconstructing 

• Knee brace until Dec? then MRI (bulging discs and hips go all the way in) 

• Linear contusion in popliteal area (hollow behind knee)… pop, knee buckles, linear contusion 

• 1st happened in NM, then again at Kyle Field 

Bonus Question

In the immortal words of the zen master, “we'll see”… make it to Dec? 

Review 

• 5 bone remodeling hormones, 5 epiphyseal growth plate zones 

1. Osteogenesis Imperfecta & **Osteoporosis; 99% of all Ca++ in bones hydroxyapatite. **Menopause **E2 & P4 (osteoblast stim!) are way down = 2 of 5 hormones (remodeling)

• E2: estrogen, P4: progesterone… 2 of 5 hormones, stimulate osteoblasts 

• Women go through menopause and get osteoporosis way more 

• -osis/-otic: condition of, por: hole, osteo: bone, osteoporosis: condition of little holes in bone

2. Sprains vs strains ***BACK for a later exam! 

3. **Arthritis, **inflammation and **NSAIDs (and their effects on enzymes)** Non-steroidal anti-inflammatory, Exs: Ibuprofen (Advil)- Comp Inh. of COX (cyclooxygenase) = **antipyretics (fever down) 

• Inflammation is a defense… fine until it becomes chemically inflammed

• Inflammation 101: 1) Get to it 2) Remove it  3) Repair it

• Supposed to feel pain associated w/ pressure

• Antipyretics is a defense, keeps fever down… pyr: heat

4. (Review)- Last but NOT least, our defenses can paradoxically lead to physiological conditions becoming worse. GUESS- Vomiting & Diarrhea (defenses)… ***dehydration = (EI) 

• dehydration leads to electrolyte imbalance

Dehydration continued

Water has a high specific heat which means you need a lot of energy into system to change its temp. 

• need to be hydrated to regulate temp., dehydration an issue 

• easier to stay cool when hyperhydrated 

(OI) = Osteogenesis Imperfecta (Brittle Bone Disease):

• Symptoms include: whites of the **eye (sclera)** are ***blue instead (5), short stature, loose joints, hearing loss, breathing problems and problems with the teeth. Papillary reflexes (nervous sys.); bloodshot eyes; Horizontal gaze nystagmus = Field sobriety test (not fluid movement of eye = “tick”)

1. 2013: Dad yellow/green in sclera → scan → grapefruit sized tumor on liver… early detection is key

2. **eye (sclera)** are ***blue instead (5)

3. shine a light in someone’s eyes → dilate less light → constrict 

4. bloodshot lower eyelid… quick & simple diagnostic 

5. spin them around, stop, will eyes only follow tip of pin? if impaired, eyes will tick instead of eyes moving back & forth 

• Cause: Lack of collagen type I (triple helix, there are **28 types of collagen and collagen has at least one segment that is a triple helix of its own collagen fibril components) 

• Genetics- In 90% of cases, the **COL1A1 and COL1A2 genes and hereditary in an **autosomal (non-sex chromosomes, 1-22) *dominant**; Allele does **NOT mean fitness of individual) manner. **Note- There are 19 different genes that are associated with at least **21 documented types of OI

  • does not add to sustainability

  • recessive does not code for functional… does missense or nonsense

  • 1 gene, 2 alleles, 3 genotypes → basis for Hardy-Weinburg

  • dominant, recessive, hetero 

Carpal Tunnel (anatomical ref.):

• Carpal tunnel syndrome is caused by pressure on the ****median nerve***. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand. When the median nerve is compressed, symptoms can include numbness, tingling, and weakness in the hand and arm. ***WRIST!!!- Flex, extend, **abduct & **adduct… 1 letter makes a huge difference 

• The anatomy of the wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome

• Proper treatment usually relives tingling and numbness and restores wrist and hand function

Carpal Tunnel Syndrome (will happen w/ excessive use of mouse) 

• CPL had it and the chiropractor fixed it

• Put several electrodes on forearm to highest setting 

• Muscles contract… was trying to fatigue muscles of forearm and put less pressure on MEDIAN nerve 

• When fatigue was over, was trying to maybe get some of those muscles to rearrange themselves in a way that didn’t continue to put pressure on nerve

• **Retinaculum = Band of thickened deep fascia usually around tendons 

Carpal Tunnel Syndrome 2

“Pop/Crack a joint = SOUND? = Gases escaping the joint 

• Left knee buckling is not the same kind of popping 

Tommy John Surgery 

Tommy John Surgery (sports that involve throwing!!):

