Pathology

Week 1 - Pathology

Select the types of mechanical stress

  • Compression
  • Traction
  • Torsion
  • Shear
  • Tensile
  • Pushing
  • Bending

Meeuwisse 'Injury Causation' Model

  • Injury
  • Proximal
  • Environment
  • External
  • Internal
  • Risk factors

Skin conditions

  • Psoriasis
    Chronic autoimmune skin disease (also affects joints). Red and white hues of scaly patches appearing at the epidermis.
  • Dermatitis/ Eczema
    A condition that causes the skin to become itchy, red, dry and cracked. It is a chronic condition in most people, although it can improve over time, especially in children.
  • Tinea Pedis
    Common contagious fungal infection that causes scaling, flaking and itchiness of the affected area (usually to the feet). Develop in warm, moist environments. Spread via skin to skin contact and/or shared clothing/linen/equipment.
  • Impetigo
    Highly contagious bacterial/fungal skin infection which often presents as reddened plaques in moist body folds or on the face.
  • Herpes Zoster
    A viral infection of a nerve and the area of skin around it. The virus lays dormant in the nervous system, erupting when resistance is low. A rash can appear, presenting as a cluster of small blisters for 7-10 days (preceded by tingling/burning/pain).

Which best describes X-rays?

  • High resolution and high contrast images
  • Plain film imaging

Screening

  • X-rays pass through soft tissues and turn plate black, whilst hard tissues block the x-rays, leaving the film white
  • X-rays pass through hard tissues and turn plate black, whilst soft tissues block the x-rays, leaving the film white
  • An MRI produces High resolution, high contrast images by using two powerful magnets, radio waves, and a computer to create a detailed cross-sectional image of the target structure
  • MRI scans only detect soft tissue issues
  • X-rays are not sensitive to early changes e.g. tumours, infections and some fractures
  • MRI scans cause radiation exposure

RtP Protocol - If recurrence of symptoms occur at any stage what should you do?

  • Return to previous stage after 24hours of rest
  • Return to same stage after 24hours of rest
  • Stop the stages and go back to the very first stage

Week 2 - Soft Tissue Healing

Tissue repair timescale

You may want to have a read over...

http://www.electrotherapy.org/assets/Downloads/tissue%20repair%202014%20Final.pdf

  • Inflammation
  • Bleeding
  • Proliferation
  • Remodelling

What are the phases of tissue repair and when do they have the greatest contribution?

  • Bleeding phase
    4-8hrs
  • Inflammation phase
    Maximum reaction 2-3 days but 2-3 weeks to resolve
  • Proliferation phase
    Onset 24-48 hours but peaks 2-3 weeks
  • Remodelling phase
    3wks - 18months or longer

The Bleeding Phase

 = Increased blood viscosity

  1. Local vaso (brief)
  2.  release - changes occur to platelets to increase clotting
  3. Platelet activation - serotonin release
  4. Coagulation - clots form upon conversion of fibrinogen to fibrin. Formation of fibrin collagen attracts RBC’s and WBC’s to make the clot even stronger.
  5. Coagulation aids in localising the injury by obstructing fluid drainage

What is hypoxia?

  • An environment where an inadequate amount oxygen is reaching the tissues
  • Programmed cell death
  • Cell death caused by insufficient blood supply to soft tissues

The Inflammation Phase

2 essential elements to the inflammatory events =  Vascular and Cellular

 

Vascular Cascade

Onset caused by remaining chemicals from the coagulation stage

Vaso and Vasopermability - increases blood flow locally

Increased exudate - mast cells release hyaluronic acid which binds with exudate to form gel like substance to  flow.

 

Cellular Cascade

 - Movements of phagocytes/leucocytes (WBC's) from blood flow to injury site

Phagocytosis - Removal of dead cells, fibrin and clot residue - this produces  which stimulates proliferation

Which answer represents a causation of swelling?

