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phase 2 limbs & back > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Posterior fixation to axial skeleton?

A

Muscles to vertebral collumn

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2
Q

Anterior fixation to axial skeleton?

A

Sternoclavicular joint

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3
Q

What is apposition? Reposition? Opposition of thumb?

A

Gripping between fingers and thumb
Release of this
Thumb meets 5th digit

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4
Q

Where is clavicle found?

A

From manubrium to acromion

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5
Q

Where does scapula overlap ribs?

A

Ribs 2-7

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6
Q

What does acromion process articulate with?

A

Clavicle

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7
Q

What does glenoid cavity articulate with?

A

Humerus

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8
Q

Label this.

A
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9
Q

Name the three bony landmarks of the scapula and where they are.

A

Supraspinous fossa: above spine anteriorly
infraspinous fossa: below spine anteriorly
Subscapular fossa: posterior

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10
Q

Which muscles hold the scapula in place?

A

Trapezius
Levator scapulae
Rhomboid minor/major
Serratus anterior
Pectoralis minor

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11
Q

What is protraction/retraction of scapula?

A

Protraction: pushing
Retraction = returning to normal

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12
Q

What is lateral rotation/abduction of scapula?

A

Tilt glenoid cavity upwards aka putting hand in air

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13
Q

What is medial rotation/adduction of scapula?

A

Bring arm back down

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14
Q

What is elevation/depression of scapula?

A

Shrugging shoulders

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15
Q

What is contained in the axilla?

A

Brachial plexus
Lymph nodes
Axillary vessels

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16
Q

What is axilla apex?

A

Continuous with neck root, top of axilla pyramid

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17
Q

What is floor of axilla?

A

Upward arching sheet of skin = where you put deodorant on

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18
Q

What is anterior wall of axilla?

A

Pectoral muscles

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19
Q

What is posterior wall of axilla?

A

Subscapularis
Teres major
Latissimus dorsi

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20
Q

What is medial wall of axilla?

A

Chest wall and serratus anterior

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21
Q

What is lateral wall of axilla?

A

Humerus

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22
Q

Attachments of pectoralis major?

A

2 heads: medial clavicle and sternum, upper 6 costal cartilages, aponeurosis of external obliques
Humerus: crest of greater tubercle and lateral lip of intertubercle groove

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23
Q

Actions of pectoralis major (both heads)?

A

Protracts and depresses scapula: pushes and goes down
Adducts and medial rotation of humerus

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24
Q

Action of pectoralis major (clavicle head)?

A

Flexes humerus

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25
Q

Action of pectoralis major (sternocostal attachment)?

A

Extends humerus

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26
Q

Innervation of pectoralis major?

A

Medial and lateral pectoral nerves

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27
Q

Attachments of pectoralis minor? Where is it found?

A

3rd-5th ribs
Coracoid process of scapula
Deep to major, triangular muscle

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28
Q

Actions of pectoralis minor?

A

Depresses shoulder
Pulls scapula and shoulder forward
Raises ribs in inspiration when scapula is fixed

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29
Q

Innervation of pectoralis minor?

A

Medial pectoral nerve

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30
Q

What do dorsal roots contain?

A

Afferent/sensory fibres

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31
Q

What do ventral roots contain?

A

Efferent/motor fibres

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32
Q

What do dorsal and ventral roots form?

A

Trunks in spinal ganglion

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33
Q

What passes through the intervertebral foramen?

A

Spinal nerves

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34
Q

What are rami?

A

Mixture of afferent and efferent fibres

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35
Q

What do dorsal rami supply?

A

Deep muscles
Skin on dorsum

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36
Q

What do ventral rami supply?

A

Limbs
Lateral and ventral (belly) trunk skin

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37
Q

Which spinal nerve roots are in the brachial plexus? Minor contribution from…?

A

C5-T1
C4, T2

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38
Q

Which types of nerve supply do the brachial plexus nerves do and where? Exception?

A

Sensory, motor and sympathetic to pectoral girdle and upper limb
Except trapezius

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39
Q

What is the back up mechanism in the brachial plexus?

A

Each terminal nerve is made from more than one spinal nerve root so if a spinal nerve is injured, the area supplied will still function

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40
Q

What is the organisation of the brachial plexus with numbers?

A

5 roots
3 trunks
6 divisions
3 cords
Branches to supply tissues

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41
Q

Draw the brachial plexus

A

Read That Damn Cavader Book

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42
Q

What are the terminal nerves of the brachial plexus?

A

Musculocutaneous
Axillary
Median
Radial
Ulnar

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43
Q

Where do brachial plexus roots emerge from?

A

Between scalene anterior and scalene medius muscles

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44
Q

What are the roots of the brachial plexus?

A

5 ventral rami of spinal nerves

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45
Q

What are the three trunks of the brachial plexus and what nerves are they composed of? Where are they found?

A

Upper - C5+C6
Middle - C7
Lower - C8+T1

In neck before clavicle

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46
Q

What do anterior divisions of brachial plexus supply?

