ECG Basics

An ECG is an electrical picture of the conduction of the heart. By interpreting changes from normal on an ECG, clinicians can identify a myriad of cardiac disease processes.

There are two ways to learn ECG interpretation; pattern recognition (the most common) or by understanding the exact electrical vectors recorded by an ECG. Most people learn a combination of the two and basing ECG interpretation on pattern recognition alone is often not sufficient.

Parts of an ECG

A normal ECG contains waves, intervals, segments, and one complex.

P wave: Indicates atrial depolarization
QRS complex: Indicates ventricular depolarization
T wave: Indicates ventricular repolarization

The P wave occurs when the SA node creates an action potential that depolarizes the atria. The P wave should be upright in lead II if the action potential is originating from the SA node. If this is so, the EKG is said to demonstrate a "normal sinus rhythm" abbreviated "NSR". As long as the atrial depolarization is able to spread through the AV node to the ventricles, each P wave should be followed by a QRS complex.

The QRS complex comes after the P wave when the SA nodal action potential travels through the AV node to the ventricles to cause ventricular depolarization. The first downward deflection is called the Q wave. The first upward deflection is called the R wave. The second downward deflection is called the S wave.

The T wave occurs after the QRS complex and is a result of ventricular repolarization. T waves should be upright in most leads (except aVR and V1). T waves should by asymmetric in nature. The second portion of the T wave should have a steeper decline when compared to the incline of the first part of the T wave. If the T wave appears symmetric, cardiac pathology may be present.

An interval is the distance between two specific ECG events. For example:

PR interval: The time from the beginning of the P wave (atrial depolarization) to the beginning of the QRS complex (ventricular deploarization). A prolonged or shortened PR interval can indicate certain disease states.

QT interval: The time from the beginning of the QRS complex (ventricular depolarization) to the end of the T wave (ventricular repolarization). QT interval prolongation can be very serious.

Normal values:

PR interval: 0.12 - 0.20 seconds
QT interval: < 0.42 seconds
QRS complex duration: < 0.10 seconds

A segment is the length between two specific points on the EKG which are supposed to be at the baseline amplitude (not negative or positive). For example:

ST segment: The portion of the ECG from the end of the QRS complex to the beginning of the ECG. The ST segment should not be elevated or depressed. Any change from baseline may indicated cardiac disease.

TP segment: The portion of the ECG from the end of the T wave to the beginning of the P wave. This segment should always be at baseline and is used as a reference to see if the ST segment is elevated or depressed.

PR segment: The portion of the ECG from the end of the P wave to the beginning of the QRS complex. PR segment depression can indicate disease, however PR segment elevation usually does not.

EKG Leads

There are 12 leads on a standard ECG. Six of the leads of considered "limb leads" since they are placed on the arms and/or legs of the person. The other six leads are considered "precordial leads" since they are placed on the person's torso (precordium).

Reading an EKG

Introduction

When looking at a 12-lead ECG, there are a few logistics that must be known. First of all, the standard 12-lead ECG is a 10 second strip. The bottom one or two lines will be a full "rhythm strip" of a specific lead spanning the whole 10 seconds of the ECG. Other leads will only span about 2.5 seconds.

Each ECG is divided by large boxes and small boxes to help measure times and distances. Each large box is 0.20 seconds. There are five small boxes in each large box, thus each small box is 0.04 seconds.

If the entire ECG is 10 seconds, then there must be 50 large boxes (0.20 seconds X 50 large boxes). Each small box is also exactly 1 mm in length and so one large box is 5 mm. In genereal, when measuring amplitudes of waves/complexes, the units are expressed in millimeters (mm) and when measuring lengths for intervals, the units are expressed in time (seconds or milliseconds).

If each small box is equal to 0.04 seconds or 1 mm, then the standard ECG speed is 1 mm per 0.04 seconds or 25 mm per second.

The standard approach to reading an ECG includes in this order:

1) Examining the rate
2) Examining the rhythm
3) Examining the axis, intervals and segments
4) Examining everything else.

Rate

There are two different rates that can be determined on ECGs. The atrial rate is indicated by the frequency of the P waves and the ventricular rate is indicated by the frequency of the QRS complexes. Normally, the artial rate should be the same as the ventricular rate in the absence of disease, however certain conditions, such as third degree AV nodal block, can alter this normal relationship.

