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Neurological, neuromuscular and musculoskeletal disease > PBL 41 > Flashcards

PBL 41 Flashcards

1
Q

The hip joint is a ball and socket joint, what is the ball and socket?

A 
Ball = head of femur
Socket = acetabulum
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2
Q

What is the acetabulum?

A

Cup-like depression located on the inferolateral aspect of the pelvis

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3
Q

What is the name of the fibrocartilaginous collar which deepens the acetabulum?

A

Acetabular labrum

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4
Q

The acetabulum and head of femur are covered in … cartilage which is thicker at the places of …

A
  • Articular cartilage

- Weight bearing

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5
Q

The ligaments of the hip joint act to increase…

A

Stability

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6
Q

The ligaments of the hip joint can be classed as intracapsular and extracapsular, give the names of all relevant ligaments to each class

A

Intracapsular: ligament of head of femur

Extracapsular: Iliofemoral, pubofemoral, ischiofemoral

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7
Q

The ligament of the head of femur encloses which artery?

A

The obturator artery AKA the artery to the head of femur

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8
Q

The iliofemoral ligament arises from the ASIS and has which shape?

A
  • Y shape
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9
Q

Which is the strongest of the 3 extracapsular hip ligaments? What does this ligament act to prevent?

A

Iliofemoral ligament

- Prevents hyperextension of the hip joint

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10
Q

The pubofemoral ligament has which shape? What does this ligament act to prevent?

A

A triangle

- Excessive abduction and extension

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11
Q

The ischiofemoral ligament has which shape? What does this ligament act to prevent?

A
  • Spiral orientation

- Prevents hyperextension and holds the femoral head in the acetabulum

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12
Q

The arterial supply to the hip is largely via the…

A

Medial and lateral circumflex arteries

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13
Q

The medial and lateral circumflex arteries are branches of the…

A

Deep femoral artery (profunda femoris)

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14
Q

The medial and lateral circumflex arteries …. at the base of the … to form a ring, from which smaller arteries arise to supply the hip joint itself

A

Anastomose

Femoral neck

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15
Q

The … artery is responsible for the majority of the arterial supply to the hip joint

A

Medial circumflex

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16
Q

Why is it that the medial circumflex artery is responsible for the majority of supply to the hip joint and less so the lateral circumflex artery?

A

The lateral circumflex artery has to penetrate through the thick iliofemoral ligament

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17
Q

Damage to the medial circumflex artery can result in…

A

Avascular necrosis of the femoral head

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18
Q

The hip joint is innervated by which nerves?

A

Sciatic, femoral and obturator

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19
Q

Movements of the hip joint?

A 
Flexion
Extension
Abduction
Adduction
Lateral rotation
Medial rotation
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20
Q

The proximal aspect of the femur consists of which landmarks?

A 
Head
Neck
Greater trochanter
Lesser trochanter
Intertrochanteric line (anteriorly)
Trochanteric crest (posteriorly)
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21
Q

On the posterior surface of the femoral shaft, there are roughened ridges of bone, called the…

A

Linea aspera (latin for rough line)

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22
Q

The medial and lateral borders of the linea aspera become…

A

The pectineal line and the gluteal tuberosity

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23
Q

Which muscle attaches to the gluteal tuberosity?

A

Gluteus maximus

24
Q

The distal end of the femur has which landmarks?

A

Medial and lateral condyles
Medial and lateral epicondyles
Intercondylar fossa

25
Q

The gluteal muscles are divided into 2 groups, what are they?

A

Superficial and deep

26
Q

The superficial gluteal muscles act to…

A

Abduct and extend the lower limb at the hip joint

27
Q

The deep gluteal muscles act to…

A

Laterally rotate the lower limb

28
Q

What is the blood supply to the gluteal muscles?

A

Branches of the internal iliac = superior and inferior gluteal arteries

29
Q

What are the superficial muscles in the gluteal region?

A

Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia lata

30
Q

What is the action and innervation of the gluteus maximus?

A

Action: Main extensor of the thigh, assists with lateral rotation
- Only used when force is required

Innervation: inferior gluteal nerve

30
Q

What is the action and innervation of the gluteus medius?

A

Action: abducts and medially rotates the lower limb
- Prevents pelvic drop

Innervation: Superior gluteal nerve

31
Q

What is the action and innervation of the gluteus minimus?

