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week 2 Flashcards

1
Q

examples of non depolarising muscle relaxants

A

Rocuronium
Pancurnium
Vecuronium
Tubocurarine
Atracurium

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2
Q

mechanism of action of non depolarising muscle relaxants

A

Structurally similar to ACh
Antagonism of nicotinic ACh receptors (competitive inhibitor) on motor end plate, prevent ACh binding

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3
Q

MOA of Rocuronium

A

non depolarising neuromusclar blocker
competative inhibitor of the ACh at nicotinic receptor

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4
Q

Administration of Rocuronium

A

IV bolus 1.2mg/kg
onset within 45-60seconds

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5
Q

Distribution of Rocuronium

A

Rapid onset, highly ionized, small Vd
Duration 20-35 mins
metabolised in liver and excreted renally
short half life

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6
Q

Mechanism of action of depolarising muscle relaxants

A

Phase 1; depolarising
acts on nicotinic receptor and opens causing Na influx
remains bound to the receptor
persistant depolarisation prevents repetitive firing
Phase 2; desensitisation
with continued polarisation membrane will repolarise

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7
Q

When and why should you not use depolarising muscle relaxants

A

Burns, nerve damage, closed head injuries
due to potassium release caused by nicotinic channels
K release can be exaggerated and risk of cardiac arrest

Also can cause increased ocular pressure so contraindicated in open globe trauma

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8
Q

what effects do depolarising muscle relaxants have on skeletal muscle?
what can this cause ?

A

Initial fasciculations
then flaccid paralysis
myalgia common post operative

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9
Q

mechanism of action of Suxamethonium

A

Depolarising neuromuscular blockade
Phase 1 depolarising, causing fasciculation
Phase 2 continued exposure, unresponsive to subsequent impulses, causing flaccid paralysis

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10
Q

pharmacokinetics of suxamethonium

A

IV administration
onset 30-60 seconds
duration 2-8 minutes
hydrolysed rapidly by plasma pseudocholinesterase

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11
Q

Adverse effects of Suxamethonium

A

muscle pain
bradycardia with repeat dosing
release K+ - especially in burns and trauma
raised IOP and ICP
risk of malignant hyperthermia
risk of prolonged paralysis

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12
Q

Definition of malignant hyperthermia

A

A pharmacogenetic disorder of skeletal muscle triggered by certain anaesthetic agents,
leading to uncontrolled calcium release from the sarcoplasmic reticulum → hypermetabolic state.

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13
Q

Genetic factors of mlignant hyperthermia

A

Autosomal dominant inheritance.

Most commonly due to mutation in the RYR1 gene (ryanodine receptor type 1).

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14
Q

triggering agents for malignant hyperthermia

A

Volatile inhaled anaesthetics (e.g. halothane, sevoflurane, desflurane)

Succinylcholine (suxamethonium)

🚫 NOT triggered by: IV agents like propofol, opioids, benzodiazepines, ketamine, nitrous oxide.

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15
Q

pathophysiology of malignant hyperthermia

A

Defective RYR1 receptor → excessive Ca²⁺ release from sarcoplasmic reticulum → sustained muscle contraction → increased ATP consumption → heat + CO₂ + lactate production → metabolic acidosis and hyperthermia.

Leads to: rhabdomyolysis, hyperkalaemia, arrhythmias, renal failure, death if untreated.

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16
Q

Features of malignant hyperthermia

A

Early signs:
Rapid rise in end-tidal CO₂ (ETCO₂), Tachycardia, Muscle rigidity (especially masseter), Hyperkalaemia

Later signs:
Hyperthermia, Acidosis, Rhabdomyolysis (↑ CK, myoglobinuria)

🧠 For ACEM: Know why ETCO₂ rises (↑ metabolism & CO₂ production) and why muscle rigidity occurs (Ca²⁺-mediated contraction).

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17
Q

Management of malignant hyperthermia

A

Immediate cessation of triggering agent.
100% O₂ (high flow).
IV dantrolene (RYR1 antagonist – inhibits calcium release).
Dose: 2.5 mg/kg IV, repeated as needed.
Cool the patient (active cooling).
Correct acidosis, hyperkalaemia, arrhythmias.
Monitor for complications (renal failure, DIC).

