GEM 2nd Flashcards
What is the design and structure of the anulus fibrosis?
The AF is a highly fibrous and well-organised tissue surrounding the outer region of the intervertebral disk. It has a basket weave formation, resisting forces from opposing directions (torsion)
Where is the most common direction for an intervertebral disc prolapse?
Lateral to the posterior longitudinal ligament. This results in unilateral compression of one or two spinal nerves.
In the lumber / sacral region, this compression can cause sciatica
What are the main spinal ligaments called and where are they located in relation to the vertebrae?
Where are the thenar and hypothenar emimences located?
Thenar = muscular bulge at the base of the first metacarpal (thumb)
Hypothenar = smaller bulge at the base of the fifth metacarpal (little finger)
Which nerve is compressed during carpal tunnel syndrome?
Median nerve
Which of the following are forms of allostatic overload?
A) Chronic, high carbohydrate diet
B) Chronic exposure to microtrauma
C) Paroxysmal elevated cortisol due to diurnal response
D) All of the above
A and B.
Allostatic overload occurs when an organism’s neurological or endocrinological load exceeds it’s normal range for an extended period. Paroxysmal cortisol spikes are observed as part of daily circadian function. A and B are both examples of allostatic load which exceeds capacity.
How does the allostatic model differ from the homeostatic model?
Homeostasis: Stability by keeping internal conditions constant.
Allostasis: Stability by adapting and changing in response to external and internal challenges. For example, predictive, fluctuating circadian hormone levels (within a normal range).
McEwen and Stellar proposed which model which concerns cumulative wear and tear from a neurological and neuroendocrine standpoint?
A) Allostatic load
B) Health belief model
C) Biopsychosocial model
D) Social cognitive theory
A. Allostasis refers to an organisms ability to maintain homeostasis with the presence of insults. Allostatic overload occurs with chronic insult without respite.
In the context of McEwen and Stellar’s model, which of the following is considered a primary mediator contributing to allostatic load?
A. Persistent, elevated cortisol and adrenaline which to physiological dysregulation.
B. An individual’s perceived susceptibility to disease.
C. The role of self-efficacy in determining health behaviour.
D. Socioeconomic factors that influence health outcomes.
A = correct
B (Health belief model)
C (Social cognitive theory)
D (Social determinants of health model)
Which of the following is an example of a nudge intervention designed to increase organ donation rates?
A. Mandatory organ donation legislation.
B. Default enrollment in organ donation programs with an option to opt out.
C. Offering financial incentives to donor families.
D. Launching a mass media campaign promoting organ donation.
B. This option creates a subtle psychological incentive to participate. The other options will generate behaviour change, but they are more direct laws/incentives and therefore less relevant to the nudge theory.
Which intervention best illustrates a nudge to encourage healthier eating in a school cafeteria?
A. Removing all unhealthy food options from the menu.
B. Increasing the price of junk food items.
C. Placing healthier food items at eye level and in prominent locations.
D. Implementing mandatory nutrition classes for students.
C.
A nudge is a behavioural intervention that encourages behaviour without restricting options (subtle cues). A and B are both direct examples. D may result in behaviour change but would not be considered a nudge as this falls more within an education intervention (although there is some crossover here)
What is the function of acetylcholine?
Neurotransmitter used to cause muscle contraction. Widely used in autonomic nervous system (especially parasympathetic).
What are the two types of acetylcholine receptor.
Acetylcholine = Cholinergic
Nicotinic (nAChRs) and Muscarinic (mAChRs) receptors. Both named as nicotine and muscarine act as acetylcholine agonists.
What is the role of Beta 1 adrenoceptors (ADRB1)?
ADRB1 increase heart rate and contractile force when activated. This increases stroke volume (per beat) and cardiac output (per minute)
Agonists = Dobutamine, Epinephrine (non selective)
Antagonists = Atenolol, Bisoprolol
What are the main causes of orthostatic hypotension?
- Medication (antihypertensives)
- Volume depletion (dehydration)
- Poor autonomic control
- Postprandial hypotension
- Reduced baroreceptor sensitivity
Around 50% of older patients may not be taking medication as intended. Why?
- Impaired cognitive function
- Low manual dexterity
- Polypharmacy
- Health beliefs
By roughly what percentage does drug elimination decrease in patients as they age (per year)?
Typical drug clearance ability decreases by around 1% per year. This is relevant as drugs will remain within an elderly patient’s system for longer
What are the two types of cholinergic receptors?
- Nicotinic receptors
- Muscarinic receptors
Why are glucocorticoids administered through different routes?
Glucocorticoid receptors are ubiquitous, so localised administration can provide more targeted effects.
Which administration route offers the least systemic effects:
Oral, injectible, intranasal, topical, inhaled
Intranasal provides the most targeted delivery
Which of these conditions is most likely to be treated with a synthetic glucocorticoid?
A) T1DM
B) Iron-Deficiency Anaemia
C) Osteoporosis
D) Acute Asthma
Acute Asthma (D). Glucocorticoids have anti inflammatory and immunosuppressant properties.
Diabetes = Insulin
Iron Deficiency Anaemia = Ferrous Sulfate
Osteoporosis = Bisphosphonates
Which two main groups of steroids are there?
