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PBL 1 Flashcards

1
Q

what are the 4 main functions of the vertebral column?

A

protects the spinal cord, supports the wight of the body, forms the central axis of the body, has roles in posture and movement

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2
Q

what are the superior and inferior aspects of the vertebral body lined with?

A

hyaline cartilage

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3
Q

what type of cartilage are intervertebral discs made out of?

A

fibrocartilage

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4
Q

what are the pedicles of the vertebral arch?

A

they connect the vertebral body to the transverse processes

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5
Q

what are lamina of the vertebral arch?

A

they connect transverse and spinous processes

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6
Q

what are articular processes of the vertebral arch?

where are they located?

A

they form joints between the superior and inferior vertebra.
located at the intersection of the laminae and pedicles

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7
Q

what is the anterior ligament?

A

The anterior longitudinal ligament is thick and prevents hyperextension of the vertebral column.

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8
Q

what is the posterior ligament?

A

The posterior longitudinal ligament is weaker and prevents hyperflexion.

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9
Q

what are the 3 ligaments that strengthen the facet joints?

A

ligamentum flavum, interspinous and supraspinous ligaments, inter transverse ligaments

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10
Q

what is the ligament flavum?

A

connect ventral parts of laminae between adjacent vertebrae. It helps to preserve the normal curvature of the spine and to straighten the column after it has been flexed.

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11
Q

what are the interspinous and supraspinous ligaments?

A

interspinous joint ligaments attach between spinous processes of adjacent vertebrae whilst the supraspinous ligaments attaches to the tips

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12
Q

what are the inter transverse ligaments?

A

they extend between the transverse processes.

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13
Q

what are nociceptors?

A

free nerve endings in every tissue apart from the brain

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14
Q

what is superficial somatic pain?

A

pain that arises from stimulation of receptors in the skin

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15
Q

what is deep somatic pain?

A

pain that arises from stimulation of pain receptors in skeletal muscles, joints, tendons and fascia

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16
Q

what is visceral pain?

A

pain that results from stimulation of nociceptors in visceral organs

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17
Q

what are NSAIDs mechanism of action?

A

they inhibit COX 1 and 2 which prevents the conversion of arachidonic acid to prostaglandins without prostaglandins we cannot get depolarisation and so an act potential can’t be formed.`

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18
Q

what are opiates mechanism of action?

A

Opioids close N-type voltage-operated calcium channels and open calcium-dependent inwardly-rectifying potassium channels. This results in hyperpolarization and a reduction in neuronal excitability.

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19
Q

in the descending pain pathway, where do the first order neurones arise?
where does it synapse with the 2nd order neurone?
how does this 2nd order neuron inhibit the ascending pain pathway?

A

periaqueductal grey matter

in the nucleus Raphe magnus

it travels to the dorsal horn of the spinal cord and releases serotonin, nor-adrenaline and stimulates an interneurone within the substantial gelatinosa to release enkephalin (an endogenous opiod)

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20
Q

what effect do serotonin and nor-adrenaline have in the descending pathway?

A

they inhibit the release of substance P

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21
Q

what effect does enkephalin have in the descending pathway?

A

it inhibits substance P release from pre-synaptic neurones and inhibits depolarisation of the 2nd order neuron

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22
Q

what is the substantial gelatinosa?

A

a collection of cells in the dorsal horns of the spinal cord

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23
Q

what is spondylosis?

A

general degeneration of the spin associated with normal wear and tear

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24
Q

what are sprains?

what are strains?

