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Medicine - Year 2 > Block 12 - Musculoskeletal and nervous system (other) > Flashcards

Block 12 - Musculoskeletal and nervous system (other) Flashcards

1
Q

Define ABCDE

A

Airway, Breathing, Circulation, Disability, Exposure, Environment

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2
Q

Where is crepitus between?

A

The bone and cartilage

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3
Q

3 reasons you would repair a soft tissue injury

A

Suspected nerve or vascular damage
Reduced tendon function
Washed if heavily contaminated or in the joint cavity

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4
Q

Define a colles fracture

A

FOOSH

Bone displaced posteriorly

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5
Q

Define a smiths fracture

A

Falls onto flexed wrists

Bone displaced anteriorly

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6
Q

What fracture is a sign of abuse?

A

Spiral

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7
Q

Define comminuted fracture

A

Part of the bone breaks off

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8
Q

Another name for an undisplaced fracture

A

Oblique fracture

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9
Q

Define avulsion fracture

A

Bone displaced due to failed muscle/ligament action/tension

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10
Q

What can happen if a patient suffers from Paget’s disease or bone cysts?

A

The bone can weaken and the risk of fracture increase

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11
Q

What are the 2 types of stress fractures?

A

Repeated abnormal stresses to normal bone (e.g. marathon)

Abnormal bone subjected to normal stresses (e.g. cast taken off too early so re-fracture)

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12
Q

What are the 3 stages of open wound management?

A

Protection: Assess, Temporary dressing, IV antibiotics, Tetanus
Debridement: Wash wound in sterile theatre
Stabilisation: May be provisional

(Pretty Damn Soon)

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13
Q

Define reduction

What is the difference between open and closed reduction?

A

Surgical procedure to repair a fracture or dislocation to the correct allignment
Open = pins or cast outside
Closed = pins inside

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14
Q

What are the two types of reduction/stabilisation

A

Closed: Traction (slowly pulling back into place) or Manupulation
Open: Surgical reduction

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15
Q

How fast is the onset of rheumatoid arthritis?

A

Slow

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16
Q

What are the 4 main joints affected by rheumatoid arthritis?

A

MCP, PIP, MTP, wrists

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17
Q

Define rheumatoid arthritis

A

A chronic, symmetrical inflammatory, deforming, polyarthritis

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18
Q

What 3 things do you test for rheumatoid arthritis?

A

CRP: C-Reactive Protein
Anti-CCP: Anti-Cyclic citrullinated peptide
RF: Rheumatoid factor

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19
Q

Where does inflammation occur in rheumatoid arthritis?

A

Synovium

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20
Q

MOA of rheumatoid arthritis

A

T cell is triggered –>

  • B cell produces RF antibodies
  • Fibroblasts inhibit TGF, IL4 and IL10
  • Macrophages activate TNF and IL –> cytokines, chemokines and adhesion molecules –> cell infiltration

–> Inflammation and tissue damage

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21
Q

7 effects of chronic systemic inflammation

A

Dementia, Insulin resistance, Osteoporosis, Pain sensitisation, Increased cholesterol, Atherosclerosis, Ischaemic heart disease

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22
Q

What joints are affected with oestoarthritis? (6)

A

DIP, PIP, CMC, MTP,

Axial skeleton, Large weight bearing joints

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23
Q

9 risk factors for osteoarthritis

A

Age, Female, Family, Obesity, Increased oestrogen, Bone mineral density
Trauma, Occupation, Pre-existing abnormality

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24
Q

What age is gout most common in?

A

Older age

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25
Q

What drugs increase the risk of gout?

A

Aspirin, Diuretics, Cytotoxic drugs, Levodopa, Ethambutol, Pyrazinamide

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26
Q

How is urate produced?

A

Adenosine –> Xanthine –> Urate

by the enzyme xanthine oxidase

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27
Q

How does urate cause gout?

A

In the right conditions, urate mobilises to the joint and precipitates out forming crystals and causing inflammation

28
Q

3 causes of increased urate

A

Increased purines in the diet/being produced (e.g. cancer)

Kidney disease stops excretion

29
Q

What triggers gout attacks (7)

A

Mobilisation of gout due to changes in serum urate levels
e.g. trauma, illness, surgery that triggers the acute phase response, dehydration, acidosis, medication, rapid weight loss

30
Q

What is the main protein fibre found in bone?

A

Collagen

31
Q

What type of connective tissue is bone?

A

BONE

32
Q

2 roles of osteoclasts

A

Break down worn out bone

Increase serum calcium levels

33
Q

What happens to how well a bone heals if you break it and have osteoporosis?

