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2017 Past Paper Questions > Past Paper Questions > Flashcards

Past Paper Questions Flashcards

1
Q

Knee joint

  1. 2 types of joints and and brief description
  2. 3 movements
  3. How does rotational locking occur?
A
  1. Tibio-femoral part: bicondylar synovial modified hinge joint
    Patello-femoral part: synovial articulation between sesamoid patella and femoral condyles
  2. Flexion, extension and rotational locking
  3. Medial rotation of femur on tibia during extension
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2
Q

Knee joint: cruciate ligaments

  1. What would indicate an ACL injury and how would you test for it?
  2. Which area of the knee do the cruciate ligaments attach to? Outside what? Inside what?
  3. What do both cruciate ligaments resist?
A
  1. Excessive anterior glide of the tibia - anterior draw test - positive
  2. Intercondylar area - outside articular cavity but still inside fibrous capsule
  3. Glide of the tibia on the femur
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3
Q

Knee joint: menisci

  1. What are the medial and lateral menisci?
  2. What are their 2 functions?
  3. Common pathophysiology?
A
  1. Fibrocartilagenous C-shaped cartilages in the knee
  2. Improve congruency between femoral and tibial condyles
    Transmit loads and act as shock absorbers during weight bearing
  3. Acute/degenerative tears
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4
Q

Varus and valgus deformities describe what?

A

What is happening to the distal part of the bone

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5
Q

Knee joint: collateral ligaments

  1. What do the collateral ligaments do?
  2. What is another lateral stabiliser?
  3. How would you test the LCL?
  4. How would you test the MCL?
A
  1. Provide passive stability to the joint, especially to varus and valgus stresses
  2. Iliotibial tract
  3. 30 degree flexion of the knee to unlock it, then apply a varus movement
  4. 30 degree flexion of the knee to unlock it, then apply a valgus movement
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6
Q

How are the tibia and fibular held together? What 2 things is it important for?

A

Interosseous membrane - weight transmission and walking

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7
Q

Ankle joint

  1. Type of joint?
  2. What movements happen at this joint?
  3. Name 2 ligaments in the ankle that stabilise it during weight bearing activities
A
  1. Synovial hinge joint
  2. Dorsiflexion and plantar flexion
  3. Lateral and medial ligaments
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8
Q

Leg muscles

  1. Anterior group: name 3 and give 2 actions
  2. Lateral group: name 2 and give 1 action
  3. Superficial posterior group: name 2 and give 1 action
  4. Deep superficial group: name 4 and give 4 actions
A
  1. Anterior
    Tibialis anterior, ED longus, EH longus
    Dorsiflexion and toe extension
  2. Lateral
    Fibularis longus and fibularis brevis
    Eversion
  3. Superficial posterior
    Gastrocnemius and soleus
    Plantarflexion of the ankle
  4. Deep posterior
    FD Longus, FH longus, tibialis posterior (and popliteus)
    Plantarflexion of ankle, inversion, flexion of toes (popliteus laterally rotates femur on fixed tibia
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9
Q

Spinal examination- testing myotomes

  1. Resisted dorsiflexion: myotome? Muscle? Nerve?
  2. Resisted big toe extension: Myotome? Muscle? Nerve?
  3. Resisted plantar flexion: myotome? Muscle? Nerve?
A
  1. Dorsiflexion - L4
    Tibialis anterior supplied by deep fibular nerve L4, L5
  2. Big toe extension - L5
    Extensor hallucis longus supplied by deep fibular nerve L5, S1
  3. Plantarflexion - S1
    Gastronemius supplied by tibial nerve S1, S2
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10
Q

Foot

  1. Foot muscles supplied by which nerve?
  2. Which aponeurosis present?
  3. Which 2 ligaments present?
  4. Medial longitudinal arch: which 5 bones?
  5. Lateral longitudinal arch: which 3 bones?
  6. Transverse arch: which 3 bones?
A
  1. Tibial nerve (S2, S3)
  2. Plantar aponeurosis
  3. Long and short plantar ligament
  4. Medial longitudinal arch: calcaneous, talus, navicular, cuneiforms, metatarsals 1-3
  5. Lateral longitudinal arch: calcaneous, cuboid, metatarsals 4-5
  6. Transverse arch: cuboid, navicular, cuneiforms
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11
Q

Describe femoral nerve pathway from anterior thigh to ankle

A

Anterior thigh: supplies quadriceps and skin of anterior thigh and knee

Becomes saphenous nerve

Follows femoral artery through adductor canal

Runs on medial side of knee and down medial leg

Supplies skin over medial leg and ankle

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12
Q

Describe the sciatic nerve pathway from posterior thigh to the foot

A

In posterior compartment of thigh it divides into tibial and common fibular nerve
Tibial nerve enters leg through popliteal fossa and gives off sural nerve (cutaneous branch)
Tibial nerve then enters foot through tarsal tunnel
Common fibular nerve enters leg through popliteal fossa aswell
Common fibular nerve divides into superficial and deep fibular branches

