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Medicine: PBL wrap-ups > Unit 5 Case 1: ACL tear > Flashcards

Unit 5 Case 1: ACL tear Flashcards

1
Q

anatomy in this case

A

anatomy of the knee joint

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2
Q

which movements does the knee joint allow

A

extension
flexion
lateral rotation
medial rotation

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3
Q

label the image

A
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4
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label the image

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5
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label the image

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6
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label the image

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7
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label the image

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8
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label the image

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9
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label the image

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10
Q

label the image

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11
Q

what is a bursa

A

synovial fluid filled sac found between moving structures in a joint
aim is to reduce wear and tear on those structures

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12
Q

4 bursae located in the knee

A

supra patellar
prepatellar
infra patellar
semimemmbranosus

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13
Q

suprapatellar bursa

A

extension of the synovial cavity of the knee
located between the quadriceps femurs and the femur

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14
Q

prepatellar bursa

A

found between apex of the patella and the skin

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15
Q

infra patellar bursa

A

split into deep and superficial
deep bursa lies between tibia and patellar ligament
superficial lies between patellar ligament and skin

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16
Q

semimembranosus bursa

A

located posteriorly in the knee joint
between semimembranosus muscle and medial head of the gastrocnemius

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17
Q

what does NSAID stand for

A

non steroidal anti-inflammatory drugs

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18
Q

examples of NSAID’s

A

aspirin
naproxen
ibruprofen

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19
Q

moa of NSAID’s

A

inhibit COX-1 and COX-2 enzymes which convert arachidonic acid into prostanoids
to produce prostaglandins, thromboxane and prostacyclin

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20
Q

COX-1 of NSAID’s

A

GIT effects
preserves integrity of gastric mucosa

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21
Q

COX-2 of NSAID’s

A

inducible form
predominates at sites of inflammation
stimulates prostaglandin formation