Corticosteroids
- Progestogens
- Glucocorticoids
- Mineralocorticoids
Gonadocorticoids
- Androgens
- Estrogens
Define steroidogenesis and name the 5 major stages
The process by which cholesterol is converted into steroid hormones.
Progestogens are the precursor. Progestogens differentiate into Mineralocorticoids and glucocorticoids. Progestogens can differentiate into androgens and estrogens.
What is the clinical significance of the hook of hamate
The hook of the hamate is a bony projection on the palmar side of the hamate bone in the wrist.
It forms the lateral border of Guyon’s canal, where the ulnar nerve and artery pass. Fractures or abnormalities in the hook can cause ulnar nerve compression.
Where are the radial and ulnar styloid processes located?
Distal end of the radius (lateral) and ulnar (medial) bones. These processes are palpable in the wrists and mark the beginning of the carpal bones
What is the difference between Carpal Tunnel and Guyon’s Canal Syndrome, specifically referring to the region of symptoms?
Guyon’s Canal = Ulnar Nerve
- 5th digit symptoms
- 4th digit partial symptoms
Carpal Tunnel = Median Nerve
- 1st to 3rd digit symptoms
- 4th digit partial symptoms
What is the clinical significance of the interosseous membrane?
The interosseous membrane is a fibrous sheet connecting the radius and ulna in the forearm (and tibia and fibula in the leg).
- Provides stability, spacing, and force dispersion (pronation and supernation)
- Is a muscle attachment site
- Compartmentalises limb into anterior (flexor) and posterior (extensor) compartments.
List the layers of muscle in the back and their functions
Superficial Layer
- Movement of the upper limb
- Trapezius, Latissimus Dorsi, Levator Scapulae, Rhomboid Major, Rhomboid Minor
Intermediate Layer
- Assists in respiration and thoracic movement
- Serratus Posterior Superior and Serratus Posterior Inferior
Deep (intrinsic) Layer
- Movement / stabilisation of vertebral column
- Spinotransversales, Erector Spinae, Transversospinales muscle groups
List the three deep (intrinsic) muscle subgroups of the back and the muscles found within
Spinotransversales
- Splenius capitis, splenius cervicis
- Maintains posture and moves head and neck
Erector Spinae (intermediate intrinsic)
- Iliocostalis, Longissimus, Spinalis
- Maintainance of correct posture
- ‘I Love Spaghetti’
Transversiospinales (deep intrinsic)
- Semispinalis, Multifidus, Rotatores
- Stabilises spine, controls posture
Outline the mnemonic for the erector Spinae muscles and name the individual muscles of the group
I - Iliocostalis (most lateral)
Love - Longissimus (intermediate)
Spaghetti - Spinalis (most medial)
Name the 5 extrinsic muscles of the back
Trapezius
Latissimus Dorsi
Levator Scapulae
Rhomboid Major
Rhomboid Minor
What fracture is this and what is the common cause?
Colles’ fracture
Swan neck deformity is typical of a fall on an outstretched hand (FOOSH)
What type of fracture is this and what is the standard cause?
Smith’s fracture
Displacement of the hand is often caused by a FOOSH onto the outside of the hand
What fracture is this and what is the common cause?
Galeazzi fracture
A fracture of the distal third of the radius with dislocation or subluxation of the distal radioulnar joint. Caused either by direct trauma or FOOSH with forced pronation/supination
What fracture is this and what is the common cause?
Monteggia fracture
Fracture of the proximal third of the ulna with dislocation of the radial head at the elbow. Caused by FOOSH with pronation, or direct trauma
What is the role of the iliopsoas and what are it’s constituent muscles?
The iliopsoas is a major muscle group in the hip region, consisting of the psoas major, psoas minor (if present), and iliacus.
The iliopsoas is the strongest hip flexor. It also supports upright posture and stabilizes the spine. Dysfunction or tightness in the iliopsoas can contribute to lower back pain, hip pain, and postural imbalances.
Outline the 5 adductor muscles of the thigh
Pectineus
Adductor brevis
Adductor longus
Adductor Magnus
Gracilis
*The sartorius can also operate as an adductor, amongst other functions
What are the 3 primary hip abductors?
- Gluteus medius (main abductor)
- Gluteus minimus
- Tensor Fasciae Latae (attaches to IT band, stabilises the knee)
How many calories are found in each of the four major macronutrients?
Protein = 4
Carbohydrate = 4
Fat = 9
Alcohol = 7
What are the two components of stroke volume?
Preload: Amount of blood in ventricles prior to contraction. Determined during diastole (relaxation of the heart). Higher preload = stronger contraction during subsequent systole.
Afterload: Resistance that ventricles overcome to eject blood during systole. Determined by systemic vascular resistance (SVR). Higher afterload = systolic resistance and reduced stroke volume
What is the formula for blood pressure?
BP = CO x SVR
Blood pressure is cardiac output (SVxHR) x systemic vascular resistance.
What are the four types of haemodynamic shock?
Cardiogenic = pump failure
Mechanical = ventricles not filling
Hypovolaemic = low blood volume
Distributive = profound vasodilation (sepsis)
Define cardiac tamponade
Medical emergency. Fluid builds up within the pericardial sac, increasing pressure and reducing stroke volume.
Pericardiocentesis is required to drain
What is Beck’s triad?
Clinical signs observed during cardiac tamponade.
- Hypotension
- Jugular Venous Distension
- Muffled Heart Sounds
