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Ortho/Rheum Wk2

Describe the pathological process of venous thrombosis Formation of clotted mass within non-interrupted vascular system. Occurs in normal vessels, usually deep veins. Virchow's triad.
What may predispose a person to venous thrombosis? Immobility, heart failure, pregnancy, injury, surgery, clotting factor changes.
Describe Virchow's triad Endothelial abnormality/injury, alteration in blood flow (e.g. stasis, turbulence), hypercoagulability
How do endothelial cells promote thrombosis? On injury/activation - Release of von Willebrand factor, binding factors IXa + Xa, and tissue factor, activating extrinsic clotting cascade
Describe how pain is experienced Stimulation (damaging or on verge) of afferent pain nerve fibre causes release of Substance P, which stimulates AP along spinal cord, thalamus, and into the somatosensory cortex.
Which skin receptor fibres are associated with pain? A-delta fibres (fast) and C fibres (slow)
What chemicals can cause pain by their release? Histamine, prostaglandins, cytokines, bradykinin, neuropeptide transmitters.
What measures can be taken to reduce the chances of atheroma? Smoking cessation, low cholesterol diet, mobilisation and exercise, identifying family history, drugs (e.g. vasodilators, statins), surgical bypass.
Describe the presentation of DVT Calf warmth/tenderness/swelling, mild fever, pitting oedema, Homans' sign (^resistance/pain on forced foot dorsiflexion)
Describe the presentation of a soft tissue infection Acute inflammation (rubor, calor, dolor, tumor), fever
Give some examples of soft tissue infections Cellulitis (Strept. pyogenes, S. aureus), gas gangrene (C. perfringens), necrotising fasciitis (in immunocompromised - Strep. or E. coli), Melaney's synergistic gangrene (S. aureus or Strep.)
How do opiates effect pain transmission? Opiate binds to opiate receptor on afferent pain fibre, blocking release of substance P and therefore blocking pain transmission
How do NSAIDs help reduce pain? NSAIDs inhibit the release of prostaglandin (a nociceptor-stimulating chemical)
Discuss the mechanism of TENS Transcutaneous electric nerve stimulation is the stimulation of of non-pain low-threshold afferent fibres, causing inhibition of neurons in pain pathways (much like rubbing the skin after a bump)
Describe the mechanism of acupuncture Activates afferent neurons leading to spinal cord and mid-brain centres that release endogenous opioids
What are the 4 causes of haemarthrosis of the knee? Peripheral meniscal tear, intra-articular fracture, bleeding disorder, * cruciate ligament rupture *
How can a tear between the quardraceps and the patellar tendon be tested for? Active straight leg raise
Created by: kuc