  • Water released from the kidneys accumulates at the injury site
  • Due to vasodilation and increased permeability, fluids are drawn from local capillaries, which accumulate in the interstitial spaces
  • Due to vasoconstriction, fluid builds up around the injury site

The Proliferation Phase

  • Fibroplasia
    Chemically mediated activity allowing fibroblasts to lay down type 3 collagen
  • Angiogenesis
    New capillary formation leading to granulation tissue develops towards the repair zone to aid with blood flow, providing oxygen, nutrients and the removal of metabolic waste

Identify if any of these statements are true

  • angiogenesis is Stimulated by growth factors
  • angiogenesis is the formation of new collegen
  • granulation tissue is formed when capillaries in the injured region bud and grow towards the repair zone

The Remodelling Phase

Overlaps  phase

Reabsorption & maturation of type lll collagen to type l

  1. fibroblast activity
  2. Increased organisation of the extracellular matrix
  3. blood flow
  4. Decreased water content
  5. organisation of new tissue
  6. Resumption of normal cell activity

Scar tissue

  • Scar tissue is less functional and flexible than the original tissue
  • Scar tissue is more functional and flexible than the original tissue
  • Scar tissue has less tensile strength than the original tissue
  • Scar tissue has more tensile strength than the original tissue
  • Scar tissue is fibrous and relatively avascular
  • Scar tissue has a high level of vascularity

Signs and symptoms of inflammation

  • Heat
  • Redness
  • Open wound
  • Pain
  • Loss of Function
  • Swelling
  • Non of the above
  • Decreased appetite

What does Ischaemic mean?

  • Restricted blood supply
  • Increased blood supply
  • Increased inflammation
  • Increased oxygen

What is required for the development and orientation of collagen fibres?

  • Mechanical stress
  • Longer rest period

Week 3 - Nociceptive Pain

Nociceptive pain

  • pain caused by an injury that stimulates pain receptors which recognise and react to a stimulus
  • pain that originates with problems relating to the nerve signals

What can nociceptors also be known as?

  • Afferent nerve fibres
  • Nerve stimulus fibres
  • Dorsal horn fibres

Types

  • Aδ fibre
    Small, myelinated fibres producing sharp, localised pain
  • Cδ fibre
    Smaller, unmyelinated slow fibres producing poorly localised burning/throbbing pain

Stimuli which pain receptors recognise and react to...

  • Pressure
  • Temperature
  • Chemical
  • Irritating substance released by other cells

2 elements

  • Central Nervous System
  • Peripheral Nervous System

Pathways

  • Transduction
  • Transmission
  • Perception
  • Modulation

Actual or potential tissue damage can cause pain

  • True
  • False

Pain results as an uncomfortable experience which warns us of potentially health threatening conditions, what other functions does pain have?

  • Protective mechanism
  • Increase swelling
  • No other effect
  • Stimulate GTO's

Which of the following are part of the meninges?

  • Arachnoid
  • Golgi tendon organs
  • Spindles
  • Nerve endings

Within the spinal cord, where are the axons of the nerve cells contained?

  • Grey mata
  • White mata

Cerebral spinal fluid helps to nourish the CNS, where is the cereal spinal fluid located?

  • Central canal
  • Brain
  • Pia mater
  • Dura mater

Which fibres bring information into the spine through the dorsal roots?

  • Sensory fibres
  • Muscle fibres

Week 4 - Ligaments

Which of the following best describe ligaments?

  • More elastic and durable in a linear direction
  • Decreased elasticity and durability in a linear direction
  • Fairly rigid with less tensile strength in a nonlinear direction
  • Decreased stiffness and more tensile strength in a nonlinear direction

What is the main function of ligaments?

  • Restrict certain ROM when taut
  • Allow more movement in all ranges
  • Supply nutrition to joints
  • Add strength to a joint

Which of the following are common mechanical to ligament injury?

  • Compression
  • Shear
  • Tension
  • Bending
  • Twisting
  • Traction

Ligament grades

Severity

Objective Findings

Functional Impairment

A

Typical Treatment

Grade 1

Minimal tenderness and swelling. Little or no bruising

Minimal

Microscopic tearing of collagen fibres

Weight bearing as tolerated. No splinting/casting. Isometric exercises. Full ROM and stretching/strengthening exercises as tolerated

Grade 2

Moderate tenderness, bruising and swelling, decreased ROM, possible instability

Moderate. Some joint laxity may be identified on stress test.

Complete tears of some but not all collagen fibres in the ligament

Immobilisation with air splint. Physical therapy with ROM and stretching/strengthening exercises

Grade 3

Significant swelling and tenderness, instability.

Severe. Loss of structural integrity and joint congruency.

Complete tear or rupture of the ligament

Immobilisation with air splint/cast. Physical therapy similar to that for grade 2 sprains but over a longer period. Possible surgical reconstruction if necessary.

From the ligament grades what does the A represent?

  • Intensity
  • Pathophysiology
  • Duration of recovery
  • Impairment

What does a grade 1 ligament sprain represent?

