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HUMB2009 Study Guide - Final Guide: Neuropathic Arthropathy, Ct Scan, Lisfranc Injury

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School
Curtin University
Department
Human Biology
Course
HUMB2009
Professor
Claudia DSR

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Document Summary

When an action is repeated too many times: pathological. When bone is already fragile due to another pathology: soft tissue lesion, simple. Soft tissue communicates with the fracture can lead to infection. Need more than radiograph, need ct or us to be coupled. With osteomyelitis, there is no signs straight away then you later will see the erosion of the bone, hence you need ct/us + radiography: complex. Extensive damage: muscles, nerves, vessels: pattern, simple, transverse, oblique, spiral (child abuse commonly bc of torsion, segmental, multifragmentary. Unimalleolar, bimalleolar, or trimalleolar (posterior tibia) fracture. Need xray + ct to see the ligaments and soft tissue around. Femoral neck + greater and lesser trochanters . Co(cid:373)(cid:373)o(cid:374) i(cid:374) older people (cid:449)ith osteoporosis (cid:894)(cid:449)ard"s tria(cid:374)gle(cid:895) Often caused by falls, flexed and abducted knees. By shear force being generated up the shaft of the femur. Need mri to see the fracture (in x ray can look completely normal) Knee ligament rupture, patella fracture, meniscus fracture.

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Related Questions

COLLAPSE

You might have heard not too long ago about a caseinvolving a New Jersey company called Biomedical Tissue Services,which was accused of selling processed body parts from stolencadavers. Bone and tissue from some of these bodies turned up inJoplin, Missouri, and were used in surgeries performed recently inboth of our local hospitals. They have of course turned up in manyother places also.

The body parts processing industry is a largely unknown but verylucrative –and usually legal – industry that takes tissue, bone,tendons, ligaments, heart valves, corneas, and various other bodyparts, processes them, and turns them into products that can beused in various kinds of surgery. Some 20,000 bodies are “processed” in this way in the U.S. each year. Typically, a familywill consent to the donation, and the body is then taken by anon-profit body harvesting foundation. This foundation then passesthe body on to various specialized companies for a token price, andthese companies then harvest the different body parts, and processand sell them to medical supply companies, which then sell them tohospitals. Every one makes a profit in these transactions exceptthe donor and the donor’s family. It is estimated that a singledonor body can generate the raw material for products that sell forup to a total of $220,000.00. If vital organs are included, thebody might generate up to a $1,000,000.00 worth of products. Theethical dilemma I would like you to discuss here concerns thequestion of whether families of donors should be paid for bodyparts donations? Is it fair that others make a handsome profit fromthe sale of body parts, but those who “donate” them don’t? If youthink people or their families should be paid when they donate, doyou feel the same way about vital organs like hearts, lungs,kidneys, etc.?

For your information – and at risk of making this posting overlylong – here is some more information about what body parts can bedonated and how they are used. Cadaver skin is used both for burnvictims and in cosmetic surgery, and skin from a single donor canbe turned into product that can be sold for several tens ofthousands of dollars. Tendons and ligaments are of course used inknee and joint surgery and they can cost patients thousands ofdollars each. Corneas can fetch $2400.00 per pair. A heart valvecosts around $7000.00. One catalogue lists 650 body parts productsthat can be purchased. Separate bones are harvested, and bones arealso fashioned into various sizes and shapes, and ground down topowder form and used in bone paste, screws, wedges, and putty.Products are typically freeze dried or frozen so that they canremain useable for up to five years after harvesting.

U.S. law requires that body parts be harvested only from donorswho have signed consent forms. There is also rigorous medicaltesting that is required, including screening for HIV, Hepatitus Band C, and syphilis. Needless to say, none of this testing was doneon the cadavers stolen by Biomedical Tissue Services. This companyis now out of business and its former owner, Michael Mastromarino,is in jail. Surely, we all agree that what Mastromarino’s companydid was wrong, but what do you think of the larger question? Whencompanies make hundreds of thousands of dollars from donated bodyparts, is it fair that the donors and their families getnothing?