A

tearing/over-stretching a ligament

tears in tendons or muscles

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25
what is intervertebral disc degeneration?
when the usual rubbery discs lose integrity as a normal process of ageing- they lose their cushioning ability, become less flexible and are therefore more prone to tearing or rupturing
26
what are herniated discs?
outer fibres of the intervertebral discs can become injured and the nucleus pulpous can bulge outwards or rupture out of its enclosed space
27
what is Radiculopathy?
compression, inflammation or injury on a spinal nerve root can cause pain, numbness, tingling that radiates to other areas of the body that are also served by the same spinal nerve root.
28
what is sciatica?
compression of the sciatic nerve which causes shock-like or burning lower back pain combined with pain. down the back of the leg. this can be caused by a tumour or cyst.
29
what is spondylolisthesis?
vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
30
what is spinal stenosis?
narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
31
what is scoliosis?
a curvature of the spine that does not usually cause pain until middle age
32
what is lordosis?
an abnormally accentuated arch in the lower back
33
describe the structure of the intervertebral discs?
the central area is composed of a colloidal gel called the nucleus pulposus. it is surrounded by the annulus fibrosis (a fibrous capsule)
34
where is the most common site of disc herniation? | why?
L5/S1 | due to the thinning of the posterior longitudinal ligament as it extends caudally
35
describe the differences between a 1) disc bulge? 2) disc protrusion? 3) disc extrusion? 4) disc sequestration?
1) small bulge but annular fibres remain intact 2) localised bulging with some damage to annular fibres 3) extended bulge with loss of annular fibres but the disc remains intact 4) fragment of disc broken off from nucleus pulposus
36
what are the symptoms of lumbar disc disease?
Sharp pain Typically, bilateral pain located at the posterior belt line Referred pain rather than radicular Usually preceded by multiple episodes of less severe low back pain Localized to the lower back and gluteal area Pain with flexion, rotation, or prolonged sitting or standing Pain relieved in a recumbent position
37
what is the difference between radicular and referred pain?
Radiating pain follows specific nerves, while referred pain is more general and can occur in many places around an injured tissue
38
what is nerve root compression? | what are the symptoms?
direct pressure on a single nerve pain, tingling, numbness, and muscle weakness, sciatica, inability to stand up, pain worse when sitting/bending/ligting/coughing, weakness, pins and needles, reduced range of movements, balancing problems. The symptoms affect just one particular part of the body, depending on which nerve is affected.
39
what is a clinical consequence of nerve root compression?
External pressure reduces flow in the vasa nervorum. This causes local ischaemia, which has an immediate effect on the ability of the nerve axons to transmit action potentials. As the compression becomes more severe over time, focal demyelination occurs, followed by axonal damage, and finally scarring.
40
what is ischaemia?
a deficiency of blood in a tissue that is caused by constriction or obstruction of local blood vessels and results in a reduced supply of oxygen to the tissue
41
what is a dermatome?
an area of skin supplied by a single spinal cord level, or on one side, by a single spinal nerve
42
what is a myotome?
the portion of a skeletal muscle innervated by a single spinal cord level or, on one side, by a single spinal nerve.
43
how do you test the nerve root for C1 (myotome)?
upper cervical flexion
44
how do you test the nerve root for C2 (myotome)?
upper cervical extension
45
how do you test the nerve root for C3 (myotome)?
cervical lateral flexion
46
how do you test the nerve root for C4 (myotome)?
shoulder girdle elevation
47
how do you test the nerve root for C5 (myotome)?
shoulder abduction
48
how do you test the nerve root for C6 (myotome)?
elbow flexion
49
how do you test the nerve root for C7 (myotome)?
elbow extension
50
how do you test the nerve root for C8 (myotome)?
thumb extension
51
how do you test the nerve root for T1 (myotome)?
finger adduction
52
how do you test the nerve root for L1/L2 (myotome)?
hip flexion
53
how do you test the nerve root for L3 (myotome)?
knee extension
54
how do you test the nerve root for L4/L5 (myotome)?
ankle dorsiflexion
55
how do you test the nerve root for L5 (myotome)?
great toe extension
56
how do you test the nerve root for S1 (myotome)?
ankle plantar flexion
57
how do you test the nerve root for S4 (myotome)?
bladder and rectum motor supply
58
where to test for C2 (dermatome)?
1-2cm lateral to the occipital protuberance
59
where to test for C3 (dermatome)?
the supraclavicular fossa in the midclavicular line
60
where to test for C4 (dermatome)?
over the acromioclavicular joint (between shoulder and clavicles)
61
where to test for C5 (dermatomes)?
lateral aspect of the lower edge of the deltoid muscle/ regimental badge
62
where to test for C6 (dermatome)?
palmar side of thumb
63
where to test for C7 (dermatome)?
palmar side of middle finger
64
where to test for C8 (dermatome)?
palmar side of little finger
65
where to test for T1 (dermatome)?
medial aspect antecubital fossa (fossa inside elbow close to body)
66
where to test for T2 (dermatome)?
apex of axilla
67
where to test for T3 (dermatome)?
intersection of midclavicular line and 3rd intercostal space
68
where to test for T4 (dermatome)?
the intersection of the midclavicular line and the fourth intercostal space at the level of the nipples.
69
where to test for T5 (dermatome)?
the intersection of the midclavicular line and the fifth intercostal space, horizontally located midway between the level of the nipples and the level of the xiphoid process.
70
where to test for T6 (dermatome)?
the intersection of the midclavicular line and the horizontal level of the xiphoid process.
71
where to test for T7 (dermatome)?
the intersection of the midclavicular line and the horizontal level at one quarter the distance between the level of the xiphoid process and the level of the umbilicus.
72
where to test for T8 (dermatome)?
the intersection of the midclavicular line and the horizontal level at one half the distance between the level of the xiphoid process and the level of the umbilicus.
73
where to test for T9 (dermatome)?
the intersection of the midclavicular line and the horizontal level at three-quarters of the distance between the level of the xiphoid process and the level of the umbilicus.
74
where to test for T10 (dermatome)?
the intersection of the midclavicular line, at the horizontal level of the umbilicus.
75
where to test for T11 (dermatome)?
the intersection of the midclavicular line, at the horizontal level midway between the level of the umbilicus and the inguinal ligament.
76
where to test for T12 (dermatome)?
the intersection of the midclavicular line and the midpoint of the inguinal ligament
77
where to test for L1 (dermatome)?
the inguinal region and the very top of the medial thigh.
78
where to test for L2 (dermatome)?
the middle and lateral aspect of the anterior thigh
79
where to test for L3 (dermatome)?
the medial epicondyle of the femur.
80
where to test for L4 (dermatome)?
the medial malleolus.
81
where to test for L5 (dermatome)?
the dorsum of the foot at the third metatarsophalangeal joint.
82
where to test for S1 (dermatome)?
the lateral aspect of the calcaneus.
83
where to test for S2 (dermatome)?
at the midpoint of the popliteal fossa.
84
where to test for S3 (dermatome)?
at the horizontal gluteal crease (the horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh).
85
where to test for S4/S5 (dermatome)?
the perianal area.
86
what is referred pain?
when the pain you feel is not where the nociceptive stimulus is. The pain is felt in more superficial tissues from the site of origin.
87
what is the cause of referred pain?
a dorsal horn neuron has convergent input from two different body regions. Because of the convergence, thalamic neurons cannot localize the origin of the dorsal horn activation. (Convergence projection theory)

B5W2 (10 decks)

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