Musculoskeletal Flashcards
(157 cards)
1
Q
Which two ways do bones arise embryonically?
A
Intramembrenous ossification and endochondral ossification
2
Q
What type of cartilage makes up the skull sutures?
A
Fibrous cartilage
3
Q
Stages of bone healing (secondary):
A
-Hematoma
-Inflammation
- Soft Callous
-Hard callous - woven bone - mineralisation by calcium hydroxyappetate
-Remodelling - lamillar bone
4
Q
What enzyme causes bone mineralisation?
A
Calcium hydroxyapatite
5
Q
Difference between osteoperosis and osteomalacia?
A
Osteoporosis = bone degradation, weakness.
Osteomalacia = mineral deficiency, bendy bones.
6
Q
Which drug class is commonly used to treat osteoporosis?
A
Biphosphonates
7
Q
What cell type manages the cartilage in joints?
A
Chondrocytes
8
Q
What are the 4 key signs of osteoarthritis on an XRay? Why are each caused?
A
LOSS
L- loss of joint space - cartilage erodes and fluids loss as proteoglycan in cartilage kept fluids in.
O - Osteophytes - TGF -B
S - sclerosis - TGF-B
S - subchondral cysts - synovial fluid can leak into bones via fissures once articular cartilage is gone
9
Q
What molecule is needed for sclerosis in osteoarthritis?
A
TGF-B made in inflammation of joint can leak into fissures and start mucking with bone (osteophytes) and causing scarring too.
10
Q
What part of the body does gout target?
A
Uric acid joins with sodium to form monosodium urate in the cold areas of the body.
Typically big toe.
11
Q
How does meat cause gout?
A
Purines –> Xanthine to be done by xanthine oxidase –> uric acid –> monosodium urate –> WBC can’t eat spiky crystals –> ouch
12
Q
List risk factors for gout:
A
Meat eater, shellfish, alcohol, thiazide diuretics, T2D, CKD, chemo.
13
Q
What is the preventative treatment for gout?
A
Allopurinol - xanthine oxidase inhibitor.
14
Q
What structure allows the leg to ‘unlock’
A
popleteus (princess diary pop)
15
Q
What is the jutty part of the elbow called and what bone does it correspond to?
A
The olecranon process of the ulnar
16
Q
Where do most arm flexors attach?
A
Medial epichondyle of the humerus
17
Q
Which joint is important in the flexion and extension of the elbow?
A
The ulnarhumeral joint only
18
Q
Which joint(S) control supranation and pronation?
A
the radial joints - makes sense cos only radius touches hand.
Radiohumeral and radioulnar
19
Q
Which muscle controls supranation?
A
Biceps brachii - also the arm must be in supranation to flex the biceps
20
Q
What does Tennis elbow effect?
A
The lateral epichondyle (think T’s together - lateral And tennis)
21
Q
What does Golfer’s elbow effect?
A
Medial epichondyle
22
Q
What is the one place the shoulder complex articulates with the rest of the body?
A
Sternoclavicular joint
23
Q
What are the three shoulder joints?
A
Sternoclavicular, acromioclavicular, glenohumeral
24
Q
What does the scapular spine end in?
A
The acromion
25
Describe the tubercles of the humerus
greater tubercle is lateral is an attachment site for literally everything, lesser tubercle is medial
26
Where do the heads of the bicep tendons attach?
Short- coracoid bone
Long - passes inside glenohumeral capsule to attach to Glenoid
27
What ligament stops the humerus from pushing superiorly?!
The coracoacromial ligament forms a roof over the glenohumeral joint
28
What is a frozen shoulder?
Inflammation of the subacromial bursa
29
Describe wrist adduction and abduction
Wrist adduction - towards midline = ulnar deviation
Wrist abduction = away from the midline = radial deviation.
30
Mnemonic for wrist bones?
So long to pinky, here comes the thumb.
31
Which wrist bone is most prone to degeneration?
Trapezium
32
Which wrist bone is most likely to fracture?
Scaphoid
33
Which wrist bone can you feel through the snuffbox?
Scaphoid
34
Which of the arm nerves is the most prone to injury?
Ulna
35
Which carpals form the walls of the carpal tunnel?
