Physiology Flashcards
1
Q
Skeletal Muscle: Functions (5)
A
Maintenance of posture
Purposeful movement
Respiratory movements
Heat production
Contribute to whole body metabolism
2
Q
Skeletal Muscle: Apperance
A
Striated
3
Q
Skeletal Muscle: Gap Junctions (Yes/no)
A
No
4
Q
Skeletal Muscle: Neuromuscular junctions (yes/no)
A
Yes
5
Q
Skeletal Muscle: What initiates contraction?
A
Neurogenic initiation
6
Q
Skeletal Muscle: Where does calcium come from for contraction?
A
Sarcoplasmic reticulum
7
Q
Skeletal Muscle: Innervation
A
Somatic nervous system - enables voluntary control
8
Q
Skeletal Muscle: Neurotransmitter
A
Acetylcholine
9
Q
Motor unit
A
Single alpha motor neurone and all the skeletal muscle fibres it innervates
10
Q
Skeletal Muscle: Do fine movement muscles have more or less motor units?
A
Fewer fibres
11
Q
Skeletal Muscle: Do power movement muscles have more or less motor units?
A
More fibres
12
Q
Skeletal Muscle: Organisation
A
Parallel muscles fibres bundled within connective tissue
13
Q
Skeletal Muscle: Each fibre contains what?
A
Myofibrils
14
Q
Myofibrils
A
Specialised contractile intracellular structures
15
Q
Skeletal Muscle: Myofibrils are composed of what?
A
Actin and Myosin
16
Q
Skeletal Muscle: What type of filament is actin?
A
Thin
17
Q
Skeletal Muscle: What type of filament is myosin?
A
Thick
18
Q
Skeletal Muscle: Actin and Myosin are arranged into what?
A
Sarcomeres
19
Q
Skeletal Muscle: What is the functional unit of muscle?
A
Sarcomeres
20
Q
Skeletal Muscle: How are skeletal muscles attached to bone?
A
Tendons
21
Q
Skeletal Muscle: Where are sarcomeres found?
A
Between two Z-lines
22
Q
Skeletal Muscle: Function of the Z line
A
Connects the thin filaments of 2 adjoining structures
23
Q
Skeletal Muscle: What are the 4 zones of the sarcomere?
A
A-band
H-zone
M-line
I-band
24
Q
Skeletal Muscle: A-band
A
Thick filaments with portions of thin filaments that overlap in both ends of the thick filaments
25
Skeletal Muscle: H-zone
Lighter area in the middle of the A-band where the thin filaments do not exist
26
Skeletal Muscle: M-line
Extends vertically down the middle of the A-band within the centre of the H-zone
27
Skeletal Muscle: I-band
Consist of the remaining portion of thin filaments that do not project in the A-band
28
Skeletal Muscle: Sliding Filament Theory
Muscle tension is produced by sliding of actin filaments over myocine filaments to shorten the muscle to provide force
29
Skeletal Muscle: Excitation-Contraction Coupling
Process whereby the surface action potential results in the activation of contractile structures of the muscle fibre
30
Skeletal Muscle: Role of Calcium in Excitation-Contraction coupling
Switch on cross bridge formation
31
Skeletal Muscle: Role of ATP in Excitation-Contraction coupling during contraction
Powers the cross-bridge formation
32
Skeletal Muscle: Role of ATP in Excitation-Contraction coupling during relaxation
Releases cross bridges and aids pumping of Calcium back into the sarcoplasmic reticulum
33
Skeletal Muscle: What does the gradation of skeletal muscle tension depend on? (2)
Number of muscle fibres contracting within the muscle
Tension developed within each contracting muscle fibre
34
Skeletal Muscle: How is stronger contraction achieved?
Stimulation of more motor units by motor unit recruitment
35
Skeletal Muscle: How do we prevent muscle fatigue?
Asynchronous motor unit recruitment during sub-maximal contraction
36
Skeletal Muscle: The tension developed by each contracting muscle fibre depends on what? (4)
Frequency of stimulation
Summation of contractions
Length of the muscle fibre at the onset of contraction
Thickness of the muscle fibre
37
Skeletal Muscle: How does summation work?
A muscle fibre is re-stimulated before it has completely relaxed
38
Skeletal Muscle: Summation enables what to occur?
Tetanus
39
Tetanus
Sustained contraction
40
Skeletal Muscle: How is maximal tetanic contraction achieved?
When the muscle is at its optimal length before the onset of contraction
41
Skeletal Muscle: Io
Optimum length of muscle
42
Skeletal Muscle: What is the optimum length of muscle?
