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Musculoskeletal System > Physiology > Flashcards

Physiology Flashcards

1
Q

Skeletal Muscle: Functions (5)

A

Maintenance of posture
Purposeful movement
Respiratory movements
Heat production
Contribute to whole body metabolism

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2
Q

Skeletal Muscle: Apperance

A

Striated

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3
Q

Skeletal Muscle: Gap Junctions (Yes/no)

A

No

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4
Q

Skeletal Muscle: Neuromuscular junctions (yes/no)

A

Yes

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5
Q

Skeletal Muscle: What initiates contraction?

A

Neurogenic initiation

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6
Q

Skeletal Muscle: Where does calcium come from for contraction?

A

Sarcoplasmic reticulum

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7
Q

Skeletal Muscle: Innervation

A

Somatic nervous system - enables voluntary control

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8
Q

Skeletal Muscle: Neurotransmitter

A

Acetylcholine

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9
Q

Motor unit

A

Single alpha motor neurone and all the skeletal muscle fibres it innervates

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10
Q

Skeletal Muscle: Do fine movement muscles have more or less motor units?

A

Fewer fibres

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11
Q

Skeletal Muscle: Do power movement muscles have more or less motor units?

A

More fibres

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12
Q

Skeletal Muscle: Organisation

A

Parallel muscles fibres bundled within connective tissue

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13
Q

Skeletal Muscle: Each fibre contains what?

A

Myofibrils

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14
Q

Myofibrils

A

Specialised contractile intracellular structures

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15
Q

Skeletal Muscle: Myofibrils are composed of what?

A

Actin and Myosin

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16
Q

Skeletal Muscle: What type of filament is actin?

A

Thin

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17
Q

Skeletal Muscle: What type of filament is myosin?

A

Thick

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18
Q

Skeletal Muscle: Actin and Myosin are arranged into what?

A

Sarcomeres

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19
Q

Skeletal Muscle: What is the functional unit of muscle?

A

Sarcomeres

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20
Q

Skeletal Muscle: How are skeletal muscles attached to bone?

A

Tendons

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21
Q

Skeletal Muscle: Where are sarcomeres found?

A

Between two Z-lines

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22
Q

Skeletal Muscle: Function of the Z line

A

Connects the thin filaments of 2 adjoining structures

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23
Q

Skeletal Muscle: What are the 4 zones of the sarcomere?

A

A-band
H-zone
M-line
I-band

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24
Q

Skeletal Muscle: A-band

A

Thick filaments with portions of thin filaments that overlap in both ends of the thick filaments

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25
Q

Skeletal Muscle: H-zone

A

Lighter area in the middle of the A-band where the thin filaments do not exist

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26
Q

Skeletal Muscle: M-line

A

Extends vertically down the middle of the A-band within the centre of the H-zone

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27
Q

Skeletal Muscle: I-band

A

Consist of the remaining portion of thin filaments that do not project in the A-band

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28
Q

Skeletal Muscle: Sliding Filament Theory

A

Muscle tension is produced by sliding of actin filaments over myocine filaments to shorten the muscle to provide force

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29
Q

Skeletal Muscle: Excitation-Contraction Coupling

A

Process whereby the surface action potential results in the activation of contractile structures of the muscle fibre

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30
Q

Skeletal Muscle: Role of Calcium in Excitation-Contraction coupling

A

Switch on cross bridge formation

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31
Q

Skeletal Muscle: Role of ATP in Excitation-Contraction coupling during contraction

A

Powers the cross-bridge formation

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32
Q

Skeletal Muscle: Role of ATP in Excitation-Contraction coupling during relaxation

A

Releases cross bridges and aids pumping of Calcium back into the sarcoplasmic reticulum

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33
Q

Skeletal Muscle: What does the gradation of skeletal muscle tension depend on? (2)

A

Number of muscle fibres contracting within the muscle
Tension developed within each contracting muscle fibre

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34
Q

Skeletal Muscle: How is stronger contraction achieved?

A

Stimulation of more motor units by motor unit recruitment

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35
Q

Skeletal Muscle: How do we prevent muscle fatigue?

A

Asynchronous motor unit recruitment during sub-maximal contraction

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36
Q

Skeletal Muscle: The tension developed by each contracting muscle fibre depends on what? (4)

A

Frequency of stimulation
Summation of contractions
Length of the muscle fibre at the onset of contraction
Thickness of the muscle fibre

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37
Q

Skeletal Muscle: How does summation work?

A

A muscle fibre is re-stimulated before it has completely relaxed

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38
Q

Skeletal Muscle: Summation enables what to occur?

A

Tetanus

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39
Q

Tetanus

A

Sustained contraction

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40
Q

Skeletal Muscle: How is maximal tetanic contraction achieved?

A

When the muscle is at its optimal length before the onset of contraction

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41
Q

Skeletal Muscle: Io

A

Optimum length of muscle

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42
Q

Skeletal Muscle: What is the optimum length of muscle?

A

Point of optimal overlap of the thick filament cross bridges and thin filament binding sites to achieve maximal tetanic tension

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43
Q

Skeletal Muscle: Contractile component of the Muscle Length-Tension Relationship

A

Cross bridge cycling is transmitted to the bone via stretching and tightening of muscle connective tissue and tendones

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44
Q

Skeletal Muscle: Elastic component of the Muscle Length-Tension Relationship

A

Stretching and tightening of muscle connective tissue and tendons

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45
Q

Muscle Contraction: Isotonic Contraction

A

Muscle tension that remains constant as muscle length changes

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46
Q

Muscle Contraction: Isometric Contraction

A

Muscle tension develops at a constant muscle length

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47
Q

Muscle Contraction: How is muscle tension transmitted to bone?