One quick and easy way to determine the ventricular rate is to examine the R to R interval and use a standard scale to find the rate. If two consecutive R waves are seperated by only one large box, then the rate is 300 beats per minute. If the R waves are separated by two large blocks, then the ventricular rate is 150 beats per minute. The scale continues down to show that if two consecutive R waves are separated by 8 large boxes, then the rate is 37 beats per minute. The pictoral explaination of this method is below:

Another quick way to calculate the rate is based on the fact that the entire ECG is 10 seconds. So by counting the number of QRS complexes and multiplying by 6, the number per minute can be calculated. This is a better method when the QRS complexes are irregular making the first method less accurate, since the R to R intervals may vary from beat to beat.

Rhythm

The rhythm is either sinus or not sinus. If there is a P wave before every QRS complex, the P wave is upright in lead II, and the P wave has a normal morphology, then normal sinus rhythm is said to be present. If there is sinus rhythm and the heart rate is greater than 100, then sinus tachycardia is present. If the there is sinus rhythm and the heart rate is less than 60, then sinus bradycardia is present.

If there are no P waves present or the P wave morphology is not normal, then the exact rhythm must be determined. See the reviews of different rhythms for more information.

Axis

The axis of the ECG is the major direction of the overall electical activity of the heart. It can be normal, leftward, rightward, or indeterminate. Usually, the QRS axis is determined, however the P wave or T wave axis can also be calculated.

Any ideas on updates or new sections are welcome and can be e-mailed to Steve@learntheheart.com. Enjoy the website!

DRUGS USED IN RESPIRATORY DISEASES

1.

DRUGS USED IN RESPIRATORY DISEASES

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Antihistamines

2.Decongestants

3.Antitussives

4.Expectorants

5.Bronchodilators

6.Beta adrenergic agonist

7.Anticholinergics

8.Antileukotriene agents

9.Corticosteroids

10.Mast cell stablizers

STUDY NOTES ON RESPIRATORY SYSTEM

STUDY NOTES ON RESPIRATORY SYSTEM
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Anatomy mcq on musculockeletal system

10 anatomy mcq


1? Where is the weakest point in the clavicle?

a. the middle point of clavicle

b. the lateral ends

c. point where middle 2/3rd meets lateral 1/3rd’

d. point where lateral 1/4th meets middle 3/4th

e. None



2. which of the following muscles are not attached to coracoid process?

a. Short head of biceps

b. longhead of biceps

c. corachobrachialis

d. pectoralis minor

e. none



3. which muscles origins from above the glenoid fossa?

a. short head of biceps

b. long head of biceps

c. corachobrachialis

d. long head of triceps

e. deltoid



4. which of the following muscles are not inserted on greater tubercle of humerus?

a. supraspinatus

b. infraspinatus

c. teres major

d. teres minor



5. which of he following muscle inserted in lesser tubercle?

a. Supraspinatus

b. infraspinatus

c. suscapularis

d. deltoid

e. corachobrachialis



6. which of the following muscles not inserted into intertubercular groove?

a. Lattissimus dorsi

b. pectoralis major

c. teres major

d. deltoid





7. Which of the following is NOT true regarding the clavicle?

(A) Its medial end is enlarged where it attaches to the sternum.

(B) Its lateral end is ?at where it articulates with the humerus.

(C) The medial two-thirds of the shaft are convex anteriorly.

(D) The clavicle transmits shock from the upper limb to the axial skeleton.

(E) The clavicle is a “long bone” that has no medullary cavity.



8 The trapezius attaches to which of the following regions of the clavicle?

(A) lateral one-third of the clavicle

(B) conoid tubercle

(C) subclavian groove

(D) trapezoid line

(E) quadrangular tubercle



9. Which of the following is true in respect to the scapula?

(A) The spine of the scapula continues laterally as the coracoid process.

(B) The lateral surface of the scapula forms the glenoid cavity.

(C) The acromion is superior to the glenoid cavity and projects anterolaterally.

(D) The scapula is fastened securely to the thoracic cage at the scapulothoracic joint.

