Mbbs2 Back

Front 1

Back 1

1. Spinous process
2. Lamina
3. Pedicle
4. Vertebral foramen
5. Superior articular facet
6. Transverse process
7. Inferior articular facet
8. Superior notch (foramen for spinal nerves)
9. Inferior notch (foramen for spinal nerves)
10. Same as 7

Front 2

Which part of bone is more prone to the loss of sex hormones characteristic in osteoporosis, and why?

Back 2

The trabeculae have a much higher turn over and so are more susceptible to weakening than the cortical bone

Front 3

What are the two functions of the lamina?

Back 3

Front 4

List 4 features distinguishing a cervical vertebrae from any other.

Back 4

1. Small transverse processes with tubercles providing attachments for scalene muscles
2. Foramen transversarium for cervical arteries and veins
3. Bifid spine on all bar C7
4. Slightly curved bodies with neurocentral articulations

Front 5

What feature is prominent on the second cervical vertebrae?

Back 5

The odontoid process (dens)

Front 6

What is a key feature of the thoracic vertebrae which others cannot boast, and how do these features vary from T1-12?

Back 6

Articulations with the ribs.
T1-10 has 2 articulations with the vertebral body, and 1 with the transverse process
T11 and 12 has 1 articulation with the body, and 1 with the transverse process

Front 7

How could you distinguish a lumbar vertebrae?

Back 7

Negatively. No foramen transversarium and no articulations with ribs.

Front 8

What passes through the pelvic sacral foramen?

Back 8

Anterior rami of sacral plexus

Front 9

Roughly describe the degrees of movement available in spine in flexion/extension, lateral flexion and rotation, assigning movement to particular areas where relevant.

Back 9

Flexion (forward) - involves lumbar (60⁰) thoracic (105⁰) and cervical (40⁰)
Extension (back) - involves lumbar (35⁰) and cervical (60⁰) only
Lateral - involves lumbar (20⁰), thoracic (20⁰) and cervical (35⁰)
Rotation - involves thoracic (35⁰), cervical (50⁰) and head (10⁰)

Remember - thoracic not involved in extension, and lumbar not involved in rotation.

Factors affecting mobility related to orientation and shape of articular facets making up the synovial joints.

Front 10

What is a key feature of the thoracic vertebrae which others cannot boast, and how do these features vary from T1-12?

Back 10

Articulations with the ribs.
T1-10 has 2 articulations with the vertebral body, and 1 with the transverse process
T11 and 12 has 1 articulation with the body, and 1 with the transverse process

Front 11

Describe the three components of vertebral discs and explain how they receive nutrients. Explain 'creep' and morning stiffness.

Back 11

1. Nucleus pulposus - Liquid aspect, deformable but not compressable
2. Annular fibrosus - Proteoglycans and type 1 collagen fibres, controls deformity by mediating forces. Fibres arranged in different orientations.
3. Outer vertebral end plate of hyaline cartilage, permeable to allow passage for nutrients.

No blood supply to the disc, so nutrients and waste moved when compression drives fluid out, and at rest when fluid is taken up.

'Creep' is the slow loss of fluid during continuous compression. Morning stiffness due to compression driving out fluid accumulated in the joints at night.

Front 12

What are the three main ligaments of the spinal cord? Describe their attachments and fibres.

Back 12

1. Anterior longitudinal - lies against the vertebral bodies and is wide. Superficial fibres are long, covering 2-3 segments, deep fibres are short.
2. Posterior longitudinal - lies in the vertebral column, against the posterior surface of the vertebral bodies. Is narrow. Also has superficial and deep fibres.
3. Ligamentum flavum - lies between the laminae and the articular capsules of the neighbouring vertebra. Contains lots of elastin.

Also note the supraspinous ligaments at the tip of the vertebral spines, and the intertransverse ligamanets between the transverse processes (especially in the lumbar region).

Front 13

Back 13

Front 14

Name the superficial or extrinsic, intermediate and deep posterior trunk muscles.

Back 14

Extrinsic (superficial);
Trapezius
Latissimus dorsi
Serratus posterior
Intermediate;
Erector spinae, consisting of
Spinalis (2-3 segments)
Longissimus (6 segments)
Iliocostalis
Deep;
Transverso-spinae:
Rotatores
Mutifidus
Semispinalis

Front 15

What important anatomical feature helps transverso-spinalis and the capitus and cervicus muscles play a key role in movement?