TOH
Trapezium and Hamate
36
What is the most degenerative joint in the body?
Trapeziometacarpal joint
37
Which movement can the metacarophalangeal joints do that the other phalangeal joints can’t?
Circumduction
38
Which two muscles shoulder muscles assist breathing?
Pec major and serratous anterior
39
Flexion - Which muscles control the distal interphalangeal joints and which muscles control the proximal ones?
Proximal - flexor digitorium superficialis
Distal - flexor digitorium produndus - must pierce through superficialis to get there
40
In detail, describe the brachial plexus?
C5-9, split into trunks and devisions and cords.
Trunks are superior, which becomes anterior devision and then lateral and then MSC nerve.
Middle which becomes posterior and then posterior and then radial and axilliary nerves.
Inferior which becomes anterior which becomes medial which becomes ulna.
Both anterior divisions unite to form the median nerve.
41
How is NAD recycled in fermentation?
By using lactate
42
Falling backward onto your hand is likely to break which bone?
Scaphoid
43
Describe the movement of the trapezius muscles.
Have 3 segements:
Descending - neck - elevates scapula
Transverse - adducts/retarcts scapula
Ascending - lower back - depress scapula
44
Deficiency in which muscle causes scapular winging? Which nerve could do the same?
Serratus anterior muscle
Long thoracic nerve
45
Mnemonic for pectoral girdle muscles? What movements are associated with the pectoral girdle?
PSST Look Right!
PSSTLR - anterior ones first, then posterior.
P - pec minor
S - Subclavius
S - serratous anterior
T - trapezius
L - levator scapulae
R - rhomboids
46
Mnemonic for the shoulder muscles? Which of these are in the rotator cuff?
Delt SPLITS (SITS muscles are in rotator cuff)
Delts
S - Supraspinatous
P - pec major
L - latissimus dorsi
I - Infraspinatous
T - teres minor
S - subscapularis
47
What muscles do shoulder abduction?
Delts and the first 15 degrees is supraspinatus
48
Mnemonic for arm compartment movements?
PEE - posterior extends elbow
49
What are the 3 muscles of the anterior arm?
Biceps brachii, brachialis, corocobrachialias
50
Where do all 3 heads of the triceps attach distally?
Olecronon
51
Which forearm compartments control suprination and pronation?
Pronation is anterior with flexors
Suprination = posterior
52
List the components of the carpal tunnel.
9 x tendons - 4xFDP and 4xFDS and 1x Flexor pollicis longus but it travels in its own sheath.
AND the median nerve.
53
Which forearm muscle does not match the theme of anterior = flexion and posterior = extension?
Brachioradialas - it is posterior but actually does flexion (traitor)
54
Describe the arteries of the hand?
The radial artery is mostly deep, the ulna artery is mostly superficial
55
Which nerve of the arm has no muscle control past the wirst?
Radial nerve - it is just dermatomes at that point
56
What are the 3 muscles that form the axilla?
Serratous, pec major, subscapularis
57
What is the function of the musculocutaneous nerve?
We know from the brachial plexus that it is in the anterior division, so it will serve the anterior compartment of the arm and then will become a supply for just the cutaneous (in the name) past the elbow.
58
Which nerve supplies the deltoid?
Axillary
59
Injury of the radial nerve causes what condition?
'saturday night palsy'
WRIST DROP
60
Which nerve succeeds the MSC nerve as muscle innervator past the elbow?
Ulna
61
Damage to what nerve causes claw hand?
Ulna
62
Describe the dermatomes of the hand?
Start with palm.
Small thumb section done by radial, pinky and half of ring finger done by ulna, rest is median.
Dorsal - ulna has same pattern. median forms tops of first 3 fingers, half of 4th. Rest is radial.
63
Which artery is the root artery for the entire arm?
Subclavian (off braciocephalic in R, straight off aorta in L)
64
Which artery gives off the superficial palmar arch?
The radial artery becomes the deep palmar arch in the hand but gives off the superficial branch to assist the ulna, and vice versa.
65
Describe the progression of the subclavian artery in the arms to the hands.
Subclavian - axillary - brachial - splits into radial and ulnar at elbow.
66
Describe the lymph nodes of the axilla and the flow of lymph.
