Loco

Question 1

Large range of movement at shoulder

Answer 1

Large humeral head - 4:1 ratio 
Support from glenoid labrum 
Physiological scapulothoracic joint 
Large joint cavity 
Rotator cuff stabilise

Question 2

Shoulder ligaments

Answer 2

Superior, middle and inferior glenohumeral
Coracohumeral
Coracoacromial

Question 3

Which rotator cuff muscle attaches to the lesser tubercle?

Answer 3

Subscapularis

Question 4

SLAP tears

Answer 4

Type 1 = partially tear
Type 2 = completely detached glenoid labrum
Type 3 = labrum hanging into joint cavity
Type 4 = labrum hanging into joint cavity and affecting biceps tendon

Question 5

Basilic vs cephalic vein

Answer 5

Basilic = drains medial
Cephalic = drains lateral

Question 6

Risk factors for DVT

Answer 6

Old age 
Sedentary periods 
Major surgery 
Trauma 
Contraceptive pill
Pregnancy

Question 7

Symptoms of DVT

Answer 7

Tenderness
Pain 
Swelling 
Eryhthema 
Oedema

Question 8

Diclofenac

Answer 8

Inhibitor of COX2

Prevents formation of prostagladins, leukotrienes

Question 9

Enoxaparin sodium

Answer 9

Low molecular weight heparin
Binds to antithrombin
Inactivates factor Xa

Question 10

Warfarin

Answer 10

Vitamin K antagonist

Question 11

Rachitic rosary chest

Answer 11

Prominent knobs of bone at the costochondral joints

Due to lack of mineralisation due to vitamin D or calcium deficiency

Question 12

Harrison’s sulcus

Answer 12

Horizontal groove along where the diaphragm inserts into the ribs showing bone weakness

Question 13

Rickets symptoms

Answer 13

Bone tenderness
Increased frequency of fractures
Muscle weakness
Bowed legs 
Skeletal malformations

Question 14

Rickets treatment

Answer 14

Calcium, phsophate and vitamin D supplements
Increased sunlight exposure
Vitamin D fortified milk for infants

Question 15

Zones of cartilage growth

Answer 15

Resting 
Proliferating 
Hypertrophy and maturation 
Degeneration and calcification 
Osteogenesis

Question 16

Vitamin D pathway

Answer 16

ProD3 found in skin
Converted to D3 by UVB light
Vitamin D3 –> 25(OH)vitD in the liver
25(OH)vitD –> 1,25(OH)2vitD in the kidney

Question 17

Action of 1,25(OH)2 vitamin D

Answer 17

Binds to nuclear receptor and acts as transcription factor tp promote many processes
Increases calcium and phosphate reabsorption in the gut
Increases calcium mobilisation from the bones
Increased calcium reabsorption from the kindeys

Question 18

How is bone resorption stimulated?

Answer 18

PTH and vitamin D stimulate RANKL expression in osteoblasts

Activates osteoclasts and causes them to mature

Question 19

What hormone is released when calcium plasma levels are low?

Answer 19

PTH

Question 20

What does PTH cause?

Answer 20

Kidney calcium reabsorption and phosphate excretion
Increased calcium release from bones by activating RANKL
Conversion of 25(OH)vitD –> 1,25(OH)2vitD to stimulate increased calcium reabsorption from the gut

Question 21

Process of bone resorption

Answer 21

Osteoclast attaches to bone
Secretes proteolytic enzymes and HCl
Bone products exit in interstitial fluid
Osteoblasts secrete new bone matrix into cleared space
Calcification of new matrix in 7-10 days

Question 22

Effect of oestrogen on bone growth

Answer 22

Increases gut calcium reabsorption

Inhibits osteoclasts

Question 23

Effect of glucocorticoids on bone growth

Answer 23

Decreases gut reabsorption

Increases bone resorption and inhibits formation

Question 24

Ergocalciferol

Answer 24

Vitamin D2

Question 25

Cholecalciferol

Answer 25

Vitamin D3

Question 26

Lateral ankle ligaments

Answer 26

Anterior talofibular Posterior talofibular Calcaneofibular

Question 27

Medial ankle ligaments

Answer 27

Deltoid ligament 4 fused ligaments From medial malleolus --> calcaneous and navicular

Question 28

Signs of compartment syndrome

Answer 28

``` Pallor Pain Pulselessness Paralysis Parasthesia Polar ```

Question 29

Diagnosis of compartment syndrome

Answer 29

Intracompartmental pressure >30mmHg

Question 30

Treatment of compartment syndrome

Answer 30

Fasciotomy Removal of restriction IV saline drip for hydration

Question 31

Rhabdomyolysis

Answer 31

Breakdown of striated muscle In this case due to ischaemia Releases muscle contents into blood Increased creatine kinase, myoglobin, potassium, calcium

Question 32

Define compartment

Answer 32

Group of muscles with the same function and with a common nerve and blood supply that are surrounded by deep fascia

Question 33

Functions of skeletal muscle

Answer 33

``` Support soft tissues - shield organs Guard entrances and exits - anal sphincters Maintain body temperature Store nutrient reserves Breathing ```

Question 34

Consequences of sarcopenia

Answer 34

``` Worsening of posture Immobility due to weakness Increased bone loss --> osteoporosis Falls more likely More likely to get fractures ```

Question 35

Sarcopenia theories

Answer 35

Neuromuscular ageing - loss of motor neurones, NMJs and vesicles Hormone levels - decrease in GH, oestrogen, testosterone, thyroxine and insulin and increase in cortisol Cellular senescence Inflammatory factors Loss of myokines Obesity

Question 36

Sarcopenia epidemiology

Answer 36

Mean age = 73 7-8% prevalence 30% of over 50s

Question 37

Sarcopenia treatment

Answer 37

Dietary - creatine, whey protein, vitamin D Hormone replacement therapy Resistance training Strength training