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DMS, palmaris brevis, Sunscreen, 8 irregular bones, 15 irregular bones -…
DMS
Dermatology
Basic
Anatomy&Histology
epidermis
layer
startum granulosum
Lamellar granules - exocytosis
stratum spinosum
Accumulate keratins, Form lamellar granules
stratum basalis
single layer, Mitosis
stratum corneum
Dead cells shed continuously
Avaskular
most formed by keratinocyte
Also contain non-keratinocytes cell : melanocyte, langerhans, merkel cells
dermis
sublayers
papillary
reticular
dermis vassels
Sub-papillary plexus > between papillary and reticular
deep plexus
innervation
sensory fibers
Corpuscular receptor : Meissner and Paccini
sympathetic motor fibers
Sweat gland, vasc. smooth muscle, arrector pilli, sebaceous gland
free nerve ending
penicillate fibers
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papillary nerve ending
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formed by connective tissue
cellular components
mast cells
type I hypersensitivity
phagocytic system
monocytes + macrophages -> phagocytosis and coagulation
fibroblasts
wound healing and scarring
dendrocyte
APC
filamentous and diffuse matrix
fibronectin
vitronectin
supporting
Glycoproteins
Facilitate cell migration, adhesion, differentiation
tenascin
Proteoglycans + Glucosaminoglcans
for regulation of water binding
fibrous matrix
elastic connectie tissue
collagen
subcutaneous layer
loose connective tissue
extensive vascular tissue
contains adipocytes
energy supply and protection
influenced by leptin hormone
Physiology
sensation
uv protection
protection from pathogens
wound repair/regeneration
thermoregulation
physical appearance
permeability barier
Efloresensi
primer
macula, papula, plaque, urtika, nodul, papiloma, kista, vasicle dan bulla, pustula, purpura, teleangiektasi, dan komedo
sekunder
skuama, krusta, erosi, ulkus, ekskorasi, fisura, atropi, sikatriks, sklerosis, likenifikasi, hyperkeratosis, kunikulus, abses, dan sinus
Clinical
Infeksi
harper
Varicella (Varicella-zoster virus)
virus masuk dan bereplikasi di sel epithelial
Virus akan dibawa oleh sel T ke lymph nodes terdekat
Secondary viremia
Setelah 2 minggu, virus akan mulai menginfeksi sel T
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Primary viremia
Virus akan menginfeksi sistem retikuloendotelial (liver & spleen)
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Non-infeksi
burn injury
Risk factor:
radiation, fire, contact, chemical, electrical
kerusakan jaringan (kulit, jaringan ikat, tulang)
deep partial thickness
epidermis, papillary dermis + reticular dermis
red-waxy white blanchable skin
++ edema
broken blisters
sensitive to pressure
full thickness
epidermis, dermis + subcutaneous tissue
dry, non-blanching, leathery, black or white skin
++ edema
-sensation
superficial partial thickness
epidermis + papillary dermis
moist, pink-red blanchable skin
+edema
+blistering
++ pain
Sub Dermal
epidermis, dermis, muscle +/- bone
unable to heal without intervention, ++ risk of infection, loss of function
superficial thickness (1
only epidermis
dry, pink-red blanchable skin
-/+ edema
-blistering
delayed pain
acne vulgaris
Risk factor:
puberty, unknown triggers, oily cosmetics, genetics
Risk factor: oily cosmetics, genetics, unknown triggers
sel epitelial folikel rambut menjadi hyperkeratinized
affects only "pilosebaceous hair follicles"
comedogenesis:
sebum & cellular debris menumpuk di dalam folikel
P. acnes menginfeksi folikel yang diisi sebum, menghidrolisis sebum menjadi asam lemak bebas
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penyumbatan sebum
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akumulasi white-yellow sebum melebarkan folikel
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sebum dan keratin dioksidasi oleh O2, berubah menjadi hitam
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pilosebaceous hair follicles concentrated on face, chest, bacl, buttocks
acne
Risk factor: puberty, unknown triggers
kelenjar sebaceous membesar dan menghasilkan lebih banyak sebum
Moskuloskeletal
Basic
Anatomy
back
vertebrae
vertebral body
vertebral arch
7 processes
1 spinous
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IV Disc
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33 regions
7 cervical
12 thoracic
5 lumbar
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intrinsic back muscles
transversospinalis
semispinalis
multifidus
