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Musculoskeletal system > Physiology > Flashcards

Physiology Flashcards

1
Q

How is cortical bone laid down?

A

Laid down circumferentially

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2
Q

How is cancellous bone laid down?

A

Site of longitudinal growth

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3
Q

What forces does cortical bone resist?

A

Bending

Torsion

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4
Q

What forces does cancellous bone resist?

A

Compression

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5
Q

What is a fracture?

A

Break in structural continuity of bone

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6
Q

What causes fractures?

A

High energy transfer in normal bones (traumatic fractures)
Repetitive stress in normal bones (Stress fracture)
Low energy transfer in abnormal bones (Osteoporosis, osteomalacia, bone mets. etc)

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7
Q

What are the four stages of fracture repair?

A

Stage 1 - Inflammation
Stage 2 - Soft callus
Stage 3 - Hard Callus
Stage 4 - Bone remodelling

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8
Q

What types of cells may be involved in the inflammation stage of fracture repair?

A

Platelets, PMNs, Neutrophils, Monocytes, Macrophages
Fibroblasts
Mesenchymal and osteoprogenitor cells

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9
Q

When does soft callus formation begin in fracture repair?

A

When pain and swelling subside

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10
Q

What factors make autogenous cancellous bone graft useful for fracture repair?

A

Osteoconductive

Osteoinductive

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11
Q

What type of bone formation may take place in hard callus formation in fracture repair?

A

Endochondral bone formation

Membranous bone formation

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12
Q

What takes place in bone remodelling?

A

Conversion of woven bone to lamellar bone

Medullary canal reconstituted

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13
Q

What may happen in fracture repair if magnitude of strain (instability) is too low?

A

Mechanical induction of tissue differentiation fails

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14
Q

What may happen in fracture repair if magnitude of strain (instability) is too high?

A

Healing process does not progress to bone formation

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15
Q

What is delayed union in fracture healing?

A

Failure to heal in expected time

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16
Q

What may cause delayed union in fracture repair?

A 
High energy injury
Distraction
Instability
Infection
Steroids
Immune suppressants
Smoking
Warfarin
NSAID
Ciprofloxacin
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17
Q

What may cause non union (failure to heal) in fracture repair?

A 
Failure of calicification of fibrocartilage
Instability
Abundant callus formation
Pain and tenderness
Peristent fracture line
Sclerosis
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18
Q

What alternative management may be considered in delayed healing in fracture repair?

A

Different fixation
Dynamisation
Bone grafting

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19
Q

What makes up the structure of ligaments?

A 
Collagen fibres (type 1)
Fibroblasts
Sensory fibres (Proprioception, stretch, sensory)
Vessels
Crimping formations to allow stretch
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20
Q

What are the stages in ligament healing?

A

Haemorrhage
Proliferative phase
Remodelling

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21
Q

What are the options of treatment in ligament healing?

A

Conservative
(If partial, no instability, or poor surgical candidate)
Operative
(If instability, expectation (sportsmen etc) or compulsary)

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22
Q

What makes up the structure of tendons?

A

Longitudinal arrangement of cells (tenocytes) and fibres (Collagen type 1 - triple helix) arranged into bundles > fascicles > tendon

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23
Q

What connects tendon to sheath?

A

Vincula

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24
Q

What are the functions of tendon sheaths?

A

Synovial lining + fluid (gliding lubrication and nutrition)

Thickenings which form strong annular pulleys

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25
Q

List some causes of tendon injury

A

Degeneration
Inflammation
Enthesiopathy (disorder of tendon attachment)
Traction Apophysitis
Avulsion +- bone fragment/Tear/Laceration/Incision
Crush/Ischaemia/Attrition/Nodules

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26
Q

Give an example of a degeneration tendon injury

A

Achilles tendon

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27
Q

Give an example of tendon inflammation

A

de Quervain’s stenosing tenovaginitis

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28
Q

Give an example of tendon entesiopathy

A

Tennis elbow (lateral humeral epicondylitis)

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29
Q

Who might traction apophysistis occur in?

A

Adolescent active boys (insertion of patellar tendon into anterior tibial tuberosity)

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30
Q

What treatments are available for tendon injury caused by avulsion +- bone fragment?

A

Conservative Treatment

  • Limited application
  • Retraction tendon

Operative treatment

  • Reattachment tendon -through bone
  • Fixation bone fragment
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31
Q

What covers the outside of axons?

A

Endoneurium

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32
Q

What covers the outside of fascicles?

A

Perineurium

33
Q

What covers the outside of nerves?

A

Epineurium

34
Q

What type of cells surround peripheral neurones to lay down myelin?

A

Schwann cells

35
Q

What is the largest nerve fibre type?

A

A alpha

36
Q

What is the smallest nerve fibre type?

A

C fibres

37
Q

What is the function of Aalpha fibres?

