A Decent Heart Bench

(I apologize in advance for the bitter tone.  It’s momentary, and will pass, but it is honest, and it will resonate with anyone who has been diabetic as long as I have been.)

I’ve had a rough couple of days – the car won’t start with the cold weather.  The basement flooded where I am staying when the snow melted.  I guess that this somehow reset some fuses … This turned the hot water heater flame off, so that there is no hot water.  I still have gas to boil water, though.  Every time that I take a bath, visitors arrive.  Sometimes they knock…So much for privacy.

I took another hard look at the x-ray from the ER visit, noting the small unreported density in the lower right quadrant between the 5th and 6th rib.

chest_xray

and analyzed what happened in the ER.  I came in hypertensive and with an abnormal EKG (all 3 components were present though P, QRS, and T waves).  The P wave coming in is slightly notched or bimodal on lead II, and the QRS duration is about 11 msec shorter than when I left.  The P-R-T shifted from (66-29-54 to 61-45-40).  They gave me 4 baby aspirin (324 mg) (decreasing the platelet (clotting) activity, and peripheral resistance to blood flow, thereby increasing my stroke volume, tissue perfusion, and cardiac output), and then rapidly treated me for dehydration by increasing my preload with the IV saline, thereby increasing my stroke volume, and lowering my heart rate.  My EKG stabilized, and blood pressure dropped.  I don’t believe the urine was accurate.  I think that I had ketones because my insulin had not been working.  They just didn’t want to report them, because I had been denied insulin at an affiliated ER the night before, or maybe because they were just trying to get me out of there.

I’m a little concerned that the rapidity of the treatment potentially could have caused a cerebral hemorrhage or edema, particularly because of the aspirin administration over an hour prior.  In retrospect, although it is of note that I did not experience severe problems from this, I might not recommend this rapidity for more fragile people, or people with long-standing diabetes.  I would have been more gentle, particularly as I was not so dehydrated that they could not find a vein on the first try for the IV.  I’m not usually that easy to find good veins on.

With all of the thoughts about ischemia and diabetes, I’ve decided that moving from a regimen that is strictly regular insulin (6 or so times a day and night) to one that includes Lantus (a very flat and the safest insulin available that one gives once a day to maintain a basal insulin level) is what is needed in my situation.  I’ve been on it before.  It is almost like being on an insulin pump, except that instead of bolusing for meals, you give carb-adjusted doses of regular (or fast-acting) insulin for meals in addition to the once daily dose of Lantus.

And herein lies the problem.  For years now, the FDA has chosen to make this insulin only available by prescription.  One can obtain both regular insulin, and NPH, and 70/30 NPH/Regular insulin without a prescription, but one cannot obtain the best insulin, Lantus, without it in the US.  This is because doctors are looking out for their pocketbooks.  They want the doctors visit, and God-forbid you try to schedule a visit to get a prescription during the holiday season, they will force you to go through a $600-$1000 ER visit to get a prescription for it.

I’ve been diabetic for 40 years.  I’ve been on Lantus in the past.  I can get a A1c kit at Wal-Mart and do my own A1c.  I have a meter and strips that will allow me to test my blood sugar and adjust my insulin levels until my blood sugar levels are more even.  I just need a better (peakless) insulin to help.  So, I thought about the situation, and realized that with the heart problems that I have, I should probably begin the stabilization of my blood sugar levels immediately.  Although I have insulin, and this is technically not therefore an emergency, I should not have to become more and more ischemic because of the highs and lows of being on an insulin that does not require a prescription, while I wait for the doctor’s offices to reopen after the holidays, and schedule a “new patient” visit.  My cardiologist (when and if I ever get one) is going to want to see that my sugars have stabilized.  They will want an A1c and some blood sugar testing values that prove that my sugars are being controlled.  It should start now, not next week, or in 2 weeks, or God-forbid 2-3 months because I am a “new” patient.  So, after a few futile attempts to contact a few prescription competent diabetic nurses (out for the holidays), I call the cardiology fellow on call at the hospital and ask him to look at my chart, and phone in a script for Lantus.  I’m redirected to India.  He won’t do it.  He’s wondering if I am really a patient.  I’m wondering if he is really a doctor, and not simply a bill collector…

I’m not Mother Teresa.  I’m furious at the denial of health care.  I’m furious that the government has legislated my dependence on a system that won’t help me.  This drug never should have required a prescription.  It makes no sense, except an economic sense, and the economics of profiting from someone’s misery, (making them more financially in debt and ischemic to make more profit) are unethical.  Like slavery.

Yes, this does bring back all the psychiatric trauma of my 6 year old denial of insulin when I first became diabetic.  Somehow, I don’t think this is therapeutic to reexperience this over and over as an adult.  At the end of the day, after I was done screaming at this system, I felt my chest again.  Some forms of Lantus (pen) seem to be available OTC in Canada.

So, in spite of everything, and no mobility or internet access, I did get some work done on the programs.  I fixed the “one word” bug (a space in the sed RE argument), so that multiple words can now be an answer, and added more options.  (Because the code evolves by analogy from other programs that I wrote, it is decidedly not fun to debug…and that is probably an understatement!) Anyway, I did a pretty decent bench of the program missing 4 times out of 100.  One time because I forgot to capitalize the word, and another time because of an answer error (that I fixed) in the file.  So, technically, I guess that makes it 2 mistakes, and a pretty good time.  There is some pride in this, even if I am slowly dying from ischemia.  I’ve also added the exercise options for the muscle file – this should be edited by a more knowledgeable health professional, since I made up the exercises.  I’m no where near a decent bench with this file.

————————————The heart bench——————————————

You worked  14 minutes for an average of:  0.140000 minutes per question, and a sum of  100 questions.
The correct answers ( 96 ): , tunica intima, stenosis, vasoconstriction, ml, left circumflex artery, bypass, vasoconstriction, right, Doppler echocardiography, ml, bypass, atmospheric, 760, pressure, chordae tendinae, atrioventricular, pulse, diastole, preload, tachycardia, diameter, left circumflex artery, right coronary artery, diameter, intercostal, Doppler echocardiography, Hypertension, aneurysm, pressure, atrial, atrioventricular, cardiac output, chordae tendinae, flow, systole, vasoconstriction, sinus, dilate, nodal, atrioventricular, sympathetic, 80, systole, increased, increased, low, papillary, actin, perfusion, stent, preload, systole, high, preload, left circumflex artery, contractility, more, mitral stenosis, regurgitation, low, low, aortic, preload, parasympathetic, hypotension, atrioventricular, tricuspid, compliance, pleural, preload, resistance, Coronary, resistance, fibrillation, actin, Doppler echocardiography, small, perfusion, 80, diameter, Coronary, bypass, sympathetic, mean arterial pressure, nodal, low, Angioplasty, Coronary, Thrombosis, low, atrioventricular, radius, stroke volume, mitral stenosis, systolic, Tachycardia
The incorrect answers ( 4 ): , Capillaries, dilation, fibrillation, Atrial
The database had  217 entries.
Your percentage:  0.960000
—————————————————————————————————

#!/bin/bash
# heartwork.sh v.0.2 a program submitted by livedoggb on 12/26/2012
# dependencies compiled random1.c, intdiv2float.c, botany directory containing a botany_pics subdirectory with jpg pictures of local flora numbered 01 dandelion.jpg 12 prickly poppy.jpg etc.
# a heart subdirectory inside the for_kids directory that has a file named gen_heart_facts.txt, gen_muscle_facts.txt, gen_vessels_facts.txt, etc.
# itunes directory named flower music with songs that you want to use sequentially numbered 01 …, 02 …, 03 … etc.
# a local_flora_txt subdirectory within botany containing files named 01 dandelion.txt, 02 prickly_poppy.txt, etc.
# with the number corresponding to the line number of the verb in the text file.
# It also outputs a file sommaire.out that has the statistics of your session.
dir_path=”/mnt/sdb1″
dir_txt_path=$( echo $dir_path/for_kids/heart )
pic_dir_path=$( echo $dir_path/botany/botany_Houston_pics )
mus_dir_path=$( echo $dir_path/botany/botany_Houston_mus )

temp_path=/root/
if [ -e $temp_path/sommaire.out ]
then
rm $temp_path/sommaire.out
fi
if [ -n $temp_path/botany_own_pics ]
then
mkdir $temp_path/botany_own_pics
fi
if [ -n $temp_path/botany_own_mus ]
then
mkdir $temp_path/botany_own_mus
fi
function choose_anatomy {
echo  “Pick a system to work on:”
echo
echo “1.  The heart”
echo “2.  Muscles”
echo “3.  Circulation”
echo “4.  X-ray interpretation”
echo “5.  Diabetes”
echo “6.  The brain”
echo “7.  Cancer”
echo “8.  The eye”
echo “9.  Emergency/trauma medicine”
echo “10. The liver”
echo “11. The kidney”
echo “12. The blood”
echo “13. The lungs”
echo
echo “Please choose an option.”
read organ
case $organ in
1)
organ_fname=”gen_heart_facts.txt”
;;
2)
organ_fname=”gen_muscle_facts.txt”
exercise_option=”y”
;;
3)
organ_fname=”gen_vessel_facts.txt”
;;
4)
organ_fname=”gen_xray_facts.txt”
;;
5)
organ_fname=”gen_diabetes_facts.txt”
;;
6)
organ_fname=”gen_brain_facts.txt”
;;
7)
organ_fname=”gen_cancer_facts.txt”
;;
8)
organ_fname=”gen_eye_facts.txt”
;;
9)
organ_fname=”gen_trauma_facts.txt”
;;
10)
organ_fname=”gen_liver_facts.txt”
;;
11)
organ_fname=”gen_kidney_facts.txt”
;;
12)
organ_fname=”gen_blood_facts.txt”
;;
13)
organ_fname=”gen_lung_facts.txt”
;;
esac
return
}
function set_path {
echo
echo “1.  Use Houston pictures and Verdi’s 4 Seasons.”
echo “2.  Use your own pictures and music moved to the root directory in a”
echo ”    subdirectory called botany_own_pics and botany_own_music.”
echo “3.  Opt out of music and pictures.”
echo
echo “Please choose an option.”
read pic_set
case $pic_set in
1)
pic_dir_path=$( echo $pic_dir_path/ )
mus_dir_path=$( echo $mus_dir_path)
show_pics=”y”
with_music=”y”
;;
2)
pic_dir_path=$( echo $pic_dir_path/$own_dir_path )
mus_dir_path=$( echo $temp_path/botany_own_mus )
show_pics=”y”
with_music=”y”
;;
3)
opt_out_of_music_and_pics=”y”
show_pics=”n”
with_music=”n”
;;
esac
return
}

function trim_line {
i=1
echo
#num_words=$(gawk ‘{ sum += $1 }; END { print sum }’ testline.out)
words_left=”c”
while [ “$words_left” != “” ]
do
j=$(( $i + 7 ))
words_left=$( echo $line | cut -d’ ‘ -f$i-$j )
echo $words_left
i=$(( $j + 1 ))
done
return
}