A

Action: abducts and medially rotates the lower lim
- Prevents pelvic drop

Innervation: Superior gluteal nerve

32
Q

What is the action and innervation of the tensor fascia lata?

A

Action: Assists gluteus medius and minimus in abduction and medial rotation of the lower limb

Innervation: Superior gluteal nerve

33
Q

Trendelenburg gait is caused by damage to which nerve? What is this characterised by?

A

Superior gluteal nerve

- Characterised by pelvic drop of the opposite leg when standing on one leg

34
Q

The deep gluteal muscles are a smaller set of muscles, located underneath the gluteus minimus. What is the general action of these muscles?

A

Lateral rotation and stabilising the hip joint

35
Q

How do the deep gluteal muscles stabilise the hip joint?

A

Pull the femoral head into the acetabulum of the pelvis

36
Q

What are the different deep gluteal muscles?

A

Piriformis
Obturator internus
Superior and inferior Gemelli
Quadratus femoris

37
Q

What is the action and innervation of the piriformis?

A

Action: Lateral rotation and abduction

Innervation: Nerve to piriformis

38
Q

What is the most superior muscles of the deep gluteal muscles?

A

Piriformis

39
Q

What is the action and innervation of the Obturator internus?

A

Action: lateral rotation and abduction
Innervation: Nerve to obturator internus

40
Q

The superior and inferior gluteal nerves are branches of…

A

The sacral plexus

41
Q

What is the action and innervation of the superior and inferior gemelli?

A

Action: lateral rotation and abduction

Innervation: Superior gemelli = nerve to obturator internus
Inferior gemelli = nerve to quadratus femoris

42
Q

What is the action and innervation of the quadratus femoris?

A

Action: lateral rotation & adduction

Innervation: Nerve to quadratus femoris

43
Q

Pathophysiology of osteoporosis

A

Imbalance between bone resorption and bone formation

The three mechanisms are:

  1. Inadequate peak bone pass
  2. Excessive bone resorption e.g. lack of oestrogen, excessive PTH
  3. Inadequate formation of new bone during remodelling e.g. calcium deficiency and vitamin D
44
Q

Drug treatment for osteoporosis

A

Biophosphates
Hormones: oestrogen
Denosumab

45
Q

Mechanism of biophosphates for osteoporosis treatment & side effects of daily use

A

Mechanism: Inhibit digestion of bone by encouraging osteoclast apoptosis, slowing bone loss

Side effects of daily use: poor compliance and gastric problems

46
Q

Social consequences of hip fractures in the elderly

A
  • Psychological problems: fear of falling, self imposed activity restriction, social isolation, depression
  • Increase in dependency and disability
  • Impact on carers
  • Institutionalisation: Admission to nursing home
47
Q

Ethical issues around confused people and their decision making

A

Just because a person is confused and forgetful doesn’t mean they lack capacity

Issues:

  • Find it difficult to make decisions
  • Vulnerable to abuse and exploitation
  • Vulnerable to being stigmatised and stripped of their personhood
48
Q

What are the 3 main DMARDs?

A
  1. Sulphasalazine
  2. Methotrexate
  3. Hydroxychloroquine
49
Q

Class and action of methotrexate

A

Folate antagonist

  • Inhibits folic acid reductase which converts folic acid to tetrahydrofolic acid
  • Tetrahydrofolic acid is required for both purines and pyrimidine biosynthesis so you can’t proceed with DNA synthesis
  • It affects rapidly dividing cells
50
Q

Class and action of sulphasalazine

A

Immunomodulatory agent

  • Anti-inflammatory agent used to treat ulcerative collitis and RA
  • MOA unknown
51
Q

Class and action of hydroxychloroquine

A

DNA/RNA synthesis inhibitor & anti-inflammatory agent

  • MOA unknown for RA
  • MOA for malaria is to inhibit parasitic enzyme heme polymerase, causing a build up of toxic heme within the parasite
52
Q

Definition of disability?

A

Any restriction or lack of ability to perform an action in the manner considered normal for a human being

53
Q

Definition of impairment?

A

Any loss or abnormality of psychological, physiological or anatomical structure or function

54
Q

Impact of disability on life

A
  • Mental health issues: anxiety and depression
  • Loss of freedom and independence
  • Reliance on others
  • Unemployment
  • Problems with learning & academic study
  • Loss of self-esteem and confidence –> Isolation

Neurological, neuromuscular and musculoskeletal disease (36 decks)

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