(E) The acromioclavicular
 

Pharmacology of Cardiovascular MCQs

Pharma -CVS MCQs


1. In PSVT the drug of choice is

a. Adenosine b. Propranolol c. Lignocaine d. Epinephrine

Ans. a



2. Propranolol is not used in

a. Hypertension b. Migraine c. Varient angina d. Thyrotoxicosis

Ans. c



3. Which of the following is not a cardioselective drug

a. Atenolol b. Metoprolol c. Labetalol d. Esmolol

Ans. c



4. Which of the following drug is contraindicated to treat hypertension with pregnancy ?

a. Enalapril b. Methyldopa c. Nifedipine d. Labetolol

Ans. a



5. All of the following are indications for use of ACE inhibitors , except

a. Hypertension b. Myocardial infarction

c. Left ventricular dysfunction d. Pheochromocytoma

Ans. d 6. Which of the following statements regarding ACE inhibitors is true

a. Has positive inotropic effect

b. No effect on preload

c. Decrease bradykinin level

d. Can result in increase plasma K level

Ans. d

7. The preferred drugs for hypertension in patients with heart failure ….

a. Verapamil b. Propranolol c. Diltiazem d. Captopril

ans. d



8. Which of the following statement regarding anti-arrhythmic drugs is false

a. Lignocaine ---- Na channel blocker

b. Verapamil ---- Ca channel blocker

c. Amiodarone ---- Na channel blocker

d. Propranolol ---- Beta receptor blocker

ans. c



9. The following persons have risk factors for developing hypertension EXCEPT:

a. A person with high total blood cholesterol

b. A person whose father developed hypertension at the age of 40 but the mother who is already age 50 and still normotensive

c. A person with a body mass index of 32

d. A person who drinks a large bottle of beer everyday

e. A person who works as an office worker and does not do any exercises

ans. d



10. A 50 year old female was given Digoxin for congestive heart failure. What is the cellular action of digoxin?

a. Inhibition of beta receptors

b. Inhibition of Na pump

c. Inhibition of ATP degradation

d. Inhibition of mitochondrial Ca ions release

ans. b

People who get less than 6 hours sleep per night had an increased risk of dying prematurely

People who get less than 6 hours sleep per night had an increased risk of dying prematurely in a recent study. Those who slept for less than that amount of time were 12% more likely to die early, though researchers also found a link between sleeping more than 9 hours and premature death.




The study aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.



Just one sleepless night can hamper the body's ability to use insulin to process sugar in the bloodstream. Insulin sensitivity is not fixed in healthy people, but depends on the duration of sleep in the preceding night.



"Society pushes us to sleep less and less," one of the study investigators said, adding that about 20% of the population in the United States and Britain sleeps less than 5 hours.



Adults typically need between 7 and 9 hours sleep a night. If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol.





References:

Bad night's sleep can hamper body's insulin use. Reuters.

Metformin on the incidence of vitamin B-12 deficiency

As many as 22% of people with type 2 diabetes could have vitamin B-12 deficiency.




This BMJ study evaluated the effects of metformin on the incidence of vitamin B-12 deficiency (lower than 150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin.



Compared with placebo, metformin treatment was associated with a decrease in vitamin B-12 concentration of -19%.



The absolute risk of vitamin B-12 deficiency (lower than 150 pmol/l) at study end was 7.2 percentage points higher in the metformin group than in the placebo group with a number needed to harm of 13.8 per 4.3 years.



Long term treatment with metformin may increase the risk of vitamin B-12 deficiency, which results in raised homocysteine concentrations. Vitamin B-12 deficiency is preventable; therefore, regular measurement of vitamin B-12 concentrations during long term metformin treatment should be considered.





References:

BMJ 2010; 340:c2181

BMJ 2010; 340:c2198

Banting and best designed an experiment. What did they do and discover?

Fred Banting and Charles Best are credited with the discovery of insulin at the University of Toronto in 1921. Banting was the chief researcher, Best was his research assistant...chosen over another man by the toss of a coin.




The Nobel Prize for the discovery of insulin was shared by Banting and another man, a Scot by the name of John Macleod, head of the department where the research was carried out. It transpires that although history seems to give full credit to Banting and Best, the real glory should have gone to Macleod and another researcher, James Collip, who between them made all the most vital contributions to the project. In fact, without their contributions, Banting and Best could not progress any further than the previous work of Romanian Nicolai Paulescu who had already had far greater success in isolating active secretions from dog pancreases. It was Macleod's and Collip's suggestions which enabled the first successful trials on human diabetics.