A

Elastic components of the muscle

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48
Q

Muscle Fibres: Metabolic process when oxygen is available

A

Oxidative Phosphorylation

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49
Q

Muscle Fibres: Type I - Colour

A

Red

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50
Q

Muscle Fibres: Metabolic process when oxygen is not available?

A

Glycolysis

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51
Q

Muscle Fibres: Type I - Characteristic

A

Slow twitch fibres

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52
Q

Muscle Fibres: Type I - Utilised in what activities?

A

Prolonged low work aerobic activities

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53
Q

Muscle Fibres: Type IIa - Colour

A

Red

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54
Q

Muscle Fibres: Type IIa - Metabolism

A

Aerobic and Anerobic

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55
Q

Muscle Fibres: Type IIa - Utilised in what activities?

A

Prolonged moderate work

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56
Q

Muscle Fibres: Type IIb - Colour

A

White

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57
Q

Muscle Fibres: Type IIb - Metabolism

A

Anaerobic

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58
Q

Muscle Fibres: Type IIb - Utilised for what?

A

Short-term high intensity activities

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59
Q

Muscle Fibres: Type IIb name

A

Fast Glycolytic Fibres

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60
Q

Muscle Fibres: Type IIa name

A

Fast oxidative fibres

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61
Q

Muscle Fibres: Type I name

A

Slow Oxidative fibres

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62
Q

Reflex

A

Stereotyped response to a specific stimulus

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63
Q

What type of reflex is the stretch reflex?

A

Monosynaptic spinal reflex

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64
Q

Stretch Reflex: Purpose

A

Negative feedback that resists passive changes in muscle length to maintain an optimal resisting length of muscle

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65
Q

Stretch Reflex: Provoked by what?

A

Tapping the muscle tendon with a rubber hammer

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66
Q

Stretch Reflex: How does tapping the muscle cause contraction?

A

As rapidly stretches the quadriceps femoris

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67
Q

Stretch Reflex: Sensory Receptor

A

Muscle spindle

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68
Q

Stretch Reflex: What do afferent neurones synapse into?

A

Spinal cord with alpha motor neurones

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69
Q

Stretch Reflex: How is muscle contraction coordinated?

A

By simultaneous relaxation of the antagonist muscle

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70
Q

Reflex: Knee Jerk - Spinal segment

A

L3 and L4

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71
Q

Reflex: Knee Jerk - Peripheral Nerve

A

Femoral Nerve

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72
Q

Reflex: Ankle Jerk - Spinal Segment

A

S1 and S2

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73
Q

Reflex: Ankle Jerk - Peripheral Nerve

A

Tibial Nerve

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74
Q

Reflex: Biceps Jerk - Spinal Segment

A

C5-C6

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75
Q

Reflex: Biceps Jerk - Peripheral Nerve

A

Musculotaneous Nerve

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76
Q

Reflex: Brachioradialis Jerk - Spinal Segment

A

C5-C6

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77
Q

Reflex: Brachioradialis Jerk - Peripheral Nerve

A

Radial Nerve

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78
Q

Reflex: Triceps Jerk - Spinal Segment

A

C6-C7

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79
Q

Reflex: Triceps Jerk - Peripheral Nerve

A

Radial Nerve

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80
Q

What are the receptors for the stretch reflex?

A

Muscle spindles

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81
Q

Muscle Spindle

A

Collection of specialised muscle fibres

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82
Q

Muscle Spindles: Intrafusal fibres

A

Collection of specialised muscle fibres found within a muscle spindle

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83
Q

Muscle Spindles: Extrafusal Fibres

A

Standard skeletal muscle fibres that generate tension by contracting

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84
Q

Muscle Spindles: Name for sensory nerve endings

A

Annulospiral fibres

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85
Q

Muscle Spindles: What impact does increased muscle strength have on muscle spindles?

A

Increased discharge from annulospiral fibres

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86
Q

Muscle Spindles: Efferent motor supply to muscle spindles

A

Gamma motor neurones

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87
Q

Impaired Muscle Function: Aetiologies (4)

A

Intrinsic disease of the muscle
Disease of the neuromuscular junction
Disease of lower motor neurones that supply the muscle
Disruption of the input to motor nerves e.g. upper motor neurone disease

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88
Q

Intrinsic Muscle Disease: Examples of Genetically determined myopathies (3)

A

Congenital myopathies
Chronic degeneration of contractile elements
Abnormalities in muscle membrane ion channels

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89
Q

Intrinsic Muscle Disease: Congenital Myopathies

A

Characteristic microscopic changes leading to reduced contractile ability of muscles

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90
Q

Intrinsic Muscle Disease: Example of disease of chronic degeneration of contractile elements

A

Muscular dystrophy

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91
Q

Intrinsic Muscle Disease: Example of disease of abnormalities in muscle membrane ion channels

A

Myotonia

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92
Q

Intrinsic Muscle Disease: Acquired Myopathies - Examples of Inflammatory Diseases (2)

A

Polymyositis
Inclusion body myositis

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93
Q

Intrinsic Muscle Disease: Acquired Myopathies - Example of non-inflammatory disease

