CLINICALS 12 + 13

Question 1

CLINICAL: rickets cause

Answer 1

• inadequate mineralisation of bone matrix at growth plates due to increased bone resorption

Question 2

CLINICAL: rickets effect

Answer 2

Deposition of unmineralised matrix causes widening of wrist + rachitic rosary (prominent costochondral junctions)

Question 3

CLINICAL: why is manubriosternal puncture done in upper half

Answer 3

to prevent injury to arch of aorta

Question 4

CLINICAL: funnel chest

Answer 4

sternum is depressed

Question 5

CLINICAL: pigeon chest

Answer 5

• forward projection of sternum
• flattening of chest wall on either side

Question 6

CLINICAL: sternotomy in cardiac surgery

Answer 6

• sternum split down midline to allow access to heart
• incision closed with stainless steel wires

Question 7

CLINICAL: ectopia cardis

Answer 7

non fusion of sternal plates; heart lies uncovered on surface

Question 8

CLINICAL: what does partial fusion of plates cause

Answer 8

• sternal foramina
• bifid xiphoid process

Question 9

CLINICAL: spina bifida

Answer 9

• failure of fusion of 2 halves of neural arch.

Question 10

CLINICAL: scoliosis

Answer 10

• body ossifies from 2 primary centres
• if 1 fails to develop - results in hemivertebra and lateral bend in vertebral column

Question 11

CLINICAL: disc prolapse

Answer 11

• after 20 yrs degenerative changes result in weakness of annulus fibrosus
• if disc strains, annulus fibrosus ruptures
• prolapse of nucleus pulposus
• internal derangements of disc

Question 12

CLINICAL: effects of disc prolapse *

Answer 12

• usually posterolateral
• prolapsed nucleus pulposus presses on nerve roots, gives rise to pain radiating along course (sciatica)
• motor effects; loss of power and reflexes follow

Question 13

CLINICAL: Dyspnoea

Answer 13

• patient is most comfortable sitting because diaphragm is in lowest position, allowing maximum ventilation

Question 14

CLINICAL: what type of respiration do pregnant women use

Answer 14

• thoracic as descent of diaphragm is limited