Best was excluded from the Nobel Prize as his contribution was purely a functional pair of hands and not an intellectual one. Collip should've received far more credit than he actually did. Banting shared his prize fund with Best 50/50 and Macleod did the same with Collip.



Actual experiment:



Some dogs had their pancreases removed. Secretions were isolated from the pancreases of healthy dogs. These secretions were used to inject into the first set of dogs in an atempt to keep them alive. The Toronto University team were the first to complete successful trials with diabetic humans.

Source(s):

Fabulous Science, Fact and Fiction in the History of Scientific Discovery, by John Waller.

Tales of the unexpected: Medicine's accidental discoveries

From Botox and viagra to penicillin, some of the greatest breakthrough cures have been discovered by happy serendipity. Roger Dobson reports

Viagra




The telephone call from a doctor in Merthyr Tydfil was one of the first clues. He had been running a small clinical trial on a new drug that had been designed for treating patients with angina. With other trials showing little efficacy for treating the disease, the future for the compound known as UK-92,480 was looking bleak.



When the doctor gave Pfizer the results, he mentioned that there had been some side effects among the healthy volunteers on the trial at Merthyr Tydfil, including indigestion and back pain. And, he added, some of the men had involuntary erections when they took the drug.



Scientists quickly discovered the scientific reason for the erections, and five years later and after much research, Pfizer applied for marketing approval for the drug – not for angina, this time, but for male impotence. Ten years on, Viagra has been used by more than 30 million men worldwide for impotence, and researchers are still finding new uses. The drug that nearly didn't make it is currently being used or investigated for treating more than a dozen diseases and health problems.


Vaccination




When Edward Jenner moved to practise medicine in rural Gloucestershire, he heard of a local saying that if a man wanted a woman who would not be scarred by the deadly smallpox disease, he should marry a milkmaid. This folk tale stemmed from the fact that milkmaids were vulnerable to cowpox, a chronic disease of cows that appeared as a rash on the milkmaids' hands.



As a result of this, in 1796 Jenner used cowpox to inoculate an eight-year-old boy called James, then exposed him, some weeks later, to smallpox. The cowpox was found to protect against smallpox.



Within six years, vaccination for the disease was an established practice, and it was Jenner's work that led to the eradication of smallpox in 1977, and the widespread use of vaccination.



Botulinum Toxin



In 1895, three members of a music club in Ellezelles, Belgium died and 34 fell ill, after eating a meal of raw salted ham. The culprit was eventually found to be Clostridium botulinum, which produces botulinum toxin, the most deadly poison of all. Work started in 1920, with researchers trying to isolate the toxin, but it wasn't until the 1950s that they discovered that the toxin could be used in tiny doses to treat "crossed eyes", spasms of the eyelids and excessive underarm sweating.



The cosmetically desirable effects of Botox were first discovered by Canadian surgeons Alastair and Jean Carruthers, a husband and wife team who noticed the softening of patients' frown lines following treatment for eye-muscle disorders.



"Its present cosmetic and non-cosmetic applications could certainly be considered a journey of serendipity,'' says Dr Arnold Klein of the University of California.



Later, Dr Richard Glogau, a dermatologist at the University of California, noticed a curious side effect when he injected Botox into the head and facial muscles of patients. The bacteria was being injected for cosmetic reasons, to temporarily get rid of wrinkles, but Glogau and his team noticed that patients who also had regular migraines were no longer getting them. Further research showed that botulinum toxin A injected into the muscles of the brow, eyes, forehead, side of the head and back of the head near the neck could induce immediate headache relief that may last for up to six months.



Penicillin



In 1928, after a period away from his laboratory at St Mary's Medical School in London, Alexander Fleming noticed that a mould had infected dishes where he had been growing experimental bacteria. Curiously, the area surrounding the mould growing in the dish was clear, suggesting that the bacteria could not survive near the mould. Fleming predicted that a compound produced by the mould must have an anti-bacterial action. He called the new chemical penicillin. Along with the other antibiotics, it revolutionised healthcare, and dramatically reduced mortality rates. He was awarded the Nobel Prize in 1945.