A

Fibromyalgia

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94
Q

Intrinsic Muscle Disease: Acquired Myopathies - Example of endocrine disease (2)

A

Cushing’s Syndrome
Thyroid disease

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95
Q

Intrinsic Muscle Disease: Acquired Myopathies - Examples of toxins that induce disease (2)

A

Alcohol
Statins

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96
Q

Intrinsic Muscle Disease: Symptoms (4)

A

Muscle weakness and fatigue
Myotonia
Myalgia
Muscle stiffness

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97
Q

Myotonia

A

Delayed relaxation after voluntary contraction

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98
Q

Myalgia

A

Muscle pain

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99
Q

Intrinsic Muscle Disease: Examples of Investigations (5)

A

EMG
Nerve conduction studies
Muscle enzymes
Inflammatory markers
Muscle biopsy

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100
Q

Intrinsic Muscle Disease: What is an EMG?

A

Electromyography

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101
Q

Intrinsic Muscle Disease: Electromyography

A

Electrodes detect the presence of muscular activity to record the frequency and amplitudes of muscle fibre action potentials

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102
Q

Intrinsic Muscle Disease: What do nerve conduction studies determine?

A

Functional integrity of peripheral nerves

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103
Q

Musculoskeletal Infections: Examples (4)

A

Prosthetic Joint Infection
Post-trauma infection
Vertebral osteomyelitis
Diabetic foot infection

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104
Q

Musculoskeletal Infections: Most common pathogens (5)

A

Staphyloccus aureus
Staphylococcus epidermidis
Streptococcus pyogenes
Gram negatives
Anaerobes

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105
Q

Musculoskeletal Infections: Gold standard for diagnosis

A

Bone biopsy

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106
Q

Musculoskeletal Infections: What makes the bone susceptible to infection?

A

Necrosis
High inoculum

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107
Q

Musculoskeletal Infections: How long does debrided bone take to be covered by vascularised soft tissue?

A

6 weeks

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108
Q

Musculoskeletal Infections: Gold standard management

A

Remove infected tissue + drain and debride + antibiotics

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109
Q

Musculoskeletal Infections: When do we choose antibiotic?

A

After taking percutaneous aspirate or deep surgical cultures have been acquired

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110
Q

Musculoskeletal Infections: When would antibiotics be given before culture?

A

Sepsis
Soft tissue infection

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111
Q

Histology: Skeletal Muscle - Nucleus structure

A

Multinucleate

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112
Q

Histology: Skeletal Muscle - Shape of fibres

A

Cylinders

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113
Q

Histology: Skeletal Muscle - Location of nuclei

A

Periphery of the fibre

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114
Q

Histology: Skeletal Muscle - What are the nuclei located in?

A

Sarcolemma

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115
Q

Histology: Skeletal Muscle - Fibres are group into what?

A

Fascicles

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116
Q

Histology: Skeletal Muscle - Epimysium

A

Connective tissue surrounding the muscle

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117
Q

Histology: Skeletal Muscle - Perimysium

A

Connective tissue surrounding a single fascicle

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118
Q

Histology: Skeletal Muscle - Endomysium

A

Connective tissue surrounding a single muscle fibre

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119
Q

Histology: Skeletal Muscle - Type I fibre have what characteristics?

A

Abundance of mitochondria and myoglobin

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120
Q

Histology: Skeletal Muscle - Type IIb Fibre have what characteristics?

A

Few mitochondria
Less myoglobin than Type I

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121
Q

Histology: Cartilage - Is it permeable?

A

Yes

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122
Q

Histology: Cartilage - Is it vascularised?

A

No

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123
Q

Histology: Cartilage - How are cells nourished?

A

Via diffusion through the ECM

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124
Q

Histology: Cartilage - Cells of the cartilage

A

Chondrocyte

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125
Q

Histology: Cartilage - Chondroblast

A

Immature Chondrocyte

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126
Q

Histology: Cartilage - What is the name for an immature chondrocyte?

A

Chondroblast

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127
Q

Histology: Cartilage - Chondrocytes live within what?

A

The lacuna

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128
Q

Histology: Cartilage - Function of the chondrocytes

A

Excrete and maintain the ECM

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129
Q

Histology: ECM - Water content

A

75%

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130
Q

Histology: ECM - Organic material content

A

25%

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131
Q

Histology: ECM - Most of the organic material is made up of what?

A

Type II Collagen

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132
Q

Histology: ECM - Where is Type IV collagen located?

A

Basement membrane of epithelial cells

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133
Q

Histology: ECM - What is the structure of the proteoglycans?

A

Keratan sulphate and Chondroitin bound to a core protein and hyaluronan

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134
Q

Histology: Hyaline Cartilage - Appearance

A

Blue-white translucent colour

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135
Q

Histology: Hyaline Cartilage - Appearance of Chondrocytes

A

Flat near the perichondrium and rounded or angular deeper in the tissue

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136
Q

Histology: Hyaline Cartilage - Matrix characteristics

A

Basophilic
Metachromatic

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137
Q

Histology: Hyaline Cartilage - Location of the Matrix

A

Lacunar capsule

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138
Q

Histology: Hyaline Cartilage - Lacuna of the chondrocyte is lined by what?

A

Territorial matrix

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139
Q

Histology: Hyaline Cartilage - What does it indicate if its pale?