A

Large motor axons} Muscle strach and tension sensory axons

38
Q

What is the function of Abeta fibres?

A

Touch, pressure, vibration and joint position sensory axons

39
Q

What is the function of Agamma fibres?

A

Gamma efferent motor axons

40
Q

What is the function of Adelta fibres?

A

Sharp pain, very light touch and temperature sensation

41
Q

What is the function of Beta fibres?

A

Sympathetic preganglionic motor axons

42
Q

What is the function of C fibres?

A

Dull, aching, burning pain and temperature sensation

43
Q

Of neuropaxia, axonotmesis and neurotmesis, which has the best prognosis?

A

Neuropaxia - basically stretching/bruising of the nerve

44
Q

List some examples of closed nerve injuries

A

Typically stretching of nerve

eg brachial plexus injury, radial nerve humeral fracture

45
Q

What is the typical rate of healing in axonal injury?

A

1 mm/a day

46
Q

What is the first modality to return in neuronal injury?

A

Pain

47
Q

What would happen to strength in a UMN lesion?

A

Decreased

48
Q

What would happen to strength in a LMN lesion?

A

Decreased

49
Q

What would happen to tone in a UMN lesion?

A

Increased

50
Q

What would happen to tone in a LMN lesion?

A

Decreased

51
Q

What would happen to deep tendon reflexes in a UMN lesion?

A

Increased

52
Q

What would happen to deep tendon reflexes in a LMN lesion?

A

Decreased

53
Q

Would clonus be present or absent in a UMN lesion?

A

Present

54
Q

Would clonus be present or absent in a LMN lesion?

A

Absent

55
Q

Would Babinski’s sign be present or absent in a UMN lesion?

A

Present

56
Q

Would Babinski’s be present or absent in a LMN lesion?

A

Absent

57
Q

Would atrophy be present or absent in a UMN lesion?

A

Absent

58
Q

Would atrophy be present or absent in a LMN lesion?

A

Present

59
Q

What type of bone cells are responsible for bone formation?

A

Osteoblasts

60
Q

What type of bone cells are responsible for bone resorption?

A

Osteoclasts

61
Q

What type of cell do osteoclasts differentiate from?

A

Macrophages

62
Q

What does RANK Ligand do to osteoclast acitivity?

A

Activates osteoclasts, enhancing bone resorption.

63
Q

List some factors that stimulate osteoblast expression of RANK Ligand?

A 
PTH
Glucocorticoids
Vitamin D
PGE2
IL-11
IL-1
PTHrP
TNF -a
64
Q

Where is Vitamin D formed in the body?

A

LIver

As 25(OH) Vitamin D

65
Q

Where is Vitamin D converted to a useful form in the body?

A

Kidney

As 1,25 (OH)2 Vitamin D

66
Q

What does Vitamin D do in the gut?

A

Stimulates absorption of calcium and phosphate

67
Q

Why are bisphosphonates first line in osteoporosis?

A

Bisphosphonates inhibit osteoclasts - reduce bone resorbtion

68
Q

List some biomechanical differences in childrens bone compared to adults?

A

Ligaments stronger than growth plate
(Epiphyseal separation, hard to get sprains/dislocations)

Young bone more porous
(Plasticity, fails in compression and tension)

69
Q

What are the 5 S’s in paediatric orthopaedics?

A 
Symmetrical
Symptomatic
Systemic illness
Skeletal dysplasia
Stiffness
70
Q

What examinations may you look at for intoeing?

A

Identify origin of rotational concern

-Hip/Tibia/Foot

71
Q

Is there more external rotation or internal rotation of the hip at birth?

A

External rotation

72
Q

What movement of the hip will result in a child with excessive femoral anteversion?

A

Internal rotation - may give appearance of intoeing

73
Q

How may you see if intoeing pathology is arising from the hips in a child?

A

Look at the knee caps - will be equally facing inward if pathology is arising from the hips

74
Q

How is Tibial torsion clinically assessed?

A

Thigh foot angle technique

Patella position with feet/ankles facing forward

75
Q

What may be a forefoot cause of intoeing?

A

Metatarsus adductus

Self correcting pathology

76
Q

At what age should children be considered for underlying pathology of bow legs?

A

Over the age of 8 years

77
Q

What may you use in clinical assessment of the lower limbs of a child in orthopaedics?

A

Walking
Standing (Alignment from front, patella position, heels/arch/toes/leg length from behind)
Tip toes
Staheli rotational profile

78
Q

What situations may require further review in child orthopaedic leg assessment?

A

Not age appropriate signs
Assymetry
Rigid flat foot
Bow legs (Blouts, rickets)

79
Q

What situations may require treatment in child orthopaedic leg assessment?

A

Metatarsus adductus
Tibial torsion (External typically more than internal)
Persistant femoral anteversion
Curly toes

Musculoskeletal system (5 decks)

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