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Medicine - Year 2 > Block 12 - Musculoskeletal and nervous system (other) > Flashcards

Block 12 - Musculoskeletal and nervous system (other) Flashcards

(67 cards)

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1
Q

Define ABCDE

A

Airway, Breathing, Circulation, Disability, Exposure, Environment

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2
Q

Where is crepitus between?

A

The bone and cartilage

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3
Q

3 reasons you would repair a soft tissue injury

A

Suspected nerve or vascular damage
Reduced tendon function
Washed if heavily contaminated or in the joint cavity

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4
Q

Define a colles fracture

A

FOOSH

Bone displaced posteriorly

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5
Q

Define a smiths fracture

A

Falls onto flexed wrists

Bone displaced anteriorly

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6
Q

What fracture is a sign of abuse?

A

Spiral

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7
Q

Define comminuted fracture

A

Part of the bone breaks off

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8
Q

Another name for an undisplaced fracture

A

Oblique fracture

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9
Q

Define avulsion fracture

A

Bone displaced due to failed muscle/ligament action/tension

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10
Q

What can happen if a patient suffers from Paget’s disease or bone cysts?

A

The bone can weaken and the risk of fracture increase

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11
Q

What are the 2 types of stress fractures?

A

Repeated abnormal stresses to normal bone (e.g. marathon)

Abnormal bone subjected to normal stresses (e.g. cast taken off too early so re-fracture)

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12
Q

What are the 3 stages of open wound management?

A

Protection: Assess, Temporary dressing, IV antibiotics, Tetanus
Debridement: Wash wound in sterile theatre
Stabilisation: May be provisional

(Pretty Damn Soon)

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13
Q

Define reduction

What is the difference between open and closed reduction?

A

Surgical procedure to repair a fracture or dislocation to the correct allignment
Open = pins or cast outside
Closed = pins inside

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14
Q

What are the two types of reduction/stabilisation

A

Closed: Traction (slowly pulling back into place) or Manupulation
Open: Surgical reduction

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15
Q

How fast is the onset of rheumatoid arthritis?

A

Slow

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16
Q

What are the 4 main joints affected by rheumatoid arthritis?

A

MCP, PIP, MTP, wrists

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17
Q

Define rheumatoid arthritis

A

A chronic, symmetrical inflammatory, deforming, polyarthritis

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18
Q

What 3 things do you test for rheumatoid arthritis?

A

CRP: C-Reactive Protein
Anti-CCP: Anti-Cyclic citrullinated peptide
RF: Rheumatoid factor

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19
Q

Where does inflammation occur in rheumatoid arthritis?

A

Synovium

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20
Q

MOA of rheumatoid arthritis

A

T cell is triggered –>

  • B cell produces RF antibodies
  • Fibroblasts inhibit TGF, IL4 and IL10
  • Macrophages activate TNF and IL –> cytokines, chemokines and adhesion molecules –> cell infiltration

–> Inflammation and tissue damage

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21
Q

7 effects of chronic systemic inflammation

A

Dementia, Insulin resistance, Osteoporosis, Pain sensitisation, Increased cholesterol, Atherosclerosis, Ischaemic heart disease

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22
Q

What joints are affected with oestoarthritis? (6)

A

DIP, PIP, CMC, MTP,

Axial skeleton, Large weight bearing joints

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23
Q

9 risk factors for osteoarthritis

A

Age, Female, Family, Obesity, Increased oestrogen, Bone mineral density
Trauma, Occupation, Pre-existing abnormality

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24
Q

What age is gout most common in?

