Case 1 - MSK Flashcards
1
Q
Bones of the gluteal region
A
Ischium
Pubis
Ilium
Sacrum
2
Q
Muscles of the gluteal region
A
Gluteus Maximus Gluteus medius Gluteus minimus Tensor Fasciae latae Piriformus Obturator internus Gemelli Quadratus femoris
3
Q
Arteries of the gluteal region
A
Inf/Sup gluteal artery
4
Q
What does the superior gluteal artery supply
A
superficial: Gluteus max.
Deep: Gluteus med, min & tensor fasciae latae
5
Q
What does the inferior gluteal artery supply
A
Gluteus max, obturator internus, quadratus femoris
6
Q
What innervates the gluteus maximus
A
inferior gluteus nerve
7
Q
What innervates the gluteus med, min & tensor fasciae latae
A
superior gluteus nerve
8
Q
Bones of the thigh
A
Femur
9
Q
Muscles of the anterior thigh
A
Pectineus Sartorius Psoas major Iliacus Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermediatis)
10
Q
Muscles of the medial thigh
A
Adductor longus Adductor brevis Adductor magnus Gracilis Obturator externus
11
Q
Muscles of the posterior thigh
A
Semitendinosus
Semimembranosus
Biceps femoris (long & short)
12
Q
Arteries of the thigh
A
deep femoral artery
13
Q
What innervates: Adductor longus Adductor brevis Adductor magnus Gracilis Obturator externus
A
Obturator nerve
14
Q
What innervates: Iliacus Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermediatis) Pectineus Sartorius
A
Femoral nerve
15
Q
What innervates:
Semitendinosus
Semimembranosus
and the long head of biceps femoris
A
Sciatic nerve
16
Q
What innervates the short head of biceps femoris
A
Common fibular (sciatic)
17
Q
Bones of the leg
A
Tibia
Fibula
18
Q
Muscles of the anterior leg
A
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
19
Q
Muscles of the lateral leg
A
Fibularis longus
Fibularis brevis
20
Q
Muscles of the posterior leg
A
Deep: Popliteus Flexor digitorum longus Flexor hallucis longus Tibialis posterior Superficial: Soleus Gastrocnemius plantaris
21
Q
What innervates: Popliteus Flexor digitorum longus Flexor hallucis longus Tibialis posterior Soleus Gastrocnemius plantaris Fibularis longus Fibularis brevis
A
Tibial nerve
22
Q
What innervates: Tibialis anterior Extensor hallucis longus Extensor digitorum longus Fibularis tertius
A
Fibular nerve
23
Q
What artery supplies the superior posterior compartment of the leg
A
Popliteal artery
24
Q
What artery supplies the anterior compartment of the leg
A
anterior tibial artery
25
What artery supplies the posterior and lateral compartments of the leg
Posterior tibial artery
26
What artery supplies the posterior compartment of the leg
Fibular artery
27
What are the bones of the foot
```
Calcaneus
Talus
Navicular
Cuboid
Cuneiforms
Metatarsels
Phelanges
```
28
What is the blood supply to the foot
dorsalis pedis
29
What muscles make up the first layer of muscles (most superficial) in the foot
Abductor hallucis
Flexor digitorum brevis
Abductor minimi
30
What muscles make up the second layer of muscles in the foot
Quadratus plantae
| Lumbricals
31
What muscles make up the third layer in the foot
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
32
What muscles make up the fourth layer (most deep) in the foot
Plantar interossei
| Dorsal interossei
33
```
What innervates the:
Abductor hallucis
Flexor digitorum brevis
Flexor hallucis brevis
Lumbricals
```
medial plantar nerve
34
```
What innervates the:
Abductor minimi
Quadratus plantae
Adductor hallucis
Flexor digiti minimi brevis
Plantar interossei
Dorsal interossei
Lumbricals
```
lateral plantar nerve
35
How can you damage your ACL
hyperextending knee joint
36
How can you damage your PCL
force on tibia when knee is flexed
37
What are the knee's meniscae made of
fibrocartilage
38
What type of cartilage lines the knee joint
hyaline
39
What are the four knee ligaments called
Anterior cruciate
Posterior cruciate
Medial collateral
lateral collateral
40
Mechanism of action of ibuprofen
COX inhibitor which inhibits the production of prostaglandins.
41
Side effects of ibuprofen
Reduced stomach protection
Impaired blood clotting
Potential to causes bronchoconstriction
42
Mechanism of action of codeine
Binds to opioid receptors in the brain, increasing patient's tolerance for pain
43
Mechanism of action of morphine
Prevents neurotransmitter release stopping pain being registered
44
5 signs of inflammation
```
redness
pain
heat
loss of function
swelling
```
45
Describe von Willebrand disease
Clotting disease affecting primary haemostasis. 3 types: type 1-least severe, type 3-most severe
46
Describe haemophilia and each type
Clotting impairment caused by decrease presence of clotting factors.
