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The muscles of the leg that move the foot and toes are divided into anterior blood pressure is high generic 40mg inderal, lateral pulse pressure glaucoma buy inderal 10 mg visa, superficial- and deep-posterior compartments hypertension xerostomia order inderal 10mg on-line. The anterior compartment includes the tibialis anterior blood pressure goals purchase inderal 10mg on-line, the extensor hallucis longus, the extensor digitorum longus, and the fibularis (peroneus) tertius. The lateral compartment houses the fibularis (peroneus) longus and the fibularis (peroneus) brevis. The superficial posterior compartment has the gastrocnemius, soleus, and plantaris; and the deep posterior compartment has the popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus. A muscle that has a pattern of fascicles running along the long axis of the muscle has which of the following fascicle arrangements? The muscle fibers on one side of a tendon feed into it at a certain angle and muscle fibers on the other side of the tendon feed into it at the opposite angle. Which of the following terms would be used in the name of a muscle that moves the leg away from the body? The large muscle group that attaches the leg to the pelvic girdle and produces extension of the hip joint is the group. Which of the following abdominal muscles is not a part of the anterior abdominal wall? Describe the different criteria that contribute to how skeletal muscles are named. What are some similarities and differences between the diaphragm and the pelvic diaphragm? List the general muscle groups of the shoulders and upper limbs as well as their subgroups. At some point in the future, will this type of technology lead to the ability to augment our nervous systems? That quote is from the early 1990s; in the two decades since, progress has continued at an amazing rate within the scientific disciplines of neuroscience. It is an interesting conundrum to consider that the complexity of the nervous system may be too complex for it (that is, for us) to completely unravel. One easy way to begin to understand the structure of the nervous system is to start with the large divisions and work through to a more in-depth understanding. In other chapters, the finer details of the nervous system will be explained, but first looking at an overview of the system will allow you to begin to understand how its parts work together. The focus of this chapter is on nervous (neural) tissue, both its structure and its function. But before you learn about that, you will see a big picture of the system-actually, a few big pictures. That suggests it is made of two organs-and you may not even think of the spinal cord as an organ-but the nervous system is a very complex structure. Within the brain, many different and separate regions are responsible for many different and separate functions. It is as if the nervous system is composed of many organs that all look similar and can only be differentiated using tools such as the microscope or electrophysiology. In comparison, it is easy to see that the stomach is different than the esophagus or the liver, so you can imagine the digestive system as a collection of specific organs. The Central and Peripheral Nervous Systems the nervous system can be divided into two major regions: the central and peripheral nervous systems. The brain is contained within the cranial cavity of the skull, and the spinal cord is contained within the vertebral cavity of the vertebral column. In actuality, there are some elements of the peripheral nervous system that are within the cranial or vertebral cavities. The peripheral nervous system is so named because it is on the periphery-meaning beyond the brain and spinal cord. Depending on different aspects of the nervous system, the dividing line between central and peripheral is not necessarily universal. A glial cell is one of a variety of cells that provide a framework of tissue that supports the neurons and their activities. The neuron is the more functionally important of the two, in terms of the communicative function of the nervous system.

A patient has thalassemia hypertension signs generic 10mg inderal with mastercard, a genetic disorder characterized by abnormal synthesis of globin proteins and excessive destruction of erythrocytes heart attack 40 generic 10mg inderal with visa. This patient is jaundiced and is found to have an excessive level of bilirubin in his blood blood pressure standards cheap inderal 80mg fast delivery. One of the more common adverse effects of cancer chemotherapy is the destruction of leukocytes pulse pressure 66 discount inderal 10mg with amex. Explain why administration of a thrombolytic agent is a first intervention for someone who has suffered a thrombotic stroke. Following a motor vehicle accident, a patient is rushed to the emergency department with multiple traumatic injuries, causing severe bleeding. In preparation for a scheduled surgery, a patient visits the hospital lab for a blood draw. There is no single better word to describe the function of the heart other than "pump," since its contraction develops the pressure that ejects blood into the major vessels: the aorta and pulmonary trunk. Although the connotation of the term "pump" suggests a mechanical device made of steel and plastic, the anatomical structure is a living, sophisticated muscle. As you read this chapter, try to keep these twin concepts in mind: pump and muscle. Although the term "heart" is an English word, cardiac (heart-related) terminology can be traced back to the Latin term, "kardia. If one assumes an average rate of contraction of 75 contractions per minute, a human heart would contract approximately 108,000 times in one day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan. Each of the major pumping chambers of the heart ejects approximately 70 mL blood per contraction in a resting adult. In order to understand how that happens, it is necessary to understand the anatomy and physiology of the heart. Location of the Heart the human heart is located within the thoracic cavity, medially between the lungs in the space known as the mediastinum. Within the mediastinum, the heart is separated from the other mediastinal