Point of optimal overlap of the thick filament cross bridges and thin filament binding sites to achieve maximal tetanic tension
43
Skeletal Muscle: Contractile component of the Muscle Length-Tension Relationship
Cross bridge cycling is transmitted to the bone via stretching and tightening of muscle connective tissue and tendones
44
Skeletal Muscle: Elastic component of the Muscle Length-Tension Relationship
Stretching and tightening of muscle connective tissue and tendons
45
Muscle Contraction: Isotonic Contraction
Muscle tension that remains constant as muscle length changes
46
Muscle Contraction: Isometric Contraction
Muscle tension develops at a constant muscle length
47
Muscle Contraction: How is muscle tension transmitted to bone?
Elastic components of the muscle
48
Muscle Fibres: Metabolic process when oxygen is available
Oxidative Phosphorylation
49
Muscle Fibres: Type I - Colour
Red
50
Muscle Fibres: Metabolic process when oxygen is not available?
Glycolysis
51
Muscle Fibres: Type I - Characteristic
Slow twitch fibres
52
Muscle Fibres: Type I - Utilised in what activities?
Prolonged low work aerobic activities
53
Muscle Fibres: Type IIa - Colour
Red
54
Muscle Fibres: Type IIa - Metabolism
Aerobic and Anerobic
55
Muscle Fibres: Type IIa - Utilised in what activities?
Prolonged moderate work
56
Muscle Fibres: Type IIb - Colour
White
57
Muscle Fibres: Type IIb - Metabolism
Anaerobic
58
Muscle Fibres: Type IIb - Utilised for what?
Short-term high intensity activities
59
Muscle Fibres: Type IIb name
Fast Glycolytic Fibres
60
Muscle Fibres: Type IIa name
Fast oxidative fibres
61
Muscle Fibres: Type I name
Slow Oxidative fibres
62
Reflex
Stereotyped response to a specific stimulus
63
What type of reflex is the stretch reflex?
Monosynaptic spinal reflex
64
Stretch Reflex: Purpose
Negative feedback that resists passive changes in muscle length to maintain an optimal resisting length of muscle
65
Stretch Reflex: Provoked by what?
Tapping the muscle tendon with a rubber hammer
66
Stretch Reflex: How does tapping the muscle cause contraction?
As rapidly stretches the quadriceps femoris
67
Stretch Reflex: Sensory Receptor
Muscle spindle
68
Stretch Reflex: What do afferent neurones synapse into?
Spinal cord with alpha motor neurones
69
Stretch Reflex: How is muscle contraction coordinated?
By simultaneous relaxation of the antagonist muscle
70
Reflex: Knee Jerk - Spinal segment
L3 and L4
71
Reflex: Knee Jerk - Peripheral Nerve
Femoral Nerve
72
Reflex: Ankle Jerk - Spinal Segment
S1 and S2
73
Reflex: Ankle Jerk - Peripheral Nerve
Tibial Nerve
74
Reflex: Biceps Jerk - Spinal Segment
C5-C6
75
Reflex: Biceps Jerk - Peripheral Nerve
Musculotaneous Nerve
76
Reflex: Brachioradialis Jerk - Spinal Segment
C5-C6
77
Reflex: Brachioradialis Jerk - Peripheral Nerve
Radial Nerve
78
Reflex: Triceps Jerk - Spinal Segment
C6-C7
79
Reflex: Triceps Jerk - Peripheral Nerve
Radial Nerve
80
What are the receptors for the stretch reflex?
Muscle spindles
81
Muscle Spindle
Collection of specialised muscle fibres
82
Muscle Spindles: Intrafusal fibres
Collection of specialised muscle fibres found within a muscle spindle
83
Muscle Spindles: Extrafusal Fibres
Standard skeletal muscle fibres that generate tension by contracting
84
Muscle Spindles: Name for sensory nerve endings
Annulospiral fibres
85
Muscle Spindles: What impact does increased muscle strength have on muscle spindles?
Increased discharge from annulospiral fibres
86
Muscle Spindles: Efferent motor supply to muscle spindles
Gamma motor neurones
87
Impaired Muscle Function: Aetiologies (4)
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
88
Intrinsic Muscle Disease: Examples of Genetically determined myopathies (3)
Congenital myopathies
Chronic degeneration of contractile elements
Abnormalities in muscle membrane ion channels
89
Intrinsic Muscle Disease: Congenital Myopathies
Characteristic microscopic changes leading to reduced contractile ability of muscles
90
Intrinsic Muscle Disease: Example of disease of chronic degeneration of contractile elements
Muscular dystrophy
91
Intrinsic Muscle Disease: Example of disease of abnormalities in muscle membrane ion channels
Myotonia
92
Intrinsic Muscle Disease: Acquired Myopathies - Examples of Inflammatory Diseases (2)
Polymyositis
Inclusion body myositis
93
Intrinsic Muscle Disease: Acquired Myopathies - Example of non-inflammatory disease
Fibromyalgia
94
Intrinsic Muscle Disease: Acquired Myopathies - Example of endocrine disease (2)
Cushing's Syndrome
Thyroid disease
95
Intrinsic Muscle Disease: Acquired Myopathies - Examples of toxins that induce disease (2)
Alcohol
Statins
96
Intrinsic Muscle Disease: Symptoms (4)
Muscle weakness and fatigue
Myotonia
Myalgia
Muscle stiffness
97
Myotonia
Delayed relaxation after voluntary contraction
98
Myalgia
Muscle pain
99
Intrinsic Muscle Disease: Examples of Investigations (5)
EMG
Nerve conduction studies
Muscle enzymes
Inflammatory markers
Muscle biopsy
100
Intrinsic Muscle Disease: What is an EMG?