function echo_in_color_br_sentence {
part1=$( echo $testline | sed “s/\(.*_\)_*_\(_.*\)/\1/” )
part2=$( echo $testline | sed “s/\(.*_\)_*_\(_.*\)/$echo_verb/” )
part3=$( echo $testline | sed “s/\(.*_\)_*_\(_.*\)/\2/” )
if [ $organ == 2 ]
then
part3=$( echo $part3 | sed “s/\(.*_\)_*_\(_.*\) EXER.*/\2/” )
fi
#”blue”
echo -n -e ‘\E[47;34m'”33[1m$part133[0m”
#”red”
echo -n -e ‘\E[47;31m'”33[1m$part233[0m”
#”blue”
echo -e ‘\E[47;34m'”33[1m$part333[0m”
tput sgr0
return
}
choose_anatomy
#rm $dir_path/hyper-tense-files_used.out
sum_fautes=0
echo “Please wait for a few minutes while the system sets up the music database.”
if [ -e $dir_path/hyper-tense-flowers-time2.out ]
then
echo “The program has found a time file.”
echo “1. Use this file.”
echo “2. Make a new time file. Choose 2 if you have changed the music.”
echo “Please choose:  (If you aren´t sure, choose 2.  The default is 2.)”
read choice
else
choice=2
fi
if [ -e $choice ]
then
choice=”2″
fi
echo “The best way to end the program in slideshow mode is to press the ESC key.”
echo
case “$choice” in
1)
echo “Using the old file.”
;;
2)
echo “Making another file.  This will take a few minutes.  Please be patient.”
echo
echo
echo “0” > $temp_path/hyper-tense-flowers-time2.out
if [ -n $mus_dir_path/*.* ]
then
echo “A link to your music does not exist in the root file system.  Please fix this.”
else
mplayer -msglevel all=-1 -profile gnome-mplayer -ss 10 -endpos 1 -volume 0 $mus_dir_path/*.* | tee $temp_dir/temp.out | grep “^A: ” | sed -e ‘s/^A: .* of \([0-9]*\).* .*/\1/g’ >> $temp_path/hyper-tense-flowers-time2.out
fi
;;
esac
time_array=($(cat $temp_path/hyper-tense-flowers-time2.out))
i=1
num_files=$(expr $(grep -c . $temp_path/hyper-tense-flowers-time2.out))

i=0
while [ $i -lt $num_files ]
do
echo “$i. ${time_array[$i]}”
i=$(( $i + 1 ))
done
num_files=$(( $num_files – 1 ))
echo “num_files=” $num_files
echo “Several options are possible.  Please choose.”
echo
echo “1. Slideshow”
echo “2. Instruction”
echo “3. Quiz (interactive).”
echo
echo -n “Please choose:”
read choice
#echo  “With quotes? Choose y or n.  Default is n.”
#read with_quotes
#echo “Oral reading? Choose y or n. Default is n.”
#read read_aloud
#echo “With pictures? Choose y or n. Default is y.”
#read show_pics
#echo “With music? Choose y or n. Default is y.”
#read with_music
with_quotes=”n”
read_aloud=”n”

more_local_info=”n”
if [ -e $read_aloud ]
then
read_aloud=”n”
fi
if [ -e $with_quotes ]
then
with_quotes=”n”
fi
if [ -e $show_pics ]
then
show_pics=”y”
fi
if [ -e $with_music ]
then
with_music=”y”
fi
case “$choice” in
1)
echo “Slideshow mode.”
set_path
viewnior –slideshow $pic_dir_path/01\ *.jpg < /dev/null &
mplayer -msglevel all=-1 -profile gnome-mplayer -volume 200 “$mus_dir_path”/*.*
;;
2)
echo “Instruction mode.”
set_path
echo “All information derives from $organ_fname in the folder botany.”
c=””
right=0
asked=0
rightverbs=””
wrongverbs=””
average=0
verb_guess=””
num_vfiles=$(expr $(ls -1  $pic_dir_path/*.jpg | grep -c . ))
echo “num_vfiles=” $num_vfiles
hours_bgn=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\1/”| sed “s/0\([0-9]\)/\1/” )
min_bgn=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\2/”| sed “s/0\([0-9]\)/\1/” )
sec_bgn=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\3/”| sed “s/0\([0-9]\)/\1/” )

while [ -e $c ]
do
if [ -e $dir_txt_path/$organ_fname ]
then
maxlinenum=$( grep -c . $dir_txt_path/$organ_fname)
#maxlinenum=$(( $maxlinenum – 1  ))
quizfact=$( $dir_path/random1 1 $maxlinenum)
correctquizfact=$( echo “$quizfact”c)
omit_line=$( grep “^$correctquizfact:” $dir_txt_path/$organ_fname)
#      echo “random quiz line is:” $quizfact $correctquizfact
if [ “$omit_line” != “” ]
then
#echo “The verb is: ” $verb
echo “Random quiz line is:” $quizfact

testline=$( grep “^$correctquizfact:” $dir_txt_path/$organ_fname | sed -e “s/^.*QUESTION:\(.*\)/\1/” )
line=$testline
echo_verb=$( grep “^$correctquizfact:” $dir_txt_path/$organ_fname | sed -e “s/^.*ANSWER:\(.*\) QUESTION:.*/\1/” )
echo_in_color_br_sentence

asked=$(( $asked + 1 ))
echo “Press enter to continue (enter e to exit):”
read verb_guess
if [ “$verb_guess” == “e” ]
then
break
fi
verb_guess=$echo_verb
if [ $verb_guess == $echo_verb ]
then
echo “Correct.”
right=$(( $right + 1 ))
average=$(( $right/$asked ))
rightverbs=$( echo $rightverbs, $echo_verb)
if [ $show_pics == “y” ]
then
random_verb_num=$( $dir_path/random1 1 $num_vfiles)
fn=$random_verb_num
#fn=1
echo “random_pic_num is:” $random_verb_num
verb=$(ls $pic_dir_path/$fn\ *.jpg | sed “s/^.*$fn \(.*\).jpg/\1/” )
echo $verb
mypid=$$
viewnior $pic_dir_path/$fn\ *.jpg < /dev/null &
cpid=$!
if [ $more_local_info == “y” ]
then
random_verb_num=$( $dir_path/random1 1 5)
echo “random verb num is ” $random_verb_num
fn=$random_verb_num
if [ -e $dir_txt_path/local_flora_facts/$fn\ *.txt ]
then
num_facts=$( grep -c . $dir_txt_path/local_flora_facts/$fn\ *.txt )
echo “I am in this loop.” $num_facts
num_facts=$(( $num_facts – 1 ))
picked_fact=$( $dir_path/random1 1 $num_facts )
correctquote=$( echo “$picked_fact”c )
dfact=$( grep “^$correctquote:” $dir_txt_path/local_flora_facts/$fn\ *.txt | sed “s/^.*c://” )
xmessage -timeout 30 $dfact < /dev/null &
fi
fi
fi
if [ $with_music == “y” ]
then
num_mus=$( $dir_path/random1 1 $num_files )
num_mus_fixed=$(echo $num_mus | sed -e “s/^0//”)
prob_time=$(( ${time_array[$num_mus_fixed]} – 20 ))
ssx=($(expr $($dir_path/random1 0 $prob_time)))

mplayer -msglevel all=-1 -profile gnome-mplayer -ss $ssx -endpos 30 -volume 200 “$mus_dir_path”/$num_mus*.*
kill -s SIGTERM $cpid
fi
if [ $with_quotes == “y” ]
then
num_quotes=$( grep -c . $dir_txt_path/environmental_quotes.txt )
picked_quote=$( $dir_path/random1 1 $num_quotes )
correctquote=$( echo “$picked_quote”c )
dquote=$( grep “^$correctquote:” $dir_txt_path/environmental_quotes.txt | sed “s/^.*c://”)
xmessage -timeout 30 $dquote < /dev/null &
fi
else
echo “No.  The correct answer is:” $echo_verb
wrongverbs=$( echo $wrongverbs, $echo_verb )
fi
if [ $read_aloud == “y” ]
then
repeat=”y”
if [ -e /mnt/sda1/Documents\ and\ Settings/TEMP/My\ Documents/My\ Music/aaenglish\ highlit/$verb$quizfact.* ]
then
while [ $repeat == “y” ]
do
mplayer -volume 80 /mnt/sda1/Documents\ and\ Settings/TEMP/My\ Documents/My\ Music/aaenglish\ highlit/$verb$quizfact.*
echo “Write the sentences that you heard on paper.  Repeat? (y or n. The default is n.)”
read repeat
if [ -e $repeat]
then
repeat=”n”
fi

done
echo
#$shighlit=$(grep “^$correctquizfact:” $dir_txt_path/$fn*.txt | sed -e “s/^.* SHIGHLIT:\(.*\)TRANSSHIGHLIT:.*/\1/”)
#$echo $shighlit
#$echo
#$echo “Count the number of mistakes in what you wrote. One point for every word.”
#$echo How many errors?
#$read fault_number
if [ -e $fault_number ]
then
fault_number=0
fi
sum_faults=$(( $sum_faults + $fault_number ))
fi
fi
#$trans_sent=$(grep “^$correctquizfact:” $dir_txt_path/$fn*.txt | sed -e “s/^.*ETSENT1:\(.*\)ETSENT2:.*/\1/”)
#
echo
#$shighlit=$(grep “^$correctquizfact:” $dir_txt_path/$fn*.txt | sed -e “s/^.* SHIGHLIT:\(.*\)TRANSSHIGHLIT:.*/\1/”)
#$echo $shighlit
#echo
#echo “Please finish by reading the above sentence out loud.”
#read
echo “The line number is:” $quizfact
#echo $testline | sed “s/.*(\(.*\)).*/\1/”
#                echo $testline | sed “s/\(.*[ |^]_\)_*_\(_.*\)/\1$echo_verb\2/”
#                echo $testline | sed “s/\(.*_\)_*_\(_.*\)/\1$echo_verb\2/”
#                echo_in_color_br_sentence
#echo $trans_sent
aver_right=$( $dir_path/intdiv2float $right $asked | sed -e “s/\([0-9]*\…\).*/\1/” )
echo $right “/” $asked ” correct.  Batting average:” $aver_right “Dictation errors: ” $sum_faults
echo “Please wait…I’m looking for another question…”
fi
fi
done
hours_end=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\1/”| sed “s/0\([0-9]\)/\1/” )
min_end=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\2/”| sed “s/0\([0-9]\)/\1/” )
sec_end=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\3/”| sed “s/0\([0-9]\)/\1/” )
hours_diff=$(( $hours_end – $hours_bgn ))
min_diff=$(( $min_end – $min_bgn ))
sec_diff=$(( $sec_end – $sec_bgn ))
midnight=12
if [ $hours_diff -lt 0 ]
then
hours_diff=$(( $(( $midnight – $hours_bgn )) + $hours_end ))
# fix hour change if it happens at midnight or noon,
fi
time_of_ans=$(( $hours_diff * 60 + $min_diff ))
aver_time=$( $dir_path/intdiv2float $time_of_ans $((asked – 1)) | sed -e “s/\([0-9]*\…\).*/\1/” )