A

Older inter-territorial matrix

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140
Q

Histology: Hyaline Cartilage - Examples of sites within the body (4)

A

Tracheal rings
Costal cartilage
Epiphyseal growth plates
Precursor to the bones of the foetus

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141
Q

Histology: Elastic Cartilage - Contains what cells?

A

Chondrocytes

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142
Q

Histology: Elastic Cartilage - Matrix is pervaded by what?

A

Yellow elastic fibres

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143
Q

Histology: Elastic Cartilage - Structure of border

A

Irregular contour

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144
Q

Histology: Elastic Cartilage - Locations in general

A

Sites with vibrational function

145
Q

Histology: Elastic Cartilage - Can it regenerate?

A

Yes

146
Q

Histology: Elastic Cartilage - Examples of sites (4)

A

External ear
Corniculate cartilages
Epiglottis
Apices of the Aryetenoids

147
Q

Histology: Bone - Are they permeable?

A

No

148
Q

Histology: Bone - How are they nourished?

A

Blood vessels that pervade the tissue

149
Q

Histology: Bone - Two types of bone

A

Diaphysis
Epiphyses

150
Q

Histology: Bone - Diaphysis

A

Outer shell of dense cortical bone that makes up the shaft of the bone

151
Q

Histology: Bone - Epiphyses

A

Cancellous or trabecular bone that occupies the end of the bones

152
Q

Histology: Bone - Structure of cancellous bone

A

Fine meshwork of bone

153
Q

Histology: Bone - What are the living cells of bone?

A

Osteocytes

154
Q

Histology: Cortical Bone - Osteon

A

Functional unit of compact bone due to bone remodelling or renewal

155
Q

Histology: Cortical Bone - Cement lines

A

Visible lines surrounding the osteon that have formed during remodelling

156
Q

Histology: Trabecular Bone - How do osteocytes survive here?

A

Due to contact with marrow spaces

157
Q

Histology: Trabecular Bone - Lacks what?

A

Haversian Canals

158
Q

Histology: Cells - 1st cell stage of bone

A

Osteoprogenitor cells

159
Q

Histology: Cells - 2nd cell stage of bone

A

Osteoblasts

160
Q

Histology: Cells - 3rd cell stage of bone

A

Osteocytes

161
Q

Histology: Cells - 4th cell stage of bone

A

Osteoclasts

162
Q

Histology: Cells - Osteoprogenitor cells are located where?

A

On the bone surfaces

163
Q

Histology: Cells - Osteoprogenitor cells are located where in the bone structure?

A

Under the periosteum

164
Q

Histology: Cells - Osteoprogenitor cell function

A

Act as a reserve for osteoblasts

165
Q

Histology: Cells - Location of osteoblasts

A

Surface of developing bone

166
Q

Histology: Cells - Function of osteoblasts

A

Secrete matrix to form bone

167
Q

Histology: Cells - Structure of Osteoblasts

A

Prominent RER and Mitochondria

168
Q

Histology: Cells - Osteoblasts can only add bone to what?

A

On the surface

169
Q

Histology: Cells - Osteocyte location

A

Trapped within the bone matrix

170
Q

Histology: Cells - Osteoclast location

A

Surface of bone

171
Q

Histology: Cells - Function of osteoclasts

A

Bone resorption

172
Q

Histology: Cells - Structure of Osteoclasts

A

Large multinucleated cells

173
Q

Histology: Cells - Where are osteoclasts derived from?

A

Macrophages

174
Q

Histology: Bone Remodelling - 2 main processes

A

Osteoclasts congregate and drill into the bone to form the Haversian Canal
Blood vessel will grow into the tunnel

175
Q

Histology: Bone Remodelling - What lines the Haversian canals?

A

Osteoblasts - to lay down lamellar bone

176
Q

Histology: Bone Remodelling - Basic multicellular unit

A

Collection of osteoclasts and osteoblasts

177
Q

Histology: Bone Mineralisation - First stage

A

Osteoblasts secrete collagen, glycosaminoglycan and proteoglycans

178
Q

Histology: Bone Mineralisation - Osteoid

A

Complex of collagen, Glycosaminoglycans and Proteoglycans

179
Q

Histology: Bone Mineralisation - Second stage

A

Osteoid becomes mineralised in the Extracellular space

180
Q

Histology: Bone Mineralisation - Mineral of bone is mainly what?

A

Calcium phosphate crystals

181
Q

Histology: Bone Mineralisation - Most common calcium phosphate crystal in bone mineral

A

Hydroxyapatite

182
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual tissue damage

183
Q

Pain Physiology: Four processes

A

Transduction
Transmission
Modulation
Perception

184
Q

Pain Physiology: Transduction

A

Translation of noxious stimuli into electrical activity at the peripheral nociceptor

185
Q

Pain Physiology: Transmission

A

Propogation of the pain signal as nerve impulses through the nervous system

186
Q

Pain Physiology: Modulation

A

Modification or Hindering of the pain transmission in the nervous system

187
Q

Pain Physiology: Perception

A

Conscious experience of pain to cause physiological and behavioural responses

188
Q

Pain Physiology: Nociceptors

A

Primary sensory afferent neurones

189
Q

Pain Physiology: What activates the nociceptors?

A

Intense noxious stimuli e.g. mechanical, trauma or chemical stimuli

190
Q

Pain Physiology: Nociceptive Pathway - 1.

A

Noxious stimulation stimulates free nerve endings

191
Q

Pain Physiology: Nociceptive Pathway - 2.