A

Flexor muscles
Skin on front of upper limb

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47
Q

What do posterior divisions of brachial plexus supply?

A

Extensor muscles
Skin on back of upper limb

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48
Q

Where are BP divisions found?

A

Deep to middle 1/3 clavicle

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49
Q

Where are BP cords found and what are they named according to?

A

Posterior to axillary artery
According to position to axillary artery

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50
Q

3 BP cords and what are they made up of?

A

Lateral cord: anterior divisions of superior and middle trunks
Medial cord: anterior division of inferior trunk
Posterior cord: uniting posterior divisions of all 3 trunks

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51
Q

What branches are formed from the lateral cord of the BP?

A

Musculocutaneous nerve
Lateral root of median nerve
Lateral cutaneous of forearm

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52
Q

What does the musculocutaneous nerve pierce and supply? Where does it come from?

A

Pierces coracobrachialis muscle
Supplies coracobrachialis, biceps brachii and brachialis
C5-C7

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53
Q

What does the lateral and medial root of the median nerve supply?

A

Forearm flexors
Thenar eminence (base of thumb)

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54
Q

What do the terminal branches of the medial cord supply?

A

Medial root of median nerve
Ulnar nerve
3 cutaneous nerves

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55
Q

What does the terminal branches of the posterior cord supply?

A

Radial nerve
Axillary nerve

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56
Q

3 types of supraclavicular branches of BP?

A

Dorsal scapular
Long thoracic
Suprascapular

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57
Q

Where is dorsal scapular nerve from and what does it supply?

A

C5 ramus
Rhomboids

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58
Q

Where is long thoracic nerve from and what does it supply?

A

C5-C7 ventral rami
Serratus anterior

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59
Q

Where is suprascapular nerve from and what does it supply?

A

Superior trunk
Supraspinatus and infraspinatus muscle

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60
Q

3 main infraclavicular bracnhes?

A

Medial and lateral pectoral
Upper and lower subscapular
Thoracodorsal

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61
Q

Where are upper and lower subscapular nerves from and their innervation?

A

Posterior cord
Subscapularis and teres major

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62
Q

Thoracodorsal nerve innervation?

A

Lattisimus dorsi

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63
Q

Crutch palsy cause and effect?

A

Prolonged use of crutches
Affects radial nerve = extensors affected

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64
Q

Radial nerve damage cause and effect?

A

Caused by intramuscular injections into deltoid
Drop wrist = cant extend hand (gay hand)

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65
Q

Carpal tunnel syndrome cause and effect, symptoms?

A

Caused by repetitive wrist flexion
Median nerve damage
Numbness, tingling and pain in palm and fingers

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66
Q

Where does axillary nerve arise from? Functions?

A

Posterior cord: C5-C6
Teres minor: laterally rotates arm
Deltoid: abducts arm
Sensory innervation to inferior lateral shoulder

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67
Q

Where does ulnar nerve arise from? Functions? Sensory innervation?

A

Medial cord, C8-T1
Flexes and adducts wrist
Flexes fingers
Adducts thumb
Controls hypothenar (palm muscles) muscles
Flexes metacarpophalangeal joints
Extends interpharangeal joints
Abducts and adducts fingers
Sensory innervation: medial third of hand, little finger, medial half of ring finger

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68
Q

Where does the median nerve arise from? Functions? Sensory innervation?

A

Medial and lateral cords, C5-T1
Pronates forearm and hand
Abducts wrist
Flexes fingers and wrist
Controls thumb and thenar muscles
Flexes metacarpophalangeal joints
Extends interphalangeal joints
Sensory innervation: lateral 2/3 palm, thumb, index finger, middle finger, lateral half ring finger, dorsal tips of these fingers

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69
Q

Radial nerve origin, functions, cutaneous supply?

A

Comes from posterior cord of BP, C5-T1
Flexes elbow
Abducts and adducts wrist
Supinates forearm and hand
Extends fingers, elbow, thumb and wrist
Abducts thumb
Sensory innervation: posterior surface of arm and forearm, lateral 2/3 of dorsum of hand

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70
Q

Where does musculocutaneous nerve come from, functions, cutaneous supply?

A

Lateral cord, C5-C7
Flexes shoulder, elbow
Supinates forearm and hand
Sensory supply to lateral surface of forearm

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71
Q

Where is sternoclavicular joint? Joint type?

A

Notch of manubrium and medial clavicle
Synovial joint

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72
Q

How is sternoclavicular capsule thickened?

A

Sternoclavicular ligaments

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73
Q

Where are interclavicular ligaemnts?

A

Medial ends of clavicle

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74
Q

Where is the costoclavicular ligament found?

A

First costal cartilage and clavicle

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75
Q

Which type of joint is the acromioclavicular joint?

A

Gliding synovial between clavicle and acromion

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76
Q

What are the three ligaments of the acromioclavicular joint? Which is strongest?

A

Coracoclavicular - strongest
Acromioclavicular
Coracoacromial

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77
Q

Which type of joint is the glenohumeral joint and what is it made from? How is it stabilised and why?

