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FRCS Orthopaedics > Basic Sciences > Flashcards

Basic Sciences Flashcards

1
Q

Osteoblasts are derived from?

A

undifferentiated mesenchymal stem cells,

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2
Q

What is RUNX2?

A

multifunctional transcription factor that directs the formation of osteoblasts from UMC

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3
Q

Osteoblasts produce ?

A

Osteoblasts produce type I collagen (i.e., bone), alkaline phosphatase, osteocalcin, bone sialoprotein, and RANKL.

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4
Q

Osteocytes are ………………………… surrounded by newly formed matrix. They constitute …………….. of the cells in the mature skeleton, are
important for control of ………………………….

A

Osteocytes are former osteoblasts surrounded by newly formed matrix. They constitute 90% of the cells in the mature skeleton, are
important for control of extracellular calcium and phosphorous

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5
Q

Osteoclasts are derived from ……………………………. RANKL is produced by ……………………., binds to immature …………………………, and stimulates differentiation into active, mature
osteoclasts that result in an increase in ………………………….

A

Osteoclasts are derived from hematopoietic cells in the macrophage lineage. RANKL is produced by osteoblasts, binds to immature osteoclasts, and stimulates differentiation into active, mature
osteoclasts that result in an increase in bone resorption.

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6
Q

What is Osteoprotegerin?

A

Osteoprotegerin inhibits bone resorption by binding and inactivating RANKL.

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7
Q

How to Osteoclasts bind to bone?

A

Osteoclasts bind to bone surfaces by means of integrins (vitronectin receptor), effectively sealing the space below, and then create a
ruffled border

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8
Q

How do Osteoclasts resorp bone?

A

create a ruffled border and remove bone matrix by proteolytic digestion
through the lysosomal enzyme cathepsin K, Tartrate resistant acid phosphates and carbonic anhydrase involved too.

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9
Q

2 types of bisphosphonates?

A

Bisphosphonates directly inhibit osteoclastic bone resorption. Nitrogen-containing bisphosphonates are up to 1000-fold more
potent than non–nitrogen-containing bisphosphonates.

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10
Q

How do the 2 different types of bisphosphonates work?

A

N containing Bisphosphonates function by inhibiting farnesyl pyrophosphate synthase in the mevalonate pathway.

Non N Bisphosphonates produce a non functioning ATP analogue which leads to apoptosis of the cells.

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11
Q

Name 2 Complications of Bisphosphonate use?

A

Atypical Proximal femoral fractures, osteonecrosis of the jaw and reduced rate of spinal fusion.

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12
Q

% of inorganic (mineral) bone matrix?

A

60%

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13
Q

% of organic bone components?

A

40%

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14
Q

Main component of Inorganic matrix?

A

Calcium hydroxyapatite

constitutes the majority of the inorganic matrix.

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15
Q

chemical formula of calcium hydroxyapatite?

A

Ca10 (PO4 )6(OH)2

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16
Q

Main component of organic component of bone?

A

Type I collagen is 90% of the organic component,

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17
Q

the most abundant noncollagenous protein in bone?

A

osteocalcin

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18
Q

Wolff’s law:

A

Remodeling occurs in response to mechanical stress.

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19
Q

Hueter-Volkmann law:

A

Compressive forces inhibit growth, whereas tension stimulates it.

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20
Q

three major types of bone formation?

A

enchondral formation, bone replaces a cartilage model.

Intramembranous formation occurs without a cartilage model;

aggregates of undifferentiated mesenchymal differentiate into osteoblasts, which
form bone -Appositional bone formation
In appositional formation, osteoblasts lay down new bone on existing bone; the groove of Ranvier supplies the chondrocytes.

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21
Q

three stages of fracture repair:

A

inflammation, repair, and remodeling.

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22
Q

Fracture healing type varies with treatment method. Closed treatment is through …………………….. and ……………………………ossification. Compression plate
treatment is through ………………………………….

