PAL xmas quiz revision Flashcards
1
Q
What is inflammation?
A
The body’s response to infection
A localised physical condition in which part of the body becomes reddened, swollen, hot and often painful, especially as a reaction to injury or infection.
2
Q
List the causes of inflammation
A
Physical injury
Chemical injury
Infection
Nutritional
Hypoxic (deprived of oxygen)
3
Q
What are the 3 main purposes of inflammation?
A
Neutralise / destroy infection
Limit the spread of infection
Prepare tissue for repair
[Remember NLP}
4
Q
What are the cardinal signs of infection?
A
Pain
Redness
Swelling
Heat
Loss of function
5
Q
What is the difference between infection and inflammation
A
Infection: invasion/production of a reproducing pathogen
Inflammation: Immune response to presence of pathogen, trauma and other stresses to the body
6
Q
What are the stages of tissue repair (with time scales
A
Bleeding – 4-6 hours
Inflammation – Maximal reaction 1-3 days up to 2 weeks
Proliferation – Onset 24 hours to 2-3 weeks peek activity then 4-6 months post-trauma
Remodelling – Onset 1 week to 12 months
7
Q
How does chronic inflammation differ from acute inflammation?
A
Chronic lasts more than 2 weeks
Persistence of infection
Autoimmune response
Unorganised granulation tissue, fibrosis/scaring
8
Q
What must be done as early management of tissue repair?
A
Protect the area:
Elevate
Avoid anti inflammatories to allow inflammation and thus the healing process.
Compression:
Exercise – when is it not painful to do so
Load – when it is not painful to do so
Vascularisation – to get the blood flowing to the site of the injury which will aid healing.
9
Q
List 6 factors that affect healing of a fracture
A
Blood supply Infection Mobility Nutrition Steroids Type of tissue Age Protein deficiency Vit c deficiency Prolonged inflammation Adhesion to bone poor blood supply Excessive movement
10
Q
Name the 2 components of bones
A
Connective tissue = elastic
Mineral component = hardness
11
Q
What are the main functions of bones
A
Surface for muscles/ligaments to attached to which enables movement.
Production of yellow bone marrow needed for fighting infections
Enables movement via articulating joint
Protection of organs (axial skeleton)
Support
12
Q
What are the 5 types of bone in the body (with examples)
A
Long bones – Femur, humerus, tibia, fibula
Flat bone – skull, sternum, scapula .
Short bones – carpal and tarsal bones
Sesamoid bone – Patella
Irregular shaped bones – Vertebra, cocycx
13
Q
What are the 5 stages of bone repair (include rough time scales)
A
Hematoma formation 1 week
Fibrocartaliginous callus formation 2-3 weeks
Callus Ossification 1-4 months
Bone remodelling 4-12 months
14
Q
What is the definition of a fracture
A
An interruption in the continuity of the bone which may be a complete break or an incomplete break
or
A loss of continuity in the substance of the bone
15
Q
What is avulsion
A
Where a muscle or tendon pulls a portion of a bone away from the rest of the bone
16
Q
Name the 3 ways you can describe the displacement of a fracture?
A
Apposition (shift)
Angulation (tilt)
Rotation
17
Q
What does ORIF stand for
A
Open Reduction Internal Fixation
18
Q
What is IM?
A
Intramedullary nail
19
Q
Name 3 possible complications post-fracture
A
DVT
Malunion
Tetanus
Compartment syndrome
Shock
Adhesions
Avascular necrosis
Infection (wound and bone)
Non union
20
Q
What are the aims of therapy during fracture management
A
Reduce oedema
Maintain circulation to area
Muscle function
Joint range
Maintain function
Education (e.g. special appliances)
21
Q
Define osteoporosis
A
A progressive systemic skeletal disease, where bone formation is slower than reabsorption and results in decreased bone strength
22
Q
Name 4 of the roles of a physiotherapist during management of osteoporosis
A
Exercise (load bearing to help bone)
Muscle strengthening
Education
Balance assessment / exercise
23
Q
What is a joint?
A
Articulation of 2 or more bones where they meet/connect
24
Q
What does joint structure determine
A
Direction of movement
Distance of movement
25
What are the 2 classes of joint
Structural – based on connective tissue type that binds bones
Functional – Based on degree of motion
26
What are the 3 types of functional joint
Fibrous
Cartilaginous
Synovial
27
What are the 3 functional classes of joint?
Synarthrosis = non moveable
Amphiarthrosis = slightly moveable
Diarthrosis = freely moveable
28
What are the 3 characteristics of a fibrous joint?