Axillary pyramid, have 3 nodes (one of which is pectoral, inflamed in breast disease), which feed into central which feed into apical node (top of pyramid) which feed into the subclavian and then the thoracic duct.
67
name for the area of the pelvis where the femur attaches?
Acetabulum
68
Describe the difference between a male and female pelvis?
male pelvis has more acute pubic angle, much narrower.
female has obtuse pelvic arch, pevlis is wider and rounder.
69
Describe the bones of the pelvis
Superior - ilium
Inferior - ischium
Anterior - pubic bones
70
What impact does the angle of the femur have on weight bearing?
Causes medial loading of the knee - hence stronger medial collateral ligament
71
Which 3 ligaments are important in stabilising leg position?
All the pelvic to femur ligaments.
Sitting is worst position, no support.
Standing - iliofemoral ligament - think because ilium to femur is more or less straight down.
Flexion - need a posterior stabiliser so use ischiofemoral ligament.
Extension - need an anterior stabiliser to use pubofemoral ligament.
72
Which way does the patella usually dislocate?
Laterally - as the medial side is the one that is damaged.
73
Compare the strength of lateral vs medial leg muscles.
Lateral muscles are more parallel to femur so are strong due to angle of femur, medial muscles are oblique to femur - weaker.
74
What is the position and role of the fibula?
Fibula is always lateral, it is NOT involved in weight bearing or the knee, its role is to stabilise the ankle joint.
75
Describe the position and angle of the ACL.
Anterior cruciate ligament - follows the femur angle. Attaches to lateral femur and medial tibia. In front of PCL.
76
What is the typical PCL injury?
Skiing - lower leg stopped in snow, upper leg keeps going.
77
Are the knee collateral muscles part of the knee capsule?
The medial collateral is - it joins to the medial meninscus. The lateral collateral is not part of the capsule it is seperated from the lateral meniscus due to the popliteus.
78
The anterior draw pull test checks what ligament?
ACL (longitudinal fibres)
79
What is the mnemonic for the foot bones?
Tiger Cubs Need MILC
T - talus
C - calcaneous (heel)
N
M - cuneiform
I - cuneiform
L - cuneiform
C
80
Describe ankle flexion and extension
Flexion is plantar flexion - toes towards ground
Extension = dorsiflexion - toes towards body
81
What are the latin word for thumb and big toe
Thumb - pollicis
Big toe - hallux
82
List the 3 gluteal region muscles I need to know and what they do.
Psoas major - anterior - hip flexion
Gluteus maximus - hip extension
Gluteus minimus - abductors and rotator - important
83
Damage to what nerve causes pelvic drop (leg drop)?
Contralateral superior gluteal nerve.
84
describe the compartments of the thigh. What actions do each do?
Medial - adductors
Anterior - flexion of hip, extension of knee
Posterior - extension of hip, flexion of knee
85
Which muscles form the anterior thigh compartment?
Dog Poo muscle - Jadob Sartorius is dog poo = sartorius muscle.
Quads = vastus and rectus muscles
85
Which muscles form the anterior thigh compartment?
Dog Poo muscle - Jadob Sartorius is dog poo = sartorius muscle.
Quads = vastus and rectus muscles
86
Which quad muscle is biarticular?
rectus femoris - can do hips and knee
87
Which hamstring muscle is biarticular?
All of them - including Biceps femoris
88
What is special about biceps femoris?
This hamstring muscle has a dual nerve supply - so a wound may only affect one head
89
Describe the 4 compartments of the calf and their actions.
Lateral - for plantar flexion and eversion.
Anterior - dorsiflexion and toe extension
Posterior - inversion and plantar flexion
Deep posterior - as above
90
Mnemonic for the extensor retinaculum of the foot?
Timothy has a nasty dirty toe (from medial to lateral)
T - tibilias
H - hallux
A - artery - anterior tibial
N - nerve - deep fibular
D - digitorium
T - tertious (fibularis tertious)
91
Shin splints are a compartment syndrome of which muscle?
Tibilias anterior
92
What muscles make up the lateral compartment? Which is special?
All the fibularis muscles, which makes sense because fibula is lateral. The special one is fibularis tertius which travels with the extensor retinaculum but reaches to the lateral foot.
93
Mnemonic for the flexor retinaculum of the foot?