echo “You worked ” $time_of_ans “minutes for an average of: ” $aver_time “minutes per question, and a sum of ” $(($asked – 1)) “questions.” | tee >>$temp_path/sommaire.out
echo “The correct answers (” $right “):” $rightverbs  | tee >>$temp_path/sommaire.out
wrong=$(( $asked – $right – 1 ))
echo “The incorrect answers (” $wrong “):” $wrongverbs | tee >>$temp_path/sommaire.out
num_entries=$(grep “^[0-9]*c:” $dir_txt_path/*.txt | grep -c .)
echo “The database had ” $num_entries “entries.” | tee >>$temp_path/sommaire.out
echo “Your percentage: ” $aver_right | tee >>$temp_path/sommaire.out
cat $temp_path/sommaire.out
echo “Life is a tree. You are a meristem.  How would you like to differentiate from here?”
echo “Choices are:”
echo “1. Painting a picture of a flower.”
echo “2. Yoga or prayer activity.”
echo “3. Nature walk with dogs and camera.”
echo “4. Gardening activity.”
echo “5. Relaxation or sleep.”
echo
echo “Enter a number, or enter R to have the computer randomly choose an activity.”
read choice
if [ $choice == “R” ]
then
comp_choice=$( $dir_path/random1 1 5 )
echo “You won the lottery! The random choice was: $comp_choice.  Enjoy your activity!”
#fi
else
echo “You chose $choice.  Enjoy your activity.”
fi
;;
3)
echo “Quiz mode.”
set_path
echo “All information derives from $organ_fname in the folder hearts.”
c=””
right=0
asked=0
rightverbs=””
wrongverbs=””
average=0
verb_guess=””
num_vfiles=$(expr $(ls -1  $pic_dir_path/*.jpg | grep -c . ))
echo “num_vfiles=” $num_vfiles
hours_bgn=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\1/”| sed “s/0\([0-9]\)/\1/” )
min_bgn=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\2/”| sed “s/0\([0-9]\)/\1/” )
sec_bgn=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\3/”| sed “s/0\([0-9]\)/\1/” )

while [ -e $c ]
do
if [ -e $dir_txt_path/$organ_fname ]
then
maxlinenum=$( grep -c . $dir_txt_path/$organ_fname)
#maxlinenum=$(( $maxlinenum – 1  ))
quizfact=$( $dir_path/random1 1 $maxlinenum)
correctquizfact=$( echo “$quizfact”c)
omit_line=$( grep “^$correctquizfact:” $dir_txt_path/$organ_fname)
#      echo “random quiz line is:” $quizfact $correctquizfact
if [ “$omit_line” != “” ]
then
#echo “The verb is: ” $verb
echo “Random quiz line is:” $quizfact

testline=$( grep “^$correctquizfact:” $dir_txt_path/$organ_fname | sed -e “s/^.*QUESTION:\(.*\)/\1/” )
line=$testline
trim_line
verb_guess=””
asked=$(( $asked + 1 ))
while [ “$verb_guess” == “” ]
do
echo “Enter your answer (enter e to exit):”
read verb_guess
done
if [ “$verb_guess” == “e” ]
then
break
fi
echo_verb=$( grep “^$correctquizfact: ” $dir_txt_path/$organ_fname | sed -e “s/^.*ANSWER: \(.*\) QUESTION:.*/\1/” )
if [ “$verb_guess” == “$echo_verb” ]
then
echo “Correct.”
if [ “$organ” == 2 ]
then
exer=$( grep “^$correctquizfact: ” $dir_txt_path/$organ_fname | sed -e “s/^.*EXER: //” )
echo $exer
read st
fi
right=$(( $right + 1 ))
average=$(( $right/$asked ))
rightverbs=$( echo $rightverbs, $echo_verb)
if [ $show_pics == “y” ]
then
random_verb_num=$( $dir_path/random1 1 $num_vfiles)
fn=$random_verb_num
#fn=1
echo “random_pic_num is:” $random_verb_num
verb=$(ls $pic_dir_path/$fn\ *.jpg | sed “s/^.*$fn \(.*\).jpg/\1/” )
echo $verb
mypid=$$
viewnior $pic_dir_path/$fn\ *.jpg < /dev/null &
cpid=$!
if [ $more_local_info == “y” ]
then
random_verb_num=$( $dir_path/random1 1 5)
echo “random verb num is ” $random_verb_num
fn=$random_verb_num
if [ -e $dir_txt_path/local_flora_facts/$fn\ *.txt ]
then
num_facts=$( grep -c . $dir_txt_path/local_flora_facts/$fn\ *.txt )
echo “I am in this loop.” $num_facts
num_facts=$(( $num_facts – 1 ))
picked_fact=$( $dir_path/random1 1 $num_facts )
correctquote=$( echo “$picked_fact”c )
dfact=$( grep “^$correctquote:” $dir_txt_path/local_flora_facts/$fn\ *.txt | sed “s/^.*c://” )
xmessage -timeout 30 $dfact < /dev/null &
fi
fi
fi
if [ $with_music == “y” ]
then
num_mus=$( $dir_path/random1 1 $num_files )
num_mus_fixed=$(echo $num_mus | sed -e “s/^0//”)
prob_time=$(( ${time_array[$num_mus_fixed]} – 20 ))
ssx=($(expr $($dir_path/random1 0 $prob_time)))

mplayer -msglevel all=-1 -profile gnome-mplayer -ss $ssx -endpos 30 -volume 200 “$mus_dir_path”/$num_mus*.*
kill -s SIGTERM $cpid
fi
if [ $with_quotes == “y” ]
then
num_quotes=$( grep -c . $dir_txt_path/environmental_quotes.txt )
picked_quote=$( $dir_path/random1 1 $num_quotes )
correctquote=$( echo “$picked_quote”c )
dquote=$( grep “^$correctquote:” $dir_txt_path/environmental_quotes.txt | sed “s/^.*c://”)
xmessage -timeout 30 $dquote < /dev/null &
fi
else
echo “No.  The correct answer is:” $echo_verb
wrongverbs=$( echo $wrongverbs, $echo_verb )
fi
if [ $read_aloud == “y” ]
then
repeat=”y”
if [ -e /mnt/sda1/Documents\ and\ Settings/TEMP/My\ Documents/My\ Music/aaenglish\ highlit/$verb$quizfact.* ]
then
while [ $repeat == “y” ]
do
mplayer -volume 80 /mnt/sda1/Documents\ and\ Settings/TEMP/My\ Documents/My\ Music/aaenglish\ highlit/$verb$quizfact.*
echo “Write the sentences that you heard on paper.  Repeat? (y or n. The default is n.)”
read repeat
if [ -e $repeat]
then
repeat=”n”
fi

done
echo
#$shighlit=$(grep “^$correctquizfact:” $dir_txt_path/$fn*.txt | sed -e “s/^.* SHIGHLIT:\(.*\)TRANSSHIGHLIT:.*/\1/”)
#$echo $shighlit
#$echo
#$echo “Count the number of mistakes in what you wrote. One point for every word.”
#$echo How many errors?
#$read fault_number
if [ -e $fault_number ]
then
fault_number=0
fi
sum_faults=$(( $sum_faults + $fault_number ))
fi
fi
#$trans_sent=$(grep “^$correctquizfact:” $dir_txt_path/$fn*.txt | sed -e “s/^.*ETSENT1:\(.*\)ETSENT2:.*/\1/”)
#
echo
#$shighlit=$(grep “^$correctquizfact:” $dir_txt_path/$fn*.txt | sed -e “s/^.* SHIGHLIT:\(.*\)TRANSSHIGHLIT:.*/\1/”)
#$echo $shighlit
#echo
#echo “Please finish by reading the above sentence out loud.”
#read
echo “The line number is:” $quizfact
#echo $testline | sed “s/.*(\(.*\)).*/\1/”
#                echo $testline | sed “s/\(.*[ |^]_\)_*_\(_.*\)/\1$echo_verb\2/”
#                echo $testline | sed “s/\(.*_\)_*_\(_.*\)/\1$echo_verb\2/”
echo_in_color_br_sentence
#echo $trans_sent
aver_right=$( $dir_path/intdiv2float $right $asked | sed -e “s/\([0-9]*\…\).*/\1/” )
echo $right “/” $asked ” correct.  Batting average:” $aver_right “Dictation errors: ” $sum_faults
echo “Please wait…I’m looking for another question…”
fi
fi
done
hours_end=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\1/”| sed “s/0\([0-9]\)/\1/” )
min_end=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\2/”| sed “s/0\([0-9]\)/\1/” )
sec_end=$( date| sed “s/.* \(..\):\(..\):\(..\).*/\3/”| sed “s/0\([0-9]\)/\1/” )
hours_diff=$(( $hours_end – $hours_bgn ))
min_diff=$(( $min_end – $min_bgn ))
sec_diff=$(( $sec_end – $sec_bgn ))
midnight=12
if [ $hours_diff -lt 0 ]
then
hours_diff=$(( $(( $midnight – $hours_bgn )) + $hours_end ))
# fix hour change if it happens at midnight or noon,
fi
time_of_ans=$(( $hours_diff * 60 + $min_diff ))
aver_time=$( $dir_path/intdiv2float $time_of_ans $((asked – 1)) | sed -e “s/\([0-9]*\…\).*/\1/” )

echo “You worked ” $time_of_ans “minutes for an average of: ” $aver_time “minutes per question, and a sum of ” $(($asked – 1)) “questions.” | tee >>$temp_path/sommaire.out
echo “The correct answers (” $right “):” $rightverbs  | tee >>$temp_path/sommaire.out
wrong=$(( $asked – $right – 1 ))
echo “The incorrect answers (” $wrong “):” $wrongverbs | tee >>$temp_path/sommaire.out
num_entries=$(grep “^[0-9]*c:” $dir_txt_path/*.txt | grep -c .)
echo “The database had ” $num_entries “entries.” | tee >>$temp_path/sommaire.out
echo “Your percentage: ” $aver_right | tee >>$temp_path/sommaire.out
cat $temp_path/sommaire.out
echo “Life is a tree. You are a meristem.  How would you like to differentiate from here?”
echo “Choices are:”
echo “1. Painting a picture of a flower.”
echo “2. Yoga or prayer activity.”
echo “3. Nature walk with dogs and camera.”
echo “4. Gardening activity.”
echo “5. Relaxation or sleep.”
echo
echo “Enter a number, or enter R to have the computer randomly choose an activity.”
read choice
if [ $choice == “R” ]
then
comp_choice=$( $dir_path/random1 1 5 )
echo “You won the lottery! The random choice was: $comp_choice.  Enjoy your activity!”
#fi
else
echo “You chose $choice.  Enjoy your activity.”
fi
;;
esac