A

Fracture healing type varies with treatment method. Closed treatment is through periosteal bridging callus and interfragmentary enchondral ossification. Compression plate
treatment is through primary cortical healing.

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23
Q

BMP-2

A

used for acute open tibia fractures

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24
Q

BMP-7

A

is used for tibial nonunions

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25
Q

BMP-3

A

has no osteogenic activity

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26
Q

Increased BMP-4?

A

associated with the pathologic condition of fibrodysplasia ossificans progressiva.

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27
Q

Bone grafts have three properties?

A

Osteoconduction acts as a scaffold for bone growth; osteoinduction involves growth factors that stimulate bone formation; osteogenic grafts contain primitive mesenchymal cells, osteoblasts, and osteocytes.

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28
Q

Calcium phosphate–based grafts are ?

A

capable of osseoconduction and osseointegration. They have the highest compressive strength of
any graft material

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29
Q

Calcium sulfate is:

A

osteoconductive but rapidly resorbed

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30
Q

The primary homeostatic regulators of serum calcium are:

A

PTH and 1,25(OH)2
-vitamin D3. PTH results in increased serum Ca2+
decreased inorganic phosphate level.

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31
Q

Bone mass peaks between

A

16 and 25 years of age

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32
Q

Physiologic bone loss affects ……………….bone more than ……………………..bone.

A

Physiologic bone loss affects trabecular bone more than cortical bone.

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33
Q

Urinary markers of increased bone resorption?

A

Both urinary hydroxyproline and pyridinoline cross-links are elevated when there is bone resorption.

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34
Q

serum marker of increased bone formation?

A

Serum alkaline phosphatase increases when bone formation increases.

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35
Q

The most common cause of hypercalcemia ?

A

Malignancy

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36
Q

Treatment of Hypercalcaemia?

A

Initial treatment is with hydration, which causes a saline diuresis, along
with loop diuretics

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37
Q

phosphorous retention and secondary hyperparathyroidism leads commonly to what?

A

Renal osteodystrophy

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38
Q

Failure of bone mineralisation leads to what?

A

Rickets (in children) and osteomalacia (in adults)

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39
Q

Which zone of the physis is affected in Rickets?

A

the width of the zone of provisional calcification is increased, which causes physeal widening
and cupping

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40
Q

WHO definition of Osteoporosis?

A

Osteoporosis is a quantitative defect in bone. It is defined as a lumbar bone density of 2.5 or more standard deviations less than the
peak bone mass of a healthy 25-year-old (T-score).

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41
Q

Treatment of osteoporosis includes

A

calcium supplements of 1000 to 1500 mg/day, as well as bisphosphonates.

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42
Q

What is Scurvy?

A

Scurvy results from ascorbic acid deficiency, which causes a decrease in chondroitin sulfate synthesis and ultimately defective collagen growth and repair. Widening in the zone of provisional
calcification is observed.

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43
Q

Components of hyaline cartilage?

A

Articular cartilage is composed of water (65%-80% of wet weight), collagen (10%-20% of dry weight but more than 50% of dry weight), proteoglycans (10%-15% of wet weight), and chondrocytes (5% of
wet weight).

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44
Q

Type of collagen in cartilage?

A

Collagen is 95% type II, contains hydroxyproline, and provides tensile strength

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45
Q

Components of proteoglycans?

A

Proteoglycans are composed of glycosaminoglycans and include chondroitin sulfate and keratin
sulfate; these provide compressive and elastic strength.

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46
Q

Chondrocytes are derived from ?

A

mesenchymal precursors

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47
Q

SOX-9?

A

the SOX-9 transcriptional factor is considered the “master switch for differentiation of mesenchymal precursors to chondrocytes.

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48
Q

What is Mechanotransduction?

A

Mechanotransduction describes how metabolism is regulated by mechanical stimulation.

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49
Q

What happens to proteoglycan content with aging and OA?

A

proteoglycan content, which decreases in both conditions.

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50
Q

Changes in cartilage wioth OA?

A

water content is increased,

proteoglycan content decreased,

keratin sulfate concentration decreased,

and proteoglycan degradation significantly
increased.