structures by a tough membrane known as the pericardium, or pericardial sac, and sits in its own space called the pericardial cavity. The dorsal surface of the heart lies near the bodies of the vertebrae, and its anterior surface sits deep to the sternum and costal cartilages. The great veins, the superior and inferior venae cavae, and the great arteries, the aorta and pulmonary trunk, are attached to the superior surface of the heart, called the base. The base of the heart is located at the level of the third costal cartilage, as seen in Figure 19. The inferior tip of the heart, the apex, lies just to the left of the sternum between the junction of the fourth and fifth ribs near their articulation with the costal cartilages. The right side of the heart is deflected anteriorly, and the left side is deflected posteriorly. It is important to remember the position and orientation of the heart when placing a stethoscope on the chest of a patient and listening for heart sounds, and also when looking at images taken from a midsagittal perspective. The slight deviation of the apex to the left is reflected in a depression in the medial surface of the inferior lobe of the left lung, called the cardiac notch. By applying pressure with the flat portion of one hand on the sternum in the area between the line at T4 and T9 (Figure 19. This is particularly critical for the brain, as irreversible damage and death of neurons occur within minutes of loss of blood flow. Current standards call for compression of the chest at least 5 cm deep and at a rate of 100 compressions per minute, a rate equal to the beat in "Staying Alive," recorded in 1977 by the Bee Gees. At this stage, the emphasis is on performing high-quality chest compressions, rather than providing artificial respiration. It is also possible, if the hands are placed too low on the sternum, to manually drive the xiphoid process into the liver, a consequence that may prove fatal for the patient. This proven life-sustaining technique is so valuable that virtually all medical personnel as well as concerned members of the public should be certified and routinely recertified in its application. By applying pressure to the sternum, the blood within the heart will be squeezed out of the heart and into the circulation.

Control active bleeding by pressure quick acting blood pressure medication cheap inderal 10 mg line, may need direct ligation in operating room or embolization in interventional radiology suite 2 heart attack questions to ask doctor buy cheap inderal 80mg line. Palpate facial skeleton for underlying bone pain and instability; rule out injury to facial nerve arrhythmia palpitations inderal 80 mg, parotid duct blood pressure scale buy discount inderal 40mg line, etc. Wounds closed preferably less than 8 hours post-injury, but primary closure may be delayed up to 24 hours b. Physical examination for asymmetry, bone mobility, diplopia, extraocular muscle entrapment, sensory loss, malocclusion, local pain c. Once occlusion is aligned, work systematically, either "outside-in" (Gruss) or "inside-out" (Manson), establishing facial height, width, and projection by aligning key facial buttresses (open reduction) and plating of fractures (internal fixation) 2. Nasal bone fracture most common facial fracture (a) Septal hematoma can cause septal necrosis; must be drained immediately (b) May be corrected by closed reduction/manipulation and placement of external splint and Doyle splints (internal) ii. Le Fort fractures (Figure 3) 51 (a) Disrupts vertical maxillary buttresses: major areas of structural stability (i) Zygomaticomaxillary (ii) Nasomaxillary (iii) Pterygomaxillary (b) Treatment involves open reduction and internal fixation with miniplates to reestablish facial proportions and occlusion Figure 3. Usually more conservative with operative repair in this patient population, due to growing facial skeleton and developing dentition. The head and neck are relatively resistant to infection due to their robust vascularity B. Scalp and orbital infections may spread intracranially via the dural sinuses and ophthalmic veins C. Facial cellulitis: mostly due to staphylococcus or streptococcus - may use a cephalosporin 2. Use extended spectrum penicillin or other anaerobic coverage (Augmentin/Unasyn) 3. Primarily managed by Otolaryngologists but provide major reconstructive challenges for Plastic Surgeons (see next section) E. Minor salivary glands: least common, with highest incidence of malignancy (about 75%) 2. Any mass in the pre-auricular region or at the angle of the jaw is a parotid tumor until proven otherwise b. Surgical removal of entire gland with sparing of nerve branches that are clearly not involved ii. Anatomical: malignancies behave differently according to anatomic site and prognosis worsens from anterior to posterior b. Examination - including indirect laryngoscopy and nasopharyngeal endoscopy when indicated b. Malignant (a) Wide local excision with tumor-free margins with/without lymph node dissection (b) Palliative resection may be indicated for comfort and hygiene (c) Immediate reconstruction with vascularized flaps when indicated by size and location of defect (see next section) b. Preoperative (a) To increase chance for cure, especially with large lesions (b) May make an inoperable lesion operable by shrinking it and reducing involvement with unresectable structures ii. Postoperative (a) If tumor-free margin is questionable (b) For recurrence (c) Prophylactic - controversial c. Primary closure often possible, can be assisted with galeal relaxation incisions (scoring) 3. Tissue expansion is an excellent option (can allow up to 50% reconstruction without obvious alopecia) C. Main goal: tension-free coverage of the globe to prevent exposure keratopathy and ectropion (chronic eyelid irritation) 2. Cutler-Beard flap: pass tissue from below the lower lid under it and tack it into the upper lid defect iii. Main goal: Create aesthetic piriform aperture coverage and maintain airway patency and nasal lining 2. Divided into 9 subunits: single dorsum, tip, columella, and paired sidewalls, soft triangles, and alar lobules (Figure 5) 3. Nasolabial flap: tissue from along the cheek-nose junction swung into defect on the nasal ala or sidewall c.

