Anatomy and Revision Flashcards

1
Q

what is a syndemoses

A

fibrous joint that unites bones with fibrous sheet fibrous membranes

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2
Q

what are fontanelles

A

wide sutures in the neonatal skull

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3
Q

what are synchondroses

A

primary cartilaginous joints joined by hyaline cartilage

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4
Q

what are the articular surfaces in synovial joints convered in

A

hyaline cartilage

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5
Q

what are the 5 types of synovial joints

A

pivot, ball and socket, plane, hinge, biaxial

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6
Q

least the joint types from least stable and most motile to most stable and least motile

A

synovial- cartilaginous- fibrous

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7
Q

what is a subluxation

A

reduced area of contact between articular surfaces

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8
Q

what is endochondral ossification

A

process in which hyaline cartilage grows and ossifies into bones

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9
Q

list the components of bones from top downwards

A
epiphysis 
epiphyseal growth plate
metaphysis 
diaphysis 
metaphysis 
epiphyseal growth plate 
epiphysis
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10
Q

describe the structure of bones

A

outer cortex surrounding inner medulla (spongy and may contain bone marrow)

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11
Q

what is the periosteum

A

fibrous connective tissue ‘sleeve: that is well vascularised and innervated

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12
Q

where do the superficial lymphatic of the lower limb follow and drain to

A

follow saphenous veins, drain to superficial inguinal lymph nodes then external iliac lymph nodes

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13
Q

what is the path of the deep lymphatics of the lower limb

A

follow deep veins
popliteal lymph nodes
deep inguinal lymph nodes
external iliac lymph nodes

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14
Q

how does lymph travel from external to common iliac nodes

A

lumbar lymphatics

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15
Q

what does the femoral nerve innervate and what are its nerve root levels

A
L2,3,4
quadriceps femoris 
sartorius 
iliacus 
pectineus
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16
Q

what does the tibial part of the sciatic nerve innervate and what are its nerve root levels

A

L4-S3

posterior leg

  • true hamstrings: semimembranous, semitendinosus, long head of biceps femoris
  • gastrocneumius
  • soleus
  • plantaris
  • popliteus
  • tibialis posterior

muscles of sole of the foot

  • flexores of digits (digitorum and hallucus longus)
  • all intrinsic muscles of the sole of the foot
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17
Q

via what does the tibial part of the sciatic nerve innervate the intrinsic muscles of the sole of the foot

A

medial and lateral plantar branches

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18
Q

what does the obturator nerve innervate and what are its nerve root levels

A

L2,3,4
all of the medial compartment of the thigh
all abductors (except hamstring part of magnus) and gracilis

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19
Q

what does the common fibular part of sciatic nerve innervate and what are its nerve root levels

A

L4-S2

short head of biceps femoris

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20
Q

what does the superficial fibular branch of the common fibular nerve innervate

A

muscles of the lateral compartment of the leg;

  • fibularis longus
  • brevis
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21
Q

what does the deep fibular branch of the common fibular nerve innervate

A

muscles of the anterior compartment of the leg
-fibularis longus and brevis

muscles of the dorsum of the foot

  • extensor digitorum brevis
  • extensor hallucis brevis
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22
Q

what type of joint is the acromoclavicular

A

plane types

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23
Q

what type of joint is the glenohumeral

A

ball and socket

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24
Q

what type of joint is the elbow (humeroulnar and radiohumeral)

