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Physiology Flashcards

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1
Q

How is cortical bone laid down?

A

Laid down circumferentially

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2
Q

How is cancellous bone laid down?

A

Site of longitudinal growth

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3
Q

What forces does cortical bone resist?

A

Bending

Torsion

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4
Q

What forces does cancellous bone resist?

A

Compression

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5
Q

What is a fracture?

A

Break in structural continuity of bone

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6
Q

What causes fractures?

A

High energy transfer in normal bones (traumatic fractures)
Repetitive stress in normal bones (Stress fracture)
Low energy transfer in abnormal bones (Osteoporosis, osteomalacia, bone mets. etc)

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7
Q

What are the four stages of fracture repair?

A

Stage 1 - Inflammation
Stage 2 - Soft callus
Stage 3 - Hard Callus
Stage 4 - Bone remodelling

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8
Q

What types of cells may be involved in the inflammation stage of fracture repair?

A

Platelets, PMNs, Neutrophils, Monocytes, Macrophages
Fibroblasts
Mesenchymal and osteoprogenitor cells

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9
Q

When does soft callus formation begin in fracture repair?

A

When pain and swelling subside

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10
Q

What factors make autogenous cancellous bone graft useful for fracture repair?

A

Osteoconductive

Osteoinductive

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11
Q

What type of bone formation may take place in hard callus formation in fracture repair?

A

Endochondral bone formation

Membranous bone formation

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12
Q

What takes place in bone remodelling?

A

Conversion of woven bone to lamellar bone

Medullary canal reconstituted

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13
Q

What may happen in fracture repair if magnitude of strain (instability) is too low?

A

Mechanical induction of tissue differentiation fails

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14
Q

What may happen in fracture repair if magnitude of strain (instability) is too high?

A

Healing process does not progress to bone formation

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15
Q

What is delayed union in fracture healing?

A

Failure to heal in expected time

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16
Q

What may cause delayed union in fracture repair?

A 
High energy injury
Distraction
Instability
Infection
Steroids
Immune suppressants
Smoking
Warfarin
NSAID
Ciprofloxacin
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17
Q

What may cause non union (failure to heal) in fracture repair?

A 
Failure of calicification of fibrocartilage
Instability
Abundant callus formation
Pain and tenderness
Peristent fracture line
Sclerosis
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18
Q

What alternative management may be considered in delayed healing in fracture repair?

A

Different fixation
Dynamisation
Bone grafting

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19
Q

What makes up the structure of ligaments?

A 
Collagen fibres (type 1)
Fibroblasts
Sensory fibres (Proprioception, stretch, sensory)
Vessels
Crimping formations to allow stretch
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20
Q

What are the stages in ligament healing?

A

Haemorrhage
Proliferative phase
Remodelling

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21
Q

What are the options of treatment in ligament healing?

A

Conservative
(If partial, no instability, or poor surgical candidate)
Operative
(If instability, expectation (sportsmen etc) or compulsary)

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22
Q

What makes up the structure of tendons?

A

Longitudinal arrangement of cells (tenocytes) and fibres (Collagen type 1 - triple helix) arranged into bundles > fascicles > tendon

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23
Q

What connects tendon to sheath?

A

Vincula

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24
Q

What are the functions of tendon sheaths?

A

Synovial lining + fluid (gliding lubrication and nutrition)