Aging is opposite but PG also decreases too in both.

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51
Q

Synovial tissue lacks ………………………….but allows nutrition via capillary-rich connective tissue.

A

Synovial tissue lacks a basement membrane but allows nutrition via capillary-rich connective tissue.

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52
Q

Type A synovial cells

A

Type A synovial cells act like macrophages

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53
Q

type B cells

A

type B cells make the synovial non-newtonian ultrafiltrate fluid containing lubricin known as a boundary lubricant

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54
Q

What is Charcot arthropathy?

A

Charcot arthropathy from disturbed sensory innervation is an extreme form of noninflammatory arthritis characterized by radiographic finds worse than clinical complaints and fragments of bone in soft tissue. Diabetes is the most common overall cause and the most common cause of Charcot disease in foot and ankle joints. Syringomyelia is the most common cause in the upper extremity
joints, followed by Hansen disease.

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55
Q

What is Onchronosis?

A

Ochronosis is black cartilage arthritis from alkaptonuria.

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56
Q

Hemochromatosis often presents first as arthritis with ………………….The cirrhosis and skin “bronzing” develop later.

A

Hemochromatosis often presents first as arthritis with chondrocalcinosis. The cirrhosis and skin “bronzing” develop later.

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57
Q 
Rheumatoid arthritis (RA) affects ................................... Late synovial changes include h..... cells, increased ......., and abundant ............. Pannus ingrowth denudes articular
cartilage. There are no ............................in pannus.
A 
Rheumatoid arthritis (RA) affects synovium and soft tissue first. Late synovial changes include hyperplastic cells, increased blood vessels, and abundant lymphocytes. Pannus ingrowth denudes articular
cartilage. There are no lymphocytes in pannus.
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58
Q

Systemic lupus erythematosus (SLE)

A

an autoimmune disease (against nucleic acids and nuclear proteins, hence almost always ANA positive) characterized by immune complex deposition with
familiar changes in the skin and kidney.

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59
Q

Seronegative spondylarthritides have many overlapping findings but are distinguished by their …………RF titer and usually ………………ANA

A

Seronegative spondylarthritides have many overlapping findings but are distinguished by their negative RF titer and usually negative ANA

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60
Q

tell me about gout?

A

Gout results in deposition of monosodium urate crystals in joints. The classical radiographic finding is the appearance of punched-out periarticular erosions. Indomethacin is the initial treatment; allopurinol lowers serum acid levels chronically, and colchicine is
used for prophylaxis.

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61
Q

CPPD?

A

CPPD (pseudogout) is characterized by positively birefringent crystals and is a common cause of chondrocalcinosis.

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62
Q

What is Hemophilic arthropathy?

A

most commonly caused by factor VIII deficiency and most commonly involves the knee. Treatment is
through correction of factor levels.

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63
Q

What is Myasthenia gravis?

A

Myasthenia gravis is an autoimmune disease with defects in transmission of nerve impulses to muscles that result from blocking, altering, or destroying acetylcholine receptors at the neuromuscular
junction.

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64
Q

what is the mechanism of action of Botulinum?

A

Botulinum A blocks presynaptic acetylcholine release at the motor end plate.

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65
Q

What determines skeletal muscle tension and force?

A

cross-sectional area.

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66
Q

three types of muscle contractions:

A

isotonic (constant muscle tension), isometric (muscle length remains unchanged), and
isokinetic (constant velocity)

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67
Q

Type I skeletal muscle fibers

A

Type I skeletal muscle fibers are slow twitch and fatigue resistant

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68
Q

type II Muscle fibres

A

fast twitch and fatigable

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69
Q

Describe the Phosphagen system?

A

ATP-creatine phosphate (phosphagen) system is anaerobic, produces no lactate, and is active in muscle activities lasting less than 20
seconds.

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70
Q

what system predominates in muscle activity of 20-120seconds?

A

Lactic acid metabolism is also anaerobic and is active in muscle activities of 20 to 120 seconds.