  • Normal ligament tissue
  • Stretching of ligament tissue with small tears
  • Large but incomplete tearing of ligament tissue
  • Complete rupture of ligament tissues

What could result from trauma to static stabilising structures or poor recruitment of dynamic stabilisers?

  • Grade 1 ligament sprain
  • Grade 2 ligament sprain
  • Complete rupture
  • Chronic Instability

What could increased the risk of developing Anke Osteo Arthritis?

  • Chronic Ankle instability
  • Hereditary joint disease
  • Hypermobility
  • Hypomobility

Where can you perform a ligament injury assessment?

  • Pitch-side only
  • Clinical settings
  • Anywhere

Why were the Ottawa Ankle Rules established?

  • Help practitioners diagnose fractures to the ankle
  • Help practitioners decide whether or not to refer for an Xray

Which of the following rules may indicate that an X-ray may be required?

  • Unable to weight bear for more than 4 steps at a time
  • Unable to walk for longer than 20minutes
  • Tenderness above and over lateral or medial malleoli
  • Tenderness over base of 5th MT or navicular
  • Tenderness over 1st MT or cuboid
  • Tenderness to dorsal surface of hallux

Week 5 - Consolidation Session

Select the types of mechanical stress

  • Traction
  • Compression
  • Torsion
  • Pushing
  • Bending
  • Tensile
  • Shear

Which best describes X-rays?

  • High resolution and high contrast images
  • Plain film imaging

What term is used for Increased Blood Viscosity?

  • Vasoconstriction
  • Haemostasis

What occurs during the vascular cascade of the inflammation phase?

  • Vasodilation
  • Vasoconstriction
  • Decreased exudate
  • Increased exudate
  • Chemotaxis

What phase overlaps the proliferation phase?

  • Inflammation
  • Remodelling

What happens to the blood flow during the remodelling phase?

  • Increases
  • Decreases

Signs and symptoms of inflammation

  • Open wound
  • Heat
  • Redness
  • Non of the above
  • Pain
  • Loss of function
  • Decreased appetite
  • Swelling

What does Ischaemic mean?

  • Restricted blood supply
  • Increased blood supply
  • Increased inflammation
  • Increased oxygen

Nociceptive pain

  • pain that originates with problems relating to the nerve signals
  • pain caused by an injury that stimulates pain receptors which recognise and react to a stimulus

What can nociceptors also be known as?

  • Nerve stimulus fibres
  • Dorsal horn fibres
  • Afferent nerve fibres

Which of the following are part of the meninges?

  • Arachnoid
  • Golgi tendon organs
  • Spindles
  • Nerve endings

Which fibres bring information into the spine through the dorsal roots?

  • Muscle fibres
  • Sensory fibres

What best describes ligaments?

  • Decreased elasticity and durability in a linear direction
  • More elastic and durable in a linear direction
  • Fairly rigid with less tensile strength in a nonlinear direction
  • Decreased stiffness and more tensile strength in a nonlinear direction

Which of the following are common mechanical to ligament injury?

  • Bending
  • Twisting
  • Compression
  • Traction
  • Tension
  • Shear

Week 6 - Muscle Injuries

What component of the Munich Consensus does DOMS fit into

  • Functional Disorder
  • Structural Injury

What hypothesis is linked to the contribution of Exercise Associated Muscle Cramps?

  • Dehydration / electrolyte loss
  • Injury
  • Neurotransmitter depletion
  • Observed in hot conditions

EAMC occurs when...

  • the affected muscle contracts in a shortened state
  • the affected muscle contracts in a lengthened state
  • the affected muscle relaxes in a shorted state
  • the affected muscle relaxes in a lengthened state

What does Type 3A structural muscle injury describe?

  • Mild partial tear
  • Moderate partial tear
  • Total muscle tear
  • Scar tissue

What risk factors contribute to muscle conditions?

  • Previous muscle injury
  • Nutritional status
  • Psychological issues
  • Fatigue

What builds and embeds muscles?

  • Fascia
  • Tendons
  • Bone
  • Bursae

What is the aim and objective of the use of The Munich Consensus?

  • Provide classification of muscle injuries for effective communication
  • Develop systematic treatment strategies
  • Provide information for new common injuries
  • Provide continual data for therapists on rehabilitation techniques

What muscle disorder can be a part of an overtraining context?

