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Year 2 > Case 14 > Flashcards

Case 14 Flashcards

1
Q

Distinguishing features of cervical vertebrae

A

Bifid spinous process
Transverse foramina
Triangular vertebral foramen

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2
Q

Transverse foramina conduct the…

A

Vertebral arteries

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3
Q

How is C7 different from other cervical vertebrae?

A

Longer spinous processes

Spinous process is not bifid

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4
Q

Inferior demifacet of thoracic vertebra articulates with…

A

Head of rib inferior to it

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5
Q

Superior demifacet of thoracic vertebra articulates with…

A

Head of its respective rib

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6
Q

Costal facets of thoracic vertebrae articulate with…

A

Tubercle of their respective rib

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7
Q

Distinguishing features of thoracic vertebrae

A

Demifacets on superior and inferior lateral surface of vertebral body

Costal facets on transverse processes
Long spinous process slanted inferiorly

Circular foramen

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8
Q

How many cervical vertebrae are there?

A

7

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9
Q

How many thoracic vertebrae are there?

A

12

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10
Q

How many lumbar vertebrae are there?

A

5

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11
Q

Distinguishing features of lumbar vertebrae

A

Very large

Kidney shaped body

Triangular foramen

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12
Q

How many sacral vertebrae are there?

A

4

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13
Q

How many bones make up the coccyx?

A

5

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14
Q

Coccyx articulates with…

A

Apex of sacrum

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15
Q

How many articulations does each vertebrae have?

A

5

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16
Q

Vertebral articular surfaces are covered with…

A

Hyaline Cartilage

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17
Q

Cartilage which makes up the intervertebral disc

A

Fibrocartilage

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18
Q

Anterior Longitudinal Ligament is (Thick/Thin) and prevents (Hyperextension/flexion)

A

Thick

Hyperextension

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19
Q

Posterior Longitudinal Ligament is (Thick/Thin) and prevents (Hyperextension/flexion)

A

Thin (weaker)

Hyperflexion

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20
Q

Ligamentum Flavum connects

A

Lamina to Lamina

Located on inner surface of vertebral foramen

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21
Q

Interspinous ligaments connect…

A

Spinous processes, attaching between ligaments

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22
Q

Supraspinous ligaments connect…

A

Spinous processes, attaching to the tips

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23
Q

Intertransverse ligaments connect…

A

Transverse processes

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24
Q

Facet joints in the spine are strengthened by…

A

Ligamentum flavum
Interspinous ligaments
Supraspinous ligaments
Interspinous ligaments

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25
Q

Primary curvatures of the spine

A

Those that develop in utero

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26
Q

Secondary curvatures of the spine

A

Those that develop when the baby holds its head upright and begins to walk

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27
Q

Atlas

A

C1

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28
Q

Axis

A

C2

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29
Q

Nuchal ligament extends from…. to….

A

Occipital protuberance

Spinous process of C7

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30
Q

Function of nuchal ligament

A

Limits flexion of the head

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31
Q

Vertebral notch

A

Notch below the pedicle.
Forms the intervertebral foramina .
Where spinal nerve roots and ganglia exit the vertebral canal.

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32
Q

Annulus Fibrosus

A

Outer, fibrous part of IV disc.
Fibres insert into epiphyseal rim.
Contains blood vessels.
Thickens with age.

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33
Q

Nucleus Pulposus

A

Central core of IV disc.
85% water at birth, dehydrates, losing proteoglycans and elastin with age.
Avascular - receives blood from vessels in AF.

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34
Q

Action of Trapezius

A

Upper fibres: Elevate and rotate scapula

Middle fibres: Retract scapula

Lower fibres: Pull scapula inferiorly

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35
Q

Motor innervation of trapezius

A

Spinal Accessory Nerve (CNXI)

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36
Q

Action of Latissimus Dorsi

A

Extends, adducts and medially rotates the upper limb

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37
Q

Innervation of Latissimus dorsi

A

Thoracodorsal nerve

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38
Q

Action of levator scapulae

A

Elevates scapular

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39
Q

Innervation of levator scapulae

A

Dorsal Scapular Nerve

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40
Q

Origin and Attachment of Trapezius

A

Skull, nuchal ligament, spinous processes C7-T12

to

Clavicle, Acromion and scapula spine

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41
Q

Origin and attachment of Latissimus Dorsi

A

Spinous processes of T6-T12, Iliac crest, thoracolumnar fascia, inferior 3 ribs

to

Intertubular sulcus of humerus

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42
Q

Origin and attachment of Levator Scapulae

A

Transverse processes of C1-C4

to

Medial border of scapula

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43
Q

Action of Rhomboids

A

Retracts and rotates scapula.