Librium and Valium



For months, the small box labelled Ro5-0690 had gathered dust. The product of work on synthetic dyes, it had been developed by Leo Sternbach, a pharmacist at Hoffmann-La Roche. During a routine clean-up, and Ro5-0690 was sent off to see if it had any pharmacological activity. The tests showed it to be highly effective. Ro5-0690 became the first anxiolytic benzodiazepine and was introduced in 1960 with the brand name Librium. Three years later, another anxiolytic benzodiazepine called diazepam (Valium) was introduced. Benzodiazepines revolutionised treatment for schizophrenia, depression and bipolar disorder. "They became one of the most lucrative drugs – thanks to luck," said Professor Ban.



Antidepressants



In 1956, Roland Kuhn, a Swiss psychiatrist, suggested to Geigy that its compound G 22,355 might have a therapeutic effect in schizophrenia. But tests showed it to be ineffective for the conditions. Just before he returned the drugs to the maker, Kuhn gave it to a patient with severe depression. Spurred by the apparent beneficial effect, Kuhn extended his trial. Not only did it have favourable effects, the patients relapsed when the drug was stopped. Within a year, G 22,355 had become the first tricyclic antidepressant, a family of drugs since used by millions.



Quinine



South American Indians discovered quinine and its anti-malarial powers by accident. The Peruvian natives found that if they drank from water close to cinchona trees, their fever would be eased. It is now known that the bark is a source of quinine, and Jesuit missionaries are recorded as having first used quinine from the tree to fight malaria in Peru in the 17th century. Quinine was brought to Europe in the same century, and the drug was eventually synthesised to become of a successful treatment for the condition, until it was superseded by other antimalarials.



Insulin



When two German doctors removed the pancreas from a dog, their plan was to study digestion processes. But they noticed that the dog's urine was attracting unusually large number of flies. Tests showed that they were attracted by high levels of sugar in the urine – a symptom of diabetes. The existence of diabetes in healthy animals led to an understanding of the pancreas's role in diabetes. It also led to the identification of insulin and treatment of the disease.

source:http://www.independent.co.uk/life-style/health-and-families/features/tales-of-the-unexpected-medicines-accidental-discoveries-826903.html

DEVELOPMENT OF CNS

Central nervous system (CNS).


Brain and spinal cord.

Both contain fluid-filled spaces which contain cerebrospinal fluid (CSF).

The central canal of the spinal cord is continuous with the ventricles of the brain.

White matter is composed of bundles of myelinated axons
Gray matter consists of unmyelinated axons, nuclei, and dendrites.

Peripheral nervous system.

Everything outside the CNS.

Spinal and cranial nerves

The cerebrum is derived from the embryonic telencephalon

The cerebrum is divided into left and right cerebrum hemispheres.

The corpus callosum is the major connection between the two hemispheres.

The left hemisphere is primarily responsible for the right side of the body.

The right hemisphere is primarily responsible for the left side of the body.

Cerebral cortex: outer covering of gray matter.

Neocortex: region unique to mammals.

The more convoluted the surface of the neocortex the more surface area the more neurons.

Basal nuclei: internal clusters of nuclei
Lateralization of Brain Function.


The left hemisphere.

Specializes in language, math, logic operations, and the processing of serial sequences of information, and visual and auditory details.

Specializes in detailed activities required for motor control.

The right hemisphere.

Specializes in pattern recognition, spatial relationships, nonverbal ideation, emotional processing, and the parallel processing of information.



The epithalamus, choroid plexus and the pineal gland thalamus, and hypothalamus are derived from the embryonic diencephalon.

Thalamus.

Relays all sensory information to the cerebrum.

Contains one nucleus for each type of sensory information.

Relays motor information from the cerebrum.

Receives input from the cerebrum.

Receives input from brain centers involved in the regulation of emotion and arousal. Hypothalamus.

Regulates autonomic activity.

Contains nuclei involved in thermoregulation, hunger, thirst, sexual and mating behavior, etc.

Regulates the pituitary gland.

• The Brainstem.


– The “lower brain.”

– Consists of the medulla oblongata, pons, and midbrain.

– Derived from the embryonic hindbrain and midbrain.

– Functions in homeostasis, coordination of movement, conduction of impulses to higher brain centers.

Midbrain. Develops from the mesencephalon

Contains nuclei involved in the integration of sensory information. visual reflexes & auditory reflexes. Relays information to and from higher brain centers



Cerebellum.Develops from part of the metencephalon.

Relays sensory information about joints, muscles, sight, and sound to the cerebrum.