A

Stimulation travels to the axon of the nociceptor

192
Q

Pain Physiology: Nociceptive Pathway - First order neurone

A

Nociceptor

193
Q

Pain Physiology: Nociceptive Pathway - 3.

A

Stimulation travels to the dorsal or posterior horn of the spinal cord

194
Q

Pain Physiology: Nociceptive Pathway - 4.

A

Travels to the axon of the projection neurone via glutamate and peptides

195
Q

Pain Physiology: Nociceptive Pathway - Second Order Neurone

A

Projection neurone to tracts

196
Q

Pain Physiology: Nociceptive Pathway - Examples of peptides for projection neurones (2)

A

Substance P
Neurokinin A

197
Q

Pain Physiology: Nociceptive Pathway - 5.

A

Travels to the spinothalamic and spirnoreticulothalamic tracts

198
Q

Pain Physiology: Second order neurones ascend into what?

A

Anterolateral system

199
Q

Pain Physiology: Second order neurones terminate where?

A

Thalamus

200
Q

Pain Physiology: STT

A

Spinothalamic Tract

201
Q

Pain Physiology: SRT

A

Spinoreticular Tract

202
Q

Pain Physiology: Spinothalamic Tract is involved in what?

A

Pain perception - location and intensity

203
Q

Pain Physiology: Spinoreticular Tract is involved in what?

A

Autonomic responses to pain, arousal, emotional response and fear of pain

204
Q

Pain Physiology: From the thalamus, sensory information is relayed to what and how?

A

Primary sensory cortex via third oder neurones

205
Q

Pain Physiology: Nociceptors

A

Primary afferent neurones innervating peripheral tissues that are activated by mechanical, thermal or chemical stimuli

206
Q

Pain Physiology: Nociceptors - 2 types

A

A-delta fibres
C-fibres

207
Q

Pain Physiology: Nociceptors - A-delta fibres - Detect what?

A

Mechanical stimuli
Thermal stimuli

208
Q

Pain Physiology: Nociceptors - A-delta fibres - Myelination is thick or thin?

A

Thin

209
Q

Pain Physiology: Nociceptors - A-delta fibres - Mediate what?

A

First or fast pain

210
Q

Pain Physiology: Nociceptors - A-delta fibres - Detect what pains? (3)

A

Lancinating
Stabbing
Pricking

211
Q

Pain Physiology: Nociceptors - C-fibres - Thin or Thick Myelination?

A

None

212
Q

Pain Physiology: Nociceptors - C-fibres - Respond to what?

A

All noxious stimuli - these are polymodal

213
Q

Pain Physiology: Nociceptors - C-fibres - Mediate what?

A

Secondary or slow pain

214
Q

Pain Physiology: Nociceptors - C-fibres - What pain do these detect?

A

Burning
Throbbing
Cramping
Aching

215
Q

Pain: Nociceptive Pain

A

Normal response to injury of tissues by noxious or damaging stimuli

216
Q

Pain: Nociceptive Pain - Provoked by what?

A

Intense stimulation of nociceptors

217
Q

Pain: Nociceptive Pain - Function

A

Early warning physiological protective system to detect and avoid noxious stimuli

218
Q

Pain: Inflammatory Pain

A

Pain caused by activation of the immune system by tissue injury or infection

219
Q

Pain: Inflammatory Pain - Pain is activated by what mediators at the site? (3)

A

Leucocytes
Vascular Endothelium
Tissue resident mast cells

220
Q

Pain: Inflammatory Pain - Causes an increase in what? (2)

A

Pain sensitivity to noxious stimuli
Pain sensitivity to innocuous stimuli

221
Q

Pain: Inflammatory Pain - Hyperalgesia

A

Heightened pain sensitivity to noxious stimuli

222
Q

Pain: Inflammatory Pain - Allodynia

A

Heightened pain sensitivity to innocuous stimuli

223
Q

Pain: Inflammatory Pain - Discourages what? (2)

A

Physical contact
Movement

224
Q

Pain: Neuropathic Pain

A

Pain caused by damage to neural tissue

225
Q

Pain: Neuropathic Pain - Examples (6)

A

Compression neuropathies
Peripheral neuropathies
Central pain - follows stroke or spinal injury
Post-herpetic neuralgia
Trigeminal neuralgia
Phantom limb

226
Q

Pain: Neuropathic Pain - How is this perceived? (4)

A

Burning
Shooting
Numbness
Pins and Needles

227
Q

Pain: Dysfunctional Pain

A

Pain with no identifiable damage or inflammation

228
Q

Pain: Dysfunctional Pain - Examples (5)

A

Fibromyalgia
IBS
Tension headache
Temporo-mandibular joint disease
Interstitial Cystitis

229
Q

Pain: Dysfunctional Pain - What is ineffective in managing this?

A

Simple analgesics

230
Q

Pain: Dysfunctional Pain - How do we treat this? (2)

A

Anti-depressants
Anti-epileptics

231
Q

Pain: Referred Pain

A

Pain developed in one of part of the body is felt in another structure away from the place of its development

232
Q

Pain: Referred Pain - Usually felt from what structures?

A

Deep structures

233
Q

Pain: Referred Pain - Due to what?

A

Convergence of nociceptive visceral and skin afferents upon the same spinothalamic neurones at the same spinal level

234
Q

Children’s Orthopaedics: 3 areas of bone growth for length increase

A

Hypertrophic zone
Proliferative zone
Reserver zone

235
Q

Children’s Orthopaedics: Where does increase in bone width occur?