United by fibrous connective tissue
Has no joint cavity
Moves little or not at all
29
What is a cartilaginous joint?
2 bones united by a continuous pad of cartilage
30
What is a synovial joint and what is it limited by?
Freely mobile joint
Allows considerable movement
Contains synovial fluid
Limited by:
Muscles
Ligament
Joint capsule
Shape
31
What are 3 types of synovial joint?
Uniaxial = 1 axis e.g. elbow
Biaxial = 2 axis at right angle e.g. MCPJ
Multiaxial – several axis e.g. shoulder, hip
32
What are the 3 types of movement that synovial joints produce and give an example
Gliding _flexion/extension of the spine
Angular – flexion/extension, DF/PF, Abduction/adduction
Circular – rotation, pronation/supination, circumduction
33
What are the 6 types of synovial joint (with examples)
Plane/gliding – intervertebral
Saddle – thumb, sternoclavicular
Hinge – elbow
Pivot – Radioulnar AND C1 and C2 in the neck
Ball and socket – shoulder, hip
Ellipsoid/condyloid – atlantooccipital metacarpophalangeal joint
34
```
What is the main role of the following tissues? Synovial cartilage (hyaline)
Synovial membrane
Capsule
Ligament
Fat pad
Bursa
Muscle
Tendons
Tendon sheath
```
Synovial cartilage (hyaline) = absorbs shock and reduces friction of movement
Synovial membrane = lubrication of cartilage
Capsule = encloses joint
Ligament = limit joint range, stabilisation
Fat pad = shock absorption
Bursa = friction reduction
Muscle = primary movement force
Tendons = stabilisation
Tendon sheath = surround tendon as they pass over bones
35
What is avascular necrosis
Death of bone due to a lack of blood supply
36
What is the difference between osteoarthrosis and osteoarthritis?
Osteoarthrosis: wear and tear; emphasises the mechanical damage rather than the inflammatory response
Osteoarthritis: emphasis the mechanical damage AND the inflammatory response
37
Name 3 structural changes seen in osteoarthritis
Cartilage: thinning and cracking
Bone: sclerosis (thickening), osteophyte formation
Synovium/capsule thickening
38
Name 8 Treatments/Interventions used in treatment of OA
Reducing pain and inflammation
Education regarding behaviour and lifestyle
Exercises to improve mobility and strength
Analgesia
Non-steroid anti-inflammatory drugs
Joint replacement surgery
Intra-articular steroid injection
Insoles, braces & supports
39
Define Rheumatoid arthritis (RA)
Rheumatoid Arthritis is an autoimmune disorder whereby the immune system attacks the tissue of the joints which leads to swelling and pain primarily affecting joints.
40
In what way does RA present differently to OA?
Symptoms tend to occur bilaterally
Rheumatoid nodules
Anaemia
Loss of appetite
Fever
Non joint issues (skin, eye, heart, kidney)
Relapsing and remitting
41
What are the 3 types of muscle tissue and what are they responsible for?
Skeletal = locomotion, facial expressions, posture, respiration
Smooth = walls of organs, blood vessels, eye, glands and skin
Cardiac = involuntary control by endocrine and nervous system, controls heart
42
# Define the following
Fascicle
Fibre
Sarcomere
Myofilament
Fascicle = a discrete bundle of muscle tissue
Fibre = a muscle cell
Sarcomere = contractile unit of muscle
Myofilament = actin and myosin containing structure
43
Describe the 3 types of muscle contraction
Isometric = no change in length but tension increases
Isotonic = change in length but tension constant
Muscle tone = involuntary constant tension of muscle for long periods of time
44
What is the difference between concentric and eccentric contraction
Concentric = the internal force is greater than the external force. When applied muscle length shortens and origin and insertion move closer together.
Eccentric = external force is greater than internal force. Muscle lengthens whilst still maintaining tension. Origin and insertion move apart.
45
State and explain the 4 functional characteristics of muscle
Contractility = ability of muscle to shorten with force
Excitability = capacity of muscle to respond to stimulus.
Extensibility = muscle can be stretched to its normal resting length
Elasticity = ability of muscle to recoil to original resting length after being stretched.
46
Name and explain each stage of the Oxford Grading Scale
0 = no muscle movement
1 = muscle movement without joint motion
2 = moves with gravity eliminated
3 = moves against gravity but no resistance
4 = moves against gravity and light resistance
5 = normal strength
47
State 4 factors affecting muscle force generation
Length/tension relationship
Velocity/speed
Recruitment
Fatigue
48
Explain the mechanical advantage of levers
The closer the load is to the fulcrum and the longer the lever, the lower the level of effort required to move the load
49
What is hysteresis?