A

Synovial ball and socket
Head of humerus and glenoid cavity
Rotator cuff muscles - stabilise joint without limiting it

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78
Q

Which structure deepens the glenoid fossa? What is it?

A

Glenoidal labrum - fibrocartilage ring around glenoid cavity

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79
Q

Where does the humerus fracture?

A

Surgical neck

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80
Q

Where are the radius, capitulum, ulna and trochlea anatomically?

A

Radius and capitulum: Laterally
Ulna and trochlea: medially

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81
Q

Functions of medial and lateral epicondyles?

A

Sites of muscle attachment

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82
Q

Attachments of synovial capsule in glenoid fossa?

A

Proximal: scapula beyond supraglenoid tubercle, margin of labrum
Distally: anatomical neck of humerus

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83
Q

What is bursae and its function? Where is it found?

A

Fluid filled sac lined by synovial membrane
In major joints reduces friction where one structure frequently moves over another
Subacromial, subscapular, subdeltoid and subcoracoid burse

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84
Q

Which muscles allow flexion?

A

Pecotralis major (clavicular head)
Anterior deltoid fibres (assisted by biceps brachii short head and coracobrachialis)

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85
Q

Which muscles allow extension from anatomical position?

A

Posterior deltoid fibres
Latissimus dorsi (asissted by scapula elevation and levator scapulae)

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86
Q

Which muscles allow extension to return to anatomical position?

A

Latissimus dorsi, teres major, pectoralis major (sternal head)
Assisted by rhomboid major and pectoralis minor

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87
Q

Which muscles allow abducion?

A

First 15-30 degrees = supraspinatus
Deltoid to horizontal
Lateral rotation of scapula to allow arm over head = serratus anterior (lower fibres) and trapezius (upper fibres)

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88
Q

Which muscles allow adduction?

A

Latissimus dorsi
Pectoralis major sternocostal fibres

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89
Q

Which muscles allow medial rotation?

A

Pectoralis major
Latissimus dorsi
Subscapularis
Teres major

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90
Q

Which muscles allow lateral rotation?

A

Infraspinatus
Deltoid (posterior fibres)
Teres minor

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91
Q

Which muscles have mechanical effect on the shoulder?

A

Deltoid
Teres major
Short head biceps brachii

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92
Q

Which muscles stabilise the shoulder joint?

A

Long head biceps brachii
Triceps brachii
Rotator cuff

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93
Q

How do rotator cuff muscles work?

A

Contract together = stabilising force
Contract individually = movement

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94
Q

Four rotator cuff muscles?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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95
Q

Location, function and innervation of teres minor?

A

Posterior to greater tubercle of humerus
Lateral rotation and stabilisation
Axillary nerve (posterior cord)

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96
Q

Location, function and innervation of infraspinatus?

A

Posterior/superior to greatus tubercle of humerus, infraspinatus fossa of scapula
Lateral rotation and stabilisation
Suprascapular nerve (upper BP trunk)

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97
Q

Location, function and innervation of supraspinatus?

A

Superior to greater tubercle of humerus, supraspinatus fossa of scapula
Abduction and stabilisation
Suprascapular nerve (upper BP trunk)

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98
Q

Location, function and innervation of subscapularis?

A

Lesser tubercle of humerus and subscapular fossa of scapula
Medial rotation and stabilisation
Subscapular nerve (posterior BP cord)

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99
Q

Which muscles are attached to scapula aside from rotator cuff?

A

Levator scapulae
Rhomboid major and minor
Trapezius
Serratus anterior

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100
Q

What happens in shoulder dislocation?

A

Fall on outstretched hand whilst arm abducted
Humeral head pushes against capsule
Tears ligaments and articular capsules

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101
Q

What happens in rotator cuff injuries?

A

When you use limb above horiszontal e.g. throwing
Tear supraspinatus tendon
Frozen shoulder = irritation and inflammation of tendons, shoulder stiffness

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102
Q

When can the axillary nerve be injured? Outcome?

A

Dislocation of humeral head
Paralysis of deltoid and loss of sensation in small area of skin over deltoid

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103
Q

Name 3 chondroid tissues

A

Articular cartilage
IVDs
Meniscus

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104
Q

What genetic processes happen with ageing?

A

Decreased tissue
Reduced synthetic capc=acity of differentiated cells
Altered levels of growth factors/cytokines
Reduced efficiency of functional tissue elements

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105
Q

Which syndrome in ageing is to do with:
Joints
Bone
Muscle

A

Osteoarthrtitis
Osteoperosis
Sarcopenia

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106
Q

Articular cartilage composition? Why is it slow to replicate?

A

Chondrocytes
No innervation/vascularisation or macrophages

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107
Q

Function of hydrophilic proteoglycans in ECM?

A

Maintain internal swelling pressure

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108
Q

What happens in articular cartilage with age?

A

Reduced water content
Fragmentation of protein components and collagen
Reduced tensile strength

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109
Q

What is osteoarthritis? Where is it common?

