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Phase 1 EDF > MSK physiology > Flashcards

MSK physiology Flashcards

1
Q

State the functions of the skeleton

A
  • Protect vital organs
  • Houses bone marrow
  • Shape/support
  • Allows locomotion/movement
  • Stores calcium
  • Transmits body weight
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2
Q

State the different classes and shapes of bone

A 
Long
Short
Flat
Irregular
Sesamoid
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3
Q

Give 3 examples of a long bones

A

Femur
Phalanges
Metacarpals

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4
Q

Give an example of a short bone

A

Carpal

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5
Q

Give 4 examples of flat bones

A

Rib
Some bones of the skull
Sternum
Ileum of pelvis

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6
Q

Give 3 examples of irregular bones

A

Vertebra
Mandible
Sacrum

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7
Q

Give an example of a sesamoid bone

A

Patella

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8
Q

What are the two macrostructures of bone?

A

Cortical (compact)

Trabecular (spongey)(cancellous)

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9
Q

What are the two microstructures of bone

A

Woven 1

Lamellae 2

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10
Q

What are the 3 parts of a long bone?

A

Epiphysis (end)
Metaphysis
Diaphysis (shaft)

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11
Q

Where are the epiphyseal plates located?

A

Between the epiphysis and metaphysis

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12
Q

What are the two devisions of the skeleton?

A

Axial

Appendicular

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13
Q

Where in the long bone is trabecular bone most likely to be found?

A

Epiphysis

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14
Q

Describe the structure of trabecular bone

A

Bone struts with hole in between, filled with bone marroq

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15
Q

Describe cortical bone

A

Dense, located at the periphery of the diaphysis in long bones

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16
Q

Describe woven bone

A

Primary bone
Poorly organised
No clear structure
Lay down quickly

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17
Q

Describe lamellae bone

A

Secondary bone
Made slowly
Highly organised
In layers

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18
Q

What is the importance of hallow areas in bone

A
  • Reduce mass
  • Mass away from neural axis
  • House bone marrow
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19
Q

What is the importance of having wide ends of bone

A

-Load spread over a larger SA

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20
Q

What is the importance of having trabecular bone within a long bone

A
  • Reduces mass

- Load spread over larger SA/structural support

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21
Q

Describe the composition of bone

A

Inorganic 60%
Organic 30%
Water 10%

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22
Q

What makes up the inorganic component of bone?

A

Calcium hydroxyapatite

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23
Q

What makes up the organic component of bone?

A

90% Collagen

10% Non-collagenous proteins e.g Glycoproteins/Protoglycans

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24
Q

What are the two types of bone formation?

A

Intramembranous ossification

Endochondral ossification

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25
Q

Define intramembranous ossification

A

Formation of primary bone with no prior cartilaginous template/proformer

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26
Q

What type of bones are formed by intramembranous bone formation

A

Flat bones

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27
Q

Describe the process of intramembranous ossification

A

Osteoprogenitor cells within a primitive mesenchyme develop into osteoblasts
Osteoblast secrete osteoid (mainly type 1 collagen)
Osteoid becomes ossified by calcium hydroxyapatite also secreted by osteoblasts

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28
Q

What type of bones are formed by endrochondral ossification?

A

Long bones

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29
Q

Describe endrochondral ossification

A

1)Proformer cartilage - hyaline
2)Shaft of the proformer is calcified
3)Bony colar develops
4)Collar penetrated by blood vessels - bring more osteoprogenitor cells
5)Osteoprogenitor cells develop in osteoblasts
Osteoblast secrete osteoid
6)1 primary ossification centre is developed
7)2 primary ossification centres later develop in the epiphyses
8)Expansion of the ossification centres -
9)Cartilage proformer reduced only to the epiphyseal plates
10) Lengthening via epiphyseal plates
11) Closure of epiphyseal plates

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30
Q

Two what hormones is the epiphyseal cartilage particularly responsive to?

A 
GH
Sex hormones (hence growth spurt at puberty)
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31
Q

Which bone cells secrete RANK ligand?

A

Osteoblasts

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32
Q

Which cells have high alkaline phosphate activity?

A

Osteoblasts

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33
Q

Describe the function of osteoclasts?

A

Bone resorption
Dissolve the mineralised matrix
Breakdown collagen

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34
Q

What do osteoblasts secrete to dissolve the mineralised matrix?

A

Hydrochloric acid

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35
Q

What do osteoblast secrete in order to breakdown type 1 collage of bone?

A

Cathepsin K

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36
Q

What are the reasons for bone remodelling?

A 
Repair damage
Obtain calcium
Form bone shape 
1 woven to 2 lamellar bone
In response to loading - exercising
Reorganise fibrils to improve mechanical strength
Pathological
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37
Q

Give an example of a bone formed by a combination of intramembranous and endochondral ossification?

A

Scapula

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38
Q

What type of collagen is found in basement membranes?

A

IV

39
Q

Where is type I collagen found?

A

Bone, teeth, skin, ligament, tendon

40
Q

Where is type II collagen found?

A

Cartilage

41
Q

What type of collagen is found at the liver/kidneys/spleen/uterus/arteries

A

III - Reticulin

42
Q

How is reticulin different from the other types of collagen?

A

Forms branched fibres

43
Q

Where is type V collagen found?

A

Placenta

44
Q

Which collagen types form fibrils?

A

I, II, III, V, XI

45
Q

Describe the structure of a collagen fibre

A

Triple polypeptide alpha helix = tropocollagen (cross linking)
Overlapping tropocollagen molecules = collagen fibril (cross linking)
Several collagen fibrils = collagen fibre

46
Q

How is collagen synthesised?