Keeps scapula compressed against thoracic wall

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44
Q

Innervation of Rhomboids

A

Dorsal Scapular Nerve

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45
Q

Origin and attachment of rhomboid minor

A

Spinous processes C7-T1

to

medial border of scapula (superior to r.major)

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46
Q

Origin and attachment of rhomboid major

A

Spinous processes T2-T5

to

Medial border of scapula (inferior to r.minor)

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47
Q

Action of Serratus Posterior Superior

A

Elevates ribs 2-5

Involved in respiratory function

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48
Q

Action of Serratus Posterior Inferior

A

Depresses ribs 9-12

Involved in respiratory function

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49
Q

Innervation of Serratus Posterior muscles

A

Intercostal nerves

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50
Q

Origin and attachment of Serratus Posterior Superior

A

Nuchal ligament, spinous processes C7-T3

to

Ribs 2-5

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51
Q

Origin and attachment of Serratus Posterior Inferior

A

Spinous processes T11-L3

to

Ribs 9-12

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52
Q

Superficial, extrinsic muscles of the back

A

Trapezius
Latissimus Dorsi
Rhomboids
Levator scapulae

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53
Q

Intermediate, extrinsic back muscles

A

Serratus posterior superior and inferior

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54
Q

Superficial, intrinsic back muscles

A

Splenius Capitis

Splenius Cervicis

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55
Q

Action of splenius muscles

A

Rotates head to the same side

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56
Q

Bilateral contraction of splenius muscles

A

Head and neck extension

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57
Q

Origin and attachment of splenius capitis

A

Nuchal ligament and spinous processes C-T3

to

Mastoid process
Occipital bone of the skull

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58
Q

Origin and attachment of splenius cervicis

A

Spinous processes T3-T6

to

Transverse processes C1-C3/4

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59
Q

Intermediate, intrinsic back muscles (lateral to medial)

A

Iliocostalis
Longissimus
Spinalis

(I long for spinach)

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60
Q

Action of iliocostalis

A

Unilateral - lateral flexion

Bilateral - extension

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61
Q

Action of longissimus

A

Unilateral - lateral flexion

Bilateral - extension

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62
Q

Action of spinalis

A

Unilateral - lateral flexion

Bilateral - extension

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63
Q

Innervation of erector spinae

A

Posterior rami of spinal nerves

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64
Q

Origin and attachment of Iliocostalis

A

Common tendinous origin

(Travels superiorly)

to

Costal angle of ribs
Cervical transverse processes

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65
Q

Origin and attachment of longissimus

A

Common tendinous origin

(Travels superiorly)

to

Lower ribs
Transverse processes C2-T12
Mastoid process of skull

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66
Q

Origin and insertion of spinalis

A

Common tendinous origin

(Travels superiorly)

to

Spinous processes of C1 and T1-T8
Occipital bone

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67
Q

Deep, intrinsic back muscles

A 
Semispinalis 
Multifidus
Rotatores
Interspinales
Intertransversari
Levatores costarum
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68
Q

Innervation of intrinsic back muscles

A

Posterior rami of spinal nerves

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69
Q

Action of semispinalis

A

Extension and contralateral rotation of head and vertebral column

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70
Q

Origin and attachment of semispinalis

A

Transverse processes C4-T10

to

Spinous processes C2-T4
Occipital bone

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71
Q

Action of multifidus

A

Stabilises vertebral column

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72
Q

Origin and attachment of multifidus

A

Sacrum, P. Iliac spine, Common tendinous origin
Mamillary processes of lumbar vertebrae
Transverse processes of T1-T3
Articular processes C4-C7

to

Spinous processes of vertebrae 2-4 segments above

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73
Q

Action of rotatores

A

Stabilises vertebral column

Proprioception

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74
Q

Origin and attachment of rotatores

A

Transverse processes

to

Spinous processes of immediately superior vertebrae
Lamina

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75
Q

Attachments of interspinales muscles

A

Span between adjacent spinous processes

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76
Q

Attachments of Intertransversari muscles

A

Span between adjacent transverse processes

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77
Q

Attachments of Levatores Costarum

A

Transverse processes C7-T11

to

Rib immediately below

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78
Q

Action oof levatores costarum

A

Elevates ribs

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79
Q

Ostoclasts

A

Breakdown bone for reabsorption

Release of calcium

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80
Q

Osteoblasts

A

Form bone

Found in periosteum in Howship’s Lacuna

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81
Q

Osteocytes

A

Initiate remodelling

Connected to other osteocytes by long projections (Form gap junctions)

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82
Q

Osteophytes

A

Bony projections that form during bone degeneration

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83
Q

Effect of oestrogen and testosterone on bone

A

Increased apoptosis of chondrocytes

Leads to ossification of growth plate by osteoblasts

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84
Q

Secreted by chondrocytes to allow bone mineralisation/calcification

A

Alkaline Phosphatase

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85
Q

Primary centre of ossification

A

Middle of diaphysis

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86
Q

Secondary centre of ossification

A

Epiphysis

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87
Q

Epiphyseal plate

A

Cartilage between primary and secondary centres

AKA Growth plates

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88
Q

Effect of vitamin D on plasma Calcium

A

Increases Ca2+

Activates osteoclasts

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89
Q

Effect of PTH on plasma calcium

A

Increases Ca2+

Activates osteoclasts

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90
Q

Effect of calcitonin on plasma calcium

A

Decreases Ca2+
Activates osteoblasts
Inhibits osteoclasts

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91
Q

Basic unit of compact bone

A

Haversian System/Osteon

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92
Q

Lacunae are connected by…

A

Canaliculi

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93
Q

Lacunae contain…

A

Osteocytes

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94
Q

Canaliculi contain…

A

Projections from osteocytes

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95
Q

Haversian Canals conduct…

A

Blood vessels and nerves from periosteum

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96
Q

Lamellae

A

Concentric rings surrounding Haversian Canal

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97
Q

Structure of cancellous/trabecular/spongy bone

A

No osteons

Has trabeculae surrounding bone marrow containing spaces.