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extends head and thoracic
interspinales
Aids in extension and rotation of vertebral column
erector spinae
Flexes/extends vertebral column
intertransversarii
Aids in flexion of vertebral column
splenius
Flexes/extends and rotates neck
levatores costarium
Elevates ribs (assisting respiration)
extrinsic back muscle
levator scapulae
Elevates scapula
rhomboid minor/major
Retracts scapula
latissimus dorsi
Extends, adducts, rotates (medial), humerus
serratus posterior superior
Elevates ribs
trapezius
Retracts scapula
serratus posterior inferior
Depresses ribs
upper limb
bone
forarm
radius
ulnar
wrist
8 carpal bones
arm
humerus
hand
5 metacarpal bones
14 phalanges
prectoral girdle
scapula (shoulder blade)
clavicle (ollarbone)
joint
Acromio-clavicular joint
Sterno-clavicular joint
Shoulder joint
Elbow joint
Radio-ulnar joints
Wrist joint
Intercarpal and Midcarpal joints
Carpo-metacarpal joints
Metacarpo-phalangeal joint
muscle
pectoral & scapular
axio-appendicular muscles
anterior
pectoralis minor
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subclvius
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pectoralis major
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serratus anterior
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posterior
superficial muscles
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deep muscle
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scapulohumeral muscle
deltoid
spinal part
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acromial part
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clavicular part
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teres major
adduction, medial rotation
rotator cuff
Infraspinatus
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Teres minor
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Supraspinatus
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Subscapularis
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arm
anterior/flexor compartment
coracobrachiakis
flex and adduct glenohumeral joint
stabilizing shoulder by resisting downwards dislocation
brachialis
flexes forearm at elbow joint (both pronation and supination)
biceps
long head
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short head
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posterior/extensor compartment
triceps
long head
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lateral head
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medial head
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anconeus
Extension of the forearm and stabilize elbow joint
forarm
Anterior compartment (flexor+pronators)
superficial
pronator teres
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flexor carpi radialis
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flexor carpi ulnaris
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palmaris longus
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intermediate
flexor digitorum superficialis
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deep
Flexor pollicis longus
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pronator quadratus
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Flexor digitorum profundus
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Posterior compartment (extensors+supinators)
superficial
extensor carpi radialis brevis
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Extensor digitorum
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extensor carpi radialis longus
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Extensor digiti minimi
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Brachioradialis
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Extensor carpi ulnaris
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deep
extensor pollicis brevis
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extensor pollicis longus
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Abductor pollicis longus
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extensor indics
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Supinator
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hand
extrinsic muscle
intrinsic muscle
hipothenar compartement
Flexor digiti minimi brevis
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Abductor digiti minimi
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Opponens digiti minimi
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central compartement