A

Older age

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25
What drugs increase the risk of gout?
Aspirin, Diuretics, Cytotoxic drugs, Levodopa, Ethambutol, Pyrazinamide
26
How is urate produced?
Adenosine --> Xanthine --> Urate | by the enzyme xanthine oxidase
27
How does urate cause gout?
In the right conditions, urate mobilises to the joint and precipitates out forming crystals and causing inflammation
28
3 causes of increased urate
Increased purines in the diet/being produced (e.g. cancer) | Kidney disease stops excretion
29
What triggers gout attacks (7)
Mobilisation of gout due to changes in serum urate levels e.g. trauma, illness, surgery that triggers the acute phase response, dehydration, acidosis, medication, rapid weight loss
30
What is the main protein fibre found in bone?
Collagen
31
What type of connective tissue is bone?
BONE
32
2 roles of osteoclasts
Break down worn out bone | Increase serum calcium levels
33
What happens to how well a bone heals if you break it and have osteoporosis?
Broken osteoporotic bones heal as normal
34
Explain how osteoclasts break down bone
Bind to bone between 2 integrins which link to the cytoskeleton forming a sealing zone Protons pumped into the bone casuing acidic degradation Lysosomal enzymes break down collagen and extracellular matrix proteins Calcium is released into the blood
35
Explain how osteoclasts regulate osteoblasts
+ve: osteoblasts --> RANKL --> osteoclast precursors | -ve: osteoblasts --> OPG --> block RANKL
36
Explain the mechanism of action of calcitonin
Released from the thyroid gland and reduces blood calcium levels when they increase too much Increase osteoblast activity Decrease intensine Ca absorption Decrease renal calcium reabsorption
37
Explain the mechanism of action of parathyroid hormone
Release from the parathyroid glands and increases blood calcium levels when they fall too low Increases osteoclast activity
38
How does oestrogen protect against calcium reabsorption?
Inhibits PTH
39
Give 9 features of cushing's syndrome
``` Aseptic necrosis of the femoral head Cataracts CVD risk Decreased wound healing Increased intraocular pressure Intracranial hypertension Metabolism change (weight gain) Osteoporosis Pancreatitis ```
40
Define posture
Orientation of a body segment relative to the gravitational vector e.g. amount of forward lean relative to a vertical position
41
Define balance
The dynamics of body posture to prevent falling | Related to the characteristics of the body segment and the forces acting upon it
42
Define centre of mass
Anatomical position = abdominal area Arms up it rises; arms to the right it moves to the right Doesn't have to be in the physical limits of the body
43
Define centre of gravity
Vertical projection of the centre of mass onto the ground
44
Define centre of pressure
Location of the body vertical ground reaction force on the floor Standing = between feet Standing on R leg = under R foot
45
Define postural set
A learned response where the body establishes an anticipated response in relation to the type of pertubation which changes based on postural orientation
46
Explain the stretch (myotatic) reflex
Muscle spindles are stretch receptors located in skeletal muscle When they stretch, an afferent nerve sends a signal to the CNS Motor neurones activate the agonist/antagonist to increase the movement
47
Explain how the ankle postural strategy works | What surface can it be used on?
Shifts the CoG around the ankle joint | Surfaces with decreased resistance to shear forces
48
Explain how the hip postural strategy works | What surface can it be used on?
Shifts the CoG around the hip joint by flexion/extension | Surfaces that have decreased resistance to torque (not on slippery surfaces)
49
Explain how the stepping postural strategy works | What surface can it be used on?
Shifts the CoG around the hip joint by flexion and extension | Realigns BOS under new CoG with rapid steps
50
What does the systems model describe?
How the CNS locates the body's CoG
51
What are the 4 sensory components of balance? | What do they gather information from?
Somatosensory: info from skin receptors (motion of body with respect to support surface) Proprioceptive: info from muscle spindles (motion of body segments relative to each other) Visual system: info from eyes (motion of body with respect to space) Vestibular system: info from inner ear (head acceleration)
52
How do you measure centre of pressure?
Using force platforms
53
What moves the centre of pressure anteriorly? | What moves the centre of pressure laterally?
Anteriorly: Increased plantar flexor activity Laterally: Increased invertor activity
54
What is EQUITEST?
A clinical diagnostic tool for vestibular/somatosensory disorders Measures the effects of a disease on the postural control
55
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
56
What is the difference between somatic and visceral pain?
Somatic: Peripheral and localised, easy to describe Visceral: Poorly localised and described
57
Explain peripheral sensitisation
Tissue damage stimulates peripheral nociceptors and releases inflammatory mediators These reduce the threshold for neuronal activation
58
Explain central sensitisation
Release of glutamate and substance P from nociceptors target NMDA receptors in the CNS (process painful info) Calcium influx causes phosphorylation and transcriptional changes
59
Define neuroplasticity
Variable relationship between injury and pain response depending on experiences due to sensitisaton, reorganisation and chronic pain states
60
Define allodynia
Pain when it is a non painful (normal) stimulus
61
Define hyperalgesia
Little pain is very painful
62
Explain what happens during central reorganisation
Neuronal sprouting in the dorsal spinal cord Altered corticol sensory matrix Established chronic pain state
63
4 yellow flags for pain
- Fear that the pain is harmful/severely disabling - Fear avoidance behaviour (avoiding activity) - Reduced mood and social withdrawal - Expectation that passive treatment (drugs) will help more than active (exercise)
64
5 red flags for pain
- Cancer history - Pain which radiates - Recent bacterial infection - Immunosupression - Constitutional symptoms (fever, chills, weight loss)
65
Define mindfulness
Relaxed and non-judgemental awareness of thoughts, feelings and sensations
66
Give 3 examples of CBT coping strategies
Pacing, relaxation, thought diversion
67
5 physical therapies to help pain
``` Exercise Hydrotherapy Manipulation Acupuncture TENS ```

Medicine - Year 2 (19 decks)

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