Tom Dick and Very Naught Harry
T - tibilias posterior
D - digiotrium (flexors)
V - vessels
N - nerve - tibial nerve
H - hallux (flexor)
94
What are the actions of the feet interossei muscles?
DAB AND PAD - dorsal abduct toes, plantar adduct toes
95
What nerve supplies the anterior compartment of the thigh and what is its path?
The femoral nerve travels under the inguinal ligament.
96
Which nerve supplies the medial compartment of the thigh?
Obturator nerve which comes through the obturator canal
97
Why must you be careful in an IM injection of the gluteus maximus?
You may hit the sciatic nerve and cause leg paralysis
98
Which nerve runs through the tarpal tunnel?
The tibial nerve
99
Describe the course and branches of the sciatic nerve
Sciatic nerve exits through greater sciatic foramen and goes through the gluteus region but doesnt innervate anything there. Will become the tibial and common fibular just above the knee. The tibial will keep following the course and do the posterior calf compartment before going beneath the flexor retinaculum.
The common fibular will almost immediately split into the superficial and deep fibular nerves. The deep fibular nerve will pierce the interosseus membrane to do the anterior calf compartment, and will go to top of the foot but only does innervation to the big toe.
Superficial fibular will do the lateral compartment and will gives sensation to most of the top of the foot.
100
Which nerves supply the knee?
All of the big 3, the sciatic, obturator and femoral.
101
Which nerves supply the biceps femoris?
Tibial and common fibular
102
Describe the blood supply of the leg from the aorta down.
REMEMBER ARTERIES FOLLOW THE FLEXOR ASPECTS OF LIMBS
Abdominal aorta gives off common iliac which gives off internal and external iliac. Internal iliac will go on to do virtually, but the only part of the leg it does is the obturator artery for the medial compartment.
The external iliac becomes the femoral, which does the entire thigh, it will give off the profunda femoris to feed the posterior thigh.
It becomes the popliteal artery briefly before becoming the posterior and anterior tibial arteries.
Anterior tibial artery does the anterior compartment of calf, posterior tibial does the posterior compartments and gives off the fibular artery to do the lateral compartment.
103
Which leg vein typically forms varicose veins?
Saphenous vein
104
What is the relationship between calcium and phosphate?
phosphate will follow calcium everywhere EXCEPT in the kidneys which are the only cells that can seperate them.
eg. PTH will tell kidneys to get rid of phosphate cos it uses up calcium
105
Name 3 causes of osteoporosis?
- Smoking - kills osteoblasts
- Menopause - low estrogen reduces OPG
- Steroids
- renal osteodystrophy
106
Describe normal bone, osteopenia, osteoporosis and osteomalacia on histology.
Normal bone looks like dip n dots, lots of pink and white dots, with solid pink trabeculae around them.
Osteopenia - less trabeculae
Osteporosis - virtually all dip n dots, not trabeculae.
osteomalacia - needs special stains.
107
Explain renal osteodystrophy.
CKD cooks nephrons which can't absrob calcium properly, make Vit D or secrete phosphate. Leads to low serum calcium. PTH activation will destroy bones.
108
What factors could impact each stage of bone healing?
Inflam - anything that reduces inflam - eg. infection, autoimmune etc
Soft callous - size of bone
Hard callous - Calcium/vit D level
Remodelling of lamellar bone - fixation
109
Two complications of a fracture?
nerve damage
fat embolus
110
What bone cancer occurs in young people, where does it usually occur and what is the typical treatment?
Osteosarcoma, in the knee, amputation.
111
describe macro appearance of rheumatoid arthritis?
Swan neck deformity of fingers
Ulnar deviation
proximal hand joints
112
What two factors cause RA pathology?
Villi in the synovium cause stiffness and increase in RANK L due to inflam causes bone degradation.
113
What is the name for RA swelling and pain?
Pannus
114
Compare RA vs OA pain
RA - better with movement - bad in mornings
OA - better with rest - worse at night
115
What is the site of disease for RA vs OA
RA - synovial membrane
OA - Articular cartilage
116
OA pathophysiology?
Wear and tear, chondrocytes proliferate, inflam, remodelling etc. Leads to LOSS findings.
117
Treatments for Osteoarthritis?