• **Ulnar collateral ligament** (replaced w/ a tendon not a ligament, overhand pitching, major surgery takes time to heal, can come back stronger) reconstruction, colloquially known as Tommy John surgery** (TJS), is a surgical graft procedure where the ulnar collateral ligament in the medial elbow is replaced with either a ******tendon** from (1) elsewhere in the patient’s body, OR with one (2) from a deceased donor. The procedure is common among collegiate and professional athletes in several sports, particularly baseball. **Aponeurosis = takes the place of a tendon (pearly white in color)

• The ulnar collateral ligament **(UCL) can become stretched, frayed or torn through the repetitive stress of the throwing motion. The risk of injury to the UCL is believed to be extremely high, as the amount of stress through the structure approached its ultimate tensile strength during a hard throw

Turf Toe = Hallux (thumb is pollux)

Turf toe:

• A turf toe injury refers to a ligament sprain of the big toe joint that occurs on turf surfaces. This may cause tenderness and swelling around the big toe joint 

• Turf toe injuries occur when the big toe joint bends beyond its normal range of motion, thus spraining the ligaments that support the joint. If the big toe continues to bend uninterruptedly, this injury can become far more severe in nature

• The term turf toe was first coined by Bowers and Martin after they noticed and increase in **ligament sprains (should there be a massive inflammation of the distal segment of the hallux) OR a dislocation of the big toe joint amongst college football players following the installation of an artificial turf at West Virginia University 

• The authors stated that a combination of flexible football shows and hard artificial surfaces increased the risk of turf toe injury

  • in 1996 switched over to grass… helps w/ ACL, MCL, etc. 

Turf Toe 2

• Swelling → pressure → pain

• 5 signs of inflammation! Pressure is NOT one = PAIN!! Pharm & pain & vet school! Kill most of the pain but NOT all

• Pain is an evolutionary significant mechanism to tell vertebrate you are wounded so we can repair it

• Animals: difference w/ regards to pharmacology associated w/ pain

• Question: joint is a condyloid joint, it can flex, extend, aDuct, & aBduct

• Parity… supinator & pronator teres

A Separated Shoulder vs a Dislocated Shoulder 

• A **separated shoulder, also known as **acromioclavicular joint injury is a common injury to the **AC joint. The AC joint is located at the outer end of the clavicle (“cleido”) where it attaches to the acromion of the scapula 

  • clavicle is the most commonly broken bone in human body 

  • dad went hunting, went off road, broke clavicle, never got it fixed b/c of orthopedic surgeon

  • next year he breaks ankle while filling a feeder… wet, fell on rock wrong → got it fixed but kept screws in 

• **A dislocated shoulder is trauma to the **GH joint**- Glenohumeral Joint = humerus and glenoid fossa

• Symptoms include non-radiating pain which may make it difficult to move the shoulder 

• The presence of swelling or Contusion = **bruising (damaged blood vessel… RBCs being broken down… Fe2+ (in hemoglobin) must be dealt with) and a deformity in the shoulder is also common depending on how severe the dislocation is. Ref: color change

  • will change color b/c of repairing of blood vessels and b/c iron is being dealt w/, can’t let it float around hazardly 

Question on Exam… contusions

CPL walking down front row & left knee buckles, contusion in popliteal area (linear), needs MRI (review MRI from exam 1)

• bruises change color… iron being broken down 

• Have to repair damaged blood vessels

• Iron is reactive, can’t let it go all over the place 

• Coracoid process: means hook

• Sub, hypo, infra: below something 

Obligate Aerobes- Use O2 as the terminal electron acceptor of the ETC

-O2 is reduced to water. **CUT in the SKIN!!!

• RBCs don’t have mitochondria or DNA, leukocytes do

• Know what obligate anaerobes use as their terminal electron acceptor! *(CO2; SO42-)? Dead organisms smell bad 

  • Still make ATP, but oxygen is a poison to them

  • Don’t have 3 enzymes

  • Use CO2 & reduce it to CH4 (methane)

  • SO42- reduced to hydrogen sulfide

• Obligate aerobes (like us!) **have the enzymes **catalase and SOD (superoxide dismutase) and **glutathione (*GSH, by itself → tripeptide, GSH) peroxidase (*GPX, 1 of 3 enzymes). Obligate anaerobes do NOT have these two enzymes! To wit, oxygen is a POISON to obligate anaerobes: **make H2O2 → water and O2 (Bubbles!!!) → KILLS obligate anaerobe (NOT have 3 enzymes !!!)