Electromyography
101
Intrinsic Muscle Disease: Electromyography
Electrodes detect the presence of muscular activity to record the frequency and amplitudes of muscle fibre action potentials
102
Intrinsic Muscle Disease: What do nerve conduction studies determine?
Functional integrity of peripheral nerves
103
Musculoskeletal Infections: Examples (4)
Prosthetic Joint Infection
Post-trauma infection
Vertebral osteomyelitis
Diabetic foot infection
104
Musculoskeletal Infections: Most common pathogens (5)
Staphyloccus aureus
Staphylococcus epidermidis
Streptococcus pyogenes
Gram negatives
Anaerobes
105
Musculoskeletal Infections: Gold standard for diagnosis
Bone biopsy
106
Musculoskeletal Infections: What makes the bone susceptible to infection?
Necrosis
High inoculum
107
Musculoskeletal Infections: How long does debrided bone take to be covered by vascularised soft tissue?
6 weeks
108
Musculoskeletal Infections: Gold standard management
Remove infected tissue + drain and debride + antibiotics
109
Musculoskeletal Infections: When do we choose antibiotic?
After taking percutaneous aspirate or deep surgical cultures have been acquired
110
Musculoskeletal Infections: When would antibiotics be given before culture?
Sepsis
Soft tissue infection
111
Histology: Skeletal Muscle - Nucleus structure
Multinucleate
112
Histology: Skeletal Muscle - Shape of fibres
Cylinders
113
Histology: Skeletal Muscle - Location of nuclei
Periphery of the fibre
114
Histology: Skeletal Muscle - What are the nuclei located in?
Sarcolemma
115
Histology: Skeletal Muscle - Fibres are group into what?
Fascicles
116
Histology: Skeletal Muscle - Epimysium
Connective tissue surrounding the muscle
117
Histology: Skeletal Muscle - Perimysium
Connective tissue surrounding a single fascicle
118
Histology: Skeletal Muscle - Endomysium
Connective tissue surrounding a single muscle fibre
119
Histology: Skeletal Muscle - Type I fibre have what characteristics?
Abundance of mitochondria and myoglobin
120
Histology: Skeletal Muscle - Type IIb Fibre have what characteristics?
Few mitochondria
Less myoglobin than Type I
121
Histology: Cartilage - Is it permeable?
Yes
122
Histology: Cartilage - Is it vascularised?
No
123
Histology: Cartilage - How are cells nourished?
Via diffusion through the ECM
124
Histology: Cartilage - Cells of the cartilage
Chondrocyte
125
Histology: Cartilage - Chondroblast
Immature Chondrocyte
126
Histology: Cartilage - What is the name for an immature chondrocyte?
Chondroblast
127
Histology: Cartilage - Chondrocytes live within what?
The lacuna
128
Histology: Cartilage - Function of the chondrocytes
Excrete and maintain the ECM
129
Histology: ECM - Water content
75%
130
Histology: ECM - Organic material content
25%
131
Histology: ECM - Most of the organic material is made up of what?
Type II Collagen
132
Histology: ECM - Where is Type IV collagen located?
Basement membrane of epithelial cells
133
Histology: ECM - What is the structure of the proteoglycans?
Keratan sulphate and Chondroitin bound to a core protein and hyaluronan
134
Histology: Hyaline Cartilage - Appearance
Blue-white translucent colour
135
Histology: Hyaline Cartilage - Appearance of Chondrocytes
Flat near the perichondrium and rounded or angular deeper in the tissue
136
Histology: Hyaline Cartilage - Matrix characteristics
Basophilic
Metachromatic
137
Histology: Hyaline Cartilage - Location of the Matrix
Lacunar capsule
138
Histology: Hyaline Cartilage - Lacuna of the chondrocyte is lined by what?
Territorial matrix
139
Histology: Hyaline Cartilage - What does it indicate if its pale?
