Loco3

Question 1

1. Name the 4 curvatures of the vertebral column, indicating if they are primary or secondary (4 marks).

Answer 1

1. Cervical lordosis, secondary
2. Thoracic kyphosis, primary
3. Lumbar lordosis, secondary
4. Sacral kyphosis, primary

Question 2

1. Draw the structure of an intervertebral disc (2 marks) and describe what is meant by a herniated intervertebral disc (1 mark)

Answer 2

1 mark for a central nucleus pulposis, 1 mark for concentric rings of annulus fibrosis around it.

A herniated disc occurs when the nucleus pulposis is forced through the annulus fibrosis.

Question 3

1. Why is Maria experiencing instability in her hips and pelvis? (2 marks)

Answer 3

During pregnancy the hormone relaxin acts on the ligaments of the pelvis (1 mark). This causes relaxation of the ligaments around the sacroiliac joints, pubic symphysis and hips, reducing the stability (1 mark).

Question 4

1. How does the anatomy of the pelvis and spine change during pregnancy?
   1.

Answer 4

1. Spine:
   
   1. Lumbar (& cervical) spine curvature / lordosis increases
      
      1. Causes:
         
         1. increased weight distribution to the breast and stomach.
         2. the centre of gravity changes: which causes changes in posture. no longer lies over the feet: increase in anteroposterior and medial lateral sway
            
            1. Lean backwards to gain equilibrium
2. Pelvis
   
   1. The anterior pelvic tilt increases during pregnancy, and especially from 12 weeks to 36 weeks of pregnancy,
   2. and then decreases 1 month after childbirth

Question 5

1. What is a slipped disc and how does it affect L4 nerve?

Answer 5

1. Nucleus pulposus comes out of annulus fibrosus = causes compression
2. IVD is poorly innervated so pain doesn’t come from the disc itself but from surrounding structures
3. Compression of surrounding ligaments causes localised pain
4. Compression of nerve roots causes numbness, tingling and pain across the respective dermatome
5. If disc herniates then the paraspinals contract on that side to try and hold things together but that causes that side to shorten and pinch the nerve root.

Question 6

what are two dermatome tests can conduct?

Answer 6

1. Pinprick test (pain sensation) - Gently touches the skin with the pin ask the patient whether it feels sharp or blunt
2. Light touch test (light touch sensation) - Dab a piece of cotton wool on an area of skin [4]

Question 8

what is EMG? - what does it test?

Answer 8

1. Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).
2. Measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle

Question 9

how do you conduct EMG?

Answer 9

1. why ?
2. to measure the speed and strength of signals traveling between two or more points.
3. Investigation to indicate a nerve or muscle disorder
4. assess whether there is any spontaneous electrical activity when the muscle is at rest. activity that isn’t present in healthy muscle tissue — and the degree of activity when you slightly contract the muscle.
5. How?
   
   1. one / more electrodes inserted through the skin into the muscle
   2. The electrical activity picked up by the electrodes is then displayed on an oscilloscope. can see when the amplitude increases and thus when a contraction took place,

Question 10

which part of pelvis is false and which part is true?

Answer 10

1. Greater pelvis (false pelvis) - located superiorly, it provides support of the lower abdominal viscera (such as the ileum and sigmoid colon). It has little obstetric relevance.
2. Lesser pelvis (true pelvis) - located inferiorly. Within the lesser pelvis reside the pelvic cavity and pelvic viscera.

Question 12

what is the pelvic inlet?

Answer 12

1. The pelvic inlet marks the boundary between the greater pelvis and lesser pelvis. Its size is defined by its edge, the pelvic brim.
2. The pelvic inlet determines the size and shape of the birth canal, with the prominent ridges a key site for attachment of muscle and ligaments.