A

Disorder of synovial joints when damage, structural damage of joint occurs
Knee, hip, hand and wrist
Women

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110
Q

Pathogenesis of osteoarthritis?

A

Joint damage occurs e.g. injury/stress
Alter joint structure (cartilage loss, remodelling of bone, osteophytes, synovitis)
Repair process structurally alters joint
When repair processes can’t compensate joint damage OA occurs

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111
Q

Osteoarthritis diagnosis?

A

45 and over
Activity related joint pain
No morning joint stiffness

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112
Q

Osteoarthritis management?

A

Individual management plans e.g. weight loss/exercise/footwear
Medication
Joint surgery

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113
Q

What happens on a cellular level in bone ageing?

A

Reduced numbers of osteoblasts
Less ability of osteoblasts to respond to mechanical forces
Increased osteoclasts relatively
Increased bone turnover
Decrease in growth hormone secretion
IGF-1 levels fall

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114
Q

What hormonal changes happen in bone ageing?

A

Decreased growth hormone secretion
Fall in IGF-1 level
Oestrogen inhibits osteoclast activity
Increased inflammatory cytokines (lifetime exposure to antigens)

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115
Q

What is osteoporosis?

A

Syndrome associated with low bone mass and deterioration of bone tissue = increased risks of fractures

116
Q

Osteoblast function?

A

Synthesise bone matrix
Mineralisation

117
Q

What is osteoid?

A

Non mineral matrix of collagen and non collagenous proteins

118
Q

What happens in bone remodelling?

A

Activation: preosteoclasts stimulated + differentiate under influence of cytokines and growth factors into mature osteoclasts
Resorption: osteoclasts digest mineral matrix (old bone)
Reversal: resorption ends
Formation: osteoblasts synthesise new bone matrix
Queiescence: osteoblasts become resting bone lining cells on new bone surface

119
Q

How often is bone replaced and when do bones weaken?

A

skeleton replaced every 10 years
bones weaken when excessive resorption happens

120
Q

Risk factors for osteoporosis?

A

Age, female, genetics, fractures, ethnicity, rheumatoid arthritis, hypergonadism
Alcohol, smoking, low BMI, poor nutrition, vit d deficiency, Eds, low exercise, low calcium intake

121
Q

How is bone mineral density calculated?

A

DEXA scan at hip and spine

122
Q

What is normal T score, osteopenia and score for osteoporosis?

A

T = 0 is normal
T = -1 and =2.5 is low bone mass aka osteopenia
T = -2.5 is osteoporosis

123
Q

What are fragility fractures? Common where?

A

Fractures from mechanical forces that usually wouldn’t happen
Fall from standing height or less
Spine, hip, wrist

124
Q

How to prevent osteoporosis?

A

Regular weight exercise
Healthy diet
Sufficent vitamin D
Avoid smoking/alcohol

125
Q

Name the antiresorpitive osteoporosis treatments?

A

Bisphosphonates - oral and IV
Densosumab - Subcutaneous rank ligand inhibitor
Raloxifene

126
Q

Name anabolic osteoporosis treatment?

A

Teriparitide - stimulates bone formation
Subcutaneous injection
Specific criteria

127
Q

What is muscle ageing?

A

Progressive loss of skeletal muscle mass/function

128
Q

Sarcopenia definition?

A

Progressive skeletal muscle disorder associated with increased likelihood of falls, fractures, disability and mortality
Low muscle strength due to decline in skeletal mass

129
Q

What 3 things are used to categorise sarcopenia?

A

low muscle strength
low muscle quantity/quality
low physical performance

130
Q

What is used to categorise severity of sarcopenia? What is primary sarcopenia?

A

Physical performance
Ageing

131
Q

What is secondary sarcopenia caused by?

A

Activity: bed rest, sentry lifestyle, zero gravty
Disease: organ failure, malignancy, inflammatory/endocrine disease
Nutrition: inadequate energy or protein intake

132
Q

What is SARC-F screening tool?

A

Strength: difficulty lifting and carrying 10 pounds
Assistance: difficulty walking across a room
Rise: difficulty transferring from chair to bed
Climb: difficulty climbing 10 stairs
Falls: how many falls in past year

133
Q

Diagnosis of sarcopenia?

A

Handgrip strength
Chair stand strength
Gait speed
CT/MRI
DEXA SCAN
Bioimpendance analysis

134
Q

Diagnosing sarcopenia?

A

SARC-F or clinical suspicion
Measure grip strenfth
Measure physical performance

135
Q

Cons of sarcopenia?

A

Higher mortality
Hospitalisation
Frailty sydrome

136
Q

Sarcopenia treatment?

A

Resistance/aerobic exercise
Increased protein intake
Vit D supplements if deficient

137
Q

Consequences of msk ageing?

A

Altered gait/balace = falls
Increased injury
Chronic pain
Social isolation
Loss of independence = care home

138
Q

Which type of bone is more susceptible to osteoperosis and why?