A

hinge

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25
Q

what type of joint is the proximal radioulnar joint

A

pivot

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26
Q

what type of joint is the radiocarpal

A

ellipsoid

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27
Q

what type of joint is the sternoclavicular

A

saddle

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28
Q

what limits the movement of the radiohumeral joints

A

is a ball and socket limited by the annular ligament

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29
Q

what is the only bone attachment of the upper limb to the axial skeleton

A

sternoclavicular joint

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30
Q

what happens to the bones in the forearm during pronation

A

radius moves over the ulna which remains still

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31
Q

what allows the pivot of the forearm during supination and pronation

A

annular ligament

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32
Q

what degree of rotation does the thumb have

A

90 degrees

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33
Q

what type of joint is the 1st CMC joint

A

saddle type

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34
Q

what type of joint is the 5th MCP

A

condyloid

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35
Q

describe a saddle joint

A

movement is almost all direction, more stable than a ball and socket

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36
Q

what movement is extension of the thumb

A

thumbs up

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37
Q

what movement is flexion of the thumb

A

back towards the fingers

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38
Q

what movement is abduction of the thumb

A

palm flat facing ceiling, thumb up to ceiling

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39
Q

what forms the carpal tunnel

A

flexor retinaculum, carpals

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40
Q

what is the deep fascia of the arm

A

brachial fascia

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41
Q

what is the deep fascia of the forearm

A

antebrachial fascia

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42
Q

what is the deep fascia of the leg

A

crural fascia

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43
Q

what is the deep fascia of the foot

A

plantar fascia

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44
Q

what is another name of the common fibular nerve

A

common peroneal

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45
Q

what nerve commonly causes foot frop

A

deep fibular

if lateral compartment involvement aswell think common fibular

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46
Q

ho can you increase bone mass

A

weight bearing exercise

body mass

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47
Q

where does the tensor fascia lata run between

A

ASIS and lateral thickening of IT band

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48
Q

what is the fascia lata

A

a fibrous sheath

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49
Q

what other conditions is sjogrens associated with

A

RA and lupus

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50
Q

what type of arthritis never affects the DIPs

A

RA

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51
Q

what is AAV

A

ANCA associated vasculitis

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52
Q

why in sjogrens in PV and ESR much higher than CRP

A

as increased immunoglobulins thicken the blood

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53
Q

why do patients with psoriasis or on chemo have increased risk of gout

A

as they have increased cell turnover

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54
Q

what is undifferentiated CTD

A

some features of CTD with some positive antibodies without specific CTD antibodies

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55
Q

why is the lateral collateral ligament smaller than the medial

A

as lateral side also has IT band crossing the knee (and hip) joint

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56
Q

where do the obturator and femoral nerves both originate from

A

L2,3,4 in lumbar spinal plexus

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57
Q

how do you check for a torn posterior cruciate ligament

A

look for posterior sag, then do posterior drawer

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58
Q

what should you do instead of the anterior drawer test to test ACL

A

lachmans

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59
Q

where should your thumb be in lachmans

A

tibial tuberosity

60
Q

where will hip pain not go

A

below knee

61
Q

what do the pedicles connect

A

the vertebral bodies to the transverse processes

62
Q

what forms the intervertebral foramen

A

anteriorly by the posterior vertebral bodies and disc

superiorly and inferiorly by the pedicles

posteriorly by the articular processes

63
Q

what is the conus medullaris

A

tapered end of the spinal chord

64
Q

why is there a C8 nerve but not a C8 disc

A

In cervical spine nerve come out above the disc, from thoracic spine down the associated nerve come below the disc- creates a gap at C8

65
Q

what is the difference in symptoms between polymyositis and polymyalgia rheumatica

A

PMR- pain and stiffness, in morning last for few hours, fine after lunchtime. No weakness

Polymyositis- weakness, persists throughout the day. Multisystem disease, may have other symptoms