  • Fatigue
  • Sprain
  • EAMC
  • DOMS

Which component of fatigue induced muscle disorders does neurotransmitter depletion occur within?

  • Central component
  • Peripheral component

What is the definition of EAMC?

  • Painful involuntary contraction of a skeletal muscle or muscle group
  • Painful voluntary contraction of a skeletal muscle or muscle group

Which functional disorder is usually felt after endurance and explosive eccentric contractions?

  • DOMS
  • EAMC

Week 7 - Tendon Injuries

What are the function of tendons?

  • Attach bone to bone
  • Attach muscle to bone
  • Transmit force
  • Transmit contractions
  • Aid with proprioception

What does the crimp pattern in collagen fibrils aid with?

  • Stiffness
  • Flexibility

What characteristics can some tendons adopt?

  • Structure
  • Cushioning
  • Limited movement
  • Spring like

What forces do tendons withstand quite well?

  • Shear
  • Tensile
  • Compression

What does the "critical zone" of tendons represent?

  • Limited vascularity
  • Increased vascularity
  • Increased water content
  • Increased collagen formation

'Complete tears' to a tendon describes which classification?

  • 1C
  • 2C
  • 3C
  • 4C

Which best describes a 3C tendon injury?

  • Injury within the tendon over longitudinal length of <5cm or <50% of the maximal tendon diameter on axial images
  • Injury within the tendon over longitudinal length of >5cm or >50% of the tendon’s maximal cross-sectional area

Which best describes tendinosis?

  • Large scale injury with inflammation
  • Chronic degeneration without inflammation
  • Inflammation of the tendon sheath

What is paratendonitis?

  • Complete tear of the paratenon
  • inflammation of tendon sheath
  • imflammation of paratenon

Which of the following factors are extrinsic aetiological factors to tendon injuries?

  • Biomechanics
  • Poor technique
  • Poor recovery
  • Vascularity
  • Changes in training pattern
  • Previous injury

What happens to the collagen during a reactive tendinopathy?

  • Remain intact
  • torn
  • inflammed
  • separation

What can degenerative tendinopathy result in if not managed?

  • Reactive tendinopathy
  • Tendon rupture

Describe what the process of neoinnervation is?

  • new vessels bringing new nerve tissue
  • Proliferation of new blood vessels

What is suggested as a sufficient rehab strategy for degenerative tendinopathy?

  • Slow heavy loading
  • Eccentric training
  • Quick movements
  • Concentric training
  • Hypertrophy training

Week 8 - Central sensitisation

Definition

Central sensitisation is a condition of the  system that is associated with the development and maintenance of   pain.

 

The  system goes through a "" process due to the occurrence of central sensitisation.

This process results in the CNS regulated in a "persistent state of high

 

The 2 pathways to heightened states of sensitivity to pain are  and  

Pain intensity

  • Hyperalgesia
  • Allodynia

Pathophysiological Process of Central Sensitisation

  • Pain perception
  • dorsal horn
  • Throbbing
  • Allodynia

What are the causes of central sensitisation according to the lecturer slides?

  • Physical and mental
  • Psychological, psychosocial and environmental

Prevalance of LBP

  • 12%
  • 23%
  • 38%
  • 40%

Predisposing factors

  • Smoking
    Strong association with LBP and sciatica
  • Increased risk in those whose work involves bending, twisting or heavy physical labour. Increased risk of LBP with exposure to vibration.
    Physical work
  • Good isometric endurance of back muscles may be associated with reduced LBP
    Fitness
  • Age
    Increased risk until aged 50

Causes of LBP

  • Spondylolysis
    Stress fracture of the pars interarticularis
  • Spondylolysthesis
    Forward slippage of a vertebral body on another. This can happen following a stress # or tumor on the pars, degeneration, or in conjunction with scoliosis
  • Spondylosis
    Degeneration of the intervertebral discs

What is the most common condition that accompanies central sensitisation?

  • Anxiety
  • Depression
  • Decreased attention
  • Alzheimer

Why can central sensitisation cause stroke and spinal cord injuries?

  • Hormonal changes
  • Insufficient PNS
  • Cellular level changes at receptor sites

Week 9 - Peripheral sensitisation

What is the definition of peripheral neuropathic pain? (PNP)

  • Pain caused by a lesion/disease of the peripheral somatosensory nervous system
  • Condition of the nervous system which is associated with the development and maintenance of chronic pain

What is the difference with PNP compared to central sensitisation?