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98
Q

Spinal cord is a continuation of…

A

Medulla oblongata

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99
Q

Cauda Equina

A

Bundle of spinal nerves and nerve roots

Consists of 2-5th lumbar nerve pairs

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100
Q

Spinal cord terminates at…

A

L1/2

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101
Q

Filum terminale

A

Continuation of pia mater from conus medullaris

Connects to coccyx

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102
Q

Conus medullaris

A

Occurs at L1-2
Tapered end of spinal cord
Branches out to form cauda equina

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103
Q

Anterior spinal artery arises from…. via…

A

vertebral artery

Foramen magnum

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104
Q

Anterior spinal artery supplies…

A

Whole cord

Anterior to posterior grey columns, bilaterally

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105
Q

Posterior spinal arteries arise from… via…

A

Posterior inferior cerebellar arteries

Foramen magnum

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106
Q

Posterior spinal arteries supply…

A

Their own side of grey and white posterior columns

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107
Q

Radicular feeder arteries enter spinal column via…

A

Intervertebral foramina

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108
Q

Arteria Radicularis Magna/Artery of Adamkiewicz

A

Large radicular artery

Found at T10/11

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109
Q

A-delta fibres are responsible for…

A

Immediate, sharp pain

Response to mechanical stimulation, cold and pressure

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110
Q

C fibres are responsible for…

A

Slow, dull pain (Visceral)

Response to high temperatures and chemical stimuli

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111
Q

Effect of substance P

A

Stimulates histamine release from mast cells

Causes vasodilation and inflammatory response

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112
Q

Mechanism for referred pain

A

Visceral and cutaneous afferents converge on a single dorsal horn.
Pain from an organ can be felt at the same level that the dorsal horn cutaneously innervates

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113
Q

Primary hyperalgesia means being

A

More sensitive to pain when tissue is damaged

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114
Q

Secondary hyperalgesia refers to a

A

Long-term potentiation of pain signals

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115
Q

Allodynia

A

Pain due to a stimulus that isn’t normally painful

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116
Q

Mechanism for primary hyperalgesia

A

Inflammation or damage causing release of Histamine/5-HT/Sub P
Decreases threshold of firing in silent neurons.
Afferents that are normally silent become sensitised and produce action potentials

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117
Q

Mechanism for secondary hyperalgesia

A

Build up of substance P in dorsal horn
NMDA receptor becomes more sensitive to glutamate.
Pain occurs in undamaged tissues

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118
Q

Endogenous opioids

A

Endorphins and enkephalins

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119
Q

Where is periaqueductal gray located?

A

Midbrain

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120
Q

Effect of stimulation of Periaqueductal gray

A

Analgesia

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121
Q

Anterior ramus of spinal root supplies…

A

Muscles and skin in anterolateral body and limbs

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122
Q

Posterior ramus of spinal root supplies

A

Muscles and skin of back

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123
Q

Two parts of Dorsal Column

A

Cuneate and Gracile Fasciculi

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124
Q

Function of Dorsal Column

A

Fine Touch
Vibration
Proprioception

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125
Q

Cuneate Fasciculus carries…

A

Information on fine touch/vibration/proprioception from upper limb

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126
Q

Gracile Fasciculus carries…

A

Information on fine touch/vibration/proprioception from lower limb

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127
Q

Where do fibres from the dorsal column cross over?

A

Medulla

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128
Q

Once fibres from Dorsal column have crossed over, they are known as…

A

Medial Leminiscus

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129
Q

Dorsal Column synapses in…

A

Thalamus

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130
Q

How does pain/temperature information reach the brain?

A

Spinothalamic tract

Enters spinal cord, ascends 1-2 levels in Lissauer’s Fasciculus
Synapses in substantia gelatinosa in Dorsal Horn.
Crosses over in AWC.
Ascends in ST tract up to thalamus.

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131
Q

Function of lateral corticospinal tract

A

Motor control of limbs

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132
Q

Function of ventral corticospinal tract

A

Axial motor control (central)

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133
Q

Post central gyrus

A

Sensory

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134
Q

Precentral gyrus

A

Motor

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135
Q

Decussation of the pyramid is…

A

Where corticospinal fibres (to the limb) cross over in the medulla

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136
Q

Motor information to the limbs is transported in fibres which cross over in…

A

The medulla

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137
Q

Motor information to the axial muscles is transported in fibres which cross over in…

A

The anterior white commissure

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138
Q

Where do neurons from motor cortex synapse?