66
Q

what is drug induced lupus

A

development of 1 clinical feature of lupus and +ve ANA in a patient who didnt have this diagnosis before taking a drug

symptoms usually fever, myalgia, skin rashes

67
Q

why can septic arthritis lead to osteoarthritis

A

as puss chondrotoxic

68
Q

what is a sesamoid bone

A

bone within a tendon

69
Q

what makes up the intervertebral disc

A

collagen- types 1 and 2

70
Q

where is hip pain usually felt

A

groin, can refer down leg

71
Q

what hip pain should you worry about

A

pain at night

72
Q

what are common causes of hip pain

A

osteoarthritis, RA, arthritides, fracture, referred from back, malignancy

73
Q

what are the rare causes of hip pain

A

soft tissue (trochanteric bursitis), pagets disease, infection, AVN

74
Q

what is the non pharmacological management for OA

A

education, exercise, weight loss, appropriate foot wear, physio

75
Q

what is osgood-schlatters

A

inflammation of the patellar ligament at the tibial tuberosity

76
Q

what happens if a hip replacement gets an infection 3 months after THR

A

hip taken out, no hip for 6 months

77
Q

what material are uncemented cups

A

plastic

78
Q

why are holes drilled in to the bone

A

for cement

79
Q

what is the aim of an uncemented stem/ cup in a THR

A

bony ingrowth

80
Q

in who is an uncemented implant better

A

younger patients, easier to remove in revision surgery, less bone loss

81
Q

what are cons of cemented and uncemented

A

uncemented stem risk of spliting bone

can get inflammatory reaction to cement

82
Q

what should you say after examining a joint in an exam

A

that you would get the contralateral side, for neurological symptoms and the joint above and below

83
Q

what material is a hip replacement

A

can be metal on metal- resurfacing, risk of ions released when worn down which cause inflammatory response and bone lysis

can be metal on plastic

84
Q

what materials for a knee replacement

A

always metal and plastic

85
Q

what will a knee replacement help resolve

A

pain but not stiffness

86
Q

what ELSE can cause a locked knee

A

torn acl or effusion

87
Q

what is a good way of testing if knee truely locked

A

heel height

88
Q

what is hanging rope sign seen in

A

perthes

89
Q

what is the treatment for an adult with DDH

A

osteotomy of THR

90
Q

what is hip FADIR painful in

A

hip impingement

91
Q

why is DDH more common in girls

A

also receptive to relaxin produced my mother during labour

92
Q

what is a condyloid joint

A

oviod shaped articular surface- allows flexion, extension, adduction, abduction and circumduction

93
Q

what joints in the hand are condyloid

A

MCP

94
Q

what epicondylitis is golfers/ tennis elbow

A

tennis lateral

golf medial

95
Q

how do you tell whether an elbow dislocation is anterior or posterior

A

proximal bone is always fixed- distal bone goes anterior or posterior

96
Q

what type of collagen is dupuytrens

A

type 3

97
Q

what is a bennetts fracture

A

fracture of base of first metacarpal bone with (usually dorsal) subluxation)

98
Q

what is the principle clinical sign of adhesive capsulitis

A

loss of external rotation

99
Q

does smoking increase risk of dupuytrens

A

no

100
Q

what mode of delivery of antibiotics for septic arthritis

A

IV

101
Q

is staph aureus found in the gut

A

no

102
Q

is clostridium perfinigens in wounds significant

A

YES ALWAYS SIGNIFICANT

103
Q

what type of haemolysis is partial

A

alpha (goes green)

104
Q

where is clostridium perfinigens normally and how could it get into a wound

A

bowels of humans and animals

faecal matter in soil where injury occurred

105
Q

how do you diagnose osteomyelitis

A

bone biopsy

106
Q

why are tetanus blood tests negative

A

as bacteria stick locally to injury

107
Q

what toxin causes tetanus

A

tetanospasmin (exotoxin)- spreads via blood and lymph, binds irreversibly to neurones, prevents inhibitory motor reflex responses

108
Q

what is the treatment for tetanus

A

IV tetanus immunoglobulins (anti toxin)
IV penicillin
debridement of injury
benzodiazepine to prevent spasms

109
Q

when do you usually get you tenanus vaccination and how many are there

A

2-4 months

5 vaccines

110
Q

what would you worry about if a patients gets bitten by a dog in india

A

rabies

111
Q

is taking aspirin/ inbruprofen/ NSAIDs significant in NF

A

yes- suggested association, can also mask initially inflammatory response so presents worse

112
Q

why in NF caused by strep pyogenes is both benzylpenicillin and clindamycin prescribed

A

benzylpenicillin- targets bacteria itself

clindamycin- targets toxin produced by bacteria

113
Q

what is the incidence of brachial plexis injury during vaginal delivery

A

0.2%

114
Q

True or false: It is common for surgery for hip fractures to be avoided due to the significant co-morbidities often present in this patient population.

