MSK Flashcards
(116 cards)
1
Q
what is potts disease
A
TB of intervertebral discs
2
Q
what is a Jefferson fracture
A
fracture of anterior and posterior arches of C1
3
Q
the olecranon process is a feature of what bone
A
ulna
4
Q
how does a anterior dislocation of the shoulder occur
A
ABduction, arm is externally rotated/hyperextended or blow to the posterior shoulder
5
Q
how does an anterior shoulder dislocation clinically present
A
loss of symmetry with loss of roundness of the shoulder and arm held in an ADDucted position supported by the patients other arm
6
Q
what do teres minor and infraspinatus do
A
external rotation
7
Q
the common extensor mechanism arises from where
A
the lateral epicondyle
8
Q
what is a swan neck deformity
A
hyperextension at the PIP and flexion at the DIP
9
Q
boutenniere deformity
A
hyperflexion at the pip and extension at the DIP
10
Q
what is ulnar drift
A
fingers all move towards the pinky
11
Q
z shape deformity
A
hyperextension of the interphalangeal joints and fixed flexion and subluxation of the metacarpal phalangeal joint
12
Q
what does ustekinumab do
A
inhibits IL12 and IL23
13
Q
what is usekinumab good for
A
psoriatic arthritis
14
Q
what is secukinimab used for
A
psoriatic arthritis and ankylosing spondylitis
15
Q
what does secukinimab do
A
inhibits IL17
16
Q
what is celecoxib
A
a COX 2 inhibitor NSAID
17
Q
when would you not use celecoxib
A
not used in people with increased risk of cardiovascular events
18
Q
side effects of leflunomide
A
similar efficacy to methotrexate, similar side effects to methotrexate, thrombocytopaenia, leucopaenia hepatitis, cirrhosis, pneumonitis, nausea/diarrhoea
also tetarogenic needs to stop 2 years before conception
19
Q
side effects of sulfasalazine
A
NEUTROPAENIA, reversible oligozoospermia
nausea, rash, mouth ulcers, can also rarely cuase a paraticularly nasty rash which stops when dtop taking drug
20
Q
side effects of hydroxychoroquine
A
no effect on joint damage
used in connective tissue damage eg in SLE helps skin joints, and general malaise, sjogrens and RA
can rarely cause IRREVERSIBLE RETINOPATHY
21
Q
side effects of TNFa
A
risk of infection-TB
potentially increased risk of cancer specially skin cancer
contraindicated in pulmonary fibrosis and heart failure
22
Q
what side effect can allopurinol cause
A
can precipitate an acute attack of gout
can cause a rash-vasculitis in the elderly, more common in elderly and in renal impairment-so use lower doses in these patients
23
Q
what would you no co presecrible with azithoprine
A
allopurinol
24
Q
why is allopurinol and azathioprine contraindicated
A
as you can cause marrow aplasia
25
HLA in RA
HLA DR4
26
what is good for looking at joints in early RA
ultrasound
27
what level on DAS28 indicates active disease
greater than 5.1
28
what does an increase PV mean
inflammation or tissue damage
29
what are the MRI findings of early Ankylosing spondylitis
bone barrow oedema, Romanus lesions and enthesittis
30
can you take live vaccines while you are on DMARDS
no
31
how does Febuxostat work
it is a XO inhibitor
32
how do uricosuric agents work
they don't affect production of uric acid but they increase the clearance of uric acid
33
when are uricosuric agents contraindicated
in renal impairment
34
what is the capitellum a bony feature of
the humerus
35
what is the elbow joint formed of
the radio-capitellar joint and the humero-ulnar joint
36
what does the radio-capitellar joint do
supination and pronation
37
what does the humero-ulnar joint do
flexion and extension
38
what muscles do pronation
pronator teres proximally and pronator quadratus distally
39
what is supination performed by
the biceps and supinator muscles
40
what is chronic regional pain syndrome
characteristics are variable but include constant burning or throbbing sensation, sensitivity to stimuli not normally painful cold, light touch, chronic swelling, paniful movement and skin changes
more common in patients with chronic pain issues
need specialist pain services
pharmacological agents include analgesics, antidepressants, anticonvulsants and steroids
41
which muscle tears can be treated conservatively
Achilles tendon, rotator cuff, longhead biceps brachii, distal biceps
42
what part fo the vertebral body is involved in a wedge fracture
the anterior part
43
does a wedge fracture require surgical intervention
no
44
where are the flexors located
on the volar aspect of the forearm
45
what mechanism helps prevent against muscle fatigue
asynchronous motor units, recruitmenet during submaximal contractions
46
how is summation of twitches possible
the duration of action potential is much shorter than the duration of resulting twitch
it is therefore possible to summate twitches to bring about a stronger contraction through repetitive fast stimulation of skeletal muscle
47
if a muscle fibre is stimulated so rapidly that it doesn't have an opportunity to relax at all between stimuli this is called
tetanus
48
can cardiac muscle be tetansied
no because the long refractory period prevents against generation of tetanic contraction
49
if the skeletal muscle is stimulated once a what is produced
a twitch
50
what does a twitch produce
produces little tension, and it is not useful in bringing about meaningful skeletal muscle activity
51
what happens if skeletal muscel receives a second stimulation before it had time to completely relax
the second response add to the first and a greater muscle tension is developed
52
how does the tension of a skeletal muscle increase
it increases with increasing frequency of stimulation
53
when can maximal tetanic contraction be achieved
when the muscle is at its optimum length
54
when is optimum length achieved
when the point of optimal overlap lf thick and thin filament cross bridges
at this point maximal tetanic tension can be achieved
55
when is the optimal length achieved in the body
the resting length of a skeletal muscle is approximately its optimal length
56
what is isotonic contraction used for
body movements and for moving objects
57
what does changing muscle length do to tension in isotonic contraction
muscle tension remains constant as the muscle length changes