Back 15

Full of proprioceptive fibres, which allow complex movements to follow a simple movement of the neck.

Front 16

Describe how the exit of spinal nerves changes down the vertebral column and why this happens. Know where the spinal cord ends.

Back 16

C1-7 exit roughly horizontally
C8 onwards go increasingly vertical
Spinal cord ends at L1/2, corda equina carries spinal nerves down below this.

Front 17

What 3 changes occur to the vertebrae as you go down the column?

Back 17

Firstly the vertebrae get bigger as you go down, to take greater load.
The pedicle region gets thicker.
The angle to the transverse processes gets larger too.

Front 18

What is this fracture, how would it be caused and how would you treat it typically?

Back 18

A Jefferson fracture is a C1 burst, due to axial load (falling on head).
It is typically stable if there is no displacement, so would be treated conservatively with a brace.

Front 19

What is a Hangman's fracture classically?

Back 19

Front 20

What is this fracture and which is the most difficult to treat?

Back 20

An Odontoid Peg fracture. Type 2 in the middle is the hardest to treat if displaced.

Front 21

What is this lower neck fracture known as?

Back 21

Clay Shovellers.

Front 22

Briefly describe a unilateral facet joint dislocation.

Back 22

Caused by flexion distraction and presenting with 25% anterior subluxation

Front 23

Describe a bilateral facet joint dislocation.

Back 23

Also caused by flexion distraction, presenting with 50% anterior subluxation.

Front 24

What are the two types of compression fractures and what might cause them?

Back 24

Wedge fracture, common in osteoporosis, with a compression of one aspect of the disc causing a wedge shape.

Burst fracture more common with compression force, can cause displacement.

Front 25

Describe a management course for a suspected neck trauma patient.

Back 25

Advance Trauma Life Support
1. Airway with c-spine
2. Breathing
3. Circulation
4. In-line immobilisation, log roll
5. Palpate on log roll
6. Neuro assessment

Front 26

Describe some tests to assess neurological function.

Back 26

C5 - shoulder abduction
C6 - arm flexion/wrist extension
C7 - wrist flexion/finger extension
C8 - finger flexion
T1 - finger abduction
L1/2 - thigh abduction
L3/4 - knee extension
L5/S1 - knee flexion
L5 - hallux extension
S1 - hallux flexion

Front 27

Describe how Scotty Dog can be used in neck trauma.

Back 27

If Scotty Dog can be drawn, the area is intact. The various aspects indicate where a problem may be if Scotty Dog cannot be drawn.

Front 28

What is Denis' classification?

Back 28

Divides the spine into three sections:
1. The anterior column features the anterior half of the body of the vertebrae
2. The middle column features the posterior half of the body of the vertebrae
3. The posterior column features the spinous processes, ligaments, laminae and posterior articulations.

Front 29

Define a stable injury and indicate management.

Back 29

Conservative management with a collar/halo traction if potentially unstable

Front 30

Define an unstable injury, and indicate management.

Back 30

Management with surgery to fuse or fix vertebrae

Front 31

Describe the development of the spine in terms of curvatures.

Back 31

Begins with a kyphosis in the womb, developing with a small lordosis in the cervical region and another at the lumber region at birth.
By adulthood, you have a cervical and lumber lordosis, and a thoracic kyphosis.

Front 32

What factors affect posture?

Back 32

Front 33

Describe some of the issues with a forward and backward tilted pelvis.

Back 33

Forward - enhanced lumbar lordosis, weakened abdominals, tight erector spinae and psoas major.

Backward - shortened glutes and hamstrings, stretched and weakened abdominals

Front 34

Which muscles help to maintain good posture?

Back 34

Quiescent:
Feet, Gastrocnemius, Tib Ant, Qauds and Hammy, Glut Max, Abdo

Active: Ligs in feet, Soleus, Iliopsoas, Glut Med and TFL, Erector Spinae and Internal Oblique

Front 35

What is postural sway and when it is more pronounced?