A

false - Despite the risk of medical complications with surgery, nearly all patients with a hip fracture undergo surgery as the risks of non‐operative management are just as high

115
Q

what deformity in boxers fractures is not well tolerated and needs manipulation and possibly fixation

A

rotational deformity

116
Q

describe a mallet finger

A

an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of the extended DIPJ
The patient presents with pain, a drooped DIPJ of the affected finger and inability to extend at the DIPJ

117
Q

nerve often injured in Blow to the lateral aspect of the knee (described as a “Bumper injury” when a pedestrian is struck by a car)

A

common peroneal nerve

118
Q

nerve often injured in Posterior dislocation of the hip

A

sciatic nerve

119
Q

nerve often injured in Supracondylar fracture of the distal humerus

A

median nerve

120
Q

Which types of Salter-Harris fractures are intra-articular?

A

III and IV

121
Q

what does secondary bone healing involve

A

an inflammatory response with recruitment of pluropotential stem cells which differentiate into different cells during the healing process

122
Q

what GCS score suggest loss of airway control

A

8 or less

123
Q

define axonotmesis

A

Nerve injury sustained due to compression or stretch or from a higher degree of force with death of the long nerve cell axons distal to the point of injury die.

124
Q

what is neurotmesis

A

A complete transection of a nerve requiring surgical repair for any chance of recovery of function

125
Q

what is neurapraxia

A

A temporary conduction defect from compression or stretch and resolve over time with full recovery

126
Q

what are the two o’s or sjorgens

A

occular and oral

127
Q

how do you remember sjorgens antibodies

A

anti ro - row in sjorgens get dry symptoms, row to LAnd, la antibodies

128
Q

what condition causes gottrons papules

A

dermatomyositis

129
Q

do you get neuro symptoms in mechanical backpain

A

no

130
Q

what type pain in spinal stenosis

A

burning

131
Q

what type of pain is claudication

A

cramping

132
Q

what is the classical appearance of aneurysmal bone cyst

A

lots of chambers

133
Q

what is the 2nd most common malignant bone tumour

A

chondrosarcoma

134
Q

do osteosarcomas respond to chemo

A

no but combining chemo and radiotherapy can help improve survival

135
Q

who gets mortons neuromas

A

women 40-50s

predisposed by wearing heels

136
Q

what are the symptoms of mortons neuroma

A

burning and tingling between 3rd and 4th toes

137
Q

what happens in mortons neuroma

A

fibrosis of the nerve

138
Q

what are the signs of an ACL injury

A

twisting, high energy, ‘pop’, swells, painful but initially gets better

139
Q

what are the signs of a meniscal tear

A

pain along the joint line, locking

140
Q

what lifestyle choices increase chance of AVN in the hip

A

smoking and drinking

141
Q

what bug probably caused the septic arthritis and osteomyelitis

A

STAPH AUREUS

142
Q

what bug causes septic arthritis in sickle cell anaemia

A

salmonella

143
Q

how can you differentiate initially between septic arthritis and osteomyelitis

A

septic arthritis- (infection of the synovium) hurts to move

osteomyelitis- hurts all the time

144
Q

what line to intracapsular fractures disrupt

A

shentons line

145
Q

when are IM nails used

A

if a shaft of a bone is fractured (subtrochanteric)

146
Q

why is there sparing of PIP in RA

A

not enough synovial fluid