A

Anterior Horn

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139
Q

Dermatome

A

An area of skin that is supplied by a single spinal nerve

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140
Q

Thumb dermatome

A

C6

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141
Q

Middle finger dermatome

A

C7

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142
Q

Little Finger dermatome

A

C8

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143
Q

Nipple dermatome

A

T4

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144
Q

Umbilicus dermatome

A

T10

145
Q

Glans penis dermatome

A

S3

146
Q

Knee dermatome

A

L4

147
Q

Little toe dermatome

A

S4

148
Q

Myotome responsible for ankle reflex

A

S1-2

149
Q

Myotome responsible for knee reflex

A

L3-4

150
Q

Myotome responsible for biceps reflex

A

C5-6

151
Q

Myotomes responsible for triceps reflex

A

C7-8

152
Q

Herniated disc is normally caused by..

A

Age related degeneration of annulus fibrosis.

Allows nucleus pulposus to bulge out into vertebral canal.

153
Q

Diagnosis of herniated disc

A

T2 MRI - visualising soft tissue

CT is not useful

154
Q

Treatment of herniated disc

A

NSAIDs +/- nerve blocks/epidurals

Surgery if severe

155
Q

Risk factors for mechanical back pain

A

Older
Female
Chronic pain elsewhere
Psychosocial factors

156
Q

Presentation of mechanical back pain

A

Stiffness
Scoliosis on standing
Muscle spasm and tenderness
Relief with sitting/standing/rest

157
Q

Treatment for mechanical back pain

A

Analgesia
Physiotherapy
Avoidance of excessive rest (to prevent chronic LBP)
Muscle relaxants may be used

158
Q

Facet Syndrome

A

Narrowing/osteopathic changes in facet joints causing back pain.
Usually cervical

159
Q

Spondylosis

A

Degenerative Osteoarthritis of joints causing narrowing

160
Q

Pathophysiology of Spinal and Root Canal Stenosis

A

Loss of disc height
Osteophyte formation
OA of joints

161
Q

Presentation of Spinal and Root Canal Stenosis

A

Pain (brought on by walking, relieved by rest)
Parasthesia - in distribution of affected nerve

Bending forward may provide relief (opens canal)

162
Q

Spondylolisthesis

A

Forward displacement of vertebra
Causing low back pain

Extreme case of spondylolysis (fracture of pars interarticularis)

163
Q

Vertebrae in which spondylolisthesis most commonly occurs in

A

L5

164
Q

Treatment of spondylolisthesis

A

Surgical realignment of vertebra

165
Q

Age group commonly affected by spondylolisthesis

A

Young people (<20)

166
Q

Diffuse Idiopathic Skeletal Hyperstosis

A

Bony growths and ossification of ligaments

167
Q

Presentation of Diffuse Idiopathic Skeletal Hyperstosis

A

Stiffness of the spine (not always painful)

More commonly in patients with metabolic syndrome.

168
Q

Treatment of Diffuse Idiopathic Skeletal Hyperstosis

A

NSAIDs

169
Q

Presentation of facet joint damage

A

Pain to myotome region of affected spinal nerve.

Pain worse on bending backwards and on straightening

170
Q

Ankylosing Spondylitis mainly affects which groups

A 
Young adults (late teens to early 20s)
Males > Females (5:1)
171
Q

Pathophysiology of Ankylosing Spondylitis

A

Inflammation settles

Calcium laid down, reducing flexibility of spine

Usually starts in sacroiliac joints and spreads upwards

172
Q

Conditions associated with Ankylosing Spondylitis

A

IBD
Psoriasis
Reactive Arthritis

173
Q

Symptoms of Ankylosing Spondylitis

A

Stiffness in lower back in the morning that eases throughout the day.
Pain in sacroiliac joints, buttocks/thighs
Associated with eye (Uveitis) and bowel (IBD) problems

174
Q

Treatment for Ankylosing Spondylitis

A 
Steroids
NSAIDs
Anti TNF
Physiotherapy 
Daily Exercise
175
Q

Pathophysiology of Paget’s Disease

A

Increased osteoclastic bone reabsorption
Results in compensatory formation of new bone which is weaker.
Leads to deformity and increased risk of fracture

176
Q

Presentation of Paget’s Disease

A

Bone and joint pain
Deformities e.g. bowed legs

Neurological complications:

  • nerve compression e.g. CNVIII causing deafness
  • Spinal stenosis
  • Hydrocephalus (blockage of Aqueduct of Sylvius)
177
Q

Cause of Osteomalacia

A

Vitamin D deficiency

Can be dietary, due to reduced sunlight or GI disease causing reduced absorption

178
Q

Symptoms of osteomalacia

A

Muscle weakness (causing a waddling gate)

Bone pain - a dull ache, worse when walking

179
Q

Symptoms of neoplastic bone disease

A

Local bone pain
Systemic symptoms (malaise and pyrexia)
Aches and pains due to hypercalcaemia

180
Q

Most common bone metastases come from…

A

Breast, bronchus and prostate cancers

181
Q

Pathophysiology of osteoporosis

A

Increased bone breakdown by osteoclasts

Decreased bone formation by osteoblasts

182
Q

Nerve roots of sciatic nerve

A

L4-S3

183
Q

Symptoms of sciatica

A

Low back pain
Buttock pain
Pins and needles
Numbness and pain/weakness in leg and foot

184
Q

Causes of sciatic

A

Pregnancy (increased pressure)
Herniated disc
Spinal stenosis
Piriformis Syndrome