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18
Q

medial articulation of clavicle

A

manubirum of the sternum
sternoclavicular joint

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19
Q

lateral articulation of clavicle

A

acromium of the scapula
acromiocalvicular joint

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20
Q

what shape are the curves of the clavicle

A

convex medially
concave laterally

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21
Q

what is the first bone to being ossification

A

clavicle

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22
Q

what muscles attache to the clavicle

A

sternocleidomastoid
pectoralis major
deltoid
trapezius
subclavius
sterohyoid (indirectly)

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23
Q

attachment of sternocleidomastoid to clavicle

A

medial end superior surface

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24
Q

attachment of pectoralis major to clavicle

A

medial half of anterior surface

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25
attachment of deltoid to clavicle
lateral third of anterior surface
26
attachment of trapezius to clavicle
lateral third of posterior surface
27
attachment of subclavius to clavicle
inferior surface (groove of subclavius)
28
what are the ligaments attached to the clavicle
Costoclavicular ligament Conoid and Trapezoid ligaments - corcoclavicular
29
what is the clinical relevance of the clavicle
most commonly fracture bone in the body, typically at junction of medial and lateral 1/3
30
what can be injured in a clavicle fracture
subclavian vessels brachial plexus apex of lung (rare)
31
what are the bony features of the superior anterior view of the clavicle
sternal end medially Conoid tubercle Deltoid tubercle Acromial end laterally
32
what are the bony features of the clavicle in the inferior view
sternoarticular facet medially impression of costoclavicular ligament groove of subclavius conoid tubercle trapezoid line acromial articular facet
33
Apex boundary of axilla
cervicoaxillary canal bounded by 1st rib, clavicle and superior scapula
34
Base boundary of axilla
axillary fascia and skin
35
anterior boundary of axilla
pectoralis major pectoralis minor subclavius clavipectoral fascia
36
what forms the anterior axillary fold
pectoralis major
37
what is the clavipectoral fascia pierced by
cephalic vein thoracoacromial artery, vein lymph lateral pectoral nerve
38
posterior surface of axilla
subscpularis teres major latissmus dorsi
39
medial surface of axilla
serratous anterior thoracic wall ribs 1-2 and intercostal muscles
40
lateral border of axilla
intertubercular groove of the humerus
41
what is the content of the axilla
axillary artery axillary vein brachial plexus cords - lateral, posterior, medial lymph nodes - pectoral, subscapular, humeral, central, apical fat and connective tissue
42
how is the axillary artery divided
3 parts defined by pectoralis minor
43
what ligaments make up the clavipectoral fascia and what muscles are supported in it?
Costocoroid ligament Suspensory ligament of axilla Subclavius pectoralis minor
44
what structures pass inwards through the clavipectoral fascia
Cephalic vein lymphatics from breast
45
what structures pass outwards through the clavipectoral fascia
pectoral branch of thoracoacromial artery lateral pectoral nerve
46
boundaries of the triangular space
superior; teres minor lateral; long head of triceps inferior; superior border of teres major
47
contents of the triangular space
scapular circumflex vessels no nerves
48
boundaries of the quadrangular space
superior; teres minor laterally; surgical neck of humerus medially; long head of triceps inferiorly; teres major anteriorly; subscapularis
49
content of quadrangular space
Axially nerve Posterior circumflex humeral vessels
50
boundaries of triangular interval
superior; teres major lateral; humerus medial; long head of triceps
51
contents of triangular interval
Radial nerve profunda brachii artery
52
what forms the Roots of the brachial plexus
anterior rami of C5-T1
53
where are the roots of the brachial plexus located
behind scalenus anterior
54
what makes up the trunks of the brachial plexus
Superior - C5+C6 Middle - C7 Inferior - C8+T1
55
where are the trunks of the brachial plexus
posterior triangle of the neck
56
what makes up the divisions of the brachial plexus
anterior and posterior divisions of the trunks
57