———————-gen_heart_facts.txt————————————————–

01c: ANSWER: 120 QUESTION: Blood pressure readings are generally represented as 120/80, for example.  _______ is the systolic blood pressure.
02c: ANSWER: 80 QUESTION: Blood pressure readings are generally represented as 120/80, for example.  _______ is the diastolic blood pressure..
03c: ANSWER: diastolic QUESTION: 70-90 mm Hg is the normal range for the ____________ blood pressure.
04c: ANSWER: systolic QUESTION: 110-130 mm Hg is the normal range for the ____________ blood pressure.
05c: ANSWER: systolic QUESTION: The __________ blood pressure is the pressure required to stop blood flow through the artery, at which point the sound of the heart beat transmits to the stethoscope as the blood pushes against the barrier.
06c: ANSWER: diastolic QUESTION: The __________ blood pressure is the pressure required to restore blood flow through the artery, at which point the sound of the heart beat is no longer detected by the stethoscope because the blood flows through the barrier.
07c: ANSWER: 4 QUESTION: The human heart has ___ chambers.  The 2 halves of the heart are separated by a septum.
08c: ANSWER: atrioventricular QUESTION: The first heart sound occurs when the ______________ valves close.
09c: ANSWER: semilunar QUESTION: The second heart sound occurs when the ___________ valves close.
10c: ANSWER: mitral QUESTION: Rheumatic heart disease can cause mild  ________ valve stenosis (< 1.5 square cm).
11c: ANSWER: Rheumatic QUESTION: ________ heart disease causes leaflet thickening, commissural fusion, and chordal fusion of the mitral valve.
12c: ANSWER: left QUESTION: Mitral stenosis causes a pressure overload in the ______ atrium, because of the obstruction to outflow.
13c: ANSWER: atrial QUESTION: Pulmonary venous hypertension, pulmonary artery hypertension, and right heart failure can all result because of an increase in left _______ pressure.
14c: ANSWER: Atrial fibrillation QUESTION: ________ ___________ can occur because of an increase in left atrial size.
15c: ANSWER: stenosis QUESTION: Treatments for mitral valve ___________ may include diuretics, slowing the heart rate, and managing atrial fibrillation.
16c: ANSWER: papillary QUESTION: There are 2 sets of ________ muscles that control the mitral valve: lateral, and medial.
17c: ANSWER: chordae tendinae QUESTION: The ________ __________ attach the papillary muscles to the mitral valve.
18c: ANSWER: dilation QUESTION: In mitral regurgitation, cardiac output is sustained with left ventricular ___________.
19c: ANSWER: regurgitation QUESTION: An operation to repair the mitral valve is the first choice in mitral ____________ if the valve is repairable.
20c: ANSWER: mitral stenosis QUESTION: Approximately 25% of all patients with rheumatic heart disease have pure ________  ________, and an additional 40% have this combined with mitral regurgitation.
21c: ANSWER: rheumatic QUESTION: Rare acquired causes of mitral valve obstruction other than __________ heart disease include left atrial myxoma, ball-valve thrombus, mucopolysaccharidosis, and severe mitral annular calcification.
22c: ANSWER: right QUESTION: Severe pulmonary hypertension results in ______-sided heart failure, with dilation of the right ventricle and its annulus and secondary tricuspid and sometimes pulmonic regurgitation.
23c: ANSWER: fibrillation QUESTION: 30-40% of patients with mitral stenosis develop atrial ______________.
24c: ANSWER: stroke volume QUESTION: Cardiac output is the product of heart rate and _______ __________.
25c: ANSWER: heartbeat QUESTION: Stroke volume is the volume of blood pumped out of the heart with each ___________.
26c: ANSWER: tachycardia QUESTION: Compensatory ___________ occurs when the heart increases its heart rate in order to compensate for a decrease in stroke volume.
27c: ANSWER: stroke volume QUESTION: At heart rates greater than 150, diastolic filling times become so short that the tachycardia will produce a drop in _______ _________.
28c: ANSWER: contractility QUESTION: Stroke volume is affected by 3 factors: preload, postload, and _____________.
29c: ANSWER: preload QUESTION: Cardiac _________ must be carefully adjusted.   Too little, and the cardiac output will be low, leading to a low ejection fraction.  Too much, and the heart muscle will stretch, leading to cardiac failure.
30c: ANSWER: preload QUESTION: Signs of inadequate _________ include: poor skin turgor, dry mucous memebranes, low urine output, tachycardia, thirst, weak pulses, and flat neck veins.
31c: ANSWER: preload QUESTION: Signs of excess ________ in a patient with adequate cardiac function include distended neck veins, crackles in the lungs, and bounding pulses.
32c: ANSWER: preload QUESTION: Increased _________ in a patient with poor cardiac function presents with crackles in the lungs, an S3 heart sound, low urine output, tachycardia, cold clammy skin with weak pulses, and edema.
33c: ANSWER: dehydration QUESTION: Insufficient preload is commonly called hypovolemia or ____________.
34c: ANSWER: sympathetic QUESTION: When insufficient volume is present in the vascular tree, the _________ nervous system is stimulated to release the catecholemines: epinephrine and norepinephrine.
35c: ANSWER: vasoconstriction QUESTION: The catecholamines epinephrine and norepinephrine cause increased heart rate and arterial ________________.
36c: ANSWER: Afterload QUESTION: ___________ is defined as the resistance that the left ventricle must overcome to eject its load.
37c: ANSWER: resistance QUESTION: The most important determinant of afterload is vascular ____________.
38c: ANSWER: compliance QUESTION: Factors affecting afterload include vascular resistance, blood viscosity, valvular disease, and aortic ____________.
39c: ANSWER: constrict QUESTION: As arterial vessels _________, the afterload increases.
40c: ANSWER: dilate QUESTION: As arterial vessels __________, the afterload decreases.
41c: ANSWER: High QUESTION: ______ afterload increases myocardial work and decreases stroke volume.
42c: ANSWER: high QUESTION: Patients with _______ afterload present with symptoms of arterial vasoconstriction.
43c: ANSWER: vasoconstriction QUESTION: Symptoms of arterial _____________ include cool clammy skin, capillary refill greater than 5 sec, and narrow pulse pressure.
44c: ANSWER: pulse QUESTION: The _______ pressure is calculated by subtracting the diastolic blood pressure from the systolic blood pressure.
45c: ANSWER: 40 QUESTION: The normal pulse pressure at the brachial artery is _____ mm Hg.
46c: ANSWER: work QUESTION: Low afterload decreases cardiac _______ and increases stroke volume.
47c: ANSWER: low QUESTION: Patients with _____ afterload present with symptoms of arterial dilation.
48c: ANSWER: dilation QUESTION: Symptoms of arterial ________ include warm flushed skin, bounding pulses, and wide pulse pressure.
49c: ANSWER: low QUESTION: If afterload is too ________, hypotension may result.
50c: ANSWER: heart failure QUESTION:  A key component for treatment of _________  __________, is afterload reduction using beta blockers and ACE inhibitors.
51c: ANSWER: resistance QUESTION: By decreasing the __________ to ventricular ejection, cardiac output is increased and myocardial work is decreased.
52c: ANSWER: cardiac output QUESTION: Increasing _________ _________ improves the functional status of heart failure patients.
53c: ANSWER: Contractility QUESTION: ___________ refers to the inherent ability of the heart muscle to contract regardless of preload or afterload.
54c: ANSWER: positive QUESTION: Contractility is enhanced by exercise, catecholamines, and ________ inotropic drugs.
55c: ANSWER: negative QUESTION: Contractility is decreased by hypothermia, hypoxemia, acidosis, and _________ inotropic drugs.
56v: ANSWER: compliance QUESTION: Myocardial ___________ refers to the ability of the ventricle to stretch to receive a given volume of blood.
57c: ANSWER: small QUESTION: A normal ventricle is very compliant: A large change in volume will produce a _______ change in pressure.
58c: ANSWER: small QUESTION: If compliance is low, a _______ change in volume will produce a large change in pressure.
59c: ANSWER: increased QUESTION: If compliance is low (the ventricle cannot stretch), it cannot increase cardiac output with __________ preload.
60c: ANSWER: perfusion QUESTION: Adequate cardiac output is necessary for tissue ____________.
61c: ANSWER: perfusion QUESTION: Tissue ___________ is the transfer of oxygen and nutrients from the blood to the tissues.
62c: ANSWER: low QUESTION: Pulse oximetry values are usually ______ when tissue perfusion is compromised to a significant level.
63c: ANSWER: elevated QUESTION: Poor tissue perfusion will be indicated by an __________ lactate level in the arterial blood gases.
64c: ANSWER: low QUESTION: Poor tissue perfusion will be indicated by a ______ pH value in the arterial blood gases.
65c: ANSWER: low QUESTION: Poor tissue perfusion will be indicated by a _______ base excess in the arterial blood gases.
66c: ANSWER: femoral QUESTION: The intra-arterial catheter is typically a 20-gauge IV catheter inserted in the brachial, radial, or ________ artery.
67c: ANSWER: subclavian QUESTION: The central venous catheter is typically a large or small bore catheter with one or more lumens inserted via the _________, interior jugular, or exterior jugular veins.
68c: ANSWER: intercostal QUESTION: To monitor pressure at the heart, the stopcock nearest to the transducer must be placed at the 4th __________ space which is the phlebostatic axis.
69c: ANSWER: Hydrostatic QUESTION: __________ pressure is the force that is exerted by the fluid within the hemodynamic monitoring system against the transducer.
70c: ANSWER: Atmospheric QUESTION: __________ pressure is the force that is exerted at the earth’s surface by the weight of the air that surrounds the earth.
71c: ANSWER: 760 QUESTION: At sea level, atomospheric pressure is ______ mm Hg, but it can vary as a function of altitude.
72c: ANSWER: atmospheric QUESTION: Zeroing the hemodynamic monitoring system eliminates the effect of __________ pressure on the readings.  It can be accomplished before the patient is attached to the system.