A

Periosteum

236
Q

Children’s Orthopaedics: Longitudinal growth occurs how?

A

From the physis (growth plate) by endochondral ossification

237
Q

Children’s Orthopaedics: How does circumferetnial growth occur?

A

Appositional growth

238
Q

Children’s Orthopaedics: Which physes contribute more to growth? (4)

A

Head of the humerus
Head of the radius
Head of the ulna
Meeting bones of the femur, tibia and fibia

239
Q

Children’s Orthopaedics: What factors affect the growth plate? (4)

A

Diet
Vitamins - D and A
Illness or Injury
Growth Hormone

240
Q

Children’s Orthopaedics: Assessment of Growth - What is the normal growth for the distal femur?

A

10mm per year

241
Q

Children’s Orthopaedics: Assessment of Growth - What is the normal growth for the proximal tibia?

A

6mm per year

242
Q

Children’s Orthopaedics: Assessment of Growth - When do both physes ablate?

A

2 years before maturity

243
Q

Children’s Orthopaedics: Knees - Varum

A

Legs curve outward at the knees whilst the feet and ankles touch

244
Q

Children’s Orthopaedics: Knees - Valgum

A

Legs touch at the knees whislt their feet and ankles spread apart

245
Q

Children’s Orthopaedics: Examples of Chondrodysplasia’s (6)

A

Achondroplasia
Pseudoachondrodysplasia
SED - Spondyloepiphyseal Dysplasia
MED - Multiple Epiphyseal Dysplasia
Metaphyseal Chondrodysplasia
Diastrophic Dysplasia

246
Q

Children’s Orthopaedics: Examples of Tumour-like Dysplasias (4)

A

Diaphyseal aclasia
Ollier’s Disease
Fibrous Dysplasia
Trevor’s Dysplasia

247
Q

Children’s Orthopaedics: Examples of Altered Bone Density Dysplasias (2)

A

Osteogenesis Imperfecta
Osteopetrosis

248
Q

Children’s Orthopaedics: Examples of Storage Disorder Dysplasias (3)

A

Morquio’s Syndrome
Hunter’s Syndrome
Hurler’s Syndrome

249
Q

Children’s Orthopaedics: Hip Ossification - Occurs where?

A

Proximal Femoral

250
Q

Children’s Orthopaedics: Hip Ossification - How many secondary ossification centres are there?

A

2

251
Q

Children’s Orthopaedics: Hip Ossification - Where are the two secondary ossification centres located?

A

Head of the femur
Greater trochanter

252
Q

Children’s Orthopaedics: Hip Ossification - Barlows Examination

A

Adduction with a downwards pressure

253
Q

Children’s Orthopaedics: Hip Ossification - What can result from Barlows Examination?

A

Posterior Dislocation

254
Q

Children’s Orthopaedics: Hip Ossification - Ortolanis Examination

A

Abduction with an upwards list

255
Q

Hilgenreiner’s Line

A

Horizontal line on an AP radiograph of the pelvis between the inferior aspects of both triradiate cartilages of the acetabulums

256
Q

Perkin’s Line

A

Line on an AP radiograph of the pelvis that is perpendicular to Hilgenreiner’s Line at the lateral aspects of the triradiate cartilage of the acetabulum

257
Q

Acetabular Index

A

The angle between Hilgenreiner’s Line and the line established between the triradiate cartilage and the lateral border of the acetabulum

258
Q

Red Flags for Lower Back Pain (8)

A

<20 or >50
Thoracic pain
Previous carcinoma - of the breast, bronchus or prostate
Immunocompromised - Steroids or HIV
Feeling unwell
Weight loss
Widespread neurological symptoms
Structural spinal deformity

259
Q

Imaging: Spine - What does X-Ray offer?

A

Bone outlines

260
Q

Imaging: Spine - What does CT offer?

A

Shows bone outline in high detail and some soft tissue e.g. lumbar discs

261
Q

Imaging: Spine - Why is CT more sensitive?

A

No overlap of bony structures

262
Q

Imaging: Spine - In what circumstances is CT used? (4)

A

Fracture present
High Energy Injury
Head Injury
Abnormal Neurological Examination

263
Q

Imaging: Spine - What does MRI offer?

A

Shows bone outline with bone marrow, discs, ligaments, spinal cord and nerves

264
Q

Imaging: Spine - In what circumstances are a CT utilised? (4)

A

Provide detail of spinal ligaments
Acute prolapsed intervertebral disc
Epidural haematoma
Spinal cord damage

265
Q

Imaging: Spine - What can MRI identify? (3)

A

Bone marrow infiltration
Extradural mass
Spinal cord compression

266
Q

Imaging: Spine - What can X-Ray or CT identify? (3)

A

Bone Sclerosis
Bone Destruction
Vertebral Collapse

267
Q

Imaging: Spine - Consistent anatomy from C3-L5 landmarks (4)

A

Vertebral body
Posterior Arch
Neural foramen inferior to the pedicle
Articular processes

268
Q

Imaging: Spine - What does the posterior arch of the certebra consist of? (4)

A

2 pedicles
2 laminae
1 posterior spinous process
2 transverse process

269
Q

Imaging: Spine - Function of the neural foramen inferior to the pedicle

A

Transmits a spinal nerve at each level

270
Q

Imaging: Spine - What do the articular processes form?

