Mock Exam Q&A Flashcards
Phase 1 - up to 2 months
Active coping
Belief that pain is controllable
Anxiety
Phase 2 - 2-6 months
Testing of different coping styles
Depression may occur
Phase 3, 6-24 months Hope of cure diminishes Reduced activity Belief that pain is uncontrollable Depression is common
Sciatic and OA - risk factors, characteristics of pain, two findings on examination
Describe four features of the anger stage of the grieving process
Name 4 of the most common symptoms associated with the late stage of dying (2 marks)
Osteoporosis
What class of hormone is cortisol?
What are the other classes?
Steroid hormone. (Lipo-Philic - fat loving, can transfuse freely across cell membrane) made from cholesterol.
Other examples of steroid hormones are oestrogen, progesterone, testosterone.
Other classes are protein/peptide hormones (insulin, leptin, oxytocin, prolactin) and amine hormones (adrenaline, thyroxin).
Describe in detail the physiological pathway of pain transmission from a joint to the brain (3 marks)
Summary: Detection → spinal cord (which fibres) → decussation → thalamus → cortex
What is the difference between A-delta and C fibres?
A-delta fibres: myelinated, sharp immediate pain
C fibres: non-myelinated, slower duller pain
Describe the pathway of A-delta fibres, including which tract they travel in
- A-delta fibres enter the dorsal root
- synapse with second order neurones
- decussate (send fibres to contralateral side)
- travel in spinothalamic tract
Describe the pathway of C fibres, including which tract they travel along
- C fibres enter and terminate at the dorsal root
- synapse with axons that pass through the anterior commissars to the contralateral side
- and up the spino-reticulocytes-thalamic tract
What is a mortise ankle X-ray?
Ankle X-rays can be AP, lateral or mortise. The UK uses mortise and lateral as standard, other countries do all 3.
Mortise X-ray is 15 degrees of internal rotation. This allows the best view of the ankle bones.
What is the reason trimethoprim should not be given work methotrexate?
Trimethoprim is a folate antagonist, therefore there’s an increased risk of pancytopenia
(Same reason for co-trimoxazole / septrin)
Vasodilation - histamine
Margination - integrins
Emigration - histamine
Chemotaxis - cytokines
Describe two responsibilities towards the patient and two rights of the health professional according to the sick role (4 marks)
What is the highest quality type of research?
Systematic review of high quality randomised controlled trials. Limit confounding and bias.
What is the definition of ‘stress’?
Demands of a situation exceed our resources to cope with the situation
How to assess for ulnar nerve function in the hand
Adduction and abduction of fingers - small
Muscles of the hand.
Little and ring finger flexion
Describe the stages of bone healing from a fracture
- Inflammatory phase - bleeding from torn vessels. Clotting cascade activated, and inflammatory cells (platelets, macrophages) arrive. Haematoma forms in fracture gap. Immediate from injury, peaks at 48hrs, subsides by one week.
- Reparative phase – Mesenchymal stem cells become fibroblasts, osteoblasts and chondroblasts at the fractures site. Callus formed by intramembranous ossification at cortical bone ends (hard callus) and by chondrogenesis at the periphery (soft callus) . Endochondral ossification converts callus to woven bone. Starts within first few days and lasts few weeks.
- Remodelling phase – Woven bone replaced by lamellar bone, and excess callus resorbed. Begins a few weeks after injury and lasts years.
Describe the main physiological processes involved in the sensation and transmission of pain from one part of the body to the brain
Initial pain is sensed by nociceptors – free nerve endings in the skin, muscle and other tissues
- Pain is transmitted by primary sensory neurons to the dorsal horn of the spinal cord - A-delta fibres for fast, acute pain and C-fibres for slow, throbbing/dull pain
- In the dorsal horn, the primary sensory neuron will synapse with a second order neuron of the spinothalamic tract
- This second order neuron immediately decussates and passes up to the thalamus
- In the thalamus, second order neurons synapse with third order neurons leading to the sensory cortex and limbic system
Haematoma
Fibrin mesh - scaffold for inflammatory cells and fibroblasts
Describe fracture healing one week after the fracture
Soft callus
See below
Describe fracture healing 3 weeks after the fracture
Bony callus
Osteoprogenitor cells deposit woven bone
Cartilage undergoes endochondral ossification
What are the systemic complications that can be associated with bone fractures or damage to associated soft tissues? (3 marks)
Shock, myoglobinuria, fat emboli, bone marrow emboli, thromboembolism
What population characteristics do you need to know to calculate incidence and prevalence?
What is incidence?
What is prevalence?
Levels of disease prevention. A national screening programme for Chlamydia would be what level of disease prevention?
Secondary prevention
What are the three main differences between the innate and adaptive immune responses? (3 marks)
Speed of response - slower / quicker
Non-specific/ specific
No memory / memory
Describe how the adaptive immune system is activated and the two major cell types involved in this process (3 marks)
Antigen presentation
T cells and B cells
Describe how morphine works (2 marks)
Describe four late complications that can arise from a fracture (2 marks)
Malunion Non union Joint stiffness Avascular necrosis Osteomyelitis Deformity Chronic regional pain syndrome CRPS