4 lumbricals
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abductor compartement
abductor pollicis
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interossei compartement
7 interossei muscle
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thenar compartement
flexor pollicis brevis
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opponens pollicis muscle
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abductor pollicis brevis
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neck
hyoid bone
Attachment for muscles, to keep airway open
muscle
superficial
sternocleidomastoid
Tilts and rotates head
trapezius
elevates/depresses scapula
suprahyoid muscle
geniohyoid
pulls hyoid, widens pharynx
stylohyoid
elevates and retracts hyoid
mylohyoid
elevates hyoid (swalloowing, speaking)
digastric
depresses mandible againts resistance
platysma
draws corner of mouth (inferior, sadness)
infrahyoid muscle
sternohyoid
depresses hyoid after elevation (swallowing)
omohyoid
depresses, retracts, steadies hyoid
sternothyroid
depresses hyoid and larynx
thyrohyoid
depresses hyoid, elevates larynx
deep
anterior scalene
rectus capitis lateralis
flaxes and stabilizes head
splenius capitis
flaxed and rotates head and neck (lateral)
levator scapulae
downward rotation of scapula
midle scalene
flaxes neck (lateral), elevates 1st rib (forced inspiration)
rectus capitis anterior
flexes head
longus capitis
longus colli
flexes neck with rotation (torsion)
posterior scalene
flaxes neck (lateral), elevates 2st rib (forced inspiration)
lowwer limb
bone
knee
Head of fibula
Patella
Condyles of proximal tibia
Knee Joint
Condyles of distal femur
Popliteal fossa
leg
fibula
facies articularis capitis fibulae
collum fibulae
Apex capitis fibulae
corpus fibulae
Caput Fibulae
Malleolus lateralis
tibia
Corpus tibiae
Tuberositas tibiae
Facies artucularis fibularis (bagian condylus tibialis lat)
Incisura fibularis
Condylus medialis & articularis
Malleolus medialis
Thigh or femoral
superior
Collum femoris
Trochanter major
Trochanter minor
Linea intertrochanterica
Fosa trochanterica
Caput Femoris
middle
Linea pectinea
Tuberositas glutea
Linea aspera (labium laterale & mediale)
Linea supracondylaris & medialis
Corpus femoris
inferior
Condylus lateralis & medialis
Epicondylus lateralis & medialis
ankle
tarsus
Navicular
Cuboid
Calcaneus
Os cuneiforme
Talus
Hip & Pelvis bone
Sacrum
Os. Coxea
ischium
pubis
ilium
coccxy
foot
Metatarsals
Tarsals
Phalanges
Joints of Lower Limb
Hip Joint
Knee Joint
Tibiofibular joints
Ankle Joints
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muscle
gluteal/hip & pelvis
Superficial Muscle
gluteus medius
Abducts and medially rotates
gluteus minimus
gluteus maximus
extensor, lateral rotation (Namun, itu hanya digunakan ketika diperlukan kekuatan, seperti berlari atau memanjat)
tensor fascia lata
Membantu gluteus medius dan minimus dalam abduction & medial rotation
Deep Muscle
The Gemelli – Superior and Inferior
obturator internus
peroformis
Lateral rotation and abduction
Quadratus Femoris
Lateral rotation
thigh
anterior compartment
Quadriceps Femoris
Vastus Intermedius
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Vastus Medialis
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Vastus Lateralis
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Rectus Femoris
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Sartorius
At the hip joint, it is a flexor, abductor and lateral rotator. At the knee joint, it is also a flexor.
Iliopsoas
psoas major
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iliacus
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Pectineus
Adduction and flexion at the hip joint
Medial Compartment
Adductor Magnus
adduct, flexes, and extending the thigh
Adductor Longus
Adduction of the thigh.
Adductor Brevis
Obturator Externus
Adduction and lateral rotation of the thigh
Gracilis
Adduction of the thigh at the hip, and flexion of the leg at the knee
Posterior Compartment
Semitendinosus
Flexion of the leg at the knee joint. Extension of thigh at the hip. Medially rotates the thigh at the hip joint and the leg at the knee joint
Semimembranosus
Flexion of the leg at the knee joint. Extension of thigh at the hip. Medially rotates the thigh at the hip joint and the leg at the knee joint.
Biceps Femoris
Main action is flexion at the knee. It also extends the thigh at the hip, and laterally rotates at the hip and knee.