where are the divisions of the brachial plexus located
behind the clavicle
58
what makes up the cord of the brachial plexus
Named in relation to position with axillary artery. Lateral C5-C7 Posterior C5-T1 Medial - C8-T1
59
where are the cords of the brachial plexus located
in the axilla
60
roots and functions of musclocutaneous nerve
C5-C7 motor function; biceps brachi, brachialis, corcobrachialis sensory; lateral cutaneous branch of forearm
61
roots and functions of axillary nerve
C5+C6 motor function; deltoid, teres minor, long head to triceps sensation; deltoid (regiments badge)
62
roots and functions of radial nerve
C5-T1 motor function; triceps brachi, extensors of forearm, extension of wrist and fingers sensation; posterior aspect of the arm and forearm, and the posterior, lateral aspect of the hand.
63
roots and functions of median nerve
C5-T1 motor function; Innervates most of the flexor muscles in the forearm, the thenar muscles, and the two lateral lumbrical muscles sensation; lateral part of the palm and lateral 3.5 fingers on palm side
64
roots and functions of ulnar nerve
C8+T1 motor functions; intrinsic hand muscles, flexor carpi ulnaris and medial half of flexor digitorum profundus. sensation; anterior and posterior surfaces of the medial one and half fingers
65
what type of joint is the sternoclavicular joint
synovial saddle joint acts as a ball and socket
66
ligaments of the sternoclavicular joint
Anterior and Posterior Sternoclavicular ligaments Interclavicular ligament Costoclavicular ligament
67
what is the clinical relevance of the sternoclavicular joint
rarely dislocates. but if it posteriorly dislocates risk of compressing the great vessels, oesophagus or trachea
68
what ligaments make up the acromioclavicular joint
acromioclavicular coracoclavicular coroacromial
69
what ligament is the main stabiliser in the acromioclavicular joint
coracoclavicular ligament
70
what are the two parts of the coracoclavicular ligaments and their function?
Conoid; resists vertical displacement of the clavicle Trapezoid; resists axial compression
71
what divides the axillary artery into its 3 parts
pectoralis minor
72
where does the axillary artery begin
outer border of 1st rib it is a continuation of the subclavian artery
73
where does the axillary artery end
inferior border of teres major it becomes the brachial artery
74
what are the branches on the medial/1st part of the axillary artery
superior thoracic artery supplies pectoralis major and minor
75
what are the branches on the posterior/2nd part of the axillary artery
thoracoarcomial artery (piercees the costocoranoid membrane) lateral thoracic artery (supplies serratous anterior)
76
what are the branches of the lateral/3rd part of the axillary artery
subscapular artery anterior and posterior circumflex
77
origin of pectoralis major
clavicular head and sternocostal head
78
insertion of pectoralis major
lateral lip of intertubercular sulcus of humerus
79
Nerve supply of pectoralis major
C5-T1 Medial and Lateral Pectoral nerves
80
function of pectoralis major
Adduction, Medial rotation and Flexion of the arm at the shoulder joint. Helps with inspiration
81
origin of pectoralis minor
3rd 4th and 5th ribs
82
insertion of pectoralis minor
coracoid process of scapula
83
nerve supply of pectoralis minor
medial pectoral nerve C8-T1
84
function of pectoralis minor
protraction and depression of scapula elevates ribs in forced inspiration
85
origin of subclavius
costochondral junction in 1st rib
86
insertion of subclavius
subclavian groove on inferior surface of clavicle
87
nerve supply to subclavius
nerve to subclavius C5 C6
88
function of subclavius
depression clavicle helps stablize the sternoclavicular joint
89
serratus anterior origin
1st to 8th ribs divided into slips
90
insertion of serratus anterior
inner surface of scapula
91
nerve supply of serratus anterior
long thoracic nerve C5-7
92
function of serratus anterior
protracts scapula rotating the scapula laterally and upwards in raising the arm above the shoulder
93
what happens to paralysis of serratus anterior
winged scapula
94
Origin of trapezius
External occipital protruberance, nuchal ligament, spinous process C7-T12
95
Insertion of trapezius
lateral 1/3 of clavicle, acromion, spine of scapula
96
Nerve supply of trapezius
Accessory nerve CNXI
97
Function of trapezius
Upper fibres elevate. middle fibres retract. lower fibres depress
98
origin of latissmus dorsi
