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OSCEazy Slide template 2021-2022 We look forward to your teaching session! • At OSCEazy, we have been renowned for our colourful slide templates and a very clear slide structure that presents information systematically • In this slide set there are slides for introductions, content, pictures, summaries...you can use as many or as few of these slides as you need by deleting/duplicating the template slides you want • We always advice to use a variety of different slide structures to keep your session engaging and interesting to look at! • You can add/replace content/pictures/textboxes to these slides as needed and delete any sections (such as this slide) as required **PLEASE DO NOT SHARE THIS SLIDE TEMPLATE OR USE THIS TEMPLATE FOR USES OTHER THAN YOUR TEACHING SESSION** • We would be very grateful to hear your feedback on our slide template. Please fill in this form once you have made your slides: https://docs.google.com/forms/d/e/1FAIpQLSdfFpHXn3QtY05WvPCqD_lq28lZoYnBRuk3jqCu8ORVKhSgAg/viewf orm?usp=sf_linkPreclineazy Toby SPINE, NERVES, BONES Nerve Physiology Bone Physiology Spinal column and spine anatomy 7pm Monday 07/03/2022 Vertebra Cervical Lordosis Thoracic Kyphosis C1-C7 T1-T12 Ribs attach to thoracic spine. Vertebra in the spine. Contains the Axis and Atlas Allows for body rotation. Vertebra(T10-12) commonly to allow for rotation of the head. damaged in compression fracture. Lumbar Lordosis Sacral Kyphosi L1-L5 Provided most support for Anchor for the spinal column. Humans are born with 4-6 the back. Large vertebral body. sacral vertebra which fuse together. Most common site for disc Nerve roots S1-S4. prolapse.Anterior superior process Pedicle Transverse Process Lamina Superior articular Process Spinous Process Superior articular facetCervical Transverse foramen: From C1-C6 it contains Vertebral Artery Vertebral ein C7 Contains only the vertebral vein (not the artery). Instead the artery Only vertebrae with transverse foramen (contains vertebral artery and vein) Large Vertebral foramen Very small transverse processesThoracic Transverse processes (no articular processes) Larger vertebral body Has demi costal facets for articulation with the ribs Lumbar Have more prominent articular processes (to reach the vertebrae below as the lumbar spine is the widest) Largest vertebral body to provide the most support • Atlas (C1) Odontoid process (dens) • Axis (C2) Special Vertebrae Enables head rotation Ribs 1-7 Ture ribs As they attach directly to the sternum Ribs 8-12 False ribs Conjoin with other costal cartilages then insert onto sternum Ribs 11-12 Floating ribs Do not attach to sternum at all Q U E S T I O1N A 82 year old man with a history of prostate A Pedicle cancer presents with back pain. An x -ray is performed which reveals a winking owl sign. B Transverse process Which part of the C Spinous process vertebrae is damaged causing this feature of D Superior articular process the X -ray E Inferior articular process. Q U E S T I O 2 The winking owl is due to a spinal metastasis causing A Pedicle The degradation of the pedicle. B Transverse process C Spinous process D Superior articular process E Inferior articular process.Spinal cord anatomy Epineurium Perineurium Endoneurium The outermost layer of a nerve. Surrounds each fascicle. Contains the nerve cell itself. Made of collagen. Contains a bundle of nerves Surrounds each myelin sheath Forms from arachnoid mater and dura Between epineurium and perineurium Contains endoneurial fluid which acts mater when nerve leaves intervertebrathere is blood supply for the nerves. CSF in the peripheral nervous foramen. system. Protects nerves from longitudinal stress Fascicl Nerve Nerve cells within endoneurium Synaptic Transmission Ca2+ Ca2+ 1. Action