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Neurological, neuromuscular and musculoskeletal disease > PBL 41 > Flashcards

PBL 41 Flashcards

(55 cards)

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1
Q

The hip joint is a ball and socket joint, what is the ball and socket?

A 
Ball = head of femur
Socket = acetabulum
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2
Q

What is the acetabulum?

A

Cup-like depression located on the inferolateral aspect of the pelvis

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3
Q

What is the name of the fibrocartilaginous collar which deepens the acetabulum?

A

Acetabular labrum

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4
Q

The acetabulum and head of femur are covered in … cartilage which is thicker at the places of …

A
  • Articular cartilage

- Weight bearing

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5
Q

The ligaments of the hip joint act to increase…

A

Stability

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6
Q

The ligaments of the hip joint can be classed as intracapsular and extracapsular, give the names of all relevant ligaments to each class

A

Intracapsular: ligament of head of femur

Extracapsular: Iliofemoral, pubofemoral, ischiofemoral

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7
Q

The ligament of the head of femur encloses which artery?

A

The obturator artery AKA the artery to the head of femur

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8
Q

The iliofemoral ligament arises from the ASIS and has which shape?

A
  • Y shape
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9
Q

Which is the strongest of the 3 extracapsular hip ligaments? What does this ligament act to prevent?

A

Iliofemoral ligament

- Prevents hyperextension of the hip joint

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10
Q

The pubofemoral ligament has which shape? What does this ligament act to prevent?

A

A triangle

- Excessive abduction and extension

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11
Q

The ischiofemoral ligament has which shape? What does this ligament act to prevent?

A
  • Spiral orientation

- Prevents hyperextension and holds the femoral head in the acetabulum

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12
Q

The arterial supply to the hip is largely via the…

A

Medial and lateral circumflex arteries

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13
Q

The medial and lateral circumflex arteries are branches of the…

A

Deep femoral artery (profunda femoris)

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14
Q

The medial and lateral circumflex arteries …. at the base of the … to form a ring, from which smaller arteries arise to supply the hip joint itself

A

Anastomose

Femoral neck

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15
Q

The … artery is responsible for the majority of the arterial supply to the hip joint

A

Medial circumflex

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16
Q

Why is it that the medial circumflex artery is responsible for the majority of supply to the hip joint and less so the lateral circumflex artery?

A

The lateral circumflex artery has to penetrate through the thick iliofemoral ligament

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17
Q

Damage to the medial circumflex artery can result in…

A

Avascular necrosis of the femoral head

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18
Q

The hip joint is innervated by which nerves?

A

Sciatic, femoral and obturator

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19
Q

Movements of the hip joint?

A 
Flexion
Extension
Abduction
Adduction
Lateral rotation
Medial rotation
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20
Q

The proximal aspect of the femur consists of which landmarks?

A 
Head
Neck
Greater trochanter
Lesser trochanter
Intertrochanteric line (anteriorly)
Trochanteric crest (posteriorly)
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21
Q

On the posterior surface of the femoral shaft, there are roughened ridges of bone, called the…

A

Linea aspera (latin for rough line)

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22
Q

The medial and lateral borders of the linea aspera become…

A

The pectineal line and the gluteal tuberosity

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23
Q

Which muscle attaches to the gluteal tuberosity?

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A

Gluteus maximus

24
Q

The distal end of the femur has which landmarks?