Digestion begins the moment you put food into your mouth heart attack song generic inderal 10 mg amex, as the food is broken down into its constituent parts to be absorbed through the intestine blood pressure ranges low generic inderal 80 mg free shipping. The digestion of carbohydrates begins in the mouth hypertension 16090 order inderal 10 mg otc, whereas the digestion of proteins and fats begins in the stomach and small intestine hypertension 2013 guidelines generic 80 mg inderal otc. The constituent parts of these carbohydrates, fats, and proteins are transported across the intestinal wall and enter the bloodstream (sugars and amino acids) or the lymphatic system (fats). From the intestines, these systems transport them to the liver, adipose tissue, or muscle cells that will process and use, or store, the energy. Depending on the amounts and types of nutrients ingested, the absorptive state can linger for up to 4 hours. The ingestion of food and the rise of glucose concentrations in the bloodstream stimulate pancreatic beta cells to release insulin into the bloodstream, where it initiates the absorption of blood glucose by liver hepatocytes, and by adipose and muscle cells. Once inside these cells, glucose is immediately converted into glucose-6-phosphate. By doing this, a concentration gradient is established where glucose levels are higher in the blood than in the cells. This allows for glucose to continue moving from the blood to the cells where it is needed. Insulin also stimulates the storage of glucose as glycogen in the liver and muscle this content is available for free at cnx. As you will see, muscle protein can be catabolized and used as fuel in times of starvation. If energy is exerted shortly after eating, the dietary fats and sugars that were just ingested will be processed and used immediately for energy. If not, the excess glucose is stored as glycogen in the liver and muscle cells, or as fat in adipose tissue; excess dietary fat is also stored as triglycerides in adipose tissues. The Postabsorptive State the postabsorptive state, or the fasting state, occurs when the food has been digested, absorbed, and stored. You commonly fast overnight, but skipping meals during the day puts your body in the postabsorptive state as well. However, due to the demands of the tissues and organs, blood glucose levels must be maintained in the normal range of 80­120 mg/ dL. In response to a drop in blood glucose concentration, the hormone glucagon is released from the alpha cells of the pancreas. Glucagon acts upon the liver cells, where it inhibits the synthesis of glycogen and stimulates the breakdown of stored glycogen back into glucose. This glucose is released from the liver to be used by the peripheral tissues and the brain. Gluconeogenesis will also begin in the liver to replace the glucose that has been used by the peripheral tissues. After ingestion of food, fats and proteins are processed as described previously; however, the glucose processing changes a bit. The liver, which normally absorbs and processes glucose, will not do so after a prolonged fast. The gluconeogenesis that has been ongoing in the liver will continue after fasting to replace the glycogen stores that were depleted in the liver. After these stores have been replenished, excess glucose that is absorbed by the liver will be converted into triglycerides and fatty acids for long-term storage. Starvation When the body is deprived of nourishment for an extended period of time, it goes into "survival mode. Therefore, the body uses ketones to satisfy the energy needs of the brain and other glucose-dependent organs, and to maintain proteins in the cells (see Figure 24. Because glucose levels are very low during starvation, glycolysis will shut off in cells that can use alternative fuels. As starvation continues, and more glucose is needed, glycerol from fatty acids can be liberated and used as a source for gluconeogenesis. After several days of starvation, ketone bodies become the major source of fuel for the heart and other organs. As starvation continues, fatty acids and triglyceride stores are used to create ketones for the body.