Older inter-territorial matrix
140
Histology: Hyaline Cartilage - Examples of sites within the body (4)
Tracheal rings
Costal cartilage
Epiphyseal growth plates
Precursor to the bones of the foetus
141
Histology: Elastic Cartilage - Contains what cells?
Chondrocytes
142
Histology: Elastic Cartilage - Matrix is pervaded by what?
Yellow elastic fibres
143
Histology: Elastic Cartilage - Structure of border
Irregular contour
144
Histology: Elastic Cartilage - Locations in general
Sites with vibrational function
145
Histology: Elastic Cartilage - Can it regenerate?
Yes
146
Histology: Elastic Cartilage - Examples of sites (4)
External ear
Corniculate cartilages
Epiglottis
Apices of the Aryetenoids
147
Histology: Bone - Are they permeable?
No
148
Histology: Bone - How are they nourished?
Blood vessels that pervade the tissue
149
Histology: Bone - Two types of bone
Diaphysis
Epiphyses
150
Histology: Bone - Diaphysis
Outer shell of dense cortical bone that makes up the shaft of the bone
151
Histology: Bone - Epiphyses
Cancellous or trabecular bone that occupies the end of the bones
152
Histology: Bone - Structure of cancellous bone
Fine meshwork of bone
153
Histology: Bone - What are the living cells of bone?
Osteocytes
154
Histology: Cortical Bone - Osteon
Functional unit of compact bone due to bone remodelling or renewal
155
Histology: Cortical Bone - Cement lines
Visible lines surrounding the osteon that have formed during remodelling
156
Histology: Trabecular Bone - How do osteocytes survive here?
Due to contact with marrow spaces
157
Histology: Trabecular Bone - Lacks what?
Haversian Canals
158
Histology: Cells - 1st cell stage of bone
Osteoprogenitor cells
159
Histology: Cells - 2nd cell stage of bone
Osteoblasts
160
Histology: Cells - 3rd cell stage of bone
Osteocytes
161
Histology: Cells - 4th cell stage of bone
Osteoclasts
162
Histology: Cells - Osteoprogenitor cells are located where?
On the bone surfaces
163
Histology: Cells - Osteoprogenitor cells are located where in the bone structure?
Under the periosteum
164
Histology: Cells - Osteoprogenitor cell function
Act as a reserve for osteoblasts
165
Histology: Cells - Location of osteoblasts
Surface of developing bone
166
Histology: Cells - Function of osteoblasts
Secrete matrix to form bone
167
Histology: Cells - Structure of Osteoblasts
Prominent RER and Mitochondria
168
Histology: Cells - Osteoblasts can only add bone to what?
On the surface
169
Histology: Cells - Osteocyte location
Trapped within the bone matrix
170
Histology: Cells - Osteoclast location
Surface of bone
171
Histology: Cells - Function of osteoclasts
Bone resorption
172
Histology: Cells - Structure of Osteoclasts
Large multinucleated cells
173
Histology: Cells - Where are osteoclasts derived from?
Macrophages
174
Histology: Bone Remodelling - 2 main processes
Osteoclasts congregate and drill into the bone to form the Haversian Canal
Blood vessel will grow into the tunnel
175
Histology: Bone Remodelling - What lines the Haversian canals?
Osteoblasts - to lay down lamellar bone
176
Histology: Bone Remodelling - Basic multicellular unit
Collection of osteoclasts and osteoblasts
177
Histology: Bone Mineralisation - First stage
Osteoblasts secrete collagen, glycosaminoglycan and proteoglycans
178
Histology: Bone Mineralisation - Osteoid
Complex of collagen, Glycosaminoglycans and Proteoglycans
179
Histology: Bone Mineralisation - Second stage
Osteoid becomes mineralised in the Extracellular space
180
Histology: Bone Mineralisation - Mineral of bone is mainly what?
Calcium phosphate crystals
181
Histology: Bone Mineralisation - Most common calcium phosphate crystal in bone mineral
Hydroxyapatite
182
Pain
An unpleasant sensory and emotional experience associated with actual tissue damage
183
Pain Physiology: Four processes
Transduction
Transmission
Modulation
Perception
184
Pain Physiology: Transduction
Translation of noxious stimuli into electrical activity at the peripheral nociceptor
185
Pain Physiology: Transmission
Propogation of the pain signal as nerve impulses through the nervous system
186
Pain Physiology: Modulation
Modification or Hindering of the pain transmission in the nervous system
187
Pain Physiology: Perception
Conscious experience of pain to cause physiological and behavioural responses
188
Pain Physiology: Nociceptors
Primary sensory afferent neurones
189
Pain Physiology: What activates the nociceptors?
Intense noxious stimuli e.g. mechanical, trauma or chemical stimuli
190
Pain Physiology: Nociceptive Pathway - 1.