185
Q

Piriformis Syndrome

A

Where sciatic nerve runs through piriformis, not below it

186
Q

Treatment for Piriformis Syndrome

A

Botulinum Toxin injection

187
Q

Symptoms of Cauda Equina Syndrome

A 
Saddle anaesthesia/paraesthesia (near anus and genitals)
Sexual, bladder and bowel dysfunction
Severe back pain
Sciatica
Loss of ankle reflex 
Paraplegia of legs 
Gait disturbance
188
Q

Nerve roots associated with saddle anaesthesia in Cauda Equina Syndrome

A

S3-5

189
Q

Pathophysiology of Cauda Equina Syndrome

A

Compression/Damage to L1-L5 and S1-S5

190
Q

Treatment of Cauda Equina Syndrome

A

Emergency surgical decompression

191
Q

Upper motor neurones originate in…

A

Precentral gyrus

Primary motor cortex

192
Q

LMNs are found in….

A

Anterior grey column
Anterior nerve roots
Cranial Nerve nuclei

193
Q

Alpha motor neurones

A

In extrafusal muscle fibres

194
Q

Beta motor neurones

A

In extrafusal and intrafusal muscle fibres

195
Q

Gamma motor neurones

A

Intrafusal fibres and muscle spindles for proprioception

196
Q

Causes of UMN Lesions

A

Stroke
MS
Cerebral palsy
Other acquired brain injury

197
Q

Causes of LMN lesions

A 
Trauma to peripheral nerves causing severance of axons 
Disease atrophy of muscle
Polio
Guillian Barre 
Amyotrophic Lateral Sclerosis
198
Q

Symptoms of UMN Lesions

A 
Decreased strength
Increased tone (Spastic paralysis)
Clonus 
Hypereflexia 
Babinski sign
199
Q

Symptoms of LMN Lesions

A 
Decreased strength 
Decreased tone (flaccid paralysis)
Fasciculations/Fibrillations 
Hyporeflexia
Atrophy of muscle
200
Q

Babinski sign occurs in…

A

UMN lesions

201
Q

Loss of muscle mass occurs in (UMN/LMN) Lesions

A

Lower

202
Q

Hypereflexia occurs in (UMN/LMN) Lesions

A

Upper

203
Q

Neurotransmitter which transmits signals from upper to lower motor neurons

A

Glutamate

204
Q

Physiological role of PGHS 1

A

GI tract
CNS
Platelets

205
Q

Pathophysiological role of PGHS 1

A

Chronic pain

Hypertension

206
Q

Physiological role of PGHS 2

A

Renal
Platelet
Vascular system
Reproductive system

207
Q

Pathophysiological role of PGHS 2

A 
Inflammation
Chronic pain
fever 
Vascular permeability 
Angiogenesis 
Tumour growth 
Neurodegeneration
208
Q

MOA of NSAIDs

A

Inhibit COX domain of PGHS

Reduces PGE2

209
Q

Effect of PGE2

A

Sensitised A-delta and C nociceptive fibres to 5-HT, bradykinin and substance P

Transmission of pain

210
Q

Effect of aspirin on blood

A

Inhibits platelet aggregation and clotting due to irreversible inhibition of COX 1

211
Q

MOA of Aspirin

A

Irreversible inhibition of COX domain of PGHS

212
Q

Why do NSAIDs cause renal failure?

A

Inhibition of COX2 which produces prostaglandins which cause vasodilation in renal blood vessels

213
Q

Indication for rofecoxib

A

Osteoarthritis

214
Q

MOA of rofecoxib

A

NSAID

Selective inhibition of PGHS2

215
Q

Why can Aspirin not be given to children?

A

Damages mitochondria in liver

Reye’s:

Causes feve, rash, dizziness, brain problems, fatty liver, coma and death.

216
Q

Reye’s

A

Caused by Aspirin administration in <16yo

Causes feve, rash, dizziness, brain problems, fatty liver, coma and death.

217
Q

Indication for naloxone

A

Opioid overdose

218
Q

ADRs of morphine

A

Respiratory depression (decreased sensitivity of respiratory centre to pCO2)

Bronchoconstriction (causes histamine release from mast cells)

Constipation

219
Q

Effect of mu opioid receptor activation

A

Analgesia
Euphoria
Respiratory depression
Dependence

220
Q

Effect of kappa opioid receptor activation

A

Some spinal analgesia
Small sedation and dysphoria
No dependence or unwanted ADRs

221
Q

How does opioid receptor activation inhibit neurotransmitter release?

A

Activation of opioid receptor (a GPCR) causes inhibition of adenylyl cyclase.

Causes K+ channels to open (hyperpolarisation occurs)

Inhibits Ca2+ channels in presynaptic cleft

No release of neurotransmitter

222
Q

MOA of Tramadol

A

Weak agonist of mu-opioid receptors

Inhibitor of NA reuptake (may have psychiatric reactions)

223
Q

Components of a nerve block injection

A

Local anaesthetic e.g. lidocaine
Adrenaline
Corticosteroid
Opioid

224
Q

Paresis means..