73c: ANSWER: mean arterial pressure QUESTION: There is no accurate way of determining aortic pressure, so the _______ ________ _________ (MAP), or the average driving force of arterial pressure throughout the system is often used.
74c: ANSWER: 60 QUESTION: A minimal MAP of _____ mm Hg is required to perfuse the kidneys, heart, and brain.
75c: ANSWER: ventricular QUESTION: A MAP of 70-90 is desirable to reduce left _______ workload in cardiac patients.
76c: ANSWER: cerebral QUESTION: A MAP of 90-110 may be required to maintain __________ perfusion in a neurosurgical patient.
77c: ANSWER: 2 QUESTION: The MAP is calculated as the (SBP + ___ x DBP)/3.
78c: ANSWER: pressure QUESTION: Invasive arterial monitoring measures __________.
79c: ANSWER: flow QUESTION: Non-invasive blood pressure measurement reflects blood ______.
80c: ANSWER: arterial QUESTION: In sepsis, ___________ vasodilation is present, and noninvasive blood pressure measurements will be higher than invasive measurements.
81c: ANSWER: dicrotic notch QUESTION: The normal arterial pressure wave form has 5 landmarks: anacrotic limb, systolic peak, dicrotic limb which is split by the _______ ________, and the end diastole.
82c: ANSWER: aortic QUESTION: The dicrotic notch of an arterial pressure waveform marks the closure of the _________ valve, and the beginning of diastole.
83c: ANSWER: systole QUESTION: The dicrotic limb of an arterial pressure waveform begins during late ________, as the flow of blood out of the left ventricle begins to decrease.
84c: ANSWER: anacrotic QUESTION: The ________ limb of an arterial pressure waveform begins as the aortic valve opens in early systole.
85c: ANSWER: contractility QUESTION: The steepness, rate of ascent, and height of the anacrotic limb of an arterial pressure wave form is related to the ___________ and stroke volume of the left ventricle.
86c: ANSWER: Hypertension QUESTION: _______________ generally results in a very steep anacrotic limb on a arterial pressure waveform and a shortened early systolic phase of contraction.
87c: ANSWER: Hypotension QUESTION: _______________ generally results in an overdamped appearance of the arterial pressure waveform with a decrease in steepness of the anacrotic limb.
88c: ANSWER: hypotension QUESTION: In ____________, the dicrotic notch may be absent in the arterial pressure waveform.
89c: ANSWER: parietal QUESTION: The pericardium is a double layer of tissue that surrounds the heart.  It is comprised of a visceral serous inner layer, and a _________ outer layer attached to pleura and the diaphragm.
90c: ANSWER: third QUESTION: The muscle fibers of the myocardium are one _______ shorter than average muscle cell fibers.
91c: ANSWER: actin QUESTION: The primary components of the myofibrils of the myodardium are ________ and myosin.
92c: ANSWER: pleural QUESTION: The _______ cavity separates the parietal epicardium from lung tissue.
93c: ANSWER: atrium QUESTION: Each side of the heart has 2 chambers: a ventricle and an _______.
94c: ANSWER: more QUESTION:  The ventricles of the heart are ________ muscular than the atria.
95c: ANSWER: semilunar QUESTION: The two _________ valves of the heart are the pulmonary and the aortic.
96c: ANSWER: atrioventricular QUESTION: The two ___________ valves of the heart are the tricuspid (3 flaps), and the mitral (bicuspid or 2 cusps).
97c: ANSWER: aortic QUESTION: The _________ valve connects the left ventricle with the aortic artery.
98c: ANSWER: mitral QUESTION: The _______ valve connects the left atrium with the left ventricle.
99c: ANSWER: diastole QUESTION: During ________, the mitral and tricuspid valves open after the pulmonary and aortic valves close.
100c: ANSWER: systole QUESTION: During ________, the aortic and pulmonary valves open after the tricuspid and mitral valves close.
101c: ANSWER: tricuspid QUESTION: The ________ valve connects the right atrium to the right ventricle.
102c: ANSWER: pulmonary QUESTION: The __________ valve connects the right ventricle to the pulmonary artery.
103c: ANSWER: pulmonary QUESTION: Blood flows into the left atrium of the heart from the ________ vein.
104c: ANSWER: right QUESTION: Unoxygenated blood flows into the ______ atrium of the heart from the superior vena cava, the inferior vena cava, and from the heart itself through the coronary sinus.
105c: ANSWER: oxygen QUESTION: Blood is pumped through the pulmonic artery to the lungs where it exchanges carbon dioxide for _________.
106c: ANSWER: right coronary artery QUESTION: Of the 4 arteries of the heart (RCA, PDA, LAD, and LCA), RCA stands for ______  _________  ________.
107c: ANSWER: left anterior descending QUESTION: Of the 4 arteries of the heart (RCA, PDA, LAD, and LCA), LAD stands for __________ _________ _________ artery.
108c: ANSWER: left circumflex artery QUESTION: Of the 4 arteries of the heart (RCA, PDA, LAD, and LCA), LCA stands for ______  _________  ___________.
109c: ANSWER: posterior descending artery QUESTION: Of the 4 arteries of the heart (RCA, PDA, LAD, and LCA), PDA stands for _________ __________ _________ (a branch of the RCA).
110c: ANSWER: Coronary QUESTION: _________ arteries originate in the aorta just above the aortic valve and empty into the coronary sinus.
111c: ANSWER: parasympathetic QUESTION: The ___________ nervous system primarily influences the atria.
112c: ANSWER: sympathetic QUESTION: The ___________ nervous system influences both the atria and ventricles.
113c: ANSWER: diameter QUESTION: The amount of blood a vessel can transport according to Poiseuille’s Law is directly proportional to its ____________.
114c: ANSWER: radius QUESTION: Blood flow through a vessel is directly proportional to the 4th power of the vessel’s ___________.
115c: ANSWER: Capillaries QUESTION: ____________ are points of connection between arterial and venous systems where gases are exchanged.
116c: ANSWER: venules QUESTION: Capillaries drain into _________.
117c: ANSWER: arterioles QUESTION: Capillaries receive blood from ____________.
118c: ANSWER: tunica intima QUESTION: A typical artery separates the lumen from the muscle by the ___________ ___________ and an elastic membrane.
119c: ANSWER: tunica media QUESTION: The _________ ________ of an artery is comprised of the elastic membrane and muscle layers.
120c: ANSWER: adventitia QUESTION: The __________ ___________ surrounds the muscular layer of an artery.
121c: ANSWER: minute QUESTION: The heart pumps about 4 to 8 liters of blood into the aorta each __________.
122c: ANSWER: ml QUESTION: Stroke volume is the amount of blood ejected from a ventricle with each heart beat.  A normal stroke volume is usually 60-100 _______.
123c: ANSWER: cardiac output QUESTION: Blood pressure is the product of the peripheral resistance and the ________ _________.
124c: ANSWER: diastole QUESTION: The Frank Starling Law states that the greater the volume of blood in the heart during ________, the more forceful the contraction will be.
125c: ANSWER: Tachycardia QUESTION: ______________ is defined as a heartrate greater than 100 beats/min.
126c: ANSWER: Bradycardia QUESTION: _______________ is defined as a heartrate less than 60 beats/min.
127c: ANSWER: nodal QUESTION: In an EKG interpretation, no discernable P wave preceding each QRS, but narrow regular QRS complexes is called a ______ rhythm.
128c: ANSWER: sinus QUESTION: In an EKG interpretation, a P wave preceding each QRS wave, with a consistent PR interval is called a ______ rhythm.
129c: ANSWER: atrial QUESTION: In an EKG interpretation, no discernable P waves preceding each QRS complex with an irregular rate is called _______ fibrillation.
130c: ANSWER: sinus QUESTION: In an EKG interpretation of an irregular heartrate, if the P wave precedes each QRS with a consistent PR interval, the observation is called a _______ arrhythmia.
131c: ANSWER: atrioventricular QUESTION: In an EKG interpretation of an irregular heartrate, if the P waves are present, but there is progressive lengthening of the PR interval ending with a non-conducted P wave (dropped beat) followed by a normally conducted P wave with a shorter PR interval, the patient is experiencing an _____ block.
132c: ANSWER: plaque QUESTION: When fatty substances, cholesterol, cellular waste products, calcium and fibrin build up in the inner lining of an artery, this is known as __________.
133c: ANSWER: compliance QUESTION: Plaque causes a narrowing of the lumen of vessels, and also a decrease in _________.
134c: ANSWER: atherosclerosis QUESTION: Elevated levels of cholesterol and triglycerides in the blood, high blood pressure, and cigarette smoking are risk factors associated with _____________.
135c: ANSWER: stenosis QUESTION: The obstruction of flow through a vessel is called __________.
136c: ANSWER: Doppler echocardiography QUESTION: __________  ___________ can be used to identify and quantify the severity of a valvular stenosis.
137c: ANSWER: aneurysm QUESTION: An _______ refers to the abnormal enlargement or bulging of an artery wall.
138c: ANSWER: abdominal aortic aneurysm QUESTION: Aneurysms commonly occur in the abdomen or the brain.  In the abdomen, an AAA or _____ ______ _____ , can result in life-threatening blood loss if it ruptures.
139c: ANSWER: cerebral aneurysm QUESTION: Aneurysms commonly occur in the abdomen or the brain.  In the brain, a CA or ____________ _________, can result from a weakness in the tunica media (muscle layer) of the vessel present from birth.
140c: ANSWER: Thrombosis QUESTION: ___________ refers to the formation or development of an aggregation of blood substances, including platelets, fibrin, and cellular elements.
141c: ANSWER: stent QUESTION: A _________ is a metal mesh tube that is inserted into an artery on a balloon catheter and inflated to expand and hold open an artery, so that blood can flow more easily through the artery.
142c: ANSWER: femoral QUESTION: Typically, stents are inserted on a balloon catheter through the _________ artery or brachial artery and guided up to the narrowed section of a smaller artery.
143c: ANSWER: Angioplasty QUESTION: ___________ is a minimally invasive procedure that mechanically widens a narrowed or obstructed blood vessel.
144c: ANSWER: bypass QUESTION: When stents cannot be placed, a patient may be a candidate for a coronary artery ______ graft (CABG) surgery where veins are harvested from the legs to be used as the bypass vessels.