Thickenings which form strong annular pulleys

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25
List some causes of tendon injury
Degeneration Inflammation Enthesiopathy (disorder of tendon attachment) Traction Apophysitis Avulsion +- bone fragment/Tear/Laceration/Incision Crush/Ischaemia/Attrition/Nodules
26
Give an example of a degeneration tendon injury
Achilles tendon
27
Give an example of tendon inflammation
de Quervain's stenosing tenovaginitis
28
Give an example of tendon entesiopathy
Tennis elbow (lateral humeral epicondylitis)
29
Who might traction apophysistis occur in?
Adolescent active boys (insertion of patellar tendon into anterior tibial tuberosity)
30
What treatments are available for tendon injury caused by avulsion +- bone fragment?
Conservative Treatment - Limited application - Retraction tendon Operative treatment - Reattachment tendon -through bone - Fixation bone fragment
31
What covers the outside of axons?
Endoneurium
32
What covers the outside of fascicles?
Perineurium
33
What covers the outside of nerves?
Epineurium
34
What type of cells surround peripheral neurones to lay down myelin?
Schwann cells
35
What is the largest nerve fibre type?
A alpha
36
What is the smallest nerve fibre type?
C fibres
37
What is the function of Aalpha fibres?
Large motor axons} Muscle strach and tension sensory axons
38
What is the function of Abeta fibres?
Touch, pressure, vibration and joint position sensory axons
39
What is the function of Agamma fibres?
Gamma efferent motor axons
40
What is the function of Adelta fibres?
Sharp pain, very light touch and temperature sensation
41
What is the function of Beta fibres?
Sympathetic preganglionic motor axons
42
What is the function of C fibres?
Dull, aching, burning pain and temperature sensation
43
Of neuropaxia, axonotmesis and neurotmesis, which has the best prognosis?
Neuropaxia - basically stretching/bruising of the nerve
44
List some examples of closed nerve injuries
Typically stretching of nerve | eg brachial plexus injury, radial nerve humeral fracture
45
What is the typical rate of healing in axonal injury?
1 mm/a day
46
What is the first modality to return in neuronal injury?
Pain
47
What would happen to strength in a UMN lesion?
Decreased
48
What would happen to strength in a LMN lesion?
Decreased
49
What would happen to tone in a UMN lesion?
Increased
50
What would happen to tone in a LMN lesion?
Decreased
51
What would happen to deep tendon reflexes in a UMN lesion?
Increased
52
What would happen to deep tendon reflexes in a LMN lesion?
Decreased
53
Would clonus be present or absent in a UMN lesion?
Present
54
Would clonus be present or absent in a LMN lesion?
Absent
55
Would Babinski's sign be present or absent in a UMN lesion?
Present
56
Would Babinski's be present or absent in a LMN lesion?
Absent
57
Would atrophy be present or absent in a UMN lesion?
Absent
58
Would atrophy be present or absent in a LMN lesion?
Present
59
What type of bone cells are responsible for bone formation?
Osteoblasts
60
What type of bone cells are responsible for bone resorption?
Osteoclasts
61
What type of cell do osteoclasts differentiate from?
Macrophages
62
What does RANK Ligand do to osteoclast acitivity?
Activates osteoclasts, enhancing bone resorption.
63
List some factors that stimulate osteoblast expression of RANK Ligand?
``` PTH Glucocorticoids Vitamin D PGE2 IL-11 IL-1 PTHrP TNF -a ```
64
Where is Vitamin D formed in the body?
LIver | As 25(OH) Vitamin D
65
Where is Vitamin D converted to a useful form in the body?
Kidney | As 1,25 (OH)2 Vitamin D
66
What does Vitamin D do in the gut?
Stimulates absorption of calcium and phosphate
67
Why are bisphosphonates first line in osteoporosis?
Bisphosphonates inhibit osteoclasts - reduce bone resorbtion
68
List some biomechanical differences in childrens bone compared to adults?
Ligaments stronger than growth plate (Epiphyseal separation, hard to get sprains/dislocations) Young bone more porous (Plasticity, fails in compression and tension)
69
What are the 5 S's in paediatric orthopaedics?
``` Symmetrical Symptomatic Systemic illness Skeletal dysplasia Stiffness ```
70
What examinations may you look at for intoeing?
Identify origin of rotational concern | -Hip/Tibia/Foot
71
Is there more external rotation or internal rotation of the hip at birth?
External rotation
72
What movement of the hip will result in a child with excessive femoral anteversion?
Internal rotation - may give appearance of intoeing
73
How may you see if intoeing pathology is arising from the hips in a child?
Look at the knee caps - will be equally facing inward if pathology is arising from the hips
74
How is Tibial torsion clinically assessed?
Thigh foot angle technique | Patella position with feet/ankles facing forward
75
What may be a forefoot cause of intoeing?
Metatarsus adductus | Self correcting pathology
76
At what age should children be considered for underlying pathology of bow legs?
Over the age of 8 years
77
What may you use in clinical assessment of the lower limbs of a child in orthopaedics?
Walking Standing (Alignment from front, patella position, heels/arch/toes/leg length from behind) Tip toes Staheli rotational profile
78
What situations may require further review in child orthopaedic leg assessment?
Not age appropriate signs Assymetry Rigid flat foot Bow legs (Blouts, rickets)
79
What situations may require treatment in child orthopaedic leg assessment?
Metatarsus adductus Tibial torsion (External typically more than internal) Persistant femoral anteversion Curly toes

Musculoskeletal system (5 decks)

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