leg
Lateral Compartment
Fibularis Brevis
Eversion of the foot
Fibularis Longus
Eversion and plantar flexion of the foot. Also supports the lateral and transverse arches of the foot
Posterior Compartment
Deep Muscles
Popliteus
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Tibialis Posterior
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Flexor Digitorum Longus
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Flexor Hallucis Longus
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Superficial Muscles
Plantaris
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Soleus
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Gastrocnemius
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anterior compartment
Extensor Digitorum Longus
Extension of the lateral four toes, and dorsiflexion of the foot
Extensor Hallucis Longus
Extension of the great toe and dorsiflexion of the foot
Tibialis Anterior
Dorsiflexion and inversion of the foot
Fibularis Tertius
Eversion and dorsiflexion of the foot
Foot
Dorsal Aspect
Extensor Digitorum Brevis
Aids the extensor digitorum longus in extending the medial four toes at the metatarsophalangeal and interphalangeal joints
Extensor Hallucis Brevis
Aids the extensor hallucis longus in extending the great toe at the metatarsophalangeal joint
Plantar Aspect
First Layer
Abductor Hallucis
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Flexor Digitorum Brevis
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Abductor Digiti Minimi
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Second Layer
Quadratus Plantae
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Lumbricals
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Third Layer
Flexor Hallucis Brevis
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Adductor Hallucis
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Flexor Digiti Minimi Brevis
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Fourth Layer
Plantar Interossei
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Dorsal Interossei
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head
bones
cranium
zygomatic
nasal
temporal
lacrimal
occipital
maxilla
parietal
mandible
frontal
sphenoid
ethmoid
orbitomeatal plane
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neurocranium
viscerocranium
muscle of face and scalp
occipitofrontalis
orbicularis oculi
closes eyelids
corrugator supercilii
draws eyebrow
(medial, concern)
procerus plus transverse part of nasalis
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elevates eyebrow,
protracts/retracts scalp (surprised)
Histology
bone
cell
osteoblast
produce bone matrix and collagen type I
osteoclast
bone resorption
osteocyte
Serves as mechanoreceptors detecting mechanical load and stress
periosteum
sharpey perforation fibers
endosteum
Contains osteoprogenitor cells, and bone lining cells
muscle
structure
epimesium
perimesium
endomesium
muscle fibers/cells
sarcolemma
sarcoplasmic reticulum
terminal cisterna
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myofibril
sarcomer
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fibers
type 2a
FOG
type 2b
FG
type 1
SO
cartilage
cell
chondrocyte
berada didalam lacuna (ecm), seperti gel
type
hyaline cartilage
fibroscartilage
elastic cartilage
Physiology
contraction of skeletal muscle
Calcium & Phosphorus metabolism and homeostasis
Bone Calcification
Mekanisme klasifikasi tulang
osteoblast akan membentuk area; osteoid
osteoblast yang berada di dalam osteoid akan berubah menjadi osteocyte
Kalsium&fosfat terkonsentrasi& mengalami pengendapan - membentuk calcium hydroxyapetite
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Bone Resorption - Fungsi Osteoklas
Mekanisme
mempertahankan kalsium
Level kalsium dalam darah akan dipertahankan
oleh PTH
PTH akan berikatan dengan osteoblast melalui OPG
Excitation of Skeletal Muscle
Secretion Of Acetylcholine By The Nerve Terminals
molekul protein menembus membran & membentuk kanal tubular
kanal terbuka apabila molekul Ach melekat pada 2 protein subunit alfa
ion Na+ masuk
End plate potential
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Penghancuran Asetilkolin
oleh enzim asetilkolinesterase
Ach berdifusi keluar dari sinaps
Impuls saraf mencapai persimpangan neuromuskuler
125 vesikel asetilkolin (Ach) dilepaskan dari terminal ke sinaptik