————————————–gen_muscle_facts.txt——————————-

01c: ANSWER: biceps femoris QUESTION: the ________ ________ flexes the leg and rotates it laterally when the knee is flexed.  It extends the thight.  It has 2 heads.  The long head is innervated by the tibial division of the sciatic nerve (L5, S1, and S2).  This long head originates at the ischial tuberosity.  The short head is innervated by the common fibular (peroneal) division of the sciatic nerve (L5, S1 and S2).  This short head initiates at the linea aspera and lateral supracondylar line of the femur.  The combined muscle inserts on the lateral of the head of the fibula – the tendon split at this site by the fibular collateral ligament of the knee. EXER: Stand up, and walk 5 steps.
02c: ANSWER: brachioradialis QUESTION:  The ___________ flexes the forearm.  It is innervated by the radial nerve (C5-C7).  It originates in the proximal two thirds of the lateral supracondylar ridge of the humerus, and inserts at the lateral surface of the distal end of the radius. EXER: Holding your arms out and fists closed and hands together thumbs aligned, move them from the table to your forehead 5 times.
03c: ANSWER: brachialis QUESTION: The ____________ flexes the forearm in all positions.  It is innervated by the musculocutaneous nerve (C5 and C6).  It originates in the distal two thirds of the anterior surface of the humerus.  It inserts at the coronoid process and tuberosity of ulna. EXER: Holding your arms out and fists closed, bring your fists toward you bending at the elbow, and rotating the fists as you move up and down.  Repeat 5 times.
04c: ANSWER: biceps brachii QUESTION: The _______ _______ supinates the forearm and, when supine, flexes the forearm. It is innervated by the musculocutaneous nerve (C5, C6).  It has 2 heads.  The long head initates at the supraglenoid tubercle of the scapula.  The short head initiates at the tip of the coracoid process of the scapula.  The muscle inserts at the tuberosity of radius and fascia of the forearm by the bicipital apooneurosis. EXER: Hold an object in each hand.  With the arm extended (as for a blood draw), slowly lift the object toward you 5 times, bending your elbow.
05: ANSWER: adductor pollicis longus QUESTION: The __________ blood pressure is the pressure required to stop blood flow through the artery, at which point the sound of the heart beat transmits to the stethoscope as the blood pushes against the barrier. EXER:
06: ANSWER: adductor longus QUESTION: The __________ blood pressure is the pressure required to restore blood flow through the artery, at which point the sound of the heart beat is no longer detected by the stethoscope because the blood flows through the barrier. EXER:
07: ANSWER: adductor magnus QUESTION: The human heart has ___ chambers.  The 2 halves of the heart are separated by a septum. EXER:
08: ANSWER: adductor minimus QUESTION: The first heart sound occurs when the ______________ valves close. EXER:
09c: ANSWER: adductor brevis QUESTION: The ___________ ___________ adducts the thigh and to some extent flexes it.  It is innervated by the obdurator nerve (L2-L4), branch of anterior division.  It initiates at the body and inferior ramus of the pubis.  It inserts at the pectineal line and proximal part of the linea aspera of the femur.  EXER: Holding your legs out in front of you, move both legs apart keeping them straight 5 times.
10: ANSWER: adductor pollicis QUESTION: Rheumatic heart disease can cause mild  ________ valve stenosis (< 1.5 square cm). EXER:
11c: ANSWER: anconeus QUESTION: The ________ assists the triceps in extending the forearm. It stablizes the elbow joint, and abducts the ulna during pronation. It is innervated by the radial nerve (C7, C8, and T1).  It originates at the lateral epicondyle of the humerus.  It inserts at the lateral surface of the olecranon and the superior part of the posterior surface of the ulna.  EXER: Pump each arm 5 times – lifting your fist from an extended position toward you.
12: ANSWER: articularis cubiti QUESTION: Mitral stenosis causes a pressure overload in the ______ atrium, because of the obstruction to outflow. EXER:
13: ANSWER: articularis genus QUESTION: Pulmonary venous hypertension, pulmonary artery hypertension, and right heart failure can all result because of an increase in left _______ pressure. EXER:
14: ANSWER: adductor hallucis QUESTION: ________ fibrillation can occur because of an increase in left atrial size. EXER:
15: ANSWER: abductor pollicis longus QUESTION: Treatments for mitral valve ___________ may include diuretics, slowing the heart rate, and managing atrial fibrillation. EXER:
16: ANSWER: foot abductor digiti minimi QUESTION: There are 2 sets of ________ muscles that control the mitral valve: lateral, and medial. EXER:
17: ANSWER: hand abductor digiti minimi QUESTION: The ________ tendinae attach the papillary muscles to the mitral valve. EXER:
18: ANSWER: abductor pollicis brevis QUESTION: In mitral regurgitation, cardiac output is sustained with left ventricular ___________. EXER:
19c: ANSWER: buccinator QUESTION:  The ____________ presses the cheek against molar teeth, thereby aiding chewing.  It expels air from oral cavity, as when a wind instrument is played.  It draws mouth to one side when acting unilaterally.  It is innervated by the facial nerve (CN VII).  It originates at the mandible, pterygomandibular raphe, and alveolar processes of maxilla and mandible, and inserts at the angle of the mouth.  EXER: kiss 5 times.
20: ANSWER: bulbospongiosis QUESTION: Approximately 25% of all patients with rheumatic heart disease have pure mitral ________, and an additional 40% have this combined with mitral regurgitation.  It originates on the scleral spur, and inserts at the meridional, radial and circular fibers intrinsic to the ciliary body. EXER:
21c: ANSWER: ciliary QUESTION: The __________ relieves tension on the lens of the eye, allowing it to become more convex for near vision.  It is innervated by the parasympathetic fibers of the oculomotor nerve and ciliary ganglion.  EXER: cross your eyes 5 times looking at your nose. EXER:
22c: ANSWER: coracobrachialis QUESTION: The ________ helps to flex and adduct the arm.  It is innervated by the musculocutaneous nerve (C5-C7).  It originates at the tip of the coracoid process of the scapula humerus, and inserts at the middle third of the medial surface of ?. EXER:
23c: ANSWER: cremaster QUESTION: The ______________ elevates the testis.  It is innervated by the genital branch of the genitofemoral nerve (L1-L2).  It originates at the internal oblique muscle and inguinal ligament, and inserts at the spermatic ocrd and tunica vaginalis. EXER:
24c: ANSWER: deltoid QUESTION: The ________ has 3 parts.  The anterior part flexes and medially rotates the arm.  The middle part abducts the arm.  The posterior part extends and laterally rotates the arm.  It is innervated by the axillary nerve (C5, C6).  It originates in the lateral third of the clavicle, acromion, and spine of scapula.  It inserts at the deltoid tuberosity of the humerus.  EXER: Hold your arms straight out.  Now clap them 5 times without bending your arms.
25c: ANSWER: diaphragm QUESTION: The __________ descends, decreasing intrathoracic pressure and thus resulting in inhalation and assisting return of venous blood to the heart.  It is innervated by the phrenic nerve (C3-C5).  It originates in the xiphoid process, inferior 6 costal cartilages and adjoining ribs, arcuate ligaments, anterior longitudinal ligaments, bodies, and discs of lumbar vertebrae 1-3.  It inserts at the central tendon of the diaphragm.  EXER: Breathe in deeply 5 times.
26c: ANSWER: digastric QUESTION: The ___________ depresses the mandible.  It raises the hyoid bone and steadies it during swallowing and speaking.  It has 2 branches.  Its anterior belly is is innervated by a branch of the inferior alveolar nerve. It originates at the digastric fossa of the mandibleand inserts at the intermediate tendon to the body. Its posterior belly is innervated by the facial nerve (CN VII).  It originates at the mastoid notch of the temporal bone, and inserts at the greater horn of the hyoid bone.
27: ANSWER: dorsal interossei of foot QUESTION: At heart rates greater than 150, diastolic filling times become so short that the tachycardia will produce a drop in _______ _________.
28: ANSWER: dorsal interossei of hand QUESTION: Stroke volume is affected by 3 factors: preload, postload, and _____________.
29c: ANSWER: erector spinae QUESTION: The _______  _________ act bilaterally.  They extend the vertebral column and head as the back is flexed.  They control movement by gradually lengthening fibers, acting unilaterally.  Acting laterally, they bend the vertebral column.  They are innervated by the posterior rami of the spinal nerves.  They arise by a broad tendon rom the posterior part of the iliac crest, the posterior surface of the sacrum, the sacral and inferior lumbar spinous processes, and the supraspinous ligament.  There are 3 points of insertion.  The iliocostalis insert at the lumborum, the thoracis, the cervicis.  The fibers run superiorly to angles of the lower ribs and cervical transverse processes.  The longissimus – thoracis, cervicis, and capitis; these fibers run superiorly to the ribs between the tubercles and angles, to transverse processes in the thoracic and cervical regions, and to the mastoid process of the temporal bone.  The spinalis – thoracis, cervicis, and capitis fibers run superiorly to the spinous processses in the upper thoracic region and to the skull.  EXER: Arch your back, lean to the right and left. Repeat 5 times.
30: ANSWER: external intercostal QUESTION: Signs of inadequate _________ include: poor skin turgor, dry mucous memebranes, low urine output, tachycardia, thirst, weak pulses, and flat neck veins.
31: ANSWER: external oblique QUESTION: Signs of excess ________ in a patient with adequate cardiac function include distended neck veins, crackles in the lungs, and bounding pulses.
32c: ANSWER: fibularis brevis QUESTION: The __________  _________ everts the foot and weakly plantarflexes the ankle.  It is innervated by the superficial peroneal nerve (L5, S1, S2).  It originates on the inferior two thirds of the lateral surface of the fibula, and inserts on the dorsal surface of the tuberosity on the lateral side of the base of the 5th metatarsal.  EXER: Turn your feet out to “first position” (ballet) 5 times.
33c: ANSWER: fibularis longus QUESTION: The _________  _________ everts the foot and weakly plantarflexes the ankle.  It is innervated by the superficial peroneal nerve (L5, S1, S2).  It originates on the head and superior two thirds of the lateral surface of the fibula, and inserts at the base of the first metatarsal and medial cuneiform. EXER: Holding your legs out and flexing your feet, turn them out 5 times.
34c: ANSWER: fibularis tertius QUESTION: The _________  ___________ dorsiflexes the ankle and aids in the eversion of the foot.  It is innervated by te deep peroneal nerve (L5, S1).  It initiates at the inferior third of the anterior surface of the fibula and the interosseous membrane.  It inserts at the dorsum of the base of the 5th metatarsal bone.  EXER: Holding your legs out, point your toes 5 times.
36c: ANSWER: gracilis QUESTION: The ___________ adducts the thigh.  It flexes the leg, and helps to rotate it medially.  It is innervated by the obturator nerve (L2, L3).  It orignates at the body and inferior ramus of the pubis.  It inserts at the superior part of the medial surface of the tibia. EXER:
37c: ANSWER: gluteus maximus QUESTION: The ____________ extends the thigh (especially from the flexed position) and assists in its lateral rotation.  It steadies the thigh and assists in rising from a sitting position.  It is innervated by the inferior gluteal nerve (L5, S1, S2).  It initiates from the ilium posterior to the posterior gluteal line, the dorsal surface of the sacrum and coccyx, and the sacrotuberous ligament.  Most of its fibers end in the iliotibial tract that inserts into the lateral condyle of the tibia. Some fibers insert on the gluteal tuberosity of the femur. EXER: stand up 5 times from a sitting position.