Please help answer 4 questions:

1. Using the information provided thus far by both Parts I and II, answer the following questions.

What problems both stated and unstated does Phyllis seem to be experiencing? What pieces of background information (patient environment and social/family history) have been provided by the family?

2. Distinguish between the relevant and non relevant symptoms/lab results needed to form a diagnosis. Of the relevant symptoms/lab results, rank them in priority and defend your answer.

3. Given what you know about the role of myelin in action potential propagation and the key information previously identified in questions 1 and 2, explain why multiple sclerosis is the appropriate diagnosis.

4. Consider you are the physician, what would be your strategy to slow progression of the disease and compensate for reduced neuronal function? What is the long-term prognosis with treatment?

The Soccer Mom:

A Case Study on the Nervous System

by

Jennifer Bolognese, Misti Coronel, Anita Intorre, and

Phil Stephens Biology Department Villanova University

Part I—At the Soccer Game

Thirty-two-year-old Phyllis Jackson was sitting on the bench at the side of the soccer ?eld, sipping a bottle of

Gatorade. Her husband, Steven, sat next to her with a concerned expression. “I’m really worried about you, honey,” he said.

“I’m just a little dehydrated; I’ll be ?ne.”

“If this were the ?rst incident, then maybe I’d agree with you. But your boss has been on your case about your lack of concentration at work, you forgot to pick up the kids from school last week, and quite frankly, you haven’t exactly been yourself with me lately. Now you’re having fainting spells during games? Something doesn’t seem right.”

“I know things haven’t been going well for me lately, but I don’t know why. I try so hard at work, at home, with the kids, to be a good wife. So maybe all this stress has made me a little unfocused and disoriented. What do you want me to do about it?” Phyllis said, blinking back tears.

“I think you should see a doctor,” Steven replied, putting his arm around her and drawing her close. “The kids are getting worried, too.”

Phyllis sighed. “Alright, if it will make you feel better. I really just think I need some time to relax, though.” “Well… I could drop the kids of at my sister’s tonight; that would give us a little free time…”

“That’s really thoughtful of you. I could de?nitely use a quiet night at home, maybe even go to bed early.” Steven seemed disappointed.

Part II—The Doctor Visit

“So, what seems to be the problem, Mrs. Jackson?” Dr. Warner asked Phyllis.

“My husband wanted me to come in and see you after I fainted during my soccer game Saturday. I’ve also been having some problems at work, but I think I’m just stressed.”

“What kinds of problems have you been having at work?”

“It’s been hard to concentrate on tasks. I’ve also had some problems typing—I’ve been making more errors than usual, and oftentimes my ?ngers will go numb.”

“I see,” said Dr. Warner, taking a few notes on his clipboard. “According to my records you are not on any long term medication. Have you noticed any problems outside of work?”

“Well, my husband has been complaining about our personal life lately. And last week, I completely forgot that I was supposed to pick up our two daughters after school. I’ve been feeling really tired lately; even my coordination seems of.”

“How long has this been going on for?”

“A few weeks, but this isn’t the ?rst time. These problems seem to come and go, but it’s getting to the point where I can’t just ignore them anymore. I don’t know, maybe I’m just depressed.”

“Why do you say that?”

“My mother suffered from depression throughout my childhood.”

“Well, depression certainly could cause some of the symptoms you’re experiencing,” Dr. Warner said thoughtfully. “Is there a history in your family of any neurological disorders?” “I don’t think so. I have some vague recollection of my grandfather in a wheelchair when I was really young, but I don’t know what was wrong with him.”

“Okay,” said the doctor, nodding. “Well, the few preliminary tests we’ve run show that you are not pregnant, and that you are not going through menopause. I’d like to send you to see Dr. Thrush, a friend and colleague of mine. She is a neurologist at the local hospital and she will run a few tests to explore your symptoms a little further.”