Noxious stimulation stimulates free nerve endings
191
Pain Physiology: Nociceptive Pathway - 2.
Stimulation travels to the axon of the nociceptor
192
Pain Physiology: Nociceptive Pathway - First order neurone
Nociceptor
193
Pain Physiology: Nociceptive Pathway - 3.
Stimulation travels to the dorsal or posterior horn of the spinal cord
194
Pain Physiology: Nociceptive Pathway - 4.
Travels to the axon of the projection neurone via glutamate and peptides
195
Pain Physiology: Nociceptive Pathway - Second Order Neurone
Projection neurone to tracts
196
Pain Physiology: Nociceptive Pathway - Examples of peptides for projection neurones (2)
Substance P
Neurokinin A
197
Pain Physiology: Nociceptive Pathway - 5.
Travels to the spinothalamic and spirnoreticulothalamic tracts
198
Pain Physiology: Second order neurones ascend into what?
Anterolateral system
199
Pain Physiology: Second order neurones terminate where?
Thalamus
200
Pain Physiology: STT
Spinothalamic Tract
201
Pain Physiology: SRT
Spinoreticular Tract
202
Pain Physiology: Spinothalamic Tract is involved in what?
Pain perception - location and intensity
203
Pain Physiology: Spinoreticular Tract is involved in what?
Autonomic responses to pain, arousal, emotional response and fear of pain
204
Pain Physiology: From the thalamus, sensory information is relayed to what and how?
Primary sensory cortex via third oder neurones
205
Pain Physiology: Nociceptors
Primary afferent neurones innervating peripheral tissues that are activated by mechanical, thermal or chemical stimuli
206
Pain Physiology: Nociceptors - 2 types
A-delta fibres
C-fibres
207
Pain Physiology: Nociceptors - A-delta fibres - Detect what?
Mechanical stimuli
Thermal stimuli
208
Pain Physiology: Nociceptors - A-delta fibres - Myelination is thick or thin?
Thin
209
Pain Physiology: Nociceptors - A-delta fibres - Mediate what?
First or fast pain
210
Pain Physiology: Nociceptors - A-delta fibres - Detect what pains? (3)
Lancinating
Stabbing
Pricking
211
Pain Physiology: Nociceptors - C-fibres - Thin or Thick Myelination?
None
212
Pain Physiology: Nociceptors - C-fibres - Respond to what?
All noxious stimuli - these are polymodal
213
Pain Physiology: Nociceptors - C-fibres - Mediate what?
Secondary or slow pain
214
Pain Physiology: Nociceptors - C-fibres - What pain do these detect?
Burning
Throbbing
Cramping
Aching
215
Pain: Nociceptive Pain
Normal response to injury of tissues by noxious or damaging stimuli
216
Pain: Nociceptive Pain - Provoked by what?
Intense stimulation of nociceptors
217
Pain: Nociceptive Pain - Function
Early warning physiological protective system to detect and avoid noxious stimuli
218
Pain: Inflammatory Pain
Pain caused by activation of the immune system by tissue injury or infection
219
Pain: Inflammatory Pain - Pain is activated by what mediators at the site? (3)
Leucocytes
Vascular Endothelium
Tissue resident mast cells
220
Pain: Inflammatory Pain - Causes an increase in what? (2)
Pain sensitivity to noxious stimuli
Pain sensitivity to innocuous stimuli
221
Pain: Inflammatory Pain - Hyperalgesia
Heightened pain sensitivity to noxious stimuli
222
Pain: Inflammatory Pain - Allodynia
Heightened pain sensitivity to innocuous stimuli
223
Pain: Inflammatory Pain - Discourages what? (2)
Physical contact
Movement
224
Pain: Neuropathic Pain
Pain caused by damage to neural tissue
225
Pain: Neuropathic Pain - Examples (6)
Compression neuropathies
Peripheral neuropathies
Central pain - follows stroke or spinal injury
Post-herpetic neuralgia
Trigeminal neuralgia
Phantom limb
226
Pain: Neuropathic Pain - How is this perceived? (4)
Burning
Shooting
Numbness
Pins and Needles
227
Pain: Dysfunctional Pain
Pain with no identifiable damage or inflammation
228
Pain: Dysfunctional Pain - Examples (5)
Fibromyalgia
IBS
Tension headache
Temporo-mandibular joint disease
Interstitial Cystitis
229
Pain: Dysfunctional Pain - What is ineffective in managing this?
Simple analgesics
230
Pain: Dysfunctional Pain - How do we treat this? (2)
Anti-depressants
Anti-epileptics
231
Pain: Referred Pain
Pain developed in one of part of the body is felt in another structure away from the place of its development
232
Pain: Referred Pain - Usually felt from what structures?