38c: ANSWER: gluteus medius QUESTION: The ____________ abducts and medially rotates the thigh.  It keeps the pelvis level when the opposite leg is raised off of the ground.  It is innervated by the superior gluteal nerve (L5, S1).  It initiates at the external surface of the ilium between the anterior and posterior gluteal lines.  It inserts at the lateral surface of the greater trochanter of the femur. EXER: Stand up and raise each leg alternately while keeping the other leg straight 5 times.
39c: ANSWER: lateral pterygoid QUESTION: The ______  _______ has 2 heads.  Both heads act together to protrude the mandible and depress the chin.  They act alternately and alone to produce side-to-side movements of the mandible.  The muscle is innervated by the mandibular nerve (CN V3) through the _______ ________ nerve from the anterior trunk, which enters its deep surface.  The superior head initiates in the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone.  The inferior head initiates at the lateral surface of the ________ ________ plate.  The muscle inserts at the neck of the mandible (pterygoid fovea), the articular disc and capsule of the temporomandibular joint. EXER: move your jaw to the right and left 5 times.
40c: ANSWER: latissimus dorsi QUESTION: The __________ _______ extends, adducts, and medially rotates the humerus.  It raises the body toward the arms during climbing.  It is innervated by the thoracodorsal nerve (C6-C8).  It initiates at the spinous processes of the inferior 6 thoracic vertebrae, the thracolumbar fascia, the iliac crest, and the inferior 3 or 4 ribs.  It inserts in the floor of the intertubercular groove of the humerus.  EXER: Standing up at a door frame, put your fingers on top of the frame, and pull up 5 times.
41: ANSWER: levator scapulae QUESTION: ______ afterload increases myocardial work and decreases stroke volume.
42c: ANSWER: masseter QUESTION: The _______ elevates and protrudes the mandible thus closing the jaws.  Its deep fibers allow retrusion.  It is innervated by the mandibular nerve (CN V3) through the masseteric nerve, which enters its deep surface.  It initiates in the inferior border and medial surface of the zygomatic arch, and inserts in the lateral surface of the ramus of the mandible and its coronoid process. EXER:
43c: ANSWER: mentalis QUESTION: The _____________ elevates and protrudes the lower lip.  It is innervated by the facial nerve (CN VII).  It initiates in the incisive fossa of the mandible, and inserts in the skin of the chin.
44c: ANSWER: medial rectus QUESTION: The _______ ________ adducts the eyeball.  It is innervated by the oculomotor nerve (CN III).  It initiates in the common tendinous ring, and inserts in the sclera just posterior to the cornea. EXER: With your face straight ahead, look as far as you can to the right, then to the left 5 times.
45: ANSWER: medial pterygoid QUESTION: Acting bilaterally, the ________ ________ elevates the mandible, closing the jaws.  It assists in protruding the mandible; acting alone.  It assists in protruding the same side of the jaw. Acting alternately, it produces a grinding motion.  It is innervated by the mandibular nerve (CN V3) through the medial pterygoid nerve.  It has 2 heads.  The deep head initiates on the medial surface of the lateral pterygoid plate and pyramidal process of the palatine bone.  The superficial head initiates on the tuberosity of the maxilla.  It inserts at the medial surface of the ramus of the mandible, inferior to the mandibular foramen. EXER: Open your jaw.  Move it to the right and close it, then open it and move it to the left and close it.  Do this 5 times.
46c: ANSWER: quadratus femoris QUESTION: The _______  ________  laterally rotates the thigh and steadies the femoral head in the acetabulum.  It is innervated by the nerve to the quadratus femoris (L5, S1).  It initiates on the lateral border of the ischial tuberosity, and inserts on the quadrate tubercle on the intertrochanteric crest of the femus and area inferior to it.  EXER: Extend both legs, and point your toes outward 5 times.
47c: ANSWER: rectus abdominis QUESTION: The _____  __________ flexes the trunk and compresses the abdominal viscera (indirectly opposing the diaphragm).  It is innervated by the thoracoabdominal nerves (anterior rami of the inferior 6 thoracid nerves).  It initiates at the pubic symphysis and pubic crest.  It inserts in the xiphoid process and 5th-7th costal cartilages.  EXER: do 5 situps.
48c: ANSWER: risorius QUESTION: The ________ retracts the angle of the mouth, lengthening the rima oris.  It is innervated by facial nerve (CN VII).  It originates at the platysma and fascia of the masseter, and inserts at the orbicularis oris, the skin of the corner of the mouth, and the modiolus. EXER:
49c: ANSWER: soleus QUESTION: The _______ plantarflexes the ankle independently of the position of the knee and steadies the leg on the foot.  It is innervated by the tibial nerve (S1, S2).  It originates in the posterior aspect of the head of the fibula, superior fourth of the posterior surface of the fibula, and the soleal line and medial border of the tibia.  It inserts at the posterior surface of the calcaneus via the calcaneal tendon.  EXER: Do 5 knee squats.
50c: ANSWER: subscapularis QUESTION:  The __________ rotates the arm medially and adducts it.  It helps to hold the humeral head in the glenoid cavity.  It is innervated by the upper and lower subscapular nerves (C5-C7).  It originates in the subscapular fossa, and inserts in the lesser tubercle of the humerus.  EXER: Hold your arms out and make 5 breast stroke movements.
51c: ANSWER: cricopharyngeus QUESTION: The __________ serves as an upper esophageal sphincter.  It is innervated by the vagus nerve (CN X).  It originates at the posterolateral cricoid cartilage on one side, and inserts at the posterolateral cricoid cartilage of the other side. EXER:
52c: ANSWER: cricothyroid QUESTION: The _________ stretches and tenses the vocal fold.  It is innervated by the external laryngeal nerve.  It originates at the anterolateral part of the cricoid, and inserts at the inferior margin and inferior horn. EXER:
53c: ANSWER: hyoglossus QUESTION: The ____________ depresses and retracts the tongue.  It is innervated by the hypoglossal nerve (CN XII).  It originates at the body and greater horn of the hyoid bone, and inserts at the side and inferior aspect of the tongue. EXER:  Stick your tongue out 5 times.
54c: ANSWER: iliacus QUESTION: The ___________ flexes the thigh and stabilizes the hip joint, acting with the psoas major.  It is innervated by the femoral nerve (L2-L4). It originates at the iliac crest on the superior two thirds of the iliac fossa, at the ala of sacrum, and at the anterior scroiliac ligaments.  It inserts at the lesser trochanter of femur and shaft inferior to it, and inferior to the psoas major tendon.
55c: ANSWER: infraspinatus QUESTION: The _____________ laterally rotates the arm.  It helps to hold the humeral head in the glenoid cavity of the scapula.  It is innervated by the suprascapular nerve (C5, C6).  It originates on the infraspinous fossa of the scapula, and inserts at the middle facet on the greater tubercle of the humerus. EXER:
56c: ANSWER: interspinales QUESTION: The ___________ aids in the extension and rotation of the vertebral column.  It is innervated by the posterior rami of spinal nerves.  It originates in the superior surfaces of the spinous processes of cervical and lumbar vertebrae, and inserts at the interior surfaces of the spinous processes of the vertebrae superior to the vertebrae of origin. EXER:
57c: ANSWER: intertransversarii QUESTION: The ___________ aid in lateral bending of the vertebral column.  They act bilaterally, and stabilize the vertebral column.  They are innervated by the posterior and anterior rami of spinal nerves.  They initiate from the transverse processes of cervical and lumbar vertebrae, and insert into the transverse processes of adjacent vertebrae. EXER: standing up, lean as far to the right as you can, and then to the left. Repeat 5 times.
58c: ANSWER: ischiocavemosus QUESTION: The ___________ maintains the erection of the penis or clitoris by compressing outflow veins and pushing blood into the body of the penis or clitoris.  It is innervated by a deep branch of the perineal nerve, and a branch of the pudendal nerve (S2=S4).  It initiates in the internal surface of the ischiopubic ramus and ischial tuberosity, and inserts in the crus of the penis or clitoris.
59c: ANSWER: mylohyoid QUESTION: The __________ elevates the hyoid bone, the floor of the mouth, and the tongue during swallowing and speaking.  It is innervated by the mylohyoid nerve, a branch of the inferior alveolar nerve of the CN V3. It initiates in the mylohyoid line of the mandible, and inserts in the raphe and body of the hyoid bone.
60c: ANSWER: nasalis QUESTION: The ____________ draws the ala (sides) of the nose toward the nasal septum.  It is innervated by the facial nerve (CN VII).  It initiates in the superior part of the canine ridge of the maxilla, and inserts in the nasal cartilages. EXER: keeping your mouth closed, inhale very strongly through your nose 5 times.
61c: ANSWER: occipitofrontalis QUESTION: The ___________ has 2 bellies.  The occipital belly retracts and elevates the scalp.  It is innervated by the posterior branch of the facial nerve (CN VII), initiating on the lateral two thirds of the superior nuchal line and mastoid bone, and inserting into the epicranial aponeurosis.  The frontal belly elevates the eyebrows and the skin of the forehead.  It is innervated by the temporal branch of the facial nerve (CN VII).  It initiates in the epicranial aponeurosis, and inserts in the skin of the forehead and eyebrows. EXER:
62c: ANSWER: omohyoid QUESTION: The ______ depresses, retracts, and steadies the hyoid bone.  It is innervated by C1-C3 through a branch of the ansa cervicalis.  It initiates on the superior border of the scapula near the suprascapular notch, and inserts into the inferior border of the hyoid bone. EXER:
63c: ANSWER: palatoglossus QUESTION: The __________ elevates the posterior part of the tongue and draws the soft palate onto the tongue.  It is innervated by the cranial part of the accessory nerve (CN XI) through the pharyngeal branch of the vagus nerve (CN X) by way of the pharyngeal plexus.  It initiates in the palatine aponeurosis, and inserts into the side of the tongue.
64c: ANSWER: palatopharyngeus QUESTION: The ____________ tenses the soft palate and pulls the walls of the pharynx superiorly, anteriorly, and medially during swallowing.  It is innervated by the cranial part of the accessory nerve (CN XI) through the pharyngeal branch of the vagus nerve (CN X) by way of the pharyngeal plexus.  It initiates in the hard palate and palatine aponeurosis, and inserts in the lateral wall of the pharynx.  EXER: Swallow 5 times.
65c: ANSWER: pectineus QUESTION: The _______ adducts and flexes the thigh.  It assists with the medial rotation of the thigh.  It is innervated by the femoral nerve (L2,L3), and may receive a branch from the obturator nerve.  It initiates in the superior ramus of the pubis, and inserts in the pectineal line of the femur, just inferior to the lesser trochanter.
66c: ANSWER: piriformis QUESTION: The __________ laterally rotates the extended thigh and abducts the flexed thigh.  It steadies the femoral head in the acetabulum.  It is innervated by branches of the anterior rami of S1, S2.  It initiates in the anterior surface of the sacrum and sacrotuberous ligament, and inserts in the superior border of the greater trochanter of the femur. EXER: raise your bent hyoknees toward your shoulders 5 times.
67c: ANSWER: plantar interossei 1-3 QUESTION: The _________ adducts the 2nd-4th digits and flexes the metatarsophalangeal joints.  It is innervated by the lateral plantar nerve (S2, S3).  It initiates in the bases and medial sides of the metatarsals 3rd-5th, and inserts in the medial sides of the bases of the proximal phalanges of the 3rd-5th digits. EXER:  Holding your legs out in front of you, point your toes 5 times.
