WEEK ONE
Fill in the blank: The endocrine system responds to stress _______.
a. Rapidly
b. Slowly
B - slowly
Which T cell recognises antigens carried by MHC class 1? And how about MHC class 2?
MHC 1 recognised by T8 (cytotoxic)
MHC 2 recognised by T4 (helper)
When holding a plank, are you using isometric or isotonic contraction?
isometric --> Tension increases to muscle's capacity, but muscle neither shortens nor lengthens
How do you perform the trendelenburg test? And what muscles are affected if it is positive?
Ask the patient to stand on one leg. Contralateral pelvis drops down rather than stay level = positive Trendelenburg
gluteus medius/minimus
A patient comes in that has been experiencing headaches for the last 2 - 3 weeks that have been occurring almost daily and increasing in severity. Patient denies any signs of aura, tingling, laterality, visual disturbances and nausea.
Is this a nociceptive, neuropathic or mixed type of pain?
nociceptive
The pipillae constrictor smooth muscle in the eyes is innervated by the release of acetylcholine causing constriction of the pupil. Which of the following drugs will cause pupil dilation?
Muscarinic agonist
α1-adrenoceptor antagonist
Muscarinic antagonist
Acetylcholinesterase inhibitor
3. muscarinic antagonist
SLE is a multiorgan disorder, involving what 4 main areas of the body?
1. skin
2. joints
3. kidneys
4. serosal membranes
What is depositied in gout? And where are the most common sites of gout?
urate crystals
•Most commonly affected joints- the first toe, foot, ankle, knee, fingers, wrist, and elbow
What is the action of pectineus and gracillus?
adduction
What are the three layers of the intrinsic back muscles?
① Superficial layer (splenius)
② Erector Spinae Muscles (Intermediate)
③ Transversospinales Muscles
(Deep to erector spinae muscles)
define allostasis and allostatic load
allostasis - short term changes to maintain homeostasis in adaption to stressful stimuli.
allostatic load - the culmination of stressors which causes psychological or physiological changes.
A patient is unable to extend their arm, name 3 muscles involved in extension.
LD, Tmaj, Pmaj, Del (post), Tri (long)
What are the three phases of a muscle twitch? And describe what occurs in these phases.
Latent period: Events of excitation-contraction coupling; no muscle tension
Period of contraction: Cross bridge formation; tension increases
Period of relaxation: Ca2+ re-entry into SR; tension declines to zero
What are the names of the 3 ankle joints?
1.Distal Tibiofibular Joint
2.Talocrural Joint
3.Subtalar (Talocalcaneal) Joint
Where does the obturator nerve innervate? Can you name its origin, a muscle it innervates and its action?
Innervates all muscles in MEDIAL compartment of thigh
ORIGIN L2-L4
Muscular branches to: obturator externus, adductor muscles (brevis, longus and part of magnus) and gracilis
ADDUCTION
What is the pneumonic, the bones and the ages related to elbow development when considering paedeatric injuries?
CRITOL
Capitulum, radial head, internal/medial epicondyle, trochlea, olecranon, lateral epicondyle
1, 3, 5, 7, 9 and 11 years
You do a physical examination of a patient. You find:
- Weakness against resistance when the wrist is in extension and the elbow is extended.
- pain on palpapation of the lateral epicondyle
- patient comments on stiffness in elbow.
What is your primary differential? What is it's more common name? And can you name three muscles which attach at this common site?
1. Lateral epicondylitis
2. Tennis Elbow
3. Aconeus, extensor carpi ulnaris, extensor digiti minimi, extensor digitorum
A patient enters your GP clinic with what appears to be claw hand. What nerve is causing this presentation and its origin in the spine? For someone presenting with claw hand, what muscles are lost? And describe how the hand will look due to the loss of these muscles.
ulnar nerve, c8-t1
interosseus muscles
causes hyperextension of MCP joints & slight flexion of DIP/PIP
On the board, Fill in a 2 x 2 table, if the sensitivity is 75%, the specificity 60% and the prevalence 40%. What is the post-test positive and post-test negative values?