Energy loss associated with cyclic loading and unloading
50
What is creep?
Gradual tissue deformation under constant load
51
What is stress relaxation?
Sudden hard force = instant deformation
| Constant deformation under gradually decreasing load
52
What is rate of loading?
The speed in which a tissue is loaded. The faster it is loaded the stiffer it is.
53
What is viscosity?
A fluids resistance to flow
54
What is elasticity?
The ability of tissue to return to its normal original length after stretch/deformation
55
What is sarcopenia and the 3 changes it causes?
Degenerative loss of skeletal muscle mass and strength associated with ageing
Loss of muscle fibre number
Loss of cross-sectional area
Preferential loss of fast twitch fibres
56
How many lobes in each lung
Right lung has 3 lobes
Left lung has 2 lobes
57
What constitutes the upper respiratory tract?
External nose
Nasal cavity
Pharynx
58
What constitutes the lower respiratory tract?
Larynx
Trachea
Bronchi
Lungs
59
Where does the trachea start and end
C2 to T4
60
What is the primary function of the alveoli?
Gas exchange
61
What is minute ventilation?
Total amount of air passing in and out of the lungs in one minute
62
What is normal respiratory rate?
12-20 breaths per minute
63
What are the inspiratory respiratory muscles?
External intercostals
Pectoralis minor
Scalene
Sternocleidomastoid
Diaphragm (contracts)
64
What are the expiratory muscles?
Internal intercostals
Abdominals
Diaphragm (relaxes)
65
How would secretions sound on auscultation?
Crackles (can be fine or course)
66
What is VQ mismatch?
Deficiency in blood supply to lungs (perfusion)
Or
Deficiency in supply of O2 to lungs (ventilation)
67
What do cilia do?
Waft secretions/mucus to the throat, where it can be expectorated
68
What 4 things effect the efficiency of the cilia?
Dehydration
Smoking
Hypoxia
Inflammation
69
Why would you use humified oxygen?
Hydrating effect on cilia prevents dehydration and optimises cilia function
70
What is the role of a cough?
Clear blockages and/or secretions, which helps to maintain a patient’s airway
71
What is lung compliance?
The measure of ease of expansion of the lungs and thorax.
72
What would low lung compliance suggest?
Stiff lungs – fibrosis or atelectasis (Collapse of the lung - partial or complete).
73
What is external respiration
Exchange of oxygen in the lungs into the blood.
74
What is internal respiration
Exchange of oxygen from the blood to the tissues.
75
What is cyanosis?
Lack of oxygen in the blood
76
How would someone with cyanosis present?
Blue lips / skin / fingers
77
Name common obstructive lung diseases
Bronchitis
Bronchiectasis
Emphysema
Asthma
COPD
78
What is pleural effusion?
Build-up of fluid within the pleura
79
What does atelectasis mean?
Collapse or closure of the lung
80
Kyphotic posture and obesity are what types of lung condition?
Restrictive lung conditions
81
What does CHD/CAD stand for and what is it?
Coronary heart disease / coronary artery disease
The partial or full blockage of the coronary arteries by build-up of LDL proteins which form plaques, increase turbulence or completely stops flow of blood
82
Name 8 risk factors to CAD
Smoking
Obesity
High blood pressure
Stress
Reduced exercise tolerance
Age
Glucose intolerance
High cholesterol
83
What does MI stand for and what is it in layman’s terms
MI = myocardial infarction
Heart attack
84
How long before lack of blood to the heart causes permanent damage?
20 minutes
85
What is angina described as
Choking of the chest
86
What are 6 symptoms of MI?
Retrosternal chest pain
Crushing, squeezing, tightness and radiating of the chest
Nausea / vomiting
Sweating, cold and clammy skin
Tachy/Brady cardia and irregular rhythms
Feeling of impending doom
87
What are the 2 types of angina and how do they present differently?
Stable = comes on after exercise/exertion or increased emotion/stress. Eases with GTN medication and rest.
Unstable = no clear cause, can come on at rest. Takes increased amounts of GTN each time to resolve.
88
What is AF? How might someone with AF present?
Atrial fibrillation
Faint or lightheaded
Palpations or irregular heartbeat
Chest pains / weakness
89
What are some of the treatments for AF?
Rate control
Rhythm control
Anticoagulation
Treat the underlying cause e.g. valve problem
90
What does LVSD stand for? What type of cardiac problem is it?
Left ventricular systolic dysfunction
Heart failure
91
Name the heart valves
Mitral/bicuspid
Tricuspid
Aortic
Pulmonary
92
What 3 things assist venous return
Valves
Muscular compression
Respiratory pump
93
What is systole blood pressure measuring?