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71
Q

Strength training ………………….myofibrils, fiber size, and cross-sectional area, with ……………………of type II fibers.

A

Strength training increases myofibrils, fiber size, and cross-sectional area, with hypertrophy of type II fibers.

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72
Q

Muscle tear healing is most reliant upon ……………cells, and …………… stimulates proliferation of myofibroblasts and ……………………..fibrosis. In
acute muscle injury, the first cells recruited are ………………….

A

Muscle tear healing is most reliant upon satellite cells, and TGF-β stimulates proliferation of myofibroblasts and increases fibrosis. In
acute muscle injury, the first cells recruited are neutrophils.

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73
Q

Preganglionic injuries: ……………………..histamine response test with medial scapular winging due to ………………………..palsy.

A

Preganglionic injuries: normal histamine response test with medial scapular winging due to serratus anterior palsy.

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74
Q

Post-ganglionic injuries: ……………………histamine response test (…………..), ……………..innervation to cervical paraspinals.

A

Post-ganglionic injuries: abnormal histamine response test (with no flare), maintained innervation to cervical paraspinals.

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75
Q

.Axon budding proceeds ………………….., and ………………………is the first sensation to return.

A

Axon budding proceeds antegrade, and pain is the first sensation to return.

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76
Q

What part of the spinal cord do SSEP monitor and are they sensitive to anaesthesis?

A

SSEPs only monitor dorsal column sensory pathways and are less sensitive to anesthesia.

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77
Q

How do tendons receive nutrition?

A

Tendons receive blood from the vincular system if they are sheathed and through simple diffusion from the paratenon.

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78
Q

Surgical tendon repairs are weakest at days ……………… to ……

A

Surgical tendon repairs are weakest at days 7 to 10.

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79
Q

the first collagen produced at sites of tendon injury.?

A

Type III collagen

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80
Q

Achilles tendon is hypovascular …. to……… cm proximal to the calcaneal insertion.

A

Achilles tendon is hypovascular 4 to 6 cm proximal to the calcaneal insertion.

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81
Q

Ligaments are composed of ……………………collagen and elastin. They differ from tendons in that they have ……………collagen, ………….proteoglycans (and water), highly cross-linked collagen, and are perfused at
insertion sites.

A

Ligaments are composed of type I collagen and elastin. They differ from tendons in that they have less collagen, more proteoglycans (and water), highly cross-linked collagen, and are perfused at
insertion sites.

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82
Q

The nucleus pulposus has a ………….collagen/proteoglycan ratio and dries out/desiccates with age, owing to loss of ………………..pressure
(from loss of proteoglycans).

A

The nucleus pulposus has a low collagen/proteoglycan ratio and dries out/desiccates with age, owing to loss of hydrostatic pressure
(from loss of proteoglycans).

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83
Q

The annulus fibrosis has a ……..collagen/proteoglycan ratio.

A

The annulus fibrosis has a high collagen/proteoglycan ratio.

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84
Q

Innervation of annulus fibrosis

A

The dorsal root ganglion gives off the sinuvertebral nerve,

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85
Q

Interleukin involved in degenerative disc disease?

A

IL-1β

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86
Q

Changes due to the aging process are ……… of intervertebral discs, ……………and fragmentation of proteoglycans, and …………….keratin sulfate/chondroitin sulfate ratio, ……………. in absolute
quantity of collagen.

A

Changes due to the aging process are drying out of intervertebral discs, decrease and fragmentation of proteoglycans, and increased keratin sulfate/chondroitin sulfate ratio, but no change in absolute
quantity of collagen.

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87
Q

Osteochondral allografts are used for lesions larger than ……..cm.

A

Osteochondral allografts are used for lesions larger than 2 cm.

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88
Q

Osteochondral autografts are used for lesions smaller than ……… cm.

A

Osteochondral autografts are used for lesions smaller than 2 cm.

89
Q

Anti-Scl-70

A

Anti-Scl-70 is linked to scleroderma.