NSAIDS
Weight loss
Steroid/Hyaluronic acid injections
Surgery is last resort as in RA
118
Acid from gout, what can uric acid crystals cause in the body?
Renal scarring
Renal stones
119
Treatment for gout?
Acute - NSAIDS
Lifestyle - less meat and beer
Long term - allopurinol
120
Describe the types of muscle fibres and the fatiguability of them.
large - like in sprinters - needed for big efforts but tire easily. Sprinters are hench. MOST AT RISK.
Small - long distance, resistant to fatigue.
121
What are dermatophytes, what do they cause, name some.
Skin infections, fungal, cause ringworm. Need keratin to live. Microsporum and -phyton fungi.
122
What organism causes tinea versicolour?
Malassezia
123
What conditions pre-dispose to candida infection?
Immune suppression, diabetes, burns, antibiotic use.
124
What fungi can cause a fungal ball in the lungs?
Aspergillus, often due to preformed cavity like from TB.
125
Which fungi is famous for causing meningitis
Cryptococcus
126
Treatment for fungal infections?
usually end in -zole.
Often target ergosterol, fungal version of cholesterol.
127
Yellow crusty sores on the skin should ring alarm bells for what? Which organism?
Impetigo - typically staph.
128
Folliculitis is usually caused by?
Staph species
129
Cellulitis is usually caused by?
Strep pyogenes
130
What is bone infection called and explain how it happens.
Osteomyelitis.
can be local or hematogenous. Capillaries are slow at bone, perfect for colonisation.
Pus forms at periosteum and sort of pushes up and out of bone.
131
What is infection of the vertebral discs called?
DISKITIS - can destroy disk
132
How do glucocorticoids stop inflammation?
They stop the formation of arachadonic acid (one step above COX).
133
Why are NSAIDS bad for asthmatics?
COX inhibiton allows LOX to dominate, more leukotrienes causes bronchospasm.
134
what affect does paracetemol have on COX?
Poor peripheral inhibitor of COX
135
What drugs are used for RA?
Methotrexate - anti-proliferative - folate path - once a week.
Biologics (mABS) - TNFa one
136
How does the body go from the hard callous to remodelling phase?
Osteoclasts chew up the woven bone from the hard callous phase and promote osteoclast action via TGFB to form new bone.
137
How does calcitonin affect the gut?
It doesnt.
138
How do steroids impact bone?
Cause osteoporosis by inhibiting osteoblasts/osteocytes and inhibiting OPG.
139
What is the first line treatment for osteoporosis and how does it work?
Biphosphonates - force calcium hydroxyapatite to bind to bone. Drugs sticks around in bone and kills osteoclasts who try to eat it.
140
Side effects of bisphosphonates?
- poor absorption - must be taken on empty stomach.
- gut issues
- irritate esophagus
141
What is a calcimimetic agent?
Mimics calcium to make body think calcium is higher than it is, less PTH made.
142
Cancer common following radiation of breast?
Angiosarcoma
143
What marker is used to check for Melanoma?
S100
144
What are 3 ways to get osteomyelitis?
- local
- hematogenous
- continguous - from septic arthritis
145
Describe the symmetry of RA and OA
RA = symmetrical
OA = assymetrical
146
Describe the shape of the scaphoid
The most odd looking bone in the hand, sort of looks like a shark tooth
147
Which dermatome supplies the heel?
S1
148
What is the order of the femoral triangle?
Most lateral: Nerve
Then artery
Then Vein
149
Damage to what nerve causes foot drop?
Deep fibular/common fibular
150
Damage to what nerve causes wrist drop?
Radial nerve
151
Order of vessels in the porta hepatis?
Opposite to renla hilum (AVAP)
It is ABAV - anterior: bile, artery, vein
152
List the parts of the anterior leg compartment that could be impacted by compartment syndrome.
Tibilias anterior, deep fibular nerve, anterior tibial artery, extensor digitorium longus, extensor hallux longus
153
Which artery is commonly lacerated by a NOF fracture?
Medial circumflex
154
Which joint does OA famously target?
Knee
155
What is allodynia?
Pain response to normal stimuli
156
List 3 complications of osteomyelitis
- fracture
- cellulitis
- septic arthritis