Back 35

Constant shifting of centre of gravity and activation and inactivation of muscles to maintain posture.
More prominent in the young and old and when eyes are shut.

Front 36

Distinguish flat back, hollow back and sway back and give their causes.

Back 36

Flat - lost lumbar lordosis, knees flexed when standing
Hollow - increased lumbar lordosis due to large abdomen and flexed hips. Weight on heels.
Sway - increased lumbar lordosis due to increased pelvic tilt, knees back and tensed hard. Most common.

Front 37

Describe the mechanisms used to help support the body during locomotion.

Back 37

Erectness of trunk achieved by erector spinae, external and internal oblique and the gluteus medius and minimis
Bone strength from trabecular pattern (compromised post menopause by loss of oestrogen)
Menisci in the knee joint
The valgus angle of the hip moves the knee in to the centre of gravity and help it straighten
The arches in the feet help transfer weight from static to dynamic phases

Front 38

Describe the phases of the gait cycle.

Back 38

Stance phase:
Heel strike
Foot flat
Midstance, body weight over the foot
Heel off
Toe off
Swing phase:
Acceleration
Midswing
Deceleration

Front 39

What are some of the ways in which the gait cycle can be measured?

Back 39

Time and distance:
Cadence
Stride length (x2 steps)
Step length (x1 step)
Step width
Foot angle

Front 40

Describe how the body moves during the gait cycle.

Back 40

The body moves forwards throughout, but fastest during double support
The trunk twists as the arms swing in an opposite direction to the legs
The trunk also rises and falls approx 50mm, highest at midstance or midswing

Front 41

Describe the actions of the hip, knee and ankle joints during a stance phase

Back 41

At heel strike the hip is flexed, the knee extended and the ankle dorsiflexed with toe off ground
As the leg moves to floot flat, the ankle plantarflexes till the foot is flat, the knee remains extended, the hip begins to extend
At midstance, the hip is neutral, the knee is extended and the ankle begins plantarflexion
At heel off, the hip is still extending, the knee is beginning to flex and the ankle is in plantarflexion
At toe off, the hip is extended, the knee is flexed, and the ankle is still plantarflexing

Front 42

Describe the degree of rotation required in the hip, knee and ankle joints during the swing phase.

Back 42

The hip flexes 30⁰ and the knee 60⁰

Front 43

List the action of the various muscles during the gait cycle.

Back 43

Heel strike:
Hip abductors, Quads, Hamstrings, Tibialis Anterior and Extensor Dig Longus
Midstance:
Hip abductors, Flexor Halluces Longus
Toe off:
Hamstrings, Hip adductors, Hip flexors
Heel strike:
Gluteus maximus, hip adductors, hamstrings, Tibialis anterior and extensor digitorum longus

Front 44

What changes would you expect to see in the gait of a young baby, and an elderly person?

Back 44

Young baby: Wider base, flat foot, extended knees, no arm swinging, external rotation, quicker cadence
Elderly person: Greater toe out angle (normally 7⁰), shorter stride, slower cadence, no arm swing

Front 45

How does gait alter on stairs and in running?

Back 45

On stairs, instead of a heel strike you land on the anterior portion of the foot. There is a 'pull up' phase, with the knee extensors holding weight and all joints flexed. Then the ankle plantarflexors drive through midstance and toe off.
In running there is no double support, a much longer 'flight phase' and Ground Reaction Force is around 250% of body weight, compared to 70-120% in normal walking.

Front 46

What has happened here?

Back 46

Herniation of the Nucleus Palposus due to weakness in Annular fibrosus

Front 47

What is a typical site for a spondylolisthesis and how is it treated?

Back 47

L4/5. Usually treated with a screw fix.

Front 48

How would you test the extensor halluces longus and what would it tell you?

Back 48

Push against big toe and ask patient to dorsiflex.
This tests the anterior rami of L5/S1

Front 49

Where do the nerves of the cauda equina arise, and what is cauda equina syndrome and what is it's classic symptom?

Back 49

Cauda equina arises at L1-5 and S1-5.
With CES you classically get 'saddle anaesthesia' - bladder and bowel dysfunction when sat down on a saddle of a bike or horse

Front 50

Label the bits

Back 50

Front 51

What is the sick role?

Back 51