Locomotor Flashcards

Question

Osteoporosis

Answer 1

Bone resorption exceeds formation - lower bone density Result of age, reduces exercise, oestrogen deficiency, diet and corticosteroids Can cause kyphosis Occurs most frequently in high trabecular content bones - femur head, vertebrae or radius Dexa scans give a t score for bone density osteopenia is -1 to -2.5 Below -2.5 is osteoporosis

Answer 2

Increased resorption and formation leading to persisting woven structure and therefore weak bones Deformities, fractures, pain and nerve compression Autosomal dominant

Answer 3

Vit D deficiency decreases calcium absorption and therefore epiphyseal mineralisation

Answer 4

Infection of bone leaving to inflammation which often affects growth plates in children

Answer 5

Airway - obstruction needing removed, oxygen support needed Breathing - observation of patient colour, breathing effort, injuries, vital sounds, symmetry and chest sound Circulation - pulses and capillary refill Disability - assess neurological function with Glasgow coma scale or AVPU plus temperature and blood glucose Exposure - keep patient warm and check for any missed injuries

Answer 6

Eyes < 4 Verbal < 5 Motor < 6

Answer 7

Alert Verbal Pain Unresponsive

Answer 8

2+ non-adjacent ribs fractured in two or more places resulting in a section of the ribs which is non functional and moves in and out during breathing

Answer 9

Complete loss of contact at a joint

Answer 10

Partial loss of contact at a joint

Answer 11

Fracture producing multiple fragments

Answer 12

Incomplete breaks with bending

Answer 13

Inadequate tissue perfusion leading to end-organ dysfunction ``` Anaphylactic - give adrenaline Cardiogenic Haemorragic/hypovolaemic neurogenic Septic ``` Permissive hypotension is allowing low BP to prevent further blood loss but maintaining cerebral perfusion

Answer 14

Physis - growth plate Apophysis - where tendon attached - stress on bone from muscle contraction Metaphysis - less stable where bone structure changes from solid to weaker

Answer 15

Where the epiphysis is broken off

Answer 16

Tibial tuberosity apophysis injury

Answer 17

Chronic apophysitis of the heel in children as their bones are not yet fused

Answer 18

Injury to medial chondyle of humerus

Answer 19

Bow legged

Answer 20

Knock kneed

Answer 21

Attaches to anterior tibia prevents joint hyperextension, anterior tibial movement, tibial over rotation and varus/valgus angulation Tears pop and feel unstable as well as swelling and pain Diagnosed with lachmans test Surgery for athletes, otherwise RICE and physio

Answer 22

Higher Q angle gives more knock-kneed stature (valgus on landing)

Answer 23

Exercise induced pain in the anterior lower leg treated with rest Can be caused by compartment syndrome where exercise causes increase in blood supply, increasing pressure as the compartment has low compliance. This reduced the blood supply and can cause ischaemia and pain Can be relieved with fasciectomy Shin splints can also be caused by dress fractures

Answer 24

Predisposition to stress fractures Diet, amenorrhea and osteoporosis High protein limits vit C and D absorption and reduced oestrogen levels increase osteoclast activity Reduce exercise, diet changes and immobilisation

Answer 25

Can cause knee clicking, locking and chronic pain The medial collateral ligament is more vulnerable to injury alongside the ACL and medial meniscus known as the unhappy triad Diagnosed with MRI or McMurrays test and cartilage lesions are graded 0-4 where 4 is complete thickness loss It has no vascular supply so cannot regenerate

Answer 26

Pressure on median nerve at wrist More common in white women as they have smaller carpal tunnels Paraesthesia, reduced sensation, muscle wasting and waking due to symptoms

Answer 27

Compression of UN in elbow flexion Paraesthesia, numbness, weakness

Answer 28

Contraction of the digital and palmar fascia Myofibrils cause it to thicken an contract Risk factors are genes, diabetes, cirrhosis, hand trauma

Answer 29

Pulling thumb back too far Inhibits tripod grip Requires surgery

Answer 30

``` Physiological Inflammatory Vascular Neuropathic Psychogenic ``` Somatic pain is peripheral and well discriminated, usually sharper and often acute Visceral pain is duller and not well discriminated

Answer 31

Bradykinin, lactic acid, serotonin, K, H, histamine, substance P, ATP Prostaglandins increase pain sensitivity

Answer 32

Early pain is sharp and transmitted quickly by myelinated A fibres which allow accurate localisation Later pain is transmitted slowly by unmyelinated C fibres and produces dull, throbbing pain Glutamate is the main excitatory neurotransmitter and acts at AMPA and NMDA receptors Inhibitory ligands include opioids, noradrenaline, 5-HT (serotonin), GABA and glycine

Answer 33

That sensory inputs elsewhere can compete to reduce pain (such as rubbing a sore area)

Answer 34

Paracetamol Acts centrally to inhibit COX which synthesises prostaglandins from arachidonic acid Decreases sensitivity to pain signals Also increases bioavailability of 5-HT, inhibiting pain transmission Anti pyretic effects Hepatotoxicity

Answer 35

Act at various levels of the visceral pain pathway via inhibitory opioid receptors These GPCRs block Ca channels to inhibit NT release and open K channels to hyperpolarise cells Nausea, vomiting, constipation, resp/cough depression, urinary retention, hypotension, miosis, itching, wheal formation Receptors are downregulated over time - tolerance Naloxone is a mu receptor antagonists to treat opioid overdose

Answer 36

Aspirin (irreversible) Ibuprofen COX inhibitor plus anti-inflammatory Affects COX-1 and COZ-2 Lower platelet aggregation which can lead to bleeding, peptic ulcers, renal damage, gastrotoxicity Celecoxib is COX-2 selective

Answer 37

Anti-epileptics or anti-depressants

Answer 38

5-HT agonists uses to treat migraines by constricting blood vessels

Answer 39

alendronate Reduce bone resorption by decreasing osteoclast recruitment and stimulating osteoblasts to produce osteoclast inhibitors Also absorb onto hydroxyapatite crystals to prevent dissolution Must be given constantly as it becomes incorporated into bone Must be taken upright in the morning with lots of water 30 mins before food to prevent oesophageal rupture Jaw pain must be reported due to risk of osteonecrosis

Answer 40

Transcription factor for intracellular receptors which inhibit osteoclasts Can cause cancer however so not really used Raloxifene/tamoxifene - osteogenesis receptor agonist at bone and antagonist elsewhere- reduces cancer risk and cholesterol AE - hot flushes and DVT

Answer 41

Initial treatment - NSAIDs then DMARDs then short course corticosteroids for flare-ups then biological therapy Prevent RA progression and reduce pain and disability May take months to take full effect and allow a reduction in NSAID use Methotrexate - dihydrofolate reductase inhibitor which blocks DNA synthesis in rapidly proliferating cells ie immune cells Many side effects such as vomiting, hair loss, rash, mouth ulcers, infections, reduced liver function and pulmonary toxicity Sulfasalazine - anti-inflammatory immunosuppressant Rash, GI upset, reduced leukocytes and platelets, photosensitivity Gold, hydroxychloroquine and penicillamine have been used in the past but had multiple toxic effects ``` Biological therapies (cytokine inhibitors) - immunosuppressants given when DMARDs so not work Infliximab is a TNF alpha antagonist given by IV in severe RA ```

Answer 42

Keratan sulphate increased, water decreased, protein/urinate increased, extractability of proteoglycans decreased

Answer 43

positive - PTH Negative - calcitonin, oestrogen

Answer 44

Positive - PTH, Vit D3, oestrogen, growth hormone Negative - calcitonin