A

Broken osteoporotic bones heal as normal

34
Q

Explain how osteoclasts break down bone

A

Bind to bone between 2 integrins which link to the cytoskeleton forming a sealing zone
Protons pumped into the bone casuing acidic degradation
Lysosomal enzymes break down collagen and extracellular matrix proteins
Calcium is released into the blood

35
Q

Explain how osteoclasts regulate osteoblasts

A

+ve: osteoblasts –> RANKL –> osteoclast precursors

-ve: osteoblasts –> OPG –> block RANKL

36
Q

Explain the mechanism of action of calcitonin

A

Released from the thyroid gland and reduces blood calcium levels when they increase too much

Increase osteoblast activity
Decrease intensine Ca absorption
Decrease renal calcium reabsorption

37
Q

Explain the mechanism of action of parathyroid hormone

A

Release from the parathyroid glands and increases blood calcium levels when they fall too low

Increases osteoclast activity

38
Q

How does oestrogen protect against calcium reabsorption?

A

Inhibits PTH

39
Q

Give 9 features of cushing’s syndrome

A 
Aseptic necrosis of the femoral head
Cataracts
CVD risk
Decreased wound healing
Increased intraocular pressure
Intracranial hypertension
Metabolism change (weight gain)
Osteoporosis
Pancreatitis
40
Q

Define posture

A

Orientation of a body segment relative to the gravitational vector
e.g. amount of forward lean relative to a vertical position

41
Q

Define balance

A

The dynamics of body posture to prevent falling

Related to the characteristics of the body segment and the forces acting upon it

42
Q

Define centre of mass

A

Anatomical position = abdominal area
Arms up it rises; arms to the right it moves to the right

Doesn’t have to be in the physical limits of the body

43
Q

Define centre of gravity

A

Vertical projection of the centre of mass onto the ground

44
Q

Define centre of pressure

A

Location of the body vertical ground reaction force on the floor
Standing = between feet
Standing on R leg = under R foot

45
Q

Define postural set

A

A learned response where the body establishes an anticipated response in relation to the type of pertubation which changes based on postural orientation

46
Q

Explain the stretch (myotatic) reflex

A

Muscle spindles are stretch receptors located in skeletal muscle
When they stretch, an afferent nerve sends a signal to the CNS
Motor neurones activate the agonist/antagonist to increase the movement

47
Q

Explain how the ankle postural strategy works

What surface can it be used on?

A

Shifts the CoG around the ankle joint

Surfaces with decreased resistance to shear forces

48
Q

Explain how the hip postural strategy works

What surface can it be used on?

A

Shifts the CoG around the hip joint by flexion/extension

Surfaces that have decreased resistance to torque (not on slippery surfaces)

49
Q

Explain how the stepping postural strategy works

What surface can it be used on?

A

Shifts the CoG around the hip joint by flexion and extension

Realigns BOS under new CoG with rapid steps

50
Q

What does the systems model describe?

A

How the CNS locates the body’s CoG

51
Q

What are the 4 sensory components of balance?

What do they gather information from?

A

Somatosensory: info from skin receptors (motion of body with respect to support surface)
Proprioceptive: info from muscle spindles (motion of body segments relative to each other)
Visual system: info from eyes (motion of body with respect to space)
Vestibular system: info from inner ear (head acceleration)

52
Q

How do you measure centre of pressure?

A

Using force platforms

53
Q

What moves the centre of pressure anteriorly?

What moves the centre of pressure laterally?

A

Anteriorly: Increased plantar flexor activity
Laterally: Increased invertor activity

54
Q

What is EQUITEST?

A

A clinical diagnostic tool for vestibular/somatosensory disorders
Measures the effects of a disease on the postural control

55
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

56
Q

What is the difference between somatic and visceral pain?

A

Somatic: Peripheral and localised, easy to describe
Visceral: Poorly localised and described

57
Q

Explain peripheral sensitisation

A

Tissue damage stimulates peripheral nociceptors and releases inflammatory mediators
These reduce the threshold for neuronal activation

58
Q

Explain central sensitisation

A

Release of glutamate and substance P from nociceptors target NMDA receptors in the CNS (process painful info)
Calcium influx causes phosphorylation and transcriptional changes

59
Q

Define neuroplasticity

A

Variable relationship between injury and pain response depending on experiences due to sensitisaton, reorganisation and chronic pain states

60
Q

Define allodynia

A

Pain when it is a non painful (normal) stimulus

61
Q

Define hyperalgesia

A

Little pain is very painful

62
Q

Explain what happens during central reorganisation

A

Neuronal sprouting in the dorsal spinal cord
Altered corticol sensory matrix
Established chronic pain state

63
Q

4 yellow flags for pain

A
  • Fear that the pain is harmful/severely disabling
  • Fear avoidance behaviour (avoiding activity)
  • Reduced mood and social withdrawal
  • Expectation that passive treatment (drugs) will help more than active (exercise)
64
Q

5 red flags for pain

A
  • Cancer history
  • Pain which radiates
  • Recent bacterial infection
  • Immunosupression
  • Constitutional symptoms (fever, chills, weight loss)
65
Q

Define mindfulness

A

Relaxed and non-judgemental awareness of thoughts, feelings and sensations

66
Q

Give 3 examples of CBT coping strategies

A

Pacing, relaxation, thought diversion

67
Q

5 physical therapies to help pain

A 
Exercise
Hydrotherapy
Manipulation
Acupuncture
TENS

Medicine - Year 2 (19 decks)

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