90
Q

Anti-Jo-1

A

Anti-Jo-1 is linked to polymyositis and dermatomyositis.

91
Q

Anti-Sm

A

Anti-Sm is linked to SLE (specific but not sensitive—i.e., only present in one fifth of those with SLE).

92
Q

Anti-RNP

A

Anti-RNP leads to mixed connective tissue disease

93
Q

Anti-ds-DNA

A

Anti-ds-DNA is linked to SLE and implicated in SLE nephritis.

94
Q

Antihistone

A

drug-induced lupus.

95
Q

Anti-Ro and Anti-La

A

Anti-Ro and Anti-La are linked to Sjögren syndrome.

96
Q

The cell cycle goes from …….. (2N) to ……….. (4N) during the S phase.

A

The cell cycle goes from diploid (2N) to tetraploid (4N) during the S phase.

97
Q

pRb

A

pRb is implicated in retinoblastoma and osteosarcoma.

98
Q

p53

A

p53 is implicated in osteosarcoma, rhabdomyosarcoma, and chondrosarcoma.

99
Q

What is a plasmid ?

A

A plasmid is a small extrachromosomal circular piece of DNA that replicates independently of DNA.

100
Q

Southern Blotting?

A

Southern—detection of DNA sequences in a sample

“DOWN SOUTH!”

101
Q

Northern Blotting

A

Northern—detection of RNA in a sample

“Right up north”

102
Q

Western Blotting

A

Western—detection of specific amino-acid sequences in protein

“Whey protein”

103
Q

ELISA

A

detects AB and ag

104
Q

RT-PCR

A

produces DNA from RNA

105
Q

Type I hypersensitivity:

A

type I: Immediate anaphylactic reaction
associated with allergy
mediated by IgE antibody activation of mast cells and basophils

106
Q

Type II hypersensitivity:

A

Type II: Antibody dependent (aka cytotoxic) hypersensitivity
mediated by IgG and IgM antibodies

107
Q

Type III hypersensitivity:

A

Type III: Immune complex (antigen bound to antibody) deposition type of hypersensitivity
mediated by IgG and IgM antibodies which when bound to antigen get deposited in various tissues

108
Q

Type IV hypersensitivity:

A

Type IV: Delayed-type or cell-mediated hypersensitivity
mediated by T cells, monocytes and macrophages
take several days to develop
examples include
tuberculosis skin test
the immune response to metallic orthopaedic implants is typically a Type IV (delayed-type hypersensitivity reaction)

109
Q

Rheumatoid factor is an ……. against …………….

A

Rheumatoid factor is an IgM against IgG.

110
Q

IgA

A

IgA is seen in mucosa-associated lymphoid tissue.

111
Q

first cells recruited to the site of injury.

A

Neutrophils are the first cells recruited to the site of injury.

112
Q

Which cells initiate the inflammatory response in osteolysis/aseptic loosening in response to particles
smaller than what?

A

Macrophages initiate the inflammatory response in osteolysis/aseptic loosening in response to particles
smaller than 1 µm.

113
Q

Carcinoembryonic antigen (CEA)

A

colorectal carcinoma

114
Q

Carbohydrate antigen 19-9 (CA-19-9):

A

pancreatic cancer

115
Q

Carbohydrate antigen 125 (CA-125):

A

ovarian cancer

116
Q

Cancer antigen 15-3 (CA-15-3):

A

breast cancer

117
Q

α-Fetoprotein (AFP):

A

hepatocellular carcinoma

118
Q

AUTOSOMAL DOMINANT CONDITIONS

A

AUTOSOMAL DOMINANT CONDITIONS

119
Q

Achondroplasia:

A

FGF receptor 3 (FGFR3)

120
Q

Apert Syndrome:

A

FGFR2

121
Q

Cleidocranial dysplasia:

A

CBFA1

122
Q

Charcot-Marie-Tooth (most common variety):

A

PMP22

123
Q

Pseudoachondroplasia:

A

COMP

124
Q

SED congenital:

A

COL2A1 for type II collagen

125
Q

Kniest syndrome:

A

type II collagen

126
Q

MED type 1:

A

COMP

127
Q

MED type 2:

A

type IX collagen

128
Q

Jansen metaphyseal chondrodysplasia:

A

PTHrP

129
Q

Schmid metaphyseal chondrodysplasia:

A

type X collagen

130
Q

Ehlers-Danlos (most common variety):

A

COL

131
Q

Hereditary multiple exostoses:

A

EXT1/EXT2/EXT3

132
Q

Neurofibromatosis:

A

NF1, NF2

133
Q

Marfan syndrome:

A

FBN1

134
Q

Osteogenesis imperfecta (types I and IV):

A

COL1A1/COL1A2 AD

135
Q

Autosomal recessive:

A

Autosomal recessive:

136
Q

Diastrophic dysplasia:

A

DTD-ST (sulfate transport protein)

137
Q

Friedreich ataxia:

A

frataxin

138
Q

Gaucher disease:

A

lysosomal glucocerebrosidase

139
Q

Sickle cell disease:

A

HbSS

140
Q

Osteopetrosis

A

malignant forM

141
Q

Osteogenesis imperfecta (types II and III):

A

COL1A1/COL1A2 AR

142
Q

(TAR) syndrome

A

Thrombocytopenia-aplasia of radius

143
Q

Charcot Marie Tooth (rare form):

A

connexin gene

144
Q

X-linked recessive:

A

X-linked recessive:

145
Q

Duchenne and Becker muscular dystrophy

A

dystrophin

146
Q

Hemophilia:

A

factors VIII or IX

147
Q

SED tarda:

A

COL2A1

148
Q

X-linked dominant:

A

X-linked dominant:

149
Q

Hypophosphatemic rickets:

A

PHEX

150
Q

Léri-Weill dyschondrosteosis:

A

SHOX

151
Q
A
152
Q

McCune-Albright syndrome:

A

Gsα subunit of the receptor/adenylyl cyclase–coupling G proteins

153
Q

t(X : 18)

A

synovial sarcoma

154
Q

t(11 : 22)

A

Ewing sarcoma

155
Q

t(2 : 13)

A

rhabdomyosarcoma

156
Q

t(12 : 16)

A

myxoid liposarcoma

157
Q

t(12 : 22)

A

in clear cell sarcoma

158
Q

t(9,22)

A

in myxoid chondrosarcoma

159
Q

The most common risk factor for Nec Facs?

A

Diabetes

160
Q

Most common cause of Nec Fas?

A

Polymicronbial, Gp A b haemolystic streptococcal most common in healthy individulas

161
Q

MOST COMMON CAUSE OF OSTEOMYLITITIS

A

MOST COMMON CAUSE OF OSTEOMYLITITIS

162
Q

Age 0 to 4 months:

A

S. aureus, gram-negative bacilli, group B streptococcus

163
Q

Age 4 months to 21 years:

A

S. aureus, group A streptococci

164
Q

Age older than 21 years:

A

S. aureus, coagulase-negative staphylococci

165
Q

Patients with sickle cell disease:

A

S. aureus and Salmonella

166
Q

open fracture

A

S. aureus, P. aeruginosa, and gram-negative bacill

167
Q

Diabetic patients

A

polymicrobial (both aerobic and anaerobic)

168
Q

Intravenous drug abusers:

A

S. aureus, Serratia spp., Pseudomonas spp.

169
Q

Meat handlers:

A

Brucella spp.

170
Q

Fishermen:

A

Mycobacterium spp.

171
Q
A
172
Q

What is a sequestrum?

A

(dead bone with surrounding granulation tissue)

173
Q

What is involucrum?

A

(periosteal new bone)

174
Q

Except for sexually active adults, in whom the most common causative organism is ……………………… the most common
cause of septic arthritis is …………….

A

Except for sexually active adults, in whom the most common causative organism is Neisseria gonorrhoeae, the most common
cause of septic arthritis is S. aureus.