Potential Arrives Ca2+ 2. Ca2+ enters via voltagegated calcium channels 3. Vesicles containing neurotransmitters e.g. Acetylcholine move to the cell surface membrane Synaptic Transmission Ca2+ 1. Neurotransmitter is released into synaptic cleft. Ca2+ 2. It binds to receptors on Postsynaptic membrane 3. Receptors cause Na+ channels to open to propagate a new action potential 4. Enzymes breakdown neurotransmitters e.g. Na+ Acetylcholinesterase, to reset the system. Depolarising vs Non depolarising neuromuscular blockers Anaesthesia Na+ Non Depolarising vs Depolarising neuromuscular blockers e.g. Atracurium e.g. suxamethonium - Are not broken down by acetylcholinesterase - Blocks acetylcholine - Overstimulated receptor - Prevents contraction/stimulus - No longer sensitive to Acetylcholine - Works in 2 -3 minutes - Initial contraction followed by paralysis - Works within 60 seconds, lasts 10m - Lasts 20-30 minutes - Action can be reversed with - ADR hyperkalaemia, malignant acetylcholinesterase inhibitors Hyperthermia - Not widely used due to side effects and action cannot be reversed Na+Seddon Sunderland Description Advancing Tinel's? Neurapraxia I Myelin damage No slowing conduction Axonotmesis II Damage to Yes Axon III Damage to Yes endoneurium IV Damage to No perineurium Neurotmesis V Complete No nerve division (including epineurium) Wallenberg's degeneration - The axon is degraded distal to the injury - Myelin sheath is then broken down - Macrophages infiltrate and clear debris - Then a new axon sprouts Occurs in nerve II,III.IV,V Q U E S T I O 1 Tommy was unfortunate to be in Wembley stadium A Sunderland type I during storm Eunice when a piece of debris from the roof fell and crushed his arm. B Sunderland type II A nerve is damaged. Tommy has no conduction in this nerve. C Sunderland type IV In a months time tommy seems to be improving. When his doctor taps his arm along the site of injury he now feels a tingling sensation 3cm D Sunderland type V distally than he did at the time of the injury. E Sunderland type IV What is the most likely diagnosis? ANSWER ON THE ZOOM POLLTommy has no conduction in this nerve. In a months time tommy seems to be improving. When his doctor taps his arm along the site of injury A Sunderland type I he now feels a tingling sensation 3cm distally than he did at the time of the injury. B Sunderland type II - This question refers to a patient with a nerve injury C Sunderland type IV affecting the axon as there is loss of conduction. - The second part of the question demonstrates a D Sunderland type V positive advancing Tinel's sign. Something that is only seen when the endoneurium is in tact. E Sunderland type IV Therefore this is axonotmesis with endoneurium and/perineurial damage, with an intact epineuriumSeddon Sunderland Description Advancing Tinel's? Neurapraxia I Myelin No damage A Sunderland type I slowing conduction Axonotmesis II Damage to Yes B Sunderland type II Axon III Damage to Yes C Sunderland type IV endoneurium D IV Damage to No Sunderland type V perineurium E Sunderland type IV Neurotmesis V Complete No nerve division (including epineurium) Bone composition 70% made from: Hydroxylate crystals (containing Calcium and Phosphorus) 30% made from Collagen, glycosaminoglycans, Osteoblasts, Osteoclasts, Osteocytes, Water Osteoclasts Osteoblasts Osteocytes Breakdown old bone Build new bone. Most common bone cell. Foundlargely in the periosteum. Secretes enzymes and H+ ions to Embedded in lacunae. cause the breakdown of bone Foundin groups which form an Are old osteoblasts which have Bone breakdown Ca 2+ and PO 43+ Osteon. Deposit proteins to form a matrix. been surrounded by the extracellular into the blood. Deposits Ca2+and PO 4+ to form matrix that they secrete. Thought to communicate with hydroxyapatite