Deep structures
233
Pain: Referred Pain - Due to what?
Convergence of nociceptive visceral and skin afferents upon the same spinothalamic neurones at the same spinal level
234
Children's Orthopaedics: 3 areas of bone growth for length increase
Hypertrophic zone
Proliferative zone
Reserver zone
235
Children's Orthopaedics: Where does increase in bone width occur?
Periosteum
236
Children's Orthopaedics: Longitudinal growth occurs how?
From the physis (growth plate) by endochondral ossification
237
Children's Orthopaedics: How does circumferetnial growth occur?
Appositional growth
238
Children's Orthopaedics: Which physes contribute more to growth? (4)
Head of the humerus
Head of the radius
Head of the ulna
Meeting bones of the femur, tibia and fibia
239
Children's Orthopaedics: What factors affect the growth plate? (4)
Diet
Vitamins - D and A
Illness or Injury
Growth Hormone
240
Children's Orthopaedics: Assessment of Growth - What is the normal growth for the distal femur?
10mm per year
241
Children's Orthopaedics: Assessment of Growth - What is the normal growth for the proximal tibia?
6mm per year
242
Children's Orthopaedics: Assessment of Growth - When do both physes ablate?
2 years before maturity
243
Children's Orthopaedics: Knees - Varum
Legs curve outward at the knees whilst the feet and ankles touch
244
Children's Orthopaedics: Knees - Valgum
Legs touch at the knees whislt their feet and ankles spread apart
245
Children's Orthopaedics: Examples of Chondrodysplasia's (6)
Achondroplasia
Pseudoachondrodysplasia
SED - Spondyloepiphyseal Dysplasia
MED - Multiple Epiphyseal Dysplasia
Metaphyseal Chondrodysplasia
Diastrophic Dysplasia
246
Children's Orthopaedics: Examples of Tumour-like Dysplasias (4)
Diaphyseal aclasia
Ollier's Disease
Fibrous Dysplasia
Trevor's Dysplasia
247
Children's Orthopaedics: Examples of Altered Bone Density Dysplasias (2)
Osteogenesis Imperfecta
Osteopetrosis
248
Children's Orthopaedics: Examples of Storage Disorder Dysplasias (3)
Morquio's Syndrome
Hunter's Syndrome
Hurler's Syndrome
249
Children's Orthopaedics: Hip Ossification - Occurs where?
Proximal Femoral
250
Children's Orthopaedics: Hip Ossification - How many secondary ossification centres are there?
2
251
Children's Orthopaedics: Hip Ossification - Where are the two secondary ossification centres located?
Head of the femur
Greater trochanter
252
Children's Orthopaedics: Hip Ossification - Barlows Examination
Adduction with a downwards pressure
253
Children's Orthopaedics: Hip Ossification - What can result from Barlows Examination?
Posterior Dislocation
254
Children's Orthopaedics: Hip Ossification - Ortolanis Examination
Abduction with an upwards list
255
Hilgenreiner's Line
Horizontal line on an AP radiograph of the pelvis between the inferior aspects of both triradiate cartilages of the acetabulums
256
Perkin's Line
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
Acetabular Index
The angle between Hilgenreiner's Line and the line established between the triradiate cartilage and the lateral border of the acetabulum
258
Red Flags for Lower Back Pain (8)
<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
Imaging: Spine - What does X-Ray offer?
Bone outlines
260
Imaging: Spine - What does CT offer?
Shows bone outline in high detail and some soft tissue e.g. lumbar discs
261
Imaging: Spine - Why is CT more sensitive?
No overlap of bony structures
262
Imaging: Spine - In what circumstances is CT used? (4)
Fracture present
High Energy Injury
Head Injury
Abnormal Neurological Examination
263
Imaging: Spine - What does MRI offer?
Shows bone outline with bone marrow, discs, ligaments, spinal cord and nerves
264
Imaging: Spine - In what circumstances are a CT utilised? (4)
Provide detail of spinal ligaments
Acute prolapsed intervertebral disc
Epidural haematoma
Spinal cord damage
265
Imaging: Spine - What can MRI identify? (3)
Bone marrow infiltration
Extradural mass
Spinal cord compression
266
Imaging: Spine - What can X-Ray or CT identify? (3)
Bone Sclerosis
Bone Destruction
Vertebral Collapse
267
Imaging: Spine - Consistent anatomy from C3-L5 landmarks (4)
Vertebral body
Posterior Arch
Neural foramen inferior to the pedicle
Articular processes
268
Imaging: Spine - What does the posterior arch of the certebra consist of? (4)
2 pedicles
2 laminae
1 posterior spinous process
2 transverse process
269
Imaging: Spine - Function of the neural foramen inferior to the pedicle
Transmits a spinal nerve at each level
270
Imaging: Spine - What do the articular processes form?