terjadi potensial aksi
Voltage-gated calcium channels terbuka
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Excitation-Contraction Coupling
Tubulus T-retikulum sarkoplasma di membran sel, terbuka ke bagian luar serat otot
tubulus berhungan dengan cairan ekstrasel yang mengelilingi serat otot
tubulus mengandung cairan ekstrasel di dalam lumen/tubulus adalah perluasan bagian dalam membran sel
Potensial aksi menyebar ke membran serat otot & tubulus T ke bagian dalam serat otot
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Excitation and Contraction of Smooth Muscle
Contractile Mechanism in Smooth Muscle
Physical Basis for Smooth Muscle Contraction
tidak ada gambaran lurik filamen aktin & miosin
Aktin
melekat pada dense bodies
5-10x lebih banyak daripada miosin
myosin
diameter 2x lebih besar daripada aktin
mempunyai "sidepolar" cross-bridges yang berperan untuk menarik filamen aktin
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The Maximum Force of Contraction is Often Greater in Smooth Muscle than in Skeletal Muscle
kekuatan kontraksi maksimum otot polos (4-6 kg/cm2) lebih besar daripada otot rangka (3-4 kg/cm2)
kekuatan kontraksi otot polos berasal dari waktu perlekatan cross-bridges miosin ke aktin yang berlangsung lama
Chemical Basis for Smooth Muscle Contraction
mengandung filamen aktin & miosin, tidak memiliki kompleks troponin
proses kontraksi diaktifkan oleh ion kalsium
ATP dipecah menjadi ADP untuk memberikan energi bagi kontraksi
Clinical
Osteoporosis
peak bone mass
risk factor
genetic
nutrition
physical activity
aging
Decreased replicative activity of osteoprogenitor cells
Decreased syntetic activity of osteoblast
Decreased biologic activity of matrix-bound growth factors
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menapouse
Decreased serum esterogen
Increased IL-1,IL-6,TNF levels
Increased expression of RANK, RANKL
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OsteoArthritis
Systemic risk factor
Intrinsic joint environment & joint loading
kerusakan articular cartilage yang progresif
Perubahan metabolisme tulang
Penurunan kadar proteoglikan
Berkurangnya viskositas fluid di cartilage
Penurunan elastisitas cartilage
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Farmakology
dermatology
Topical Antiviral Agent
Acyclovir
Menghambat enzim spesifik pada virus
Chain termination
Pensiklovir
Herpes Labialis dan Herpes Genitalis
Sunscreen
Physical
menyerap UV radiation
Chemical
memantulkan UV radiation
Antifungal Agent
Azole Derivates
Menghambat sintesis ergosterol
Candida albicans, Pityrosporm orbiculare
Nystatin
Increase membrane permiability
Cell death
Acne Preparation
Retinoid Acid
menstabilkan lisosom, meningkatkan aktivitas asam ribonukleat polimerase dan prostaglandin.
meningkatkan pergantian sel epidermis
mendorong sintesis kolagen, angiogenesis, dan penebalan epidermis
Benzoyl Peroxide
mengurangi lipid, asam lemak bebas, dan P. acne
oksidasi protein bakteri
Antibacterial Agent
Mupirocin
Mengobati impetigo
Gentamicin
Menghambat sintesis protein
muskuloskeletal
AINS
Piroxicam
Menghambat enzim yang memproduksi prostaglandin, yaitu
senyawa yang dilepas tubuh dan menyebabkan peradangan.
Rheumatoid Arthtritis, Osteoarthtritis, dan gangguan muskuloskeletal akut
Agents that affect bone mineral homeostasis
Vitamin D
Meningkatkan resorpsi kalsium dan fosfat serta meningkatkan pembentukan tulang dengan 1,25(OH) 2D
Bisphosphonate
Menghambat sintase farnesyl pirofosfat, yang penting untuk
osteoklat
Merangsang pembentukan tulang
Berguna untuk pengobatan: Hypercalcemia, Paget’s disease, Osteoporosis
Drug Used In Gout
Allopurinol
Menghambat enzim xanthine oksidase sehingga menghambat pembentukan asam urat dan juga dapat menghambat sintesis purin
Disease-modifying antirheumatic drugs
Chloroquine & hydroxichloroquine
Digunakan
untuk malaria dan pada penyakit rematik
palmaris brevis
Wringkle skin of hypothenar eminence(strong grip)
Sunscreen
protecting skin from UVA & UVB
Problem :
masih banyak masyarakat yang malas menggunakan sunscreen
Penyebab :
Masih ada nya kurang pengetahuan tentang manfaat sunscreen
Faktor kondisi yang hampir semua pekerjaan dirumah aja
membuat masyarakat menjadi nggan untuk memakai sunscreen
Flek hitam/Hiperpigmentasi
Melanoma
Idea :
Edukasi Masyarakat
Sunscreen Spray
8 irregular bones
15 irregular bones