Type A - 8
Type B - 9
Type C - 11
47
What indicates haemophilia
increased APPT
| All three types act on intrinsic pathway
48
What are the intrinsic blood factors
9, 11 and 12
49
What are the extrinsic blood factors
7 and tissue factor
50
What are the common blood factors
10
2
1
51
What is the main difference between anticoagulants and antiplatelets
Anticoagulants work on secondary haemostasis
| antiplatelets work on primary
52
What do alpha delta nerve fibres do
Detect initial sharp pain
53
What do C nerve fibres do
throbbing/burning pain
54
What do alpha beta nerve fibres do in disease
detects non-noxious stimuli but in chronic pain, it misfires and detects normal stimuli as painful
55
Scanning methods that are radioactive
CT
XRAY
PET
56
Scanning methods that are not radioactive
Ultrasound
| MRI
57
Types of fractures
```
Linear
Comminuted
Transverse
Pathological
Greenstick
Spiral
Oblique - displaced
Oblique - non-displaced
```
58
What neurotransmitter is the most common in excitory neurones
glutamate
59
What neurotransmitter is released when high levels of pain is detected
substance p
60
What is the spinothalamic tract for
pain, temp, simple touch
61
What is the dorsal column for
discriminative touch, proprioception, vibration
62
What does naloxone do
Counters the activity of opiates, given to people have overdosed on heroin
63
How can a nociceptor be chronically stimulated
Substance p builds up in dorsal horn and causes neuronal responsiveness to increase, making light stimulus more painful
64
What is the gate theory of pain
Pain signals can be blocked by a neuronal gate before reaching CNS with inhibitory neurones
65
How can pain be controlled by the body
Serotonin neurones descend to block a painful stimulus' access to the CNS
66
What is cutaneous pain
Pain originating from the skin
67
What is somatic pain
pain within the body (muscle, tendon etc...) usually caused by injury
68
What is visceral pain
autonomic sensation from visceral organs (often referred)
69
What is referred pain
Pain from organs often perceived to be on the skin, pain is felt away from the site of injury
70
How can pain have a psychological origin
Pain can be felt due to stress, particularly in the lower back
71
How can dislocations be observed in the lower limb
Internally rotated flexed leg
72
How can fractures be observed in the lower limb
Externally rotated leg
73
What increases hip stability
acetabular labrum
thick joint capsule
3x strong extraarticular ligaments
1x intraarticular ligaments
74
Types of hip fracture
Intracapsular - inside acetabulum
| Extracapsular - outside acetabulum
75
3 stages of wound healing
Phagocytosis and removal of infection
Angiogenesis, fibroblast proliferation, collagen synthesis
Epithelialisation, remodelling and apoptosis
76
Give an example of where inflammation can occur without infection
sunburn
77
Innate immune cells
```
Macrophages
Mast cells
Eosinophils
Basophils
Complement
Natural killer cells
Neutrophils
```
78
Adaptive immune cells
t cells
t killer cells
help t cells
b cells - antibodies
79
What does TNF alpha do
Makes endothelium more leaky
Increases body temp
Mobilises glycogen
Increases compliment activity
80
Name the types of nociceptive pain
somatic
| visceral
81
Name the types non-nociceptive pain
Neuropathic
| Sympathetic
82
What are the four phases of nociception
Transduction
Transmission
Perception
Modulation
83
Role of the medial thalamic nucleus
Evaluates aspect of pain. Activates anterior cingulate cortex which is responsible for the emotional and cognitive response
84
Role of the lateral thalamic nucleus
Mediates sensory, discriminative aspects of pain
85
What is it called when scar tissue forms around a foreign body
Granuloma
86
Symptoms of compartment syndrome and treatment
Symptoms: Severe pain, poor pulse, decreased movement, numbness, pale colour
Treatment: fasciotomy
87
How does osteoarthritis present on an xray
sclerosis - whiteness at joints
Osteophytes - bony protrusions
Joint space narrowing - narrow joints
88
How does rheumatoid arthritis present on an xray
```
Proximal and bilaterally symmetrical
Soft tissue swellings
Osteoporosis - less white on xray
Joint space narrowing
Marginal erosions
```
89
Stages of natural bone healing
```
haematoma
Inflammation
Granulation
Callus
Consolidation
Remodelling
```
90
Types of osteoporosis and their characteristics
Primary - age-related, postmenopausal
| Secondary - drug related, co morbidities
91
How can you diagnose osteoporosis
DEXA scan with a score of less than -2.5
92
Risk factors for osteoporosis
```
female
over 50
post menopausal
early menopause
no children
```
93
What is the required DEXA score for osteopaenia
-1 - -2.5
94
What does raised ALT suggest
hepatocellular damage
95
What does raised AST suggest
possible hepatocellular damage
96
What does raised ALP and GGT suggest
cholestasis - bile flow impeded
97
What does raised ALP suggest
Bone problems eg, primary/secondary bone cancer, multiple fractures, low vit D
98
What does raised GGT mean
Possible drugs/alcohol
99
Presentation and possible cause for pre-hepatic damage
Raised unconjugated bilirubin, normal urine and stool
Diagnosis - gilberts
100
Presentation and possible cause for hepatic damage
Raised conjugated bilirubin, dark urine, normal stools
Hepatocellular injury
101
Presentation and possible cause for post-hepatic damage
Raised conjugated bilirubin, dark urine, pale stools
Cholestasis
102
What does low albumin/clotting factors indicate
Impaired synthetic function, late presentation liver damage or significant paracetamol overdose