A

Weakness

225
Q

Plegia means…

A

Paralysis

226
Q

Duration of action of lidocaine as an LA

A

10-20mins

227
Q

Duration of action of bupivacaine

A

2-8hrs

228
Q

Onset of action of lidocaine occurs after…

A

1.5 mins

229
Q

Onset of action of bupivacaine occurs after…

A

15 mins

230
Q

Maximum dose of lidocaine

A

3mg/kg

231
Q

Maximum dose of bupivacaine

A

2mg/kg

232
Q

Maximum dose of lidocaine with adrenaline

A

7mg/kg

233
Q

Maximum dose of bupivacaine with adrenaline

A

5mg/kg

234
Q

Characteristics of non depolarising neuromuscular blockade

A

Longer duration f onset

Lasts longer (20 mins)

235
Q

Characteristics of depolarising neuromuscular blockade

A

Fast acting

Shorter duration (10 mins)

236
Q

MOA of Atracurium

A

Non depolarising neuromuscular blockade.

Competitive antagonist of ACh receptor

237
Q

MOA of Suxamethonium

A

Depolarising neuromuscular blockade

Competitive agonist of ACh

238
Q

Effect of Suzamethonium

A

Fasciculations for 30-40s

Become paralysed when ca2+ runs out

239
Q

MOA of botulinum in neuromuscular blockade

A

Inhibits ACh release at synapse

240
Q

Characteristics of Botulinum when used in neuromuscular blockade

A

Long acting

Temporary

241
Q

Indication for botulinum (neuromuscular blockade)

A

Cerebral palsy patients
Post stroke

  • Reduces contractures
242
Q

Benefits of paralysing patients for surgery

A

Stops breathing - easier in abdominal surgery

Releases tension in muscles

Easier to intubate (relaxation of muscles around mouth and throat)

243
Q

Neurapraxia

A

Damage to myelin sheath, conduction is slowed

244
Q

Axonotmesis

A

Axon has been damaged

No conduction

245
Q

Neurotmesis

A

No conduction

246
Q

Classification of Nerve Injury: Sunderland I

A

Myelin sheath damaged

Slow conduction

247
Q

Classification of Nerve Injury: Sunderland II

A

Loss of axonal continuity, endoneurium intact

248
Q

Classification of Nerve Injury: Sunderland III

A

Loss of axonal and endoneurial continuity

Perineurium intact

249
Q

Classification of Nerve Injury: Sunderland IV

A

Loss of axonal, endoneurial and perineurial continuity

250
Q

Classification of Nerve Injury: Sunderland V

A

Nerve trunk divided

No conduction

251
Q

Wallerian Degeneration

A

Degeneration of axon distal to injury

Anterograde/orthograde

252
Q

Neurotropism

A

Nerve endings send out neurotrophic factors which lure degenerated end to grow towards it

253
Q

Rate of regeneration of neuron axons

A

1mm/day

254
Q

Neuroma

A

Ball of raw ends of nerve fibres

255
Q

Tinel’s sign

A

Tapping on a nerve to initiate a response

Causes an electric shock sensation occurs at site of injury

256
Q

Advancing Tinel’s

After 30 days recovery, how far from the location of original injury should the electric shock sensation be felt?

A

3cm

257
Q

Surgery required for class IV and V neuron injury

A

Repair/Graft

258
Q

Surgery required for class III neuron injury

A

Internal neurolysis (or none at all)

259
Q

Which class of neuronal injury does Advancing Tinel’s Sign occur in?

A

II and III

260
Q

Which class of neuronal injury does Tinel’s sign occur in?

A

II-V

261
Q

Fibres responsible for proprioception in golgi tendon organ

A

Ia, Ib or II

262
Q

Muscles spindles detect

A

Change in length/stretch

263
Q

Primary sensory endings

A

Type Ia fibres

264
Q

Secondary sensory endings

A

Type II fibres

265
Q

Golgi tendon reflex

A

Feedback mechanism to control muscles tension.

Prevents muscle tension being so high that the tendon will tear.

266
Q

Wallerian Degeneration is mediated by…

A

Ca2+

267
Q

Chromatolysis

A

When Nissl bodies (made up of RER in cell body) are damaged and begin to swell 10-20 days after injury

268
Q

How does chromatolysis act as a signal?

A

Signals to glial cells to help with recovery

269
Q

How does the body synthesis biologically active vitamin D?

A

Cholesterol converted to vitamin D3 in skin due to UV light
Liver converts this to calcifediol.
Kidneys convert this to caliol (biologically active)

270
Q

Effects of calcitriol

A

Increases plasma calcium by:
Increased absorption from GI tract
Increased release from bone via osteoclasts

271
Q

Overall effect of PTH

A

Increased plasma calcium

272
Q

How does PTH increase plasma calcium?

A

Activates osteoclasts
Increased Ca2+ reabsorption in kidneys
Increases production of calcitriol (therefore Ca2+ absorption from GI tract)

273
Q

Calcitonin is produced by…

A

Thyroid gland

274
Q

Overall effect of calcitonin

A

Decrease plasma calcium

275
Q

How does calcitonin decrease plasma calcium?