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13
Q

Tibial nerve in foot

  1. Divides into what 2 branches?
  2. Which has a larger sensory supply and which has a larger motor supply?
A
  1. Medial plantar nerve and lateral plantar nerve
  2. Median plantar nerve has a larger sensory supply
    Lateral plantar nerve has a larger motor supply
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14
Q

Explain the arterial supply to the leg, starting with the abdominal aorta

A 
Abdominal aorta
Common iliac (right/left)
External iliac (right/left)
Femoral artery
Enters posterior thigh and travels through popliteal fossa
Enters leg
Popliteal artery
Posterior compartment of leg
Anterior tibial artery given off and passes to anterior compartment
Posterior tibial artery
Gives off fibular artery branch
Posterior tibial artery goes through tarsal tunnel to enter sole of foot
Branches into medial and lateral plantar arteries
Popliteal- anterior tibial branch
Enters anterior compartment
Enters foot as dorsalis pedis artery
Connects with deep plantar arch
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15
Q

What are the 5 parts of venous system of leg that finish by joining the femoral vein?

A

Dorsal venous arch
Deep veins
Short saphenous vein (posterior) joins popliteal vein
Long saphenous vein

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16
Q

Popliteal fossa

  1. What is it formed by?
  2. What are the 4 contents?
A 
1. Semi-membranosus and semi-tendinosus
Biceps femoris
Medial and lateral heads of gastrocnemius
Capsule of knee joint
Deep fascia
  1. Popliteal artery
    Popliteal vein
    Tibial nerve
    Common fibular nerve
17
Q

Tarsal tunnel

  1. Formed by?
  2. What are the 6 contents from anterior to posterior (tom, dick and very nervous harry)?
A
  1. Medial malleolus and tarsals
    Flexor retinaculum
  2. Tibialis posterior, FDL, posterior tibial artery, tibial veins, tibial nerve and FHL
18
Q

What are the 2 stages of the gait cycle?

A
  1. Stance phase (foot is on the ground)

2. Swing phase (foot is swinging through)

19
Q

Common fibular nerve

  1. Motor supply to which 2 muscle groups of the leg?
  2. Sensory supply to which 2 areas?
  3. Motor supply to which muscle in thigh?
A
  1. Lateral and anterior
  2. Lateral leg and dorsum of foot
  3. Short head of biceos femoris
20
Q

Tibial nerve

  1. Motor supply to what?
  2. Sensory supply to what?
A
  1. Posterior muscle compartments of thigh, leg and sole of foot
  2. Heel and sole of foot
21
Q

Apoptosis

  1. Short definition?
  2. Long definition?
  3. 3 physiological roles?
A
  1. Regulated cell suicide
    • Energy dependent
      - cells activate enzymes to digest their own DNA and proteins
      - cells fragment
      - plasma membrane intact but altered to attract phagocytosis
      - cells cleared without leakage of contents and without host inflammatory response
  3. Digit formation in embryo/maintenance of cell number when high turnover/eliminating unwanted cells like neutrophils after an infection
22
Q

Explain the 7 steps in the morphology of apoptosis

A 
1. Cytoskeletal framework degrades
DNA fragments
Loss of mitochondrial function
Nucleus shrinks and fragments
Cell shrinks
Membrane intact but attracts phagocytosis
Cell fragments to form apoptotic bodies
23
Q

What are the 6 steps in the morphology of apoptosis?

A

Severe damage to cell membrane
Severe swelling of mitochondria and lysosomes
Lysosomal enzymes released into cytoplasm
Enzymatic digestion of cellular contents
Leakage of cellular contents
Adjacent inflammation frequent

24
Q

What are the 3 main difference between apoptosis and necrosis?

A 
1. Type of injury
In necrosis there is severe depletion of ATP
2. Magnitude of injury
Necrosis more severe
3. Duration
Necrosis longer
25
Q

Patterns of necrosis

  1. Depends on what 2 things?
  2. Explain coagulative necrosis
  3. Explain liquefactive necrosis
  4. Explain caseous necrosis
A
  1. Type of tissue and nature of causative agent
  2. Coagulative necrosis
    Due to infarction/denaturation of protein/ gross is firm,dry and slightly swollen/ microscopically retention of tissue architecture but loss of nuclei and cellular components
  3. Liquefactive necrosis
    Due to hydrolytic enzymes/ neutrophils contribute/ gross local accumulation of protein/ microscopic no architecture
  4. Caseous necrosis
    Due to coagulative and liquefactive necrosis/ gross cheesy white nodules/ microscopic no architecture and proteinaceous areas surrounded by granulomatous inflammation
26
Q