58
what is isometric contraction used for
supporting objects in fixed positions and for maintain body posture
59
how does muscle tension develop in isometric contraction
muscle tension develops at constant muscle length
60
how is muscle tension transmitted to bone
via the elastic components of the muscle
61
how does the velocity of muscle shortening change
velocity of muscle shortening decreases as the load increases
62
when maximum load is carried
zero velocity of shortening ie isometric contraction
63
are skeletal muscle fibres all the same
no
64
spinal segment and peripheral nerve in knee jerk
L3, L4
| femoral nerve
65
spinal segment and peripheral nerve in ankle jerk
S1,S2 tibial nerve
66
biceps jerk
C5-C6 musculocutaneous nerve
67
brachioradioradialis
C5-C6 Radial nerve
68
triceps jerk
C6-C7 Radial nerve
69
what are the sensory receptors for the stretch reflex
muscle spindles are the sensory receptors for the stretch reflex
70
what are muscle spindles known as
intrafusal fibres
71
what are ordinary muscle fibres referred to
extrafusal fibres
72
where are muscel spindles found
within the belly of muscles
73
where do muscle spindle run in relation to ordinary muscle fibres
muscle spindles are found within the belly of muscles and run parallel to ordinary muscle fibres
74
what are the sensory nerve endings known as
annulospiral fibres
75
what happens as the muscle spindles are stretched
the discharge from the muscle spindle sensory endings increases as the muscle and hence the spindles are stretched
76
what is the nerve supply to the muscle spindles
muscle spindles have their own efferent (motor) nerve supply
77
what are the efferent neurons that supply the muscle spindles
gamma y motor neurons
78
how do the y motor neurons work
they adjust the level of tension in the muscle spindles to maintain their sensitivity when the muscle shorten during muscle contraction
79
delayed relaxation after voluntary contraction
myotonia
80
what does EMG do
electrodes detect the presence of muscular activity
records frequency and amplitude of muscle fibres action potentials
helps differentiate primary muscle disease from muscle weakness caused by neurological disease
81
what is a stretch reflex
serves as a negative feedback that resists passive change in muscle length to maintain optimal resting length of muscle
82
where is an enchondroma most commoly found
in the digits
83
what are multiple enchondromas associated with
a non inheritable condition Olliers syndrome
84
what are multiple enchondromas and haemangiomas associated with
Maffuccis syndrome
85
where do osteomas tend to be found
in the cranial bones
86
what are some of the features of an osteoid osteoma
tend to be sore at night
| pain resolved by NSAIDS as tumour releases prostaglandins
87
features of osteosarcoma
tend to be in kinds
tend to be long bones
x ray shows codmans triangle
any malignant tumour that produces osteoid is osteosarcoma until proven otherwise
88
features of Ewings sarcoma
malignant tumour of unknown cell origin
small round blue cell tumours
specific genetic abnormlaity
89
what type of collagen is found in cartilage
type II
90
how does type II cartilage differ from type I cartilage
type II is finer and forms a 3D meshwork but type I is thicker and aggregates into linear bundles
91
what is the most common type of cartilage
hyaline cartilage
92
what are the three forms of cartilage
hyaline, elastic, fibrocartilage
93
what is fibrocartilage
a hybrid between tendon and hyaline cartilage, it has bands of densely packed type I collagen interleaved with rows of chondrocytes surrounded by small amounts of cartilaginous ECM
94
what is bone made up of
mineral-calcium hydroxapatit crystals, water, collagen and non collagen protiens
95
where is cancellous bone found
cancellous or trabecular bone is found at the ends of the bone the epiphyses
96
what type of bone is lamellar
both cortical and cancellous are lamellar
97
what are the living cells in bone
osteocytes
98
what are the lines surrounding the osteon called
cement lines
99
where and what are volkmanns canals
they are inside osteons, they transmit blood vessels from the periosteum into the bone and lie perpendicular to and communicate with the haversian canals
100
what does trabecular bone lack
it lacks haversian canals but because the struts are thin, the osteocytes can survive from contact with the marrow spaces
101
what is osteoid
collagen, glycosaminoglycans, proteoglycans and other organic components of the matrix which becomes mineralised over time in the extracellular space
102
where are osteoclasts derived from
macrophages, several of these will fuse to form a single giant cell
103
how is bone laid down after it is broken
the collagen fibres are laid down in a random fashion=woven bone
this is not as strong as lamellar bone and is subsequently remodelled into lamellar bone by being broken down by osteoclasts and reformed by new osteoblasts
104
what is the short head of biceps supplied by
common peroneal nerve
105
what is adductor magnus supplied by
tibial nerve
106
what is the nerve supply to the posterior thigh
tibial L5-S1
107
what are the nerve roots of the femoral nerve and obturator nerve
L2-L4
108
what is froments test for
palsy of the ulnar nerve associated with cubital tunnel syndrome
it specifically tests for the adductor pollicis
109
common extensor origin
lateral epicondyle
110
common flexor origin
medial epicondyle
111
what is a swan neck due to
volar plate rupture
112
what is a boutenniere deformity due to
torn central slip extensor
113
dislocation at lunate can cause what type of nerve injury
median-ie carpal tunnel syndrome
114
what tests can be used for carpal tunnel
Phalens test and Tinels test
115
what tests can be used for cubital tunnel and describe how they work
hold piece of paper, test the adductor pollis muscle usually thumb will be straight but with positive forments the thumb isn't straight
can also get hyperextension of the thumb on the ok sign
116
what is finkelsteins test
grab the thumb and ulnar and deviate the hand sharply
| check for tenosynovitis in the ABductor pollicis longus and the extensor pollicis brevis