Articular surfaces of the facet joints
271
Imaging: Spine - How do we view intervertebral ligaments?
MRI
272
Imaging: Spine - What colour are normal intervertebral ligaments on MRI?
Black
273
Imaging: Spine - What colour are damaged intervertebral discs on MRI?
White
274
Imaging: Intervertebral Discs - Visualisation on X-Rays
Invisible
275
Imaging: Intervertebral Discs - Visualisation on CT
Shows lumbar disc prolapse
276
Imaging: Intervertebral Discs - Visualisation on MRI
Best view - shows disc prolapses and dehydration
277
Imaging: Spinal Cord - Visualisation on X-Ray
Invisible - as soft tissue
278
Imaging: Spinal Cord - Best imaging device
MRI
279
Imaging: Spine - Key feature of thoracic region on X-ray
Ribs are superimposed over the vertebrae
280
Imaging: Spine - C1 - Characteristics (2)
No vertebral body
Comprises anterior and posterior arches
281
Imaging: Spine - C1 - United by what?
Articular with the occipital bone (superior) and C2 (inferior)
282
Imaging: Spine - C2 Hallmark
Odontoid process
283
Imaging: Spine - C2 - How does the Odontoid process project?
Superior - into C1
Anterior - to the spinal canal to form a joint with the C1 anterior arch
284
Intervertebral Disc Disease: Function of the discs
Cushion the vertebrae from the stress
285
Intervertebral Disc Disease: Structure of healthy discs
Pliable and contain water
286
Intervertebral Disc Disease: What may occur if a disc herniates?
Goes through the disc lining into the spinal canal to press on spinal nerves
287
Intervertebral Disc Disease: Prolapsed discs replace what?
Epidural fat
288
Upper Limb Trauma: Comminution
Bone broken in at least two places
289
Upper Limb Trauma: Angulation
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
Upper Limb Trauma: Displacement
Bone end is no longer in contact with the other end
291
Upper Limb Trauma: Impaction
Two fracture fragments are pushed together to appear more dense
292
Upper Limb Trauma: Avulsion
A bone piece attached to a tendon or ligament gets pulled away from the main bone body
293
Upper Limb Trauma: Examples of Avulsion Fracture Mimics (3)
Sesamoid bones
Accessory Ossification Centres
Old non-united fractures
294
Upper Limb Trauma: What may be seen anterior to the distal humerus on normal X-Rays?
Fat density
295
Upper Limb Trauma: Posterior Fat Pad Sign
A displaced fat pad becomes visible posterior to the distal humerus if an elbow effusion is present
296
Upper Limb Trauma: Posterior Fat Pad Sign is a sensitive indicator of what?
Elbow trauma
297
Upper Limb Trauma: Paediatrics - What may happen to ligaments and tendons in child patients?
May avulse the soft bony attachments
298
Upper Limb Trauma: Paediatrics - What may simulate a fracture?
The physis growth plate - between the epiphysis and metaphysis
299
Upper Limb Trauma: Paediatrics - What is the weakest part of developing bone?
Physis
300
Upper Limb Trauma: Paediatrics - Salter Harris Classification
Classification system used to grade growth plate fractures
301
Upper Limb Trauma: Paediatrics - Radial Buckle
One side of the radius bends but does not actually break
302
Upper Limb Trauma: Paediatrics - What is the risk factor for a Radial Buckle?
Child with soft bones
303
Upper Limb Trauma: Paediatrics - Radial Greenstick
The radius bends and breaks but not all the way through
304
Upper Limb Trauma: Paediatrics - Plastic Bowing
Incomplete fractures of the tubular long bones
305
Upper Limb Trauma: Bony Rings - Examples of Bones/Joints that form rings to share transmission of force (4)
Spinal canal
Pelvis
Forearm
Lower Leg
306
Upper Limb Trauma: Bony Rings - What occurs when a ring is disrupted?
>2 disruptions are present in the ring - may be fractures or dislocations
307
Upper Limb Trauma: Cause of Pathological Fractures
Normal stress on a weakened skeleton
308
Upper Limb Trauma: Focal Skeletal Weakening
Metastatic deposit causing a fracture nearby
309
Upper Limb Trauma: Diffuse Skeletal Weakening
Osteoporosis or Metabolic bone disease induced weakening
310
Upper Limb Trauma: Typical patient for Colles Fracture
Elderly individual with osteoporosis
311
Upper Limb Trauma: Complications of Scaphoid Fracture (3)
Non-union
AVN
Early wrist osteoarthritis
312
Upper Limb Trauma: Concern with Scaphoid Fracture
Proximal scaphoid blood supply disruption
313
Upper Limb Trauma: Surgical Neck Humerus Fracture typical patient
Post-menopausal women
314
Upper Limb Trauma: Surgical Neck Humerus Fracture - What indicates impaction?