to mineralize the osteoblasts/clasts and maintain matrix. bone. Release ALP during mineralisation ke b t m a bone Osteoporosis o blas b sorb ne O st stsa ai b o eocla aint Low bone mineral Treated with Vit D, O st ts m density Calcium, Bisphosphonates teocy e.g. Alendronate or Os Caused due to: Zoledronate low oestrogen, alcoholism, Alendronate is given smoking, once a week. anorexia, Long-term corticosteroids,oumust take it on an SSRIs, empty stomach and PPIs, remain sat up for anti-epileptics 30mins to prevent oesophageal erosions. Measured via a T-score (diagnosed with score <-2.5) FRAX score shows risk of osteoporosis o nePaget’s disease of the bone Overactivity of osteoblasts and osteoclasts. Leads to deformed bones with sclerotic lesions (high density bone) and lytic lesions (low density bone) Symptoms: Bone pain, Deformity, Hearing loss (if ear bones affected) Complications: Osteosarcoma (dense bone cancer with poor prognosis) Spinal stenosis (narrowing of spinal canal) ofle ne pr Management: n bo NSAIDs, Bisphosphonates, Calcium, Vitamin D ALP o H i h Paget’s disease of the bone Slerotic lesions and Tam o’shanter sign due to frontal bone thickening Role of Parathyroid HormoneFrom diet, supplements and sunlight 2+ 3+ Increased Ca /PO 4 in blood for healthy Vitamin D3 new bone Liver converts Absorbs Ca and PO 43+from GI Calcidiol tract and Increases osteoclast Kidney converts activity Calcitriol Decreased and PO 3+ 4 in the blood 2+ Increases Ca in the blood Increases PO 43+excretion Increases osteoclast activity. Low Ca2+ in blood Increases calcium absorption from GI tract and kidney. Increases Vit D activity. PTH release From chief cells in parathyroid Osteoclasts reabsorb bone to increase blood Ca2+ Decreased Ca and 2+ 3+ PO 4 in the blood 2+ Decreases Ca in the blood 2+ 3+ Increases Ca and PO 4 excretion High Ca2+ in blood Inhibits osteoclast activity Calcitonin release From Thyroid Osteoclasts reabsorb bone to increase blood Ca2+ Q U E S T I O 3 What is the function of calcitonin? A Decreases Phosphate excretion B Decreases Sodium excretion C Increase osteocyte activity D Decrease Osteoblast activity E Decrease Osteoclast activity ANSWER ON THE ZOOM POLL Q U E S T I O3N What is the function of calcitonin? A Decreases Phosphate excretion B Decrease Sodium secretion Calcitonin inhibits osteoclastic activity. It has opposite effects to PTH and Vit D. C Increase osteocyte activity D Decrease Osteoblast activity E Decrease Osteoclast activity ANSWER ON THE ZOOM POLL Hyperparathyroidism Primary Hyperparathyroidism is due to a tumour causing increased PTH se->etion High calcium Secondary hyperparathyroidism is due to low Ca2+ so increased PTH secretion Tertiary hyperparathyroidism is due to long term low Calcium causing hyperplasia of the parathyroid gland (due to increased PTH secretion demand). When Ca2+ is corrected back to normal you get excess PTH secretion and high Ca2+ as a result. Q U E S T I 3 N A 60 year old male presents with bone pain. A Osteoporosis You decide to get an Xray and a bone profile of the patient. B Osteromalacia On the x -ray notice some bowing of his tibia as well as sclerotic lesions. What pathology is most likely C Pagets ALP High D Bone metastasis Calcium Normal E Primary hyperparathyroidism Phosphate Normal PTH Normal ANSWER ON THE ZOOM POLL Q U E S T I O3N A 60 year old male presents with bone pain. A Osteoporosis On the x -ray notice some bowing of his tibia as well as sclerotic lesions . B Osteromalacia What pathology is most likely C Pagets Calcium Normal D Bone metastasis Phosphate Normal PTH Normal E Primary hyperparathyroidism ANSWER ON THE ZOOM POLL PLEASE FILL OUT THE FEEDBACK FORM PLEASE TUNE IN TO OUR REMAINING SESSIONS THIS WEEK! @OSCEazyOfficial @osceazyofficial OSCEazy Osceazy@gmail.com