A

Articular surfaces of the facet joints

271
Q

Imaging: Spine - How do we view intervertebral ligaments?

A

MRI

272
Q

Imaging: Spine - What colour are normal intervertebral ligaments on MRI?

A

Black

273
Q

Imaging: Spine - What colour are damaged intervertebral discs on MRI?

A

White

274
Q

Imaging: Intervertebral Discs - Visualisation on X-Rays

A

Invisible

275
Q

Imaging: Intervertebral Discs - Visualisation on CT

A

Shows lumbar disc prolapse

276
Q

Imaging: Intervertebral Discs - Visualisation on MRI

A

Best view - shows disc prolapses and dehydration

277
Q

Imaging: Spinal Cord - Visualisation on X-Ray

A

Invisible - as soft tissue

278
Q

Imaging: Spinal Cord - Best imaging device

A

MRI

279
Q

Imaging: Spine - Key feature of thoracic region on X-ray

A

Ribs are superimposed over the vertebrae

280
Q

Imaging: Spine - C1 - Characteristics (2)

A

No vertebral body
Comprises anterior and posterior arches

281
Q

Imaging: Spine - C1 - United by what?

A

Articular with the occipital bone (superior) and C2 (inferior)

282
Q

Imaging: Spine - C2 Hallmark

A

Odontoid process

283
Q

Imaging: Spine - C2 - How does the Odontoid process project?

A

Superior - into C1
Anterior - to the spinal canal to form a joint with the C1 anterior arch

284
Q

Intervertebral Disc Disease: Function of the discs

A

Cushion the vertebrae from the stress

285
Q

Intervertebral Disc Disease: Structure of healthy discs

A

Pliable and contain water

286
Q

Intervertebral Disc Disease: What may occur if a disc herniates?

A

Goes through the disc lining into the spinal canal to press on spinal nerves

287
Q

Intervertebral Disc Disease: Prolapsed discs replace what?

A

Epidural fat

288
Q

Upper Limb Trauma: Comminution

A

Bone broken in at least two places

289
Q

Upper Limb Trauma: Angulation

A

Fracturing of the bone where the normal axis of the bone is altered so that the distal portion of the bone is pointing in a different direction

290
Q

Upper Limb Trauma: Displacement

A

Bone end is no longer in contact with the other end

291
Q

Upper Limb Trauma: Impaction

A

Two fracture fragments are pushed together to appear more dense

292
Q

Upper Limb Trauma: Avulsion

A

A bone piece attached to a tendon or ligament gets pulled away from the main bone body

293
Q

Upper Limb Trauma: Examples of Avulsion Fracture Mimics (3)

A

Sesamoid bones
Accessory Ossification Centres
Old non-united fractures

294
Q

Upper Limb Trauma: What may be seen anterior to the distal humerus on normal X-Rays?

A

Fat density

295
Q

Upper Limb Trauma: Posterior Fat Pad Sign

A

A displaced fat pad becomes visible posterior to the distal humerus if an elbow effusion is present

296
Q

Upper Limb Trauma: Posterior Fat Pad Sign is a sensitive indicator of what?

A

Elbow trauma

297
Q

Upper Limb Trauma: Paediatrics - What may happen to ligaments and tendons in child patients?

A

May avulse the soft bony attachments

298
Q

Upper Limb Trauma: Paediatrics - What may simulate a fracture?

A

The physis growth plate - between the epiphysis and metaphysis

299
Q

Upper Limb Trauma: Paediatrics - What is the weakest part of developing bone?

A

Physis

300
Q

Upper Limb Trauma: Paediatrics - Salter Harris Classification

A

Classification system used to grade growth plate fractures

301
Q

Upper Limb Trauma: Paediatrics - Radial Buckle

A

One side of the radius bends but does not actually break

302
Q

Upper Limb Trauma: Paediatrics - What is the risk factor for a Radial Buckle?

A

Child with soft bones

303
Q

Upper Limb Trauma: Paediatrics - Radial Greenstick

A

The radius bends and breaks but not all the way through

304
Q

Upper Limb Trauma: Paediatrics - Plastic Bowing

A

Incomplete fractures of the tubular long bones

305
Q

Upper Limb Trauma: Bony Rings - Examples of Bones/Joints that form rings to share transmission of force (4)

A

Spinal canal
Pelvis
Forearm
Lower Leg

306
Q

Upper Limb Trauma: Bony Rings - What occurs when a ring is disrupted?

A

> 2 disruptions are present in the ring - may be fractures or dislocations

307
Q

Upper Limb Trauma: Cause of Pathological Fractures

A

Normal stress on a weakened skeleton

308
Q

Upper Limb Trauma: Focal Skeletal Weakening

A

Metastatic deposit causing a fracture nearby

309
Q

Upper Limb Trauma: Diffuse Skeletal Weakening

A

Osteoporosis or Metabolic bone disease induced weakening

310
Q

Upper Limb Trauma: Typical patient for Colles Fracture

A

Elderly individual with osteoporosis

311
Q

Upper Limb Trauma: Complications of Scaphoid Fracture (3)

A

Non-union
AVN
Early wrist osteoarthritis

312
Q

Upper Limb Trauma: Concern with Scaphoid Fracture

A

Proximal scaphoid blood supply disruption

313
Q

Upper Limb Trauma: Surgical Neck Humerus Fracture typical patient

A

Post-menopausal women

314
Q

Upper Limb Trauma: Surgical Neck Humerus Fracture - What indicates impaction?