Sclerosis
315
Upper Limb Trauma: Surgical Neck Humerus Fracture Can cause damage to what?
Axillary Nerve
316
Upper Limb Trauma: Posterior Shoulder Dislocation - What imaging view should be obtained?
X-Ray Oblique View
317
Upper Limb Trauma: Posterior Shoulder Dislocation - What would an oblique X-Ray show?
Abnormal humeral displacement posterior to the articular surface of the glenoid
318
Upper Limb Trauma: Supracondylar Fracture - Must assess what?
Humerocapitellar alignment
319
Upper Limb Trauma: Supracondylar Fracture - The presence of what assists diagnosis?
Posterior fat pad
320
Upper Limb Trauma: Supracondylar Fracture - Can damage what?
Brachial artery
321
Upper Limb Trauma: Supracondylar Fracture - What occurs if the damaged brachial artery is not treated?
Malunites to cause life long disability
322
Upper Limb Trauma: Bennett's Fracture - Involves what structure?
Articular surface of the first metacarpal base
323
Upper Limb Trauma: Bennett's Fracture - What causes displacement?
Tendons pull the thumb distal to the fracture
324
Lower Limb Trauma: Main consequences of lower limb fractures (5)
Dehydration
Starvation
DVT
PE
Pneumonia
325
Pelvic Ring Fractures: High Energy - Typical Aetiology (2)
Road Traffic Accident
Fall from height
326
Pelvic Ring Fractures: Gold standard imaging if only the pelvis is impacted
X-ray
327
Pelvic Ring Fractures: Gold standard imaging for polytrauma patients
CT
328
Pelvic Ring Fractures: High Energy - Typical patient
Young individual
329
Pelvic Ring Fractures: Low Energy - Typical patient
Elderly person with osteoporosis
330
Pelvic Ring Fractures: Low Energy - Typical Aetiology (2)
Minor fall
Insidious onset
331
Pelvic Ring Fractures: Low Energy - Imaging of choice
MRI
332
Pelvic Ring Fractures: Low Energy - Typically impact what structures?
Sacrum
Pubic rami
333
Pelvic Soft Tissue Injuries: Most common cause (2)
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
Pelvic Soft Tissue Injuries: Gold standard imaging
MRI
335
Acute Hamstring Tendon Avulsion - Associated with what?
Sports-related pelvic injury
336
Acute Hamstring Tendon Avulsion - Acute occurs due to what?
Muscle tear or Tendon avulsion
337
Hip Dislocation - Most common causes (2)
Road traffic accident
Contact sports with hip flexed
338
Hip Dislocation - Typical presentation
Posterior dislocation with acetabular rim fracture
339
Hip Dislocation - Investigations
CT
340
Hip Dislocation - What may complicate recovery? (2)
Femoral head AVN
Early osteoarthritis
341
Proximal Femoral Fractures - Investigation for Un-displaced Fracture
Repeat X-Ray after 10 days or Immediate MRI
342
Proximal Femoral Fractures: Intracapsular - Prone to what two problems (2)
Femoral head AVN
Non-union
343
Proximal Femoral Fractures: Intracapsular - Do they interfere with the blood supply to the femoral head?
Yes
344
Proximal Femoral Fractures: Intracapsular - Treatment
Hemiarthroplasty
345
Proximal Femoral Fractures: Extracapsular - Do they interfere with the blood supply to the femoral head?
No
346
Proximal Femoral Fractures: Extracapsular - Treatment
Internal Fixation
347
Femoral Shaft Fractures - Complications (2)
Bleeding
Fat Embolus
348
What can avulsed bone fragments indicate?
Soft Tissue Injury
349
Lipohaemarthosis
Collection of fat and blood within the joint
350
Lipohaemarthrosis is a specific sign of what?
Intra-articular fracture
351
Knee dislocation can induce what complications? (2)
Complex soft tissue disruption
Damage to the popliteal artery
352
Tibial Plateau Fracture - Mostly affects what?
Lateral Condyle
353
Tibial Plateau Fracture - Most common cause
Valgus force with foot planted
354
Tibial Plateau Fracture - Why is CT used?
Provides information on condylar involvement and depth of depression
355
Examples of Extensor Mechanism Injuries (2)
Quadricep tendon tears
Patellar tendon tears
356
What Knee injuries can MRI show? (3)
Meniscal tears
Ligamentous injuries
Hyaline cartilage damage
357
Diagnostic tool for Meniscal Tears
MRI
358
Diagnostic Tool for Un-displaced knee fractures
MRI
359
Trauma Cases require what scans? (2)
AP View
Horizontal beam with Lateral View