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A

Medial and lateral condyles
Medial and lateral epicondyles
Intercondylar fossa

25
The gluteal muscles are divided into 2 groups, what are they?
Superficial and deep
26
The superficial gluteal muscles act to...
Abduct and extend the lower limb at the hip joint
27
The deep gluteal muscles act to...
Laterally rotate the lower limb
28
What is the blood supply to the gluteal muscles?
Branches of the internal iliac = superior and inferior gluteal arteries
29
What are the superficial muscles in the gluteal region?
Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia lata
30
What is the action and innervation of the gluteus maximus?
Action: Main extensor of the thigh, assists with lateral rotation - Only used when force is required Innervation: inferior gluteal nerve
30
What is the action and innervation of the gluteus medius?
Action: abducts and medially rotates the lower limb - Prevents pelvic drop Innervation: Superior gluteal nerve
31
What is the action and innervation of the gluteus minimus?
Action: abducts and medially rotates the lower lim - Prevents pelvic drop Innervation: Superior gluteal nerve
32
What is the action and innervation of the tensor fascia lata?
Action: Assists gluteus medius and minimus in abduction and medial rotation of the lower limb Innervation: Superior gluteal nerve
33
Trendelenburg gait is caused by damage to which nerve? What is this characterised by?
Superior gluteal nerve | - Characterised by pelvic drop of the opposite leg when standing on one leg
34
The deep gluteal muscles are a smaller set of muscles, located underneath the gluteus minimus. What is the general action of these muscles?
Lateral rotation and stabilising the hip joint
35
How do the deep gluteal muscles stabilise the hip joint?
Pull the femoral head into the acetabulum of the pelvis
36
What are the different deep gluteal muscles?
Piriformis Obturator internus Superior and inferior Gemelli Quadratus femoris
37
What is the action and innervation of the piriformis?
Action: Lateral rotation and abduction Innervation: Nerve to piriformis
38
What is the most superior muscles of the deep gluteal muscles?
Piriformis
39
What is the action and innervation of the Obturator internus?
Action: lateral rotation and abduction Innervation: Nerve to obturator internus
40
The superior and inferior gluteal nerves are branches of...
The sacral plexus
41
What is the action and innervation of the superior and inferior gemelli?
Action: lateral rotation and abduction Innervation: Superior gemelli = nerve to obturator internus Inferior gemelli = nerve to quadratus femoris
42
What is the action and innervation of the quadratus femoris?
Action: lateral rotation & adduction Innervation: Nerve to quadratus femoris
43
Pathophysiology of osteoporosis
Imbalance between bone resorption and bone formation The three mechanisms are: 1. Inadequate peak bone pass 2. Excessive bone resorption e.g. lack of oestrogen, excessive PTH 3. Inadequate formation of new bone during remodelling e.g. calcium deficiency and vitamin D
44
Drug treatment for osteoporosis
Biophosphates Hormones: oestrogen Denosumab
45
Mechanism of biophosphates for osteoporosis treatment & side effects of daily use
Mechanism: Inhibit digestion of bone by encouraging osteoclast apoptosis, slowing bone loss Side effects of daily use: poor compliance and gastric problems
46
Social consequences of hip fractures in the elderly
- Psychological problems: fear of falling, self imposed activity restriction, social isolation, depression - Increase in dependency and disability - Impact on carers - Institutionalisation: Admission to nursing home
47
Ethical issues around confused people and their decision making
Just because a person is confused and forgetful doesn't mean they lack capacity Issues: - Find it difficult to make decisions - Vulnerable to abuse and exploitation - Vulnerable to being stigmatised and stripped of their personhood
48
What are the 3 main DMARDs?
1. Sulphasalazine 2. Methotrexate 3. Hydroxychloroquine
49
Class and action of methotrexate
Folate antagonist - Inhibits folic acid reductase which converts folic acid to tetrahydrofolic acid - Tetrahydrofolic acid is required for both purines and pyrimidine biosynthesis so you can't proceed with DNA synthesis - It affects rapidly dividing cells
50
Class and action of sulphasalazine
Immunomodulatory agent - Anti-inflammatory agent used to treat ulcerative collitis and RA - MOA unknown
51
Class and action of hydroxychloroquine
DNA/RNA synthesis inhibitor & anti-inflammatory agent - MOA unknown for RA - MOA for malaria is to inhibit parasitic enzyme heme polymerase, causing a build up of toxic heme within the parasite
52
Definition of disability?
Any restriction or lack of ability to perform an action in the manner considered normal for a human being
53
Definition of impairment?
Any loss or abnormality of psychological, physiological or anatomical structure or function
54
Impact of disability on life
- Mental health issues: anxiety and depression - Loss of freedom and independence - Reliance on others - Unemployment - Problems with learning & academic study - Loss of self-esteem and confidence --> Isolation

Neurological, neuromuscular and musculoskeletal disease (36 decks)

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