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