• SOD makes H2O2 (from the reactive oxygen metabolites) and catalase breaks down H2O2 down into O2 and H2O2. Why? Because oxygen is a reactive molecule aerobes make plenty of reactive oxidative intermediates using O2

  • GSH → glutathione *(cysteine can scavage free radicals = Antioxidant)

  • most ubiquitous tripeptide found in higher vertebrates 

  • glutamate, cysteine, glycine 

• Reference to a cut on one’s hand. What do you see if H2O2 is poured into the cut??? Why pour hydrogen peroxide (H2O2) into the cut? 

• *5 fluids: aqueous humor of the eye, blood, lymph, bile, interstitial fluid

Antiperspirants vs Deodorant

• Antiperspirants work on the apocrine, sudoriforous glands of the axillary region 

• Deodorant interacts w/ thiol alcohols 

High Ankle Sprain:

• A high ankle sprain is also known as a syndesmotic ankle sprain. This type of sprain is a stretching and twisting of the **syndesmotic ligaments** that connect the tibia and fibula of the lower leg. ***The fibula is the NON-weight bearing bone of the lower leg! (tibia is the weight-bearing bone) ***Interstitial space = space between cells!!

• The “high ankle” component of the term comes from the sprain being characterized as pain or discomfort “above the ankle.” LONG TIME TO HEAL !?!?!? Why !?! Think level of vascularity. Think cells that are highly perfused w/ blood/O2; Friendly reminder- cells that are MORE than ****6-8 cell lengths away from capillary bed do NOT receive as much blood ERGO, nutrients and gases much DIFFUSE to these tissues!

Types of ankle sprains

• Most broken (ankle): talus, end of tib. or fib. 

• Syndesmotic lig. injured in any form → high ankle sprain 

  • ligament keeps tibia and fibula together 

• Don’t confuse high ankle sprain with broken ankle 

Broken bone

• A ****broken bone** is commonly referred to as a fracture of that bone. Speak the language of broken bones 

• Factors such as the direction and extent of the break are all considered prior to the diagnosis of the fracture 

• Also, has the fracture **penetrated the skin (compound, goes through skin) and are there **pieces (comminuted) of the bone visible at the site of the fracture? These elements are considered as well 

• **Blunt force trauma** (Joe Brrr, turf toe, high ankle sprain)… leads to the fracture and/or contusion (bruise) = hockey puck hits anterior crest of tibia 

• ****Add depression fracture (cranium); Ex = Hammer to cranium and bone fragment is dislodged towards brain = perfect impression of the actual impact 

  • Forensics… (1) hair follicle has DNA (2) ^

  • Depression: takes place of whatever object, directly into superior aspect, leaves a perfect outline

Bone Fractures

Oblique fractures are when the break is at an angle. A compound fracture has broken the skin. **Transverse and Traverse are the same!!

• Traverse: perpendicular to medullary cavity of diaphysis 

• Linear: parallel to…

• Oblique non-displaced: diagonal, on top of each other 

• Oblique displaced: apart/off-set 

  • same plane or offset?

• Spiral: planted leg… why we switched to grass. plantar leg, upper torso contorting 

• Greenstick: associated w/ young… bend then break 

• Comminuted: pieces

Greenstick fracture

A greenstick fracture typically happens in the very young. The bone bends then it breaks

Rotator Cuff

• The rotator cuff (helps stabilize shoulder socket) is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion

• Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are the (1) supraspinatus muscle, the (2) infraspinatus muscle, (3) teres ***minor** muscle, and the (4) subscapularis muscle. The rotator cuff muscles are important in shoulder movements and in **maintaining glenohumeral joint (shoulder joint) stability

  • 2nd GH… glenohumeral & growth hormone

  • 2 HAs… hyaluronic acid & hydroxyapatite 

• These muscles arise from the scapula and connect to the head of the humerus, forming a cuff at the shoulder joint. They hold the head of the humerus in the small and shallow glenoid fossa of the scapula 

• Clavicle is most commonly broken bone in body

Causes of Rotator Cuff Pain 

A *****tendinopathy is pain, swelling or tenderness typically due to overuse 

• -pathy: overuse/swelling… leads to pressure… leads to pain & tenderness

**Bruise/**Contusion (**deep bone bruise***) Leakage… lymphatic sys pick it up!! Swelling = **Edema

A bruise, also known as a contusion, is a type of hematoma of tissue the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates (leakage of blood, **lymph fluid**) into the surrounding interstitial (#5) tissued. Most bruises occur close enough to the epidermis such that the bleeding causes a (**hemoglobin = **Fe2+ = TOXIC) ***visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch (**blanching** = skin has whitish appearance caused by diminished blood flow to that region) under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone

• hema or hemo = blood… or emia/emic

• Why do bruises change color? (1) vessels are being ruptured (2) iron is being transported out 