A

Trabecular: has greater surface area and is remodelled more rapidly than cortical bone

139
Q

Where is cortical bone found?

A

Compact: diaphyses of long bones

140
Q

Where is trabecular bone found?

A

Spongy: vertebral bodies and ends of long bones

141
Q

Bone composition?

A

70% inorganic hydroxyapatite mineral calcium
22% organic collagen type I
8% water

142
Q

Which noncollagenous protein is specific to bone?

A

Osteocalcin

143
Q

Functions of noncollagenous proteins?

A

Attchment of bone cells to bone matrix
Regulating bone cell activity

144
Q

Osteocyte functions?

A

Embedded in bone matrix
Have lancuna
Sense mechanical strain
Release signalling molecules e.g. prostaglandins, nitric oxide

145
Q

What happens to osteoblasts after mineralising osteoid?

A

Become osteocyte
Apoptosis

146
Q

Where are osteoblasts, osteocytes and osteoclasts derived from?

A

OB, OCy: mesenchymal stem cell
OC: haemopoeitic mononuclear cells

147
Q

4 stages of bone remodelling? What happens and why?

A

Resorption: osteoclast recruitment, differentiation, activation
Reversal: osteoclast removal/apoptosis, osteoblast recruitment, differentiation, activation
Formation: matrix synthesis
Queiescence: mineralisation
Due to bone damage

148
Q

How long does remodelling take?

A

6 months

149
Q

Which enzyme are osteoclasts rich in?

A

tartar resistant acid phosphatase TRAP

150
Q

Which molecule interaction stimulates resorption?

A

RANK-RANKL

151
Q

How does osteoprotegerin inhibit resorption?

A

Expressed by osteoblasts/bone marrow cells
Binds to RANKL, acts as decoy
Prevents RANK activation

152
Q

How do osteoclasts resorb bone?

A

Form tight seal over bone surface
Secrete hydrochloric acid and proteolytic enzymes
Acid dissolves hydroxyapatite, giving access to enzymes to dissolve colllagen/bone matrix proteins

153
Q

Cathespin K function?

A

Proteolytic enzyme degrading matrix

154
Q

Carbonic anhydrase function?

A

Acid generation

155
Q

CBFA1 function?

A

Converts mesenchymal stemcell/pre-osteoblast to osteoblast

156
Q

Osteoblast shape?

A

Cuboidal cells

157
Q

Which 2 molecules determine whether an osteoclast will mature?

A

OPG = negative feedback
RANKL = positive feedback

158
Q

Which molecules stimulate RANKL?

A

Parathyroid hormone
TNF
IL-1

159
Q

Where are most receptors for hormones/growth factors/cytokines in bone?

A

Osteoblasts

160
Q

What hormone regulates expression of RANKL pre-menopause?

A

Estrogen

161
Q

Which cells express RANKL?

A

Osteoblast lineage cells and many others e.g. lymphoid cells

162
Q

What causes maturation of osteoclasts?

A

RANK binding to RANKL on osteoclasts

163
Q

What happens when RANKL is bound to opg? What is OPG?

A

Osteoclasts cannot form, function or survive
a Protein

164
Q

What do osteocytes secrete to prevent wnt signalling and therefore resorption?

A

Sclerostin

165
Q

Describe what happens when a crack appears in bone.

A

Osteocytes near crack undergo apoptosis
They detect strain and secrete GH, PGs, Nitric oxide
Lining pulls away from bone matrix
Stromal cells released due to sclerostin inhibiton
They generate pre-osteoblasts and secrete macrophage colony stimulating factor - helps generate pre-osteoclasts
Pre-osteoblasts express RANK-L, pre-osteoclasts have RANK receptors
Mature osteoclasts form and resorb bone, then apoptose
Mature osteoblasts form and secerete OPG
Osteoblasts secrete osteoid and mineralise it
Matrix accumulates mineral

166
Q

How long is primary and secondary mineralisation?

A

Primary = <100 days, 5 days after osteoid synthesis
Secondary = slower and increases number and size of hydroxapatite crystals

167
Q

What is degree of bone mineralisation dependent on?

A

Amount of solid protein present
Enamel has most mineralisation

168
Q

Stimulators vs inhibitors of bone remodelling?

A

Stimulants: parathyroid hormone, growth hormone, IL-1, TNF, IL-6, prostaglandins
Inhibitors: estrogen, androgen, calcitonin, OPG, interferon gamma, progesterone

169
Q

Why do boys hit puberty later than girls?

A

Girls reach peak BMD before boys

170
Q

What happebs to bones during puberty?

A

Increased suze if vertebrae
Increased thickness of trabeculae
Increased bone length and diameter

171
Q

When do men and women hit peak bone mass? Why do womens bones decrease in mass faster?

A

30-40
Menopause due to estrogen deficiency

172
Q

4 determinants of peak bone mass?

A

Genetics
Lifestyle
Hormones
Nutrition

173
Q

How does estrogen affect bones?

A
  • Allows normal bone maturation and mineral acquisition
  • Can affect ECM through chondrocytes
174
Q

Androgen role in bones?