MAYBE
Post-test positive = 30/54 = 55%
Post-test negative = 36/46= 78%
??
What functional loss would occur if the sciatic nerve was damaged at the:
a) ankle
b) knee
c) pelvis
a) loss of platar flexion and toe flexion
b) loss of knee flexion
c) weakness in lateral rotators
Explain how the stress response could be described as a protective response against sudden physical danger (flight or fight). Make sure you identify any specific contributions from the nervous and or endocrine systems
A patient arrives at your GP clinic with excessive fibrosis on their fingertips, and some of their toes. Their fingers seem to have dermal oedema, the first phalange also appears to have Raynaud's phenomenon. They tell you their fingers have been this way for a month, but in the last week they have also had some breathing difficulties, however, the patient is unsure if this is related.
What is your diagnosis? And what are the different types of pathogenesis that can lead to this disease?
1. systemic scleroderma
1. Autoimmunity
•CD4+ T cells activation to unidentified antigen
•Presence of ANAs
2. Vascular damage
•Chronic inflammation leading to microvasculature damage
•Repeated cycles of endothelial injury and platelet aggregation
•Pulmonary vasculature involvement
3. Fibrosis
You're taking a musculoskeletal history of a female patient, 55. At the end of the history you find;
- presenting complaint: left knee pain that worsens with use but also worse in the mornings. Also suggests stiffness and after a long day at work can have swelling.
- social hx includes smoker (10/day, nicotene), drinks 4x beers saturdays/sundays
- works in the mines as Manager, so out in the field a lot.
- Suggests diet is healthy, runs 4x a week, always been active, played netball for 20 years.
What is your primary differential? What are your other differentials? Describe 4 morphological changes that occur for this diagnosis.
1. Osteoarthritis
2. osteoporosis, early signs of gout, rheumatoid arthritis,
3. •Early: Fissure and cleft at the articular surface- granular soft surface
•Eventually: sloughing of full thickness portions of cartilage
•‘Joint mice’
•Bone eburnation of exposed bone
•Cysts
•Osteophytes
What is the physiology of bone deposition and resorption?
PTH & Vit D bind to receptors on adjacent o’blasts →formn of RANKL & release of macrophage colony stimulating factor (M-CSF).
RANKL binds to RANK & M-CSF binds to its receptors on pre-o’clasts→ differentiation into mature o’clasts.
Mature o’clasts develop a ruffled border, release enzymes & acids that promote bone resorption
O’blasts →prodn of OPG which acts as a decoy, binds to RANKL & prevents interaction with its receptor, so pre-o’clasts do not differentiate into o’clasts
Your Patient, Charlotte explains that she’s been feeling unwell for a few days with her throat feeling, “scratchy”. However, this morning when she woke, her throat was really sore. She describes the pain as “sore and scratchy”. She could feel the glands in her neck had become swollen. Swallowing and talking is very painful. She has been feeling a little hot over the past couple of days and has had a slight headache. No earache, and her nose is clear of congestion. Her joints are a bit “achy and painful”.
What type of pain is this? What is your approach to treatment management (WHO diagram, either normal or inverted) and why? What Recommended class(es) of analgesic would you prescribe and why (Are there non-pharmacological measures you could implement)? What is the most appropriate route of administration for Charlotte?
Nociceptive - tissue damage, not from trauma
Normal WHO analgesic ladder (treating with mild - severe analgesics) - Paracetamol (has little inflammatory help) ibuprofen (better for inflammatory), Panadeine, codeine
Paracetamol – starting mild, Weak opioid – codeine – if pain persists, Nonpharmacological – ginger tea, honey and lemon, salt water, chilli and garlic concution, turmeric
Soluble paracetamol so doesn’t hurt to swallow tablet
Tablet? immediate release