68c: ANSWER: plantaris QUESTION: The __________ weakly assists the gastrocnemius in the plantarflexing of the ankle and in the flexing of the knee.  It is innervated by the tibial nerve (S1, S2).  It initiates in the inferior end of the lateral supracondylar line of the femur and in the oblique popliteal ligament.  It inserts into the posterior surface of the calcaneus through the calcaneal tendon. EXER:
69c: ANSWER: platysma QUESTION: The __________ depresses the mandible and tenses the skin of the lower face and neck.  It is innervated by the facial nerve (CN VII).  It initiates in the superficial fascia of the deltoid and pectoral regions, and inserts into the mandible, the skin of the cheek, the angle of the mouth, and the orbicularis oris. EXER:
70c: ANSWER: popliteus QUESTION: The __________ weakly flexes the knee and unlocks it. It is innervated by the tibial nerve (L4, L5, S1).  It initiates in the lateral surface of the lateral condyle of the femur, and lateral meniscus, and inserts in the posterior surface of the tibia, superior to the soleal line. EXER:
71c: ANSWER: procerus QUESTION: The _____________ depresses the medial end of the eyebrow.  It produces transverse wrinkles over the bridge of the nose, producing a look of concentration. It is innervated by the facial nerve (CN VII).  It initiates in the aponeurosis covering the bridge of the nose, and inserts into the skin of the lower foreead between the eyebrows.  EXER: draw your eyebrows together 5 times.  EXER:
72c: ANSWER: pyamidalis QUESTION: The __________ tenses the linea alba.  It is innervated by the subcostal nerve. It initates in the crest of the pubis, and inserts in the lower portion of the linea alba. EXER:
73c: ANSWER: sartorius QUESTION: The __________ flexes abducts, and laterally rotates the thigh at the hip joint.  It flexes the leg at the knee joint.  It is innervated by the femoral nerve (L2, L3).  It initiates in the anterior superior iliac spine and superior part of the notch inferior to it, and inserts into the superior part of the medial surface of the tibia.  EXER: extending your legs forward,turn your feet out and bring them back together 5 times. EXER:
74c: ANSWER: semimembranosus QUESTION: The _____________  extends the thigh, flexes the leg, and when the knee is flexed, rotates it medially.  When the hip is flexed and the knee is extended, it can raise the trunk against gravity.  It is innervated by the tibial division of the sciatic nerve (L5, S1, and S2).  It initiates in the ischial tuberosity, and inserts in the posterior part of the medial condyle of the tibia.  Its reflected attachment forms the oblique popliteal ligament to the lateral femoral condyle. EXER:
75c: ANSWER: semitendinosus QUESTION: The ____________ extends the thigh, flexes the leg, and when the knee is flexed, it rotates it medially.  When the hip is flexed and the knee is extended, it can raise the trunk against gravity.  It is innervated by the tibial division of the sciatic nerve (L5, S1, and S2).  It initiates in the ischial tuberosity, and inserts in the medial surface of the superior part of the tibia. EXER:
76c: ANSWER: stapedius QUESTION: The __________ damps vibrations of stapes reflexively in response to loud noise.  It is innervated by the facial nerve (CN VII).  It initiates in the internal walls of the pyramidal eminence of the posterior wall of the tympanic cavity.  It inserts at the neck of the stapes. EXER:
77c: ANSWER: sternocleidomastoid QUESTION: The ____________ tilts the head to one side, i.e. laterally.  It flexes the neck and rotates it so the face is turned superiorly toward the opposite side; acting together, the right and left muscles flex the neck so that the chin is thrust forward.  It is innervated by the spinal root of the accessory nerve (CN XI) (motor_ and C2 and C3 nerves (pain and proprioception).  It initiates at the lateral surface of the mastoid process of the temporal bone and the lateral half of the superior nuchal line.  It inserts at two points:  on the sternal head, at the anterior surface of the manubrium of the sternum.  On the clavicular head, at the superior surface of the medial third of the clavicle.
78c: ANSWER: sternohyoid QUESTION: The __________ depresses the hyoid bone after it has been elevated during swallowing.  It is innervated by C1-C3 through a branch of the ansa cervicalis.  It initiates at the manubrium of the sternum, and the medial end of the clavicle.  It inserts at the body of the hyoid bone. EXER:
79c: ANSWER: sternothyroid QUESTION: The _________ depresses the hyoid bone and the larynx.  It is innervated by C2 and C3 through a branch of the ansa cervicalis.  It initiates at the posterior surface of the manubrium of the sternum, and inserts into the oblique line of the thyroid cartilage. EXER:
80c: ANSWER: styloglossus QUESTION: The ___________ retracts the tongue and draws it up to create a trough for swallowing.  It is innervated by the hypoglossal nerve (CN XII).  It initiates at the styloid process and stylohyoid ligament, and inserts in the side and inferior aspect of the tongue. EXER:
81c: ANSWER: stylohyoid QUESTION: The ___________ elevates and retracts the hyoid bone, thereby elongating the floor of the mouth.  It is innervated by a cervical branch of the facial nerve (CN VII).  It initiates at the styloid process of the temporal bone, and inserts in the body of the hyoid bone. EXER:
82c: ANSWER: stylopharyngeus QUESTION: The ____________ elevates (shortens and widens) the pharynx and larynx during swallowing and speaking.  It is innervated by the glossopharyngeal nerve (CN IX).  It initiates at the styloid process of the temporal bone, and inserts at the posterior and superior borders of the thyroid cartilage with the palatopharyngeus.  EXER:
83c: ANSWER: subclavius QUESTION: The _____________ anchors and depresses the clavicle.  It is innervated by the nerve to the subclavius (C5, C6). It initiates at the junction of the 1st rib and its costal cartilage.  It inserts at the inferior surface of the middle third of the clavicle.  EXER: Shrug 5 times.
84c: ANSWER: subcostal QUESTION: The ________ elevates the ribs.  It is innervated by the intercostal nerves.  It initiates at the internal surfacs of the lower ribs near their angles, and inserts at the superior borders of the 2nd or 3rd ribs below.  EXER:
85c: ANSWER: supinator QUESTION: The ___________ rotates the radius to turn the palm anteriorly.  It is innervated by a deep branch of the radial nerve (C5, C6).  It initiates at the lateral epicondyle of the humerus, the radial collateral and anular ligaments, the supinator fossa, and the crest of the ulna.  It inserts at the lateral, posterior, and anterior surfaces of the proximal third of the radius.  EXER:  Holding your arms in front of you, palms down.  Rotate your palms up 5 times.
86c: ANSWER: supraspinatus QUESTION: The _______________ initiates and asssists the deltoid in the abduction of the arm, and acts with rotator cuff muscles.  It is innervated by the suprascapular nerve (C4-C6).  It initiates at the supraspinous fossa of the scapula, and inserts on the superior facet of the greater tubercle of the humerus. EXER:
87c: ANSWER: temporalis QUESTION: The _______________ elevates the mandible, closing the jaws; its posterior fibers retract the mandible after protrusion.  It is innervated by the deep temporal branches of the mandibular nerve (CN V3).  It initiates at the floor of the temporal fossa and the deep surface of the temporal fascia.  It inserts in the tip and medial surface of the coronoid process and the anterior border of the ramus of the mandible. EXER:
88c: ANSWER: thyroarytenoid QUESTION: The ____________ relaxes the vocal fold.  It is innervated by the recurrent laryngeal nerve.  It initiates in the posterior surface of the thyroid cartilage, and inserts in the muscular process of the arytenoid cartilage.  EXER: Stop talking 5 times.
89c: ANSWER: thyrohyoid QUESTION: The _________ depresses the hyoid bone and elevates the larynx.  It is innervated by the hypoglossal nerve through C1.  It initiates at the oblique line of thyroid cartilage, and inserts at the inferior border of the body and greater horn of the hyoid bone. EXER:
90c: ANSWER: transversospinalis QUESTION: The _______ extends the head and thoracic and cervical regions of the vertebral column and rotates them contralaterally.  It stabilizes the vertebrae during local movements of the vertebral column, and stabilizes the vertebrae assisting with local extension and rotary movements of the vertebral column.  It may function as organs of proprioception.  It is innervated by the posterior rami of the spinal nerves.  It has 3 transverse processes: the semispinalis arises from the transverse process of the C4-T12 vertebrae and inserts through spinous processes in the thoracis, cervicis, and catpitis, its fibers running superomedially to the occipital bone and spinous processes in thoracic and cervical regions – spanning 4-6 segments.  The multifidus arises from the sacrum and ilium, the transverse processes of T1-T3, and the articular process of C4-C7. Its fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments.  The rotatores arise from transverse processes of the vertebrae, and are most highly developed in the thoracic region.  They pass superomedially to attach to the junction of the lamina and transverse process or spinous process, of vertebra above their origin, spanning 1-2 segments.  EXER: rotate your trunk as far as you can to the right and left 5 times.
91c: ANSWER: trapezius QUESTION: The  ________ elevates, retracts, and rotates the scapula.  Its superior fibers elevate, its middle fibers retract, and its inferior fibers depress the scapula.  The superior and inferior fibers act together in the superior rotation of the scapula.  It is innervated by the spinal root of the accessory nerve (CN XI) (motor_ and cervical nerves (C3, C4) (pain and proprioception). It originates in the medial third of the superior nuchal line, and the external occipital protuberance, nuchal ligament, and spinous processes of the C7 to T12 vertebrae.  It inserts into the lateral third of the clavicle, acromion, and spine of the scapula.  EXER: Roll your shoulders in circles from front to back 5 times.
92c: ANSWER: vocalis QUESTION: The _______ relaxes the posterior vocal ligament while maintaining (or increasing) tension of the anterior part.  It is innervated by the recurrent laryngeal nerve (a branch of the vagus (CN X)).  It initiates in the vocal process of the arytenoid cartilage, and inserts into the vocal ligaments. EXER:
93c: ANSWER: gemelli QUESTION: The ___________ are two muscles (a superior and an inferior).  They laterally rotate the extended thigh and abduct the flexed thigh, keeping the femoral head steady in the acetabulum.  The superior muscle is innervated by the nerve to the obturator internus (L5, S1).  The muscle initiates at the ischial spine.  The inferior muscle is innervated by the nerve to the quadratus femoris (L5, S1).  The inferior muscle initiates in the ischial tuberosity.  Both muscles insert at the medial surface of the greater trochanter (trochanteric fossa) of the femur.  EXER: holding both legs out, point your toes away from one another, then bring them together 5 times.
94c: ANSWER: external intercostals QUESTION: The ________  __________ elevate the ribs (when the upper ribs are fixed by scalene and sternocleidomastoid muscles).  They are innervated by the nerves that bear their name.  They initiate at the inferior border of the ribs, from the tubercle to the costochondral junction, and insert at the superior border of the ribs below.  EXER: lean to the right and then to the left 5 times.
95c: ANSWER: external obliques QUESTION: The _________  ____________ compress and support the abdominal viscera.  They flex and rotate the trunk.  They are innervated by the thoracoabdominal nerves (inferior 6 thoracic nerves).  The initiate at the external surfaces of the 5th-12th ribs, and insert at the linea alba, pubic tubercle, and anterior half of the iliac crest.  EXER: holding your arms up, rotate your trunk to the right and left 5 times.

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