A

Mineral accrural

175
Q

How can estrogen deficiency cause bone loss?

A

E restrains bone turnover
E maintains calcium fluxes in intestine and kidneys
Can induce osteoclast apoptosis
Can lead to excess RANKL which increases bone resorption

176
Q

3 main points of osteoperosis?

A

Decreased bone mass leading to increased chance of fracture, with decreased bone strength

177
Q

What is a Colle’s fracture? Feature?

A

Fracture caused by falling onto outstretched hand
Dinner fork - wrist is bent back

178
Q

How can patients lose height?

A

Collapsed vertebrae from compression fractures

179
Q

Risk factors for osteoperotic fractures?

A

Age >65
Vertebral compression fracture
Fragility fracture >40
Hyperparathyroidism
Osteopenia
Hypergonadism
Early menopause

180
Q

Complications of osteoporitic fractures?

A

Permanent disability
Loss of independance
Many die 1 year after fracture
Kyphosis
Loss of height
Back pain
Deformity

181
Q

2 determinnts of fracture risk?

A

Bone strength
Propensity to fall

182
Q

What is T score?

A

Number of standard deviations above or below the mean for a healthy adult population of same sex and ethnicity

183
Q

Normal, osteopenia and osteoperosis t score? What is established osteoporosis?

A

Normal = 0, -1
Osteopenia = -1 to -2.5
Osteoporisis = less then -2.5 or equal
Established is osteoporosis with a fracture

184
Q

How is bone density measured?

A

Dual energy x ray absorpitometry

185
Q

How to calcualte absolute fracture risk?

A

Age
Past fracture history
BMD

186
Q

Lifestyle changes for postmenopausal patients?

A

Dietry calcium
Weight bearing and muscle strengthening exercise
Stop smoking
Drink less

187
Q

How to minimise fall risk?

A

Avoid sedative drugs
Treat neurological conditions
Balance training
Occupational therapy = home mods
Hip protectors

188
Q

Effect of estrogen HRT on BMD?

A

Slows decline of BMD

189
Q

Consequences of HRT?

A

Increased risk of disease e.g. heart attack, stroke, DVT
Not recommended for woman

190
Q

What is estradiol?

A

Estrogenic hormone treating menopause symptoms
Prevents osteoperosis

191
Q

What is raloxifene?

A

Selective estrogen receptor modulator SERM
Manages postmenopausal osteoporosis

192
Q

How do SERMs work?

A

Bind to estrogen recptor, it undergoes conformational change

193
Q

How do bisphosphonates work?

A

Decrease bone remodelling by binding to surface of bone
Increased bone mineral density, increased bone strength
Either by increasing osteoclast death or inhibiting osteoclast activity

194
Q

Name 2 bisphosphonates

A

Alendronate
Zolendonic acid

195
Q

Funcion of parathyroid hormone receptor? Type of receptor?

A

Controls level of calcium in blood
Bone formation role
GPCR
Decreases fractures

196
Q

Strontium ranelate function?

A

Increases pre-osteoblast replication into osteoblasts = increased bone matrix synthesis
Reduces pre-osteoclast differentiation into osteoclasts
Increases BMD, decreases fracture risk

197
Q

Denosumab function?

A

Binds RANKL to inhibit osteoclast formation/function/survival
Reduces fractures

198
Q

Romosozumab function? Type of drug? What is it?

A

Inhibits sclerostin
Sclerostin usually inhibits bone formation
Subcutanous injection
Monoclonal antibody
Decreases bone resorption, increase bone formation

199
Q

How does treatment affect fracture risk?

A

Decreases it by half

200
Q

How to know if osteoporosis treatment is working?

A

Fewer fractures
DXA measurement

201
Q

How is ca distributed in the body?

A

99 percent mineral in bone
1.2mmol/l extracellular ionised
less intracellular cystolic

202
Q

Calcium functions?

A

Muscle contraction
intracellular messenger
nerve excitability
blood coagulation

203
Q

Distribution of serum calcium?

A

47 percent free aka unbound / ionised
47 percent bound to albumin
6 percent complexdd

204
Q

Why is free calcium important?

A

feedback mechanisms regulated by free calcium

205
Q

what is total calcium?

A

bound and free

206
Q

What happens when patient has low albumin?

A

total calcium low but free calcium normal

207
Q

how to calculate adjusted calcium?

A

total calcium + 0.02(45-alb)

208
Q

normal range of serum calcium?

A

2.2 - 2.6 mmol/L
above is hypercalcaemia
below is hypocalcaemia

209
Q

organs involved in calcium homeostasis?

A

kidney
gut
bone
parathyroid glands

210
Q

parathyroid gland function?

A

senses calcium

211
Q

hormones involved in calcium homeostasis?

A

parathyroid hormone
1,25 dihydroxyvitamin d

212
Q

what is calcitriol?

A

active form of vitamin d

213
Q

how much calcijm do we get in our diet per day?

