WEEK 3

Question 1

Brain trauma (what happens?)

Answer 1

trauma -> trus si membran2 depolarisasi and the channel2 calcium, natrium sama potasium buka plus glutamat release–> tp krena ini malah jadi toxic dan stress, terus kebanyakan calcium –> trus mitochondria dtng, inflamasi, lewat bbb, gangguan saraf deh

Question 2

Intracerebral hemorrhage

Answer 2

intinya kek brain trauma trus darah juga susah ngalir kan ya krna hemorrhage, tapi ada tambahan trombin keluar dan inflamasi sehingga lewat bbb trus ada necrosis cell

Question 3

Cerebral oedema

Answer 3

cytotoxic = intraceluler, intinya kek air mausk kedalam cell dan membesar krna si pompa2 na k ca ga berfungsi dengan baik. si Na masuk mulu kedalam cell - di gray/white
vasogenic = bbb rusak, air masuk jadinya intracranial pressure naik = biasanya di white

Question 4

Diffuse axonal injury

Answer 4

microscopic damage of TBI (traumatic brain injury) kek pas shearing (brian move tp axon ga move akhirnya axonal injury

Question 5

Spinal cord Injury

Answer 5

primary : fracture/trauma (compression contussion shear)
secondary : dari dalam misalnya ischemik, mitochondrial stress, inflamation, apoptosis (trus kek banyak axonal demyelination krna oligodendrocytesnya die) terus akhirnya bkin glial scar

Question 6

Anterior cord syndrome

Answer 6

full depan lesi si medulla spinalis/cord

loss motor dan pain/temperature, sensory masih ada di bawah lesi

Question 7

Central cord syndrome

Answer 7

upper extremity weakness, sensory loss dibawah lesi dan susah pipis (bladder retention)

Question 8

Posterior Cord Syndrome

Answer 8

motor ok tp touch dan propriosepsi, vibrasi loss dibawah lesi

Question 9

Brown sequard

Answer 9

dia kek setengah medulla spinalis

loss semua tapi in one side yg ruska ajah dibawah lesi

Question 10

conus medullaris syndrome

Answer 10

leg weakness, gangguan sphincter, reflex bladder dan rectal gaada, terus sensasi di atas paha gitu menurun

Question 11

myelopathy

Answer 11

injury to THE WHOLE spinal cord

Question 12

Autonomic dysreflexia

Answer 12

spinal cord injury tapi di atas T6 (complee lesions)

Question 13

Apoptosis

Answer 13

mikroglia –> respons sekunder
oligodendrocyte –> demyelination
neuron –> saraf hilank
How? ekstrinsik ada iNOS dan FAS, intrinsik ada kaspase 3 and 9, sitokrom c

Question 14

Neurogenik shock vs Medula/spinal shock

Answer 14

kalo neurogensik lebih ke sistem saraf simpatis jadi heartbeat suhu tensi –> more because primary lesion.trauma
kalo medula lebih ke motorik sensorik –> more inflamasi

Question 15

How neurogenik shock

Answer 15

vasodilatory, cardiogenik, neuroendocrine

Question 16

Therapy Spinal cord dan neurogenik shock

Answer 16

spinal cord- Methylprednisolone stem cell therapy (supaya regenerate)
neurogenik- vasopressor kek dopamoine norepinephrine

Question 17

Peripheral nerve injury types

Answer 17

kok bisa rusak? - stretch, compressed, laceration
terus akibatnya apa?
biasanya compress/crush jadi neuropraxia (nerve rusak, sensory dan motor terganggu temporer),
laceration/penetrating/fracturs bisa bikin nerve kepotong,
twist/traction/crushing bisa jadi neurotmesis dan axonotmesis

Question 18

Seddon vs Sunderland Classification

Answer 18

Seddon : Neuropraxia, Axonotmesis, Neurotmesis
Sunderland : neuropraxia, axonotmesis, neurotmesis (masih ada perineum), neurotmesis (tinggal epineurium), neurotmesis full cut

Question 19

Wallerian Degeneration

Answer 19

nerve break down (axon dan myelin juga) di bagian lesi anterograde, mast cell makrophag and schwann cell bantu bersihin debris, terus kalo kerusakan udah sampe distal nanti nerve sama otot communication kepotong. TInggal sisa schwan cell (whats left of it namanya bands of bugner)

Question 20

Nerve Regeneration

Answer 20

Axon akan tumbuh searah bands of bugner terus dia konek ke otot yg tadi di lepas. Dibatu oleh NGF yg dirangsang makrofag di schwann cells

Question 21

How is pain felt?

Answer 21

transduction (stimuli felt) –> transmission (stimuli sent to center) –> modulation (brain kek ok i got ur message, dont do anything stupid intinya untuk inhibit impulses) –> perception (kita merasa pain)

Question 22

Therapy nsaids

Answer 22

non selective = aspirin, ibuprofen,
kinda selectif/preferential = yg nac2 kayak diclofenac
selectiv = coxib

Question 23

Ganggu medula spinalis (compress misalnya) dari disc dan tumor

Answer 23

disc herniation, disc degeneration, tumor ada 3 (intramedular, intradural tp extramedular, extradural/epidural)

Question 24

disc herniation steps

Answer 24

internal disrupsi dari si disc, disk protrude tapi posterior longitudinal ligament still intact, terus jadi ruptur, disk kemana2

Question 25

Types of fractures

Answer 25

transverse, segmental, spiral (complete) | buckle, torus, greenstick (incomplete)

Question 26

Bone repair (fractures)

Answer 26

callus hematoma --> inflamation --> soft callus osteoblast and clast & hard callus mineralization (jadi lamellar bone bukan yg spongy osetocyte) (repair) --> remodel direct/gap healing --> immobile extra : hyperbaric oxygen chamber helps

Question 27

How callus works?

Answer 27

``` tissue destruction and hematoma inflamasi dan proliferasi sel (dari stem cell) awal mula bikin callus Consolidation remodelling ```

Question 28

Kalo ga heal dengan bener?

Answer 28

``` non union (hyper dan a trofik) malunion avascular necrosis extra : wolfs law = controlled mobilitation > immobilitation ```

Question 29

healing of tissue

Answer 29

acute/reaction phase - inflamasi repair/regeneration - scar tissue & fibroblast Remodeling - more scar tissue but lebih maleable

Question 30

healing of tendon

Answer 30

hemostasis inflamation organogenesis remodelling

Question 31

healing of ligament

Answer 31

inflamation proliferation remodeling maturation