  • Involves persistent state of high reactivity
  • Involves physical insult to the peripheral nerve(s)

Which of the following are processes of neurological insult?

  • A systematic process e.g. toxins, disease &/or drugs
  • Secondary process e.g. toxins, disease &/or disease
  • Secondary process e.g. surgery, trauma &/or local invasive malignancy
  • A systematic process e.g. surgery, trauma &/or local invasive malignancy

Where are PNP symptoms usually present?

  • Legs
  • Heart
  • Hands & Feet
  • Core

Signs and symptoms of PNP include?

  • Numbness
  • Redness
  • Weakness
  • Burning pain
  • Increased strength
  • Tingling

What does a myelin sheath composed of lipids and proteins surround?

  • Axon
  • Cell body

Which fibres conduct at a slower speed?

  • myelinated
  • unmyelinated

Which fibre conducts a sharper pain?

  • myelinated
  • unmyelinated

What is associated with diabetic neuropathy?

  • Occlusion of blood flow through vaso nervorum
  • damage to cell body

What does polyneuropathy describe?

  • one nerve
  • multiple nerves diffusely
  • several discrete nerves

Sciatic neuropathy presentations including 'weakness of haul extension' & 'drop foot' occur from what level of lumbar(s)?

  • L3/L4
  • L4/L5
  • L5/S1

What is spondylolisthesis?

  • Slippage of vertebral body caused by stress #
  • # within the pars interarticularis

Week 10 - Concussion and Head injuries

What is concussion?

  • A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces
  • Violent collision affecting the brain following by loss of function
  • Short-lived impairment of neurological function

A contra-coup injury is?

  • A sudden, violent stop that causes the brain to accelerate forward and hit the cranium
  • Occurs when the brain accelerates forward, hits the cranium, and bounces off the opposite side

What should be ruled out prior to assessment of the concussion?

  • Cx injury
  • Dirt
  • Wounds

When should a player NOT continue to play?

  • Doesn't want to
  • LoC
  • Presence of blood due to a cut on the finger

What is included in a Sports Concussion Assessment Tool?

  • Symptom Assessment
  • Memory Assessment
  • Balance Assessment

If intra-cerebral or structural lesion is suspected what should be utilised?

  • SCAT3
  • Eye test
  • Neurological imaging

What is the most important aspect of medical management of concussion?

  • Initial Treatment
  • Return to Play timing

What should you advise not to do following concussion?

  • Drink alcohol
  • Take sedatives
  • Take aspirin
  • Take NSAIDs
  • Drive

What symptoms would someone experience with Post-traumatic vertigo?

  • Nausea
  • Sense of spinning / dizziness
  • Dysphagia
  • Concentration difficulties

What is a subdural haemorrhage?

  • Occurs between arachnoid and pia mater
  • Occurs between dura mater and the cranium
  • Occurs between the dura and arachnoid mater with a tearing of the bridging veins in the subdural space

Week 11 - Fractures

What is a fracture?

  • A small crack in a bone
  • A significant break with multiple segments
  • Any defect in the continuity of a bone

What is the shorthand abbreviation for a fracture?

  • *
  • #
  • $
  • "

What is termed 'repetitive trauma fracture'?

  • # due to a single traumatic episode
  • # due to repeated stress
  • # due to weakened/diseased bone

What theory is mostly linked with the risk of fractures?

  • force-velocity curve
  • stress-strain curve
  • Inverted-U curve

What time of fracture often requires operative fixation?

  • Comminuted #
  • Open #
  • Complicated #

What type of fracture occurs mainly in flat bones?

  • Spiral
  • Depressed
  • Impacted

Inappropriate training patterns as well as biomechanical predispositions result in what type of #?

  • Stress #
  • Compound #
  • Pathological #

What becomes weakened during the mechanism involved with stress fractures?

  • Osteoclast
  • Cortex

What fracture site is most associated with jumping?

  • Femoral neck
  • Femoral shaft
  • Scapula
  • Olecranon Process

What does a Salter-Harris fracture affect?

  • Scaphoid
  • Growth Plate
  • Epiphyseal plate

What does a Salter-Harris fracture affect?

  • Growth Plate
  • Epiphyseal plate
  • Scaphoid Plate

What is an avulsion fracture?

  • tendon/ligament pulls off a piece of the bone
  • bone pierces through the skin

What is PoP?

  • Paris of Plaster
  • Plaster of Paris
  • Plaster of Protection