A

25mmol

214
Q

how is calcium absorbed?

A

1.25 dhcc
duodenum and jejenum
active transport pathway controlled by 1.25 dhcc
passive diffusion depending on luminal ca conc

215
Q

how much calcium is absorbed daily?

A

20-60 percent
changes when dietry intake falls or during growth, pregnancy, lactation

216
Q

how much calcium is reabsorbed in kidney and where? coupled with?

A

65 percent
proximal tubule
bulk transport of solutes e.g. na and water

217
Q

what allows ca reabsorption from kidney?

A

parathyroid hormone

218
Q

what allows ca resorption from bone?

A

parathyroid hormone
1.25 dhcc

219
Q

what is parathyroid hormone secretion regulated by? what is it?

A

free calcium - calcium sensing receptors
amino acid polypeptide produced by parathyroid gland

220
Q

what type of receptor is calcium sensing receptor? where are they?

A

GPCR
parathyroid cells
remal tubule

221
Q

cinacalet function?

A

reduced pth secretion in patients with primary hyperparathyroidism and parathyroid cancer

222
Q

parathyroid hormone actions?

A

stimulates renal tubular calcium reabsorption
-promotes bone resorption
stimulates formation of 1.25 dhcc in kidney = enhance ca absorptiom from gut
allows rise in ionised ca to normal

223
Q

Where is vitamin D obtained from? Where is it converted to active forms?

A

Sunlight and diet
Cholecalciferol is converted to 25OH cholecalciferol in the liver
25OH cholecalciferol is converted to 1,25(OH)2 cholecalciferol in kidney

224
Q

Which 3 things can activate vitamin D in kidney from 25OH cholecalciferol?

A

Parathyroid hormone
Hypocalcaemia
Hypophosphataemia

225
Q

What happenns when ionised calcium levels fall?

A

parathyroid hormone increases
1,25 dihydroxycholecalciferol increases in kidney to enhance sodium absorption from gut
renal tublar calcium reabsorption
bone resorption

226
Q

Causes of hypocalcaemia?

A

Hypoparathyroidism
Vitamin D deficiency/renal disease

227
Q

Causes of hypoparathyroidism? (not enough PTH)

A

Neck surgery - may affect thyroid
Idiopathic (random)
Magnesium deficiency - required to absorb calcium

228
Q

Causes of vitamin D deficiency?

A

Malabsorption
Little exposure to sunlight

229
Q

How can vitamin D problems be caused by renal disease?

A

Kidneys fail to make active form DHCC

230
Q

Hypercalcaemia causes?

A

Hyperparathyroidism
Vitamin D overconsumption/overdose

231
Q

Hyperparathyroidism cause?

A

Adenoma of parathyroid gland

232
Q

Difference between hypercalcaemia caused by hyperparathyroidism and malignancy?

A

Hyper - increased calcium and increased PTH
Malignancy - increased calcium and suppressed PTH

233
Q

Which peptide causes hypercalcaemia and where is malignancy observed?

A

PTH related peptide
Lung/breast/multiple myeloma

234
Q

Functions of phosphate?

A

Skeletal development
Bone mineralisation
Composition of cell membranes, nucleotide structure, cell signalling

235
Q

Distribution of phosphate in body?

A

85% mineralised in bone
Predominantly intracellular bound to lipids and proteins
1% in EC fluids

236
Q

What is phosphate bound to?

A

Cell membranes, nucleic acids, glycolytic intermediates, ATP

237
Q

What does phosphate shift between?

A

Organic phosphate pool and inorganic pool
In and out of cells

238
Q

Example of phosphate moving into cells?

A

Insulin mediated entry of glucose into cells after meals results in phosphate moving into cells

239
Q

What is the true number of phosphate stores?

A

Serum phosphate numbr

240
Q

Organs and hormones involved in phosphate homeostasis?

A

Kidney, gut, bone
Paeathyroid hormone, fibroblast growth factor 23, 1,25 DHCC

241
Q

Where is phosphate absorbed? Where does it come from?

A

Small intestine
Plentiful in diet

242
Q

Which phosphate condition causes activaton of vitamin D?

A

Hypophosphateaemia

243
Q

How much phophate is protein bound? How much is filtered in kidney and wher?

A

15-20% protein bound
80% left
75% proximal tubule reabsorption
20% in distal tube

244
Q

What inhibits reabsorption of phosphate by renal tubule?

A

PTH
FGF23

245
Q

What happens when serum phosphate levels increase?

A

Decreased ionised calcium
Increased PTH
Increased urine phosphate excretion
Increased FGF23

246
Q

What influences serum phosphate values?

A

Diurnal variation rhythm: nadir before noon, peak after noon
Dietary effects: rise after meals then falls due to insulin
High in infancy when growing

247
Q

Where is calcium mainly reabsorbed?

A

Duodenum and jejenum

248
Q

How can phosphate absorption be increased?

A

1.25 DHCC
In entire small intestine

249
Q

What is the population growth rate?