A

Tropocollagen molecules synthesised by fibro/osteoblast and secreted
Collage fibrils/fibres arranges extracellularly

47
Q

What is the purpose of collagen in the organic bone matrix

A

Provide tensile strength

48
Q

What is the purpose of protoglycans in the organic bone matrix?

A

To withstand pressure

49
Q

What are the properties of protoglycans

A 
Negative charge
Allows binding of water
Friction free surfaces
Compressive stiffness
Can also be used a signalling molecule
50
Q

Where are protoglycans found?

A

All cartilaginous tissues

51
Q

How does cartilage breakdown occur

A

Inflammatory response - cytokines

Chondroclasts release protienases in response to cytokines

52
Q

What is the role of integrins in terms of bone?

A

Collagen and fibronectin receptors
Control cell shape, movement and can alter gene expression by a kinase cascade
Allow cross talk between ECM and cells

53
Q

What provides the function of bone

A

Extracellular matrix

54
Q

How does a deficiency of sex hormone lead to someone being tall?

A

Late closure of the epiphyseal plates

55
Q

What type of cells are osteoblasts derived from?

A

Mesenchymal

56
Q

What type of cells are osteoclasts derived from?

A

Haemopoetic cells

57
Q

Where in the bone do osteoblasts lie?

A

Howship’s lacunae

58
Q

What are the sex hormone stimulators of?

A

Bone growth

59
Q

What is growth hormone a stimulator of?

A

Growth of epiphyseal cartilage

60
Q

What is calcium needed for?

A

Blood clotting
Nerve function
Muscle contraction

61
Q

Where is calcium stored?

A

Skeleton - Calcium hydroxyapatite

62
Q

In what different forms does calcium exist in the body? Which in the most imp

A
  • Ionised*
  • Complex
  • Bound to plasma proteins (not filtered at kidneys)
63
Q

How does pH affect the extracellular (ionised) Ca?

A

Increase in pH
Increased negative charge on albumin
Increased binding of Ca
Decreased extracellular Ca

64
Q

What hormones are involved in Ca homeostasis?

A

Parathyroid hormone
Calcitonin
Vitamin D

65
Q

Where is parathyroid hormone released from?

A

Chief cells of parathyroid gland

66
Q

Where is calcitonin released from?

A

Parafollicular C cells of thyroid follicles

67
Q

Where is vitamin D (inactive D) synthesised?

A

Skin, in the presence of UV radiation

68
Q

What is the active form of Vit D

A

1,25-hydroxyvitaminD

69
Q

Where is Vitamin D activated

A

1) Liver

2) Kidney

70
Q

What is the overall aim of PTH?

A

Increase Ca serum levels

71
Q

What are the individual actions of PTH?

A

1) Increase bone resorption - increase osteoclast activity
2) Increase Ca reabsorption at the kidney - DCT
3) Decrease phosphate reabsorption at the kidney - PCT
4) Activate vitamin D (at kidney 1-hydroxylase) - increase absorption of Ca and phosphate

72
Q

What is the overall action of calcitonin? How does it do this?

A

Decrease serum Ca levels

Decrease bone resorption - decrease osteoclastic activity

73
Q

What are the variables of strain put on bone?

A 
Magnitude
Frequency
Hold/rest periods
No. of cycles
Site
Age
Drugs
74
Q

What affect does increased physical activity have on bone?

A

Increased activity
Increased strain
Bone formation

75
Q

Define a fracture

A

A soft tissue injury further complicated by a breach in continuity of the bone

76
Q

In terms of bone remodelling, what is coupling?

A

Formation occurring at the same sites as resorption is taking place

77
Q

Other than coupling, what is an important factor of bone remodelling?

A

Balance

78
Q

Which bone cells CONTROL bone remodelling?

A

OsteoBlasts

79
Q

Which cells secrete RANK-Ligand

A

Osteoblasts

80
Q

Where are RANKL receptors found?

A

Osteoclasts

81
Q

What is the role of RANKL?

A

Stimulates resorption - osteoclasts to release Cathepsin K and HCl

82
Q

What is the role of Osteoprotegrin?

A

Prevents RANK-RANKL binding by binding to RANKL

Increases bone density (prevents bone resorption)

83
Q

What other factors beside RANKL/OPG influence bone remodelling?

A 
Hormones (endocrine) including
1,25 dihydroxyvitamin D
PTH/PTHrP
Oestrogen
Leptin
Paracrine/autocrine including
Prostaglandins
Interleukin-1 (IL-1)
Interleukin-6 (IL-6)
Tumour necrosis factor (TNF)
84
Q

What are the stages of fracture healing?

A 
Haematoma/Inflammation
Soft callus(repair)
Bony callus(repair)
Remodelling
85
Q

Why do bones break?

A

Normal bone - abnormal load

Abnormal bone - normal load

86
Q

State the different types of fracture

A 
Comminuted 
Spiral
Wedge
Open
Transverse
Oblique
Avulsion
Segmental
Impact
Torus (looks like welling)
87
Q

What happens during the haematoma phase of fracture healing?

A

Death of osteocytes

Periosteal stripping

88
Q

What happens during inflammation of fracture healing?

A

Neovascularisation

Osteoclasts clear debris

89
Q

What happens during repair stage of fracture healing?

A

Cartilage proformer - soft callus
Osteoblast secrete osteoid - hard callus
Increased vascularity

90
Q

What happens during the remodelling stage of fracture healing?

A

Woven bone to lamellar bone

Vascularity returns to normal

91
Q

How is fracture healing (closed) unique?

A

No scaring

92
Q

What are the principles of fracture management?

A

Reduce
Immobilise
Rehabilitate

93
Q

What factors affect fracture healing?

A 
Patient
-Age
-Sex
The fracture
-site
-bone-cortical v cancellous 
-vascularity
Treatment

Phase 1 EDF (12 decks)

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