A

Inhibits osteoclasts
Activates osteoblasts
Inhibits absorption of Ca2+ in kidney and GI tract

276
Q

Medical uses of calcitonin

A

Hypercalcaemia
Paget’s Disease
Bone metastases

277
Q

Diaphysis

A

Shaft of a bone

278
Q

Epiphysis

A

Ends of a bone

279
Q

Vokmann’s Canals

A

At 90 degrees to Haversian Canals

Connect osteons

280
Q

Periosteum is made of

A

Dense irregular connective tissue

281
Q

Resorption phase of bone remodelling

A

Osteocytes release chemical transmitters/chemoattractants OR undergo apoptosis.

Encourages osteoclasts to undergo apoptosis (takes 3-5 weeks)

282
Q

Reversal phase of bone remodelling

A

Osteoblasts activated and mature when osteoclasts are apoptosed.
Osteoblasts begin to secrete osteoid

283
Q

Formation phase of remodelling

A

Osteoid and matrix is mineralised
Osteoblasts become resting bone.

Bone is quiescent again (inhibition of osteoclasts and osteoblasts)

284
Q

Osteonectin

A

Anchors bone to collagen

285
Q

Composition of hyaline cartilage

A

Water
Proteoglycans
Type II Collagen
Chondrocytes

286
Q

Osteoblasts secrete…

A

Osteoid and collagen

287
Q

Osteoclasts secrete…

A

Carbonic Anhydrase

288
Q

How do osteoclasts cause breakdown of bone?

A

Secretion of carbonic anhydrase which acidifies the matrix.

Causes it to decalcify

289
Q

Primary hyperparathyroidism causes what change in blood?

A

Hypercalcaemia

290
Q

Symptoms of hypercalcaemia due to hyperparathyroidism

A

Bone pain/fracture
Kidney stones
Abdominal pain (due to constipation, indigestion, nausea and vomiting)
Psychiatric problems

291
Q

Hypoparathyroidism causes what change in blood?

A

Hypocalcaemia

292
Q

Symptoms of hypocalcaemia due to hypoparathyroidism

A 
Muscle spasm (tetany)
Paraesthesis around mouth/feet
293
Q

For the first 4-5 days after a bone fracture…

A 
Phagocytic cells (macrophages) remove debris
Granulation tissue forms
294
Q

What is granulation tissue?

A

Loosely gelled protein-rich exudate which later is fibrosed into scar tissue.
Forms 4-5 days after a bone fracture.

295
Q

How long does the inflammation phase of bone healing last?

A

Minutes to days

296
Q

Inflammation phase of bone healing:

A

Formation of haematoma for stability.

Increased permability of capillaries so that inflammatory mediators are released.

297
Q

Repair phase of bone healing:

A

Osteoblasts migrate to site of injury and secrete osteoid into granulation tissue.
Forms a soft callus which is ossified to a hard callus.

298
Q

Remodelling phase of bone healing:

A

Restructuring of hard callus by osteoblasts and osteoclasts.

Formation of periosteum

299
Q

Fibrous union occurs following bone fracture due to…

A

Improper immobilisation

300
Q

Effect of delayed union following bone fracture

A

Healing takes 2x longer than normal

301
Q

Where is non union of a healing fracture common?

A

Scaphoid

302
Q

Malunion of a healing fracture

A

Has healed incorrectly

Twisted/rotate/shortened/bent

303
Q

Risk factors for osteoporosis

A 
Female
Age
Genetic predisposition
Alcohol
Smoking 
Unfit
Low oestrogen
304
Q

Diagnosis of osteoporosis

A

DEXA

> 2.5 standard deviations below normal bone density (T score)

305
Q

Non pharmacological management of osteoporosis

A

Exercise
Calcium and vitamin D supplementation
Cessation of smoking
Reduce alcohol intake

306
Q

First line drugs for osteoporosis

A

Bisphosphonates:

Alendronate
Risedronate
Ibandronate

307
Q

Ratio of matrix to bone in osteoporosis

A

Normal

308
Q

Ration of matrix to bone in osteomalacia

A

Decreased

309
Q

Amount of bone in osteoporosis is (decreased/normal)

A

Decreased

310
Q

Amount of bone in osteomalacia is (decreased/normal)

A

Normal

311
Q

Treatment of osteomalacia/rickets

A

Oral vitamin D2/3

312
Q

Symptoms of rickets

A 
Genu varum (bowing femurs)
Bone tenderness
Muscle weakness
Tetany (muscle spasms)
Hypocalcaemia
313
Q

Blood tests in Paget’s Disease

A

Normal Ca2+, vitamin D, PTH and phosphate.

Increased alkaline phosphatase

314
Q

Treatment of Paget’s Disease

A

Bisphosphonates:

Risedronate
Zolendronate
Alendronate
Ibandronate

315
Q

Acute Spinal Cord Injury -

Frankel’s Type A

A

No motor or sensory function below level of injury

316
Q

Acute Spinal Cord Injury - Frankel’s Type B

A

No motor function and sensory preservation below level of injury

317
Q

Acute Spinal Cord Injury - Frankel’s Type C

A

Useless motor function below level of injury

318
Q

Acute Spinal Cord Injury - Frankel’s Type D

A

Useful motor function below level of injury

319
Q

Acute Spinal Cord Injury - Frankel’s Type E

A

Normal motor and sensory function

320
Q

Effect of spinal cord injury C1-C3

A

Requires ventilators for breathing (due to loss of phrenic nerve)

321
Q

Effect of spinal cord injury C4-T1

A

Loss of arm function

322
Q

Effect of spinal cord injury T1-T8

A

Lose control of abdominal muscles and trunk stability

323
Q

Effect of spinal cord injury T9-T12

A

Partial loss of trunk and abdominal muscle control

324
Q

Effect of spinal cord injury in lumbosacral region

A

Loss of control of legs, urinary system and anus.