A

Sclerosis

315
Q

Upper Limb Trauma: Surgical Neck Humerus Fracture Can cause damage to what?

A

Axillary Nerve

316
Q

Upper Limb Trauma: Posterior Shoulder Dislocation - What imaging view should be obtained?

A

X-Ray Oblique View

317
Q

Upper Limb Trauma: Posterior Shoulder Dislocation - What would an oblique X-Ray show?

A

Abnormal humeral displacement posterior to the articular surface of the glenoid

318
Q

Upper Limb Trauma: Supracondylar Fracture - Must assess what?

A

Humerocapitellar alignment

319
Q

Upper Limb Trauma: Supracondylar Fracture - The presence of what assists diagnosis?

A

Posterior fat pad

320
Q

Upper Limb Trauma: Supracondylar Fracture - Can damage what?

A

Brachial artery

321
Q

Upper Limb Trauma: Supracondylar Fracture - What occurs if the damaged brachial artery is not treated?

A

Malunites to cause life long disability

322
Q

Upper Limb Trauma: Bennett’s Fracture - Involves what structure?

A

Articular surface of the first metacarpal base

323
Q

Upper Limb Trauma: Bennett’s Fracture - What causes displacement?

A

Tendons pull the thumb distal to the fracture

324
Q

Lower Limb Trauma: Main consequences of lower limb fractures (5)

A

Dehydration
Starvation
DVT
PE
Pneumonia

325
Q

Pelvic Ring Fractures: High Energy - Typical Aetiology (2)

A

Road Traffic Accident
Fall from height

326
Q

Pelvic Ring Fractures: Gold standard imaging if only the pelvis is impacted

A

X-ray

327
Q

Pelvic Ring Fractures: Gold standard imaging for polytrauma patients

A

CT

328
Q

Pelvic Ring Fractures: High Energy - Typical patient

A

Young individual

329
Q

Pelvic Ring Fractures: Low Energy - Typical patient

A

Elderly person with osteoporosis

330
Q

Pelvic Ring Fractures: Low Energy - Typical Aetiology (2)

A

Minor fall
Insidious onset

331
Q

Pelvic Ring Fractures: Low Energy - Imaging of choice

A

MRI

332
Q

Pelvic Ring Fractures: Low Energy - Typically impact what structures?

A

Sacrum
Pubic rami

333
Q

Pelvic Soft Tissue Injuries: Most common cause (2)

A

Sports injury - induces a muscle tear or tendon avulsion
Chronic overuse - can cause bone or soft tissue pain at site of ligament or tendon attachment

334
Q

Pelvic Soft Tissue Injuries: Gold standard imaging

A

MRI

335
Q

Acute Hamstring Tendon Avulsion - Associated with what?

A

Sports-related pelvic injury

336
Q

Acute Hamstring Tendon Avulsion - Acute occurs due to what?

A

Muscle tear or Tendon avulsion

337
Q

Hip Dislocation - Most common causes (2)

A

Road traffic accident
Contact sports with hip flexed

338
Q

Hip Dislocation - Typical presentation

A

Posterior dislocation with acetabular rim fracture

339
Q

Hip Dislocation - Investigations

A

CT

340
Q

Hip Dislocation - What may complicate recovery? (2)

A

Femoral head AVN
Early osteoarthritis

341
Q

Proximal Femoral Fractures - Investigation for Un-displaced Fracture

A

Repeat X-Ray after 10 days or Immediate MRI

342
Q

Proximal Femoral Fractures: Intracapsular - Prone to what two problems (2)

A

Femoral head AVN
Non-union

343
Q

Proximal Femoral Fractures: Intracapsular - Do they interfere with the blood supply to the femoral head?

A

Yes

344
Q

Proximal Femoral Fractures: Intracapsular - Treatment

A

Hemiarthroplasty

345
Q

Proximal Femoral Fractures: Extracapsular - Do they interfere with the blood supply to the femoral head?

A

No

346
Q

Proximal Femoral Fractures: Extracapsular - Treatment

A

Internal Fixation

347
Q

Femoral Shaft Fractures - Complications (2)

A

Bleeding
Fat Embolus

348
Q

What can avulsed bone fragments indicate?

A

Soft Tissue Injury

349
Q

Lipohaemarthosis

A

Collection of fat and blood within the joint

350
Q

Lipohaemarthrosis is a specific sign of what?

A

Intra-articular fracture

351
Q

Knee dislocation can induce what complications? (2)

A

Complex soft tissue disruption
Damage to the popliteal artery

352
Q

Tibial Plateau Fracture - Mostly affects what?

A

Lateral Condyle

353
Q

Tibial Plateau Fracture - Most common cause

A

Valgus force with foot planted

354
Q

Tibial Plateau Fracture - Why is CT used?

A

Provides information on condylar involvement and depth of depression

355
Q

Examples of Extensor Mechanism Injuries (2)

A

Quadricep tendon tears
Patellar tendon tears

356
Q

What Knee injuries can MRI show? (3)

A

Meniscal tears
Ligamentous injuries
Hyaline cartilage damage

357
Q

Diagnostic tool for Meniscal Tears

A

MRI

358
Q

Diagnostic Tool for Un-displaced knee fractures

A

MRI

359
Q

Trauma Cases require what scans? (2)

A

AP View
Horizontal beam with Lateral View

Musculoskeletal System (9 decks)

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