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22
Q

what are adverse effects of NSAID’s caused by

A

COX-1 pathways

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23
Q

how are NSAID’s administered

A

orally
topical gel
parenterally
suppositories

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24
Q

when are NSAID’s given

A

for mild-moderate pain as they have analgesic effects
inflammation
and pyretic

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25
when should you avoid NSAID's
if severe Renal impairment heart or liver failure
26
NSAID's side effects
GI toxicity renal impairment increased risk of cardiovascular events hypersensitivity reactions fluid retention
27
how can you gastroprotect when giving NSAID's
low dose NSAID standard dose of PPI
28
types of prostaglandin
E2, PGE2 D2, PGD2 F2 alpha, PGF2 alpha prostacyclin, PGI2
29
prostaglandin function
inhibits gastric acid secretion, E2 maintains renal blood flow, E2 inflammation, E2 and D2 pain, E2 inhibits platelet aggregation, E2
30
thromboxane function
stimulates activation of platelet aggregation
31
thromboxane function
stimulates activation of platelet aggregation blood clotting vasoconstriction
32
prostacyclin funciton
inhibits platelet aggregation vasodilation
33
label the image
34
function of osteoprogenitor cells
stem cells to osteoblasts
35
function of osteoclasts
erode mineralised bone
36
function of osteoblasts
synthesis of osteoid
37
function of osteocytes
inactive osteoblasts trapped in mineralised bone
38
function of osteoid
organic component of bone matrix
39
label the image
40
features of hyaline cartilage
perichondrium type 2 collagen fibres chondrocytes arranged in groups articular ends of bones, nose, trachea, ventral end of ribs
41
features of fibrocartilage
perichondrium contains elastin and type 2 collagen pinna of the ear, epiglottis
42
features of elastic cartilage
no perichondrium chondrocytes are arranged in parallel rows dense, coarse, type 1 collagen in the matrix for withstanding tensile strength intervertebral discs, pubic symphysis
43
inflammatory response to knee injurt
immediate response is an increase in synovial fluid releases IL-1 alpha, IL-1 beta, IL-6, IL-8, TNF- alpha, matrix metalloproteinases, cartilage oligomeric matrix protein
44
function of IL-1 alpha
DAMP released to the extracellular space after apoptosis stimulated chemokine production results in infiltration of neutrophils first followed by monocytes
45
function of IL-1 beta
pro-inflammatory cytokine crucial for host defence responses to infection and injury
46
function of IL-6
induces synthesis of acute phase proteins (CRP) serum amyloid A fibrinogen hepcidin in hepatocytes inhibits albumin production
47
function of IL-8
chemoattractant produced by tissue and blood cells targets neutrophils activates neutrophils in inflammatory regions
48
function of TNF-alpha
vasodilation edema formato leukocyte adhesion to epithelium through the expression of adhesion molecules regulates coagulation contributes to oxidative stress in inflammation sites induces fever indirectly
49
function of MMP's
activity of inflammatory cytokines and chemokine collagen breakdown
50
function of cartilage oligomeric matrix protein
non-collagenous extracellular matrix protein expressed in cartilage ligaments and tendons binds to other ECM proteins catalyse polymerisation of type 2 collagen fibrils regulate chondrocyte proliferation
51
where are similar inflammatory responses found to those in the knee
elbow inter pharyngeal joints (hand, foot, tibiotalar of ankle)
52
bundles of the anterior cruciate ligament
anteriomedial posterolateral
53
function of the ACL
restraint to limit anterior movement of the tibia knee rotational stability
54
location of the ACL
normally will parallel blumensaats line
55
clinical presentation of an ACL tear
popping sensation significant pain hemarthrosis (delayed) loss of full range of motion tenderness along the joint one discomfort/ inability to walk rapid joint swelling
56
hemarthrosis
bleeding into the joint
57
differential diagnosis for an ACL tear
proximal tibial fracture distal femur fracture meniscal tear collateral ligament tear quadriceps tendon tear patellar ligament tear
58
examinations done in order to test ACL tear
Lachman test anterior draw test x ray MRI ultrasound
59
lachman test
30 degrees flexion stabilise femur pull tibia forward assess anterior movement of tibia vs the femur compare knees
60
anterior draw test
90 degrees flexion place thumbs on joint line index fingers on hamstring tendons apply forces anteriorly to see tibial excursion compare knees
61
x ray in this case
rule out fractures doesn't confirm any soft tissue injury
62
MRI in this case
hard and soft tissues radio waves
63
ultrasound in this case
sound waves check injuries in ligaments, tendons and muscles
64
treatment options for ACL tear
elevate and stay off leg (immediate) apply ice and take NSAID's (immediate) leg brace ACL reconstructive surgery
65
when is ACL reconstructive surgery completed
not straight away, when the swelling has reduced assessed to see if it is severe enough for surgery
66
ACL reconstructive surgery
67
phase one of the rehabilitation program
weeks 0-2 eliminate the swelling receive full range of motion regain strength in hamstrings and quads exercises: calf raises, lateral band walks, balance, static cycling
68
phase 2 of the rehabilitation program
weeks 3-6 regain balance recover majority of muscle strength single leg exercises low impact exercise: walking, swimming and cycling
69
phase 3 of the rehabilitation program
weeks 7-12 hopping performance complete agility exercises regain strength and balance light jogging, outdoor cycling and swimming
70
phase 4 of the rehabilitation program
3-6 months knee feels normal but no strenuous sport polymetrics sports drills
71
phase 5 of the rehabilitation program
months 6+ continue with strength, balance, landing and agility return to pre-injury exercise
72
MDT involved in an ACL tear
physio trauma team theatre nurse social teams ward nurse discharge coordinator clinical support worker ward clerk porter GP osteopaths occupational therapist pharmacist radiologist anaesthetist orthopaedic surgeon
73
psychological implications of an ACL tear
very painful depression pain after surgery decreased athletic identity

Medicine: PBL wrap-ups (21 decks)

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