175
Q

In non–sexually active adults, ……………………. and …………. are the most common causative organisms.

A

In non–sexually active adults, S. aureus and streptococci are the most common causative organisms.

176
Q

rules on tetanus prophylaxis?

A

Tetanus immune globulin is administered only when tetanus status is unknown or the patient has received fewer than three immunizations.

Tetanus toxoid is given if the wound is severe or occurred more than 24 hours previously and if the patient has
received no booster vaccination within the previous 5 years.

177
Q

The risk of acquiring disease from a needlestick from contaminated source is as follows: hepatitis B, ………%.in unvaccinated persons;
hepatitis C, ….%; HIV, …………%

A

he risk of acquiring disease from a needlestick from contaminated source is as follows: hepatitis B, 30% in unvaccinated persons;
hepatitis C, 3%; HIV, 0.3%

178
Q

β-Lactam antibiotics (penicillin and cephalosporins):

A

inhibit cross-linking of polysaccharides in the cell wall by blocking
transpeptidase enzyme

179
Q

Vancomycin:

A

interferes with the insertion of glycan subunits into the cell wall

180
Q

Rifampin:

A

inhibits RNA polymerase F

181
Q

Clindamycin:

A

binds to 50S ribosomal subunits and inhibits protein synthesis

"Buy AT 30 and CELL at 50"
  'Buy AT 30'      
Aminoglycosides
Tetracyclines
  'CELL at 50'
Chloramphenicol
Erythromycin
Linezolid
cLindamycin
182
Q

Quinolones (ciprofloxacin):

A

inhibit DNA gyrase

183
Q

mecA gene ?

A

Antibiotic resistance is mediated by plasmids and transposons. MRSA has the mecA gene that produces the enzyme penicillin binding protein 2a, which prevents the normal enzymatic acylation of
antibiotics.

184
Q

Virchow triad:

A

endothelial damage, venous stasis, and hypercoagulability

185
Q

Warfarin

A

inhibits posttranslational modification of vitamin K–dependent clotting factors (factors II, VII, IX, and X; proteins
C and S)

186
Q

Fat embolism is characterized by the triad of

A

hypoxemia, CNS depression, and petechiae

187
Q

There are four types of shock:

A

Hypovolemic: volume loss
• Cardiogenic: ineffective pumping
• Septic: blood pooling from vasodialation
• Neurogenic: blood pooling and bradycardia

188
Q

Malignant hyperthermia

A

autosomal dominant condition. It is triggered by “-ane” inhalational agents, depolarizing muscle relaxants (succinylcholine), and amide-based local anesthetics. The first signs are increased end-tidal CO2

and tachycardia. Treatment is
with dantrolene sodium, which blocks calcium release by stabilizing
the sarcoplasmic reticulum.

189
Q

How would u reduce radiation exposure in theatre?

A

decreased radiation exposure with increased distance between surgeon and radiation beam, limiting fluoroscopic time, using the mini c-arm, orienting the beam in a position inverted to the patient, use of protective shielding, and
collimation

190
Q

MRI basic principles are as follows:

T1 weighting:

T2 weighting:

The following appear dark on T1-weighted images and bright on T2-weighted images:

A

T1 weighting: fat best demonstrates anatomic structure. • T2 weighting: water is best for contrasting normal and abnormal tissues.
• The following appear dark on T1-weighted images and bright on T2-weighted images: water, cerebrospinal fluid, acute
hemorrhage, and soft tissue tumors.

191
Q

Define force?

A

Force is a mechanical push or pull (load) causing external (acceleration) and internal (strain) effects.

192
Q

Define a moment?

A

Moment is the rotational effect of a force.

193
Q

What is the mass moment of inertia?

A

the resistance to rotation

194
Q

Define Stress?

A

Stress is the intensity of internal force. Stress = force/area. Unit of measure: pascal (N/m2
).

195
Q

Define Strain?

A

Strain is a measure of deformation resulting from loading. Strain is the change in length/original length. There is no standard unit of
measure.

196
Q

what is Young’s modulus of elasticity?