May affect sexual function.

325
Q

When looking at X-rays of cervical spine, we assess:

A 
T1/C7 junction
Alignment 
Vertebrae
Odontoid peg
Soft tissue
326
Q

Ideal imaging view for odontoid peg fracture

A

Open mouth

327
Q

What does an peg/dens fracture look like on an X-ray?

A

Ring of C2 is incomplete

328
Q

Hangman’s Fracture

A

Fracture of pedicles of C2

Body and dens displaced anteriorly

329
Q

Teardrop fracture

A

Hyperextension causing displacement of anterior part of vertebral body.
Usually of C2

330
Q

Most common cause of anterior cord syndrome

A

Ischaemia/Infarction of anterior spinal artery (supplies anterior 2/3 of spinal cord)

331
Q

Effect of anterior spinal cord syndrome

A

Bilateral spastic paralysis below level of injury.
Loss of pain/temp/light touch sensation below level of injury.
Sacral sparing.

332
Q

Most common cause of Posterior Cord Syndrome

A

Tumor(s) pressing on spinal cord

333
Q

Effect of posterior cord syndrome

A

Loss of proprioception, vibration and 2 point discrimination below level of injury.
Motor preservation

334
Q

Cause of central cord syndrome in elderly

A

Degenerating IV discs in spondylosis causing compression of vessels.
Centre of spinal cord is at highest risk of ischaemia.

335
Q

Effect of central cord syndrome

A

Profound motor weakness (in upper limbs more than lower)
Varying degree of sensory loss below level of lesion.
Urinary retention.
Sacral sparing

336
Q

What is Brown-Sequard?

A

Hemicord lesion - damage or impairment to left or right side of spinal cord.

337
Q

Causes of Brown-Sequard

A

Penetrating injury
Disc herniation
Vertebral artery dissection

338
Q

Effect of Brown-Sequard

A

Ipsilateral loss of proprioception, vibration and light touch sense.
Ipsilateral spastic paralysis
Contralateral loss of pain and temperature sense.

339
Q

Why does ipsilateral loss of proprioception and vibration sense occur in Brown-Sequard?

A

Dorsal column is responsible for this sensation.
Crosses over in spinal cord higher up in the spinal cord.
Therefore, sensory impulses on the side of the lesion will not reach the brain.

340
Q

Why does ipsilateral spastic paralysis occur in Brown-Sequard?

A

Corticospinal tract is responsible for motor function.
Crosses over higher up in spinal cord.
Therefore, motor impulses travelling to limbs on the the side of the lesion will not reach their target.

341
Q

Why does contralateral loss of pain and temperature sensation occur in Brown-Sequard?

A

Spinothalamic Tract is responsible for this sensation.
Crosses over immediately in spinal cord.
Therefore, sensory impulses on the opposite side to the lesion will not reach the brain.

342
Q

Spondylolisthesis of C2 is also known as

A

Hangman’s Fracture

Forward displacement of C2

343
Q

Disc Herniation in children is associated with…

A

Fracture of vertebral ring apophysis.

Common in young athletes.

344
Q

Commonest tumor in bone

A

Metastases

345
Q

Commonest primary tumor in bone

A

Myeloma

346
Q

Common primary tumors in bone

A

Myeloma and osteosarcoma

347
Q

Myeloma

A

Arises in plasma cells in blood when they start releasing paraprotein antibody.

348
Q

Sarcoma

A

Cancers which arise in supporting tissue (connective or other non epithelial tissue)

349
Q

Osteosarcoma most commonly occurs in…

A

Teenagers as their bones are growing.

More commonly arms or legs.

350
Q

Vertebra prominens

A

C7

351
Q

How does breast cancer metastasise to spine?

A

Azygous venous plexus (to thoracic spine)

352
Q

How does prostate cancer metastasise to the spine?

A

Pelvic venous plexus (to lumbar spine)

353
Q

How does lung cancer metastasise to the spine?

A

Segmental arteries

354
Q

How does pancreatic cancer metastasise to the spine?

A

Direct spread

355
Q

Batson Venous Plexus

A

Valveless veins
Connect pelvic and thoracic veins
Low intraluminal pressure
Common route of spread of cancer.

356
Q

Microbes commonly responsible for Spinal Infections

A

60% Staph aureus
30% Enterobacter

(+ TB, Fungi, salmonella)

357
Q

Risk factors for spinal infection

A 
Age (teens and elderly)
Immigrants
Diabetes 
Renal failure 
Spinal surgery
Rheumatoid Arthritis 
Steroids/Immunosuppression
358
Q

Spinal TB causes…

A

Cord compression

Destruction of vertebral bodies and disc spaces w/ local spread of infection

Year 2 (17 decks)

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