Coordinates motor commands issued by the cerebrum



Pons. Develops from part of the metencephalon

Contains nuclei involved in the regulation of visceral activities such as breathing.

Relays information to and from higher brain centers

Medulla oblongata. Develops from the myelencephalon

Contains nuclei that control visceral (autonomic homeostatic) functions.

Relays information to and from higher brain centers

DEVELOPMENT OF URINARY SYSTEM

INDIANA UNIVERSITY


SCHOOL OF MEDICINE

The urogenital system develops from:


• the intermediate mesoderm (fig. 12-1B),

• the mesodermal epithelium (mesothelium) of the peritoneal cavity,

• and the endoderm of the urogenital sinus (fig. 12-20A).

The intermediate mesoderm used to lie lateral to the somites, then moved away from the somites during the lateral fold. It forms the urogenital ridge (fig. 12-1F) which is comprised of:

• a nephrogenic cord or ridge (fig. 12-2A)

• and a gonadal or genital ridge (fig. 12-29C).

3 successive sets of kidneys develop:

• The nonfunctional, rudimentary pronephroi develop early in week 4. But they degenerate, leaving behind the pronephric ducts which run to the cloaca (fig. 12-2). These ducts will remain for other kidneys.

• The mesonephroi develop later during week 4, serving as temporary excretory organs.

• The functional metanephroi or permanent kidneys develop early in week 5. They are functional by week 11-13 and excrete urine into the amniotic fluid. This excretion continues during fetal life and the fetus swallows this urine mixed in the amniotic fluid. It is then absorbed in the stomach and duodenum to the blood for transport to the placenta and disposal.

o If renal agenesis or urethral obstruction occurs, oligohydramnios results.

o If esophageal or duodenal atresia occurs, then polyhydramnios results.

The metanephros develops mesodermally from the metanephric diverticulum or ureteric bud which is a dorsal outgrowth from the mesonephric duct near the cloaca (fig. 12-6).

• Its stalk gives rise to the ureter (fig. 12-6C),


• its cranial end to the renal pelvis,

• its first 4 generations of tubules to the major calyces,

• its second 4 generations to the minor calyces (fig. 12-6D)

• and the remaining generations of tubules to the collecting tubules (fig. 12-6E).

The metanephric diverticulum or ureteric bud penetrates the metanephric mesoderm in the caudal part of the nephrogenic cord and stimulates the formation of the metanephric mass or cap (fig. 12-9).

The metanephric mesoderm gives rise to the nephrons (glomerulus, Bowman's capsule, proximal convoluted tubule, loop of Henle and distal convoluted tubule; fig. 12-7). The cortex of the kidney in the newborn contains mostly undifferentiated mesenchyme; the nephrons continue to develop several months after birth.

Ascension of the kidneys (fig. 12-10): The kidneys are first located in the pelvis ventral to the sacrum but gradually ascend to the abdomen. They reach the adult position by week 9 having touched the suprarenal glands (fig. 12-10). This is due to the disproportionate growth between the lumbar and sacral regions: the sacral region grows faster than the lumbar region.

The kidneys rotate 90 degrees from anterior to medial.

During their ascension, the blood supply changes continuously so that an adult may have 2 to 4 renal arteries (fig. 12-11).

The suprarenal glands ( fig. 12-27):

• The cortex forms from the mesoderm,

• the medulla from neural crest cells (receiving preganglionic sympathetic fibers from the celiac plexus).

The urinary bladder develops from the urogenital sinus and the surrounding splanchnic mesenchyme (fig. 12-20). The urogenital sinus is comprised of 3 regions:

• The cranial or vesical region which will form the bladder and which is attached to the allantois. After birth, the allantois degenerates and becomes the urachus forming the median umbilical ligament. The transitional epithelium of the bladder develops from endoderm of the urogenital sinus.


• The middle or pelvic region.

• and the caudal or phallic region.

The female urethra and almost all of the male urethra have the same origin.

The glans penis in the male develops from the ectodermal glandular plate (figs. 12-24, 12-25)

Developmental abnormalities of the kidney and excretory passages are common:

• Incomplete division of the metanephric diverticulum or ureteric bud results in double ureter (fig. 12-12B-D) and supernumerary kidney (fig. 12-12F).

• Failure of the kidney to "ascend" from its embryonic position in the pelvis results in an ectopic kidney that is abnormally rotated (fig. 12-12B).