• blanching: inflammation, push, turns white (ant bite)

Inflammation Basics

• Inflammation (from Latin: inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants and is a protective response involving immune cells, blood vessels, and molecular mediators (mediators of inflammation). The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair  

• ******The five cardinal signs are heat, pain (via pressure), redness, swelling, and loss of function**

• (next week) Mediators of Inflammation- Included among these mediators are (1). arachidonic acid derivatives (leukotrienes and prostaglandins) (5), (2). vasoactive peptides (-kinins), (3). phospholipid mediators (platelet activating factor), and (4). cytokines (interleukins and other bio-response modifiers); Ref to cyclooxygenase = **COX enzymes; Histamine = Sources (Mast Cells)!!!

Review 2

1. **Osteogenesis Imperfecta (collagen!) & **Osteoporosis 

2. **Sprains vs strains (back!!0

3. **Arthritis, inflammation, and **NSAIDs (and their effects on enzymes) **Non-steroidal anti-inflammatory, Exs: Ibuprofen (Advil) - Comp Inh. of COX (cyclooxygenase) = **antipyretics (fever down) 

4. Last but NOT least, our defenses can, paradoxically lead to physiological conditions becoming worse 

Active Transport (AT) vs Passive Transport 

Active Transport → energy into sys 

(A) 1° (primary AT) → use ATP directly → “ATPase”     Ex: Na+/K+ ATPase pump

(B) 2° (secondary) AT → uses ATP indirectly       Ex: Na+/glucose co-transport system 

Passive Transport → no energy into sys 

(A) Ex: diffusion… spray perfume, goes from high conc. & is going to start colliding w/ air molecules, goes in diff. directions 

(B) Osmosis: water does moving 

“U-Tube

(C) Facilitated Diffusion → PROTEIN 

Integral Protein → found w/in cell membrane 

Channels

Channels (3 types)

1. “leak” channel → K+ leak channel

2. voltage-gated channels (excitable tissues, Na+, K+)

3. ligand-gated receptor/channel

• Ligand is a molecule that binds either NT or hormone… have to be hydrophilic b/c they bind to cell surface receptor 

• Latin ligande, to bind or tie off

• Receptor becomes channel b/c of MIFCC 

• Molecular Interaction Facilitates Conformational Change (MIFCC)

Integral Protein → found w/in cell membrane

Carriers 

Ex: Na+/glucose co-transport system 

• Univ. of Florida… Gatorade early ‘60s

  • 2° AT symport 

  • Integral protein 

  • Oral rehydration therapy 

Integral Protein → found w/in cell membrane

Pumps

Ex: Na+/K+ ATPase pump

• “ATPase”

  • 1° AT 

  • ATP hydrolysis 

  • +∆G rxn → -∆G rxn 

  • “∆S” → entropy disorder

  • ∆G = ∆H-T∆S

  • ATP hydrolysis → -∆G rxn… -∆H, +∆S

  • ATP → ADP + PO4 → +∆G rxn → -∆G rxn… ATP hydrolysis, coupled together… can’t happen spont., not happening thermodynamically 

• Against gradient, potassium wants out, keeps getting pushed in

• Sodium wants in, gets pumped out

• ATP hydrolysis makes things in nature that don’t want to happen thermodynamically happen

• Ex: biosynthesis +∆G → -∆G

  • ATP hydrolysis can couple rxn, make something that doesn’t want to happen thermodynamically happen

Integral Protein → found w/in cell membrane

Receptors 

Going to be on cell surface 

Pharmacology- study of drugs & drug interactions 

*Antibiotics (kill bacteria) vs Antimycotic fungi (kill fungi)

• Pharm 101 → attack something that pathogen *has that host does *NOT

• Ex of antibiotic targets 

1. peptidoglycan biosyn. enzymes (if don’t have, can’t divide via binary fission)

2. 30s/50s (svedberg) → 70s ribosomes humans: 40s/60s → 80s

3. one small “circular” chromosome → DNA gyrase “supercoils” (enzymes)

• cyanide will kill bacteria, but also humans b/c it uncouples ETC

• humans don’t have cell walls

• mitochondrial ribosomes are closer to bacterial 70s ribosomes

• no nucleus… nucleoid region

Antimyocotics (kill fungi) → Fungacidal (dead)

Targets:

(A) Chitial biosyn. enzymes (NOT CHITON)

(B) Eagosterol (fungal version of cholesterol… steroidal lipid)

• bacteria have defenses against our antiobiotics

  • drug will go into bacterium, break down w/ an enzyme, pump it out