spinous process of T7-L5 thoracolumbar fascia iliac crest ribs 9-12
99
insertion of latissmus dorsi
floor of intertubercular sulcus of humerus
100
innervation of latissumus dorsi
thoracodorsal nerve C6-C8
101
rhomboid major origin
T2-5 spinous process
102
rhomboid minor origin
C7-t1 spinous processes
103
Insertions of rhomboids
medial side of scapular Rh major - below spine of scapula Rh minor - at level of scapula spine
104
innervation of rhomboids
dorsal scapula nerve C4-5
105
action of rhomboids
retracts the scapula
106
origin of levator scapulae
posterior tubercles of transverse processes of C1-4
107
insertion of levator scapulae
medial border of the scapula superior to the spine of scapula
108
innervation of levator scapulae
dorsal scapula nerve C4-5 cervical nerves C3-4
109
function of levator scapulae
elevates scaupla
110
where does the subclavian artery arise from
left; aortic arch right; brachiocephalic trunk passes laterally between anterior and middle scalenes
111
where and what from does the axillary vein arise
at lower border of teres major from union of brachial veins and basilic vein
112
7 stages of action potential
1. Resting membrane potential -70mV 2. Threshold potential -55mv response from depolarising stimulus 3. Depolarisation. Entry of Na through voltage gated ion channels 4. Equilibrium potential 5. Repolarisation +30mV. Opening of K channels, K efflux 6. Hyperpolarisation -90mV. slow voltage gated K channels are slow to close 7. return to resting membrane potential
113
difference between absolute and relative refractory period.
After voltage gated ion channels are activated and open, they close and are inactive for a short time. This is Absolute refractory, no stimuli can open them. Then they are closed and resting, Relative refractory. Can be stimulated with higher stimuli.
114
function and speed of Aalpha fibres
motor to skeletal muscle, proprioception. very fast ~80-120m/s
115
function and speed of Abeta fibres
Touch, pressure. ~35-90m/s
116
function and speed of Agamma fibers
motor to muscle spindles ~10-45m/s
117
function and speed of B fibres
Preganglionic autonomic fibres ~3-15m/s
118
function and speed of C fibres
dull pain, temperature, itch slow 0.5-2m/s
119
nerve fibres in order of most to least susceptible to hypoxia
B A C
120
nerve fibres in order of most to least susceptible to pressure
A B C
121
nerve fibres in order of most to least susceptible to local anaesthesia
C B A
122
which nerve fibres transmit pain
A delta - sharp pain C - dull pain
123
in a sarcomere what is the z line
line where actin (thin filaments) is anchored marks the edges of each sarcomere
124
in a sarcomere what is the I band
region contain only thin filaments (actin)
125
in a sarcomere what is A band
Region where thick and thin filaments overlap; remains constant during muscle contraction
126
in a sarcomere what is the H zone
where only thick filaments are (myosin) shortens in contraction
127
in a sarcomere what is the M line
Center of the sarcomere; holds the thick filaments in place
128
what is the role of Calcium in the sarcomere
binds to troponin C that uncovers the myosin binding sites on actin to allow for attachment for contraction
129
morphology of cardiac muscle
striated involuntary muscle. branches fibres. single nucleus. intercalated discs. gap junctions
130
phase 0 of cardiac muscle action potential
rapid depolarisation. opening of voltage gated Na Channel. Na influx
131
phase 1 of cardiac muscle action potential
initial rapid repolarisation. opening of K channels. transient K out of cell
132
phase 2 of cardiac muscle action potential
plateau phase. slower prolonged opening of Ca channels. Ca influx
133
phase 3 of cardiac muscle action potential
repolarization. closure of Ca channels. Influx of K channels. K efflux.
134
phase 4 of cardiac muscle action potential
resting membrane potential -90mV. maintained by leak K channels
135
Phase 0 of pacemaker cell action potential
Depolarisation at -40mV. Rapid influx of Ca through L type calcium channel.
136
Phase 3 of pacemaker cell action potential
Repolarisation. Efflux of K through voltage gated potassium channels. back to resting potential -60mV
137
Phase 4 of pacemaker cell action potential
spontaneous depolarisation. -60 to -40mV. slow influx of Na through funny channels/ If. T type Ca channels open late in this phase.

Acem Primary (18 decks)

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