Ventricular contraction and ejection of blood (pressure on the artery.
94
What is the sinoatrial node?
The heart’s pacemaker
95
What is the CNS and. Its function?
Central nervous system.
Brain and spinal cord
Controls most of body’s function. The command centre
96
What is the PNS and its function?
Peripheral nervous system.
12 cranial nerves, spinal nerves and root + autonomous nerves
Transmits information from peripheries to CNS
97
What is the difference between afferent and efferent nerve signals
Afferent = to the CNS with sensory information
Efferent = from the CNS with motor commands
98
What influences the speed of action potentials?
Myelin sheath (saltatory conduction)
Diameter of the axon
99
What is the reflex arc
Sensory message is sent from the PNS to spinal cord.
Spinal cord sends a motor command straight back to affected tissue
Action potential transmission bypasses brain
E.g. pin in foot
100
What is Golgi tendon reflex?
When you lift weights, the Golgi tendon organ is the sense organ that tells you how much tension the muscle is exerting. If there is too much muscle tension the Golgi tendon organ will inhibit the muscle from creating any force (via a reflex arc), thus protecting you from injury.
101
How many pairs of spinal nerves exist?
31 pairs
| run from foramen magnum to L2
102
Define a dermatome
Innervation from a single nerve root into the dermis
103
In terms of myotomes, what movement does C5 innervate
Shoulder abduction
104
What is a myotome?
a set of muscles innervated by a specific, single spinal nerve
105
Name an ascending spinal tract and its function
Spinothalamic trace = pain, temperature, touch, pressure
Spinocerebellar tract = proprioception, balance and co-ordination
Fasciculi’s cutaneous tracts = discriminative touch
106
What is the primary function of the brain stem?
Heart rate
Respiratory rate
Temperature regulation
Blood pressure
107
Define 3 types of neurological conditions and give examples for each.
Sudden onset – stroke
Intermittent and unpredictable – epilepsy, early MS
Stable with changing needs – cerebral palsy
108
What are the following acronyms:
SCI
PD
MND
MS
TBI
ABI
SCI – spinal cord injury
PD – Parkinson’s Disease
MND – Motor Neuron Disease
MS – Multiple Sclerosis
TBI – Traumatic Brain Injury
ABI – Acquired Brain Injury
109
Define some common symptoms of neurological damage
Abnormal movement
Spasticity
Clonus
Hypo/hypertonus
Flaccidity
Rigidity
Weakness
Ataxia
Atrophy
Loss of function
Bradykinesia
Dyskinesia
Vertigo/dizziness
Lack of coordination
Reduced/absent sensation
Autonomic symptoms
Dysarthria
Dysphagia
Dysphasia
Tremor
110
Define neuroplasticity
The ability of the brain to change its structure in order to facilitate or enhance a new/unpractised function
The brains' ability to rearrange and form new synaptic connections in a response to learning or following injury
111
Name 3 requirements for neuroplasticity to occur
Intact neuromusculoskeletal system
Intact sensory-motor control
Intact cognitive process
112
Movement is an interaction of which 3 factors
Task
Individual
Environment
113
What are the principles of neuroplasticity
Use it or lose it
Use it and improve it
Specificity
Repetition matters
Intensity matters
Time matters
Salience matters
Age matters
Transference
Interference
114
What are the respiratory system functions?
Gaseous exchange - o2 enters CO2 exits
regulation of blood PH - alters by changing CO2 levels in the blood
Voice production - As air travels through past vocal cords sounds/ speech is produced
Olfaction (smells) - Airbourne molecules enter the nasal cavity
Protection - Against microorganisms entering the body, and expells/removes through the respiratory tract
115
What are normal values for:
BP
RR - Respiratory rate
Pulse -
Temp -
BP - 120/80
RR - Respiratory rate = 12 - 20 breaths per minute
Pulse - 60 - 100 bpm
Temp - 36.1 - 37.2
116
What is a nociceptor?
sensory receptors that are activated by noxious stimuli that damage or threaten the body's integrity.
Nociceptors are specific receptors within the skin, muscle, skeletal structures, and viscera that detect potentially damaging stimuli.
117
What is nocioception?
Nociception is the process by which noxious stimulation is communicated through the peripheral and central nervous system.
118
What are the 4 basic steps involved in nocioception (in the correct order)
1. Transduction
2. Transmission
3. Perception
4. Modulation
119
Definine transduction (nociceptive pain)
The process by which external stimuli are converted to electrical signals that can be perceived as pain.