A

Young’s modulus of elasticity (E) is a measure of material stiffness (ability to resist deformation in tension): E = stress/strain. Materials
with higher E withstand greater forces.

197
Q

List the common orthopaedic materials in order of stiffness

A

ceramic,
cobalt-chrome, stainless steel, titanium,
cortical bone,
PMMA
, polyethylene,
cancellous bone, tendon/ligament, and cartilage.

198
Q

Material types include the following: • Brittle: ………….stress-strain curve with limited capacity for ………………deformation • PMMA

  • Ductile: large ………..deformation before failure
  • Metal
A

Material types include the following: • Brittle: linear stress-strain curve with limited capacity for plastic deformation • PMMA
• Ductile: large plastic deformation before failure
• Metal

199
Q

what is meant by viscoelastic materials?

A

materials that have time- and rate-dependent stress-strain behavior and exhibit hysteresis (loading and unloading curves differ)
• Bone, ligaments, and most biological tissues

200
Q

Define isotropic materials?

A

mechanical properties are the same for all directions of applied load
• Golf ball

201
Q

Define Anisotropic materials?

A

mechanical properties vary with direction of applied load

• Bone is stronger with axial load than with radial load.

202
Q

when dissimilar metals are in direct contact and result in corrosion products (metal oxides and
chlorides).

A

Galvanic corrosion

203
Q

Risk of galvanic corrosion is highest between?

A

316 L stainless steel and cobalt-chromium (Co-Cr) alloy.

204
Q

316 L stainless steel contains:

A

iron-carbon, chromium, nickel, molybdenum, and manganese

205
Q

Cobalt:

A

cobalt, chromium, molybdenum, and nickel

206
Q

Titanium:

A

: titanium, aluminum, and vanadium

207
Q

Components of bone cement powder?

A

PMMA (polymer)
BENZYOL PEROXIDE (INITIATOR)
BARIUM SULPHATE/ZIRCONIUM(RADIO-OPACIFIER)

CHLOROPHYLL

(ANTIBIOTICS)

208
Q

Components of bone cement liquid?

A

Methymethacralate (monomer)

(accelerator) DMPT
(stabiliser) Hydroquinone.

209
Q

Phases of Cementing?

A
  1. Mixing phase - up to 1 min, wetting and polymerisation
  2. waiting phase - variable upto several minutes….chain propagation, neither sticky nor hairy.
  3. working phase - 2-4min, heat generation
  4. setting phase-
210
Q

1st generation cementing

A

hand-mixed cement
finger packed cement
no canal preparation or cement restrictor

211
Q

2nd generation cementing

A

cement restrictor placement
cement gun
femoral canal preparation
brush and dry

212
Q

3rd generation cementing

A

vacuum-mixing to reduce cement porosity
cement pressurization
femoral canal preparation
pulsatile lavage

213
Q

Main type of lubrication during dynamic function.

A

Elastohydrodynamic lubrication

214
Q

Hip arthrodesis?

A

25 to 30 degrees of flexion, 0 degrees of abduction and rotation

215
Q

Knee arthrodesis?

A

0 to 7 degrees of valgus angulation, 10 to 15 degrees of flexion

216
Q

Ankle arthrodesis?

A

neutral dorsiflexion, 5 to 10 degrees of external rotation, 5 degrees of hindfoot valgus angulation

217
Q

Shoulder arthrodesis?

A

30 deg abduction 30 deg flexion 30 deg of int rotation

218
Q

elbow arthrodesis?

A

Elbow: 90 degrees of flexion if arthrodesis is unilateral. If it is bilateral: one elbow at 110 degrees of flexion for the hand to reach the mouth and the other at 65 degrees of flexion for
perineal hygiene.

219
Q

wrist arthrodesis?

A

Wrist: 10 to 20 degrees of dorsiflexion for unilateral fusion. If arthrodesis is bilateral, fuse the other side at 0 to 10 degrees of
palmar flexion.

FRCS Orthopaedics (7 decks)

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