Questions: Analyze

1. Using the information provided thus far by both Parts I and II, answer the following questions.

What problems both stated and unstated does Phyllis seem to be experiencing? What pieces of background information (patient environment and social/family history) have been provided by the family?

Part III—Diagnostic Tests

Dr. Thrush looked over the results of Phyllis’s Magnetic Resonance Imaging (mri) and evoked potential tests. She was thinking how glad she was that Steven had accompanied Phyllis on this visit as she showed them the MR images of Phyllis’ brain.

“The machine took pictures of Phyllis’ brain in slices. The dark areas are the brain tissue, Phyllis, and the white areas in the middle and around the outside are the cerebrospinal ?uid.”

“Is that normal? Am I ok?” Phyllis asked. “And what are those little white dots in the tissue?”

“The white dots are what concerned me,” replied the doctor. “So we did another type of mri, called dark ?uid, so that your cerebrospinal ?uid would not show up white.”

“But I still see the white dots in my brain tissue. What does that mean?”

The doctor looked down, knowing that this was never an easy thing to tell a patient.

“I am afraid that this indicates that there are plaques or scars in your brain, and that you may have multiple sclerosis.”

Tears began to form in her eyes as Phyllis squeezed her husband’s hand.

“I am afraid that the evoked potential test and the elevated levels of myelin basic protein in you cerebrospinal ?uid indicate the same thing.”

Questions: Evaluate and Apply

2. Distinguish between the relevant and non relevant symptoms/lab results needed to form a diagnosis. Of the relevant symptoms/lab results, rank them in priority and defend your answer.

3. Given what you know about the role of myelin in action potential propagation and the key information previously identified in questions 1 and 2, explain why multiple sclerosis is the appropriate diagnosis.

Part IV—The Diagnosis

Dr. Thrush informed Phyllis that she was probably suffering from the relapsing-remitting form of multiple sclerosis (ms), in which relapses of symptoms are separated by periods of remission. ms is a disorder in which the myelination of axons is degraded due to unknown factors. The most commonly accepted explanation is that ms is an autoimmune disorder in which myelin in the central nervous system is attacked by the body’s own immune system. There is no known cure for multiple sclerosis. During remission, axons affected by the disorder regain their function. Voltage-gated sodium channels are concentrated in the nodes of Ranvier and the distribution changes at disease onset.

Questions: Create

4. Consider you are the physician, what would be your strategy to slow progression of the disease and compensate for reduced neuronal function? What is the long-term prognosis with treatment?

Thank you for your time with this

For Discussion (2-3 paragraphs) • What was the concentration of your pre-diluted NPs? • Determine the effect of NPs on brine shrimp lethality. • Determine the effect of NPs on cell viability. • What is (are) the control(s) in this experiment? What is its purpose? • Based on your data in this lab, what is a safe concentration for brine shrimp Threshold Level of Toxicity (TTL)? • Often indicator species are used to study the overall health of an ecosystem. If you were to study an ecosystem containing brine shrimp, would you use it as an indicator species? Why or Why not? Explain your reasoning. • What possible sources of error were present in this experiment?

