Anatomy and Revision Flashcards
what is a syndemoses
fibrous joint that unites bones with fibrous sheet fibrous membranes
what are fontanelles
wide sutures in the neonatal skull
what are synchondroses
primary cartilaginous joints joined by hyaline cartilage
what are the articular surfaces in synovial joints convered in
hyaline cartilage
what are the 5 types of synovial joints
pivot, ball and socket, plane, hinge, biaxial
least the joint types from least stable and most motile to most stable and least motile
synovial- cartilaginous- fibrous
what is a subluxation
reduced area of contact between articular surfaces
what is endochondral ossification
process in which hyaline cartilage grows and ossifies into bones
list the components of bones from top downwards
epiphysis epiphyseal growth plate metaphysis diaphysis metaphysis epiphyseal growth plate epiphysis
describe the structure of bones
outer cortex surrounding inner medulla (spongy and may contain bone marrow)
what is the periosteum
fibrous connective tissue ‘sleeve: that is well vascularised and innervated
where do the superficial lymphatic of the lower limb follow and drain to
follow saphenous veins, drain to superficial inguinal lymph nodes then external iliac lymph nodes
what is the path of the deep lymphatics of the lower limb
follow deep veins
popliteal lymph nodes
deep inguinal lymph nodes
external iliac lymph nodes
how does lymph travel from external to common iliac nodes
lumbar lymphatics
what does the femoral nerve innervate and what are its nerve root levels
L2,3,4 quadriceps femoris sartorius iliacus pectineus
what does the tibial part of the sciatic nerve innervate and what are its nerve root levels
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
via what does the tibial part of the sciatic nerve innervate the intrinsic muscles of the sole of the foot
medial and lateral plantar branches
what does the obturator nerve innervate and what are its nerve root levels
L2,3,4
all of the medial compartment of the thigh
all abductors (except hamstring part of magnus) and gracilis
what does the common fibular part of sciatic nerve innervate and what are its nerve root levels
L4-S2
short head of biceps femoris
what does the superficial fibular branch of the common fibular nerve innervate
muscles of the lateral compartment of the leg;
- fibularis longus
- brevis
what does the deep fibular branch of the common fibular nerve innervate
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
what type of joint is the acromoclavicular
plane types
what type of joint is the glenohumeral
ball and socket
what type of joint is the elbow (humeroulnar and radiohumeral)
hinge
what type of joint is the proximal radioulnar joint
pivot
what type of joint is the radiocarpal
ellipsoid
what type of joint is the sternoclavicular
saddle
what limits the movement of the radiohumeral joints
is a ball and socket limited by the annular ligament
what is the only bone attachment of the upper limb to the axial skeleton
sternoclavicular joint
what happens to the bones in the forearm during pronation
radius moves over the ulna which remains still
what allows the pivot of the forearm during supination and pronation
annular ligament
what degree of rotation does the thumb have
90 degrees
what type of joint is the 1st CMC joint
saddle type
what type of joint is the 5th MCP
condyloid
describe a saddle joint
movement is almost all direction, more stable than a ball and socket
what movement is extension of the thumb
thumbs up
what movement is flexion of the thumb
back towards the fingers
what movement is abduction of the thumb
palm flat facing ceiling, thumb up to ceiling
what forms the carpal tunnel
flexor retinaculum, carpals
what is the deep fascia of the arm
brachial fascia
what is the deep fascia of the forearm
antebrachial fascia
what is the deep fascia of the leg
crural fascia
what is the deep fascia of the foot
plantar fascia
what is another name of the common fibular nerve
common peroneal
what nerve commonly causes foot frop
deep fibular
if lateral compartment involvement aswell think common fibular
ho can you increase bone mass
weight bearing exercise
body mass
where does the tensor fascia lata run between
ASIS and lateral thickening of IT band
what is the fascia lata
a fibrous sheath
what other conditions is sjogrens associated with
RA and lupus
what type of arthritis never affects the DIPs
RA
what is AAV
ANCA associated vasculitis
why in sjogrens in PV and ESR much higher than CRP
as increased immunoglobulins thicken the blood
why do patients with psoriasis or on chemo have increased risk of gout
as they have increased cell turnover
what is undifferentiated CTD
some features of CTD with some positive antibodies without specific CTD antibodies
why is the lateral collateral ligament smaller than the medial
as lateral side also has IT band crossing the knee (and hip) joint
where do the obturator and femoral nerves both originate from
L2,3,4 in lumbar spinal plexus
how do you check for a torn posterior cruciate ligament
look for posterior sag, then do posterior drawer
what should you do instead of the anterior drawer test to test ACL
lachmans
where should your thumb be in lachmans
tibial tuberosity
where will hip pain not go
below knee
what do the pedicles connect
the vertebral bodies to the transverse processes
what forms the intervertebral foramen
anteriorly by the posterior vertebral bodies and disc
superiorly and inferiorly by the pedicles
posteriorly by the articular processes
what is the conus medullaris
tapered end of the spinal chord
why is there a C8 nerve but not a C8 disc
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
what is the difference in symptoms between polymyositis and polymyalgia rheumatica
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
what is drug induced lupus
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
why can septic arthritis lead to osteoarthritis
as puss chondrotoxic
what is a sesamoid bone
bone within a tendon
what makes up the intervertebral disc
collagen- types 1 and 2
where is hip pain usually felt
groin, can refer down leg
what hip pain should you worry about
pain at night
what are common causes of hip pain
osteoarthritis, RA, arthritides, fracture, referred from back, malignancy