A

Rate at which number of individuals in a population increases in a given time period
Expressed as fraction of initial population

250
Q

What is the rule of 70?

A

Divide number 70 by expected rate of growth (%)
Estimate in years produced e.g. 70/1.09 = 64 years
Doubling time

251
Q

2 things world population growth is determined by?

A

Births and deaths and migration

252
Q

What is the crude birth rate?

A

number of live births/1000 persons/year

253
Q

What is the crude death rate?

A

number of deaths/1000 persons/year

254
Q

What is replacement level fertility? High vs low income countries?

A

Number of children a couple must bear to replace themselves
Higher than 2
2.1 for high income country, 2.5 for low income because some female children die before reaching reproductive years

255
Q

What is the total fertility rate?

A

Average number of children that would be born to a woman during her lifetime if she passed through all her reproductive years from 15-44
Aka average number of children a woman will bear

256
Q

Factors affecting birth rates?

A

Education/affluence levels
Importance of children in family labour force
Urbanisation
Cost of raising chldren
Education/employment for women
Marriage age on average
Infant mortality rate
Birth control availability
Religion/culture

257
Q

Factors affceting death rates?

A

Sanitation/safe drinking water
Nutrition
Income level
Infectious diseases/vaccination
Urbanisation
Education
Health care access

258
Q

What are demographics?

A

Scientific study of human populations especially with reference to their size, structure and distribution

259
Q

What does demographic transition mean?

A

Transition from high birth and death rates to low birth and death rates as a country develops from a pre industrial to industrialised econmic system

260
Q

What is an age pyramid?

A

Illustration of distribution of various age groups in a population
Forms pyramid when population is growing aka low income country

261
Q

Before vs after demographic transition?

A

Before: high birth/death rates, low life expectancy, smaller population, population growth low
After: birth/death rates low, high life expectancy, large population, low population growth

262
Q

What is epidemiology?

A

Science and practice which describes and explains disease patterns in populations

263
Q

What is epidemiological transition?

A

Long term shift in pattern of disease in a country away from infectious disease to degenerative disease

264
Q

Where is population ageing fastest? Scotland?

A

Fastest in low and middle income countries e.g. cuba, mongolia
Scotland has increasing proportion of older people in population

265
Q

Life expectancy scotland men vs women?

A

Men - 77
Women - 81

266
Q

What is compression of mrotality?

A

A greater proportion of deaths occur during a narrow time period at upper limit of human life span

267
Q

What is compression of morbidity?

A

Scenario where increasing proportion of population will live long, health life in which death will be preceded by a very short period of ill health

268
Q

Leading contributor to disablity? Effect?

A

Lower back pain
Signidicantly limit mobility and dexterity, leading to early retirement, lower levels of wellbeing, reduced ability to participate in society

269
Q

Why are number of people with MSK conditions rapidly increasing?

A

Population increases and ageing

270
Q

Examples of MSK conditions?

A

Fractures/sprains/strains
Low back pain, osteoarthritis

271
Q

Main reasons for premature exit from workforce?

A

Low back pain

272
Q

How many adults over 65 have long term condition of MSK system?

A

1 in 3

273
Q

What are years lost to a disability?

A

Number of years with a lower quality of life due to a disease

274
Q

What are DALYs?

A

Disability adjusted life year
Loss of equivalent of one year of health

275
Q

What are incidence rates?

A

Number of new events (disease etc.) occuring in a specified time period in defined population excluding prevalnt cases

276
Q

What is prevalence?

A

Number of cases of disease or other health outcome present in specific time period in defined population

277
Q

Health definition?

A

State of complete physical mental and social well being and not merely the absence of disease or infirmity
Chronic illness = ill

278
Q

What is wellbeing?

A

Integrates mental health and physical health resulting in more holistic approaches to disease prevention and health promotion

279
Q

What is ageing associated with?

A

Progressive and generalised impairment of functioning resulting in a loss of adaptive response: lung function, circulation, muscles, nerves, immune system

280
Q

What can stepwise deterioration in physiological function be caused by? Name of this model?

A

Bereavement
Falls
UTIs
Extension of morbidity model

281
Q

How to measure health?

A

Functional status
Activites of daily life
Wellbeing

282
Q

WHO 6 domains of quality of life?

A

Physical
Environment
Social relationships
Psychological
Level of dependence
Spiritual

283
Q

Impacts of chronic musculoskeletal disorders on quality of life?

A

Chronic disease morbidity
Long term pain
Sleep disturbance
Exacerbate symptoms of anxiety and depression
Accessibility problems
Social intercations
Drug side effects

284
Q

What does care seeking behaviour due to musculoskeletal disorders seem to depend on?

A

Factors associated with symptoms severity and persistence
Mental distress and depression

285
Q

What are QALY?

A

A full year of life quality
Years of healthy life lived
(DALYs are years of healthy life lost)

286
Q

How to add more QALYs to people?

A

Early interventions
Olfer people at heart of community
Plan for needs of older people
Value their contribution to society
Provide affordable health care

phase 2 limbs & back (5 decks)

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