• Various congenital cystic conditions of the kidneys may result from failure of nephrons derived from the metanephric mesoderm to connect with collecting tubules derived from the metanephric diverticulum.

NOTES ON Osteoarthritis

Osteoarthritis


By: Sue Renfrow, RN, BSN



Osteoarthritis

* A form of Degenerative Joint Disease (DJD) * A common disabling joint disorder (problems with hips, knees, ankles) *Osteoarthritis is the most prevalent activity limitation among the elderly leading to disability *Affects 16- 20 million people in U.S.



Causes

*Idiopathic- Primary *No prior event or disease * Aging *Secondary *Resulting from previous joint or inflammatory disease *Congenital diseases ( Legg-Cave’-Perthes) *Gout *Obesity the more you weigh the harder it is on your joints



Clinical Manifestations

*Pain *Stiffness/ swelling *Functional Impairment/ asymetric *Heberden’s Nodes



Assessment/Diagnostic

*Physical assessment of musculoskeletal system *Location and pattern of pain *X-Rays- Show loss of joint cartilage, narrowing of joint space, osteophytes (bone Spurs) *Labs-ESR, RH-rule out RA (RH 40 or less)



Medical Management

*Decrease weight *Injury prevention *Ergonomic modifications



Conservative:

-heat/cold -avoid overuse -supports for joints -isometric, postural and aerobic exercise -Physical/Occupational therapy



Pharmacological

*Tylenol, Acetaminophen (drug of choice) worry about liver damage





*Salicylates, Aspirin - the “grandfather” *NSAIDS: Ibuprofen, Advil, Motrin & Nuprin (eventually will wind up on NSAIDs) *Cox-2 (Celebrex) worry about GI bleed *Opiates *Corticosteroids *Glucosamine/Chondroiton *Hyaluronic acid (Synivisc) *Topical- Capsain, methylsalicylate



Surgical Management

*Osteotomy-moderate to severe loss of function, may have this (realign joint) *Arthroplasty-surgical repair of the joint p. 1628



Treatment

*GOALS of treatment include: GOALS *decreasing joint pain and stiffness *improving joint mobility and stability *increasing ability to perform ADL’s *optimizing functional ability



Nursing Management:

*Chronic pain related to joint degeneration *Impaired physical mobility related to restricted joint mobility *Body image disturbance related to visible body changes *Self-care deficit related to immobility *Knowledge deficit *Ineffective individual/family coping or compromise



Preventative Measures:

*Joint Protection Joint *Correct body mechanics *Avoid grasping actions that strain finger joints *Spread weight of an object over several joints *Maintain good posture *Use strongest muscles and favor large joints

NOTES ON UPPER LIMB

NOTES ON UPPER LIMB

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NOTES ON UPPER LIMB

LIVING WITH DISEASE

Great peoples and their disease.

.
Albert Einstein
Albert Einstein did not speak until the age of three. Even as an adult Einstein found that searching for words was laborious. He found schoolwork, especially math, difficult and was unable to express himself in writing. He was thought to be simple minded (retarded), until it was realized that he was able to achieve by visualizing rather than by the use of language. He work on relativity, which revolutionized modern physics, was created in his spare time.

Stephen Hawking
Stephen Hawking is a physicist/mathematician who has Lou Gehrigs Disease. He uses a wheelchair for mobility and a computer to speak.

Helen Keller
Helen Keller was suddenly shut off from the world at the age of 19 months by the loss of sight and hearing. Against overwhelming odds, she waged a slow and difficult but successful battle to re-enter the world. A near-savage deaf and blind mute child grew into a woman who wrote, spoke, and labored incessantly for the betterment of others and almost single-handedly destroyed age-old myths about people with disabilities.

John Milton
English Author/poet (1608-1674): He became blind at the age of 43. He went on to create his most famous epic, Paradise Lost.

Leonardo da Vinci
Leonardo da Vinci, an Italian painter, sculptor, writer, scientists, engineer, musician and architect. Renaissance genius. Strephosymbolis (unable to process symbols accurately).

George Washington
George Washington was unable to spell throughout his life and his grammar usage was very poor. His brother suggested that perhaps surveying in the backwoods might be an appropriate career for young George.

NOTES ON SKULL TUTORIAL

NOTES ON SKULL TUTORIAL

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Notes on skull tutorial