what are the rare causes of hip pain
soft tissue (trochanteric bursitis), pagets disease, infection, AVN
what is the non pharmacological management for OA
education, exercise, weight loss, appropriate foot wear, physio
what is osgood-schlatters
inflammation of the patellar ligament at the tibial tuberosity
what happens if a hip replacement gets an infection 3 months after THR
hip taken out, no hip for 6 months
what material are uncemented cups
plastic
why are holes drilled in to the bone
for cement
what is the aim of an uncemented stem/ cup in a THR
bony ingrowth
in who is an uncemented implant better
younger patients, easier to remove in revision surgery, less bone loss
what are cons of cemented and uncemented
uncemented stem risk of spliting bone
can get inflammatory reaction to cement
what should you say after examining a joint in an exam
that you would get the contralateral side, for neurological symptoms and the joint above and below
what material is a hip replacement
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
what materials for a knee replacement
always metal and plastic
what will a knee replacement help resolve
pain but not stiffness
what ELSE can cause a locked knee
torn acl or effusion
what is a good way of testing if knee truely locked
heel height
what is hanging rope sign seen in
perthes
what is the treatment for an adult with DDH
osteotomy of THR
what is hip FADIR painful in
hip impingement
why is DDH more common in girls
also receptive to relaxin produced my mother during labour
what is a condyloid joint
oviod shaped articular surface- allows flexion, extension, adduction, abduction and circumduction
what joints in the hand are condyloid
MCP
what epicondylitis is golfers/ tennis elbow
tennis lateral
golf medial
how do you tell whether an elbow dislocation is anterior or posterior
proximal bone is always fixed- distal bone goes anterior or posterior
what type of collagen is dupuytrens
type 3
what is a bennetts fracture
fracture of base of first metacarpal bone with (usually dorsal) subluxation)
what is the principle clinical sign of adhesive capsulitis
loss of external rotation
does smoking increase risk of dupuytrens
no
what mode of delivery of antibiotics for septic arthritis
IV
is staph aureus found in the gut
no
is clostridium perfinigens in wounds significant
YES ALWAYS SIGNIFICANT
what type of haemolysis is partial
alpha (goes green)
where is clostridium perfinigens normally and how could it get into a wound
bowels of humans and animals
faecal matter in soil where injury occurred
how do you diagnose osteomyelitis
bone biopsy
why are tetanus blood tests negative
as bacteria stick locally to injury
what toxin causes tetanus
tetanospasmin (exotoxin)- spreads via blood and lymph, binds irreversibly to neurones, prevents inhibitory motor reflex responses
what is the treatment for tetanus
IV tetanus immunoglobulins (anti toxin)
IV penicillin
debridement of injury
benzodiazepine to prevent spasms
when do you usually get you tenanus vaccination and how many are there
2-4 months
5 vaccines
what would you worry about if a patients gets bitten by a dog in india
rabies
is taking aspirin/ inbruprofen/ NSAIDs significant in NF
yes- suggested association, can also mask initially inflammatory response so presents worse
why in NF caused by strep pyogenes is both benzylpenicillin and clindamycin prescribed
benzylpenicillin- targets bacteria itself
clindamycin- targets toxin produced by bacteria
what is the incidence of brachial plexis injury during vaginal delivery
0.2%
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.
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
what deformity in boxers fractures is not well tolerated and needs manipulation and possibly fixation
rotational deformity
describe a mallet finger
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
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)
common peroneal nerve
nerve often injured in Posterior dislocation of the hip
sciatic nerve
nerve often injured in Supracondylar fracture of the distal humerus
median nerve
Which types of Salter-Harris fractures are intra-articular?
III and IV
what does secondary bone healing involve
an inflammatory response with recruitment of pluropotential stem cells which differentiate into different cells during the healing process
what GCS score suggest loss of airway control
8 or less
define axonotmesis
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.
what is neurotmesis
A complete transection of a nerve requiring surgical repair for any chance of recovery of function
what is neurapraxia
A temporary conduction defect from compression or stretch and resolve over time with full recovery
what are the two o’s or sjorgens
occular and oral
how do you remember sjorgens antibodies
anti ro - row in sjorgens get dry symptoms, row to LAnd, la antibodies
what condition causes gottrons papules
dermatomyositis
do you get neuro symptoms in mechanical backpain
no
what type pain in spinal stenosis
burning
what type of pain is claudication
cramping
what is the classical appearance of aneurysmal bone cyst
lots of chambers
what is the 2nd most common malignant bone tumour
chondrosarcoma
do osteosarcomas respond to chemo
no but combining chemo and radiotherapy can help improve survival
who gets mortons neuromas
women 40-50s
predisposed by wearing heels
what are the symptoms of mortons neuroma
burning and tingling between 3rd and 4th toes
what happens in mortons neuroma
fibrosis of the nerve
what are the signs of an ACL injury
twisting, high energy, ‘pop’, swells, painful but initially gets better
what are the signs of a meniscal tear
pain along the joint line, locking
what lifestyle choices increase chance of AVN in the hip
smoking and drinking
what bug probably caused the septic arthritis and osteomyelitis
STAPH AUREUS
what bug causes septic arthritis in sickle cell anaemia
salmonella
how can you differentiate initially between septic arthritis and osteomyelitis
septic arthritis- (infection of the synovium) hurts to move
osteomyelitis- hurts all the time
what line to intracapsular fractures disrupt
shentons line
when are IM nails used
if a shaft of a bone is fractured (subtrochanteric)
why is there sparing of PIP in RA
not enough synovial fluid