Define ischaemia

A

Impaired vascular perfusion
Affected tissue deprived of vital nutrients especially oxygen
Effects can be reversible but this depends on duration of ischaemic period and metabolic demands of tissue

27
Q

Define infarction

A

Death of tissue as a result of ischaemia
Irreversible
Tissues vary in their ability to repair/replace the loss
Dead tissues elicit an inflammatory response
Infarct heals by fibrosis

28
Q

Explain the cellular events in ischaemia

A

Loss of oxygen
ATP production fails so energy dependent processes fail
Limited anaerobic respiration
Membrane pumps fail due to lack of energy
Sodium and water influx leads to swelling
Increased cytosolic calcium
Damage to membranes, cytoskeleton and proteins
Can initiate apoptosis
Lysosomal breakdown digests the cells components
Active oxygen species damages the cells which will damage membranes, pumps, DNA and mitochondria

29
Q

What is reperfusion injury?

A

Effect of ischemia
Flow of oxygen restored
Ischaemic damage caused the accumulation of oxygen free radicals
When blood flow (and therefore oxygen) is re-introduced, the free radicals are converted into reactive oxygen species
Re-introduced blood also brings in more inflammatory cells
Tissue damage due to inflammation

30
Q
  1. List the steps in the HPA axis
  2. What can trigger it?
  3. Name the 4 negative inhibitions that can take place
  4. What 7 things does cortisol release result in?
A 
1. Input from higher centres
Hypothalamus
CRH
Anterior pituitary
ACTH
Adrenal glands (above kidneys)
Cortisol
Metabolic effects
2. Stress
3. ACTH inhibits hypothalamus
Cortisol inhibits hypothalamus
Cortisol also inhibits anterior pituitary
And finally the metabolic effects can inhibit the stress trigger
4. Anabolic liver/ catabolic muscles and fat cells/ increase in blood sugar/ preparing the body for stress/increases BP/ immunosuppressive and anti-inflammatory/ increases appetite (weight gain)
31
Q

Name the 3 classifications of HPA axis disorders and state where the abnormality is in each of them

A

Primary defect: adrenal cortex releasing cortisol

Secondary defect: anterior pituitary releasing ACTH

Tertiary defect: hypothalamus releasing CRH

32
Q
  1. What is cushings disease a result of and name 3 side effects
  2. What is addisons disease a result of and name 3 side effects
  3. Name the 2 types of endocrine dynamic testing
A
  1. Increased ACTH (pituitary defect - cushings syndrome is a non pituitary defect)
    Easy bruising and thin skin/ hypertension/ muscle wasting
  2. Increased ACTH due to adrenal insufficiency
    Weight loss/ hyperpigmentation/ hypoglycaemia
  3. Hormone levels low then do stimulation test
    Hormone levels high then do suppression test
33
Q

Endocrine testing

  1. What should you do when you first suspect an abnormality?
  2. Describe the stimulation test for adrenal insufficiency
  3. How would you assess pituitary function?
  4. After an abnormal synacthen test, how would you figure out if the cause is secondary (pituitary) or tertiary (hypothalamic)?
A
  1. Measure pituitary hormone (ACTH) and target organ hormone (cortisol)
  2. Synacthen test: ACTH injected, cortisol in blood and/or urine measured, normally should rise, if insufficiency then poor/no response
  3. Insulin hypoglycaemia test: insulin induced hypoglycaemia causes stress, plasma cortisol should rise if normal, dont use if patient has low serum cortisol
  4. Give IV synthetic CRH, measure blood cortisol before/30/60/90/120 mins
    If primary (adrenal) then high ACTH but no cortisol
    If secondary (pituitary) then absent ACTH and deficient cortisol
    If tertiary (hypothalamus) then delayed ACTH
34
Q

Explain the dexamethasone suppression test

A

Dexamethasone is a synthetic glucocorticoid
Suppresses ACTH production by binding to ACTH receptor in anterior pituitary
First you do a low dose test with 1mg
Inject it, if patient has hyperfunction the cortisol suppression is limited (in a normal person cortisol would be suppressed)
Can follow this with high dose test with 2mg
6 hourly for 48 hours
Cushings if cortisol drops more than 50% (if less than 50% then source is outside pituitary)

35
Q
  1. How could you confirm for anterior?
  2. How could you confirm for ectopics?
  3. What therapy is given in treatment?
A
  1. MRI for anterior pituitary
  2. MRI/CT for ectopics
  3. Hydrocortisone replacement therapy

2017 Past Paper Questions (1 decks)

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