Transduction begins when the free nerve endings (nociceptors) of C fibres and A-delta fibres of primary afferent neurones respond to noxious stimuli.
120
What 3 stimuli can activate nociceptive pain?
Mechanical (pressure swelling, abscess, Tumor growth)
Heat (burn, scald)
Chemical (toxic substance, ischemia, infection)
121
Where are nociceptors found / distrubuted?
Somatic structures (skin muscles, conective tissue, bones)
Visceral structures (e.g Gastro intestinal tract)
C fibre and delta A fibres are associated with different pain qualities.
122
Explain the transmission process (nociception) 3 stages
from the site of transduction along the nociceptor fibres to the dorsal horn in the spinal cord;
from the spinal cord to the brain stem via spinothalamic tract;
through connections between the thalamus, cortex and higher levels of the brain where the signal is processed.
123
Explain perception (nociception)
Perception of pain is the end result of the neuronal activity of pain transmission and where pain becomes a conscious multidimensional experience. The multidimensional experience of pain has affective-motivational, sensory-discriminative, emotional and behavioural components.
When the painful stimuli are transmitted to the brain stem and thalamus, multiple cortical areas are activated and responses are elicited which are:
The reticular system
Somatosensory cortex
Limbic system
124
Explain modulation stage (nociception)
Changing or inhibiting transmission of pain impulses in spinal cord.
Decending modulating pain pathways either increase transmission of pain impulses (excitatory) or decreases transmission (inhibition)
125
What are the categories of pain (5)
1. Nociceptive
2. Neuropathic
3. Sypmathetic
4. Nocioplastic (Centralised pain)
5. affective
126
Clinical features of nociceptive pain
```
Small area
easy to demarcate
clear aggs and eases behaviour
Stress tissue =pain Remove stress = no pain
May have referred pain
```
127
What is neuropathic pain?
initiated by primary leison or damage to the nervous system.
Pain is a direct consequence of a leison or disease effecting the somatosensory system (peripheral or central level)
128
Neuropathic pain causes
Trauma - nerve injury / compression
viral infection
Cancer related disease or treatment
Surgical procedures / amputations
Exposure to drugs alcohol, toxic substances
129
What is sympathetic maintained pain?
Sympathetic mediated pain, is a chronic neuropathic pain condition
The sympathetic nervous system inexplicably sends pain signals to the brain.
The pain associated with the condition is chronic and often debilitating, with even the slightest touch causing severe pain.
130
How does sympathetically maintained pain present?
Chronic regional pain syndrome
Sympathetic nervous system involved
Swelling
glossy skin
Sweating
temp change
vascular changes
131
What is nocioplastic pain / central sensitisation?
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.
132
Nocioplastic clinical features
Wide spread pain
Less clear aggs and eases
Allodynia
Secondary hyperalgesia
spontaneous pain
133
What is:
```
Hyper algesia
Primary hyperalgesia
Secondary hyperalgesia
Nocioception
Allodynia
```
Hyper algesia = increased sensitivity to feeling pain and an extreme response to pain.
Primary hyperalgesia - increased responsiveness to both heat and mechanical stimulation in the area of injury
Secondary hyperalgesia = increase in sensitivity to mechanical nociceptive stimuli delivered outside the area of tissue injury.
Nocioception = the process by which noxious stimulation is communicated through the peripheral and central nervous system
Allodynia = extreme sensitivity to touch. Activities that aren't usually painful (like combing one's hair) can cause severe pain.
134
Dextrocardia - what is it?
When the heart is pointed to the right side of the chest.
135
List three cardiovascular system changes in response to Exercise.
regional muscle vasodialation,
increased cardiac output,
Systolic blood pressure increases, diastolic blood pressure decreases
Heart mass and volume increase • Resting heart rate can decrease significantly • Cardiac output increases significantly during exercise • Stroke volume increase • Blood flow to skeletal muscle increases • Blood plasma volume increases in the majority of the blood vessels)
136
What information is carried in the corticospinal pathway?
motor pathway from the brain’s motor cortex to lower motor neurons
responsible for voluntary movement of the muscles of the limbs and trunk.
137
What is the cardiac cycle?
Period between the start of one heartbeat and the start of the next. • Alternating periods of contraction and relaxation
138
What is MS?
Autoimmune response in which the myelin in the CNS is destroyed, this contributes to impaired connectivity in the impacted brain areas and tracts, this can happen in the brain and in the spinal cord
139
Name 3 non physical causes of pain
```
anxiety,
depression,
fear avoidance,
patients beliefs,
catastrophising,
thoughts,
emotions,
stress,
learned
helplessness
```