Introduction

LD50 is a commonly used term to describe acute toxicity: LD stands for Lethal Dose and 50 is used because the dose could kill 50% of the animals exposed to the chemical. For LD50 tests, the animals are given specific amounts of the chemical, orally, by injection or dermally. The value is then reported along with the method of administration and the type of animal used in the test. LD50 is typically reported in milligrams or grams per kilogram of body weight of the animal. The lower the LD50 is, the higher the toxicity of the chemical would be. This information is always provided in Safety Data Sheet (SDS) of chemicals in the “toxicity data” category. A similar measure, the LC50 is usually used to describe the ecological hazards of chemicals. LC stands for lethal concentration that could kill 50% of the animals after 24-96 hours. This value is always provided in Safety Data Sheet (SDS) of chemicals in the “Ecological Data” category. In this lab, you will be measuring LC50 or LD50 of iron oxide nanoparticles using brine shrimp. Iron oxide nanoparticles are magnetic. Application of magnetic nanoparticles ranges from magnetic storage media to medical industry where they can be used for targeted drug delivery or as contrast agents in MRI. Thus, measuring environmental and biological toxicity of these nanoparticles is crucial. To test toxicity of any such reagents on small organisms, Daphnia and brine shrimps (also known as Artemia) can be used. Artimia are found in salt lakes around the world. They are important live food for aquarium fish. In this lab, you will use brine shrimp to measure toxicity of the nanoparticles. Trypan blue is a stain used to assess cell viability. It is able to diffuse through cell membranes of dead cells but is unable to permeate live cells. This stain can be used to assess cell survival 1 Fall 2017 following exposure to chemicals, nanoparticles and experimental drugs. The ratio of live: dead cells can be used as a preliminary assessment of cytotoxicity and translated to tissue viability.

Methods Part A: Serial Dilution of NP Solution 1) Label 5 test tubes as 0, 1:1, 1:10, 1:100, 1:1000 2) Add 2mL of seawater to tube 0 3) Add 2mL of specific group stock solution to tube 1:1 and add 2mL of seawater to it. 4) Transfer 1mL of stock solution to tube 1:10 and add 9mL of seawater to this tube 5) Transfer 1mL of 1:10 solution to the tube labeled as 1:100 and add 9mL of seawater to 
this tube 6) Transfer 1mL of 1:100 solution to the test tube labeled as 1:1000 and add 9mL of 
seawater to this tube Part B: Preparation of test environments 1) Label 5 wells of 6-well plate as control (0), 1:1, 1:10, 1:100 and 1:1000 2) Label 3 petri dishes as: control (0), 1:1 and 1:1000 
NOTE: Be sure to include your initials on all plates 3) Transfer 2mL of each solution from the corresponding test tube to the respective wells on your six-well plate and each petri dish Part C: Preparing specimens for the Trypan blue cell viability test 1) Transfer 2 brine shrimp into each of the pre-labeled petri dishes containing the solution of NPs and seawater (0, 1:1 & 1:1000) and set a timer for 30 minutes. 2) Transfer a single brine shrimp into the unlabeled petri dish with a drop (~50ul) of seawater and use the dissecting microscope to make observations related to the behavior and morphology of untreated brine shrimp.
Make observations in lab notebook of all samples Part D: Preparation of specimens for the toxicity assay 1) 2) 3) 4) 5) Add 10 brine shrimp into each well in the 6 -well plate Make observations in lab notebook Using a dissecting microscope (if needed), count the number of brine shrimp in each well (alive shrimps).
Record your data in your notebook using the graphic below as a template. Close the plate and store it for next observation.
Observations must be done within 24h-96h
Note: There will be times allocated and a sign up paper for observations Part E: Trypan blue viability test 2 Fall 2017 1) Label 3 glass slides to match the petri dishes prepared in Part C. 2) Transfer 1 brine shrimp from each petri dish onto the corresponding slide. 
Make observations in your lab notebook 3) Add a drop (~60 μl) of PBS on top of each specimen 4) Add 60 μl of Trypan blue to your shrimp and incubate for 1-2 minutes at room 
temperature. 5) Wick away excess liquid 6) Add 100 μl PBS to sample and observe (while alive!), looking for blue cells, using the 
dissecting scope 
Make observations in your lab notebook 7) Label 3 microfuge tubes to align with each sample. 8) Transfer each brine shrimp from the slide into the corresponding microfuge tube 9) Add 50 μl of PBS to the tube and use the mechanical disruption tool to homogenize the 
sample for ~2 minutes until a cell suspension has been generated. 10) Load 30-50 μl of your sample onto a new glass slide and add a cover slip. 11)Observe the sample on high power and use the scale below to qualitatively assess cytotoxicity” 0-no blue 1-some blue 2-fairly blue 3-totally blue.